MMXIII

Somerset, KY

#21 Apr 22, 2013
Ambulance service in Kentucky: Emergency care falls short in rural areas
Author: Alan Maimon
On a winter day two years ago, a 56-yearold heart-attack victim in Trimble County was clinging to life as a county ambulance pulled up to his home.
But the ambulance wasn't carrying the drugs and breathing tube needed to resuscitate him, nor was there a paramedic trained to use those aids.
'He was dead by the time he reached the hospital,' said Trimble County's ambulance director, Sharon Law.'If we had a paramedic, we could have saved him.'
In what officials say is an all too common problem in rural Kentucky, people with lifethreatening emergencies are being served by ambulances -- both public and private -- that lack paramedics and advanced life support equipment. And given the distances that these ambulances need to go, that can be a deadly combination, officials say.
Rural counties with small populations often lack the tax base to pay the hundreds of thousands of dollars needed for advanced life support -- hiring a paramedic and equipping ambulances with a heart monitor, IV bags, a drug box and breathing tubes.
And poorer counties without colleges or technical schools struggle to find and retain paramedics who leave for better-paid positions in urban areas after training.
'It's a problem and a growing concern for a lot of people all over the state,' said Ashley Davis of the Kentucky Board of Emergency Medical Services.
Seventeen rural Kentucky counties lack advanced life support in all their public ambulances: Bracken, Elliott, Fulton, Hancock, Henry, Lee, Leslie, Menifee, Owen, Pendleton, Powell, Robertson, Rockcastle, Todd, Trigg, Trimble and Wolfe. Fourteen of those counties -- all but Fulton, Hancock and Trimble -- also have private ambulances, but those, too, all lack advanced life support.
'It hurts that you can't get people the level they need sometimes. Our hands are tied because we don't have advanced life support,' said emergency medical technician Dorvin Bush of Powell County.
EMT Larry Karsner, director of the Owen County Life Squad, knows what it's like to cope with medical crises without any paramedics or enough equipment.
Karsner, who accompanies his crews on their runs, said he and his staff of seven EMTs make about 1,300 runs a year in the county, where about 10,000 people live.
MMXIII

Somerset, KY

#22 Apr 22, 2013
Continued....

'We have to rely on Carroll and Scott counties for help,' he said.

Counties without advanced life support are at a major disadvantage, said Gallatin County emergency medical services director Barry Alexander.

'Basic life support is basically transport,' said Alexander, whose county has upgraded to advanced life support.'You lay them in the back and coddle them.'

To allow EMTs to provide more services, a bill has been introduced in the General Assembly that would give the state Board of Emergency Medical Services authority to create the classification of EMT intermediate. Such workers would be permitted to give IVs and administer certain drugs. To qualify, the workers would need nine months of training rather than the two years necessary for paramedics under the bill, sponsored by Rep. Jim Callahan, D-Wilder.

Michael Swift, director of the Kentucky Ambulance Providers Association, said the new classification would particularly help rural counties.

Tommy Bryant, judge-executive of Henry County, said his county spends $200,000 to support six basic life support ambulances. With four hospitals all 20 miles from the county seat of New Castle, Bryant says not having paramedics is a major disadvantage.

'It's always been a concern and always will be,' Bryant said.'I hope someday we'll have paramedics and be able to go to advanced life support.'

In Harrison County, it cost $125,000 last year to acquire advanced life support for the county's three ambulances, said Judge-Executive Dean Peak.

'We're thrilled to death to have it,' Peak said.'It was an expensive endeavor, but it was well worth it.'

But judge-executives in rural counties say tight budgets make service upgrades difficult.

'We would love to have it, but we just can't afford it,' said Henry Bertram, Pendleton County judge-executive.

And Trimble Judge-Executive Ray Clem said that his county recently spent $350,000 just to upgrade from a strictly volunteer EMS to a paid basic life support service.

'We're always concerned about getting service to people. There have been closer calls than we would have liked,' Clem said.

In an effort to help, the Board of Emergency Medical Services offers any county seeking to improve ambulance service a matching grant of up to $25,000 a year.

But experts in emergency health care say the state is not spending enough to help ambulance services in places like Todd County, where there are no hospitals, doctors or ambulances with advanced life support.

'If you don't have a hospital, you certainly need to have' advanced life support, said Larry Allen, a director at the UK Center for Rural Health.'For some reason, the state hasn't put enough money into EMS.'

Because of the state budget crunch, the Board of Emergency Medical Services will have its budget of about $2.5 million cut by 5 percent, or $139,000, next year.

Level 1

Since: Mar 13

Georgetown, IN

#23 Apr 22, 2013
Bronston man, yes a lot of counties do run private ambulance companies, however you are then reliant on their desire to keep their pockets lined.
The money is not in "emergency calls" it is in non emergent transport, such as what American Medical Response and Rural-Metro (the two biggest private companies in the country), and there is not enough "convalescent" transports to warrant their desire to enter this county, especially if they aren't going to be providing the services to anyone inside the City of Somerset, where all of the nursing homes will be.

The fact that the county will have to sign a contract with them to get them to agree to do emergency services here will have to be worth their time, which I feel would be far more than the city is already asking for the same contract.

“smiling on a cloudy day”

Level 7

Since: Jan 09

Shakedown Street

#24 Apr 22, 2013
TitanPrometheus wrote:
Bronston man, yes a lot of counties do run private ambulance companies, however you are then reliant on their desire to keep their pockets lined.
The money is not in "emergency calls" it is in non emergent transport, such as what American Medical Response and Rural-Metro (the two biggest private companies in the country), and there is not enough "convalescent" transports to warrant their desire to enter this county, especially if they aren't going to be providing the services to anyone inside the City of Somerset, where all of the nursing homes will be.
The fact that the county will have to sign a contract with them to get them to agree to do emergency services here will have to be worth their time, which I feel would be far more than the city is already asking for the same contract.
Makes sense. Where I'm originally from we always had private ambulance services, and they basically milked Medicare off old-timers who just needed a monthly trip in to town.
pulaski gal

East Bernstadt, KY

#25 Apr 22, 2013
Several years ago didn't we have a company that did just non emergency transport? I think they sold out to or merged with current EMS.
jong

Pineville, KY

#26 Apr 22, 2013
We did and they just went out cause they wasn't making enough money, thats when the city took it over, now thats almost gone, i can not believe the city council is not fighting for this, the county is paying what they owe, so whats the problem? I tell you the problem Kim Jong Girdler. The council are just a bunch of little minions that do as they are told.

Level 8

Since: Sep 08

Location hidden

#27 Apr 22, 2013
pulaski gal wrote:
Several years ago didn't we have a company that did just non emergency transport? I think they sold out to or merged with current EMS.
Didn't merge - Med Transport - Private company - I drove for them for a while - Good BLS training - 3 of the employees were also firefighters -
carson

Georgetown, IN

#28 Apr 22, 2013
Years ago I worked as an EMT in a town about the size of Lexington. Our office was in the ER and our trucks were maintained in a garage at the hospital. I'm guessing an ambulance ride was part of the hospital bill. We ran two trucks. A paramedic and an EMT in each.

“smiling on a cloudy day”

Level 7

Since: Jan 09

Shakedown Street

#29 Apr 22, 2013
jong wrote:
I tell you the problem Kim Jong Girdler
http://tinyurl.com/cyj7kso

=D
jong

Pineville, KY

#30 Apr 22, 2013
Bronston Man wrote:
<quoted text>
http://tinyurl.com/cyj7kso
=D
I like this

“smiling on a cloudy day”

Level 7

Since: Jan 09

Shakedown Street

#31 Apr 22, 2013
jong wrote:
<quoted text>
I like this
Might want to save it. Topix mods don't like making fun of dear eternal leader, for some reason.

Level 1

Since: Mar 13

Elizabethtown, IN

#32 Apr 22, 2013
From what I understand it isn't about the shortfall that has been in question as much as it is the city's desire to keep it from happening again. Whereas they are now asking for an increase of 400,000 per year that the county doesn't want to pay.

Which is where the break down happens. Someone is feeding the county government information that isn't accurate. They are trying to convince them that they can run a service for less than what they are paying to the city now and why the people in the county need to demand negotiations in the matter start.

Level 1

Since: Mar 13

Elizabethtown, IN

#33 Apr 22, 2013
This person has told the county that paying EMTs 10/ hour and paramedics 15 and run the county's service 4 trucks a day 24 hours a day the salaries just for the employees is 876,000... What about fuel, upkeep, buildings, utilities, workers compensation, vacations, sick time, disposable equipment, office staff, managers, ect?

The county government is not getting the whole story and should at least attempt negotiating with the city.

Level 1

Since: Mar 13

Elizabethtown, IN

#34 Apr 22, 2013
If you just paid them minimum wage the salaries are $508,080, as a paramedic or an EMT would you pass over a job making the 15 and 12 respectively the city is already paying here to work for the county? Who would you get to staff it?

People talk to your magistrates and demand them negotiate with the city or vote them out before it's to late!
NOPE

Junction City, KY

#35 Apr 22, 2013
From my experience, ems agencies generate enough money to pay for supplies, upkeep, etc. in surrounding areas with very little funding from there governments. As a matter of fact some surrounding areas dump money generated by ems into the general fund and finance other departments and or projects. Something is all wrong about this situation. Not sure if it is mismangement or it could be as simple as needing to raise billing rates, but there is more to this story.

“smiling on a cloudy day”

Level 7

Since: Jan 09

Shakedown Street

#36 Apr 23, 2013
From doing a little research, looks like Medicare pays a base rate of $216.19 in Kentucky per mile. Now there's a big formula that actually is used to determine the actual amount depending on the services provided, but this gives us a pretty rough estimate.

Read all about it here:
http://www.cms.gov/Medicare/Medicare-Fee-for-...

An average ambulance ride for anyone 65 or older for county residents is going to run $1500-$2000. Now if they're really paying paramedics $15/hr I don't see how they aren't rolling in the dough. Is that really what they make, around $31K? If so that is absolutely nuts.

The average paramedic salary in Kentucky is $47,000. Nationwide it's $54K.
http://www.indeed.com/salary...
carson

Georgetown, IN

#37 Apr 23, 2013
That was my point. When I worked it, the ambulance service was just part of the hospital and the patients paid for their ambulance ride.
We also didn't have expensive custom paint jobs.
What's wrong with a white ambulance with standard EMS decals.
It just seems like another mismanaged program and excuse to justify taking more money. They probably created a couple of fake jobs for family members as well.

How many runs does Pulaski EMS make per year?
agatha

London, KY

#39 Apr 23, 2013
Why can't the state do a audit? To bad that Billy Miller could not look at the budget and service and tell us what the real problem is with EMS.
jong

Pineville, KY

#40 Apr 23, 2013
i can tell you the problem, money is being moved around at city hall from one account to another just to keep up with the bills, and the amount of waste is unbelievable, they have a open check book and have had for the last 6 years, the reason they always had a surplus was the former mayors expected them to turn back in 10 to 20 percent of their budget every year, this mayor encourages spending it all.
For Real

London, KY

#41 Apr 23, 2013
jong wrote:
i can tell you the problem, money is being moved around at city hall from one account to another just to keep up with the bills, and the amount of waste is unbelievable, they have a open check book and have had for the last 6 years, the reason they always had a surplus was the former mayors expected them to turn back in 10 to 20 percent of their budget every year, this mayor encourages spending it all.
All that money the city is "supposed" to have and all those tax breaks will come back to bite the residents of Somerset sooner than one can imagine!

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