by Catherine J. Rourke

The miracle is not that we do this work but that we are happy to do it for humanity.

- Mother Teresa

Nobody does it for the money.

They work 24-hour shifts, from 7:30 a.m. to 7:30 a.m., and range in age from 23 to 78. They’re exposed to everything from fire and flood to HIV and hazardous materials – and sometimes even death. Yet they never miss work, and no one is ever late.

Sedona’s emergency medical service workers are always on duty, 24-7, to answer the call in a shift three times longer than most. Response is more than just getting a patient to the hospital; it’s about quelling crisis and distress, often under extreme conditions, with more than 50 pounds of heavy equipment and after 12 hours without sleep, in a world where things always seem to go wrong.

A hiker falls off Bell Rock, and a car hits a bicyclist on Hwy. 179. A fire breaks out in a kitchen on Harmony Drive, and a tourist in Uptown faints from heatstroke. A toddler stumbles into a swimming pool, and a resort guest has difficulty breathing. A snake needs removal from a back yard in the Chapel area, and a teenager reports a drug overdose. A resident at Sedona Shadows goes into cardiac arrest, and a high school athlete has a sports injury. A car goes off the road in Oak Creek Canyon, shattering glass as well as a life.

Sometimes it’s simply a case of dehydration, the sick child with a raging fever or a scared senior with flu-like symptoms. No matter how trite the call may seem, EMS workers never hesitate to respond.

They splint broken bones, stop bleeding and treat shock. They revive the unconscious and cradle the traumatized victims of auto accidents. They cross frigid streams to prevent a drowning and rappel down precarious ravines to rescue a fallen hiker. They enter burning buildings and witness the aftermath of domestic violence. They hug frightened children and hold hands with an old man gasping for breath. They are often the first person to hold a newborn baby and the last to close the eyes of a dying man.

Seizures and shootings, car crashes and cardiac arrest, fires and flus and even the common cold: It’s the full spectrum of life and death and just another gripping day for Sedona’s EMS workers.

Braun and bravado

07:30 - Ken Krebbs, an EMT firefighter with a wife and two kids, is on duty at the Station No. 1 on Southwest Drive. He’s already been at work for 45 minutes, checking the engine truck, ambulance and medical equipment. With more than seven years in EMS, he knows that everything must be ready to go at any given moment. “You never know what’s going to happen,” he said.

In the Verde Valley, all EMTs also serve as firefighters and work in three platoons of rotating shifts, with 24 hours on and 48 hours off. An EMT is trained to provide basic life support while a paramedic administers pre-hospital medications, interprets EKGs and performs advanced life and cardiac support duties.

The district maintains a full-time EMS staff of approximately 29 EMT firefighters and 32 paramedic firefighters, who include two women, as well as several battalion chiefs, captains and engineers. A crew usually consists of five or six team members per shift. In addition, SFD has part-time SCRs, or shift coverage reserves, and paid volunteer OCRs, or on-call reserves.

07:51 - EMS workers gather with their captain for a brief meeting. The Sedona Fire District consists of four manned fire stations in West Sedona, Uptown, Oak Creek Canyon and the Village of Oak Creek, in addition to other unmanned stations. Sedona serves as the regional emergency communications dispatch center for all 911 calls in the entire Verde Valley, from I-17 south of Camp Verde and north to Munds Park to the top of Mingus Mountain and everywhere in between. Think of it as an air traffic control tower with planes in constant trouble around the clock.

08:16 - But it’s not all flashing lights and daring rescues as portrayed in reality TV dramas. Every job has its mundane chores, and Fire/EMS work is no different. Every shift includes routine maintenance checks, station chores, staff meetings, special projects, training new personnel and even an hour of intense exercise.

Sedona’s unique topography requires an array of specialized skills to mitigate area emergencies, and EMTs must maintain top-notch physical endurance. Whether trudging through canyons with heavy equipment to rescue hikers or loading a gurney onto an ambulance, the job demands enormous strength. Today the crew will walk three miles in less than 43 minutes, with 80 pounds of weight strapped to their backs, as part of their daily fitness routine.

09:22 - Dispatchers’ voices crackle over the radio in mysterious codes used to describe the kind of emergency runs.  Their job is to determine the nature of a call, whether or not it is life-threatening and assign it to the right unit. A Language Line translates more than 150 different languages within seconds while an Automatic Location Identifier details the police, fire and ambulance units pre-assigned to the caller’s location.

A high-tech computer system guides 911 dispatchers to assist callers through life-saving measures within seconds of the call. According to Gary Johnson, SFD’s fire inspector and public information officer, they remain “the unsung heroes” of EMS. “Like the EMT firefighters, they make a difference each and every day they come to work,” he said.

11:08 - The first call comes in: “Rescue assignment – Code 962 – Area 402 – Intersection of Apple and Jordan Road – Engine 541 and Ambulance 541 – Delta response.” These cryptic codes often spell crisis or disaster. In this case, it’s a two-car accident with injuries in Uptown. Delta response means sirens on, step on it and run any red lights. Still, Krebbs and his colleagues remain unfazed as they dash to answer the call.

11:09 - Sedona’s “Ninjas” are on already on their way with blaring sirens while Dispatch follows up with more details en route. Their fully-equipped ambulance, a rolling medical clinic, is loaded with every life-saving device known to man. Meanwhile, Dispatch instructs the caller with critical guidelines. Every second counts. Once the heart stops, there’s a window of approximately six minutes before brain tissue death occurs.

“Our system enables us to be on the scene, from the time a call is dialed to the minute we show up, in less than five minutes,” said Fire Chief Matt Shobert. “We have rolling emergency rooms strategically located throughout the community equipped with the latest 12-lead, EKG monitors.” 

11:13 - A hysterical motorist greets EMTs at the scene. Inside the other car, an elderly man is slumped unconscious over the wheel. “When you get on the scene, your training instantly takes over,” Krebbs explained. “You go into auto-pilot.” The EMTs stabilize the patient’s spine, maintain an open airway and transport him to Sedona Medical Center.

EMS workers are now diagnosing conditions in the field and relaying the info to medical centers during transport so patients can access immediate treatment upon arrival. “We’re focusing our pre-hospital medical training toward conditions associated with older sectors of the population,” Shobert said. “And we’re improving the patient survival rate in rural Arizona by greatly reducing the time it takes to get them to definitive operating rooms.” Top-notch professionals, excellent equipment and ongoing training all add up to a state-of-the-art emergency response system that means saving more lives.

Courage and commitment

12:47 - In 24 hours, EMTs will get two meals, possibly interrupted, and hopefully some sleep. Challenges are frequent, crisis is no stranger, and camaraderie runs deep in what can be an overwhelming responsibility. For now, it’s time for lunch – if they don’t get another call.

On average, the EMS team responds to 10 emergencies per shift. The most frequent calls are medical ones, such as respiratory and heart problems, but others require the rope and swift water rescue skills of the Technical Rescue Team. Crews are also trained to perform mock mass-casualty and terrorism exercises.

“It’s no longer like ‘Mayberry RFD,’” said Fire Capt. Bill Maxwell, a 23-year veteran at SFD. “Times have changed and so have our responsibilities. There’s a huge difference in today’s EMS because there’s a lot more training. We now have to maintain different certification levels, such as HazMat, that require ongoing education.”

13:10 - Crews conduct station projects, inspecting street hydrants and commercial buildings, doing paperwork and computer data, undergoing two to four hours of training and participating in community education – all around incoming emergency calls.

Public education now involves the use of Automated External Defibrillators, a device about the size of a lunch box that delivers electrical stimulation to the heart to restore its natural rhythm after cardiac arrest. Battalion Chief Bill Boler, who has served 23 years with the SFD, has launched a new Public Access Defibrillation or PAD Program, which trains laypersons to respond to cardiac emergencies in public places. SFD will install approximately 16 AEDs in high-traffic areas around Sedona and, according to Boler, more than 30% of cardiac arrest victims could be saved through this program.

“Our job is community service and we do everything we can to help people deal with their emergencies,” he said. “Our job is never the same from day to day and it’s a critical team effort. It’s a huge commitment that starts with education.”

When asked if there was anything the public could do to help save lives, the response was unanimous: “Please pull over to the right for emergency vehicles when driving – and learn CPR.” According to EMS veterans, initiating CPR within the first two minutes of an incident is the single most effective life-saving technique.

14:02 - The job requires the strength of a power lifter, the bravado of a Marine, the patience of a saint and a stomach woven of steel. And endless training.

Initial certification involves a six-month course and passing a rigorous exam. From there, EMTs go on to master an endless list of subjects: anatomy and physiology, respiratory and cardiac support, trauma, infectious disease, triage, pediatrics, hazardous materials incidents and pharmacology – to name a few. Perpetual training remains a fact of life for EMS workers and most have multiple certification levels.

“You have to make a commitment from Day One that you’re going to educate yourself on a continual basis,” said David Marshall, interim director of Public Services at Yavapai College. “This is due to the constant changes in the technology of delivering emergency services.”

15:20 - What kind of person does it take to be an EMT?  “Someone who is truly dedicated to community service and helping people,” said Marshall, who has been in EMS for 25 years and oversees training programs in fire science, law enforcement and emergency medical services. “This kind of person has the characteristics to operate under pressure and remain calm while enjoying a high-intensity job. You learn to think quick on your feet.”

The quintessential EMT is a hard-working person who thrives on alleviating other’s pain and distress. Dedicated to humanity and to making a difference, emergency workers are unflinching professionals who make split-second decisions and handle unimaginable trauma and near brushes with death with heroic stoicism. “We like the adrenaline rush,” said Krebbs. “But we’re really just average people put in extraordinary circumstances.”

Family and camaraderie

17:09 - A potluck-style dinner offers a chance for camaraderie. "You don't know what a real family is until you spend a day at the firehouse" is a common saying among EMS personnel, who forgo weekends, holidays and family gatherings. “We work together as a family,” noted Krebbs. “We actually spend more time with each other than our families.”

War stories do not impress this fraternity. For them, traumatic incidents are simply de rigueur in the course of duty. Instead, the spirit of service prevails over a combat mentality. “You do your job, take care of your family, complete extensive training and perform community service,” said Maxwell, who also teaches in addition to his EMS work. “Family and community is what we’re all about.”

18:36 - Evenings and meals are often interrupted by the rasp of the Dispatch radio: “EMS assignment – Fall injury - Area 103 – Posse Grounds – Engine 511 and Ambulance 511 – Alpha response.” The EMS team heads back out onto the street and into the unknown. With an Alpha code, at least it means they don’t have to run lights or drive in life-or-death mode.

19:24 - When the radio is quiet, EMTs don’t just sit back and watch sit-coms. While most workers take lunch hours, coffee breaks and rest periods for granted, EMS crews never know when and if they will have the time. Obviously they can’t delay a run because somebody is in the bathroom. They accept the nature of their work and learn to adapt. Spending 24-hour shifts on duty at the station means that eating and sleeping quarters must be cleaned and training areas equipped, along with the usual maintenance and repairs.

Station No. 1 also serves as an Instant Command Center – a unified response and defense hub for all city, police and fire departments in the Verde Valley – during major incident such as the recent floods. Thus it has to be ready and equipped at all times.

23:00 - On duty for more than 15 hours now, the crew’s eyelids are heavy and in need of rest.  While bedding is available at the stations, EMTs are often startled awake by a call in the wee hours. Just like a watchdog, one ear always stays tuned to the radio for a late-night call. These can be some of the worst: drunk-driving accidents, domestic violence assaults and drug overdoses, in addition to the usual bout of routine medical emergencies. “One day we get three calls, and the next day we get 20,” said Krebbs. “It’s unpredictable.”

01:52 - EMTs sometimes find themselves awake for a good portion of the night, which can tax the mind and body. Yet no one ever complains of exhaustion. “Your body adjusts to it,” said Krebbs. “We learn to survive on less sleep than most people due to the nature of the job.”

Time off doesn’t mean that Sedona’s EMS workers are kicking back and catching up on their sleep. Most juggle family life with multiple jobs, training classes and community service. Sometimes, it means answering a call during off-duty hours. “I’ve yet to find an EMT firefighter who didn’t hesitate to help in an incident when he wasn’t on duty,” said Krebbs, noting how the SFD lent a helping hand during the Rodeo-Chediski Fire.

03:05 -The EMS crew has clocked more than 20 hours on the job now. Work weeks average anywhere between 48 and 56 hours, and, according to workers, Arizona labor laws exempt EMT firefighters from overtime pay. The average national wage of an EMT-Basic is $10.69 per hour. For an EMT-Intermediate, the pay ranges around $11.53 per hour. Paramedics average an hourly rate of $12.47.

In comparison to mechanics and computer techs, who earn five times that amount to revive cars and computers, it appears the average wage of workers who resuscitate humans from near-death could use some intravenous life support. Yet passion seems to override any desire for wealth, and the rewards of saving a life far outweigh any financial remuneration.

06:37 - A call comes in just minutes before the completion of a 24-hour shift: cardiac arrest – always so frequent in the morning. Today’s log shows reflects than a dozen assignments including a seizure, brush fire, fall injury, vehicle rollover, diabetic problem, traumatic injury, dumpster fire, difficulty breathing, one unconscious person and two chest pain complaints. Crews are still transporting the victim long after the shift officially ends. But their work never follows the hands of the clock, only the hands of fate.

Risks and rewards

EMS is a sacred trust. We let paramedics into our homes, let them open our wallets and give us needles and drugs. Theirs is a world of trauma, tragedy and human misfortune, along with the saves and rescues. They learn to cope with daily stress, uncertainty, danger, death and even burnout while remaining cool, calm and collected. They can run red lights but they can’t let their emotions run loose and interfere with their work. Undoubtedly, they experience its full range of fear, grief, joy and hope.

 “It’s a calling,” declared Maxwell. “It’s really rewarding work.”

Most EMS workers describe deep satisfaction after saving a life or even when answering a simple call. “You go in knowing you’re going to make a difference in somebody’s life, and that’s a great feeling,” said Krebbs.

One EMT claims that bandaging wounds is far more appealing than mending fences. For another, tending the injured holds greater reward than tending bar.

“It’s all about trying to stop people’s pain and suffering,” said Maxwell. “When it’s all coming apart, we try to hold it together.”

Hopefully most of us will never require their services, but it’s good to know Sedona’s Rescue 911 team will respond to our every beck and call at any hour of the day or night. “911 is not an information line,” said Boler. “But if you need us, call us. We’ll be there.”

All-weather and no glamour, the nobility of their calling inspires them to deeds of daring and even self-sacrifice. Yet they seek no recognition for their exemplary service.

“This work gives you a stronger sense of your own humanity,” concluded one EMS worker. “Plus you can drive like hell and probably never get a ticket.”

Help save a life

• Don’t ignore the subtle signs of a potential medical problem
• Call 911 immediately with a specific location
• Follow the explicit instructions of dispatchers
• Remain calm until EMTs arrive
• Enroll in local CPR and PAD programs
• Become an AED Service Provider
• Educate children in basic life-saving procedures
• Call SFD at 282-6800 for more information  

Catherine Rourke is a public service journalist who writes investigative reports about socioeconomic and work-life balance issues and who volunteered on Sedona‘s first Affordable Housing Committee in 2001. In 2006 her columns won the state’s most distinguished press recognition - a “Community Journalist of the Year Award” – from the Arizona Press Club. Read her full bio on the WHO page and e-mail her at editor@SedonaObserver.com.

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