The Island Life - Isolated But Not Alone

by Joseph Cahill

New Shoreham, which encompasses Block Island located off the Atlantic coast of Rhode Island, is home to 1,010 year-round residents, according to the 2010 U.S. Census, and covers a total geographic area of slightly less than 10 square miles. The Block Island Volunteer Fire and Rescue Department (BI-VFD) provides fire and emergency medical services (EMS) for the entire island community.

Despite the limited number of full-time residents, the island hosts numerous special events each year ranging from those – a Fourth of July fireworks celebration, for example – celebrated in hundreds of other towns and cities across the United States as well as several others, such as a week-long sailboat race unique to Block Island itself. In several ways, though, the most significant special event for BI-VFD itself is preparing each year for the additional 15,000-20,000 summer vacationers, many of them from overseas, visiting the island on almost any given day during the summer.

Self-Sufficiency & A Solar-Powered Ambulance Barn Geographic isolation is an ever-present factor that obviously must be considered in any and all emergency responses on Block Island because many traditional sources of help – provided through mutual-aid agreements from neighboring towns just a few miles up the road – are simply not available. The island’s solution, therefore, is an uncommon degree of self-sufficiency, which means: (a) making do with what is already available on the island 24/7; (b) always looking for, finding, and using better ways to meet most foreseeable emergencies; and (c) finding nontraditional as well as traditional partners to help as and when needed.

In 2007, when the BI-VFD’s ambulance barn was being replaced, the cost was borne in part by the Town of New Shoreham itself through a fundraising drive within the community, supplemented by grants and various donations in kind from local businesses. Thanks in large part to that local support, the facility was built by the community, for the community.

Two closely related challenges addressed at the same time the new construction was proceeding were ensuring that: (a) sufficient supplies of portable oxygen would be available in the future; and (b) there would be a reliable source of emergency power available when needed. It was determined that the best way to meet the first challenge was to find a reliable way to refill the portable oxygen cylinders that would be stored in the new ambulance barn. The previous system, which required the constant replacement of empty cylinders with filled ones ferried in from the mainland, therefore was replaced with a system that concentrates the oxygen on-site – similar to an oxygen-concentration system designed for use by individual patients who require a continuing supply of oxygen in their own homes.

Thanks to a working partnership with the Block Island Medical Center, the new system installed in the ambulance barn now supplies all of the oxygen needed by both the Medical Center and the BI-VFD itself. The same approach was used in resolving the need for a reliable source of emergency power. More specifically, the ambulance barn was designed to meet its own continuing needs with an array of solar power charged batteries – enough, in fact, to power the barn for up to six days.

Sharingeas, Self-Reliance & Building Mutual Aid Many of the island’s other emergency solutions are similar to those used on the mainland – for example, dispersing emergency resources in various convenient locations throughout the island to ensure availability. As in various other U.S. jurisdictions, a Semi-Automatic External Defibrillator program also has been implemented to install life-saving devices not only in most fire and police vehicles but also in a number of the island’s public buildings and hotels – thereby significantly improving the survival chances for cardiac arrest patients.

According to BI-VFD’s Fire Chief Tristan Payne, mutual aid agreements also have been completed with a number of mainland fire departments, but it is recognized that the travel distances involved pose additional challenges for response times. When responding to an emergency situation, firefighters outfitted with hand tools and bunker gear could arrive by air within 12-15 minutes or so, but any fire apparatus and/or other necessary resources may take up to several hours by ferry – weather permitting.

When coping with a mass-casualty incident, the BI-VFD has a trailer that is already stocked with medical supplies and readily available for any incident creating a large number of patients. If additional services and/or resources were needed from the mainland, the Rhode Island-1 Disaster Medical Assistance Team (DMAT) would be deployed to the island to provide an emergency hospital and other medical resources.

During Hurricane Sandy in 2012, the local flooding was significant enough that the main rescue barn became part of an island within the island. To maintain service throughout the community, one ambulance was stationed at the barn while others were deployed to various locations on the island. Privately owned 4x4 trucks were then used to move EMS personnel and their equipment to the locations in greatest need at any given time, a process that helped maintain coverage for the entire island despite the main base being isolated by the storm.

In summary, the BI-VFD has had to adapt to a unique and somewhat uncompromising geography, but so do many other communities. Those on other islands, and/or on the mainland itself, can easily borrow a page from Block Island’s emergency playbook to upgrade and strengthen the safety of their own populations – and visiting guests. By effectively communicating with, and forming strong ties to, outside resources, communities can maximize the combined effect of all available emergency resources. As Bryan Wilson, BI-VFD’s EMS Captain, sums it up, “Out here, we take care of each other.”

_________________________ Joseph Cahill is a medicolegal investigator for the Massachusetts Office of the Chief Medical Examiner. He previously served as exercise and training coordinator for the Massachusetts Department of Public Health and as emergency planner in the Westchester County (N.Y.) Office of Emergency Management. He also served for five years as citywide advanced life support (ALS) coordinator for the FDNY – Bureau of EMS. Prior to that, he was the department’s Division 6 ALS coordinator, covering the South Bronx and Harlem. He also served on the faculty of the Westchester County Community College’s Paramedic Program and has been a frequent guest lecturer for the U.S. Secret Service, the FDNY EMS Academy, and Montefiore Hospital.