Wayne Gretzky is beyond doubt one of the greatest hockey players whoever played the game. He holds 61 National Hockey League records, including most goals, most assists and most points. Upon his retirement, a sports reporter asked him why he had obtained so many scoring records in his career. Gretzky told the reporter, “I don’t go where the puck is, I go to where the puck will be.”
This approach is certainly an unconventional method for playing the game of hockey. But it achieved success with great magnitude. The Bangor Fire Department in Maine has also taken an unconventional approach to delivering service to its community – and it too has met with great success.
In the 1990s, members of the Bangor Fire Department heard repeated complaints from citizens, hospitals and nursing homes about delayed responses and long waits for interfacility transport service from the private ambulance company operating in the city. In some cases, there were waits in excess of 21¼2 hours.
The Bangor Fire Department was already doing first response and emergency medical service transport, and some interfacility transport service. The interfacility transports – typically the transfer of a patient from one medical facility to another – was done on a limited basis and by request only. There was nothing in the Bangor Fire Department’s mission statement that said it provided this type of service and it did not market it to the community. However, with the repeated complaints, members of the fire department saw an opportunity to enhance their value to the community through a value-added service of doing interfacility transports.
Chief Jeff Cammack of the Bangor Fire Department made his first pitch to the City Council in January 1998. The proposal called for the fire department to do interfacility transports in the community by having firefighters do the transports on their off days, earning overtime pay.
Cammack and the city’s finance director pored over the numbers to see whether it would be feasible. Their approach to the number crunching was very conservative on the revenue side and they went overboard on the cost of the program. As Cammack said, “It is better to be safe than sorry.”
Naturally, the ambulance company operating in the city tried everything, including politics, to stop this process. Not only would it lose revenue, but it would lose market share. And the market share for Bangor was significant. The Bangor metropolitan area has a population of over 180,000 with an estimated 90,000 to 100,000 people in Bangor on a workday.
Part of that market share in the community was two main hospitals – Eastern Maine and St. Joseph’s. Eastern Maine already worked closely with the existing ambulance service. As part of his effort to win approval from the City Council and to shore up support in the hospital community, Cammack went to talk to the CEO of Eastern Maine to ask for this backing. As soon as Cammack left his office, the CEO telephoned the mayor and members of the City Council and told them, “The fire chief is crazy. There is no money to be made doing interfacility transports.”
As it turned out, Eastern Maine was close to inking a deal to purchase the private ambulance company. Ironically, the deal with Eastern Maine and the private company was being finalized as Cammack was making his presentation to the City Council. The City Council tabled the proposal and formed an EMS committee to look at the issue of EMS delivery in the community.
As the EMS committee got moving on its objective, Eastern Maine came in with an offer to pay the city for doing all transports, including 911, for the City of Bangor. The fire department would have to still provide first response and maintain its ambulances and crews as a backup to Eastern Maine in the event its units were unavailable for 911 calls or interfacility transports. The city turned down this offer.
For 14 months, Cammack worked with Eastern Maine on other proposals, but the negotiations just continued to drag on. Finally, the City Council and the EMS committee agreed to an Ambulance Service Policy that outlined where the fire department could provide service and what type of service. That policy included doing interfacility transports that originate in the City of Bangor. The Bangor Fire Department could not go into the surrounding communities and pick up patients for interfacility transports. But that was fine with the Bangor Fire Department, since both hospitals are located in Bangor and the majority of interfacility transports already originated at the two hospitals.
As part of the new policy of doing interfacility transports, several laws had to be modified. The first was the City Charter, which did not specify that the Bangor Fire Department could do interfacility transports. The second item to be modified was the state law defining fire and EMS mutual aid policies. As part of the new defined mutual aid regulations, the Bangor Fire Department now provides advanced life support (ALS) backup to eight surrounding communities. As it stands today, both the Bangor Fire Department and Eastern Maine perform interfacility transports in the community. Eastern Maine has gone on to purchase a helicopter and operate an EMS helicopter operation.
The Bangor Fire Department model has been retooled and all interfacility transports are done with on-duty ambulance crews. However, the policy stipulates that only one of the three on-duty ambulances can be on an interfacility transport at any given time. As a result of its unconventional value-added service to the community, the Bangor Fire Department averages approximately six interfacility transports a day with net revenue of $280,000 a year.
Sometimes, in order to be successful, you have to think outside the box and be unconventional. The Bangor Fire Department has certainly proven it thinks outside the box.
For more information, you may contact Chief Jeff Cammack at 207-942-6335.
Gary Ludwig, MS, EMT-P, a Firehouse® contributing editor, is the chief of Special Operations for Jefferson County, MO. He retired in 2001 as the chief paramedic for the St. Louis Fire Department after serving the City of St. Louis for 25 years. He is also vice chairman of the EMS Section of the International Association of Fire Chiefs (IAFC). He is a frequent speaker at EMS and fire conferences nationally and internationally, and is on the faculty of three colleges. Ludwig has a master’s degree in management and business and a bachelor’s degree in business administration, and is a licensed paramedic. He also operates The Ludwig Group, a professional consulting firm. He can be reached at 636 789-5660 or via www.garyludwig.com.
