George,

Let me comment on the misinformation that Mr. Barry gave in his e-mail on “Bob Gibson is Right”

First off, both are wrong in their facts and statements. The following are the facts and being involved in the process I speak with authority not myths.

To start with the Charlottesville-Albemarle Rescue is and has been for forty-nine years a great organization that has served the citizens of both localities well. However, we are not the same area we were forty-nine years ago.

Mr. Barry speaks of competing organizations

Simply put he is wrong. If you read and understand the proposal it would place another ambulance in the transport system. CARS would still get the calls for service and when they are out of resources (no more units available) and calls are pending, then the City ambulance would response.

Volunteer squad

While the majority of folks may be volunteers, since they partnered with Albemarle County three years ago to provide staff (to benefit both organizations) they are no longer an “ALL VOLUNTEER” service. The history behind the partnership is that Albemarle County Fire/Rescue needed to precept their new medics. So to do that efficiently they partnered with CARS to have them staff their units Monday-Thursday during the day, thus giving CARS another unit in the system. They also give CARS $ 80,000 dollars annually and have bought them two ambulances, a cost of over $300K. The system proved so successfully and secretive for CARS that they asked the county to add the staff on Fridays as well, while still claiming to be “ALL VOLUNTEER”.

Level of equipment

CARS does have a lot of units and specialized vehicles, but thus lies the problem, they can’t drive themselves. In order for pre-hospital care to be effective it needs certain things to happen in a timely fashion. One, you need a minimum of two people to run the call, a driver and a patient care provider. Two, an immediate response to the scene of the incident. Three, patient assessment and stabilization. Four, movement of the patient to the hospital. In this debate “response times” have been referenced in every article or statement. The problem is one of service delivery and movement of the patient. While the Fire Department may run the call along with the CARS unit and get there first and fulfill the first three functions of effective patient care, they can not transport the patient to the hospital. They sometimes have to wait on the scene for a vehicle to move the patient. So, if the patient has a care provider on the scene in 5 minutes but has to wait 20 minutes of more for the vehicle to transport them arrives they are no longer getting effective care.

Response Times

Here is an example of how a call works. The patient calls the 911 center and explains their problem to a dispatcher. The dispatcher enters the information into what is known as “CAD” which stands for Computer Aided Dispatch.” The computer sets off a set of radio tones that alert the rescue squad and the fire department if the call requires a fire response. If the rescue unit is available they respond along with the fire department and arrive at about the same time in most cases. If however the rescue unit is not available, (i.e. on other calls, at the hospital, getting equipment, on a call in the county) then the fire department is left on the scene providing care with no means to move the patient to the hospital. Again, remember the goal is to stabilize the patient for movement to the hospital and do so in a timely manner. They need definitive doctor’s care and they only get that when they get to the hospital.

Since the system is computer driven times are stamped on the tape recording of the call when the units are dispatched, sign on responding, sign off at the scene, are enroute to the hospital, and when they are back in service. The times are available to all the agencies that use the 911 center from the fire departments, city and county, both police organizations and CARS. The tapes do not lie and are fact and for folks to say other wise or that they do not have access to them is a falsehood.

Billing

Over 70% of the localities in the Commonwealth use some sort of revenue recovery system for their EMS Systems. Locally, Nelson, Waynesboro, Staunton, and others have gone to this system to offset the cost of providing the service. It is a system that bills the insurance companies for the service and the rate range is set on Medicare standards. If the patient does not have insurance they are ask (once) to pay what they can or set up a payment system. While I’m sure most will disagree but the trend in other localities is that these folks actually do pay what they can. Talks have been on-going for months with CARS and Albemarle County about instituting a revenue recovery system and even doing so in the city when the county staffed ambulance is the one that responds. For further go the Albemarle Co website and look under Board of Supervisors Meeting podcast date Oct 6, 2006.

The main thing lost in this debate is the ultimate goal “effective, prompt, patient care”. The proposal put forth by the city would add more “available” units into the system. Allow for an increase in the advanced life support providers in the system and make for better patient care and outcomes. It would not be a duplicate service and would be seamless to the patient who just wants someone to come and solve their problem.

Robert Bragg (Electronic mail, April 6, 2007)