Blount EMS goes where "nobody's gone before," earns recognition nationwide

Calls from around the country have landed on the desks of emergency medical services personnel in Blount County asking about the newly implemented clinical performance based contract with American Medical Response, Inc.

The answer has been overwhelmingly positive.

Blount County Director of General Services Don Stallions said when someone from the department asked him about hiring a third-party contractor to help with the new EMS contract, he thought it may be too expensive. Now that the new contract has been implemented with the help of Fitch & Associates LLC, Stallions said it is the best work-related decision he has made in a long time.

“I think that’s a sign of Blount County and how everyone works so well together,” Stallions said. “And I appreciate everyone’s input and everyone’s willingness to go down a road that really nobody’s gone down before.”

The new contract focuses on clinical performance from the time a 911 call is placed to triage at the emergency room, instead of time-based performance. It shifted the EMS model from start to finish for the county, as opposed to singling in on when an ambulance arrives on scene.

Beginning during the pandemic, AMR was accruing large fines imposed by their contract with the county because ambulances weren’t arriving on time. The EMS Board of Directors forgave a portion of those fines and were happy to say during their quarterly meeting Wednesday morning that it won’t be happening with the new contract like it had with the old one.

On Wednesday, the board dispersed $367,000 equally between 11 emergency response agencies in the county. The fund had accumulated from fines under the contract that ended with AMR at the end of June.

“I don’t anticipate, under the new contract, us having fine money to disperse,” Stallions said. He added that minimal fines are likely to offset that cost to do a routine audit — about $50,000 — as required by the new contract.

“We hope we don’t,” Maryville Police and Fire Chief Tony Crisp responded, “we’re excited,” as another board member agreed and said not accruing money from fines is the goal. While funds are returned to local agencies, high dollar accrual means the county has a less effective emergency response system, officials said.

Severe staffing shortages with AMR also increased pressure on ambulances to arrive at scenes on time. Although AMR implemented shift changes that alleviated some of the pressures before the new contract, more changes have also helped crews.

“I have noticed the change,” Stallions said. “The crews seem a lot happier. And on scene, it’s kind of back to the old days where we cut up a little bit, and you can just tell they’re enjoying their jobs.”

Difference makers

AMR Operations Manager Jonathan Rodgers said ambulances are stationed in locations throughout the county, and the company adjusted how they respond to scenes.

Another change AMR made was with software that tracks how emergency responses are handled. Rogers said the software reacts in “real time,” and checks down a list as AMR completes responses from step to step. If a step is missed, the system flags that step and requires AMR review and explain why it was missed. Rodgers used allergies as an example — a patient being unable to receive a certain medication.

“I think it’s 100% better,” Rodgers said. “The crew morale is a lot higher. We got happy employees. They’re taking interest in the operation itself. They want to do more. They’re coming up with ideas. It’s just overall better.”

Under the new contract, the county also hired a medical director to oversee emergency response, as opposed to paying AMR for their medical director’s services.

The county chose Blount Memorial Hospital’s emergency room doctor Benjamin Roe to serve as the medical director. Roe will review high stakes cases, like strokes, and create the clinical score cards EMS will use to base performance.

Roe said EMS is now officially triaging calls, whereas before a call was emergency or “take your time.”

“In real life, there’s an in-between,” Roe said. “And that’s what we’ve created. The idea of these cards having three tiers is that you don’t have to expend all your resources on calls that really don’t require as much manpower.”

Stallions said state law mandates that local responding agencies operate under Roe’s medical license, so he’s personally involved and responsible for ensuring agencies are responding efficiently.