In case of an emergency
To combat paramedic shortage, Gwinnett offers certification program

Editor's note: Reporter Alex P. Joyner spent 12 hours in early April with a Gwinnett Fire and Emergency Services medical supervisor to report parts of this story. This is the first installment of several forthcoming reports on Gwinnett's public safety personnel.

LAWRENCEVILLE - It's a cloudy Friday afternoon in early April when a dispatch for a multi-vehicle car wreck goes out at Station No. 9 in Lawrenceville.

Gwinnett Fire and Emergency Services Lt. Mack Brannan, a 25-year veteran who supervises all emergency medical services, or EMS, calls in the Southern portion of the county on this shift, quickly paces to his response vehicle.

"You ready to go for a ride?" he asks before jumping into his emergency vehicle and clicking in his seat belt. With sirens blaring, Brannan - a friendly man with a Bourbon-smooth drawl - maneuvers his vehicle through rush hour traffic on Five Forks Trickum Road. Hearing Brannan's approach, cars ahead begin to pull off at angles. Moments later, with a clear stretch of road, Brannan steps on it. Adrenaline and anxiety begin to congeal.

After a quick right turn on a residential road with a hard curve, two mangled vehicles sit face to face. Glass covers the road. Thick fluids from the damaged vehicles slowly ooze downhill. What many would expect to be a chaotic scene is void of sound.

As open-mouthed onlookers stare, Gwinnett paramedics move quickly to load the victims into units bound for area hospitals. Every movement by these professionals is automatic. They are, of course, trained in this fine art. The mindset is simple, the pressure constant. They have to do it right. They have to do it fast. Because in this line of work, best efforts don't mean anything.

"It's not like the days of throwing them in the back and hauling butt to the hospital," Brannan said later. "Care starts as soon as we arrive."

The paramedic: A street doctor, problem solver

A paramedic is essentially the highest level an Emergency Medical Technician, or EMT, can achieve - though the term EMT usually refers to personnel below the paramedic level.

In the U.S., paramedics usually provide the most advanced level of prehospital care, known as Advanced Life Support, or ALS. Although each state's protocols are different, paramedics normally administer drugs orally and intravenously, interpret electrocardiograms (EKGs), perform endotracheal intubations, and use monitors and other complex equipment.

The county's size and call volume make EMS big time in Gwinnett.

Gwinnett's expanse - 437 square miles - requires that chiefs strategically staff between 45 and 50 paramedics per 24-hour shift (Gwinnett uses a three-shift structure). The department operates 21 ambulances, which are individually called a "Medic" followed by a number designate. The county's 27 engine companies (the water) and seven truck companies (the ladders) also are ALS compatible. Of the 60,044 calls the department ran in 2007, 40,694, or 68 percent, were EMS-related.

At street level, the paramedic is a quasi doctor and wise sage. At one call, a paramedic could be resuscitating a victim felled by a heart attack, administering drugs en route to the hospital while making thousands of decisions in as little as five minutes. Later, a medic could be comforting an elderly patient who only needs someone to talk to.

Rod Dawson, the department's EMS battalion chief, said the paramedic assumes the most unique role in public safety.

"You're one of the most fortunate and unfortunate people ever because you get to see people at their very best and very worst," he said. "And we have the ability to make a huge impact every time that we go out."

A national shortage, a local solution

With the public's reliance on the 911 system increasing, paramedics are needed more than ever. Yet throughout the country, especially in the Southeast, a shortage of medics exists. Observers say the deficit is caused by several factors, one of which is notoriously low pay that sends potential candidates to more lucrative fields, such as nursing. Training is time-consuming, with course work lasting up to two years.

This creates strains that are far-reaching and expensive for departments. With fewer paramedics, commanders must constantly rearrange staffing to fit current needs. In turn, paramedics must work longer hours - usually overtime - and absorb more stress, leading to burnout or costly on-the-job mistakes.

To counter the shortage, Gwinnett Fire and Emergency Services has cut nonessential items in its budget to operate its own paramedic certification program for the first time since 1997. Compared to Gwinnett Technical College's two-year course, the department's program offers paramedic certification to department personnel in about seven months.

Once the course is completed, graduates are sent to a preceptor unit before transitioning to full-time medic duties. Those enrolled in the program are entitled to substantial bonuses and are given preference on promotional exams.

"We can't wait two years for a class of paramedics to come out," Dawson said. "We can't even really wait seven months. It's something we have to do, but we're spreading our paramedics thinner and thinner and thinner to try to meet the demand."

Julio Diaz and Chad Bird, both Gwinnett firefighter/paramedics, are the program's lead instructors. They graduated a class of 12 in late March and oversee a new group that began in mid-April. Diaz, who came to Gwinnett after an 18-year career with DeKalb County Fire Rescue, said the class exceeds national standards by 300 hours and could become an accredited program in several years.

Gwinnett Fire Chief Steve Rolader, who says the in-house strategy creates retention and weeds out those not up to the challenge, predicts the department will be fully staffed with paramedics in three to five years due to the reemergence of the program.

"We will be the one that (everybody) looks at with envy because we're going to have the paramedics," he said.

EMS culture embraced, rewarded

Though the Gwinnett County Fire and Emergency Services is just under 40 years old, its relative youth has its advantages.

Several older, big city departments nationwide are finding it difficult to absorb an EMS component - basically assuming responsibility of the ambulance service - due to unrest and confusion among the ranks. In these cases, the majority of firefighters are middle-aged and reluctant to change - after all, many argue, the allure of the job is about fighting fire, not riding an EMS unit for 24 hours every shift. Additionally, third-party medics being absorbed by the department find it difficult to adjust to a paramilitary operation. Politics are involved, too.

In Gwinnett's case, the county's 1986 merger of fire and EMS occurred when the average age of personnel was 26 years old. There were initial growing pains, but they didn't last long.

"It was accepted much better," said Casey Snyder, Gwinnett's assistant chief of business services who is also a paramedic. "And we grew with it."

It's not unusual to find that many of the department's top brass are also paramedics, evidence that the emphasis on EMS is not just lip service, officials say.

Rolader says his paramedic badge beats all the house fires he has run in his 30-year career.

"If you're truly in this business to make a difference in people's lives, this is where you do it," he said. "You do it in the medical sector."

The early acceptance of the system, officials say, has cultivated a pro-EMS attitude in the department that has been passed down to incoming rookies.

It also pays: Those who want to move up the ranks to lieutenant and above must be certified as a paramedic before taking promotional exams.

"We all come in knowing we provide a service," Rolader said. "If it happens to be a medical service, then that's what we're going to provide to the highest level. If it's fire fighting, the same exact thing."