October 19, 2010

UPDATE…EMTs and paramedics are mobile emergency rooms 


Ocracoke had more paramedic-level calls in 2009-2010 than any other type of emergency call, according to figures released at a special meeting Sept. 22 about the cost of emergency medical services in Hyde County.

Brian Carter and Jeff Hibbard, chief paramedics on Ocracoke and the mainland respectively, made a presentation to the Hyde County commissioners about Emergency Medical Services.
The commissioners are trying to determine if and how they can reduce the $1.5 million budget for EMS services in the county.  Expenses for the service ballooned to that amount following a law change in 2009 requiring paramedic-level emergency service for the mainland, too. Before that, the EMS expense budget was $928,672, and paramedics were only on Ocracoke.

According to Carter’s figures, Ocracoke had 130 paramedic-level calls that involved transport to a medical facility, while there were 12 basic-level calls and 9 intermediate level calls.

The mainland had 183 paramedic calls, 173 intermediate calls, and 160 basic calls.

Total calls in both places were: 313 paramedic, 182 intermediate and 172 calls.  Of those, 47 percent were paramedic level.

All told, there were 667 billable calls and 428 non-billable, which means they were canceled, the patient refused treatment, or there were fatalities. However, non-billable calls still must be paid for, noted David M. Smitherman, interim county administrator.

Carter explained that first-responder and basic emergency medical technicians can do CPR and cardio-shock. They also get a medical history.

Intermediate-level EMTs have more diagnostic tools. They can intubate airways, start some intravenous medications, and give oxygen. They try to determine the underlying cause of the emergency.

Paramedics can deliver more drugs and most anything that would be in a hospital setting.

Then from Ocracoke, there’s the long trip to a hospital.

“Even if we get spontaneous resuscitation, we still need to monitor someone on the way to a hospital,” Carter said. By land, that’s a two-hour ride. Airlift to the hospital in Greenville is about 35 minutes.

Basic-level EMTs can administer seven medications and must be proficient in 29 skills. Intermediate EMTs can give 16 medications and must have 36 skills.  Paramedics can give 51 medications and must have 59 skills.

“All (911) calls are potential paramedic calls unless deemed otherwise,” he said. Peak times for medical emergency calls are between 10 and 11 a.m. and 2 and 3 p.m. Tuesdays are the peak days for calls.

Cheryl Ballance, director of the Ocracoke Health Center, in a subsequent interview, noted that the numbers Carter shared are collected by the state for each emergency call, which collects the ages of patients, where they’re from, what skills the responders performed and more.

The Hyde County EMS system is overseen by Dr. Charles Boyette, the Hyde County medical director.

Ballance noted how far the EMS unit on Ocracoke has come since 2004 when paramedic-level service began on the island.

“This began as a group of volunteers and now they have uniforms and training and they’re very professional.”

The Ocracoke Health Center is a family practice business and is not equipped to respond to emergencies, such as heart attacks, shark attacks, drownings or fractures.

(Cheryl Bierlein is also a reporter for The Observer in Ocracoke.)

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