Lack of supplies, including life-saving medicines, create situations paramedics say they’d be afraid to rely on
By RON AIKEN
At the county maintenance shop off Powell Road, nine new ambulances sit in knee-deep weeds.
The trucks, which represent an investment of more than a million dollars, haven’t carried a single passenger or treated a single patient since being bought. But more than just sitting as idle monuments to wasteful spending tucked out of public view, what the trucks really symbolize, current and former Richland County emergency service personnel interviewed by Quorum say, is an even more serious problem, one they allege puts the safety of anyone who rides in a county ambulance at risk.
Though the trucks exists, the crews to run them do not.
Since the floods of 2015, when sources allege Richland County Emergency Management Service (EMS) leadership refused emergency help from neighboring counties in an effort to bolster their own reputations and, in the process, stretched crews past the limits of exhaustion (including, some allege, breaking the law by keeping crews in emergency rotations even after the state of emergency declaration was rescinded), the county has experienced sky-high attrition rates in what already is a high-stress, high-turnover field.
Sources say where five years ago the county averaged 20 or more ambulances on the road in an evening, that number is now just 14, even less when some of those aren’t always available because they are sent to cover special events such as concerts at the Township or basketball games at the Colonial Life Arena or the Columbia Fireflies. The numerous special events over the course of the year, which include high school sports, community/charity walking and running events and the like, mean take those trucks and their crews are out of service, especially on weekends, anywhere from four to six hours during times of peak demand.
The situation, multiple sources say, has led to a very real patient care crisis that crews say the public needs to know about and one, they allege, their top bosses turn a blind eye to.
In addition to 12-hour shifts that often stretch to 13 or 14 hours by the time all paperwork is completed and employees regularly being forced to work on “standby” days, current and former crew members paint a grim picture of a service they admit they would not be comfortable relying on themselves. The allegations, which Quorum has confirmed independently, include:
- EMS personnel being told to log “ghost trucks” to show more trucks on paper than are operating on the street;
- a workload so high that crews are made to run “Code Four,” meaning with operating with lights and sirens on, every shift whether the situations are emergency in nature or not to increase responses and in spite of the well-documented public danger for accidents it creates;
- having so few trucks on the street during key hours that dispatch has to hold 911 calls until trucks become available, leading to ambulances dropping off patients at the emergency room on the truck’s stretcher and leaving crews without a stretcher themselves the rest of their shift;
- a reliance on inexperienced, poorly trained personnel to replace those who have left, resulting in situations they say that have resulted in loss of life; and
- once supplies and medicines run out in a fiscal year, they often are not refilled until the next budget cycle, including life-saving medicines for overdoses and cardiac arrests.
For this story, Quorum spoke to more than 10 current and former Richland County EMTs, many with more than 10 years of experience at the county and some with more than 20 years of experience in the field. To a person, they corroborated the allegations specified in this story — and more that aren’t — including a situation that led to the death of a patient and an attempt by management to cover it up.
“I feel sorry for the new people,” said one long-time paramedic still with the county who did not wish to be identified.
“They’re walking into hell and they don’t know it.”
‘A COMPLETE FAILURE OF LEADERSHIP’
While many critical issues were identified, the one problem each medical professional identified as the most serious facing EMS was the same.
“You have leadership that is completely disconnected from the reality of what’s happening on the street,” said Matt Gottlieb, who spent five years with Richland EMS before leaving in September of 2016.
“You have leadership that doesn’t care about morale. Myself and another employee were at work one day and were complaining to a supervisor who had just been promoted without the position being advertised about a new policy that said no vacation days could be taken that fell on a Gamecock football weekend regardless of the reason.
“He said if we tried to to take it off he could make us work it. We said, ‘You know morale sucks around here already,’ and he said, ‘Morale is a street issue, not a management issue. If you don’t like it, you can leave.’ We both walked outside, looked at each other and said ‘OK.’ We both left on the same day. There’s just a complete lack of concern or understanding.”
One longtime EMT still with the county who asked not to be identified said the grueling hours are made worse by the lack of pay increases coupled with other rising costs.
“We haven’t had a pay raise in five years, and the calls keep increasing,” they said. “We have to pay for our own parking, which is in a terrible, unsafe lot. It’s not secure.
“Plus our health insurance, our contributions to the state retirement, those all keep going up. The hours, the pace, leadership is just terrible for morale, just so negative. I’ve never been at a place where so many people can’t wait to leave.
“The ones who stay mostly do so because they have too many years in to leave, too much seniority or because they’re raising families or some other issue that they need to be here. They still hate it. I had a guy come in (Monday) and say ‘I hate this place’ three times at the start of his shift. You hear it all the time.”
Another longtime paramedic who requested anonymity told Quorum they had only seen Michael Byrd, director of Richland County EMS, twice in five years.
“He’s nowhere to be seen,” they said. “And when problems come up, serious problems like a lieutenant who sleeps constantly while on the clock right in the open or out in the parking lot, nothing happens. Management knows, but nothing gets done and it just becomes the way people think about management here.”
Gottlieb said even after five years with the county, Byrd wouldn’t recognize him if the two ran into one another.
“He could walk in right now and not recognize me because there is no relationship between him and employees working the streets,” Gottlieb said. “(Byrd) hides. He comes in the back door, stays in his office and leaves out the back door. Then you have people getting promoted to positions they’re not qualified for and which were not properly advertised, and it creates a poisonous environment. It’s a complete failure of leadership.”
Sources tell Quorum when they ask management about new hires they’re told it’s not in the budget, which for 2017 is $11.8 million, down from $13.2 million in 2016.
In both years, Richland EMS claimed 160 full-time employees.
“Our supervisors say County Council won’t authorize more positions, and that’s that,” said a source with nearly 10 years at Richland County EMS who did not wish to be identified. “We’re told that as if it’s out of their hands.”
Another paramedic with Richland EMS said the same.
“Michael Byrd put a freeze on hiring,” they said. “It’s ridiculous.”
“We were always told that County Council won’t approve more people,” he said.
Reached Wednesday afternoon, County Councilman Greg Pearce said that is not the case.
“(Saying we won’t approve that is) very easy to say, but nobody has brought these issues to county council,” Pearce said. “I can’t fathom county council being aware of that and permitting a situation like that.
“It had not made it up the food chain to us. Other than the staffing shortages, I knew of long delays and sirens attributed to shortages of personnel, and it was implied that you might have some quality of care issues, but in terms of equipment and drug shortages and policy stuff, all that is new to me. I’m going to find out about it.”
Councilman Seth Rose said he had been told by EMS personnel of some of the other issues but was told they were being fixed.
“Someone on EMS reached out to me a while back and I took those concerns directly to staff,” Rose said. “I tried to help.
“I was assured by staff it was being looked into and addressed. I was told everything was being resolved. That’s the last I’ve heard about it.
“As for personnel shortages, I can’t recall their directors ever coming to us saying there’s a problem that has to be fixed. No one on county council would block that. Each director submits a budget and says ‘Here’s what we need and why. If you don’t ask for it, you can’t get it. We can’t say no to something that we’ve never been asked.”
RUNNING ON EMPTY
Over and over, EMTs and paramedics Quorum spoke with described the incredible strain on their lives, personal and professional, that constantly running understaffed inflicts.
“You’re going nonstop physically,” said a paramedic with more than 10 years working with Richland County who did not wish to be identified. “You get physically hurt because you’re lifting too many people. The paramedics are under constant pressure.
“I love what I do, but it gets to where day in and out, you’re holding reports to be written because you’re so overworked. At the end of shift you’re rushing to finish your chart because they won’t pay you overtime. There are too many calls and not enough trucks on the road. It’s so hectic from the minute you walk in that often you can’t take a lunch or even go to the bathroom. Dispatch is constantly saying ‘Get on the road, get on the road.’
“You have to be up, at your best, for 12 hours, and even if you’re doing your best you can get reprimanded because you’re not answering dispatch in a certain amount of time. And you work on your days off because you’re always on standby. They’re always calling people in because they’re always shorthanded. You can easily work 30 days a month. I’m so tired on some days that I cannot physically drive myself home.”
To a person, EMTs and paramedics complain about having to run “Code Four,” meaning operating with lights and sirens on, every day.
“Running Code Four every shift because you don’t have enough ambulances on is a dangerous practice and absolutely not necessary,” said Greg Sieverding, a paramedic with 34 years of experience including stints with the Army, Air Force and EMS units in Iowa and New York who left Richland County in May of 2015 after just eight months on the job.
“It’s well known that such practices lead to what are called ‘wake accidents.’ It’s excessive. It’s a lawsuit waiting to happen every day.
The practice also places undue stress on ambulance drivers themselves.
“Sirens are loud and meant to get your attention,” said a former EMT who worked for Richland County for six years before leaving who also requested anonymity. “It puts stress on your mind and body just to be hearing the siren constantly during your shift. It makes everyone’s adrenaline go up, your pulse rate, everything.”
“Running with lights and sirens is one of the scariest parts of the job because you don’t know how other people are going to react on the road. People are crazy and unpredictable, and accidents are inevitable over time.”
That risk is not worth the reward, said a current EMT who requested anonymity.
“Running Code Four even though you’re non-emergent (non emergency) is not good for anyone,” they said. “You have people coming on, constantly running Code Four the whole shift.
“It doesn’t matter if it’s a patient with toe pain or someone who just needs to get their medicine refilled, you’re running lights and sirens to get back to the next call. It puts an insane amount of pressure on people that is completely unnecessary and just begging for trouble.
“(Running Code Four every day) is a ticking time bomb. It puts you at risk and it puts others at risk, and for nothing except management trying to hide the personnel problem by making response times look better.”
Richland EMS employees say not only are they short on people, they’re often dangerously short on key medical supplies.
A former multi-year employee who left to work for another county after being frustrated with the lack of supplies described several examples where a shortage of medicine resulted in poor patient care.
“I had a call where the patient had a compound ankle fracture, the bone sticking out of the ankle, and I had nothing to give him for pain relief because we were out of morphine, which is the only medication Richland carries for pain. We can only give aspirin to patients suspected of a heart attack because it thins the blood.
I had many people with breaks that I couldn’t help with pain.”
The reason for the shortages, Gottlieb said, is management’s financial practices.
“They buy supplies at the start of the fiscal year, and if you run out, you run out unless it’s an extreme circumstance,” Gottlieb said. Often times we’d have to borrow things from other trucks or other county’s trucks, things like gloves or D-sheets, which is the paper you put down on a stretcher for sanitary reasons.
“You name it, we ran out of it and often would be out for months — nitroglycerine tablets, veinguards, syringes, spine boards, Narcan for overdoses, electrodes, our betadine wipes were expired by years, the list just goes on and on. We were told to make due with what we have.”
A paramedic still employed with Richland EMS agreed.
“We don’t even have thermometers on the trucks,” they said. “The equipment is old and doesn’t always work. Supplies are always on back order. The radios are in and out and the batteries for them don’t stay charged.”
Being without Narcan in particular is disturbing to paramedics and EMTs Quorum spoke to for more than one reason.
“We were lied to about why we can’t get more,” Gottlieb said. “We were told, ‘Oh, there’s a nationwide shortage.’ Then how is every other county getting it? That was their excuse. Here we are in a nationwide opioid epidemic, and the one thing that can save people we can’t get any more of for no real reason.”
He’s not alone in his concern.
“If someone overdoses on an opiate, with Narcan you can bring them back,” said a longtime Richland EMS paramedic. “When we don’t have it and a patient is unconscious, you can’t do anything. They will die if they don’t get it on the way to the hospital, and we’ve been without it for over a year. We had some for about two weeks, but it’s on back order again. Not for Lexington or Fairfield, just for us.”
The demands to get trucks on the road also led to situations where crews were forced to make situations that led to unsafe conditions.
“One of the grossest abuses is that they wanted us to leave patients on stretchers at the emergency room so we could turn around and respond the next call, but now you’re out without a stretcher the rest of the night, which is not OK,” Sierverding said.
A paramedic no longer at the county but still in the area said the stretcher issue is a recurring problem.
“DHEC says you have to have two stretchers available at all times, but you’ll get reprimanded if you don’t leave one there and get back out,” they said. “With that and how often we were out of medicine or supplies, I bet you’d be hard-pressed to find a truck on the street that meets DHEC’s (guidelines) for the minimum equipment ambulances must have.”
EMTs and paramedics Quorum spoke to all say the public has a right to know the risks they take when they board an ambulance.
“I have seen patient care deteriorate to the degree that lives are lost,” said a current paramedic with more than a decade of experience. Someone misses a defibrillation, a patient ends up dying. I’ve seen a paramedic miss something on the monitors, not believe it needed a defib and incorrectly treated it as a seizure. I was standing right there. It’s not just one case, it’s the way things are.”
The same source said high turnover means less-experienced people replace those who leave.
“I’ve seen paramedics right out of school in just two weeks be in charge of a truck,” they said. “People aren’t trained enough. Someone goes right from class to being in the hot seat. I think over a year period, you’re talking between 10 and 20 people who die that didn’t need to because of things that happen. These are unnecessary deaths.”
Said another source still with the county, “I wouldn’t put my mother on a truck with some of the people we have working them,” they said. “I’d sooner take her myself.”
For Sieverding, getting the word out is worth the risk involved with revealing his identity.
“I think people in Richland County expect exceptional care,” Sieverding said. “I don’t think they know they’re not getting it.”
GHOST TRUCKS AND COVERUPS
While there is no legal mandate for how many ambulances must be on the road, the South Carolina Department of Health and Environmental Control issues guidelines — guidelines sources say Richland County does not meet.
“DHEC says you should have 12 trucks on the road by 7 a.m., then 16 on the road by noon,” said a current longtime employee of Richland EMS. “We don’t have that even though we should because besides not having enough crews, management will send trucks out to cover five events sometimes in an evening, USC and high school football games, womens’ basketball games, the Fireflies, a half-mile run somewhere, anything anyone asks EMS to come out for. All management cares about is flying the (Richland EMS) flag.
“So all off a sudden that 16 is down to 12 trucks, and on a Friday or Saturday night. This happens every day, but mostly on weekends.”
To appear compliant, the same source said, employees are told to make what are called “ghost trucks.”
“On every shift, captains will tell us to ‘Make a ghost truck,’ which is recording a truck showing two people on it, but that truck never leaves the parking lot and the people never leave the office,” the source said. “It’s just so your paperwork can be compliant, showing 16 trucks when you don’t have 16 trucks.
“When trucks are out at an event, they show up as being out, but in reality they’re not out, they’re sitting for five hours at a game somewhere. It’s rare that we actually get 16 trucks out, and it’s worse on weekends, which are the busiest times.”
Overstretched crews mean more chances for mistakes. Gottlieb said one such mistake he witnessed he’ll never forget — nor management’s response to it.
“A patient was in cardiac arrest,” Gottlieb said. “I backed up the crew. The medic on the scene didn’t recognize the patient was in cardiac arrest and wasn’t doing anything. By the time I got to the patient it was too late. We weren’t able to get the patient back.
“I asked what was going on and was told there would be an investigation. About a month later I asked about it again and was told there wasn’t going to be an investigation because they didn’t want anything to be on paper in case the family decided to sue the county.
“The next year the guy was promoted.”
An EMT who was with Richland County for nearly 10 years before leaving because of poor management said poor training led to poor care and poor decision-making.
“I mentored new medics, and our training was absolutely pathetic,” they said. “There’s no minimum training for anyone, nothing set in stone. People weren’t challenged to achieve a level of competency. Just because you have a certification as an EMT, which is about six months of night school, doesn’t mean you’re competent.
“The only mandatory training we had was after someone botched something. A senior paramedic put a tracheal tube into a patient’s gut. You can go ahead and write that check because that’s a fatality. I reported numerous people for sub-par performances and recommended termination and nothing would happen. Management turned a blind eye or would put them with someone else and they’d be deemed competent.”
For Sieverding, Gottlieb and many more, the problems were too serious to endure.
“I couldn’t work there one more day,” said an EMT with more than 20 years of experience who left Richland County within the past year. “I love my job, I love what I do, but I grew to hate where I was doing it because the unsafe conditions and the way employees were worked.
“Nothing about it was conducive to ensuring patient care.”
For Gottlieb, the lack of willingness to do anything about the issues by management became unbearable.
“When I left, I wrote eight-and-a-half pages detailing my reasons,” Gottlieb said. “I could have written more.”
For an EMT who has been with the county more than a decade and fights against policies that stress crews and negatively impact patients, leaving isn’t a realistic option.
“I wish it was, but it isn’t,” they said. “It’s that way with a lot of people; they want to go but can’t. They came here when things were good.
“It’s not that way anymore.”
Neither Richland County spokeswoman Beverly Harris nor Byrd have responded to a list of questions sent Tuesday.