Finances drive ambulance debate

15 years ago
By Kathy McCarty  
Staff Writer

    PRESQUE ISLE – Debate continued over the last week regarding the city’s interest in adding ambulance service to the duties of the Presque Isle Fire Department.


ImagePhoto courtesy of TAMC
    Community members, business leaders, TAMC employees and others gathered at Northern Maine Community College to learn about how the city’s proposed ambulance service, if implemented, could change the level of care provided in the community.


    “The idea started a year ago, as part of the City Council’s budget discussion. Since that time, the fire chief and I have followed through with Council, holding workshops with Caribou Fire and Ambulance, a workshop with The Aroostook Medical Center,” said Tom Stevens, city manager.
    According to Stevens, the city has two goals he believes can be addressed by getting into the ambulance business – create revenue for the PIFD and provide quality ambulance service to the community.
    Officials with The Aroostook Medical Center held a meeting Oct. 30 at Northern Maine Community College, joined by others worried by the city’s proposal, stressing their concerns over the quality of care the department would be capable of providing.
    Dr. Stacy Jandreau, who serves as director of TAMC’s Emergency Department and works closely with Crown Ambulance personnel, said she knows the people she’s currently working with and has formed mutual trust. Working with a different service would take longer to develop that type of relationship, noting there’s a “fairly extensive job of questions and answers between TAMC and Crown.”
    “I am not going to be able to branch out any further than I am – don’t see anyone who will be able to,” said Jandreau. “If you divide our service between the two, we will diffuse the experience.”
    “The city of Presque Isle, in my opinion, has one of the best EMS systems in the state. I cannot fathom why they’d want to change that,” said Jandreau.
    “No one seems to be suggesting the quality of care is the rationale for the new service. The proposal is based on another crisis – a budget crisis for the city,” said Dave Peterson, president and CEO of TAMC.
    Peterson said there are lots of people at the fire department and that, “the solution is either reduce the number or find something else for them to do.”
    Peterson said that although TAMC officials have had discussions with city officials in recent months, “at this point it seems a decision has been made to pursue the proposal.”
    Daryl Boucher, an instructor at NMCC, also spoke at the meeting, expressing concern over the training required to serve as a basic, intermediate or paramedic level responder.
    “Basic requires one book for training; intermediate, two. It takes 20 books to train for a paramedic. It’s critically important to notice that an intermediate isn’t almost a paramedic,” said Boucher.
    Boucher’s real concern appeared to be with his students and the training they receive off campus.
    “Currently, students train with Crown – put in the hours required for certification responding to real calls. Splitting between the two places will require them even more time to obtain the education (due to reduced call volume with two services providing the same services now offered by Crown). There’s a need to maintain educational standards,” said Boucher.
    City officials are quick to point out discrepancies in TAMC’s arguments.
    “We don’t have an issue with the quality of care currently provided by Crown,” said Stevens. “This isn’t about people, it’s about improving services,” by adding ambulance coverage to the services already provided by the PIFD. “It is a financial issue, as we look for ways to increase revenue for the department and at the same time keep costs down for taxpayers.”
    Darrell White, chief of the PIFD and a former member of the Crown staff, explained what it will mean for the PIFD to be licensed at the intermediate level, rather than the paramedic level Crown is currently licensed at.
    “The state of Maine is the one that certifies ambulances – staffing and quality of care. We need to remember the state is the one dictating certification/level of training; it’s not who you work for making the decision. What they (TAMC officials) aren’t explaining is that you can be licensed at the basic level, but that doesn’t prevent you from having an intermediate or paramedic onboard. We’d like to run at the intermediate level, but will have a paramedic available 24/7 for any calls,” said White.
    White said not all calls are serious enough to require a paramedic, but with Crown, one must always dispatched with the ambulance.
    “At the intermediate level, we wouldn’t be required to send a paramedic if one isn’t needed,” said White. “It allows us to operate in more instances at intermediate. If we don’t need to put a paramedic on, we don’t have to, whereas TAMC does have to.”
    “Our interest is, with regard to quality of care, to license at the intermediate level and respond with a paramedic – same level as the Caribou Fire Department,” said Stevens.
    Staffing wouldn’t be a problem, according to White.
    “We have four licensed paramedics, all currently working elsewhere; three intermediate, one of which is a couple credits away from being a paramedic; and five EMTs,” said White.
    Training through  NMCC will cost $4,500 to train an intermediate to a paramedic level, White said. Of the three intermediates currently with the PIFD, one will get the training paid by the National Guard, a second is only shy by a few credit hours.
    “We can thank Caribou Fire and Ambulance for this, as they paid for his training to date,” said White. “The PIFD will only be required to pay tuition for one employee at the full rate.”
    White said, “Ninety percent of all training could be done online through CE Solutions, which is approved by Maine EMS. Other hands-on classes required we have been getting through Caribou Fire & Ambulance and Cary Medical Center for free. We will continue to use this system as it is very common for fire departments to combine training and cost with other departments.”
    TAMC, according to White, is not offering training to PIFD. “And it’s safe to assume this will not change,” added White.
    White said TAMC officials have expressed concern over response time but haven’t pointed out a little-known fact about Crown’s coverage.
    “From 8 p.m. to 8 a.m. TAMC themselves have only one ambulance staffed in Presque Isle and one call crew,” he said.
    He indicated TAMC’s call crew is given a 30-minute response time, much longer than that of the PIFD.
    “PIFD’s on-call crew has a 15-minute allowed response time,” said White, who continued with the issue by adding, “TAMC says they can pull ambulances from their other bases to cover calls. What does that do for coverage in other communities? That also means one ambulance covering seven communities. Presque Isle is only looking to cover its own community.”
    The PIFD would also continue to receive mutual aid from Caribou.
    While it is a financial issue, the city will save money by reducing the amount currently paid annually to TAMC through a contract for Crown Ambulance to provide service to the community, reallocating over $100,000 to be used for the proposed ambulance service.
    “We’re looking at a $235,000 net gain to the city through the fire department in the first four and a half years,” said Stevens.
    Stevens explained that over $100,000 of the $235,000 would be derived from savings from no longer having a contract with Crown. Initially, high-quality used vehicles would be purchased. But over time, newer equipment could be obtained much the same way the PIFD acquires new fire trucks – by putting money aside in a designated account for equipment upgrades.
    “The startup cost to equip the department will be paid for by using the $101,386 subsidy that we now pay to TAMC on a yearly basis, meaning no budget increase for startup. It’s already there,” added White.
    Duane Walton, of the Northern Maine Development Commission, was instrumental in putting together a financial package on the feasibility of the Presque Isle taking on the duties of an ambulance service.
    “More than $100,000 is saved for the taxpayers alone. The rest of the cost is commensurate with the anticipated calls based on Crown’s historical numbers,” said Walton, in a recent statement.
    Walton said the PIFD is well-staffed to handle emergency calls.
    “Presque Isle has a 33-person volunteer department as well to cover fire calls, in addition to the paid regular personnel. It is more a matter of scheduling than it is on availability,” said Walton. “PIFD also has mutual-aid agreements with Caribou on fire calls. It would also have mutual aid with Caribou on ambulance calls, when needed.”
    Walton said the bottom line is a financial one.
    “Given that Crown is fighting so hard not to lose the service to Presque Isle is evidence in itself that there is money on the bottom line,” said Walton. “Presque Isle is doing this in order to help the taxpayers afford to operate a fire department at the level that they need, rather than an all-volunteer force, and to also reduce the cost that they contribute to in order to have an ambulance service in Presque Isle. My bet would be with proper education on the issues and removing the misleading comments and manipulation of the numbers, the taxpayers will go with the city plan and result in the savings that have been shown to them.”
    City Council anticipates making a decision on the proposal at its December session. For more information, contact 764-4485.