Emergency medical technicians and paramedics are often overlooked compared to the attention given to police officers and firefighters. Many may also not know that Oʻahu is short-staffed when it comes to emergency medical services, a situation that has been stretched even further by the pandemic.
Mark Kunimune is the clinical coordinator at Kapiʻolani Community College’s Emergency Medical Services Department. He helps train Hawaiʻi's future EMTs and paramedics, often riding on ambulances alongside them and long-time paramedics.
A former paramedic himself, Kunimune recently started taking first responders to work in the Ho’okua’āina taro fields in Kailua as a way to process stress and trauma. The Conversation went to Oʻahu’s windward side to talk with Kunimune out in the loʻi kalo.
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On what it takes to become a paramedic
MARK KUNIMUNE: To become an EMT, which is the basic level, it's basically a semester-long course and then you work for between one and three years. And then you go to paramedic school. And then paramedic school is a full year. So when you think about it, that's maybe two to four years of really being in the field to become a paramedic. The skills that a paramedic possesses and the interventions that a paramedic does are highly skilled — tracheal intubation, which basically anesthesiologists and respiratory therapists and paramedics are the ones that do that, nurses, anesthetists. Starting intravenous lines, administering emergency cardiac medications, doing a thoracentesis, which is decompressing a hyperinflated chest. There are some pretty invasive things that paramedics do. I don't know if everybody understands the depth and the breadth of what medics have to do and the decisions that they have to make on a daily basis.
On the volume of 911 calls throughout the pandemic
KUNIMUNE: I primarily do all the clinical instruction for the paramedic program. So I'm out in the field riding on the ambulances with my students pretty much throughout the year. I've seen the ebb and flow of the stress pre-COVID. In 2020, the call volume actually dropped when COVID first came around because people were afraid to go to the hospital. But then come the end of 2021 and the beginning of 2022 when omicron came, the call volume increased. In 2021, early, the call volume went somewhat to where it was before, pre-COVID. But then what happened was that call volume did not decrease, it stayed the same. And then on top of that, the COVID calls came. People were calling for every little thing. People who thought they had COVID were calling the ambulance to say "Hey, you know, I think I got COVID. Can you take me to the hospital and get a test?" So you add that number of calls to the normal load, which is already high. It really put a lot of stress on the medics. On an average day, a busy station would be 10 to 12 calls. And then I think at the beginning of 2022, the call volume was 15 to 24 calls on a shift, on the 12-hour shift. So that's a lot of calls.
On helping paramedics process stress and trauma by bringing them to work in a loʻi kalo
KUNIMUNE: One of the really important things in the University of Hawaiʻi System is to integrate the Hawaiian culture into the curriculum of all programs... We started off with just students and then we expanded into inviting our field instructors, who are working paramedics, to come with us. I want to say one of the most significant cases was after — I think it was January 2020 — a bad pedestrian accident, a three-person fatality and the district chief had called me because she experienced the loʻi and knew the value — dealing with traumatic experiences. And so she said, "Hey, can we bring the crews down to the loʻi, the crews that responded to that triple fatality." So we had about maybe seven, eight medics come down and they worked in the field, and kind of sat around after. We talked a little bit and had lunch. It was really good. You could kind of somewhat sense that there was some weight lifted off of these folks. But the telltale thing was a few months later when I came back to the loʻi with another group of students and the farm managers and the interns pulled me aside and said, "Uncle, pretty amazing to see the transformation of these medics because you said when they came, they were really heavy and dark and down." When they left, they said they could see a marked difference. They were lighter, they were more upbeat. They were happier. And so for us, it was kind of validation that there is something that happens when they come to the loʻi. It's not necessarily having conversations about feeling bad. It's, I want to say, it's almost nonverbal. It's being in the ʻāina and being in the lepo, the mud. One of the things I like about this loʻi is the lepo is deep because it's spring-fed. So if you work in the loʻi, you get into the loʻi, you get inside. And so if you go with the theory that the toxins are drawn out when you're in the mud, this is a really good place... People sit in the loʻi and they talk story. Seems like the conversations flow real easy in the loʻi while they're pulling weeds. Other people, they want to be by themselves so they kind of go off and be by themselves and that's absolutely fine. But everybody's in the loʻi, everybody's kind of working with their hands, putting their hands in the soil, stepping in the soil. Other times we're cleaning the kalo, some of the farm managers will pull kalo and we just help them to clean it off — whatever work needs to be done, we do.
On learning about the healing powers of the loʻi
KUNIMUNE: We'd go to the loʻi in Kānewai. It was a good experience but we didn't really have a deep understanding of the value. I think this particular time, we went to the loʻi up in Lyons Arboretum, and we came out and there was a Lāʻau lapaʻau practitioner that joined us. And she saw us coming out of a loʻi and we went into the hale over there and she looked at us as we walked up, and she said to us, "Hey, you know, it's really good for you guys. The kind of work you do, what you're exposed to, the negative energy and the negative vibe in the air, when you respond to a lot of your calls, that's absorbed into your body." And so she said, "When you go in the loʻi, it's really good, because the ʻāina will draw out all that negative energy, and not only will it draw it out, it'll kind of replenish it."
On how EMTs and paramedics cope with the job
KUNIMUNE: From my experience, the number one way people destress is talking to their partners or talking to their colleagues. A lot of times it'll be, "Let's go have a beer and sit down, have a beer and talk." Or sometimes it's just — I've been on a call where it was a really bad pediatric call and just really bad, really gut-wrenching, and the medic that was in charge asked the chief to shut the unit down for a little bit. And we went down to the beach and stood on the beach and just kind of let it all, the salt air, kind of pull it all out of us. So people over the years, I mean, drinking unfortunately has been a common practice. So a nice thing about the loʻi — one of the medics that were here, he says, "Usually the conversation that I had in the loʻi today is a conversation I have in a bar." So he says, "It's probably better that I have this conversation in the loʻi versus in the bar." We're like, "Yeah, hell yeah." But then, you know, I've seen it kind of evolve over the years. It used to be, if you can't handle it, you shouldn't be in the field — you gotta suck it up and do whatever you got to do. So, you know, I think a lot of people just consciously or subconsciously would get in the ocean, surf, dive, whatever. A lot of guys workout, lifting, now there's CrossFit, that kind of stuff, running, or people would have hobbies. I think people find ways to do it. Because you have to, you have to. You know, just being that the university system wants us to integrate the culture. It's like, well shoot the culture is all around us. So let's utilize it.
On how EMS departments can better support their workers
KUNIMUNE: The first thought that came to my mind is I think the organizations themselves, the EMS agencies, I think they need to kind of start really looking at how can we help our providers destress and not just say, "Do it on your day off, or here's a discount on a membership." I think there needs to be a greater conscious effort, and working with the whole to destress.
On how the public can show appreciation to EMTs and paramedics. National Emergency Medical Services Week runs through May 21
KUNIMUNE: I think the community can pull together and do things for first responders, whether it be having a first responder day at a loʻi — or there was a time when a couple of groups of paramedics went out to Camp Erdman to do a ropes course — it could be community-sponsored, community-led, things like that. Could be a potluck: let's feed the paramedics, let's take care of the firefighters. That's kind of a very local way to think — being community-minded like that — but I think it'd be highly effective. I think that that does speak volumes.
This interview aired on The Conversation on May 17, 2022. The Conversation airs weekdays at 11 a.m. on HPR-1.
