Single Ambulance Provider Sought In Everett

Everett fire

The Everett Fire Department would prefer to deal with one ambulance company instead of four.

Currently when you call 9-1-1 for the Everett Fire department in a non-immediate-life-threatening event that requires a trip to the hospital, they call one of four ambulance companies that serve the city. Much like the tow companies, the ambulance services are on a rotation basis. If the first up doesn’t have an available unit they go to the next one on the list and so forth until one is available. This has led to delays and other issues, so last night the Everett Fire Department went before the city council with a plan to go out to bid for a single ambulance provider to serve the city’s needs.

We asked the city some questions about the plan and received the following responses from Emergency Medical Services Division Chief Tim Key…

  1. Why EMS wants a single company instead of the rotation?

The city seeks to contract with a single ambulance provider in order to guarantee availability of ambulances for non-emergent (BLS) transport to the hospital. Under the current system, ambulance companies respond on a rotating basis when available, and there are frequently periods where no ambulances are available for transport. In those cases we are sometimes forced to utilize a medic unit to transport a non-emergency patient. This reduces the availability of that medic unit for true emergency responses. Each of the ambulance companies currently operating in Everett have contractual relationships with other healthcare institutions that are the mainstay of their business operations. Transporting Everett’s 911 patients to the hospital is something they do interspersed with their contractual duties. If faced with a choice, the ambulance company will always be compelled to comply with their contractual obligations rather than deferring to transporting 911 patients. We seek to have a similar contractual relationship to guarantee availability.

Additionally, the city has no arrangement with the ambulance providers that allows for Quality Assurance and Quality Improvement interactions. Nor are there provisions to define response times, equipment standards, training standards for ambulance employees or medical oversight by the Fire Department’s medical control physician.

A contractual relationship with one provider would define the relationship between the city and the contractor in each of those areas.

  1. Have there been efficiency issues with the multiple providers?

Yes. SNOPAC dispatchers have to physically dial a telephone and speak with up to four ambulance dispatch centers to find an ambulance to respond to Everett calls for 911 transport. The RFP will seek a contractor that has instant electronic contact with SNOPAC, allowing dispatchers to simply ‘push a button’ to have an ambulance respond. This will result in significant efficiencies in the dispatch center which will translate to reduced time on scene by fire units waiting on ambulances.

A contract will also require the contractor to utilize a medical reporting system that is the same as, or easily interacts with, the fire department’s system. This will eliminate the need to prepare paper reports on the scene to hand to the ambulance crews. Patient data will now be transmitted electronically.

  1. Is the $158,167.04 the amount budgeted for ambulance services and for what length of time?

The $158,167.04 is the amount that the ambulance contractor will pay to the city as an administrative fee to cover the cost of servicing the contract. This fee will offset the expense of .3 of an existing FTE to oversee operations and Quality Assurance of the contractor, as well as to offset costs of additional radios operating on SERS, as well as payments to SNOPAC. This type of fee is consistent with ambulance provider contracts in other municipalities such as Seattle and Tacoma.

  1. Will this replace any medic transports?

No. We will continue to operate as we have in regard to BLS transport and ALS transport, only now we will have a contractual relationship rather than a relationship of convenience with our 911 BLS transport service provider.

The Everett City Council expects to get a look at the request for proposal next week and would have to approve any contract before the single ambulance provider agreement goes into effect.


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8 Responses to “Single Ambulance Provider Sought In Everett”

  1. Anon Says:

    “4. Will this replace any medic transports?
    No. We will continue to operate as we have in regard to BLS transport and ALS transport.”

    Yeah, the fire dept will keep BLS transport the same! There is NO BLS transport by Everett Fire right now because they DO NOT STAFF AID 2 or AID 6! Those are the only two BLS transport vehicles EFD had prior to not staffing them.

    And SWH stated: “Mind you, the two Aid units Aid 2 and Aid 6 are sitting ready to go but rarely called out.”
    – That is because they are not staffed. If the fire dept put people on the Aid Cars we could get the BLS transport that our tax dollars are paying for vs. paying a private company to do the job we are already paying for!

  2. Steve Says:

    Good points above. I do want to point out that there are other EMS systems in other parts of the US where the private ambulance provider lives in and responds from the fire stations. This creates a cohesive relationship between the private provider and the fire deparment and allows accountability as they can train together and improve the quality of all providers in the system. This would be a no brainer if efficient response time and quality patient care were truely the top priorities of the fire department. Unfortunately politics, union interference and ego prevent this from working the way it should. I have found that *most* career firefighters want to be firefighters and could care less about emergency medical services. They simply recognize that EMS is the bulk of the calls, and a neccessary evil to maintain their jobs but will do what they can to “get by” and clearly are not all in when it comes to patient care.

    With New World CAD Everett dispatches are now broadcast on Channel 9 (previously unused F DISP West) by locution (the robotic voice). Responding crews then switch to Tac 1 for the remainder of the response. If you are not hearing dispatches you might want to make sure you have that talkgroup (496).

  3. Anonymous Says:

    “Falck isn’t a player” hahahahahahaha. Do some more research. Falck is the largest private provider of ambulance service in the world (45 countries/6 continents). Also, AMR just acquired rural metro so they are now one in the same. You do bring up some good points about premature requests for ambulances that only prevent another engine company from getting that resource who may actually need it. A responsible, efficient public/private partnership is possible and would solve a lot of problems. The union has tried to hire more firefighters but it sounds like they are realizing that is not feasible.

    • SWH Says:

      In my defense, I relate the ‘level of play’ to who I hear responding to the calls from Everett Dispatch. Rural Metro and AMR are dispatched as Rural Metro and AMR. And Falck gets far fewer callouts than either of the first two. I only hear Northwest responding once in a relatively long while. Again, these are observations that I have made from listening to Fire, so they are by definition anecdotal in nature. It may be completely different in ratio during periods of time that I don’t listen to the channel, so empirical evidence could absolutely refute my observations certainly.

      Another issue that came to mind was that you always see unassigned private ambulances camping out in private corporation parking lots. You don’t see them staging at City owned properties and certainly not at a fire station. While I don’t consider them as clogging up the parking lots so that shoppers are denied parking, it does seem to be a rather shoddy treatment of the crews. (If I should happen to need their services, I would prefer them not to be dancing to alleviate the need to visit a lavatory.)

      No doubt that a such a partnership is desired and can probably be achieved to the benefit of everyone. I would hope that we see that happen regardless of whether a single source or gaggle ends up being the answer. But as it stands, from what I observe, the FD treats the private crews as annoying ‘wannabes’ who can’t meet the expectations of fulltime dedicated and organized firefighters. I would much rather a cooperative partnership so that if I needed a response that I would get a seamless partnership, professional, and efficient instead of the ‘heroes’ passing off my carcass to the lower caste transport types after they have saved the day or something.

      How we get there remains to be seen.

      (note: My observations of Station 6 are profoundly more difficult since “New World” dispatch has come into play. The calls aren’t broadcast nearly as often as before, so it’s harder to determine the time between call and departure from the station. If they improve their times, I will probably not be able to tell in all fairness. While I don’t expect the staff to run to the engine, a brisk walking pace would be nice. Just sayin)

  4. SWH Says:

    I hope the Council digs a bit further into this situation. In my mind, there are many unanswered questions. And some statements from Fire that don’t happen as often as they suggest.

    Firstly, there are 4 companies that have units in the area for this. Rural Metro (usually 2), AMR (usually 1), Falk (Usually 1) and Northwest. (unknown number) If you want, you can usually see a Rural Metro unit around 79th and Evergreen. Falck sometimes sits at the former Haggens or maybe one of the Starbucks parking lots. In my experience listening to the scanner, there has been maybe 2 situations where they had to dispatch a Medic Unit to transport. (Mind you, the two Aid units Aid 2 and Aid 6 are sitting ready to go but rarely called out.) The most frustrated I have heard a FD unit was when they had a female patient who they felt needed to have a female BLS transport person. And there was none to be had. (not really a good example of not having BLS unit available but am sure that’s one they would cite.)(And mind you, they didn’t apparently have a female FD employee available themselves to help this lady out)

    If anything, the lack of BLS units available comes from pretty much every medic call ends up with the Engine dispatched calling for an ambulance/”AMB” dispatch regardless of the nature of the call. And MOST OF THE TIME, the ambulance dispatched is called off, sometimes just as they arrive onscene. (Code Greened) I am sure that the engine company wants to get the request out quickly to reduce response time. But it really ends up wasting gas, time and money for the ambulance company. If there is a payment to the ambulance company for a callout but then dismissed with no transport, I am completely unaware of it. It does result in costs that are likely not recovered by the responding ambulance company.

    I notice that there is a line item mentioned that would be an ‘administrative fee’ that the sole source ambulance provider would be required to pay to the City of Everett, but no discussion on how the ambulance service gets paid. Should a company be compensated for dispatching a unit that doesn’t result in a transport? How about in light of ‘service levels,’ ‘quality,’ and ‘availability. I have a sneaking suspicion that the City would demand to have more units available to them than call volume would dictate, just because they could under a contract. And I am sure that the knee jerk ‘dispatch AMB’ on every call would continue just as it is right now. Sounds like there would be potential abuse that should be considered and monitored.

    As I understand it (and I could very well be wrong), the transition to private ambulance companies was driven by the desire of the FD to reduce the costs incurred by having their own units respond. The paperwork necessary to do billing of insurance companies and such would be a big drain on resources. Therefore, farming out the transports to private companies would benefit both by cutting FD costs and that the ambulance companies already had the infrastructure in place to handle the hassle of billing the insurance companies. (I assume if they couldn’t get anyone to pay for a transport, they would have to eat the cost.) Hey, a great deal for the FD and Everett taxpayers, right?

    Folks, Rural Metro is about the only company up this way that has the resource and would be willing to pay the ‘administrative’ fee for the privilege of being the sole source provider. Falck isn’t a player. AMR is big in South of Tukwila. Northwest is a pretty small outfit. Your sole source ambulance company is going to be Rural Metro. It would be a charade to accept and ‘evaluate’ bids from the ambulance companies. Rural Metro already keeps 2 units in Everett idle and available, so they are willing to spend money with little chance of cost recovery.

    And with all of the Terms and Conditions that would no doubt be in a contract to be honored with the privilege of paying the City for business, more non revenue calls for dispatch are inevitable.

    (Makes one wonder why the local IAFF doesn’t press the department into having some BLS aid employees at stations 6 and 2. The units are there collecting dust, and there’s no one to drive them. It’s odd to me that the IAFF wouldn’t want to have more full time, paid FF in the department.)

    Don’t get me wrong, I think the FD does some good work. I don’t think they are evil. I appreciate them trying to keep costs down for taxpayers. I appreciate the men and women who are called out and the job that they do. (though I note here that Station 6 seems to be very slow in getting out of the station consistently. To the point that I have seen them take several minutes to amble out to the rig, get everyone strapped in and start the engine. I don’t know if it’s motivation or hubris, but if I needed their response, I think I would appreciate a little more urgency on their part. It almost seems like they are waiting to see if the call will be canceled, another unit will take the call for them, or whether they can farm the call off to someone else and only get in the truck if there’s no chance that they can get out from under the call. Recently, a call regarding someone at a Safeway in distress having initially located the call in 8600 Evergreen ended up with a multiple minute back and forth with the dispatcher by Medic 6 who basically refused the call and at every attempt by the dispatcher to correctly dispatch, would argue that Station 1 was closer. A LOT of wasted time there and the Medic 6 person sounded like a complete arrogant jerk to the dispatcher. Medic 6 won. They got to stay home instead of having to leave the station.)

    I would hope that any proposed contract relationship would be very carefully scrutinized by Council before approving it. While the FD is important and for the most part does a good job, there is an element in it that might be less than upright in their dealings.

    I suppose the counter-argument would be that the winning ambulance company (Rural Metro) signed the contract and would deserve every bit of overarching expectation and demand placed upon it by FD as they know what they are in for.

    • DuCal Says:

      I was with you until you stated “Falck” is a non player. Falck is the largest EMS transporter in the world, how are they a non player?

      • SWH Says:

        I never see more than one Falck unit in the area and never more than one called out at a time. For the physical presence here in Everett, the statement stands…

        They may be the biggest. But here. There’s just one.

  5. Anonymous Says:

    There are four companies with ambulances now. Assuming for the sake of argument that each company fields one ambulance each and further assuming that there are indeed periods where a fifth ambulance would be kept busy, one of the existing four companies would field a second ambulance. That this has not happened means either EFD or the city council is concocting a fabrication in order to hand over all ambulance business over to a crony while summarily disbanding three (or even all four, if none are owned by the crony) existing businesses.

    If we were rational citizens, we would be watching who on the council votes for this and who gets the business but we won’t because we’re too busy entertaining ourselves.