HELSINGIN SANOMAT international

A hard day's night in H691

By Ari Lahdenmäki
Photos: Juhani Niiranen / HS

The taxi-driver is worried. A tired and emotional customer has slipped on getting out of the cab and has hit his head on the icy surface of his front yard in an East Helsinki suburb. Now he is not responding to the taxi-driver's attempts to rouse him.
2.35 am. Olof Nevalainen ventilates the unconscious patient while his partner Matias Turunen calls the emergency room.
2.35 am. Olof Nevalainen ventilates the unconscious patient while his partner Matias Turunen calls the emergency room.
   The Regional Alarm Centre routes the call to the City of Helsinki's Herttoniemi rescue station, and ALS* ambulance unit H691 is sent on its way. It is 1:55am on Saturday morning.
   Firefighter-ambulance driver Matias Turunen steps from the ambulance cab into the frosty night air and starts to examine the prone figure: the victim is breathing, and Turunen finds a pulse quickly enough. But the injured man is clearly unconscious, and he has a large bump on his forehead. Turunen and his colleague Olof Nevalainen lift the man onto a stretcher and move him into the back of the warm ambulance.
   The cab radio plays “Living the life I love”. Nevalainen grunts. Yeah, right.
   It has indeed been a harder day's night than Lennon or McCartney would have envisaged. The two men came on shift at nine on Friday morning. Since then their clientele has included a stab-wound to the neck in Pihlajamäki and a gunshot wound to the stomach in Kontula.
   “It sounds like a cliché, I know, but the spice of this work is that you really do not know from one minute to the next what is going to happen”, says Nevalainen. But then again it is heavy on the soul. “That's what stresses you out, when you start to think that these people never ever learn.” This particular accident could have been avoided if the victim had not had those last two or three drinks. Or if his yard had been sanded properly.
   But these ifs and ands don't do anyone much good. Nevalainen measures the man's alcohol level. Since the victim is unconscious, blowing into an alcometer isn't going to work too well, so Nevalainen has to make do with a reading off his breath. The dial still goes up well over 1 ppm. Nevalainen also takes his blood pressure.
   The injured man starts to throw up. He does not react in any shape or form to the retching. This indicates a deep state of unconsciousness. If the vomit gets into his lungs, the man may well suffocate and die. Jimi Hendrix went that road.
   Turunen calls to the duty ambulance M.D. He asks for permission to intubate the patient. This means inserting a tube into the patient's windpipe to ensure that the trachea remains open and the vomit cannot reach his lungs.
2.40am. Paramedic Olof Nevalainen gives the patient an intravenous relaxant. Time to get moving.
2.40am. Paramedic Olof Nevalainen gives the patient an intravenous relaxant. Time to get moving.
   It is quite a demanding exercise. First the man is connected up to an ECG monitor that provides a graphical read-out of the electrical impulses of the heart. A sensor is attached to the tip of one finger to serve as a blood oxygen monitor, measuring oxygen levels in blood haemoglobin.
   Before the intubation, Nevalainen gives the man three drugs intravenously. The medication relaxes him and he does not choke on the tube as it is inserted. Finally the man's breathing stops and it becomes Turunen's responsibility. He ventilates the patient's lungs by gentle squeezing on the bellows of a bag-mask-ventilator.
   Before the ambulance can get moving, the man has been treated at the accident site for nearly an hour. Turunen continues with the ventilation during the entire trip to the Töölö Casualty Station.
   The trip takes ten minutes or so. Aside from the ambulance there is little else on the road. Medical staff are waiting at the entrance to the emergency room when the ambulance arrives. Turunen has reported the incoming patient on his mobile phone. The two paramedics light up a cigarette when their patient disappears into the casualty station. It is 3.05 am.
   Time to head back to base and Herttoniemi. The rest of the night passes peacefully, and nothing intervenes to disturb the TV coverage of qualifying for the Australian Grand Prix from Melbourne.
   Over the course of a year, ambulance H691 will be called out around 3,600 times. Roughly ten calls a day on average. One in ten of these patients is in critical condition. The less urgent journeys and hospital transfers are made in Helsinki by the ambulances of two private companies.
3.05 am. The unconscious head injury patient has been delivered. Matias Turunen lights up and wonders who's next.
3.05 am. The unconscious head injury patient has been delivered. Matias Turunen lights up and wonders who's next.
   Out east, where the Herttoniemi crews are, the patients are different from other parts of the city. There are a good number of immigrants in this area of town, and language problems come up on a daily basis. So do drugs, and what they are capable of.
   A shift lasts 24 hours. This is followed by two days off. After four consecutive shifts, there are five free days. As often as not, time-off is spent in the company of colleagues. This week, the entire second shift at Herttoniemi, to which Nevalainen and Turunen belong, went to the Ice Hall to watch the hockey local derby match between HIFK and Helsinki Jokers.
   Just before five, Nevalainen and Turunen are able to turn in and get a quick nap. Their beeper interrupts their sleep around six. H691 is called out to deal with a hyperallergic reaction.
   Later that morning, Turunen calls Töölö Casualty. He wants to know how the head injury case fared. The man has spent the remainder of the night under supervision in the intensive care ward. He has a cerebral contusion. And that is all that either Nevalainen or Turunen will come to learn about the man they spent an hour saving.
   A lot has changed from the days when an ambulance would howl through the streets to the patient, bundle him or her into the back, and roar back to the emergency room, lights flashing and siren wailing. And yet it is only ten years or so since this was the norm.
   The City of Helsinki's Rescue Department now has two kinds of ambulance: the basic BLS units and ALS ambulances. Even the personnel in the standard ambulance carry out demanding first aid operations on patients, for instance giving intravenous glucose to a hypoglycaemic diabetes victim or providing emergency resuscitation.
   ALS ambulances have an arsenal of drugs and equipment. If necessary, the crew can fax a patient's ECG film off to the waiting doctor on the run. Helsinki also has a fully-equipped doctor-ambulance unit if the patient is in immediate danger.
   Finland's best first aid services are in the capital. There is no disputing this, according to Ari Kinnunen, a pioneer in the field and one of the doctors manning the privately-owned Medi-Heli emergency helicopter service based at Helsinki-Vantaa Airport.
   There are plenty of towns and cities in Finland where there is less to shout about, however. In sparsely populated areas it can take tragically long for help to arrive. Kinnunen offers legislation as a remedy: the level of emergency medical services should be defined on a nationwide basis.
   As of now, Helsinki is the only place where the quality of emergency care is monitored scientifically. Helsinki's BLS and ALS services cost an annual FIM 24 million to operate. The mobile emergency room with an onboard doctor at all times eats up FIM 4.5 million of this.

*) Translator's note: ALS - for Advanced Life Support. This indicates a higher level of readiness and skills than in conventional emergency medical services, or BLS (Basic Life Support). Paramedics may be qualified to give intravenous drugs and - as in this instance - to intubate patients en route to the emergency room. WLM

Helsingin Sanomat / First published in print 20.3.2000