“Things there are dire” Fmr. Richland Co. EMS employees decry culture, training and lack of supplies at agency

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Published: Feb. 14, 2022 at 6:25 PM EST
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COLUMBIA, S.C. (WIS) -Former Richland County EMS employees say that while they worked there, conditions at the agency left patients in danger.

A wife of a Richland County EMS patient claims the responding medics made questionable health decisions and slowed appropriate care.

They all spoke to WIS after an investigation into the system this past October.

It detailed the experience of a couple as the husband suffered a stroke and the wife was told by Columbia-Richland County dispatch that no ambulances were available.

Two former employees spoke with WIS after the story and expressed their frustration and concern over their personal experiences with the agency.

The interviews were conducted independently, and the former employees provided WIS with documentation connecting them to the agency.

Additionally, WIS confirmed Richland County EMS received a 911 call from the home address of the wife and her husband (the patient).

WIS agreed to keep the employees’ identities private out of their concern for professional retaliation.

Supply shortcomings

The first former employee provided documentation showing employment through mid-2021 and said that employment began in 2015.

The worker referred to themselves as a paramedic and things went well at first.

“A lot of great people there. There’s a lot of very strong paramedics and EMTs. I didn’t really notice much of a negative progression until about a year or so in,” the paramedic said.

However, the former paramedic said equipment failures/shortages, training issues, and leaders who harassed subordinates all became noticeable. It ultimately led to that worker leaving the agency.

“The more and more I started to see, the more and more it kind of built upon me. I took a month-long vacation and came back and hated my job. I started noticing that I wasn’t caring for the population like I should. I would do what needed to be done, but at a minimum,” the former paramedic said.

“I would do exactly what the protocol stated, but I didn’t go above and beyond for my patient and that’s when I started noticing that I needed to get out. At that point my career there was finished.”The former paramedic said it was routine to go on calls without functional equipment and without the drugs needed.

That former worker said at one point during their tenure, Richland County EMS was without Naloxone (also known as Narcan, a lifesaving and overdose-reversing treatment).

“They were told there’s a shortage. So, knowing our call volume, knowing the population that we have with overdoses and drug use, you didn’t plan accordingly for that?”

South Carolina Department of Alcohol and Other Drug Abuse Services (DAODAS) tallied 410 drug overdose deaths in Richland County from 2014 through 2019.

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DAODAS also reports EMS administration of Naloxone in Richland County climbed significantly from 2015 to 2020, topping off at 506 administrations in 2020.

“[The Naloxone shortage is] very eye opening, because at that point the only thing you can truly do for that said overdose patient is manage their airway,” the worker said.

In addition to issues with Naloxone availability, the former paramedic pointed to shortfalls in cardiac medications and IV supplies.

“We were told at one point not to spike a bag of saline unless it was truly needed, truly needed,” the former paramedic said.

The paramedic said it’s unclear where the blame falls, but Emergency Services Director Michael Byrd should ultimately have acted on it.

Additionally, the former paramedic said medics were routinely working with nonfunctional cardiac monitors.

The paramedic said the monitors are used to discover, and sometimes treat, heart problems.

“Those monitors, during my time, they were seven years past their end-of-life cycle,” the former paramedic said.

The former paramedic said the monitors would fail “daily” and their failure could be “deadly.”

“As a paramedic that is putting my license at risk, because if I miss something that somebody’s grandmother was having a heart attack, but I can’t see that. I can’t do my job. I can’t give the correct medications, notify the hospital that ‘hey you have got a heart attack patient coming in,’” the former paramedic said.

“All you’re doing is not treating the patient and then it’s delayed at the hospital. It’s not the hospital’s fault, it’s our fault. It’s the county’s fault.”

The paramedic said if monitors broke mid-shift, Richland County EMS supply workers would attempt to fix the monitor. If the workers couldn’t, the paramedic said medics were given a new monitor of the same brand.

The paramedic said monitors should be tested daily, but some went months without tests. The paramedic said middle management and Byrd are aware of the monitors.

The former worker’s claim about cardiac medications was corroborated by the second former employee.

That second former employee provided WIS with emails showing employment from 2018 to 2019.

The second former worker also raised concerns about what drugs medical control allowed the medics to use to help patients and pointed to a lack of sedation medication needed to intubate a patient during major head or airway trauma cases.

“I’ve run calls down there where you’re sitting there and you’re just like I need an airway but that’s too bad I guess, I’m just going to have to wait for this person to code because we can’t give any drugs to knock ‘em down and give them an airway,” the second former worker said.

Concerns over training

Paramedics are EMS professionals who have received more training than EMT’s and are trained to handle higher-risk scenarios.

Both former employees said Richland County EMT’s are not given the opportunity to fully use their certified skills and improve before becoming paramedics.

The second employee said a mixture of agency culture and legal bureaucracy stifle in-the-field experience.

“I would get in trouble for ‘over-stepping my boundaries’ by simply doing things that I should be allowed to do with my patch,” the second former employee said.

The second former employee said a supervisor told them the other factor was legal concerns.

“Everything they do is protocol, has to go through lawyers and go through legal and be literally made what he called ‘stupid-proof’ because they didn’t trust a lot of their employees to be able to do their job,” the second former employee said.

That employee said, as a result, Richland County paramedics are working more than is the industry standard in South Carolina.

The second employee said it resulted in over-worked paramedics “getting buried” in paperwork. “They were burning out, they were leaving, I think that’s still why a lot of them are leaving,” the second former employee said.

The second former employee said it also resulted in under-experienced EMTs.

“You’re not learning anything. You’re just driving and cleaning for six months and then after that six months they throw you into paramedic school,” the second former employer said.

The second employee also raised concerns about the agency-trained EMTs who ultimately become paramedics.

“That’s when you have medics that are scared and they’re making mistakes, which everybody makes mistakes, that’s inevitable, but mistakes that could be prevented if they actually had the opportunity to learn how to be a good EMT. At Richland County, they don’t have a chance.”

The former paramedic (first employee) expressed concern about the use of EMTs at the agency. The paramedic said there’s often an issue of respect between paramedics and their EMTs.

“You’re there to basically take a set of vitals, put a band-aid on, and transport them to the hospital. That’s it.”

The former paramedic also corroborated the claim that a lack of EMT use in the field contributes to paramedic burnout.

Employees say leadership is lacking

Byrd is head of Richland County’s Emergency Services Department.

The department includes EMS, Emergency Management, Fire Enforcement Division, and Hazardous materials.

Both former employees hold Byrd responsible and said he was inaccessible to express concerns.

“Michael Byrd will tell you that his office is an open door. Email him, text him, call him, whatever. I can honestly tell you I’ve had one email that Michael Byrd responded with in an hour, otherwise I’ve never heard back from him,” the paramedic said.

The second worker shared a similar story. “I never met him once the whole time I was there. He’s never around. There’s people that I worked with there that were there over a year that never met him. He’s not involved with his employees at all,” the second employee said.

That second employee went on to state:

“I hate to be the one to say this, but Michael Byrd’s got to go and I’m not the first person that’s said that, because he doesn’t care. If you’re at Richland County you’re nothing but a number and that’s how they’re going to treat you.”

A patient’s experience

In the aftermath of the October report, Richland County resident Kathy Jolly reached out to WIS about an incident on the morning of April 21, 2021, involving her husband.

Jolly is a registered nurse with the U.S. Department of Veterans Affairs.

She said she called 911 after her husband, Stephen, was struggling to breathe.

“I’m like frantic because at that point he is steadily worsening fast,” she said.

She said she called 911 twice out of frustration with the response time.

Richland County EMS documents show the first unit arrived at the Jolly house in just over 18 and a half minutes after the 911 call was answered.

When medics did arrive, Jolly said she questioned their decision-making.

She said one medic struggled with the stretcher instead of rushing oxygen to Stephen, and then subsequently attempted to take the oxygen mask off while Stephen was still struggling to breathe.

“I found it very interesting that nobody was talking to anybody, the two medics were not talking to each other. It was really strange,” she said.

Richland County EMS documents show Stephen was transported to Prisma Health. Jolly provided WIS doctor’s notes from Stephen’s stay, where he was ultimately treated for a series of heart conditions.

Additionally, she provided WIS a doctor’s note stating Stephen was found on the floor and had been administered Narcan. She said that information had been provided to the doctor by the Richland County medics.

She said that description of the situation was not accurate. Additionally, she said the administration of Narcan was without her knowledge while Stephen was in the ambulance.

She said that administration was unnecessary, potentially dangerous, and delayed hospital doctors from determining Stephen’s care.

“To see that this medic, behind my back, had gave this medication to someone who was not in an opioid overdose situation it was just totally unreal. I couldn’t believe it and I’m so angry about it,” she said.

Kathy said now, “everyday is questionable” for Stephen.

She said she contacted agency management to complain and ask for explanation later that month, but did not receive any.

DHEC records on Richland County EMS

On Nov. 17, 2021 WIS submitted a Freedom of Information request with the DHEC Bureau of EMS for all reports, investigations and documents generated by DHEC’s Bureau of EMS since the start of 2015.

The bureau serves as a regulatory agency for EMS services statewide.

WIS received 21 ambulance inspection reports for the year 2021, but no others for the years 2015 through 2020.

DHEC’s FOIA office sent WIS a statement saying the bureau moved to a new system in 2021, rendering the rest of the ambulance reports inaccessible.

The inspections documents include 118 or 132 items to be checked in the vehicles.

The reports show only a limited number of the items are inspected during each review.

Out of the 2,688 items to be checked, DHEC only reviewed 575 items.

Only 2 items were found to be “unsatisfactory,” both involving the captain’s chair of the ambulance.

DHEC sent the following statement in relation to the reports:

DHEC conducts initial ambulance inspections prior to issuing an ambulance permit and then compliance check inspections are conducted on ambulances thereafter. The initial ambulance inspection covers vehicle design, construction, staffing, medical and communication equipment and supplies, and sanitation.

Because Richland County EMS did not seek any initial ambulance permits during the period of time reflected in the FOIA record production, all of DHEC’s ambulance inspections were compliance check inspections. Compliance check inspections are performed at random on permitted ambulances in accordance with Regulation 61-7 and often on ambulances in the field at hospital emergency departments, clinics, or renal dialysis facilities.

Because of the nature of emergency medical services and ambulance transport, the compliance check inspections are spot checks that take the ambulance and crew out of service for a brief period of time, unless DHEC inspectors observe violations. The nature of the compliance check inspection also depends on the EMS agency’s compliance history.

Only 2 items in the reports were found to be “unsatisfactory,” both involving the captain’s chair of the ambulance.

The documents also included the agency’s license renewal application to DHEC for 2021.

Large portions of the application are redacted. However, it does give some basic information about the state of the agency.

It lists 57 vehicles are equipped for to the “EMT-basic” level, while 32 are equipped for the “paramedic” level.

The application states the agency serves 227 calls per day or 40,850 over the previous six months. The document was dated Feb. 22, 2021.

The DHEC documents reflect only two investigations by DHEC into the agency, both dating back to a 2016 incident.

County response

Byrd did not respond to multiple requests for an interview.

Richland County Administrator Leonardo Brown called WIS, stating he was not speaking on Byrd’s behalf, but rather hoping to communicate his position on handling employment-sensitive stories.

WIS explained to Brown the nature of the story and the concerns raised by the employees and Jolly.

Brown explained this story would likely lead to an internal review of Byrd’s employment performance and discussion of private patient care information. He said it would not be appropriate for comment.

“These things are concerns that are brought to light if you will. Those are things that Mr. Byrd will have to address as an employee of Richland County, he’ll have to go through the process of addressing those because those will be things are really directly a matter of his employment,” Brown said.

However, Brown did state Byrd could comment “if he chose to,” but no requirement would be given by Brown.

He said his team takes feedback (positive and negative) and acts on it if appropriate. He said in the aftermath of the October report, staff members were questioned.

RELATED STORY | Stroke victim waited 11 minutes before being told no ambulance available

WIS asked what came of those conversations.

“What came of it is, there are a couple things, if you look at some of things that have been going on. I would not necessarily say that they were specific to your story, but I would say your story also raises concerns that are statewide and nationwide concerns,” he said. Brown pointed to increased funding for personnel and capital improvement projects.

The FY2022 budget shows Emergency Medical Services budgeted for more than $16 million in FY2022, an almost $3 million increase over FY2021 and $2 million above FY2020.

That reflects more resources put toward personnel and operating costs.

Brown sent a statement reading in part:

Of the $2.998 million increase, $1.178 was for personnel costs to include:

  • 6 Additional Paramedic Positions
  • 6 Additional EMT Positions
  • $807,375 in additional overtime
  • $96,630 in additional part time wages
  • Funding for EMS staff for 40 hour per week instead of the County standard 37.5 hours per week.

The county is also slated to spend $5.3 million in FY2022 on capital improvements, including new CPR monitors, ambulances, and quick response vehicles.

Additionally, Brown emailed FY2021 documents, showing $3.8 million paid toward ambulances and EKG monitor/defibrillator/pacers.

Brown also pointed to a partnership with Midlands Technical College, where Richland County pays...
Brown also pointed to a partnership with Midlands Technical College, where Richland County pays students while they train to become EMS professionals.(WIS)

Brown also pointed to a partnership with Midlands Technical College, where Richland County pays students while they train to become EMS professionals.

Without directly addressing Jolly’s experience, Brown stated this, ”I certainly don’t want to try to make this an apples-to-apples comparison because it would never be because I wasn’t on scene and I don’t have medical training but what I will say is one thing I’ve learned during the pandemic is we have a lot of medical professionals who have a lot of differing opinions dealing with the same scenario,” he said.

The South Carolina EMS Association is actively recruiting for the profession, you can find more information here.

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