Solutions sought for lack of EMS coverage in rural Jefferson

Jerry Griggs had been feeling poorly in the days before he collapsed with a heart attack.
“I kept thinking I just had the flu, but I’d be all right,” he said last week at his Modern Aerobic Treatment Systems office in China. “I worked in the rain that day. I passed out and they found me on the floor.”

His family called an ambulance, but were told it would be at least 60 to 90 minutes before help could reach him, Griggs said. Not willing to chance the wait, Griggs’ wife drove him to the hospital.

“We understand our circumstances out here and that if anything happens, we have to fend for ourselves,” he added. “I think most people are aware it will take some time for an ambulance to get here, but I think we would be delighted to know there’s an ambulance close by to take care of us.”

In China, Nome, Bevil Oaks and much of the surrounding rural areas, the chance that an ambulance will be available when an emergency happens is slim, officials said. But, with the area fire chiefs leading the call, possible solutions to the problem are beginning to find support. In the meantime, fire chiefs want to get the word out: living in some rural areas of Jefferson County, such as China and Nome, means taking the risk that help might not arrive during an emergency.

“A lot of folks do expect the same level of services in the rural areas as in the city,” said China Volunteer Fire Chief Phillip Kibodeaux. “It’s not important to people until it affects them.”

Kibodeaux is one of several volunteer fire chiefs concerned about the problem – a situation he said has worsened since Hurricane Ike.

“One afternoon, at the end of October, we were called in to a fall with injuries,” Kibodeaux remembered. “We arrived on scene and dispatch told us there were no (EMS) units available.”

Kibodeaux said in his assessment, the woman was in need of quick attention, possibly because of a stroke.

“We tried calling for a ‘copter, but they were busy. We did everything we can think of, and, finally, 1½ hours later, a basic ambulance unit arrived, then a paramedic unit,” he said. “That’s the first time it really received my attention.”

“No person should go without EMS services if they need it,” he added.

Since then, Kibodeaux and China Assistant Fire Chief Doug Saunders have been researching how other rural areas have dealt with the same issue.

“The problem now is what is the answer?” said Saunders, who also is a paid firefighter in Nederland. “Do we not worry about this? Is this the risk you take living in a rural area?”

Although Saunders doesn’t advocate a particular solution, he said there are several points that should be discussed.

In some counties, such as Chambers, the county government has taken some financial and organizational responsibility for the solution, funding the staging and staffing of ambulances in strategic rural locations. Setting up a permit system or some type of permanent rotation with the private ambulance services also might work. Finally, the volunteer fire departments could go into the ambulance business.

Each possibility has its own unique difficulties attached.

Chambers County was experiencing similar problems as rural Jefferson County when Judge Jimmy Sylvia and the county commissioners decided to do something about it.
Commissioners proposed a health services district sales tax that would fund EMS service in the county.

A county with fewer than 50,000 people can establish a health services sales tax to fund health services only in the county, according to the Texas comptroller’s Web site.

“We took it to the people and proposed it and it passed overwhelmingly because it was dedicated to EMS,” Sylvia said by phone.

The tax brings in about $1 million, Sylvia said, almost all of which goes straight to four EMS stations set up through volunteer fire departments already in place.

“I like it because we get to keep the volunteer organizations in place,” he said.

Jefferson County’s population is too large to allow a health services district, but an emergency services district could be legally possible. An emergency services district would levy sales taxes as long as the new combined local sales tax rate would not exceed 2 percent at any location within the district, according to Texas comptroller’s Web site. Another possibility is to adopt a property tax at a rate no greater than 10 cents on each $100 of taxable value.

County Commissioner Eddie Arnold said that an Emergency Services District could be established, but that those interested in it would have to drum up support in the community to get a vote passed.

Legally, the county has no responsibility to provide EMS or fire service, Arnold said, adding that he hasn’t heard anything about the issue from the citizens in his precinct, which covers China, Nome and much of the northwest corner of Jefferson County.

“If they approach us and say we need some help, we’ll do what we can,” Arnold said. “Our role is to kind of facilitate it. Once it gets to the point of taking it to the voters, they have to get the support.”

In Chambers County, ambulances are staffed round the clock with two paid personnel per ambulance. The county gives the volunteer fire departments a quarterly allotment. The volunteer departments then deal with the day-to-day operations, including paying the ambulance staff.

“Once we got the bugs worked out, it’s worked really well,” Sylvia said.

Paramedic supervisor Jerry Hamilton has been with the Winnie-Stowell EMS since before the county began funding the EMS program and thinks communities need to think about where they are spending their tax dollars.

“Look at how many millions and millions of dollars we spend to protect our property, and look at how many hundreds of dollars we spend on saving lives,” he said.

As the rural population grows, StatCare EMS President Rod Carroll said it is getting more difficult to properly serve the area.

“If we don’t start addressing the issue, it’s only going to get worse,” he said. “This thing was noticed three years ago and we haven’t been able to fix it. We’re headed for disaster.”

Carroll lives in China and is a member of many of the volunteer fire departments in Jefferson County, he said. He also serves on the Texas Ambulance Board.

“Is it a necessity or a quality of life issue? That depends on if you’re the one calling 911 or not,” Carroll said.”I think the public and the state of Texas believes if you dial 911, you will have an ambulance, fire truck and police car show up and that’s not true in much of the state.”

On the private ambulance side, Carroll said it would not be financially feasible for a for-profit company to permanently station an ambulance in the rural area. An ambulance costs between $600,000 and $650,000 per year to operate, Carroll said.

“In a government model, you’re there to serve,” he said, explaining that most government-funded EMS services lose money.

Carroll advocates putting up highway signs letting people know that EMS service may not be available.

“Maybe that will get people talking,” he said. “It’s getting dangerous now. You can’t find an ambulance to respond.”

While feasible, setting up ambulance service through the volunteer fire departments in Jefferson County without additional funding from an emergency services district or the county would strain already tight resources and staffing with volunteers could be a problem, area fire chiefs said.

In China, the volunteer firefighters had an ambulance until the late-1990s, Kibodeaux said.

“We had EMS service in China since the beginning of the fire department,” he said, adding the department received a new ambulance in the mid-90s. “As the decade ended, people got tired with volunteering and they figured it was time for someone else to take over.”

The program went downhill, and the department ended up selling the vehicle to StatCare EMS, Kibodeaux said.

The China Volunteer Fire Department runs on about $20,000 a year, Kibodeaux said, a budget that comes from donations and is all spent on items like fuel and equipment upkeep.

In Nome, Volunteer Fire Chief David Studdert said the department could find the money to fund such a program, but staffing it would be an issue.

“I feel like if you can’t man that vehicle 24/7, you probably shouldn’t be in the business,” he said. “I don’t know that you can expect volunteers to be on standby every day like that.”

In the future, some local volunteer fire officials plan to bring their concerns before the Jefferson County Commissioners Court. They want to start a discussion about the problem and possibly find a solution that’s right for the area.

“We want to provide the best care for our people we can and give them what they need,” Kibodeaux said. “I’m not satisfied with the EMS care provided in this area.”
By Blair Dedrick Ortmann, The Beaumont Enterprise