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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
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Nailed it! First person works! Th only thing is try not to get too technical. I would leave out the information re: Medicare and please look at last paragragh-undeservedly(sp). I can't wait to see your book in print. For those of us who are a bit more vintage, the TV show EMERGENCY! comes to mind. and thank you for saying that people use ambulances for free transportation! Good call! Looking forward to the third chapter!
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Hi again,
Thank you once again for the nice review. The book is out. You may find it at thepoetschoice.com or Amazon, I think.
Since you have been "Looking forward," to another chapter, here it is...
The Tenth Call
6:35 pm
The Dutiful Nevada Housewife
We had just discharged our last patient, a man with a shotgun wound, and were still
parked in the ambulance parking area in front of the double doors leading into the
emergency room. After each transport (not all dispatches result in a patient or a transport
of a patient), there is always some cleaning and restocking.
Besides re-stocking, the four things always needing to be done were to wipe down the
gurney, change the linens, wipe all surfaces and mop the floor. Always.
On most calls, it was usually as minimal as that. On others, it could be a major
cleaning involving the walls, floors, gurney, equipment, ceiling, cabinet doors, and
passenger bench. In other words, everything. After the call we had just completed, the floor needed special attention, specifically, the corners where the floor meets the walls.
Our patient had injured himself critically by shooting himself with his shotgun.
Despite two tourniquets, pressure dressings, and tight wrappings, a lot of venous and
arterial blood was still escaping. There was also leakage of intracellular fluids from all the
individual cells which had been blown apart or open. This wound was too large to stop
all the bleeding. It involved the loss of the entire front or top part of the left leg, from the
groin to the knee.
The man no longer had the top front part of his left upper leg. Most of it was still back
in his house on the floor. That is, of course, except for the tissue fragments and the liquids,
which were now on our patient compartment floor.
The patient's condition required a lights and sirens transport from the incident scene
to the emergency room. There was no time to spare. This man needed many infusions of
whole blood.
Because of our emergency transport to the ER, the rocking and tilting of the
ambulance spread the tissue fragments and liquids all over the floor. This caused the
small pieces of tissue and bone within it to collect in the wall/floor corner junctions.
These areas were difficult to clean correctly, but there was no other option. It had to
be done to sterilize the junction area. The removal of the solid materials prevented any
bacteria from growing, thus preventing the unwanted smells of rotting human tissue.
I was applying the “toothbrush method” with alcohol to clean the corners when a car
pulled up right behind the open double rear doors of the patient compartment. The
gurney was still outside and was now between those doors and the car. We hadn’t yet slid
it back into the patient compartment because I was still cleaning the corners.
A woman was driving the car, and an older man was slumped forward in the front
passenger seat. Slumping is not a good sign, especially for an older man. But we’ll get
back to that.
After the dispatch had come in for this GSW, we responded with lights and sirens to
a small, older house. When we pulled up, the front door was closed, and no one was in
sight. No one at all. Paramedics know it is not good to be the first to arrive at a call that
involves a gun. The police must first secure the scene and then allow us to enter. That is
the standard operating procedure, and there were no police.
We contacted dispatch and were told they would arrive in about five minutes. We
were also told they were talking with the caller and that entering was safe. The emergency
was an accidentally self-inflicted wound, and the gun was empty. The guy was alone in
the house, and the front door, although closed, was unlocked.
It’s not that I didn’t trust the dispatchers in the Emergency Call Center. They could
only act on the information they received. However, there were many times when there
was a big difference between their information and what we found upon arriving at any
emergency.
Anyway, the Police rolled up as my partner and I were discussing whether or not we
should enter the house. With their hands on their weapons, they slowly opened the front
door, looked in, stepped in, then looked back out at us and waved toward us to enter.
The small older house was built many years ago and still had the original linoleum on
the floor. The living room was furnished as any small living room probably would have
been, with one exception. A folding card table was in the middle of the room, and it
was covered with gun-cleaning supplies. One folding metal chair was tipped backward
and resting in a large pool of blood. A huge pool of blood.
As I entered the front room, I saw a broad streak of smeared blood on that original
linoleum floor. It was a straight line trailing away from the huge pool of blood. It almost
looked like someone had done a long, narrow, red finger painting. Mixed into that finger
painting-like smeared blood were small pieces of fabric and chunks of human tissue.
The tissue chunks included red muscle pieces, white skin, yellow fat, and ivory-white
bone. Not big pieces, all of them were shavings and small chips. At the same time came
the smell of gunpowder hanging in the air.
The finger painting-like smear of blood stretched to and through a door on the far
side of the room about ten feet from the table. It went directly into the kitchen another
eight to ten feet and ended at a guy sitting on the floor and talking on the phone. He had
somehow managed to drag himself almost twenty feet to the nearest phone.
There was so much blood on the linoleum between the pool and the streak he should
not have been alive, let alone conscious and talking intelligently. He was sitting upright
on the floor with his back against some drawers to the left of the sink, and he had a faded
yellow phone receiver in his hand.
It was part of one of those old-style wall phones designed so the receiver could rest in
the cradle over the dialing wheel when it wasn't in use. The cord was one of those long
curly cords, also a faded yellow, almost touching the floor when the handpiece was in the
cradle. It was mounted on the kitchen wall about five feet above the linoleum floor to the
left of the sink. How this guy reached it is a mystery I’ll carry forever.
It must have been the closest, if not the only, phone in the house, and to say this guy
needed a phone would be one of the greatest understatements of the year. He had been
sitting in that tipped-over, folding metal chair cleaning his “unloaded” shotgun, and then
“Bang!” Because he had been sitting with his legs bent at the knees, all the damage was
to the top surface of his leg, and that damage was devastating. He was missing the top of
his upper left leg from the groin to the knee.
Little pieces of bone in the blood that had come from the top of the Femur were mixed
in with skin, muscle tissue and a lot of blood. His leg had sustained incredible damage.
The only reason he was still alive was due primarily to the engineering of the arterial
circulatory system of the human body.
When arteries are severed by a blast like the one produced by this guy’s shotgun or by
a crushing or tearing injury, they automatically pucker, or constrict, to close themselves.
It’s an ingenious and sophisticated method of stopping blood from squirting from the
high-pressure arteries. Only the arteries do this.
Blood escaping from the low-pressure veins flows much slower and is less life-
threatening. I have no doubt the Master Medical Engineer designed this incredible ability
of the arteries.
However, even with his arteries “puckered,” he still had lost so much blood he was in
critical condition, perhaps extremely critical. After rapidly applying a tourniquet and
some pressure dressings, we put him on the gurney and rolled him to the ambulance.
We had decided to do the rest of his care on the way to the ER as we drove lights and
sirens. That included starting two fluid-replacing IVs, some more pressure dressings, and
applying high-flow oxygen. A lot of time was saved by doing this, and this man’s time was
running out, just like his blood. We arrived at the emergency room in time for him to
survive his blood loss.
So there I was at the emergency room doors. I was on my hands and knees cleaning
the floor corners using that toothbrush method. During the transport, our patient’s blood
and pieces of tissue were spread around the floor and gathered in the corners. My partner
was inside getting replacements for the supplies we used.
Without warning, that car I previously mentioned pulled up to the ambulance's open
rear doors, with the older man slumped over in the right front passenger seat. Again,
slumping is not good for an older man. I stopped what I was doing, got out of the
ambulance, walked to the car, and looked in.
The man’s face was blue, and he was not breathing. I turned and ran to the emergency
room doors, pushed one of them open, and yelled, “Cardiac arrest in the parking lot!”
Immediately, all the right things began to happen. In an instant, the Cardiac Team
came out with a gurney and pulled the man out of the car.
As they laid him onto it, two members of the team, one on each side, stood on the
bottom rails, so they were riding along with the gurney. One began CPR, and the other
began rescue breathing. At the same time, two other people, one at the head and the other at the foot, began rolling the gurney with the old man and the two attendants into the ER.
As it moved, the two riders on each side of the gurney continued CPR and rescue
breathing. It was all done very quickly and efficiently.
The man’s wife remained outside with me. She was telling me what happened, and it
seemed important for her to tell me her story and that I should listen to her. She even
delayed going inside to be with her husband to talk with me. Usually, you can’t pry the
family away from their loved one(s) in an emergency. But here she was, talking to me.
Strange, very strange indeed.
Earlier, her husband had admitted he wasn’t feeling well. She said this was a big
admission for this self-reliant and stubborn Nevada pioneer.
“He never complained,” she said. “Never. He did what he felt needed to be done his
whole life, even when I could see he shouldn’t be doing it.”
“He would say,” she continued, “It has to get done, Ma. Who else is going to do it?”
Then she added, “There was no use arguing with him.”
“For the fifty-seven years we were married, he would never give in. He would never
let me or any of the kids have our ways. It was always his way. Today I was surprised
when he admitted he wasn’t feeling well. He didn’t ever do something like that.”
I couldn’t help noticing she was referring to her husband and their marriage as in the
past and showing no sadness.
She had suggested calling 911 to send an ambulance, but he would have none of it,
and that was it. He had made his decision. Once again, things were going to be done his
way.
“Drive me in the car, Ma. I’ll be fine. Just don’t drive too fast like you usually do,”
she said he had told her.
“All our lives,” she continued, “we always had to do things his way. So, I did. That
way, I would be sure not to cause “the stubborn bastard” (her words) any discomfort. I
drove really slow. Really slow.”
There was a double meaning in her tone. The hospital was only about ten minutes
from their house. Not too far. I knew this because she had told me where they lived. I
also knew three traffic lights were between their house and the ER, and it was dinner time
rush hour.
So, she was driving slowly and carefully and watching the traffic. Somehow she had
managed to stop at all three lights, turning a ten-minute drive into twenty.
“At the third stoplight,” she said, “he fell asleep. I knew he was probably gone.”
During their whole marriage, she had faithfully kept her wedding vows of loyalty and
duty to her husband. On the final day of his life, she had once again completed the task
he had told her to do. Slowly and dutifully, she had driven “that stubborn bastard” (her
words) to his death.
I felt confident she knew what was happening to her husband for the entire drive. I
was also sure she knew that I knew what she was implying. It was as if she wanted me to
know.
While we were talking, a nurse came out and asked her to come inside with her. She
needed to register her husband. And, that was it.
My partner and I finished cleaning and restocking the ambulance and drove back to
the station. I didn’t say anything to him about the conversation with the wife. I
considered it private and was perfectly content to keep it between her and me. I felt
honored she chose me to hear her story.
The patient with the shotgun blast to his leg needed multiple blood transfusions, and
his leg was amputated just below the hip.
The stubborn bastard in the right front seat could not be saved.
This is the first time I have told this story.
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that was an amazing, loving, romantic story of a long married couple. You're right, it was her private words to a person that she felt would listen to her. I'm glad you felt privileged to hear it. I was an ER nurse and I remember one day, an older man was brought into the trauma slot (where all cardiac arrests were brought). We tried to revive him but had no luck. As nurses, we have to do postmortem care. I was the RN assigned. As I was preparing him to go to his rest, I noticed he was dressed to the nines. He had on a black dress suit, black tie, starched collar shirt and his shoes were spit shined. He was very dapper, I do not believe he had on his work suit, I believe he dressed himself in his funeral suit, some patients just know. I am a firm believer in death with dignity and that the last thing to leave a patient is their hearing. I spoke to him and apologized that we had to cut his shirt, but the rest of his suit was okay, just a bit wrinkled. I told him I was going to wash his face and wrap him in a blanket because he was cold. He would be clean when his wife came in to see him for the last time. She seemed appreciative of the respect we showed. As hard as the job is : sometimes we are lucky to be abe to be a part of the most personal and loving action humans have to go through. Bereavement is different for everyone, and your story tells of a successful transition and how much love the wife felt for her husband and the relief she had being able to tell someone.
Sorry, it took so long to read your amazing chapter 3 ; life got in the way of reading and writing. Congratulations on you published novel! Well deserved!
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After enjoying Casino Patient, I dug into this one. You have a book in you, and with the popularity of responder shows (Chicago Fire and 911 are two of my favorites), I think folks would love to read it. I once produced a recruitment video on a rural service that saved a young girl with congenital heart problems — EMTs public or private are to me the indisputable heroes of community emergency response, and need the public to see why funding, support, and cooperation are so crucial.
Like Joseph Wambaugh, you tell a suspenseful real-life story that reads like terrific fiction. Incredibly nice job, and the kicker is touching and powerful. Thanks!
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Nice submission! You have super great narrative skills! Your character felt very genuine, which is hard to obtain a lot of the time. Super interesting story too!
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Hi,
I know it has been quite a while, but I want to thank you for your review of my story. You are very kind. Henry
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Hi, I did not know you had sent me a message until today. Please send me your story. I would like to read it again. HLW.
mazatlannywood@gmail.com.
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Thank you for your review and kind words. I did not know you had reviewed my story until today. All the characters were genuine. I was the Paramedic. This is a true story. If you want more true stories, please email me. mazatlannywood@gmail.com
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