Tuesday, August 20, 2013
(Editor’s Note: Part 3 of a look inside a day with EMS.)
7:06 p.m. – difficulty breathing
The patient is a 54-year-old who is suffering from nausea and is having trouble breathing. She is sitting on the porch next to an overflowing ashtray. Yes, she tells them, she is a smoker but “only four a day.”
She has myriad health issues including COPD.
They give this patient a breathing treatment and put her on humidified oxygen.
She is delivered to Trident Medical Center. Medics change the linens, clean up and call dispatch to let it know they are back in service.
A stop at Publix for dinner – ready-made food from the deli – and Medic 2 returns to base.
8:40 p.m. – psych call
Arriving, Medic 2 stages a block away from the address to wait for law enforcement. Eventually, dispatch radios that the scene is “safe” and they can proceed. Arriving, they discover the patient is an 11-year-old child. The child has finally taken his medication and is calmer.
However, both medics and the deputy, inform the family that 911 is not to be used as a discipline tool. This child has many medical and psychological issues but the parents do not want Medic 2 to transport the child to the ER because they know they will be there all weekend. Instead, they wanted the child to calm down under the “threat” of calling an ambulance and police.
The medics explain to the family that if there is a medical of psychiatric issue they should call 911 but they then will need to allow transport.
The deputy is a bit tougher in his explanation. He tells them 911 is for emergencies and misusing it can result in a hefty fine. They family says they understand.
Back at station 3 the Selachii gore is still going strong on television although after the umpteenth limb being lost it is getting old.
10:15 p.m. – sick person
Arriving at the address, Medic 2 is greeted by an 87-year-old patient under a huge pile of blankets. She has just been released from the hospital today, but is not feeling well. They take her vitals and notice she is somewhat dehydrated. They ask her is she has been drinking plenty of water. She has been drinking milk…she doesn’t like water. Her daughter tells the medics she won’t drink water.
The medics sit and talk with the patient, telling her that without water she will simply end up back in the hospital and, that at her age, the hospital is not where she should be. Too many hospital-born infections are possible that elderly people have less resistance to.
They give her a glass of water and firmly iterate that drinking water is vital to her health. They leave.
12:05 a.m. – structure fire
The call goes out to Medic 6 for a possible structure fire with all residents out of the building except for one who is intoxicated and refusing to leave. Eventually, the person is removed from the residence and Medic 6 is transporting to the hospital. Medic 2 is toned out to go to the scene of the fire.
Fires can last for hours and the medics are on scene until the fire is out to aid firefighters with the myriad problems the smoke and intense heat can cause.
In this case, the fire was relatively quickly under control and Medic 2 returned to quarters.
Anyone listening to a scanner wonders at the nature of some of the calls the DCEMS respond to. Especially those of what sound like a non-emergency nature. The sore throats, sprained ankles, rashes, fevers, etc.
There are a number of factors though, according to the paramedics. Sometimes it’s a case of “Operator” like information, says Mandeville. In other words, there what the patient tells the person who calls, what the person who calls relays to the dispatcher and then what the dispatcher relays to the medics. As in the Operator game, there can be things lost in translation so the actual issue is more severe than it sounds.
“An emergency is defined by the individual,” says Arrant, “so we respond to all emergencies.”
And, sometimes, 911 is used for the wrong reasons. Sometimes it’s an abuse of the system issue – such as the drunk who wanted to go to SMC for a meal; sometimes it is the fact that there is no other transportation available to the patient; sometimes it is an education issue.
For example, says Reilly, “I remember a call for a baby with a fever. When we arrived the mom had no idea what to do. We spent a half hour educating her on what to do if her child had a fever, for different levels of fever, and so forth. That baby didn’t need to go to the hospital … her mom just needed some help in knowing what to do.
“We spend at least half our time educating the community,” Arrant and Mandeville agree.
In addition to on the call education, such as Reilly’s, they also teach community classes for CPR and First Aid.
Nevertheless, EMTs work long, hard hours for relatively little pay. Consequently most work multiple jobs. This is true nationwide, not just in Dorchester County.
Paramedics have high qualifications and some are certified beyond paramedic such those who have taken or are enrolled in a critical care class.
Most EMTs, says Arrant, are in school for a Bachelor’s degree. However, working 24/48 shifts make going to school tough. One paramedic came into headquarters to resign. He is in medical school, on his way to being a doctor, and has classes five days a week. He can’t work the schedule and take his classes.
Trident Technical College recognizes this difficulty and has structured its instructional program to work with the 24/48 schedule enabling working medics to further their education.
Arrant teaches at Trident Technical College. He is certified as a paramedic at the state level as well as at the national level. He also carries PEPP and ITLS certification. PEPP is Pediatric Education Prehospital Professional and ITLS is International Trauma Life Support.
Dorchester County, says Arrant, will “grow its own” paramedics by educating BASIC EMTs and paying for their education.
Further, there is always in-service/in-house education so that medics keep current with their certification.
It’s not all good times. Those working Medic 1 have the best accommodations, with private rooms, a fully equipped kitchen and a lounge area with television, etc.
The others, however, have a small co-ed room, with two beds, a TV and a bathroom. The shower is in the fire department side. So is the kitchen. Alber says they don’t often use either so as not to disturb the fire personnel. Mandeville says, forget the shower, getting a call while covered with soap is not what he wants.
“But this is home, this is where we live,” says Mandeville of the approximately eight- by 12-foot room.
Mandeville is married with two kids. Alber is engaged to her best friend. Reilly is the single mother of twins, Arrant is divorced and has a daughter, Bisnett has a girlfriend – a SMC ER nurse.
The burn out rate is high.
“Three years is about it for EMTs,” says Arrant.
“Those that do make it past that do this for dedication to helping people and the EMS mission. Not for the money, not for the hours.”
Paramedic Michele Pierce’s husband is with North Charleston Police Department. Her solution to the stress work brings, is to leave it at work. “Neither of us bring it home with us…we simply do not talk about work.”
Paramedic Andrea Hamilton works seven days every other week, and five days on the in between weeks. “The stress comes from the things we see,” she says, “and the way some patients treat us.” These women have been kicked, punched, spit on and sworn at by the people they have been called to help.
DCEMS has a high standard and continuous quality assurance and improvement. “Our standard,” says Arrant, “is sometimes more aggressive than the American Heart Association’s standard.”
They review colleagues’ reports to ensure best practices, he says.
Reilly says she spends a third of her life away from her family often working double shifts to support the family that she doesn’t get to have dinner with.
“I sometimes wonder,” she says, “if they [the people calling 911] stop and think when they call at 3 a.m. for a sore foot that has been sore for three days and could wait until the morning…do they think about waking us up?”
Reilly says most likely the callers would simply say “it’s your job” and they would be right.
“But it’s the people that really need you, that you really help that keep you going. I have done this job for 10 years and I love it…I would never do anything else.”