Holub says EMS is changing, but how?
The county EMS service is without a permanent director, the state hasn’t been forthcoming about pending suspensions and possible investigations, and surveys of EMS personnel indicate they are concerned about leadership.
Uncertainties abound, and it’s no surprise what commissioner Dan Holub had to say about what he’s been hearing.
“The rumor mill is just running rampant,” he said. “All these people are speaking as authorities on this, and some of them don’t have a clue.”
In a conversation Monday with Marion County Record staff, Holub tried to bring some clarity to the system’s troubling issues and future direction.
As Holub sees it, the system was cobbled together over decades from city-based units that share common county funding but continue to identify more with their home bases.
“The county needs to take the hit for that,” he said. “We were dealing with community ambulances, that thought process. Right now, we have a county-funded budget, but how many times do you hear, ‘Peabody ambulance, Marion ambulance, Tampa ambulance?’ You don’t hear ‘county ambulance in Tampa.’ The big one we need to do is to start working as a county ambulance.”
Reporting procedures and how close attendants must be to an ambulance when they’re on call are examples Holub gave of how county policies have been implemented differently across crews.
“We test them and train them on medical stuff, but we haven’t trained and tested them on county protocols,” he said. “We have to start doing that.”
Crew chiefs lack job descriptions to hold them accountable for knowing and enforcing those procedures, he said. Staff schedules are created by crew chiefs and made available to county dispatchers, but Holub said inconsistencies occur.
“There are a lot of times we call people out and there’s nobody answering,” he said, “so they dispatch one from another area. Then the one that was originally dispatched calls up and says they’re on their way and to send the other one back. Now we have two ambulances running around.”
The state EMS board has been scrutinizing the service since at least last summer when it disciplined former director Brandy McCarty for doing procedures beyond what she was certified to do.
Holub confirmed two more EMS crew members are awaiting formal notification of 90-day suspensions but said the state hasn’t notified commissioners of other infractions or a possible investigation of the service as a whole.
“Nobody’s ever communicated with the commission other than to let us know Brandy was being investigated,” he said. “The grapevine was giving me more information than I was getting officially from the state.”
At Monday’s commission meeting, consultant Terry David suggested the state board could discuss Marion County at its February meeting, and recommended commissioners attend to avoid a tendency for the board, as he put it, to “nail somebody to the cross.”
If the board was to take action against the county, it could include decertifying advanced life support transfers by EMS, forcing the county to rely on out-of-county providers for that service.
“We need to get this ironed out because I don’t want to lose our ambulance service,” Holub said. “I think if there was something serious pending that they’d be talking to us. If there were heated discussions already there would be lots of people down here.”
Commissioners still haven’t decided whether they will reinstate fired paramedic Larry Larsen to the Peabody crew. Holub said they were waiting on guidance from their attorney.
Who and where?
Interim EMS director Ed Debesis gives the service experienced, albeit temporary, leadership as commissioners work with David to change the future of EMS.
What that will entail hasn’t been determined, but Holub said change was long overdue.
“We ended up being behind the times,” Holub said. “That’s what Terry David and everybody is pointing out to us.”
It appears from comments in recent meetings that commissioners are resigned to the fact that the so-called volunteer EMS crew system can’t continue, although Holub balks at the use of the word “volunteer.” EMTs are paid to be on call and for runs; they get county checks, Holub said, and they’re really employees.
Nonetheless, when he talks about the possibility of hiring full-time personnel for EMS, Holub slips back into the familiar.
“We’re going to have to look at that because of the shortage of volunteers,” he said. “There are 60-some people who are qualified, but nowhere near that are working. A lot of them are young; they have kids in school; they have jobs. It’s not that they don’t want to; they just don’t have the time.”
One possibility would be to hire some full-time paramedics who could respond throughout the county and supplement with volunteers.
However, competition is fierce for paramedics, Holub said, and finding even two to cover weekdays would be hard.
“They’re not really interested in Marion, or Peabody, or Hillsboro, unless they’re from here or want to be here,” Holub said. “They’re going to Johnson County, Sedgwick County, places like that where the big bucks are.”
The cost of providing service in various areas of the county could affect not only who gets hired but also how many ambulances are needed and where they would be placed.
David has drawn attention to the relatively high cost of maintaining an ambulance and crew in Tampa, for example. Financial considerations could influence decisions about how many ambulances the county needs and can support, and where they would be housed.
Holub, who represents the northern part of the county, said his position was that services shouldn’t be cut back in Tampa.
“It’s come up several times that it’s a lot of money for the number of calls they make,” he said. “I was trying to make sure they weren’t talking about just yanking it all out of there and everybody would come out of Marion or Hillsboro.”
Holub said David haf shifted the conversation to focus on patients receiving immediate, stabilizing care from qualified first responders. Under that scenario, the timing of the arrival of an ambulance isn’t as critical, he said.
Revisions to the job description for a permanent EMS director are nearly complete, and Holub said the county hoped to advertise the opening next week.
As for other changes?
“We’re not at that point,” Holub said. “We’re still looking, interviewing people, seeing what works and what doesn’t. We’re still going to the books.”
David’s advice is essential to developing a full range of options, Holub said.
“That’s what we’re paying him to do, but it’s our decision,” he said. “We’re going to have to pick an option or come up with something different. But every possibility, everything is on the table. You might as well have it all out there.”