Union County commissioners have halted talks with Carolinas Healthcare System regarding a new EMS contract after public outreach meetings garnered negative feedback from residents.
Slow paramedic response times to portions of the county have provoked planners to look for ways to improve an agreement between CHS and Union County that hasn’t been changed since 1997. The county will set response time goals for EMS workers to reach under the new contract where not hitting the goals would constitute a breach of contract and grounds for termination.
The proposed contract had been based on the dynamic deployment model, in which paramedics are stationed near areas where calls are expected to originate. Those estimates are based on data collected through the previous 20 days that considers the time and location of all medical emergency calls and tries to predict where upcoming needs will occur.
Some people became concerned at the potential that the system would lead to less ambulances in rural zones, such as the area near the South Carolina border or in towns like New Salem, and put those vehicles in more densely populated towns like Waxhaw and Monroe, potentially leaving rural residents – especially the elderly – vulnerable.
At Mineral Springs Fire Department on July 31 during the final of three public outreach meetings, county commissioner Jonathan Thomas told the crowd, “There is no room for error on this. Life, limb and property is paramount.”
About 60 residents and first responders from surrounding communities showed up to the meeting and voiced their concerns. Their comments and insight would later influence planners to put their plans on hold and push back the proposed mid-August date for a finalized contract.
A firefighter from Sandy Ridge voiced her concerns to County Manager Cynthia Coto and the commissioners in attendance on July 31. Firefighters are often the first responders to a medical emergency and have to stabilize victims until an ambulance can arrive to transport them. Sandy Ridge is in a “Rural Zone” on the deployment map and the firefighter worried that moving the ambulance stationed there now would cost lives.
“[Pulling the unit] we have there now will make it a 20-minute wait time. The time now is three minutes max,” the woman said. “If we are there on scene doing CPR for an extra 20 minutes, that’s time taken from the victim’s life. I don’t think the county is taking that into consideration.”
County commissioner Richard Helms assured the crowd that those issues would be handled in the final drafts of the contract. He said that crowds who had attended previous meetings in New Salem and Lane’s Creek brought up similar concerns and that planners are looking into the viability of keeping some ambulances stationed at fire departments in rural areas while using a form of the dynamic deployment model in more densely populated areas.
Helms said that these are the reasons the county planned the outreach meetings and his team would do everything they could to fix the issues that some smaller towns could be facing.
“The model has already changed since the first meeting, and will continue to change,” Helms said. “Data is great, but we need to use a little common sense and compassion while drawing these plans up.”
Thomas said the county has not been in touch with EMS workers about the changes, as they are contracting those jobs through Carolinas Healthcare System and are not in charge of how those who handle daily operations will get their employees to reach the goal response times.
Under the proposed model, EMS workers would work 12-hour shifts in which they would be constantly on the move. This change differentiates from the usual 24-hour shifts during which paramedics can rest wherever they are based for stationary deployment, usually the closest hospital or a nearby fire station.
Some at the Mineral Springs meeting were concerned paramedics would be too tired in the final stages of a 12-hour shift and would not be as effective. Thomas said this could be a concern but would be under consideration by CHS, who is in charge of managing EMS workers.
“We’re basically setting the response times and CHS will manage how to get them to reach those, whether they want to give them breaks every once in a while is up to them,” Thomas said. “We just want to set the expectations for the provider, give them the funding and let them go at it.”
Marie Cangemi, a Monroe resident who attended the meeting in Mineral Springs, believes the issue brought up by the Sandy Ridge firefighter is crucial. She came away understanding the new system a little better, but believes the county still has to hammer out some details about how people in rural areas can be guaranteed help when they need it.
“My son suffered a severe accident down (N.C. 75), and if the response time was any longer he may not have made it,” she said. “The commissioners still don’t have all the answers. We need to keep (paramedics) in the rural areas. It’s the only way.”
Thomas said following the meetings that the county would go back to the drawing board as it seems citizens have rejected the idea of dynamic deployment, and it is so far unclear whether a hybrid of stationary deployment and dynamic deployment can work.
The county has already begun to see success with automatic vehicle location, which uses GPS to send the closest truck available as opposed to one stationed nearby. They’ve also changed staff in ambulances, using a team of one paramedic and one emergency medical technician, who isn’t as highly trained but still acts as a first responder. This staffing strategy creates the chance for paramedics to be in more locations at once.
County staff decided Aug. 6 to push back the deadline of mid-August for an indeterminable time and decided that the dynamic model pitch would be put on hold. “We are going back for a total re-evaluation,” Helms said. “We heard what the people said and we are going to get this thing right.”