SMITHFIELD - For a while on the morning of May 16, only one staffed ambulance - in Princeton - was available to respond to a medical emergency in Johnston County. More than a dozen others were busy handling other calls.

The situation that Monday worried local emergency-management leaders, who say Johnston County needs more ambulances and staff to respond quickly to a rising number of 911 calls. Some say patients are waiting longer for paramedics to arrive, especially in southern Johnston, because the county doesn't have enough ambulances standing by.

Other days, like one Friday afternoon in March, have also seen high call volumes with only a handful of ambulances at the ready. On that day, the county would have had few paramedics to respond to a pileup on I-95, or an EMS squad would have had to travel across the county to reach a heart-attack victim.

"That was not a tornado day, not a disaster day," said Billy Langston, Smithfield's EMS division chief and president of the Johnston County EMS Association. "They were typical days. ... At the drop of a hat, you can get busy and hear the pager going off back to back. Within 10 minutes, you can have half the county deployed out on calls."

While the number of EMS dispatches is on track to exceed last year's figures, some EMS leaders are decrying a drop in funding from the county. They say the decrease is coming at the worst time, as fuel costs are high and insurance rates are climbing.

This year, the county is giving its six contracted EMS squads a total of $1.9 million - down from $2 million last year and $2.2 million the year before.

Meanwhile, EMS workers responded to nearly 7,800 calls between January and May this year - up more than 300 calls from the same period last year.

In 2010, EMS squads received about 19,000 calls, the first drop in more than a decade. But overall, the number has risen dramatically over the past 10 years: In 2000, squads fielded just 12,000 calls. During that same time span, Johnston County's population swelled nearly 39 percent to 169,000 residents.

While the amount of time it takes for EMS workers to respond to calls has fallen steadily over the past years, some emergency leaders say squads are having to rely too often on other agencies to handle calls. So far this year, it has taken local EMS squads an average of nine minutes and 32 seconds to arrive at the scene of an emergency. That's down nearly a minute and a half from an average response time of 11 minutes in 2006.

The average response time for most rural EMS districts is 11 minutes and 59 seconds, said Josh Holloman, training officer for Johnston County Emergency Services. In urban districts, the average drops to eight minutes and 59 seconds.

Major growth

To help keep up with growth, and to shorten the amount of time it takes emergency-medical workers to get on scene, EMS leaders want to add a third daytime ambulance in the Benson area.

County Commissioners are set to consider the change next month. The addition would cost taxpayers about $167,000 a year.

In Johnston County, 18 staffed ambulances are available during the day; the county has 13 at night. In the past six years, the county and its contracted agencies have added a total of four ambulances, said Kim Robertson, director of Johnston County Emergency Services. Those include Clayton, Benson, the 50-210 squad in western Johnston County and the Thanksgiving community north of Selma.

Robertson said she's known for awhile that the Benson area needed more coverage. From January through May, 171 calls came in when Benson's ambulances were already busy handling other emergencies. That meant other EMS squads farther away had to go instead.

"I'd say everyone needs to be concerned that they could call 911 and it could take longer than usual for an ambulance to come," Langston said, adding that he believes the southern end of the county needs at least two more ambulances.

Other EMS stations relied less on other agencies from January through May. Smithfield issued 37 so-called "mutual aid" calls in the first six months of the year. Clayton's two squads - in the core of town and in the Corinth-Holders community - made 90 such calls for help. Clayton is considering adding another ambulance to help keep up with growth.

It's common for EMS squads to help each other, Robertson said. If ambulances in the western and central parts of the county are busy, for instance, a truck from the eastern edge might move into Smithfield to be more centrally located.

"We try to shift our resources around," Robertson said.

EMS workers from surrounding counties also cross into Johnston for some calls. And even if a Clayton squad has to respond to a call in the Cleveland area because the 50-210 squad is tied up, most local fire departments have trained first responders who can administer basic medical care, Holloman said.

"They're one of our biggest benefits to the EMS system," he said.

A shift in services?

The long-term future of emergency services in Johnston is murky.

In North Carolina, counties are responsible for overseeing EMS services, but they can use contract agencies for help. But the state has seen a shift to county-wide systems that don't depend on outside agencies. Of the state's 100 counties, 88 handle the whole system themselves, said Brent Myers, director of Wake County EMS.

Like Johnston, Wake County pays some outside groups to provide EMS services. The bulk of these nonprofits get their revenue from patients' private insurance and government-run health plans, but they also get some local money.

Johnston has a contract with six nonprofit EMS agencies - Clayton, Four Oaks, Princeton, Selma, Smithfield and the 50-210 district.

In 2008, the county took over stations in the Benson and North Johnston areas when those squads were having financial troubles.

For now, Johnston County leaders are happy with the current system of working with the nonprofit squads, said County Commissioner Cookie Pope, who serves on the EMS advisory board. But she said she wouldn't rule out the possibility of a county-wide system.

"It may happen, (but) I don't foresee it in the next five or 10 years," Pope said. "Right now we've got a great group of people doing a superb job."

The benefit of a county-wide system could be lower administrative costs and shared resources, said Myers, the Wake County EMS director. But some EMS groups are hesitant to consider a merger out of allegiance to their squads.

"It's the difference between working for a small business or a larger corporation," Myers said.

As of now, he said, Wake County officials have determined that it wouldn't be cheaper to consolidate the agencies into one big county-run system.

In the meantime in Johnston, some EMS leaders say one of their biggest challenges is money.

"It all stems back to money," said Langston, the EMS association president. "That's what everybody is needing right now, and the economy has hit (us) here just like everybody else."