The high desert of northern Nevada has been compared to an ocean of sagebrush washing up against islands of short, steep mountain ranges. Interstate 80, stretching from San Francisco to New York City, follows the original California emigrant trail and first transcontinental railroad through this area. Only half a dozen towns lie along the 500 miles between Reno, NV, and Salt Lake City.
As you would expect, most of the EMS agencies here are volunteer, and they face the same challenges today as other volunteer units around the country. But the story is different in the town of Winnemucca, NV, about 150 miles east of Reno. Here, Humboldt General Hospital (HGH) has developed an EMS system that rivals many in cities 10 times as large.
Humboldt County covers 10,000 square miles with a population of only about 16,000. EMS began with a group of volunteers in the 1950s. About five years ago, it became part of the hospital, a volunteer EMT-I service. One of the goals of this was to go ALS, something that would have been difficult as a stand-alone volunteer agency. Some volunteers put themselves through paramedic school and were hired by the hospital as full-time employees. A paramedic was on duty 24/7, and volunteers would respond to the ambulance station when a call was received. But the hospital wanted something better.
"We wanted to improve the EMS unit," says HGH CEO Jim Parrish. "We are in one of the most remote areas of the lower 48 states. We felt we had to have excellent prehospital care. We needed to have the ability to move people from the Winnemucca area to more definitive care facilities without having to use helicopters and planes."
GROWING A SYSTEM
Pat Songer was hired as director of EMS in September 2005. Then, "it was still mostly volunteers with a few paid paramedics," Songer says. "We have evolved into a system of mostly paid crews with some volunteers. The focus of the hospital was to expand and develop the program. I was given a fairly substantial budget to update the service with new ambulances and equipment. We have a fleet of four new ambulances and have developed a critical care paramedic program, completed a training center, developed an extensive QA and QI program, and expanded our auto extrication program."
Another goal was to recruit and retain more volunteers and classify them as "casual call" employees. This let the hospital increase their benefits by paying them for training and calls. The hospital then developed a competency and training program that provides all its recurrent training and a lot of new education.
"We do all our quarterly skill competencies with our human patient simulators," says Songer. "I think this helps with retention by keeping people involved and providing the latest education.
"One of the best things for retention is our rescue extrication program. The volunteers get fully trained on all the equipment, and we have no problem getting them to come in for rescue callouts. I don't have a high turnover rate. As a matter of fact, the number of volunteers is growing."
HGHEMS does all the rescue work in Humboldt County. This began with the original volunteers back in the 1950s. Each ambulance carries hydraulic spreaders and other basic rescue tools. The service also has a fully equipped medium-duty rescue truck. Crews have responded as far as 130 miles for rescue and medical mutual aid calls.
Current staffing is a crew of two (either two medics or a medic and an Intermediate), 24/7. There are nine full-time medics and three full-time Intermediates with 15 casual-call volunteers. Staffing is heavy during weekdays, with office personnel available, and three ambulances can often be in service within a matter of minutes. Everyone carries pagers, and when a call comes in that's outside the city, off-duty crews are paged, and people come in to staff another ambulance. The same is true for transfers.