As Steve Main places 29 years of keepsakes from UCHealth’s Poudre Valley Hospital Emergency Medical Services into a box, he shares his one desire for the organization he helped grow for nearly three decades.

“My hope is that we are now positioned for a successful future,” said Main, who recently retired.

PVH EMS has already come a long way in its 40-plus year history — and mostly under the leadership of Main.

“Steve put the pieces in place,” said Ted Beckman, PVH EMS education and outreach chief, who worked with Main for 10 years. “He may not be physically present anymore, but his presence will always be felt by what he’s put in place, which made us relevant and successful.”

Main started with PVH EMS in 1988, when there were only two ambulances and 16 employees who ran fewer than 3,000 calls. By 1994, Main was placed into the only leadership role for PVH EMS paramedics — the resource paramedic. In 1999, he became the shift supervisor, then the department manager and in 2012, the director.

“He’s always enabled us to create successful programs,” said Tom Cain, logistics and support chief, who worked with Main for nine years.

“He’s encouraged us to think outside the box,” Beckman added.

During the wildfires of 2010, under Main’s leadership, the department began to morph from a 911 ambulance service into a diverse community resource in both public health and public safety.

“We didn’t have a robust special operations team that first time we provided support for the Crystal Fire in 2010,” Main said. “After that fire, we got our SORT (Special Operations Response Team) trained in wildland fire support and purchased special equipment, which proved very timely when we had the High Park Fire in 2012. By that time, we’d already worked about five fires, so we were positioned to support what became the largest fire in Larimer County’s history.”

Main said it’s hard to anticipate natural disasters, but he believed that the area was likely — with its population growth and development creeping into surrounding forests — to have future catastrophes.

“I was here for the 1997 flood, and that was hard to work through,” Main said. “No matter what the threat might be, I knew we needed to be better prepared for it.”

SORT continued to develop and now partners with the Fort Collins Police Department and Larimer County Sheriff’s Office to provide medical assistance for high-risk warrant and SWAT calls. They also have provided training to about 300 law enforcement personnel in self- and buddy-rescue techniques. Its medics have specialized training to support the Larimer County Sheriff’s Department bomb squad. And in the past several years, it has added dive- and swift-water rescue capabilities to the services it was already providing to Larimer County Search and Rescue.

“We’ve really become an all-hazards support unit,” Main said.

The PVH EMS team is on foot and on bicycles and provided medic support for an estimated 400 special events in 2016.

“These relationships we’ve created with other agencies wouldn’t exist by just going on calls with them,” Main said. “Because of these relationships, everyone is on the same page on game day. So when we have those high-risk events, we are all in it together.”

This experience, coordination and preparation showed during the 2013 floods, according to Braden Applegate, manager and operations chief, and 15-year veteran of PVH EMS.

PVH EMS played a major role in what became the largest aerial rescue operation since Hurricane Katrina. Because SORT had been trained as certified medical unit leaders, as well having completed the Colorado Wildland Fire and Incident Management Academy, the team established and managed a medical base for flood rescue operations, Applegate explained. And SORT members — because of previous high-angle rescue and rope training — helped search and rescue crews with backcountry rescues. They were airdropped into communities to help residents who had been cut off from medical services.

Main and the PVH EMS team have been innovative in their approach to helping Northern Colorado communities.

“Steve has always been very good at letting us take our interest — what we are passionate about — and build that up,” Cain said.

One example is the creation of BERT: Bicycle Emergency Response Team.

“We live in an amazing bike community, so our staff started thinking innovatively,” Main said. “We cover a lot of events that cover a lot of miles and acres. They figured out we could be there quicker and be more efficient on bicycles than if we dispatched an ambulance.”

BERT started with a small staff and donated gear. It now has a full team that this summer began patrolling weekend nights in Old Town to alleviate unnecessary use of ambulances and stress on police and fire department resources.

Main also helped start the community paramedic program in 2010 through UCHealth’s Aspen Club. This program allows paramedics to make house calls, helping those residents with such things as medication reconciliation, health exams, home safety checks and vaccinations. Their presence has allowed people to stay in their homes and has decreased unnecessary visits to the emergency room.

“The program has allowed us to be part of a person’s care coordination, with an objective to keep them out of the hospital. It’s a paradigm shift in health care,” Cain said.

To unify all that PVH EMS had been doing, Main decided to pursue the industry’s leading accreditation. And in 2015, PVH EMS was awarded the Commission on Accreditation of Ambulance Services certification, becoming one of only about 200 ambulance services in the country to hold such an honor.

“I looked on it as do the Marines: the few, the proud,” Main said. “We had taken the time and effort to analyze our processes because we wanted to take it to the next level and be the best ambulance service around. And I do believe we are one of the best in the state.”

The list of accomplishments goes on and on and includes faster-than-standard response times, expanded boundaries, including into Weld County in 2013, and the creation of a critical care ground transport unit. The service had grown fast under Main’s leadership, now with about 170 paid staff members and around 80 volunteers.

“We had grown so far, so fast in the past seven years that I felt like things were starting to wobble a little bit, so last winter (2015-16), we went through a reorganization,” Main said.

The team created new positions, repositioned others and reorganized around contracts to create deliverables and streamlined reporting and evaluations. Main said it was a move to help PVH EMS position itself for a successful future, and his division chiefs agree.

“Paramedicine is young compared to nursing and other health care models,” Cain said. “Progressing our industry is important, and I believe we’ve done a good job so far.”