Anderson County EMS: Past, Present, Future...

In 1969, the Anderson County Board of Commissioners (Anderson County Court at that time) passed a resolution to build and provide an ambulance service to the citizen's of Anderson County. The State of Tennessee did not have an EMS Act until 1973, so even in the 60's Anderson County Government was setting the benchmark for Tennessee EMS. In October of 1998, County Executive Rex Lynch hired now Director Robert Byrd to rebuild and manage this EMS System. Byrd had previously served ACEMS from 1984 until 1990 when he left accepting a position as Flight Paramedic with UT Lifestar.

The County Executive's agenda was firm, clear, and defined as a mandate from the people. The agenda: Build a professional EMS System that is self-supportive. The County Executive had previously tracked the ambulance service numbers between 1994 and 1998 as a County Commissioner; therefore Mr. Lynch had a firm vision of an ideal EMS system. Lynch felt a licensed Paramedic at the helm was the missing piece. Once offered, Byrd respectfully declined the job on more than one occasion. Byrd recalls "Leaving Lifestar to take the helm of an EMS system in disarray was not in my plans. Frankly, I didn't think I could rebuild the system into what I would demand of it, and I was even more concerned with the County Executives expectations of a financially self-supported system." Byrd had never met Lynch prior to his being elected as County Executive. The Director shares stories about differences he and Lynch had in the beginning. For instance, Byrd needed an upstart, however Mayor Lynch's fiscal conservative management limited that need. Differences aside, Mayor Lynch and Director Byrd have become effective allies, working toward the common goal of providing the best possible patient care for the citizens of Anderson County.

Once Byrd accepted the position, his agenda was also clear: "build the best patient care system in Tennessee." During a 1998 interview with the Knoxville News Sentinel, Director Byrd was quoted as saying, "we are going to build the premier EMS System in this region." At this present juncture, Anderson County EMS firmly believes they have already accomplished this goal. From the beginning, Director Byrd developed a three tier system to effectively manage his new look EMS system. The first tier included staff reorganization, training, and education for the EMT's and Paramedics as well as the office and billing staff, all while introducing a new computer charting system and implementing a chain-of-command. The second tier was to write and enforce Standard Operating Procedures, equip the medical staff with the best prehospital equipment in the field and to provide the latest office and billing software on the market. The third tier was community outreach and gaining political support. The Director realized that he had to give the community a new EMS System before he would receive the community and political support needed to manage this system. This included the implementation of a county wide First Responder program.

The three tier plan was successful, and still remains under construction today. Paramedics with advanced training were placed in positions of supervision. Office personnel were trained in the latest prehospital coding and billing. The Service was equipped with a $70,000 computer system (which Byrd claims paid for itself the first year). Continuing Quality Improvement (CQI) was implemented and patient care improvement became and remains remarkable. One of the many important aspects of the success of this EMS System is the support from the Anderson County Board of Commissioners. Byrd gained this support swiftly, and credits this achievement as an important achievement in his tenure. "If there is one single most important event to measure the success of this EMS System, it was the third Monday in October 1998. I had been on the job only two weeks. I was transitioning from Lifestar and working both jobs. The Board of Commissioners didn't know me, and had no history with me, yet they took a very big chance with my request for a $70,000 computer system. I had not been to committee, so this request would require three quarters vote for passage. The vote was unanimous, and this was the beginning of our success."

Anderson County EMS has seen it's system grow from 6,000 responses in 1998 to over 24,000 in 2007. The staff has grown from 36 employees in 1998 to 93 employees in 2008. The fleet consisted of seven ambulances and one command unit in 1998. Anderson County will license 18 ambulances and have two command units in 2008. "Our system to this day remains a constant work in progress, but the progress thus far has been immensely successful." According to Byrd one of many important achievements in developing the EMS System was winning the support of the staff. "The EMT's and Paramedics had to believe that they were coming to work and know they were making a difference in the community. The office staff needed to connect with the public, and let them know that their health was more important than our collections. This was most difficult as we needed money to function, yet their medical care must come first. Our transport numbers showed that one half of our transports were not Anderson County residents, yet the Anderson County taxpayer was subsidizing this EMS System hundreds of thousands each year."

With Lynch's fiscal conservative attitude and Byrd's respite to "let the patient pay for the service", Anderson County EMS was soon self-supported. The most important achievement in accomplishing the success of this EMS System was winning the public support. This could only be accomplished by providing the patient with the best service and patient care available. "You are not going to fool the public; if the patient care is poor...the system is weak." Ultimately, the number one goal (patient care) is being met while operating a top tier EMS service and setting the benchmark for EMS services in Tennessee.