Washington Evening Journal
111 North Marion Avenue
Washington, IA 52353
Editor's note: This story is the third of a six-part series on how the EMS crisis is affecting local communities in southeast Iowa.
An ambulance is something everyone hopes they never need, but are sure thankful for it when they do. A quick response to a 911 call can make the difference between life and death. The team of professionals who can bring a person back from the brink are paramedics and EMTs, emergency medical technicians.
Members of the general public might think of a paramedic and an EMT as interchangeable, two words for the same thing. But they are different. A paramedic has more training than an EMT, and as a result, can perform more procedures on a patient.
An EMT can perform basic life-saving functions such as administer CPR, stopping a bleed, using an automatic external defibrillator to restart the heart, and more. Midwest Ambulance in Fairfield has a machine called a LUCAS device that performs chest compressions for CPR. The EMTs at Midwest Ambulance rave about it, and one said it has saved five patients within the past year or so.
Richard Young, Washington County Ambulance director, listed some of the things that only paramedics can do that EMTs cannot:
' Start an intravenous drip (IV)
' Administer medication
' Intubate a patient by inserting a tube down their mouth into their lungs to allow them to breathe
Most ambulance departments rely on both EMTs and paramedics, to differing degrees. For instance, Henry County Health Center has a paramedic on every ambulance, and usually two of them.
'Our EMT staff are like our as-needed staff. If one of the paramedics is on vacation, we use the EMTs to fill in holes in the schedule,” said Jacob Dodds, director of EMS for Henry County Health Center.
Washington County Ambulance has 14 paramedics and eight EMTs. Midwest Ambulance in Fairfield has five paramedics and six EMTs.
Dodds said an EMT receives an introductory level of instruction on anatomy, whereas a paramedic receives a 'collegiate level” of instruction on anatomy and physiology.
He said EMT certification normally requires about 180 hours of training, about half a year. After completing the classroom training, EMTs must complete many hours of ride-along time on an ambulance, and spending time observing an emergency room. At the end of their program, they take a national registry exam to get their state license.
Young said becoming a paramedic requires completing a two-year degree program. Programs are offered at several community colleges in the area. Young said the three major colleges that supply paramedics to him are Kirkwood Community College (based in Cedar Rapids with a satellite office in Washington), Southeast Community College in West Burlington, and the University of Iowa in Iowa City.
The University of Iowa's paramedic program is different from the other two in that it's full-time, and can be completed in six months.
Chris Sanders, paramedic supervisor and base manager of Midwest Ambulance in Fairfield, said most of his staff got their training at local community colleges such as Indian Hills Community College, Des Moines Area Community College, and others. Sanders is from Missouri, and got his medical training at Arkansas State University. Before coming to Fairfield a year ago, Sanders once worked as an ambulance driver in the city of Riyadh, Saudi Arabia.
Dodds said a person needs around 10 times as many hours to become a paramedic as an EMT. He estimated a student needs between 1,500-2,000 hours of coursework to become a paramedic. Paramedics-in-training rotate through multiple departments at a hospital such as surgery, obstetrics and many others.
Henry County's ambulance service is the only one in The Union's coverage area based in a hospital. Dodds said that means a typical day for one of his staff members is a bit different from those of paramedics and EMTs in other counties.
'When we're not on ambulance calls, we're utilized for other calls in the hospital,” he said. 'If someone comes in for radiology who needs contrast material injected into their veins, [the hospital] calls us to insert the IV. We also help in the emergency room, and respond to emergencies in the hospital.”
Shortage of EMTs and paramedics
Sanders said Midwest Ambulance transports patients between Jefferson County Health Center and other hospitals. He estimated that the company makes two trips to the University of Iowa Hospitals and Clinics every day. Apart from that, his team of EMTs and paramedics typically respond to five to seven 911 calls each day.
Sanders mentioned that he always has at least one ambulance staffed with a paramedic, and another truck ready to go, equipped with either paramedics, EMTs, or a combination of the two.
'I'm trying to bring in more paramedics, but there is a nation-wide shortage of them and of EMTs,” Sanders said.
Zachary Kendall, a Midwest Ambulance EMT, said the stress of the job causes people to drop out after a short time. Fellow EMT Tyler Cardwell said a number of people who start out training to be EMTs or paramedics switch to nursing because of its better benefits and pay.
Sanders said that paramedics must complete a 'ridiculous” number of clinical hours to become certified. Some feel that, if they need so many clinical hours, they might as well get a degree in nursing. He added that he feels the continuing education required for paramedics is more demanding than that required for nurses.
Cardwell said he's committed to becoming a paramedic, something he's wanted to be ever since he was 3. He plans to go back to school at the next available opportunity, either at Indian Hills or at Iowa Wesleyan University.
Kendall said he hasn't started studying to become a paramedic, but he's looking into it. Specifically, he's contemplating returning to the college where he got his EMT training, at Southeast Community College in Lincoln, Nebraska.
Kendall said that the 24-hour shifts can be rough, but on some days, there are few calls. The really tough days to get through are when the responders are on their feet for 20 of those 24 hours.
'Those are the hard days,” he said.
Midwest Ambulance EMT Nicholas Meleteo said that even when responders are able to sleep, it's not deep sleep because they're having to wake up every 30 minutes or so. Cardwell said that, once every week or two, he'll work a 24-hour shift where he won't get any sleep at all. There's no such thing as a typical routine to the day, either. Kendall said responders have to eat and sleep when they can.
Why choose a career in EMS?
Dodds has been Henry County's paramedic director since August, and has worked in EMS for 18 years, most of that time as a paramedic.
'I grew up around paramedics because my dad was a volunteer firefighter and a first responder,” Dodds said. 'He helped teach EMS classes, so he dragged me around to those when I was younger.”
Going into EMS was not Dodds's first choice. After graduating high school in Danville, he studied landscape architecture at Iowa State University. One year into the program, he realized it was not his calling. He got his tax return that year, and he received enough money to afford the EMT class, so that's what he chose to do. He returned to Danville and joined its fire department. He later did his paramedic training at the University of Iowa.
'I found this job to be very unique and exciting,” Dodds said. 'People get into this and find it's not for them, because it's not an easy job. It comes with a lot of risks they don't tell you about in paramedic school, such as risks to your physical and mental health. But If I had to do it over, I'd still choose the same path.”
Stress of the job
Dodds said post-traumatic stress disorder is a problem among EMS providers. He was diagnosed with it two years ago. It came as a shock to him, but after going through a series of tests, his therapist confirmed that he had it.
'It's not something that defines me,” he said. 'It's stigmatized in our profession.”
Dodds said he had always associated PTSD with a singular event, like a suicide or a violent car crash. He has seen plenty of those in his nearly two decades on the job. He has been called to the scene of a couple of homicides, and one child abuse case that resulted in a death. But he can't recall ever having recurring nightmares about those instances, like some sufferers of PTSD. Instead, his PTSD appears to be caused by the cumulative stress of responding to emergencies for 18 years.
'We work 24-hour shifts, and we have to go from sleeping one minute to driving 80 miles per hour on the highway the next, where we have to make split-second decisions,” he said.
One way in which Dodd's PTSD manifests itself is that he does not like crowds. He said a lot of other EMS providers he's talked to feel that same discomfort in large groups of people.
Cardwell said EMS responders are taught that, 'We don't have emergencies – patients have emergencies. We have to be calm for them.”
Sanders said the ambulance has a protocol that, in the event of a particularly traumatic event such as a mass casualty accident, the EMS responders will go through a stress debriefing, and therapists and members of the clergy will be brought in.
The job's high stress level is the reason that a lot of emergency responders burn out within six years, Cardwell said.
'You don't do this job to get rich; you do it for the love of your community,” he said.
History of EMS
Dodds said EMS is a fairly new profession, having started around 45 years ago. Prior to the modern EMS system, funeral homes operated ambulances. The person responding to the scene might have had first-aid training, but not much medical knowledge. Dodds said it wasn't until the 1970s that EMS became a distinct entity.
An article published in the late 1960s in the National Academy of Sciences related a study showing that deaths from automobile accidents could be reduced if trained medical professionals were sent to stabilize the patients while they were transported to the hospital.
'We get this information from the Vietnam War, where medics stabilized people before transferring them to a hospital for ongoing recovery,” Dodds said. 'They found that you could be mortally wounded on the battlefield in Vietnam and have a better chance of surviving than if you were in an automobile accident in the United States.”
Apart from the scientific studies, a major push for EMS came from an NBC television show called 'Emergency!” which ran from 1972-1977. It depicted paramedics working in Los Angeles at a time when such EMS services were limited to big cities. But the television show got people in rural America to ask, 'Why can't we have that here?”
At that time, decisions about EMS were made within the Department of Transportation, because the field grew out of saving car crash victims. Since then, EMS has expanded into responding to other medical emergencies.