Isolated receiving times for ambulances at HCA Mission Hospital and a strained emergency response system are some of the issues Macon County Emergency Services Director Warren Cabe brought to the public’s attention at the Nov. 14 Macon County Board of Commissioners meeting.
Cabe’s address to the board followed regional media reports regarding McDowell County putting a moratorium on inter-facility non-emergency transports to HCA Mission Hospital in Asheville. The week of the meeting, Cabe said Buncombe County also reported they had issues with HCA Mission Hospital regarding receiving times.
“Receiving time is the time from when one of my trucks gets to a facility like a hospital until patient care is actually transferred to another provider,” Cabe explained. “What’s happened is these counties have issues with that time frame, they talk about some lengthy time frames.”
Cabe said Macon County wasn’t immune to lengthy time frames and there have been some issues, but “not nearly as severe” as other counties.
Cabe said the average receiving time in September and October was 4.84 minutes. This was due to Macon County emergency services having options and only critical patients going to HCA Mission in Asheville. Other counties such as McDowell take many of their patients to HCA Mission.
In October, there was one instance where the receiving time for a Macon County unit was 128 minutes. That turns a three-hour round trip into a five-hour round trip, Cabe explained.
In September, 10 calls were long. Nine of those were in the 30-minute range.
“10, 15, maybe 20 minutes…probably not a big deal,” Cabe said. “When we get to 30, it concerns me, and we had another outlier in September that was 70 minutes.”
“I wanted to bring that to your attention because I’m sure somebody’s going to ask, ‘are we having that same issue here,’ and we are occasionally, but not to the same level as some other services,” Cabe said.
There are five ambulances on call in Macon County, three in Franklin and one each in Highlands and Nantahala. The bare minimum for Macon County is four.
“The longer that truck is out of town, out of pocket, that puts us at risk of not meeting our chute times,” Cabe said, noting the industry standard is that 90% of the time when a 911 customer calls, they must immediately have a truck ready to pull up.
As a result, Macon County EMS is declining some local non-emergency transfers, Cabe said, so they can be there for local 911 callers, which is their primary business.
“We are the only option for those folks to call,” Cabe said of Macon County 911 callers.
Cabe said from 2019 to 2022 there has been an 11% increase in call volume while the department is down six staff members. Cabe said they’ve tried to mitigate the issues by training four part-timers, but only one is interested in a full-time career.
Regarding the regional transport system by HCA Mission, Cabe said they no longer have a truck in Franklin due to staffing issues.
Cabe said they have “great communication” with HCA Mission and Angel Medical Center and that HCA Mission addressed some issues.
“I’ve actually been very pleased with the communication we’ve had with these folks,” Cabe said. “I think they’re struggling as much as we are to find out the solution. If I could tell you I could fix all the healthcare [issues] tonight, I’d probably quit, walk out the door and be a millionaire somewhere.”
The average response time in Otto is 2.28 minutes, but Cabe is concerned that in October, the chute time was 10 minutes, and once it was 26 minutes.
“Ten minutes, it doesn’t sound like a lot, but when you call me and you need one of the orange and white trucks and you live in Mulberry, or if you live in Tellico or if you live on Ledford Branch and I still got a 20-25-minute drive to get to you, and you add 10 minutes on top of that, we’re starting to see strains on that system on the health care end that I’m not sure where we’re going to get with it,” Cabe said.
Another mitigation effort is covering the shortages with overtime. There are 26 people on the part-time list, but many are retired or working, so they’re limited in responding. Out of those 26, 15 worked in the previous two weeks, but they had to use full-time staff to cover extra shifts.
That week, Cabe said they were down to two trucks in Franklin. Cabe said that really hampers their ability to keep numbers up when 88% of their callers are 911.
“I’m not telling you the system is broken. We’re seeing some of the same issues that other counties are seeing,” Cabe said. “I’m not sure where we’re going to come out of this one.”
Cabe said to Board Chair Paul Higdon they’ve “pulled some rabbits out of hats before,” but “at some point in the near future, we’re gonna reach into the hat and I’m not going to be able to pull a rabbit out.”
“I don’t know how to fix it,” Cabe said. “I usually don’t come to you unless I have a solution. I usually don’t ask a question unless I have an answer. I’m not sure on this one.”
Cabe clarified folks shouldn’t worry about 911 not being there, saying they’re still making calls.
Commissioner John Shearl said as someone who has retired from emergency services, he feels some of those paramedics might start breaking. Cabe said some paramedics can only do regular shifts while others can work overtime. One way to help them is to schedule them one 24-hour day in Franklin, then another 24-hour in Nantahala, where they average one call every two-plus days, but admitted it’s rolling the dice.
“It’s a strain mentally and physically,” Shearl said.
Cabe said there’s a new ad campaign coming out in conjunction with NCWorks, plus he’s putting together a recruitment team and working with Human Resources on a strategy to recruit out of the school systems.
However, Cabe said there doesn’t appear to be enough paramedic graduates coming down the pipeline to cover the increased needs in WNC.
Cabe said he has high standards for his employees and hasn’t compromised on that yet. The recent staffing shortage has led to him seriously thinking about adjusting the standards but hasn’t done so yet.
“It will be a very bad day when I come to you and tell you we lowered our standards to get more people,” Cabe said.
Commissioner Josh Young said between the home fires, accidents and more, emergency responders are going through a lot recently.
The staffing issues are also in the dispatch office, with Cabe saying he doesn’t know how to cover if he would have a dispatch vacancy tomorrow.
“It’s across the board with all these folks,” Cabe said.
Shearl suggested using the CTE program from Macon County Schools to get recruits. Young replied they already have programs.
Cabe responded that they’re open to making contingent offers based on graduation, which is something that didn’t happen years ago.
Commissioner Danny Antoine said as a chaplain for first responders, they have to do a better job of taking care of them.
“A few weeks ago, at this fire, it took four fire departments to put out this fire in this small house. As chaplains, when we arrive at the scene, we’re there at 3 o’clock in the morning and you’re looking at all these faces of these people and doing it over and over and over again,” Antoine said, noting that while entertainers are making millions, first responders “are paid peanuts” for an exhausting and thankless job.
Antoine said sitting in debriefs with first responders is heartbreaking, seeing the trauma they go through. Antoine said he supports the first responders 100%.
Higdon told Cabe to keep the board apprised going forward.