UPDATE: Hinsdale County EMS announced on Thursday, May 7, that it regained Advanced Life Support (ALS) status. The county said that after discussions between the medical director and EMS director "regarding our new medical oversight" under paramedic consultant Ruben Farnsworth, the agency is "officially back to ALS status" with its advanced EMT captain "operating at his full scope of practice." However, the county said calls "needing paramedic-level care" will still be intercepted by "Gunnison Valley Health Paramedics or helicopter ambulances, just as we have operated for the past two winters."
Hinsdale County is the most remote county in the lower 48. Lake City, the only statutory town in the county, has a year-round population of about 400 people.
In the summer months, the population swells to several thousand because of seasonal residents and tourists.
This significantly increases the call volume for the EMS team, a small, mostly volunteer-based organization. Hinsdale County budgets for a paid EMS director and chief paramedic.
However, it mostly relies on community members to volunteer their time as EMTs or drivers.
In early April, Chief Paramedic Brad Jones resigned. He was the only paramedic on the county's EMS roster.
In his resignation letter, Jones said he stepped down due to "the county becoming a hostile employer." He also alleged that the Hinsdale County Board of Commissioners pushed to have him fired.
Though he said the EMS director refused that request he resigned anyway "under protest."
Hinsdale County Administrator Sandy Hines said she wouldn't comment on personnel issues, but the county would like to hire a chief paramedic who can stay in the community year-round rather than seasonally.
Hines said that the county's medical director is based in Montrose and oversees EMS operations remotely.
"When an EMT goes out on a call, essentially that medical director has to be sure that their skills are up to par," she said. "The way that medical director does that is that they have someone on the ground here with an advanced license like a paramedic license. And that is sort of their eyes and ears on the ground."
As a result of the chief paramedic's resignation, the medical director has downgraded the level of care Hinsdale County EMS can provide. It went from an Advanced Life Support System to a Basic Life Support System.
Hines, also a former Hinsdale County Volunteer EMT, said a majority of the emergency calls the county receives aren't life saving calls.
"So we call that Basic Life Support," she said. "EMTs that are certified to do Basic Life Support can do airway protection, they can stop bleeding, they can give oxygen, they can splint, and then they can transport. And, this is the heart of EMS."
Under an Advanced Life Support System, the status the county had previously, paramedics can do things like manage cardiac emergencies and provide advanced trauma care. But now that care won't be available locally.
She said the county has a mutual aid agreement with EMS in Gunnison County to assist with advanced calls, such as someone having a heart attack. The concern is that advanced calls are more likely to be situations where minutes and seconds matter.
"So if there is an advanced life support need on a scene, we can do one of a couple of things," Hines said. "We can call Gunnison and have them do an intercept and meet us or we can call a helicopter."
The nearest hospital to Lake City is in Gunnison, 55 miles away.
Paramedic Danny Barela is the executive director of the Western Regional EMS and Trauma Advisory Council. It's a service agency for EMS and trauma centers in six Western Slope counties, including Hinsdale.
Earlier this year, Barela was part of a coalition that lobbied state lawmakers to pass a bill declaring emergency medical services as essential services in Colorado.
He said because Hinsdale County is so remote, it falls into what he calls the "Advanced Life Support Paradox".
"You do best for patient care to have the highest level of skills and training in areas where it's used very seldom," Barela said. "And so the more rural you are, the further you are away from a hospital the more that advanced training is beneficial. But it's also the least likely service level you are going to find able to provide and able to sustain."
Barela said one of the best things Hinsdale County and other rural EMS agencies can do is encourage and support current EMTs to further their education.
"The people who provide emergency medical care are definitely vital to the community," he said. "Each and every one of them. You can't not support the people who do that because they are very hard to find. It's very hard to find new people willing to just take that job on."
What's Next for Hinsdale County
Hinsdale County Administrator Sandy Hines said the county recognizes the risk of not having an Advanced Life Support status, and is pursuing a solution. The county recently contracted with paramedic Ruben Farnsworth of Delta County to help the EMS system move forward.
"He's going to be able to step right in and start doing some of those duties that were being done by our paramedic, and now a lot of that was oversight," she said.
She said under his direction, the county hopes to regain its Advanced Life Support status by the end of May, ahead of the summer tourism season.
Hines also said Farnsworth will help onboard three new volunteer EMTs set to graduate this month.
Looking to the future, she said in addition to hiring a new chief paramedic, Hinsdale County is also encouraging its current EMS volunteers to further their certifications.
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