He saw a flash of light. Before he knew it, his hands, arms, and face were badly burned by a surge of electricity.

 

Now Joe Kiss, a veteran electrician, rests in a Camden emergency room. The hospital staff dressed his burns, administered pain medication, and hooked him up to humidified oxygen. But he'll need high-level care from a burn specialist. They're transferring him to Temple - the region's only burn center at a Level 1 trauma center.

 

Steve Teitelman, RN, CCRN, and Frank Mitchell, RN, from Temple Transport Team (T3) enter the hospital room, dressed in matching grey polo shirts, black slacks, and heavy-duty work boots. After some quick introductions, they converse with Kiss and ready him for the trip.

 

"How's your pain?" Teitelman asks.

"Okay," Kiss answers. His swollen face forces him to squint.

Teitelman leans close, carefully lifting the oxygen mask to survey the facial burns.

 

"Is it bad?" Kiss asks shakily.

"No," Teitelman answers without hesitation. "These spots here and here, those are second-degree. The rest are first-degree. Looks like a bad sunburn."

"Good," the patient's broad shoulders relax a little. "I haven't looked yet. That's good that it's not horrible."

Teitelman gently brushes the patient's burned hairline, which is visibly darker than the rest of his hair. "Looks
like you got a bad dye-job, dude!" Teitelman says.

Kiss laughs, his tattooed chest heaving a little. Teitelman explains that, in cases like this, the main area of concern is the throat. Get burned there, you have big problems. Teitelman takes a quick look inside the patient's mouth. "Nice and pink," he reports, prompting more chuckles from Kiss.

Mitchell fills out a detailed report, exchanging information with the ER physician and nurses. He wants to make sure everything is in place so Kiss's treatment can continue en route to TUH. As a thoughtful last step, he grabs an extra blanket and lays it across Kiss's chest.

T3 isn't an ambulance company. It does a lot more than just move patients from Point A to Point B. Teitelman and Mitchell aren't "ambulance drivers." They're critical-care
transport nurses with 30 years of experience between them. And this T3 ground vehicle isn't just an ambulance.
It's stocked with more sophisticated equipment and a much larger collection of medications than your standard-
issue emergency transport vehicle.

The combination is best described as a "mobile intensive care unit," as T3 Director of Operations Thomas Kurtz puts it. And, once secured in this mobile ICU, the patient receives a level of treatment very few Philadelphia-area
patients get during transport.

"You know, my pain is getting pretty bad," Kiss says a few miles into the trip. Mitchell immediately administers
IV pain medication.

"Better?" Mitchell asks.

"Yeah, a lot better," Kiss answers.

Then, with a bit of a struggle, he leans his head toward Mitchell and says, "Where'd you get your training at?"
"I've been a critical care and ER nurse for nine years," Mitchell replies, glancing over his shoulder at a monitor to
check Kiss's heart-rate.

"That's good," Kiss says as the ambulance hits a bump. He's relieved to be in such capable hands.

This is what T3 does about 1,500 times a year - transport high-acuity patients from community hospitals to TUH and provide high-quality care during the ride.

 

 

Beacon House, an unassuming red brick building next to Episcopal, houses most of the T3 operation. It looks more like an apartment building than the headquarters of a highly-trained critical-care transport team. Inside, things are quiet - for the moment.

 

With no warning, pagers start vibrating in unison. A heart-attack patient needs to be transferred from the Northeastern Hospital (NEH) emergency room to the cardiac cath lab at TUH. T3 handles about 4,000 patient transports among TUHS entities every year.

The characters "D-2-B" in the page message reveal that this is an especially time-sensitive transport. "D-2-B" is
shorthand for "door-to-balloon" - a national critical-care benchmark designed to drastically improve outcomes for
certain types of heart-attack patients. The clock starts ticking once the patient arrives in the emergency department and stops once the blocked heart artery is opened via balloon catheter.

Timothy Lydon, Mitchell, and Teitelman respond to the call. It's a bitter-cold morning with temperatures in the 20s, so they throw on their T3 uniform fleece jackets before marching out to the ambulance.

Joumar Miranda, an EMT from American Medical Response (the company T3 contracts with to provide the ambulance drivers) fires up the engine.

The ambulance rumbles down Lehigh Avenue. Teitelman flips open his Nextel and calls the charge nurse at NEH.

"Hey. It's Steve from T3. We're on the way to get that D-2-B. What drips is he on?"

"Is he stable?"

"Good BP?"

"We'll be there in a few."

The distance from Episcopal to NEH is less than 2 miles - just enough time to call for the patient status and ready
whatever intravenous medications the patient may need.

Teitelman snaps open a drawer and prepares a nitroglycerin infusion. "This is our office," he says, gesturing toward the neatly-arranged cabinets and drawers that line the interior of the ambulance. "We know where everything is."

"You can't open a book when a patient is dying in front of you," he adds. "You need to know what to do, and
where things are, before you can do this job."

The ambulance revs into Northeastern's ER parking lot. Lydon quickly makes his way into the ER while Teitelman
and Mitchell unload the stretcher.

Inside, they find the patient. Lydon negotiates his stethoscope past all the tubes hooked to the man’s chest so he can listen to his heart and lungs.

"Any allergies, pal?" Lydon asks.

"No," says the patient.

His relatives stand nearby, visibly concerned.

"How you feeling?" Teitelman asks the patient. The man shakes his head disgustedly.

After a short discussion about the patient's pain level, Teitelman sprays nitroglycerin into the patient's mouth and hooks up the heparin infusion.

Then, the T3 responders surround the patient, count to three, and lift him onto their stretcher.

"You're doing great, pal," Teitelman says as they wheel the patient toward the exit. 

 

 

 

The dispatch orders blare from the walkie-talkie, "Proceed directly to the cath lab."

"Did they explain the procedure to you?" Teitelman asks the patient.

He doesn't answer, so Teitelman calls upon his years of ER experience, synthesizing the complex medical procedure description into direct, patient-friendly
language.

"Think of your heart arteries as highways. They're the highways the blood has to travel to get to your heart. This procedure gives the doctors an aerial view of those highways so they can see where there are jams - where the traffic isn't getting through," Teitelman explains.

The patient nods but says nothing.

As the vehicle backs into the TUH ER lot, Teitelman quickly Nextels the TUH charge nurse to alert her of the patient's arrival.

When the patient arrives at the cath lab, the hospital staff is already prepared to continue his care. Lydon offers the attending physician a brief summary of the patient's condition and prior treatment.

Minutes later, images of the patient's heart flash across monitors in the lab's control booth. Several of his arteries
look remarkably like the "highways" Teitelmen described where the blood "traffic" is blocked. "See all those
pinches?" Teitelman says. "He has extensive heart disease."

In a flurry of activity, nurses surround the patient and ready him for emergency surgery. Physicians review the
patient's EKG and angiogram images to determine where to place artery-opening stents.

Mitchell watches the imaging screens. "The stents look like click-pen springs," he observes. For the first time
in several hours, he stands still for a brief moment.

But not for long. His beeper just went off.

--Thomas Mitchell