Communities share service

By Observer Upload May 09, 2013 08:39 am

Following an ambulance run, EMT-I Stan Grove, left, and paramedic Steve Hogge arrive back at the La Grande Fire  Station to await their next call. (Chris Baxter/The Observer)
Following an ambulance run, EMT-I Stan Grove, left, and paramedic Steve Hogge arrive back at the La Grande Fire Station to await their next call. (Chris Baxter/The Observer)
 

Union County EMS is a layered system with La Grande Fire and Ambulance serving as sole ALS provider 

by KELLY DUCOTE / The Observer

Two ambulances traveling together may seem inefficient and redundant on the surface. But La Grande Fire Chief Bruce Weimer says it’s part of a system that works for La Grande and the surrounding communities.

“I believe that for a rural community, we have an emergency medical system that rivals larger EMS systems,” he said.

Union County’s EMS system is a layered one, with La Grande Fire and Ambulance serving as the county’s sole Advance Life Support ambulance provider.

“We are the only ones with paramedics,” Weimer said.

Other communities, like Elgin and Union, have Quick Response Teams made up of EMTs, but the majority of these teams are volunteer, the chief said. Local QRTs can provide Basic Life Support (BLS) on their own ambulances using their own equipment.

When a medical call comes in to one of these communities, a QRT will respond to the call and head to the scene to “perform life-saving emergency medicine, and then we come in with ALS with paramedics on board,” Weimer said.

The layered system is similar to those used in metropolitan areas, though the distance covered here is much greater. Getting an ALS ambulance to Elgin may take up to 20 minutes.

“It makes sense because we are coming from so far out that they have someone there locally,” Weimer said.

When a La Grande ambulance is dispatched to Elgin, North Powder or another community, it heads to the scene to meet the EMTs and other ambulances in case ALS is needed. But sometimes ALS isn’t needed, so the La Grande team can be told, “You guys can turn around,” Weimer said.

In other situations, the La Grande team meets the QRT wherever is necessary — at the scene, at a location between the scene or even at Grande Ronde Hospital.

If the La Grande team meets the QRT at the scene, it will take over, but both ambulances will accompany the patient to the hospital.

“That is when you see two ambulances together,” Weimer said.

The decision to tell the La Grande team to turn around — or to enlist the help of Life Flight — is one that seems to come instinctively to first responders.

Elgin Ambulance Service President Travis Perkins said it’s one of those things “you just know” based on the call coming in. If it cannot be determined by the call, a decision is made once the ambulance team makes it to the scene.

Before Life Flight was established in La Grande in June 2011, a situation like a broken bone could have meant Elgin volunteers would be driving to Walla Walla, Wash., if no orthopedic surgeon was on call at Grande Ronde Hospital.

“It saves our service by utilizing Life Flight. If it’s something clear out of town, we go ahead and call,” Perkins said.

Volunteer EMTs are the ‘backbone’

On the tier of emergency responders, paramedics sit at the top, holding the most medical responsibility. Below them are the Emergency Medical Technicians that can be trained at the basic or intermediate level. Then there are the First Responders, mostly drivers in the rural communities, who can perform basic first aid at the scene. Only paramedics can perform ALS services.

In Elgin, four EMTs and eight drivers are on staff, but sometimes only one EMT is available.

Other communities can be even more shorthanded and sometimes no EMT is available, Weimer said.

“Small communities struggle to field EMT basics, so it’s very hard to field paramedics,” Weimer said. “Volunteers are the backbone of the system.”

One barrier to keeping and attracting volunteers is training, which is expensive and can be hard to find in the area.

Elgin currently has two grants pending that would pay for two individuals to get EMT-basic training, which would double its EMT staff.

All EMTs in the county are joined by a common denominator: Grande Ronde Hospital’s Dr. Ken Chasteen.

“He certifies everybody,” Weimer said. “He monitors all the EMTs in the county, and we have monthly case reviews.”

Perkins said working with the EMTs and paramedics from La Grande makes his team’s job easier.

“All of them are great to work with. I don’t have a bad thing to say about them,” Perkins said. “On ALS, it’s great to have them. They’re here when you need them here.”

Elgin volunteers spend the first Sunday of each month training, sometimes with the help of La Grande Fire.

“We have a training officer, but if we want someone to come out, they do. It’s just a good working relationship we have with them,” Perkins said.

Elgin received 77 medical calls between January and April.

“Everybody has their opinions on whether we should have an ambulance, but we have a lot of BLS calls that if La Grande had to handle would take a lot of time out of their day and an ambulance out of service,” Perkins said.

Costs vary
by community

Each municipality handles its own billing and controls its own ambulance fees, but when ALS services are rendered, costs are split between that municipality and La Grande Fire and Ambulance.

La Grande’s base rate starts at $1,000 for BLS and ALS services with a $17.50 per mile mileage charge.

“It’s scary. It’s horrible. That’s what we have to charge for what we do,” Weimer said. “”We charge $1,000. We don’t get $1,000.”

With an aging population in Union County, many patients transported by ambulance are on Medicare, which reimburses slightly more than 40 percent of the total ambulance service cost.

Another factor that contributes to the lack of revenue received by the ambulance service is FireMed, an ambulance transport membership program that eliminates a member’s out-of-pocket expenses, Weimer said.

“A FireMed member’s insurance company will be billed for the cost of the transport. We will accept whatever reimbursement amount we receive as payment in full,” Weimer said. “Nonmembers are billed directly for the amount of our transport fee that is not reimbursed by their
insurance.”

As of March 31, La Grande Fire had 2,910 FireMed memberships. Memberships are $55 annually and are available to those living outside of La Grande. Revenue from memberships sold to Elgin or Union residents is split based on the percentage of members living in the two response districts.

For those without FireMed protection, the fees vary by community.

The current Elgin fee for BLS is $500, with an $11 per mile mileage fee, Perkins said. Elgin Ambulance Service is currently in the process of raising fees, a first since 2008. If the proposal is approved by the city, it would raise fees to $900 for BLS services, to $1,200 for ALS, from the current $900, and to $18 per mile.

As call volumes go up, Weimer may not be happy with what La Grande Fire has to charge for its ambulance service, but it’s a necessary — and effective — service, he said.

“I think it’s a good system,” he said.