A Mountainous Ambulance Ride-Along, Ecuadorian Style

There is nothing quite like a Friday night in the emergency department at the regional hospital in Cuenca. The previous Friday, prisoners streamed in throughout the evening after eating bolts and screws—I guess that is one way to get out of the high-security prison. Well, this last Friday did not disappoint either. It actually started off pretty slow, but soon picked up as the night drew on. As the ER was getting pretty crowded, I volunteered to ride along with the MSP Ambulance stationed at the hospital to take a researcher out of the ER. Essentially, that meant I sat outside the ER watching for incoming ambulances and working on Spanish vocabulary until the ambulance got a call. I was looking over “gordo/flaco” and “blando/duro” when Leonardo rushed over to me and said they just received a call. He asked if I had a jacket because we were heading up to Cajas, where it gets quite cold even in the day. I replied in my broken Spanish, “no, pero listo...soy de Alaska.” Leonardo, Victor and I jumped into the new Mercedes Sprinter and were off.

New Mercedes Sprinters are commonly used by MSP throughout Ecuador 

Unlike in the US, MSP’s ambulances usually go out with a doctor and a paramedic on board (based on the European model). Victor, our fearless paramedic, drove us through Cuenca in record time, flying within inches of other vehicles. Victor and Leonardo (the doctor) had clearly spent a good amount of time together and worked well as a team in preparation for the call.  Victor sped as Leonardo prepped the IV. As we cruised up the mountain pass, Leonardo explained to me that a truck had flipped with four people inside and that the Red Cross and firefighters were also sending ambulances to the site.

To give you some context, Cuenca sits in the Andes at 8,200 feet above sea level, whereas the accident occurred on a mountain road in Cajas National Park at 12,200 feet above sea level.

This picture was taken during our first week when we went hiking in Cajas. In the background there is a windy road, and the accident took place just at the end of the road on the left side of the picture.

My view on the ride up the mountain.

Thanks to Victor’s driving we were the first ambulance to the scene (the firefighters already had the road blocked off), and with a doctor on board, we had the responsibility to take care of the highest priority patient. A large group of people crowded over the 4 wounded, who had been placed on the side of a hill next to the flipped truck, and let Leonardo through as he rushed in to perform his initial assessment. By the time we had patient on the body board with the cervical collar placed, most of the other ambulances had taken off with their patients. Once inside the ambulance, Leonardo performed a more in-depth assessment. The patient felt pain in his chest, but Leonardo could not hear any signs of fluid or air in the lungs. His vitals signs were in the normal range, and he appeared relatively stable, although in pain. Leonardo placed the IV, and we were off again to the hospital, although a little slower this time.

Crowded scene just after arrival

The crowd let emergency workers through. Red Cross in the back 

Leonardo's initial assessment, and Red Cross about to transfer a patient

Red Cross leaving the scene

We eventually pulled up to the emergency department, and as we swung open the back doors of the Mercedes, we were greeted by a crowd of people—the patient’s family, who had been eagerly awaiting his arrival. One of them broke into tears after seeing his condition. With all the rushing, I found our arrival quite ironic. We wheeled the patient into the ER and everything seemed to just slow down. Leonardo presented the patient to three different doctors over a period of 20 minutes, the time it took to transfer the patient from the gurney to a bed (they had to wait until another body board could be found in the hospital). It should be noted that the patient seemed to be in a stable condition, and Leonardo even had him smiling before the hospital’s back board could be found. Still, I found it interesting that the pre-hospital care was pretty efficient in this case, and it was not until we got to the hospital that things seemed to slow down (an interesting observation in the context of our research). Overall, it was a heart-pumping learning experience, and I am grateful to VCU and our partners in Cuenca for the opportunity to study medicine in this way.