Weekly Newspaper covering Marion, Schley, Chattahoochee, Webster, and Stewart Counties.
Inside Stewart County EMS
From the Oct. 16, 2013 issue of The Journal
By Chip Jones
We don’t think about cost when we encounter life-threatening conditions. Someone at risk for cardiac arrest with chest pains isn’t going to hesitate to call 911. Falls and other accidents prompt us to react quickly. We just do it. Our 911 services are part of the essentials we expect from local government in our communities today.
Prior to 1996, calls from mobile phones were required to verify subscription service before calls were routed to a public safety answering point (PSAP), or a 911-call center. In 1996 the FCC ruled that all mobile calls must go directly to a PSAP without verification.
“Enhanced 911” (E911) systems that are required today were rolled out by the Federal Communications Commission (FCC) in two phases beginning in 1998. This additional support was created specifically for wireless devices, or mobile phones. Locating the origination of an emergency mobile call quickly had to be addressed to save time and lives.
When a person makes a 911 call from a landline (a traditional phone with ground wires), the call is routed to the nearest PSAP. The PSAP then routes the call to the proper 911-response center closest to the victim, providing emergency personnel with the exact origination point of the call.
In 1998 phase one of the FCC’s E991 system required that mobile phone carriers identify the originating phone number and the location of the signal tower. Phase two required the carrier to identify the location to within 50 - 300-meters of the mobile phone, rather than just identifying the signal tower. The technical process is called “triangulation.” Phase two was complete in 2005.
These location-based services (LBS) operate on all smart phones and are more accurate in metropolitan areas with a higher density of signal towers. Rural areas in South Georgia may not be as accurate in determining the exact location, but should do so within 300 meters. A victim lost in the woods could be as many as 900 feet from the estimated location. That’s equal to about three football fields.
Even so, the odds of being found are better than they were before we could take our mobile devices everywhere. Having excellent area cellular service becomes a much more critical issue for mobile users, considering that it could mean life or death.
Stewart Co. Emergency Medical Services (EMS) manager Ed Lynch told The Journal last week that situations like the recent shooting at a motel in Richland create problems for local EMS and law enforcement. Cell calls to 911 were routed to the Ellaville E911 center because signal towers in Webster Co. transmitted the calls.
The Ellaville center transferred the request for services to the correct E911 center located at the Clay County Sheriff Department. Stewart, Quitman, Randolph and Clay share a consolidated E911 center. It has come under scrutiny prior to this incident.
According to Lynch, calls going directly to the call center in Clay County are not answered by dispatchers as “911,” but as “Clay Co. Sheriff’s Department.” This is confusing to the caller.
Lynch previously served with 911 units on post at Ft. Benning. The problems he’s encountered in Stewart Co. are beyond what one would normally expect, he said.
In the case of the shooting incident referred to in the county, information that the perpetrator had a gun and was threatening another person was transferred from the Ellaville center to the Clay Co. center. The dispatcher in Clay Co. called the Stewart Co. Sheriff’s dispatcher. In the confusion, Richland Police were not told that a gun was involved in the call they made to the motel.
Cases like this, Lynch said, are going to get someone killed. These cases may be isolated, but regional E911 continues to put our first responders in situations that could endanger them and the victims they are trying to reach. One day, someone may pay the highest price, if these lapses aren’t corrected, he insisted.
Lynch also explained to The Journal the costs involved in making a 911 emergency call. He stressed that he didn’t want to discourage anyone who needs emergency medical services to hesitate to call 911.
“Many times, we don’t transport the victims, and there is no cost to them,” he told us. “We are not doctors and we can only give opinions.”
“We can’t make a medical determination, but we can make recommendations.”
If a patient who has called 911 decides not to be transported, they are required to sign a waiver, which releases EMS from liability. This protects the county and the EMT.
The county predetermines the base rate for a 911 response when transport is required. If there are medications administered or other life-saving services required, additional charges are added. There is also a standard mileage rate added.
A 911 response that requires a victim to be transported to Americus, for instance, could cost well in excess of $500, without any life-saving intervention in route. Lynch reported that Stewart Co. EMS has billed more than $641,000 for services since the beginning of 2013.
They are collecting about 66 percent of the charges billed. He also said the county will likely bill close to a million dollars before the end of the year.
“This is more complex than people understand,” Lynch added.
“Our E911 services do not make money,” he said. “It would be nice to break even.”
“We may go four or five days without moving a truck, but we have to be here when we are needed.”
“We have four EMTs on duty at all times in the county,” Lynch explained. “We staff one ambulance in Richland and one in Lumpkin.”
The staffs are on 24-hour shifts, seven days a week. The staffing, Lynch said is achieved with full-timers and part-timers. It’s hard to maintain a full-time staff, he said, but that is the goal for the department.
“The fewer people you have working shifts, the more overtime you have,” Lynch admitted. “That drives up cost.”
Stewart Co. has a mutual aid agreement with Webster Co., as well. Since Webster Co. only has one truck, when they have two calls, Lynch and his staff helps them cover.
Both of Stewart County’s trucks are remounts, but Lynch reported that even with that, they cost $88,000 each. A truck with the emergency unit shell would run around $145,000. That doesn’t include the supplies and the machines that are needed to provide emergency services in transport. A conservative guesstimate for a truck with all the bells and whistles would be around $250,000.
“A cardiac monitor, alone, for one of these ambulances runs $20,000 - $25,000,” Lynch reported.
The original intent of The Journal visit to Stewart Co. EMS was to meet and introduce to the public, Jill Walker. She was recently selected and hired as the billing clerk for the Stewart Co. EMS office. She handles all department contact with the third party billing service and documents billing and payments to the county from various sources, including Medicare, Medicaid, insurance companies and self-pay services – those who are not insured.
Any portion of the services rendered by EMS not covered by other sources is billed to the patient by the third party service. Walker works with patients on their share of the cost for services and self-pay patients to set up manageable payment schedules.
She said the county tries to work with people who owe for services. Walker’s hours are 8 – 4:30 p.m., the same as the Courthouse staff. Her office is in the EMS headquarters on the square in Lumpkin. She knows she’ll be plenty busy, not just learning the job, but helping the county to reach their goal of breaking even on these services some of us would not live without.