This concept is not an “insider trading” as you put it. Troy Hagen and the big wigs in ACEMS are fully aware of this and will be offered the same contract as anyone else, if it even comes to contracting for services. It will be interesting if Hagen and ACEMS will even work with the City of Boise. If history is any indication, probably not.

I have nothing but the greatest admiration and respect for Ada County Paramedics; but so long as a superlative Standard of Care is unrelentingly provided, I don’t care if Rocky and Bullwinkle are the ones scooping me up.

However – While the bottom line is that the bottom line is indeed the bottom line… You get what you pay for.

This is timely for me. On Saturday I was wearing a new pair of jeans for the first time and was carrying a new, and expensive Kershaw pocket folder with a belt clasp. I slipped the clasp on my pocket and the knife in the pocket. I then slid in my keys and cut a BIG chunk out of a finger. The knife had partially opened in the pocket. I was bleeding all over and could not control the mess. My spouse called 911 and in under 2 minutes we had an officer at the door, VERY professional (once he found I had not knocked off my spouse and was in fact bleeding all over the front porch, he had the good grace not to laugh and provided a lot of good advice.) A minute later an ambulance arrived. They slowed the bleeding enough so that I could go to a local clinic for a more permanent solution. All told, a VERY classy and rapid response. I feel I would be amongst the survivors if I had an emergency and had those folk show up.

So, here I type, with two fingers, shivering as a result of the reaction to the tetnus shot and vowing to NOT use that knife again…

Its not just about kickbacks, its about control and lack of transparency. If you look at the “Public Private Partnerships” in California, you often have a dysfunctional system that covers its own mistakes in the process.

Simply put, If you are dependant on a city organization (i.e. the fire department)for revenue (via contract), are you really going to blow a whistle at shoddy medical care, poor attitudes/customer service, protocol violations, response time violations, and similar issues? If you are dependant on the fire service for revenues (because such services are awarded based on exclusive contracts, to be renewed every so often. And who helps pick the contracted provider???), then they , not the patient , are your customer.

This not only sets up a dysfunctional system where, as one person put it, the bottom line is the bottom line….but also a dysfunctional system where there are no checks and balances. Contracts will not be awarded on who provides better care, who has the best protocols, who has better equipment, etc etc. It is awarded on who is more friendly and supportive of the Union. And that’s just the way the union wants it.

This bodes poorly for the public at large, who will not have a choice in who comes to pick them up.

This doesn’t even discuss the disadvantages of system status management response plans these privates use to keep overhead low.

Nor does it discuss what happens when in 5 years or so , a private either goes belly up (like in the 70’s) or simply decides an area isn’t profitable and pulls out (wich has happened with AMR, and Rural/Metro Both). Who is left holding the bag then?

Excellent points Nemo. I wonder, as well, just what point we will be left holding that expensive bag of responsibility. Seems to me we should be promoting local services owned and operated by local providers!

Rural-Metro started years ago as a Private Contract Fire Suppression Business (Fire for Hire). Their Fire side of the house has since went through bankruptsy snf re-organization and have lost many clients. So RM went into the ambulance business, they have expanded that side of the house but still aren’t up to par with FD run EMS Transport Services. Low Pay, Poor Working Conditions ect hasn’t helped RM Medical Services…it all for money in the pockets of the CEO, BOD’s, and Stockholders. Good Luck Boise.

I think it is amazing how mis-information becomes fact in such a short time.
First of all, there is no conspiracy here – if you read a little closer, the City is simply exploring options, not doing insider trading! I believe the printed statement is “We will be looking at many different companies and styles. We will continue to gather data and prepare a report for chief Doan.” If/when the time comes, I’m sure, all private/county agencies will be able to bid. And from what I hear, Chief Doan has kept Troy H. and ACP in the loop from the very beginning.

Second – the Public/Private partnership is actually a very good and effective system that has proven itself over and over again, ie: Vancouver, Tacoma, Salem, San Diego, Etc. The contracted service provider is under contract to provide the same level of care as is currently being provided. I don’t get where the county gets-off stating that other services are sub-standard! All Paramedics/EMT-I/EMT-Basics go to the same schools, take the same tests and are obligated (by law) to maintain the same skills and knowledge as every other provider out there. Who do you think RM will hire to run these ambulances? I don’t see them hiring a bunch of out-of-state, unfamiliar-with-the-area Medics and EMT’s.

Also, RM or any-other service that is contracted here is simply that, under contract. Spelled-out is the minimum coverage/minimum staffing, maximum response times (with costly financial penalties), minimum certification qualifications for entry-level and on-going certification personnel, vehicle equipment standards, vehicle reliability standards (minimums on maintenance/maximums on age), etc. Yes, they do pay [the City] for the privilege of working here, but amazingly they do it for about half the cost to the patient (major sore spot with the county, I’m sure!) Another positive is that under a combined service, the initial response is only one vehicle (FD with EMT’s and paramedics) going lights and sirens(increased danger to the public and the responders) and the transport vehicle is traveling at normal speeds (non-code, no lights and sirens), unless it is a critical call or the initial response crew requests that the transport upgrade (to lights and sirens.) This is to save on public safety and crew safety – no more FD AND ambulance racing through town for a splinter! As for raising taxes, the FD is already here and operating and the contract company pays to be here – where is the tax increase?
I have worked both the Fire-based EMS system and the Public/Private cooperative system and to tell you the truth, the Fire-based EMS system is by far the best system (no duplication, same level of EMS but with the added expertise that comes with the fix anything/do anything/know about everything/take care of anything expectations of the FD) but the Public/Private Partnership is a very effective system because it is supervised by one agency (FD), so whatever the City decides, the level of care and effectiveness of the response will only get better than the current divided/combative system we currently have.

In response to the uninformed comments made about accountability and quality of service under FD/Contract provider, just sit through a QA/QI review with RM and you will not feel so negative about their level of care. I can’t say for the other privates out there, but RM is VERY strict about quality assurance, customer service, high accountability, and of course the bottom line, but you would expect that from any well-run business.

There seems to be a consensus that something needs to be done about the current divided system that exists here as well as Canyon County (I hear).
It is so frustrating that there can be so much lack of cooperation and unity between the services that are centered around and paid to work together for the public good. If the current players can’t ‘get along and play nice’, then things need to change, and quickly!

First, let me say that if the PATIENTS and the TAXPAYERS are unhappy with their county ambulance services, it is absolutely their right to take that dissatisfaction to their county commissioners and make changes in their service or hire a new service. When it is the city fire department who is unhappy (primarily because there is a tax dollar somewhere in the universe that is not allocated to the fire department), they do not have the right to entertain “offers” from private companies to line their own pockets at the expense of taxpayers who don’t even know what is happening. This is the ultimate insult to the taxpaying public. We didn’t elect you and we don’t need you to go out and do the jobs of the people that we did elect. This is perhaps the greatest example of taxation without representation that I have ever seen.
With regard to Rural Metro, you can certainly claim that it will benefit the fire departments to have them here. I don’t think it is very honest to claim that it will benefit the patients. If there is anyone who honestly believes that their healthcare needs are best served by a for-profit company from another state, please view a few of the following links regarding rural metro:

http://www.azcentral.com/business/articles/2008/07/24/20080724biz-ruralmetro0725-ON.html

http://m.wbir.com/news.jsp?key=51658&rc=ne

This is a corporation that did not meet its contracted response times even one month last year in Knox County, TN. It was fined every single month of the year and this trend has continued throughout 2008. This included a man having a stroke who waited 48 minutes for an ambulance! Why are they not meeting their response times? It is cheaper to pay $220,000 in fines per year and default on your contract than it is to adequately staff that county.

This is also a corporation that paid one million dollars last year to settle a billing fraud case with the federal government.

Kurt, I am glad you are inspired by Rural Metro. I doubt you would leave your posh job at Boise Fire to work for them. Just don’t try to tell me that you are doing me any favors by hiring them to come here and let me lie on the floor for 48 minutes while I’m having my stroke and then send me a fraudulent bill.

By the way, how many of my tax dollars have already been spent for BFD to “research” this brilliant plan?

Kurt,

A paramedic is not a paramedic is not a paramedic.

ACP puts its Paramedics through a much more rigid selection, orientation, and training process than 90% of the services you will see out there, and it is a clinically orientated process. Is it perfect? No, but its far more progressive than most agencies, including our local FDs approach to paramedicine. Again, is it perfect? No. But its one of the best in the nation.

And BTW, the standards for employment far exceed the minimum required to certify as an EMT or paramedic in this or any other state. That is why having your national registry only gets you the right to test (maybe if you pass lil things like background, etc), not get hired, not to work. This is much different from the private model. The State and National Registry sets the MINIMUMS…not the standard. Therefore the assumption that any state certified paramedic is good enough..well..is false.

Not saying that ACP paramedics walk on water, but when it comes to medicine they walk in better prepared than most medics you will encounter nationally.

That type of process takes $$$, the type of dollars and commitment that most privates, and many other models simply aren’t willing to dish out.

The only thing you did get right is that in the public private partnership the FD is in control. Not the public, not the BOC…the FD (and by extension the Union).

BTW, it seems to me that the thing that “Divided” this system to begin with was the FD….not ACP. God forbid ACP tries to put in place a an EMS SYSTEM???

Boy, Joe C. You need to open your eyes and stop drinking your own (union) punch. I wouldn’t let a BFD fire-medic touch me with a ten foot pole. Now, Nampa is a different story Tom A. has taken the time and energy to make sure fire medics do the right thing for the patient.

I call 911 first and then the taxi. Whoever gets to me first takes me to the hospital.

I think Nemo is trying to pick himself up off the floor…Bam, Smack, Whap, Ooof. Wake up Nemo Wake Up.

Jack,

Even though your comment was made to be ironic, here is a thought provioking issue. In several studies, critical trauma patients did better with both BLS transport and TAXI service in both time to the ER and overall survival, than did those attended by Both ALS engine medics and ALS transport.

Now this was in system(s) that have many issues, including PARAMEDIC OVERSATURATION (see a recurring theme???), but the point remains, the BS about needing a paramedic in the first 10 minutes for 90% of calls is just that..BS. BS and a waste of tax dollars.

We DONT need paramedics on every fire engine. We dont need as many ALS Ambulances in this Valley as we have.

We need a few select highly trained medics for ALS ambulances and a whole slew of BLS engines and BLS ambulances…and a SYSTEM (nto a single agency, a system) for them all to work under….

…and even a whole slew of Taxis too…. 🙂

Putting Medics on Engines is not just Overkill..it actually contributes to DECREASES in survival.

So your comment was closer than you thought.

Nemo

Nemo,

How did you get that lame name anyways…Nemo? To scared to use your real name….we know it anyways!I’m afraid I would feel like kind of a sissy living in a Disneyland frame of mind….Cause your really in Fantasyland saying that having a Paramedic/Firefighter on and Engine decreases the survivabilty! Show us that Data Mr. cartoon fish!

Lets see a Paramedic Engine and an Ambulance get dispatched to a cardiac arrest same time from different locations, the Engine arrives 2-3 minutes ahead of the Ambulance. FF/PM’s along with 2 FF’s start ALS procedures (Defib/IV/Intracardiac) vitals are restored and patient is breathing on his/her own…Bring in the gurney Ambulance Guys we have a live one!.

Lisa…

Defib is a BLS skill, not a paramedic skill. You dont need to ALS engines to Defib. Period. Educate yourself.

NOONE does Intracardiac anything (except pericardial centisis and if your doing that in the first 5 minutes of a call your WRONG) anything in the field. Educate yourself

If in your scenario, there was 2-3 minute gap, then the fire department should be doing BLS. Thats according to nationally recognized ACLS and CPR guidelines..and also of note: BLS care (CPR, Defib) is the only thing that hse been proven to save lives, not paramedic drugs, not paramedic ETT.

So once again, educate yourself to the medical facts, the standard of proactice, the current guidelines….not what you read on the bathroom stall wall at the union house.

Lisa, if you ever want to learn the medical/clinical reality of EMS, not the IAFF agenda, let me know. If you want to know what actually saves lives, let me know.

Now back on track..how does this relate to the rural metro debate…well…
Rural Metro is a means to the end for BFD, the end is job security by deveoping a big red curtain over EMS in Boise, adding more medics to every engine, and ensuring their expansion goes unopposed and unsupervised.