EMERGENCY MANAGEMENT SERVICES (EMS) COMMITTEE MEETING MINUTES
26 FEBRUARY 2024
Chair Commissioner Caleb Savage opened the meeting asking Commissioner James Lathrop to offer a prayer and lead the pledge. The minutes of 8 May 2023 were moved for approval by Commissioner David Wamble and seconded by Commissioner Shelly Goolsby. Motion approved unanimously. The Chair, then noting a change in committee membership since previous meeting, introduced all members of the EMS Committee (See attendees below). The Chair then asked County Executive (CE) Graham Stowe if he had any announcements. The CE said he had been in discussions with Senator Blackburn for an alternative date for visiting Giles County.
The Chair then asked Bill Myers Director of the EMS county office, to provide an update on the organization. He started by introducing members within his staff and asking Supervisors/Chiefs to provide an individual update. He gave information on the “reverse audit” for Medicare billing which uses EMS data for a four-year period to help determine future Medicare rates for all. He noted, that by doing inhouse, the county saved approximately $35K if the effort would have been contracted out.
Josh Young, Deputy Director, gave an update on the Tennessee Advanced Communications Network (TACN), noting the implementation was moving well to form an emergency communications system allowing interoperability with multiple local counties. He expects a soft launch in October and the old system will be shut down 31 December. Some of the equipment, e.g. radios, will be shipping soon to allow familiarity with the system. He noted that one tower will cover most of the North end of the county. For the Search and Rescue, training is being offered for EMS as well as some of the other departments such as the Sheriff’s office. He mentioned training with the Corps of Engineering especially for the 107-level certification for drone pilots. He discussed the Ag Park grant which was started in 2019. FEMA has approved the grant and the county is now waiting on the funding. That grant will cover a 9500 sq. ft. shelter where the current concession stand is located. The county is currently using churches which in some cases turns out to be difficult in finding the right people to open the churches timely. There are approximately 8 or 9 churches involved in the program. The homeland security grant for $11K is funding a mobile command unit capability. The current capability has had significant roof problems especially when the tower on top of the unit is laid down and breaks the seal. The insurance company said will fund no more, since it is your equipment causing the situation. The HealthCare Coalition offers grants for training and equipment. The county has received $13K for a mannikin, and those dollars require no match. The CE asked if the Ardmore and Elkton area include a tower, with Josh replying that Minor Hill, Elkton are in. Ardmore is not part of the area covered but Giles County can utilize the Alabama tower. Commissioner Terry Jones asked about Lynnville, with Josh saying that had been submitted to TACMS. He noted elevation is a problem in that area, but eliminates need for a higher tower. Commissioner Judy Pruett asked about the use of drones where previously it had been noted that there was no one qualified to use. Josh said that now he and Bill Myers and Jeremy Mitchell were now certified and that Jeremy is also certified and can train other individuals. He discussed the need for one to fly and one to observe and that the different manning of the towers also makes the use of drones more difficult. Josh also mentioned legislation is in the works for drones.
Giles EMS Chief Willow Chavez next spoke on the number of calls received for the ambulance service, i.e., 6400 at year end and approximately 1K in CY 2024. She then addressed by category numbers of staff, e.g. 16 paramedics. She noted a recent hardware purchase to monitor the vehicles, e.g., speed, g forces, braking, all of which give an alarm if the vehicle crosses the given threshold. She also mentioned that when the vehicle is in reverse, that someone is always stationed outside to watch for safety purposes. She noted the hardware purchased has helped increase both safety and maintenance. She also mentioned the Healthcare coalition assistance with training, e.g., active shooter training. And again, some of her own staff can now do inhouse training in some areas. Training is now being done monthly rather that once a year (which included large groups and longer one time training). In addition, she said that leadership training through the EMS world Expo was being conducted. The safes used for storage of narcotic pharmaceutical is now digitally monitored and there is also Handtevy software to customize the treatment for individual patient, e.g. dosing meds. Commissioner Wamble asked if they were fully staffed and Ms. Chavez said they currently have 33 personnel and 36 would be fully staffed. One member had left for another county and one had dropped from full time to part time (FT to PT.) The Chair asked if exit interviews were being done, with Ms. Chavez saying one left unexpectedly and the one who is now PT, will be providing information. Bill Myers mentioned that 4 EMTs are in paramedic classes now and will graduate in August. Commissioner Shelly Goolsby asked if it wouldn’t be more beneficent for an outsider to do the interviews, where they might feel more open to speaking. The Chair mentioned the county human resource individual, and other commissioners thought the potential leaving members would already be open to speaking.
Jeremy Mitchell, as Chief Fire and Rescue (F&R), mentioned some “outside the box” learning such as bringing in some outside peers with impressive credentials, such as an instructor who is the Chief of a large city fire department. Jeremy mentioned that having all the organizations under the one EMS umbrella had worked really well, giving several examples. He also mentioned the inclusion of other departments e.g., law enforcement who are also doing some of the trainings, clinical rides, and pursuing certification. Budgeting had been a concern and one of the fire fighters who worked for Valley Packaging asked if they could help, and Valley Packaging donated $10K for the kits used by the organization as well as funding can reimburse some of the training costs. He mentioned the call volume increase noting he expected based on previous need that volume would be around 1K calls for 2024. Commissioner Wamble asked if they were attracting any new members. Jeremy responded by listing some of the ways they are working to showcase their service, events, schools, social media. He noted that he needs 60 to 70 members to be fully “staffed” and a lot of those also have FT jobs. He has about 6 to 10 who can almost always respond and that he also has mutual aid with other counties and organizations such as the Mennonite Navy who provide assistance. Commissioner Shelly Goolsby asked about F&R being a 501c3 and does Jeremy not work for the county (following through with the use of county vehicles pulling F&R trailers, co-mingling a problem with a 501c3.) Bill Myers noted that Jeremy does work for the county, and the 501c3 is not problem. The CE noted that question had been thoroughly vetted prior to consolidating and establishing the Emergency Services Department. Commissioner Joseph Sutton asked for clarification on previous statement about schools. Jeremy noted they consider the schools a huge recruitment avenue, mentioning “hero days”, using some real damaged wrecked vehicles and students doing role playing. Josh mentioned the career coaches in place at the schools had invited them and that next would be Elkton, Minor Hill and Bridgeforth. They are also pursuing the Explorer program for young adults.
The Chair then discussed Resolution 2017-41 (a handout) and recommended that resolution be rescinded. He noted it had never been followed, and is not realistic. Resolution 2017-41 authorizes the county ambulance service to only make emergency runs outside of Giles County. The Chair noted that the emergency runs are 24% of the transports, which represents 30% of revenue for the service. A motion by Commissioner Shelly Goolsby to rescind the resolution was made and seconded by Commissioner David Wamble. Motion was approved unanimously after the following discussion: Example given by Commissioner David Adams on neighbor who lived close to county line and had called 911 but did not want to go to Giles County. Commissioner Gayle Jones asked if you can turn down a transport with Bill Myers answering yes if don’t have enough trucks and that they encourage the hospital to call others letting the hospital know each morning truck availability. Commissioner Judy Pruett asked if the patient can ask to be transported to their choice with Bill Myers answering yes. He clarified that response that the decision should be made after discussion, e.g. emergency nature of needed timely treatment.
The chair then discussed Resolution 2017-42 which provides a $50 fee for responding but needing no further transport. Resolution originally approved because of lift assist calls and no treatment required, and no Medicare payment. Several examples were given, e.g. person laying on floor for several hours because didn’t want to or couldn’t pay $50. Mr. Myers said in 2023 less than $1500 was received from effects of this resolution. He also said if treatment or assessment is required then Medicare can be billed for that service. Commissioner James Lathrop moved to rescind, and with Commissioner Gayle Jones providing the second the motion was approved 6 to 1 (Commissioner David Wamble voting no) after the following additional discussion: Commissioner David Adams noted this resolution had passed originally for several reasons, the lift assist take same personnel so other more important needs may not be addressed and there is always an associated cost to the trips. The Chair asked if there has been reduction in times service not available due to lift assist calls and percentage that pay the fee. Bill Myers said most are written off, and Medicare is diligent in looking for fraud so records must be meticulous.
The Chair noted he had been in discussion with Bill Myers to show county employees are valued and he recommended a portion of a claim not covered by insurance be funded by the county for county employees, spouses, and children under 18 years of age. At this time a motion was made and later rescinded. Questions arose on would include teachers, county coverage requirements would be minimum due to few transported, legal to offer a discount, fairly common practice, distinguish between FT vs PT and how long employed, difficulty in being consistent across employees, married spouses vs divorced and children living with one parent, elected officials should not be included, children living with separated parents, children that receive more than 50% support covered, responsibility on employee to bring up front info within 180 days, put in personnel policy. A motion by Commissioner David Wamble, seconded by Commissioner Shelly Goolsby, to progress with a draft. That draft would include specific statements FT with dependent children under 18 years, ask for remittance, and be residents of Giles County and per motion send to full commission. Motion approved.
A handout of Emergency Operations Specialist was provided. Bill Myers noted that additional hire has been previously requested but denied at full commission, due in part to another significant cost to the county on all employee insurance. He noted that several commissioners had encouraged him to resubmit his request at a later date. In the meantime, he had reworked his budget using an unfilled three-year vacancy to hire Jeremy Mitchell to fill that need. He noted that savings had accrued due to that hiring and he requested an additional $17K be added in his budget for the rest of the fiscal year. Financial Management Director (FMD) Beth Moore-Sumners noted that the $17K should be considered next year as only a partial funding requirement since it represents only 1/3 of the yearly cost. Bill Myers also commented that cost is a fully loaded cost, e.g., includes personnel taxes. The chair called for a motion and lacking any motion the request failed. Commissioner Shelly Goolsby asked what is he now doing and for which he is now receiving pay since the county commission had previously refused the new position. The FMD gave examples, e.g. Sheriff’s department, where the movement within a department’s approved budget to reassign people to more needed roles has been the usual process. The request failed due to lack of motion. Commissioner David Wamble asked for numbers on how the ambulance services revenues look after the upcoming increase, and have available at next meeting.
The Chair asked for any Old Business – None. New Business – Commissioner Evan Baddour asked about fire suppression where in the county there are some places that do not have enough water, e.g., 6-inch lines. Bill Myers mentioned every station has a tanker but their refill possibilities e.g. ponds, other hydrants, can cause a slow refill. Commissioner Baddour said he wanted to know for preparation planning across county.
Motion to adjourn made by Commissioner David Wamble, seconded by Commission Shelly Goolsby, and was approved unanimously.
ATTENDEES: Members of the Committee Chair Commissioner Caleb Savage, Other Commissioners: Shelly Goolsby, Annelle Guthrie, Joseph Savage, Gayle Jones (for Brad Butler – absent), David Wamble, James Lathrop Other Commissioners in attendance: Joyce Woodard, Terry Jones, Erin Curry, David Adams, Evan Baddour, Judy Pruett, Tracy Wilburn, Other Attendees: County Executive Graham Stowe, EMS Director Bill Myers, Other EMS: Willow Chavez, Josh Young, Jeremy Mitchell FMD Beth Moore-Sumners, Shana Woodard,
