What about transport?
Tonight, City Council is going to revisit the issue of whether or not the Fire Department should take over responsibility for ambulance transport from the current provider, Universal Ambulance. There are a lot of moving parts to this issue. Although some things are a matter of opinion, there are some facts which are not in dispute. Let’s take a look at those facts first.
Facts Not In Dispute
First and foremost, this is an ideological issue, and it has the distinction of being perhaps the most polarizing local political ideological issue in town. There are two factions involved: a “conservative side” and a “firefighter/labor side”, and the battle lines are familiar to anyone who follows state or national politics. More on this later, but in short the conservatives are against this, and the firefighter/labor side is for it.
Another fact: the Sterling Heights Fire Department currently responds to every emergency medical call in the city, and has done so for many years. Out of the tens of thousands of runs annually, only a few hundred are for structure fires; most of the department’s runs are medical in nature. The costs for these runs are being paid for directly by the taxpayers.
Also not in dispute is the matter of Universal Ambulance. As the current provider, Universal Ambulance has been providing the service for decades. They are headquartered in Sterling Heights, and are contracted to have a certain minimum number of ambulances available within the city at all times. They are a good corporate citizen, and their competent, if somewhat unremarkable service has been very reliable for all of this time.
Now that we have gotten the basic facts out of the way, let’s take a quick look at the factions on each side of the issue and their main concerns.
How Conservatives Stand
The typical Sterling Heights conservative, when confronted with this issue, will recite for you the dogma that local governments should not intrude into the private sector. Outside of their concerns about the potential government takeover in this space, which some will term “socialist”, they typically will state concerns that:
- The expense of acquiring ambulances and additional personnel will not be recouped by collecting from patient insurance companies
- Adding to the payroll, in this case in hiring fifteen additional firefighters, is unwise considering the uncertain state of the economy
- The voters were once called upon to decide this issue in the past and they rejected it
- The union firefighters will do the job at several times the cost per hour that it is currently being done for by the employees of Universal Ambulance
It bears mention that some on the conservative side of this issue are proponents of transforming the Sterling Heights Fire Department into a volunteer service, similar to that of Troy. They see the potential expansion into medical transport as a roadblock to that goal, and as a way for the professional union firefighters to further cement their hold on the fire service overall.
The Firefighter Perspective
Firefighters will point out to you the fact that they are currently doing everything there is to be done in terms of emergency medical response in town except driving the ambulance. Besides the fact that they are at every medical run in the city, they will tell you that:
- They provide the most highly trained, professional advanced life support in the city
- They are currently watching Universal Ambulance collect all of the insurance revenues even as the Fire Department does most of the work
- In addition to being Emergency Medical Technicians, every firefighter assigned to a new transport service will, in fact, be a firefighter, and thus capable of doing extinguishment, rescue, and other duties that Universal Ambulance personnel cannot
The Lens of Ideology
As I said before, no matter how it is spun, this is first and foremost an ideological issue. Your political party preference typically informs your standpoint on the issue, and if you are a political moderate you might be amazed tonight at the level of vitriol that will be on display on both sides of the issue. Expect a large turn out of residents, especially conservative activists. Also expect a large turn-out of firefighters and labor supporters. There will be clapping after everyone on one side or another speaks, and people on either side will probably feel like the other side is crazy.
And a few short years ago, I would have been clapping right along with my conservative brothers and sisters, but today I’ve got a different viewpoint.
First of all, there is nothing to be gained by being an ideologue. If the only way you can approach this issue is by viewing it through the “conservative” lens or through the “firefighter” lens, you’re not adding anything to the discussion that hasn’t already been said many times over as this issue has resurfaced over the years. You are not contributing anything new, and you are not considering how the situation may have changed.
So instead of asking the same old questions and giving the same old answers, which I have basically outlined for you above, I have a few new questions for you to consider.
- First, is delivering emergency services, in this case emergency medical transport, a legitimate function of local government?
- Second, if the goal is to provide a high level of service and costs are secondary — and that does seem to be the pattern in this country with regard to medical expenses — are no revenues for the sake of ideological purity better than some revenues?
- Third, how important is the mission of saving lives and minimizing property damage to the Fire Department and the city at large?
How I Answer These Questions
In my opinion, emergency services are the main reason why we have local government in the first place. When I pick up the phone and dial 911, I want a cop car, fire truck or ambulance to show up at my door in the least amount of time, and have the people riding in them ready to go to work as soon as their wheels stop turning. You can take all of the other services that local government provides — recreation, trash collection, road maintenance, snow removal, the library, etc. — and all put together they aren’t close to being as important as what happens when someone dials 911. The citizens feel the same way about this. They’ve voted for the recent public safety millage, and they voted some time ago to borrow the money required to reconstruct the city’s fire stations. Sterling Heights voters value emergency services.
So, is a local municipality providing emergency medical transport a legitimate function? You had better believe it is. It is cut from the same stock that firefighting and policing are, and it frequently goes hand-in-hand with those activities. Many towns have had their fire department transporting patients from the very beginning, and although it is certainly not a profitable endeavor, it is a necessary function that fits in quite well with the emergency services infrastructure that we already have. Typically, the firefighters are there immediately after the injuries that require an emergency response happen, and in cases of sudden illness, they are the first to arrive.
As to the second question: the main concerns about taking transport in-house seem to be ideological and financial. Ideologues don’t want a “socialist government takeover” and the fiscal conservatives worry about not recovering the cost associated with operating a medical transport service. But right now we’re shipping one and sometimes two fire trucks to every medical emergency. SHFD personnel are working on every heart attack victim. And none of this is being paid for by the patient’s insurance company. Do we want ideological purity, or do we want fiscal responsibility? If you want fiscal responsibility, you don’t want to exclude the insurance company revenue source. The only other choice is a much lower level of emergency medical service in Sterling Heights by mandating that the firefighters stick to putting out fires and cutting people out of wrecks, and given the support of the voters for public safety issues, that seems to be a non-starter.
It seems to me that if we’re already paying for a high level of service out of the tax revenues, we ought to make the investment in the vehicles and additional personnel and do it right, and possibly get to a point where it is revenue neutral.
The biggest difference, however, between this time and all of the other times this issue has come up, lies within the answer to question number three: how important is saving lives and minimizing property damage via the Fire Department?
You may recall that not long ago the Fire Department had to shrink its shifts down to the point that now we have three firefighters per truck instead of four. This was done for financial reasons: the industry trend is towards three-firefighter trucks, and the pressure of tax revenues still not fully recovered from the downturn of 2008 demanded some cost control.
One thing that didn’t change with the shift to three-firefighter trucks, however, are the OSHA rules concerning how many firefighters must be at the scene of a structure fire before that structure can be entered. Under the current rules, a three-firefighter crew cannot advance into a structure unless there is the potential that someone inside needs to be rescued. For all other situations, they must wait until the second truck arrives, thus reaching the mandated level of four firefighters before the structure can be entered.
Waiting a few additional minutes to enter a burning structure increases the property damage literally exponentially. Fires typically double in size every ten seconds, and at about the four minute mark they reach the flashover point where the temperature of the combustion gases trapped in the building reaches the kindling point of common building materials. Once that happens, survivability is reduced to near zero, even for a fully suited firefighter with SCBA equipment.
But, you see, if the firefighters are also operating the medical transport service, 66% of the time there will be a two-man ambulance crew on hand right at the start of every structural firefighting effort. And that two man crew? Yep. Certified firefighters. An advance into the building can thus be made as soon as they arrive, 66% of the time.
If you want to get to the bottom of why bringing transport in-house is a good idea this time, where it might not have been as convincing in the past, it is here: by doing this, we’re augmenting the staff of firefighters who can respond to a critical firefighting event. This will produce better outcomes with lower property damage losses. And that is the difference that makes the idea of bringing transport in-house a winner.
Will bringing transport in-house make the Fire Department a profit center for the city? I am told under no uncertain terms that it will not. At best it will be self sustaining, with some years very slightly profitable and some other years very slightly unprofitable. In the case that the projections are way off and it turns into a financial boondoggle for the city, there is an “out clause” in the Memorandum of Understanding that will allow the city to back away from the service if need be. With the conservative nature of the current Budget Director, I trust that the recommendation would not be made to take on this new venture unless the “out clause” was very unlikely to actually be needed.
On the other hand, sending a fire truck to every medical run is most assuredly NOT financially sensible. We do it because it is what is best for patient outcomes, not because it makes financial sense. Getting the insurance revenue will make this approach more sustainable, and that is something that conservatives can at least agree makes sense.
In the end, I don’t think there is any question: we are going to bring transport in-house. It has the support of the administration, it has the support of the firefighters, and I believe it has the support of the majority on council. It mostly makes financial sense, and it makes more financial sense than what we are doing today.
Council should vote yes on this issue. They can reverse it later if it turns out to be an unforeseen financial problem.