(WJHL)- As part of WKRN’s “Counties in Crisis series,” News Channel 11 asked EMS leaders in Hawkins, Greene and Unicoi County to explain the challenges rural providers are facing.

How do response times in your county differ from EMS services in more metropolitan areas?

When minutes matter most, people in rural areas often wait longer for emergency medical services. 

“In Hawkins County, your response time may be up to an hour,” said EMS Exploratory Committee Chairman Dr. Blaine Jones. “In Johnson City, your response time is probably going to be pretty close to five or six minutes no matter where you’re at.” 

Adam Copas, a division chief with Washington County/Johnson City EMS, recently took over as operations director for Unicoi County EMS after the County Commission opted to start it’s own service rather than renew a contract with a private provider.

When asked to compare services in Unicoi County to those in Washington County, Copas said, “The response times that we have here [in Unicoi County] are longer, our turn around times from the time that call comes in to the time we get units available again is longer.” 

“There are times when we may even go down to level zero on trucks, not have anything available. So if an emergency call comes in that means that one has to wait until somebody clears,” said Greene County EMS Director Calvin Hawkins. 

Do you have enough ambulances on the road to adequately cover your county?

Jones said there are currently five 24/7 ambulances on the road in Hawkins County. He said there are normally six but staff shortages have taken one out of commission. A recent study found nine ambulances would be the ideal number to improve wait times in the county, according to Jones.

Copas said there are two 24/7 ambulances serving Unicoi County. “That’s exactly the number that we need to have here,” he said. 

Before Washington County began helping Unicoi County establish its own EMS agency, Copas said Washington County EMS had to respond to calls outside of its service area “several times a day at times” to fill in holes in coverage. He said in the first five months of their partnership that’s happened about 12 times. 

Hawkins said Greene County currently has seven 24-hour trucks in service and two power trucks, which run 12 hours a day and 4 days a week respectively. 

“I would like to see two more 12-hour trucks and maybe another 24-truck,” he said.

Do you have enough staff to adequately cover your county? If not, what is preventing you from hiring additional staff?

Jones said “to get staff up to an acceptable level” Hawkins County would need ten to twelve additional employees. 

Copas said in a perfect world he would hire ten more people in Unicoi County.  

Hawkins said for ideal coverage in Greene County he would like to hire fourteen additional employees. 

All three said these positions would be additional field staff, including paramedics and EMTs.

Jones said part of the problem is rural counties often don’t have the budget to hire more people, in part, because a higher percentage of their patients are uninsured or underinsured.

“The majority of our payor mix is Medicare, Medicaid, and TennCare,” he said. “When you go into the cities, you have a bigger payer mix of private pay insurance, which reimburses at a higher rate and therefore you’re able to maintain a bigger staff.” 

They said this problem is compounded by a nationwide shortage of EMTs and paramedics. They said low pay and long hours can be deterrents for prospective students who, for an additional semester of work, can make more money as a registered nurse. 

“Everybody wants their employees to make more money and give them greater benefits but at the end of the day it’s a balancing act between revenues coming in and expenses going out and trying to meet that bottom line,” Copas said.