Remote Response

     HGHEMS is also heavily involved in community education programs. One of its greatest successes has been its public-access defibrillation program. Around 200 AEDs are now in the field throughout Humboldt County. All law enforcement vehicles, schools, community centers, senior centers, the local convention center, some rest stops and gas stations, and fire departments have been equipped. Several local businesses also participate. Four saves have walked out of the hospital due to the program. A full-time person coordinates community programs such as PAD, CPR training and a child car seat inspection program.

FUNDING INNOVATION

     How does a rural hospital pay for all this? Humboldt General is a public entity supported by a hospital tax district. It has also been designated as a federal rural critical access hospital, which allows a higher reimbursement rate from Medicare/Medicaid. Overall, the reimbursement rate for the hospital (and EMS) is 92%.

     "Gold mining is a huge business in this area," notes Parrish. "They pay their employees well and have good insurance benefits. But gold mining is a boom-or-bust industry. We've been cross-training EMS people to work in cardiac rehab, and they can also assist in the ED. We try to integrate EMS into the hospital as much as possible, as well as getting our existing personnel integrated into EMS. We would like to see people like our phlebotomists and ward clerks become EMTs so they can help out. If and when mining goes down, we will have a much more flexible staff in the hospital that can do several things."

     "I think EMS will become very important for community health programs in the future," Songer says. "We are looking at creating a community paramedicine program. We don't know exactly what it will look like yet, but it is coming. Things like flu shots, wellness checks and injury-prevention programs for seniors will be involved-anything we can do to reduce the number of hospital stays and promote the health of the community. I think this will become an important function for rural paramedics.

     "I don't think, just because we're rural, we shouldn't have the same survival chances as in urban areas for cardiac arrests and strokes, and have PAD programs and programs to keep our kids safe. Having these things in your community shouldn't depend on where you live," Songer adds. "You have to be able to think outside the box to develop programs that fit rural areas. We have to figure out how to use new technologies to improve outcomes. For instance, we're going to start using a portable blood analyzer to obtain lab values in the field and do a trial on a portable ultrasound machine to detect internal bleeding. We want to be able to shorten the time it takes to get a patient to definitive care without needlessly calling a helicopter from 150 miles away simply because a patient met a mechanism-of-injury criteria. We should be able to offer the same level of care and outcomes for our citizens that is available to people in larger cities."

     For more information on Humboldt General Hospital's EMS operations, contact Songer at PSonger@hghospital.ws.

     Barry D. Smith is ground CQI coordinator for the Regional Emergency Medical Services Authority (REMSA) in Reno, NV. He has been involved in EMS for over 30 years, 29 as a paramedic, and has written five books and more than 200 magazine articles. Contact him at bsmith@remsa-cf.com.