1. #1
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    Default Providence, Cranston Mayors Clash Over Mutual Aid

    WPRI News 12
    A public safety dispute brewing between the mayors of Providence and Cranston. Stephen Laffey of Cranston says his city can no longer afford to make hundreds of rescue runs for Providence.

    And Providence Mayor David Cicilline says Laffey does not have a good understanding of the mutaul aid system between the communities.

    There simply are not enough rescue vehicles in Providence to handle all the calls in the capital city. And surrounding communities make hundreds of runs for Providence under a mutual aid pact. But Mayor Laffey says Providence is abusing the system at the expense of its neighbors.

    Cranston rescue vehicles made 545 runs into providence in the last fiscal year. While Providence made only 34 runs into Cranston. And Mayor Stephen Laffey says that's not mutual aid, it's a rip-off.

    "So something has to be done about this. We cannot be funding Providence's problems. We do not want them funding our problems."

    Cicilline: "I would say to mayor Laffey mutual aid is very important to all communities. That it is important that when there is a need for a rescue or for other emergency equipment that we all be willing to respond to neighboring communities no matter what the numbers are."

    Laffey says Cranston would never refuse to make a rescue run for Providence, but he insists that Cicilline do something to correct the stiuation or cranston could start charging Providence a fee.

    "If we don't get a response, we'll have to put some ordinance in, maybe charging the city of Providence a differential over a certain percentage," said Laffey. Cicilline says Providence is buying a new rescue vehicle, but the real expense is manning the vehicle and that is a sticking point with the firefighters union.

    The union says the city needs two new rescues and additional personnel. Providence's five rescue vehicles make more than 25,000 runs a year. The communities around Providence are called into the city for rescue runs about 2,600 times a year. For example, Johnston and North Providence made almost 900 runs to Providence last year, while Providence made about 55 runs in return. But Johnston Mayor William Macera and North Providence Mayor Ralph Mollis say mutual aid is too important to jeopardize. They say they depend on Providence for major emergencies.

    And Cicilline says the numbers are not as bad as they seem.

    "Every run is reimbursable. If it is not covered by insurance, then it's recoverable from the person transported. So cranston has that ability."

    Laffey says Cranston does not get reimbursed for many of the Providence runs because the people transported don't have insurance and they do not have the money to pay for the run. He and Cicilline have exchanged letters on the subject, but have yet to reach any solution.

    "We all want to help each other and I want to help Providence, but the city of Cranston is strapped."

    Laffey says Cranston has severe fiscal problems and can no longer afford to subsidize Providence. He also says when his rescues are in providence his own community is at risk and has to call on others for help.

    -----------------------------------------------------

    Background:

    Providence FD runs 14 engines, 8 ladders, 5 ALS transport rescues, 1 Special Hazards (heavy rescue), 3 battalion chiefs. Approximately 35,000 runs per year. Community is just under 30 sq. miles, population approx. 170,000.

    Cranston FD runs 6 engines, 3 ladders, 4 ALS transport rescues, 1 deputy chief. Approximately 14,000 runs a year. Community is 28 square miles, 79,000 population.

    -----------------

    Personal observations: It's not uncommon for Cranston Rescue 1 to make 3 or 4 runs into Providence per shift, especially weekend nights. (Their nickname in local buff circles- and once over the air by their officer- is "Providence Rescue 6.") On the flip side of that coin, it's very common for Providence to NOT have a rescue available when Cranston makes their occasional call for M/A. Sometimes it gets to the point where Cranston is calling for mutual aid rescues because all 4 of their own are responding to calls in Cranston and Providence.

    Providence does, however, help with station coverage and on-scene manpower during working fires in Cranston and elsewhere. In fact, the ENTIRE second alarm assignment for Our Lady of Fatima Hospital in North Providence is made up of PFD apparatus. But it's impossible to deny that as far as EMS goes, Providence's contributions to surrounding communities are incomparable with the mutual aid that they receive on a daily basis.

    Also of note is the fact that EVERY ONE of Providence's own rescues makes 5,000 or more runs per year.

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    There is much more to this story. The number of runs we do to Providence is ridiculous. I hope it is just a coincidence but I can guarantee a rescue will go to Providence around lunch time and between 4:30 and 5:00, shift change. There is no doubt that the guys in Providence are running their rear ends off. Another thing that is not mentioned in the article is that if Providence has to relocate to another city for station coverage, they will not stay for more than 2 hours. Any longer than that and they would have to call back OT to put an engine back and the city can't afford it. The best part of the interview is the part that made Laffey look like a jack***** by the mayors of Johnston and NP.

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    I've heard stories about the "timing" of m/a rescue runs as well Tom... I would hope its just a coincidence, but then again....


    Its a good thing for Pawtucket that Providence's apparatus were committed to the fires early and Providence was forced to call back several companies worth of personnel.

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    Seems Providence need to buck-up and get a couple of more rescues. Running 5000 calls a year is asinine, for both personel and equipment. What are their respective staffing levels?
    Does anyone have a formula or standard for the ratio population vs. ALS rescues vehicles?
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    All cities mentioned in the article run ALS transports with 2 EMT-Cardiacs (couple of Paramedics here and there probably, but as the exception rather than the rule). Providence runs 3 and 4 man engines and ladders, the Hazards is 4. 4 platoons on a 2/2/4 schedule.

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    Thumbs down Let's do the Math...........

    170,000 people divided by 5 Ambulances. (Yes I call a spade, a spade) I don't care if it's ALS or BLS, If it transports you to the hospital, lying on a stretcher, it's an Ambulance. And, that's on the authority of my Funkin Wagnalls desktop dictionary. 170,000 divided by 5. 34,000 people per unit? Crazy. Here's some more:

    Prince Georges County Md. 830,000 people, 58 Ambulances, 14,311 per unit.

    Annapolis, Md. 35,000 people, 3 Ambulances, 11,667 per unit.

    You get the idea..........
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    Default RI is screwed up anyways

    Who cares?

    Maybe Providence should buy more AMBULANCES and hire more EMS crews so it can provide the service it should have been providing all along.

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    Nah, that'd be the smart thing to do.....

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    Is the problem that Cranston doesn't get reimbursed for transports have to do with them running into a lower income part of Providence?

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    Is the problem that Cranston doesn't get reimbursed for transports have to do with them running into a lower income part of Providence?
    It really isn't a problem with the FD as much as our broke city. We bill for rescue calls but most is reimbursed by insurance companies. Many people in our city and Providence don't have insurance and if you tell the billing company that you don't have insurance and can't afford the bill, they don't chase you down and just forget about it.


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    Does Providence have ALS Engines or Ladders? That would help along with a call to a private. More then 1 mutual aid call per day is not acceptable the Cranston Mayor should be outraged.
    Why doesn't Providence put on a BLS rig or two. Chicago did that and while they have problems the ALS units run slightly less transports.

    A van ambulance and two EMT's could cost under 150,000 to set up and under 75,000 a year to maintain. Tell me that Providence couldn't go with that. Try it part time, save the new hires and use ot (which is less expensive than new guys)

    A band aid on the situation would be cheep. Pheonix gives out taxi vouchers try that for the drunks and sniffles. Their is no reason that should be happening.

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    Default Re: Let's do the Math...........

    Originally posted by hwoods
    170,000 divided by 5. 34,000 people per unit? Crazy. Here's some more:

    Prince Georges County Md. 830,000 people, 58 Ambulances, 14,311 per unit.

    Annapolis, Md. 35,000 people, 3 Ambulances, 11,667 per unit.

    You get the idea..........
    Providence gets a lot of commuters; I've heard that its population pushes 3/4 of a million during office hours. It is probably the reverse in the Maryland FDs mentioned; there is also the socio-economic class of the residents to consider, as lower income people tend to rely on EMS more than private physicians.

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    The personell on the rigs are a mixture of BLS and ALS. The engines and ladders used to be "BLS non-transport" licensed vehicles but the city recently pulled the BLS meds from the rigs because they can't afford the licensing fees anymore. Ergo, a BLS ambulance or the two more ALS that the union wants is a pipe dream.

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    Question My part of the world

    In my part of the world it costs $250,000 to put an ambulance on the road. That's for two paramedics, benifits, retirement, insurance, etc. On top of that is the vehicle which is $58,000 without equipment. Yes they need another unit but the costs are high. If they get it for nothing they will continue to use mutual aid. Citizens seem to get what they are willing to pay for both in EMS and fire.

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    cfdeng3-

    Southeastern Ohio...

    I thought the idea of a mutual aide contract was to keep the bean counters out of the equation? People need to get off of this "my town here, your town there" attitude and figure out we all do the same job. Who cares about the money when people need help?

    Not to blame the money problem in Cranston, a city close to me is feeling the pinch as well. My department has started to pick up the pace, but our trustees didn't tell the city council to screw off when they told us we would be called in to help more often, because that's just coldhearted. Maybe Cranston should bill Providence for causing a medic to leave it's area and place a strain on other resources because they can't support their own population. How do you guys bill? Insurance only or to insurance and/or Medicare/Medicaid?

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    Who cares about the money when people need help?
    If you're an elected official, the money aspect always comes into play. If it doesn't, you stand a good chance of being shown the door at the next election.

    Several folks close to, or directly involved in this issue have posted so they're the experts here. If I'm off the mark I apologize but some parts of this story bother me.

    The Providence mayor said:
    "Every run is reimbursable. If it is not covered by insurance, then it's recoverable from the person transported. So cranston has that ability."
    Down here, you only bill if you transport. If the patient refuses, even after you render treatment (happens a lot with diabetics), then you can't bill. If the same applies in RI, then any mutual aid run that turns into a no-haul is wasted money for Cranston. I also think that it is safe to assume that if Providence viewed these missed EMS runs as lost revenue, they would add additional rescues in a heartbeat. Odds are, the Providence EMS operation is a money-loser right now and adding another rescue will probably only make it worse.

    It sounds like a very difficult situation. When you're elected to represent a population, you MUST first look out for those folks. It would be hard to explain to a Cranston resident why they had to wait for transport because a rescue funded by Cranston tax dollars was making a run in Providence. On the other hand, it looks like Providence has the ability to render a great deal of aid on the suppression side should Cranston ever need it.

    There seems to be one option that hasn't been discussed. Are there any private providers that could be added to the 911 rotation as backups to the FD resources?

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    I work for a local private. Occasionally we'll get called to take a run that Providence doesn't want or doesn't have time for, but only AFTER they've been dispatched and assessed the patient.

    Two such calls that I've been on in my time in the company:

    1) 70 year old female, FD called by family for removal from the (second floor) apartment (she weighed a good 250, 280) and transportation to the hospital for evaluation to get admitted into a nursing home becausethe family could no longer care for her. Providence was kind enough to stay onscene (and even called a ladder company to assist) to help my partner and I get her out of the apartment and onto the cot. They even deconed our stairchair for us! (You don't want to know.)

    2) 60 year old female with what I can only describe as a zit in the OB/GYN area that she wished to have looked at at a local ER. (PFD was NOT onscene when we arrived.)


    To my knowledge we have NEVER been called to provide the initial response to a medical call in any city or town in RI. Three cities and towns that I know of have called us to provide non-emergent transportation.

    I have a few ideas as to WHY we aren't providing intial-response backup, but but the last thing I need around here is a reputation.


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