Ambulance issues

Elizabeth Janie Ward, regional director for Global Medical Response, the parent company of Lifeguard Ambulance, speaks to the Prestonsburg City Council about a contract that would allow the company to “lease” Prestonsburg firefighters.

The need for improvements in ambulance services came to the forefront of a Prestonsburg City Council meeting on Monday.

The city council received a contract proposed by Global Medical Response, the parent company of Lifeguard Ambulance, that would allow the company to provide an ambulance staffed by Prestonsburg firefighters.

The fire department currently has 14 emergency medical technicians and three paramedics on staff.

No action was taken on that proposal, and Mayor Les Stapleton reported that the city also plans to file an application for a Certificate of Need to launch its own ambulance service.

Elizabeth Janie Ward, regional director for Global Medical Response, talked about the proposal with the city council.

Ward described the contract as a “shared services agreement,” explaining that through it, Lifeguard  “basically would lease” Prestonsburg Fire Department employees to help Lifeguard respond to 911 calls if Lifeguard is not available “to respond in a timely manner.”

“So, kind of the premise of it is or the bullet point is we will provide an ambulance ... fully equipped. All the medical supplies would be restocked at our Floyd County station,” she said. “Currently, the city fire department, if there’s a 911 call, they respond on every call. So, on those medical calls, they would go ahead and respond in an ambulance, and if there was not a ground, we didn’t have an ambulance ready to respond, then your crews, under our contract, would be able to go ahead and transport those patients as well. Right now, that is their limitation. So, I think it’s kind of the best of both worlds in that you have EMTs and paramedics that work at your station, here apparently, there’s two stations...but it would give that extra added layer of support to EMS in this community without having to go through or wait for any sort of Certificate of Need process.”

It marked the first time the Prestonsburg City Council has addressed the contract publicly at a meeting. A copy of the proposed contract was not provided to the newspaper.

Ward said that, under the contract, Prestonsburg firefighters would work under Lifeguard’s policies, procedures and medical protocols if they were responding to and transporting patients. She said Prestonsburg firefighters would have to undergo training at Lifeguard because the company requires a 16-hour course for certification instead of four hours, as required by the state.

She said in exchange for leasing firefighters for this service, Lifeguard would pay Prestonsburg $1,500 a month.

“We needed to start somewhere. Don’t know what that’s going to look like, but $1,500 a month for the lease of your staff whenever they’re actually having to transport a patient,” she said.

She explained that Lifeguard and Prestonsburg would continue to maintain insurance for their own vehicles and Lifeguard will maintain liability insurance on the ambulance it provides the city, while the city could continue to maintain workers compensation insurance for its employees and Lifeguard will maintain medical malpractice insurance.

Stapleton told Ward that Prestonsburg plans to file an application for a Certificate of Need to start its own ambulance service.

“That’s something we started quite some time ago, before you even came on board, we started initiating that,” he told Ward.

He said city officials have to figure out “what’s best for the City of Prestonsburg.”

Prestonsburg officials have complained about ambulance response times in the city for more than a year. In response to an open records request, officials provided records of more than 30 calls in which it took Lifeguard more than 30 minutes to respond to emergencies in the city between April and December.

The documents show that it took Lifeguard more than an hour, and at times, two hours or longer, to respond to calls in the city. The dispatch logs show, however, that repeatedly, Lifeguard did not provide a code showing they arrived on scene, and instead, only reflect that the ambulance was en route or leaving the scene.

Such was a Sept. 22, 2019, call to Mays Branch for a female who had fallen and needed help up. Lifeguard was dispatched to that call at 6:23 p.m., reported it was in route at 6:30 p.m. and reported it left the scene, after a “refusal” for services was obtained, at 7:57 p.m.

On July 23, 2019, dispatch logs show, Lifeguard was called to help a diabetic whose sugar was over 600 at 7:37 p.m. Lifeguard’s dispatch reported that an ambulance was in route at 7:44 p.m., the log shows, and no arrival time was recorded. The log shows, however, that Lifeguard left that scene at 12:16 a.m. the following morning —  about five hours later.

In response to an open records request, the Kentucky Board of Emergency Medical Services provided copies of complaints filed against Lifeguard and letters reporting that no violations were found in any complaint. All complaints reviewed by the newspaper were dismissed by KBEMS.

The KBEMS also provided copies of letters written to Lifeguard, following inspections of its facilities. The letters reported that Lifeguard violated some regulations.

A Sept. 12, 2019, letter said Lifeguard violated a regulation requiring control points in both the driver’s and patient care compartments of ambulances. A Sept. 3 letter said Lifeguard violated a regulation that it was not staffing ambulances 24 hours per day, seven days a week, as required. Another letter sent Sept. 3 stated that Lifeguard was in violation of regulations because ambulances would not start, because did not provide some equipment — including IV pumps, incubators or portable ventilators — at the time of inspection, because it was not providing the minimum number of staff required and because it provided an “unauthorized level of service,” referencing a neonatal specialty care ambulance agency.  

Lifeguard officials have repeatedly highlighted the need for more staffing in response to complaints about ambulance response times in Prestonsburg and Floyd County. Last year, it launched a fast-tract class to train new EMTs. The company is hosting a graduation ceremony for the first class on Jan. 22.

Prestonsburg Fire Chief Mike Brown told the city council that Lifeguard services has improved.

“They’ve been very well lately,” he said. “Lately, they have. Lately, they have.”

He defined “lately” as between three weeks to a month.

Council Member Shag Branham asked whether the improved response will continue, saying that it “certainly didn’t continue previous to the past three weeks.”

Ward told him that she will “hold people accountable” at the company, explaining that the improvements will continue or the company will take action to make corrections.

“I will hold people accountable,” she said. “We have to set some expectations and we have to set some processes and we have to provide the leadership.”

Both Council Member Harry Adams and Stapleton said the city doesn’t want to “get in the ambulance business.”

“Your CON, I understand, is for a safety net, and I can’t speak for everybody here, but I feel that the last thing we want to do is get in the ambulance business,” Adams said. “However, we still have to take care of the citizens, and when you have 30 minutes to an hour wait on people in critical condition, you just can’t do it.”

Ward explained there’s nothing the company can do to “fix everything.”

“I’ll do the best that I can. I’ll work as fast as I can, but, I mean, there’s no silver bullet,” she said. “There’s nothing we can do today that’s going to just fix everything, but I’m willing to take different approaches to get the services.”

Stapleton reported that if the contract is approved, it will mark the first such contract in the state. He said KBEMS has determined that the city can approve the contract, “with certain stipulations.”

He also talked about legislation that would allow local governments to skip the CON process to establish ambulance services, stating that if a CON was not required, the city would already have an ambulance service.

Adams said it’s “tough to answer people” when he gets calls from people asking why no ambulance is available.

Ward told him, “We will respond. We will get to it. We will see why we weren’t able to meet an expectation. I can’t guarantee that we’re always going to have an ambulance available, you know. We thought we would never need more than four ambulances to launch at Magoffin County. We were so excited to have four ambulances on shift, and we still went to level zero. Things happen. You just, you can’t always plan ahead for 911.”

Ward said she could not answer questions from Stapleton about what provides the most money for ambulance services, 911 calls or other runs. He asked to find that out for him.

“Because that is something that I think is important to us. Again, we’re not in it to make money, and the council and I, you know, I’ve talked to all of them individually at different times when I run into them in town — what are we going to do about an ambulance?” he said. “Our important part is 911. We don’t want to get involved in an ambulance business, I’ll be honest with you. It’s a liability, physically, it could be an issue for us. But, now, we had to take a look at it and that’s why we’re all here today, is to try to figure this out, and Janie, I appreciate you coming out today. I sure do.”

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