Jan. 24—FLOYD COUNTY — The Floyd County Commissioners are considering the next steps for addressing EMS issues in the community.
After dissolving the previous Floyd County EMS Advisory Board, the commissioners plan to form a new board to guide their approach to EMS matters. The board would assist the commissioners as they consider changes to the county's EMS contract.
The commissioners met for a workshop last Thursday to discuss how to proceed with the board and EMS issues in the county. New Chapel EMS is the county's provider, but in recent years, there has been debate among county officials about whether to take a different direction in ambulance service.
The commissioners first voted to remove the advisory board at its Jan. 3 meeting, and they approved the measure on the final reading at the Jan. 17 meeting.
The new board will include all three Floyd County Commissioners. John Schellenberger was the only commissioner on the previous EMS Advisory Board, and he was the only commissioner to vote against dissolving the advisory board.
In addition to the three commissioners, the new EMS board will include at least one emergency room doctor, a representative from the Lafayette/Greenville fire districts, a representative from the Georgetown fire district, an EMS/EMT expert and a representative from the Floyd County Sheriff's Department.
The commissioners are considering Floyd County Health Officer Dr. Tom Harris and/or Dr. Steven Pahner for the board. Both are ER doctors at Baptist Health Floyd, and Pahner serves as medical director for New Chapel in Floyd County and the county's fire districts.
Tim Kamer, president of the Floyd County Commissioners, said the new EMS board will likely be established in February, and the board would meet monthly.
Kamer said the inclusion of all three commissioners on the board will help the officials to "voice concerns, request data, dig in a little deeper and make us more accountable for the EMS service."
"So by completing clearing out the old board and starting brand new, the goal is to really bring the experts to the table with all three commissioners where we can ask questions and have dialogue around more than just response times, but also look at things like quality of care in collaboration with our fire partners in each of the districts throughout the county," he said.
Floyd County Commissioner Al Knable said he appreciates the work of the earlier advisory board, but he believes the new, restructured board will have more direction with three commissioners at the table.
"That particular board has served well and accumulated a lot of time in regards to run times...but progress seemed to stall for one reason or another, and it wasn't their fault," he said. "It was probably on the county government's end not being able to put things together."
Schellenberger said he does not understand why the majority of commissioners moved to end the former EMS advisory board, saying they could have made changes to the existing board instead of removing it and starting from scratch.
As the commissioners pursue the creation of a new board, he wants to see a focus on the quality of care, including a study of pre-emergency room care.
"There needs to be a way that you can go back and review the level of care that was provided to the patient from the time that the ambulance got there to the time that the patient was dropped off at the emergency room," Schellenberger said.
Automatic vehicle location (AVL) and documentation of response times are also top priorities. He wants a new contract to have "teeth" in assuring that these will be included.
This could include fines if criteria for response time or level of care are not met, Schellenberger said.
The commissioners would like to see requirements for data such as Computer-Aided Dispatch (CAD) reports in the county's EMS contract.
Kamer noted a need to determine how the county will measure EMS response times.
"For the contract directly, there will be things like vehicle tracking, response times for the county as a whole, but we will have to figure out what response times really mean — is that average per month, is that average over a week or a quarter," Kamer said. "We haven't really decided what that looks like yet. That will be the responsibility of the board."
Kamer said the commissioners will take the "reporting piece out of the providers' hands" and "put that directly into the county's hands working with the sheriff's office."
"We will establish what kind of reporting we want to see and work with the sheriff's office to actually get the reports created and distributed automatically each month to the EMS board and the commissioners," he said.
The commissioners and the board will also consider the level of service per ambulance, Kamer said.
"Are we going to have four units and each one has a paramedic and a [Basic Life Support] certified person, or are they all going to be paramedics," he said. "Those are the kind of details we're going to figure out with the board."
New Chapel provides two ambulances with full-time staffing for Floyd County, and a third ambulance runs during peak hours. County officials have debated whether to expand to four ambulances, and funding for a potential expansion is one of the matters the county will need to consider, according to Knable.
"Everyone seems to think that the magic number is four ambulances for the county rather than the two and a half," Knable said. "In theory, that would reduce run times, and in theory, we hope that would translate into better outcomes."
Knable said the contract needs to include "specific metrics that we expect to be attained by whomever the company is."
"There's a discussion about vehicle locators, so if we have an ambulance contracted to be in Floyd County, we can ensure that it is in Floyd County, and if it's not, we can ask the question, why was it not in the county at this point in time," he said. "Sometimes they may need to go render aid to an adjacent county, and that's OK if it's an aberration and not the norm."
In November of 2022, the commissioners received proposals from New Chapel and American Medical Response (AMR) for EMS service in response to the county's requests for proposals (RFPs), but the efforts to consider an alternate provider stalled.
Kamer said he anticipates letting the previous RFPs "fall by the wayside." He has long been a proponent of staying with New Chapel, and at previous meetings, he voiced concerns about the former EMS Advisory Board having an "agenda" to get away from the current provider.
His focus is renegotiating the contract with New Chapel, describing the current contract as "rudimentary." The contract automatically renews at the end of April or the beginning of May, he said.
"It doesn't have a lot of details that an EMS contract should have," Kamer said. "And so that's what we're going to work through with a provider in partnership to define a lot more detail around service and service levels and locations of ambulances and all of the details you would typically see in a well-constructed contract."
Knable said he would be open to bringing "all potential players to the table," and he wants to see "multiple contenders" for the contract.
"That's the way that we can usually get the best deal for our taxpayers," he said. "So in my opinion, it would not be wise to exclude anybody at this point and say we're going to work with this particular [provider]. I look forward to discussions with New Chapel as well as other providers to see who can offer the best service at the best price."
Schellenberger notes that the former EMS Advisory Board recommended three options for ambulance service in the county, including forming a county-wide fire/EMS service, partnering with Baptist Health Floyd for ambulance service or renegotiating the current contract with New Chapel.
County officials have previously discussed the possibility of forming a county-wide fire and EMS service, and Kamer was appointed in late 2020 to lead a subcommittee to consider the potential unification of services. However, county officials did not reach a consensus on the matter.
In 2022, Baptist Health Floyd proposed an EMS partnership with Floyd County, but the hospital ultimately did not submit a response to the county's RFP.
Knable said the "whole idea" in reviewing EMS coverage is "to give greater coverage and assure quality of care."
"This has been hanging over the county for a long time, so I really want to push forward to get some resolution for this so people have the greatest confidence that we're doing everything we can for them," he said. "It's just time to have some resolution on this particular issue."