Forming a Unique Alliance

View a video interview with Jeff Dumermuth below this article.

In an effort to improve EMS care in Iowa, Jeffery Dumermuth,  CMO, EMT-PS, chief of Emergency Medical and Communications Services for the city of West Des Moines, spearheaded one of the more unique partnerships within EMS.

Dumermuth combined private hospital interests with a municipal city EMS operation to form the Iowa EMS Alliance, one of the few, if any, partnerships of its kind in the nation.

“The city of West Des Moines EMS had a good relationship with our area hospitals, and we’ve tried to be on the edge of providing emergency medical care,” Dumermuth says.

Some of the hospital’s primary concerns were centered on their specialty transport teams. Example: The hospitals have created pediatric and neonatal specialty transport teams that respond to emergencies involving babies 1 month and older, children, and adults 18 years of age who are critically ill or injured. Specially trained nurses and paramedics staff these specialty teams. The surrounding hospitals in the area asked West Des Moines EMS to back up another EMS agency that supported their hospitals, and the agency agreed.

“It didn’t take the hospitals very long to like what they saw,” says Dumermuth, who has been with the city of West Des Moines since 1983. “Our staff is highly professional and highly trained. We were already going out to the rural hospitals in the state with our specialty care and transferring it back to the hospitals.”

The Need for a Better Answer
When the hospitals began having service issues, they considered starting their own ambulance service. Dumermuth saw a rare opportunity to provide a solution where everyone could win. “We sat down at the table and told them [that] we have the expertise, management, and billing and purchasing operations it takes to run an ambulance service,” he says. He asked if there might be a way to form a partnership, instead of providing separate services. And so the discussions began.

The city’s EMS service had five 24-hour trucks serving the city and surrounding area, as well as the major hospital systems. It was more than equipped to provide the partnership service.

As the talks continued, the hospitals liked what they heard. Dumermuth outlined criteria that had to be met. Example: 9-1-1 response times could not suffer. “We had to take care of the citizens of West Des Moines and make sure they had a rapid and high-quality response that they’d become accustomed to,” he says.

A deal was struck. Four hospitals in the West Des Moines metro area signed agreements, resulting in a nearly statewide response.

“Our transport ambulances were in nearly two-thirds of the state of Iowa over the last year,” says Dumermuth. The agreement allows others to join, but Dumermuth says the city hasn’t aggressively pursued those opportunities at this time.

The participating hospitals essentially pay all the costs associated with running the ambulances out of their facilities, and administrative costs are shared between each hospital and the city of West Des Moines. “We share in the administrative costs, which is where the city got the biggest benefit,” says Dumermuth. “Before the agreement, the city was paying 100% of costs. With the new agreement, the city pays about 40% of the costs. It saved our citizens $200,000 in the first year.”

Rural Areas May Benefit the Most
Although the city of West Des Moines and the four area hospitals certainly benefit from the unique partnership, it is perhaps the rural communities who feel the advantage most. They are notoriously underserved, something that Dumermuth kept in mind while crafting the agreement.

“The specialty teams will transfer any patient to the hospital from the rural communities,” he says. “So now the rural hospitals have an ambulance available.”

Before the partnership, dispatch­ing an ambulance in one of the surrounding rural communities–whether it was for 45 minutes or three hours–left the community uncovered, because most of these small communities have only one ambulance. “They are unwilling, for good reason, to leave their response district open. We fill that need by making those transfers,” he says.

It’s not just the city, hospitals and rural communities that benefit from the partnership. The EMS staff and paramedics, 20 full-time and 50 part-time employees, also enjoy many advantages. The staff bids on, and rotates, shifts between units at EMS stations and the hospitals, which create more opportunities for exposure to advanced clinical situations than the 9-1-1 environment can provide.

“They are usually assigned to a station for six months, depending on where they bid,” Dumermuth says. The agreement has created nine new full-time paramedic and three EMT basic jobs.

The bidding arrangement has resulted in attracting and keep­ing high-quality staff, professionals who tend to take their jobs seriously and stay for years.

“We get them trained and make sure the staff we send to the hospital is the highest quality staff out there,” says Dumermuth. “Our full-time staff are critical care trained paramedics, and we are the only agency in central Iowa that requires a two-year degree to start full time with our department. Those extra things are what set us apart.”

Enhancing Care While Strengthening Core Skills
In addition to traditional runs, paramedics assigned to the hospitals, and functioning in the specialty teams, also have the opportunity to assist within the hospital setting. “They are stationed at the hospital when they are assigned to their trucks,” says Dumermuth. “If the hospital needs extra help in the ICU or the ER, the team has the ability to do that.”

This has allowed many of the paramedics to not only be exposed to a variety of medical situations, but also to follow a patient through the whole spectrum of care, something the traditional 9-1-1 environment rarely allows.

“When they are in the hospital, they have the ability to use their skills in the ER, or elsewhere throughout the hospital, to keep their skills refined,” Dumermuth says. “We have the advantage of exposing our staff to more situations in different environments, and they are presented with so many more training and educational opportunities.”

The cross training and exposure has also provided paramedics with greater ease in acute situations.

“In EMS, one of the challenges we get presented with is taking care of kids, which is always a high stress time for paramedics or parents,” Dumermuth says. “With our paramedics going out with these specialty teams and frequently being exposed to these sick kids, they are much more comfortable dealing with children when they come back into a 9-1-1 environment.”

The agency also is committed to making sure the ambulances and equipment are of the highest quality and in good repair. “We portray a professional image,” Dumermuth says. “Our high-quality equipment, high-quality staff, and our commitment are things we’ve worked hard to achieve, and it was important to the hospitals.”

Extending Resources to Fortify Communities
Dumermuth is credited with creating the partnership vision and overseeing all the logistics to make it a reality, but he is quick to give accolades to all the people who helped him bring the idea into existence. “I’m very blessed to have some extremely talented staff,” he says. “Taking care of patients is what we do, and we make sure we do a great job in that.”

The program has given the city a way to effectively deploy scarce resources in a time of severe budget constraints, which assists all involved, especially the more rural towns within the state of Iowa.

“It gives us the ability to extend our arm and our professionalism and help out some of these smaller communities that are running out of resources,” he says. “If we can share our resources and go out and make a difference, not only in our community but also in the state, I think that’s a blessing.”

Just sitting by and doing nothing was an option, but that’s not part of Jeff Dumermuth’s makeup, nor is it the makeup of the city he works for.

“Thinking outside the box is what we do,” he says. “It would be easy to keep things status quo with budgets and the economy the way it is. But being able to diversify services and look for revenue resources without getting stuck in the traditional 9-1-1 delivery of service has been a great benefit to our community.”

The community would certainly second that.

Please view the interview with Jeff Dumermuth that took place at EMS Today.

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