Amid physician shortage, Pamlico Rescue Squad’s emergency services fill health care gaps

The radio intercom rings in different tones throughout the day at the Pamlico County Rescue Squad’s headquarters in Bayboro. It is usually followed by a dispatcher answering an emergency call.

“They are the most important people you will ever need, when you don't want to need 'em,” Starr Murphy, a retired emergency room nurse for nearly 45 years who spent the last 15 of those years working as a county prison nurse, said of the Rescue Squad.

The county has three primary care offices and, according to the Pamlico County Community Health Assessment for 2021-2024, released last month, the county’s physician to patient ratio is 5.75 primary care physicians per 10,000 residents. The state average is 7.47 physicians  per 10,000 residents.

Yolanda Cristiani, a licensed practical nurse for nearly 30 years and the executive director of Hope Clinic, a nonprofit that provides health care for low-income, underinsured and uninsured residents, said “A lot of our patients (150) have gotten Medicaid, but being able to get them to a new doctor has been very difficult.”

With a shortage of primary care physicians in the county, Dr. Sharon Stevens, a retired OB-GYN of about 25 years and a member of the county health department advisory board, said that while it’s unrealistic to have numerous specialty physicians in a county like Pamlico, it still needs to have “enough primary care providers that could accommodate the number of people that are here.”

Don Morris, a 30-year paramedic at the Rescue Squad, said “people don't have family doctors as much anymore. They use the ER as their ‘doctor,’ which just overloads the system like crazy.”

Cristiani is hopeful about a new urgent care clinic slated to open in Pamlico this year. The Carolina QuickCare facility planned for Grantsboro could ease the burden on emergency services.

“It’s a difference between emergency care and urgent care,” she said. Urgent care is "not something you’ll seek out an ambulance for, but it could lead to you calling an ambulance later.”

Pamlico is currently designated by the U.S. Department of Health and Human Services as a Health Professional Shortage Area. With those deficiencies, “having EMS is critical because they provide another level of service that's not going to come from your physician,” Stevens said.

Emergency medical services personnel are trained medical technicians meant to be the first responders at a scene in order to assess a person's needs, making care faster and more effective.

“In most health care situations, the first hour is what matters. They call it the golden hour,” said Gary York, captain of the Rescue Squad. “Definitive care needs to be met or reached within that hour and if it's not, your chances of survival drop off dramatically.”

Cristiani grew up in a rural town outside of Asheville, where her mother had a stroke at age 29 and needed an ambulance. “It could have been better helped if she had gotten help quicker,” Cristiani said. The time it took to get to Asheville led to worse complications, but Cristiani was grateful for the specialty care her mother got in Asheville’s hospitals.

“When I moved down here, the gaps in the health care were a lot more apparent because there's not anything close by in the county itself,” Christiani said.

According to the U.S. Census, Pamlico has 336 square miles of land. Rescue Squad Chief T.W. Harris, who has worked with the county’s EMS since 1998 and became the chief in 2008, noted the time it takes to arrive at the home of someone in need. An example would be the squad arriving at someone’s home in Minnesott Beach in 12 minutes, then spending 15 minutes at the house, and then taking the patient to New Bern’s hospital.

New Bern’s CarolinaEast Medical Center serves three counties.

There is currently an EMS station in Bayboro and satellite locations in Reelsboro and Oriental during the day on weekdays. For the next government cycle, Harris has made a budget request to the commissioners to ask for additional personnel for full service on the weekend.

Brandon Anderson, a paramedic, EMS’s highest level, became a medic because of his father’s experience with an ambulance. “It took probably 15 minutes before an ambulance got to my house and he was already dead by then from his heart attack,” Anderson said. “If I can prevent that from happening, then whenever it comes my time to go see the man upstairs, I'll never question if my life mattered.”

Yet Anderson, who worked in Florida before moving to North Carolina, where his relatives live, said that with the immense amount of time away from his family, “I think everybody's overworked, underpaid and underappreciated.”

When hiring EMS staff, Harris said, “I need to make sure when that person that walks in a door has the knowledge that when they get to lowland and they’ve got that hour transports to the hospital, they can make that decision that needs to be made in the right sense for that patient.”

Still, he welcomes less-seasoned staff, but pairs them with experienced professionals so they can learn and grow.

Including the chief, the Rescue Squad has 17 full-time positions, with 11 paramedics, three advanced EMTs and three EMTs. There are 17 part-time positions and 13 volunteers.

The Rescue Squad is a 501(c)(3) nonprofit and covers all of its expenses, besides payroll, through billing.

The annual payroll, which the county pays through a contract system with the Rescue Squad, totals $1.4 million. The annual operating cost, which is handled exclusively by the Rescue Squad, is $550,000.

The squad’s independence and relationship with the county is what Harris views as beneficial to the community. The county would have to pay the total payroll in addition to operating fees if the Rescue Squad were owned by the county, Harris said.

The EMS team doesn’t pursue aggressive billing. Harris said this might be different if the EMS was owned by the county.

“I don't want Grandma or Grandpa, or whoever, not buying the medications they need for their life because they're worried if they don't pay us, we're not coming. We're still coming,” Harris said.

In addition to the lack of access to health care in the county, Pamlico has the fifth highest percentage of older adults in the state, at 30%. And 13.8% of people in Pamlico live below the poverty line. The state’s average is 13.3%.

Older residents have more health issues, especially when it comes to chronic conditions like heart disease. Similarly, those in the lower-economic demographic have added barriers to accessing health care, such as lack of transportation.

The county has prevalent pockets of poverty, but Pamlico’s economic data is skewed by a large and wealthy retiree population. Still, “We have a lot of our community members who are trying to work paycheck to paycheck, put food on the table and support their family,” Cristiani said. “They're not taking time for themselves to get seen, get regular checkups or being able to do preventative care.”

Thirteen percent of adults in the county under age 65 don't have insurance, which is higher than the state average of 11%, according to the health assessment. In addition, the percentage of people in Pamlico with medicare is 38%, while the state average is significantly lower at 21%. Medicaid in the county is 21% and the state average is 20%.

Not getting regular primary care leads to worse health outcomes. In return, this leads to a higher need for emergency medical services.

Even with the urgent care coming, Stevens points out that “recruiting physicians to rural areas is difficult.”

She said that regardless of pay, many physicians may not want to live in a rural area that has fewer resources such as child care. However, she mentioned that there are programs in which medical students get financial aid for their education and, in return, spend at least four years after they graduate in rural counties like Pamlico. This, she said, could help.

With the lack of health care in the county and the strain on New Bern’s hospital, “the nurses and the doctors are overwhelmed,” Morris said. “The more we can do in the field to turn these patients around before we get them to (the hospital), the less work that (medical staff) have to do, the quicker they can turn over patients and get them out. It benefits the system.”

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