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Emergency Medical Services in southeast: neighbor helping neighbor: mostly volunteer squads of first responders meet panhandle challenges.

The town of Pelican on the northeast corner of Chichagof Island spans only about a mile and a half end-to-end--mostly along a raised boardwalk that serves as the Main Street of the town. Residents don't have cars; their preferred method of motor transport is by four-wheeler. With a population of about one hundred year-round, everybody knows everybody else.

So it wasn't unusual that Allen Stewart, riding his four-wheeler down the boardwalk one day some years back, would see a friend riding the other way on his four-wheeler. Then, the friend unexpectedly stopped his ATV. He had suffered a heart attack. But the friend was very lucky.

Stewart, an EMT 2, is the leader of a small group of volunteers who are called upon to be the first responders in times of medical emergency. He and a few others were on the scene immediately and quickly moved the still-breathing man to their tiny clinic building located in the center of town. Although there was no resident health provider in Pelican at the time, Stewart and other responders were able to use the clinic's equipment. Then, the man's heart stopped and he stopped breathing. But Stewart and the others were able to restart his heart with defibrillator paddles and stabilize him.

A US Coast Guard helicopter was summoned and arrived about two hours later. The man was flown to Mt. Edgecumbe hospital in Sitka. He was gone from Pelican for a few months. And then Stewart felt satisfaction one day when he saw the man astride his four-wheeler again, riding down the boardwalk.

"When he came back to town we were glad to see him," says the plain-talking Stewart. "We know we've done the best we can when we get them out of here breathing. And if they come back, great."

Stewart is a prime example of the first responders who comprise the Emergency Medical Services (EMS) squads in small towns and villages up and down the Southeast Panhandle. Stewart's day job is directing the City of Pelican Public Works Department. He says the city is very supportive of his role as a responder, letting him take the time he needs when emergencies arise.

Another EMS call Stewart answered circa 2000 couldn't have been closer to home. Stewart was having lunch when a call came in that a fishing boat had run aground nearby. He and a few other responders were halfway to the scene when Stewart realized it was his family's boat that had had the accident. His daughter had fractured her skull. He rode with her in the US Coast Guard helicopter to Sitka, where she was stabilized. By midnight, she was being treated in a trauma unit at a Seattle hospital. She recovered fully and, recently, graduated from college.

Stewart moved to Pelican in 1986 and has been head of the EMS squad since 1995. Telling the story of his daughter's close call elicited a comment.

"Family is the reason I got into EMS," he says. "Too many times there was no medical out here. So, I thought, well, somebody's got to do it."

Neighbor Helping Neighbor

Bobbi Leichty sees her job as making sure seeing that people such as Stewart have the equipment and training to do their jobs. Leichty is the executive director of Southeast Region Emergency Medical Services (SEREMS), one of seven regional EMS organizations in Alaska.

"SEREMS works to make sure they are trained and equipped and have plans and to understand the management of small volunteer services," Leichty says. "If they respond to a resident or visitor in need--and stabilize the person--then they have to figure out a way to get them, for example, from Elfin Cove to Sitka."

Southeast Alaska is a one-thousand-mile long maze of islands and bays. While temperatures in Southeast are mild, by Interior Alaska standards, the weather is by no means unchallenging. Autumn gales may make a village unreachable by air for two or three days. Roadless wilderness starts at the edge of town. Due to the constant rain and nearby ocean, hypothermia is a threat twelve months of the year.

EMTs might have to double as wilderness searchers, and first responders may sometimes have only the equipment they can haul up by hand.

"It's a very intricate network of being able to take a sick person from a small, remote place and get them into what we call definitive care," Leichty says. "It's like a spider web--you have to be sure that this point contacts to that point. The network that we have designed doesn't fit the national design for best care. If you are in Seattle you are trained for 'seven minutes to the scene, seven minutes on scene, and seven minutes to the hospital.' Unfortunately, that model doesn't fit here."

The protocol is to do what is necessary to get the patient to the next higher level of care. That may involve being in the care of several groups.

"You have to call for local help and then Search and Rescue comes and gets you," she says. "You may be taken back by the first responder to a village that has a health aide. From there you are assessed and handed off to a small fixed wing that can get you into a regional hub. And then you may take a medevac flight to a trauma center in Seattle or Anchorage."

SEREMS was started in the 1970s by two doctors, the late Dr. George Longen-baugh of Sitka and Dr. Michael Copass of Seattle. Leichty says the two doctors met when Copass came to Sitka to teach a class in advanced trauma life support. While the physicians were there, three children who had been badly burned in a village house fire were flown into Sitka. All three children died. The two doctors surmised that the children might have had a better chance of survival if there had been a better response before they were brought to the hospital. SEREMS was the result of their concerns.

Today, Copass still helps guide the organization, Leichty says. SEREMS is now advised by Dr. David Carlbom of Seattle's Harborview Hospital and Medic One program. Dr. Rodney Vaught of Washington also works with SEREMS, as well as volunteering in several places in Southeast, where he used to live.

The Alaska Marine Safety Education Association, also based in Sitka, received crucial support from SEREMS in its earliest years, says executive director Jerry Dzugan. The Alaska Marine Safety Education Association is now a now a model for other marine groups around the United States and even worldwide. Alaska Marine Safety Education Association trainers teach classes or give talks in in the majority of US coastal states and in ten foreign countries.

Among other activities, the Alaska Marine Safety Education Association conducts a mariner's first aid course for commercial fishermen and recreational boaters. They also conduct more advanced marine/wilderness EMS classes.

"The situation that a boater or a fisherman faces is more of a wilderness environment context than a first responder in the community," Dzugan says. "So we use a lot of wilderness protocols."

Volunteer Challenges

The Juneau Fire Department has 42 paid employees covering five separate fire stations, along with volunteers. The Ketchikan Fire Department has 18 career staff and volunteers in the city, with largely volunteer squads located at two fire stations both north and south of town. Sitka has 9.5 paid positions and 105 volunteers working out of one fire house in the center of town. Wrangell has only 1 full time and 1 part time professional staffer and 67 active and reserve volunteers: The smaller the community, the larger its reliance on volunteers.

The volunteers are for the most part uncompensated. Sitka Fire Department volunteers man a search-and-rescue squad, operate the ambulances, and provide EMS and can deploy rescue divers, as well putting out fires. Volunteers receive only gas money to come out for calls--less than $5 per event.

"Volunteering is a huge time commitment," says Sitka Fire Chief Dave Miller, who began as a volunteer in 1988 and worked his way through the ranks. He says volunteering numbers are sagging nationwide.

But he also described job satisfactions similar to Stewart's. About fifteen years ago, Miller and another Sitka firefighter rode a US Coast Guard helicopter to the scene of a fire aboard the state ferry Columbia. When the fire was out, they switched to EMS mode. Miller helped transport to the hospital a Sitka local who was having heart problems.

"He's still kicking around," Miller chuckles. "I see him every other day."

Miller reserves his highest praise for the US Coast Guard. Air Station Sitka helicopter crews rescue countless residents and visitors from both land and sea.

"They do yeoman's work for Southeast and make Alaska a lot safer," Miller says. "We have [commercial] medevac services between communities or to Anchorage or Seattle. [But] when those others can't fly because of weather or something else, the Coast Guard always jumps up and does it."

A Culture of Cooperation

One of the three ambulances Sitka Fire Department uses was partially paid for by a program called the Alaska Code Blue Project.

SEREMS Director Leichty says that during the "easy money" days of the 1970s and early 1980s it was simple to appeal to a legislator for a new ambulance or other EMS equipment. Later, funding became more difficult to obtain at the same time the ambulances were wearing out.

"In the mid-to-late '90s it became very obvious that those 1970s ambulances were falling completely apart," Leichty says. "It was like a $6 million need."

She said EMS planners put their heads together and came up with the Code Blue program, a series of protocols that allow funding requests to be prioritized by representatives of all seven EMS regions. The prioritized lists are presented to legislators in a united front, rather than by competing groups. Code Blue also has received funding from the Denali Commission and the Rasmuson Foundation. Communities that receive Code Blue funding are required to come up with a local match.

Leichty says the program is in its twelfth round of funding and has distributed more than $20 million.

Code Blue also seeks to tailor equipment to community needs. A standard ambulance can cost more than $175,000 and may not be appropriate for EMS squads that need to traverse potholed logging roads.

The answer was dubbed a "patient transport" vehicle. One iteration is basically a four-wheel-drive truck with a club cab. A fiberglass canopy covering the back contains a gurney for patients, light and heat, oxygen, and EMS supplies and equipment. The rigs are easier for rural mechanics to maintain and can cost about a third of a standard ambulance. Other types of specialized ambulances may have tank treads or are meant to be towed by an ATV.

In Whale Pass on northern Prince of Wales Island, Jenny Vasser and five volunteers answer calls for about a thirty-mile area with a patient transport vehicle of the pickup type. On one call to help an older man who had broken his back in a fall, the sides of an old logging road were crumbling as they drove over it.

"The rig was invaluable because it had all the equipment we needed," Vasser says. "If we had had a regular ambulance, we would have never made it up there."

Vasser has to make a bumpy two-hour ride to Craig, where she can pick up EMS supplies, fill oxygen tanks, and attend training classes. Chaundell Piburn, Craig's EMS director, says city leaders have allowed her to set up community supply cabinet where the smaller EMS squads can order or borrow supplies.

"On Prince of Wales, it's all volunteers," Piburn says. "Neighbors helping neighbors, and we would have it no other way."

Piburn is SEREMS' Prince of Wales Island coordinator. She hopes to use a newly snagged grant to provide laptops, televisions, and collaboration software to responders in the widely-spaced communities, so they can attend training classes close to home.

Making things easier for volunteers could make it easier for Vasser to get some new members for the Whale Pass squad. Vasser notes that half her squad members are sixty or older.

"I'm so grateful to these people for volunteering," she says. "They give their time and money. And they get no compensation for anything. Except a thank you."

Author and journalist Will Swagel is based in Sitka.
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Title Annotation:HEALTHCARE
Comment:Emergency Medical Services in southeast: neighbor helping neighbor: mostly volunteer squads of first responders meet panhandle challenges.(HEALTHCARE)
Author:Swagel, Will
Publication:Alaska Business Monthly
Date:Jul 1, 2015
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