Help is on the way

Recently, a question arose about the process when someone calls 911 for an ambulance. With many community residents having never been in such a situation, Brad and wife Lexi McKee, owners of K.A.R.E. EMS Solutions, the company that is taking the lead in administrative support for Moorcroft's ambulance service, considered this an opportunity to talk about the procedure for this area, hopefully making this a less stressful situation.

Using as an example a possible heart attack, you have called 911, told the person on the other end of the line your symptoms and requested an ambulance.

If you're in Crook County limits, your phone call has gone to the Crook County Dispatch in Sundance. They will take your information and, based on the resources needed, they will send it out on a page to either Moorcroft ambulance and/or Moorcroft Fire.

"In recent years," Brad shares the extra effort they use to ensure the message reaches the volunteer responders, "An app has been developed to help relay dispatches through mobile phones as well. This program receives the same page sent to pagers, however with some delay. It is a great resource to use to help alleviate the cost of pagers for services. Using the Edispatches App allows for pages to be received on a tool that everyone has right at their fingertips. Another resource used by most services is the IamResponding App."

While each of these applications has certain issues, according to Lexi, "On one of all those forms, we make sure we get our pages so we know what's going on."

One of the first duties the McKees enlisted when K.A.R.E. began running the Moorcroft Ambulance Service, last year, was to collaborate with the county dispatch to "make sure that even if our ambulance didn't have a response, there would be an ambulance coming from somewhere", Lexi speaks with confidence.

The duo set up an auto-dispatch so that when the call comes into Crook County Dispatch, they automatically send the information to either Sundance EMS or Campbell County Dispatch, where the ambulance crew is advised that Moorcroft has a call and their ambulance may be needed.

So the call is dispatched. While you are unaware of this immediate mobilization, Lexi spoke to the two ways this auto-dispatch will help you.

"If we don't have a response or if we have somebody who cannot actually take the patient in the ambulance, for example our Emergency Medical Responders (EMRs), if we just have an EMR, we already have another ambulance service coming to help," she says.

Under Wyoming law, EMRs are not allowed to transport a patient in the ambulance without an Emergency Medical Paramedic (EMP) present.

The second reason addresses the resources available on Moorcroft's ambulance, maybe even for you, "If we end up in a call where we need extra resources, pain management, extra Advanced Life Support (ALS) services that we don't necessarily offer on our ambulance, we could intercept with one of the other ambulance services to get that extra help."

Moorcroft's medical service is an AlS, Lexi says, "We do have the capability of taking care of advanced calls; we carry cardiac medications in case there is a cardiac arrest we need to work and we carry other advanced life saving measures on our ambulance."

"But there are some instances when we call for an intercept because we're going to need more help and resources... [Certain] pain medications and Benzo medication that help stop seizures, are very controlled substances and it's a lot of work for us to keep those under lock and accountable," she continues.

"Those are things that, right now, we're just not carrying on our ambulance. If we're going on a call that has that happening, we automatically call for another ambulance service to come intercept with us. It's not that we're not capable of those abilities, we just don't have them right now on our ambulance service."

The ambulance has arrived and the emergency personnel are kind, smiling as they talk with you, asking questions and working quickly and efficiently; devising a treatment plan based on your answers, both verbal and via monitor, to get you safely to your destination.

"Usually, we'll probably have two providers in the back and a driver up front. Occasionally, it can be one provider in the back and sometimes, if we have a student, we'll have a provider and a student... but preferably, I like to keep it at two providers and not a lot more than that because it gets hard to move around in the ambulance."

The pedal's to the metal and the rubber's on the road. As for your destination, there are a couple considerations the EMTs will take into account.

"The Wyoming Rules and Regulations require that we providers transport our patients to the closest most appropriate medical facility that can handle that patient's situation," Lexi explains. "So you may be a little closer to Sundance if we picked you up on the far east side of town. However, Sundance doesn't have a cath lab so we may actually need to go to Gillette if you are having chest pain indicative of having a heart attack; they sometimes don't have their cath lab open, but they have more resources and capabilities to get you where you need to go."

Of course, the ambulance will take you where you want to go, but remember that the trip is reviewed by your insurance company and, if they deem there was an appropriate facility closer, you may be on the hook for the difference in cost.

You're in the ambulance and perhaps connected to an IV for fluids to facilitate hydration and/or medications and the king of them all, monitor of monitors, the Life Pack 15.

"We're giving [the hospital] a patient report on how things are going and what we're seeing with you; we're transmitting 12 leads to the ER," according to Lexi.

"We're trying to see if you are having a heart attack. We're sending those ahead to the hospital to let them know ahead of time that we're coming in with a possible heart attack and they can let their doctors know... Lots of preparation for what's going to come. They are capable of defibrillating a patient if their heart needs that and pacing a patient...all sorts of things that are needed for cardiac issues."

Moorcroft's Life Pack 15 is currently programmed to communicate only with Campbell County Health and the Sundance ER. Lexi says, "Those are the ones we can automatically send to, anything further than that we don't have programmed into them just because we most likely won't be going further than that. We most likely will end up going to the hospital of one of those choices and then [you] will be stabilized at one of those hospitals and sent on from there."

Occasionally, the Moorcroft ambulance will intercept the other responding medical transport right in Moorcroft.

"Sometimes," the K.A.R.E. owner states, "If we're on scene a little longer, trying to get things done, and Campbell County Health is quick enough to make it into town, we will rendezvous at the Coffee Cup Fuel Stop or the Rozet exit, in one of those parking areas."

You've been transported to the hospital and are prepared for the next part, all due to the diligence of the ambulance service that started with a phone call.

Many people do not realize that, while fire and law enforcement are considered essential services for a community, the State of Wyoming does not deem the municipal ambulance service as such. This means that the towns and cities must fund their own, if they want to provide this service to their residents and visitors.

There is hope, though.

"The state of EMS in Wyoming and the lack of volunteers and EMTs has gained attention," Bran acknowledges. "The Wyoming Workforce Development has recently put into place a grant which can allow for EMT training to be reimbursed as long as the students agree to volunteer or work in EMS, take their certification exam within 30 days of completing their education course, and report their wages to the Wyoming Workforce Development for two years following their course. This is a huge opportunity for anyone who would like to become an EMT!"

"Currently," Brad describes the situation in Moorcroft, "There are five EMTs, one A-EMT, one EMT-I and three Paramedics on the roster. We also have ten drivers who volunteer their time to help. However, most of our roster often work outside of the Moorcroft area and all have responsibilities to their personal lives as well. We typically have three to five active personnel in the community during most calls."

Unfortunately, this is not always enough.

"There are still times when we do not have anyone certified to transport patients. Many of our ambulance drivers are trained and able to start emergency care before a provider arrives, however the provider must be an EMT or higher-level provider to transport the patient via ambulance," he says.

Since K.A.R.E. took over the service several months ago, the McKees have been actively seeking more immediate care providers to build the roster, allowing the few who always respond rest time as well. "Hopefully," says Lexi, we'll get there..."

Brad has set up classes to teach those interested in this opportunity to make a difference in people's lives, "We have offered two Initial EMT Certification Classes, as well as two EMR/First Responder Courses to help build providers for the service... We currently have five EMT students who have recently completed our EMT Initial course and are awaiting testing for the National Registry of EMTs for their licenses. This will greatly help improve our coverage [and] we are still seeking new volunteers to help drive or take one of the many courses we offer! We currently have an EMT Course starting Thursday, April 18, and have one community member signed up."

Providers and Drivers for the Moorcroft Ambulance Service are volunteers, thus

qualify for the Wyoming Volunteer First Responder Retirement Program.

Brad explains, "We have worked to acknowledge the time and commitment of our volunteers and, together with the Town of Moorcroft Leadership, have arranged to pay volunteers for their dedication."

This means there are incentives to respond to calls including the $50 per answered call. However, the volunteer must schedule and attend 36 hours of call time a month as well as complete all requisite documentation after every call attended.

"We know that our volunteers don't give their time for money," Brad commends these individuals who go the extra distance, "But we want them to know, we recognize their commitment to this ambulance service, and sometimes that means missing their family dinners and other important events, and we want them know how much we appreciate them."

Even with the shortfall in volunteers, Moorcroft's ambulance service works hard to ensure at least BLS level response for all 911 calls. "This includes EMRs, and EMTs. We also have ALS level response when local paramedics and AEMT, IEMT providers are available [and] ALS level response from both Sundance and Gillette regardless of our local response."

"We are always seeking new volunteers who are willing to help this community. The more people we can have on our roster the better our coverage becomes. Anyone looking for something more and to be involved beyond coffee, is encouraged to reach out to Town Hall or K.A.R.E. EMS for more information."