Thursday, April 10, 2008

Where have we come from...

I think back to my days on the North Ward First Aid Squad, and I have to laugh. How far we have come since the wild and crazy days of 1981...

Typically a call would come in over a seven digit phone number (9-1-1 was still in its infancy in the early part of the 1980's in Newark, NJ!).

We were a BLS unit, as ALS was still a pilot program, so there were only 7 paramedic units in the whole state of NJ, two of them, Jersey City and Hackensack, were the only ones in urban areas. We wouldn't have paramedics in Newark until 1983! The paramedics had no standing orders, and if they wanted to do a fingerstick to check someone’s glucose level they had to call the medical control doctor at the base hospital!

All volunteer, we rode out of a building in the North Ward of Newark, NJ, a city rocked by riots in 1967, still trying to make its way back. You could run a call in a housing project (Sheffield Drive) for a maternity patient or an asthma. Hopefully the elevators worked, if not you were going to have to walk up a few flights of stairs. Maybe respond down on Broadway and Second for a shooting.

Either way we always tried to get the patient to the 'bus' (that is what we called ambulances back then, don't ask me why...ask Mario Piumelli that is who taught me!) and then rock and roll into one of the area hospitals (Martland/College/University, United, Columbus, Claara Maas, St. James, St. Michaels, Newark Beth Israel).

We were scrappy, proud of who were and what were doing. We took pride in our ambulances, and magically, without explanation, we often had better equipment and supplies than they had on the City ambulances...

MANY times we would get calls from outside of the North Ward, our level of care was legendary. I remember one time we actually took a call that came in direct from Newark Police for a child struck by auto, down the street from the South District police precinct on West Bigelow. They had been waiting 20+ minutes for a City ambulance and with no ambulance in sight they called us. Just as we began to load the patient into the ambulance, Martland (which was really College Hospital then, but everyone still called them Martland) showed up.

When we pulled up, the crowd was tense, since this poor child had been lying in the street for so long. The crowd made way and actually applauded us for our quick response. It got very vocal when Martland showed up, and the cops actually ran over to the ambulance to tell them to leave before any other words were exchanged!

January of 1981 I enrolled in my first EMT course, which was 110 hours (with an additional 12 hours in the emergency department) in length. We were part of a visionary program in EMS education lead by Chief Al Freda of the Newark Fire Department. At that time MOST EMT courses were 81 hours (the DOT standard at the time). Chief Freda gave us additional material on mass casualty incidents, HAZMAT, helicopter landing zones, etc. He was truly ahead of his time. At this EMT course I also had the pleasure of meeting for the first time Jud Fuller.

And while Chief Freda was not the only one to run an extended length EMT course in NJ (Keith Holtermann, another visionary in EMS comes to mind), he will always have a special place in my heart for giving me my first shot in this profession. I got the opportunity to pay him back years later, when after I became a paramedic I had the opportunity to do the Anatomy and Physiology, Bleeding and Shock lectures, for the Basic EMT Class at UMDNJ.

Jud Fuller was the director of EMS for College Hospital and also the director of communications, which was called REMCS, the Regional Emergency Medical Communications System. Another outstanding leader, he later went on to work with the federal government to start DMAT (Disaster Medical Assistance Teams) and NDMS (National Disaster Medical System).

When Jud went over to work for NDMS, I ran into him one day at the VA Hospital in East Orange. I asked him what he was up to, and he immediately grabbed me by the arm and led me into his office. He showed me a plan for a disaster he drill he wanted to run in NYC.

The scenario: an earthquake strikes Manhattan, causing catastrophic damage to the Twin Towers, resulting in their collapse. The subsequent damage to other buildings and to New York City would necessitate using resources from outside NYC (which until that time, had not been done been done since a catastrophic fire had destroyed much of Manhattan in the 1800’s and the FDNY called for help from across the tri-state area).

The year Jud wanted to do this? 1991, a full two years before the first attack on the World Trade Center, and 10 years before the tragedy of September 11.

Chief Freda and Jud Fuller taught me so much, it is a shame that they are not with us today.

So much has happened since then, in NJ and around the nation. The one thing that has always been a constant is the people. Never lacking for patients, I have personally not seen an EMS system that has had a DECREASE in call volume. Calls for care keep going up.

On the other hand, the dedication exhibited by providers is not lacking, but the number of providers is. Where ever we look, in urban areas where pay scales and health benefits are attractive for people in an economy that has slowed down, to rural areas, where the sense of community and the spirit to help ones neighbors has always sustained the volunteer community, we can’t seem to attract people to the profession, and those that do come, don’t stay that long.

The field of emergency medical services has allowed me to help people, to respond on assignments from a call for a lost child to large scale mass casualty incidents. I have had patients who not only needed someone to intervene immediately for a life-threatening emergency, but also to just sit and listen, when that is what they really needed.

I have had the opportunity to meet some of the best doctors and nurses in our field, compassionate, caring individuals, who are on the front lines each and every day. I have had the opportunity to see some ground breaking research in our field, field test the latest equipment, new drugs.

I remember one time in 1987, our medical director, a doctor by the name of Tino Gonzalez, wanted to get glucagon approved as a drug for paramedics. We had some very bad diabetics who we had difficulty getting IV access on. Dr. Gonzalez, try as he might, he couldn’t get it approved for a trial study in the field.

What did he do? He went out every time we had a diabetic emergency, and if we couldn’t get the IV line he would administer the glucagon. After he had acquired a statistically significant number of field administrations, he went back to the state medical directors and got the drug approved. If I close my eyes I can still see him running out of the emergency department at Jersey City Medical Center, his lab coat flying, as he jumped into the supervisor’s truck for a Code 1 response.

I have also had the opportunity to work with some outstanding EMT’s and paramedic’s, many of whom are the best in the field. I will never forget the lessons I learned from them, I can't even go on to mention them all here in one space, but I will tell a story about all of them in due time. I owe the success in my career and in my life as much to my former partners. It was truly a family, a brotherhood.

I remember my paramedic clinical with Ray K. He was so pumped up to be at the bedside, practicing new skills and learning from a truly dedicated group of doctors. We were in the maternity ward and he got to do an episiotomy on a woman!

I asked him what it was like and he said the maternity doctor guided him through the whole thing!

Ray was describing the procedure to me and I picked up a pair of scissors and pantomined the procedure...the whole time my hands were shaking! And I was just play acting! I said to Ray: did your hands shake?

He said no, things were happening so fast he didn't have time to be scared! I told him I gave him a lot of credit for doing it, I don't think I could have...

The one thing I learned from Ray: Be a life-long student. Ray was older than me, but he approached everything with his eyes wide open. He was always open to new ideas and techniques. He sat in the front row of every class, taking notes and asking questions. He would be the first one to grab a piece of equipment, take it apart and put it back together.

He told me that true failure came from not trying your best. My grandfather, Richard O'Brien taught me that also. He said that any job is a job worth doing well, to do your best and always to give your best effort.

Stay safe my brothers and sisters.