11 minute read
EMS: Ready at a moment’s notice
READY AT A MOMENT’S NOTICE
Grand County EMS moves into a new facility and prepares for another busy year
Written by Rachel Fixsen | Photos by Murice D. Miller
“It really runs the gamut; you have to be prepared for a lot of potential scenarios,” said Emergency Medical Technician Katie Grauel, talking about what a “typical” shift might look like with Grand County Emergency Medical Services. Crews might respond to a cardiac arrest in someone’s home, an injury in the backcountry, or the urgent need to transport a patient to more advanced care at a hospital in Salt Lake City. All of those calls might happen in just one 12-hour shift—or, they might not get any calls at all, and spend the shift training and maintaining gear and equipment. Call volumes in the GCEMS response area have been increasing in recent years, so those training and maintenance days are less common. GCEMS aims to keep pace with the rise in need: the team recently moved into a brand new facility, and they stay up-to-date with training methods. They’re also implementing a new “Mobile Integrated Health” program to help cover gaps in community health care. State legislators last year and this year are working on bills to help support and fund EMS services, particularly in rural areas like Grand County.
THE NEW BUILDING
“We’re happy to be in the facility—it will be a game-changer for the staff,” says EMS Director Andy Smith.
GCEMS has been working towards finding a consolidated, adequate space for its operations for more than ten years. In 2018, the special service district (which had been a county department until that year) applied for funding from the state Community Impact Board, a body that distributes grants and loans to governmental entities in areas that host mineral leases on federal land. They received $1 million in grant money and $3.5 million as a zero-interest, 30-year loan to go toward constructing a new facility. The district also contributed $120,000 of its own money to the project. Construction began early in 2021, and the building was nearly complete by the fall. Staff have now moved their operations to the new location.
The new building occupies an elevated position on the east side of town, with a view over the Moab valley. There’s a spacious equipment bay where the district can keep all of their ambulances. Due to supply-chain issues, the final piece of the building—the garage doors—aren’t installed yet, but the resourceful agency has improvised their own temporary doors so they can use the new bay. The facility also has indoor rooms for training, presentations and conferences, with large doors that open onto a patio space so sessions can easily transition between indoors and outdoors. Offices for administrative staff, a workout space, laundry machines and crew quarters for ambulance staff serving multiday shifts are all housed under one roof.
The crew quarters, in particular, are a significant upgrade from the previous accommodation says Smith.
Full-time EMTs typically work 48-hour shifts with 96 hours off in between. During those on-call shifts, they live and sleep at the EMS station so they’re ready to respond quickly when there’s an emergency. Before the new facility opened, crews were living in what they called “the white house”—a decades-old ranch residential-style house owned by the county, in need of repair, and too small for staff to have their own rooms. Two or three people would sometimes share a bedroom, and a staff of seven shared a kitchen.
Now, each person on shift has their own small bedroom with a window. A black-out shade allows staff to sleep well during daylight hours, and each room has its own temperature control. Promoting adequate rest for staff on an unpredictable and sometimes grueling schedule is a key upgrade of the new facility.
Grauel, who works part-time and usually serves either 12 or 24-hour shifts, recently spent her first night in the new building while on shift.
“It was super nice to be able to go upstairs and crash in a bed after [responding to calls],” she says. A DAY IN THE LIFE Grauel says the first thing staff do when starting a shift at 7 a.m. is go over the rigs and make sure they’re in good shape and fully stocked with necessary supplies. They make sure each crew member has the appropriate personal protective equipment, which currently includes an N95 mask to prevent the spread of COVID-19. Staff also make sure they have items like snacks layers, and hiking gear, in case there’s an incident in the backcountry, at high elevations, or that takes many hours, sometimes into the night.
Once they’re as prepared as they can be, the crew meets to go over any chores or tasks that need to be done. For example, Grauel and a crewmate recently finished setting up the free weights and exercise equipment in the new workout area. Some staff members oversee specific duties like ordering supplies and equipment, or keeping track of training hours.
The crew tries to do an hour of physical training each day—previously at the Moab Recreation and Aquatic Center, but they’ll now be able to work out at the station. They also try to complete at least an hour of professional training each day. Staff might suggest a topic or skill they’d like to brush up on. The district recently acquired a new device that simulates the type of monitor EMTs use to track a patient’s vital signs during a real incident. The person conducting the training can program the simulator to immerse trainees in a range of possible situations.
Grauel remembers a recent shift when, at 7 a.m., she reported to a 24-hour shift that was halfway through the full-time staff’s 48-hour shift.
“When I got to the station, no one was up, which is unusual. So I looked at the call list and they had had seven calls after 4 p.m. [the day before],” Grauel says. One of the calls was at 1:30 in the morning—the crew was active for much of the night, and were catching up on sleep.
Even if there aren’t a lot of calls, sometimes even one can take most of a day. Grauel said a recent transport of a patient to Salt Lake City took 13-hours round-trip.
“You just don’t know what to expect from your day,” Grauel says. “There’s a possibility that you might get to sleep through the night, or there’s the possibility that you don’t get to sleep at all. There’s a lot of unknowns.” Grauel says that cycle can be exhausting, but it can also be exciting.
MOBILE INTEGRATED HEALTH In a presentation to the Grand County Commission this summer, Smith said the district’s call volume has increased 132% over the last 20 years.
“That’s quite a number,” Smith remarked at the time.
In 2020, the district broke five monthly records for number of calls. The district responded to roughly 1800 calls in 2021.
“We’ve gotten a lot busier,” Grauel says. She’s worked for the district for about four years.
In response to that growing need, in 2016, the department shifted from being staffed by volunteers to employing full-time, paid EMTs. Currently there are 17 full-time responders, and 47 staff total.
Another approach the district is taking to respond to the growing need for emergency care is a new program called Mobile Integrated Health, or MIH.
Smith explains that responders noticed that some individuals called EMS regularly, often for
a repeat issue, such as elderly residents falling inside their homes. Sometimes people don’t have access to regular health care—whether they lack insurance, don’t have the mobility to get to a provider, or they don’t think they need medical attention.
“EMS becomes the safety net” for those people, Smith says. They may call EMS multiple times a week, or even multiple times a day.
Will Barnhardt, a former GCEMS crew member who has since relocated, initiated the idea of the MIH program, through which crewmembers responding to those repeat callers could make a note in their incident reports that the individual may be a good candidate for follow-up care. EMS would then contact the person and ask if they want to participate, and a trained paramedic would visit and assess their home. The hope is that these visits can help prevent future 911 calls and trips to the emergency room. Smith says that, with participants so far, EMS staff have installed handrails and non-slip rug underlayments to prevent falls, and they can help patients while they adjust to new medications or ensure they’re taking their prescriptions correctly. The district has partnered with Moab Regional Hospital’s Dr. Whitney Mack to begin the MIH program.
The district is working with state legislators to clarify language in the code to make sure EMS is covered to provide care that’s not strictly an emergency, so the program isn’t completely operational yet. Smith says the department is also hoping to secure federal funding to support a full-time position to oversee the MIH program.
“I’m very excited about its potential as a program,” Dr. Mack says. “Ultimately I think it will be an opportunity for skilled people to help [patients] when they’re at their most vulnerable.” She says MIH provides her an avenue to visit patients in their homes, which can be valuable in her assessment and advice.
“It’s nice for me to be able to see people in their own environment,” she says. “It doesn’t matter to me if someone’s house is orderly or not orderly—I just want to see how they’re living, how they’re getting their food, what their space is like.” Not only does that give her greater insight into the person’s health, she says, it’s also humanizing. She adds that taking preventative steps to help people can be very positive for EMS staff as well—a welcome change from damage control of emergencies that may have been preventable.
Mack says that she can visit patients at home outside the MIH program, but that EMS staff are uniquely positioned to identify the people who need that attention the most.
“They’re already mobile; they have the skills to interview and assess patients,” Mack says. She and Smith have high hopes for the program.
Smith noted that GCEMS is part of another community initiative spearheaded by the Moab Free Health Clinic called Unite Us. It’s a database through which service providers and community members in need of care can find one another.
“I think that’s one of the issues in our community—I don’t think we’re all plugged in,” Smith says. “My staff might go to a home and see a need, maybe there’s food security issues—but we don’t know who’s addressing that.” The Unite Us network can help make those connections between services and the people who need them.
Smith says he plans to hold a community event to mark the opening of the new building and invite the public to tour the space, but he’s waiting for COVID-19 activity to calm before scheduling the event, likely in the spring. In the meantime, staff will stay prepared for the unexpected. n
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