If Grand County’s Emergency Medical Services (EMS) does not move to the level of Paramedic care, it may lose the ability to perform lifesaving services it now does.
At this time, Grand County operates under Intermediate Advanced certification, a level of certification that will be phased out as the State of Utah moves its certification to reflect the national norm.
Grand County EMS would be losing variances under the Intermediate Advanced (IA) certification that allowed IA-trained EMTs to perform specific lifesaving techniques, such as intubation, needle decompression, as well as use a variety of medications.
“We wont be able to do it without going paramedic,” said Andy Smith, director of Grand County EMS. “We now have 23 medications at our disposal. It would be only eight without variances.”
Some of the medications for pain relief and seizures would be lost.
Smith presented a plan to move the EMS from Intermediate Advanced level care to Paramedic level care at the Grand County Council’s June 4 council meeting. Paramedic care is the highest level of pre-hospital care available.
He said the state is now allowing for part-time paramedic agencies. Smith’s goal is to have paramedics on 50 percent of the calls, which would require one more full-time employee.
“This is something we want to take advantage of,” Smith said.
EMS now has three full-time employees, including Smith. There is also one part-time employee, Jake Blackwelder, who earned his paramedic certification in February 2012. The remaining staff is made of 30 volunteers who are paid $1 an hour for being on call, and a little over $10 an hour while responding.
Smith outlined both the advantages of higher level of medical care for the county’s residents and visitors, as well as a financial plan that would outline how the organization would pay for training.
“There are financial incentives for being paramedic,” Smith said.
That financial incentive includes being able to charge more for transport and care. At this time the current billing rate under Intermediate Advanced is $785, plus mileage. Under paramedic it would be $1148, plus mileage. Smith said that his agency collects money from between 50 and 60 percent of bills sent. He showed the council a budget that outlined expenses in the first year for an additional full-time employee as well as paying for half of the tuition for eight EMTs to earn paramedic training. This would put the self-sustaining agency over-budget by approximately $10,000 the first year, but it would be able to recoup that deficit with a surplus of $27,000 the second year and $69,000 the third year by being able to charge for half the transports at the paramedic level of care.
Councilman Lynn Jackson asked that Smith return with a detailed cost / benefit analysis.
“I don’t think we can afford not to do this,” Jackson said. “I’m very supportive of this.”
Council chair Gene Ciarus said that “even though we want the best, remember we’re only a community of 9000.”
“But we have two million visitors,” Smith said.
In his report, Smith pointed out that 40 percent of the ambulance runs involve visitors to the area, and treatments for those visitors are “exacerbated by increased levels of activity.”
“Many of the 949-plus runs per year involve extended patient contact time due to the complexities of accessing and transporting patients in remote areas in the back country of Grand County,” Smith stated in the report.
Many of these runs include the what Smith called the big three: Trauma, heart attack and stroke.
“Moab is the mecca of bad trauma,” Smith said. “These skills are life and death for some people.”
Blackwelder said that there are many paramedics in urban areas, but it is needed more in rural areas. He referred to his paramedic training with a fire department in Murray where they would pick someone up and transport to the hospital within only a few minutes without providing much care.
The average EMS transport time within Grand County is two hours.
The state medical director, Peter Taillac, referred to the two-hour average transport time in a letter he wrote to the Grand County Council expressing support for Grand County EMS to move to paramedic level of care.
“In EMS, we speak of the ‘golden hour’ of care after the injury, which is the time in which critical interventions by EMS and hsoptial personnel can mean the difference between life and death,” Taillac wrote. “In Grand County that golden hour is completely in the hands of EMS providers, with an additional hour still remaining to keep the patient alive.”
Blackwelder echoed this sentiment.
“If a patient is in need of a higher level of care, that makes the difference between life and death,” Blackwelder said. “If someone gets hurt or sick, they need more than just a ride to the hospital. They need medical intervention beyond that of a taxi driver.”
Blackwelder said that visitors from urban areas expect more care as well.
“They come from all over and they expect urban level response, urban level care, urban level pre-hospital medicine,” Blackwelder said.
Smith said that the big difference from Advanced training to Paramedic is the level of training.
Advanced EMTs have 140 hours in the classroom and 10 hours of clinical time. Paramedics have 1500 hours of classroom time and 500 clinical hours before taking the test.
EMS volunteer Ashley Kent recently earned her IA-certification.
“As an IA you learn what to do, but as a paramedic you understand what you’re doing,” Kent said.
During the council meeting councilwoman Pat Holyoak expressed concern that residents would have to pay more for transport that may not require Paramedic-level care.
“Some people say that they don’t need that level of care,” said Jenny Tuft, an EMT, in a later interview. “You may not need it, but there are people in this community that will.”
Smith said that he would like to work with the council to allow a discount on bills for residents. However, Smith sees a value in a higher level of care.
“There’s a cost to being prepared. There’s a cost to the service,” Smith said.
They come from all over and they expect urban level response, urban level care, urban level pre-hospital medicine.”