Understanding how EMS works in Dinosaur — and what that unique community needs — is an essential part of the conversation to determine the future of EMS. But it is definitely a complex piece of the overall puzzle.

Dinosaur is located in far-western Moffat County, 3 miles from the Utah border and 90 miles from Craig. Dinosaur is home to approximately 340 residents within the town limits, and more live in surrounding communities in the furthest corner of Northwest Colorado.

When someone in Dinosaur or surrounding areas in the county needs emergency medical services, the ambulance and response team is sent from Vernal, Utah, which is a 45-minute drive one way. The drive time alone from Vernal to Dinosaur puts patients outside of the “golden-hour,” which is often referred to in emergency responder training as the hour of time from the initial trauma until the patient gets access to critical care.

Getting care within the golden hour is understood by emergency professionals to lead to better health outcomes and can often mean the difference between life and death.

“We have an aging population in Dinosaur, and we’ve had several new families move into Dinosaur. But considering the overall population, we have members of the community who would like to see the call times cut down,” said Nichole Becker, who is representing the town of Dinosaur on the Moffat County EMS committee.

One local Dinosaur resident, Jay Kaufman, is a veteran who lives alone and has medical needs that have required emergency services five times in the last year alone. Kaufman has personally experienced all of the barriers that residents face in getting timely emergency care in our rural and remote areas.

One issue that increases the response times, explained Max Becker from the Dinosaur Marshal’s Office — who is also Nichole’s husband — is that when someone in Dinosaur calls 9-1-1, it can either be routed to Rio Blanco, Moffat County or Vernal’s dispatch, depending on which cell tower the call goes through. Landlines will automatically go to Moffat County dispatch, who will then need to contact Vernal dispatch in order to send an ambulance.

“It’s all just pieces that end up chinking away at the time. It’s not anything that anyone is doing wrong, it’s just the position that we are in. And it’s a unique position to Moffat County, because no one else has that. That’s what we want to fix,” Nichole said.

Around the first of the year, Kaufman had a medical emergency in which the long call time became life threatening. Because of the unreliability of being able to connect with the appropriate dispatch, Kaufman called upon another local resident, Joe, for assistance. Joe, who declined to share his last name for this story, had to sit and wait for an hour and a half while Kaufman’s oxygen levels slowly dropped.

“None of us are certified to administer oxygen, so we just have to sit and wait,” Joe said.

Kaufman has had other experiences where he was transported by EMS to Vernal and needed to be transported back within 16 hours of his release for more extensive care. On another occasion his oxygen was critically low and, though EMS services arrived within 45 minutes, the responders were not carrying enough oxygen to administer to Kaufman.

Rather than calling 9-1-1 when there is an emergency, Kaufman utilizes a make-shift system that has developed within the small community based more on desperation than efficiency.

“This is really a community where we just have everyone’s cell phone number to get in touch with each other,” Nichole Becker said.

When Kaufman has a medical emergency, he will call Joe, who will call the Marshal’s Office and the fire chief, and they all will go and help with what they can until someone else arrives. Joe said he has the direct line for Moffat County Communications programmed in his phone for when Kaufman needs help. He calls dispatch directly to try and save time.

Kaufman is not the only local resident who is in this position. There is a local woman who was having medical issues and was calling the Marshals and Fire Chief every other day for assistance until EMS services arrived, residents said.

“That’s a testament to how long the community has been without and has just adapted to being without. And I will say that this community, if someone needs something, someone is going to step up and provide it. But that doesn’t make it right,” Becker said.

There is a minimum of a 45-minute wait for EMS services to respond out of Vernal, but there are other other variables that increase the call time and limit access for rural residents. EMS services prioritize calls based on the nature of the call and available EMS response teams.

“Gold Cross is doing everything they can for us, and we cannot thank them enough for everything they’ve done for us. But 45 minutes is a long time when you only have that golden-hour of response time,” Becker said.

If there are other calls in front of a call from Dinosaur, it increases the call response time. And if there are two critical calls at once, EMS will prioritize the one that is closer, because responders would be able to get them to treatment within the golden hour window.

For cardiac calls where Gold Cross determines the ambulance response time is too long, which Kaufman experienced earlier this year, a helicopter will be dispatched to transport the patient to Salt Lake instead. A helicopter transport costs $87,000, an extreme expense for local residents, especially those on a fixed income.

Gold Cross also covers a huge service area which includes five counties across the state of Utah. The EMS company also recently added Daggett County to their service area, which covers Red Fleet and Flaming Gorge in Northeast Utah.

Gold Cross has been providing EMS services to Dinosaur and the Northwestern reaches of Moffat County since 2013. Dinosaur mayor Richard Blakely, who was born and raised in Dinosaur, was mayor at the time of Gold Cross taking over EMS services in the region. The agreement didn’t happen without effort.

Prior to 2013, EMS services had been provided out of Rangely, though that only lasted for a short time. Rangely is located in Rio Blanco County just 20 miles south of Dinosaur. There is one small hospital in Rangely that, over the years, has been decreasing the level of services that it provides.

Blakely said there was a contract in place previously between Rangely Hospital and the Moffat County Commissioners for Rangely to provide EMS services to Dinosaur. At the time the contract was valued at $15,000 per year, an expense which was shared between Moffat County and the Artesia Fire District with the help of a grant.

When the contract was up for renewal, Rangely increased the amount of the contract to $20,000, which was over budget for Artesia Fire District. The Town of Dinosaur attempted to take over responsibility for the contract, and the entities met for negotiations but never reached an agreement.

“I went into panic mode,” Blakely said, “and got a hold of Gold Cross and started negotiating with them.”

There were some legal components to being able to transfer patients over the state line to Utah, but the entities were able to navigate that and add Dinosaur to Gold Cross’s service area. There is no fee for Gold Cross to provide EMS services to Dinosaur, because they bill for the services rendered.

Gold Cross has been a solution for the lack of EMS services in Dinosaur, but it’s clear to residents that a more local solution is needed. If Dinosaur is able to get a local response team in place, they will still maintain that relationship in case residents were to ever need additional help.

Ideally, residents say, Dinosaur would have a local ambulance that could be housed under the Artesia Fire District. There are two local residents who are trained as EMTs, one of whom is working on her intermediate certification right now. Three other community members are working on their Basic Life Services (BLS) certifications, with the aim to get certified as instructors who can then train the whole fire department.

Being able to have a local ambulance would cut response times down from 45 minutes to 3 minutes, and it would allow residents to access care within the golden window.

“We want to look just like Maybell looks, just like Craig looks. There’s no reason we can’t have the same service here, just on a smaller scale. We’re not asking for ten ambulances, we’re asking for one,” Becker said.

Although many community members are ready to step forward to help make this happen, there are other barriers that will need to be addressed. Getting access to remote BLS trainer training, responder equipment, and getting a certified ambulance with medical oversight are just some of the hurdles to cross.

Getting support from the rest of the citizen’s in Moffat County may also be a challenge due to the distance and lack of information. The EMS committee has been looking at financial and call data in order to better understand the needs across the county.

This information is just not readily available for Dinosaur, due to calls being dispatched out of three different call centers. These call numbers won’t reflect the calls citizens make to the Marshal’s Office, the Fire Department, or one another, for assistance in an emergency.

Many residents will drive themselves to the hospital in order to save time. Still more residents just don’t call 9-1-1 when it’s needed because of the wait.

Even if the EMS committee is able to obtain call data for Dinosaur, it may not accurately reflect the need for EMS services.

“One of my worries is that the issue of call volume coming out of Dinosaur is going to be a sticking point with people,” said Kyle Baker from the Marshal’s Office. “And it’s just my opinion, but frankly, I don’t think call volume matters. If someone needs an ambulance, they need an ambulance, and if they need it sooner than 45 minutes, they need it sooner.”