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At the intersection of rural and remote: EMS at 40 below

Minnesota EMS pioneer Kalie Klaysmat faced winters without running water


Klaysmat treating a patient with a fractured femur.

Courtesy photo

When Kalie Klaysmat describes Crane Lake’s fire department as the end of the road, she’s not being fatalistic.

“Crane Lake is literally at the end of the road – Route 24, to be exact,” Klaysmat says of the northern Minnesota community five miles from the Canadian border. “When you get there, you can keep going in any of three directions, but you’re going to need a boat.”

Klaysmat, who moved to Crane Lake with husband John in 1972, endured temperatures of minus 40 degrees Fahrenheit – cold enough to deprive the couple of running water during their first nine winters there.

A remote town like Crane Lake with only 100 year-round residents – that’s a different kind of animal for EMS,” says the Hibbing, Minnesota native. “It’s not about splinting bones with tree branches like you see in the movies. It’s about covering 60,000 acres that have only eight miles of road. It’s about patients waiting hours for boats or snowmobiles or airplanes to take them where an ambulance can’t.”

Of undertakers and outboard motors

Klaysmat was introduced to prehospital medicine during childhood visits to Cook, a tiny city halfway between Hibbing and Crane Lake. During the 1960s, before “EMS” meant anything, Klaysmat listened to the local mortician tell stories about responding in one of his Cadillac wagons – the red one, not the black one – to car wrecks on country roads without stop signs or traffic lights. Young Kalie was awestruck, not only by the specter of unrestrained, broken bodies scattered across two-lane highways, but by the undertaker’s concern about properly triaging and treating patients. “That man, Ken Leding, was a big part of my inspiration to get involved in emergency services,” Klaysmat says.

But Kalie had to wait until May of 1976, four years after settling at Crane Lake, until she could pursue her interests in both fire and EMS.

“That spring, one of the resorts had a fire in their outboard-motor shack. There was no fire department. The best we could do is form a bucket brigade and use whatever portable pumps were available. It was a real struggle; the resort lost all their motors a few weeks before fishing season started. That was our impetus for getting organized.”

Klaysmat joined Crane Lake’s new volunteer fire department that same year. They didn’t have EMS but Cook did, 50 miles to the south. Kalie got her American Red Cross first-aid certificate and, through Cook, become Crane Lake’s lone first responder on medical calls. “Cook actually had an ambulance – something Crane Lake was lacking,” Klaysmat recalls. “I’d spend an hour or more on scene taking care of patients while Cook was on the road.”

Fifty miles was also the distance Klaysmat had to travel for her first EMT course in 1980. “It was an 81-hour class on an Indian reservation. Thank goodness they gave it during the day; driving in winter at night with temperatures 40-below was not a fun thing.”

Asking “why not” instead of “why”

With only 15-20 calls per year, Crane Lake couldn’t justify putting all its members through EMT school. An instructor Kalie knew suggested first-responder classes instead.

“We licensed our agency as a training center and gave the 40-hour CFR course at Crane Lake,” Klaysmat says. “We developed sort of an advanced CFR program that included some EMT material. Pretty soon, all the other little departments in northern Minnesota wanted first responders, too.

“So much of our progress in those early days had to do with asking ‘Why not?’ instead of ‘Why?’ Volunteers know the reality of working with what you have instead of what you want.”

Being rural doesn’t mean the emergencies are any less real, though. Kalie’s last call at Crane Lake was a good example of the teamwork and improvisation that saves lives when doctors, and even paramedics, are nowhere close.

From a distance

“It was late November when we got a call about a hunter who’d fallen from a tree in the woods about five miles west of Crane Lake,” Klaysmat remembers. “The caller thought it might be a broken neck. I heard the tones go out, so I radioed dispatch to assume command and responded in my car. It was gravel road all the way.

“I met up with the hunter’s companion shortly before an ambulance arrived from Orr (a small town southwest of Crane Lake). We were joined by our first responders and a few good Samaritans on ATVs. As the sun was setting, the hunter’s friend guided the ATVs through the brush to the scene of the fall. By then, the hunter had been lying on frozen ground for over an hour. He said he heard his neck pop when he fell, and was having sharp pain with even the slightest movement.

“He was loaded onto a sled and wheeled by ATV to a landing zone – a heavily forested area about 100 feet in diameter. By this time it was dark, so we lit up the scene with the lights of our vehicles. The medevac landed and flew that patient to the trauma center in Duluth, 100 miles away. All together, the rescue took about two hours.

“About 10 days later I got a call from that hunter, thanking me for our efforts. It turns out he had two broken vertebrae in his neck, but no permanent disability.

“I guess you could say that’s an example of how far we’ve come in EMS, but it’s also a reminder of how dependent rural departments will always be on folks who can improvise and won’t take ‘no’ for an answer.”

The end of the road, revisited

In 2005, after 30 years in EMS and fire, severe arthritis forced Klaysmat to retire. She and John moved to Soldotna, Alaska, 65 miles southwest of Anchorage. According to Klaysmat, Soldotna, with its population of 4,000, is a metropolis compared to Crane Lake. “I’m one of the few people who ever moved to Alaska to be nearer civilization,” she says.

“They have a wonderful EMS system – a paid fire department with paramedics. They even have their own hospital. And we’re only five miles from the grocery store.”

Klaysmat missed the challenges of patient care in rural Minnesota, but stayed active in Alaska’s essential services for another decade. Her resume includes four years as executive director of the state’s police chiefs’ association. Now, she says, “It’s rocking-chair time.”

“I’m just kicking back and enjoying Alaska. It’s so beautiful. Trumpeter swans land in front of our house before heading south. Moose walk through my yard. Sandhill cranes feed here all summer long.

“Plus, it’s a lot warmer than Crane Lake.”

Mike Rubin is a paramedic in Nashville, Tennessee. A former faculty member at Stony Brook University, Mike has logged 28 years in EMS after 18 in the corporate world as an engineer, manager and consultant. He created the EMS version of Trivial Pursuit and produced Down Time, a collection of rescue-oriented rock and pop tunes. Contact him at