EMS eyes 'dynamic' deployment of ambulances

Aug. 02, 2014 @ 04:26 PM

Concerned residents turned out for a series of meetings last week about proposed changes to Union EMS service.

Thursday evening, a group of county residents and emergency response personnel met at Mineral Springs Volunteer Fire Department to hear a presentation by Union County officials. Similar meetings were held earlier at Lane’s Creek and New Town fire departments.

The county is negotiating a new contract between it and Carolinas Healthcare System for operating the county’s EMS system. The county pays CHS to operate EMS instead of it being run directly by the county.

Though no formal contract has been decided, proposed changes have included strategic placement of ambulances, Commissioner Jonathan Thomas said. Because the proposed changes affect all county residents, commissioners wanted to give the public an opportunity to ask questions and make recommendations about the new contract.

A new contract could be signed within seven to ten days. Planned improvements would be implemented “with zero tax increase,” Thomas said.

The county’s contract for EMS service has been largely unchanged since it was signed in 1997. It was renewed with only minor amendments every year or two since, Thomas said. The need for a new contract became apparent two years ago when Union EMS planned to move Quick Response Vehicles based at New Salem and Lane’s Creek volunteer fire departments. After a community outcry, commissioners appropriated $400,000 from the general fund to keep manned QRVs at those bases. Less than a year later, Thomas said he learned that the QRV was staffed less than half the time.

“The frustration was that...we couldn’t require any level of service there,” Thomas said. “This is a very vanilla contract that’s gotten us to this point.”

The problem, he said, was that the county has not been clear in its expectations of Union EMS.

The county hired consultants Fitch & Associates to recommend the best level of EMS service needed in the county. Fitch recommended Union County continue its partnership with CMC-Union and CHS, but negotiate terms of the contract to address specific issues. Those negotiations are ongoing between CMC-Union President Michael Lutes and County Manager Cindy Coto, Thomas said.

So far, there is a general agreement about most aspects, but there are still details to sort out. The public meetings gave county officials an opportunity to hear the concerns of residents.

It is a 5-year improvement plan with performance goals that county officials expect EMS staff to achieve. Though it should give the county more say over how EMS works, the contract will not give the county authority over how EMS operates or its employees.

After the economic recession, the county has not increased EMS spending much, Coto said. With this plan, the county will make a significant investment in improving the EMS system.

Priorities for the new contract includes decreased EMS response time. Working together, the county and CMC-Union would increase the number of ambulances from 14 to 22.

The proposed method of increasing response time is by using a “dynamic deployment” method, Thomas said.

“This dynamic deployment takes away the base concept and puts them out in the community,” he said.

Currently, ambulances are assigned to one place. Officials have considered strategically placing staffed ambulances based on computer modeling of historical data about locations and times of calls. The public asked many questions about reduced response time in the far corners of the county if the change took effect.

“Let’s just be honest; you can’t predict acute onset. Heart-attack, diabetic, stroke, those are the things that computer models do not predict,” Thomas said. “But they do predict the calls based on volume.”

Ambulances would be spread out along the U.S. 74 corridor. Proposed goals would take emergency response times in “urban zones” along U.S. 74 from an average of 12 minutes the first year to 11 minutes in the plan’s fifth year. Response time goals in “suburban zones” in the west around Waxhaw and Weddington and north of Monroe near Unionville and Fairview from an average of 15 minutes to highest priority calls the first year to 12 minutes in the fifth year. Likewise, “rural zones” south of Monroe and north of Marshville will be assigned the goal of going from a 20 minutes average response to a 15 minute response time for highest priority calls.

Less urgent and non-emergency call response time goals would also be reduced from 16 or 19 minutes in urban zones to 12 or 15 minutes. Rural zone goals would shrink response time from 22 or 24 minutes to 18 to 20 minutes for less urgent calls.

Commissioner Richard Helms said the county is negotiating to balance call response with inter-facility transfers. Because Union EMS is the only ambulance system in the county, its staff responds to emergency calls and provides non-emergency but medically necessary transports of patients between hospitals and other medical facilities.

“One of the things that we’re asking very hard is what is the cutoff so we keep so many ambulances available to be able to respond,” Helms said.

At Mineral Springs VFD and earlier meetings at Lane’s Creek and New Salem, firefighters commented on the importance that most on-duty ambulances be available instead of doing non-emergency transports. Enough people stressed worry that transports and pulling ambulances from rural bases would negatively impact response time. The commissioners heard them, Helms said.

“You can disagree with me if you want to, but the model has changed since Monday night,” Helms said. “Monday night, it was all dynamic. But that’s not what y’all told us.”

From the tone of public meetings, county officials found that placement of ambulances is a senstive issue among residents. People expressed worry that dynamic deployment system will mean a longer wait before paramedics arrive in remote rural areas. They also voiced concern that rural-based ambulances would be moved to more developed areas to the detriment of rural residents.

Though the county is about a week from a final contract, Thomas said the public’s concerns would be addressed during negotiations. All residents will receive equal service under the new contract.

“How’s it going to look? I can’t tell you. But I can tell you that we’re going to do the very best with the resources we have to meet the need of the rural markets,” Thomas said.

County officials invited the public to share thoughts on the proposed changes. Details will be posted on the county’s website, www.co.union.nc.us. You can also email your comments to the commission at askbocc@union.nc.us. Commissioners Helms and Thomas also invited the public to call them directly to discuss their concerns. Helms can be reached on his cell phone at 704-576-3357. Commissioner Thomas can be reached on his cell phone at 704-242-0644.