1994-06-30 Work Session
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xrNUTES OF EKS WORK SESSrON, JUNE' 30, 1994
PAGE 173
ASSEKBLY
The New Hanover County Board of Commissioners held a. Work
Session on Thursday, June 30, 1994, at 10:15 A.M. in the Assembly
Room of the New Hanover County Administration Building, 320
Chestnut street, Wilmington, North Carolina.
Members present were: Commissioners Sandra Barone; William A.
Caster; William E. Sisson, Jr.; Vice-Chairman E. L. Mathews, Jr.;
Chairman Robert G. Greer; County Manager, Allen O'Neal; County
Attorney, Wanda M. Copley; and Clerk to the Board, Lucie F.
Harrell.
Chairman Greer called the meeting to order and reported the
purpose of the Work Session is to hear and discuss the functions
and operation of the New Hanover County Emergency Medical Services
Department.
DrscussrON OF THE FUNCTrONS AND OPERATrON OF THE EKERGENCY MEDrCAL
SERVrCES (EKS) DEPARTMENT
Deputy County Manager, Andrew J. Atkinson, presented a slide
presentation on the functions and operation of the Emergency
Medical Services Department.
The following key issues were presented on the past, present
and future of Emergency Medical Services in New Hanover County:
r. Historical view of EKS: In April 1986, the Emergency Medical
Services Department was established. until that time, the EMS
service was provided by the Wilmington Fire Department, Ogden/New
Hanover Volunteer Rescue Squad, and the Pleasure Island Volunteer
Rescue Squad. The purpose for establishing the EMS Department was
because of the poor outcome of pre-hospital cardiac arrests with a
save rate of 0%. In order to train emergency medical technicians
to an advance intermediate level of service, an Emergency Medical
Service was developed by working with the volunteers and hiring
personnel to handle a 7,500 call volume. with the implementation
of the EMT-Advanced Intermediate level of service, the save rate
increased to the national average of 21% by December 1986. New
Hanover County was the first county in the State to establish an
EMS service at the advance 'intermediate level of care. On July 1,
1986, the EMS Department assumed the responsibility for
administering, the EMS service for the City of Wilmington, beaches
and the unincorporated areas of the County. The estimated call
level was approximately 7,500 annually with 54 trained employees.
In FY 1987-88, there was a large area of the County covered by
station 1 at Ogden. In order to assist with EMT response, a first
responder service was placed at the Juvenile Services Center on
Blue Clay Road. Also, the Pleasure Island Rescue Squad ceased to
operate and the County began to provide this operation. In 1989
training began for the EMT-paramedic level of service which was
implemented by March 1990. Also, crash/rescue operations were
provided by the city of Wilmington Fire Department and the
Ogden/New Hanover Volunteer Rescue Squad. Due to problems
experienced with the bridge opening at Wrightsville Beach, a first
responder was placed at the Wrightsville Beach Fire Department and
by 1993, this unit was functioning at the EMT-Defibrillator level
of care.
rr. Present: Currently, there are stations located in the
following areas of the County:
station 1 - Ogden - Military Cut-Off Road
station 2 - North Second Street
station 3 - Empie Park
station 4 - Carolina Beach Road
station 5 - Pleasure Island
Castle Hayne (First Responder)
In 1986, EMS began with 54 full-time EMT's with a call volume
of 7,500. Eight years later, EMS has 56 EMT's with a call volume
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MINUTES OF EMS WORK SESSION, JUNE '30, 1994
PAGE' 1.7'4'
of 17,955 with six ambulances, one advance life support, one first
responder, and one crash rescue unit. The crash rescue service is
provided by the County from 8:00 A.M. until 5:00 P.M., Monday
through Friday. All other services are provided 24 hours per day,
7 days per week. The City of Wilmington provides crash rescue
service on a 24-hour basis in the city Limits, and the County
contracts with the Wilmington/Ogden Volunteer Rescue Squad to
provide crash rescue from 6:00 P.M. to 6:00 A.M. Monday through
Friday and from 6:00 P.M. on Friday night until 6:00 A.M. Monday
morning.
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New Hanover County has a franchise with Medical Transportation
Specialists, Inc. to provide non-emergency ambulance service to the
citizens of the County. This company performs its own billing and
collections including billing private and third party
reimbursements. Through the services provided by Medical
Transportation Specialists, Inc., the County does not have to use
fully-equipped EMS ambulances for non-emergency transports..
Charts were presented reflecting the call volume. Fifty-four
percent of calls are received from 8:00 A.M. until 6:00 P.M.;
therefore, the County EMS is responding to the largest number of
calls. station 2 located on North Second Street receives the most
calls with station 4 on Carolina Beach Road being second; and
station 3 in Empie Park being third.
Chairman Greer inquired as to whether statistics are available
reflecting the number of non-payments for each station?
Deputy County Manager Atkinson reported no figures are
available; however, he will check into preparing a report through
the use of zip codes and report back to the Commissioners.
Chairman Greer inquired as to whether the North Third Street
Community Health Center will help to reduce the non-emergency calls
at station 2.
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Director of EMS, Larry Ray,
Center.could reduce the calls, but
people want an immediate response.
reported the Community Health
under emergency circumstances,
Discussion was held on the location of first responder units
throughout.the county. Deputy County Manager Atkinson reported a
first responder could be established in many areas throughout the
County, which would provide for an immediate response with an
ambulance on the way, if needed. The problem with this idea is
that citizens have shown a great deal of concern about not having
a fully-equipped ambulance located in their vicinity.
commissioner Sisson inquired as to whether the County has held
any discussion with the Volunteer Fire. Departments to see if a
first responder could be established in these facilities through a
contractual arrangement. In other communities, this is being done
in order to be of assistance if all the County ambulances are in
use.
Reports from' the state of North Carolina were presented
showing the increase in the volume of calls through the years.
From 1986 through 1990, the growth was steady. From 1990 to 1993,
there was a 63% increase ~n the call volume. A chart was presented
showing the number of calls received and the number of calls
cancelled. The percentage of calls that actually do not require an
ambulance is approximately 35%. These figures do not include the
calls received by the Volunteer Rescue squads.
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The total cost for providing EMS services is $2.6 million with
a collection of $780,000 in fees for a net cost of $1.9 million
annually. There is a $200 charge for transports; however, Medicare
pays $121 with a write down of $79 and Medicaid pays $83 with a
write down of $117. The private patient is billed $200.
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MINUTES OF EMS WORK SESSION, JUNE 30, 1994
PAGE 175
commissioner sisson inquired as to whether private insurance
companies feels this is an unreasonable charge?
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Deputy County Manager Atkinson reported the County does not
bill the insurance company. The private patient is responsible for
payment and the County will fill out the necessary form for the
patient to receive reimbursement. The insurance company
establishes the reasonable charge based on certain regions of the
state. Many regions have a number of counties undercharging for
the service, which causes the insurance companies to pay less for
the service and creates underpayment for large counties, such as
New Hanover County. Since 1993, the County's collection rate has
increased from 34% to 53%, which is the average collection rate
throughout the state. The reason for this increase is due to the
collection efforts being made in the Legal Department.
In order to provide better service, the County would like to
establish an EMS Auxiliary. The call volume has escalated from
7,500 to 17,500 with a very small increase in the number of
employees. with the same number of employees, it is difficult to
cover for employees who are sick or on job related injuries. This
has created the employees reaching their maximum on vacation leave
without the ability to take the leave. An EMS Auxiliary would
provide enough personnel to allow for sick and vacation leave to be
used as well as save on overtime pay. Also, three persons in an
ambulance when responding to a call will provide a better quality
of medical care.
The EMS Auxiliary members would be treated the same as regular
staff. The County would pay for physical examinations, drug tests,
uniforms, equipment, etc. at an initial cost of $1,600 per
auxiliary member.
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III. Future: OSHA Impacts: A comprehensive and safety program
will have to be developed for the EMS Department. The OSHA
requirements for hazardous materials incidents are complex and need
to be clarified. At this time, the additional costs for compliance
to the Bloodborne Pathogen Program, American with Disabilities Act,
and Tuberculosis Program are unknown. These new requirements will
have to be addressed and funded as mandated by the federal and
state governments.
Other future needs are facilities. Presently two sites are
owned by the County, the North Second Street location and the
Castle Hayne first responder station. The Military Cutoff Road
station and Carolina Beach Road sites are owned by the Ogden-New
Hanover Rescue Squad. A portion- of the County's contribution
covers the use of these building. The City of Wilmington owns the
Empie Park site and the Pleasure Island station is owned by the
Federal Point Medical Center with an annual rent of $21,600.
When reviewing facilities, the following items should be
considered:
(1) Are the stations placed in locations that will best serve
the County?
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(2) If Independence Boulevard is extended to the Empie Park
Station, this site will not be available; therefore, another
site will have to be selected.
(,3) If the County changes to 12-hour shifts, design and cost
of stations would be reduced since no lodgipg would be
required-.
(4) The new Computer Aided Dispatch Program (CAD) will allow
for better data. collection through pre-arrival instructions
and allow for better utilization of resources through
Emergency Medical Dispatch with calls being prioritized as to
the need, for emergency vehicles or a non-emergency response.
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MINUTES OF EMS WORK SESSION, JUNE'30, 1994
PAGE 176
Another major issue to consider is being flexible enough to
respond to change. CAD will be most beneficial, and the EMS
Auxiliary will provide the needed flexibility at a minimum cost.
In summary, the Commissioners were requested to consider
establishing an EMS Auxiliary to address the following problems
-Job related injuries and non-job related injuries resulting
in long-term personnel shortages.
-Provide more flexibility in scheduling personal leave for
staff in order to avoid EMS personnel from losing vacation
time.
-An EMS Auxiliary would allow three staff members on some
calls, which would provide better medical care.
-Provide a pool of trained applicants for openings within the
EMS Department.
-Provide training and experience for auxiliary members. This
training and experience would enable them to provide better
care.
-Save on the cost of overtime.
Deputy County Manager Atkinson report staff feels implementing
an EMS Auxiliary will be a positive move for the provision of
better services at a minimal cost with no negative impact on the
Volunteer Rescue Squads.
Mr. Jim Cumins, a member of the Board of Directors of the
Ogden-New Hanover Volunteer Rescue Squad, reported three years ago,
the EMS Director requested the establishment of an EMS Auxiliary.
At that time, the Board of Directors questioned why the Ogden-New
Hanover Volunteer Rescue Squad was not used as the auxiliary. An
offer was prepared to provide the necessary personnel for County
employees on sick leave, vacation leave or on other absences. At
that time, the Department of Labor ruled that volunteers who were
County employees could not volunteer to serve on the Volunteer
Rescue Squads. After three years through the court process, it has
been determined that County employees can volunteer to serve on
Volunteer Rescue Squads. The Ogden-New Hanover Volunteer Rescue
Squad would like for the Board of County Commissioners to know that
this offer still stands and the volunteers are willing to assist
the EMS Director in providing better services to the citizens of
New Hanover County. This would allow the County to save money and
in return provide an opportunity for the volunteers, who are very
interested in being a part of this service.
Discussion was held on the initial costs involved with
establishing the auxiliary. Deputy County Manager Atkinson
explained that the auxiliary would be implemented gradually;
therefore, -it would evolve over a period of several years with the
costs spread over this period of time. Staff feels the costs can
be absorbed annually in the EMS budget.
ADJOURNMENT
Chairman Greer expressed appreciation to all persons present
and emphasized the importance of the County staff working with the
local Volunteer Rescue Squads when discussing procedures for
establishing an EMS Auxiliary.
The Work Session was adjourned at 12:35 P.M.
~Pt:l~)tJ sub~itted,
'-{~ F. ~
Clerk to the Board
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