July 9, 2020

Dear Chairman Welch, County Commissioners & County Manager,

I am writing on behalf of the Blowing Rock Civic Association to request that the Commission vote to approve locating the new 24/7 EMS team at the Blowing Rock station.

My observations and recommendations are based on my research, data provided by the County Manager, and consultation with EMS experts.

As you know, the leaders of Blowing Rock have asked the County for 24/7 coverage for a number of years and were told that Blowing Rock would be the next location after the new facility was built and staff in Vilas in 2017. We are now in 2021 with an opportunity to fulfill that commitment and expectation.

Investing in protecting the health and safety of our county residents is a major responsibility of the County Commission. We realize that there are a lot of demands on resources, but given that health and safety of all county residents is at the top of your priorities, we believe that placing the new 24/7 EMS team in Blowing Rock is an important next step in achieving the national standard of 90 and 9, meaning reaching 90% of the residents within in 9 minutes.

The current strategy set by the County Manager and County Commission and reflected in the contract with the provider sets a standard average response time of 10 minutes and does not address coverage of 90% of the population. These criteria do not reach or even setting a long-term goal of reaching the recognized 90/9 standard. As you know, the only way to meet the standard is to place EMS teams throughout the county like was done for the new station in Vilas. As a consequence of the current standards, the County does not meet the recognized standard of maintaining an ambulance to serve each effective population group of 10,000 of people.

Your decision making process is evidenced in the February 2017 consulting report that did not include mention of the effective population of the county. For example, Blowing Rock was set at the census population of 1,200 with little growth and did not include the additional 5,000 to 6,000 higher risk taxpayers who return to Blowing Rock in May through October. All resident taxpayers and their risk profile throughout the County should be included in setting standards use to measure results.

Currently only 57% of the response times for emergency calls are under 9 minutes, leaving 43% of the county below standard. Response times for emergency calls outside of Boone are all above 9 minutes. Boone is 6:10 minutes and all over districts range from 10:24 minutes to 24:51 minutes. Adding a 24/7 EMS team in a no cost facility already built by Blowing Rock taxpayers will decrease response times by 12% of all emergency calls bringing 69% of all emergency calls toward meeting the 90% goal. It only make sense to house EMS teams in the two concentrated population areas of the County in addition to key rural locations. The current system is too centralized to achieve a high quality outcome. This is not the fault of the contractor, but the County who sets the rules of the contract. Examples of rural counties who do achieve much higher outcomes are Caldwell County that contacts with the Blowing Rock and Monroe County that contracts with the current County contractor.

The taxpayers of Blowing Rock and the greater Blowing Rock Fire District invests $1.6 million annually in Fire & EMS services that enable the county to leverage our all paramedic EMS teams as Quick Response Vehicles with Advanced Life Support Equipment (QRV) for Delta and Echo emergency calls. This investment has allowed the county to improve the quality of emergency calls without funding. Our local investment should not be used to avoid improving our arrival and transport times to the hospital. Thank goodness we have this first responder coverage for critical emergency calls, but our teams are not allowed to transport patients to the hospital because the revenue is contracted to the third-party provider.

In summary we ask that you consider the following:

• Honor your commitments from 2017
• Adopt the 90% and 9 Minute Benchmark for the entire county and work towards raising the standards for service
• Place the new 24/7 EMS team at the Blowing Rock facility that has been provided at no additional cost to the County
• Serve the areas north of Blowing Rock with the 24/7 EMS team as appropriate
• Consider the higher risk and effective populations throughout the County in setting your standards

I am happy to speak before the Commission or with you individually. Please place this letter in the public records as part of the next board package.

Regards,

Tim Gupton
President
Blowing Rock Civic Association
919-418-8555