Aug 13, 2010 Ami Olson Uncategorized
For 30 years, Rural/Metro has held the exclusive franchise to haul Syracuse’s sick, injured, dead and dying.
But that changed this spring. TLC Emergency Medical Services believes there’s enough business to go around, and have begun taking 911 emergency calls dispatched from the county alongside Rural/Metro.
TLC contends that its presence in Syracuse’s emergency ambulance field means more resources for an increasingly needy population. Rural/Metro argues TLC never proved the city has enough need to justify a second ambulance service, and has taken the fight to the state health department with a request for an investigation.
More need, indeed?
There’s no arguing that calls for emergency services have steadily increased, according to the 2009 Onondaga County 911 annual report. In 2006, Syracuse fire and Rural/Metro were dispatched to 18,422 calls; by 2009 the number had jumped to 20,512 dispatches.
“The demands are growing by leaps and bounds,” said TLC Director of Operations Lon Fricano. “Anybody who listens to a scanner can tell that calls are being held because there’s not enough resources.”
Fricano said instances of mutual aid — when outside emergency service providers come into the city to pick up overflow — should be the exception, not the rule. But in Syracuse, it’s happening fairly routinely, he said.
Mike Addario, Rural/Metro’s Central New York general manager, disagrees.
Of the approximately 50,000 calls Addario said Rural/Metro answers in its six-county coverage area each year, he estimates about 200 of them are turned over to mutual aid organizations.
“That’s less than one percent,” Addario added.
In most major urban centers in New York and beyond, more than one emergency ambulance service patrols the city and responds to 911 calls. In Rochester, Oneida, Utica and Binghamton, at least two different ambulance services provide emergency medical transport to residents.
Staying healthier, longer
While the rate of violent crime has stayed relatively steady in Syracuse, there is another statistic that points to an increased need for emergency medical transport: an aging population.
In 2008, 13.7 percent of the city’s population is 65 or older, and as baby boomers age, that percentage will only grow.
Add to that the fact that medical technology is improving and people are becoming better educated about risk factors and warning signs, and the need for additional emergency transport resources, and TLC sees that demand growing even more.
Addario, in contrast, said the need isn’t for more ambulances to transport patients, it’s in the number of paramedics available to provide care to them, evidence of a larger problem in the system.
But there is yet another population whose growth indicates a need for additional resources: the uninsured.
In 2008, the NYS Department of Health reported that more than 10 percent of Onondaga County residents under the age of 64 were uninsured. And when the uninsured need medical care, they are more likely to call 911 and head to the emergency room than to call a general physician and set up an appointment.
“There’s a lot of people without medical insurance, and their only option is to call an ambulance,” said Ed Binns, paramedic supervisor with TLC.
Sending ambulances out on emergency calls for what turn out to be non-emergencies ties up those resources and can take them away from actual life-threatening events. Transportation to the hospital — which paramedics cannot deny, regardless of the seriousness of the injury or affliction — means additional time and resources spent on non-emergencies.
When paramedics and EMTs are faced with actual emergencies, the level of service available through an ambulance has become significantly more sophisticated in recent years, and therefore is more time consuming to administer, which again means fewer available rigs for 911 calls.
It’s a business, after all
TLC’s presence in the city will essentially break Rural/Metro’s monopoly, and like in any commercial field, the customers could stand to benefit from a competitive market.
Additional resources will be available to residents, and its realistic that the costs of those services could drop as a result, Fricano said.
“And it puts you on your toes, to take better care of the customer,” he said.
But Rural/Metro has plans to stop any competition within the marketplace almost as soon as it has begun.
Addario said Rural/Metro has requested New York State investigate the method by which TLC went about getting a Certificate of Need, necessary to provide ambulance service in the city.
“We are concerned about how they went about getting a certificate of need,” Addario said. “They never showed there was a need for additional resources.”
And, in this case, flooding the marketplace with more resources than is necessary could pose a bigger risk than benefit for the public, he believes.
“Just putting more resources into the system without having any kind of coordination isn’t necessarily better for the public,” Addario said. “How do you coordinate between three different providers? … We don’t want ambulance wars happening in the streets.”