POCAHONTAS - Dan Paulsen balances himself on his left leg, apparently with ease, as he climbs in and out of the ambulances lined up in a garage at Pocahontas Community Hospital.
Periodically checking out the vehicles and their equipment is a routine part of his job as an emergency medical service leader.
And he has no choice but to rely on his left leg, as he does that because he lost most of his right leg to cancer.
Paulsen has dedicated himself to improving pre-hospital emergency care throughout Pocahontas County while at the same time fighting his own illness.
Losing a leg, he said, made him a better supervisor. He said that since he can no longer routinely take care of patients, he's forced to concentrate on the training and resources needed to run an emergency medical service.
He added that enduring surgeries and other intensive treatment has given him a new level of compassion for patients.
''Being a consumer of health care, by default, makes you a better health care provider,'' he said.
Paulsen holds three jobs. He is the emergency medical service director for Pocahontas Community Hospital. He's also the Pocahontas County emergency medical service coordinator. And he's a medicolegal death investigator for the county medical examiner.
In his hospital capacity, he supervises 16 emergency medical technicians who operate three ambulances. Those EMTs, he said, are paid for each call they answer.
''I don't know a single EMT that got into the job for the money,'' Paulsen said.
He said he hopes someday to employ full-time paramedics who would provide the highest level of pre-hospital care.
In his county role, Paulsen helps to ensure that emergency medical units there are up-to-date on their training and are able to coordinate their activities. He works with ambulance squads in Laurens, Rolfe and Fonda, plus the Palmer Fire Department, which operates as an emergency medical first response unit, but doesn't have ambulances.
He's a member of the Iowa Department of Public Health's Bureau of Emergency Medical Service Quality Assurance, Standards and Protocol Subcommittee. He's also a member of the boards of directors of the Iowa Emergency Medical Service Association and the Northwestern Area Training Academy.
Paulsen joined the Nora Springs Volunteer Ambulance Service in Nora Springs, a town on the border of Cerro Gordo and Floyd counties, while he was still in high school. He said he was planning on a career in law enforcement when he was recruited to join the ambulance service. He was 17 when he started his EMT training. Paulsen soon found emergency medicine to be a better fit for him than law enforcement.
''I got a lot more satisfaction out of helping people this way,'' he said.
When he completed his training, he was given a pager so that he could be alerted for ambulance calls. The pager remained silent for what seemed like weeks, Paulsen recalled.
''I swore that pager didn't work,'' he said. ''Then one morning at 15 minutes after three it went off and I about hit the ceiling.''
That morning, the ambulance crew was called to transport a nursing home resident with a fever to a hospital in Mason City. It was the first response of Paulsen's career.
He worked for Mary Greeley Medical Center in Ames for 13 years. He also increased his level of training to the emergency medical technician (intermediate) level. In 1996, he started teaching EMT classes.
He began working in Pocahontas in April 2007.
The following year, a malignant tumor was discovered in the cartilage of his right ankle. Part of his right leg had to be amputated, and he was fitted with a prosthesis.
That, he said, slowed him down and led him to focus more on management skills.
Paulsen said that transition became very apparent when he responded about four years ago to help a man who had fallen about 48 feet at the Havelock elevator and landed on concrete in a cellar. Paulsen said he knew he would get in the way if he climbed down into the cellar, so he directed the rescue operation. He secured a crane to hoist the man out of the cellar and directed volunteer firefighters in setting up a landing zone for a medical helicopter.
After the man was on his way to a hospital, Paulsen apologized to his crew for not climbing into the cellar and helping to treat the patient.
''They said, 'No, we needed you up there getting everything else done,''' he said.
Last year, Paulsen had to have most of the rest of his right leg amputated. He had a prosthesis with a hydraulic knee, but it didn't fit him well. He now gets around the hospital and anywhere else he needs to be in a wheelchair.
For Paulsen, ambulances are a hobby as well as a key component of his job. He once owned a 1976 Cadillac ambulance and he's now trying to find out what happened to a 1971 Oldsmobile ambulance formerly owned by Pocahontas Community Hospital.
His wife, Jessica, is also in the business of helping others. She's a dispatcher for the Pocahontas County Sheriff's department and was recently named Dispatcher of the Year by the Iowa Emergency Medical Service Association.
The Paulsens have three children.