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The Citizen, 2001-02-14, Page 6•:k A team Arriving at their destination, Harold Martin, foreground, and Dave Wagner take a Wingham patient to University Hospital in London for a bone scan. Because much of what they are called upon to do is more critical, working as a team has meant becoming familiar with how the other works, anticipating what they will do. PAGE 6, THE CITIZEN, WEDNESDAY, FEBRUARY 14, 2001 A walk in their shoes Paramedics' job often a matter of life or death Editor's note: This is the fifth in a series of stories about area people and the jobs they do. As an attempt to provide some insight on what it's really like in certain professions, not just our perceptions, we invite you to join us as we take "A Walk in Their Shoes". By Bonnie Gropp Citizen staff Their job can be a matter of life or death. It's 7 a.m. and paramedics Harold Martin, 28 and Dave Wagner, 26 are beginning their 12-hour shift out of the Wingham base. (Weekends are 10 hours on) They conduct vehicle checks making sure that all equip- ment is in place and functional. Today they will be driving ambu- lance 1156. The numbers, they explain actually have a rationale. They work out of region 1, this par- ticular vehicle has one stretcher on board and- the ambulance number is 56. Wagner contacts central dispatch in London, to tell them who's on and a beeper test is done. The beepers are an important aspect of the job as paramedics working the 10-10 shift are on-call those evenings and have eight minutes to get to the base. "They're fairly sticky on the times," says Martin. "But it's never been an issue. People on this job know what it means. They are conscientious." A fax comes in giving the weather report for the day, a new feature since the county assumed responsi- bility for the ambulances. Knowing what to expect on the roads is critical as the paramedics in Wingham cover a large area, past Lucknow in the west, just north of Teeswater, south of Blyth and Brussels a few miles and occasionally into Fordwich, which they share with Palmerston and Listowel. Martin tells of an indi- vidual with a chronic illness who lives 28 km away from Wingham, the closest base. "It's a long time in summer to get there, dreadfully long in winter." Complicating the distance factor is the fact that for the first time in a long time there is a problem finding enough qualified staff. This is the first year that paramedic training has been a minimum of two years, mean- ing that there were essentially no graduates in June. "The county has brought the services up to the stan- dards the Ministry hadn't met so there are few qualified paramedics in the province right now who are not already actively working," said Martin. With the vehicle check complete and minimal paperwork finished the pair wait. Because it is an emergency service the job can of course have its slow times. At 7:50 a.m. the team get its first call, the transfer of a patient to London for a bone scan. A non- scheduled run, this is considered a Code 1. Code 2 is scheduled, Code 3 is urgent, but non-life threatening and Code 4 is life-threatening. Transfers are the primary reason for an overlap of shifts during the day. "There are quite a few people who can't make the trip to the city hospital for tests or a better quality of care by car. Then usually we have someone to, bring back," says Martin. When both ambulances are out of the area or tied up, another from a neighbouring base is sent in to cover. Enroute to London, Martin drives while Wagner rides in back. Also along for the trip is an RPN, who must accompany the patient as hos- pitals don't assume responsibility for another hospital's patient. "It's ridiculous," says Martin. "This patient doesn't need a nurse, but it's the cuts to health care and every- one's looking out for themselves." The ambulance cruises at the speed limit for the trip. Martin says the policy for paramedics is that they can travel about 20 km per hour over the limit and 120 km per hour maxi- mum on Code 4s. "Even with the policy in mind, if we really felt time was of the essence we would proba- bly exceed it, but you certainly want good road conditions and reasonable traffic," says Martin. Also, with- this D'eing a Code 1, Martin says they can stop at an acci- dent scene or do a first response. The ambulance has passed through Blyth and Martin contacts dispatch to change channels. This happens at several points along the way. Throughout the trip Wagner, the nurse and patient can be heard talk- ing. "You can have all the skills, but the patients remember extra things you do. It's about going out of your way, seeing to their needs, sitting with them," says Martin. Arriving at the destination Wagner calls up for mileage. This is a prac- tice that they do as some calls require billing for the service. Within minutes the patient has been given to the hospital staff. Though the arrival went smoothly, such is not always the case. "Sometimes they're not expecting the patient; and once they even sent us back because they wouldn't have a bed until the next day," says Martin. Dispatch informs them that there may be need for a transport back, so Martin and Wagner stop for coffee at 10:45. It isn't long before they are told to return to University Hospital to pick up a patient recovering from hip replacement surgery for transport . to Walkerton. As they arrive; four ambulances are parked at the emer- gency entrance, including another from Huron. By 11:14, a new patient has been settled in. This time Wagner takes the wheel. The switching helps to relieve boredom. Mileage is noted and they set out. Enroute, Wagner tells about the job. Salaries for paramedics are in the range of $18-$25 per hour in this area. There are three levels of para- medic. As graduates of the Ambulance and Emergency Care course they are primary care para- medics. Once hired by a service, they work under the license of the base hospital doctor and can give symptom relief and defibrillate. They are allowed to administer five drugs, epinephrine, nitroglycerine, ASA, glucosamine, ventolin. There are strict rules to follow for when they can administer them. For exam- ple, in the case of nitro there has to have been previous use and the blood pressure must be over 100 sys- tolic. Advanced care paramedics take a course from the Nlitchener Institute. Most of these work in the cities. They are able to do IV starts and intubate, as well as administer more kinds of drugs, including cardio medication and morphine. Critical care paramedics ride with air transport from Toronto. "They can do just about anything," says Wagner. For some of the paramedics the levels can be frustrating. "It's all about money and here we can't afford to train to that extent," Wagner says. "We have one para- medic who is a nurse and she knows when someone needs an IV, can give them an IV, but can't do -anything about it." -Param.edics can pronounce death _ in certain situations. "If I look at a person and know they are dead, I put a monitor on for 10 seconds, then again, then I call a doctor in Owen Sound. I give him the history and through me the doctor will pro- nounce death. It is pretty undignified to do CPR on someone who has died, On the other hand, sometimes the family needs that, sometimes they need to think there's hope." One instance when this applies is with a SIDS (Sudden Infant Death Syndrome) baby. "That is tough. It's one of those ones you work on no matter what," says Martin. "It even makes us feel a little bet- ter," Wagner adds. At 12:55 p.m. they are approach- ing Walkerton. The patient has slept most of the way. Though there was little doubt this would be an uneventful trip, the men have come to expect surprises, to be resourceful. Saying that it's "tricky" doing CPR in the back of the ambu- lance, Wagner adds that there's a lot of "irnprov" in what they do. "Sometimes it takes interesting ideas to deal with a case," Martin says. As an example he tells of a patient who had collapsed in their bathroom and needed a spinal board. Unfortunately the person was wedged between the wall and toilet. Admitting their respect for small town doctors, who need to have a broad medical knowledge, the pair are also quick to point out their strengths. "Doctors are used to working in a controlled environ- ment. We deal with cold, rain, heat, traffic. We work with what we have," says Wagner. Dispatch calls; all ambulances are out of the area and 1156 is needed to cover Wingham. As they head back for lunch at 1:16 p.m., Martin takes over the wheel. A Code 4 call from another team comes over the radio about a 90-year-old woman who was short of breath. There is no question seeing the expressions on their faces, that the pair would like to have been the ones to get the call. It is not about enjoy- ing another's misfortune, but rather about doing what they have been trained to do. They expect to deal with emergen- cies, they are prepared to deal with emergencies. And to stay sharp they have to deal with emergencies. Trauma, they say, is a good way to refine their skills. "It's a medical brain teaser," says Martin. You have to find things out and piece them together." Accident scenes, a prevalent emer- gency in rural Huron, also means determining which victim is more critical. The pair talk in detail about mass trauma, triage and colour-cod- ing of victims. "If they're blue it's beyond our capabilities and we have to go on," says Wagner. "One of the most difficult things is to make someone dead who's not." "But you can't leave others where there is hope, unattended. Down the road, you realize the decision was in the best interest of the rest," says Martin. Another aspect of the job that some might not consider is the ele- ment of risk. "Dispatch often doesn't have all the information and we don't know what we're walking into," says Wagner. His partner adds, "We climb around bashed cars, you can smell gas. When you come back to the base you go into the washroom and shake glass out of your clothes." The fluorescent strips on that clothing have been a benefit, too. "It has saved a lot of lives," says Martin, referring to the fact that paramedics are often walking in the dark on the roadways. In snowstorms, when others may not venture out, the paramedics are required to make a reasonable effort. They can also get a snowplow escort. On this day, weather has been on their side, however. It is now 1:41 and they fill up at a gas station then pick up lunch before heading to the base. Shortly after 2 p.m., dispatch con- tacts them to pick up a resident at Huronlea in Brussels for transport to Wingham hospital for x-rays. The pair kibitz about pranks among the paramedics and about the work they do. "It is difficult to relate to people who don't do this job," says Martin. It's difficult for family and friends to understand." So keen is their involvement that they don't stop when they get home. Their favourite shows are the Learning Channel's Paramedics and ER, though they think the latter has become a "little soap opera-ish." "We know about making those split-second decisions that you have to live with most of your life. But you go with the training and do what has to be done as efficiently and effectively as possible," says Martin. The emotional aspect of death and tragedy is perhaps rookies' biggest fear, Martin says. "You go in and do what has to be done. How you feel about it comes into play afterwards." "I believe when it's your time to go, it's your time to go," says Martin. "That said, people ask me-what the point of my job is then. My response is to make people as comfortable as possible."