Joanna Sokol's ‘A Real Emergency' looks under the hood of a broken emergency response system

San Francisco Chronicle​

2 days ago

Growing up in Oakland in the late 1990s and early 2000s, Joanna Sokol felt adrift and uncertain, a school-averse black sheep among her academically inclined family. Eventually, she found her calling as a paramedic, spending a decade serving the communities of Reno, Santa Cruz and San Francisco. She started to make sense of her experience writing essays for Reader's Digest, Epoca and Hazlitt.
Her revelatory book 'A Real Emergency: Stories from the Ambulance' details her painful, abusive love affair with driving an ambulance. It's a mordant, sometimes stomach-churning immersion into the world of first responders dealing with ailing bodies, drug-addled minds, bean-counting bureaucracies and eventually a pandemic that pushed the system to the breaking point.
Q: During your early days working as a medic at concerts and festivals, did you notice any patterns between styles of music and emergencies?
A: There were certain patterns in drug use — you're going to get more alcohol at a metal concert, more psychedelics for a jam band, more MDMA variants at a rave. But you'd be surprised how much overlap we saw. Like — sir, why are you using ecstasy at a hardcore show? You are on the wrong drug, my friend!
And I would say even more than the genre, we noticed differences between the overall energy levels at an event. A late morning reggae set at a festival I would expect maybe dehydration or bee sting allergies, whereas a 4 a.m. heavy electronica warehouse rave; well, you can imagine.
A: I had some amazing mentors as a new EMT. This sounds trivial, but I would jump on the floor and teach young me some core strength exercises. When you're first getting into the job, everyone says 'take care of your back,' but no one really explains exactly what that means.
It's actually less about lifting heavy patients and more about poor working conditions. Most ambulance workers don't get their own stations to rest or stretch in between calls the way that firefighters do. Instead, we are in the ambulance driving around for 12 or 16 hours a day.
Q: Along those lines, 'A Real Emergency' shows how poor work conditions make the job so much more difficult than it needs to be. What are the biggest hurdles EMTs face in organizing for better work policies?
A: This is really layered, and there is some fascinating history behind it. But the short answer is that ambulance systems are run by a wide variety of entities in the United States. Some public, some private, some by fire departments. There's no real cohesion on a national level. In many places, the ambulance is very much treated as a steppingstone to a fire engine, so most people don't stick around long enough to see paramedicine as a realistic career.
Q: Your descriptions of the early months of COVID-19 while you were working in San Francisco are beyond chilling. What did that period reveal about our emergency and hospital system?
A: A lot of us knew for years that the emergency system was falling apart: overcrowded ERs, long wait times for ambulances, never enough staffing.
And suddenly the rest of the world was looking at us with this sense of fear and shock, asking us if there were enough resources, and we were thinking, 'No, of course there aren't enough resources.'
It felt like we'd been inside a burning house screaming our heads off and suddenly everyone else was saying to each other, 'Oh, no, what if that house catches fire?'
Q: In researching the history of ambulance/EMT services, what are some of the challenges that remain unchanged over more than a century?
A: The ambulance has never turned a profit. It's generally used by those in poverty, and those with chronic medical and social issues. And there have always been arguments about what constitutes a 'real emergency.'
I found records of one of the first ambulance agencies in the country arguing with their local police department about overuse of ambulances for drunks. This was back in the 1800s! The ambulance has always tried to focus on immediate life threats, and it has always ended up as a resource for all of the issues that society can't or won't deal with in other ways.
A: More EMS staffing. There are some very cool ways that ambulance crews can get trained and be more involved in these issues, but unfortunately every single one of them starts with having enough of us available to respond to calls.