FIRST RESPONDERS....By Devin Greaney...November, 2001. Partially published in Feb 14, 2002 WILLIAMSON COUNTY SUN

Think “Emergency Medical Services” and most imagine ambulances and city employees in blue and white uniforms. But a lesser known group of people, many volunteers, are part of the EMS system. These people, known as first responders, generally arrive before an ambulance and provide a critical link in the fight against time and even death in emergencies. To use an early American analogy, if ambulances were the Continental Army, first responders would be the Minutemen.

To understand the scope of first responders, one just needs to look at the numbers. Austin-Travis County has about 250 paid medics but about 2,000 total people make up the area’s EMS system. A first responder can be a firefighter. In the city these are most common and that is why a fire truck arrives when someone is complaining of chest pains. A first responder can be another government employee such as Austin Parks Police, Austin Airport Police and the Lower Colorado River Authority (LCRA). There are also some industries in the area including Dell, 3m and Solectron who have their own first response group. In the case of an accident at one of these locations, corporate first responders can arrive in seconds to help the injured employee well before sirens can be heard. A first responder can also be a volunteer with a first response group in the small towns and unincorporated areas.

Living in the 21st century a patient has access to trained paramedics, ambulances located strategically throughout the area, cell phones to access 911 and even helicopter transportation that can have a Hill Country rancher flying 135 mph to a big city hospital. Who could ask for more?

Well, a cardiac arrest patient could ask. After the first minute of a cardiac arrest, 10% of the heart muscle has been weakened, after 5 minutes that is 50%. Even an ambulance with a 6 to 7 minute response time seems slow from a heart attack patient’s point of  view. First responders, said Warren Hassinger, public information officer of Austin-Travis County EMS,  “are such an integral part of this organization where they literally made the difference weather or not someone lives or dies.”

In rural Travis County, the Emergency Service Districts have both paid and volunteer fire fighters who respond, plus volunteer first responders who are not firefighters. Pagers and the volunteers are closely linked as they go about their lives knowing they may be called at any second to save someone else’s. A loud, long, high-pitched whine or a pulsating series of beeps that would make anyone take notice signals the responders to get ready, then the dispatch follows. “The people who do this for nothing are committing themselves twenty four hours a day,” Hassinger said.

Volunteering for this type of work takes commitment and high tollerance for inconvenience. Opening presents on a Christmas morning could be interrupted by an asthma attack nearby. A romantic evening could be put on hold for a knife fight at a bar. A child’s birthday party could be missed because another child decided this would be a good day for a birthday and sent mom into labor.   

Paid. Volunteers. Government. Private. Firefighters or not. With all their variety, first responders in Texas do have some things in common. They are overseen by an EMS system and a Medical Director. All have had at least a 40 hour course and passed a test to become an emergency care attendant, or ECA with many continuing their training to become emergency medical technicians or EMT’s. In Texas EMT’s need at least 120 hours of training, but generally have more than 200 before being certified. Training is done in different places from community colleges to local EMS systems.  All first responders have been instructed in their county’s Standards of Care, which outlines policies and procedures on how a patient is to be assisted. They carry color coded badges that show their level of training. In an emergency with several rescuers, doctors, Paramedics and ECA’s can instantly tell each other’s level of training. A paramedic is licensed by the state to provide a higher level of care than an emergency medical technician, who can provide more care than an emergency care attendant.

In Williamson County the fire departments in the incorporated areas serve as first responders while the unincorporated areas are served by The Georgetown Medical Assist Team (GMAT) and the Eastside Medical Assist Team. Dave Withers, president of the Georgetown group says people generally hear about his organization via word of mouth. Last summer volunteers responded to about 20 emergency calls a month and assisted first aid cases at events such as the Fourth of July celebration, Little League World Series and the rodeo.

Withers said GMAT’s members carry oxygen, albuterol (for asthma), nitroglycerin(for heart patients), epinephrem (for allergic reations), aspirin, activated charcoal, syrup of ipecac (Both for poisonings), airway maintenance equipment and trauma equipment.

“I was brought up in a country environment where everybody did everything for everyone else,” said EMT Mike Nappo. In 1975, at age 17,  he started with Sloatsburg, New York Volunteer Ambulance Corps and has been with GMAT since 1997. The IBM employee has never been a paid EMT, preferring doing this as a volunteer. He estimates he has answered about 1500 calls in New York and Texas. “I’ve delivered a baby with my own two hands. The day before I saw someone die in my hands,” he said. Nappo said often being a first responder is a thankless job, but great satisfaction is there. “God works through me to save lives,” he said.

“I can’t think of any advanced life support group I’ve loved more than Williamson County,” Nappo added. A disadvantage of volunteers is an emergency during business hours may find the responders at work away from the area. Critical minutes may be lost as the patient awaits an ambulance. Nappo says there is no quota on the number of calls a first responder answers. The team understands the first responders have jobs but if calls are not answered on nights and weekends “they would start getting to wonder where we are. That hasn’t happened,” he said. Nappo recommends this type of work for someone “interested in people who are really in need.” . However “If you want to get a big pat on the back whenever you get called out - wrong job,” he added.

In the Piney Woods of Bastrop County, George Martinez is President of Bastrop County First Responders. “Living in the rural community there is kind of a void in emergency care and I was interested in volunteering,” he said. Martinez, an engineering manager for Austin Energy, has been a first responder since 1994.  Unlike Travis and Williamson counties, Bastrop’s EMS is provided through a private contractor, Rural Metro Ambulance, who has an ambulance in Bastrop, Elgin and Smithville and provides medical direction for the thirty or so first responders. Another first responder agency in Bastrop County is based out of Elgin.

The longer the response time, the more first responders are needed. Once when the ambulances were tied up on calls Martinez had to stay with a patient for 55 minutes until the ambulance arrived (a typical call lasts from 20 to 30 minutes he said). Bastrop first responders assisted the air ambulance crew in packaging and loading an auto accident  patient, again because the ambulances were on other calls. First responders in Texas are not permitted to take a patient to the hospital, but sometimes ride with the ambulance to assist.

In addition to medical assistance, responders generally live in the area of the calls so they are helpful in assisting the ambulance in finding locations. As people move and lifestyles change, responders leave the group so they are always recruiting. Some responders, but not all, are Bastrop Volunteer fire fighters. Martinez says traffic accidents are the most common calls for the first responders. “We’re the rollover capital of the state,” he said.

Saving lives and comforting people in distress can be a satisfying way to volunteer. But some of the work is the stuff of nightmares. “The one I remember is the woman hit by the semi,” said Lupe Portillo of the Kyle Area Volunteer EMS in Hays County. After being hit by two trucks and a RV,  “It was to the point we knew she had long hair and that was it,” he said. The volunteers walked down the highway recovering the woman’s remains. “I pulled a state trooper of the car who was shot in the head. I never want to do that again,” said Chris Chomel, also a Kyle Area First Responder. The trooper, shot during a traffic stop in Hays County, died a few days later. Recently several of the responders performed CPR on a cardiac arrest patient. The patient died, but the family thanked the group in the obituary.

Different things motivate the responders. Portillo talked about joining the group so much he says his wife finally told him to join just so she would not have to keep hearing him talk about joining. Personal experience is why Bill Booker does this. “I’ve lived in a rural area and I’ve seen people have heart attacks and driven 16 miles to someone who knew CPR,” he said. “Adrenaline rush,” said Chomel, “I like helping people, but its that rush you get,” he said on a quiet evening at the Kyle Fire Department.

The unexpected is an element all first responders deal with. Less than 24 hours after the Hays County group was interviewed came one of those days an emergency worker will not soon forget. Storms moved through the area Nov 15 setting rainfall records. Five tornadoes touched down in Central Texas damaging buildings and knocking tractor trailers off the road. Flash flooding in and around Austin required rescues from homes and vehicles. David Knight, president of the group, said the group responded to seven calls that evening ranging from auto accidents to standing by at water rescues to illnesses unrelated to the weather. Three calls a day is average.  

The next day was much quieter, with first responders and their pagers ready and waiting for that familiar whine.