As Medical Calls Surge, Milwaukee Fire Department Paramedics Respond

Sept. 23--It's been almost five hours without a call -- an unnerving lull for the busiest paramedics in Wisconsin.

The Milwaukee Fire Department's MED Unit 5, an ambulance housed with Engine 36 near N. 27th St. and W. Capitol Drive, handles about 400 calls for help each month.

But as this summer day slips into evening, the overhead speakers remain silent.

The city's firefighters -- about 17% of whom are also trained as paramedics -- know well the ebb and flow: One minute, they're standing over a sizzling fish fry for dinner or playing pingpong; the next they're racing toward a fire, or a kid who can't breathe, or a man bleeding from a gunshot wound.

The Fire Department is working to increase the paramedic ranks -- last year 88% of calls to the department were medical -- and is incorporating paramedic licensing into its retooled cadet program. Some of the cadets will train at MED 5, giving them a taste of the busiest Fire Department ambulance in the state.

MED 5 responded to 4,801 calls in 2013 -- 1,000 more calls than the next busiest medical unit in Milwaukee. The busiest medical unit in Madison responded to 4,396 calls in the same period. For the busiest unit in Green Bay, the number of calls was 2,906.

"Trouble breathing" and "chest pains" are common refrains on the dispatch radio. So are false alarms, both fire and medical.

"It can be hard to tell what's really going on, and people change their stories all the time," said Lt. Tim Heling, who has been a firefighter for 10 years, six of them as a paramedic.

"We see so much of it," he said. "Maybe 1% actually are having heart attacks, and 99% of the time it's not cardiac; it's muscular or something different."

But each call could be that 1% -- a life hanging in the balance.

Dealing with death

Paramedic Nathan King remembers the first time he brought a man back to life.

The man was in his early 50s and cutting the grass when he dropped to the ground. Bystanders called 911, and dispatchers alerted the paramedics to the PNB: a pulse-less non-breather.

"We worked him right on his lawn and did everything we could do," King said. "I got my first intubation."

To intubate, a plastic tube is inserted into the patient's lung. The outside end of the tube has a balloon, so someone can breathe for the person. It's a tricky process as paramedics guide the tube into the body and aren't able to see exactly where the tube is going. They have to resist the urge to tilt the person's head back to better see. If they do, they risk breaking teeth or causing other injuries.

King and his colleagues hooked an IV into the man and used a defibrillator, a machine that sends an electrical current to the chest.

"We got pulses back," King said.

The man was still unconscious, and the paramedics still were breathing for him, but he had a heartbeat.

For a stretch during his 10 months as a paramedic, King would get a PNB call nearly every shift. Most of the time, he and the other paramedics couldn't bring them back.

"When you've done everything you can, it can be confusing for the family when they see you stop," King said. "Some family members think that's because they're better."

He recalled one woman saying, "Oh, thank the Lord."

"You have to jump in there right away and say 'Your loved one has died,'" King said. "You don't want to use slang things, you say died. You gather your things, you walk out of the house and everybody you pass, you look at them and say 'I'm sorry for your loss.'"

On a Friday evening, King is partnered with Heling, a third-generation firefighter. They take a woman reportedly having a seizure to Wheaton Franciscan-St. Joseph hospital. To them, her movements -- tensing on the left side of her body -- look more like muscle spasms. On the way back to the engine house, they overhear a call for a car fire just a few streets away. They change course.

The ambulance getsto the car before the fire engine.Flames engulf the front of a black BMW. To Heling and King, it looks like arson: A gas can sits on the grassy strip between the street and sidewalk.

A garden hose lies near the car. Heling picks it up and directs a stream of water at the car. A minute or two later, a fire engine and Milwaukee police officers arrive and take over.

Later, Heling and King treat a 70-year-old man with chest pains and a history of cardiac problems. The man suffered a heart attack a few weeks ago, but is alert when King hooks him up to a heart monitor.

The man's family hands off plastic bags of medication and folders filled with medical documents. King and Heling take the man to Columbia St. Mary's Hospital, where his family will meet him.

MED 5 moves on, and over the course of the night, the paramedics treat Milwaukee residents suffering from asthma, diabetes and allergic reactions.

The next day, firefighters on Engine 36 are called to a car accident just blocks from the fire station. Firefighters check over the drivers, determining that the injuries are not quite severe enough to summon paramedics. They call a private ambulance instead.

While at the accident, Lt. Harold Johnson, the fire officer on Engine 36 that day, notices a boy with tears dribbling down his face. Learning that the boy's father is among the injured, Johnson bends down to comfort him.

Later, he reflects on the moment.

"I've always been the type of person that likes to see something that goes from bad to better, and not worse," he says. "We see so many different things, and we're able to come on scene and change it for the better, for the most part."

The calls that really hit close to home are those they can relate to.

Heling was at work when he learned his grandfather, who had been in a hospice for some time, had died. Heling took one more call that day for an elderly man, who ultimately was not saved.

"I don't know if he was in hospice, but it was an older guy and he was expecting to die, and it just kind of hit me," Heling said.

He told his boss, who sent him home immediately.

'Quite the shake-up'

On a Saturday afternoon, the younger firefighters at Engine 36 cook dinner. But before the firefighters take a bite, they're sent to a car crash. It's a minor fender-bender; King is on duty, but he and Lt. David Hensley and their ambulance don't need to leave the station.

Their colleagues come back in 10 minutes, only to be called out almost immediately for another crash. Again, the injuries aren't severe enough to call out the two paramedics on MED Unit 5. A private ambulance is summoned instead.

King and Hensley don't wait for the otherfirefighters to return. They eat while they have the chance.

Hensley, the senior paramedic on duty, checks a list of Fire Department calls in the city and notices a scrapyard fire in the Menomonee Valley. Because so many firefighters are working there, he and King will likely need to cover a wider area than usual.

Beep -- beep -- beep.

Three separate tones signal a medical call. A robotic voice follows, announcing the vehicles that should respond. MED 5 is among them.

A digital stopwatch mounted on the garage wall starts counting off seconds.

A printer churns out a call sheet describing a car crash at Melvina St. and Appleton Ave.The ambulance pulls out before the stopwatch hits 60 seconds.

Driving to the car crash on the city's northwest side, King blares the ambulance'shorn when the sirens aren't enough to make drivers move aside. The vehicles don't have navigation systems.

As he and Hensley pull up to the crash, a small crowd gathers in the rain. The SUV crunched the driver's side door of the car, sending shards of glass flying.

King and Hensley focus on a 58-year-old Milwaukee man who was driving the car, and get him into their emergency room on wheels.

"My back hurts," the man says.

"Lower back? Upper back? Any tingling in your arms or legs?" Hensley asks.

"No."

As Hensley taps notes on a heavy-duty laptop, King secures the man to a stretcher with medical tape. He places his hands on the man's feet, while Hensley instructs the man to push against King's palms.

The man pushes -- a good sign. No paralysis.

King continues to examine thepatient, patting his legs and hips, as Hensley fires off questions.

"Any pain down in your legs? In your hips?" Hensley asks. "No dizziness, no trouble breathing?"

"No, just my back," the man replies.

Hensley takes a seat in the back of the ambulance, near the man's head, and picks up the radio to update dispatch.

King returns to the driver's seat and sets out for Froedtert Hospital, pulling away15 minutes after they arrived at the scene.

Hensley asks the man if he remembers what happened.

"Last I know it was a shake-up," the man says.

"Oh, it was a shake-up," Hensley says. "Quite the shake-up."

After parking in a tight space between other ambulances in the Froedtert Hospital garage, King and Hensley roll the gurney through sliding glass doors and deliver the injured man to a team of physicians and medical students.

Hensley, the senior paramedic, confers with the doctors, then stops in the break room to finish his report. Meanwhile, King pauses at a laundry hamper near the hospital doors. He swaps the dirty white sheets on the gurney for fresh ones.

King loads the gurney into theambulance and closes the rear doors with a clang. Hensley snaps his laptop shut and steps out to the garage.

The two paramedics climb aboard, and the ambulance rumbles out into the darkness.

Paramedics in the Milwaukee Fire Department

The majority of the calls that come to the Milwaukee Fire Department -- 88% in 2013 -- are medical rather than fires, mirroring nationwide trends. As the total number of calls continues to rise, thegulf between the percentage of fire and medical calls becomes more pronounced, according to data submitted to the National Fire Protection Association by departments across the country.

-- In 1986, fire departments nationwide received nearly 11.9 million calls -- 19% fire-related and 54% medical. By 2012, the most recent year available from the national fire association, departments received more than 31.8 million calls, of which 4.3% were fire-related and 68% medical. Other calls include false alarms, mutual aid and hazardous materials.

-- The roughly 830 sworn firefighters on the Milwaukee department serve as emergency medical technicians, trained in basic life support. They can assess patients' conditions, dispense limited medication and care for external injuries and some wounds.

-- Of the Milwaukee firefighters, 140 also are licensed paramedics, who treat the most serious medical conditions. Paramedics can start IVs, insert breathing tubes and dispense a wide variety of medication.

-- Some of the paramedics staff the department's 12 mobile emergency department, or MED, units. Two paramedics are assigned to each ambulance on every shift. The rest are assigned to fire engines and trucks where they serve as paramedic first responders.

-- Milwaukee County EMS provides training and support for Milwaukee Fire Department paramedics. Each year, paramedics must undergo 24 hours of refresher training, in addition to the 15 hours of refresher EMT training.

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