August 8, 1980
As it nears its first anniversary, the rural Advanced Life Support System offered by the Door County Ambulance Service is still the only formal rurally trained paramedic program in the nation.
Dr. John Herlache, an initiator of the paramedic service, noted that you “can’t say how many people got better quicker” since the paramedic service began in Door County last September 1, but the number of people who received advanced life support since then “indicates there’s been as obvious need in the past…”
Apparently, the need has been greater than anticipated, despite a relatively mild year in terms of ambulance calls in the county.
Joseph Mango, director of the Door County Ambulance Service and one of its full-time paramedics, said it had been estimated that 16 to 18 percent of the total calls for ambulance assistance in the county would require paramedic service. Instead, records show a 25 to 26 percent paramedic response.
The north and south squads of the ambulance service, based in Sister Bay and Sturgeon Bay, averaged from 120 to 130 calls per month during 1979, but so far they have averaged only about 100 calls per month this year.
Since January 1, there have been 150 calls which required paramedic response for such cases as cardiac distress, cardiac arrests, cardiac arrhythmia, comas, internal bleeding problems, heat stroke, liver failures, cancer, and different medical emergencies.
As Herlache put it, “Rural patients need that care” as shown by the significant volume of calls for advanced life support, about one every day. “If it’s me, it’s significant,” Herlache said.
Herlache noted that in Wisconsin, others have applied for rural paramedic status but have not formally trained and have not completed the Department of Transportation-approved curriculum.
Mango and Herlache developed their plan for advanced life support, meeting with county and community support. The plan to provide aid to cardiac arrest patients in all points of Door County was aided with $32,000 funding provided by the Regional Emergency Medical Services Council (EMS) with strong support from the state Division of Health.
With the funding and approval by the state of Wisconsin and Door County Memorial Hospital as a training center, 10 persons certified as emergency medical technicians (EMTs) began training in a 71-hour course allowing them to perform cardio-pulmonary resuscitation, extrication, and splinting.
Twelve staff physicians from Sturgeon Bay provided classroom instruction. The clinical experience came from instructors Ceci Steed and Mark Fink, both registered nurses.
That support offered by the local medical group was one of the biggest assets of the program, according to Mango, and “something you don’t really find in many places.”
He said working directly with the doctors and getting to know them personally has been a strong point in the paramedic response. “The doctor knows what an individual can do, and he can adjust his orders accordingly,” Mango said. “The doctor has confidence in you.”
The doctors have continued to volunteer their services in monthly topic-oriented, in-service training sessions in different areas. “We have an unwritten policy with the hospital personnel that the techniques will be worked on whenever we feel there’s not enough exposure in the field,” Mango said.
The training sessions are part of a continuing education requirement required by the state for the paramedics.
The paramedics are also doing some training of their own, going out into the community to teach cardio-pulmonary-resuscitation (CPR) techniques. Those efforts have paid off both in creating public exposure for the paramedic program and instructing the general public, Mango noted.
Another education effort is designed to better educate firefighters teams in the Door County area. Called the First Responder Program, its goal is to teach those persons who first respond to emergency situations how to stabilize cardiac and trauma patients and decrease the response time of the paramedics, according to Herlache. It is expected that most of the First Responder training will be carried on through Northeast Wisconsin Technical Institute.
He said the response time from the paramedic base at the police department in Sturgeon Bay to point outside the city limits is about nine minutes, while the response time for the crew in Sister Bay to outlying areas is about 12 minutes.
Of the original 11 paramedics trained at Door County Memorial Hospital, nine are still in active service with the paramedic team. One of the paramedics left to join the Ashwaubenon Public Safety Department and another one has joined the Sturgeon Bay police force. Two replacements have been made, one of whom will probably go to Milwaukee to finalize his training. No more paramedic courses are scheduled at this time.
In the spring, the EMS Council and other contributors provided $54,000 in grant money for the purchase of new communications equipment which has not yet arrived. The UHF Communications System will be tied into the one used in Brown County and will provide a better range and more reliability between the paramedic unit, the monitoring physician, and the hospital.
Herlache said the paramedic program is most costly in its training phase. The ambulance units require a costly cardiac monitor, but otherwise, their equipment has mostly renewable items. Vehicles average $30,000 to $35,000.
Mango praised the Door County government for providing money to help with the training of the paramedics and to cover the costs of hiring backup persons to cover the ambulance service while the other EMTs were training.
“It’s been a very interesting year,” Mango said of the infant paramedic service. “We feel that what we’ve tried to accomplish has pretty much come to be.”