Leader

The Taney County Ambulance District

The ambulance situation in Taney County became a county-wide problem recognized by most Taney County citizens in the winter of 1976 and spring of 1977. The ambulance business serving the Eastern half of Taney County became particularly concerned over the developing operational trends. Several factors were responsible for bringing the existing situation into sharp focus. They were: 1) the government ruling that all ambulance personnel on call over forty hours per week must be paid overtime; 2) the Vietnam experiences showing vastly improved chances for recovery where rapid response was available; 3) fee collection problems were hindering some ambulance/funeral home operations reducing profits; 4) the rapidly increasing amounts of tourist traffic and increasing accident rates; 5) the influx of older Americans retiring in Taney County with their usual health problems increased rapid medical transportation needs; and 6) the continual upgrading of emergency medical equipment and personnel. The net result was that many of the funeral home/ambulance services, according to directors surveyed in a specific study, were not receiving a satisfactory profit for the investment and the regulations required by law.

This led to the decision by the service covering Eastern Taney County to withdraw from the ambulance business. Because of the crooked roads, tourist traffic and communication facilities, the service operating from the Western half of the county just could not offer a satisfactory response time for emergency situations in the far Eastern areas of the county. When the public received notice from Clarkson's Funeral and Ambulance Service that he was discontinuing service due to insufficient profit, a group of citizens approached Clarkson with an offer of subsidizing the operation to insure its continued availability. Clarkson agreed to this approach and the citizen group formed a not-for-profit corporation. Solicitation of funds began and service was maintained. After a period of time, the contributors began to tire of the effort and expense. Seeking other methods, they petitioned the County Court for assistance.

The presiding Judge as well as several community leaders requested assistance from the University of Missouri Community Development Specialist Jim Perry. Agreeing to assist with this community problem, the C.D. Specialist attended the hearing. Each of the several small groups present had a different proposal to make and several seemingly felt that is was the only approach to be considered; a conflict began to develop. The conflict seemed to be over the retention of an organization which made a business of offering grant application assistance for a fee. At this point, it became apparent, another approach was necessary.

Objective:

The objective of the C.D. Specialist was to get the group back up and begin to utilize the community development process for the solution to their problem. The group was becoming polarized and opportunity for the Extension C.D. Specialist to pull them together into a group was now apparent. He pointed out that many problems have been solved and opportunities realized by citizens using the community process. The specialist then went over the process explaining each step briefly as follows: 1) identifying the problem(s), 2) establishing priorities, 3) considering needed and /or available resources, 4) anticipating obstacles, 5) defining their causes, 6) determining alternatives ways to solve problems or reach the objective, 7) deciding upon the best way or combination of ways to use, 8) assigning and assuming responsibilities, 9) determining the time frame or anticipated time schedule, and 10) evaluating the process – what worked, what didn't, and how could it have been done better.

The Presiding Judge and associates judges suggested that the group consider this approach, form a committee to work on it, and keep the Court informed on progress made. Marge Simpson agreed to serve as chairperson of the group until a more permanent leadership structure could be formulated. The group also decided to work on their own without engaging the consulting firm for the purpose of obtaining federal funds. Loyd Pitchford born and reared in Douglas County, which joins Taney County on the East, retired in Taney County from Douglas Aircraft Company of Wichita, Kansas. Pitchford brought to the committee native reasoning and experience in ambulance district organization.

At the suggestion of the C.D. Specialist, the committee formally worked through outlined community development process giving particular attention to ways to broaden the citizen support base through their involvement and by providing factual information on the situation and ways that the problem could be solved. Up to this point, a "scattergun" approach in the media had been used. Specialist Perry suggested that a public information plan be developed for newspaper, radio, and TV. The committee requested that media representatives meet with the committee as they prepared informational releases on the Taney County Situation. Dates for releases and the objectives of each public information segment was written into plan form and given to the media.

Supplementing this, the committee decided upon speaking engagements, formed a Speaker's Bureau, showed U.S.D.A. and D.O.T. ambulance films, formed a special public relations/public information task force to circulate over the eastern Taney County explaining the proposal and listening to the citizens' suggestions. The underlying objective of this approach was to present information, show concern for the citizens' opinions and feeling, and develop a feeling of credibility for the committee and the ambulance district proposal.

Western Taney County had a good ambulance service operated on a sound business management basis. Since this area was much more heavily populated and the ambulance district would be county-wide requiring all tax payers to provide support, it became apparent that western Taney County citizens must favor the district if it was to carry.

Functioning as a liaison person, the specialist began contacting key people expressing concern and need for service for the entire county. Doctors, hospital administrators, hospital Board of Directors, and other key leaders were contacted. After laying the ground work, a meeting was called at Skaggs Hospital to discuss mutual support. Ironically, the representatives from eastern Taney County sat on the east side of the room while those from the western part of the county sat on the west side of the room. It appeared that the stage was set and the feeling of confrontation was prevalent in the room. The efforts on the part of the C.D. Specialist to break down barriers and promote confidence over the next hour and a half were successful. In fact, after this point was reached, mutual agreement and an action plan were agreed upon in about fifteen minutes.

Another facet of planning was interjected at this point by the C.D. worker in the questions, "Do you think that we need to be thinking about who would be concerned, knowledgeable, and fair-minded directors of the ambulance district? How about at least two good people for each position so that the county can't lose regardless who is elected? You know we could carry this election and still not have good emergency transportation unless we have good directors, couldn't we?"

Results:

The Election Day results reflected the planning and efforts of the committee, media, and county leaders by carrying 5,281 for, with 2,652 opposed.

The Board of Directors was nominated as per suggestion and the election held. Upon their formal installation and election of officers, an educational training film was obtained from D.O.T. in Washington D.C. This film was shown and it covered ambulance district operation and responsibilities.

The district functions for approximately a year covering the county with satisfactory service. "Much credit is to be given to community and county leaders and citizenry as well as the extension Council for this achievement. I feel that our people gained community development knowledge through the process of learning by actually doing. The cumulative effects of this approach are becoming more apparent as each project is undertaken and achieved," states Community Development Specialist Perry.

Taney County Ambulance District

Jim Perry 1975

The provision of ambulance service has been literally a "thorn in the flesh" for many counties since wage and hour decision was handed down by the courts. The situation has gradually but steadily worsened pinching profits on the better-managed business and creating hardship on those less adept at ambulance service management.

Taney County, in the early 50's, was a typical "hill county" lying on the south Missouri state line and bordering northern Arkansas. The County was experiencing a declining population until Bull Shoals Dam was built on the White River 1950. This impoundment began to attract tourists to the area. The rate of growth really began to mushroom with the completion of Table Rock Dam in 1958. As tourists began to decide that this was the place to retire this rate of immigration continued to accelerate. In fact, Taney County was recognized as the fastest growing county in rural Missouri in the 1960-1970 census period with a 28 percent increase and at a time when rural counties were declining in population.

This flood of immigrants, who primarily were retired people, created a demand for service needs, two of which were hospital and ambulance services. Skaggs Hospital, with sound managerial guidance from the Board and administrator, managed to keep pace with the increased medical demands.

South Missouri ambulance services in many instances were not this fortunate. Such was the case for the ambulance services covering eastern Taney County. As profits diminished, Mr. Clarkson, owner of Clarkson Ambulance Service, began to seek ways to maintain a more favorable operating position. Encountering difficulty in gaining widespread community support for several reasons, he announced that he would discontinue his ambulance service.

Welchel's could serve Forsyth fairly effectively from Branson, but services for eastern Taney County were another matter. The rugged hills, sharply curved roads and thirty to forty miles distance meant that Whelchel's could not serve eastern Taney County satisfactorily from their location on the western side of the county. If Clarkson did not continue, eastern Taney County just would not have medical transportation other than by passenger car or the open bed of a pickup truck.

A group of retired people became concerned and established a group of people to consider the problem. They decided that the immediate solution to the problem was to subsidize the operation. Retirees, farmers, businessman, and Home Economics Extension Club women formed a corporation for the purpose of collecting donations to keep the ambulance service going. After several months of $750 per month subsidy checks and with the operator still not satisfied, it became apparent that another method must be sought.

The community development specialist was approached for information pertinent to this problem. Jack Timmons, Director of Missouri University's Department for Regional Affairs, and his staff responded with information and experiences of the Green Hills and Camdenton ambulance services. Information on laws pertaining to the formation of ambulance districts was provided by Missouri University's Governmental Affairs Department. The Department of Emergency Medical Services in the University of Missouri Medical School responded with information on E.M.T. Other members of the committee contacted Senator Eagleton resulting in referral to Steve Eaton in the Division of Health, Bureau of Emergency Medical Services. This action eventually led to the procurement of a $15,000 vehicle for $2,500 local match monies.

Next this group simultaneously approached the Bank of Taney County and the Taney County Court for financial aid. As is the case many times in rural counties, the members of the group had already divided into several camps each campaigning for their own proposal. Anticipating that this situation would occur, the Banker, County Court Judges, and chairman of the ambulance committee each requested that the community development specialist attend the hearing. As the hearing progressed, each group feeling that their solution was the one began to pressure more for their proposal.

It was at this point that the Extension Community Development Specialist had to tactfully force his way into the rather heated interaction. Using the questioning technique, he was able to get each group to defer their proposals until they at least considered some other alternative options. When Presiding Judge Strahan asked what some other possibilities were, the community development specialist suggested the following: 1) sell memberships to provide the subsidy 2) vote in an ambulance district 3) county court provide the subsidy from Revenue Sharing or general appropriation funds 4)Skaggs Hospital, a private institution, either operate or subsidize the service 5) the towns and county governments provide combined funds for ambulance support 6) form a fire protection district and add on the maximum allowable tax of 5 cents to the levy for ambulance operation 7) set up volunteer ambulance districts.

The group and the court, with the assistance of the community development specialist, analyzed the strengths and weakness of each option. After about two hours, they established a priority ranking by consensus. Their decision, in order of priority, was as follows: 1) ambulance district 2) volunteer department and membership combination 3) hospital operate service with some financials assistance 4) cities and county cooperate providing funding 5) fire protection district with 5 cents set aside. They felt that options four and five were weak and unsatisfactorily for Taney County's situation.

With this decision behind them, the committee began to formulate plans to both inform the public and seek their input and support. Lloyd Pitchford, a retiree with considerable experience in ambulance district formation in Kansas, and the community development specialist teamed up showing the file, "The Emergency," to every group possible.

The committee developed a public information plan for use with the news media. They decided upon the key points to be communicated and with media representative assistance developed a schedule hopefully designed to bring momentum to a peak at election time.

Several critical areas still remained to be handled, and they were: 1) The western side of Taney County was the most populated 2) the western half was being served by a very good service, Welchel's Ambulance of Branson 3) the people of the Branson-Hollister area (west side) were satisfied and very loyal to Welchel's 4) why should the western side vote to raise their taxes when they already had good service.

The community development specialist, performing a liaison role, advised the committee that they needed to meet with some of the leadership in the Branson area. He stated that things were just too quiet. After agreeing upon this, the community development specialist arranged a meeting with some key leaders, the hospital administrator, and a representative group of the ambulance district committee. The aire of the meeting was quite guarded, but with tactful questions by the community development specialist, the group continued to interact for about an hour with little response. When the feeling of trust was finally established, the agreement upon the course of action was reached within ten minutes. Pictures were taken for the papers, and the story filed. One reporter remarked to the community development specialist, "I thought they never were going to do anything and suddenly it was all over with a genuine feeling of consensus upon the issue. How in the world was that done?

On Election Day in November, the voters carried the proposal making the formation of the ambulance district a reality. The efforts of Taney County people in the development of the district were selected as "Top News event of 1976" in Taney County. "Taney County people are to be commended for the way they utilized the resources of State and Federal agencies, the University of Missouri Extension Division, hospital and doctors, in working through the community development process," sates community development specialists. Jim Perry

TANEY COUNTY AMBULANCE DISTRICT 1976-2008

Taney County Ambulance District (TCAD) was established in 1976 and it began operations in February 1977. Before it was voted on as a district there were two ambulance services in Taney County. One operated by Walter Cobb at Welchel Funeral Home and one in Forsyth operated by Clarkson Funeral Home. After the district was voted in, these services ended and Taney County was served by the newly formed ambulance district. The tax levy was set at 11 cents per $100.00. In 1985 the residents voted for an increase of 3 cents per $100.00 and in 1989 a 4 cent per $100.00 increase. The first directors were appointed by the Taney County Commission, they were Lyle Bonney, Shirley Johnson, Jerry Coffelt, Tom Baker, Tom Dustin, and William Zeller. This first board of directors was instrumental in setting up the operations of the district. The first ambulances were bought from the City of Branson for not more than $7,000.00. The other ambulances that were used came from the original funeral home services. Shortly after the district was formed, the board of directors hired Walter Cobb to manage the service in November 1977. Since Walter had served the area with a private ambulance operated out of the funeral home, they felt he was the right person to continue the district. Walter served the district from 1977- 1990.

There were two ambulance stations in Taney County, one located in Forsyth and the other in Branson at 124 East College. The Forsyth station was housed at a little cabin in Forsyth where the present day courthouse parking garage is located. The ambulance was kept underneath an awning outside. If a call came in at Forsyth, it was answered by the EMTs on duty, and then they would respond and call the sheriffs office to have them switch over and answer any new calls. There was no paramedic in Forsyth or Branson until 1980. In 1980 there was only one paramedic in Taney County and he stayed in Branson. If the east side had a call then the EMTs would respond and do CPR, EOA's or advanced first aid and call for the paramedic from Branson if they needed him. In Forsyth there was a time that you may go 5-6 days without a call and 3-4 days in Branson without a call. The service originally had only 4 people to operate the ambulances two in Forsyth and two in Branson. Walter Cobb hired Chris Spitzer to manage the Forsyth office while he managed the Branson Office.

Dr. William Zeller was on the first board, He was very instrumental in getting Advanced Life Support services established in the Ambulance District. After the district got its first paramedic, Terry Cobb, it was able to start providing these advanced skills. The paramedics still had to call in to medical control for all orders, including; IV's Medications etc. The first defibrillator monitor was purchased for $2,500.00 in 1980 with donations that were raised by Presley Music Show and Dr. William and Cindy Zeller. Several of the doctors still did not like the idea that you could shock a patient out in the field and start an IV. It took several months for this to become a reality. It cost a total of $3,000.00 to set up an Advance Life Support ambulance, and most of the equipment was received from the state of Missouri to help start up the service.

The first four employees were Chris Spitzer, Ted Strom, Jay Huff and Terry Cobb. Other employees that were involved in the district at the beginning were Steven Davis, Ted Conway, Rick Holland, Rick Youngblood, Gerry Gillenwaters, Mark Snowden, Allen Stuart, Ron Hill, Steven Harris, Kevin Tweedy and Pam Harmon. The starting pay for each of these was $650.00 per month, and if they received their paramedic license then it would go to $700.00 month. In 1986 the board voted to raise the starting pay for EMTs to $10,000.00 and top out in ten years at $15,000.00. Paramedics would start out at $12,000.00 and in ten years top out at $21,000.00. There were no benefits, such as health insurance, dental, etc. provided by the ambulance district. Employees had to provide their own uniforms and any extra equipment they wanted. The crews worked a schedule of six 24 hour shifts and then would have two 24 hour shifts off. At night you were able to go home and answer emergency phone calls from your house. It was set up on a fire bar system so that it would ring into employee's home and you had a switch so you could turn it off when you were off duty. Employees were required to live within a mile of the ambulance office and if you were in town on your days off you needed to be available for calls. The first year the district did a total of 900 ambulance calls. If you had more than one call at a time, you would take an ambulance and respond to where a volunteer was, and pick him up to go with you. Usually this was at the Western Auto Store, Davidson Jewelry, or the Old Cheese Plant by where Branson Fire Department station one is now. The first volunteers were Keith Schultz, Larry Davidson, Klein Calvert and Milton "Tubby" Hayes

During the first few years that Walter oversaw the district, operation and billing of the calls were done out of the Branson office. The ambulance fees in 1977 were established based on what the private service charged. Resident Base rate was $25.00 and 85 cents a mile. Non-residents were charged $30.00 and $1.00 a mile. In 1978 the first full year budget was set at $97,000.00. In 1987 the budget was $256,756.00 and went up to $319,078.00 in 1991 Walter was able to collect and save money in a CD for 13.25% interest and in 1980 was able to buy a new ambulance for $19,500.00. This was the first vehicle purchased after becoming a district. In 1982 the board raised the base rate to $40.00 for residents and $1.25 per mile; and $55.00 for non-residents and $1.55 per mile.

In November 1990, the board accepted Walter's resignation to take effect in January 1991. At that time Steven Harris would take over as manager and Terry Cobb would be assistant manager. At Walter's retirement we had nine full time employees. Terry Cobb, Steven Harris, Kevin Tweedy, Pam Harmon, Rebecca Ranard, Danny Ingenthron, Steve Ingenthron, Ted Martin and Clarke Whitted.

In 1991 Steven Harris became Administrator of Taney County Ambulance District, Steve started with the same nine employees that Walter had retired with. As stated earlier the budget for 1991 was $319,078.00 and a lifepak monitor cost $9,470.00, we had a total of 2600 ambulance calls. The district had just switched to a new Sweetsoft billing program. Prior to the new Sweetsoft program, the district during Walter's time would use 4 X 5 note cards to keep track of payment by hand. Dana Aumiller and Steve Harris created a billing program through a DOS based system that was used until the purchase of the professional Sweetsoft billing program. With the implementation of the new Sweetsoft program, TCAD was able to keep better track of the billing and was able to file Medicare by computer. In December 1992 Taney County Ambulance started its first 24 hour dispatching service. This was done in the office of the ambulance station in Branson. The first dispatchers were Kent Vanderpool, Chris Strobach and Farrell Jeter. The dispatchers would sleep at the station and answer the ambulance phone and give directions to the crews responding. This way of dispatching was a great improvement over the crews having to answer the emergency phones at home and respond to the station to get the ambulance. This process cut TCAD response time by several minutes. Over the thirteen years that Walter Cobb managed the service the calls went from 900 a year to 1800 a year. In 1991 with the start of the boom in Branson the calls jumped to 2600 and we had 10 full time employees. In 1992 total calls were at 3096 and then went up to 5000 in 1995 with an annual budget of $1,219,600.00 and 23 full time employees.

1992 was the first time that we started having crews to stay at the station for 24 hours. We started with the downtown station located at 124 E College Street and then later expanded to the West Station on Cedar Street after we worked out a lease agreement with the City of Branson. When we started having crews stay at the station, we increased to 12 full time employees and still pulled from our part-time help. The first few years we knew that TCAD was going to outgrow the downtown office and needed better access to Hwy 65. TCAD had the opportunity to purchase property at the Hollister Industrial Park. We purchased the corner lot at Birch Street and Industrial Park Drive for $10,000.00. In 1993 we began clearing the property and started building the new Central Office, Dispatch Center and Crew Quarters. The land was excavated by Water and France construction and build by Morton Building, we moved into the new building in February 1994.

Between 1994 and 1999 the district begin hiring more employees and changed to different shifts to help accommodate better working hours. In 1994 we had 4400 calls with 17 employees. Most of the calls were in the western portion of the county, with 96% of the calls West of Forsyth and 4% east of Forsyth. In 1996 Taney County Ambulance won Emergency Medical Service of the Year for State of Missouri. In 1996 the budget for the district was $1,538,904.00 with around 22 full time employees. We increased to 32 full time and 26 part time employees in 1998.

We served over 5000 patients in 1999 and had 9 ambulances, 1 communications bus, 1 support unit, one jeep and one van. The crews worked three twenty four hour shifts and two 12 hour shifts to cover both day and night, with an eight hour car as needed. The dispatch center was operating 24 hour shifts. In 1999 a lifepak monitor cost $16,000.00 each and a new freightliner cost $116,000.00.We owned three stations, Central Station, in the Hollister Industrial Park; Forsyth Station, located north on Hwy 160; and the West Station on Cedar Street in Branson. We had 33 full time employees, with 18 paramedics and 15 EMTs and 25 part time employees with 9 paramedics 15 EMTs, and 1 nurse. This was also when we started the Heartsafe Community and had placed over 40 AED's in Taney County. In 1999 we had three patients saved by Early Defibrillation.

After moving into our new facilities we were able to be licensed as a training entity by the State of Missouri. We offered two EMTs classes a year and started our Paramedic class in August 2000.

In 2000, Steven Harris was named Administrator of the Year by Missouri Emergency Medical Services Association. In 2001 Steve received the Star of Life Award given by the American Ambulance Association.

In 2003 the Taney County Ambulance district received the Emergency Medical Service of the Year for the second time.

In March of 2005, we were able to purchase the Edie Mechanical property, next door to the central station which had 12,889 square feet. We moved our education department into that building and started remodeling the warehouse for training room. We started using the new training rooms in the spring of 2006. At this time we started to remodel the front half of the building and moved our business offices in summer 2006.

In 2006 the district saw one of its biggest changes since the district was formed. The budget was just under $5,000,000.00, with patient revenues reaching $1,600,000.00. We had a total of 60 full time employees including paramedic, EMTs, office personnel and dispatchers. In 2006 the district started progressing toward a paperless trip ticket system. We originally started with the Zoll billing and dispatch system. Both of these systems were put together nearly at the same time. From these two systems we then migrated into the paperless trip ticket. We implemented a Panasonic Tough Book computer into each car with the Zoll program. In 2007 the district was finishing implementation with a CAD system that could handle the mapping and dispatch information. This system was completed in the fall of 2007.

Starting in 2008 the district was in the process of finishing up the Zoll system and working on the new mapping system for dispatch. The new mapping system will collect and stores call information, so that we can look at a map of Taney County and see where our busy areas are. We also have implemented the new scheduling program where the employees can see the information from home and bid for shifts that are open and request time off. Over the last couple of years the district has worked with grants from Homeland security. The District has received over $2,000,000.00 in equipment for disaster that is housed in the Hollister area. Currently the district has just acquired a grant through SEMA for $1 million to build a mobile medical hospital that will be available for the State of Missouri and will be kept in the Hollister area.

At the end of 2008 the district has 61 full time employees and approximately 29 part-time employees. The expense budget for 2008 was approximately $5.8 million with payroll and benefits contributing to 78% of the expense.