Glasgow Daily Times, Glasgow, KY

February 26, 2014

Shortage of Barren-Metcalfe County Emergency Medical Service staff is a problem

Glasgow Daily Times

GLASGOW — Barren-Metcalfe County Emergency Medical Service will have to wait at least two more months to learn whether its board of directors will OK additional staff positions.

The estimated cost-to-additional-revenue ratio was not on the side of hiring, but ambulance service personnel told the board at its regular meeting Wednesday that more than money is at risk.

With current staffing, between three and 12 instances per month have occurred since June 1 when no one was available to respond to a call, said Mike Swift, ambulance service director.

“We’re having a hard time meeting the needs of the hospital as far as patient transfers,” he said. “We’ve got patients going to Louisville, Nashville and Bowling Green and that takes a truck out of the county for an extended period of time, and during that period of time, it’s just impossible for us to devote another  ambulance, one of the three ambulances that are left, to transporting another patient out of town, so basically the patient has to wait at the hospital maybe four or five hours until [one returns from out of town].”

Swift said the service started tracking in June the number of times an ambulance was not available each month, and that month had the highest number so far. In July, it was 10 and August, eight. The following three months, there were three, four and three instances, but in December, they started climbing again with six. January had 10 instances, and nine have occurred so far in February, he said.

Ambulance crews typically work 24 hours on, 48 hours off, but Swift said he could probably get by with a 10- to 12-hour crew, with 12 probably being better. Swift separately told the Daily Times his objective was to have the increased staffing primarily during daytime hours, with his intention being that a crew of two would work a 12-hour shift two days in a row, then be off for two days, during which the other 12-hour crew of two would work.

His request to the board followed a discussion regarding the service’s revenue being less than expected so far this fiscal year that ends June 30. If the service or the hospital has to ask another county to come in and make the run instead, that other county or company gets the revenue, he said.

“If we could make all the runs that we have,” Swift said, “we would get more revenue.”

Follis Crow, who also serves on T.J. Samson Community Hospital’s board of directors, said that when he saw that a request for additional staff was going to be on the agenda, he spoke to Melanie Watson, an ambulance board member who is chief of compliance at the hospital but couldn’t be at Wednesday’s meeting, and another member of hospital administration.

“It is critical out there, [with] a lot of people having to wait,” Crow said. “So the need is there for the patients.”

Board chairman and Edmonton Mayor Howard Garrett asked whether income from the extra runs would offset the additional expense or if it would put them in the hole.

Swift said he had asked the service’s billing company for a study so he would have a better idea of that. The average revenue per run for claims that had been completely processed “so far for 2013” was nearly $326, Swift said.

Ambulance service office manager Nancy Jolly said the total of 65 calls for which Swift gave the month-by-month breakdown were calls that were delayed, but three to four times a week, other services had to cover calls. Those are ones for which the service loses the revenue, she said.

At an average of four calls a week, the associated missed annual revenue for those would be $62,567, Swift said. The estimated cost of hiring four additional emergency medical technicians would be $153,895.61.

Bill Bucher asked whether an ambulance was sitting empty and available during these times when no staff was available, and Swift told him it was.

Garrett said that would create a further deficit in the neighborhood of $90,000, but Swift said the overall volume of runs has also been increasing and is likely to continue on that trend as the average age of the population is increasing.

Jolly said the biggest issue is when there are emergency runs and no truck is available, and Swift estimated that at least half of those were emergencies.

BMCEMS Assistant Director Tim Gibson told the board the issue can’t be boiled down to just money.

“This is not a money-making venture. This Barren-Metcalfe ambulance service will never be a money-making venture. It will never break even. It provides a level of care that Barren and Metcalfe county residents have come to expect,” Gibson said. Now, if you want to make it break even, we can rid of a bunch of stuff and maybe we’ve got a truck to send you and maybe we don’t.”

One day last week a small child and an elderly lady with a fractured hip each had to wait approximately five hours before the service here could take them, Gibson said.

“I know it’s money, and I totally understand that, but you have another factor that you have to consider is the human factor, and you can’t put a price on how long your spouse or your mom or your dad or your child is sick, hurt or laying there. We can’t send but one truck at a time out of town,” he said.

Either last week or the one before, Gibson said, the service had five out-of-area runs to Louisville, Nashville or Lexington and six runs to Bowling Green, all in a 24-hour shift. Another thing that needs to be considered is the shift length, especially in conjunction with those long drives.

“Let me tell you, Bluegrass Parkway is a mighty lonely place at 3 in the morning,” he said, especially if it’s your second or third trip out of the area in one day.

“We just need help,” Gibson said. “Will this crew be required every single day? Who knows? You can’t predict when and where something will happen.”

Board member and Glasgow Mayor Rhonda Riherd Trautman asked whether ambulances are overused for nonemergency transportation and whether other options may be available.

Howard asked whether the government entities that help fund the service could get to a point where it needed to get out of the ambulance service business and let a private company handle it, because government has fiscal responsibilities outside the service.

Other ideas were batted about, and Trautman and board member Jason Coomer said in similar ways it may be time to re-evaluate who pays for what share of the service.

“I understand y’all are busy and everything,” Trautman said, “but to vote to agree to this impacts our budget, and we only set aside so much in our budget this year.”

Board member Bill Bucher said making a profit is not the primary goal of the service.

“We’re obligated, as I see it, to provide proper ambulance service for the community, and if we’re not doing that and we’re not able to transport emergency patients, then maybe this is justified,” he said. “Our obligation is not to make a profit, it’s to provide adequate ambulance service.”

Crow acknowledged that several of the board members are in elected positions and that probably impacts how they feel about taxes, but Metcalfe County’s tax for the ambulance “makes more sense to me than anything.”

“If the county and city want that ambulance service, I think everybody ought to pay for it,” he said. “I’m just saying it’s one way to pay for it without breaking the city and county’s budget. I know it’s not a popular thing, especially in an election year.”

Garrett paused the conversation there and said he thought the board shouldn’t take action that night, and each of the government leaders involved – the two mayors and the judge-executives for county – should take a look at their budgets for the next regular meeting, which would be April 23. He also asked Swift to bring a list next time of all the ambulance services in the state and whether they are privately or publicly owned and how many employees and units they have.

Norris said he believed they were there to serve the public, and “and I think we’re hearing from you all that we’re not doing that the way it needs to be done, … so we need all the facts on the table.”

But, he said, “we need to take care of our people.”

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