High ambulance rates up for approval, again

March 21, 2011

By LISA RIZZO

The San Luis Obispo County Board of Supervisors will soon decide whether to approve a new contract with San Luis Ambulance Service, further solidifying one of the highest rate schedules in California — and stoking a controversy that burned years ago.

If the supervisors approve a new five-year contract, which would replace the old one that is set to expire June 30, it would continue the grandfathered designation of the private ambulance company as the exclusive service provider in the county’s north, central and south emergency response zones.

The county’s ambulance customers, averaging about 15,500 a year, are billed rates which represent the third highest in the state, according to a May, 2010 survey conducted by the Emergency Medical Services Administrators Association of California (EMSAA).

San Luis Obispo County’s base ambulance rate, which has nearly tripled in less than a decade, increased to the current rate of $1,947, which became effective Jan. 1. It’s a growth rate that has far exceeded the rate of inflation.

Back in 2002, the base transport rate was a mere $664.

The current critical care base rate is even higher at $2,466.33. Additional charges include the use of oxygen – $76.62, disposal of infections materials – $19.18, standby time – $153.41 and mileage – $19.85/mile, $24/mile for critical care.

Since health insurance companies take statewide averages into consideration in setting reimbursement rates, local residents may find their coverage fall short of paying the total bill.

Transport rates in the county are well above the median, so the customer is often left to pay the difference, which could amount to more than a $1,000 in out-of-pocket expenses.

While some criticize the high ambulance costs, no organized effort opposing the contract has surfaced from the general public.

San Luis Obispo County’s high ambulance rate schedule follows behind the state’s top two, Monterey and San Benito counties. However, Monterey County’s situation is unique since the contracted ambulance service provider suddenly pulled out, leaving the county to sign a short-term contract with American Medical Response (AMR) at a temporarily higher base rate while the county accepted bids for a long term transport provider.

Charges in Monterey County soared from $1,298 in 2008 to a 2010 base rate of $2,265.54 per transport.

“We are generally reimbursed for 50 out of every 100 transports we provide,” said Jason Sorrick, spokesperson for AMR (the largest ambulance service provider in the country). “In Monterey County we have a high percentage of fixed reimbursement with Medicare being 39 percent of our pay mix and Medi-Cal at 15 percent.”

Built into the high cost of an ambulance ride locally is the fact that San Luis Ambulance Service is facing first-responder fees of about $708,410 for the 2010/2011 fiscal year, a slight increase from the year prior due to a consumer price index increase.

First-responder fees are a relatively modern concept, coined within the last 20 years as a way for fire departments to receive compensation for assisting the private ambulance company as the first to arrive on scene in medical emergencies.

In several counties, fire departments have completely taken over emergency medical services and own and operate their own ambulances.

Other community emergency service programs mirror San Luis Obispo County’s. In those programs, firefighters are initially dispatched and generally arrive before paramedics from San Luis Ambulance Service, who then take the lead in patient care.

Some critics question the cost efficiency of the system.

“We are running these fire trucks on ambulance calls,” said Pacific Energy President John Ewan, who is also an energy analyst and former San Luis Obispo City Council member. “I can understand for a vehicle accident, understandably.

“But to run a fire truck to someone who has a heart attack, when they need an ambulance to transport them to the hospital and they need EMT care?

“We are paying the cost of equipment rolling out. We are paying the cost of not having the equipment available if there were a fire emergency. And we are paying the environmental cost.”

As the nationwide controversy over the costs versus the benefits of having firefighters respond to all medical calls heats up, several communities in California have switched or are in the process of switching to a system where private ambulance personnel respond to most medical calls without dispatching fire trucks and safety workers.

In San Joaquin County, for example, it adopted the practice of sending out the “correct resource” for each call during contract negotiations with ambulance agencies about five years ago.

“If you send the cavalry to each call, even if they are not needed, they may not be available when you need them,” said Dan Burch, San Joaquin County’s director of Emergency Services who also noted the cost saving of not rolling out unneeded vehicles for each call.

Burch said the change saved taxpayer dollars, but he has not put a specific figure on it.

Supporters of the current system defend the ambulance price schedule as being appropriate for San Luis Obispo County.

For one, ambulance companies are required to provide care regardless of a patient’s ability to pay, which increases the cost for those that can.

The cost of emergency responses for the homeless, uninsured and below-cost reimbursement from government insurers is absorbed into the overall cost to run operations, which, in turn, translates into increased prices for the average Joe.

The San Luis Obispo County Health Agency leads the ambulance contract negotiations, review, and rate setting. Among other things, it considers the ambulance company’s expenses, revenue/pay mix and pay sources.

Jeff Hamm, Health Agency director and chairman of a county advisory group that recommended the new five-year ambulance rate agreement to the county supervisors, defends the rates being one of the highest in the state because of the demographics of the county, the high level of service and increasing operating expenses.

Bob Neumann, a former San Luis Obispo fire chief who also is a consumer representative on the another county advisory body known as the Emergency Medical Care Committee, agrees, noting that the Cuesta Grade mountain range is like a barrier that creates a variety of population areas, some dense, and others far from hospitals.

“An ambulance company has a hard time delivering ambulance service in the county. Add on the [Oceano] dunes, which has a huge need; we have a large amount of trauma at the dunes,” Neumann said. “And the lakes are far from hospitals. There is a huge mechanism of injury.”

San Luis Ambulance General Manager Chris Javine said the relatively limited response volume is another factor. “We are a very rural area and that tends to increase the rates because you don’t have the call volume. We have to maintain a certain level of readiness,” Javine said.

The ambulance company reports it responds on average to more than 23,150 medical service calls per year. Of those trips about 30 percent are dry runs, which means the ambulance is discharged from service, doesn’t transport anyone to a hospital, and no one is billed for the cost.

On March 8, the San Luis Obispo County Ambulance Performance and Operations Committee (APOC), the advisory body that Hamm chairs, voted to recommend that the supervisors approve the new contract.

The new tentative ambulance agreement also calls for San Luis Ambulance to reduce its target profit margin nearly in half from a range of 8 to 11 percent to 5 to 7 percent. Kelton said the company is already complying.

Under the constraint of less profit, San Luis Obispo Ambulance Service is also expecting increased expenses as it prepares to make a $650,000 investment in the replacement of its EKG monitors, new ambulances and other equipment.

As budget crises threaten programs and jobs across the country, firefighters are also looking for a bigger piece of the pie, which may come in the form of more first-responder fees that could — once again — raise the cost of ambulance service.

Wade McKinney, Atascadero city manager and an APOC member, who within minutes of the start of the March 8 APOC meeting moved to recommend approval of the new contract, said they need to “make sure fire department staffing is correct.

“We don’t want to go to the public and say, ‘You are losing your house but we need to raise fees,’ ” McKinney said.

APOC moved quickly to recommend approve of the new contract despite concerns from some committee members, who wanted more time so that they could obtain and review the formula behind the first-responder fees.

At the time of the meeting, none of the members could recall the methodology behind the fees.

McKinney argued that with the ambulance contract expiring in just over three months, the committee members would be hard-pressed to find a mutual time to meet again, considering their busy schedules.

In the past, APOC had failed to comply with its own bylaws, which require the committee to meet quarterly.

Until last September, the committee had not met since the summer of 2006. It has since complied with its bylaws.

Despite the rush, two committee members, Paso Robles Fire Chief Ken Johnson and Acting County Fire Chief Rob Lewin, opposed the motion that recommended approval of the contract, which included the ambulance rate schedule and first-responder fees. Nevertheless, the motion was approved by a majority of APOC.

After the meeting, Johnson said that while the first-responder/San Luis Ambulance working relationship is “wonderful” compared to other counties, he “did not feel comfortable voting to approve the new contract” until he sees the first-responder payment calculation.

“It might be appropriate to see if it is applicable today,” Johnson said. “The decision was made in the past. We have more time, experience, and understanding today.”

A 2001 APOC report details the first-responder fee methodology as being a formula that includes individual fire department’s number of employees, number of medic credits, training costs, and equipment costs which have all most likely changed since the formula’s inception more than a decade ago.

However, at the ambulance contract’s optional rate reviews, those factors have not been recompiled and recalculated for a number of years.

Now that Johnson, who says his position represents municipal fire agency interests, has reviewed the methodology he believes a present recalculation is one of several factors that needs “to be jointly considered in preparing any recommendation for policy level changes.”

He said, “Our group will continue to internally discuss the fee issue, understanding that we represent only one perspective. I am confident that a clearer set of fire agency points will aid in the later APOC discussions and its ultimate recommendations.”

 

 

The history behind high ambulance rates

As some of the founders of the first-responder fee plan explained, the arrangement, which contributes to the high ambulance rates, was a compromise to keep the local fire agencies out of the paramedic transport business.

The history is a litigious one – a battle San Luis Obispo County has managed, for now, to keep out of the courts.

“People were suing each other left and right,” said retired San Luis Obispo City Fire Chief Bob Neumann.

“The court battles were about who had the authority to do transport. The cost of doing business increased and fire felt it was important to be reimbursed for the work they were doing in the field. That’s when they considered starting a transport operation.”

According to the California Fire Service, 80 percent of fire agencies’ responses are non-fire emergencies. It is a trend that began in the 1970’s.

Since then, building codes and improved construction meant new buildings and homes that are safer, resulting in fewer fire emergencies. Combined with an aging population that was growing, the paradigm shifted to a major majority of medical and rescue emergencies.

Under the pressure to maintain their jobs and pensions, firefighters across the nation launched an effort to expand into the paramedic/ambulance business. Adding fuel to the fire, a San Luis Obispo City Fire chief purchased an ambulance from the City of Los Angeles in the late 90s.

According to San Luis Ambulance Service President and CEO Frank Kelton, the fight for market share in San Luis Obispo County really heated up in the late 1990s with litigation in San Bernardino County that could have potentially threatened the future of the company’s contract. In two historic cases, the California Supreme Court was confronted with varying interpretations of the 1980 EMS Act.

While at the time, the lawsuits’ outcomes were yet to be determined, Kelton said he made a deal and proposed the first-responder fees.

“I thought, ‘How do we make this work for everyone without getting into a legal battle?’ So we came up with first-responder fees,” Kelton said.

“It later turned out that the county had the authority to handle ambulance contracts but nobody knew that at the time. We compromised and became a partnership so we didn’t have to go to court and fight over who was right and who was wrong.”

Neumann, the former San Luis Obispo fire chief, helped negotiate the first-responder fee deal.

“Fire is delivering a significant service,” he said. “If it was not for the fire company we would need more ambulances. We went out to find the budget to deliver these services. We put together the formula that exits today.”

The fight for market share is long from over across the country, where heated debates are calling into question the firefighters’ role as an integrated part of the emergency medical services system.

But in San Luis Obispo County, the “official” response from the Health Agency, San Luis Ambulance and several fire chiefs is that the fight for turf is over.

“Here we haven’t had those controversies. These systems have been in place for a number of years. They were put in place to enhance service and raise the level of service,” said San Luis Ambulance Service General Manager Chris Javine.

Neumann said, “If the fire guys want to get into the transport world, they would get in — in a heartbeat. If they thought they could get into it– they would. It would cause ambulance rates to go ballistic.

“It is like taking the cream out of the center of the donut. They [firefighters] think about the county as a whole, which is why the troops get along really well together.”

Those who came up with the first-responder fee deal knew that the additional costs would likely result in higher rates for consumers. But they were of the opinion that the so-called “turf” war over responding to 911 calls was more important to settle.

“You can get away with a lot cheaper operations,” said Neumann. “But you really diminish the standing army available to you in a time of disaster. You just don’t have the same capabilities. That has been a characteristic this county has valued. Other counties don’t value that so ambulance companies can get away with a lot cheaper rates.”

While that fire may have been put out years ago, a looming fiscal crisis threatens to reignite it.

Once again, firefighter jobs are in jeopardy as cities try to get a handle on their soaring budget deficits under the threat of bankruptcy.

“The city of San Luis Obispo is projecting a $3-million shortfall this year and at least another $3 million next year, maybe as much as a $5-million shortfall. They are simply spending more than they take in, in revenue,” said Steve Barasch, San Luis Obispo Property Owners Association (SLPOA) treasurer.

In 2006, SLOPOA privately funded and hired a consultant, The Center for Government Analysis, to study San Luis Obispo’s finances. The author’s conclusion was that the city would go broke in five years. The group went to the city with a detailed report of the findings and suggestions for short and long term budget reduction measures and implementation strategies.

“They were laughing at us,” Barasch said. “They are not laughing anymore.”

SLOPOA, which has spent the last six years pressuring the city to reduce its costs, believes San Luis Obispo is paying far too much for public services than it needs to.

Looking at labor rates in San Luis Obispo’s public safety sector, Barasch says, “Everything is jacked up here. It’s considerably higher compared to other cities of similar demographics. It’s the local benefits that drive things up. Salaries are fairly high but the benefit packages are ungodly high.”

While Barasch did not want to comment directly on the ambulance-fire issues, he pointed out that “fire and police account for the largest salaries and benefits within the city’s general fund, about 79 percent.”

Critics contend there are too many firefighters on the job, which is driving up the cost, particularly in light of the public pension fund crisis brought on by the recession. They say emergency response in the county could be run more efficiently from an environmental and economic standpoint.

Currently, three to five firefighters arrive in a full-sized fire truck for medical calls, including heart attacks and seizures.

Considering how other cities introduced an ambulance service to offset public safety costs, a 2007-2008 San Luis Obispo Grand Jury report scrutinized “whether equipment and fire department personnel are appropriate to meet changing department service demands.”

It also concluded that the “fire department should evaluate the benefits versus the costs of adding an ambulance service.”

There is no doubt tough decisions lay ahead. And desperate times could call for desperate measures.

Former San Luis Obispo councilman John Ewan says, “People have not been willing to sit down and work it out and it is costing all of us. The moment I asked the question when I was on the [city] council, people said to me ‘this is the way it is.’ The issue, it’s not being talked about. A report needs to be done.”

One of the reasons for the apathy is, despite the price tag, by and large people are satisfied with the quality of the ambulance service and emergency medical response in the county, according to the officials we spoke to.

While every side has its cause, as Paso Robles Fire Chief Ken Johnson explains, the problems and any resolutions are complicated.

The “system participant (public providers, private ambulance, system administrators) focus has been to provide the highest level of pre-hospital emergency medical service possible at a reasonable cost. This lives within a dynamic environment that requires a continual balancing of interests and needs,” Johnson said.

“Changes in any one area also tend to affect others and I’m always hesitant to push for any solution without a better understanding of systemic impacts.”

When it’s all said and done, “each city has to decide how they want to service their citizens. We are the support.” Kelton said and added that if the ambulance and fire did not respond in tandem, the public would still be served.

“There would be times when we need additional help. Response times could be affected especially in remote areas and even in the cities, but not by much.”

Neumann says, “If we don’t deliver advanced life support in a certain level of time, the outcome would be significantly bad. This is not hocus pocus.”

Questions over why San Luis Obispo is using its new tiller ladder truck for most station one calls when it is larger than standard fire trucks, is manned by up to five firefighters and costs more to roll out, resulted in the following city response:

Tiller Truck Memo


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cfd2220

On average, homeowners pay around $1.40 a day for a full-time Fire Dept including salaries & benefits. If you own a smart phone, you pay $3.40 on average a day for it. That cell phone won’t die FOR you, protect your property, save your life, perform CPR or drive you to the hospital in an emergency. Life is worth less then a cell phone. How sad!


Typoqueen

You need to switch cell phone providers.


So because they perform what might be life saving actions then it’s okay for them to charge what ever they want. As long as the board approves it then you’re right, but it doesn’t make it fair.


simplelife

Someone needs to really recalculate these figures. Fire departments are paid through the general fund. Which means the funds come from multiple sources. Every dollar you spend in the community a portion of that ends up in the general fund which funds them. This is propaganda and banter and we will see more things like this as budgets get squeezed tighter. We are over taxed as it is and we all have been effected by this economy. Dont get me wrong I believe in the fire service and what they do although I feel they could be alot more effiecent. Some departments are running over staffed while others are more in line with the needs of the community they serve.


SLOBIRD

I contacted SLO Fire Department and the SLO Ambulance response service (not Admin) was stationed at Station #1 until a couple of years ago, they have since relocated. According to fire personnel, the City does not have an ambulance and does not use or provide any ambulance service. I further reviewed the Fire Department City site and according to the webpage, the department has 55 full-time staff: 1 chief, 13 captains, 15 engineers, and only 12 firefigters. The administration and prevention bureau staffing consists of 11 employee (which adds up to 52??). I and my family have had the unfortunate opportunity to use the medical services through 911. There is no question that the service is “outstanding”. However, I really think the City needs to evaluate the need for the 4-6 fire employees (at least two city fire vehicles), a city police car, and then an ambulance per incident. The service is outstanding, but at a very high cost, and a little over done. I have no doubt that the same service could be provided with less response staff. I do agree that incidents involving accidents, disasters, etc. need a great response than a citizen that is sick, etc. and yes, I truly appreciate the work and dedication of our police and firefighters, and I wish everyone would remember, this is business and not personal. We can only afford what we can afford and we all want the best bang for our buck. These are tough, frustrating, difficult economic times!


cfd2220

Well instead of paying the firemen extra for things like haz mat, that requires the knowledge of a chemist, we could create another whole agency that deals with nothing but haz mats. Oh but wait, when a big haz mat spill happens where will they get all of the people to staff the team to clean it up? You need at least 10 people to run a small haz mat incident. So another agency with 10 full time people. These extra duties have evolved because of how our world is today. If the fire dept. didn’t take on these new roles then who will? The extra pay covers duties that are above and beyond the normal, everyday duties of a firefighter. I’m sure everybody out there working, an all ready dangerous job, would be willing to have new dangers, increased workload and threats to their lives that come with these new threats. This in a job that has proven to shorten their lives by 5-10 years, reason for earlier retirement, in addition to physical demands on the body and the mental toll of seeing horrific accidents that are with you for a lifetime. If you think about it, these extra duties that firefighters get paid for could be saving money.


Mr. Holly

BS. Maybe we just need to change the job description. If they don’t like it we’ll just hire someone out of the 100’s of people who apply for the job who are equally qualified, not impressed with themselves and would be grateful for a job.


slotired

Actually these haz-mat firefighter merely contain the scene and call in a contracted waste hauler to actually clean up anf remove the mess. Not one of the fire agencies in this county are legally licensed to haul chemical waste from a scene. For the very small number of actual hazardous materials incidents, contracting with a private firm saves money.


cfd2220

The Haz Mat Specialists do more then just contain the scene. They’re responsible for obtaining a sample of the product, they then analyze the material to determine what the product is, they then neutralize or try to stabilize the product. They’re also tasked with any rescue of a victim in the hot zone. Support personnel set up a decontamination area so the contamination isn’t spread, then perform the decontamination on the victim and the entry team. Support team roles also includes medical monitoring, entry team leader, decon leader, safety and incident commander. The private firm cannot perform the rescue and they don’t identify the product. Fire Dept. will be on scene anyways since these accidents alot of times involve victims that need to be decon before they can be transported or released back into the non-contaminated area. Not all firefighters get extra pay for haz mats. The majority are haz mat first responders that get no extra pay. The haz mat technicians and specialists usually gets a small compensation for the this position.


slotired

You aren’t serious, are you? County Environmental Health sends out the chemists and the prison sends out the decontamination team. I have seen them work and the prisoners do a really good job at a fraction of the CDF salary. Besdies, you can not possibly identify all of the substances in a haz mat scene in the field and merely identify chemical groups. I hope you are not one of those highly trained specialists.


cfd2220

Yes I am serious. The Haz Mat guys can identify most materials in the field using a system called Haz Cat. This system can at the very minimum give them a general category the chemical falls into and alot of the time identify the entire chemical makeup of the product. This needs to be done on sight so evacuations and safety for everyone. The haz mat team then stabilizes ar neutralizes the product. Then the private contractor will come in and dispose of it. The decontamination team is CMC Fire Dept. which also has full time Captains with them at all times. The prisoners do a good job and this was a great cost saving measure by this CA State Fire Dept. that has prisoners on sight, much like Cal Fire that uses prisoners for hand crews. Using prisoners in positions as firefighters also can cause problems that could have very bad outcomes on a incident. Most counties don’t have the luxury of using prisoners in this capacity. No I’m not one of those specialist, but I do know the facts. This isn’t a us against them. Just like alot of things there is more to this story that people don’t know about.


slotired

Pick a lane, either your equipment does or does not identify chemical compounds. First you say it does then “This system can at the very minimum give them a general category the chemical falls into and alot of the time identify the entire chemical.” I suspect that your fire truck is not equipped with a gas chromatogrph mass spectrophomiter to actually identify the chemical make up. The only accurate thing you have said is that there is more to theis story that people don’t know. My suggestion to best support the firefighters is for your to stop blogging. You are making the good ones look bad.


cfd2220

You’re making yourself look bad by your last 2 sentences and yes haz mat teams do have gas chromatograph mass spectrophomiters on their haz mat units. Unfortunatley SLO Co. uses the older haz cat system, but the other is fast coming the standard, Santa Barbara County has them. You have your mind made up and aren’t open to hearing the rest of the story. That is ok.


oto

“If the fire dept. didn’t take on these new roles, then who will?” That’s a great question, 2220, and the answer is, ‘concerned citizens will,” if you give them half a chance and the training they need to be good volunteers. But the fire dept. resists providing even the most basic first aid classes, which should be offered in every community, at every local fire station. Why? Because giving your fire personnel the responsibility to teach first aid –on an on-going basis–will not only give the local station an opportunity to know its community in a non-emergency situation. And, most importantly, it will require each fireman or dept. employee to study and re-study that which he has learned. One evening class, once a week, does not adversely affect the station, or “back-up” personnel. Between fighting fires and answering emergency calls, there is a lot of “hanging around the station.” Some of that time could be put to better use. All you have to do is give up the ego and share your knowledge in basic safety. If you scoff at the possibility that volunteers can be as capable as you, consider the fact that before Cambria had a firestation and regular staff, all firemen were in fact, volunteers. These great guys got their EMT licenses between working for pay at regular jobs and taking care of family. Then, they competed in the statewide “Firemen’s Muster” where firefighters from all over the state compete in challenges which require them to do everything from using their equipment in mock-emergency situations, to carrying a one-hundred and seventy-five pound “victim” down a ladder. Cambria fire volunteers won this statewide contest three years in a row! So, 2220, when will your team compete? Where do I go to sign up for one of your first aid classes? And by the way, the Red Cross does not teach first aid on a regular basis. Remember that, citizens, the next time they ask you for money. Better to put your money towards your local fire station–so long as they are empowering the community to knowledgeable assist in an emergency. Every man, woman and child can learn basic first aid and the fire station should be delivering these classes. Now, go out there and do your heros’ work, Firemen! (Is there a female firefighter in the entire county? Why not?!)

oto


zaphod

Is there a female firefighter in the entire county?

Atascadero has a woman ff IIRC


simplelife

Cal Fire and Motto Bay and Paso are the only ones that have women working on the fire engine.I don’t think SLO has ever had one. Very good ol boy thing maybe.


Bluebird

The Atascadero fireman’s union is a very strong cheerleader for McKinney. Fire Chief Stone and McKinney fraternize after hours. Interesting that McKinney is suggesting he may have to hire more firemen when the city said there were layoffs in every department. The firemen have much more clout then the police and they are much more active in city politices.

Further if McKinney spent more time in Atascadero, rather then attending all the meetings that further his personal agenda, he wouldn’t have to rush out of meetings.


Mr. Holly

It seems that everytime that McKinney gets in hot water, which is often that the Atascadero Firemen appear in full force to support him. I believe that their overtime pay and benefit package relates to the fond relationship that they both have.

Too bad that the city council doesn’t have the huevos to stand up to this guy.


Mr. Holly

This is really very simple, it’s all about money and possibly more so than providing care. If you make your 911 call and it goes to the Sheriff’s dispatcher the ambulance is the first unit to be dispatched and then the info is transferred to CDF or the local city for them to dispatch. This is why the 3-5 minute delay occurs. Then on the other hand if your 911 call goes to a city their dispatchers call the FD first and then contacts the Sheriff’s dispatcher to dispatch the ambulance. It should be quite clear that the ambulance company is better equipped to handle the emergency than the fire department based solely on the equipment that is onboard the ambulance and therefore the ambulance should probably be the first unit to be dispatched on all calls. As far as the qualifications of the paramedic I do not believe that this is an issue as both the FD and the ambulance companies respond to numerous calls and have the experience needed to handle the calls. If this were not the case the ambulance chasing attorneys in the county would be lined up at the courthouse doors.

I think the city’s may be dispatching their FD first so that they can make claim to being the first reponders and then making claim to the funds they are collecting. To address the dispatch system in the North County one would see that the ambulance in Paso Robles is stationed at the fire station and when a call comes into the city the FD is notified and then 3-5 minutes later the ambulance is dispatched. Both units are parked next to each other and the personel live together. The same is true in Templeton. In Atascadero the FD and the ambulance company are only separated by a few hundred feet.

We all pay taxes and expect our political leaders to provide us with the best of service. Our firemen are paid to be on duty for a 24 hr. shift and we expect them to respond to emergency calls which they do. But at the same time are we expected to pay them extra for doing their job?

This problem is definetly an area that needs to be looked at. I believe the dispatch priority needs to be adjusted so that the ambulance is the first responder. Then the fee needs to be looked at. Can these FD’s really justify that this is the extra cost to respond? If it is, then that part of the system is also broke.


cfd2220

Lets look at some facts. Ambulance rates would be lower if people would be their bills, possibly by 50%. More savings if the public knew when to call, ie stub toe, hang nail… it happens all the time. The first responder fee is paid to help the ambulance company to comply with the time requirement of their contract, a firemedic on scene stops the time, the ambulance avoids contract violations which can result in a fine$$. The fee assists the fire dept. with $$ for the added cost of paramedic service, including cardiac monitors that can run $25,000. I guess by all of the negative feedback that if the fire dept. showed up at your house and your child wasn’t breathing it would be ok that they didn’t have the advanced equipment, trained personnel to possibly save their life. There are times the entire system gets so busy that you have a 5, 10 ,15 even 20 minute wait for the ambulance to arrive, you are ok with that? It happens all the time. Cal Fire does have PCF’s and they’re more then just “volunteers.” Many of the volunteers are full time firefighters at other depts., ambulance personnel and your neighbors that have the guts to contribute to something that is dangerous and alot of other people don’t have the stomach to do. Firefighters do more then just respond to medical aids and house fires, try also haz mat spills, surf rescue, swift water rescue, bomb incidents, cliff rescue, weapons of mass destruction incidents, vehicle accidents, wildland fires, vehicle fires,smoke investigations, odor investigations, fire alarms, co2 alarms, gas leaks, power lines down, public assists and on top of those responses they educate your children about fire safety at all of the schools, inspect the the public buildings you go into everyday, investigate fire causes, train to keep certified for all of the types of responses listed above, checkout /maintain all of the equipment needed to respond to the calls listed above and the list goes on… The point is this, medical care is expensive, look up cost of equipment , paramedics wether ambulance or fire perform procedures that doctors perform, in a uncontrolled enviroment and save lives that wouldn’t be saved otherwise. The public isn’t educated enough to know what happens in a emergency, what training is required, who is ambulance and who is fire. Until you are fully educated about how and why the system works the way it does you better watch out what you say and do. If these responders aren’t there anymore due to the continued ignorance of the uneducated it could be someone that you love or care for that needs them right now. Think of them as a insurance policy, you hope you never need them, but if you do they will be there.


slotired

I guess we are just too stupid to understand how important you are. This is exactly why the public is reversing their position on the firefighters. The lack of flexibility and refusal to work with the community to find that balance between service and budget has cost the careers of the entire Costa Mesa Fire Department. How did that work out for them? When the insurance premiums are too high, we look elsewhere for coverage.


cfd2220

Fire Depts. all across America have made sacrificies to help in the budget mess caused by big business. Consolidation with Orange County can be a great cost saving measure. The firefighters I know are for consolidation. Be aware of possible less control and say so. The problem is when they ask for pay cuts and we have no money, you then read a article about the $150,000 the city just spent on new decorated trash cans to replace ones that work fine.


Kevin Rice

In fact, often the FD EMTs and PMs are more experienced than the ambulance personnel. This, of course, varies from jurisdiction to jurisdiction depending on how the local system works. The FD often arrives first and handles extrication and initial treatment and drug administration and makes base hospital contact. It is typically the FD purview as to how a patient is classified, treated and transported. Your experience may be valid in some areas, but cannot be used to qualify every locale. In many areas, the ambulance simply transports and their personnel have very little say. Their personnel are often youngsters with little experience and who are seeking a fire or hospital career.


Kevin Rice

I can’t speak for SLO, but in MANY communities the FD personnel do all the treatment and stay with the patient all the way to the hospital. One ambulance EMT drives, and the other assists with oxygen and blood pressure. The FD does ALL of the care and decision making, and the ambulance is simply transport.


Now, on BLS calls the FD does turn over the patient, but those are band-aid transport runs that lend very little experience.


Like I said, I can’t speak for how SLO does things, but I suspect you are somewhat to very mistaken about the expertise of our local FD personnel. Ambulance work usually doesn’t pay enough to attract more than young newbies. But, again, I don’t know how it works here.


That said, the measures you suggest would save some cost, but if you’re going to still have all the FD people on-duty and working you might as well use them. Labor costs far, far more than running the trucks. If you want to save money you simply have to cut labor or cut pay. Simply not driving the trucks 15 extra miles a day really doesn’t save squat in the big picture.


simplelife

I have to correct you regarding your comment regarding fire dept medics vs. Ambulnce service medics. San Luis Ambulnce has over 75% of there medics with overvten years of service as Paramedics. And I have been working in EMS for 25 years and can honestly tell you the ambulance Paramedics are better clinicicians. The main reason is they run more calls than there fire dept peers. I mean no disrespect although its a fact on the central coast. Ambulances carry some equipment fire trucks don’t depending on fire agency. Equipment like 12 leads to.diagnose heart attacks in the field to alert the cath lab team sooner. C-pap for respiratory calls to name a couple.


SLOBIRD

There is something wrong with this whole concept. The cities hire, train, and staff paramedics, provide special vehicles and are the first responders, all with the citizens tax dollars. Then after stabliablizing a patient, the ambulance transports. Last week in the paper, a school teacher commented on the great job the fire department did in responsing to a student heat issue. She stated there were six, yes, six firefighters on the scene… BINGO, the problem.


In SLO the ambulance service is housed at the SLO Fire Station #1, you can even see the ambulance in one of the bays. The eat, sleep, and reside in the same quarters as the Fire employees and pay the City rent for the use of the facility. Why do we have to have paramedics and ambulance staff both responding, duplication of services? Actually, why does SLO need paramedics when the ambulance is right there. Please, someone explain to me…


easymoney

Well first, not all communities have their own fire departments, especially these days. Calfire is becoming the county wide agency on many calls. Areas like five cities contract with Calfire because it is simply cheaper than maintaining their own departments.

Second, there is safety in redundancy, if one engine goes down there is a second still responding. And county dispatch makes the determination on who and how many go, depending on the initial call.

Usual response for emergency calls is at least two engines depending on the severity of the call, once on scene the Incident IC determines the resources needed and releases all non needed equipment or requests more.

Third, the state and federal standards determine training, staffing and many times finance. Only small fire districts which are usually all volunteer have different staffing because the stations are not staffed 24/7 like the bigger city departments or Calfire stations. And since they are volunteer the entire county tax base does not pay for them even though they do respond right along next to the other departments. And they have the same training requirements mandated.

IMHO, most citizens do not really care who or how many are coming, when they are suffering they want help and immediate relief. Like the person who walks in the front door at night, they just expect the lights to go on without thinking about all that goes into that litle luxury…


slojo

Easymoney,


Sounds like you are CalFire? Well, IMHO, I do care who shows up when I call 911 and I wouldn’t want it to be CalFire. I expect an engine with 3 firefighters with at least one being a medic. CalFire can not deliver that…..most of the time CalFire provides a 20 something EMT fresh out of Allan Hancock. No thanks!


easymoney

slojo,

No I am not with Calfire, but I like all firefighters do have to have much more training in a wider range of areas than an ambulance driver/EMT or Paramedic does. The chain of medical command starts with BLS and ends with the ER doctor on call at the hospital ER. Even the paramedics have to have authorization to do certain procedures or give certain medications.

Seems you have been making some disparaging comments about Calfire and all I can say is hopefully you never need medical help or need to be cut out of an automobile or your home is never on fire, because Calfire will be there and probably first on scene.

Big cities have big departments and the accompanying big budgets and San Luis Obispo county is a fairly large dispersed area with overlapping jurisdictions which can not be served by any one agency.


slojo

easymoney……..yes, I pray to God that if I ever need medical assistance I am within the city limits so SLOFD can help me. If I am in the county areas, I’m S.O.L.


Kevin Rice

Six is not uncommon, although I’d bet two of those are ambulance personnel, not fire. However, if that heat emergency turned into a full arrest requiring CPR, then six personnel easily become busy:


(1) chest compressions

(2) ventilation

(3) intubation

(4) establish IV and push medication

(5) complete paperwork and obtain information from family/bystanders

(6) bring in gurney/assist with moving patient


…and that’s if the incident is only a simply medical aid without any vehicles burning, wires down, multiple patients, etc…


What we are paying for is a level of service that is somewhat rarely utilized, but is important to have when it is needed. The state standard is two paramedics. Two paramedics can get the job done, if necessary, but much less effectively. Meanwhile, you get six personnel to the 90% of calls that are band-aid runs. The other thing you get with combined fire/ambulance response is a qualified supervisor (Fire Captain). An experienced manager goes a long way toward maintaining a professional operation. Two young paramedics roaming the city unsupervised occasionally can lead to trouble.


Emergency services contradicts fiscal efficiency. It’s simply the nature of the business. That doesn’t mean we’re stuck with paying for all the overkill, but it does mean there are compromises to be made if you lower service. On the other hand, many cost saving measures would only negatively affect 1% of calls and would save tons of money.


Perfection doesn’t exist, and every step towards perfection doubles the cost. I’m a proponent of finding a reasonable balance.


easymoney

Very well put…

One thing that dictates some of the higher costs involved, is distance and peoples perception after moving here to a predominately rural area and expecting the same level of service each and every time regardless how far out they have chosen to reside.

We have excellent emergency services and a great record of response, despite the often far distances that response will be.


slojo

SLOBIRD,


Get your facts straight. SLO Ambulance is not housed at station #1 and that ambulance you see is not thiers.


SLOBIRD…..bottom line is people would die if your fire department didn’t respond with paramedics. Believe it.


SLOBIRD

Why are you so nasty…


Bob

What the fire chief and the firefighters association is hiding from the public and not being honest about is the high cost of using a tiller quint as a sole response apparatus in place of a engine that is adequate to handle 95%+ of station one responses.


The average life span of a tiller truck as a front line responder preforming truck operations is 30 years. Substituting with a tiller quint significantly increases the maintenance costs. Additionally, by using a specialized truck as the primary response apparatus for all station responses dramatically reduces the service life of the apparatus from a average of 30 years to an average of 15 years and as little as 10 years, resulting in a significant increase in cost to the tax payers.


There are some options:


1) Since the relocation of station 1 at it’s current location, station 3 could be closed with engine 3 reassigned to station 1. Allowing a standard operation of both a engine and a truck company to respond from station1 city wide central location.


2) Station 1 personal could cross staff a engine and truck, responding with the appropriate apparatus required by the call reducing operational costs. However, there is that 5% chance that the crew could be out on the engine when a truck response is needed.


3) In addition to a cross staffing operation, create a call firefighter program at station 1 to respond with the 2nd apparatus when needed. IE: truck-1 when paid crew is out on the engine or vice versa.


4) Reduce expenses while increasing staffing to operate both types of apparatus by contracting with CalFire.


slojo

1. Don’t think all the old people in the assisted living places in Station 3’s district would appreciate the extra response time when they are dying.


2. Hmmm. I wouldn’t wan’t to fall in that 5% if I had an emergency….would you? Didn’t think so.


3. STUPID.


4. Even more stupid.


Educate yourself on the difference in the level of service between SLOFD and CALFIRE. There is a HUGE difference.


Bob

slojo,


Your response is typical of a follower, not a leader and certainly not a thinker.


Your right there are big differences between SLOFD & CalFire. CalFire is a leading firefighting agency with far more experience and resources than SLOFD will ever have. CalFire firefighters are paid well, receive good benefits while SLOFD firefighters are significantly over paid with significantly higher & costlier benefits and work just about 1 day per week less than their CalFire counter parts.


CalFire is a leading provider of cost effective contract firefighting throughout the state, including numerous cities & counties much larger and more challenging than San Luis Obispo.


I am not or never was affiliated with CalFire.


slojo

Bob,


Wow. That is laughable.


SLOFD provides more personnel per apparatus, paramedics on all apparatus and faster response times.


It would be an absolute disaster for the city to contract with CalFire.


Bob

slojo, Compare apples to apples.


Try comparing CalFire contract cities statewide with the stats of SLOFD. You’ll find on average they are the same and in many cases better and at a lower annual operating cost.


Remember the county of San Luis Obispo gets from CalFire what they pay for, and they are getting a good deal and far more for the money spent than the city of SLO. County-CalFire does a very good job with the few resources they have spread over 3,000 square miles with a mostly rural population and it’s many remote locations.


Trying to compare urban city response times with rural county response times is comparing apples to oranges.


Again, be a thinker not a follower.


slojo

Bob,


Comparing SLOFD to CalFire is comapring apples to oranges.


For example, on my scanner tonight just about an hour ago I heard a medical call go down. SLOFD responded and was there in less than 4 minutes with at least one paramedic and advanced life support equipment. Guess where the ambulance was responding from? CAMBRIA.


So my question to you is, how do you think CalFire could have done a better job by responding to that call with NO PARAMEDICS on thier engine??????


Kevin Rice

So, you’re saying SLO has inadequate ambulance service, then?


slojo

SLORider….you are the firefighter, you tell me. Is it adequate service with a response time from Cambria to San Luis?


Kevin Rice

Not enough info. Depends on frequency of occurrence and what exceptional circumstances may have existed. Fire could respond from Cambria as well, given an easily imagined scenario.


Bob

If they were not paying the ridicules and expensive surcharge to the fire department to respond to the same call, the ambulance service could afford to increase the number of ambulances to provide greater coverage and availability in the event of multiple responses or large incidents. Most medical responses do not require ALS treatment from fire departments.


CalFire provides firefighter paramedics to those contract jurisdictions who fund it. IE: Los Osos, Nipomo and numerous contract city locations statewide.


easymoney

On all 911 medical aid calls the ambulance is dispatched first, then fire departments. Many times the closest ambulance is responding from a considerable distance from a previous call or from delivering their last patient to a hospital.

And the reason why firefighters are called first responders is because they tend to arrive FIRST…


Again it is those calling 911, who trigger dispatch to send resources depending on the severity of the reported incident.

The only time an ambulance arrives by itself, is when a citizen calls them directly and requests transport. And unless you are unresponsive and critical para medics always ask if you wish aid and wish to be transported via ambulance. You always have the option to arrange for private transport for non emergency incidents. Most people do not chose that option, secure in knowing they are being attended to constantly by medics and being delivered to the hospital of their choice at code 3.


slojo

Fire is dispatched first due to the enchanced 911 system.

Also, your firefighters area is the City unlike SLO Ambulance, thier’s is the county. The only available ambulance could be as far away as Atascadero. Your fire medic will never be more than 4 minutes away.


slojo

Your response is ignorant. SLO ambulance was responding to a call in SLO from Cambria. I don’t know why the heck they were in Cambria in the first place but they were.


There are not 5 fireman on an engine standing around. There are only 3 (4 on the truck) and at least one is a medic and they happen to be the ones who save these people’s lives. When the ambulance gets there, the fire medics continue thier patient care by riding in the ambulance to the hospital with thier patient. The ambulance medic is an “assistant” at that point to the fire medic.


Don’t you get it? The fire dept. can get there faster.


easymoney

slojo,

Hope you were not refering to me. Personal attacks serve little constructive good. And since I am a first responder I know exactly how many are on my engine and what SOP is for county response…


simplelife

They may get there faster. Although that doesn’t mean there doing anything that’s going to make a difference. Let the ego go for a minute. Small % of calls require true advanced life support intervention and that takes place after basic life support procedures.


simplelife

Actually regardless of which paramedic arrived first they are by law equally responsible for the pts level of care and treatment.