In this episode, Middle of Nowhere, EMS in Rural America, here to discuss saving lives, is a licensed paramedic and executive vice president at Texas EMS school: your host, Judson Smith.
Juddson:
Yes, I am Judson Smith. That’s become my official intro when these things start. I always reassure everyone in the audience. Yeah, that’s me; I’m Juddson Smith. All right, I have one of my best friends, Mark Flores, here today.
Juddson:
Mark and I have been around EMS for roughly the same time. Maybe I have, like, one year.
Marc:
Maybe. Yeah, I think 1 or 2. I just hit ten years.
Juddson:
Yeah. And I’m almost at 12. Yep. So, Marc’s time has been significantly busier than mine through EMS.
Juddson:
Just because of the situations you’ve put yourself in work wise. So, I didn’t say this before, but how this work is, there are cameras on us, but you and I, we’re just going to talk the whole time through this, okay? I don’t care if everyone that’s listening knows that. That’s how this works.
Marc:
I’ll try not to be super awkward about it.
Juddson:
You just did. Okay, so you made me feel awkward, at least,
Marc:
You’re welcome. You got it.
Juddson:
All right, so we’re going to start with what I usually like to have all my guests tell their story. Like who you are, why did you get into EMS, and what are you doing now? So you go ahead and tell me those things.
Marc:
Okay. Awesome. Well, my name’s Marc. I have been in EMS now for a little over ten years. I got into EMS because I was graduating high school, and my awesome band director was like, hey, you need to go to college.
Marc:
It would be best if you did something, make something out of yourself. He’s like, so your life so far? So, you’re about to graduate in a couple of days. You need to figure something out. Okay. Yeah, I guess so. We sat down. He did some tests on the computer, and he said, well, it says here you need to be a firefighter.
Marc:
In Texas, you must be an EMT or paramedic to be a professional firefighter. So, yeah, I went through EMT school and decided that EMS was more of the route I wanted to go at that time. So, I was an EMT for probably three, three, or four years.
Marc:
I got my paramedic and have been a paramedic for about six years. Getting a job immediately was a little hard because I just turned 18. Nobody wanted, really take a chance on somebody fresh out of high school brand new EMT.
Juddson:
Oh yes, hand me the keys to our $200,000 EMS machine.
Marc:
At one of the ambulance services, we had that amazing orange and white 2001 e350.
Juddson:
Oh, reliable. Mark is talking about an ambulance service that I ran, I appreciate that. Hey, that was a good investment. That truck outlasted all the other trucks.
Marc:
It did. It’s probably still alive right now. It’s going to outlive all of us.
Juddson:
Have you seen the movie Christine?
Marc:
No.
Juddson:
Do you know what it’s about?
Marc:
No, No idea.
Juddson: It’s about this car that the devil possesses. I mean, that’s how it is throughout the book; it plays it out a little more. I think that the ambulance was maybe possessed by, like, an angel because it saved so many.
Marc:
Maybe. Yeah. There are many sticky situations where, like, I hope this survives. And then it always did.
Juddson:
All right, keep going. Sorry. Where are you now? How did you get to where you are now? And what are you doing now?
Marc:
Whenever I first got into EMS, we started interacting with the Air Evac Life team because I always worked in a rural setting, so I decided I wanted to be like those guys. I did my years as a. paramedic and applied for air evac, jumping through all the hoops necessary to work at six three here in Abilene. And here I am. Now, this is interesting because you are our second six three member to have on the podcast in a row.
Juddson:
Our last episode was Derek from six three. And then it’s you from six three. Eventually, I guess I’ll just have everybody from there rotate through. Also, you have a sticker on your sleeve just so you know. I don’t want it to poke you. Eat it.
Juddson
All right, so you’re at six three, so you’re a flight medic now; you got your FPC, right? I do. Okay, so you’re in FPC and EMT. Yes. And you usually retake the test when you rectify, right?
Marc:
Well, the. Oh, man, I’m losing track here the last one or two times. Yeah. No, no, no, I, actually, last time I didn’t tell you about this, so I just submitted my CS, so I heard the test was changing soon.
Marc:
I didn’t know when because I was too lazy to go look.
Juddson:
You’re like, oh, might not pass it.
Marc:
Yeah, I had not fully prepared myself to take that test. So, you know what? I’m going to submit all the CS and go from there.
Juddson:
I can prepare you. I’ll get you ready. You’re going to retake it because you’re ready.
Juddson:
You’re my test-taking idol at this point. You have passed it every time. Why are you afraid now?
Marc:
I don’t know.
Juddson:
They eliminated the psychomotor exam. You know that, right? That’s completely gone. So they think they’ve built a written test that simulates that well enough, which, you know, but we’ve been training our students how to pass it, we make them verbalize every single thing they do when they do scenarios.
Juddson:
Then, it makes them think through the process. It makes it easier to see it on paper; I would do this, this, this, and this. Anyways, that aside, you’re the only medic I know who was retaking the test every time so that they could recertify. Everybody else is like, oh, thank God I passed that test one and done like, no, I’m going to go for it again.
Juddson:
I would assume that it doesn’t take away your medic. It would mean you’d have to redo your service or do your keys instead.
Marc:
Sounds right.
Juddson:
Everybody take that as it is. That was legal advice from Texas EMS School. I’m just kidding. Thanks for the sponsorship, Texas EMS school. All right, you mentioned before you got to the medic thing, that you did rural EMS, and that’s where you and I spent our time together.
Juddson:
That’s where we got to know each other in school. Mark is one of the best medics that I’ve ever known. Pretty much everybody else that has ever worked with him will say the same thing.
Marc:
Thank you, I value your opinion a lot.
Juddson:
Oh, that’s a totally different response than I usually get. All right. That, but it’s just reality. It’s something about this you just get and, thank God you do, because people need that. So working with Mark was always really interesting.
Juddson:
There are people’s stories that I want to bring up just because they’re funny. But I always ask everybody, It’s the question that nobody likes getting, I’m asking if they’re willing to tell, what’s the most memorable call? It could be good or bad. Remember, don’t share too much information.
Marc:
I’ve been a medic for a year or two. I wish there were certain people here who could help me share the story because they’d be like, I’m sure they still remember everything that happened. I was working at Stanford.
Marc:
Stanford EMS is a small ambulance service that covers a lot of ground, way out in the middle of nowhere. So, we were called to assist Haskell EMS with a possible delivery. So, we went out there and loaded the patient up in the Haskell ambulance so we could have the Stanford ambulance back in service.
Marc:
The reason is that they are neighboring.
Juddson:
Just a little backstory for everybody, you know, listening and watching. Yeah, they’re like, right by each other. Yes, sir. In neighboring towns, the Haskell ambulance covers the whole county, and Stanford EMS covers a more significant part of Jones County, the county just south of that.
Marc:
So, we wanted the Stanford Ambulance back in service in case, you know, there is a need for a call or mutual aid in Haskell. We still have that one truck up, we get a patient in the ambulance, and we’re thinking, oh, man, we’re out in the middle of nowhere, too. It is about 50 to 60 miles to the nearest hospital with a labor and delivery department.
Marc:
So because most, most small hospitals. And we’re going to get into this, most small hospitals don’t manage things like that. No, they don’t. They don’t have anybody there that’s ever delivered a baby in that situation. So. So, yeah, we’re, making her way, down the, major highway 277, and, our, ambulance decides it will have some issues.
Marc:
So, remember, medic one, that Ford, the one that took forever to get.
Juddson:
Yes. Yeah, I remember it.
Marc:
So that one, the turbo decided it did not want to work. So, we were probably limping along around 30 to 40 miles an hour. We probably made it out of that 60-mile trip; we probably made it halfway.
Marc:
And then we ended up having to assist with the delivery. So healthy, baby boy. I remember catching the baby and Melissa going, “Marc give us the baby.” What? I was just kind of just frozen.
Marc:
I was afraid that I was going to drop the baby. So, you know, you don’t want to be that guy. The baby is, you know, slippery and what not.
Marc:
It was awful. It was cool, but I was like, I don’t want to drop this baby. What do I do here? We were also really terrified at the same time. It was weird. A lot of people were there.
Marc:
All the first responders there said it was neat that the whole group came together and had a successful outcome on that call.
Juddson:
So that’s awesome. Have you seen the kid since?
Marc:
No, but I know some of the family members.
Juddson:
The funny story, the I’ve only done one delivery in the field, so no big deal. However, I delivered that baby and five years later, my wife was his kindergarten teacher.
Marc:
Wow. Yeah, that is wild. And that the mom and the family still remember.
Juddson:
I told the kid I delivered him, and he was pretty wild, so he wasn’t paying any attention to me. He probably will never care, but he has a picture of me somewhere.
Juddson”
Yeah, well, she invited us, me and the EMT, I think it was, invited us over to meet the baby. I remember that.
Marc:
Pretty cool. Yeah. That was. I would agree, though. That’s one of the most memorable things you can do in EMS.
Marc:
And it’s positive. Like, you don’t get a lot of positives. Well, you know, we get prepared always to handle the worst with our job. We should always be prepared for the worst-case scenario. Right. And what’s the worst-case scenario with the delivery? It goes wrong. Yeah, That whole time that it’s just going through your head, you know, you want everything to be fine.
Marc:
You want to do your job. You want to be able to do the least amount of your job because, you know, if we’re doing less as paramedics, that’s better for the patient because, oh, yeah, they don’t need the intervention, which is good. Yeah. The less we have to do, the less is wrong with the patient.
Marc:
It was terrifying but also pretty darn cool. Well, these are the types of situations that you find yourself in in rural EMS. Delivery is less common. But the idea that the hospital you’re near can’t handle what you’re doing or what you have is very common.
Juddson:
That’s different from the way they’re set up. They’re set up for emergencies to some extent, but there’s only so much they can do. At times, we have the same or more tools to do the same job. For example, if you were in Abilene, you may have five or ten minutes with your patient.
Marc:
When you and I were working together, you could have 30 minutes to an hour with that patient to try to manage what’s going on. And that can be a great thing. Or it can be extremely scary because a lot can go wrong in an hour when you’re trying to get this patient to the appropriate facility, such as the truck not wanting to run.
Juddson
Well, exactly. And that’s the other part of this. In rural EMS, you don’t always have the same resources either. When you’re in the ER, they are typically well equipped and have what they need, but we have both worked at services that did not have anywhere near what they needed at any given time.
Marc
Correct. I remember working for a small service, and after we worked the code, I was restocking, and I went, hey, where do I get the haad pads to replace on the monitor? And whoever was with me went, there are none. And I was like, what do you mean, there are none?
Marc:
Or where are we going to restock the AP? Let’s see if the pharmacy has some in the hospital. It’s just like, whoa. That’s, you know, some essential things to do. Our job, EMS in general, if there’s a backorder or a delay or anything, you may not have it, or you may not have the funding to get all those things because still, in Texas, EMS is not considered an essential service.
Juddson:
So, were you, were you on that huge wreck, where we had to land, like, three helicopters?
Marc:
Are you talking about the one where they had to cut quite a few people out of it?
Juddson:
No. Well, you know, situations like that where we have 6 or 7 patients, that was not all that uncommon to us.
Marc
Having one or two ambulances, maybe just one, to manage the situation was common. And so we learned that’s how you and I grew up in EMS. We learned to manage these problems in a totally different way because we didn’t have the same resources, so we just figured it out.
Juddson:
When you first start, you’re scared of everything. I would get call after call, and it was up to me and my partner to figure out what to do. There were no other resources to help us figure it out.
Marc:
In a trauma emergency, they do their best, but they don’t know necessarily.
Juddson:
Yeah, absolutely. Their specialty is a lot broader than ours. Sometimes, they’re just like, do whatever you think is best. Yeah. To be told that it is a 20-something-year-old who is responsible for these multiple patients on these wrecks and stuff?
Marc:
Just do whatever. This patient looks like they’re stable. Can we keep them stable enough to get them to the big hospital at the trauma center? Or do we take them to the closest hospital, which is, you know, that little critical access hospital?
Marc:
Now, they must jump through all their hoops and get all their treatments done. Then they must line up a transfer, which puts you in a weird spot because, you know, are you going to do best for the patient by getting them to that bigger hospital or the smaller one? And that’s the kind of thing that is going through your mind as you’re also trying to figure out how to handle this huge responsibility.
Juddson:
This whole episode is a kudos to all the people who work in rural EMS. And I’m absolutely not at all slamming EMS services in different environments because the medics who work in cities are very, very fast at what they do, which is always impressive to me. And they’re and they’ve got these resources. And sometimes, even when I worked in the city setting, I didn’t know what to do with those resources.
Juddson:
That was a skill set all on its own. You have the resources. How do you even use them? I’m still over there trying to manage this patient all by myself because that’s what I’m used to; it’s just different. Like I said, being in that environment can prepare a paramedic in a precise way.
Juddson
And I think it’s probably what made you into this medic that I view as one of the best. You were put in those situations, and you were much younger than me, and you were still making those decisions, and you were making good decisions. Neither one of us has always made the perfect decision.
Marc:
I agree. I can think of calls where I’m like, I could have done something different there. Oh, well, we all do that.
Juddson:
But somebody had to make a call. You know, and somebody had to do something. And I can’t think of any time when it caused harm to my patient or anything. Just things that I might do differently that would have been better for my patient in that situation. What is a time when you were on a call when you recognized that you needed more help than you had?
Marc:
Oh, man. Probably, a big chunk of serious calls that I’ve had where another set of hands, another paramedic would have been great, or another experience provider. And I’d only experience with somebody that you mesh with. That works well because I’ve, I’ve worked with some paramedics where I thought, man, I hope I never have to work with that person again.
Marc:
I’ve also worked with EMTs, where I’m like, oh, shoot, this guy’s fantastic at his job, or a woman is good at it. And I’m like; I hope she works with me more, or he works with me more. I might have to do more of the reports, but that was fine.
Juddson:
It goes back to Stanford and how many serious calls you have had where you’re like, our volunteer department is here, and now it’s not knocking anything on those guys. I’m 100% fortunate for their help, but we must not only do our job. Such as, you know, on a cardiac arrest, and analyzing the rhythms.
Juddson:
Get an IV, you know, getting an airway when only you and your partner were licensed to do that. However, the help that arrived was from the volunteer fire department. You’re like, hey, can you go get a stretcher for me, or can you do CPR? Or, hey, you’re doing that too fast. Slow down. And yeah, it feels like much more directing has to go on.
Juddson:
Which I mean may be good, as it’s supposed to be. And you know, maybe. But the difference is, is without the other paramedic there, you can’t delegate everything. No, there are only specific things that can be done. And you’re just trying to manage what’s left over. Like, if you want the monitor to be shocked or figure out the rhythm needs to be shocked, it’s on you.
Marc:
If you want an airway or have them intubated, it’s on you. If you, want to give meds, most of the time, it’s on you. Yeah, of course I’m going to bounce ideas off my partner and make sure we’re doing our job to the best of our ability. But if you’re the only paramedic on scene and then that’s it, it’s still falls on you at the end.
Juddson
Because Higher Certification gets the responsibility whether it was your fault or not, that can be difficult. Probably one of the hardest parts of being in EMS is the things you realize are falling on your shoulders. Sometimes, you look at a situation you’ve just been in, and you’re like, that could have gone so terrible, and it would have been all my fault.
Marc:
That’s hard; it’s one of those things that you can’t get away from. And it’s always, what if there I did have more help. What if I did have a more experienced provider there to help me because, you know, I appreciate your confidence in me, but I’ve not been doing this job very long yet?
Juddson:
I know there are many people who are a lot smarter than me, or maybe not even smarter, but they just had a better idea at that time. We all have different thought processes, even though we’re trained to think pretty much the same. Yeah, it’s a very challenging burde sometimes to deal with, but I like it. I enjoy it.
Marc:
Yeah. I try to be optimistic about it. All right. I’m having a good time doing it. You know, it is. It’s interesting.
Marc:
Yeah. I mean, it just is what it is, and you are making a difference because if you weren’t there, there would be nobody. You know, and these people dedicate their time to these positions where it can be scary because they don’t have everything. You know, that’s brave of them. That’s, that’s cool.
Marc:
And not I’m not saying that about myself; I’m speaking about anyone else who’s in the rural setting. I can think of a handful of people right now who are one of the few medics in that county, but they choose to stick around because they have family and friends. They’re raising a family in that area. They’re on the local fire department, school board, or the city council.
Juddson:
They are doing their best to help the community and make a living. That’s the other part of it. Soon, I’ll do a whole episode about how difficult that is.
Marc:
Yeah. Well, it just isn’t a high-paying job unless you’re willing to put in a great amount of time. The biggest benefit is that you get paid for your overtime. And so, you know, it can be a difficult job, but it’s a service job. It’s not meant to be the highest paying position out there.
Juddson:
There are some things that could be improved with how the pay structures work. But that’s a whole different episode. That I probably will never do. I don’t know.
Juddson:
Something that that always comes up when we’re talking about rural EMS, as we already mentioned. What are the most patients you’ve ever had on a scene with one ambulance available?
Marc:
When the patients were not green? I don’t know, quite a few.
Marc:
Yeah, I can think of one where there’s more than five. Yeah, I’ve had a I’ve had a couple, like, 6 or 7, but nothing super crazy where I black tag somebody. I’ve never had to do that yet.
Juddson:
Better knock on wood?
Marc:
It’s the kind of thing you have to do in those situations. You assume you’re never going to have to do that, but when you have limited resources and lots of patients at one time, you’ve got to make choices. And that’s just part of it.
Juddson:
I’ve noticed that, for some reason, in rural EMS, we have a crazy number of strokes that we have to deal with. Does it feel that way to you?
Marc:
Yeah, it does. I mean, it felt like we were dealing with a stroke every day. And even in a, in a low population area. But how many times was it dispatched as a stroke?
Marc:
Maybe twice. Yeah. Or you’re just needed for a lift assist. And you get there, and you’re like, hey, let’s get you off the ground. How are you feeling? Can you tell me your name? No, and they have that face from the ACLS video about strokes.
Juddson:
Those providers out there who have seen that ACLS video from that lady are the best actors or actresses ever because that stroke face is dead on. It’s impressive because she’s in other stuff in those videos where she doesn’t have a stroke; it’s clear that she’s just making a face.
Marc:
And she is committed to it.
Juddson:
So we talked about equipment. Mark mentioned the orange and white ambulance we used to have, which we bought from a military base for about $9,000. That little truck still ran for years. And we were, you know, all our new equipment, which I could sit here and tell that whole story of how we got that ambulance. And that would be a great episode. I should have Melissa on and talk about that sometime. We had this ambulance, and our new equipment was breaking left and right.
Juddson:
But this $9,000 ambulance that we got from an Air Force base or whatever, worked all the time. I mean, it just kept running.
Marc:
That truck would not die, off road, snow, tornado, you name it, it survived it.
Juddson:
I spun that thing around on the ice so many times. It was awesome.
Marc:
I’m a good driver. Melissa and I, there’s been a couple of times we’re like, oh, the water looks like it’s two feet. Oh, well, don’t stop. Just go. Somebody needs us. Let’s go. Was it the best idea? Probably not, so that’s just one example of some of the weird things that you have to deal with equipment-wise.
Marc:
Sometimes we, we couldn’t get our hands on, you know, the little boards that you put on there to keep people’s wrist straight when you do an IV. And so, they are expensive. I think it was Melissa and I went through and took pieces of cardboard, taped them together, and they’re still there.
Juddson:
I’ve seen them at the ambulance service still.
Marc:
It was thick enough that it was hard to move your wrist.
Juddson:
Hey, if it works, shoot. Exactly. You’re just going to take it off at the hospital anyway.
Juddson:
Well, so to kind of begin to wrap things up here with EMTalk, could you give advice to somebody who’s never worked rural EMS?
Marc:
Try to learn from your coworkers. The good and the bad. You’ll work with many people you’re going to be like, “Man, I hope I don’t form that habit.” On the other end, try to learn from those who are always optimistic and who want to strive for what’s best for that ambulance service for that county.
Marc:
I think that’s what’s made me survive all this time: I always try to be positive and optimistic about doing what’s best for the patient.
Juddson:
I like that advice and agree wholeheartedly. You’ll notice that you didn’t say to try to learn from the medics or the people who are there.
Marc:
Because there are EMTs who have been running their own truck for years. Before you ever got to be a paramedic at their service. And some people have been making more significant decisions than you’ve ever made because they’ve had to work in that rural setting.
Juddson:
Learn the good and the bad, and the bad will be obvious. It will be apparent that some people, just like any EMS system, are just done with it. They do whatever. It happens sometimes and tells you can’t stay in this game forever.
Marc:
Don’t remain stagnant. Just because you’re in a role environment where you’re sometimes not going to be running a lot of calls, don’t allow yourself to be lazy, stagnant, or not learn something. Always try to learn something, even if it’s something very minor even if it’s a five minute video on YouTube that day.
Marc:
Always try to better yourself, not only yourself but you know your partner and your coworkers as well.
Juddson:
I like that, and that is part of why I think you’re an excellent medic; it’s because you don’t. You don’t stop learning. You you’re always telling me about something new you learned. You especially were doing that when you first got on the helicopter every day; you’re like the new dude.
Juddson:
And which I welcome. Yeah, I love it. It’s great.
Juddson:
So, anyway, if any of this is interesting to you and you work in a rural area or you live in a rural area and you’re thinking, man, I’d like to be an EMT and help out my community and learn about this, we’re sponsored by Texas EMS school, and it’s a great place to start that journey or to continue your journey and get your medic.
Juddson:
And, maybe one day flying a helicopter or whatever you think works for you and whatever comes your way. So, look us up at texasemsschool.com.
Juddson:
Marc, thanks for coming today, buddy.
Marc:
Thank you all for your time. I appreciate it.
Narrator:
True stories about saving lives from the people that save them. This is EMTalk. EMTalk is sponsored by Texas EMS School. Join Juddson Smith again next time, because the life he’s saving could be yours.