Advisory board forms to unify approach to EMS

With a critical lack of volunteers and growing legal requirements and pressures on all sides, first responders and health care providers in Lincoln County are partnering for the sake of the public they serve.

Over two days of meetings, prior complaints and grudges were set aside, and contentions turned into collaboration.

After a discussion facilitated through the Lincoln County Commission, stakeholders agreed to form an eight-member EMS advisory board that will work to improve communication among the various entities, as well between the health care community and the general public.

Meetings held Tuesday and Wednesday included Libby, Troy and Eureka volunteer ambulance services — all of which are struggling to find volunteers — Cabinet Peaks Medical Center, Lincoln County Sheriff’s Office and the Libby Volunteer Fire Department.

The need for discussion was identified in June by Commissioner Jerry Bennett after disputes over the use of volunteer ambulance services — there is no other kind in the area — came to a head.

Commissioner Mark Peck suggested the commission bring in Bret Romney, a paid facilitator whom Peck had worked with on similar discussions in Flathead County.

Jeff Holder, president of Libby Volunteer Ambulance, said that, with only 16 volunteers, members have to put in excessive hours just to keep 911 calls covered.

As a result, LVA has stopped doing non-critical transports from Cabinet Peaks Medical Center to Kalispell. They have also stopped going to lift assist calls where there is no medical need — such as when someone cannot get up after falling without injury, or when someone has sat down intentionally but requires help to stand or move elsewhere.

Such calls are currently handled in the LVA response area by Sheriff’s deputies.

Roger Gilligan, with Troy Volunteer Ambulance, said TVA only has about six volunteers they can depend on for 911 calls. If two are out of the area on a transport, it could prevent them from being able to answer a 911 call.

Holder said that there have been times when two LVA crews pass each other on Highway 2, one leaving on a transport and one returning. The service only has four ambulances, and not enough volunteers to man all of them even in the best of times.

In a previous meeting, ambulance representatives acknowledged that a single incident — such as a two-car collision — would require an ambulance for each injured person needing transport, and could tie up every resource in Libby and Troy combined.

Last year, LVA had over 800 calls, and TVA had around 500.

Hammering it out

The meetings were civil, though the discussion periodically flared as accusations boiled to the surface.

But early into the first meeting, Peck said something that seemed to resonate with meeting participants: that the legal and logistical requirements and waning community involvement were the problems everyone faced.

“That’s the enemy, not the people in this room,” he said.

Peck said the meetings were an opportunity for stakeholders to figure out what they want health care to look like in Lincoln County 20 years into the future, and to head off the consequences — such as the collapse of ambulance service — that would result from inaction.

By the second day, Holder and Cabinet Peaks CEO Bruce Whitfield went from sitting apart and barely speaking directly to one another, to sitting side by side, collaborating before and after the meeting.

One long-standing issue was resolved before the end of the first meeting.

Though paramedics are needed for some ambulance calls, the years of training required and lack of local jobs mean that the ambulance service must rely on the hospital’s paramedics for those situations rather than recruit its own.

In the past, hospital paramedics could hear a call being dispatched and respond if they believed they would be needed, Holder said. Abuse of the system led to changes that — compounded by other communication problems — led to problems getting paramedics when LVA needs them.

During the meeting, Mark Harding, an ER doctor at Cabinet Peaks, proposed that ER doctors could upgrade a call, allowing the paramedics to leave. It would be a direct solution with few additional steps that could prevent abuse.

Both Troy and Libby ambulance welcomed the suggestion.

In addition, the group discussed future training that would involve all three ambulance services, including Harding’s suggestions for how Cabinet Peaks physicians could act as trainers and teachers.

The hospital also offered to allow the ambulance services to use their teleconferencing equipment for training involving all three services, so that trainers and students from Eureka would not have to travel to and from Libby.

Planning

At the end of discussions, the group came away with a template for the advisory board to “oversee and provide direction and accountability to EMS operations and progress.”

The board will not have enforcement authority, but will provide a means for stakeholders to regularly come together and hammer out the challenges they all face.

That board will include a representative from each of the three ambulance services, the Sheriff’s Office, a county commissioner, a physician and a hospital administrator, and a community member.

Whitfield suggested that if voting is involved, the physician and administrator could have a single vote between them, so the hospital would not have disproportionate sway.

The county agreed to advertise for someone to fill the community member position. The board, which is expected to first meet on Thursday, Aug. 9, will then pick from the applicants.

Having a community member involved is essential, Peck said. The themes of community involvement, and communicating the needs of the ambulance services to the public, repeated throughout the meeting.

The top priority the group identified was raising community awareness of what the volunteer ambulance services do, and how they benefit residents and businesses. In doing so, they hope to attract volunteers and to encourage businesses to support employees who serve their community.

They also hope to stop people from abusing the 911 system, tying up the already overtaxed ambulance services and endangering people who may need lifesaving care.

Most of the challenges identified in the meeting were far from resolved by the end. One task is just finding the words that will make residents understand that their healers are in critical condition, and that they need the community to rally around them.

Yet, succeed or fail, the participants appeared resolved to face the challenges together.