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Losing EMS: The human cost

Union photo by Gretchen Teske

Local southeast Iowa ambulance and emergency medical services directors warn that the absence of local EMS could lead to more lives lost, especially in accidents involving trauma or cases that involve cardiovascular issues.
Union photo by Gretchen Teske Local southeast Iowa ambulance and emergency medical services directors warn that the absence of local EMS could lead to more lives lost, especially in accidents involving trauma or cases that involve cardiovascular issues.
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Editors note: This story is the second of a six-part series on how the EMS crisis is effecting local communities in southeast Iowa.

It goes without saying that emergency medical services saves lives. When minutes, and even seconds, really matter, the difference between having local EMS and not having local EMS can dramatically alter a person’s chances for survival.

As rural Iowans face the possibility of losing local services, they are also having to contend with the potential cost in human life.

Richard Young, the director of Washington County Ambulance, notes that about 5 percent of the 1,700 transports that the service generally provides within a year are “true emergencies” that would result in fatalities if a local service did not exist to provide care in a timely manner.

Similarly, Jacob Dodds, the director of EMS services at Henry County Health Center, noted that about 10 percent of calls his crew receives are “truly life threatening” and require “time sensitive care.” Dodds explained that while it would be difficult to pin down an exact number, without EMS, emergencies that involve trauma patients (such as those that have been involved in car accidents), or calls for people suffering from heart attacks, would lead to worse outcomes for over a hundred calls that the health center’s service responds to each year.

In situations where a rural county loses EMS services, the bottom line is that lives that could have been saved, will be lost.

When thinking about stories that showcase how EMS saves lives, people often think of incidents like Brad Sheetz’s. For Sheetz, a Washington farmer, even with an ambulance service nearby, a medical emergency of considerable proportion like the one that he faced required extra help — help that would take longer to access without local EMS.

The then-40-year-old farmer found himself pinned under the force of several wagons, that totaled about 13,000 pounds of weight, early on a crisp September morning in 2014.

“I could feel and hear every bone in my body pop and snap,” Sheetz said, describing the experience.

Although he didn’t know it at the time, Sheetz had injured his anterior cruciate ligament (ACL), medial collateral ligament (MCL) and posterior cruciate ligament (PCL) in his right knee and his ACL and MCL in his left knee. His right hip had popped out from the weight of the wagon and his left shoulder was broken on his fall to the ground as he attempted to prevent the wagon from getting to his organs. Sheetz’s femoral artery was hanging outside of his body.

Accompanied only by his two young sons, the farmer called 911 for help on his own, expecting first responders to immediately show up. However, because Sheetz was in Washington Township, unlike all other towns in the county, the area does not have a first responder unit due to being the home base for the ambulance service.

Help was also delayed because Sheetz didn’t know his exact location.

“Typical farmer, I didn’t know the exact address of the street. I was giving them landmarks,” Sheetz said.

“‘You have to come out on Lexington, where the new cop shop is. Three quarters of a mile, I’m on the east side of the road, out by some bins,’” the farmer had said to 911 dispatch, describing his location. Without the help of a local 911 operator and ambulance drivers familiar with the town, help could have potentially taken even longer to find the farmer. By the farmer’s estimation, it took help about nine minutes to arrive, even with his proximity to the emergency services’ base.

To further complicate the situation, because Sheetz’s legs had been crushed and splayed in opposite directions, it required more than the two EMS providers, who arrived with the first ambulance, to be able to transport Sheetz into a vehicle. The responders had to wait for assistance from the second ambulance, which, at the time, was traveling from Ainsworth, a town approximately 10 minutes away from Washington by car.

Sheetz was quickly transported to Iowa City for emergency surgery and care, spending a week in the intensive care unit. At the end of the ordeal, Sheetz had close to 200 stitches, all concentrated around his groin area.

Despite the enormity of his emergency, Sheetz views his story as a success. He’s alive to tell the tale, but definitely would not be if local EMS did not exist. Should services go away, Sheetz would have had to wait for an ambulance from a different county, possibly upward of 20 to 30 minutes, to come and transport him to a hospital.

“Sometimes you don’t have that time. Even 15 minutes could make or break a lot of people .., that’s why EMS is so important. In my case, I got really lucky. It just wasn’t my day to go,” Sheetz said, explaining why he thinks it is of utmost importance for Washington to have a local EMS service.

Washington’s chief of police, Jim Lester, notes that when a person calls 911, the essential services required by the state are fire and police, but that neither of those entities in Washington County have the training or means to safely transport a person going through a medical emergency.

“We show up and we can provide immediate care, stop bleeding, do CPR, but we have no way to transport anyone ... we’re not authorized by the state to transport patients,” Lester explained.

For Lester, the safety and well-being of his officers are also at risk if a local EMS service does not exist.

“When I hear both ambulances go out, I do get a little nervous,” Lester said.

“If anything happens here and, god forbid, one of my men need help and both cars are out on calls, it could take a while before they get help,” Lester said of how losing EMS could impact his department specifically.

Options for counties without local EMS services chalk up to either waiting for a service from outside of the county or for injured individuals to find independent transportation, such as transporting themselves or calling for help from friends and family.

“[That care] given during the transport is just as important … we’re constantly monitoring them on the way to wherever they need to go … any trauma injuries, we’re stopping the bleeding, getting an IV started and getting them to a surgeon,” Young said of continued care that EMS provides outside of initial help on-scene.

The services EMS provides saves lives in instances that many also do not consider.

“I think a more realistic question is not how many people would die but how many would have worse outcomes because of a lack of ambulance service, and that would be a much higher number,” Dodds remarked on how EMS impacts a community.

“People think of the highly visible cases like car crashes … but the calls we truly make a difference on, we see improvement while they’re in the back of our ambulance. For example, patients that have severe shortness of breath. We have literally brought patients back from the brink of death in those cases to the point that when we roll into the hospital, sometimes they’re like, ‘why did you bring them in?’” Dodds continued. Other examples of cases that aren’t often considered but are greatly impacted by EMS include people suffering from allergic reactions, seizures, or even instances drug overdoses.

But the reach of losing EMS does not stop with individual lives. Danielle Pettit-Majewski, director of public health and Marissa Reisen, the emergency management coordinator in Washington, both pointed to other instances in which EMS provides critical services.

“If you think about it, if we had a mass casualty event, if we had to wait 30 to 45 minutes to get a response, that’s life and death,” the director said.

Reisen echoed similar concerns, explaining that services are really only beholden to their own counties and borders.

“There’s no guarantee that outside-county services would be available to help … we have agreements with all of these other agencies, but a big line within agreements is ‘if you can help, you will help.’ There’s nothing that defines why they couldn’t help, if they say no, they can’t do it and we might need them in 10 minutes, we’d reach out to the state for assistance. But when you have to reach that far, your time that you’re going to be waiting for those resources is going to increase greatly,” Reisen explained.

Pettit-Majewski added that should the service should go away, even if there are attempts by other departments to provide additional services, it would be difficult to “fill that gap.”

“We would do our very best to try … but we wouldn’t come close. We don’t have the same capacity, we don’t have the same training, we don’t have the same equipment. Even law enforcement and fire don’t have the same training as EMS,” she noted.

“EMS is there when you think about our sporting events. They’re there for when somebody is injured so they can respond. I think about them when I’m on a race or when there’s RAGBRAI. If something happens, they’re there. And that’s something, as a community, we would all be worse off without having them as a resource,” Pettit-Majeweski said.