Commission discusses the EMS service in county
The Emery County Commission held a meeting to discuss the Emergency Medical Services in the county. Jim Gordon is the director for the EMS and this is a part-time position.
Gordon has prepared a plan which he presented to the commission regarding the EMS and addressing concerns within the system. He said the system should operate on a foundation of trust and open communication. He will set aside time at each meeting with the EMTs to address any concerns and questions they have.
All employees will have open access to the director and have his cell phone number so he can be reached 24/7. Any changes within the EMS system will be put into writing and each EMT will have a copy of these changes. The director will develop a policy and procedures manual where job descriptions are outlined in a clear manner. Gordon hopes to build a more clear and solid foundation for the ambulance department. There are state guidelines and protocol which the EMS system operates under and Gordon said they will focus on these state guidelines to ensure compliance.
The EMS will hire good EMTs free of criminal backgrounds who can contribute positively to the department. Interviews will be held for each new applicant. Ambulances will be kept well maintained and well stocked. Ambulances are on a replacement schedule and will be replaced as budget allows. Any equipment which needs to be replaced will be done so in a timely manner.
Regular trainings will be held and different training topics will be addressed and will be fit with state protocol in areas of training. All these trainings will help EMTs in their recertification hours which are 100 hours of additional training in a four year period in different emergency areas.
Training schedules will be adaptable and flexible as many EMTs work shift work. The director will work to accommodate the different schedules of the EMTs. The topics to be addressed in these trainings will be chosen through quality review and doctor recommendations.
Rural ambulance services have long transport times and one of the trainings will focus on enroute patient care. Special emphasis will be made to help local EMTs acquire the skills needed for patient care in transit. Professionals will be invited to the county to conduct these trainings.
Each ambulance run which takes place is accompanied by paperwork. Gordon will review each run and address any concerns there, he will review anything unusual to improve patient care. Trainings will also be geared to any suggestions offered by the hospital staff on ways to improve the service. Concerns with response times will also be addressed.
Gordon said it is vital that the EMTs work as a team and training will take place which includes local law enforcement and the highway patrol to increase cooperation between the agencies in emergency response.
Gordon said EMTs compensation needs to be increased. Currently the on- call pay for EMTs is 50 cents per hour. When EMTs are on call they cannot leave their area for hours at a time and sometimes for days, if they are short handed. Gordon proposed this on call pay go to $1 per hour for the remainder of this year and increase to $2 per hour over the next five years.
Gordon said there are five ambulance stations in the county. Three people from each station are on call at all times. This equals 131,400 on call hours per year at the five stations. "People are expected to respond at a moment's notice for 50 cents an hour?" questioned Gordon.
Gordon wants to work with the compensation for the EMTs to help with retention of current and former EMTs and recruitment of new EMTs.
Gordon said, "Most people don't think about EMS services, unless they need it."
Gordon also proposed the director for EMS needs to be a full-time position, he is currently a part-time employee and puts in more hours than allotted. He also proposed a part-time secretary to help with paperwork.
The plan also included holding Basic classes every other year and Intermediate classes every other year.
Gordon said they also wish to begin an education program for the public. The public needs to know when it's appropriate to call an ambulance and for what situations an ambulance is required and when it is not. Some people call an ambulance when it isn't needed, but some people do not call an ambulance when it could be a real benefit to the patient and a civilian transport puts the patient in danger.
An emergency medical responder class will also be taught. This is a 60 hour class welcome to anyone who would like to learn what to do if you're the first one on scene at a medical emergency. Gordon said CPR is taught in this class and a lot of basic first aid. Gordon said they would like to begin education in schools to educate people on what to do before the ambulance arrives. They want to hold classes at the high school level and increase awareness there and possibly generate some interest in older students becoming EMTs.
Sue Copinga is the trainer for EMS in Emery County. She explained to the commission the trainings planned for Emery County EMTs. Their focus will be on making sure the trainings fit the needs of the local EMTs for their recertifications. It is also her responsibility to check the training hours to be sure each EMT is getting what they need. She likes all the EMTs to train together so they can learn from each other.
This year the county EMTs didn't go to the EMT conference, but will use that $30,000 that was budgeted for local trainings and to compensate the EMTs for attending their trainings. Copinga believes there are many benefits for training in smaller groups. In the past some EMTs would attend the outside the county trainings and bring the information back to train the local groups. There is benefit in that too.
In the future as budget allows, EMTs will be sent to outside conferences as well. One reality this year is the EMS is shorthanded and sending the EMTs we do have out of the county was not in the best interest of the county at the time. Trainings are held the second Thursday of the month in Green River, the third Thursday of the month for the Emery/Ferron area and the fourth Thursday for the Castle Dale/Huntington areas. The EMTs are told if they can't make it to the training in their area, they are welcome to attend one of the other trainings in another town. Each training is the same for all three areas. Copinga said they have the training schedule mapped out for the next 12 months. In September they will hold a mini-conference of trauma systems and the mechanism of injury which will be taught by Rick Howard, the batallion chief in Lehi. In October, November and December the trainings will take place in the towns. In January-2010 another mini-conference covering EMS for children.
Some of the presenters will charge to come and train and others have said, just feed them dinner and they will come for free.
A Basic EMT class will begin on July 15. At the conclusion of the class the participants will spend 10 hours in the emergency room doing their clinicals. They will mostly help with vital checks and observations. A Basic class is also planned for Green River in September or October. Any people from Green River wishing to take the class sooner are welcome to come to the class which starts in July. In January-February 2010, an Intermediate class will be held. Any Basic EMTs are encouraged to take this class so they can advance to Intermediate.
Commissioner Jeff Horrocks said the decisions Jim has made have been made after consulting with him. "Jim and Sue are doing an admirable job," said Horrocks.
The meeting was opened up to citizen concerns. Valarie Newland spoke, she said she has been a certified EMT since 1989. She has worked for Emery County the past 20 years. She is currently the scheduler for Green River. "The current system is not working for Green River. To be an EMT you must be a strong creature. Green River has 11 certified EMTs currently working. Not enough to cover all the shifts at all times. The Green River ambulance covers a wide range of area. They make approximately 170 runs a year. They cover from Ghost Rock on I-70 to the west to 20 miles east of Green River on I-70 to the east. They cover to Woodside on SR-6. Any transport for the ambulance is at least 76 miles to the Price hospital and 104 miles to Grand Junction. The EMTs must cover all these miles, maintain their certifications, balance their jobs and find time for their families. And in doing all that, they must maintain their own health. "This is turning into an unhealthy structure," said Newland.
Newland said one year ago they took the ambulance service out from under the sheriff's office and are trying to run it more like a business. She said the hiring of a director and a traveling trainer were good moves. She said at the time of the switch they took away the meal allowance at the end of a run and the credit card. "They took away the spirit of volunteerism," said Newland. "They took away any position of authority that can make tough decisions in this 100 mile area. The law enforcement link was a great comfort to us in Green River. The lack of having enough EMTs is an ongoing problem. I request at this time a team be put together to research other agencies and see what works. See what is a fair monetary system for retention. Bring this information back and be ready to vote by August. A lot of work has gone into that new plan. Keep in mind we want to be more involved in those decisions. Communication is a big issue. We have many concerns in Green River," said Newland.
Commissioner Gary Kofford asked Newland if the new proposals for compensation would help, she said yes it will help. Newland said she felt like they had been playing around with the system for a year now. Up until April they only had five EMTs. In June she had health problems and couldn't run, but was still on call. "We are just out there by ourselves. I have to make Green River work, we have made great progress, but we need to do more," said Newland.
Kofford wanted to make it clear that the commission didn't take away their meal allowances and credit card. He said if the commission had changed any policy it would have sent out a memo in writing, so everyone could know. The county is looking into the policies and travel allowances.
Horrocks said they had been receiving bills for astronomical amounts for meals. "If we send an ambulance to Grand Junction we should feed them, there were just some bills coming in that seemed extravagant," said Horrocks.
Kofford pointed out the use of the credit card for meals was changed without any explanation. He said it was a good learning experience. Things need to be explained you can't just put out a directive. "There wasn't enough communication when these directives came down. You need to stop and evaluate how what you're doing is affecting people. We are trying to come to a conclusion as a group on what's the best course to move forward. This plan should have been put forward a year ago,' said Kofford.
The three commissioners will make a decision based on budget and human resources. They will consult the appropriate parties.
Horrocks said, "This program needs to move forward. It takes time to recruit people. We have more EMTs now than we have in awhile. We are working on communications."
Kofford said it's gone on for too long. "I'd like to say I got on it quicker, but I didn't I would like to bring it back on July 14 or 28th commission meeting and decide how to move forward. We will look at the money."
The covering of shifts was also talked about. Gordon said he is responsible for seeing the shifts are covered, if he sees holes in schedules and he can find people to cover in Green River as well as other areas. But, Gordon said he needs to be aware of when these shortages are really taking place. If he sees blanks, then he can make plans.
One possible solution for shortages was looked at in contacting Grand and Carbon counties. Newland said they were supposed to meet Carbon half-way on SR-6 and transfer. That happened twice. Once Carbon came to the Green River clinic and the PA decided not to transport to Castleview, but the patient needed to go to Grand Junction and the Carbon crew fell apart and didn't handle it well. "You need to know a lot of the pieces and these things need to be discussed," said Newland.
Horrocks said they are working on those problems with Dr. Engar. If a patient is going to Grand Junction then air med can be used.
Newland said, "Things have been very tense and very tough. There is a huge lack of confidence being portrayed at your ambulance service."
Kofford questioned Newland on her remarks that she felt more secure under the umbrella of the sheriff's office. She responded that they go out on all types of calls all hours of the day and night. Tourists and transients make up a large number of those calls. Oftentimes, it is three women in the ambulance responding to those calls. They asked the sheriff's office to show up at all of their calls which they have done. "It has been a blanket of comfort, in difficult situations," said Newland. "We knew who to call. We already had a clear picture and the sheriff's office was part of that. It was invaluable."
Newland described a situation they had the other night where they had to get the rescue vehicle to respond to a call. They have been instructed that they can't take the ambulances off the pavement. This patient was about three miles from a paved road, so the rescue vehicle had to be utilized and the ambulance crew didn't have the rescue vehicle there at the ambulance garage, nor did they have the keys to it, so luckily one of the deputies was available to get into the sheriff's office in Green River and pick-up the key for the rescue vehicle. "We did work hand-in-hand with the sheriff's office and we became familiar with how things were done. We've had to learn new ways to do things," said Newland.
Horrocks pointed out that the sheriff's office still responds to calls when the ambulance goes out.
Newland said there are new rules now and in the past their supervisor always knew who to call and they would say this is what you are to do and do it now.
Kofford said, "Do you feel like you have to go through channels now to get to the sheriff's office?"
Newland said yes, they used to have a key to the rescue vehicle and it was parked at the ambulance garage.
Bruce Funk spoke next. He said he is very familiar with the workings of the ambulance as he spent 23 years as the Emery County Clerk. The ambulance was under the sheriff's office during his time as clerk and there were problems then as there are now. Funk said he felt good when they hired Jim Gordon as it took it out from under the political realm and the political muscle of the sheriff. "The opportunity to take it out of the political arena has been good, because now you can hire and fire the director. I've watched good EMTs fall aside. The credit card issue is a problem," Funk stated.
Funk said there were write-offs from the ambulance service that totaled $300,000.
This was before the ambulance billing was contracted out and now it is no longer done in-county. "The sheriff should respond at any critical situation. The proposal presented today was very good. I commend all the volunteers.
" I don't feel a great deal of compensation is necessary.
"You've got a good chance to do something and to do it right. I hope the sheriff will rally around and get the EMTs to join in. I don't see that turning back the system is worthwhile," said Funk.