I am amazed at the media blitz covering emergency medical services over the last 4 or 5 years--television shows with true-to-life performances and movies with real EMTs and paramedics. Maybe we can finally say good-bye to Cal and Fred (the ambulance drivers on Emergency). The biggest change in the media has been the way they portray rescue calls. What really bites, though, is the way stories are re-enacted on shows like Rescue 911.
For example, here's how William Shatner would narrate the following call:
On a rainy day in Los Angeles, CA, 23-year-old Jenny Smith dons her bikini and gets ready for 30 minutes of sunshine at the Radical Tan salon. Jenny sets the timer and begins to dream about the lifeguard at tower #12, unaware of the danger that looms. Twenty-two minutes into the tanning session, Jenny decides to turn over on her side and attempts to adjust the level of the enclosed tanning bed. She tries to move the top enclosure, but finds it stuck, then presses it with her legs, to no avail. She beckons for the manager, Tim "Cool Breeze" Nelson, who is only on his third day at the job. He hears the call for help and rushes to the room, but is unable to open the locked door. As Jenny screams for help, Tim rushes to the phone and dials 911. Dispatcher Susan Jones receives the call and immediately dispatches the crew from Station Five.
You get the picture? Shatner might go into the same great detail about Elmo Johnson getting stuck in a manure spreader in Jasper, AL, but that call would never make it on the show. Maybe Elmo doesn't look good in a bikini, but it is still a rescue call of great importance.
EMS providers in rural America may always take a back seat to those working in the urban environment, but we rural providers always work best in odd situations. Many of us face perils that are foreign to urban responders. Problems with budgets, manpower and equipment often present difficulties even before the call for help is received. Overcoming those and other difficulties is the greatest challenge.
The mountains of northeast Tennessee offer a prime example of rural America--scenic views, great weather conditions and a whole bag of possible rescue situations. Having the necessary equipment to respond to rescue calls can be a tremendous financial nightmare. Ropes, harnesses and other rope rescue supplies are costly and have to be replaced very often. Four-wheel-drive trucks and utility vehicles are a must for travel and response in snow, ice and rough terrain, but new vehicles can cost $25,000$40,000 each, not including costs for fuel, maintenance and radios. County and municipal officials question these expenses, not based on the outcome of their intended usage, but on how many times the equipment is used during the year. If the ropes are used once during the year to save one life, an EMT will say that the equipment was worth the money. A politician would say that the expense did not justify the one call. Who is right? They both are.
We often forget the people and resources right under our noses. Most of them are just a phone call or a handshake away. Every community has an abundance of the various resources needed to provide rescue services. It is up to each and every emergency medical and rescue professional to work together as a team to seek out and know how to utilize the resources their community provides. Some examples might include: hardware stores, farmer's co-ops, construction companies, four-wheel-drive clubs and junkyards.
Local hardware stores have equipment needed in all phases of rescue. For vehicle rescue, they have 2 x 4s, 4 x 4s, crowbars, lubricant oil, rope, hacksaws and chains. They are also suppliers of trench rescue equipment, such as, plywood, crowbars, wheelbarrows, chainsaws, hammers and nails.
For environmental rescue, you'll find items like shovels, mattocks, rakes, buckets and flashlights.
Many hardware stores will donate items to your agency. Others may not be able to donate the equipment, but will work out an extended, low-cost payment plan. If you have very little storage space, the store may be able to keep the equipment until it is needed. Regardless of how you receive equipment, it should be acknowledged in a newspaper article, television story or some other form of thanks that also can serve as advertising for the store and will ensure its future cooperation.
Farmer's co-op stores offer most of the same equipment carried by hardware stores, but they also offer valuable information for hazmat responders, such as information on farm and household chemicals. Co-op employees also are a great asset for teaching farm machinery rescue courses. Their expertise and access to equipment manuals and hands-on training can help rescuers learn how to disassemble a manure spreader.
Every town includes a construction company. Whether locally owned or part of a big operation, these companies have heavy equipment resources that are critical in trench rescue, building collapse and environmental rescue. Bulldozers, front-end loaders, backhoes and cranes are a necessity in rescue situations. This heavy equipment can move dirt and snow, dig out collapsed trenches and buildings, and lift large, heavy objects.
I can recall responding to a situation where a large tractor and hay trailer had overturned. Although air bags worked on the tractor to remove the victim, a crane or forklift would have lifted the trailer and eased the load on the air bags. Along with the equipment, the construction company provides a highly qualified operator. Most heavy-equipment operators have years of experience and extensive training and can provide precision when the equipment is going to be within inches of the victim and rescuers. As a consultant, any emergency operations plan that I draft includes listings of local construction companies, their available equipment, and a list of contacts and how to reach them. All of the companies I have talked with were more than happy to assist with equipment, logistics and manpower for any emergency callout. This type of cooperation prevents rescue agencies from having to purchase hundreds of thousands of dollars in heavy equipment that may get used only once in a blue moon.
The most valuable resource for a rescue agency is a junkyard, which provides already-wrecked cars for vehicle-rescue training. You rarely have the Ford dealership offer to let you trash a new Mustang. Growing up in rural Hamblen County, TN, I learned to appreciate junkyards and spent many hours in Roe Junction (the Junkyard Capital of the Free World) getting parts for my 1973 Chevy Vega. All of the boys were willing to lend a hand when the rescue squad needed cars to cut up and a place to practice. Several cars are needed for a good vehicle course, and the wrecked cars offer a variety of scenarios and makes of vehicles to practice on.
During a blizzard, vans and modular ambulances are shut down, and chains offer access to main roads only. A four-wheel-drive vehicle is needed for temporary transport, but it can only respond to one call at a time, so multiple vehicles are needed. In 1993, the Tennessee National Guard was called out with its four-wheel-drives, but it took a lot of time to get authorization, notify the soldiers and mobilize.
One group that is often overlooked is the local four-wheel-drive club. The highly skilled drivers who belong to these clubs often have training and hands-on experience in operating their vehicles in snow, mud and other adverse conditions. Most clubs offer a variety of vehicles, from large trucks to sport utilities. An EMS service I worked for several years ago had a mutual-aid agreement with a local club, which offered a truck and driver to provide the emergency crew transport to calls. If necessary, they transported the patient to the main road where an ambulance took over. The club also provided trucks and manpower in lost-person searches and asked only to be reimbursed for fuel. Most of the clubs utilized citizen's band radios or cellular phones for communications. These clubs are a tremendous asset to any emergency operations plan.
Experts are needed for their technical support, manuals and access to other resources. People who know a lot are needed to offer hands-on experience, their ability to teach students and simple common sense.
County officials, such as agricultural agents, building inspectors and public-works managers, can offer technical support for rescue situations in building collapse, farm machinery and trenches. Construction and mechanical engineers can be of assistance in scenarios involving industrial rescues or hazardous materials calls. Wildlife and game officers are your one-stop-shopping source for detailed topographical maps that are needed in search and rescue. Many of the officers know the mountains, lakes and rough terrain by heart and can be excellent guides. They will have access to four-wheel-drive trucks, boats and possibly helicopters. Local farmers can offer common-sense insight on different types of farm machinery. Chances are, they have had their own shirt caught in a manure spreader, or their overalls caught in the PTO (power takeoff) shaft.
Of all the people who know a lot of stuff, my favorite is the junkyard mechanic. In vehicle rescue training, who better knows how to disassemble a car? One time, my old buddy, Icepick, got mad at this old boy for trying to scam him on some tires and chrome wheels. Icepick sold the tires and the dude was taking forever to pay, so Icepick followed him and his girlfriend out to the lake where they parked to...well, you know. Icepick jacked up the car, took off the tires and slid them under the car, and left the car on blocks, all in a matter of minutes while the dude was in the car. Now, if Icepick can lift a car and remove its tires without the guy in the car knowing it, why can't he teach a class on how to crib and support a crashed vehicle without moving the trapped victim inside? Icepick was a Picasso with a bumper jack.
You know how the Rescue 911 story goes: After Jenny was trapped for 42 minutes, the fire department used the Jaws of Life to open the tanning bed. Jenny quit dreaming about the lifeguard, found Mr. Perfect in her firefighter rescuer, and it all ended in storybook fashion. I am still waiting for Shatner to tell the story about Elmo Johnson being trapped in the manure spreader. Maybe Elmo will go from being neck-deep in dung to finding true love in the barnyard. Only in rural America.
| Robert W. Davis, EMT-P, is Chief Associate for Emergency Services Associates of Tennessee in Jonesborough and a paramedic/reserve officer with the Washington County Sheriff's Department. |