20-A at West End & Harrison (Plane Crash)

Despite the reporter guy's enthusiasm trying to make a Hindenburg-esque "Oh the humanity!" moment out of this, the resounding phrase is "We're fine."
"WHAT HAPPENED?"
"A plane hit my car."
Duh.

...It’s Carnival Time And Everybody’s Drinking Wine!

...It’s Carnival Time And Everybody’s Drinking Wine!

We find ourselves once again in that special time unique to our city, our much-loved and much-hated Mardi Gras season. There is much to hate about Carnival - the hundreds of thousands of tourists who all come from dry counties and immediately proceed to down “only” five or six Hurricanes or Hand Grenades; the ubiquitous smell; the “can you tell me where such-and-such is?” (two blocks, make a right); the overloaded emergency rooms, the ungodly traffic. There is also much to love about Carnival - EMS gets the absolute best spots on the parade routes (especially if you can back your truck right up to the route), being pelted with throws, Polish sausage & pizza, parade-goers offering you food from their grills, the big parties after the season is done, and of course, the “entertainment” that comes with French Quarter details. One of my favorite feelings is going 10-8 early Mardi Gras day and driving down St. Charles while everyone is setting up for parades; there’s hardly any other traffic and everyone is in a great mood. Good or bad, it’s uniquely New Orleans and the challenges it poses to EMS (and all the emergency services) make it a source of pride when we’ve handled it bravely every year. 

If you’re new to NOEMS, or if you’re a veteran, here’s a few pointers (and yes, I’ve seen EMTs with years of Carnival experience who still need every one of these tips. So pay attention.):

Number ONE, first and foremost, superseding all other pointers: LISTEN TO YOUR RADIO! If you’re unfamiliar with directions in the city, let your more experienced partner listen to the SPEC channel and NOPD. There is nothing worse than being one block from an emergency and not responding because you weren’t listening! 

Know what to say on the radio, especially when communicating with the police. Base 9 (NOPD parade dispatch) doesn’t care or need to know when you’re at the hospital, or that you’re waiting for a bed or whatever. This is what you need to tell them: 1. You’re leaving your assigned location. 2. You’re on scene at a parade item (but not when you get pulled for a regular 911 street call). 3. You’re back at your assigned location. By all means, ask for specifics about a call they sent you to, like if you’re having trouble finding a scene. But do not crowd up the air with “en route to whatever hospital,” or “bathroom break” or “Code 77.” Base 9 doesn’t care and the cops have actual parade-related traffic to air on the SPEC channel. 

Know where your partner is at all times! Since you’re on two different channels, he won’t know if there’s a call on your channel and you won’t know if there’s a call on his channel. Delaying response because you didn’t follow the long-established rules is unprofessional, dangerous and downright wrong. Don’t be that guy.

Do not expect free anything (except parade throws). Expect to pay full price for any snacks or drinks you buy at concession stands, even if you know for a fact that they’re offering free stuff to EMTs. Pull out your wallet to show your good intentions. If you do get anything for free, tip nicely and do not be greedy, going back for more. Otherwise, you’ll ruin it for everybody. Don’t be that guy.

If you’re on the parade route, do not scramble to get parade throws. If you catch something mid-air, great. Otherwise let the tourist or little kid have that cheap Chinese plastic thing.

Act right. Of all times of the year, stressful though it is, be nice. You never know who you’re picking up out of the gutter. I once picked up a very influential travel writer at his worst moment during Carnival. That one story from that one patient can seriously impact our city’s tourist economy for years. Let’s hope it’s a good impact. And if you can’t be nice to the patient (e.g. they’re unconscious or a real asshole), be nice to the friends. When the patient comes around, the friends will tell the patient how great the EMS crew was. Or how awful they were. This goes double, no... triple, for the crew stationed at Gallier Hall. Remember, your bosses (the city council and the mayor) are there watching you. 

Related: Act right. You know perfectly well that someone is drunkenly filming the EMTs picking up the drunk pukey guy in bad drag face down in the gutter on Bourbon Street. That video is gonna be on YouTube, HIPAA be damned. It will go viral and millions of people will see you performing EMT work. Do everything National Registry-style. Swab your IV sites. Don’t walk trauma patients who need a spineboard. Do not let patients turn blue because you didn’t feel like lugging the oxygen around. Do not stop chest compressions till there’s a pulse. I guarantee you there’s someone who will write EMS to complain after seeing that video, and then they’ll put up some huge news story about the poor patient care in NOLA. It would be far better if they wrote in to say what a perfect job was done. 

When responding in elbow-to-elbow crowds, try to get a mounted officer to lead you. People won’t get out of the way for a siren, stretcher, ambulance or ASAP unit, but they will damn sure get out of the way for a horse.

Make sure your boots are snug and protect your ankles. You WILL be walking across seas of grounded beads and you WILL slip. Do not sprain your ankle or break your leg in the process. 

Do not assume that everyone you pick up is drunk, and do not assume that the drunks you do pick up are only drunk. There are some hellacious occult injuries and medical conditions that have been missed because the crews assumed “they’re just drunk.”

And lastly, LISTEN TO YOUR RADIO!

Good luck with this year, guys. I miss you! 

EMS Myth #7: System Status Management lowers response times and enhances patient care

Here's an excellent article about the science (actually, the lack thereof) behind System Status Management:

http://www.emsworld.com/article/article.jsp?id=2030&siteSection=14

Feel free to read it while en route to your next posting location (and racking up a whopping 46% increase in ambulance maintenance costs).

Don't kill the messenger.

From Both Ends: Food Poisoning In All Its Glory

Lately I’ve seen a few references to “food poisoning.” Most recently is an outbreak in Japan where 840 students were out sick. No doubt that you, dear EMS practitioner, have encountered this same malady, either in your patients or yourself. Perhaps your patient asked you if you thought their symptoms could be food poisoning from that restaurant they patronized. You probably recognized the telltale sign of dollar symbols in their eyes ($_$) as the thought of a lawsuit against the establishment occurred to them. Perhaps your experience came after consuming whatever passed for food at the local convenience store at 3a.m., which had been sitting under the heat lamps since the previous morning (which you consumed on the way to the dollar sign patient). By its very name, it sounds like “someone” poisoned your food. I’ve seen people begin plotting their revenge on this unknown individual, perhaps some busboy or salad chef. Even more hilarious have been the times when the “victim” thought he or she knew exactly who had “poisoned” him, and started to hatch their plan for dark vengeance. 

Food poisoning is not the horrendous plague or crime that is commonly imagined. It occurs when food has been improperly prepared. It’s not caused by someone pouring a foul elixir from a vial marked with a skull & crossbones (that would be actual poisoning; or perhaps voodoo). Food poisoning is caused by bacteria, plain and simple. If you’ve ever had diarrhea, and I know you have, you’ve had some form of food poisoning. 

Very commonly, it’s caused by bacteria that we normally lug around with us every day. The problem comes when it gets somewhere it isn’t supposed to be. For example, escheria coli and staphylococcus aureus (e. coli & staph) are two species living in abundance on your body right now. E. coli lives in colonies weighing kilograms within your lower GI tract. When you poop, about a third of its mass is pure e. coli. Staph lives on every inch of your skin. The problem comes when these little critters set up shop in our upper GI tract, between the mouth and duodenum. It’s not supposed to be there and the anatomical structures in your stomach don’t have the mechanisms to accommodate them, so you get sick. 

Generally food poisoning is facilitated from the way food is prepared. In the case of meat, remember that meat comes from animals that have to be killed and chopped up. It is not grown in those little plastic packages in the supermarket (sorry to shatter your illusion). Animals also have an abundance of bacteria in their GI tract. Food inspectors have to check that the bacteria and germs in the guts don’t contaminate the meat in the slaughtering process. But as you can imagine, when there are a thousand tiny, wooly, innocent lambs cowering in fear or  little calves mooing out of sheer terror as they witnessed their brothers and sisters being disemboweled and dismembered, things can probably get a little hectic as your lamb chops and veal begin their way to your table. With lots of creatures you grew to love in Mother Goose fairy tales dying and being drawn & quartered, it’s reasonable to picture that some of  the bacteria in Little Bo Peep's sheeps' guts might get into the actual chops that make it to the plastic packages in the store. 

Now, with that image firmly in your head, keep in mind that bacteria are living things. They consume, metabolize and excrete, just like us. While that meat is waiting for you to purchase it and not think about where it came from, all the e. coli, salmonella, clostridium, staph, listeria and enterococcus is happily consuming the meat and excreting the bacteria version of poop into your lamb chop. Later, if the heat of the cooking process isn’t enough to kill all the bacteria and break down all the bacteria poop, it ends up in your tummy. Even if your body can handle the bacteria, it probably can’t handle the bacterial poop, which is made up of all kinds of fun toxins & chemicals. What doesn’t end up in your tummy winds up in tupperware containers so you can eat it later. The bacteria process starts all over again in the leftovers, so even if the first batch didn’t sicken you, the leftovers might, particularly since microwaves don’t heat evenly. So relatively vast colonies of bacteria and their poop can make it into your belly from the cooked leftovers too.

And for all you vegetarians out there, sitting at your laptop all smug and self-righteous, the same thing can happen with your bean sprouts and tofu. Who's picking and packaging your food? Probably not a bunch of other vegetarians. It's a bunch of undocumented workers trying to hustle a buck or euro by picking your lettuce, arugula, swiss chard and soybeans. They're out in the fields picking and packaging with some foreman yelling at them to hurry up before Immigration catches up with them. So when Juan or Abdullah or Cho needs to go to the bathroom, he'll be hitting the outhouse, or maybe he'll just go right there in the field. With no time or facilities to wash his hands, your broccoli arrives to you with a little staphylococcus souvenir.

How to prevent and treat food poisoning? First, proper handling and cooking is paramount. Unless you work in a slaughterhouse, that part is kind of out of your hands. Wash your food, because God only knows what illegal immigrants with questionable bathroom hygiene handled it between the farm and your table. Cook it thoroughly to kill bacteria and denature the poop chemicals. Store it refrigerated to retard bacterial growth, and reheat it thoroughly. Basically do everything they taught you in grammar school. One other thing - those heat lamps over prepared food or the tiny burners under the chafing dish at a buffet do NOT prevent bacterial growth. In fact, the slightly elevated temperature provides a bacterial paradise for the little guys to be fruitful and multiply. When treating food poisoning, diarrhea and vomiting can cause severe dehydration. If PO fluids can be tolerated, rehydrate that way. Most likely, IV fluids will be necessary. On the streets, there’s not much you can do for the electrolyte imbalances that occur, but expect an abnormal EKG from hypokalemia. Some patients may have burned up all their glycogen reserves since they can't eat without vomiting, and their cells try to consume glucose, so some may experience hypoglycemia. Urine output will be decreased, so be sure to ask your patient about that, as acute renal failure can occur. Be especially suspicious of dehydration in the elderly and the very young. Expect a few rounds of antibiotics to deal with the invading bacteria. 

So no, food poisoning is not fun, but it’s not an insidious crime and it probably should be renamed. It can happen to anyone, anywhere. And if someone in the house gets sick with food poisoning, throw out the offending culprit. Don’t do as I saw, when two people were obviously sick from bad crawfish. When I told them to throw it out, old Grandpa decided to start eating them right there in front of us. New crawfish is cheaper than a hospital visit and no, you won’t win your stupid lawsuit.

Onward and upward...

As If New Orleans Hasn't Lost Enough...

The City of New Orleans has lost something today. With the resignation of Dr. Jullette Saussy, now former Director of the city’s Emergency Medical Services, our community has lost one of the few people in city administration who upholds the highest standards of integrity and ethics; a quality that few need to be reminded is often sorely lacking in our leadership.

Many, especially the Times-Picayune, are quick to attribute scandal where none exists. Several weeks ago, the T-P “broke” a story regarding Dr. Saussy. In it she was accused of holding a second job while working as Medical Director of EMS. The second job was with Vidacare, supplier of the EZ-IO device, now widely used in many ambulance services. She was also accused of taking donated sick leave from other employees while she was having cancer treatments. To top it all off, she was the highest-paid city employee at around $187,000 per year. All of these “accusations” are true.

So, why do I say that Dr. Saussy upholds the highest standards of integrity and ethics in view of these facts?  Because there was no scandal. Nothing Dr. Saussy did was in any way subterfuge or “under-the-table.” Her second job with Vidacare was cleared and blessed by none other than the city attorney and the Nagin administration. Anyone who wanted to could see that Dr. Saussy was holding another job. Nor is it anything unusual for physicians to hold second jobs. In fact, I cannot think of a single physician I know who does not have another job. Virtually every emergency room doctor I know has a second job; one owns a vineyard, one is a contractor and a lawyer, one has a holistic alternative medicine practice. Even the new acting Medical Director of New Orleans EMS, Dr. Jeff Elder, holds a job at University Hospital. 

Dr. Saussy’s second job did not take time away from her primary function as the city’s EMS Director. I know, because I was there. I witnessed firsthand that never did an issue come up that Dr. Saussy was not available to handle promptly. Therefore, despite the Times-Picayune’s insistence that Dr. Saussy’s second job was some sort of a scandal, it clearly was not.

Vidacare is the supplier of the EZ-IO device, a type of specialized needle that injects fluids and medications into bones rather than into veins. It is particularly useful in emergency situations where vascular access is difficult or impossible to obtain. New Orleans EMS uses the EZ-IO on all of its ambulances and sprint vehicles. Is it scandalous that Dr. Saussy worked for a company that supplies devices that her other job uses? As anyone who is familiar with the purchasing procedure regarding supplies among city services, which I will not describe in its arcane detail, it becomes quickly apparent that no matter whom the products’ representative is, they have no influence on whether the city purchases the product. As far as I know, there is not another device similar to the EZ-IO, and I have personally used it to save the lives of many of the citizens of New Orleans, perhaps even some of those who are so quick to declare “scandal.”

While receiving treatment for cancer, Dr. Saussy was donated hundreds of hours of sick leave by fellow employees. This was done under a policy approved by City Hall for city employees. If anyone has a problem with the donation of sick leave hours, I suggest they take it up with City Hall, the masterminds behind the policy. Many city employees are donated sick leave when they are out for an extended time. Does the Times-Picayune (or anyone else) have a problem with a firefighter being donated sick leave because of broken leg, or a paramedic who is out for an extended time because he contracted a disease from a patient? No? Then why is this practice a problem when Dr. Saussy utilized it? Never were any employees “coerced” or “forced” to donate sick leave, each one of us who donated did so voluntarily. Feel free to investigate the city’s email system (again) in a fruitless search for coercive correspondence. It isn’t there.

The Times-Picayune asserts that city employees complained that Dr. Saussy “quit showing up for work,” according to the Metropolitan Crime Commission. Have they taken into consideration that the offices at “work” consist of two trailers, the same two trailers that EMS has been relegated to since Katrina, one devoted to supplies and the other occupied by the shift supervisors? Where, exactly, was Dr. Saussy supposed to report to work, given the tiny trailers at 300 Calliope, and seeing that her office is actually within City Hall? Further, must we reiterate the fact Dr. Saussy was receiving treatment for cancer? If anyone is fighting for their life, isn’t it vaguely possible that answering phone calls and emails might temporarily take a backseat to survival? If any city employees did, in fact, complain, then shame on them. I hope others show as much mercy to them when they are fighting for their lives.

So you see, the media, specifically the Times-Picayune, has tried to create a scandal where none exists. Dr. Saussy’s salary is a matter of public record. Her outside employment got the thumbs-up from City Hall. It is impossible for her to have influenced anyone in city services to purchase the device she helped to market. And her sick leave donations were part of a policy that City Hall has had in place for years. So where is the scandal? Further, why has Mayor Landrieu and the rest of City Hall asked for her resignation for following the procedures that they, themselves, approve? 

It seems that some of the writers at the Times Picayune have a personal vendetta against Dr. Saussy. Why? We likely will never know. In addition, it is shameful that WDSU grouped Dr. Saussy in with their list of officials who have resigned since Mayor Landrieu took office, including Greg St. Etienne, Joia Perry, and the executives of the Public Belt Railway - all of whom are followed by legitimate, concrete evidence and accusations of wrongdoing.

As you’ve no doubt gathered, I know Dr. Saussy personally. I worked for the city’s EMS system for eighteen years, from 1991 until 2009. Dr. Saussy and I have not always seen eye-to-eye, but in our occasional differences, it was nearly always me that was in the wrong. Dr. Saussy’s mission has always been straightforward: deliver the best care possible to the people of New Orleans, and never do anything to tarnish EMS’ reputation. She not only preached this, she lived it every day. 

The paramedics and EMT’s of New Orleans EMS will continue to serve the public. Under Dr. Saussy’s leadership, and by that I mean genuine leadership, she has transformed our city’s EMS into a world-class example of prehospital care. I hope you remember that when the paramedics show up for you or your family’s crisis. We will care for you in the most professional, technologically advanced way this country has to offer. But for those who rejoice at Dr. Saussy’s departure, we will be ashamed of you.

-Sean H. Fitzmorris, EMT-Paramedic; RN

Councilman Stokes Is an Explosion In An Idiot Factory

Someone on Twitter, @RobRiscoe, asked my opinion on this fiasco:


The incident occurred in Jackson, Mississippi and there's been considerable hullabaloo in the EMS community regarding it. Normally I don't voice my opinion on things where the answer is as clear as this situation. But since I was asked...

As you can tell by the title of this article, Councilman Stokes has proved to the world that he knows absolutely nothing about the subject on which he has chosen to pontificate in hilarious ignorance.
"You got to take risks; you can't let citizens die!" In a backwards way, he is correct. The shooter and victim took their risks in whatever behavior preceded the shooting. The EMT's try not to let citizens die. But Councilman Stokes, I must ask you, had the EMT's arrived on an unsafe scene and gotten themselves shot and killed, then wouldn't there be two more citizens dead besides the first victim? We can continue this formula - then two more EMT's show up and get shot, and so on - until all the EMT's in the city are dead. You see, going into that scene and 'taking risks' might not be the best policy. As every EMT is aware, even scenes that are declared "safe" often remain very unstable and can go downhill to "extremely unsafe" in a heartbeat.

(Should we tell Councilman Stokes about what we do when that happens? Actually leave the scene?)

One of the solutions for this "problem" that Stokes has proposed is having the city go into the ambulance business themselves, rather than contracting with AMR. That's fine. No offense to AMR, but certainly few would have a problem with there actually being more ambulances in the city. Tell us, Mr. Stokes, where will you find the EMT's to staff your city ambulances? No doubt you wouldn't want those wimps from AMR to come over and work for you, with all their insistence on "scene safety" or whatever they call it.

Councilman, I have news for you. Your "problem" isn't with AMR. Every EMT in this country, to be certified as an EMT, has to go through an EMT course approved by the nation's Department of Transportation. And in every single one of those classes, the first lesson on day 1 is "Scene Safety." During that class, it is ingrained into the brains of every prospective EMT that you do NOT go into scenes that are not safe! If the scene becomes unsafe, leave! Every practical exercise that the EMT's will perform during class must include the question "Is my scene safe?" If they do not ask that question and determine scene safety, then no matter how magnificently they perform the practical exercise, they will fail. Every day from day one, scene safety will be burned into their brain.

That, Councilman Stokes, is the culture of the pool of EMT's from which you have to staff your nascent city ambulance service.

Perhaps Councilman Stokes would prefer if the class would go something like this: "Hello and welcome to EMT class. The first thing you should know is if you are called to a scene where gunshots are still going off or cars are still colliding with each other or gangs are stabbing each other all over the place, don't worry, just go right ahead in. Everything will be fine and unicorns and rainbows will sprout from your footsteps."

Really, Councilman Stokes? Would you actually want EMT's who were schooled to take such risks? If they are willing to "take risks" with their own personal safety, then what kind of risks will they take with the care they deliver to their patients? When you're in the back of that ambulance one day, maybe when the medic pulls out some big scary tube or needle to put into your body, will you want the EMT's to say "I've never done this procedure before, but I'm willing to take the risk!" Or maybe "You don't have to sterilize the site where you're going to stick in that needle/tube/scary device. It's a risk that he may die from a horrible infection, but we're willing to take it!"

As a casual aside, according to the news video, which I trust more than the "facts" of either Councilman Stokes' or the outraged mother-in-law of the victim, I notice that AMR is accused of taking 21 minutes to arrive at the patient. But then later in the video, the dispatch, en route, arrival and at-patient times add up to only 7 minutes and 25 seconds. This is well under the national average of 9 minutes. Did Stokes even bother to actually investigate the details of the call? Or is he just taking the word of some emotional, angry woman off the street?
Councilman Stokes, you are a fucking idiot.

"Found Wanting" now available for everyone!

Just wanted to announce the release of my book, "Found Wanting." If you've seen my Facebook profile, you know I've been yammering about various problems with its release. Well, finally, it's out now! It hasn't yet hit retailers like Amazon and the iPad app store, but it's available already! You can get it from the wholesale publishers (for a LOT cheaper than my original publisher!).

If you'd like the print version, a real, actual book, then click this link: http://www.lulu.com/product/paperback/found-wanting/12812792
Just click Add to Cart and checkout like any purchase!

If you'd like to download "Found Wanting" to your mobile device like iPhone, iPad, Kindle, Nook, Kobo, Stanza or other device, then click this link from your mobile device: http://www.smashwords.com/books/view/25111
You have to register (it's free) and select which format you want. Don't panic!  Pretty much any device will read the .Epub format. If you have a Kindle, you can download the .Mobi file. You can also read a free preview of the book! Just remember to go back and purchase the full copy!

"Found Wanting" will be available via retail outlets like Amazon and the iPhone app store in 4 - 8 weeks, so get your copy now! Why wait?

Thanks to everyone, and enjoy "Found Wanting"! All the best!
-Sean

Scary

I don't know what's more frightening - that "frank petta ems" was used as a search term or that "frank petta ems" was a search term for TWO different people?!

From the traffic report on this webpage via Google Analytics:

Five years later...

This article was written two years ago: http://blog.nola.com/editorials/2008/10/a_911_for_ems.html. In it, EMS' plight in securing a new home following Hurricane Katrina was addressed. Back then, EMS was responding to "700 calls" a week. That number has increased greatly, yet New Orleans EMS is still operating from two trailers in a parking lot under a bridge. Employees are still dodging trash thrown from the bridge, there's nowhere near enough space for parking, supply storage or even washing the ambulances.

Now, call volume has required the purchase of additional ambulances and sprint vehicles, taking up more already scarce space, yet EMS is still relegated to their position of "trolls hiding under the bridge." There is talk of new headquarters on City Park Avenue, but little or no progress has been made toward moving there. How long will one of the city's most vital components be ignored and have to "make do," especially in view of the scads of unoccupied territory everywhere in the city? Everyone understands that New Orleans' city budget is tight, yet every firehouse and police station has been rebuilt, renovated or relocated, but the red-headed stepchild of emergency services remains barely an afterthought in the grand scheme of things.

Repost this, tweet it on Twitter, write an email or letter to your city councilperson, spread it on Facebook... whatever. Help to spread the word and get those that will help you and your loved ones in a crisis a decent headquarters.

It's a damn shame.

EMS Gets a Little Recognition - Especially "portly, balding Chris Martinez"

This makes me proud to have spent the last twenty years working with Martinez, Schlumbrecht, Frezel, Petta and ALL the medics of New Orleans EMS! It's not for just anybody...

Original Article: http://www.nola.com/crime/index.ssf/2010/07/citys_ems_teams_handle_life_an.html

City's EMS teams handle life and death on the streets of New Orleans

Published: Monday, July 05, 2010, 5:59 AM     Updated: Monday, July 05, 2010, 9:19 AM

 Ramon Antonio Vargas, The Times-Picayune 
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The paramedics heard the call from two different points in the city.

Michael DeMocker / The Times-PicayuneParamedics prepare to transport Chester Reeder after he was shot in the head in Algiers on May 24, 2009.

Chris Martinez and Scott Schlumbrecht were cruising the streets in an ambulance near the Crescent City Connection.

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Dave Frezell and Frank Petta were standing on the porch at EMS headquarters -- two trailers in a parking lot under the bridge -- when the radio emergency line crackled to life.

"Male down, 34S." It was a shooting near the corner of Ptolemy Street and L.B. Landry Avenue in Algiers. Next came "Code 3," a life-threatening emergency. Then, the orders: Wait for police to secure the scene, but get in position.

"Crap," Petta said. "We gotta go."

Petta and Frezell hopped into separate sport utility vehicles, blared their sirens, turned right on Calliope Street and barreled toward the bridge's on-ramp. Petta quickly hit 70 mph. Some cars deftly shifted out of his path. Others were perilously slow to do so.

Schlumbrecht and Martinez, slightly ahead, drove the ambulance.

Six minutes later, the rescuers approached the intersection, not knowing exactly what they might see.

Working as an emergency medical responder in New Orleans, the country's most murderous city, is not for the faint of heart. The city's paramedics are like MASH doctors in wartime. Sometimes their patients suffer a heart attack or a stroke. But far too often, paramedics are rolling out on a shooting or stabbing, where the victim's chances of making it depend on how well the EMS team does its job. It's a hugely stressful line of work, and one that brings with it constant reminders of man's capacity for cruelty.

'Save him, y'all'

The four medics sailed through a mob of people drawn from a nearby second-line parade to the crime scene by the gunshots, flashing lights, and yellow crime scene tape put up by police officers.

Frezell and Petta put on latex gloves and fetched equipment from their trunks. Martinez and Schlumbrecht grabbed a stretcher and spine board from the ambulance.

The victim, in a white T-shirt and blue jeans, lay unconscious, face-up atop a rusty storm drain. He had been shot once in the head. Blood covered his face. It mixed and clumped in with dry grass in his dreadlocks.

The paramedics rushed out with the spine board, the stretcher and an electric heart monitor. A crowd of spectators in quiet conversation watched them. Police officers implored them to back up. One woman, her voice shaky, called out, "Save him, y'all."

Martinez jogged to the man's feet. He pulled a pair of scissors from a belt holster and snipped off the victim's jeans and T-shirt. Martinez spared the man's boxers because hundreds of strangers surrounded him. He ran his eyes down the man's legs, torso and arms but saw no wounds apart from the gunshot wound to his head.

The man's toned stomach rose and fell slowly. Frezell pressed his fingertips on the man's wrists. "He has a pulse," he said.

The man was alive, but he had lost a lot of blood. His breathing was slowing. They had to hurry. If he was to live through the next hour or two, the four paramedics needed to carry out a frantic but crucial process in less than 10 minutes to stabilize him. Then, they had to whisk him to an emergency room six miles away.

"Let's load him and go," Martinez said.

Petta ran to the ambulance to prepare a thin breathing tube. Frezell strapped on a dark blue brace that immobilized the man's spine. Schlumbrecht grabbed the man's side and gingerly rolled him to the left. Frezell and Martinez checked his back for bullet holes but found none.

All three slid the spine board under the man and gently rested him on it. They snapped the yellow board onto the stretcher and wheeled it under the tape, past the growing crowd.

A bright red bubble suddenly emerged from the man's mouth and popped. Blood sprayed onto his closed eyelids.

A woman watching gasped. She said, "Oh Lord, he's dead."

The man's arms dangled. His head lolled to the left. Blood pooled in his right ear.

A trembling voice called out to the rescuers once more: "Save him, y'all."

Frantic, yet controlled, activity

Martinez -- portly, his dark head of hair balding -- placed a plastic shield over his own face when he boarded the ambulance bay, occupied already by his three colleagues and the stretcher.

Paramedics work on Chester Reeder, who was shot in the head after a second line in Algiers on May 24, 2009. They stabilized Reeder and rushed him to a hospital, but he died two days later.

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He shut the door behind him. The murmur of the crowd disappeared. It was replaced with the ripping of plastic and paper equipment wrappers.

The smells outside -- barbecue, beer and grass -- gave way to the smells of sweat, rubbing alcohol and latex.

Martinez kneeled at the wounded man's head and prepared to slide the breathing tube into his trachea. But blood in the man's mouth choked him and blocked Martinez's view.

Martinez reached for a catheter and suctioned out some blood. He tried sliding the breathing tube in again but the man gagged, nearly vomiting into Martinez's mask.

"He's still choking on his blood," Schlumbrecht offered.

Martinez pressed a stethoscope against the man's chest. "I know. It's all up in there," he said. He reached for the catheter and suctioned out more blood.

Schlumbrecht placed the heart monitor's leads on the victim's left bicep and right pectoral muscle. They registered a beat. As the monitor emitted an unnerving beep every three seconds, the man's stomach rose and fell, rose and fell.

Frezell sat on a bench seat to the right of the stretcher. Martinez's suction hose, wine red, wrapped around his right arm and across his chest like a bandolier.

Not bothered, Frezell wound a band tightly around the man's right upper bicep. A vein bulged. He slid a needle and catheter in and removed the needle. He then started an intravenous saline drip -- to compensate for the blood the victim had spilled on the street -- and secured it with adhesive tape.

Petta mirrored Frezell's actions across the stretcher. When they were done, they peeled off their bloodstained gloves and ducked under the bevy of tubes to the side door and out of the cramped quarters.

Back in the bay, Martinez slid the breathing tube in. The patient's stomach jutted out abruptly, and he gagged. But Martinez didn't remove the tube. He slowly slid it further down. The patient didn't resist, and Martinez announced, "Good. We're good."

Schlumbrecht jumped out of the back doors and hopped into the driver's seat. Martinez attached the breathing tube's tip to a bag connected to a pump. He handed it to a New Orleans firefighter who had climbed aboard to provide help.

"Hold on to this. Just squeeze the pump for me every few seconds," Martinez instructed. He flipped a wall switch. Air whooshed through the tube.

"Scotty, we can go! Let's go!" Martinez shouted.

Schlumbrecht backed out. Martinez radioed doctors at Interim LSU Public Hospital to brief them about the new patient.

Seven minutes after the ambulance arrived at the scene, it was headed to the emergency room.

'Damn. That's the guy I worked on'

Five days later, Martinez, 44, threw a copy of the newspaper onto his kitchen table. After pouring himself his morning cup of coffee, he sat down and perused the headlines.

"Man dies two days after being shot" grabbed his attention. A paragraph detailing the location of the shooting then jumped out: the corner of L.B. Landry and Ptolemy, near a second-line parade on May 24, 2009.

"Damn," Martinez muttered. "That's the guy I worked on."

Unless paramedics specifically ask emergency room staff about patients they care for, they rarely learn their fate. They often don't even catch the name of the victim or his exact age during the frantic race to the emergency room, unless they handle the paperwork.

Martinez and Petta had worked to save three shooting victims, two of them 15 and one 18, the night before they worked on the 25-year-old on Ptolemy Street. Martinez didn't know any of their names.

The weekend before that, Martinez tried to help two shooting victims: Devin Goines, 23, at the corner of North Broad and Duels streets, and Qian R. Sabatier, 26, at a bar in the 8500 block of Hickory Street. Both died.

Typically, if patients' names and ages don't make the news, it means they survived. The New Orleans Police Department doesn't release the names of shooting survivors, and the coroner's office can identify only homicide victims.

Martinez read on. The young man he tried to save was Chester Reeder III, who made a living in Houston but was in town briefly to visit his mom and kid sister for the Memorial Day holiday. He died at 6:29 p.m. two days after the shooting.

"Two days," Martinez thought. "At least his friends and family had two days."

He folded the newspaper and set it aside. He wished he hadn't read it.

A nightmarish scene

Longtime paramedics say those who can shake the images of shattered skulls and bloody bodies -- and suppress their revulsion at the culture of violence that feeds the carnage -- have the best chance at a career in New Orleans EMS.

Those who are haunted by what they see, or who turn to alcohol or drugs to dull the pain, don't last.

Martinez doesn't talk much about his job. At family gatherings, his relatives can't stomach the few stories he does share.

"I don't want to hear no more," they often say, almost immediately after he begins one.

Generally, he just tries not to think about work during his free time. If he did, he'd go crazy.

He was called out in March, for instance, to one of the most gruesome crime scenes in memory -- an Upper 9th Ward home where a 25-year-old mother and her 7-year-old daughter, 4-year-old son and 17-year-old sister had been fatally shot, allegedly by a relative.

There was little for Martinez to do but connect the leads of a heart monitor to their corpses and watch as a doctor pronounced them dead.

As he drove away from the nightmarish scene, he was troubled. "Even animals don't do s--t like this," he thought.

But he said he was able to "let it go" by the end of his shift.

"Seeing those kids shot was horrendous," said Martinez, a paramedic for 18 years. "But I can't spend time trying to make sense of it. ... I couldn't do this job otherwise. No one could."

In a career where he routinely works on the victims of suicide, shootings and car accidents, he has never seen a trauma counselor.

"It must be something that's built into you," Martinez shrugs. He knows some may be confounded by his seeming ability to erase human tragedies from his thoughts. It puzzles even him.

When his grandparents died in 2008 and 2009, Martinez could not cry. He was sad, even depressed. But he simply could not cry.

Several weeks later, Martinez's husky, Sheba, died from a seizure.

The hardened paramedic sobbed for days. He couldn't explain it, even to himself.

"I guess animals, especially dogs, have unconditional love," Martinez said. "That's hard to find in human beings."

Ramon Antonio Vargas can be reached at rvargas@timespicayune.com or 504.826.3371.