Call for paramedics to save lives on island
Paramedics could save lives if they were introduced on the island, a Bermudian trained in the field in America has said.
Gilbert Darrell, who was a paramedic in New York State, explained that the specialists have higher qualifications than emergency medical technicians and would be a valuable addition to the island's emergency services because of the range of procedures they are trained to perform.
He said: “Having paramedics can save an hour or two ahead of time. It has a really strong outcome for mortality and mobility. The emergency department can be maxed out as it only has a set number of doctors and nurses.
“If a patient comes in with a list of interventions already done such as IVs, fluids and medications, that really helps the physician.”
Mr Darrell, who also worked as a firefighter and firefighting instructor in New York State and who has 18 years of experience in emergency services, said vital minutes could be saved if a paramedic was able to work on patients on the way to hospital.
He added: “Load times into the ambulance can be five to 15 minutes even when you're moving as fast as possible.
“Then add a 45-minute ride from the far ends of the island or even a five-minute ride from Hamilton and you have the ability to get life-saving care to the patient.
“You can give blood in the field. For a bad trauma, paramedics can give certain medications and blood products to keep a person's blood pressure up and keep them alive before they get to the emergency room.”
Mr Darrell said: “EMTs do a good job but they are missing two years of education and skills. An EMT has basic life-support skills like bleeding control, cardiac arrest procedures, CPR, logistics of the ambulance service — they are really first responders.
“Paramedics were designed to bring the ER to the field — to the patient. We have 50-plus drugs we can administer and a whole plethora of things that EMTs aren't able to do because they aren't trained.”
He added that a paramedic qualification takes two years to complete and was a rewarding career.
Mr Darrell said: “The great part about it is you get exposed to a tremendously high level of medicine without having to give up four years of your life in medical school and residency.
“There's a certain amount of job satisfaction you get from providing acute care in the field and having a good level of autonomy.
“You are out there helping the community directly. A paramedic can make some life and death decisions by their own — it takes a certain calibre of person.”
Mr Darrell, who now runs his own telecoms business, assisted at a serious crash in March, where he applied a tourniquet to a woman's severe arm injury before she was taken to hospital.
He is also a volunteer with charity St John Ambulance and provided emergency medical services for an America's Cup team last year.
Paramedics gained official recognition in Bermuda after a 2015 amendment to emergency services law, but there are none registered on the island at present.
The Bermuda Hospitals Board said that it welcomed the use of paramedics — but that they were not vital in Bermuda because of its small size.
A spokeswoman pointed to problems with keeping them certified due to the low number of patients that would need their help.
She said: “Treating trauma patients in the ED is preferable to treating them on the scene. For this reason getting patients to the ED as quickly as possible is the model used in Bermuda.”
She added: “In order to become a licensed or registered paramedic, individuals, in addition to course work, have to achieve a certain amount of practical experience.
“Keeping this experience current might be extremely difficult in Bermuda as the volume of serious trauma would not suffice for them to attain the required practical experience to retain their licence.
“Such individuals would be required to leave the island regularly just to clock practical hours and be considered safe to attend to patients locally.”
The spokeswoman said: “BHB Emergency Medical Services and Fire Services have EMTs who function at a very high level. The emergency medical service is supervised by a medical director who is trained in managing all facets of acute unscheduled care.”
The report sent by volunteer paramedic Gilbert Darrell to St John Ambulance on the night of a serious crash he assisted first responders with in Flatts:
“I was driving through Flatts and saw flashing lights and come across the car accident. The SUV jumped the curb and absolutely destroyed a stone wall, with a number of people around and apparently five or so patients.
“I found an 18-year-old? woman on the ground barely talking with a pretty heavy arm bleed and multiple open wounds on her left arm. She's alert and conscious but not exactly stable.
“Quick assessment she's somewhat alert but talking minimally, seems to be headed downhill and has lost a large amount blood from her left arm. The arm is badly damaged.
“I could basically see every structure on her left upper arm bicep and lower forearm. It's not bleeding heavily so that's a good sign ... but there is a lot of blood on the ground. No other wounds or obvious fractures.
“She's being attended to by a few people so I tell them to hold pressure on her left arm and find a pressure point, which is still bleeding quite well, as I run over to another patient trapped inside the overturned SUV.
“At this point is absolutely pouring. It's a kind of rain that you can't hide from. Fire is trying to extricate this other patient a 20-year-old? woman, but we're having difficulty. I really cranked on the back hatch and finally get it open enough to help extricate her.
“She's screaming and seemingly in a lot of pain, but it's an important rule of medicine that your loudest patients are often the ones potentially who are going to be OK. Quick assessment I find no broken bones, no major injuries externally so I leave her with the fire service to keep triaging.
“Move over to a few other patients suffering from possibly a head injury but they're awake alert and conscious. No sudden LOC [loss of consciousness] and another ambulance has arrived, I asked to start taking the minimally injured patients for a check while the police are busy figuring out what happened.
“Bystanders and fire are having trouble controlling the bleeding so I grab a tourniquet, heavy gauze and a tight wrap ... I then applied the tourniquet high up on her left arm.
“Some were a little uncomfortable as we're putting a tourniquet on an open wound but I'd rather that than have this woman bleed out in front of us. It looks like a litre or two of blood was already on the ground but it's pretty hard to tell with the heavy rain.
“Once we get her semi-stabilised a second ambulance rolls up and I help rapidly transport her. No medical history, no meds, [she] had a few to drink that night but wasn't the driver.
“She's in a ton of pain but barely talking. I'm a little concerned, obviously. Intermediate on-board starts an IV, I suggest we dump at least two litres of lactated ringers and get her into the hospital ASAP.
“I jump back out to reassess a few other patients but thankfully all in all nothing extremely major.
“Fire service, the ambulance crews and the bystanders all did a great job and were working well together. We got everyone moving within ten or 15 minutes at most.”