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Teams meet monthly to review the latest information on lifesaving measures.
A total of 64 paramedics service Midland, Gladwin, and Alpena Counties, with a bulk of that coming from Midland. That team handled the response to more than 11,000 service requests in 2019, a considerable amount when you factor in there are two paramedics on nearly every call within that service area.
Teamwork is in MidMichigan Health’s makeup, and has been for some time.
Since 1977, Midland EMS has been a two-paramedic service, meaning that every ambulance in Midland and Gladwin County is staffed with two paramedics, a role that receives extensive training beyond emergency medical technicians (EMTs).
While the level of staffing has played a role, two other factors have put MidMichigan Medical Center–Emergency Medical Services on the map for lifesaving measures and outcomes, highly specialized training that is updated in real time and the most advanced equipment.
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Scott Shawl, manager of MidMichigan Health EMS for Midland and Alpena.
“We’ve done dedicated training in disciplines like cardiology, stroke, and trauma with our EMS teams,” says Scott Shawl, manager of EMS for Midland and Alpena. “We’ve also got the most current and optimal equipment here at Midland EMS, including automated CPR devices. Our specialized training in those three areas, along with our standard EMS training, has allowed us to achieve some pretty significant results.”
That training has paid off in big ways.
MidMichigan Health’s paramedic staff has a survival rate more than twice that of both the state and national averages for cardiac arrest.
Those outcomes have been built on a history of extraordinary care, as the Midland EMS training program is in its 10th year of cardiology training, a distinction noted by their recent recognition as a 2020 recipient of the American Heart Association's Gold Plus Award for EMS Agencies, the highest honor awarded to EMS for work in cardiology.
From the cardiac standpoint, the STEMI Alert Program implemented by MidMichigan Medical Center–Emergency Medical Services and MidMichigan Health is designed to rapidly identify patients who are suffering from ST segment elevation myocardial infarction (STEMI) — the most serious type of heart attack.
The program was the first of its kind in the state of Michigan and is now something that MidMichigan Health has implemented regionally.
“Our paramedics are specially trained to do 12 lead EKGs and recognize this type of heart attack and we activate our STEMI protocols from the field,” says Shawl. “That also activates the STEMI Team here at MidMichigan Medical Center – Midland, so the patient is met by an interventional cardiologist and his or her team, who are available 24/7 and patients completely bypass the emergency department and are taken into cardiology for this invasive work.”
It’s also training that MidMichigan Medical Center–Emergency Medical Services intentionally keeps fluid, adapting the most helpful protocols along the way.
“From the cardiology aspect, our paramedics have to pass examination twice each year on the latest STEMI protocols and we also meet and train monthly to see if any changes need to be made with our interventional cardiologists, our Emergency Room physicians and our EMS team,” says Shawl. “The process for our stroke patients is very similar, and we meet regularly with our neurologists and staff. It's continually updating and improving the process, and it never ends.”
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A team of two paramedics responds to every call in Midland and Gladwin.
Shawl has had a long career in the emergency medical field, starting in 1979 as a volunteer while he was a freshman in high school. Under normal circumstances, a person must be 18 years of age to get licensed as an EMT. However, Shawl was part of a group that received special permission from the Michigan Department of Public Health during a shortage of staff at the time who were available and qualified to cover the ambulance in Coleman. He has been with MidMichigan Health in a full-time capacity since 1982, when he hired on after his senior year in high school.
“I’ve been working in emergency medicine for a while now and what the medical community has realized over time is that by including EMS in the initial assessment, we know what our interventional cardiologists, neurologists or trauma surgeons are looking for from us as far as preparation before the patient gets to the hospital,” says Shawl. “They are also preparing for our arrival based off of the data we are relaying to them from the field. Everything we do is so very critical and time-dependent. The faster we get these protocols implemented and the sooner we transfer the patient with the information the doctors need, is where we see improved patient outcomes.”
MidMichigan Medical Center – Midland is a level two trauma center and the nearest level one trauma center is in Flint.
“We see a significant amount of advanced trauma here. Our paramedics are trained on both trauma code one criteria and trauma code two criteria. Both of these will activate our trauma surgeons and trauma team,” says Shawl. “Depending on what type of code we are dealing with will determine the resources that are brought to the emergency department, all based on the report given by the paramedics.”
“Being able to make medical interventions and have positive outcomes in a large percentage of our patients makes it worthwhile,” says Shawl. “When we see patients who may be critically ill and in a time of need and lead them to a positive outcome and moving forward with their families, that's the most rewarding.”
Midland EMS also provides education and training to all law enforcement and fire departments in Midland County.
“They all have a medical component in their training, and in the case of our local fire departments, whether they are volunteer or paid, Midland EMS provides that training and supports our local fire and law enforcement agencies with education in order for them to maintain their licenses as medical first responders,” says Shawl.
The difference is also one that is felt by employees, and many credit the combination of staff, excellent equipment, and unparalleled training for the successful outcomes EMS has been able to achieve.
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Brittin Short, paramedic with MidMichigan Medical Center–Emergency Medical Services.
“When you think about what we do as paramedics, it’s consistently working in an uncontrolled and ever-changing environment,” says Brittin Short, paramedic with MidMichigan Medical Center–Emergency Medical Services. “We do a lot of in-house education and training above and beyond what the state requires and we have great working relationships with our other first responders, like the fire department. That all helps give the patient the highest level of pre-hospital care possible and that it is a seamless transition when we arrive at the hospital.”
Short says the experience among the staff and the level of training have made a big impact for him, as he is coming up on his 10th year with MidMichigan Health.
“It has been really meaningful work, and the two biggest things for me is seeing those positive patient outcomes and the depth of our training. You see people often on their worst day, dealing with significant trauma, and we are able to provide them with the best care to give them the best shot at life,” says Short. “We are also very fortunate to have the system in place that we do, it’s one of the reasons I’ve been with MidMichigan for 10 years.”
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For Trish Knivila, a paramedic coming up on 17 years who also handles dispatching in Gladwin, the teamwork aspect is key.
With the training we receive, you think of it like a team with the staff at the hospital. You develop relationships with these teams and you want to do well for them,” says Knivila. “Since this training has created a team environment, we always feel like if there is an issue where we’re not comfortable with something, we can speak up. For me, that has been invaluable to be able to have that training and trust.”
“This is why we do this work. Each day I go to work, I get the opportunity to activate this training and change the course of someone’s health outcome,” says Knivila. “The STEMI Program is the perfect example of that integration and troubleshooting in action.”