Marlboro County's first county-funded and operated Emergency Medical Services started answering calls at midnight Monday.
County Administrator Ron Munnerlyn said it was a challenge for the county.
"There was no equipment or facilities," he said.
The county had to start from scratch. County Council voted in December of last year to establish a county-funded and operated EMS department, which did not begin operations until the contract with Marlboro Rescue expired at the end of June.
Marlboro County government had contracted with Marlboro Rescue to provide EMS since the 1990s.
The decision stemmed from five recommendations of the Emergency Medical Services Task Force, which was established in 2017 to examine the situation and develop recommendations for the future of EMS.
The need for emergency medical services had become extremely important to the community after Marlboro Park Hospital closed in 2015.
During 2017-18, the Task Force members researched EMS issues, factors contributing to the problems and met with Marlboro Rescue leadership to discuss issues.
These discussions led to the Task Force recommendation of having a new annual contract with Marlboro Rescue that became effective July 1, 2018.
The contract outlined areas of concern, requirements for future operations, and increased funding by $400,000 annually.
"As the year progressed, it became clear that some of the issues we had identified were not being addressed and problems still existed," Munnerlyn said.
At a County Council meeting in October, Chairman Dr. Carolyn Prince said the Task Force concluded the challenges of operating a viable, well-funded EMS could be best met by a county-funded and operated EMS department.
After the decision was made, the county started looking for an EMS director.
Brian Watts started in February and has just over 30 years of experience in urban and suburban areas.
He said Marlboro County is his first rural area and the first time that he has helped to start an EMS department.
County EMS will have four ambulances. Two will be at the EMS building, which is the former Northeastern Technical College campus on Marlboro Street. Another ambulance will be in McColl at the former McColl Rescue Building and property has been purchased on Highway 9 for another site and ambulance to serve the Wallace area.
There will be 29 people and four ambulances running calls 24 a day/seven days a week.
Five of those are administration and include Watts, a training manager, and three operation supervisors.
All are certified as EMTs or paramedics. There is a pool of six-eight part-time people.
Watts said they will provide excellent care and service.
"Many of the same providers are providing care," he said. "The services will be enhanced."
One of Watts' goals is for Marlboro County EMS to be a model for rural EMS in the state.
"With the protocols, medical direction and the employees we have, we are well on the way," he said.
County officials want EMS to be an accredited agency through the Commission on Accreditation of Ambulance Services.
This is a project that will take about five years.
"I really think the community has supported what we are doing," Watts said. "I think that will continue. We have to provide good service and continue to provide good service."
Funding for the new department will come from the money they were paying Marlboro Rescue, insurance billing, and the Marlboro General Hospital Charities Trust.
Jane Rogers, chair of the Marlboro General Hospital Charity Trust, said $185,000 has been committed each year for five years to help EMS capital expenses.
"We are glad the county is choosing to go this route," she said. "I think it will be a huge benefit to citizens."
Prior to the county-run EMS, the Charities Trust provided for the capital needs of Marlboro Rescue.
County Council unanimously voted to establish a Marlboro County Emergency Medical Services advisory board in February.
The advisory board will review, advise and make policy and operational/technical recommendations related to EMS in the county to the council and Munnerlyn.
The board will consist of the CEO or designee of Scotland Health, CEO or designee of McLeod Health, CEO or designee of CareSouth, chair of Marlboro General Hospital Trust board, two people who are physician/physician's assistants, registered nurse or nurse practitioner with service area encompassing the county, Medical (control) director - Marlboro County EMS, fire coordinator for the county, city of Bennettsville fire chief, E911/Emergency Management Director, public/citizen, coroner or designee and the Sheriff or designee.