NEWFANE-As a rural emergency medical services (EMS) nonprofit, Rescue Inc. faces formidable challenges on any number of levels.
Case in point: 650 pages of new requirements recently received from the federal Occupational Safety and Health Administration (OSHA).
"These 650 pages of new regulations will affect every aspect of what we do at Rescue Inc.," said Drew Hazelton, chief of operations, as he calmly explains that a plan is already in place.
"Meet Corey Miner," said Hazelton. "Her new position at Rescue Inc. is our health and safety plan programmer."
New to the position, but hardly new to Rescue Inc., Miner, who hails from Newfane, was trained as a nationally certified EMT at Rescue and works as a member of the ski patrol at Mount Snow.
"These new regulations will need to be quickly integrated into every aspect of our work at Rescue," she says confidently. "The impact reaches all over the map, from respiratory protection to medical reviews, electrical safety to hazard mitigation."
EMSes in rural Vermont are struggling with external challenges, like rising call volumes from an aging population, mounting budgets due to the costs of medical care, and fewer volunteers able to cover a system that is overburdened.
"I can solve any problem internally," Hazelton said. "We have the equipment, we have a talented staff, and we can respond to any type of emergency. My focus has always been on the external issues and how to solve those."
His answer to those issues? Diversification and collaboration.
"We've been diversifying what we do and how we do it for years," said Hazelton. "We're building the future of EMS. We've created what needs to happen and as an organization, we're happier than we've ever been."
Finding partners
Hazelton believes that partnering with others is the way to best serve the public.
"We don't compete with people, we partner with them," he said. "In our organization, our mission is broad, and it is to support the communities we serve. We are a regional partner, supporting other agencies with EMS, training, technical rescue, industry and education. It's all our world, and it has allowed us to do things that a lot of organizations cannot."
For Hazelton, stepping up to deploy Miner to infuse 650 pages of federal regulations into the agency's processes and procedures is typical of Rescue.
"Most EMS groups are small, often underfunded, and they don't always have the time or expertise to figure out new issues quickly," he said.
By positioning Rescue in a regional leadership role, "we're tackling the challenges that affect emergency services, and we're setting ourselves up to be able to help other organizations in the process of doing so," he said.
"Our circles are big," Hazelton said. "We do a lot of things here."
Creating the future
An example of solving external issues by collaborating with others involves Brattleboro Memorial Hospital.
Captain Chris Finnell, director of special programs at Rescue, oversees Mobile Integrated Health (MIH), which Rescue describes in its most recent brochure as "a game-changing health initiative."
Begun just over one year ago, Rescue is partnering with BMH, serving patients who had total joint replacements.
"Rather than patients returning to the emergency room or their health care provider for follow-ups when issues arise," Finnell said. "Rescue can provide high-quality at-home care, in an effort to avoid future issues."
He described the partnership as "the future of health care."
"Primary care offices can't travel to a home the way that Rescue is able to," Finnell said. "We can observe the patient in their familiar surroundings. We can report back to the doctor how their patient is progressing. We're able to educate and assist the patient to avoid future hospital stays and emergency room visits."
He said the program was so successful that "it is now expanding into home health care for patients with chronic obstructive pulmonary disease."
The collaboration has also devised a training program for phlebotomists, and many new graduates of that program have already been hired at BMH.
Expanding the team
"We need to be innovative," said Hazelton. "We've learned to problem-solve in creative ways. We're doing things differently than what has been done in the past - different, in fact, than any other EMS organization in the state of Vermont."
Finnell has seen the needs of the organization change over the years.
"We can't keep doing the same thing and expect different results," says Finnell, "Change requires change."
With more than 6,000 calls per year, servicing 14 communities across 500 square miles, the nonprofit organization has shifted over to a mostly paid squad of 120 employees. Women comprise 60% of the squad.
"We have a very flexible staff that has always included basic life support and advanced life support, but we also have a specialized mental health transport staff that can bring patients all over Vermont and New Hampshire to the Brattleboro Retreat," Finnell said.
During the pandemic, Rescue "expanded to fit the needs of the public," he added.
That expansion included vaccinations delivered to towns large and small all over the state, over 450,000 miles worth of travel, and the mobile integrated health program with Brattleboro Memorial Hospital.
Beyond addressing public health needs during a once-in-a-century lockdown, Rescue created a flood response team that travels wherever they are requested. It's developed programs with local elementary and high schools providing CPR and first-aid education to staff and students, an EMT training program with Leland & Gray High School, and many connections to local industry.
"We're not waiting around to find out what the future is, we're going to create it," said Hazelton.
A resource for education
The next area of Rescue's expansion - education - started because of workforce issues in EMS during the pandemic, when hospitals and emergency services lost record numbers of workers to exhaustion and burnout.
At the time, Rescue was investing in staff by sending them out for paramedic training. One of the places students were encouraged to attend was Southern Maine Technical College in South Portland, Maine.
"The trouble was, our young up-and-coming professionals were getting hired by the departments on the Seacoast with whom they did their training. When we sent out our highest potential people for an out-of-state education, many didn't return," says Hazelton.
Logistics and cost were also issues.
The former Vermont Technical College, now part of Vermont State University, offers a paramedic program, but the closest place to take the course is in Bennington.
In-state tuition runs around $25,000, and out-of-state tuition for students from New Hampshire and Massachusetts - where many of Rescue's staffers are from - is around $50,000.
In January, Rescue Inc. will roll out the latest licensed and accredited paramedic training program in Vermont. The new program is an answer to another external issue the organization was experiencing.
Tuition for the program is $14,000, with an additional $3,000 needed for textbooks. Some scholarships are available.
"We've been doing EMS education at Rescue Inc. since our organization began back in the 1960s," Hazelton said. Despite a few attempts to find a sustainable educational model over the years, "we really struggled to come up with a sustainable educational model," he said.
Also emerging from the pandemic: the Vermont EMS Academy (VEMSA), established in Newfane in 2022.
"We were fortunate to have the financial capacity after the pandemic to be able to build VEMSA," Hazelton said. "Our answer to having a strong workforce always available to us is to not only grow our own, but help grow EMS personnel for other organizations as well."
In that context, "A paramedic program makes sense," he said.
Hazelton said Rescue didn't create the workforce problem, "but we need to fix it."
"We not only want to meet the needs of our students educationally, but we also need to meet our students where they are at," he said.
One student issue has been testing. When a student completes EMT education, an online exam is required. Students needed to drive to Springfield, Massachusetts; to Concord, New Hampshire; or to Burlington, Vermont, to become certified for their emergency medical licenses.
"What we learned was that we were losing students due to the amount of time it took them to schedule that test," Hazelton said. "Some got all the way through their education and never took the test."
The solution? Rescue built its own testing center in the VEMSA building.
"Providing the testing lab is a convenience for us that helps retain our students and gets them certified," Hazelton said. "Other agencies are now busing their people to the Newfane center to take tests of all kinds."
The testing area, in a secluded part of the building, is certified by Pearson Education, which administers certification tests remotely for the National Registry of Emergency Medical Technicians, with a staff member trained to oversee five students at a time.
The center can also provide testing via Pearson for professionals working in all kinds of industries, including plumbers, electricians, educators, information technology professionals - even the U.S. Secret Service entrance exams.
"This fits with our goal of assisting the community and building relationships with others," Hazelton said.
Hands-on learning
One remarkable aspect of the new Paramedic Program rolling out in January is the way the curriculum will be delivered. A walk through the new training facility shows why.
Education is now being delivered in hands-on ways. Students will receive in-classroom training, followed by time in an assortment of laboratories where they can practice their skills. From there, education is delivered through simulation.
"We can throw any scenario at our students which keeps them on their toes," said Hazelton with a big grin.
Students might be called to the lounge area, where they might find a $65,000 simulator in the form of a mannequin in respiratory arrest. These specialized "patients" respond with tears, bleeding, and vital signs like heartbeat and breathing, which might be changed quickly by the operator of a console in another room.
The mannequins respond to treatment in real time, and they also can be made to speak to their rescuers.
The students put the mannequin onto a patient transfer board and, in turn, load it into a fully simulated ambulance across the room.
"The hydraulic ambulance can be programmed to turn corners [and] hit bumps in the road, and it is fully integrated with audio and visual support so that their instructors can watch them work in real time," Hazelton said.
During the simulated journey, students are evaluated on their skill at communication about the patient's well-being over the radio.
When the simulated ambulance arrives at the hospital, "they move the patient to a simulated fully stocked and realistic emergency department," Hazelton said. "This gives them practical experience and a chance to take the skills they have developed and put them into action in real time. It's amazing what we can do."
Each of these laboratories, simulators, classrooms, and mannequins is also fully mobile.
"All we need is a parking space, and we can bring all this equipment anywhere we need," said Hazelton. "We can be fully operational on a remote basis. That means we are also using our classroom equipment to offer classes anywhere we're called to do so."
Double duty
The mobile classroom, funded entirely by grants, was custom designed for VEMSA and can also double for other needs the organization might see in their future.
If another pandemic were to hit, the mobile classroom could become a new inoculation center or deployed for any scenario that presents itself.
In fact, the experience of the last pandemic taught Hazelton that Rescue can be ready for a wider number of possibilities by carefully planning multiple uses for all equipment.
"Last summer, flooding affected towns and cities in northern Vermont, and thankfully we were untouched," Hazelton said. "Instead of keeping all this equipment to ourselves, we sent fully operational teams to those places. We are prepared with shelter, housing, boats, trailers, air-conditioning, or heat. Whatever is needed we have here, ready to go at a moment's notice."
Staff are cross-trained, giving the organization a great deal of flexibility in assembling teams of highly-trained people.
"We have set ourselves up so that if there were, for example, a blizzard and our classes were cancelled, we can deploy our highly trained teaching staff to cover where they are needed by moving our teams around without having to worry about another aspect of what we do [not having] enough coverage," Hazelton said.
Rescue has not missed a call in over nine years. And in the last decade, the organization has never had to call for mutual aid to cover for them.
"No one else has our configuration of services," said Hazelton.
Rescue will hire additional staff as the Paramedic Program begins in January, but 30-year paramedic veteran Mark Considine will be its primary instructor.
Known within the organization as "the professor," Considine was one of the first paramedics hired at Rescue Inc. in the 1990s.
"This role has been great for Mark. He's incredibly knowledgeable and he still does our quality assurance," says Hazelton.
So far, the program, with a capacity of 20 students, has 12 enrolled for the January classes.
And even though Rescue is offering the program at a substantially lower cost, the tuition can be a formidable investment.
"We always appreciate donations to our Joe Thompson Scholarship Fund," said Hazelton. The Vermont Student Assistance Corporation (VSAC) will also offer financing.
"Rescue is so very grateful for the support of our communities," he said, noting that the nonprofit has "been blessed with several grants this year."
"We spend money very carefully, and we're still doing fundraising," Hazelton said. "Really, we're just getting started."
For more information about Rescue Inc. and VEMSA, or to donate, visit rescueinc.org and vemsa.org, respectively.
This News item by Fran Lynggaard Hansen was written for The Commons.