When the city started running advanced life support calls out of Station 2 in 2000, Great Falls Fire Rescue had five paramedics.

In 2001, 2002 and 2004, the department was able to train 22 firefighters as paramedics thanks to funding from the Carrico Foundation. The first class of eight firefighters in 2001 completed the paramedic program at what was then known as MSU College of Technology and the initiative was the first of its kind statewide, according a history of GFFR.

After those paramedics were trained, the department capped the number of paramedic slots at 20 and since then, GFFR has been losing paramedics through promotions, retirements and relocations. 

The department currently has 16 paramedics, which allows for one paramedic per shift per station, but only when no one is on vacation, sick, or injured.

“That’s critical mass for us,” said Jeremy Jones on his first official day as assistant chief for operations at GFFR.

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Jones is a paramedic, but when firefighters reach the administration ranks, they aren’t able to run calls anymore. The current fire marshal, deputy fire marshal and the department’s training officer are all paramedics as are several battalion chiefs.

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After those classes of paramedics were trained, the department never had a strong plan to handle attrition, Jones said.

Over the last few years, current GFFR leadership has developed a strategic plan for the department, including a goal to staff 24 paramedics.

The question, Jones said, is “how the heck do we get there?”

Through rookie hires over the last few years, GFFR has been able to add a few paramedics, but so far, hiring isn’t keeping pace with the loss of paramedics. Jones said they don’t necessarily hire just because someone is a paramedic. They also need to be a good fit for the department, Jones said.

The new class of four rookies starts March 1 at GFFR.

All firefighter candidates statewide go through the Montana Firefighter Testing Consortium and GFFR competes with other Montana fire departments for paramedics, as many of them are experiencing a similar shortage. The paramedic shortage isn’t unique to Montana and communities nationwide are facing the same challenge.

The Cincinnati Enquirer reported last year that northern Kentucky would need 175 paramedics over the next five years and Ohio was anticipating a number of paramedic retirements in the next few years.

Pay is one of the challenges for those areas, the Enquirer reported. In Great Falls, certified paramedics get certification pay up to the rank of captain.

GFFR doesn’t have the resources to train a new crop of paramedics and the Carrico Foundation no longer exists, but two firefighters are currently enrolled in a paramedic training course. A paramedic training course can be up to $12,000 per student, Jones said.

Nolan Taylor and Joe Tinsley found a hybrid program through the National Medical Education and Training Center and have started their online coursework portion of the program.

NMETC offers accredited EMT and paramedic training programs. To test for the National Registry, which is the national EMS certification board, candidates must go through an accredited program.

“It’s an intense model,” Taylor said. “It requires a certain level of commitment on your part.”

Accredited paramedics exist in Montana, but often don’t fit the working firefighter’s schedule, financial situation, or other circumstances.

“I needed the flexibility to fit the kind of craziness that our schedule can be,” Taylor said.

Once they complete the online portion, they’ll go to Boston in August for the skills testing portion and then return for their field internships.

The skills testing is 12 days at NMETC’s Boston campus where students are trained in all of the National Registry Skills stations and “adequately prepared for a multitude of real-world situations through extensive hands-on training and instruction during our simulation labs,” according to the program website.

Jones said GFFR is working to set up an agreement with a larger department in the region that sees a lot of advanced life support, or ALS, calls so that Taylor and Tinsley can get their required experience.

The program requires 250 hours in a clinical setting and another 250 hours of ride time and 50 ALS calls.

Once they complete the NMETC program, they’ll be required to run 25 ALS calls in the city before GFFR formally recognizes them as paramedics, Jones said.

Taylor and Tinsley have already been moved to the same shift and are running calls with Jeremy Virts, an experienced paramedic at GFFR who is serving as a mentor. Virts is also an instructor for the department rookie training program.

Virts is knowledgable and confident in his skills, Taylor said, and he’s always calling Virts to ask questions.

“He’s awesome,” Taylor said.

Taylor and Tinsley enrolled on their own and have made the financial commitment to complete the program while continuing to serve as firefighters in the city.

But the city is supporting them by reimbursing some of their tuition, according to Jones and Taylor.

“It’s great to know that the city has that type of commitment to making sure we’re good paramedics,” Taylor said.

Training current firefighters who have an interest in paramedicine makes sense, Taylor said.

“If we’re going to put an ALS sticker on the side of our engine, we need to be able to staff it,” he said.

When the Great Falls native and his family moved back to town, he started working at Great Falls Emergency Services part-time as an EMT basic. Taylor has been on GFFR for five years and becoming a paramedic has always been a goal.

“I knew even then this was something I wanted, it just wasn’t going to work. It wasn’t a good fit until this year,” he said.

Taylor said he’s always been the kind of guy with his nose in a book.

“I’ve always wanted to know more,” he said.

Paramedics are able to provide more advanced medical care to patients on the scene or en route to the hospital.

As an EMT, Taylor said he would sometimes would be on a call and not understand what he was seeing or why certain things were happening.

“If I didn’t know what I just saw or know what to do, I would come back and try to learn about it,” he said.

Being a paramedic is a different responsibility on the engine, he said.

“I’m proud of what we do and having paramedics on every engine…and I want to be able to be one of them,” Taylor said. “I’m pretty proud of what we can do with paramedics on the engine and make a difference.”

Much of what they’re doing for pre-hospital care is coming from research happening on the East Coast, he said, so through his paramedic course, Taylor and Tinsley are learning some of the newest information and sharing it with other paramedics at GFFR.

Going through the program with Tinsley is helpful since they can be study partners and talk about what they’re seeing on calls and how it relates to what they’re learning, Taylor said.

Recently, they were on a cardiac call and were in the cardiac segment of their training program. During the call, Taylor said they looked at each other and realized they understood what was going on.

Jones said GFFR leadership is watching this program to see how it works for their members and hoping to get more GFFR firefighters into the same or a similar program.

“We’ve got to do something,” Jones said.

Another of the strategic goals is to add a fifth shift that would be housed at Station 1 downtown. The idea is to create a squad unit that would handle minor calls and use other vehicles, leaving the engine companies available for ALS or structure calls.

That’s a big expense and would require more firefighter positions. The staffing request wasn’t funded in last year’s city budget.

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Right now, when staffing allows, GFFR has been running a fifth unit out of Station 1 with two firefighters to handle minor calls. They’ve been using the brush truck, Jones said, and the unit doesn’t include a paramedic yet since there aren’t enough. If the city fully funds a 5th shift, it will include a paramedic, Jones said.

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Fire officials say that with a fifth unit, they can relieve stress on the engine companies and improve response times around the city.

In 2017, District 1 ran 3,392 calls, Jones said.

Earlier this month, Fire Chief Steve Hester told City Commissioners that Station 1 was the 75th busiest fire house in the U.S.

“It’s a busy house,” Jones said.

Currently, if there’s an engine company tied up on a minor call and an ALS call comes in, the department starts pulling engines from other stations, leaving the remaining stations to cover the rest of the city.

Station 3 is also a busy house, with 2,105 calls in 2017.

“We start having gaps that leave areas of the city unprotected,” Jones said.

GFFR transported patients 54 times last year. The city contracts with Great Falls Emergency Services for ambulance service and only transports when there’s a surge, meaning all ambulances available from GFES are out on calls.

Time is of the essence on fire and medical calls, so getting their quickly and having the necessary medical skills are important, firefighters say.

If a person isn’t breathing, brain damage can start within six minutes if CPR isn’t started. Jones said that if they can get there quickly, it increases the chances of a favorable outcome.

They want to put medics on engines, get out there, and make a difference, Jones said.