IL Medics Took Future into Their Own Hands

Paramedic work suits Steve Siltman - that's why the manager of the Logan County Paramedic Association has been at it for more than 30 years. At one time, though, it looked certain that Siltman would leave the industry, and the highly trained team he belongs to would be broken up for good.

Then came the LCPA gambit.

RAISED ON a Brown County farm, Steve Siltman had farming in his blood. Or so he thought when he enrolled in agricultural college right after high school. By the end of that first year, though, he knew it wasn't in him to follow in his father and grandfather's footsteps. He left college to find his own path.

Siltman worked for the railroad for a short time. He drove a concrete truck for a while. Nothing grabbed him until he signed on at Logan County's Abraham Lincoln Memorial Hospital in 1974 and took the six-month EMT Basic course. "Ambulance work appealed to me right away," Siltman says. "I like to help people, I like to be on the move..."

The program Siltman had entered was an exceptional one. Ambulances of that era most often were associated with funeral homes. They were operated by trained - but part-time - volunteers. ALMH, on the other hand, hosted a team of specialized EMTs.

This was possible through an arrangement with the county, which purchased and maintained all four ambulances via a tax levy. It also was due, in large part, to the efforts of hospital administrator Emil Stahlhut and Dr. Gene Blaum, a physician practicing in Lincoln at the time. They felt ambulance crews had the potential to do more than transport patients.

Blaum describes the situation as he saw it. "Back in the early '70s, when a person got sick or hurt, the ambulance that came out would be basically a stretcher in a hearse. There was no first aid, nothing. But I'd been in Vietnam. I'd seen firsthand from the medics what could be done to treat a patient at the scene."

Siltman enjoyed the working environment at the hospital.

"When we weren't on call, we were part of the emergency room staff. We'd help on the floor ... help with IVs, put in catheters, prep people for surgery ... it was a community hospital, and I liked that."

In 1978, at the direction of the hospital and with the blessing of the county, Siltman and about 10 other EMTs were sent for training in advanced life support. The course at St. John's Hospital in Springfield was the first in Illinois held outside of Chicago and served to advance the team from a classification of "EMT basic" to that of "paramedic."

The training took a full year. Once they became full-fledged paramedics, the men and women were certified to perform life-sustaining acts not available to basic EMTs. They could conduct invasive procedures like intubations, deliver meds and start IVs, among other duties.

Siltman continued with ALMH and was promoted to assistant supervisor in 1983 and then to supervisor in 1988. He stayed in that post until 1997, when he stepped down to return to serving as a line medic, citing life changes. "I felt I'd done a good job as supervisor," he says, "but at the time I needed to have less responsibility."

MEANWHILE, changes were occurring at ALMH. In 1994, the management of the hospital was taken over by Memorial Health Systems. It quickly came up that the hospital was losing money on its ambulance service.

The level of county subsidization played a roll. "Logan County had a smaller tax levy for ambulances than some counties, and that contributed to the problem," Siltman says. "Some counties - Mason County, for example - have a higher tax levy for ambulance service. They can offer the service without losing money. The ambulances in Havana are still attached to the hospital."

There also was an issue with Medicare, Siltman adds. "A high percentage of our patients are retired and on Medicare. Hospitals answer to Medicare Part A for reimbursement. Part A pays a lower percentage than Part B for the same services. A nonattached ambulance service answers to Part B."

ALMH announced in May of 1999, citing financial reasons, that there would be no new contract for its paramedics when the current one was up in November of that year. This sent the ball back to the Logan County Board, which determined that ambulance services for the county would have to be put up for bid.

The announcement was unsettling news for Logan County paramedics. Would they be able to get jobs with the incoming company? If so, would they be treated fairly, or would preferential treatment go to existing employees? ALMH always had done right by them, but what would be the case under new management?

That was where the situation stood when Siltman went on vacation with his wife and daughters on a planned trip to Arizona. It was as good a time as any to go. It offered a chance to reflect: He'd been at ALMH for a long time. Did he want to throw in with the new ambulance company, or was it time for a change?

DAN DEAN was another paramedic at ALMH. While Siltman was thinking over his options, Dean and some of the others felt they had none.

"We were between a rock and a hard spot," Dean says. "We didn't know if we'd have jobs or not when the dust settled. So we started talking about forming our own company."

Dean recalls: "We didn't know where to go, or who to talk to. But I remembered Mike Abbot, the instructor of a class I'd taken, talking about Fulton County. They'd been in a situation like this one in the early '90s and had started a nonprofit ambulance company."

The group would have to come to a decision quickly. Two well-established, for-profit companies already had submitted bids to the Logan County Board: Springfield Area Ambulance and Decatur Ambulance Service.

"We didn't know if we had a chance or not," Dean says.

One crucial decision was made early, he says. "All of us involved sat down and agreed: If we were going to do this at all, we wanted Steve (Siltman) for our manager."

SILTMAN, MEANWHILE, knew none of this. He had returned to Lincoln convinced he was ready to move on.

"I had in mind to start a small contracting business - build wooden decks, room additions, that sort of thing. When Dan called and explained what the paramedics were thinking, I had to digest it for a while. I wasn't sure," he says. "But after a few meetings, it looked doable, and I signed on."

The paramedics of ALMH began to actively pursue the idea.

Dean says, "Tina Pitchford (another paramedic) and I and Clifford Sullivan (a county board member) went and talked to Andrew Thornton, who started the company in Fulton County. He's their CEO, and he was a lot of help.

"We went through loads and loads of paperwork. We got that to Thornton," he says. "His recommendation was to approach community leaders, look for support there."

What they needed first was a strong enough board of directors to impress the bank.

"We thought of people who had expressed an interest in the ambulance service," Siltman says. "People with clout."

One obvious choice was a longtime supporter who knew the field, knew the players and had the right connections in the community: Blaum.

"All through his career, he's been highly respected," Siltman says of the physician who now practices in Springfield. "He has a heart for this."

Blaum agreed to help enlist volunteers to serve on the board of the new venture and to oversee the acquisition of financing. Soon, the team was holding meetings in the doctor's home, on the sly.

"We were doing things covertly," Siltman says. "Sneaking around. We didn't know if we could make a go of it. If we decided against bidding, or if our bid was refused, we didn't want to alienate the very people we would be turning to for jobs."

The Logan County Paramedic Association - a not-for-profit corporation - came into being in mid-October 1999, just four weeks before the Logan County Board would meet to make their final decision. They had their board - an impressive team with Blaum in the director's chair and a strong list of members. People like Warren Peters, a local attorney and longtime friend of Blaum, and Shirley Edwards, a member of the Board of Trustees for Lincoln College.

"The people who served on the LCPA board - I asked them to sign on the bottom line," Blaum says. "They took on the financial risk for the loan."

That loan was substantial - $200,000 to cover equipment, plus all fuel, payroll and incidentals until the first billing cycle was complete and money would start coming in.

The LCPA submitted its bid to the county board immediately, complete with a detailed business plan. There were no more secrets. They were committed.

THE SECOND WEEK of November 1999, at a crowded meeting of the Logan County Board, members heard arguments and made their final decision. At the end of the evening, the upstart company, LCPA, won out over the established rivals.

"The board was anxious to keep it local," Blaum says. "But what I think won it over is that the paramedics supported it, those on (the LCPA) board supported it, the ALMH doctors supported it - and we were all present at that meeting to say so."

The company had two weeks to assume responsibility for ambulance service in Logan County. Facilities and garage space were rented from the hospital; equipment was purchased, most of that from the hospital as well. Everyone pitched in.

LCPA was up and running by Dec. 1, 1999, with Steve Siltman at the helm. For the first six months, the association operated with almost no money coming in while waiting for its first reimbursements from Medicare, Medicaid and private insurance companies.

"The concern of myself and the (LCPA) board at that time," Blaum says, "was could we survive financially? Fortunately, the bank supported us. We were tight with spending, and we were successful."

Before the end of the first year, the upstart ambulance service had paid off the $200,000 bank loan. It was building a reputation. The gamble had been a success.

IN 2002, LCPA found new independence with a move into its own building - a renovated car dealership on Postville Road in Lincoln, purchased contract for deed. The sharp new facility was a far cry from the days of sleeping next to the morgue. In 2005, LCPA went to the Logan County Board looking for a fifth ambulance, and got it. This summer, the association hopes to expand the garage.

"We've had all kinds of support from the county board and from the hospital," says Blaum, who still serves as board chairman. "The building we're in now is great; we have no problem attracting paramedics... It costs over a million dollars a year to run the company - we almost have to have a new ambulance chassis (the box that sits on back) every year. Yet we continually ask the county board for less money than they were spending when we took over."

One thing everyone currently is excited about, looking to the future of LCPA, is the new "paperless" system, which allows information to be entered directly into laptop computers with a docking station in each ambulance and a link to hospital and LCPA computers.

"We just switched over," Siltman says. "It's going to be a great time-saver. Some people have neat handwriting and some don't. So, charting will be more precise and concise this way and a lot quicker.

"Also, we recently purchased a 12-lead EKG," he says. "That piece of advanced equipment allows doctors at the hospital to see the heart from 12 angles. That's one way they diagnose an acute heart attack."

The EKG was paid for by LCPA itself, with money from FEMA.

"We loaned (FEMA) three or four paramedics and an ambulance for (Hurricane) Katrina," Blaum says.

Siltman, Blaum and Dean all stress that the formation of the LCPA was possible only through the combined effort of many people, and that its continued success depends on community support.

And the farmer's son, who chose a new direction some 32 years ago? At 52, Siltman has no regrets.

"For me," he says, "it was the right move. I'm quite satisfied. My wife, Ann, supports me despite the sometimes rough hours. I have a daughter working toward her master's in nutrition at ISU, and a son studying cinematography. I hope to stay with this job until I retire."

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