Eva Murray: The smallest emergency medical service around
MATINICUS — Summer is a busy time for most emergency medical service agencies in Maine. The influx of tourists increases the population, obviously, and there is the chance that vacationers suffering from any sort of illness or injury won't have access to their usual health care providers, so they'll call 911 instead. Emergency responders have their hands full with vehicle accidents, cardiac arrests and strokes, and all manner of life-threatening problems.
On Matinicus Island this summer, one elderly islander with significant health issues called her friendly neighborhood emergency medical technician at home multiple times complaining of medical worries when she really just wanted somebody to come to her house and deal with other minor household needs. She did the same thing to the local electrician, claiming to have power problems when she really wanted somebody to find her cat or whatever.
A child with widely-known pre-existing health concerns fell off a bicycle in front of the post office, putting bystanders into a tizzy. Four people, including two toddlers, fell and banged up their faces. (It always seems that injuries come in clusters like that; one year it'll seem that everybody sprains their ankle; another summer a half-dozen people will present with a minor dog bite or a paint chip in the eye.) A little girl who had just arrived on the island with her family felt ill and had some abdominal pain. Several young men wanted advice about cuts on their hands. An individual residing on a remote island across the harbor fell while walking on the rocks and sent somebody for help; the EMT had to respond by rowboat, climbing a long ladder to a wharf with a jump kit over the shoulder and a bag of ice in her teeth. Thankfully this call did not require emergency transport. None of them did.
None of this is anybody's business, by the way, which is why you'll see no names here.
When we started Matinicus Island Rescue 20 years ago, five of us were trained as EMTs -- five year-round, working islanders. As of this writing I am the only licensed EMT in this community, and as such, the only state-acknowledged responder in our EMS service. Thankfully call volume is extremely low, because the island's population is extremely low, but this tiny agency is expected to meet the same requirements as any other EMS service. We make an effort. We are inspected annually, we maintain the required equipment and then some, and licensed responders keep their training and supplies up-to-date. We respond correctly when it comes to matters of EMS protocol (that is, we do not make believe we're doctors, and we resist the entreaties of patients who want us to suture them at their kitchen tables. I am not kidding.)
We treat every patient with respect and compassion, even if our neighbor-to-neighbor relationship with that same person may not always be so warm. We have three automated external defibrillators and numerous tanks of oxygen on the island.
Thankfully, what people usually need is not an AED but use of the loaner crutches, or somebody to talk to about their concern. Also thankfully, we have a handful of other people on the island with medical backgrounds who will assist neighbors on an informal basis — a former EMT and paramedic, a couple of retired registered nurses, a couple of ski patrollers. We also have a veterinarian, which helps a lot, because until he moved here I would get — and have to respond to — veterinary calls as an EMT.
We do not, however, have a clinic or a health center or an ambulance. We do not sleep in our clothes, ready to race out the door. We do not promise all things to all people (or animals). Most importantly, we cannot offer the 24/7 coverage that is officially required. I will admit that, right here, in public and in writing. It is impossible for me to never leave the island. I suppose when I am on the island I am on duty, regardless of the hour, assuming I don't have the plague. That's how the old Island Nurses did it back before the 1970s, when one nurse at a time was hired to stay out here and handle whatever might come up — so historically that's my obligation. Nobody else has any obligation. There is no "duty schedule." I do leave the island fairly frequently some times of year because I have a number of other jobs and commitments besides EMS. I am a volunteer.
Earlier this summer the inspector from Maine EMS was riding out on one of our infrequent ferries with me; I happened to be making a scheduled freight-and-trash run on that ferry as I am also responsible for trucking the recycling and solid waste off the island. The state inspector asked me why my agency hadn't been submitting the electronic run reports as required (a run report is formal documentation of details of an EMS call).
"I have been," I assured him. "For each of the past few months I have sent in the 'no runs to report' form." He asked how it could be possible for us to have no EMS runs month after month for close to a year.
"I was instructed to send a letter describing our unusual circumstances to Maine EMS in Augusta. I intend to send them this article."
I explained: "The typical call I get is not through the 911 dispatcher, for one thing, which makes it sometimes unclear whether it is technically an EMS call. Sometimes it's obvious to me that it should be, but often it's an informal first-aid assistance thing. Even when it's serious, usually somebody will call me at home on the land line, or grab me while I'm on another job, or send some panic-stricken third person who has no information other than to come and find me. That's scary, when that happens. I'm preparing to respond and I don't know whether it's a hangnail or a boiler explosion.
"Usually if an islander knows they have a real emergency, they don't call me anyway, because they live here and know how to do the transportation. An injured lobsterman will often just put his boat in gear and head for the mainland. A local person who feels truly sick will often get on the plane and go in. (Of the three sudden hospitalizations of islanders this summer, none of them involved EMS at all.) Usually people call me because they hope I can do something to make it so they don't have to leave the island. Or else they're new here, renting somewhere and they have no idea what to do.
"Those people are often fairly startled to learn that we don't have a doctor.
"I respond to quite a few non-emergency calls, but even when I say "quite a few" it isn't very many, because there are so few people here. Once I got paged by the Knox County Dispatcher for somebody who had accidentally locked himself inside a storage shed. He had a cell phone. It's odd that his phone even worked out here — mine doesn't — but his did. He panicked and called 911."
Non-emergency calls are by far the majority. I guess in a sense I am practicing nursing without a license.
I continued: "When there is an emergency, it's generally unlike anything that I've ever done before. There is no 'standard operating procedure.' You should know that over the past 20 years of doing this I have been called to a few crime victims, violent settings, homes filled with out-of-control drunk people where I know there are weapons, and there are no police officers out here. That's a whole discussion in itself, about the role of a responder in those circumstances. I remember one call when my husband was worried about me and he joked, 'You'd better take a baseball bat,' but deep down I don't think he meant it to funny."
The state inspector made the logical observation about how we need more volunteers, how it must be hard to be the only one.
"I'm not on island every time something goes wrong, either," I explained. I remembered the unexpected death of a young woman years ago. It happened while I was off taking a Wilderness EMT update course; that was a bit hard on my conscience, to be on the mainland "playing mock emergency" while the rest of my community was dealing with the real thing. My husband got the job of finding the victim's mother and breaking the news to her. My kids babysat the victim's toddler that morning. The other EMT who did respond was practically related; he shouldn't have had to do that alone. I did nothing to help. That still bothers me.
As the two-hour ferry trip continued, I explained to the inspector a few other ways our EMS service is unlike most of the others he sees. I set foot in the emergency department of Penobscot Bay Medical Center so seldom that it seems things are rearranged each time and I can't find anything, or anybody familiar. I ride with patients in the backs of pickup trucks along bumpy, rutted Matinicus roads — and usually I'm trying to get the driver to slow down because of the big potholes, but they think they need to speed to the airstrip because, oh my God, somebody's hurt. Either that or I drive patients to the airstrip in my Jeep. Matinicus Island Rescue is a non-transporting service, so when we do transport somebody to the mainland, we meet up with a mainland ambulance — usually South Thomaston's — at the Knox County Regional Airport in Owls Head. LifeFlight could come but they haven't had to respond here so far.
We're truly in the back-country. There's no 3G and no reliable cell service, so there's no using a laptop or smart phone on scene like some EMTs do these days. Some of the higher-ups also think it strange that I've been a "basic" EMT for 20 years; generally, people move up to advanced or paramedic levels if they mean to stay in this business so long. But my community can't support a paramedic service, and I'm not just talking money. It would be false advertising to claim to be a skilled paramedic when you never get to use your skills, and with so few calls, a paramedic out here would get awfully rusty. I wouldn't want a paramedic intubating me who hardly ever does it. That's a reality.
I'll never be the kind of highly skilled medic who stares down death every day and does the heroic stuff with the latest technology, or who goes tearing through the city at top speed with lights and sirens. I'll never get that kind of experience. But, out here, we do learn a thing or two about holding the patient's hand when the storm is pounding on the windows.
We talked about how there will be times when no transport off the island is possible, such as during a hurricane. "I keep a bunch more oxygen on hand than the state requires, because somebody might be stuck overnight when there isn't any help coming."
I told him about the time we got the Coast Guard out here with a paramedic from Rockland to respond to a diabetic emergency in thick fog at 3 a.m. I told him about the times I have had to respond to my own husband and children. I told him that I offer free CPR classes on the island. but I can't seem to get the fishermen to come. I told him about how I fear my 911 pager, which I take with me everywhere on the island, and I sleep with, that it goes off so seldom when it does it drives my heart rate right to the ceiling.
"Sometimes it isn't even an emergency call," I explained. "Once, my pager rang when somebody over in a Knox County office was filling out forms and wanted to know who we use for tow truck service out here. Seriously! I thought there was a big wreck or somebody was having a heart attack. Scared the hell out of me!"
"I think you'd better write this all down," said the inspector.
Eva Murray lives on Matinicus.
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