Embracing emergency care has been a really long process. It's almost as though fate has led me to it.
Starting six years ago, over the course of a year and a half I found myself as the 'first responder' at four trauma or medical emergencies. Three of them were pretty scary. In each case, I had no idea what to do.
The first step was in Aberdeen, on the way back from my uncle's funeral in Salisbury. A pickup truck immediately in front of the car I was driving veered sharply left, crossed the median, the opposing two lanes of traffic, and bounced up onto a berm, ending up against a fence. I went up to the truck to see what I could do but there was nothing obvious. The occupant, an older man, was not wearing a seatbelt and was crawling around inside the cab of the truck in an uncoordinated manner. A police officer finally arrived and did the right thing; he got into the cab and held the guy's head and neck, providing manual stabilization until the EMTs got there.
Seven months later, I was leaving a nightclub in Torrington. A woman fell down the exit stairs and was unresponsive. Again, I was right there but had no idea what to do. I left before the EMTs got there; it was crowded and not my place to be spectating.
Eight months later at Folkfest, as an acting field supervisor, I was called to deal with a comatose young man in the near parking lot. He was just passed out, but I had no idea how to assess him. I had to wait about ten worried minutes for an EMT to arrive from the medical tent.
Leaving the Folkfest several days later, I had driven only about a half mile down the road when the jeep immediately in front of me made an abrupt right-hand turn into a telephone pole. Of course I stopped. The passenger, a twentysomething male, jumped out, shrieking. As I approached, he was screaming about his girlfriend and pacing about. I went around to the driver's side and observed a woman slumped over the wheel and not moving. As I moved back around the car, the man started screaming that he had glass in his eyes.
Fortuitously, there was an EMT in a camper several cars back. She got out with her jump kit and I did what little I could do; get myself and my car out of the way.
Although I had unhappily faced my own limitations, it took me a while to respond. Dave and I started camping, then rock climbing, then ice climbing. I did a lot af reading about backcoutnry accidents and I finally realized that it was time to get some first aid training.
The next summer, I managed to talk my boss into sponsoring me to take a Wilderness First Responder course from the school that pioneered wilderness prehospital care.
Wilderness First Responder is the baseline certification for outdoor program leaders, guides, and rangers; NOLS and Outward Bound both require WFR for their trip leaders.
The Wilderness First Responder course takes the minimum requirements for a ‘street’ First Responder as defined by the Department of Transportation and adds additional skills for use in the backcountry. Wilderness First Responder teaches about urgent immediate care as well as the issues regarding long-term care of acute injury or illness in the backcountry. ‘Wilderness’, for the purposes of medical protocols, implies more than one mile or one hour from ‘definitive care’. ‘Definitive care’ means the ambulance picks you up and takes you to the hospital.
Wilderness and street protocols are quite different. You are expected to provide much more invasive care in a wilderness setting than in the street; it's going to be a long time before the patient sees a doctor. Plus, on the street, an hour of patient contact is a lot; in the backcountry, one hour is just the very beginning of the long-term care possibly involved in a rescue.
The course was eight hours a day for ten days, living on SOLO’s campus. The instructors were excellent, and all were either MDs or EMTs. All had extensive experience and could relate the training to situations from their past. The course was very interesting although I spent much of the time psychically cringing at the thought of having to actually perform any of the techniques we were learning.
I learned a lot. At first, I thought I would not need any further medical training. The following weekend, though, a friend’s child injured himself in my backyard and I messed up the assessment. Happily, he was okay, but I clearly still had a lot to learn.
I had not used my training further by the following spring, so I took a three day refresher at SOLO just before moving west to sharpen my perishable skills.
A few months later, I took a mountaineering course through NOLS. I had the most recent medical training (if not experience), and the instructors asked me to teach the simple first aid curriculum. I was pleased in that the other students seemed to understand what I was trying to convey.
Having realized that I needed to practice in order to keep my skills, I spent the next year volunteering around the SF Bay area. As a volunteer, I helped teach several WFR courses at UCSF, helped teach CPR at various places, and staffed first aid stations for the Red Cross at marathons, concerts, and a county fair. While I did not see any serious injuries at these events, I was exposed to other volunteers with EMT training and came to the conclusion that I needed to go to the next level. I did provide some good care, but I also provided some care that I felt was substandard and unacceptable.
After moving back east, I looked around for a local EMT course. I found two courses that met one or two nights a week for several months, but none of the instructors were willing to work with my work travel schedule. I finally decided that the full-time WEMT course at SOLO made the most sense. Although I had taken a second refresher when we moved back, my original WFR was old enough that the school asked me to take the course again as a prerequisite for the WEMT module. Again, my employer was supportive and agreed to cover cost and time for the entire WFR/WEMT progression.
I took WFR in June and WEMT in October. My attendance in the WEMT course was complicated by the discovery of lead paint in our rented house and elevated lead levels in our kids; I had to take time off in the middle of the course to deal with the problems. For a while it seemed that I would not be able to complete the course at all. I did manage to squeak through the course, though, barely passing the National Registry practical exam (I managed to score a respectable 83% on the infamous written exam).
I received my National Registry certification, but I had few oppportunities to gain experience. While I was already working with a search and rescue team, most search and rescue tasks have little to do with patient care. Wilderness SAR is a semiskilled set of tasks; most of the skills involved have to do with keeping yourself safe in the wilderness while looking for clues. Also, care certifications are thick on the ground when it comes to SAR crews.
I began to realize my skills were deteriorating. I would tell someone I was an EMT, sure, I’ve got National Registry certification, but I would feel like an imposter. There are EMTs, and there are EMTs. Experience counts for something important, something crucial.
I had no idea how to exercise my skills. I really did not want to run with an ambulance squad and the NH and VT Red Cross chapters seemed disinterested in my offers to help. I came to the conclusion that I would retain WFR but let my WEMT-B certification lapse.
One of the people I mentioned my NREMT certification to was a man who drove me to the airport once, right after we moved to Vermont. He turned out to be a local state representative with contacts all over the county, moonlighting with occasional trips for the local car service.
The ambulance service in the next town had lost its transport license for lack of staffing, and had been reduced to a first responder service. They were desperately in need of EMTs. One day eight or ten months after my conversation with the limo driver, the squad coordinator happened to be talking to him and he gave her my name. She called me up out of the blue and asked me to join.
It was an offer I couldn’t refuse.
Four months later, my practical skills are about as sharp as they’ve ever been. I still have a lot to learn and a long way to grow, but I think I must be on the track. Lately I’ve been thinking that perhaps I’ll go for EMT-Intermediate in the next year or two.
I think about the car accident at the Folkfest frequently; the beauty of the day, the moment of the accident, and the horror of the aftermath are clear in my memory. It was very upsetting for me at the time; I was acutely aware that I had no idea what to do and had no way to help. I feel the despair of the boyfriend, realizing that his girlfriend is seriously hurt and that his eyes are no longer functional.
I measure my skills against that event. Recently I have come to the conclusion that I am finally ready for that event; that I can ‘first respond’ to that accident and handle care competently while managing my emotions.
Unfortunately, when the next testing event occurs, it will be one that I have not had the luxury of years to consider. Given the gradual way fate has led me to my current situation, the possibilities are terrifying. The day will come, though, and I will do my best.