A CHANCE CROSSING
Paul’s career as a paramedic began in the 1980s, working the South Bay of San Diego along the border with Tijuana. One evening, Paul and his partner were dispatched to the border crossing to pick up a patient that was being repatriated from Mexico back to the U.S. When they arrived at the crossing, they were directed to the secondary inspection area, where they parked so that their ambulance was lined up back-to-back with an ambulance from La Cruz Roja Tijuana. When the doors opened and they began to transfer the patient, it was impossible for either of the two crews not to notice the stark difference between their ambulances: on the U.S. side, an ambulance with every compartment and cabinet stocked with the best supplies and medications available; on the Mexico side, an ambulance with virtually nothing – not even a sheet to cover the orange, faded vinyl pad atop their rusted squeaky gurney.
“In those days, we used to get all our supplies from the hospitals,” Paul recalled. “We didn’t have to worry about inventories or costs or anything like we do today so we just started giving them everything we could – armfuls of supplies, whatever we had that they didn’t – and they were so grateful. It really struck me how appreciative they were just to have gurney sheets and blankets. It was really eye-opening – humbling.” As a sign of their gratitude, the Tijuana crew invited Paul and his partner to come down for a ride-along, and a few days later Paul took them up on it. On his first visit, he be-friended a bi-lingual paramedic and, soon after, found himself with a regular shift and a regular partner with La Cruz Roja, squeezed in between his “day job” as a medic in San Diego.
From the outset Paul saw that his limited Spanish was clearly a barrier, and in order to make sure he was saying and doing the right things, he took whatever opportunity he could to learn the language – both professionally and personally – constantly asking his partners, “‘Cómo se dice this? Cómo se dice that?’
“And I listened to my mother, for once,” he remembers. “She told me to write down everything I was learning and I did.” These notes eventually led to him writing and self-publishing his Rapid Rescue Medical Spanish pocket guide, an invaluable learning tool published by Mosby.
AN ACCIDENT OF BIRTH
At that time La Cruz Roja ran their ambulances out of a hospital that was regularly overburdened, where supplies were so scarce that whatever they could salvage was washed and re-used: sheets, gloves, and even syringes. The hospital predominately served the indigent population, and as a result, so did the ambulances. “The dispatcher would be seated in an elevated box, kind of like in the TV show Taxi. I never really understood where the calls were coming from because they didn’t have a public access number like they do now, but I do know a lot of them came from the police, who was often provided a stipend on-scene for their assistance. It couldn’t have been much, because very few of our patients ever had any money; the patients who did have money were always transported by the private ambulance services who had all the same gear and equipment we had in San Diego.”
“Most of the calls took place in the streets. Sometimes we went into houses, but not too often, because we were often called to lower-income neighborhoods where the houses were built very close to one another. We were always guaranteed at least one auto-vs-pedestrian call per shift. I remember the vehicles always fled. One time we actually had a guy who had treadmarks across his chest. He was unconscious, but still alive, and we brought him from one hospital to another, but all the hospitals were turning us away cause he didn’t have insurance. Finally, after nobody would take him, we had to go all the way back across town to La Cruz Roja’s hospital, and he died shortly after we got there. I don’t know if anything could’ve really been done for him, and the hospitals knew this, but they wouldn’t even give him a look.”
“Another time we were called to a private home where a young boy had pulled a fish tank down on top himself. “He was bleeding a lot, but it wasn’t anything he should have died from.” Tragically, the little boy died, and for a lack of basic resources. “That was the most difficult part about it: knowing that people were dying who shouldn’t have, and it was all due to an accident of birth – born 15 minutes too far to the south.”
A few of La Cruz Roja paramedics had received formal training, but it was typically the ones who were lucky enough to have had a border card and were able to attend classes in San Diego. The majority of them had little or no training, and learned most of their skills on the job from their co-workers. Most of them were also total volunteers, showing up to work for the love of it, and the ones who were paid didn’t earn much at all. At the same time, Tijuana was still just beginning to build their system; there were no formal requirements for training yet, and the cadillac ambulances they had were largely still being donated from the U.S.
A CALL ONE WOULD NEVER WANT TO RUN
Paul’s last day as a volunteer in Tijuana wasn’t scheduled, and it happened in a way no EMS professional would ever want: “It was the morning after a 24-hour shift and I was packing up my bags to go back to San Diego because I had to work the next day, and just as I was getting ready to leave dispatch told us we had another call. My partner was trying to get me to go along but I needed to get back to San Diego so I could sleep before my shift the next day, so I turned him down. After my partner left, I went back to getting my stuff together and not long after the dispatcher came back to me and was pretty forceful saying, ‘You have a call, Pablo. You must go now’, and I told him I had to get back to San Diego, but he wouldn’t accept ‘no’ for answer, and basically put me into the ambulance. So there I was in the ambulance with two other guys and no one was saying anything, and I knew something was up. Sure enough, within a minute or two we saw this van that was completely wrecked, and behind it was my ambulance, flipped upside-down in the middle of Avenida Revolución, and there was my partner.”
That was his last day. He never went back. “There wasn’t much regard for safety down there back then. No one ever came to a complete stop at intersections, or wore their seat belts. And there was certainly no restraints for any one in the back of the ambulance. While it was a total tragedy, it’s also served as the root of my passion for ambulance safety – something I’ve been involved in for over 20 years.”
[Paul Maxwell has been working as a paramedic in San Diego County EMS for over 25 years. He’s also an EMS educator and the author of Rapid Rescue Medical Spanish, an essential Spanish language pocket guide for EMS providers in Spanish-speaking communities. That book was borne of his own experiences volunteering in Tijuana for many years.]