By Clark Judge
(December 6, 2023) — The Killingworth Ambulance Association is so active that each year it answers more calls than the one before. In fact, from October, 2022 through September, 2023, it responded to a record 581 dispatches, a jump of 43 from the year before, and 122 from the year before that.
But those are just numbers. Someone must answer those calls, and that someone is a group of 15-20 volunteers who serve as EMTs and EMRs answering calls day and night … no matter the time … no matter the weather … and without warning.
Two summers ago, KAA president Dan O’Sullivan responded when no ambulance was available for what turned out to be an automobile fatality. He wasn’t on that evening’s schedule, but when he heard an urgent request for EMTs and Life Star he drove to the scene of the accident and assisted with the victim who survived.
Unusual? No. More like typical. It was one of 283 responses for O’Sullivan that year, breaking the previous KAA record of 207 set in 2019-2020.
He, Lisa Barbour, James Fretz (photo above) and wife Mary Robbenhaar-Fretz are the most active of the EMTs, handling more KAA calls the past two years than all others – often double-teaming as they combined for 1,409 responses, a figure so astounding that I had to know how they did it.
So, I joined James and Mary Robbenhaar-Fretz (photo above) on a cold and blustery November afternoon to observe first-hand what most of us can’t – namely, what an EMT does when answering a 911 call.
Here’s what happened:
12:04 p.m. – It’s Tuesday – James and Mary’s day on the weekly KAA schedule — and the day won’t wait. Shortly after awakening, they answer a 7:15 a.m. call that turns out to be a simple lift assist, and within an hour they’re back home. But they return later to the ambulance building so that James can address an ambulance issue and Mary can inventory equipment in the attic.
And that’s when it happens: A page comes in from Valley Shore Dispatch in Westbrook, seeking EMTs to respond to a call coming from a Killingworth resident in distress.
James and Mary are officially on the clock.
12:13 p.m. – The ambulance exits the KAA parking lot, with James driving and Mary sitting in the passenger seat to his right, helping to navigate.
12:17 p.m. – They arrive at their destination, with James backing the ambulance down a short driveway. When he and Mary emerge from the ambulance, there’s a surprise: The caller … and patient … is standing in the driveway, waiting to speak with them. Normally, patients are inside their homes awaiting help. But not here and not now.
A senior male, the patient is cognizant, courteous and in no visible discomfort. However, he immediately complains of severe abdominal pain, with symptoms that James and Mary seem to recognize. His condition is not life-threatening, but it can be … and, apparently, is …excruciating, according to the patient. After several minutes of questioning, Mary leads him into the ambulance, with James behind, and soon he’s secured in an upright position to a stretcher. On request, he rolls up the right sleeve of his plaid shirt so that Mary can monitor his vitals, including blood pressure. Then she and James cover him with blankets, set the temperature in the ambulance at 75 degrees and prepare to leave. As they do, Mary begins to review the patient’s medical history, making notes on a white pad as he speaks. She asks if he’s comfortable, and he’s not. The pain has radiated to his lower back, and it’s severe. Mary tries to comfort him, assuring him that the ride will be short. Then we’re off.
12: 23 p.m. – As we head south on Route 81, Mary sits to the right-hand side of the patient – approximately 12-18 inches away — and continues to write on a small sheet of paper as he responds to her questions. She’s calm, comforting and intent on engaging him in conversation. But he’s anxious and distressed and wants to know how long before we reach a clinic. Our destination is the Yale-New Haven Shore Line Medical Center in Guilford, approximately 15 miles away.
Mary: “Usually, when we approach, we’re trained to assess the scene right away. So, when we walk in, we ask ourselves: ‘Is it safe?’ Then we put on our gloves. It’s what we call ‘BSI’. Body Substance Isolation, which is a system of generic infection precautions. It’s a nice day, and it’s dry outside. It looks pretty safe, and … wow! … the patient is right here, and he’s upright. He doesn’t have a traumatic injury, he’s alert and he’s oriented. So, right off the bat, we know it doesn’t look like he cut himself because he’s not bleeding, he doesn’t have a head injury and he’s able to tell us what’s wrong. And that’s great. But we knew from Valley Shore that he’d had a recent surgery. So this probably was going to be related to that. Why Guilford? Because he requested it. His doctor was in the Yale system, and he had his surgery at a location associated with Yale. Plus, all his records were there.”
12:26 p.m. – The patient continues to experience significant back pain and asks Mary to move him to a more upright position. She does, then punches information into a portable computer to her left. Now in visible discomfort, he asks if she can remove the straps tying him to the stretcher so that he can stand. “I can’t,” Mary says. “It’s not safe. Try taking deep breaths.” She asks if he’s had anything to eat or drink recently, and he hasn’t. Then he begins to cough violently. “We’re almost there,” she assures him.
12:37 p.m. – We join the traffic on I-95, and it’s heavy. “Holiday traffic,” Mary says. Nevertheless, James is able to maintain a speed of 60-65 mph. By now, the patient is so uncomfortable he asks to have straps loosened so that he can sit more upright. Mary does what she can but reminds him that he must be secured to the stretcher. She takes his blood pressure again, checks his heart rate and is confident nothing … outside of lower back pain … is wrong. His blood pressure is good, and his heart rate is stable. It’s the pain that’s the issue, and she asks him to rate it on a scale of 1 to 10, with 10 the worst. “An 8 or 9,” he says. Mary seems relieved. She thought it would be worse.
12:44 p.m. – The ambulance exits onto Route 77 in Guilford and takes a right-hand turn. Mary asks the patient to sign a medical form on her computer so that Medicare … and not the patient … is billed, and he complies. His pain hasn’t subsided. If anything, it’s worse. “We’re here,” she tells him, “and they’ll figure out what’s going on. But you should be OK.”
12:45 p.m. – We arrive at the Medical Center.
Mary: “I was just trying to make sure he was stable and that there was nothing else going on. He said he was feeling nauseous, so I was worried. But he hadn’t eaten much. So I think the nausea was from so much pain. I was just trying to get accurate vital signs for documentation and distract him a little bit to make him as comfortable as possible. Because we really can’t give pain meds, we try to keep patients as comfortable as we can until they can be assessed. I didn’t want him to stand up, but I did want to keep him sitting upright in case he vomited so he wouldn’t choke. Essentially, I wanted to keep him as safe as possible, gain an accurate assessment of his vital signs and get pertinent medical history for the patient-care record – information that might shed light as to what’s going on. When you get to the clinic, they want to know the story. But they also want to know his history, like what meds he’s taking and any allergies he might have. So you prepare in your head a brief report for when you get there, and I did. But there are a lot of things to think about.”
12:46 p.m. – James opens the rear doors of the ambulance. Sitting upright, the patient is lowered from a power lift inside the ambulance to the parking lot below, then pushed into the medical center … with Mary in front and James pushing from behind. They pass the front desk and walk to a station not more than 10-15 yards down the hall where the triage nurse is located.
12:48 p.m. – Mary speaks with the nurse and shares the patient’s medical history. He remains with James outside the glass enclosure and, remarkably, seems to feel better now. He answers Mary when she asks for the date of his prior surgery and information on allergies and medicine he should avoid. “They’re all on my chart,” he calls to her. James then attaches an ID bracelet to the patient’s left wrist.
12:51 p.m. – Mary and James wheel their patient around a horseshoe-shaped hallway and take a left-hand turn into an area with an empty bed and curtain that, once pulled, turns the space into a private enclosure. They lower the stretcher, unstrap the patient and ask him to stand. He does, without assistance. Then he reclines on the bed, again sitting upright. James removes all towels and linens from the stretcher and deposits them in a hamper for dirty linens. Once that’s done, he pushes the stretcher out of the building and into the parking lot where he will clean it. Meanwhile, Mary remains behind, making certain the patient has his wallet before she gives a nurse her report. “It’s our division of labor,” she says, nodding to her husband as he leaves.
12:59 p.m. – Mary finds the triage nurse, has her sign off on the report and declares the trip complete. “That’s it,” she says as she packs up. “We’re good.” She wishes the patient good luck, and he thanks her. “Hope they get everything figured out,” she says as she walks away. He nods and waves.
1:09 p.m. –After cleaning the back of the ambulance and dressing the stretcher in clean towels and linens, James and Mary climb back into the vehicle, exit the parking lot and head for home, James again at the wheel, Mary in the back.
1:28 p.m. – James pulls into the KAA driveway and notifies Valley Shore that he and Mary have returned and are back in service.
1:29 p.m.: — The ambulance is parked inside the KAA building, and the engine is turned off. Mary and James walk to the office inside, sit down in front of computer and enter the necessary information to complete their trip. Within a half-hour, they will head for home … and wait for the next call.
James: “That was an easy one because everything went smoothly. What you’re worried about when you transport someone is the patient getting worse while they’re in the back. But that didn’t happen. The patient stayed stable, and there wasn’t anything critical as far as the status of the patient. But you can tell right away when you go into the call and start evaluating. You can tell when they’re talking to you … and, in this case, the patient was conversant, alert and oriented. So it was pretty straight forward. We just happened to be in the building when the call came in, and we answered after the first tone. Simple as that. If you’re on call, you respond right away. And that’s what we did.”
Photos by Clark Judge