Answers to questions about local EMS

April 26, 2017

By Chief Jeff Lindsey As questions in the community come up about our county's ambulance service, as the chief, I like to take time and answer them. A question that I hear occasionally is this: Why does Boundary Ambulance employee so many paramedics? To answer this question I want to make it clear on the difference between skill sets on an ambulance.   * EMT-Basic is the entry level certification that you must have to treat the patients in “the back” of the ambulance. This is considered Basic Life Support (BLS) and the course is around 140 hours. EMT-Basics are taught how to handle medical and trauma emergencies with basic skills like bandaging, splinting, oxygen delivery all within what is called “scope of practice.” Currently BAS is holding an EMT-Basic class with hopefully new EMT-Basics to join our team soon!    * EMT-Advanced is the next level certification and this adds other tools into a scope of practice. EMT-Advance providers are able to use skills like IV therapy and some pharmacology. Currently we have several EMT-Advanced providers who volunteer with us.   * EMT-Paramedics are the highest level of providers on the ambulance. Paramedics generally have to go to school for two years with over a thousand hours of clinical time required. Paramedic schools are hard to find and the education can be costly. Our most recent paramedics hired spent around $15,000 for the education. Paramedics provide Advanced Life Support (ALS), which includes ECG interpretation, drug administration, advanced airway skills, chest decompression among others. Boundary Ambulance Service (BAS) employs seven fulltime paramedics, including the chief, and two pro re nata (PRN, or "as needed") paramedics. This equals two paramedics 24/7, 365 days a year. Currently BAS has three shifts, each running 48 hours on and 96 hours off. Each shift has two paramedics assigned and these paramedics work alongside the EMT-Basic and EMT-Advanced volunteer providers. This works much like some fire departments, where you have paid and volunteer staff, or police departments with paid officers and reserve officers. Our volunteers are integral to our agency as they provide the “other half” of the ambulance crew. This brings us back to the question; why two paramedics per shift? This is the model that I, as the chief, have adopted, to try and keep ALS coverage in the county 24/7. We have a contract in place with Boundary County that specifies we will provide coverage to Boundary County at the ALS level. Currently we average around 30 interfacilty transfers from Boundary Community Hospital per month. This averages to one transfer per day. When an ALS transfer is requested, depending on the destination, this could take a paramedic out of our county for quite some time, usually no less than four hours. Because we have amazing volunteers who drive transfers and back-fill for coverage, we can staff that ambulance and send a paramedic out of the county and still have a paramedic covering. During bad weather when the helicopter isn’t flying, we could be handling multiple requests for transfers to other hospitals -- and some of these are time critical! Many days, I have covered while we had two ALS transfers at the same time. Since I am a paramedic before I am a chief, I can cover ambulances day or night if needed. Using our paramedics as wisely and efficiently as possible, each shift will soon have paramedics trained at the Critical Care Paramedic and Community Paramedic level, which is my goal by the end of 2017. Our ambulance service has some of the best and most dedicated volunteers of anywhere I have ever experienced. We are fortunate as well to have paramedics from all over with different diverse backgrounds and experiences. Together, side by side, we work to provide the best and highest level of pre-hospital care available. Anytime anyone from our community has questions about the way Boundary Ambulance operates, please ask me, I love to talk about our great service. I will make this one of many questions and answer type posts, so in return our community is better aware of how their ambulance service works for them.