Fire Department-Based Ambulance in Partnership with Private Ambulance Provider

September 10, 2007 Paul Cohen, Town Manager

Goals
High-Quality Pre-Hospital Emergency Medical Care Public Safety: Have All Five Fire Stations Open to Provide Effective Response Time for Fire and Medical Emergencies.

WhatChanged From the Initial s Proposal?

Fire Department operates one primary response ambulance. A private ambulance contractor, responds at all emergency medical calls by bringing an ambulance into town to provide secondary emergency response ambulances.
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Advantages Over Initial Proposal

Essentially replicates the current delivery method of emergency ambulance service. A primary response ambulance continues to be located in the town center. An additional ambulance is stationed in town each time an emergency medical call is dispatched. Firefighter/EMTs at the West Fire Station would not be operating an ambulance and transporting patients out of town. This would increase fire and emergency medical capability and response time.
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How Do the Finances Change?

A private ambulance provider would respond to approximately 30 calls per month. This equates to 292 transports per year. The Townprojected net revenue by operating s one primary emergency response ambulance would be $218,000. The two ambulance model forecast $285,000 from ambulance operations.
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Why Consider This?

Currently Closing A Fire Station Daily Due to Budgetary Constraints Five-Year Financial Forecast Projects Mounting Budgetary Deficits Contract with Trinity Expires on 12/31/07 All Aspects of Town Operations Being Reviewed For Effectiveness.
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Ambulance Call Volume

Calendar 2006: 2,648 Medical Calls Average of 7.25/day 2,145 Medical Transports (81% of calls) Average of 6/day

Current Emergency Medical Response

Fire Department Responds to All Calls 54 of 56 of Firefighters are EMTs Trinity EMS Staffs an Ambulance 24/7 in Chelmsford Center at No Cost to the Town. Trinity Transports Patients to the Hospital & Bills Patients for Ambulance Transportation Services. Secondary Response Ambulances Are Available from TrinityMain Headquarters at Drum Hill. s Greater Lowell Emergency Medical Service Provides Paramedic Service
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Fire-Based Ambulance
Fire Department Staffs an Ambulance at the Center Fire Station. Secondary Response Ambulances are Provided at No Cost to the Town by a Private Ambulance Provider,. Hire Five Additional Firefighter/EMTs. New Fire Captain Oversees Operations.
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Fire Dept. Staffing Levels

Current Staffing Level: 13 Assigned per Shift with Minimum of 9. Daily Closing of Either East, South, or West Fire Station. Proposed Staffing Level: 14 Assigned per Shift, with Minimum of 12. All Five Fire Stations Open.
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Simultaneous Ambulance Transports

Calendar 2006: Average of 23/Month Are Two Transports Within 90 Minutes Average of 3/Month Are Three Transports Within 90 Minutes. Fire Department Responds to All Medical Calls A Private Ambulance Contractor Responds When the TownAmbulance is Not Available. s
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Mutual Aid
Establish Mutual Aid Agreements with Westford, Tewksbury, Billerica, & Carlisle. Seek to Establish Mutual Aid Agreements with Additional Private Ambulance Providers. Chelmsford Would Respond to Mutual Aid Requests From Other Communities.
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Enhanced Public Safety

All Five Fire Stations Open Provides Faster Response Time for Fire and Medical Emergencies. Firefighters/EMTs Assigned Per Shift Increases from 13 to 14 and the Minimum Per Shift Increases from 9 to 12. Weekday Compliment of 19 Uniformed Personnel if All Positions are Filled.
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Finances
Switch to Attached Financial Spreadsheets

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Question
Did Trinity EMS, the TownCurrent s Private Ambulance Service Provider, Have An Opportunity to Partner with the Town? Yes, discussions took place with Trinity EMS officials on August 9, August 21, August 22, and August 23. Trinity EMS declined.
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Question
Can This Be Done with Only Five Additional Firefighter/EMTs? Yes, because the additional staffing levels provide the necessary personnel to staff the ambulance. Comparable towns such as Tewksbury & North Andover operate two ambulances with 12 Firefighter/EMT Minimum Staffing Levels.
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Question
What is the cost to increase the minimum staffing to 12 personnel? This cost is exceeds $100,000. Funding for the additional staffing levels would come from the projected $218,000 in net revenue from ambulance operations.
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Other Mass. Cities & Towns

69%, which is 242 out of 351, Massachusetts Cities & Towns Provide a Town-Based Ambulance Service. Adjoining Communities of Tewksbury, Billerica (Separate Dept.), Westford, & Carlisle Provide Fire-Based Ambulance.
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Question
Why DoesnThe Town Award an Ambulance t Contract to the Highest Bidder? Town Counsel has advised that the anti-kickback provisions of the US Social Security Act prohibit the solicitation or receipt of, or the offering or payment of, compensation (or remuneration as the statute calls it) in exchange for referrals for services for which payment may be made, in whole or in part, under a Federal health care program such as Medicare or Medicaid.
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Question
Why doesnthe Town consolidate the t number of fire stations? A recently completed analysis performed by the MMA Consulting Group concludes that the Town needs to maintain its five fire stations to provide an effective response time for fire and medical emergencies.
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Question
What about the cost for pension and retired health insurance for the five new Firefighter/EMTs? The contribution levels of newly hired employees into the pension system essentially covers their future pension costs. As for retired health insurance costs, these costs would not be incurred for about 30 years. Ituncertain what this s nationhealth care system will be at that time. s
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Question
What About the Additional Liability? The Town already responds to all medical emergency calls and has liability insurance coverage. There is no additional premium if the Town were to provide ambulance transportation service.
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Question
Would there be additional Workers Compensation insurance costs? Police and Firefighters are not covered under Workers Compensation insurance, but are covered by MGL Chapter 41, Section 111F which provides for no loss of pay if injured on duty. The Town has an insurance policy for injured on duty medical costs and lost time. The Town already responds to medical emergency calls.
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Question
How will ambulance billing take place? The Town would contract with a vendor that is experienced in municipal ambulance billing services. The fee is estimated to be 4% of funds collected and is included in this analysis.
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Question
Could a Fire-Based Ambulance Service be Operational By January 1? Yes, the Town could purchase a new ambulance off the State bid list and receive the vehicle within a few weeks. Existing Firefighters are already trained as EMTs.
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Question
Will a private ambulance contractor provide coverage for Town events such as Chelmsford High School football games and the 4th of July parade at no cost to the Town? Yes.
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Closing Thought
Finally, we believe that the most important element of emergency rescue is a well-trained and professional First Response team. The Town should never lose sight of the fact that it is the immediate response of our EMT-trained firefighters, police officers and ambulance personnel in those first few minutes of an emergency medical situation which can literally determine life or death. During the highly publicized and politicized course of our study, this has remained the central focus of our committee. Ambulance Study Committee Final Report June 26, 1995

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