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FORT WORTH, Texas (AP) — The calm and sometimes curt-sounding voices on the other end of 911 calls are often choking back tears.
The Fort Worth Star-Telegram (http://bit.ly/1OvxWie ) reports a little over a month ago, 911 call-taker Erin Falkenberg clicked on one of the nine computer screens in front of her at MedStar Mobile Healthcare's communications center and answered the hardest call she had ever taken.
Through her headset, she heard a man in his 60s say that he was in his bedroom and was having difficulty breathing. The computer screen prompted Falkenberg to ask more questions, but the man suddenly interrupted and asked her to cancel the call.
He said it one more time while she tried to keep him on the line. There was something about his breathing that told her to keep talking into her headset and not do what he asked. Not cancel.
Then she heard his last breath.
"His wife woke up and I stayed on the phone with her while she did CPR," Falkenberg said through tears a month later. "Because (the caller) was a paramedic, I don't think he called for himself, I think he called 911 so his wife wouldn't feel alone when she found him."
Falkenberg is one of the lead dispatchers at MedStar headquarters. Her screens show maps of the city, ambulance locations and even signals of where cellphone and land-line calls are coming from — sometimes as specific as what part of a building.
She works 12-hour shifts and sometimes takes her 911 calls home with her. She copes by talking to her husband and writing in a journal.
"I write a lot," she said. "It helps."
A 2015 survey by the Journal of Emergency Medical Services of more than 4,000 emergency medical services workers in all 50 states found that they are 10 times more likely to contemplate suicide than the national average and 13 times more likely to commit suicide.
Gallows humor keeps employees sane, MedStar spokesman Matt Zavadsky said, but mental health remains an important issue in the EMS world, where employees are routinely exposed to traumatic situations and events.
"The epidemic of stress and depression in our workforce has been unreported for years," he said, adding that EMS professionals believe they need to keep problems to themselves to maintain their reputations.
Talking about it can be seen as a sign of weakness, he said.
"The increase in suicide in EMS workers in the last decade is scary," Zavadsky said.
As recent examples, he referred to the suicides of two Austin-Travis County medics, one in June 2014 and then another this past January.
MedStar EMS workers are members of Code Green, a campaign started in 2014 by EMS professionals concerned about suicide among first responders and motivated by the need for mental health awareness.
The nonprofit provides first responders an outlet to tell their stories anonymously and then publishes them so others can see they aren't alone.
Two crew members recently worked with a Dallas musician on a music video that raises awareness about stress and suicide.
Zavadsky said he's certain the video will be featured on Code Green's website upon completion.
On a cool December night, 38 ambulances across the Metroplex are on duty, stationed at QuikTrip parking lots and busy intersections.
Each ambulance is staffed with an emergency medical technician and a paramedic, who work 12-hour shifts five days on, three days off.
The difference between EMTs and paramedics is the amount of training and scope of practice. Most states don't allow EMTs to do anything that involves breaking the skin; paramedics can do more advanced work.
Drivers wait for dispatchers like Falkenberg to route them to the nearest calls.
"Emergency medicine is generally 59 minutes of boredom and one minute of sheer panic," Zavadsky said.
MedStar doesn't have individual stations like a fire department does.
Instead, dispatchers deploy ambulances using a computer program that analyzes call volume over the past 20 years and produces data that show areas of high call volume.
EMT Stephen Russell is a 13½-year veteran who has seen and heard it all.
Russell ticks off all the medical devices and drugs inside an ambulance, including naloxone, which is used to reverse the effects of opiates during an overdose.
Naloxone works only on people who have abused opiates.
Patients "are fixin' to quit breathing on you, and you give them this drug. Then they come back and say, 'I didn't do any drugs,' " Russell said, shaking his head.
"Some are very good actors," he said.
The insides of the ambulances are all the same. They carry ventilation and airway equipment, including oxygen masks, defibrillators to shock the heart, immobilization devices such as neck braces, and IVs and serious medicine such as epinephrine and anti-nausea medicine.
"Riding backward in an ambulance can make you sick," paramedic Tiffany Cook said.
An ambulance pulls up to the Presbyterian Night Shelter, where an ill woman is strapped to a stretcher.
Homeless people mill about, some staring at the ambulance.
The driver has to get in and out fast, Zavadsky said, otherwise people start to line up with "aches and pains."
MedStar's new battery-operated hydraulic ambulance cots let one person load a patient weighing up to 700 pounds into an ambulance.
The cots, made by Stryker, are pushed into a locking mechanism in the ambulance and then powered to move up and into the ambulance — taking the weight off the medic.
All 55 ambulances in the fleet will have them next year.
The ambulances are mounted on Chevrolet 2500 chassis, diesel-powered and designed for durability, not speed, Zavadsky said.
Monitors inside MedStar's ambulance activate on-board cameras if drivers go faster than 80 mph.
Per policy, crews are allowed to exceed posted speed limits by only 10 mph, Zavadsky said. This avoids accidents.
Speed and response time aren't necessarily intertwined, he said. Dispatchers monitor screens to see which ambulances are closest to certain calls, and direct drivers to new locations based on call statistics.
And if a 911 call doesn't meet emergency response criteria, a nurse will talk to the caller and decide if the patient should follow up at the doctor or if MedStar should send a community paramedic who helps with less-severe calls.
Among the relatively benign calls that MedStar has received are hiccups, toothaches, ingrown toenails and peanuts stuck in someone's nose.
Patients generally get to decide which hospital they want as their destination. Sometimes their clinical condition makes the decision for them.
For instance, a person with serious trauma from a shooting or big fall would go to a designated trauma center, such as Texas Health Harris Methodist Hospital Fort Worth or John Peter Smith Hospital.
A person with a significant burn would go to Parkland Memorial Hospital's burn unit in Dallas.
State law allows ambulance drivers to park where they want, drive through stop signs and red lights with due regard, exceed the speed limit and drive against directional signage.
"It's acceptable for an ambulance to go the wrong way on a one-way street with lights and sirens, but if they crash into somebody, it's no longer with due regard," Zavadsky said.
MedStar ambulances respond to 125,000 calls a year, he said.
Of those, about 50,000 to 60,000 are lights-and-sirens emergency calls — ones that are verified actual emergencies — but there are rarely collisions, he said.
The unpredictability of other drivers frustrates ambulance drivers the most, Zavadsky said.
Although state law requires drivers to pull to the right and stop when an emergency vehicle is approaching, oftentimes people pull to the left, don't move at all or are too busy texting.
The busiest 911 call times are 5:15 p.m. Tuesdays, Zavadsky said. Car crashes are a frequent destination for ambulances any weekday from 5 to 7 p.m., he said.
Most of the weekend calls come from outside the loop, which is why dispatchers send ambulances to new street postings every five minutes.
MedStar is the exclusive emergency and nonemergency ambulance service provider to more than 880,000 area residents, yet the governmental agency receives no tax subsidies.
"We bill for the services we provide, and that revenue offsets the expense of providing a service," Zavadsky said. "That's huge and different from other large EMS services in the country."
But MedStar doesn't collect full payment for most of its calls — even when patients have insurance — so most of its revenue comes from nonemergency calls from nursing homes to hospitals.
An emergency ambulance call costs about $1,500 for people without insurance. A nonemergency call, like an inter-facility transfer, costs $900.
MedStar's coverage area is 15 cities, including Fort Worth, Haltom City, Burleson, Saginaw, White Settlement and Haslet.
MedStar evolved from the Fort Worth Ambulance Authority, which was created in 1985 and served only the city of Fort Worth. After other cities asked to join, it evolved into the Area Metropolitan Ambulance Authority three years later.
The MedStar system is governed by AMAA's board of directors: Fort Worth City Councilman Zim Zimmerman; Dr. Darrin D'Agostino, medicine department chairman at the University of North Texas Health Science Center; Fort Worth surgeon Dr. Rajesh R. Gandhi; and former Star-Telegram executive Paul Harral.
Former Burleson Mayor Byron F. Black recently resigned.
Other cities have since expressed an interest in joining, Zavadsky said.
Despite the stress, long hours and unpredictability, working EMS is truly a calling for many of its employees, who view the job as challenging but integral to the community.
MedStar currently has 450 employees, including 280 in the field.
"Most people will tell you they got into EMS because they wanted to make a difference — and they are able to do that one call at a time," Zavadsky said.
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Information from: Fort Worth Star-Telegram, http://www.star-telegram.com
This is an AP Member Exchange shared by the Fort Worth Star-Telegram
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