February 13, 2001

WRT weighs pros, cons of Rural/Metro versus public ambulance

       If residents in White River Township want to upgrade ambulance service in their area, they’re going to have to pay for it.  They’ll also have to decide how they want to pay for it — either a tax hike or an increase in user fees — and who they want to provide the service — the local fire department or a private company.  A think tank recently recommended that the White River Township community look into the pros and cons of starting a public ambulance service based at the township fire department.  And while township fire officials say a public service is the best way to keep up with the demand, the private company that’s been providing ambulances to the region for more than 30 years begs to differ.


Profit or people

White River Township Fire District has 15 firefighters trained as paramedics. The firefighters can stabilize patients at the scene, but they have no means to transport them to the hospital.  The fire district has a contract with Rural/Metro Ambulance to transport patients to local hospitals. The contract, which expires next month, stipulates that Rural/Metro will have an ambulance on an emergency scene within eight minutes at least 90 percent of the time.  So far, the company has achieved that response time on 70 percent of the calls.  “We’ve had the contract for more than a year,” said White River Township Fire Chief Mike Dutton. “They have yet to arrive within eight minutes in any one month. It’s not their fault. They’re just stretched beyond their resources.”  Dutton said the fire department typically arrives on a scene in half the response time of the ambulance service.  “We can get there in four minutes,” he said. “But if we have to wait seven or eight minutes for a transport, we’re not doing the best for the citizens that we can.” The solution, as Dutton sees it, is to establish a fire-based emergency medical service. That means the fire district buys ambulances so they can not only treat patients but also take them to the hospital.  With fire-based EMS, the fire district would no longer need to contract with Rural/Metro. “We want to make sure we’re not doing anything against Rural/Metro’s effort,” Dutton said. “They’ve been very good to us. But if we’re looking to increase our effort for service to the citizens, that’s the way to go.  “I think what we’re looking at is, what is a service that’s for profit, and what is a service that’s for the people.”  Rural/Metro officials disagree.

Time is money
 
The debate over whether Rural/Metro is adequately covering the township is an issue of service level, not a matter of public versus private, said Jim White, central Indiana general manager for Rural/Metro. White said the ambulance company is not struggling to provide
service in White River Township. But if the public wants to buy an increase in service, Rural/Metro could sell it to them, he said. There is always a potential for improving an EMS delivery system,” said White, who also is the Bargersville fire chief. “I have had the opportunity to be responsible for municipal and private sector public safety budgets and have found the same holds true for both. At the end of the day, available funding dictates the level of service provided.” Rural/Metro has been providing ambulances to central Indiana since 1967. It has 18 staffed ambulances covering 911 and non-emergency calls from all of Marion County and parts of Johnson and Morgan counties. As one ambulance takes an emergency run, another ambulance from a nearby location moves in as needed to cover the area in its absence.  In White River Township, one ambulance is stationed at the fire department headquarters on Runyon Road for 911 calls to the area.  “Saying that there is one ambulance in White River Township is a true statement,” White said.   “However, that is not an accurate representation of the emergency medical services system.”  There are six paramedic response vehicles between White River Township and Bargersville fire departments, two paramedic ambulances responsible for the township and seven area hospitals within 10 miles of the township.  Both Bargersville and White River Township are building new fire stations, making five fire stations in the township within the next year.  “If you have a heart attack, there are a lot worse places than White River to have one,” White said. “It comes down to the community. If the community of White River wanted to pay for three or four ambulances to sit around there in their community, then they should support that.”  White doesn’t dispute that Rural/Metro has failed to fulfill the response time obligation spelled out in the contract.  The eight-minute response time is based on a recommendation from the American Heart Association for when advanced life support equipment should be on the scene in an urban community.  The suburban area of the township makes the recommendation less realistic in White River Township, he said.  In addition, the equipment is on the scene once the fire department arrives. The fact that the transport unit from Rural/Metro arrives several minutes later does not diminish that response, White said. 

 

Max the tax

It would take a chunk of change and a change in legislation to start a public ambulance service in White River Township.
White River Township Fire Department officials already have been lobbying state legislators to allow them to go beyond the maximum tax levy to raise the money it would take to start a public ambulance service. Dutton estimates it would cost about $250,000 to buy one ambulance and the equipment needed to run it.  The personnel cost to pay a paramedic and an emergency medical technician for each of the three shifts would run about $80,000 a year. The fire portion of property taxes in the township is 52 cents per $100 assessed valuation.  Dutton’s proposal is to raise the tax to 85 cents per $100 assessed valuation. As an example of the impact of the increase, Dutton said that would be about a $55 annual property tax increase on a $150,000 home.  State Rep. David Frizzell, who represents the northwestern edge of Johnson County, said the request for the fire district to go beyond the maximum tax levy must be taken to Chairman Pat Bauer of the House Ways and Means Committee.  And, in addition to convincing the Legislature, Dutton also would need to sell the public on the idea.  “Any time you talk about increasing the levy, there’s always going to be some public concerns,” Frizzell said.  On the other hand, residents stand to benefit from greater insurance savings with increased public safety measures.  “In the long run, it may be a wash,” he said. “But that’s always a difficult thing to explain to taxpayers. It all boils down to trying to get the message out to the residents of White River Township in expressing the need and trying to convince them that that need might be reflected in a change in the levy.”  White agrees it would be a hard sell.  “As a resident of Bargersville, I would not be pleased if they raised the tax levy for a service we already have,” he said.  Dutton said that if he is not successful in getting a change in the legislation, he may seek a referendum from the residents on the issue.


Example set

Johnson County has a model for fire-based EMS in the Franklin Fire Department, which has run its own public ambulance service since 1975.
Franklin has 29 emergency medical technicians and seven paramedics. Every firefighter hired there within the past 10 years has been required to be trained as an EMT within one year.  Just as the personnel are cross-trained to fight fires and handle medical emergencies, several of the department vehicles double for either fire or ambulance service duty, so firefighters can go directly from a fire to an EMS call when needed.
“National studies have shown fire-based EMS is more efficient than private sectors because of the firefighters’ familiarity with the city, their 24-hour shifts, and their response times are shorter,” said Franklin Fire Chief Mike Herron.  Last year, the fire department began billing patients to supplement the cost of medicine and other disposable supplies.  In the past, the patient paid the hospital for the supplies and then the hospital gave the fire department fresh supplies. But federal guidelines changed to prohibit that arrangement. Now patients pay a flat fee of $150 for basic life-support service and $250 for the more serious, advanced life-support service.  For the most part, Franklin transports patients only to Johnson Memorial Hospital. If a patient needs to see a doctor at another hospital, Franklin calls in Rural/Metro to transport them, Herron said.
If Rural/Metro is unavailable, and it’s a medical necessity, Franklin will take the patient to another hospital for the same flat fee.  Rural/Metro transports patients to all central Indiana hospitals. Their fees vary, not only on the level of service, but also on the length of transport, White said.
That understood, the average fee at Rural/Metro is $350, he said.
 

Unbiased opinion

Paul Kite, chairman of the White River Township Fire District Board, said the board hasn’t reached a conclusion on the issue of fire-based EMS.  “I think the board has indicated that we’re interested in having additional conversation about it, but we haven’t made any decisions,” he said.  Though board members support Dutton’s efforts to generate more revenue for public safety funding, they’d like an unbiased voice to teach them more about fire-based EMS. “Certainly, Rural/Metro has an interest in continuing to provide the coverage because that’s the business they’re in,” said Kite, a former Greenwood fire chief. “The fire department thinks they can do it quicker, better, faster. Finding that middle ground is probably going to be a challenge.”  For now, Kite anticipates that the fire district will renew its annual contract with Rural/Metro in March.  (Reprinted with permission from the Daily Journal)

 

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