At last Monday’s Town Hall (December 4), a four-person panel of ambulance administrators were speakers at the meeting that was held at the Three Rivers Memorial Building, providing insight into the Tulare County Emergency Medical Services contract and the challenges of response times in rural areas in a complex health care landscape.
Dale Dotson, EMS coordinator for the Central California EMS Agency, a division of the Fresno County Department of Public Health, explained that his agency provides contracted ambulance services for a four-county area: Fresno, Madera, Kings, and Tulare.
One of the Tulare County providers, American Medical Response left Tulare County in September 2016, leaving behind a problematic situation for the other providers to cover all calls and still meet the 20-minute response times as stipulated by the County of Tulare contract for rural zones. Dotson said through some creative scheduling and positioning of ambulances the response times are still being met under the threshold for rural zones 3 and 4, which contain Three Rivers (Zone 4), Woodlake, Elderwood, and Badger.
Dotson said when the contract was first approved after the Three Rivers Ambulance, a volunteer service, was disbanded in 2013, the Lemon Cove Fire Station was designated as the strategic place where the ambulance would be staged to serve the area.
Recently, owing to several factors including extended wait times at the two hospital emergency rooms in Tulare County (Sierra View-Porterville and Kaweah Delta Medical CenterVisalia), there have been numerous occasions where the ambulance that would normally park in Lemon Cove has been staging at the Highways 65/198 intersection or in downtown Exeter.
Dotson explained this situation was necessary as additional resources are needed where there is a higher call frequency. Three Rivers, according to Dotson, typically averages one call every three days whereas other areas like Exeter and Lindsay average substantially more; Woodlake averages 1.5 calls daily.
Dotson said Three Rivers calls spike seasonally. Since September 2016 the month with the greatest number of calls was May 2017 when there were 18 emergency calls to Three Rivers.
Of the calls that come from Three Rivers, 95 percent of the ambulances arrive at the scene within the prescribed 20 minutes response time, he said.
But there are always a few calls that don’t make the response time, sometimes because the driver has difficulty locating an address, it was reported. In terms of the county-wide situation, there may be less ambulances available too because of the one-to-two hours of wait times to discharge patients at overcrowded emergency rooms.
Tim Stahl, interim manager of the Exeter District Ambulance, said his ambulances handle the majority of calls dispatched to Three Rivers. They are working on ways to improve the local service after going through some reorganization of the Exeter district’s board.
Stahl said one way to vastly improve local service might be to station a full-time paramedic in Three Rivers with a smaller emergency vehicle.
“The district will be looking at the feasibility of how we can speed up response times,” Stahl said. “A paramedic on scene with first responders could make the critical difference.”
Dotson said the ambulance conversation is an ongoing one with Three Rivers and the residents of Tulare County. His agency, CCEMSA, will attend future Three Rivers meetings and present data on how often an ambulance is actually staged in Lemon Cove, emergency room wait times, and how response times and services can be improved.
Inquiries to Dale Dotson, EMS coordinator, may be emailed to email@example.com or he may be reached by calling (559) 600-3387.