Firefighters to potentially take over ambulance service?

[rcjunkie]

While I have disagreed with public safety employees re: funding issues, this is one area I support, the firefighters are dedicated to the citizens and as always, would provide excellant service.

[Steve]

If I am not mistaken this would save the city a ton of money on fuel costs and maintenance. You would be able to reduce or eliminate the need for ambulances to sit idling burning fuel around the city because they would be parked at the fire stations. ...

This is not necessarily true. The ambulances COULD be parked at the fire stations now. They are located at various intersections, convenience stores, etc., based on some very sophisticated mapping software that uses past call patterns to determine where demand is most likely to exist.
Another thing to keep in mind with this thread is that the council always does this evaluation at the end of each EMSA contract. It's felt - I think by all sides of the fire union debate - that this council is far less politically beholden or swayed by the fire union than past councils. So it may stand to reason this council is even less likely to go this route than others - UNLESS - Tulsa bails out of EMSA. And if that happens, all bets are off the table and ANYTHING can happen.

[barnold]

Steve,
Some stations could handle indoor parking of an ambulance and some cannot. But overall Yes, apparatus could be moved around the city to ensure enough ambulances are positioned to provide adequate coverage. The "sophisticated mapping software" you speak of is neither sophisticated or new. It's called system status management and was developed by Jack Stout when AMCARE was going out of business. It was a quick fix of how to reduce the total number of ambulances and personnel on the street. The things that this simple spreadsheet cannot predict are variances each day caused by little things like heat waves, snow storms, traffic problems such as car accidents on a major highway, special events like Basketball games, concerts, etc. It's an OLD antiquated system that has proven to fail time and time again, which is why EMSA is at Level 0 so many times everyday.

As to the council and their opinions, I think you hit the nail on the head. They will follow whatever direction the Mayor and CM take and probably see this as "more political power for local" rather than what it truly would be- a major improvement in patient care for the citizens of Okc. Tulsa is closer than Okc has ever been to bailing out of the EMSA merry go round and as you said all bets are off if that happens. EMSA cannot survive without both Tulsa and Okc. I'm happy to say that if this happens, Okc FD is in a much better position and has been doing the preemptive work for the past 10+ years more so than Tulsa. It would be a much better transition if plans were made rather than having everything dumped with little warning like the potential EMSA walkout that nearly happened a few years ago.

[Steve]

Never meant to say it's new software. It's been around at least since the mid-1990s. But yes, now that you mention it, considering the advancement of GPS technology, what struck me as sophisticated when I saw it a decade ago probably wouldn't be so impressive to those in the field today. I stand corrected.
Here's one twist that may be interesting to follow - what if the council decides to go a third way and pursue a creation of a medical public safety agency that address mental health needs and ambulance service separately from police, county sheriff or fire?

[barnold]

That idea was also suggested in lieu of a 3rd party service several years ago, but was never pursued per council and CM direction. It has merit but would also have some issues that would need to be worked out like any other plan. As in the past, all the players will come with their latest and greatest suggestions; but reading between the lines and becoming a fortune teller will be once again on the council's back. I just hope that they look at the last 10 years history with EMSA, models that have proven to work in other similar sized cities and gatherer information from all sides before moving in any direction.

[Steve]

That sounds like a goal I doubt any sane person could argue with. Gosh - this thread is becoming reasonable and intelligent. Which means, of course, it will die.

[jn1780]

What's the current reason for sending both fire and EMSA to a call? Is it just in case they need the extra equipment and personal or is this just an excuss? If this is the case they would still need to send two trucks to a call. Obviously, you would need the firefighters on scene for a bad car crash.

[oneforone]

The Fire Department can usually be on scene with in 3-5 minutes. EMSA is usually there within 5-7 minutes. Depending on activity it can be as long as ten minutes. The firefighters can usually stablize the patient until EMSA arrives. Most cities that have seperate services use this model because the fire department can be there faster and they have the tools on their trucks in situations where people need to be rescued from a car,building or remote location. They also have the muscle to move large patients. I work in a local hosptial. Many of the paramedic crews I have seen are teeny tiny people that barely weigh 200 pounds between the two of them.

[bluedogok]

This is not necessarily true. The ambulances COULD be parked at the fire stations now.

That is how it is done here in Austin, Austin/Travis County EMS (not private like EMSA) posts at fire stations in whatever area they are located, sometimes Austin or sometimes in the other communities/fire districts like Westlake. A few of them have indoor parking for the ambulance but most park outside and the crew can wait for calls inside the firehouse.

[barnold]

Such optimism. If it follows past threads you may be right.

The FD's goal is an average response time of 4 min. and 30 seconds to all calls; which has been met (give or take a few seconds) for the past 10+ years. EMSA goal is to maintain an average response time of 8 min. and 59 seconds, which has been met sporadically over the past 10 years. When EMSA does not meet their quarterly goal, the provider (paramedics plus) is fined. To keep this from happening EMSA watches the numbers very closely and Paramedics plus will put up extra trucks at the end of the quarter if they are falling behind in compliance. So if they have had good quarter no extra trucks and it's a crap shoot on how long you will wait for transport service. With the recent heat wave over the past couple of weeks we've routinely waited 15-20 minutes for a transport to arrive. It's not the ambulance crews fault; its the way the system was designed and just one of the flaws with system status management. With the FD you will always have 35 fire stations to respond-unless they cut more manning and put rigs out of service as they recently did. (but that's a topic for another thread)
The ALS FD rigs have paramedics on them (in some cases two) and carry all the same equipment as an ambulance for Basic to critical calls. They stabilize and make the pt. ready for transport until the ambulance arrives and turn the pt. over to the EMSA crew unless it's a critical call. If it's critical pt. then FD rides along to assist with pt. care until they get to the hospital. A single provider for all EMS in Okc would merge all players (somehow) into providing some of the best pt. care in the country. IMO

[Larry OKC]

That sounds like a goal I doubt any sane person could argue with. Gosh - this thread is becoming reasonable and intelligent. Which means, of course, it will die.

Steve

Has it been 2 weeks already? How was Vienna? Welcome back.

[corwin1968]

I like the idea of ambulance service being provided by the fire department. I've been the recipient of the OKC fire department's services and I cannot speak highly enough of them. I know that if me or a loved one is in need of emergency care we can depend on the OKCFD.

[metro]

I wish we would bring up again Mick's attempt to bring county-wide service for reconsideration. It'd make more sense if we could consolodate city-wide if some of our surrounding suburbs like Bethany,Warr-Acres, The Village would give up their pride. It'd save us all money and make a more efficient system.

[Steve]

week and a half... still not blogging. Still not doing any writing or reporting. Just messing with you guys! Didn't go to Vienna. But went to a place that was pretty darn nice!

[Larry OKC]

I wish we would bring up again Mick's attempt to bring county-wide service for reconsideration. It'd make more sense if we could consolodate city-wide if some of our surrounding suburbs like Bethany,Warr-Acres, The Village would give up their pride. It'd save us all money and make a more efficient system.

Vaguely recall that and seemed like a good idea. If different people are in power now, may be worth another shot.

[urbanity]

Emergency functions

OKC leaders consider revamping the current arrangement for emergency medical services.

http://www.okgazette.com/oklahoma/ar...functions.html

[bombermwc]

This has been done to death ever since EMSA came about (which was a huge mistake). It's not going to get resolved now either. Unless the city takes ownership of all assets, the city can't afford to leave EMSA. So we'll keep pumping money into the system to make it survive.

Problems are coming from the federal level though as well, which will happen whether the city or EMSA runs the service. The decline in Medicare and Medicaid pay outs is contributing to a huge downfall in income levels in healthcare. Not to mention that the unemployment rate has caused so many people to lose insurance coverage. Then they can't afford their medical bills and default on them. So EMSA is just a mircocasm of the larger picture of problems in healthcare. One problem is the overinflated cost of it. Things like an MRI cost such different amounts for the same machine from one hospital to another...and even the cheaper one is higher than it should be. That's why price structure was going to be part of the new healthcare plan...but didn't make it. Or take prescriptions...they aren't cheaper in Canada or Ghana because it's a different pill, the profit margin is just reduced to an acceptable level for the consumer (or subsidized in Ghana's case).

But anyway, currently, the fire facilities aren't able to absorb the workers anyway. Not to mention adding everyone to city payroll...training them as FF's, then adding them to the retirement plan. And then there's the question of manpower, dispatch, etc. There are millions of issues at play here that aren't seen on the surface in articles. EMSA would flat out have to go bankrupt before the city will force its hand.

[MustangGT]

Would patient choice of hospital still be in effect? Meaning that if a patient in Surey Hills wanted to be transported to Norman Hospital and the time would not adversely afect the medical situation,the OCFD ambulance would be mandated to make the transport. This is one of about 10,000 concerns I have is this. I am totally agaisnt the service not honoring patient choice first and foremost. Also how would the dissolution of EMSA effect the surrounding communities?

[Mikemarsh51]

BomberMWC, you are highly misinformed about this situation. All these years of adding subsidies to Emsa, the city did require something in exchange for the cash. The city of Okc owns all property in the west division of Emsa. Buildings, ambulances and the like. Secondly if you go to the agenda for the council meeting on the cities website you can find the OCFD proposal. The city is to hire 88 paramedics and 88 EMT's. They will be city employees not firefighters. The basic premise is to move the current system as it is with minor changes under the OCFD. It will be a division of the dept. Not a for profit company out of Texas. All monies could be put back into the system, not paid out to shareholders.

[rcjunkie]

BomberMWC, you are highly misinformed about this situation. All these years of adding subsidies to Emsa, the city did require something in exchange for the cash. The city of Okc owns all property in the west division of Emsa. Buildings, ambulances and the like. Secondly if you go to the agenda for the council meeting on the cities website you can find the OCFD proposal. The city is to hire 88 paramedics and 88 EMT's. They will be city employees not firefighters. The basic premise is to move the current system as it is with minor changes under the OCFD. It will be a division of the dept. Not a for profit company out of Texas. All monies could be put back into the system, not paid out to shareholders.

Hopefully this will happen, should have been done years ago.

[MustangGT]

The basic premise is to move the current system as it is with minor changes under the OCFD.

Please specify and delineate exactly each and every "minor" change that would be involved. Thanks.

[kevinpate]

if it is a stand alone, not part of FD, department being proposed, why would it be under the direction of the FD? Seems like that could eventually result in FD funds helping to run it instead of growing the FD

[Mikemarsh51]

MustangGT, I appreciate your interest. I don't believe all minute details have been released. From scuttlebutt I have heard at our union meetings. I get the idea that the most cost effective way to do this is to move it into the fire dept. Leaving the system almost exactly as is, changing small details in the upper management. Placing ambulances in 14 fire stations, using old station 4 as a supervisor station with extra ambulances. All this information is in the proposal. Look I will let the cat out of the bag here! The proposal the fire chief presented was based on a proposal the International Association of Fire Fighters tailored for Oklahoma City. Obviously with most of the larger 200 fire departments running the ambulance services already, the IAFF has great resources of how to operate this type of system. Bottom line is this plan provides greater service at less cost!

[Mikemarsh51]

Kevinpate, if you look at the proposal you see some strong phrases like "gives the city more control". To me it would make sense to put any profit right back into the system. The city has some unusual accounting practices. As an example if somebody crashes into a city vehicle and the insurance company pays for it, that money goes into the general fund and the vehicles are repaired out of that departments budget. I would be sorely disappointed if any revenues created by the city ambulance service went right back into the genereal fund. That to me seems like the main idea. Paramedics Plus is a for profit company based in Texas, I believe the name is the East Texas Hospital Corp. They make money. There is a lot of money in this. I have heard these medics talk about the bonuses they are given when manpower is low. A bonus and time and a half just to man the ambulances. I know there will be OT to be made, that is the nature of the business. But it will not be 100% stand alone. It will be intergrated with the fire dept., no competition between the services, there is definitely a competitive edge on Emsa's side. They need to prove they are needed just as it is. Just think about the amount of money that is being spent right now to influence the powers that be to keep the system as it is.

[bombermwc]

Contrary to Marshe - they would be part of the FD...not standalone. That's always been something he's been against beacuse it means dual training and he feels the city wouldn't compensate the person for that properly. You can't make both arguements man, you have to pick one.

As for the assets, no the city does NOT own them all. In fact if you read anything at all, it expressly says how the city does NOT own them all and that should the city leave the agreement, such things would be decided in court. Read with your eyes, not your ears.

You'll see an elimination of dual services for a paramedic being in the engine AND an ambulance at the same call. You won't see both parties responding to calls either. Right now you might see an engine with a medic respond to say a house call. You'll see only the party needed...which should result in cost savings from reduced fuel expenses (which is big right now). When you find the synergies between the groups and REALLY integrate them, it works out much better. There are countless cities out there with combined services that are hugely successful. And what we have now, is not at all.