York County officials are planning changes to how emergency calls are dispatched in an effort to curb ambulances from racing each other to patients and the dollars they pay for services.
Some county rescue members are concerned that the changes may give their competition more power, putting them at a disadvantage, a fear county officials hope to quell.
Under the county’s current system, dispatchers call on two ambulances to respond to every call – one from Piedmont Medical Center’s for-profit ambulance service, which contracts with the county to provide EMS services, and one from the county’s nonprofit rescue squads.
The rescue squads have never had contracts with the county and are run mostly by volunteers. Proud of being able to serve their communities, they rely on donations and medical payments for support.
Recognizing the threat of racing ambulances and feeling pressure from the state, the county this year will create contracts with the squads and purchase new software that will allow the county to pinpoint ambulances, position them strategically and dispatch the unit closest to an emergency call, said Anna Moore, assistant county manager.
Included in the 2012-2013 budget, the $175,000 system won’t be approved until mid-year and could take until year’s end to be up and running.
Until then, county emergency officials say they need a more immediate fix. That temporary solution has some rescue squads uneasy.
Public safety and patient care
When the county began dispatching calls to Piedmont Medical Center and the rescue squads in 1995, the two had a different relationship: crews ate lunch together, rode on calls together and sometimes loaned each other equipment. Piedmont’s contract with the county requires the hospital to “cooperate and coordinate” with the rescue squads.
But now “dual dispatch” leads to units racing each other to arrive on scene first, earning the right to treat the patient and collect payment, turning emergency response into a competition for dollars.
The competition occurs mostly in the Fort Mill and Lake Wylie areas, where the rescue squads have grown from all-volunteer to crews that now have multiple ambulances, some full-time paid employees and scores of volunteers.
The county also has a part-time squad in York, a volunteer unit in Clover, and a Rock Hill squad that specializes in water and vehicle rescues and doesn’t run an ambulance or transport patients.
Under pressure from the S.C. Department of Health and Environmental Control, the county must address the issue soon, said Gary Loflin, York County’s director of public safety communications.
“It’s getting to the point that it’s beginning to affect the medical care that people are receiving in York County,” Loflin said.
In a Jan. 30 letter to all York County EMS agencies, Henry Lewis, EMS coordinator for DHEC, said the agency had received complaints of “patient coercion, delay in patient care, and circumvention of the existing 911 system,” he wrote.
The complaints were “not from patients” – they were from EMS agencies against other agencies, said Adam Myrick, DHEC spokesman.
Loflin and River Hills Rescue director Dick Mann explained that one of the instances was related to the River Hills squad giving an assisted living facility a cell phone number to call the squad’s ambulance parked in its lot.
“Just because we were there so frequently, it was easier for them to call us on their cell phone,” Mann said. “That has been construed by others that we were attempting to circumvent the 911 center.”
Mann has since agreed with DHEC that the practice isn’t appropriate.
After investigating the complaints, DHEC found nothing to “prompt a violation” and found all EMS agencies in compliance, Myrick said. DHEC officials have since met with the rescue squads and representatives of Piedmont to remind them of state law.
But the state, along with local emergency officials, did find the competition among the EMS agencies alarming. Racing ambulances could threaten public safety, and conversations between competing agencies on the scene could delay patient care, Myrick said.
Toward a solution
Representatives of rescue squads in Fort Mill and Lake Wylie look forward to the county’s new software.
But a temporary solution, first presented to the York County Council at its budget retreat Saturday, is one that may test the already shaky ground between the county squads and Piedmont’s EMS service, county officials acknowledged at the meeting.
It involves giving Piedmont temporary control over which ambulances get dispatched to calls.
Piedmont, unlike the county, already tracks its own ambulances using GPS trackers, said Moore, the assistant county manager.
Piedmont EMS service has agreed to loan York County’s rescue squads four GPS tracking units, Moore said.
Under the proposal, when York County dispatches calls, sending out two ambulances, a supervisor at Piedmont will determine which is closer. The one that’s farther away will cancel, Moore said.
Piedmont will produce weekly reports on how calls are being distributed for county review, Moore said.
Mann doesn’t trust that the county’s review will ensure fairness.
“You can make numbers say anything you want them to say,” he said. “If you take it out of the hands of (Piedmont) and give those routers to dispatchers in Rock Hill, I trust them. They are not beholden to anybody.”
Moore said the end goal is to ensure calls are distributed fairly.
“If we do see that there are trends that skew (distribution), we’ll have to look and see what the parameters are and make adjustments.”
Tim McMichael, assistant director of Fort Mill Rescue, and Mann also expressed concerns that only four trackers would go around. They wonder where that would leave ambulances that don’t get trackers, but could otherwise respond to an emergency call.
“There’s an extreme amount of distrust on both sides of the table,” McMichael said Tuesday afternoon.
Moore said county officials are aware of the concern and negotiations on how many tracking devices are ongoing.
Before negotiating for more trackers, the county will wait to see how many rescue squads are able to meet the requirements of new contracts, a process that take effect in coming months.
Part of the county plan also involves establishing contracts with the rescue squads and requiring them all to receive the same training and follow the same protocols. Piedmont may be the agency to provide that direction, Moore said.
A Piedmont representative wasn’t available to answer questions about the plan, but released a statement.
“... We have worked with York County to provide emergency services throughout the county since 1980. We have not only met, but have exceeded our contractual obligations. ... We will continue to work with York County and the State of South Carolina to ensure that the emergency care needs of our community are appropriately addressed,” the statement said.
Tuesday evening, county officials met with members of the rescue squads in a closed meeting to discuss the plan and hear concerns. Other meetings will follow, Moore said.
Her impression of the meeting was that the squads and Piedmont staff are willing to move forward together.
“Everyone is ready to move past the distrust and move toward providing consistent, high-quality service to the citizens,” she said.
“We certainly don’t expect it to happen overnight, but that is the common goal.”
Herald reporter Shawn Cetrone contributed