Rural EMS... Staffing the Rescue Squads in Rural Areas

The following is a letter that I sent to the St. Albans Messenger, our local daily newspaper in regard to an article they published on Aug. 5th. No further introduction needed I guess. Read on.


Franklin County Fire and Rescue Squads Face Staffing Shortages Too

As an EMT-I with Enosburgh Ambulance, the bold headline on the front page of Tuesday's Messenger caught my eye (Rural fire depts. struggle to recruit). "At last", I thought, "a timely story about a major challenge facing Fire and EMS squads here in Franklin County". I was surprised and disappointed, however, to find that the story was not written from local interviews and research, but was from the AP wire with a dateline of Big Springs, Nebraska.
Recruiting and retaining highly skilled emergency medical, firefighting, and rescue personnel is difficult in all rural areas of the U.S. In fact, the communities in Franklin County and throughout Vermont are facing this issue as well. Why couldn't the Messenger inform its readers of the importance of this issue by looking at the situation right here in Northwestern Vermont?
As the AP story points out, the ranks of rural fire and rescue squads have traditionally been made up of volunteers from the local community. The majority of these services in rural areas still rely on non-paid first responders to fill their fire departments and rescue squads. Significant changes in our society over recent years, however, have made it tough for people to find the time to commit to these essential organizations. Today, many people travel away from their communities to work. Once home, family time is at a premium. While many employers support employees' efforts as firefighters and EMTs, jobs located 30 or more minutes from their town make it impossible for the crewmember to be available to respond to an emergency call during regular work hours. Volunteering, especially in the public safety realm, requires a big time commitment.
The education and training required even at the most basic level is a large time commitment. Scientific and technological advances have made firefighting and pre-hospital emergency care safer, more effective, and more reliable than ever before. Of course the days of the bucket brigade for fighting fires is long gone. Likewise, ambulances are no longer simply transportation to the hospital. The seven ambulance-equipped EMS organizations in Franklin County are all, as required by law, staffed by certified EMTs, many of whom are trained at the advanced level, and provide life-saving care and treatments to patients while en route to the hospital's ER. Getting and maintaining the required State of Vermont certifications involves hours of classroom and hands-on training. EMTs must re-certify every two years by passing written and hands-on exams, and must also have earned a minimum of continuing education. Furthermore, in the aftermath of large-scale tragedies such as 9/11 and Hurricane Katrina, more and more is being asked of your local police, fire, and rescue organizations. In order to effectively manage future large scale incidents, the federal government, through FEMA has mandated that these groups implement specific systems when multiple agencies work together in response to an incident. To put this mandate in place, squad members are required to take classes in command structure and multi-agency interaction. Squads whose members are not compliant risk losing federal monies for equipment and training. Fire, police, and EMS must also periodically work together on large scale training drills aimed at putting the new systems into action. Learning new skills and training to stay proficient at these skills takes a lot of time, usually weeknights and weekends, in order to avoid work-place conflicts.
Of course the reason behind all the study, training, and preparation, is to be ready to climb in the truck and respond when the tones go off. Here in Enosburgh, a typical 911 ambulance call can take two hours, from the initial dispatch, until the crew returns to quarters after transporting the patient to the hospital in St. Albans. Fire departments can spend a whole day or more at a structure fire. While the firefighters and EMTs that I know are passionate about their roles in helping their communities, the candle can only be burned at both ends for so long before something has to give.
If squads can't retain experienced first responders, or recruit enough new ones, how will we assure that these essential services are available when we really need them? As a result of staffing and recruiting shortages, more fire and rescue squads are now starting to pay EMTs and firefighters, either on a per-call basis or as hourly or salaried employees. The EMTs at Enosburgh Ambulance (EAS) work regular shifts and like a handful of EMS organizations in our county, are paid professional rescuers, not volunteers. EAS staffs around-the-clock crews, the majority of whom are certified at the most advanced care level available in our EMS district. In addition to serving Enosburgh, EAS also responds to 911 calls in Sheldon, Berkshire, and Bakersfield. Recent staffing shortages at Montgomery, Richford, and Franklin Rescue have resulted in frequent gaps in coverage for these towns. Enosburgh Ambulance now provides many hours of emergency ambulance coverage, as needed, for these communities as well.
More often than not, small rural towns are run on a very tight budget. Adding the cost of payroll for services that have traditionally been volunteer will likely be a hard adjustment. To make this change even harder to swallow, towns may go days at a time without having to call EMS, and it could prompt some to argue that their tax dollars are paying for nothing. But emergencies can and do happen around the clock The number of calls a squad responds to is generally proportional to the population of their service area. Rural areas experience fewer emergencies than large urban systems, but whether a squad responds to 100 calls a year or 10000, if the call involves you or your loved ones, you want trained first responders to be there quickly. I like to think that I get paid not so much for my skills in first aid or for transporting the sick and injured, but to guarantee that I will available and ready to quickly respond to an emergency.
Thankfully, as individuals we seldom need to call for the fire department or EMTs. But like the insurance we keep on our cars and homes, when we need them we should be confident that they will be there. Having at least a core group of full-time staff on salary is keeping the problem at bay for a good portion of Franklin County, at least for the time being.
This is one of the bigger issues regarding fire departments and EMS in our area. These groups certainly face other challenges. If the citizens of this region could be better informed about the public safety system we have, they will likely be better served in the years to come. Perhaps at some point, the St. Albans Messenger will consider investigating this and giving their readers a story from local sources before they grab something off the wire and plop it on the front page.

Help Out!

Our job is all about helping others, especially those who need someone with the skills to manage an emergency. Recently I had the opportunity to discover again that helping others can be accomplished other than in the ambulance.

A colleague of mine teaches CPR and EMT classes and recently asked me to help out. Yesterday we taught CPR to a group of high school juniors involved in a local project called MedQuest. The students spend a week learning about and shadowing various medical professions, including EMS. We spent about 4 hours with them and I was pleasantly surprised to find out that several of the students had already had CPR and were interested in EMS. I was able to put in a plug for our local squads by telling them to be proactive...if you want to volunteer or work for your local squad, let them know. Even at age 16 or 17, there are some squads that will let you ride and use your skills up to your cert level, and at 18 you can move up to EMT or beyond. The squads rarely have the time for recruitment, but almost always have a need for additional members.

I also got to help out at a "final class before testing" EMT-B class last night. Sure, I was lured there by the promise of a barbeque (which was excellent!), but I ended up helping them practice practical stations and reviewing what they'd learned. What a great way to beef up those BLS skills as well as helping others in EMS. Here's some pics from that class, held in Georgia, VT.











(That's me with the NRB on. Love that high flow O2!!)

EMS and Stress relief

If you've been on duty for much time at all, you know that stress, sometimes a lot of it, goes with the job. Sure, we can spend hours lounging around quarters and goofing around with our crew mates, but when the tones go off, we might just be thrust into a situation where we are face to face with someone else's life or death struggle and we are the only solution at that time and place. Stressful, even if everything goes right and things turn out OK. So how do you deal with it? I'm asking any readers to drop me an e-mail @ Danvtemt@gmail.com and let me know. I'll post your responses on here if you'd like.

One solution to the accumulated stresses of this career is being enjoyed at an open field adjacent to our quarters here at Enosburgh Ambulance. Several of us have started flying electric powered RC airplanes and have formed sort of a club, although it is very informal. We come around when off duty and fly and have something to talk about with each other, other than EMS. It is great fun. One of our guys started a blog about it and it is really fun to look at...video, pictures, and friendly jabs at each other's flying abilities. You are welcome to check it out at: www.enosburghambulanceflyingclub.blogspot.com

I'd love to hear what you think of the RC blog too.

Stay safe out there!

Dan

Don't Shoot, I'm Only the Piano Player...or A Pianist by Any Other Name

Ya gotta love EMS. In the midst of the misery and suffering we see on a regular basis, you can usually count on one thing: Your partner is as twisted as you are and will likely share some of the whacked out ways that we EMTs see the world.

We were en route code-3 to a shortness of breath call at one of the local nursing homes. On just about every call there's someone on the road who seems to have forgotten what to do when they see a large vehicle with flashing lights and siren. I dunno about you all, but my partner(s) and I have come up with some pretty descriptive nicknames to yell at these jokers, knowing all the while of course that they can't hear us. I suppose it makes us feel better anyway. So this car seemingly goes out of his way to cut us off and the first thing out of my mouth is "NICE JOB YA P*NIS!" I felt better and my partner got a chuckle out of it.

Soon afterward we had the patient in the ambulance, and while my partner was getting vitals, I reviewed the paperwork supplied by the nursing facility. The patient was having a hard time communicating and I wanted to get as much info on him as possible. The first page listed name, DOB, etc. but also listed this elderly person's previous occupation: PIANIST. Being a part time musician myself, I leaned over and said " I see you're a pianist, that must have been a fascinating career, I don't think I've ever met a pianist before."

Without missing a beat, my partner looks up from the monitor, and in a voice just loud enough for me to hear says, "Whatya mean? We just saw one on the road a few blocks back!"

Ouch.

Untimely

Called out this AM to a possible untimely. These calls can be depressing, and sometimes I wonder why EMS should be called. I guess our medical training lets us tell if the person is really dead. Nearly a half hour down time and cold to the touch... confirmed. No CPR done before we arrived. A quick chat with the on duty Medical Director fulfilled our legal angle on things.

A case of giving care, respect, and consolation to the family when nothing can be done for the patient. As I've said before, perhaps our most important role is just showing the people we deal with that somebody cares and will do what we can to help.

Later.

24 at EAS

No details are forthcoming in this post about my recent misfortune, but as a result I get to work more often here at Enosburgh Ambulance. I'm on a 24 today. EAS is a relatively small, very rural service that responds to 911 calls in Enosburgh Town, Enosburg Falls, Berkshire, Sheldon, and Montgomery, VT. We have great equipment and good EMTs, and even though our call volume is fairly low, we get some tough calls, long transports. It's not uncommon to spend the better part of an hour with the patient.

Pretty slow today, just one call, a basketball injury at a local high school. We have snow coming and the scanner has picked up with the local sheriff's department getting busy. Maybe we'll get something happening later.

Take care ya'll.

Search Engine

I just put a spot on the top of this blog that allows the viewer to do a web search directly from this site, while also allowing a seacrh of this site only as well. I'm hoping this will allow me (and other readers) to look through the blog for specific content a little more efficiently. Sometimes I remember writing about saomething awhile ago, but can't remember when. This should allow a quicker search for info.

Is There Anybody Out There?

My first post since September. I'd gotten several comments and e-mails with positive feedback on this blog, and I feel like letting it drop for so long to be a disservice to my readers.

That said, I believe I may have alluded to (though very ambigously) that I have been going through some tough stuff recently. Well, as we say here in Vermont, most of the stuff I was expecting to happen has "sugared down". I am not comfortable sharing with cyberspace the exact nature of what went down and what continues to be a very stressful part of my life, but I am back and hope to continue with the WayOutEMS blog. Hopefully I haven't lost my readers, but I guess as it says in the header, I write this stuff to help me get through the day to day in EMS, and I suppose even if no one reads this, at least I'm getting it out of my head.

Good news is that I broke down and bought myself a laptop with wireles access, and so I have access to the web a lot more often now than I have had in many months. I think one of the factors that makes blogging so successful is to be able to write and publish whenever you feel like it.

So, is there anybody out there? I'd appreciate an e-mail or comment from anybody. I suppose getting back to this is gonna help me work through the crap going on now, and a little encouragement from my fellow EMTs would mean alot to me. Hope to hear from you soon!!