Jody Ratliff, director of the West Virginia Office of Emergency Services, speaks to lawmakers Tuesday, Jan. 7, 2025, during interim legislative committee meetings. (Will Price | West Virginia Legislative photography)
Speaking to lawmakers Tuesday, the head of the state’s Office of Emergency Services said more should be done to support the mental health of paramedics and emergency medical technicians in the state.
Jody Ratliff told the Joint Committee on Volunteer Fire Departments and Emergency Medical Services that another provider had recently died by suicide. He did not specify which agency or county the provider was from.
“I’ve been preaching for mental health for the past few years. I don’t know if it’s sticking or not. I hope it is,” Ratliff said. “My office — even though we’re not in charge of mental health, we are literally doing everything that we can, beyond and above. I’ve spent time with providers crying. I’ve spent my off time with them. I went to meet them. I’ve texted them, I’ve called them. So have other paramedics in my office. We are literally doing everything we can to keep these providers as safe as we can keep them.
“Right now, things are rough, and I think they’re going to continue to get rough, unless we do something as a state,” he said.
Job stresses contribute to an estimated 30% of first responders developing behavioral health conditions like depression and post traumatic stress disorder.
In the past three years, the state has had 1.6 million EMS transport calls, he said. Of those, 70% were done by the 20 largest agencies in the state, he said. Over the same time, 30 agencies ran fewer than 100 calls a year, he said.
“And why is that important? Three-thousand-four-hundred patients were seen a year. That’s rural EMS,” he said. “When you only run 100 transport calls a year, you can’t survive financially. You can’t do it. That’s 3,400 patients in our state that we were able to reach because those agencies are still intact.”
Ratliff said the state also has a 45% utilization rate for advanced life support (ALS), above the national average of 35%.
“We’re low on paramedics, We’re low on EMTs, and yet we still have a high rate of ALS utilization,” he said. “We’re trying to get paramedics out there, everywhere, and we do a pretty good job of it. That number needs to come down because of the ones that have committed suicide, most of them are ALS providers.”
There are 800 active ALS providers in the state and 1,000 emergency medical technicians, he said. Those 1,800 providers completed about a half million calls in 2024, he said.
“We’re killing them,” he said. “Literally that’s what we’re doing.”
Ratliff said the state also has a problem with its payor mix for EMS providers. Medicaid covers roughly 36% of residents, while Medicare covers 35%, he said. He said Medicare not covering the full cost of calls has led to EMS agencies shutting down in the state.
“That’s why we have EMS agencies shutting down,” he said. “Because most of our patients are Medicare, Medicaid. Medicare does not pay the rate of what it costs to run the call. We can’t survive. But we’re asking our paramedics to do more and more and more.”
Medicare rates are set at the national level. Ratliff said the state has done all it can to help increase reimbursement rates.
Ratliff also said the state’s hospitals do a poor job of quickly getting patients from EMS care into hospitals. National guidelines call for patients to be offloaded to hospitals within 20 minutes of arrival, he said. In West Virginia, the average is 32 minutes “on a good day,” and 92 minutes on a bad day, he said.
“This is not a nursing problem. This is not a bed problem. This is administration problem with the hospitals,” he said. “Cabell Huntington Hospital does not have a problem with off loading patients; They are the best in the state. Trying to get the other hospitals to look at them and say we should follow this guideline. We’ve been doing it for two years, and can’t seem to get them to do it.”
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