The Ruby Valley Medical Center could not find an ambulance service within four counties to transport a patient in need of immediate care to Butte July 19.
A week after Herbert Smith’s heart attack, he was back in RVMC. He needed to go to St. James Hospital in Butte, where the pacemaker and stint in his heart were put in days earlier.
The single paramedic crew, working the Ruby Valley Ambulance Service July 19 could not make the transfer because it had to remain in Madison County in case of a 911-call.
"It was kind of like the perfect storm,” Ruby Valley Medical Center CEO Landon Dybdal said. “Everyone was out.”
State laws and regulations that guide EMS services require ambulance services to have a paramedic and an emergency medical technician in its service area to respond to 911-calls. One crew for the day meant that RVAS would not be able to make any transfers that day.
A patient in critical enough condition could warrant a helicopter transfer through Life Flight. But the service can cost tens-of-thousands-of dollars, insurance companies do not always cover the cost and patients’ bear part of the cost. Patients cannot request a Life Flight transport. The emergency care provider or treating physician decide whether an air ambulance is needed.
Herbert’s wife, Kelly, and their neighbor Nancy Males drove him to Butte Sunday afternoon. The next day Herbert, 76, died at St. Joseph’s Hospital.
“It was pretty traumatic,” Kelly said. “None of us get out of this alive.”
RVMC has mutual aid agreements with surrounding ambulance services. Jefferson Valley, Dillon, Ennis and Butte ambulance services were either short staffed due to COVID-19 or did not have a crew available to help.
“I love those nurses up there,” Kelly said. “They did their best and saved him. They called the ambulance and the ambulance refused.”
According to Dybdal, it is rare for the RVAS to have a single paramedic crew working. He said about once a year RVAS cannot transfer a RVMC patient to another hospital because of the 911-response requirement. RVAS has three full-time paramedics and several EMS volunteers.
“Because we operate on a volunteer crew,” Dybdal said. “We didn’t have a crew available for a second out.”
According to Kelly, a few hours passed as RVMC searched for an ambulance service to transport Herbert to Butte. Herbert was in pain but according to the RVMC emergency room log, he was not having a heart attack. Around 12:30 p.m. Kelly, Herbert and Males drove an hour to St. Joseph’s Hospital.
“We want to make sure that we try to provide the best possible care that we can to our community,” Dybdal said. “I wouldn’t say we dropped the ball but it’s something we need to look at and see if we can improve our care here and make sure that we do the best job that we can.”
Dybdal said there needed to be better communication between EMS and the nurses July 19. RVMC may consider using a nurse in an ambulance transfer if RVAS does not have enough crew members.
“I’m going to talk highly of my crew - they are doing a great job. We do what we can based on the limited resources that we have because when it comes down to it, we’re still a rural critical access hospital and a rural EMS service. So, we don’t have unlimited resources, unfortunately, but we do the best with what we have.”