Night shift tales: THE BALLAD OF KILLER MILLER, Part 1

In the 80’s and the 90’s there were a bunch of small ambulance companies in San Bernardino County. One of them was called Howard’s ambulance. Howard’s was the direct ancestor of Lifecare Medical Transport which was in turn the company that eventually became the Redlands Division of American Medical Response.

Back then, EMS* was like the Wild West. There wasn’t a lot of supervision over emergency workers, nor much back up from the Company when there was conflict. Our scope of practice was very limited and the private ambulance side was looked down upon by public agencies and the Emergency Room. 

Besides your own paramedic skills, your equipment was the only thing you really had control of. If anything went wrong with your gear, it could mean a bad day. You’d definitely get some crosseyed looks from people on a call if you didn’t know exactly where everything was in your drugbox. But if you were missing something critical or if a piece of equipment like your cardiac monitor wasn’t working right there could be consequences for the patient, not just your reputation. Ambulance medics were like ants trying to carry something 30 times the size of their body weight. 

That’s where this guy Lance Miller comes in. Miller was a perfectionist, very detail oriented. When he was in Medic school, instead of being happy that he earned a 96% on his EMS Theory final, he spent two hours arguing with the instructor about why he was actually right about the other 4%. He intended to be the new definition of ‘Para-god.’ 

When he earned his ‘hard card’ (that’s what we called our paramedic cert), he’d spend nearly an hour checking out his gear every day. Everything had to be 100% dialed in. He felt that the cardiac monitor and the drug box were what separated him from the humiliating existence as an EMT. Therefore, he made sure everything was perfectly perfected to perfection.

Miller knew his cardiac monitor, the LP5, inside and out. He became fascinated with it as an EMT, but during medic school, he became its master. “This is my monitor. There are many like it, but this one is mine,” he used to say in a not-necessarily-joking way. 

He was especially insistent on testing the defibrillator every day. There was a load tester in the checkout room. The ”Guy-in-Charge-of-Supply” (an early ancestor of the VST) was supposed to do it once a month to make sure the monitors were discharging properly, but Miller trusted no one. He load-tested the monitor daily and always demanded an extra battery or two. He would go as far as snatching some out of another ambulance if he couldn’t get the Guy-in-Charge-of-Supply to give any up.

One day, the 9-1-1 system was very busy. One of the supervisors ran out into the parking lot where Miller and his partner were about to start their checkout. He wanted them to handle a call that was right around the corner at one of the many senior living apartment complexes. The call was for shortness-of-breath, there were no more ambulances available, and the manager on duty didn’t want to give the call to another company. . 

After arguing till he was red in the face, Miller jumped in the passenger seat and ordered his partner to go. He vented his frustrations at his EMT partner at a volume higher than the siren. It was a three minute drive, but to his partner, it would feel like ten.

Miller and his partner arrived first on the scene. They started loading up the gurney with all the required equipment: the airway bag, the COR radio, the Drugbox, the clipboard, and … the monitor. A LP-10? He pulled the new monitor off the shelf. Miller dropped it on the gurney and eyed it like he’d discovered a new species of tree mold. A brand new LP-10? He’d never used one. Throughout school and work, he’d only known the simplicity and perfection of the LP-5. Someone had involuntarily upgraded him.

His mind started spinning. Control was slipping away from him and he wasn’t even in the house yet. How bad could it be though? It was just a respiratory call. You listen to lung sounds, count breaths, and give oxygen. No big deal, right?

Well, you can probably guess what happened next. 

Miller was carrying Murphy’s Law in his back pocket that day. The respiratory call turned out to be a full arrest. The family was fanning the patient with a manilla folder saying “She’s not breathing very well.” The patient, probably in her late fifties, was blue around the mouth, her eyes were lifeless and half open, and she was very obviously not breathing.

Miller barked at his partner to start “bagging”* her. He couldn’t feel a pulse. He reached over to turn on the monitor and instantly recoiled. He felt like he was looking at Egyptian hieroglyphics. The green dial was usually for switching between leads but it wasn’t labeled that way. Instead, a trio of dormant indicator lights crested the top of the dial. He turned it one click to the right, the first indicator light lit up green and the unit powered on.

With new cnfidence, he quickly attached the three lead wires to her torso to see what rhythm her heart was in. It was ventricular fibrillation! Like a catchy television commercial jingle, the mantra for ventricular fibrillation cycled through his head. Shock, shock, shock, everybody shock, little shock, big shock, shock, shock, shock.* No problem.

In a frenzy he darted through the canvas pouches of the brand new monitor cover until he found the tube of defib gel. In seconds, he had the paddles lubed up and pressed against the patient’s chest. When the monitor tones indicated he was charged and ready to shock, anxious fingers pressed down on both paddle buttons. 

There was a loud “pop” sound and the monitor display blinked out. Was it supposed to do that? The woman did not stiffen or arc her back or even twitch like she was supposed to! A moment later the screen turned back on showing the same rhythm. His head spun. He repeated the process, and again the screen shut down, this time in the middle of charging! 

He knew the battery was done. And he wasn’t sure what to do next. Right when he started imagining the murder of his supervisor, his EMT partner reached over and turned the green dial one more click to the right. The screen lit up again! With newfound hope he initiated the defib sequence again. Again the monitor blinked out again, this time at the top of the charging tone, before he even pressed the shock buttons.

He angrily reached over and clicked over to the third position and this time the monitor didn’t respond at all. 

“Had to rush me off the main. He couldn’t just give me five more minutes?!” he muttered, mostly to himself. He closed his eyes and pinched the bridge of his nose with his thumb and index finger. He started to say something profound and curse-laden but he was interrupted by the arrival of the Fire Department.

The engine company entered the apartment like a football team busting through a paper banner before the homecoming game. Sunlight shone through the door behind them. One of the family said “Finally the paramedics are here! That ambulance driver is having problems with his machine.” 

The guys from the engine brought in their paramedic gear, as was their policy. They immediately attached their monitor, a LP5, to the patient. Now the screen showed a flatline, no electrical activity. The opportunity for defibrillation had passed. Now they were basically climbing uphill while wearing flip flops. Success would cost them twice the effort and if they succeeded at all, it meant a lower quality outcome for the patient.

They took steps to move the patient to the floor and started an advanced airway. Miller’s partner became the CPR mule for the remainder of the call. Eventually, he found himself standing there holding the IV bag as the Engine crew took over.

They were transported to the closest ER and on the way there the Fire department medic asked what Miller happened to his monitor. While doing standing chest compressions, Miller just fumed and ranted about management and how they rolled out new equipment. 

The other firefighter in the back holding the clipboard told him that the new “10s” have three battery slots but he only had two batteries installed and they were low. “We’re training on them now. Probably gonna roll them out next month.” He said, “Just take an extra minute next time and check out your stuff, man.”

Miller still didn’t respond. He just kept pumping chest, not wanting to say anything nice. Only the sirens made noise for the rest of the trip.

That incident generated a nice little phone call from the Fire Captain to the Howard’s Ambulance Management team. But that wasn’t the end.