In the back of the ambulance, there is a lot going on. Once an ill or injured person is picked up, the ambulance will transport them to a hospital or facility with one paramedic and one emergency medical technician (EMT), unless their condition is critical, in which case, two paramedics will ride in the ambulance. The ambulance staff will check the person's vitals, such as pulse, respiration rate, blood pressure, blood sugar levels, oxygen levels and other tests depending on the reason of transportation.
If a person's condition is serious, the paramedic and EMT can administer almost 30 types of advanced medications through an IV and have advanced airway equipment, vascular access equipment, cardiac monitors, advanced cardiac life support equipment and blood glucose testing equipment. All of these materials make the ambulances a hospital emergency room on wheels. In a rural county like Madison, it is vital that EMS is able to begin treatment while heading to the hospital.
This process, which is called Advanced Life Support, or ALS, is used by the Madison County EMS. There are three ALS ambulances used by the county. The Madison County EMS staff has 10 full-time paramedics and one full time EMT, in addition to 10 occasional paramedics and 12 occasional EMTs, according to the county website.
But what if the support system were to change? What if these medical services could not be provided to the citizens of Madison County?
After receiving many tips from anonymous sources, Greene Publishing, Inc. discovered that the ALS procedures used by the Madison County EMS could change to Basic Life Support, or BLS.
BLS units are designed for inter-facility transportation and pre-hospital response to ill or injured patients; BLS units are staffed with two licensed EMTs that generally have over 300 hours of training. BLS units do not have the advanced medical tools but instead, each of the EMTs working in the BLS unit have practical knowledge in trauma care, cardiac and stroke care, CPR, first aid, child birth and more. BLS providers cannot use needles or other devices or administer medication; a BLS provider does not have any right to provide basic treatment of cuts or injuries as well.
An anonymous source and former Madison County paramedic, says switching to BLS will “severely decrease the amount of medical services and treatment [provided] to the people of Madison County.”
Although small rural hospitals like Madison County Memorial Hospital provides many services to their respective communities, they cannot give patients in critical condition the treatment they need; thus, many times, patients are transferred to larger hospitals, such as Tallahassee Memorial Hospital. In order to keep the patients in stable conditions while being transported to a better facility, ALS procedures are better suited. Patients are able to get the care they need until they arrive at an appropriate facility.
For instance, if someone is experiencing stroke symptoms or is about to have a heart attack, a BLS unit could not transport them to a cardiologist for further treatment.
Madison County Memorial Hospital could also be hurt financially if BLS takes over, points out the anonymous source. “[If BLS happens] a large percent of the emergency calls will have to go to Madison County Memorial Hospital [adding a burden to the staff and requiring the hospital to bring in more personnel],” they said. They also stated that, for example, a patient with heart issues cannot be transported from ambulance to ambulance at different hospitals. By federal law, in Florida, steps for treatment need to be taken before the patient is transferred to another hospital.
When asked whether or not Madison County EMS was going to switch to BLS services, EMS Director Lisa Jordan stated that Madison County EMS is not changing to BLS and will continue using ALS services. However, Jordan seemed to contradict her statement later when she stated that Madison County EMS will change to BLS if “we don't get more paramedics soon.” Jordan claimed that the shortage of paramedics is a state-wide issue.
County Coordinator Allen Cherry mimicked the same thing Jordan did. “There are no plans to get BLS,” said Cherry. “Due to a shortage of paramedics, sometimes there may be a case where EMS has to get BLS. But right now, there are no projects or plans for BLS.”
Cherry explained that the shortage of paramedics is an issue because Madison is competing with other counties. Pay rates in the surrounding counties have gone up but because Madison County is unable to afford a rise in pay rates, as they are not able to pay their paramedics the same rate as the other counties. Cherry also commented that paramedics are being used more frequently in emergency rooms and getting paid more than they would if they worked in EMS.
Being a former paramedic of the county, one of our sources found difficulty seeing Cherry's reasoning as to why there is a shortage of paramedics in the county that could cause the shift from ALS to BLS, as Madison County is surrounded by counties with similar statistics. “[Madison County] is the lowest paid EMS service in the entire area,” said our source. “We're competing with similar counties. It's not like we're wedged between Tallahassee and Valdosta to compete. [The county commission] cannot justifiably claim we're competing. These counties have nothing more to offer.”
They went on to say that the supposed “shortage” of paramedics should not be an issue, as paramedics can be found from other counties. “Paramedics are used to driving an hour to work,” they said.
“[The county] can get paramedics,” said (source). “They just have to pay them at least the average pay and provide a good working environment. If there's some other reason [why they're thinking of switching to BLS], [the commissioners] need to fix it.”
After some additional investigation, Greene Publishing, Inc. also discovered another cause for concern: Madison County EMS is outsourcing in order to get its billing done.
In October of 2014, Madison County EMS began working with Intermedix; the county paid $68,000 plus during the 2014-2015 fiscal year (October 2014 to September 2015); outsourcing was established in order to bring in more revenue, but because the county is paying Intermedix more money than it has, revenue is not being acquired. On top of that, Intermedix has errors within their numbers and do not do the billing correctly.
According to several sources, if Madison County EMS did their billing in-house, an employee could do it for 1/3 of the cost of Intermedix's payment.
Clerk of Court Tim Sanders explained that while the county used to do their billing in-house, using Intermedix is helpful to the county because the company has “expertise in coding with new healthcare options as well as added technology,” such as the new tablets that have been used when ambulance staff take down patient information and condition. Sanders also mentioned that the county switched to Intermedix due to the fact that the company “could get revenue from many different sources.” The board of county commissioners approved the switch from in-house billing to Intermedix about a year and a half ago, according to Sanders.