Ask Anything: 10 questions with Cary EMS Chief Steve Cohen

Bob, a great question to start off with. The easy answer is that it's a person who enjoys helping others.

The person also has to like people and have a sense of humor. There is a lot of bantering that occurs in EMS between partners and others in EMS. You must like to eat fast food (at times you never get a chance to finish or even order). A person who likes to be challenged every day, because you never know what or when the next call will occur.

I am in my 27th year in this profession. I am not an expert on what the common traits are, but I do have an opinion. I can tell you what I have seen and learned.

Here are some of the traits I have seen. The EMS person is caring, compassionate, is able to communicate well, has fast instincts, is a problem-solver, is able to think fast to make quick and correct decisions, moves furniture (we find patients in tight spaces), and is able to gain a patient’s trust.

This last one is important. We have a short time to gain the patient’s trust because they are having an emergency and they are depending on us to help them through this emergency. I want to end this question with this: it is also cool to drive an ambulance.

Kristie, first let me define heart attack and cardiac arrest. This may help everyone understand the two terms, which get used interchangeably on a regular basis but have different meanings.

A cardiac arrest is when a person stops breathing and the heart stops. First, I want to tell you and everyone, do not delay calling 911 if you are having chest pain or any symptoms that you feel are not normal.

In the Wake County EMS System, we use 12-lead technology on all our ambulances (different views of your heart) to see if you are experiencing a heart attack. We then use Bluetooth technology to transmit our findings to the hospital. We want to transport you to a hospital that can correct the occlusion. We are currently studying this aspect and should have data to report soon.

What I can tell you is that the percentage of patients surviving a cardiac arrest out of the hospital to then be discharged from that hospital is 38 percent in Wake County. The national average is about 20 percent. Why are we so much better? We have a great team that starts with the lay public.

Kristie, for example, you recognize that someone is in cardiac arrest, you call 911, and you tell the 911 operator the requested information, including that you do not know CPR. The 911 operator has already dispatched EMS and the fire department while talking to you. The 911 operator can teach you to do CPR over the telephone. The fire department arrives and takes over CPR and applies the defibrillator. A few minutes later, EMS arrives and provides emergency treatment that includes IV therapy, medication administration, advance airway procedures, and defibrillations if necessary and then transports to the hospital.

One of the reasons we have been successful is that our medical director instituted additional training and new protocols that cool down a person who has been resuscitated in the out-of-hospital environment. So it is a team effort from the public, 911 operator, fire department, EMS and hospital that allows us to be on the cutting edge.

Jim, I am asked this question on a regular basis. It is a good question.

I am not sure what occurred with the patient you mentioned, but more than likely she would not have received a bill. When we respond, our intention is to treat the patient and transport them to the hospital. Some patients call EMS and then do not want to be transported after receiving treatment. Depending on that treatment (assessment, vital signs, IV, medication, heart monitor placement and evaluation) the patient would receive a bill. If a patient receives an assessment, vital signs, and a blood sugar check and still refuses transport, they would not receive a bill.

Susan, all Wake County EMS System ambulances carry epinephrine. Please stop by and I will give you a tour of our ambulance and the equipment we carry.

We have an excellent volunteer program. We are always looking for volunteers all year round. Our volunteers are one of many reasons Cary Area EMS is great.

No, you do not have to live in Wake County or Cary to be employed or volunteer at Cary Area EMS. If you are interested in riding along as an observer, just give me a call at 380-6909 and I will schedule a ride-along for you.

Sarah, I am glad you asked this question. There is a lot of talk and news coverage on the new compression rate when using CPR. I am proud to say that the Wake County EMS has been performing this new standard for more than two years. Our medical director is proactive and placed this skill in our practice.

Chief, thanks for writing. I see your portrait on the Chief’s Wall everyday and we thank you for your service to Cary Area EMS.

Training has changed in EMS since your tenure. In North Carolina, there are three state certifications a person can achieve in EMS. All three levels learn about medical, trauma, obstetric and environmental emergencies and treatments.

The first level is Emergency Medical Technician (EMT), which is 169 hours of training. This is the initial certification and includes course work and practical sessions. After completing this course work, there is a state certification test that the student will take to obtain the certification as well as the other two levels.

The next step is EMT-Intermediate, which is 256 hours. At this level, the student builds on what he or she learned as an EMT, which includes recognizing and treating heart rhythms, IV therapy, pharmacology, administrating medications, advance airway procedures and clinical rotations in the hospital and in the field.

The next level is EMT-Paramedic. In North Carolina, the course is 1,096 hours, which builds on both the previous levels, includes extensive education and training: recognizing and treating heart rhythms, cardiology, pharmacology, administration of medications, IV therapy and advance airway procedures, to name some of the topics covered. There are also clinical rotations.

After becoming state-certified, there is continuing education. At Cary Area EMS, we train every month. As a paramedic, I attend mandatory training with the medical director every other month. There are numerous EMS professionals that attend training every month. Also, if you hold a national certification, you must complete 48 hours of core training, plus an additional 24 hours within a two-year period.

Here is an interesting fact to know: you can obtain an associate, bachelor's, or master's degree in EMS.

Bob, thanks for being part of a great system and great organization. I will do my best to answer your questions.

Please indulge me for a few seconds as I explain for those who do not know how EMS works in North Carolina. In North Carolina, the counties are responsible for providing EMS to the citizens and visitors.

The Wake County EMS System is made up of Apex, Cary, Garner, Eastern Wake, Six Forks and Wake County EMS. We function as a system, using the same protocols, standardized equipment (heart monitors, computers for example), training and medical director.

The Wake County commissioners have asked all departments to look at consolidations. Since Apex, Cary, Eastern Wake, Garner and Six Forks EMS have contracts with Wake County government to provide EMS, the system is looking at consolidations. There is no time table for consolidations. At this time, I do not know if Cary, Apex, Garner or Six Forks will consolidate.

Heath, thanks for asking about this topic. I can tell you that on a regular basis, the Wake County EMS system looks at data to see how we are performing.

As mentioned above, Wake County has a 38 percent discharge rate from the hospital after a cardiac arrest. What we want is to have a defibrillator to the scene of a cardiac arrest as fast as we can. We do this by having defibrillators on fire trucks. The fire departments in Cary, Raleigh and Wake County all have defibrillators as part of the equipment on their apparatus. We work well with all the fire departments, which is important because we all want the same outcome, which is to save lives.

The public can help by making sure that AEDs (automatic external defibrillators) are in public buildings, churches and airports, to name a few places. The public can learn CPR. One other aspect to know is that there should be no hesitation for the public to call 911. We know that some of our patients say they do not want to bother us, but you are not. So please, if you need an ambulance, do not hesitate to call 911.

The data for the system is presented at the quarterly meeting of the Peer Review Committee. This meeting is open to the public and is mandated by the state. The next meeting is in September, which you are invited to attend. The meeting is held at the Wake County EMS Training facility. If you want more information, please contact me at 380-6909.

Stephanie, you ask a question that is difficult to answer. Let me start by telling you what we learn on our first day in EMT school.

We learn to make sure the scene is safe before entering. We also learn that we cannot help if we are injured or dead. For example, we respond to a shooting. We will stage a few blocks from the incident until the scene is secured by law enforcement. Though we are trained to handle emergencies and want to get to the patient as fast as we can, we let the professionals do their job so we can do ours. It is a tough lesson to learn.

In my career, I have been trapped for 45 minutes under gun fire, almost stabbed and have had a few frozen turkeys thrown my way. I, as well as other EMS professionals, understand the risks involved in our job, but we also want to go home at the end of our shift.

So to answer your question, my advice is that if you see an accident, call 911 and let the professionals perform their duties.