Monday, November 12, 2007

Anti-logic: Toledo ambulance runs

Well, here goes another post on the anti-logic so prevalent in today's governmental actions.

On Sunday, The Blade had an article with a terrific headline: Ambulance runs will pay off for city, fire officials assert. New service squeezes private transporters.

Doesn't that just about say it all?

But that was just the headline. In the second paragraph you see that perhaps the headline is a bit misleading.

"But so far, basic life-support ambulances - which began their full operation last month - haven't brought in any profit and are projected to cost the city nearly $1 million over the next five years to lease six rigs."

Granted, the article is filled with quotes and estimates that the profit will be there, despite a projected collection rate of only 40%. But I can't help but wonder if the 'profit' that is projected was ever balanced with the lack of payroll taxes, income taxes and other taxed due to the city caused by the elimination of jobs and income by the private ambulance companies.

Certainly someone looked at that DECREASE in tax revenue, even though it was never discussed by city council. Perhaps not, though, as that would have required city council members to think of such a question in the first place.

But the real zinger is the false claim that better patient care is a result of this decision - based upon the following:

"Jim Martin, president of Toledo Firefighters Local 92, said first responders are able to more quickly return to service. In the past, fire engines were out of service while they waited for a private ambulance to arrive.

"Now, they turn around and go back into service," Mr. Martin said.

Rescuers were called to a West Toledo apartment last week and were able to quickly transport a 3-year-old boy, who had fallen and hit his head, to Toledo Hospital.

Previously, first responders would have arrived, assessed the scene, and then called a private ambulance company to transport the boy - which sometimes took up to 20 minutes, Mr. Harman said.

Within minutes of the call, the little boy was buckled into a child safety seat inside the rig and was on his way to the hospital.

"He might still be there waiting for the private ambulance [and] now he's at the hospital," Mr. Harman said. "That's where the patient care gets better.""

If the main 'problem' government was trying to address in taking over this task was the delay waiting for the arrival of the basic life support ambulance run, it would have been easy to fix. Ambulance companies have, for years, asked to be dispatched at the same time as the rescue squad, with the understanding that they'd respond without lights and sirens. They even offered to cover any internal expenses as a result of getting to the scene only to find that they might not be needed. But if they were needed, they'd be present and ready to transport, allowing the fire unit to return quickly to service.

But that idea was routinely rejected by the fire department without much explanation - or at least none that made a lot of sense.

And here's where the problem with article comes in. The article explains that:

"Basic life-support units and first responders are dispatched simultaneously, which also reduces the amount of time it takes to get patients to the hospital, said Luke Harman, a firefighter and EMT at Station 9 in South Toledo."

Did you note that? Under the city-run transport services, they're now dispatching the tranport unit AND the first responders at the same time - and then they're using this as an example of 'better patient care.'

Of course, they could have agreed to this dispatching protocol without going to expense of leasing ambulances and then staffing them ... and without significantly impacting local private companies. But where's the fun in that?

Again, it's anti-logic. It doesn't make sense to say that 'governmentizing' such tasks results in better patient care when a simple change in protocol was all that was needed. Face it - this really had nothing to do with patient care or time at the scene because both these issues could have been addressed by implementing the protocol the city changed - dual dispatching.

So why did government have to take over this function? I'll let you decided - and comment accordingly.

ASIDE: background on this issue is available here and here.


DeeDee Liedel said...

Sylvania now has simultaneous dispatching of private ambulances when our first responders are called to a medical emergency. We began looking in to this earlier this year when due to budgetary issues, our transport unit taken out of service because it was losing hundred of thousands of dollars a year.

In conversation with Lucas County EMS, we found out that when temperatures drop below a certain level in the winter, private ambulances were routinely dispatched at the same time for auto accidents, so victims were not put at risk due to the weather conditions.

If simultaneous dispatch can be implemented part of the time, why not all of the time? And so we proceeded to work with the county to have this enhanced service in Sylvania - at not cost or risk to the taxpayer.

So far it has been working well. Our first responders get back in to service sooner; patients get transported to medical facilities faster; and taxpayers don't have to subsidize ambulance service.

Tim Higgins said...

OK Maggie, you asked the question ... and I will respond with one. Which party and which candidates did the firefighters union support in the recent election?

Isn't it amazing that a problem previously without solution, finds one when union workers are involved?

... I'm just saying ...

Kurt said...

Typically, I'd have no problem with the local government buying ambulances and providing that service...BUT the city decided to enter an otherwise efficient market (or at least it would have been efficient if the private companies were called at the same time). Even so, I wouldn't have a problem if the government did this and competed FAIRLY with the private companies. Since the government controls 911, it can determine who gets the call first. This, in my opinion, looks a lot like an anti-trust violation. If the city were a private company and had the power to do this, they would certainly be in violation of anti-trust laws and lose a whole lot of money in a law suit. I'm not an expert in anti-trust law, but I'm assuming there's some law protecting the city from such a law suit. But the city has clearly not been a fair market participant, and it should be ashamed of itself.

From a more philisophical perspective, it is a complete waste of government resources to enter an already efficient government. Indeed, the government's role should have simply been to call the private companies at the same time, and if they did not respond in time, then perhaps fine them. Some government regulation or oversight would have been acceptable to correct any inefficiencies in the market. But, the government had no business throwing itself into an otherwise efficient market.


Maggie Thurber said...

Interesting perspective Kurt - and one I hadn't heard before.

I don't have a question of COULD the city do this - but SHOULD they...and I agree that a system already existed that was, by all reports, working well - so there was no need for government to create a competing enterprise and take the business away from the private sector.

thanks for adding to the discussion!

Kurt said...

Indeed, Maggie, and in rereading what i wrote, I made a huge error. The sentence read "it is a complete waste of government resources to enter an already efficient government," but replace the last word of that with "market," and you'll have what I meant. I recognize that this blog has moderation, so I will assume there are people who didn't catch what I meant. I just wanted to clarify my position before you approve moderation. In addition, to your question of SHOULD the city government have done this, the simple answer is no. And I think we can agree on that.

kateb said...

Maggie asked "I don't have a question of COULD the city do this - but SHOULD they."

No they should not. It is predatory and a betrayal of the public trust to charge the tax payers fees to access the very services that they already pay for. One more reason for beginning to plot the move away.

I need to know that the leaders of the city that I live in aren't predators.

Maybe my standards are just unreasonably high.....

Chad said...

It's flat out theft from private Business. It also takes "Choice" away from the individual as to whom responds in crisis. I'm flatly against it.

Steven said...

Let's do some math. 6 new fire dept ambulances, X (2) firefighters per unit, X (3) 24 hour shifts requires a minimim of 36 firefighters to man the units, not counting vacation days, sick days, etc. Where does all this manpower come from? Are other units being mothballed, or have firefighters been taken off other units, shorting them? Or, was Toledo Fire already so overstaffed that they needed to justify the numbers of people, or face layoffs?

When Toledo has a big fire or fires at the same time, do the ambulances stop transporting and is manpower re-assigned to fight fire? If this is the case, where will ambulances come from to transport Toledo's ill and injured while the fires are being fought? The private ambulances had to cut way back on units and staffing, so can Toledo Fire fall back on them?

What do you suppose will happen when, due to ice and snow we have multiple traffic crashes requiring many transport units at the same time? There have been several times over past years where no ambulances were available due to high volume. Now that the privates greatly decreased their numbers, what do you suppose will happen? I hope the privates give the burbs priority, and we'll see what a great idea this was.

Maybe Toledo Police will be transporting in the back of their paddy wagons?

Oh, and just an after thought. You don't suppose that all that patient lifting will result in more firefighter injury leaves and early retirements do you?

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