Sergey Tsipenyuk peered at the graying, frail man lying on a stretcher in front of him, bleeding from his face.
"What month are we in?" Tsipenyuk asked, his hands deftly working to prepare an IV in the man's arm as Tsipenyuk's partner, Chris Santillo, hooked him up to a heart monitor.
The man, in his 80s, hurt and confused after apparently losing consciousness and crashing his car in Abington Township, stared for a long moment, then answered. "September," he said slowly.
"Who's the president?" Tsipenyuk pressed.
"Obama," the man responded, quicker this time.
They're questions that Tsipenyuk, a paramedic and pre-hospital nurse, and Santillo, an EMT, ask over and over again throughout their 12-hour shifts working for the Second Alarmer's of Montgomery County. They're two questions among a myriad of inquiries the men calmly pose to patients as they stabilize them in the sterile bed of an orange and white ambulance, where they work to save patients' lives as they determine their level of alertness, figure out what happened to them, and decide how to fix whatever's wrong.
As the primary emergency medical service for Abington and its many communities, the Second Alarmer's platoons based out of the Edge Hill station in Glenside's North Hills section, where Santillo and Tsipenyuk work, tend to stay busy. Edge Hill is one of the Second Alarmer's seven stations across the lower portion of Montgomery County, where the nonprofit EMS organization serves as the primary ambulance service for Abington, Upper Dublin, Upper Moreland, Whitpain, Hatboro, Jenkintown, Rockledge and other surrounding communities.
For Tsipenyuk, each patient presents a new mystery to solve.
"It's always a puzzle," Tsipenyuk, 34, said as he and Santillo, 35, took their third patient of the day, a man a few years shy of 100 whose heart rate dropped unusually low for a not-so-apparent reason.
The man's condition stumped Santillo and Tsipenyuk, both of whom have more than a decade of experience working in EMS. Senior-citizen patients, who make up a high volume of the people Tsipenyuk and Santillo treat, tend to be trickier to handle than their younger counterparts, Tsipenyuk explained. A lot can be going on, and there's almost always more than meets the eye.
"They're the ones who need us most," Tsipenyuk said.
With each call, he and Santillo work seamlessly together to solve a new case, putting together the puzzle pieces of information to give as full a picture as possible to the nurses, doctors and specialists waiting when they arrive at Abington Memorial Hospital. The hospital, set on Old York Road in the heart of Abington, receives the lion's share of Second Alarmer's patients in that area.
For the duo and their fellow EMTs and paramedics, the job comes with ups and downs. The shifts are long -- usually 12 hours, three days on, seven days off. Breaks are elusive on some days, nonexistent on others.
"It's a double-edged sword," Tsipenyuk said after treating a woman in her 90s after she passed out during a shopping trip. The last thing the woman wanted to do was wind up at the hospital -- but Tsipenyuk and Santillo knew they had to convince her to go, for her own safety and for their peace of mind as the people tasked with saving lives.
"I would feel horrible if she goes home and something happens to her," Tsipenyuk explained. "But I will also feel horrible if now she's in the hospital for three weeks."
That's just one of the struggles Tsipenyuk and Santillo face in a day's work. But both, like most other EMTs and paramedics who work for Second Alarmer's, love the job so much that they pick up other EMS-related jobs. For Tsipenyuk, that means working on transport teams for city hospitals. For Santillo, it's working at another ambulance company and as a 9-1-1 operator.
"At the end of the day, this place is like family," Tsipenyuk said.
Montgomery County's Second Alarmer's came a long way since the squad first formed in Willow Grove in 1938. The organization first developed to support firefighters, police and other rescue workers at major incidents quickly placed itself at the cutting edge of first-responder companies, morphing into its own rescue team. In the 1970s, the Montgomery County Second Alarmer's became one of the first EMS companies in the country to use the infamous "Jaws of Life."
Officials with the Second Alarmer's of Montgomery County say the nonprofit rescue squad continues to push ahead when it comes to lifesaving equipment and technology. Second Alarmer's recently became the first EMS company in the state to pilot new, streamlined breathing tubes called "i-gels" that simplify and speed up lifesaving intubation, Assistant Chief of Operations Kenneth Davidson said. The new tubes will likely be approved soon for use statewide, Davidson said, and the Second Alarmer's, who were instrumental in bringing them to Pennsylvania, will help design the training program for other EMS agencies.
Montco's Second Alarmer's also started using LUCAS automatic CPR devices over the last few years, Davidson said, making CPR -- a physically exhausting task -- easier to administer consistently via a machine.
"We've seen our cardiac arrest survival rate go up," Davidson said. The use of the LUCAS automatic CPR machines and now the i-gel breathing tubes contributed, he added.
But better equipment comes with a price -- and for the Second Alarmer's, who run 12 ambulances, it can be a hefty one. Davidson said the new breathing tubes cost about $25 apiece, compared to $3.50 for the current standard breathing tube. Each LUCAS automatic CPR unit comes with a price tag of about $16,000, Davidson said, so to outfit the whole Second Alarmer's fleet, the costs is nearly $200,000.
The squad is also working on getting tactical gear for use in case of active-shooter situations -- including body armor, roll-up stretchers and trauma "go bags" -- for each ambulance. Those are expensive, too, Davidson said.
The Second Alarmer's is nonprofit and relies heavily on donations and grants to pay for equipment.
"It's a double-edged sword for a department like ours," Davidson, who's been with Second Alarmer's since 1992, said. "Obviously, we want to do what's best for the patient."
In the field, paramedics and EMTs said they've seen the results of the new technology.
Now, Battalion Chief John Townsend said, with use of the LUCAS machine, people more often than not regain consciousness from automatic CPR. Before, Townsend said, with manual CPR, it could be a toss-up of whether or not they would.
"People have a better chance now than they ever did," Townsend said.
Back on the rig, Tsipenyuk and Santillo worked hard to solve the puzzle of the man who lost consciousness driving. Systematically, the men ruled out diabetes and other probable causes before they made their way again to Abington Hospital, where this time, a team of nearly a dozen people waited in a trauma bay for them to arrive.
As a whirlwind of what Tsipenyuk calls "organized chaos" converged on the man, joining forces to make him better, the paramedic and his EMT counterpart headed back out the EMS door of the hospital, their black, laced boots clopping down the same antiseptic hospital hallway they've seen a thousand times.
On the other side of the sliding glass door, in a rare moment of downtime, the pair joked with Townsend and other fellow EMS workers, ears trained on their radios for the inevitable moment they would hiss back to life with the next call for help -- and for the puzzle to start again.