OSCODA – Talks have been had for months regarding ambulance response times in Iosco County, as well as the possibility of Oscoda Township partnering with Alcona County for Emergency Medical Services (EMS).
The issue was further discussed at the June 24 township board of trustees meeting, where officials heard from Iosco County Commissioner Terry Dutcher, Iosco County Enhanced 9-1-1 Central Dispatch Director Michael Eller and Scott Kiernicki, operations manager for both Iosco County EMS and Arenac/Iosco Mobile Medical Response (MMR).
One of the major points they tried to get across was that there are some instances where ambulances take longer to respond, but there are reasons for this.
Dutcher began by sharing that a concern of his has been the number of questions surrounding ambulance response times, and what the county is doing about same.
“Our average time for January, February and March, I believe, ran between seven and 11 minutes,” he said of Iosco’s priority one calls. “Well within the guidelines and the national level.”
He noted that there are outliers, however, one of which has been pointed out by Oscoda Township Supervisor Aaron Weed. This is in reference to a 9-1-1 call in 2018, for which there was a response time of 58 minutes.
According to Kiernicki, this incident was initially paged out as a difficulty breathing call. “Later on, while the ambulance was en route, they were asked to stage by PD that was on scene. And they were staged for the remainder of that time, which led to the 58 minute response time.”
He said staging may be required in a variety of situations, including if someone is hallucinating, has drugs in their system, or anything else which may have altered their consciousness. Therefore, if police deem the scene to not be safe, they will have EMS hold off until things are under control.
Kiernicki said the clock still runs, though, because emergency personnel are technically on the scene. In this case, what was paged out as a breathing problem turned out to be a psychiatric incident.
As he has said previously, average response times are typically based on priority one calls – responses with lights and sirens for life-threatening emergencies. “So when we segregated all the priority one response times out, we did find that our average was about 10 minutes. I even ran response time averages just for your township, and they were actually better than the county.”
Kiernicki said there are going to be occasions when the times are extended. “We don’t hide from those, but we can’t put an ambulance on every street corner. It’s just not possible.”
He added that sometimes there are two emergencies within the same township and ambulances have to be pulled from other areas. So one will have a quick response time, but the other will be delayed if it’s coming from somewhere else in the county.
Oscoda trustees have also discussed the transfers conducted by ambulances, where a patient is taken from one facility to another.
Clarification was given when Treasurer Jaimie McGuire asked about the frequency of these, and who receives the money from transports.
“About 25 percent of the calls that we do in this county are transfers. It’s very important that we do those. We can’t bring patients in to the hospital, unless we take patients out,” Kiernicki said, noting that there are only so many emergency rooms in Tawas City’s Ascension St. Joseph Hospital. “And the money received in those transfers does stay within the county; not in the general fund, in our own EMS fund.”
Eller said transfers are very important to the way things operate in Iosco, but he feels that this has been reflected negatively. There may also be misconceptions that MMR is responsible for transfers.
Eller said it is those from the hospital who make determinations on transfers, after which a call is placed to 9-1-1 dispatch. “And if we have an ambulance available that meets the standards, we will send it out. If we don’t have enough ambulances available where we can send that ambulance out, then we turn down the transfer.”
In such situations, he said Arenac County MMR, an Alcona ambulance or another agency will handle the transfer.
He noted that Alcona EMS utilizes two ambulances for their county and half a rig for transfers, which is the same in Iosco.
“Iosco keeps two rigs on, at minimum. At dispatch, we’re not allowed to dispatch additional rigs out past two rigs unless it’s a stat transfer, which means that person, if they don’t get out now, they’re highly likely to not survive very long,” Eller said.
He explained that the board of commissioners, not MMR, approved going down to one rig if there is a stat transfer.
Kiernicki said when there is just one ambulance available it is only for a short period of time, usually 10 minutes.
“We have 4½ rigs, and four of those could be on local emergencies, which leaves us with one rig,” Eller said. Or three could be doing transfers, he cited of another example, but within minutes the situation changes, as noted by Kiernicki.
According to Eller, there are a lot of local emergencies and when the number of available ambulances is down, it is not solely due to transfers.
“If we didn’t do any transfers at all, we couldn’t afford to have 4½,” he went on. “We would then be down to two or three ambulances here in Iosco County.”
Eller also mentioned the fact that the people being transported are Iosco County citizens.
“It’s our families, our neighbors, our loved ones that are being transported out of this county to a higher level of care. Tawas hospital, not only do they need room in their ER, but they don’t offer cardiac care, they don’t offer ortho, they don’t offer vascular, they don’t treat burn victims. If you need that higher level of care and you can’t go in your own personal vehicle and have to be transported, our ambulance service provides that service,” he said.
“Our ambulances are owned by the county, the employees are county employees and all of the rules and regulations that they’re governed under is established by the county board of commissioners or the local med control. Zero of those items are maintained or controlled by MMR,” Eller said.
“Now my issue has not been that transfers are being done, my issue has been is that rigs dedicated to Iosco County are being pulled from the county to do transfers,” Weed commented.
As for Alcona County, he said there are two dedicated rigs, with a third one implemented that specializes in transfers. “So what I was asking for from the county was to implement additional rigs specific to transfers.”
He noted that Alcona’s population is about 10,000, while Iosco County’s is in the area of 25,000.
Alcona also has a unit that specializes in just lift assists, so that they’re not pulling ambulance units for that task, Weed said.
But their response times are very good, he continued. “All 9-1-1 calls were under 30 minutes for the year 2018, including priority threes.”
“That’s not true,” Kiernicki said.
“If you have data to tell me otherwise, please let me know,” Weed said, to which Kiernicki answered that he does.
Eller said the information he received is that there were 45 calls last year in Alcona with response times of more than 30 minutes, 14 of which were more than an hour.
Weed then compared the two dedicated units in Alcona for a population of 10,000 to the two dedicated units in Iosco for a population which is more than double.
“You’re right, we can go down to two. But like I said, the other ambulances are still in this county on other emergencies that will soon be at the hospital,” Eller said. “The hospital then resides in our county, and they will clear, and they’ll be available for additional calls. Yes, there’s still other ambulances in our county, they’re just on other calls and they’ll eventually get to the hospital, they’ll get eventually clear and they’ll eventually be available for other calls.”
Eller said Alcona has an excellent EMS director and 9-1-1 system, but the difference is that there is no hospital in that county.
“So when an ambulance picks up a patient from a residence in Alcona, they have to leave the county,” he said, which essentially makes every emergency call a transfer. “They have to leave their county and go to either Tawas hospital or Alpena hospital. So their ambulance is out of the county for a minimum of one hour, every single call that they have.”
He also shared that Alcona has eight first responders agencies, plus they use two from Alpena County when needed in their northern townships.
Weed posed a series of questions to Kiernicki, asking if he sits on the 9-1-1 board, is a voting member of the 9-1-1 board, provides annual evaluations on the 9-1-1 director, sits on the med control board and is a voting member of the med control board.
All of these were confirmed by Kiernicki.
“I’m done. Anybody else have anything?” Weed remarked.
Trustee William Palmer said he believes what precipitated this conversation is that the Oscoda Area First Responders (OAFR) will be dissolving this October.
He said most of the board of commissioners’ comments have been that they don’t receive complaints from residents about response times. But, based on the monthly reports from OAFR, first responders are often on scene prior to EMS; so it makes sense to him that they’re not getting a lot of complaints since somebody is showing up at the person’s door.
Palmer said he was curious if MMR is putting anything in place to keep closer track of Oscoda, now that OAFR won’t be around to make up that difference in time.
Kiernicki said referencing MMR is where a lot of the confusion is coming from, as MMR doesn’t put any of that into place.
He said EMS personnel go over reports every month and, if there is an extended response time, it is dissected to determine the cause.
Kiernicki said OAFR is vital to the community and he wants to see them stay open, but those at EMS have also questioned what the impact will be once the first responders service shuts down.
Eller said there were 883 emergency calls in Oscoda last year which were responded to by Iosco County EMS.
He said he doesn’t know how many calls OAFR went to but, historically, it has been 150-180 per year. “So they’re only going to a fraction of them anyway.” Further, some of the calls first responders go to – including structure fires, personal injury (PI) accidents and water rescues – are because they want to and choose to go; not because an ambulance isn’t available or is out of position.
Clerk John Nordeen said he would be interested in seeing the reports which track the transfers, to which Eller invited all board members to his office at any time to go over this and other data.
Eller said he has never received a complaint about response times until recently, when a township supervisor reached out to him after being contacted by a resident.
Eller said he pulled up the data for the call, listened to the recordings, discussed it with Kiernicki and they viewed the precise route taken by the ambulance for the call in question.
He said what it came down to was, in this particular community there are multiple roads with the same name and same address, and the ambulance went to the wrong location.
According to Eller, the supervisor of this township is working very hard to have some roads renamed and install better signage.
“I’m on the 9-1-1 review board, and I’ve just been tasked with rewriting the bylaws, as well as our policies and procedures,” Dutcher shared.
He said this is one of the things he intends to look into, as far whether there is a breakdown in the system and, if so, how to get things straightened out.
“I live in this community, too. I do not want long response times,” said Dutcher, who acknowledged that there will be extended response times, but that there are also explanations. “I’m quite certain that when I take this back to the board of commissioners, they’re all going to be on board with it. If there are problems, we want to know it.”
If officials receive complaints about response times, he asked that it be brought to those at the county level to be addressed. He said this is their job and they don’t take it lightly. “If we don’t have the calls, we can’t check into them.”
Another reason for extended response times, Eller said, is it simply takes longer to get from one location to another.
“If you’ve got a PI on [M-65] and River Road, how long does it take to get there? That’s what’s happening with the outliers for EMS,” he said. “If you want to eliminate the outliers in your township, not only are you going to have to build a station out there, put equipment out there, but you’re going to have to man it, too.”
He said the local response times are incredible but, for calls in the “middle of nowhere,” it does take EMS longer to arrive because they aren’t manned there.
He said he believes there are 14 municipalities in Iosco. “If you had 14 ambulances – one in each municipality – and they were responsible for only that municipality, some of these areas only have 33 calls a year, 44 calls a year. So 330 days out of the year, that ambulance would do nothing.”
When dividing the 883 emergency calls in Oscoda last year by 365, he said this equates to 2.4 calls a day.
As reported, when trustees discussed the potential contract with Alcona EMS, one possibility mentioned was bringing in upwards of 2½ ambulances to serve Oscoda. Again, no final decisions have been made on this topic.
With this in mind, Eller said it would amount to one call a day, per unit. “How can you afford that? Maybe you can, I don’t know.”
Dutcher added that if there are two ambulances in the township but one responds to a call, the level of backup available wouldn’t be the same as what is offered now at the county level.
Eller said another reason response times may be lengthy is that some people who visit the county don’t always know where they are. For instance, someone may not be aware of the point where north M-65 turns into west M-65, so they’ll give dispatch an address on one road, when really the caller is elsewhere. “We’ll send the ambulance to the wrong area, because that’s where they told us.”
Eller said this happens a lot in the summer and it isn’t something EMS can improve on, as they already ask numerous questions to narrow down the exact locale, such as what the cross streets are.
He stressed that he is not against what Oscoda is trying to do, and he hopes the township is able to provide additional service, be it first responders or more ambulances. “The more resources we have in this county, the better.”
However, he said what he doesn’t want is for Oscoda to go forward with such a plan while criticizing the hard work of 9-1-1 personnel and EMS staff. There are no intentions of having drawn out response times, and they drop everything they do to provide a service to the community.
Weed said the employees do a great job, and at no time did he criticize them. “But sometimes those employees are under the pressure of some higher level.”
He said his concern lies with the fact that he approached the county, told them there was an issue, asked them to look into it and requested some adjustments.
“And the kickback from the county was, really to sum it up, how dare you question us? There are no problems. There is no money to fix this. This is just how it is; quote, ‘be grateful for what you’re getting, with what you’re paying for.’ That’s just not appropriate,” Weed said.
“My recommendation to the county has been, maintain the four ambulances that you currently have, add two more units that specialize in transports so that you can maintain four units in a county of nearly 25,000 people; that will provide adequate response for them,” he went on.
He said this will require more resources, but it should be brought up to the people.
“Put it on a ballot and say, if we increase the millage, you’re going to get a lot better ambulance service,” he suggested.
“But when I get directly told by county officials, ‘no, we’re not going to do that,’ that’s a problem. Because the people want better. The people don’t want 40-minute response times, not even on a priority three call,” Weed added.
“On a bad winter day, icy roads, I can drive from one corner of the county to the other in 50 minutes. I’ve had to do it. I hear the complaints about the geography. There is no geography problem here,” he proceeded.
“How many Pine Streets are there? That’s common in all communities,” Weed said of repeat street names and addresses.
He added that he has spoken with representatives of other EMS services in different counties, and they aren’t having such a problem in this field. These entities often maintain response times of less than 20 minutes, with very few calls going over 30 minutes. “I’ve talked to these people; I’ve called around the country.”
He again said that he is not criticizing the work of emergency staff in Iosco but, rather, he applauds them for working under the conditions they do.
Eller said a situation could arise where an ambulance is at Old Orchard Park in Oscoda for a call and, when checking out the patient, there could immediately be another call on Alvin Road, off of Bissonette Road.
“How long is it going to take them to get there? It doesn’t matter if the county’s flat, you have to drive all the way around,” he said. “It’s the same thing from station one in Tawas or Baldwin Township. If we have a call on Wilber Road, we have to drive all the way down 55, go all the way across to Wilber, and go all the way up. Our community is trapped in several locations.”
“I know the road layouts in this county. I’ve driven most roads,” said Weed.
“I’m telling you what I’ve experienced, sitting in the chair at the 9-1-1 dispatch center,” Eller said.
“Have any of you sat in a police car for over a year? A 9-1-1 dispatch chair for over a year? Ran a rig for over a year? Any of you? I’m guessing no. Until you have, you don’t understand how it works; you can’t,” he continued, saying that he doesn’t understand what it’s like to do their jobs at the township, either.
He again invited officials to his office to learn more about the work which goes on there.
“All I wanted was for the county to look into making improvements,” Weed reiterated.
Dutcher said all of the items at hand will be looked at and, if there are areas where improvements can be made, something will be put into place.
“If there’s something that can be done with what we have to work with, we’re going to do it. That’s a promise. And I’m quite certain I have the full pledge of the board to do that,” he vowed.
“If you can make improvements without raising the millage, that’s even better,” Weed said.
“I don’t know how great the improvements are going to be, but if we find a spot that needs to be improved, we’re going to do it,” Dutcher said.