Part-Paid Department Provides EMS That Avoids Burdening Taxpayers
Bountiful City, Utah, Fire Dept.
The Bountiful City, Utah, Fire Department has implemented an emergency medical program that has grown into a successful, well-equipped operation that has not caused a heavy financial burden to the city or the individuals it serves.
A suburb 10 miles north of Salt Lake City, Bountiful City has a population nearing 40,000 in an area of 9.7 square miles. It is chiefly a residential city. Through this area run a major interstate freeway, major railroad lines, large oil company pipelines, transcontinental communication lines, and traffic vital to national defense.
In 1975, the Bountiful City Fire Department started to look into the many problems involved with providing emergency medical service to its then 38,000 residents. At that time, ambulance service was provided by a volunteer ambulance service stationed outside the city limits. At times, the service was slow and there was no control over the service by the city. There were a few bad experiences where an ambulance was needed badly but a crew could not be found.
It was decided at this time that Bountiful City would provide its own ambulance service. Application for a federal grant was made through the Utah State Health Department to help purchase a modular ambulance. Early in 1976, Bountiful City received a $7500 federal grant and ordered an ambulance. The ambulance was delivered in the latter part of June 1976, and went into service July 7.
How department operates
The fire department operates with full-time and part-time fire fighters. There are two full-time personnel on duty at all times at each of the city’s two stations. These crews are backed up by callmen. Most of the part-time fire fighters are city employees and are more available than private industry employees.
When an ambulance leaves on a call, a standby crew is called in by pager to provide coverage at the station while the full-time crew and ambulance are out. This maintains coverage at the station at all times and gives instant response with either the ambulance or minipumper should another call come in while the first crew is still out. If a fire alarm is received, more part-time personnel are called to handle the alarm.
When the decision was made to provide emergency medical service for the city, personnel were trained and certified as emergency medical technicians-ambulance. At present, 34 personnel have had EMT training, which includes 120 hours of classroom work plus the practical part of the course and the on-the-job training in the hospital emergency room and on the ambulance. The decision was made to title the fire fighters trained as EMT-As “firemedics” because of the dual roles they serve.
A pay classification was approved that pays the firemedics one step higher than other fire fighters. This helps compensate these personnel for the extra time they must put into training. The term firemedic seems to be self-explanatory to the public and the dual role as fire fighters and EMTs has met with excellent public approval and fire department personnel acceptance because of the increased activity of the firemedics while they are on duty. The increased number of calls per year has enhanced the public image of the fire department.
Training for recertification
Every two years, each EMT must be recertified. There is a prescribed amount of training that must be completed during this time. To accomplish this, one fire drill training night per month is dedicated to EMT training. Usually local physicians, nurses and emergency specialists have assisted in these special training sessions.
The need for a medical training officer was realized and Captain Michael Barfuss was appointed to this position. Captain Ronald Hatch was appointed combat training officer, assuming training duties in the department. Training plays an important role in the medical aspects of the firemedics’ job just as it does in fire fighting. Each firemedic is involved in ambulance duties. The full-time personnel get more calls because they are available for initial response, but when the part-time personnel are working firemedic shifts at both stations, they respond on ambulance as well as fire calls.
To further help with firemedic training and recertification, the department has purchased two ResusciAnnies, one Resusci-Baby, and one Recording Annie, plus several medical films that are used not only for department training, but also for training community groups.
In conjunction with the Jaycees, we have conducted weekly public training classes in the last two years that have concentrated on CPR but have included many phases of emergency first aid and what to do until the ambulance arrives. In public training as well as department training, nobody learns as much as the instructor, so by letting the personnel teach others, they benefit greatly from the knowledge and gain expertise.
Good relations with others
The department has a good working relationship with many emergency service specialty organizations, such as Life Flight in Helicopter, Davis County Paramedics, University of Utah Medical Center, Intermountain Burn Center, Primary Childrens Medical Center, Poison Control, and others.
The local hospital, Lakeview, has been very helpful in assisting with training and allowing the EMTs to observe and participate in emergency procedures. The physicians and specialists have assisted in classes on medical subjects.
Hands-on training has proven to be the best learning retention method and has held the interest of the firemedics. A critique is held for unusual medical calls and department officers as well as the firemedics involved in the call, get the opportunity to discuss and evaluate how the call was handled and what improvements could be made.
Firemedics are welcome to come to a station on their own time to discuss and review medical procedures or subjects with the personnel on duty. This also gives them an opportunity to be first out on a call while they are at one of the stations. A sheet is posted each month, showing how many calls a firemedic has responded to that month. It also shows the total number of calls for the month and so far each year. This helps firemedics to keep track of their calls for recertification.
Public appearances
The firemedics conduct emergency demonstrations and often stand by at large sporting events, public or religious gatherings, and activities on public holidays. While on standby at events, the emergency vehicles are on display and questions pertaining to emergency services are answered. Fire department vehicles lead local parades and this has gained us public support.
The fire department rescue crew has assisted EMT training classes by providing the facility, equipment, vehicles, and personnel for the vehicle extrication phase of the training. This helps to defray some of the training expenses and gives the firemedics practical teamwork training.
The Bountiful City Fire Department has a good mutual aid agreement with the neighboring fire departments and ambulance services that provide backup coverage for each other. On major fires in the city, the ambulance crew stands by at the fire scene, where they can handle a fireground medical emergency or respond to a call anywhere in the city.
Taxpayer kept in mind
One objective of the fire department in providing EMS was to keep it from becoming a burden on the taxpayers. It seems that many programs implemented by government agencies are used by a select few, yet paid for by all. We found that about 90 percent of the residents had insurance that included payments for ambulance service. These policies were already costing taxpayers so much money each year that if we went ahead and increased the tax mill levy to pay for ambulance service, then most of our residents would be paying twice for something they might never use.
It was decided to charge for our service. To start with, the charge was $25 per call within the city and $30 per call outside the city. There is no extra charge for mileage, oxygen, bandaging, splinting, CPR, etc. An agreement was made with area hospitals to have them replace medical supplies we used and charge these items to the patron’s hospital bill. We also have an exchange program with the hospitals for the linen used on a call. They provide the ambulances with fresh, clean linen and put the dirty linen through their laundry at no charge to the ambulance service.
The money collected from the ambulance service goes into the city general fund under a separate account number, so we can keep track of how the service is doing. By 1978, we had recovered the cost of the first ambulance and had enough money to purchase a second ambulance without using any federal funds.
On -July 1, 1979, the rates were raised to $40 per call in the city and $45 outside the city to keep up with the rising costs of operation. This is still way below the average of $83 per call and $3 per mile charged by other ambulance services in the area.
Ambulance calls have increased from 186 in 1976 to 902 in 1979. The ambulance service provides nonemergency transportation when truly needed. This provides a beneficial service to the nursing homes in the community. If a person has a financial hardship and no insurance, the city drops the charge for the ambulance. This has been a help to a few needy citizens.
Economical, effective service
The Bountiful City Fire Department has tried to prepare itself for any type of emergency it may be called upon to handle. The city government has backed the department in its growth in the EMS field and the equipment the city helped provide, along with the dedicated service of the part-time and full-time firemedics, has culminated in an effective, economical service which can be credited with saving many lives.
I feel the fire department can provide emergency medical service better in every way than private companies can. The personnel are more dedicated, they are better trained, they take pride in their equipment, and they have a will and desire to serve that isn’t present with most private ambulance services.
We maintain our own equipment and it is checked daily by each crew.
I feel fire departments need emergency medical service if they are going to survive in today’s world of budget cuts and consolidating departments.
