Meet Your Local Medic

As I approach my eighth decade, I’m preoccupied with issues that may not concern paramedics in their prime. For example, how many teeth can I lose and still eat a bagel? Will I keep getting shorter? Do diapers work the way they did on my daughter 40 years ago? And whatever happened to my pocket comb?

A more important question—one that all adults but especially seniors like me should be asking—is, Can I count on my EMS provider? Maybe yours is the same one for which you work, in which case you already know the answer. But for many of us, including almost everyone not in EMS, the first time we meet our local rescuers is the first time we really need them.

I decided not to wait that long. I visited my hometown squad, Robertson County (Tenn.) EMS, and sat with their new assistant director, Josh Rice, on a carefree spring day when I had the luxury of neither answering nor experiencing an emergency.

From Tikrit to Tennessee

Josh is an interesting guy. His dad was in the oil business and moved the family all over the U.S.—as far north as Alaska and as far south as Texas. At 18 he joined the Army and was sent to EMT school at Fort Campbell, Ky. before his 1999 deployment to Egypt.

“They needed extra medics,” Rice recalls. “At the time I had zero interest in EMS. I didn’t know anything about it. I had to ask one of my platoon sergeants what EMT meant. He looked at me like I was an idiot and said, ‘You know, woo woo woo—the ambulance?’”

Josh enjoyed his introduction to prehospital care but realized he lacked experience.

“I developed a relationship with the base hospital and volunteered all my free time before we deployed,” he says. “I partnered with some of the best military medics and special ops guys. They taught me a lot about responding to emergencies in the middle of nowhere.

“When I was discharged four years later, I went to paramedic school and did contract work overseas—places like Iraq and Afghanistan. It was the kind of lifestyle I was looking for and gave me a chance to practice my skills.”

Rice came home in 2013 and was hired by Robertson County, a middle-Tennessee agency that handled more than 10,000 calls last year. By 2015 he was their training officer—a position he held until his promotion last May. One of his priorities, he told me, is to “think outside the box.”

“I’ve never liked the attitude, Well, we’ve always done it this way, so let’s keep doing it. That’s not good enough. We have to figure out how to make it better.”

Fortunately for Rice, RCEMS turned out to be a good place to experiment.

Southern State of the Art

One of Josh’s early initiatives was to eliminate backboards during transport. “We still use them to move patients,” he says. “Other than that, the evidence shows they do more harm than good.

“We’ll eventually get rid of conventional c-collars, too. We’re actually trying a new style that looks like a vacuum splint for the neck. I did some research, bought a few, and began stocking them on our ambulances. 

“We were also early adapters of video laryngoscopy and capnography,” Rice adds. “And IOs have been routine at Robertson for a while.”

That’s a lot for an old-timer to process. Having been boarded and collared more than once, I’m not sure how I’d feel sitting up on a stretcher with a balloon around my neck. I suppose I’d have to remind myself that thousands of doctors have graduated high school, college, and medical school since I last placed a tube or started an IV. I should probably shut up and let the youngsters take over, but if they try tapping my bone marrow with power tools, they’re going to need a bigger ambulance.

Josh was sympathetic, if not 100% reassuring: “Mike, we only do IOs when someone needs meds or fluid right now,” he insists.

OK—maybe. On second thought, no.

Evolving as an Agency and Industry

Protocols and procedures are important, but what about the bigger picture? What’s it like working for a municipal service that’s as much country as city?

“Because of the rural areas and extended response times, we train our people to be like flight crews,” says Rice. “We encourage them to become critical-care medics and equip them for that mission. 

“For a while we had only two or three CCs. Now most of our full-time medics have that certification and are paid for it.

“As for EMTs, when I started you stayed at that level for a few years before advancing. Now we’re seeing some who go straight from basic to paramedic. I’m not sure if that’s a good thing or bad thing—I guess it depends on the person. I can certainly understand wanting to make more money.”

Speaking of wages, when Robertson County began losing employees to Nashville last year, Josh assumed the main issue was pay. Exit interviews painted a different picture: Some people just didn’t want to do 24-hour shifts anymore.  

“We’re going to change to 12s,” says Rice. “It’s not just a retention thing; there are safety issues. Still, it’ll cost us over a million dollars to start.”

Long shifts aren’t the only problem. According to Rice, Tennessee surveyed EMS personnel right before COVID and found poor leadership was a bigger dissatisfier than low pay.

“I think we need formal leadership training like in the military,” the 41-year-old manager says. “They don’t just make you a lieutenant and say, ‘Have at it.’ You have to go to school first.”

Family Matters

It’s hard to judge a company’s culture from a distance, so I asked Josh for a story that would help define RCEMS for those of us who haven’t ridden there. He told me this: 

“Five or six years ago, my partner and I were working the night shift and got called to a structure fire as we were leaving the hospital. When we got there this guy came toward us with skin hanging from his arms. Turns out he had second- and third-degree burns to 55% of his body. I remember that like it was yesterday.

“He had his little girl with him. She was burned as well, although not as badly. We got both of them in the back of the truck and began working on them.

“Dad was bad, really bad, pretty much from the face down. I was focusing on him when the side door opened and the fire department handed us another patient—a lifeless infant. I’d seen bad stuff in the military, but this made me freeze up for a second or two. Then they brought us three more kids, all dead.

“I was still working on dad, trying to intubate him. I couldn’t, so I did a surgical airway and called for another unit. By then we had the father, the daughter, and four dead children on our ambulance.

“When it was over off-duty crews volunteered to fill in for us so my partner and I wouldn’t have to take any more calls that night. The captain shut us down, and we were debriefed.

“The father actually survived. The daughter too. I’m proud of the care they got from everyone involved, but what I appreciate most is the way Robertson rallied around us and showed what a tight family we are. I tell new employees that the best thing about working here isn’t the cool tools or the stuff we do with them, but the fact that we’re still small enough to know each other really well. We’ll bicker and act crazy sometimes, but we’re here for each other.”

A Position of Comfort

After we talked a bit more about life in and outside EMS, I realized Rice and I have lots in common: He’s a medic, and I’m a medic. He plays hockey, and I played hockey. He’s a young man with a whole career ahead of him, and…did I mention I played hockey?

Yep, it’s easy to feel inadequate compared to today’s hard-chargers and free-thinkers. Being one thrombus from a trip in the woo-woo truck doesn’t help, but I’m happy to have Robertson Couty standing by. I like their mix of youthful enthusiasm and steely-eyed experience, plus gadgets with otherworldly wave forms I wouldn’t find on my old Lifepak 5.

I trust Josh and his people. If I need them, I promise not to act like an obnoxious has-been who hasn’t seen a patient since 2013. Just don’t come at me with a drill. 

Mike Rubin is a paramedic in Nashville and a member of EMS World’s editorial advisory board. Contact him at mgr22@prodigy.net.