I took my paramedic refresher course last week. Considering that my state requires a refresher every two years, it was my 14th paramedic refresher. I realized that I know hardly anyone in the classes any more, as most of my contemporaries in EMS have gone on to retire or otherwise just gone on.
I was excited, however, to see one of my old dear department pals, a woman who has been a paramedic even longer than I have and retired almost 10 years ago. We bungled through it together. We laughed about our first meeting: I was all alone, the only rural EMS responder in the median of the interstate highway at 3 a.m. with a rollover accident and a patient with two fractured femurs; she was on the county rescue unit, and she was absolutely gorgeous. There were very few women firefighter/paramedics, and I thought she was a queen. She was actually nice to me, a lowly volunteer, and I remember it to this day, almost 30 years later.
There were also a couple of paramedics who work in my home county in the class, and it was good to get to know them better. We barely pass on scenes, like ships in the night. Somehow, during a break, we got to talking about the rural area where I live, an area now covered by a countywide fire department EMS service. One of them asked me if I remembered his grandfather, who was a county chief in a neighboring county. His grandfather?!
Well, then we got serious. They were talking about the challenges in locating the many rural homes tucked away in the foothills in my community. I asked them if they could imagine providing EMS care there with no paved roads at all and no road signs or addresses. I also mentioned there were no street lights or maps. They looked at me as if I were an alien. Then I asked if they could imagine not having portable radios or a dispatch system -- just a couple of red phones in people's homes (those of us who were fortunate enough to have phones at all) and a "telephone tree" to alert responders of an emergency. Of course, there were no cell phones, GPS or other gizmogadgets either. Oh, and the 9-1-1 system wasn't here yet.
The EMS jump kit and oxygen bottle were kept at the village store. When the red phones rang, the store owner would set the equipment out on the road so that the first responder to come by could pick them up. Somehow, all of this worked.
There were no EMS medical protocols. EMTs were not yet licensed in my state; as usual, the law takes a while to catch up with the rest of the world. There was only a voluntary EMS registry. We were truly "paramedics at large," with very little supervision, medical or otherwise. There was no EMS medical director; the local family practice doctor told us that we were OK to do whatever we thought would help somebody in accordance with our training. Somehow, this worked too. I don't recall anyone doing anything terribly irresponsible or dangerous during those times.
We took blood pressures with a manual cuff and a stethoscope. We didn't wear gloves or masks. We touched our patients and felt their skin with our hands. Most of us didn t catch anything.
There were no transport protocols either. We took patients to the hospitals that, in our judgment, could best care for them in whatever vehicles were able to transport them safely, whether they were fire department rescue vehicles or private ambulances. Most of the time, that worked out OK, although we did have a lot of breakdowns, and once a transport unit I was in blew the transmission while we were en route with a trauma arrest patient. I told the wide-eyed EMT doing chest compressions that if there was any open flame, we'd bail out. We made it to the hospital (no trauma centers) trailing smoke, and the unit was towed away. The patient died, but not in my ambulance. No one died in my EMS unit.
There were no mandatory EVO, EVOC or whatever driving courses. Largely, you learned on the job not to drive like a maniac and to pretend there was an egg under the gas pedal when you had a patient in the back. You could tell the experienced paramedics because they could drive Code 3 while talking on the radio and eating a burrito -- and not get anything on their shirt. There were no "black boxes" monitoring our braking, and no GPS tracked our movements during a shift. I never had a significant accident -- a couple of bumps, but no one was injured.
The heart and soul of EMS will always be the responders who are willing to brave the elements, the dark and anything else out there to take care of patients. We didn't have a lot back then but we didn't feel we were entitled either. High-tech EMS has taken us a step back from the healing touch. I was shocked to find myself excluded from a transport because I knew the patient. In a rural area, you know most of your patients. If you strip away all of the gadgets, EMS providers still need to know how to touch and talk to a patient, and empathy will always be our best medicine. Don't let the gizmos get in the way of good patient care; but use them to enhance it. If you think the gadget is wrong, remember: Uou can still do it the old-fashioned way: palpate, auscultate, look, listen -- and don't forget to feel.
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