EMS challenges — CEO shares concerns about hospital’s ability to get ambulance services

CEO Cathy Harshbarger said at the July 17 meeting of the Weston County Health Services board of trustees that the hospital is having trouble getting emergency medical services transfers at times, which is “pretty scary.”

She said that around July 15, a patient had sepsis and gangrene in their intestines, and EMS said they wouldn’t take the patient because they were at a shift change.

“We don’t find that an acceptable reason at all,” Harshbarger said.

Shane Kirsch, EMS manager, told the News Letter Journal that occasionally – in a pattern that isn’t unique to Campbell County Health – transfers out of facilities at night are more challenging to manage, in part because hazards and fatigue increase. 

The challenge is exacerbated by CCH’s service contract in Newcastle, which is with the city of Newcastle and Weston County, not WCHS. That means CCH’s priority is to keep a 911 “truck” available for service within those geographic boundaries – and only then can they take facility transfers, after shifting resources, according to Kirsch. Often, that means CCH needs to move an ambulance from Gillette or Wright to help transfer patients, or one of the “very limited number” of pro re nata, meaning “as the need arises,” staff who live in Newcastle might help cover the calls.

He believes the incident Harshbarger brought up at the meeting was the result of “a bit of a communication error.”

“In this instance, I believe, specifically, I don’t know if the crew in Newcastle remembered that we’ve made this recent change to try to help facilitate this patient movement, and I also don’t know that the patient’s condition was relayed as critical as what it should have been,” Kirsch said.

He said that when he interviewed his staff after the incident, they indicated that it didn’t “feel like the information that we received.”

Harshbarger said that WCHS has a good partnership with CCH EMS, which she recognizes covers a huge area, but it wasn’t the only time WCHS has had difficulty getting transportation for patients in grave situations.

In another case, “a surgeon was barking down our backsides” because they didn’t have the patient in for surgery yet and the hospital couldn’t get an ambulance, Harshbarger said in the meeting. On certain days, the weather makes it impossible for the hospital to get air flight EMS, she said.

Not only are these situations dangerous for patients, but the hospital is “in a liability situation because we have somebody that’s only going to get better with surgery that we don’t provide,” Harshbarger said. “So it’s very concerning.”

One time, a patient developed sepsis with what would normally be a simple surgery and they died, she said. In other cases, the patients survived but the delays shouldn’t have happened, according to Harshbarger.

Kirsch said CCH has begun making a change in its shift model to help address the situation, and he believes the incident Harshbarger brought up at the meeting was the result of “a bit of a communication error.”

Kirsch explained that the conversations regarding hospital transfers are now directed to the leadership medic in Gillette, who has a little bit better understanding of the logistics required for a facility transfer. 

Kirsch told the NLJ that local EMS services are hindered by a number of systematic challenges, but indicated that CCH CEO Matt Shahan has some ideas on how to work better with WCHS and is eagerly anticipating having time to meet with Harshbarger about those challenges. However, CCH’s preparation to go live with a new electronic health record system, Epic, has delayed that meeting.

According to Kirsch, he and some of his leadership team members meet monthly with some of WCHS’ administrative team to come up with solutions for any unique challenges and determine how to work better together, and he thinks those meetings have been beneficial.

“The relationship between Campbell County Health EMS and Weston County Health Services continues to grow and develop, like any relationship does,” Kirsch told the NLJ. “I can appreciate their frustration, along with my own frustrations, in regards to operating a service in Weston County.”

Harshbarger said the hospital will have a Zoom meeting from 11 a.m. to 1 p.m. Aug. 6 with Campbell County Health EMS and SafeTech Solutions as part of a needs assessment for EMS in northeast Wyoming (see related story above).

“Historically, the biggest problem that we’ve had over there, is staffing that lives in or around Newcastle,” Kirsch said. “We have a couple of very dedicated employees, and I can’t thank them enough for the services that they provide. They come in at all hours of the day and night, but we also have to have a reasonable expectation for them to not be at work on occasion.”

Solutions may be hard to identify, however, because Kirsch said that population demographics contribute greatly to the challenge. Weston County has seen a decline in its population and number of volunteers, while what remains of the population is aging rapidly.

“We’ve got a perfect storm of people that are requiring more care and less people that are in the community that are probably able and trained to provide that kind of care,” he said.

Kirsch said he hopes a proposed EMS taxing district makes it onto the election ballot because he wants to have the buy-in from the community to increase ambulances and staff availability in the Newcastle area. Kirsch said EMS is not defined as an “essential service” in Wyoming, which means the state doesn’t dedicate funds for the service.

“When you call 911, there’s no guarantee that an ambulance shows up, to run you or to deal with your medical emergency,” he said.

He said he thinks that if EMS were viewed as an essential service, tax dollars would be dedicated to it, but since that isn’t the case, communities have to supply the money and manpower themselves

“With volunteerism on the decline, we’re having to pay people to run these calls and to maintain their certifications and maintain their education,” he said. “It’s not as easy as throwing somebody in the back of an ambulance and just driving them to the next hospital.”

Kirsch said another issue is how many ambulances CCH can use. The hospital has 18. It staffs three 24/7 in Sheridan, three 24/7 in Gillette, one 24/7 in Wright, and one 24/7 in Newcastle. Often, the hospital has to bring on a few extra ambulances to accommodate patient movements, stand-by requests, and special events.

He said that he imagines that if WCHS could afford to have a Level 3 hospital or Level 1 trauma center, they would love to.

“But they can’t. Those are some of the realities we’ve got to face, and so, how do we work together to get people where they need to go quickly, appropriately,” he said. “That’s the struggle that many hospitals and many organizations are facing.”

WCHS is able to stabilize patients in its emergency room, but it doesn’t perform surgeries, both because it doesn’t have surgery units and likely wouldn’t have the patient volume. Sometimes patients who have been stabilized in the ER need surgery urgently, as was the case in the shift change incident.

“It was communication between Campbell as well, but we called the local people to tell them they had a transfer, and they said it was near shift change time so they weren’t going to be taking the patient,” Harshbarger told the NLJ, reporting that it took five hours for CCH to get a transfer.

In a couple of cases, patients have been critically ill and WCHS is “waiting around trying to find support for them,” she said. Sometimes, patients “have to” take themselves in their own vehicles to the next higher level of care center because doing that was less risky than waiting for an ambulance.

“That’s not ideal because you really would want them medically managed, but we don’t have any real other choices,” she said.

She said WCHS has changed some of its policies so staff members will help transfer patients with its own staff, if necessary, to provide the transportation. But even then, they need an ambulance.

“I don’t want to attack the ambulance service, but at the same time, I’m saying that the services for people who need the care are not predictable,” she said.

Harshbarger said she wonders what state- and county-level decision makers will come up with to provide the best services possible for residents.

She likes the idea of setting up an EMS district because she wants EMS to have the resources it needs to make sure people throughout the district receive timely care.

“We don’t have a system in place to make sure that patients get where they need to be in a timely manner,” she said.

Harshbarger said that cuts to property taxes impacted health care, and she believes counties and the state need to work together to find a solution for these challenges and preserve health infrastructure in Wyoming communities. 

“It’s not an easy problem, but we have to recognize that we live in Wyoming and choose to live in Wyoming, in part because we enjoy rural living for the most part,” she said. “We need to embrace that somehow and say that we also know that there’s a certain amount of things that we have to have available for those people that choose that lifestyle.”

According to Harshbarger, if someone lives three hours from a hospital, it is understandable that emergency care may be difficult to provide. She feels like transfers between hospitals should be timely, however, and she believes CCH needs support in finding solutions to the challenge, and she hopes Wyomingites and their communities can embrace a solution collectively.

“I just don’t want us to shove it around the plate and not have it ever resolved,” she said, noting that she has never experienced this particular challenge in any other rural environment she’s worked in.

“Other than severe weather delays, we just didn’t have delays like this, and I’m really pretty shocked about it,” she said. “It just really worries me, so I support any solution.”

Kirsch said he wants Weston County residents to know that CCH is committed to helping provide the best care possible and it would like to provide more, but funding impacts that ability.

“I can appreciate the frustrations that Cathy had the other day,” he said. “We’re trying. We are. I promise you that.”