News

Rural/Metro, Tenn. County Working Together

Gerald Witt

08/20/2015

Aug. 20--A triage system, basic life support ambulances and a little patience are expected to help Rural/Metro response times better meet a 10-minute standard, according to Knox County's Health Department director.

"Rural/Metro staff are really making an effort to improve service for the community," said Dr. Martha Buchanan, head of the county's health department. "They're working really hard to improve staffing, but that's not something that happens quickly or overnight."

On July 1 Knox County officials sent a letter to Rural/Metro demanding action to improve response times, address staffing for shifts and to explain their calls for mutual aid. The letter from Knox County Purchasing Director Hugh Holt also pinpointed two instances in April when Rural/Metro had no ambulances available.

County officials and Rural/Metro staff have said those events, known as "level zero" situations, did not affect actual emergency response, as backup plans are in place to send ambulances in those times. Also, first-responders such as firefighters typically arrive before ambulances, they said.

But the letter did spark scrutiny of the county's longtime ambulance provider, and started a conversation on how Rural/Metro could improve.

Both parties want to limit the times those "level zero" moments occur in the future. According to Rural/Metro officials, staffing levels and use of resources are key to avoiding that problem.

Added ambulances for basic life support calls will help keep paramedics available on advanced life support ambulances for other emergencies, according to Rural/Metro officials.

"It's a tiered system," said Erin Downey, regional director for Rural/Metro in East Tennessee. "It's pretty standard across the country."

The system is new here, and came as a result of multiple conversations between emergency and medical personnel that rely on ambulances.

Until recently, the same ambulances that responded to a heart attack call were the same that answered a call to move someone between hospitals, transport a body to the county's regional forensic center for autopsy, or handle an emergency psychiatric call.

With the county's blessing, Rural/Metro now has separate vehicles to transport hospital patients, take psychiatric emergencies to emergency rooms and deliver the deceased to the forensic center, Downey said.

"Everybody's emergency is their emergency," she said, adding that emergencies can cover a broad scope of issues, "whether it be chest pain or a mental health patient who has needs that are nonlife-threatening."

Basic life support ambulances, which won't have more highly-trained paramedics on them, will answer some calls under the new system.

"We have EMTs who are trained medical professionals, therefore freeing parametic-level ambulances," Downey said. "Historically, (county policy) said you have to send a paramedic to every single call, regardless."

And at scenes where a deceased body needed transport for autopsy, that sometimes meant a wait of an hour or more until an ambulance could arrive, according to an email received through a News Sentinal public records request.

On July 17, John Lott, senior director of the county's regional forensic center, emailed Holt to notify him that medical death investigators were being held up while waiting for an ambulance to transport a body.

"I realize that coming to pick up and transport a deceased body is not a priority for Rural Metro," Lott wrote. "However, when we have elongated wait times for Rural Metro to pick up the body, it means that we could have law enforcement at another scene waiting on my Medical Death Investigators to get to another scene to do the investigation and get the scene cleared."

Downey said that a separate, non-ambulance vehicle will respond to those calls. It's being prepped now, she said.

"The focus is really on the appropriate level of response," she said.

Otherwise, the company is offering bonuses to employees to incentivize night or weekend shifts on ambulances. And a new crop of interns are in training to become EMTs at Rural/Metro.

"We're working aggressively to hire EMTs and paramedics," she said. "And offering signing bonuses."

Both Buchanan and Downey agreed communication between the county and its ambulance provider is more open since the letter and meetings between staff from both parties.

"Open communication is a positive part of any relationship," Buchanan said. "What we see is they're really doing the things that they need to do to improve service."