Ambulance choice needs in-depth study
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Quality ambulance service at a fair and reasonable price is crucial to our community. In the city of Columbus, statutory responsibility for emergency medical services prior to arrival at Columbus Regional Hospital, rests with city government. As your mayor, this is an awesome responsibility I take most seriously.
The Columbus Fire Department, as well as the nearest available ambulance, respond to every life-threatening 911 call for emergency medical services in the city. In 2011, that number exceeded 3,000 calls.
We do this, because, at any time, we have 25 firefighters housed in six fire stations strategically located throughout the city. They are best positioned to provide time-critical medical interventions. Most often, our firefighters arrive first on the scene, on average between three to five minutes, and begin medical treatment to ensure optimal victim survivability until an ambulance arrives.
More than 90 Columbus firefighters are trained and certified in basic emergency medical treatment and many are paramedics who perform advanced medical treatment. All provide medical services under the medical control and supervision of Columbus Regional Hospital.
Until 2006, the Columbus Fire Department also provided county-wide ambulance service. Since then, the city and county have outsourced our ambulance service to CRH, which operates four dedicated advanced life support ambulances, each manned with an emergency medical technician and a paramedic. CRH personnel provide excellent emergency medical care for which we are tremendously grateful.
Our contract with CRH for ambulance service expires this December. Since 2006, the city and county governments have paid CRH nearly $6 million in tax subsidies to supplement CRH’s user fees. Ambulance service is a reimbursable medical expense. This year, the payments from the city and county to CRH total almost $1 million.
We surveyed the other 42 municipalities in the state with populations greater than 20,000. The majority provide ambulance service directly through their fire departments. Only 15 cities outsource their ambulance service, 10 to private providers such as Rural Metro and five to local hospitals. Of those, we found none paying a tax subsidy to either a private provider or a hospital.
Earlier this year, the County Commissioners challenged CRH to eliminate the tax subsidy. CRH responded with a “flex” plan that allows the hospital the flexibility to reduce the number of ALS ambulances dedicated to 911 emergency runs at various times. By what number and when would be determined in the future after further analysis.
Service levels are the city’s first and foremost requirements. Price is very secondary. Our fire chief and deputy chief of emergency medical services determined the city’s needs based on national standards for response times and quality of care.
Factoring in our geography and run volume, they determined the city needs three dedicated ALS ambulances at three of our fire stations in order to exceed the national standard for urban response times of fewer than nine minutes more than 90 percent of the time.
For a county-wide service, which is preferable to all, our fire department determined that we need to continue with no fewer than our current level of four dedicated ALS ambulances.
With these quality of service requirements set, the city is considering CRH and other experienced front-line 911 ambulance providers. The city is not required by law to undergo a competitive process but we have voluntarily chosen to do so. We requested city-wide and county-wide proposals from three private 911 ambulance providers in our region, Columbus Regional Hospital and the Columbus Fire Department.
If a provider other than CRH is chosen, we require hiring preferences be given to CRH employees. The need for our community’s competent and compassionate ambulance personnel doesn’t go away.
Also, medical control and medical supervision of ambulance personnel by the emergency room doctors at CRH remains a must, just as it is today for our firefighters.
Private providers, Rural Metro and Trans-Care, both offer to provide four dedicated ALS ambulances for a countywide service for zero-tax subsidy. Private provider Seals requires a $175,000 annual subsidy. CRH requires an annual subsidy of $583,750 with 3 percent annual increases.
Columbus Fire Department estimates it can provide countywide service at a net loss of roughly $300,000 a year after an initial cash outlay of $1.2 million.
To date, we have had 16 public meetings with public comment, including four City Council meetings, six Board of Public Works and Safety meetings, one County Council meeting, one commissioners meeting and four city-county ambulance board meetings.
Much healthy dialogue is occurring by all concerned parties and the public about this vital community service and all options are being explored thoroughly.
The public’s best interests are being served by weighing all reasonable options in this open and transparent process. This process affords the Columbus City Board of Public Works and Safety the best opportunity to choose the highest quality ambulance service to serve our community at a fair and reasonable price.
Kristen Brown is the mayor of Columbus.
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