Provincetown Fire Dept. cited for delayed EMS runs
The notice cited the department's practice of responding to calls in a town ambulance and then having the patient transported to by a different ambulance
Provincetown Banner, Mass.
PROVINCETOWN, Mass. — The state Dept. of Public Health (DPH) has issued a "notice of serious deficiencies" to the town's all-volunteer fire department for violating state regulations in responding to emergency medical calls.
The notice cited the department's practice of responding to such calls in a town ambulance and then having the patient transported to Cape Cod Hospital by a different ambulance operated by the Lower Cape Ambulance Association.
After conducting an investigation the DPH "discovered EMS [emergency medical services] system deficiencies in the manner in which Provincetown fire responds to emergency calls and its failure to complete patient care reports for every EMS call," stated the April 22 notice from Renee Atherton, a paramedic and compliance officer for the state. She wrote that the department has failed to meet its obligations to "immediately dispatch the closest ambulance and provide assessment, treatment and transport to an appropriate health care facility. By doing so, it is creating an obvious delay in the dispatch of a transporting ambulance."
The investigation involving the fire dept. was triggered by a patient complaint filed with the DPH. The patient's name was withheld in accordance with privacy rules of the Health Insurance Portability and Accountability Act (HIPAA).
According to the notice, Atherton spoke with Provincetown Fire Chief Mike Trovato on April 9 and asked him to provide the patient care report for the person who filed the complaint and to explain the department's protocol when it receives an EMS call.
Trovato told her a town ambulance is dispatched to determine if a patient needs to be transported to a hospital. If so, the department asks Lower Cape Ambulance to do the transport, according to the notice. Atherton stated the DPH determined this practice violates state EMS regulations.
All three towns at the far end of the Cape currently have a three-year contract with Lower Cape Ambulance, said the association's treasurer, Steven Roderick. The contract with Provincetown and Truro has been in place since the association was founded in 1937. Wellfleet opted out of the contract in 1971 after becoming a full-time fire rescue squad.
"Lower Cape Ambulance is in fact the transport company," Roderick said by phone on Tuesday. "We are called to the scene of an incident if there is a transport or not."
Roderick did not want to address the specifics of the complaint.
"We work cooperatively with the towns, so any one of the ambulances, whether it be a Provincetown or Lower Cape Ambulance, or even Truro, can do transports," he said. "But what we try to do is have Lower Cape Ambulance transport first, and when that crew is out of town, we rely on the town or summer standby to do transports and provide station coverage."
In many cases both ambulances arrive on the scene simultaneously, said Roderick.
Lower Cape Ambulance operates two advanced life support ambulances and has over 30 employees, of which 22 work full-time. Those positions are filled by local members of the rescue squads and fire departments. Almost 1,000 patients are taken to Cape Cod Hospital each year by the service. Provincetown currently owns and operates three ambulances.
Trovato was in Louisiana this week and did not respond to requests for comment except to state by text that the notice of deficiencies "is not what it seems." He responded to the state in a plan of corrective action that the town was required to file with the state by May 10.
In the plan of corrective action, Trovato stated that his department has "ceased the practice of responding to calls and not transporting patients in the ambulance initially responding to the scene."
"While that practice wasn't happening all the time, it will now never be happening," he stated, "unless there is a unique circumstance like a truck breaks down or some catastrophic equipment failure, in which case a transfer of care situation would exist and we anticipate this to happen rarely if at all."
Trovato stated that new policies were already in place after the department was cited for similar violations in 2014. "At that time a plan of correction was submitted and the policies were created, policies that we assumed were sufficient," he wrote.
The recent violation notice highlights a problem that select board member Louise Venden has talked about for years. That is, Provincetown is 47 miles away from the nearest hospital, which is the longest distance from a hospital of any town in Massachusetts.
It takes a minimum of two hours for one ambulance run to Cape Cod Hospital, which taxes the resources of the town's fire department.
Venden said one solution is for Outer Cape Health Services (OCHS) to treat patients whose conditions can be handled at an urgent care facility by getting a waiver from the DPH to accept such patients by ambulance. But, she said, OCHS has not applied for such a waiver. She doesn't understand why.
"At this time, we are not in a position to act as an emergency care center nor are most community health centers across the country," Gerry Desautels, the senior development and communications officer at OCHS, said by email.
Desautels stated the Provincetown OCHS clinic offers far more services under one roof than most private medical offices.
Opening the doors to ambulances would reduce the center's "capacity to focus on providing high-standard primary care in a consistent and timely manner, including the host of wrap-around services we currently offer," he stated.
As for the failure to complete patient care reports, Trovato said his department will strengthen its practices.
Trovato said his department always completes a patient care report for every EMS call in Provincetown, but "we haven't been completing multiple patient care reports when multiple agencies — two usually, and sometimes in the same fire department's licensed ambulances — have been involved in the care of a patient."
Trovato said the plan of correction will entail extra attention to adherence with state policies, and will refresh his staff on those policies, both new and old.
"With the new policy," said Trovato, "we will have the responding ambulance complete the call from start to finish whether it is a transport or not."
Trovato said his department is also in the process of creating a full-time EMS supervisor position. The new role will absorb many of the duties now being split among volunteer personnel, he said.
"Having a person dedicated to this job on a full-time basis will ensure quality control," he said, adding that he hopes to have something in place by next year, after funding for the position has been secured.
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