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Firefighters eye taking over emergency ambulance service 

Thinking bid

click to enlarge Springs firefighters could transport using a vehicle like this, but seldom do so. - PAM ZUBECK
  • Pam Zubeck
  • Springs firefighters could transport using a vehicle like this, but seldom do so.
Colorado Springs residents who call for help in a medical emergency are used to seeing city firefighters arrive first, ahead of an ambulance.

In fact, the Colorado Springs Fire Department arrives first at scenes with advanced life support for five out of six calls, records show, with the city’s ambulance contractor, American Medical Response (AMR), arriving first the rest of the time.

That could soon change. A CSFD spokesperson says via email the department is “investigating the possibility of an insource option” but no decision has been made.

If that option goes forward, CSFD would bid on the emergency ambulance contract for the first time. The service has always has been provided by the private sector.

Given AMR’s more than 25-year history of transport in the Pikes Peak region, turning that job over to firefighters would be a radical change.

Firefighters support the idea, International Association of Fire Fighters Local 5 president David Noblitt says.

“When you do show up first and stabilize that patient,” he says, “the key is to make sure they [patients] have quick response as far as transport.”

AMR’s vice president of operations for the Rocky Mountain Plains, Scott Lenn, says via email the company has never competed for an emergency contract against a city fire department but is ready to go head-to-head.

“We’re happy to compete against fire departments, provided they don’t have undue influence on the RFP or the selection process,” Lenn says. “As long as the playing field is level, we’re always up for a healthy competition.”

CSFD began providing advanced life support first-response medical service in 1975. But transport to hospitals has always been handled by private ambulance companies.

That dual model calls for CSFD — with 68 sworn firefighter paramedics — to respond to medical calls along with AMR, but leave transport to AMR. While CSFD has two or three units that can transport patients if necessary, it rarely does so.

In 1995, the Emergency Services Agency (ESA) was formed, placing all transport in the hands of one contractor, AMR, across El Paso County. In 2003, the contract was renewed, as it has been periodically since then.

In 2013, then-Mayor Steve Bach pulled the city out of the ESA and contracted directly with AMR of Greenwood Village in 2014, charging the company $1.17 million a year to recoup the cost of firefighters’ supplies and efforts.

When the five-year deal was about to expire, the city issued an RFP (Request for Proposals) that upped the fee to $1.4-million a year. The city initially chose Knoxville, Tennessee-based Priority Ambulance for further negotiations last year, prompting a protest from AMR. The city later canceled the RFP, saying the city needed to “refine” the scope of work, and extended AMR’s contract 18 months.

While the pending RFP could represent the first time firefighters bid on the contract, CSFD has studied the idea at least twice.

In 1999, TriData Corp. of Arlington, Virginia, recommended the city “consider a study to examine the cost of providing emergency medical transport services itself.” One reason: The study predicted medical calls would rise from 23,066 in 1999 to 25,288 in 2005.

Reality outpaced that prediction.

In 2006, the department responded to 30,825 medical calls, which ballooned to 43,338 in 2017, the most recent full-year data available, a 41-percent increase.

The study also noted that Portland, Oregon, and Orange County, Florida, found firefighters could provide EMS transport at “significant savings.”

“Counter to what many citizens assume,” the study said, “this is one field where the public sector can be more efficient than the private sector.”

In 2004, the city revisited the issue and concluded a fire-based system “will not be financially sound.”

In its 67-page report submitted to City Council in January 2005, CSFD noted $4.1 million was needed in “start-up funding” for ambulances and equipment, data management systems and software, and more than $7 million in first-year operational costs.

The study also noted the city would collect only 50 to 58 percent of gross billings and pointed out reimbursement rates from Medicare and Medicaid are far from rock solid. Added risk arises from lawsuits over alleged improper medical treatment or other actions.

“While it is possible that a CSFD medical transport system could generate a positive annual fund balance,” the report said, “it is also possible that it would require a subsidy or increase in rates to cover costs. In a worst case scenario, the City may be forced to abandon the system and layoff employees.”

So what’s changed since then? No one is talking details.

Bret Waters, deputy chief of staff, can’t disclose components of the RFP, because it’s still being developed.

“We’re seeking to find the best value for our community,” he says. “We think the responsible approach is to evaluate all models. It could be a fire department response. It could be a contractor who handles transport. We’re going to look at all options.”

Asked how firefighters could compete, given the capital investment required, Waters says, “They’re going to have to provide that information — how they’re going to capitalize and how they’re going to resource that.”

The Fire Department didn’t provide details of its possible bid, but other departments — legal, finance and the Office of the City Auditor — are cooperating with firefighters in drafting a plan, Waters says.

Mayor John Suthers has said he’s skeptical a fire-based service could work if paramedics are paid the same as firefighter paramedics, particularly if Issue 1 passes in the April 2 city election, granting collective bargaining to city firefighters.

“I guarantee if we took these paramedics in,” Suthers said during a recent interview, “they’d want to turn them into fire paramedics and that would destroy the finances of the whole deal.”

But Noblitt, who also declined to discuss specifics, says ambulance paramedics would be “separate from” sworn firefighters and paid at market rate for EMTs and paramedics, which is considerably lower than firefighters.

A fire-based service makes sense, he says, because it would require one dispatch — to the fire service — not two. “It would really be a benefit to our citizens,” Noblitt says. “We think it’s an incredible positive.”

Waters says the city will choose a preferred provider this summer with hopes of having the new contract take effect in early 2020.

“We want to provide the most efficient, highest quality, most cost effective service we can,” he says. “That is why we are going to look at all options. All participants are going to be treated fairly and equitably.”

AMR has complied with contract response-time requirements when paired with firefighters’ responses, meaning with CSFD involved, help arrived within 8 minutes roughly 95 percent of the time over the last four years.

But when AMR’s response is viewed in isolation, its response record to emergency calls drops to within 8 minutes 66 percent to 73 percent of the time, records show.

AMR’s Lenn says the current setup in Colorado Springs “is working very well” and “rivals the best response times in the nation.”

Waters emphasized that CSFD wouldn’t be given an edge, noting that in 2018, the city’s support services department lost its bid for fleet maintenance to the incumbent private 
company, Serco.

“Because we want to protect the integrity of this process,” Waters says, “those who are proposing from the Fire Department are essentially walled off from the RFP development committee and those who will be evaluating RFPs, so they’re treated fairly and there’s integrity in the process.”

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