Surfing the Chaos.

We get called for a motor vehicle accident (MVA) a few kilometers away on the nearby desert highway. Though we are a company EMS service that exists to provide medical care to our own facilities, we are often called upon to help out the general public. No problem. I like the work.

My Arab partner, AJ, and I both hop on the responding ambulance since it was reported there were multiple patients. AJ gets in the back and I ride up front. Neither of us is driving. Over here, the ambulance drivers are, typically, company workers from other departments who are nearing retirement. They have no medical training, limited usage of English and, other than getting the cot in and out of the unit, aren't very useful to a paramedic on-scene. 

We arrive at the place where two ribbons of asphalt meet in a "T" in the middle of the rocky waste of the desert. A small pickup truck carrying two young men went barreling into the intersection without considering the large lorry that had stopped to make the turn. That is typical of how men drive over here. Just go fast!! The rest is in God's hands!

By the time we arrive, there are at least fifty men all standing around the accident scene, looking, talking to the victims, pulling them out of the car; It's chaos. The front of the pickup is trashed. The driver is sitting in the front seat looking dazed. There's a nice star on the windshield over the steering wheel. Ok, Got it.

The passenger is lying on his back next to the truck. AJ and I can tell that he got out himself and laid down. He's pretty bloody from what looks like a busted nose but it's hard to tell what else. More on that in a bit. AJ and I have to physically push people out of the way to get to our patients. There's no concept of "stand back, the paramedics are here" in this country.

The driver is swiveling his head back and forth and talking to people. I figure he's been there for about 20 minutes before we arrived, he can wait 5 more. (yes, It takes us that long to get there sometimes). I quickly decide to help AJ package the passenger.

Now. My USA readers must understand some key differences here: there is NO rescue squad, no fire engine blocking traffic, no reliable and competent rescue techs briskly deconstructing the wreckage to allow us easy access to the patient. Also, there is no concept of "get out of the way and let the paramedics do their job" either. Everyone who shows up either wants to get close and look or feels they can contribute by grabbing the nearest thing and pulling, pushing, hollering and getting in the way. I get more than a few angry looks as I use my 230 lbs to shove people out of the way between the patient and me.

Oh, police? Yes, the police are there.  Probably the ENTIRE shift has come to the scene and
parked their cars everywhere. Only about half of them have put their lights on. Are they controlling the crowd? No. They are a part of the crowd: equally shoving, pushing, jostling for a look and so on.

Like I said: Chaos.

Back to AJ and I with the passenger: AJ is chattering in Arabic with the patient. I do a rapid trauma assessment and find blood everywhere. Is the patient bleeding everywhere? No. He's wearing a
Thawb. A Thawb (or Thobe) is a long, white garment that is traditional with Arab men. Imagine a white dress shirt that goes all the way to the ankles. They come in many colors but the most common is white and they're almost always made out of finely woven cotton. Which makes them an excellent blood sponge. I'm serious. Get a nick on your wrist and before you know it, your entire sleeve will be red and drippy.

This guy's got a bloody nose, a busted lip and a cut on his elbow. It's making him look like an extra from
Shaun of the Dead. Talk about challenges to patient assessment! Awesome!

AJ and I quickly get this guy collared, boarded and loaded in the ambulance. Now, there's two patients and we're basically the only available ambulance for about 150km. We move the patient from the stretcher to the bench-seat and secure him with the seatbelts. He's maintaining his own airway, able to answer my questions and, since we have no other choice, is left in the ambulance while AJ and I go get the driver.

Yeah, I know. I'm sure some of you who are EMTs and paramedics are shaking your heads and thinking, "Abandoned your patient?" or "The driver should not have been left. He should have been boarded and collared too!"

Yeah, I know, I know, I
know!!! I was thinking the same thing! I had just arrived from the USA and had not yet grown accustomed to being completely unsupported. Yeah, we had about 50 bystanders but they were all medically useless. Even if I had additional resources to call upon, even the most basic of them would have taken 30 -90 minutes to arrive. If a Mass Casualty Incident is one which the number of patients exceeds the capacity of the local EMS to handle, then this was an MCI.

And that's how we do it over here.

So, back to the driver: AJ and I again have to wade through the crowd to get to this guy. Collar on, lay him down onto the board. Slide board onto cot. Re-assess ABCs and we head for the ambulance. The crowd is getting so pushy and curious that we need some isolation to work. We get to the ambulance and I'm astounded to see it
full!! There are about 5-7 Arabs in the ambulance. They're all talking to the passenger, kissing him, touching his head, one or two are weeping and one or two have a look of morbid curiosity on their faces.

Now, I've learned that my size and strange appearance (bald, beardless, big and, dare I say it?, burly) scares most of the Arab men I've met. I use this to my advantage. Out comes the "Sarge" voice and, even though I'm hollering in English, they get the message and clear out of the ambulance pretty quick as I go charging in.

We get the driver into the ambulance and divide our efforts. The passenger speaks a little English. He's mine. AJ discovers that the driver is asking the same questions over and over again and, though he denies losing consciousness, can't remember why he's there or how the heck he got into an ambulance. Both these guys are boarded, collared and can only look at the ceiling of our ambulance but they can hear each other. The driver is worried about the passenger. He keeps asking where he is and reaching out to touch him. The passenger keeps repeating that he's okay over and over again.

Yep! Driver's got him some head trauma!

Neither of these patients were in a hurry to die so, AJ and I didn't have too much of a challenge managing them medically. Our biggest challenge was physics. The driver of our ambulance (remember him?) has gotten so excited by all the drama, blood and people that he's driving the ambulance as if he were being chased by the devil. In all my years of having to deal with over-enthusiastic volunteer firefighter drivers, I've never encountered a ride as chaotic, bumpy, swervy and generally crazy as this!! Even in 35-foot (10 meter) seas in the Bering Sea, I had an easier time.

Keep in mind that, even though each of our patients presented with signs of pretty serious injuries, our treatment plan was constantly being adjusted and re-evaluated based upon priority, safety and the vagaries of the situation. If chaos is a sea, we do our best to surf the swells and keep from capsizing. Really!

Somehow, we managed to start a couple IVs, get some vitals, assess the patients, immobilize and bandage some injuries.

We survived the trip to the hospital which was chosen, not on the nature of the patient's injuries and the closeness of the facility but, as it works over here, by the employer of the patient. More on that later. In fact, my whole experience in a non-company hospital (we have our own) was so surreal and interesting that I think it deserves its own post with its own ruminations.

Suffice it to say that it was an eye-opening welcome to the world of EMS in the Kingdom.

My thoughts at the end of the call? "This is going to be a blast!"