Paul McNabb has cut five umbilical cords. He once administered care to an Elon student who impaled her leg hopping a fence to a party.

And when not working as a paramedic for Alamance County Emergency Medical Services, he’s in charge of a fire truck a half-hour away, in Guilford County.

He also spends his nights watching Elmo. Because his favorite job position — it's being a dad.

First responders are trained to respond to emergencies. McNabb's been conditioned since birth, scrambling around fire trucks as far back as he can remember. Trace two generations back is Grandpa John — he captained the Pleasant Garden Fire Department. His dad, Gary, is the assistant fire chief for the Southeast Guilford Fire Department, and has been in the fire service more than 40 years. His mom, Susan, is a retired Greensboro Police Department officer and his sister, Brianna, is a critical care nurse at Wesley Long ICU. (And can’t forget cousin Jeremy and uncle Jeff — more firefighters.) Last name, all: McNabb.

“We’re a family of givers,” Susan said.

“They supported me one hundred percent,” McNabb said. “At first they wanted me to be a doctor or a major league baseball player — something to make millions of dollars. But for realistic goals — absolutely.”

Paul McNabb's Southeast Fire Department leather fire helmet.

He’s a third-generation firefighter — now, fire engineer — and a first-generation paramedic. His family history and 11 years as a first responder allow him to provide insight into different high (and low) pressure scenarios — and the climate surrounding the people who navigate them.

“I wouldn’t have it any other way,” McNabb said.

Alamance County Emergency Medical Services (EMS)

A shift in Alamance County EMS is 24-hours on, 72-hours off. As a paramedic, McNabb works alongside EMTs to respond to emergency and non-emergency calls in the county. This Halloween will mark his 12th year in the job.

Paul McNabb checks inventory in the EMS supply room.

There are 17 employees on each shift, and there are four shifts. Typical EMT training lasts 3 to 5 months, whereas a paramedic is often a year or more of schooling.

Walking into the West Base — one of three in the county — is surprising to a lay-person. The blacked-out windows and massive industrial garage intimidate, but when the door opens, the first sight is five well-worn recliners and a modest kitchen.

“If we’re not on a call, we’re all here,” said paramedic Lisa Raines. “Some people will hang out here, watch TV. Some will go to their rooms. We try to sleep when we can because we never know when we’re gonna get it. It’s like a big ol' family.”

Raines is also in the family business. She grew up with her parents involved in rescue, but unlike McNabb, who always wanted to fight fires, Raines never thought about being getting involved with Alamance County EMS until adulthood.

“I used to work for Lowe’s Home Improvement. I was always on the lookout for something that I thought I could have a future at. One of the girls I worked with was going to school while we were working together. The more I talked to her, the more I thought, ‘Well, this sounds like fun.’ I decided to get my EMT and my paramedic and I’ve been here 17 years.”

The ambulance driver has access to all sorts of controls not found on any other type of vehicle.

Now, her and McNabb are co-workers at Alamance County EMS.

Forget typical co-worker archetypes — the flatterer, the long-lunch-goer, the water cooler gossip. In the ambulance, it’s "shit-magnets," "black clouds," and "baby magnets."

“I’m pretty good at having a light cloud. I get lots of working calls, I get lots of sick people,” McNabb said. “There are other people who are white clouds that they don’t ever ride any sick people — it’s weird. There’s a man who retired in December who cut 17 umbilical cords. If there was a pregnancy he was probably going to be there, somehow. My big thing — airway. If somebody needs to be intubated, I’m the guy that’s gonna be there.”

“A lot of stuff is low frequency, high fidelity,” said EMT and paramedic-in-training, Lanning Honeycutt. “You’ve got to keep your skills sharp, even pregnancies, which you don’t see every day.”

According to the Alamance County EMS 2018-2019 workload measures, from June to December the average emergency response time was 12 minutes and 36 seconds. Once the ambulance arrives, if McNabb’s driving, the passenger EMT or paramedic will jump out quickly, and McNabb will start to grab the bed or follow inside.

“My initial impression sets the pace for the rest of the time,” McNabb said. “If I went in, and they look sick as crap, then I’m just going to go straight to work.”

Most frequently the emergency calls are for falls. According to the North Carolina Department of Health and Human Services, the county is home to eight nursing facilities and another 18 adult care homes.

“Gravity is super strong in Alamance County,” McNabb said. Added Honeycutt, “When you cluster those geriatric people all in one spot, that’s the people that are going to use our services. We go to those places a lot — it’s like, ‘Alright, we’ve been there five times today.’”

“If a late call comes in, we just take it,” Raines said. “Do we like it? No. But we take it.”

Data from Alamance County EMS 2018-2019 Workload Measures report.

As call numbers increase, the need for more equipment does too.

“I know that there's some really cool technology advancements that are being made,” said Hannah Alcock, Elon junior and EMT. “There's automated CPR machines or there's new medications for diabetes or for certain other illnesses or situations that can take place."

The ambulance is home to what McNabb calls, “a defibrillator on crack.” It's worth about $50,000.

“It’s one of those services that a lot of times people don’t appreciate until you need it," said EMT Donald Robinson. It’s just something you don’t even think about until you’re sick or you’re having a bad medical event. They’ll say, ‘Oh my God, I’m so glad you’re here,’ but a lot of times you’re just in the background.”

Alcock took the EMT certification exam on the day she moved into Elon. Though she’d love to work for Alamance County EMS, her experience with emergency services so far has been as an EMT lifeguard in South Carolina.

“I want to say that I treated 145 jellyfish stings in one day at the end of July,” Alcock said.

Elon junior Melissa Menard took EMT courses through Alamance Community College, and did her "ride-along" with Alamance County EMS. During a ride-along, the EMT-in-training rides with an active ambulance crew for 24 hours. Whenever Menard's assigned unit recieved a call from the dispatcher, she would follow along. Her ride-along experience was reflective of the community of nursing facilities and adult care homes — it was mostly elderly people being transported to the hospital.

"It was pretty upbeat, talking to patients who were responding, but also could be very serious and down to business when it needed to be," Menard said. "I learned a lot about the community here, and the relationships that EMTs can have with their patients, especially when we were doing elderly patients transport. They were all very happy to talk and explain about their lives and their situations."

Being a first responder isn't all sirens blaring and hearts pounding.

“I have stayed up all night long,” said McNabb of his EMS paper work. “One a.m. is when I sat down and I got done five minutes ‘til six.”

Alcock says first responders need to have great situational awareness, strong leadership skills, compassion and empathy.

“You'll run into situations where there's a lot more at play other than just treating the patient, whether it's dealing with family members, controlling a crowd or working with other agencies,” Alcock said. “People put a lot of trust in us just by the badge that we wear on our shirt.”

“The biggest thing is capabilities," McNabb said. "We’re not just ambulance-drivers. We get called rescue. We get called ambulance-drivers. If that was the case, then call an Uber. You’d get the same dag-gum result.”

Data from Alamance County EMS 2018-2019 Workload Measures report.
The biggest thing is capabilities. We’re not just ambulance-drivers. We get called rescue. We get called ambulance-drivers. If that was the case, then call an Uber. You’d get the same dag-gum result.
— Paul McNabb, paramedic

Southeast Guilford Fire Department

When a 911 call reaches the dispatch, a fire station is an equally likely candidate as an ambulance for responding to a medical emergency.

"If there’s a call at Elon for an unconscious person, maybe because they were partying too hard, that’s automatically an emergency response," McNabb said. "You’re gonna get a fire truck from Elon and an ambulance from Alamance County EMS."

And fire stations drastically outnumber EMS stations and are often the closest to the emergency scene.

“I had always been interested in being a paramedic, but I wanted to be on a firetruck full time,” McNabb said. “I couldn’t get a fire job, didn’t have any luck, so I went ahead and took paramedic academy.”

Paul McNabb fills fire truck tanker with water from hydrant.

Some fire departments require their fighters to be certified paramedics, and McNabb’s skillset definitely helps his work for the station. Even though he’s a paramedic, he’s an EMT basic for the fire department. He just doesn’t have access to the equipment he would need to do what he could on an ambulance.

“The equipment on here is a heck of a lot more different,” McNabb said.

The fire truck does have a familiar piece of machinery — the exact same computer system as the ambulance. Even the transport button is there, although a firetruck will never actually take someone to the hospital.

As a fire engineer, McNabb’s primary job is to operate the tanker. Along with driving, he's tasked with monitoring water pressure to the fire hose and unloading large equipment from the truck.

“My dad told me that I needed to pay attention to algebra in high school and I thought he was full of shit, because I didn’t think I’d ever need to know whatever ‘X’ meant. Well, here I am. My biggest job at the fire station now is to figure out what that X is.”

My dad told me that I needed to pay attention to algebra in high school and I thought he was full of shit, because I didn’t think I’d ever need to know whatever ‘X’ meant. Well, here I am. My biggest job at the fire station now is to figure out what that X is.
— Paul McNabb, fire engineer

Hidden compartments are everywhere. One compartment opens to expose limp rope and a traffic cone — the next, the jaws of life.

“Whatever they need inside, I can grab it and go,” McNabb said.

On the way to the scene, the firefighters (up to six can fit in the tanker, along with one thousand gallons of water) talked shop — where’s the fire, who’s coming with us, where’s the nearest hydrant — interspersed with good-natured trash-talking. And raw engine noises spew out of the massive truck. The ride’s a bumpy 60 mph, max 68, and they’re each strapped in with a full harness.

“This truck, it doesn’t like hills,” McNabb said. “As much weight as it carries, if you aren’t going as fast as you can, it slows down tremendously.”

Then, wailing sirens.

The first couple minutes at the fire, it’s very fast paced. It’s hard for McNabb to even describe holding the firehose.

“It’s like somebody is standing right in front of you and pushing 100 pounds directly at you,” McNabb said.

Once the other firefighters start to tackle the fire, it begins to slow down for the driver. If at some point they run out of water, McNabb can leave the scene to refill the truck.

When he gets back, he doesn’t need to get out of the driver's seat. At the firefighters' signal, he turns a wheel on the dashboard which controls the water pressure. The water is then able to speed from the large water tank to the firehose.

"There’s a lot of science in firefighting that people don’t realize," McNabb said.

It's not until the fire's out that the work is done.

“My job doesn’t stop, because anything can happen,” McNabb said. “I can learn something new on every call. There’s always something that could go a little bit more different, that could help things flow a little smoother.”

All in a day's work

Even with a family so deeply emersed in the world of emergency services, McNabb juggles priorities.

“Sometimes in relationships, the job is different and difficult to get used to,” McNabb said.

"You get to the point where you see stuff that normal people that haven’t been in medical professions don’t see," Raines said. "You see something happen and you’re able to step back and it won’t bother you. And other people would be like, “Oh my God,” you know, freaking out. And we’re like, “OK, let’s eat, c’mon.”

There was a point in his life where he was working six jobs, and opposite shifts with the mother of his daughter — also a paramedic. They’d have 24-hours together and 24-hours apart in order to take care of the baby.

"I had a bad wreck a few weeks ago, and my patient was five years old. I have a 20-month old at home," McNabb said. "She had two broke hips, and that ate me up a little bit. All I wanted to do was go see my daughter."

His family supports him, and so does his community.

His co-workers at Alamance County EMS will cook together over their 24-hour shifts, mostly roasts and soups that can sit at the base during calls and be better for it. And if crock pot meals are the staple of the EMS community, then the fire department has the claim on barbecue.

After an 8 a.m. to 5 p.m. shift at the fire station, McNabb met Susan and his daughter, Adalynn, at the annual Alamance Community Fire Department barbecue fundraiser. It’s at his old middle school, and many of the faces he greets, he’s known since then. He clapped hands with off-duty firefighters and traded gossip about people from Susan’s church. Another man there once took him out to dinner as a thank you for administering him CPR.

He left Adalynn at the table for a minute to exchange niceties with his best friend's family, then scooped her right back up. It’s actually hard for the volunteer Boy Scouts to navigate coleslaw dishes through the cafeteria because her adoring fans are taking up the aisle.

Adalynn McNabb and her grandma, Susan, enjoy a BBQ dinner made by the Alamance County Fire Department at its annual fundraising event.

Will she be fighting fires one day, fourth-generation? Maybe. For now, she’d be perfectly content mouthing the firetruck keys.