Jennifer Van Syckle  0:00  
Maybe you've never considered joining your local ambulance or volunteering with an emergency medical system. Either way, you don't want to miss today's episode, where you learn about tools that are available for EMS training, as well as what Emergency Medical Services looks like in Montana today.

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 Vansickle, longtime healthcare workers turn health educator. And we're once again joined with our guests Francine Janek of the Jefferson Valley emergency medical services. Let's listen in. As she tells us about EMS in Montana today,

Francine Janik  0:52  
we were able to purchase three mobile sim units. And the mobile sim unit is a semi truck truck that has an ambulance box in the back and an emergency room in the front. And in the middle of it is a control room. And they have high fidelity mannequins that you run from the control room, that you can run a variety of high fidelity training scenarios. And we know that when we train people, if we train them with mannequins that can interact with just like a real human, we can make people better at their jobs. And we can reduce mistakes. And we just get people that can do perform at a much higher level of proficiency. And so the idea behind these was is to go out and take these to rural Montana where they don't have any training. They can't afford the 20 or 30, or $40,000 mannequin to do this high fidelity training and we have a very train group that's run now by a nonprofit that goes around the state and charges just the cost of providing that simulation training to ambulance people, to emergency room staff to local physicians, anyone that needs or wants that high fidelity training. And it's a way to for if you get both the emergency room and the EMS staff, they can literally put the mannequin outside and create a scenario the ambulance crew loads them up into the ambulance box, spends a few minutes with them, transporting them and then works on that integration and transfer that patient to the next level of care.

Jennifer Van Syckle  2:35  
I was lucky enough that a few weeks ago, a co worker and I got to experience this in his truck, and they guided us to a mannequin that was pregnant, and said, Okay, you're gonna deliver a baby and the mannequin screamed and asked for an epidural. Not scary screen, I have to say that and it was cool. I offered to just stand back and watch and let my coworker be the one to deliver the baby. But yeah, they you know, they know they can set it up with you know, a postpartum hemorrhage. They can set it up with kids, they had a young child mannequin there, you know, with head injury, lots of different scenarios.

Francine Janik  3:15  
What's nice is they can do low incidence, high acuity type training. So like delivering babies, not many of us EMTs out there get to deliver a baby, most are very controlled. There's a lot of scheduled C sections. But you just never know when that's going to happen in 16 years, you know, I've been doing EMS for 32 years. And for 16 years, I was always able to get the mother to the hospital before she delivered. But on your 16 I delivered four babies in like eight weeks. Wow. And so it's just one of those things that it's a normal human process. But it's very scary. And it's just sheer panic for several moments until the delivery is done and the babies out crying. And then it's just one of those most incredible processes you get to see. And so it's nice to have a very highly simulated experience that the patient talks to you and screams at you and interacts and ask questions and you can ask them questions. It just gives you more comfort with experience in that whole process in a very safe environment where there's a there's not many women that are pregnant that wants to let a new EMT deliver their babies this is probably true. So it's just nice to be able to do that they do a burn scenario. That's incredible. We don't see a lot of burns, thankfully in the state of Montana. But when we do we need to know how to be able to treat those patients. And so it's nice to be able to simulate that whole experience and get your adrenaline flowing so that you learn how to operate under those high stress conditions.

Jennifer Van Syckle  4:51  
Perfect and so if somebody wanted to join their local EMS, you know, we know there's a sim truck that can come around the state and how Have them so that they can feel comfortable with with that, that they're not, you know, stepping into the abyss of the unknown. What are some of the other benefits of joining EMS or volunteering?

Francine Janik  5:13  
Well, you know, the obvious benefit to joining EMS is you get to help your neighbors in small town. I've lived there for 54 years. And, you know, I've literally hauled my teachers and my family and my friends and my foes, you get to him, you know, take everybody in, it's kind of funny. He's a law enforcement officer and EMT they don't ever see you want to see you as a law enforcement officer. But they begged us, us and EMT. But other things is it's a great stepping stone for many professions. And it's required for many professions. My sister's, all took EMT classes. Two of them were nurses and said it was the most beneficial training they got in their whole career was to do EMS work because it taught them how to interact with patients and how to make high stress decisions quickly. And just understand all those things that happen to people, when they're in emergency situations, whether it's trauma, medical coaches benefit because they learn how to treat patients, especially when you have that person that goes into cardiac arrest or severely injured or if you're in a bus crash that we hope we never see that you're able to interact and take care of your children that you're taking care of. Force people that want to do firefighting and law enforcement, these are all professions that you have a leg up, if you want to, if you get that EMT before you join those professions, because it's easy, you'll get hired much quicker. And then for the medical profession, they all require patient contacts and, and things like that. So we see right now a lot of college students want to go into being a physician or physician's assistant, or a nurse practitioner, they are taking EMT courses to get a lot of those patient contacts that they may not get in a small hospital or even a bigger hospital because they're so specialized. We're an EMS, you get to see everything, you have to know how to treat everything that somebody calls 914.

Jennifer Van Syckle  7:20  
And it's interesting that, you know, when you think everything, I think, broken leg, I think, you know, head injury. But not only that. The main reason for transports of kids under 17 is behavioral health. So you that's a whole other world you learn how to deal with it's

Francine Janik  7:40  
a huge thing right now after having COVID. You know, people are just did not handle the stress of it really well. So it's stressed families out, people have used more drugs and alcohol over the last couple of years. So their coping mechanisms are down. And children just aren't able to, to cope with what's happening and not being around their friends or the different things that happened when the school was online. And in those children that had issues already with mental health. They seem to have been exacerbated by COVID. And so these these kids are suicidal, they want to hurt themselves and others. And so we have transported double or triple the young people this last year than we've ever hauled in the past.

Jennifer Van Syckle  8:35  
It's very scary. That's horrible. I mean, COVID was horrible, but that's also just incredible. And you know, definitely an area a lot of people don't know how to even begin to touch which we could probably have a whole other podcast series on definitely. And then printing can you talk more about the different levels of EMS and getting to those?

Francine Janik  8:57  
Sure, there is four licensure levels of emergency care providers in the state of Montana. And they are in sync with the National Registry of EMTs for levels and the first one is Emergency Medical Responder. That is the lowest level of licensure. It takes about 80 hours of coursework. To get that certification, you get all the certifications through a testing procedure. You have to take an exam to show that you are have the knowledge base to provide care at that level EMRs you can find them in most of your non transporting services or like fire departments that don't run ambulances ski patrols, search and rescue units, even police officers that is very easily level to achieve it. and to maintain it takes about 16 hours every two years of core competencies that you have to refresh on every two years and is that

Jennifer Van Syckle  10:09  
like basic first aid, CPR, those type of competencies. It's

Francine Janik  10:15  
you learn splinting, you learn how to treat breathing, diabetic emergencies, you're taught how to use Narcan for overdoses, how to stop bleeding, excessive hemorrhaging, hadn't even deliver babies how to do all those basic things. What you don't do is IVs you don't backboard people, typically, you don't have to have the competencies necessarily to move patients in an ambulance. Now, the EMT level is the next level. And that is probably the most common level across the United States. I mean, most people are certified at that level. That level takes between 120 and 160 hours depending on the course that you're taking of instruction. Those EMTs are trained to do stabilization of fractures, to treat breathing emergencies, diabetic emergencies, overdoses, cardiac emergency strokes, spinal injuries, traumatic brain injuries are trained how to move patients, you know, to lift them, stabilize them and get them down the road. In Montana, which is unique to many states is we have what's called endorsements. And those endorsements EMTs can take with additional training and approval by the medical director. They can do IVs, they can give some medications like epinephrine for anaphylaxis, they can give nitrile an aspirin for heart attacks and the Benadryl. They can give some of those life saving treatments that they need out in the field. With those endorsements, they can put in more advanced airways, they can use the 12 lead EKG machines, they can even use it without the endorsements, the 12 leads, but then additional training really helps them then there is the AMT level, which is probably the smallest level of providers we have out there. This class is much more extensive than the EMT level. Again, they provide pain medications, some of them do, they're able to provide more IV medications than the EMT with endorsement level is but they're you know, they're pretty much an EMT with just more advanced training. And then our last level is a paramedic level training. The paramedics now have to be gone through an approved and accredited paramedic course. So the colleges in the state of Montana offer those classes. And so like the University of Montana, at the Missoula colleges offers it I think flathead Community College offers it, Great Falls, College of Great Falls offers it, there's the Billings MSU Billings offers that same course. But the problem with the paramedic schools is that we can't produce enough of them. And you know, EMTs are done locally classes. And last year, we this last renewal cycle, which ended March 31, we lost over 580 EMTs in the state that chose either to not be licensed or they aged out, because we do have a very elderly or are aged EMT force. I think I'm probably bright in the average age for EMTs. And at 57. You know, these people are wanting to retire and, and do other things other than help their neighbors all the time.

Jennifer Van Syckle  13:58  
Wow. Wow. And so, you know, aside from stepping up oneself to volunteer, I mean, that's a, you just think what is Montana going to do? Because that's tough. I mean, especially in a state with a million people. And the number of you know, EMTs EMS services in the state to lose 500 is huge.

Francine Janik  14:22  
It's huge and, and EMS, unfortunately, is not an essential service in the state of Montana, and what is what is an essential service on essential services like fire protection. Okay, so your fire insurance that you have on your homes. The fire insurance companies have demanded that, over the years have demanded that people have fire departments in your fire insurance rating depends on what kind of fire department you have and how close they are to your house and that all goes into how you pay for your fire insurance. The other essential sir This is law enforcement. So we may never use or see a law enforcement officer in our whole lifetime. But we all pay for that service, through our taxes the same way with the fire department, EMS has been people just stepping up and saying we're going to make this happen. And we still have ambulance services in the state that survives solely on bake sales that sell enough pies in 10 years to buy a new $200,000 Ambulance, wow. Which is pretty incredible. But it is no way to run a healthcare entity that is expected to go to any emergency 24/7 365 days at the year. And there is a very large cost to being ready for emergencies. I mean, just because I'm a Volunteer Ambulance person, doesn't mean get an ambulance cheaper than a paid ambulance company, or, you know, for profit or hospital based ambulance service. The equipment all costs the same whether I do 10 runs a year, I do 1000 runs a year, it costs the same amount of money to have that vehicle and all that equipment and all that training. So

Jennifer Van Syckle  16:15  
these that are getting funded by big sales are expected to step up and play with the big dogs that are that are in the urban areas. And you know, not only that, but the small bakesale ambulances, you know, most of them are critical access hospitals, they're having to take their EMS service out of their area. You know, I know there's one stat that 31% of all inter facility calls come from a critical access hospital.

Francine Janik  16:43  
Yes, yes. You know, in some of these animals services, you know, they they transport, like, if you live in wisdom, Montana, it takes you hours to get to a hospital, and they're tied up and gone from their community, and they don't get paid. They're 100% volunteer. So those people not only pay for all their training, and they help raise money and funds for their ambulance service, but they leave sometimes a 40 or $50 an hour job to haul their neighbor to the hospital. Wow.

Jennifer Van Syckle  17:19  
And so, you know, who could volunteer for an ambulance service can can a 16 year old high school kid that here's this volunteered or, you know,

Francine Janik  17:28  
do you guys so that age group that 16 to 810 year old is kind of hard because they can't get a state license unless they receive some special waivers, they can get a national registry, EMT card if they're 16 years or older, but they can't get on an ambulance service. And there's a lot of ambulance service that their insurance companies dictate the age of the people that can ride and provide care on those ambulances. And so like here in Helena, they can't hire anybody that's like, under 25 years of age. And in the town of Whitehall, when I first started, we had to be 25. Before you can even think about volunteering on the ambulance service. As a nonprofit, we're able to get down into that 18 year old range my son who just graduated from high school last year, as soon as he turned 18, we trained him to be a driver and brought him up gradually and he got his EMT here. About a month ago.

Jennifer Van Syckle  18:25  
Do you have to have a CDL to drive an ambulance? No, you

Francine Janik  18:28  
do not yet. ambulances and fire trucks are exempt for the most part for CDL drivers, although some agencies make them get some kind of commercial driver's license, especially for those big fire trucks. But ambulances, for the most part do not need a commercial driver's license. So interested, the big thing is, is that if you've trained in volunteer, then usually those folks come back when they have time to do it. That age group of folks that are between 26, or seven and 40 are really busy raising families and trying to do careers. And then once you get kids, those folks are just busy, busy, busy with trying to get everything done and to make a living and both parents usually work. So there's just not much time to volunteer beyond at the school for the kids. And so we're seeing a lot of people that once their kids are grown and off to college, then they find they come back to EMS, especially if they've had any interaction with EMS and they begin to volunteer again and that's a really ideal age for us. They're settled. They're able to they have time to take the class and they have time to volunteer and they enjoy doing community integrated health. Some of them do we have nurses that are that close to retirement age that don't want to go to the hospital but they don't want to quit taking care of people and community and greater health. Have opens a whole new realm of them being able to assist patients out there. And so in our community and graded health, we have registered nurses that helped provide that care and give us a broader basis services like we can help take care of urinary catheters or do more wound care, and some of those more advanced things that the local EMT may not be able to do.

Jennifer Van Syckle  20:24  
Okay. And it's funny, as you mentioned that because I don't know how many times I've heard people that are, you know, they could retire very easily. And they sit there and say, I'm not going to retire, what would I do with my time? Exactly? Well, a lot. There's,

Francine Janik  20:37  
and there was some federal legislation, or whatever happened to it, but they were going to they were trying to pass federally, that if you volunteered for an emergency service, whether it be law enforcement or fire, or ambulance, that at age 55, you are eligible for Medicare. If you were a volunteer at the at the time, when they developed it, it was hoped that they would get more folks that were that retirement age to retire and then come back and work in those volunteer systems because they could provide health care because that's where most of us gets stuck with volunteering from that age where you can retire and when you really should retire is is that health care issue and so that they were hoping that that might help. I don't know what happened to that.

Jennifer Van Syckle  21:27  
Thank you to Francine for joining us with today's podcast and thank you for joining us for another episode of talking health in the 406. Tune in again next month for next episode. For any information discussed on today's podcast. Visit our website at talking health and the 406 dot gov. Until next time, take care

Transcribed by https://otter.ai