On the front line of medical emergency

A Shanghai Daily reporter spends a day with an ambulance crew, where a tense job is measured in minutes and performed against a backdrop of mitigating problems.

Filmed by Tang Dafei and Tan Xinru. Edited by Zhong Youyang. Translated by Shen Tianyu. Polished by Andy Boreham.

Tang Dafei / SHINE

Yao Ming is one of the city’s most experienced emergency doctors in the ambulance squad that responds to emergencies. He’s been at the front line for 30 years.

On a scorching summer morning, doctor Yao Ming sits beside the telephone in the Hongkou substation of Shanghai Medical Emergency Center, waiting for any hotline 120 calls to be sent his way.

Yao is one of the city’s most experienced emergency doctors in the ambulance squad that responds to emergencies. He’s been at the front line for 30 years.

Tang Dafei / SHINE

Doctor Yao Ming (left), driver Chen Bin (middle) and stretcher bearer Wu Ye provide first aid to a patient in an ambulance. One ambulance is usually staffed by a three-member team like the one seen here.

At 9:10am, the phone rings. A Metro passenger at Line 10’s Tiantong Road Station is suffering what may be a heart condition. Yao and his team reach the station in five minutes. The passenger, surnamed Zhou, has a rapid heartbeat, and his legs and arms are numb. 

Yao gives Zhou a saline injection in the ambulance and makes an initial diagnosis. Zhou, he learns, suffers from arrhythmia, and his symptoms may have been triggered by the heat and lack of rest. The ambulance reaches Shanghai General Hospital in minutes, where Zhou is immediately taken for an electrocardiogram.

Tang Dafei / SHINE

The ambulance crew arrives at Shanghai General Hospital, where their patient is immediately taken for an electrocardiogram.

“We ask for patient’s choice of hospital first,” Yao says. “If there is no particular preference, we send him to the closest hospital.”

Yao receives his second call of the day at 10am. A colorectal cancer patient has lost all feeling in one of his legs and needs to be transported from his home to a hospital.

“Picking up patients, especially the elderly, who cannot walk is a difficult maneuver if they live in old neighborhoods,” says Wu Ye, a stretcher carrier and assistant in Yao’s team. “Sometimes stairways are narrow and steep. Extreme weather like heavy rain can complicate the situation. Most of us, including the doctor, suffer lumbar pains after years of work.”

One ambulance is usually staffed by a three-member team — one doctor, one driver and one stretcher carrier. Yao’s team works for 12 hours on a day shift, from 8am to 8pm, followed by a night shift from 8pm to 8am the next day. They then get a day off before starting another day shift.

“There are no holidays for us, not even during the Spring Festival,” says Yao. “I haven’t spent a New Year’s Eve with my family in years.”

The team typically receives an average eight to 10 calls a day. When demand is high, the number might be doubled, leaving them almost no time for rest or meals.

“We grab a bite to eat whenever we can during small breaks, sometimes at street-side food stalls” Yao says. “We often have to finish our meal quickly. If an emergency call comes during a meal, I tell my staff to take another bite of meat and leave the rice behind.”

Tang Dafei / SHINE

Yao tries to ease an elderly patient’s discomfort at a nursing home before putting him into the ambulance for emergency medical treatment. 

The most urgent call of this particular day comes at 2:13pm. A 69-year-old patient at the Hongrong Nursing Home has suffered a sudden drop in blood pressure. Medical records provided by a relative show that the patient suffered a stroke in the past and also has an inflamed gall bladder.

Yao spends half an hour trying to ease the patient’s discomfort at the nursing home before putting him into the ambulance. His initial diagnosis: septic shock, which can be life threatening without immediate medical treatment.

“His blood vessels are in poor condition, leading to bad blood circulation,” Yao says after the patient has been dispatched to Shanghai TCM-Integrated Hospital. “I gave him an injection to help raise the blood pressure. I was told he had not been eating well in the past few days. Lack of nutrition is a partial cause of low blood pressure.”

Yao says every patient presents a new challenge for the team.

“We have to get as much information about a patient’s medical history as possible, and make a quick judgment in a very limited time,” he says. “Unlike doctors of hospital emergency rooms, we usually face these challenges alone, which requires a lot of experience.”

Before working on an ambulance crew, a doctor usually requires at least five years’ experience working an emergency room, but the current shortage of emergency room doctors often means fewer years of experience.

“Patient complaints about doctors, coupled with low pay, have resulted in a loss of medical emergency professionals,” Yao explains. “Additional ambulances cannot be put into service due to lack of staff, meaning that patients sometimes have to wait a long time for an ambulance to arrive. That just leads to more tensions with patients. It’s a vicious circle.”

He said relatives of patients frequently complain about slow response times.

“I confess I grow tired of explaining to them about high demand and staff shortages,” Yao says.

Shanghai has a network of 157 pre-hospital medical stations and one ambulance for every 30,000 residents, though a certain number of ambulances are not in frequent use because of inadequate staffing. On average, ambulances reach downtown emergency victims in 12 to 13 minutes.

In the first half of this year, local ambulances responded to 403,000 calls, mainly involving elderly people with medical emergencies like heart attacks or strokes. 

Yao says public misuse of ambulance and emergent medical resources is another serious problem.

“Only about 10 to 20 percent of calls we receive are true emergencies,” he says. “Patients have other transport methods available in non-urgent cases. Citizens need to understand that an ambulance should be called only in true emergencies.”

Yao’s team also provides medical backup at major events, including international exhibitions and marathon runs. A digital dictionary on his cell phone is used to communicate with foreign patients.

“We are cautious when dealing with foreign patients, especially those from Western countries who are used to contacting their family doctors before allowing us to start any treatment,” Yao adds.

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