Updated February 2015
The Tracy, Calif., fire department was recently caught in the crosshairs of the national media when New York Times columnist Thomas Friedman picked up a report from a local TV affiliate about the city’s plans to charge residents “every time they call 911 for a medical emergency.” Sound hinky? That’s because it is.
Facing a $9 million budget shortfall, the Tracy City Council decided to charge a subscription fee of $48 a year per household—or $4 a month—to cover some types of EMS responses. Only residents who didn’t pay the fee would be charged $300 for basic or advanced life support, while non-residents would be charged $400. Firefighting and other services, such as answering calls to help seniors who’d fallen, would not be subject to a charge. Nor would calls to 911. (The county contracts with AMR to provide transport, so those charges would continue to be billed the usual way.)
Even though the proposal had been discussed publicly for many months, the department was inundated with calls from confused residents, while bloggers from around the nation had a field day. Tracy, of course, is far from the first fire department to charge a membership or usage fee.
“We had citizens concerned that the simple reporting of a roadside grass fire would result in a $300 charge,” says acting Fire Chief David Bramell. “This misrepresentation of the fee sparked national interest and complicated our efforts to share accurate information about our cost-recovery program.”
Credit where it’s due?
Should there be credit card readers on ambulances? The question launched a vigorous discussion on the National EMS Management Association listserv recently.
Wake County (N.C.) EMS Chief Skip Kirkwood remembers being told to use manual card-imprint machines on ambulances when he started as a paramedic in 1973. Others recall being offered a small percentage of the money collected as incentive. “Our bosses expected us to use them, but I doubt I ever did,” Kirkwood says.
While other health care professionals, including doctors and dentists, ask for payment at the time of service, they typically don’t do it themselves. Instead, administrative staff handle it. And Kirkwood points out how difficult it would be for crews to ask for payment, given many patients’ state of mind. “Many patients are in some emotional distress. Half the time they don’t even want to go into the ambulance with you or are unsure if they should go,” he says. “If you threw the money question at them, that would freak them out even more.”
Yet that doesn’t mean paramedics and EMTs should be oblivious to the financial environment in which they operate, Kirkwood adds. In medical schools, doctors take courses on medical economics; likewise, paramedic and EMT schools should make sure their graduates have a basic understanding of the business of EMS, he says. Could employers teach it? Perhaps, but it’s better taught in an academic setting, Kirkwood says. Employers would have to tread carefully not to appear as if they were encouraging crews to improperly seek to boost revenues.
Fighting the good funding fight
A third news event also shined a spotlight on ongoing issues with finding sufficient resources to fund EMS. Giving voice to longstanding frustration, the National Association of Emergency Medical Technicians (NAEMT) is calling for higher pay and benefits for EMS workers to bring their wages more in line with those of other public safety and health care workers.
“People throughout the United States rely on the quick actions and professional, competent care provided by EMTs and paramedics,” an NAEMT position statement reads. “EMS practitioners are required to respond to varied incident types in often dangerous and austere environments, providing a vital medical service caring for the nation’s sick and injured 24 hours a day. However, wages and benefits have not increased to enable the EMS workforce to grow in accordance with the ever-increasing public demand.”
Not only is the shortage making it more difficult to recruit workers, but some are working second jobs or leaving the field for other professions. According to the most recent data available from the U.S. Bureau of Labor Statistics, the mean hourly wage of the nation’s nearly 208,000 paramedics and EMTs is a little over $15 an hour, for a mean yearly wage of about $32,000. That’s below the mean for all U.S. workers, which is about $42,000.
Jerry Johnston, immediate past president of NAEMT and director of EMS services for Henry County, Iowa, says causes of the notoriously poor pay can be traced to low Medicare reimbursement rates and the transport-only system of payments. He acknowledges there might not be all that much NAEMT can do to directly impact wages, but says it is still important to take a stand. “We hope it catches people’s attention and starts the discussion,” he says.
Hospital type, transport time impact storke survival
Stroke patients taken to hospitals designated as primary stroke centers (PSCs) have a better chance of surviving than patients taken elsewhere, research shows. The problem is that nearly half of Americans can’t be driven to a PSC within an hour, according to research from the University of California, San Diego, School of Medicine and the University of Pennsylvania, presented Feb. 24 at the American Stroke Association’s International Stroke Conference 2010 in San Antonio, Texas.
The Joint Commission’s Primary Stroke Center Certification Program was developed in collaboration with the American Stroke Association to recognize hospitals that provide the highest level of stroke care. As of late 2009, there were about 600 stroke centers in 49 states.
Approximately 22 percent of Americans can be driven by ambulance to a PSC within 30 minutes; 43 percent can make it within 45 minutes; and 55 percent have access within 60 minutes. Adding air ambulance transport using existing medical helicopter resources would increase 30-minute access to 26 percent of individuals; 45-minute access to 66 percent; and 60-minute access to 79 percent.
“Better use of helicopters to transport patients with ischemic stroke to a primary stroke center could increase the U.S. population with rapid access to stroke care, saving lives and avoiding a lot of long-term disability,” researchers note. “Regionalization of acute stroke care—much like the system used to transport trauma patients to specialized facilities—needs to be addressed at both state and national levels.”
And keep in mind: Stroke among younger people is on the rise. The proportion of strokes that occurred among those aged 20 to 45 rose from 4.5 percent in 1993 and 1994 to 7.3 percent in 2005, while the average age of stroke patients dropped by three years, from 71.3 years in 1993 and 1994 to 68.4 in 2005. The study’s authors, who undertook the research after seeing a rash of strokes in people in their 50s, blame the epidemic of obesity, diabetes and hypertension in younger people and urge first responders to consider the possibility of stroke in their younger patients with those risk factors.
The study is in the Feb. 22 online issue of the journal Circulation: Cardiovascular Quality and Outcomes.
For more stroke news, see Research Monitor on page 4 of this issue.
