Weekly Feature

2017-12-07 / Front Page

Town, ambulance provider continue contract negotiations


While the Cheektowaga Town Council awarded a bid to American Medical Response to continue ambulance service at its Nov. 20 meeting, town and AMR negotiators are still working to address two sticking points — regarding response-time compliance and crew composition — and finalize the proposed three-year contract.

Currently, AMR is rated on its response times to each of the 10 fire districts that cover Cheektowaga and the Village of Sloan, where AMR also provides service, and must ensure that 90 percent of calls in each district are responded to in eight minutes or less. AMR is advocating for a new system that would calculate the response time for every call and then average those times. That townwide average would still need to be at eight minutes or less, according to Steven Yohe, chief EMS officer at AMR.

Thomas Maxian, AMR’s regional director, said other area municipalities the company serves, such as Buffalo and Amherst, are split between calculating response times on a percentage or average basis, but AMR is pushing for the average times nationally.

The rationale is this: Under the fractal calculation, if a low-volume district gets only 10 calls per month, and the ambulance provider misses the eight-minute mark on the first two, the maximum response rate it could achieve would be 80 percent, below the compliance threshold. Compliance then wouldn’t be possible in that district for that month, thus the provider’s incentive to keep up quick responses goes out the window.

“What’s going to happen is, you know you’re not going to make that time there, you divert resources to other places where you have a chance, so these calls no longer really count,” Maxian said of the hypothetical. “In an average-response-time rubric, every single call counts, so nothing falls by the wayside.”

Maxian and Yohe said using average response time would be a better metric for measuring successful emergency medical care.

“What we want to do is create a system that’s going to ensure two things: great service, and it incentivizes the right thing,” Maxian said. “The incentive is get ambulances to every call as quickly as you can.”

Alan Wieberg, chairman of the Town Emergency Medical Services Board, said the board agrees with the eight-minute average mark for response times but is advocating to keep the district by-district calculation.

“The reason we really want to stick with that individual district requirement is that it prevents any type of oversight or any type of skewed numbers,” he said. “Certain districts may have a shorter response time, let’s say somebody like Forks [Fire District] who’s centrally located in the town, but then you take somebody like maybe Hy-View or South Line, where it’s going to take longer to get to those calls. If we went to just one number, they may just get lost in the shuffle.”

In addition to the debate on response calculations, AMR is hoping to change the configuration of ambulance crews.

As it stands, paramedics and advanced emergency medical technicians are both on Cheektowaga ambulances. According to Maxian, basic EMTs tasks include bandaging skills, bleeding control, CPR and airway management, while Advanced EMTs can start IVs and perform some advanced airway procedures. Because paramedics and AEMTs can provide some of the same treatment, pairing them creates redundancy and increased on-scene times, AMR contends.

“We have three studies that we included in our proposal … and there are about 15 more out there that have said when you have multiple advanced providers on a car, it increases on-scene times in situations where you don’t want to have a longer on-scene time,” Maxi- an said.

Additionally, Maxian said, the current setup provides fewer opportunities for individual first responders to master particular EMS skills.

“When you have two providers on the vehicle, they don’t get as much repetition as they get when they’re alone,” he said.

Wieberg, who is also the chief of the Sloan Fire Department, said the EMS board is concerned the changes could disrupt the progress made to boost care since AMR took over ambulance service.

“My concern is are we going to lose some of that crew continuity if we start losing the Advanced EMTs because that’s a big part of what we do,” he said “We work together as a team, and I’m afraid we might lose some of that. … We really gel as a team, and I’m not sure what’s going to happen, if we go that route. Am I saying we’re going to have a degradation of service to our residents? No, I don’t believe that’s accurate to say that, but I do think it’s something nice to have that advanced provider on scene to be able to help with some of those tasks.”

Wieberg said the Town Board, EMS board and AMR have already worked past seven of the nine points the company raised with the request for proposal, and that since AMR took over ambulance service a little more than a year ago, the relationship has been strong and service has improved.

“At this point, I believe some of the negotiation is going to happen partly from the Town Board but also keeping the EMS board involved on whatever talks or discussions are going on with that,” he said.

Maxian echoed Wieberg’s comments on the relationship between AMR and the town and said AMR is now waiting to hear from the town to iron out the two final issues.

email: bjackson@beenews.com

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