S.C. county residents worry over ambulance response times as communities grow
Members of the Lexington County Ambulance Response Solutions group encourage residents to work on improving EMS
By Bristow Marchant
LEXINGTON COUNTY, S.C. — Marilyn Baatz had ridden in the back of an ambulance hundreds of times, but never as a patient. Not until the day she died.
The 83-year-old retiree and former volunteer first responder officially died from septic shock in October 2022, but her son Mark blames a different culprit: the nearly two hours his mother waited between when an ambulance was called and when it showed up to their Chapin home.
“I’ll always blame Lexington County,” Mark Baatz told The State, arguing the delay in the ambulance’s arrival could have caused his mother’s condition to worsen before she received treatment.
The son’s complaint resonates with many Chapin -area residents, who have organized meetings in recent months to share stories about what they say are lengthy ambulance response times in the area north of Lake Murray. They’ve pushed for more information from Lexington County EMS about why so many seem to run into the same problem when they ask for lifesaving help.
For their part, county officials say they have taken steps to improve responses to increased demand in a quickly growing part of the state. The efforts have included raising pay for EMTs and paramedics and training firefighters to become EMTs.
“It’s not just this area; the whole Southeast as a whole has just exploded,” said Charli Wessinger, the Lexington County Council member for the Chapin area. She cites a statistic from the town of Chapin that the 29036 ZIP code has grown by 33% in the past decade.
“If you scheduled a doctor’s appointment with a specialty doctor, it’s months out,” she said. “Our medical facilities can’t keep up with it, our doctor’s offices can’t keep up with it. Everything is under pressure from the intense amount of growth.”
In recent years, the Chapin area and the north shore of Lake Murray have seen explosive growth. New housing developments have gone up on what was once farmland. Many of the houses are retirement homes for older people who enjoy the leisurely pace of life but who can also have health problems that may lead to calls for emergency help.
That was the case for Cam and Marty Koblish. The couple split their time between South Carolina and Cape Cod, Massachusetts, and they spend the winter months at their home in the Timberlake area near the lake, close to their daughter.
Just before Christmas 2022, husband Cam woke up early one morning with chest pains. Wife Marty, a retired cardiac care nurse, checked his vitals with an app on her phone while the couple waited for an ambulance to arrive.
“We’re used to them coming within seven to 10 minutes,” Marty Koblish said. “It was a good 30 minutes before they showed up.”
Cam went to the hospital and was released within hours. The Koblishes moved on from the health scare, until a month later, when it happened again.
This time, Cam woke up feeling dizzy with “very low” blood pressure, his wife said.
“He said, ‘I think I’m going to pass out,’” Marty Koblish remembers. “We’re waiting 45 minutes for an ambulance. I called them twice. The fire company came first, but they couldn’t do any more than I could do. They couldn’t transport him.”
By the time the ambulance finally arrived, “I just wanted him on the rig and out of here,” Koblish said.
Later that spring, Cam Koblish again felt unwell one afternoon, and an EKG on Marty’s phone detected an atrial fibrillation, or irregular heartbeat. This time, she didn’t wait. She bundled her husband into the car and drove him to an Urgent Care in Chapin. They thought that would be the best place to get Cam much needed attention, but instead they ended up waiting longer after the doctor there called for an ambulance.
“They called for an ambulance about quarter to 5, and we ended up waiting until 6:30,” Marty Koblish said. “I was absolutely floored that in such an emergency we waited an hour and a half... when a doctor called from an Urgent Care.”
When the ambulance finally arrived, it wasn’t Lexington County EMS, but MedTrust, a private medical service the county contracts with to respond to less acute calls. Cam Koblish ended up spending the next four days in the hospital, and his doctors inserted a cardiac catheter and two stints.
“This was not an unserious call,” Marty Koblish said. “It was a potentially life-threatening situation.”
She credits the staff at the Urgent Care for staying after closing time to treat Cam, monitoring his vitals, starting an IV and giving him medication as they waited for the ambulance to arrive.
“My level of anxiety increased,” Cam Koblish said. “I felt sorry for the staff that was stuck there.” The Urgent Care staff called county dispatch more than once to check on the progress of the ambulance, but were told the time of day meant roads in the area were congested, Koblish said. Lexington Medical Center, which operates the Urgent Care in Chapin, said the health care system does not comment on the details of a patient’s care.
The couple said that at their “remote” Cape Cod home, similar calls led to a response in five to eight minutes from the ambulance stationed at a nearby firehouse. They estimate the station is about 20 minutes away by car if you aren’t driving with emergency lights and sirens.
After the Urgent Care incident, the Koblishes got involved with a local group that’s pushing the county to improve ambulance response times. The Lexington County Ambulance Response Solutions group has held several meetings across the area in the last few months, drawing together residents at the Timberlake Country Club.
Heather Burkhart, a retired nurse, helped organize the group along with two other nurses, a retired paramedic, a school principal, a psychologist, two mothers and a former member of Beaufort County Council. Burkhart said the group wants Lexington County to hire more personnel, especially paramedics, at more competitive salaries, and expand its ambulance fleet. The group has peppered the county with requests for information about its operations.
Lexington County currently has a fleet of 29 ambulances, said EMS Chief Brian Hood. The department replaces an average of five ambulances a year and has added nine ambulances in the past 20 years. The county currently has 11 ambulances on order, including one additional ambulance that would bring the fleet up to 30, but those aren’t expected to be available until next year.
“Ambulance build time is now 24 months or longer on average, and EMS is receiving ambulances in April of this year that were ordered in 2022,” Hood said.
The average response time to the Chapin area in the last quarter of 2023 was seven to eight minutes for the most serious response cases, according to Lexington County EMS, and for less acute calls the average response was 11 to 12 minutes. That’s slightly higher than the countywide seven-minute average for the most life-threatening calls, and the 10-minute average for less serious calls.
The wait time for Chapin is equivalent to an ambulance heading to Boiling Springs or South Congaree for a high-acuity call, and about a minute more for low-acuity calls. Batesburg-Leesville, Cayce, Irmo and Lexington have shorter response times, while calls to Pelion, Swansea and Hollow Creek take one to four minutes longer.
The National Fire Protection Association recommends a response time of eight minutes for the highest-need calls on 90% of emergency calls.
Lexington County officials use a system of dynamic deployment to move ambulances around the county so they are better positioned to respond to areas with the highest expected call volumes, Hood said.
Depending on call volume, Hood said Lexington County EMS usually has an ambulance stationed in Chapin for high-acuity cases, and almost always has an ambulance stationed in Ballentine to respond quickly to that side of the county.
“Lexington County virtually always has an ambulance in the Chapin community,” Hood said. “It’s important to remember that not all 911 calls are medical emergencies. Emergencies of lower priority may receive an ambulance from farther away to keep the ambulance in the community and available for a more severe emergency.”
Staffing levels change each day depending on anticipated call volumes, Hood said. The majority of calls, 81%, come between 6 a.m. and midnight.
She kept asking, ‘Where are they?’
When Marilyn Baatz called her son at 3:30 a.m. complaining of pain in her abdomen, her son knew it must be something serious.
“That’s not something she would normally do,” Mark Baatz said. “She was a tough old New Jersey broad.”
His mother had been living in the Timberlake area for seven years, moving south with her ex-firefighter husband, Jack, to follow Mark, who works in real estate in the Columbia area. A registered nurse who went by “Lynn,” she had worked for years as a volunteer first aid captain at the family’s local precincts in Spring Lake and Brielle, New Jersey. Mark Baatz remembers his mother jumping out of bed in the middle of the night to go out on a call whenever the emergency scanner in their house went off. She even was part of the response to the terrorist attacks of Sept. 11, 2001, when she helped staff a station for evacuees coming over from Manhattan.
Mark Baatz called 911 on his way to his mother’s house that morning, and called again after they had waited more than an hour, he said. He even got a call back from the EMS supervisor, explaining that his call had come in during a shift change, Baatz said.
”She was very aware,” throughout the wait, her son said. “She kept asking ‘where are they?’, and I don’t have an answer ... She was in so much pain, I just wanted to get her out of the house.”
Six weeks prior, Marilyn had been treated at Lexington Medical Center for dehydration, something that Mark attributes to medication she was taking. Other than that, he says, the 83-year-old had never had a serious health issue.
EMS Chief Hood said the call was originally reported as a possible kidney stone, with the addition that Marilyn Baatz was taking antibiotics for a urinary tract infection.
“Although painful, a kidney stone or urinary tract infection isn’t generally life-threatening, and based on the answers to the questions asked by the 911 operator, the event was coded as a low acuity (non-emergency) call for service,” Hood said in an emailed response. “A low acuity asset wasn’t immediately available, so the call was held until one became available and the call was dispatched. It would not be prudent to send the only ambulance in a community to a low acuity call and have nothing available for a higher acuity emergency should one arise.”
Hood said the call was held for approximately 58 minutes after Baatz’s original call came in at 4:55 a.m., with the supervisor calling Baatz several times to keep tabs on his mother’s condition. An ambulance eventually arrived at the scene at 6:20 a.m., Hood said. The EMS chief said a shift change would not have affected the ambulance’s arrival time, as those changes are staggered to occur “around the clock.”
When the ambulance arrived, Baatz jumped in his truck ready to follow his mother to the hospital. After about 15 minutes of sitting in the driveway behind the ambulance with his engine running, Baatz said he got out to check on his mother.
“I’m thinking she had a heart attack and they’re working on her,” Baatz said. Instead, when he got to the rear of the vehicle, “She waved at me through the back window,” he said. “They weren’t giving her medicine. They weren’t checking her vitals.”
Hood said, “Many tasks are carried out in the back of an ambulance, sometimes before transport.”
“This includes a detailed assessment, gathering vital signs, and preparing for transport,” he said. “This was a non-emergency transport to the hospital, and scene time was not an issue.”
Once she arrived at Prisma Health Baptist Parkridge Hospital, doctors gave her antibiotics for an infection that developed into sepsis. Staff there were optimistic Marilyn Baatz would be back home in a few days. Mark even left the hospital to go home and take a nap.
But when he checked in on his mother later that day, her condition suddenly took a turn for the worse.
“Ten minutes before I was talking to her,” Mark Baatz said. “They had got her blood pressure up, so I went to talk to the nurse. Then they called out ‘Code Blue.’”
He looked at the nurse and asked: “Is that for my mother?”
Marilyn Baatz had gone into shock. After 20 minutes of CPR, “they called it,” her son remembers. “The doctor didn’t think they could get her back.”
After his mother’s death, Baatz attended a community meeting of the Ambulance Response Solutions group, which he said drew around 150 people to the Timberlake Country Club . But while many people shared their own stories of waiting for a response from emergency services, there was no representative of the county there to hear their complaints.
“They didn’t want to face the heat,” Baatz said.
”It’s so ironic. My mother probably saved five or 10 lives in her lifetime,” Baatz said. “For that community to let her down in her time of need was, with no call or explanation after … I know we could do better.”
‘Can feel like you’re in the middle of nowhere’
While the roads that snake down the peninsulas sticking into Lake Murray still wind around cow pastures, the area’s bovine residents now share this space with rows of homes in new developments branching off toward the lakeshore.
“It can feel like you’re in the middle of nowhere, but there are hundreds of homes here,” said Burkhart, the response group’s co-organizer. “People don’t realize how very populated it is. The neighborhoods are hidden.”
She worries that people further down Amicks Ferry, near the tip of the peninsula that juts out into Lake Murray south of Chapin, will end up waiting far too long if someone suffers a heart attack or an accident on the lake.
“I’ve heard so many stories of people driving their loved ones to the hospital because it’s faster than waiting for an ambulance,” Burkhart said.
One such story is the Koblishes’, who said they waited more than 90 minutes for an ambulance after Cam Koblish suffered a heart emergency.
“I find that unconscionable, in this day and age, that anyone would wait that long for an ambulance,” Marty Koblish said.
During an earlier transport, Cam Koblish relieved some of his stress by chatting with the ambulance crew. He said one county EMT told him they were paid $20 an hour.
“I was quite surprised,” Cam Koblish said. “I understand the economics of South Carolina, but for something as critical as care in a life-or-death situation? I don’t understand it. With the training requirements associated with those skills, you would think they would get more in terms of compensation.”
Lexington County currently has 71 emergency medical technicians, or EMTs, 72 paramedics and another 22 field commanders with paramedic training. There are currently 20 open positions with the agency, 17 of which are in positions that directly respond to calls from the public. Hood said that like jobs across the healthcare industry, EMS agencies around the nation are experiencing shortages, a problem that was only exacerbated by the pressures of the COVID-19 pandemic.
In the meantime, EMS employees work overtime and part-time at an increased pay rate to fill staffing vacancies, Hood said, allowing the agency to have as many ambulances available as possible at any given time.
“Eighty-nine percent of EMS staff are in our Operations Bureau answering the citizens’ call for help,” Hood said.
EMS staff have received a 24% raise in the last two years, Hood said, with a current range of $44,000 to $53,000 for an EMT and $51,000 to $61,000 for a paramedic.
“Every industry has job openings right now,” Wessinger said. “The paramedic industry is a very difficult one to staff. There’s a national shortage of paramedics right now.”
Firefighters are also being cross-trained as EMTs, which will allow each fire engine dispatched to have a trained EMT on board, Wessinger said. Lexington County Fire Chief Mark Davis said that training has expanded as the county’s population has grown.
The fire service “has historically provided CPR/First Aid as part of our delivery model with some of our members holding higher levels of certification,” including certifying firefighters as trained paramedics, Davis told The State. “At the same time, we offered our incumbent employees an opportunity to expand their training and capabilities to the EMT-Basic level by offering in-house EMT programs. Our first recruit school to graduate as Firefighter-EMTs was June of 2020 and our first in-house incumbent program was Fall of 2021.”
Eighty percent of calls are for lower-acuity, non-life-threatening calls, said Wessinger, the county council member who represents the Chapin area. “You don’t need paramedics for those calls.”
The county now depends on a contract with the private medical transport company MedTrust to respond to lower-acuity calls, which county officials say allows EMS to prioritize more serious calls.
“The (response) times for the high-acuity calls have decreased significantly,” Wessinger said. “Eight to nine minutes for a true life-threatening call is well above the standard for a rural call.” A national 2022 study found that it takes twice as long for ambulances to respond to rural areas as the overall average — 14 minutes instead of 7 — and that one in 10 callers waited almost 30 minutes.
“I have continually told my constituents that it takes time to make changes, and the majority of them are happy with it,” Wessinger said.
But some residents say they wish local officials had been more forthcoming about response times and other information.
While Cam Koblish finds the pace of life here to his liking, he said native South Carolinians can be resentful of new people moving in and asking for changes, even if it’s to improve the quality of public services.
“If your last name isn’t Moultrie or something else, you can be viewed as not fitting in,” he said.
Wessinger counters that the county has held public meetings in recent months to address concerns about response times at Chapin Town Hall, the county administration building and the Timberlake Country Club. But while she says the county is making progress, nothing seems to move fast enough for some of those who want a pay bump up to $62,000 for paramedics and increased staffing at local stations, as the Ambulance Response Solutions group wants.
“For what they want, we would have to raise taxes to have millions of dollars to jack up salaries and recruit from around the United States, and raise everybody’s taxes for the citizens of Lexington County,” Wessinger said. “It’s on the county to take care of our people affordably. Some of it is people moving here from other areas with a higher tax base.”