EMS Pioneers: Missouri paramedic says 'EMS chose me' 37 years ago
Sara Wainwright lauds ROSC progress, laments opioid epidemic
As a teenager in De Soto, Mo., Sara Stewart Wainwright wasn’t sure what occupation she should pursue. “I thought I wanted to be a physician,” she says, “but something drew me to EMS. I’m not sure what.”
“When someone asks me why I picked this profession, I tell them, I didn’t choose it; it chose me.”
That was 37 years ago. Now, Wainwright is a battalion chief for the St. Charles County Ambulance District (SCCAD), just across the Missouri River from St. Louis. “I supervise anywhere from five to a dozen-or-so (all-paramedic) crews,” she says.
Leading by serving in EMS
Wainwright usually responds to calls in her own vehicle, then meets up with her staff on scene. “I see myself as a team leader whose main job is to support the folks I work with,” she says.
“The first thing on my mind is safety. Next is making sure the medics have everything they need. Then I’m going to be thinking about egress – getting everyone out of the house, into the ambulance and on their way.
“Our people are very capable and usually don’t need clinical help. I’m more of a problem solver; someone who can swap out a bad lead on a monitor, for example. I carry spare equipment just in case.”
Wainwright believes leaders have to be assertive at times and self-confident, but communication skills are even more important. “I try to keep the patient’s family informed about what we’re doing, especially if it’s something major like a cardiac arrest or an overdose. I’d rather be the one to handle those conversations, so our paramedics can focus on their jobs.”
Resuscitation: Lives saved, lives wasted
Speaking of cardiac arrests, Wainwright credits cardio-cerebral resuscitation (CCR) and SCCAD’s pit-crew routine for two saves on a single September Sunday three years ago.
The first call came in as a seizure, but turned into an arrest shortly after Wainwright arrived with paramedics Kelly Maull and Heather Briggs. The responders began with passive O2 via non-rebreather and six minutes of manual chest compressions, per protocol. Within minutes, the patient regained a pulse and became responsive.
The second arrest, a 46-year-old awaiting an ablation to eliminate chronic PVCs, stopped breathing in front of his wife – a nurse – who started CPR right away. After CCR and defibrillation by SCCAD, the patient woke up and was able to follow the crew’s commands en route to the hospital. “He’s fine,” says Wainwright. “We see him every year at our survivors’ luncheon.”
“CCR has been saving lots of people prehospitally. We’re even getting some back from asystole.”
But that wasn’t the case for two 20-something mothers of young children who overdosed on heroin one day several months ago. “Those calls still get to me,” Wainwright says.
One of the girls had been to rehab twice, then relapsed when she left her house to drive a friend home. The next morning, her mother found her dead in the bathroom – another victim of what Wainwright calls “a heroin epidemic in St. Charles County.”
“I’ve commented on social media about making [naloxone] more available, but some folks feel it’s an enabler. My answer to that is, ‘You don’t understand addiction,’” Wainwright reports.
“Narcotics abuse is highly resistant to treatment,” she explains. “Addicts aren’t going to be rehabilitated after one attempt; they need multiple tries. I see [naloxone] offering them a second or third chance. At least that buys them some time until we can get control of the overall problem.”
Nursing vs. EMS: A bigger picture
Drug addiction is just one issue Wainwright can see from another perspective: as an RN. “I graduated nursing school in 1995, about 10 years after I joined St. Charles,” she says.
Ask her about nurses versus paramedics and she’ll tell you there are plenty of misunderstandings between them. “I think that started when medics first came into the field,” Wainwright says. “Insecurity on both sides led to a turf war.”
“There is some overlap in what we study – anatomy and physiology, for example – but the fundamental philosophy of nursing is very different from EMS.
“Paramedics are episode-driven, in that they’re seeing patients briefly and don’t have to make long-term plans. Nurses look at a much bigger picture – not just physical care, but emotional, social and spiritual needs as well.”
Wainwright suggests paramedics starting nursing school put aside their prehospital mindset. “Nursing doesn’t require the same assertiveness and independence,” she says. “I’ve seen medics kicked out of nursing programs because they couldn’t adjust to not being ‘rescue rangers’ anymore.”
As much as Wainwright enjoys being one of those rescuers, she knows she can’t do it forever. That’s one reason she’s becoming a nurse practitioner. “I only have two quarters of school left,” she says. After that, she has a pretty good idea where she’s headed.
“I used to work a lot with cancer patients. I see it as a privilege to care for those people at such difficult times in their lives. I wouldn’t mind doing that again.”
It sounds like Sara has been chosen once more.