By: Jennifer Britt
The Parsons Advocate
The Tucker County Ambulance Authority has set forth plans that they hope will ensure the success of EMS and its operation. Ambulance Authority President Dennis Filler presented the other members of the board with a slide presentation that outlined the current status and challenges as well short-term options to consider going forth.
For the current status and challenges Filler listed a minimum service goal of two EMS stations operating 24/7 with advanced life support (ALS) capability, but with the EMS levy a failure the minimum service goal is unachievable. The near-term challenge is to have the ambulance authority provide the maximum level of EMS services within the funding that they have available. To do this the authority must explore options.
Filler explained the short-term options to consider. One of those options is to continue with one station 24/7 with increased paramedic support. There would also be support for the second station six days a week for 12 hours a day. The authority would consider a mix of a part time EMS squad to expand the second and/or transport crew staffing. Another option to consider would be asking financial assistance from the Tucker County Commission to provide additional funding that is needed. The last option would be disbanding the ambulance authority and returning the EMS operations to the county commission. This would allow the commission to manage and operate the EMS out of the county’s general funds.
Pros and cons for the option to consider continuing operating the EMS at its current status were presented. Pros consisted of the feasibility to easily sustain one station in service with predictable marginal levels of service availability. This option would satisfy state statute.
Cons presented were the need to reprioritize a staff mix. There would be longer EMS response times due to the increased average distance to medical emergency occurrences. There would be no local EMS support for simultaneous service calls placing a continued increased burden on the surrounding county EMS crews to assist. Thus, leaving no availability for EMS to provide additional community events or business ambulance services or support.
Filler said, “When you have two stations you obviously dispatch the crew that is available closest to the scene, so our response times would improve and that means we can start delivering treatment as quickly as possible.”
Filler presented the pros and cons of considering operating a second station for a 12-hour shift. Pros considered were increased response time that aligns a peak demand period with the maximum crew availability. This would lead to improved levels of service with the assumption that better outcomes are possible. Filler said, “Seventy percent of our calls happen between 8 a.m. and 8 p.m. and that is the peak of our demand. The rest of the demand happens 8 p.m. to 8 a.m. and we would still have the one station available.”
The board discussed the best ways possible to staff the two EMS stations and on what days. It was said that staffing Station One during the week for Monday through Wednesday or Thursday 24/7 with Station Two staffed on the weekends 24/7 due to the population being higher on the eastern side than the western side of the county on the weekends.
Cons discussed were the variations of crew staffing and schedules between stations the 12-hour shift would create. This would lead to the managing of the EMS staff more difficult, and more paramedics would need to be hired.
When considering to hire part-time staff Filler presented this option as the cheapest way to augment staff with the lowest overhead expenses and a short duration of staff augmentation. Hiring part-time staff also has the potential to include the option for a third crew to conduct transports.
But do the cons outweigh the pros for considering part-time staffing? Part-time staffing could lead to unpredictable staffing, initial expenses for retraining or recertification the employee as well crew integration, and it adds complexity to management. Thus, meaning the part-time staffing would not be a primary means for professional staffing.
Filler said, “When you are short because of vacations, holidays, sickness, or COVID at least there is reserve pool out there to be able to consider drawing from.”
The list stating the pros and cons for requesting long term funding from the county commission was short and to the point. The pros consisted of enabling the authority to provide the commission with a summary of actions taken over the past 18 months, current financials, and current response statuses. This would demonstrate that the authority is acting responsibly in light of the levy failure and despite the commission’s actions according to Filler. The only con stated was the risk of negative response from the community and the commission.
Lastly, Filler explained what the pros and cons for disbanding the authority and turning its operations over to the commission would consist of and that includes putting the EMS service delivery solely on the Tucker County Commission. But, the commission may not have the legal capability to operate the way that the 1975 Ambulance Act permits ambulance authorities. The commission would be limited in their ability to hold debts, collections, etc. as the LLCs or authorities are granted by state law. Either way this leaves funding issues, but the responsibility would solely be on the shoulders of the county commission.
Filler stated, “This is just put out there as an option to say we looked at it, consider it, but we are not doing it. It is out there, and it is one of the options that is clearly identified in the EMSAC report.”
Filler touched based on three other options that included cross training select fire fighters across the county to be EVOC certified, but the authority would have to work out the part- time cost, as well as disability and additional insurance coverage. EMS Director Shelia Marsh and Assistant Deputy Director Scott Kennedy explained the necessary training and certifications that would be needed to cross train a fire fighter to be able to drive an ambulance. Commissioner Mike Rosenau said, “The county commission has come to the board before and said if there is an issue about paying for training or anything that would enhance our ability for our EMS and improve it, recertifications, additional training, or whatever the county commission would try their best to help you.”
This would be same for adding part-time EMTs as well as managing the rosters and roles of the EMT for handling transport needs. Filler explained that working with business owners and event planners in advance to better understand their EMS needs would help the authority achieve some financial offset while improving community relations.
Filler also explained a recommendation he received by saying, “I have a recommendation to pull the full-time service providing paramedic to spend time in the office working on the issues we have talked about like public relations, building in volunteer staffs, certifications of our individuals, doing the reporting that is required in the system, making sure our charts are in fact being submitted in a timely manner and processed. So that is why you see (on chart) the Director time in the office. It is at either of the stations, but it is not about when that person is on the call roster. Yes, they are there as a call backup and those kinds of issues, but the bottom line is we need to have EMS management more. We need to schedule our people for when it is going to deliver the biggest bang for the buck.”
Filler also said, “It is a tougher approach, but it has to take the pieces that we talked about and at least put it into a framework to try to make something work with what we have.”
Discussion then turned to the possibility of providing EMS services to the businesses or events on a for hire basis. Such businesses would include the ski resorts on the weekends during the winter months. The service would be provided on an hourly rate with one EMT and one paramedic on a part-time basis but could provide over-time for current staffing. Filler said, “Is it big money? No, but it does one of two things. One it provides EMTs additional income and from our business perspective it puts a positive number going into the till which is unique.”
Filler asked the board to consider two things. Does the short-term plan make sense moving forward? And, does providing commercial services as an option make sense? Filler said, “We can look at the commercial issues going forward. Does everyone agree with that? (Everyone agreed.) In a model where we staff a location 12 hours a day keep in mind even when we staff and run two rigs right now we are running two 24/7s. We can get more bang for the buck by splitting the 24/7s into 12s and covering 70 percent of our demand.”
During the discussion Filler asked if everyone was in agreement to pursue the commercial events and do the study on the overhead costs. Everyone agreed. Everyone also agreed that there was a need to hire another paramedic. Kennedy said, “You probably will not find a paramedic to come to work part-time.” Filler in turn said, “You know what. I got news for you guys. If we do not try and we have an attitude that is like what is right now coming out of my Deputy Director I do not think we are going to hire. So, I am not going to buy that one.” Kennedy said, “But when you have eight people that are full-time as a resident of Tucker County work some where else besides the county,” and was interrupted by Filler saying, “Scott, you are either part of the solution or you are part of the problem. Which one do you want to be, son?” Kennedy responded by saying, “You are giving out the orders you go ahead.” to which Filler responded with, “Ok, thank you.” But then Kennedy asked, “Now that you are giving out orders, how do I become part of the solution? What do you suggest?”
Filler asked the authority members their thoughts on the proposed actions going forward. Authority member Diane Hinkle said, “I think we are in agreement that we need to move in this direction. This is absolutely a conversation that has to be held with the EMS Director for a response. The board is most interested in what the response would be. I mean if there is a better solution than this, we are all ears and we need to hear it sooner than later. But in the absence of anything else coming forward, I think what has been presented is our best option in the short-term. I agree it has to be a conversation between EMS and the Ambulance Authority board. It is a two-way conversation.”
Marsh asked, “Can we back it up and rewind and repeat what was said?” Filler responded with, “The bottom line is we will set up a meeting and that is why, quite frankly, folks need to be at these kinds of meetings.” Kennedy said, “Quite frankly give me twenty minutes and I will be there Dennis.” Steven Sponaugle asked Marsh if she wished him to screen time her so she could see what was on the board and she responded by saying, “No, I am going to go ahead and come down there and be there when Scott gets there.”
Filler said, “I expected this but again that is why I wanted to make sure as an Ambulance Authority board we are the ones that are in charge with at least taking and providing the framework. Implementation and executive are in their barrel of work, and we have got to work through this issue.”
There was a motion placed on the table to move forward with the short-term plan presented by Filler. The motion was seconded by Hinkle who added on the condition that the discussions included the EMS Director and Sponaugle added that it had to include that there would be not only a night shift EMS on the mountain but also in Parsons. The board members voted to approve the motion.
After the conclusion of the meeting Marsh and Kennedy did arrive at the meeting site and it was later discovered that both parties turned in their resignations. The authority held an emergency meeting by phone and accepted Marsh and Kennedy’s resignations. Upon speaking with Filler, the following week, he said, “The resignations happened in such a way, that we had to act to maintain the continuity of services from a medical and operational perspective. Yes, we had an emergency phone meeting to decide how to move forward. Ergo, we have an Interim EMS Director in place as of this morning.”
Marsh and Kennedy were asked if they wished to make a statement on their behalf. Both declined.
The next meeting time for the Ambulance Authority was not discussed.