I rise early in the morning. I shower and shave. I put on my working clothes and lace up my black boots.
It is dark outside. I drive through deserted streets to the ambulance base, where I punch in -- always fifteen minutes early (even though I don't get paid until the top of the hour).
I get the keys to the narcotics box from the duty medic, and then walk out to my ambulance. I put my backpack in the front between the seats, set my Diet Coke in the drink holder, and lay my stethoscope on the dashboard.
In the back of the ambulance, I methodically go through my gear.
Cardiac monitor -- Electrodes, defib pads, 12-lead cable, spare roll of ECG paper, ETCO2 filters both intubated and cannula. Both batteries at full power. Spare batteries on the bench. I run the user test. Everything okay.
House bag:
Intubation roll first. All the blades in working order. I leave the Mac 3 blade on the handle. One of each side tubes. Two stylets, one adult, one pedi. 2 ten cc syringes. Mouth holders, one pedi, one adult. Spare ETCO2 filter. Nasal trumpets and oral pharyngeal airways in assorted sizes. Petroleum jelly. Check.
Med Kit. 8 Epis and 3 Atropines. Bristo-jets. 4 Lidocaines and one smaller bristo jet. Two 20 unit vials of Vasopressin. Amiodarone. 2 D50s, 1 Sodium Bicarb. I check off each of the drugs in my head. Calcium, Magnesium, high dose Epi. Solumedrol. Adenosine, Toradol, ASA, NTG, Lasix, Zofran, Phenergan, Glucagon, NTG paste, Benadryl, Cardizem, Narcan, Haldol. Assorted syringes and needles. Everything in order.
IV kit - 2 catheters each size - 14s, 16s, 18s, 20s, 22s, 24s. Two saline locks, 2 saline vials, 2 10 cc syringes, 5 cc, 3 cc, 1 cc. A tourniquet, alcohol wipes, 4x4s, Venoguards. Io needle. Check. Glucometer.
Oxygen supplies. Nonrebreather, cannulas, nebulizer, albuterol, atrovent, cpap mask, ambu-bag, LMA and syringe.
1000 cc bag of Saline, Buretrol, premixed dopamine and lidocaine, 500 cc bag. Blood pressure cuffs in three sizes, pedi, adult and obese. Assorted bandages trauma dressing, burn sheet, tape and kling. Spare run form. Sharps box.
I take the keys out and open up the narc box. Two sets of drugs. 20 mg of morphine, 4 mg of Ativan and 10 mg of Versed in each. Lock them back up.
Everything on the shelves in good. More bandages, IV supplies, 02 gear. Combi-tube, emergency tracheotomy kit, EZ-IO, OB kit, mass casualty bag.
Two boards, scoop stretcher, board and collar supplies. Stair chair, Ked, traction splint. Urinal and bed pan.
Portable 02 has a 1000. On board 02 at 2000.
Suction works, house and portable.
Tourniquet hanging from the top rail. BP cuff on bench.
Lots of linen -- sheets, towells, pillow cases, bath blankets, and one heavey blanket.
Ambulance is gassed and the lights are in working order.
Only thing to do is reload the metal clipboard with run forms.
What's written on them over the next twelve hours will tell the story of the shift.
