Serving Barnwell County and it's neighbors since 1852
A Thorne ambulance is pictured parked outside of the Barnwell County Administration building on August 7 after the company moved into the county, replacing Medshore.
A national shortage of EMS personnel mixed with an increased cost of transport since the COVID-19 pandemic has left many rural regions in danger of becoming ambulance deserts – places without reliable EMS and ambulance services. The recent state of EMS in Barnwell County suggests the area could be nearing this title.
Barnwell County has had a tumultuous two years trying to maintain emergency medical services. In August 2023, the county ended its contract with Medshore after months of the agreed upon terms not being met.
Medshore was being paid $992,000 annually to maintain and staff four ambulances and a quick response vehicle in Barnwell County, but could not support the county for this price amidst national personnel shortages as well as rising costs for vehicle repairs, parts, and fuel after the pandemic.
Medshore aimed to renegotiate the contract in early 2023 after reporting a nearly $450,000 per year loss, but was met with pushback from the county as the initial terms of the contract were not being met. This led county officials to look at other options.
The county eventually signed a three-year contract with Thorne Ambulance Service (TAS) for a first-year cost of $1.164 million. The contract agreed to four ambulances plus spares in case of breakdowns. It was signed with negotiations regarding price being made minutes before the county council was set to vote.
A lawsuit was then filed by the county against Medshore claiming breach of contract after a rocky transition to TAS despite the claims of Medshore leadership.
County officials anticipated better services, quicker response times, and staffed ambulances from TAS. However, this provider is still struggling to maintain contract terms with nationwide issues looming over the industry.
“The current provider we got, and the one before that, we’ve had trouble getting four units staffed, and they’re having trouble with the EMTs and the medical staff because there is just not enough of them,” said Barnwell County Council Chairman Jerry Creech at the Jan. 2 Legislative Delegation meeting.
In this meeting with Representative Lonnie Hosey and Senator Brad Hutto, Chairman Creech asked for assistance from the state: “If y’all don’t, I don’t know how future councils are going to fund EMS services.”
“The current provider we have now has asked for a substantial increase. We can’t hardly afford what we are paying them now,” said Chairman Creech.
In October 2023, the county expressed concerns to TAS CEO Ryan Thorne regarding the four advanced life support ambulances set to be in the county per the contract. The county expressed they are rarely seeing four staffed ambulances on duty.
The primary challenge facing TAS is a recently increased pay scale for EMTs and paramedics by competitors such as MedShore and Medtrust, causing TAS to have difficulty recruiting and maintaining staff.
When TAS first presented a contract and cost to Barnwell County in September 2023, they were based on the entry rates for EMTs and paramedics in Aiken County. Since then, entry rates and pay scales offered by competitors have increased and TAS cannot find enough personnel to keep four ambulances running.
An approximate $397,000 subsidy increase is needed to cover this gap in compensation.
In recent months, The People-Sentinel staff has heard numerous ‘status zero’ reports over the police scanner. This means there were no active and staffed ambulances in the county during those times. In these cases, first responder-trained firefighters are called to assist until an ambulance is available.
Due to these issues, Barnwell County has stopped providing mutual aid to Bamberg County.
“Our county council chairman Mr. Creech has been up front with Bamberg County that until we get our ambulances fully staffed here in Barnwell County, we’re not going to cross the county line and leave our citizens without sufficient coverage,” said Barnwell County Administrator Tim Bennett.
Bennett explained exceptions would be made if a catastrophic event were to occur and the county anticipates this being a temporary policy to be revisited upon four fully-staffed ambulances.
During last week’s tornado that devastated Bamberg’s Main Street, Barnwell County Emergency Management Director Roger Riley and Fire Coordinator Wesley Gatlin coordinated sending approximately 20 volunteer firefighters, light towers, barricades, and cones to Bamberg as well as coordinated a shelter.
The American Ambulance Association found the main reasons for personnel turnover across the industry is low pay and benefits, burnout, or a change in career path.
EMT and paramedic positions are experiencing high rates of turnover and a lack of people entering the field after the pandemic. This is coupled with a national median hourly pay of $17.64, according to 2022 studies by the U.S. Bureau of Labor Statistics, leading to less and less ambulances being staffed.
“It’s not just a Barnwell problem, it’s not just a South Carolina problem, it’s a national problem,” said Sen. Hutto.
At the Jan. 2 meeting, Sen. Hutto explained the state must work to incentivize young adults to embark on a career in emergency services.
Ambulance services were deemed an essential service by the state only last year, but numerous organizations have been working to draw more people to the career.
The South Carolina EMS Association offers numerous opportunities for those interested to begin a career in EMS, such as scholarships and training programs, and has done so since its inception.
Bills have even been presented at the state and federal level to increase support for EMS services and personnel.
In November 2023, the first broad, stand-alone bill to help address the EMS workforce shortage known as PARA-EMT was introduced at the house level. If passed this year, the bill would establish a pilot grant program for the recruitment and training of paramedic and EMTs.
However, the problem still persists and is drastically impacting rural areas such as Barnwell County.
Another area limiting EMS providers is the reimbursement rate for Medicaid and Medicare non-emergency transport.
Low reimbursement rates do not only impact rural regions, but also largely populated areas like Los Angeles County in California where non-emergency transport has recently ended due to financial trouble.
According to an article for the National Conference of State Legislatures, Medicare or Medicaid reimbursements do not cover the total cost of care, leaving EMS providers to make up the difference.
At the Jan. 2 legislative delegation meeting, Councilman Ben Kinlaw explained the reimbursement for Medicaid transport in S.C. is capped at $99. Sen. Hutto said a statewide proposal to subsidize local emergency services may be a possible solution.
