By Happy Carlock
After a car of 11 Washington and Lee University students crashed on Turkey Hill Road in Rockbridge County four months ago, the injured passengers felt they had a long wait before receiving any medical attention.
W&L junior Ellen Gleason remembers being pulled from the car and waiting 20 to 30 minutes for EMS responders to arrive at the scene of the accident.
“I remember lying on the pavement for what felt like an hour,” she said. “I’m sure it wasn’t that long, but it felt like a really long time until one ambulance finally came.”
Kim Arbaugh, the Rockbridge Area Central Dispatch 911 Technician, said the first ambulance arrived 15 minutes after the call came into the 911 center.
But concern about response time to remote county locations is nonetheless real.
Rockbridge County’s emergency medical service agencies are completely staffed by volunteers, while Lexington has paid and volunteer workers. And recently, the county has seen a decline in available volunteers.
The county is considering hiring an EMS service or paying county employees to fill daytime gaps when volunteers can’t respond to calls.
County Administrator Spencer Suter said it is becoming harder for county agencies to provide safety to roughly 36,000 people in the Rockbridge area.
“The ripple effect of that is Lexington, with their paid career ambulance, is being spread thinner and thinner covering calls out in the county and out in Buena Vista,” he said. “It’s reached the tipping point where we’ve got to do something.”
Rockbridge County Director of Fire and EMS Craig Bryant was hired in February and has worked with Suter to address the issue.
“Some people may only have time to volunteer two hours during the day, or they can only volunteer at nighttime,” Bryant said. “What the county is looking at is where are those gaps when volunteers aren’t able to staff an ambulance.”
EMS budget and funding
The county started with a $2.7 million gap between revenue and expenditures in the upcoming year’s budget. But the gap has been reduced to about $1.26 million. Suter said unfunded EMS training hour mandates from the state are partially to blame for the gap.
“When new EMS regulations come out, it increases the stress on departments, both volunteer and career,” he said. “They have to meet these standards, and that stuff costs money.”
Hiring two contracted crews for 12-hour days, five days a week, would cost around $500,000.
“You can’t have a service without the cost,” he said. “Right now the service is lacking, and the city of Lexington is responding to the four corners of the county on a regular basis.”
The Board of Supervisors has discussed allocating $500,000 in this year’s budget to establish a contracted EMS service or hire paid employees. A public hearing on this and other budget details will take place April 23, and the final county budget will be adopted on April 30.[pullquote]“You can’t have a service without the cost. Right now the service is lacking, and the city of Lexington is responding to the four corners of the county on a regular basis.” – Craig Bryant [/pullquote]
Lexington shouldering the burden
Because there are not enough volunteers for county EMS, Lexington Fire Chief Ty Dickerson said that Lexington fire and EMS workers respond to calls from the county more than once a day, on average.
“The workload has gotten to the point where everybody needs more help,” Dickerson said. “We need more ambulances to handle the rising call volume and the workload and the declining availability of volunteers.”
Lexington contracted with Carilion Hospital in 2006 to provide medics to staff ambulances, according to Dickerson. In 2009, the city hired its first direct employees and career fire chief. Lexington now staffs a 24-hour ambulance, and paid staff members work 10-hour shifts Monday through Friday.
Bobby Wright is a volunteer firefighter and EMS responder at Lexington Fire Department. He said that many employers used to let fire and EMS volunteers take time off to respond to calls, but that is often not the case now.
“Around this area, that’s not an option,” Wright said. “You have to stay at work, and when the tones drop, you won’t be able to respond to an emergency call.”
Response times
When a county resident calls 911, the call goes to the Rockbridge Central Dispatch Center, which identifies the address of the emergency and then tones the “first-due” agency. The first-due agency is the fire or EMS agency located closest to the scene of the emergency. The dispatch center receives a response check six minutes after they dispatch an agency. After eight minutes, if the first due has not responded, the call is transferred to the second-due agency, which is determined based on roads and mileage.
Lexington Fire Department is second due for many county calls. Wright says that timing is always critical when volunteers are responding to an emergency.
“I would always say that you try and do the best for what you have,” Wright said. “We don’t really think of it as, ‘Oh if we were there 30 seconds sooner.’ You kind of just deal with what you have when you arrive.”
Many of the delayed response times can be blamed on lack of coordination between agencies. Bryant said that the biggest challenge he’s faced in his new position is establishing communication between the fire and EMS agencies.
“The county is spread out. It’s all volunteer,” Bryant said. “We’re trying to get out and effectively establish lines of communication with the departments, with the chiefs and captains, and with the organizations within the county.”
Bryant thinks that as the agencies identify gaps in volunteers and responses, they will be able to collaborate and respond better.
“My specifically being hired doesn’t address those gaps in response times,” he said. “Hiring me is the county’s step toward having a plan to address issues like EMS response times, ISO, volunteer recruitment and retention, risk reduction in the county.”
Volunteer Shortage
Both Bryant and Wright recognize a major challenge for volunteers is completing the required training hours, which they think has contributed to the decline in volunteerism. Wright
has his EMT intermediate certification, which required an 11-month training class.
“You’ve got about 700 hours tied up in certification,” he said. “And it’s constantly increasing. Firefighter training just went from 100 hours to 150.”
But Jeff Conner, a firefighter and EMT at Lexington Fire Department, thinks that fewer people are volunteering because of a lack of interest.
“The generation between my age and my cousins’ age has changed a lot,” Conner said. “Kids are more interested in becoming video game players and sitting at home playing computer games.”
Suter also blames the generation gap and the growing demand for people’s time outside of the fire and EMS agencies.
“Back in the ’70s and ’80s, before video games and additional activities, volunteers followed daddy and granddaddy down to the firehouse and that’s where they spent their time. They grew up in that culture,” Suter said. “These days, everybody’s busy. The allure of going down and being part of that volunteer group has been lost.”
But if the Board of Supervisors adopts a budget that includes funding for a contracted EMS service or paid county employees, the hours that volunteers can’t work will be covered. Responders will also be able to reach victims like Gleason much sooner.
“It was really hard for all of us after the crash to have to deal with — not only coming to terms with being in shock and trying to process what happened –, but also worrying about being injured and not having any kind of medical team there to help,” Gleason said.