By Reggie Ellis
Let's say you live in the county halfway between Exeter and Lindsay. Your spouse calls 911 because something has completely blocked your airway. When the ambulance picks you up they either have to take you to Sierra View Hospital in Porterville or Kaweah Delta Hospital in Visalia.
The emergency medical technicians on the ambulance can't insert a needle-like tube into the lower portion of your throat so you will have to wait until you reach the emergency room - unless the EMTs are paramedics.
The difference between depriving your brain of oxygen for several minutes or 10 minutes can be the difference between a bad headache and severe brain damage. Transtracheal jet ventilation, or TTJ, is one of the six procedures that paramedics are trained for in addition to the training that Emergency Medical Technicians Level II (EMT-II) receive. Currently there are no paramedics working in Tulare County, but thanks to a recent decision by the Tulare County Board of Supervisors there will be.
At its Feb. 24 meeting the Board of Supervisors agreed to join the Fresno/Kings/Madera Emergency Medical Services Agency. The agency will oversee the training of the nearly 100 EMT-IIs in Tulare County waiting to become paramedics through a $600,000 federal grant. It will take about two years for all of Tulare County's EMT-IIs to receive the additional 726 hours of training (EMT-IIs require 306 hours of training while paramedics require 1,032 hours). Fresno County Board of Supervisors was expected to approve the addition of Tulare County at its March 16 meeting.
After the initial training, Tulare County will have to find an alternate source of funding to continue the training for future paramedics. The logistics of the partnership have yet to be worked out. The Agency will be meeting with Tulare County ambulance providers at 2 p.m. today, March 17 in Conference Rooms A and B at the County Administration Building, located at 2800 Burrel Ave. down the street from the courthouse.
Dr. Michael Maclean, health officer for Tulare County, said that the Board of Supervisors was initially approached about upgrading to paramedics back in 1996. He said it wasn't primarily a lack of funding that prevented the shift to paramedics from happening sooner.
"There was a perspective that it wasn't necessary, and [was] potentially harmful for small communities who relied on volunteers," Maclean said. "They were worried that a volunteer would not want to take the time to get the extra training."
Both Exeter and Lindsay have lost their hospitals in the last three years - Lindsay's in November 2000 and Exeter's in December 2002. The closures have forced both Imperial Ambulance in Lindsay and Exeter District Ambulance to take all emergency care patients to either Sierra View in Porterville, Kaweah Delta in Visalia or sometimes to Tulare District Hospital.
Exeter District Ambulance Board made the decision to cut back to one full-time ambulance crew at its Jan. 15 meeting. The district provides ambulance service to Exeter, Farmersville, Lemon Cove, Woodlake and occasionally Three Rivers and Sequoia National Park. The district always has a backup crew on call and calls can be covered by other ambulance services. However, calls shifted to another company or backup can add to the response time. The cut was the last of a series for Exeter Ambulance District that included closing its Farmersville Station in November 2003. The financially strapped district was forced to make cuts in order to save about $150,000 due to decreased call volume, and reduced Medicare reimbursements, which make up about 30 percent of the district's revenue.
Exeter District Ambulance Manager Don White said the upgrade shouldn't affect the payscale of district employees.
"All of our employees want to be paramedics," White said. "It isn't a financial thing to them, they will get the additional training for the benefit of the community."
White said the additional procedures a paramedic is trained for could make a difference on a case-by-case basis.
"We have had a good system all along," White said. "But adding one of those procedures could help them save a life."
Maclean said most of the time, the difference between and EMT-II and paramedic is inconsequential. He said EMT-IIs are trained to handle 95 percent of the situations they will face. Paramedics are only necessary when "less common conditions arise."
Rick Noel, an EMT-II with Imperial Ambulance, said 70 percent of the calls in Tulare County are for chest pain and respiratory distress, which EMT-IIs are already trained to handle. Noel likened the upgrade to the difference between a licensed vocational nurse and a registered nurse.
"There is more education so there is more understanding in a given situation," Noel said.
However, Noel said in his 15 years as a paramedic he has yet to lose a life because of a situation for which he was not trained.
"I don't think there has been one instance, for myself or anyone else with Imperial, where we wished we could have done something else for a patient," he said. "There is more than one way to treat a patient. Some procedures may be better but they both work."
Doyle McKee, an EMT-II with Exeter District Ambulance, is currently certified as a paramedic in Fresno County. McKee, who has almost 40 years of experience as an EMT, said he has never lost a patient in Tulare County because he was not certified to use his paramedic training. He said EMT-IIs are trained to handle 90 percent of the cases they treat.
"There were times when I could have done more for the patient," he said. "The main difference is not knowing what to do for symptoms but knowing what causes those symptoms. That is what helps you decide what treatment is best for that person."
In addition to procedures such as transtracheal jet ventilation (inserting a needle in the neck to open an airway) and decompression of a collapsed lung, paramedics can also use five more medications such as dopamine, which keeps blood pressure low in heart attack victims until they can get to an emergency room.
"Paramedics have much more training which allows them to operate independently," Maclean said. "Our hospitals are real busy so it is a definite advantage to have paramedics."
