By Antonio Graceffo
Third of three parts

Editor’s note: Read parts 1 and part 2

EMTs in the Philippines have not cross-trained as most police and therefore don’t have knowledge of advanced first aid. They also don’t learn rescue. Erik, one of our professors, told us, “You are EMTs. That means no Spiderman. No rescue, no rappelling, no defusing bombs, and no terrorist threat elimination. You only think about the medical.”

Too boring. I want to change courses.

Sir Erik told us how to do triage in Manila. “If you have one patient suffering from a gunshot wound and one with a sprained wrist, who do you take to the hospital first?”

Answer: the rich one.

Sir Eric lectured us about the golden hour. Basically the brain starts to die after 4 minutes. It takes ten minutes of no oxygen for the brain to completely die. The next deadline is the internal organs, which start to die after 50 minutes. We call it the golden hour—the narrow window of time we have to respond and take the patient to the hospital.

Of course the hour starts when the patient gets hurt, not when we arrive. We are told that our goal is to spend only ten minutes on site.

In the US, someone sees an injured person and calls 911. The dispatcher uses GPS to locate them, gets some pertinent information, and sends out an ambulance.

“But in Manila,” laughs Erik, “things don’t work the way they do in the States. If they see an accident, they call an emergency number. The dispatcher asks, ‘What kind of emergency do you want: police, ambulance, or fire?’ You tell her which one you need. Then she asks, ‘Where are you?’ It’s not always easy in Philippines to know where someone is, so a long discussion follows. Then the dispatcher looks up your location and gives you a landline phone number for the closest command station. You call them and they refer you to the specific station. You call them and, assuming they answer the phone, they come. A lot of time is lost in traffic in Manila, where it could take over an hour to travel five kilometers. Also, a lot of time will be lost looking for the place. When the ambulance arrives, the police are not trained and don’t necessarily take control of the situation. Often the crowd is a huge impediment to the rescue workers.

“When you have an accident in the Philippines, the first people to respond are the onlookers.” In a country where many people don’t have a lot of disposable income and aren’t bogged down by a job which eats up their time, EMS emergencies can be seen as a cheap source of entertainment.

“The second group to arrive is the media. Then the politicians.” Ostensibly this ancient system of ward bosses still exists where they would show up and shake babies and kiss hands. “Next comes EMS. Once we are sure the situation is safe, the police arrive.”

EMS does its job and transports the patient to the hospital. At present there are only three trauma centers in Manila. It could take ages to reach one of these trauma centers only to find out that the hospital is full and you are being turned away.

The golden hour could easily turn into the golden three hours, especially if your patient is poor. For rich people, once again nearly everything is possible with private ambulances and private admission to the best hospitals.

Determining pain
In primary assessment training, we ask the patient, “What is the quality of the pain?”

Quality? It sucks. It’s pain, so I would say the quality is quite shitty.

Our reference book suggests giving the patient a scale so they can measure their pain. The example given uses a scale of 1 to 10, with the latter being the highest. The book stresses that this is just a suggestion, and we can do it how ever we wish. Given that creative freedom, I prefer a scale of 3.9 to 11.7 with 11.7 being the lowest.

We studied ten ways to tell if your patient is unresponsive. Aiden pointed out it is pretty easy to determine. “Just say hello to him, and see if he answers. Ask him some questions and see if he gibbers nonsense.”

All the guys in my class knew that Master Frank is the one who took me to the school. They all love the UFC and knew that referee Big John McCarthy is a paramedic. They love martial arts and found my videos on line. Now, they all want to learn kuntaw. It was one more sad example of a piece of local culture that is dying. I have studied the ancient Filipino martial art of kuntaw, but they hadn’t.

This course is excellent. I am learning some interesting stuff like, what the hell is a spleen? I mean you’ve heard of the spleen, but what is it?

I am always amazed at the English spoken here. They do prefer to speak Tagalog to each other, but when they have to talk to me in English they are all near-native speakers. They watch all of our movies and eat at Taco Bell. So the cultural differences are not so huge, except for the time issue.

I wrote in my notebook, “Cytoplasm is made up of protoplasm and occupies the space between the plasma membrane and the nucleus.” How many times have I written that exact sentence in my life? Probably at least five times between fourth grade and freshman year of college? Why? And why did it always seem new to me each time? Even now it has very little meaning for me. I barely understand what it means and how it reflects to what I need to do to save a life.

I daydream a lot in class and start laying out screenplays for movies that should never be made. During anatomy lecture I came up with this one, “Thoracic Park, a trip back to a time when the internal organs ruled the earth.”

Sir Eric was excited to tell the guys in our class, “Being a paramedic is one of the only times you get to cut a girl’s clothes off.” Of course he meant without buying her dinner first or getting hit with pepper spray. A training video from the US showed us how to cut the clothes off the victim.

Teacher Eric laughed, “They do it wrong in the US. They cut straight up the front. Here in the Philippines, you need to cut along the seam, so that the people can have the clothes repaired if they want to reuse them.”

Antonio Graceffo is an adventure and martial arts author living in Asia. He is the host of the Web TV show, Martial Arts Odyssey. Currently he is working inside of Shan State, documenting human rights abuses and doing a film and print project to raise awareness of the Shan people. His videos about martial arts, Burma, and other countries are available here.

Antonio is the author of four books available on Amazon.com. E-mail him at antonio@speakingadventure.com or visit his Website. He is self-funded and seeking sponsors. If you wish to contribute to the “In Shanland” film project, you can donate through Paypal, through this page.

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