Brian Patterson is on the 28th hour of his 24-hour shift. He's alert for what some may deem to be a sleep-deprived person. “You get used to it,” he said. “Before you know it, an hour of sleep is all you need.”

A moment later, an emergency call is transmitted from the field to dispatch. An elderly man slipped on ice outside the local mall. Patterson meets his partner in the garage and steps up into the shotgun seat of the orange-striped ambulance. They check in with dispatch and then turn on the sirens.

Patterson, 24, is part of the new generation of paramedics in Benton Harbor County, Mich. He's the youngest full-time paramedic on staff with the area's Medic Ambulance Community Emergency Service, and he just recently completed his license certification. He scoffs when his partner razzes him that he's a rookie. He actually started as a first-responder at 18 for a local volunteer department in northwest Indiana.

The ambulance has three radios, a mobile to dispatch and a Kenwood portable to communicate with colleagues. There's also an 800 MHz Motorola portable that lets the paramedics communicate with different agencies using the national interoperability channels.

Using two-way radios for emergencies is simple and direct compared to a commercial cell phone, Patterson said. It's a controlled relay of vital information, such as location and type of incident. “I can't be interrupted or distracted; I can pick up the radio and tell the doctor exactly what I need,” he said. “For non-critical patients when you're not pressed for time you can use a cell phone to have a more detailed conversation.”

However, radio signals are not always reliable, and signals often are lost in the area's beach communities. In addition, one antenna is 40 miles away, which also hurts communications, Patterson said. When there is no signal, he often will use a patient's landline to communicate to dispatch and hospital staff.

The paramedics use “plain speak” language when communicating. “It takes away from confusion because you have such a broad perspective of rookies and veterans and codes are different between counties and agencies,” Patterson said. “For us, if we get a car accident it's a code 1, but in a neighboring county it's a 1050.”

But most communication is non-verbal between the partners. They go into automatic mode when at an incident. The two paramedics grumbled simultaneously as the ambulance moved through traffic and dodged motorists who didn't pull to the right. When they arrived at the scene, the elderly man was on his back with blood pooled around his head. They both moved quickly to bandage the head wound, each taking on a role without the other's direction. Paterson attended to the patient while his partner pulled the gurney from the back of the ambulance.

The man was frightened and cold. He must have been pushing 80 and was talking to Paterson about his motorcycle.

“I hope this isn't my last day,” the wounded man said, telling of his long-ago rides down Route 66 at upwards of 120 miles per hour.

“Not if I can help it,” Patterson said.

They seamlessly lifted the man onto the gurney and into the ambulance. They wrapped him in blankets, hooked him up to an IV and checked his vitals.

Patterson loves the job, he said, looking up from the patient. When someone is truly in trouble and hurt or in their worst moment, they call 911 to get help.

“And they get me,” he said. “I think that's cool.”

Mary Rose Roberts is the associate editor for Urgent Communications.