By Savannah Tryens-Fernandes
al.com
PICKENS COUNTY, Ala. — In the three weeks since Pickens County dropped down to one ambulance, two women died after waiting an hour for paramedics to arrive.
One woman went into cardiac arrest and died before an ambulance could arrive in Aliceville, her small town in rural west Alabama. Volunteer first responders performed CPR for an hour as they waited for an ambulance to make the 50-mile drive from Tuscaloosa. It was a bad weather day so the helicopter couldn’t make it in time either.
Another woman, just 37, went into heart failure at the federal prison in Aliceville. The county’s only ambulance was transporting another patient so it took about an hour to get to her. She died shortly after arriving at the hospital.
“We’ll never know if she would’ve lived if we made it on time,” said Vicky Sullivan McCrory, the paramedic manager at Pickens County Ambulance Service. “But I think she would have. I think her situation could’ve been corrected.”
Pickens County moved to only one ambulance on Oct. 25 . The reduction in ambulance service is just the latest in a downward spiral, as rural communities across Alabama watch emergency rooms and hospitals shutter, and as pediatricians, dentists and maternity care have disappeared in over a third of the state’s counties.
Sullivan McCrory said her team of paramedics has had to triage callers ever since the move to one ambulance. She said it’s not unusual to get two to three calls all within an hour, forcing them to decide where to go based on which call is most life-threatening.
“All I know is people are suffering,” she told AL.com. “What can you do when you have one ambulance in a county with over 19,000 people in it?”
‘Ambulance desert’
Pickens County used to have more people. But it lost its only hospital in 2020, and the population has gone down by 10.5% since then.
“The loss of critical medical infrastructure threatens not just individual health,” said Stephen Katsinas, director of the Education Policy Center at the University of Alabama, “but the entire sustainability of rural communities.”
Alabama has the second lowest number of ambulance stations per capita in the country, according to a report by the Rural Health Research and Policy Centers.
Of the state’s 67 counties, 64 are considered to be in an ‘ambulance desert,’ impacting over 300,000 people, mostly in rural communities.
Neighboring Greene County nearly lost all ambulances in 2022, while companies shut down ambulances in Livingston in Sumter County and Smith’s Station in Lee County.
“Losing ambulance services in the rural Black Belt is devastating,” said Katsinas. “It creates a life-or-death scenario where residents face dramatically increased emergency response times and potentially preventable deaths while simultaneously accelerating the community’s economic and population decline.”
Now Pickens county is coming up against a Dec. 1 deadline where if they can’t find more money, they’ll have to cut that last ambulance, too. But officials said they are working towards solutions, possibly with the help of neighboring counties.
“At the end of the day, we will have an ambulance service for this county,” said county commissioner Jody McGee.
‘What can we do’
When the county’s only hospital closed in 2020, revenue for the ambulance service declined, making it more difficult to attract and retain qualified EMTs.
Pickens County does not have taxes and fees to support the service, relying instead on payments from patients and insurance companies, Sullivan McCrory told AL.com.
The ambulance service couldn’t afford to pay their employees as much as other counties and went into debt. According to Sullivan McCrory, they have been operating in a $200,000 hole since the hospital closure. Their staff dwindled from 12 people to four.
A six-month agreement with the county took effect in March to provide $17,000 a month to the service so they could bring their employees back and give them raises. With the additional money, the ambulance staff grew back to 12 members, allowing them to operate two trucks.
But that agreement — which pulled funding from each small city to cover an amount proportionate to their population and from the county commission — ended in September.
County commissioners told AL.com that they couldn’t keep up the payments under their current budget. They also said some of the mayors couldn’t make it work either.
“We just didn’t have the money to continue,” said Commissioner Drew Elmore.
Mayors from Gordo and Aliceville — the two biggest towns in the county — told AL.com they could keep up their portion of the funding. Aliceville Mayor Terrence Windham said the city budgeted for their $4,000 monthly payments to continue through October of 2025.
Gordo Mayor Craig Patterson said he still has an agreement in place with an emergency helicopter service, but their availability is often dependent on weather.
During a Nov. 14 meeting, county commissioners voted to spend $37,500 to buy a new ambulance from the state. However, commission chair Jill Noland said she could not comment on when the ambulance would be running or whether it would replace the current ambulance or operate in addition to it.
Commissioners said they are still looking for solutions ahead of the Dec. 1 deadline.
“Everybody’s working together to try to fix the situation, we’re looking at all options for different resources and funding,” said Noland. “We’re just trying to see what we can do because we know that an ambulance service is needed here, we all feel the pain.”
State Rep. Ron Bolton, R- Northport, represents Pickens County. He said he has a proposal for the upcoming legislative session to hold a public vote on whether to increase license tag fees to provide ambulance funding.
“This will help but it’s not immediate,” he said. “The state currently has no program in place or funding identified to fund local ambulance services.”
In 2022, Alabama passed a law deeming emergency medical services and ambulances an essential service, saying “emergency medical services are an essential public service and a part of the health care safety net for many residents of this state.”
Alabama is one of 37 states to pass such a law. But unlike most other states, Alabama does not require the state government to fund the service.
Alabama’s law even states that no part of it “requires a county commission to fund or otherwise provide emergency medical services or ambulance services.”
State Sen. Jabo Waggoner, R- Vestavia Hills, the bill’s sponsor, told AL.com the law was intended to secure federal money for ambulance services. But he could not recall which grants or funding sources they were targeting.
U.S. Rep. Terri Sewell represents Pickens County in Washington. Her office said typically the only source of federal funding for those services comes from Medicare reimbursements. She has introduced two bills in the House since 2021 to increase rates for both ambulances and rural hospitals to help them stay operational. But neither bill has received a vote.
“Congresswoman Sewell and our whole team have spent years pushing for congressional action to address these ambulance shortages at the federal level,” said Christopher Kosteva , Sewell’s Communications Director, in a statement to AL.com. “This issue has been exacerbated by the state’s refusal to expand Medicaid, which has put an enormous strain on the resources of rural health care providers.”
When asked by AL.com if any emergency support could be provided by the state to keep an ambulance running, a spokesperson for Gov. Kay Ivey’s office said “We continue monitoring and are aware of developments in Pickens County, but at this time, you may wish to reach out to local officials.”
‘Life or death’
Jamie Calaway lives in the small town of Reform with her 11-year-old son with chronic medical conditions. She said losing an ambulance “can be life or death.”
Calaway has relied on the ambulance service to care for her son since he was 5 months old. She said he has to have a tracheostomy tube to breathe during the day and goes on a ventilator at night.
“They all know him really well,” she said of the paramedics.
When there is trouble with his equipment or he struggles to breathe, the paramedics often come to their home and help Calaway troubleshoot or open his airways. When he needs to go to the hospital, they drive him 45 minutes away to DCH Medical Center in Tuscaloosa to get stabilized for another transport to Children’s Hospital in Birmingham.
“I hope nobody ever has that experience, to watch your child almost die in your arms, and not knowing if you’re going to have somebody there in time to get you to where you need to go,” Calaway said. “I have many times come across the ER with my child barely breathing.
“It is anxiety-ridden knowing, for somebody like me, that there might not be any ambulances here,” she added. “Whoever makes these decisions obviously doesn’t have a loved one in the area or hasn’t been in that predicament.”
Moving closer to a hospital isn’t a simple solution as a single mom with six kids, though she thinks about it a lot.
“If we move somewhere else we wouldn’t have the family support. People say we should just move closer to the hospital, but it’s not always that easy,” she said.
At the Aliceville Manor Nursing Home, the ambulance shortage has already impacted residents and could cost their business.
“I’ve had multiple incidents where we have performed CPR for over an hour waiting for the ambulance to get here. I’m not criticizing the ambulance service, I know they’re doing the best they can, but it’s cost lives throughout the county,” said Jennifer Carr, the nursing home’s administrator.
Her residents need an ambulance about twice a week for emergency situations, she said, and each time it takes anywhere from one to two hours for them to arrive.
“It hurts our business. People don’t want to come here,” she said.
Carr estimates that she’s lost somewhere between 30 to 40 admissions in the last year as families choose to put their loved ones in nursing homes in Tuscaloosa where they’ll be close to a hospital and ambulance services.
“It’s an extremely large amount of money we’re losing,” she said. “And we put back money into this community. We support this community. All of our 120-something employees are local and their income comes from this facility. The majority of our residents are from Pickens County. So when it hurts us, it hurts the county economy.”
And the shortage of emergency medical care doesn’t just pose a risk for the nursing home. In rural Alabama, people injured in car crashes sometimes don’t make it to a hospital in time.
Pickens County already has one of the highest rates of traffic fatalities in the state, at 31 residents dying per 100,000. The state average is 19.5 deaths per 100,000.
“With the closing of that one ambulance service, there is a greater chance for those injured to receive trauma care outside of that Golden Hour due to the delays in EMS response time due to travel time, which in turn increases the chances that they die from their injuries,” said Russell Griffin, associate professor in the UAB Department of Epidemiology.
‘Couldn’t get worse’
Last year, on Dec. 28, LaKeya Hall-Phillips’ sister died while waiting for an ambulance.
Hall-Phillips said she got a panicked call from her 13-year-old nephew that night saying his mom, Regina Harris, wasn’t breathing.
She said she rushed over and performed CPR for over an hour while the ambulance rerouted from a prior call in Gordo to her home in Ethelsville.
“It’s hard when young kids are involved. We had to put my nephews in a room so they wouldn’t see their mom like that,” Hall-Phillips told AL.com. “We even had to put a sheet up because the oldest son kept coming out to see what was going on.”
When the ambulance arrived, Harris, who was only 39 years old, still had a faint pulse, but it was lost somewhere on route to the hospital.
At the time of Harris’s death, two ambulances were still running in the county.
She worries what it will mean if the county is down to just one ambulance, especially as she now cares for her aging parents.
“It just saddens me,” she said. “I already feel like they failed my sister. I thought it couldn’t get worse but it will if nothing gets done.”
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