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LETTERS / Watauga County Manager Responds to Tim Gupton Letter Concerning Ambulance Service in Blowing Rock

Dear Mr. Gupton:

Thank you for your email and input regarding Watauga County’s ambulance service.  The County appreciates your comments but would respectfully disagree on some of the generalizations you have made. 

First, the Watauga County Board of Commissioners has never promised the Town of Blowing Rock a 24 hour crew.  I have reviewed the official meeting minutes of the Board of Commissioners and was unable to verify your claim.  The Board has worked extensively with the Blowing Rock Town Council in reviewing and discussing ambulance service for the Town of Blowing Rock and the County as a whole.  Based on these discussions the Commissioners authorized a study of the system in 2017.  The purpose of the study was to determine how the County could maximize limited resources with the location of future sites and the addition of new crews.  Again, MAXIMIZING the benefit and impact to the overall system and not just one section or area of the county.  The conclusion of the study recommended the following:

  1. Due to rising land costs and development pressures, it will be in the best interests of the County to acquire property for the construction of future EMS bases.  Stations will be needed within five years east of Boone and at a location near the Bypass off 105 south of Boone.
  2. In the near term and in order to handle the current call volume, a twelve hour crew should be placed in Boone at existing Base 2 (Alternative 2B).  Although Alternative 2A and 2B are identical in cost for personnel, Alternative 2B (Adding a 12 hour crew in Boone) makes the crew available where the bulk of the calls originate and does not detract from the response time in Blowing Rock.  MEDIC President Craig Sullivan made clear that adding a 12 hour crew in Blowing Rock would involve having that crew responding to calls in Boone, Foscoe, Deep Gap and Meat Camp when the crews at the existing EMS bases are committed.  The bulk of the calls in Blowing Rock are non-emergency calls and the Blowing Rock Fire and Rescue Services units provide critical life support prior to the arrival of MEDIC units.

Even though the study did not recommend a crew in Blowing Rock, the Blowing Rock Town Council continued to lobby strongly the Commissioners for a crew.  The Commissioners through their partnership with the Blowing Rock Town Council agreed to provide a nine (9) hour crew (no reference or acknowledgment in your email) Monday through Friday from 7:00 AM to 4:00 PM on a test basis to determine the impact to the overall system since this was not a recommendation of the study.  In addition, the County funded a new 12-hour crew (per the study recommendation) primarily stationed at Base 2 depending on call outs.  The County has been using the study to guide the decisions regarding improvements to the ambulance system. 

Second, the County would concur 100% with your statement regarding a major responsibility of the Commissioners is protecting the health and safety of all of our citizens and residents.  It is a top priority of the Board and this is the reason for the funding for additional crews in 2014, 2018 and 2021.  You noted the national 90 and 9 model referencing 90% of emergency calls are responded to within 9 minutes.  As I do not have this data, one question since you reference the 90 and 9 model, would be how many entities, especially counties with similar geographical and transportation challenges, actually meet it?  Due to geography and transportation infrastructure, meeting the 90 and 9 model would be financially difficult if not impossible for Watauga County.  Thus, the County has used the 10-minute average response time noted in the County’s contract for 20 plus years which is 28.5% lower than the national average for rural EMS systems (2017 Journal of the American Medical Association).  However, the goal of the County has always been to reduce the overall call response times in a prudent financial manner recognizing the balancing of other service demands on the County.  The 2019 Watauga Medics Annual Report detailed the average response time for all emergency traffic EMS calls in the County was 9:01 minutes.  I have attached a map of the elder population distribution ages 60 and up for the County per your risk profile statement. 

Your email was unclear regarding the effective population group of 10,000.  My understanding of your question is for every 10,000 in population there should be one ambulance.  As stated previously, the County will be adding an additional 24-hour crew effective January 1, 2021.  The additional crew will bring the County closer to that standard.  If on the other hand, you are referencing the seasonal fluctuations in population not being factored into the study that is because the fluctuations are able to be applied throughout the County with specific areas in the County seeing higher increases than Blowing Rock during those seasonal periods. 

Third, according to the 2019 Watauga Medics Annual Report, the average response time for all emergency traffic EMS calls in the County was 9:01 minutes.  This average is not applied equally across the entire County due to the aforementioned challenges of geography and highway infrastructure.  For example, in 2019 Blowing Rock had the fourth fastest response time in all of Watauga County behind Boone, Cove Creek, and Zionville.  It should be noted that Cove Creek and Zionville are in immediate proximity to Base 3, which was opened to serve multiple townships on the western side of Watauga County which previously had response times in excess of 30 minutes on average.  While fourth best may seem disappointing, this response time is still below the national average response time for rural systems and sits at a respectable 12 minutes whereas other areas in our community have response times still exceeding 20 minutes.  The 2017 study recognized this point and in 2020 the data trends presented in 2017 verified placing the next EMS base in the Perkinsville area to allow more rapid access to Meat Camp, Deep Gap, and the Triplett communities that all have response times longer than Blowing Rocks.  Keeping the next unit in the Boone area would also allow the current 9-hour Blowing Rock crew and Base 2 crews to stay in closer proximity to Blowing Rock, which would likely reduce Blowing Rock’s average response time even further.

Blowing Rock Fire contracts with Caldwell County for ambulance service so it may seem logical to compare it with Watauga County.  However, there are many differences between the two counties.


  Caldwell County Watauga County
Budget $100 million $75 million
Tax Rate 63 cents per $100 valuation. 40.3 cents per $100 valuation.
Rescue Tax Rate 5.75 cents per $100 valuation.  0.0 cents per $100 valuation.
Population 82,178 56,177


These are just a few differences not to mention the geographical, weather, and transportation infrastructure differences between the counties.  Therefore, to state that Caldwell County achieves much higher outcomes than Watauga County is at best inaccurate and solely an opinion based on the multiple variables associated with each County and lack of specific details provided to warrant such a claim.  Consequently, Mr. Sullivan, Watauga Medics Owner, stated that of the three (3) EMS systems he contracts with Watauga County is not only the busiest but has the overall best response times.  Watauga Medics does not contract with Monroe County as there is no such County in North Carolina. 

I did note your reference regarding your observations and recommendations were based on your research, data provided by the County Manager, and consultation with EMS experts.  However, a detailed list of the EMS experts you consulted with was not provided.  To ensure you had the most reliable data and information at your disposal I telephoned Mr. Craig Sullivan to make sure he provided any information you needed.  Mr. Sullivan relayed you had not contacted him.  I’m sure you know that with Mr. Sullivan’s 20 year’s experience operating the County’s ambulance service he has a vast knowledge and expertise regarding our system.  I have requested and Mr. Sullivan has agreed that he is more than willing to meet with you to discuss the system, its numbers, and the decision behind where crews are stationed. 

Fourth, the County in partnership with the Blowing Rock Town Council and Blowing Rock Fire and Rescue Department has leveraged over $2.5 million and $1,051,651 additional funding to the Town of Blowing Rock and Blowing Rock Fire and Rescue Department, respectively.  This is over the past seven (7) years equating to $357,657 and $150,236 annually with the County’s decision to change the sales tax distribution from per capita to ad valorem.  The local investment as you have stated is not being used to avoid improving your arrival and transport times to the hospital but rather providing the maximum benefit to the overall system and not just one area. 

In closing, the County has honored its commitment to ALL citizens of the County to fund improvements and enhancements to our ambulance service.  This is evident by the addition of the new crews in 2014, 2018, and 2021 at a total cost of $691,875.  These increases are unprecedented as the last change to the system was in 2001.  Further, the County in cooperation with the Blowing Rock Town Council provided a nine (9) hour crew (with no reference or acknowledgment made in your email) Monday through Friday from 7:00 AM to 4:00 PM on a test basis to determine the impact to the overall system even though the recently completed study did not recommend this option.  The contractor in consultation with County staff has reviewed the system numbers that warrant the new 24-hour crew budgeted to be stationed at Base 2, which affirms the 2017 study.  This strategic placement allows the nine (9) hour crew to remain at the Blowing Rock station for it’s agreed upon time during heavy call volumes or at the very least lessens the amount of times the crew is pulled back from that location to respond to system calls.  The Base 2 assignment also allows the potential to respond from that station to the Blowing Rock area instead of from Base 1 or Base 3 during heavy call volumes.  Forty percent (40%) of Blowing Rock’s emergency calls are to Chesnutt Ridge and App Ski Mountain (both of which have medical assistance available) that has the same travel time from Base 2 or the Blowing Rock Fire Station.  Subsequently, the review of the system numbers confirm that the nine (9) hour crew currently stationed in Blowing Rock would have more of an impact on the overall system by reassigning the unit back to Base 1 or 2.  However, because of the strong working relationship and mutual cooperation between the Board of Commissioners and the Blowing Rock Town Council the decision has been made to continue with the nine (9) hour crew Monday through Friday from 7:00 AM to 4:00 PM even though the numbers suggest otherwise and was not recommended by the study. 

Regardless of the model chosen, the County agrees with you that more resources will be needed to continue to meet the needs of the system.  Watauga County continues to strive to make necessary improvements and enhancements to our ambulance service.  This process will not happen overnight and has to be balanced with all of the other demands for service. 

Again, I appreciate your email and interest in this most important matter. 


Deron Geouque

Watauga County Manager