By Eric Fleischauer
The Decatur Daily
DECATUR, Ala. — First Response ambulance response times failed to meet Decatur City Code requirements, but the EMS committee on Tuesday did not recommended City Council action or make a finding that the ambulance service had good cause for its failure.
Decatur Fire Chief Tony Grande said he’s frustrated at First Response’s failure to meet the requirements of the city code, but noted that some of the failure could have been the result of overly conservative classification of calls as emergencies by Morgan County 911 and by delays at Decatur Morgan Hospital in preparing patients for non-emergency transport from the hospital.
Grande also reiterated his preference for a city-owned ambulance service.
The city code requires that First Response, which has a monopoly in the city, have a response time of eight minutes or less on 90 percent of its in-city calls and 12 minutes or less on 90 percent of its calls in the police jurisdiction. In 2017, according to reports presented to the board at its first meeting of the year, First Response met the eight-minute mark on 88 percent of its in-city calls. It met the 12-minute mark on 83 percent of the calls in the police jurisdiction, which is an area generally extending 1½ miles beyond the city’s border.
In the first half of this year, First Response failed to meet the requirements of the code for in-city calls in two of six months. It failed to meet the city code for police jurisdiction response times in each of the first six months of the year.
The city code allows the EMS committee to grant exceptions to the code’s requirements “for good cause only,” with the burden on the ambulance service to file “a request for each response time exception.” Tuesday’s short meeting included no questions or discussion about the reason First Response failed to meet the code requirements.
“The hurdle we’re facing is we have a broken EMS system,” said David Childers, president of First Response, after the meeting.
Childers said his company’s average response times are excellent, but are hampered by Morgan County 911. He said dispatchers frequently classify calls as an emergency requiring an ambulance staffed by paramedics when they should be classified as a non-emergency requiring only advanced EMTs.
“The 911 system will dispatch a fire engine and a paramedic unit on a toe pain,” Childers said. “I don’t mean to be facetious, but somebody will hit the bed post with their toe and it’s bleeding, and dispatch tells us it’s a Category 1 hemorrhaging. That’s a lot of the problem.”
Another hurdle, he said, are ongoing renovations at Decatur Morgan Hospital’s emergency room.
“I applaud them for a much-needed expansion, but we’re having a significant amount of time holding there in the (Emergency Department) both picking up patients and dropping off patients,” Childers said. “This is growing pains for Decatur Morgan Hospital.”
EMS coordinator Janice Johnson, a deputy chief at Decatur Fire and Rescue, on Tuesday provided committee members with a breakdown of First Response wait times at the hospital’s two campuses.
The wait times, which were exclusively for non-emergency transports from the hospital to other facilities, ranged from 19 to 33 minutes at the main campus and from 14 to 26 minutes at the Parkway campus.
“The provision of emergency medical services involves a combination of agencies,” Grande said after the meeting. “The (ambulance service) is just one cog of the wheel. For example, if the dispatch center is not triaging its calls in an appropriate manner, the ambulance service could be dispatched to more emergencies than there truly were. The hospital, the ambulance service and the 911 center have to work together as a team. … If people stack up at the (emergency room), ambulances stack up at the ER. If ambulances are stacked at the ER, they’re not able to take a call.”
He said the decision on whether to recommend that the City Council impose sanctions on First Response is in part dictated by whether the company has the resources to have enough ambulances and staff to meet the code’s response-time requirements.
“Very few private enterprises I know of are going to commit so many resources that their expense exceeds their revenue,” Grande said. “They’re in it for a profit.”
He said when First Response is close to meeting the 90 percent requirement, the committee tries to work through issues rather than being “punitive and disciplinary.”
“We want them to be at 90 percent,” Grande said. “We push hard for them to get to 90 percent. We’ve been accused of pushing too hard; the ambulance service sometimes thinks we’re targeting them.”
Grande said he thinks the best solution would be to replace the private ambulance service with a city-owned service.
“The city provides fire trucks to put out fires and to deal with car wrecks and hazmat situations,” Grande said. “We have police officers to help with break-ins and other issues. But if somebody is having a heart attack at home, we allow a private provider to provide that care. I think that is a service that should be provided by the municipality.”
He said he believes the city could run an ambulance service at a cost that most residents would find reasonable.
“There’s the potential to get the community onboard to support this as an option,” Grande said. “When you have a fire department or police department responding to an emergency, people know these folks are dedicated to the community. We want that same feeling for our ambulance service.
“Privatization of EMS has created a profit mentality for a thing that I don’t think should be a profit-making venture.”
Childers said the average response time for First Response since it began in 2012 is five minutes and 32 seconds, which he said ranks it among the best in the nation.
“I don’t believe a subsidized or government-run service can produce a better result than we do,” Childers said.
The chairman of the EMS Committee, Dr. Ricaurte Solis, said he’s concerned that First Response is not consistently meeting the city code, but said some of that may be the result of factors outside the company’s control. He said enforcing the ordinance could cause hardship for First Response.
“They could increase staffing and put more ambulances on the road to meet those numbers, but that has a monetary cost,” Solis said. “We have to balance that against whether First Response is going to be able to survive.”
He said First Response must work within its budget, but he said he does not know what that budget is.
“I don’t have that information,” Solis said. “I have to trust the ambulance service is putting out the number of vehicles and staff it thinks are adequate. I can look at numbers and say this is not acceptable, but I can’t do much more than that.”
Solis also said one solution would be to replace the private ambulance service with a city-owned service.
“There are pluses and minuses,” he said. “That would be a solution that should be seriously looked at. It’s been successfully done in other places.”
Private ambulances also work in other cities, he said.
“In order for it to work, you have to have a true partnership between the city and the private entity,” he said. “I’ve been here for a year, and I don’t have the sense that we’re on the same page. We need to get to the point that we’re on the same page. I would like to have the best service possible, whether that’s provided by the Fire Department or by a private entity. I don’t really care how we get there.”
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