Amb District Letters

Ambulance District Letters of Support

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As the medical director of the Red Lodge Ambulance Service, I feel it is critical to convey the importance of passing the initiative to fund the proposed Ambulance District. This would maintain the same level of care in Red Lodge and the surrounding area for emergency services. Without this initiative, there will be a significant drop in the level of emergency care. I also feel it is necessary to address several common misconceptions regarding the ambulance service and this initiative.
Currently, we have a service with four paid paramedics who respond on average within three minutes of a call with medications and supplies ready to begin resuscitative interventions while awaiting the full ambulance crew. Without the initiative, response times would increase to 15 minutes due to voluntary staffing. The responders would provide basic services without the ability to give medications such as pain medications or other life saving medications or IVs.

Our paramedics now work 40 hours per week with the addition of 36 to 56 hours on call apiece. Without them, it would take an additional 24 volunteers working 12-hour shifts once weekly just to cover those shifts. This would not include administrative duties or backup call. Current call volumes are around 500 per year with a third of those being in the city and a third being outside of the city limits and a third being transfers from the hospital.

It has taken six years to build to this level of service, any losses are extremely difficult to replace. When comparing pay of our paramedics, one must compare apples to apples. Including health and benefits in the base pay has created the artificially employed numbers previously referred to. Our paid staff are more than just field paramedics. They are firefighters, Chief Officers, administrators, and managers. They teach, train and help maintain a high level of committed volunteers. In comparison to national standards, they are significantly underpaid and could easily earn 20% more in other settings. This makes recruitment and retention very hard.

Our struggling economy has resulted in the city being unable to fund the service at previous levels. Increased demands upon the city are not only due to paying ambulance personnel but are also due to decreased reimbursement from Medicare, insurance and higher levels of people unable to pay. With a basic level of service this reimbursement would only decrease more. Currently, 40% of income received comes from ALS level transfers between hospitals. Though previously funded by the city, budget constraints will not allow city contributions to continue at the current level. With this initiative, there would be no “double taxing” of city residents because their city taxes will no longer be going to the ambulance service. Instead, it will be $69 per property, which would remain fixed and fairly distributed unless voted upon again. When deciding on how to vote, please consider the long term benefits of having paid professionals able to respond immediately when you or your family are at your greatest time of need. This would be $69 well spent.

Sincerely,

T. Bradley Fouts, M.D.
Red Lodge

- From Carbon County News 6/10/10

In July there will be a mail ballot to secure funding for the Red Lodge Professional EMS. I want you to think about what this service means before you vote. The cost is $69 a year for each residence. That is less than I have spent for a family dinner on more than one occasion.

If you haven’t had the experience of holding your dying child for the golden hour while waiting for emergency service, try to imagine what that is like minute by minute, although I don’t wish it on anyone. Imagine that a crummy $69 a year insurance might take away that pain.

Perhaps in our farming/ ranching county, dad, or husband, or young son accidently runs the tractor into the coulee, or a horse throws him, or the brakes fail on the swather. Most ranchers spend more than $69 every year making sure the equipment is safe. Do you want to sit in a field somewhere watching the time and your loved one slip away for the cost of one tank of diesel fuel for your tractor?

If you don’t want to think about the pain, remember you can pay for the funeral; $69 a year for a hundred years might do it if you’re careful with the funeral expenses. One of the things to keep in mind is that speed of treatment is almost always vital. A well staffed agency is more likely to provide speed for treatment at the site and to the hospital. On most emergency calls, every minute of delay means additional damage to organs which means more hospital procedures, medications, days, and they will cost a lot more than $69.

I am not arguing that we should just hand them the money. Of course, there should be supervision of expenses, employee behavior, training, equipment purchase and maintenance.

It is the responsibility of the property owners in the district to be sure that we get the service we pay for. There is nothing wrong with the volunteer services as far as they go, but they are often strapped for cash for new equipment, training, and personnel.

I am going to vote for this proposal. It won’t get my daughter back or my father, but if it saves one fifteen year old child, it is worth it to me.

Kerry Burns

- From Carbon County News 6/10/10

To the Editor,

Okay. There is a mail ballot election coming up. The question: Shall the proposition to organize the Red Lodge Roberts Ambulance District be adopted? The District will primarily provide both emergency and non-emergency ambulance response, emergency medical services, and other emergency services beneficial to the citizens of the district. The proposed district shall include the Red Lodge, Roberts, Luther, and Bearcreek areas. The District will be financed by an annual fee of $69 on residential lots/parcels that contain a dwelling unit and on developed commercial properties (and by user fees). An appointed Board of five citizen members shall administer the District.

The ambulance service is currently operated by the City of Red Lodge. By ordinance, it is operated as part of the City Fire Department. There are more than 40 volunteer EMT’s supported by 3 full time staff. (There is an additional full time employee of the Fire Department that is also an EMT, making 4 full time staff.) User fees make up just over half the revenue that supports the ambulance service. The rest of the revenue comes from the City’s General Fund. Carbon County contributes $10,000 per year from their Payment in Lieu of Taxes (PILT) monies they get from the Federal Government. The ambulance service provides coverage to most of the area in consideration for the new District.

It’s the city tax payers that currently subsidize the ambulance service. County tax payers do not. The formation of this district will spread out the subsidy to all who benefit from the ambulance service. But here is an interesting fact. If the voters do not approve the district, the city tax payers will continue to subsidize the service provided to the citizens outside the city limits. Two of the three full time staff will be laid off. Paramedic level service will not be available 24/7/52. So there will be a lower level service, and the city taxpayers will still be footing the bill. True, it won’t be to the extent it is today, but they will still be doing it. Please support your local EMS volunteers: Vote yes on the formation of the Red Lodge Roberts Ambulance District.

Linda Barbee,
EMT-Basic
Red Lodge EMS
Volunteer
Red Lodge

- From Carbon County News 6/17/10

To the Editor,
As part of the Trauma Program at St. Vincent Healthcare in Billings, I am writing in support of the Advanced Life Support EMS in Red Lodge. Billings hospitals receive many seriously ill or injured patients from the Red Lodge area. I am concerned about the impact of altering or reducing critical care and advanced life support (ALS) Prehospital care in the Red Lodge area.

Only 20-24 percent of the nation’s population live in rural areas but rural areas are the site of 60 percent of the fatalities from traumatic injuries. With trauma, as with heart attacks and strokes, reduced time to identification and care is linked to survival. Advanced life support personnel can shorten the time to care with better diagnostic and care capabilities by starting the care BEFORE the patient arrives at the hospital. An ALS crew can provide care beyond basic life support (BLA) to reduce the impact of injury or illness. We see that in patient outcomes here in Billings. In a 2001 study done in an urban area (where ambulance times are shorter) published in the journal Prehospital Emergency Care[1], it was shown that BLS staff and firefighters don’t always identify advanced life support needs and 87percent of their patients needed an emergency action in the emergency department that ALS could have provided. So the care deficit could be even greater in a rural area like Red Lodge with longer delays to patient discovery and transport times. That’s why, in Red Lodge, the most important element of successful emergency care, where geography, weather, and remoteness get between the patient and the hospital, is the capability of the Prehospital providers.

Red Lodge has a growing population. It is a bedroom community for Billings and a town that is a retirement, vacation and sport destination for America and gate to a National Park. I see a mismatch between expanding the size of the hospital while altering or reducing the capability of the Prehospital personnel that transport patients to it. Your need for ALS is greater, not less.
The current Red Lodge EMS is unparalleled amongst rural towns in Eastern Montana. They could make an ALS ambulance run to Billings with a critically ill patient, if the single Billings area helicopter were unavailable and not have to take doctors from your hospital to do so. It was Red Lodge ALS that were able to identify the Carbon monoxide mass casualty event at one of your local resorts and trigger a mass casualty response. That early recognition and critical thinking is what your trained and proficient ALS crew provides.

Please consider research and investigation into alternative and creative ALS funding paths in other rural towns so you can preserve the integrity and quality you currently have in your EMS for Red Lodge residents and visitors.
Thank you.

Penny Clifton RN / Trauma Coordinator / St. Vincent Healthcare
Red Lodge

- From Carbon County News 6/17/10

To the Editor,
As the vote to approve the formation of the ambulance district approaches, I feel that it is important to share my story. Living on a ranch in rural Montana can provide many challenges, especially when it comes to dealing with life threatening emergencies. Unfortunately, over the last month I have needed the ambulance more than once due to heart problems. I had an eye opening experience as I came to understand and appreciate the roles of our Red Lodge paramedics and the importance of keeping the level of service provided by our ambulance service. They are competent, professional, and can make the difference between life or death.

Before my experience, I did not realize that a paramedic can make all the difference in the world when you are having chest pain. Not only can paramedics give oxygen and start an IV, they can give life saving medications that relieve pain, and more importantly help get more oxygen to the heart preventing serious or long term damage. None of this will be possible if we lose our paramedics.

If the vote for the ambulance district does not pass, we will lose the level of care we currently have and desperately need. I hope that you don't need an ambulance, but if you do, I can tell you from experience that you want the professional paramedics and skilled volunteer EMTs from Red Lodge Ambulance. It occurs to me that, if these paramedics are not on board, you might as well just be calling a taxi when you have a medical emergency and need to get to a hospital quickly. A small tax is not much to pay when you consider that your life, or the life of your loved ones, is priceless. Please join me in voting for the formation of the Red Lodge Ambulance District.

Gerald Sherman
Roscoe

To the Editor,
I am writing in support of the Ambulance District decision soon to be brought before Red Lodge area voters. As an Emergency Physician working at Saint Vincent Healthcare Emergency Department, we receive patients from Emergency Medical Services (EMS) that are staffed by Paramedics as well as services that are staffed by Emergency Medical Technicians (EMT’s). There is a distinct difference in the time spent in training and in the level of skills between levels of certification. These differences are most notable in the care needed in critical situations. In short, the major difference between these two providers is that Paramedics can provide Advanced Life Support (ALS) measures such as airway management and administration of medications, and EMT’s (at the Basic and Intermediate levels) are limited in the skills they have been trained to perform.
The Red Lodge area has unique geographical challenges such as long distances exacerbated by extreme weather and fluctuating traffic volumes through the area that make the importance of a Paramedic level of care that much more important. For those needing emergent interventions at the site, such as airway control and administration of medications that are life saving, (as in the case of car accidents, heart attacks, stroke etc) there is no question that a service supported by 24/7 trained Paramedics will be able to provide a higher level of care.

Another concern for your area is that without a paramedic level service, inter-facility transfers from the Beartooth Hospital to referral centers, are dependent upon outside variables such as ambulance availability in Billings, weather, and area demands on a system outside of your own. These variables fall to a prioritization process to dictate service to Red Lodge from AMR in Billings (Ambulance service) or Help Flight from St. Vincent’s. I would not want my or my family member’s emergent care needs to be dictated by such unpredictable events.

This higher level of service to your area, of course does not come without a price. This service cannot function without some level of tax payer subsidy. Through my experience and research into this issue, I have come to the definitive conclusion that an area the size of The Red Lodge Ambulance District needs a 24/7 paramedic service, and I encourage you to support this tax-measure.

Sincerely,

Jim Bentler MD
SVH Emergency
Department
Medical Director

To the Editor,

I feel I must respond to those writing letters wanting to decrease our ambulance service to a basic level of care.
I realize that some of these "concerned citizens" are angry about their past work experiences in our service and others feel threatened that the new district boundaries would extend more north that they are, presently. Anger and fear often leads to misinterpreting and manipulating of facts. The quoted paramedic salaries are an example of this.

Our paramedics, because of our small services are also filling job responsibilities in administration and fire duties. Their salaries for this job description are significantly below national average. Total cost quoted in the newspaper includes all benefits, including insurance. This has been unfairly compared to Billings field paramedics income.

I must ask if those against maintaining our present level of care-now standard in most of the country-would refuse this care if they or their families desperately needed it?

Sincerely
Bill George M.D.
Red Lodge

To the Editor,

This letter is being written by Gordon W. Van Fossen who would not be alive today if the Emergency Ambulance and Paramedic Service had not saved my life five years ago in May of 2005.

I was helping to move furniture in our home on Highway 212 at the South outskirts of Red Lodge when I experienced a sudden cardiac arrest and collapsed on the living room floor at approximately noon. A lady immediately called 911 while my wife, Ruth Van Fossen and Wally Nordstrom started performing cardiopulmonary resuscitation on me. The Red Lodge Emergency Ambulance and Paramedic Service was at our home within five minutes and immediately used a defibrillator to restart my heart and rushed me to the Red Lodge Hospital. Dr. Fouts and others worked on me and then called St. Vincent Hospital in Billings which rerouted a helicopter to Red Lodge.

I was flown to Billings where I was treated with a radical new body cooling treatment (first one in Montana). I spent three weeks in the hospital including over a week in emergency care, but then went home to Red Lodge after making the front page of the Billings Gazette as an almost miraculous survivor from the new medical treatment. I have had a few after effects from the cardiac arrest but am now living a good life.

The immediate response to our 911 call by the Red Lodge Emergency Ambulance and Paramedic Service was very instrumental in saving My LIFE.

Sincerely,

Gordon W. Van Fossen
Billings

“Without this initiative, there will be a significant drop in the level of emergency care”

Dr. T. Bradley Fouts, MD

Red Lodge

“If it saves one fifteen year-old child, it is worth it to me”

Kerry Burns

“The formation of this district will spread out the subsidy to all who benefit from the ambulance service”

Linda Barbee

Red Lodge

“Only 20-24 percent of the nation’s population live in rural areas but rural areas are the site of 60 percent of the fatalities from traumatic injuries”

Penny Clifton, RN

Trauma Coordinator

St. Vincent’s , Billings

“The current Red Lodge EMS is unparalleled amongst rural towns in Eastern Montana”

Penny Clifton, RN

Trauma Coordinator

St. Vincent’s , Billings

“They are competent, professional, and can make the difference between life or death”

Gerald Sherman

Roscoe

“Before my experience, I did not realize that a paramedic can make all the difference in the world when you are having chest pain.”

Gerald Sherman

Roscoe

“I can tell you from experience that you want the professional paramedics and skilled volunteer EMTs from Red Lodge Ambulance”

Gerald Sherman

Roscoe

“Through my experience and research into this issue, I have come to the definitive conclusion that an area the size of The Red Lodge Ambulance District needs a 24/7 paramedic service, and I encourage you to support this tax-measure”.

Jim Bentler, MD

Medical Director

SV Emergency Department

“The Red Lodge Emergency Ambulance and Paramedic Service was at our home within five minutes and immediately used a defibrillator to restart my heart”

Gordon Van Fossen

“The immediate response to our 911 call by the Red Lodge Emergency Ambulance and Paramedic Service was very instrumental in saving My LIFE”

Gordon Van Fossen

More Letters on Next Page. . .

“It is because of our paramedics’ skill level, timely response and astute clinical decision-making that all three patients survived”

Deirdre McNamer MD

Red Lodge

“Here in Red Lodge, our paramedics become an extension of the ER staff when they arrive at the hospital, and play an extremely valuable role in helping us to stabilize patients”

Deirdre McNamer MD

Red Lodge

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