Answering the Call in Nebraska’s Most Remote Corners

When KC Merrihew hears his pager go off, he knows it’s something serious. As the Emergency Medical Services (EMS) Department Leader at Garden County Health Services in Oshkosh, Nebraska, he also knows time is of the essence.

“Out here, these are not the type of people that call 9-1-1 for no reason,” he said. “These are the type of people who, when they break a leg, they jump in the car, and they’ll drive to the hospital.”

EMS plays a critical role in rural areas. Nebraska is one of three states with the highest rates of rural residents living more than a 25-minute drive from where an ambulance is stationed. Parts of Garden County are so remote and sparsely populated that they have earned the classification “super rural,” with an average response time of 40 minutes due to the distance covered.

KC was born and raised in the Nebraska panhandle, from an unincorporated community called Ashby. Population? “Me,” he said. 

He joined the United States Navy and completed “A school,” where sailors receive technical training to become a medic, and eventually served as a Green Side combat medic with the Marines. 

“I think growing up on a ranch south of Ashby provided me with a ‘make-do’ mindset and a superior work ethic. The military taught me how to save lives and get the job done,” he said. 

After completing his military contract, he returned to Nebraska and became a Nationally Registered Paramedic and earned his Flight Paramedic certification. He’s been with Garden County Health Services for the last 10 years.

EMS for the county is a bare-bones operation. They have an EMT and a paramedic on duty 24 hours a day, seven days a week. When a 911 call comes in, the first step is to contact air support to see if it can even be available. If the weather is bad or a helicopter is out for maintenance, it may not be possible. Immediate air standby or activation is important because the closest helicopter is 40 minutes away, so standby helps decrease the time for the patient to receive definitive care. According to KC, helicopters are very rarely turned around.

“Garden County has no surgical capabilities, no neurologist, no anesthesia or respiratory therapy — big lifesaving factors — so we have to be able to transfer to facilities that have those capabilities,” he said.

It is increasingly difficult for ambulance services to respond to emergencies in rural America due to workforce shortages and growing financial crises. About a third of rural EMS agencies in the U.S. are in immediate operational jeopardy because they can’t cover their costs.

“The biggest challenge for us here is for people to be able to work consistently, autonomously, without direction, and be able to do it well. It’s a very tough area because when you go out on a call, it’s you. That’s it. There’s probably no help coming. The mental toughness and the ability to adapt to situations of our people is remarkable,” KC said.

KC calls the whole of Western Nebraska a small-town community. He has friends in every town. So, when that pager does go off, he not only knows that a patient really needs him, but that it could be one of his friends or family members.

“I love rural health because it contains some of the most versatile, willing, hardworking people that I’ve ever met. In rural health, we go from running a code or high-level critical care to pushing a mop bucket,” he said. “I love rural health because I’m caring for the people that I care about.”

KC Merrihew
Emergency Medical Services (EMS) Department Leader
Flight Paramedic
Garden County Health Services
Oshkosh, Nebraska