1. How will outsourcing EMS cut costs from the University City General Fund, how much revenue generated from ambulance billing would be lost if EMS was outsourced, and what amount, if any, is the aggregate net savings?
On September 2nd, 2014, the City Manager appeared on television and told a reporter from Channel 4 that outsourcing EMS could save the city in excess of $1,000,000. The City Manager did not give specifics as to how those savings would be realized. Presumably, savings would come through staffing cuts by eliminating some, or all of the 12 full-time positions in the UCFD required to staff the 2 ambulances it operates.
In the RFP, on page 5, Section 3, the City Manager details that University City collected $718,000 in 2013 and $930,000 in 2012 from billing from ambulance transports.
The top salary for a Fire Fighter/Paramedic is roughly $63,000 annually. Assuming a 30% multiplier for the cost of benefits and employment taxes born by the city, the approximate aggregate “total cost” for a full-time, top pay, Paramedic/Fire Fighter is $82,000.
If 12 full time positions are eliminated, the payroll for the UCFD would be reduced by approximately $984,000, however the General Fund would lose between $718,000 and $930,000 in revenue generated by the UCFD from ambulance billing. The net reduction in cost to outsource EMS is between $54,000 and $266,000 depending on collection rates, not the $1,000,000 suggested publicly by the City Manager.
2. How many times per year are mutual aid ambulances from surrounding cities required to come into University City to respond to EMS calls when both UCFD ambulances are already on other EMS calls?
What impact will outsourcing EMS have on the EMS mutual aid agreements University City has with its neighbors, and how long will University City residents be required to wait for an ambulance for a 911 call if w no longer have those mutual aid agreements and the private provider does not have an ambulance in University City?
Mutual aid ambulances – primarily from Clayton, Olivette, and Richmond Heights – respond into University City, on average, 18 times per month, or about 216 times per year. These EMS mutual aid responses occur when both UCFD ambulances are already dedicated to another EMS call or fire call within University City.
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EMS mutual aid agreements stipulate that both parties must operate fire department based ambulances. Should University City outsource EMS, its residents will not have the safety net of an EMS mutual aid agreement and will be subjected to exceedingly long waits for an ambulance when the primary EMS units are dedicated to other emergencies.
3. How will outsourcing EMS affect the ability of the UCFD to mobilize the proper amount of Fire Fighters required to safely fight a house fire or building fire in University City?
The current minimum staffing for the UCFD is 11 fully cross-trained Paramedic/Fire Fighters daily.
When a 911 call comes in for a medical emergency, an ambulance with 2 cross-trained Paramedic/Fire Fighters responds to that emergency in an ambulance.
When a 911 call comes in for a fire or rescue, the 2 cross-trained Paramedic/Fire Fighters respond to the fire, and in that scenario function as essential manpower for fire suppression operations.
For outsourcing EMS to begin to make any fiscal sense, it would likely lead to the elimination of 12 full time Paramedic/Fire Fighters, and would likely drop the minimum daily staffing to 7. Not only would outsourcing EMS eliminate the ambulance service provided by the UCFD, it will likely reduce by up to 36% the number of Fire Fighters on duty to protect the residents of University City.
4. If the outsourcing of EMS takes place and 12 firefighters positions are eliminated, which firefighters will be laid off?
The contract still in force between the fire fighters and the City stipulates that layoffs will occur from the least senior employee up, regardless of rank. Of the bottom 12, least senior employees in the UCFD, 6 are African American, one of who is female and one of who is the fire chief. Should the CM elects to lay off 12 employees and outsource EMS that would leave the UCFD with only one African American employee and only two female employees.
5. How will outsourcing EMS, and the likely reduction in on duty Fire Fighters that comes with it, affect the city’s ISO rating and the rate University City residents, businesses, and property owners pay for property insurance?
ISO (Insurance Services Office) rates fire departments on a scale of 1-10 based on a wide array of statistics and data. A city’s or department’s ISO number plays a prominent role in the assessment of annual insurance premiums paid by property owners in a community. While there are many components to an ISO rating, one of the most prominent is fire department staffing. More on duty Fire Fighters means less property damage because the fire is put out more quickly. That translates into lower risk for insurance companies, which is translated to lower premiums for property owners.
Reducing the staffing of the UCFD will almost certainly unfavorably impact the ISO rating of the UCFD. Should that occur, there is a very strong likelihood that the property insurance premiums paid by property owners in University City will increase.
6. Why does the RFP, on page 6, Section 4, under “Staffing” and “Response,” allow bidding private service providers to staff ambulances in University City with one Paramedic, and why does the RFP define the acceptable response time as 7 minutes?
In the event of a cardiac arrest, or heart attack that has not yet devolved into cardiac arrest, what impact will a delayed response from 4 minutes under the UCFD EMS system to 7 minutes under outsourced EMS, have on a patient’s morbidity and mortality?
How many EMS calls does the UCFD run annually that would fall into the category of “serious” or “life threatening,” and where a 3 minute delay would presumably have an impact on the outcome?
The UCFD currently staffs each of 2 ambulances, full-time, 24/7/365 with 2 cross-trained Paramedic Fire Fighters. Those units are dedicated to 911 response in University City, and the average response time for a 911 EMS call is less than 4 minutes.
The RFP allows bidders to cut the number of Paramedics on ambulances serving University City residents by 50%, while at the same time, allowing an acceptable response time that is nearly double that of the response time presently enjoyed by University City residents. Further, because outsourced EMS will not be cross-trained as Fire Fighters, privatizing EMS will reduce by 100% the number of Fire Fighters on ambulances in University City.
According to the RFP, UCFD fire trucks currently respond with UCFD ambulances 900 times per year, on average, to assist on the most serious calls. For patients suffering from cardiac arrest, a heart attack, a stroke, or a traumatic injury, often the difference between life and death, or between a favorable outcome and debilitating aftereffects, is minutes if not seconds.
7. Why was the RFP written in such a way as to allow bidders to provide far lower services than is currently provided by the UCFD?
Will the bid from Abbott be eliminated because it does not meet the expectations of the RFP, in that it will only station 1 ambulance 24/7 in University City?
The RFP, on page 6, Section 4, under “Response,” states that it is “preferred” that 2 in-service ambulances be stationed in University City 24/7. The RFP does not mandate that 2 ambulances be permanently stationed in University City and exclusively dedicated to 911 EMS responses, as is currently the case with the UCFD.
The bid from Abbott only offers one ambulance be stationed in University City, and is worded in such a way as to leave open the possibility that that ambulance could be assigned to do a routine, non-emergency transfer from, for example, a nursing home to a hospital, thus taking it out of service for 911 EMS responses in University City.
8. If EMS is outsourced, will UCFD fire trucks be responding on more EMS calls with the private ambulance service than they do with the current UCFD run ambulances?
If so, how will those added responses impact the response times of the UCFD to fire calls within University City, and what is the projected additional cost in terms of maintenance on the fire trucks for the additional EMS responses they would be running?
Over the last three years, the UCFD has responded to between 3,900 and 4,200 EMS calls per year. UCFD fire trucks do not respond on many of those calls. Due to the inevitably delayed response of private ambulances, UCFD fire trucks will likely be required to respond to many more EMS calls than they do currently. By doubling, or potentially tripling the UCFD fire truck’s annual call load, it is unavoidable that concurrent fire and EMS calls will render UCFD fire trucks unavailable for fire calls within University City.
The City Manager refused to allow the Fire Chief to attend the study session on EMS and so I was unable to ask him about his position on outsourcing in University City. Directly after proposals were submitted to the City, the City Manager issued a separate RFP seeking a consultant to review the management of the Fire Department.
In 2008, previous City Manager, Julie Feier requested the opinion of the then Fire Chief, Steve Olshwanger, on outsourcing the EMS operations in University City. He wrote a memo
on the topic, suggesting it was not in the best interest of the residents of University City, and "the money savings (if any) would not be worth the Risk vs. Benefit of human life."
Based on the recent behavior of the City Manager with regard to the Fire Department and his employees, it is legitimate to ask whether the RFP to outsource EMS operations of the UCFD is a continuation of the retaliation from the City Manager towards the Fire Fighters of the UCFD for their participation in the April, 2014 municipal election. The question also arises concerning the RFP on Management Review is a reflection on the unknown position taken by the Fire Chief.
10. How much of a time delay will be experienced between the time a 911 call comes into the University City dispatch center, and the time an outsourced ambulance is dispatched by that services dispatch center?
University City operates its own dispatch center, and as such, is what’s known as a Primary PSAP, or public service answering point. That means that 911 calls go directly into the University City dispatch center, and there is minimal delay between the time a 911call is received and the time a UCFD ambulance is dispatched.
Under outsourced EMS, the private agency will almost certainly be a Secondary PSAP. That means that 911 calls will still go into the University City dispatch center, however, in order to dispatch a private ambulance, the University City dispatcher will have to get on the phone or radio to contact the private ambulance service’s dispatch center and then give their dispatcher the 911 call information so that they can dispatch the outsourced EMS unit. Nationally, the delay between a Primary PSAP and Secondary PSAP is, on average 45 to 120 seconds, depending of a variety of factors. That added delay is not addressed or reported in the RFP, and when that delay is added to the aforementioned 7 minute response time, University City residents may find themselves waiting for between 8 and 10 minutes for an outsourced ambulance, where they currently can expect a UCFD ambulance to arrive within four minutes.
11. If we are not collecting the revenue from EMS calls, has the City Manager put out an RFP for EMS billing services?
Apparently we are not going to pay the private contractors for EMS directly, but they will be able to keep all monies associated with billing. If this were not lucrative, no private entity would be interested, and two firms have submitted proposals. Mayor Welsch claims that we collect only half of what is due us. If this is the case, it behooves us to look at outsourcing EMS billing and collections to increase the amount collected.
12. Have any cities/municipalities who were using private contractual ambulance services reverted to or developed in-house EMS?
Most St. Louis county Fire Departments have followed U. City and Clayton’s lead with Paramedic ALS service (service requiring drugs or invasive procedures), replacing private contractual with in-house. Most recently Kirkwood, Florissant and Frontenac dropped contractual and developed in-house EMS. To date no Department has gone back to private contractual arrangements for emergency response.
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There is an old adage: "why fix something that is not broken?” While there is always room for improvement and we should try to deliver services as efficiently and cost effectivly as possible, It is my belief that the City Manager should continue to provide the level and quality of service for EMS we have come to expect in University City and reject outsourcing EMS.
I would encourage citizens and residents to let your representatives know how you feel about outsourcing EMS.