Garrard EMS saving money, improving service

LANCASTER — Garrard County Emergency Medical Services Director Chuck O’Neal and his staff emptied every piece of medical equipment from their ambulance fleet last week.

Baskets of bandages, gloves, IV bags, oxygen masks and more were piled on stretchers as they determined which things are necessary to carry and which could stay to lighten the load.

O’Neal has taken a similar approach in his overall management of Garrard EMS — perfect the most important services and prune the extra expenses.

Since he began in July, O’Neal has more than doubled the amount of coverage provided by advanced life support crews, while saving roughly $10,000 in supply costs. He’s also secured new technology and implemented a weekly education and training schedule for his staff.

“I’m trying to teach these guys and talk to them about things being new and it being a new day,” he told the Garrard Fiscal Court recently. “If they had a poor attitude before, it’s time to change that. If they had a good attitude before, then we can improve on that. If they were giving good service before, we can improve on that, as well.”

O’Neal stressed that EMS was in good shape and under solid leadership when he arrived this summer.

But the agency experienced a few tough years after longtime director Colby Arnold suffered life-threatening brain injuries in a bicycle crash in September 2009.

About a month after Arnold’s accident, EMS employee Thomas Shelton was charged with 21 counts of theft of a controlled substance after allegedly taking bottles of morphine that belonged to the ambulance service.

Shelton ultimately was fired, and Mike Tuggle stepped in as interim director for Arnold, who officially retired from the director post in September 2010.

Garrard County Judge-Executive John Wilson credited Arnold for building EMS into a valuable county agency, and said quickly replacing him with interim leadership was challenging.

“It was kind of just to hold the status quo in the meantime, but as you’re holding the status quo, there’s less of an incentive to strive for improvement,” he said. “Mike did a great job in the meantime.”

O’Neal agreed, saying he inherited a well-structured agency and a staff with great fundamentals.

However with his background as an independent EMS consultant, he quickly identified areas for improvement, starting with staff scheduling.

When O’Neal arrived, Garrard EMS operated with two advanced life support crews only two days a week. The other five days were covered by one advanced crew and one basic crew.

Basic crews operate with emergency medical technicians, who complete a six-month training program and can perform core medical procedures such as splinting, immobilizing and bandaging. But advanced crews contain paramedics, who have two years of training and can give injections, perform intubations, operate ventilators and start IVs, among other things, O’Neal said.

Using dual advanced crews only two days a week saved money in salaries and overtime but left county residents playing a potentially risky game.

“It was kind of the luck of the draw when you called,” O’Neal said. “You may get a basic life support crew. You may get an advanced life support crew.”

So he adjusted the schedule to staff dual advanced crews five days a week.

Wilson said he was “extremely skeptical” of the plan because EMS is already the county’s largest single general fund draw and requires about a $100,000 supplementation annually.

But because agencies like Medicare and Medicaid reimburse at a higher rate for advanced life support services, EMS was able to recover much of the staffing costs.