Dede Biles
Aiken Standard, S.C.
AIKEN COUNTY, S.C. —The Aiken County Emergency Medical Services Department is continuing to struggle to provide local residents with the assistance they require, even after a series of pay raises for employees and other efforts to correct a troubling — and potentially life-threatening — situation.
“We’re kind of at our wit’s end,” Aiken County Administrator Clay Killian said recently. “I hate to use the word crisis, but when we can’t get people the help they need, it’s not where we want to be.”
In August, there were 71 incidents of status zero and on 161 occasions, there were calls pending.
“Status zero is when every truck (ambulance) is on a call, and while they’re all tied up, we don’t get any other calls for service,” Killian said. “If we get a call for service and they’re all tied up, that call becomes a pending call.”
Since 2019, Aiken County Council has increased salaries for EMS workers by more than 30%, which includes four cost-of-living raises received by all county employees.
The county also has conducted a basic emergency medical technician (EMT) course in collaboration with the South Carolina Fire Academy while covering the costs for students.
In addition, the county has paid for its EMS workers to further their education and has tried harder and spent more money to recruit EMS employees.
In May 2021, the county’s EMS director, Chris DeLoach, reported that his department had experienced “a huge turnaround.” He said that there were only three vacancies on a staff that had more than 70 budgeted positions. The number had climbed to more than 20 in 2020.
More recently, in February and March of this year, there were no status zeroes and no pending calls.
But that good news was short-lived.
The number began creeping upward and in July there were 32 status zeroes and 49 calls pending.
As of Sept. 9, there were 13 EMS staff vacancies.
“The major issue appears to be that there is just a lack of people wanting to work in emergency medical services right now,” said County Council Chairman Gary Bunker.
Finding new employees and retaining the existing ones both are major challenges.
“You’re saving people’s lives, but it’s hard work and it’s very stressful work no matter what the pay is,” Killian said. “It’s probably going to always have some churn because of burnout. It takes special people to do what these folks do.”
According to a 2021 study conducted by the American Ambulance Association and Newton360, an EMS-based performance management software company, the voluntary and overall turnover rate was in the 20% to 30% range for emergency medical technicians (EMTs) and paramedics.
“With percentages that high, an organization is looking at replacing most of its workforce within a four-year period,” the executive summary of the study stated. “In other words, over a four-year period, there will be 100% turnover.”
Turnover has been trending upward since 2008, according to the study.
The executive summary described involuntary turnover as “relatively low.”
“They’re leaving the industry in droves,” Killian said. “We lost two that left to go to nursing school. Hospital emergency rooms are hiring paramedics because in some cases they can do more than nurses can and the hospitals don’t have to pay them as much.”
Meanwhile, Aiken County’s population is growing and that means call volumes are likely to rise.
COVID-19 also is continuing to cause staffing problems from time to time locally.
While Aiken County has arrangements with Gold Cross EMS and SouthStar EMS of Augusta, along with the nonprofit Aiken Rescue Inc., to provide supplemental ambulance service, their ability to help is limited by many of the same EMS-related issues.
“We’re doing everything we can to figure out what to do,” Killian said. “We’re trying to start another basic EMT class (in conjunction with the South Carolina Fire Academy) in October. For this class we not only are going to pay for the class, but we’re also going to put them (the students) on the county payroll.”
Killian also discussed some other steps that the county plans to take.
“We are developing a policy now and we’re going to be meeting with the PR (public relations) directors, and probably some of the CEOs, of the area hospitals to talk about how we can reduce turnaround times (how long it takes ambulances to get back on the road after delivering patients to emergency rooms),” he said.
In August, the turnaround times ranged from a low of just under 25 minutes to a high of 46 to 47 minutes on average, according to county EMS statistics.
At Doctors Hospital in Augusta, the turnaround time was the longest. It was the second-longest — “about 42 minutes,” Killian said — at Aiken Regional Medical Centers.
“That’s where we take about 50% of our patients,” Killian said.
In addition, the county plans to reach out to assisted living facilities.
“They all have transport contracts with mostly private services to do general transports, but sometimes we get a call that’s really not a 911 call,” Killian said. “We’re going to try to help better educate them on when they should call us and when they should use a regular transport service to take somebody to their doctor and not to the emergency room.”
One possible solution mentioned by Bunker was “to just flat out keep increasing pay.”
“It’s becoming a little bit of a bidding war out there,” he added.
Bunker said he also is “strongly looking at, right now, standing up ambulances number 11 and 12. We have 10 right now that were budgeted for.
“If we would buy two more ambulances, we could pull that money from the capital project sales tax (funds),” he continued. “The issue with buying ambulances now, however, is that there appear to be none or very few available to purchase because of supply chain issues.”
Another strategy would be to change the county’s 24 hours on, 48 hours off shift schedule for EMS workers.
“What is described as the gold standard is to go to 24/72, which means they would be on for 24 hours and off for 72,” Bunker said.
Killian told the Aiken Standard that 12-hour shifts also are under consideration.
Twelve-hour and 24/72 shifts, however, would create the need for more EMS employees and obviously the downside with both is that “we can’t find the people we need now. They’re not out there,” Killian said.
Bunker believes the county has enough available funds in the short term to keep increasing pay and/or hire more EMS workers because of cost underruns due to a significant number of vacancies among the budgeted positions for the county’s staff as a whole.
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