Posted on 06/13/2003 5:19:55 AM PDT by Lorenb420
For two hours on Monday, an ambulance sat in the parking lot of Sunnybrook hospital's emergency department with a suspected SARS case on board. In the back of the ambulance, two paramedics kept a close eye on the deteriorating and contagious patient, all within the tiny 1.5-by-2.5-metre isolation unit on wheels.
The paramedics had called ahead to tell the hospital to prepare a negative pressure room and be ready for this patient. It didn't matter. They were forced to sit and wait.
"There's a lot running through your mind," said paramedic Marty Bulai, who had a similar incident at Scarborough General hospital. "It's one thing when you take a risk on yourself, but it's different when you take it home to your wife and kids."
That is just one of the risks and dangers paramedics on the frontlines of the fight against SARS face each and every day as part of the "new normal."
SARS is like nothing our health care system has faced before, and it has forced unbelievable stress and changes to the people who handle patients in some of the most dangerous situations in the city.
"In my 19 years I've never seen anything like this," said paramedic Dave Doiron, who now drives an ambulance bus. "This is our Sept. 11, just longer.
"I think some people are saying '$25 an hour for this, it's not worth it.'"
Older paramedics are considering taking retirement packages as soon as possible, younger workers are questioning whether they want to do the job at all anymore.
People avoid them in elevators and give them extra room in line at the coffee shops, treating them like lepers.
And every paramedic is dreading the first heat wave. The medics are already drowning in sweat under the double gowns, double gloves, goggles and double masks.
From start to finish of every call, all their precautions -- including the masks -- have to stay on at all times or their infection control barrier would be broken. They can't lift their masks to inhale a breath of fresh air, grab a sip of water, or even wipe sweat out of their eyes.
The cold start to summer has been a blessing. When it ends, the paramedics fear they'll be passing out all over the city.
One paramedic already reported overheating and briefly passing out behind the wheel, snapping back to consciousness when his rig hit the shoulder of the road and slid sideways. Others have reported dizziness and dehydration.
That isn't the only problem of working on the road, rather than in the air-conditioned, controlled setting of a hospital.
"What makes us good and unique is in an uncontrolled environment we're good," said paramedic Brian Parsons. "Intubating (inserting a breathing tube in) a patient in a moving ambulance, working on a patient that's fallen off a bed and is trapped.
"That's the nature of our job and we love it," Parsons, who has 20 years on the road under his belt, said after delivering a patient to Sunnybrook's emergency department.
But they've seen doctors and nurses intubating patients in hospitals and later becoming infected with SARS. They see them moving to Stryker suits -- or space-like suits -- to ensure they're protected from the virus.
Like all health care workers, they're finding doing standard procedures like finding a vein to start an intravenous line is harder through double gloves and fogged-up goggles.
Toronto Emergency Medical Services are summoned to 20,000 calls a month, many of them for trouble breathing. In the past three months, the paramedics never really knew what they'd find when they arrived on a scene, or how many patients might have SARS.
Through it all, the medics kept coming to work. Temporary EMS supervisor Rob Hughes thought no one would want to come to work and face SARS and all the uncomfortable precautions needed to keep the virus at bay.
Instead, the paramedics have stepped up, Hughes said.
"I thought a lot would book off, but actually our sick time has gone right down on my shift," said Hughes, who's been a paramedic for 26 years.
And the best news of all is since full safety precautions have been enacted on the road, not a single paramedic has contracted SARS. There are also no Toronto paramedics in quarantine right now.
There are 850 paramedics in the infected city, these are some of their stories.
***
Marty Bulai peels off his SARS mask to reveal creases carved into his face.
While SARS has been a major annoyance for most paramedics, it's been enough to send Bulai over the edge.
He spent more than 40 days in quarantine after being one of the first medics into Scarborough Grace, the epicentre of the original outbreak. He got sick, his wife got sick, his daughter had a fever. York Region Public Health gave him the runaround. He spent four nights in a SARS unit. His daughter celebrated her 11th birthday in hospital and was also hit with a Section 22 order, forcing her into quarantine. Officials also threatened to take his kids away from him because they thought the children weren't getting proper care.
Bulai, 41, never had SARS, just symptoms. He missed six weeks of work and his kids missed five weeks of school.
"The principal would bring homework to the door, leave his car door open and car running, drop off the work and run away," Bulai said. "I've never seen that before."
The Red Cross referred to his Newmarket home as the "SARS house" and his neighbours are finally starting to approach him again after three months of avoidance.
Back on the job, procedures have changed, too.
"You can't treat asthma patients the way you used to," the 16-year veteran said. "Asthma patients can't get Ventolin -- the puffer -- because of the aerosol that it puts out."
Only severe asthma attacks are treated now with an epinephrine shot.
Bulai said intubations are delayed three to four minutes while paramedics put on two layers of gowns, masks, gloves, goggles and shields. Then they have to pre-medicate the patient to essentially paralyze them so there's no gag reflex.
Bulai's seeing another problem: People are waiting too long to call for help because they fear going to the city's hospitals.
***
Francesca Rigano knew SARS hit a new level of absurdity when a birthday party ban hit her two nieces.
Two days before the party, the hostess found out Rigano's nieces were at her house. That just wouldn't do.
"How do you explain that to a four-year-old?" Rigano asked. "You can't go to a birthday party because your aunt has SARS."
Of course, Rigano, who has been a paramedic for three years, doesn't have the virus, just the stigma.
After dropping off a patient at Mount Sinai yesterday morning, Rigano said being a paramedic has changed remarkably in the short time she's done the job. The stress load has exploded, and she's worrying about new things like masks and goggles.
"My biggest concern three years ago was dealing with a call I've never seen before," the medic said. "Now I fear I'll bring home an unknown infectious disease that can kill someone so quickly.
"Everyday I have to force myself to come to work," she said.
"Sometimes I consider trying something new," Rigano said. "But I love my job."
***
Two jobs is better than one for Debbie Grant. Or it was until SARS.
Grant has been a paramedic for 14 years, and two years ago she also became a nurse. But nursing is on hold. No hospital will accept her. And the hospital where she was working as an emergency room nurse, North York General, has closed its emergency room anyway.
"I'm glad I'm not nursing," said Grant, 40. "So I don't have to wear the mask all the time."
The mask also created another problem for Grant -- she turned out to be allergic to the safety shield.
***
Des Fan is known to run a marathon or two.
He's finding running up two flights of stairs exhausting these days.
It isn't the climb, it's the gowns, gloves and masks that make it a sweltering run. By the time he gets to patients he's often out of breath, straining for air through the mask, but the patients can only see his eyes and wonder why they aren't being helped immediately.
That isn't the only problem the 17-year paramedic is running into. He says keeping full infection control in the field is next to impossible. There's just too many places where cross-contamination can occur.
Fan, 40, said he used to call in for overtime when he had four days off in a row, trying to make a little extra cash.
"I don't want it anymore," he said. "The money isn't worth the risk."
***
None of these experiences compare to what happened to paramedic Greg Bruce.
Before full precautions were put in place, Bruce, a married father of three, took one of the city's first SARS patients to hospital. He wasn't wearing a mask at the start of the call, and within days he was sick.
On March 23 he was admitted to hospital. He spent 11 days in intensive care, and nearly died. His fever soared to well over 40C. It was April 10 before he was released from hospital.
When he first got home, Bruce would become short of breath just brushing his teeth.
After 70 days, he finally returned to work, but not out treating patients. He started working four-hour days and is still on light duty.
"Right now, going back on the road scares me," said Bruce, who has been a paramedic since 1996.
"We're taught to assess risk and benefit for each of our patients," Bruce said. "Now I look at my job that way. My job put me at a risk I never expected. It also put my family at risk.
"Then there's the whole almost dying thing," he said.
"I anticipate I'll be physically ready to go back on the road before I'm mentally ready," Bruce said.
Before SARS, Bruce knew there was danger on his job. He had been exposed to flesh-eating disease, meningitis and AIDS. SARS, with all its unanswered questions, is different.
"There's no question this job has changed forever. There's a new risk. I understand the fear everyone is working under better than anyone."
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