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Serving Northern St. Louis County, Minnesota

Rethinking EMS?

Discussion is warranted but change will have to have broad local support

Posted

Last week’s presentation in Tower on the state of emergency medical services in the region by Virginia Fire and Ambulance Chief Allen Lewis was informative without offering a clear path forward— and that was by design.

Chief Lewis is well aware that area EMS services are rightfully proud of the work they do and that any push for a new approach will take time and will have to come from within. In most cases, area ambulance services will need to think hard about mission, limited financial resources, and the ongoing struggle to attract and keep staff as they contemplate the next five-to-ten years. If Chief Lewis’s presentation starts that conversation, it will have been a success.

While much of the information presented last week was useful for that longer-term discussion, portions of his presentation helped inform the ongoing discussion in Tower over whether and how to provide advanced life support service on a part-time basis. Providing the best care possible should be the goal of any ambulance service, but some of the information presented this past week raises serious doubts about the prospect for a Tower-based, part-time ALS service.

Consider these points made last week:

 Tower currently calls on Virginia or Ely for ALS service about 15 percent of the time, based on medical need. But as Chief Lewis noted in his presentation, there is no discernible pattern to that need. “You don’t schedule your heart attack,” Lewis said, and he’s right. If you could identify a period when demand for ALS service is the highest, you could potentially staff for those periods to maximize benefit for patients and financial efficiency for the TAAS. But if you’re as likely to need ALS intervention at 10 a.m. as you are at 10 p.m., any staffing decision would be purely random. That expends resources that very well might not be utilized effectively.

 Staffing part-time ALS would be challenging. As David Rogers, of the Minnesota Emergency Medical Services Regulatory Board stated at last week’s presentation, the state faces an acute shortage of paramedics as it is. He said Hennepin County has at least 50 unfilled paramedic positions and those are for full-time positions with benefits. A full-time paramedic in Virginia runs just over $100,000 annually, including salary and benefits package. If Tower pays to train paramedics, what do they plan to pay them in order to keep them? That’s a question that’s never been answered. A contract requiring them to stay in Tower if the city pays for their training would likely be unenforceable.

 While Chief Lewis didn’t make the point during his presentation last week, he did note in an interview later in the week that any staffing plan for the TAAS or any other neighboring ambulance service should not be relying on an expectation of increased revenue from inter-hospital patient transfers. He said he intends to continue to ramp up his own department’s capacity to handle the demand for transfers from Essentia-Virginia, and that’s likely to limit growth in revenue to neighboring departments. Virginia, after all, has the right of first refusal for transfers emanating from within its coverage area.

While the Tower City Council had encouraged cooperation between Tower and Virginia as a means of expanding ALS capacity, that approach quickly fell by the wayside as TAAS Supervisor Steve Altenburg opted for a Tower-based solution. The city council told Altenburg back in August to go slow on that approach until he could provide much more information on how such a service would work and whether it was financially sustainable.

Since then, Mr. Altenburg has again asked the council to approve spending tens of thousands of dollars to start training paramedics, even though he’s answered none of the questions that the council posed back in August about whether his plan is even feasible.

The information presented last week confirms that the council was wise to take a go-slow approach.

One thing is almost certain… we are in a period of change for emergency medical services in the region. We all need to move thoughtfully to ensure that it’s change for the better.

ems, taas