Rescue Squad

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Many rescue squads now have added paramedic skills to the services they offer their communities. The training required is rigorous—anywhere from four hundred to fifteen hundred hours, plus additional hours of continuing education. But the advanced life support that paramedics provide, nearly the functional equivalent of a mobile emergency room, saves lives.

Today’s EMTs have at their disposal rescue tools that Julian Wise would have envied back in 1928. In the late sixties an inventor named George Hurst designed an oversize hydraulic can opener to help remove drivers from the tangled metal of wrecked race cars. Dubbed the Jaws of Life, this tool, which can generate five tons of force, quickly found a market among rescue workers who were faced with highway crashes just as severe as those on the Indy track.

The biggest impact of the computer on emergency volunteers has been in the development of automated defibrillation. Battery-powered defibrillators became available during the 1960s, but use of the units required an ability to interpret the heart rhythm displayed on the monitor. The new machines perform this analysis internally, requiring the operator only to press a button if they indicate the need for a shock. This type of defibrillation is rapidly becoming a standard EMT skill.

AIR TRANSPORT OF PA- tients represents the state of the art in emergency medical services, taking Larrey’s concept of an ambulance volante to its literal limit. Again the military led the way. During the Korean conflict helicopters ferried wounded soldiers to the mobile army surgical hospitals made famous on the television show “M*A*S*H*.” The Vietnam War familiarized the nation with the “dust-off” helicopter that brought medical evacuation right into the battle zone. The civilian version of the idea took off in the 1980s. Today hundreds of hospitals, police departments, and private firms offer helicopter service.

 

The squad started by Julian Wise still operates out of a large brick building constructed in 1955 near downtown Roanoke. The headquarters houses a rescue truck, nine ambulances, a dormitory, a meeting hall, and a kitchen. Rotating crews of six or more volunteers man the station for twelve-hour shifts. None of them works for the railroad now. The average age of members has dropped to the early twenties. Kristine File, a newer squad member, is one of those who are very much aware of the crew’s long history. “It gets into your blood,” she says, talking over the drone of the television in the squad lounge. “It’s a rush for me to stand where Julian Wise stood. I never met him, but I feel I know him.”

But the world that File and the other Roanoke volunteers contend with is far different from the one Wise knew sixty years ago. Even in the late 1950s the crew was handling about a dozen calls a day. The city now generates an average of more than forty. “We have some sixty-eight names on the membership roster,” says Sidney Robertson, chairman of the group’s board of directors since 1989, “but only about forty are really active.”

Calls to drug overdoses, domestic disputes, and shootings—along with the specter of AIDS —remind today’s volunteers of the job’s grim possibilities.

A bright-eyed man whose energy belies his seventy-seven years, Robertson is leading the organization through a time of extensive change. During the 1980s paid city personnel increasingly assumed responsibility for the burgeoning load of calls. The Hunton crew, unable to recruit enough members, folded. The Roanoke squad merged with the other volunteer crew in the city to form the Roanoke Emergency Medical Services, Inc. And in 1989 financial constraints required the squad to begin charging patients for their service.

“People don’t understand,” Robertson says, “how they can be treated by two volunteers and then receive a bill for a hundred ninety dollars.” But the group’s annual operating budget has climbed to more than three hundred thousand dollars. Additional assumption of EMS responsibilities by the municipal authorities is inevitable.

Many of the Roanoke squad’s problems are shared by volunteers around the country. A single rescue truck can cost ninety thousand dollars, and automated defibrillation units run as high as eighty-five hundred each. Bakedfood sales and fundraising appeals don’t always pay the bills. In Vermont, where 86 percent of emergency medical services are provided by volunteers, nearly three-quarters of the squads bill those who use their services. “In the future you’ll see a lot more hybrid squads, part volunteer and part paid,” says Dan Manz, who heads the EMS in Vermont and is president of the National Association of State EMS Directors. “But volunteers are still strong across the country.”

The types of calls are changing too, especially in cities. The urban poor often use the 911 system indiscriminately. “Another taxi call,” one of the Roanoke EMTs says with a sneer after a nonemergency run. Abuse of ambulance service is common. Like hospital emergency rooms, rescue squads feel the strains that are affecting the nation’s medical system as a whole.