"In my mind, it was sort of a perfect storm scenario," Frantz said.

Two widespread entiroviruses, a rotovirus, respiratory illnesses and flu vaccines that missed the mark translated to the busy emergency departments.

"What these things did is they caused pretty profound nausea and vomiting and you just couldn't stop," Frantz said about the entiroviruses. "You put all these things together plus our weather and it was just a perfect storm scenario and there were lots of things that were conspiring to keep people in emergency departments."

If those numbers had continued, the system would have seen 158,000 people during the year, Frantz said.

"We have incredible people. We have incredible docs. We have incredible nurses. We have incredible medics. And they are able to stretch and make it work pretty much no matter what's handed to them," said Eddie Sims, manager of the EMSStat ambulance services.

Many factors contribute

A collaborative and quality attitude starting with the community and extending throughout the health system lends itself to better outcomes.

"It's not just one factor," said Frantz, who said he provides "fierce support" for his team. "And everything is up for review. We look at everything. And everybody's excited about doing it."

He said the American Heart Association calls it the "chain-of-survival" -- what happens to the patient from the time an event occurs.

Frantz gave an example of what happened last year when a York employee became ill.

"We had an individual who suffered a sudden cardiac arrest at the York plant a little over a year ago and his coworkers recognized it and applied an external defibrillator. It recommended shock and they shocked him," he said. "And then the firefighters were there and they started provided oxygen and other supportive care, and suddenly the paramedics are there and they are establishing IVs and giving medication and every one of these little links in the chain sort of serve as a safety line for that patient. And they are all critical."

Norman's EMSStat paramedics, who are employed by NRHS, are trained to read electrocardiograms or EKGs. They do prep work, put in IVs and draw blood, so the lab work can start immediately upon arrival.

The paramedics were featured in the November 2007 trade magazine Hospital and Health Networks for their training, which can save heart muscle when every second and minute counts. They have the highest published "code" survivability rates, or for sudden cardiac arrests.

"I tell patients this all the time. (Paramedics) do exactly what I would do if I were there. They give the exact first-line care that I would give if I were in the truck. Because I have been in the truck," said Frantz, a former paramedic. "They are having one-on-one care while they are sitting there."