GREENWOOD TWP- Virginia Fire Chief Al Lewis told township officials and residents here last week that there are ways to improve their emergency medical response system, but none are likely to be inexpensive.
Lewis made his comments as an invited guest to an informational meeting sponsored by the town board in response to concerns raised over the future of EMS in the community, including financial issues and the lack of advanced life support services. About 35 people, including township officials, residents, and local emergency responders, attended the public meeting.
Lewis said the challenges currently facing emergency medical services are systemic, created by an outdated funding structure, and that the only real solution will involve the creation of larger regional districts with professional staffs, along with a financial system that is based on actual needs, and not tied to where the financial resources are coming from.
Some township officials and a few vocal Greenwood residents have been critical of the Tower Area Ambulance Service. A few have even suggested the township look at joining the Cook Ambulance District (an option that would involve joining the Cook Hospital District, a taxing authority), or asking Virginia to locate a staffed ambulance in the township.
Town supervisors have made it clear they are not interested in managing or running an ambulance service, with the financial obligations involved. Meanwhile, first responders in the township, have expressed strong support for the Tower Ambulance Service.
Lewis started out his presentation with an overview of the systemic issues facing emergency medical services in our region.
“We are trying to keep a system going that was designed years and years ago,” he said. “The system has not evolved.” Even with a professional department, like Virginia’s, he said there are times when they cannot meet the demand. The Virginia department consists of 44 staffers, with trained firefighter/paramedics, as well as members who are just paramedics.
“We ran out of ambulances today,” he said. “We had to call on Eveleth.”
Lewis said that when the first fire departments were formed in this country, they were tasked with putting out fires.
“In the 1960s they started adding medical services, responding to vehicle accidents, working with hazardous materials, and doing rescues,” he said. “If you didn’t know what else to do, you called the fire department.”
Lewis noted that it was obvious this community did care about emergency medical services. He urged them to consider a collaborative coalition to bring about change, finding the level of community support, defining the public value, and then building the operational capacity.
“Legitimacy and support are needed to drive the funding issue,” he said.
The Virginia Fire Department has a budget of over $5.5 million a year, which averages out to $500 per household, Lewis said. The department brings in over $3.2 million a year in EMS-related revenues.
He predicted that in the future, a regionalized EMS delivery model will emerge.
“No more single room schoolhouses,” he said. “A sustainable, broadly-spread funding base is essential for the tiered delivery according to need, not geographical location.”
“Ambulances do not save lives,” Lewis said. “Well-trained EMRs, EMTs, and paramedics do.”
Response times will always be a challenge in rural areas, he noted, and in cases that involve heart attacks, the time involved can mean the difference between life and death. It can take precious minutes between the time a 911 call is taken to when an ambulance department is dispatched. If a department does not answer a call within a minute, they are called on again. Dispatchers will try three times before paging out another ambulance service.
“It can take seven or eight minutes before that second department gets its page,” he said..
Right now, Lewis said, we are delivering these services based on who is using it and what they pay.
“What is your life worth?” he asked.
“There needs to be a balance of funding.”
Last year in northern St. Louis County (defined as a line drawn just north of Cotton), there were 11,669 EMS calls, 1,232 fire calls, and 792 other types of calls.
“The bulk of the call numbers are for EMS,” he said, though he noted that the call number does not equal the time required per call, since fire calls often require long deployments.
Of the 11,669 EMS calls, 3,089 were transports, where patients needed to be transported from one hospital to another that can provide a higher level of care.
Transfers take more time than other emergency calls, Lewis said, and mean an ambulance is out of the normal service area. But transfers also provide a source of revenue for many departments, including Virginia’s.
“This is why we are in the black,” he said.
Local data
The Tower Area Ambulance Service (TAAS) had 404 calls last year. Of those, Lewis said, they requested ALS (Advance Life Support, with paramedic on board) for 128 calls.
“The number of times TAAS calls us is a credit to their service,” he said. “It shows us they are putting their patients first. Not every service is amenable to calling ALS.”
First Responder Jeff Maus, a member of the Greenwood department, said they are trained to call for ALS based on the type of call.
Over half of the ALS calls for TAAS were to Greenwood, with about a third to Tower/Breitung, and the rest to other rural area townships.
Response times
Lewis said that emergency responders can’t magically decrease response times to rural locations. What they can work on, he said, is decreasing the time between the 911-page and the time the ambulance leaves the hall, the “chute” time.
The data on response times shows TAAS with an average chute time of 7:56 minutes, and average response time of 15:30. But when you look at the 90th-percentile times that filters out data outliers, the chute time increases to 13:36 and response time to 24:36.
This data doesn’t include the time it takes to have a First Responder on scene, Lewis said, noting that the care provided by these initial responders is also critical to patient care.
The response times for Tower are similar but slightly lower than for the Cook area, which had 90th-percentile chute times of 14:19 and response times of 28.11. Cook has a much larger geographical area to cover.
“They have a huge district, distance-wise,” Lewis noted.
The future of EMS
“The volunteer model worked fine when there were only dozens of calls,” said Lewis, “now there are hundreds and hundreds. We are burning out our volunteers.”
He noted that paid-on-call staff are often stressed, juggling other jobs, but still trying not to miss a call.
Another issue, Lewis said, is attracting professional leadership, which is essential for keeping ambulance services staffed with volunteer and paid-on-call employees.
“When you treat people well, pay them well, and give them training, their pride will show in the care they give to their patients”
As far as working towards a new model, the first step, Lewis said, is education.
“Allow people to see the data and ask questions,” he said. “Meetings like this are a good first step.”
“People don’t know what they don’t know. There is a naivete about how the system currently works.”
Talking with local and state officials is also important, he said, as well as working with surrounding cities and townships to talk about joint delivery of services. The state does not consider EMS to be an essential service, Lewis said, something that needs to change at the state and county level. Itasca County, he said, has started to help fund EMS.
Recent changes to state law have opened up taxing districts as a more viable funding model, he said. And paying more is required for better service.
“You can’t get a better service for what you are paying now.”
Lewis said he feels that joint fire/ambulance services are the model for the future.
“Fire departments are generally well-funded for the small number of calls they get,” he said, “But EMS has many more calls. One department can do both fire and EMS…Some firefighters do not want to do EMS, but as many as 80-plus-percent of our calls are EMS. We have to provide funding to do it.”
The real question is , Lewis noted, “Are people willing to pay?”
St. Louis County spends almost $50 million a year on the county sheriff department, Lewis said.
“Where is your county tax bill going?” he asked.
Rumors, future steps
Lewis said he didn’t know where the rumors about Virginia bringing an ambulance up to the Greenwood area had come from.
“We don’t have the money, personnel, or legal authority to do that,” he stated.
He said there are consultants that work on developing models for rural areas, and figuring out what type of taxing district would be needed, and potential costs involved.
The creation of a fire district takes administration and funding away from individual governments, which can then focus on other issues.
“A fire district is just worried about fire and EMS,” he said. “City councils have to worry about the whole city.”
Such districts generally have career staff for day-to-day duties, but still rely on paid-on-call volunteers.
There are grant dollars available for pursuing a fire district, but the process is complicated and time-consuming.
The meeting was not an official town board event, so no board action or discussion was held. Greenwood holds their regular board meeting on Tuesday, Dec. 14 at 6:30 p.m.