York County Council set to end dual dispatch of ambulances

jzou@heraldonline.comOctober 5, 2013 

Piedmont Medical Center EMS Director Steve Cotter with monitors for the MARVLIS system at EMS headquarters in Rock Hill.

ANDY BURRISS — aburriss@heraldonline.com

  • Average Response Times By Fire Districts

    Below are the average response times in minutes by the Piedmont Medical Center EMS system to various York County communities. The first chart shows response times to fire districts in York County from Sept. 1, 2012, to Sept. 30, 2013. The numbers were calculated by the York County Department of Public Safety Communications.

    The second chart shows response to areas of the county identified in PMC’s contract with York County. The numbers, from June 2012 to May 2013, are provided by PMC.

    York County fire districts

    Bethany 16:05

    Bethel 11:08

    Bethesda 13:15

    Bullocks Creek 16:10

    Clover 10:09

    Flint Hill 8:58

    Fort Mill 9:07

    Hickory Grove 16:52

    Lesslie 11:46

    McConnells 17:47

    Newport 10:06

    Oakdale 17:32

    Sharon 13:54

    Smyrna 16:09

    Riverview 8:07

    Tega Cay 9:27

    York 9:05

    Rock Hill 8:03

    Note: Some of these averages may change after the Department of Public Safety Communications reviews some individual calls.

    York County communities

    Eastern York County 6:53

    Clover/Lake Wylie 8:22

    City of York 5:56

    Western York County 9:13

— After years of ambulances racing on calls and months of negotiations, the York County Council is preparing to end highway competition for healthcare dollars among the county’s emergency medical services.

Under the current system, residents in some northern areas of the county who call 911 for a medical emergency may have to choose between two ambulances at their front door. One may be from Piedmont Medical Center and the other from either the Fort Mill or River Hills rescue squads.

The practice, known as “dual dispatch,” has drawn concern not just from county officials who point to competing ambulances barreling down roads, but also from the state’s health department, which prodded the county for a resolution.

The county has long had a contract with Piedmont Medical Center to provide EMS service to all areas. But until now, no formal agreement has existed between the county and the rescue squads.

PMC’s ambulance service and the squads operate at no cost to the county, footing bills on everything from insurance to software and equipment.

Over the last several months, council members have worked closely with rescue squad volunteers, PMC, and county entities to hash out an agreement that ends dual dispatch. The agreement also heightens countywide standards for ambulance response times. In some areas, EMS response times exceed 17 minutes.

The council will consider initial approval of a contract with the rescue squads, as well as changes to PMC’s contract, on Monday. The meeting will be held at 6 p.m. in the county’s agricultural building in York.

Historical Differences

Competition between non-profit EMS and for-profit PMC ambulances came to a head in the mid-to-late 2000’s, said Gary Loflin, director of the county’s Department of Public Safety Communications.

In 1995, the county agreed to the dual dispatch system, which allowed for emergency calls to be sent to both PMC’s system and the rescue squads. The intent was to coordinate responses during a time when the services cooperated with each other and shared resources.

But the relationship deteriorated and gave way to an “adversarial” tone and “he/she said” accusations as PMC ramped up the number of its ambulances and volunteer agencies struggled to keep up, Loflin said.

“There was a day years ago that we had that trust in place,” he said. “That trust has diminished.”

He added, though, that all EMS staff, regardless of affiliation, have put patients first. “There’s not a paramedic on the road that cares about the dollars,” said Loflin, whose office handles countywide dispatch for fire, police and EMS.

His staff of 31 dispatchers is counting down the days to the end of the practice. “It doesn’t make sense,” Loflin said. “If we could eliminate dual dispatch, we could have a system that’s second to none.”

Under the new arrangement, the county will use newly installed geolocating software to send only the nearest ambulance to an emergency – reducing steps and resources.

The MARVLIS system, implemented in May, takes the guesswork out of dispatching by pinpointing ambulance locations, calculating drive times, and using data to constantly predict areas that may have a large volume of calls. PMC purchased the software in 2011 and uses it to position the hospital’s units countywide.

Heightening Response

Dueling ambulances have become less of an issue as the number of rescue squads in the county have dwindled from five to two, leaving competition mostly in the urbanized Fort Mill and River Hills areas.

For council member Joe Cox, who chairs the committee drafting the rescue squads’ contract, the main issue hasn’t been racing ambulances, but slow response times in rural areas.

“The response times in my district are appalling,” said Cox, who represents the mostly rural areas of western York County. “This is a countywide contract.”

The proposed contract calls for a tiered response where calls are prioritized into three categories: “life-threatening,” “emergent but not life-threatening,” and “non-emergent.”

Currently, response times are measured by geography. PMC’s contract calls for its ambulance to respond within 12 to 20 minutes, depending on whether an area is urban or rural.

PMC staffs 14 ambulances countywide, based on population. River Hills/Lake Wylie EMS operates one of two ambulances at a time and Fort Mill rescue squad operates two.

Under the proposed standards for both PMC and the rescue squads, ambulances will arrive on scene within 10 minutes of a “life-threatening” condition such as cardiac arrest whereas less urgent events such as high blood pressure are given a 15-minute window. All other calls, such as an elderly person who has fallen, would be answered within 20 minutes.

The standards would apply to all areas of the county.

The contract mandates that ambulances also be en route within a minute of all calls. Providers are expected to meet the specified times for at least 90 percent of the time after the first year of the contract or face punitive measures.

But giving EMS some leeway on response times is troublesome for some residents.

When Jessica Elliott, 31, awoke on an August morning to sharp pains, the family immediately called 911. Elliott, who was seven months pregnant at the time, had been suffering from high blood pressure the week before.

She sat bleeding on the floor of her bathroom for 23 minutes before a PMC ambulance arrived at her McConnell’s home.

“It’s a miracle she didn’t bleed out on us,” said Sandra Branch, Elliott’s mother. Branch said the situation worsened when the ambulance got stuck in the mud trying to back out of the family’s driveway.

The family then waited an additional 46 minutes for a back-up ambulance to take Elliott to Carolinas Medical Center in Pineville, N.C.

PMC spokesperson Amy Faulkenberry said the hospital doesn’t comment on specific cases because of privacy laws, but cited the hospital’s improvement.

“We are substantially above performance requirements per the contract” the hospital currently has with the county, Faulkenberry wrote in an email. “We are providing a valuable service at no cost to taxpayers and doing it in such a way that has demonstrated constant improvement.”

EMS director Steve Cotter also noted that response time is a subjective metric where no accepted national guideline exists.

Ongoing Friction

While the current contract has been tied up in discussions for seven months, the county began talks with volunteers in 2011. By 2012, the state health department sent letters to EMS groups after the bickering agencies filed complaints about one another.

Later that year, negotiations broke down when the county floated a plan for PMC to dispatch all ambulances on the county’s behalf. That idea was scrapped, but concerns over control have continued to color the conversation.

“The county has, to a large degree, abdicated management of the EMS system to providers,” said Leo Yakutis, vice president of River Hills/Lake Wylie EMS. “We want the most aggressive, reasonable standards possible.”

Concerns over whether standards apply equally to EMS volunteers and PMC have been raised by all parties, causing friction over the simplest revision.

Negotiations for the volunteer contract have been open to the public, whereas talks over PMC’s updated contract have taken place behind closed doors.

Councilman Bruce Henderson has been a vocal advocate of the squads. “You can’t help but be skeptical of who’s going to be snuffed out,” he said after squads relayed concerns over independence.

Henderson said it was important the council avoid politicizing a life and death issue.

The Decline of the Rescue Squad

Since contractual discussions opened up in 2011, the county’s landscape of volunteer EMS providers has seen a decline.

Of the five EMS squads covered by the contract, only two remain: River Hills and Fort Mill. The others – York, Hickory Grove, and Clover – are no longer active, but can opt to resume service under the new agreement.

Hickory Grove’s rescue squad cited increased competition from PMC as a reason for ending EMS services in early 2012. Last September, York Rescue Squad eliminated paid medical responders, shuttering its operations.

The non-profit squads rely on a combination of donations and transport fees to pay for insurance, equipment, volunteer training, and paid staff. “EMS is a business,” said Yakutis. “Even as a non-profit.”

David Clay, PMC’s chief operating officer, said the hospital has been “contractually bound” to respond to all calls. Unlike the squads, which cover small areas, PMC must proactively stage, or position, its trucks, to deliver service countywide.

Fort Mill rescue squad member and attorney Brian Murphy said his group has continued to coordinate with River Hills for a contract that isn’t just fair for them, but also continues to improve the quality of service for all residents.

“The goals of Fort Mill rescue and River Hills rescue are the same,” he said. “We’re the only rescue squads left to fight.”

To Stage or Not to Stage

The strategic placement of ambulances, or staging, is one issue the county hasn’t been willing to touch.

Previous drafts of the rescue squad contract called for the county to take a stake in positioning ambulances. But in the current contract, all references to staging have been removed. During a meeting councilman Joe Cox explained the county has no authority to say where privately-owned trucks at positioned.

The choice to omit staging struck Murphy with the Fort Mill rescue squad as odd because PMC and volunteer agencies have butted heads over vehicle positioning in the past.

“Our organization has had historical difficulties, who’s to say that’s not going to happen again?” said Murphy. “There’s no coordinated response.”

Yakutis said River Hills privately met with PMC to voluntarily stage their respective ambulances far enough from each other to decrease the chances of racing. In two months since they met, Yakutis said the squad has shaved off a minute in response.

Yakutis said PMC, under new CEO Bill Masterton, has made “extraordinary efforts.”

“We’re hoping the contract formalizes this relationship,” he said.

While the county will not play a role in staging under the proposed contract, it will lead an advisory committee comprised of EMS representatives.

County attorney Michael Kendree, who drafted the contract, reminded the parties that the committee “has no teeth,” but is a way to provide “avenues for comment.”

For Loflin and Clay, response times and elimination of dual dispatch are enough to avoid staging conflicts. Though, both conceded that no system is perfect.

“There are going to be those days when you’re going to run out,” Loflin said of the county’s ambulances during peak times. “Those days cannot be completely avoided.”

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