2006-04-15 / News

City Reduces Ambulance Rating to Basic Service

By Karen Gould

Less than three months after receiving a new state-of-the-art ambulance with the latest patient care features, the City of Mackinac Island has reduced its ambulance service operating license to basic status, following recommendations made in a study of the service. Previously, the city-owned ambulance was licensed by the state for Limited Advanced Life Support, utilizing the Island's skilled paramedics and other advanced emergency responders.

The change takes the Island's service back to that provided by a basic Emergency Medical Technician (EMT) and a driver, with limited on-site treatment capabilities. The study proposed that the police could be the drivers, if needed.

The sudden reduction in services is based on staffing levels and financial issues addressed in the $7,000 ambulance report commissioned by the Mackinac Island Medical Center.

The City of Mackinac Island owns the new $75,000 ambulance, a gift last year from cottagers and business owners to replace a 14-year-old vehicle, but contracts with Allied EMS Systems, Inc. of Petoskey to operate the service. Allied assumes the operation expenses, including wages and benefits for the ambulance crew, and the city provides the service with up to a $30,000 subsidy when operations don't generate enough revenue to pay for the contract. Allied EMS also is responsible for providing mandated training, and extra staff if needed.

The change in service was made following a private meeting held in late February with city, hospital, and ambulance officials to discuss the independent study on ambulance operations conducted by Wingrove Consulting of Buffalo, Minnesota.

Wingrove was asked to study whether the Medical Center should take over the ambulance service as a way to increase insurance reimbursements and, thereby, reduce the city's $30,000 annual subsidy. Because of the low number of ambulance runs made in a year, however, the study concluded that no benefits would result from such a change.

Instead, the study revealed that the city should renew its contract with Allied EMS Systems. It cited the low volume of transports, the limited opportunity that paramedics have to use critical skills, the high-risk nature of the skills used in limited advanced life support, the staffing standard required by the state for the limited advance service, and the typically-short transport time from an accident scene to the Medical Center.

"It's going backward, but not a huge step backwards," said Mark Wilk, Allied EMS Systems team leader for St. Ignace and Mackinac Island.

"It's a baby step backwards," he said of the reduced license now attached to the ambulance.

Mr. Wilk explained that the change back to basic status primarily affects one procedure performed by the ambulance crew. If an intravenous procedure is needed, it no longer can be administered until the patient arrives at the Medical Center. Bicycle and horse-related accidents dominate the Island's ambulance runs, the report notes.

A worst-case scenario would be if a patient were bleeding and needed intravenous fluids to keep their veins from collapsing. Such a procedure can no longer be performed on-site by the ambulance staff under the new license.

To supplement Island EMTs' field experience, Mr. Wilk suggested that they could maintain their skills by working on the ambulance in St. Ignace, and he would send personnel over to the Island to cover in their absence. He explained that continuing educational training maintains an EMT's certification, not field experience, however, field experience would offer the EMTs an opportunity to use skills learned in the classroom.

The report also recommends that the city should consider recruiting additional personnel to work during the Island's peak tourist season. Currently, the ambulance has a staff of six, most of whom are year-around residents.

"At seven or eight employees, the service is one or two resignations away from being unable to provide 24-hour ambulance coverage," states the report.

Minimum ambulance staffing for limited advanced life support requires an EMT Specialist and a Basic EMT on board during ambulance runs. A basic level can operate with a Basic EMT and a Medical First Responder, which means police officers can be ambulance drivers, if needed. The report notes that police have other responsibilities, including managing traffic, during an accident.

The report also recommends that grants be sought, a designated fund should be set up to stabilize the city's subsidy of the ambulance service, and a new fee structure be established.

The report suggests that Allied EMS Systems charge non-residents more for the ambulance service than Island residents, who contribute to the Island's infrastructure costs through property taxes, which also support the ambulance service.

"Tourism-dependent communities often use this strategy as one method of off-setting infrastructure costs," states the report, noting only 14 of 177 patients transported in 2005 were Island residents.

With the city budgeting $30,000 each year to subsidize the ambulance service, never knowing the exact yearly cost, the report suggests a special account be established, taking in excess money that is not used in a given year and disbursing funds from that account when costs go over the budgeted amount.

The city council discussed this point at its March 1 meeting and decided to follow through on the recommendation.

The report recommends contacting the county emergency manager to secure state Homeland Security grants, noting that a new provision in the grant requires states to support EMS activities. The federal Fire Act grant fund also could be used to upgrade the radio system used by the EMTs, and the U.S. Department of Agriculture has funding available in some states for rural EMS agencies.

Mackinac Island's ambulance is operated around the clock by a crew of two Basic EMTs, Tony Spata and Sam Barnwell, four Specialists, Pam Lach, Allen Burt, Christine Roguska, and Nona Tacey (who is on a leave of absence in 2006), and one Paramedic, Rick Linn. Mr. Wilk also is a Paramedic and Mr. Barnwell is enrolled in classes to become a Paramedic.

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