By John Green
Hutchinson News – November 30, 2016
Photo by Sandra J. Milburn
For the first time in some 18 months, Reno County’s ambulance service is fully staffed, formal protocols are now drafted that will allow rural fire services to once again make emergency medical calls, and local paramedics and EMTs are in new uniforms.
That’s after just five months on the job for Terry David, Reno County’s new director of Emergency Medical Services.
Moreover, David, 63, promised that more changes are on the horizon.
With a 30-year career in EMS, including 21 years as Rice County’s EMS director, David changed his title from director to EMS chief and named interim director David Trotter as deputy chief of EMS operations.
“Reno County was the largest service in the state without an operations manager,” said David, who also retitled daily “team leaders” as “division chiefs.”
With the hiring of eight new paramedics, the ambulance staff is to a full complement of 32 paramedics and seven EMTs, including on-call staff, covering three 24-hour shift rotations.
The employees are in a uniform of a white button shirt and black pants, now provided by the hospital and which David feels looks more professional. The shirts include a patch featuring a new logo, with the medical “Star of Life” in the center of the Hutchinson Regional Medical Center symbol. After 10 p.m., personnel on duty can switch to department-designed T-shirts.
“We’re busy,” David advised the Reno County Commission during a recent commission meeting. “We have a lot of calls that require transfer of people to Wichita and at times we didn’t have the staff to do it.”
“When I left 25 years ago,” said the chief who originally started with EMS at Hutchinson Hospital in 1986 but left to be an administrator, “we ran 2,500 calls a year. We are on target to hit 6,000 this year. The population hasn’t grown, but the population is getting older.”
The previous staff shortage, David said, resulted in 2,055 hours not fully covered between June and September and, consequentially, lots of overtime.
The 10 people on each shift include a street supervisor, two staff each at Arlington and at the downtown Hutchinson ambulance station, and the rest at the hospital.
Each shift works 24 hours on and then 48 off, with shifts starting at 7 a.m. daily.
“We have so many long-tenured that we have a lot of accumulated sick leave and paid time off and vacation,” David said. “We’ve got somebody off almost every day.”
He has changed the agency’s time-off policy, requiring advanced approval for time off over a certain level, David said.
He is also working to add part-time paramedics to fill in, though employees are still guaranteed more than 800 hours of overtime a year based on the work schedule.
They have contemplated going to 12-hour shifts, which Sedgwick County has implemented, David said, but “kids coming out of any paramedic program don’t want to work for less money because they’re working less hours. They want the same at year’s end.”
It would also require double the staff to have day and night shifts, and filling current positions was difficult enough, he said.
The lack of a medical director and uniform countywide response protocols has been preventing rural fire services and volunteer EMTs from running on medical calls. That was one of the drivers behind residents and business owners in the Pleasantview area seeking new fire-district boundaries last summer.
Working with the emergency room at the hospital, they have drafted the new protocols, though are not yet distributing them pending printing of some 65 copies by the Reno County Emergency Management office.
“We have over 200 EMTs or paramedics in the county,” David said. “I was given a printout of everyone who is certified and living in Reno County, and found half our staff lives someplace else, Wichita or Derby. If there is an EMT, they can only respond if they have the medical direction and protocols to operate under. They wanted a duty to act, but there was not a firm set of guidelines,” David explained.
The protocols are basically an algorithm that is based on who responds.
“If it is a certified paramedic, an EMT or a first responder, the algorithm tells each of them what they can do,” David said. “For example, if they go for chest pains, they start at the top of the algorithm. They can do certain things like apply oxygen. As they get to the different skill levels, it flows into what each level can do for that particular patient.”
They are exploring how to develop the protocols into a computer or phone app.
“We’ve been meeting with the folks at Nickerson, Haven, Pretty Prairie and Trail West,” discussing training, the protocols and other needs, David said. “We plan to do that three times a year. Haven and Pretty Prairie have their own separate ambulance licenses, but they face the same problems as across the county of maintaining volunteer staff.”
The service is implementing a new patient reporting system because its current system, supplied by the state under an annual contract, “is going away Dec. 31,” David said. The new system, which “went live over the last 30 days,” allows crews using iPads to enter information during a call, such as an EKG readout, and transfer it directly to the hospital.
“As with any new software, we’ve got some bugs to work out,” he said.
He is also looking at acquiring a different type of ambulance for the service that is smaller than what they currently use and costs half as much to purchase. It operates inside a van with an elevated top.
“We do a lot of transfers to Wichita for more advanced care, and we’re looking at buying a sprinter, a smaller ambulance on a Mercedes frame,” David said.
A number of other smaller area services use them, since they cost much less than a typical ambulance. The smaller interior means less room for equipment, but they are already carrying much less equipment than in the past, and most transfers are stabilized patients not requiring everything carried in a typical ambulance.
“One of the things Butler County told me is once the employees start working out of them, they get used to it and like the way it’s set up,” David said. “It’s easier to run an emergency call out of them, too, but there is a learning curve, a change in thought process.”
Another area he is examining for change is how the service respond to calls.
“We don’t need a $200,000 ambulance and $400,000 fire truck responding for someone who’s been sick for five days,” David said. “Our greatest liability is wrecking trucks, not patient care.”
“We’re looking very carefully at how long it takes to run with red lights and siren versus not running with red lights,” he said.
For example, he timed a couple of runs from Hutchinson hospital to Wesley Medical Center and found using lights and sirens cut the drive by just eight minutes. In town, he made a non-emergency run from Second and Adams to an incident on East Fourth Avenue and, even stopping for traffic lights, arrived before the ambulance and fire truck were on the scene, he said.
“We haven’t (changed policies) yet, but along with the fire department we’re having real discussions,” he said. “We’re waiting to gather more data.”
Reno County Commission Chairman Dan Deming praised David for examining the issue.
“That’s a huge step in the right direction,” Deming said. “I’ve been trying to get it done for 25 years.”
David also plans a longer-term study on call volumes to adjust where ambulances respond from for certain parts of the city or county.
“The response areas have been the same for 35 years, but the population has shifted, the call volume has shifted,” David said. “The station behind the courthouse, for example, responds all the way north to Wesley Towers retirement center. With having more personnel at the hospital, it might make sense to have a crew from the hospital go to that part of the community, rather than from downtown.”
“Honestly, though, we’re so busy anymore it’s pretty much who we’ve got available that responds,” he said. “We need to do this in concert with the entire county, to look at where the runs are and if the stations are in the best places.”
Meanwhile, David is planning minor upgrades at the existing ambulance stations at 209 W. Second Ave. and Arlington.
“They have been neglected,” he said. “It’s not anybody’s fault. The Arlington station is a rough place to live. They’re interested in doing some improvements out there with their fire facility.”
One other longer-term study David would like to have done is similar to one recently completed in Harvey County, that drilled down into 911 call addresses, and discovered a large percentage of that agency’s calls were from just a few addresses.
Many of those users did not need emergency medical attention, but relied on 911 to respond to other needs.
“It’s called integrated community para-medicine,” David said. “A lot of smart people around the country have been successful in doing it, but we’d have to design a system that makes sense for our community.”
“A number of stakeholders and players would have to be engaged to have those conversations,” he said. “When I took the job it was one of my goals, but with a three- or four-year implementation period on it.”
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