It’s more than a job – it’s about saving lives.
Carla Caruso and John McGovern are part of Guelph-Wellington EMS’s 123 full- and part-time paramedics serving the area.
According to the EMS website, there are currently eight stations throughout Wellington County and a fleet consisting of 15 ambulances and two supervisor emergency response units.
During peak weekday hours 12 ambulances are staffed and at night staffed vehicles are reduced to eight.
In addition to daily EMS operations, the service provides a variety of special purpose assigned units as needed. That means for partners like McGovern and Caruso, each day can take them to a new place.
Caruso is an advanced care paramedic while McGovern is a primary care paramedic. McGovern explained a typical day includes providing equal coverage within the county. For them, it could include being on standby for stations in Mount Forest or Fergus.
“Teviotdale for us,” he said. “That location provides the optimal coverage.”
At this time of year calls could include everything from multi-vehicle collisions and falls to people overstraining themselves shovelling snow, McGovern said. Caruso added that first part includes “treating the person on the scene, then transporting them to the closest hospital.”
The job also means having the right training. But when choosing this career, people arrive via different paths.
Caruso was 18 years old and working at a ski hill doing ski patrol.
“I just enjoyed the medical field and responding to people who needed help. I thought that possibly this would be the field I would like to be in.”
She did some ride alongs in ambulances in the Kitchener-Waterloo area and enjoyed it. She applied to the two-year Conestoga College program and “the rest is history. There was some in-class, but it was mostly hands-on scenarios; a lot of practical.”
The program included a paramedic lab that featured all the equipment used in the ambulance. Students would rotate through various work stations where there would be detailed medical examples requiring a response.
“We’d go through how we would treat those patients,” Caruso said. “I enjoyed every minute and was excited about getting out into the actual job.”
Years later, when Caruso returned to upgrade to advanced paramedic care, she noted training had changed and there are now computerized simulation labs.
“They’re pretty cool, where they have mannequins that can speak, breathe, stop breathing. They can do everything from blinking, to sneezing to having an airway obstruction. There is no miscommunication with the person who used to run the scenario verbally. It just really prepares you for the real job – and the unknown.”
Caruso said paramedics are told by dispatchers what the call could be, “but often we actually walk in and you are going down a totally different path. What the patient may think is the issue, is not actually what is going on.”
McGovern said he had to work doubly hard to get as much out of the program as he could.
“I was a late starter for this profession. I did many things before; I had the life lessons.”
After high school, he took a landscape technology course, bought a business, later went to radio broadcasting, “and then at the age of 34, I thought something was missing.”
“I finally found out what I was missing, was what I originally wanted to do – this job.”
McGovern said he had a chance to attend Conestoga College and Humber, but decided instead on the one-year program at Canadian Career College in Barrie.
“When I went back to school at age 34, I had a family, so I had to still work at the same time. But it gave me the chance to become what I am today.”
He said much critical thinking is required in the field. “Usually if it quacks like a duck, it has got to be a duck. But in this field when we are told it’s a duck, it might potentially be something else.”
He cited the example of being called out to a multi-vehicle collision and being told there were four potential patients. Maybe only two need assessments or a backboard and collar, and the other two are okay.
“But when we are initially told four patients, we have to be thinking whether more ambulances are needed or whether a helicopter is required. You’re doing that clinical thinking before you get there.”
He said, “School prepares you with the confidence to go out there and start your job. But it is your job that gives the ability to think ahead.”
Caruso agreed school teaches various diagnoses and ideas of what might be going on. But it is the approach to being in the field that makes a difference dealing with patients.
She explained, “I was always told to act like a duck on the scene: be calm and cool on the surface, but underneath, I’m paddling like crazy getting all my thoughts organized.”
Being calm and cool is important because the patient is usually in distress and anxious, Caruso said. Part of that ability to remain calm is due the partnership between the two.
Caruso has been a paramedic for 11 years, and McGovern for six years. But they’ve been emergency partners for only the past 18 months. That relationship comes through as each picks up on nuances and non-verbal cues.
She added, “We’ll have people say to us that we must have been working together for years and years.”
McGovern said, “It’s like having your best friend at work. It’s being able to communicate without having to use words. When you are on scene, you can give each other that look – that I need this, can you help me here, or what are you thinking? We can just read each other that way.”
McGovern added, “When you have a great partnership like Carla and I have, when we go to the call, it is with the best professionalism we can give the patient or patients.”
If Caruso takes the lead on one call, McGovern will take the lead on the next. But McGovern noted Caruso has advanced care training, while his forte is primary care.
“When we go into a house, if it is my call, I’ll start asking questions, getting the history of the events having taken place, pain scales – things like that. Carla would be hooking up the monitor and the oxygen. But if it gets to a point where it is beyond my skill set, then Carla with her [additional] skill sets, would take over.”
But an advanced care partner usually has more to do.
McGovern said, “I always think a good partnership always depends on what we both put into it. I don’t think it’s my call in – it’s both of us.”
Caruso agreed. Even though they try to rotate calls, “It is never just one person’s call,” she said. The idea, she added, is to try to have just one person asking the questions so it doesn’t overwhelm the patient.
“You are the patient’s advocate,” McGovern said. “In a stressful situation, one person asking the questions helps bring down the anxiety level, rather than two asking.”
Caruso said most paramedic teams in the county try to have at least one person with advanced training when possible, for optimal service.
McGovern said, “Sometimes, it is after the call – when you need to talk about something that just happened – stressful or not stressful. Having a great partner makes you want to strive to be better because you have that grounding of your partner to help you through anything.”
He noted a close partnership is particularly important during difficult calls.
“We went to a VSA [vital signs absent] to a patient south of Arthur last year around Christmas time. I remember going in there and that same visual was the same as my father before he passed away.”
“I still did my job the way I was supposed to, but afterwards, there was that whole bringing things back into my mind. Having Carla beside me and talking to me afterwards brought everything back into perspective. Without the partnership that you have, people and paramedics, you don’t always get the chance to talk.”
Caruso said of having that trust, “You can go to your partner to talk you through sometimes – and let it out. We have to find a way to deal with what we have just witnessed, too, or it builds up. And that affects your job and your family life.”
McGovern added, “At the end of the day, we are still parents, somebody’s son or daughter. It’s hard. But it is having that partner to get you through.”
For Caruso, “The best part of this profession is being out there, using my skills, and making a difference in people’s lives for the better. Every day the job is different, and there is something unexpected … I love that part of the job … It can be scarey, nerve wracking, thrilling and exciting. I love to be on scene and thinking about what is going on with the patient and all the different avenues and ways I can help treat the patient. The best thing is having that amazing partnership and knowing that I’m not out there on my own.”
The not-so-good part, she added, “is seeing that look in people’s eyes. They know, I know, we know [when the situation] is not good. It is also the family being present at the scene of an incident, the emotions they express and the devastations that they feel – all those sad, angry, upset feelings we have to deal with and carry with us afterwards as well.”
McGovern said the worst part of the job “is the death and the dying. It is not just the one patient you are dealing with who has passed away, but there is the family as well.”
He added, “We’re lucky enough to have police and fire services at the scene as well, to offset the demand on us.”
McGovern said the job is rewarding, “But if you are looking for someone to pat you on the back every shift, it can be thankless. But at the end of the day, I’m not looking for a thank-you because I know I’ve done what I could do.
“Occasionally on the street, we’ll get someone stop us and say we think what you do is amazing. Just that once in a while … It gives you that fuzzy feeling inside,” McGovern added.
He said it sometimes feels that paramedics are unsung heroes. That is not conceit.
“I think the public knows why ambulances exist and why they come to people’s homes. I just don’t think the public knows all of what we do. We’re like an emergency room on wheels. We just don’t have the bright lighting or the controlled environment.”
Caruso said. “But, we have all the tools. We’re there to make a bad situation a little bit better, before the hospitals and their excellent staff take over.”
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