Holiday Cheer in EMS

This is what happens when you let us out in public. Happy holidays folks!

--CW

Everybody, Somebody, Anybody and Nobody

"This is a little story about four people named Everybody, Somebody, Anybody and Nobody. There was an important job to be done and Everybody was sure that Somebody would do it. Anybody could have done it, but Nobody did it. Somebody got angry about that because it was Everybody's job. Everybody though that Anybody could do it, but Nobody realized that Everybody wouldn't do it. It ended up that Everybody blamed Somebody when Nobody did what Anybody could have done."--Anonymous

There's been a huge shift in mentality in this country in the past few decades. Vague, I know, but it's true in an ungodly amount of contexts; attitudes about sex, marriage, adulthood, responsibility, accountability, parenting, education, politics, and civic involvement have all changed drastically since my parent's generation. While the shift in many of the attitudes I have just listed deeply concern me and make me frightened for the world that my generation will inherit and be responsible for living in and attempting to fix, I'd like to spend a bit of time discussing the last one that I mentioned, civic involvement, including attitudes towards community, volunteering and citizenship.

This change in attitudes about civic responsibility is something that I've been thinking about for awhile--for a lot of reasons. It is something I've been discussing a lot with my fellow volunteer EMTs in the context of the rescue squad, and this idea has also been consistently resurfacing in discussions with my social studies education cohort as we've been talking a lot about the responsibilities that social studies teachers have to their students, including fostering a notion of civic responsibility and citizenship.

There is a radically different approach taken to volunteering within and for one's community in today's world of instant gratification and looking out for the top dog than there was even ten to fifteen years ago. Growing up, I was regaled with stories of the tight-knit community that my mom grew up in the mid-20th century Midwest. It was a place where friends and neighbors served one another in a capacity unfathomable to many small towns today. I was raised on my maternal grandfather's reminiscences about the civic capacities he served in, and the pride that he derived from not only serving his local community, but also his country as a military man. I was raised by parents who understood what it meant to serve as they volunteered much of their time in the schools, as coaches and as church leaders. Growing up, I never lacked role models of citizenship and commitment to the community, and I think that foundation of support is what continues to drive me today in my dedication to public and civic service. I am lucky in that regard.

Unfortunately, people like my parents and grandparents are fading in numbers. While they are people who understand that doing what is right can be satisfying in spite of the hard work and thanklessness that  community service often demands, they are largely outnumbered by people who expect (and often demand) such time consuming and passionate dedication for nothing in return. Today, we live in a culture that has socialized us to expect instant results, instant pleasure, and minimal effort when we do something. Just think about the smart phone revolution in the past few years. Never has been accessing information and entertainment been as rapid and effortless as it is in our technologically driven society.  However, volunteering in and for a community does not always offer such immediate rewards for such little input, and I feel like I can accurately say this drawing largely on  my experience as an EMT.

As an EMT, I am required to run a duty crew once a week for 12 hours. When it is my duty night, there are roughly 1000 individuals relying on me to fulfill my commitment to the community. Running for such a small-town service, if I fail to show up for my shift then we may not get a truck out of the building that night. There are few acceptable reasons for me to miss my shift, and if I do it's my responsibility to find coverage. For my actions, I am held accountable. Not every night in EMS is glamorous though, and there are nights where running duty conflicts with some other interest of mine or is an inconvenience at best. Some nights I show up and we don't turn a single wheel. Some nights I arrive at the station planning on (and needing to) complete several homework assignments or tasks, and we proceed to run all night. Every once in awhile I may run a call that taxes my patient assessment skills and ability to triage and treat; more likely than not I will spend a call addressing the feeling poorlies or "take me to the hospital because I said so." It is in this capacity that I serve my community, and I serve it proudly--regardless of the situation.

However, the town where I run is not the area in which I was born or raised. In fact, it is a community in which I am a transplant whom for some reason has become attached to the people and the way of life in this sleepy little town. I have chosen to make this little town my community-- and in tradition with the values upon which I was raised, my responsibility. There are many like me whom have stumbled across this community and have found a place to serve and call their own. Yet the dwindling numbers of native volunteers baffles me when I see so many transplants ready and willing to serve this area. When the rescue squad first came into existence, it's membership was comprised of a thriving group of individuals and families that were directly served and benefitted by the rescue squad. It was public service staffed by and for the community it called home.

But in recent years, membership has dwindled. In reality, there are about 25 individuals who run all of the calls at our service and about half of them commute into our little town once a week for their duty shift. New members are recruits that aren't residents of the town; they come from neighboring cities and towns, attracted by the pace of calls and type of patient care a rural, small town service offers. For a community that often prides itself on taking care of its own, there are very few residents that see volunteering for places like the fire department and the rescue squad as a worthwhile means of living out that pride. There are many that talk the talk, but few that walk the walk, so to speak. The responsibility is consistently passed down the line, thinking "How wonderful it is to serve (insert person X/place Y), but it's not my responsibility. Someone else will take care of it."

And that unaccountable attitude is more pervasive than I feel comfortable admitting. Not only do I see it in the town where I run EMS, but I see it in the classrooms I teach in as well. The other day I was discussing hot topic current events with a student in the government class I work with. When I asked them if there were any specific policy issues that they cared about, they replied, "Care? Why should I care? It's not like I can vote or do anything about it? I'm not even of age." When I pointed out that come the next election year, these would be issues that would concern them as they would be able to vote, they replied "It's not my responsibility to change anything. My vote doesn't even count in the grand scheme of things. I'll just let everyone figure out what to do about it all. There are people smarter than me out that can care." This is not the first conversation that I have had that echo such sentiments; even over a matter as simple as voting, there is that same widespread sense of passing along the responsibility to another. Yet the line eventually runs out and the duty cannot be passed on anymore; someone is eventually held responsible, and, thus, accountable.

And at that point, voluntary service becomes a duty. In fact, maybe that's the way it's supposed to be; that we all have a duty to serve our community in some capacity. Maybe it's this understanding of citizenship and service that has gotten lost over the past few decades. Maybe we've been passing the buck for too long that the notion of responsibility has gotten lost in the shuffle. Maybe, just maybe when we reach the end of the line people will be jolted back into realizing what it takes to make a community run.

I have long realized my duty to serve and I do so with a sense of pride and satisfaction that I have yet to find anywhere else, whether it be in the back of an ambulance or in front of a high school classroom. I only hope that Everybody realizes their duty as well, and Somebody steps up, before Nobody does what Anybody can (and should) do.

Deja Vu

I ran a call yesterday--a priority black cardiac arrest. There really wasn't much to do by the time we arrived on scene. The medic unit was already placed in service, and we ran a strip just to confirm asystole; not a surprise really, given that we had a 15 minute ETA to the scene and the estimated down time was close to 30 minutes or more by the time we arrived.

But what threw me on that call more than anything else was a missed turn on the ride back to the building. Lost in conversation about the call, we missed the road for the most direct route back to the building, so we continued on down to find the nearest driveway to turn around in.

It was pure luck that I looked out my window as we pulled out away from the driveway to head back down the road, and I gasped at what I saw. An eerie feeling made its way down my spine. There was a black fence at the end of the driveway, with horizontal three slats, and the house number running down the corner post.

The last time I saw that fence and house number, there had been a body wrapped around the corner post, and a motorcycle in the ditch. And I had proceeded to work another code, with similar results: priority black.

Deja vu, no?

And as we rode back to the building, I couldn't help but notice only that they had repainted the house number, but left the crack in the fence.

Some Calls You Never Forget

In EMS, there are just some addresses that you remember. Some of them may be associated with frequent fliers, some are associated with the most bizarre calls of your EMS career, and some are forever associated with those calls that leave ghosts behind.

In EMS, we all have those calls that we'll never forget. Over time, the may fade or blend into the memories of other calls, but they are never truly forgotten. In time, you are often able make peace with those ghosts left behind from tough calls, but in a small town EMS service there's a very good chance that you'll never be able to let them truly rest.

Small town EMS is an entity unlike any other. When you run those "oh sh*t" calls, they are to addresses that you may know; they are for family, friends, people you have grown up around, and maybe even members of your own department. That's not to say that you don't run those same calls in big city EMS, they just happen to be a bit more concentrated out here in the country.

I ran a call with a good friend of mine awhile back--ultimately, a fatality from an MVC (motor vehicle crash). The call was one of a series that we had that night (because where I run, when it rains it pours); this was our second response from the hospital, and as we were en route to the scene, we were advised that we were facing a potential code.

My friend and colleague happens to be small-town-born-and-raised, as many of my fellow providers are. Even as a transplant from the North, one of the first things you understand about this town is that it's a tight community, and when you hear a potential code go out over the radio you start fervently wishing that it's no one you know--that this time you'll get lucky and you won't be working a family friend or acquaintance. There was a look that flashed briefly over my friend's face, a look of desperation like I had never seen from her before.

Needless to say, she was not so lucky that night. Our transport for that call was to the hospital, but more specifically the morgue. The front of the truck was silent on the ride in, with few interruptions limited to the tones for the rest of the county dropping quietly in the background.

No words were needed that night, at least not immediately. The talking will, and does come, and the support of other providers can help you reconcile your actions as an EMS worker and make peace; yet the question remains, how do you grieve? Because it these kinds of situations you are not just a provider, you are a friend, a loved one, an individual who shares more common ties with the patient than just a singular call.

It's a question that I'm not sure a lot of small town providers have yet answered; in fact, I think that there are many answers to this question that are as unique as the relationships between patient and provider themselves. But I do know this: there are just some calls that you never forget. And that's okay.