Commission looking for interested ambulance providers

By Bob Steenson, bsteenson@charlescitypress.com

Representatives of the city, the county and the hospital spent a couple of hours Thursday afternoon discussing ambulance service and how to sustain it.

The two primary issues facing the Floyd County Ambulance Commission are how to continue service without spending a lot more money, and how to expand service to cover transfers from the Floyd County Medical Center to other facilities when needed.

The commission decided to seek information from several regional ambulance companies in addition to the current provider, AMR, to see if they are interested in providing service to Floyd County, what that level of service would be, and what it will cost.

Requests for information will be sent to Area Ambulance Service of the Cedar Rapids and Marion area, which made a presentation to the commission at the last meeting two weeks ago, and to Chickasaw Ambulance Services, the Mason City Fire Department ambulance services, Waverly Health Center ambulance and possibly others.

The topic of ambulance coverage has been in the forefront for more than a year, since AMR ambulance said it could no longer afford to provide its service level for the money it was earning.

Last year, Charles City agreed to a one-year contract with AMR for fiscal year 2019-20, paying the ambulance company a $50,000 subsidy and dropping almost $24,000 in fees it had been charging AMR, for storage of the ambulances at the city fire station, for firefighters to drive the ambulances and for county radio dispatch service.

That was short the $125,000 that had been requested, and the contract required that AMR have an advanced life support ambulance with a paramedic available at all times to serve the city and St. Charles ambulance district.

That requirement has meant that sometimes AMR has not had a paramedic ambulance to respond to calls outside Charles City, although Dawn Staudt, AMR station supervisor in Charles City, has said the company continues to respond to all 911 calls in the county.

The other problem is that AMR often does not have a paramedic-level ambulance available to transport patients.

Kathy Haus, the emergency room nurse director at Floyd County Medical Center, presented information at the meeting showing the number of patients who needed transfer to a facility with a higher level of care, and how long they had to wait for transfers.

Looking at the time the ER began looking for an emergency medical service for transfer until the time the patient left the ER, Haus said, in October 42% of transfers occurred within an hour.

“So over half did not,” she said.

In November, 48% of transfers left within 60 minutes, and in December 62% left within an hour.

The majority of transfers were done by ambulance services other than AMR, or by private vehicle or the Sheriff’s Office, Haus said.

Haus said a couple of times when they needed advanced life support-level transport and a paramedic wasn’t available from AMR to leave the area, a registered nurse accompanied the AMR ambulance.

But Rod Nordeng, medical center administrator, said a recent annual review by the hospital’s malpractice and liability insurance provider told the hospital to “immediately end” the practice of sending a registered nurse on ambulance transports.

The commission members had a lengthy discussion on sending nurses when a paramedic is not available.
Some commission members said they knew of other hospitals where RNs went on ambulance calls, and Staudt said getting a registered nurse certified as a paramedic is “just paperwork.”

“A medical director may require them to do maybe a four-hour refresher on certain cardiac things that they don’t deal with on a regular basis, or covering intubation,” Staudt said.

But Haus said the Floyd County Medical Center registered nurses do not do intubations because they have certified registered nurse anesthetists that do that, and Police Chief Hugh Anderson said a registered nurse may put his or her RN license at risk if they go on an ambulance transfer and do something wrong.

The real issue, Nordeng said, is staffing. Nurses are already cross-trained to cover multiple departments and the hospital doesn’t have the staff to have nurses gone for hours for transports. And, nurses don’t want to do transports.

Anderson noted that at the previous ambulance commission meeting the group had voted to recommend the city and the county each set aside $75,000 for ambulance service in the next fiscal year beginning July 1.

AMR has requested more than $260,000 in subsidy next year, commission member and Floyd County Supervisor Roy Schwickerath has said.

“Has the hospital talked about budgeting for ambulance?” Anderson asked.

Nordeng said the hospital board has not discussed it, and “ I just don’t see it on the radar screen for the hospital, with the cuts that we’ve had … to add that in the budget.”

Commission members wondered if the city and the county both decide to subsidize AMR in the next fiscal year, if the contract would be rewritten so that a paramedic ambulance isn’t required for only Charles City.

Staudt said the conditions of the contract are up to whoever signs it.

Steve Diers, Charles City administrator, said he had been looking at the call reports and wondered if the city’s 24/7 paramedic requirement had been too restrictive, because many times a paramedic-level ambulance could have been used for transfers without being needed in the city.

He noted that the representatives of Area Ambulance at the previous commission meeting said they couldn’t remember a time when a paramedic ambulance was used for transport that a basic life support ambulance staffed by EMTs wasn’t sufficient to cover calls in Independence, where Area Ambulance also provides service.

Nordeng and Haus both said that transfers should be looked at the in the same light as emergency responses, because if someone needs to be transported to a hospital that can provide cardiac care, that’s just as important as responding to an emergency in the field.

The commission had on its agenda to consider sending requests for proposals to other ambulance companies, but decided it didn’t have enough specific information for that, and instead would send requests for information.

Various commission members will gather statistics about the service level in the county and send it to Diers in the next week, and he will compose a request for information, send it to commission members for comment, then send it to the ambulance companies in about two weeks.

Schwickerath said if the commission is talking about a countywide service, it will be important to get the ambulance services in Nora Springs and Greene to be part of the conversation, also.

Ambulance commission members are City Council member Keith Starr, Police Chief Anderson, Fire Chief Whipple, Supervisor Schwickerath, Floyd County Medical Center Administrator Nordeng and ER Nurse Director Haus. Staudt as the representative of the ambulance service is a non-voting member.