Bladen County EMS’s mission is “To provide Bladen County with professional and efficient patient care in a responsible and timely manner,” but how much can the county afford?
Commissioners met Tuesday afternoon to review the current system and discuss ways to make it better.
The purpose of the meeting was to provide the board an overview of the EMS system, and to discuss challenges related to:
1) 15 minute response time
2) Staffing
3) Volunteer Squads
4) Review and discuss the use of QRV’s (Quick Response Vehicles)
The meeting began with EMS Director Bradley Kinlaw and EMS Chief David Howell leading the discussion that included;
1) Employee Duties
2) Response Areas/Times
3) Call Volume
4) Volunteer Squad Challenges
5) Crash Truck
6) Suggestions for the boards consideration
The discussion included Organizational Structure, overlapping roles and responsibilities of EMS including Health Care, Public Health and Public Safety.
Howell spoke about the duties of the Chief, the Training Officer, Supervisors, EMT/Medics.
He provided the commissioners information related to hiring and assessment.
Kinlaw and Howell then provided graphs showing the regional responsibilities of the County EMS and the Volunteer Rescue Squads. The graphs were broken down into “Week Night” with staffing from 6 p.m. to midnight and from midnight to 6 a.m, for weekend staffing as well as weekdays.
Weekday coverage is provided by the County EMS with backup from Rescue Squads as needed. The picture becomes a little more blurred in the evening time when the volunteer units play a larger role. However, after midnight some volunteer squads cease their service, except in cases of an emergency. Volunteer squads provide much of the service in the evening and on weekends.
Charts were provided that indicated Bladen EMS coverage with 15 minute response times, from 6 a.m. to 6 p.m. The maps included daytime coverage, night coverage, weekend coverage and weekend night coverage.
Staging areas are provided in the Bladenboro/Clarkton area, Elizabethtown/White Lake area, White Oak/Tar Heel area, East Arcadia/Kelly area and other units at the EMS Base and Elizabethtown area. Response Times change depending on the time of day and day of the week.
Commissioners were provided statistics from the past 3 months related to Response Time. Elizabethtown had the shortest response time during that period of time of about 9 minutes. The Rowan community had the worst response time.
The presenters said there were several times used, for instance, the time the call is received at the 911 center. Another time is from the time the call is received until the ambulance is rolling, and the time it takes for EMS to arrive on the scene. Chairman Charles Ray Peterson pointed out that some of those times may be deceiving or inaccurate. If it is a Rescue Squad responding, there is an additional time for the volunteers to arrive at the squad building.
Chief Howell addressed a question related to why it usually takes some time after the patient is in the EMS vehicle before they depart from the scene. Some of the decisions that must be made include the primary assessment of the patient. He said it is difficult to obtain a good 12 LEAD ECG with the ambulance moving, they need to determine base line vital signs and secure as much patient history as possible to share with the hospital. Airway passage and obtaining IV access is important and easier prior to the ambulance rolling.
He also said the “scoop and run” philosophy of the early years of EMS are “no more.” The EMS personnel need to determine if the patient should be taken to the nearest hospital or if it is obvious the patient needs to go to a hospital that provides more services, and some of the decisions are based on family preferences.
Total call volume is increasing. In 2014 over the period from January 1 through August 31, there were 6532 emergency and non-emergency calls responded to. This year that number increased to 6812.
In addition to the normal runs, Howell and Kinlaw spoke of non-emergency transports, a total of 562 this year, including 164 last month that requires vehicles and staff.
They also provided information related to out of county transports that cause a shortage of coverage in the county, until the unit returns.
EMS pay scales were provided, including comparisons that indicates Bladen salaries are less than some nearby counties.
Howell and Kinlaw talked about recruitment process, including visiting BCC and high schools, and providing EMS students ‘ride time opportunities.’
Volunteer squads provide more challenges including maintaining ALS providers (EMT-Intermediates), increasing cost of medical supplies, increasing cost of capital items, decreasing Medicare and Medicaid reimbursement rates and personnel call reimbursement.
Squads are constantly in need of more help. Right now, one of the biggest challenges is the Clarkton Rescue Squad that has a shortage of personnel.
Other items covered included the possibility of purchasing a crash truck. One possibility is to set up a 501(c)3 organization that would be eligible for grant funding to assist in replacing older equipment.
Challenges include maintaining adequate emergency coverage and handling unscheduled transports from the local hospital to out of county facilities. Staff and available units are a concern.
Kinlaw and Howell offered suggestions related to adding additional trucks and personnel. Currently, there is 1 QRV per shift. They are located in Bladenboro, Elizabethtown, Clarkton, White Lake and Dublin.
Commissioners questioned why QRV’s were not being used in off hours. 4 QRV’s have high mileage, but 3 new vehicles were approved in the recent budget and should be available soon and are expected to be more readily available.
It would take 6 additional full time EMS positions if part time positions were eliminated.
The meeting was contentious at times with some attention related to personnel issues and the current location of vehicles where the data indicated they may need to be re-positioned. Chairman Peterson said the location of ambulances should be data driven.
Kinlaw and Howell are expected to review comments from Tuesday’s meeting and submit proposals to the board in the next 2 or 3 weeks that would provide the best use of personnel and vehicles as they continue their efforts to provide the best service possible to all areas of the county.
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