On the Road With Cooper EMS

By Rosaria Mineo, Manager, Social Media, Cooper Communication and Marketing Department

As a self-professed cubicle jockey, I don’t spend much time with clinicians in their natural habitat. In fact, I actively try to stay out of the way. This occurred to me as I sat alongside Nadeem Ishaq, Cooper’s EMS Supervisor, who had invited me on a ride-along with his team. We were on our way to Walter Rand Transportation Station in Camden just after 7:30 a.m. on a cold morning in mid-January.

A small crowd had formed on the platform, hunched over or crouched low, working on man who looked like he was sleeping, but had overdosed. The team was calm, decisive. They administered Narcan intranasally, monitored his pulse and breathing, and firmly rubbed the center of his chest with their knuckles. A few moments passed without much change. A second dose was delivered intravenously. I kept waiting for the gasp of breath, the shock back to life – it doesn’t work that way. Slowly, color came to his skin. He was disoriented, but by the end of the ordeal was able to help himself onto the stretcher to be loaded into the ambulance and on to Cooper’s Emergency Department for evaluation.

I didn’t realize how cold I was until I returned to the passenger seat of Ishaq’s EMS Supervisor vehicle. I was bundled in layers, with a coat, gloves, and boots. I looked again at the man on the stretcher wearing a thin shirt and open jacket as we drove back to headquarters.

Ishaq has spent 25 years in EMS. He helped me understand the basics: Emergency Medical Services are the first on the scene and able to provide full care on site. If EMS can stabilize a patient, that buys an ED nurse upwards of 45 minutes. So, patiently, he set me straight: EMS is not just transport to a medical facility. These teams have the ability to do what they can to save a life on the spot.

That said, the shift starts in the garage: everyone on the team is responsible for everything on their shift, from the available oxygen and life-saving equipment to the brakes and headlights of their vehicle. EMS teams take medicine into the field, a make-shift hospital on wheels, and they know every component like the back of their hands.

There are two types of EMS units: BLS, or Basic Life Support, and ALS, Advanced Life Support. BLS units include Emergency Medical Technicians (EMTs) who are able to perform essential emergency care, from CPR to treating an asthma attack. Training is approximately 200 hours and can be completed over several months. Paramedics on the ALS teams go further in their training and are able to start an IV, manage trauma patients, and more. They invest thousands of hours over a two-year degree program.

As of 2017, Cooper EMS averages more than 110 ambulance runs per day and has two ALS transport vehicles, in two separate locations, on call 24 hours a day, seven days a week, improving the timeliness of care and transport of critically ill or injured patients. Cooper also has at least two BLS units on call 24 hours a day, seven days a week and up to five BLS units during peak call times.

These stats and facts came sporadically during a day full of calls. I listened for police calls and watched as Ishaq took information from three different sources to direct his team efficiently and expediently. I observed the intubation of a man in his living room in cardiac arrest, saw his pulse stabilize, and was there when he was received in a room ready for him at Cooper. I witnessed ambulances and police vehicles canvass a small neighborhood trying to find a young woman, overdosing in a field, who had been called in by a concerned citizen. In fact, I saw Narcan bring people back to life on three separate calls. It was thrilling and devastating when I had a chance to sit and think about it.

Those calls are still particularly vivid. On TV, an overdose involves chaos, barking commands, pleading. Each call that day was quiet: on an empty train platform, in a field of tall grass, and behind a landscaped slope. The team runs like a well-oiled machine, silent and focused. Ishaq attributes this to each person knowing their role, and relying on a combination of trust, skill, and communication. He’s quick to add that community rapport and involvement of concerned citizens also help them find individuals in distress.

“It’s not the big events like 9/11 that break you, it’s the everyday tragedies that burn you out,” Ishaq shared.

As we were preparing for another call, I wondered how you prepare yourself emotionally in this line of service. I knew my run of positive outcomes that day was pure beginner’s luck. In truth, it’s relying on a team for check-ins, moral support, and camaraderie through thick and thin that makes it possible to keep moving forward.

Back in the break room, I asked the crew what keeps them busy. The answers came immediately: lack of access to preventative care, lack of education about available resources, lack of follow-up care. Over-reliance on the ED for things that are better addressed in a doctor’s visit, like pain management or prescription refills. These factors are what contribute the most to EMS calls, ED visits, and overall hospital volume. So what can we do about it?

They shared the story of a patient suffering from renal disease. He made constant, regular calls for EMS because he wasn’t compliant with his medication and wasn’t compliant with follow-up care. At the root, he was alone and depressed, so a personal investment in self-care didn’t seem worth it to him. After three months of weekly visits by a medic spending regular, quality time with him, it was another six months before EMS received a call for help. Community Paramedic Programs like this are a formal way of acknowledging how EMS teams are fully woven into the fabric of our communities and how they can positively affect health outcomes under non-emergent circumstances.

For a 12-hour shift, I sat alongside men and women who enter the lives of strangers at a moment of panic. They step into our homes, workplaces, and neighborhoods ready for anything. For 12 hours, I was invited to see the humanity of medicine at its most humble: working diligently outside in the cold and racing against time through intersections and over potholes.

What I had read and heard from the safety of my cubicle couldn’t prepare me for what I saw, heard, and felt that day. So I decided to stop “getting out of the way.” I took a Stop the Bleed course, I bought a first aid kit for my car, and I’m getting a tourniquet to keep with me every day. This opportunity went beyond “a day in the life of an EMS team.” My biggest lesson was learning first hand that every second counts.

Many thanks to the Cooper EMS team and especially Nadeem Ishaq for inviting me to this opportunity to get onto the street and see firsthand what happens before you reach the hospital doors. Many thanks to so many others that day who shared their stories and experiences with me: Misty, Amy, Mike, Mike, Gary, Chris, Craig, Steve, Sherry, Barry, Rick, and more. Thank you for all you do. Happy EMS Week.