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Healthy Talk
Answering the Call: Emergency Care in Boone County
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In this episode of Healthy Talk, we explore the critical role emergency medical services play in keeping our community safe. Rob Fenley, Director of Ambulance Services at Boone County Hospital, shares insight into the work EMS teams do every day to respond quickly, provide life-saving care, and support patients during some of life’s most urgent moments.
Rob walks listeners through what really happens when someone calls 911—from dispatch to on-scene assessment and the advanced care that often begins before a patient ever reaches the hospital. He also discusses the unique challenges of providing emergency care in a rural community like Boone County and the training and preparation required to ensure crews are always ready to respond.
The conversation also highlights the importance of reliable equipment in emergency care, including the recent addition of a new ambulance made possible through community support. Whether you’ve ever wondered what happens behind the sirens or want to better understand the people and preparation behind emergency response, this episode offers a meaningful look at the dedication, teamwork, and readiness that help protect Boone County every day.
Stay informed, stay healthy, and keep the conversation going with Healthy Talk.
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Welcome & Introduction
SPEAKER_00Hello everyone and welcome back to Healthy Talk, Empowering Your Wellness One Conversation at a Time. I'm your host, Rachel Mann, and today we're talking about something that most of us don't think about until we really, really need it. Emergency medical services. When you hear sirens in Boone County, that's someone's worst day. And it's someone else's job to run towards it. I'm joined today by Rob Fenley, our director of ambulance services here at Boone County Hospital. Rob, first of all, welcome and thank you for being here.
SPEAKER_01Well, thank you for having me.
SPEAKER_00You're still relatively new in this director role, so I'd love for our listeners to get to know you a little. How did you end up in EMS in the first place?
SPEAKER_01I started on a volunteer fire department pretty much right out of high school and really didn't want a whole lot to do with the medical side of it. But then a friend of mine that I went to school with was a paramedic, and he just happened to pick my grandma up one day, and he kept telling me, you should take the EMT class. And I'm like, hey, I'll think about it. And he was like, Well, don't think too long because it starts tonight. Oh, jeepers. So talked to my wife about it, and I took the class and I was almost 36 years ago.
SPEAKER_00Oh my goodness, that's a fantastic story.
SPEAKER_01So yeah.
SPEAKER_00What during your time as director has surprised you or maybe encouraged you in the last few months?
What EMS Really Looks Like
SPEAKER_01I've been a part of it for a long time, and I've seen some of the behind the scenes, but a little bit maybe in shock of what it really does take to keep everything running. Sure. You know, the meetings, the finance and everything with it. But really, other than that, I've been a part of this for so long that feels second nature. Yeah.
SPEAKER_00Let's pull back the curtain a little. Most of us only see the ambulance drive by. What actually happens from the moment someone calls 911?
SPEAKER_01So when you call 911, it used to be, you know, your landline when they went to 911 was hooked to nowhere going. And now cell phones, it'll go to whatever closest tower how it bounces off. And that's what the closest 911 center is where it will go to. So we actually do have a few places in the very far south part of the county or north part that you know you might still be in the county a little bit, but your call may go to Dallas County. Sometimes it goes back and forth. So then it goes through our dispatchers who are emergency medical dispatch trained. So they have an algorithm that they go by. So it may seem like they're asking you a lot of questions and it's taken time, but there's a reason to take that extra little bit of time of the questions to improve the speed of us getting to you. So then they page us out over radios and uh pager, and they'll give us name, address, what's going on. We have two crews on all time, and usually are out the door within three to four minutes. Pretty much everybody knows based on what the call is, and pretty much everybody from the beginning, and it works more as you get more experience. We're thinking, okay, this is what we were told, this is the equipment we're gonna need. This might be what we need to do. Do we need these extra resources? You're always thinking ahead of what you're getting ready to do. Sometimes what you get told over the radio is not even close to what we walk into. Then it's just uh matter of seeing what you got, assessing the patient and treating what's wrong with them as the best you can and getting you transported.
SPEAKER_00It's not just sir, do go, go, go, go. There's some planning that's involved while you're trying to fast, right?
SPEAKER_01It's it's a lot more than Chicago fire in your watch.
SPEAKER_00I'm sure everybody has heard the phrase every second counts, but when it comes to medical emergencies, that's not just a phrase, is it?
SPEAKER_01No, no, and there's some more than others, of course. Your heart conditions, your strokes, you know, major traumas, stuff like that. Those are probably the most very time sensitive. There's a lot of different things that we look at and that we can go off of as far as for where we're going to transport you to, how we're gonna transport you, whether we take you by ground, whether we bring you back here, maybe transfer you then. Sometimes we fly people directly from the scene based on what it is, because there are some things that they've changed over the years, whether it's us in the hospital, wherever, is changing daily. It's especially in the last 10, 15 years, it's really gone that way. So it makes a big difference as far as what we can do to treat you. We used to have a system of 10 minutes for a trauma, 20 minute for a medical on scene. They've kind of did away with that just because they found out that if we stay on scene and begin certain life-saving measures, the patient outcome is greatly improved. So that's why we stay on scene a little longer. You know, it's not so much that, hey, what's wrong with you, throw you on the cot and go.
SPEAKER_00Would you say that being in a rural community could add complexity to how fast you can get places?
SPEAKER_01Oh, absolutely. Winter time.
SPEAKER_00Sure.
SPEAKER_01Yeah. Whenever we talk to people about the distance we travel, we cover a very large area, we cover all of Boone County and we assist in other surrounding counties. We try to tell it as on a perfect sunny day, this is how long it would take. There's parts of our county that it may take us 25, 35 minutes to get to on a good day.
SPEAKER_00It makes preparation even more important.
Common EMS Misconceptions
SPEAKER_01Yeah. You look at Boone County mostly as people travel through on the highways, unless you're going on 30, it looks nice and flat. And so you get along the Des Moines River Valley and there are some very, very big hills. So when it snows icy, it makes it hard to get to people. We had an ambulance got stuck yesterday because of the snow.
SPEAKER_00What's something that you would say people often misunderstand about the ambulance service?
SPEAKER_01Well, right now, the biggest issue that a lot of people see in the news, a lot of people still don't understand it, is you know, people always do complain about hospitals in small communities. It's just human nature. Yeah. If you call 911 and I've been there before, you might be right across the street from the ambulance, and it's gonna seem like it takes forever for them to get there. And like I said, we do cover a big area, so you know, it's gonna take a little while. Boone County is set up very good as far as for our EMS system. There are a lot of counties that wait over an hour, hour and a half, if they have an ambulance coming. Because the whole EMS is an essential service, is a big issue in Iowa.
SPEAKER_00You know, and right now nationwide, it's a I was shocked to hear that Michaela wrote an article about it in our community newsletter last year. And the fact that we lose a million dollars as from having it, yeah, that that it's not by is Medicare and Medicaid don't deem it uh necessary which you'd think like of anything in the hospital.
SPEAKER_01Yeah, but the st but the state doesn't either. Like if if you live in a town over a certain amount of people, population, then fire and police are an essential service. Yeah, they have to have that. They fund it or whatever. EMS isn't that way. There's a lot of towns that don't have ambulance services, or if it is, it's a volunteer. And you know, it's a different time. People are busy, people work out of town, they're away from stuff. People don't volunteer like they used to for you know EMS and fire departments. The volunteer services, it's hard for them to get help. You know, you might be waiting for a long time in a lot of places, and people don't realize that. Most people just think if I call 911, an ambulance is coming. Sure. Not necessarily. In Boone County, you will be.
Training and Preparation for EMS Staff
SPEAKER_00Yeah. We're very lucky. Yeah. What kind of training and education does your team need to complete to keep certifications or well?
SPEAKER_01They have different courses. They have a lot of online courses now for like to get an EMT, it's about six, eight months. Uh paramedic, anywhere from about a year to sometimes around two years. They have advanced levels that's kind of in between the EMT and the paramedic. We only have actually one of those. Everyone else that we have right now, except for maybe a PRN, is all paramedic level. Once you get that, then medicine EMS is forever changing, you know, constantly changing. So you have to have a certain number of continuing end hours to recertify. We have to recertify every two years. You used to have to go to conferences, you have to go to places. And it's actually made it a lot easier now. You know, when it first started, everything online, it's like, well, you're not going to learn anything just watching it on hands-on is better. I still think it is, but really with COVID, it really took off of the online courses that you can do. We use what's called Prodigy. It's a system that has all kinds of training scenarios and training videos that you watch. And basically it's like sitting in a classroom, only you don't have to travel all over to do it. You can get all your containing ad hours. You still have to do some hands-on, like your ACLS and your PALs and uh CPR, all that stuff. And working full-time really helps. Just besides the minimum stuff that you have to have, there's a lot of new stuff that comes along that hey, we're gonna add this. We need to have a training on it before we put it on the truck. We're gonna change this medicine. It's like a constant training.
SPEAKER_00How many staff do you have?
SPEAKER_01We have 14 full-time, I believe, and six or eight, I think, PRN.
SPEAKER_00Two per rig?
SPEAKER_01Yes.
SPEAKER_00Okay. So you always have four people here.
SPEAKER_01We have four people here 24-7, and then the fire department has our third crew rig. And then we have the fourth truck that we either use for a spare, if one's in the shop, we use it for events, or sometimes if you have a crew available, if you got a lot going on.
SPEAKER_00So I do want to talk about the new ambulance that recently came into service because I think sometimes people see it and think, oh, that's nice, but it's more than nice, isn't it?
SPEAKER_01Dependability is so much for us. When I first started here, some of our trucks had a lot of miles on them and they're very expensive. It takes a lot to keep them up and keep new ones going. It's hard to provide the best care you can when you think in the back of your mind, what if this breaks down? It was just in the shop last week. So when you get new equipment like we've got now, and you've got the dependable, well, not just the trucks, but the everything else that we have, it takes that out of the back of your mind. And there's everything like that helps with providing better patient care.
SPEAKER_00Absolutely. For those of us who aren't inside the ambulance, what's actually in there? Because we talked about purchasing this new ambulance, and we were telling everybody, you know, like this is how much it costs, but it comes empty. Yeah, it doesn't include all the things that you need for life-saving measures.
SPEAKER_01On average, I would say from the time you buy an ambulance, equip it, probably at least half a million dollars to put everything in it because anything medical equipment is it costs a lot. And with the technology that's changed in the last 20 years or so, expense goes with that. But all that people see is they might look in the back or you see the cot, of course, that we come out with, and maybe the bag. Well, that bag has a lot of stuff to begin the life-saving treatment. We have the heart monitors, which we just got all new in the last year or so. We can do anything from blood pressure to check your oxygen level to the defibrillation that people see when you shock people to get their hearts going. We have the equipment to start IVs, give different IV fluids. We have a whole great big medicine box that we can give.
SPEAKER_00It's almost like you take a room out of the ER kind of pretty much exactly.
SPEAKER_01We like to joke around with the ER people that we do the same thing you do, only at 70 mile an hour. But yeah, there's a lot of equipment in the back of there that we use depending on the different situations.
SPEAKER_00Do you have the Lucas machines? I'm sure those have been around for a long time, but I know when we were doing the educating and empowering you programs, Mark Addy came and talked and showed. And I'm like, I've never seen this. And I was a lifeguard growing up, so I took CPR class, but it's really cool to see that machine that Lucas device, it never gets tired. Right.
SPEAKER_01You might have to change the battery, but you take the human element of wearing out. I really don't care how good a shape you're in, do CPR for two minutes or a couple cycles of two minutes, and it seems like a half hour. It makes such a huge difference in rural communities. You know, the small towns, a lot of the normal first responders you might see in the evenings and at night. Well, they work out of town during the day. So you might be limited on how much help you have. Well, that takes the whole aspect of somebody being tied up doing chest compressions that can be doing other things to help save people. It's a very, very, very nice thing. And they really haven't been around that long in the grand scheme of things. They're 10 years. Okay.
SPEAKER_00So right now, with this new ambulance, we have four ambulances, three here. Yes. Okay. We raised money in 2018 at Harvest Festival for an ambulance, but foundation only paid half of it. Yes. And so I thought it was really cool this time around being able to fund the whole thing. So knowing that our community really stepped up and made this possible, what does that mean to you and your team?
SPEAKER_01Well, it's huge. It's just like the ribbon cutting that we had the other day. And without the support of donors and community members and businesses, people that care, you we wouldn't be able to buy these ambulances like me. It would take probably two or three more years of trying to save and trying to get or buying at Ablins and then not being able to get other things that True. You'd have everything tied up into just that.
SPEAKER_00Yeah. Without sharing private details, would you be able to give us an example of when dependable equipment really made a difference?
SPEAKER_01A long time ago, not here. This wasn't here, but had a patient that was partaking in extracurricular activities and was all over. And there's three of us in the back just trying to kind of keep him under control. There's bars in the back up along the roof. We always joke about people hanging from those. Yeah, he was. We couldn't keep him down. And all of a sudden we hear the driver, and if this was a truck that we'd had issues with, and all of a sudden we hear him go, oh no. And we're 20 minutes from hospital or any help coming or anything, and the truck breaks down on the side of the road.
SPEAKER_00What do you do?
Community & Trust
SPEAKER_01We this was before you had medications, the type that we do now that helped sedate people. And it was just an all-out wrestling match until another truck got there and law enforcement. It was a small community, so you know, that maybe only had like one sheriff's deputy. He may have been the other side of the county. You know, that's one that it wasn't necessarily a life-threatening. Sure, thank goodness. But I've also had equipment fail in that type of situation. And that is the most gut-wrenching feeling when something like that happens. I mentioned before, and I think that's why when you have equipment that is older, if you've done this for a long time like I have, you've had those experiences. So it's in the back of your mind. So it's hard to focus on providing the best care you can with that. So when you have the equipment like we do, you don't have that. It's your mind's clear, you don't have to worry about that. You know, there's always going to be stuff happen, but you're not thinking about, oh, you know, this truck's been in the shop for the last three years, or this monitor, the batteries keep going mad. Yeah. It is so nice to have basically to say top of the line equipment is what we have right now. And it's really nice.
SPEAKER_00So this goes perfectly then with what you were saying about this person you picked up. When someone in Boone County dials 911, maybe they're scared, maybe it's chaotic. What do you want them to know?
SPEAKER_01Help is coming. You say perfectly that they're scared, chaotic, you know. There are times when that pager goes off and people are thinking, oh, you know, it's this person again, and everybody's guilty of it. But to that person on the other end of that phone, you know, you may not think it is, it may not sound like it is, but it's an emergency to them, whether it's a mental health crisis or whether it's a little boy or girl that for some reason mommy or daddy's laid on the floor, they can't wake them up. Everything is different, and it's hard sometimes not to take things for granted, but it takes one time of getting caught on that that you realize, you know, that person just because they've called 30 times, the 31st might be the one. People get very frustrated. I've heard the 911 tapes of the dispatchers asking them questions, and they feel like it's taken them too long. They don't need to answer all these questions. In the end, the questions they ask might be taking 30 seconds to maybe a minute.
SPEAKER_00Everything's gonna feel longer.
SPEAKER_01To that person, it seems like an hour, but it's all for a reason. So you gotta try to stay calm, try to answer the questions as best you can because that saves us so much time of doing a lot of it once we get there.
SPEAKER_00Looking ahead, what excites you most about leading this department?
SPEAKER_01I think we've got a good department. I think we've got a good group of people. I think the future of the hospital looks good, where the leadership that we have here, I think, is going to make it to where we can continue to grow and provide better care just in the last few years. The change in the equipment and everything and the support that we have from administration and the community, it just makes me feel like we can continue to grow. We've started doing a lot more stuff within the community, like schools, you know, helping us CPR. And I like doing that. And can it possibly do an outreach, like write-along type situations to get younger people involved? Whether it's nursing, EMS, stuff like that, there's a shortage. It's hard to get people do it. So if we can reach out to the younger generations and get them interested in what we do and show them what we do, the best way to do that for kids is hands-on. Absolutely. And it's fun to just watch them, they get so excited about it. So, yeah, being able to continue to do that and grow within the community, I think, is gonna be fun.
SPEAKER_00If someone's considering supporting local health care, what would you say to them or what would you want them to understand about the impact of their support?
Closing Thoughts
SPEAKER_01We can't do it without the community support. Based on incoming revenue, it's hard to keep up with you, or you're not you're not going to because of the return that you get with EMS. You know, we could not even remotely have the equipment we have without the work the foundation has done for us the last several years. The generosity of local businesses, people, it would not be possible whatsoever. I can't tell you thank you enough. And thank you on behalf of myself, my crew, the hospital, and the entire community. Yeah. You know, when people do that, it's not just helping us to do stuff, it's the entire county, the entire community. Yabors with the Yeah, yes. It's huge.
SPEAKER_00Rob, thank you so much, not just for being here today, but for stepping into leadership in a role that truly matters when it matters most. And to our listeners, when you hear those sirens, know that behind them is a team that's trained, prepared, and supported by our community. Until next time, stay informed to help you and keep the conversation going with Healthy Talk.