By Bayne Hughes
The Decatur Daily
DECATUR, Ala. — Decatur Morgan Hospital officials asked Tuesday for changes to Decatur’s ambulance ordinance that would give the hospital more flexibility in meeting response-time requirements, staffing ambulances and managing its fleet.
Bret McGill, regional chief operating officer for Huntsville Hospital’s emergency medical services, presented the proposals at the monthly Ambulance Regulatory Board meeting at City Hall.
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McGill said Huntsville Hospital consolidated seven ambulance services under a president during the past year and increased resources. Decatur Morgan Hospital EMS serves Decatur, Hartselle and the rest of Morgan County.
“We would be doing the very things like we’re doing in other communities,” McGill said.
He said the hospital wants “to be in the same time response and have the same resources available to all of our different communities. Sometimes that’s possible, and sometimes it’s not.”
McGill said Decatur’s ordinance restricts operational decisions that Huntsville Hospital can make in its other ambulance services.
“What we’re trying to do is try to find points that will kind of align and bring things back together,” McGill said. “We know what we’re asking works because we’re already doing it in different counties and cities.”
Among the proposed changes are:
- Allow advanced life support, or ALS, ambulances to be staffed under Alabama Department of Public Health EMS rules rather than requiring a paramedic aboard every ambulance.
- Allow ambulances with more than 250,000 miles to remain in service if maintained under Huntsville Hospital’s fleet management program.
- Stop the on-scene response clock upon arrival of ALS personnel in a quick response vehicle and/or upon arrival of the designated transport unit.
- Combine city and police jurisdiction calls when calculating quarterly response-time compliance while retaining the 9-minute city and 13-minute police jurisdiction standards.
Fire Chief Nathan Springer, the board’s chairman, said members would review the proposals and could respond in November.
Response times and ambulance mileage have been contentious since the City Council adopted the ordinance in 2019.
First Response, then the city’s only ambulance service with a certificate of public necessity and convenience (CPNC), fought the requirements for years before abruptly shutting down March 15, 2021.
Decatur Morgan Hospital EMS began serving Decatur in 2021 and received its second CPNC on Oct. 1 when the city renewed its certificate.
The ordinance requires the hospital to reach 90% of calls within 9 minutes inside the city limits and within 13 minutes in the police jurisdiction, which extends about 1 1/2 miles beyond the city limits. Compliance is calculated quarterly.
Violations can result in fines and penalty points. An ambulance service can lose its certificate if it accumulates 26 points within five years, with points expiring after five years.
The hospital has been fined $5,000 twice and assessed 15 penalty points for failing to meet police jurisdiction response-time requirements, including 10 points assessed in September for the second quarter of 2026. Five points expire Nov. 1.
McGill said the hospital does not object to the required response-time standards.
He said the smaller number of calls in the police jurisdiction means one or two delayed responses can significantly affect quarterly compliance. He cited an example of 10 police jurisdiction calls compared with 300 city calls.
“We’re wanting the average, so we’re wanting the divisor to be that larger number,” McGill said. “It’s a little bit hard of a distinction when you’re only running five trucks. It’s putting more weight on one (PJ) over the other (city), and we don’t want to do that.”
Fleet management
McGill said Huntsville Hospital’s fleet management program provides routine maintenance for all its vehicles.
He said engines, transmissions and other major components are regularly replaced, sometimes including engines at 150,000 miles. As a result, an ambulance’s odometer reading may not reflect the mileage on its replacement components.
“That means an engine does a lot less,” McGill said. “So, by the time we get to 250,000 miles on an ambulance’s engine, the unit might only have 30,000 miles on a new transmission.
“So, the box, the interior are all in great shape and, mechanically, the ambulance is nearly as new as it was six months from the time we purchased the ambulance. This puts us at a little bit of a disadvantage. We have to monitor the mileage and then rotate that truck to the county.”
Huntsville Hospital EMS President Jon Howell said software tracks vehicle performance, and a scoring system evaluates 13 or 14 factors to determine maintenance schedules.
Howell said the system replaces about 15 ambulances annually, and Decatur Morgan Hospital EMS Director Tyler Stinson said its ambulances typically remain in service three to four years.
“We’re trying to have our best ambulances on the road and replace our worst,” Howell said.
Decatur requires a paramedic aboard each ambulance, a staffing rule McGill said the hospital wants to bring into line with state EMS regulations.
Stinson said Decatur Morgan typically operates five to seven ALS ambulances per shift and three basic life support ambulances. BLS ambulances generally handle less serious medical needs and nonemergency transports.
Under the proposal, an advanced emergency medical technician and a basic EMT could staff an ambulance, with a paramedic responding separately in a chase vehicle when needed.
McGill said approximately 88% to 90% of Alabama ambulance services do not require a paramedic aboard every ambulance, a practice he attributed partly to the statewide paramedic shortage. He said advanced EMTs can provide the care needed for most calls without a paramedic aboard.
“Our response model is to have the ambulance with the advanced EMT respond when it gets the dispatch from (Morgan) 911,” McGill said. “And then when they get there (on scene), we would have a paramedic in a chase vehicle.”
For calls involving potentially serious injuries or illnesses, a paramedic in a chase vehicle would be dispatched simultaneously with the ambulance. The ambulance crew would assess the patient, determine whether additional paramedic care is needed and provide transportation. Paramedics in chase vehicles could provide critical care and administer medications beyond an advanced EMT’s authority.
Stinson said advanced trucks frequently operate in the city and county, “so they have two ALS providers instead of just one.”
He said chase vehicles are dispatched “on high-acuity calls like cardiac arrests, wrecks with entrapments, residential fires” and other serious emergencies. The vehicles would be staffed by paramedics, including personnel with critical care qualifications.
“If an ALS unit gets on the scene and figures out ‘We can handle this,’ or they can call and say, ‘It’s not what it was dispatched as,’” Stinson said.
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