EMSA or TFD?

[Double A]

The city of Tulsa paid paid almost two million dollars in subsidies to EMSA this year. That cost is expected to increase substantially over the next few years. Not to mention, that it looks like Tulsa is also subsidizing EMSA service to the suburbs. I am willing to give the TFD a shot.

Firefighters seek to supplant EMSA
By P.J. LASSEK World Staff Writer
10/11/2006

The Tulsa Fire Department will submit a proposal Wednesday that claims it can provide ambulance service to the city cheaper than EMSA can, Deputy Fire Chief David Dayringer said.

Tina Wells, a spokeswoman for the Emergency Medical Services Authority, responded that no service provider can match EMSA for cost and quality.

This is the first year that the city has been asked to subsidize EMSA because of reductions in Medicare and Medicaid reimbursement.

The cuts, which started in 2002, are scheduled to lower the reimbursements to 27 percent less than the cost of service by 2010, Wells said.

EMSA was able to absorb the reduction-fed deficit through its cash reserve, but that is now depleted.

The subsidy for EMSA this year is $2,745,000. Tulsa is paying $1,873,000; Bixby, Jenks, and Sand Springs are paying a total of $192,000; and EMSA is paying $680,000 from its cash reserve.
The City Council has until Oct. 31 to

decide whether to renew the EMSA Trust for five more years.

The renewal will be automatic if the council does nothing. If the council dissolves the trust, there will be a two-year transition period.

Dayringer said the department was asked during the budget process last spring to submit its costs for providing ambulance service after it became apparent that EMSA would seek a direct city subsidy.

Dayringer said he could not release specifics until after Mayor Kathy Taylor reviews the proposal, "but we think we can provide at least the same quality of service at a savings to the city."

He said the Fire Department already had an emergency system and available staff.

Firefighters Local No. 176 President Dennis Moseby said this was not the first time the department has suggested taking over the ambulance service. The department is already the city's first-responder to medical emergencies, he said.

The department also has cross-trained firefighters as paramedics or emergency medical technicians, he said.

EMSA provides a good service, but it is run for profit, Moseby said. The Fire Department "can take the profit nature out of it and return the profit back to the general fund," he said.

The Oklahoma City Fire Department also is trying to determine whether to take over ambulance service, Moseby said.

Wells said EMSA was included in the Oklahoma City Fire Department's cost analysis and was able to review its figures for providing service.

"We don't know what Tulsa is doing," she said.

The situation is not isolated to Tulsa, she said. No matter who provides ambulance service, she said, the cuts in federal reimbursement are an issue.

Wells said 49 percent of EMSA patients are covered by Medicare or Medicaid; 30 percent are uninsured; and 21 percent pay billed charges.

A rate increase would cover only about 9 percent of costs because the uninsured can't pay and the federal government reimburses according to its own schedule, she said.

"How high can you raise the rates?" Wells asked. "They have to be an amount that the officials can stand behind politically."

Wells said EMSA had been "highly successful in limiting costs for cities it serves and providing excellent value for patients."

She noted that EMSA has the second-lowest subsidy per response among 10 other comparable cities.

[Kiah]

quote:Originally posted by Double A

The city of Tulsa paid paid almost two million dollars in subsidies to EMSA this year. That cost is expected to increase substantially over the next few years. Not to mention, that it looks like Tulsa is also subsidizing EMSA service to the suburbs. I am willing to give the TFD a shot.

So a city "subsidy" is the only basis for your opinion on the subject?

What about the fact that the city is "subsidizing" TFD to the tune of $56,000,000 this year?  What about TFD's Hazmat and other response "subsidies" to the suburbs?

City Budget - Public Safety

For that matter, what about our $80 million annual "subsidy" to the Tulsa Police Department?  Maybe all public safety responses should be offered only a fee-for-service basis?

[shadows]

I was billed for over $700 dollars for a non-emergency 10 mile transfer by EMSA.   Compare after finding out how much an emergency run will cost the taxpayer who is maintaining two standby services where only one is needed.  Let the FD transfer non-emergency transfers.

[fung shui]

Trying to get the collective bargaining unit of TFD to agree to the duties of an EMS will be next to impossible. Plus EMSA subsidy is less due to non-emergency transfers. Do we really want our FF out making nursing home runs when your house is on fire? I do agree that first responders should be driving smaller vehicles.TextText

[shadows]

It is time to have an outside audit of the operations and compare cost anticipated.  This government has too many non-producing duplicating management.  Who do you think is paying for office and management space for EMSA?

[Double A]

quote:Originally posted by shadows

It is time to have an outside audit of the operations and compare cost anticipated.  This government has too many non-producing duplicating management.  Who do you think is paying for office and management space for EMSA?

I wonder how much the executive compensation packages are for EMSA?

[planejanedoe]

Correct me if I am wrong - but doesn't it seem like no matter who you call the Fire Department shows up first....that is a plus if you think about it!!!

[p_tulsa]

The thought of the Tulsa Fire Department taking over EMS is an endeavor I hope to never see in my lifetime.  As a resident or Tulsa and someone with firsthand knowledge of both entities, I hope the superb clinical care of EMSA is not dissolved.  Several years ago, the Tulsa Fire Department put some firefighters through training to be "paramedics" and they began to provide first reponse at that level.  Tulsa Fire "paramedics" take care of patients for only 2-3 minutes before an EMSA paramedic arrives and transports the patients.  Some of them are excellent paramedics and have experience taking care of patients, they all happen to work at EMSA as well.  I will not get into specifics, but I hope that pre-hospital care is left to those who are experienced in managing the patient for more than 60 seconds.  If money needs to be saved than the fire department should stop sending their 4 mile to the gallon fire trucks to stubbed toes or headaches to justify their existence.  The system works well with an excellent fire supression agency and a separate EMS provider.

[papaspot]

I don't know what's best on this but I sure don't have any problem with looking at stuff like this once in a while and asking the question. I'm just not sure that TFD fully realizes what they'd be getting in to. And there are questions of money that go beyond just the day to day cost of running the operation. There's a lot of capital that the City would have to buy if TFD took it over. I ASSUME that EMSA owns its rolling stock and I doubt if they're gonna just hand it over to the City as a present.

As far as the better response time goes, that's one of many factors. And just because the fire truck is usually on scene before the MICU doesn't mean that TFD could routinely get there first with an MICU. I know that one poster said that EMSA has units all over Tulsa, but I'd have to see the distribution on that before I would agree that the distribution of the fire stations wasn't the main reason for that. And unless you're gonna have a MICU at EVERY FIRE STATION, you can't assume that TFD would be able to have a quicker response time than EMSA does now.

[Mike G]

Update on the EMSA contract:

OKC decided today to renew with EMSA Western Division (Oklahoma City and surrounding suburbs).

Tulsa's City Council seems to be pro EMSA once the fire departments proposal was looked at in depth.

quote:Originally posted by papaspot

I ASSUME that EMSA owns its rolling stock and I doubt if they're gonna just hand it over to the City as a present..

Actually the city owns most of our non-disposable items, including trucks, equipment like monitors, our building, etc...

Paramedics Plus, which is our contract owner, pays for all disposable items like one-time use medical eqipment, personnel, etc...

quote:Originally posted by papaspot

As far as the better response time goes, that's one of many factors. And just because the fire truck is usually on scene before the MICU doesn't mean that TFD could routinely get there first... ...one poster said that EMSA has units all over Tulsa...

Actaully our trucks aren't considered MICU units, just regular Paramedic units which is basically the next step down.  Response vehicles are generally classified (from lowest to highest) as First Responder, Basic, Paramedic (which is what EMSA has), MICU (Mobile Intensive Care Unit).  A first responder is someone (generally an EMT or Paramedic) without an ambulance.  Basic would be an ambulance with only Basic level EMT training.  Paramedic would be an ambulance with at least one Paramedic on board.  I believe in Oklahoma, a MICU is an amublance with at least one Paramedic and one Intermediate.  We do have Intermediates at EMSA, but we really don't consider any of our trucks MICU even though we might have two Para's on a truck.

Now on the response times.  TFD has an average response time of 4m20s.  EMSA's average is 6min.  The catch is this:  We use what is called System Status Management (SSM) to place our trucks around town.  This means we have no stations, but "posts" (where you see the ambulance setting at QuikTrip).  The system is designed to keep the trucks evenly distributed in strategic locations around town.  So each time a call comes in, the trucks move to even out coverage.  This is very nice in the event that you have multiple calls in the same area in an hour or less (which happens all the time).  So in a lot of situations, the fire dept. arrives first because they are responding from no more than a mile or two away, while the amulance might be four or five miles away.  The fire dept first responds on a lot of our calls because they have trained Basics and some stations have Paramedics that can begin to treat the patient until an amulance arrives.  Then they return to the station.  Now in the event another call goes out in the same area say 5 minutes later after the first call was made, the fire dept can first respond to the call to treat the patient while the next truck is en-route.  This is best for the patient because they call 911 and within minutes someone is there to help.

Now the issue that can lie with having ambulances at stations is after that second call, a third goes out in the same area.  Now instead of having an ambulance either already in that area or headed that way, you have to call a third ambulance from a station which now is farther away than the first two.  So now you REALLY have no coverage for that area until one of those three amulances is done.  Assuming they all transported, you're talking about 25-35+ minutes until they are ready for another call, so that area of town would be left short.  Nevermind how busy the stations in the busy areas of town would be for a whole shift and the other stations would get very few calls.  SSM keeps trucks distributed so that there is always one close by, no matter how many calls are going out in that area.  I can't tell you how many times we've had calls literally within minutes of each other that were located within blocks of each other, or in the case of like the Day Center or Salvation Army area, we might have 3-4 trucks on calls within an 1/8th mile area around Archer and Denver area which is home to the Day Center, Salvation Army, and John 3:16 shelters as well as the YMCA and the Jail.

Hope that wasn't too confusing, but I'm just trying to demonstrate how our SSM is better than having ambulances at a fixed station when it comes to response times.  Tulsa Fire does an excellent job with medical calls and helping us when we need an extra hand.  But I would rather live in a city that when I call 911, I know someone will be there within minutes to help.  So by the fire dept. first responding, then EMSA taking over care and the fire dept. clearing from the scene, they are now available within minutes of them arriving at the call to take another emergency if need-be.  We also try to help each other out by if we show up first and don't need fire, we will cancel them.  If they show up and there's no need for an ambulance, they will cancel us.

[RecycleMichael]

Welcome to the forum, Mike.

It is nice to have an EMSA EMT on the forum. We have experts in many areas on this forum and we love to share information.

I don't have any firm positions on the topic, but feel there has to be a more fuel-efficient vehicle to respond besides the big fire trucks.

You said that the Tulsa City Councilors had looked at the Fire Department proposal and now were pro-EMSA. Do you know which councilors?

I liked your rational for having ambulances staged at better locations than just at fire stations? Could there be a combination of some fire stations and some Quik-Trips for staging?

I was not aware of the contract owner, Paramedics Plus. I always assumed it was ran by EMSA themselves. How long has the work been contracted to them and how much time is left on the contract?

[makelifebetter4ok]

quote:Originally posted by recyclemichael

I don't have any firm positions on the topic, but feel there has to be a more fuel-efficient vehicle to respond besides the big fire trucks.

Miami, FL uses motorcycle responders.  Probably more for quicker times through traffic jams more than fuel efficiency.  EMT Mike, thanks for the inside scoop.  Very enlightening read.

[protulsa]

quote:Originally posted by recyclemichael

Welcome to the forum, Mike.

It is nice to have an EMSA EMT on the forum. We have experts in many areas on this forum and we love to share information.

I don't have any firm positions on the topic, but feel there has to be a more fuel-efficient vehicle to respond besides the big fire trucks.

You said that the Tulsa City Councilors had looked at the Fire Department proposal and now were pro-EMSA. Do you know which councilors?

I liked your rational for having ambulances staged at better locations than just at fire stations? Could there be a combination of some fire stations and some Quik-Trips for staging?

I was not aware of the contract owner, Paramedics Plus. I always assumed it was ran by EMSA themselves. How long has the work been contracted to them and how much time is left on the contract?

The cost of running big fire trucks is nothing compared to the ENORMOUS fire stations they are building.  The one at 111th and Yale looks to be about 15,000 square feet.  That much space for 4 firemen?  I cant imagine what it would cost to run the utilities.

Why cant the city build with an eye toward the future? Do they assume tax revenue will increase forever?  The answer is YES when you take a look at this new station.  It seems highly irresponsible.

[sgrizzle]

I would imagine that 15,000 sq ft is more than 4 fireman.

[protulsa]

most stations have 1 company. thats 4 or 5 men
some stations have 2 companies. 8-10 men
only a few have chiefs, so 9-12 men max.

I have been told that new south station will have 1 company, no chief.