The Seward City Council heard two starkly contrasting presentations from Seward Volunteer Ambulance Corps, or SVAC members Monday night regarding the care that the Seward Volunteer Ambulance Corps currently provides, and how it could be upgraded in the future.
The all-volunteer ambulance corps responds to emergency calls, provides needed care to help patients and stabilize their conditions well enough to transport them to higher level care facilities such as the nearest hospital (Seward Providence Medical & Care Center), or to the nearest emergency Life-Flight transport. The corps operates both inside city limits, and outside to Seward Highway mile 38, the “Y” at Tern Lake.
SVAC volunteer Randy Rydberg, who is trained as a Mobile Intensive Care Paramedic, gave a power point he had created outlining the problems he sees with the small, rural care provider model, and proposing some radical solutions. His own paramedic license is expiring in December, and he’s leaving the field after 36 years, most of them in larger cities than Seward.
SVAC adheres to Alaska State Standards and does not, and cannot provide the same quality of emergency care that is considered the National Standard of care in cities Outside because of slower response times, the lack of manpower, advanced professional medical training, the number of services and medications provided, Rydberg said. The corps also lacks some commonly used medical diagnostic equipment.
SVAC’s average response time inside the city is about seven minutes, he said. But if the emergency is beyond the city limits, it can range anywhere from 10-30 minutes or more, depending on where the volunteers and the emergency happen to be. Everybody knows that time is of vital importance to brain cells and cardiac muscles in cases such as stroke or heart attack, he said.
He gave some examples of the limitation of services that SVAC E.M.T.s provide. A patient who is experiencing a seizure would receive oxygen and IV fluids, but not standard medications typically used to stop the seizure, he said. A patient undergoing a severe asthma attack, who is panicking, flailing and desperate, would not be sedated or receive paralyzing drugs or intubation by SVAC E.M.T’s. Someone suffering a heart attack will receive oxygen, aspirin, nitroglycerin tablets, IV fluids, EKG monitoring, but fewer procedures would be available than those offered under National Standards, he said. SVAC does not carry, nor provide morphine to heart attack victims.
Due to the relatively low number of calls to respond to compared to that of big city ambulance workers, Seward SVAC volunteer’s skills grow rusty on certain procedures, and their level of training is lacking when it came to performing certain basic procedures such as reading 12-lead heart monitors, or putting IV into bones, he said.
Rydberg had not shared his presentation, nor his own recommendations with the corps’ president prior to the council meeting, and it took the rest of SVAC completely by surprise, they said. It was a harsh assessment that the other dedicated longtime volunteers felt slammed the corps, slammed them, misrepresented their abilities, and devalued the hard work that they do for no pay, and at great personal cost.
“I’m trying to catch my breath!” said SVAC President and longtime volunteer Mike Moore after Rydberg finished. He added that it was hard to sit there and “get slam dunked” publicly, and not be able to criticize his colleague’s presentation as he had been told not to do.
“I just don’t know how to say it to you,” Moore said. Since 1953, corps volunteers have saved many hundreds of lives, and done a great job; “I think we’ve really got a good organization and some really good people,” he added.
SVAC does not carry certain drugs like Morphine as it is a Class One narcotic, and SVAC would have trouble properly securing it in an open, all-volunteer facility such as the corps operates, according to state required safety standards, Moore said. In his 27 years of responding to emergencies here, there have only been two call requests for morphine, he added.
As for being short staffed, Moore said it’s always been difficult to have volunteers on call for at a minimum of two, 12-hour shifts a piece, and their training and re-training requirements for E.M.T’s are increasingly extensive—especially for volunteers. But early on the corps had 12 members, and although it rose to 25 at one point, incredibly, it still has 12 people filling the ranks. Plus, three more interested volunteers showed up at their last meeting, he said.
“Manpower is always an issue, (but) I think we are trained better than Ryberg led people to believe,” SVAC 32-year volunteer Sue Schmidt told SCN later. “We (E.M.T-3s) are trained in reading EKGs. We are trained to recognize and treat lethal arrhythmias, and we spend quite a bit of time learning this stuff. Several of us have gone other places and taken training in it.” SVAC members also are, in fact trained and skilled at getting an IV straight into a bone, she said, despite Ryberg’s claims to the contrary.
Another point of contention between Rydberg and the others at SVAC was whether Seward is ready to start paying trained paramedics to provide ambulance service for a community of this size. Emergency service would be significantly improved if the city hired two or three full-time paramedics, folded them into the Seward Fire Department, and had them augment the existing group of SVAC EMT volunteers who respond to emergencies, Rydberg said. The city also should also acquire two new well-equipped SUVs to transport patients, and acquire more extensive lifesaving equipment, including 12-lead heart-monitoring equipment. He also suggested the corps establish a better working relationship with Providence wherein the hospital would recognize the corps individual’s training and expertise, allow the corps access to certain meds, and offer joint community health education, training and screenings. While acknowledging its high cost, Rydberg said it was a matter of priorities, and whether improving such care to ones’ own friends and neighbors would be worth the increased cost.
SVAC President Moore admitted he wouldn’t be surprised if the Seward community would demand paid paramedics to complement existing ambulance services after growing another 10 years. But for now, the corps is simply getting by the best it can, he said. The corps has kept purchasing new ambulances based on need, donating their used ones, and is considering purchasing some of the costly monitoring equipment to supplement their own. The Life-packs cost $75,000 apiece when last priced, however, and there are all sorts of costly add-ons that are recommended for each piece of equipment purchased. To the council’s offer to help the corps obtain state-funded equipment, Moore replied that his corps members tend to be singly old-fashioned and independent-minded, and they prefer to purchase their own equipment and ambulances.
Seward Fire Chief Dave Squires told the council he’d fight “tooth and nail” against Rydberg’s proposal to add full-time paramedics to his department. The city fire department’s duties only extend out to the city limits, while SVAC regularly responds to emergencies all the way to mile 38. Unless borough residents voted to pay the city for paramedic service in their areas, with their own property taxes, he did not feel the city should bear the additional cost, Squires said. His staff has more than enough work to do already, and should not be expected to take on that additional burden.
Alaska has adopted different standards of emergency care than the rest of the nation due to its geographical remoteness, Schmidt said. Having just researched the ambulance corps of other Alaska communities the size of Seward, she could find none with paid paramedics. Moving to a system of paid paramedics would be extremely costly for Seward, and she believes would undermine the corps’ spirit of volunteerism—especially if paramedics hired from Outside are employed here, and get to be first in line to do the procedures that volunteers have taken their personal time to get trained to do, Schmidt said.