City’s EMS learning curve continues

Now into the fourth year of operating its own fire-based ambulance service, city leaders are reporting a continued increase in call levels, as well as the growing challenge of retaining trained paramedics needed to handle 911 and transfer calls.
City Administrator Rick Melcher reported that the EMS staff averaged just under 3.3 calls per day for the fiscal year which ended Sept. 30, setting a new high of 1,191 calls — an increase of 11 calls from the previous year. Emergency, or 911 calls, increased from 678 to 703, while transfer calls were down slightly from a high of 475 last year to 446 this year. Standby calls were up from 27 to 36 and there were also four public assists and two intercepts, involving rare situations where Aurora crews met a volunteer ambulance en route to a hospital in order to have a paramedic available during transport.
Melcher said the overall call totals are part of a continuing learning curve dating back four years when the city took over what had been a county owned and operated service.
“As we said in the beginning, the EMS services would be a work in progress and that remains to be the case,” he said. 

A new EMS captain
Among the most notable changes in the service this past year was the recent transition in the captain’s chair. Former EMS director/captain Tanner Greenough stepped down from the post in October, returning to a similar job in Grand Island. Taking the reins was Dalton Chastain, an Iowa native who joined the Aurora EMS staff in August of 2021.
“It’s pretty much been business as usual,” Chastain reported after two months in his new role. “I took over in October and Tanner has been coming in and helping me with some stuff, as well as Brent (Dethlefs, former director).”
Melcher said he has complete confidence in Chastain’s ability and leadership.
“With the experience of the previous EMS director (captain) and current fire chief recommending Dalton as the new EMS director we feel operations will go on as usual,” he said. “We feel he understands the goals our administration has for emergency services and communicates well with EMS staff, other emergency services within the county as well as medical facilities that we work with on a daily basis. Therefore, we look forward to the future working with Dalton as EMS director and the rest of the EMS staff at their respective positions and that they will be available to the citizens when medical emergency assistance is needed.”
Chastain, age 26, grew up around the fire department, as his father is a 20-year veteran on the Council Bluffs staff. He earned a degree in kinesiology from UNO and worked for a time in that field before applying to a job opening he saw with the Aurora EMS crew back in August of 2021. He is trained as an EMT and is a second-year paramedic student at Central Community College in Grand Island.
“I worked under Tanner for 2-1/2 years, just kind of learning everything that he does,” Chastain said. “We’ve made a few small changes since I started, one involving our most difficult issue, which is paramedic retention.”
Chastain reported that the Aurora crew was expanded to 13 members over the past two years, due in large part to the growing number of 911 and transfer calls. However, he said, the ability to handle that call volume has become increasingly difficult because the role of paramedics is growing in value, as is the pay levels available, which lead to some departures.
“A lot of hospitals are now hiring paramedics because they are seeing them as big of an asset as we’ve seen them for a long time and they’re able to pay a little bit more,” he said. “I’ve been working closely with the city in order to kind of fix that issue. That can involve more pay, or sometimes adjusted benefits or something that shows we want to keep them in the 911 realm.”
Melcher confirmed the city’s commitment to addressing that issue.
“The challenge is maintaining an adequate number of staff members to provide services when called upon while other EMS services provided in the Tri-Cities area pay their staff considerably higher wages,” he said. “Therefore, we have increased our paramedic wages to be more comparable to services necessary to provide ALS (Advanced Life Support) services, which reimburse at a higher rate than BLS (Basic Life Support) services, and to help with employee retention.”
In 2022, Melcher reported, the city’s EMS crew turned down 109 ALS transfers. That number grew to 136 in 2023, which he said affects the city’s ability to generate more revenue.
Breaking down the numbers further still, Melcher estimated the cost per year for ambulance service at $30 for rural residents, and $110 for Aurora residents, up from $85 last year.
The department’s overall budget increased from $1.4 million last year to just over $1.5 million in FY 2024.
While focused on creating a supportive work environment, Chastain said for some paramedics staying in Aurora comes down to finances.
“I know these larger departments and hospitals are able to pay a lot more,” he said. “Every paramedic that I’ve talked to here really enjoys working here. It’s just that they want to be able to make that livable wage while doing it.”

Increased staffing
Another change Chastain has pushed for in his short tenure is boosting the staff from 13 members, including himself, to 15.
“We currently have 10 EMTs and four paramedics and myself, so we’re at 15 now,” he said. “We have two shifts with one extra person and that allows us to both take the transfers and then also still have two ambulances available for the community for any 911 calls. That’s something Tanner always wanted was to go to five per shift with himself, which would be 16.”
Chastain said he provided information regarding staffing levels and call requests, concluding that additional staff members would pay for themselves over time.
“Once I kind of ran the numbers and reports, we showed that the transfers are there,” he explained. “We’ve had more requests than we’re even able to take and with us going out on 911s or already being out on a transfer, then we’re not able to take a second one. But, having five per shift will allow us to do that.”
Accommodations are not a problem, he added, as the four-bedroom housing facilities were expanded to five recently by converting a storage room into a fifth bedroom. Chastain and his wife Jordan, an X-ray technician, currently live in Grand Island and are expecting their first child later this month.
Asked how he feels things are going now just two months in as director, Chastain had this to say.
“It’s been going good,” he said. “Once we can get our paramedic numbers stabilized I expect those transfer numbers to really skyrocket.
“The transfers that we have turned down are primarily the ALS transfers, and you have to have paramedics to take the Advanced Life Support transfers,” he continued. “We have to have two paramedics on a shift in order to take an ALS transfer because we have to leave a paramedic in town for the community’s 911 calls. If we have two paramedics a shift, we can take a transfer and still have an ALS provider in town. This year, for most of the year, we’ve only had one paramedic per shift just because our numbers have been down, which has limited the amount of ALS transfers we can take for the hospitals.”
Being a paramedic a student himself now at CCC has been beneficial, Chastain said, as well as insightful.
“I do clinicals at our surrounding hospitals and I’m able to talk to the nurses and doctors in the ERs (emergency rooms) and they tell me quite a bit that they prefer to wait 40 minutes for us to get there as opposed to having some of the transfer services around us take their patients because we provide that great care that they are looking for,” he said.

Grow your own
Facing a reality many businesses have had to deal with in terms of workforce shortages, Chastain said the city’s strategy has evolved into a grow your own paramedic strategy.
“We have to raise our own paramedics pretty much because it’s pretty difficult hiring paramedics,” he said. “So to do that we get our EMTS and then we’ll send them to the program at CCC, kind of a grown our own paramedics kind of thing. Being able to have those EMTs already established here and then become paramedics is helpful.”
Another aspect of the training regiment involves learning the do’s and don’ts of being a firefighter.
“We like to do our EMS training in the morning, generally, and then they’ll go on to fire training which is later in the afternoon,” he said. ‘Since we have three shifts they will be the same training for three days, so every shift is getting the same training before we move on to the next training. That’s kind of the rotation.”
Training medical staff members to assist on a fire scene is a goal first established by Greenough, and is one that Chastain sees value in.
“We get a lot of guys who come over with a lot of interest on the fire side,” he noted. “I know we’ve had a Firefighter 1 class in the past and I’m hoping to set one up here again at the beginning of this year to get our employees Firefighter 1 certified and then going on to that Firefighter 2 certification.”

Communication
Another goal Chastain has as captain is to work with fire chiefs in area towns to see how they can help each other.
“We had a meeting and I believe the fire chiefs from Giltner, Hampton and some of the other towns were there and we are working with them to find out what needs they have,” he said. “Training wise, Tanner started countywide EMS training. We’re all volunteer (fire) departments so once a month we would rotate the location and put on EMS training with one of our paramedics to kind of bring them not to the ALS level, but the higher EMT BLS level.”
Another change expected soon is the arrival of a new ambulance, which was actually ordered more than a year ago. The city has made a concerted effort to upgrade its ambulance fleet, with two of the four units acquired during the 2019 transition from the county now serving Giltner and Marquette. A new ambulance was added in 2023, with the newest unit expected to be ready to roll by the end of this month. Yet another new ambulance has also been ordered, which Chastain reports is expected to arrive in January of 2025.