Every U.S. city has to budget for its emergency services — police, fire, paramedics. And almost every city gets that budget paid by charging the population of that community. A simple formula of need and payment.
But that formula is wildly disrupted every night — and especially on weekends — in at least one location: Las Vegas.
In the city that never sleeps, the population base can easily expand by more than 200,000 people in a 24-hour period — tourists and visitors who come to stay and play, many of whom strongly embrace the notion that what happens in Vegas stays in Vegas.
But for the paramedics of the Clark County Fire Department, what often happens in Vegas makes them the hardest-working, busiest paramedics in the U.S. In the last ten months, they’ve answered more than 80 thousand medical calls.
The county has 25 fire stations and 156 paramedics, and recently I got a chance to ride along on the late shift — 8 p.m. to 4 a.m. on a Friday night/Saturday morning with the team from station 11.
Welcome to the wild, wild West, where visitors end up gambling not only with their money ... but in many cases, also with their health.
And as the sun goes down on the Las Vegas Strip, the action heats up. And the alarms keep rolling in. A sick person at the Mandalay Bay hotel, an incoherent man at the Monte Carlo, a possible drug overdose at the Tropicana. A woman in possible labor in the lobby of the MGM Grand hotel.
We’re rolling. Lights, sirens down the crowded Las Vegas Strip, we bob and weave around cars, over traffic medians and down back alleys. The paramedics are the only folks who are given carte blanche by the casinos — to enter any hotel at any time, go into any hotel room, and — literally — break up any craps, blackjack, poker, roulette or baccarat game in order to save lives.
And their beat is that Las Vegas Strip — a congested five-mile stretch that just happens to include 15 of the 20 largest hotels in the world.
The hits keep coming. A confused and dazed visitor from Japan, bleeding from the mouth and carrying a wad of money, walking aimlessly near Treasure Island. A domestic dispute — following a bad run at the blackjack table, with a wife punching the husband; another possible drug overdose during a bachelorette party. And an elderly gentleman sitting near the entrance to a hotel, babbling and unable to move. Diagnosis: The man mixed his medications with a little alcohol.
“How much alcohol did you drink?” the paramedics ask him. “Just two drinks,” comes the reply.
“A lot of the behavior we see is predictable,” says paramedic Brent Hall. “When we ask those questions, the answers are always ‘two drinks.’”
But of course, it’s usually more than that. At a paramedic call for a possible drug overdose at the Tropicana, the paramedics enter a hotel room — accompanied by the hotel’s own security guards — to find a half-naked woman sitting in her bed, surrounded by an array of pill bottles, and on the nightstand, a line of shot glasses filled with tequila.
Once they determine the criticality of the case, the paramedics then need to determine if the woman needs to be transported to a local hospital.
“Ma’am, we need to ask you some questions if we can,” says one of the paramedics, as they read the labels on the plastic drug bottles and assess her vital signs. “How many of these pills did you take tonight?”
“Enough,” she says.
“And how many shots of tequila?”
“Two,” comes the predictable answer, followed by “that I will admit to.”
“And who is the president of the United States?” the paramedics ask. The woman thinks and pauses. “George W. Bush,” she responds, and then makes a political comment: "Unfortunately.”
The paramedics laugh at this, but without making a political comment of their own, and determine that she does not have to go to the hospital.
Many cases aren’t this easy. Often, the paramedics have to practice crowd control inside casinos, when they need to interrupt the gambling in order to save a life. “We had one woman who had collapsed at a slot machine, with her hand still on the handle,” one paramedic told me. “As we were trying to treat her, another woman just walked in, tried to push her — and us — away so she could insert money into the machine and pull the same handle, insisting that it was her favorite machine and was about to pay off.”
In another legendary case, a large, overweight man was at the craps table, rolling the dice. He blew on the dice each time before rolling them out on the green felt. And then, suddenly, he collapsed and fell to the floor. The paramedics were called. The game was interrupted. A crowd gathered as they tried to revive him. Was it a heart attack? Possibly. But then the pit bosses told the paramedics they couldn’t find the dice. Quickly, and with the aid of some security guards, the paramedics stood the man up as one of the paramedics grabbed him around the waist, then put pressure right under his rib cage and applied the Heimlich maneuver. And from the man’s mouth, out flew … the dice, right on to the table. (No one will report what the man, uh, threw, but his life was saved, and yes, the game continued.)
In Las Vegas, if the alcohol (and in some cases, drugs) don’t get you, the heat and dry air can.
“People come here,” says EMT Paul Lopez, “they don’t drink enough water, they get dehydrated really fast, and that’s when their problems really start.” A lot of drinking, too much walking, and not enough sleep add up to something the paramedics call the Las Vegas syndrome.
Sadly, the paramedics have more than their fair share of suicides in Las Vegas, but on the whole, they save many more lives than they lose — and part of that is because of their fast response time. “The old motto,” says EMT Hall, “is ‘What happens in Vegas stays in Vegas.’ But the reality is that what happens in Vegas is handled by EMS.”
And whether you are traveling to Vegas, Vienna or Virginia, the Clark County paramedics suggest the following:
1. Don't pack your medications in checked bags. Carry on only
2. Wear a watch. In Las Vegas, a city devoid of clocks, it's easy to lose track of time — either too much time in the sun, not taking medications as scheduled — real problems.
3. Hydrate yourself often. Desert climate notwithstanding, just flying somewhere dehydrates you. (My advice: Once on the ground, buy small 8-ounce bottles of water and carry them with you.)
4. Print up (and carry with you, in your wallet or purse) a list that includes your blood type as well as your regular medications, and any allergies you may have, as well as an emergency telephone/text message contact for a relative or close friend.
And finally, in a worst-case situation, one of the best places to have a heart attack is now —inside a Las Vegas casino! The Clark County paramedics have trained hotel and casino security guards how to use defibrillators. And the success rate has been phenomenal in the three years since the training began — to date, the guards have saved nearly 2,000 people using the defibrillators. With a heart attack, response time is key — and the security guards easily beat the paramedics to the scene. Often within two minutes.
Peter Greenberg is TODAY’s Travel editor. His column appears weekly on TODAYshow.com. Visit his Web site at .