“As the EMS coordinator, if this were a weather event I would be coming to you asking you to declare a state emergency. That is how bad this is.”
That was the sobering message Stokes County EMS director Greg Collins had for the county Board of Commissioners Monday night, telling them that combination of low salaries, unavoidable leaves of absences and declining numbers of new paramedic candidates meant the county would not be able to cover at least 92 shifts over the next three months.
“It has been on the horizon for some time but we are in a much deeper crisis than we thought,” said Collins. “We have lost six employees since the end of last year. Compounding these losses we have three worker’s comp injuries that are long, extensive, out-of-work injuries and we have two employees out on family medical leave.”
County Manager Rick Morris said if the problem was not solved immediately the county would have to take one of the two ambulances serving the King area off line as soon as next week.
He proposed a short term solution to increase pay for full-time and part-time EMS employees willing to work extra shifts through June 30, saying that he would propose a different long-term solution in the next budget.
Under that plan full-time paramedics willing to work an extra shift to would see their pay increase to $30 an hour, full-time intermediate employees willing to work an extra shift would see their pay increase to $22.50 an hour and full-time basic EMS employees wiling to work an extra shift would see their pay increase to $19.50 an hour. Part-time paramedics willing to work an extra shift to would see their pay increase to $20 an hour, part-time intermediate employees willing to work an extra shift would see their pay increase to $15 an hour and part-time basic EMS employees wiling to work an extra shift would see their pay increase to $13 an hour.
Morris said the plan could cost the county $66,000 but said that funding could come from increased revenues the county had received already due to increased EMS call volumes.
Collins said the problem was a regional one with counties around the area seeking additional qualified EMS personnel, noting that many had much higher starting pay and much better shift structures. He said declining enrollment in EMS programs at community colleges meant that EMS organizations across the state were competing for fewer and fewer candidates.
“We are at a critical point,” said Collins. “We have to have additional pay to attract and then retain our employees.”
Collins thanked the commissioners for their willingness to increase pay for EMS personnel by three pay-grades last year, but said that increase had only put the county just below what other counties were willing to pay, noting that other counties were continuing to increase their pay scales.
For example, the entry level pay for paramedics in Stokes County is $12.07 an hour. That pay increases to $12.43 an hour after two years of service maxing out at $18.33 an hour after 30 years of service. The same paramedic would start at $15.28 an hour in Surry County and would reach $16.60 an hour after only two years.
“In Caswell County they are paying salaries over $50,000 a year,” he added. “Starting pay in Stokes County is $34,253.”
He added that the decision to bring in LifeStar to handle basic transports from the county had helped.
“If they were not in this county it would be even more critical because our ambulances would be out of the county all the time,” said Collins, adding that the closure of the emergency room in King had also added to the problem. “Every call that used to go to J.R. Jones now has to go to another facility out of the county. We had about 200 calls that went there just in King last year. Now it is down to zero. Insurance companies will not pay for any transport to an urgent care facility.”
Commissioners were shocked at the news and split over how to deal with the problem.
“You came to us last year and asked for a tremendous raise and said it would fix it and it has not fixed it,” said Commissioner Ernest Lankford. “Evidently we have a problem beyond money. What you are coming with here now saying $30 an hour for a paramedic is just unreasonable. One shift is going to cost us $720. We can’t be competitive. There is no reason to try. We may have to look at privatizing some of it. I don’t know how we are going to stop this. Money is just not going to take care of it.”
Commissioner James Booth agreed, asking Morris to bring some proposals for privatizing the EMS service to the upcoming budget discussions.
Morris said he would be happy to, emphasizing that the pay increases were just a temporary fix until a more long-term solution could be figured out during the budget process.
“We are open to ides of how to fix it, otherwise we will take an ambulance out of service this week and the first one will come out of King,” said Morris. “We can’t just pretend this does not exist. We have to realize that if you are going to provide EMS service it is a very expensive business.”
The county runs five ambulances on a regular basis, two in the King are, one in Walnut Cove, one in Danbury and one in Lawsonville.
Commissioners Ronda Jones and Jimmy Walker said they would support the short-term fix proposal because they did not see any other options.
“I am willing to do this just to get us through the budget and have a chance as part of that process to deal with this further,” said Walker, noting that he would be okay with an ambulance being taken out of service in the King area if that became necessary.
Jones said she felt the county had to invest the money due to liability issues.
“What is going to happen if one or two people die because we were not there quick enough because of this situation?” she asked. “I feel like this is a small price to pay.”
Lankford said he did not think enough time had been put into finding a solution.
“We should be looking at some way of getting people to come in here,” he said. “Something needs to be done other than say we are just going to give you this kind of money. I just can’t support it.”
Chairman Leon Inman said he needed more time to think about the issue, postponing further discussion on the issue until the budget meeting already scheduled for Tuesday.
On Tuesday, the board voted 3-2, with Booth and Lankford voting nay, to approve the emergency funding request.
Inman said he had sought legal advice before the vote and had been advised that if the county was offering the service and then a shift was not covered the commissioners could be held responsible should there be an issue.
During Tuesday’s meeting Walker and Inman agreed with Booth and Lankford that the county needed to look at options to privatize the EMS services in next year’s budget.
Nicholas Elmes may be reached at 336-591-8191 or on Twitter @NicholasElmes.