Ambulance service concerns escalate

EMT shares disturbing information, Patriot Ambulance owner responds

BY RACHEL DOVE
MOUNTAIN CITIZEN

INEZ — Emergency patients in Martin County have been waiting extended periods for ambulances to travel from surrounding counties to drive them to hospitals. This has prompted several complaints over the last month about the service provided by Patriot Ambulance Service (the new owner of NetCare). In four cases, the patients did not survive, while in another, the patient remains in serious condition.

In investigating these complaints, the Mountain Citizen spoke with family members of the patients, a former ambulance service employee, Martin County officials and the ambulance service co-owner to shed light on the matter. Martin County Sheriff John Kirk confirmed the validity of residents’ concerns.

“It’s very troubling to me to see a patient struggling to breathe and a family distraught,” said the sheriff. “This has to end. This same scenario has repeated itself four to five times that I personally know of in the last month or so, and it’s unacceptable. We need to address this situation and do what’s right for our residents.”

‘Not on my watch’

Amid rising concern in the community, one former ambulance service employee (who wishes to remain anonymous) chose to leave his job at Patriot. He told the Mountain Citizen the decision was not an easy one. However, after seeing “firsthand the unsafe conditions that employees work under … and that residents are left without an ambulance in the county at least once on any given day,” he resigned.

The former employee, who started working several years ago for NetCare and quit after Patriot purchased the service, said the job was taking a mental toll on him. He said people were dying, and he could not cope with the thought of losing a patient whose death possibly could have been prevented with a quicker ambulance response time.

“There’s no way anyone could say if someone would have lived or died if the situation surrounding their demise had been different,” he said. “But it’s common knowledge that the quicker emergency crews respond to a call, the more the patient’s odds increase. A 10-15-minute response time versus a 45-minute time is a no-brainer. Each second that clicks by is another you’re losing to treat that patient and get them to the nearest medical facility. Once that window of opportunity passes, there’s no getting it back.”

The EMT continued, “I can’t explain the frustration and hopelessness you feel when you’re on a non-emergency call, and you hear radio transmissions from the dispatcher to the ambulance responding from another county. They’re constantly asking for the estimated time of arrival. You hear the seriousness of their condition. You hear ‘they’re struggling to breathe,’ or ‘they only have a faint pulse,’ or ‘no one on scene knows how to perform CPR.’ In layman’s terms, you’re hearing how the final minutes of that patient’s life play out. And then you hear, ‘the patient has no pulse and is not breathing; they’re cold to the touch.’ Then the call for the coroner to respond is heartbreaking.”

The former employee said he had to operate ambulances with no air conditioning in the front or back, even though air conditioning is a state requirement and “shall minimally deliver a temperature of 65 degrees Fahrenheit or less in warm weather conditions.”

“We had EMTs that would show up for their shift, and when they found out the ambulance they were assigned to did not have working air conditioning, they’d refuse to work because of how miserable it is in the back where there are no windows,” he said. “When it’s 90 degrees outside, the patient area is unbearable.”

According to the EMT, there were small portable fans in some ambulances.

“All those did was circulate the hot air; they didn’t help cool anything off,” he said. “On several occasions, we’d have to use cool packs on the patients because they were so overheated. Employees also got sick from it.”

The EMT claimed that on more than one occasion, he had to ask emergency room personnel for nasal cannulas because there were none on the ambulances to provide oxygen to patients. He stated there were expired medications on the ambulances and that stock was extremely low on life-saving necessities such as D-50, which is critical for treating a diabetic patient who loses consciousness.

“It wasn’t safe, and it wasn’t right,” said the former employee. “You’re playing with lives, and I refuse to be part of that. If you can’t stock the ambulances and maintain them in proper running order, then it’s time to rethink if you’re in the right business. I’m not about to compromise my license, certification, and reputation that has taken me years to build for anyone.”

The EMT alleged the ambulance service is prioritizing non-emergency transports and leaving Martin County without coverage for emergencies.

“One of the first things taught in EMT or first responder classes is ‘service over self’ and ‘people over profit,’ but those facts seem to be long forgotten,” he said. “They’re making good money, especially since they now serve several counties in more than one state, but Martin County hasn’t received any of it so far. They bought three new ambulances, but you will be hard-pressed to see one of them here.”

The former employee said it bothers him greatly that the residents in Martin County are at the bottom when it comes to priority.

“Martin County deserves so much more than what they now have. It saddens me to hear of any death occurring, but I become angry when they were the subject of a 911 call in which an ambulance had to be dispatched from another county because one wasn’t available here. Transports can be delayed if they are non-emergency in nature. But when someone calls 911 and says a family member is struggling to breathe — maybe having a heart attack or a stroke or is unresponsive – those have to take priority.

“It’s like playing Russian roulette with a fully loaded pistol: There’s no chance of avoiding a bullet when you are 45 minutes or even longer getting to the location. Bad things happen, lives are lost, and families are left suffering and trying to pick up the pieces without their loved ones.”

The EMT said the company needs three ambulances at the NetCare station to provide adequate service for the county. He said that would not happen and relayed a comment he allegedly heard: “If the county wants three ambulances, they’ll have to pay for at least one of them.”

Family waits an hour and a half for ambulance

On the evening of Sept. 12, Megan Jude was on Blacklog Road on her way to pick up a pizza at Giovanni’s when she received a call from her father stating he had just called an ambulance for her mother. Her mother was having difficulty breathing, and Jude’s father told her to pick up her pizza and come to their home on Spence Branch off Milo Road.

“It took me probably 7-8 minutes to get the pizza and get back on the road,” Jude said. “As I approached the NetCare station there on Backlog, an ambulance with its lights on pulled onto the road in front of me. I was relieved and planned to follow it to Mom’s, taking for granted it was for her. When I got to the turnoff for my parent’s house, the ambulance went on. I was confused but thought maybe they were going in a different way. I got to my parents’ home only to find no ambulance.”

Jude said that after 20 minutes, she called dispatch and asked where the ambulance was. She told the dispatcher that she had followed the ambulance, which went in a different direction. Jude said the dispatcher first told her the crew had marked “on scene,” to which Jude allegedly replied if that were the case, the ambulance was at the wrong location.

According to Jude, the dispatcher told her the ambulance she followed was doing a transport and a unit from Lawrence County would respond for her mother.

Jude called back numerous times, asking for an ETA. She said she spoke directly with the dispatcher for Patriot, who allegedly insisted the ambulance was on its way. 

“Mom’s oxygen levels were at 70 percent, and that was with her on two units of oxygen,” said Jude. “She was to the point of gasping for breath at times — and that’s what I kept saying each time I called back. I’m not one to easily lose my temper or to say words I shouldn’t, but that evening was definitely the exception for me. The more frightened I became, the angrier I got.”

Jude’s mother has severe osteoporosis.

“Just moving her the wrong way can cause bones to break,” said Jude. “I knew we could not get her loaded in a private vehicle on our own, so we were at the ambulance crew’s mercy. Finally, after an hour and a half had passed, they showed up. When I asked what took so long, they said the Martin County ambulance had been sent on a BLS transport call, and this crew came from Lawrence County and had gone to a wrong location before finding us.”

Jude claims that when the crew entered the home and began evaluating her mother, she asked them to take her temperature.

“They informed me they didn’t have a thermometer on the ambulance and asked if I was sure we didn’t have one that goes under the tongue,” she said. “I would think a thermometer would be considered a basic stock item for an ambulance. I also asked them to check her oxygen stats to ensure our reading was correct, and they said, ‘We won’t check anything until we get her loaded.’ I’m not even sure they gave her oxygen en route to Three Rivers, to be honest, because her stats were still around the same level they were at home. The emergency room staff had to put her on 4 liters of oxygen before there was any difference.”

Jude said the entire time they were waiting on the ambulance, she was praying for her mother. 

“I had read the article in the Mountain Citizen about Mr. Goble passing away under similar circumstances,” said Jude. “And with every passing minute, I became more scared that the same thing would happen to us.”

Jude’s mother remains hospitalized.

“This has opened my eyes to the fact that our county has a problem that has to be corrected immediately,” commented Jude. “How many have to die before everyone admits it’s time for a change? It could happen to anyone at any time. No one is immune.”

According to Martin County 911 records, the ambulance responding to the call from Lawrence County did not have a working radio system radio and had no way of communicating with 911 dispatch as required by regulations.

Three calls end in death

The dates Aug. 27, Sept. 2 and Sept. 3 have something in common. On each of those dates, a Martin County resident called 911 needing an ambulance, but there was no ambulance in the county, and one was dispatched from a neighboring county. Also, in all three instances, the patient died.

One died at the scene waiting on the ambulance, another coded en route and was pronounced dead after arrival at a medical center, and a third patient died shortly after arriving at a hospital.

Aug. 27—Rockcastle Road

On Aug. 27, a caller on Rockcastle Road requested an ambulance for a patient having difficulty breathing. There was no ambulance available in Martin County, and one was dispatched from Patriot Ambulance Service’s Lawrence County station. Dispatch advised the caller the ETA was approximately 30 minutes. The caller expressed concern throughout the call, saying that the patient’s breathing was more labored. When dispatch stated the ambulance was on its way, but it would be another 15 minutes, the caller said, “He may not have that long.”

Approximately 40 minutes later, the patient was loaded and coded en route to Three Rivers Medical Center. Attempts to resuscitate the patient continued after arriving at the emergency room, to no avail, and he was pronounced dead.

Sept. 2—Hode

On Sept. 2, a caller requested an ambulance for an elderly Hode resident, saying he had pneumonia and was struggling to breathe. There was no ambulance available in Martin County; the closest one was at Paintsville ARH, where it was wrapping up a call. The caller reported the 77-year-old patient was making a “gurgling” sound and, shortly after that, started CPR.

According to the 911 log, the NetCare station on Blacklog sent out a request for a firefighter to serve as driver. An EMT at the NetCare station did not have a partner.

Inez assistant fire chief/Martin County 911 director Nick Endicott volunteered to drive the ambulance, but the selfless act could not save the patient’s life. The patient was transported to Highlands ARH, where his death was confirmed.

Sheriff Kirk was near the location of the call when he heard the radio traffic about no ambulance in the county and went to offer his assistance.

Sept. 3—Lovely

On Sept. 3, a 911 call came in from Lovely. A resident had gone next door to check on a neighbor. When he did not answer, she looked through a window and saw him lying on the bed unconscious. Police responded, as did firefighters from the Warfield Volunteer Fire Department, but the ambulance was delayed as it was responding from Lawrence County.

Attempts to resuscitate the man were unsuccessful, and the coroner arrived to pronounce him dead.

Fire departments not equipped as ambulances

According to Endicott, firefighters from both Inez and Warfield fire departments have been toned out several times in the last month. In the past, the number of times that occurred in a month was much lower.

Endicott said several firefighters are EMTs but do not have direct access to the same life-saving equipment that an ambulance would have.

Sheriff Kirk applauds the volunteers for responding to the calls.

“But the ambulance service has a duty to the residents of the county to be there when needed and to respond in a timely manner,” added Kirk. “We none know when it may be one of us that finds ourselves in need of medical assistance, and the way it stands right now, that’s a scary thought.”

Patriot responds to complaints

Ironton, Ohio-based Patriot Ambulance Service co-owner Krista Ellison responded to residents’ complaints of delayed response time in a phone interview Tuesday.

“First of all, please remember that we have only been in charge for four weeks,” Ellison said. “We base two ambulances in all the counties we service, with the exceptions being in Boyd and Greenup counties, and they have three. The reason they have three, with one of those being designated for 911 calls only, is the tax subsidy their fiscal courts pay our company to cover the cost of the ambulance and crew. The other counties do not have a subsidy set aside for this, and we cannot afford to provide a third truck without it.”

Ellison said when residents are told there is no ambulance available in the county to respond and that one will be coming from another county, that doesn’t necessarily mean that Martin County ambulances are tied up on calls in other locations.

“It’s a well-known fact in the world of EMS that calls are placed every day requesting an ambulance for reasons other than a true emergency,” said Ellison. “So when we’ve had to dispatch an ambulance from another location for someone that truly needs our assistance, there could actually be a county-based unit just a few miles down the road responding to a situation that we would not consider a priority, but we nonetheless have to see it through.”

Ellison said she had traveled Martin County to get a better feel of the layout of the communities. She remarked that even if an ambulance were at the station on Blacklog, there are several locations in the county that would take additional time to reach, especially in outlying areas. 

“You can’t get everywhere in any county we service in a 10 to 15-minute timeframe, no matter how hard you try,” said Ellison. “That’s just reality.”

“To all the residents of Martin County, I want to say this: We’ve only been the owners for one month. There are many issues and problems to solve and it will take time. It’s not going to be an overnight fix. I ask for your patience and understanding as we make changes. We will get there, but it’s going to take a lot of work and commitment from everyone involved.”

Ellison said she met with Martin County Judge/Executive Colby Kirk and Deputy Judge Eric Phelps to discuss the possibility of the county contributing a tax subsidy to cover a third truck.

She said she is also willing to travel to Martin County to meet with the public to address concerns.

“We strive to provide coverage the best we can and I’m happy to say that we now have a backup medic that lives in Martin County that can respond to emergency calls when we don’t have a truck available. He is highly qualified and is a true asset to our company. Hopefully, that will help alleviate some of the public concerns, but please remember that if there’s more than one call happening at the same time, he can only be in one location.”

Ellison said Patriot is completing numerous repairs on the ambulances, including air conditioning, that stemmed from a lack of maintenance by the previous owner. She said each would be inspected, properly stocked and in compliance with regulations.

“I can say without a doubt that had we not purchased NetCare, Martin County would be without ambulance service,” said Ellison. “The original owner had built a solid business but when it was bought out the first time, things began to fall apart. Money was not reinvested into the company, the units were not being maintained, supplies were not ordered, employees were pretty much unsupervised and the payroll for the last month before we purchased them was late. Actually, when we bought NetCare, we covered the final payroll for the previous owner.”

Ellison said Patriot “runs a tight ship.”

“We don’t tolerate or allow rules to be broken, and that didn’t go over well with some previous employees who are no longer with us for a variety of reasons,” she said. “But I am happy to say we have made recent hires to replace them and as far as personnel goes, we are now in a good place.”


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