It takes 180 hours to train an emergency medical technician to level-one compliance. Seventy hours of training are required to receive a basic firefighting certification. Seventy more hours are required to reach advanced firefighter status -- the status required for a responder to go inside a burning building. That's not to mention the two to three hours each week emergency responders spend in ongoing training at their local stations, often adding up to more than 100 hours each year.

The emergency services department has an overall budget of more than $3.2 million. Tens of thousands for training supplies, on-call pay for responders going through training, and training equipment.

The Mat-Su Borough Assembly, for two budget cycles, has voiced a commitment to making the borough's emergency responses as effective and efficient as possible, and they've backed that commitment with funding for new positions, more on-call pay and added incentives. What they get in return is hundreds of on-call responders who are prepared to fight fires, perform search-and-rescue operations, dive into dark, cold Alaska waters looking for people and sometimes animals, or respond to the scene of an accident, extricate those involved and rush them to the hospital.

A team of firefighters goes through a training exercise at a borough fire training facility earlier this year. The training exercise is one of many borough emergency responders go through each year to keep their working skills current and learn new techniques. Photo courtesy Mat-Su Borough

It's been a year since the Mat-Su Borough reorganized and later renamed its emergency services department. In that time, ambulance response times -- the time it takes from a call for transport to the time the ambulance and personnel are on the road, heading toward the incident -- have dropped off sharply, from more than 15 minutes to under two minutes in some areas. But has the reorganization been effective? Is it enough to ensure the highest level of treatment available is provided to a patient as quickly as possible when they dial 911? How long until the Valley outgrows this type of coverage?

At your service

As of this week, the Mat-Su Borough had 406 on-call responders on its rolls. They range in age from 18 to 78 and, while some may have only been with the department a few months, others have been providing service to their community for more than 30 years. Most who complete training stay with the department between three and five years.

The number of responders is lower than it was earlier in the year by about 50, according to information from Borough Volunteer Coordinator Kathleen Krug, who said the drop in numbers is typical. Several join the flow of people moving out of the Valley or Alaska in the summertime, a time when people changing living situations is traditionally highest. But when classes start in October, it's likely those positions lost over the summer will be regained.

Of all the challenges facing emergency responders, Krug said, the many, many hours of initial and ongoing training is often the most difficult. Yet many of the responders launch headlong into the training process, striving to be certified both as emergency medical technicians and fire responders.

"Many of them want to be certified in as many areas as they can be," Krug said.

The borough offers two levels of firefighter certification: basic, which allows responders to fight fires on the outside of a building, for example, and advanced, which allows responders to enter a building and fight the fire internally. Four levels of EMT certification are available -- EMT1, 2 and 3 and paramedic. Each consecutive level provides added responsibilities, requires a certain number of patient contacts and, after the initial 180 hours required for EMT1 certification, an additional 50 hours of training and testing. Paramedics training, Krug said, requires an Outside internship in a larger area, because Alaska doesn't often see the severity of incidents seen in larger cities in the Lower 48.

All of the courses are state certified, and Krug said responders are encouraged to progress in their training. In fact, increasing the level of clinical care in borough ambulances is one of the goals of the department.

"We're trying to enhance our clinical capability to keep up with the growth of the borough and provide consistent, advanced-level care to our patients," Brodigan said. "At some point in time, every single ambulance in the borough should have one paramedic on board."

The training is free, although borough staff are currently working on a responder agreement in which the responder commits to one year of service with the borough in return for the free training.

"It's a standard volunteer agreement," Borough Manager John Duffy said. It outlines what the responder will do, such as be on time and ready for service when on duty, as well as what the borough will provide in return. "The main purpose of the agreement is really to inform the volunteer of their responsibilities, and also to inform them of the investment the borough residents are making in them."

Moving toward the future

A shift in attitudes toward training may be one of the most significant efforts the borough is making to help prepare for the future of emergency response. In addition to the goal Brodigan mentioned of having at least one paramedic on board each ambulance, the borough is seeking to keep paramedics' training skills up to date with current techniques. And the goal is to make training levels consistent across the Valley.

"Currently, depending on the day of week or the time of day, you may not get the same response time after time," Brodigan said. Some ambulances, he said, run with only an EMT1 and EMT2 on board -- individuals qualified to respond and offer some levels of care, such as administer intravenous fluids and some medication, but not equipped with advanced cardiac-response skills or other more advanced skills. "We want to get it to be consistent around the clock, seven days a week."

That's not to say the borough's emergency services are lacking, Brodigan said -- it's simply in a transitional period.

"It's the typical growing evolution of a rural EMS system," Brodigan said.

To fill in while more responders are trained to the paramedic level, the borough has instituted a pilot "Medic One" program. In the program, paramedics -- of which about 12 are currently certified in the borough -- are asked to be on-call 24 hours a day, seven days a week. Medic One staff, according to information from the Mat-Su Borough, provide daily operational supervision to two staffed ambulances and on-call responders; responding to every call and assisting with assessment and, in some cases, transport of patients. But the key to the program, Duffy said, may be its flexibility. The Medic One staffers, when not needed in the ambulance, travel in a separate vehicle that allows them to move immediately from one call to the next.

So far, Duffy said, the program has proved beneficial. It's been in place since March, and about 14,400 man-hours have been put into the program. In that time, 155 critical patients have been responded to, stabilized and transported. Twelve times, LifeGuard was called and the paramedic managed the scene until the helicopter arrived. In 27 instances, patients were intubated; 15 cardiac arrests were managed and three additional cardiac arrests were handled on children under five years old.

"It's really improved the quality of service," Duffy said. "It's actually saved lives because we've had a paramedic on scene."

That program, in addition to 24-hour, seven-day-a-week service in Wasilla, Palmer and Big Lake and at peak times in other communities, has helped offset the increased demand felt in those communities.

"It's all part of an evolutionary process; it'll continue to develop and develop, just as it did in Wasilla," Brodigan said. "The core area has evolved very, very rapidly over this last fiscal year."

The communities of Big Lake and Meadow Lakes, he said, are seeing significantly higher call volumes than in the past, as are Palmer and Wasilla. Some of the outlying areas have remained the same, for the most part -- and that's where an added challenge has come into play.

Krug said one of her biggest challenges as volunteer coordinator is to get people from the outlying communities to join on as emergency responders.

"We have a very big need in our outlying communities -- Sutton for fire, Willow for fire and ambulance -- a real dire need," Krug said. "I sent out letters to everybody living in the fire service area in Sutton, letting them know we have a need, and I've received no response."

Without emergency responders, Krug said, people are placing their community in a precarious position.

"People have to start to realize if they want to feel safe in their communities, they have to contribute their time," Krug said. Currently, communities without service are relying on service from nearby areas -- Palmer provides service for Sutton, for example. But, Krug pointed out, time is crucial in emergency situations such as fires. "It's not if there's going to be a fire, it's when," Krug said.

What's next?

Where the borough moves next, Brodigan said, is largely a political decision. Currently, the borough's EMS program is subsidized by borough taxpayers by about 50 percent. The other 50 percent is recouped through transport fees -- $350 for basic patient care, supplies and medications or $450 for acute care, supplies and medication, plus $5.50 per mile.

Those fees went up recently, by $50 for each type of transport, and also by 50 cents per mile. The raise -- the first in five years, Brodigan said -- was requested after he looked into what other municipalities charge for their service in Alaska after a study of transport fees came out recently. The new fee levels puts Mat-Su on par with other services across Southcentral Alaska.

"We were charging less than the state average," Brodigan said. "We need that revenue coming in to ensure we can upgrade our system. We're not in business to make a profit."

The added charges haven't received any complaints, and Duffy agreed they've allowed the department to move forward in addressing issues of growth.

"It was a significant source of revenue for EMS," Duffy said. "It funded the $900,000 that came up in the last year, and we've been able to continue with what we're doing without having to ask for an increase in the mill levy."

While full-time paramedics is the next step to address ongoing growth in the Mat-Su Borough, where it goes from there, Brodigan said, is a question for the elected officials.

"It's a political decision, in terms of what level of service you want to provide," Brodigan said.