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MORGANTOWN - Clinton Burley, President and CEO of HealthNet Aeromedical Services, said his position gives him a unique perspective on the state of emergency medical care in West Virginia.
After all, HealthNet is a statewide operation with 10 aircraft and more than 50 ground ambulances providing primary 911 coverage under the banner of four separate EMS agencies.
It's not uncommon, Burley said, that he'll find himself in three or four different counties over the course of a week dealing with EMS-related issues of some variety.
"And what I can tell you, very honestly, based on my nearly a half century of experience in the delivery of emergency medical services in West Virginia, is what has been built here in this county since 2019 with the public-private partnership between the citizens of your county, you folks as commissioners, and the health systems here is national standard level stuff. It is the level of care and the level of delivery that make your colleagues across the state envious of what's being delivered here," Burley said during a recent appearance before the Monongalia County Commission.
That standard, Burley continued, has been achieved in no small measure because of two developments.
The first is the July 1, 2019 merger of separate EMS providers operated by the two hospital systems - Mon Health EMS operated by the Mon Health System, and WVU Medicine's WVU HealthTeam - that created Mon EMS as it exists today.
The second is the November 2022 passage of an excess levy supporting EMS services in the county.
The question of renewing that levy will be before voters starting Wednesday as early voting opens ahead of the Nov. 3 general election.
Renewal of the levy would hold rates at their current level - 4.8 cents for every $100 of assessed valuation for Class II (owner occupied) property and 9.6 cents for every $100 of Class III and IV (commercial) property - through June 30, 2031.
It's anticipated the levy would generate $5,345,131 annually for an estimated four-year total of $21,380,524. Those projections will fluctuate over the life of the levy based on changes to the county's tax base.
Excess levies are calculated using assessed value, which is 60% of appraised value.
The average appraised value of a home in Monongalia County is $270,000. That home, which has an assessed value of $162,000, would cost the owner $77.76 annually in EMS levy fees.
The average appraised value of a vehicle in the county is $30,000, which, assessed at $18,000 would equate to $8.64 annually in EMS levy fees.
"Sometimes I get lost in the numbers because that's what I love. But those minutes, those seconds are all impacted by these dollars that the citizens agree to provide," Monongalia County Commissioner Sean Sikora said, later adding, "We certainly are the jewel of the state, and I proudly support this levy, and I hope our citizens understand how important this levy is to every single one of their fellow citizens."
According to information presented by Mon EMS, the nonprofit agency has an average operating budget of approximately $13 to $14 million annually. Of that amount, approximately 48% of the agency's revenue is generated by patient billing, and 37% comes by way of the levy. The hospital systems combine to provide about 13% of the budget and the remainder, about 2%, comes through grants and other sources.
Dr. Christopher Edwards is an emergency room doctor who's served on the Mon EMS Board of Directors since its 2019 formation.
With the support of levy funding, Edwards said Mon EMS has been able to implement a scheduled staffing rotation to locate crews in seven staging locations; deploy an acetech fleet management and telemetry system that provides real-time GPS tracking and driving behavior monitoring; increase command and control training for field officers including the addition of paramedic captains who oversee incident operations and respond to all high-acuity calls; and deploy the Handtevy mobile drug dosing and dispensing platform, among other improvements.
Further, Edwards noted Mon EMS has become one of only three agencies in the state with a whole blood program that allows blood to be administered prior to the patient's arrival at the hospital.
"Research indicates that time of death for patients who are hemorrhaging is about 30 minutes. We know that, average in the U.S., it takes 74 minutes from the time of 911 call for the patient to get to an operating room. Since we instituted the blood products program here in Mon County, 911 call to first ambulance arrival is 10 minutes on average. Time to arrival of blood products is 16 minutes ... And time of 911 call to the emergency room is 48 minutes."
Edwards went on to say that Mon EMS performs better than American Heart Association standards in terms of heart attack and stroke response - both in terms of time to diagnosis and hospital notification and delivery.
It was also noted that Mon EMS has utilized levy funds to support the creation of a self-created EMT Academy. Through seven rotations, the academy's participants have achieved a 100% pass rate on national exams.
"I'm very proud of the service that we provide. And again, I know we have several levies throughout the county that help provide wonderful services to our communities. I'm proud to say I've voted for all of them. I think it brings great opportunity for our citizens with all of the levies we have. But with the data I showed you today, the EMS levy here in the county clearly saves lives; clearly makes a difference,” Edwards said.
In response to criticism highlighting the number of nonemergency hospital transports conducted by the agency, Edwards said 73% of all calls/transports conducted between 2024 and 2026 were emergency transports while 27% were non-emergency transfers, which, he said, are a necessary component of the service.
"When we don't have beds at our hospitals and the people are waiting to be transported out to rehab facilities, to nursing homes, back home, those beds can't be utilized by patients waiting for admission in the emergency rooms at both Mon and WVU," he said.
Addressing mutual aid, meaning an agency other than Mon EMS responding to calls in the county, Edwards said that describes about 2.5% of the calls over the past five years.
"The term 'stacking calls' is if you've got seven trucks out on calls and an eighth call coming in. So, then you have a decision to make. The decision is whether you hold it for one of your squads to go or whether you roll it to another agency," Interim Mon EMS Director Bob Swickard said. "Ours is a simple policy. If there's a closer agency, send them. We do not hold the call."
Ultimately, Burley said, EMS service is a unique business in that it's a vital service being provided and yet the value gets to be determined after the fact by insurance carriers and programs like Medicare and Medicaid, which cover a small percentage of the actual cost.
According to data provided, roughly a quarter of the agency's billable services go uncollected. That's to say nothing of the incidents in which an ambulance is dispatched and stands by, but never utilized.
"The levy fills that gap between those insurance collections and that high readiness cost to make sure those paramedics are ready to go," Burley said.