Growing Pains

Published 8:29 am Monday, March 31, 2014

WINDSOR – Lean and agile.

That’s what Bertie County Manager Scott Sauer says he wants the new budget for the county’s Emergency Medical Services to be in the upcoming year.

Sauer opened with those remarks at the March 20 reconvened meeting of the county’s Board of Commissioners before county Emergency Services Director Mitch Cooper and Emergency Medical Services Director Matt Leicester presented a preliminary budget before the Board.

“We’re going to try to maximize the use of the trucks and the vehicles you’ve already allowed us to buy,” said Sauer to the commissioners. “Anything else we need is going to be the absolute minimum to make this thing work.

Sauer said EMS would also try to minimize personnel.

“This is probably the third or fourth gyration (we’ve) been through,” he added.  “And every time we sit down they cut out a little bit more overtime and a little bit more in terms of the actual new number of personnel.”

According to Sauer, when the brainstorming began earlier this month, EMS was looking at a little more than a dozen additional people on top of what the Board had approved, and they were still trying to whittle that number down. Additionally, they hope to get ahead on the revenue the service will generate.

“This thing will fly best when (he’s) got revenue to cover his costs,” advised Sauer.

Cooper and Leicester’s preliminary plan – which all sides acknowledge is not yet finished – would cover the non-emergency transport as well as Emergency Medical Services. And, says Sauer, there are still other items – like the franchise fee – that have yet to be determined.

“We’re not there yet, but we’re very close,” Sauer cautioned.

Cooper followed and explained what’s being done now and the direction EMS would like to go in the future.

“This will kind of give you an idea of our transition from EMS and trying to get into emergency and non-emergency transport,” Cooper said.

Leicester then made a PowerPoint presentation to the board of the current system and the preliminary one they propose.

Currently, Bertie EMS runs four full-time ambulances 24 hours a day, seven days a week from stations in Aulander, Colerain, and two in Windsor staffed at all times with a Paramedic and either an intermediate or basic Emergency Medical Technician (EMT).  That works out to 12 full-time Paramedics and 12 full-time Intermediate or Basic EMT’s. Leicester himself staffs the county’s only Quick Response Vehicle (QRV).

The Bertie EMS crews work a 24/48 schedule with a ‘Kelly Day’ – a system first adopted by firefighters to bring down the number of hours emergency personnel work by including an additional day off. On the ‘Kelly Day’, Bertie EMS uses part-time personnel to minimize costs.

The first proposed budget, at a cost of $3.04 million, would be to run two separate divisions: one EMS, the other, transport.

“EMS trucks would not run transport,” Leicester emphasized. “Transport trucks would be able to back-up the EMS system but we would not co-mingle those resources together.”

Leicester said that put the budget figures at $2.18 million for EMS and $860,000 for transport.

Through its first 72 days of operation, EMS has billed over $355,000 in revenue for EMS only; with no transport billing revenue over the same period.

That, according to the proposed budget, would project for the year billable EMS revenue of just under $1.8 million.

The addition of transport revenue would project to about $600,000 per year, when implemented.

Because that left a shortfall, Leicester is proposing several staff and equipment changes that might work more economically:

During daytime hours they propose putting four ambulances each in service and staffing each with an EMT-basic or an EMT-intermediate.

“We are going to remove the paramedics off the ambulances day-to-day,” Leicester says. “We would have one each in Aulander and Colerain and two in Windsor.”

The proposal places paramedics in the QRV’s, possibly Ford Explorers, and the paramedics would then respond with ambulances on emergency calls.

“Now every time a 911 is dialed we send a paramedic with an EMT or intermediate,” Leicester said.  “If it (the call) doesn’t need a paramedic, that paramedic is still committed to that call. Under this system we’re still going to send a paramedic every time someone dials 911, but not on the ambulance.  If it (is a call that) doesn’t need a paramedic, we’re able to release that paramedic to stay in the system and we still have an ambulance to transport to the hospital leaving our higher-level care available to respond to another call in that district.”

When asked if it was a call that required a paramedic, Leicester said the equipment could then be transported from the QRV to the ambulance and the paramedic could then ride in the same as they’re doing now.

“If it requires any type of advanced life-support care they’re going to get on that (ambulance) and they’re still going to ride,” he contended.

One of the two crew members on the ambulance would then

Leicester said this proposed system would run both EMS and transport out of one combined budget using existing resources.

“What we don’t want to do is commit our paramedics on a (Basic Life Saving) transfer or transport from a nursing home to a doctor’s office and have them sitting in a doctor’s office for two hours,” he continued.

The proposal requests additional QRV’s with the idea that the savings would be in equipment over personnel man-hours.

“As you know, EMS on the emergency side is a losing business,” said Sauer. “So we don’t want to have to bring that back (to the commissioners) in the form of a tax increase. The model they’re discussing is used in a lot of other counties.”

“What we’re proposing is that you have these three vehicles and four ambulances all the time,” said Cooper. “Two of these ambulances will run transport during the day.  So as long as we get a paramedic on the scene and we get a truck coming from somewhere else in the county then we can maintain the highest level of care.”

“Instead of putting two more ambulances on the road with two more people every day with all the salaries, where instead of putting a $100,000 ambulance we’re putting them in a $30,000 Explorer and we’re still able to provide that care and we’re using the existing ambulances to do the transports,” Cooper added.  “They’re moving a lot more and they’re burning a lot more fuel, but at the end of the day when we look at the salaries, the overtime, just by going to this system and putting a few more people and vehicles on, you’ll see that there’s still a half-million (dollars) cut out and we’re still able to handle that call volume.”

The commissioners had a number of questions with the proposed plan.

Sauer said under the preliminary proposal he’d like to submit a package where the county would begin transports in June, but that was still in the planning stage.

“What we want to do is we want to allow for us to get in and start generating revenue before we go deep into it with a huge overhead cost and have a big operating expense that’s going to take us two or three years to get there versus running it leaner now, generating that business, letting people see how we do it and as they start picking up and (clients) start seeing we’re doing a good job and want to start using us more, and the phone starts ringing more, and the revenue it generates then we can bring on those additional trucks and we can start to separate the two (EMS and transport) back out,” Leicester said.

“We really want to be lean and not dig you a hole that you can’t get out of,” said Sauer.

Leicester said Bertie’s EMS is able to compete as well as some urban areas.

“We’re doing it very well from that perspective and we think this is a way for us to continue to do that and not jeopardize anything that we’ve built up to this point going forward,” he said. “We’re underneath the 20 minute requirement by a full two minutes.”

Sauer said for now, these are proposals, but that the Emergency Management team would continue to brainstorm and hopes to bring a full package in about 30 days.

A question was raised about EMS service to the Indian Woods area to which the team said once the QRV system is in place and EMS and transport are separate, then they hope to get the paramedics back on the ambulances and station the QRV’s in areas of Bertie County that require longer response time, but call volume doesn’t justify setting an ambulance in that area 24/7.

In conclusion, the new proposal has the EMS budget down from $3.04 million to just over $2.6 million combined; and they hope to be able to trim even more.

However, a final proposal will not be submitted until April.