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Dual Careers

Sept. 1, 2005
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Which came first, dental hygiene or their other careers? Why pursue two careers? Is boredom a driving factor? Do additional careers provide greater financial stability, or are these hygienists fulfilling lifelong dreams? Did their desires to learn new things propel them into second careers, or did events channel them into other arenas?

Several months ago, I and five other dental hygienists spent a couple of days at a dental hygiene continuing education course with one of these rarities, Kim Grant, RDH. She fascinated us with stories of balancing 17 years as a clinical dental hygiene and a 10-year career as a critical care paramedic. Her stories are even more remarkable because her husband owns a business, and together they raise two children they adopted at birth.

Kim Grant, RDH
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Grant is a petite, slender woman without an ounce of visible fat. At a glance, she doesn’t look capable of knocking down a flea - much less tending severe medical crises in the field.

LISA DOYLE, RDH, BS, has practiced dental hygiene in Virginia Beach for 20 years. Her questions focus on job and career satisfaction.
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All weekend we peppered her with questions about the who, what, where, when, why, and how of a profession that seems so different from what we do as dental hygienists. We were mesmerized by her answers, and collectively, we interviewed Grant via e-mail. We are excited to share her story with you from each of our perspectives. Before we tell her story, read a recent e-mail she sent me. It reads like a real life TV drama.

ANGELA DUNN, RDH, from Rutledge, Tenn., is interested in how Grant's professions are alike or dissimilar with respect to supervisory issues and the professions' national organizations.
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“Anne, we’ve had some things going on here that need my attention. We had a camper trailer fire early this morning - 2:30 a.m. A man was found in the rubble. I am arranging debriefing for all of the firefighters here today. I’ve been on the phone all day taking care of business. Also, one of my former patients - a regular on the rescue side - passed away today. I have gotten close to his wife and will try to be available for her. Between that and working a lot more than usual, I haven’t been able to get to e-mail. I will probably be able to by the weekend. Just another day in my life. I appreciate the interest in my careers. I’ll write later. Kim.”

BRIDGETTE RIDDLE, RDH, BS, Cleveland-area wife and mother of three, asks Grant questions about balancing family with two careers.
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Grant began her clinical dental hygiene career after she graduated from Missouri Southern State College in 1987. Two events helped shape the professional life she juggles. Grant loved clinical dental hygiene, but she developed radial tunnel syndrome, a repetitive stress injury that afflicts many hygienists. Subsequent surgery did not relieve all of her symptoms, which made it difficult to practice without hand and forearm pain. Her only choice was to reduce her clinical work load.

CHERYL THOMAS, RDH, of Galveston, Texas, received her brother’s kidney in 1999 after she suffered renal failure. Those events made her curious about several issues.
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Fate has a funny way of tweaking people’s lives. Grant lives in a small town on the outskirts of Springfield, Mo. Several years after her college graduation, the town lost its local ambulance service. That increased the time for an ambulance to reach patients in her community to 25 minutes. Lives were going to be lost and health ­outcomes compromised as precious minutes would have ticked away while patients waited for rescue.

DEBBY NIGH, RDH, BS, shares insights of practicing alongside Grant with Drs. Curry, Powell, and Jordan in Missouri.
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In 1990, Grant and other residents in her area took a 40-hour, advanced first-aid course. They also developed a first responders group that offers basic care until ambulances arrive. Grant quickly found a niche in her community as an emergency medical technician. EMTs focus on patient assessment and a basic level of care. Grant enrolled in an EMT course consisting of 110 classroom hours and additional clinical hours at an accredited training facility. Missouri EMTs must be tested by the National Registry of Emergency Medical Technicians to gain state license.

ANNE GUIGNON, RDH, MPH, talks ergonomics.
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Six months after she became a licensed EMT, Grant enrolled in paramedic school. She received her license in 1992. Paramedics must receive one year of classroom training, more than 600 clinical hours at an approved clinical facility, and perform competencies on many critical skills. Paramedics also must pass a national registry exam to be licensed in Missouri.

The scope and depth of a paramedic’s practice is much broader than Grant’s previous two levels. A paramedic provides advanced level care. Paramedic duties include advanced patient assessment, IV, fluid, and medication therapy, assessing cardiac rhythms including advanced cardiac life support for code blue and critical patients, and advanced airway procedures such as endotracheal intubation and cricothyroidotomy. Missouri allows paramedics to administer thrombolytics - clot-dissolving drugs given during heart attacks - and paralytics for rapid intubation.

KIM GRANT, RDH, moonlights as a volunteer firefighter in southwest Missouri.
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Grant said her dental hygiene career prepared her for emergency medicine. It helps her interact with ­emergency patients with no hesitation. According to Grant, many who are new to the EMS field have trouble talking, interacting, and touching patients. Because of her dental hygiene background, Grant came equipped.

What to wear?

GRANT reinserts an infant's feeding tube. She also works as a licensed paramedic.
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Even though Grant only does basic firefighting, she wears turnout gear - a helmet, heat-resistant Nomex® hood that goes under her helmet and over her head, a turnout coat, pants, and boots when she responds to motor vehicle accidents or fire calls. All her gear is fire-resistant, not fireproof. Grant wears a basic uniform for ambulance duty and responds in civilian garb for unscheduled rescue calls. She always travels with a fully loaded paramedic fanny pack and jump bag.

Her local fire and rescue department is the area Emergency Medical Response Agency, or EMRA, and holds the state license for advanced medical care. Their equipment includes a cardiac monitor/defibrillator/pacer, emergency medications and equipment for advanced airway, spinal immobilization, splinting, and extrication equipment, including the Jaws of Life. Mental stress also plays a role in the life of those in Grant’s position.

She works a paid position with the hospital-based, not-for-profit, Cox Paramedics Ambulance Service, a company that serves a large portion of southwest Missouri. Grant generally works out of their Greene County location. She also volunteers with her local district’s fire and rescue department in the town where she and her husband live. The fire department covers the firefighting and rescue calls for the immediate 35-square-mile area.

It was interesting to hear Grant’s account of her first emergency call. Originally, she had told her supervisor that she was scared of motor vehicle accidents and didn’t want to go on that type of rescue. But when one of those calls came in, Grant was one of the first at the station. She recalls being terrified. Much like dental hygiene ­education, EMT education only prepared her to be competent in procedures. The experience defused her fears and she became hooked on the ability to work on people.

Grant says it isn’t easy being an emergency provider in her own community.

“It is both a benefit and a detriment to respond in your own town because frequently you know the patients,” she says. “If they are critically ill or injured, it is hard to work on them, knowing the possible outcomes, but it makes patients feel more at ease when they know the person caring for them. When there is a ­fatality, you can become more per­sonally involved if you know the victim or family.”

Even though Grant has never had to create a surgical airway, she told us a touching story.

“The first time I saw a cricothyroidotomy performed was on a 4-year-old boy who was one of my dental patients. He’d suffered ex-tensive head trauma after being hit by a slow-moving pickup truck loaded with concrete blocks. We couldn’t secure an oral or nasal airway. Although successful, it was too late to make a difference in the outcome. You do ­everything humanly possible on a child. I still remember his perfect teeth, and that happened 14 years ago.”

Grant responds to critical situations by becoming quiet and focused. She describes herself on the scene as direct and “sometimes bossy.” Nearly half of the fire department volunteers in Grant’s area are women, and fewer than 20 percent of the paramedics on the ambulance team are female. The average starting pay for a paramedic in her area is around $10 an hour.

Unless Grant directly interacts with a patient or family, HIPPA regulations prevent her from knowing final outcomes. Emergency work can lead to persistent memories. Grant’s response was forthright and typical of all caring providers when asked if certain experiences ever haunt her.

“I tend to rerun some calls - good and bad - in my mind, over and over,” she says. “For better or for worse, some are a part of me forever.”

The ergonomics of advanced patient care

I wanted to know more about Grant’s other career. I wanted to find out about the specific ergonomic injuries she faces in the emergency and rescue world.

Ergonomic and safety issues in emergency rescue are complex, challenging, and never routine. Grant describes a world full of contrasts to the controlled environments of dental offices. Rescue personnel frequently assume awkward positions to extricate patients. Rescue workers, riding in the backs of the ambulances with patients, are not secured. Many EMS personnel have been injured or disabled as results of motor vehicle accidents involving their rescue vehicles.

Most dental professionals have occaionally dealt with patients under the influence of drugs or alcohol, but emergency workers regularly face these situations. Grant says emergency patients under the influence can be calm during the first half hour, then turn combative and violent during the final 10 minutes of transport.

Sometimes, removing patients from their homes become logistical nightmares. Emergency workers often must treat patients in residences so full of garbage that there are only pathways through the houses, she says.

If you’ve ever thought that hygienists have a lot of credentials with subsequent continuing education requirements, Grant’s commitment will make you take notice. In addition to a paramedic license, she has four additional certifications: critical care paramedic, advanced cardiac life support, or ACLS, pediatric advanced life support, or PALS, and pre-hospital trauma life support, or PHTLS. She also has a critical care license, or CCEMTP. Grant’s paramedic license requires 72 hours of continuing education every two years. Every three years she must complete 24 hours to maintain her critical care license. Each of her other certifications require eight hours of CE every two years.

Remember that fully loaded fanny pack? As Grant was getting ready for the weekend continuing education course, she took inventory of her emergency gear. She wouldn’t leave without a blood pressure cuff and gauze. “I have to have these with me,” she says.

So how does someone live with dual careers and remain enthusiastic, organized, and focused? “I hope my children will see that life isn’t about what you have, but what you have to give others,” Grant says. “They see vicariously how poor lifestyle choices affect people. I have conversations with my 12-year-old son about this. My son is interested in the fire department more than the medical side. He is a very hands-on kind of person and the mechanics of it are interesting to him.”

The six of us left feeling glad that Grant is part of our lives and a member of the dental hygiene profession.

Anne Nugent Guignon, RDH, MPH, is an international speaker, has published numerous articles, and authored several textbook chapters. Anne is an ADHA member and has practiced clinical dental hygiene in Houston, Texas, since 1971. You can reach her at [email protected] or (713) 974-4540.


CHERYL THOMAS: Have you ever used your EMT knowledge during clinical dental hygiene?

GRANT: During the medical history review, I sometimes find out things about a patient that need to be evaluated by his or her physician. Also, there can be medical emergencies in dental offices.

LISA DOYLE: What do you like most about your job?

GRANT: I like the patient interaction and the satisfaction of knowing I’ve made a difference in someone’s quality of life - however major or minor that might be.

ANGELA DUNN: Are you involved in an organization like the ADHA for paramedics?

GRANT: Yes, I belong to the Missouri Emergency Medical Services Association. I also am licensed by the National Registry of Emergency Medical Technicians. My title is NREMT-P.

BRIDGETTE RIDDLE: What does your family think?

GRANT: I have a fantastic husband who supports my decisions. He is a former firefighter and chief who understands the urgent nature of calls. My kids don’t know anything else.