When Seeley Lake calls 9-1-1

SEELEY LAKE – As of Tuesday, July 21, Missoula Emergency Services Incorporated (MESI) and Life Flight Network will no longer automatically respond when an Advanced Life Support (ALS) call is dispatched in the Seeley Lake Fire District. Instead, MESI will respond as mutual aid resource when requested and Life Flight will be on standby.

Seeley Lake Fire Chief and Paramedic Dave Lane requested the change to automatic dispatch that has been in place for more than 30 years.

“In my mind, these are changes that are going to reduce public safety issues by not having multiple resources from multiple agencies responding to the same call,” said Lane. “It gives the same patient care people have been getting for the last two years. The only difference is how they are dispatched.”

When you call 9-1-1

The Missoula 9-1-1 Center is the dedicated Public Safety Answering Point for Missoula County. All calls are routed through the 9-1-1 Center to dispatch all fire, medical and law enforcement units.

Missoula County 9-1-1 Center utilizes Emergency Medical Dispatch (EMD). Dispatchers are trained to follow EMD dispatch protocols that provides them with medical questions that help them determine if a patient requires Basic Life Support (BLS) or ALS service.

Once the level of response is determined, the 9-1-1 Center utilizes “run cards” to facilitate the dispatch of appropriate resources. Run cards are customized to each district and are established by the district leadership. Run cards are routinely adjusted based on the district’s needs or preference.

Missoula County Office of Emergency Management (OEM) Director Adriane Beck explained that the OEM has a memorandum of understanding in place with MESI to provide basic and advanced level transport services to any location within Missoula County. This includes responding to all 9-1-1 calls to which they are dispatched.

“That being said, the dispatch in almost all cases is based on the above referenced run card system,” wrote Beck in an email. “In areas where other ambulance service is available, those districts have the authority to determine when and how MESI will be utilized.”

Once the 9-1-1 Center dispatches the resources determined by the run card, the person in charge of the scene always has the ability to request additional resources through mutual aid or cancel incoming resources.

Beck said while the patient has the right to refuse medical service when capable, they do not have the right to determine what resources provide them care. If the call is made within the Seeley Lake Fire District, it is up to the responder in charge to determine what resources are needed. A patient does not have the authority to request another ambulance provider or Life Flight.

History of auto response in Seeley Lake

MESI’s Regional Manager Don Whalen said MESI has been automatically responding to Seeley Lake for ALS calls since before he started with MESI in 1982. Dominic Pomponio, Region 3 vice president for Life Flight Network, said Life Flight’s autolaunch protocol for ALS calls in Seeley Lake was established many years ago by Northwest MedStar, which was purchased by Life Flight four years ago.

If a call was dispatched in Seeley Lake as an ALS call, MESI would roll their ambulance and Life Flight would autolaunch. If the first responders on scene determined the patient only needed basic care, both would return to Missoula and get ready for the next call. They only time either were paid was if they transported the patient.

“Part of Emergency Medical Dispatch is to make sure the proper resources are coming,” said Whalen. “That has been the system that has worked very well ever since I’ve been here.”

“The autolaunch protocol is only as good as the information that you have to get the resources that you need on scene,” said Pomponio.

Pomponio explained that Life Flight Network only has three helicopters located in Missoula, Butte and Bozeman. Since Life Flight was autolaunch for all ALS calls in Seeley Lake, as soon as a helicopter was activated, the helicopter was dedicated to the call. That rendered it out of service for any other call until they transported the patient or were canceled.

Past Seeley Lake chiefs utilized MESI and Life Flight because their responders had more qualifications and experience than the volunteers. They also only had one ambulance, making that service unavailable if the ambulance was transporting and there was another call.

From August 2014 – October 2017, Bob Vanden Heuvel served as the Seeley Lake fire chief. Vanden Heuvel was the first chief that was a paramedic.

On several occasions Vanden Heuvel told the Fire District Board of Trustees that to ask volunteers to transport all the way to Missoula was “asking a lot of people who already give so much.” If they could hand the patient off to MESI, they could return to the District, freeing up the ambulance and volunteers for the next call.

In January 2016, the Seeley Lake Rural Fire District Board approved a $60 per trip stipend for volunteers who transported a patient to Missoula between the hours of 8 p.m. – 8 a.m. Vanden Heuvel also secured a grant to purchase a second ambulance that was put into service during the summer of 2016.

Despite these changes, Vanden Heuvel still chose to keep MESI and Life Flight on automatic response for all ALS calls. Whalen said of the more than 10,500 calls they run per year, in 2015 there were 95 ALS calls in Seeley Lake and MESI transported 24. In 2016, Seeley Lake had 123 ALS calls and MESI transported 26. In 2017 of the 101 ALS calls, MESI transported 27 patients.

Michael Greer served as the interim fire chief from November 2017 until April 2018 when the current Chief Dave Lane was hired. Both were certified paramedics.

While the number of ALS calls in Seeley Lake has dropped slightly to 85 in 2018 and 84 in 2019, Whalen said they only transported 12 patients in 2018 and five in 2019. MESI has not transported any of the 54 ALS calls they were dispatched to in 2020.

Lane said this is the first department he has worked for that when rendezvousing with another ambulance, the patient is unloaded, often on the side of the highway regardless of weather, transferred to the receiving ambulance’s stretcher and then reloaded for transport. In the past, when Lane was used as an ALS provider, instead of transferring the patient, he would get in the back of the ambulance with his ALS bag and ride along for the rest of the transport.

“I would never expect them to unload their patient, put them on our gurney and load them into our ambulance,” said Lane. “That is just poor.”

Whalen said there are several reasons why MESI chooses to transfer the patient instead of jump in with the volunteers.

First, by transferring the patient to their ambulance, it allows the volunteer service to return to their district for the next call.

Second, MESI carries specialized medications and equipment on their ambulance that are not in the paramedics’ ALS bag and are not used that often, but are critical to have on specific patients. MESI paramedics may also not be familiar with how some of the equipment may operate in a different ambulance.

Finally, MESI’s drivers go through extensive training for running lights and sirens and are used to driving in Missoula. Many of the rural districts are not.

At the July 21 Fire Board meeting Lane told the Board, “We get on scene and determine that we can transport the patient safely and we do that. This is our District, we take care of our community and I think we do a great job at it. So does our medical director and others.”

The Change – What does it mean?

Pomponio said because Life Flight is dispatched for standby, it sets protocols in place that saves time. From the point of activation to point of launch is less than eight minutes.

“Standby gets the entire crew to the helicopter, GPS coordinates to the scene are already loaded, everything is ready to go if needed,” said Pomponio. “It is putting the judgments back to the possible providers of when it is appropriate to use Life Flight and allows better availability for the entire region.”

When MESI is requested, Whalen said the request will be filled based on resources available at the time, like any other mutual aid request. Departments with automatic aid agreements are given priority.

“We go as far as requested because we know with these little departments, like Philipsburg and Drummond, they can’t put an ambulance together. If we don’t go, we know no one is coming,” said Whalen. “We want to make sure we meet the needs of all the patients but sometimes it is really tough.”

Whalen expressed two main concerns regarding the change.

“I fully support [the change] if there was going to be 24/7 ALS coverage,” said Whalen. “If their medic is transporting a patient, where is the next medic for that next call? You will have more than one call [at once].”

Lane said Seeley Lake is a BLS service. Of all the medical calls, only 5-10% are true ALS calls of which he has the ability to provide the care required. Life Flight would be used to reduce the time to definitive care.

Lane said several ALS calls have been dispatched when he was out of the area.

“The volunteers followed my guidance and direction using their knowledge and experience to call Life Flight or to transport the patient to the hospital without further assistance,” said Lane. “None of our patients have suffered from our service.”

Lane added when he is on a scheduled day off, the Department will notify MESI so they can pay attention to calls in Seeley Lake. If there is an ALS call and the responders request mutual aid, then MESI’s supervisor can make the necessary changes to fill the request.

“We will need to request early and it is within a minute so really the response isn’t changing or at least not by a measurable amount of time,” said Lane.

Whalen’s second concern was more general regarding the decline in volunteerism across the country. He feels the chief in volunteer departments must ensure that there are resources to cover the next call with fewer volunteers, employers that are less likely to allow their employees to leave work to respond and increased call volumes.

“We do need volunteers but we have enough volunteers to cover the calls,” said Lane.

According to the Seeley Lake Fire Department online roster as of Aug. 1, the Department has nine volunteers that are EMTs. Lane said Seeley Lake volunteers are willing to run transports into Missoula and the $60 transport stipend has been extended to cover day trips. All volunteers and equipment meet the statewide requirements.

“We get inspected just like MESI. The inspection doesn’t say volunteer or paid they say ALS or BLS,” said Lane. “While we don’t have the experience MESI does, we are trained to the same standard.”

While Lane recognizes using Life Flight is more expensive than ground transport, Life Flight Network does offer an annual membership of $69 that will cover the cost after insurance for anyone in the household should Life Flight be used for any emergent, medically necessary transport.

Lane requested another meeting to clarify dispatching protocol as it relates to neighboring emergency services. Beck said the Greenough/Potomac Volunteer Fire Department and Swan Valley Emergency Services along with their medical directors have the authority to determine what works best for calls that originate in their district and how they will utilize Seeley Lake, MESI and Life Flight to respond to calls.

“We are going to try it,” said Lane at the July 21 board meeting. “If it doesn’t work we will switch back. We need to stay current with care, we need to continue our continuity of care and to me it was a topic that needed to be addressed.”

“It is not our position to question whether it is appropriate or not,” said Beck. “It is to ensure that all the parties involved have the opportunities to talk through what that means and that we all understand and honor his wishes. It is squarely within [Chief Lane’s] responsibilities. If the community feels that the services they are being taxed for are inadequate, then the grievance process for that is through the [local fire district] board.”

If a patient feels that the service they received from a medical provider was inconsistent with established state protocols, they can issue a complaint to the licensing entity and the State Board of Medical Examiners. For more information visit https://dphhs.mt.gov/publichealth/EMSTS/emsservices