A report analyzing the operations and performance of Las Vegas Fire & Rescue (LVFR) recommends the department revamp response protocols and improve its working relationship with private ambulance provider American Medical Response (AMR) to increase efficiency and cut costs.
Currently, LVFR units handle 28 percent of medical transports, while AMR does 72 percent, according to the 180-page report. Each LVFR ambulance has a target of at least three transports per 24-hour shift.
Commissioned by the city in July 2012 to analyze the fire department’s operations, finances, response times, staffing levels and organizational structure, the report—by the International City/County Management Association’s Center for Public Safety Management—recommends that LVFR:
- Eliminate the three-patient-per-day target, which is too low to meet demand.
- Stop duplicating efforts with AMR.
- Develop a protocol clearly defining transport decision-making based on efficient use of resources and patient interests. Such a protocol is especially needed in situations in which both AMR and LVFR units respond to the same call, according to the report.
Over the longer term, the report also recommends—but does not come down in favor of either one—that the city consider one of two options: discontinue having LVFR do patient transports using its 21 rescue units, saving $14 to $18 million in personnel and equipment costs annually; or have LVFR transport all patients, bringing in $12 million to $14 million in added revenue.
“In the short-term as these alternatives are being considered, ICMA recommends: LVFR improve its working relationship with the private ambulance service and establish a global view of the total EMS system with a focus on efficiency and effective delivery of the service, utilizing all available resources from both agencies,” the report reads. That includes having the LVFR fire chief, LVFR medical director and AMR general manager meet at least monthly and implement a quality improvement program to improve the EMS system and measure performance.
LVFR’s budget swelled from $77 million in 2004 to $111 million, a 43 percent increase and a rate of growth that’s not sustainable, City Manager Elizabeth Fretwell said in a statement. Other findings:
Firefighters’ collective bargaining agreement restricts management’s ability to cover scheduled and unscheduled leave, leading to an over-reliance on overtime pay. In union negotiations, LVFR should attempt to use full-time employees in lieu of overtime to cover staffing needs.
The 24-hour staffing model leaves LVFR with underutilized capacity in some units, while others are handling the bulk of calls. The report recommends switching to demand-based staffing through a combination of 12- and 24-hour shifts.
In compiling the study, the Center For Public Safety Management made two site visits to observe department operations, interview staff and analyze data on the department’s performance. Best practices already in place at LVFR include having “state-of-the-art” fire and EMS equipment, being well staffed to handle an array of different emergencies and effectively planning for future fire station locations, according to the report.
The full report, released in December 2012, is available at lasvegasnevada.gov/Find/27730.htm.
Lumberton Rescue and EMS Making House Calls in North Carolina
Paramedics with Lumberton (N.C.) Rescue and EMS will start making house calls in February to patients recently discharged from Southeastern Regional Medical Center. The program, funded by a two-year, $310,000 grant from the Duke Endowment, is designed to reduce hospital readmissions.
Under the Affordable Care Act, the Centers for Medicare & Medicaid will withhold up to 1 percent of reimbursements for hospitals that have too many readmissions within 30 days of hospital discharge. Southeastern is one of more than 20,000 U.S. hospitals facing a penalty in fiscal 2013, according to Kaiser Health News.
Lumberton Rescue and EMS will bill $35 per visit; paramedics will see patients who have experienced congestive heart failure, heart attacks and respiratory failure, says Chief Robert Ivey. During visits, they will check vitals, make sure patients have safe home environments that are free of trip hazards, check on medication compliance and make sure they are following post-discharge instructions. The 12 medics involved initially will receive training in home visits from the hospital and their medical director, and will carry laptops to transmit patient information to the hospital. “Our goal isn’t to make money off of this; we mainly want to cover our costs,” Ivey says. “Initially, we’ll cover the city of Lumberton, but if it’s successful, we’d like to take it county-wide.”
Lumberton Rescue and EMS has about 40 paid EMTs and paramedics and 25 volunteers who serve largely rural Robeson County. Ranked one of the poorest counties in North Carolina, about 31 percent of its population of 134,000 lives below the poverty line, compared to 16 percent for North Carolina as a whole, according to the U.S. Census Bureau’s 2007–2011 statistics. About 38 percent of residents are Native American, 33 percent are white and 25 percent are black.
“A lot of people can’t afford insurance or medications, or they don’t have transportation to see their doctor or get their medication fills,” Ivey says. “We see a lot of repeat people who wouldn’t have to go back to the hospital if they had a little bit of help on what to do next.” Southeastern has a 27 percent readmission rate, Ivey says.
Ivey, who had followed the advanced practice paramedic program in nearby Wake County, worked with the hospital to determine how his paramedics could help reduce readmissions. He also worked with his county board of commissioners and state EMS office to authorize medics to make home visits for non-emergency conditions.
Read more about the CMS readmission penalties here.
New Jersey Fire Department to Charge for Non-Transport Medical Services
In January, private insurance companies began receiving bills from the Clifton (N.J.) Fire Department for calls that result in medical care being delivered on scene but without transport. The goal, says EMS Chief Daryl D’Amour, is to recoup some of the costs of providing readiness, equipment and personnel. Patients will not receive the bill for $100 directly; nor will public insurance (Medicare, Medicaid).
“If we are giving a patient oxygen, bandaging or splinting a patient, or providing glucose, that costs us money,” D’Amour says. “If we don’t bill that patient, they are getting all of that stuff for free, and we eat the cost.” D’Amour says other municipalities in New Jersey have established similar policies and have been successful in getting a portion of the bills paid.
The Clifton City Council unanimously passed the ordinance authorizing the fire department to make the billing change in December 2012.
The Latest Trend in Ambulance Colors: Pink
Around the nation, EMS agencies recently wrapped, painted or taped their ambulances pink to recognize October’s National Breast Cancer Awareness Month.
In Pinellas County, Sunstar Ambulance spent about $1,000 on 3M reflective tape to change their orange stripes to pink on an ambulance that was stationed at the 3-Day Susan G. Komen Walk in Tampa Bay. They also painted a door in the station pink, where employees could sign the names of loved ones touched by breast cancer; and they made pink Sunstar T-shirts, which they sold at the walk. Proceeds from the T-shirt sales were used to donate $1,000 to the Susan G. Komen Foundation, says Mark Postma, Paramedics Plus vice president.
Other pink ambulances have been spotted in Tulsa, Okla. (EMSA); Lower Makefield, Pa. (Yardley Makefield Emergency Unit); San Juan County, Utah (San Juan County Ambulance); Bullitt County, Kan. (Bullitt County Emergency Medical Services); and Peoria, Ariz. (Southwest Ambulance). “This fight is personal to many of our employees since they represent those who are touched by breast cancer,” Holly Walter, public information officer for Southwest Ambulance, told the Daily News-Sun. “Breast cancer affects our employees as providers, survivors and supporters of loved ones lost.”
Check out Sunstar’s pink ambulance here
