Giving at its best

by Mary Rains
Mille Lacs Health System

It’s another below-zero, winter weekday evening. I’ve stayed at work to get some things done when I’m startled by the ambulance pager, which nearly hops off my desk as it vibrates and buzzes with serious insistence. I listen to the dispatcher as I hurry to get out the door.

This time, I’m going to make this run. I have exactly five minutes to get to the Onamia ambulance garage, and I’m about one minute away by car. The last time it went off earlier in the day, by the time I’d gotten to my car, I heard the ambulance wailing away down the road. Those people are fast.

I am prepared better now. I have everything ready by the door of my office: the reflective EMS jacket, boots, and notebook are situated so I can grab and go.

I make it. I ride shotgun in the front for my first time, listening to the 911 dispatcher calmly describe the situation and the location as we head to the scene. As Margaret Willis - Ambulance Department manager and the driver tonight - carefully winds around motorists that don’t seem to understand the urgency of an ambulance (sirens and lights going) and what they should do, I’m frustrated already with the cars, but the she just does her best to navigate safely, yet swiftly, to the scene. From the back, the EMTs give out reflective vests used in multiple-vehicle accidents like this so everyone stays visible and safe.

I work in Marketing at Mille Lacs Health System, and in my job, I really do have to try to know everything about everything. In a conversation about this with Willis, she asked, “Do you really want to know what my department does?” I nodded. “Here,” she said, and offered me a pager.

Minutes count

I am not the typical rubbernecker driver in a car now, who is trying to see what’s happened as I go by. This time, I see the accident scene on the dark road unfolding first-hand, like in slow motion, as we come upon it and maneuver into place amid the gathering of rolling red lights and vehicles. In an instant, everyone in the rig exits. I do too, and even though Willis has told me to go to the left side of the rig and stay there, I get out and stand momentarily stunned.

Up-close, there are volunteer firefighters and fire trucks, police and the Sheriff’s. Dept., the Mille Lacs Health System Paramedic and a back-up ambulance from Isle, and a lot of EMTs. On the darkened highway are crumpled cars and fragments of glass and vehicle parts and injured people.

Those present to assist move into their roles with precision and purpose and speed, working together. I try to figure out who the leader is but I can’t, they are working as a team that closely. Some are asking questions of the drivers and others, some are dealing with victims, some are directing traffic, and some are trying to extricate a child from a car. It is dark. It is absolutely freezing. My ears go numb and each frigid gust of wind takes my breath away. I’m shivering, but everyone around me is too involved in the tasks at hand to notice the cold, or even have a hat on.

It all happens so fast, and suddenly we are back in the rig. I sit in the “jump seat” and observe the steadiness of the Paramedic and EMT. The fireman, who has carried the child from the car, stays in the rig. The child will not let go of him. The Paramedic quickly tries to determine the patient’s status through physical assessment of vital signs, (including blood pressure and heart rate) and trying to ask the patient about injuries. They cut jacket sleeves to look for a vein so they can start an IV while the ambulance bumps and barrels down the road, and it is expertly done. The patient isn’t able to communicate, just whimpers. I watch the small hand, clutching the fireman’s sleeve, all the way to the hospital.

Once there, another level of quick-action with staff that all instantly know what to do is obvious in the Emergency Room. Although on this night the ER bays are full, and incoming accident victims are arriving, no one is flustered. The trauma room is opened, nurses from the nearby Acute Care station arrive to help, I can hear the emergency helicopter’s blades axing through the night air overhead.

I also hear that one person in the crash died at the scene.

I stand off to the side, observing the firefighter (who is also an anesthetist at the hospital), the police, the nurses and ER PAs, the doctor on call, the EMTs and Paramedics. It’s a machine that works, all the many moving parts in a flurry of organized-chaos that’s awesome to witness.

Incoming

Mille Lacs Health System is situated in a rural area, yet because it’s also a tourist area with its proximity to Lake Mille Lacs and the Casino, as well as being on a gateway road to the many northern resorts and lakes, the Emergency Department and Level IV Trauma Center deal with a higher than normal amount of incoming emergencies. The job of the Emergency Department is to stabilize the patient and then if another level of care is needed, have transportation at the ready. This could be an ambulance to St. Cloud, the Twin Cities, or in some cases, as far away as North Dakota (and yes, the EMTs do these very long transfers.) Or, for some patients, a helicopter to North Memorial Hospital is the swiftest way to get them to specialists or emergency surgery.

There is a reason why the semi-annual trauma reviews done by North Memorial’s Emergency Dept. always give MLHS gold-star ratings. There’s a reason why the Emergency Department has received two years in a row an award for Best Emergency Care from the National Women’s Choice organization.

It’s because the department has an outstanding team. And the first people at “ground zero” in the field are the EMTs and Paramedics.

Mille Lacs Health System EMTs are volunteers from the communities of Onamia and Isle. They get a small stipend for their work. Obviously, they are not in this for the money, and this is not the “job” that pays the bills.

Community support

When an EMT is on call, their employers know the EMT on their staff may need to leave in a hurry. This can be tough for a business owner, but they make it work. Retired Isle School Superintendent Mike Conners says it was a win-win situation for him, having two EMTs on staff. “These people are doing such an important community service, why wouldn’t you try to uphold that?” Conners notes. “And, they’re on staff so I always felt good knowing their skills could help save a life in the building someday. Equally, they added to our depth of teaching at the school.” Were there issues about “double-dipping” during the work day? He laughs. “Really, the calls they have to go on, and what they sacrifice in their lives to do that, the emotional element of having to come back to work after dealing with something traumatic or even fatal, or sometimes it’s someone they know… it was a no-brainer for me. It’s about supporting our communities. We’re all in this together.”

The fact that there are enough highly trained, dedicated EMTs who can, within five minutes, get to an ambulance garage in Onamia or Isle is impressive. Paramedics, who provide advanced life support and another level of medical intervention if needed, are paid hospital employees and work 12-hour shifts in the emergency room between ambulance runs.

So if EMTs aren’t in it for the money, why do they do it? I can tell you that, being on “call” with them, I’ve heard that pager go off in middle of the night, or out planting tomatoes, or just after settling into a movie with my husband, or while making cookies with my grandson. Beautiful days, bad weather – emergencies happen and when they do, minutes matter. They are ready to go at the first buzz of that beeper, no matter what. And it’s not comfy to bound out of bed at 3 a.m., get dressed in 1 minute, and race to the ambulance garage when it’s blowing snow out and minus 20 degrees.

Yet, for all the inconvenience, EMTs I’ve gone on calls with have told me it “gets in your blood.” Tommy Vogtlin, from Onamia, says he got the training but it was an interim idea. Yet with every call he went on, he began to see how crucial the job was in the community. “I’m hooked now,” he says. “The extreme focus you need to have to perform the way we’ve been trained to, stay calm yet be in that high-intensity mode, is something you work on all the time to make sure you’re functioning in that zone as perfectly as you can.”

Karen Tramm and Lisa Larson, from Isle, both say that to be a part of this service in their community is “giving at its best.” Larson notes that being a long-time veteran of the Ambulance squad, she still feels the same adrenaline-infused anticipation, coupled with the sobering seriousness of what may lie ahead, on every call. “And we have to give our very best, every time,” adds Tramm. “Every ride to a scene or a home, no matter how small the situation or traumatic the event, deserves equal respect and attention and care from us.”

I have heard the calm 911 dispatcher while riding with the teams explain situations that are occurring in homes, at the Casino, on county roads, at regional events, at resorts, and on major highways. The EMTs have been spit on, bled on, thrown up on, cried on, sworn at. Their patients may be lonely, unconscious, scared, severely injured, extremely ill, overdosing on heroin, or dying. The people they pick up are not having their best day, and these EMTs know that. They take it all with an even-ness that is professional yet empathetic. They have seen it all.

Which brings up the feelings of coming to a traumatic scene involving someone they’ve known in the community. “We’re trained to do a job and when we get there we put the emotion aside because otherwise, we couldn’t do that job,” says Karen Tramm.

But afterward, this is when Tommy Vogtlin says the adrenaline gives way to a kind of shakiness, and the reality of what they’ve seen sinks in. Ambulance Manager Margaret Willis says in these cases, the teams will “de-compress” together and support the feelings that surface among the group. “Sometimes,” she says, “the emotions kick in pretty heavily.”

After completing the detailed and exacting paperwork at the hospital after the runs, these volunteers go back to their lives – work or home. But sometimes, as it is on some of the calls I witnessed, they aren’t even done with paperwork when another page comes in for another run.

Another season

It is now late spring with a wet snowfall and an accident now has occurred in the daytime. I see more clearly how the Sheriff’s Dept. re-directs the oncoming traffic. It’s windy and cold as I watch EMTs dealing with passengers in a car that is in the ditch; the volunteer firefighters cutting the car’s battery cable to prevent fire and/or airbag deployment, and using every skill and extrication tool needed to cut a crash victim out of the car. MLHS Paramedic Jim Overkamp waits nearby, ready to assess as quickly as possible as soon as the victim is pried out of the vehicle.

Overkamp tells me later that adrenaline is an interesting phenomenon. Too much and it makes one ineffective. Not enough and you’re lagging. “This job requires you to be acutely aware of where you are with that. To make life-saving decisions in these situations, you have to be able to be calm yet think very fast. The training and experience are key. And there are a lot of both here.”

Because they care

I’ve been on so many different kinds of calls over the last year, but am still awestruck by the complex job of dealing with a multi-car crash, everyone doing their part and expertly so. At the same time I’m reminded of how a split second ̶ on a highway with just a few feet between cars traveling in opposite directions at 65 m.p.h. – can change lives forever.

Later in the week, I overhear a conversation in the town of Isle; the EMTs at the Isle Ambulance Garage are being observed from across the street. Two ambulance teams involving a shift change and two separate calls, and then another call coming over the pager, create a flurry of action after some time spent relaxing and winding down. The onlooker mentions “there goes our taxpayer’s money” and a flood of defensiveness overcomes me. When these people are done with the run, nobody is paying them to stand and talk. They are using their own time, probably to talk themselves down and prepare for the next run.

From what I’ve learned over the last year going on call with these EMTs, most of us have no idea the sacrifices they make. There is no glory in it, no pay to speak of, there are long hours, intense training, time away from family, and leftover emotions to grapple with. Yet they do it. They do it because they really and truly care. Most people don’t know what they do and it doesn’t really matter to them. Until they need an ambulance.

I will never hear a siren and feel the same way again.