County ambulance service: high marks from grand jury County ambulance service: high marks from grand jury (December 24, 2003)

By Renee Batti

Almanac News Editor

The interests of county residents are "well-served" by the emergency medical care and ambulance service program in place for about five years, according to the San Mateo County Grand Jury.

In a report issued earlier this month, the grand jury said its investigation of the countywide emergency medical care program -- a private/public partnership between a for-profit ambulance company and most of the county's fire agencies -- showed that it is "a substantial improvement over the system that existed prior to 1999."

The report comes at a critical time: The county is set to extend the current emergency medical services (EMS) contract, which expires at the end of 2004. At the same time, a key player in the partnership, the Menlo Park Fire Protection District, has stepped up its criticism of the contract and has urged other fire agencies in the county to consider teaming up for a fire service-based ambulance program to replace the private transport service now in place.

The Menlo district and most other fire agencies in the county provide the "first response" component of the EMS system, sending fire engines with a paramedic to medical emergency calls to care for sick or injured patients until an ambulance arrives.

The grand jury investigation was prompted by news articles and a citizen complaint regarding ambulance service response times and other issues, the grand jury report stated.

The report cites a patient satisfaction survey sent by the county's EMS Agency to those in the county who received treatment and/or ambulance transport services through the EMS program. It said that 89 percent of the returned surveys "indicated that the services provided were good to excellent in the areas of timeliness of response, how they were treated medically and handled as patients, skills and knowledge of the providers, and how well the response teams worked together."
Two-tiered system

The county contracts directly with the private, for-profit firm American Medical Response (AMR) for handling countywide emergency medical care. The county's EMS Agency monitors AMR's performance through a number of measures, including paramedic and ambulance response time. AMR has met its response-time commitments consistently through the years, according to county records.

While AMR-staffed ambulances provide most of the transportation of emergency-care patients to the hospital, AMR subcontracts with fire agencies in the county to provide the "first-response" component of the two-tiered system. A fire truck with a paramedic on board is almost always the first on the scene of an emergency medical call. When an ambulance arrives on the scene, its staff takes over medical care and, if needed, transports the patient to a nearby hospital.

The "first response" paramedic program is organized through a joint powers authority (JPA) made up of fire districts and cities in the county. While most of the county's fire agencies participate in the partnership with AMR through the JPA, the Menlo Park and Woodside districts also subcontract with AMR to operate ambulances, as do the city-run fire departments in Pacifica and Half Moon Bay.

The Menlo Park district recently negotiated with the JPA and the ambulance company to get out of its contract to operate the ambulance next year. Both the Menlo Park and Woodside districts have lost millions of dollars running the ambulances and are pushing for changes in the system.
Findings

The grand jury interviewed representatives from fire districts, AMR, the JPA, the county emergency services agency, and the patient who filed a complaint about the service, according to the report.

The report said that interviewees involved the EMS program stressed that services under the two-tiered system "are now fully integrated." They cited as improvements over the former service the single dispatch system, and the standardization of training, equipment and record-keeping.

Those interviewed said that, although response times for both fire truck/paramedics and ambulances are within or better than contract requirements, they "can and should be shortened even further."
2007 and beyond

The county is poised to extend AMR's contract by at least two years -- through 2006 -- and possibly for four years. Although Menlo Park fire officials acknowledge there is little choice but to extend it at this point, they maintain that a coalition of the county's fire agencies could provide better and less expensive ambulance service, and they are lobbying their colleagues to consider forming such a coalition.

Bart Spencer, the Menlo Park fire board member who also sits on the JPA board, argues that the surveyed patients who rated their care good to excellent don't see the flaws in the system that fire service paramedics on the streets are familiar with -- flaws that lead to ineffective use of fire agencies' resources and, at times, jeopardize patient care.

He and other district officials and paramedics also complain that AMR doesn't put enough ambulances on the street, and that fees to patients taken to the hospital are among the highest in the country.

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