Ride Along in Nairobi

David and I were fortunate enough to get the chance to ride some ambulances with E-Plus, an ambulance service in Nairobi operated by the Kenyan Red Cross. They are an ALS agency with advanced care provided by Critical Care Certified Nurses, typically operating with EMT or First Aid Certified drivers. By all accounts, they are the most well equipped and probably the busiest agency in Nairobi. I knew that this was just like every other ambulance company out there when the driver announced, "I have to go argue with the dispatcher."

The day started with some confusion, which, having spent most of the last 15 years in and around ambulance services comes as no surprise. To amplify the chaos, the entire staff was in the process of getting evaluated by HR, so tensions were higher than normal. As soon as I was paired with a Paramedic, she was yanked to meet with HR, so I got to run some errands with a driver and logistics coordinator. Neither were EMTs, but both offered a great picture of the company and EMS in Nairobi.

After dropping off some supplies, I was told we were going to fill oxygen tanks at a company called Noble Gases. It's a gas supply company operated by some Indians (from India, not Turning Stone). Noble Gases is what a gas supply company would look like if a bunch of kids decided to get in to the pressurized gas business. Random tanks of unlabeled gases everywhere. Trucks coming and going within inches of HUGE liquid nitrogen storage tanks.

In the back ground of the photo below is a tank. If you look closely, you can see a jet of gas spraying from the neck. Judging from the odor in the area, it was a canister of acetone. Apparently it needed to be emptied and what better way than to put it outside and open it up!

On the way out, we passed within feet of a worker struggling with these hoppers of liquid nitrogen. I have no clue what he was doing (and it would seem neither did he), but there was a cloud of nitrogen surrounding the two hoppers, the guy working on them and the intermodal supply tank in the background.

As we pulled away, our driver just shook his head and said, "I hate coming here."

After we dropped off the full oxygen tanks, we returned to dispatch and I was told they had a transport waiting. As it turned out, I went 7000 miles to do a vent job in Kenya!

This, however, was no ordinary ventilator transport...oh no, this is Kenya baby! I hop into the ambulance with my crew and we go blazing out of the parking lot lights and sirens blaring. I asked, "Is this an emergency? Is the patient critical?" Which would more than justify the urgency of our response (for all the non-EMS folks that might be reading, we don't typically travel with lights and sirens to non-emergency transports). Our driver responded, "No, he's stable. Just headed to Nairobi Hospital for a CAT scan...but we're late!" He smiled as he returned his attention to the road and continued pushing both oncoming traffic and vehicles he was overtaking off the road.

As the gas peddle was depressed closer to the floor boards, and the concept of LANES becomes even more optional, I distinctly heard a subtle slamming noise. As I sat in the middle of the front seat, I peered left and right to see if either the driver or Medic heard the same thing. As neither of them seemed to care, I assumed it must have been the sound of every sphincter in my body slamming shut simultaneously. The seatbelt for my seat was safely stowed under the seat somewhere, so I held onto the cushion and pinned my other hand against the dashboard. I was trying to be discreet, but I probably looked like a guy plucked off the street and placed in the front seat of the space shuttle...which is about how fast we were going.

To his credit, my driver was never out of control. He actually handled the rig as well as anyone I'd ever driven with before. After talking to him a bit, I found out why...he had been driving since he was 11 years old! Keeping my composure, I asked how old you had to be to get a driver's license. He said, 18 to drive legally, but he started driving on the side streets at 11. He must have seen the look on my face, because he started laughing and again returned his attention to the road.

The transport itself went like just about any transport I'd done before. The ICU nurse taking care of the patient knew very little about the patient and repeatedly referred to the doctor or the previous nurse's notes. The Medic completed a more comprehensive exam than had likely been done since the patient had been admitted. We discovered a very poorly secured tracheostomy tube, was probably febrile and had cerebral spinal fluid draining from his nose. Without getting into too much detail, I can say that the patient had suffered a traumatic brain injury secondary to a car accident in a neighboring country and was flown to Kenya for a higher level of care. We needed to take him to another hospital that had a CAT scanner to see the extent of his brain damage. We had him attached to our transport ventilator, Propaq, and portable oxygen. He was sedated with fentanyl, which we use for pain management more than sedation, but whatever works for ya I suppose.

The trip went without a hitch, and I got back to dispatch in one piece. The only other item of interest was the name of the hospital we picked our patient up at. I mean, I knew she was good, but to name a whole hospital after her? I don't know...