What exactly does Smithsburg EMS do?
Smithsburg EMS is dedicated to providing excellent prehospital emergency medical services to citizens of Smithsburg and the surrounding communities. For more information about our department, please see our About Us page.
What level of EMS service does Smithsburg EMS provide?
Smithsburg EMS is a third-service, not-for-profit EMS entity. That means we solely provide medical services to the sick and injured. SEMS provides both basic life support (BLS) and advanced life support (ALS) services. When two or more Emergency Medical Technicians (EMTs) respond to the call for service, it is considered BLS. An EMT can handle simple lacerations, sick persons, and basic fractures. When one or more paramedics comprise the crew, the call for service is said to be ALS. Patients suffering from severe trauma, chest pain, shortness of breath, or cardiac arrest will typically receive evaluation by a paramedic.
How many people are on duty at any time?
At a minimum, one EMT and one paramedic are in the station or on the street 24 hours a day, seven days a week, 365 days per year. This includes during holidays or natural disasters. This level of service is guaranteed under a staffing subsidy agreement between Washington County Government and Smithsburg EMS. It is not uncommon for additional volunteer or career staffing to be in station, depending on the needs of the department. During large public events, times of crisis, or inclement weather additional paramedics and EMTs may be brought in to meet demand. This additional staffing is typically added based on historical call volume data.
What is the difference between an EMT and Paramedic?
Emergency Medical Technicians typically receive approximately 200 hours of didactic education along with a certain amount of “precepted,” or supervised, training on the street. Paramedic training varies nationally, but is typically provided at the community college and university level. Paramedics first undergo EMT training followed by two to four years of undergraduate postsecondary education. Paramedic training is regulated by the National Scope of Practice Model, which is set by the National Highway Safety and Transportation Administration (NHSTA) of the U.S. Department of Transportation (DOT). Each state may further specify additional requirements above and beyond the national model. Paramedics wishing to obtain certification through the National Registry of Emergency Medical Technicians (NREMT) must complete their education at an institution accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP). Paramedics may undergo additional specialty training in critical care (CC-P or CCEMT) or as flight paramedics (FP-C). Every paramedic at Smithsburg EMS is certified at the National Registry level (NREMT-P/NRP) and holds a license to practice in the State of Maryland. Paramedics who received their training at a college or university typically have an Associates of Applied Science (AAS) or Bachelor of Science (BS) degree.
What sort of procedures and medications does a paramedic perform/give?
Paramedics in Maryland perform numerous emergency procedures including endotracheal and nasal intubation, intravenous cannulation, external jugular IV placement, defibrillation, transcutaneous cardiac pacing, electrical cardioversion, needle thoracostomy, and medication administration. Paramedics can also perform electrocardiograms, including 12-Lead ECG analysis and transmit their findings to emergency physicians at area hospitals. Both EMTs and paramedics can perform numerous splinting and immobilization techniques for serious injuries. Paramedics in Washington County carry over 30 different medications used to treat any variety of medical emergencies.
Is Smithsburg EMS a fire department?
No. Smithsburg EMS is an EMS-only department, although many of our staff hold qualifications as firefighters and rescue technicians. Some of our personnel hold memberships and positions with specialty rescue teams and firefighting organizations. Citizens interested in performing firefighting duties should consider joining our partner agencies. These include the Smithsburg Community Volunteer Fire Company, Leitersburg Volunteer Fire Company, or Mt. Aetna Volunteer Fire Department.
How is the department funded?
SEMS is funded by private donations, direct billing of insurance companies and patients, and various tax-supported county and state funds. Approximately 50% of our operating budget is funded through private endeavors, such as direct billing and tax-deductible donations.
Why is it important that I donate to Smithsburg EMS?
EMS is a capital-intensive field. Donations continue to be a large part of our operations. Government grants and tax revenue are strictly provided for the purposes of assisting with the provision of qualified staff and utility reimbursement.
SEMS maintains a fleet of three ambulances and several support vehicles, our main building on 8 Maple Avenue, and several hundred thousand dollars worth of EMS equipment. A single cardiac monitor costs nearly $40,000. As technologies change, we are often forced to upgrade to provide EMS services consistent with the current standard of care. Almost all of these purchases are made using savings realized through volunteers and private donations to the department. Ambulances are replaced every 12 to 15 years, cardiac monitors every five to seven years, and support vehicles every eight to 10 years, depending on maintenance cost and mileage. Private donations are also an important part of our outreach programs, as CPR classes and other public education initiatives are funded almost entirely by your gracious contributions.
Why is EMS transport so expensive?
EMS services, particularly those that operate in rural and suburban environments like the Smithsburg area, have a relatively high cost of readiness. Unlike our more urban partners, our call volume does not provide enough direct billing revenue to adequately staff and equip our units; therefore, EMS departments in Washington County are subsidized by county and state government.
As good stewards to the community and to keep cost to tax-paying citizens down, SEMS bills rates that are competitive to the local market and allow us to recover as much of the actual cost of providing the service as possible. By doing so, EMS services in Washington County have been able to maintain a relatively low amount of tax-supported subsidy in comparison to the world class service they provide.
EMS equipment is expensive and sophisticated. Much of our equipment is designed to perform with an extraordinarily low rate of failure and to meet the strictest specifications available. Our career paramedics and EMTs must be paid competitive market rates so that we can deliver the very best talent to your door. Diesel fuel and other exhaustible items must be replaced and paid for frequently. Finally, like any business, there are certain human capital expenses associated with providing proper administration, accounting, and legal representation.
Please know that your bill is being spent in the best interest of the community. We encourage patients to schedule a visit at our facility on 8 Maple Avenue and see where their donations and billing revenue go.
Why did I receive a bill after an ambulance transport?
All bills are processed through Medical Claim Aid of Denton, MD who functions as our third-party billing company. In order to receive funds from Medicare and/or Medicaid, we are required to bill all of our patients for services rendered. SEMS often bills insurance companies directly and the bill you received most likely reflects the overall (gross) amount billed to Medicare and/or your primary or secondary insurance company. When you receive a bill, the first thing you should do is call your insurance company. The bill may have already been paid. If the insurance company was not billed directly, you will be required to submit the bill to them for payment.
Most insurance carriers have a co-payment or provide for a percentage of ambulance transport. You may receive a bill from our billing office because you owe the department this co-payment or balance. We ask that you remit this balance to the address listed on your bill. Patients who are members of our fund drive receive the rest of their bill written off as part of our secondary insurance program.
I saw one of your ambulances or SUVs going to a call with their lights and sirens on, but then they turned them off. What is this all about?
What you observed is called a “cancellation.” This means that we received a 9-1-1 call for service and that either the caller decided they no longer wished to use EMS services or units already on scene have evaluated the patient(s) and have determined our services are not needed. When a unit is dispatched, they often receive very limited information. Typically this will only include the patient’s primary complaint and any key information obtained by the dispatcher prior to hang-up. For example: “79-1 you’re responding for a 80 year old male with chest pain who is diaphoretic and pale in color.” Dispatch will also tell units whether the call should be responded to with lights and sirens or non-emergency.
It surprises many people to find out that cancellations occur fairly regularly. While it may seem silly that ambulances respond only to be turned around, it is important to remember that for many segments of our society the paramedics may be their last line of defense. People call 9-1-1 when they no longer have a solution for their respective problem. In the vast majority of cases these are legitimate, bona-fide emergencies. Society has the expectation that paramedics arrive timely and with the knowledge and authority to fix a vast array of problems.
Your ambulance or emergency vehicle was going way too fast. Where do I file a complaint?
First, we apologize that one of our units would make you feel uncomfortable or unsafe. This is not consistent with the mission of our department and does not reflect our values. Before you file a complaint, please understand that emergency vehicles utilizing both lights and sirens are allowed to exceed the speed limit and perform maneuvers that would otherwise be illegal under Maryland Law.
With this being said, SEMS personnel are required to use “due regard” when performing these actions. Our crews are expected to uphold this standard on every call they run, regardless of the information provided by our dispatchers. In some limited cases, the circumstances may allow for an experienced emergency vehicle operator to accelerate their response. A child choking with no air exchange, a cardiac arrest, severe or multiple trauma patients, an injured police or other public safety officer, or patients who are indicated to be near death will necessitate a rapid response to the scene. Please take a moment and consider what you observed. Please remember that speed can seem exaggerated if you are a stationary observer or moving toward the vehicle.
Regardless, all humans are subject to a certain amount of adrenaline-induced tunnel vision and we welcome citizen concerns and complaints. Please see our contact page if you’d like to discuss the event with one of our friendly officers.
Why do I often see multiple vehicles responding to an emergency call?
It depends on the circumstances of the call. Vehicle accidents and structure fires will, by their nature, receive a response from multiple different public safety agencies. Some medical emergencies that are dispatched as exceptionally serious will often necessitate that a second paramedic respond from our department to provide additional support to the patient. Examples of these types of calls include: overdoses, cardiac arrest, severe respiratory distress, choking, chest pain with acute myocardial infarction, strokes, and severe trauma.
Additionally, our supervisors will occasionally respond to perform real-time quality assurance and quality improvement while on scene. They may also respond to assist with lifting obese patients or may have a special skillset not available to the first paramedic who responded.
One of your paramedic crews responded to my residence and performed medical procedures in my home. I thought you were supposed to rush patients to the hospital?
Our understanding of emergency care has evolved greatly in the last several decades. We now understand that in some cases direct and immediate treatment provided by a qualified paramedic can result in a significant decrease in morbidity and mortality. This is particularly true of the management of cardiac arrest, which has only recently begun to be understood as a condition best treated with aggressive CPR and advanced life support at the scene of collapse. Paramedics perform many of the same interventions and push many of the same medications as emergency physicians in your local emergency room. With some small exceptions, the care is virtually identical for cardiac arrest resulting from unknown etiologies. Our paramedics now work to aggressively begin high quality CPR (often with a mechanical device called a LUCAS II), administer defibrillation if possible, and provide ACLS medications in the home. They may also establish an advanced airway before ever leaving the scene.
Several other conditions such as anaphylaxis (severe allergic reactions), asthma, acute pulmonary edema, episodes of hypoglycemia, and some cardiac arrhythmias may require the paramedic to administer immediate interventions before the patient is moved from the home. Additionally, due to advances in our understanding of treatment for trauma, heart attacks, and stroke the paramedic may need to perform a brief history and evaluation of the patient before determining which hospital is the most appropriate destination.
Some conditions still warrant rapid transport. Most families can tell if we’ve identified one of these conditions as our pace and level of urgency noticeably increases. Patients suffering from severe trauma benefit from seeing a surgeon immediately. EMS professionals colloquially call this the “Golden Hour,” a term coined by the late R Adams Cowley of Maryland’s Shock Trauma Center. EMS crews strive to have the patient at an accredited trauma center within one hour of the time of impact. Patients suffering from acute myocardial infarctions (AMI) have increased survival if they have “EMS to balloon times,” sometimes called e2b, of less than 90 minutes. This is the time from which a paramedic identifies a heart attack until the time the blockage is opened via percutaneous intervention (PCI) by an interventional cardiologist at the hospital. This level of treatment is considered the gold standard and is provided locally by Meritus Medical Center. The resources required to provide such a timely response are tremendous and require a combination of cutting edge technology, skilled paramedics, and excellent local hospitals.
One of your paramedics seemed overly relaxed during my recent emergency. What happened to the rushing around I see on TV?
Most of our paramedics are seasoned professionals who are accustomed to responding to a variety of medical emergencies. The last thing you want to see is a panicked or rushed paramedic. Our job is to identify any medical emergencies requiring immediate intervention and provide a pleasant and relaxing experience on your ride to the hospital. In some cases, individuals suffering immediately life threatening emergencies will see paramedics directing a variety of procedures among numerous staff, rapidly performing interventions, and asking poignant questions of the individual’s past medical history. In these cases, we ask that you answer questions as accurately and thoroughly as possible. If, due to the urgency surrounding a call, you still have questions about the service provided, please do not hesitate to contact us directly.
If I call 9-1-1, do I have to be transported to the hospital?
EMS personnel generally cannot make any individual accept transport to the hospital. Exceptions are provided for those individuals who do not meet the legal definition of orientation and are suffering from a form of altered mental status. Under Maryland State Law, these individuals are assumed to provide what is called implied consent and must seek evaluation by an emergency physician at a local hospital. Implied consent is the principle that a reasonable individual in similar circumstances would want to be treated based on the clinical findings of the EMS professional on scene. Individuals placed under an “emergency petition” by a peace officer of the State of Maryland are required to seek medical evaluation with EMS.
If I am transported is there a cost associated with the service?
There is a cost associated with EMS transport. Individuals who receive transport to a hospital will receive a bill for service in accordance with the relevant care provided by the EMT or paramedic. Most major insurance companies and Medicare and Medicaid provide coverage for EMS transport, although there is typically a form of co-payment or co-insurance that the patient must pay. We encourage all local citizens to participate in the Smithsburg EMS Fund Drive Program. This program provides for a tax-deductible donation that serves as supplemental insurance for transport by Smithsburg EMS ambulances. Patients who participate in the fund drive will have any remaining balance waived after payment by your primary insurance carrier.
I received a bill for an “ALS assessment” but no paramedic was on the ambulance. Is this correct?
If the patient received an IV, blood draw, or ECG, then an advanced life support provider (paramedic or cardiac rescue technician) provided care during your transport. If a call is triaged by 9-1-1 as ALS and necessitated the response of a paramedic and that paramedic provided a medical assessment of your condition prior to transport, regardless if they rode along to the hospital, then you will be billed a fee for this evaluation and expertise. This fee is to assist the department in recuperating the additional cost associated with fielding qualified paramedics, who receive significantly more training than the standard EMT and have additional expertise in the assessment and management of medical emergencies. The paramedic was ultimately responsible for determining the level of prehospital care you required. Medicare and many third-party insurance companies have recognized the benefit provided by ALS evaluation and do remit payment for such services.
I already donated. Why did I receive another letter in the mail?
SEMS performs two direct mailings annually to make sure we give all of our residents the opportunity to participate in our fund drive. Receiving a letter does not necessarily mean that we did not receive a donation from you or your family. Fund drive membership is good one year from the date of payment and you do not need to donate twice, unless of course you desire to provide additional support for our mission and service. We have previously investigated performing “smart” mailing that would only mail letters to those individuals at risk for lapsing coverage or to those who have not yet donated; however, we found that this was prohibitively expensive and not appropriate for the mission of our small organization. Mailings are typically performed in the Spring and Fall of each year. The Fall mailing provides individuals and businesses another opportunity to donate one last time before the end of the tax year.
My local fire department is soliciting me for donations. Are you the same people?
No. Each fire department is a separately operated independent not-for-profit responsible for providing fire protection services to your residence. They do not provide ambulance transport or advanced life support services, although they may respond to your home to provide first-responder assistance if you suffer a severe medical emergency. It’s important to donate to your community fire department as they, like Smithsburg EMS, heavily rely on your generous support.
When should I call 9-1-1?
You should immediately dial 9-1-1 for any of the following: shortness of breath, chest pain, an unconscious or unresponsive person, a broken long bone (arm, leg), long falls, severe and debilitating pain, an individual suffering cardiac arrest, a choking child or adult, seizures, individuals suffering stroke-like symptoms, motor vehicle accidents with injury, and those individuals suffering from an altered mental status. Fire or smoke in a home, in a yard, or impinging on an outside structure also warrants an immediate call to 9-1-1.
You are the best judge of your own health. If you feel in distress, a call to 9-1-1 is warranted. Certain types of medical emergencies, such as chest pain, strokes, and cardiac arrest, need to be treated by EMS immediately. Rapid treatment and transport to a hospital is key to survival.
Do you perform routine interfacility transports?
SEMS is not licensed by the State of Maryland to perform routine interfacility, or between hospitals or from hospital to nursing homes, transports. We are only accredited as a 9-1-1 emergency service. In some limited cases, we will perform transports for patients coming from the hospital back to their home in the immediate Smithsburg community. It is important to note that this is highly dependent on available staffing and is generally performed by volunteer personnel.
Why are volunteers such an important part of your operations?
Smithsburg EMS does not receive enough revenue, either tax based or privately obtained, to provide our service with 100% career staff. Volunteers are the lifeblood of this department and provide a significant part of the day-to-date operations. Additionally, we believe that volunteers keep the organization close to the community and committed to our goals. Volunteerism is a big part of EMS and Fire services, especially in rural areas like Smithsburg. Every hour volunteered is money saved for the advancement of our mission with the community.
I’d like to volunteer my time. What do I get in return?
First, you receive the knowledge that you are providing an invaluable service to the members of your local community. Helping someone in need is one of the most honorable and rewarding experiences that many of us have felt in our lives.
Second, SEMS provides you with uniforms and training 100% free. We’ll even provide transportation to and from class. For students, SEMS has propelled numerous high school and college aged young adults to great heights. EMS experience is an excellent extracurricular when applying to college and graduate school. For those interested in health professions, EMS allows students to perform direct patient care relatively early in comparison with other professions. Unlike many nursing fields, students can start EMT training as young as sixteen years old and gain direct responsibility for patient care as young as 18. Furthermore, EMS is relatively autonomous in comparison to other allied health professions. Paramedics work independently based on standing physician-approved protocols and consult directly with emergency medicine physicians when seeking specialized orders. Several students have found this training and experience to be a superb stepping-stone into other areas of medicine, including medical and nursing school.
Finally, the EMS profession is going through many changes, with most leaders predicting rapid advancement and additional autonomy over the next 10 to 15 years. Paramedics who become certified today will most likely see their scope of practice continue to evolve and expand. It is also very possible that some form of advanced practice will be implemented in many states during their career. The American Board of Medical Specialties (ABMS) recently approved EMS as a certified subspecialty for board certified emergency physicians that will allow EMS personnel to eventually be represented by physicians who have received specific education in the management and medical direction of an EMS system.
Do you provide CPR instruction to groups or individuals?
Yes, and we’re glad to do so. Learning CPR is something every engaged citizen should do. SEMS offers classes on a per-instance basis. All of our CPR instructors are credentialed through the American Heart Association (AHA), are licensed EMTs and paramedics in the State of Maryland, and have performed CPR in real-life scenarios countless times.
- Families and Private Groups: For individuals and families, this service is typically provided free of charge as part of our community outreach programs. Priority is given to at risk populations, including athletic organizations and families with individuals suffering from coronary artery disease (CAD), previous stents, implanted pacers/defibrillators, congenital heart diseases, certain cardiac arrhythmias, previous transplant recipients, or those individuals who have received one or more coronary artery bypass grafts (CABG). Clubs or student organizations that would like to learn CPR without certification are encouraged to do so at any time. Staff can typically teach the basics of hands-only CPR in less than one hour.
- Special Needs: For families with special needs, we provide a small kit complete with DVD, mannikin, and reference materials for self-directed CPR education. All you need is a DVD player and floor space. This service is part of the American Heart Association’s Family and Friends CPR Anytime® program. Due to the cost associated with this program, this service is typically limited to families whom our paramedics have identified as at risk for sudden cardiac arrest (SCA).
- Businesses: For businesses, commercial childcare facilities, and healthcare organizations, we typically charge our cost (fees for CPR cards, career staff, and overhead) and a small fee to support the organization’s mission. We find our courses to be a competitive alternative when compared to other commercial CPR instruction services. However, it is important to understand that SEMS’ primary mission is the provision of 9-1-1 EMS services. Lead-time for a class is often dependent on the availability of our CPR instructors. For larger local businesses in excess of 20 employees, we suggest contracting with one of several reputable area instructors. This is due to student to instructor ratios mandated by the American Heart Association. Our staff would be happy to match you with one of our contacts.
Please complete our contact form to schedule a CPR class for your family, church group, scout troop, or private club.
Where can I find more information about careers at Smithsburg EMS (SEMS)?
Those individuals interested in careers with Smithsburg EMS should visit our Careers page.
What does Servare Vitas mean?
Servare Vitas is Latin for “To Save Lives.” The central mission of Smithsburg EMS is to preserve and protect the life of residents and visitors of Smithsburg and the surrounding communities. We accomplish this mission through a variety of preventative and response based initiatives.
What does your shield represent?
The current Smithsburg EMS shield was formally adopted by the membership and Board of Directors as the company’s corporate seal and shield in 2012. The top of the shield has the company’s county number: 79. The heraldic banner of George Calvert, 1st Baron Baltimore (the Maryland State Flag) emblazons the top of the shield, split horizontally by the company’s name in a circumscribing red banner. The company’s motto - Servare Vitas (to save lives) - is found immediately below the banner. The bottom half of the shield serves as a “window” into our community and is currently occupied by rolling farm fields and fences to represent Smithsburg’s agricultural past and present. The bottom of the shield has the Star of Life, the Federal symbol for emergency medical services. Each branch of the Star of Life represents six main tasks executed by all EMS professionals: Detection, Reporting, Response, On Scene Care, Care in Transit, and Transfer to Definitive Care. The center of the Star of Life contains the Rod of Asclepius, who was the god of medicine and healing in ancient Greek religion.
How old do I have to be to volunteer?
Smithsburg EMS accepts new members at 18 years of age. Paramedic training may begin as early as 18 years of age. Worried about being too advanced in age? Don’t worry. Our oldest operational members have successfully functioned well into their seventies.
Is EMS a dangerous profession?
When well managed, EMS services can be provided in a remarkably safe manner, but it is important to note that EMS is a statistically dangerous profession. Studies show that there are an estimated 12.7 fatalities per 100,000 EMS professionals, more than twice the national average for all workers (5.0) and in line with other high risk professions like police work (14.2) and firefighting (16.5)1. Paramedics die during transport, on roadways, and unfortunately, the occasional homicide. Unfortunately, abuse of EMS professionals is very high. Most EMS professionals will be assaulted during their career and, because we do not carry weapons, we are often defenseless. Additionally, paramedics and EMTs must “do no harm,” constantly reminded that our attacker may also be our patient. The good news is that the risks can be well managed with proper training and diligence in the field. Local police agencies often “clear the scene” of threats before we arrive. Advances in reflective striping, radio communications, traffic safety vests, and scene lighting have also allowed us to mitigate some of these risks.
While it is important to know the risks associated with a career in EMS, it is also important to understand the significant impact a paramedic or EMT can have on someone’s life. EMS is a selfless profession worthy of the best our community has to offer.
I’m a concerned parent. Is Smithsburg EMS a safe and nurturing environment for my teen?
Smithsburg EMS has a history of mentoring generations of Smithsburg youth. Certainly EMS can be a dangerous job and it is true that those exposed to our line of work may see things that are disturbing to some individuals. We ask that parents closely evaluate their child’s level of maturity before considering EMS as a potential career.
SEMS offers every positive of a club or private recreational organization with countless additional benefits. Few organizations have the resources and experience in mentoring youth. Uniforms are provided at no cost to the student. Students who elect to stay overnight at the station are provided housing, access to high-speed internet for homework and recreation, and an entertainment center for afterhours relaxation. Through a cooperative agreement with the Fort Ritchie Community Center, SEMS personnel have access to their gym and recreational facilities during normal business hours. SEMS has many professional paramedics who serve as good role models and mentors for students considering a career in healthcare. Embracing a home-like environment, students learn to work and live among adults. For some, they may experience their first exposure to family pets, as several of our paramedics bring their canine companions to work. They will respond to a variety of high-stress incidents where they are taught to think on their feet and accept responsibility for their actions. SEMS’ training officer often liaisons with parents regarding academic difficulties, reviews grades, and mentors students when selecting college coursework or study pathways.
SEMS is particularly interested in college-bound junior and senior high school students who are considering a career in healthcare, the biological sciences, or other technical professions. For students who are unsure about what they want to do post-graduation, we encourage you to consider EMS as a potential career and schedule a ride-along today.
How can I thank you for your service?
The single most meaningful thing you can do is say “thank you.” Find a young EMT or paramedic and shake their hand. Thank them for their service. Many of the men and women you see around the community are indeed volunteers. Many receive virtually zero compensation for their countless hours of work. Similarly, many of our career paramedics have chosen to remain in a rural environment despite the allure of higher pay and prestige at nearby metropolitan departments. Many of them work for SEMS because they enjoy the unique and challenging clinical environment associated with a rural area.
Many people are surprised to learn that paramedics and EMTs are struck and abused in the line of service. Families, whom we often see during the worst moments of their life, can become violent and aggressive. We are occasionally exposed to the intoxicated and drug-induced fits of rage. Our providers love written correspondence and we proudly display your letters in the department.
1 Maguire BJ, Hunting, KL, Smith GS, Levick NR. Occupational Fatalities in EMS: A Hidden Crisis. Annals of Emergency Medicine. 2002, 40(6): 625-632.