The call came from a Chatham address that the rescue team recognized immediately. An elderly woman was having serious trouble breathing. It was another in a series of cascading medical crises for the woman.
When Lt. Gerard Smith, joined by paramedics Rachel McGrath and Scott Long, arrived at her home, they discovered her upstairs in a room populated by medical equipment.
“How are you feeling,” asked Long.
Her breathing was labored, but she was lucid.
The rescue team ever-so-carefully escorted her down the stairway in the home and gently placed her on an ambulance cot for the 30-minute drive to Cape Cod Hospital’s Emergency Department.
With the ambulance’s heat turned up and a blanket swaddling her, the patient was immediately hooked up to a heart monitor and a 12-lead EKG was administered. Long placed a tourniquet around her right arm to help locate a vein for the IV.
While Long worked on obtaining IV access, McGrath concentrated on obtaining the woman’s oxygen levels to determine the appropriate oxygen therapy.
“Have you been eating?” Long asked.
“Not much in the last few days,” she said.
Knowing her recent medical condition from referencing the onboard computer, the team was more concerned about her not eating and drinking than her immediate breathing issues. She was on the cusp of malnutrition and dehydration.
The EMS System
- Detection – When a medical emergency is evident
- Reporting – A 9ll call for help
- Response – Local EMS services dispatched
- On Scene Care – Trained EMTs and Paramedics begin immediate medical treatment
- Care in Transit – In direct communication with hospital; ongoing medical treatment administered
- Transfer to Definitive Care – Seamless medical care continues as patient transferred to Hospital Emergency Department staff and physicians.
An Ambulance Workup
Probing for a vein to insert the IV became an immediate challenge for Long. The patient’s veins were dangerously thin and extremely fragile.
“We don’t like to make you hurt,” Long explained to her. “Let me try one more time.”
After several attempts on both arms, the vital solution finally was flowing.
Meanwhile, McGrath was reading the first of several EKGs to get a better picture of her heart and checking her blood pressure, sugar levels and temperature. At the same time, McGrath questioned her to learn as much as possible about her condition, which would be shared immediately with the Emergency Center staff at Cape Cod Hospital.
“You’re just having a nice afternoon drive with us,” Long reassured her, as McGrath contacted the hospital with an estimated time of arrival. “We’ll be there in 10 minutes.”
As soon as they arrived at the hospital, the team took her to a designated room. Their job was over, but during their 24-hour shift the team would escort two more elderly patients to Hyannis.
On The Front Lines
While paramedics across the Cape are trained for the most severe and traumatic events -from car crashes and water rescues to strokes and cardiac arrest – they devote an ever-increasing amount of their time and effort to cases just like this.
As first-responders, they serve as general practitioners and geriatric specialists.
“Many elderly, not only in Chatham but across the entire Cape, are falling between the cracks,” explained Chatham’s EMS Coordinator Mark Heller. “Amid all this wealth, there are thousands of very old residents who live alone in frail and failing health. Many of them have family far away who visit only in the summer. They get isolated at home and don’t want – or can’t – reliably cook for themselves. It’s estimated among many fire departments on Cape Cod that between 50 and 70 percent of all EMS calls involve elderly issues – including falls.”
Many times, rescue squads are called only to end up tending to patients right in their homes without transporting them to the hospital, explained Falmouth’s EMS Officer Lt. Craig O’Malley.
“We’re on the front lines of geriatric care – from listening to their lungs and heart to giving them medications to observing safety hazards throughout their home that need remediation,” he said. “These are people who can’t get out on their own to even get to the doctor or grocery store. And it’s not only those living alone. Among elderly couples, one of them may suffer from Alzheimer’s and the caregiver is overwhelmed, isolated and suffering ailments as well.”
Their observations are vividly supported by statistics.
More than 40 percent of all households on Cape Cod have one or more residents age 65 or older, compared to 26 percent throughout Massachusetts, according to the U.S. Census. Nearly five percent of Cape Cod residents are older than 85 years old, more than double the state average.
Fourteen of the Cape’s 15 towns have higher proportions of people 65 and older than does the state, according to the U.S. Census and noted in the most recent Community Health Needs Assessment Plan for 2017-19 (CHNA) published by Cape Cod Healthcare’s Community Benefits department.
All these older residents are much more likely to suffer from multiple chronic illnesses, placing increasing strains on the entire healthcare system, including town rescue squads.
The growing rates of age-related dementia and risk of injury due to falls have been identified as significant health concerns in the CHNA.
Dementia and Falls
According to the Alzheimer’s Association, one in nine people over the age of 65 have the disease and one in three seniors die of it or other form of dementia. The CHNA estimates that in Massachusetts, the number of Alzheimer cases will increase 25 percent by 2025.
“With Barnstable County’s aging population trends, Alzheimer’s disease and dementia will place a significant demand on our health system and community to address these (conditions) and the complexities of how they impact the lives of individuals and families,” the assessment concludes.
Meanwhile, from 2008-2012, the total discharge rate for falls at Cape Cod and Falmouth hospitals was 3,449 per 100,000 people, significantly higher that the state rate of 2,763, according to the CHNA.
Public health experts cite additional concerns regarding age-related sight loss, hoarding, depression, social isolation, alcoholism, and substance abuse by seniors.
With paramedics and EMTs confronting this rising tsunami, they are increasingly joining forces with other institutions in the community, especially town Councils on Aging and the Visiting Nurse Association of Cape Cod.
Eyes and Ears of the Community
In Chatham and other communities, the police and fire departments meet regularly with the COA and town health officials to chart trends and coordinate efforts.
“It’s a very positive way not only to respond to issues, but to anticipate and prevent health hazards for the elderly,” said Heller. “No one wants to admit getting old, and many are reluctant to seek help until it is too late, for fear they will have to leave their homes permanently and enter a nursing facility.
“When we enter a home and discover medications are not getting filled or that there is no food in the refrigerator, we can immediately refer them to the COA or a social worker. We can also make sure they get personal alarm systems to notify us in case of a fall and to safe proof their home.”
And simultaneously as firefighters, they often discover significant risks to the house itself, noted Michael Winn, Chief of the Centerville, Osterville and Marstons Mills Fire Department – from overloaded extension cords and bad circuit breakers to failed or nonexistent smoke and CO2 detectors.
All this is adding the need for yet another level of training for paramedics and EMTs, all while they also are fighting fires or racing to accident scenes.
The old image of the fireman is long gone.
Today, it’s firefighter/paramedic or EMT and social worker all in one.
“We’re truly the eyes and ears of our community,” said Winn. “Our job is to protect our most vulnerable population, and when possible keep them out of the hospital.”
By: Glenn Ritt