STATE OF NORTH CAROLINA BOARD OF COMMISSIONERS
COUNTY OF HENDERSON NOVEMBER 6, 2001
The Henderson County Board of Commissioners met for a special called meeting at 3:00 p.m. in the Commissioners= Conference Room of the Henderson County Office Building at 100 North King Street, Hendersonville, North Carolina.
Those present were: Chairman Bill Moyer, Vice-Chair Marilyn Gordon, Commissioner Grady Hawkins, Commissioner Don Ward, Commissioner Charlie Messer, County Manager David E. Nicholson, and Clerk to the Board Elizabeth W. Corn.
Also present were: Public Information Officer Chris S. Coulson, Assistant County Attorney Jennifer O. Jackson, Finance Director J. Carey McLelland, Fire Marshal/Emergency Management Coordinator Rocky Hyder, EMS Director Tom Edmundson and Asst. EMS Director Terry Layne.
CALL TO ORDER/WELCOME
Chairman Moyer called the meeting to order and welcomed those in attendance. He stated that the purpose of this meeting was a workshop on EMS and related issues that deal with responding to emergency and critical situations. He stated that this meeting would go until about 4:30 because the Commissioners have another meeting scheduled for that time.
He explained that there is some new legislation pending that deals with emergency medical services. He asked Mr. Nicholson to review that legislation.
HOUSE BILL 453
David Nicholson distributed a hand-out that reviewed the new legislation as well as a table of EMS calls for the year 2000 and average response times for those calls.
NCGS 131E, Article 7 [NCGS 131E-155 et seq.], entitled AEmergency Medical Services@ was amended by HB 453 (S.L. 2001-210) which was ratified on June 5, 2001. This amendment becomes effective on January 1, 2002.
Mr. Nicholson referred to page 5 of 7 of the hand-out, stating that under the new regulations Henderson County will have to apply to become an EMS System even though we=ve been in the emergency medical services for a lot of years. By the end of December of 2002 we must apply for an initial EMS System.
He reviewed the entire process briefly with the Board and how it would require us to study our whole system and how we provide the services, coordination, etc.
Under the new regulations the County would be responsible for establishing an EMS System which meets the requirements of the new and revised statutes and rules. This System must encompass at least all of Henderson County and may allow more than one EMS provider. The highest level of service within any EMS provider service area must be available 24 hrs. a day. The County is responsible for overseeing the System. Once the rules are finalized and put into effect the County will have one year to evaluate its program and submit an application for its EMS System to OEMS for approval. Our current EMS Ordinance (Code Chapter 87) and the contract with Dr. Crit Harley should be reviewed.
The volunteer fire departments do and should play a role in the provision of emergency medical services since they provide MRs (first resonders). This aspect of the EMS System, along with the other aspects, needs to be analyzed with respect to the new rules.
Mr. Nicholson cautioned against making any large policy or procedural changes until the rules are adopted. Waiting to see what the rules will be would allow better analysis and development of the EMS System for Henderson County.
Henderson County would like to be a model EMS System rather than a Basic EMS System. He suggested that the Board look at an organized method of addressing this issue.
Tom Edmundson stated that the new regulations don=t look much different from what Henderson County currently is doing. We are one of the few counties that is close to being a model system in the State. In February of 2002, Henderson County will have been providing EMS service to the citizens of Henderson County for 40 years. There have been no major rules changes since 1973, which implemented the existing rules they work under. Half of the rules are controlled by Legislation and the other half are controlled by the Medical Board. They are trying to clean up and redefine the rules and get it all under one authority. Mr. Edmundson stated AWe have a lot of hoops we=re gonna jump through to please the State@. He didn=t see any major changes they would have to make. He thinks that maybe sometime in the future EMS personnel will have to be licensed.
Mr. Nicholson stated that he sees this as a good opportunity to review our process.
Current Facilities, calls, etc.
Terry Layne reminded everyone that the base station is located on North Justice Street and three of the ambulances are operated from that station. This station responds to the East, the West, and the Southern part of Henderson County.
We have a Northwest station that responds to Mills River, Fletcher, and Etowah-Horse Shoe. In the event that all four EMS units are busy, we use the Rescue Squad or Arc Angel. Rescue Squad and Arc Angel answer approx. 10% of the calls (575 calls yearly). Arc Angel is located on Haywood Road behind the Opportunity House and they only provide basic life support.
It is mandated by the State Office of Emergency Medical Service that each advanced life support service (Paramedic Service), which we have, have a Medical Director. If you=re advanced life support service it means you=re at one of these levels:
The Medical Director sits on the Board which is made up of physicians from the hospital, administrators from the hospital, and EMS personnel. Our Medical Director, Dr. Crit Harley, is currently the Chairman of that Board. They review EMS calls, they set protocols which have to be approved by the State. These EMS people work under the Medical Director=s license. He is responsible for each Paramedic. The Rescue Squad also works under his license.
Dr. Harley has been the Medical Director for 18 - 20 years. He was present at the meeting.
Terry Layne explained the various EMS levels:
Emergency Medical Dispatcher - These are the people who receive the 9-1-1 calls and route them to the proper person. They also give directions over the phone to the caller on what to do for the patient. They dispatch the First Responders and EMS simultaneously.
First Responders - These people respond from their location. All the Fire Departments are currently at the EMT-D level.
EMT-D - They can insert a combi-tube which is a tube that goes in and maintains a patent airway and they can defibrillate using automatic external defibrillators. All the Fire Departments are currently at the EMT-D level. This requires approx. 160 hours of continuing education, taught at Blue Ridge Community College or AB Tech. They also have to have 96 hrs. of continuing education every 4 yrs. to recertify.
Paramedic - Without the First Responders, the Paramedic would have a hard time doing all they have to do to the patient. The Paramedic arrives in the ambulance. They can monitor the patient with a 12 lead EKG, they can hook up an external pacemaker, they can give medications. Most Paramedics have either a 2 yr. or a 4 yr. degree. AB Tech. has the 2 yr. degree program and Western Carolina University has the 4 yr. program. A Paramedic has to have 96 hours of continuing education every 4 yrs. to recertify. They have to take a State written test every four years.
EMS is a teaching institute, an approved State Teaching Institute. They do their own continuing education in house.
There are 100 or so EMT-Ds in the fire departments and the Rescue Squad. The EMT-Ds are all under the Medical Director. Arc Angel is not at the EMT-D level. The Paramedics, EMT-Ds, and EMDs (Emergency Medical Dispatchers) all work under the Medical Director.
There was some discussion regarding liability and equipment.
Terry Layne stressed the need for substations in the County to help lower response times.
Mr. Layne reviewed the chart of number of calls and response times. There was a total of 6,873 EMS calls in 2000. There appears to be a real need for a substation in the southern part of the county because 25% of the calls are from that part of the county. The American Heart Association recommends an 8 - 10 minute response time. Our fire department areas that have a response time over 10 minutes are:
Bat Cave 24 minutes
Blue Ridge 11.5
Green River 18
Terry stated that first responders are normally at the scene within 4 - 5 minutes.
Terry explained that they would like to maintain a central location for the main station. There has been some discussion about moving it from the Pardee Hospital location. Their recommendation for the last five years has been to have satellite substations.
Fire Chief Greg Garland, Fletcher Fire, discussed response times for his two fire stations, stating that first responders are usually on site in 4 - 5 minutes. Fletcher had expressed interest to the Commissioners in having paramedics in their Fire Department. If they can get to the scene in 4 - 5 minutes, they feel the patient should be getting the highest level of care possible, not having to wait for it. He does not think that EMS is being deficient in anything they do. He felt that he and his staff could help provide that service. He proposed to have paramedics on his staff so if they got to the scene first they could provide paramedic service. He currently has 16 full time personnel. Eight of his staff have approached him about going to a higher level (paramedic level) of care. They would like to work closely with EMS and use Crit Harley as Medical Director if possible. They would need some additional equipment, approx. $25,000 to equip one truck.
A question was raised about a recent update on a HICFA lawsuit. Carey McLelland came forward and stated that the HICFA lawsuit has not been resolved.
Blue Ridge Fire
Gary Brown, Chief of Blue Ridge Fire, stated that they will receive about 1,400 calls for this year. About 80% of those calls have been medical calls with the remainder being fire calls. He currently has no firemen interested in going to the paramedic level.
Mr. Brown stated that they would be happy to work with Henderson County to have an EMS station at Blue Ridge, but as a separate structure on their property. This could help cut down the response time in the southern part of the county. It would have to go through their Board first but he felt that could be a workable situation.
There was discussion of the pros and cons of locating EMS at fire stations. Commissioner Hawkins felt the Board should pose this idea to the Fire Advisory Committee for a recommendation back to the Board of Commissioners.
Chairman Moyer asked Greg Garland, Chief of Fletcher, to address the issue of the location of EMS at the fire departments. Chairman Moyer had mentioned that it had taken place some time in the past but was unsuccessful. Mr. Garland stated that it had taken place at the Fletcher Fire Department. He felt that if both sides went into it willing to make it work, that stationing ambulances in the fire departments could work. He sees it work on a daily basis at the Skyland Fire Department. He thought it would be a cost effective way to get the ambulances spread out into the county.
Chief Garland from Fletcher Fire felt that it could work to have EMS located at fire stations. Some discussion followed about the industry located in the Fletcher area and the amount of calls they generate. Terry Layne explained that most of the industries contract with physicians in Buncombe County and most of the patients are transported to Buncombe County from the Skyland area. Occupational Health contracts with the physicians in Buncombe County and EMS hardly ever has to respond over that way.
Terry Layne stressed that we all have the same goal - to provide the citizens of Henderson County with the best quality medical care and the best response time to the whole county. He was asked if we could accomplish that with what we have now.
Terry Layne explained that he needed approximately 12 additional personnel and place a full-time satellite station in the east and one in the south and have one in the northwest as well as the central station, that would do what they want to be able to do. He would need two more vehicles. He explained that in 1978, 87% of their budget was personnel and in 2001, 87% of their budget is still personnel. He stated that by placing a satellite station near I-26 and Upward Road they could respond to Blue Ridge, Green River, Dana, and Saluda with a quicker response time.
Mr. Herman Davis thanked the Board for the opportunity to address the Board at this time. He reminded the Board that Park Ridge had helped the county locate a substation in Mills River and stated that they would be happy to work with the county on a substation in the Upward Road area. They already have some land in that area.
David Nicholson stated that in meeting the new legislative directive, Henderson County has the opportunity to become a model county in EMS. He has talked with our State representative about this issue and he would like to work with Henderson County.
Mr. Nicholson proposed putting together an Ad Hoc Committee to study this issue with the involvement of many of the people interested and involved. Henderson County will have to analyze their current system and consider changes to the Franchises and to the EMS ordinance. He would work with some of these people and put together a Charter and present it back to the Board at the next meeting or so.
Mr. Nicholson felt that the Board would need to respond to Fletcher=s request first.
Chairman Moyer stated that the objective is to have 8 - 10 minute response time. He felt it would be a good idea to have an Ad Hoc Committee that would make a short term and a long term recommendation to the Board. After discussion, it was decided the Board would like to aim for 60 days in getting a response back from the Committee.
Chairman Moyer made the motion to adjourn the meeting at 4:30 p.m.
Elizabeth W. Corn, Clerk to the Board William L. Moyer, Chairman