A Blueprint To Increasing EMS Service Levels

Perseverance and persistence do pay off. Just ask the fire chief and firefighters of Cuyahoga Falls, OH, who saw a need to increase EMS service levels to their citizens - and did something about it. It all began in May 1998, when the mayor formed a...


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Perseverance and persistence do pay off. Just ask the fire chief and firefighters of Cuyahoga Falls, OH, who saw a need to increase EMS service levels to their citizens - and did something about it.

It all began in May 1998, when the mayor formed a committee to discuss EMS transport issues and report its findings to the city's EMS Commission. The main issue was whether the Cuyahoga Falls Fire Department should retain American Medical Response (AMR) as transport provider or begin to transport patients itself. Using a report prepared by certified public accountants, the committee explored four possibilities:

  • Allow the Cuyahoga Falls Fire Department to transport all patients.
  • Allow the Cuyahoga Falls Fire Department to transport only patients requiring advanced life support care.
  • Continue with a non-transport policy.
  • Collaborate with private ambulance companies for a portion of the fees.

The debate pitted the fire department against AMR. The department argued that it could provide a better continuity of care and quality of care to the community, while AMR contended that there was nothing wrong with the system and that 93% of its responses come in nine minutes or less. Further, AMR questioned the fire department's ability to take over patient transport with the current number of personnel and anticipated cost of running the system.

Of course, it was in AMR's best interest to keep the system in place. Cuyahoga Falls was typical of a public/private cooperative in which the fire service does first response and specialized rescue while the private company does the transport. Under a public/private cooperative, only the transport agency is reimbursed by Medicare, Medicaid or private insurance. Further, it is illegal to "kick back" federal money to another agency on specific calls. Therefore, the vast majority of fire departments doing first response in this country receive no reimbursement for those services. Can you name any other government agency which supplies materials and human resources to help a private contractor make a profit?

What a sweet deal! The fire service bears the cost and responsibility of maintaining response times to provide advanced or basic life support usually within four to six minutes, provides any specialized rescue needed, and sometimes sends a paramedic/firefighter in the back of the private ambulance as third person with a critical or serious patient. But then the private ambulance provider walks away with the money.

Citizens of Cuyahoga Falls said they were not pleased with the public/private arrangement. In September 1998, about 100 people showed up to express their opinions to the EMS Committee. One resident expressed frustration when he was charged what he considered an exorbitant fee for transport. He further elaborated that he "could throw a rock from my house to the hospital." Another citizen said, "I feel that we have the best fire department in the nation. They have always been there when we needed them and if they feel they can do the job, I'm behind them 100%. Anything we can do keep the money in this city, I think we should do."

After several presentations from AMR and the Cuyahoga Falls Fire Department, the EMS Committee said it saw advantages to the fire service providing EMS transport. In September 1998, a motion was made to recommend to the mayor that the fire department take over patient transport for all calls and begin charging residents and non-residents for the service. All the members of the committee voted in favor of the motion except the AMR representative and the International Association of Fire Fighters (IAFF) union president, who abstained. Steve Durkit, president of IAFF Local 494, abstained since he had not had an opportunity to let his membership vote on the transport issue. But the opinion of the firefighters did not take long. On Sept. 4, 1998, the union membership voted unanimously in favor of a fire-based transport system for the city of Cuyahoga Falls.

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