EMTs deal with stress, fear, shortages as they battle pandemic

By Krista Allen
Special to the Times

TS’AHBIIKIN, Ariz.

They call it “CARD 36” over the radio. Emergency medical technicians sometimes don’t know if the patient they are going to help is either CARD 36 positive or negative, meaning febrile respiratory illness — the dispatch code for coronavirus in the Navajo Nation.

Either way, they have to don Tyvek suits, gowns, powered air-purifying respirators and gloves before meeting the patient as though the patient is positive for COVID-19.

“It really depends on the dispatcher,” said Geraldine Hernasy, who goes by Gheri Williams, an EMT basic at the Nation’s Emergency Medical Service’s Inscription House Field Office. She is originally from Window Rock and the Oak Springs area.

“They call it CARD 36 over the radio – positive, negative,” she said. “Some of them (dispatchers), they’ll get that information for us ahead of time. That way it gives us a heads up. It’s kind of like you’re walking into the hot zone.” The dispatcher then gives the patient’s or family’s phone number to the EMT team for further questions.

If a patient is inside a house, the team cannot go inside unless they have to, said Julia Johnson, 57, an EMT Intermediate at the Inscription House Field Office. But that puts them at risk.

For instance, the Ts’ahbiikin EMT crew during the first wave of the coronavirus used their microphone system to call the patients outside – if patients were able to go – where they helped them get onto a gurney and into the ambulance. “We had to call out our patients,” said Johnson, who’s been in emergency medical services for 22 years and has never seen anything like this. “If we have to go in, we go inside the house. It’s very, very difficult.”

The hot zone

Before the pandemic, a 911 call for respiratory distress would have sent EMTs inside a house to examine a patient and take vitals. With COVID-19 infections surging, EMTs are making adjustments to a new reality: A coronavirus-tinged world without a foreseeable end.

Just as in nearby border towns, the Ts’ahbiikin EMT crew have had to do something they’re not used to: Think of their own safety and well-being before that of their patients. “I say my prayers,” Johnson said as she sat inside a homey EMS quarters at the Indian Health Service housing near Inscription House Health Center.

A Christmas tree was erected in the living room on a snowy Monday afternoon while one EMT rested in a room before working on the night shift. “The first thing when I get up, I say my prayers and I prepare my mind for what the day might bring us because every day’s different,” said Johnson, who goes home to her husband every night after a 12-hour shift.

At home, she remains on call. Johnson, along with some of her colleagues, keeps her EMT uniform at the quarters so it stays neat and clean, the professional standard for EMTs and paramedics. Even in the middle of a deadly pandemic, she said, her uniform provides a professional image inspires confidence in her patients when they see her.

“I make sure I’m fully dressed in uniform, shirt ironed, and I look professional,” Johnson said. “Impression is very important to our patients – making a good impression. That’s the start of building confidence between our patients. And that’s one of the very important things I feel I do … when I come on shift.”

220 EMTs

The Navajo Nation Emergency Medical Service has 220 EMTs stationed at 14 field offices across Diné Bikéyah. Their mission is to save lives at any cost – even when it’s hard for them to breathe because high-grade filter masks fit tightly and cover a large area of their faces.

The 14-member EMT crew at Inscription House Field Office covers at least seven northwestern Navajo communities: Ts’ahbiikin, Shonto, Kaibeto, Tonalea-Red Lake, Wildcat Peak-White Mesa, Black Mesa and Naatsis’áán-Rainbow City, Utah. Johnson works the day shift, which she starts by filling out forms and disinfecting and decontaminating the ambulance despite that it has already been done after the last transport.

She replenishes supplies that were used on the night shift. “I make sure I have everything ready,” Johnson said. “It’s my small mobile clinic. We do a lot of cleaning.”

The night shift is less tense because EMTs cannot go outside to do routines. They wait for calls instead. “Sometimes we get calls back-to-back, three to four calls, depending on the weather,” Williams said. “And the peak times, usually that’s at the beginning of each month.”

Virus reaches Nation

When the virus first reached the Nation in March, it created its own form of terror. The microbial killer upended daily Diné life, paralyzed the Navajo economy, divided people from one another, and descended on communities like a heat-seeking missile.

The people were already beaten down by diabetes, high blood pressure, opioid abuse, chronic illness and lack of job opportunities. It created fear in people, of the unknown and the unseen, said Johnson. “We all – as a team – were very scared,” Johnson said of her EMT colleagues. “Really, the unknown of this coronavirus. We were somewhat prepared as far as PPEs, but we did what we could as supplies started coming in.”

To tamp down anxiety accompanying the viral threat, Johnson said she and her colleagues gathered ts’ah and sweetgrass to not only create medicated vapor in the EMS quarters, but also to make an herb drink as well as a steam inhaler. The sweetgrass they used for purification and blessings. “I think that really calmed us because there were thoughts (of early retirement or shifting to less intense jobs),” Johnson said. “It just seems like this dangerous virus is lingering somewhere. We don’t know exactly where – in between cracks, around the corner.

“Everywhere,” she said. “In the air, just that scary thought. And the worst part of it is the effect it has on our patients. We’re so worried, we’re so concerned about our (non-COVID) patients, especially the elders.”

“It’s heartbreaking as we go along to (transport) them,” she said. “Some have survived and some didn’t.”

Fear and anxiety

During the first wave, the virus emptied communities, businesses, chapter houses, and convenience stores. It locked down the Nation and instilled agoraphobia.

And it demanded a response: Stay home or it will bring death and fill hospitals. “That was pretty much the first (wave), seeing the communities empty, which was good (during) lockdowns,” Johnson explained. “No one was driving around. It was kind of like driving through ghost towns when we transported to Tuba City.”

“The interns, we don’t (allow them to encounter COVID patients),” Williams added. “We try to keep them away from them. We’re the ones who deal with the most severe COVID cases. Dale Jensen, supervisor of the Inscription House Field Office, said the Ts’ahbiikin crew receives around five 911 calls a day. And it takes up to three hours to transport a patient to a hospital, depending on the location.

For instance, it takes two hours to get from Naatsis’áán to Tuba City Regional Health Care in Tónaneesdizí. “If you multiply that by four (calls), that’s 12 hours at the maximum,” Jensen explained. “That’s a lot of hours that we’re out. There’s a need, a strong need here in Inscription House.”

“(When) the pandemic hit, we were terrified by the virus,” said Jensen, who resides in Naatsis’áán. “There were a lot of unknowns and we didn’t know how it would spread.

“We didn’t know who it would hit next because we were dealing with them,” he said. “We were seeing patients pass away and I could feel it (anxiety) in our EMTs.”

No time to disinfect

The virus also has eerie echoes, said Williams. When the Ts’ahbiikin EMT crew gets back-to-back calls, there is often not enough time to disinfect and decontaminate the only ambulance the field office has.

There is another ambulance but it is currently in maintenance, making things a lot more difficult. “But we try our best to get in (the cabin) and wipe everything down, all the equipment before the next patient,” explained Williams, who saw the catastrophic suffering and death as a member of a rapid response team in Kayenta during the first wave. “We’re always cleaning, always cleaning,” she said.

Williams said she saw a grim environment on the Nation during the first wave. She lay on a bed inside a COVID ICU at a hospital in Phoenix. She contracted the virus and survived. “The virus itself, the disease – I saw that they (patients) were trying to breathe,” Williams said as she talked about the stark conditions inside homes around the Tódinéeshzhee’ area. “They were really in distress and it was hard to see.

“We had to do whatever we could to help them,” she said. “A majority of them, we flew out to facilities in Flagstaff, Phoenix, and in San Juan. Sometimes we did ground transports to Tuba City, Shiprock and Chinle.

“It was tiring,” she said. “You’re tired. You have that fear: ‘I don’t know if I’m going to get it. Did I do it right? Did I wipe things right? Did I make sure that everything’s OK?’

“I wish people would listen to the first responders, the frontline workers,” she said. “The (Navajo Nation president) is trying his best to (warn) people and take precaution and preventive measures, but they don’t do it.” As a survivor, Williams is well aware what COVID-19 can do.

“It’s horrible,” she said. “It really affects your lungs and it really affects you. You’re constantly trying to get air. You have shortness of breath – it’s hard. “I was put on a CPAP (continuous positive airway pressure) machine,” she said.

Williams is the mother of Window Rock Fire Capt. John Williams of the Navajo Nation Department of Fire and Rescue Services. She’s also the cousin sister of Vice President Myron Lizer, whose mother is the sister of Gheri’s father.

Becoming an EMT

Lula H. Babbitt, a paramedic at the Inscription House Field Office, returned back to the office that Monday evening after a morning of back-to-back calls. “First caller: COVID,” she said as she settled inside the EMS quarters. “I feel so bad. We took (the patient) to Tuba City.”

The patient, Babbitt said, had shortness of breath with a respiratory rate of 40. The second call was about a dog bite. Babbitt was born and raised behind Wildcat Peak in Tonalea-Red Lake.

Herding sheep as a child, she would see the ambulance going by and she’d tell her siblings, “I’m going to be driving that!”

She thought at that point ambulance drivers only drove and didn’t come in contact with patients. But she found out that her childhood thought wasn’t true when she became an EMT basic in 1990 after serving as an EMT for Peabody Western Coal Company and serving 10 years as a firefighter EMT at the Kayenta Volunteer Fire Department.

A supervisor asked her one day if she wanted to complete education requirements to be an EMT for the Navajo Nation. “I applied and got the position,” she said. “From there, my interest grew. The people I work with, too, they were just like family … I love my job. I love what I do.”

That’s even under the stress of the pandemic, said Babbitt. Even as the pandemic enters a new vigorous phase, clinicians’ and first responders’ mental exhaustion is at an all-time high.

“At this time, our people need us more,” Babbitt said. “We do what we can for them. We’re doing something good for our people. It’s the way of life. It’s the way I was taught: Help your people. You grow up and in return, you help your people. That’s what my (late) father taught me.”

Prayer ceremony

Jensen said a prayer ceremony was done for him and his staff as the pandemic first spread across the globe in early 2020. “It was scary, it was really scary,” Jensen said. “With the pandemic, with the coronavirus and the amount of death we’ve seen, it’s really hit home for us because we were suddenly aware of how dangerous it could be.”

While medical workers in the Navajo Nation have been celebrated as heroes for their commitment to treating COVID-19 patients, Jensen said he and his staff were hurting badly and became more susceptible to post-traumatic stress.

“Some of the EMTs, myself included, we had some depression,” Jensen explained. “And I know you don’t hear about that, but I worked with them – some of the team with Indian Health Service – and we didn’t know how hard it hit us until we had a counselor come in.”

The pandemic, along with the tragedies, served as a devastating wake-up call about the mental health of medical workers, said Jensen.

“Suddenly it became real how we were suppressing the fear and how we were trying to muster all of our strength to work through it,” he said.

“We were talking about PTSD. I think we do have it but we’re not really aware of it because of the scenes that we see, what we face,” he said. “I think that’s the reason we laugh, we try to get over it,” he said. “We try to comfort ourselves by laughing and joking.”

Jensen added that he unwinds at the end of his shift by taking long walks or going on long hikes with his four dogs.

Challenges

Over the coming weeks, the Navajo health system is expected to face an extraordinary strain on resources and workers. With that comes the challenge of being on the front lines of the epidemic, said Jensen.

“We’re dealing with electronic documents,” he said. “Every morning we’re on a race to get all the documents together to send them over the internet and to do follow-ups. And sometimes departments are closed, and we have to wait a while to get through. So it takes a lot of our day.”

Other challenges include sending mail, fetching new PPE gear, the ambulance shortage – in a few cases, someone died waiting – and slow internet speeds, said Jensen. “Especially with the internet being congested as it is, we have a hard time with online documents,” Jensen said. “That’s what I’m really pushing for, I’m hoping that we have a really strong, reliable internet.”

As far as ambulances, the Navajo Nation EMS is working on purchasing new ambulances this year, Jensen said. But it may take a while because of paperwork and payments.

“Right now, we just have one,” Jensen said as he waited for the only ambulance to return back to the field office that Monday. “It would be nice to have two because our calls have gone up.”

A new variant of the coronavirus is spreading across the globe. It was first identified in the United Kingdom and now is found in multiple countries. Diné are wearing facemasks and practicing social distancing. Still, the number of cases in the state is ticking upward.

“The second wave, I think people are more relaxed,” said Julia Johnson, who sees households with a large number of people in tight quarters or poor ventilation. “We have more equipment, more protection, and a little more knowledge … on how we can protect ourselves.”

She continued, “That thought about wanting to maybe retire or resign, or do something else, all that has gone through my head too. But I think, if most of us leave and do something else, who is going to be there for our community? “It takes a very special person to do what we do,” she said. “Not everybody is able to have that mentality to do what we do. We’re the first ones who come in contact with the patients. We’re the ones they see, and they cling to us and say, ‘Help me.’ We’re the first help.”

‘Warrior culure’

The Navajo Nation EMTs are part of a “warrior culture,” which sees itself as tough, carrying pain and suffering, even during the pandemic. But they are human, and they do what they can to help people, said Johnson.

She explained as tears trickled down her cheeks, “We have our ups and downs. We stayed together to help each other. We can’t take it home. We have to get it all out here (at the office) because we all understand what we’re going through.” And it’s hard to be happy after a long shift when fatigue kicks in, said Gheri Williams.

“Sometimes we get callbacks because maybe somebody’s family member got sick or something happened,” Williams said. “We’re on standby. We have to be.”

She stays in the EMS quarters and often misses her family in Window Rock. She does a lot of phone and video calls with her children and grandchildren. “I just think to myself that there are a lot of people out there who are so lucky to have a home,” she added. “People who wander around, I ask them, ‘Do you have a home?’ They’ll say, ‘Yeah. This is where I’m from.’ I say, ‘Stay home.’ We talk to (wanderers) like that. ‘If you have a home, go home. It’s the safe place to be.’”

The coronavirus can cause pneumonia or widespread lung inflammation resulting in acute respiratory distress syndrome, said Chris Kescoli, the EMT supervisor and the delegated department manager for the Navajo Nation EMS. Kescoli said COVID-19 took a big toll on the Navajo Nation EMTs. And it shows. “I wish there was more that we could do,” Kescoli said. “But it limits us because we can’t have that face-to-face. We can’t have group interventions or counsel. This virus really puts a barrier on that.”

Kescoli said that even though the Navajo Nation EMTs fear taking the virus home, they still get up every morning to put on the EMT uniform and help people. “This is what we were trained to do in this line of work,” Kescoli added. “All of our employees have been with us since Day One and we’re still here. We haven’t backed down on it. Our department has actually kept all employees on board, and we’ve had 100 percent of their participation in response to COVID.”

Of the 220 Navajo Nation EMTs, 50 contracted the virus and all have made a full recovery.

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