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Squads report EMS problems, solutions

By Nancy Lindsey
The Patrick County Board of Supervisors heard reports and opinions from four of the county’s five volunteer rescue squads Monday night, but took no action.
Three squads—Ararat, Blue Ridge and CCDF—were not in favor of a paid emergency medical services (EMS) system for the county. Vesta Rescue Squad said a paid service is needed to back up the volunteers, and a Smith River Rescue Squad spokesman said a private ambulance service is not the answer.
J.E.B. Rescue Squad did not send a report to the supervisors or have a representative present.
Michael Fulk of the Ararat Rescue Squad said its stipend system, “plus respect and encouragement of our personnel by each squad member, is our greatest strength.
“Our squad members treat each other and the other squads in the county with respect and gratitude for their willingness to be a volunteer,” Fulk said. “The citizens of our area and any we treat through mutual aid realize right away that we are concerned for their individual welfare. They are important to us as neighbors, friends and fellow citizens, unlike a paid service which would only be a billing number.”
Fulk said what hurts the squad’s ability to reach all the citizens is primarily communication. “Some calls are never heard as the radio service is so poor and text messages may get through or not.”
Also, the squad needs more members, he said, adding that it is discouraging to have new members who can’t get training for six months to a year or more.
The county has the opportunity to offer more training without the high cost to the squads, Fulk said. At one time, squads did not have to pay for EMT, EVOC or advanced life support (ALS) training because it was funded by the county and state, he said.
There should be more access for volunteers to acquire continuing education hours, and volunteers should not have to travel to Roanoke, Floyd, Martinsville, Richmond or Staunton to receive those hours, Fulk said.
The county should also help with restocking medical supplies, “a monetary burden that should not fall to the squads,” he said.
Addressing the question of a paid service in Patrick County, Fulk said, “Does the board really think the citizens of Patrick County can be taxed more? And does the board actually think that the volunteers will stay once a paid squad is up and running?
“It would be more feasible to pay a stipend to your volunteers, do a 20% increase in each squad’s yearly money, so the squads can do more training and/or the county needs to furnish the medical supplies and restocking,” Fulk said. “Also, Patrick County does not have the call volume to provide 100% funding for a paid service. A volunteer is not going to pay for a paid service and also be a volunteer.”
Blue Ridge Rescue Squad member Billy Aldridge, representing both Blue Ridge and CCDF, said some people are pushing for a paid EMS system and some would like to see more help for the volunteers who have “carried the county for more than 44 years.”
“Both sides have good points and weak points,” Aldridge said. “It all comes down to the cost. You have already raised the real estate tax rate 3 cents starting in the 2016-2017 budget year, stating it would go to the EMS system. Does this mean it only goes to a paid system or do the volunteers also get help from this tax?”
Currently, each rescue squad gets about $16,000 from the county for building improvements, help with equipment or insurance on the building and units, Aldridge said. However, the insurance alone is about $8,000 a year, he said.
“The squads and the volunteers have done an outstanding job with not only covering calls for years, but also keeping the doors open,” Aldridge said.
Aldridge said he has learned that “some of the volunteers feel abused and belittled by a small but very vocal group that is pushing for a paid EMS service” and that while numbers of volunteers have dropped in the past eight years, the Virginia Office of Emergency Management Services (OEMS) reported that Patrick’s response times were good and the agency had no problems with Patrick’s squads.
Aldridge said he asked Steve Allen, emergency management coordinator, how many providers had showed up to be “checked off,” or have their skills assessed, and Allen said less than 80 personnel.
Other volunteers from fire departments and rescue squads have said they find Allen “hard to work with” and that they feel “disrespected or talked down to or harassed,” Aldridge said.
A problem is that training and check-offs are only offered in Stuart, which is 27 miles from the Blue Ridge Rescue Squad, Aldridge said. Training should be done at all squads every month covering BLS and ALS skills, he said.
Aldridge summarized his comments, telling the board it has three choices: stay with the volunteer system and work to improve it, investing about $100,000 to pay stipends to ALS and BLS providers and drivers; start a paid EMS system with a total cost of more than $500,000, with one ambulance based in Stuart; or a combination of options 1 and 2.
The cost of a paid system will “continue to increase every year forever as you add personnel and more ALS ambulances,” Aldridge said. “In three to five years the EMS service could be your second highest department in the county budget next to the Patrick County school system.”
He later added the LifeCare Medical Transports proposal for a paid service at about $262,000 a year as a fourth option.
“I would like to see us all pull together and help keep the volunteer system in place,” said Pat Shouse of the CCDF Rescue Squad.
Valerie Foley, secretary of the Smith River Rescue Squad, said her squad is successful because of the strength of its on-call schedule and a lot of community support.
“We bring peace of mind because people know we’ll be there if we’re needed,” Foley said. “We have dedicated members.”
She urged the board of supervisors and citizens to “stop fussing at meetings.”
“We don’t want a private ambulance service paid by the county,” Foley said. “Squads want to do soft billing and pay their members. Emergency situations are more complex than in the past, she said; today there are mental and drug problems. “EMS is no longer load and go,” she said.
Crystal Webb of Vesta Rescue Squad, answering a series of questions about strengths and weaknesses, said the squad has good officers and keeps up with state rules; has well-maintained and stocked equipment and a building in very good shape; and good morale.
The squad has positive outcomes to emergencies “due to provider availability and quick response times when volunteers are available,” along with “assistance from Steve Allen and Lamont Bryant to assist with EMS calls when volunteer EMTs are not available or when ALS support is needed,” Webb said.
When members are available, “we get an ambulance of caring, well-trained medical providers to people who have called 911 and we get them emergency medical help at the closest hospital,” Webb said.
Vesta’s “differentiating factors” are “a dedicated group of volunteers who strive to provide the best possible care by completing required continuing education courses and skills check-offs required by our Operational Medical Director (OMD),” Webb said.
Webb said weaknesses include a shortage of members and the fact that many of those who do volunteer work outside of Meadows of Dan or can’t leave their jobs to answer calls, resulting in some lengthy response times; attempts to recruit new members through open houses or social media have been “mostly unsuccessful;” and the drug box exchange at Pioneer Community Hospital can take an extensive amount of time.
The squad’s ability to answer calls is hindered by “provider unavailability due to providers working outside of the county,” Webb said. “We have paramedics and intermediate EMTs that work in neighboring counties instead of working here in Patrick County.”
When asked what the citizens of Meadows of Dan and Vesta dislike, Webb said, “they don’t like the uncertainty of EMS response time and level of care. They don’t like obstructive supervisors who put their own ego and opinions ahead of the good of the county citizens.:”
In response to the question, “What should we stop doing?” Webb said, “stop bickering and having unproductive discussions in public meetings. It’s a waste of time and it undermines the confidence of citizens.”
Webb also said people should “stop undermining Steve Allen’s ability to do his appointed job;” “stop disrespecting the experience and the counsel of the volunteers;” and “stop allowing misleading statements concerning costs to be disseminated as if it’s the truth.”
“Patrick County needs to start an objective study of what surrounding counties have done to remedy similar EMS situations and then accept and learn from their experience,” Webb said. “Patrick County should draft two or three viable proposals with solid financial estimates for staffing and equipment.”
“I don’t think it’s fair to get into a discussion when we haven’t had a chance to absorb all the comments,” said Peters Creek District Supervisor Rickie Fulcher. “A lot of good ideas have been presented, and everyone needs to be working as a team. We need to find a solution that’s best for the people of the county.”
Fulcher told Aldridge that the tax increase (which was 2.5 cents per $100 assessed value, not $3 per $100) was not designated for anything when the board passed it.
“We’ll find a solution for this,” Fulcher said. “We’ve got to. We don’t have any choice.”
Mayo River District Supervisor Lock Boyce said there are several options in terms of funding. A paid service as proposed by LifeCare could cost $262,000 for 12 hours a day, 365 days a year, or twice that for 24-hour coverage, he said. Providing stipends for volunteers, as he suggested—$50 for an ALS provider, $40 for a BLS provider and $20 for a driver, would cost about $260,000 annually, he said.
The county should definitely pay for volunteers’ training, Boyce said.
He told the audience that there had been a “big misunderstanding about soft billing” and that Joey King of LifeCare had warned the board that it could be illegal because there is no way to means-test the patient.
“If soft billing is illegal, then Floyd County and Carroll County and some other counties will be going to jail with us,” said Blue Ridge District Supervisor Karl Weiss.
Dan River District Supervisor Roger Hayden said he was “under the misconception that half” of the tax increase was going to EMS. He said soft billing (when patients are not charged if they have no insurance or means of paying their bills) is bringing in “astronomical” figures and could fund a paid service.
“I’m not in favor of a paid service,” Boyce said.
Later in the meeting, Boyce made a motion that the board reach a consensus to allocate the “3% tax increase” to EMS.
“There are two people on the board who are trying to tell us how to spend it and they didn’t even vote for it,” Weiss said.
Erika Cipko said the Patrick County Fire and Rescue Association reached a consensus recently that its members would work to get the meals tax approved. The board has said it would be designated for EMS if approved.
“We as fire and rescue want to work with that,” she said.
“I need a second on my motion,” Boyce said, “and that includes the meals tax.”
After several attempts, and several angry exchanges between Boyce and Hayden, Boyce’s motion died for lack of a second.
“I think it’s inappropriate and not good judgment to allocate funds from the 2.5-cent increase without knowing what we’re allocating it for,” Fulcher said.” We still have a budget deficit. There was a big increase in the school budget. We need to get a plan in place before voting on it.”
County Administrator Tom Rose said there was also a deficit in the state budget which cancels out the 2% salary increases for state employees.

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