In the event of a medical emergency, calling 911 is recommended. And, as long as a phone with service is readily available, help should arrive regardless of your location. Once the call is made, who is dispatched to provide life-saving care? How did responders get to where they are, and why? While each community in south-central Indiana has access to emergency medical services (EMS), individual journeys into this field are varied, and EMS configurations can differ by geography. However, there is a strong spirit of interconnectivity for EMS personnel and agencies across our region.

Paths for entering an emergency medical profession

In Nashville, Dave Frensemeier is a paramedic and supervisor of the Brown County Ambulance Base. He is also the assistant chief at Hamblen Township Volunteer Fire Department. When Frensemeier moved to Brown County in 2000, he read a newspaper article about how all of the local volunteer fire departments were short-handed and needed help. “So I decided to join my local volunteer fire department and help out,” Frensemeier recalls. “I fell in love with the job and I’m still with that department.”

Frensemeier obtained certifications for emergency medical responder (EMR) and emergency medical technician (EMT), followed by advanced EMT certification. 

“By 2015, I had worked with Cummins for twenty years, and my kids were all grown. I didn’t have sports and stuff to pay for, and thought, ‘You know, I’m going to pursue a career I want.’” Frensemeier proceeded to work as an advanced EMT, then pursued paramedic schooling in 2018. Since then, he has been with the Brown County Ambulance Base, where the ambulance service provider transitioned from Columbus Regional Health to IU Health LifeLine in 2021.

At the Columbus Fire Department, Cody Hercamp is a lieutenant and paramedic. He is also a volunteer fire chief in Jackson County and works part time at Jackson County EMS. Hercamp had his sights on emergency response at an early age, starting with memories of playing with toy fire trucks as a preschooler. 

“In eighth grade, I joined Seymour Firefighter Explorers through the scouting program,” Hercamp recalls. “When I got into high school, I took athletic training and medical biology, then started an EMR class while I was a senior.” After graduating from high school, he pursued EMT training, as well as fire science and paramedic degrees through Ivy Tech Community College.

Similarly, flight paramedic Ashley Lucas remembers making miniature casts out of tissues and tape for her dolls as a child. She knew she wanted to pursue the medical field and initially considered nursing, but found the duration of nursing school to be an obstacle while parenting an infant daughter. While working as an aide in a nursing facility, Lucas recalled a patient with bilateral amputations who developed sepsis. “I remember everybody was panicking because he was starting to crash, and they called for an ambulance,” Lucas recollects. “They came around the corner and just did their thing. They were very matter-of-fact and to-the-point. They were calm in the midst of everything else that was not calm.” 

Tom Figolah, Bloomington Fire Department’s Community Engagement Officer

Inspired by the service and demeanor of EMS crew members, Lucas pursued EMT training through Pelham Training, which was based in Bloomington but has since moved to Bloomfield. “The EMT program was three months long back then, and I was able to get my EMT certification and start working as an EMT,” Lucas notes. Quickly realizing how much she enjoyed EMS work, she then pursued her paramedic certification. Now, Lucas works out of the Seymour base for StatFlight, which is a collaboration between PHI Air Medical and Ascension St. Vincent Health.

For Tom Figolah, Bloomington Fire Department’s Community Engagement Officer, a career in emergency services started after he graduated from Indiana University with a degree in public management and environmental science. In particular, addressing wildfires with the United States Forest Service sparked his path toward firefighting. 

“I was missing out on some of that action and adventure that I was not getting in the cubicle writing reports in the EPA,” Figolah recalls. He switched from environmental consulting work to a position with Chesterton Fire Department, in his hometown. From there, he moved to the Fishers Fire Department, then ultimately to the Bloomington Fire Department. Figolah notes that everyone in the Bloomington Fire Department is trained in first aid and CPR (cardiopulmonary resuscitation), and many crew members have EMT certification.

More autonomy versus more resources

Although the stakes can be high, Frensemeier finds responding to medical emergencies in relatively remote areas to be rewarding. “I love rural medicine,” he notes. “It really allows me to use my skills and education, because we’re so far from a hospital. In a big city like Bloomington, you’re so close to the hospital, you usually don’t have enough time to really do a lot.” From receiving a call, picking up a patient, then arriving at the hospital, Frensemeier observes that his crew generally spends at least an hour on each assignment. “We go a lot deeper into our protocols and medications to bridge that time gap. I get to see how things work. I like the challenge of it.”

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We back up Monroe County quite often. They’ll get so busy they run out of trucks, and we’ll go over and take a run.

—Dave Frensemeier of the Brown County Ambulance Base

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In her first 911 job, Lucas worked in Orange County, where Paoli and French Lick are located. “It was a pretty rural community. They do have a small hospital, but there’s a lot that can’t be done at that hospital, so I got to do lots of rural EMS.” She concurs that EMS crews spend notably more time with patients in rural settings. “You have to develop really good assessment skills,” Lucas notes. “You have to not be afraid to treat a particular type of thing. Whenever you’re a little bit more urban, you have a little bit more help on-scene. It kind of takes the pressure off a little bit. There are still high-pressure situations, don’t get me wrong, but there are more resources to help you in an urban setting.”

The Star of Life has been adopted in many places around the world as a symbol of emergency medical services. It features a serpent and the Rod of Asclepius, an ancient Greek god associated with healing.

As an example, Bloomington Fire Department has five fire stations. According to the city’s website, the department has 117 employees and responds to over six thousand emergencies annually. “We are two-and-a-half minutes away from any emergency after we get the call,” notes Figolah. “We have lots of fire hydrants, water pressure, and volume. We now have top-notch fire engines and ladder trucks. Our training has never been more intense, with more hours spent training, than it is now.” Figolah notices that Bloomington Fire Department and the nearby Monroe Fire Territory, which primarily focuses on calls outside of city limits, currently have similar training and equipment. “So, when we do work together out of mutual aid, things are less confusing.”

With roles in both urban and rural settings, Hercamp appreciates that each day presents different situations, while the gratification of helping neighbors is consistent. “It’s kind of cliché to say, but on their worst day, we’re there to make it better,” Hercamp notes. “It can be that they’re having a heart attack and we saved their life, or they’ve been in a bad car wreck and we’ve been a part of the team to help see that patient through to the end of survival.”

EMS challenged by supply and demand

While larger urban communities tend to have the tax base to fund salaried fire departments and EMS crews, rural communities commonly rely on volunteers. Frensemeier and Hercamp noted that barriers can prohibit individuals from joining or staying with a volunteer fire department. “The standards a volunteer firefighter has to have are the same training a paid firefighter has. We have to go through all the same classes,” Frensemeier explains. “Used to be, we could do a little more of an abridged class, but now it doesn’t work that way. Just to become a firefighter, your first class is a three-month class.” Hercamp adds, “It’s almost a six-month process to get your Fire I and II [certifications] if you’re doing it two nights a week.”

In addition to a rigorous onboarding process, balancing work and home lives with volunteerism can be difficult. “It is very hard to get volunteers. It’s not like it was, even when I started back in 2001, that people could leave their jobs to go on an emergency,” Hercamp recalls. “Now, you can’t.” Frensemeier adds, “It’s hard to get people to have that kind of time commitment to take the training, the meetings, and the fundraisers to keep the departments running, and then making runs on top of it. It’s quite the undertaking nowadays.”

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It’s kind of cliché to say, but on their worst day, we’re there to make it better.

—Cody Hercamp, Columbus Fire Department

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In Jackson County, Hercamp notes that the volunteer departments are tax-based as either a fire district or a fire territory, but the levies were set about twelve years ago. “We’re at a point that that money that was set back then is no longer able to sustain the services that are needed,” he explains. “So, my department does two fundraisers a year to help supplement. We’re not poor by any means, but we’re not rich. We’re able to replace the basic stuff like PPE [personal protective equipment] every ten years, trucks, and stuff like that. But a fire truck three years ago cost $300,000. Now, it’s $500,000. And it’s the same amount of money coming in. So, we have to make our stuff last longer and stretch our dollar, which is very, very difficult at times.”

Dave Frensemeier in the garage of the Brown County Ambulance Base. | Photo by Christine Brackenhoff

Minding that rural EMS crews tend to be smaller and volunteer-driven, Lucas observes that it can occasionally be more challenging for a flight crew to obtain on-scene help in more remote areas. “Most of us are pretty strong, but there are patients that aren’t able to help bear any weight. If it’s just you and your partner, you have to figure out how to get that patient from Point A to Point B so that they can be transported,” Lucas notes. “Or, if they’re in cardiac arrest, it’s just you two to figure that out.”

While Bloomington has a larger EMS infrastructure, a larger population can also push the limits of available resources. “The demographics give us a wider array of emergency calls that we go on,” Figolah explains. “The university makes things very dynamic: the sheer number of kids, and then every year there’s over 10,000 kids that move out of the dorms into our community, and now they’re cooking for the first time in their life. So we have a lot of kitchen fires, cooking fires.” Figolah also notes that, over the past decade, the Bloomington Fire Department has seen an increase in medical runs. “We now run a medical rescue truck that has two firefighters on it that run our medical runs downtown. Instead of running a four- or five-person fire engine through town, we have a two-person rescue that goes to medical runs.”

EMS closely intertwined locally and regionally

To serve the public, collaboration among EMS workers is essential. “We back up Monroe County quite often. They’ll get so busy they run out of trucks, and we’ll go over and take a run,” Frensemeier explains. “Same here, with us only having two trucks.” For example, if both of the Brown County trucks are responding to calls and a third call comes in, a truck from Monroe County may respond to it. “We’ll call the closest county to us to send an ambulance for the call. There’s a lot of mutual aid between counties.”

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Every year there’s over 10,000 kids that move out of the dorms into our community, and now they’re cooking for the first time in their life. So we have a lot of kitchen fires, cooking fires.

—Tom Figolah, Bloomington Fire Department

”

Likewise, Lucas describes first responders as a close-knit community that assists one another whenever possible. “If a fire department is there, they can help carry, help lift, help do CPR if needed,” Lucas notes. “Some of the fire departments have paramedics, and then they can show up ahead of us and start the ALS [advanced life support] process. They can start an IV, they can start doing CPR, they can start pushing medications, if necessary.” Even if a particular fire crew does not have paramedics or EMTs, Lucas notes, “most of them will be like, ‘I can hand you things. I can hold things. If you tell me what you want me to do, I will do exactly what you tell me to do.’”

In Bloomington, a mobile integrated health (MIH) team is composed of EMTs. The program identifies community members to whom EMS frequently responds, then works to connect them to local aid. Figolah notes that the MIH program has noticeably decreased these types of runs for the fire department. “That’s been a game-changer for us,” he explains. “They’re working a lot with people in poverty and getting the resources they need. Area 10 Agency on Aging is a resource that some people don’t know about. If they’re not able to feed themselves, we contact those agencies for them, so they’re not on their own. The MIH team coordinates all those contacts, makes sure those resources contact that person … like a social-work side of things, with that medical edge.”

While the EMS community is familiar with this interconnectedness, Hercamp acknowledges that this can cause confusion for the general public. “Some people don’t understand that when an ambulance is called, the fire department comes too. We’re all part of that emergency medical system.” 

While scopes of practice vary, EMS professionals work together to bolster health and safety across the map. They cannot always reverse the effects of a medical emergency, but they aim to improve outcomes. “Sometimes, we can take you to the hospital. For certain things, there’s nothing we can do. We can do stuff that we’re trained for, but we’re not doctors,” notes Hercamp. He would also like the public to understand that understaffing, or simply busier-than-usual conditions, can affect EMS workflow. “There is an increased call volume and a decrease in volunteers. I think there’s still even a shortage of EMTs and paramedics in the state of Indiana.” While medical emergencies are distressing, there is reassurance to be found with the highly trained workers who are ready to respond to calls for help.

Editor’s note: Christine Brackenhoff is a nurse at IU Health but was assigned this story by Limestone Post as a freelance contributor.