Log in

Missouri Emergency Medical Services Association

Missouri EMS Connection - Service Spotlight articles

The Missouri EMS Connection is a quarterly magazine established in 2015 that educates, informs, leads, and connects the EMS community. This high-quality, full-color publication is being published by the Missouri Emergency Medical Services Association (MEMSA) for EMS professionals across Missouri and beyond.  In each issue of the magazine, we feature an EMS service in Missouri that is a member of MEMSA.  We move these around the state.  Below you can read a few of the most recent spotlight articles.

If you have any questions, contact Mary Napier, Editor at memsa@memsa.org.

  • 09/15/2022 12:43 PM | Mary Napier (Administrator)

    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.


  • 06/15/2022 12:51 PM | Mary Napier (Administrator)

    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.


  • 03/15/2022 1:03 PM | Mary Napier (Administrator)

    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.

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

Powered by Wild Apricot Membership Software