Jerome Tharaud/Havre Daily Newsemail@example.com
After one of its firefighters spent hundreds of hours in training, Havre has its first paramedic. But because of new state regulations, the department now has to find out how it can use his new skills.
Firefighter Sean Peck, 28, often drove to Great Falls multiple times a week over a nine-month period to complete the 700-hour course. He took the test in November and found out he passed in December.
There are three different levels of emergency medical technicians: basic, intermediate and paramedic. The Havre Fire Department has four firefighters who are at the basic level, and 10 at the intermediate level. That equips them to perform a variety of procedures when they respond to a medical emergency, like putting in an IV or using defibrillation to restart someone's heart.
Paramedics take that training one step further, and their extra medical expertise allows them to do more procedures, the most important of which is administering drugs to help restart the hearts of patients in cardiac arrest before they reach the hospital.
"You will be able to start almost everything the hospital can do - in their living room," Peck said.
"The things I've seen them do were just amazing," said Peck, who decided to become an EMT after watching paramedics work on a cardiac arrest patient at a wild animal park in San Diego in 2000. Paramedics can also administer drugs for other medical emergencies, including drug overdoses and diabetic emergencies, Peck said.
Only a small number of cases would require those skills. Nationwide, about 10 to 15 percent of ambulance runs require advanced life support, said Jim DeTienne, acting supervisor of the Emergency Medical Services and Injury Prevention Section of the Montana Department of Health and Human Services, which authorizes emergency medical services licensing. The two biggest uses of paramedic skills are for cardiac arrest patients and trauma patients, he said.Sooner or later, Peck said, chances are it will save a life.
"You save one person, and in my mind all the time and effort are well worth it," he said.
There are still some details to work out before that can happen. The department must get an advanced life support license from EMS. Peck is the only paramedic at the Havre Fire Department and, like the other Havre firefighters, works a 24-hour shift every four days. The state might not grant the department an advanced life support license when the only paramedic is on duty a quarter of the time, Havre Fire Chief Dave Sheppard said.
"We're in the process right now of feeling that whole thing out," Sheppard said. He said there are some answers the department will have to get from EMS over the next few weeks.
"Chinook's been able to do it, so obviously there's some way it can be done," he said, adding that he would like to see the cardiac medicines available to the department as soon as possible. It is even possible that under the new regulations, intermediates could be trained to administer the drugs without taking the entire paramedic course.
"Right now the whole EMS system is in flux," Sheppard said. "We're kind of in a wait-and-see mode."
DeTienne said several small communities in the state don't have 24-hour-a-day coverage, but are still licensed to use the paramedics they do have.
"The first thing we talk about with a community is the liability of having only one person able to provide it," DeTienne said, adding that one day the paramedic may be on duty, but "tomorrow he's off duty and a patient gets a lower level of care." Many communities decide that having a paramedic sometimes is "better than nothing." He said there have not been any lawsuits or complaints so far in those communities.
The important thing, he said, is to make it clear to the community that just because a department has an advanced life support license doesn't mean the services are available all the time.
"We're revising our rules to make that clear to the community," he said.
Under the current rules, Havre will be able to send in an application for an advanced life support license and should be approved by EMS within 30 days, he said.
Once the new rules go through, probably this summer, Havre would probably not have an advanced life support license, but would be approved to administer the care a paramedic can provide.
"It makes it a little cleaner and a little clearer to the community that's asking what's available from the Havre Fire Department," DeTienne said.
Sheppard said he would like to see paramedic coverage around the clock in Havre. Whether that happens is up to the firefighters themselves, he said.
"Sean has really been the first person to jump in with both feet and go through with that program. I think there's some interest in the other guys, and I hope they'll do it too now," Sheppard said, but added that he won't require them to do it.
"It's a big commitment - a lot of time, a lot of hours," he said. "What's going to drive the whole thing is the (firefighters)."
The time commitment and cost can discourage EMTs from becoming paramedics, particularly in small rural communities. The new state regulations now being implemented may change that, Sheppard said. Instead of having to take one long course over nine months or more to attain each EMT level, firefighters will be able to take a series of smaller modules, one for each skill. The rules for the courses are still being drawn up.
Havre firefighter Bob Bergren, now an EMT at the intermediate level, said that especially with the new changes he's interested in acquiring additional skills to become a paramedic.
"There's a lot of trouble keeping intermediates in rural areas," Bergren said. "Different modules will hopefully make it easier for guys to get skills."
Havre firefighters have an added incentive to get more training this year. Contract negotiations between the city and the firefighters union resulted in a contract provision to give skill pay of $175 a month to paramedics. Skill pay was given to EMTs at the basic and intermediate levels under previous contracts, but not paramedics.
Peck was on the union's negotiating committee, but said he did not know that would be a contract issue when he decided to become a paramedic.
Peck is already looking ahead to more training. He recently applied to attend a two-week class in October to become a hazardous materials medic, to administer antidotes to people who are exposed to poisons like cyanide.
He would eventually like to attend critical care paramedic school, which includes more specialized kinds of treatment and monitoring. That requires two years of being a paramedic first.