Wise County EMS Chief Randall Preuninger looked at the date and started doing the math. It was Oct. 12, 2024, a day that marked his 20th year of working in public safety.
There wasn't time to celebrate the milestone.
After a relatively quiet morning, the afternoon started with wreck in Boyd. A truck t-boned an SUV. Then a carport collapsed onto a man's boat on Lake Bridgeport, resulting in a head injury. About an hour later, medics responded to a rollover wreck on Farm Road 51 near a Dollar General that resulted in crews extricating a patient. Then a car struck a tree on the same road at County Road 3690. The next several hours were marked by medical emergencies and minor accidents, up until about 9 p.m., when a vehicle swerved into oncoming traffic on U.S. 81/287 near Alvord. While two patients had already died, multiple people in the two vehicles were still breathing, beginning a massive effort to save the five patients in critical condition. After arriving on scene, Preuninger's usually cheery voice boomed over emergency radio traffic.
"We need a total of five," the EMS chief told dispatchers as his 20th anniversary neared the final hours. "Five helicopters."
As aircraft after aircraft touched down on U.S. 81/287 -- a highway that his crews seem to always be working, near the spot that had seen the deadliest wreck in the county in decades just months before -- Preuninger hadn't lost his passion to serve, a passion that started decades before.
"You blink and it's here," Preuninger said. "I would never say it's been 20 years. But I'm going to go until the good Lord tells me I can't."
Overnight, as Preuninger's career reached a few hours past 20 years, Wise County EMS crews worked a car versus a tree accident, a vehicle versus a fence accident and rollover wreck that resulted in another flight to the hospital. That is the nature of emergency medical services in 2024, as the 900-square mile county grows in both traffic and population.
Despite the challenges -- the public infrastructure that hasn't caught up with the demand, the long hours and closely experiencing the growing toll of tragedy -- Preuninger said he believes he is exactly where he needs to be.
Answering the call
Preuninger grew up in Bowie. At the age of 15, he knew what he wanted to be when he grew up.
His dad was a volunteer firefighter, and he eventually joined suit, volunteering with the Bowie Rural Fire Department after graduating high school.
"I got to know some of the career guys there, and I fell in love with it," Preuninger said. "I wanted to be a paramedic. After high school, I got my start."
Oct. 12, 2004, marked Preuninger's first day on shift as a firefighter paramedic. He was 20 years old.
Over the next few years, he advanced up at Bowie, eventually taking on leadership roles and expanding his training and certifications.
Now 40, Preuninger said much has changed compared to when he started.
"We are far advanced compared to where I started, from technology and patient care, but also, when I started, cell phones weren't a huge thing," Preuninger said. "[While the accidents were different] we didn't have power cots. We didn't have CPR machines. If you compare today to back then, our save rates are much higher. All the blood in the field, it's not something we thought of. Now we have ventilators that can fit in your hand. There's so much that made the job safer and easier."
In 2008, he got hired at Wise County EMS, eventually joining the agency full-time in 2010.
He got his start at the agency under the leadership of Charles Dillard -- a man he would eventually replace after Dillard's retirement in 2019.
Preuninger said Dillard's influence as a mentor was not only critical to his career, but to the agency as a whole. When Preuninger took over the position, there weren't culture or morale issues to address.
"The biggest thing that he did was he made the job enjoyable. You can love the job, love the work, but hate where you're working," Preuninger said. "That was not the case. I love the job, I do, but I have also loved the place I worked. I think a lot of that credit goes to Charles. He also kept the agency progressive, especially on the EMS side -- we just have tried to keep up what he built.
"I would work for Charles again today," he added. "I ask him sometimes, 'Are you ready to come back?' He made a big impact on all of us."
Where Wise County EMS is now
Wise County is growing, and so is the agency tasked with emergency medical services.
When Preuninger started in 2008, Wise County EMS responded to around 5,000 calls per year. He expects that number to nearly double by the end of the year, with around 8,000 calls for service.
In response, Wise County EMS opened a station in New Fairview, cutting down response times in the area. Next up will be a station in Alvord, which is expected to begin construction in 2025.
Beyond stations and staffing, Wise County EMS has also expanded how it responds to various emergencies, whether it's on the road, in the water or through rope rescues. '
One example of how that has made the difference between life and death is Brandon Bushaw. Bushaw and his fiancée Bailey Cross were traveling on County Road 4757 shortly after 6 p.m. Feb. 2, 2022. As they approached the Trinity River, Bushaw lost control of his 2021 Infiniti, careening over the bridge and plunging into the cold water. Bushaw was submerged in the frigid waters of the Trinity River for more than 30 minutes. Thanks to a Wise County EMS rope rescue team who waded into the river, Bushaw was rescued and resuscitated. The man, who didn't have a pulse initially, shook their hands months later.
"We have had calls where people are clinically dead, and they come back talking to us," Preuninger said. "Tragedy is the vast majority of what we deal with. The ones that end up good keeps that somewhat balanced out."
These types of rescues have been accomplished through investments in equipment and training of personnel.
With the rise of drownings and the need to respond on both lakes and rivers, Wise County EMS recently brought a rescue boat into service, and has also advanced the capabilities of its rescue team, which was recently activated after a man fell into the Lake Bridgeport dam earlier this year.
While the agency continues to push the boundaries of how they can help, Preuninger said they are also working to be more efficient -- a necessity to adapt to what Wise County requires in 2024.
One piece of that is the staffing of ALS vehicles, essentially an ambulance without a cot, which primarily runs medical calls.
"We have been able to cut down on Rescue-1's call volume by about 20 percent," he said. "It's not enough, but it's helpful."
The makeup of the Wise County community has changed significantly in Preuninger's career, and really, even in the five years since he's been leading the agency. The amount of deadly accidents have been higher than normal. Preuninger said he keeps waiting on things to balance out, with a break from the fatal accidents.
That hasn't happened yet.
The task is large and heavy, but the chance to make a difference makes the work worth it. And when he looks at the next 10 years, which would make 30 in public safety, Preuninger said there will be new challenges to address. In his time, he's seen the nature of calls shift, from devastating rock truck wrecks to the types of accidents from more distracted drivers traveling at high speeds that seem to be a daily occurrence today.
But his team and other Wise County first responder agencies are already working to answer the call.
"It's going to be a lot of research, with what we're doing now and moving to different places. We're going to keep up with the latest and greatest [techniques, trends and technology]. Keeping up is going to keep us safer. Both sides, the EMS and Rescue will keep moving forward."