Blood Brothers

In the fast-paced realm of EMS, a close-knit crew is invaluable. Deft communication through a word, even a glance, saves precious time and can mean all the difference for a patient in need. While the relationships of most teams are cemented through lengthy shifts and shared on-the-job experiences, paramedic Cody Kunkel and EMT Brady Kunkel of Dodge Center, Minn., have a deeper well to draw from. They spent nearly two decades under the same roof as brothers.

“Growing up together and living in close quarters, you learn how to communicate early on or the ship doesn’t float very well,” says Cody, 23, a volunteer at Dodge Center Ambulance. “Communication is a huge strength for us because if, God forbid, we ever do have to get in the back of the rig with a critical patient, we can give each other a look or say a handful of words, and we instantly know everything the other person is thinking.”

The two also have another bond shared by only about 20,000 other people in the United States: hemophilia. The brothers were diagnosed with severe hemophilia A before birth; an older brother, Jeff, was discovered to have the hereditary bleeding disorder as a baby.

“It’s a disorder that prevents the blood from clotting normally. People with hemophilia are missing a specific protein in the clotting cascade. For us that specific protein is clotting factor VIII,” explains Brady, 21, a full-time EMT at Dodge Center Ambulance. “Our bodies just never had the genetics to make the protein.”

Childhood Medical Education

For the Kunkel brothers a childhood with hemophilia meant dozens of hospitalizations for internal bleeds or associated injuries at the Mayo Clinic in nearby Rochester. Most stays lasted just a few days, but more significant events, like a tear in the iliopsoas muscle, could take weeks to treat. When he was in middle school, Brady started hanging on to his old hospital bands. He’s collected about 20 since then and displays them in his office. 

“When you’re stuck in a hospital bed as a child, at a very young age you’re surrounded by all of these Latin and Greek medical terms—hemophilia, hematoma—and you don’t really understand them,” Brady recalls. “And you have two possible responses: You just want to get the hell out of there and go back to watching Mickey Mouse Clubhouse, or you want to know what they’re talking about. I was the latter.”

During extended stays Cody remembers visits to the Mayo One helicopter, where he got to meet the medical transport team and tour the craft. For the most part, the repeated hospitalizations didn’t bother him, since it had been his whole life. But having to stay away from high-contact sports like football, hockey, and lacrosse frustrated both brothers. 

While Cody and Brady may have felt hindered in their choice of extracurricular activities, they weren’t coddled when it came to their condition. At just 5 years old, the boys took on the responsibility of self-administering injections of factor replacement therapy at home. They still routinely inject their factor product (usually right before a work shift), which significantly bumps up their clotting ability in the hours afterward. Injuries still pose a risk, however, of taking longer to clot and to heal, requiring more intensive treatment, or even doing long-term damage. Hemophilic arthropathy—joint damage caused by repeated bleeds—is common in people with hemophilia. Brady deals with such arthritis in his ankles, and Cody in his elbow. Both have undergone several surgeries to ease the pain.

In recent years Cody has prioritized getting to the gym for regular workouts in an attempt to boost his self-care.

“When I was growing up, there was a huge movement in the hemophilia world to keep these kids in bubbles: ‘They shouldn’t be out at the gym. They shouldn’t be out playing sports. These kids are fragile,’” Cody says. “But now we’re seeing studies coming out about people with hemophilia showing lower rates of injury if you are active and training your body to interact with its environment. Also, being active strengthens your muscles in your joints and lowers your risk of injury.”

The Call of EMS

The brothers credit their firsthand exposure to the medical world with spurring them on to careers in healthcare. In fact, Cody was finishing up the prerequisites to get into nursing school when his younger brother announced plans to pursue EMT certification.

“My first thought was, Whoa, that’s a lot of work, dude. That’s a lot of running around. We have hemophilia,” Cody remembers. “I was concerned about his ankles, and I was absolutely concerned about future injuries.”
Yet it was the very unpredictability of EMS that called to Brady.

“I think wild is the best word for it. You don’t have the comforting feeling of being in a hospital, where you have hundreds of nurses and dozens of doctors and support staff behind you to assist with things,” Brady says. “When you have a 9-1-1 call and things turn bad and the situation gets chaotic, it’s a lot more challenging when it’s just you and your partner and maybe a law-enforcement officer or a couple of firefighters. That’s kind of what draws me: It’s the challenge.”

So Brady began studying for his EMT cert, with Cody helping as needed. Then, when Cody had a semester free before beginning nursing school, he decided to kill time by enrolling in the EMT program himself. He ended up loving the field too. And after both brothers earned their EMT certifications, Cody convinced Brady to volunteer with him at Dodge Center Ambulance. 

Shortly afterward, paramedic Jared Oscarson came on board as ambulance director.

“When I arrived at Dodge Center Ambulance, Brady and Cody were new volunteer EMTs with the service. They had recently graduated from EMT class and were ready to help,” says Oscarson. “Their compassion, empathy, and desire to learn was evident in all their work. These two jumped right into the operation, learning and growing.”

Oscarson admits to being caught off guard when he learned they had hemophilia. He had never knowingly encountered anyone with the condition, so he sought more information. 

“They talked openly and taught other staff members and me about hemophilia and what to do for them if they ever required care,” Oscarson says. “They manage their hemophilia with medications and care just like any other chronic disease and have a normal life. They are no different than anyone else in the department.”
Last year Brady took a full-time EMT position with the ambulance service, while Cody continued to volunteer and enrolled in paramedic school at the Mayo Clinic School of Health Sciences. He graduated and earned his paramedic credential in May.

No Looking Back

While Cody has accepted a full-time position as a paramedic an hour or so east in La Crosse, Wisc., he has every intention to continue as a volunteer EMT with his brother back in Dodge Center. 

“As a volunteer EMT, my requirements aren’t too strenuous, so I’ll be able to go out there from time to time throughout the month and make it work,” Cody says. “Being able to be part of a volunteer EMS agency that gives back to a community that can’t necessarily afford the luxury of a full-time service is huge to me.” 

Their two years of experience in EMS has taught the men one thing: Their career choice has not been a mistake. Neither Brady nor Cody has ever been seriously injured or felt limited on the job. Through life experience both have learned to quickly think things through before jumping in and to ask for help when needed to avoid injury.

“As kids, the doctors prevented us from doing a lot of stuff. I hated that, and I always had a little chip on my shoulder when I couldn’t do something because of my hemophilia,” says Brady. “I try not to let that affect me, especially when I want to be hardheaded and go beyond my bounds. At the end of the day I realize, if I get hurt, I can’t help anybody.”

Oscarson predicts bright futures for them both. 

“I believe Brady and Cody have long careers ahead of them in EMS,” the ambulance director says, “and will continue to develop as leaders.”  

Jolynn Tumolo is a freelance writer in Morgantown, Pa., and frequent contributor to EMS World.