L+M paramedics celebrate 30th year and imagine the future of emergency care
New London _ Sometimes, the paramedics at Lawrence + Memorial Hospital rescue people from horrific car crashes and fires. They treat stab wounds. They appear in times of chaos.
Just as often, the scenes are quieter, inside people’s homes. Someone with lung disease is having trouble breathing, again. They’re having a heart attack. They’ve overdosed on heroin. They’re showing the symptoms of a stroke.
For 30 years — on many thousands of calls following the first one in March of 1988 — the hospital-based paramedic team has been bringing emergency room tools and training into people’s homes and onto sidewalks and highways.
When the program was first created, paramedics were an untested cog in the emergency response machine that some welcomed with wariness. Now, the L+M paramedics are woven into in the complex network of private ambulance services and volunteer and paid fire departments ready to respond to emergencies in southeastern Connecticut, and its leaders are starting to imagine what the next 30 years will look like.
“We have become more than what we were 30 years ago,” said Ron Kersey, the hospital’s coordinator of emergency medical services and emergency management. “We’re more a part of the health care in the community than we are just the emergency response.”
Kersey was one of the first paramedics in eastern Connecticut, completing his training at the William W. Backus Hospital in 1983 with 12 others. While working in his first job at a private ambulance company, he began meeting with a planning committee group of emergency responders, fire chiefs, ambulance companies and hospital officials who wanted to spread local paramedic resources across the region.
“At the time we didn’t know how paramedics were going to be delivered in southeastern Connecticut,” he said. “We just knew that they needed paramedics.”
Paramedic programs had become relatively common in other states by then, said Bob Holdsworth, who helped started the L+M paramedic program as the hospital’s emergency medical director and later worked as a paramedic with the program for two decades. But in the 1980s, he said, Connecticut towns and hospitals were recognizing the need for them more slowly.
“As one set of communities would get service, other communities would say, ‘we want that as well,’” Holdsworth said.
The planning committee decided that L+M would host the new program for southeastern Connecticut, and that it would be modeled as an “intercept” service, deploying paramedics from the hospital with advanced equipment and training to supplement the basic lifesaving work that local ambulance companies and EMS-trained firefighters were already doing.
Paramedics essentially bring the first two minutes of care that a person with a life-threatening condition would get in the emergency room, Kersey said. “IVs, medications, advanced cardiac monitoring and treatment, breathing tubes and devices,” he said. “If you were going to get it in the first few minutes in the emergency department, you now get that in the first first few minutes in your bedroom (or) in the car.”
“We listen to your lung sounds, your heart sounds, your bowel sounds,” he said. “We poke around.”
On March 19, 1988, the first call came in. Kersey remembers the details; he was there.
A person called in complaining of abdominal pain in New London. Less than a month later, the program started staffing a second truck based at the hospital’s Pequot Health Center in Groton and hired three more part-time and two more full-time paramedics.
Some veteran EMTs and L+M staff were skeptical.
“Some department heads were not necessarily supportive, because they didn’t really know what the medics did,” Holdsworth said. “It was just new. It was like, ‘What do you guys actually do?’” Before then, “nobody really paid a lot of attention to EMS,” he said. “They came to the hospital, they dropped off patients, and they left.”
With paramedics responding to 911 calls along with the ambulances and fire companies, patients were arriving at the emergency room intubated, with cardiac tests already completed and their blood already drawn.
Ken Black, who became an L+M paramedic more than two decades ago after a career as a Navy hospital corpsman, said staff in the emergency department soon started to appreciate the extra time they found when patients arrived at the hospital having already been treated.
“The nurse would have four or five patients, and I would come in with all this stuff already done,” he said.
Fire department and ambulance EMTs were also wary of paramedics with more advanced skills making them irrelevant. But soon, partly thanks to meetings Kersey arranged between paramedics and EMTs, they started to see the value of the extra help.
“They were surprised, because we would get pulses back on a patient,” Holdsworth said. “We would have overdose patients wake up…and have a conversation on their way to the hospital. You started seeing what would have been a cardiac arrest that was not viable, now coming in and their pulse was back.”
And patients — the people having the heart attacks or trouble breathing — didn’t notice the change, Kersey said.
“The average person didn’t even know,” he said. “The system is developed so that nobody sees a difference — if you sprain your ankle and you dial 911, you’re going to get an ambulance with two very qualified emergency medical technicians to treat you and take you to the hospital. We don’t want you worrying about whether you need a paramedic or not. People don’t request the level of service that they get, nor do we want them to.”
That first year, the program’s paramedics responded to 4,195 calls.
In 2018, Kersey predicts they will respond to more than 12,000. The program now sends one of 22 full time and part time paramedics into seven towns, covering 400 square miles and about 225,000 people.
Around half the time, the 911 calls for paramedics are cancelled — the emergency medical technicians on the local fire department or private ambulance teams determine the patient does not need the advanced lifesaving care provided by the paramedics.
That’s when they will find a Dunkin’ Donuts parking lot to turn around, or head back to a spot underneath the Gold Star Memorial Bridge to wait for the next call.
During a quiet few hours on Friday, paramedic Patricia Davis returned from a nursing home, where an elderly woman had asked an aide to call 911 because her chest had been hurting two days beforehand.
When Davis arrived, EMTs had already determined the woman was not in any immediate danger. She turned around and came back to the tiny office the hospital paramedics share when they’re on duty.
Scenes like the one at the nursing home are more common than the big-drama crashes or violent crimes, Davis said. While it may seem absurd to launch a full medical response to so many patients who do not seem to need emergency medical care, the paramedics’ philosophy dictates that everyone deserves the care they ask for.
“It’s an emergency for them,” Davis said. “If they want to go by ambulance, they go by ambulance.”
Kersey said that’s a mindset he tries to instill in the young paramedics who join the program (though new hires don’t come in too often: L+M’s paramedic program is highly selective, and people rarely leave).
“My interpretation of an emergency, your interpretation of an emergency and their’s is different,” Kersey said. “If you need health care, I’m going to come, I’m going to help you access health care.”
Kersey said he sees the future of the program in a concept known by several different names, but that he calls mobile integrated health. It’s a theory that has been tested in several other states: that paramedics and emergency responders can also be purveyors of everyday community health, checking up on whether a person is taking their medication or taking them to their physician or a clinic instead of the emergency room.
Some emergency responders and public health officials have started to imagine how such a system might work in Connecticut. Mostly, Kersey said, it would require a change in the regulations governing what EMTs and paramedics can legally do.
“There is nothing in my scope of practice that says I can have a conversation with you and say, ‘stay right here.’ Or have a conversation with you and say, ‘let me drive you to you doctor’s office,’” he said. “It is my job to take you to a hospital.”
Kersey said he will continue to push to allow L+M’s paramedics to test new regulations allowing them to develop a new job for paramedics: preventative, rather than reactive, health care.
“That is the future of this program,” he said. “The better idea is to help the community with better access to health care, instead of telling them they’re abusing the only healthcare they know of.”