At a Wednesday work session, the Fort Payne City Council listened to a proposal by Fort Payne Fire and Rescue to transport patients to the hospital since they already have paramedics and emergency medical technicians responding to emergency calls.
Fire Chief Ron Saferite said the nature of fire departments nationwide has trended toward providing emergency medical treatment rather than simply putting out fires, so his crews are well trained to offer this service. He said they often wait at the scene with patients and their families until DeKalb Ambulance Service arrives.
“This is nothing against the ambulance service we presently have,” Saferite said. “This is something we feel like is going to help the citizens of our town to receive quicker service. We usually beat [DAS] to the scene by five to seven minutes and sometimes that can be life-saving. They’ve been known to take 20 to 30 minutes to get to the scene before they can transport the patient. When you’re talking about strokes and heart attacks, seconds means living or dying, much less minutes.”
Council member Johnny Eberhart, who required transport to a hospital during his bout of COVID-19, said, “I didn’t think they were ever going to come get me. Our guys were Johnny on the spot.”
In response, DAS Director Cheryl Turner said Thursday that in the past 60 days, her crews averaged 8 minutes responding to emergency calls inside Fort Payne. She argued it would actually take more time if a patient was found to be suffering from a major heart attack and Fort Payne Fire and Rescue had to then request DAS send another ambulance to the same location to transport the patient to Chattanooga. Saferite disputed this would happen in a life or death situation and said a patient would likely be transported by helicopter if the situation demanded.
When the pandemic began, Fort Payne deferred to DAS on some calls to avoid outbreaks of the contagious coronavirus among firefighters.
Turner said she was proud of how DAS “crews really stepped up to the plate during COVID-19 and provided the most excellent pre-hospital medicine to the citizens of this county in a way that is astounding and amazing. What these guys and gals have been through in the last year is nothing short of a miracle. While other ambulance services across the state have reduced resources and services, DAS has seen not a single reduction in the services we provide.”
She said DAS mitigates any gaps in coverage using system status management tools to predict where their next call will likely come from. For example, if two ambulances were simultaneously dispatched to Rainsville and Sylvania, DAS would temporarily position ambulances from their Hammondville and Collinsville stations closer to Fort Payne, which has the highest population concentration.
“Sometimes Fort Payne Fire and Rescue has to wait for an ambulance to come from an outlying station, which takes upwards of 20 minutes sometimes,” Saferite said. “It’s usually the one from Hammondville, Crossville or Collinsville that has to come if the Fort Payne ambulance is out of town. That’s where the delay comes in. It’s not that DAS isn’t trying to do their job. There’s just a delay because the ambulance has to come from farther out.”
DAS operates six stations across the county, including their headquarters in Fort Payne. Their board has recently invested in replacing the Rainsville station, where the alternate transport service has filled a growing demand for wheelchair-bound patients who don’t need a full ambulance. However, “the main offices, the heart of DeKalb Ambulance Services, is right here in Fort Payne, where it has been for 35 years and we have no intention of going anywhere,” Turner said.
He said the two agencies would still help each other if needed and DAS would still make money as the next available agency to transport a patient if both ambulances were unavailable or a patient needed transported outside the city limits. Turner agreed that regardless of what ends up happening, DAS will continue to make the professional relationship work and take care of patients to the best of their ability.
“There will be no confrontations from us or unprofessional comments or behavior,” she said.
Turner said this discussion has arisen before, and it is inaccurate to suggest that DAS merely chauffeurs patients who Fort Payne Fire and Rescue has treated at taxpayer expense while the ambulance service files with insurers and Medicaid/Medicare once a patient has arrived at the hospital.
Chief Saferite told the Council that adding transport capability would also potentially boost revenue for the city to fund things like keeping his personnel from leaving for other departments offering better pay. An initial investment would have to be made to purchase two vehicles and six personnel in order to maintain the city’s ISO rating that affects local homeowner insurance rates. The city might lower its initial overhead by applying for grants, but once those ran out, Fort Payne would assume the costs of those salaries.
EMS Director Scot Westbook surveyed fire departments in nearby counties and they averaged collections of around $300 per call. He said Fort Payne spends about $15,000 per year on medications administered to people they treat, yet receives no reimbursement from DAS for these items, which states that it is not licensed as a supplier of medications to other agencies.
Turner thinks Fort Payne may be overestimating the amount of money the department would be able to collect and is underestimating the financial burdens and liabilities the city would take on if they decided to attempt this. Many 911 calls involve uninsured and indigent patients from whom money may never be collected and it becomes costly to keep certifications and maintain a firm grasp of Medicare rules and guidelines, for example.
“That may be what they’re looking for, but I’m not sure that’s what they are going to find,” Turner said, adding that she understands Fort Payne’s need to offer competitive salaries as a paid rather than volunteer rescue service.