So long as TLC Emergency Medical Services has two ambulances in the barn, it will respond to calls of people who might need help up a flight of steps, or getting out of a car, its division manager said Friday.
That’s not quite a reversal of the standard it told Cortland County’s dispatchers in December, and the public in January. But it is a clarification of its standards that will change who dispatchers call, and how, should someone need assistance that might not require a medical response.
“If I have at least two ambulances available, we will respond,” Trish Hansen, Cortland division manager for TLC, said. But it reserves the right to refuse a call with no need of a medical response if TLC has just one ambulance available. “Helping somebody up the steps is not a medical emergency.”
The statement is less a change in policy than a clarification of what she told the county’s Emergency Response and Communications Department, she said. She told dispatchers that TLC would not respond to “personal assist” calls, but would respond to “lift assist” calls. The difference, she said, is that a personal assist call has no chance of a medical need, where a lift assist — such a person who has fallen and cannot get up — has the possibility of a medical need.
Dispatchers, however, began rerouting all such calls — except in the city of Cortland, where the Cortland Fire Department would respond — to other ambulance services, from Dryden, Marathon, Cincinnatus, Groton, Moravia and Tully.
The decision made sense, said Scott Roman, the county’s director of emergency response and communications; it saves time. “It’s a waste of time to call if you said you’re not going to go.”
‘DOING THE BEST WE CAN’
Roman, and leaders of two other ambulance providers that serve the greater Cortland area, appreciate Hansen’s difficulty. Staffing is difficult, and Hansen reports that calls are up 20% this year from a year ago. But they have the same problems.
Kevin Westcott, director of operations of Dryden Ambulance, had said earlier this week his organization wouldn’t send an ambulance and crew all the way to Cortland to provide service. It’s not a decision Westcott made lightly — and it will still provide lift assists in Dryden, he said. “It’s a huge issue to solve,” he said Thursday, as Hansen, Roman and other county emergency officials discussed the matter leading to Hansen’s announcement Friday. “But we cannot be the long-term solution to this problem.”
The Marathon Area Volunteer Ambulance Corps will continue to answer those calls, for now, said Chief John Tillotson. “We will continue to monitor the situation to assess the impact on our own operations.”
Those ambulance crews have their own areas to worry about, Tillotson said. “Every agency is doing the maximum mutual aid they can handle.”
“It’s fair for a local taxpayer to ask ‘Why am I paying for service outside my community?’” he added. “It’s put agencies in a difficult spot.”
“We’re all doing the best we can,” Hansen said.
TIME ON THE ROAD
Ambulance companies cannot bill patients or insurance providers for such calls. Keeping an ambulance and crew ready in Dryden costs $190 an hour, plus the fuel, wear-and-tear on the vehicle and other costs should it need to respond to Cortland, about 10 to 12 miles away.
But it’s not simply the money, Westcott said; it’s the time. Responding to Cortland can take 45 minutes to an hour for a crew, an hour that ambulance cannot serve Dryden.
And if the time to respond to a Cortland call is less for TLC, 30 to 45 minutes, that’s still time when an ambulance and crew cannot help someone else. TLC has responded to 137 fall calls so far this year.
The Cortland Fire Department has said it will respond to such calls in the city, but volunteer departments might not.
Both types of agencies, fire departments and ambulance crews, face similar difficulties: a need for people, paid or volunteer, with the training and equipment to respond, yet still leaving enough resources to deal with the next call, Tillotson said. He described a recent night where he went to watch a relative’s basketball game. He let the first ambulance call during the third quarter go to others, but the next call came in the fourth quarter, and his wife had to find a way home so he could help respond with MAVAC’s second ambulance.
It doesn’t have a third.
For ambulances, actually transporting a patient swallows time. A trip to Guthrie Cortland Medical Center is relatively close, but a MAVAC trip to a Johnson City trauma center can take an ambulance out of circulation for two hours, or 2 1/2 if the ambulance has to go to Syracuse. Dryden Ambulance is nearly an hour to either trauma center, plus the return time.
That’s part of why MAVAC, which started 25 years ago with one paid medic and a crew of volunteers, has moved to an all-paid model, Tillotson said: two full-time paramedics, a full-time emergency medical technician, and a variety of drivers and other medics who receive a stipend for per-shift work. Ambulance services could keep even more crews busy, he said, if they had the crews.
Dryden Ambulance has about two dozen volunteers, Westcott said, but like the fire departments, they have limited availability.
SEEKING SOLUTIONS
“This is not a new problem in any way, shape or form,” Roman said. Volunteer fire departments lack volunteers. Ambulance services have difficulty retaining EMTs — 45% of whom make $19 an hour or less, state data show.
Westcott suggested that volunteer fire departments can step up and respond to such calls, even as he understands that volunteer agencies have fewer volunteers and some have said they do not have the resources to respond to lift-assist calls.
Hansen isn’t sure what the solution might be. “There are some people in our community who have nobody,” she said. “It’s not about the money. It’s about providing the best care.”
Roman, however, notes that municipal ambulance services are expanding, and many new ones have started. Tompkins, Madison and Chenango counties have created ambulance services. And Auburn in Cayuga County has created one through its fire department.
Across the state, 21 counties have created municipal ambulance services, up from 10 in 2020 and four in 2000.
Madison County started with a single basic life support ambulance, and now operates six advanced life support rigs, Roman said.
“These really are becoming municipal services,” he said, and may become more common in the future with a plan in Gov. Kathy Hochul’s budget proposal to declare rural emergency medical services an essential service, opening it to more funding and easier regulation to create a service.
What’s not going to be acceptable to the public, Roman said, is nobody showing up when someone calls 911. “Somebody needs to check on these people,” he said. “To me, it’s simple: A call comes in, a call goes out.”
THE BOTTOM LINE
But at the bottom of all this, and what Westcott said has him most concerned, are the patients on the ground.
They might not be injured, Tillotson said, but who knows? “Older people are sometimes not great historians about their medical history.”
And even if they are, waiting for help from Marathon or Dryden takes time, Westcott said. Bed sores can set in within 20 minutes and should a limb be stuck under the rest of the body, the pressure can lead to compartment syndrome and health complications to surrounding tissue and organs that can take weeks to recover from. Sometimes, compartment syndrome can lead to death.
“This is what could happen,” Westcott said. “It’s not just a simple fall.”
“You still have a patient who’s lying on the ground,” he added. “For how much time? Who’s going to help?”
