BRATTLEBORO — Dial 911. A dispatcher answers. Paramedics, firefighters, or police respond to the emergency.
It's simple for the public to call emergency services, said Chief of Operations for Rescue Inc., Drew Hazelton.
For emergency medical services (EMS) to respond, however, an intricate system of moving parts is required - a system that the public takes for granted.
This week, local EMS organizations will participate in National EMS Week, designed to honor and highlight the work of emergency responders.
“We want to thank all the EMS volunteers that make the system work,” said Hazelton.
An estimated 160 people volunteer in EMS services across Windham County.
“It's very rewarding and somewhat simple,” said Hazelton. “Our goal is to be the best part of somebody's bad day.”
The state has divided Vermont into 13 emergency response or ambulance districts. The Windham County region is #13. Each of the 12 member-towns and two ambulance services in the district has a representative to the #13 board.
This board oversees multiple EMS concerns, such as coordinating training, keeping members apprised of changes to the law, and hosting re-certifications.
Organizations within District 13 will celebrate EMS Week in a variety of ways, from holding an ice cream social for the crew to hosting cookouts for volunteers.
Calling all volunteers
Board chair Capt. Leonard Howard of the Brattleboro Fire Department said many EMS organizations lack volunteers.
The number of calls has increased while the number of volunteers has shrunk, he said.
Burnout for EMS volunteers is high, Howard continued.
Hazelton added, certification requirements and expectations on volunteers have also “increased dramatically.”
District 13 Training Coordinator Emily Yelle elaborated.
Keeping up with training can equal a full-time job, said Yelle, a paramedic. Volunteers often pay for their own certification. It can become too much of an investment of money and time for some people.
In general, EMS certification holders undergo 76 hours of continuing education training every two years, she said. This requirement includes a 24-hour refresher class that can be spread across two days - like a weekend - for four weeks. Some certifications may require additional training. This is true for organizations that combine fire and EMS services.
As a full-time EMS professional, Yelle said she's paid to keep up with her training. Volunteers are expected to have the same level of training as professionals.
“They're doing this out of the goodness of their hearts,” she said.
District 13 looks to raise funds to pay for volunteers' training costs because these volunteers dedicate their time and skills to their communities, Yelle said.
Volunteers can also run into barriers with their employers.
Not all employers give workers slack time to respond to calls, said Putney Fire Chief Tom Goddard.
“It's a balancing act,” Goddard said.
Howard added that it can also prove difficult for employers to provide time because EMS calls can come as infrequently as one a month or as often as twice a day.
Marlboro Assistant Rescue Chief Daniel Garcia-Galili added another influencing factor: the economy.
When people work three jobs to pay the bills, he said, it cuts down on the time they have to volunteer or it could mean they work 30 miles away from their home base.
“The volunteers just aren't there,” Goddard said.
Yelle commented that the providers who stick it out through the training and tough calls are very dedicated to the work and their communities.
“We're family,” she said. “A little dysfunctional, but we're family.”
Hazelton said between fundraising, responding to calls, and training, EMS organizations have a lot on their plates.
“Things don't cost what they used to,” he said.
For example, every ambulance must carry EpiPens, syringes pre-filled with epinephrine designed to halt anaphylaxis in the case of extreme allergic reactions.
The pens cost $160 each and expire after a year, said Hazelton.
More calls
All the board members present commented that in addition to the higher number of calls, their organizations are witnessing higher levels of illness.
“We're seeing a lot sicker patients,” said Yelle.
Yelle said that the call volume at the EMS organization she works for in Massachusetts - outside of District 13 - has seen the number of calls increase from approximately 4,500 to 6,000 last year.
Hazelton said Rescue Inc.'s calls increased 15 percent to 20 percent over the past two years.
Again, those present pointed to a host of reasons for this increase.
Hazelton said that hospitals are releasing patients, even those undergoing complicated procedures, earlier. When complications with a surgery arises after discharge, the ambulance gets called.
Brian Richardson, director of emergency services at Brattleboro Memorial Hospital, commented that hospitals are under pressure from insurance companies and the Affordable Care Act (ACA) to release people to home care sooner.
While people often do very well recuperating at home, sometimes there are complications, he said.
He added that Windham County is home to one of the oldest populations in the state and that its population needs more health care.
Yelle said that with medical costs higher than what many people can pay, people don't visit to their doctors' offices regularly. Instead, the ambulance becomes a last resort.
When asked whether they've seen more people covered by insurance post-ACA, everyone at the table laughed.
Just because a person has insurance doesn't mean they can afford their health care or medications, said the EMS responders.
According to Richardson, while more people have insurance, they might not have enough and the deductibles or out-of-pocket expenses are too high.
Many heads nodded in recognition when Goddard commented that Putney is seeing more and more emergency calls related to homelessness, mental-health issues, and substance-abuse issues.
“People don't like to hear and recognize homelessness is here and substance abuse is here,” Goddard said.
The system is overwhelmed, he said.
Emergency calls related to mental health or substance abuse take longer to respond to and require more understanding and compassion, said the responders.
Garcia-Galili commented that if the responders' safety is in question, police must respond and clear the scene before EMS can enter a building. In a town like Marlboro, that means the Vermont State Police must drive from Brattleboro or Rockingham, and a call can take two to three hours.
Bevan Quinn of the Guilford Volunteer Fire Department said people dealing with a mental-health crisis might not need EMS, but EMS is the catch-all.
Richardson characterized mental-health and substance-abuse issues as diseases that “know no bounds.”
From BMH's perspective, mental-health-related calls do not represent a huge percentage of the hospital's caseload. The patients' needs, however, are more intense and require more resources from the police, the ambulance, Health Care & Rehabilitation Services (HCRS), and the hospital.
Training hasn't kept up with the issue, he said. EMS providers receive hundreds of hours on medical emergencies, such as strokes, yet few EMS organizations have a strong background in mental health.
Mental-health-related calls started to spike after Tropical Storm Irene in 2011 closed the Vermont State Hospital, he said.
The EMS responders have also experienced an increase in the number of suicide attempts.
It's the economy, said Goddard. People are in survival mode, trying to scrape together an adequate baseline of existence, he added.
Having the 'coolest job'
Ker Ambulance Service member Harley Laundry said his five-year old thinks he's “got the coolest job.”
It feels good to be a hero for your child, he said.
“EMS is a crucial part of our health-care system” but is often overlooked, said Richardson.
BMH hopes to change that by bringing more awareness to what EMS providers do, he said.
“Camaraderie between EMS responders” and “helping their community” topped the why-we-still-do-this list for the responders in the room.
Yelle and Howard also described the feeling of helping someone during an emergency and then seeing that person later, healthy and part of his or her community.
Hazelton said he saw a 12-year-old girl walk past him at a recent school event he attended with his children.
She had no idea who Hazelton was, he said. But when she was five, he resuscitated her after she went into cardiac arrest.
That feeling? It's unbeatable, they said.