Monday, July 13, 2009

Is That A Siren? Huh? Huh? Is It?

After many years of 911 response in the San Francisco Bay Area, then moving to Mexico, it took about 2 months before going into withdrawal. It came to my attention every time I heard a siren. I would bolt for the door from wherever I was, run into the street, and wistfully watch the ambulance wishing I knew where it was going and what the call was for. What a geek.

One day I could take it no longer and decided to turn myself in to Cruz Roja as a volunteer. Turned out to be one of the best things I've ever done. Volunteering on the ambulance and in the clinica, making new EMS friends, and learning how Mexico practices emergency medicine was a blast!

Here is a day-in-the-life account of a volunteer shift at Cruz Roja. . .


Cruz Roja Chapala Delegation

Saturday night—and ten minutes before my shift was to end—the radio crackled with a report that the medics were on their way in with seven patients from a motor vehicle crash on the Libramiento. To make matters worse, many of the patients would be children. Everyone scattered to prepare. Somebody asked me to find a pediatric breathing device and with a heavy heart I began the ominous search. The first of two ambulances arrived, cut the siren, backed in, and a parade of gurneys with bloody patients strapped to backboards began. Not one of them would have been there had they been belted. Not one. Instead, five ‘borrachos’ eventually got their heads shaved and sewn up. One fatality had been left on scene.


L-R: Nurse Trini, Dra. Lorena, Radiology Tech Jesús, and Nurse Nena

True to the report, many of them were children; all were sobbing quietly. Alone and perched on the edge of a big white gurney was a small, terrified child. Her beautiful round face was dirty, cut, and streaked with blood and tears. For some reason, her left hand clutched a fistful of pesos. I thought back to the last hour of her life and what it must have been like for her. Someone her size, unbelted, would have been tossed around like a rag doll inside a rollover vehicle. I stopped what I was doing and put my arm around her. She shyly leaned into my side, and I picked her up. I carried her around as I prepared equipment for Doctora Amparro who was examining her mother and looking concerned. The little girl kept reaching for her unconscious mother on the far gurney and I worried about what I would do with her if her mother died.

As the second siren got louder, I found a relative of the child in the waiting area and handed her over. Then one of the nurses and I went out to the bay to wait for the ambulance and to get a glimpse of the patients so we could begin triage. They pulled up and turned off the siren. With lights and wig-wags flashing they swung out into the street preparing to back in. Then they stopped. . . and sat there. Then I heard clip-clop clip-clop clip-clop, and watched as trauma’s ‘Golden Hour’ ground to a halt while a band of seven horses passed between us. A young colt brought up the rear, picking its way among the cobblestones, concentrating hard to stay on its feet. Annoyingly, he paused to scratch his belly.

Earlier that morning, as I was helping the paramedics load their equipment into the ambulance, Dani, Carlos, and I traded gory ambulance stories. We discussed cardiac arrest saves and losses and I noticed that we shared the same feelings. I looked away when Dani said he had just lost a patient on a tennis court and nothing he had done made a difference in the outcome.

As we chatted, I saw a police truck pull up and an obvious urgency in the movements of the officers caught my attention. We brought a gurney out to the truck and from the back they slid a man with a bloody t-shirt who was curled in a fetal position onto our gurney. He moaned a couple of times as we wheeled him in. It was difficult for him to talk but the police said he had been cutting tiles with an electric saw when it slipped—and then we saw it! He had an eight inch lateral laceration where the saw had cut through his abdominal wall. I held his shoulders down and repeatedly reassured him while the doctor prodded his organs with her gloved hand. She proclaimed his organs intact and we bandaged him up and the paramedics were summoned to transfer him to Guadalajara for surgery. This man would return several months later and shyly ask me if I remembered him. I did not. He then lifted up his t-shirt to show me the scar and said he had come back to thank me for being so kind to him when he had his accident. Tears sprang to my eyes and I fell all over myself telling him how happy I was to see he had made it, I had not been optimistic.

Later that afternoon, a call came in for the ambulance. A boy had been pushed by his schoolmates and had fallen under the Chapala Bus in front of the plaza. I jumped on board the ambulance as it pulled away. On arrival we found a crowd around our little patient who had been pulled out from under the bus. A kind woman was holding his head and whispering in his ear. Fortunately it looked like the only part of him that was involved was his left foot, although it was mangled and partially amputated. We brought him back to the clinic, splinted and stabilized him then transferred him to Hospital Civil in Guadalajara where he would have surgery.

Rubén - who never cried.

A battered, once white, Toyota pickup clattered up to the clinic in a puff of exhaust and a stern middle aged Mexican woman in black and white emerged. She was the Forensic Investigator who had been summoned for the body of a neighborhood man found dead in his home that morning. She would take possession of the body, take it to the morgue in Ocotlán for autopsy, and store it until the family could arrive. She thrust a gray, extra-long, plastic garbage bag in my direction.

Arriving at the man’s apartment, we found the body in a chair on his second-floor terraza. Dani bent down and put the man’s feet in the bag. I grabbed his waistband waiting for someone to take the other side so we could gently—and respectfully—slip him into the bag.

“Tip the chair.” Dani said.

“No”, I protested, “why don’t we just. . .”


I stepped behind the man and tipped the chair; he slid down, and bounced neatly into the bag. Dani, a police officer, and I rolled the bagged body onto the flat, slid him onto the bed of the pickup headfirst, and rolled him off the flat. With his head flush against the cab, he barely fit and his feet had to be adjusted in order to close the tail gate.

“Señora,” I asked, “won’t the truck’s cab cause trauma to the man’s head?”

The Forensic Investigator scowled, grabbed an empty 2-liter Coke bottle from the curb, and shoved it between the man’s head and the cab of the truck, then she and the body rattled off to Ocotlán.

Although the doctors and nurses and I come from different countries, we have the culture and language of medicine in common. They have welcomed me and my spoiled American medical ways into their emergency clinic so I can learn how emergency medicine is practiced in Mexico and help them in the process. As a volunteer paramedic at the Cruz Roja Mexicana Chapala Delegation, I sometimes work on the ambulance or in the clinic, utilizing my California paramedic experience and training. The doctors and nurses are quick and smart and work together without having to talk. I’m happy to see that the patients are treated with respect, dignity, and empathy

It’s quiet now and the doctors, nurses, and I are sitting around an empty gurney, like a quilting bee, with an 8 inch stack of gauze squares in the middle. While we talk and laugh we fold the squares, wrap them in brown paper and put them in the sterilizer. The nurses laugh and ask me if paramedics make bandages in their spare time in the states. . .yeah, right.


Cruz Roja mural - Cruz Roja Guadalajara


In 1958, when the Chapala Delegation of Cruz Roja began, the ambulance was a pickup truck and the gurney was a piece of canvas strung between 2 poles. The only beds were rush mats on the floor. The oxygen tank was good for 15 minutes so the flow had to be reduced in order to make it all the way to Guadalajara with the patient.

In 1966, the Cuevas family of Chapala donated the land where the clinic stands today. An administrator was hired in 1991, but at that time the delegation was still using volunteer doctors. The first ambulance was acquired 2 years later, and all services were rendered by volunteers. When a system for local businesses to pledge a monthly donation was set up, improvements were possible. With a regular income, they were able to hire paramedics and doctors. In 1995, Sr. Jorge Agnesi became president. Together with his partner George Cardis, they greatly improved the services and their efforts resulted in increased contributions. Major improvements were made to the clinic and more equipment was purchased. Over the years more and more sophisticated equipment and training have brought Cruz Roja Chapala to a higher level of emergency care.


The Chapala Delegation of Cruz Roja is part of Cruz Roja Mexico and in turn, part of the International Red Cross headquartered in Geneva, Switzerland. The Chapala Delegation, like all other International Red Cross chapters throughout the world, provides relief to local residents for natural and man-made disasters. They are a humanitarian organization with doctors, nurses, and paramedics who are dedicated and proud to serve regardless of race, origin, or ability to pay.

Cruz Roja Chapala provides 24/7 Emergency Medical Services 365 days a year with EMTs working the ambulances and doctors, nurses, and techs working the clinic 24 hours a day every day. They see everything from heart attacks to scorpion bites. They provide emergency medical ambulance service, stabilization at the Chapala Clinic and transport to Guadalajara hospitals as needed.


Cruz Roja is mandated by Mexican law to respond to all disasters and accidents in all public places. Consequently, many ambulance personnel are trained in Disaster Management, Mountain Rescue, Water Rescue, Confined Space Rescue and other specialized areas.

The International Red Cross regulations prohibit their chapters from accepting money from any government source, anywhere in the world. All International Red Cross chapters must remain politically neutral. Cruz Roja receives no funding from the Mexican Government and exists entirely on donations.

You can drop off monetary donations at the clinic or in the little boxes so designated at various stores and businesses. Cruz Roja also appreciates donations of functioning medical equipment, blankets, towels, and medicines that are not expired. Thank you for your support.

The motto of Cruz Roja Mexicana is:

Somos Todos Hermanos

We Are All Brothers.

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