Paramedic’s Corner: History of the Pulaski County Ambulance District

Gary Carmack, Ambulance Director

Paramedic’s Corner: History of the Pulaski County Ambulance District

Gary Carmack
A few days ago a person was telling me about someone who thinks Pulaski County Ambulance District (PCAD) is a county entity or department and should give part of our revenue to the Pulaski County sheriff’s department. I told the person that would not be legal, and it is not appropriate. I explained to the person that PCAD is not a county department, rather a state entity. We take care of patients and are not public safety, we are healthcare. I realize that longtime readers and citizens here probably know all of this; after all, the citizens are the ones who developed the ambulance district. No large organization, no big money, a true grass-roots endeavor by the people…for the people. So, before telling the history for the new readers and new people in the community, the most salient point of this article is to inform the readers that PCAD is a State Political Subdivision licensed and regulated by the state Department of Health and Senior Services (DHSS). The ambulance district is not regulated by the county or the county commission. I also explained to the individual, if the few people who want to do this could, which legally they can’t, but if they did this, where would it stop? No organization would be safe, school districts, fire districts, cities. All could be targets. This would be a very dangerous precedent to establish and would no doubt result in law suits for years to come.

Telling the history of PCAD requires a look back at the hospital that was here for years: The Pulaski County Memorial Hospital (PCMH); and even a glance backwards in time to local funeral services. In the 1960s and early 70s, many of the ambulance services in the nation were provided by funeral services. Here in Pulaski County funeral services provided ambulance coverage until 1973-74. Then the hospital started providing the ambulance service.

What brought about these changes in ambulance service was the need for adequate civilian prehospital emergency care. Most advances in trauma care back then occurred during wartime. In the civilian world rescue techniques were crude, ambulance attendants were poorly educated, and equipment was minimal, usually little more than a cot and maybe some oxygen. Police, fire, and ambulance had no radio communications. In 1966 a study was conducted and a report made to Congress called “The White Paper.” It was realized that in 1966 more Americans were dying on our roads and highways, than in the jungles of Vietnam! Congress passed the National Highway Safety Act, which established the U.S. Department of Transportation (DOT), a cabinet level department charged with providing grants to states for emergency medical services (EMS) development.

Then, in 1973 Congress passed the Emergency Medical Services Systems Act. This was big because of the famous 15 Components of EMS Systems, which actually created situations whereas most funeral services then turned ambulance responsibilities over to local hospitals or fire departments across the nation. One of the biggest components, costing a lot of money, was the new federal requirement of manpower and training. Each ambulance would be required to have two licensed people on the ambulance and many states required at least the patient attendant to be what was called an Emergency Medical Technician (EMT). The funeral homes at that time usually just had an ambulance driver and no attendant. The driver might or might not have some first aid training, far from the level of EMT and paramedic training.

Locally, here in Pulaski County the funeral service turned the ambulance service over to PCMH. This is also when this writer’s career started. I was hired at PCMH to work as an ambulance attendant/driver and had to agree to attend an EMT course as soon as possible. In Missouri, the ambulance services were to have two licensed EMTs on each ambulance by the end of 1975. I went to EMT school in 1975 and then attended paramedic school at the University of Missouri Medical Center in 1975-76, receiving a paramedic license in August of 1976. With this and a great emergency room physician, the late Dr. Warren B. Hamilton, the hospital started the first Advanced Life Support (ALS) ambulance in this county.

Sadly, the hospital closed in 1986. Without a hospital the PCMH Ambulance service was discontinued as well. Citizens had to call Fort Wood or Dixon ambulance to receive medical assistance. There was no 9-1-1. Response times were long. People suffered and some died. In 1987, the citizens lead by the late Dr. Edward Jenkins, Attorney Tyce Smith, Nurse Candy Wrinkler, Businessman Keith Pritchard, and many citizens worked hard and got an ambulance district put on the ballot. The citizens approved the ambulance district and a board of directors was appointed. The citizens named the district the Pulaski County Ambulance District. The board of directors hired this writer in September of 1987 to start putting together an ambulance service with the goal of being operational November 1, 1987. We succeeded and responded to our first calls on November 1, 1987. The board appointed Dr. Jenkins as the first medical director.

The ambulance district is governed by Missouri Law, section 190. The State of Missouri Department of Health and Senior Services issue a license to the district every five years following a very meticulous state inspection. The district is required to follow regulations and medical standards as established by federal and state laws and standards.

The district is required by law to have a board certified physician as the medical director. The physician also must meet certain stringent emergency training requirements. The district is very fortunate to have Dr. Barton Warren as our medical director.

The district has 4 ambulance bases, one in Waynesville, Crocker, Richland, and Laquey. We have 5 first out emergency ambulances and teams. This requires 5 paramedics and 5 EMTs daily. PCAD also has call-ins for transfers and we cover a lot of community events. The paramedics respond to fires to be on standby in case a citizen or one of our firefighters get hurt or sick. We are often called for special standbys by police. PCAD currently employees 41 employees and the district works hard to attempt to keep employees as the Fort Leonard Wood Ambulance paramedics are Civil Service GS7 employees and the fort is constantly hiring. Currently the fort is looking to hire 6 EMTs and 6 paramedics. The EMTs are GS6s, which will make more money per hour than most of our paramedics. The district maintains a very aggressive education program and we respond to a large number of emergencies. A lot of new paramedics like to start here because of our call volume and our training program. After gaining experience many go on to other services. We do have a core of longtime employees who remain at PCAD and work hard toward our goal of being the best ambulance service possible and taking excellent care of our patients. We are very thankful for them. Thank you to the employees and to our citizens for their support.

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