TRI-CITY AMBULANCE SERVICE STAFFED BY PARAMEDICS/FIRE FIGHTERS
RESCUE/EMS
A private/public paramedic ambulance service employing combination paramedic/fire fighter personnel is proving an innovative and cost effective means of improving both emergency services and public relations.
Although the ambulance service costs for Kane County, Ill., continued to rise (from $173,238 in 1976 to $593,600 in 1982), the service delivery stayed the same. Two ambulances, each staffed by two paramedics, operated out of two area hospitals 24 hours a day to service the cities of Batavia, Geneva and St. Charles.
In June 1982, when one of the hospitals gave notice that it was not interested in renewing its contract to provide ambulance service, the three local fire chiefs, Larry Swanson of St. Charles, Frank Johnson of Geneva and myself, met with Batavia’s Mayor Jeffery Schielke, a nine-year veteran of the Batavia Fire Department and an avid fire buff, to determine what alternatives might be available.
Schielke was aware of a private company. Paramedic Services of Illinois (PSI), and after careful investigation and observation of PSI’s operations, Schielke arranged a meeting between Earl Field, president of PSI, and the three fire chiefs.
Field fully explained his company’s functions and let us know that he was definitely interested in bidding on ambulance service for the Tri-Cities. Now, all the political decisions and obstacles had to be overcome. Schielke had to convince the other two cities’ mayors, who all had to convince the County Board that the cities, through their fire departments and PSI, were willing and able to provide quality emergency medical services, really increased services at a reduced cost of $151,200 over the current year. With this in mind, the three city councils and the Kane County Board, city attorneys, mayors and fire chiefs began to lay all the groundwork for the new service.
Four ambulance services bid for the contract, which was awarded to PSI due to cost, experience and the option of having both certified fire fighters and certified paramedics in one person. I might add that all four bidders’ price ranges were between $322,000 and $345,000. The cost included only personnel expenses, which was $367,020 during the last year of hospital based service for two instead of three units.
The fire department paramedic plan was put into service Dec. 1, 1982, and the ambulances were moved from the two local hospitals to a fire station in each city. Instead of only two advanced life support (ALS) ambulances in service, we now have three. The number of on-duty paramedics remained at four and two additional EMTs were added. The ambulance in St. Charles is staffed with two paramedics, the ambulances in Geneva and Batavia were staffed with one paramedic and one EMT each. The paramedics are employees of PSI and the EMTs are members of the fire departments.
The 103 square miles of Kane County, lll.’s fire protection district includes the cities of Batavia, Geneva and St. Charles, a total population of approximately 75,000 people. Kane County, about 30 miles west of downtown Chicago, is primarily a residential area with several commercial, industrial and agricultural interests.
The ambulance service had been taken over jointly by the county’s three cities in 1973 and then by Kane County with intergovernmental agreements between the county and the cities. Citizens were billed $90 per ambulance call. The county collected the funds and contracted with the two local hospitals to provide the manpower to operate both ambulances on a 24-hour basis.
The PSI paramedics are also certified State of Illinois fire fighters, thus each city is not only receiving additional manning for medical incidents, but also has additional personnel for fire fighting situations. Since all three cities operate as combination departments, the extra paid personnel from PSI are a tremendous asset to each fire department. As a result of the PSI program, the city of Batavia was able to reach two very important goals: open both fire stations on a 24-hour-a-day basis, and have a paramedic-based ambulance in service in the city.
The total budget for our service for 1983 is $442,400:
The cost for transport to patients living in the ambulance district was reduced from $90 to $50. The tax to the area citizen was also reduced by 11 percent the first year.
Communications and dispatch is performed through the Tri-Corn dispatch center, which provides dispatch services for Tri-City fire, police and ambulance incidents, another example of successful intergovernmental cooperation. Intergovernmental cooperation is also very apparent with our attomatic aid agreements and mutual aid agreements through our 911 Tri-Com center.
The Tri-City ambulance service is controlled by a board comprised of two elected officials from each city with the three fire chiefs and the PSI area supervisor serving in advisory roles. The board controls the budget and allows the fire chiefs to control the service on a daily basis.
The Tri-City contract was the first contract to cover three separate fire departments and by far exceeds the total square mileage area of any other department. PSI sends their employees through a local fire department fire academy. Some of the main advantages of PSI in the Tri-City area are:
- Combination paramedic/fire fighter employees.
- Competent chain of command, complemented with a rules and regulations manual.
- Lower annual cost to fire department, no pension funding costs.
- Responsible for all uniforms, insurance, salaries, benefits, payroll.
- Handles all EMS reports, meetings and continuing education requirements.
- Departments no longer need to worry about paramedic disciplinary problems or paramedic burnout.
- Personnel provide extra manpower for fire fighting, station and equipment duties.
- Implement nonemergency seminars to the public, such as CPR and first aid classes, blood pressure screening, equipment demonstrations and get-well card program.
Each fire department backs up the ambulance with either first responses and/or additional manning whenever requested. The system has two backup basic life support ambulances running out of the St. Charles and Geneva fire departments. Thus we are able to handle five emergency medical situations at one time or provide backup when additional ambulances are needed at a severe accident or vyhen an ambulance is out of service for maintenance or repairs.
It is very effective to have three ALS units in service instead of only two under the old system. Whenever two of the three ALS units go into service, the third unit automatically changes quarters to the middle city of Geneva so as to keep a unit equally stationed to all our citizens. Whenever a unit with one paramedic needs an additional paramedic, the second unit is automatically dispatched. Each city receives $10,000 for providing the backup ambulance and/or EMTs to work duty shifts on the units. The ALS units are never used for nonemergency transfers. Instead, local private services are first contacted and only if all these are unavailable do one of the ALS fire department units respond. An ALS unit is used for emergency transfers from one hospital to another. Patients have the option of being transported to seven area hospitals.
PSI has been in existence since 1975. All 77 full-time employees, including President Field are both certified paramedics and fire fighters. Presently PSI has contracts in 12 Chicago suburban cities, ranging in size from 13,000 to 100,000 population. PSI works in both fully paid, combination and totally volunteer fire departments, wearing the same uniform as the department they are contracted by.
