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EMS System Needs Rehab, Finds Review

CHEYENNE, Wyo. -- An independent analysis calls for a restructuring of ambulance services countywide.

The report presented to Laramie County and fire officials Wednesday recommends a joint powers board be created to govern countywide EMS services and that officials should seek a new contract with a provider in 2009.

"We don't like to fix the blame but to fix the problem," said David Shrader of the Polaris Group, a consulting company for emergency services.

The consulting company's report, he said, was prepared using independent experts and a variety of means to assess current services and ways to improve them.

"An EMS system is a lot more than an ambulance contract," Shrader added.

And there are many new liabilities and responsibilities involved. "What used to be a mistake by a billing clerk can end up being a felony," he said.

City officials have been critical of the private ambulance contractor, American Medical Response of Greenwood Village, Colo., which has been Cheyenne and Laramie County's ambulance provider since 1998.

Its contract expires Dec. 31.

Officials have complained about the number of times that an ambulance was tied up on other calls, forcing patients to wait for service and transportation to the hospital.

Staffing is part of the problem, according to the report. There is a tight national market for paramedics, and it is difficult to recruit to rural areas and smaller cities like Cheyenne.

The ambulance contractor must figure out how to address staffing issues "or declare defeat and find an easier business," the report said.

But it also says that with a new contract, improved technology and improved evaluation of needs and deployment, the staffing issues could be brought under better control.

"Your incumbent provider shouldn't be afraid of competition," Shrader said. AMR is competitive providing service around the country.

And those who are working for that service should not fear losing their jobs if there is a transition to a new provider.

"We don't want to speed up the turnover," he said.

He hopes to have a request for proposals drafted in about a week.

The creation of the joint powers board should be kept to simple appointments of personnel from each entity and not require purchasing office space or special materials.

Much of the technology improvements and some other costs to the taxpayers could be passed through to patients, as well, in a better designed system, Shrader said.

Those costs should include creation of a new office of the medical director for medical oversight of EMS operations.

Under the current system, he said, there are multiple medical directors.

"What you really want is a united medical direction for the entire system," Shrader said.

The report also recommends that the fire department control the scene and scene safety.

Fire department paramedicsshould have the authority to intercede in patient care matters when they feel that another paramedic is not providing optimal care to any patient, according to the report.

The report also calls for establishing a position of an EMS battalion chief within the Cheyenne Fire and Rescue Department, as well as an EMS lieutenant.

The report encourages the continued use of volunteer services in outlying areas of the county, with more specific contracted interaction with the service provider.

It also calls for more medical training for sheriff's deputies, including the use of defibrillators. The deputies' cars also should be equipped with the devices, which are used to restart a patient's heart.

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