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Ambulance RFP called into question, and more from our inbox



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Sad prospects

With this letter I would like to express my disappointment and outrage at the city's sudden decision to not open Prospect Lake Beach and the beach house this summer. On October 25, 2018, I attended a Park and Rec meeting where the hours and days for motorboats and swimmers were decided. At this time the grant from Great Outdoors Colorado with $700.000 for the renovation of the beach and beach house had been received, and we were promised that this work would be done by this summer. As late as January 28, 2019, Ms. Kim King stated in a letter to another swimmer who complained about the condition of place that the renovations would be started this spring and finished by the summer of 2019.

What happened? Did the city forget about the lake? I found out when I talked to Ms. King on the phone on Friday, March 30, about this new development, and she had to try to explain and justify it. This weekend and this Monday, April 1, the YMCA also offered the reduced season rates for the outdoor pools and the beach, and the employees were not aware that the beach was no longer included in the deal, as stated in their SummerGoals and in their website.

I hope that the city can be persuaded to reopen their contract with the YMCA and open the beach, even in its old condition, so that it does not loose all faith and credibility with the lake swimmers, many of whom bought the season ticket unaware of the omission.
— Getty Nuhn

Sorry sidewalks

Almost 4 years ago a public meeting was held for our neighborhood by city personal. The subject matter was about new sidewalks that going to be put in within the next two or three months. This was welcome news for most of us as we have highly deteriorated sections of side walks in the 31 hundred block of Jon St. Moreover, there were two residents who were wheel chair bound. They  have since passed away!

In the years since that meeting we have seen new sidewalks appear throughout our area as well as other near by areas-without any attention given to our block! Several residents have inquired and complained about this situation to no avail. There are many seniors in our neighborhood, and  walking on these sidewalks presents opportunity for injury if you don't use extreme caution when trying to traverse deteriorated sections.

It appears that the city put our street the on the new Sidewalk Self Healing Program. News Flash: It doesn't work! I have suggested (to neighbors) that we petition the city to designate our sidewalks as bike lanes. Folks have to walk in the street anyway, and on the upside once they achieve bike lane status, magic money will appear for new concrete and the former sidewalks (now bike lanes) will be new once more albeit with lane paint on both sides! I know a few voters who will not be in favor of any tax increase of any kind in the future. You can guess where they live!
— Len Bentley

Ambulance RFP needs transparency, innovation

As the Colorado Springs Fire Department's request for proposal for the city ambulance contract reenters the news cycle, articles are already beginning to echo the past. In 2013 when the city terminated its agreement with the county's Emergency Services Agency, the city considered a proposal to take over ambulance transport.

Now the city is once again "investigating the possibility of an insource option." This comes after last year's botched negotiations with a Tennessee-based company that led to an 18-month extension for 40-year contract-holder American Medical Response. One thing has remained constant through all these negotiations: a shroud of secrecy.

A brief query of articles from the last six years always describes this process as "tight-lipped" and "behind closed doors" with city and fire department leadership "unavailable for comment. As a resident of the city and an employee of AMR, it is very concerning to see this process handled with so much secrecy every year on repeat.
I have worked for AMR in Colorado Springs for a year and a half and I have been a paramedic over 7 years. I was drawn to the system by the progressive nature of the clinical environment. But I was also almost immediately dismayed by the hyperfocus on response times. While it is important to handle calls for service in a timely, efficient way, resource management is also very important. The "emergency" in "emergency medical services" is no longer what it used to be. Since technology put a phone within arms reach of everyone above the age of ten 100% of the time, call volumes across the country have skyrocketed, including in our city. It is simply not an appropriate use of resources to immediately send, lights and sirens, a paramedic-staffed ambulance as well as a fully staffed fire engine to every exacerbation of chronic back pain that caused "abnormal breathing" or drunk person with an "altered mental status".
Part of the problem is the emergency medical dispatch system (EMD), a scripted algorithm that errs extremely too far on the side of caution in the name of what could remotely be life-threatening instead of what is statistically based in medical research and fact. Additionally, a disparity exists between dispatch protocols for medical and law enforcement. Police officers and sheriff's deputies are frequently used to "clear a scene" for the safety of EMS and fire but a call that identifies an "emergency life threat" demanding lights and sirens on the medical end could be a low priority for law enforcement. In the meantime, an ambulance and fire company stage away from the scene until law enforcement clears it, sometimes for an extended period depending on their availability. In the case of a domestic dispute that never escalates to physical violence, an ambulance may have just staged up to an hour before law enforcement was dispatched just to find there is no victim at all.
This unnecessarily depletes the resources available to other life-threatening events.
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In the age of improved business codes and after teaching generations of Americans fire prevention, the fire service has practically put itself out of a job. According to the Fire Department's Statistical Abstract for 2017, the latest year for which statistics are available, Colorado Springs Fire Department responded to 160 structure fires. A department of 450 uniformed personnel spread across 22 stations and 34 fully staffed companies with a $50 million budget only performs their primary job every 2.4 days. Factor in the department has three shifts working equal numbers of days per year and a firefighter may go weeks without responding to a working structure fire.
What they do respond to a significant number of are medical calls. In fact, it is 75% of their total call volume. A fire company (company refers to one staffed apparatus e.g. engine, ladder truck, squad, rescue, etc.) arrives before an ambulance 75% of the time. This is because there are many more of them and they are spread across the city very evenly. When not responding to a call or writing its report, firefighters are often in their station doing chores, fraternizing, and doing a heavy amount of training for the task they may perform five times a year.

Their counterparts at AMR have no station. You've likely seen them posted at the Citadel mall, or behind various gas stations and fast food restaurants. That is when they aren't running back-to-back calls. And when they aren't running emergency calls they are likely doing interfacility transports, non-emergent law enforcement requests, or wheelchair van overflow.

Unit-hour-utilization, the ratio of ambulances actively engaged in a call, versus overall time averaged across all the units in service, is always high in this region. When call volume spikes, due to unforeseen circumstances or even in an anticipated event such as extreme weather, the time to scene for the assigned ambulance can become prolonged. But with a $2 million per year franchise fee due the city, unreliable Medicare/Medicaid reimbursement, and a collection rate for services around 30%, being overstaffed becomes unsustainable almost instantly. Employee retention is also driven by multiple factors and turnover is a significant problem here as it is for every EMS agency.

In urban zones, which most of the city is classified as, the expectation is to have an ambulance on-scene within 8 minutes of dispatch 92% of the time. That clock stops, however, if the fire company responding is staffed with a paramedic, trained in advanced life support, arrives first, and almost all of them are paramedic-staffed. This, the city says, is the only way AMR is able to meet compliance for its urban zones. But according to the 2017 Statistical Abstract, the city is only able to meet that same standard 87.9% of the time.

Out of my AMR orientation class, less than half remain after only 18 months. Almost all of the others left for higher paying, less demanding jobs as did one of my field training officers not long after I completed training. The few that remain are dedicated to patient care. They don't see AMR as a stepping stone to something greater but enjoy the daily challenges the job presents. They practice the skills they trained for and are able to specialize in those skills rather than put up with them as a part of another job they'd rather be doing.
Response times and staffing are the main reasons why IAFF Local 5 had a referendum in the city election to gain collective bargaining rights. They say they need additional staffing to maintain a safe response and additional pay to maintain the staff they have. Well so does AMR. A recruit firefighter on day one of the Department's academy makes over $25 an hour. At AMR, $25 an hour would be a 50% pay raise for most medics. At graduation, that recruit becomes a fourth class firefighter and begins making $28/hour day one on the job. This would be a 100% raise for all but the most senior EMTs. The Department and its union recognize compensation as a key factor in employee retention. They should understand the pressures their contracting standards have on AMR and the outcomes to expect from those operational practices.

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As stated above, unlike in a growing structure fire or wildfire where lives and property can be in danger and seconds actually matter, many medical calls are far from life and death situations where the same difference can be made. Additionally, lights and sirens have never been correlated with improved patient outcomes but instead lead to unnecessary traffic accidents with measurable morbidity and mortality. In fact, in 2002, Annals of Emergency Medicine, a top scientific, peer-reviewed journal called the death toll of ambulance personnel in traffic accidents a "silent epidemic."
Last month, New York City mayor Bill de Blasio was asked to comment on the pay disparity between FDNY EMS personnel and firefighting personnel to which he stated, “the work is different.” Of course that is true but that does not make it lesser. Across the country, and definitely in our system, there is typically less downtime working on an ambulance and to attend training they have to find time off to attend it. If it implies it’s less dangerous, don’t forget our colleague who was assaulted early February while breaking up a carjacking. Back injuries and other disabilities are common. All of my colleagues know equal numbers of fire and EMS personnel who have committed suicide, as do I.

We should consider moving away from the same goal posts used by the fire department when responding to medical calls. Rather than an immediate response by 6 personnel on two apparatus followed by an expensive but inconclusive trip to the emergency room, most patients need resource education and more comprehensive primary care. This city's system is already better than others I've worked in but the alternative programs the Department runs like CARES' mobile integrated health care, Community Response Team's advanced field psychiatric treatment, and CMED2's low priority call management need to be expanded to reach all citizens. This would require a drastic restructuring of the response framework to medical calls into something more similar to a police department with multiple units at dozens of calls for up to an hour each sometimes. It would also require viewing EMS as a public service instead of a profit-making opportunity. Ambulance transport would be reserved for all of the sickest patients and responses would never be prolonged with improved resource management. This could become a model for EMS to the rest of the country. First, though, the process needs some sunlight and more input from the community as well as the EMTs whose careers are up in the air every 12 months.
— Adam White

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