EMS Agencies Face Host of Challenges

Sept. 07--With a number of changes on the horizon in emergency medicine, companies are bound to run into some challenges that can make those switches more difficult.

In fact, the constant changes being made in the field pose some of the biggest challenges right now, said Nathan Harig, the assistant chief of Cumberland Goodwill EMS in Carlisle. Every time a change is made to any part of the job, it has to be implemented and then taught to personnel. Then the EMTs and paramedics have to put that change into their routines and remember to follow the regulation.

Because the field is constantly changing, the entire staff is almost always being re-educated and new equipment is being purchased, and that can get expensive -- which poses yet another problem for the EMS companies.

Sharon Boyles, an EMT at Shippensburg Area EMS, said when it comes to technology, new protocols and new staff members are great, but also expensive.

"All of this new technology is great, but it's very expensive," she said. "The first thing is you've got to pay for it. You want to put it on your trucks to help the public, but it is very expensive. And then the next thing is you've got to train all of your people on it. And a lot of people still are volunteers, which means you have to take your time to go to training to learn how to operate the new equipment."

Although being a nonprofit helps to reduce costs with tax-exempt statuses and keeps the company invested in its community, expenses almost always outpace revenue for services, Harig said.

Paul Christophel, the executive director for West Shore EMS, said finding staff and then keeping them is a challenge they face regularly. The number of applicants for EMT or paramedic positions is not growing at the same rate as the number of calls coming in, so they are constantly looking for new people to join the company.

"It's kind of tough finding somebody that can meet all of the requirements," Christophel said. "The people that you find like that, they love it and that's their niche. It's just there's a lot more competition for those folks."

Staffing

Finding and keeping staff has and always will be an issue for ambulance companies. There are a number of reasons that staff members choose to leave the field, but one of the biggest is that there isn't much of a career ladder, especially in the Midstate, said Robert Pine, the chief of Cumberland Goodwill EMS.

"We struggle as an industry to bring in and keep good quality providers," he said. "It's not like nursing where you can go in and (move up the ladder)."

At Cumberland Goodwill, it costs about $5,000 to bring in a new staff member, between training them and getting them to the point where they can either work by themselves or with a partner, depending on what their job is going to be. Harig said the issue is people need to sort out the difference between their expectations and the reality of the job.

A lot of people come into emergency medicine thinking it's a lot like a television program's depiction of a New York City ambulance company, but that's not what they're going to get in Carlisle or the rest of the Midstate, really.

Harig said it doesn't turn out to be the job that people think it is when they start out and they get bored and don't want to do the required paperwork, so they leave the field and become a doctor or nurse or they go to a bigger city.

"The curriculum doesn't really jive with what they're actually encountering on the field," he said. "Whenever you see a recruitment video for EMS it's always lights, sirens, action, blood, guts. But what we actually do is we care, we hold granny's hand, ferrying them back and forth to appointments, we have the fall victim that we're trying to figure out a better living situation for them. There's that disconnect that you go into it and you're like, 'This is not what I was presented with.'"

The West Shore also has the same kind of issues keeping their staff members. If someone is not from the Midstate and doesn't plan to stay here, they likely aren't going to be drawn in by their work with emergency medicine in the area. Christophel said getting new people interested in the field has been a challenge.

In Shippensburg, there are a number of volunteer EMTs, which is a whole different issue, because it's hard to keep staff when they aren't getting paid, Boyles said.

But, because being an EMT requires a lot of training and is a large time commitment that is getting bigger each time more technology comes out, it's becoming impossible to sustain a volunteer organization.

Call volume

In recent years, West Shore EMS has seen an increase in calls from patients in a higher age range than before. Because people are living longer, the calls are getting more frequent and complex as more disorders and diseases are diagnosed. Also, as people live longer, they develop numerous conditions, so it's harder to treat than if they just have one disease.

In 1985-1990, the average age of a patient was 60-65. Now, West Shore reports 81-90 years as the age range with the highest volume of patients.

Boyles and Christophel said while they have seen more heroin overdoses, they haven't noticed an increase in the total number of overdoses in their coverage area.

Harig said the Carlisle area has also seen an increase in heroin overdoses in recent years, but mostly in more rural areas. Harig said the studies are showing that once a person is out of their prescriptions, they will turn to heroin.

Boyles said with Shippensburg University in town, on weekends there is always some sort of call about alcohol or drugs, but that most of the time it's not students but rather their visitors. She said heroin is the popular drug now because it's cheap, but that will probably change to something else soon.

"Since we're a college town, I think that's remained pretty steady over the years. I don't think that's had a big change," Boyles said. "We've had them before and we still have them. Heroin overdoses are up. A couple of years ago it was a different drug, a couple years before that it was a different drug. Overdoses have remained pretty steady -- it's just that the drug of choice has changed."

Christophel said having police officers carry Narcan is one of the ways the system has chosen to combat the heroin overdoses, but it's only a safety net. Harig said Narcan isn't always the answer if someone has overdosed, because if the heroin is laced with something, it won't work, and someone still needs to breathe for the patient until they wake up.

"The problem is, people have billed it as a miracle drug and it's not," Harig said. "It's a good drug. There's a lot of chance for (withdrawal or vomit). They both can potentially be violent."

Calls for psychiatric patients are more frequent, but it's difficult for everyone to handle those calls since there aren't a lot of beds for those kinds of patients, Harig said. They're also seeing calls for everything from trouble breathing to someone being afraid of the dark.

Calls for bariatric patients have also increased recently, which is due to the increasing amount of obese people, Harig said. The bariatric truck is designed especially for patients that weigh more than 350 pounds and has a ramp, a winch and a special stretcher. That truck goes out at least twice each week, Harig said.

Funding

Funding itself can be broken down into a couple of issues, since there are a handful of ways companies make their money.

First, since Shippensburg, Cumberland Goodwill and West Shore EMS are all nonprofits, they can apply for grants. They can also accept tax-exempt donations and are tax-exempt themselves. There is also the collection of reimbursements for services from insurance, Medicare and Medicaid.

Christophel said they can also do something to supplement their income, such as offering non-emergency transports, which can bring in a bit of extra money and help balance the budget.

The companies in the county also have membership fees for the residents in their "first due" area, allowing families to pay a flat price each year so all family members are covered if someone has an emergency and needs to be transported to the hospital.

In all emergeny cases when 911 is called, an ambulance is sent and that patient can refuse to be transported to the hospital. If the patient refuses, that ambulance company doesn't get compensated by insurance, Medicaid or Medicare.

"They view us as a transportation benefit on all calls except one, which is a cardiac arrest, which we get paid if we don't transport because they are deceased," Harig said. "That's how our external stakeholders view us."

"The only way that we are ever going to be able to be there for the people who need to go, is to be paid for everybody we go out to get," Pine added. "When somebody gets their bill for the ambulance service ... you didn't pay for the trip, you paid for somebody to be available for that trip, which is a steeper price. We don't know when that pager is going to go off, so we're paying people to sit here to be ready to respond, we're paying to have those resources to be ready to respond."

Copyright 2014 - The Sentinel, Carlisle, Pa.