Regional districts could be answer to rural EMS needs
A combination of increased training requirements for medics and declining civic participation contributing to difficulty in staffing volunteer departments
The Times-Reporter, New Philadelphia, Ohio
NEW PHILADELPHIA, Ohio — Rural emergency medical service is in crisis, in the opinion of Robert L. Smith, owner and president of Dover-based Smith Ambulance.
He sees a combination of increased training requirements for medics and declining civic participation contributing to difficulty in staffing volunteer departments.
"Volunteerism has dwindled to virtually nothing," he said.
"Daytime staffing is one of the most critical times for a volunteer service," said Shane Stull, certified flight paramedic captain with the Tri-County Joint Ambulance District, based in Newcomertown.
A volunteer might live in Gnadenhutten and work in Bowerston.
"They can't respond from Gnaden to Bowerston to run a call," Stull said.
Tri-County and other regional services with paid staffing aren't waiting for volunteers to appear.
Emergency medical services in the Gnadenhutten, Newcomerstown, Port Washington and Coshocton County areas have been operating with taxpayer support to make sure an ambulance will show up when someone calls for help.
Arrowhead is newest
The Arrowhead Joint Fire District, providing both fire and EMS service, is the newest of the three, having been formed in 2014 with the combination of services in the village of Gnadenhutten and the adjacent Clay Township.
In 2018, Arrowhead transitioned from an all-volunteer organization to a combination part-volunteer and part-paid department, hiring 16 new firefighters, seven of whom are paramedics and six of whom are emergency medical technicians. That raised the overall strength of the department from 17 to 33, according to Chief Steve Wright.
The increased staffing was made possible by voter approval of a 4-mill, 5-year levy in November 2017, and estimated to cost the owner of a $100,000 home about 38 cents per day.
"It was advertised as something to support the paid staff," Wright said.
The first day of paid staffing was July 2. They are on duty Monday through Friday from 6 a.m. to 6 p.m.
Wright said the biggest change was a reduced "turnover rate," either requiring another agency to answer Arrowhead's call or bringing in a backup crew. The addition of paid staffers reduced the need to call Smith Ambulance, Newcomerstown Emergency Rescue Squad and Tri-County Joint Ambulance District.
He said Arrowhead is "very thankful" for continued aid from Smith, Newcomerstown and Tri-County.
"We are now in a better position to help them in return," Wright said.
Arrowhead's call volume set an all-time record in 2018, with a 16 percent increase over 2017.
"The fire district staffing plan slashed call turnover and reliance on outside agencies by over 55 percent over 2017," Wright said. "We still have much work to do to meet our goal of less than 10 percent reliance on outside agencies."
Tri-County started in 1972
Tri-County Joint Ambulance District has a full-time paid paramedic and emergency medical technician on duty at all times, according to Stull. It covers Newcomerstown, Port Washington, and the townships of Salem, Oxford, Washington and Perry. Newcomerstown Emergency Rescue shares coverage of Newcomerstown with Tri-County. One department provides the primary response on even days, and the other, on odd days. Tri-County responds to Jefferson Township, which is covered by a Smith Ambulance contract, if Smith is busy. Tri-County also has agreements to cover some townships in Guernsey County and responds at the request of United Ambulance of Cambridge.
Stull sees the regional ambulance service as providing a cost-effective service for sparsely populated areas.
"Perry Township, it's very remote," he said. "You have very little people living out that way. By having an ambulance district, now that township doesn't have to pay a lot of money to have the benefits of having a full-time ambulance service. We're their full-time ambulance district."
Tri-County was first formed in 1972 when village and township residents voted to be in the ambulance district. It is supported by a 1-mill levy last renewed in 2017 for five years. It also gets money from billing for services.
Although Tri-County will respond wherever called, Stull said, it is governed by a board of representatives from Port Washington, Newcomerstown and the townships of Salem, Washington, Oxford and Perry.
Stull said Tri-County has sources of revenue other than responding to 911 calls for medical emergencies. It provides transport when MedFlight helicopters are grounded by weather, and handles transports for Riverside Manor Nursing & Rehabilitation Center in Newcomerstown.
"It's very challenging," Stull said. "You can have all these contracts that you want, if you're unable to provide for those contracts, eventually you're going to lose those contracts, you're going to lose that revenue.
"We are very fortunate where we are sitting. We are the only department in southern Tuscarawas County that is running 24 hours a day, seven days a week, 365 days a year," Stull commented.
Tri-County has two crews on duty during the day, so one crew is ready to respond after the first is in on the road.
"Our philosophy is we need to get to the patient as soon as possible," Stull said. "The sooner we can get somebody out the door to the patient, the sooner we can start treatment ... the better the patient outcomes."
That's especially important for stroke, heart attack and respiratory cases, he said.
Stull said a squad leaves the station within a minute or 90 seconds of receiving a call. They can be anywhere in Newcomerstown in a few minutes.
"For the most part, we can get to our furthest service area just driving normally in 20 to 30 minutes," Stull said. Peoli is 15 to 20 minutes away.
"You're probably going to see more of districts — fire districts, EMS districts — because that's where you have the chance to shine," Stull said. "We've got a little chunk of money coming from everybody to cover a large service area."
Coshocton County has experienced the growth of its emergency medical service from local volunteer squads to a paid regional system.
Coshocton County EMS began in 1976 when volunteer emergency squads in the villages of Warsaw and West Lafayette joined with the newly formed volunteer emergency squads in the city of Coshocton and the Keene Community into a county EMS system, according to Todd Schroyer, the agency's director.
"There are a few of us left from the volunteer system, and there was some resistance when the county transitioned from volunteer to partially paid in the mid-1990s, and more resistance in 1996 when the county had to move to a paid crew 24/7/365," Shroyer told The Times-Reporter in an email.
"Ultimately most decisions on how to provide EMS to a community ends up being a compromise between the level of service the community wants versus how much can the taxpayers afford," Shroyer wrote. "The more you can afford ... the more you can have. The less you can afford ... the less you can have. This problem is more difficult in the rural areas because they do not have the financial resources.
"Many communities simply cannot find the resources to replace the loss of volunteers. It cost Coshocton County residents over $2 million in wage and benefit costs last year to staff four EMS crews. The volunteer squads used to do that for free."
Coshocton County pays for its emergency medical service with a 4-mill property tax levy, which will produce about $2.7 million in tax revenue, according to Shroyer.
"We bill for our services and collect another $1.1 million in transport revenue," he said. "Currently we do not require Coshocton County residents to pay out-of-pocket. We collect what your insurance pays and write off the balance. We are very fortunate to have the service that we have in Coshocton County, but we only have it because our community is willing to pay for it."
What it costs
Shroyer said Coshocton County's townships are covered by volunteer fire departments supported with property tax levies of 2.5 to 4.5 mills.
"When you combine the millage for their fire and EMS services, the majority of our townships are paying between 6.5 and 8.5 mills," Shroyer said. "No one likes to talk about taxes, but that is really where any discussion has to begin when determining the level of fire and EMS service an area will have.
"It will easily cost $300,000 per year to staff two people 24/7/365. For a small township or village, $300,000 per year is a significant tax burden. And this is just the staffing cost. It doesn't include the $200,000 to $250,000 it costs for an ambulance and the equipment for it. It doesn't include the $400,000 or more that it costs for a fire engine and the equipment for it."
Coshocton County commissioners own and operate their county's emergency medical service and appoint its director.
"We are extremely proud of our response times," Shroyer said. "The average response time for a 911 ambulance call in Coshocton County in 2018 was 5 minutes and 50 seconds. There is a national standard that says you should have a firetruck or ambulance to the scene of the emergency in eight minutes or less. We are very proud that we met this standard 77 percent of the time in 2018."
In Tuscarawas County, Goshen Township Trustee Sam Wise wants to see some kind of countywide system for emergency medical service.
The township, which adjoins New Philadelphia, has seen its costs rise recently. It has paid Smith Ambulance $1,000 per month to cover its emergency medical calls since October, according to Trustee William Miller. The township previously paid about $650 per month.
Wise wants to see Tuscarawas County commissioners investigate creating a countywide system like Coshocton County's, or an arrangement that would make use of existing public and private EMS, fire department and private companies to ensure every area is covered.
Ambulance company owner Smith believes such regional arrangements may be the wave of the future.
"I just think you're going to have to see more districts," said ambulance company owner Smith. "But the question is: Where does the money come from to pay for these services?"
©2019 The Times-Reporter, New Philadelphia, Ohio
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