Are we protected? Data suggest county EMS stretched too thin

Almost every day, ambulances from northern Beaufort County must rush south to help EMS crews in Callawassie, Bluffton and Sun City handle emergency medical calls, according to new data gathered by the Bluffton Township Fire District.

Over a recent 16-month period, ambulances stationed in northern Beaufort County had to drive south 444 times to lend a hand in southern Beaufort County, where a growing population has stretched ambulance crews too thin, the fire district says.

Armed with the new data, Bluffton fire officials are repeating what they've said for several years: That Beaufort County Emergency Medical Services is stretched too thin in the southern part of the county to serve residents adequately.

The Bluffton fire district has a vested interest in ambulance service because it is required to respond to emergency medical calls, not just to fires, to back up county ambulance crews.If there's a traffic accident on U.S. 278 involving serious injuries, for example, a Beaufort County ambulance responds, along with a fire truck from the Bluffton fire district, whose crew is trained in emergency medical care.

The Bluffton fire district and Beaufort County don't always see eye to eye on the best way to provide emergency medical care -- especially recently and especially in southern Beaufort County. When a Beaufort County EMS crew came under fire several months ago for the care it gave a Bluffton man who'd been brutally beaten in his backyard, fire district officials seized the moment to weigh in: One of the problems affecting the quality of emergency care in southern Beaufort County is a shortage of ambulances and crews, they said.

At a minimum, they said, one more ambulance is needed in southern Beaufort County to serve a population that has mushroomed over the years.

The point was underscored in a letter that Bluffton Township fire chief Barry Turner sent county administrator Gary Kubic on May 27. When two of the three county ambulances based in southern Beaufort County are responding to calls, the remaining ambulance is left to cover the whole area, Turner wrote.

"...With a service area of 264 square miles and a difficult road system, this only leads to greater response times,"Turner wrote.

Response times are important because they can mean the difference between life and death for gravely ill or injured patients. Victims of cardiac arrest, for example, have much better chances of survival when treated quickly, according to studies by the American Heart Association.

Likewise, trauma patients must get to a hospital quickly, according to the S.C. Department of Health and Environmental Control. The "golden hour" is a term used to describe the first hour following a serious trauma injury. If a patient gets proper medical care in that first hour, chances of survival triple and the long-term effects of trauma are significantly decreased, according to DHEC.

ARE WE PROTECTED?

Bluffton fire chief Turner, whose department relies on the county for some funding and whose criticism of Beaufort County EMS has usually been measured, did not return calls for this article. Earlier this year, however, Turner was blunt about southern Beaufort County's need for at least one more ambulance.

"We want to make sure our citizens get the protection they need," Turner said then. "With three, they're not."

His comments reflected the position of the fire district's eight-member governing commission. The commission's 2008 strategic plan noted that "county-provided services are not keeping up with the current growth rate."

The work load for the two Beaufort County ambulances stationed in Bluffton and the one stationed near Sun City has more than doubled since 2000 -- rising from 2,300 calls that year to 5,356 in 2008.

Along with worries about the number of ambulances serving southern Beaufort County, concerns also have arisen about quality of care. State officials cited lapses in the treatment of Brian Lanese, the Bluffton man who suffered severe head trauma last October after being attacked in his backyard.

In March, the mother of 17-year-old Josh George, a Bluffton High School student who died following a prom night car wreck last May, filed a wrongful death suit against the county, alleging that paramedics took her son to a hospital not equipped to treat him.

And in April, a county ambulance crew was delayed for three minutes at an unmanned security gate outside a Bluffton neighborhood. The crew was trying to get to a 62-year-old man who'd suffered a massive heart attack, but complications with the gate's code box slowed them down. The man died 10 days later. To prevent a recurrence, Beaufort County Council proposed an ordinance to install emergency overhaul systems at electronic residential gates. The Beaufort County Planning Commission is scheduled to discuss the proposal tomorrow.

BY THE NUMBERS

Reacting to the Bluffton fire district's criticism of Beaufort County EMS, Kubic on May 12 asked the district to supply him with hard data on response times in southern Beaufort County. His letter to fire chief Turner took the form of an official records request that cited the state's Freedom of Information Act -- an unusual step in dealings between government officials.

Turner complied, sending Kubic a study based on voluminous data collected over a 16-month period ending on April 15. Kubic has declined to release the study or its underlying data, citing medical privacy laws. Kubic also declined to provide redacted records that would not compromise patient privacy. He said Thursday he plans to get an opinion from the state Attorney General's Office about whether patient privacy laws allow him to release any of the material.

Kubic did, however, release a cover letter written by fire chief Turner that accompanied the study. The letter includes summary statistics on response times. Among them:

• Of 3,533 calls handled by Beaufort County EMS over the 16 months, two of the three ambulances stationed south of the Broad River were on calls simultaneously 991 times -- 28 percent of the total calls.

• All three ambulances south of the Broad were on calls simultaneously 144 times -- 4.1 percent of the total calls.

• When all three ambulances are busy, an ambulance must be dispatched from northern Beaufort County -- increasing response times for patients waiting for that ambulance. All three ambulances south of the Broad and another from north of the Broad were on calls in southern Beaufort County simultaneously eight times.

• An ambulance from northern Beaufort County had to be dispatched to southern Beaufort County 444 times -- one of every eight responses. This is how several emergency calls were handled on a day earlier this year when the ambulance normally stationed on Bridge Street in Bluffton was out of action for 14 hours. Despite repeated attempts to determine the ambulance's whereabouts that day, Kubic and former Beaufort County EMS director Rusty Hollingsworth haven't provided an answer.

• The average response time for Beaufort County EMS is 7 minutes, 24 seconds -- one minute and 12 seconds more than the Bluffton fire district's.

• A national benchmark suggests that ambulances should arrive within eight minutes on 90 percent of their calls. Beaufort County EMS arrives at calls in 12 minutes, 11 seconds 90 percent of the time, falling short of the benchmark. Beaufort County EMS's times are 2 minutes, 18 seconds more than those of the Bluffton fire district, which doesn't meet the national benchmark either.

The Bluffton fire district has six stations in southern Beaufort County. Only three of those stations have Beaufort County EMS ambulances.By comparison, the Town of Hilton Head Island Fire & Rescue Division has seven stations, all of them with ambulances. Hilton Head's goal is to have an ambulance anywhere on the island within 5 minutes 90 percent of the time. The Hilton Head department's response times were under 5 minutes about 85 percent of the time, according to 2008 data.

The Bluffton fire district's strategic plan says additional stations are needed to "strengthen our distribution and provide a quicker response to all emergencies. ...Should additional EMS units be staffed and placed into service, we would expect that the EMS 90th percentile response would decrease and become closer to the benchmark..." Turner's letter to Kubic said.

POLITICAL SENSITIVITIES

For nearly a decade, the Bluffton fire district has persisted in questioning whether Beaufort County EMS has enough ambulances in southern Beaufort County, according to minutes of fire district commission meetings.

In May 2002, when the fire district commission discussed a third ambulance for southern Beaufort County the minutes note: "Our effort to try and help the county in lowering the cost of EMS and give our citizens better coverage has failed. ... We have to get through the (County Council's) public safety committee, but they have refused to meet with us."

Again the next year, the fire district commission raised the issue. Then-county administrator John Kachmar "stated that there are issues a lot larger with the current EMS system than a need for another ambulance south of the Broad," according to minutes from a January 2003 meeting.

Barely eight months later, the minutes summarize a meeting between county and fire district officials: "Naturally, the director of EMS Ed Allen was not receptive to the idea and stated that the call volume did not justify an additional ambulance."

The minutes also indicate that the county has resisted another change suggested by fire district in 2001 -- combining operations of the county's EMS and the fire district. That's the approach taken by Hilton Head and an increasing number of other U.S. localities in recent years -- using fire fighters who also serve as paramedics. Combined fire and EMS operations have gained popularity because advances in fire prevention have decreased the number of fires, allowing fire fighters to take on other duties.

In Beaufort County the idea died in part because of political sensitivities, the minutes say. One concern was that "people (in Beaufort County EMS) may lose their jobs" if fire and EMS were combined, they say.

The fire district considers the issue of absorbing EMS responsibilities a necessary -- but uphill -- battle, records show. The fire district's strategic plan says "it will be difficult to convince the County Council that fire-based EMS will work in the Bluffton district," partly because the existing system generates money by billing patients.

Kubic on Thursday acknowledged that recent relations between the county and the Bluffton fire district have been "tense."

"There's information out there that isn't comprehensive," Kubic said. Bluffton fire officials pushing for another ambulance should recognize that the county is "in an economic decline" and that another ambulance and crews to man it would be expensive and could create ill will in northern Beaufort County, he said.

Kubic said he hoped to meet with fire district officials after the July 4 weekend to discuss additional records he wants from them. Like his first request for records in May, Kubic's new request notes that the county is entitled to the records under the state's Freedom of Information Act.

Kubic's request seeks documents relating to "any type of training provided by the Town of Hilton Head Island Fire & Rescue for Bluffton fire district personnel since 1995," how much that training cost, and any correspondence between Bluffton fire officials and their counterparts in the Hilton Head department.