Reprinted with permission of Journal of Emergency Medical Services, copyright July, 1996, JEMS Communications, PO Box 2789, Carlsbad, CA 92018.

Listening to Deaf Medics

By, Marion Angell Garza

Can deaf individuals be effective EMTs and paramedics? It is a difficult question to answer, but in a number of communities across the United States, deaf people are working the streets, providing emergency medical to hundreds of patients each year. How are these medics doing? What kind of hardships are they facing? What special accommodations have been made to facilitate their work, and at what cost to their employers? Are there instances in which their disability has hurt-or helped-their job performance? JEMS interviewed nine deaf men and women who are working in prehospital emergency medicine or who have trained to become EMTs. Here are their stories.

Kathy Hagerty, NREMT-P, Erie, Pennsylvania
A full-time paramedic with Emergycare In Erie, Penn., Kathy Hagerty applied to the commonwealth of Pennsylvania to become an EMT in 1979, the first deaf person in that state to do so. "I threw them for a loop because they hadn't encountered [a deaf EMT applicant] before, and they didn't react fast enough to keep me out," she said. "Then when I applied for paramedic training, I had already established myself as a very good EMT.' In fact, Hagerty, who lost her hearing after contracting German measles as an infant, had become so skilled at lip reading and other methods that compensated for her hearing loss that Bill Brown, executive director of the National Registry of EMTs, said that he didn't know Hagerty was deaf until several weeks after she took-and passed-the Registry's paramedic exam. In addition to her 13-year career with Emergycare, Hagerty teaches EMS classes, performs autopsies for the Eric County coroner's office and was the county's director of EMS education for four years. She was profiled in JEMS in October 1991.

Audrey Hill, EMT, Prince George's County, Maryland
When Audrey Hill was in fourth grade, a teacher told her to abandon her dream of becoming a firefighter because Hill was born with only 20 percent hearing. But Hill ignored that admonition, and by the time she was in high school, she was riding along with the Snowmass (Colo.) Fire Department, and taking first aid and CPR classes. Hill's interest in public safety continued into college at Gallaudet University in Washington, D.C., the nation's only university for the deaf. Gallaudet does not offer an EMS track, but Hill enrolled in an EMT course at nearby George Washington University (GWU). Then, in 1991, she passed the National Registry's EMT exam (an interpreter helped her only during the introduction to the practicum) and began an internship with the Ladensburg Volunteer Fire Department in Prince George County, Md. After graduation, Hill applied for a job with the Prince Georges County Fire Department, but was rejected, she said, because of her hearing loss. Hill appealed the decision, but was unsuccessful, and remains a volunteer EMT in Ladensburg where she "takes the lead' on obstetrical calls, she says, since she helped deliver 55 babies while working with a nurse/midwife in Colorado. Employed as a medical assistant for Kaiser Permanente, Hill presently is awaiting a decision on a complain filed with the U.S. Department of Justice claiming that Prince Georges County violated the American with Disabilities Act.

Nicole Hill, EMT, Fairbanks, Alaska
Audrey's younger sister, Nicole Hill, was born with hearing, but developed an 80-percent hearing loss as an infant. Last year, she became an EMT in Alaska, where she studies biology and fire science at the University of Alaska. She also works part-time grooming ski trails, belongs to the Fairbanks Wilderness Search and Rescue Team and the National Ski Patrol, and climbed 16,700 feet up Denali (Mt. McKinley) in May. She will try for the 20,320 feet summit in May 1998. Despite her accomplishments, Nicole Hill has faced prejudice working as an EMT/firefighter. "The state [of Alaska] withheld my EMT certificate until I wrote a letter explaining how I can do this and that," she said, adding that even though she is a volunteer for a small fire department near Fairbanks, the first chief won't let her fight fires. "He only lets me work as the third medic on a call," she said. "I can't drive the ambulance or respond to calls from home because I can't hear the radio." The fire chief also refuses to support Hill's attempt to become an EMT-2 (Alaska's equivalent of EMT-intermediate) or to attend paramedic classes, she said.

David Tagg, EMT, Allentown, Pennsylvania
David Tagg was born with more than a 70-percent hearing loss, has worked with one partner, Mike Page, for more than 10 years at Cetronia Ambulance Corps, a part-paid, part-volunteer ALS service in Allentown, Penn. Tagg, who become an EMT in New Jersey in 1975, volunteers with Cetronia as an operations supervisor (and pays the bills by working as a workshop instructor and librarian at a residential facility for mentally handicapped adults). Tagg would have liked to become a paramedic, but never did, he says, because Pennsylvania law requires paramedics to receive direct verbal orders from medical control, and he has difficulty communicating over the radio.

Tricia Ney Brownlee, paramedic, North Versailles, Pennsylvania
Tricia Ney Brownlee graduated at the top of her EMT class in Allegheny Community College in Pittsburgh, then worked as an EMT for the six months required in Pennsylvania before she went to paramedic school. 'We teamed Tricia up with a set of ears, so she could do full assessments," said J.R. Henry, director of Ross/Westview EMS in Pittsburgh where Brownlee volunteered as an EMT. "If she was paged, she'd be activated by a light at her home and would communicate with us by TTY [teletype]." In 1995, Brownlee became a registered nurse, and now works as a paramedic for Priority One Ambulance in North Versailles, Penn., and as a registered nurse in a nursing home.

Communication Problems?
The most obvious concern that many people have about deaf people working as EMTs and paramedics is their effectiveness in performing accurate patient assessments, particularly because accuracy often depends upon hearing, such as listening for breath sounds. Several of the medics interviewed said that, while patient assessment is not easy for them, they can do it by using a regular stethoscope or an electronic stethoscope, which costs approximately $300. 'When I put [the stethoscope] in my ears, it tunes out background noise," said David Tagg. While breath sounds are "iffy sometimes," Tagg said, he can take blood pressures "pretty well" because he palpates. Chris Oberlander, a paramedic with HealthSpan Transportation in St. Paul, Minn., since 1992, said that assessment is not as much of a concern to her as other skills, such as nasal intubation-a skill her current provider does not allow. "You have to hear them breathe, and sometimes they don't breathe fast enough," she said. In addition to special challenges with regard to patient care, deaf EMS providers often have to devise creative solutions to enhance radio communication. "Talking on the radio is the hardest thing," Oberlander said. "Sometimes I don't heard the doctors very well so I crank it up, and sometimes that's bad because the patient can hear the doctor." Oberlander recently started using behind-the-ear hearing aids, which she reports are making radio communication easier. Hagerty overcomes radio communication problems by memorizing the sequence of radio procedures, then giving her report when her partner gives her a "thumbs up" sign. Her partner repeats medical orders or questions that come up by radio, and Hagerty reads his lips-sometimes via the rearview mirror-then confirms the orders verbally over the radio. The use of protocols established by medical command physicians have allowed Brownlee to work with relative ease. "I must notify them of procedures I have completed for patient signs and symptoms," Brownlee said. Another medic helped her set up a cellular phone that connects with a TTY at Allegheny General Hospital in Pittsburgh. "You cope in any number of ways. You speech read, say 'huh?' a lot and/or wear hearing aids," said Glenn Luedtke, who directs the Cape and Islands EMS System in Hyannis, Mass. Although Luedtke lost much of hearing as an Army band drummer, his long-time career as a volunteer firefighter/paramedic has led him to believe that hearing loss is not uncommon in EMS. "I know a lot of people who lost some of their hearing in the days when the sirens were right over our heads," rather than in the grill, as they are today, he said.

Being Accepted
Although most of the providers interviewed reported that co-workers generally have been supportive and helpful, ignorance and fear of hard-of-hearing medics is not unusual in the EMS community. "Some people are very good, and some aren't," Oberlander said. She says she began telling people she works with about her hearing loss after one co-worker who didn't know about it "complained to management because he though I was spacing him off." Tagg said the biggest challenge he has faced in EMS is "proving to the people I've worked with over the years that I could actually do what they can." Because of the term "deaf and dumb,' many hearing people think that deaf people are dumb, Haggerty says. "But 'dumb' in this context means only that someone cannot speak," she added. Deaf and hard-of-hearing people, who are unable to speak clearly have the most problems, Hagerty says. "When I was growing up, I had terrible speech problems and was degraded by teachers as well as by other kids. I was beat up on a daily basis for being 'dumb,' and I even had Girl Scout leaders pick on me and refuse to defend me when other girls made fun of me," she said. "All deaf and hard-of-hearing people can tell you stories like that," Hagerty said. "Is it any wonder that we don't trust the hearing world?"

Are Deaf Medics Safe?
Misunderstanding often leads to fear-which perhaps is the greatest barrier faced by people with hearing loss who want to work in EMS. Hagerty says many co-workers now tell her that "a long time ago when they were scheduled to work with me, they were frightened because they didn't know how to work with me." She says she's convinces they were "afraid for their own safety." In fact, the Registry's Bill Brown and Oklahoma state EMS director Eddie Manley, who are involved with the case of a deaf applicant trying to become nationally registered, expressed concern that deaf medics could get hurt on the job of endanger their co-workers. Manly said he asked Registry applicant Ken Brown, who speaks, but not clearly, "how he could protect his other firefighters if he saw a wall falling and couldn't holler." (Brown told him he would pull on the fire hose.) "You must be able to hear someone sneaking up behind you ready to hit you on the head," said Bill Brown. Hagerty admitted that she probably wouldn't hear someone sneaking up behind her. But, as Ken Brown pointed out, many hearing medics might not hear someone creeping up behind them either. GWU professor Steve McGraw, who has taught a number of deaf EMS students, described a man in his 70s who made it through GWU's EMT program despite being extremely hard-of-hearing and have had a laryngectomy. "He was almost killed on the interstate after he became an EMT when a car blew through police barricades," McGraw said. "Someone yelled to him, but he couldn't hear.' But Hagerty says deaf people are even in more danger of being overprotected. "A theme I keep hearing over and over again is that the deaf community needs the hearing community to protect us and keep us from harm," she said. "I appreciate the sentiment but it is much like an over-protective parent who doesn't allow room for growth and attainment of goals." Deaf medics can be successful, Hagerty said, "If people are willing to work with the deaf instead of trying to set limits for the deaf in the guise of trying to protect us."

BOX ARTICLE
Deaf Medics and the National Registry
Sometimes deaf people pass their EMT classes, but then can't get certified. Ken Brown, who graduated from an EMT program at Oklahoma City, says he failed the National Registry of EMTs practical exam in August 1994 because he was embarrassed and upset after a sign language interpreter he had brought along to help him understand instruction and the testing scenario was "rudely" ejected from the testing room by Oklahoma sate EMS director Eddie Manley. Manly says he had told Brown the day before that he couldn't use an interpreter. "As soon as I got word we ha d a handicapped candidate, I called the National Registry for advice," Manley said. "We decided through the Registry policy that we would test him but not provide accommodations." Since Brown has not retaken the test and Oklahoma requires EMTs to pass the National Registry exam to be state-certified, he can't care for patients while he volunteers with the Newalla (Okla.) Fire Department. Brown says he plans to retake an EMT class, then try the National Registry exam again in another state in which he's heard sign language interpreters are allowed in the practical exam. Meanwhile Brown is studying police and fire science at OSU with the goal of becoming an arson investigator. (He also responded with the Newalla Fire Department and helped carry the wounded out the rubble of the federal building in Oklahoma City after it was bombed in April 1995.) "The role of the Registry is to protect the public by ensuring that the person who passes the test can practice at a minimum level of competency," said Bill Brown, executive director of the National Registry. "The bottom line is that there has been a functional job analysis developed for the jobs in EMS, and candidates have a responsibility to meet those. Otherwise, they put their patients, partners, and employers at risk. If someone cannot perform the essential functions of the job, that person cannot become an EMT." Although some deaf EMTs and paramedics have passes National Registry exams, Bill Brown says that's only because they were able to do so without any accommodations. Steven Doleac, an athletic trainer and first responder at Gallaudet University in Washington, D.C. who is deaf, passed the National Registry's EMT exam last year. "I was asked if I would need accommodations and warned I wouldn't be given any, and that I couldn't have an interpreter," he said. "They said the test is standardized for all people." Doleac took his EMT course at GWU, and said he usually could understand instructors-unless they spoke while turning their backs to write on the board. GWU also provided a sign language interpreter to help, especially when other students asked questions.

BOX ARTICLE
We Want You to Know
We asked the medics we interviewed what they would like JEMS readers to know about working with deaf partners or deaf patients. Here are some of their comments:

Ken Brown: "People should not feel sorry for the deaf and hard-of-hearing. We just can't hear-that's it. We use different methods to obtain information, [perhaps] by feeling, using high-technology or by reading gestures and body language."

Tricia Ney Brownlee: "Be patient. If worse comes to worse, write everything down on paper. Do not doubt [us]; you'll be surprised by what we can do."

Steven Doleac: "Most EMTs will tell you they can't hear in the back of an ambulance so they basically palpate blood pressures. So they have made accommodations for themselves."

Kathy Hagerty: "It may take some work and adjustment by both hearing and hard-of-hearing people to work together. But if the deaf are willing to adapt to the hearing world, is it unreasonable to ask the hearing world to lend a helping hand in that adjustment?"

Nicole Hill: "I would like EMTs, firefighters and fire chiefs to know it takes time and patience to work with a deaf partner. You need to get to know them well and learn to communicate with them."

Chris Oberlander: "Everyone has something they aren't good at, some deficit, even if it may be hidden. For example, I know some medics who are excellent at trauma, but not as good at sitting and listening to an old lady."

Glenn Luedtke; "Be sure you look right at your [deaf or hard-of-hearing] partner when they talk. Tap them on the shoulder, and give them a chance to look at you."

David Tagg: "Don't shout at us. Talk in a normal tone of voice and look at us; we need eye contact. Also, don't cover your mouth or chew gum."