EMS contract extended as county seeks solutions to Level Zero status

A committee formed after local firefighters and residents expressed frustrations over EMS response times and service


By Jonathan Vickery
The Augusta Chronicle, Ga.

ANDERSON, S.C. — As the county and its ambulance provider continue to look at ways to improve service, Barnwell County Council granted Medshore Ambulance Service a one-year contract extension.

The extension of the $954,000 annual contract follows a year-long effort by the county's Emergency Medical Services committee to study EMS-related challenges and identify solutions. A motion to approve the extension was unanimously approved at the Feb. 11 meeting.

"We've done everything to build on our strengths and chip away at our weaknesses," said Josh Shore, general manager of Anderson-based Medshore, during a presentation at the Jan. 14 meeting.

The committee formed in January 2019 after local firefighters and residents expressed frustrations over EMS. Some residents were unhappy with response times and service. Firefighters were overwhelmed with calls to assist EMS, including assisting patients until an ambulance was available.

Medshore acknowledged there were issues, particularly with ambulances being tied up longer than in the past. This often created a "Level Zero" situation where there were no available ambulances in the county, so firefighters with first responder training would respond until an ambulance from Medshore or a neighboring community was available.

"The root cause of our problem was not having that hospital in our county," said Shore of how the closure of Southern Palmetto Hospital in 2016 greatly affected their operation.

Losing the hospital led to Medshore's average time on task increasing from an hour or hour and a half to three hours or longer because ambulance crews had to drive patients to other facilities outside of the county.

"Approximately 70% of all Barnwell County 911 EMS patients were transported to Southern Palmetto Hospital emergency department prior to the hospital's closure. The hospital closure created a significant gap in medical care within Barnwell County," states a report from the committee.

The committee quickly got to work by holding an organizational meeting Feb. 8, 2019. Committee members included City of Barnwell Fire Chief Tony Dicks, Williston Fire Chief Milton Widener, then-Blackville Fire Chief James Haskins, E-911 Dispatch Director Beverly Martin, Josh Shore, Medshore Barnwell County Operations Supervisor Phil Clarke, and medical practitioner Penny Langford.

"Those folks worked hard to educate each other," said Dicks.

After nearly a year of meeting to explore the issues and come up with solutions to improve the EMS system's performance and effectiveness for the near- and long-term.

"It was essential to identify the highest priority areas for improvement and to determine how fire and police department first responders and EMS professionals could work together to enhance emergency services for our citizens," states the report.

The four areas for key improvement in the Barnwell County EMS system are to:

  • Significantly reduce or eliminate "Level Zero" status.
  • Improve interagency relations and interoperability.
  • Improve county E-911 system infrastructure -- enhanced mapping, signage and roadway access.
  • Improve communication between emergency dispatch centers.

The community started experiencing some relief after the opening of the Bamberg-Barnwell Emergency Medical Center (BBEMC) near Denmark in April 2019.

An average of at least 100 patients are transported to the facility each month, according to data from Medshore. This has helped reduce response times and the time on task for each patient transport has returned to normal levels, according to the report.

Recent data shows Medshore had 471 calls in January that led to 338 transports, including 109 to BBEMC. The average response time was 12 minutes and 51 seconds while the average time on task was one hour
and 48 minutes.

However, the opening of BBEMC isn't a complete fix.

Medshore has added a Quick Response Vehicle (QRV) to the Barnwell County system to improve response time coverage during peak demand. The QRV is staffed with a paramedic-level responder capable of advanced life support care.

One issue that burdens EMS is how some people call 911 for non-emergency situations. However, EMS has to respond and can't turn away someone seeking help.

"This puts a lot of burden on our system," said Dicks, who believes educating the public will help.
Clarke also hopes a new community paramedic program will help reduce some unnecessary calls. The community paramedic goes into homes to provide preventative services, chronic disease management, and follow-up care for high-risk patients.

Medshore has also been working to improve relationships with fire departments and other stakeholders through improved communication and training opportunities.

As a way to thank firefighters who ride in an ambulance with patients and EMS crews, Medshore has implemented a gift card program.

"We could not operate without our local firefighters," said Medshore President Greg Shore.

During the committee's work, first responders expressed significant concerns about the county's E-911 system infrastructure, including outdated property descriptions and photos, lack of numbering on some houses, and maintenance of road signage. These issues can create problems for EMS and first responders with finding the address of someone in need.

Planning is underway to purchase Pinpoint, a next-generation 911 software, within the next 12 months, states the report.

Another issue for Medshore, as well as many other ambulance providers, is a shortage of workers.

"The only way we can cure the shortage is to grow them here ourselves," said Councilman Jerry Creech.
That's why Medshore is funding one person from each local fire department to attend an Emergency Medical Technician (EMT) program through the Fire Academy, although others can attend at a reduced cost.

The hope is to hire some of those who complete the program.

Medshore is also partnering with Jefferson Davis Academy next school year to teach an EMT class. Clarke said eight students are interested.

Another area identified by the committee was communication between emergency dispatch centers.
Barnwell County's 911 dispatchers receive the calls for help from residents and deploy resources. During medical emergencies, they work with Medshore dispatchers who monitor requests in real time and enter data into Medshore's system.

Sometimes Medshore dispatchers request additional information before EMS arrives, which can add radio traffic. Another system inefficiency is fire departments being toned out to set up a landing zone for a medical helicopter, only to have the helicopter canceled later.

Medshore has invested $5,000 for new mobile data terminals in all Barnwell County units to provide dispatchers with real-time monitoring of every unit's location. This improves deployment efficiency and reduces unnecessary radio traffic, according to the report.

They are also exploring a new instant messaging team tool to improve efficiency of communication between centers for simple, non-patient-related questions.

New procedures have also been implemented to help the helicopter issue so first responders aren't unnecessarily deployed, said Josh Shore.

While improvements have been made without any cost to the county, the committee believes there are further steps to be taken.

"Based on expert recommendations and detailed analysis, additional resources will optimize system status management and deployment for the benefit of our citizens," states the committee in its report.

To further improve the EMS system, the committee recommends five options that could help reduce or eliminate Level Zero status (in order or least costly to most costly):

  • Add one EMT during peak demand hours (8 a.m. to 5 p.m. Monday through Friday).
  • Add a 24/7 paramedic on a Quick Response Vehicle,
  • Add a 12-hour paramedic to focus on peak demand hours Monday through Saturday,
  • Add a 12-hour, 7-days-a-week paramedic ambulance focusing on peak demand hours.
  • Add a 24/7 paramedic ambulance.

The report was taken for information. No action has been taken on the above recommendations.

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