'Awakened' by tragedy

A volunteer emergency medical technician discusses the challenges of serving rural Colorado

Imagine you're in the backcountry on an ATV that just flipped over. In a rural community, emergency responders worry whether they will even find you and that's just the first of many difficulties they face.

The death of Dinosaur resident Jack Riggan, possibly because of a lack of equipment and patient transport issues, brought to the forefront the myriad of difficulties emergency medical technicians (EMTs) face in their efforts to treat patients and sometimes save lives.

"We have many problems," said Karen Burley, president of the Maybell Ambulance Service. "It's more than just equipment problems."

The first is a state mandate that patients be transferred to a hospital equipped to deal with their specific injuries, something that's just not feasible in a rural county where the choices are few because of the distance to any hospital not just ones with certain treatment abilities.

"It's our job as EMTs to make sure you get those patients to the right facility," Burley said.

The Maybell Ambulance Service covers 3,400 square miles, much of it rough terrain and barely accessible.

The Maybell Ambulance Service was created more than 20 years ago after five youth in an automobile accident waited more than an hour for an ambulance. Three of them died.

After that, 12 Maybell residents became certified EMTs and raised the money to purchase an ambulance.

But the time it takes to get to victims is still an issue in rural emergency services.

Burley said the average call for the Maybell crew is three hours. Many times, much of that time is spent just getting to the victim.

"We call the BLM, the Forest Service or the Wildlife Department for help in determining access and other conditions," Burley said. "You try to get anyone on scene to determine whether you need to fly them out. We're making decisions even before we even see the patient."

In a rural community, sometimes an ambulance just isn't enough.

The problem is compounded by communication problems. In rough country, there are several zones where there is no cellular or radio signal.

"We may travel 20 to 30 miles before you get a signal," Burley said.

A call from a cellular phone, which cannot be pinpointed, once had the Maybell Ambulance crew responding to an accident "somewhere between Craig and Dinosaur."

"When you know there's an accident and there's an injured person waiting for you, it's very stressful," Burley said.

In many places, the ambulance crew can't get a radio signal either, she said, which means they have no contact with emergency rooms, doctors or support services just when they need it most.

"We lose contact with the ER, so we're making decisions on our own," Burley said.

Recruiting and retaining EMTs has been identified as a statewide issue, but Burley said rural areas suffer the most.

There are nine EMTs in Maybell, eight who have full-time jobs in Craig, which leaves only one person to respond to emergency calls during the day. Another works shifts, so that volunteer might be available, but many times the crew is just searching for someone to drive the ambulance.

"It's very challenging to man that ambulance with one person," Burley said.

Luckily, they've always had the resources when they needed them.

"In the 18 years I've done this, the Lord has been very good to us," she said.

The problem and one that Dinosaur also faces is that it's an all-volunteer department. EMTs don't get paid for making runs.

"The state has made grants available for retention and recruitment but grant money can't move people into your town," Burley said.

Maybell's population is 84, with more than 60 percent of the population over the age of 65. Dinosaur has similar issues with a growing senior citizen population, which is making it difficult to recruit EMTs.

It's difficult to recruit for a volunteer position when it demands so much time an energy outside of a person's regular job and family.

Maybell EMTs put their own time into the six months of classes required to become certified, continuing education, fund-raisers and emergency runs, which can last from three to five hours.

It is estimated an ambulance service could make 150 runs a month and charge Medicare rates and still only meet 60 percent of its operating costs, according to Regional Emergency Medical Service Trauma Advisory Council Coordinator Danny Barela

"We're looking at the feasibility of putting EMTs on the payroll," Burley said. "In Dinosaur and Maybell, who do 30 to 40 runs a year, how do you do it?"

Rural communities have enough financial problems in establishing an ambulance service, purchasing the equipment and paying to operate and maintain it. In Craig, the ambulance crew is a department of The Memorial Hospital and funded as such. In Maybell, a portion of the tax collected for fire services helps fund the ambulance service.

Not only does the ambulance face financial, logistical and terrain challenges, but the weather can also be formidable.

"I've been on runs where you have to wear mittens over your body substance isolation gloves because your hands would freeze without them," Burley said. "You can't even feel a pulse."

But the greatest risk is to patients who may be without heat or lying on the snow or in below-zero temperatures for the time it takes an ambulance crew to find and treat them.

Burley said while the state recognizes the problems, it is working to solve them in a way that benefits metro areas, not rural ones.

"There are a lot of challenges with rural EMS," she said. "The rules and regulations tend to support policy and issues for the metro area. They don't understand rural issues and how we have to do things differently."

Burley said she is working to get the town of Dinosaur an ambulance service, but said it's a long process and will take much support.

"To really help EMS in Moffat County it takes a whole community," she said. "Dinosaur residents know what they've needed for a long time, but they didn't know how to get it, how to go forward."

"Tragedy awakens people, motivates people," she said.

The first step, Burley said, is to make it so Dinosaur's quick response team can transport victims. It is within the Moffat County Commission's power to pass a resolution that would enable the team to transport patients in emergency circumstances. She is working on a draft to present to the commissioners.

The next step is to find a physician advisor. Dr. Thomas Told, who is Moffat County Public Health officer, has been the physician advisor for the Maybell Ambulance Service since 1975 and has never been paid for his services.

Currently, Burley and others are working with doctors in Craig and Rangely in an effort to get a volunteer physician advisor, but it's difficult.

"That puts their license on the line," she said. "A physician advisor needs to know and trust the comsmunity."

Burley said the community of Dinosaur, by the same token, must show its trust and support for the effort to bring better emergency medical services there.

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