When a medical emergency prompts you to dial 911, chances are that after it is over, you might not see the people who rescued you ever again. Emergency medical personnel understand that. They know that those they serve might be having the worst day of their lives, and they are willing to jump into the fray. No call goes unanswered.
Capt. Winta Adams started working for Richland County Emergency Services at age 19 when she was still living in Hopkins with her parents. Now she is the payroll captain and a spokesperson for EMS and a supervisor to emergency medical technicians and paramedics. She also monitors safety and compliance and serves as a liaison with the risk management department, public information office and human resources department, often being the first point of contact for new employees.
“We are always looking for employees, just people who are dedicated and loyal to helping people and having compassion,” Winta says. Though first responders — emergency medical technicians, paramedics, firefighters, and police officers — are considered heroes, Winta wants people to remember that they are also human beings. “We’re in uniform, but we look completely different outside of work, and you wouldn’t even know what we do.”
Richland County EMS keeps at least 16 ambulances in service during the day and 13 at night, all with paid workers. In 2020, the department answered more than 76,000 calls.
Letting go of the stress of a 12-hour shift under lights and sirens is key for many paramedics and emergency medical technicians. Cathy Hart, an EMT and married mother of three young children, is studying to be a paramedic in what little free time she has. “The drive home at the end of the day, at least for me, is where I shift gears and do my best to leave work at work and switch into mom mode.”
Cathy works the 4:45 a.m. to 5 p.m. shift, as does veteran paramedic Sgt. Ryan McMenamy. Married with three daughters, Ryan has even delivered a baby on the way to the hospital, and he was in uniform when his wife gave birth to their second child. His biggest challenge, Ryan says, is tackling one call after the other. “If you have a really bad call, you clean your truck up and then you have to go back out and go to the next call. You’ve got to separate your calls.”
In Richland County, paramedics and EMTs team up with various colleagues on the same shift, spreading out among 13 substations in the county. “You never know where calls are going to come out,” Ryan says. “Dispatch has to place us strategically, so we can get where we need to go.” If a call comes to an area that is not covered because an ambulance has been dispatched elsewhere, the fire department might respond first.
Paramedics and EMTs can receive training through Midlands Technical College or the SC Midlands EMS school in West Columbia. Cathy, who has a bachelor’s degree in microbiology from the University of Central Florida, is finishing up 1,200 hours of instruction and clinical training, and is riding with a mentor paramedic on days she is not scheduled to work. “We do clinical time in emergency rooms, the ICU, and various areas of the hospital, which is a good opportunity to build positive relationships with the hospital staff,” Cathy says. In November, she will take the national registry examination, a combination of written and psychomotor tests designed to evaluate her performance, from getting to the scene of an emergency call to delivering a patient to the hospital.
According to Cathy, paramedics can give more medications than EMTs, and they can intubate patients, secure an advanced airway, and perform cardiac monitoring. Ryan stresses that EMTs have a crucial role on the ambulance crew. “EMTs on my truck help me tremendously,” he says. With experience, EMTs know how to assess patients quickly and do what needs to be done. Also serving as a preceptor, or trainer, for prospective EMTs and paramedics, Ryan works to help them develop confidence. For example, he says, performing a needle decompression, or thoracostomy, to release trapped air in the pleural cavity can be scary to attempt on a human, rather than a mannequin, for the first time. New medics have to learn not to be apprehensive in dealing with trauma.
Whether an EMT or a paramedic will work on a patient depends on the nature of the call. “If it’s a basic call,” Cathy says, “then I’ll be in the back of the unit with the patient, and Ryan will drive us to the hospital. If it’s an advanced call, with a patient that requires cardiac monitoring or interventions that I can’t perform, then he’ll be in the back with the patient, and I’ll drive us to the hospital. In the case of a critical patient, we can utilize a member of the fire department to drive the ambulance to the hospital, so Ryan and I can both be in the back of the unit providing patient care.” There is never a point at which the ambulance crew does not have backup, Ryan notes, or access to a physician.
Sgt. Neil Schmitz, who once worked a night shift with Winta Adams, now works with her during home football games at the University of South Carolina. “During football season, they’re bringing in about 80,000 people, which includes citizens who live here in Richland County but also people coming in from other areas,” Winta says. Neil normally operates a golf cart outfitted with emergency equipment, which can maneuver inside the stadium to transport patients, if necessary, to an ambulance outside. Several first-aid stations are staffed with nurses, paramedics, and EMTs. Richland County’s mass casualty bus also is parked outside the stadium; it can handle up to 21 patients. In addition, the department has three paramedics in its motorcycle unit who staff home games.
During the week, Neil works as one of four community paramedics in the Mobile Integrated Healthcare program. Initially funded through a grant from the S.C. Blue Cross Blue Shield Foundation in 2015, the MIH program operated in a partnership with Prisma Health. Designed to serve unfunded and underfunded patients who might use the emergency room for their primary care, the program’s initial goals were a reduction in diabetes, high blood pressure, and heart problems. Services are free of charge and include home visits with patients.
“We assess everything from their living situation to their medications, their vital signs, what their social needs may be. Maybe they don’t have insurance, and they would like insurance,” Neil says. “Sometimes it’s as simple as, ‘Well, I live in Hopkins, and they keep giving me a follow-up visit with a cardiologist at Parkridge.’ And there’s no realistic way this person is going to get to Parkridge for a doctor’s appointment. There’s not even a bus that goes out there. So, a lot of times, it’s as easy as us getting them an Uber ride or a taxi.” Other times, community paramedics might realize that some patients are unable to follow doctors’ orders or complete insurance paperwork because they cannot read. Community paramedics will help with this, too.
Medics answering emergency calls often make referrals. Ryan says, “If we go on the scene with somebody and we see they’re having building problems, and their house is not set up safely, we can say, ‘Would you mind if I put you in for an MIH consult, so they can come and help you out?’” Most patients are receptive.
Community paramedics try to reach the homeless population as well. “Our program works with Transitions and the Oliver Gospel Mission,” Neil says. “Sometimes it’s just going out to the area behind McDonald’s on Gervais Street or some of the other areas where we know we can find people and pulling a couple of chairs out of the back of the truck. We sit in the shade and have a conversation. Sometimes that’s how we help people.”
When COVID-19 prompted a state of emergency, the Richland County MIH unit switched its focus to helping limit transmission of the virus. Community paramedics provided in-home testing for patients, getting results from DHEC and following up with affected families. “I think that about 26 percent of the population that we saw during that time tested positive, which was high because we were specifically testing people who were experiencing symptoms, making them more likely to have a positive result. We found it more often than just a screening that covered an area. But a lot of those patients did great. They stayed in their home for 14 days, they followed up with a primary care doctor, and they went about their lives,” Neil says.
Fairfield and Lexington counties are also developing community paramedic programs, Fairfield with a grant from the South Carolina Office of Rural Health and Lexington with a three-year grant from The Duke Endowment, written by the Lexington Medical Center Foundation on behalf of Lexington County EMS. Tanee Thomas-Tedford and Austin Pace, both community paramedics with Lexington County EMS, are working toward having the program fully operational next year. Their primary goals are lowering EMS call volume and reducing recidivism.
“Mental health, drugs, and alcohol are three of the biggest risks in our county that affect our people,” Tanee says. Along with other colleagues, Tanee and Austin have been working on an unofficial basis to develop relationships with members of the community who need help. The grant brings vital resources for equipment, vehicles, and staffing. “We’ll be working with the Lexington County Community Mental Health Center and Lexington Medical Center’s Social Services, as well as Serve & Connect,” Tanee says. “They’re a nonprofit working with law enforcement and communities.”
Kassy Alia Ray, CEO of Serve & Connect, founded the organization in 2015 to honor the memory of her first husband, Greg Alia, who was killed in the line of duty in Forest Acres.
Both Tanee and Austin believe that collaboration among agencies helps them meet their community’s needs. They meet monthly online with 10 other community paramedics across the state. Austin says, “The guy who has probably been our best person to get us up and running and give us information is a fellow named Steven Demby. He’s a captain down at Clarendon County Fire and Rescue, and their program is just phenomenal with all the various things they’re doing.”
Teamwork is essential to the success of ambulance crews as well. In Richland County, Ryan says, “We rely on each other a lot. If we show up on a call, we’re a team, and we’re bouncing off each other all the time.”
Cathy believes each call must be approached with a positive attitude. “Like Ryan said earlier, you’re doing your best to leave your last call behind you, making sure your patient knows that they’re your only priority right now, that we’re going to do everything we can to assist them, building that rapport with them, so they open up and tell you what’s really going on so we can help them to the best of our ability.”
One way to show appreciation to the Richland County EMS is to contribute to their holiday toy drive to benefit CASA, Richland County’s court-appointed special advocates. EMS personnel deliver the unwrapped toys and gifts in a caravan of various rescue vehicles, which is a lot of fun for all involved and can bring smiles to many children in difficult circumstances. Look for more information in November.