People of EMS:
J. Montalvo, Licensed Paramedic, with more than 10 years of service.
G. Kumpf, EMT, with 2 years of service.
Z. Ontiveros, EMT Student, soon to become an EMT.
J. Cuellar, AEMT, with 6 years of service.
D. Mendoza, Licensed Paramedic, (left) with 16 years of service, and O. Mendoza, Licensed Paramedic, (right) with 13 years of service, attending Pharr EMS Memorial Service.
Zack, McAllen FD Cadet and EMT Student, soon to become an EMT/FF.
C. Hinojosa, Driver and EMT Student, soon to become an EMT.
S. Gomez, EMT, with 1 year of service.
M. Palacios, EMT, with 1 year of service.
L. Villarreal, EMT, with 1 year of service.
L. Chapa, EMT, with 7 months of service as primary medic and soon to become an Advanced-EMT.
F. Alvarez, Paramedic and Supervisor, with 25 years of service.
J. Martinez, Paramedic and Supervisor, with 21 years of service.
D. Garza, EMT, is 2 months away from a year of service and a semester from completing paramedic school.
S. Davila, EMT, with 3 years of service, in the process of going to paramedic school.
D. Villarreal, EMT, with 6 months of 911 service.
R. Cantu, EMT Student, on her third ride out.
H. Caballero, EMT, with a year of 911 service.
M. Lopez, EMT, with 6 months of service, recently completed Advanced-EMT class.
S. Ortiz, EMT, with 3 years of service.
A. Sotelo, Paramedic, with 15 years of service.
K. Bernal, AEMT, with 3 years of service.
S. Cabanillas, EMT, with 7 years of service.
E. Hernandez, Paramedic, with 13 years in service.
A. Hayward, EMT, with 3 years of service and 4 months away from completing paramedic school.
J. Hernandez, Licensed Paramedic, with 5 years of service.
A. Soria, EMT, with 19 years of service.
R. De La Garza, Paramedic, with 3 years of service.
M. Saldana, AEMT, with 6 years of service and is currenlty a Paramedic student.
S. Montiel, EMT, with 4 years of service and is currently a Paramedic student.
J. Silva, EMT, with 17 years of service.
S. Michalk, EMT, with 4 years of service.
C. Espinoza, Paramedic, with 7 years of service.
B. Najera, EMT, with 1 year of service.
E. Gutierrez, Paramedic, with 18 years of service.
F. Gonzalez, EMT, with 1 year of service.
P. Coronado, EMT, with 1 year of service.
A. Sierra, EMT, with 7 years of service.
G. Guerrero, Paramedic, with 1 year of service.
O. Lopez, EMT, with 4 months of service.
A. Ramirez-Rivera, EMT, with a year of service.
E. Amaya, EMT, with more than a year of service.
Angel 1: Flight Medic Ozzy (left), Pilot Zac (Middle), Flight Nurse Sam ( right)
D. Rodriguez, AEMT, with 16 years of service.
R. “ Red” Salinas, EMT, with 24 years of service.
T. Ruelas, Paramedic, with 6 years of service.
C. Guerrero, EMT, with 2 years of service.
J. Hernandez, EMT, with 13 years of service.
L. Ramirez, Driver-Only, with 2 years of service in 911.
EMT Student Ariel on her second ambulance ride out.
Everyday EMS:
Call No. 1 Nature of illness: Stroke to cardiac arrest. Weather: flyable- Helicopter Angel 1 launches. Scene details: Nearest hospital 20mins / 10 miles away. Family reports last known 10 mins before calling 911. PD officer on scene performing CPR. Chief Complaint: Not attainable. Airway: unsecured. Breathing: Absent. Circulation: Absent. Assessment: cardiac assessment, stroke assessment, trauma assessment and glucose assessment. Treatment: CPR, BVM w/ OPA, heart monitor w/ pads, IO access, intubation, cardiac medication- Epi, Lucas device. Differential diagnosis: Heart failure. Rule out: Stroke, hypoglycemia, hypovolemia, overdose, sepsis. Reassessment: Asystole to PEA. Transfer care: Angel 1: Flight Paramedic and Flight Nurse at LZ approx 1 mile away.
Call No. 4 Mechanism of injury: Fall Weather: 100 degree weather. Scene details: Backward fall from delivery truck approx 5ft to asphalt pavement. Mental Status: Abnormal, altered mental status-name and event present-reports taking a wrong step. Chief Complaint: Posterior head pain Signs/Symptoms: Diaphoretic, laceration- 1 inch in length present and bleeding present to the back of the head. Airway: Good, no abnormalities. Breathing: Good, no abnormalities. Circulation: Good, no abnormalities. Assessment: Wound assessment, head-to-toe assessment, pupil assessment, lung sound assessment, vital signs, heart rhythm, 12 lead assessment, glucose assessment, skin turgor assessment. Treatment: C collar, bandages and bleeding control, IV access, IV fluids. Differential diagnosis: TBI-Concussion, dehydration. Rule out: Heart arrhythmia, stroke, ICP, drug or alcohol abuse, hypoglycemia. En-route: Monitor mental status, ABC’s, reassess vital signs and notify hospital-trauma alert. Repeat until we arrive at the hospital.
Call No. 1 Mechanism of injury: Auto vs Bicycle. Scene details: Speed->20mph, dragged on top of the hood of the car approx. 8ft, no helmet, negative LOC. Mental Status: Good, no abnormalities. Chief Complaint: Head pain and left shoulder pain. Signs/Symptoms: Head- abrasion present, left shoulder- abrasion present, left elbow-avulsion present, right knee-swelling. Airway: Good, no abnormalities. Breathing: Good, no abnormalities. Circulation: Good, no abnormalities. Assessment: Head-to-toe assessment, pupil assessment, lung sounds, vital signs, heart rhythm, glucose assessment. Treatment: C collar, bandages, IV access. Rule out: Heart arrhythmia, traumatic brain injury, concussion, spinal cord injury. En-route: Monitor mental status, ABC’s, reassess vital signs and notify hospital. Repeat until we arrive at the hospital.
Call No. 5 Nature of Illness: Breathing problems. Mental Status: Good, no abnormalities. Chief Complaint: Shortness of breath- x4 days onset, back pain-x3 days onset-8/10 to mid back, pressure, non-radiating and not new. Hx: Bronchitiis. Signs/Symptoms: difficulty catching breath, anxiety, rhonchi wheezing. Airway: Good, no abnormalities. Breathing: abnormal, respiratory rate-28, rapid, SPO2 93%. Circulation: Good, no abnormalities. Assessment: Lung sounds, chest assessment, back assessment, vital signs, heart rhythm-NSR, 12 lead- right axis present, blood glucose-179 mg/dl. Treatment: IV access, O2, Albuterol, Atrovent and Solu medrol. Differential diagnosis: Bronchitis. Rule out: Heart arrhythmia, Heart failure, Anaphylaxis. En-route: Monitor mental status, ABC’s, reassess vital signs and notify hospital. Repeat until we arrive at the hospital.
Call No. 4 Mechanism of injury: Motor vehicle collision. Scene details: Major damage to driver side, left side airbags deployment, seat belt in place, negative LOC. Mental Status: Good, no abnormalities. Chief Complaint: Neck pain and left side shoulder pain. Signs/Symptoms: Neck tenderness, shoulder- tenderness and emotionally unstable. No other abnormalities. Airway: Good, no abnormalities. Breathing: Good, no abnormalities. Circulation: Good, no abnormalities. Assessment: Head-to-toe assessment, pupil assessment, lung sounds, vital signs, heart rhythm, glucose assessment. Treatment: C collar, IV access. Rule out: Heart arrhythmia, traumatic brain injury, concussion, spinal cord injury. En-route: Monitor mental status, ABC’s, reassess vital signs, provide emotional support and notify hospital. Repeat until we arrive at the hospital.
Call No. 1 Nature of Call: Shortness of breath. Mental Status: Good, no abnormalities. Chief Complaint: : Back pain and vomiting- post being fed via peg tube. Pain 1/10, pressure and non radiating, not new. Signs/Symptoms: Tenderness to upper back-no other abnormalities, vomiting x2-liquid food. Hx: Stroke ( 2 yrs ago, ischemic), HTN, DM2, Enlarged gallbladder ( 3 months ago) not removed. Airway: Good, no abnormalities. Breathing: abnormal-rate 24 regular, no other abnormalities. Circulation: Good, no abnormalities. Assessment: back assessment, lung sounds-clear, abdomen assessment-no pain/tenderness or Murphy sign, stroke assessment, vital signs- MAP of 57 mmhg, heart rhythm-NSRw/ 1st degree block, 12 lead- RBBB and Left axis deviation- bifascicular block present, glucose assessment- 167 mg/dl. Treatment: IV access- NS fluids. Reassessment: MAP > 65mmhg responding to fluids. Rule out: trauma, heart arrhythmia, heart failure, stroke, sepsis, hypoglycemia, Differential diagnosis: cholecystitis, Bowel obstruction. En-route: Monitor mental status, ABC’s, reassess vital signs, and notify hospital. Repeat until we arrive at the hospital.
Call No. 4 Mechanism of injury/Nature of Call: Syncope/Fall. Mental Status: Good, no abnormalities. Chief Complaint: : Left Head pain/ Pelvic pain. Signs/Symptoms: Head injury- hematoma present-actively bleeding-positive LOC, Pelvic-tender, no obvious deformities. Hx: No blood thinner medication, occurring falls, DM2, HTN. Airway: Good, no abnormalities. Breathing: Good, no abnormalities. Circulation: Good, no abnormalities. Assessment: Head-to-toe assessment, pupil assessment-4mm-PERRL, stroke assessment-negative, spinal cord injury assessment-negative , lung sounds-clear, vital signs, heart rhythm-NSR, 12 lead-prolong QT, glucose assessment-187mg/dl, skin turgor assessment- positive. Treatment: C collar, bleeding control-multiple bandages, IV access, Pain management-Morphine/Zofran, IV fluids. Rule out: Traumatic brain injury, seizures, sepsis, stroke, heart arrhythmia, heart failure, hypoglycemia. En-route: Monitor mental status, ABC’s, reassess vital signs, and notify hospital. Repeat until we arrive at the hospital.
Call No. 2 Nature of Call: Seizures. Mental Status: Unresponsive. Chief Complaint: Not available. Signs/Symptoms: Actively seizing, husband reports x2 seizures ( 1st: 1 min duration, 2nd: 5 min duration) Hx: Seizures. Airway: Good, no secretions present. Breathing: Good, SPO2 100% Room air. Circulation: Good, skin condition-pink, warm and sweet. Assessment: Ask specific questions to events leading to present, temperature-98.8 F, heart rhythm-NSR, glucose-120, skin turgor-positive and vital signs-no abnormalities. Treatment: IV access, Ativan ASAP, IV fluids. Rule out: Trauma, Drug/ Alcohol withdrawals, Heart Arrhythmia, Pregnancy, Hypertension crisis, Hypoglycemia, Sepsis. Reassessment: Mental status improved-COAX 1 (name) and GCS 13 w/ complaint of weakness. En-route: Monitor mental status, ABC’s, vital signs, anticipate another seizure and notify hospital. Repeat until we arrive at the hospital.
Call No. 4 Nature of Call: Non-Traumatic Chest pain. Mental Status: Good, no abnormalities. Chief Complaint: Chest pain-onset 2 weeks, 10/10 constant pressure, non radiating. Signs/Symptoms: GBW, SOB and new onset of pedal edema. Airway: Good, no abnormalities. Breathing: Respirations at 24, no other abnormalities. Circulation: Cyanotic lips present, no other abnormalities. Assessment: Chest assessment, lung sounds, vital signs, cardiac rhythm, glucose and 12 lead-STEMI-V1 (2.72mm) V2 (3.57mm), Left Bundle Branch Block, Left Axis Deviation, QRS 0.16s. Treatment: Aspirin, Nitro, IV access and transport-lights and sirens. Differential diagnosis: Septle MI-LAD occlusion. En-route: Monitor ABC’s, reassess vital signs, continue treatment, notify hospital ASAP. Repeat until we arrive at the hospital. Patient-reports feeling better with treatment-chest pain now 4/10, lips normal and SOB subsided.
Call No. 1 Nature of Call: Emergency Transfer-ER to ER, Hemorraging Stroke and A-Fib RVR. Patient: female. Mental Status: not available, sedated. Chief Complaint: not available , sedated. Airway: Good, secured via endotracheal tube. Breathing: Good, assisted with ventilator. Circulation: Good, no abnormalities. Assessment: Stroke assessment, pupil assessment, ventilator settings, medication drips, vital signs, cardiac rhythm, 12 lead, glucose evaluation, obtain patient/medical history. Signs/Symptoms: Pt reacting to pupils assessment. Treatment: administer sedation medication, continue ventilator and multiple medication drips ( Amiodarone, Mannitol, Fentanyl, Keppra) Rule out: Heart arrhythmia, hypoxia, hypoglycemia, medication errors, ventilator errors. En-route: Monitor and maintain ABC’s, reassess vital signs and continue sedation as needed. Anticipate patient to decline and manage as needed.
Call No. 4 Time: PM Nature of Call: Emergency Transfer-ER to ER, GI bleeding. Patient: Elderly female. Mental Status: Good, no abnormalities. Chief Complaint: GBW Airway: Good, no abnormalities. Breathing: Good, no abnormalities. Circulation: Good, no abnormalities. Assessment: Mental/Neuro status, vital signs, cardiac rhythm, 12 lead, glucose check, medical history. Signs/Symptoms: Nausea, high blood sugar >300. Treatment: antiemetic med, NS fluid bolus. Rule out: Hypovolemic shock,Sepsis, Heart arrhythmia, Heart failure. En-route: Anticipate decline of patient condition and have a plan ready. Reassess mental status, ABCs, Complaints, Vitals signs and Treatments. Repeat until we arrive at the hospital.
Joel studies while he waits for his truck to arrive to start his shift.
Omar and Felipe attempting to find medics to come in.
In this situation, we are activated, lights and sirens, prior to coming up to a crowded intersection. No other option but to use the opposite lane; less of a mess and danger to everyone. These are some of the things we must consider as EMTs and Paramedics. This is the reason why you stop despite the road having a median. It's one less hazard to factor in when responding to an emergency. There are many factors to consider. Lights/Sirens on = you stop or pull to your right.
Push up competition between co-workers.
E. Garcia, EMT, waiting with the patient at the EMS line.
"Medic 37, unit wash at central”-Dispatch.
Medic 16 check off.
Medic 33/ Air Methods: 1 Death: 0
Flight Medic Sergio checks lungs sounds post intubation. One of the 7 P’s of RSI, placement and proofing.
AMS pt required a person or two to hold him down to help him.
He uses is phone light to find a vein to place an IV.
Another day, another partner and another check off in the morning.
We were tasked to go and represent EMS, Medcare, and our societal role as medical professionals in the streets to these high school future EMT students.
Day nap.
An interstice in EMS, we sit and comfortably eat. A rare moment.
Head wrapping a head injury
Post Cardiac arrest.
Arriving on scene with McAllen PD.
Sergio and his lunch bag for his 24 hour shift.
There are always things to do on a critical scene. Idle hands are lazy or ignorant hands. Again…. Idle hands are lazy or ignorant hands. If one shows up on the scene, ask yourself, how can I effectively help? Because if you gonna do something, do it once and do it right. If not, don’t do it at all. And that in itself is effectively doing something; don’t be in the way. This goes to any “ First Responders” that answer the call. P.S. Shout out to Peñitas officers who helped me and my partner in the recent cardiac arrest. You were all part of the team. We all equally carried the weight. Thank you. Teamwork makes dream work!
Medic 32/ Angel 1 / Penitas PD: 1 Death: 0
Every 6 seconds giving a breath as we make our way to meet the flight crew.
Morning unit check off
In between calls, messy or clean ones, a meal goes a long way in EMS. It’s really the only time for yourself when you give 12, 24, 48 hours or more of your time. That meal is not just any meal. It’s important. It can be interrupted at any time. Go all out.
Newton’s 3rd law: For every action, there is an equal and opposite reaction.
Switching main o2 tanks.
Medic 38: 1 Death:0
An EMS gatheing while waiting at the front doory of the ER.
Sergio spikes a NS bag to administer fluids to a dehydrated patient.
Responding to a pediatric cardiac arrest. 20 mins out… I prepare with crucial information to help the flow of the call. 1. Age. 2. Estimated weight by age. 3. Tube size 4. Tube depth 5. Epi dosage ( ML and MG) 6. Amio dosage 7. total mg of Amio 8. Shocking joules
S. Perez, EMT, mops the driver seat before clocking out from her 24 hour shift.
Medic 33: 0 Death: 1
Advance-EMT J. Pena sweeps the floors of the Sullivan Fire Department station that also houses Pharr EMS personnel.
We clean and ready the unit to go back to central and call it a shift.
Medic 16: 1 Death: 0
Load up and go… Patient on the stretcher, we rush out of the apartment to the unit to further help them with a life-threatening condition.
Walking in..
Since before the pandemic, Los Villas Taqueria by McAllen Medical Center has been giving out food to all first responders. Thank you, it doesn’t go unnoticed.
Post-call hangouts….
Medic 23: 1 Death: 0
At MMC waiting for our rooms…
We can only do our best in those times when patients refuse to get medical attention despite the life threats that present themselves. There are no wrongs in these situations because they have the right to deal with their consequences. Here, Paramedic and Rescue Raul Torres makes a great effort to explain the risks at hand for not seeking medical attention.
He makes an attempt to get food but soon walking in, he walks out due to a call. He walks back to the unit looking up the address.
Its been a long time since Ive worked with someone so skillful and proficient as a partner. His work ethics is impressive.
I care about you, he said to the patient, who voiced that no one from their family cared about them. He was able to convince them to go and get help. Caring is a universal skill anyone can learn to do.
I palpate her abdomen for medical reasons. She looks at me as I ask, Does it hurt? And she says no, in the sweetest old voice. She suffers from massive distention to her stomach, possible bowel obstruction, or worst, intestine paralysis. She also has Alzheimer’s, a disease that prevents any human from being coherent in life. But yet, the same disease protects her from her current condition and really, any other struggle in life. Stomach pains are crippling. They’re no joke. Now having massive distention, is an uncomfortable and painful experience for anyone else. What a silver lining….
IIt’s a skill developed over time to be able to get comfortable in the ambulance. No other choice when you’re in one for 12 or 24 hours at a time.
Gaby checking off the narcs as she takes over the night shift.
FD station No. 4, at the end of the city of Pharr, near the Mexican border.
A great secondary goes a long way.
Arriving on sene, car vs semi, we prepare for the worst..
One of after another, we roll in helping to our best ability and scope of practice.
Post transferring patient care.
On our last call, she has one more ride out.
Flight medic knowledge being used in real time. This is a portable ventilator, which breaths for a patient who can’t breath for themselves. It is important, without it, they will die.
EMT student Destiny on her 5th ride out.
Frequent flyer: Strangely, them calling, always, is an indicator of everything is abnormally-normal and when they don’t, it’s abnormal-abnormal.
I teach her how to draw and administer medication.
She checks the glucose level of the patient.
Giving her a chance to learn to start IV's
She fights cancer.
Paramedic and Supervisor Felipe checking the miles of each unit requiring fuel before fueling.
Roadside life-saving medical assistance at $19/HR in the year 2022.
Lunch during shift.
She prepares her breakfast at her station.
Students paper, rock and scissors each other to see who rides out with me. Who ever it is, be prepared to learn is what i say.
Newly certified paramedic Segovia riding out before she runs her own truck.
Medic 16: 1 Death:0 Convincing her, for she didn’t want to go. Perks of giving a shit.
Paramedic Eric (left) signs over the narcs during crew change.
Last patient at the end of shift
Angel 1 at MMC.
Patient alive and well, signing the report post saving his life. This is how I end my shift.
Unresponsive, to combative, to the best part, patient singing the report. Medic 31: 1 Death: 0
Officer helping a citizen get home.
He calls dispatch over the radion during a call.
Medic 31: 1 Death: 0
We take over and cover the area for other trucks can clear and go home.
6 am views, we respond to help PD.
Soria and I start our 12 hour shift with the usual, check-off.
A. Hernandez, EMT, (right), and his partner, E. Valdiviez, EMT, (left) wait for their truck to arrive to start their 24-hour shift.
EMT Lerma studies for his MCAT test during his shift.
Diane is one of many gatekeepers at central. She checks the temperatures of every employee coming in to shift to control the spread of Covid.
The Inconvenience….That reminds us that we are mortal and alive. It teaches us to appreciate and see life; to prioritize. And at any point, more inconveniences can occur. But don’t wait to be reminded. “ Inconvenience” is what this patient called this situation.
Arriving on scene with McAllen FD initiating first-aid.
She picks and prepares her bed, hours before seeing the station tonight. In hope that sleep is possible. Yes, thats a sloth blanket.
Search and Rescue: we enter the building in search of the patient. Situational awareness is key to safety.
Taking down necessarry tools.
A birthday sing along, the group of coworkers prepar to sing Happy Birthday to Ronnie, owner of Medcare EMS.
Flight Meeting No.3: Tier 1 medics, tip of the spear of EMS.
Medic 32: 0 Death: 0 No ciritial patients today.
Medic 32 with Ashley, EMT.
Medcare EMS and McAllen FD working together. “𝘛𝘦𝘢𝘮𝘸𝘰𝘳𝘬 𝘮𝘢𝘬𝘦𝘴 𝘵𝘩𝘦 𝘥𝘳𝘦𝘢𝘮 𝘸𝘰𝘳𝘬; 𝘮𝘦𝘢𝘯𝘴 𝘵𝘩𝘢𝘵 𝘦𝘧𝘧𝘦𝘤𝘵𝘪𝘷𝘦 𝘵𝘦𝘢𝘮𝘸𝘰𝘳𝘬 𝘢𝘤𝘩𝘪𝘦𝘷𝘦𝘴 𝘮𝘶𝘤𝘩 𝘮𝘰𝘳𝘦 𝘵𝘩𝘢𝘯 𝘢𝘯𝘺 𝘪𝘯𝘥𝘪𝘷𝘪𝘥𝘶𝘢𝘭 𝘤𝘢𝘯 “
“ Medic 33 on scene” We arrive to an MVC.
Police escort to the hospital.
Paramedic Espinoza calling EMS report over the radio.
Medic 33 with M. Martinez, EMT.
It was a different situation initially, but with the help of my partner. The patient sits upright and responds appropriately to my questions when arriving at the hospital. Medic 33: 1 Death: 0
EMT Michalk restocks her cooler with drinks and snacks that are provided by the hospitals. This gesture goes a long way when working 24 to 48hrs out in the field. It’s one less worry for a working medic. In order to help others, you first must be in good shape.
April, Supply Clerk, prepares the equipment for the trucks in the field to be kept fully stocked.
EMT Jazmin driving
EMT Davila in good spirits at work.
Only honored for a week.
Small units, very small.
Medic 16 with EMT Cruz. Here, we wait to transfer a STEMI patient out.
36 hour shift on going...
Posting on the side for Sheriffs to check an overdose scene.
Morale and humbling patches
Incoming cardiac arrest.
Keeping track of fuel in the units.
Our unit goes 10-7 with a patient. We call for backup.
EMT Puente camera shy
“𝘠𝘰, 𝘑𝘰𝘳𝘨𝘦. 𝘎𝘦𝘵 𝘮𝘦 𝘳𝘦𝘴𝘱𝘪𝘳𝘢𝘵𝘪𝘰𝘯𝘴.” Any student of mine is not just gonna sit and watch. They will take this great opportunity to be part of the team and put in work. Dirty gloves are working hands. Good job, Jorge.
Jorge, High-School/EMT Student, on his second ride out.
We wait. Nothing else to it.
McAllen PD calls for EMS help.
After multiple calls, he builds confidence to do more.
Long lines at DHR. I wait 5 hours this time.
A gesture from a local hospital.
We arrive at the receiving facility.
Here we go… we knock and we hear a voice telling us to come in.
From inside the patients house.
He studies cardiac rhythms between calls.
We arrive to clear the other unit.
The first 10-8 of the shift is right after checking off the unit.
Medic 34 with C. Rodriguez, EMT, with 16 years of experience.
Checking out the special paramedic candies : Opiates, Benzo’s and paralytic.
Early morning supply line.
Arriving at a definitive care.
Intubation kit is one of many skills sets as a medic.
Some of the medications medics are responsible to give.
Solo lunch at the station.
The long EMS lines at DHR.
M. Lopez, primary EMT, finishing her report as she waits at the EMS line.
Medic 33, first call at 10 am
Me
Shift change for that unit.
It was a slow ride out with zero calls for her.
We show up to a fire alarm but get cancelled eventually.
M. Saldana on her last ride out of paramedic clinicas.
Jesse reparing his rescue truck during shift.
Dr Van Kanawade, MD, presenting an orthopedic lecture on emergency manangement.
The end of shift, staying behind to train on my own. Practice and practice till I get it wrong.
In the medical field, you can’t save them all. It’s something you quickly learn and have to come to terms with. Despite all efforts, skills or knowledge, you just can’t. Death is part of the equation.
Flores, getting the stretcher ready.
Hospital on diversion, so we wait. Nothing new, except for a stressed and understaffed E.R. Doctor giving us attitude for bringing a patient to the hospital.
She has food on her mind.
It’s a known practice for some medics to let competent and trust worthy secondaries to start IV’s or push medications. It helps them to not do one more thing and it’s also an opportunity for the secondary to learn.
On the sun visor, Valley humor and words of frustration.
Medic 36 with C. Flores, EMT; not the first time we work together.
Critical Care 1: F. Alvarez, Paramedic, (left) and J. Montalvo, Licensed Paramedic, (right) flying to Houston.
Soria, cleaning the stretcher at MMC.
Medic 31: 1 Death: 0
M. Saldana, Paramedic Student, and A. Soria, EMT, unloading patient at the hospital. We get a save.
She was on her way out but we saved her; It was a great save. (GCS 3 to 14/ SBP 64 to 163/ HR 187 to 89)
On the way to help someone else.
Sleeps post call. EMS- Earn Money Sleeping.
A team of 3 helping a pateint with an arterial bleed to his head.
Medic 31: 1 Death: 0 (GCS3)
Medic 31 with A. Soria, EMT, signing my report. It’s been a few years last time we worked together.
Medic 71: 1 Death: 0 (AMS)
J. Garcia, Licensed Paramedic, checking in the narcotics at the end of shift.
EMS picnic at the wheel.
We part the sea of cars to save someone. Just like Moses and the Red Sea.
Long waits is the new normal.
At the EMS line at MMC giving report.
Walking in, always, with high quality of care, no excuses.
“Best job Ive ever had” It is I, in the back doing what I do, saving lives and taking photos.
Reports…..
Hydrating Pt at a high flow rate. She uses forearm strength to bolus.
After each patient, replacing the sheet with a new one after disinfecting the stretcher (including the straps) and any equipment used, is standard. But, poor work ethics or fatigue play a major role and some don't meet this standard. Here, K. Bernal, AEMT, meets that standard.
We arrive the hospital and she opens door “ You ready?” she asks, to take down the patient.
At scene, getting off the stretcher...
In a spontaneous meeting with Rescue at the EMS lounge.
R. Yanez, Flight Medic, in good spirits despite the shit storm happening at Medcare.
Saving lives at the Hidalgo port of entry.
The end of shift.
Doors wide open, airing out Covid from the rear compartment.
FD requested to gain entry inside., ETA 15 minutes as per dispatch. We wait….
No one answers the door, he tries to see through the window for the patient or someone.
Patient No.3 of the day, he signs the report to send it off to whom it may concern.
Straight into Covid...
Sometime between calls and food.
Police drag a patient to jail for intoxication after the Doctor refuses to help.
Paramedic Shatto giving report.
Restocking the truck to save lives!
Medic 38 with Sergio, aka Night-stalker, aka El Spidey, aka Latin Lover. First time working together.
Palmview EMS coming priority 1 with a trauma alert.
Frequently used to clean multiple units. I question the cleaning capabilities.
Fuel line at central.
A cold and windy shift with extra elements of danger today.
She works on her reports.
R. De La Garza, recently obtaining her Paramedic patch, struggles like every other medic did at some point in the beginning of their career, with reports.
Patient in distress.
Rescue 7 leading the way through traffic. We respond to another uni requesting assistance.
A significant head injury on the stretcher.
M. Saldana, Paramedic Student, evaluates the abdomen looking for abnormalities, part of the head to toe assessment performed on every trauma involved emergency.
She draws, leaving her mark, on the table at central.
Post-Covid patient No.1
Situational-awareness during a call is key for safety and may offer clues for the call.
She cleans the stretcher soon after transferring the patient to their room.
We wait for the room to be available.
A great amount of effort was made to find an alternative but gaining entry by force was the only choice in the end.
Rescue 7 responds to my overdose call.
Richard holds a quick training demonstration before medics go into the field. This training is how to convert Epi 1:1 to 1:10.
Rudy on a 48 hour shift.
The flow of a call and the workload you carry as a primary medic depends on who your partner is. For this reason, I’m selective to who I take with me to battle death. There’s no room for mistakes in this war; for every action there’s chances for life threatening consequences. Medic 42 with J. Cuellar, AEMT.
J. Cuellar, AEMT, finishing his report at the stop sign in DHR.
At DHR, waiting with a pt at the stop sign, signing my report because without his signature, I can’t submit my report.
My partner, E. Cordova, AEMT, with more than 20 years of experience.
Posting at McAllen Fire station 5, having my lunch (Thanksgiving left overs) in the unit because we’re not welcomed inside by FD.
Inside of Station 3, Christmas spirit at the end of November.
It's a slow, cold and gloomy day at staton 3 in the North side of McAllen.
6 am views, I start shift on Medic 35 in the South side of McAllen.
It's rare to see this old ambulance vans since the take over of the new modern designs.
That’s known as the captain chair and captain area. That’s my area, look at me, Im the captain.
We stand by at an event at Firemen Park in McAllen.
I was told once “ Medics” were like pirates. We dock at many ports (hospitals) and take what we want. This port is at DHR.
There’s always a difference made on ever shift. But, there is that one shift that stands out from them all. The one that you learn that there's a difference in the "difference" you make. You see the impact you’ve made despite knowing all paramedics have the same knowledge and same skills as you do. It shouldn’t be that different but yet, it is. Who you are and what makes you, you, is what made it. And no other medic that takes your place would have gotten the same result as you did. You know this. You’ve been told his. This is the kind of shift I had on this day. It was a good day.
A little more than 3 years ago, E. Hernandez, License Paramedic, was an EMT and worked with me as a secondary. He now sits in the primary medic seat, running his own truck with his own secondary.
There was a time I didn’t think I would see this view again. I wouldn’t be sitting inside of an ambulance as primary medic. But here I am. Finding my rhythm again, It feels good to be back.
Posting... I find it odd randomly posting at spots in the city, waiting for the next emergency. Cars peacefully navigating on near by streets and businesses going on as usual and there sits an ambulance with two medics inside waiting for chaos.Suddenly, the ambulance moves and lights and sirens go off. And for the most part, cars stop but not all. The lives that fill those cars react in panic, in prayer or in anger cause theres an interruption in life. Soon as the ambulance speeds through, life continues again. To me, this is quite odd.
We arrive on scene and immediately canceled by dispatch.
We get the shift started as Medic 14 (Edinburg) but eventually end up as Medic 37 (McAllen) because they needed MICU coverage.
We were all waiting in the moment; some for their supplies, some for the shift to end ,some for a truck to breakdown and some for their truck to arrive.
Thats my old supervisor, Juan Martinez, Licensed Paramedic, when I was a full time medic. Good supervisor who took care of crews who put in work.
These machines take no breaks and they’re constantly abuse until they breakdown. They run 24/7, 365 days on repeat.
A tribute to Armando Amaya on the window.
In between call, we sit around, continuing where we left off or finding things to keep our minds distracted.
Seconds away from calling 10-8 “ In service”
Starting shift with units fueling up at the gas pump at central.
The VIP w/ their Mercedes SUV
It’s the first day at his first EMS job, fresh out of high-school and EMT school. I cant help but see myself in him. I was once there too, a few years back. Sitting in that chair, just as many others before me have. It’s a special day. Life is never the same, after the first day.
I get nostalgia walking back to EMS. Just like going back to the halls of high school. This is where I started my paramedic career in 2014. I make my return again.
Scott,(sitting), Eddie (left) and Jesse (right) discussing the call that was just accepted for transfer to Houston, TX.
Scott, Paramedic and Flight Director, speaks to the group of flight medics about the future of the flight program
R. Becerra, Flight-Paramedic and Clinical Coordinator, screens a call for flight to meet the patients need.
Bill, Chief-Pilot and Paramedic, explaining to the group of flight medics, the proper way to load a patient and equipment into the plane.
A tour of the Cessna 414 at the airport, second airplane for Medcare EMS Flight program.
Flight Meeting No. 2 at central, we get certified with Medcare to do flight calls.
At the end of my shift, this is my view, with the last 30 minutes being the longest.
“ Code Blue room 652” said the intercom as we got off the elevator. That is my patient, who I was gonna transfer to another hospital.
My partner sleeps for hours cause it was a slow shift.
Medic 32: 0 Death: 0 Cancels: 2 It was slow shift and its the worst type of shifts for me.
A major MVC but no transports reported Medic 35.
We cruise through a call another unit is attending to.
They get screened before heading home for having Covid related symptoms.
Medic 32: 1 Death: 0 (AMS)
Post late call, we clean the unit before heading back to central and calling it a good shift.
It’s almost crew change, 30 minutes to go. But, I don’t mind a late call.
She prays for the Police to cancel us, as we post a few blocks from the call. Her prayer comes through.
Air drying my 3M respirator after a positive Covid patient. He was young and struggled to breathe with a Spo2 of 76% room air. This could be me in the future, soon or eventually. It's not if but when. We will all get it one way or another. This man-made virus, recently discovered through a congressional hearing, funded with U.S. tax payer money, is now part of our eco system. Set your affairs, eat healthy, take vitamins (vitamin d), exercise and live, always, like tomorrow is not coming. Make it count.
She hides behind the tablet and points at the marks the N95 mask left on her face.
She takes EMS report, but before she does, she attempts to calm her self down. The hospital is packed and patients don’t stop coming.
Medic 32 and Medic 34 secondaries, both EMT, waiting by the EMS hall inside MMC.
I get fed today by a friend from the hospital. Thank you.
She listens to the patient who is feeling alone in this life. She later says, not many people listen to others and makes an effort to change that when she can. I agree, not many listen to listen. Most listen to respond.
Medic 92, P. Arredondo, Licensed Paramedic and E. McLaughlin, EMT, waiting for a room.
EMS life at the hospitals, waiting…….
She is not feeling good and yet, she comes in to work to help others who are not feeling good.
We wait to get triaged by the charge nurse. This is standard operation procedure.
She restocks the truck with the supplies we asked for.
Medic 32 with M. Lopez, EMT, we check off our unit. First time we work together.
We enter the gates of RGR to deliver a patient at the end of my shift.
There’s a change that happens to students from the first call to a couple calls later. They start the shift nervous, afraid and unassured and eventually, they participate, feeling confident and taking the initiation on calls.
We post. He chills. I eat lunch. Thanks, Mom.
Medic 32: 1 Death: 0 Clean uniform: 0 Blood on uniform: 1 (AMS)
She helps me save a patient from death. Here, she looks through my notes of the call.
My partner for the shift, sleeps on the couch post first call.
Sleeping quarters in the dinner room area of a apartment that has been converted to an EMS station.
A physician, waiting and in deep thought outside of the hospital. Whats wrong Doc?
F. Alvarez, Paramedic and Rescue 1, on gas duty for C-shift.
The sirens stop. Lights flash. Doors open. Footsteps are heard. Doorbell rings. And we wait, wait for the unknown behind the door.
It's a cold shift, this EMT walks from her unit to supply and back with a blanket.
S. Davila, EMT, checks her unit, Medic 35, while she waits for her partner to arrive.
Medic 32: 1 Death: 0 (LHF)
She checks patients lung sounds after asking me about them. I push her to get personal experience that will help her in her EMS career.
It's not about genders, skin color, what god(s) you believe in, status quo or what department you work for. It’s all about the human in need in that very moment. From that need, a team forms and can you help the team help that human, that's it. Everything else is nonsense.
I encourage her to do more on each call.
M. Herrera, EMT Student, on her second ride out, checking the patient’s medication on the way to the hospital.
He checks “ the blue bag” that has some necessary medications and tools in it before giving them out.
Sol from supplies, getting supplies for a unit.
She sneaks a nap before the first call.
The shift change, medics come in and other come out and head home.
J. Solis, Paramedic, orginizing the morning shift as people show up to the shift.
He sleeps in the unit while I finish my report at the hospital.
Boredom kills. I listen to music. He watches Netflix.
We wait…
No beds….
A good secondary helps a great deal, he helps me out with certain skills while I check monitor and other things I must complete.
McAllen PD needing EMS help with this dramatic scene.
The essential medications I must know everything about.
We arrive at the hospital with patient 1. We’ve done everything we could, time to unload and let the hospital help.
Medic 32 with R. Melchor, EMT, checking off the unit. He checks the half of the unit and I check the other half. First time we work together.
We all wait our tun to turn in our check off sheets and then we wait to get our supplies.
For some reason, we find it funny for women driving really close to the steering wheel with the chair inclined forward. So, she drives in this manner while we crack up.
I study, waiting for the first call all day.
The view at post 18…..for more than 3 hours.
She watches a show on her phone while we post at a gas station. Boredom is the second killer in the job next to complacency being number one.
J. Garcia AKA “Tonto”, Paramedic, shares his weird tranny call he had last shift with us.
We gather for a Holiday lunch and we bullshit.
Medic 35: 0 Death: 0 Zero calls on this shift.
She fought my photography process but eventually she gives in and trust me hours later. I finally got a solid photo of her.
McAllen FD responding to a structure fire.
Medic 37 checking off their unit just as we, medic 35, goes into service.
J. Montalvo, Licensed Paramedic and Rescue, talks to a co-worker and has himself a smoke before starting the shift.
My first unofficial paramedic student I start training.
Randomly biking around in The Grinch costume taking pictures with people.
“All done!” She says after signing the report post refusal.
At Mcallen Heart port with the first call of the shift on Medic 35.
Medic 36 arriving on scene to a MVC as the second unit as requested by Medic 35, first unit.
Fueling up with snacks at a local grocery store, parking at an accessible area to respond to a call.
The long EMS line at DHR. 2 hours plus waiting….
Mother saves me. She cooks for me. You're the best, Mom.
Upcoming company celebration. To go or not to go, is the question.
The start of A-Shift, trucks are being checked and resupplied.
EMS Life…..
Medic 36: 0 Death: 0…... It was a slow shift.
J. Cuellar, AEMT, disinfecting the front while I disinfect the back. A must to do before starting shift and after each call.
A spotter is used to back an ambulance to prevent hitting someone or something.
D. Lagas, EMT, puts on gloves to clean her unit before going into service at the beginning of her shift.
M. Palacios, EMT, mops the unit at the end of a busy and sleepless 24hr shift.
Medic 31 resupplying post cardiac arrest. To save a life, especially in a cardiac arrest situation, a great amount of effort and supplies is required.
The end of my 12 hour shift. One shift down, another one to go..
Off-load and then upload on repeat.
A soul in need at the MMC gates
Walking into the hospital because the hospital needs EMS help with a patient.
To the left, always.
Reports are a tedious process but essential for each emergency.
Officer Vega with the McAllen Police Department, arrives on scene and with an impeccable skill, opens the locked door in less than 30 seconds, saving the day.
The most important meal of the day is the first meal soon after calling 10-8 (in service)
Medic 37 in service and in the streets. Let's go!
M. Palacios and I getting our supplies to resupply our unit.
Medic 37: 0 Death: 1 (N)
B-Shift ends and C-Shift begins.
Dispatch at their command center.
Lights and sirens on, this car attempts to enter our lane. It was close but we're not hit today.
On the way to the hospital, patient resting their head on the cabinet.
My partner helping me assess the patient.
Some bring food to work and others buy food when they get chance. It’s at a risk of being interrupted by an emergency. There’s no official lunch breaks in EMS.
A. Hernandez, Provisional Paramedic, checks off her unit at the beginning of her shift. A duty that is performed each time a new shift starts.
She touches up her made eye lashes. One of many worries women in EMS worry about, their war face.
Medic 33: 1 Death:0 (Bleed)
Lights and sirens on. We always travel on the left lane and force cars to the right.
Stretcher, trauma bag and cardiac monitor is the minimum equipment for most emergencies.
My partner decons the equipment after a call as I finish the report.
She cried out of fear and I did my best to provide emotional support.
There are different topics of conversation with every secondary I work with. Not one story is the same. It’s quite interesting the subject you cover in a shift. You quickly get to know someone. On this shift with L. Villarreal, EMT, we talked the entire morning, before the sun came out, about animals; we googled owls and foxes. We even saw Youtube videos about owls being rescued. It was random but it was quite entertaining.
Post-scenario: Richard, Licensed Paramedic, goes through the call with the team.
The simulator is active and running with the first crew inside.
S. Dillman, Neonatal Resuscitation Instructor, shares life saving information.
They set up the mannequin to simulated a delivery.
Setting up the command center, where the scenarios will be viewed from.
A $2300 premature neonate mannequin that reacts to interventions.
Ambulance Simulator: OB and Pediatric Emergency edition.
J. Hernandez, Licensed Paramedic, comes in for the second half of Medic 37. He checks the intubation kit even though I checked it this morning. This is standard for a good and responsible medic with a good habit. Good habits are important to have in anything you do, but more so in EMS. It’s essential for a long and successful career in EMS that benefits you, your peers and patients.
He watches a movie while I finish my report after a call.
Waiting at the EMS line inside MMC.
We arrive at MMC port with a human in need.
Sundays usually start slow, 5 hours later, we get our first call.
Homemade lunchables; saves time and money during shift. A full medic is an effective medic.
Full time EMT and Full time student takes a toll. He sleeps on the stretcher as we wait for the first call.
Kumpf and Isabel smoking at the smoking section at central.
It’s a Sunday on Medic 37 with G. Kumpf, EMT, who is currently a Paramedic student.
Leaving DHR port at the end of my shift just as the others continue the second half of a 24hour shift.
My unit, Medic 37 on B-Shift.
We wait in line at the receiving facility.
My usual view as we make our way to the hospitals.
Responding to a call at PD jail; we wait for the gates to open.
Coming up to the traffic light with lights and sirens on. Today is not the day we get hit.
Before any call, my partner requires coffee.
Medic 37: 0, Death: 0 Psychs: 3 It was a shift w/ drama.
Driving up to the main station to clock in and start the shift in this cold Saturday.
Many in EMS go unrecognized. Lets not forget there is people still out there living their lives because of those who wake up everyday and put themselves in the position to help them and others. One day, we will be noticed and recognized properly.
Names of those who lost their lives on duty.
Day one of the new EMS Memorial Service.
Rudy Rodriguez speaking the name of Felipe Huerta Jr, who passed away on duty.
At the end of my shift, I gather with other medics and share a laugh or two. .
12 hours later, we enter the night and the end of the shift.
Many years coming to my house during shift and not once did I ever photograph this until today.
Arriving at the hospital, a group of people gather outside celebrating the discharge of a patient, who survived Covid.
Coming up to the traffic light with lights and sirens on. Today is not the day we get hit.
Post call, at the hospital, she finally gets to eat her lunch.
From the inside of a building, were we stop for breakfast.
Supply window; waiting for my supplies.
It was more than 3 years ago we first met. She was an EMT student riding out for the first time and I was her preceptor. Today, we work our first shift together as friends and co-workers. And through normal chatter, she shares the story of her fathers accident that occurred before she joined EMS. Unknowingly to both, I was the lead medic on that call. It was one of those calls I can't forget and in some degree, it had an impact on me. She wanted to know all these years who the medic was just as much as I wanted to know how the patient recovered from that. Life has many ways of connecting people. Life is fascinating. Medic 37 with M. Palacios, EMT.
We start the process of checking the unit in the morning.
F. Alvarez, Paramedic and Supervisor, managing the trucks in the beginning of C-shift.
M. Palacios, EMT, and I meet up at the hospital. She is camera shy but yet, wants to be documented.
We wait for the gates to open.
“Is this it? The day we get hit?” A critical moment when coming up to traffic lights with lights and sirens on. I prepare myself by visualizing the crash and having to attend myself, my partner and then those who are involved; if only my injuries allow me. Soon, after passing the intersection, I focus again on the original emergency……..until the next traffic light.
Post-call, we chill, reflecting back on the call and the others before.
She reacts to the print of her portrait I just took.
My partner signing my report. I do my best to submit an accurate report soon after each call. I dislike stacked reports and having something pending.
A life changing event; we help with emotional and physical pain that comes with it.
Driver/EMT student and EMT helping me with the weight that comes with helping others.
Today, I save a life with the help of my secondary and a student. Medic 32: 1 Death:0
The end of shift, the traffic jam delays our return to central for shift change.
Arriving at the hospital, we off-load the patient.
From Donna to Harlingen.
She blocks the sun from hitting the patients face with her arm.
After cleaning the stretcher, they're loading the stretcher back into the unit to eventually get back into service.
New gadget, first-time using nasal capnography.
We respond to Donna International port for a sick call.
Light + sirens = cars sliding over.
Medic 42 at Donna fire station.
