Jefferson County hosts second meeting addressing EMS crisis

BROOKVILLE — The Jefferson County Commissioners held the second large scale meeting aimed at addressing the EMS crisis facing the county and the state.

This meeting focused on the municipalities in the county, welcoming borough and township officials to the table for this round of discussion. Also present were State Rep. Brian Smith and a representative for State Sen. Cris Dush's office.

Commissioner Scott North led the meeting, first sharing everything the county has learned in talking to local EMS stations, the 911 center, the fire departments, municipalities, education institutions, hospitals and legislators. He said when speaking with local legislators several months back, Sen. Joe Pittman asked him "what do you want from us?" and that these meetings are part of the process of answering that question.

Early in the meeting, North had 911 Director Chris Clark speak to the call volume the county 911 center receives, and how many calls for service (CFS) involve EMS agencies. According to Clark, of the 31,073 total CFS the center received in a 12-month period, 8,216 of them were directly for EMS. This category was second only to calls for law enforcement.

"Behind those EMS calls anymore, the biggest consumption of time –it's not just call taking and dispatching that EMS organization, it's finding a back up for that EMS organization. Whenever an ambulance is not available, we’re dispatching that service…" Clark said.

He explained that the nearest service is dispatched, but if they don't have an ambulance to respond, that eats up about five minutes of time. The call is then turned over to the next closest service, and that service might not be available either, bringing the time up to 10 minutes of not having an ambulance to a scene.

"We’re investing a lot of time into non actions, and that's a public safety hazard whenever somebody needs that service," Clark said.

North then began explaining what they have found in talking with each interested party on this matter. He started by addressing the municipalities that were present in the room, saying the commissioners felt they have a "moral and ethical obligation" to help with this issue.

"To help you get to where you need to be in 2023, you need funding, you need people. Those are the two key things that are breaking the back of our EMS services," North said.

Educational institutions

North said high schools can, and have to be, partners in building future EMS interest. He spoke about the Future First Responders Club at Punxsutawney Area High School. He said the club is a great way to get young people interested in emergency services, and that needs to be fostered in every school district.

He also said Jeff Tech is an excellent resource, providing an LPN class and supplying the area with nurses. He said the problem is the "demands of the citizenry is outpacing the supply."

The third layer he spoke about are the higher education facilities in the area. He shared a program being developed by IUP Punxsutawney, independently of the county's efforts. IUP has established a curriculum for a dual credit program that will qualify someone to be a paramedic, or at the least an EMT.

North said this program is going to be put into a pilot program at the Punxsutawney Area High School in the fall.

"They started this on their own because they identified the need. They also saw that as a good business decision because if they get (students) involved in that in 12th grade, maybe (they’ll) go to IUP and continue on. But the benefit for us is two-fold. Get them interested in high school, they migrate to the next level into college, but what we need to do is grab that and help foster that," North said.

He encouraged the emergency services to help the school advance these programs. North followed this by saying they aren't putting all their hopes on this one program, but it is something that could be helpful once launched.

Emergency services

In speaking with the ambulance services, North said they found the concerns were different from each organization across the board. The main issues he found were the minimal payments and the time it takes to receive those payments from Medicare and Medicaid.

Staffing, money, qualifications and training, and keeping employees qualified and interested in the job were all major concerns.

In speaking with the fire departments, North said the fire departments and ambulance services use to function as one unit. He has since learned that "economics and regulations have driven them apart."

Fire departments are still important because of the Quick Response Service they provide to fill in the gaps of EMS, saying "we dare not try and live without them." He said the process for QRS needs to be strengthened, and that to do this it needs a standard of training, support from a higher level, and money.

The issues put forth by the hospitals come after a patient arrives at the facility. He said when a person is brought from a skilled nursing facility or something similar, often an ambulance is taken out of service to return that person to the facility.

"Sometimes the nursing home or the personal care home are not anxious to get them back, or it's after 7 o’clock and the readmission people aren't available, or maybe they just don't want to deal with it. So this puts a burden on the hospitals, an unnecessary one, something that needs to be avoided," North said.

He also spoke to the idea of the hospitals having their own ambulance service, such as the Clarion Hospital. He said the hospitals realize there is an issue here as well, and while their problems differ from the ambulance services, "there is a link."

Legislators

North shared what the county has identified as the major problems the legislators could help with in this process, which amount to oversight and overregulation.

He said the National Registry requirement needs removed, saying he had experience with it when it comes to nurses. Where nurses are concerned, he said it "has no value whatsoever… So I’m assuming it has no value whatsoever for EMTs or paramedics."

Smith said he understands EMTs are required to take the test, and there are things in the test that Pennsylvania doesn't require for EMTs. His understanding is that Pennsylvania used to have its own test, but removed the state test to save money by going with the national test. He said work is being done to correct this.

North further said people have to pay to take the test, and often if people fail the first time, they are less inclined to take it again. He said this is because they aren't told what they answered incorrectly, and don't want to take a test that doesn't feel like it pertains to their career.

North also said the reimbursement for the ambulances is taking too long, making funding an issue. He also complained the Department of Health propagates rules and regulations that are counter productive. He called for EMS people to be brought to the table to say what regulations make sense and what don't.

Clark again spoke to the 911 side of things, calling for funding legislation for the Next Generation 911 System, which is the newer infrastructure needed to upgrade the center. This offers better integration between counties to be able to assist one another.

Clark also spoke to the need to classify telecommunicators as first responders, as this would help get them benefits when they need assistance for PTSD related to their job. This is not unique to Pennsylvania, but rather is a nationwide issue. Clark said it is being pushed to state legislators, and the commonwealth has a proactive 911 office in Harrisburg.

EMA Director Tracy Zents also spoke to the issues laid out by North, agreeing about the overreach of the DOH and explaining how it is a deterrent of people staying in the EMS field.

"Those are some negative impacts that this whole thing is going to have on us, but I’m hopeful that we as a county and a whole can come up with a solution at least to sustain this for the future," Zents said.

The public

North said educating the public on the issue is critical in mitigating some of the issues.

"Do the people of Jefferson County understand the state of affairs and how critical it is, and the burden that you face trying to keep this alive? And what is an appropriate call to 911? No one in this room is going to say ‘don't call 911 if you feel you need an ambulance’ but there are times that 911 is called when it's not appropriate," North said.

In talking about possible funding solutions on the local level, several of the borough and township officials expressed concerns about the idea of installing a new tax or fee on constituents.

"Somebody's going to need an ambulance at some point and we’re not going to have anybody to send. We’re going to fight the fight from the Department of Health standpoint on their regulatory stuff, but we need a way to sustain it for here," Zents said.

He said this is a problem that's been looming for a while, but keeps getting stalled. Zents said he did not mean anything against the current legislators because it takes more than just them in Harrisburg to accomplish something too, but that it's to a critical point now.

"I’m sure that everybody, every supervisor that's in here from every township has the same problem. You get the school district taxing, then you get the county taxing, and we’re the last ones in line. When we put something on, people notice it and they complain about it. Yeah, you need the stuff. Everybody needs a lot of stuff and we need ambulance services, but there comes a point when how much tax is enough?" said Gordon Greeley of Eldred Township.

Chris Benson, Brockway Borough Council president, asked about a tax credit that Gov. Josh Shapiro proposed. He was curious if this would apply to EMS and firefighters. He also asked if the county was considering something like this.

Benson mentioned this because the Brockway Borough Council was recently approached about a fire tax credit, which he said the borough is considering establishing for both fire and EMS, but have not taken action on yet.

Smith said there is legislation on the table for all first responders and nurses, but said "it's just getting it done." Benson said he was hopeful the state would pass something first so it could be used as a template for the smaller municipalities.

"If the state's planning on doing something, hopefully it's sooner rather than later, and then maybe that can be a template for counties, boroughs, and townships to follow suit," Benson said.

North said he would take the discussion from the meeting and share it to each of the organizations he has approached. He also suggested having another meeting in July to "start throwing some things on the table" as far as courses of action.

"I don't think we’re going to fix this and forget about it, but what we have to do is make this into a manageable state of affairs," North said.

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