Caswell debates ambulance transport

By Shannon White
Special to the Register & Bee
Published: October 5, 2008

YANCEYVILLE, N.C. — The Caswell County Board of Commissioners is continuing discussions regarding the patient transport policy of the county’s Emergency Medical Service with some commissioners questioning the feasibility of patients being transported to the hospital of their choice instead of the nearest facility.

Commissioners Nate Hall and Kenneth Travis have questioned the consistency, cost effectiveness and risks associated with the current transport policy numerous times in the past few years. Hall has pointed to increased fuel costs and longer transport times as reasons to investigate the current policy, which states patients are to be transported to the “closest appropriate facility” and how that policy is implemented consistently by EMS personnel.

Travis has said that taxpayers pay for the county’s EMS service and that the county is “not running a taxi service.”

Jeanne Riddick West came forward last week during the public comments portion of the commissioners’ meeting to defend residents’ rights to be transported to the facility of their choice, arguing that complicated medical histories did not always allow the most appropriate facility to necessarily be the closest.

West, a former Caswell resident who now lives in Sanford, said she was addressing the board on behalf of her father, Sam Riddick, who died on Sept. 3 before he had the opportunity to voice his concerns regarding the EMS transport policy.

West argued that her father’s complicated medical history, which included an 18-year battle with multiple myeloma, an incurable cancer of the plasma cells, required that he be transported to Durham Regional Medical Center because that was where his doctors and medical record were located.

“Citizens of Caswell County deserve a choice,” she said, adding that families should not have to argue to ensure their family members are taken to the most appropriate facility.

West went on to say that Caswell County is too big to only have two ambulances in service and that with patients and insurance companies being billed for transports, the county should have enough funds for additional ambulances.

“My family takes issue with the statement about this service being used as a taxi service,” West stated. “Is there abuse of this service? Yes, but don’t penalize the people who really need this service.”

Not ‘black and white’

Jim Gusler, director of Caswell EMS, said the department continues to work with area hospitals in an effort to reduce turnaround times.

A recent grant also is making it possible for the county’s 911 telecommunicators to receive the training needed to become certified emergency medical dispatchers, which Gusler said will help prioritize incoming calls and ensure that the necessary equipment and personnel can respond quickly.

Gusler said the current policy states patients are to be transported to the closest appropriate facility and sets out general guidelines to help EMS personnel determine which facilities are appropriate.

“The majority of our patients do go to the closest facility,” he said, “but sometimes the closest facility is not the most appropriate, and that is a call EMS personnel have been well-trained to make.”

Gusler explained those decisions most be made on a case by case basis and said there are a number of factors involved in determining the most appropriate facility, including the nature of the call, the ability of facilities to treat certain levels of trauma or cardiac emergencies and other medical complications that may impact the level of treatment needed by the patient.

“It’s not a black and white policy,” Gusler said. “It can’t be, it has to have some gray areas to allow EMS personnel to make the decisions they are trained to make, the decisions that are in the best interest of the patient.”

maintaining trust

Gusler said that not every patient request for transport to a specific facility can be honored given call demands and weather conditions, but emphasized that EMS personnel have been trained to determine the medical necessity of such longer transports.

“For the most part, it does go back to patient choice,” Gusler said. “We’re a service organization and there are certain expectations there.”

Gusler said he is worried that current discussions could erode the trust residents have in the service.

“I don’t want someone who’s having a heart attack to think twice about calling because they’re worried about where we might take them,” he said.

The discussion is expected to continue on Monday when commissioners plan to receive a detailed report from their personnel committee examining the current policy regarding patient transport and how that policy is implemented.