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Ambulance service options under scrutiny

Ambulance service options under scrutiny
This map handed out at a Floyd County Ambulance Commission meeting last week, shows districts used by Floyd County dispatchers to dispatch ambulance service in the county.
By Bob Steenson,

If you have a medical emergency and call 911, will an ambulance come?

In Floyd County, the answer is yes.

But it’s not always certain which ambulance company, in what amount of time, and with what level of service you’ll get.

And concerns over funding and being able to find properly trained staff are making those questions increasing difficult to answer.

About 30 people — elected officials, ambulance company representatives, EMS (emergency medical response) personnel, law enforcement, firefighters, dispatchers, hospital representatives and others — got together last week to discuss the situation.

In the end, the group agreed to form an ad hoc committee with a representative each from the county, city and hospital to come up with a list of the services required and potential funding sources.

The gathering last week was held as a meeting of the Floyd County Ambulance Commission, a group that was formed in 1982 with representatives of Charles City, Floyd County and the Floyd County Memorial Hospital, but which has not been very active in recent years.

A number of developing issues have combined to create uncertainty regarding ambulance service:

• AMR ambulance in Charles City has signed a one-year contract with Charles City, requiring that an advanced life support (ALS) ambulance and paramedic crew be available 24/7 to serve Charles City and the St. Charles ambulance district.

That contract came after the city agreed to drop $23,775 in annual fees it previously charged AMR for ambulances to be housed at the fire station, for dispatch services, and for city firefighters to drive the ambulances on calls. The city also agreed to pay AMR $50,000 to support the service, but that is short of the $125,000 that had been requested.

• Neither the county nor the hospital contributed toward supporting AMR, and neither is part of the city contract. AMR has no contract with any other Floyd County community or the county itself.

• Both AMR and the Mason City Fire Department ambulance service previously had informal agreements to provide backup to Nora Springs’ volunteer ambulance service, but now neither of those ambulance companies wants to regularly provide that service. It is common for the Nora Springs ambulance to have too few volunteer members available to respond to a call.

• There are times when the Floyd County Medical Center is not able to get an ALS ambulance as quickly as needed to transport a patient who needs more advanced care than the county hospital can provide.

At the meeting, Dawn Staudt, AMR’s station supervisor in Charles City, said several times that AMR will continue to respond anywhere in the county with whatever resources it has available.

“We’ve never not responded to a 911 call,” she said, but it’s a regular puzzle to have the required crew available for Charles City, plus have a backup crew, and the response may not be advanced life support.

John Gohr, the county dispatch supervisor, said if one ambulance company can’t respond to a call the dispatchers will continue contacting area ambulance companies or companies in area counties until it can find one that will.

Staudt said the number of people with EMT (emergency medical technician) certification for basic life support is sufficient, but the number of paramedics — who have advanced life support training — has decreased.

Other EMS staff at the meeting agreed that it is a problem all over to find paramedics.

The meeting delved into a wide range of topics, lasting an hour and a half. Most of the topics, however, boiled down to the amount of money available to support ambulance service and the number of paramedics available to staff the number of needed ALS crews.

Viva Boerschel, the director of nursing at Floyd County Medical Center, said that last week the hospital had a patient with a cardiac issue who needed transport to another facility, but there was a delay in getting an ambulance for transport.

“That’s not good for patient care, but it happens all the time,” she said.

Staudt said that kind of transport requires a paramedic, and if she only has one paramedic available, then under the city’s contract that paramedic has to stay in town to respond to any calls locally.

Even just going to Mason City, a hospital transport can take a paramedic out of service for about three hours, Staudt said.

Boerschel said the city should allow AMR to use the advanced life support crew to transport an emergency and have a basic life support crew ready to serve Charles City if two paramedics aren’t available.

Mark Corley, AMR’s regional director, said the city would have to allow that in its contract.

A member of the audience suggested that the hospital send an appropriately trained nurse along on medical transfers so a paramedic wouldn’t be needed, but Boerschel said the hospital didn’t have the staff.

“We can’t leave the patients we have,” she said.

Mike Hammond, a member of the Charles City Council and the city’s representative on the Ambulance Commission, said that last spring the Ambulance Commission had raised the issue after AMR said it was losing money and needed changes to continue providing service.

“The city responded. The county and the hospital didn’t,” Hammond said.

Steve Diers, Charles City administrator, said even the one-year contract the city has with AMR is a stop-gap agreement.

“It provides about half of what is needed just to have what we have now,” he said.

Roy Schwickerath, a Floyd County supervisor and member of the Ambulance Commission, and also a former Charles City firefighter and fire chief, tried to sum up the current situation.

“We have enough BLS crews, and AMR will respond, right now, to the area,” he said.

Staudt responded, “I’ll send them to any call if I have the resources.”

Schwickerath asked, “So where do we go from here?”

Corley, the AMR regional director, said the city, county, hospital and anyone else interested needs to tell him what services they want.
“You tell me the geography and I’ll tell you the number,” he said.

“I don’t think it will be pretty,” Corley said, referring to the potential cost.

“We’re upside down. We’re losing money every month,” he said.

Staudt estimated that to cover the city, county and hospital transfers would require three ALS ambulances with crews available on call.
Merrill Meese, the EMS coordinator with the Iowa Department of Public Health, said he thought the group was going down the right path.
“Figure out what you want. Figure out how to pay for it,” he said at the meeting.

Meese said there are income tax and property tax levies that can be used for emergency medical services.

Corley pointed out that even if funding is found for the level of service requested, there will still be a challenge to find enough paramedics.

Staudt said the starting salary for her paramedics now is $45,000 to $47,000.

Schwickerath said the ad hoc committee, tentatively composed of him representing the county, City Administrator Diers representing the city, and a representative from the hospital, would work to put together a goal for ambulance service coverage, and also look at the issue of staffing.

Eric Whipple, the Charles City fire chief and a former paramedic, said, “It comes down to how much you’re willing to spend, compared to what you need.”