By Brad Hicks
Unicoi County Sheriff Mike Hensley said he has pulled the numbers and has noticed a trend – one he feels needs to be addressed immediately.
“We can do better than this,” he said. “We have to do better than this.”
The sheriff said he believes there are simply not enough ambulances in Unicoi County to meet the county’s needs. He said reports from Unicoi County 911 indicate that over the past two months there have been 14 separate occasions in which someone contacted 911 but no ambulances were available.
“My main complaint is there are not enough ambulances here to meet the needs of the people here in Unicoi County,” Hensley said.
Hensley made his feelings on the topic known throughout last week, starting with a July 19 post to the Unicoi County Sheriff’s Department’s Facebook page. That post was made one day after an accident on Interstate 26 near the Unicoi Walmart in which Hensley said no ambulances were available. Hensley said members of Unicoi Volunteer Fire Department and local off-duty EMS employees shopping at the store responded to stabilize the injured patient until an ambulance became available.
“Citizens of Unicoi County, as your Sheriff I am informing you we have a serious problem concerning Ambulance Service,” Hensley wrote in the Facebook post. “There is not enough Ambulances here to meet the needs of our county. There is documented evidence on several occasions we have called for an Ambulance, and there was not one available in Unicoi, Carter, or Washington Counties. The EMS workers we have do an excellent job. Yesterday there was an accident near Wal Mart with injuries, no ambulance available. I want to commend the Unicoi Fire Department and off duty EMS persons who responded and stabilized the patients until an Ambulance was available. It is not my job to negotiate Ambulance Contracts, BUT it is my job to inform the Legislative bodies of this county & cities, as well as the citizens when a serious safety or security problem exist. You have been informed.”
MedicOne Medical Response has served as Unicoi County’s ambulance services provider since 2011. Under its original contract with the company, the county paid to MedicOne an annual subsidy of $180,000. But as the April 1, 2015, expiration of the original contract approached, county officials began to express concern that the county could no longer afford the subsidy.
This would lead MedicOne to having to rebid on the county’s ambulance services. Per its bid submitted early last year, the company would require a $132,000 annual subsidy under the new contract. The bid was approved by the Unicoi County Commission in February 2015.
Hensley again expressed his concerns during a July 20 meeting of the County Commission’s Budget and Finance Committee after Unicoi County Commissioner Loren Thomas suggested that county officials look at the possibility of increasing the subsidy paid to MedicOne to allow for more ambulance coverage.
“We have got a serious problem and it needs to be addressed immediately,” Hensley said to members of the committee. “We do not have enough ambulances in this county to do what we need to do.”
Under its current contract with the county, MedicOne is required to operate two 24-hour ambulances – a requirement that Hensley said the company is meeting. And, as he stated in his Facebook post, Hensley said the problem is not MedicOne’s employees.
“The EMS workers that we have here do an excellent job, an excellent job. No problem whatsoever,” he said. “The problem is there’s just not enough to go around.”
Because situations requiring emergency medical response are impossible to predict and can occur at any time, Hensley said Unicoi County needs more ambulances that are ready, as minutes and seconds count in such situations.
“Two ambulances cannot meet the needs of Unicoi County now,” he said.
The sheriff added that he took to social media to voice his concerns as it is his responsibility as Unicoi County’s top law enforcement official to make fellow county officials and residents of the county aware when a safety or security issue exists.
Also, as he stated in his Facebook post, Hensley said it is up to the Unicoi County Commission to come up with a solution to the issue.
“There’s no question in my mind I have done my duty. The people know,” he said. “It’s not my job to work this problem out. It’s not my job. But it is my job to say, ‘Look, we have got a serious problem and you need to address it and address it immediately,’ and I have done that. The rest of it lies on (the Unicoi County Commission’s) shoulders.”
Lt. Stacy Wigand, public information officer for MedicOne, said that no local ambulances are available is an inaccurate statement. Instead, Wigand said it would be more accurate to state that, in some instances, response times are higher than the average.
“The statement that there is an ambulance unavailable is wrong,” he said. “That’s not the case. If there was truly an ambulance unavailable, then that would result in that patient needing to be transported to the hospital by other means, and that is not the case. I don’t think there is one documented case where there was literally no ambulance available and that patient was forced to be transported to the hospital, either by themselves, by family members or other means.
“The problem is not that we have no ambulances available. It is that the response time is delayed.”
Wigand said a third 24-hour ambulance would be “ideally beneficial” to Unicoi County, but this is not fiscally feasible due to several factors, including funding, staffing and an increased number of out-of-county transports.
Wigand said it was the county’s decision to reduce MedicOne’s subsidy was perhaps the first domino to fall.
“We cautioned the county back during the negotiations, ‘If you cut our subsidy that much there will be cuts. We have to make cuts,’” Wigand said.
But the lower subsidy is not the only area in which MedicOne has seen reduced revenues. Wigand said the passage of the Affordable Care Act led to significant losses in insurance reimbursements, such as those from Medicare.
Maintaining a full staff has also presented an issue, Wigand said. Like Hensley, Wigand said there is a shortage of EMTs and paramedics throughout the state of Tennessee, both because government-operated ambulance agencies have the ability to provide better employee benefits than private companies like MedicOne and because EMTs and paramedics are finding better paying jobs outside of the emergency services field.
“Even if we had four ambulances sitting there and the funding, I don’t think we would even be able to staff them,” Wigand said. “We don’t have the staffing, and it’s not just us. We’re struggling to keep our staffing as it is with the trucks we have simply because there’s such a shortage.”
MedicOne has also realized a recent increase in out-of-county transports, both Hensley and Wigand said. Wigand said more local patients and residents of Unicoi County’s nursing homes are being transported by MedicOne ambulances to facilities such as Sycamore Shoals Hospital in Elizabethan and the Johnson City Medical Center. Such transports tie ambulances up for longer periods of time, Wigand said.
Once a patient is transported to a hospital, Wigand said that a briefing of aid offered by EMS crews must be provided by hospital staff and crews must wait until the facility accepts the patient.
“So we’re at their mercy,” Wigand said. “If they’re busy…We’re at their mercy. We can’t just walk in and say, ‘Here you go. Bye.’”
Wigand said MedicOne’s current average response time in Unicoi County is around 11 minutes 34 seconds, lower than the national average of more than 19 minutes in rural areas. He said prior to last year’s renegotiation of the company’s contract, local response times were around 8 minutes.
Wigand also said Ken Tipton, MedicOne’s operations manager in Unicoi County, compared local ambulance agencies and found that the ratio of ambulances to the county’s overall population is better in Unicoi County than in Washington or Carter counties.
MedicOne President and CEO Jim Reeves is intending to visit Unicoi County in the near future to speak with county commissioners and discuss possible options for additional funding, Wigand said. A timetable for Reeves’ trip to the county has not yet been set, but Hensley told commissioners during the July 20 Budget and Finance Committee meeting that he has spoken with Reeves and he is open to speaking with county officials to “try to work something out.”
“MedicOne takes the concerns of (Unicoi County’s) citizens to heart,” Wigand said. “At MedicOne, our corporate leadership, our local leadership, we feel like the residents of Unicoi County are family to us. We don’t want them with the image that they’re not going to have an ambulance. It’s not that an ambulance isn’t available. There will still be an ambulance coming to them, but it may take a little bit longer.”