TOWER- The Tower Ambulance Commission gave the go-ahead to order a new ambulance to replace the aging 2013 GMC 4500 rig, that currently has 118,663 miles and is rated in less than fair condition. The purchase will need to be approved by the Tower City Council, and it will require the ambulance service or city take out a loan to cover the shortfall between the estimated amount in the ambulance subsidy account and the actual cost of the new ambulance. The service received a quote of $233,736 back in 2021, but the cost has increased $8,500 since then due to the rising cost of aluminum, to $242,236. The rig will be purchased from Life Line Emergency Vehicles. It is similar to the 2019 Chevrolet Unit 2 purchased three years ago, but will be built on a Ford truck, and will not have quite all the interior “bells and whistles” found on unit 2 that the ambulance service personnel feel is not necessary. The new unit will have auto-load and air-ride, which make the transfer of patients in and out of the unit easier.
The ambulance subsidy account currently sits at $149,196, but this amount is expected to increase to $219,000 by the end of 2023, plus any additions due to the city’s contribution for $1.66 per mile for non-emergency transfer calls.
The vote to move ahead with ordering the new ambulance, which won’t be ready for at least 12 months, was 5-1, with newly-appointed Greenwood alternate representative John Bassing voting against, at the commission’s Nov.2 meeting.
“We were promised a business plan for years,” said Bassing, who complained that consultant Betsy Olivanti had developed one plan that showed a profit for the service, but then the city started working with the state’s Emergency Medical Services Regulatory Board (EMSRB) and started looking at other ideas.
“You said you’d have a more robust plan,” he told the ambulance commission. “Where is the business plan that will lead us to figure out how many ambulances you need in what time period, what type of ambulances, and how to cut the overhead.”
Tower representative Kevin Norby said the department doesn’t do enough transfers to justify purchasing a less costly type two rig (instead of the type three rigs currently in service). In addition, he noted, while some transfers do generate a profit for the service, others do not.
Ambulance Supervisor Dena Suihkonen agreed and said while that type of rig would cost less than half of what a type one rig costs, the department doesn’t have enough staff to increase the number of transfer calls it takes. In addition, she said, that type of rig is not suitable to respond to many of their calls, which involve travel on rougher, rural roads, and that they don’t have enough interior room for an EMT to actively care for a patient while on the road.
Operating the ambulance service with only one ambulance is not an option, Suihkonen said.
“If unit one [the 2013 unit] goes down and we only have one ambulance, are you willing to wait for us to call Virginia or Ely to respond if unit 2 is already out on a call?” she asked.
Ambulance services in Ely and Cook get a much larger number of transfer calls, but they also are the first to be called on any transfers from their local hospital. The Cook Ambulance, she said, is looking at buying a type 1 rig, but they do enough transfers from the Cook Hospital to keep that rig in regular service. The Cook Ambulance is paying their personnel $2 per loaded mile on transfer calls, but even with that reimbursement are having trouble staffing their transfer calls.
As of Oct. 30, the service had taken 54 non-emergency transfer calls. Most of these, Suihkonen said, were for local area patients who needed to be transported from the hospital back home, or from a local hospital to a different hospital. Transfers are only taken when there is enough staff to cover an emergency call during when one ambulance is out of the area doing a transfer. The service has responded to 377 emergency calls in this time period.
“Our main concern is having good solid units on the road,” said Eagles Nest representative Larry McCray. “I’d hate to lose a life because we wouldn’t finance a new ambulance.”
Bassing also was the lone no vote on approving the new 2022-2023 ambulance subsidy agreement. Greenwood Township has yet to agree on making the $15 per capita subsidy payment this year. All the other townships in the ambulance service area are making their payments and have also agreed to make double subsidy payments in 2023.
Bassing said the removal of the indemnity clause, added in 2021 at the insistence of Greenwood’s attorney, was a problem.
“If someone on the Tower Ambulance does something wrong,” Bassing said. “Greenwood wouldn’t be sucked into any lawsuit.”
Norby said the city’s attorney said any indemnification clause should be mutual.
“We would take responsibility for our employees,” he said, “just not for the first responders or fire department members from other townships.”
McCray reiterated that the ambulance commission’s sole purpose is to help determine when to purchase new ambulances and what to do with the old ones.
“This had no place here [in the agreement],” he said. “It should not have been in the contract ever. We are discussing it for no good reason.”
McCray said this was an issue that Greenwood could negotiate one-on-one directly with Tower if they so desired.
Jeff Damm, who is the Bois Forte/Fortune Bay representative, agreed. “I don’t understand what the problem is as far as liability,” he said.
The ambulance commission has no authority at all over the operation of the service itself, which is run by the city of Tower.
Future plans
“In my personal opinion,” said Bassing, “Greenwood is going down a different path. We want to reduce our response times and want a higher level of service.”
Greenwood has commissioned a study that is looking at regional ambulance issues and possibilities for the future. Though Greenwood officials have repeatedly said they have no interest in running an ambulance service themselves.
“I don’t anticipate any payments coming forward until we see the results of the study,” said Bassing. The township is expecting to see the report by the end of the year, though Bassing told the commission the consulting firm had had “nothing but parochialism from the area.”
Bassing reiterated criticism of the ambulance service dating back to the time it was under the direction of Steve Altenburg.
“We’ve seen mismanagement in this operation for some time,” he said. “The ambulance garage isn’t there. Where did that money go. Where is the business plan. We’ve had violation of the contract. It is November and the contract isn’t signed yet. What kind of business is this?”
Norby responded that the city is working in good faith on the issue.
“We are working to save people,” he said.
“You can ride that flag up all you want,” said Bassing.
“We are past that now,” said McCray. “You may come up with some great ideas, but in the meantime, we are working on changing this business and doing something real to make a change here. We would love to have you on board for that.”
Ambulance services throughout the area have been struggling to find staff and finding trained paramedics who can provide ALS-level service is even harder. The Tower Ambulance is providing on-call 24/7 staffing with its EMTs and EMRs.
Damm said the city of Buhl can’t find any paramedics, and the private ambulance service they hired to cover their community has since left. Finding staff has also been more difficult during the pandemic, Damm said, because of the risks to ambulance personnel.
The Tower Ambulance Service has called for ALS/paramedic support 56 times from Virginia and three times from Ely in the first 10 months of this year, on average once every five days.
Bassing also asked why he hadn’t been invited to participate in the ad-hoc committee that is discussing future plans for the service.
“We did invite elected officials from Greenwood three times,” said Norby, who also sits on the Tower City Council. “You aren’t on the town board. This is an ad-hoc committee formed by the city.” The committee consists of elected officials from the townships in the ambulance service area who have chosen to participate.
The ad-hoc committee has been discussing options for the future of the department, including the formation of a joint powers committee to oversee and run the department, so that the department would not be solely run by the city.