A Hard Day's Night in L.A.

By James Willwerth/Los Angeles

Frantic family members and blinking squad-car lights surrounded Antonio Ramirez. Knocked down by a passing pickup truck, the six-year-old boy screamed in pain as he lay on a curbside patch of grass in a south Los Angeles County barrio. For paramedics Edwin St. Andrew, 27, and Walter Tayenaka, 32, summoned to an "unknown T.C." (traffic collision), the moment was routine yet unnerving. The boy briefly lost consciousness and appeared to have broken bones. They had to move him quickly to a hospital. "You never know about kids," explained St. Andrew. "They seem to be doing well, and suddenly they just drop."

St. Andrew and Tayenaka work for Paramedic Squadron 39 of the Los Angeles County Fire Department, a unit that serves a working-class white and Hispanic area within comfortable reach of five hospital emergency rooms. But as time passes each day, one E.R. after another claims saturation and closes down. Paramedics with life-and-death cases must sometimes beg or bluff their way in. Equally frustrating, trauma-care capability gets entangled with the community's demand for street medicine. High-speed runs for "unknown rescue" all too often involve nothing more than cut fingers, headaches and family hysteria.

Little Tony Ramirez seemed to be in serious trouble. Wrapping the boy in head-to-knee flexible braces to keep his spine straight, technicians gingerly placed him in the ambulance. It left the scene at 7:05 p.m., just 13 minutes after St. Andrew and Tayenaka got the call. St. Andrew monitored Tony's blood pressure while he cradled a portable phone and asked a county trauma center for permission to bring in the case. He tried to insert an IV needle, but the boy, who spoke no English, cried and resisted. "No moveas," St. Andrew cajoled in semi-Spanish. An impatient nurse on the phone demanded a blood- pressure reading. Suddenly Tony stopped crying. St. Andrew shook him gently: "Antonio, Antonio!" The boy began to wail again. Everything was chaotically routine. Hospital tests eventually showed that Tony had neither head injuries nor broken bones.

The radio barked again while St. Andrew and Tayenaka were still in the parking lot, and they took off at top speed. Arriving with the siren blaring, they found a man who had cut his hand in a minor traffic accident and wanted hospital care. A county-contracted private ambulance took the case. "He'll get a bill," said Tayenaka, "but nobody pays." Later a drunken partygoer fell and cut his head slightly; he wanted an ambulance too.

At 8:05 p.m., retired landscape gardener Robert McKinney, 76, sat shaky and pale in a room full of firemen. As paramedics attached red EKG clips to his chest, McKinney explained in a raspy voice that he had got out of bed at 1 a.m. -- 19 hours earlier -- and had been struggling to breathe ever since. His blood pressure was an alarming 200 over 140 (120 over 80 is normal). Such severe hypertension can impair lung function and lead to congestive heart failure. McKinney's EKG showed an irregular, rapid heartbeat.

In the ambulance St. Andrew turned on oxygen, spritzed nitroglycerin under McKinney's tongue to relieve the hypertension and potential heart problems, and briefed a hospital over the phone. He warned McKinney to be ready for "a stick," then put in the IV needle to administer the diuretic drug Lasix, which dilates blood vessels. McKinney rallied as his pressure slipped down to 164 over 120. "I was scared," he admitted hoarsely. "I didn't think I'd make it." He did.

"I'm so sick! I'm so sick!" wailed Mona Aguayo as the paramedics entered her tiny bedroom at 1:30 a.m. Observed St. Andrew: "She's 96 years old, maybe senile, hurts all over. But basically she's healthy." Carried out by burly firemen, Aguayo seemed like a wounded bird with her thin, angular features, frightened eyes and short silver hair. "My hands! My hands!" she cried. She began to vomit as the ambulance sped toward Santa Marta Hospital, the last "open" emergency room of the night. But her pain and terror were apparently caused by hysteria. The woman was sent home within hours.

St. Andrew and Tayenaka remember the night they forced a local community hospital to admit a man who was gushing blood from a bullet wound to the neck. The sophisticated county trauma centers were closed; a less-equipped emergency room at Downey Community Hospital, six minutes away, was full. The paramedics were ordered to St. Francis Medical Center, twice the distance. They went instead to Downey, and the man survived the night. "I know the situation," said St. Andrew. "I'd pay extra taxes to keep the trauma centers open. I want one available if my kid is hurt."