EMS services play a critical role in our county’s first responders program. The Elizabethtown Rotary Club learned about the Bladen County EMS system from Director David Howell on Wednesday.
Howell said the county’s EMS system is made up of Bladen County EMS, which is a paid service, and three volunteer rescue squads —Tar Heel, Bladenboro and Elizabethtown. He said that the Bladen County EMS system is classified as a rural EMS system by the State of North Carolina.
Howell said there are challenges that are currently being faced by all rural EMS systems.
The five most critical challenges, according to Howell, are:
*Low reimbursement rates for Medicare and Medicaid;
* Increased insurance deductibles are impacting EMS reimbursements;
*Financial overload on EMS systems due to increases in prices of such things as ambulances and equipment and increases in costs of medical supplies;
*Severe manpower shortages;
*Volunteer EMS services are seeing a decline in manpower, as well.
For rural EMS systems, the low reimbursement rates are a serious problem, said Howell. It creates a problem because the cost of operating is not spread out over a large number of trips.
Howell said the EMS Director’s responsibilities include the oversight of the personnel for the county’s paid EMS service and also to oversee the EMS system with respect to the volunteer services.
Howell said he ensures that everyone is in compliance with their training and education. Howell also explained the state has a required set of “Mandatory Skill Sets” and as EMS Director he must ensure everyone has completed their Mandatory Skill Sets each year to stay proficient.
Howell said his position also must deal with patient care complaints whether it involves the Bladen County EMS or the volunteer squads. He also serves as the liaison to Bladen County Board of Commissioners.
Howell briefly spoke about the quarter-cent sales tax referendum that is on the ballot for November. He said one quarter of every dollar spent will be used to pay for EMS personnel and equipment.
Howell said that currently the average EMS response time is 21 minutes to a call. He said there is a 60 minute window in which if a patient is diagnosed or thought to be having a heart attack, the quicker the patient receives care, the better the outcome. Howell said it is important to increase staffing in order to be able to improve response times.
Howell said that before 1995, Bladen County’s EMS services were strictly volunteer services. He said it was decided the volunteers needed help because people had to work and were not always available to respond to calls.
Howell said the volunteer rescue squads do bill for services just as the paid service does.
Howell said the county’s paid EMS service is unique in that they run both non-emergency and emergency calls. Non-emergency calls can consist of things like transporting patients for dialysis treatments.
“The whole system averaged 10,800 calls of which 4,300 were non-emergency calls,” said Howell of the past year.
When asked about the levels of EMT certification, Howell said there are three different levels—the EMT basic which provides for a basic level of life support; the EMT Intermediate and the Paramedic designation which Howell said has the highest scope of practice.
Howell said for example that a paramedic can perform a defibrillation or perform surgical airways. He added that a paramedic can pace patients if their heart rates require it and they can perform pain management.
Howell said that some members of the group may have noticed the automobiles and SUVS with the EMS logos traveling throughout the county answering calls. He said those vehicles are quick response vehicles. Howell said there are certain areas of county the QRV with paramedics on board can respond quickly and begin treatment until an ambulance or helicopter arrives.
Howell told the group that there some non-traditional roles developing for paramedics as well. He said that currently there are no paramedics working in the emergency room. He said that paramedics can perform a lot of things RNs can do but the paramedic must function under the guidance of the medical director of the Emergency Department.
Another growing role for paramedics is the field of Community Paramedicine, said Howell.
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