LYNN - The Winston County Firefighters Association voted in favor of Arley, Helicon and Addison fire departments continuing their efforts to bring an additional ambulance service into their communities at its monthly meeting at the Lynn Volunteer Fire Department on Jan. 31.
The association initially voted to present a letter to Regional Paramedical Services (RPS) stating what it needs from the ambulance service and then give RPS 30 days to respond before taking further action. However, RPS Director of Operations Robin Earley, after hearing the letter read aloud, told the association there and then that RPS would not be able to meet those needs.
Earlier in the meeting, RPS Operations Manager Tim Brown had addressed the association on the scope of practice of advanced EMTs, stating that he wanted to clarify that it is not true that advanced EMTs can’t do anything for patients, which he believed to be the gist of a comment made by Addison Police Chief Brett Rodgers at the January Addison Town Council meeting and quoted in the Alabamian.
Rodgers had actually said, “If you’re having a heart attack and you get an advanced (EMT) there, you’re still no better off, because that advanced EMT cannot push drugs on you. They can’t give you nothing. If it’s a major medical, they can’t do nothing.”
At the firefighters association meeting, Brown said that advanced EMTs can start IVs, use CPAP and BiPAP devices, acquire and transmit 12-lead EKGs, place blind insertion airway devices and administer saline, acetaminophen, aspirin, nitroglycerin, diphenhydramine (aka Benadryl), antibiotics, dextrose, glucose and medicines for asthma, croup, bronchial spasms, nausea, seizures, hemorrhages, anaphylaxis, pain, overdoses and even Epi 1:10,000 for cardiac arrest.
According to the EMT and Paramedic Medication Formularies, which state the drugs each practitioner can administer, an advanced EMT can administer 26 medications while a paramedic can administer 47. The formularies may be viewed on www.alabamapublichealth.gov/ems/equipment.html.
“RPS is part of a pilot program for the state where (advanced EMTs) can actually monitor a full-ream EKG for any changes and call for an upgrade,” Brown added. “I wanted to make sure everybody in here knew that if you got an advanced, they can take care of a patient.”
Rodgers does not disagree. He reached out to clarify his earlier comments. “There is so much that basic and advanced EMTs can do, and we need them both. I appreciate everything they do,” he said. “It’s just that there are certain medications that a paramedic can administer than an EMT cannot.”
Later, Helicon Fire Chief Neil Feist rebutted RPS’s statement, recently reported in the Alabamian, that its average response time to Helicon is 25 minutes. Actually, Chief Operations Officer Eric Pendley told the Alabamian that the average response time for calls during the last quarter of 2022 was 23 minutes in Helicon and 25 minutes in Addison and Arley. He also said these averages were “pretty consistent” all the time.
“There’s no way the average response time to Helicon is 25 minutes,” Feist said. “Just the other day we had a V-tach with a pulse and the ambulance took 56 minutes to get there. Helicopter was on the ground before the ambulance got there. If the weather had been bad or one of my paramedics hadn't been there, we would have been calling for the coroner, right? Does that sound accurate?” He directed the question to one of his firefighters.
“Potentially,” she replied.
“The rest of y'all get good response times,” Feist continued. “Sometimes you probably get a medic; sometimes you don't. And I'm not saying advanced aren’t qualified to do what they need to do. But we need to do something on the east side of the county about response times. And that's why the towns invited those ambulances to come in.”
The Addison and Arley Town Councils voted to do that in their January meetings. The Addison Town Council also extended the same invitation to base an ambulance in its town to RPS.
The association voted to go into an executive session at 7:06 p.m. to discuss what it wanted RPS to do and within what timeframe. President Cody Wakefield stated that he would participate in the session but not preside over it because he had a conflict of interest as an RPS employee. The regular meeting resumed at 7:51 p.m., and Vice President Ashley Tucker announced that the association had prepared a letter for RPS and then read it aloud.
The letter stated, in part, that the association was “providing the upper management at RPS with this list of grievances. We would like to see a resolution of these conflicts within the next 30 days or by the next firefighters association meeting,” which is Feb. 28. It then listed the following needs it wanted RPS to meet: “20-30 minute ETA response to all Winston County calls. All times will be provided by Winston County 911. Three ALS (Advanced Life Support) trucks in the county with two paramedics on all shifts, one ALS paramedic truck on the east side of the county and GPS accountability with Winston County 911 for all Winston County trucks.”
Tucker said, “We’ll give this to ya’ll and see if ya’ll can help fix this.”
Secretary-Treasurer Tammy Williamson said, “I guess the question is are you willing to try to work this out?”
“Please don't think that I'm being ugly when I say this, and it's going to come across very ugly,” replied Earley. “Or what?”
She then asked, if RPS couldn’t meet the stated needs, whether Winston County would start operating its own service or be willing to pay a subsidy to cover the costs of its requests.
“I don't know if anybody really knows (the status of) EMS right now in the state of Alabama, but we are in a massive shortage, nationally,” she continued. “You can request this, and you can want this, but if it doesn't pay and if it doesn't staff . . . It’s our career too. It's our income as well. Someone has to pay for it. The transports has to be paid for. The east side of the county has 1.5 transports a day. We need eight transports a day to pay for a 24-hour truck, and that's if the bill pays $400 a run.”
She acknowledged that long response times are an issue on the east side of Winston County and noted that Crane Hill has addressed this problem by hiring its own medics. She said it pays them out of its fire dues to be on duty 24/7 so they can care for patients until a Cullman EMS ambulance arrives.
She said that RPS has been “trying to fix the problem” by allowing ambulances staffed with advanced EMTs or even BLS-E ambulances “to work as lead” on calls “because if we had to have a medic on every truck in Winston County, y'all would have one truck a day for the whole county. So, in order to offset that, advanced (EMTs) can run a full arrest all by themselves for 50 minutes, all the way to the hospital now, because our scope of practice is so big, almost to the point (where) you don't even need a (para)medic. Because there's only a few more things that a paramedic can do that an advanced can't do.”
Earley continued by asking who would pay for the GPS system and extra ambulances the association had requested. “Now, if the county, the fire association (or) that side of the county is willing to talk about a subsidy and offset our loss of having a truck sitting on that side of the county doing nothing, then we are more than willing to look into that.”
She said that the best option, though, was for one of the fire departments in that area to “invest your money into a transport system” and staff it.
“I wish there was a good solution for this,” she added, “but there's not a solution until somebody pays for something, whether you pay a private service or you pay yourself. But I'm more than willing to take that (letter) back (to RPS) and bring back exactly what I just said next month.”
“So, to answer your question,” Feist replied, “I don't think there is a ‘or what.’ We’re asking for that. That's it. So when you come back next month, if it's the same thing you said . . .”
“We’ll look at other options,” Williamson finished.
“What’s written in this letter is what the other company agreed to,” Fire Chief James Rickett pointed out.
“Who is the other company?” Earley asked. She went on to say that, if it’s Gregg’s Ambulance Service, RPS had been told by Gregg’s that it has not confirmed it would be willing to operate in Winston County.
“If Greg was to come into Addison and that side of the county,” she continued, “we would not have a problem with it. If they can do better than we can, that’s what they need. Because I'm in Arley every day. I’m in Helicon every day. And it could be me. So, if Greg can be in that side of the county and do a better job, they are welcome to come in. There's no fight with it.”
“That’s all we want,” Rickett said, adding, “Nobody gets a dime out of this. We do this to take care of our people. We just want somebody that’s getting paid to come over there and help us take care of our folks.”
“Somebody who’s getting paid,” Earley repeated. “Who’s paying them? Whether it's Greg or it's RPS, (the company) is providing a service for your community for free. So, they bill your insurance. The community, the fire department, the fire association is not paying for us to be here. So, we are actually providing a service for the county for free.”
“I don’t know about that,” Rickett said.
“If you have no health insurance, and I have to take you to Birmingham, who’s paying me?” Earley asked.
“Write it off,” Rickett responded. “I'm not worried about who's paying what. I just want an ambulance over there to take care of our folks.”
“Well, you’re just saying that they’re doing it for free. I'm telling you, it could be me, too. But I also know what it takes to run a business,” Earley said. “We're in the business of taking care of patients, but we also can't do it for free. When Narcan is $42 a box for us for two milligrams, we can't do it for free.”
She went on to say, “We quit running calls in Hoover, because they could transport, so we could move our units out and cover other areas. If we were after the finances of it, we would have stayed in Hoover and not covered Winston County. Right? Because we're gonna make a heck of a lot more money in Hoover than Winston County. But we're not about that. We’re about patient care, and we are doing everything that we can to cover Winston County.”
“Part of patient care is speed,” Rickett pointed out. “And that (is) something that we can’t do anything about.”
Earley asked him if Arley Fire Department is an ALS department and he said it is not.
She told him that his department could do much more for patients if it were an ALS department.
“The majority of my guys are in (their) 60s and 70s and 80s. None of them are gonna go to school to learn how to do that,” Rickett said. “There’s not enough to do that. We can't get young guys to come in here and do none of this stuff.”
Tucker then asked Earley if the Crane Hill paramedics have to travel to the hospital in the Cullman EMS ambulance once it arrives.
She acknowledged that they do if the paramedic has “exceeded the advanced (EMT’s) scope of practice” and there is no paramedic on the ambulance. She added that the fire departments are informed whether RPS is sending an advanced EMT or paramedic to the scene, remarking, “And if you don't want to ride in, then don't do anything out of that advanced (EMT’s) scope of practice.”
“How do we know that?” Feist asked, and there was general agreement that the fire departments are not given this information.
“Then we can fix that because that's a breakdown between our dispatch and 911,” Earley said.
Tucker returned to the earlier topic, noting that if a paramedic on the call Feist referenced earlier had not exceeded the scope of practice of an advanced EMT, her patient might have died.
“But if you're all about patient care and that patient needs a medic level supply, then couldn’t you just ride on in because what you're doing is best for your patient?” Earley replied.
Helicon Assistant Fire Chief Greg Ackley said he didn’t want to have to ride in on every call, and Earley pointed out that not every call requires a paramedic’s level of treatment.
Helicon firefighter Christopher Hood said that out of 133 calls, 64 had required ALS, and Ackley clarified that of those that needed ALS, maybe ten percent had needed a paramedic, most likely because fentanyl was administered.
While it is mostly known to the public as a street drug, fentanyl is used in medical settings as a pain medication.
Earley said that instead of giving fentanyl Ackley could give Toradol without exceeding an advanced EMT’s scope of practice.
“You can’t give Toradol to somebody that’s actively bleeding. You can’t give Toradol if they're over the age of 70, which is a lot of your elderly,” Ackley pointed out.
“Then you need to give fentanyl when your patient needs it,” Earley said.
Ackley reiterated that he didn’t want to have to ride in.
“Is that was this is about?” Earley asked. “Is (it) that Helicon’s ALS now and the medics don’t want to ride in?”
“No!” Feist said. “It’s about 56-minute response times. That’s what it's about.”
Earley said, “Hey, your average response time is 25.”
Feist said that was not true.
Ackely said, “You can’t even drive from Double Springs to Helicon in 25 minutes if you're going 100 miles an hour.”
“I understand, and I am telling ya’ll we are doing the best that we can,” Earley said. “I can fight with ya’ll all night long but it’s not gonna change anything.”
“We don’t want to fight,” Feist said. “That’s why we wrote the letter. So, we're gonna give you the letter and—we're not accomplishing anything here by arguing.”
“I know, and I'm telling y’all we are doing the best that we can. I just said if another service wants to come into the east side of the county and cover that, that's fantastic because I'm going to be over there. You could be running on me, so I am fine with that,” Earley said. “We have no beef with it, but if the expectation is for us to meet all of this, this is what we have to have as well. It's a give-give. I can't put GPSes on all the trucks and have it hooked up to the 911 system and everybody have access to where our units are without money.”
“Can you fix your response time?” Feist asked.
“How would we do that?” Earley replied.
“OK,” Feist said. “Then that's a no.”
Earley pointed out that “part of the problem in Winston County is because (the ambulance) doesn't stay in Winston County. The transports go outside the county, which takes longer to get the trucks back into the county.”
“I make a motion that we allow the east side to continue on with finding their other coverage. We just need to move on with it. She’s already said that (she) can take this (letter), but what you're asking for, she can't provide,” said Lynn Fire Chief Derreck Cagle. “There's no contract for one single service in this town. So, we will go from there. So, that's my motion. We allow the east side to follow up with their ambulance service and move into there.”
“So, now we’re east side and west side,” Feist said.
Cagle said he was not suggesting a split in the county but acknowledging that the departments on the east side need a solution.
“Bottom line is two ambulance services are not going to survive in Winston County,” Feist said. “One’s going to go away at some point.”
“I agree, and we’ll have to let those ambulance services battle it out,” Cagle replied.
“If another service comes in and does cover Arley and Helicon, then that’s fantastic,” Earley said, “Because you've got your own ambulance (…) then the trucks that we have are covering the rest of the county.”
When discussion had concluded, Wakefield called the vote and the motion passed with none opposed.
Later in the meeting, Birmingham Regional EMS System (BREMSS) Executive Director Michael Minor offered a final comment on ambulance service in Winston County. “This issue of ambulance response times and ambulance service issues is all over the state; it's all over the nation,” Minor said. “But there has to be local solutions. I would just advise ya’ll to work on a local solution. That will get you the best you can get with what you got to work with.”
See complete story in the Northwest Alabamian.
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