Ross questions ambulance proposalImproved response times, lower costs, continuity of care, and the ability to utilize staff already on duty are just some of the things promised if the Superior Fire Department took over ambulance services, according to a proposal submitted to council committees last month.
By: Shelley Nelson, Superior Telegram
Improved response times, lower costs, continuity of care, and the ability to utilize staff already on duty are just some of the things promised if the Superior Fire Department took over ambulance services, according to a proposal submitted to council committees last month.
Revenue generated by the estimated $2.3 million fee-for-service ambulance runs could provide about $90,000 revenue to augment the fire department’s budget.
In spite of those promises, Mayor Dave Ross is skeptical the proposal on the table for a fire department-run ambulance service support the claims prefaced in the proposal.
It will be up to a task force to determine if the proposal for a city-run ambulance service has merit. The task force meets for the first time Tuesday.
Superior got out of the ambulance business in the mid-1960s, when Douglas County took over the service. However, in 1992, the Superior Fire Department started a First Responder program. Under the program, the fire department responded to medical emergencies in certain areas of the city. Firefighters were certified for the lowest level of emergency care under state Department of Health regulations.
In 1996, as Gold Cross took over medical transport services from Douglas County, the fire department’s program expanded to respond to all medical emergencies citywide. Firefighter’s level of emergency medical training was elevated to provide basic life support – Emergency Medical Technician-Basic.
All of Superior’s firefighters are trained to a EMT-Basic, said Fire Chief Jim Rigstad. Only one member of the department holds a paramedic’s license, the chief said.
However, the chief said, several firefighters have expressed a willingness to get the advance medical training to support a city-run ambulance service. Initial training costs are estimated at $50,000.
Gold Cross, which provides ambulance service to Douglas County, operates a paramedic service. The medical transport service requires its paramedics to maintain licenses in Wisconsin and Minnesota, and maintain national standards in terms of certification, said Matt Will of Gold Cross. He said they must be CPR certified, have certification in advanced life support and pediatric life support and international certification for trauma care.
Achieving an acceptable level of competence varies; however, the average paramedic requires between 1,000 to 1,200 hours initial training, according to the U.S. Department of Transportation, which establishes the national standards for paramedics. EMT-Basic, Superior firefighters’ minimum standard of training, consists of about 120 hours initial training to meet the national DOT’s standards. Both require ongoing education.
Ross said that puts most of Superior’s firefighters about 1,000 hours behind the initial training of Gold Cross paramedics.
However, the proposal couldn’t be accomplished at the fire department’s current staff level. Rigstad estimates the city would need to hire nine additional firefighters to operate two ambulances and one reserve ambulance that would serve the city and potentially Douglas County.
Ross said the need to hire additional staff highlights a major weakness in the proposal. While the proposal accounts for the cost of additional fire department staff, equipment and startup costs, and the potential impact on the fire department’s overall revenue, it falls short of accounting for the costs to administer the service likely to absorbed outside the fire department.
The initial proposal didn’t account for additional liability insurance, an expense Rigstad estimates will cost the city another $15,000, which would reduce excess revenue from its initial estimate of $104,139.
“They make no accounting in several key areas,” Ross said. “One is [human resources], the other was legal services, the other was the finance department … and those stood out like a sore thumb … there are zero costs for administration and this concerns me.”
Ross said hiring plans would be handled by the human resources department, which is operating with fewer staff today than when he took office in 2003. He said recruitment and hiring doesn’t come without administration costs.
Human resources provides a vital function in recruiting, training and skills evaluation of paramedics, in addition to benefit management and other personnel matters, Will said. It’s one of many non-paramedic positions Gold Cross relies on for its operation, he said.
“Our education department is key in delivering training to our team members,” Will said. “We don’t put a new cot or piece of equipment into service until all of our people have been trained.”
He said Gold Cross relies on its physician medical director to guide policy and work paramedics are doing in the field. In addition, Will said, quality assessment to improve service, information technology services to ensure the transfer of medical information when the ambulance arrives at the hospital, facilities to maintain the highly specialized vehicles, purchasing supplies and pharmaceuticals are all important to the operation.
“I have long been opposed to this idea; there’s a number of factors that make me skeptical this is going to work out the way our fire department thinks it should work out,” Ross said. He said when the idea of starting a fire department-run ambulance service was presented in 2004 by former Fire Chief Steve Gotelaere he has opposed the idea because he doesn’t believe it’s a solution to the city’s budget problems and could make things worse.
Douglas County got out of the ambulance business in early 1996 because taxpayers were supplementing the department’s budget by more than a half-million dollars annually.
While taxpayers hold no liability for the cost of unpaid ambulance services or losses Gold Cross may face, Ross said taxpayers would be on the hook for those expenses if the city ran the ambulance service.
“If this thing started losing money or got off track, or something happened, you bet we [city administration] would be involved. We’d be committing resources, time and people,” Ross said.