Patience, trust are keys to success for Anacortes’ retiring community paramedic
In the 18 months before Anacortes launched its community paramedicine program in July 2021, one woman had called 911 for help 73 times, resulting in 42 trips to the emergency room.
Nearly every morning, the 64-year-old — who lived alone and had been struggling with complex medical and mental health issues — would call 911 after falling while trying to get out of bed.
“I would go visit her pretty much weekly as I was developing the program,” said firefighter and paramedic Steve Monrad, who arranged for the woman’s daily caregiver to arrive a little earlier each morning.
“It was a pretty simple fix,” he said. “All it really took was a fresh perspective, and those daily 911 calls stopped. The only times we got calls after that was when she truly needed us.”
In the first six months of 2022, that woman called 10 times and was transported to the hospital six times.
Since the program began, Monrad said he’s achieved similar results for all of his 278 patients, cutting their 911 calls by at least 50% each year.
Reducing nonemergency calls is exactly what the city and Island Health aimed to do in 2021 when they teamed up to create the first community paramedicine program in Skagit County.
Now, as Monrad prepares to retire in June, he says he’s certainly proud to have been able to save the city and the hospital money and help each make more efficient use of their resources.
More than that, though, he said he’s fortunate to have had the chance to get to know his patients on a more intimate level than he ever could as a regular firefighter and paramedic.
“This job requires a certain degree of deprogramming to get out of the mindset that any given problem is going to be resolved in just 30 minutes,” Monrad said.
“This isn’t a sprint,” he said. “This is more of a marathon, and you might get to know some people pretty well in the process of helping them.”
The Concrete native, who comes from a long line of volunteer firefighters, said he’s had a passion for helping people solve their problems since he began studying social work in college.
At the same time, he was volunteering with his hometown fire department each summer.
After graduating, Monrad worked at an inpatient treatment center and considered pursuing a master’s degree in social work. Then he took an emergency medical technician class.
“As soon as I got involved in the EMS side of the fire department, I was bitten by the bug,” he said.
Monrad has been a paramedic for 29 years, spending the past 27 years with the Anacortes Fire Department and the past five years as its sole community paramedic.
“You can look at me either as a paramedic who’s a social worker or a social worker who’s a paramedic,” he said.
One thing that sets Monrad apart from his fellow paramedics is that his time is dedicated to helping the most frequent 911-callers, nearly all of whom are facing nonemergency challenges.
“They’re calling 911 because they don’t have or know of a better way to deal with the issues they’re facing,” he said.
Four in five of his patients are aging and disabled, and more than half are managing complex medical problems, he said. Many are at risk of falling or have mental health issues.
About 20% of his patients have experienced homelessness, and nearly 15% have been struggling with substance use disorder, he said.
Early on in the program, Monrad teamed up with the police department and a social worker from the Anacortes Family Center to help people who were experiencing homelessness.
“The community was seeing an influx of people living in vehicles on the streets,” he said, adding that such a partnership remains unique in Skagit County.
“There are no other teams like this in the county that pair fire and police and a social worker,” he said. “That’s something I think we should be pretty proud of.”
Another thing that sets Monrad apart from his peers is that he can serve as a liaison between patients and their healthcare providers. With patient consent, he’s able to access medical charts and prescription lists in order to help patients manage their health issues.
“I don’t know of another community paramedic program that has the access to the hospital and the facilities that I do here,” he said. “On the flip side, the hospital has access to me.”
Monrad is better able to visit patients where they live, “put eyes on people and support them in place,” he said.
That’s especially valuable with the majority of Monrad’s patients, who are older residents managing the myriad challenges that come with age.
One of his longest-running patients had never called 911. Instead, Island Health’s primary care clinic expressed concern about that patient’s ability to manage his medications for a chronic disease.
Monrad gave that patient a daily pillbox and showed him how to fill it once a week.
“Once you help to build those habits and those behaviors,” he said, “it doesn’t become such the issue anymore.”
He also recalled helping a man whose wife was in hospice care.
“He was trying to navigate that alone,” said Monrad, who asked the man if he had any children or other family he could call for help.
The man said he had a daughter, but they hadn’t talked to her in years.
Monrad said he’s been surprised at how often he hears that from his older patients.
“It was shocking to me how many elderly people are just kind of blowing in the wind with no supports,” he said. “They have family, but their family aren’t aware of what’s going on.”
So Monrad did what he’s done with many people in this situation: He expressed how terrible he would feel if his mom or dad were struggling and he didn’t know about it.
That worked. The man called his daughter, and she came to help.
“He had rekindled this relationship with his daughter,” Monrad said, “and he was so appreciative of my nudge to reconnect.”
The man recently called Monrad to thank him again and to let him know that he would be moving closer to his daughter now that his wife has died.
Much of the help Monrad’s been able to offer his clients has only been possible because he’s taken time to get to know them and establish trust, he said.
“For some people, I was that person they could call,” he said.
When it came to the 64-year-old woman who would often fall when getting out of bed in the morning, Monrad would simply stop by and knock on the door every so often to make sure her needs were met.
“She actually got mad at me for knocking,” he said. “She told me, ‘You don’t have to knock. You can just come in and holler my name and make yourself at home.’”
One day, they were sitting in her living room watching “The Rifleman” when Monrad looked over and noticed she was asleep.
“I figured, ‘Well, I can’t leave now. That would be rude.’ So I just sat there quietly and watched TV,” said Monrad, who soon fell asleep himself.
“I’m not sure if my own snoring woke me up or what, but suddenly I realized I had taken a nap in her living room,” he said with a laugh.
Eventually, she ended up in the hospital with social workers on the way to discuss alternatives to her continuing to live alone, which Monrad said had become increasingly unsafe.
“She asked me to stay and be part of that conversation,” he said. “She had gotten to know me, she trusted me and she wanted my two cents.”
Monrad was able to convey that he was worried about her safety living alone, and she willingly agreed to move to an assisted living center, he said.
“She was able to get the help she needed and an improved quality of life until she ultimately passed,” Monrad said. “It was just so great that she wasn’t at home alone.”
Monrad’s last day on the job will be June 10. After that, he plans to spend his summer out on the water in his live-aboard Tollycraft cruiser before visiting national parks this fall and traveling to Norway next spring to see family.
“We are fortunate in the fire service and in law enforcement that we can retire younger than the general population,” the 54-year-old said.
In 2020, Monrad was diagnosed with a rare autoimmune disorder that ultimately left him needing a kidney transplant. Now, with that behind him, he said he’s healthier than he’s been in years and eager to enjoy life.
“I’m looking forward to a change, a new chapter,” he said.
The city has been seeking applicants to replace Monrad since early May. His advice for whoever steps into the role: Practice patience with your patients.
“At the end of the day, we’re just working with people,” he said. “So treat people like people, and have patience.”
Published on June 3, 2026