SIOUX CITY | There were dire pronouncements for ambulance service in rural Woodbury County in late 2017 after Siouxland Paramedics ended its 911 service.
That left just one full-time paramedic to serve small towns and rural areas in the county. Woodbury County Emergency Services Department Director Gary Brown predicted the failure to add more paramedics would leave rural residents without sufficient service and set "the county back 35 years."
The lone rural paramedic, Jerry Kelley, couldn't remotely provide the needed coverage for all 24 hours and every day of a week, Brown pointed out.
Ultimately, the county supervisors decided to open the purse strings and fund two paramedics. So now it is down to four months until Kelley has some colleagues working alongside him in responding to heart attacks, strokes, vehicle collisions and elderly people falling.
"At times it can be (stressful), the fact that you are out there by yourself," Kelley said.
He may be the first or possibly second person arriving to an incident, depending on whether a volunteer EMT gets there first. Many of the incidents play out with Kelley spending 45 to 60 minutes with patients, with the care at times stopping there or sometimes continuing with a rush to a Sioux City hospital.
Some weeks, Kelley has worked 12-hour shifts, from 7 a.m. to 7 p.m., for five days. This Wednesday, by 8 a.m. Kelley was in Pierson, Iowa, on a call.
Brown said the addition of the two new paramedics should happen right as a new county fiscal year begins on July 1. Brown said the hiring process will begin in March, so the workers can be ready to go.
"We are going to try to get it all approved, so they can come to work on July 1,'" Brown said.
Joe Collins has been a volunteer EMT for almost 20 years. Although Collins has an address of rural Danbury, he serves as the fire chief in nearby Anthon and often may be the only volunteer available in the daytime for the ambulance crew in Oto, since so many volunteers are away at their full-time occupations.
Collins said there were 72 ambulance calls in Oto in 2017, and he has been happy to have Kelley's "very good" help for advanced emergency care for many incidents.
"As an EMT, we cannot do some of the advanced stuff," Collins said.
Collins said the next four months can't go by soon enough, so he shared a mindframe that volunteer EMT's should have for the next two months: "Do your best, sharpen your skills until July 1."
Kelly is based in the county emergency services department at the Public Safety Center in the small town of Climbing Hills, located roughly in the middle of the sprawling county.
Even though he's been working in the emergency services field since 1975 in Sac, Story and Woodbury county entities, Kelley said working alone has a downside. Therefore, he hopes the new additions actually arrive July 1.
"Until it happens, I don't count on it," Kelley said.
Kelley said it is preferable to have colleagues to share discussions on how to handle certain incidents, for when some basic protocols may not apply. He said the most challenging calls are obviously those where a person's life hangs in the balance.
Citing financial difficulties, Siouxland Paramedics officials in August announced that after 35 years they would cease providing 911 services to Sioux City, North Sioux City and the county by year's end. Sioux City Fire Rescue now runs a new city emergency medical services division to 911 ambulance calls in the city. With the changes, Brown and other people in the county knew they needed more paramedic coverage.
It was a long process for Brown to get the county supervisors, who set department spending budgets, to fund paramedics. Early in 2017, Brown sought to add two paramedics as part of setting the fiscal year 2017-18 budget, but that hiring was not approved.
After four spending proposals, the supervisors in late January agreed to hire two paramedics at a cost of $146,267, which includes salary and benefits.
Beyond the work Kelley does, Brown said it is important to remember there is a solid system in place, it is not just Kelly out working by himself on all incidents.
Brown said the system includes the volunteer EMTs who work in may rural towns, Kelley doing his part, then perhaps ambulance drivers or a helicopter pilot who may take an injured person to a hospital, plus the emergency room personnel who give treatment.
"It really is a multi-level system of components that save lives, it is not one paramedic, one EMT. One without the other, the (patient) outcomes are different," Brown said.