Ambulances stay busy in bustling Sevier County

Apr. 01, 2013 @ 12:01 AM

 

With the nation’s most visited National Park, a popular amusement park, a water park and all its other attractions, Sevier County has plenty of activities that can keep ambulances rolling.

The county has an estimated population of around 90,000 people, and that’s in addition to the thousands of tourists who are usually visiting here at any given time. Visitors who might be doing anything from driving a go cart or riding a roller coaster to riding an inner tube down a river or hiking on the Appalachian Trail.

So it’s unusual, but perhaps not a surprise, that Sevier County is served by two emergency medical response agencies. Sevier County serves much of the county, including Dollywood and Pigeon Forge, while Gatlinburg Fire Department doubles as an ambulance service that covers the national park and stretches out of the county including nearby Cosby.

Both provide Advanced Life Support (ALS), meaning they have at least one paramedic on the ambulance as well as life saving equipment not available on basic life support ambulances.

Sevier County Ambulance Service (SCAS) explains the importance of that distinction like this: “If you’re having chest pains, you’re going to want a paramedic who can put a 12-lead EKG on you.”

In the ambulances running in Sevier County, there’s at least one paramedic capable of doing that, and they can also communicate directly with a doctor when necessary.

What all that means for regular people is, when a person suffering a massive heart attack rolls up to the emergency room the hospital staff has a much better idea what they’re dealing with and can be ready to take them straight in to surgery, if necessary.

“Our ambulances are basically mobile intensive care facilities,” Gatlinburg Fire Chief Greg Miller said. “It really speeds up their time ... Both of us have had documented saves because of our aggressive protocols and the level of care we can provide.”

Keeping response times low

With that kind of personnel and equipment available, the next step is figuring out where to station them so they’ll have the best response time to as many people as possible.

Between the two services, there are eight stations where ambulances are generally assigned.

SCAS actually stations three in its headquarters at the LeConnte Medical Center campus on Middle Creek Road.

Its first substation was located at Pigeon Forge Fire Department, and they kept an ambulance stationed there when it moved from the Parkway to the current municipal complex, Huskey said.

In Seymour, an ambulance is kept at a substation funded by the county and located near the intersection of Pitner Road and Boyds Creek Highway.

An ambulance at Walden’s Creek Volunteer Fire Department serves that area and Wears Valley. “If we get tied up they can get into Chapman Highway pretty quick, too,” he explained.

They serve the Kodak area with an ambulance that typically stays at the Northview-Kodak Volunteer Fire Department station on Douglas Dam Road.

And they’re about to add a new one at the intersection of Jones Cove Road and Ole Newport Highway. They plan for it to serve the New Center and Jones Cove communities.

“That was kind of the weak link in the chain right there,” Huskey said. “We didn’t have anybody readily available in the east end of the county, so we had to fight traffic and that’s where we lost our response time.”

The county purchased the building for it, and now they are in the process of getting staff for it, he said.

In Gatlinburg, there are ambulances stationed at the main fire hall on Highway 321, on Reagan Drive near the Space Needle and on Ski Mountain Road at the entrance to Ober Gatlinburg.

That department actually serves a broad area, Miller said, because they respond to calls inside the Great Smoky Mountains National Park as long as they’re in the city, as well as serving to Cosby and into Pittman Center under their agreement with the county.

Keeping up with calls

In both cases, they have staff working on 24-hour shifts — they work for a full day, and then are off for 48 hours.

Both staff their ambulances with at least one paramedic and one EMT. At Gatlinburg, the goal is to have two paramedics on all ambulances — they are staffed by firefighters who have also been trained as EMTs or paramedics, and the duties are rotated through the personnel so that they spend some time responding to fires as well as on ambulances or on other duties.

“They don’t get as burned out as when we have one (paramedic), and you’ve always got that second opinion,” Miller said.

While they’re assigned to certain locations, they don’t necessarily get to spend a lot of time sitting still. They’re constantly shifting the ambulances around, trying to make sure they can cover for each other when one is out on a call.

For SCAS, they can sometimes go for hours without making it back to their station.

“They drop patients off at a hospital in Knoxville, then get a call in Seymour on the way back and by the time they’re coming back from that, there’s another call,” he said.

Unusual history

They also work with each other as well as with other ambulance services to keep their areas covered.

Both Miller sand Huskey praised the way their agencies cooperate to provide coverage.

“We’re basically sister agencies. Anytime we’re in need they send an ambulance up and anytime they’re in need we do the same,” Miller said. “It’s just a good relationship.”

“I’m telling you, we’ve got the best working relationship with the City of Gatlinburg of anybody anywhere,” Huskey said.

It’s an unusual relationship that started because GFD had something of a head start in the business. When it started in 1946, the city’s resident doctor, Ralph “Doc” Shilling, was also fire chief. He provided emergency medical service from the start.

“The community really took hold and valued their service so when the county started an ambulance service they said there’s no need in taking over Gatlinburg.”

GFD is now one of just six fire departments in the state that also provides ALS service.

They rotate duties among the personnel, so that at different times they serve on fire trucks or on ambulances. “They keep their skills up on all aspects of fire, rescue sand EMS by doing through that rotation,” Miller explained.

Answering all calls

Anyone who listens to a police and emergency scanners knows that the ambulances are summoned to a number of calls that might not sound like medical emergencies — nosebleeds, ear aches and similar ailments.

Huskey acknowledged they get a lot of those, and sometimes they also wonder if the person couldn’t drive themselves to a hospital. But they can’t make that assumption, because many times when they arrive they find out the person wasn’t telling a dispatcher all the details of their situation.

“Something sounds very minor to use on the telephone, but when we get there sometimes we might go, ‘How long has this been going on, why didn’t you call sooner?’”

That isn’t always the case — sometimes an earache really is just an earache. But once the call is made, the only way to find out is to respond and take the patient on.

While they might get taken straight back to the emergency room by doing that, it typically don’t result in bypassing the other patients who came in on their own.

“If they don’t have a life-threatening emergency, the staff is going to triage them and put them back out with the others,” he said.

The ambulances start out responding to many wrecks. Unless the dispatcher can confirm the accident doesn’t involve injury, an ambulance is sent as a precaution.

“Time is of the essence, so if somebody calls and says there’s an accident out here and you can’t confirm no one is injured, you want to go until you have someone on the scene.”

They also respond to fires, keeping at least one ambulance on standby in case a firefighter is injured or needs treatment.

And in between all the more urgent calls, they respond to convalescent calls — helping to ferry patients from hospitals back to nursing homes or other facilities, or carrying them from their homes to the hospital for treatment when necessary.

Some of those are handled by appointment, he said, but even then they are placed at the bottom of the priority list. If the ambulance is needed somewhere else, the person waiting at home or at the hospital might have to wait a while longer.

Facilities like dialysis clinics and hospice care might also use other commercial ambulance services, which typically provide basic life support service — more than sufficient for carrying a patient to appointments, but a lower level than the ALS offered by GFD and SCAS.

The need for quick responses only looks to increase as the population continues to grow and greater number of tourists visit each year.

“Sevierville didn’t used to be a big factor but now ... They cater to tourists just as much as Pigeon Forge and ‘Burg do,” Huskey said.

At Dollywood and Splash Country, they work with the medical staff at the park, who generally bring patients right to the entrance for them.

‘They’ve got well-trained people there to handle just about every first aid (need) you can think of.”

Finding rest

With the volume of calls constantly increasing, Huskey said they try to relieve the burden on their personnel as much as possible.

If the crew finds they are running low on supplies, he send a shift supervisor to take them what they need. It’s one less thing for the crews to deal with and is a little less wear on the ambulances, he explained.

At one time, they might go hours between calls but these days that’s rare. And staff have a number of other responsibilities, like cleaning up the ambulances and checking the inventory.

But if they find some spare time during their shift after dealing with all that, they know they can try to get a little rest.

“The last thing you want is a crew that hasn’t (rested),” Huskey said.