We now have city ambulance

Did anyone see we now have a city ambulance service? What is "continuity of care" and why is it important?


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The idea is that the person who first responds to a 9-1-1 call begins to give treatment. Under the current system (prior to government takeover of a private service, IMHO), the thought was to return the fire fighter/paramedics to service as quickly as possible. If the injury or illness was life-threatening, then a Lucas County life squad (supported with tax dollars) would be called. If, for some reason, a life squad wasn't available or would take too long (as in multiple injury accidents), a private ambulance under contract with the County could be called. This was ALS - advanced life support - and the fee charged by the private ambulances was capped by the county's contract with them.

If the illness or injury was not life-threatening (BLS - basic life support), then the first responders would call for a private ambulance to transport to the hospital. Again, the amount the ambulance company could charge for such transport was capped by the county through their contract.

In these examples where the private ambulance is called, the care of the injured/ill person is transferred from the first responder to the ambulance staffer - usually a paramedic as well - and the fire fighters go back into service upon the 'transfer.'

Under the idea of 'continuity of care' the person who first treats the injured/ill person is also the person who accompanies the individual to the hospital...that is, the care is continued by the same person.

The ambulance companies, in response to this issue several years ago, asked for dual dispatch...that is, for them to be dispatched along with the first responders instead of waiting for a subsequent call. However, the fire departments were not happy with this proposal because the first to arrive at the scene would be responsible for rendering immediate aid. If an ambulance company paramedic got there first, they'd start with the treatment/evaluation of the patient and could then continue such treatment even after the first responders arrive.

That's the 'continuity of care' referred to so often. If you have any questions...

This is a sound bite used to mask (and justify) taking something away from private enterprise without compensation.

Next year at this time, after we factor in the actual cost to maintain and operate the city's own ambulance service less of course the cost of lost taxes from the employees who were laid off in the private sector,we will know whether there was a profit. I am sure if not it will be because we need to wait at least two years before knowing the wisdom of this adventure.


Here's and example of how corrupt and idiotic the city and the fire department and union is. I guarentee you Toledo could have HALF the number of firefighters and citizens would receive better care than they do now. In fact, if I were mayor that would be the first action I would take.

There is absolutely no reason that the firefighters should serve as first responders. Actually, there is.....it's called greed on their part. They need to justify the minimum staffing requirements (their jobs) even though the number of fires is a fraction of the number of fires three decades ago. The number of firefighters needed for fire suppression today is a fraction of what it was in 1970. However, I am willing to bet that Toledo has more firefighters now than it did in 1970 even though the population has declined and the number of fires has been cut in half.

Here's an example why the current setup is about the dumbest thing I've ever heard: There's a head-on collision at Heatherdowns and Reynolds. A guy sees the wreck and calls 911. The 911 dispatcher calls in the firefighters to respond to the wreck. 8-10 minutes after the wreck the firefighters get there and realize that these people need to get to a hospital but they can't transport.....so they then call the dispather back and ask for an ambulance. By the time the call is relayed, the ambulance gets the call, and the ambulance arrives another 5-7 minutes passes. They then transport the patient to University Medical Center 30 minutes after the wreck happens.

Does anyone else see that the initial 8-10 minute wait could be completely done away with if the ambulance is called first? While 8-10 minutes may not sound like much, to someone in a head-on collision with a torn aorta that very likely means death.

The fire department is in effect saying, "We know a few people will die, but at least our jobs will be protected." Why is the city council approving this plan to improve continuity of care when they could have improved continuity of care by allowing ambulances to be dispatched first?

Good blog entry. I didn't even comment on the business aspects of this decision, which I think is also very important.

This hits at what the fundamental role and position of government truly is. Government shouldn't do jobs that private companies can do equally as well. Government shouldn't be in business to make money off its citizens in ways other than taxes. Government is there to provide services that private industry cannot provide. And government is there to enable private citizens to make a living.

This also points out that the fire department is overstaffed and wasting taxpayer money. The city says the TFD can still do an adequate job of fire suppression even with the transfer of several firefighters to the EMS service. If that's true, then why did we have so many extra firefighters over the last few years? If X number of firefighters can do an adequate job tomorrow then X+25 firefighters yesterday and today is too many and a waste of taxpayer money.

I have a proposal for the fire department. Let all ambulance calls be handled by private ambulances initially. Drop the first responder crap and just focus on mass casualty and fire suppression (it's called the fire department for a reason). Then, through attrition and layoffs, cut the number of firefighters to 50% of the current levels. With the remaining 50% increase their pay by 20%. Now with the remaining firefighters let them work their normal hours, and in addition to their normal hours let them take "home call" during half the time they are off duty. If a major fire breaks out that on-duty firefighters can't handle then the off-duty but on-call firefighters can be called in to a level necessary to fight that fire.

With the tax savings from this plan we could add more patrolmen to the police department (which is understaffed) and probably cut the city income tax in half. The lower income tax would be a stimulus for business investment in the city limits.

this is just another form of Eminent Domain! These types of acts to confiscate "private property" are just not apprporiate. If you look at the facts, I think you can make a good argument that the city did in fact confiscate the property of another - in this case their business and jobs.

I don't believe service will be better but it will cost more even if most or all is covered by insurance. I have always used the "yellow pages test". If you can find it in the yellow pages, government has no business being in the business. There might be an exception or two to come along but this one is not it!

but to me, this may be puristic in it's intentions, but the result of this decision is that a local government body may have become engaged at monopolizing a service.

I thought that kind of thing was frowned upon in an 'open' marketplace? I can understand the city wants the business - but I don't understand putting a private company out of a market.

What if the city decided there was money to be made at selling groceries, (there is). Would they pass a law that says the city only would be able to provide groceries?

If you're here to tell me it's my fault - you're right. I meant to do it. It was alot of fun. That's why I have this happy smile on my face.

For those looking for all the technology on wheels.

Perhaps the city can rent out their new ambu-lances for parades, proms, and parties.

Safety first!

First, the 'first responders' are paramedics whose training was paid for by the 9-1-1 levy funds. The life squads are also funded by the 9-1-1 levy.

The concept of sending a paramedic out first makes sense in terms of the treatment of the patient. The concept of calling a private ambulance for transport in the case of non-threatening illnesses/injuries was born from the need to return the fire fighter/paramedics back into service as quickly as possible.

If it's a life-threatening situation, the patient is transferred by life squad.

The ambulance companies had requested to be dispatched at the same time as the paramedics, but the fire departments vetoed this arrangement.

I want this to be perfectly clear: the TPD is NOT understaffed. It's staffed perfectly well, although a bit lower in per-capita. What's true here is that it's UNDERDEPLOYED. There are about 680 trained, uniformed and armed cops in the TPD. Only about 250-280 of those (about 1/3rd) do "field ops" -- in short, the guys who patrol and respond to your 911 calls.

What are the rest doing? Filing reports. Driving "non-service" vehicles. Doing "community service". In short, they are occupying desks or performing services that are of dubious value when compared to the average cost of $50K/officer.

What Toledo is really lacking are more clerks to clear these real and bullshit workloads to let our trained police officers hit the streets (where the CRIME is, fer crissakes!). Of course, it's a bit more dangerous on the streets than it is driving a desk in the Safety Building (the TPD's HQ on Erie St), but I could have sworn that putting on that police uniform implied that you understood what you were facing.

What is happening in the TPD is just another terrible example of unionization mixing almost lethally with politics ... i.e. getting way out of control. Too many cops just give up and let the system carry them along. Eh, why not? There's not that much support from above in the first place, so the frustration on the street must be phenomenal. Arresting bad guys and stopping crime in its tracks is just not that rewarding to the corps of command officers. In some cases, handling crime comes at too high of a political cost, such as acknowledging the gang problem in Toledo. I don't know for sure, but I suspect that actual and dutiful handling of the gang problem would in short order spark a riot in North Toledo again, and no politician wants to risk that again. Real law enforcement against gangs can always be written up as a racist issue, sending pols running for cover.

You're ignoring the fact that every MedCorp ambulance has a paramedic on it. The county life squads aren't any better equipped than MedCorp's. I also believe Mercy Health and Promedica ambulances have paramedics. In fact, Mercy Health ambulances often have ER residents on board (if you're wanting the highest quality of care then maybe they should be dispatched). I can't speak for Rumpf. So again, I ask, why not dispatch MedCorp? Why should the county have gotten involved if MedCorp was already providing paramedic coverage (which they are)? Why even have the 911 tax? Maybe the Life Squads were a mistake.

I believe there are only 5 or 6 county Life Squads. If you think every life-threatening situation is handled by a Life Squad, you're mistaken. In fact, if I'm in a life-threatening situation get me to the hospital FAST. If that means going with a certain ambulance that doesn't have a paramedic on it (even though I believe all do) then send me on the paramedic-less ambulance.

Good point. You're absolutely correct. There's no reason we should have that many "non-patroling" police officers.

Hmm, I know way too much. While tempted, I can't go there.

I've always wondered why the city didn't hire civillians to do many (if not all) the desk type duties at the TPD freeing up so many more officers for real police work.

{poke} Oh, you can't? {poke poke} What, you need a note from your momma? {poke} C'mon, are ya a man or a mouse? {poke poke poke}

During budget cuts, and there have been a few over the last few years, they have looked to cut clerical and other areas before police officers. As they cut back on clerical and support personnel, most of the clerical and support functions must continue so you assign an officer. As time goes on, most functions are handled by officers. You don't cut the uniformed ranks. It's not popular with a powerful union and most times with the public. Obviously it would be less expensive to the public if the clerical and support functions were manned by civilians. But you have to remember the politics of the situation.

In conclusion, they cut civilians to lower the budget and they keep uniformed officers even though they are assigned to support functions.

My last recollection was that there were 11-12 county life squads strategically stationed across the county...

I believe that all ambulance companies eligible to respond to Advanced life support calls have at least 1 paramedic.

If a County life squad transports you, you don't get billed. If a private ambulance company transports you (either BLS or ALS), they can bill no more than the what the contract calls for in caps.

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