Long-time Operations Manager for the non-profit MedStar Ukiah Ambulance Theresa ‘Terry’ Gowan was Cobb Martin’s guest on KXYX’s “Mind, Body, Health” program last Tuesday morning. Ms. Gowan is one of the long-time stalwarts of inland Mendo’s emergency response system. Gowan, a Philo resident, frequently helps out responding to Anderson Valley calls when she’s not at work for Medstar in Ukiah.
Medstar has about 40 employees and operates four ALS (with a paramedic and an EMT) ambulances 24/7 and one BLS (EMTs). Willits, Redwood Valley and two in Ukiah. Also BLS ambulance (two EMT) for interfacility transfers between hospitals. Paramedics can give more meds and intervenous injections.
CoronaVirus — Gowan said the best thing to do is wash hands or use hand-sanitizer all the time. “Wearing a mask is not helpful unless someone is coughing in your face which they should not be doing.” Kids too. Use wipes before and after touching ordinary things like shopping carts or after pumping gas.
Mendo College’s Paramedic training program had been a feeder system for Medstar — there are six graduates of that program still in Mendocino County — but it went away in 2011 and "it was a huge hit." Santa Rosa JC and College of Redwoods in Eureka are the next nearest programs, “but it's a commute.: Mendo College, where Gowan teaches a fire safety program among other classes, is trying to re-start their paramedic program by partnering with another school for a satellite program while they work on accreditation. They don't have specific timing yet, but the satellite training program could begin as early as this fall “if things fall into place.” It's about an 18 month program, added Gowan, including classroom time, clinical time and internship. A prospective paramedic needs 480 hours on an ambulance before getting a paramedic license. And generally you need to be an EMT first with some anatomy and physiology classes. So it won’t be any time soon that Mendo College produces a new paramedic for Mendo.
Program Host Aaron Cobb Martin asked Gowan and what she liked about her job as a paramedic:
"I was working in the emergency room and decided I wanted to go to nursing school. At the time Napa College had a bridge program for paramedics to registered nurses. That would've taken me less time than if I went the traditional way. So I got my paramedic license. I was working for Ukiah ambulance (now MedSTAR) as an EMT and I realized I liked working in the field. But when I got my paramedic license I realized I had much more freedom than a nurse does to make my own decisions. I follow the protocols of course, but I don't have to ask a doctor for permission to do something for a patient. And I'm the first one there in their time of need. It's very satisfying to know you are actually helping somebody as opposed to having — and I'm not putting nurses down at all, they do an amazing job and they work some of the same situations that we do — it's just a little different. I like to work on my own and use my brain to figure out what's going on with the patient with the limited resources we have in the back of the ambulance. I don't have a lab to tell me what's going on with the patient's blood work or an x-ray machine. It's kind of like a guessing game to figure out what's going on with your patient by talking to them and seeing what's going on. Every day, every call, every 911 call that comes out, you never know what you're going to see. Just because they tell dispatch one thing when they call 911, that does not mean that that's what's going on with them. So I like to think outside the box and be the first person there for a patient in their time of need."
Medstar has a huge response area. From Cominsky station to the south (south of Hopland) all the way up to the Highway 162 turnoff to Covelo going north, to the Lake County line going east, and to approximately mile marker 23 on Highway 20, as well as Anderson Valley. Medstar also responds up to 15 calls a month or so to Covelo when requested. Response times range from two minutes in downtown Ukiah to up to an hour “if we are going to deep Anderson Valley, Covelo, or some places in Potter Valley.”
Gowan said that despite the difficulties keeping ambulances on call on the inland corrider, they’re doing better these days. The City of Ukiah will put an ambulance in service if necessary and Laytonville’s one paramedic ambulance makes a big contribution as well.
Gowan said that emergency rooms these days are “crazy busy.” The Ukiah Emergency Room is seeing about 100 cases a day recently. And “it’s busy everywhere.” “We’re having good weather and people are still having accidents.”
“We’ve been seeing more drug overdoses than we used to,” worried Gowan. “So we’re using Narcan more than we used to.” EMTs and other volunteer fire responders and law enforcement have been trained in using Narcan and they are using them “a lot.” The opioid overdose problem “is huge and it’s just getting worse.” Gowan said that if a family needs to, Narcan can be obtained for personal use over the counter from local pharmacies. Typically, opioid overdoses cause someone to stop breathing leading to cardiac arrest. Narcan essentially gets someone breathing again and in a number of cases a patient may need “repeated doses.” Gowan said that she knows of cases where people are cutting heroin with fentanyl. “That’s a bad situation. Especially if you don’t know that, like when you get your drugs from a different supplier. I have to ask people what drugs they use and whether they got their drugs from their regular supplier. That can be huge. If you buy it from someone other than your usual source, you don’t know what it’s cut with. What’s in that marijuana or that heroin you just bought? I don’t judge. I don’t care, but I need to know before I can fix you. People will say, ‘I’m not using drugs,’ but I have to ask.”
Gowan said emergency responders are trying to use fewer opioids in emergency medicine, but it’s still necessary for pain management. Sometimes these days pain med prescriptions even come with a Narcan package. “We only give Narcan when someone is not breathing enough to maintain life,” said Gowan. “There are no side effects from it, so there’s no harm in using it if indicated.”
“We also have to be aware of combativeness,” added Gowan. “You have just taken away their high and they’re not going to be happy. People have been known to vomit, a withdrawal syndrome. Also seizures are common with patients who use opioids regularly. Narcan will cause someone to go into withdrawal. So you have to watch those symptoms. Hopefully, they’ll start breathing. Take care of the breathing first, of course, then the Narcan.”
Cobb Martin noted that Narcan is a nasal injection and is not too difficult to administer, so people might want to get familiar with it and get a little Narcan training.
Gowan concluded by urging people to volunteer or even enter into an emergency services career. Some higih schools are now conducting entry level training for seniors. Contact your local fire department or Mendocino College for more information.