The rate of change and the fast pace of everyday life makes it hard to look back at what interventions could have changed the course of history. Twice last year I took calls from associates concerning a friend whose health and social conditions were declining. They had made number of attempts to help that person with no success, and they shared their frustrations over what should be done verses what could be done. Sadly, fears became reality by the end of the year.

Renee Paper was an emergency-room nurse in Henderson, Nev. My relationship with her began out of respect for her steadfast values on patient care and her tenacious defense of patient dignity. If I was sick, there are few people I'd rather see at the foot of my bed than Renee. One long conversation with her in the emergency room led to a discussion on hemophilia and her own affliction, von willibrands disease.

With some generous donations from a local hospital, pharmaceutical companies, and a dedicated group of volunteers, she founded the Hemophilia Foundation of Nevada in 1990 and ran it from the spare bedroom in her home. Renee soon drafted a well-rounded board of directors to help carry out the foundation's mission. Renee knew how to attract professional, quality people who understood the need for such a foundation.

One day after getting passed over for a promotion, I went to the mailbox and found my foundation newsletter. On the back page was a request for board members. Helen Keller once said, “when one door of happiness closes, another opens; but often we look so long at the closed door that we do not see the one that has opened for us.” I eventually served on the board for three years, helping the foundation grow although I had no personal connection to the disease. Volunteering at a non-profit was a rich and rewarding experience that taught me a lot about the less fortunate; it should be on every chiefs list of things to do.

Renee traveled extensively for the foundation to teach and network, soliciting help from many people at the state and national levels. She had become world-renowned for her knowledge on bleeding disorders. Through her efforts, her dream of the first federally funded Hemophilia Treatment Center of Las Vegas became a reality. Soon after, I left the foundation to move on to other opportunities, and I had fewer interactions with Renee.

Renee was considered a full-size woman; after years of carrying that weight and with joints ravaged by hemophilia she decided on gastric bypass surgery. The dramatic weight loss necessitated further surgery to repair several slipped disks in her cervical spine. The surgery was successful, but hospital error caused Renee to fall in the bathroom at the hospital. That fall damaged the surgical repair, leaving Renee with chronic pain triggering events that would spiral out of control. She became drug-dependent and soon lost her job after 25 years of employment. She continued on her downward spiral and found herself on the other end of a 911 call.

People tried to intervene. EMS supervisors struggled to activate social services that already were overburdened. Renee fought efforts to help her, and her drug-seeking behavior bought her a label of a system abuser. Newer staffers who saw her repeatedly but didn't know her history discounted her as a malingerer.

She was presented after a serious fall to an emergency room where the staff didn't know her and with a complaint of a different kind of pain — a bleeding exacerbated by her hemophilia that proved fatal. It wasn't until weeks later that the word of her death finally started to get around.

This highlights one of the issues seen so often today in fire-based EMS. High call volumes and load fatigue change our perception of what constitutes a real problem. If it's not a car wreck or a shooting, many EMS folks don't concern themselves, especially not for the more minor complaints of pain or vague symptoms.

The term “iceberg injury” is used by clinicians to refer to relatively innocuous symptoms that are indicative of major injuries. Now its true most symptoms aren't hiding a catastrophic problem, but if it was a member of your family, you would at least want someone to look deeper. Medicine used to involve how to rule out or work backward from the worst-case scenario to the least or most minor issue. More commonly you providers who show up at the scene with the attitude that the patient must prove he or she is sick before getting a ride to the hospital. There are a thousand other contributing factors to the proliferation of that attitude, yet they all boil down to respect for human dignity and an appreciation for the human condition.

When a friend suffers a tragedy, the first feeling is often guilt. Was there something I could have done? Should I have tried harder? Was there another way?

Many of our people see and do so much for others in this profession over the course of 20-year period that we tend to numb ourselves of the constant weight of problems presented in the health care system. It is the intersection of the experience and our need to cope that requires fire and EMS chiefs to take a hard look at the system in place to help people within their own organizations when it becomes overwhelming or out of control. Our people are our greatest asset.

An emergency services organization needs to have an employee-assistance program. Supervisors and chief officers need to know how to access the program and not just where the book is, but how to initiate, contact and enter an employee into an employee-assistance program. Why and when to intervene needs to be clearly defined to EMS and fire Service leadership. This should be part of a contract with an employee and, as hard as it may be, every effort should be put forth to maintain a persons privacy. The service end needs to be there. So many mental health services are overburdened and do not provide quality care. So often a person is processed like cattle or mixed with general psychiatric patients. The last thing an employee wants is to wind up at the cuckoo's nest waiting for someone to steal a bus and take him fishing.

So make a resolution as a chief officer to have your EMS chief review your agency's employee-assistance program and be sure it is doing what it should. Look back on the last five years and see if anyone was lost from the organization that could have be saved. Stop and see someone you haven't seen for a while, as isolation is often a sign of trouble. Ask a retiree or someone out of the system that had made significant contributions to come by; our veterans do it so why doesn't the fire service do it. There is absolutely no reason to let people who have given so much slip through the cracks in a system they have served for so many years. Let's make sure our people get to enjoy a long and healthy career.

Bruce Evans is the EMS chief for the North Las Vegas (Nev.) Fire Department. He also is the fire science program coordinator at the Community College of Southern Nevada and an adjunct faculty member for the National Fire Academy's EMS and injury prevention courses. He has an associate's degree in fire management and a master's degree in public administration.