The First Call
It took me 10 minutes to get to the station from the time I responded to dispatch. Within another five minutes, three more people had arrived--a driver named Ed, Sandi, and Pita, who was the president of the squad's auxiliary organization and also served as the squad's vice president. In another five minutes, we rolled out the door in ambulance #42. Note that 20 minutes had passed since the call was first "toned out" over the radio. One-third of the golden hour was gone before the ambulance hit the road. If you're planning a move to a rural community, you might want to keep this in mind.
Pita was an EMT-B (Basic), which is the fundamental EMT certification level. EMT-Bs practice the skills of basic life support, of which defibrillation is the most crucial. An EMT-B can administer 1st aid and oxygen, assist a patient in taking certain medications (upon medical direction), and carry out instructions from senior providers--as long as the instructions are within the EMT-B scope-of-practice. EMT-Bs cannot perform invasive skills, such as starting IVs.
We arrived at the scene within 10 minutes of leaving the station. Half the golden hour was now gone. The patient had been pitched over her horse's head when the mount refused a jump. Her right forearm had an unnatural angle, which was apparent even under the sleeve of her jacket, but the trauma appeared to be limited to that extremity and she didn't seem to be in any immediate mortal danger.
Pita and Sandi immobilized the patient's injured arm and helped her onto the ambulance stretcher. About 10 minutes after we arrived, we left the scene for the hospital. As we rolled down the highway to the hospital (about 30 minutes away--are you keeping track of time?), Pita set up an IV while Sandi stripped the patient's clothing off and re-examined her for injuries that might have been overlooked at the scene.
The purpose of advanced life support is to respond ASAP to certain fundamental patient needs, which can save time at the receiving facility. The ALS skill of venipuncture provides two particularly significant benefits. It establishes a route for intravenous medications that might need to be administered on route to or at the hospital. It allows the EMTs to administer intravenous fluid--which can temporarily bolster and sustain blood pressure, delaying the onset of shock--and rehydrate dried-out patients.
Establishing an IV line requires inserting a cannula--you might think of it as a needle--into a vein, usually in the patient's arm or hand. Because our scene-to-hospital transport time was so long and because time is life, one could not linger at the scene to start the line. Instead, IVs were started en route, while bouncing down the road. In the case of this particular call, the patient didn't think it was a very good idea.