In medicine, a lot of terms get thrown around that are utterly devoid of meaning without additional context. At my hospital, one such lexeme is “CHET:” “There’s a CHET coming in.” “We can’t get this IV started, call CHET.” Turns out “CHET” is not the nickname of a guy named Chester, but is in fact an acronym for “Children’s Hospital Emergency Transport,” a hospital strike force that goes out by ground or air to bring critically ill kids from surrounding hospitals to Rady Children’s, where they can receive more specialty care.
A CHET team typically consists of a highly-trained nurse and respiratory therapist pair, with the overnight PICU physician on speed-dial. Upon arrival at the outside hospital, their job is to stabilize the patient to the point that they can be safely moved. I’ve been in awe of them since I started residency: While they get a summary of the situation over the phone, they never know exactly what awaits at the other end of the trip. They’ve showed up to everything from a kid that probably could have been discharged directly home to an active Code Blue. Their stories are incredible. When I’m admitting, I love getting transports from them: they’re always calm, know exactly what’s going on, and have already done everything possible en route.
I’d been wanting to go on a CHET “mission” for a while, especially since this is my final PICU rotation of my general pediatrics training and I still hadn’t had the opportunity. I brought it up again the other night: lo and behold, they were about to head out on one. A story we hear all too often: Young kid with prior psychiatric history presenting with first-time suicide attempt via drug overdose. Going by ground instead of air, which is less cool of a vehicle but makes it much easier to talk to and learn from the team.
We strapped in to the five-point harnesses and they prepped me on the way–about an hour drive during which they made sure I remembered PALS stuff like compressions and arrhythmias. My brain casually reminded me that the last time I’d ridden in an ambulance, I was a kid myself and my mom had gotten bumped by a slow-moving car in a parking lot.
Everything was calm when we arrived: the kid was stable, talking, and disgruntled that they would be taken to another hospital for monitoring “just in case.” I wouldn’t be doing compressions that night, but instead, a different type of chaos was in process: Somehow every printer in that hospital was broken, rendering them incapable of us (or anyone else) copies of the treatment record. Modern medicine!
We improvised with old-fashioned pen and paper charting and began the journey back. Benefit of a children’s hospital ambulance? One of the compartments housed a slipcase of DVDs to play on the built-in TV (the night’s feature: Despicable Me). Our patient was reassuringly alert and talkative, but wasn’t impressed by the team’s multi-pocketed flight suits packed with emergency supplies: “You guys look like janitors.”
Although the patient might have meant it as an insult, it didn’t take. The highly experienced nurse with decades of intense critical care experience simply laughed. “There’s nothing wrong with being a janitor, kid.”
Strapped in to the ambulance seat. 
As seen from outside.