Missouri EMS Connection - Service Spotlight articles

Written by Heather Scruton, Missouri EMS Connection Editorial Advisor
Photos provided by NSCAD

North Scott County Ambulance District (NSCAD) Chief Larry Chasteen is justifiably proud of his team. “We’ve been here since 1987, after an approved property tax provided funding. Our community approved a sales tax in 2020 to expand support for our services, which helped tremendously. We’re here to take care of that community,” said Chasteen.

NSCAD headquarters is located in Scott City, Mo., just south of Cape Girardeau. They provide 24/7 Advanced Life Support ambulance services for a district that covers the northern half of Scott County. They serve the towns of Scott City, Chaffee, Oran, Benton, Morley, New Hamburg, Commerce, Perkins, Kelso, Rockview, and others. In a county of 37,840 residents, the service covers approximately 17,000 of them.

Chief Chasteen reports transport times of 10-30 minutes, for calls including falls, traumas, mental health and overdoses, cardiac, respiratory issues, and more. He said, “We really run the gamut from minor calls to multi-casualty traumas, since we’re responding to residential calls, Interstate 55 accidents, Cape Girardeau airport, and a wide swath of Scott County. We also provide pediatric specialty transport in partnership with Cardinal Glennon in St. Louis.” NSCAD responds to pediatric calls over a multi-state area, including Illinois, Tennessee, Arkansas, and Missouri. The service offers multiple advanced procedures, and is trained for 12-lead application, interpretation and transmission, cardiac and other emergency medications, and respiratory support including intubations, ventilators, and bi-pap.

The service runs five ambulances, but has six including the Cardinal Glennon pediatric rig. They staff two paramedic/EMT or paramedic/paramedic teams 24 hours a day. NSCAD runs out of two stations and responds to more than 2,200 calls per year. It employs 16 full-time staff members, including 11 paramedics and five EMTs. Two paramedics are critical care trained. The team is also supported by two administrative coordinators. “Our administrative support team does a little bit of everything: billing, accounts receivable, board meetings, you name it,” said Chasteen. In addition to full-time staff, the service employs six PRN paramedics and eight PRN EMTs.

Staffing stability and longevity is a point of pride for Chief Chasteen. “We have pretty low turnover. One of our employees has been here over 40 years, a couple of us are 30 years in, and there are several over 20 years. We have in-house training and education and provide PALS and ACLS in the station. Geographically, we’re a good place to work. We have competitive pay and benefits and our run volume is manageable,” he said. Chasteen chuckles when reminded that employees have been shown to stay or leave a job because of their management. “I try to be an advocate for my team,” he said. “I’m fair. Pay is equitable. And people talk. I’d like to think I’m a good person to work for.”

The district supports continuing education for the team in a variety of ways. In addition to the in-house training and education, NSCAD supports career advancement through continuing education. The district provides tuition support for paramedic training with a three-year contract. Critical care physicians and nurses from Cardinal Glennon are actively involved in multi-disciplinary training. “I’m never going to discourage anyone from going back to school or getting more education. I support students of all disciplines. We definitely want to help everybody improve themselves,” remarks Chasteen.

North Scott County AD employees are actively involved with their community. Chasteen commented, “We love being a part of our community. We assist schools and health agencies with education and training. We attend health fairs and other events. We provide outreach education through CPR classes, ACLS/PALS for other healthcare providers and pre-prom teen classes. We will do stand-bys for community events. We pride ourselves on being involved with our county’s residents.”

To say Chief Chasteen is busy is an understatement. Scott County recently passed a 911 sales tax to help dispatch services. He has been integrally involved with implementing changes and improvements with dispatching capabilities. He serves on multiple regional and state committees including the Missouri Ambulance Association Board of Directors, chairman of the Scott County 911 Board of Directors, chairman of the Scott County Health Department Board of Directors, prior president of the Southeast Missouri Emergency Medical Services Network, and many other multi-disciplinary teams and committees across the region. He takes seriously the responsibility he carries to ensure safe, timely medical response to his state’s residents. Chasteen states, “I really try to stay involved in regional and state committees, but it does keep me busy.”

Chasteen entered EMT school in 1989. He became a paramedic in 1992. He joined North Scott County Ambulance District in 1991 and stepped into a leadership role in 1994. “My mom was a nurse, and I always admired what she did. I admired the paramedics and EMTs on the ambulances,” he explained. “When I decided to become an EMT, my wife was pregnant. I figured, well, at least I could learn how to deliver a baby! Learned how, but never had to do it.” Chasteen says that first response emergency care has been very challenging, but extremely rewarding. He encourages those considering the field to make sure it’s something they want to do, as it’s not an easy path. He said for the right candidates, EMS can be an exciting, rewarding career.

For information on NSCAD, check out https://northscottambulance.org.

To view the article as it appeared in the magazine, click here.

Written by Matt Cushman, Missouri EMS Connection Editorial Advisor
Photos provided by RFPD

Our service spotlight for this issue is the Raytown Fire Protection District (RFPD). It is a fire-based EMS operation that is located in the heart of Jackson County, Missouri. RFPD is their own political subdivision, independent of the municipal government, and operates under the direction of a three-member elected board of directors. The District services the entire city of Raytown, Mo., which is a first tier suburb of Kansas City, nestled between Kansas City and Independence. The District is a member of Mid-America Regional Council and the West Central (Region A) EMS Advisory Committee.

The City of Raytown is an increasingly diverse community with just over 30,000 residents living in approximately 10 square miles. A major state highway cuts through the city that is highly traveled by commuters from the suburbs into Kansas City.

A Rich History of Service

Since 1947, the city of Raytown has been protected and cared for by RFPD. Over those years, the mission has changed, and now the District oversees and operates the EMS system for the city. Spanning nine decades, Raytown Fire has evolved from a small volunteer service to full-time paid firefighters. In the early 70s, the District expanded the roles of the responders to include EMTs and later at the turn of the century, expanded to include enhanced services by becoming an EMRA agency with paramedics providing ALS care in advance of the municipal ambulance service. In 2018, after nearly a year of negotiating with city officials, the District assumed control of the EMS service and began a fully integrated fire-based EMS model.

Service Make-Up and Call Volume

RFPD operates under the direction of Chief Matt Mace. A paramedic himself, Chief Mace has a long history and experience in the EMS community. He started his career working for the municipal ambulance service in 1996. When the Fire District expanded their capacity to deliver ALS care, he began his career in the fire service where he soon advanced up the ranks through the prevention division and eventually into the chief’s office. From time to time, you can still find Chief Mace on the ambulance keeping his skills up to standard.

Four years ago, the service was charged with not only absorbing ambulance responsibilities, but the district had to create a plan to take to the citizens to fund it and to eventually hold the license to operate EMS. Those measures, including a property tax increase, overwhelmingly passed with the support of the community.

When the District assumed control of the ambulance service in 2018, Chief Mace and the Board of Directors needed an experienced administrator to shepherd the transition into this new frontier. Assistant Chief of EMS Ben Chlapek is an EMS icon in the Kansas City region. There was no better person to get the service through all of the growing pains of operating EMS.

Chief Chlapek has been a paramedic for over 40 years with experience as a flight paramedic, operations manager, EMS director, and firefighter having also earned the rank of deputy chief. Chief Chlapek serves on the Governor’s Advisory Council for EMS and has served on the Board of Directors of the National Association of Emergency Medical Technicians (NAEMT) as well as the National Volunteer Fire Council’s Emergency Rescue Committee. Additionally, Chief Chlapek is a veteran of the U.S. Army.

The Fire District is comprised of two staffed pumper crews and two ambulances called squads. The pumpers are ALS equipped and staffed and the ambulances are staffed with a minimum of one EMT and one paramedic. The squads are equipped with ESO reporting software and utilize the Lifepack 15 cardiac monitor. Additionally, the service enjoys the use of video laryngoscopes and ultrasound dopplers. Being a first-tier suburb of Kansas City, RFPD is about 10 minutes away from its closest level one trauma, stroke, and STEMI destinations.

RFPD is part of an Automatic Aid Agreement with the Kansas City Fire Department (KCFD). As part of that agreement, the District’s Fire and EMS operations are dispatched using KCFD’s Dispatch Center. They graciously provide and receive mutual aid from their Kansas City Fire partners. The ambulance is not included in the Automatic Aid aspect in order to maximize ambulance coverage for citizens based on the inherent intra-city call volume.

Through the years after the acquisition of the EMS service, RFPD has seen significantly increased calls. In 2018, the service had 3,800 EMS calls and in just four years, they are projecting 4,900 EMS calls or more. Since Raytown Fire is in the KC CAD System and have an automatic aid agreement, total calls for service are just over 8,300 with a portion of that number representing requests for service in Kansas City. From the fire operations side of things, they stay very busy assisting Kansas City. Often, they are the closest resources to some areas in the southeastern Kansas City area.

Several EMS education programs are using Raytown Fire and their crews for clinical sites allowing staff to precept their students. Megan Thurston, assistant director of education at Central Jackson County Fire Protection District speaks to the importance of sending students to Raytown Fire. She said, “We are so fortunate to have them as a clinical partner.  Raytown Fire sees the value in teaching the next generation of EMS providers and welcomes our EMT and paramedic students. Their high call volume gives the students a lot of opportunities to gain experience and their providers go out of their way to help the students learn.”

Station Life

There are three stations used for operations. Assimilating into the KCFD CAD, RFPD stations follow their numbering and unit numbers. Station 51 is the location of Squad 51 (which for older paramedics and EMTs is pretty cool if you have watched EMERGENCY), and Pumper 51 as well as the chief officers, fire marshal, and assistant fire marshal. Station 52 houses Squad 52 and Pumper 52. Station 53 is the former municipal ambulance service’s base, and is now used for training, storage, and the Raytown Fire HELPS MIH-Community Paramedic operations. Each station has individual living quarters, quality kitchens, and state of the art fitness centers. The crew life at Raytown is attractive for most. “I’ve come to realize, again, the camaraderie between crews is the most important aspect of this job. The people you spend so many days together in a month are really what makes this job great. Everything else that comes along are additional bonuses. I’ve learned so much from different levels of experience here and hope that I can continue that for others in the future,” says Brandon S, NRP, who recently came to Raytown Fire from a private EMS agency.

Focus on Quality Care and Service

The service has many mechanisms in place to create quality in the care of their patients. Through the Quality Improvement (QI) process, the District looks to not only ensure protocol compliance, but also create exceptional patient care and customer service. The district takes a unique approach to this concept by outsourcing the process to an independent contractor. The person responsible for this robust process provides crews with over 30 years of professional EMS experience and expertise in quality management and similar oversight functions.

Community Involvement, Taking the Prevention Model a Step Further

RFPD has long been involved on many fronts to assist the community’s needs. Through prevention programs in the schools, to the standard inspections and smoke detectors given away, the District does all it can to reduce the loss and harm of fires. The District also offers robust opportunities for children to learn fire safety with a Prevention Program lead by Captain Ferguson, FF/EMT.

In 2021 after seeing a significant need within the community, RFPD started a Mobile Integrated Health program and employed its first community paramedic. The program, called Raytown Fire HELPS, is a comprehensive program designed to look at all aspects of the community’s health and safety needs. The community paramedic assists in care coordination and case management, assists with medication compliance, connects people to valuable and necessary resources, performs home safety checks and fall risk assessments, disease mitigation and risk management, post discharge education and coordination, and works closely with police and mental health professionals as a certified CIT trained paramedic. The degree to which the community paramedic has helped those suffering with mental health and substance abuse problems in Raytown is remarkable.

The urgency is now for services that are trying to figure out the best approach to current trends in the area of mental health and substance use. Chief Chlapek reports, “We run twice as many behavioral health calls and more overdose calls than we did when we first started.” Thinking outside the box with these types of calls creates opportunities to reduce the burden on EMS, reduce congestion in the emergency departments, and create better outcomes.

Medical Direction

When Chief Mace and the Fire District assumed control of the ambulance district, they already had a professional working relationship with Dr. Tucker Lienhop, DO, at Research Medical Center. Before the transition, the Fire District and the municipal ambulance service had an existing EMRA agreement that stipulated they both used the same protocols and medical direction. “It was natural to just continue that relationship,” Chief Mace said, understanding that the need to have medical direction from the closest level one trauma center and TCD hospital would be one more way to naturally create a solid working relationship. “It is important for the medical director to see our crews in the emergency department setting,” said Chief Mace.

Future Challenges

Like all EMS and fire agencies today, the post COVID-era has taken a toll and staffing tops the list of concerns most managers and chiefs face. Raytown Fire certainly has felt the continued struggle to find paramedics. Chief Chlapek says that in addition to the standard lack of paramedics and dispatchers the industry is facing, “Educating the public so the community understands when to call an ambulance is an ongoing challenge. Additionally, there needs to be a serious talk about reimbursement from the insurance companies and the government.” Chief Chlapek also sites the NAEMT position paper on the importance of EMS as an “Essential Public Function” as a necessary starting point. The fire and EMS industry is at a significant crossroads in many ways, and it seems that the challenges in the next several years will continue to grow. These include the difficult times in getting even the basic supplies that all agencies need, like medications, but even more alarming is the difficulty in getting truck chassis making an ambulance purchase difficult to plan because of the wait time.

Through all of the concerns and roadblocks, through pandemics and staffing shortages, the mission of the RFPD has not changed. It is simply to help those in need. The service has gone on the offensive to attract quality providers and are doing things that a lot of other fire-based systems have not done. The first is that starting this winter, RFPD is hiring part-time staff to offset full-time shortages and coverage gaps that are not able to be filled by overtime. The second is to significantly increase paramedic pay. Third, the District has been successful with hiring non-firefighter certified paramedics and putting them through an internal Fire Academy. Crissi C. NRP, said that she was attracted to Raytown Fire because “it is a place that offered to put me through the fire academy and give me the opportunity to expand my knowledge and skills and give me future opportunities for advancement.”

For information on RFPD, check out www.raytownfire.com.

To view the article as it appeared in the magazine, click here.

Written by Janet Taylor, Missouri EMS Connection Editorial Advisor
Photos provided by GVMH EMS

Our service spotlight for this issue is Golden Valley Memorial Healthcare (GVMH) EMS. It is a hospital-based service that is centrally located in Henry County, which is an hour southeast of the Kansas City metro area. Henry County covers 697 square miles of land and 35 square miles of Truman Lake with a population of 22,000. The GVMH EMS provides emergent and non-emergent transport.

History

GVMH opened in 1972. At that time, ambulance services were provided by a volunteer-based service. Prior to that, the local funeral directors were responsible for transporting the sick and injured to the GVMH emergency room. In 1975, GVMH took over operations of EMS services for Henry County with one ambulance provided by the state and staffed by emergency department RNs and EMTs. Since that time, the need for EMS has steadily grown and GVMH has met the demand with four additional ambulances and an operations vehicle. GVMH EMS is supported by several volunteer fire departments and one full-time fire department. Two of these departments operate under the same medical direction allowing for more uniformity in protocols and quality assurance.

Staffing and Call Volume

GVMH EMS receives an average of more than 4,000 requests a year and runs an average of 3,200 transports. They are staffed with 30 team members including an EMS director, medical director, and three operations supervisors. GVMH EMS operates out of one building centrally located in Clinton, the county seat of Henry County. The new EMS station officially opened in October of last year. The new station includes an ambulance garage and living quarters for on-duty EMS employees.

“We are excited to have this new space available for our EMS team,” said Lynnette Hayes, Chief Nursing Officer at GVMH. “This gives employees a place to recuperate and will help speed our response time for emergencies.”

Quality Improvement

Quality improvement and protocol review occurs every month with the EMS director, medical director, operations supervisors, and local first responders attending. Local fire personnel and EMS staff are encouraged to attend to gain CEU for protocol review. Charts are reviewed to see trends in care and sections of the current protocols are reviewed and updated throughout the year to make sure everything is up-to-date with current best practices. GVMH EMS considers itself lucky to have support from the Clinton Fire Department, as well as the local volunteer fire and rescue departments in the outlying areas.

Community Service

GVMH EMS works with the local fire and rescue departments in providing education and training to its members. Every year, the “Olde Glory Days” festival is held on the square in downtown Clinton, Mo. in July and the GVMH EMS provides a first aid/hydration station, as well as offering compressions only CPR training to participants. The team also works with the local vocational school and junior high/high school in offering the Stop the Bleed program that teaches the public how to control bleeding and to help save the life of someone with uncontrolled bleeding.

Unique Features

GVMH just received its Level 3 Stroke Designation for the state in July 2022. GVMH EMS uses NIHSS stroke scale to assess patients who may be having a stroke and can now provide definitive patient care quicker with GVMH being located so close.

GVMH also set a goal of increasing sepsis recognition and treatment and included EMS in the plan. As of July 1, 2022, GVMH EMS completed its sepsis training and is currently working with the emergency department to increase sepsis recognition and decrease the time from recognition to intervention by drawing blood cultures and hanging antibiotics in the field. This process has proven results in decreasing mortality in other EMS systems across the nation and GVMH EMS is proud to be one of the few in the state with such progressive protocols.

GVMH EMS is also pleased with the relationship it shares with local EMT and paramedic programs that utilize GVMH and its EMS as a preceptor location to accomplish their clinical and ambulance competencies. GVMH EMS can provide these students with the experience and opportunity to practice their skills in a rural environment.

With the current state of healthcare and the struggles every agency is having with staffing, GVMH EMS is elated that staff turnover has remained low and that the department is more than 90% staffed. GVMH EMS believes that this is possible because of the family-like atmosphere that they have worked hard to create. “We cook meals together, babysit each other’s kids, we laugh, and we cry together,” said one GVMH EMS crew member. “You do not get that at every EMS agency.”

If you would like to learn more about GVMH EMS, visit www.gvmh.org/service/emergency-services.

To view the article as it appeared in the magazine, click here.

Written by Dean Meenach, Missouri EMS Connection Editorial Advisor
Photos provided by MFPD

Mehlville Fire Protection District (MFPD) is an advanced life support (ALS) stand-alone fire protection and ambulance service located in south St. Louis County, Mo. MFPD is considered a political subdivision that provides fire, rescue, emergency medical, fire prevention, and inspection services for the cities of Sunset Hills, Green Park, Lakeshire, the townships of Oakville, Mattese, Concord Village, Sappington, and portions of the township of Lemay and unincorporated St. Louis County. Founded in 1953, Mehlville Fire Protection District (ISO 3 Rating) is a 100% career department that now protects a resident population of 110,000 and a daytime population of more than 130,000.

In 2021, the Mehlville Fire Protection District responded to more than 17,000 requests for service. Of those, approximately 90% were EMS related calls.  The district serves three area hospitals, including Mercy Hospital South, Kindred Hospital at Mercy South, and the Jefferson Barracks VA Medical Center. Additionally, the District covers nearly 22 miles of riverfront including the Meramec and Mississippi Rivers, several St. Louis County Parks, and the Jefferson Barracks National Cemetery. Over the last decade, the district has seen a consistent 5-7% increase in annual EMS volume with that trend expected to continue in the coming years.

To meet the growing needs of the community, MFPD deploys a wide array of service equipment from its seven engine houses expertly implemented by 125 full-time firefighters/EMTs, firefighters/paramedics, critical care paramedics, and community paramedics. The District presently operates the following equipment 24 hours per day, 7 days per week:

• 5 Dual Critical Care Paramedic Staffed Ambulances
• 7 Paramedic Staffed, ALS Equipped Engine/Ladder companies
• 1 Paramedic Staffed, ALS Equipped Heavy Rescue
• 1 Deputy Chief (Fire Supervisor)
• 1 Assistant Chief of EMS
• 1 Battalion Chief (EMS Supervisor)
• 1 EMS Administrator
• 1 Battalion Chief of Mobile Integrated Healthcare (MIH)
• 2 Community Paramedic units

The District also staffs two ambulances on rotating 12-hour schedules seven days per week staffed with critical care paramedics.

Organizational Mission and Values: A Culture of Commitment to Service

Mission Statement: Mehlville Fire Protection District is committed to ensure the community will receive the highest level of life and property protection through quick, professional, and efficient responses dedicated to the best possible outcome.

Vision Statement: Mehlville Fire Protection District is focused on providing professional, progressive, and efficient emergency services. We are recognized by our leaders, peers, and the community for excellence in delivering the best service in a fiscally responsible manner.

Assistant Chief of EMS Todd Besancenez reflects on the evolution of the district he has witnessed over his 27 years of service. He said, “The District has seen the writing on the wall. Originally started as a fire protection district, our role has evolved considerably over the last several decades. We find ourselves today as an EMS driven fire department and are actively adapting to meet the needs of our community without sacrificing any of the commitments made previously to residents with regards to fire suppression, rescue response, or hazardous materials mitigation.”

The leadership team is “proud of the employees who make the system work every day.  We are a busy department with high expectations for our staff.  Our frontline professionals have embraced many changes in our rapidly evolving environment and deliver superior service every single day. As a department we are growing and looking to add equipment now and in the future.  We are employee-driven and committed to providing the highest possible level of service to our residents,” explained Besancenez.

The frontline staff are highly engaged and collaborate with the board of directors to create solutions to serve the community. “The board is very committed to implementing processes and decisions that are transparent and demonstrate that we are sound financial stewards of the taxpayers,” stated Board of Director and Treasurer Dr. Bonnie Stegman. Demonstrating the board of directors’ fervent pledge to financial accountability and organizational process improvement, the district budget reflects fiscal awareness of the District’s services and costs.

“We have a scheduled equipment replacement plan and a fleet replacement strategy, which is part of our annual capital fund budget,” said Dr. Stegman. The District is always researching better and more economically responsible ways to serve the residents and conserve the resources their taxes provide for service. For example, the board of directors utilizes a “just-in-time asset management strategy, which uses proactive Total Cost of Ownership (TCO) analysis to decide when it makes sense to replace equipment versus a reactive run-to-fail strategy,” explained Dr. Stegman. Multiple studies show how a just-in-time asset management strategy can save you time and money over the long haul. The District is also persistent in exploring ways to increase reimbursement from the Centers for Medicare and Medicaid Services (CMS) and private insurance companies, while ensuring they address the rising costs of service.

The District’s vision and commitment to service was recently recognized by those they serve and by fellow EMS professionals. They have received numerous awards related to incident response in recent years. In 2021, MFPD paramedics received two of the five East Central Regional Lifesaving Awards for complex or unique cases wherein timely, exceptional EMS care saved the lives of a district resident. Additionally, “Our crews were recognized by the St. Louis County Fire Chiefs Association for their efforts related to the successful resuscitation of a young child who was removed from a residential fire,” reported Besancenez.

Serving the Community: More than Just Responding to Emergencies

The leadership team’s philosophy toward serving the community is a multifaceted approach that includes a critical appraisal of the community’s needs, establishing an atmosphere of shared accountability and teamwork, providing structure to achieve sustainable change, and collaborating with other public service entities and healthcare partners to meet those needs.

“Mehlville Fire Protection District is the only Fire District in the St. Louis Region to employ single role, critical care paramedics to staff ambulances.  This has allowed us to enhance what was an already high performing EMS system.  The District takes an all-hazards approach to everything we do, and has taken a similar approach to EMS responses.  We provide a complete system including 911 responses with critical care trained paramedics and a mobile health division with Community Paramedics.  Furthermore, Mehlville Fire is an active participant in the ET3 pilot project through CMS,” reported Adam Hagar, a 14-year EMS veteran and Battalion Chief of EMS.

MFPD offers several different community-focused programs that include first aid and Cardiopulmonary Resuscitation (CPR) classes, health fairs, and specialty education for civic groups, businesses, and churches just to list a few. The District also implements STOP the Bleed programs with school districts and law enforcement agencies.

The District is an active participant in the Cardiac Arrest Registry to Enhance Survival (CARES) registry and tracks dozens of metrics related to quality assurance and quality improvement. By comparing the system’s performance to established national benchmarks, the District is able to ensure they are actively providing a high-quality service to district residents.

In addition, MFPD is one of the few fire districts in Missouri to engage in a Special Needs Tracking and Awareness Response System (STARS). This is a progressive patient-focused program that RTAD facilitates in collaboration with its healthcare partner SSM Health Cardinal Glennon Children’s Hospital. The program is designed to identify children with special needs within the community and provide specialized resources and training so prehospital professionals are best prepared and equipped to meet the unique needs of their star patients. “This incredible program has helped so many of our community children,” reported Besancenez.

Mehlville’s Community Paramedic Service: Mehlville Mobile Health (MMH)

After evaluating the district’s needs assessment, MFPD identified an immediate and overwhelming need in the community. Instead of trialing a mobile integrated healthcare (MIH) pilot program, MMH engaged the community with an aggressive high utilization program. Mehlville Mobile Health evaluated their first patient at the end of March 2018. 

Next, in 2019, MMH participated in a pilot program with an insurance company enrolling their high-cost clients who live in the district. The pilot lasted for a year and the district’s data contributed to the proof the insurance company needed to prove the MIH program does indeed reduce costs for insurers. 

“We learned during the pilot program that all patients may not always have high utilization. We found that some of our patients on the list had one procedure that flagged them as a high-cost client. We also learned it is very important to get all data and information on all patients or clients so we can target the ones for which we can demonstrate cost savings. This has resulted in the district currently talking to other insurance payors about starting pilot programs,” explained Besancenez.

MMH has evaluated or enrolled more than 200 patients from the start of their program to early 2021. In 2020 to early 2022, the pandemic changed the role of MMH. MMH started focusing on how they could help with COVID. MMH turned the focus on deploying a COVID Unit, which was made up of a Community Paramedic and a Critical Care Paramedic. They allowed people in the community who were showing symptoms of COVID-19 to call in and make an appointment for their COVID Unit to come evaluate them in their home. The COVID Unit team provided education and care while avoiding transport and potential exposure at the emergency department (ED). During 2020-2022 MMH vaccinated more than 5,000 people in their clinic and more than 180 homebound residences in the community. MMH also provided First Responder COVID testing for all of St. Louis County and performed more than 3,500 tests.

In addition, MMH continues to serve patients by helping them manage their hypertension, asthma, diabetes, COPD, anxiety, depression, and dementia to list a few. MMH continues to connect patients with different resources like Meals on Wheels for Seniors, physical therapy, social workers, transportation, primary care, and medical equipment. 

MMH has not only been successful in helping patients navigate through the complex healthcare landscape but has also demonstrated economic and clinical value to its community as evidenced by an 80% reduction in 911 calls, a 68% reduction in 911 transports, and an 85% reduction in high utilizer transports.

Training and Education: A Key to Sustaining Quality Outcomes

MFPD dedicated its new EMS training facility in May 2019 in honor of Dr. Christopher Bosche, the District’s late medical director who in the eyes of the District, contributed more to the fire district than anyone else in recent memory. Dr. Bosche died Sept. 12, 2017, after a three-year battle with cancer, which was the result of his exposure as a Ground Zero responder after the 9/11 attacks in New York City. Dr. Bosche had served as medical director of the fire district since mid-2008. On July 26, 2017, the fire board unanimously adopted a resolution to rename the district’s EMS training facility the Dr. Christopher J. Bosche EMS Training Center.

Adam Hagar explains the consistent focus of quality training at MFPD. He said, “The District hosts monthly training from the District’s Medical Director on a variety of topics under a ‘just in time’ model.  Also, MFPD hosts regular training in partnership with hospital stakeholders, as well as local, regional, and nationally recognized subject matter experts in a variety of areas.”

The District’s critical care paramedics perform several uncommon and advanced interventions.  These include the use of Rapid Sequence Induction for airway management, video laryngoscopes, point of care ultrasound to improve cardiac arrest care, infusion pumps for vasopressors, vasodilators, and various other infusions, mechanical ventilators for intubated patients as well as BiPAP for patients requiring noninvasive respiratory support, and an optimized cardiac arrest resuscitation model that is sometimes referred to as Pit Crew CPR.

All of the District’s paramedics hold certifications in BLS, ACLS, PALS, and PHTLS. 

The District continues to mentor the next generation of EMS professionals. MFPD has partnered with Total Access Urgent Care’s EMT program and the Christian Hospital EMS Academy for paramedic students.  Each year, many students gain field experience with Mehlville’s paramedics, resulting in hundreds of hours of field internship experience.  Additionally, the District has hosted an EMS fellow from Washington University School of Medicine for several consecutive years, and regularly hosts EMS fellows and Emergency Medicine residents in both the 911 division as well as MMH.  They also host newly hired ED registered nurses from Mercy Hospital South who ride along during their orientation.

The Future of Service at Mehlville Fire Protection District

The world of EMS is rapidly changing as it attempts to fulfill the needs of complex and diverse communities. To be successful, EMS must effectively respond to an increasingly uncertain climate of healthcare reform and policy resulting in an evolving complex healthcare landscape. Most agree that EMS currently functions as an entangled mesh of clinical, operational, economical, regulatory, and managerial variables.

The MFPD leadership team, board of directors, medical director, prehospital clinicians, healthcare stakeholders, and community partners are challenged with considering these obstacles and creating a vision of a patient-focused, evidenced-based EMS system. Their critical care clinicians and MMH team will lead the way toward solutions that are data and value-driven, fully integrated, and visionary. MFPD’s cultural and organizational change will make them more capable to effectively respond to the future trends, technological changes, and financial uncertainties, while synergistically providing opportunities to improve performance, productivity, outcomes, and sustainability. No matter what future challenges face the Mehlville Fire Protection District community, the district’s caring philosophy and culture of collaboration will rise to the challenge and fulfill their mission to their community.

To learn more about Mehlville Fire Protection District, please visit www.mehlvillefire.com or call 314-894-0420.

Written by Mary Napier, Editor, Missouri EMS Connection
Photos provided by MCAD

Mercer County Ambulance District (MCAD) is located in Princeton, Missouri at the junction of US Highway 65 and US Highway 136 in the northcentral portion of Missouri. The county seat is Princeton. While learning more about this ambulance district, I came up with a few words that are embodied by MCAD, including: service, longevity, community, and Calamity Jane. You will have to read on if you want to know more about that last one.

Service

MCAD provides advanced life support service to Mercer County. The county started running an ambulance service in the 1970s. A petition to create the district was brought forth Aug. 16, 1982, and the district was voted in and formed April 12, 1983.

These days, the service transports about 800-900 patients a year while providing lift assists, treat and release, or standbys for another 300-400 per year. Mercer County Fire Protection District also responds with MCAD on accidents and rescues.

The ambulance district has one station located in Princeton, which includes a business office, crew quarters, and a training area. The crew consists of six full-time paramedics, one part-time paramedic/RN, two part-time RNs, and two part-time EMTs. Responses are handled with three first out units and two others as backup. The first three are E450 large box modules, a 2019 and two 2021 units. The backups are a four-wheel drive F series and an older E450 Road Rescue, they can pull up when a first out is down for maintenance or repairs. According to Director Doug Priest, they have a lot of deer in the area, so backup units are important.

The crew members hold certifications such as ACLS, PALS, PHTLS, AMLS, and Critical Care Paramedic/Community Paramedic. Protocols for the service include: adult and pediatric RSI, facilitated airway management, COVID home and transport advanced care, sepsis, adult I/O, 12 lead, Time Critical STEMI Stroke, tranexamic acid (TXA) severe hemorrhage, and AMI protocols include prehospital Berlinta or Plavix, Heprin bolus/drip, Metoprolol, and Nitro gtt. The crews are supported by Medical Director Dr. Tammy Hart.

Director Priest explained, “We staff two crews with two ALS providers as much as we can. We are a long way to the closest hospital. Everything isn’t cut and dry, so having an advanced level partner to confirm something with really helps. Dr. Tammy Hart has done a great job!”

Longevity

The population of Mercer County is about 3,600 people making it the second-least populated county in Missouri. While the population number might be lower than most other ambulance districts, the longevity and experience of the crew at MCAD is impressive. The crew members include: Shane Grooms, paramedic since 1993; Doug DeVore, paramedic since 1998; Gary Porter, paramedic since 2003; Shaun DeVore, paramedic since 2008; Dakota Thompson, paramedic since 2012; and Doug Priest, paramedic since 1992. If you do the math, that is a total of 126 years of experience as paramedics (not counting EMS experience before they became paramedics).

When the pandemic hit, MCAD realized quickly that this is the situation they were dealt, and they had to take it on. They now provide clinical guidelines symptoms and response, home care instruction, response with home treatment, and transport/treatment.

Since the pandemic started, all crew members have stayed on and helped. Priest mentioned that DeVore has been in EMS since 1981 and was going to retire in March 2020. He postponed his retirement and stayed to work through the pandemic as long as he could. He finally retired in February 2022. This dedication is shared among the crew members.

Community

When you talk about a tight-knit community like Mercer County, the community really supports the service and appreciates all they do.

In the community, MCAD teaches CPR and first aid, provides standby at sporting events, and puts on mock accidents. They also encourage EMS and the healthcare field with ride-along opportunities for seniors. Their training entity provides CEUs, EMT, and first responder classes.

The six-member board of the ambulance district is also very active with MCAD and provides a wide diversity of perspectives and assistance, including: business management, professional purchasing, CPA, farming, and equipment operations. Director Priest said, “They all have used the ambulance for themselves and/or family members, and they are our biggest supporters. They come together to help me solve problems and provide lasting financial security for our district.”

Calamity Jane

You might still be wondering what Calamity Jane has to do with Mercer County. Well, Calamity Jane was born, Martha Jane Canary, on May 1, 1852 in Princeton, Missouri. She was a well-known American frontierswoman and sharpshooter who preferred men’s clothing to dresses. Throughout her life, she moved all over the United States, worked a variety of jobs, and was known to spread salacious rumors about herself. She rode with real cowboys like General Custer, Wild Bill Hickok, and Buffalo Bill Cody. She also appeared in Buffalo Bill’s Wild West show as a storyteller.

While Calamity Jane was tough as nails, she had something in common with the crew members of MCAD. She never hesitated to help others or nurse them back to health especially during a smallpox epidemic in Deadwood, South Dakota. It was said that she was always open to helping others no matter their circumstances.

Every September, the community members of Princeton and Mercer County celebrate Calamity Jane, one of the most notorious figures of the Old West, with great food, a parade, vendors, the shootout gang, a melodrama, and a golf tournament. This celebration comes just a few weeks after Mercer’s Homecoming, which is their Labor Day weekend parade, races, music, and more.

Along with these community events, the area offers experiences for its residents and visitors. The Stacy Center offers year-round indoor swimming, gym, weightlifting, and exercising. The great outdoors offer conservation areas, lakes, hiking, camping, and hunting. One such area is the Lake Paho Conservation Area in central Mercer County. The lake was built in the late 1940s and was opened to public fishing in 1951. The 273-acre lake was named “Paho” from the Indian word meaning “first” or “number one” as the area is rich in Native American history. The many prairie plants around the area are enjoyed by its visitors along with its other attractions.

For hunting, hunters visit the area for spring and fall turkey hunting, archery deer, and turkey. The large Missouri deer make fall rifle deer season a favorite time of the year.

Whether you want to hunt, explore the great outdoors, visit Calamity Jane’s birthplace, or stop and meet some of the long-standing crew members of MCAD, Mercer County is a great place to visit the next time you are in northcentral Missouri.

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