Water, Drownings and Paramedics

The AMR EMS Water Rescue Boat Prepares to dock.
The AMR EMS Water Rescue Boat Prepares to dock. (Photo - JohnRey Hassan/Global Medical Response)

Responding to the Needs of Increased Water Recreational Activity

Learn how Napa County (CA) EMS adapted to a sudden surge in water-related emergencies in a remote location of the county.

Introduction

The cycle is all too familiar to first responders. Someone calls 911 screaming that someone is drowning or, worse, has drowned. Law enforcement, fire, and EMS are toned out. In a matter of minutes, sheriff boats, fire engines, and  ambulances are on scene – but it’s too late. In 2020, this scene played out six times in a mere four months in one location in Napa County, California, in Lake Berryessa. If six tragic drownings weren’t enough, the number of water sports-related injuries tripled as more and more people took to the outdoors during the COVID-19 pandemic.

After a year in which the Napa County EMS System evacuated the same hospital twice in 40 days, grappled with massive wildfires, and responded to the COVID-19 crisis from the Grand Princess Cruise Ship at the Port of Oakland to New York City, suddenly there was another crisis – the water. Fortunately, through a close partnership among the Napa County Sheriff’s Office, Napa County Fire/CALFIRE, the California Highway Patrol (CHP), and the Bureau of Reclamation, the Global Medical Response American Medical Response (AMR) and REACH Air Medical Services (REACH) Napa County EMS team was able to develop an innovative strategy to support drowning prevention efforts and rapidly increase the speed of advanced care to those in need. This involved the deployment of an ALS paramedic rescue boat, the establishment of a lifeguard program and the re-positioning of air medical assets.

Background: The Napa County EMS System

REACH 3 departs from Lake Berryessa with a critical patient on board.
REACH 3 departs from Lake Berryessa with a critical patient on board. (Photo – JohnRey Hassan/Global Medical Response)

Situated 60 miles north of San Francisco, the 45-mile-long Napa Valley – with a daytime population of approximately 150,000 – is world-renowned for winemaking, fine dining and outdoor recreation. For the past decade, AMR has served as the exclusive 911 ambulance provider in the county. A REACH helicopter is stationed at the Napa County Airport for response to remote areas of the county and beyond. The City of Napa and City of American Canyon provide ALS fire first-response while Napa County Fire/CALFIRE, St. Helena Fire and Calistoga Fire, provide BLS first-response. The AMR Napa County EMS system includes a fully integrated tactical medical team with the Napa County Sheriff’s Office, a wildfire EMS team, a bike team, a CISM support team and a remote operations team. The Napa County EMS Agency serves as the regulatory body and, along with fire departments, law enforcement, and hospitals, is a key partner in the development of innovative programs and clinical practice.

The Need: Lake Berryessa

The manmade freshwater Lake Berryessa sits approximately one hour from downtown Napa in Northeast Napa County. Lake Berryessa was established by the creation of the Monticello Dam in 1958 and, at capacity, contains over 1.6 million acre-feet of water, 165 miles of shoreline and is 26 miles long. A once-popular destination in the 1990s and early 2000s for boaters, swimmers and partiers, Lake Berryessa had experienced a decline in visitation, usage, and, as a result, a decline in EMS call volume. The 2020 COVID-19 pandemic changed all that – rapidly. With travel restricted and other common tourism destinations closed or restricted, purchases of boats increased and visitation at Lake Berryessa soared. This increase in visitation has continued into 2021 and, with Napa County recently signing an agreement with Sun Communities to spend north of $100 million to revitalize the resorts and areas around Lake Berryessa, the visitation and associated EMS call volume shows no sign of slowing.

A Paramedic Water Rescue Boat

Members of the 2021 AMR River Rescue Team in Oregon who were essential in getting the Napa County program operational.
Members of the 2021 AMR River Rescue Team in Oregon who were essential in getting the Napa County program operational. (Photo – Barrett Hendrickson/Global Medical Response)

With the sudden increase in activity and incidents both on the water and in the surrounding lake area, the need for additional EMS resources was apparent. Given the geography of Lake Berryessa with 165 miles of shoreline, getting around the lake by vehicle can be challenging and time-consuming. The Napa County Sheriff’s office has been the sole public safety agency with boats on the water. The Sheriff’s Office is an essential partner in responding to emergencies, joint training and sharing certain facilities. Fortunately, when one GMR operation has the challenge to address, it’s likely that somewhere in the nearly 700 GMR operations across the country, someone else has encountered it before. In the case of Lake Berryessa, GMR had encountered a very similar challenge at AMR’s Lake Havasu River Medical operations. After discussions between the two divisions, GMR moved a water rescue boat previously deployed on Lake Havasu to Lake Berryessa. By doing so, GMR was able to add an on-the-water paramedic asset in addition to shortening response times to shore-based incidents around the lake.

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Napa Operations Manager Jason Bond reports, “The boat allows us to respond to areas in 10 minutes that would take 45 minutes or longer by vehicle.” The Thunder Jet Boat is equipped as a full advanced life support first response vehicle and has marine, VHF, and county radios, water navigation equipment and assorted rescue devices.

Without proper training, simply having a boat with a paramedic on it isn’t enough. AMR Napa County sent personnel through an external 40-hour rescue boat operator course designed for public safety agencies. The course provided education in close quarters boat operations, water rescue operations, navigation and much more. Beyond just the boat and training, AMR invested in various water rescue devices, life jackets, and specialized bags to ensure the boat was fully prepared to respond.

A fully deployed boat crew consists of one driver/operator, one lifeguard/paramedic, and at least one additional paramedic. Fully capable, the boat can bring the paramedic directly to the patient on the water or, if necessary, deploy a lifeguard directly to a patient. Within the first hours of the boat being in service, it was responding to calls. During the team’s first call, a patient was experiencing a possible cardiac issue at a campground adjacent to the lake. The boat responded to the dock at the campground and deployed two paramedics who were able to walk up to the campground and begin advanced life support care. Without the boat being able to directly deploy ALS from the water to shore, it would have taken an additional 20 minutes for ground ALS to respond from their location at the lake. This call proved to be just one of over 20 incidents the EMS boat responded to over the 2021 summer season.

Lifeguards

AMR Napa Paramedic/Lifeguard Anthony “Lambo” Gallardo-Moser trains with AMR River Rescue on the Clackamas River in Oregon.
AMR Napa Paramedic/Lifeguard Anthony “Lambo” Gallardo-Moser trains with AMR River Rescue on the Clackamas River in Oregon. (Photo – Barrett Hendrickson/ Global Medical Response)

For two decades, the AMR River Rescue program in Multnomah County, Oregon, has provided river rescue lifeguard services to the community. Over the years, this program is credited with saving hundreds of lives. The program trains EMTs as U.S. Lifeguard Association Certified Lifeguards and also in swift water rescue, and staffs them at Glen Otto Park on the Sandy River and High Rocks Park on the Clackamas River. The two-week training program is physically intensive, consisting of everything from shore-based rescues to kayaking, high-lines and lifeguard-based boat deployment. To apply to this highly selective program, an applicant must be an EMT or higher and able to swim 500 meters in under 10 minutes. When the AMR Napa team identified the need and opportunity for lifeguard services, the decision to turn to the experienced team at AMR Multnomah River Rescue was easy. Program Coordinator Phillip Stoinoff and Operations Manager Jason Mahle and their team spent countless hours with AMR Napa leadership ensuring the Napa team understood the nuisances of beginning a lifeguard program and requirements for safe operations.

The Water Rescue Boat on Lake Berryessa. (Photo – JohnRey Hassan/Global Medical Response)

To help jumpstart this new program, AMR Napa sent paramedic Anthony Gallardo-Moser to the AMR River Rescue Academy in Portland. An experienced paramedic and former lifeguard, Gallardo-Moser excelled in the River Rescue Academy. Paramedic/Lifeguard Moser was able to immediately put his training to use back in Napa County, becoming an integral component of the water-rescue boat program. By having a lifeguard on-board the boat, AMR Napa can insert a trained professional directly into the water to affect a rescue. Ultimately, to ensure maximum safety and inter-agency cooperation, AMR Napa decided that the full implementation of a lifeguard program will wait until 2022. As we look to 2022, the goal is to expand this valuable program to offer shore-based lifeguard and prevention services around Lake Berryessa.

Air Medical Operations

AMR Napa County and REACH Air Medical Services pre-positioned at Lake Berryessa.
AMR Napa County and REACH Air Medical Services pre-positioned at Lake Berryessa. (Photo – JohnRey Hassan/Global Medical Response)

The REACH helicopter is a fully integrated asset in the Napa County EMS system providing 911 scene response and critical care interfacility transports. The aircraft is a twin-engine, IFR-capable, EC135-P2 staffed with a flight nurse, critical care paramedic and pilot. In response to the increase in call volume at Lake Berryessa – and its location being nearly an hour by ground from the nearest trauma center – GMR began repositioning the helicopter directly at the Lake on summer weekends. Having the helicopter already at the Lake has proven beneficial in shortening the time it takes to get someone to definitive care while bringing advanced critical care directly to the patient. Through the use of an EMS gator, a patient can be transferred a short distance directly from the EMS Boat to the REACH helicopter. The CHP has been an essential partner in allowing REACH to use their second helipad and providing paramedic air rescue services when REACH is encumbered.

Innovate Solutions for a Unique Challenge

On September 14, 2021, AMR was selected by the Napa County Board of Supervisors to serve as the sole 911 ambulance provider – and sole provider of most paramedic services in the County – for another 10 years. With this new contract comes a renewed call to service. To that end, the paramedic-staffed water rescue boat, lifeguard program, and integrated use of the REACH helicopter will remain essential tools to help ensure the safety of residents and visitors to Napa County. GMR Napa is infinitely grateful for the strong support and partnership of our fire, law, government, and health system partners. Our dedicated EMTs, paramedics, and local leaders are the backbone of our success.

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