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Evanston has operated an ambulance service as part of its fire department for many years at a net cost to taxpayers of about $2 million a year

The ambulance service generates nearly $1 million a year in revenue from insurance reimbursements from patients, but staffing it costs about $2 million of the city’s $13.5 million fire department budget, plus a proportionate share of its more than $6 million in annual fire pension costs.

That makes for a total out-of-pocket cost to taxpayers of nearly $2 million a year.

Contrast that with the situation in Ann Arbor, Mich., a college town somewhat larger than Evanston, where ambulance service is provided by a regional non-profit agency — Huron Valley Ambulance

The 30-year-old service, according to its webiste, serves more than a million people across 121 municipalities in the region. It has over 650 employees including nearly 400 paramedics, runs more than 100 ambulances and has an annual budget of nearly $47 million.

And it does all that while receiving no tax dollars from participating communities.

The service, in addition to providing emergency ambulance service in response to 911 calls, also transports non-emergency patients to generate additional revenue. It’s nationally accredited and offers advanced life support service on its ambulances.

As in Evanston, most costs are reimbursed by insurance, and the agency has a reduced payment plan for low income residents.

Would such a solution work for Evanston and its neighboring communities? No way to tell without a lot of further research. But the Huron Valley Ambulance experience provides one example worth investigating as the city looks for long range solutions to its budget problems.

Related document

Fire Department Budget – 2012 Proposed Evanston City Budget

Bill Smith is the editor and publisher of Evanston Now.

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13 Comments

  1. Firetruck used with ambulances

    I have always wondered why when an ambulance is called a fire truck is always included. Is this really needed ? I am originally from Britain where this paractice is not followed and wondered why this is the case here ? I had a conversation with a firefighter the other day who said it was done simply to provide extra manpower if needed. If this is the case why don't they just add a fireman to the ambulance crew as there is more then enough room and this would seem to be a fairly easy way to save some money. I do understand the safety concern but how many ambulances calls result in the fireman being utilized and is there not some way to determine which calls might need the assistance of fireman and which do not ?

    1. what is the difference?

      What is the difference if a truck follows for assistance? They're already on duty. I could understand your concern if Evanston had a volunteer FD but our City is staff with full time. Also, only so many guys can travel along in that ambulance. If additional assistance is required to move a victim, then wouldn't you want those guys already there?

      Not much of a cost savings issue having an additional truck go along or stay behind is all I'm saying..

       

    2. Fire truck emergency response

      The explanation I know of our fire services is that all of our firefighters are also cross-trained as paramedics (we're in a very limited number of communities that take that approach), and because the whole city only has two ambulances of coverage, a fire truck will be dispatched to the scene of a medical emergency because it is more likely to arrive before an ambulance, especially on a busy night. 

      This way emergency medical treatment can begin as soon as possible, because losing the first minutes to waiting for an ambulance greatly increases the risk to the victim. 

      When they are issued at the same time, I think it is exactly what you said, that the manpower at the scene could come in handy. All in all, I don't think that anyone can really complain about gold-standard fire coverage. Certainly it is easy to take about budgets when your home isn't on fire, but I can only imagine how terrible it would be to have my home ruined or even worse my family hurt because we wanted to "be efficient"

      1. Emergency response

        This is the last place we should cut. There are plenty of other "savings" in our budget..

      2. Fire truck with no fire

        The question might better be why send a fire truck when the call is for a medical problem and the call makes it clear that there is no fire, no gas leak, etc..

        1. answer

          what part of this statement

          "… all of our firefighters are also cross-trained as paramedics (we're in a very limited number of communities that take that approach), and because the whole city only has two ambulances of coverage, a fire truck will be dispatched to the scene of a medical emergency because it is more likely to arrive before an ambulance, especially on a busy night."

          doesn't answer that question?

  2. Reply to whats the difference

    Having a fire truck following an ambulance all the time as a matter of policy is simply a waste of resources.  The fire truck probably has, at a minimum, 3 guys.  The ambulance has 2, or maybe 3 people.  The argument that just because we are paying people already (ie not a volunteer fire department), why not send them along, just in case is crazy.  Aren't these people doing other productive things such as fire inspections or something answering 311 calls?  In a city this size, it seems there is something more productive these people can and should be doing.  What about the tremendous amount of wasted gas to operate the fire truck, which I suppose gets about 5 mpg or less? 

    While on this topic, the Evanston Now article mentions that the ambulance charges are typically covered by the patient's insurance company.  The implication is that since your insurance will cover an ambulance call, why not charge whatever we need to (ie including a fire truck and fire men following behind just in case) .  This attitude of waste is fine because someone else will pay explains some of the excesses that have caused the mess we are in with our enormous health care costs.

    These wasteful practices – and our matching attitudes – need to change.

    1. Ambulance reimbursement

      The reimbursement rates are set by the insurer — primarily by Medicare. They pay up to a certain amount for the transport by the ambulance, not for any additional response. So the city derives no additional revenue from sending both a fire engine and an ambulance.

      — Bill

  3. Why the entire FD shows up when you call for an ambulance

    As cynical as this is, I've been told that the reason fire trucks accompany ambulances is because it increases the number of department vehicle responses each year, a metric that is important to the Fire Department in order to justify their staff size and equipment needs. The question I'd like to see asked is: If in 2009, the Evanston FD responded to 8,566 calls, which resulted in 18,790 department vehicle responses, how many of those calls were for an ambulance and how many other vehicles responded in addition to the ambulance? The idea of contracting to a not-for-profit Ambulance Service, similar to Huron Valley Ambulance, is worth considering and, if found to be viable, may not only eliminate / reduce the net $2M expenditure noted in the article but significantly reduce the number of calls the Evanston FD needs to respond to, thereby saving the City additional money. 

    1. Ambulance calls

      The proposed city budget says that the Fire Department responded to 5,350 requests for an ambulance and 3,567 calls of all other types during fiscal year 2010-11.

      Those calls included 157 fires, of which 75 were structure fires.

      Typically a fire engine is sent on every ambulance call. One of the justifications used is that because the city typically has five fire engines but only two ambulances in service, a fire engine can frequently get to the scene more quickly, and since the firefighters are generally cross-trained as paramedics, they can start assisting the victim before the ambulance arrives.

      Another rationale used is that it can require more than two people to get a person, especially a heavy person, out of their house and into the ambulance.

      Of course, there is no reason that a fire engine from the Fire Department and an ambulance from a multi-community ambulance service couldn't both respond to an ambulance run if the independent ambulance service model were adopted.

      — Bill

  4. Evanston must privatize

    I think this is worth repeating – If you are against the proposed 8 percent city tax hike then privatization is absolutely the best way to go.

    Another reason to privatize is to eliminate government corruption. When employee matters are in the hands of the private sector, unions can't donate to and elect politicians who then negotiate union contracts or make policy decisions that benefit unions at the expense of taxpayers.

    This is why Ted Loda and other Evanston union chiefs oppose privatization. As we have seen in our own backyard, government unions in Evanston keep getting pay raises, overtime pay and sweetheart deals.

    The City Council just voted to give the Police Sergeants Union a 3 percent pay raise that might go even higher if three other unions negotiate a BETTER deal this year! And you thought we were in a recession.

    Last year, Evanston laid off three firefighters for the first time in decades but then the Evanston Fire Union filed a lawsuit against the city for unfair labor practices. The city agreed to rehire the firefighters and let a third party arbitrator decide any future layoffs!! That's a bad deal for Evanstonians. The unions got that sweetheart deal by simply filing a lawsuit against the city, and dealing with politicians they supported in elections. And guess what, the Evanston Fire Department is recruiting more firefighters!

    How did this happen? Well, consider that you have aldermen on the City Council that received campaign donations from these very same public unions. The mayor, who got the Evanston Firefighter union endorsement and a campaign donation in the 2009 mayoral election, appointed the president of the city employees union on a budget task force, designed to make budget cut recommendations.

    Privatize ambulance, garbage services and recycling services. Close down one of the two fire stations on Central Street, layoff at least three firefighters and hash out a tri-city fire service agreement with Wilmette, Skokie. It's a no brainer and should have been done way back in 2008.

    Another good reason to privatize – less pension and insurance costs. Let private companies pay for union pay raises, overtime pay, pension benefits and so on. Labor costs is THE single largest expenditure in our budget. Cuts must start there.

    The power is also in the hands of people. We can vote against candidate who have government union support
     

  5. Re; Fire truck with no fire

    Have you ever been to an ambulance call, or are you just guessing as to what goes on? In medical emergencies, manpower can be critical. The current ambualnces have two people on them. If your heart stops, one person is required for chest compressions and one is required for respiration. Thats it for the crew you advocate! Who is going to communicate with the hospital? Who is going to administer drugs? Who is going to put the stretcher in the ambulance while the two are keeping you alive with CPR? Should they just stop doing CPR to do all the other things required?

    If you go to the emergency room, make sure and tell them you only want two people working on you. You might want to watch an ER re-run to see what actually goes on with a major medical issue.

  6. Ambulance are very much

    Ambulance are very much important like police cruisers. It needs to be available 24/7 during emergencies. These transformations from truck accessories to a mobile hospital would likely the most important vehicle in town.

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