Driving at Code 3 presents risks for the ambulance crew as well as other drivers. "It's a pretty dangerous thing. The general population doesn't know what to do. We're putting ourselves at risk by going through red lights, even though we stop at them to insure that everybody has stopped before we go through. We don't demand the right of way, but we request the right of way. A lot of people try to outrace us. They want to get where they're going, and they don't want to be bothered with pulling over and stopping."
We arrive at Paradise Valley Hospital at 9:34 and pull into a special ambulance entrance at the emergency room. Before Terlouw and Delao unload the patient on the gurney, Delao punches in a numerical code at a sliding glass door, which opens automatically. When the patient is wheeled in, two doctors recognize him immediately. One of the doctors addresses him in Spanish, jokingly asking what he's doing back here already. Evidently, this man was discharged this afternoon. While Terlouw briefs the physicians and fills out a pile of forms inside the hospital, Delao removes all materials that touched the patient -- gurney covers, pillow covers -- and disposes of them.
Delao confesses that he is starting to feel very tired. "We're one of the busiest stations. The other busy areas are Normal Heights, Sports Arena, and Station 26 at Krenning and 54th. Those are usually the hardest hit. They can average 8 to 14 calls in a 24-hour period. And each call usually runs from an hour to an hour and a half. You get to the scene, take the patient to the hospital, restock the ambulance, do all the paperwork, and get back to the station." To emphasize his point, Delao goes back to the computer in the ambulance's cab and punches in a code to bring up a display of all relevant information on the call he just completed. "This call came in at 21:03, we responded at 21:06, we arrived on the scene at 21:11. We departed the scene at 21:27, so we were only there about 20 minutes. It took another 8 minutes to get here, as we arrived at 21:34. We'll spend another 10 to 15 minutes here, finishing paperwork, so that's about an hour. And this was a mundane, low-key, run-of-the-mill, everyday call. Things like New Year's Eve, holidays, Super Bowl days -- things like that we always have a higher level of activity. Full moons affect it, and so do paydays."
Triage -- sorting patients according to need -- is critical to the efficiency of the paramedics. "They'll page us and say, 'Twelve, you got a call.' We'll get in the ambulance and head out. We don't know what the call is for yet, because they'll say [on the radio] it's still in triage. So they're continuing to define -- to upgrade or downgrade the call as we are going to the scene. They want to minimize the down time by getting an ambulance going to the call as soon as possible. They know that someone accessed 911 because he or she needed help, and that's what we're here for. When we get to the scene, dispatch has triaged it to whatever level call it is, and we're there to render assistance."
The ambulance computer provides a wealth of information for all the drivers in the system. Another entry provides a list of every ambulance unit in the city by numerical code, and next to each unit is a status designation. The designations read, "In Quarters," "At Hospital," "En Route," "Dispatched," "Departing Scene," "At Scene," "Available," or "Out of Service." Delao explains why one particular ambulance, Medic 3, is special. "That ambulance is designated for the airport. We have a contract with the port authority that even though it's listed as a medic unit, it doesn't leave the airport. After the airport closes, it's available for areas around the airport.
"Because our unit, 12, is one of the busiest, some paramedics don't like to work here -- because it's so busy. Today we had a fairly easy day, eight calls. But a lot of times when you get back-to-back calls over and over again, you're up until 3:00 in the morning, you get an hour's sleep, you wake up, go home, and you have to go to sleep again." Delao's pager begins to beep. "We've got another call." It's 9:56.
Terlouw comes out of the hospital and jumps in the ambulance. After checking the computer screen, Delao says it's a Level I call. "A diabetic problem." This time, we will be going outside of Station 12's designated area, as no other ambulances are available. We drive east on Skyline Drive as more information comes in. A 62-year-old male is unconscious. Once again, the cars do not respond to our lights and sirens and block the road. The patient's house is on a small street in the Lomita area, overlooking Spring Valley. The street is lined with well-kept, modest-looking one-story houses. We arrive at 10:10. We are met by two paramedics from the San Miguel Fire Department.
As we enter the house, a late-middle-aged woman is standing over the head of a sofa where her older-looking husband lies, barely conscious. His eyes are open, and his arms have a slight shake. Their daughter, who appears to be in her early 20s, stands near the hall at the foot of the sofa. We find out the man is a woodworker; the house is overcrowded with his hand-crafted furnishings. Delao and Terlouw ask questions, which the wife answers confidently. She affirms that he is diabetic but doesn't know when he last checked his blood sugar or injected insulin.
The first sign of life comes when the man's finger is poked for a blood test -- he groans. As they discuss his medications and medical history, a Chihuahua barks in the hallway. After determining that his blood sugar is dangerously low, they start him on an IV. As Terlouw starts the IV, the man slowly regains his consciousness while she tells him what she's doing. She asks him what month it is, and he is alert enough to answer correctly. After inserting the IV, Terlouw pulls out a large plastic hypodermic; she injects dextrose directly into the IV line. When she injects him, the man begins to yell with pain. When Terlouw explains that he's getting a sugar injection, he loudly objects, "I'm a diabetic, for Christ's sake! What the hell are you doing, giving me sugar?"