Charging Up EMS
Photos By Nathalie Walker
Most of us cannot point to a specific moment when we knew what we wanted to do for a living. Some stumble into careers, others are told from small-kid times what they will be. For Patty Dukes, chief of Honolulu Emergency Medical Services (EMS), there was an epiphany 30 years ago and she remembers it like it was yesterday.
She was working as a checker at Safeway, a job she loved and had brought her to the Islands, when a customer in line suddenly dropped, his body racked by a seizure, and as she hurried from behind the counter, she realized something: I have no idea what to do to help this man.
She tried to comfort him but could not shake the feeling that there was something more she could have done. She learned later in her training for the EMS that she had done all she could for him, but she could never escape the memory of not knowing what to do.
“I never wanted to get caught short again,” says Dukes.
So instead she answered an ad in the paper looking for paramedics. She has a family history in the medical field. Her grandma, aunt and two cousins are all nurses, but Dukes had no desire to follow them into the sterile air of the hospital.
“I loved medicine, but it wasn’t something I wanted to do. I didn’t want to be inside wearing a white dress and starched cap,” says Dukes. “But being outside in the chaos and making it right, that was the draw.”
EMS tends to attract thrill-seekers, the kind of people who thrive when the pressure is on. Each year they respond to 66,000 calls that cover the full range of tragedies, and if you are on Dukes’ squad, you are going to treat those patients with a smile on your face.
“It’s not a job for everyone. I know plenty of nurses and doctors who say, ‘I don’t know how you do your job!'” says Dukes. “It’s all in what your thrive on – first responders are adrenaline junkies. People always ask if my job is stressful, and I tell them waiting around for the call, that’s stressful.
“It’s like a roller-coaster climbing up that first big hill, click-click-click, and your anxiety level is going up and up, but once you get to the top, your arms are up, your eyes are wide and you are like, ‘Yeahhhhh!’ That’s what it’s like, and this is not to celebrate a person’s misfortune, but I am thrilled to take care of them and do the best job I can.”
When Dukes joined EMS, the picture of that personality type was predominately male. In fact, in the entire EMS team of 150, there were but six women.
“I thought it would be a nice job – perish the thought that any woman could be in a male-dominated job, but it didn’t even dawn on me until someone brought it up,” says Dukes.
She was ahead of this wave that forever changed EMS. Today, 40 percent of emergency medical technicians (EMTs) are women. And when Dukes was named chief in 2004, she became the first female to hold the top position at an EMS unit in a major metropolitan area in the United States.
The staff has grown with the population of Oahu – they soon will have 20 ambulance stations with 220 employees. While this gives them a nice spread to help cover the whole island, recent hospital closures have led to some logistic difficulties.
The shuttering of Hawaii Medical Center West has had a domino effect, leaving Pali Momi the closest hospital to Central and West Oahu, and causing it to be at capacity nearly all the time. Ambulances therefore have to transport patients either to Kaiser Moanalua or all the way to Honolulu for treatment. This may sound daunting, or even downright terrifying if you are at death’s door in the back of an ambulance, but Dukes assures us that there is no better place you could be (under the circumstances).
“I know it sounds terrible to have to travel that much farther,” says Dukes, “but actually our ambulances are little emergency rooms on wheels. We have everything we need in there short of surgery, so we can take care of everything that would be getting taken care of in the hospital.”
Another issue with the distance they have to travel is that it can leave areas without coverage for hours at a time while the truck is transporting a patient to town. This is where dispatch comes in, and Dukes has the advantage of all of Oahu being one big county, because with all the ambulance stations being under her auspices, she can shuffle ambulances around to cover areas as needed. So a team in Waipahu may be sent to Makaha, while the Makaha truck is heading in with a patient. That way, if there is another call, they are not waiting for hours for help.
Everything is not life-and-death for EMS, though – about 80 percent of its calls are not “lights-and-sirens” calls, but people in need of minor aid that won’t even need a ride in the ambulance, just the aid of the paramedics. But no matter what the case is, Dukes knows they have an important role to play in that patient’s well-being.
“There is always something we can do,” says Dukes. “Sometimes it’s as simple as holding their hand. I don’t mean that in a condescending way, we hold their hand and talk to them. It makes them feel better and keeps them calm until we can get them to a hospital.”
Holding hands is not why Dukes loves this job. It is more for evenings like the self-described “pinnacle of her career” that occurred one night in 1991.
She was answering a call for a pregnant woman in Makaha. She was in labor and needed a ride to the hospital, so Dukes and her partner picked up the woman and her niece, who was seven months’ pregnant herself. On the way to town, there was another call for a pregnant woman in Nanakuli, and dispatch asked if Dukes could pick her up as well.
Knowing they were the closest available vehicle and with the first patient seeming fine, she agreed to pick her up, too, and they arrived to find a huge gathering of Hawaiians anxiously awaiting their arrival. No sooner had mom No. 2 made it onto the ambulance bench, the baby started coming, and within a few minutes Dukes was holding the baby aloft in both hands showing the newborn to his family surrounding the ambulance.
“I invented that move, The Lion King stole it from me,” says Dukes with a laugh.
After a quick blessing from the tutu to bestow a Hawaiian name upon the baby girl, they began the drive to the hospital, and having just watched that birth, the first mother decided it was her time, too.
“I looked and sure enough I see the head popping out,” says Dukes, her eyes dancing with the memory. “First thing we check is to see if the cord was wrapped around its neck, and it was. I had never had that happen before, and we are driving 60 mph, but my brain is going even faster!”
Through quick trial and error, she figured out which way to unwrap the cord, and out came baby girl No. 2, Dukes’ second delivery in about 10 minutes, all in the back of her ambulance.
“We got to St. Francis West and people and babies and everything else fell out of the car like the Keystone Kops – the only male in the vehicle was my driver,” says Dukes. “All total in that ambulance there were four pregnant women, the two who gave birth, the niece and me. It was so, so cool. Delivering a baby is the happiest thing you can do.”
Dukes’ son Kasey came a few months later and now plays football at Pacific University in Oregon. Dukes is full of stories like this, but her life of excitement is in the past now as the chief. While her truck is equipped to save lives, it rarely gets used for emergencies. Instead she functions much like a CEO, writing policy and balancing budgets, but she makes sure she instills in her team the attitude that carried her through her years in the field.
“Its kind of like customer service when I was working for Safeway,” says Dukes. “People weren’t happy at the amount of money they had to spend on groceries, but customer service or patient service is most important. And if I can make someone smile at the end of it all, then my job is done. Make them smile through the pain.”