Re: Tiered system using private ambulances

[Guest guest]

Which city?

[texasems-L] "Tiered" system using private ambulances

Our City Manager is proposing that we reduce EMS unit utilization rates (call volume) by dispatching a private ambulance to low-priority calls. We currently provide all-paramedic MICU service, responding to 9-1-1 calls only. We use "Power Phone" to provide EMD and priority dispatching. We currently use three priorities for EMS calls: Priority 1 (life-threatening), to which an MICU and a first responder are dispatched; Priority 2 (urgent), to which only an MICU is dispatched; and Priority 3 (non-emergency), to which only an MICU is dispatched, in non-emergency mode. EMD-trained firefighters serve as both call-takers and dispatchers.

The City Manager's proposal is to dispatch a private ambulance to the Priority 3 calls instead of a City EMS MICU. Alternatively, he is considering sending our MICU, having our crew assess the patient, then our crew would call a private ambulance for transport if the patient is non-urgent.

The problems I see with this are:

1. Even perfectly done, EMD is not always accurate. All of us have been dispatched Priority 3 only to find a critically ill or injured patient. How significant is this risk? (As our City Manager says, every thing we do involves some risk...).

2. Even if the complaint is just a stubbed toe, the caller perceived it as an emergency when s/he called 9-1-1. How will they feel if we send a clear message that their "emergency" did not warrant the City ambulance? Will they complain? Will it matter?

3. If we go to the call and then call a private ambulance for transport, it will not save an appreciable amount of time (our hospitals are all VERY close, and transport times VERY short). However, we will lose the revenue.

Does anyone out there have any experience with this sort of arrangement? What can you tell me about it? If it would really improve our system utilization rates, I'm all for it.....I just don't have any experience with such a system from which to evaluate. I'm familiar with internally tiered systems (BLS and ALS units within the same department), but this is fundamentally different.

Please give me any advice you can. Thanks in advance for your help! Please email me directly.

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