Summit County Ambulance sounds alarm over Breckenridge service change
March 7, 2014
In an effort to help resuscitate the county's cash-strapped ambulance service, an agreement between Summit County and Red, White & Blue Fire Department of Breckenridge aims to reduce the redundancy of ambulances arriving to service 911 calls in the area.
Currently, Summit County Ambulance Service (SCAS) has first-call status throughout the county, including in the Breckenridge district. Under this new agreement, Red, White & Blue would be the first agency to respond to 911 calls for ambulance service in its district, which covers 140 square miles between Hoosier Pass and the Frisco town limits.
The Board of County Commissioners (BOCC) supports the plan, but SCAS has recently raised concerns about the impact this change could have to their staffing and service levels down the line.
“We have some pretty significant funding problems going on right now, none of which is the result of any problems with the ambulance service, but the world is changing.”
Summit County manager
In a press release, Red, White & Blue fire chief Jim Keating said, "By adding another 24-7-365 ambulance into the EMS system, this enhanced partnership with SCAS is going to allow us to do a better job serving the residents and visitors in our district."
Keating clarified this statement, saying Breckenridge is not purchasing an additional ambulance. Red, White & Blue will be using its current ambulance and staff to respond to first-calls in the district, freeing up one of the county ambulances.
Don Koogle, SCAS paramedic, said there are currently three SCAS ambulances that operate 24-hours, seven days a week, 365 days a year. The SCAS also has two regular part-time ambulances, and can have a total of nine ambulances staffed to serve the county.
With "the first-out model, the goal is to get the fastest care in the county to our residents and visitors," he said. "We want to make sure the best care is there at the fastest time possible. We're not upset Breckenridge is running its 911, it's the whole system we're concerned about."
Koogle said the amendment to the Red, White & Blue agreement was presented at a Feb. 19 meeting between ambulance staff, Summit County manager Gary Martinez and one county commissioner. There was not a quorum present, so it was not posted as a BOCC meeting and no minutes were taken. Koogle said a comment was made that to realize some savings for SCAS, there could be possible cuts to staffing.
Martinez said there are no plans at the moment to cut any services or staff from SCAS, but he first wants to see how the new plan with Red, White & Blue plays out. He said one possible way to reduce costs might be a reduction in staff or cutting one ambulance from the fleet.
"That would be something, if they ramp up and are successful, that's an opportunity, perhaps we would have the ability to have one less ambulance standing by in the Breckenridge area because they would be doing first-call," he said.
However, with increased call rates — up 13 percent in 2013 — Martinez said he is not planning on any cuts at the moment.
The SCAS operates as an enterprise fund, which means it is intended to support itself using revenue raised from insurance reimbursements and payments to pay for the paramedics, drivers, equipment and training.
However, this model has changed during the last few years. Martinez said the introduction in 2005 of St. Anthony Summit Medical Center, while it has been a huge benefit and much-needed improvement to the health care system, at the same time, "reduced some of the activities and revenues because people can stay here in a hospital rather than being transported to Denver," he said. That fiscal impact along with the recent recession, lower Medicaid reimbursements and increased operating costs led to the SCAS being supplemented out of the county's general fund since 2012.
Martinez said he believes having Red, White & Blue on first-calls in Breckenridge will help reduce some costs. Between 2011 and 2013, SCAS deficits averaged more than $460,000 annually.
"If we are able to get to a more efficient system by using others, we would transfer less money or maybe no money at some point from the general fund to support the ambulance service," he said.
Keating said his department purchased two ambulance vehicles in 2006, and currently has enough staff to operate one. Red, White & Blue was more often than not the first responders on the scene in Breckenridge, causing redundancy when SCAS would arrive as well.
"It would be an additional cost to hire (those) employees," Keating said. "We are just offering the resource we have in place."
There are currently 15 full-time SCAS employees, three supervisors and a deputy director and director. There are four administrative staff for billing and training, and anywhere from 30 to 52 part-time employees.
Without benefits included, Koogle said, a basic EMT makes about $40,000 per year, while an intermediate EMT would make about $46,000 and a full-time paramedic has a salary of $54,000.
"We have some pretty significant funding problems going on right now, none of which is the result of any problems with the ambulance service, but the world is changing," Martinez said.
DOWN TO denver
Red, White & Blue can not transfer patients to Denver, however, which concerns Koogle if the SCAS operations were to be cut. There has to be one ambulance in the county and if their numbers went from three to two full-time vehicles, and both were transporting patients to Denver, then there could possibly be a reduction in services, he said.
Koogle said Red, White & Blue Fire District would pay the county all revenues except a 5 percent operating cost. Breckenridge is allowed to transport patients to the hospital and clinics.
Koogle said the SCAS does not take any issue with Red, White & Blue taking the first call.
"911 is only one piece of the system," he said. "If things don't change, it can work."
Every county ambulance runs on three shifts, with five people per ambulance plus one part-time worker or trainee, meaning two people work per shift.
Koogle said the call volume in the Breckenridge district is about 700 to 750 calls annually, about 20 percent of the total calls.
The amendment should be finalized this week, Keating said, and the system would switch over in late May to early June. He said the other Red, White & Blue ambulance serves as a backup for the one that operates full time.
He also said his paramedics were not getting enough experience, leading to turnover in the last few years.
"In most cases we are the first on the scene in our district, we could do the evaluation and stabilize the person, but then we would have to trade off to (SCAS) to transport," Keating said.
Keating said historically, transports occur more on weekends, when there is more serious ski resort traffic, and in the later part of the day. He said the main obstacle to this new plan is how to manage assurances there will be enough capable ambulances to make the needed Denver transports while giving the county the same level of service.
Breckenridge already was involved in ambulance services, so Martinez said it was a good place to start. However, the county has also reached out to Lake Dillon Fire Rescue to discuss future expanded collaboration as well.
"One of the ways to help with the financial pain is to get other, under-utilized people and equipment involved," Martinez said.