By Nancy Lindsey
A small but vocal contingent of emergency medical services (EMS) providers, firefighters and other volunteers told the Patrick County Board of Supervisors Monday night that the time has come for some form of paid EMS in the county.
Too many emergency calls are being “toned out” to one or more squads, going countywide and sometimes turned over to neighboring counties due to a shortage of Patrick County volunteers to run the calls, audience members said.
The mood of the meeting was heated and peppered with shouting—especially between some of the volunteers and Mayo River District Supervisor Lock Boyce, an outspoken opponent of a county-paid “quick response vehicle” (QRV) or ambulance staffed with county-financed EMS workers.
Dan River District Supervisor Roger Hayden, board chairman, pounded his gavel trying to get people to take turns speaking, but was largely unsuccessful.
There was no resolution to the issue, which has been a topic of discussion for several years but has apparently grown more controversial in recent months.
Ray Wells, a veteran paramedic from the Woolwine area, said a QVR would pay for itself with soft billing (when the patient is billed for an emergency call but is excused from payment after three bills if his insurance doesn’t cover the charge.)
Wells urged the board not to institute any system requiring hard billing, which means that the bill must be paid and turned over to a collection agency if it is not.
Too many people don’t have insurance and can’t afford the cost of an ambulance ride to the local hospital or a trip to a trauma center 60 miles away, Wells said.
Clinton Weidhaas, a state trooper and Stuart Volunteer Fire Department volunteer, said the distances between communities in Patrick County are too great for both law enforcement and fire and rescue to adequately serve.
If two police officers respond to a disturbance in a remote part of the county and one is shot, he’s got “five minutes to save himself” before he bleeds out, and no rescue agency available, Weidhaas said.
A paid EMS service might not be the answer to that scenario, he said, but it would offer a better chance. “Every county around us has a paid service,” he said.
As a Patrick County taxpayer, Weidhaas said, “We want something better to supplement volunteers. If someone shoots you, you need to know some ALS (advanced-life-saving) service is coming.”
Weidhaas responded to some criticism he said he has heard about Steve Allen, the county’s emergency management coordinator. Some people think Allen’s $100,000 EMS truck (with supplies and equipment) is excessive, Weidhaas said, but “he got it because he needed it.”
He added that Allen and his assistant, Lemont Bryant, run a lot of calls assisting other departments.
Much of the criticism toward Allen is because he implements regulations set by the state dealing with training and reporting, Weidhaas said.
Chris Corbett, a longtime member of the Stuart Volunteer Fire Department, said he had been “responding to one bad situation or another for 35 years,” and had seen clear trends.
It’s harder to be an EMT (emergency medical technician) today, it’s harder to keep EMTs enrolled in rescue squads, and much less free time to volunteer, Corbett said.
The board of supervisors can look at how other localities cope with their volunteer shortages and try to come up with the best solution, Corbett said.
But throwing money at the situation “can’t make time, it can’t create time,” Corbett said, and that’s the crux of the problem.
Carlton Largen, a member of the Meadows of Dan Volunteer Fire Department, asked the board and audience members to raise their hands if they carried a current CPR (cardiopulmonary resuscitation) card, and most people in the back of the boardroom did.
That’s part of the problem, Largen said: the people in the front of the room are relying on the people in the back of the room to save them if they have a life-threatening emergency or illness.
Meadows of Dan, like most of the county, is experiencing an increase in its elderly population while young people are leaving the county, Largen said. Those that remain are working full-time jobs or running their own businesses and don’t have time to carry the whole load of volunteerism.
“The board has to do something to give citizens adequate fire and EMS,” Largen said. “We’ve got to do something to keep people in Patrick County.”
Largen asked Boyce if the state requires Patrick County to provide fire and rescue service.
“The law requires the county to make an honest attempt, and we have too,” Boyce said. “We spend a tremendous amount of money.”
Boyce added, “I’m not going to sit here and trash the volunteer system we’ve got.”
Boyce said recruitment is the key to getting more volunteers, and he said he used to go out and talk with employers about encouraging their employees to volunteer.
Meadows of Dan Volunteer Fire Department member Ronald Terry said if squads are unable to answer 100% of their calls, they need help. When citizens in the county call 911, they have a right to expect a response, he said.
“Do you want us to put an ambulance in every area?” Boyce said.
Terry said a paid service would respond to a call (or tone) after there is no response from the area where the call originates and no response from a countywide tone.
“That’s not how people do,” Boyce said.
“You got to learn what’s going on in the county,” Terry said. He said he had talked to volunteers and officials in Floyd, Carroll and Henry Counties about Patrick’s problem.
“Floyd’s a smaller county,” Terry said. “But when someone in Floyd calls 911, they know an ambulance is on the way.”
A discussion ensued between Boyce and the audience about the value of an ALS-trained person vs. a BLS (basic life support) volunteer.
It’s not true that every call needs ALS, Boyce said.
“If you were having a stroke which would you rather have, ALS or BLS?” Terry asked.
“BLS,” Boyce answered.
Several audience members laughed, Hayden rapped his gavel, and Boyce thundered: “Don’t laugh at me; I spent 12 years working with a rescue squad.”
Boyce said the county doesn’t have enough calls to warrant a paid service.
Daniel Hill, a member of the Stuart Volunteer Fire Department, said he was once a member of the J.E.B. Stuart Rescue Squad, but left because of “corruption.”
“He’s no friend of Jeb Stuart,” Boyce said.
Hill said he is now a paramedic working in Henry County. His beginnings in Patrick County led him to become a paramedic, he said, but told Boyce, “After this meeting and the show you’ve put on, it makes me ashamed.”
Hill thanked Smith River District Supervisor Crystal Harris, captain of the Smith River Rescue Squad, for her support in his career and said many people had helped him.
“I know you’re struggling right now,” he told the other volunteers, “and everything is 100 times more difficult than it was 20 years ago.”
Ray Wells said he was part of a group that met a few years ago with Dr. Jason Edsall, the rescue squads’ medical director, and a representative of the Western Virginia EMS Department, to collect information and come up with a plan for improving volunteerism and response time. He said the program could be presented to the board at a later time.
After another heated exchange between Boyce and some of the citizens, Hayden said, “Every time we try to hold a meeting with EMS and the public, this happens. We can’t sit down as a group and work o
ut the differences for the people of Patrick County. I’ve been working since last year to find ways to improve services. It’s not fun and games…Let’s try to work together.”
Weiss said he wanted to apologize on behalf of Hayden. “We’ve got people who worked all day and then came here to try to work it out,” he said. “I apologize for his saying ‘fun and games.’”
Erika Cipko, a member of the Stuart Volunteer Fire Department and an EMT-E (enhanced) with the Ararat Rescue Squad, said she experienced a situation last Tuesday in which a patient at Caring Hearts Free Clinic needed to go to the Pioneer Community Hospital emergency room, but there was no transportation under the EMS protocols—even though the clinic and hospital are only a short distance apart.
The 911 Dispatch Center toned out several squads and the LifeCare hospital service which was unavailable, leaving Ararat as the only option—at least 35 minutes away.
The nurse practitioner on duty suggested that the man’s wife drive him to the hospital, Cipko said.
“All we want is the possibility of having an ambulance,” said Cipko, who was excused from her job as Chris Corbett’s secretary to respond to the call. “Not everybody has the opportunity to leave work.”
The approximately 20 minutes it took to get the patient to the hospital was contrasted with an hour and a half to dispatch an ambulance from Ararat, Cipko said.
Harris thanked everyone for attending the meeting and commended certain volunteers, including Weidhaas, who she said had wanted to be a firefighter since he was in kindergarten. She talked about all the changes in methodology since she started doing EMS 30 years ago, and how it “broke her heart” to lose a promising EMT to another locality.
All the volunteers work hard and get up in the middle of the night to respond to calls, Harris said.
“I was not an advocate of a paid service, but now I think we need something,” Harris said. “We’ve got to get a better system. My sympathies are with you and you have my support.”
Peters Creek District Supervisor Rickie Fulcher said he wanted to hear all sides of the story. “We do have a real problem when 911 calls are not being answered in a timely fashion,” he said.
Fulcher said the EMS providers have other responsibilities and lives beyond their volunteer work, and the whole issue needs to be addressed in a “logical and businesslike manner.”
“Our continuing focus needs to be the health and welfare of our citizens,” Fulcher said. “I appreciate every one of you. There are no bad ideas, just bad solutions.”
Hayden said he fully supports some type of program to improve EMS. The rescue squad members are getting older and there aren’t enough young people to take their place and provide the necessary manpower, he said. He added that he would like to see more participation at meetings where EMS issues are discussed.
Weiss said he would vote Monday night to budget funds for a paid ambulance service if he thought it would pass. He told Ray Wells, in response to his earlier request, that he would never vote for a service with hard billing.
Weiss said he had already had several incidents with problems getting family members to the hospital, and knows how serious the situation is.
Weiss said Corbett’s statement, “nobody can create time,” was one of the smartest comments he had heard.
Whatever system the county chooses, there must be accountability, Weiss said. “I don’t think it can work without it.”
Boyce said the squads already have the infrastructure, equipment and people, but may need to pay volunteers to be available to run calls, probably funded with soft billing.
The problem shouldn’t be approached with “emotional arguments,” but looked at logically, Boyce said.
“Buying an ambulance and hiring a staff may not be the most efficient way,” he said.
The board plans to discuss the EMS topic at the Feb. 29 meeting.