Emergency responders deal with tragedy, sometimes joy around Rancho Santa Fe, Calif.

San Diego Medical Services Enterprise at your service.

 The ambulance at Rancho Santa Fe Fire Station 1 sat idle, if only for a moment, as paramedic John Salinsky contemplated the upscale North County beat he works for San Diego Medical Services Enterprise, the area’s 911 paramedic provider.

“This is a lot different than working downtown,” Salinsky said. “It’s just better quality here. It’s like the difference between Thunderbird and fine wine.”

Upscale, yes, but areas served by Salinsky, his partner Angelo Sanchez, an emergency medical technician, and the other medical emergency responders in places such as Rancho Santa Fe, Del Mar, Carmel Valley and Solana Beach suffer life and death traumas like anywhere else.

“One gentleman was at a formal dinner wearing a tuxedo and choking on a steak,” Salinsky said. “He was in a room full of doctors all standing over him. You walk in the door and see a doctor with a giant steak knife trying to do a tracheotomy on him.”

No happy ending there. The patient died. But potential tragedy many times turns to joy due to quick acting by paramedics such as Salinsky and a sense of humor never hurts.

“I always like the one about the fabled Rancho Santa Fe deer,” Salinsky said. “Usually occurs around 2 o’clock in the morning. Someone hits a tree. I get there and they are standing around a little tipsy saying the deer ran across the road and I hit it. I’ve heard variations like a coyote of bunny rabbit ran across, too. The elusive RSF deer only seems to come out after they’ve been drinking.”

loralee olejnik(Loralee Olejnik, shown here, provides SDMSE Project Heartbeat community services around Rancho Santa Fe, Solana Beach, Del Mar, Encinitas and San Diego County.)

Paramedics and emergency medical technicians are part of a groundbreaking public-private partnership in place since 2001. The umbrella operation is called San Diego Medical Services Enterprise. This combines resources from the city of San Diego Fire-Rescue Department and Rural/Metro Ambulance, a leading national provider of emergency and non-emergency medical transportation.

The organization employs about 410 people covering Carmel Valley and the city of San Diego as well as North County from Encinitas to Del Mar, 4S Ranch to Elfin Forest. Beyond San Diego city limits, the coverage area is referred to as County Service Area 17. Crews respond to about 5,100 emergency calls and transport about 4,300 patients annually. Three ambulances are staffed 24 hours a day out of Rancho Santa Fe Fire Station 1, Encinitas Fire Station 5 and Solana Beach Fire Station 1.

The service also participates in numerous community outreach programs. It offers free blood pressure checks at senior centers, Distributes free emergency medical information kits and defibrillator training. Crews attend various community events telling people how best to contact 911 service providers and other helpful bits of advice about what to do in emergency situations.

Doing the good work

Medical service providers work as two-person paramedic units, generally in 24-hour shifts, saving lives side-by-side with regular fire engine crews that include five or six firefighters and a paramedic. This requires teamwork and a commitment to patient care above all else.

“This is not like you’re sitting behind a desk pushing paper,” said 24-year paramedic Randy Stark as he manned Solana Beach Fire Station 1 with emergency medical technician Jason Gray, a new hire, during the final days of the San Diego County Fair at the Del Mar Fairgrounds.

The day before, the crew made three trips to the fair. Two visits were for alcohol-related injuries. One trip was to help a person suffering an off-track motorbike spill.

“I like this job,” said Stark, leaning on an ambulance with an interior resembling a fully stocked hospital triage unit. “One day, it’s a child birth, then an auto accident, then a stabbing, over to a parachute that didn’t open to shark bites, everything you hear over the news.”

The journey from tragedy to hospital can be emotionally gut wrenching. Emergency workers undergo extensive psychological and situational training to help them deal with sometimes-unconscionable events. They must act quickly and decisively under pressure.

“We’re out there by ourselves,” Salinsky said. “We really need to be prepared. You need a certain detail-oriented personality, someone who likes to be autonomous. You’re constantly re-assessing during transport like Sherlock Holmes, deducing, trying to narrow down the complaint from an endless list of things, determining what is wrong and how to treat the patient.”

Salinsky and Sanchez had just finished transporting a Rancho Santa Fe patient with abdominal pain to Scripps Encinitas Hospital.

“We have a higher percentage of older people around here, but they know to call 911 when they need it and not for reasons other than emergencies like happens downtown a lot,” Salinsky said.

But for Stark and Gray over at Solana Beach, the day was quieter as they contemplated life, not death.

“I’ve participated in delivering 100 babies,” Stark said. “We had a child birth in Solana Beach last year where they called 911 saying the baby was coming. The lady delivered in her driveway, leaning on a Mercedes. She called me the other day, and we went to her son’s first birthday party.”

Medical supervisor Todd Smith checked his on-board computer’s global positioning system pinpointing active cases, of which there were several, driving to another of his units on the front lines of emergency medical care in County Service Area 17.

“I was a third-generation San Diego County firefighter before I went to paramedic school,” Smith said. “No, I’m not superstitious, but we always have our full moon scenarios. It must be a full moon tonight.”