Chapter Twenty Six: First aid, first hand
I noticed the paint fumes when I first got home from work, then not again.
The building superintendent had painted the halls of the three-story walkup where I lived in Jersey City Heights, but my thinking was so hazy from pain killers I did not notice the inappropriate use of outdoor paint indoors or the spray device used to apply the paint to the walls.
It was Friday afternoon. I had been through oral surgery that week and a tough week of work. I just wanted to sit down, tap a little on the computer and then eat supper.
An hour later when I tried to stand, the whole world swayed. I felt drunk, but a bad drunk with flashing lights across my eyes. Later, I learned this was a sign of oxygen depravation common to people overcome by paint fumes. But I thought I had overdosed on the over-the-counter pain medicine I'd been taking all day to dull the pain from oral surgery.
I told my wife, who had just come home from work that I needed to lay down for a while. I thought a nap might make the dull tightening in my chest go away. It was about 6:20 p.m. Ten minutes later, I felt worse, and asked my wife to call Jersey City Medical Center.
"Maybe someone down there can tell us what to do about a drug overdose," I said.
My wife called information and then the hospital. She was shaking, but did not yet think this was an emergency. The hospital in such cases prefers 911 -- which puts the call through to the police who then determine what form of emergency and what kind of unit is needed: fire, police, EMS, or a combination.
In my case, someone pushed a button sending my wife's call to the communication center in the heart of the Jersey City Medical Center -- the heart of EMT and paramedic operations for Jersey City and most of Hudson County.
It was then 6:41 p.m.
In the center, information about my wife's call popped up onto a small black computer screen, listing the address from which the call was being made.
While this center in JCMC handles all the EMS needs for Jersey City and Secaucus, it also provides 911 service for the whole county, issuing backup units and parametics wherever they are needed. The center receives 80,000 911 calls a year and 350 a day on average, more on weekends, dealing with everything from drug overdoses to auto accidents to births to heart attacks. It operates with a total staff of 225, EMTs, paramedics, dispatchers.
The dispatchers, who sit in this dimly lighted room before their consoles full of computer screens, must decide quickly what the problem is and how to respond to it.
Despite the fact the number and location appears, the dispatcher first asks party on other end to verify the information. Sometimes the number on the screen is a public phone. If the call is disconnected for some reason, the dispatcher calls back. The conversation is also recorded in case the dispatcher could not hear the number properly.
At this point the dispatcher asks about the problem, flipping through a 29-page book of laminated cards that list questions that help the EMT-trained dispatcher to better access the emergency. People on the other side of the line are usually upset, sometimes incoherent,
Once enough information has been elicited, the dispatcher decides whether to send the fire department First Responder Team, send an EMT unit, or a paramedic unit. In my case, we got all three.
If for some reason, none of these units could get to me quickly enough, the dispatcher could have given my wife instructions over the telephone. The center is usually staffed with at least two dispatchers and sometimes as many as four, as well as between one and three supervisors. During high volume situations, such as the train crash in Secaucus last year, this number goes up. The center, in fact, becomes one of the pivotal operations post for the County's Office of Emergency Management.
"Last year during the train crash we had this room packed," said Ron Hamman, director of Communications, who boasted of the continual upgrades to the facility. "We've put more than $1.5 million into this room and we're not done yet."
The multiple of computer screens give the dispatcher valuable information, not only about the location of the patient, but about their units as well.
"Right now, we can tell from the maps on our screen the last location of each of our units," Hamman said. "That'll change when we upgrade."
Soon, he said, a dispatcher will be able to call up the map onto to one of the consol screens or the larger main screen and tell exactly where each unit is at any given moment.
"Time is key to each change," said Hamman. "Anything that reduces the time it takes for a patient to get treatment, we will do."
During the peak times, the center has seven ambulances available and three non-emergency vehicles which can be called into services for emergency use, as well as one vehicle permanently stationed in Secaucus.
Within minutes of the call, First Responders from the Jersey City Fire Department were at my door. First Response teams are a vital part of the system, because fire departments generally have teams in the general geographic area and can often be on the scene within four to five minutes, beginning an evaluation and reporting details to the EMT center which can save time once the paramedics and EMTs arrive.
The First Responders, who have been trained in various areas of first aid, also provide a professional on-site assessment of the patients condition and the circumstances surrounding the call. Since my wife was scared and I was delirious, our information was not enough.
The firemen smelled the paint the minute they came through the downstairs door and said it was appalling. By this time, my asthma had kicked in and I was struggling to breathe. The fire department turned on fans to clear the room, then immediately began to give me oxygen. Since the initial report said I had chest pains -- something that could indicate a heart attack. They made me lie down and made me comfortable, as they called the EMTs by radio informing them of my condition. Chest pains are a common complaint and something the staff takes extremely seriously.
Within minutes, the EMTs and Paramedics had arrived, already privy to the situation.
"Because the first responders were there, we didn't have to rehash everything," said Steve Viaud, an eight-year EMT veteran with two years experience as a paramedic. He had arrived with his partner Keith Skully as one of the two units dispatched to the scene. While EMTs and paramedics both travel in teams of two, they serve different functions. EMTs are trained in basic first aid, they carry oxygen and some basic heart monitoring equipment such as the semi-defribulator, but it is the paramedics who are trained to before medical procedures in the field, carting with them a whole array of tools from intravenous solutions to an external pace-maker for the heart.
They continued oxygen, began to monitor my heart, blood pressure, looking for signs of heart attack, relaying all this back to the hospital -- which looks over the information to determine next step, evaluating my condition and what level of treatment they should give me before transporting me. Everything they do is monitored by a emergency room doctor. Nothing is done to a patient without the doctor's approval, unless there is a break down in communication -- then the paramedics have the authority to treat a patient up to a point.
I was asked a series of questions, seeking to better define my condition. I was also asked which hospital I wanted to go to. If my condition was listed as critical, I would have had no choice.
"We would have had to brought you to the closest hospital," said EMT John Cruz, who has been an EMT for four years and is currently in training to become a paramedic, attending the courses in Union County College.
The training is intense. Paramedics go through two-year training process. JCMC requires new paramedics ride with experience paramedics. But even before a new paramedic can hit the streets, he or she must do training in the Emergency Room, getting hands-on experience side by side with a doctor.
JCMC provides paramedics for the county. Has EMT training center at the hospital, providing training to other ambulance services, fire departments and industrial facilities.
"We believe the faster the access to the system the better chance a patient has to survive," said Hamman. "The more trained people who are out there the better things are when we get a patient to a hospital."
Training, he said, is essential on every level and is part of a continual program, including an ongoing lecture series.
After receiving authorization from hospital, Cruz and fellow EMT Michelle Kelleher, eased me into a portable wheelchair and began the arduous task of carrying me down the twisting stairs to the street where they helped me into a stretcher and put the this into the ambulance. At this point, Viaud went into his routine -- he and Cruz strapping me in and wiring me up. Viaud pasted terminal connections to my chest, then hooked up a cable to each, which fed the most current information about my heart into a monitoring devise. He also sprayed nitroglycerine under my tongue, pausing only to answer my stream of questions.
"You might get a head ache from this," he told me. "This opens up blood vessels allowing blood to reach your brain."
The paramedic also started an IV to provide instant access to my veins in case he needed to administer a life-saying drug.
"Time is of the essence, said Cruz later. "Everything we can do to save time later, we do."
Viaud also took samples blood that would save time after we arrived at the hospital, blood that would be immediately tested to determine -- in my case - if a heart attack had occurred. Certain enzymes appear in the blood after an attack. He also attached a nitroglyserine patch to my chest.
"Heart attacks are often deceptive," said Cruz."Some kinds can strike in minutes often without the typical indications. Sometimes a person just feels a little ill and yet extensive damage to the heart is under way."
So paramedics treat each report as if it is the real thing, relying on procedure and training to make sure their patient arrives at the hospital safely.
The EMTs wheeled me into JCMC' emergency room a little after 7 p.m, at which point they handed me over to the nurse on duty, giving her a call sheet detailing everything they had done, accompanied with a verbal report.
In my case, I showed no sign of heart attack, but was kept me over night for additional test. I received treatment for my asthma and later, received additional treatment as an outpatient.
In 1994, I was among the reporters who covered allegations made against the JCMC's EMT service, that included charges ranging from stealing patients away from other hospitals to inappropriate or careless care by its personnel. While JCMC sued and the charges were eventually recanted, a shadow of doubt has hung over the staff ever since.
"We can't operate effectively if people don't trust us," said Hamman.