Code 10-8: The Night Before Christmas

A paramedic reflects on his career and the challenges he and his EMS team face in the line of duty.

His bunker coat, helmet, and rescue gloves will be hanging in his locker on Christmas Eve, alongside his ballistic vest and shatter-resistant goggles. David Nesbit II, AAS, NRP won’t be rolling “code 10,” as he did last year. No lights and siren from his specially outfitted white and blue Chevrolet Suburban roaring through the streets of Dover, Del., home to Dover Raceway and NASCAR and the state’s capital. Working “four on and four off,” Nesbit and his emergency medical services (EMS) crew earlier this year drew the long straws, so he and his brothers and sisters will have the big winter holidays off.

“We’re off on both Christmas and New Year’s Eve,” Nesbit explained in an email to ICD10monitor. “I plan on spending the days with my family, specifically Christmas day with my children, which will be the first time in about three or four years – and they’re 9 and 6 now. The kids and I will spend the weekend cooking because my wife will be working.”

While Nesbit, who is also president of Local 781 of the American Federation of State, County and Municipal Employee (AFSCME), will be enjoying time off, his department is expected to add another Chevrolet Suburban to the station’s platoon. During normal operations, the Kent County Department of Public Safety’s EMS Division has four platoons that run the 24-hour shifts. Two other platoons are on call for 12-hour shifts from 7 a.m. to 7 p.m.

There are five advanced life support (ALS) paramedic units. Each unit is outfitted with two sets of equipment, consisting of two Phillips cardiac monitors, medication bags with medications and IV equipment, advanced airway bags for intubation (advanced airway management), continuous positive pressure (CPAP) machines, and pediatric bags. There is also extra oxygen and other gear for different situations, along with personal protective gear. Adding an extra unit means that they will put another one of these groups in service overnight for Christmas and New Year’s.

Nesbit described one New Year’s Eve that remains seared into his memory. That was the time he worked in Atlanta, at Grady EMS.

“From about 10 p.m. until about 4 a.m., we literally ran nonstop,” Nesbit recalled. “We would barely arrive at a hospital before dispatch was trying to give us a new run. If I remember correctly we ran approximately 140 calls in six hours between 18 units.”

Nesbit says he really and truly loves his work. As a paramedic, he is proud that he can help so many people in a very unique way.

“Most of the time, I have to take my own reward from the work that I do,” Nesbit said. “The ‘thank yous’ and accolades are very few and far in between, so you have to be able to be content with the job that you are doing. But on those occasions that you do get that ‘thank you,’ it’s something that sticks with you. If we’re lucky enough to see someone walk out of the hospital who was very sick or injured, that is just an exceptional feeling!”

How does Nesbit maintain his own well-being and handle all the trauma he encounters without getting symptoms of post-traumatic stress syndrome?

“Well, there are times that I cannot say I don’t feel like I’m having some symptoms of PTSD,” Nesbit admits. “I’m on my third marriage; I have sleepless nights and relive some things in dreams that wake me up. To be completely honest, I probably drink a little too much alcohol at times.”

Nesbit believes that his being around his co-workers who are dealing in the same reality makes it easier.

“I have an exceptional crew and we continually make each other laugh,” Nesbit said. “But when it counts, we are there for each other as well. I really don’t talk about myself much at all with others, but I have a counselor who I see regularly (and) prescribes medications to help with depression.”

Nesbit is beginning to take yoga to focus on himself. He reports that it is helping him to enjoy family time with his children much more.

“Luckily, I don’t have a great long-term memory, so I forget most (things) to move on to the next call,” Nesbit added. “Either that or I just bury it somewhere. Not really sure which it is.”

While he believes that the public and even other healthcare professionals do respect the role of paramedics, Nesbit also acknowledges that it’s hard for those folks to understand exactly what it is that first responders do.

“EMS is still fairly young compared to the hospital emergency department,” he said. “We’ve only been in existence for almost 50 years, and no one really knows how to classify us. Are we part of the fire department? Or the hospital?”

In his judgment, most family members of accident victims and even law enforcement may think that they are ignoring them or being arrogant because paramedics are not giving them their complete attention once crews arrive on scene.

“This is especially true in a traumatic scene, where there is this ‘golden hour’ that we are fighting against to get our patient to where they belong, to be in surgery within that hour,” Nesbit said. “Of that 60 minutes, we are allotted 10 minutes, the ‘platinum 10 minutes,’ during which …we need to assess the scene, see how many patients are actually there, triage the patients, assess the patients to see what life-threatening trauma is there, address it quickly, and think about the next five or six steps we need to accomplish. Scene times are always under watchful eyes and highly scrutinized, so it’s not that we’re ignoring (other first responders); we are multitasking and thinking and moving and organizing in utter chaos.”

Still, Nesbit believes people are starting to understand what paramedics are up against and what they are doing.

“Until you’ve been in that situation or in the back of ambulance running down the road, weaving in and out of traffic, attempting to put in IV in someone or decompress a chest, there is only so much one can appreciate,” he said. “Most patients and families after the fact are thankful, but I don’t think anyone can truly appreciate it until you’ve lived it. That includes the majority of the emergency department staff. Please do not think that I am knocking what they do; they are great at it. But at times we do some of what they do, with one-eighth of the staff, one-third of the room and light, and at 70 mph!”

But not on this Christmas Eve.

Nor New Year’s Eve. David Nesbit will be with his kids, playing games and trying to stay awake until midnight to usher in 2018 and all that it will bring.