Posted on: Sunday, June 5, 2005

Rapid response critical in life-death situations

By Rod Ohira
Advertiser Staff Writer

The second call one recent day for the new Nanakuli ambulance unit comes from dispatch at 11:14 a.m. A patient is suffering a possible stroke at the Wai'anae Mall Shopping Center.

Paramedics Laurie Grace, a 15-year EMS veteran, and her partner for the past six years, Laura Keomalu, are in their office, a converted conference room at the Nana'ikeola Kaiser Clinic, at 87-2116 Farrington Highway.

The paramedics rotate assignments, so this is Grace's case. All EMS calls to the scene are "hot," which means the siren is on. The patient's condition determined whether the siren is used en route to the hospital.

For two of Honolulu's EMS workers, it's another call on a typically busy day.

The ambulance is equipped with Opticom, a priority control system that automatically changes lights to stop traffic. Even with Opticom, ambulance drivers slow down and check before proceeding. The westbound motorists on Farrington Highway during this run consistently clear a path for the ambulance despite road construction. "In the Leeward area, motorists tend to be respectful and helpful," Grace said.

The paramedics arrive at the mall at 11:25 a.m., about two minutes ahead of a fire company also responding. Firefighters on this day are also battling a brushfire in Nanakuli.

The patient is an elderly man. Keomalu sets up an intravenous feed. The firefighters wheel the patient out on the gurney and the ambulance is off to St. Francis Medical Center-West.

Grace tells the patient they are going to St. Francis-West because Wai'anae Coast Comphrehensive Health Center cannot perform a CAT scan.

The ambulance is racing along as Grace deftly inserts the IV needle into the man's arm. At 11:40 a.m., as the ambulance passes Ma'ili Beach Park, Grace sees an improvement in the patient while calling St. Francis-West to say they will arrive in 10 minutes.

"I want you to smile for me and say a sentence for me," she tells him. The man complies with "I l-u-u-v you." That's better, Grace tells him, noting that he is not slurring as much.

The ambulance arrives at St. Francis-West's emergency room. Grace again asks him for a sentence. "I love you," he said, pausing before adding: "more."

As Grace checks the patient in, Keomalu is back in the ambulance cleaning up. It's a matter of procedure because the next run could come in a minute. It's not unusual for the back of the ambulance to be laden with vomit or worse. Everything needs to be sanitized by the paramedics before the ambulance is put back in service.

Keomalu talks about her partner as she cleans the back, noting how they anticipate each other's working needs. "We feed off each other so there's no need for a lot of verbiage," she said.

It's a job that demands compassion.

"When you stop feeling affected, you can't be effective," Patricia Dukes, Honolulu EMS chief, said. "We want to treat everyone we deal with as if they were our own family members."

That's another reason why a good partner is so important, said Grace.

"We rely on each other for the best of calls and the worst of calls," Grace said. "We've handled thousands of calls, many of them criticals. When we have a rough call, we have to understand we're not God but just tools to help life along. A bigger power determines the outcome of life. Understanding that alleviates a lot of stress. At the end of our worst days, Laura and I are still friends."

Parked next to the Nanakuli ambulance at St. Francis-West is paramedic Russell Gaza's Rapid Response Unit van. Gaza works solo and handles between two and eight calls a day. "I've only had one no-call day since January," he said.

"My job is to hold the fort for a few minutes until (other units) are available," Gaza said. "The hardest thing is you have no one watching your back, especially in violent situations."

Rapid Response provides advance life-support help but cannot take patients to hospitals.

Dukes was doing Gaza's job from January 2003 until December when she was promoted to chief. "As a single responder, you have to be multitasked," Dukes said. "To be a rapid responder, you need to have confidence in what to do and the competence to do it."

The 'Aiea ambulance is one of the busiest units outside of metropolitan Honolulu during the shift that's between 7 a.m. and 3 p.m.

The second of three shifts, from 7 a.m. to 3 p.m., is usually the busiest, said Derrick Young, an EMS field operations supervisor.

Char calls communications "a closet." It takes a lot of patience to work a stressful job with nothing to look at except the faces of co-workers and computer screens.

Calvin Nakagawa, the second-shift supervisor, has been walking the 20 steps up from the ninth floor to the small room on the roof since 1997. Inside the room, Lee Lenchanko is seated at the front console closest to the door while Lance Aimoto is at a desk in the back of the room. Teresa Allen is working relief on the console next to Lenchanko. Between them is a CML Emergency Services monitor, which at the press of a button, can include a first responder to listen in on the emergency calls.

"We average 30 calls a shift but we can get up to 60," Nakagawa said. "Some callers can be difficult but we try to work around them. People are excited when they call so we try to calm them down. It makes it easier if they just answer the questions without yelling and using profane language."

Calls can get backed up because people are reporting the same incident. "Ideally, we could use four or five (dispatchers)," Nakagawa said. "Sometimes, all three (dispatchers) are talking and calls just get backed up. Usually, it's for about a minute."