EMS crews say hospital is trading safety for savings

August 22, 2004

By JOHNNY JOHNSON, The Daily Sentinel

NACOGDOCHES, Texas - When Nacogdoches County Hospital District officials

admitted two weeks ago that they had scaled back ambulance coverage three nights

a week, administrators said they were not really cutting back any services, but

they were looking at ways to save money by " working smarter. "

A local firefighter, along with a handful of paramedics and emergency medical

technicians who would only talk on a condition of anonymity, have a different

version of that story - that the hospital is routinely sacrificing public safety

to save a few dollars.

In the early hours of Monday, Tuesday and Wednesday, the number of on-duty

ambulances has been reduced from three to two, with a third crew on call.

Hospital administration has said that the ambulance service only averages about

1.5 calls per night, during those times, and it may not be the best use of tax

dollars to keep three crews ready when a third crew is not needed.

Ricky Ivy says he is just a concerned resident, who also happens to be a

firefighter with the city of Nacogdoches. And in his opinion, cutting back on

coverage, even in the slowest hours of the week, is a big mistake.

Ivy said he knew of a couple of instances where people have had to wait several

minutes for EMS crews to arrive on the scene, and in emergency situations,

minutes count.

Nacogdoches firefighters and EMS were dispatched at 5:52 a.m. July 19 to a

CPR-in-progress sick call at Pinecrest Nursing Home.

Fire Lt. Shepard was one of the first-responders at the scene, arriving

at 5:57 a.m., and he wrote the following narrative about the response:

" There was not an EMS crew on duty at Station No. 3. They had to come from their

central station. On arrival, we found nursing home staff doing CPR on the

patient in the floor of her room. We helped the nursing home staff with CPR and

airway until the EMS crew got on the scene. We then provided a driver for EMS. "

Paramedics say firefighters were " working that code " for nearly 10 minutes

before an ambulance arrived on the scene.

Both Ivy and paramedics confirm that the elderly patient died, but they could

not say the outcome would have been any different with an ambulance crew

stationed at the nearby Station 3, ready to go with firefighters.

The point that Ivy said he was trying to drive home was that accidents can

happen anywhere at any time, and if a major event occurred, a 30-minute response

time from a backup crew might not cut it.

" All I'm saying is that those people are the ones who are gonna save your life, "

Ivy said.

And from what Ivy has seen, even three ambulances are not always sufficient,

because when someone is really hurt, it may take two paramedics in the ambulance

" working on them " while a firefighter leaves his truck to drive the ambulance to

the hospital.

" The bottom line is that EMS crews are emergency services, " he said. " That

should be the last thing you cut. Somebody could die because of this. "

Nacogdoches Memorial Hospital officials say they do not believe they are

chipping away at emergency medical services, because any time one of the two

ambulances responds to a call, the on-call team hits the road and goes to work.

Three paramedics, who would comment only on the condition of anonymity for fear

of losing their jobs, disagree with the administration's version.

According to all of the EMTs, it's up to the supervisor's discretion whether or

not to call in backup. And if that call for backup does go out, the on-call crew

has 30 minutes to respond.

EMS employees also say that even though it is up to the supervisors to decide

when to call in backup, the supervisors are also informally discouraged from

calling a crew back in, unless absolutely necessary.

One EMT said they were told directly not to call the on-call crew out, unless

both the other units were out, and another emergency call comes in.

Another EMT said he has never seen the on-call team called out, including five

or six instances when one unit was out on a run, and two instances when both

ambulances were on runs.

" I've actually gotten in trouble before for calling a crew in, when I had a unit

available, " the EMT said.

EMS employees say they know of more than one incident when people have had to

wait up to 20 minutes for an ambulance, but EMS dispatchers were told, in no

uncertain terms, that they could not call a private ambulance service to help

pick up the slack.

One EMT said upper management in the hospital became upset when they heard that

a supervisor was going to " punt " an emergency call over to GoldStar, a private

ambulance service.

" We have been told in no specific terms, and you won't be able to find this in

writing anywhere, but we were told that under no circumstances would GoldStar

ever be called to make a 911 call for us, " an EMT said. " So if the hospital

really is concerned about taking care of the people of Nacogdoches County and

not taking care of their money, why shouldn't we be allowed to 'punt' it over to

(GoldStar) if we get in a bind, instead of making someone wait 20 minutes for an

ambulance? "

Y'Barbo, director of emergency services, said the reason that supervisors

are told not to contact GoldStar is because Nacogdoches County EMS has every

resource it needs to do the job themselves.

If EMS service gets backed up, Y'Barbo said, supervisors are encouraged to call

him at his house, and he will come in and man an ambulance, if he needs to.

EMTs say they know that some people may dismiss their comments, saying that they

are upset about the effects the cutbacks will have on their salaries if they are

not allowed to get overtime, but each of them says that is simply not the case.

" Most of us don't care about the money, " one EMT said, pointing out that the

starting pay of about $10 could be beat at several local industries.

" We do this because we care about our work, we enjoy doing what we do, and we

have flexible hours and time to spend with our families, " he said.

" One of the things that concerns us the most is that a majority of the people in

the ambulance service live and work in this community, " another EMT said. " I

don't want my family to have to wait on an ambulance if they ever get into a

major situation. "

The emergency response is unpredictable, the EMT said, but major wrecks are more

likely to occur at night, either because people may be driving faster or because

drivers are more likely to be tired or intoxicated.

In the event that the accident is a two-vehicle accident with both drivers

severely injured, it would automatically max out the ambulance service, during

those hours, according to EMTs. And if just one of those vehicles had a single

passenger who was also critically injured, one of the victims would have to wait

for up to 30 minutes before a third ambulance could make it to the scene.

August 22, 2004

When supervisor start endangering the public it is time for the supervisor to

move on. Anamosa calls to a private service might occur if there is not a

written area law forbidding a private service from running private emergency

calls in response to the public.

=========================================

EMS crews say hospital is trading safety for savings

By JOHNNY JOHNSON, The Daily Sentinel

NACOGDOCHES, Texas - When Nacogdoches County Hospital District officials

admitted two weeks ago that they had scaled back ambulance coverage three nights

a week, administrators said they were not really cutting back any services, but

they were looking at ways to save money by " working smarter. "

A local firefighter, along with a handful of paramedics and emergency medical

technicians who would only talk on a condition of anonymity, have a different

version of that story - that the hospital is routinely sacrificing public safety

to save a few dollars.

In the early hours of Monday, Tuesday and Wednesday, the number of on-duty

ambulances has been reduced from three to two, with a third crew on call.

Hospital administration has said that the ambulance service only averages

about 1.5 calls per night, during those times, and it may not be the best use of

tax dollars to keep three crews ready when a third crew is not needed.

Ricky Ivy says he is just a concerned resident, who also happens to be a

firefighter with the city of Nacogdoches. And in his opinion, cutting back on

coverage, even in the slowest hours of the week, is a big mistake.

Ivy said he knew of a couple of instances where people have had to wait

several minutes for EMS crews to arrive on the scene, and in emergency

situations, minutes count.

Nacogdoches firefighters and EMS were dispatched at 5:52 a.m. July 19 to a

CPR-in-progress sick call at Pinecrest Nursing Home.

Fire Lt. Shepard was one of the first-responders at the scene,

arriving at 5:57 a.m., and he wrote the following narrative about the response:

" There was not an EMS crew on duty at Station No. 3. They had to come from

their central station. On arrival, we found nursing home staff doing CPR on the

patient in the floor of her room. We helped the nursing home staff with CPR and

airway until the EMS crew got on the scene. We then provided a driver for EMS. "

Paramedics say firefighters were " working that code " for nearly 10 minutes

before an ambulance arrived on the scene.

Both Ivy and paramedics confirm that the elderly patient died, but they could

not say the outcome would have been any different with an ambulance crew

stationed at the nearby Station 3, ready to go with firefighters.

The point that Ivy said he was trying to drive home was that accidents can

happen anywhere at any time, and if a major event occurred, a 30-minute response

time from a backup crew might not cut it.

" All I'm saying is that those people are the ones who are gonna save your

life, " Ivy said.

And from what Ivy has seen, even three ambulances are not always sufficient,

because when someone is really hurt, it may take two paramedics in the ambulance

" working on them " while a firefighter leaves his truck to drive the ambulance to

the hospital.

" The bottom line is that EMS crews are emergency services, " he said. " That

should be the last thing you cut. Somebody could die because of this. "

Nacogdoches Memorial Hospital officials say they do not believe they are

chipping away at emergency medical services, because any time one of the two

ambulances responds to a call, the on-call team hits the road and goes to work.

Three paramedics, who would comment only on the condition of anonymity for

fear of losing their jobs, disagree with the administration's version.

According to all of the EMTs, it's up to the supervisor's discretion whether

or not to call in backup. And if that call for backup does go out, the on-call

crew has 30 minutes to respond.

EMS employees also say that even though it is up to the supervisors to decide

when to call in backup, the supervisors are also informally discouraged from

calling a crew back in, unless absolutely necessary.

One EMT said they were told directly not to call the on-call crew out, unless

both the other units were out, and another emergency call comes in.

Another EMT said he has never seen the on-call team called out, including five

or six instances when one unit was out on a run, and two instances when both

ambulances were on runs.

" I've actually gotten in trouble before for calling a crew in, when I had a

unit available, " the EMT said.

EMS employees say they know of more than one incident when people have had to

wait up to 20 minutes for an ambulance, but EMS dispatchers were told, in no

uncertain terms, that they could not call a private ambulance service to help

pick up the slack.

One EMT said upper management in the hospital became upset when they heard

that a supervisor was going to " punt " an emergency call over to GoldStar, a

private ambulance service.

" We have been told in no specific terms, and you won't be able to find this in

writing anywhere, but we were told that under no circumstances would GoldStar

ever be called to make a 911 call for us, " an EMT said. " So if the hospital

really is concerned about taking care of the people of Nacogdoches County and

not taking care of their money, why shouldn't we be allowed to 'punt' it over to

(GoldStar) if we get in a bind, instead of making someone wait 20 minutes for an

ambulance? "

Y'Barbo, director of emergency services, said the reason that

supervisors are told not to contact GoldStar is because Nacogdoches County EMS

has every resource it needs to do the job themselves.

If EMS service gets backed up, Y'Barbo said, supervisors are encouraged to

call him at his house, and he will come in and man an ambulance, if he needs to.

EMTs say they know that some people may dismiss their comments, saying that

they are upset about the effects the cutbacks will have on their salaries if

they are not allowed to get overtime, but each of them says that is simply not

the case.

" Most of us don't care about the money, " one EMT said, pointing out that the

starting pay of about $10 could be beat at several local industries.

" We do this because we care about our work, we enjoy doing what we do, and we

have flexible hours and time to spend with our families, " he said.

" One of the things that concerns us the most is that a majority of the people

in the ambulance service live and work in this community, " another EMT said. " I

don't want my family to have to wait on an ambulance if they ever get into a

major situation. "

The emergency response is unpredictable, the EMT said, but major wrecks are

more likely to occur at night, either because people may be driving faster or

because drivers are more likely to be tired or intoxicated.

In the event that the accident is a two-vehicle accident with both drivers

severely injured, it would automatically max out the ambulance service, during

those hours, according to EMTs. And if just one of those vehicles had a single

passenger who was also critically injured, one of the victims would have to wait

for up to 30 minutes before a third ambulance could make it to the scene.

August 22, 2004