Ala. city board sets up new rules to manage multiple ambulance services

The new rules cover rig availability now that two services are licensed to operate in Decatur for the first time since 2014

Bayne Hughes
The Decatur Daily

DECATUR, Ala. — The Ambulance Regulatory Board approved new rules to govern ambulance services in Decatur now that two services are licensed to operate for the first time since 2014.

Emergency Medical Services Director Chris Phillips proposed the rules for First Response and Decatur Morgan Hospital ambulance services to follow at the monthly ARB meeting Tuesday, and he immediately got opposition from First Response owner David Childers.

The new rules for First Response and Decatur Morgan Hospital ambulance services immediately got opposition from First Response owner David Childers.
The new rules for First Response and Decatur Morgan Hospital ambulance services immediately got opposition from First Response owner David Childers. (Photo/First Response Ambulance)

Phillips, who took over as EMS director last month, was charged with coming up with a plan after the hospital started an ambulance service in October that will compete with First Response.

The ARB approved a plan with three main rules:

  1. Every day, each ambulance service must have available two ambulances for 24 hours a day and one ambulance for 12 hours for emergency calls. The services can be flexible in their scheduling of the 12-hour trucks, making sure they have full coverage during peak hours.
  2. Prior to assigning an ambulance to a non-emergency call, the ambulance services must show that an ambulance is available for emergency calls.
  3. An ambulance must stay in service at the end of a shift if the ambulance service doesn't have another ambulance available for emergency calls.

The plan is effective immediately and does not have to go to the Decatur City Council for approval, Fire Chief Tracy Thornton said.

Thornton said the objective of the plan is to end the high number of emergency calls refused by the ambulance services.

Phillips said the city had 310 rolled calls in the third quarter of 2021, most of which were by First Response. The company was the city's only licensed service in July. The hospital received its operating license in August, but wasn't running a full service in August and September.

After the meeting, Thornton said he doesn't understand why Childers was upset with the plan because "everything he's asked for in the past he now says he can't do."

Thornton said he doesn't know if any of the rolled calls resulted in complications for a waiting patient, or even death.

"We have to do something to stop the rolled calls," Thornton said. "I don't like the fact that when someone calls Morgan County 911 they might be told there's not enough ambulances available to answer their call for help."

Childers told the ARB that the 310 rolled calls "is an erroneous number."

"It's not accurate at all," Childers said.

Phillips said the rules are similar to those used when Decatur last had two ambulance services. First Response started serving the city in 2012, and competed with Decatur Emergency Medical Service Inc. until DEMSI folded in 2014. This gave First Response a monopoly in the city and its police jurisdiction for the next seven years.

Phillips said having the two services "worked out well with very little problems" for the city during those two years.

"We actually saw excellent response times and coverage (during the period with two ambulance services)," Phillips said.

Using data from Morgan County 911's computer-aided dispatch system, Phillips said he "attempted to balance out the city" while making sure Decatur receives the coverage that it needs on emergency calls.

Phillips said he created the average plan using seven-day periods in the months of May, September and November, focusing on the number of ambulances in operation and the number of rolled calls. May had the fewest rolled calls, September had the most and November was the first month in which both ambulance services were fully operating.

Phillips said Morgan County 911 Director Jeanie Pharis has stated that four to six ambulances are needed in service to cover the city. However, the data shows the slow period for calls is between midnight and 6 a.m., he said.

These nighttime hours only saw 20% of the calls during the third quarter of the year, Phillips said.

"We know that there would no need for a full six trucks during the night," Phillips said. "So, that's why we determined a 12-hour truck (run during the day) would be most advantageous."

He said the peak hours for emergency calls are between 6 a.m. and 6 p.m.

Phillips said each ambulance service running two 24-hour ambulances and one 12-hour truck "would give the city the minimum service it needs."

He said the city needs to start counting the number of times a basic-level ambulance is sent to an advanced-level call in the same way it looks at rolled calls.

"A patient is getting a ride to the hospital (in a basic-level ambulance) but they're not getting the pre-hospital care that might be needed," Phillips said.

Phillips said it's up to each ambulance service how many non-emergency ambulances they schedule. The ambulance services work with Morgan County 911 to schedule non-emergency calls.

Morgan County 911 now dispatches emergency calls to the ambulance service that has an ambulance closest to the call.

Childers said one thing that's missing in Phillips' plan is the "BLS week" instituted in 2012 for basic life support services and used in the two years his company competed with DEMSI. During that week, the ambulance service was responsible for all hospital discharges and transfers except for dialysis calls and individual contracts with a local company.

"That facilitated the revenue that produced the two 24-hour ALS (advanced life support) units," Childers said.

Childers said the requirement to run two 24-hour ambulances and a 12-hour truck for emergency calls is "a death sentence" if his company is not receiving revenues from discharges and transfers.

"You can't mandate X number of trucks if the revenue is not there to support X number of trucks," Childers said. "The call volume we're transporting at this time will not support two 24-hour trucks running at one time and a 12-hour (basic life support) truck."

Thornton reminded Childers that he once said, before the hospital started its own ambulance service, that five to six ambulances are needed to provide daily coverage.

Thornton said the ambulance services should each get half of the non-emergency calls now.

Childers said the problem is, other than contract calls, his service no longer gets non-emergency transfers from the hospital.

He said non-emergency calls are where his ambulance service makes money and this pays for emergency ambulances to operate. Emergency calls produce little revenue because many of Decatur's residents are uninsured and are unable to pay for an ambulance service.

The hospital "is getting 100% of the transfers and discharges out of their own facilities," Childers said. "That's why this is a convoluted mess."

Hospital EMS Director Tyler Stinson said 100% isn't correct because First Response does get some transfers from the hospital to local nursing homes.

Childers said former city EMS Director Ashley England said in August that "patient preference" would be used for non-emergency calls "but we feel that's not the case at this time or they're choosing the hospital."

Childers said there is also an issue with the requirement that an ambulance can't go out of service at the end of a shift if there's no other ambulance available for emergency calls.

" The Alabama Department of Health says that, if an ambulance runs its calls and depletes its supplies, it is illegal for them to respond to another call," Childers said.

Thornton said the number of times an ambulance runs out of supplies "from running normal calls is very slim."

Phillips said he was in the ambulance business 26 years "and I've never been so depleted with supplies that I couldn't run one more call."

Thornton said he understands, especially now during the COVID-19 pandemic, that there are times when a truck has to be decontaminated and cleaned, but they don't want people just going off shift without providing some coverage.

Stinson said he's OK with the changes approved by the ARB. The hospital's ambulance service is fully operational now.

"We're already running three ambulances a day and sometimes four or five," Stinson said.

Phillips and Thornton said they will follow the data created in the next few months to see if an adjustment is necessary in February.

First Response last week filed a federal lawsuit against the city and hospital alleging they conspired to damage its business.

Also on Tuesday, the ARB voted to recommend an ordinance change in which it would penalize an ambulance service if it doesn't respond or gives false information to the city EMS director. The current ordinance says a service would only be penalized if it doesn't respond or gives false information to the ARB.

The board also voted to penalize Decatur Morgan Hospital one point for violating the city ordinance when it failed to have a field supervisor on duty at all times. Morgan County 911 was unable to reach a Decatur Morgan ambulance supervisor on Dec. 6. Phillips said Stinson told him that the scheduled supervisor called in sick. Point penalties can trigger fines and, if 26 are accumulated over two years, can cause revocation of the license to operate an ambulance service.


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