The anatomy of an EMS call

Posted 7/10/19
Steve and Yvonne Engle were walking in downtown Port Townsend after a May 3 morning at the gym when they noticed a man collapsed on the parking lot at Quimper Mercantile.

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The anatomy of an EMS call

Steve and Yvonne Engle were walking in downtown Port Townsend after a May 3 morning at the gym when they noticed a man collapsed on the parking lot at Quimper Mercantile. “My wife noticed it first,” Engle said. “She goes, ‘Why is there someone laying down in the parking lot?’” Within seconds, the Engles were by Paul Gomes’ side. To the bystanders who had witnessed the 63-year-old’s collapse, it probably looked like a smooth takeover of the situation. But for the off-duty EMT and ER nurse, the wheels in their brains were accelerating as they evaluated what to do, where to turn, as Engle says, “organizing the chaos.” “From 30 feet away, I can see I have a man down,” he recalls. “You could see him doing agonal respirations. I know from my experience of being on probably 300-plus cardiac arrest calls that this is something we’re going to do CPR on.” Engle has been an EMT for 40 years and currently works with the North Kitsap Fire and Rescue. Through the chaos of injuries, heart attacks, car crashes and fires, Engle has built what he calls a “mental rolodex” that allows him to stay calm and evaluate patients in the thick of it. While every 911 call is different, Engle’s checklist (“I call it a hard drive now for the young trainees,” he said) is full of key steps he uses to deal with emergency situations. The first is organizing the chaos, which is when you figure out what is going on and try to remove the emotion from the situation, he said. “In training, you will learn all the basics of how to do a patient assessment, but it doesn’t teach you the art of triaging the call,” he said. At the parking lot of the Quimper Mercantile, even though Engle and his wife were off duty, they immediately began organizing the chaos. “There was a lady with the man and two bystanders,” he said. “I had no idea what their experience was in terms of doing CPR. My wife is an ER nurse, between the two of us we have 56 years of medicine.” Yvonne Engle pulled out her phone and started a timer for CPR, while Steve Engle began the process and asked the bystanders, who had already called 911, if they could help. Meanwhile, his wife pulled the man’s partner, who was distraught, from the situation. The bystanders did the right thing by immediately calling 911 in that situation, said Emily Stewart from East Jefferson Fire Rescue. Not only that, but Steve and Yvonne Engle stepping in was right. “Once you’re trained to do something, it would be negligent not to respond if you’re there,” she said. “It’s always a good idea to stop and help, unless you are putting yourself in danger.” The next step for Engle is what he calls conducting the orchestra. “The next thing you have to do is figure out what resources you need,” he said. “And when your resources arrive, we all have our strengths and weaknesses … When everyone shows up, if you’re the lead medic you have to know what everyone’s strengths and weaknesses are and get them to play the music to their strengths so that way your symphony is in harmony.” Having worked with a team of people for so many years, Engle is capable of merely making a hand signal at his teammates to indicate that he needs an airlift to Harborview, or a heart monitor. Once the orchestra of resources is in harmony, the third step is getting your “command presence,” Engle said. “That part is when we walk into the room, I have to present myself as though whatever is happening with you, you have confidence that I can handle it,” he said. “Inside your mind, you can be going through your hard drive, figuring out what’s going on, organizing the chaos, but outwardly you’re going, ‘Everything is going to be fine.’” Building a rapport with the patient can be easy, but it can also be extremely difficult depending on the person. An EMT’s job is to understand as soon as possible what the patient is going through and be able to keep them calm despite it. It is only after organizing the chaos, conducting the orchestra of resources and providing a command presence to the patient and bystanders that an EMT can finally begin to assess the patient, Engle said. Using a hard drive of past experience, training and quick thinking, all of these steps take only moments for EMTs, because there are often only moments to act in order to save a life. And even then, sometimes there is not enough time. Although the Engles were quick to the scene of Gomes’ cardiac arrest at the Quimper Mercantile—and East Jefferson Fire Rescue was there in minutes to take over for the Engles—Gomes did not survive, even though he was airlifted to Harborview Medical Center in Seattle. “It’d be a great story if the person walked away,” he said. But when that doesn’t happen, you add the experience to your hard drive. You ask what you could do better. “Sometimes you work so hard to save someone,” he said. Not every call has a warm and fuzzy ending.” But it’s the small things that help an EMT deal with the calls that don’t have happy endings. Talking with people, exercising, getting enough sleep and eating well help Engle deal with the stress. On top of that, he remembers the times he has helped someone just by being there, like the time he talked someone down from a panic attack. “She sent me a teddy bear and a letter that said I had saved her life that day,” he said. “I realized that it’s not the big rescues, it’s the little rescues that make a difference. I keep the bear on my headboard.”


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Thank you to all the emergency responders who dedicate their lives to helping others. You can (and are not) never be paid enough for the great work you do and all you must go through to serve us.
| Wednesday, July 10