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By DAN TELVOCK
On nights, weekends and holidays, Spotsylvania County has enough volunteers to staff three of nine ambulances with responders trained to handle the most serious medical calls.
A Nov. 16 Spotsylvania County Fire and Emergency Medical Services Commission memo to the Board of Supervisors states that until more volunteers are certified with advanced life-support training, the volunteers will continue using a backup medic in a response vehicle to handle most serious medical calls. That medic can be responsible for answering ALS calls in a very large area, the memo states.
A review of the county budget shows it could cost as much as $3.1 million--a third of the paid fire and rescue system's $9.3 million budget--to hire and train enough rescue workers to make sure every ambulance is capable of providing advanced life support around the clock.
The county has 133 paid emergency services employees, according to the budget, and more than 300 others who serve with Spotsylvania Volunteer Fire, Spotsylvania Volunteer Rescue and Chancellor Volunteer Fire and Rescue.
Spotsylvania Fire and Rescue Chief Chris Eudailey says having more ALS coverage is his preference. But other rescue officials say having someone trained on each ambulance is uncommon and unnecessary when fewer than 30 percent of medical calls require such a response.
Many volunteers are trained in basic life support and can perform CPR and administer oxygen and glucose.
Advanced life-support training allows a rescue worker to administer life-saving drugs and procedures to patients. An ALS-certified medic is especially important for patients with serious brain and heart conditions.
The memo states that paid career staff have an ambulance at every station in the county with at least one responder trained in advanced life support during weekdays from 4:40 a.m. to 6 p.m.
Getting more ALS coverage would require hiring more paid personnel and helping the volunteer system with recruiting and training.
"It is going to get down to a point that someone is going to have some real dialogue with the Board of Supervisors to determine what level of service they want," Eudailey said.
The memo states that the goal is to eliminate the disparity in how ALS services are provided during career and volunteer hours, but that no target date is set.
MEETING STATE STANDARDS
Elizabeth Singer, spokeswoman for the Virginia Department of Health's Office of Emergency Medical Services, said it is not uncommon for there to be fewer ALS providers during volunteer hours.
She said the state requires one driver and one person with basic life support certification for every ambulance, and the Spotsylvania volunteer agencies are meeting that guideline and sometimes exceeding it.
"You are going to have some jurisdictions in rural areas that don't have any ALS providers. The closest ALS provider might be the [helicopter] service," she said.
Singer said that although a person trained in basic life support cannot administer an IV, he or she can perform CPR and use a defibrillator. ALS-trained providers can read heart rhythms from an electrocardiogram, she said.
"The important thing is getting them to the hospital," she said.
Stafford County has around-the-clock ALS service with paid staffing. Fredericksburg has mostly basic life support, volunteer crews at night and on weekends, with paid ALS backup.
DISPARITY IN SERVICE?
Eudailey said he prefers to have an ALS provider on every ambulance during career hours because it is the best level of service.
"We don't have the crystal ball to know what 30 percent of the calls we need to send ALS on," he said.
Eudailey said residents in rural parts of the county have as long as a 45-minute ambulance ride to a hospital.
Kevin Dillard, administrative chief for Chancellor Volunteer Fire and Rescue, said jurisdictions across the nation have different styles of managing combined systems.
The county's two volunteer squads, Chancellor and Spotsylvania Volunteer Rescue, are regularly meeting response-time goals and have a record of good patient care, he said. In consecutive years the two squads won Virginia's top award for rescue units, and county resident satisfaction surveys consistently give the combined fire and rescue system high grades, he said.
Dillard said he is not aware that any patient has been compromised by the volunteer model.
"We are doing the best that we can with the resources that we have, and we are meeting the needs of the public," Dillard said. "Ideally, would we love to have more ALS providers? Yes."
TRAINING CENTER OPENS
Eudailey said he recognizes that recruiting and retaining volunteers is a continuous challenge for the county.
He said it is a significant investment of a person's time to get better training, especially when the person already has a full-time job and a family.
Spotsylvania Volunteer Rescue Squad recently opened a training center after a $300,000 renovation of its old rescue building behind the county sheriff's office in the Courthouse area.
Doug Found, who is the squad's training director, said the center needs state certification before any ALS classes can be taught there. He hopes to be providing the classes by March. EMT-Intermediate, which is a step above basic life support training, will be taught.
Found said one problem the squads face is that once volunteers receive the ALS training, they often find full-time jobs in fire and rescue services.
Found said Stafford County recently hired four of the squad's ALS providers. He has six members taking an ALS class at Rappahannock Emergency Medical Services.
Found said it doesn't make much economic sense to have every ambulance staffed with an ALS provider when a majority of 911 calls require only a basic life-support provider.
Another issue is the amount of time it takes a volunteer to finish the training. Singer said it can take at least a year to get ALS certification and two years for paramedic certification.
"Most of your volunteers are going to be basic life-support providers because of the number of hours it takes to get ALS certification," Singer said.
Dan Telvock: 540/374-5438
Email: dtelvock@freelancestar.com
