Neighbors to the rescue: rural areas, small towns, and even some cities depend on volunteers to respond to medical emergencies - emergency medical technicians

American Demographics, July, 1997 by Nancy Ten Kate

Thousands of Americans commit themselves to hours of classroom training, grueling tests, and all-nighters in hospital emergency rooms to become certified emergency medical technicians, or EMTs. Most are volunteers, whose communities count on them to be on the scene for emergencies large and small.

Its 4:45 a.m. on a Wednesday, when the station alarm startles the crew out of bed. Dryden Ambulance, youre needed at 65 East Main Street; elderly female, difficulty breathing, previous heart history. They hastily dress, run out of the bunk rooms and pile into the ambulance. On a typical 6 p.m.-to-6 a.m. shift in rural Dryden, New York, a crew of three volunteers is responsible for responding to all medical emergency calls in Dryden and parts of two surrounding towns. The crew consists of an ambulance driver, an EMT, and a paramedic. On this night, the three are a parks supervisor, a magazine editor, and a mechanical engineer. Other shifts are staffed by truck drivers, mechanics, insurance agents, a mortician, a pilot, a landscaper, and several college students.

In 1997, the U.S. and its provinces have more than 805,000 EMTs and paramedics, according to Dennis Hitchens of the Florida EMS (Emergency Medical Services) Clearinghouse in Tallahassee, Florida. Fewer than two in ten held paying jobs in emergency services in 1994. Most who are paid to provide this vital service work in metropolitan areas, according to the Bureau of Labor Statistics. Rural areas, small towns, and even some cities depend on volunteers to respond to medical emergencies.

Volunteer EMTs are becoming a dying breed, however, says Hitchens. One reason is the many hours necessary for training, internships, and recertification. For EMT-Basic certification, trainees must participate in 100 to 150 hours of class time, an internship in a hospital emergency room, and related study time. Advanced-level EMT training varies by state but includes about 50 hours of additional classroom instruction in more advanced skills, such as inserting breathing tubes and administering intravenous fluids. They also must log 100 hours in emergency rooms and ambulances.

Paramedic training is even more grueling. These emergency-medical personnel spend up to 2,000 hours in training and internships. In addition to the time commitment, EMT and paramedic courses are credited college courses with associated tuition. Volunteers often pay these out of their own pockets. EMTs outnumber paramedics by about six to one, but while most EMTs volunteer, almost all paramedics plan a career in prehospital emergency medicine.

Justin Norfleet is one of those rare volunteer paramedics. He graduated from Cornell University in 1996 with a degree in mechanical engineering and now works 40 to 50 hours a week in customer relations for the Chrysler Corporation in Syracuse, New York.

He has been with the Dryden Fire Department and Ambulance since January 1995 and is currently EMS captain. He covers one weekly 12-hour shift as well as responding to calls where advanced life support is necessary on nights when there is no ALS coverage. He also fills in on an occasional weekend shift and attends two to three meetings at the station. And most weekends, he works a 12-hour shift for a paid ambulance service.

He initially became involved in EMS so that he could respond to more calls. Ambulance calls outnumber fire calls by about three to one. Once I was exposed to EMS, I just kind of fell in love with it, says Norfleet. I like helping people, making a difference in their lives and the lives of their families. Our presence and what weve done is significant. I can affect the outcome of a call in the way I act; I try to empathize with the family, he says. I also like the camaraderie. We share common interests and spend time together in pursuit of those interests.

My EMT instructor said I would make a good paramedic. But I thought it was too much work, too much effort, and not enough reward. Now I feel differently--there is enough reward, says Norfleet.

Once an EMT is certified, he or she faces strict guidelines and local protocols for administering emergency aid. But that doesnt hinder them from responding effectively to dozens of different types of medical emergencies.

All EMTs are trained to open airways, restore breathing, perform CPR, control bleeding and bandage wounds, treat shock, administer oxygen, immobilize fractures, assist in childbirth, provide initial care to burn and poison victims, treat heart attack and stroke victims, and apply anti-shock trousers. With advanced training, they use heart defibrillators, administer intravenous fluids, perform endotracheal intubations, administer drugs orally and intravenously, and interpret electrocardiograms. With all those skills to be maintained, most states require that EMTs be recertified every two or three years and participate in continuing medical education.

So why do people put themselves through this? The bottom line is to give something back to the community. Something I do today may pay benefits years later, but Ill never know, says Andrew Dorman, an Intermediate EMT who volunteers one 12-hour shift each week in Dryden. There is also a sense of satisfaction--crews bond, work together, and function as a unit.