Episode 93: Calling 911: Tips We Hope You'll Never Need

 This episode of "Informed Aging" offers vital, proactive advice for older adults on how to make 911 calls more efficient and less stressful. Host Robin Rountree and guest James Estep, a firefighter and paramedic, discuss common avoidable accidents and essential steps to take before an emergency. Learn why having a pre-written medical history on hand, ensuring your house number is visible, and securing pets can drastically improve emergency response and patient outcomes. The conversation also covers the critical aspects of Do Not Resuscitate (DNR) orders and local fire department resources designed to keep you safe. 

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Transcript

Welcome to Informed Aging, a podcast about health, help, and hard decisions for older adults. I'm Robin Rountree, a former family caregiver. I've worked in the home care industry and now work for the Alzheimer's and Dementia Resource Center. The thoughts and opinions expressed on this podcast belong to myself and my guest, not our wonderful employers and sponsors.

Before making any significant changes in your life or your person's life, please consult your own experts.

Today we're gonna give you some great advice that we hope you never have to use. It's all about calling 9 1 1, how to make that awful experience a little bit better and to get you care faster if needed. That's coming up. [00:01:00] 

Robin Rountree: We are back and we are talking with James Estep now. He is a firefighter and paramedic with the Orange County Fire Rescue Department here in Orlando, Florida.

There's more than one Orange County. I'm aware of that. Hello, how are you James? I'm 

James Estep: doing very well. How are you? Thank you for having me. 

Robin Rountree: Absolutely. It's a pleasure. How did you get into this line of work? 

James Estep: for me, I actually came from the corporate world. I worked for GNC Yeah, general Nutrition Center for about 10 years.

And for me personally, I just, , making money was awesome, but I wanted to do something more impactful. You know, I wanna do something I can be really proud of. So that led me here. 

Robin Rountree: And so how long have you been a paramedic and firefighter? You've done both at the same time, 

James Estep: correct? Yeah. When I got hired, I was actually an EMT, so I was a firefighter, EMT.

Had that role for about two years. So the last six years I've been a firefighter paramedic, so I've been in the county for eight years total. 

Robin Rountree: Okay. So what's the difference between an EMT and a paramedic? 

James Estep: It's a great question. A lot of times people kind of get 'em intermixed

but a, , paramedic has advanced life support functions. So they can give medications, they can, uh, treat cardiac rhythms, they do IVs, essentially an EMT or. It's very similar to a paramedic, but the paramedic has just that little dash of advanced life support.

Robin Rountree: Alright. Now I know on TV, if you watch any TV at all and you realize that, you know, all these EMT and firefighters, paramedics are going off and rushing to these incredible disasters. But I'm sure that's not really what happens on your day to day, is it? 

James Estep: I always say our day to day is never the same except for the first hour after that.

It's all, all bets are off. Right? Our first hour starts the same way every day. We check on our equipment, check on apparatus, make sure everything's working. So God forbid we get a call, we're ready to go. Right? after that though. It's a different day every day. It really is. We might go to training, we might go to PR events.

Uh, we might work out. There's all kinds of things we do throughout the community. We do, pre-incident plans to check up on businesses, to get a layout just in case we ever respond for emergency. We slow hydrants, we do all kinds of things. But in between those, at any point, we could stop whatever activity we're doing and respond to a 9 1 1 call.

So every day we're gonna get 9 1 1 calls. I've never had a day where I didn't get someone, call 9 1 1. But outside of that, every day is different. 

Robin Rountree: Okay. So there's, there's no typical day which, and that's gotta make it a little more exciting than sitting behind a desk. 

James Estep: Yes. It's definitely not, not short of excitement.

100%. 

Robin Rountree: . And, what are some simple accidents that happen that you go, ugh, that could have been avoided? 

James Estep: Oh my goodness. I'm really glad you, so I've dealt with this recently in my past. 

My mother, about a month ago, fell and broke her femur. Oh. Oh, yeah. It was completely avoidable. It did not have to happen. She tripped over a little dog bed that was just I know. Yeah. Yeah. Tripped over dog bed in the middle of the floor fell, broke her femur did not have to happen. Right. Unfortunately it did.

. But that's a clear example of, especially for someone like my mother, you know, she's 75 years old, she has issues with coordination, so that shouldn't have been on the floor, right? So just preventing falls or accidents is the best form of medicine, right? If you can prevent it from happening, right? It never happens.

Other deal with the problem. So, for someone like my mother, for example, who we know is trip prone, we shouldn't have had the dog bed out. Thinking about things that the, like ladders, furniture, anything we can do for her, we should have done a better job of making sure it wasn't her way. And that happened.

The other incident that I can tell you was my father who's now passed away, but he had a life alert. If you're familiar with those, you wear 'em on your neck. Yeah. You can click on it and you can get 9 1 1 or a family member to come help you. Well, he had a fall when he was in his eighties and he laid on the floor for almost a day and a half.

No one could get to him. And unfortunately that led to his death 'cause he ended up going into, kidney failure. But again, completely avoidable if he just would've worn the life alert, he didn't have it around his neck, so he could've hit the button. Right. So prevention's the best form of medicine, right?

Um, if you have a life alert, use it. If you have a walker or a cane. Use it. I can't tell you. Many times we run on calls where people have walkers and canes, but they get up to use the bathroom. You know, in the middle of the night they say, oh, I'm just walking down the hall. I don't need it. And then they fall.

Anything you do to prevent an accident or a fall, or medications, right? Anything you do to make sure that you're taking your medications on time, whether you're going to see your doctor regularly. Is super important. Prevention is huge. 100%. 

Robin Rountree: Okay. And God forbid that we do have to call 9 1 1, how can we make that better?

James Estep: Yeah, a hundred percent. I'm glad you asked me this. So I kind of break this down in my mind in two things, right before we call 9 1 1, right before the incident happens or the medical complaint. Okay? And then when we call 9 1 1. So there's two different ways to look at it. So. Before I call 9 1 1, God forbid, any of us have to call, right?

, Right. It's a stressful situation for everybody, right? For our loved ones, for us, for the first responders even. It is stressful. So anything you can do to make access to you quick and efficient before a call were to take place, that's the best. So what I mean by that is if you look at your home, right, pretend you've never been to your home.

Look in the outside. How long does it take you to identify the numerical of your house? Right. You'd be surprised how many people, whether they've painted over it or they have some kind of tree or obstruction, we've never been to your house, right? So we don't know where it's at and if it's dark or it's raining out, it, believe it or not, it can be difficult to find numericals on houses sometimes.

So anything you do to make sure your house is easily identifiable, right? , Also your yard, right? Your yard or your driveways. Are there obstructions? Are there plants? Anything like that? Think. If I had to take a stretcher through your driveway into your home, would it be easy or hard? Yeah. And if anything we do to make it hard, consider a way you can do to mitigate that right before you call.

This is the biggest thing. I hope anyone listening takes this away. If you anticipate, you may, it doesn't matter what age you are, if you may have to call 9 1 1, if you had a pre-written out list of all of your medical history. Your information, your medicines, your allergies, your past surgeries, all that written out.

So God forbid you call 9 1 1. You could just hand it to us and we walk in the door, you hand it to us. And without even asking a question, I know what you're allergic to, what medicines you take, what medical problems you have, what surgery you've had. 'cause again, think about it, you, you call 9 1 1, right? It is stressful.

If you don't feel good, you might be having trouble breathing, you might be having chest pain. The last thing you wanna do is answer 17 questions about your personal history. And what happens is you typically ask a question more than once. 1, 2, 3, 4. People might ask you the exact same question.

Imagine why you're having chest pain, right? It can make it. It happens all the time. And the unfortunate news, when you get to the hospital. The nurse and the doctor, they're gonna ask you the same questions. 

Robin Rountree: Oh, 

James Estep: so imagine if you just had one sheet of paper that'd probably take you five, 10 minutes to write out one day that, God forbid someone comes in, you call 9 1 1, you hand it over and you get asked zero ques, maybe a couple clarifying questions here or there, but all your information would be there.

It would make you less stressed during your medical event, but it'll make your care faster and more efficient. Right. Big time. Yeah. So, yeah. 

Robin Rountree: And I want fast. If I'm having chest pains, I don't wanna spend five minutes answering questions. 

James Estep: 100%. The goal is to get on scene, treat what we can treat, and get you to the doctor as fast as possible.

So that is so big. I wish I would've known that for my dad before he passed away, because before I got the fire service I didn't know either. You don't know what you don't know, right? Right. And a lot of people that call 9 1 1, it's their first time ever calling 9 1 1. So that's a vital piece to have that ready to go.

So we 

Robin Rountree: want, uh, on that piece of paper, your medications Yep. Uh, the major diseases that you're dealing with right now. Yep. History of surgeries and allergies. Those are the big things. 

James Estep: Allergies. Yeah. Those are the big things. And those don't violate any of your rights, right? It's not, um, you're not asking for like your ID or your social security number.

You don't even have to put your name on it, really, you know, if you don't want to. So that would just give a general overview of you as the patient so that the medic can have a better idea of what's going on, what can possibly be treated, what hospital to take you to. There's a lot of good information.

Maybe you need to go to a certain hospital, depend on what's going on or your past medical history. That's huge. If anyone can dig anything from today, please take that, that one piece of paper can save literally five, 10 minutes on a call, which means you're getting to the hospital five or 10 minutes quicker.

Robin Rountree: Okay. Very good advice there. And should you put that on your refrigerator? 

James Estep: Absolutely. Yeah. Wherever it's accessible, right? So your refrigerator, in your purse, in a full wherever you or, and or your family member can access it quickly. That's what's important as long as you know where it's at.

Robin Rountree: Okay. Okay. So a do not resuscitate order. Yeah. Can you talk to us about that, what that means to you as a paramedic? 

James Estep: Yeah. So that's a legal document, alright. That's filled out by your doctor. Uh, and some people, when they get into certain conditions of their life or towards the end of the life, they may make the decision with their family and their doctor that God forbid they were go into cardiac arrest.

They do not want to be resuscitated. Okay? That's a decision that they've made. They spoke to their doctor about it, and it's a legal document that the doctor has approved and signed. That document has to be followed by fire rescue, but couple of things. It has to be present. It has to be on the correct copy paper, which is yellow paper, and it has to be signed by the doctor.

So in order for that to be valid, it has to be again, yellow, signed and present. What we found is that it happens a lot. Someone will make a decision. They don't want to be resuscitated. God forbid they go into cardiac arrest and we can't find it. So we get to their house. Unfortunately, they've gone into cardiac arrest, but their family can't find the document.

If we can't find the document, then we have to do, you know, implied consent. We have to do what we believe is right and help save the patient. Unfortunately that potentially could be against their wishes, right? Right. But that legal document has to be there. So , one situation we find is that the person who's in cardiac arrest does not wanna be resuscitated, but the family member isn't ready for that, and then it goes missing.

So I think it's super important. Do not resuscitate is a very serious document. It takes a lot of time and thought, and it should be respected, right? If that's what someone wants. It's really important that we have conversations with our family members so that we're all on the same page with that decision.

It's super important because we wanna respect the person's wishes. Yes. As their patient. , But there's just legality to it. There has to be those certain things. It has to be present inside or we can't. You can't follow what's not there. Right, 

Robin Rountree: right, right. And I've heard that you should keep that on the refrigerator, but is that not necessary?

James Estep: So again, wherever it's kinda like the list, right? Wherever's gonna be accessible wherever, and obviously, God forbid you're in cardiac arrest, you're not gonna grab it, so someone's gonna have to grab it for you. So it's usually a family member, a sibling, a spouse, or a child, or you know, a grown child.

They just need to know where it's at. It's really important and they can access it. 'Cause again, if you, we cannot find it, we cannot go by it. 

Robin Rountree: Right. And if you live alone, then you really need to have it out somewhere. Conspicuous, I would think. 

James Estep: Yeah. Living alone's a tough one, right? Um, yeah. It's no one plans to go into cardiac arrest, so God forbid you pass out.

Who's gonna be there? our crews in Orange County. Do everything we can, right? To look for not just a DNR, but your medications. We're gonna look around the room, see what could potentially happen to you. So we find a DNR. We would 100% respect that, but we'd have to find it. And even if you put it on the refrigerator, god forbid, you might pass out in the backyard in your bedroom, and it might not be super accessible if we walk in and see someone in cardiac arrest.

Our main focus is taking care of the patient, right. Right. Um, so hopefully there's someone that, you know, a spouse or a loved one that you could get it to., There's also life, the little, uh, medical ID bands that you can also get.

Right? Yeah. That can, you can get one that says DNR on it. If we saw that, that would clue us in to look for a DNR. Oh. So that's something to think about. 

Robin Rountree: Okay. Any other technology that you recommend? Of course, the Life Alert and the bands, but anything else that makes your job easier? 

James Estep: So, I will tell you it's a simple piece of equipment, but wheelchairs uh, canes,

walkers use those. They're, they're annoying to some people, right? People don't wanna use them, but they 100% will help you. The last thing anyone wants, I don't care what age you're at, is to fall and break a femur or a hip. I can tell you from my mom's experience, the recovery is not fun. It's gonna take months, it's gonna take time, money, and you lose your mobility 100%, right?

You end up in the hospital, broken leg, your hip, you will not walk at all. So walking around a walker is gonna feel 10 times better than laying in bed. I can't emphasize that enough. The life alert I told you about my dad falling and unfortunately passing away. All he had to do was wear that thing, you know?

Yeah. And so many times we see people just forget 'em. Please, please, please don't forget 'em. remember to take your medications is huge. I always advocate. Yeah. Having some kind of system for taking your medications, whether you use the pill organizers,, you have a calendar, you know, they have now.

Calendars that can give you updates automatically. Electronic calendars that can give you updates every day remind you they have apps you can download. There's a lot of different ways, but so many people, get into medical situations just 'cause they flat out forget to take their medicine. Mm-hmm.

Right? Believe it or not it happens. So anything you do to prevent, again, I said this at the very beginning, but I think it's worth repeating. Anything you can do to prevent a medical emergency, you want to do that. Gotcha. That's why we have smoke detectors, right? That's why we have pull alarms, things like that, so that we can prevent accidents from happening instead of trying to, um, take care of 'em after the fact.

Robin Rountree: Okay, so we've called 9 1 1 and unfortunately I've had to do that before and I was surprised about Put your pets away. 

James Estep: Yes. Yes. So. I have two dogs. Right. I get it. Everyone's dogs are friendliest dog ever. Right. Unfortunately, we walk up to a dog barking dog. We don't know that dog. so we don't know. He is the nicest dog ever.

Right, right. Um, I know I got a, like a big laugh and he sounds like a monster from the outside. He's super nice, but we don't know that. So yes, that's putting your animals away. , We kind of touched on this a little bit earlier, but it's worth saying again, if you have to call 9 1 1 and you have a vehicle that takes up your driveway, if there's someone else with you that could move it before we get there, it makes getting the stretcher inside the house faster and more efficient.

The stretcher can be taken over grass and dirt, but it's not made for it, so it's very unstable. Right. The last thing we want is for you to take a spill, right? While we're trying to get you to the rescue. So if you have to call 9 1 1 for a loved one or yourself, even if someone can move obstructions, like again, think of it, if I had to take a stretcher from the sidewalk into here, is there anything preventing that?

Also little things. I don't know if people think about shoes. If you're able to, or a loved one's able to help you put on shoes or socks before we get there, that's gonna make it easier for you. Standing up and getting on the stretcher. It's not a must, but we have a lot of people that want their shoes on, right?

I would too. So it's really important. Little things like that. Phones, cell phone, chargers, wallets, purses, bags. You don't need to bring your medications to the hospital. Okay? We get that question quite a bit. Any medicine you take, you can be given at the hospital, right? They're, they're not gonna run out a medicine in the hospital.

So you don't need to bring your personal, you can, it's your, it's your right, but it's just one more thing that can go missing, right? Making sure on that, that list, I don't know if we've covered it, that list with all, you know, your medical history, your meds, having your loved one's phone number in contact information.

I don't know if we mentioned that. Ah, 

Robin Rountree: yeah. But, but 

James Estep: it's huge, right? Because when you get to the hospital, a lot of times people are gonna ask, Hey, when did they come from home? Is there a loved one coming? If someone's gonna be having a stroke symptoms, one of the first thing the hospital's gonna want to know is a loved one's contact information.

Because they're gonna be the best historian as to what's normal for this person. How do they normally speak? How do they normally move? How do they normally act? So having that already printed when you just hand it over to the hospital, and again, it just saves time, it saves communication errors, it saves so much.

Just that one little piece of paper can make a big difference in your care. 

Robin Rountree: That's incredible. So good to know. And, hopefully our listeners will, uh, do that for themselves and their loved ones to make your job easier. Because I would think minutes really do matter. 

James Estep: 100% there. The difference between five minutes and 10 minutes in this job, night and day, right.

Outcomes could be much different depending on,, how quickly we can give care. Okay. 

Robin Rountree: And, um. Of course we see on TV the loved one hops into the ambulance on the way to the hospital. Does that typically happen or you ask them to come separately? 

James Estep: So, that is a great question. It really depends on the situation with the patient, right?

What's the, what's their condition? What are we planning on doing as far as treatment if we can, right? If it doesn't interrupt treatment. In any way, and the scene is calm. Absolutely. We'll let them ride to the hospital with us, but something to think about, how are we getting back? Right? Right. So that's a big question.

Can you uber back Absolutely. And take a bus back? Absolutely. But a lot of people wanna drive their own vehicles. Most hospital trips are gonna take, depending on where you live, and you want to go 5, 10, 15 minutes at tops, if they're stable, what we call stable, meaning that their condition,, is not life threatening in that moment.

He usually will ask if they can have your loved one drive themself to the hospital so you have a ride back, yeah. But it's just for that purpose. That's all it's for, is to make it more convenient when you get out. , A lot of times people have children, right? So you have to think about car seats.

What are we gonna do with that? Yeah. So absolutely. We're never gonna say, uh, no, unless we have to say no. God forbid we're working a cardiac arrest. We're not gonna let you ride in the back because we're trying to provide lifesaving care. But if it's a stable patient, you know. scene is calm, I'm sure it'd be no problem with a ride.

Okay. As long as they're okay with the, uh, getting back home situation. . 

Robin Rountree: Now you are from Orange County, Florida, that fire department what are some services that you guys offer that other fire departments typically offer in the community to help keep you safe? Like do you do the fire alarm checks and supply free fire alarms?

James Estep: That's great question. So, one, we're an all hazards department, right? So we do fight fire, right? If a house catches on fire, we'll fight it, but we respond to hazmats throughout the county. Oh, we respond to dive rescue calls, we respond to high angle rescue calls. , We respond to, technical rescue calls.

Uh, there's a building collapse. , Obviously medical EMS is our primary driver of 9 1 1. Right? That makes up the bulk of our calls. So we respond to EMS. As far as community service, we do a lot of work on that side as well. So we do, if you request, we'll come and install smoke detectors for you. We are now to install pull arms on sliding glass doors.

So if you have a door with a pool in the back, right, especially the little kids running around, we'll install alarm so that it'll, it'll alert you when the door opens. Um, we flow hydrants all the time to make sure they're operational. We go to elementary schools.

Another big push we have is, , our CRS team. They go out and they do workshops for different people. So they'll do workshops for elderly people talking about fall prevention, talking about fire hazards, all kinds of stuff. They go out and do a lot of good work throughout the community, and it's all free. If anyone ever want to contact us, they can contact us and they can get a class come out. They can go over all tons of different topics related to prevention and fire and, and, uh, medical calls.

Robin Rountree: And if you live some other place other than Orange County, Florida, just call your local fire department and see what re resources are available. 'cause I have a feeling most of the time it's gonna be way more than what you thought it was gonna be.

James Estep: Absolutely.

Robin Rountree: Alright, James, we've got time for one more tip for everybody. What's, uh, what's something you wanna spread the news about? 

James Estep: Oh, man. What, there's so many things going on, right? I could suck a million things, but I will just say. Taking care of yourself, right?

Try to move around. Exercise, eat well. If you see a doctor, see 'em regularly, right? Try to um, eat as well as you can. Move every day. Prevention is the best medicine. Anything you do to prevent a problem is gonna go tenfold and, and, and helping you. .. But uh, hopefully, if God forbid, you have to call, we're preparing, we're ready to help you out. 

Robin Rountree: All right, well hopefully we won't meet you James, in a 9 1 1 situation.

Thanks so much for being on the podcast. 

James Estep: Yeah, my pleasure. Thank you.

Please make sure to subscribe to our podcast Informed Aging, tell your family and friends about us too. If you'd like to support the work that we do with the Alzheimer's and Dementia Resource Center, please go to adrc cares.org/donate. You can find us at facebook.com/informed Aging. Today's episode was recorded at ARC's Podcast Studio.

That's it for now. We are looking forward to our next visit.