EMS week is May 14 through 20 with a theme of "EMS, Serving on Health Care's Front Line." It's 11:30 p.m. you notice your father is looking pale and sweaty as he leaves the bathroom. He tells you he has not felt good for the past half hour. He says has vomited and the indigestion won't go away and now he hurts into his left arm. You know from what you have seen on TV, something is really wrong with him. You go to the phone and call 911. After the longest five to six minutes, the local volunteer fire department first responders arrive at your door with oxygen and a small device called an automatic defibrillator. Several strangers enter the house, one responder starts asking a lot of questions, other responders begin taking his blood pressure and attaching the pads of the defibrillator. In all this confusion, two more people enter wearing uniforms. EMS has arrived! Carrying a large black box, the Paramedic listens intently to the report given by the first responders. Opening the box, the Paramedic reaches in and gets a small bottle and sprays something into your father's mouth. He is then quickly loaded onto a stretcher and is whisked to the ambulance.

Medic 10 is a primary response extrication truck. According to American Heart Association a heart attack takes place every 20 seconds and every 34 seconds a person in the United States dies from heart disease. Coronary heart disease is the number one cause of death and 250,000 people die of heart attacks each year before they reach an emergency department. Awareness, public education and advances in pre-hospital care significantly decreased these numbers by 26 percent between 1993 and 2003.

History

The origins of EMS date back to the days of Napoleon, when the French army utilized horse drawn "ambulances" to transport the injured soldier from the battlefield. The evolution of the ambulance took yet another turn during the American Civil War when ambulances were too few, often late, and driven by civilian drunkards and thieves. A physician named Jonathan Letterman reorganized the field medical service to provide an effective ambulance service for the evacuation of battle casualties. In 1864, an act was passed in Congress entitled "An Act to Establish a Uniform System of Ambulances in the Armies of the United States," which spelled out who was responsible for each phase of the ambulance system. One of the first civilian EMS services can be traced back to 1869, when Dr. Edward L. Dalton at Bellevue Hospital, then known as the Free Hospital of New York, in New York City started a basic transportation service for the sick and injured. The component of care on scene began in 1928 when Julien Stanley Wise started the Roanoke Life Saving and First Aid Crew in Roanoke, Va., which was the first land-based rescue squad in the nation and the site of the "To The Rescue" museum dedicated to telling the history of EMS in the United States. Over the years EMS has continued to evolve into much more than a "ride to the hospital."

Awareness, public education and advances in pre-hospital care significantly decreased the number fatal heart attacks by 26 percent between 1993 and 2003. South Carolina passed the Emergency Medical Services Act in 1974 that created standards and regulations for the improvement of emergency medical services and forming a state EMS Advisory Council and its membership. In 1973 President Gerald R. Ford established EMS week to honor the men and women who are dedicated to saving lives when accidents and sudden illness strike and this year EMS week is May 14 through 20 with a theme of "EMS, Serving on Health Care's Front Line." On May 19, Upstate Carolina Medical Center Emergency Medical Services will hold their annual EMS dinner during which time EMT Basic, EMT Intermediate, Paramedic and Call of the Year will be announced.

How to be an EMT

There are three levels of Emergency Medical Technician in South Carolina: Basic EMT, EMT Intermediate and EMT Paramedic. The Basic EMT is trained in bandaging, splinting, CPR, basic anatomy and physiology and airway management. The class takes 6-8 weeks to complete including clinical hours in an emergency department and some hours in an ambulance. EMT Intermediate is trained as a basic first and has been one for at least six months. They are trained to initiate intravenous lines and to intubate. That is to put a tube into a person's airway to breath for them. This class usually takes 4-6 weeks and includes more ER clinical hours and ride time in an ambulance. This class also gets more involved in anatomy and physiology of the human body. The highest level of the EMT is the Paramedic. This class involves more intense and longer training. Ten months of class time, over 700 hours of clinical time in an ER and ride time. The paramedic learns pharmacology, cardiology including EKG interpretation, in depth anatomy and physiology, Advanced Cardiac Life Support (ACLS), Pediatric Advanced Life Support (PALS), vehicle extrication and medication administration. Testing at all three levels include an intensive written and practical exam overseen by South Carolina DHEC and a National Registry examiner. It is a challenging course and not everyone passes the exams the first time and the education doesn't stop after the exam. Each level of EMT must keep up with new trends in pre-hospital care and numerous hours of in house continuing education to maintain their certification with the state and the National Registry of EMT's. If you were to ask an Emergency Medical Technician, at any level, why they do what they do, their answer would be to make a difference or to save lives.

Cherokee County statistics

Cherokee County is 382 square miles and has approximately 52,000 residents and that number is steadily rising. Upstate Carolina Medical Center EMS responded to 7,377 calls in 2005 that averages to about 20 calls a day. That number is up 202 calls from the previous year. The number of calls goes up each year with the rise of population. Of those 7,377 calls, 4,688 were transported to hospitals. Those not transported to a hospital were either canceled before EMS arrived or the people who called 911 changed their minds about going to the emergency department after EMS arrived or EMS called one of several helicopter ambulance services. Upstate Carolinas Medical Center Hospital and EMS utilize Spartanburg Regional Medical Center's Regional-One for serious trauma from the scenes of bad car wrecks and some transfers out of the hospital. Regional-One is the first helicopter ambulance service called to Cherokee County due to their close proximity. If Regional-One is busy, Med-Center Air out of Charlotte, Med-Trans out of Greenville or Care Flight out of Columbia is used. Survival of trauma patients is based on how quickly the patient can get care. That is referred to as the "Golden Hour" because the survivability of a trauma patient decreases dramatically after one hour.

What is an Emergency?

So, what is an emergency? Webster's dictionary defines an emergency as an urgent need for assistance. After years of dealing with "emergencies" from serious car wrecks, to heart attacks, to a cut on a child's foot, paramedics find emergencies differ from person to person. A cut on a child's foot is not as much of an emergency as a heart attack is but, to the mother of a crying child, it is. A recent study showed that one out of twenty 911 calls are true life threatening emergencies. What can be done? Educating the public is one answer. First aid and CPR classes taught to church groups, youth groups, and clubs of all kinds, that are taught by qualified instructors, is a good start. Many medics also teach first responder and CPR courses to members of local fire and police departments. Sometimes all it takes is a little common sense. Cold and flu symptoms in a normally healthy adult do not warrant an ambulance ride. Aches and pains that last for more than a few days do not need an ambulance ride either. What does warrant an ambulance ride? It is difficult to be defined. The question has to be, can I go to the emergency department or doctors office on my own or not?

Paramedics may be faced with death every shift they work. Sometimes a paramedic may seem cold, unaffected and uncaring. That is not the case at all. Paramedics and EMT's have to keep control and be able to step back from the emotion of an emergent situation and make decisions based on the paramedics' experience, what has been learned in class and what the paramedic has assessed about the patient. Paramedics attempt to treat each patient as they would their own family.

How 911 works

Some older people still remember having to dial direct to the ambulance service headquarters or talking to an operator to get an ambulance enroute to an emergency. Most ambulance services were run by funeral homes at one time. Hard as it is to believe, there are still counties in the United States that do not have 911 service though not very many. 911 services began in 1967 and have been in Cherokee County since 1991. The use of 911 streamlines the time it takes for an emergency call to be dispatched and emergency services to be enroute. Cherokee County has an enhanced 911 service and uses a new Computer Aided Dispatch, or C.A.D., system which means that when a call is made to 911 the phone number, address, closest cross street, closest EMS unit and fire department and the name of the caller shows on a computer screen. The call is then referred to either the EMS, fire or a law enforcement dispatcher who immediately dispatches the appropriate units. Each dispatcher is trained for one week in Columbia, SC on how to dispatch. Dispatchers are also trained in Emergency Medical Dispatching or E.M.D., which teaches each dispatcher how to talk a caller through CPR instructions and what questions to ask for medical emergencies. That information is given to responding units to better prepare them for what to expect upon their arrival. In 2005 Cherokee County 911 received 67,663 911 calls. That averages out to 185 calls a day.

The Future of EMS

The future of EMS changes with every new medical and technological break through. In the last six years pre-hospital care has changed dramatically. Paramedics can do a 12 lead EKG in a patient's house and fax it over a cellular phone to a doctor in the Emergency Department to decrease the time it takes for the doctor to give appropriate interventions upon the patient's arrival to the Emergency Department. Paramedics can also do what is called a Rapid Sequence Intubation. Under specific circumstances, a paramedic can administer drugs that paralyze a patient so the paramedic can place a tube into the patient's airway to secure and breathe for them. In the near future, paramedics may be able to give "clot buster" medications to stop the damage of a heart attack or stop a stroke. Studies are currently being done to see what the effectiveness of administering those medications and what the exact protocols would be. A little farther into the future there may be a hand held device that shows paramedics if a bone is fractured or where a bullet is. EMS is a young career in comparison to other medical careers. The fact that paramedics have gained the trust of doctors is a large step. Paramedics do not go to school as long as a doctor but, doctors have to trust paramedics to be their eyes and ears and to make proper decisions in the field. Upstate Carolina Medical Center EMS director John Gelok hopes to add another EMS unit to the western side of the county, buy new ambulances and keep up to date with new equipment and procedures, all which costs money. With health care costs and the cost of operating an EMS system rising, it is a difficult proposition at best. EMS systems across the United States have to do what they can with what is given to them. In Cherokee County, Upstate Carolina Medical Center has given the citizens a competent and well equipped EMS service that keeps to its mission statement to "Every day deliver the best patient-first healthcare in the Upstate."