Day in the Life: Plymouth Paramedic Robert Farmer

28-year Paramedic Robert Farmer, Plymouth, MA.

28-year Paramedic Robert Farmer, Plymouth, MA.

Describe your career in EMS and what led to your becoming a paramedic.

RF: I was basically working as a male nursing assistant at Quincy City Hospital. Part of our duties was to accompany patients to other medical centers via ambulance. I got to know the guys in the ambulance service that served the hospital and took interest in what they did. I took an EMT class put on by Boston Health and Hospitals (Boston EMS) and got my EMT license and then went to paramedic school later. I started working with Metro Ambulance in 1983/84 and was with them until 1986. Brewster acquired them in 1986, and then I was with Brewster until 1997 when they sold the business to Laidlaw's Wakefield-based ambulance subsidiary, Medtrans New England Inc.

After Brewster started back up, I came back when they got the Plymouth 911 emergency ambulance service contract in 2013. I thought about going to nursing school in 1986, but I worked in the hospital and worked in the units and the ER as a male nursing assistant, and wasn't totally thrilled with it. I've been in Plymouth since 1988 as a paramedic, so when Brewster got Plymouth, I came back.

What was it that you liked about the pre-1997 Brewster Ambulance?

RF: Back then it was a very strong family company, as opposed to now they are still family company, but they are much more sophisticated. They are trying to use the best equipment, the best ambulances, and they're even using aerial drones. It was as if they wanted to stand up and be recognized as a major EMS provider. They want to raise the bar of their service. The first iteration was more of a quality family company that exploded into a very busy service.

What are some of the things that you see now that you like that Brewster is doing?

RF: I can't find fault in anything they are doing at Brewster. They are concerned about contracts, people and their equipment, getting more contracts, introducing drones, so they're just trying to raise the bar as a private ambulance service. I don't think any other private ambulance company provides the level of service that Brewster does. Everybody does their calls, but Brewster is trying to provide service rivaling a municipal third service like Boston Health and Hospitals (Boston EMS) as far as quality goes. They are involved in hazmat, mass casualty situations, large scale events like the Boston Marathon, that kind of thing. They run the service and provide what they can provide and are always looking to improve things.

They are also plugged in and engaged with the family environment. They run a professional service, and are always accessible as far as Mark, Lorna, Chris—they're always willing to help out and answer questions, address problems with equipment and even talk with you about particular calls. They cover a large area, and try to do their best to shift resources around to make sure that all customers get the right coverage. They are proactive working with the contracts, hospitals, and working with team education-wise.

What would you like to see added to training and education?

RF: More robust ventilator classes. The vent classes that I've been exposed to have been more hands on how you work the vent, equipment-wise. As far as the actual qualifications, what do you do when something happens using a vent? The problem is that some of us may not be well-versed. There is a natural problem understanding the actual physiology of the vent, as far as if they are desatting when oxygen saturation is dropping, and they're having an issue, what lung sounds to listen for and what they mean, and how the settings can be adjusted to increase the ventilation total volume; the rate they are breathing at and the pressures that the vent works on. The actual training, instead of a 1-2 hour class, we could get deeper.

Is there a particular call that you remember that had a good outcome?

RF: I was working with my partner and we responded to a call in Pine Hills for chest pain. The fire department got there and started doing oxygen and interviewing the patient. We pulled up and just as I walked out the door with the blue bag and monitor, the lieutenant said, "he just stopped breathing and became unresponsive." He went into cardiac arrest. So we put the monitor on the patient, defibbed him and he regained his heartbeat. We started an IV, lidocaine, put on an oxygen mask and he was awake and talking on the way to the hospital. In and out the door in less than 10 minutes and it was very simple. I've had a number of those in my career.

What do you like about Plymouth?

RF: As far as Plymouth goes, Plymouth always had a good system. They always worked well with emergency response, the fire and police department and the hospital. I've worked a bunch of different places from Brookline, Marshfield, Marlborough-Hudson, Dedham, Weymouth, and the working relationship seems different in Plymouth. We're in the fire department a lot. Depending on where you work, it's different than it used to be, it's not an us versus them, it's an eat together, work together thing, more of a helping hand type of thing. Everybody works really well together. If you needed a hand, they did it. They were always willing to jump in. There was a point in time, and they were very busy in the ER and we'd help them out because they are so busy. There was one occasion where they had a difficult intubation and a paramedic helped out.

It's also where I got my experience for the most part, my home-field was Plymouth. I had some really great partners over the years that I've learned from. I've always wanted to be here. Now it's a lot busier than before. 

Plymouth fire standby at Full Sail Pub in Plymouth, MA.

Plymouth fire standby at Full Sail Pub in Plymouth, MA.

What do you do in your spare time?

RF: Aside from camping in Maine, my wife and I enjoy day trips. We spend a lot of time with my son and his wife. We go to the zoo, travel around the eastern part of the state to places like Rockport and Gloucester. We're a seacoast type of family, and we also go down to Newport or P-Town and walk around and experience the towns and whatever's going on. We'll have a meal and a couple of drinks, go to the historic part of town, Beacon Hill, Back Bay, and simply spend time together.

Other stuff I do is work around the house, yard and mechanical work. I guess you could say I'm a hobbyist mechanic, I like to take apart things and fix them. I don't mind getting my hands dirty, taking something apart and putting it back together again. I work on my own cars a lot. I miss the days when I could work on engines with a wrench and a matchbook cover. I had a thing for an old Pontiac way back. A neighbor kid bought it, worked on it and screwed it all up, and I bought it from him for $50 and spent two hours on it, got it running and then put 100K miles on it. That went through a couple of iterations as well. I basically beat on it as kids do, hopped it up a little bit, that was my hotrod for a while. I've always had beaters. I've rebuilt transmissions in my basement and fixed cam shafts. My father's car broke three times and I repaired it. I was 18 at the time. I'll work on anything. I learned how to do it some from my dad, and some from a friend in high school who was a mechanic. I worked for him after I got out of high school. There's nothing you can't learn by reading a good manual. 

Sunrise at White Horse Beach

Sunrise at White Horse Beach

If you could have any dream job, what would it be?

RF: I've never thought about it. I've always enjoyed this job, so I've never entertained the thought of doing anything else.

Have you ever heard from a patient after you've done a transport?

RF: I have in the past, not recently. You'll get letters written every once in a while, or you'll bump into a family member that remembers you from doing a call and talks to you about what went on. Sometimes you get thank-you notes. We've had our share of thank you's and things like that.

In your 30 years of experience, what advice do you pass along to new EMTs?

RF: I've worked with a few new EMTs. I don't mind teaching and all that stuff, hands-on, communication, etc. Skills are important provided you do everything else like introduce yourself, look the patient in the eyes when you're talking to them, make the focus about them, and convey that you have the capacity to care for them and that you will. Patients find a level of comfort in that. Communicating through holding a hand is just as important as doing other things. Developing a rapport and level of security with the patient is important. You want them to think, "Hey, they know what they're doing. They look professional, and the way they treat me, focus on me and examine me, I know that they're going to take care of me too."

I quoted a paramedic many years go and although I never liked the saying, it makes sense to me now. It was, something like, "It's not what you do, it's how you look while you're doing it." When I first started thinking about that I didn't appreciate the saying. It seemed to be basically saying well, here's an excuse not to do the best work, but look good while doing it, but I think it's more than that. You can do everything to a patient in a cold, calculating manner, and the patient gets nothing from it other than a ride to the hospital and treatment. But when you introduce yourself and touch the patient, when you are compassionate to the patient and make it about, "It's you and me, and let's focus on you and see what's going on," it makes a big difference.

This is what I do and this is what I like doing. I've never thought of doing anything else.