D.C. fire officials tout improvements in emergency service made possible by the use of a private ambulance company that handles less-urgent 911 cases. But it remains unclear whether the multimillion-dollar strategy will become a permanent remedy.
The city signed a one-year contract in November with American Medical Response that can be re-upped annually for four more years. The new deal is estimated at about $12 million per year, fire officials said, and follows on the $10.5 million paid to AMR from March 2016 — when its private fleet began answering calls — to the end of February.
Nearly 15 months after adding the private operation, D.C. Fire and EMS Chief Gregory Dean still describes the plan as a bridge to stabilizing 911 response.
“We like the fact that AMR has taken a workload off us, to allow us to be available to improve our response time, improve our training, improve our maintenance of our vehicles,” Dean said. “Whether it’s AMR or some other form, we recognize that to be successful, we need help in delivering emergency medicine in the District.”
The private service transports patients who’ve first been assessed by city paramedics and firefighters as not having a life-threatening condition. The city crews respond to all 911 calls, but under the year-old system, they transport only the most serious cases.
The program has not been without its troubles.
The city contends that AMR should pay $198,590 in penalties for not meeting contract performance standards on response times or available units since November.
AMR said in a statement that it intends to challenge those fines once it sees what information the city used to calculate the penalties. The company said its contract contains an exemption for issues beyond its control and that requests for service are higher than some of the expectations used to set the performance measures.
After it sees the city’s underlying data, the company statement said, it expects “the exemption process under the agreement will greatly reduce or eliminate any penalties.”
The partnership with the city, AMR said, was “exciting” and is “helping the District and its residents.”
AMR has periods when it does not have units available, but Dean said the shortfall works out to less than 10 minutes a day on average.
That performance, Dean said, has not prevented the District from reaching its goal of shifting thousands of non-urgent medical calls to AMR to free up D.C. fire and emergency crews for the most pressing needs and to relieve a system that has a growing number of 911 calls.
Fire officials face a D.C. Council Committee on the Judiciary and Public Safety oversight hearing Thursday on the contract and performance of AMR, as well as the budget for other programs meant to reduce how often emergency personnel are dispatched on 911 calls that are not dire circumstances.
The District is 24th in population nationally but ranks eighth in 911 call volume, giving the District the highest per capita EMS call volume in the country, fire officials say.
The new programs include adding a nurse triage line at the 911 center — which already has budget approval for $1 million — to help assess medical urgency in calls and steer nonsevere cases away from emergency crews and toward proper medical providers. Fire officials also are planning an education and communications program that could cut how often residents call 911 for situations that aren’t life-threatening.
Charles Allen (D-Ward 6), chair of the D.C. Council’s public safety oversight committee, said department officials have convinced him that the private contract works to meet response needs, but the city will need more time to decide whether having a parallel private service should be permanent.
“We are seeing a real stabilization in the response time and the ability for emergency services to get to people in need, even in the face of ever-increasing call volume,” Allen said. “Are we in the midst of creating a dual system or will this truly be the temporary stabilizer that is it was meant to be? It is unclear to me.”
The D.C. firefighters union continues to back the decision to use AMR as a short-term remedy to buy the city time to find a long-term solution to the glut of 911 calls. But Dabney Hudson, the union’s president, said the city needs to solve the calculus of how many units and personnel are needed to match call volume on a day-to-day basis if it wants permanent improvement.
“We would have killed people if we didn’t have this, that’s safe to say. More units are more units, and at the end of the day, we need more units,” Hudson said.
During the first year, AMR transported an average of 144 patients a day, nearly 900 per week and 4,337 a month, according to fire department data.
“The majority of transports by AMR are people that should not be going to the hospital. They should be going to a clinic or a primary care doctor,” Hudson said.
Hudson said the union wants the city to continue to figure out how to better manage 911 call volume with a public education campaign to cut back on minor calls that clog the system.
When AMR first started working with the city in March 2016, it was under an emergency contract that set performance goals based on 2014 data.
The AMR contract from November is less stringent on response times and was changed to reflect the reality of increased call volumes overall and seasonal adjustments for heavier call volumes outside of winter months, fire officials said.
Under the new contract, AMR can be penalized if the company fails to respond to service calls within 10 minutes 80 percent of the time from May through October. From Nov. 1 to April 30, when call volumes are lower, the target for AMR, fire officials said, is 90 percent in the 10-minute window.
Dean said officials are confident that even with the new leeway on times, the department can achieve its goals of prompt response and improved readiness.
“We had many stories on our inability to deliver care and service; today what we’re talking about is how do we refine and how do we improve that system,” Dean said. “We do risk-management. We don’t staff for the biggest alarm, we staff right in the middle.”
The chief said the current contract has helped slice average response times from 8:07 minutes to 6:50, and he said he hopes to steer the department to National Fire Protection Association standards of four- to six-minute response times for the most critical calls.
Left unsettled is whether it will require a private ambulance service — with its $12 million annual cost — for the city to hit its performance goals.
“I don’t have a dollar figure . . . is it too much or is it too little,” Dean said. “Our job is to provide confidence to the citizens that if you have an emergency, whether it’s a fire, medical hazmat or whatever, that the District has resources and trained personnel to get there and take care of you.”