By Sarah Pridgeon
Back in October, Crook County Medical Services District announced plans for a shake-up within its ambulance service, transforming from the traditional staff of volunteers to a hybrid agency with full-time paramedics as its pillars. This summer, says EMS Division Chief Jay Kenealy, the move has begun to bear fruit.
“Our level of care is now more consistently at the advanced life support level,” he nods. “We have four full-time personnel now; three are paramedics and one is an EMT Intermediate.”
Along with Kenealy, the ambulance department now includes Nate Deiksen and Tracy Arroyos, paramedics, and Kenny Weaver, EMT Intermediate.
“We have a person around the clock, 24/7, that works in the emergency department, but the priority is ambulance,” he says.
“We’re lucky here to have a paramedic-level ambulance service in a town the size of Sundance. Not many towns this size have staffed advanced life support providers.”
The new structure brings plenty of advantages, Kenealy says, not least the level of care that a patient might expect when the ambulance arrives. Where an EMT Basic receives around 170 hours of training, a paramedic undergoes 1400 hours.
This comes to bear, for example, when a 911 call comes in for a cardiac event.
“We basically have the same tools and knowledge that they are going to provide in probably the first ten minutes in the emergency room,” Kenealy says.
“We have the drugs, the cardiac monitor that can correct fatal arrhythmias…anything less than a paramedic level can’t do that.”
Of course, it’s not just cardiac patients who will benefit – paramedic training brings an advantage to numerous medical situations.
“We can do advanced airway management as paramedics and give medications for many other things besides cardiac events,” he says.
Full-time personnel also make it considerably easier to maintain reliable service, he continues.
“Right now, we’re trying to staff so that we have an advanced life support provider, preferably a paramedic, around the clock. Since the full-time staff has ramped up to four personnel, it’s helped us a lot in filling our schedule,” he says.
The department is still looking for on call volunteers, both EMTs and ambulance drivers. A driver can be anyone from a person with a driver’s license and knowledge of CPR to another EMT or paramedic.
“I’m trying to recruit a lot more personnel to be as-needed or on call volunteers. They do get compensated while on call,” Kenealy explains.
“We’re going to have an EMT Basic class this fall. If anyone is interested, I believe it’s going to start in September and go through December.”
The tentative schedule it for classes on Tuesday and Thursday nights and some Saturdays, with a total commitment of around 170 hours.
Meanwhile, Kenealy has also been recruiting within the hospital, training up personnel who may be able to drop what they are doing for 15 minutes to be on call to drive the ambulance. It’s all about flexibility, he explains.
“We need to be proactive and diversified in the way that we staff,” he says.
An additional advantage to the new structure is the improvements it allows in response times. Time is of the essence when responding to an emergency, Kenealy says.
“If someone is severely injured or in respiratory distress, time is the most significant thing. We can be out the door in a couple of minutes when we’re staffed, rather than getting paged out,” he says.
“It’s a huge advantage for decreasing the response times.”
Another big advantage of dedicated paramedics, especially in a small community, is that it can solve the inevitable crossover between emergency departments. Many ambulance volunteers, for example, are also fire department members.
“Let’s say the fire department goes out on a structure fire and, maybe before, a lot of the personnel who were relied upon on the ambulance were also on the fire department – well, they need to fight the fire,” Kenealy says.
As part of his role, Kenealy is also working to strengthen the relationships between the county’s emergency departments through, for example, joint trainings. He would like to work on this with everyone from the volunteer firefighters to law enforcement, he says.
Though it may seem that a small rural hospital does not need a full complement of paramedics, the structure has been developed to make use of each personnel’s time. While one of the team is on duty but not responding to a 911 call, they devote time and expertise to tasks in the hospital.
“Our number one priority is if there’s a 911 call or a transfer, but our second priority is the emergency department,” Kenealy says.
“They are utilizing us in the emergency department constantly – if there’s a chest pain patient comes in, I know my role and I’m going to be right in there with the nurse.”
The team’s third priority is to help the nursing staff with all other necessary tasks. For example, Kenealy says, they can help transport a patient to the ER from the clinic or Long Term Care.
“You’re kind of a jack of all trades at the hospital,” he nods.
Sundance is the first community in Crook County to benefit from a dedicated ambulance service, but Kenealy points out that the ripples will spread outside the city borders.
“We can assist other agencies – we’ve been called for intercepts from neighboring departments, which helps other communities out as well,” he says.
“Neighboring communities are also welcome to call us for events, life support intercepts…or if they need a higher level of care.”
Originally from Wisconsin – where he was a full-time firefighter-paramedic in the fire service, spent some years on the volunteer side and has served as an officer, captain and training officer – Kenealy brought his experience to CCMSD in November as the first person hired for the new department structure. He took over as director in May.