AIKEN, Ga. -- Harvey Jay has been a paramedic for a long time.
For 33 years, he's been ready and willing to hop in an ambulance to help someone in distress.
He loved his job. But he wasn't always thrilled with where he worked: Aiken County EMS.
"I used to be so, so proud to be an employee here," Mr. Jay said.
When EMS coordinator Phil Clarke left last year under a cloud of suspicion over missing money, the department had more than a problem with its bank accounts.
It had an image problem. And a management problem. And, it turns out, a lot of other problems.
"It was little things that over time grew to big things," Mr. Jay said.
The past eight months have been about fixing them, said Nick Bianco, the new director of emergency services.
"When I came here, we had a reputation," he said. "We were not a place that played friendly with other people."
When Mr. Bianco was hired in October, he swiftly did two things: He began discovering all the flaws in the department, and he put all supervisors on probation - including himself.
The problems he found disturbed him:
Six of the county's EMS stations were overdue for their state licenses to dispense narcotics, and two of them didn't have those licenses at all.
The county had lost its right to self-inspect and self-report to the state.
Supplies were outdated and stored improperly.
"We found supplies on the backs of toilets," Mr. Bianco said.
But those weren't the only concerns he had. The county's EMS had a extremely high employee turnover rate - 75 percent - and more than 20 open positions.
Paramedics on different shifts almost had a "gang mentality," he said, and there was infighting over unequal pay for the same jobs, sometimes by as much as $5,000.
Also, more than half the patients paramedics were called to take to the hospital were refusing to go, leading Mr. Bianco to suspect that emergency workers weren't being diligent enough about their care.
One man who'd called for paramedics but then declined to be transported to the hospital died two hours later, Mr. Bianco said.
The "no transport" rate of 52 percent was unacceptable, he said, and Mr. Jay agreed.
"There was no way we had that many people saying, 'No, I don't want to go,'" Mr. Jay said.
Now before paramedics leave without a patient, a shift supervisor has to find out why, Mr. Bianco said. Since that change, he said, the "no transport" rate has dropped to between 30 percent and 40 percent.
That's not the only change the former hospital administrator has made.
The department is now fully staffed. There's a new system for distributing and keeping up with supplies. Efforts have been made to eliminate the rival factions among different shifts, and unequal pay for the same work has been addressed. New rotations have been implemented.
Shift supervisors who were once buried under paperwork are now free to ride with their crews.
Policies are now uniform, being enforced, updated every six months and are now available to staff. And needed training on new techniques and equipment is now up-to-date.
Not all of those changes are going over well.
Mr. Bianco said he has met some resistance from workers who don't like the new policies, the restructuring of staff and the new standards. He's gotten unsigned letters saying so.
But they're here to stay.
Internally, the mood and morale might be getting better. The department recently held an awards banquet to reward outstanding employees for the first time in years.
Mr. Bianco is looking for more. He's pitched an idea of a "provider network" that would increase EMS coverage around the county and reduce response times.
The only catch is that it would require cooperation from three volunteer rescue squads and private ambulance services.
County Administrator Clay Killian has supported all of Mr. Bian-co's efforts. Despite the problems, he said, EMS has some of the hardest working, most dedicated people in the county.
"If you need help, and you get an Aiken County paramedic, you're in good shape," he said. "And I believe that with all my heart."
Reach Sandi Martin at (803) 648-1395, ext. 111, or firstname.lastname@example.org