The Bedford County 911 Center on Thursday reversed a controversial change it made four months ago by restoring a five-minute interval for ambulance services to commit to answering emergency calls.
Four months ago, the center reduced the time it gave ambulance services to muster a crew to about 2.5 minutes, because of increasingly long and increasingly frequent delays before patients received help, especially after COVID-19 mushroomed in Bedford County, according to officials.
But all seven volunteer ambulance services in the county objected that the shorter interval was inadequate, which, coupled with easing of the COVID-19 outbreak, led to a recent compromise agreement to bring back the five minutes for the first service called — although reduced times remain for secondary services, while paging responsibilities for the 911 Center have shrunk.
The agreement represents an attempt “to implement protocols which needed to be modified to facilitate optimal response time from first responders and 911 staff, giving greatest attention to the emergency needs of the public,” wrote Bedford County Department of Emergency Services Director Dave Cubbison in an email.
The shrinking of the commitment interval that occurred
Nov. 30 was necessary so that the 911 center could get ambulances to emergency scenes in a “reasonable amount of time,” said Carl Moen, executive director of the Southern Alleghenies EMS Council.
“Clearly, if a call involves a failure of the primary EMS unit to respond, it creates significant delays,” and with five minutes allotted to each successive service that couldn’t handle a call it was “taking up way too much time,” Moen said.
Data from the fall showed that when at least one service failed to respond, average arrival time on scene was 25 minutes — almost twice the average for all calls in the previous two years, according to Moen.
Last year, there were 210 incidents in which an ambulance didn’t arrive on scene for 30 minutes and eight incidents in which it took more than an hour, Moen said.
“I believe it was an appropriate decision the 911 Center made at that time,” Moen said.
Not so, the volunteers say.
Shrinking the time from five minutes to about two minutes to muster a crew was unreasonable — and counterproductive, according to Mike Smith, Emergency Medical Services chief for the Saxton Volunteer Fire Company.
“Five minutes might seem short, but it’s an eternity compared to two minutes,” Smith said.
Volunteer services don’t staff their stations around the clock, and on many calls, there are members who can’t respond because of work or family commitments or because they’re out of town, Smith said.
It can be a challenge even to get in touch with the 911 center after a page, because not all volunteers have radios, because cell service in the county is spotty and because workers may not be near a landline, Smith said.
It may take some time to determine whether a service can respond to a call because two or three workers may be needed, depending on the severity of the emergency and the certifications of the workers available, and because some may struggle to make necessary arrangements before they can commit — finding someone to babysit their children or to meet their children at a bus stop, for example, Smith said.
Most calls in rural areas require a commitment of an hour or two, so workers need to look ahead to ensure that the time is clear for them, he said.
How it works
The 911 Center pages members, and members let the center know if they can go, informing the center and sometimes one another whether they’re going directly to the scene or to the station first, with the 911 Center keeping track of who’s going and ultimately learning whether the service can handle the call, depending on the number and certifications of the workers who can go.
It’s different for paid ambulance services, like the two in Bedford County — Bedford Area Ambulance Service and Raystown Ambulance Service — which are staffed around the clock, Smith said.
Moreover, the change was made without prior notice and without consultation with the volunteer services, Smith said.
“Agencies were not notified until the last second,” he said. “We were expected to adapt without input.”
The COVID-19 outbreak created the conditions that led to the change, according to Smith. COVID-19 cases “had gone through the roof,” he said, adding that the number of ambulance calls was “unprecedented.”
Thus, services frequently had crew and vehicles out on calls when other calls came in, he said.
Moreover, the number of available workers shrank, because some had COVID-19 or were quarantining because of COVID-19, he said.
The dispatch center was also struggling to keep up with calls, he said.
“Their remedy was to cut down the time,” Smith said.
It actually made things worse, at least for his service in Saxton, Smith said.
Before the change
In November, before the change, his company managed to respond to twice as many calls as in December, after the change — even though the number of calls was constant for both months, Smith said.
Each time that a call went to another service, that other service would be coming from farther away — perhaps 12 to 15 miles farther, which meant that there was additional travel time required to reach the scene, Smith said. Similar things happened with other services, he said.
His service has common borders and mutual aid agreements with five other services, only one of which — the Martinsburg, Blair County, substation of Hollidaysburg American Legion Ambulance Service — has a paid staff, Smith said.
Before Nov. 30, the center was sending an initial page, then as many as one page per minute until five minutes elapsed, before moving on — with the same five minute interval afforded each successive service until one could answer the call, according to Smith.
After Nov. 30, the center was sending an initial page, then a page two minutes later, then moving on at 2 minutes and 30 or 40 seconds, if it didn’t get a confirmation from the primary service, Smith said.
The center followed the same procedure with subsequent services until finding one that committed to the call.
The order for which service to call next is set by each municipality, Smith said.
Now, as of Thursday, there will be an initial page to the primary service, then pages at two and four minutes — then at five minutes, if there’s no commitment, the 911 Center will dispatch the next service in line, according to Moen.
For that second service and any subsequent services, there will be an initial page, another page two minutes later, then at three minutes after the initial page, a call to another service, Moen said.
In addition to letting the 911 Center move more quickly through the list until it finds a responsive service, the new protocol will impose a less onerous paging burden, Moen said.
As was true previously, including the last four months, services that have failed to gather a crew in the allotted time before the 911 Center moves on can still handle the call if they can get a crew together before a secondary service reaches the scene, according to Smith.
If the 911 center has already called a second service, and the first service then manages to assemble a crew, the first service can inform the 911 Center, and the 911 Center will cancel the call to the second service, provided the second service hasn’t mustered a crew by then.
If the primary service gets a crew together after the secondary service has mustered a crew, but before the secondary service reaches the scene, the primary service can call the secondary service and claim the call, with no hurt feelings, Smith said.
Once the secondary service reaches the scene, the “game” is over, he said.
The volunteer services wrote a letter soon after the change, asking for a meeting and got an acknowledgement, but no action for some time, Smith said.
Then the 911 center agreed to a meeting, but two weeks passed, and nothing happened, Smith said.
In February, the volunteer services sent a letter to the commissioners that resulted in a meeting on Feb 23, which led to the compromise agreement, he said.
The response problems for the volunteer services go back about a decade when the state approved a new EMS Act, Smith said.
Before then, EMS certification classes were affordable, about $150, because of state subsidies, he said.
It could be as little as $75 at community colleges, Moen said.
Since then, there have been changes in community college funding structures that have removed “some of the support,” Moen said.
Nowadays, EMS certification classes can cost more than $1,000, because the subsidies are lacking, Smith said.
Lots of people can’t afford it, Smith said.
Between 2005 and 2009, about 250 people per year were certified in the six-county Southern Alleghenies EMS Council region — Blair, Bedford, Cambria, Huntingdon, Somerset and Fulton counties, Smith said.
By 2014, it was down to about 30 per year, he said.
“All of us have staffing issues,” including the paid services, he said.
The compromise agreement calls for quarterly meetings involving the volunteer services and the county’s Department of Emergency Services, which oversees the 911 Center, to deal with issues, Smith said.
“We want to be clear that the volunteer services are not asking for more time, only the time that was taken away arbitrarily and without warning or input,” Smith said.
Five minutes had been the norm for the county since about 1984, Smith said.
The length of time that a county’s 911 Center waits to receive a commitment from an ambulance service that it will respond to a call is “arbitrary,” with no established time applicable to all counties, Smith and Moen indicated.
Legally, it’s up to each municipality to establish such an interval, but it would not make sense for each to set its own time separately, as that could lead to confusion, Smith said.
Issues aren’t new
The issues connected with the volunteer ambulance services aren’t new, Moen indicated.
An “online availability system” was put into practice at one point to allow the 911 Center to identify which services were available, “but agencies would not provide accurate information as to their status,” Moen said. That system ended “due to budget cuts and the failure to appropriately utilize the program,” Moen said.
Yet systems are in place in the other Southern Alleghenies counties, according to Moen.
“Bedford 911 is currently the only public safety answering point within our six-county region that does not require EMS agencies to provide daily status reports as to their availability, largely due to the EMS agencies refusal to participate,” Moen wrote in an email. “Huntingdon, Blair, Cambria and Somerset all require agencies to provide availability to the 911 Center.”
It would be ideal if a full crew for all the volunteer services would commit to staying home all day, so the 911 Center would know whether those services are available, Smith said.
The volunteer services in Bedford County tried that, but it didn’t work, he said.
Too many things would “crop up” that would interfere with individuals’ commitments to be available, he said.
The state’s EMS Act actually requires services — including volunteer services — to schedule personnel, so that 911 centers know which can respond to calls and when, according to Moen.
Typically, that isn’t followed, even though it’s a licensure requirement, he said.
The nominal solution has been to provide services that can’t do ’round-the-clock scheduling with provisional, temporary licenses, coupled with a requirement for correction plans, Moen said.
But “truthfully,” that hasn’t had much practical effect on how the volunteer services operate, according to Moen.
“The big elephant in the room” is the increasing difficulty of retaining and recruiting EMS workers, especially at smaller services in rural areas, Moen said.
That retention and recruitment problem extends to volunteer firefighting, he said.
The state Bureau of EMS has offered exemptions and waivers designed to offset some of the difficulties caused by the COVID pandemic, according to Moen.
ö Easier worker recertifications.
ö Waivers of some ambulance staffing requirements for calls, including the potential to make such waivers long-term.
ö Extensions for EMS and CPR certifications.
ö A waiver of an “outside” testing requirement for those who’ve completed certification courses and a National Registry certification exam.
ö Scholarships and “ongoing support” to decrease the cost of EMS training programs.
The volunteer services are pleased to get the five minutes back, Smith said.
“Compromise is better than no compromise,” he said. And the continuing dialog called for in the agreement is essential, he said.
“Our job is to be able to get patients the care when they need it,” Moen said.