Emergency medical care: Orcas Island Fire Department

The five core interrelated aspects to emergency medical care on Orcas Island are the paramedics, the EMTs, the medical director, the ambulances, and communication.

PARAMEDICS: There is a paramedic on call at all times. The use of critical decision-making skills to identify, stabilize, and transport, if indicated, ill or injured patients is the primary task of the paramedic. As such, in addition to regular training, OIFD paramedics complete National Certification courses in advanced cardiac life support, pediatric advanced life support, advanced neonatal life support for the infant from birth to 27 days of life, and pre-hospital trauma life support.

They complete 50 hours of continuing education as well as CPR updates every year. The paramedics have extensive and varied duties that extend beyond being emergency care providers. One of their main focuses includes designing all of the training schedules and conducting ongoing teaching of EMTs.

Lieutenant Valerie Harris, Lieutenant Mik Preysz, and Lieutenant Patrick Shepler are the department’s three full-time paid paramedics.

Val Harris has 21 years of experience as a paramedic, preceeded by three years as an EMT. She has practiced in both busy city and isolated rural paramedic services. She has worked in several capacities in emergency hospital settings. Val owns a home and lives on Orcas Island full-time.

Mik Preysz has 27 years of experience as a paramedic, preceeded by four years as an EMT. Mik was also a police officer from 1977 to 1987.

Patrick Shepler has 28 years of varied experience as a paramedic. He owns a home and lives on Orcas Island full time.

All three paramedics are also Firefighters.

EMTs: The OIFD EMTs, who are all volunteers, must complete intense academic studies and “hands on” practicals, with rigorous testing in both categories.

They have earned Emergency Medical Technician certificates in Basic Life Support (BLS) skills from the State of Washington. Further, they must complete 30 hours of continuing education each year in order to maintain active standing in the OIFD. Basic Life Support skills focus on the ABCs of emergency care: opening and maintaining an airway, respiratory (breathing) assistance, and controlling bleeding.

The EMTs, who usually are first “on scene,” begin treatment by focusing on stabilizing and doing a rapid assessment of the patient. The next tasks are to give an accurate and brief communication of the situation by radio or telephone to the paramedic on call or the medical director, and to proceed towards either “packaging” the patient for safe transport, or continuing into a more thorough examination and further first aid until the arrival of the paramedic. EMTs are trained in the use of an AED, or automatic external defibulator, a tool that has saved the lives of many patients having heart attacks. Every EMT carries an AED, as well as portable oxygen tanks and masks. EMTs are empowered to make the decision to call for Airlift, shortening the time to a mainland ER.

We are an island community and our Emergency Medical Service responds to every medical call from 911, facing every kind of problem. At the very best, a hospital emergency room is at least an hour away. At times, weather can prevent Airlift from flying, and Navy transport may be four hours away. Sometimes transport must be delayed for much longer. These situations require that paramedics and EMTs have and know how to use a sophisticated array of equipment, techniques, and medications.

Paramedics and EMTs are prepared 24 hours a day to treat trauma from a wide array of mishaps, including falls in and outside of the home, motor vehicle, bicycle, and airplane crashes, burns, water related accidents, overexposure to heat or cold, suicide attempts, substance abuse incidents, interpersonal violence and mass casualty incidents. They are prepared to treat cardiovascular, neurologic, respiratory, diabetic, obstetric, pediatric including neonatal, and gynecologic illnesses and emergencies. Often these medical emergencies pose imminent threat of life-long incapacitation or death.

AMBULANCE: The two ambulances, or Aide Vehicles, are vital to the quality of care offered. Equipped with the standard supplies and equipment for basic life support care, they also carry invaluable advanced life support machines and supplies. The Life-pak 12 machine functions as a cardiac monitor, automatic blood pressure monitor, O2 and CO2 saturation monitor, ECG, pacemaker, defibulator, and can perform cardio inversions. The Dopler stethoscope monitors fetal heartbeats. The C-pap machine enhances positive pressure breathing for specific respiratory arrest problems.

The paramedics have skills in using a variety of techniques for airway management, including placing breathing tubes and use of a ventilator machine.

The aide vehicles carry standard medications. They also are stocked with many rarely used but life saving drugs, such as the “clot buster” drug used for cardiac problems.

MEDICAL DIRECTOR: The department’s medical director, Michael Sullivan M.D., emergency care physician with St. Joseph Hospital in Bellingham, is contacted by telephone on virtually 100 per cent of all medical calls. He is called just after the patient is assessed, stabilized and some history has been obtained from the patient, family, and bystanders (if possible). The Lifepac 12 can fax ECG tapes to Dr. Sullivan for analysis.

In consultation with the paramedic or EMT in charge of the incident, treatment and transport decisions are made. Dr. Sullivan stays in contact with personnel until the situation is resolved.

One evening a month, Dr. Sullivan travels to Station 21 in Eastsound to conduct a “run review” of cases handled in the previous month. A run review is a critique of emergency personnel performance and a discussion of what lessons can be learned for treatment in future incidents. Because of privacy laws, patient names never are used. Following the run review, Dr. Sullivan conducts classes in pertinent areas of emergency medicine. Run reviews are attended by EMTs, fire fighter/first responders, and paramedics.

COMMUNICATION: “911” is an all inclusive emergency response system. Upon receiving a call, the 911 operator notifies the appropriate agency to take the lead in responding and transmitting the information obtained from the party making the call. Ideally, the information includes the age and sex of the victim, the nature of the illness or injury, and the location, including directions to the scene. If the call is a medical emergency, the operator transmits the information to alert “Orcas Aid,” including which fire station is closest to the reported incident. The closest volunteer EMTs proceed to the scene, rapidly assess the situation, stabilize the patient using basic life support (BLS) protocols, and, via radio, communicate their observations and actions to the paramedic in route.

There are seven fire stations on the island, Station 21 in Eastsound being the central station. Both ambulances are at the Eastsound station. Five paramedics, 35 EMTs, and four First Responders live on the island.

There is an emergency helicopter flight pad in every station area. The airport is used for fixed wing emergency airlift.

The Coast Guard, the Navy, the Sheriff’s boat, and by ambulance on the ferry are other avenues by which patients can be taken to the mainland in weather when Airlift cannot fly.

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