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Doczilla

FD billing EMS for crash response?

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Not to mention on a roadway I want that engine as a blocker vehicle for me and everyone else on scene.

The argument they are making is that if that's the only reason they are there, "that's not the business we're in", to quote the email from the city council member. They feel it is not worth their time and the expenditure of fuel. It's a crappy argument. I can think of plenty of things that we do in EMS (and emergency medicine, for that matter) that aren't conventional or lifesaving, but are part of the job nonetheless.

'zilla

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Remember Doc asked for no EMS vs Fire. Thanks. Play nice.

This was not an EMS vs FIRE thing. EMS can do the rescue, then FD does not need to show up at all. That keeps everyone happy, until election time!

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Sounds like fire is going to "not our job" themselves out of a job.

If they don't do medical, and say the gas company gets sent to CO alarm calls and the city building inspectors take over fire inspection...

I don't think there's a good way to convince them. It seems less that they don't want to do the job as much as they don't want to do the job for free. Short of calling their bluff.

Question: if both EMS and Fire are municipal isn't this just a matter of the municipality approving money being shuffled from one department to another? I'm not sure where, other than fuel costs, the demand for money would come from. FF's are paid regardless right? Equipment costs are lower if they're not needed since they don't use anything right? For medical calls the cost could be decreased by having EMS supply and stock the kits they use for these calls (O2 tank replacement, C-collars, etc). I don't quite buy a wear and tear argument because any paid department I've ever seen swaps out their trucks long before the end of the chassis serviceable life and they end up with a cash strapped VFD.

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The funding is complicated. The EMS covers several different municipalities, which all support EMS through tax levies. It's a separate municipal service, with oversight by a board consisting of city council members from each of the jurisdictions served. The board oversees budget and finance, approves new equipment purchases, and looks into any problems with the service, with advice from the Chief and operational supervisors and medical director (me). Each jurisdiction pays a certain percentage of the EMS budget. Since the EMS is not under direct control of the city, and since there is a limit that the city will pay to the EMS, billing EMS for these responses will put more money in the FD's coffers. That money coming from the EMS's coffers comes from 3 different cities, so they are essentially robbing the other cities. It's a way to rob Peter to pay Paul. It's also a preview of how EMS will be treated if combined with the fire department.

'zilla

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A few years ago, our one fully paid fire department considered billing us (non-profit, quasi-hospital based) for assist calls. (Not crashes, but lift assists and the like. Serious calls that we are unable to back ourselves up).

Our management embraced that, then stated that the city would be billed for fire and police incident standbys. Also, we would bill the city for workmens comp for injured firefighters and police officers. That stopped very rapdily.

Since then, fire and police have been willingly responding on all possible cardiac/respiratory arrest calls.

Within the last 2 months, the fire cheif approached our managment, and wanted to respond on all ALS calls to keep firefighters active.

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I don't know if the counter billing argument would work as I imagine there's less need for EMS on standby for structural fires than there is fire on standby at MVC's without extrication/fire.

A large part of me is tempted to say F'em, but I honestly believe that FD should be at any MVC with injuries until absolutely sure they're not needed. Dispatch info, as we all know, cannot be considered reliable to the extent that they shouldn't be dispatched based on it. So you're left in an awkward spot where FD isn't willing to step up to what seems to be their duties (standby for fire/extrication duties at an MVC) without some money being shelled out and telling them where to go with it starts a pissing match where only the public are put at risk. I'd argue that a reasoned argument that says that they are there for the same reasons EMS is at fire scenes under NFPA might convince if that was the actual reason for the problem in the first place. But as Doczilla said, it's about money and the FD wanting EMS for themselves as a funding source. Since their argument doesn't reflect their actual wishes or agenda it's damned near impossible, I'd imagine, to reach an understanding.

Let's approach this from another angle then. Has anyone crunched the numbers to see just how much of a budget hit this would be and then combined that with the potential revenue if they were charged for every standby. Multiply that by all the FD's in the catchment (since if one get's it...) and see what the potential hit might be. It's a sour pill, but can it potentially be swallowed in the name of taking the high road? And if so can you cement the role of EMS in your community even more by making a public deal of taking the high road?

To be honest, I'm reaching for ideas as this one feels like a fight that's less about the money and more about the FD securing a position of poverty in time for the next year's budget. If they're so broke they need to cut back responses are charge from them and since EMS won't pony up, them obviously the city MUST find a way to increase their funding. Gotta love municipal politics.

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This is an interesting discussion.

The service I work for is private for profit. We cover 40 miles of interstate plus a few hundred miles of two lane road outside the city limits.

The local FD staffs one person on an engine. They page out paid on-call for all calls. If extrication is even hinted at we call for them because it will take time for them to get a crew and respond out to us. If they are needed they will bill the pts insurance for the time and equipment. But for the most part its a 2 person ambulance crew getting the job done.

If you call that the pt is out they will cancel unless you request manpower.

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I was involved with a volunteer department that charged to respond to every MVC. The charges were increased as the level of involvment increased. The breakdown went something like this;

1) scene response $100

2) fire response/extrication $100/vehicle

3) BLS medical $50/pt

4) ALS medical $100/pt

These charges were taken care of by EMS, who would send the bill inclusive to the insurance companies. The good thing was that most ins. companies paid without batting an eye. Also fire made the scene faster than EMS did and we would cancel them if they were not needed. The EMS would get 10% collection fee per incident. The EMS would pay us once monthly for services rendered. If an insurance company would not pay, EMS did not, nor were they expected to, pay us. If it was a person in our fire district, no collections would be involved, because of the dues charged to those individuals. If they were outside of our district, they would be sent to collections through EMS's collection service and their fee was raised to 17.5% of amount due I think (10% plus the collection agencies fee).

This worked great as the FD was able to buy better equipment and developed a more specialized heavy duty rescue truck. With the amount of coal trucks in that area, we needed different stabilizing equipment to make it safe for EMS and FD. Also we got better turnout gear and higher visibility garments than bunker gear.

I look at it as a win win situation as long as it is used correctly, however it sounds like your area is not moving at it like we did. KY state law places max. on amount that an insurance must cover, and I would advise staying under that so as not to have the hassle of dealing with adjusters. It is a whole lot easier to give adjusters one bill for the accident for emergency response. This is why we used our EMS service since they already had everything set up. They also liked their fees as it gave them about an extra $10,000/yr.

Hope all works out good in the end. Feel free to PM me about specifics if you would like.

Michael

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to the last poster im in louisville,ky what part are you from

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Do they bill for any other services that aren't "FD functions"? Since ambulance can't safely block the scene (you need it available as your transport vehicle if someone crashes into the scene and it's not big enough the block well, anyway), you need someone to protect the car MVA victims (who are usually tax-paying citizens). So, the service is to the citizens really, not to EMS.

And if they do list things they do on-scene for EMS, then they're doing more than blocking traffic in those cases and are thus needed for EMS duties.

In the end what a FD function is depends on the city. I'm sure they do other stuff like that's not firefighting (public assistance type stuff), but it BECOMES FD function because they are the CITY'S resource most suited to handling it. Blocking traffic is needed for safety of car accident victims, oil cleanup, and additional hands. They are the city's resource best suited to handling that, too. They're not doing anything for YOU/EMS, they're doing it for the citizens. They're a public municipal resource like PD and Public Works.

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