Commission considers more EMS staffing amid growing number of transfers

EMT Alison Peters wipes down an ambulance at the end of a shift at Cole County Emergency Medical Services in Jefferson City on Tuesday, July 18, 2017. Peters said response trucks are cleaned after every call and at the end of each shift.
EMT Alison Peters wipes down an ambulance at the end of a shift at Cole County Emergency Medical Services in Jefferson City on Tuesday, July 18, 2017. Peters said response trucks are cleaned after every call and at the end of each shift.

Finding a balance between providing the anticipated service for local emergency calls and transporting patients long distances for medical treatment is a constant battle for ambulance services.

While the emergency calls must be answered, a service's ability to handle transfers back and forth from facilities can lead to more revenue, some Mid-Missouri ambulance directors say.

The Cole County Commission currently is considering adding ambulance personnel to handle more transfers, but commissioners are wary of spending more on the service after adding five employees in the current budget cycle along with capital improvements totaling more than $600,000.

Cole County EMS has 90 employees - 51 full time and 39 part time - and a fleet of 12 ambulances, 10 of which are active. The most ambulances on duty at a given time is seven, and the least is four.

Last year, the service responded to 10,715 calls, and officials believe they'll top 11,000 this year.

Over the last year, the overall call volume for Cole County has increased 25 percent, transfer volume has increased approximately 60 percent and emergency call volume has increased 20 percent.

The time it takes from dispatch to in-service has increased by 90 percent, from 45 minutes to one hour and 25 minutes, largely due to the increased volume of transfers, according to ambulance officials.

Ambulance Director Jerry Johnston has proposed immediately replacing an ambulance supervisor position with a paramedic to reduce the staffing cost, then adding a new 12-hour crew from noon-midnight in the 2018 budget cycle.

Johnston said patient transfers can be for time-sensitive medical emergencies or for chronic admissions that require ambulance transfer.

Many times, the people they transport on emergency calls can't pay the bill, so the service has to write it off, he said. Facility transports get payments from Medicare, so the transfer volume subsidizes emergency calls that go unpaid.

"From a business perspective, it makes sense to do transfers," Johnston said. "The bottom line is, the more transfer volume you maintain, the better your financial position and the less reliance you have on the community subsidy."

For ambulance services in counties surrounding Cole, transfers to out-of-county medical facilities are the way of life, as they have no hospitals in their coverage area. It's also how they get their money to keep the services going.

The Osage Ambulance Service employs 38 full- and part-time personnel, staffing two crews 24 hours a day with another crew on call if both crews are busy. The service covers most of Osage County and a small part of Gasconade County.

"We do transfers when requested and help out other counties," Osage EMS Chief Joshua Krull said. "We rely on the transfers for extra volume. We're a third-class county next to a first-class (Cole), so our tax revenue and income are lower. Those extra few transfers helps us. They are our life blood when we're only running around 1,200 calls a year. Nonetheless, if we have a crew out on a call, we still have to maintain local coverage, and that can be challenging."

For the Mid-Mo Ambulance Service, which covers all of Moniteau County and most of Morgan County, Director Lee Kempf staffs five ambulances, with 41 full- and part-time personnel.

"We've seen a slight increase in emergency calls, but not having a hospital in our service area means we are going to have crews out longer," Kempf said. "Every patient goes to either Columbia, Sedalia, Lake Ozark or Jefferson City. That means our out-of-service time is longer."

From the time a Mid-Mo Ambulance crew drives to, picks up and delivers a patient to a facility, Kempf said, it's about an hour and 40 minutes.

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Robin Phillips

"If it takes 25-45 minutes to get back to one of our bases, then the average total time one of our crews can be out is two and a half hours," Kempf said. "That's the key to running an ambulance service - not the number of transports but the out-of-service time that your vehicles roll.

"For example, say in Jefferson City, the Cole County crew goes 15 miles for a call," Kempf continued. "You figure 15 minutes to get there, maybe 15 minutes on the scene and another 15 to get back to base, then you're out for almost an hour. We're not able to respond for about an hour if we've got crews making transports or transfers."

Kempf also noted every call means some time with an empty ambulance, which doesn't generate any income.

"If we do a trip from, say, St. Mary's Hospital to Versailles, you've got an hour trip generating something and then one hour not coming back," he said. "All the while, you still have to deal with the fixed costs of running the ambulance. When it gets busy, we get to status zero (where no ambulances are available, and outside agencies could be called in to take a medical call), and the wait can be as long as an hour and a half. We have had to request help from Cole County many times."

Kempf noted while Mid-Mo Ambulance Service has a $3.5 million budget, it doesn't have a big reserve - around $60,000 - so sometimes the service has to spend its entire reserve when it has only 3,500 calls a year.

Cole County ambulances are based at five locations - the EMS base on Southridge Drive, the Regional West Fire Protection Station on Apache Trail, the Cole County Fire Protection Stations at Brazito and County Park, and the Cole County Jail.

In Jefferson City, the ambulance response time is less than eight minutes. Outside city limits, it is around 12 minutes.

One local ambulance district did expand its staff recently - the Callaway County Ambulance District, whose board of directors voted May 16 to add an additional crew from 9 a.m.-9 p.m daily.

Director Charles Anderson has three trucks staffed 24 hours: one in Holts Summit, one in Kingdom City and one in Fulton.

"Our call volume is down about 6 percent from compared to the same time last year, but the problem we run into is we end up taking a lot of people out of Callaway County to Columbia or Jefferson City hospitals," Anderson said. "We may have a truck out of service for two hours. So even though we've seen a decrease, we have more people wanting transport outside of Callaway. That's why we added a 12-hour truck."

With a staff of 50, Anderson said he doesn't anticipate any further additions in the immediate future.

The Cole County Commission will hold its regularly scheduled meeting Tuesday, but as of Friday afternoon, there was no discussion of ambulance staffing on the agenda.