November 30th, 2016
From Larry Hansen, Emmet County EMS Director
In November of 2014 I was hired by Emmet County as the new EMS director. At that time I was instructed to start an EMS system and have it ready to operate at 0600 on the first of January 2015.
With the groundwork that had been done by the AAC and Tim Ladd, the team I selected was able to make this happen. Since operations began we have met or exceeded every goal that was given to us.
We had many things to do but one of the most important tasks was to select a team of qualified staff that would work together and were enthusiastic about the new operation. We were able to put together this team and have them begin the orientation process on the 1st of December 2014.
State licensing paperwork was completed and we took delivery of the first six ambulances and stocked them with the required equipment that we needed to keep the staff and patients safe as well as take care of the medical problems of the patients we responded too. State inspections of the agency and all vehicles were completed and we were approved to operate.
Policies and procedures were drafted and approved and distributed to all staff members. Mutual aid agreements were signed with our neighboring agencies and the operational plans for ambulance placement and system status management were implemented. Training on all new equipment was done and the staff were approved to operate within the Medical Control area by the Medical Director.
With staff trained, vehicles and equipment in place and the approval of the State of Michigan Department of Health and Human Services and the Northern Michigan Medical Control Authority, we were able to begin operations assisting Allied EMS between the week of Christmas and New Year.
We formed a billing office with two staff members in January 2015. One staff member was an experienced hospital medical biller and one was a county employee who was trained on-site. She left our operation and a new biller was hired to replace her. She was a graduate of NCMC and was trained as a biller and coder also. Paperwork needs to be filed with Medicare, Medicaid, BCBS and other private insurance companies. We started collections on a limited basis in January but did not have approval from Medicare and Medicaid until April. Once those approvals came through we were able to start collecting retroactive to the start of operations on January 1st for all patients with those payers.
We started with Tri-Tech billing and patient care reporting software because it was what the crews were familiar with from the old operation and the billing staff was also familiar with it. In September of 2016 we were notified by Tri-tech that they were no longer going to provide software for patient care reports. At that point we began investigating other options. Our staff met with a number of ambulance companies that were using different programs and met with the companies offering the programs. After much research it was decided to contract with ESO. The changeover will occur on the first of January 2017.
Training is a huge component of EMS. Initial orientation was provided to all staff members and as new staff come onboard they are also orientated and put through an intensive process that includes online education, policy and procedure review, equipment training and third riding in the ambulances. When the Field Training Officers and Management staff are satisfied with their competency they are put into the schedule. All staff members were behind in required training when ECEMS began operations. There had been no Disaster Training for years at the prior operation and many staff members were in need of required Medical Control training, which was also not provided or mandated by the prior service. Continuing education requirements were not being provided and ECEMS has been committed to ensuring that all staff members are receiving the training they need to relicense and the training they need to meet the standard of care that ECEMS has set forth.
Our ambulances are maintained by highly trained and certified mechanics. We ensure that preventative maintenance and oil and lube service are performed on the recommended schedule. All systems are checked and tire wear inspected each time the vehicle is serviced and we have had very few maintenance issues on our ambulances when we have been transporting patients. We are confident we are driving the safest vehicles on the road.
The bottom line: Patient Care
We make a difference in people’s lives every day. Our No. 1 job is to save lives and take care of the sick and injured and we are all committed to doing that the best we can. On average we treat and transport about 13 times a day. Every patient we care for has friends and family that are affected by what the patient is going through. When you expand that out we potentially affect hundreds of people a day. It is a huge responsibility and liability. We assess and make treatment decisions on every patient we have contact with and are expected to be right 100% of the time, and if we make a mistake the consequences can be grave. We are expected to be knowledgeable in cardiology, pulmonology, endocrinology, neurology, pharmacology, pediatrics, geriatrics, OB/GYN and traumatic injury. We use high-technology medical instruments and are expected to be competent in their use. This is why we train.
There is a huge physical and emotional toll on EMS providers as well. A study by the U.S. National Library of Medicine found that EMS providers are injured at a rate that is three times higher than the national average for ALL occupations. Back injury is number one followed by sprains and strains caused by the cumulative damage of constant twisting, bending, and lifting. EMS providers are assaulted at a much higher rate than other professions. Our fatality rate on the job is on par with police and fire.
The emotional toll is also quite high. We see and deal with horrible tragedy on a regular basis. This summer has seen an unusually high fatality rate in our area. We all outwardly deal with it and take care of our patients and move on but recent studies have shown that the constant nature of our business opens us up to a higher than normal PTSD (Post Traumatic Stress Disorder) rate. Recent studies have shown that 24% of EMS workers will be diagnosed with PTSD at some point in their careers and many more will go undetected or fall somewhere within the spectrum. Suicide rates are twice as high for first responders than the rest of the general population. We have worked hard to develop a culture of caring and support for both our staff and our patients. We are proud of what we, as a team, have developed for the citizens and visitors of Emmet County. We are better trained, better equipped and better prepared to handle any situation than we ever have been before.
We have moved into two new stations and hope to move into the third, in Resort Township, in June of 2017. Station One will be the main station and will be located on Eppler Road near the intersection of Sheridan Street. This spot was chosen after hours of study and time studies for ambulance access to the high volume areas in our service area as well as rapid access to primary roads and intersections. This building with allow us to house our south crews, our billing office and our administration staff all at one location. We will have a general purpose room that will be available for staff meeting and education. In addition, the Sheriffs’ Department will be able to hold snowmobile safety, hunters’ safety and boating safety classes in this area. There will be an office for the Sheriffs’ Department as well as an interrogation room. Storage space in the basement will be used for the large amounts of paperwork that must be kept for decades under the law. The ambulance bays will be utilized by ambulances, the E-car and sheriff vehicles. There is a wash bay to keep the vehicles clean and a maintenance bay where small jobs can be completed.
Station Two is located on M-119 and Pleasantview Road. This was the first station completed and currently houses two primary response crews and the transfer/day truck. This is a prime location as it allows rapid access to Harbor Springs, Alanson and areas north off Pleasantview. Station Three is in Mackinaw City on Central and Louvigny streets. There is one primary crew located in that station. This location allows for rapid access east and west down Central Avenue and rapid access to both north and southbound I-75. We were paying $2,000 a month for the Mackinaw City owned station and we currently pay the City of Petoskey $1,000 a month in rent for the Curtis Street location.
With completion of the third station and the consolidation of our department we will be better able to manage the department as a whole. Medical stores can be moved from their current location and put in a secured area and a supply inventory and par system can be developed and managed with better efficiency and perhaps some cost savings. Supervisory staff will have actual offices and will not have to have their paperwork stored in their personal vehicles or other locations. Billing staff will have direct access to crew members and be available to answer billing and reimbursement questions as they arise. Vehicle maintenance and records can be stored in the same place and a maintenance inventory and stores can be set up for faster management of vehicle issues. Staff education and staff meetings can be held in an area where everyone can sit in the same room and not in hallways and garages. We will not have to work around others’ schedules and we can train when and as we see fit. Supervisory staff will be available for staff questions and issues as well as for interaction with the Director.
Photos as of Nov. 29, 2016 at EMS Station #1, Petoskey:
Christmas and New Year holidays
At 0600 1/1/15 Allied EMS backed their ambulance out and ECEMS moved theirs into the Petoskey station. Because of the teamwork and generosity of the Bear Creek Fire and Harbor Springs Fire Departments, we were able to house an ambulance in the station at Mitchell and Division and we also were given a bay and living space at the Harbor Springs Fire sub-station within the Little Traverse Township Hall on Pleasantview Road. We rented the old Mackinaw City EMS station and kept a back-up vehicle in the City Building to cover the north end of the county.
We started off with 17 ambulance runs the first day of operations and it went smoothly. We started the service with five newly purchased ambulances and ultimately purchased two 2014 Braun ambulances from Allied EMS and two from Mackinaw City. We currently have 8 ambulances in our fleet and an E-car which was added in November 2016. Four crews were initially scheduled and after the first four months of operation we noted that we had turned down approximately 80 requests for transfers. In addition to not being able to provide service to our customers and the realization that we were missing out on income opportunities it was decided to add a 12-hour transfer/day ambulance from 1000 to 2200 Monday thru Saturday. This was based on data collected that showed this was the period of time we were most likely to be dispatched on a transfer. Since this staffing model has been in place we have had to turn away fewer transports.
We were given the task of meeting or exceeding the American Ambulance Associations standard of responding to our ambulances from dispatch time in less than 2 minutes at least 90 % of the time and having a response time to the scene of 8:59 minutes at least 90 % of the time by the Medical Control Director. Since starting operation we have met that goal and have improved our response times over the previous service and over our first year of operation.