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Published on May 24, 2017

Dealing with life and death daily

Dealing with life and death daily

This is part of a continuing series of stories from Cape Cod Healthcare’s Cape Cod Health News, exploring the world of paramedics and EMTs across Cape Cod, and their incalculable contribution to the region’s healthcare system. There are nearly 1,000 of these professionals who also serve as firefighters in all 15 towns. Paramedics undergo up to two years of classroom training and 400 hours of clinical work in the hospital, as well as continuous retraining coordinated by the Cape and Islands Emergency Medical Services System.


Tom Brady and his New England Patriots teammates know they must be in peak physical and mental shape the minute the whistle blows during the season. But, the nearly 1,000 paramedics and EMTs – who simultaneously are the Cape’s firefighters – must be on top of their game every minute, every day.

While a flat performance for the Patriots may result in a lost game, a bad day across the Cape’s 20 fire and rescue squads could risk lives, including their own.

Nationwide, about 70 firefighters die annually in the line of duty, with half succumbing to cardiac arrest, according to the National Fire Protection Association. Another 30,000 get injured during an average year, with half of those suffering the kinds of injuries experienced by football players, such as sprains, strains and muscular maladies.

So, why do these men and women – neighbors and friends – dedicate their lives to public service, responding to some 13,500 incidents a year as firefighters, while treating and transporting more than 47,000 patients annually to the Cape’s hospitals in Hyannis and Falmouth?

What is an EMT?

EMT stands for Emergency Medical Technician, specially trained and certified to provide basic emergency medical treatment before and during transportation to the hospital.

“We tend to deal with people on one of the most difficult day of their lives,” observed Lt. Craig O’Malley, EMS Director for Falmouth’s Fire Department. “From being locked out of their house to the other end of the spectrum, death of a loved one – and everything in between. We try to make a really bad day better.”

Adds Falmouth’s Fire Chief Michael Small: “People never think it will be them calling 911.”

A colleague of O’Malley’s vividly recalls rushing a patient suffering a severe heart attack to Cape Cod Hospital’s cardiac catheterization lab.

“Having stabilized him in the ambulance, we were able to watch doctors catheterize him. It was an epiphany. There was someone whose life was being saved because of what we were able to accomplish.

What is a Paramedic?

A specially trained EMT certified to provide a wide range of advanced procedures whose daily practice is overseen by the hospital’s medical director. They are certified to provide Advanced Life Support treatments such as defibrillation, intravenous medications and advanced airway techniques. Training includes a year or more of classroom education and hundreds of hours of clinical work in the hospital.

“Oftentimes, it’s hard for a paramedic to grasp what he or she is accomplishing in the rush of the moment. Most of the time, we never see or learn about the outcome of that patient. This time, it was so vivid. It’s why we work so hard, stay in such good shape, just for that next moment when someone’s life is in our hands,” he explained.

The toughest part of the job is when there’s nothing you can do for someone, O’Malley said.

“But, there are all those other times when you are able to save someone’s life; that without our help, they would not survive. What’s more satisfying than that?” he said

For a surprising number, they became enamored with life as a firefighter or paramedic when they were youngsters, or as they watched and experienced their fathers and grandfathers do the same work generation after generation.

Just ask Dr. Jake Crowell, an emergency department physician at Cape Cod Hospital and medical director of the Cape & Islands Emergency Services System. He is a call firefighter with his hometown Dennis Fire Department, following in the steps of his father and grandfather.

Brains and Brawn

Dr. Evan Weinstein was an emergency room physician at Falmouth Hospital and one of two medical directors for the Cape & Islands Emergency Services System before his untimely death in April 2017.

“They really are quiet heroes, so much so that many of their neighbors don’t realize they also are firefighters who must master skills and tasks entirely different from lifesaving,” he said during one of his last interviews with Cape Cod Health News. “It’s amazing that the ethic is so ingrained in them and that they don’t believe they could be doing anything else. It’s what they do.”

Weinstein spoke from experience. While he was in medical school, he served as a volunteer medic.

“I remember being on my belly in a drainage ditch full of very cold water starting an IV on an injured man. Never mind that there was manure and diesel fuel all over the place. Your mind is totally focused on the patient,” recalled Weinstein. “That is just what you do. You adapt and move on. Afterwards, you don’t think anything of it.”

Not only must each and every one of these 1,000 men and women be physically fit, but they also must be very smart. Just to get the job, they attend a year or more of classroom training, often in college. Then, they work side by side with hospital staffs for more than 400 hours.

Many Hours of School and Training

Shawn Clark of the Wellfleet Fire Department recalls vividly the 442 hours of clinical work he performed across multiple Cape Cod Healthcare hospital departments, as well as the two semesters at Cape Cod Community College studying fire science and paramedicine for an associate’s degree -all while holding different jobs as a carpenter to make ends meet.

That was followed by state and national testing, as well as intensive mentoring.

Even then, he wasn’t guaranteed a paramedic position. All that work was totally on his own just to qualify someplace for a role he deeply wanted.

Cape & Island EMS Training

Approximately 225 Paramedics and 48 EMTs per year are trained at the Barnstable County Fire Rescue Training Academy.

This number accounts for 5 Paramedic re-certification classes with 45 students per class and 2 EMT re-certification classes with 24 students per class per year.

“In the hospital setting, you are encountering life and death responsibilities every day. You are working alongside nurses and doctors, talking, learning every minute of the day, developing interpretation and treatment skills, as well as patient interaction capabilities,” said Clark. “One day, it’s learning to intubate a patient, the next it is witnessing a birth. It’s all very humbling.”

Like so many of his peers interviewed for this series, Clark views his dual role as paramedic and firefighter with hardly a superman attitude.

“It makes sense,” he explains, pointing to those emergencies when both sets of skills naturally merge. “We’ve responded to a car accident that requires us as firefighters trained with the equipment such as cutters and spreaders to extricate the driver or passenger, then immediately treat injuries that could be life-threatening. They are interconnected roles.”

“Part of Our DNA”

Most people don’t comprehend or even think about what it takes to be a paramedic and firefighter simultaneously, explains Cameron Bucek, who as a nationwide fire and EMS clinical educator, has taught at the Barnstable County Fire Rescue Training Academy.

ems members

*CIEMS also has members from Nantucket, Martha’s Vineyard and Wareham, Marion, Mattapoisett and Rochester. Statistics as of November 2016.

“You respond to 10 calls in the ambulance before 3 and then there is a fire at 5 in the summer when the heat index could reach more than 120 degrees. How exhausting is that?” he said.

“Being a firefighter, being a paramedic or EMT, it’s in our blood. It’s part of our DNA,” he said. “Big department, small department; Cape Cod or Florida, where I live, we’re all the same.”

As a teacher, Bucek impresses upon his students how crucial it is for them to not only stay in top physical, mental and emotional condition, but also to take care of each other on the job.

“You can die,” he tells a class. “You can be in top shape, but become stressed and dehydrated at the scene as you climb six flights of stairs and carry someone 250 pounds to safety, with all that gear on your back and that heavy suit on.

“That’s why you must treat your body like an athlete, stay well rested, eat nutritiously, drink lots of liquids. One in five of you in this room right now is suffering from hypertension.”

Bucek minces few words about the inherent dangers always lurking.

“This job is mentally and physically exhausting. One or two calls in your career to a fatal fire or accident can affect you for the rest of your life. The experience never leaves your heart and mind. People in the civilian world can’t understand that,” he said.

Bucek continuously advises firefighters, EMTs and paramedics to fight their natural humility about their jobs to acknowledge they are not islands, but rather integral parts of their communities. You needn’t brag about your roles, he counsels, but acknowledge to yourselves and your colleagues the stresses and dangers.