Stew Lilker’s

Columbia County Observer

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Columbia County EMS - Public or Private
An expert speaks

Toby Witt addresses the Columbia County Commission.

Madam Chairman, Commissioners, thank you for allowing the opportunity to speak on the topic of EMS operations tonight.

I have been a paramedic for fifteen years and a certified flight medic for the last five. Throughout my career I’ve worked for both public and private EMS agencies. In 2007, I was awarded the “flight paramedic of the year” award by the International Association of Flight Paramedics. In 2008, I was elected president of that organization.

I am active on local, state and national EMS councils. As business manager with a national air medical company my job is interacting with EMS and hospital management throughout a twelve county region in north east Florida.

Mike Grogan is not an expert on EMS operations

Mr. Grogan may be an experienced labor attorney, but an expert on EMS operations he is not. His statements two weeks ago were not only inaccurate, but key points concerning the issue were left out.

Mr. Grogan's notion that a two tiered response, a  fire unit with a paramedic arriving on the scene first, followed by the transport unit [ambulance] arriving  second, is flawed.

The most emergent EMS calls - strokes, heart attacks and severe trauma all require rapid transport to definitive care in larger cities. In the case of stroke, the patient has to be at a stroke center within three hours of symptoms and a heart attack victim has to be at interventional cath lab within ninety minutes.

The golden hour

We all have heard of the golden hour for trauma. The patient needs to reach a trauma center within an hour of the accident.

Life saving drugs and procedures are withheld in some of these cases if the patient misses the time window by even a few minutes. A heart attack call can initially begin as simple arm pain, a stroke as simple leg pain. You often rely on air medical to meet these critical timelines, but transport by an ambulance to a suitable landing zone is still required.

The goal should be for a transport unit to arrive at every scene as quickly as a fire unit.  Paramedics on fire trucks do provide extra support on scene, but to rely on first response fire trucks with paramedics to meet your response time goals is doing a great disservice to the citizens of this community. 

Mr. Grogan's assumption that private services have better system design and equipment is just ridiculous. Park one of your county units next to the local private provider and look inside. You will see which service has the most advanced equipment.

The county purchases equipment on government contracts, with no sales tax. The county purchases based on the needs and recommendations of your providers. Unlike the county, a private provider makes purchases with profit margins in mind. This means they may often settle for less advanced equipment to maximize profit.

Mr. Grogan was correct that private companies are more efficient in billing and collection. They do collect more money. The county does not turn over patients who cannot pay to collection agencies or place liens on their property. A private company will aggressively pursue collections.

You are raising the cost

By privatizing EMS you are not making the service cheaper, but actually raising the cost. You don’t have to make a profit. Private companies do.  They will raise the rates for service, seek a subsidy from the county and be more aggressive in billing. Anything the county saves by not funding EMS will be offset by putting an increased burden on the users of the service, the vast majority who are the elderly and poor in our community. 

This is a complex matter. These are just a few of the issues involved.

If you do ultimately decide to move forward with privatization, the choice of a vendor should not be taken lightly.

You have many who will be directly impacted by your action.

Employees who have been loyal to this county for nearly twenty years and have been passing up higher paying opportunities to stay with this service.

Two  hospitals who receive patients from EMS and may benefit if more competition is allowed and you have citizens of both the city and the county who will be affected by this decision.

The choice of a vendor should not be made without input from those who are affected by your decision. You rely on the opinion of knowledgeable well represented committees when dealing with utilities, fire service and economic development to name a few. I hope you will show the same due diligence and form well a rounded committee when selecting an EMS vendor. 

Thank you for your time and if I can be of help in the matter please don’t hesitate to ask.

This work by the Columbia County Observer is licensed under a Creative Commons Attribution-Noncommercial 3.0 United States License.

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