Every Carroll County resident today is just minutes away from a defibrillator, one of the upgrades in equipment Bill Fish saw in his 18 years as Carroll County Ambulance Service director. Fish (left) was succeeded as director by Patrick Gray (right), who’s returning to the Ambulance Service after serving on the Carroll Police Department since 1999. Gray, a Keokuk native, was on the Ambulance Service from 1989-99. Daily Times Herald photo by Larry Devine
Every Carroll County resident today is just minutes away from a defibrillator, one of the upgrades in equipment Bill Fish saw in his 18 years as Carroll County Ambulance Service director. Fish (left) was succeeded as director by Patrick Gray (right), who’s returning to the Ambulance Service after serving on the Carroll Police Department since 1999. Gray, a Keokuk native, was on the Ambulance Service from 1989-99. Daily Times Herald photo by Larry Devine
Bill Fish says his strategy for continually advancing quality of care provided by Carroll County Ambulance Service during his 18 years as the service's director was simple.

"I think my proudest moment was to get out of the way of all the employees and volunteers and let them be the best they could be," he said during a recent interview as he prepared to turn over the director's position to Patrick Gray on Jan. 15.

He added, "When somebody congratulates me that I did such a great job and there have been so many big improvements, my answer is, and it's absolutely true, 'I just got out of the way, and I let those improvements happen.'"

Sitting nearby, Gray quickly said Fish was being way too modest, remarking, "He was a big part of the improvement."

Gray credits Fish with making sure Carroll County Ambulance Service had the best equipment and personnel had the latest training.

Gray served as a Carroll County Ambulance paramedic from 1989 to '99 when he joined the Carroll Police Department and rose to the rank of sergeant. Returning now to succeed Fish, Gray says, "To be able to say I work for Carroll County Ambulance is a major pride factor."

Fish, who now will be devoting his time to his Ambulance Billing Service of Iowa that currently serves five services, cites a number of reasons for Carroll County Ambulance Service's advancement, including:

Equipment

"When I arrived here there were three defibrillators, one on each ambulance, and they were very old. That's all there were in the county, besides the hospital," Fish recalls.

Now defibrillators are available throughout the county - ambulances including all the satellite stations; law-enforcement offices; workplaces; and public places such as city halls, golf courses, churches and Carroll Recreation Center.

Whereas previously it could take up to 30 minutes to get a defibrillator to a patient, Fish says, "Now nobody in the county may be more than three minutes away from one."

"That's just one example of making sure they have the equipment that makes us a better service and improves patient care," he adds.

Training

Carroll County Ambulance is made up of 10 full-time employees. All are paramedics, and a few of those have advanced to critical-care paramedic certification. The satellite stations in Breda, Coon Rapids, Manning and Templeton are served by 128 volunteers, ranging from first responders to paramedics, although most are EMTs.

The service benefits from significant experience, as three on the staff were here when Fish arrived: Gray and Denise Rohrbeck were both full-time, and Mike Lloyd was part-time.

Finances

When he arrived 18 years ago, Fish says, Carroll County Ambulance was typically running a $250,000 deficit each year, but he initiated a billing system that allowed the service to break even after his first year and eventually reach a surplus of nearly $250,000. However, because of cuts in Medicare reimbursement and the number of patients who are covered by that program, the service is now back to break-even.

Fish comments, "It's difficult now to have a break-even service without cutting the level of service you provide."

Fish also introduced a big community attraction and valuable fundraiser for ambulance service training - the annual Christmas festival of lights at Swan Lake State Park.

Tiered Response

Carroll County Ambulance works with the satellite stations in Breda, Coon Rapids, Manning and Templeton, staffed by volunteers, to provide tiered response.

Under the tiered-response system, the ambulance in one of those towns may be called to an emergency such as a patient with shortness of breath.

"As soon as they're going out," Fish explains, "one of our paramedics is heading to them to get on board with that crew and provide that higher level of care. That's something our full-time staff does for the entire county.

"So we support our volunteers very well, and at the same time the volunteers support us very well. It's a very close-knit group working together."

Team Effort

The service's main office is located in Carroll and is supplemented by satellite stations in Breda, Coon Rapids, Manning and Templeton. All those stations have their own volunteers, but everybody works under the same medical director and same protocols, Fish notes.

"We purchase equipment for them, provide training and continuing education for them," Fish says of the satellite services.

The service has maintained a rotation of seven ambulances, replacing one every two years. The newest ambulances stay in Carroll four years and then are rotated to one of the satellite communities.

With the break-even revenue situation, Fish says, the fortunately has received strong support from the Carroll County Board of Supervisors.

"The supervisors have been very supportive in keeping us a great provider and making sure we have the right training and right equipment," Fish says.

The service works in coordination with the medical community, law enforcement (police, sheriff and State Patrol) and fire departments.

"We have tremendous cooperation with St. Anthony Hospital," Fish says. "We work shoulder to shoulder with the emergency-room nurses and operating-room personnel. We have terrific support."

Dr. Eric Paulson was the service's first medical director, and Dr. Dominick Ervelli of Carroll now serves in that position, directing protocols of procedures and medicines that can be given. He reviews records of calls.

Because of the medical community helping ambulance personnel with their skills, Fish says, "We have very highly trained people who know what to do in an array of situations."

In turn, Ervelli says of Fish, "He's very knowledgeable in his field. He's a good, compassionated person who really worked tirelessly at his job. He was first and foremost an advocate for patients. As well as being an excellent paramedic, he had to keep up with all the regulations and paperwork. And he always kept this squad up to standards."

On the road to his position in Carroll, Fish graduated from Red Oak High School in 1976, attended Morningside College in Sioux City and then switched to Iowa State University, where he received a general-studies degree.

He then took a job in photography and production at the Red Oak Express newspaper and also worked the weekend shift at the radio station in Red Oak.

While at the Red Oak Express Fish became a volunteer firefighter on the town's fire department.

Fish was following in footsteps of his dad, who enjoyed a longtime career in optometry.

"Dad was a volunteer firefighter in Whittemore (north-central Iowa). I still have his firefighter badge (from 1947). In the 1940s, he served in the Army Air Force as a medic in World War II, and he always had stories about that," Fish says.

Fish moved into full time on the fire department and the rank of captain. In that position he received first-responder, emergency-medical-technician and paramedic training.

His ambulance-service responsibilities included equipment, training and billing.

"The beginning of my (emergency medical service) career was as a firefighter in Red Oak, developing that entire system for them," Fish says. "Part of that included getting resources available to me, including from Mercy Medical Health Systems in Des Moines."

Fish says of upgrading the ambulance service at Red Oak, "As I was going through training I noticed that we were running the ambulance service but nobody had real training for the service. That was back in the day when you'd go out in the ambulance, pick patients up and go fast to the hospital.

"In the 1980s, it was just the beginning of formal training for EMS (emergency medical services). So I contacted the University of Iowa and also pitched the idea to the Red Oak City Council, which approved the expense of having formal EMS training for fire department members."

Fish's work drew the attention of Mercy Medical Health System, which recruited him to become director of the ambulance service it was creating in the southern Iowa community of Bloomfield in Davis County.

Fish was in Red Oak from 1982 to '92 and in Bloomfield from '92 to '94, before coming to Carroll, which was a dream opportunity.

The fifth of six sons and eighth of 10 children in the family of Dr. Fred and Isabel Fish, he grew up in Red Oak - all 10 children graduated from Red Oak High School - and when dad took the boys on a fishing trip every summer to the Iowa Great Lakes, Carroll was the halfway point and therefore was always the lunch stop.

"I always thought Carroll was a terrific town," Fish says. "So when I was in Bloomfield and I saw that the director's position opened in Carroll, that was a dream-come-true. I'd always wanted to move to Carroll."

The Carroll move began with a big change for Fish. In his previous two ambulance positions he had the highest level of training and therefore was the lead care provider on calls.

"When I came to Carroll that changed immediately," he says. "There was an entire group of paramedics. It was interesting to have so many other people also trained at that level."

However, he adds, "We also saw there was a huge need to improve this system and for everybody to improve on their abilities."

Fish saw big advances over the last 18 years.

"I couldn't be prouder of where (the service) is right now," he says, "and the number-one reason we have a great system is that we have great employees and great volunteers here. And the (county) supervisors have been very supportive, allowing us to be on the leading edge of EMS by making sure we have the right training and right equipment."

In Carroll, Fish has been on calls from the very unusual - a woman with her big toe caught in her bathtub faucet - to the most traumatic.

"That's our main job," he says, "is to respond for people at their most need. When they may be at their worst, they're counting on us to get them better."

Fish says of a day on the job of an ambulance service, "You can have your worst day possible and you can have your best day possible all within a two-hour period. But definitely the rewards are terrific, or we wouldn't stay in it."

Fish describes ambulance service as a "different animal."

"A huge part of what we do is in the dark, in bad weather, with no backup," he says. "You have to think for yourself, 'How are we going to help this person?' It's not like we're in a well-lit, well-staffed emergency room. We're out there on our own. We have to do the best we can in very difficult situations."

Fish has impacted ambulance service not only locally but also statewide through his service from 2000 to '08 on the Iowa EMS Association Board as well as regional and state boards.

"During that time there was formation of a lot of rules that are in effect today," Fish says of Iowa EMS Association Board action.

Stepping away from the ambulance service, Fish will now focus on his Ambulance Billing Service of Iowa, which he started 12 years ago and currently provides billing for five services.

He's been active in community and church.

As a graduate of the Iowa State University Extension master-gardener program, he was instrumental in developing the waterfall on the Carroll depot grounds. He plans to put more work into that feature.

He's also trying to work with the City of Carroll on establishing a dog park.

Since he will have some extra time, Fish's daughters Beth and Katelyn recently purchased a terrier-Chihuahua mix for him from the Humane Society in Perry. The Fishes named the nearly 1½-year-old dog Paddy.

Bill's wife, Deb, teaches Spanish at Carroll High School.

Beth will graduate in music education this spring from Morningside College and she's currently student-teaching in Denison. Katelyn is a freshman at Northwest Missouri State University in Maryville and is interested in studying medicine, possibly orthopedic surgery.

New ambulance director Gray, a Keokuk native, says the high quality of the ambulance service is a tribute to its first director, Larry Cruchelow, and Fish, along with the employees and volunteers.

Becoming only the service's third director, Gray says, "I have all kinds of plans, but mainly to keep it moving in the future as progressive as it has been and keep it as one of the icons of the state, keep it moving the right direction and as Bill says, letting people do what they do best."

Fish says, "With the pride from what I've seen that has been accomplished, there's still a lot that needs to be done. Pat's the right choice to make things happen in the future. There are terrific opportunities for him to continue the improvement of this service."