This is the second in a series exploring what modern emergency medicine looks like in the Wasatch Back and how departments like Park City Fire District, North Summit Fire District and South Summit Fire District are improving care. Emergency medical services make up the vast majority of Summit Co unty fire departments’ responsibilities. So, as officials have worked to improve response times, they’ve also improved personnel’s capability. At Park City Fire District, crews are certified at the top levels of emergency medical care: Advanced EMT, paramedic and critical care paramedic. An advanced EMT is certified in basic life-saving procedures, splinting, bandaging and airway management, and they can carry medications or start IVs. A paramedic is a step up from that. “It’s equivalent to getting your very basic (nursing degree),” explained Park City Fire District Captain Michael Dean, who oversees training. Those in training participate in a field internship during that time, working for Park City Fire as a student and also completing clinicals. Dean said that means they’ll work in ICUs, ERs, medical-surgical floors and obstetrics, so they’ll hopefully gain experience assisting with baby delivery. “They come out pretty good and very knowledgeable,” he said. All Park City Fire staff are certified as advanced EMTs, and roughly 25% are paramedics. Dean said the department also rolled out certifications for staff to perform rapid sequence intubation, a more advanced skill that temporarily paralyzes a person to insert a tube in their throat to help with breathing. According to Chief Scott Thorell, South Summit Fire Protection District went from two advanced emergency medicine technicians in its first year to four available 24/7. South Summit Fire also runs a second ambulance 12 hours a day with two trained medical technicians, as well as a single paramedic and a rescue unit almost 100% of the time. North Summit Fire District reports close to an even split of advanced EMTs and paramedics across a mix of its full and part time staff. There are currently 21 advanced EMTs, with one incoming, and 17 paramedics, with one incoming, said Battalion Chief Tyler Rowser. While some calls can be treated on site, ambulances transfer patients to hospitals, including Park City Hospital, for more definitive care. Where someone is taken depends on their insurance. Park City Fire has gone as far as cities like Logan, Spanish Fork and Payson, Dean said, and the department also works with medical helicopters to move critical patients when necessary. Becoming ‘clinicians’ Around 23% of Park City Fire’s paramedics are or are becoming critical care paramedics, said Dean. It’s the highest certification in the field and transitions what he calls “reactionary” providers into “clinicians,” meaning crew are starting to think more about the “why” and not just the “what” and “how” of treatment.  “It brought in a bigger perspective of what is happening to the patient. Not just, ‘Not breathing, put on oxygen.’ It’s, ‘Why aren’t you breathing? Do I have something in my tool bag that would be more helpful for you, besides just oxygen? Is there a medication or something that can help?’” Dean said. These providers have more advanced skills such as using infusion pumps to microdose medications rather than just pushing with a syringe and using ultrasound. Paramedics can also carry more medications, meaning more options for care.  The goal is for all the department’s paramedics to become critical care paramedics, Dean said, which involves a 10-month didactic course in-house with hands-on training days. They attend intensive care units, practice intubations at Park City Hospital and even go to the cadaver lab at the University of Utah to train with real bodies.   “Outcomes are going to improve. It just can’t not. People are going to get better faster and go home sooner because of what the state of Utah is doing, what Park City Fire is doing,” Dean said. That’s part of what makes the shift so exciting, said Dean, who’s been in the industry for decades. A Park City Fire District pediatric life support training goes through a scenario to help keep staff skills sharp. Credit: Jonathan Herrera/Park Record Medicine has become so good that actually deploying these skills in the field only applies to about 1% of patients Park City Fire sees, he said. He calls them the “big sick” patients. “We’ve gotten so good at what we do that we’re only now working with this 1% to see if we can make a difference there,” Dean said. “We’re closing that gap, which is, for us, amazing. You change that one life.” He said critical care paramedics are stationed around the district, along with ambulance crews at paramedic and advanced EMT levels. And they’ve seen that even having one person at that highest level makes the whole team better.  “When you drive the ceiling this way … naturally, everybody gets a little better. So our EMTAs are getting smarter and getting a better perspective as to what medicine is and how it works,” Dean said. “It’s the ‘rising tide raises all ships.’ It’s just advancing our medicine and our capabilities even higher.” A rising tide The push to higher-level medical skills and more top-of-the-line resources isn’t cheap, Dean said. It’s one of the reasons so few departments have critical care paramedics and why Park City Fire is the only one in Summit County pursuing it. For reference, Park City Fire’s budget is more than 10 times the size of South Summit’s, Thorell said. There are a few agencies in the Salt Lake Valley achieving that skill level, too, Dean said. West Valley City Fire Department is there, Layton City Fire Department is partially there, and he added that South Jordan and Provo fire departments are headed in that direction. For 2025-26, West Valley City earmarked $26.1 million for fire, according to its budget. For the same year, Layton City listed $16.3 million, South Jordan $13.7 million and Provo $15.6 million in fire expenditures. Park City Fire is well in that range. According to the Park City Fire District’s 2026 final budget, it expects to receive about $25.3 million in revenue and spend about $25.8 million in 2026. The district’s projected ending fund balance is about $31.2 million. It’s how they were able to afford to replace all 15 of their cardiac monitors, which cost around $55,000 each. Park City Fire District personnel perform mock pediatric cardiac arrest training in April. Recently, the Fire District rolled out state-of-the-art cardiac monitors to improve its emergency medical response. Credit: Jonathan Herrera/Park Record “This will do all of it. Blood pressures, oxygen level, respiratory rate, full cardiac view,” said Dean about the new machines, now with touch-screens. “With modern technology, they communicate with the internet, and so we can share the information directly, live-stream with the hospitals if they so choose to look. It makes our paperwork a lot easier because it collects all that information.” They also would replace an ambulance after seven years, though they’re now shifting that to every 10 years. All of Park City Fire’s vehicles, including specialty rigs, carry frontline medical equipment, Dean said: red bags for medical, green for airway, canvas bags with splints.  Next for Park City Fire would be the ability to carry whole blood, hopefully by next year, Dean said. Currently, West Valley Fire is the first and only department in the state certified to carry whole blood on an ambulance, but Dean is working to change that. Due to a surge of disease transmissions in the 1980s, blood is much more tightly regulated than even narcotics. Until West Valley, flight crews were the only whole blood carriers in the state. The regulations come with logistical challenges. Blood has to be kept between 4 and 6 degrees Celsius, and there is only one out-of-hospital refrigeration unit approved by the Association for the Advancement of Blood and Biotherapies for EMS, which costs around $17,000 a piece. Out of the cooler and in perfect conditions, blood has a 30-minute shelf life. EMS equipment carried by Summit County fire districts is sorted into red and green bags. Credit: Jonathan Herrera/Park Record When approved, the ambulances will carry O+ low-titer blood. About 70% of the population can receive O+ blood, and the low titer means it has minimal antibodies and antigens, which makes it compatible with 95% of the population. The universal donor, O-, is just too rare. “Why do we care about more medicine? Why keep going more? Very simple. In the many years I’ve been doing this, we always use cardiac arrest as kind of the pinnacle of medicine, but this translates to every other patient that’s out there; we were not getting success. We show up, and they remained dead,” Dean said. “In my career, because of the improvements of CPR, the improvements of defibrillation, the improvements of airway management and improvements in medications, we are now getting success where there wasn’t. People who have died are now skiing again in three months.” ‘An oath to serve and protect’ For Dean, “EMS is a happy place.” He used to work as an air ambulance pilot and has been with Park City Fire for 10 years. “Twenty years ago, when I started, it felt pretty military. It felt pretty, ‘This is how you do it.’ It felt very much like a boys’ club, all the good and bad that come with that. I think we’re way more balanced and better at our jobs than we’ve ever been,” he said. “And we’ve become very much EMS. We mostly provide medical care. And so that brings in a different kind of personality type as well.” There are still big personalities and competitive ones, too, he said. They’re the types to be “running in when everybody’s running out,” even though that’s not really what the day-to-day job entails. But that same mentality makes them great providers, Dean said. Park City Fire District Capt. Michael Dean oversees the department’s training. He’s spent 22 years in emergency medical services. Credit: Jonathan Herrera/Park Record “When you sign up for public service, and you sign up to say an oath, (because) they all have to swear an oath to serve and protect and uphold the law, it takes a certain mentality,” he said. That personality, combined with dedicated training, an unusually mandatory fitness test and a familial, tight-knit culture, are part of what makes Park City Fire so special — and so good at what they do. “We work 48 hours on and 96 hours off, so two days full-on. We’re a family. We make meals together; we train together. Everything is together,” said Assistant Chief Ashley Lewis. “When you have someone dying on the ground, you have to operate as a team. You have to be cohesive. And that’s what builds that in the station.” And at the end of the day, it’s all for one key outcome: saving a life.  Dean recalled a cardiac arrest incident on the Rail Trail out by Richardson Flat as an example of how far emergency medicine has come.  “Having been in this a really long time, someone that far away from a hospital, away from roads, probably would have died,” he said. “That guy’s alive, and he was dead when we got there. That wouldn’t happen anywhere else. What we brought to that patient at that time is pretty unheard of.” The post Elevating EMS care means the difference between saving a life and not appeared first on Park Record. ...read more read less