Published Oct. 27 in the Henry County Local

Henry County addresses EMS deficiencies

By MELISSA BLANKENSHIP
Henry County Local

CAMPBELLSBURG — At the beginning of the discussion, Campbellsburg EMT Bobby Burnett offered to tender his resignation if county departments were forced to consolidate their five EMS licenses into one. But by the end of the meeting of the Henry County EMS Advisory Board, Burnett had resigned to the fact that the county had no other reasonable option.

"Let's face it people," he said. "We've got no choice in the matter. We've got to do it."

When the board met earlier this month, its sometimes heated discussion centered around correcting deficiencies of its EMS departments noted during an annual inspection in July. At that time, each department - volunteer and paid -was cited with missed runs. According to state regulations, all ambulance services must be able to run 24 hours a day, seven days a week. The fact that any one department was unable to complete a run that had been designated specifically for it constituted an infraction of the 24/7 regulation.

"We need to make sure that when the tones drop we have an EMS unit to respond. The biggest issue is availability," said Keith Smith, Regional Advisor/Inspector for the North Central Region of the Kentucky Board of Emergency Medical Services. "We are having a problem countywide with volunteers coming out for calls. We're just not getting ambulances out the door."

Currently, there are five licenses in Henry County-one for each volunteer service (Campbellsburg, Eminence, New Castle and Pleasureville) and a fifth for the paid service, which operates Monday through Sunday, 5 a.m. to 6 p.m. By regulation, each service must operate 24/7, and if dispatched on an emergency run, must have a fully staffed unit on the road in 10 minutes or less. If the department does not answer the call, it is considered a "missed run."

Missed runs

Anytime one department is dispatched to make an ambulance run, that department has 10 minutes to respond-that is, have two people in the ambulance and be driving out of the garage within 10 minutes. Currently, after a dispatch goes out, KSP waits three minutes to hear if anyone from that particular department calls in on the radio to advise that they will be responding.

If KSP doesn't hear from an EMT within three minutes, they call for a "code yellow." This is a countywide call asking for any available department to respond. Typically, another department can get a crew put together and respond within the 10-minute requirement. The run is made and the sick person gets medical attention, but it is still recorded as a "missed run" for the department that was initially asked to respond.

"Mutual aid is not for 'covering' your runs, but only if you're already out on a run and can't make it yourself," Smith explained.

In the most recent inspection, each and every department had missed runs; the state can fine the license holder up to $5,000 per day per violation per department because that means that none of the departments are truly providing ambulance services on a 24/7 basis. Currently, Henry County Fiscal Court, as the license holder for each of the five departments, would be responsible for paying any fines incurred due to continuing deficiencies. Combining all the departments under one license would not change the way each operates and cooperates with the others, but would eliminate the deficiency of missed runs.

For example, instead of a dispatch going out to Campbellsburg EMS, with the potential to become a missed run if Campbellsburg doesn't respond and another department has to make the run, the dispatch would go out to Henry County EMS and be directed to units in Campbellsburg.

Because the county's departments' licenses are due for renewal in December, the state mandated that the issue of missed runs and the continued state of noncompliance be remedied before then.

Options

The options available to the county include providing a paid 24/7 ambulance service, which Henry County Judge-Executive John Logan Brent contends the county cannot afford, or develop a way to prove to the state that the existing five licensed departments were all indeed providing services on a 24-hour, seven-days-a-week basis. The only other option available to the county is to consolidate their five licenses into one, thereby eliminating the potential of missed runs by any one specific department, an option the county hoped to allow the volunteer departments to vote on.

The worst case scenario, however, was supplied by Thompson.

"If we cannot correct the deficiencies as far as getting trucks out the door, the state would be forced to pull your licenses. Then it wouldn't be up for a vote," Thompson said. "One license would protect the county with 24/7 service.

"My goal is to fix the problems here in Henry County," Thompson continued. "This is not Frankfort coming down to take your licenses away, but I am here to make sure that the regulations that order what EMS services are required to do are followed. If you want to keep things as is, that's fine. But the problem is that you'll be in complete and continuous violation."

Thompson allowed that fiscal court had the latitude to allow for a vote by its volunteer departments, but that as the license holder, it also had a responsibility to make necessary changes to ensure that the deficiencies were corrected.

"It's their butt on the line," Thompson said.

The decision

Because representatives from the state board of EMS stated that they could not renew the county's licenses if the deficiencies were still in place, the departments and the county needed to make a relatively quick decision. While reinstatement from the board was not a "huge issue," Thompson said, reinstatement to received Medicare and Medicaid payments could take up to six months-a price to big for the county to pay.

"We collectively decided that the volunteer squads would go under one license sponsored by fiscal court," said Homer Druin, chairman of the local EMS Board and representative for Pleasureville EMS. "The volunteer departments will still elect their own officers, create their respective budgets, have autonomy, and be in charge of their own training and maintenance programs for vehicles."

Fiscal court will maintain its current level of financial support to each department and will pay the license fee. The only difficulty in making this decision centers around a wage and labor law that stipulates that county employees of the paid ambulance service cannot make volunteer runs at night and on the weekends, limiting available personnel. The county is currently investigating a way to continue to allow its paid employees to serve as volunteers by offering stipends for each run.

All those involved assert that the general public will see no change in EMS service, and that response times may sometimes be faster, which Brent said is the overall goal of the changes being made. And volunteer EMTs in the community want to continue to effectively provide emergency medical care to the county.

"Effective patient response in a timely manner is our number one concern," Druin said. "Hopefully, this will cut down on code yellow or secondary responses."

With this licensing change and a change in management at the county's EMS service, Brent hopes to see improvements not only in the elimination of code yellows and missed runs, but in the quality of care and accessibility of the EMS services throughout the county.

"I think that you'll see our paid service even more visible in our community," Brent said. "And I think you'll see a lot of new creative ideas that will make us a better service for the people of Henry County."

In other business:

•EMS Advisory Board members also discussed whether or not to allow First Responders to ride along in ambulances as one of the required two-person crew. Previously, both crewmembers had to be certified EMTs, but a change in state regulations now allows for one EMT and one First Responder to answer an emergency call. Brent requested that the county's protocol be changed to allow for First Responders to serve in this capacity as a way to supplement available personnel for both the paid service and for volunteer departments. There are currently 18 people in Henry County certified as First Responders. A sub-committee was asked to evaluate the request and make a recommendation to the board.

•Members and volunteer department representatives have also considered offering a $10 per run stipend to volunteers as an incentive to make the night and weekend runs. The discussion of offering a stipend to volunteers who make those runs was in the hope that the money would act as a "catalyst" or "dangling carrot" to guarantee that the runs would be made, protecting the county from further violations of missed runs. "They're not looking at is as an income factor," Druin said. "It's more of a show of appreciation for the efforts of our volunteers. And some are looking at donating the checks back to their squad or putting the money toward training."

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