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UNHS EMS celebrates one-year anniversary - Medically Speaking, Volume Two, Number Six, 12/18/2014

In China, 2014 was officially the Year of the Horse, but for the new Utah Navajo Health System EMS department, 2014 could be the Year of the 'Horse Power.'

On December 9, 2013, UNHS launched it's own EMS program with four ambulances, serving the Utah portion of the Navajo Reservation, from Montezuma Creek and Monument Valley. EMS officials knew the service would benefit residents on the Utah Strip, but they had no idea how busy they would be. According to Dustin Coggeshell, UNHS Patient Transportation Director -EMS Director - AHA Instructor & Site Coordinator, the UNHS ambulances provided the needed 'Horse Power' for 364 runs, between December 9, 2013 and November 30 of this year.

"There's been a significant improvement for EMS here," Coggeshell said. "We upgraded our ambulance to advanced life support, and we always have qualified EMT's to staff our 911 Ambulance and our Inter-Facility Transport Ambulance in Montezuma Creek. Montezuma Creek is the busiest ambulance in the county with one of highest call volumes. And we respond to a wide variety of calls."

In the past year, UNHS EMT's have responded to a full laundry list of emergency medical calls, involving everything from allergies, trauma, cardiac cases and emergency childbirth, to diabetic emergencies and traffic accidents. The majority of the traffic accidents are due to narrow roads and open range," Coggeshell explained. With animals on the road and no shoulders between the roads and the desert in that area, traffic accidents happen frequently. UNHS has provided training for Emergency Vehicle Operations, closing roads to just one lane, providing traffic control, and working with local fire and police departments, and other EMS agencies, if there is a multi-casualty accident that requires mutual aid between agencies.

"Accidents are a concern, with narrow roads and large ambulances parked right on the road because of steep drop offs along the side of the highway," Coggeshell said. "Emergency lights are on and ambulances are parked in such a way that they are positioned to protect the scene, and the crew, just in case someone keeps driving and doesn't see the emergency lights. If the ambulance gets hit, the crew is on the other side of the vehicle working and out of the way."

He said at times in the past ambulances came close to getting hit, while on the scene of an accident. However, new laws that require motorists to slow down for emergency vehicles, and move to the other lane, have helped.

UNHS has 14 EMT's available to man it's four ambulances. Montezuma Creek has two advanced EMTs and one paramedic (soon to be two). Seven EMT's are also just now completing an Advanced EMT course in Montezuma Creek.

In Monument Valley, there are four EMTs now. A Basic EMT course in Monument Valley, earlier this year, was not very successful. The class ended with only two students qualified to take the written and practical exams, Coggeshell explained. One student left the area, and one let time lapse without taking the exams. Three attempts at the written test and three attempts at the practical test must be finished within 120 days of the course ending. The exams are conducted through the Utah Department of Health and the Bureau of EMS, Coggeshell said.

"We have another Basic course scheduled for Monument Valley in January. Hopefully we gain more EMT's from that class. But the only way any EMT program is going to work there, is with community involvement. UNHS has been there to offer the service, to help improve the service and help make the change. But community members have to meet us on the other side to make it happen and make it a successful program for the community," Coggeshell said. "That's how all volunteer-based ambulance services normally are. There has to be a lot of community involvement to make it happen and make it work."

That's one of the things UNHS is working on in Montezuma Creek with the Advanced EMT course; to increase their staffing. There's a lot of community involvement in Montezuma Creek, including the oil companies that are involved with donating to the schools and other programs.

"One of the other concerns for the EMS program on the Navajo Reservation is the traditional Navajo teachings that say what we can and can't do, according to our culture. But we manage to keep it going." Coggeshell explained. "Of course, a lot of our EMTs really want to make that difference in our community, so they still participate. That might play a big role in the difference between Montezuma Creek and Monument Valley in getting new EMT's."

Coggeshell said traditional residents would oppose being involved in EMS. It's usually the very young people that are just now getting out of high school, or graduating from college, who show an interest in EMS. The older people are not interested as much because they believe in the older teachings.

According to official numbers, in the General Report from the Patient Care Reporting System, managed by the Utah Department of Health - Bureau of EMS, UNHS ambulances were dispatched to 364 calls, during the past year. Of that number, they transported 256 patients. 108 were no transport – that were either transferred to other services, like air ambulance, or were stable enough to go to a hospital in a private vehicle.

"Every single call is different. None of them are the same. I think that type of working environment is what makes it interesting to a lot of our EMT's," Coggeshell said. "We're out in the field 24/7. We're out in the rain and snow and wind, or we're driving on muddy roads. Some days we're just in the office doing paperwork. That's the boring stuff. It's the important stuff."

Each ambulance crew consists of two EMTs and an ambulance driver. The crew captain is the highest-level EMT in the ambulance. Advanced EMT's or Paramedics would take the responsibility as crew captain for that specific run. They are also incident command.

If a call has multiple patients, UNHS has two incident command vehicles that are 4x4 SUV's. These were recently added to UNHS EMS, bringing the total number of EMS vehicles to six. These SUV's are utilized as direct response vehicles to provide an immediate first-responder level of care for patients, if a call is severe enough to need an immediate and direct response. The ambulance meets the SUV on scene.

"We'll load the patient and start monitoring, administering medications, establish an IV and things like that. We haven't kept numbers but I would say 25% of calls require our SUV's to respond," Coggeshell said.

The SUV's are used in many types of calls, including cases that require access to patients, where the ambulance can't go.

"If we have to go into the woods, down by the river, or into some canyons, we'll use the SUV's to retrieve the patient. The SUV's are also used for scene lighting at night and traffic control for accidents," Coggeshell said.

Both SUV's are based in Montezuma Creek. One is the incident command unit used by Coggeshell. The other is equipped with basic life support equipment.

One of the things that hasn't changed is the primary hospital UNHS uses when transporting patients. UNHS uses Blue Mountain Hospital, in Blanding, because that's the nearest emergency room. They also continue to transport to Southwest Memorial Hospital, in Cortez, Colorado, and Northern Navajo Medical Center, in Shiprock, New Mexico. Those are usually used for stable patients, or if the incident happens to be closer to one of those facilities.

According to Coggeshell, the majority of EMS runs are all home and residence calls. The next highest is street or highway, car accidents. Male patients are involved in the highest number of calls, for no specific reasons. But, Coggeshell said, it might be due to their work environments in the oil fields. UNHS has emergency plans in place with the local Resolute Oil Company. They worked with Resolute on one practice disaster drill, recently. The drill involved a gas leak with multiple patients.

Resolute has donated an emergency radio to the UNHS incident command vehicle, and supported local EMS by collaborating with EMS classes and providing information for emergency preparedness. Resolute does not have its own EMS crew and relies solely on the UNHS EMS service.

In addition, UNHS EMS has improved its response time to about 20-25 minutes. That's good for an area like Montezuma Creek and Monument Valley, where a lot of EMT's have to drive a long way to get to the ambulance. Coggeshell said his EMT's have a monthly on-call schedule and everyone rotates on 12-hour shifts from 8 a.m. to 8 p.m., and 8 p.m. to 8 a.m. Crew members sign up for days they are available, and a calendar is created for the entire month. All EMT's carry pagers and some carry radios. Some EMT's are still involved with the local fire department, which is under San Juan County.

UNHS is the primary ambulance provider for entire Utah Navajo Strip, as the licensed EMS agency for that area. San Juan County, and nearby EMS agencies like Navajo Nation and Ute Mountain Ute Tribe, from Towaoc, Colorado, are all under more of a mutual aid agreement. So if UNHS has a disaster, these other agencies can come in and assist them. If UNHS ambulances are on a run and they need a second ambulance in Montezuma Creek, the dispatcher can call an ambulance from Red Mesa or Bluff to take the second call.

The closest county ambulance is located in Bluff, but UNHS EMS, in Montezuma Creek, has responded to each and every page it has been given. Monument Valley EMS responds to most calls, but Monument Valley also has a good, close relationship with the Navajo Nation ambulance out of Kayenta, Arizona. Kayenta is the secondary ambulance service provider for the Monument Valley/Oljato area.

UNHS EMS also works with the Navajo Nation ambulance service, which still has some jurisdiction in the Montezuma Creek area. The Navajo Nation ambulance is the contracted ambulance service, for Indian Health Services, on the entire Navajo Nation.

UNHS ambulances are dispatched through the San Juan County Sheriff's Office. Coggeshell said he is grateful the Sheriff's Office provides this service to UNHS and the community.

"They are more our directors for every call. Without them we couldn't do anything," Coggeshell said. "So they are an important part of our team, in order for these ambulance runs to go smoothly every time."

Coggeshell also stressed the importance of having a dedicated staff of EMT's. He said without the EMS crews, the program would not perform as well as it does right now.

"I'm glad that we have dedicated staff members that will work 24/7 to ensure we have a good program within our community. They're always striving to advance themselves, to go higher and become more knowledgeable EMT's," he said.

Some of the UNHS EMT's worked when San Juan County ran the ambulance service in Montezuma Creek and Monument Valley. A couple of them have been EMT's for 15 years. The average for most UNHS EMT's is 3-7 years. Coggeshell has been involved in EMS for 8 years.

Coggeshell also noted that the UNHS call volume has increased, making the Montezuma Creek ambulance one of the busiest in the county. They're always going. More Horse Power!

"Why? I think in the past, EMS did not have a solid, scheduled on-call crew 24/7," Coggeshell said. "Sometimes they couldn't get a crew. The community viewed it that way. But I think, after UNHS assumed the EMS duties, and guaranteed we would have a crew 24/7, the community has noticed that difference and the improvement in EMS service. Now they feel comfortable. They trust us, and picking up the phone, dialing 911 and saying, 'I need an ambulance,' because they know for sure an ambulance is going to show up.

"First, they used to load the patient in their vehicles and start heading out to one of the three hospitals. Then they would call one of their ambulances to meet them half way. They're not doing that any more. That's one of the big differences, I think. Community members notice the difference in the EMS service that's provided now," Coggeshell added.

Overall, 98% of UNHS EMT's are UNHS employees. A few work for other companies, but a couple are nurses with medical backgrounds. Some are medical assistants. Some work with the Patient Transport Department. UNHS EMS also manages it's own billing within the Patient Transport Department and EMS, Coggeshell said.

"One of the things that's made a huge difference on improving response here, is that UNHS allows staff members to, basically, drop what they're doing and go on the ambulance if they're on call as an EMT," he explained. "At other ambulance agencies people have jobs with different companies and they don't have any control over that. Here, we own the ambulance service and the organization. Employees work for the organization and the ambulance program, so it's easier for us to have them drop what they're doing, leave, and get on the ambulance and go. So that works really well in Montezuma Creek and Monument Valley," he explained.

Whatever the secret of the EMS program's success to this point, it is likely to just get better in the future. A new ambulance building is expected to be ready for use in the next month or so. It will house all three ambulances in Montezuma Creek, and have additional bays. One of those additional bays will have a hydraulic lift with a 19,000- pound capacity to lift the ambulances, when they are being serviced. The new building will also house all those who work in Coggeshell's departments.

UNHS EMS had a very successful, very busy, first year in 2014. So yes, 2014, The Year of the Horse, in China, could possibly be called the year of the 'Horse Power' for UNHS Emergency Medical Services. It's a stretch, we know, but consider this... 2015 is, officially, The Year of the Sheep, in China. So, stretching things a bit more, could you say, that 2015 will be The Year of the 'Ewe'NHS Emergency Medical Service? It's just a thought.

Congratulations and Happy Birthday to the all EMT's and everyone involved in UNHS EMS. And thanks for all the community for their support.

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