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Emergency services vital in small towns

Union photo by Andy Hallman

Emily Sobaski, left, and Aaron Ledger display the contents of one of their “first out” bags containing medical supplies such as a first-aid kit, oxygen and an automated external defibrillator. Members of Quick Responder Services keep first out bags in their vehicles at all times in case they are called to the scene of an emergency. Sobaski is the head of Packwood QRS. Ledger is a member of Packwood QRS, and assistant fire chief on the Packwood Fire Department.
Union photo by Andy Hallman Emily Sobaski, left, and Aaron Ledger display the contents of one of their “first out” bags containing medical supplies such as a first-aid kit, oxygen and an automated external defibrillator. Members of Quick Responder Services keep first out bags in their vehicles at all times in case they are called to the scene of an emergency. Sobaski is the head of Packwood QRS. Ledger is a member of Packwood QRS, and assistant fire chief on the Packwood Fire Department.
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Editor’s note: This story is the fifth of a six-part series on how the EMS crisis is affecting local communities in southeast Iowa.

Washington, Mt. Pleasant and Fairfield all host ambulance services, but those ambulance services respond to calls throughout the county, and sometimes even in neighboring counties. In fact, the majority of the population of Washington, Henry and Jefferson counties do not live in the three cities just mentioned. They live in one of the smaller towns or in the countryside, and they need emergency services just like everybody else.

Given that some residents live as many as 20 minutes away from a big town with an ambulance service, they would be in a bind if they were ever in an accident where they required quick emergency care. That’s why a network of Quick Responder Services has sprung up in small towns to assist accident victims while the ambulance is on its way.

For instance, the town of Packwood in Jefferson County has a QRS service. It does not have its own vehicle. Instead, members of Packwood QRS keep medical supplies in a kit called their “first out” bag in their vehicle at all times. In the event of an emergency, the members of Packwood QRS are dispatched to the scene, taking their own vehicles. They usually arrive before the ambulance does, and they begin administering basic medical care to the patient. They cannot transport the patient. Only the ambulance can do that.

Aaron Ledger, Packwood’s assistant fire chief, is also a member of the Packwood QRS. He said all members of the QRS unit can perform CPR, stop a bleed, take a patient’s blood pressure, check their oxygen levels and a host of other things.

“We stabilize the patient before the ambulance gets there,” Ledger said. “We communicate with the dispatchers, and can tell the fire department or sheriff’s deputies about traffic control.”

The medical supplies in the first out bag include an automated external defibrillator used to restart a patient’s heart, an oxygen tank, a first-aid kit for treating wounds, equipment to help a person breathe, a flashlight, a blanket and more. It even has an obstetrics kit for those cases when quick responders have to help a pregnant woman in labor.

Though only paramedics can administer medication to a patient, the emergency responders in those QRS squads can help patients administer their own medications, like assisting them with their EpiPen or nitroglycerin tablets for their chest pain.

Ledger said patients never forget the aid he and other first responders gave them in their time of need.

“They thank us for months afterward,” he said.

Since the quick responders operate in small towns, they tend to know a lot of the people they rescue. Ledger said that, when he learns the address of an emergency, his mind runs through a list of the people he knows on that street.

Emily Sobaski, head of Packwood First Responders, said the first out bags were purchased with grants and donations. In fact, that is how QRS is funded in general, not through public money but through the generosity of the community.

“We would not be a group without community support,” Sobaski said.

Sobaski said Packwood QRS holds a soup supper every other year to raise money for supplies. One of the first out bags, including an AED, was purchased thanks to money raised through a cookbook sale.

Packwood QRS has seven members, and two other people are taking classes to join. Becoming a member requires attaining certification as an EMR, an emergency medical responder. The class lasts eight weeks and provides 96 hours of instruction. Six of the seven members have gone on to become EMTs, emergency medical technicians, the next level up. That normally requires 180 hours of classroom instruction plus sitting in on ambulance rides and observing an emergency room.

Classes to become an EMR are offered at several community colleges in the region. The Fairfield Fire Department, which started its own QRS last year, hosts emergency medical training classes that are led by an instructor from a local college.

Zachary Kendall is an EMT for Midwest Ambulance in Fairfield. He said that 911 calls from the countryside or small towns prompt not just QRS but sheriff’s deputies and sometimes fire departments, depending on the call.

There are some towns in the area that are about equidistant between two hospitals, such as Lockridge, which sits on the border between Jefferson and Henry counties. Midwest Ambulance director Chris Sanders said that, most of the time, Lockridge patients are taken to Jefferson County Health Center in Fairfield, though Kendall added that if the patient is in critical condition, the ambulance might take them to Henry County Health Center because of the unique serves offered there.

Not all small towns have their own QRS. For example, Batavia in Jefferson County does not, so it relies on members from Libertyville QRS.

Washington County Ambulance director Richard Young said his ambulance crews sometimes go just over the border into Wayland when Henry County’s crew is busy, and other counties come to Washington County when its ambulances are out on calls.

Midwest Ambulance EMT Tyler Cardwell said having extra first responders at the scene is very helpful. Sanders recalled one instance where a man was very sick, and had to be lifted off the ground. He said it was nice to have members of the local QRS, deputies and firefighters there to lift the patient.

Sanders mentioned that the state does not consider EMS a necessary service, and some ambulance services have pulled out of towns they used to serve.

“Ambulance service in a small town is a blessing,” Sanders said.

The town of Coppock has only 46 people, and yet it still manages to fall within three counties: Jefferson, Washington and Henry. It’s much closer to the city of Washington (10 miles) than it is to either Mt. Pleasant (22 miles) or Fairfield (21.5). Kendall said Coppock is about as far as Midwest Ambulance can go and still be in Jefferson County. It takes about 22 minutes to drive there from Fairfield, even in an emergency, because the ambulance service’s policy is to go no more than 10 miles per hour over the speed limit.

Washington County Ambulance’s policy is to drive no more than 15 mph over on two lane roads, meaning the ambulance won’t go over 70 mph on a 55 mph road, and it won’t go more than 10 mph on a four-lane road, so no more than 75 mph in a 65 mph zone.

“If you drive faster than that, you’re just putting more people’s lives at risk,” Young said. “And yet we still get passed all the time.”

Sanders said motorists often fail to get out of the way for ambulances, and on a few occasions, motorists have even followed directly behind them even when their lights were on and sirens were blaring. State law requires motorists to yield to ambulances, and to move to the side of the road and stop when an ambulance is approaching.

Bond vote

The Washington County Board of Supervisors has discussed putting a referendum on the ballot for county voters to approve a tax levy for ambulance service. The matter came to the fore in October when the supervisors established the Washington County Ambulance Advisory Committee.

The county has a contract with Washington County Ambulance, a private company, which lasts until June of 2020. Richard Young, Washington County Ambulance director, plans to retire at that time, and it’s not clear what Washington County will have for an ambulance service after that.

The Washington County Ambulance Advisory Committee has been researching a variety of options, such as discontinuing the service, contracting with a private firm outside the county, drafting an agreement with the municipalities in the county to share the cost, establishing a county-run ambulance and QRS service, and having the Washington County Hospital and Clinics operate the service, among others.

Washington County Supervisor Jack Seward Jr., one of the co-chairs of the ambulance advisory committee along with Young, said the committee is not planning to put an EMS service levy on the ballot, at least not at this time. If the supervisors were going to put it on the ballot in March, they would need to make a decision in December, and pass a resolution in January. Seward said it appears the ambulance advisory committee would not have to raise extra money through a levy in order to fund the ambulance.

If the supervisors did put it on the ballot and the voters in the county approved it, the property tax levy would be in effect for five years.

“We’re still working on budgeting and seeing what it would cost to start the service,” Seward said. “Until we know exactly, that’s the point at which a decision would be made.”