Paramédico

Three paramedics from a Basic Life Support (BLS) ambulance arrive. They too comment on how lucky it is the Mercedes escaped damage. Two of them help with patient care, while the third, a stern-looking African man with spectacles on the end of his nose and epaulettes studded with shiny stars, stands to one side and starts a stopwatch hanging round his neck.

The Leopard looks over at me and rolls his eyes. ‘What did I tell you? Five minutes, let’s go!’ Maybe The Leopard is burnt out but tonight he’s playing the game. We’re being timed like athletes, timed by a stoney-faced supervisor with a digital stopwatch. Crazy.

Medics from the ambulance drag over a flat spine-board onto which we lay some pelvic sheeting. Once the patient is rolled over, we use this to stabilise him from the waist down, wrapped and clamped. Any unnecessary movement in pelvic fractures, even multiple examinations springing the iliac crests, increases internal bleeding and risk of death.

‘One, two, three, lift!’ The stretcher legs lock down and the trolley is wheeled to the ambulance. As the supervisor gets in the front seat he glances over at us and laughs.

‘Hey Rucker, four minutes, thirty-three. Close shave!’

The Leopard grunts and lights a cigarette.

From Netcare’s depot at Milpark we watch a retrieval helicopter descend onto a landing pad at the doorstep of the company’s very own fully equipped trauma hospital.

‘Heard it on the radio,’ The Leopard tells me. ‘Some lion safari gone wrong, a 4x4 rollover.’

Running parallel to public medical services, Netcare has fifty-three private hospitals like this throughout South Africa and Swaziland. Milpark alone employs some of the country’s brightest doctors, offering every imaginable specialty and a staggering ninety intensive care beds. For those who can afford private health cover the company has become South Africa’s provider of choice. But as an act of goodwill to the poorer people of South Africa, Netcare offers its ambulance services free to those who earn below a certain income threshold. Nowadays, the vast majority of emergency calls are made by non-subscribers. These patients are, however, always conveyed to public hospitals. Although it is currently common practice in South Africa to dial 911 – Netcare’s clever exploitation of the widely known US emergency number – bystanders will also ring the government’s metro ambulance service at the same time. In a crisis people will take whatever ambulance comes first.

As a consequence, driving to emergencies has become a frantic race between the public and private services. This ‘healthy competition’ has only improved response times in Johannesburg, according to Netcare medics. Relationships between crews from both systems generally remain harmonious despite this challenge. Stress comes instead from pressure placed on them by management to reach the scene first in order to uphold the service’s image as the quickest.

While good for the public, it’s a dangerous game for medics. In 2002, nineteen ambulances were written-off in the city of Johannesburg, mostly by Metro Ambulance Service drivers. Netcare are not so worried. Official figures show their average response times are five minutes faster than the government service.

‘Sometimes on the way to hospital with the patient we pass the Metro ambulance still heading to the scene,’ chuckles The Leopard. ‘We always give a little wave, of course.’

As we prowl for work in those raw, bloodstained streets of central Johannesburg, I have become The Leopard’s cub, learning to hunt with the master.

‘Are you ever afraid?’ I ask him. Stories of gun battles with drug gangs, resuscitations at knifepoint and snipers taking shots at reflective vests have kept me on the edge of my seat all night.

‘Ja, sure I get afraid.’

‘Of what?’

‘HIV.’

It isn’t what I expected him to say.

‘Average sixty people are shot every day here, ten thousand people die on the roads each year, 90 per cent of our calls are trauma, but HIV is the leading cause of death. At least 20 per cent of sub-Saharan Africa is HIV positive. Just do the math. If you consider 90 per cent of our work is trauma with active bleeding and 20 per cent of these patients are HIV positive, you will understand what we’re really afraid of. Get blood on you in Australia, England, America and you don’t sweat much. Get blood on you here and you don’t sleep till the results come back.’

The Leopard plans to enrol in a paramedic research degree, a doctorate perhaps. ‘I need to get off the road. I have children now, they live with my wife but I want to see more of them. You know, I have a responsibility to them, a responsibility to stay alive.’

The streets of Johannesburg seem eons away from the immense beauty of South Africa’s wilderness. The contrast is extreme. But then, some of the most stunning places in the world have a dark underbelly, a place shared by the poor, the sad, the criminal, the beggar, the victim and the paramedic.

‘Zero zero three?’

Reluctantly The Leopard picks up the handset and replies. Our lights and siren ignite the dark road ahead.

‘It’s not a bad neighbourhood, this,’ says The Leopard. ‘We’re less than a kilometre from Hillbrow, I have a drink here sometimes, you know, during the daytime.’

But descending a steep hill we are first on the scene of a chaos like none I’ve encountered.

From what I can make out, a fully laden semitrailer lost control, veered to the opposite side of the road, crushed five cars and continued on to plough through a restaurant packed with diners, finally coming to rest deep within the building.

The carnage is widespread and horrific.

Bodies lie everywhere. Cries and screams and groans puncture the air. Hands pull us this way and that. I’m dizzy and cannot focus on any one patient, there are so many, perhaps twenty, perhaps more. Where do we start? Triage, triage. My French comes back to me. We need to sort them, make sense of it, get perspective.

The Leopard is so cool it shames me. He strides through the devastation like a war-hardened general, calmly slipping his hands into latex gloves. He takes no gear, no oxygen kit, no medicine, no bandages. Just the man and his portable radio. One at a time he stoops down to check the breathing and circulation of those lying motionless. Effortlessly he elicits responses from those who are conscious and checks the smashed vehicles and the truck for occupants. As I follow behind him, I finally hear him speak into his handset, his voice steady and commanding, his report plain and precise.

‘MVA, truck versus restaurant, no persons trapped, four dead, sixteen patients on the ground, unknown number of walking wounded, need fire brigade and as many ambulances you’ve got handy.’

The Leopard grabs my shoulder and points to a man lying near a car that looks like it’s been through a wrecking yard. ‘Start with that guy, he’s not well. I’m going to delegate the back-up as it comes.’

From the responder I get our gear and race back, stepping over the bodies of those beyond help.

‘He can’t feel his legs,’ cries the man’s wife, crouching beside him. ‘He can’t feel them!’

I ask her name. It’s Melanie. She tells me the patient is Martin. Today is their wedding anniversary and he took her for dinner, alfresco, with candles.

‘Listen,’ I grab her attention. ‘Melanie, you’ve got to help me now. Here, take Martin’s head and don’t let it move. Keep talking to him. Stay calm because you need to keep him calm. We’ve got a job to do and we’ll do the job together.’

After fitting the oxygen mask, I mould a hard collar round Martin’s neck and begin a head-to-toe examination. His breathing is rapid and shallow. I place my stethoscope in his armpits and listen. Limited air entry on the right, I’m certain of it. There is movement and crepitus, a popping sound and grating of crushed ribs when I palpate the chest wall. I suspect a collapsed lung. It may be tensioning, in which case an immediate procedure to release the pressure with a needle is required. As I break out in a sweat at the prospect of doing this, a Netcare ambulance team with a senior paramedic join me and begin cannulating and getting ready to board the patient. They will decompress the man’s chest once loaded up, the medic tells me. They work at lightning speed and I wonder if another supervisor is standing somewhere in the shadows holding a stopwatch.

Medics are swarming all over the site now. Metro EMS, Netcare 911, even ER24, a company I’ve not yet come across. Suddenly The Leopard is behind me, leaning in.

‘Boet,’ he says in Afrikaans, meaning ‘brother’. ‘We got to go, we got a gunshot to the head just round the corner, they got no one for it.’

I’m stunned. Broken glass crunches and mixes with blood underfoot as I carry the responder kit back to the car. It’s an awkward response in tragic times, but as I get into the front seat I begin to laugh. I laugh at the sheer absurdity of leaving the biggest accident of my career to attend a shooting. I laugh because it has taken me less than twenty-four hours to reach this point, this point where a paramedic’s work in Johannesburg is encapsulated entirely by a single, staggering moment of madness.

And the night is but young.

SHEIK, RATTLE AND ROLL

England

On the rain-drenched morning Henry takes the wheel I am secretly relieved the old man we are carting from one sad nursing home to another is afflicted by a state of dementia so advanced he is seemingly oblivious to our existence and stares silently ahead into a land beyond. Normally I wouldn’t wish the illness on my worst enemy. But as Henry pushes the siren and races down Herne Hill towards Brixton at the speed of a Grand Prix driver on amphetamines, it’s a good thing our patient – someone’s dear grandpa – is numb to it all. The old man bounces around like a leg of ham in a delivery van. In fact, groceries and daily mail probably get better rides than this in London.

Approaching the intersection of Milkwood Road and Half Moon Lane is where we have the fourth near miss of the day. A car appears from nowhere, as Henry puts it afterwards, making it sound like a supernatural phenomenon beyond human comprehension. While hurtling through the red signal without slowing I assume this apparition has approached from the right, but I see nothing at all as I’m riding in the back clutching a crossbar with one hand and the patient’s shoulder with the other. When Henry plants his generous weight on the brakes I’m only half ready for it. Equipment flies into the front cabin, some of it catching me while passing. Airborne oxygen masks and kidney dishes are the least of my concerns. Our old man, drooling and wide-eyed, has long lost the instinct to hold onto the stretcher rails and our extreme deceleration threatens to catapult him through the windscreen. I have little choice but to throw myself on top of the patient, his brittle bones digging into me as I pin him to the mattress with my body. A sound of screeching tyres and angry horns is followed by the choking smoke of burning rubber pumping into the back of the wagon.

‘You all right, geezer?’ Henry asks once he has pulled over past the intersection, his face pale and puffing.

‘Think so,’ I say in a neutral tone, until it occurs to me how pissed-off I really am and I add, ‘Why the urgency anyway, mate? We’re going to a bloody nursing home.’

‘He should ’ave seen me comin’, tha bastard.’

But Henry has only himself to blame and he knows it. Lights and sirens are merely a request for people to give way, not a demand.

Henry’s hands are trembling as he collects the bits and pieces littering the front cabin. Though he seems shaken, I know he will do it again, maybe even today. Like a poker machine that eventually pays out, we’re long overdue for a prang. And if eventually he kills a man, or more than one, I want nothing to do with it.

Got to quit, got to quit, got to quit.