Israeli Paramedics Association
The Fishermen
by
Paramedic Neomi Zvi
The morning shift just started. 7:36 am , Israel.
We were dispatched with the MICU (1 paramedic & 1 EMT-B) to the beach to:
" a fisherman that was stabbed..."
"But there is a 'slight' problem" said the dispatcher. "We got several of calls
- regarding the same event - from a fishing boat - through a mediator , but
each time they are telling us they are expected to land in a different shore".
Almost on Scene:
It took us (the MICU and the Police car) 27 minutes to find the exact location
of the nervous fisherman that met us on the beach.
We found out that the emergency call came from a small fishing boat that
was still sailing - far away from the shore and transmitted via radio SOS
alarm to their friend on the beach.
The fisherman said that 3 fishermen were badly attacked while fishing on
their boat and at least one of them is critically injured.". "They were attacked
by 4 other fishing boats, but the attackers escaped" he added.
I asked for time estimation "it will take them at least 20 minutes till they will
and the shore IF everything is going well..."
I updated the dispatch center:
"There are wounded on a boat in the middle of the sea. Therefor:
1. We are going to meet them in half way.
2. Send another ambulace to the beach because we are expecting at least 3
wounded and just in case they will land the shore before we will be able
to meet them....
3. Try to check if it possible that the Army Helicopter can be on standby (**)
4. The police is trying to get a motor boat to help us in the rescue mission.
5. If you will not be able to hear us through the mobile radio - you can call
us via my privet cellular phone.
Shortly after 8 am , and the sun was already burning........
We got 5 people on a small fishing boat:
2 fishermen , 1 policeman , the EMT-B and me. We loaded all the equipment
I thought we might need - and we all sailed towards the injured fishermen.....
In the mean time we prepared few infusion bags and fighting the waves not
to flood our equipment.
On the Rocking Scene:
After more then 12 minutes - we located them....The policeman reported....
Their boat was rocking by the sea waves and the sky winds.....with no one to
navigate......The struggle tracks were shown everywhere.......
Quick look - two were sitting on the boat's floor with few fracturs and stab
wounds - in their extremities , moaning of pain ...The third one was laying
with sever chest wounds and broken hand - His screams were tearing the
peaceful - pastoralic view of the blue sky kissing the sea .....
Armed with my Stethoscope , I jumped into their boat , and after rapid A+B
accessment to all 3 wounded - I ordered to transport the critical pt. on back
board to the ' IC boat ' we came with , and told my EMT-B to take the trauma
bag and back board and to move to the other boat along with one of the two
fishermen that sailed with us.
"Keep both boats close to each other while navigating to the shore" I
confirmed with the sailors.
My 41 y/o pt. - screaming for air and from pain , no breath sounds on his
right lung , 16-17 deep stabs wounds at his right armpit and his back ,
another two on his right broken arm... well shown emphysema , ...
Well palpated 120/min Radial pulse.
I preformed needle application , while ' teaching/ordering ' the policeman
how to open one of the two Oxygen cylinders I loaded ...(our policmen have
no medical training at all)....
The pt. did not collaborate due to pain...and keep on shouting he is
suffocating...
I opened an IV , gave him 2 mg MO + anti-emetics ......, and no
improvment due to another 2 needles I sticked in his chest ...
My cell phone was 'playing' and the policeman answered: "your
dispatcher said you can forget the chopper you asked for"
"and from a motor boat as well...." he added.
I calculated the time :
About 8-9 minutes of sailing to the shore , another 2 minutes from the shore
to our MICU , and another 5-6 minutes to the nearest hospital (which is not
a trauma center...or something near that....)
I decided to put chest drain (Trocar) - Adding 4 mg of MO...The policeman
helped me hold the pt........The sea contributed 'its part' and wets us all .....
Right there , while the sailor navigating our shaking , wet , non-motor boat...I
put the chest drain (and I can't say it was easy..)
Almost immediately 500 cc of blood drained out with lots of air.. ... The
policeman was about to vomit any minute...(lets call it sea sick ...:-)
I kept a full contact with the other boat that was sailing next to us , uptated
our dispatch center , reported the hospital and asked for permition to bring
the pt. direct to the Respiratory ICU (they did not authorized , so I called the
ER asking for a surgeon to meet us there) .....
Till we arrived the shore - the pt. was with good air entrance to both lungs ,
BP 120/70 , HR - 90 , NSR , SaPO2 of 97% , 2 IV lines with Ringer Lactate ...
stitches on the sucking wounds ...stripped , on back board....(I confess - no
collar for C spine), wrapped with Aluminium blanket........ and sleeping ..
(ok , ok..exhuasted and under MO effect..).
On Shore:
The boats were a total mess.....and so were we.... full of sea sand....mud....
wet to our bones ......
Another BLS ambulance with 2 EMTs was waiting for us already. I sent them
with oxygen cylinders an one more back board to the second boat - to help
completing treatments and transporting the wounded. The other two pts that
were already with two IV lines each one , one of them on back board , collar
(!) , all vital signs were taken and okay ...
I was damn proud of my EMT partner ! ....
Out of the water , loading pts on both ambulances and driving to the
hospital.......
In the Hospital:
We were standing at the enterance of the ER with our 3 trauma pts , but
nobody was waiting for us there.
The ER so-call �Shock Room� have only two beds and one was already
occupied with a cardiac pt. The total ER capacity is 11 beds - 4 for trauma
and 7 for a non-trauma pts.
The nurse in charge approached and start to yell at us:
�Don�t you think you have to let us know you are on your way here?
�We did , but now show me where to put the pts and call the surgeon please�
She kept arguing , so I left my EMT-Bs to deal with her , and went down the
hall and knocked the ER manager room.
5 docs were sitting there in a staff meeting , staring at me
�We need you for 2 multiple fractures trauma pts and another one with
Tension-Hemo-Pneumothorax� I said.
The all 5 of them jumped out of their sits�.
Wait !
An hour and a half later.......after scrubbing the MICU , the equipment and
ourselfs.....we were in the kitchen , drinking our second liter of cold water...
we heard our dispach center calling on the radio: ....."MICU and BLS
ambulances - to the Marina shore , 5 injured fishermen on a boat...."
S***T......."not again.....".....we both jumped towards the radio...:.....
then we heard MICU 12 "we are on our way to the beach"....... Sigh...
MICU 12 belongs to our neighbor beach-town (sometimes I'm working there
too).-and was called to take care of the injured attackers of my pts. .......
(**)
These madly calls are only showing the screwed up system of ours.......
- No air ambulance availble (only from the army , at not less then 1 hour till
you got it and it is first of all assigned for the army needs...)
- No motor boat availble for rescue missions.......(the local police station -
accidently have one for police tasks but , the time it takes to operate it for
rescues.....there is nothing to rescue anymore..) ....ect...
That makes you improvising all the time,,,,,,and we all know - that the more
you are improvising - that much you are doing fatal mistakes..............
Paramedic Neomi Zvi - Jan 2000