A Weighted Issue – The Fire Service Helping Private EMS

Very true.

By reading your response here I can only assume you agree with the FD that the EMS company should handle it on their own.
Had this been a public agency, would you feel differently?

When someone tells me, “that’s not my job.” I have two replies 1) Then what is your job and 2) What else don’t you do? Rhetorical traps that almost inevitably lead to the refuser doing the job anyway or really wishing they had just done it in the first place.

I had enough to say about this that I wrote a post http://www.everydayemstips.com/?p=3736

Thanks Chris for sparking and encouraging this discussion.

The Deputy Chief states that the FD has had “[s]everal firefighters had received workers’ compensation because of back injuries suffered while lifting obese patients under those circumstances…” (http://www.jems.com/article/news/illinois-fire-department-refus)

So, it is known that these types of non-emergent calls have resulted in injuries to FF’s in the past, and the FD does something to protect their employees.

The primary job of the FD is to respond to emergencies. If a firefighter or firefighters are injured while on a non-emergent call, that puts the company out of service and unable to perform their primary job.

The FD has the responsibility to protect its workers as best as possible, and maintain their core service. SFD has done so with what is (in my opinion) a bad policy.

But, their argument for having the policy is perfectly valid, and reasonable. And, as Mercy is, the FD is obligated to ensure their employees safety while on the job. Mercy chose to try and save a few nickles at the expense of the Springfield taxpayer. (Personally if I was SFD I would rewrite the policy and bill private EMS for 1/2 of all calls the FD responded to with them.)

“Esmond said Medicare and Medicaid, which often cover patients Mercy Ambulance transports, don’t pay him enough to justify sending more vehicles to help the two paramedics in a single ambulance.”

Mercy wanted free labor. The owner of the company even says as much in the article..

“Esmond said he never before was refused free assistance from a municipal fire department…”

“Fire departments in those towns have been willing to spare several workers, at no charge…”

“Esmond said he hoped the [other EMS] company would help at no charge.”

Instead of Mercy eating the cash, he wanted the taxpayer to soak it up.

They knew the patient weighed 700#’s before they ever went to get her, and failed to staff their vehicle adequately to perform the task they were HIRED to do because it would have cut into their profit.

I don’t think the FD policy is smart, but the total fault here lies only with Mercy Ambulance.

As far as this idea goes. It is their call. What if the call was to help lift you or your family member into bed after a surgery? Your argument is one that happens over and over again in the Fire service. “be available for the next call” What about the current call? It seems to me that this person pays taxes too is a citizen and deserves all the compassionate care we can give. Sometimes this includes lifting a person up, cleaning a person up or just flat out being there.

Agreed, EMS 2.0 is many things to different people.

I will give it to you that in the big picture transport companies can be identified as part of the EMS system in some systems.

However, failure to complete a task will not get them a warm reception.

I still stand firm with…

Fire Departments and EMS Departments have too much to worry about doing more and more with less and less. We simply cannot be taxed by private companies shortcomings.

As for “what if” the transport companies didn’t exist…that is preposterous. Where there is that much money to be made, there is someone willing to make it!

Remember this was a non-emergent transport for a woman back to her house.

HERE IS ANOTHER POINT TO PONDER….

If the company owner is that fumed over the fact that they didn’t get any help…The next 911 EMS call the County gets, they should call Mercy Ambulance and have them run the call, transport the pt. and then the County can turn in the billing to insurance or otherwise to collect…How do you think the owner of Mercy would feel about this? Working for free and doing someone else’s job?

Wow. Your comments are very telling of your attitude toward patients in general. “This is a cab ride for a fat person. Plain and simple.” This is perhaps the most jaded view of the people we serve I have ever seen. I sincerely hope this is not your view. As the leader of an EMS organization, people that talk like that don’t last long. It is a shame and perhaps the saddest depiction of your jaded view is that you said “No EMS required”

Your view is the heart of the problem with our industry. We really need compassionate health care providers not a light and siren chasing adrenaline junkies.

Lol… is this an attempt to make me take over Chris’s blog or write another blog post?

The short answer is that, traditionally, EMS is horrible in communicating. We’re horrible in communicating our value, what we can and cannot do, what the cost of not funding that value is, and how we provide it effectively.

One of the problems with the fiscal requirements is that when we think in terms of EMS we think in terms of only fiscal loss. When the public thinks in terms of Fire and LE (just examples), they think in terms of fiscal cost vs. value loss. Property damage from a fire can be reduced with a fire service, and property loss can be reduced with law enforcement. People do not make the connection of fiscal loss with their health.

It’s a challenging roadblock to overcome… but nothing’s impossible… impossible just takes a little longer.

I don’t work for a company that transports people from the hospital home. I work for a public service department that runs calls for anyone who wants to call 911.

We don’t have priority dispatchers, and our dispatchers are trained in first responder at best. They have SOP’s to follow on who goes on what.

If someone calls 911 they get any or all of the following: PD, Medic Truck, Engine Company.

I have a great attitude, I have great pt. care, and I am a great EMT. I am compassionate and I am great at what I do. I don’t work for a private ambulance company, Lowe’s, or McDonalds and I don’t intend to do their jobs if they think that is what the FD is for.

What bothers me most about all of these comments is that so many EMS professionals complain about BS calls in the middle of the night but they have no problem with helping out a company complete their task that THEY are getting paid for. If they need 10 people to move the person then they need to call their boss to find them. Not 911.

If this person had an emergency you better believe that I would break my back getting them into the ambulance and to the hospital. That is what I do….Our EMS system is a one way fare as I believe that most are with the exception of departments like the Richmond Ambulance Authority (911 and non-emergent xport).

I apologize if you don’t like my candor on this forum. I just find it hard to believe that anyone is making any headway with progressing EMS with much of the mindset on this forum.

I also imagine that many of you are pulling your hair out at my comments. That is fine. I am only hanging around because I really want to hear some COMPELLING argument why this situation is ok.

This situation is ok because it is the right thing to do.

Not to constantly be repeating myself here, but I agree that the private ambulance company in this case was also in the wrong. For that matter I would hold their accountability higher than that of the fire department due to inept communication and planning, but that still does not excuse the inaction of the fire department.

I do want to address one specific part of your comment:

As for “what if” the transport companies didn’t exist…that is preposterous. Where there is that much money to be made, there is someone willing to make it!

Actually that is not preposterous. Private ambulance companies see on average a profit margin of between 3%-5%. Some years are slightly better, some years are slightly worse but that’s generally what the average is. With the continual reductions in Medicaid and Medicare since the 90′s they have been doing more with less longer than most municipalities. So do not be surprised if one day your local private ambulance company closes and your municipality is placed in the position of doing the non-emegency transports… or close your local hospital to incoming emergent patients.

I’ve already addressed the perspective of emergent vs. non-emergent, but in closing I will say that as far as I can tell had the Fire Department provided the assistance the firefighters would still be getting their paychecks at the end of the week and the department would still have their budget at the end/beginning of the year funded by taxpayers for the services they are to provide. The same way that the Mercy Ambulance medics would get their check, and Mercy Ambulance would have a fiscal budget at the end/beginning of the year funded by the insurance companies for the service they provided as opposed to have yet to provide… hopefully.

At the end of that call though, the one who truly suffered was the patient who spent 8-10 hours (based on Chris’s travel estimates) strapped to a stretcher, 4-5 of those hours undoubtedly embarrassed and depressed at the seeming hopelessness of her situation.

That to me is the greater crime, if there has to be one.

Obviously you know more about transport companies (and I knew that going into this discussion)…It just seemed to me in my area that the companies aren’t hurting. Although going on the current healthcare trends and projected stats read in magazines I can understand the lack of growth.

You keep bringing up the not caring part…If the private ambulance crew had cared they would have had the forethought to have some help when they got to the destination to get the person into the house.

What kind of planning goes into a transport that long without thinking about what they are going to do when they get there?

Why go after the FD for poor PR? Why not go after the private ambo company for poor planning, irresponsibility, poor decision making, and not caring? Is the FD that easy of a target that you are willing to overlook the wrong doing of the private ambo company?

Sure, we do stuff every day in our ever expanding job description but we have to be able to draw the line in the sand somewhere!

http://rescuingprovidence.com/2006/11/03/dignity/

Here’s a little blast from the past. Send the FD, lift the lady and let the ambulance company bill the patients insurance. It’s not like it happens every day, why do we make such a big deal out of little (well, maybe not so little) things. I haven’t read all the commentary here, that’s a lot of comments!

It seems to me like there is a happy medium in here somewhere. The fact remains that this woman needs to wind up at home. Since she is likely bed confined, she meets the Medicare requirements for ambulance transport. If the fire-based ambulance is unwilling to drive 5 hours to pick her up (as is their right as they are not contractually obligated to do so) someone has to do it.

I will certainly grant HM that the ambulance service was foolish to take a job they knew they could not complete but think the FD is equally as foolish for turning down a “public assist” call. People call 911 for all kinds of ridiculous things. Most of those things get a response from fire, PD or ambulance. I fail to see the difference between this woman needing a “lift assist” to get into her house and her needing a “lift assist” after sliding out of her recliner. The only one in my mind is that she would have activated 911 on her own for the second call.

I don’t necessarily buy the argument that the ambulance company took this call for the right reason. Not knowing the billing scheme for that particular system, I think that it is likely that the provider is reimbursed a base rate and then paid for mileage. A five hour transport is a good money maker, particularly for a small, upstart service. Like any call, it is incumbent on the provider to ensure that they can complete the call they accepted. They didn’t send enough resources to the call, same as if a BLS crew responded for an interfacility transfer for a patient on a vent and a balloon pump.

At the end of the day, both parties are at fault. The BLS provider assumed that help would be available and the fire department just isn’t playing nicely in the sandbox. As much of a cliche as it is, we’re all on the same team. I have routinely picked up 911 patients in one town and transported to a receiving facility in another and requested a FD life assist, I have not yet been turned down.

As far as the fire department charging for the response, I can see both sides. I think that fee for service fire response is a dangerous road to go down but there is certainly precedent. Many search and rescue programs (particularly ski patrols) will charge for those of us foolish enough to go out of our way to get lost. Businesses with frequent burglar alarm activations are charged after a certain number of responses.

It’s a tough argument either way you look at it, but ultimately it is incumbent on us to do what is right for the patient.

I had a twitter discussion with Happy Medic about this last night.

My take on it is that, given the extenuating circumstances (Long Distance run, etc)… the FD should have just done the lift assist, and they then spend the next weeks sending harshly worded letters back and forth.

I’ve been on both sides here – my 911 ambualnce was called by a private because they needed a lift assist. We did it… and managment addressed the issue so it didn’t happen routinely.

The private I currently work for has bariatric capabilities, including the super Stryker strecher, ramps and winch kit. That whole kit gets deployed with at LEAST 4-6 people. And more will be needed, depending on how we have to move the patient. I can’t fathom a private company accepting a transport like this in my area without sending 2+ units. It almost sounds like the transport company was trying to suck up to the hosptial and take a run as a “favor” so they get more work.

I will say that I don’t think this should be a routine expectation of the local FD. However, in extenuating circumstances, I don’t see why a taxpayer can’t get some help from the FD in a time of need.

What drew my ire on this story (and I posted on it today without knowing about the hornets nest in here) was the air of entitlement bellowed out by the owner of a private company to demand the taxpayers bail his ass out for not being able to complete the job he got paid for. By the taxpayers.

God bless America.

Let’s stop talking about SFD as if they, in this single action, represent the spirit of the American fire service. They don’t. Did they have a right to do what they did? Yes. Was it the right thing to do? No.

This is one big EMS service fail.

When people get stuck in a bad situation that they can’t get themselves out of, they call the fire department. When private EMS services get themselves stuck in a bad situation, they call the fire department. And we come. And we fix it. Every time. All across America, right now, firefighters are helping people out of bad situations.

Shame on the ambulance service for getting the patient into a bad situation. Shame on the fire crew for not helping them out of it.

Couple things. 1) The SFD was following a policy that had been in place for over a year prior to this incident and was created because of injuries to their personnel. Everyone is complaining about taxpayer money, what happens when a couple firefighters are injured moving this patient and then go out on disability? The taxpayer is being hit twice in that scenario. 2) My department has had several of these pt’s in town over the years. The last one that we dealt with on a regular basis resulted in the department dispatching a full-still assignment when she called. 2 Engines, a Truck and an Ambulance. Most times our Squad company would also be special called. Now, the difference is that this happened when she called 911 because she couldn’t breathe or had another ailment. Never once when she was coming back home from a stay in the hospital.

Risk is risk. But there is calculated and non-claculated as well. When someone calls 911 and you are thrust into a situation that is non-calculated and you adjust on the fly or go off past experience, SOG’s etc. When you face a situation enough times you develop a plan for handling it, calculated. The plan in this case was to not expose personnel to undue risk of injury in the event a private, for profit, entity called for non-emergent assistance. They wrote a rule and reg or SOG and it was followed. Period.

Had the situation been reversed and the pt were at home and decided to call a private for transport because, say she wanted to go to a hospital that is outside the FD or local EMS agency’s area, and the private called for help once they got there, different story. In that situation the pt is seeking medical treatment for an emergency, severe or not, and wishes to go to the hospital for treatment. Then, SFD would have been obligated to help. My department does that exact kind of thing regularly. To get someone back home, however? I’m with the FD on this one. Someone at Mercy should have looked at the big picture and done some planning before this transport. A phone call to the FD ahead of time by someone at the private and no one would know about this.

There is a large difference between a FD refusing to help EMS 911, and a private prescheduled transfer to a residence. I hope that were you worked your FD has a change of heart towards their EMS providers on 911 calls, because that is a very bad problem.

Being a medic at a private IFT company and having experience with working for a 911 company also I can easily see both sides. SFD’s policy is well within their rights to have. The private service should have not relied on the FD do provide the extra manpower. However the fact is that taking three rigs out on one call for however many hours the call actually took. Not just getting the patient from the hospital to home, but also how long did it take for the crew to get back. In my experience typically when you get a call that takes four or five hours to get to the destination, it becomes an all day task. Should the private service taken the call…. probably not. More then likely what happened was the crew arrived onscene and requested additional crews for help and were told that they would need to call the FD when they got the patient home.

SFD does not provide transport services period.