The Charlottesville City Council has voted to allow the City Fire Department to begin preparations to offer full-time ambulance service. The move comes despite the objections of the president and chief of the Charlottesville-Albemarle Rescue Squad (CARS), an all-volunteer service.
The vote came after members of the City Emergency Medical Services Committee
gave a report
to the City Council on the future of EMS Services for the City. Delegate and former City Councilor
David Toscano (D)
chaired the 14-person committee, which was charged in August 2007 with providing recommendations on how to improve EMS services in the City. The Committee un
animously agreed that more personnel and rescue vehicles were needed to address “peak” service times. The question is – which organization should best provide that service?
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The Committee voted 5-3 at a meeting on October 24, 2007 to recommend that the City Fire Department provide ambulance service seven days a week, with a medic on board every engine company as soon as possible. Two of the three no votes were from CARS President Larry Claytor and CARS Chief Dayton Haugh. After a subsequent poll was taken via e-mail of the full committee, the vote changed to 10-2, with Albemarle County Fire and Rescue Chief Dan Eggleston changing his vote to yes. Councilor
and Albemarle County Supervisor
(White Hall) were members of the committee but abstained from the vote.
Before the official discussion on the matter, Claytor told Council his organization is concerned they would be made obsolete by the move.
“Our volunteer professionals have done an outstanding job of providing service to this community, and by all records and accounts we feel we’re doing a fantastic job,” Claytor told Council.
“We feel like you’re trying to solve a problem that does not exist,” he said, adding that CARS exceeds targets for response times.
COMMITTEE DECISION BASED ON CAPACITY CONCERNS
Delegate Toscano was not available to attend this week’s City Council meeting, so three other members of the Committee made remarks. The presentation was lead by City Representative Mary Loose DeViney, who owns Tuel Jewelers and serves as Chair of the Charlottesville Regional Chamber of Commerce.
“One of the overwhelming reasons for choosing 24-7 over the peak was the cost factor,” DeViney said. Ensuring that medics were staffed on each engine company during peak hours would cost $500,000, but moving to a full-time system would cost only $100,000 more. These costs are for staffing and operations and not for capital costs. The City budgeted $1 million in last year’s budget to address the issue.
DeViney told Council she had never had any experience with ambulances before, but that the experience of working on the committee was valuable, particularly her tour to the area’s Emergency Communications Center. When emergency calls come in, the call is to the ECC, which then contacts the appropriate first responder agency. She said capacity, and not just response times, was a major factor in the committee’s recommendation.
“When we were at the ECC that morning, by 9:15, we’d run out of ambulances,” she said. “That means that all the ambulances at CARS had been used for calls, and that Medic-5, which is the one at the University of Virginia, had been called out.”
DeViney said she was also struck by the fact that the ECC is a tiered system, where the dispatcher who receives 911 calls asks the caller to give details about the situation so the appropriate service can be dispatched.
“And a lot of our thinking was, if you had a medic [on each engine company], you don’t tier anything,” she said. “You just send them, and they just go.”
But she stressed that the extra ambulance is not being positioned to supplement CARS, but to supplement the area’s EMS system as a whole.
Citizen Representative Martin Burks, a funeral director, said all members of the committee felt the need to add more medics to the system, and that each of the fire stations should have medics.
“More medics cut the dispatch time for EMS calls, because you don’t have to worry about asking those extra questions,” Burks said. “The 24-7 staffing approach provided that extra medic ambulance as well as a medic on every engine, something the third party proposal didn’t do.”
George Lindbeck has been the medical director for both CARS and the Charlottesville Fire Department since 1989. He said he disagreed with the idea that CARS would be destroyed if other agencies boost up their ability to provide EMS services.
“By implementing the plan the committee recommended, we’re going to augment the entire system,” Lindbeck said. He added that Council needed to think of the long-term future of the community, and called the recommendation an investment in the fire department. He said CARS would improve its ability to train new volunteers because full-time medics would be available.
Finally, Chief Charles Werner spoke to Council about why he thought his department should run its own ambulance service. He likened the area’s multijurisdictional approach to EMS services to a patchwork quilt put together by a family for protection.
“We’re not looking at taking that quilt apart, we’re looking at making that quilt stronger and making it a bit bigger,” Werner said. “This is not anything negative about CARS. I want to reiterate that CARS is an exceptional organization.” He said growing response times are a symptom of a lack of ambulances in the system, and added that he would investigate looking at ways to help ensure CARS’ financial stability.
Councilor Kevin Lynch asked why the City should pay to add more medics, when CARS could possibly hire more personnel trained to administer advanced life support methods. Werner responded that would still cluster resources in CARS’ central location, and would not provide any faster service.
“The reason we have three fire stations is to meet response times, to get there as fast as we can,” Werner said. “In an EMS life threatening situation, those moments of first-response care are the most critical, so you need to have them strategically located.”
When Lynch asked why CARS couldn’t just have its own bay in the City’s proposed fire station at Fontaine, Werner responded that wouldn’t solve the staffing issue. Lynch remained unconvinced, and sought further information from Lindbeck.
“There are a lot of people at Charlottesville Fire right now who are great EMS providers, have years of experience, and don’t necessarily have a way to carry that on in the fire service,” Lindbeck said. He said CARS had a highly qualified staff , but had a high turnover rate as well. CARS is currently being supplemented by about sixty-hours of labor each week provided by the Albemarle County Fire and Rescue Department. He said he thought the County would likely pull out those units as it moves to staff its own fire stations with ambulances.
Werner said going to a 24-7 approach would allow his department to more effectively utilize the resources. Each of six medics trained to provide advanced life support would work a 56-hour work week, on 24 hour-shifts. That would allow at least one medic to be available at all times.
Councilor Kendra Hamilton said she thought there had been a lot of hysteria around the proposal. She said the 10-2 vote gave her a strong level of confidence that the committee’s recommendation was the correct one.
However, Councilor Lynch said he was not convinced that the Charlottesville Fire Department taking on a new role would provide the promised efficiencies.
“One of the challenges of being on City Council is that any successful organization wants to grow,” Lynch said. “Most of our departments want to grow. But that doesn’t mean that growth in a situation where the number of taxpayers is finite is always a good thing.”
Mayor Brown, who was chairing the Council meeting as Mayor for the last time before passing the gavel in 2008, said he supported the plan, but was concerned that it did not have the support of either CARS President Larry Claytor, or CARS Chief Dayton Haugh.
“We have fences to mend, and I think it’s incumbent on everyone in the community, on me, the members of the committee, and our City Fire Department to reach out [to CARS,” Brown said. “What does happen in other communities is once the community moves to paid service, they lose volunteers, and we can’t afford to let that happen.”
But Hamilton said giving money to CARS would not necessarily solve the capacity problem.
“This community is not standing still. This community is growing,” she said. “It’s not realistic in my opinion to think we’re going to be able to address the growth in our community, the growth in our traffic, the overutilization of our roads, and the fact that our ambulance vehicles and response vehicles are competing with so much more traffic and so many more people and just a much different situation going forward.”
No specific motion was prepared for the Council to review before deciding on the vote, so Mayor Brown asked City Manager Gary O’Connell to suggest one. O’Connell actually suggested two motions. One to approval of the developing a budget based on six new full-time positions as well as operating costs.
“And the second one, and this is the more immediate one, of moving forward to acquire an ambulance, whether it’s lease purchase or pay for it with cash,” O’Connell said. “We’d like to do some investigation of that to be sure that the use of the money that we now have available, money you approved in the [FY 2008] budget, we can stretch it as far as possible.”
On the matter of providing budget direction to Gary O’Connell for the upcoming FY 2009 funding request, Council voted 4-1 in favor of adding new ambulance services, with Kevin Lynch voting no.
The second motion was on how to most effectively purchase two ambulances. There were two options.
“One is to use the money that was previously appropriated in last year’s budget and just buy them,” O’Connell said.
“The second [option] is a lease purchase that spreads the cost over a period of time, which is how we buy a lot of big equipment, we buy fire trucks right now.”
Werner said it would cost the City $53,000 a year for ten years to lease two ambulances, versus $460,000 to purchase both out-right immediately. Councilor Norris made a motion to take the lease-purchase option. Again the vote was 4-1 with Councilor Lynch voting no.
NO DECISION MADE ON BILLING RECOVERY
The issue of EMS “revenue recovery billing” was not up for a vote at the meeting, but Councilor Norris did ask for an explanation of what that might be.
“First of all, the whole billing discussion was not something that was started by the City,” Werner said. “The County has a revenue recovery committee that has a recommendation to their board that will come forward. I think what will happen is revenue recovery as it goes forward will be something that we all do, and it’s something that’s being done by almost every locality in the Commonwealth.”
Werner said that if people do not have insurance, the Fire Department would bill under a “compassionate” system that either waives or reduces the cost. Norris said he wanted people to know that billing would be a separate decision. City Manager O’Connell said Council would likely have that discussion during the upcoming budget cycle.
Brown said that the City would have to work hard to help raise funds for CARS, given that people may be less likely to donate if they get a bill for ambulance services.