The success of a Minnesota volunteer fire department in providing volunteer paramedic services has defied those who thought the expanded EMS program would fail.
The lengthy training at no pay made it especially difficult, but 10 members of the White Bear Lake, Minn., Volunteer Fire Department have become certified paramedics. And their record in the field continues to be a source of pride.
“Even I was doubtful at first, and there were problems,” admits White Bear Lake Fire Chief Cordon Vadnais. “But the effort was really worthwhile and now there is no turning back.”
Since the advanced life support (ALS) program began in 1979, the 10 volunteer fire fighters have each spent more than 850 hours without pay training to become state certified and nationally registered paramedics. Then the program required countless additional non-paid hours of inservice training and regular monthly training.
Their conversion rate for witnessed full arrests in 1981 was 38 percent. In addition, 46 percent of the full arrest patients, or those who arrested in the presence of the paramedics, were delivered to a hospital with obvious vital signs. They have saved one patient, prone to full arrests, seven different times.
Besides the 10 paramedics, 26 of the 49 White Bear Lake volunteer fire fighters are EMT-trained (90-100 hours) and 13 have taken advanced first-aid.
Each volunteer also is trained in all aspects of fire fighting. All personnel are expected to respond to both fire and medical calls (there are about four a day). In 1981, the department answered 268 fire alarms, 412 rescue calls, and made 761 ambulance runs.
“The calls plus the training are demanding on the personal lives of our volunteers, especially the paramedics,” says Vadnais. “But this is a proud department and we do it because of the self-satisfaction. It’s always been that way here.”
Vadnais, with 33 years on the 92-yearold department, is chairman of the board and past president of the Minnesota State Fire Chiefs Association. He suffered a mild heart attack in 1980 while organizing the paramedic program, and became the only full-time paid member of the department in 1981. The other volunteers are paid only for responding to fire calls.
In addition to White Bear Lake, a suburban community north of St. Paul, members protect four other surrounding communities by contract for fire, rescue and ambulance service. The total area is 20 square miles, with a population of 30,000. Another 5,000 residents of the 16 square mile Hugo area contract with the White Bear Lake department for paramedic and ambulance service only. Thus, the White Bear Lake volunteer EMS program serves a growing population of some 35,000 persons in a 36-square-mile area that includes some of the most expensive homes in the state.
The major benefit of the EMS program is the high level of emergency medical care the residents receive for a low investment of public funds.
Vadnais estimates the volunteer paramedic/EMT service saves taxpayers approximately $750,000 a year, based on comparison with other similar paid departments that have an annual $1 million budget. The 1981 operating budget for the White Bear Lake Volunteer Fire Department, including EMS, was $293,340.
“The city council and the community recognize the value of our volunteer service, and therefore they support our requests for equipment,” Vadnais says.
In 1981, the department took delivery of one new heavy-duty rescue truck and two new pumper-tankers that cost the city $300,000 in capital expenditures. The department operates out of two cityowned fire stations.
Station 1, built in 1960, has four bays, a hose tower, meeting room, training room, chief officer office, sleeping quarters and a central dispatcher for fire, police and EMS. Rolling stock includes three pumper-tankers, a 100-foot aerial ladder truck with 4inch water pipe, one heavy-duty rescue truck, one modular Type III ambulance, a grass fire rig and a rescue boat.
Station 2, built in 1972, has a drivethrough design, hose tower and a complete emergency operations center in the basement that can run 14 days on its own heat, power, food and water. It also has a four-story fire training tower and a test pit for pumpers. Rolling stock includes two pumper-tankers, one modular Type III ambulance and one heavy-duty rescue truck with front-mounted boom strong enough to pick up a car.
Photos by Lowell Ludford
“We are well equipped,” Vadnais acknowledges, adding, “I firmly believe that to survive well over the coming years, fire departments will have to provide full EMS service. A fire department can make the best fire stop in the world and will be lucky if anybody recognizes it. But start saving lives on the street corners and in people’s homes and the whole town will come to your support like you wouldn’t believe.”
Chief’s attitude changed
At first, Vadnais argued against going to ALS. That was in 1977, when he took issue with a local newspaper article quoting Dr. Brian Campion, who heads the paramedic training program of the St. Paul-Ramsey Medical Center. Dr. Campion pointed out the need for paramedic service in large suburban areas like White Bear Lake, but Vadnais declared that a volunteer fire department couldn’t do it, especially because of the extensive training requirements.
Later, Vadnais found that some of the younger members of the fire department were interested in being paramedics. He mentioned this at a subsequent meeting with Dr. Campion, who then asked him for a proposal on how to train volunteers.
Vadnais responded with a research project that indicated his department’s existing EMT program could be expanded to include volunteer paramedic service. He discussed it with the members, who approved the idea.
The city manager, mayor and four of the five city council members strongly supported the program and agreed to maintain it. The fire department raised the $50,000 to get started.
Vadnais contacted three prominent citizens who donated a total of $26,000, and he obtained a $25,000 grant from the Ramsey County Health Service. The White Bear Lake Lions Club, that provided BLS ambulances for the EMT program, agreed to supply ALS ambulances.
The training begins
The first two paramedic trainees were seasonal workers who were free to start their training in the fall of 1978 at the St. Paul-Ramsey Medical Center. After graduation, they did their in-service training by riding with the police paramedics in a neighboring suburb. Their initial paramedic run was on March 31, 1979, to aid the sister-in-law of the former White Bear Lake Fire Chief, Walter Berg.
Four other volunteers began their paramedic training in the spring of 1979. They worked their regular full-time jobs during the weekday and trained four hours a night, even on weekends. They were taught by St. Paul-Ramsey medical personnel who drove 10 miles to the White Bear Lake fire station for the classes.
One of the six paramedics quit in October 1980 because a job change took him out of the city. However, three more volunteers arranged for leaves of absence with their employers and began paramedic training in early 1981.
But the training wasn’t easy, and Vadnais recalls that he offered a good deal of personal counseling and encouragement that helped the trainees make it through the course, especially the difficult period at the end.
The White Bear Lake volunteer EMS program was designed to have eight paramedics, but another man took paramedic training on his own at an area vocational school.
The tenth man wanted to be a paramedic so badly, Vadnais felt he couldn’t hold him back. “He volunteered to quit his regular job to train and even paid his own schooling,” Vadnais says.
The two extra paramedics serve as backups to the eight regular volunteer paramedics, who are divided into four two-man teams. One team is on call 24 hours a day from Friday noon to Friday noon, when another team takes over. One of the four teams always is on standby to help the on-call team, if necessary.
High turnout to calls
According to department response records, an average of three paramedics and at least nine EMTs turned out for each medical rescue call during the past year.
“With that kind of response, we have to make sure the EMTs are allowed to practice their skills,” Vadnais explains. “The paramedics don’t do it all.”
There is a minimum of one regular drill night a week, with fire training two nights a month and EMS covered on the other two drill nights. In addition, the paramedics attend one two-hour in-service training session at St. Paul-Ramsey Medical Center each month, and they also attend a monthly run review at which a doctor critiques their work of the previous 30 days. A separate monthly run review is held by an M.D. for the EMTs and advanced first-aiders, with the paramedics in attendance.
Vadnais says adjustment to the change was a major problem in expanding from BLS to ALS service. “We had to change our way of thinking and our way of doing things, and that took six to eight months,” he recalls. “When you’re used to handling medical responses one way for so long, and then a few guys come back from paramedic training with a whole new routine and new language, you wonder if you’ve done the right thing.”
But when the chips were down,” he adds, “everyone pulled together and then we began to get good results.”
The EMTs did learn the paramedic drug system and terminology, and they learned to anticipate paramedic needs. The paramedics stopped repeating the assessment of a patient if it already had been done. The time per EMS call dropped as coordination grew, but cleanup time at the station increased because more medical equipment came into use.
Making it all work
The chief believes the high 1981 conversion rate for witnessed full arrests was due to three factors:
- Public education. The First State Bank of White Bear Lake sponsored public CPR training all year. A dozen fire department volunteers served as instructors,
- training several thousand people.
- Fire fighters respond from home to nearby EMS calls, so they can reach those patients very fast and begin CPR immediately.
- Dedication of the EMS volunteers to rapid response 24 hours a day all year.
Vadnais cautions that the volunteer fire department considering paramedic service should be careful and not proceed unless the dedication of the members and the chief is assured.
“The chief who goes to the city council, or the department members who go to the chief wanting a paramedic program, should have it all laid out first, including costs, training, necessary equipment, number of medics and EMTs, rotation schedule and much more,” he advises.
It is also important, the chief believes, for the training hospital to bend a little to meet the needs of volunteer paramedics. At White Bear Lake, for example, doctors drove to the fire station to conduct training, rather than do it at the hospital. This saved the volunteers precious time.
“The pressure on the paramedics in training is tremendous,” Vadnais explains. “Without help from the hospital, I don’t think we could have done it.”
Pressure on the chief is also great.
“I thought that selling the need for our $650,000 Fire Station 2 was a big deal,” Vadnais notes. “But it wasn’t half the challenge of the paramedic program.”
Nevertheless, he says he would do it over again because of the satisfaction he and the members of the department have received.
“With our EMS program, we handle more lives in one year than we would in 20 years as a fire department,” he points out, concluding that the charge of the fire service is preservation of life and property. “If we are to live up to that charge, then we also must provide first class rescue and emergency ambulance response.”