Being the best you can be

   

People’s lives are constantly at a risk; some lives are surrounded by danger while others get involved in unfortunate sudden collisions. Then there are those who put themselves at risk in order to save other lives at risk. At Johns Hopkins Lifeline, you will find those people - picking up calls at each of their own little desks, monitoring screens, tracking locations, rushing to save people, and doing their jobs - working as paramedics. Former paramedic EMT for nearly 32 years, John Oliveira, toured me around the Lifeline and brought me into their lens. Now working as a critical care paramedic supervisor for 15 years, Mr. Oliveira is the “main man” keeping everything in order.

 

The day starts pretty early and as a supervisor, the first part of his job is to check with the communications center to see what’s going on - staff meetings, calls on board, etc. The communications manager runs a report and pulls on information on the big screens to see what to expect. Mr. Oliveira checks to see if they’re going to need site beds or ER beds, then answers his own questions. “If our ER is full, we have to send people to different hospitals. If our ICU’s are filled, which is our main job, same thing happens and this happens every day so we have to move people around.” Using Systems Status Management (SSM), the crew at Lifeline posts their ambulances based on where they expect calls to be. After sending the crew outside, Mr. Oliveira, moving to another floor, checks on the crews and runs through some reports. According to Mr. Oliveira, compliances are a big thing - state, government, and insurance. “If we get a call and there’s a report of that call which has to be filed, I’ll do that. Then as I was saying, we have to put out fires because things happen all the time. We have to go help the crew upstairs, get the crew in service, run a call, etc.” As if this much movement wasn’t enough for a day at work, the worst part comes yet: meetings. But for Mr. Oliveira, the real struggle is motivation. “The struggle with me personally though, is to be motivated to do the administrative duties - I hate it. But I love being clinical. I love helping out my patients and I love being with my colleagues. So a bad day here isn’t even really a bad day at all.” Wow, if only everyone had that mindset.

 

“We’re the only approved operation that can move highly infected patients”

 

At Lifeline, a lot of responsibility takes place in and out of the hospital. But at Hopkins, the amount of responsibility becomes heavier when more critical patients arrive.

 

“One of our jobs here at Hopkins is we’re the only approved operation that can move highly infected patients - patients with Ebola, SARS, or MERS. So we have a special operations team called Sort Team.” The Sort Team gets training about twice a week in the BCU (Biocontainment Unit), which is the only part of the hospital that accepts highly infected patients. Unfortunately, there are times when there are unexpected occurrences and visitors. “In this part of the world - Maryland - we have a lot of international travels here. A lot of international workers. No matter how healthy you are, you can get exposed.” Besides the struggle with international workers, Hopkins puts in the effort to make the greatest achievements. “We caught eight CID (high consequence infection/disease) and that’s usually how we call it because it can’t just be a bullet - it could be anything. So we get ready for it, and we train and train and train.” The supervisor tells it all. The phrase “No pain no gain” that I have been trying to figure out as a student finally makes sense to me now in one sitting.

 

 

Critical calls and a mission that settles it all

 

As a critical care transport team, each and every incoming call is critical. Of course, there are ambulances available for basic calls (like discharges to home or long-distance calls) that work with the hospital line. But everybody else here at Lifeline is in the critical care advance support unit. The calls at critical health can be of any kind of issue; brain issue, heart issue, lung issue, but Mr. Oliveira says they’re all tied together regardless. Yet, the main diagnosis here at Hopkins, he says, is if any patient needs to come to one of their ICU’s, they’ll come get anyone who’s in need. “Our bread and butter call is you’re in Hopkins ICU and you need to go do a test. So there is what’s called a cusp study.” That means the risk of moving a patient out of an ICU for a test and the percentage of resistance is nearly 22 percent. At Hopkins, by sending a special team consisting of nurses, paramedics, and the EMT, they’re less than one percent. According to Mr. Oliveira, training is vital. Being able to deal with the patient if anything were to happen and moving them safely is their number one job. That’s what’s unique about the system at Hopkins and surprisingly, it’s nothing new to them. Patients become very sick and the team at Lifeline has those ICU experiences even in ambulances and training becomes endless. But sometimes the patients are at extreme risk and that has to be taken care of. “When we put you on an ambulance, we put physics to you; we move you around and all these monitors and drugs and tubes get shifted.” Though there’s less shifting in the ER, it’s not much of a difference. In the ER, doctors deal with a lot of indigent mental-health issued patients but overdose is a bigger, more common issue. In the state of Maryland, so many people are addicted to overdose and they all like stronger drugs. But Mr. Oliveira couldn’t know the city better. “I’m born and raised in Baltimore so this is my city. I love it and now it’s worse. We’ve even lost providers and people you would not suspect. It’s so prevalent everywhere and it’s so easy to get in - it’s so strong. That being said, Hopkins has its own security force here.” Some of them are armed, he says, and it’s important to have that kind of security around not only for the patients, but for the workers. “Baltimore is a sick city for sure but I think it’s a great city. This institution alone is world famous - Hopkins has done a lot for Baltimore. Day to day, overdose is a problem and our providers work through it.” They also do standbys for supporting events; EMT based ambulances responds to the campus or any other fairs and events. There are a lot of under-aged drinking in the campus and a lot of the same calls in the city (heart attacks/strokes). But the team at Hopkins has their own objective. “Our mission here at Lifeline - we’re not like a fire department - we’re critical care so we move inner facility into inner hospital.”

 

 

As you walk into the entrance, you will see a mat of different languages welcoming patients and visitors. On the far right corner labels a welcome in Korean.

 

“We do everything we can and sometimes it doesn’t work. But we don’t give up.”

 

Picking up calls from people who are in extreme danger, paramedics as the first responders, carry a lot of pressure on their shoulders. They put themselves in danger but there are a couple of ways to cope with that kind of conflict. “As I’ve said before, we actually train our providers how to talk to people and it’s called Team Steps and that is where regardless of your training, you have some power in the situation. Then, everyone has a knowledge base too.” This means that even the EMT should be aware of the situation so if anyone misses information, they have the operation to speak up and they can listen to them. Moving locations also becomes a problem, especially going into another hospital. Sometimes, walking into another hospital feels like they’re walking into their space and taking over. In order to keep things professional, they have to dial back and have somebody talk to their staff. But not everything works the way we want it to. “Stress is stress, and some people don’t do well. The most stressful situation is family member, usually.” Mr. Oliveira understands that it’s normal for any family member to be stressed out and have come along way of that as a team - now they allow family members come with them to see that they’re doing everything they can. This has improved immensely. “You’ve got to filter the noise.” But even once that’s over with, there are some people who believes that can’t happen to everybody. “But man we try. We do everything we can and sometimes it doesn’t work. But we don’t give up. We also don’t believe in somebody who is too sick to transport. You need to come here and we’ll go get you.” I could tell just how powerful the mindset and sympathy is for the people at Lifeline. This made me question - if anything bad happens, is the pain universal? Indifferently, he says it’s not universal; in fact because they all have their own issues, the whole team is almost invulnerable - their emotions are bulletproof. Though there are some triggers, the team will see that and protect each other by stepping back. “The main thing we do as far as team steps is we huddle. We make a plan and afterwards do a ‘hot washer’ and ask how did we do - is everyone okay? We talk it through and that is an amazing difference it makes.” They make a great team, but just like every other relationship, there can be struggles. Personally, for Mr. Oliveira, the problems are not medical. Sometimes, different beliefs in many aspects can turn a conversation uncivil quickly. “If that can be fixed, that’d be great.”

 

“As far as healthcare, I’m paying for it.” Mr. Oliveira strongly believes in healthcare being a right. “People are afraid to exit health departments and healthcare because they can’t afford it. Our current government and about half the population don’t see healthcare as a right, and to me that’s wrong because healthcare is a right. If you want a healthy country, you need healthy people. Everybody should have an access to good healthcare - it should be a right. That’s what needs to happen. If not, people don’t care.” To work towards his belief, Mr. Oliveira ensures that healthcare can become a right by helping the community and making a difference for the better.

 

“Talking is just as big as to listening; it’s paramount to everything”

 

At Lifeline, you will hear a lot of dial tones and questions like “what, where, and when(s)” in every direction you turn. Because talking is so prevalent, I was curious to know to what extent the importance of talking is both in and out of the hospital. His answer - simple – it’s vital. First thing is first, if they’re talking about anything, they have to know what they’re doing and maintain that. “Talking is just as big as to listening.” Even between students/interns and residents/doctors, talking and listening go hand in hand. To go back to civility, some people just need to be heard.

 

“If we can emotionally calm you down, it’s a huge thing.” To make communication easier and more effective in terms of its relationship in the medical field, they created something called telemedicine. “In your house, in a clinic, we’ll have you and an intermediary with a computer and a camera talk to your doctor. We have face-to-face but they’re not there with you so it’s huge and it’s impressive.” As far as EMS, they’re working on community care medicine - going to houses, making sure people are okay, checking to see if patients are taking the right medications, and seeing if there’s anything in need. Using telemedicine, they bring a doctor and do tests instead of going to a hospital, which allows the patient to go where they need to go. He says insurance companies like doing that because it saves mission bills. The problem with this is that there is no money because nobody wants to pay for it. Mr. Oliveira believes that it’s almost criminal to simply see people just sit there without getting help and waiting last minute until they have to go which all could’ve been prevented when people started acting faster. “Our culture is broken; some people don’t have family to support them here. There’s a lot of people by themselves - not just old people - young people.”

 

 

 

 

 

Why is training so important?

 

As far as training goes, there are a lot of opportunities and experiences yet to learn for many aspiring paramedics. For instance, the simulation labs at Hopkins were specifically created to give students/interns a first hand experience using mannequins. “The main thing is when we use simulation, it ties in your book learning and your real world experience to a human being thing and it makes you more confident for real life. We also can focus on a single skill but we try to tie things scenario based.” He says the higher fidelity and the consistency of the scenario are all valid tests and that’s why it’s amazing. During testing with students/interns, there are two terms in which they have to make relations with: reliability and validity. To be valid, if a group tests on the same mannequin, they all have to do the same test - this is valid because everyone will know the same thing. Mr. Oliveira also adds on that training in this generation is much more effective and easier compared to the training that he went through when he was in paramedic school. Back then, everyone used to put IV’s into each other but now mannequins have made that easier - though you will have to intubate someone eventually, simulation definitely makes students feel more prepared than before. “When we train, no matter who you are in the team, we all train the same way.” Besides training, I asked him about summer volunteering/internships and whether he thought it was important. Followed by a simple “yes,” Mr. Oliveira added a short anecdote - he in fact did summer volunteering when he was just a student. “The reason I’m a paramedic is because my mom was a nurse, and I came to this hospital when I was 13 and I had to summer volunteer. I was in the CT scan department and I would move people around and watch the films - it was fascinating. They taught me about it and it was great.” At that age, he remembers a specific emergent incident in which he witnessed. A woman had to get her chest cut wide open after a sudden cardiac arrest, and Mr. Oliveira stood there, watching with his eyes widening - an unforgettable memory. When doctors asked Mr. Oliveira - a kid at the time - if he was okay, his answer was yet again simple but unexpected: “That was awesome.”

 

Working through bad situations and overcoming the obstacles

 

So far, Mr. Oliveira - the man who is a role model for many aspiring successors - has told me about the rules, the issues, the priorities, the unforgettable experiences, and some of the future hopes that he along with everyone working at Lifeline has. Now, it was time to ask the big question: what is the definition of success?

“To keep it simple, I’d say be the best you can be. It’s entirely dependent on you personally. My best is for sure not your best and vice versa. But be the best you can be, and do the best that you can.” Throughout his years of learning and teaching, he remembers both the good and bad experiences he dealt with. The bad calls, the mistakes, and the times where he tried everything he could but nothing worked out - unfortunately, he says, this sticks in his mind more. Yet despite the falls, Mr. Oliveira affected hundreds of lives which remains as his highest satisfaction. He also has an immense satisfaction and pride teaching young EMTs and paramedics. He loves mentoring providers and feels like they’re all part of his family.

 

After interviewing Mr. Oliveira, I not only learned more about a field that I had no familiarity with before, but I also became intrigued and inspired by the integrity and grit expressed by the team. Walking into the communications center and touring around the whole building at Lifeline allowed me to step into their “home” and to put myself in their shoes. I was able to feel the tension, the movement, and the pressure as I heard the stories and experiences that Mr. Oliveira himself and the team went through during the 15 years at Lifeline thus far. Even simply listening to someone talk about their job, my day there genuinely felt like a ride; hearing the ups and downs, the lessons learned, and the motive to keep moving forward, all led me to think and feel like a paramedic.

 

Although this “ride” ended for me, it’s endless for Mr. Oliveira along with the rest of the critical care team at Lifeline.

 

 

 

 

 

      

NEWSROH column 'Claudia’s Web of Wonder'

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