RETAC director explains scope of ambulance oversight

BoCC completing ambulance licensure plan

SAN LUIS VALLEY – Saguache County Commissioners confirmed Tuesday during their regular meeting that County Attorney Ben Gibbons is working on the program for the county to certify and license county ambulances, adding the plan should be done later this month.
“The policy will include everything required by statute,” Commissioner Chair Tim Lovato said. The new plan will assure the ambulances are monitored on a local level, and will help complement work done by regional authorities.
The medical director for ambulance services in Saguache County, Dr. Patrick Thompson, sits on the Regional Emergency Medical and Trauma Advisory Council, (RETAC), Region 8 and is currently on staff at Rio Grande Hospital in Del Norte as co-director of the hospital’s emergency department. The council meets every six months and is responsible for regionalizing ambulance protocols, Thompson said during an interview last month.
These protocols are based on Denver metropolitan protocols and protocols for Emergency Medical Technicians (EMTs) nationwide. Dr. Thompson explained that the Valley’s ability to attract qualified EMTs depends on how well the agencies involved follow emergency care protocols and he commended EMTs for “doing really well for not having any direction from the top.”
Dr. Thompson is responsible for ensuring all EMTs are trained and certified to the appropriate levels. He also reviews charts to make sure EMTs are following the necessary protocols. Thompson set up protocols for each level of EMT/paramedic training. “Monte Vista, Alamosa and the Baca have some paramedics, but Del Norte, Center, Saguache, and South Fork have none,” he noted.
Because of the disparity in the ambulance personnel, Dr. Thompson had to adjust the protocols specifically for the San Luis Valley. “My job is not to get into who they hire, what they pay, or the wear and tear on ambulances,” Thompson explained. As a medical director, he can revise ambulance call charts, make sure patients are receiving the proper medical care and make sure the EMTs have checked off all the boxes in their reports.
He repeated what he told Crestone area residents earlier this year, that trauma patients can only be taken to the most qualified hospital within a certain radius. San Luis Valley Regional Medical Center in Alamosa is where all local trauma patients must go because it has a 24/7 surgical suite, anesthetists only a call away and orthopedic specialists to evaluate patients.
Some Crestone area residents were asking to be transported to Salida, but Salida is rated a Level IV trauma center and SLV Regional Medical Center is rated a Level III.He added that he does not see Heart of the Rockies in Salida rising to a Level III facility any time soon. He also cited the difficulty of the drive when minutes even seconds count, especially in the winter, since to reach Salida means crossing over Poncha Pass.
Medical patients can request they be taken to Salida, but not trauma patients, he pointed out. “If you live south of Villa Grove, you’re going to Alamosa,” he reiterated.
RETAC is trying to increase their services but have limited resources, he commented. Each hospital in the Valley gives $5,000 to RETAC and RETAC disburse the $15,000 to the ambulance services. “[Ambulance transport] is a very underappreciated service,” he observed, “especially when it is all volunteer.” While state grants are available for ambulance supplies and equipment, the money from the grants cannot be used to supplement pay, he said.
Dr. Thompson helped resolve the ambulance transport problem in the Valley by creating a Valleywide paging system to speed up response to requests for transport. Prior to the establishment of the new system, all three emergency rooms in the Valley were transporting 85 percent of each 100 patients by flight for life even though the need did not always justify the transport. Each trip cost patients $6,000.
With the new paging system, any ambulance service in the Valley has 30 minutes to respond to the page and 90 minutes to arrive to pick up the patient. Now about 90 percent of patients are transported by area ambulances. This saves patients in transport costs and saves nurses time once spent calling to arrange for ground transport. The three top responding ambulances services compete for the business and help save millions of dollars each year, Dr. Thompson said.
“At the end of the day it is all about patient care,” he emphasized. “There is a 50 percent higher mortality risk in rural Colorado,” and RETAC is doing its best to reduce that number.

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