One Night in a Reno Parking Lot

One Night In a Reno Parking Lot

The tale of an  ignored hero

Except for occurring in the middle of the night, this call was relatively easy for my partner and me.  Some are.  Then there are those calls that are ugly and terrible and end or alter people's lives forever.  

Another type of call we see all too often is the one for people who have been ill for years with real medical problems and the only new problem is their medicines have run out.  Although this is not an emergency, they call 911 because when they arrive at the ER by ambulance Medicare pays for the medicines, the  ambulance , and the ER charges.  A lot of people do this.

Because there is no one to drive them, or because they don’t have any money for a taxi or Lyft or Uber, they call 911 and say they need the Paramedics because they are having trouble breathing.  What they don’t say is they have had trouble breathing for many years.  Essentially, what they are doing is taking a very expensive taxi to get a free refill of their medicines.  This ties up a Paramedic ambulance and wastes a lot of money.  This time, however, the trouble breathing emergency was real.

After our CODE THREE, lights and sirens response, we arrived at a parking lot filled with scared people, Firefighters, and Police Officers.  Because it was so cold, the exhaust coming from all the still running emergency response vehicles was joining the fog and hanging in the night air like small, white clouds.  The headlights and flashing emergency lights from those vehicles were reflected within those clouds and the fog thereby amplifying their colors and brightness and producing an eerie panorama.  This type of eerie setting with unknown medical problems could be very scary for a lot of people.  

Some of those standing in the parking lot had their heads bent forward and downward.  They were coughing and gagging loudly into both their hands as they held them in front of their faces, covering their nose and mouth with their fingers pointing upward like an upside down “V.”

 Again, the night was so cold, their breath was visible in those flashing lights as it was forcefully coughed out.  This added silhouetted puffs of clouds around their hands, faces and heads.  All together, it looked like a night movie set for the filming of a scary movie.

The parking lot was at a local UPS processing center.  The night shift was working with their normal load of boxes, and for some reason one of those boxes fell from the conveyor belt and hit the floor.  The sound of breaking glass drew everyone’s attention.  Immediately, a lot of the workers began to have problems with irritated throats and painful breathing.  Then came the panic.  To a person, everyone at the same time ran to the one and only exit.  In the chaos of the resulting stampede it was astonishing, and probably no small miracle,  no one was trampled.

The Police and Firefighters in the parking lot were also being affected.  I could see their frustration from just standing by while all the people were suffering.  They seemed lost.  Firefighters don’t like not jumping in and helping, and tonight there was no way for them to know how to help.

The co-workers who were not coughing or gagging also looked worried and concerned.  How could they not be thinking that they too would soon become affected and have their own problems breathing?  On that One Night In a Reno Parking Lot it was a very scary time.

As I stepped out of the ambulance from the driver’s side, the Fire Chief was at the door almost before my feet hit the ground.  In a calm but tense voice he said, “I’ve separated all the casualties into two groups, those injured and those who are not.  The uninjured are isolated over there near the Straw Hat Pizza facility and everyone who is sick is over there,” turning his head as he pointed at the group of fifteen to his left almost directly in front of the ambulance.

Everything was already under control.  The Chief had already done it all, almost.  The injuries had yet to be evaluated medically, but the emergency itself had been contained in a most professional way.  The Chief had already done all the things that needed to be done in a setting of multiple casualties.  He was a natural.  This man was the hero of this mass casualty situation.

What the Chief had done was called, “Triage,” and it is the first and most important thing that must be done to manage a situation involving so many injured people.  All that was left for me to do was to diagnose the medical problem(s) and then to notify the staff at the ER what was about to arrive at their door.  In the next five to ten minutes, I was to send fifteen sick people with unknown medical problems to the Washoe County Medical Center Emergency Department and they had to have a chance to prepare for them.

There were people always on-call for events like this, but they had to be notified they were going to be needed.  Also, there had to be justification for them to be called and paid.  For the ER to do this, there had to be an official declaration of a “Mass Casualty Situation.”  That’s where I entered the picture.

While the Chief was the scene “Incident Response Manager,” and in that capacity was in charge of everything non-medical, I was the scene “Medical Response Manager,” and responsible for the medical aspects of the event.  It was on me to justify and declare the medical mass casualty situation and I knew I would ultimately be the only one accountable for that decision.  Many people were about to have their night altered drastically as an entire hospital went on maximum effort.  That’s a big thing to happen at a huge cost.  I took a deep breath and to myself whispered out loud “Okay” and grabbed the radio mic.

“Washoe County, this is Lanny with AIDs ambulance service.  I am officially declaring a mass casualty situation and invoking the mass casualty protocols for Washoe County.  This is not a joke.  This is not a drill.  Let me know when you are ready for a report,” and with that, I waited for their response.  I knew they had to get someone in charge to speak with me.  The usual staff nurse would not be authorized to accept this communication, that’s why I had not immediately begun my report.  

“Hi Lanny” she said, “What do you have?”  I gave a quick summary of the situation and informed her that we really did not know what we were dealing with.  Then I said, “What are your questions?”  

She came back, “How many patients are there?”

I replied, “Fifteen.”

“What are their medical problems?” she continued.

“It’s all respiratory.  Everyone is having trouble breathing.  You are going to need a lot of Oxygen.  They all inhaled some kind of irritant,” I responded.

“Okay,” she responded, “when will you send them?”

I replied, “The first six, the ones most affected with breathing problems are already on the way.  They will arrive in about five minutes or less.”

She answered, “We’ll be ready.”  That was it.

Before I had initiated the communication, I had called out loudly over the night parking lot, “who thinks they need to go to the hospital first?  Don’t be shy, we don’t know what we’re dealing with here.”  That is when the first six came forward.

Immediately, and without me having to ask, the EMTs from my co-responding EMT ambulance took them in charge and loaded all six into the back of their ambulance.  One EMT entered the back with them and I handed her an extra Oxygen tank from my Paramedic ambulance with a mask and tubing.  She now had two complete Oxygen treatment systems and the patients could take turns breathing pure Oxygen on the way to the ER.  The other EMT jumped into the driver’s seat and started a CODE THREE, lights and siren, emergency transport to the ER.  The first six were on their way.  Only nine more to go.

I had to keep my Paramedic, Advanced Life Support ambulance with me.  It held all the things I might need in case the condition of anyone who was still here became worse.  Dispatch had been following what was happening and had already dispatched another Paramedic ambulance.  They arrived seconds after the first ambulance had left.  It was great teamwork.

We loaded the next five worst and and the Paramedic jumped in the back with them and his EMT partner drove them CODE THREE, lights and sirens, to the ER.  The second wave was on the way.

There were now only four patients remaining and they were for us, my partner and me.  I thanked the Chief for everything he had done and we left the scene with me driving to the ER at normal speed.  The EMT was riding in the back with our four.  Because they were all well controlled, I was able to do the driving while my partner attended our patients.

By the time my partner and I arrived at the ER, it was about as busy as I had ever seen it.  All the rooms were filled and there were gurneys with patients on them in the entrance way, the lobby, and the hallways.  The ER had already been busy with their usual patient load, and having to care for fifteen more all at one time was taking a herculean effort.

The patients were finally diagnosed with the inhalation of some kind of pesticide resulting in burns to their windpipes and possible systemic poisoning.  We had been able to get everyone to the ER successfully before anyone’s windpipe had swollen shut or they went into anaphylactic shock .  It was a good ending to a call that could have been far worse.  Over time, everyone turned out to be fine.  Teamwork and that incredible Chief at the scene had controlled this emergency.  That was it.  My partner and I cleaned the rig and got ready for the next one.  It was almost two AM and we still had over six hours of our shift remaining.

I hadn’t given this call another thought (after all, it was just another call) until a letter arrived from the Assistant Medical Director of Washoe County, Nevada.  I am including a copy of it because of the irony of receiving a letter of recognition for a call where another person had really been the hero.

In my years as a Paramedic, there had been many emergency situations that I had managed that seemed much more “laudable” than this one, and yet, there had been no recognition at all.  Firefighter Paramedics and EMTs received public recognition fairly often,  but it seemed  that the heroics of private ambulance company Paramedics and EMTs went unnoticed.  I never knew why this was the case, but it was.  So, to have received a letter of recognition for this call, where the Chief had been the real hero before I even arrived, was very unfulfilling and almost embarrassing.  I’ve attached a copy of that letter to this story.  Notice how I was undersivadly given the credit for triaging the patients.  

I never told the Chief about the letter.  I wish I had.  I should have.

Henry Lansing Woodward

Paramedic