A majority of members of the Patrick County Board of Supervisors are exploring options to strengthen the county EMS system.
Patrick County helps fund rescue squads and fire departments, but each entity is independently owned and operated, officials said. However, local governments are required by state law to “seek to ensure that emergency medical services are maintained throughout the entire locality.”
To that end, supervisors are primarily considering two options, both of which involve a joint volunteer/career venture.
Under the first option, the county would hire EMS personnel to man a single, centrally located squad to help backup volunteer squads on calls and in other areas. Supporters of this option say proceeds from billing patients would be tapped to help offset the estimated base cost of more than $500,000 per year.
Under a second option, volunteers would be paid a per-call stipend, based on their level of training. Stipends would be limited to a maximum of three volunteers per call: an ALS (Advanced Life Saving), volunteer, $50; a BLS (Basic Life Saving) volunteer, $40; and $20 to an EVOC driver.
Proponents of this option say it would cost less than half the amount to implement, including the cost to add a second 12-hour shift to LifeCare, a career squad that now operates 12 hours per day and currently is stationed at Pioneer Community Hospital of Patrick.
The underlying goals of each option are to help combat lagging volunteerism, funding and/or resources, and response times and calls that may require multiple countywide tones before being answered, especially during the day when many volunteers are at work.
Crystal Harris of the Smith River District and current board chairwoman, said the second option will not accomplish those goals, partly because the problem isn’t limited to Patrick County.
Most, if not all, volunteer-based agencies struggle to recruit, train and retain volunteers, “this isn’t just our fire and rescue” services, she said. Many adjacent localities have incorporated the volunteer/career effort into their EMS systems, she added.
“My main goals are to keep volunteers as the center of our 911 service and to take care of the needs of the people in Patrick County,” Harris said. “Those needs aren’t being met at this time,” Harris said, but she was quick to add it wasn’t for a lack of volunteers’ efforts.
“Volunteers are the lifeline, the heartbeat of the fire and rescue system,” Harris said, and added she supports the first option — not to replace volunteers, but to support them.
The addition of career staff would be a support system for overworked volunteers, Harris said. In addition to helping to run calls, career EMS personnel could help provide required continued education, and otherwise help squads/fire departments if requested with things like checking expiration dates and other tasks, she said.
Supervisors currently are searching for a way to raise $47,700 to pay tuition for 18 volunteers ($2,650 per) to participate in an Advanced EMT class.
Harris said revenue saved by continued education offered in-house, the fact that some squads/fire departments have offered to donate equipment and/or materials to the county to help start a career service, as well as money generated by career squad in soft billing, all could be used to help offset the county’s expenses.
“I feel like it would probably take six months to a year to start being able to recoup what the county is putting out,” she said. Harris noted career staff also will be trained firefighters. That also will result in taxpayer savings, because “our fire departments are hurting for members too. If we had to do a paid fire separately, it would raise taxes” for certain, Harris said.
“I’m not for raising taxes. In all the years I’ve been on the board, I think I’ve voted to raise taxes three times, but when you hear tones go off six or seven times countywide and the calls still are not being covered,” it is time for action, she said.
Roger Hayden, Dan River District Supervisor, said he supports the stipend option, as do the squads in his district.
“The three squads in the Dan River District propose keeping all volunteer squads as is, and the county can contribute to help pay by stipend by call,” Hayden said. “[Patrick County] would subsidize volunteers” with a stipend, and pay for backup service from LifeCare.
“That’s the plan I support because it wouldn’t cost as much money to do. Full paid service is unreasonable for Patrick County,” he added.
Rickie Fulcher, of the Peters Creek District, said he is considering the merits of each option. “Right now, I’m looking at dollars and what we can afford. I had hoped the citizens would pass” the meals tax. Revenue generated by that tax would have “gone a long way towards funding” either plan and helping to pay associated costs, Fulcher said. However, voters defeated that proposal in November.
“Whatever we do, there’s got to be a joint effort between paid and volunteer,” Fulcher said. “We can’t live without our volunteers … There’s a solution out there.”
Supervisors must find it and reach a consensus, preferably before budget talks begin because funds will need to be earmarked to pay for whatever option is selected, Fulcher said. “The Board is going to have to make a decision on which way they want to go and then stand behind it,” he added.
Lock Boyce, Mayo River District Supervisor, said he delved into the career option, and determined the single benefit of adding a career staffed squad is “two guys around the clock” for $500,000. “That [estimate] does not include the cost of the ambulance, operating costs, fuel or medical supplies. Just two guys who are available to run calls … that’s all you get for half a million dollars.”
He also thinks it would be difficult to attract and retain career staff, partly due to the low number of calls. Additionally, Boyce said the tax rate would have to increase dramatically, and eventually double, to raise the revenue needed for a career service.
Boyce suggested the stipend plan to supplement volunteers, and believes the county should pay for their training.
Boyce said the county cannot afford a paid service, but even if it were financially feasible, there are a number of other obstacles, including a large geographical area to cover, and road conditions. He said a paid squad would do little to increase response times.
Also, “the call numbers per week are small. Countywide, approximately 50” calls total are received per week, Boyce said. “That’s a pretty low number of calls, and JEB [Stuart Rescue] runs about half” of those calls.
Although “we do have a problem with calls especially during the work day, when you may not even get a response” from volunteer squads because many members work — some work out of the county — Boyce said overall, “we have a very good volunteer system in this county. Every one of our squads has the latest in ambulances. The crew halls are strategically located,” he said. “Considering how spread out our county is, our response times are actually very good.”
Karl Weiss, Supervisor for the Blue Ridge District, said he supports adding career [paid] staff “100 percent to cover calls 24/7 when the volunteers are not available. That’s the only way, in my opinion, that we can have accountability.”
“The best option” to fund a career squad would have been the meals tax that was defeated in November, Weiss said. Additionally, Weiss said he thought 1.5 cents of the last tax increase was supposed to have been earmarked for a paid service.
“I was disappointed that didn’t happen,” he said, but noted he has a number of other ideas, including soft billing generated by the career squad. “I have spoken extensively with Floyd County” which has a career service, and Weiss said he learned that 60 to 70 percent of their EMS cost is paid by soft billing.
“There are a lot of options to pay for it. It just takes doing it and quit putting people’s lives at risk,” Weiss said. “This is 2017. We can do better.”
(If you have an experience with a local EMS provider you would like to share for possible publication in an upcoming story, please call Debbie Hall at 694-3101, or email dhall@theenterprise.net.)
