Thursday, February 1, 2018

Times a' Changin' in Peoria

Peoria Fire Department--Advanced Life Support
January 29, 2018

I was at a location the other night and a person suddenly passed out. PFD E3 arrived in a matter of minutes and began evaluating the patient. AMT arrived about 4 minutes later. Both teams of medics worked together very well. E3 just became ALS-First Response on January 1.
Nothing I have to say in this post has anything to do with the providers from AMT or the PFD who are working the streets in real time. The EMTs' assessment of the patient when first evaluated and the evolution of the patients' course with their interventions was very important for me as I evaluated the patient upon arrival in the ER.
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John Carroll---Forum Article, PJS--January 27, 2018
Let Peoria firefighters provide advanced life support
On Jan. 1, Peoria Fire Rescue 1 on Monroe and Engine 3 on Armstrong became Advanced Life Support First Response.
They join three other advanced life support engines in Peoria — Engine 12, Engine 20 and Engine 4. This is the first time Peoria firefighter-paramedics from Rescue 1 and Engine 3 have ever been able to provide independent advanced life support when they arrive at a 911 call. Sick and injured patients no longer need to wait precious minutes for Advanced Medical Transport (AMT) to arrive.
Why did our local project medical director, Matt Jackson, M.D., allow these two Peoria fire engines to upgrade to Advanced Life Support First Response now? During much of the last two years, Dr. Jackson had opposed any PFD engine upgrade from basic life support to advanced life support.
In August 2017 Illinois House Bill 1952 was signed into law by Gov. Bruce Rauner. It stated that the “ambulance assistance provider shall be authorized to function at the highest level of EMT license … held by any person staffing the ambulance assistance vehicle.” This means that if there is a Peoria fire paramedic on a basic life support engine, and if Dr. Jackson approves, this paramedic can now provide advanced life support immediately upon arriving at the scene of a 911 call.
There were more than 19,000 medical 911 calls last year in Peoria. Peoria Fire has enough paramedics to staff all 12 engines. This law should help level the playing field in Peoria between AMT, which is supported by the powerful medical and business communities, and the shackled Peoria Fire Department, which wants to provide advanced life support for all the people of Peoria.
This two-decade-long EMS saga in Peoria shows how medicine, politics and money intersect at a dangerous point. The project medical director in Peoria should keep money and politics out of the equation and allow all of the remaining Peoria fire engines that are basic life support to become advanced life support.
John A. Carroll is a medical doctor. He lives in West Peoria.
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Now the following paragraphs will be a "deeper dive" into the above article, and I will start out with this quote from Councilman Jim Ardis from the PJS in 2002--
Councilman Jim Ardis: ”If we want to have a highly trained fire and medical department in the city, there is nothing that AMT can do to prevent us from doing so.” I don’t think that anyone can make the argument that anybody would not want the best-trained people to be there for them all the time in case of an emergency. Why would you not want that?”
1. Two Engines, Rescue 1 and E3 just became ALS for the first time.
Over the last two years, there have been frequent discussions at the City Council, AMT, PAEMS, and the Peoria Fire Department. The PFD wanted to upgrade Engine 19 from BLS to ALS. The PFD has firefighter-paramedics at the station now who are not able to provide paramedic skills when they arrive at a 911 call before AMT arrives. But Engine 19 was denied their upgrade. E19 on the northwest side of Peoria is still BLS.
Dr. Jackson made a power point presentation to the City Council in 2017 and wrote several letters to the City Council stating that he saw no reason for the PFD to upgrade ANY Engine in Peoria to ALS.
It is amazing there was no media coverage when the PFD was allowed to upgrade two Engines on January 1. The silence in Peoria over this upgrade is incredible but understandable for the powers who control EMS in Peoria.
Most of Peoria has no idea that the PFD is mainly BLS. Most people have no idea that these two stations just became ALS. Most people have no idea that Dr. Jackson gave his approval for these two stations to become paramedics. Most people think that the PFD paramedics can function as paramedics...but the truth is that today when 911 is called, most PFD paramedics on duty cannot offer independent life support. And I will explain why.
We have 12 Fire Stations in Peoria but only 5 of them are ALS--12, 20, 4, 1, and 3. However, all 12 Engines could be ALS because we have 55 PFD Medics. I will come back to this in a second.
And I want to emphasize that AMT is the only provider in Peoria who can transport the patient. AMT is supported by the titans of Peoria--Peoria's three hospitals, influential businesses, and by many of our politicians. AMT's revenues are 23 million dollars transporting patients around the state of Illinois. That is where the money is. I want to make it clear that during the last two years the PFD was not asking to transport anyone. The PFD does not own an ambulance.
2. Bill 1952
What did Bill 1952 really mean?
The idea for the creation of this bill came from Peoria but was sponsored by representatives from different parts of Illinois...specifically NOT by Peoria's representatives. The feeling is that our sponsors representing Peoria could shy away from supporting Bill 1952 due to the hot politics in Peoria regarding EMS.
What do I mean by hot politics? How can an issue of prehospital care in Peoria be a hot topic? The answer is AMT wants to remain the only transport/ALS business in Peoria like it has been for the past 25 years. And when AMT is supported by Peoria's bosses, the influential business and medical community in Peoria, beware if you rock the boat. There is a lot of money involved. And when AMT and PAEMS, which is located at OSF, put obstacles in the way of the firemen, politicians are simply afraid of AMT and OSF and the business community. The politicians want their support and their money. Big businesses stick together. OSF supports AMT. In other words, our local politicians don't want to make AMT and OSF upset with them.
Well, this bill was written to help Peoria Fire Fighters give advanced life support in Peoria.
Having said that, Bill 1952 passed unanimously except for Ryan Spain who voted "present" due to several family members being on the Board of Directors at AMT. In other words, all of the state representatives voted that they believed that paramedics on a basic engine anywhere in the state of Illinois should be able to offer ALS at the medical 911 call. This, of course, makes sense. The bill was signed into law in August by Gov. Rauner. Every representative in the state of Illinois voted "yes" except for Ryan Spain.
I want to make clear that R1 and E3 in Peoria did not become ALS under this new law from Bill 1952. I happen to believe they were "gifts" to the PFD by the project medical director. Why do I call them gifts? I think that since Bill 1952 now gives all the Peoria Fire Engines ability to be ALS if the PMD signs off. Unfortunately, I believe that the PMD has plenty of pressure put on him to keep the PFD as "basic" as possible.
However, did you know attempts were made in Springfield to stop Peoria from being covered by Bill 1952? Oh, yes. There is a lobbyist in Springfield named Molly Rockford who was hired by the Illinois College of Emergency Physicians (ICEP) and represented ICEP. She lobbied that Bill 1952 should pass for the entire State of Illinois...except for Peoria. Sounds incredible, doesn't it? Why would she lobby for this? Why would ICEP not want Peoria included where the PFD paramedics would not be allowed to provide advanced life support at the scene? I don't know for sure. But I do know that George Hevesy, who still works at OSF and is the President of the Corporate Board of AMT, was the President of ICEP years ago and is a councilor on the Board of ICEP now. (Another OSF physician holds a similar position on the ICEP Board.) In other words, ICEP lobbying to exclude Peoria from Bill 1952, MAY lead right back here to Peoria.
3. So, this brings up the next question: I wonder what the PFD needed to do to swap this time with AMT and PAEMS to give more Peorians advanced care.
Why do I say swap? Because it is a matter of politics and money and making deals in Peoria. This discussion has never been about providing improved patient care.
Right now our politicians in Washington, DC are bartering for the lives and futures of about 2 million immigrants under DACA and the Dreamer's children versus a 25 billion dollar wall and enhanced border security. In DC they are bartering 2 million lives for a 25 billion dollar wall to be built along the Mexican-US border. That is how politicians work.
So what does this have to do with Peoria? I will tell you.
In 1996, the PFD wanted to upgrade their service from BLS to Intermediate Life Support for the people of Peoria. But the PFD didn't quite make it. In fact, the headline of an article in the Journal Star from May 1, 1996 stated:
“Ambulance Plan Abandoned–Fire Department to Add Defibrillation Program”.
The PFD met resistance in 1996 from AMT's CEO Andrew Rand and from George Hevesy, MD who was PMD and receiving a salary from AMT and from OSF.
Rand, of course, did not want the PFD to upgrade.
Rand stated that the PFD should spray the "wet stuff on the red stuff" and stay out of EMS. Dr. Hevesy, his sidekick, explained to the City Council during those years that there would be "duplication of services" if the PFD upgraded.
The PFD finally backed down to the powers that be but were able to do something very incredible for the people of Peoria. The PFD stated that if you give us the ability to defibrillate patients we will not seek to upgrade. This was truly amazing.
So the trade was electricity to save lives for PFD BLS engines that would not upgrade to ALS.
When a person's heart stops suddenly and they are in cardiac arrest, their heart is usually beating too fast or quivering and needs to be shocked to start beating again effectively. And for each one minute the heart is not shocked, the chances of recovery go down by 10%. So if the person has a witnessed arrest and five minutes go by before the first shock, the chances of that person coming back are down 50%.
Defibrillation with portable monitors has been done since the 60s. It is the only proven weapon to save people from out of hospital cardiac arrests.
In 1996, defibrillation, or shocking the patient, was standard of care around the developed world even for Basic Engines like all 12 of the PFD Engines. But amazingly the PFD in Peoria was not using the best technique to save lives in out of hospital cardiac arrests--electricity.
AMT WAS using electricity. Why wasn't the PFD? I was a resident physician at OSF in the early 80's and people were shocked frequently in-hospital and out-of-hospital cardiac arrests. It was called "standard of care".
How many people died in Peoria as outpatients prior to 1996 because they were not shocked in time by the earliest arriving EMT which was usually the PFD?
Our Basic PFD, of course, should have been shocking people back to life..but they weren't. Where was Dr. Hevesy? Did he insist to the City Council that the PFD as BLS providers use defibrillators? If he did, I am not aware of it.
Why did our PFD have to barter to shock people in 1996? Because that is how it works in Peoria. I wonder what would have happened if the PFD still wanted to upgrade? Would Hevesy and Rand have told the PFD that they would remain as they were--BLS without the paddles to shock the patient?
4. What happened in the 2000's?
Early in the 2000s, after the death of a man at a restaurant in Peoria where the firefighters were first on the scene but unable to use ALS skills, Rick Miller was the PMD. Behind the scenes, Miller changed the protocol, which stated that the PFD paramedics could use their skills only when the AMT paramedics arrived. This was never published in the newspaper or in the public media in Peoria-- just like we have today with R1 and E3.
And as the years went by in the 2000s, even though I was told it was a dead issue at the City Council meetings by someone who was high up in the ranks, three stations were able to upgrade--Engines 12, 20, and Engine 4. And it took until 2013 for this to happen. Please remember, that even though these three Engines became ALS, they did not have an ambulance and transport was not a possibility. And it still isn't today in 2018 for the PFD. Transport is where the money is for AMT and they don't want to lose it.
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Summary--
Peoria EMS has been fraught with problems for years. In my opinion, the PFD has been obstructed for years in their battle to provide ALS for the people of Peoria.
Last year the PFD voices were silenced for fear of a significant fine or imprisonment. Peorians as a whole are quiet also because they don't want to lose their jobs, their health insurance, and their seat at the Peoria Country Club. And well-meaning citizens have been threatened with possible lawsuits if they dissent too much. And as I said before, THE PFD HAS BEEN THREATENED WITH FINES AND JAIL TIME IF THEY SAY TOO MUCH.
In my opinion, it has never been about patient care in Peoria. It is about money.
People in Peoria don't know that their tax dollars are being wasted. The PFD medics make 2.5% more than a non-medic. And if these medics are not allowed to use their skills for the 911 patient, what is all of this about?
So what needs to happen?
With the recent passage of Bill 1952 into law, the next step should be that the PMD gives his approval for the remaining 7 BLS stations to become ALS. They would need a four thousand dollar box filled with ALS material on their Engine to function as independent paramedics--just as AMT has done for the past 25 years.
I think there has been a concerted effort to keep the PFD from upgrading during the last 22 years. Bill 1952 is law and can be used by the Basic PFD Engines if Matt Jackson, MD, the current Project Medical Director, agrees. Dr. Jackson just signed off on R1 and E3 to become ALS, which goes against what he has been saying and writing during the last two years.
For the Peoria neighborhood not covered by an ALS Engine, it will take a critical mass of people to influence their City Council Members to advocate for the Engine upgrade.
Clearly, the people who have controlled EMS in Peoria for a quarter of a century need to be replaced now. A fire chief of a very large city in Illinois told me years ago regarding EMS: "You have a very unfortunate situation in Peoria." And we still do.
"These titans stick together in the way that many titans do, not because they share some special affection or particular philosophy but because each sees in the others’ stature an affirmation of his own." (NYTimes)

John A. Carroll, MD
January 29, 2018
Peoria

Thursday, January 4, 2018

Peoria Fire Stations Advance to Paramedic--January 1, 2018

January 4, 2018

Dear Everyone,

Happy New Year. It is cold in Peoria. Very cold. Polar vortex and global warming combining to make the midwest very cold.

Great news regarding the Peoria Fire Department--

January 1, 2018--

This full moon lighting up the Illinois River and Peoria tonight on the first day of 2018 is the largest and brightest – supermoon you have ever seen.

But even bigger news than the supermoon is that today the PFD Rescue 1 Engine in downtown Peoria is offering independent Advanced Life Support for the first time ever. The Firefighter Paramedics will now be able to respond to a 911 call and offer the people of Peoria Basic Life Support and Advanced Life Support even when the AMT Paramedics are not on scene. 

Engine 3 on Armstrong in Peoria will be doing the same starting today also. 

John Carroll, MD
www.peoriasmedicalmafia.blogspot.com

Saturday, April 8, 2017

OSF/Joe Piccione--2017

Yesterday the Peoria Journal Star had this article regarding the Ethical and Religious Directives for Catholic Medical Centers in the United States.

Joe Piccione, OSF's Catholic ethicist said that "we don't live by the ERD." This meant that OSF will follow some of the Directives but don't need to follow all of the Directives established by the US Bishops.

OSF allows its physicians to prescribe oral contraceptives so they don't lose the physicians. This is promoting oral contraceptives which the Directives say cannot be done by medical centers such as OSF.

"When OSF Medical Group was created in the 1990s, some physicians didn’t want to sign on if it meant giving up their ability to prescribe birth control to patients, something that ERD allows for treatment of underlying conditions but not for the purpose of family planning. But OSF was able to create a loophole, allowing those physicians who wished to prescribe birth control to do so of their own volition, covered by their own supplemental liability insurance as a sort of practice within a practice."

This Journal Star article does not mention that it was Joe Piccione who constructed this loophole with the blessings of The Catholic Diocese of Peoria which still continues today. 

Mr. Piccione was also on the Diocesan Haitian Hearts committee which effectively ended Haitian Hearts patients from returning to OSF for follow-up heart surgery. A number of them have died. This action also is against the ERD for Catholic Medical Centers.

Here is the article which is hyperlinked above:



PEORIA — Hospitals and health care organizations have to follow not just state and federal laws, but a moral compass when delivering care to the communities they serve.
While nearly all health care providers and professional organizations have some form of a code of ethics or statement of mission, vision and values, many Catholic-based hospitals and health systems also adhere to a document called “Ethical and Religious Directives for Catholic Health Care Services.” Created by the United States Conference of Catholic Bishops, ERD, as it is more simply known, helps organizations such as OSF HealthCare make policies for how care will be delivered and prioritized within their systems.
“The ERD is not the story of our life,” said Joseph Piccione, senior vice president of ethics for OSF Healthcare.
It’s less of a step-by-step guide for providing health care under a Catholic tradition than it is big-picture advice that sets priority and tone for Catholic health systems.
There are parts of ERD that are quite specific — the definition of abortion, Piccione said, is “one of those directives in which every word counts” — while others give more general advice that hospitals interpret and apply with guidance of their local bishop.
Some parts of the ERD are unoriginal. The first directive under the category of “professional-patient relationship” in ERD states, “The inherent dignity of the human person must be respected and protected.”
Similar sentiments are included in the codes of ethics of the American Medical Association and American Nurses Association, as well as individual health care organizations.
UnityPoint’s Mission, Vision and Values statement, for example, contains the phrase, “We connect with each person treating them with courtesy, compassion, empathy and respect.”
Other parts of ERD are sometimes inapplicable to certain organizations. The ERD explicitly forbids Catholic care organizations from performing euthanasia, though physician-assisted suicide is legal in only six states.
To understand the complexity and varied specificity of ERD, consider its conglomeration of directives for providing end-of-life care, which makes mention of specific interventions without a simple list of dos and do-nots.
ERD states that “a person has a moral obligation to use ordinary or proportionate means of preserving his or her life,” followed by a directive that says “a person may forgo extraordinary or disproportionate means of preserving life” and leaves the determination of what’s extraordinary or not up to the patient. It explains the moral obligation to provide patients with food and water, while stating that providing such becomes “morally optional” when they can’t be expected to prolong life or would be excessively burdensome.
It goes on to recognize “a person has the right to prepare for his or her death while fully conscious” in the same paragraph that it says patients should be “kept as free of pain as possible” and that “patients who experience suffering that cannot be alleviated should be helped to appreciate the Christian understanding of redemptive suffering.”
Because ERD is created by a group of bishops and updated periodically, the Catholic approach to health care has adapted to modern technology.
“When transplantation and organ donation was first clinically available, Catholic health care had a hesitancy about it because there was a thought that could be wounding a human person, the destruction of a person,” Piccione said. “And only as time developed it was clear that this was a work of charity, of love, for someone. Now it’s encouraged and placed in ERD.”
As the bishop of the local diocese is responsible for guiding health care organizations in their application of ERD, each bishop and organization has some ability to maneuver the directives.
When OSF Medical Group was created in the 1990s, some physicians didn’t want to sign on if it meant giving up their ability to prescribe birth control to patients, something that ERD allows for treatment of underlying conditions but not for the purpose of family planning. But OSF was able to create a loophole, allowing those physicians who wished to prescribe birth control to do so of their own volition, covered by their own supplemental liability insurance as a sort of practice within a practice.
The real application of the 72 directives of ERD is much more than restrictions on reproductive treatments.
“It’s an affirmative document,” said Steve Mattern, vice president of mission services.
“The ultimate, ultimate reason that we exist to care for those who are sick, is we want to create an environment where people, at a time of most vulnerability, pain and suffering, are able to experience the greatest care and love. And we hope and pray they also experience something that helps them connect with God’s love for them.”
Laura Nightengale is the Journal Star’s health and lifestyle reporter. 

John A. Carroll, MD
www.haitianhearts.org

Tuesday, January 3, 2017

2017

Dear Peorians,

Just wanted to let you know that EMS in Peoria is confusing. The only thing that is straightforward is understanding the conflict of interest involved in pre-hospital care.

Now, most people do NOT know the following:

If you suffer a medical problem in the area covered by R1 (main fire house in Peoria), you or your family member or your friend, calls 911. When R1 arrives at your side, which is usually faster than AMT arrives at your side, R1 can only give you Basic Life Support. They cannot give you Advanced Life Support even if R1 has Paramedics working for them and have the knowledge base and the ability to help you. The PFD Paramedic can’t even start an IV. They cannot give you medication. They can only give you Basic Life Support. They have a great knowledge base but they are not allowed to offer advanced life support skills that they have. You must wait for AMT and their paramedic to arrive. Then, and only then, can the PFD Paramedic help you. And this, in turn, helps the AMT medic.

Does this make sense to you? Not really?

Let me tell you something. People's lives in Peoria are being risked every day in medical scenarios where the PFD and their Paramedics are restricted from caring for you. And during the last 15 years, I am aware of many precarious medical situations that have happened after 911 was called.

There is a lot of fear in Peoria about this. AMT has many businesses supporting them. People in Peoria are afraid to like or share a post like this. They do not want to lose their jobs. Rich people do not want anything to change. Poor people are just getting through the day and can’t take on another battle. So both rich and poor are silent on this issue for completely different reasons.

Bishop Daniel Jenky is aware of the problem. The Sisters at OSF are aware of the problem. They will do nothing to improve the prognosis of the 911 patient in Peoria. Trust me. The ethics committees will bury their heads in the sand. The majority of Peoria medical community will stay quiet. Nothing will change until the politicians legislate for improvement in Peoria’s EMS. Or there is a lawsuit.

Please consider the following: Engine 4 is located on the South Side of Peoria. It has been a Paramedic Engine since 2013. During the last 11 months, Engine 4 responded to 2,140 EMS calls. Yes, you read that correctly. And during October and November 2016, just two months, Engine 4 Paramedics provided 49 Advanced Life Support interventions. Yes, you read that correctly also. So, do you think the South Side of Peoria is better off with Engine 4 staffed by Paramedic/Firefighters since 2013? Remember, that for many many years our leaders told us that it was NOT necessary for Engine 4 to advance to Paramedic. Wonder what they say now?

I think it is way past time to listen to the PFD. It is way past time to listen to Rick Waldron who has been a firefighter-paramedic for greater than 10 years working at ground zero in Peoria regarding EMS calls. 

At the scene of an accident, multiple firefighter-paramedics are often needed to extricate and give advanced life support care. This is not hard to understand. When Peoria has a shooting or multiple shootings, multiple paramedics are needed. This is not hard to understand either. 

And at a house fire where there are flames, smoke, and people with smoke inhalation and burns, potentially with superimposed chronic medical problems, there is only one agency to call in Peoria to handle all of these problems—the PFD. This is not hard to understand either.

Peoria needs to wake up before even more lives are lost due to a corrupt and inefficient Peoria Area EMS.

John A. Carroll, MD
www.haitianhearts.org

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Conflict of Interest in Peoria

January 3, 2017

Dear Everyone,

Happy New Year.

Please see this post.

The Peoria Fire Department has three Engines that can give paramedic care--Engines 4, 12, and 20.

During much of 2016, the PFD tried to have Station 19 upgraded to paramedic. So far the powers that be have been able to rebuff these attempts to improve pre-hospital care medical care in Peoria.

Please stay tuned.

John

Wednesday, January 28, 2015

Chillicothe 33 and Conflict of Interest in Central Illinois

Doug Marshall is Peoria Area Emergency Medical Services attorney. He is also OSF-SFMC’s attorney.
Matt Jackson, MD is Medical Director of Peoria Area Emergency Medical Services. He is also OSF-Emergency Department Emergency Medical Services Medical Director.
(It is interesting that both of these key figures in pre-hospital care in central Illinois had no comment on the ongoing Chillicothe 33 saga.)
OSF has always supported Advanced Medical Transport (AMT). George Hevesy, MD, OSF’s former Emergency Department's Medical Director and Emergency Medical Services Medical Director, is still receiving a salary from both OSF and AMT. Dr. Hevesy has been a valuable employee for AMT and OSF for over two decades.
It will be interesting to see what OSF will do if Chilicothe 33 attempts to become an Advanced Life Support ambulance service for Chillicothe. My guess is that the gloves will come off yet again.
A widely used definition of conflict of interest is:
"A conflict of interest is a set of circumstances that creates a risk that professional judgement or actions regarding a primary interest will be unduly influenced by a secondary interest."
Stay tuned.
John A. Carroll, MD
Peoria




Ambulance service will answer emergency calls in Hopewell starting Sunday
PJSTAR.COM|BY SCOTT HILYARD OF THE JOURNAL STAR


Saturday, November 15, 2014

A Big Loss for Peoria...

Dr. Dale Geiss, cardiac surgeon, recently moved his practice from Peoria to the Quad Cities. Dr. Geiss began his practice of adult and pediatric
PJSTAR.COM
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  • John A Carroll Dr. Dale Geiss established the surgical pediatric heart program at OSF-CHOI through incredible hard work, tenacity, and skill. It took him decades to do this. 

    Dr. Geiss operated Haitian Hearts patients and never sent me one bill. And neither did his perfusionist, operating team, or the myriad of pediatric speciality physicians taking care of the Haitian kids post-operatively. (Haitian Hearts did pay OSF-CHOI over 1.1 million dollars for use of their facility and excellent cardiovascular ICU staff and ancillary services.) 

    And don’t forget Dr. Geiss mentored a young pediatric heart surgeon, Dr. Randall Fortuna, for the last decade at CHOI. Unfortunately, Dr. Fortuna just left town too. 

    Pediatric heart surgeons of these doctors abilities are not found on every street corner. What a shame for central Illinois babies, children, and young adults. 

    Like most everything else in life, we don’t know what we have until it is gone.

Thursday, October 30, 2014

AMT Wants Peoria Heights EMS Contract

AMT and OSF, along with the support of the local business elite, try to get control of ambulance services in Peoria Heights.
Re. Oct. 4 story, “Nonbinding ambulance question on Peoria Heights ballot”:The article did not include important details about emergency
PJSTAR.COM
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