EMTs bring the emergency room to the patient
EMTs, ambulance crews trained to respond quickly to medical emergencies, trauma situations and accidents, are a critical but often overshadowed component of public safety
By Susan Spencer
Telegram & Gazette, Worcester, Mass.
WORCESTER — They've pulled injured people out of burning buildings, performed ice rescues, delivered babies while on the road, started IVs and intubations in the back of a truck, and revived far too many people who have overdosed on opioids with their ever-present supply of Narcan.
Emergency medical technicians, ambulance crews trained to respond quickly to medical emergencies, trauma situations and accidents, are a critical but often overshadowed component of public safety.
They'll be found working in what one EMT called "a well-choreographed dance" with firefighters and police officers anytime a 911 call comes in. But often the role of emergency medical services as health care providers gets lost from public view in the tidy news summary that a patient was rushed to the hospital.
May 21-27 is the 43rd annual National EMS Week, in which the National Association of EMTs, in partnership with the American College of Emergency Physicians, seeks to recognize the vital contribution of EMTs to community health and safety.
A Telegram & Gazette reporter and photographer rode along with Worcester Emergency Medical Services paramedics this week, getting a view from the road of calamities large and small. On these days, it was mainly the everyday stuff of age, illness and disability -- perhaps not dramatic, but the conditions and events that ultimately take their toll on most people.
Worcester EMS is a clinical department of UMass Memorial Medical Center. With approximately 90 paramedics, EMTs who have the highest level of training, Worcester EMS contracts with Worcester and Shrewsbury to provide around-the-clock coverage.
Seven ambulances drive all day in Worcester and four handle the nights. Shrewsbury has one ambulance assigned during the day and one at night, but Worcester will cover for Shrewsbury if needed.
In addition to the ambulances, supervisors, who are also paramedics, ride the streets in two Chevrolet Tahoes or a Suburban, outfitted with communications equipment and medical supply bags, to direct emergency response, coordinate with police and fire departments, or provide backup.
Serious situations or not, Worcester EMS gets 40,000 calls per year between the two communities, averaging 90 to 115 a day, according to Capt. Mark Wilson, one of four captains in charge of the department.
Capt. Wilson has worked with EMS since 1980 when it was operated out of Worcester City Hospital. It moved in 1991 to what was then UMass Medical Center.
"The whole city has changed. Every intersection is different from when I started," he said.
What used to be eight hospitals receiving emergency patients is now three. The population has increased too, as has the proportion of people who call EMS.
Capt. Wilson said, "People are using the emergency system more as primary care. It's a lot more busy."
Emergency 911 calls go to the Worcester Emergency Communications Center, which dispatches to the appropriate agency -- fire, police or EMS. Most calls now come in by cellphone, however, and those first get routed to Massachusetts State Police in Weston and then to the local community.
Worcester Regional Transit Authority buses can also radio EMS.
According to Capt. Wilson, the EMS system is moving in the next year to have cellphone calls go to the closest EMS department. Text messages and FaceTime video calls are also on the horizon.
"You can get 15 calls in 45 minutes," Capt. Wilson said. And although some people call an ambulance so they don't have to pay for a cab to the hospital, "We're required to respond, by the commonwealth. We cannot make that judgment over the phone."
The high volume and variety of calls Worcester EMS handles have made it one of the most active departments in the state and a place where even paramedics from Boston come to sharpen their skills.
Christian Grant, 25, is one of those who started his career with Worcester EMS, then got a full-time job with Boston MedFlight air ambulance. But he still works 30 to 40 hours a week as a per diem paramedic in Worcester.
Waiting for a call at the former Providence Street fire station, one of three ambulance hubs in the city, he said, "One of the bigger things here is you deal with everything. You are on all the calls."
Violence, drugs, Mr. Grant has worked on it. "This is a very addicting place to work," he said.
Worcester EMS crews are stationed at garages at 23 Wells St. and UMass Memorial's University Campus on Lake Avenue, in addition to Providence Street, to get to calls throughout the city as quickly as possible. In Shrewsbury, the ambulance is based at the Harrington Street fire station.
Driving through Worcester's narrow streets, including unpaved residential neighborhoods, is a constant challenge. The DCU area downtown "is a nightmare," Capt. Wilson said, especially in the afternoon and evening when school buses and commuters are on the road.
"Drivers have gotten better (about letting EMS through)," he said. "But the biggest thing is they don't come to a stop." And while bicycles haven't been much of an obstacle, pedestrians who aren't in crosswalks and aren't paying attention present another hazard.
The radio crackled as Capt. Wilson drove around the city in the SUV on a recent weekday afternoon. An iPad on the console showed the location of the ambulances.
A call came in from 67 Belmont St., a medical office building at UMass Memorial's Memorial Campus. An elderly woman had fallen when coming in from the parking lot, suffering a cut over her eye.
Capt. Wilson turned on the siren in bursts, which has been shown to be more effective in gaining drivers' attention than a continuous siren, and arrived first on the scene. He jumped out of the SUV, medical bag in hand, and started checking the patient's condition.
Soon police, firefighters and an ambulance arrived, with paramedics Evan Kirby and Eric Laighton, who took over care of the patient. Although the injury didn't appear life-threatening, the paramedics placed the woman on a stretcher and took her to St. Vincent Hospital.
The scene was quickly repeated with a call to East Mountain Street, where a man in his 40s was suspected of having a stroke.
In addition to police and firefighters, Worcester EMS paramedics Darren Brock and Andrew Person were on the scene, assisting the patient.
Worcester EMS paramedics started an intravenous line in the patient and transported him to UMass Memorial's University Campus emergency department.
From the second they arrive at the hospital, EMTs have 20 minutes to check the patient in, bring the patient to the treatment room, give the resource nurse all the necessary medical information, and then clean and prepare their ambulance for the next patient. It's a precision operation, requiring an ability to focus calmly while multitasking.
Another call came in for a combative patient in an altered state, whom paramedics Patrick Ring and Eddie Murphy interviewed and took to UMass Memorial for an emergency mental health referral.
Capt. Wilson said the number of people in police custody has increased over the years, whether they're intoxicated or having a mental health crisis.
"It's important to use your persuasion skills and to listen," he said. Some communities include social workers with EMTs to help with these calls.
Most of the time, though, Capt. Wilson said, "You see a lot of medical issues. With the baby boomer population, there's an influx of heart, aging, diabetic, respiratory issues. Everyone who's young thinks it isn't going to happen to them, until it happens to them."
And then there are the motor vehicle crashes, such as the next call. A "rollover with entrapment" was on Acton Street. The driver, a woman who was alone in the car, had been wearing her seat belt and was uninjured as she stood up in the car, which was resting on its driver's side. Firefighters needed to stabilize the car before they could get her out.
Once she was safely extricated, EMTs sat the woman on a stretcher and assessed her condition, but she declined further treatment.
Capt. Wilson said improved safety features and more people wearing seat belts have cut down on serious vehicle-related injuries. "The biggest thing is, you don't get ejected from the vehicle if you wear a seat belt," he said. Injuries suffered in the vehicle are usually minor.
On another afternoon, EMS supervisor Bill Humphrey drove around during an unusually quiet spell, after a nonstop morning. A few calls came in, one for an elderly man with a fever and shortness of breath, and another for a middle-aged woman with suspected seizure who was described as "in an altered state."
Paramedics, firefighters and police officers efficiently did their jobs, with compassion and attentiveness to each patient. Vital signs were checked and IVs were started.
"It's a version of the emergency room coming to the patient," Mr. Humphrey said.
Efforts to professionalize emergency medical services took off in 1976, with the passage of a federal law outlining training and equipment standards. The field has been building research to improve pre-hospital emergency care, which means EMTs must keep training and gaining experience. Among the updated practices, for instance, studies found that backboards generally aren't as important as a cervical collar to stabilize the spine, for patients under age 65.
EMTs have to be recertified by the state Department of Public Health's Office of Emergency Medical Services every two years, which requires 60 hours of continuing education.
The wage for new paramedics starts around $16 an hour, according to Mr. Humphrey, and it goes up slowly to around $22 an hour.
"EMS is in its infancy," he said. "It's still working on itself."
(c)2017 Telegram & Gazette, Worcester, Mass.