By Alison Clapp
As many of you may be aware, there was an effort in the town to approve a second ambulance for the Fire Department. Tuesday, April 29th the City Council’s Committee on Budget & Fiscal Oversight took up the proposal which had strong support from many residents including a broad group of seniors. The case for a second ambulance was based both on the increased demand for the current ambulance based out of the Orchard Street station and response time when waiting for a contracted private ambulance to arrive at calls. The Council approved the request in mid-May which means the addition of eight firefighter/paramedics to staff a second ambulance.
Given this recent addition to the Fire Department, the recent Coffee with the Chiefs session was devoted to the types of services an Advanced Life Support (ALS) ambulance offers. Two current paramedics: Tony Caruso and Katie Boudreau gave a presentation about these services. Both noted how the addition of a second ambulance will relieve the current staffing issues with the current ambulance. Currently, staff are extremely busy.
Watertown ambulances carry all state-required equipment plus some additional items unique to the needs of the city. Attendees were able to see a small camera-like device which aids in intubation of a non-responsive patient. This allows the paramedic to view the vocal cords and originally was only used in operating rooms. Another device was a pair of scissor-like tongs which could be used to remove an airway obstruction. Clearly, this is only used in the event that the Heimlich maneuver or subsequent chest compressions have not dislodged the obstruction.
These were followed up with a demonstration of the Lucas (Lund University Cardiopulmonary Assist System) machine. This machine has been revolutionary in CPR care. Humans tire, usually in less than a minute, when doing chest compressions. CPR done properly requires the right number of compressions (100 per minute) at the right depth (2.5 inches). In the event that a patient is moved, the LUCAS machine again has the advantage as it is able to provide uninterrupted compressions. This machine is set and automatically provides continuous compressions during CPR.
There was a question about the size of the mannequins. Patients are usually never the same size and during training, different size patients can be used. Additionally, Boston Children’s Hospital provides specialized training for newborns. Watertown ambulances are essentially mini-emergency rooms.
Tony noted that the next piece of equipment was a bit cringe-worthy. During or right after a heart attack, it is essential that certain drugs be administered which will get to the heart as quickly as possible. To do that paramedics would drill a small hole in the tibia to administer the drugs as the fastest way to get the drugs to the heart is through the blood in the bone. Tony was correct … the sound of the drill reminded many of a dentist’s drill. This procedure would only be used in certain heart attack or burn situations.
In response to another question about AEDs (automatic external defibrillators) designed for the public, Katie and Tony noted that while everything is well marked on the equipment, the 911 dispatcher also will be giving instructions until the paramedics arrive. A public AED, unlike the ones used by the paramedics, is designed for a single use which is to shock the heart. If the pads detect a heartbeat, the machine would not deliver a shock. The AED machine on ambulances are more versatile and can help staff determine which drugs in what amounts to administer at what time. They also are monitoring oxygen, carbon dioxide and other vital signs.
After 20 minutes of CPR without a response, it is likely that the patient is no longer alive. In such a case, the ambulance would call the police who in turn would call the medical examiner’s office. The paramedics also have a medical director at the hospital (in Watertown’s case, Mount Auburn Hospital) and would be working with this individual making sure they have all the necessary information before ceasing resuscitation.
The final piece of equipment demonstrated was a CPAP mask which aids patients in respiratory distress. This could be a patient with chronic obstructive disease (COPD) or asthma. Unlike home CPAP machines designed to relieve sleep apnea, this CPAP mask puts a full seal around the mask making sure that the oxygen or any aerosolized medications such as albuterol are being used to maximum benefit and being delivered directly to the lungs. A mask can sometimes be used in place of intubation which is a more uncomfortable procedure.
In response to a question about medications, they are given according to state determined protocols. Before attendees were able to see the ambulance, there was a final question about what sorts of information would be helpful to have in the event emergency personnel need to be called to your home. Attendees were reminded about the File of Life, previously distributed by the Fire Dept., which is a document which can be posted on the refrigerator. Anyone who does not have the File of Life can also post, at minimum, a list of their allergies and medications on their refrigerator. An attendee requested that the File of Life document be posted online so that it could be downloaded and then printed out.
The meeting then moved to the parking lot for a look inside. This photo shows Tony and Chief Ryan Nicholson ready to load a patient into the ambulance. Watertown is very fortunate to have such dedicated, smart and extremely well-trained emergency staff working on our behalf. Attendees also expressed gratitude to Mark Sideris (City Council President), Vincent Piccirilli (District C), and Emily Izzo (District D), who all attended the meeting, and to the rest of the City Council, for all their work to get the necessary funding for the second ambulance.
