By Savannah Tryens-Fernandes
al.com
PICKENS COUNTY, Ala. 鈥� 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鈥檛 make it in time either.
Another woman, just 37, went into heart failure at the federal prison in Aliceville. The county鈥檚 only ambulance was transporting another patient so it took about an hour to get to her. She died shortly after arriving at the hospital.
鈥淲e鈥檒l never know if she would鈥檝e lived if we made it on time,鈥� said Vicky Sullivan McCrory, the paramedic manager at Pickens County Ambulance Service. 鈥淏ut I think she would have. I think her situation could鈥檝e been corrected.鈥�
Pickens County Oct. 25 . The reduction in ambulance service is just the latest in a downward spiral, as rural communities across Alabama watch emergency rooms and , and as , and have disappeared in over a third of the state鈥檚 counties.
Sullivan McCrory said her team of paramedics has had to triage callers ever since the move to one ambulance. She said it鈥檚 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.
鈥淎ll I know is people are suffering,鈥� she told . 鈥淲hat can you do when you have one ambulance in a county with over 19,000 people in it?鈥�
鈥楢mbulance desert鈥�
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.
鈥淭he loss of critical medical infrastructure threatens not just individual health,鈥� said Stephen Katsinas, director of the Education Policy Center at the University of Alabama, 鈥渂ut the entire sustainability of rural communities.鈥�
Alabama has the second lowest number of ambulance stations per capita in the country,
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Of the state鈥檚 67 counties, 64 are considered to be in an 鈥榓mbulance desert,鈥� impacting over 300,000 people, mostly in rural communities.
Neighboring Greene County , while companies shut down ambulances in Livingston in Sumter County and Smith鈥檚 Station in Lee County.
鈥淟osing ambulance services in the rural Black Belt is devastating,鈥� said Katsinas. 鈥淚t creates a life-or-death scenario where residents face dramatically increased emergency response times and potentially preventable deaths while simultaneously accelerating the community鈥檚 economic and population decline.鈥�
Now Pickens county is coming up against a Dec. 1 deadline where if they can鈥檛 find more money, they鈥檒l have to cut that last ambulance, too. But officials said they are working towards solutions, possibly with the help of neighboring counties.
鈥淎t the end of the day, we will have an ambulance service for this county,鈥� said county commissioner Jody McGee.
鈥榃hat can we do鈥�
When the county鈥檚 only hospital closed in 2020, revenue for the declined, making it more difficult to attract and retain qualified EMTs.
Pickens County does not , Sullivan McCrory told .
The ambulance service couldn鈥檛 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 鈥� which pulled funding from each small city to cover an amount proportionate to their population and from the county commission 鈥� ended in September.
County commissioners told that they couldn鈥檛 keep up the payments under their current budget. They also said some of the mayors couldn鈥檛 make it work either.
鈥淲e just didn鈥檛 have the money to continue,鈥� said Commissioner Drew Elmore.
Mayors from Gordo and Aliceville 鈥� the two biggest towns in the county 鈥� told 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.
鈥淓verybody鈥檚 working together to try to fix the situation, we鈥檙e looking at all options for different resources and funding,鈥� said Noland. 鈥淲e鈥檙e just trying to see what we can do because we know that an ambulance service is needed here, we all feel the pain.鈥�
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.
鈥淭his will help but it鈥檚 not immediate,鈥� he said. 鈥淭he state currently has no program in place or funding identified to fund local ambulance services.鈥�
In 2022, deeming emergency medical services and ambulances an essential service, saying 鈥渆mergency medical services are an essential public service and a part of the health care safety net for many residents of this state.鈥�
Alabama is . But unlike most other states, Alabama does not.
Alabama鈥檚 law even states that no part of it 鈥渞equires a county commission to fund or otherwise provide emergency medical services or ambulance services.鈥�
State Sen. Jabo Waggoner, R- Vestavia Hills, the bill鈥檚 sponsor, told 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 and to help them stay operational. But neither bill has received a vote.
鈥淐ongresswoman Sewell and our whole team have spent years pushing for congressional action to address these ambulance shortages at the federal level,鈥� said Christopher Kosteva , Sewell鈥檚 Communications Director, in a statement to . 鈥淭his issue has been exacerbated by the state鈥檚 refusal to expand Medicaid, which has put an enormous strain on the resources of rural health care providers.鈥�
When asked by if any emergency support could be provided by the state to keep an ambulance running, a spokesperson for Gov. Kay Ivey鈥檚 office said 鈥淲e continue monitoring and are aware of developments in Pickens County, but at this time, you may wish to reach out to local officials.鈥�
鈥楲ife or death鈥�
Jamie Calaway lives in the small town of Reform with her 11-year-old son with chronic medical conditions. She said losing an ambulance 鈥渃an be life or death.鈥�
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.
鈥淭hey all know him really well,鈥� 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鈥檚 Hospital in Birmingham.
鈥淚 hope nobody ever has that experience, to watch your child almost die in your arms, and not knowing if you鈥檙e going to have somebody there in time to get you to where you need to go,鈥� Calaway said. 鈥淚 have many times come across the ER with my child barely breathing.
鈥淚t is anxiety-ridden knowing, for somebody like me, that there might not be any ambulances here,鈥� she added. 鈥淲hoever makes these decisions obviously doesn鈥檛 have a loved one in the area or hasn鈥檛 been in that predicament.鈥�
Moving closer to a hospital isn鈥檛 a simple solution as a single mom with six kids, though she thinks about it a lot.
鈥淚f we move somewhere else we wouldn鈥檛 have the family support. People say we should just move closer to the hospital, but it鈥檚 not always that easy,鈥� she said.
At the Aliceville Manor Nursing Home, the ambulance shortage has already impacted residents and could cost their business.
鈥淚鈥檝e had multiple incidents where we have performed CPR for over an hour waiting for the ambulance to get here. I鈥檓 not criticizing the ambulance service, I know they鈥檙e doing the best they can, but it鈥檚 cost lives throughout the county,鈥� said Jennifer Carr, the nursing home鈥檚 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.
鈥淚t hurts our business. People don鈥檛 want to come here,鈥� she said.
Carr estimates that she鈥檚 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鈥檒l be close to a hospital and ambulance services.
鈥淚t鈥檚 an extremely large amount of money we鈥檙e losing,鈥� she said. 鈥淎nd 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.鈥�
And the shortage of emergency medical care doesn鈥檛 just pose a risk for the nursing home. In rural Alabama, people injured in car crashes sometimes don鈥檛 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.
鈥淲ith 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,鈥� said Russell Griffin, associate professor in the UAB Department of Epidemiology.
鈥楥ouldn鈥檛 get worse鈥�
Last year, on Dec. 28, LaKeya Hall-Phillips鈥� 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鈥檛 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.
鈥淚t鈥檚 hard when young kids are involved. We had to put my nephews in a room so they wouldn鈥檛 see their mom like that,鈥� Hall-Phillips told . 鈥淲e even had to put a sheet up because the oldest son kept coming out to see what was going on.鈥�
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鈥檚 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.
鈥淚t just saddens me,鈥� she said. 鈥淚 already feel like they failed my sister. I thought it couldn鈥檛 get worse but it will if nothing gets done.鈥�
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