Palo Alto Weekly

Spectrum - January 27, 2012

Editorial: Top marks for paramedic system

Report praises Palo Alto's unique emergency medical services system

After a year in 2011 when voters agreed to drop binding arbitration in fire and police employment contracts and the firefighters' union finally accepted a deal that achieved cost reduction goals, the City Council is set to assess delivery of emergency medical services after receiving a consultant's study this week.

The city's EMS gets high marks from the same consultants that about a year ago found significant other areas for improvement in the administration of the fire department, including eliminating the minimum staffing requirements and consolidating fire stations.

This time, few faults were found with EMS, which performed well on benchmark tests when compared to other similar cities. Nevertheless, the consultants recommended numerous ways to improve the department, including elevating its coordinator to the new position of EMS chief to reflect the fact that 60 percent of all 911 calls to the department were requests for emergency medical service.

Those 5,306 calls were mostly answered by fire department paramedics, the only service in the county that operates its own equipment staffed by fire fighters. All other cities are part of a countywide EMS system that is provided by an outside contractor.

The consultants endorsed Palo Alto's unique status, which it inherited in 1980 when the county took over EMS service for most other cities. Those offering EMS at the time were permitted to continue if they wished, as long as they provided the same level of service. Palo Alto has not wavered in its commitment to operating its own ambulances, even though some county officials would like the city to join the county, which then would have 100 percent coverage.

Of particular interest to the council's Policy and Services Committee, which will take a first look at the consultant's report, will be an analysis of the response times for first responder fire engines and paramedic ambulances. Fire engines are dispatched when a 911 call is received and staffed by one paramedic and one or more emergency medical technicians (EMTs), who on average arrive at an accident scene in 8 minutes, ranking them in the 90th percentile of response times. Palo Alto ambulances, with two paramedics aboard, can be expected to follow in 4 minutes or less. These benchmarks are in the top tier, although the consultants said they could improve and cited possible slow processing time for 911 calls as the reason.

More interesting for the committee and the council will be whether to operate two ambulances, Medic 1 and Medic 2 on a 24/7 basis, which would upgrade Medic 2 from a half-day of service to full-time. Another sensible recommendation is to drop Medic 3 entirely, which was used to transport non-emergency patients, a service that is available from other local providers.

Revenue generation for the department is a sore spot for some council members, who would like to see the city earn more on transporting patients to the hospital. But the consultants were not much help, saying that state and local laws, current contracts and the needs of the community would make it difficult to make major changes. The cost for 28 firefighter/paramedic positions and 7 firefighter/EMT positions are expected to be $5.3 million this year, the consultants said, and with other expenses will total nearly $6 million.

Unfortunately, department revenues are expected to fall far short of the total expenditures, based on transporting only about 3,100 patients last year, despite making 5,300 calls. The revenue is further reduced by a less than a full price reimbursement of $790 per trip, which produces just $2.2 million, for a short-fall of nearly $4 million. And although the consultants say the city could save up to $300,000 by increasing collections and ending the service of Medic 3, a break-even year is not in sight.

The EMS department traditionally has been one of the city's top performers, delivering quality service from a highly motivated group of paramedics and EMTs. This is not a department that can recover its full costs, a factor recognized by the consultants, who we believe identified every area of potential savings.

The biggest challenges in our judgment are aligning both staffing and equipment with the widening gap between medical calls and fire calls, and not over-responding with more equipment than is needed. Too many citizens have seen such over-response first hand, where multiple trucks and the paramedics all respond to minor injury accidents.

After the controversies of the last two years relating to the firefighters union complete insensitivity to the budgetary needs of the city, it is good to have such a positive outside assessment of the emergency medical services role of the department.

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