The times, they are a-changing.
Throughout the state, Emergency Medical Services (EMS) are being revised with many counties opting for completely paid systems. Gone are the days of neighborly volunteers answering the call and the Madison County Rescue Squad (MCRS) worries it might be next.
The relationship between MCRS and the county’s paid EMS, MEMS, has been slowly evolving. The paid system was created in 1998 as support for the volunteers. Since then, EMS has consistently ran daytime calls, unless more staff is needed in which volunteers are alerted and respond. Volunteers cover nighttime hours, with each choosing a set day of the week. They are required to be at the squad house on their chosen day from 6 p.m. to 5 a.m. There is also a paid medic on duty every night to respond to advanced life support (ALS) calls. One medic is required to respond with volunteers to ALS calls whereas a medic is not needed for basic life support (BLS), or less serious calls. The MCRS does not have medics, but rather EMTs which MEMS does not have.
However, with a decrease in available volunteers to run calls, MCRS began requesting additional coverage by paid staff, both in 2018 and 2019. As a result, three new medics were hired by MEMS at approximately $62,000 each and eventually, MEMS began operating under 24 hour shifts.
In June 2019, a new MOU between MEMS and the squad was agreed to and signed. The MOU states that EMS will provide two advanced life support ambulances 24/7 with volunteers assisting when additional coverage is needed. The volunteers will provide BLS staffing per their established response plan, with an annual exception report submitted to the county administrator for review. The EMS Lieutenant or designee will provide ALS backup for the volunteers when possible and at 6 p.m. the volunteer crew leader and EMS Lieutenant or designee will communicate that evening’s staffing plan. In addition, the MOU states that there is no discussion on the dissolution of the volunteer squad and that volunteer contributions are integral in the success of the county’s EMS system. The MOU was signed and reviewed by squad officials Steve Grayson and Wayne Jones as well as MEMS Director Noah Hillstrom before being approved 5-0 by supervisors.
During this year’s budget discussions, supervisors faced a shortfall and a result, requested 1% cuts be made across the board. Included was a $25,000 cut to the county’s annual MCRS donation, reducing it from $100,000. That decision was reversed, when according to board of supervisors chairman Clay Jackson, the squad noted it couldn’t afford the reduction. However, the county did decide that an updated memorandum of understanding (MOU) was needed with the rescue squad. The squad agreed.
However, it seems like negotiations have come to a halt.
County administrator Jack Hobbs said a letter was sent to the MCRS in June asking to discuss the county’s existing MOUs, of which there are several, with the squad. The county sent a proposal for changes, and it’s been discussed, but no decisions have been made.
Hobbs said the MOU would still allow the MCRS to run calls, but they would do so under county leadership, particularly Hillstrom.
“Part of the problem is we have multiple MOUs and we need to get them all in one box,” Hobbs said.
He said the idea would be multiple crews under one roof, so to speak, with the lieutenant in charge determining how the call is answered. Being that MCRS can only answer basic life support calls, Hobbs said it doesn’t make sense for them to have “first due,” which he said should lie with MEMS which can answer advanced life support calls. The volunteers would still fill in when able, as well as handle some transports and standby duties at various events.
Jackson agreed, stating the county, including himself, Hobbs, supervisor Charlotte Hoffman, Hillstrom and Emergency Management Coordinator John Sherer has met with leaders of the squad, including their newly hired attorney Jack Berry, three times to discuss the proposed MOU. He said the proposed agreement represents the direction the board sees EMS moving, which is changing throughout the state. In return, the squad requested a 12-month study period led by active members, which Jackson said the board isn’t interested in.
“We feel we had a committee that worked on this a long time,” he said. “The idea is to still utilize the volunteers through basic life support calls, but take over the paperwork.”
Not so, says the rescue squad. In a letter to citizens issued last week, squad officials said the organizations role in providing emergency services would end, with its responsibility shifted almost exclusively to fundraising and public relations. The letter also took issue with the development of the proposed MOU in closed session, without citizen input.
According to meeting minutes, the supervisors discussed the MOU in closed session three times in July and August, which is legally allowed since it represents contract negotiation.
Jackson said the idea the squad would be reduced to fundraising and public relations is not correct.
“We have been very clear [they] will continue running basic life support calls,” he said.
Jackson said the board has tried to be encompassing in working with the volunteers, but the volunteers don’t like the direction it’s moving.
“We’re engaging constantly to find a solution that works for both parties,” he said.
No talk of pulling money has occurred, Jackson and Hobbs said, although both acknowledged that a large portion of the annual $100,000 county contribution to the squad is for the usage or rental of its equipment. The county currently rents the squad’s two ambulances for a total of four (the county owns two of its own). However, the county has plans to purchase two new ambulances through CARES Act funding, making renting equipment unnecessary. The rental agreement expires June 30, 2021.
“We wouldn’t particularly need to rent equipment from them, but we see great value in working with them,” Jackson said. “The business of EMS has changed and we have the potential to preserve the volunteer rescue squad and work with them for the benefit of the citizens.”
Jackson said the board also hasn’t discussed pulling the revenue recovery funds the squad receives when running a call or the $150,000 that was contributed annually for four years to build a new squad building.
“That’s not part of the conversation,” he said.
Jackson added that the supervisors have no intention of shutting the squad down.
“We prefer to be cooperative,” he said, stating the county feels like the proposed MOU moves in the “direction best for Madison County citizens in their most trying times.”
It’s unknown when a decision will be made on the MOU between the county and the squad. Hobbs said the two are still in discussion, but at some point the county will have to act.
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