As the summer season gains momentum, Vineyard emergency medical crews are working overtime and drawing from off-Island resources in order to meet an increased demand for service. And with fewer paramedics available this summer for ambulance calls, the current group of staffers have also increased cross-town efforts to maintain the highest standard of care possible.
A 2010 Massachusetts law requires that any ambulance equipped for advanced life support must have a paramedic on hand at all times in order to retain its state license. Volunteer emergency management technicians (EMTs) can perform basic life support tasks, but do not have the extensive training required of all paramedics.
The paramedic pool took a hit before the start of the season when a longtime Tisbury employee moved off-Island for a new job. At the same time, regular paramedics in both Tisbury and Oak Bluffs took medical leaves of absence. Though each town has its own ambulance crews — Aquinnah, Chilmark, and West Tisbury form the Tri-Town ambulance service — all share resources through mutual aid agreements. Many full-time paramedics for one department take per diem shifts in other towns in order to help fulfill state requirements. A jolt to one town is a jolt to the entire system.
“We all try to work together as far as sharing paramedics goes,” said Tisbury fire chief John Schilling. In Tisbury, as is the case up-Island, emergency medical services fall under the administrative realm of the fire department, although the town has its own ambulance coordinator. “But when you look at the fact that you’re required to have somebody on duty 24/7, 365 days a year . . . you get to summer and your demand goes up, people are asking for more staffing than minimal, you have special events, all of which require additional staffing.”
Chief Schilling continued: “You can’t say closed, you can’t have reduction in hours or reduction in service. All those things, you’re not allowed to do or you put your state license in jeopardy.” Tisbury has the lowest pay scale for paramedics on the Island, he said, making it hard to recruit new people. There are currently two full-time Tisbury paramedics, so the town is relying heavily on per diem work from other Island towns. Tisbury has also brought in three per diem paramedics from Cape Cod and southeastern Massachusetts to fill shifts. The Tri-Town service is being supplemented in this way as well.
“That, in the short term, is our answer for what we’re dealing with right now,” Chief Schilling said.
But even in Oak Bluffs, which had a full-time staff of nine paramedics before injury-related leaves of absence cut summer numbers to six, meeting demand is a challenge.
“We are all struggling with the need for new paramedics,” said John Rose, Oak Bluffs ambulance coordinator and fire chief. The summer is noticeably busier in terms of calls. Ambulance calls in Oak Bluffs from the end of June and beginning of July are up at least 25 per cent, he said, with no signs of slowing down. Oak Bluffs is also in the unique situation of handling transport from the Martha’s Vineyard Hospital. It handles Medflights to Boston and provides interfacility services. Patients brought to the Vineyard hospital and stabilized sometimes require additional care at other locations.
“We’ve gone as far as Long Island, New York,” Chief Rose said. “Last week we went up to Groton.”
Not all interfacility transports require a paramedic on board — this decision is made by the hospital physicians — but the majority do, and they take another player out of the Island system.
Oak Bluffs receives the greatest number of 911 calls, Chief Rose said, and because it sits between the two other busiest towns on the Island it is also called on frequently for mutual aid.
“There are times, and it’s happened many times, when every ambulance [on-Island] is on a run, and it’s not in their town,” Chief Schilling said. “We had a run when we went out to Chappaquiddick last week because Edgartown was on a run . . . there are a lot of moving pieces.”
There are currently just two people on-Island, both in Oak Bluffs, training to become paramedics and bolster the crews. They are being sponsored by the town, much as police departments sponsor recruits in the police academy. The training takes place off-Island.
The process is no easy task. Basic EMT training is the first requirement, which allows people to get a feel for what ambulance shifts are like.
“You can pretty much tell if somebody has what it takes to move on and be a paramedic,” Chief Rose said.
“When I was in the EMT basic class, I knew that I wanted to be able to do more,” said Tri-Town deputy chief Ben Retmeir, who has been a paramedic since 2011. “There’s a certain level that the EMTs can go up to; I wanted to be able to do everything possible pre-hospital to help somebody.”
Mr. Retmeir spent two years completing coursework and training, ultimately turning in about 1,500 hours of class time and 700 hours of field time, which included 450 hours at the hospital learning skills and 200 hours on calls with a supervising paramedic called a preceptor. Mr. Reitman took a paramedic class that was offered on-Island, but those are not always available. The average time to complete the entire process is 18 to 24 months, he said. It can take up to three years to become a full paramedic, able to ride in an ambulance without a preceptor. Still, paramedics are never alone in an ambulance as they always have an EMT on board as well.
“You have to pass the national standard [test] and receive a license from the state, and you also have to be approved by what’s called local medical control,” Chief Schilling said. Dr. Karen Casper, who works in the emergency room of the hospital, oversees paramedic services for the Island. She must be comfortable with potential newcomers’ skill levels before she approves them as paramedics.
Paramedics must also complete 70 hours of continued education every year in order to maintain their license.
“It’s a large commitment and you have to be in the right mind to start it,” Mr. Retmeir said.
“These people have incredibly stressful jobs,” Chief Schilling said. “They are literally making life and death decisions on people that in all likelihood they have some previous knowledge of.”
The small town aspect of being a paramedic can be a challenge, Mr. Retmeir said. But at the same time, the Island community makes the job worth it.
“You’re a known face, people recognize you and wave to you,” he said. And the EMT community itself is a tight-knit and supportive one.
“When something happens to one of us, everyone closes ranks and you support them,” Mr. Retmeir said. “If I go to a bad accident scene, a couple hours afterwards I have people in Edgartown and Oak Bluffs calling me, are you okay, how are you doing? Same with the hospital crews.” Chief Rose concurred.
“Even though it is a huge commitment and a strain on your life, the difference that a paramedic can make in someone’s time of need is substantial,” he said. “I see that on a continuous basis in Oak Bluffs when our paramedics get there. Probably in ninety per cent of the cases they’re bringing the ER right to your doorstep.
“The benefits of that are just unbelievable — to get the treatments started that much faster,” he said.
Last month, the full complement of Island ambulance services, including EMTs, paramedics, mutual aid and hospital transfer, was in effect as crews worked to save the life of Christopher MacLeod of Chilmark. Mr. MacLeod, 47, had a heart attack at work and was brought to the Menemsha Crossroads fire station by Rodney Bunker. He had no vital signs for about 20 minutes. While paramedic crews assembled — Mr. Retmeir, who was off-duty at the time, came to Chilmark, as did Tisbury off-duty paramedics Kyle Gatchell and Tracey Jones — EMT Kristina West began basic life support (“beyond textbook perfect,” Mr. Retmeir said) with EMT Alan Ganapol stepping in. Chilmark and Aquinnah town officials came to help with the life support as well.
“It’s things like that, when you see your community [at work], everybody coming in to help,” Mr. Retmeir said.
“They all came together and they worked hard to give me a good fighting chance,” Mr. MacLeod said by telephone. “They never gave up, which is just amazing.”
“I’m absolutely grateful, every minute. Every one of them that I meet [now], they just grin from ear to ear,” he said. “It’s a community effort,” Mr. Retmeir said. “No one person or one small crew can do it.”