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Across from Lincoln High School, San Diego Fire Station 12 has three fire trucks and an ambulance. Although all firefighters are trained medical assistants (most are paramedics), the ambulance crew is the most critical life-saving link between the victim and the hospital.

Chuck Delao and Janet Terlouw have worked as partners on the Station 12 ambulance ("Medic 12") for about a month. It's one of the busiest ambulance units in the city. Next month, they'll change partners again. Both are experienced paramedics and work 24-hour shifts on the ambulance. Delao, 43, has been with the department for ten months. "I worked at the Sycuan Fire Department for two years. Before that, I was in the city of Indio." His current job requires long hours. "We've worked ten shifts this month. You work 24 hours, then you're off 24 hours. You do that four times, then you get four days off; then you do it another four times, and you get six days off." Terlouw, 32, has been with the department since July of 1997.

It's 8:30 p.m. on the first Thursday in December, and they've been on the job since 7:30 this morning. According to Terlouw, the busy hours are consistent but not always predictable. "The last few days have been very busy during the daytime and slowed down at night, but on Friday and Saturday nights -- any night of the week can be busy; it doesn't have to be a weekend night. But lately it's been very busy during the day and slower at night, but this is before the flu season hits. During the flu season it's busy all day, every day."

At 9:05, Delao and Terlouw's pagers go off, and they head for the ambulance without saying a word. As we board the ambulance, Delao explains the computer display that sits between the seats. "Somebody called 911. When a caller calls our dispatch center, he will be asked a series of questions to determine the acuity of the call or the type of call." He points to the information on the screen, which includes a description of the patient (a 39-year-old male) and the address. "This one fit the unconscious/fainting category. Does that mean the person is unconscious? No. It just means that the questions they've asked through the triage process have determined that category." A voice on the radio calls out for an engine to respond. Delao turns on the lights and sirens but drives just over the speed limit. Terlouw, holding a Thomas Brothers map, navigates him through the streets. "Head north on 47th to Market, turn left and go to 41st Street. It's on 41st between F and Market." As we approach intersections with red lights, Delao stops before crossing. Cars remain in front of us, in spite of the siren. Delao explains, "Many of these drivers just don't know what to do. Safety is our biggest concern, and there's really no need to drive recklessly. Anyway, we have different levels of calls -- a Level I, which is an ambulance, an engine, lights, and sirens Code 3. A Level II call is just an ambulance, lights, and sirens Code 3. Then we have a Level III call, which is just an ambulance at its own leisurely pace. This is a Level I call."

We arrive at the house at 9:11. The engine has arrived before us, and several neighbors are standing out on the sidewalk to watch. This is a poor neighborhood, with small, one-story houses. Delao opens the side of the ambulance and pulls items out of a compartment. "The engine company responds with a captain and some EMT firefighters. We always bring in a heart monitor, an airway bag, and the drug box." There are already four firefighters in the house.

We enter a dark house with religious artwork on the walls. The patient is a young, long-haired Hispanic man who speaks no English. He lies shirtless on his bed with his wife standing by as they monitor his breathing and check vital signs while questioning him in Spanish. He is surrounded by firemen, all doing some task. We are told he has the flu and has already been in the hospital once this week. Delao continues to explain what is happening. "We always try to rule out the most life-threatening types of problems, like heart attacks, strokes. We always hook them up to a monitor, take blood pressure, read oxygen saturation, pulse rate." There are several sensors taped to the patient's abdomen and chest. As Delao reads the printout, he says, "That's an EKG machine, and it's got all the little bumps in the right spots. That's a normal rhythm. We found out that his age is really about 38." His wife tells the paramedics what medications her husband has been taking. He has not responded well to the medications, and she was concerned that he was not talking so she called 911. The patient is given a glucose IV and loaded into the ambulance on a gurney. His wife rides with him in the back on a padded bench.

At 9:27 we leave for Paradise Valley Hospital without the lights and sirens -- that's only for acute-status patients who will die without immediate hospital treatment. Terlouw is in the back administering oxygen and monitoring the patient. According to Delao, this is a typical call. "The majority of the calls we get are chronic problems. They've had something and it's gotten worse, or they don't know what's wrong with them, but it's been an ongoing problem. [They] have a history.

"Communication is really important. Our communication center is known for its triaging -- the sorting of the calls as they come in. The answers to their questions determine how the patient is treated. This guy might have said chest pains or paralysis or hemorrhage. Those buzz words or complaints will trigger a Level I, II, or III call. A broken arm won't get an engine.

"This call was triaged as a Level I call. He called in and said he'd been sick for a couple of days and had chest pains. If that patient went downhill quickly or was dying, my partner and I could not take care of it alone. We'd need more hands, so that's why the engine was there too. And everybody in that man's room was doing something. We have a contract with the city that says that each call will get two paramedics. We at San Diego Fire and Life Safety put a paramedic on each engine, so they would get a 4-minute to 6-minute response time. Then they put a paramedic in the ambulance -- it just so happens that there are two paramedics tonight -- with an 8- to 10-minute response time. So you're guaranteed a paramedic and an advanced level of care within 4 to 6 minutes and another transport within 8 to 12 minutes."

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