Thursday, February 15, 2007


By Sean Fitzmorris

One of the best scenes we go on are those in which there are no bystanders. You can just do your job without worrying about what you say, who's watching you or family members having conniptions about how "slow" you're working. Those scenes are few and far between. By far, most EMS scenes seem to have more than their share of bystanders, offering "helpful" information and lending "assistance" by shouting 'Hurry up!" Mostly, bystanders pretty much just get in the way.
The bystander experience (sounds like a ride at Six Flags, doesn't it?) often begins before the EMS crew even arrives at the scene. From a mile down the road, there will be a bystander doing his "signpost" imitation. He will be standing in the middle of the road, waving his arms, apparently daring the ambulance to run him down. He will remain in the street, waving, until long after the EMT's park the truck and exit the vehicle, shouting "Here! Right here!"
Thanks. We wouldn't have guessed.
He will direct the crew to an unruly crowd of more bystanders gathered around the patient. It often seems that the patient has hosted a family reunion upon becoming sick or injured There will be relatives, friends and long-lost associates all "tending" to the sick one. On the outer periphery of the vortex of people, several will have engaged in some sort of argument, which is usually ongoing throughout the time the ambulance crew is on scene. Farther in the mêlée will be several older folks, all fanning themselves and speaking in loud tones about how they "can't take this; my nerves are bad." These bystanders often compare the severity of their own chronic maladies to whatever problem the patient is experiencing in a bizarre display of one-upmanship.
After pushing through the crowd, the crew eventually comes to the Inner Sanctum of bystanders. These are the ones immediately orbiting about the patient, hovering like a swarm of nervous hornets. One will be holding the patient's hand, another will be fanning the patient ("to give him some 'air'"), while yet another will have a large quantity of ice applied to the patient.
Ah, the ice! In the public's eye, ice apparently serves as a cure-all miracle drug. Ice will be applied to patients suffering from virtually any complaint, whether it is a gunshot wound, asthma, appendicitis, or cardiac arrest. What logic prevails that makes people believe that ice will stop bleeding, halt vomiting, heal diseases and resurrect the dead? I must have missed the class that discussed the panacea effect of ice.
But I digress. By the time that the EMT's have made it to the Inner Sanctum of bystanders and have determined that there actually is a patient, which can be difficult given the census of people on the scene, the next problem comes at the realization that they must now maneuver back out of the riot with the patient in tow. Clearing a path through the humanity is not easy. Often it must be facilitated by giving all the extra souls "tasks" to do. Useful tasks may include sending bystanders to find the patient's identification and medicines. After that, busywork must be found for the remaining crowd members just to get them out of the way. This is how the task of boiling water and tearing sheets was created. Useless, yes, but it gets people out of the way.
The relationship of these "family" members to the patient is often questionable. Many identify themselves as "cousins" or "aunts" of the patient. When inquired about basic information such as the patient’s name, these will give you names such as "Pookie" or "TeeTee" without an inkling as to what their real name is. "Cousin" and "aunt," it turns out, are very broad terms that includes not only blood relatives of the conventional definition, but also neighbors, grammar school classmates, former stickball teammates from 1954, and people whom the patient may have passed once on the street.
As the EMT's try to treat the patient, it all has to be done over the shrieks and bellowings of the vast multitude of bystanders. If evaluating a patient takes more than two seconds, the inevitable "Hurry up! You're not going fast enough!" will begin to take first place amid the helpful hints. Occasionally, these delightful tidbits will take on racial tones, particularly when European-American EMT's are on the scene of an African-American patient. "If that was a white lady, you'd be on the way to the hospital already!" is a common complaint. Personally, I just respond flatly, "I don't play that game," and diligently ignore the offending party afterward.
Then comes the argument over who is going to go to the hospital with the patient. This generally takes one of two paths. One, the entire tumultuous crowd will want to come in the ambulance. They will all clamber to get in, pushing each other out of the way, shouting "I'm gonna go!" Occasionally several will climb into the front passenger seat and sit on one another's lap! I have personally seen up to four people trying to cram into the front seat, which is pretty comical, considering that the seat in question was clearly designed for leprechaun dwarves. Often it will occur that the person who actually ends up riding to the hospital didn't know the patient at all, but just wanted a ride into town and disappears immediately after arriving at the hospital.
The other course of action by the bystanders is that nobody will want to go with the patient. This scenario is quite common around the holidays, when it's real inconvenient to have poor old Grandma around, what with all the friends coming over for the party. Yes, people frequently ship the old-timers off to the hospital, attributing them some vague, unquantifiable complaint like 'nausea' or 'weakness' when it's time to host a party. After all, who wants to be distracted from the festivities when Grams starts drooling or needs her Depends changed?
Our call volume would be reduced enormously were it not for the thousands of Concerned Citizens who feel it is their civic duty to call 911 every time they see some drunk sleeping it off in an alleyway. These would-be Good Samaritans are usually the very epitome of the hypocrite. They'll be walking down the street or driving in their car and they'll spot some fragment of humanity lying on the side, usually with the detritus of the day's iniquity (i.e. liquor bottles) strewn about. The Concerned Citizen will, without bothering to see if there is truly any emergency, call 911 on their cell phone to report the "man down." When the 911 operator asks for specific information such as if the unfortunate soul is breathing or hurt or whatever, invariably the Concerned Citizen will respond that they "didn't want to get that close." What's the deal with that? They're not being asked to go and initiate a sexual relationship with the person or anything; just a "Hey buddy, are you OK?" Heck, just kick his foot and see if he's alive or whatever!
One of the most dreaded bystanders is the physician. Having a doctor on your scene can be one of the most annoying experiences in EMS. It's not bad if the physician happens to be someone like a good emergency room doctor, but that isn't usually the case. There are few situations that make an EMT want to pull his own fingernails off like treating a critically injured trauma patient and having to deal with some random podiatrist or psychiatrist or ass-crack doctor who's trying to run the show. Usually Doctor Do-good has diagnosed and treated the patient's sprained toe while conveniently ignoring the lungs hanging out of the big hole in the patient's chest. At our EMS service, the protocol for handling on-scene physicians dictates that the doctor may assume care of the patient, but he takes complete responsibility and must not only ride to the hospital in the ambulance, but also write the documentation on the run report. Once this is explained and the physician considers the inconvenience and huge legal liability, it is quite amusing to see how quickly he does an about-face and disappears. It's like magic!
Bystanders come in all shapes and temperaments. Sometimes hostile, rarely helpful, usually just another obstacle to avoid kicking, like the china cabinet. Who knows what the next call will bring in the way of bystanders? Probably a drunken ophthalmologist trying to “help” with a gynecological emergency while fighting with the signpost guy who gets hit by a car while waving his arms… and so on.
Onward and upward.

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