Modest Property Tax Pays Medical Service Expenses
EMS Operations
After 25 years of service with a metropolitan fire department plus an additional 18 months with the United States Fire Administration in Washington, D.C., I have been privileged to witness the birth and subsequent tremendous development of fire service EMS.
Thirty years ago, EMS was at best nothing more than basic first aid (“In goes the good air, out goes the bad.”) and while lives were saved, fire fighters lacked the knowledge to save many, many more. Anyone who served in the fire service prior to present EMS can remember countless incidents where it was evident a life could have been saved if only those working on the victim had possessed additional skills.
Today, EMS is a highly sophisticated pre-hospital emergency medical service. The U.S. Fire Administration claims 80 to 85 percent of all pre-hospital emergency care is being delivered by the fire service, with 60 to 70 percent of all fire departments now delivering some level of EMS. Nearly all successful advanced life support programs in medium to large cities are being delivered by fire departments. Lives previously lost are now being saved.
Yet it’s a very expensive operation—one that fire officials must justify if the present level of service is to continue.
Pioneer program: The Seattle Fire Department’s successful pre-hospital emergency care is well known to everyone in fire service EMS. One of the first to enter the paramedic field, possessor of the most successful citizen CPR program in the nation, and a strong advocate of the “layered response system,” Seattle is acknowledged as a leader in the EMS field. So, as this is our first column, perhaps it would be fitting to examine how Seattle is meeting the expense and growth issue.
Last August, an EMS levy was proposed in King County, the county surrounding Seattle. It called for a tax of 21 cents per thousand of assessed valuation of property, with the money going to the communities engaged in EMS. This meant a house in King County with an assessed value of $60,000 would pay a levy of $12.60, or to a family of four in that home, a yearly tax of only $3.15 per occupant—a very small amount when a life is at stake.
With virtually everyone supporting the proposed levy, it was passed and the Seattle Fire Department was assured of approximately $2 million a year to run its EMS program.
This year the levy will pay the salaries and benefits of Seattle’s 50 paramedics, the three medical services officers and the one supervising battalion chief—a total of $1.6 million. It will also pay for the operating supplies, auto expenses and hardware, plus a portion of the salaries of the EMT specialists and a part of the communications expenses.
Service level formula: To assure proper growth of pre-hospital care, the Seattle Fire Department now uses a formula for measuring paramedic level of service throughout the city.
Fire department officials wanted to determine the probability of long-term survival (survival of six months and discharge from the hospital), if it was a witnessed incident of ventricular fibrillation (someone present when the victim collapsed), when CPR was initiated by fire department personnel.
Through previous studies, they already knew the precise time—down to seconds— that it would take for an engine company to reach any intersection in its first response district. They also knew the same time figures for the closest medic unit to reach the same intersection.
Based on this knowledge, the formula reads: P(s) = F(RT1, RTmu).
In plainer language, it means: The probability of survival is equal to the functions of the first unit response time (an engine company) and the response time of the medic unit.
The implication of the medic level of service formula is that a minute, more or less, in response time for the engine company is every bit as critical as a minute, more or less, in response time for the medic unit.
At this time, the entire system can be displayed geographically and is used to convincingly show why a medic unit or a fire engine should be relocated, added, or eliminated. Such moves are often very emotional and a good statistical base is the only answer. This system was developed by Dr. A1 Halstrom a Ph.D. in biostatistics, while he was in the employ of Dr. Leonard Cobb, known as the founder of Seattle’s paramedic system.
Private service pact: Last, in an effort to further cut city costs, the fire department has been successful in obtaining a letter of understanding, with standards of behavioral conduct, with Seattle’s only private ambulance company at a saving of $50,000 a year.
Fire department policy is to transport only the critically ill or when common sense dictates transportation is advisable. The rest of the transportation is left to the private carrier and the carrier was billing the city $20 per call when unable to collect from the patient.
On an average, the city (fire and police) called for the private carrier 10,000 times a year. Patients paid for 7000 to 8000 of the calls. The 2000 to 3000 unpaid calls were billed to the city—$50,000 a year.
The private carrier in Seattle was professional and cooperative and after a series of meetings, an agreement was reached. The private carrier was allowed to use Seattle’s EMS radio system and become more involved in transportation between hospitals. In turn, the carrier stopped billing the city for uncollectable transports—a saving of $50,000.
From this brief description of progress in Seattle, it’s evident problems—both financial and growth—can be met. It may not be easy, but very few thing worthwhile are simple to achieve.
In the forthcoming months we hope to explore many of the solutions and problems confronting the fire service EMS program.
If you have a problem or a possible solution you would like to share with the rest of the nation, contact Fire Engineering or this writer personally.
Fire Engineering’s mailing address is 666 Fifth Avenue, New York, N.Y., 10103. This writer can be contacted at 6821 153rd. N.E., Redmond, Wash., 98052, or by calling 206881-7726.
