Council, others examine future of Culver’s EMS as mandated changes loom

As a result of new state standards, Culver's EMS service will make a marked change in 2014; Culver's town council met with members of the service last Tuesday to consider just what that change will look like.

Indiana's new curriculum, according to Culver-Union Twp. EMS director Bob Cooper Jr., mirrors national standards and will go into effect July 1, 2014. Current levels of EMS provider certification -- which include First Responder, EMT-Basic, EMT-Basic Advanced, EMT-Intermediate, and Paramedic -- will be replaced with Emergency Medical Responder (EMR), Emergency Medical Technician (EMT), Advanced EMT, and Paramedic.

Culver's service currently operates at the EMT-Basic Advanced level, said Cooper, who also distributed a handout to council members outlining details. He described the various patient treatments allowed by Culver's level of service.

The new Advanced EMT standards retain the basic skills with the addition of a few skills, but, said Cooper, one very important skill would be lost: that of cardiac monitoring. Instead, Culver's service -- if it transitioned to Advanced EMT -- would be limited to use of an Automated External Defibrillator (AED) for cardiac arrest patients.

The new mandate does allow a "bridge" course of approximately 100 hours for existing EMTs, while brand new certifications will have to complete a full course of 175 to 250 hours.

Outlining Culver's three options, Cooper pointed out the Basic EMT level would be easier to recruit for and less expensive, since most of the staff would be volunteer. However, there would be a tradeoff, since EMTs could administer no medications and offer no advanced airway procedures, IV, or cardiac monitors. Culver's EMS would essentially become a "band aid bus," he said, and would have to rely heavily on other communities' mutual aid for more advanced pre-hospital care.

The Advanced EMT option for 2014 would include limited medication administration, IV access, and blood glucose readings. The department's income would be higher (since patients would be charged more for the care), and there would be less reliance on mutual aid for paramedic assists.

However, hundreds of hours would be required for training, making recruitment difficult, and paramedic assists would still be necessary. The department would still lack the ability to administer advanced skills such as advanced airway procedures, cardiac monitoring, and pain or seizure medications.

The third 2014 option for Culver would be to become an all-Paramedic service, which would offer the highest level of pre-hospital care possible and far greater patient assessments, advanced airway procedures, 12-lead EKG heart monitoring, and no need for paramedic assists. This option would offer the service the highest possible income and the possibility of increased coverage area.

More training would be required, however (625 total classroom hours for certification and 600 hours of clinical time) and the cost would be considerably higher.

It was noted a number of surrounding areas -- including Plymouth, Bourbon, and Bremen -- are currently at Paramedic level. Starke, Pulaski, and Fulton Counties offer county-wide paramedic service.
Of the 144 shifts covered in Culver by the EMS service, 68 are covered by paid personnel, according to the handout.

Culver resident Mike Leonard, a Paramedic and PRN here and in other communities, noted Culver has already purchased Paramedic-level 12-lead "Life Pack" heart monitor equipment.

"It's a tragedy to have to park those and not be able to use them anymore because the state says you can't," he said, adding the testing made possible with that equipment "is what the cardiologists want (to) see. When we get to the (patient's) house, we slap the 12-lead on and they (cardiologists) expect us to interpret and show that to them. That triggers a response at the hospital and they call the transfer unit and reserve a cath table at St. Joe (hospital). The goal is to have all this happen...with no delay."

The equipment would only be used by Paramedics, explained Leonard, and would become useless in Culver in 2014 unless the local EMS service goes Paramedic.

Council member Lynn Overmyer suggested not having a driver on ambulance runs, reducing run staff from three to two, would save money.

"It does help to have three," said Cooper.

Council president Sally Ricciardi, a longtime member of Culver's EMS service and past director, said back injuries are a consideration when reducing staff to two.

Several members of Culver's EMS who also serve in other departments, note many get by by having firemen called out to ambulance runs, something presently not happening in Culver.

Councilman Ed Pinder suggested Cooper outline dollar figures to the town with each respective option, which Cooper said he would do.

In response to a question from Chad Becker, in the audience, Cooper -- who recommended going to a Paramedic service -- noted the service currently pays a third full-time person minus benefits. An additional full-timer on 24 to 48 hour schedules could be supplemented with volunteer drivers, and EMTs, allowing the volunteer core to still participate.

"I think the new Advanced service (allowed by the state in 2014) is a few-year Band-Aid," said Cooper. "If you're putting the time, effort, and money into upgrading, let's make it count (by going Paramedic)."

Council member Bill Githens asked if the service could be contracted out entirely. Cooper said it's possible, but Culver would lose all volunteering options and local jobs would be lost. Leonard noted a contracting company "will want enough (money) to make it profitable for them, not just to break even." Bremen, he said, is charged over $300,000 per year for contracted EMS service.

Ricciardi said Bourbon signed over its ambulances to contracted services for a low initial service rate, but found the rate increasing dramatically the next year.

Githens also thanked Cooper and Kimberly Irsa for representing Culver's EMS in their trip to New Jersey to assist in the aftermath of Hurricane Sandy recently.