Pat Songer, NREMT-P, ASM, has always had a passion for public service and a desire to direct that passion to the underserved, and sometimes overlooked, EMS agencies in rural America. Working now in Winnemucca, Nev., two hours east of Reno, Songer, director of EMS for Humboldt General Hospital, has developed and launched some of the most influential programs and initiatives that region has ever seen.
The past five years have been particularly busy ones for the energetic EMS director. He has spearheaded the establishment of a critical care paramedic ground system, introduced a new clinical program to use portable ultrasound units in the field to detect internal bleeding and possible blockages in prehospital patients, helped provide handheld blood analyzers to the field, and launched a community paramedicine program designed to reduce ED visits and hospital readmissions. It’s a pretty impressive track record, given that he’s only been at Humboldt General Hospital for 6 1/2 years.
Critical-Care Ground System
Establishing the critical-care paramedic ground system was, perhaps, one of the most crucial and ambitious programs on Songer’s plate at the time. The closest trauma center from the hospital sat in Reno, 175 miles from Winnemucca, and required a patient needing critical care to be flown by helicopter for three and a half hours at a cost of $28,000. Clearly, something had to change.
“Being in frontier Nevada, I’ve always felt that there was no reason we shouldn’t be able to provide the same level of care and the same quality of care that you get in a high-performance urban system like Reno,” says Songer. “We needed to change the system and reduce transport times. We could do that and still get people the appropriate care they needed by doing more aggressive medicine.”
So with the support of the chief executive officer, Songer led the hospital’s EMS system redesign, complete with major ambulance and equipment upgrades, staff hiring and training, and strict schedule improvements. As a result, patient transport times have been reduced to a little more than two hours, and costs have dropped from $7.8 million a year to $1.4 million a year.
“We are getting people to definitive care quicker because we are integrated into the hospital,” he says. “We went from three to 12 full-time paramedics, with someone who does full-time quality assurance. We are immediately notified when there is a potential for transport, so that we can be ready for it and leave immediately.” In short, Songer says he’s surrounded himself with an excellent team that produces quality results.
As part of his five-year plan, Songer applied for and received a grant from the state of Nevada, through the University of Nevada Reno, to start a public access defibrillation program to place 250 automated external defibrillators (AEDs) in government buildings, area businesses, churches and casinos. The hospital donated AEDs to all the public schools in the area.
“We encourage these businesses to purchase the units outright, and then we provide the training, medical direction and supplies at no charge for the life of the AED,” Songer says. “Our hospital decided it’s an important part of the community, and we needed to get everyone equipped.”
The hospital also equipped the police and sheriff’s departments. All officers are trained at an EMT or first responder level and respond to all medical calls. “This increases the survivability rates in those rural areas where getting to someone in four minutes is difficult.”
Songer also introduced a new clinical program to use portable ultrasound units in the field, which can detect internal bleeding or possible blockages in prehospital patients. The units have allowed EMS responders to reduce decision-making time in the field, allowing patients to be transported to a trauma center faster.
“We have trained all of our paramedics in ultrasound, and then we partnered up with our radiology department to help us with our reads and keep us continually competent in the reads we do,” says Songer. The reduced time in the field, along with the added support of radiology, has allowed paramedics to make treatment and transport decisions quickly, saving time, money, and lives.
“Now we can utilize the system better by appropriately bringing air medicine out when needed, or rendezvous on the way to a trauma center,” Songer says.
Along with the ultrasound, Songer also introduced handheld blood analyzers to the field, which allows EMS to quickly identify critically injured patients who need surgery. “We are using the units for everything from analyzing electrolytes to making better determinations on STEMI patients to the use of thrombolytic drugs in the field,” says Songer.
The changes that Songer and his team have implemented in hospital processes and procedures, as well as the equipment he has deployed in the field, are all part of an overall community paramedicine program he’s designed to help reduce ED visits and hospital readmissions.
Humboldt General has been slowly developing its community paramedicine program during the past few years to address such issues as wellness in the community, flu shots, discharge summary follow-ups, medication reconciliations and education on diabetes control and inhaler use.
“The more preventive things we can do in the field, the less of a burden ambulances will be on the healthcare system,” he says. “Conversely, the program can keep more patients out of the hospital and reduce the number of patients we transport. By doing preventive medicine in the field, we can keep our communities healthier, which ultimately will be a savings to all small, rural communities.”
Not only has the community paramedicine program had an effect on Songer’s community, but it has also had an equal, if not greater, effect on the recruitment and retention of EMS personnel. Paramedics at Humboldt are put through a paramedicine course, a move that has been met with an enthusiastic response.
“They see this as the next step of their professional career and a way to provide a higher level of service to their community,” says Songer. “They are able to take care of their community, and the payback is 10 times what it is doing safety-related medicine. Because of this, I have very small turnover. Since I’ve been here, I haven’t had a paramedic leave because they don’t like the job.” Songer also attributes the success of his programs and the retention of his staff to the hospital’s focus on customer service. All of the tools and technology Humboldt uses is in service to its community, and residents are positively responding to the benefits.
“We get excellent feedback from the community, and they support us in all of our functions,” Songer says. “We are reducing the costs to our customers by the technology we are bringing into the field and the level of care that we are providing to them. People love it because they love being taken care of appropriately.”
Despite the significant inroads Songer and his team have made at Humboldt Hospital, he believes there is still more work to do. For one thing, he would like to see more emphasis paid to the needs of healthcare in rural America, which he sees as sometimes taking a backseat to the healthcare needs of more populated urban areas.
"My passion lies in rural communities and making sure they are taken care of,” he says. “In many rural communities, we have paid physicians, and paid fire departments, and paid nurses, yet we still aren’t able to support paid ambulance and paramedic service to take care of community residents. Volunteerism is an important aspect to EMS, but we’ve got to do a better job of tying it all together. We’ve got to take better care of our people.”
To that end, Songer continues to advocate for the best possible care for both his rural community and rural communities across the nation. More than just advocating for rural healthcare, Songer sees his mission as advocating for his rural community family.
“I grew up in a rural EMS system, and I still believe in that small family relationship, no matter how big we are or how big we get,” he says. “Our goal is to provide high-level critical care to a very rural area. Our job is to take care of our community and produce good outcomes. We’re doing all of this so we can build a future for our community.”