Isabel de Lourdes Bonnin Pérez works three part-time jobs as a paramedic. For many people, that would probably be enough.

But in her spare time, she’s also a volunteer paramedic with Puerto Rico’s First Response Emergency Medical Services (FREMS). “Once you get a taste of it, you can’t leave,” she said of her volunteer work.

FREMS began as a group of paramedics and emergency medical technicians (EMTs) scanning emergency response radio frequencies in and around San Juan, with the goal of responding to accidents. Today, this 30-year-old institution is a nonprofit organization of first responders donating their time (and often their resources), to help those involved in car accidents, traumatic injuries, fires, floods, and other emergencies.  

Bonnin first joined on the suggestion of a colleague. After a “test run” with several team members, she was hooked. “Anyone who works in this field cannot do it for the money because we are underpaid. You don’t do this because you like it; you do it because it is your passion,” she said. 

José Nieves Rivera works full-time as a Lieutenant for the Special Operations Division of the Puerto Rico Fire Department. His other passion, working as an EMT and paramedic, prompted him to join FREMS 18 years ago.  

“Even though the fire department is a specialized unit, and we assist on medical cases, it is more targeted to certain specific tasks, and I wanted to provide my clinical and trauma management expertise, so here I am,” said Nieves who is currently the group’s president.  

Composed of 25 EMTs and paramedics, every FREMS volunteer is certified and trained in advanced pre-hospital medical response and treatment services. Their Advanced Life Support (ALS) rescue units allow them to respond quickly and effectively to provide urgent treatment in various medical emergencies, including advanced cardiac resuscitation.  

Fitting into the local landscape

On a recent night on the field with the Direct Relief team, FREMS left their base at 8 p.m. on a Friday night as the first call came in. A woman was unconscious in her house. She had mixed drugs and alcohol.

FREMS volunteers, the first on the scene, stabilized her and called an ambulance to transport her to the hospital.

It was only the beginning of the night’s shift. Over the next eight hours, the group responded to car accidents, an overdose, and multiple injuries.

Many agencies see FREMS as competition, which can occasionally make it difficult to coordinate with the local emergency response system. The group’s goal is to be seen as an aid organization that supplements the existing system, providing lifesaving expertise and equipment when they’re needed.

Over the past few years, they’ve made progress: FREMS currently has collaborative agreements with the municipality of San Juan, the state emergency management agency, and the 911 system. These agreements allow FREMS to deploy members to provide rescue.

Unlike in the mainland United States, 911 officials in Puerto Rico don’t dispatch help directly. Instead, they request aid from public safety and emergency response agencies.

These collaborative agreements allow FREMS members to conduct rescue work in the field, where they perform rescue missions and stabilize patients in life-and-death situations, such as victims of gunshot wounds or severe falls. Once stabilized, most patients are transported by ambulance to the Puerto Rico Trauma Center.

The “golden hour”

This short period of time, in which fast initial treatment is needed, is called the “golden hour” by people who work in trauma or emergency care. That’s because it significantly impacts a patient’s likelihood of survival and clinical outcomes. By reducing the time from trauma to initial treatment, FREMS plays a pivotal role in the overall prognosis of the people they serve.

Part of that means doing it faster. In 2020, as El Vocero reported, the average emergency response time in Puerto Rico was roughly 25 minutes. A year later, EFE announced that wait time had decreased to approximately 9 minutes. 

FREMS is even faster. Group members have measured their response time in over 200 documented cases since September of 2021. The result? “Our [average] response time is 6 minutes and 52 seconds. Those two minutes are life,” said Eliel Báez, one of the group’s founders and its current executive director.

To continue expanding their emergency response capacity in Puerto Rico, Direct Relief, as part of AbbVie’s $50 million donation, awarded a $350,000 grant to FREMS to purchase a new rescue unit and medical equipment such as complex cardiac monitors.

The new smaller, more agile vehicle will add flexibility to the existing fleet, allowing for rescue missions in steep and remote locations.  

“In the end, our work and our dedication make it so that others can live,” Nieves said.