WV’s EMS agencies also want COVID-19 assistance

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It’s difficult to predict where a worker will end up during a 24-hour shift at the Boone County Ambulance Authority.

A car wreck in the middle of the night on the outskirts of rural county. An unconscious overdose who needs a dose of naloxone to recover. A sick baby in a cradle. Travel as far as Pennsylvania or Ohio to transport a patient because all the surrounding hospitals are full or not accepting patients.

One Friday in mid-October, a COVID-19 positive nursing home resident with respiratory complications takes Camron and Shawna Ramsey out of Danville station in Boone’s newest ambulance. The married couple return two hours later, just after another crew returned to the station after being away all morning.

Between bites at the station’s dining table, the four discuss work in emergency medical services during the pandemic. They are stretched and feel underrated compared to other healthcare workers.

“The hospital [staff] was considered frontline heroes, which is good and understandable, ”said Camron Ramsey. “But everyone is forgetting the EMS.”

In West Virginia, that even includes the governor.

In September, Governor Jim Justice announced he would allocate additional funds to hospitals and nursing homes. The new initiative, dubbed Saving Our Care, would help pay for the additional expenses incurred during the surge of the Delta variant. Health officials applauded the governor for the program.

But from Boone County EMS, the governor’s office received an email, asking “what about us?”

“So for 6 days I sat on my hands and remained silent, but with each passing day I am more and more upset by Governor Jim Justice’s announcement regarding the ‘Save Our Care’ plan” , begins the email from Boone County Ambulance Authority to Director of Operations Joseph Smith, obtained through the Freedom of Information Act. He said that while he understands the need to help hospitals and nursing homes, EMS services face the same challenges.

“My heartburn lies squarely in the fact that not once has EMS been mentioned. We all know and fully understand that EMS is and always will be the forgotten piece of the healthcare puzzle.”

Her boss, Bryan Justice, said being left out in this round of governor’s office funding reflects a longer-term trend, which has relegated EMS departments and staff to the back of the line when people are talking about frontline workers.

For Justice, the executive director of the Boone County Ambulance Authority, Saving Our Care would have been a short-term, but useful, solution for his department. But he is more concerned about what follows.

“We have to find a solution to finance the SME. If we don’t, in a few years there may be no more EMS agencies in some counties, ”he said. “If there is one essential service needed in our rural counties, it is EMS. We’re the only health care some of these people see. “

“We bleed people in EMS”

Bryan Justice says a lot of people don’t fully understand the role his staff play.

“We are the ones who make the calls at 3 am to enter the houses,” he said. “We are responding with two people. We do not have a controlled environment. We basically operate an emergency room in the living room of one person.

And this has only become more difficult since the start of the pandemic in 2020, and more recently with the emergence of the Delta variant. This push that crushed hospitals and nursing homes had a downstream effect on the state’s EMS services. With hospitals at full capacity or unable to accept patients due to understaffing, ambulances have had to find other places to pick up patients.

In Boone County, that means their ambulances had to transport patients to hospitals in Charleston, Morgantown and Huntington, but even to Pennsylvania, Ohio and Virginia. This puts staff off duty for hours, sometimes leaving the 500-square-mile county with no ambulances available.

Headquarters of Boone County EMS in Racine. Photo by Quenton King

Rescuers in Roane and Mercer counties say they have also had to transport people further with full hospitals this summer. And even when they arrive at the hospital, they still have to wait for the staff to accept the patient. Sean Cantrell of the Bluefield Rescue Squad says he waited up to three hours with his patients on stretchers.

And these challenges are magnified in an industry that has struggled to maintain a full workforce – even before the pandemic.

“The most important thing is the salary. That’s why we bleed people in EMS, ”said Bryan Justice.

He was able to give his employees some raises over the past year. But even so, Boone County EMS workers are starting to make between $ 12 and $ 15 an hour. And that means it’s competing for workers, both in the county to places like Walmart and Wendy’s, and out of state to other EMS agencies. He says he lost two staff members to temporary EMS jobs in Texas who pay $ 70 an hour.

EMS administrators say their agencies need more support from state and federal governments.

“The federal government does a great job of trying to distribute cash to everyone who needs it – except EMS,” said Jody Ratliff, director of the Roane County Emergency Squad. “Last year, when everything was going so badly, we were able to take advantage of the CARES law. It has helped tremendously. Well, it stopped and now we are not able to exploit it anymore.

Other states gave “hero pay” to frontline workers during the pandemic. An attempt by the justice government to do the same last year in West Virginia using funds from the CARES Act confused local governments: counties each received $ 100,000, but the governor gave little guidance on how it might be used.

Some counties, like Roane, used these funds to pay the hero of the EMS staff. Boone County Commissioners have awarded bonuses to some frontline staff, including the 911 call center and firefighters. Bryan Justice says Boone EMS was left out of this.

The governor’s office did not respond to a request for comment for this story.

“All we want is to be included in the discussion”

In addition to staff shortages and low wages, hospitals and nursing homes share another challenge in West Virginia: insurance reimbursements. West Virginia has one of the highest shares of residents on Medicaid and Medicare in the country. According to Bryan Justice and Ratliff, the majority of patients treated by their EMS services are covered by one of these insurance plans.

Justice says Medicaid and Medicare will typically only pay about 30% of a patient’s bill.

“Sometimes that doesn’t cover the cost of fuel. Especially now with the price of fuel over $ 3 a gallon. You take a patient as far as we do now and we bill Medicare [or] Medicaid. Our refunds are really not that good. We are probably losing money by the time you pay for maintenance, fuel costs, [and] crews, ”Justice said.

Bryan Justice is the director of Boone County EMS. Photo by Quenton King

Insurance reimbursements aren’t the only way counties like Boone can fund their EMS agencies. Justice said that a significant portion of the Boone County Ambulance Authority’s budget comes from the county’s EMS tax. And in this county, faced with declining population and income, a levy that brought in $ 1.8 million to the department ten years ago may not even bring in $ 800,000 this year.

In Roane County, residents voted to maintain their EMS levy last year. Ratliff appreciates local support, but says more state aid is needed.

“The citizens of Roane County have really stepped up to help,” he said. “And now we are at the state level. The state must step in and help the state SME. If they don’t, it will be a disastrous problem for the state’s EMS. “

Chris Hall, executive director of the West Virginia EMS Coalition, agrees with Ratliff that the state needs to create a long-term funding structure for EMS agencies. In an email, he said county support varies across the state. And while neighboring state governments provide assistance to their EMS through tickets, fees, or block grants, West Virginia has done the opposite.

“In fact, due to repeated budget cuts, the EMS office within DHHR has increasingly relied on fees charged to EMS agencies, paramedics and paramedics to support its regulatory functions,” he said. Hall said.

He also says that in 2018 the legislature passed a bill to create an EMS equipment and training fund within the West Virginia Office of Emergency Medical Services, but they did not yet allocated funds.

Back in Boone County, Bryan Justice points out that it’s not bitter that hospitals and nursing homes are getting extra help under the Saving Our Care justice program. He says he knows these employees are also under pressure.

“All we want is to be included in the discussion,” he said.

In the meantime, he is happy to have recently secured a new ambulance thanks to a federal grant. Now the county has five rotating, although a couple have over 400,000 miles on them.

“I’m excited to have a truck around $ 250,000, now I have to get back to work and figure out how I’m going to buy the next one,” Justice said.


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