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Palo Alto advised to change its ambulance service
Consultant study recommends scrapping non-urgent transports, adding a full-time ambulance

by Gennady Sheyner

Palo Alto's emergency medical services are already among the best in the region, but the city's program could benefit from a new leadership position, a second full-time ambulance service and elimination of the city's non-urgent "basic life service," according to a consultant study that was presented to the City Council Monday (Jan. 23).

The report from Systems Planning Corporation/TriData provided a broad overview of the city-run emergency medical services and while it offered a glowing review of the existing operations, it also included 23 recommendations for improvement. These included big-picture suggestions such as maintaining the local operation (as opposed to joining Santa Clara County's ambulance program) and increasing the Fire Department's participation in "community health improvement." They also included micro-level recommendations about staffing levels and organizational changes.

Monday's discussion gave the council its first look at a study that has been close to two years in the making. It is an addition to a broader Fire Utilization Study that TriData worked on last year, a broad analysis of the Fire Department that recommended consolidating some police and fire operations and merging two fire stations.

While the earlier study was in many ways critical of the Fire Department, pointing to its "leadership malaise" and poor coordination, the EMS report was mostly positive in its tone.

"The level of care delivered to the citizens and visitors of Palo Alto from the local fire-based system is quite good and exceeds national performance standards for response to an emergency scene and level of care delivered," the report states. "The benefit to the residents is they get multiple services from one public agency; in other words, the fire department provides fire/EMS/public assistance from multi-role trained personnel and equipment, distributed across the City of Palo Alto."

For this reason, the report states, Palo Alto should remain the only city in the county to provide its own ambulance service. The city's location in the northern part of the county and the county's management plan "would make a large-scale change unwise."

Harold Cohen, a consultant with TriData who presented the study to the council Monday, pointed to the department's fast response time and its high percentages of "excellent results" for different clinical skills (including different types of injections) — percentages that in 2011 exceeded the national average.

"When it comes to the patient care the citizens are receiving, it's very good — it's excellent," Cohen said. "I believe that you're setting a trend and setting an example for many things around the country."

But the city, he said, can also take steps to make things better. One such step is increasing the number of full-time ambulances from one to two (the city also has one part-time ambulance). Another step is scrapping of the BLS ambulance, which Cohen said is no longer necessary because the area has other companies that can provide non-urgent transport service.

"I believe the program is like banging your head against the wall — you feel so good when you stop," Cohen said. "The community has other means of providing medical transportation. That allows the Fire Department to focus on its mission and that is emergency services."

The study was commissioned to assist the city with its broader effort to overhaul its public-safety services — an effort that also includes consolidating the administrative functions of police and fire departments and working with Mountain View and Los Altos to link the three cities' respective dispatch services.

The TriData report noted that 60 percent of 911 calls the Fire Department responded to in 2011 were requests for emergency medical services. Given the increasing prominence of the service, consultants recommended creating the position of an EMS Chief and promoting the present EMS coordinator to the new position. The department's medical services are currently overseen by an acting deputy chief in the emergency operations division, a veteran employee who the report notes has "minimal EMS background."

Kimberly Roderick, the city's EMS coordinator, said staff largely concurs with the report's recommendations about organization changes.

"The Fire Department recognizes that the calls for service on the EMS side are rising while the fire calls, while still important to train and prepare for, are decreasing," Roderick said.

Councilman Larry Klein wondered about ways to get more revenue from the ambulance service, but Cohen said he didn't have any suggestions on this matter and said that the city "does pretty well" when it comes to collecting dues.

The council did not vote on or dispute any of the recommendations, which will now be referred to its Policy and Services Committee.

READ MORE ONLINE

Read the full report from Systems Planning Corporation/TriData at www.cityofpaloalto.org .

Staff Writer Gennady Sheyner can be emailed at gsheyner@paweekly.com.

Posted by Martin, a resident of the Downtown North neighborhood, on Jan 24, 2012 at 9:50 am

I am hoping that the "BLS service" proposed for elimination, is the endless fire truck and ambulance runs to PAMF. On a daily basis, the fire department is running to PAMF for transport of patients to Stanford.

This is ridiculous, and an enormous waste of resources and time.

Posted by Mark, a resident of another community, on Jan 24, 2012 at 10:30 am

The Fire Department going to PAMF would not be an issue if PAMF could rely on the private ambulance companies it contracts. When the private ambulance company doesn't have enough ambulance to provide to PAMF, PAMF calls 9-1-1.

(My point is that if you're not happy with the setup, this is actually an issue to raise with PAMF rather than the Fire Department.)

Posted by Anne, a resident of the Downtown North neighborhood, on Jan 24, 2012 at 10:48 am

@Martin : Glad to know that saving my father's (very productive) life was ridiculous. Having a massive heart attack, and need to be at Stanford, of course my mother should have transported him in the family car without any lifesaving equipment. DOA is much more cost effective.

Obviously there are situations where an ambulance is appropriate, and the decision is up to the medical professionals.

Posted by Martin, a resident of the Downtown North neighborhood, on Jan 24, 2012 at 12:09 pm

So Anne, let's post an ambulance at PAMF full time, instead of sending fire trunks and unneeded gear.

Another option, is to have the fire department as a "backup", rather than "first call".

Posted by What are you talking about, a resident of the University South neighborhood, on Jan 24, 2012 at 12:42 pm

The Fire Department isn't first call! PAMF actually hires a non-City ambulance company...fire department only goes when non-City company aren't able to deliver.

Posted by Martin, a resident of the Downtown North neighborhood, on Jan 24, 2012 at 5:28 pm

If the preferred provider is not available on a daily basis, then PAMF needs to change providers.

Posted by Insider, a resident of another community, on Jan 24, 2012 at 7:50 pm

Martin, PAMF has been known to ship out multiple patients. On busy days, they can have as many and have had as many as 5-7 patients shipped out in a matter of less than 2 hours. It is unreasonable to expect a private service to have units crawling all over Palo Alto to cover this. Now, if PAMF actually contracted and paid for standby coverage, it would be different. This is not a private ambulance, county EMS, or PAFD issue, this is PAMF and their patients.

Posted by Also..., a resident of the University South neighborhood, on Jan 24, 2012 at 8:42 pm

I think if PAMF did a better job educating patients on when to use urgent care vs go to the Emergency room, it would divert a lot of those who are quite ill (i.e. chest pain, shortness of breath, etc) away from PAMF and reduce the need for emergency transfers substantially.

Posted by Anonymous, a resident of Another Palo Alto neighborhood, on Jan 25, 2012 at 7:45 pm

In good humor, here are example signs PAMF could post:

- No Dying!

- No shirt, no service.

- If your heart stops, keep driving.

- Just like Blue Cross, we prefer healthy customers ...

On a more serious note, though, how could the message be effectively be delivered to the community, so PAMF is known as clinic, and not an emergency room?

Posted by Also..., a resident of the University South neighborhood, on Jan 26, 2012 at 1:01 am

I have been a PAMF patient for 4+ years. Not once do I recall ever receiving a mailing addressing the difference between Urgent Care and the Emergency Department. On the PAMF homepage you have to click "medical services" then "urgent care" then "what is urgent care" to figure out "What is the difference between an urgent health care need and an emergency?"

But some of the information is contradictory. For example, it says,

"Some examples of conditions that can be treated at urgent care include...Breathing difficulties"

But then the page also says "Common situations needing emergency room care...difficulty breathing".

And the difference between the two for a layperson reading this is????