Innovation Aids Growth Of EMS in Laramie F.D.
features
Laramie, Wyo., Fire Department
The wide expanses and long severe winters, together with sparse population and remote services have made for a unique challenge to the emergency medical services personnel in Wyoming. Providing service to large areas, with limited resources, manpower and equipment has called for innovative approaches. Funding has been generated across intergovernmental lines. Federal, state, county, city, hospital board and fire districts have all contributed dollars for the effort.
In the not so distant past the only help an injured or ill citizen could rely on was from his neighbors. This was true whether he lived in a town or was remote from one. Later, International Travelalls with first-aid trained attendants were available. Today, modern ambulances with direct emergency room doctor communications and trained technicians are in use.
The road has been rough and the trip made too quickly. The end is not yet in sight, but dynamic leadership and a supportive populace have made innovation possible. Some of the problems are solved and others only identified.
Laramie is a community of approximately 28,000 people who live and work on the high plains (7200 feet) of the Rocky Mountains in southern Wyoming. It is the county seat of Albany County (4248 square miles, 53,000 population) and the home of the University of Wyoming (9000 students), the state’s only four-year institution of higher learning.
The Laramie Fire Department is a fully paid force of 41 men under the direction of Chief D. E. Young.
Fire service involvement
The Laramie Fire Department became involved in providing emergency medical service to the community in the mid-1960s. Prior to that time, the department merely responded a pumper to the scene to provide basic life support until an ambulance could be summoned. The only professional ambulance service in the county was based at Ivinson Memorial Hospital in Laramie.
The department began transport service with a converted chiefs station wagon. Later, the hospital furnished an old Travelall. In 1973, the city purchased its first ambulance, a 1-ton Chevrolet truck with a modular ambulance unit. At this point, the LFD rescue squad was responding to all emergency calls inside the city limits (9.25 square miles) as a free service to the citizens. All funding came directly out of the normal operating budget of the fire department. Out-of-city and nonemergency calls were handled by ambulances from Ivinson Memorial Hospital.
In 1978, a proposal was made whereby the hospital would relinquish all of its ambulance service to the city. After well over a year of negotiations, an agreement was finalized to take effect on July 1, 1979. This joint powers agreement was a contract between two elected bodies, the Laramie City Council and the Ivinson Memorial Hospital Board.
Covers entire county
Under the terms of this agreement, the LFD provides the emergency medical and ambulance service for the entire county. Even in sparsely populated Wyoming, the average coverage for one service is 1360 square miles. The Laramie Fire Department emergency medical service covers 4248 square miles. One ambulance at Ivinson Hospital and one at Fire Department Headquarters are manned by fire fighter EMTs 24 hours a day. Additionally, there is a back-up ambulance which sees frequent use, and chiefs’ cars are still pressed into service occasionally.
The. hospital provides the equipment and the emergency room doctors (under contract to the hospital board) provide training and direction. Ivinson Hospital also pays the city a sum equal to the salaries of six fire fighters, one-half of all operating costs, plus whatever overtime costs the city is obligated to pay by virtue of the contract. This approximately $112,000 cost represents a sizable portion of the LFD budget.
The chief advantage of this agreement to the city is that six additional fire fighters are available for fire suppression. The contract requires that two men be on duty at Ivinson Hospital at all times (except for department training periods) to handle emergencies at the hospital. These men spend their 24-hour shifts at the hospital—for the most part outside the regular fire department activities. However, it is felt that in a critical fire situation, additional support could be rendered by these fire fighters, who maintain their training in fire suppression.
Hospital advantages
For the hospital, there are two major advantages. First, all money generated by ambulance fees and charges goes to Ivinson Hospital. The hospital handles billing and collection, which in most cases is only a part of the patient’s health care bill. Operating an ambulance service was never a money-making proposition for Ivinson Hospital, a problem compounded by the fact that they were in competition with an organization providing free service.
Secondly, Ivinson was never able to overcome certain personnel problems in its ambulance operation. Offering a minimal wage and no career structure, they experienced continual rapid turnover of employees. This situation not only made it impossible to create the stable work force necessary for emergency medicine, but also led to haphazard training programs. This problem has been eliminated by having the fire department provide the manpower. The LFD has a history of attracting and holding high-quality personnel through a competitive salary structure, good promotional opportunity, and a good benefit package, including 20-year retirement.
Practical operation of the ambulance service is under the supervision of the fire department, a sizable portion handled by the EMTs themselves. Trip reports, filled out and processed entirely by fire fighters, contain all pertinent patient information as well as that data necessary for hospital billing. Medical supplies used in patient care are recorded accurately, yielding not only an easy billing method for Ivinson but also a simplified means of inventory. The average in-city ambulance run costs approximately $45. Mileage charges are added to a minimum run fee.
Number of runs doubles
Since entering into this joint powers agreement, the LFD emergency medical division has witnessed the most substantial changes since its inception. In addition to doubling the number of calls made, the character of the ambulance call itself has been altered considerably. Averaging less than 5 miles per call when restricted to a citywide service, the average distance traveled has increased to 25.41 miles per call. This, of course, means longer response time, especially on the often treacherous winter roads in Wyoming. It also means longer ambulance time for the patients, a significant reason for raising the levels of training for attendants.
Since January 1978, all ambulance personnel have been required to have a minimum of EMT-1 certification. Although certification to this level began in 1968 and virtually all members of the department have been certified at some time, fire fighters are no longer able to actively participate while still in the process of gaining their EMT cards. This has created somewhat of a burden on the LFD since, although advanced first aid and cardiopulmonary resuscitation instructors are numerous in the department, all EMT training is handled by the State Emergency Medical Services Office in Cheyenne. Over the years, the basic course has been expanded both in quantity of subject matter and extent to which the material is covered.
After completing the course and obtaining state certification, fire fighter EMTs participate in an on-going training program of weekly assignments and lectures in specific areas of emergency medicine. In January of 1980, 12 EMTs began a course of instruction at the EMT-2 level, which includes IV therapy, certain limited drugs and application of anti-shock trousers. This training is being supervised by the emergency room doctors at Ivinson Memorial Hospital.
Photos by Fire Figheter Don Drolet
More highway accidents
Another change in the nature of the emergency medical division since July 1, 1979, is the increased number of highway accidents with their accompanying severe trauma cases and multiple patient situations. Calls of this type led directly to the Laramie Fire Department bringing Squad 1 into service in December 1979. This is a four-wheel drive vehicle carrying specialized extrication equipment. This unit has proven itself valuable in getting additional manpower to the scene as well as the equipment.
Another area totally new to the LFD is the transfer call, both emergency and nonemergency. Providing outpatient transportation to the hospital and transferring patients between Ivinson and other health care facilities comprises about 11 percent of the total ambulance work. Additionally, patients are frequently transported outside the county, often to specialty centers in Denver, 130 miles away. This has led to the eight-hour ambulance run, often requiring sophisticated medical gadgetry on board which tests the mental stamina of the fire fighter EMT.
The intensive growth and change of the emergency medical division has caused some strain on the administrative functions of the LFD. Looking to the future, one can only theorize that this area will only continue to grow, though probably not at the accelerated rate it has since the summer of 1979.
To alleviate this problem, the department named Fire Fighter Randy J. Vickers to the recently created position of emergency medical service director. The director administers the medical division and coordinates its activities, training and policies. Additionally he acts as liaison officer and coordinates the program with the various government agencies. The department is proposing that the hospital bear half the cost of the position.
Higher pay for EMTs
A differentiation between fire suppression and emergency medical service was recognized in the contract negotiated this year with the Fire Fighters Union. For the first time, higher compensation was established for EMTs to reflect their additional training. An EMT-1 now gets a 6 percent increase over fire fighter pay and an EMT-2 gets a 12 percent increase.
This system will foster professionalism considerably by basing salary on skill. Previously, fire fighters drew regular assignments on both pumpers and ambulances and received a flat rate “pro-pay” for each ambulance shift worked.
The new pay system will foster professionalism considerably by basing salary on skill and will funnel into EMS those fire fighters with the most desire and ability. At the same time, the city will shrink the pool of EMTs available for ambulance duty so that it can provide more training to the remaining EMTs. Paramedic training is still far in the future and will be considered later.
It has not been an easy transition, but the joint powers agreement is working much better than even its proponents had hoped. On the fire department side, the emergency medical component has generated some impressive statistics. The LFD uses these statistics to justify its manpower requirements and budget requests to city government. In these days of rampant inflation and the resulting budget crunch, it has provided the department with the only manpower expansion opportunity available.
In the first three quarters of the contract year the three ambulances responded to 1022 calls for medical assistance and transported 1061 patients. The average run was 25.41 miles (round trip). These statistics are more than double the numbers from the same period a year ago.
