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THUNDER RADIO EXCLUSIVE: Short-staffed and short on pay, EMS virtually unable to transport emergency patients out of county

By Josh Peterson, news director

Just three days before Christmas, Manchester resident Brandon Imhoff got a scare. The local business owner was having a heart attack.

Imhoff was flown by helicopter to a Murfreesboro hospital where a stint was put in and he was home for Christmas. Thankfully – weather conditions were favorable for a helicopter flight that day. Had they not been, this story may have ended differently.

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Why? Because he may not have had access to emergency transportation.

Thunder Radio News has learned that a myriad of obstacles and conditions have led to a major issue in regards to ambulance transports from Coffee County hospitals to Murfreesboro or Nashville hospitals. Basically – transportation is not available.

Coffee County EMS service is battling a staff shortfall that can likely be attributed to poor salaries. Absences due to COVID-19 have only amplified this issue. The insufficient staffing numbers has led to a shortfall in available ambulances which, in the end, renders the Coffee County EMS either unavailable or unwilling to transport patients from Unity Medical Center in Manchester or Tennova Harton in Tullahoma to larger hospitals when the need arises.

“We feel that our function is to take care of people,” explained Coffee County EMS chief Michael Bonner. “We are your first introduction into the healthcare system. If you are already in a hospital and you need to go to Nashville … well you have a doctor, a nurse and medical staff around you. If we don’t have enough ambulances available, we cannot put that transfer call ahead of a 911 call with someone on the side of the road or injured in their home.”

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Currently, the Coffee County EMS service has six full time openings in what Bonner called a “constant battle” to remain fully staffed. When fully staffed, the Coffee County EMS service has five staffed ambulances to cover Coffee County. Removing one for a transport to Nashville is a strain on the system. When short-staffed and only four units are available, using one for a transport is basically impossible.

In fact, while on the phone with Thunder Radio News for 15 minutes, four ambulances were paged out for various emergencies.

“If I had one ambulance in Nashville right now, we would literally have no ambulance to cover another emergency here at home,” explained Bonner. “We have some private services in this area but they are usually busy with private, non-emergency transports like dialysis and we can’t rely on that.

“Those private services theoretically are supposed to do discharges, dialysis and non-emergency transfers to Nashville or Murfreesboro,” explained Bonner. “I say theoretically because they are busy, too. They are not able to run Nashville. They have staffing issues too.”

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The payscale is lopsided

In Warren County, an advanced EMT (AEMT) starts off making $14.12 an hour at full time. A part time AEMT takes home $13.15. Meanwhile, a full-time paramedic in Warren County takes home $15.91 an hour while part time makes $15.12.

In comparison – a full-time AEMT in Coffee County makes $10.91 – a $3.21 per hour difference. Paramedics in Coffee County make $14.04 an hour to start, a difference of $1.87. Estimates have Warren County’s population about 14,000 fewer residents than Coffee County.

The pay difference seems to help Warren County stay fully staffed. Warren County EMS chief Preston Denney told Thunder Radio News that he is fully staffed with 34 full time and 12 part time employees. There are also no private groups operating in Warren County.

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A fully staffed operation for Coffee County would include 35 employees.

Both operations run in the negative and are subsidized by county tax dollars. In Coffee County last year, the ambulance service, after bill collections, was subsidized about $619,000 by tax dollars to break even, according to the budget office. Meanwhile, the Warren County service was subsidized $900,000 by tax dollars there. Coffee County took about 1,500 more calls.

“Franklin County [ambulance] is run by private company,” explained Bonner. “They pay more than we do. St Thomas and Vanderbilt have their own ambulances. We aren’t close enough in pay scale. That gap has gotten too big. And as long as it exists in that size I cannot convince anyone to stay here. Second issue we have is call volume.”

Unity Medical Center: “This is jeopardizing patient health”

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Unity Medical Center in Manchester issued a statement about lengthy wait times for patient transport. The hospital said that patients have waited over six hours for a transport out of Unity to a Nashville hospital for care.

“Unity Medical Center is deeply concerned about the situation at the Coffee County EMS, especially in this extraordinarily difficult time in the medical industry. Patients needing emergency transport to other facilities often have excessive wait times before a transport is available. On occasion, patients have waited over six hours for an ambulance to be available for transport. These delays not only jeopardize the patient waiting to be transported to the appropriate facility, but other patients needing care as well since the patient to be transported still ties up medical resources while waiting.

“Unity has met with Coffee County EMS to address concerns about patient safety due to long wait times. After investigation, it appears the problem is simply due to insufficient staffing, not a lack of available equipment. The market for qualified emergency medical technicians (EMT’s) is competitive and Coffee County has not budgeted enough money to hire the needed EMT’s. Unity sympathizes with Coffee County EMS in this regard because it also faces a similar issue. In order to hire and retain qualified personnel, Unity has to compete with hospitals in surrounding areas including Murfreesboro. While Unity recognizes that Coffee County EMS is not at fault for its lack of funding, this situation has created a substantial health risk for the citizens of Coffee County. Unity is proud to work with Coffee County EMS and considers them an essential part of the health care team caring for residents of Coffee County. However, something must be done about this situation quickly in order to continue to have an effective health care network that the citizens of Coffee County deserve.”

Staffing stagnant despite rising call volume

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Call volume and need for Coffee County EMS has increased significantly over the past 15 years as the county population grows and Interstate-24 produces accidents. However, staffing levels have remained stagnant.

For example – in 2006 Coffee County EMS took 5,265 calls. At that time, the EMS was operating five units with three stations.

Fast forward to 2020 – EMS answered approximately 9,345 calls (an increase of over 4,000). And while there is an additional station, there are still only five units staffed. And with staffing issues due to pay discrepancies with surrounding competitors and even more shortfalls due to COVID-19, five units aren’t always available. (see table at the bottom of this story)

“Almost every month we are short staffed more than 50% of the month right now,” explained Bonner.

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In December, the EMS was short staffed 19 days. In November it was short staffed 17 days. And in October – the EMS was short staffed 22 of the 31 days that month.

“COVID has multiplied staffing shortages and really leaves us unavailable to make these transports,” explained Bonner. “We just can’t afford to have an ambulance gone for three or four hours.”

What is also shocking and goes to the concern expressed by area hospitals – when flight conditions aren’t ideal for a helicopter, the ambulance service is still often unavailable to transport patients.

“We have times when it is raining or a helicopter is on another call – we take those calls but it’s only when we can,” said Bonner. “If I’ve only got four ambulance and they are on a call, well I can’t magically produce another crew.”

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And when helicopters are available – they are substantially more expensive to the patient than an ambulance. How much was Imhoff’s helicopter bill he received for his heart attack in December? That came to over $46,000. Thankfully for him, his insurance covered that cost. But that isn’t always the case.

Funding for the county EMS comes from the Coffee County Commission and the Budget & Finance Committee. Thunder Radio spoke with Coffee County Mayor Gary Cordell for this story. He expressed a strong desire to find more funding for not only the ambulance service, but other county personnel that are lagging behind surrounding communities. 

Contact your county commissioner

Not sure how to contact your county commissioner? You can do so by clicking here. 

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The table below represents number of calls answered, stations and units staffed for the EMS since the year 2000. 

Mayor responds
Thunder Radio News took these alarming trends to Coffee County Mayor Gary Cordell. The mayor
acknowledges that salaries across the board in the county must be addressed.

“This is a lot like our sheriff’s deputies who are in the same boat (and are underpaid compared to
surrounding agencies),” explained Cordell. “We are starting our budget process here soon. I wish we
could find a million or two. We’ve got to look at some things for our county personnel in terms of
salaries. This is nothing new.

“We’ve got to somehow get more money appropriated with our ambulance service and other areas.”

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