Jan. 05--When the Edina City Council gets a handwritten thank you note, it's likely to be from a grateful senior citizen about a speedy city ambulance and the kindness of firefighter paramedics who responded to a 911 call.
Edina is among the metro cities, including St. Paul and Burnsville, that run their own ambulance service through their fire departments.
For residents, it's a city amenity that ranks right up there with parks and prompt snowplowing.
But in an ever-more-complicated medical environment, city ambulance services face challenges. Equipment is expensive. Trained personnel must be available in an instant. And though ambulances are busier than ever responding to calls from senior citizens in aging suburbs, each year cities collect a smaller percentage of what they bill for ambulance runs.
Some cities, such as partners Apple Valley, Lakeville and Farmington, have decided it's easier to guarantee quality service by hiring an outside provider.
Cities such as Edina, Burnsville and St. Paul, meanwhile, say that they are committed to their ambulance services and that they are proud of their speedy response times.
"This is something that our residents have grown to appreciate and expect," said Edina City Manager Scott Neal. "They like it when the city shows up to help at what is sometimes their lowest moment."
Burnsville Fire Chief B.J. Jungmann echoed that.
"This is one of those public service things where residents get excellent care and excellent response," Jungmann said. "We get people who stop by our stations, send notes and call. They are very thankful for the service."
In St. Paul, where city officials say the survival rate for cardiac arrest patients is two to three times higher than average, the ambulance service also is efficient, said Steve Zaccard, the city's fire marshal.
"Firefighters are being used for ambulance service, as well; it's dual staffing," Zaccard said.
Since 1980, Minnesota has been divided into ambulance service areas, with one license holder per area.
Among 321 ambulance services, 47 are linked to city fire departments and another 110 are public services that likely are connected to cities, according to the Minnesota Emergency Medical Services Regulatory Board.
Covering costs tricky
Anyone who runs an ambulance service knows they are likely to collect only part of what they charge for an emergency trip, said Buck McAlpin, who works with North Memorial Health Care and is lead lobbyist for the ambulance industry in Minnesota. Ambulance services that charge $1,400 for an emergency trip usually are reimbursed $425 or $450 by Medicare or Medicaid, he said.
"If you're a community-based system, city councils have to look at this as a service they want to offer," he said. "I would say the majority of large fire [department]-based systems do not cover their costs, so they offset with tax dollars."
Some smaller cities have dropped their ambulance service and hired larger organizations such as hospitals or health companies to provide the service, McAlpin said.
"Most all of these shifted from city-based [emergency medical service] to large hospital-based [services] because of economy of scale," he said. "We can buy materials cheaper when we buy in bulk. Buying 12 ambulances is cheaper than buying one."
In the case of partner cities Apple Valley, Lakeville and Farmington, the three agreed to drop their ambulance service in 2008 to contract with Allina Health and to improve service, said Steve Mielke, Lakeville city administrator.
"We were concerned about quality of care," Mielke said. "For smaller agencies, it can be difficult just to maintain the latest and most up-to-date capabilities and training. ... We're very pleased. They've brought a level of expertise we didn't have."
Hiring Allina eased the burden on city employees who were responsible for running the ambulance service. The city consortium still holds the ambulance license, which Mielke said allows it to change providers if service isn't good enough.