We Are the Ambulance Boys

     Know your limits. Don't blame yourself if you don't save every patient, because not every patient can be saved. I'm able to perform my job, but if a family is weeping, I'll weep too. I don't think that's unprofessional. When I stop being affected by events, I won't be an effective professional. If I become cynical, I'm not doing the best thing for patients. That's not good for me, and it's not good for my loved ones.

     So says Patty Dukes, chief of EMS in Honolulu. Dukes is the first woman to hold such a position in a major U.S. city, and the first woman in Hawaii to lead a public-safety agency. She became chief on December 1, 2004.

     Dukes is honored to be among the ranks of women leaders across the U.S., but she never wanted to become chief just because she's a woman. When Dukes first started in the department in 1983, there were six women out of approximately 150 personnel. Today, women comprise 30% of the department, and their numbers continue to grow.

"The Coolest Job in the World"
     Before she moved to Honolulu in 1979, Dukes worked for the Safeway supermarket chain in Los Angeles. At that time, she was an early "box girl." Today, the position is referred to as courtesy clerk.

     During those days in Los Angeles, the TV show Emergency! was filmed near where Dukes' parents lived. She watched filming and thought being a paramedic must be "the coolest job in the world." But in the 1970s, it was uncommon to even see a female firefighter. The idea of women's equality had yet to fully permeate American culture. "At Safeway," recalls Dukes, "it was difficult for other women to even let me push their grocery carts or put their groceries away."

     Despite the lingering sexism of the times, a family background in healthcare helped prompt Dukes to enter the EMS field.

     "I'm from a family of nurses," she says. "My grandmother was a nurse during World War I. Her daughter became a nurse, and my two cousins are nurses. I moved to Hawaii in 1979, and in 1983, I saw an ad in the paper. I didn't have any medical experience, but my enthusiasm impressed the interviewers."

     When Dukes began in EMS, it was uncommon for people to see two women responding to an emergency call. "We would arrive at the scene," she says, "and people would ask us where the 'ambulance boys' were. We would tell them we were the ambulance boys."

     In her early years, Dukes learned how to coordinate dispatching. When those first units responded on radio, she was amazed. Dukes has retained a passion for EMS dispatching ever since, and has taught it in Hawaii, Australia, New Zealand and on the U.S. mainland.

Putting It in Perspective
     Now, as chief, "I know where I want to go," explains Dukes. "It just takes a lot longer to get there."

     A chief's concerns are many more than a field provider's.

     "As field personnel," she explains, "you're focused on patients and addressing their situation immediately. Instead of looking at 110 degrees as an EMS field professional, as chief, I'm looking at 360 degrees. It's a different perspective, because there are so many different maps."

     Entering 2006, Dukes is facing budget issues. She's been moving pieces of the puzzle around in an attempt to find a solution. For example, Makakilo (a rural area outside of Honolulu) has had a 60-hour station since 1990. Honolulu EMS has a response unit at St. Francis Medical West (located in another rural area) that is 24 hours. The response unit is a non-transport paramedic vehicle that responds to calls and then waits for a transport. Dukes has closed that unit at the midnight shift and opened the Makakilo unit, which is a full-service ambulance transport. She's using the same amount of money, but applying it more effectively.

     Beyond such concrete issues of dollars and cents are more nebulous concepts like maintaining a human connection with patients. When paramedics are busy, they may have a tendency to rush, and forget that they're treating people--someone's aunt or grandmother. Dukes seeks a "customer service" approach to interacting with patients. Her leadership style asks personnel to see this vision with like-minded passion.

     "I think it's challenging to persevere in this profession because there are many emotional issues," she says. "We have emergency calls involving children that break our hearts. It's an emotionally, as well as physically, demanding job."

     Despite the demands, Dukes notes that there are many paramedics in Honolulu who have been in the profession for more than 20 years. That's well above the national average of 5-7 years. And despite her administrative position, Dukes herself still responds to calls. She won't ignore a call if she's nearby. She has responded on days off. She has monitored a call relating to someone who was having difficulty breathing about a block and a half from where she was, and responded.

     For many chiefs, field work becomes a thing of the past. But Dukes still finds it worthwhile.

     "There have been times when I've wondered why I'm in this profession," says Dukes. "There were cases that were horrendous. One was a hanging of the son of someone I knew. It broke my heart. The ones that are especially heart-wrenching are those that involve children and the elderly. At those times, I think about the lives I've saved, and I realize that's what I'm here for.

     "The most satisfying part of my job is saving lives and making a difference. For the next generation of paramedics, I'd like to tell them to look in the mirror each day and be proud of the uniform they're wearing."

George Furukawa is a freelance writer based in Hawaii with 29 years of experience. His articles have appeared in national publications including EMS, Nuts & Volts, Engineering News-Record, U.S. News, and Nature Conservancy.