From Provider to Patient

Rain, maybe even a thunderstorm, was on the way, but it looked like Matt Deicher would get the steaks grilled before the downpour hit. His wife, Melissa, was in the house, their two kids nearby.

Matt and Melissa were EMTs for Mosinee Area EMS in Mosinee, WI. They loved it. Predictably, the steaks would get abandoned by a page for an ambulance call. "Do you want to go?" Matt would ask. The service had a crew roster, but until 6 p.m. on this Thursday evening, anyone could take the call. Melissa stayed back to finish grilling, while Matt hopped in his truck and sped away.

The patient had been transported by the crew before. Like several times in the past, he was complaining of hip pain. They started off for the hospital. Matt was in back with the patient, along with another EMT, Mary Beth Lingl. Jason Tobeyek, who Matt had met in EMS school, was driving. The transport was progressing normally, as was the thunderstorm.

With a few miles yet to go to the hospital, the patient's condition appeared to change. No one is sure what actually happened, but both Matt and Mary Beth observed a loss of consciousness. They decided to activate the ambulance's lights and siren and upgrade to an emergency transport. "All I heard from the back was 'Let's run hot,'" says Jason. By this time it had started to rain, and he had the windshield wipers on.

All of a sudden it happened.

"I felt something in the rear, a jerk or a buck," says Jason. "Then we slid into the center median. I yelled back for them to hang on."

The ambulance rolled over, coming to rest on its wheels, lights still flashing and siren still wailing.

"It seemed like we rolled forever," says Jason. "The engine was still running, and the ambulance was still in gear."

Matt doesn't remember anything. In fact, it would be weeks before he would be able to communicate.

Melissa heard the frantic calls over the radio. Jason was reporting that the ambulance had rolled over. "We have two 10-7," he said, meaning two people in the crash were critically injured or worse. Then Melissa heard Mary Beth's voice. A process of elimination would lead her to her next conclusion: She knew there were only four people in the ambulance, and her husband was one of them.

Back on the scene, Jason got out of his seat belt and ran to the rear of the ambulance, where he found Matt up against the rear doors. He still had a pulse, but was barely breathing.

"Hang on!" Jason told his friend. "You have two kids to take care of!"

The hip patient lay motionless, still strapped to the cot. He would later be pronounced dead at the scene of massive head injuries.

Jason's wife, who had been only a mile or two behind the ambulance, came upon the scene. Members of the Mosinee ambulance service were also in the area and arrived in less than a minute. After pagers for neighboring departments began sounding, it was only a matter of minutes before the scene was full of responders. The thunderstorm was in full bloom.

By this time, a Combitube was in place, and Matt's ventilations were being assisted. He wasn't breathing on his own, but he had a pulse.

Back at home, Melissa told the children that their father had been in a bad accident. She called Matt's father and asked him to meet them at the hospital. The next message she heard, however, was that "All of our people are OK." Perhaps it wasn't as bad as she first thought. Maybe, with all of the chaos, all that was going on, Matt was all right after all.

Now thinking her husband was only slightly injured, if at all, she slowed her pace a bit. She was on her way to the hospital, but was no longer frantic.

A telephone call asking her where she was and if she was coming to the hospital shattered any sense of calm. She knew they couldn't tell her the details on the telephone, but she could sense the urgency.

"Honey, it's bad," an emergency department nurse said when she saw Melissa. Because Melissa worked part-time at the hospital as an ED tech, she knew, and had worked with, the nurse. The hospital's halls were already lined with EMTs and firefighters from the local services.

Matt was in CT scan, but x-rays had already been shot and were in the ED. "Oh, my God--his neck!" Melissa exclaimed when the physician showed her the x-rays. It didn't take a radiologist--or anyone with medical training--to see the injury. Matt had suffered a fracture of his cervical spine at C3, C4 and C5. No one knew it at the time, but his spinal cord was severed somewhere between C2 and C3, rendering him quadriplegic.

As the ambulance driver, Jason was wearing his seat belt. He escaped the crash with a lower lumbar fracture, abrasions and puncture wounds, and a slight concussion. Mary Beth's most serious injury was a broken leg. For the most part, both of them would recover from their physical injuries. Their emotional injuries wouldn't be as quick to heal.

Statistically, passengers don't do well riding in the backs of ambulances that crash. Rarely are EMTs who are providing care wearing seat belts. At the time of the crash in Mosinee, it had been nearly 10 years since the last fatal ambulance accident in Wisconsin. In the five years preceding this crash, only 17 people had even been injured in ambulance accidents in the state. With 16,000 EMTs in Wisconsin, the odds were pretty good--just not for Matt.

No one could be sure if Matt would survive through the night or into the next day. One thing was certain: Regardless of the outcome, the lives of Matt and Melissa Deicher and their two children had been changed forever.

The Aftermath

News about the crash spread quickly. The Mosinee Fire Department and its members were inundated with calls and requests for information. Many of the department's members gathered at the ambulance building to watch Friday's evening news. Even national EMS and fire news outlets were reporting the story.

Before long, it was learned that the state ambulance inspector had, just days before, completed an inspection of the rig involved in the crash. He found that two of the four rear tires had been worn and needed replacing. He gave Mosinee 10 days to complete the repairs, but did not order the vehicle out of service.

Matt's and Melissa's lives had been turned upside down along with the ambulance. Matt still lay in a coma. The days turned into a week. By this time, a Worker's Compensation representative was meeting regularly with Melissa. She told her they'd do everything they could for Matt.

For the first two days, Jason couldn't bring himself to visit Matt. The guilt he carried was immense. On the third day he finally was able to go, and after that, he would visit every day.

Melissa was concerned that Matt's injuries were beyond the capabilities of the local hospital. She began researching specialty centers that could handle his care. One of the top places she found was Craig Hospital in Colorado.

After 2½ weeks in Wausau, Matt was taken by air ambulance to the Spinal Rehabilitation Center at Craig. It was now mid-August 2003. Matt would not return to Wisconsin until January 2004.

Matt doesn't remember anything from his stay in Wausau. He may have recognized several people, but for the most part, he was a critical spinal-cord-injury patient, dependent on a ventilator to breathe and on his care team to live.

The challenges of any spinal-cord patient are significant. An injury as high as Matt's is devastating. Nearly all of the body's systems are regulated through the spinal column. A spinal injury involves much more than not being able to move your arms and legs. Matt will never walk again--that is obvious to most EMS providers. The fact that his heart rate, blood pressure, kidneys, bladder and nearly everything else do not work as they should is, perhaps, less obvious. Muscles are no longer used. Bedsores are a constant problem. The incredible challenges a spinal-cord-injury patient endures can only be understood through firsthand knowledge.

Before too long, the staff at Craig had Matt up and in a wheelchair. Over the next several months, they would work to wean him from the ventilator. At first it was just a couple of minutes at a time, then longer, finally an hour.

The accomplishments were enormous, but as satisfying as they were, they would also nearly kill Matt. The amount of tidal volume he could move on his own paled in comparison to the amount he needed and what the ventilator could provide. After several bouts with pneumonia, Matt would no longer try to push the envelope with the ventilator.

Christmas would come and go. The lives of the people at Mosinee Area EMS would, for the most part, return to normal. But a newspaper article or an occasional television update would snap them back in an instant.

The accident investigation had concluded several months earlier. It found that Jason was driving too fast for conditions, even though investigators were unable to determine the actual speed of the ambulance due to a lack of evidence at the scene and the ambulance manufacturer never activating the recording device that would have recorded the vehicle's speed. Investigators found that the rear right passenger-side tires were worn and did not meet standards. They stated that wet roads also contributed to the accident.

Potential lawsuits from the hip patient's family, and even from the Deichers, were continuing to loom. Newspaper editorials called for tougher requirements for ambulance inspections. The use of lights, sirens and emergency vehicle operations would again be questioned.

For many with the EMS service, these things would continue to affect their lives in various ways and at various levels. Those who had been involved in the crash, however, found their lives completely changed.

Rarely does a day go by that Jason doesn't blame himself for Matt's condition. He visited Matt several times while he was in Colorado. He helped get everything ready for Matt's return home. He did anything he could to help Matt's family.

It took a long time for Jason to ride comfortably in a car again. Riding in the backseat was even harder. Even today, loud noises bring the events of that evening back again. Sleep is often hard. Even his own injuries continue to be a problem, including a loss of memory.

A New Normal

Six months after the crash, Matt was ready to return home to his wife and children. The kids had been staying with family members in Wisconsin while Melissa spent time with Matt in Colorado. It is here that the rest of the story begins.

The house where Matt had been grilling the steaks on the day of the crash was old. The needs of a spinal-cord-injury patient are many, not the least of which is wheelchair accessibility. The Deichers quickly discovered that there would be no way for Matt to return to his old home. The costs of upgrading it would exceed its value. Insurance was not willing to foot the bill.

The Deichers eventually decided to move into a hotel until a permanent solution could be found. Toward the end of January, Matt, Melissa and their two children moved into an AmeriHost hotel only a couple of miles from where the crash occurred. They would continue to reside there for nearly one full year, until Christmas 2004.

At first the kids loved it. What child wouldn't like having their own swimming pool, eating out all the time and essentially living on vacation? Within a couple of months, Matt's son would say that when they get a new home, he never wanted to stay in a hotel again.

The Deichers have no stove to cook food, no place to store belongings, no living room to entertain friends, no place to just be alone. One of their hotel rooms is taken up by Matt's hospital bed. Healthcare providers are scheduled nearly around the clock, but because of the challenging conditions, it continues to be a struggle to find staff. Because of her medical background, Melissa takes care of her husband during the night.

"It's hard to go from being the helpers to needing the help," says Matt. Tears fill his eyes as he describes how hard it is to know he will never walk again, never play ball with his son, never hug his wife.

His condition is challenging enough, but there's more. While colleagues from several neighboring ambulance services have tried to help the Deichers, members of their own department have been less involved. Some have never come to visit.

"I was crushed that they didn't come to see me," says Matt. "I would have done anything for that department. What did I do wrong?"

Melissa isn't sure either. Is it the potential of a lawsuit? Is seeing what happened to Matt too much for them to take? Does seeing him make it hard for them to respond to their next call?

Department representatives say they're just not a tight-knit group. Everyone pretty much just does the job and goes home. No doubt legal muzzling has come into play as well. A patient died in the crash. Lawsuits are likely. Department members may have felt like they were walking a tightrope.

At the time of the accident, Matt, Jason and Mary Beth had only been members of the service for a relatively short time. They hadn't had a lot of time to get to know everyone. After the crash, Matt was gone for six months in Colorado. While it's hard to understand the distance his colleagues have kept from Matt, it may be explainable. Still, the pain of not having fellow EMTs from his service by his side is evident.

Harsh Realities

In August 2004, without any warning, Matt's heart rate went out of control. Within minutes he slipped into cardiac arrest. While his nurse worked to revive him, members of Matt's old ambulance service raced to the scene. The dispatch information left no doubt about whom the call was for, prompting nearly every department member to respond. For some of them, it was the first time they'd been to Matt's hotel room. But their concern was clearly apparent.

If the spinal-cord injury weren't enough, there are the harsh realities of finances. Matt was injured while volunteering. That means his insurance coverage comes from Worker's Comp. Wisconsin law requires all ambulance services, including volunteer organizations, to provide Worker's Comp insurance. However, providing the insurance doesn't mean the service can dictate how payments are made, or in what amount. Ambulance service directors have no control over what Worker's Compensation will or will not pay.

There is no obligation to take care of Matt's family--only Matt.

"They want me to go into a nursing home," he says. "I won't go. That's where people go to die. I'm 34 years old--I don't belong in a nursing home."

The obligation to take care of Matt means that a house could be built for him, but not for him and his family. The Deichers would be responsible for any costs above those of a simple one-bedroom home. In fact, insurance would not even have to provide a second hotel room for the family. Currently, the children share a room that the Deichers pay for themselves.

When a volunteer EMT or first responder is injured, the closest full-time ambulance service or fire department is consulted to obtain the wage the volunteer would receive if they were employed at the full-time department. That means that the injured volunteer EMT or first responder may be paid considerably less than they were for doing their full-time job. The $75,000-a-year accountant injured while volunteering may receive less than $25,000 a year on disability.

"Everything becomes a negotiation," says Melissa. "We needed a van so Matt could travel. Before they would provide a van, we had to sign a release stating they would no longer be responsible for his transportation."

Clearly Matt has been provided with superb healthcare, but how does his family survive financially? How do they save for the future? How do they get a loan to finance their portion of building a house? How do they keep paying for the everyday expenses of life?

"Most people don't understand," says Jason. "Everyone thinks that money would be Matt's last concern, that everything would be taken care of."

Indeed, most people don't understand the ramifications of trying to raise a family with no income and little capacity to work. It seems impossible to believe. How can someone have their life so significantly changed forever and then have to go through all of the financial and emotional troubles as well?

Other EMS providers in the same situation agree. "I am permanently disabled due to my injury," writes paramedic Mark Hamlin on an industry website. "I never received any calls or encouragement from any of my employers or fellow employees. I have not received any assistance beyond the Worker's Comp payment (less than half of my wages) and social security."

"Had it not been for my savings, I probably would have filed bankruptcy," says Ernie Eberhard, a firefighter from the East Coast.

Things most people take for granted become large struggles for Matt. Privacy is a thing of the past. Someone is always around. "If you're upset or have an argument with your wife, you can walk away and take some time to yourself," says Matt. "Where can I go?" The same problem exists when he needs to discuss personal matters with his wife. "There are things we simply don't want to discuss in front of the children," he says, "but where can we go? How can we talk privately when we're all in the same hotel room?"

Occasionally Matt and Jason send Matt's caretaker out to get something, or while shopping they send her down another aisle just so they can have an opportunity to chat--to be guys.

It's just as hard for Jason. "People talk about me and what happened," he says. "They talk about Matt. They ask why they need fundraisers or financial assistance. They assume everything Matt needs is being provided."

Even in their trying situation, it's hard for the Deichers to accept charity. In Colorado, a church group provided them with a $300 donation at Christmas. The Deichers, in turn, donated $100 of it to a cancer patient whom they felt was in more need than they were.

Life Goes On

Matt doesn't blame anyone for what happened. He believes it was a freak accident that could have occurred just as easily anywhere else. It just happened to be in the back of an ambulance.

Melissa and Jason don't completely share Matt's view. Both of them wonder how big a role the worn tires played in the crash. They wonder why the vehicle wasn't taken out of service. They ask why the backup ambulance wasn't used instead.

The crash occurred on a stretch of road that changes from cement to asphalt. Did the change in road surface play a part in what happened? What about the speed of the vehicle? Had the lights and siren not been on, would it have mattered? What about seat belts? If Matt had been belted, rather than moving around and taking care of the patient, would that have made a difference?

Some Wisconsin EMS services have asked these questions as well. Since the accident, some services have instituted stricter driving standards. At some services, EMTs and first responders with poor driving records are no longer authorized to drive department vehicles. The use of lights and sirens while transporting is now reserved for only the most critical patients. Those driving the ambulance see their job much more like the awesome responsibility it is. EMTs riding in the patient compartment wear their seat belts whenever possible. Vehicle maintenance is taken more seriously. Trucks with potential problems are removed from service until repaired.

Some services have upgraded their insurance. Additional coverage for accidental death and disability has been considered or provided. Some providers have purchased extra coverage on their own.

Life continues to go on for Matt, Melissa and their children. They have been living in their new home since the beginning of the year. The home includes living quarters for healthcare staff. Worker's Comp paid for a portion of the house, and the Deichers took a loan out for the rest.

Melissa has returned to Mosinee Area EMS's active roster, although she has yet to respond on an ambulance call. Because of injuries from the crash, Jason has not been able to return to duty. He has had to hire an attorney because insurance is now refusing to pay for any more treatment or for his medications. He is hoping to go back to being an EMT again soon. He continues to struggle with the aftermath of the accident.

"People don't understand that for them, this is all in the past, but for me, it's part of my everyday life," he says. "They don't understand how important continued support is, how important their continued contact and friendship is--especially for Matt."

Recently, the state ambulance inspector who failed to take the vehicle out of service was sued by the Worker's Comp carrier. That case has yet to go to court.

"Life Is a Risk"

While life for Matt Deicher will never be the same, he doesn't regret any of his choices. "If I could get out of this wheelchair, I'd go back to being an EMT," he says.

When asked how he thinks others in EMS might react to hearing his story, he doesn't hesitate. "Life is a risk," he says. "I don't stop my kids from riding bikes or playing sports. I don't try to remove everything from their lives that might have a little bit of risk to it. I really enjoyed being an EMT. Even after what happened, I wouldn't stop doing it. You have to live life. You have to enjoy it to the fullest. Please don't stop doing the things you enjoy doing. Please don't stop being an EMT."

A fund has been set up to help the Deichers. To make a donation to Matt and his family, send your check to: The Family of Matthew Deicher Fund, River Valley State Bank, Mosinee Branch, P.O. Box 185, Mosinee, WI 54455.

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