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.