By Aaron Collins

High-speed, head-on collision. Three survivors at the scene, two unconscious, ambulances en route to the hospital. Thus may begin a day’s work for Visalian Dave Sanbongi, RN. As Prehospital Coordinator for Kaweah Delta Medical Center Emergency Department, he focuses on the interface with EMTs and paramedics. Whether the immediate impending crisis is a still-conscious man in his late-50s complaining of chest pains, or a multi-auto collision on a freeway shrouded by Tule fog — broken this, lacerated that, you name it — Sanbongi is there to coax order from chaos.

But Sanbongi says emergency medical care differs significantly from how the public may see his field. Things can be far less dramatic, though no less poignant, but with far fewer life-threatening situations than one might expect. Perhaps that is because a typical person’s vision of an emergency medicine career is filtered through popular TV shows like ER, or exciting movie dramatizations.

“Many times (TV shows) make things look more dramatic than they really are,” says Sanbongi, whose name is Japanese in origin. “Don’t get me wrong — because we see our share of excitement. But some of the things that you see on TV are just over the top.” Hollywood would never be able to sell these shows without all the manufactured drama, he admits. In reality, emergency care providers are far more concerned with keeping the drama to a minimum.

That vision of drama — in 1970s shows like Emergency — drew Sanbongi himself to first responder work. In the ‘80s he worked as an EMT-II in Visalia for American Ambulance. “I wanted to be a paramedic,” he said. But he also “wanted to stay in Tulare County.” The county, at that time didn’t hire paramedics, who have a wider scope of medical skills. “So I decided to go to nursing school. I’m glad I didn’t wait, as it was almost 20 years later that Tulare County finally upgraded to paramedics,” Sanbongi recalls.

So what’s his life in the ER really like?

During his two decades in the field, he has seen it all and knows the drill, the lingo, the ethos. For starters, scratch ER and call it the ED, for Emergency Department. Full-fledged EDs long ago became complex and advanced operations that can’t be encompassed by the word “room.”

Words of Warning
The cardinal rule in the ED is “Never say the ‘Q’ or ‘S’ words.” Those letters are for “quiet” or “slow,” Sanbongi explains, words that seem to conjure an onslaught of patients, and suddenly things are not all that different from on-screen ERs. “The bus just unloaded” is a familiar turn of phrase for those situations, he says.

One common myth is that an emergency visit means that an interminable wait is in store. Believe it or not, there occasionally are times of quiet (… er, the “Q” word). One conception that is true, he says, is that the ED sees far too many cases that are not emergencies at all. Sanbongi says these cases are the result of a healthcare system so burdened by those without any alternative to the ED that California’s emergency department physicians have recently filed a lawsuit against the state of California in response to the degenerating healthcare funding crisis.

Sanbongi’s role as Prehospital Coordinator means that he works with the EMS agency and EMS personnel to help improve care of patients prior to their arrival at the hospital. He may answer a radio call from paramedics, but just as likely he is involved in the training and regulation compliance issues he must track. He fields questions from EMS personnel and fellow Mobile Intensive Care Nurses (MICNs), the EMS agency-certified emergency department RNs who have specialized training in EMS policies, procedures, and treatment protocols; EMS communications; disaster management; and disaster triage. MICNs go through a 40-hour training program and complete an internship alongside a certified MICN. MICNs have mandatory training and educational requirements in order to maintain their certification, and they must be recertified every two years.

He also still steps into his hands-on role as an ED nurse. So anything can happen on his typical day — if there is any such thing as a typical day. The tempo of his work life is tied to the vagaries of regular people going about their daily lives, only to discover that everything has changed in an instant, and suddenly they find themselves en route to the ED. Sanbongi himself had a visit a few years ago, courtesy of his appendix, but his first trip came at just one year old, when he and his mother were in a car accident that nearly took her life. He got away with a broken leg, a tough start in life for a baby.

‘Fun Job’ in the Sky
As if all the variety in his ED job isn’t enough to keep things interesting, Sanbongi’s other job—his “fun job,” as he puts it—is being a flight nurse with Fresno-based SkyLife, work that makes him especially qualified to decide what’s drama and what’s not, attending to patients in the skies as they’re transported from accident scenes to EDs around the Valley, or shuttling patients via helicopter between hospitals when patients with life-threatening conditions determine they must be sent to facilities elsewhere for their specialized treatment.

Sanbongi says the flight crew consists of an EMS pilot, a flight nurse, and a flight paramedic. When they are not flying or doing clinical rounds, they stay together in the crew quarters, “so you get to know your partners well. It’s like a second family,” says the Fresno native who has a wife and two kids. “I trust the pilots I work with … I know my life is in their hands.”

One reward common to his ED and flight nurse jobs: The ability to act immediately to save lives, Sanbongi says. “I love the autonomy. In the ED, the nurses have an extensive list of treatments and diagnostic (tests) that they can initiate prior to the physician, nurse practitioner, or physician assistant seeing a patient,” although ultimately, staff still works under their direction, he notes. In his job as flight nurse, too, he has that expanded scope of practice, authorized to perform several procedures that most hospital-based nurses are not.

“In most circumstances, we do not have the luxury of having rapid access to a physician to help guide patient care, so you have to be comfortable with your skills,” says Sanbongi. But that independence can also leave emergency personnel wishing occasionally that a doctor were at hand, especially in trying circumstances. This is “extremely rare,” he says, but when it happens, you have to remember that “you and your partner are the best that is available for the patient at that particular time,” he says.

Mission: Safety
With the rush of rising to a medical emergency and flying around the Valley in a helicopter, it’s not hard to see why Sanbongi refers to himself as an “adrenaline junkie.” But safety is in the forefront of the crew’s minds on every flight.

Sanbongi says that many of the recent air ambulance accidents in the news have been preventable. “Where I work, any member of the flight crew can cancel a response if they are uncomfortable with any aspect of the mission. All three crew members have to be in agreement for us to go. For example, if we are going to land at the scene of an accident and I’m uncomfortable with the landing zone the pilot has selected, I can tell the pilot I am uncomfortable with that site and we will look for an alternative landing zone.”

It’s nice to have veto power, he says, but in ten years he has never been in a situation where he was in disagreement with the pilot during a response. “In the end we all want to go home at the end of the shift,” he says, noting that during his career, the harrowing moments have all been on the ground, the tragedies of others. “When I was a fairly new flight nurse, one call that I will never forget was an accident where there were thirteen fatalities on the scene. We flew out the two lone survivors from that accident,” Sanbongi recalls, still evidently deeply affected by that day.

Fortunately the burden of such emotional memories are overshadowed by the rewards — “The people I get to work with” are among them, he says. “We have an awesome team in the ED. It’s the only department I’ve worked in since being hired at Kaweah Delta in 1990. I truly enjoy my job and will probably retire from there. But I always tell people if I win the Lotto, I’m going to quit, get an RV and travel all over the country.” If anyone understands the value of living in the here and now, not holding out for some eventual reward, it’s an emergency care provider like Sanbongi.

“Several years ago I took care of an elderly lady who injured her hip. She told me that her husband just died the day before. I told her I was sorry and she told me ‘Don’t feel sorry for me. Me and my husband had a good life together. We did a lot of things and did a lot of traveling while we were young and still had our health. I have a lot of good memories. You should do things now with your family while you still have your health.’ Her words have definitely had an effect on my outlook on life,” he reflected.

The beneficial influence Sanbongi has over others’ life-or-death health matters, suggests he’ll have no regrets, when all is said and done, having made a major difference in the lives of so many.

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