The business of SCWEMS

SCWEMS elects new board, hears what it takes to effectively run ambulance service

South Central Wyoming Emergency Medical Services (SCWEMS) Joint Powers Board (JPB) met at 6 p.m. on March 20 at the Platte Valley Community Center's Great Hall in Saratoga.

This was the first time SCWEMS JPB had met since the resignations of several board members last month.

Cindy Talbot, Saratoga representative and treasurer of SCWEMS, chaired the meeting.

The board approved the resignations of Jeb Steward from Encampment, Donna Pipher as the Carbon County representative and Judy Redding from Elk Mountain.

The new representatives are: Mark Dunning for Encampment, Ralph Brokaw for Elk Mountain and John Rutherford as the representative for Carbon County.

The resignations required the board to elect new officers for SCWEMS JPB.

Brokaw was elected Chairman, Rutherford the Vice Chairman, Matt Cox, the representative from Hanna, Secretary and Talbott remained Treasurer.

Brokaw said since he was still new, he would have Talbott direct the meeting.

After the elections, the board approved the Feb. 20 meeting minutes and the special meeting on Feb. 26.

Melissa Sikes, assistant ambulance director, said the service was running well although an ambulance was taken out of service while it gets worked on in Laramie. She said the Medicare evaluation form, a 52-page document that has all aspects of SWCEMS business, must be filled out every five years. Sikes said it had been filled out, but needed an authorized signature. Sikes and Linda Crane, the office manager/bookkeeper, were made the signers of the document.

Crane went over the financials and the board approved them.

The board then removed signers Steward, Redding, Pipher and Heidi Sifford, the ex-ambulance director.

This brought up who would be authorized signatories. Brokaw was not comfortable with a facsimile of his signature. He also said he thought that having all board members as authorized signers was not easy to understand.

Cox said the bylaws required the treasurer be a signer on checks and said he agreed with Brokaw that a minimal amount of people should be authorized. The board decided to only allow the chairman, vice chairman and treasurer be authorized signatories.

All other signers were taken off and no facsimile was to be used for the time being.

Morgan Irene, mayor of Elk Mountain, said there was going to be a large lawyer's fee from the Feb. 26 meeting. He said Steward had not authorized the attorney to be there. The board will look into who asked the attorney to be at the Feb. 26 meeting.

Mark Meyer, the Emergency Medical Services (EMS) supervisor for Little Snake River, gave a presentation on EMS as a business.

"I have been in EMS for over 25 years and have worked in a multitude of roles from a volunteer EMT (Emergency Medical Technician) to a manager of a level two hospital's ambulance and flight service. I have been in Wyoming since 2002 and began work with Wyoming Medical Center as a ground and flight paramedic," Meyer said. "I have served on numerous committees in the state regarding EMS such as the WATRS (Wyoming Ambulance Trip Reporting Services) selection and Wyoming Mission Lifeline."

He said he was at the meeting to give an idea on what it takes to run EMS as a business. Meyer gave more personal background.

"I have been active in promoting EMS through our state's professional organizations. I served as Director at Large for WAEMSA (Wyoming Ambulance and Emergency Medical Services Administration) and have served as President on Wyoming EMS Advocates. I am completing my undergraduate degree in Healthcare Administration which will be done the end of May. I am currently the supervisor for Little Snake River EMS out of Baggs."

He said healthcare for a community costs money and it takes dollars to run EMS. Meyer said the biggest cost is salaries. He said this cost will be 80 percent of budgeted income. He added that equipment is a cost that can't be volunteered.

Meyer said an EMT also has to have a significant amount of education requirements fulfilled to maintain a license.

He said realities of the industry are sometimes hard for people to accept. Call volume versus call revenue can be a problem for smaller communities. He said increased volume without increased revenue is a decrease and can't be perceived any other way. Revenue not captured is a loss of more than just money.

"EMS systems must diversify in order to survive," Meyer said. "The days of relying on volunteering are diminishing. Overtime is an acceptable business practice."

He said the cost of having an employee has several facets to be acknowledged when laying out a budget for EMS personnel. Meyer said cost of employment is salary, benefits, hiring, moving, training, education, uniforms and retention.

"EMS employees are hard to retain and attain," Meyer said. "Finding the right person costs money."

He said an expense not always considered is moving an employee to a community. In small communities, it is not easy to find trained EMTs.

Meyer said an important component when an EMT is hired is to give them understanding of what is expected of them and what the job entails.

"Too often we say 'the keys are in the ignition and this is the code to get in the garage,'" Meyer said. "You set your system up for failure when you do this."

He said all the education needed should be compensated saying. "We are professionals and education is a part of staying on top of the profession. There is no substitute."

He said salaries should compensate people for their experience. Meyer said doctors and nurses don't donate all their time to see patients for free. They expect to be paid for the years they put in. EMTs need to be treated in the same way.

The cost of an ambulance can run $180,000 to $275,000. He said a service like SCWEMS has to ask what is the return on investment when getting equipment. He said a four wheel drive ambulance will cost almost double the cost of a two wheel drive ambulance.

"You live in Wyoming and you need four wheel drive," Meyer said. "Specialty equipment can be expensive even if you got a grant to begin with. Equipment breaks and it doesn't replace itself."

Meyer went over items that cost money initially like an ambulance and essential equipment that had monthly costs, like cell phone service. Buildings and ground maintenance is another budget consideration.

$23.27 is the actual cost per mile for operational expense, salaries, ambulance, maintenance and labor, specialty equipment, standard equipment, radios and cellphone. This is what takes to run operations Meyer said.

Meyer said his educational requirements as a paramedic requires 84 hours every two years. He said most EMS will fall into that criteria. Meyer recommended monthly training sessions. He said education to keep licenses is often a cost not considered when preparing a budget.

Meyer said building relationships with hospitals was essential as an EMS director. It will benefit all.

He said only 30 percent of calls are paid for by patients. Meyer said of the 30 percent, the ones on Medicare don't pay the full amount. He said Medicare pays approximately 31 cents on the dollar.

"You have to be prepared for these realities," Meyer said. "Revenue not captured is a loss of money and time."

Meyer said EMS community programs will become the future. He said a community must do a needs assessments. He said when an EMT visits a patient at their home instead of them being in an assisted living facility, it helps the patient and it provides income for the service.

"We have to learn to diversify," Meyer said. "Teaching CPR classes. This intertwines our system into the community and then the town will be willing more listen when funds are needed."

Outreach to the community is essential he said.

Meyer concluded for an operation like SCWEMS to be successful policies, procedures, strategic planning, support from top to bottom, accountability and a sound fiscal commitment are components for the service to work.

"We have to be more than a stretcher service," Meyer said. "To make a service work like this you have to think outside the box."

Meyer said he didn't have all the answers but by being in the industry for the years he has, he came to help SCWEMS in any manner he could.

"We are one team here," Meyer said. "I rely on you guys to be community partners and allies."

Currently Hanna has five EMTs, two Emergency Medical Responders (EMRs), and two drivers. Elk Mountain has three EMTs, one EMR and three drivers. Saratoga has 10 EMTs, one EMR , one Registered Nurse (RN) and two drivers. Encampment has three EMTs, one RN and three drivers.

When Meyer concluded his presentation, the board went into executive session at 8:30 p.m. They came out at 10:30 p.m.

The next scheduled board meeting is at 6 p.m. on April 17 at the Elk Mountain Fire Station.

 
 

Reader Comments(1)

stephenson writes:

Mike Anderson has done a wonderful job reporting on the trials and tribulations of SCWEMS over these past few weeks. I appreciate his clear, concise, and factual representation of all of the meetings. Leroy Stephenson