Life Support: The Essence of EMS
Larry Zacarese isn’t home nearly as much as he’d like to be. The assistant police chief and director of emergency management at Stony Brook University in New York is also a paramedic and attorney, either of which could limit his discretionary time to, say, weekend mornings before sunrise. When Larry’s wife, Yvonne, asks him about his workday, I’m guessing she’s already cleared her schedule for at least the next 30 minutes.
It’s a vibrant life, but not one Larry had imagined when I met him in medic school 22 years ago. He wanted to be a cop like his dad, uncle and great-uncle. New York City was the biggest, most messed-up place he could do that east of the Mississippi—perfect for Larry, who wasn’t raised to take anything easy.
Zacarese got his wish in 1998: He graduated NYPD’s academy and was assigned to the 113th precinct in Jamaica, Queens—not known for its serenity. Larry embraced his beat as the proving ground it was, and tried not to lose all hope for humanity when the viciousness of the streets exhausted the patience of both cops and paramedics.
On the morning of September 11, 2001, Zacarese started a vacation that lasted only until the first jetliner hit the first 110-story tower. Larry’s life, like so many others, changed forever in an instant. He told his dad he wasn’t coming home until the rescuing was done. None of us knew it already was.
After a few days, saving turned to salvage at Ground Zero. Officer Zacarese worked at the world’s biggest crime scene for another three months because that’s what he was told to do.
The following summer, toward the end of a four-month training program for the city’s elite Emergency Services Unit (ESU), Larry started having trouble catching his breath. His persistent cough and low peak-flow readings disqualified him for the scuba component of ESU. He transferred to K-9 and completed their requisite schooling in six weeks, using an inhaler as a hedge against his newly diagnosed reactive airway disease.
By 2004, Zacarese was tired all the time. His list of prescribed medications resembled the formulary of a 60-year-old COPDer. He was promoted to sergeant and stayed with NYPD until the Stony Brook position opened in 2009—well short of the 20+ years he’d planned in the city. Resentment isn’t what he feels, though.
“Mostly I’m pissed,” the 40-year-old Long Island native says. “I’m angry about what happened to the country, about what happened to my friends, and about what’s continuing to happen to them. Every day they’re either battling to stay alive or dying. After 15 years, it’s only getting worse.
“I’ve never wished I didn’t go. I’ve never said, ‘Why did this happen to me?’ I’m just pissed off it happened at all.”
A source of frustration is the assurances Larry and his coworkers got about safety from desk-bound officials who should have known better.
“We went with the advice we were given,” Zacarese says. “People tell you, ‘The air’s safe.’ Bullshit. A block away, it was still death and destruction—acrid smoke and bodies. It’s not like they misjudged; they knew. Here we are 15 years later and people who were there are sick and dying or already dead.”
Larry hopes EMS is better equipped to resolve what he considers the No. 1 operational deficiency during 9/11: communications. “We still see those problems whenever we drill. You have to be able to talk to each other; to listen, and follow commands.”
The father of four tries to educate the uninitiated about what to expect when the next disaster hits, but such advice, even when backed by hard-earned experience, isn’t always popular.
“Part of the problem today is that a lot of our new people were very young when 9/11 happened. For them, it’s ancient history. It’s like trying to get someone my age to understand Vietnam. I was just a kid during that war. I’m not going to be able to relate to the veterans who lived through that.
“For me as a cop and a medic, 9/11 was a defining moment. I know lots of others who responded and feel the same. If it happened again, I’d kiss my wife and kids and I’d go, because that’s what we do. It sounds like some corny movie line, but that’s what I believe.”
* * *
Rob DeMeo, 37, is a paramedic for MedicOne Medical Response in Nashville, TN. That’s a long way from Huntington, NY, where Rob was born, and from West Street in Manhattan, where he was staged with Hunter Ambulance between 1 and 2 World Trade Center on the morning of 9/11/01.
“I was thinking we should have helmets like the FDNY guys, because debris was falling all around us,” DeMeo recalls. “No one thinks about private ambulances needing helmets.
“The debris started getting bigger—computer components and insulation, then steel. It made a lot of noise, falling from that height, but I didn’t see anyone get hit. Then I heard some guy scream, ‘Everybody run!’
“There was a rushing sound like another airplane, so I turned away from the building and started running. When I saw a debris cloud in front of me, I knew it wasn’t a plane; I just assumed the top of the tower had fallen off.
“I was caught between the building and the cloud. I just covered myself and kept running. I wasn’t thinking about dying; at 22, that doesn’t seem possible. I just didn’t want it to hurt.”
Rob suffered a broken leg, a head laceration and burns to his back. He was triaged in Manhattan, then transferred to a hospital on Long Island. He says he’s fully recovered and has no regrets.
“I don’t think I was there long enough to be bummed out about it, or as scarred as the people who were there longer. My on-scene time was probably two hours tops—not enough to leave a lasting impact.
“It’s like a dream that gets harder and harder to remember. Sometimes I feel like, was I really there?
DeMeo became a paramedic two years later and joined Delaware’s New Castle County system. He relocated to Nashville in 2008, where he’s continued to work in EMS. He says he doesn’t think much about 9/11 until he hears about other terrorist incidents.
“I think I know what some of those victims go through—the confusion, the feeling of being lost. On 9/11, the street corner I’d been standing on became unrecognizable. I couldn’t even tell which direction to walk.”
In the aftermath of an attack, it’s normal to want to assign responsibility, but Rob thinks conspiracy theories are weakened by people who try too hard to force a fit. “It’s like blaming somebody other than the Japanese for Pearl Harbor,” he says. “I’m not sure why our culture and our education system can’t simply accept that the people who hijacked those planes are the ones responsible.”
Educating people about 9/11 is something DeMeo knows he can do. It can be hard, though, to accommodate the opinions of those who were somewhere else that day.
“I’d rather just listen to others act like experts about it, and not even let them know I was there. I’ve learned to get entertainment value from them instead of feeling angry.
“What I think is most important to take away from that day is how our jobs and our lives can change in a fraction of a second.”
* * *
The last time I wrote about 9/11 was five years ago; I did a column about Larry in 2011 and one about Rob in 2009. Checking in with them seemed like a good way to start a story about the 15th anniversary of that day.
Both medics downplayed the personal consequences of their service. They spoke more of healing than hurting, and denied having second thoughts about participating in their nation’s most lethal MCI.
I sensed they omitted their most disturbing memories, perhaps because there are no words to describe such things to those who weren’t there. More important, though, they had no trouble articulating the essence of EMS: not heroic rescue, but simply being bold and sharp when weeks of tedium become moments of terror.
I think EMS has changed a lot in the last 15 years. We’re focusing more on chronic illness and well care while acquiring new technology to better diagnose acute conditions like STEMI and sepsis. To me, we seem like an occupation in search of a role.
Maybe we’re looking too hard. Maybe we need responders like Zacarese and DeMeo to remind us that our primary mission is to show up when others can’t or won’t. I have a feeling we’re going to be needing lots of that.
Related Content: Sharing the Burden—In Shanksville, a cross commemorating 9/11 also symbolizes fellowship.
Author’s note: This is my 91st and last Life Support column. After being away from patient care for three years, I’m finding it harder to write fresh material about the operational issues most of you face each shift. I feel it would be disrespectful of me to keep portraying myself as a street guy who’s one of your peers. It’s time I focused on other ways to contribute.
You’ve probably noticed my columns dealing less with medicine and more with administrative or even philosophical matters. Judging by your responses, primarily on Facebook, it seems you’re at least finding those articles worth reading. I’m going to stay on that course for now. You’ll continue to see features from me about diverse and less traditional topics. As always, I’ll appreciate hearing what you think.
Thanks for all of your correspondence, and for helping to keep Life Support going for almost eight years. I’ll still be just an email away.
Mike Rubin is a paramedic in Nashville, Tennessee and a member of EMS World’s editorial advisory board. Contact him at mgr22@prodigy.net.
