Week 3: Etiquette.

"Rule Number 1: Don't get emotionally involved with your patients."

Parsons leaned back and looked at the class.

"You're going to hear that over and over again," he said. "You're going to repeat that to yourselves over and over again. You're going to repeat that to others over and over again.

"And you're still going to break that rule not once, but many times," he continued. "Because you're a human being. Because you'll want to help these people.

"The question is how you break that rule…..Do you find a kid's lost dog? Do you water a person's plants? Do you take someone into your house if you've treated them or a family member? These are things you're going to have to think about. And it's not easy."

Roy frowned at Parsons' statement. If it's not easy, like he says, how come he tells us it's Rule 1?

He didn't want to ask the question out loud in front of the others, but made it a point to corner Parsons during a break.

"Dr. Parsons, can I ask you about Rule Number 1?"

Parsons chuckled. "I figured that would get some attention," he said. "What do you want to know?"

"Have you ever had to worry about it as a doctor?" Roy asked. "Because at least you're inside a hospital. As a paramedic, I suppose I'd deal with all sorts of people in all sorts of situations-"

"And don't think I live in a bubble just because I work in a hospital, Roy," Parsons responded with a chuckle. "Not even the astronauts going to the moon live in a bubble."

He stopped and saw the concerned look on the young firefighter's face.

"I know – this is serious for you," Parsons said. Roy nodded.

Parsons put an arm around Roy's shoulders. He smiled.

"I wouldn't worry about it so much," Parsons said. "Yes, the issues are going to come up. But I've heard a lot about you, DeSoto. I think you'll handle them in a way that you can live with."

E! E! E! E! E! E! E!

"Now comes manners training," Parsons began when the break was over. Laughter filled the room.

"Some of you have experienced a bit of this. But as paramedics, you're going to go into even more houses, shops, schools and so forth than you ordinarily would. As you know, you will have all sorts of crazy situations. So you're going to have to work even harder on keeping your cool."

Parsons had a wicked grin. "So we're going to do this with role playing."

In the first scenario, Roy was teamed with one of the Inglewood firemen as a paramedic team responding to the scene of a car crash. Two nurses played the victims in one car; another LA County firefighter was the driver of the other car. Dixie played the nurse at the hospital base.

"Just to give Kel Brackett at Rampart a reason to sweat, identify yourself as a Harbor General nurse, Dixie," Parsons teased her.

"My pleasure," Dixie responded with a smile.

The LA County rescue men looked at one another with knowing grins. Somehow, this was going to get back to Dr. Brackett – who wouldn't be the least bit pleased.

"OK, go," Parsons said.

Roy and the Inglewood fireman raced over to the scene of the "accident" – actually two mats representing the twisted cars.

The Inglewood fireman attended to the male "victim" while Roy went to the females.

"Help! Help us, please!" one of the nurses called.

Roy carried two plastic containers – one representing the communications they would have with hospitals, the other representing the drug box. He put them down and kneeled next to one of the female "victims."

"How are you doing?" he asked one of the women.

The nurse did a good acting job. "You're supposed to tell me that, wise guy," she said, through clenched teeth.

Roy smiled. "Yes, I am," he said. "Give me a chance to check you out for a moment."

From one of the boxes, Roy took out a blood pressure cuff and a stethoscope. Roy proceeded to take the "victim's" blood pressure and got the respirations and pulse.

"Do you have any pain?" Roy asked. Immediately, he silently cursed himself. That's the first thing I should have asked her!

"Yes, my head and chest hurt!" she replied. "I think I hit my head on the steering wheel. But check my sister; she's much worse!"

Roy went to check the second woman. The nurse was feigning unconsciousness.

"Nurse Palmer, you do a good imitation of someone who's comatose," Parsons couldn't help interrupting. That got a laugh from everyone – including "paramedics" and "patients."

The diversion helped get Roy refocused. He felt for a pulse, took the penlight and checked the "comatose patient's" eyes – the nurse looked down in order to help make things more realistic – and took her blood pressure, pulse and respiration.

"How's she doing?" the other nurse, in character, asked urgently.

"We're checking her out right now," Roy answered in a voice he hoped sounded reassuring, even as the answer was noncommittal.

"What have you got?" he called to the Inglewood fireman.

"Not too bad here," the other fireman said. "How about you?"

"One is unconscious; the other is complaining of head and chest pain," Roy said. "I'm going to call into Harbor General."

Roy reached into one of the plastic boxes and pulled out an old office telephone. Not exactly the new, portable phone he'd heard and read about.

Roy shook his head and lifted the handset. "Harbor General, this is LA County Rescue," he said.

"Go ahead, LA," Dixie responded from across the room. She stood next to another retired phone that was supposed to represent the communications bay.

"We have three patients at a car accident. One has been treated for minor injuries. The second is conscious, but complaining of head and chest pain," Roy began. "The third is unconscious."

"Oh, God, get me something for the pain!" the "victim" with the head and chest pain suddenly cried out.

Roy turned to her. "We'll do what we can, Ma'am," he said.

"Can we give her something?" the Inglewood fireman whispered to Roy, who shook his head.

"Head injury," Roy mouthed. "Both of 'em."

"LA County, do you read?" Dixie asked. "Can you provide more detail on the unconscious patient?"

"Uh, yes, Harbor General," Roy stammered. "She does not respond to visual stimulation. Her pulse is thready and her breathing labored."

"What's her blood pressure?" Dixie asked.

Roy silently cursed himself. I'm just sinking in front of everyone.

He re-took the blood pressure. "BP 90 over 60 for Patient 1," he said. "Stand by for Patient 2."

He moved over to the "conscious" woman, took her vitals and relayed them.

"Can you give me something for the pain?" the woman asked.

"You've had a head injury," Roy said. "We'll do what we can to make you comfortable."

"I'll get the oxygen," the Inglewood fireman said. He grabbed the equipment from across the room.

Dixie said, "LA, 10 liters of oxygen for Patient 1. Also start an IV with D5W for both patients, TKO, and transport immediately."

"10-4, Harbor General," Roy replied.

"OK, stop," Parsons called out. "First of all, a round of applause for our cast here." Roy and the others stood – all blushing slightly – as people clapped.

Parsons grinned wickedly. "Now, we start tearing into you," he joked. Everyone laughed.

"OK, first, what did the paramedics do correctly?" he asked the group.

"No morphine," one voice rang out.

"Right," Parsons said. "Because….."

"Head injuries," another voice said.

"Correct," Parsons said. "No pain relieving drugs for head injuries. Repeat that to yourselves a million times if you have to. Get it tattooed on your chest – well, maybe not the nurses."

The group laughed.

"What else?" Parsons asked.

"He tried to reassure the patient," called out a fireman, who looked at Roy.

"Yes, he did," Parsons agreed. "You have a good 'carside manner,' Fireman DeSoto."

"Uh, thanks." Roy blushed. He avoided looking at Dixie.

"As for what you could have done better-" Parsons began.

"Be faster on reading the vitals?" Roy asked.

Parsons nodded. "Yeah. Those three stats – blood pressure, pulse and respiration – will tell a lot of the story to the doctor. But don't be tough on yourself."

Roy frowned. "What do you mean, Dr. Parsons?"

Parsons grinned. "I have a feeling you think you should have told Nurse McCall those things even before mentioning anything else."

Roy blushed. "Yeah."

Parsons chuckled. "The doctor has to know a few other things besides the three. Now, if you open up communications with those three things, and nothing else, the doctor does have an idea of whether the patient is in good shape or not. But why is her pulse fast? Does she have trauma, or is she in love?"

The class laughed.

"Sometimes both at the same time," one fireman shot out, prompting even louder laughter.

"Especially if she's involved with a fireman," a nurse shot back.

Parsons continued laughing. "OK, class," he said. "I think this scene is over. Good job, all of you."

"Jo?"

Joanne smiled. "Chris woke up and woke me up, too."

"Oh, honey." Roy looked pensive. "I should have-"

Joanne kissed her husband's cheek. "Don't worry. You've got a big test tomorrow. Finished studying? You should get a good night's rest."

"I guess I should," Roy replied.

"After all, no rest for the weary paramedic," Joanne teased.

Roy smiled and kissed his wife. "Thanks for the note of good luck."

Joanne ruffled her husband's hair. "I have faith in you, Fireman DeSoto."