From Humble Beginnings: Door County Emergency Services

“You either love it or you don’t and you don’t do it unless you love it.” – Aaron LeClair, Paramedic

The Door County Emergency Medical Services (EMS) of today is a stark contrast to its beginnings in the 1950s when sheriff’s deputies patrolled in station wagons armed with a first aid kit, oxygen and a stretcher, and funeral home hearses were the only ambulances.

According to Dick Burress, Door County’s EMS director, who began his career driving hearses for Casperson Funeral Home in Sister Bay, “They were trucks that drove fast! It was a case of grab ‘em and run! They weren’t requiring training at the time; most of us just had first aid [training] which was:  clear the airway, stop the bleeding, treat for shock and call the doc. Remember, there were no cell phones, so someone injured on a roadway needed to flag down a passerby and ask them to find a phone and call an ambulance.”

Dick continues, “In 1973, the state started training EMTs [Emergency Medical Technicians] and by 1975 there were three full-time EMTs in Sister Bay and four in Sturgeon Bay, plus ambulance service from both locations. In Sister Bay we only had room at the old fire station for one vehicle, so we had to park the back-up ambulance in then-Fire Chief Lyle Lundquist’s garage. Prior to 1986, there was no 911 system in the county, so all calls to dispatch for help were made on regular phone lines. The dispatchers, who were also the jailers, often had to balance the needs of those in jail against those calling for help.”

Dick explains further, “Finally, in 1978 the County Board of Supervisors felt we should begin to upgrade training from EMT to paramedic. We needed more training to ensure that a patient would get to a hospital despite the long distances up here. At first the state said no, you have to have a base population of 40,000. But, we were able to convince them that we are with our patients over a longer period of time due to the length of travel in the county and the amount of time one treats a patient is as important as the volume of patients they see in a larger city. One local doctor, Dr. John Herlache, along with then-EMS Director Joe Mango, stepped up and convinced enough of the other docs to teach the paramedic training locally, and this move was rewarded by both state and federal grants. We became the first rural paramedic facility trained and licensed in the country.”

Dick credits Chairman of the County Board of Supervisors, Leo Zipperer, for the idea that EMS and paramedic services should be county-wide rather than by individual township and fire department, so they wouldn’t have to depend on local funding. Today, there are only three out of 72 counties in Wisconsin that have county-based EMS ambulance services. “Leo has been a great friend and supporter to EMS as has been the county board,” says Dick.

Today, there are 12 full-time paramedics in Door County along with four to six part-timers. They are split between the Central Station in Sturgeon Bay, located in the Emergency Services of Door County building on 18th Avenue in front of the Ministry Door County Medical Center (MDCMC), and the combined fire station and EMS building in Sister Bay.

Both facilities have a lounge and sleeping rooms for those on the 24-hour shift. Paramedics require the equivalent of two years of training (including 1,200 hours of classroom, mostly in cardiology and pharmacology), plus their clinical work in the hospital lab, ER, surgery, critical care and obstetrics, finished by two months of field work under another paramedic designated as field supervisor. In addition to maintaining direct contact with the hospital, paramedics work under written and oral protocols, which are doctors’ authorizations to initiate various treatments under specific conditions.

Each township in the county has a fire department along with other emergency workers, first responders, and EMTs. The first responders have basic first aid training. An EMT’s training, meanwhile, is roughly equivalent to a college semester or five credit hours. EMTs can administer treatment, but their value lies in their assessment of the medical problem, relaying it to the oncoming paramedics and assisting them when needed. The EMT must be affiliated with an approved service, and there are various designations depending on the amount of training. So, some EMTs can dispense medication, use defibrillation equipment and even administer invasive treatment such as intravenous solutions. Most of the county’s EMTs are affiliated with the South County Brussels station, the Washington Island station, or work to augment the North Paramedic station during the summer season.

Both EMTs and first responders receive ongoing training, as well as recertification and CPR refreshers on a regular basis. Further, EMTs and first responders provide services for special events such as the Baileys Harbor Fourth of July parade, the Door County Fair, sports and other community events…like standing in the icy water for Jacksonport’s New Year’s Day Polar Bear plunge!

For over 30 years Door County has led other rural communities across the country in providing emergency medical services to its residents and annual influx of tourists. Its first responders, EMTs, paramedics, dispatchers, and ER personnel, in cooperation with Door County firefighters, police and local physicians, is a network without pretense and solely dedicated to keeping residents safe, secure and healthy. These workers care for their communities and give back expecting little recognition.

To volunteer or receive additional information about EMS, contact Dick Burress at (920) 743-5461.

SOURCES

“10 Years of Paramedic Care,” Door County Advocate supplement, Joe Knaapen, 1989.

The Chain of Life

Emergency Medical Services (EMS) is the umbrella that handles the emergency network in Door County from Washington Island to the southern county line. It reports directly to the County Board of Supervisors. Director Dick Burress describes its work as the “chain of life” process.

The first thing needed if a person becomes ill is access to the emergency system services, achieved by a 911 call immediately connecting to a dispatcher who will then route the call appropriately to either police, fire or EMS (medical).

If it’s EMS, the 911 dispatcher first contacts the local first responder group, of which there are 11 in Door County. All responders have pagers and go directly from their home, equipped with their own medical packs including oxygen and defibrillators, to the person requesting assistance. These first responders are supported by their local municipalities and handle everything from patient care to traffic control, to taking care of pets and notifying relatives.

The second part of the “chain of life” process involves response from one of seven county ambulances located in Sturgeon Bay, Sister Bay, Washington Island and Brussels. The paramedics and EMTs on board then stabilize the patient and prepare them for transport to the hospital.

The “receiving facility” (the ER at Ministry Door County Medical Center) is the third step in the chain. The ER doctors and nurses make the decision to treat locally or to send the patient to another facility in Green Bay or Milwaukee for more specialized care. If that is necessary, the physician-ordered transportation is provided by ParaTran, an ambulance service specializing in inter-facility transportation; consequently, none of the local ambulances need to be out of the county. Infrequently, a helicopter is used for multiple trauma cases such as burns, neonatal cases or transportation from Washington Island. These air ambulances respond from County Rescue Services in Green Bay or ThedaCare in Neenah, Wisconsin and are referred to as “24-hour airborne trauma centers.”

To show this “chain of life” in action, Dick took me first on a tour of the Dispatch Office located in the Sheriff’s Department in the County Justice Center. He introduced me to the three dispatchers on duty, Diane Krohn, John Doyle and Holly Bridenhagen, each seated at tri-sectioned, six-application console. There are a total of 12 dispatchers. They take all calls – not just 911 – and must route each appropriately:  alarms, administrative, police, DNR, Coast Guard, Highway Patrol and, of course, EMS. Just quadruple the job performed on TV’s Criminal Minds by Penelope Garcia and you’ve got an idea of their job description.

While we were there, an actual 911 call came in from downtown Sturgeon Bay and the seamlessness with which this team worked was impressive. As John spoke calmly and reassuringly to the patient, Diane activated the call to the first responders in the area and did the same with the ambulance and paramedics. Holly, meanwhile, was taking a call on another matter from a policeman on duty in Sturgeon Bay requesting a license plate check. These are the champions of all multi-taskers. As we arrived back at the EMS office, we saw the ambulance delivering the 911 caller to the ER. Patient stabilized. “Chain of life” complete.

Dick stressed the importance and excellence of our local ER recently upgraded to a state-of-the-art addition that opened in August. He credited hospital CEO Gerald Worrick with the vast improvement to the facility, now under a parent organization, Ministry Health Care. Because Ministry Door County Medical Center (MDCMC) is classified as a rural hospital, the number of beds is limited. However, they are paid at a higher rate for Medicare reimbursement, so it’s this “additional” money that they’ve poured back into hospital improvements of facilities and staff.

Dick continues, “We have an educated audience and the people who move up here expect good medical care. The increasing elderly population and retirees assures a steady level of business and they are getting the best at MDCMC; additionally, our EMS is one of the highest rated services in the county. I can’t say enough about the excellent interaction and communication between county paramedics, EMTs, first responders, area firefighters, law enforcement and our hospital. Mock disaster drills are held and the disaster plan is tested every three years.”

This system passed with flying colors in two recent Door County disasters:  the tornado of August 23, 1998 and the Pioneer Store explosion in Ellison Bay on July 10, 2007.