EMT or Paramedic:What's The Difference

So it’s a busy Saturday afternoon, you have the kids piled in the back of the SUV and a stack of errands to do before you get home to make dinner. The traffic on Boston Road is slow and tedious and nothing seems to be going well for you. All of a sudden you hear the wail of a siren and see a burst of bright lights in your mirror. You pull to the right side of the road and stop while the Wilbraham Fire Department Medic 2 flies by you. As you watch the white box with the red stripe go by you wonder to yourself, “What exactly do they do in the back of that thing?”

First off, thank you for pulling to the right and STOPPING. It’s dangerous and difficult enough to drive an emergency vehicle without having to jockey for position with every vehicle that fails to move to the right and stop. It’s very frustrating as you try to deal with vehicles that don’t see you, don’t hear you or just plain ignore you. Cars pull out of driveways and side streets without looking. People pull over but don’t stop, forcing you to drive along side them while you try to avoid oncoming traffic. That’s why everywhere but on a divided highway, traffic coming at an emergency vehicle is also required to pull over and STOP. Another good tip to keep in mind, if everyone in front of you is pulling to the right and stopping, it’s probably not so you can go by. Check your rearview mirror and make sure an emergency vehicle is not waiting to pass.

Now back to the original question, what exactly do they do in the back of that thing?

Wilbraham Fire Department is located at 2770 Boston Road. Not only do we provide fire prevention, suppression and education but also we, like many area fire departments, provide our citizens with emergency medical services (EMS). In other words, we run the ambulance. Some local cities and towns are provided EMS by privately owned and operated ambulance services. For instance, American Medical Response (AMR) covers Springfield and Holyoke. Private service providers offer very competent and timely coverage; however there is a certain personal touch that goes along with a fire based service in your own community.

Ambulances have a history that date back to Civil War times. We’ve come a very long way from creaky wagons and bumpy horse trails. Today’s EMS provider is not simply “an ambulance driver”. Many months and sometimes years of training go into making emergency medical technicians (EMT) and paramedics.

There are three levels of training for EMS personnel. Everybody begins as an EMT-Basic. EMT Basics attend a three-month program to be taught basic life support or BLS. Locally the program is available through Springfield College, STCC and Human Services Training Consultants out of West Springfield. The course is designed to make you proficient in CPR, use of the semi automatic heart defibrillator and airway training. You learn bleeding and shock management, splinting, oxygen and oxygen delivery devices, and cervical neck and spine immobilization. Newly introduced skills include use of epi-pens for allergic reactions, administering aspirin for chest pain, assisting a patient to use their own nitroglycerine or asthma inhalers and the paramedic assist program. While learning these skills, students also become familiar with basic anatomy, physiology and medical terminology so that the EMT is able to accurately and concisely give reports to nurses and doctors. Ten hours observation in the Emergency Room rounds out your training. Students not only must pass the classroom with a 70 average but also need to pass a written and practical exam administered by the Commonwealth. Students then become certified as emergency medical technicians

An option after becoming comfortable as a Basic is to go back to college to become an EMT-Intermediate. There are a couple of EMT-I courses offered locally, most notably at Springfield College and through Mary Lane Hospital.
Intermediates begin their training with a semester of classroom lecture and hands on skills training. More in depth training is provided on the anatomy and physiology of the airway and respiration. Students are trained to use a laryngoscope and endotracheal intubations (like on ER when they “tube” the patient) as an option for airway management. Much detail is focused on to understand the pathophysiology of shock and how to optimally manage it using oxygen and IV therapy. Intermediates are drilled to become proficient at patient assessment. Many times illnesses or injuries are identified in the field (our word for prehospital) but they’re out of the scope of our training to resolve. Then it becomes our job to accurately report to the receiving nurses and doctors what we’ve found. This can greatly decrease the time between the patient becoming sick or injured and receiving definitive care at the hospital. The second part to becoming an EMT Intermediate is to spend a set number of hours at Baystate or Mercy Hospital. Your time is spent in the ER assessing patients and starting IV’s under the watchful eyes of the nurses, PA’s and doctors. The rest of the time is extremely challenging as you head to the operating room to intubate surgical patients under the tutelage of experienced anesthesiologist.

Not everyone chooses to become an EMT Intermediate. Some folks stay at the Basic level and are quite comfortable at that level for their career. Some brave souls however, choose to move on to paramedic school and the challenges it presents. Locally, Springfield College offers a two-year program. Paramedic students are refreshed in their basic skills and taught IV, advanced airway and patient assessment techniques similar to those that are taught in Intermediate school. During the first semester students begin to become acquainted with pharmacology. Not only are medications learned but also their uses, contraindications and how they work with the physiology of the patient. Semester one flows right into the summer session. That’s when students begin learning Advanced Cardiac Life Support (ACLS). In depth study of the anatomy and physiology of the cardiac and respiratory systems goes hand in hand with learning how to use newly acquired pharmacology knowledge. By the end of the summer session, students’ ability to identify and treat cardiac, respiratory and stroke patients is second nature. Third semester is a continuous review of classroom and practical skills while learning new subjects such as, special needs of the geriatric and pediatric patient, overdoses and poisonings, psychology and many other necessary subjects that round out the professional paramedic.

A semester is spent at an approved facility, most likely Baystate Health Systems, doing a series of clinical rotations. ICU, CCU, psych, ER, Pedi ER, OR, Infants & Toddlers, OB/GYN all provide the student the opportunity to learn necessary skills while being monitored by experienced nurses, doctors and Physician Assistants. Another semester is spent riding with more experienced paramedics, to begin putting all the knowledge gathered to good use for patients.

So the next time you’re pulled to the side of the road, stopped, and one of our town’s ambulances cruises by you, think to yourself, “what’s going on in there?” Is a heart patient being monitored with 12 lead EKGs, being given medication to treat a heart attack? Is an accident patient being stabilized through splinting, airway management and pain control medications? Is a child receiving asthma treatments to not only help them breathe easier, but receiving one on one TLC from an EMT, EMT-I or Paramedic who is well trained and calmly reassuring both child and patient.

One thing is for sure, in Wilbraham, it isn’t just an ambulance driver whose only hope is to drive fast to the emergency room. In Wilbraham, it’s one of the well-trained, professional firefighters who are cross-trained to deal with any emergency.

As always, Acting Chief Fran Nothe and the members of the Wilbraham Fire Department are there for you in fire safety and good health.

Front Page

At the end of 2003 I was finishing my fifth year as a firefighter/paramedic with the Wilbraham Fire Department. I was always bugging the Chief for extra projects to keep me busy. One day he came to me and asked me to write a fire safety article for the local newspaper, The Hampden/Wilbraham Times. If I did a good job I could expect to write a new one every week.
I was thrilled. Not only was it added responsibility but it was a chance to productively combine my two loves, writing and emergency services work. I also knew I would have the chance to share important messages with a broad audience. My first article was the very dry but necessary: Woodstoves and Chimneys Need Special Attention This Time of Year. Oh yah, quite the page turner. I'd like to think I successfully imparted a wise message but I fear I may have just provided extra fuel to more fires buring in unsafe flues. I won't blame my material though. There had to be a way to get people crazy for home safety lectures. If Dana Carvey can sell choppin' broccoli, I could bring fire education to life.

I'll admit the urge to get scandalous reared its amoral head. I considered presenting my lessons as tales of horror gone terribly wrong. "Your child just cut his leg off but YOU NEVER TOOK THE TIME TO MAKE A FIRST AID KIT!" But I resisted. I would find a way to sell my snake oil without actually making anybody drink it.

I'm happy to say more lively articles followed as I steered readers through the maze of home oxygen use, how to bike and swim safely and my personal favorite: "My House Is On Fire-Now What?"

Every Thursday I would trek down to Town Hall to pick up a copy of the new Times and flip through really fast to see which page my article had landed on. A good week meant I stopped flipping around page 15. An average week meant I made it to 26+. A bad week would have me flipping through the paper twice because the first time I missed it posted above the classifieds.
Imagine my surprise when one Sunny afternoon in May 2004 I picked up my Thursday copy and didn't have to flip at all. I was on the front page! Other than the fact thatI ran up and down the corridors of Town Hall screaming, "I made the front freakin' page!" I was speechless.

So here's the article as originally printed. Is it truly front page worthy? I don't know, it really may have just been a slow news week. What I do know is that for seven days I was on page one and they can't take that away from me! I saw my byline and article everywhere I went in town that week. It was in the pharmacy, all the restaurants, the library, on the desk of the guys who work at the dump and in the can at the firehouse. I had arrived!

Cowboy in the City foreword

Before the beginning…

…and probably at the end too…

It was late…and it was getting later…My life was careening down narrow windy roads completely in the dark and constructed by blind corners…Careening is a subjective motion…You can feel it standing still if you’re dizzy...But when you feign control careening is fun...
...sitting next to the Almighty Kelly O’Brien it was intense….
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This is the story of a 24 y/o GWF who grew up wanting to be Johnnie or Roy who then grew up and met Kelly O’Brien… who was way cooler than Johnnie or Roy could have ever hoped to be… and suddenly it all made sense…There is no feeling more liberating than the realization that one has stumbled upon their destiny… Now I’m scared to think where else I could have turned up…There are so many fine lines in life…friend-lover…lord-devil…blah blah blah…and you can end up in the strangest of places for a 16th of a degree’s difference in fate’s line…I was a 16th of a degree away from a life as doomed whiskey tango… Now I don’t believe there is anywhere else to be…anywhere else would not be as true... I thought I was applying for a job…what I got was a new perspective…I began to see life for what it isn’t….I saw it from the bottom up…I liked the view…In fact...I have grown afraid that they might try to take it away from me and if they did I don’t know what I’d do…
...ours is not a profession…it is a religion...

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...and I think all religions are basically the same…They all teach that the world sucks and it’s because evil kicks good’s ass…The only chance good has is the Gods…The Gods who have the right to say anything they want because whatever they want is right...

...they are Gods and that’s what Gods do...

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I believe in the God of EMS…he is a he right now…but Kelly O’Brien is giving him a good run for his money… I’m able to believe in the God of EMS because I have seen him in action… This is a god who can be fair... sometimes he just chooses to be a bastard…However…fair is fair and at least he doesn’t care if you call him a bastard when he deserves it…

…I don’t know how Kelly will feel about being called a bitch…^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^

The God of EMS operates on certain rules...I share them as I figure them out or as they are shared with me…only a few are allowed to the inner sanctum…Ariel taught me my first rule…be careful what you wish for…because you will get it...Like if you wish for a code because you’re bored you’ll get a pedicode…and for some strange reason looking at a dead kid and knowing you wished for it kinda sucks...Ariel also explains that there’s a special Angel for drunks...kids and EMTs…Sometimes I think Ariel is my Angel…I mean with her by my side I have carried a lot of drunks…cried with a lot of kids and drank with a lot of EMTs...

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Ours is a religion passed through stories told well…you are taught respect…respect for yourself…respect for your patients…most importantly respect for learning…One reason we share the rules as we figure them out is because nobody knows all the rules yet…maybe collectively we can come up with a complete set…Dark nights are the best time to learn...Sit next to the almighty Kelly O’Brien in florescent truck stops…under the neon glow of the light bar...and listen to her as the stories pour out…They tell our history…a history loaded with heroes…leaders...goats and devils…

All religions have a book that explains the rules…the book also outlines punishment for failure to comply…Some people might think regional protocols are our bible…but they’re not…we have no such book… because no one can tell you how to feel holding a dead baby…sometimes it just gets to you and no one holds it against you if you go home and stay there...So like any good religion…guilt is all the punishment we ever need...

...bless me Hoppy for I have sinned…

So now I’m going to tell you some stories...parables if you will...and this is how they came to be... I listened to all their stories…I lived a good portion of them myself…I paid attention to the details…I remembered how everything felt… Everything you read is true…it happened to somebody…if you can feel it you know how we felt…

...we’re just people too…^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^

It’s scary when you realize that somewhere along the line you sold your soul to the devil…We all heard the story and we all know how it ends…you enjoy the promised ride and then get pissed because the ride doesn’t last forever …yet we fall for it every time…Sometimes when I’m really enjoying some sick thing I get to work with I wonder “...why am I having so much fun…how did I get lucky enough to be here...” …I always forget the part about how much it’s going to cost…Some kids sell their soul to get backstage at a rock concert…I sold mine to get behind the tape on crime scenes…to approach the bench for the Commonwealth and to witness autopsies with homicide detectives…

....and the chance to work with Kelly O’Brien…

Looking Back

Once I was the talk of town
And people came from all around
Saying, "Today we'll see her."

Now I'm all alone, standing in line,
Nothing to do but play with time,
Hoping someone remembers.

Once it was worth it but now it's vain.
It's like being lost in the rain,
All wet with no where to go.
Some say, "Well that's show biz.
Sorry kid, that's just the way it is."
Sorry is one word I know.

As a kid I dreamt so muchOf being a star,
big time and such.
But when push came to shove

All I was left with
Was a long list of "if's"
And "maybe I should have's..."

God Bless America The American Dream vs. American Industry

Imagine you're floating along on a calm, balmy ocean day. Your head is thrown back on the comfy edge of the inner tube and your feet dangle lazily into the warm ocean surf. Your warm, floating security makes you oblivious to the fact that you are totally on your own and hundreds of miles from the nearest life station. Who cares, you're doing just fine. Suddenly, a helicopter hovers above you in the clouds, painting shadows on your body where there was once pure sunshine. A loud crisp voice falls on you from the loud speakers battling above the whap of the blades lacerating the clouds. "You are in danger!" it informs, "A swarming school of SHARKS is headed your way! You must leave the water to ensure your safety!" Your body whirls into action. You struggle to remain on your inner tube. Blood vessels dilate under the surge of epinephrine and your brain becomes engorged with blood. Thoughts of impending demise have caused your cerebrum to swell against the walls of your skull. A life rope drops in front of you. You can no longer hear. You're blind and unable to focus your eyes. An inner strength comes over you and you instinctively cling to the rope. As it pulls you vertically and perpendicular to the horizon you look down to see the swarming school of sharks passing below your feet. Twenty feet below your feet now separates you from a horrifying, painful death. Thankful for your security you kiss the rope and inwardly reward each member of the team that saved you. You're flying free when you notice you're dropping vertically and at an increasing speed. The line's been cut. The helicopter is flying away from you. You hit the water with an excruciating slap. Your left leg breaks in two places and your right leg snaps in three. Blood spills into the water and the savagely swarming school of sharks turns its frenzied rage on you. The copter safely lands on shore. It is thankful it didn't let you drag them down to death. They never knew your name. It was an impersonalized experience for them; it was the most terrifying nightmare of your now ended life. True, as things stood, you would have died anyways. The helicopter made no difference. But what if you were to find out the helicopter invited the sharks to begin with. In fact, they were working together and had the whole plan concocted to get you. Oh well, too bad for you. "You should have stayed in the pond, back floater!"

American Dream versus blah blah blah

In May of 1996 I graduated from Holyoke Community College with an associate’s degree in Science. I have never used that degree to find myself meaningful employment but yet I still treasure it as one of the most enlightening experiences of my life.

As I highlight in Cowboy in the City, I came to my adult years as a pretty naive, suburban chick. My ideals and morals were shaped by a conservative upbringing that left me constricted in view. Thank goodness for education! Sitting in classrooms, participating in discussions led by the motivated and progressive professors of HCC challenged me to open my mind. Slowly, new ways of seeing things came into focus. Most importantly, I realized that the large problems in the world have been around forever and will never be solved with quick judgments and clichés.This piece was the opening to a term paper I wrote for Urban Sociology, a course that teaches how cities are formed and an overview of the of the socio-economic layering that results. It's where I learned the concept of vertical disintegration I quote in "Cowboy." It's also where I developed the bitter taste for corporate politics that soon ruled our lives. The characters in "Cowboy" have to deal with their small local ambulance company being bought by a large international corporation who forces them to merge with their heated city rivals. I learned it and then I lived it. In keeping with good form, then I wrote about it!

What is most special to me about this piece though, was the comments the professor wrote on it when he corrected it, "Did you make this up or take it from some source? If the first, well done, if the latter, you should have given the author credit!"Wow, can you believe it; I wrote something so good he didn't even believe it was mine!

Looking Back

Now before you get all harsh and judgmental on my wee bit of prose you need to know one important fact, I wrote it when I was fifteen years old. Not sure where my worldly, looking back on it perspective came from but I did read a lot of Dickens as a child.

It is also noteworthy to add that this was my first published work. Long before the days of the Internet, when you actually had to read trade journals to understand a business, I used my allowance to subscribe to every publishing related magazine available. One day a card came in the mail with the invitation to enter a poetry contest and win the chance to be published! I was thrilled. There was no entry fee and I could submit as many works of poetry as I wanted. I had many in my collection to choose from as I had spent that entire summer banging out poems left and right on the raggedy old typewriter I had picked up at a tag sale for $15. In the end I decided I wanted to pick just one so as to make the strongest statement of my young literary career.

Later I was heartbroken to find out the contest was nothing more than a way to get a bunch of people to buy a book with a bunch of other people's poems surrounding their one. I remember my father coldly laying out the harsh facts to me. However, his pragmatism didn't stop me from begging him to buy me a copy of the anthology. Maybe it was a scam but that didn't change the fact that for the first time I could see my words in black and white and on a page I could bookmark for easy future reference!

Door open...proceed with purpose!

I plan to post samples of my writing. You will find them to be diverse in style and form and they span a lifetime of my creation. I also want to share stories with you about the people and experiences that went in to writing them.

My first entry is the foreword to my recently completed novel, "Cowboy in the City." I became an EMT-Basic in 1992 and started working for a small local ambulance company. The hours were long and tiring, the pay sucked and nobody ever appreciated a thing you did for them and yet I have never had a better job-ever!The best part is I wasn't alone. I found an entire culture of workers who shared this upside down version of the world and excelled in managing its tragedies and storylines. I made friends with some of the most complete human beings you'll ever meet and I am honored to be able to tell their stories to you.

"Cowboy in the City" is currently unpublished. I am early in the process of finding a publishing agent. Similar to when I first climbed into an ambulance equipped with training but zero experience, I find myself at the foot of a tall mountain. I would appreciate any guidance or information you feel comfortable sharing with me about the process.

Door's open...proceed with purpose

Hello World! It's been awhile since I updated. I won't bore you with the reasons why. I had the privilege of attending the "Springfield College 20 year Paramedic Class Reunion" last week. It was crazy to stand in a room filled with so many of the characters I chose to write my novel about. I took the chance to fill everyone in on the book's creation and potential publication. I'm glad to say everybody seemed excited that someone had taken the time to document that block of our history.
To the new people in EMS, the way it is now is the way it's always been. That's not true though and hands down the old way was better!Watching the slide show reminded me of how cool those early days were. Not only was our profession young and just getting off the ground, but we were too! And most of the photos in the slide show accurately portrayed the youthful confidence that we exuded. Sometimes our individual egos made for interesting "conversations" but over all, after time has passed and judged us, we all share the thought that we were part of something special.
I spent this passed Saturday with an attorney interested in being my publishing agent. His number one question was, "why did you write the book?" That's easy! The people and times I wrote about were by far the greatest I've known my whole life. I don't want to get stuck in time and exist solely for my "Glory Days" (boy, the older I get the more that song bugs me) but I also believe those days should not be forgotten. We weren't perfect and I think my book amply points that out, but we were willing to do some pretty crappy things no one else wanted to go near. And we learned to do them with skill, compassion and professionalism. A lot of cool stuff goes on in the back of that ambulance trying to pass you! My friends, my heroes, are the ones who got this great big giant puppy off the ground. I came in a little later and rode on established coat tails. I believe writing my book is a sign of respect and awe for them. Maybe you could just pull to the right and let them go by!