Life as an EMT, whether it be in city of 100,000 people or a small town of 10,000, can bring many hats to wear. From life-saver to therapist, often there are moments that any amount of training won't prepare an EMT for.

Some EMTs will tell you that there's a very vulnerable period that happens in the back of an ambulance. There are moments of clarity that offer a new lease on life. Instances of denial are masked in cockiness or arrogance that can turn into belligerence. Those feelings may give way to tears of remorse or sorrow.

In a four-foot by eight-foot box traveling at speeds in excess of 80 miles per hour, the ambulance is, for some, a confessional on wheels. The paramedics, in a race against time, double as priests hearing what might be a patient's final words as they come to grips with the grave reality that the EMT may be the last person they ever see on Earth.

"When you get someone to truly open up, or they open up on their own, you hear that they're a brother, a son, a mother or daughter," Acushnet Fire and EMS Chief Kevin Gallagher said.

Life as an EMT — whether it is in a city of roughly 100,000 people like New Bedford, or a small town like Acushnet with about 10,000 people — can bring many hats to wear. From life-saver to therapist often there are moments that any amount of training won't prepare an EMT for.

The way James Baptiste, a part-time paramedic for the town of Acushnet, explained it made sense. A traveler is walking down a path. Along the way he encounters these stones. One by one the traveler picks the stones up and adds them to his backpack — the bag getting a little heavier with each new addition. At a certain point, the weight from the stones become too much to bear, slowing down his strides.

"What do you say to someone that just lost their son or daughter," Baptiste said. "Is it going to be the right thing? Is it going to trigger somebody to get pissed off?"

Next to him was Brian Donohoe, a former full-time Wareham paramedic who works part-time in Acushnet and has nearly 30 years experience in the field. He picked up where Baptiste left off.

"You can't say anything that's going to change their feelings at that time," he said. "The only thing you can do is provide supportive care. That's truly the only thing we can do to help in that moment."

In the ongoing path, the traveler is stuck at the intersection of empathy and detachment. He picks up another rock, places it in his backpack and continues.

 

Young man's game

At about 5:16 p.m. on a sunny Sunday evening New Bedford senior medic Mike Thomas gets a call on his radio. A possible overdose is sending him to the the woods of Buttonwood Park near Kempton Street.

Racing through city streets in his SUV, Thomas, as a senior medic, aids EMTs in the field if necessary, jumping from call to call when needed. On arrival, Thomas weaves through joggers along the park before making his way to the scene. Through the woods he hears Megan Robitaille, a New Bedford paramedic, calling out her location. He's joined shortly after by New Bedford firefighters who have also responded to the scene, a usual occurrence in the event a call requires multiple departments.

In the woods, Robitaille and her partner, Shain Ramos, were on either side of a twenty-something who had just lost consciousness. A few feet away, the man's friend, who had called 911, leaned against a large rock as he watched his companion come back to consciousness. The EMTs did not administer Narcan, the overdose reversing drug. Instead they used a sternum rub, a touch of pain that can be enough to wake up a patient from a deathly deep sleep.

The man, shirtless, was covered in dirt and grass. His shaggy hair, falling just above his brow, was drenched in sweat. Amid the dirt and sweat, two bloody marks just above his left elbow stood out.

The two paramedics help the man up and bring him to the ambulance to read his vital signs. On the way out, Robitaille warns to be careful of the surroundings as she picks up what appeared to be a used syringe.

"There's probably needles all over this park," Thomas said.

As the man is hooked up to the heart monitor, Robitaille and Ramos begin talking to him. They ask if he did any cocaine as his heart rate is between 150 to 160 beats per minute. The average healthy heart rate ranges between 60 and 100. The heart rate for an overdose victim can be two or four. 

He denied using any cocaine, but said he took "about five to six shots." 

The man, strapped down to the stretcher, was fidgety. As he pulled out his license, crumpled up dollar bills fell out of his wallet. His mind seemed scattered — in one breath asking about his friend and then next apologizing before telling the EMTs he's been using heroin for close to two years.

"You guys probably hate me," he said. "I'm sorry you have to do this."

The next stop was St. Luke's Hospital, where the man was checked in for observation and Thomas suspected he would be given a drug like Ativan to calm him down. But Robitaille and Ramos couldn't stay long. Before they had a chance to fill out their report, they already had another call to go to. Running on an eight-day cycle, four trucks are active for four days and five the other days. On this particular day, there were five trucks active.

Thomas, who has nearly 20 years experience, said jumping from one call to the next is the life of a city paramedic. Short staffs, budget cuts and an uptick in emergency calls create a hectic workday, which can be a 24-hour shift for full-time EMTs.

"You can work as much as you want," Thomas said. "But the burnout rate is high."

It's a young person's game, Thomas said, pointing out only a few grizzled vets above him with more experience. The average career span for a paramedic is five years and future reserves may be a ways away. Of the six EMTs interviewed for this story, everyone said the state of their profession in Massachusetts has grown stagnant. They said they think it's because of the state's shift from certificate-based programs to college-accredited courses. Many of the paramedic schools folded after being unable to obtain college affiliation, leaving an unfilled void for newcomers.

That burned-out feeling was the reason Donohoe transitioned from a high-call area, Wareham, to Acushnet which Gallagher said averages about three calls per day.

“After 20-plus years, I knew I was feeling tired,” Donohoe said. “I wasn’t getting short with my patients, but I was getting short inside.”

The down time Acushnet EMTs see, which a city like New Bedford can not always afford to include, is filled with preparation. Truck maintenance, supply checks and studying — a lot of studying — goes on between calls.

“It’s more common than not the laptops are fired up and not the TV,” Gallagher said.

 

The toll it takes

Matthew Morrisseau, an Acushnet EMT studying to become a paramedic, finds comfort in running through questions and scenarios with industry vets like Donohoe and Baptiste.

“They’re always there to teach or correct you,” he said.

Sitting at the station’s kitchen table he has a binder chock-full of notes open in front of him. There are three levels of an EMT: basic, intermediate and paramedic. Morrisseau, looking to make the jump from intermediate to paramedic, is staring at anywhere from 1,200 to 1,800 clinical and riding hours. From proper protocols, EKG reads and medication variances for adults and pediatrics, studying is not his biggest struggle. It’s the time away.

“Being away from the family is the biggest thing,” he said.

He works part-time in Acushnet, on top of a full-time job and going to school three days a week. There’s clinical hours he has to put in for, as well organizing ride times aside from the year and a half of schooling.

At home Morrisseau just welcomed his second child through it all.

“The time being away from the family is a lot,” he said.

The unsung heroes, Donohoe said, are the wives and husbands at home who make it all work. Families stop by during down hours to check in, bring food and get quality family time when they can.

“They put up with our god-awful hours,” Donohoe said.

More than the hours, families deal with any residual effects from a traumatic call.

“Some things stay with you. Some things bother you. Post traumatic stress disorder is real with us,” Thomas said. “I don’t know the percentages or anything, but I think that can be a common diagnosis among paramedics. I would assume alcohol use is high in this field and the divorce rate too.”

First responders have access to Critical Incident Stress Debriefing (CISD), or the ability to talk with social workers from local hospitals in order to deal with a traumatic incident. 

Gallagher watches out for different signs of stress like anxiety, overeating and restlessness. In New Bedford, where the volume of calls can run a short staff thin, debriefing times often fall to the wayside, Thomas said. 

"It is offered," he said. "But the focus isn't there enough because we're so busy now and short-staffed unless it's a real serious call." 

 

A compassionate approach

An extended time on the job will shape a paramedic's attitude toward society. 

"We see things no ordinary person should ever see in their life," Baptiste said. "We see people at their worst."

Thomas said anyone who's been on the job for more than five years has a new view on human nature.

"When I started I was 23 years old. I went to Catholic school. I wasn't even allowed to swear in my house. I think I was a little naive when I first started," he said. "To see some of the stuff you see leaves you in a wow moment."

Most paramedics will tell you the question they get asked all the time by people is 'What's the worst call you've been on?'. They'll also tell you most people regret asking the question after it's answered. When Robitaille was asked, she told a story about a mother who miscarried her child. The mother took the dead child and buried the body in the backyard, she said. 

"You can't come to work with any emotions," she said. "You just can't. It's different. You may break down after the call, but in the moment it's like you're pumping with adrenaline."

In a small town like Acushnet separating business from personal thoughts can be a challenge. Gallagher said there's probably one or two degrees of separation of calls from patients in a town of roughly 10,000 people. 

"The call can go out and I'll know the address. I'll know who lives there just because I've been here for 33 years," he said. "If I don't know you, one of the EMTs on the call will know you. That, I think, is one of the areas where smaller community EMS departments get hit hard. We have people who have responded to medical emergencies for family members or neighbors or high school friends. I'm not sure that happens as much as, say, Boston."

Despite a possible loss of their sunny outlook on life from treating some of their patients, judgments go out the window. Thomas has been on hand treating gunshot wounds for gang members, he said, and domestic violence calls.

"My views go out the window when I'm on the clock," Thomas said. "I may think you're a horrible person but that doesn't matter right now. You want to treat everyone the same."

From Donohoe's perspective, it's not a paramedic's fight to pick. It's the police department's. 

"That's not our job to judge," he said. "We're kind of blind to whatever their demographic may be."

A loss of faith in man doesn't change why they got into this profession to begin, he said. 

No matter how many stones they carry in a backpack that weigh them down, in speaking with the EMTs interviewed, many stay resolute in the reason they chose to travel down this path — to help people.  

The albatross they carry allows a person's ailing grandmother to see one more birthday because of the multiple ride-alongs for dialysis. Acting quick on a call could mean the difference in a family getting to say goodbye or not seeing their loved one at all. 

The little victories aren't always seen right away, Gallagher explained. They may show themselves down the road in the form of a thank you from a family member or the patients themselves. 

"Patient care is first and foremost, that's our number one goal," Gallagher said. "But so many paramedics have a compassionate approach. The strength of our service is character."

 

Follow Wesley Sykes on Twitter @WesleySykes_SCT