It wasn't that long ago - seven years, in fact - that ambulances and staff from the Upper Pine River Fire Protection District couldn't even transport patients needing medical care to the hospital.
Starting to transport patients directly to Mercy Regional Medical Center, instead of having to wait for them to send an ambulance, or meeting one half-way to Durango, was a big step forward in 2007.
On Monday, the district made another big move forward in emergency medical services - providing paramedic-level care.
Through a combination of new and contract hires, Upper Pine now has a trained paramedic on staff 24/7, and it's already improved the level of patient care, said Chief Bruce Evans.
That's important in this district, he said, where more than 80 percent of the calls are medical.
Paramedics are certified in advanced life support, head injuries, heart issues, and critical trauma issues.
Working under the district's medical director, Tony DeMond, a paramedic drives his own "chase vehicle" that follows behind the Upper Pine ambulance when he thinks paramedic-level care might be required.
This is a higher level of care than the intermediate emergency medical technician services the district has offered since 1999.
Paramedics also can administer some medicines and have training in more advanced cardiac procedures and advanced airway procedures.
"It's faster care," Evans said. "More efficient care."
While certified paramedics have been on call in the past, they were either volunteers or worked part-time. Having a paramedic on staff all the time is a better solution.
The paramedics for Upper Pine include Joel Clause, who has worked in Pagosa Springs, Denver and in the Boston area and Dan Miller, an Upper Pine veteran who just completed his 360-hour paramedic field internship in Iowa. Another paramedic on staff is Steve Burns, who has worked for Flight for Life and area skip patrols, and Josh Lorenzen, the district's new deputy chief. Two part-time staffers will help fill in as well, Ean Zeller, a Durango Fire and Rescue paramedic, and Casey Pascale, a former firefighter in Ogalalla, Neb. The district is advertising to hire one more full-time paramedic, and Evans, also a paramedic, is available to fill in as needed.
Burns said the paramedics already have been going on one or two medical calls a day. Earlier this week, he responded to a medical call in Vallecito for a young man who had a past heart condition, and he was suffering from cardiac arrhythmia. Burns met the ambulance, got the patient hooked up to a heart monitor, and was able to get an electrocardiogram report to give to both the emergency room and the patient's cardiologist.
Another call this week was for an elderly patient who had fallen in his home, but this was the third time in five days he had called the fire district for help.
Burns said in these cases, that's where the paramedics need to help a patient get a referral to La Plata Social Services or a home health care aide. These referrals can help a patient get services so he can stay at home and live independently.
Responding to these "small" calls also helps paramedics and EMTs get to know their patients and what issues they are facing so they are better prepared for a more critical medical call, Burns explained.
The paramedics have a new Ford equipped with special equipment, thanks to a grant from the state emergency medical system. The state funding comes from a $2 charge for every vehicle registration in Colorado.
The SUV has a heated compartment to keep medicines from freezing, power in the back, and the four-wheel drive can be used to get to places where a large, heavy ambulance might not be able to maneuver. An iPad has replaced the paper maps that drivers used to use.
"This is a big step," Evans said of the new service and vehicle.
Next up for the department is getting every deputy in the Bayfield Marshal's Office certified as a first-level emergency responder. Another grant could provide oxygen, tourniquets and a first aid kit for every police car in the department.