Some rescue officials are suggesting merging volunteer rescue squads with fire departments to improve emergency medical response in Gaston County.
They also say that no matter what happens, the county must find a way to provide the squads with more funding to keep them running.
Rescue squads have been losing volunteers in recent years, making it harder for them to respond to an increasing call volume. And some critics say that they aren't needed because fire departments and paramedics with Gaston Emergency Medical Services are already doing the job.
But Gaston County's eight volunteer rescue squads remain an integral part of its emergency response system.
Some days, rescue squad volunteers say they feel like the forgotten cousins of firefighters and paramedics. They can help pry victims from wrecked cars, treat patients and take them to the hospital, or search for someone lost in the river or woods.
But they don't respond to all of their calls for service. They don't have the medical training to provide advanced life support. And they don't receive anywhere near the level of public funding as volunteer fire departments, which have taxing authority.
"We feel like we're pushed aside, even though we do a lot," said Randy Neill, chief of the Cherryville Rescue Squad.
GEMS, the only emergency medical services provider in the county with highly trained paramedics, is the primary EMS provider in Gaston County. Rescue squads and some of the county's 27 volunteer and city fire departments are staffed by emergency medical technicians, who cannot provide advanced life support.
On average it takes GEMS 10.7 minutes to respond to an emergency, nearly two minutes longer than nationally recommended standards.
GEMS directors blame slow response times, in part, on rescue squads that don't answer all of their calls. That leaves the more highly trained paramedics tending to less serious calls. An Observer analysis showed that GEMS, on average, is unable to meet nationally recommended guidelines for response -- less than nine minutes -- on six out of 10 calls.
The biggest problem for squads is funding, officials say. Gaston County provides and maintains two ambulances for each rescue squad. The squads also get paid to take patients to the hospital. Some are paid $15 per call and others are paid based on the number of calls they answer, ranging from $35 to $72 per call.
The squads also rely on their own fund-raising, which can bring in as much as $50,000 per year to help pay for equipment, medical supplies and utility bills.
But fund-raising also can raise questions. Last year the State Bureau of Investigation began investigating what police called a misuse of tens of thousands of dollars at the South Point Lifesaving Crew. The SBI plans to present its finding to the district attorney next week.
Even with fund-raisers, rescue squads don't usually bring in enough money to hire full-time crews during the day when volunteers are at work and unable to man the stations.
In August, for example, the Cherryville Rescue Squad hired four part-time emergency medical technicians at $9 an hour to cover the daytime shift. But the squad couldn't afford to keep them for long and hasn't had the money to start paying those employees again, Neill said.
They're stuck in a Catch-22: The squads can't make money without answering calls, and they can't always answer calls because they're volunteers. And when they do answer a call, it can take up to two hours to treat and transport the patient and fill out the paperwork. During that time the crew isn't taking calls, and thus not getting paid.
In other cases, GEMS has to transport because the patient needs advanced life support. If that happens, the county pays the rescue squads even less money for the call.
"You've really got to transport a lot of folks to keep the bills paid," said Joe Smith, former chief and member of the board of directors for the South Point Lifesaving Crew in Belmont.
The squad would have to answer only six calls to pay the $200 monthly power bill, but the $26,000 truck payment every year is much harder to make, he said.
Last year, rescue squads failed to respond to one out of every four calls, a recent Observer analysis showed. Response rates vary by squad.
Squads dispute those numbers, blaming what they call a convoluted and unfair system that fails to credit agencies that respond outside their districts or don't transport patients.
Gaston Lifesaving Crew in Gastonia answers enough calls to staff the station with 12 full-time EMTs who respond to both serious and minor emergency calls 24/7.
"If they call us, we take it," said Flip Dow, president of Gaston Lifesaving. But not every squad can because they don't staff their stations full time. And the county does not require the squads to answer their calls.
"They can't help it. They're volunteers," Dow said. "The squads do a lot, and they're not getting paid. You can't obligate somebody when they're doing something for free."
Some rescue squad leaders have suggested giving their agencies the ability to tax residents in their districts like fire departments. The fire departments last year collected tax revenue ranging from $2,500 to $226,000.
But squad leaders recognize that additional taxes won't go over well in the county, said Hoyle Withers, chief of the Dallas Rescue Squad.
"This county is already taxed to death. Talk about making people mad," said Neill of the Cherryville squad.
Gaston County Commissioners Chairman Joe Carpenter said he would prefer to combine rescue squads with fire departments and avoid creating new taxing districts. In a few areas, including Mount Holly and Crowders Mountain, that has happened.
"It would probably save the taxpayers money if they can cover the county and be dependable on responding," Carpenter said.
Smith, of the South Point Lifesaving Crew, also said merging rescue squads with fire departments is the best way to ensure the agencies stay afloat and the county gets proper coverage.
"Pooling the resources would be a great advantage to the community," Smith said. "However, most rescue squads don't want to lose their identity. That may occur with mergers."
GEMS Director Mark Lamphiear and other emergency officials have talked about other funding options as well. They're considering giving rescue squads and fire departments an annual stipend as an incentive to take more calls. He said that has worked in other departments but acknowledged that volunteers still would be unable to respond to all of their calls.
And Dow plans to ask commissioners to pay for six more EMTs and three additional ambulances to help handle the call volume at Gaston Lifesaving, which answers more calls than any other squad.
"We're just trying to help out," Dow said. "Call volume is getting a lot more for everybody, and we're just growing with it."