Teaming up for care
Emergency crews work together to overcome challenges
ALPENA — When Mark Sullivan began cutting wood outside of his Harrisville home on May 4, he had no idea he was about to experience a life-threatening emergency.
Sullivan began tuning up his firewood processor when his loose-fitting sweatshirt got caught on the controls, pulling his arm into the chainsaw bar of the machine and severing the veins, arteries and bones in his forearm.
Doctors considered it a “total amputation.”
Sullivan managed to “fish” his arm out of the machine while it was still running and walked about 60 feet, where he knelt down in the grass and dialled 911.
Harrisville Fire Department medical first responder Roger Klukowski was en route to another call, but made it to Sullivan’s home first, followed by the ambulance a few minutes later.
Sullivan was transported to MidMichigan Medical Center-Alpena, where he says he was met at the door by doctors and nurses in masks. He was later transported by helicopter to Henry Ford Hospital in Detroit, where doctors were able to reattach his arm.
“You hear the stories of Alpena — some good, some bad — but they did an amazing job for me,” Sullivan said. “They stabilized me and got me where I needed to go. I couldn’t ask for anything more.”
Sullivan’s story is an example of how — in spite of the challenges of distance, terrain and weather that can slow ambulance response times to as long as 22 minutes — emergency medical teams coordinate with staff at the Alpena hospital to overcome the challenge of responding to emergencies in rural Northeast Michigan.
Where a person lives can affect how quickly first responders and ambulances are able to reach them and how quickly a patient can be transported to the hospital. The type of emergency the patient experiences can decide whether they’ll receive treatment in Alpena or, as happens about twice a day, be transferred to another hospital.
Tanya Rouse, coordinator for Northeast Michigan’s Medical Control Authority, said a quicker response is always best.
“However, in a rural geographical area like we live in, it’s not always possible,” she said. “There are farther distances. We live in a community that is driven by seasons of winter and bad road conditions, so, really, our response times can vary.”
Rouse said that’s why rural communities like ours have a robust medical first responder program, teams of staffers and volunteers who live in the townships and can respond quickly to provide basic care until paramedics arrive to transport patients to the hospital.
While every township in Alpena County has medical first responders or emergency medical technicians who can provide basic, on-scne care, only the City of Alpena has paramedics. A patient in an emergency in an outlying township must wait for a city ambulance to arrive for a trip back to the hospital.
‘RESPONDERS ARE CRITICAL’
Alpena County’s advanced life support ambulances, which are stationed in the city, made 1,578 medical runs between June 16, 2018 and June 19 of this year, with a little over half of those runs in Alpena, according to city Fire Chief Bill Forbush.
The city contracts with Alpena County to provide ambulance transfers for the rest of the county, a service is funded by a countywide property tax.
The average ambulance response times to the scene of emergencies ranged from 5.33 minutes in the city to as long as 21.64 minutes in Hubbard Lake, according to data provided by Forbush. It takes that long again to get from the scene to the hospital.
Forbush said it takes a team effort to provide timely and adequate care in the far reaches of the county. That team includes a 911 dispatcher, township responders, and city ambulance personnel.
Forbush said most townships in rural areas have medical first responders on staff. Those crews have the most basic level of training that allows them to provide basic life support, such as CPR and splinting a potentially broken bone. Other levels of training in the townships include emergency medical technicians — the minimum level needed for patients in ambulances — to fully credentialed paramedics, as the city has on staff.
“One medical first responder, which is in that community, responds pretty quickly,” Forbush explained. “They will bring a rescue squad, which has EpiPen, narcan, an automated external defibrillator and those types of things. They are all trained in high-performance CPR. These responders are critical, and we are always in need of more of them.”
Response times for Alcona, Montmorency and Presque Isle counties were not made available to The News because those counties’ computer-aided dispatch systems could not generate reports averaging response times.
Rouse, of the Medical Control Authority, said response times are “typically very good.”
“Certainly, we don’t want to put those constraints on them and goals and pressure them to drive faster, because that just puts everyone in danger,” she said. “We do monitor and make sure (response times) are reasonable and appropriate, which they always have been.”
‘JUST THE WAY IT IS’
Alcona County 911 Director Jeff Brackett said some of the things he loves about the county, such as how big it is, can also make it a challenge to respond to an emergency quickly.
Brackett said there are about 11,000 people spread over 640 square miles in his county, so it can take longer to get to people who live in more isolated areas. The county has three ambulances: two stationed in Lincoln and one in Glennie.
“If you want to live in a beautiful county, with lakes and everything around you, response times are going to be less. That’s just the way it is,” he said. “But I can say I think we do a very good job of getting people where they need to be as quickly as we can.”
Brackett guessed the typical response time in his county is 20 to 25 minutes.
Brackett said one of the county’s strengths is quickly finding out the location of the person calling 911 and figuring out what their needs are, so the appropriate resources can be sent.
Rouse said that, while all phases of treatment are important, early recognition of the patient’s problems is key, and treatment should be started as soon as possible.
“With EMS being the initial point of contact for that, that’s truly when the care starts, so that’s an important phase,” she said. “And then, when they get to the emergency department, that’s an important phase.”
135 MINUTES IN THE ER
The most recent data from Medicare.gov shows that, in 2017 and 2018, it took, on average, 135 minutes from the time a patient arrived at the ER until they were discharged, or 225 minutes from the time they arrive at the ER until they were admitted, if the doctor decided to do so. Both of those figures were better than both the state and national average.
The Alpena hospital does worse on some measures, however.
It took 26 minutes, on average, for an emergency patient in Alpena to see a health care professional, compared to 20 minutes nationwide and 18 minutes statewide, according to Medicare.gov.
Ann Lorenzi, emergency room director at MidMichigan Medical Center-Alpena, said more recent data shows an improvement. On average, the roughly 2,000 patients who visit the ER each month wait an average of 17 minutes to be seen by a provider, she said. The national average is about 20 minutes, according to data provided by the hospital.
The hospital’s clinical staff triage patients based on the severity of their injuries, meaning patients with life-threatening injuries are seen first.
Lorenzi said the hospital has recently instituted a process through which staff take patients back into the ER rooms as long as the rooms aren’t full. Hospital President Chuck Sherwin said that has greatly alleviated the number of patients stuck in the waiting room.
The hospital is currently operating as a Level III trauma center, said Rouse, who, in addition to the medical control authority, also serves as the hospital’s trauma program manager. ERs are rated between a Level V, meaning a patient is evaluated and transferred to another hospital, to a Level I, ERs that can treat every aspect of the injury.
Patients with significant injuries, who may need procedures such as heart surgery, brain surgery, or amputations, must be transferred from the Alpena hospital to a Level I or Level II trauma center, such as MidMichigan Medical Center-Midland or the University of Michigan.
On average, about 3% of the hospital’s patients end up being transferred to another hospital, according to data provided by the hospital for the months of March through May. Sherwin said that translates to about two patients transferred a day.
Those transfers come at an added cost to the patient or their insurance carrier, though it wasn’t immediately clear what that cost was.
In a 2017 report, the federal Government Accountability Office found the average cost of air medical transfers in 2014 was about $30,000, double what it was in 2010.
The ability for emergency personnel to adequately serve the public often depends on funding. Alpena and Alcona counties have property taxes dedicated to helping fund their 911 operations.
Taxpayers in Alpena County pay 1 mill — about $50 a year for the owner of a $100,000 house — for the county’s ambulance tax. That buys taxpayers a fleet of ambulances, including advanced life support units capable of handling nearly any health emergency the paramedics might face.
Alpena Fire Marshal and county Commissioner Bob Adrian said that, if voters ever rejected that tax, it would leave a lot of questions as to how the ambulance service would move forward.
“If it failed, I would have to believe the city would go back to covering the city only, like prior to 1981, when the tax was first passed,” he said.
Voters in Alcona County recently approved a millage in the amount of 0.25 mills, which is being used to purchase telephone and software upgrades for the county’s 911 dispatch center. Those upgrades will allow emergency service personnel to better track a caller’s cellphone and pinpoint their location.
“This new system will help us allocate manpower,” Brackett, the Alcona County 911 director, said. “It will help us to know whether we’ve been to a run before.”
Brackett said changes in technology also allow people to text 911 in situations where they are not able to speak.
Montmorency County and Presque Isle County do not have emergency medical millages, but do receive funding from a 911 surcharge on phone lines in the county. Voters in Presque Isle County agreed to raise the telephone surcharge from 41 cents to $2 during the November 2016 election.
Emergency medical service personnel work together to overcome Northeast Michigan’s isolation.
Alpena and various emergency medical service providers in and around Alpena County share a mutual response agreement, allowing neighboring communities to respond to help each other out in large emergencies. They can also provide coverage for one another should a full department be called out.
In Alcona County, Brackett estimated it takes 90 minutes from the time an ambulance leaves for an emergency and transports a patient to a hospital to the time the ambulance returns to the station.
He said there have been occasions when all three of his county’s ambulances were in use at the same time. In such instances, Iosco County will move one of its ambulances to the county lines until an Alcona County ambulance becomes available again.
Because of Alcona County’s limited resources, the county relies on its first responders to initiate care until the ambulance arrives. Brackett said the county really needs more first responders.
Without the immediate response from Klukowski, the Harrisville first responder, Sullivan’s wood-cutting emergency could have turned out differently.
Sullivan has since learned that, had Klukowski arrived just a few minutes later, he probably wouldn’t be alive today.
Klukowski had his military tourniquet in the vehicle with him when the call came out, which saved him from having to run back to the fire station to get one.
“It just shows you how important medical first responders are to the community,” Klukowski said.
After eight hours in surgery, doctors at Henry Ford Hospital were able to reattach Sullivan’s arm. A little over two months later, he is starting to get sensation and movement back in his hand and fingers.
“I have sensation on the top of my hand,” he said. “Three of my five fingers have feeling, and it’s just amazing. Alpena did a great job in getting me stabilized and getting me to Henry Ford. I’m very thankful for that.”
Crystal Nelson can be reached at 989-358-5687 or firstname.lastname@example.org. Steve Schulwitz can be reached at 989-358-5689 at email@example.com. Follow him on Twitter @ss_alpenanews.com.
About this series
For the past several weeks, News reporters have interviewed health care providers and compiled and reviewed local, state and national data to compile a comprehensive picture of the challenges of providing timely medical care in rural Northeast Michigan.
∫ A closer look at the time it takes for medical teams to respond to an emergency.
∫ A look at behavioral health care in Northeast Michigan.
∫ The challenge of caring for Northeast Michigan’s athletes.
∫ A look at plans for future improvements to health care our region.
∫ Our view: The News calls for residents, officials to share responsible for area care.
In case you missed it
Find previous stories online at TheAlpenaNews.com or stop into the news at 130 Park Place for a copy of a previous edition.