About 40 miles northwest of Dubuque, Iowa, on the Wisconsin side of the Mississippi River, county roads A and X intersect at the village of Bagley – population 379. That doesn’t sound like a lot of people, but it’s 108 more than the census showed in 1970, the year before fellow-citizen Steve Teale got curious about prehospital care.
“I took first aid and advanced first aid as part of my health and safety minor at the University of Wisconsin,” Teale says of the education degree he was pursuing in Platteville, 30 miles to the southeast. “Pretty soon, I was teaching first aid, which is the closest thing we had to EMS in Bagley at the time.”
Joining the first generation of EMS
After graduation, Teale found a full-time teaching job in Rockford, Illinois, then signed up for one of the first EMT courses in the region. “Most people didn’t know what an emergency medical technician was in 1973,” he remembers. “Some called us paramedics, even though we weren’t.” Steve would add that title in 2003.
“Like so many others, I had some pretty unrealistic expectations in the beginning,” he adds. “I thought I was going to save everyone. No one told me about the screaming, the crying, the dying.
“The public can be just as naïve. They think they’re going to get the same level of care they see on TV shows – critical-care medics who know how to do everything. That’s not the way it works in most places.”
Like in Albany, a Wisconsin village of 1,018 near the Illinois border, where Teale volunteered as an EMT for almost 30 years. “In most of the state, it was rare that any town under 100,000 could afford paid ambulance service,” he says. “There were a number of fire departments that assumed the role of EMS, but very few stand-alone EMS agencies.
“I left Albany soon after I became a paramedic because they weren’t ALS. I knew I’d see patients who’d need more advanced care than I was allowed to give. I didn’t want to feel like I was letting them down.”
Big responsibilities in small towns
Teale’s determination to use all his training wasn’t just an intellectual exercise. As one of the few EMS providers in Albany and Bagley, he knew most of his patients so well, he’s reluctant to discuss any of their cases out of concern for their privacy. “These are people I’d see in restaurants, at the post office – pretty much anywhere in town,” he says. “When they’d get sick or hurt, it was much more of a personal thing than for career medics in large urban areas, where most patients are strangers.”
Bad outcomes can be particularly hard on those treating their neighbors. “Imagine seeing friends or family die,” Teale says. “Some responders never come back after that.”
One key to longevity, according to Teale, is learning to manage your feelings. “I believe empathizing with your patients makes you a better provider, but it can wear on you. You find yourself thinking, ‘If I care so much about everyone, I’ll burn out.’
“This might sound counter-intuitive, but one way to keep empathy from turning into apathy is to follow up on your patients. If someone having an MI got to a cath lab early because of you, then recovered with no neurological deficits, well, that’s pretty cool.”
Tough calls are just one of the challenges for small-town volunteers, says Teale. Keeping up with training is another. “It’s going to cost you quality time with your family,” he warns. “God knows how many activities I missed with my kids.
“Maybe your medical director wants everyone to take some new course. Well, how long is that? Is it on your bowling night? Does it interfere with your work schedule? You have to be willing to sacrifice and compromise.”
Time away from rescue is important, too. Teale spent much of his as an educator. In 1979, he joined the Wisconsin Technical College System board, where he supervised EMS courses and served as the NREMT’s chief examiner at the basic level. “Our system emphasized practical experience,” he says. “If you hadn’t been on the street as an EMT or paramedic and you walked into a classroom to teach those skills, you wouldn’t be taken seriously.”
Contemplating life beyond EMS
After retiring from WTCS in 2008, Teale continued to volunteer as a paramedic in Madison. “That’s the town of Madison, not the city,” the 70-year-old says, contrasting the fragmented, 1.5-square-mile community with Wisconsin’s capital. “There’s not much left of it. In fact, it’s all going to be annexed by the city in 2022.”
Teale isn’t sure what he’ll do then. “I’ve been in EMS 45 years – more than half my life. All of a sudden, it won’t be there anymore. I’m trying to figure out how I can fill that hole.”
Keep us posted, Steve; lots of us are facing the same dilemma.
