The Golden Minute

By Michael Morse

He opened his eyes. The bugs in his head stopped buzzing, and he looked at me.

“You weren’t breathing,” I said.

It was just me and him in the back of an old ambulance in Providence, Rhode Island. A team of people had helped get us to this point. Some of them lingered outside the truck, waiting.

They used to talk of the “Golden Hour” back when I was new at EMS; those precious 60 minutes between the onset of symptoms or a traumatic event and the arrival at the hands of a competent hospital staff. Times have changed, and so has EMS. We are doing things in the field that no longer need an hour or doctors. I learned a few things over the years, and I used something called “The Golden Minute” when I responded to suspected overdose patients. My goal was to get my patients breathing, not to straighten them out.

“I gave you enough Narcan to get you breathing on your own,” I explained. “You are probably still high from whatever it was that got you here, and there is a very good chance that you could stop breathing again when the drug wears off. “

The person on the stretcher relaxed a little and considered his options. He could flee and shoot up again. He could find a quiet spot and ride it out, hoping he didn’t go back into respiratory distress. Or, he could take a moment in a safe, clean, quiet environment and gather his thoughts.

“Chasing the high sucks,” I said nonchalantly. “You can never recapture the feeling of the first hit.”

He stopped thinking and looked at me again. I’m was no longer a threat. I neutralized the situation; the power I could hold over a relatively helpless person lying down while I looked down on him had been given away. I lifted the back of the stretcher so he was in more of a sitting position and took a seat on the bench across from him.

“You know the worst part?” he asked. I listened.

“I don’t even care if I OD. The risk is worth it. Either I’ll be high, or I’ll be gone.”

If ever there was a time for quiet reflection, it was now.  I closed my eyes and let that statement sink in. I hoped my patient was able to do the same.

The Golden Minute had passed. We could talk all day about getting clean, getting sober, getting his life back in order. I could lecture him and do the “You were dead until I saved you” nonsense talk. I could have the police respond and have them do their thing. I could do a lot of things but chose to do nothing, hoping that I’d already done enough. A firefighter working as a medic in the city was not going to cure anybody’s addictions, but I could certainly lube the rusty wheels of rational thought with some honesty.

“I’m required by law to transport you to an appropriate medical facility,” I said, not really sure if it was true. “In this case, it’s the closest emergency room. It’s a madhouse, people lining the halls, all the rooms full, overworked staff, and not at all conducive to healing.”

Sometimes the magic worked. This was one of those times. He agreed to go willingly. I stood and opened the side door, told the police officer he was all set, and let my partner know we’d be transporting. It was a five-minute ride, silent but comfortable. As expected, the ER was at capacity, people screaming for pain meds, intoxicated homeless men restrained on their stretchers, bored elderly people scattered about, a dozen ambulance crews waiting for triage, and the staff working relentlessly to care for the never-ending stream of people that we bring them.

I said goodbye to my patient and headed back into the city. Another person had overdosed, and police were on the scene.


Michael Morse is a former captain with the Providence (RI) Fire Department (PFD), an author, and a popular columnist. He served on PFD’s Engine Co. 2., Engine Co. 9, and Ladder Co. 4 for 10 years prior to becoming an EMT-C on Rescue Co 1 and Captain of Rescue Co. 5.

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