“And to make matters worse,” I say. “I hear the governor and health commissioner are cutting all the EMS programs in the state. All the work I put in to building it up when I worked for the governor, and nothing is going to be left. It’s like, why have I even bothered to make an appearance on the planet. They don’t care about paramedics on the street, and they don’t care about EMS in the state.”
“You and I have talked about paramedic power before. You don’t get together and speak up, it’s not going to happen.”
Just then, my radio goes off. A drunk at the corner of Albany and Vine. I just shake my head. I am tired and don’t feel like taking on the world, much less giving a ride to a drunk.
Keep Hope Alive
I am standing outside Hartford Hospital restocking my ambulance when Cressy Goodwin comes by. Cressy is an expert in mass casualty events and a longtime EMS activist in Connecticut.
“I hear you’re getting involved in trying to stop these cuts,” he says.
“Well, not exactly.” He is talking about cuts in the state budget for EMS. All that I have done is tell an old friend at the state Office of Emergency Medical Services (OEMS) that I would think about writing a letter to the editor, and maybe posting a sign at the hospitals to alert people to the cuts. Neither of which have I done, though nearly two weeks have passed since I spoke with my friend.
“There’s a lot of people out there angry about this,” he says. “Do you have an e-mail address?”
I give it to him hesitantly.
A few days later I get a phone call from Betty Morris, who is the regional coordinator for the North Central EMS Region. She asks my opinion on EMS leaders requesting a meeting with the governor.
“The hell with just meeting with the governor,” I say. “You have to march on the capitol.” After our phone conversation, I make the mistake of putting my thoughts in writing and e-mailing them to her in a memo titled “Battle Plan,” which details a multipronged approach of letter-writing, phone calls, and individual and organizational protests culminating in a rally at the state capitol.
Before a week has passed my plan has been circulated across the state and over the Internet.
Initially there seems to be genuine enthusiasm. My dormant political juices suddenly stirring, I write a flyer, which I post at hospitals in the area. I send a modified version to the Hartford Courant as a letter to the editor.
Stand up for EMS!
We risk our lives and health to help those in need. The pay isn’t good, and many volunteer for nothing. The work is tough, but it is honest, and our presence makes a difference in the world. The tone goes off, they call our number, and we go.
Most of us are too busy trying to support our families to pay much attention to what happens at the State Capitol. The news, snuck into the new state budget, isn’t good, and unless we speak up, it will only get worse.
Since 1995, the state’s commitment to EMS has been rapidly abandoned. Proposals for increased EMS funding have been squashed. Regional Council budgets cut. Support for the state conference ended. Ideas of the EMS Advisory Board ignored. OEMS has been demoted within the Health Department. Positions have been slashed. The Deputy OEMS Director and Head of Education eliminated. The EMS data specialist transferred. Now the state OEMS director and the head of EMS regulation are having their jobs axed. The law requiring an EMS director is being skirted by pinning the title on an overburdened Health Bureau Chief with no EMS experience. And a federal EMS assessment team, whose 1991 report on Connecticut EMS led to significant gains (the reestablishment of an EMS advisory committee with strong medical input, hiring an EMS director after a nationwide search, the establishment of the statewide trauma network, and a move toward statewide protocols) has been disinvited from their scheduled April 1997 review.
What does this mean for us on the street and our patients? It means Connecticut EMS will fall further behind national standards. The effort to bring all EMS systems up to top medical standards will cease. Federal funding lost. Curtailed support for volunteer services. PSAs possibly abolished. EMS policy set by people with no EMS background. Lengthy delays at the state office. Investigations of EMTs and paramedics conducted by people who have never been in the field. We will be a laughingstock for other states. And we—EMS—will have no voice for our issues and concerns at a time when health care delivery is being revolutionized.
Don’t let them disrespect us any longer. Call Governor Rowland and your state Representatives today. Tell them EMS—what we do—is important. Tell them to reverse the EMS cuts. And tell them you will not forget how they stand on this issue.
Posting the flyer, I feel like Tom Paine, the revolutionary pamphleteer. I give ambulance crews copies of it to post in their bays, and I spend a day at home folding, stuffing, licking, and stamping 269 envelopes, mailing a copy to each EMS service—volunteer, commercial, first responder—in the state. Cressy sends the flyer out over the Internet, and soon it is posted in the emergency department of hospitals throughout the state.
“People are excited,” Cressy tells me. “There’s a ground-swell out there.”
Others set a date for the rally and preparations begin. I continue in my role as adviser. My letter to the editor appears in the Courant. They highlight it with a big graphic of an ambulance.
I am getting pulled in a little more than I want to, but I feel I am safe as long as I keep saying I am not going to organize this. I am not an organizer. I want to stay in the background.
Cressy and I talk daily. He keeps the fire stirred up. When the guy who we thought was going to be running the rally has to drop out because his bosses have told him not to get involved, I tell Cressy, “I will not run this thing.”
“They’re looking to you,” Cressy says. “You’re the leader, you’re the man.”
“No, I’m not,” I say.
I’m counting on other people and groups to carry the ball, but many who were originally behind the rally get cold feet and drop out. Most decide a quieter approach will work better and cause fewer problems. People are worried about antagonizing the commissioner. It seems everyone is afraid the commissioner will retaliate against them. Because he regulates hospitals, ambulance companies, doctors, nurses, and paramedics, he has enormous power over them, and that power causes fear. Even I fear that he will come after me and find some reason to take my certification away. When the North Central EMS Region backs out, I say that’s it. I’m not doing it alone. The rally is off. I’m not going to be the only one up there.
I tell people, “I wasn’t going to stand up there by myself. Screw that. Screw that.”
I feel enormous relief, but I admit to being a little depressed. A little beaten. It’s not like I put myself on the line and then backed off. I got close to the line, then shied away. I spoke up, but I couldn’t move the people to action. Just as well.
An emergency physician from Milford, Jay Walshon, calls me and says he’s heard about my rally and wants to participate. I tell him the rally’s off, I can’t get any support. Everyone is heading for the weeds. He urges me to reconsider. Strongly urges. He is practically yelling at me. He sounds personally angry with me for quitting.
Each day I go to work. I do cardiac arrests, room-one traumas, intercepts with volunteer ambulances. In between heart attacks, MVAs, and drunks, I do my part to get people to call the governor’s office. They don’t know anything about the politics, most don’t even know what a Regional EMS Council is, or what the state director does. Will this affect my pay? they ask. I try to explain. I try to tell them the big picture: it is about building a system that works for the patients. They nod and say okay, and I dial the number for them, and they leave their messages. They do it for me, but I sense many are skeptical. The nature of our work makes EMTs distrustful of authority, of management, of politics, of people who claim to have control.
I think about my patients—the man having chest pain, the woman badly injured in a car accident, the child who eats poison. I help the
m with my hands. I am there with them. But what about the larger structure that put me there to help them? What about the framework that provides the training, takes the 911 call, sends the ambulance, and ensures that I have the right equipment, that there is a system in place from 911 call to trauma surgeon, that there is a system to make sense out of chaos? The system is vital. If a paramedic cares about a single patient, he has to care about the system, too. The patient is what we are all about.
Hell, I think. I don’t need an army out there, all I need is myself and a TV camera. So what if the commissioner comes after me, and I suddenly find myself being investigated? This is America, the land of the free and home of the brave. I am a citizen and I am unafraid. If I hold the rally, they will come, and if they don’t, at least I won’t have this emptiness in my gut, this certainty that I didn’t dare stand up for what I thought was right.
That night I send a message out on the Internet to a group of a hundred or so EMS people who have been debating what to do about the cuts at the state office. The rally is on, the capitol booked, the microphone secured.
I send Betty Morris an e-mail telling her I am going ahead with the rally because I think it is the right thing to do. A day later the North Central Region is back on board. “We have always put the patient first,” she says, “and if we are out of step with the other regions, it won’t be the first time.”
I talk to groups and sign them up. The Connecticut College of Emergency Physicians, the Connecticut College of Surgeons—Committee on Trauma, the Connecticut Fire Chiefs, the Emergency Nurses Association, the Connecticut Society of EMS Instructors, the Connecticut Sponsor Hospital Clinical Care Coordinators Committee, and many groups and individuals from across the state, including numerous volunteer ambulance services. We are now the Coalition to Save the Connecticut EMS systems. I make up some letterhead on my computer. We are in business.
I write letters to the governor requesting meetings, press advisories go out. Paul Smith, who was the Head of Education at OEMS, and had his position of more than twenty years eliminated the year before, works with me, working the phones, spreading the word.
“You have to come to the rally,” I say to Arthur.
“I’ll go if we’re back from camp in time.”
In my dreams, I see a Woodstock of EMS, where I’ll stand like Martin Luther King at the Washington Mall, looking out over Bushnell Park, a sea of people in uniforms, backed by ambulances, the Life Star helicopter circling above. I am at the microphone. “I have a dream that one day we will all stand together. Commercial, volunteer, fire, doctor, nurse, EMT, and policeman. We are the colors of the rainbow, red, green, blue, yellow, black and white, we’re all equal in God’s sight. Common ground! Keep hope alive! Keep hope alive!”
In my nightmares, it is raining, they take our microphone away, and there are only three people there anyway, all of them laughing at this joke of a rally. The commissioner stands there, cackling to himself, then says to me, “Come on, just give me your cert now, let’s get it over with, save us both the trouble. What are you worried about? The welfare office is just down the street. Ha ha ha.”
Monday arrives. The weather is overcast with periods of showers, but it clears by noon. Slowly, ambulances arrive and a crowd gathers. Maybe sixty to eighty people, most of whom I know. There are a number of local volunteer ambulances. Joe Schwartz, the director of operations at our company, brings down several ambulances, unexpected support for which I am grateful. The TV stations are here. At high noon, I give the signal for the ambulances to let their sirens run for a minute—a sound bite for the news. I act as MC, giving a brief opening statement, then introducing the speakers—physicians, nurses, fire chiefs. They are very eloquent. They are men and women whom I have worked with at the health department, sat with in countless meetings, witnessed their time volunteered to improve the system.
“I am here as medical control for thirty ambulance services,” declares Dr. Ian Cummings of the Eastern Region. “More than that I am here as a citizen, a person whose family is being cared for by the EMS system, a system I am responsible for, a system being decapitated, that is now at threat. Therefore, the people I care about are at threat.”
Dr. Mark Quigley of the North Central Region—who, months later, will tragically lose his life after being hit by a car while assisting the victim of a car accident on a dark country road—declares, “The collapse of this system will be a catastrophe for the citizens of Connecticut. The commissioner should be leading us into the next century of EMS, not dragging us toward the last one.”
Marty Stillman of the Connecticut Society of EMS Instructors gives a fiery performance. “We’re here because we’re concerned about patient care. We want to see the best possible patient care.… Three million citizens rely on a system when it’s a question of life and death.… It is a system. It’s not just the ambulance that responds or the doctor in the emergency room or the nurse in the emergency room. It’s all of us working together to make sure that the emergency medical system provides the best possible patient care. It’s all we care about.… It’s been underfunded, and the people making these decisions don’t even know what EMS is about. It’s not an economic issue. For the money this state spends on EMS they get a hell of a bargain. A real bargain. But they don’t know they’re getting a bargain because we haven’t told them. We’ve been too busy providing the best patient care, the best emergency care in the field and in the emergency room. We must educate the public.”
The gathering is over in forty-five minutes. Afterward, Dr. Walshon and I go up to see if the governor is in. I have written and called repeatedly but received no answer to my request for a meeting. We stand in the outer office while the secretary eats an apple and talks to someone on the phone. A staffer walks through the gate like I used to when I worked there.
“Is the governor in?” I ask.
“He is in a meeting,” the secretary says.
“We’d like to meet with him.”
“You can make a request in writing.”
“We have,” I say.
“Well, let me take your number then.”
I give it to her, and we walk back down the stairs. The steps are vacant now. Dr. Walshon and I shake hands. He walks off. I gather my box of press kits and head to my car.
That night the rally is the lead story of the news on Channel 30. Jerry Brooks, the coanchor, begins, “Our top story tonight, a warning from the people who work in the state’s emergency medical services program.” His coanchor Joanne Nestie continues, “They say if budget cuts go through, their system will collapse and lives will be jeopardized.” They cut live to the state capitol where correspondent Tom Monohan says, “EMS workers staged a protest rally outside the state capitol today. They said if there are budget cuts they will not be able to do the best possible job they can. They also said at the current spending levels they have been able to save lives.”
The TV then shows two examples of EMS dispatchers helping people save lives.
The correspondent continues. “At the capitol today, doctors, EMS workers and volunteers slammed the proposed cuts.” The camera pans the rally, and because it is on the broad back steps, it looks sparsely attended.
They interview Dr. Martin Gross, a surgeon from Stamford hospital, who says, “With the budget cuts that they’re going to pull, it will essentially eliminate the ability of the regional councils to function.”
They cut back to the correspondent who is shown walking in the health department with the bureau chief of regulation. “But the state says no lives will be jeopardized by any of the cutbacks.” They interview the bureau chief who says very matter-of-factly, “When you call nine-one-one, you will continue to access the same quality emergency medical services you currently receive.”
And that’s it, end of story. It is over and forgotten minutes later as other stories come on: an earthquake in some foreign country, the weather, sports, consumer tips, a health update.
I sit alone. I have
a beer, take a bath, get a headache, go to sleep. Exhausted.
The next morning there is an article on page A6 of the Courant. The headline reads AT CAPITOL, 60 PROTEST CUTS IN EMERGENCY SERVICES.” Sixty, I think. There were at least eighty there, maybe ninety. A hundred.
“How’d the rally go?” Arthur asks.
“It was all right,” I say. “There’s an article in the paper.”
“You’re kidding, I missed it.” He reads it. “We stayed an extra day at the campground,” he says. “Other than a morning shower, it was a beautiful day.”
Our first call is for a woman having a seizure. She has fallen and hit her head, so we have to C-spine her. She has never had a seizure before, so we are concerned. At the hospital, while waiting in triage, she says she thinks she’s going to throw up. “Art,” I yell. He comes down the hall. “Quick,” I say. I am at the head. We snap the strap buckles off, and start to turn her so she won’t choke on her vomit. I see her cheeks swell and, like a volcano, she projectile vomits straight up. My face is hit with a blast of warm water and vomit.
“I’m sorry,” she says.
It covers my glasses and drips from my mustache. I wipe it off with my sleeve and say, that’s okay. I give my report to the nurse, and we transfer her over. In the bathroom, I wash my face and mustache.
“The poor paramedic,” I hear the woman tell the nurse. “I can’t believe I threw up in his face.”
We have to go back to the base, where I have a clean shirt in my car.
“I bet that never happened to you when you worked for the state,” Arthur says.
“Detail completed,” I tell the dispatcher, and we’re back on line.
Shaman
Debbie sees me in the hallway and asks if I am going to the EMS conference sponsored by the Journal of Emergency Medical Services that is coming to Hartford. She says the speakers they have are really good, and it might do me some good to expose myself to them. It is a chance to hear national speakers and to show that Hartford is a town that supports EMS education. It costs $120 for a one-day session, which is all I can do because I play in a softball league on Sundays. I can get education credits for free by attending the regular sessions at Saint Francis, but I think I really should support this, so I go ahead and sign up for the Saturday session.
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