By Jeffrey Yago, P.E., C.E.M

Last fall my wife, Sharon,announced that she wantedto take a first aid course andasked if I was interested. I

must admit that I have helped at morethan my share of car wrecks andalways worried about not knowingwhat I should and should not do dur-ing these emergencies. However,Sharon and I were both in our mid-50s with no prior medical training,and the thought of learning a totallynew vocation seemed monumental.Like many readers, we live in a ruralarea, over 50 miles from the closesthospital, and although our childrenhave left the nest, we are facingincreased health risks for ourselvesand our elderly parents.

Since we do not have any familymembers or close friends in thehealth care field, we were not surewhere to begin. After many calls andsome Internet surfing, we found thatthere are actually endless opportuni-ties for anyone, regardless of age ordisability, to become part of an emer-gency medical program for yourcounty or town.

Prior to the advent of micro-elec-tronics and radio communications, anambulance was little more than anempty panel truck to transport anuntreated patient to a distant hospital.Once hospital medical equipmentcould be miniaturized, and voice anddata communication became possiblefrom the field to hospital staff, anentirely new multi-level of emergencyrescue services came into existence.

In case you have not noticed thisgradual change, the interiors oftoday’s ambulances look like emer-

gency rooms on wheels that can nowstabilize most patients in transit andavoid driving 90 miles per hour rush-ing to the hospital. In fact, these vehi-cles contain all of the life supportequipment, patient monitoring sys-tems, and medications found in anymodern hospital emergency room.The people you see riding in today’srescue vehicles have a very high levelof emergency medical training, yetmany are local volunteers, not paidmedical staff.

In 1973, Congress passed theNational Emergency Medical

Services Systems Act which estab-lished national standards for allambulances and ambulance equip-ment, and defined the emergencymedical training required for ambu-lance personnel. Today, any personyou see in a 911 rescue vehicle,including the driver, has several levelsof formal emergency medical train-ing.

Levels of trainingIf you are interested in becoming

the “medic” for your family or localcommunity, the first thing you needto understand is that there are actually

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by becoming a First Responder, EMT, or Paramedic

Interior view of an ambulance showing patient monitoring and treatment equipment

(All photos courtesy of Goochland Fire/Rescue, Goochland County, Virginia.)

Save a lifeSave a life

four recognized levels of volunteermedical training and certification.From basic to advanced skills, theseare:

• First Responder• Emergency Medical Technician

— Basic (EMT-B)• Emergency Medical Technician

— Advanced (Cardiac)• ParamedicWith the exception of Paramedic,

which requires some college and in-hospital courses, the other three med-ical courses can be taken as eveningclasses at most local volunteer fireand rescue stations, and at some RedCross offices and community col -leges. Although these are not degreeprograms, you will hold a statelicense to practice and will be underboth liability and injury insuranceprotection.

If you agree to volunteer severaldays per month after completing yourtraining, most counties will pay allcosts for you to attend these classesincluding books, uniforms, and on-call pager. Some students taking theFirst Responder and EMT coursesplan to eventually become volunteerfiremen, while others choose ambu-lance rescue. There are even specialvolunteer positions that accommodatepersons with physical handicaps.

First Responder: The FirstResponder is the most basic level ofemergency training and is available atlittle or no cost. This training is usu-ally given to a designated safety per-son at many businesses, schools,health clubs, and churches. It isassumed that this will be the first per-son on scene while waiting for anambulance to arrive.

You can learn the First ResponderCPR procedures and the ABCs of ini-tial patient assessment in a single 8-hour class. This is the starting pointfor working with any volunteerfire/rescue association and will beyour first level of emergency medicaltraining.

Human brain cells start dying 4 to 6minutes after a person stops breathingand their heart stops beating, andclinical death usually occurs in 10minutes. It should be obvious that itis difficult for emergency personnelto arrive this fast in many rural areas,and even limited medical assistanceduring those first few minutes prior tothe arrival of a 911 team can signifi-cantly improve patient survival rates.

First Responder training teaches theABCs of what needs to be doneimmediately to delay the onset ofirreversible brain cell damage ordeath until advanced medical carearrives. Cardiac Pulmonary

Resuscitation, or CPR, is an easy-to-learn medical procedure used to pro-vide artificial breathing and manualheart blood pumping for a patient andis included in this ABC training:

A—Airway: When most peoplesuddenly become unconscious, theirtongue will become extremelyrelaxed and settle back into theirthroat and block air flow to the lungs.Knowing how to simply repositionthe victim’s head may correct this lifethreatening problem.

B—Breathing: Falls, electrocution,near-drowning, and chocking cancause a person to stop breathing. Ifnot corrected immediately, the heartwill also stop beating soon afterbreathing stops. Providing temporaryrescue breathing can keep the bloodoxygenated and the heart pumping.

C—Circulation: Circulation is theflow of blood throughout the body. Ifthe body’s cells do not receive ade-quate blood flow, the body will soonshut down and go into shock. Thiscan be the result of a heart attack,high blood loss from an injury, ordrug overdose. CPR can maintainblood circulation when the heartstops beating until a defibrillator andadvanced help arrives.

Emergency Medical Technician—Basic (EMT-B): The next level ofemergency medical training is theEmergency Medical Technician -Basic, or EMT-B, which is the mini-mum level of training for all ambu-lance personnel.

Now returning to our own story.Sharon noticed a sign in front of ourlocal volunteer fire station last Augustindicating that EMT-B classes werestarting soon, and she signed us bothup. However, after receiving a copyof the textbook syllabus and a briefdescription of the hands-on trainingrequired for an EMT-B certificate, weneeded CPR ourselves.

I didn’t want to go to medicalschool, I just wanted to know the“basics.” We both still had full timejobs and all the familiar professional

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Ambulance to hospital data and voice communication equipment

and family obligations that alwaysseem to fill up each day. The time ittakes to complete the EMT-Basic pro-gram will vary depending on instruc-tor and class hours per night, but willrequire taking between 140 and 180hours of classroom instruction over afour to six months period.

At the end of these classes you willbe required to take a written stateexam at a regional testing center. Thestate testing also includes the comple-tion of three different live “scenarios”requiring demonstration of patientassessment and treatment on a livepatient in the presence of state certi-fied instructors.

Stage makeup is used to make any“wounds” appear more realistic, andyou are not told what the injury ormedical problem is before enteringthe testing room. Our particular train-ing would take place several nightsper week for four months, andinclude 10-hours of emergency roomwork at a local hospital. The stan-dardized National EMT-B trainingcourse was going to teach things Icouldn’t imagine myself learning injust four months including:

• How to move a patient and scene size-up

• Spinal immobilization and back boarding

• Initial patient assessment and tak-ing vital signs

• The “ABCs”: Airway, Breathing, Circulation

• Human body systems and general pharmacology

• Inserting oropharyngeal and nasopharyngeal airways

• Administering oxygen and patient suctioning

• Treating pediatric, adolescent, and geriatric patients

• How to apply bandages, splints, and head restraints

• Heart defibrillator operation and CPR techniques

• Respiratory and cardiac emergen-cies

• Diabetic and allergic emergencies

• Poisoning and overdose emergen-cies

• Snake and insect bite emergencies• Treating smoke, fire, and chemi-

cal burns• Obstetrics and gynecological

emergencies• Treating bleeding and shock

emergencies• Treating frostbite and near drown-

ing • Soft tissue and musculoskeletal

injuries• Treating head and spinal injuries• Ambulance operation and safety• Multiple casualty situations and

car wrecksAlthough I think you will agree it

would be very useful for all of us toknow how to administer these emer-gency treatments, when we read thislist we were ready to quit before westarted. To make matters even moretraumatic, when we went to our firstclass, we were at least 30 years olderthan most of the other students and15 years older than our two instruc-tors.

Modern building construction tech-niques and materials have significant-ly reduced the severity and frequencyof structure fires, and over 75% oftoday’s 911 calls are for medical oraccident emergencies, not fires. Torespond to this changing trend, moststate governments now require allfiremen to complete the EMT-B levelof emergency medical training. If youwant to be a vol-unteer fireman, inmany areas youwill need to be anEMT-B first.Since being afireman is highon the list of vol-unteer activitiesfor many ruralteenagers, it willnot be unusual ifmany of your

EMT-B classmates are still in highschool.

Emergency Medical Technician—Advanced (EMT-Advanced): Thereare several add-on courses you cantake after completing the EMT-Basiccertification depending on your owninterests and goals. These includeadvanced cardiac, helicopter rescue,rope rescue, vehicle extraction, waterrescue, and wilderness rescue.

Paramedic: The highest level ofvolunteer emergency medical trainingis the Paramedic . In most largercities, at least one person on anythree-person ambulance crew will bea Paramedic. Although not a medicaldoctor or nurse, a Paramedic hasadvanced emergency medical trainingand is licensed to administer drugs,intravenous infusions, perform emer-gency tracheotomies, intubations, andwill know endless techniques to keepa person alive until they can reach atrauma center. Although you can alsobecome a volunteer Paramedic, mostParamedics today are full-time paidpositions due to the extensive trainingand constant retesting needed tomaintain this certification.

Many rural counties and sparselypopulated states cannot afford to havepaid emergency ambulance personnelwho have this advanced Paramediclevel of emergency medical training,and will rely entirely on EMT-B vol-unteers for all emergency medicalservices.

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Modern emergency rescue ambulance

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Over the next four months of ourEMT-Basic classes, Sharon and Isoon found ourselves becoming veryclose to what had been a room full ofstrangers. We studied together, testedtogether, bound one another to backboards together, took turns bandagingand splinting each other, and sweatedout the state exams together. Wequickly learned that medical treat-ment is hands-on personal and thatmeans touching others—somethingmost day jobs do not involve.

After completing the course andpassing our exams, we are now work-ing with our local rescue squad sever-al days per month, alternating ourtime with other local volunteers.Sharon and I have found a wonderfulopportunity to give something back toour community, and we have alreadyexperienced how very rewarding it iswhen you save someone’s life.

We no longer stand around whensomeone in a crowd suffers a heartattack or pass a car accident and won-der why someone doesn’t do some-thing. It has taken away our feeling ofhelplessness and is providing a higherlevel of confidence for our familymembers and neighbors. I hope youwill make the decision to help yourown local volunteer fire/rescue sta-tion. Since the terrorist attacks ofSeptember 11, I think the need foryour help today is far greater than atany time in our history.

Although we actually signed up forthe classes several months before theWorld Trade Center and Pentagonattacks, the number of volunteers formany fire and rescue agencies hasactually been declining sinceSeptember 11. If you do not have thetime for the more intensive EMT-Basic certification, please consider atleast becoming a First Responder foryour family or neighborhood.

If you have teenagers wanting tohelp their community, I encourageyou to let them participate in thisemergency medical program. Weknow several students who took theirtraining in high school, and continuedto volunteer when they went away tocollege. This gave them a secondhome away from home, a maturitybeyond their peers, and added pieceof mind for their parents. If you areunable to donate some time with yourvolunteer fire/rescue squad, at leaststop by the station to make a cashdonation during their next fund raiserto buy a new ambulance, and be sureto take cookies. ∆

(Jeff and Sharon Yago live in their solarpowered home located in a rural county inVirginia. When not riding around in anambulance, Jeff is a licensed ProfessionalEngineer and a regular contributor toBackwoods Home for solar and energy relat-ed issues. His book, Achieving EnergyIndependence-One Step At A Time, is avail-able from BHM—see page 95.)

Emergency Care, 9/e by O’Keefe, Limmer, Grant, Murray, Jr., and Bergeronwww.prenticehall.com

National Registry of Emergency Medical Technicians www.nremt.org/about/nremt_news.asp

American Red Cross Sponsored Training www.crossnet.org

National Association of Emergency Medical Technicians www.naemt.org/

On-Line CPR Training www.emsadvocate.com

First Aid Instruction Locator by State www.rescuebreather.com

Emergency Medical Bookstore www.hultgren.org/books/index.htm

Helpful references and web sites