Wednesday, February 25, 2009

Looking Back....The Peoria Ambulance Monopoly

On November 17, 2002, the Journal Star published an article I had written as an Op-Ed.

The article expressed my concerns over the ambulance/paramedic monopoly in Peoria.

(I have been unable to find this Op-Ed in the Journal Star Archives and so I was not able to post it here.)

Over the next few months after the Op-Ed was published readers wrote to the Journal Forum. Some were in agreement and others wrote that Peoria's EMS situation was just fine.

However, in 2008, the Peoria Fire Deparment became Paramedic for the first time. So things probably weren't fine in Peoria during the previous 15 years.

The following article was exceptionally good and appeared in the Journal Star.

My comments follow.

December 8, 2002


City explores giving fire department more power -- However, proposal taken off Peoria City Council's agenda

PEORIA - The city of Peoria wants to upgrade its fire department from offering basic life support services as it does now to becoming an intermediate service that can also administer medication in emergency situations.

''The fire department has been given the power by the city to explore the possibility of going into ILS (intermediate life support),'' said Fire Chief Roy Modglin. ''Intermediate life support is one step higher than what we are allowed to do at this time.''

At the intermediate level, firefighters would be able to administer drugs and other medication in addition to instituting a defibrillation program that will increase the chance of survival for those who suffer a heart attack. A proposal to make this happen was on the Peoria City Council's agenda for this week, but it recently was retracted.

For 15 months, representatives of Advanced Medical Transport, the fire department and the city have been meeting to discuss the issue and possibly develop a collaboration program with AMT. The latter group would provide the necessary training.

One caveat of the proposal was that it didn't let the fire department enter the ambulance business for a certain number of years, said at-large Councilman Jim Ardis, who is involved in the negotiations. Most ambulance services are certified to provide advanced life support services - which is yet another step higher.

For years, AMT has balked at the fire department entering this arena. AMT is an independent not-for-profit organization initiated by the three Peoria hospitals. It has been providing ambulance and wheelchair van transportation services to 22 communities in the Peoria area for more than 10 years.

The majority of municipal fire departments provide ambulance services says Pete Stehman, information service manager of Associated Firefighters of Illinois in Springfield. According to the association's figures, in Illinois there are 16 union fire departments with 100 or more firefighters. Of this number, at least 13 of them or 81 percent transport patients. There are eight fire departments that serve populations of 90,000. Of this, six departments or 75 percent handle transportation.

AMT is willing to help the fire department advance to the intermediate level, but it does not want the department to transport patients, said Andrew Rand, AMT executive director.

''They can provide more comprehensive care than they do now,'' Rand said. ''It's a powerful system, and in fact we agreed to provide that training free.''

Rand said Ardis had also proposed a franchise agreement where both parties would collaborate on improving services.

''We were going to receive hazmat training and decontamination procedures from them because we are on the frontlines of bioterrorism and decontamination,'' Rand said.

The point of contention however, Ardis said, is AMT's insistence that the city keep out of the ambulance business for an extended period of time.

''That's one of the issues that has fluctuated a lot,'' Ardis said. ''It has been anywhere from four years to 10 years. My impression is that we aren't going to commit to anything longer than four to five years.''

Proponents of letting the fire department transport patients argue that the fire department should be in the ambulance business because it is usually first on the scene of an emergency situation and provides basic life support. They argue that two or three minutes can make a difference in saving a life. In addition to transporting patients, proponents want the firefighters to be able to administer the necessary drugs and bill the patient for the service.

The proponents have written several letters to the editor recently publicizing their stance.

Rand disputes that the fire department is usually the first responder.

''That is absolutely false,'' Rand said. ''They keep propagating it but their response time doesn't jive with their records.''

Rand said he's obtained fire department records through the Freedom of Information Act which shows otherwise.

In addition, Rand said that while the fire department responds to all calls with lights and sirens, the AMT uses lights and sirens only half the time. ''We prefer not to risk life and limb of citizens when there is no immediate emergency,'' he said, adding that if a person had a minor injury, an additional two or three minutes would not make a difference in that situation.

Rand also said the fire department has stated it is not interested in providing ambulance service.

''All of the discussions have been that the fire department wants to do intermediate life support, and it does not want to transport patients. That has always been the position. That was what the agreement was written to address; to balance the collaboration of both parties,'' Rand said.

But, city officials have not ruled it out.

''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,'' Ardis said. ''That is a policy decision. I don't think that anybody 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?''

Rand said he requested that the proposal not be presented to the Council at this time because City Manager Michael McKnight had advised the council not to adopt it. McKnight did not return Journal Star phone calls.

''I don't think it is appropriate for that agreement to come up, and what we have asked the city to do is sit down and see what it takes to solve 15 months of negotiation,'' Rand said.

While Rand is confident that all the differences will be resolved, Mayor Dave Ransburg said he did not know when the subject is likely to come before the council.

''Will it come back on? I don't know,'' Ransburg said. ''It may never come up again.''

Another part of the proposal is for AMT to pay the city a fee of $60,000 a year for using the city's dispatch system. Currently, they pay nothing.

''All that the city provides to AMT is an address to an emergency situation,'' Rand said. He said the service is not comparable to what other departments, such as the Peoria Sheriff's Department, receive.

''The city's dispatch center actually follows a deputy to that whole call,'' he said. ''With AMT it is not even dispatching; it's simply messaging from their computer to ours.''

My comments from today, February 25, 2009:

1. Not much had changed since 1992. AMT wanted to keep the transport monopoly of sick EMS patients in Peoria. And Andrew Rand was proven wrong when Matrix came to Peoria and studied response times in and reported to the City Council that the PFD responded about 1.5 minutes quicker than AMT to life threatening events. Peoria Fire Fighter Terry Carter had hit it all on the head 10 years earlier.

2. Where were Drs. George Hevesy and Rick Miller? Why weren't they supporting that the PFD upgrading to Intermediate level? Did OSF have anything to do with their silence?

Dr. Hevesy was being paid by AMT.

3. The next month, January 2003, AMT lost a City Council vote for the contract to be the only paramedic/transport agency in Peoria for the next ten years. And Andrew Rand and AMT did not teach the PFD to become Intermediate providers.

4. I will provide Forum letters that appeared over the next several years in coming posts. Dr. Rick Miller at OSF continued to defend Peoria EMS and the PFD stayed at Basic-D with Basic drugs. When a man died in the restaurant a few years later, and I spoke to the City Council about this, things started to change.

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