Jasper County’s reserve deputy paramedics may be a solution to EMS struggles in rural Iowa

Editor’s note: The following story is the first in a multi-part series about Jasper County’s efforts to improve emergency care for rural residents and assist the volunteer teams struggling to keep crews full and find new members, many of which may not have the means or time to be certified for paramedic-level care.

When the reserve deputy paramedics of the Jasper County Sheriff’s Office arrived on scene to give an overdosing patient a life-saving dose of Narcan to temporarily reverse the symptoms of the narcotics they had consumed, the first words that came out of the man’s mouth were: “Thank you.”

Emergency response teams throughout Iowa — whether they are employed by a municipality or are strictly volunteers — have experienced moments like these in some form. But the decline of volunteerism is leaving some rural communities vulnerable to lower response times and, in some cases, less adequate care.

Jasper County Sheriff’s Office was thrust into a perfect opportunity last year to address the struggles of volunteer agencies and provide extra assistance by creating the advanced life support pilot program. About $180,000 in CARES Act funds paid for two part-time reserve deputy paramedics.

The county then received $7.22 million in American Rescue Plan Act funds, and the board of supervisors was willing to designate $2 million to expand the program by adding four more part-time positions. As of January, two of those positions have been filled, and they, too, will provide paramedic-level care.

The county also authorized the purchase of EMS vehicles for the part-timers leading the program, including a more than $354,000 ambulance.

Steve Ashing, one of the two reserve deputy paramedics that launched the program in March 2022, described the opportunity as a perfect storm, lightning in a bottle. Funds were available, two reserve deputies already had paramedic training, the need was there and the county supervisors were willing to try it out.

“Things have aligned just right to make this all work,” Ashing said in the early hours of his Thursday shift. “Having two paramedics as reserves, that is very unheard of in a lot of places. We had an opportunity with a sheriff who is very EMS- and fire service-driven and understands it, which is another anomaly.”

EXTRA SUPPORT FOR THE SMALL TOWN AGENCIES

In addition to his duties as sheriff of Jasper County, John Halferty regularly volunteers for the fire department in Mingo, a town populated with a little more than 300 people. Ashing, too, has worked a volunteer crew in his 23-year career as a firefighter; for the past 16 years he has served at the Newton fire station.

When Newton receives an ambulance call, Ashing said there are always two people who can respond, and then two to four more who can assist the primary responders within five minutes. Generally, there is always someone on scene with paramedic-level experience to administer advanced life support services.

However, when a rural EMS agency responds to a call, the likelihood of having a paramedic with a patient is less certain. Ashing said about every community — if not every community — in Jasper County has at least one paramedic. But life and other factors may limit that individual’s response time.

Which is where the sheriff’s office’s part-time reserve deputy paramedics come into play. When either Ashing or fellow paramedic Jacob Halferty arrive to a scene, they have to step in and serve as the primary care provider as they have the highest level of care experience among the volunteer EMTs.

Oftentimes the small town volunteers are still the first teams to respond to calls, but there have been instances where the reserve deputies administered care before other agencies arrived. John Halferty said there are good, dedicated people watching over the small towns, and the program is not taking them away.

“Some agencies, including a couple within this county, do an outstanding job,” John Halferty said. “They’re able to staff calls every time. But I also believe those services, along with others, if just two or three people decide to not be volunteers or respond anymore, they’re going to be hurting.”

DOUBLE DUTY AS A RESERVE DEPUTY PARAMEDIC

Officers and emergency response personnel never want to say the “Q” word, but it was abnormally silent during Ashing’s shift last week. Two days prior his fellow reserve deputy paramedic was constantly responding to calls in his 12-hour shift. But if there was a call, Ashing was more than equipped to handle it.

Inside the trunk of his patrol vehicle is what seems like an endless supply of medical equipment and supplies for almost every situation; backpacks filled with gauze and tourniquets, airway management tools, IV bags and all kinds of medicine. This is not what the typical sheriff’s deputy has in their vehicle.

Most of the first aid kits in patrol cars are for the individual officers. Some may have traffic control equipment, but none of them carry a cutter-spreader combination tool or a fireman’s axe for extractions. Ashing even carries a NarcBox to keep controlled substances locked away.

“A deputy is going to have a lot less,” Ashing said, noting a regular deputy that is not a regular EMT will have accident investigation supplies, evidence bags, first aid kid, “go bags” and perhaps more ammunition-based equipment. EMT-certified deputies may also carry an EMS bag with basic life support supplies.

Of course, there is also a large difference in medical skills between most law enforcement officers and the reserve deputy paramedics. Usually, officers know basic first aid and CPR, and they are trained how to use an automated external defibrillator (AED).

For some of Jasper County’s reserve deputies to have trunks full of medical equipment and have the skills to use them, Ashing said it is uncommon.

When Ashing and Jacob Halferty are not responding to medical calls, they are still conducting duties as reserve deputies by providing backup to other deputies, patrolling communities, following up warrants, covering administrative duties, enforcing code violations and conducting traffic control.

THERE ARE DIFFERENCES BETWEEN EMT AND PARAMEDIC

Several of the volunteers in the small towns are EMTs, but that level of certification still limits what they can do. Ashing said an EMT can perform CPR, use AEDs, package wounds, stop bleeding and use splints, among other things. A lot of what an EMT does is assessing patients and recognizing conditions.

“Stroke, heart attacks, breathing problems. Does this person have a breathing problem? Is it just a simple asthma-type thing? Or is it more? A lot of it assessing the patient and being able to know when to call a higher level (provider),” Ashing said. “And they can’t give many medications themselves but they can assist.”

Apart from giving aspirin and glucose, EMTs may assist patients in taking medicine they are already prescribed, like an EpiPen.

Hours of schooling also differentiates EMTs from paramedics. For some people, Ashing said it is too much to ask a volunteer to dedicate the amount of hours it takes to be a fully trained, fully certified paramedic. Unless they are working for a municipally owned fire/EMS station, there is not much incentive. Plus, it’s costly.

“It’s a daunting thing,” Ashing said. “You have to be the right person. EMT is a basic stage and gives you some basic knowledge of major life threats, major bleeding, major breathing issues. But it doesn’t get down into the nitty-gritty, the pathophysiology of different disease types that a paramedic does.”

OTHERS SEE COUNTY’S PROGRAM AS A STATEWIDE SOLUTION

Word is getting around about the pilot program. Ever since it was implemented, other agencies have contacted the Jasper County Sheriff’s Office and wanted to know how it is handling similar challenges. It may not be the solution, but it is a solution that has intrigued others, including the state.

“It’s interesting to have people that curious and engaged and wanting to learn more from us,” Ashing said. “We’re making a wave of some sorts.”

Support from the Jasper County Board of Supervisors has helped the program gain momentum this past year. Innovation does not come easy in the field of first responders, or rather the acceptance of innovation. So often, Ashing said, people get complacent and do not want to change the way things are currently operated.

Refusing to change or choosing not to respond, however, could prove disastrous for the residents who rely on their local EMS crews to provide timely and adequate care. Ashing understands the hesitancy. Solutions don’t come easy; neither is implementing a solution. There is no guarantee it will work.

The county’s program was a “big, outside-the-box step,” John Halferty said, and it was a big step. But he, too, felt apprehensive about introducing the program.

“It continues to grow, and with growth sometimes you have growing pains and challenges,” John Halferty said. “But I guess that’s the good part of this program. We’re not getting complaints from the public. We’re not limited on funding at this point. We’re working on plans to sustain the funding of the program.”

The impact of the program is clear to the sheriff. There have been numerous calls, he said, where the sheriff’s office was able to provide a paramedic more timely than if the county had to collaborate with a metro agency, like Mercy Ground or first responders from Altoona in Polk County.

“On the highest level, we can provide a paramedic when they’re working who can either assist that medic or take over primary care if needed,” John Halferty said.

If there was an individual suffering a heart attack in one of the rural parts of the county, all the first responders and EMTs know CPR and how to control the airway. But even then a care provider with advanced life support skills is needed to either provide medications or use other methods to restart the heart.

Emergencies that require a timely response to save the patient — like a heart attack or stroke — can still result in a death no matter if a paramedic is on scene or not. But getting that level of provider there is critical to ensuring each patient has the best care possible in their time of need.

“When you have a witness cardiac arrest and CPR is started and you get advanced care there as quickly as you can, you know they had the best opportunity,” Halferty said. “And the family knows that, too,”