New Ambulance Service Fills Medical Void in N.D.

Feb. 22--MANDAREE -- In a way, Mandaree comes out of nowhere, a small turnoff from Highway 22 just inside the Fort Berthold Indian Reservation.

For a while, when it came to medical emergencies, it was too far away from any one place. Ambulances would take at least a half-hour to arrive from Watford City, Killdeer or New Town.

One Colorado couple has changed that.

Dr. Benji Kitagawa had seen first-hand the swamped emergency rooms of the Bakken in his rotations at Minot and Williston. Then he and wife Antoinette saw a study that showed a dearth in emergency medicine services for Mandaree. Using crash hotspot data, population figures and looking at existing resources, engineering firm Ulteig found Mandaree to be one of the biggest areas in need of an ambulance station in western North Dakota.

The couple wanted to do something, but wasn't sure what. They first looked at a transport business, but the finances wouldn't work out. Then Randy Phelan, tribal council representative for Mandaree, showed enthusiasm for the station's potential there and said he'd provide the ambulance barn and crew quarters -- the two biggest expenditures.

Now the Kitagawas, from Greeley, Colo., have put more than $500,000 of their retirement money into the service and Mandaree's residents have had their own ambulance service since November. A community walk-in clinic is also in the works.

Tom Nehring, North Dakota's director for emergency medical services and trauma, said his department makes sure a need is there for a new ambulance service before issuing a license, and it found Mandaree was medically underserved.

The oilfield and its traffic along Highway 22, which winds past Mandaree near fellow boomtowns Killdeer and Watford City, bring the traumatic, bloody car accidents and work injuries that stick with paramedics after a shift ends. But the need is stronger from the people of Mandaree, a fairly barebones community of several hundred who, until recently, relied on other communities' paramedics.

Before Mandaree EMS, the state of North Dakota hadn't licensed a new ambulance service in at least five years, Nehring said. But that's not the only unique part.

"I think it's a hugely generous thing for somebody to invest their own funds into this as opposed to let's say a corporation or a hospital or whatever," Nehring said.

But as volunteer paramedics become harder to find as calls increase, Nehring said he's worried for the sustainability of this EMS service, and those across North Dakota.

"A person can only put so much money into an ambulance service," Nehring said. "It is expensive obviously with vehicles, with personnel, with medical equipment -- all of that is expensive."

For the long haul

Mandaree EMS is working now, but in a way that won't last forever.

The staff is mostly people from Colorado that commute between there -- where they have their homes and their careers -- and Mandaree. Two used ambulances came through Benji's connections in tiny Yuma, Colo., and Aspen. The Delta County, Colo., hospital has donated equipment.

Mandaree EMS has a small group enrolled in a training class starting this month to start building the base of locals that will one day hopefully take over.

The Kitagawas hope their focus on training Mandaree locals will allow them to leave behind a self-sufficient service. The walk-in clinic, they hope, will financially sustain the ambulance service.

"In the next five years I would like it to be run completely by locals because of course that will also help it sustain itself. Not only that, but local people know each other," Antoinette said. "It's more personal; it gives locals jobs that they wouldn't have probably had."

After giving a half-million dollars of their retirement fund to the project, the Kitagawas are now reaching out to oil companies for support.

"We also were hoping that we could get some funding from people who need it, like for instance, the oil companies are drilling right around there," Antoinette said. She estimated oilfield-related calls make up 20 percent of the service's activity, but said only Calgary-based Enerplus Corp. has shown serious interest in donating.

Like with the ambulance bays and crew quarters, the reservation has set up rooms in the existing elders center for the clinic. There, within the next few months, paramedics and EMTs will begin offering walk-in checkups for strep throat tests, physicals, flu tests and minor suturing.

"It's the best thing that ever happened to our community, really," Mandaree resident Luke Yeahquo said from his home as the crew visited.

"There never was anything on-site like there is now."

Putting the passion back in EMS

Gaining the trust of locals has been a side project for the ambulance service. The group is, after all, coming in from the outside to provide an intimate service to a historically betrayed demographic. But over time, they say, the trust is growing.

The newcomers are building trust with visits to elderly residents -- a part of the "community paramedicine" approach, a style of health care in which paramedics provide more than emergency response. During those visits, they'll fill out what's called a "File of Life," a form that goes on the fridge with any medications or allergies listed in case they return for an emergency and the patient can't speak.

Mandaree native Jessica Spotted Horse provides the local knowledge base to the service. She was only a emergency medical professional before the EMS service started, and knows most of the residents and where they live. When a 911 operator is getting used to dispatching with the Mandaree EMS, Spotted Horse said, "all they gotta say is the name," and she knows where to go.

Ann Hafner, who manages the Killdeer Area Ambulance Service, said emergencies aren't slowing down despite lower oil prices. KAA has fielded 60 percent more calls than it had this time last year.

Paramedics want to be needed, she said, and Mandaree EMS has found that.

"The community in Mandaree, they appreciate that because most of them have known somebody or had a family member or themselves had a condition worsen because they are so far away from help," Hafner said. "And it shouldn't be that way."

Drinking coffee around the kitchen table of the crew quarters, Spotted Horse, Lawrence Bejarano and Abel Feltes grimace and whisper when one recent oilfield call -- an apparently gruesome rig death -- comes up in conversation. Health information privacy laws prohibit any more detail, but their reaction to the thought of that day says enough.

They decompress after work, tears and prayers. Those that travel back and forth from Colorado -- the majority of the staff of nearly 20 -- say the need for a service in Mandaree is what keeps them going.

"They're not getting a career in Mandaree," Antoinette said of the commuters. "But they're helping to create a career for a local. And they understand that."

In Mandaree, it's something residents have never known. There, drivers pull over when they see a lit-up ambulance, Feltes said, whereas back in Colorado some drivers might take it for granted. Filling a void in service where the community is so appreciative is an opportunity many paramedics never get, Bejarano said.

"It's a place like this that puts the passion back in EMS."

Lymn is a reporter for The Dickinson Press. Contact her at 701-456-1211.

Copyright 2015 - The Dickinson Press, N.D.