Bill Keeley
Emergency Medical Services Officer, Kootenai County Fire & Rescue, Post Falls, Idaho

Lake and river rescues require Lt. Bill Keeley, 46, to throw himself into miserable situations. When an emergency call sends him rushing to one of the two Kootenai County Fire and Rescue boats, he wears a heavy fire-resistant uniform and life jacket, no matter the weather.
“We arrive, and people are injured and freaking out in the water. We jump in … wearing uniforms, long pants and T-shirts,” he says. The rescuers try to remember to remove their shoes, radios, cell phones and wallets beforehand.
Some of Keeley’s most difficult situations have been boat and personal watercraft accidents not far from shore.
“Most of them happen right off Tubbs Hill in Lake Coeur d’Alene. There are usually multiple injuries with people in the water, screaming for help. I have to pull people out of the water or go in after them,” he says. “Then I have to take care of them.”
Keeley focuses on the injured, administering first aid, while relying on a colleague to handle the boat.
 

“I need to trust that while I’m in a boat, traveling 30 or 40 miles per hour, concentrating on my patient, the person operating the boat is making decisions to keep us safe. That makes us awfully close,” he says. “The boat engines are screaming, and I can’t hear well as we’re trying to get people to shore. I need to listen to the patient, listen for blood pressure. There’s noise from the wind. In a boat rescue, you have to completely change the way you take care of people.”
Even if the lake or river is calm on a warm summer day, a boat rescue is a formidable task.
“I don’t care if the lake is completely smooth, the boat still bounces all over the place just because it’s a boat. Every wave you go over, your equipment is flying in the air. Open a gear bag, and anything will blow completely away,” he says. “You have to open it up, grab what you want and close it fast.”
And that’s just what’s going on in the rescue boat.
“People in other boats do stupid things. We have lights and sirens on our boat like an ambulance, but people don’t realize that if you pass a fireboat with a patient on it, the waves you make passing it make my job 20 times harder. The patient is moving, and anything I’m trying to do, like start an IV, is now incredibly difficult,” Keeley says.
Add a storm or wind with high waves, and sometimes Keeley may only be able to put oxygen on his patient, explain what’s going on and try to reassure him or her. “I’m not a doctor. I don’t have an x-ray machine or CAT scan. I can treat your immediate needs. I can talk to you and figure out where the problems are, and comfort you,” he says.
Making quick decisions about treatment is key in extreme conditions. Keeley says it’s part of why he loves his job. He finds it rewarding to help people in trouble and to get a chaotic situation under control.
“I have a huge amount of training, and there’s a lot of satisfaction to being able to put it all to use,” he says. “You’re on your own, making decisions. This career doesn’t work well for people who are wishy-washy.”
For him, being a paramedic has been a lifelong dream, ever since he was watching Emergency! on TV when he was 7 years old.
Keeley began his career with the Kootenai Country Fire & Rescue as a volunteer firefighter and worked his way up to take charge of the Emergency Medical Services division last summer. Although he has administrative duties now, he continues to go out on calls.
In a typical summer month, his department will go on three to five boat rescues. The rest of the year they respond to another five to 10 emergency calls on the water. In addition, Kootenai Country Fire & Rescue transports sick and injured people by boat when it’s a faster option than a ground ambulance.
Married for 24 years with two children, Keeley says his own encounters with loved ones’ health issues have given him insight and compassion in his work. “When my wife was seriously ill, I learned a lot about being on the other side of the call. I learned what it’s like to not get information. I make a point now to stop and talk to families — at least give them an idea of what’s going on,” he says.
In fact, that can be the most challenging part of his job at this point in his career. “I can deal with any bloody, messed-up person. I can deal with any mangled body,” he says. “But it’s another thing to tell someone that they’ve lost a loved one, or tell a wife her husband is so traumatically injured there’s nothing I can do. That’s the tough part of the job.”
In spite of the extreme circumstances under which he meets people, Keeley feels a connection to his patients. Sometimes he gets cards or phone calls from the people he’s helped.
“You’d be surprised at the personal bond paramedics and firefighters feel with these folks. I want to know how they did, and whether what I did truly helped them,” he says. “I like it when someone says, ‘I felt taken care of by you.’” n

Registered Respiratory Therapist with 
Northwest MedStar, Spokane, Washington

Alison Scott is a frequent flyer, but not to anywhere you’d want to visit. In her job as a registered respiratory therapist with Northwest MedStar, Scott took more than 110 flights in two helicopters and a small, fixed wing airplane last year, helping people survive medical emergencies.
Northwest MedStar is the region’s critical care transport. In 2009, it transported about 3,500 people while operating 24 hours a day, every day of the year.
Scott is always paired with a registered nurse who’s trained in adult or perinatal care. While 90 percent of the flights are inter-hospital transports of seriously ill or injured patients, the other 10 percent are “on-scene” emergencies or assistance with search and rescue missions.
Scott, 46, never knows what’s going to happen when she arrives for work, and that’s fine with her.
“It’s fun because you never know what you’re going to be doing or where you’re going. We go to Seattle all the time. I could end up hiking up part of a mountain, or we may have to land on a highway to help someone,” she says.
On the way to an emergency, she usually sits in the front of the helicopter, with complete confidence in the Metro Aviation pilots who do the flying for Northwest MedStar.
“MedStar has strict safety standards, and we have awesome pilots. If the weather minimums don’t allow us to fly, we don’t go,” Scott explains.
The pilots decide whether to fly based solely on weather conditions. They aren’t given details about emergency calls, so the situations won’t sway their decisions. Heavy rain and dense fog? The rules dictate that flying is not permitted. But what if it’s an accident involving a busload of children? Since that information isn’t shared, the pilot isn’t tempted to risk a flight. The crew may be dispatched to the scene via MedStar’s two ground ambulances instead.
Still, the thought of administering first aid and assisting people with breathing problems while swooping through the air in a helicopter going an average of 140 miles per hour makes most people a little queasy. Not Scott.
“I’ve never gotten sick, but I’ve felt nauseated lots of times if it’s real bouncy,” she says. “It’s loud in there, and sometimes it’s dark, and the moving up and down makes it difficult. Let’s say you’re trying to set up an IV and hit an air pocket, or you’re drawing blood — that movement doesn’t have to be much, and it makes the job challenging.”
What Scott finds most stressful about her job is working in extreme weather: pouring rain, freezing cold and high heat.
One of the most memorable rescues in her six years with Northwest MedStar happened on a hot summer day.
The helicopter flew to an accident in Oregon’s Blue Mountains, landing on the highway. The crew walked a quarter of a mile to the scene carrying their 20-pound gear packs. (Police clear the road for helicopter landings, and Northwest MedStar crewmembers scrupulously follow “scene safety” procedures, like making sure no cars are driving around the police barricades as they exit the helicopter.)
When they arrived on the scene, they found a logging truck had flipped. The driver was trapped inside, on a hillside, with logs everywhere.
Ambulances, paramedics and EMTs arrived first, and were cutting the truck apart to extricate the driver.
“Sometimes they get there first, and they do a phenomenal job of helping people,” says Scott, “But some EMTs aren’t allowed to give medications or start an IV. We got the driver’s arm out of the truck window and started an IV. We gave him pain medication. I administered oxygen and monitored him to make sure he was OK. We’re standing on logs in 103-degree heat, and it took three hours to cut him out of the truck cab,” Scott said.
The most trying part of that rescue was the heat. Year-round, Northwest MedStar crew must wear heavy, fire-resistant Nomex fabric jumpsuits with T-shirts underneath, plus heavy socks and boots. Soon, she was overheating, as was the equipment. “We knew what we were going to do when we got him out: we were going to lay him down on a back-board, and that was burning hot because the sun was beating down on it, and we were trying to shade that as well as keep everyone hydrated,” she says.
Scott wasn’t always involved in emergency rescues. She worked as a respiratory therapist at Sacred Heart Medical Center for 17 years before moving to Northwest MedStar. Scott had the requisite two years of critical care experience to qualify for the flight crew, but she also had to become an EMT and earn Advanced Cardiac Life Support and Pediatric Advanced Lift Support certifications. Ongoing training keeps her skills fresh.
What appeals to Scott most is the autonomy and decision-making required. “You have to have confidence. It’s not like you’re in a hospital with a whole room of people to draw on for information and advice. You have to be more independent in this job because it’s you, your nurse and your protocol book,” she says.
Like the other people in emergency care, Scott admits to being a Type A personality: high energy, compulsively neat, and interested in taking charge.
“I think the majority of us are Type A, because we want things to go well. When I arrive on scene and have a trauma patient, I go through my ABCs [airway, breathing, circulation] and assess the patient, and then I do what needs to be done. You have to focus and take control of the situation and, if you’re calm, everybody else around you will stay calm,” Scott says.