, 2014

Turf war: County and volunteer
rescue squads at loggerheads

by Audrey Thomasson

When a resident makes a 911 call for emergency medical help, they expect a quick and efficient response from the rescue squad. When minutes count, as in the case of a heart attack or stroke, they want the ambulance crew to provide the best emergency care possible until their arrival at the hospital.

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EMT-Basic: Emergency Medical Technicians trained in Basic Life Support. They use CPR, a defibrillator, and administer simple medications.
ALS: Advanced Life Support, includes intermediate EMTs and Paramedics with additional training in starting IVs, handling cardiac and respiratory arrest emergencies and other life saving measures. Paramedics provide the most advanced service in the field.

Squad staffing:
Lancaster County Department of Emergency Medical Services (EMS) paid professionals: 10 paramedics, 6 intermediates, 11 basics.
Upper Lancaster Volunteer Rescue Squad: 7 basics
Kilmarnock-Lancaster County Volunteer Rescue Squad: 1 paramedic, 15 basics

But what happens when politics and power struggles get in the way of saving lives?

A battle that has been brewing for a couple of years among the volunteer squads and the county boiled over last month when Upper Lancaster Volunteer Rescue Squad (ULVRS) members attempted to have State Police remove from their squad building a paid county paramedic who was staffing the station.

The paramedic was present on the authority of county supervisors who approved funding for around-the-clock coverage by paid advance life support providers (ALS). Without them, most weeknight calls would be handled by EMT-basic volunteers.

However, ULVRS captain Mike Wilson said paid county EMS personnel are not allowed in their building during evening shifts when volunteers are on duty. “The county has no right to put staff there on weeknights,” he said.

The county’s paid personnel work 12-hour shifts weekdays and around-the-clock Friday through Sunday. Volunteer rescue squads are expected to cover four 12-hour shifts, Monday through Thursday.

Kilmarnock-Lancaster County Volunteer Rescue Squad captain Erik Brown also put the county on notice that paramedics were not welcome in their building on weeknights. In an email, Brown said the county “is not permitted to staff our building after 6 p.m. with the ALS responder for countywide ALS response. The membership decided this due to the fact it is not in the agreement and also that the person should be housed in a centralized location and we are not willing to permit such staffing or housing at our building at this time.”

County attorney James Cornwell notified the volunteer squads that their conduct “was unlawful, unprofessional, and contrary to the obligations of the squads to protect and serve the public health, safety and welfare and constitutes a breach” of their 2005 agreement with the county. He noted that the county’s chief of emergency services, Christina Hubbard, was clear in her notification of the county’s right to staff the station to protect and serve the public as outlined in the agreement.

“The problem is lack of communication by Christina Hubbard,” said Wilson.

Wilson lodged another complaint at the county for billing for emergency calls made by volunteer crews.

“That takes away from our ability to get donations,” he said. Volunteers rely on contributions from the community to fund their equipment and services.

Wilson estimated his rescue squad has 20 active members and admitted they have slow response times, but are working to improve. Members who live near the squad building respond from their homes, while he responds from his home in Weems. He later said he sometimes stays at the squad house when he’s on call.

“We don’t really get a whole lot of calls. Our goal is to be at a person’s house within 10 minutes...the state hasn’t put into effect any set amount,” Wilson said.

Response failures

According to documentation provided by Hubbard, for some time Upper Lancaster volunteers have fallen short in a number of areas, including not sufficiently staffing its units, gaps in coverage on holidays, an unacceptable response time of 32 minutes in 90% of calls, and missing 14 calls in the past 11 months.

Ambulances have responded to calls without fully qualified personnel on board, she added. Also, the squad has not provided the county with a duty schedule since last June, leading to the unit missing calls.

“They continually did not have an EMT-basic on call and didn’t notify the county,” said Hubbard. “There are times when the 911 dispatcher sends a call out to the volunteer squad and no one replies. That’s a loss of two minutes. Another attempt goes unanswered—that’s two more minutes. After the third attempt the call is transferred to Kilmarnock.” Factoring in the time for the initial 911 call, eight minutes was added to the response time, she said.

Several of the county’s paid staff have complained of volunteers leaving harassing phone calls and of juvenile behavior at the squad house, such as arming the door with mousetraps and creating a hostile work environment. Additional complaints about both squads include inappropriate messages and videos posted on Twitter and Facebook, according to several county officials.

Hubbard, a 13-year veteran paramedic from the York County area, said squad captains continually question her qualifications and that of the paid staff.

Squad complaints

ULVRS president Judy Hammell appeared before the board of supervisors last week to say they received no notice that “the county planned to staff on a 24-hour basis. You should have warned us...our membership does not appreciate it. We have retained an attorney. We are going to fight this to the best of our knowledge. I do not want to see this happen as do the other five agencies [volunteer fire and rescue units in the county].”

In a recent memo to the county, she listed a number of other concerns.

“The main concern of the squad at this time is the fuel mileage reimbursement check. We have not received a check since April...” she wrote.

According to county administrator Frank Pleva, the county pays the volunteer rescue squads $9 per mile of loaded transport (when they carry a patient), even when the county is not reimbursed by Medicaid and Medicare.

Due to an increase in the number of paid EMS staff, Hammell asked the county to provide a list of current employees using ULVRS’s facility and their certifications, the names of anyone with a key, and a copy of the current contract with the county. She included a few rules they would like people to follow in using their building and equipment.

Hammell also questioned the county’s authority to use their facility for the ALS provider on weeknights and asked for compensation to offset some of their costs, such as utilities, fuel, and service of vehicles since the county uses them more than the volunteers.

“We’ve been trying to work this out since April,” said Wilson. “The board of supervisors voted for this without talking to us. The county doesn’t own none of that up there in Lively and they’re trying to take it over. It’s going to cost the taxpayers a lot of money. Why would you pay someone to sit there watching TV when you have volunteers?”

Many volunteers expressed concern that the county planned to “take them over” on October 1. The rumors spread to the volunteer fire departments as well.

County liability

Michael Berg, director of codes and compliance with the Virginia Department of Health, said it is the responsibility of local government to provide emergency medical service to citizens, either through their own emergency services or through a contract with an independent service.

When service failures result in lawsuits, Berg said people follow the money.

“In cases I’ve seen, they went after the county,” he said.

County officials understand their obligation, but feel the volunteer squads think they are not responsible to county authority.

“The county is legally, morally and ethically obligated to provide emergency medical services to its citizens,” said county administrator Frank Pleva.

The chairman of the board of supervisors and head of the county’s emergency services, Wally Beauchamp, agreed.

“The volunteer units fail to understand they serve at the pleasure of this county,” Beauchamp said.

Since 2005, the county has paid $210,996 to ULVRS and $192,783 to KLVRS in mileage reimbursements. Additional county contributions since 2004 totalled $446,312 for ULVRS and $534,880 to KLVRS.

Beauchamp denied the county has any interest in taking over the volunteer rescue squads or fire departments. “Nothing could be further from the truth,” he said.

For many years, both the Kilmarnock and Upper Lancaster units received $50,000 a year in support from the county. However, in September 2010, when the Upper Lancaster unit requested the county take over a substantial amount of their coverage time with paid personnel, the county withdrew their funding and used it to help defray a portion of the personnel costs, said Hubbard.

Beauchamp said he asked Wilson several weeks ago to come up with a lease arrangement so the county could cover the costs associated with paid staff staying in their facility. “He never got back to me,” said Beauchamp.

County officials met Monday night with Wilson, Hammell and their attorney. While Beauchamp felt positive about their progress he said all had agreed not to continue publicly airing problems. However, he confirmed that the county’s plan for full-time ALS service will continue, but the provider will be dispatched from the county offices in Lancaster which are more centrally located.

Quality care

Despite their disagreements, both the county and the volunteers are concerned about continuing to provide quality emergency care for citizens.

“Our main concern as providers...of emergency medical services...should be the same now as it was when we first started, regardless of what level we are—as patient advocate,” one volunteer wrote. “I feel that everyone is not currently focusing on this. For my family...I want a quality trained EMT with a timely response to respond no matter whether they are career or volunteer. I hope...the patient will come first and that volunteers and the county can work as a team to provide the excellent, quality emergency services that our citizens deserve.”

“I think the units are doing a good job,” said Dr. Paul Sutherland, operations medical director for the volunteers. “They are getting things done in the field that would have been done in the E.R. I’d like to see them advance to the next level of care, but it takes a lot of time and commitment.”

Dr. Sutherland said the costs for training have escalated over the past 20 years and are prohibitive for volunteers who also have responsibilities for families and jobs.

“Everybody would like to have the time and money for the training needed to advance their qualifications. It takes people in the community stepping up and helping them out.”

He also praised the county for adding paid rescue staff and those with advanced training.

“Having the paid staff is helping out,” he said.

“We take the concerns expressed by the volunteer fire departments and rescue squads...seriously and will evaluate each in detail,” said Hubbard. “The county desires to continue supporting the volunteer squads with human, physical and financial resources as long as the volunteers are willing to work with the county to provide citizens and visitors with quality, expedient and dependable emergency services.”

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