Making Right Call on Emergencies

* The March 23 letter from Sherri Butterfield, chair of the Orange County Fire Authority, states “. . . paramedics arrive within five to seven minutes and begin treatment immediately. Within 15 minutes or so, the private ambulance staffed only with emergency medical technicians arrives, not to treat the patient but simply to transport him.”

The fire department dispatches itself with red lights and siren on all calls, dispatching the private ambulance via normal driving. The differences in response times do not reflect a lack of ability or willingness on the part of the private sector but rather the policy of the public sector fire department in preserving their right to always “get there first.”

As to the level of training, not all firefighters are paramedics. Most are only emergency medical technicians, a state standard for all private ambulance personnel not currently met by many of fire department’s own volunteer firefighter staff.

The letter states, “A firefighter paramedic climbs into the private ambulance and accompanies the patient to the hospital.” This is true on only half the calls. The other half of the time, the patient is transported and cared for by the private ambulance emergency medical technician all the way to the hospital. When a firefighter paramedic does accompany a critical patient, the emergency medical technician is actively involved in that patient’s care, taking vital signs, performing CPR, ventilation and assessments as part of a high-quality emergency care system designed by the fire department.

The letter states, “While the private ambulance company receives the payment from the patient or his insurance carrier, the Fire Authority receives no portion of these funds and is not currently compensated for the emergency medical services it provides.” The private ambulance companies do not bill anyone for recognized services provided by the fire department and, surprisingly, neither does the fire department. It makes no sense whatsoever to continue to let the insurance companies keep their premiums and not pay benefits for fire department paramedic services that have been approved for payment by Medicare since 1982.

The statement that the fire department takeover would “free for-profit ambulance companies to concentrate on the nonemergency transportation of patients between care facilities, which constitutes their primary source of revenue” is false. Fully 70% of my company’s business is as a contract responder for the fire department. The remaining 30%, nonemergency transports, is increasingly more dependent upon the ability of the private ambulance provider to offer comprehensive transport services.

The Orange County Office of Emergency Medical Services should call for an independent third-party evaluation of our 911 system.

That evaluation should lead to the competitive proposal process being finalized so that all qualified parties, private ambulances and fire departments alike, could compete on a level playing field, thus changing the focus from “who’s right” to “what’s right” for the citizens of Orange County.

MICHAEL DIMAS

Medix Ambulance Service

Mission Viejo

* Recent publicity has criticized the Orange County Fire Authority for considering a change in the emergency transportation system.

Currently, patients are transported by commercial ambulance from emergency scenes to hospitals. Fire Authority staff have asked their board of directors to evaluate, through a public review process, several options that could change that system. Staff has recommended that Fire Authority employees take over the role of emergency ambulance transport of patients.

Before looking at the merits of the ambulance transport issue, it is necessary to have a basic understanding of the Fire Authority and its emergency service role.

The Fire Authority is a joint powers authority which contracts with 19 cities and the county. The areas served by the authority are Buena Park, Cypress, Dana Point, Irvine, Laguna Hills, Laguna Niguel, Lake Forest, La Palma, Los Alamitos, Mission Viejo, Placentia, San Clemente, San Juan Capistrano, Seal Beach, Stanton, Tustin, Villa Park, Westminster, Yorba Linda and the county unincorporated area.

The authority is governed by a board of directors consisting of elected city council members and county supervisors appointed from each jurisdiction served. The OCFA is a regional system that is not limited by city boundaries; as such, its personnel, equipment and facilities are used to the best economic advantage. Overhead is minimal and spread over a much broader organizational base than is possible in independent city fire departments.

The term “fire service” is really a misnomer today. The Fire Authority responds to virtually all emergencies experienced by Orange County residents. In addition to fires, this list of emergencies includes medical emergencies, earthquakes, floods, windstorms, aircraft crashes and hazardous material spills. OCFA personnel also conduct search and rescue activities and perform community life safety training. All of those activities have been absorbed by the same work force that is necessary to suppress fires without the addition of new or specialized employees.

The authority exists because it is cost efficient and provides a high quality of service. Like any organization that depends on contract customers, it has to be better than its competition to survive. The personnel needed to combat the fire risk in Orange County represent a fixed cost of operation. Any other tasks that they can perform while waiting to respond to fire emergencies, without jeopardizing their ability to respond to fires, results in more service to the community for the same cost. This has been the OCFA’s guiding philosophy in providing the multiple services mentioned earlier.

Attacks by the commercial ambulance industry have characterized the OCFA as a “demagogue” and worse. Accusations have been leveled that “government” is interfering in the private sector. Neither government nor the private sector can lay exclusive claim to ambulance services. A review of nationwide practices shows an even split between private and public transport services.

The debate on this issue should not be about the motives of the parties involved but about who can best serve the needs of the public. In evaluating the merits of the various alternatives to be presented to the OCFA board of directors, staff established three main criteria: quality of service, cost to the consumer and public subsidy of private business. The staff recommendation of public emergency transport will result in improvements in all of these areas.

Finally, it must be emphasized that no decision has been made. The board of directors has not considered the merits of the arguments, much less reached a conclusion. The process is being conducted in public with ample opportunity for input from interested parties. It is ironic that in a time and culture that demands more of public employees at the same or less cost, a segment of the business and political community find fault with even a proposal to look at such benefits. Let us have some faith in our well-tested democratic form of government. The OCFA Board of Directors are elected to represent their constituents. Their final decision will be made with the best interest of their taxpaying constituents in mind.

KEN MACLEOD

Acting Director of Fire Services

Orange County Fire Authority

Orange