Getting Tossed The Keys

American Medical Response (AMR) is going through some tough financial times. Earnings and financial projections have not been attained. Its parent company, Laidlaw, was delisted by the New York Stock Exchange last year for failing to keep a minimum stock price. The company has exited several major markets, including Chicago and Philadelphia. In some of those cities, fire departments suddenly found themselves "getting tossed the keys" as AMR was leaving. One of them is the Reading, PA, Fire Department, just outside Philadelphia.

The relationship which AMR had with Reading was pretty good. AMR had a performance contract with Reading with zero subsidy dollars from the city in which it agreed to keep at least two medic units available for 911 calls at all times. In return, AMR was given an exclusive right to operate in Reading without competition, including non-emergency routine transports.

Reading is 10 square miles in size and has a population of 81,000. Construction in the town is mostly rowhouses, and with all those fire exposure problems, that makes the Reading Fire Department the third-busiest fire department in Pennsylvania, behind Philadelphia and Pittsburgh. The Reading Fire Department has 152 career personnel operating from nine stations.

In March 2000, AMR notified Reading that it would cease operations on Jan. 1, 2001. In order not to leave the town without an ambulance service, AMR had plans to have Keystone Quality Transport, another ambulance service operating in Delaware County, assume its exclusive contract. But problems cropped up when Keystone could not obtain exclusive contracts from the hospitals in town for routine transports. Key-stone felt the exclusive contracts were vital to its financial success.

When things fell apart for Keystone and with no one else interested in operating an ambulance service in Reading, the mayor turned to Fire Chief William Rehr III and the Reading Fire Department to look into taking over the EMS service.

Operating EMS was not new to the Reading Fire Department. In probably one of the first recorded cases of a fire-based ambulance system in the nation, the Reading Fire Department began operating a horse-run ambulance on Nov. 1, 1887. William Goelz was the first driver, receiving $9 a week, and was on duty 24 hours a day, seven days a week, with every third Sunday off.

The fire-based ambulance system in Reading continued to grow. A second ambulance was added in October 1908. In the late 1940s, the Schuylkill Fire Company in northwest Reading began ambulance service, bringing the total number of fire company ambulances to three.

In 1976, four firefighters from the Reading Fire Department were enrolled in the first paramedic class in eastern Pennsylvania. The fire department's advanced life support (ALS) service continued until 1987, when a private ambulance called Health-Tec made a bid to take over the service the fire department was providing. Since privatization was the rule of the day in the 1980s, the city fathers decided to shut down the fire department EMS system and have the private ambulance company assume all emergency responses. So exactly 100 years and one month after the Reading Fire Department transported its first patient, its ambulance service was shut down. Eventually, Health-Tec was bought out by AMR.

When the fire department was directed by the mayor to look into the city resuming EMS, a task force was formed which included the regional EMS council, local hospital officials and financial advisors. After visiting several cities, including Allentown, Bethlehem and Philadelphia, the task force felt the fire department was best suited to provide a fully integrated emergency and non-emergency transport service.

But time was short. With only about six months before AMR ceased operating, opposition to the fire department EMS system came from the City Council president, who contended the new endeavor would make the firefighters' union stronger.

Rehr and Jonathan Gowombeck, president of Reading Local 1803 of the International Association of Fire Fighters (IAFF), partnered on the EMS issue and presented a unified front to the City Council. Additionally, Gowombeck had to do a lot of convincing to his membership that instituting a fire-based EMS system was the best way to go. Eventually, in a 4-3 vote by the City Council, approval was given for resurrecting ambulance service in the fire department.

To accomplish the mission by Jan. 1, 2001, the Reading Fire Department hired 24 paramedics, including 17 from the existing AMR operation. Additionally, the EMS operations manager from AMR was hired to run the new EMS system and was given the rank of deputy chief. All existing firefighters in the Reading Fire Department had to be retrained and licensed as EMTs. Half were trained before the new program was implemented, and the others were trained just after the beginning of the new year. All EMT training has been completed.

The plan also called for operating three ALS vehicles 24 hours a day, seven days a week to handle emergencies, and three wheelchair vans and one EMT basic transport ambulance 10 hours a day, five days a week to handle routine and inter-facility transports. Additionally, the fire department handles standby details at public events and at the local baseball stadium for the Philadelphia Phillies AA minor league baseball team.

On Jan. 1, 2001, at 0800 hours, the Reading Fire Department was officially back in the EMS business. Every engine company now carries an AED, oxygen and a medical bag, and engines respond to all life-threatening emergencies.

Reading citizens now have an EMS system which has been averaging about 900 emergency responses per month with an average response time of three minutes 80% of the time and a turn-around time of 291/2 minutes, down from 45 minutes when AMR operated the system.

Projected revenues from the first four months of operation from emergencies, interfacility transports and standby details show a system which not only will be self-supporting, but will generate approximately $500,000 in excess revenue over expenses by year's end. The extra money will be used to make capital purchases.

So what do those critics in the City Council now think about the fire department "getting tossed the keys"? They think it's great!

Gary Ludwig, MS, EMT-P, a Firehouse® contributing editor, is the chief paramedic for the St. Louis Fire Department and is the vice chairman of the EMS Executive Board for the International Association of Fire Chiefs. He has lectured nationally and internationally on fire-based EMS topics and operates The Ludwig Group, a consulting firm specializing in EMS and fire issues. He can be reached at 314-752-1240 or via