Macon County Emergency Management Director lays out concerns of system failure due to Covid19 surge

Last updated on September 1, 2021

Last week, the Highlands Board of Commissioners voted to reinstate the town’s mask requirement during a special called meeting. The decision came at the recommendation of Highlands Cashiers Hospital CEO Tom Neal, who warned the hospital system was stretched too thin.

Neal read a letter from Macon County Emergency Management Director Warren Cabe that highlighted his concerns for the county.

Cabe’s letter in it’s entirety:

Dear Tom, Per our previous discussions on the situation of healthcare systems within Macon County and the relation to the COVID crisis, here are a few areas of concern that I currently have.

1. Staffing EMS currently has eight(8) full-time vacancies out of our forty-one(41) full-time positions. We have a large roster of part-time/as needed employees and through the use of those staff members and liberal use of over-time funds, we, for the most part, have been able to maintain our existing levels of service through the month of August. Our staff is In contact almost daily with COVID patients and Inevitably we will have staff that will need to be isolated and miss work due to illness. We did experience a four(4) hour time period on August 16’^ when we had all of our administrative and supervisory staff on ambulances due to employee vacancies related to isolation and sickness when we had to drop an ambulance in Franklin. That left us two staffed ambulances in Franklin, one in Highlands, and one in Franklin with no supervisor backup to maintain all of our county coverage. We were able to get back to 4.5 ambulances by noon and returned to full ambulance coverage of 5 staffed ambulances but still with no supervisor backup by 4 PM that day. We did inform Regional Transport of our staffing issues to they would be prepared for Inter-facility transport Issues. We do not see our staffing issues improving for several months. The 9-1-1 center Is just now returning to full staffing after having several openings during the summer but we have no abundance of part-time/as needed staff there to cover any unexpected vacancies or step into any future full-time positions that may become available.

2. Equipment We maintain a fairly large inventory of spare ambulances In our fleet. For every front-line staffed ambulance, we also have a spare ambulance at the same ambulance base mainly due to our large geographical area we serve to mitigate any unexpected equipment failures. We also maintain a fleet spare ambulance rotated to each ambulance base as needed when one of the front-line or spare ambulances is taken out of service. We have been experiencing problems with vehicle repairs with one ambulance waiting on repair diagnosis from a manufacturer representative for three weeks and one ambulance waiting on parts for over a month. We had a routine equipment failure last week that normally would not have been an issue except with two trucks already out of service, the routine repair dropped our fleet below what we would consider a secure reserve status.

3. COVID patients There is almost no shift that goes by now that our EMS crews are not evaluating, treating and/or transporting a COVID patient. Even during the surge of the virus last winter, we were not seeing this number of patients with this diagnosis or presenting with these signs and symptoms. Each of these patient transports requires significant decontamination and cleaning of our equipment which, along with delays at receiving facilities as they undergo their appropriate Isolation processes, can cause Increased times for ambulances to return to service.

I wanted to present all of these Items to present my concerns that the pre-hospital healthcare system all the way from the call takers to the transport crews are as close to a single point of failure as I have ever seen In my career. We have so far been able to maintain our coverages but there Is no expectation of providing any improved services and we could very easily see increased delays or hindrances to such provision of care. I don’t have all the answers and I don’t know that there is one single answer but any measure that can be reasonably taken to help us maintain the availability and effectiveness of the pre-hospital healthcare system would certainly be supported by our office.