Adapting to emergency services needs is like aiming at a moving target.

That's the imagery Public Safety Director D. Scot Brooks used in a presentation to the Moore County Board of Commissioners during its recent planning retreat at Little River.

Brooks told the commissioners that he is repositioning ambulances according to need and looking at leasing space in three municipalities to improve efficiency and response time.

The problem with all these plans is the unpredictability of circumstances, especially the weather. Brooks said that the county's emergency services must be able to adapt to those unexpected changes.

When a school bus wrecked last year, three ambulances were put into use to transport the injured. That meant that other ambulances were not available to meet other types of emergencies occurring at about the same time.

Bryan Phillips, Emergency Medical Services manager, reported that the county has been offered space in the Vass area to station an ambulance for 12-hour periods to provide peak demand coverage.

Commissioner Tim Lea asked why 12-hour service but not 24-hour service. Brooks replied that the volume of calls overnight does not justify full-time ambulance service for the area.

The commissioners recently approved appropriations to buy two additional ambulances and to add nine staff members. Brooks said this should improve response time.

But even with more ambulances and additional staff, there is always that moving target, representing unexpected changes in service direction in a geographically large county.

Brooks said he is looking at proposed lease agreements with rescue squads in Pinehurst, Southern Pines and Vass and is considering relocation of some staff and equipment during peak demand periods.

Potential building projects are under consideration on N.C. 22 south of the airport, on the nearby Sandhills Community College property and for a fire/rescue/EMS base in conjunction with Southern Pines.

Moore County currently owns two EMS stations, North Moore and Union Pines. The county has lease agreements with Seven Lakes EMS, Aberdeen Fire Department, Pinehurst Fire Department and the Moore County Airport.

Funded by Special Tax

The county's EMS system is funded through a special Advanced Life Support tax, which is added to the countywide property tax. The rate is currently four cents and, by law, cannot exceed five cents.

In 2005, the commissioners approved an EMS billing service, whereby bills are dispatched to patients with private insurance, Medicare or Medicaid.

If the patient is a Moore County resident, the co-pay is waived. If the patient is a non-resident, he or she is billed for the co-pay or deductible.

The billing is handled by contract with a company based in Lewisville, which has similar contracts with about 40 other counties.

"They don't involve themselves in emergency care, and we don't involve ourselves in billing," Brooks said.

In the first year of billing, 2005-2006, covering a period of about 11 months, the collection was more than $1.7 million.

Brooks said Moore County's EMS rates are lower than most counties, some of which charge as much as $1,000 for a call. He said the standard fee is $425.

The county charge is about $200 less than the FirstHealth system, which uses a different system and charges mileage.

Wireless Outreach

The Enhanced 911 emergency communications system undergirds all emergency services, because it is the resource for dispatching ambulances, rescue units, fire departments and other emergency units.

Brooks advised that the job of emergency communications is "a very stressful job" and it is difficult to attract and keep the best qualified people. It's a job that calls for multi-tasking and staying calm.

A breakthrough in communications is expected in the future when the E-911 system's wireless outreach is enhanced, making it possible to "locate" callers using cell phones. The present system is wired to locate calls made from the residential or business location entered into the 911 addressing system, but the technology is not yet in place to pinpoint the location of cell phones.

The cost of emergency communications is met in part through special fees charged to telephone users and passed on to customers in their telephone bills.

Fire Marshal Carlton Cole described the work he directs through fire investigations, safety inspections, training and education of the public. In the past year, some 1,700 individuals participated in various training opportunities.

Efforts are under way to coordinate the standardizing of equipment among the 17 fire departments. Cole said this would improve efficiency and represent a considerable saving. He is also working on a proposed fire prevention and protection ordinance for the county.

The latest ambulance purchased by the county cost $122,500 and came equipped with climate control, a need for medications stored in the ambulance, not comfort.

Brooks said that among the county's needs is a "stair chair" to transport patients up and down steps. At present staff members must physically transport patients up and down stairs, which can be dangerous to patient and staff.

County EMS works in cooperation with 10 rescue squads, most of which are all volunteer units. They respond to most EMS calls along with county paramedics.

"We have a great relationship with the rescue squads," Brooks said.

Day-to-day emergency services are at the heart of the program, but Brooks reminded the commissioners that paramedics, rescue squads and firefighters are on hand and on call during the numerous special events held in Moore County, ranging from golf tournaments to street festivals. The county even has a bicycle team trained to work at street festivals in areas where it is difficult for an ambulance to maneuver.

Later this year, these services will be needed for two special events: the U.S. Women's Open June 25-July 1 at Pine Needles in Southern Pines and the Jimmy "V" Golf Classic Aug. 25-26 on Pinehurst Courses 2, 4 and 8.

Florence Gilkeson can be reached at 947-4962 or by e-mail at florence@thepilot.com.