Jennifer Van Syckle  0:00  
Many years ago in Montana, if you were sick or injured and needed to go to the hospital, there wasn't an ambulance to call. Instead, you would have called the local funeral home director and had a ride in a hearse.

Thank you for joining us for this episode of Talking Health in the 406, where we're one community under the Big Sky. I'm your host, Jennifer Van Syckle, longtime health care worker turned health educator. And today our guest is Francine Janik of Jefferson Valley Emergency Medical Services. So Francine, can you

Francine Janik  0:44  
tell me about the history? Like where did EMS start in Montana? How did it get founded? So EMS started with just neighbors taking care of neighbors, you know, you all have, we all have those people that kind of like the the old midwives and stuff when somebody got sick, they call whoever that was good at taking care of people. And we did have physicians in the state that would make house calls. But in the 1960s, those positions became fewer and far between, in the small rural communities. And so they were moving out of the rural communities go into the bigger

areas where they could have a decent schedule and better pay and less call uptime. And in 1966, during the Vietnam War, there was a white paper wrote. And it said that in rural United States, there was more people dying from traumatic injuries than in the Vietnam War, and that the United States needs to do something about that traumatic death rate and needed to help fix it. And so the Department of Transportation at the time was assigned to look into this problem and and help fix it. And at that same year, they did the the national was a Safety Act for EMS. And they started getting federal funds to create ambulance services.

And like in Montana at the time,

more than 50% of the so called kind of ambulances were run by morticians and funeral homes. Wow. And so like in Whitehall, the local funeral home director ran the ambulance service and use the hearse to save her city hauled the bodies in. And you would dial a phone number and he would come when he felt like he was ready for him to come. And he would just put you in the back by yourself and drive you to the hospital. And I had a guy tell me that he had wrecked on the interstate. They were building the interstate system through Montana about that time. And he said that he had rolled a car and got ejected and was pretty banged up, he thought he was going to die. And it took a couple hours before somebody pulled over and found him and loaded them in their vehicle and drove him to town. And at the local gas station, there was a phone that you could make calls to the funeral home at no cost. And so you take people would take you there and you would dial the funeral home and the funeral home director would answer the phone. And he says, you know, I'll get dressed and I'll be there and about 30 minutes later, he would show up and pick you up and drive you 50 miles an hour to the hospital to Butte 27 miles. And he said, I thought it was gonna die. He says I didn't know if I was going to make it to the hospital. But he said I did. And I'm here to tell the story. But that was very typical across the state and across the nation that

the mortuary people were making those initial transports of patients getting double use out of their stretching who

well after that 1966 white paper, they realized that that was not the most appropriate way to transport patients, and that we needed dedicated ambulances and there was lots of talk about

the mortuaries needed to upgrade and provide oxygen and maybe provide some medical training and a lot of the morticians were not willing to do that. And so the one in our area. He walked in and brought his oxygen bottles and said, You know, I think that the town needs to create an ambulance service to take care of these people. Your family has a long history in EMS and law enforcement in Whitehall. So when did your family stepped in with So in 1969, my parents moved about May of 1969 to Whitehall and Whitehall did not have other than calling the mortuary did not have any central numbers for anybody to call for police or ambulance or fire and how people called the police was there was a red light downtown

And so she was paid, I think, eight hours a month to run a phone system. And it was kind of whenever she wanted to answer the phone, they wanted to answer the phone. And that Boulder had the same kind of situation. They had a person in a house answering a phone to dispatch services. And one Sunday, a good friend of my dad's got sick, and we were all at church and he died because he couldn't get a hold of an ambulance. And my dad said, this is never gonna happen again. And so they dedicated my mom did 24 hours, seven days a week dispatching to make sure that emergencies were covered. And she did that for 45 years. Wow. And that was your dad,

like a sheriff's officer or law enforcement at that time when your mom was a dispatcher. So originally, my dad worked at the Anaconda Company in Butte, he was a crane operator for them. And but on his free time, and the evenings and on weekends, he would either work as a special deputy it was called at the time for the county, or he was a deputy town Marshal. And so my dad from 1973 on was the town Marshal. And he moved into working as a special deputy more. And in 1981 the Anaconda Company

had a major layoff. And at that time, he lost his crane operator job. And so we went to work full time for the Jefferson County's a deputy. And then he wore many hats for many years. What were some of those hats? So originally in EMS, he helped my mom and dad to help start the ambulance. And originally, you only needed a First Aid CPR card to that fact, when you first started, they didn't have any training. A lot of the physicians didn't want people trained you were just an ambulance driver. You put people in the back and you drove as fast as you could to the hospital, nearest hospital, that in the 19, early 70s. They decided that probably advanced First Aid CPR was a good thing for people to have to learn how to do splinting and how to wrap wounds and and how to move patients in 1973. In about that time, 72-73 the state started doing pilot EMT courses. And he was I think,

Drew Dawson said that he thought they were the third town in the state of Montana to have an EMT class Boulder did and Whitehall did and they drove to the Helena hospital into the Butte hospital and they had classes in Boulder and physicians taught this EMT class. And so this was a major Hattie wars, you know, he was closest to the phone when the phone calls come in. So he jumped in the car and and usually went over there and in the early years, he rode in the back of the ambulance and helped take care of patients whenever anybody needed something when he was around.

See, and and he also assumed a deputy coroner duties. And he did work on the fire department. And we also did all the brand inspecting, and we did all the burning permits. The dispatch center dispatched early on Highway Patrol, county sheriff, ambulance, fire any other agency at the time that might needed any dispatching. Wow. And that's probably how it is for a lot of towns in Montana where you have one person wearing five or six hats that in your urban areas you have five or six people handling. And it's still that way in in rural Montana. You know, people do multiple things are on the fire department. They may be on the ambulance. They may do DES duties they may do public health duties. People that decide to serve the public tend to serve it in multiple arenas. Yeah. Yeah. And it's interesting because I know I grew up in in Whitehall and your dad was not Sheriff Jono is just Topper. And everybody just referred to him as his first name. And I you know, I can personally remember getting picked up from Girl Scouts and over

just a white whole neighborhood one afternoon and having my grandma get flagged down and somebody saying can you show me where the police department is? And she says, yeah, it's that red house right there. And so all of this was based out of a home, you know, yeah, the home when people had a domestic going

On in their house, a lot of times the domestic showed up right inside the house one person would run in and the other one to run in and we'd have this big fight. Wow. Right in the middle of that house. Like remember one time, we had a young man showed up the house and everybody that wanted assistance, for like fuel and food would come to our house and get a background check done on them. And the churches then would give us money to disperse to those people to move them along down the road. And this one guy come in, and he sat down and on the floor with all of his kids and was teaching showing everybody magic tricks and watching TV and my mom ran his name and numbers. And pretty soon she calls me back to the dispatch area. And she says you need to wake up your dad now because this guy is wanted on milk, multiple felony warrants. He's driving a stolen truck. And so I had to go wake up my dad because he was napping before his night shift. He'd worked all day. And I went and told dad and he got the guy and he said, Well, let's go get your your gas. And as soon as he got him outside the front door, he rested him right there. But here we had a wanted felon in our house for about 45 minutes before all the records came back. Oh my gosh, you could probably write a book. I bet if you stopped and thought about all the interesting characters that came along, I am sure you could have a Yeah, there was a lot of interesting characters in the White House. Oh,

my goodness. And so now fast forward. Whitehall has a great ambulance service. Jefferson Valley EMS and EMS has been getting pretty established and relatively well I imagine around the state.

Jennifer Van Syckle  11:44  
And can you tell us about what the ambulance service in Whitehall looks like today dispatch call still go to your parents homes. You know, what, what does that look like? Well, my parents both retired here about 10 years ago from public Well, at least from dispatching and in law enforcement. My dad still at 81 years of age takes every ambulance call it comes in. Really Wow. EMS in the state has has changed immensely.

Francine Janik  12:12  
And you know, in the early 70s, we were just arrived to the hospital. And now we're a actual moving emergency room. Ambulance Services are able to treat patients and to reduce hospital stays, they're able to reduce morbidity and mortality immensely out there. We're able to do 12 lead EKGs and help heart attack patients and get them aspirin and oxygen and IV fluids sooner. We literally can take a heart attack patient. And during our transport to the local hospital, we were able to provide that EKG to the hospital and the patient leaves a backdoor angles and within three minutes can be on a table in the cath lab at the hospital getting a stent and getting that heart attack fixed. And that means less time wasted and less time wasted means more heart tissues saved. Same as stroke patients were able to do those initial things for patients like make sure that it's not a blood sugar issue and do that 12 lead EKG and put in IVs and drop blood samples, put them in a patient gown instead of sitting in an emergency room for another 30 minutes to get those things done, then go straight to the CAT scan to make see what kind of stroke they're having so that they can immediately get treatment. And that reduces brain damage and meet reduces any kind of disability they may have in the future. And and I could tell of a 100 different things that we can do. That reduces time in the hospital for those patients a really good one is those patients having severe COPD, COPD or asthmatic conditions, we can put them on what's called CPAP and 30 minutes a CPAP literally eliminates the need to have them intubated and put on an ventilator to get them straight. And wow, that's huge. And so ambulances have really taken on that role of the country doctor, and you know, they go to the house, they they move those patients and patients have gotten a lot larger. Yeah, when I started in EMS in 1990 the average patient weighed between 100 and 170 pounds. And now the average patient weighs about 230 pounds. Yes. And so these patients have a hard time moving their families aren't able to move them to the emergency rooms. houses that have been built are not one level anymore and then not very conducive to getting people out of them. We had to haul a patient the other day and she was on the third floor of her house and had to come down all those stairs and she lived in the mountains and so

It was a very long process of getting her out of her house. Oh my goodness. We've gotten new power loads, and power cots and power stair chairs and things to help us move those patients a little easier in the field. And so Francine, do our all ambulances equal, like if I'm gonna get in an ambulance in rural eastern Montana, will it have the same capabilities as the Jefferson Valley EMS, will it be able to remotely send an EKG

Jennifer Van Syckle  15:33  
is there variance, there's quite a bit of variances across the state. There's different levels of ambulances across the states. We have ambulance services that are called basic life support or BLS. Those ambulance services are able to use that they more than likely will have a an AED and automated external defibrillator to help try and stop a chaotic cardiac arrest and trying to get the person back into a rhythm. They have oxygen, they have a lot of the basic tools, but they do not have medications, they do not have IVs. They do not have advanced monitors that can transmit those EKGs to the hospital. But most of those ambulances do have some kind of maybe hopefully, ALS backup advanced life support where they have a larger,

Francine Janik  16:39  
Now, majority of ambulances in the state are licensed that the basic life support with authorization for advanced life support. And this allows ambulance services to rapidly change the the treatment that they can give patients by both the personnel available and the equipment available at that particular time. So in say, Whitehall, if we have an advanced EMT available that can do all those things with sending transmitting the EKGs and putting the IVs in and giving them multiple amount of medications, we can operate that level. Or if we have a paramedic on board, we can operate at the paramedic level. Or if we have the trained staff such as nurses and a paramedic, we can actually do critical care transports and provide even more of care to our patients. And then the last level that we have in the state is the advanced life support. And that is typically your paid services in the state or your helicopter or fixed wing services that always have an a paramedic available and that upper level care and have a very large amount of medications and procedures that they can do to take care of patients. And those are I'm guessing mostly in your urban areas where you have like a hospital, that is most ambulances in your own ambulances are owned by a variety of ways in the state of Montana. We have ambulances that are owned by hospital systems.

Unknown Speaker  18:12  
We have ambulances that are owned by the private sector that are for profit ambulances, and those tend to be in our more urban areas. We have ambulances that are owned by counties. We have ambulances that are owned by towns or cities. We have ambulances that are run by fire departments. And then we have a few ambulances out there that are either run by a nonprofit or some group that has decided that they needed an ambulance in their area. Okay, so just a wide variety of ownerships and there's getting to be ambulances owned by districts now where they have actually created ambulance districts and they charge some fees to help support those ambulances. Oh, interesting.

Francine Janik  18:55  
And so do ambulances tend to get funds from taxpayers is it

Unknown Speaker  19:02  
depends. So there is a state law that allows for counties to charge up to three mills to provide EMS in their their counties, there are a few counties that take advantage of that.

Francine Janik  19:14  
Some counties you pay additional funding through the fire departments and in their mill levies with the fire department runs the ambulance.

Fees for services. So this is where we bill, Medicaid, Medicare, private insurance, private pay workers comp. Those are things that help pay for EMS. So if somebody breaks their leg, you know, I think the first thing they think of is I don't want to have to pay for that ambulance ride. And so you're typically able to bill that person's insurance if they have Yes, insurance. Yes, all ambulance services, we use a lot of ambulance services now use third party billers. And they're highly trained in how to do ambulance billing, they charge a percentage of what they collect, to help do that billing process. And so they're very good at finding the person's insurance and making sure everything's built correctly. So the insurance companies paid for that. That trip to the ED, okay, which, you know, you mentioned all the different technology AEDs, everything that's on that ambulance. And it's, it's interesting, because in Montana, the average length of a call in town is about 45 minutes. But when you start talking about a rural Volunteer Ambulance Service, you're looking at 30 minutes more so about an hour, hour and a quarter, that you could be getting assistance on your ride to the hospital, which seems very worthwhile to me, in most cases, in case all of a sudden your condition that rapidly deteriorates in Whitehall, if we haul a patient to Butte, you know, you're looking at three hours, it takes you to do that round trip and that ambulance in that crew is out of service for that three hours except for that patient. We go to Bozeman, it's four hours. If we go to Fort Harrison and take a veteran to Fort Harrison, then we're out five or six hours times. And so those rural ambulances have to travel further to, to those hospitals, especially to the level two hospitals.

Jennifer Van Syckle  21:58  
Which normally would just take a person, you know, you think you to Whitehall is 30 miles, if that. And then yeah, by the time you go and get somebody and load them up and take them in. That makes sense, which and you have to do quite a bit of patient transfers, like you just don't walk into an emergency room and drop somebody off. You take them in, you move them to the bed, you give an extensive report, the physician questions you the nurses question you, you sometimes even have to help with that initial patient care in the emergency room, depending how busy they are. And you make sure that you have to get signatures and paperwork so that you can complete your electronic patient care reports. So there's just lots of things that happen, and then you have to restock and clean your ambulances.

That's very true. And then

EMS also has a different function besides just transporting to the hospital these days, which we've heard about, it's called the Community Integrated Health Program. And I know your ambulance is part of that and a few others in Montana. So are Could you tell us about that? Yeah, sure.

Francine Janik  23:14  
In 2019 the State Legislatures passed legislation to allow for a Community Integrated Health, and Community Integrated Health really, for rural EMS is not something new we've always taken care of our neighbors. And a lot of times I don't need an ambulance ride. They just need their blood pressure checked, or they need help getting off the floor. There's just a variety of things people need that, that they don't necessarily need an ambulance ride. And this opened up a great opportunity for EMS. And it's so we can help our neighbors even more. And the idea is that

health care when done at the emergency room is super expensive. I mean, it's the most expensive way to get healthcare accomplished. And so if we can keep people from using the emergency rooms as their primary care, or using that as a way to get straightened back out because they're not managing their blood pressure or not managing the cardiovascular disease or their asthma, we can help them manage some of those chronic diseases before they get bad. We literally save healthcare millions and millions of dollars in the state of Montana. So I was fortunate enough to get involved. Jefferson Valley EMS and rescue applied for a pilot position in this Community Integrated Health Program. I was able to take you have to take college classes to get your endorsement, whatever level emergency care provider you are. And I'd went to Hennepin Tech and took it online.

A handful of people in the state that's a board certified community paramedic. And in Whitehall, we started a project we have no hospital in Jefferson County, we have a limited clinic hours in Whitehall where the physicians are only available certain days of the week for certain hours. And so there's a lot of time that people need access to some kind of health care. And they can't necessarily drive to Butte or that maybe they're unable to drive or maybe they're homebound that they need help. And so, with COVID, hitting at about the same time, or shortly thereafter, we found ourselves having to help a lot of folks in the community to help manage all kinds of things because they couldn't get into physicians. They couldn't get tested easily for COVID. At some points, we even did vaccination clinics for COVID. With the help of the local pharmacists, we vaccinated

We actually went into the homes and vaccinated people that couldn't even get out of the homes and the health department couldn't get to, we're able to go into homes and do the COVID tests and drop blood we had one patient that she was super sick, and they didn't know if she had COVID or not. And she had multiple other health problems. And so they sent us in and we drew blood and we did COVID tests, and we gave her some initial treatment like fluids because she was super dehydrated, and it all in conjunction with their primary health care physician we were able keep her out of the hospital. And they were able to diagnose her without her ever having to step foot in a clinic that was had COVID COVID patients coming in and out of and she didn't have COVID. And so that just saved her from being exposed to a lot of extra sickness that she didn't need to be exposed to. Right. And to do that all in the home instead of having to deal with the worry and the travel and then going out that's that's amazing. And that's huge for the vaccination numbers. I mean, 1500 is more than probably more than the population of Whitehall, the city, the town itself. Yeah, it was really nice when we worked at the pharmacy because most of the vaccination programs were very county based. And so he had to go through your county. And when we did it through the pharmacy, we were able to Whitehall is where three counties meet, Madison, Silver Bow and Jefferson. So we were allowed to let anybody wherever they came from whatever county they came from, could get a vaccine. And we even had people from Gallatin County and Broadwater County in places that couldn't get anywhere else at the time, they were able to come get vaccinations there, I believe that and that's, you know, that's one thing that a lot of people forget about as you can be on one ended with county in Montana. And all the resources are at the other end. And sometimes it's easier just to go where it's close. So that's great that you guys were able to open up that to others. That's amazing. Definitely.

So that difference in in number would that have been something like a Community Integrated Health or a paramedic deciding also to that, you know, maybe we don't need to go.

That's the hard thing about EMS, anyone can call 911, one thing that we get a lot of non transports to is highway accidents. People are going down the highway, they see an accident they call 911. And 911 is duty is to send both medical and fire and law enforcement to those scenes. Well, today, the vehicles are designed so that people don't if you weren't your seatbelt. Very rarely, unless it's a very significant crash to you even get injured in those motor vehicle crashes. They may look horrible, but you go unseen in you check out the patient and you evaluate them and most of the time they decide not to be transported by an ambulance. We also get patients that just need to be lifted,

they are not a second decide that maybe the best way is to go to the primary care physicians instead of go to the emergency department. And usually when we make those decisions not to transport someone, we're very obvious some of them are patient driven patients, especially if a family member calls 911 and the patient refuses to go we cannot kidnap people and take them to the hospital. So some of them the patients refuse and, and there's some that we talk to the emergency department or physicians or medical control or medical directors or even the patient's physician to make decisions on what really is the best thing for that patient at that particular time.

Jennifer Van Syckle  29:55  
prior to recording this podcast, I had no idea my Montana family

used a Hearse to get to the hospital all those years ago. Thank you for joining us for this episode of Talking Health in the 406. And thank you to Francine for shedding a little light on an interesting page of Montana's history.

Francine Janik  30:14  
Join us for our next episode where Francine looks at current EMS services in Montana, and shares a few great stories as well. For more information on what you heard today, and emergency medical services in Montana, check out our website at TalkingHealthInThe406.mt.gov. Until next time, take care.

Transcribed by https://otter.ai