American Medical Response in DC

As the days tick past American Medical Response draws closer to going “live” with their new public/private partnership with the District of Columbia Fire and EMS Department.  After a story posted earlier this week about a traumatic cardiac arrest that sat for close to 30 minutes without a transporting unit being available, it is clear that the time is now for something to change in the nation’s capital.

The coming months are going to be very telling for the future of EMS not only in DC but throughout the country.  From a personal stand point, I am very excited to see in what direction everything goes.  There is a lot of influence in the AMR DC operation from my old stomping grounds in Springfield, Massachusetts.  Their Operations Manager, a guy by the name of Mark Nuessle, was one of my first supervisors when I hit the streets back in 2000.  About a half a dozen people who are being brought in from around the country to help with the hiring and training process of close to 200 new employees have some sort of tie to Springfield as well.  It really speaks volumes about the system that I came from.

With the involvement of national resources, I also think that this partnership says a lot about AMR’s ability to strive for success.  Often seen as the biggest of big business in prehospital medicine, when AMR steps up to the plate like they have recently on the east coast, they deserve a lot of credit.  Some critics of private EMS will speak of the “lost jobs” from the closing of companies like Transcare or like Falck’s recent move to pull out of Pennsylvania but AMR has been there to pick up the pieces.  Closures like this do not mean that jobs are going away.  People still have to do the work, it just means that a company with a better ability to operate in today’s health care climate are stepping up to the plate to provide the service.  In fact, AMR is adding close to 200 jobs to the Washington, DC market in particular, and that is a huge step forward for the private sector.

I cannot stress how important I see this new public/private partnership is to our industry.  Normally, when a partnership is formed, its one of the first steps towards a strategic takeover of transport medicine by the fire department, much like what happened in Las Vegas a couple of years ago.  The fire department will nibble at some transports, then take a little bigger bite, and before you know it, they can suddenly “do it better” for one reason or another.  All this usually leads to is the exclusion of some great single-role EMS providers from the 911 system.  Well, in DC, it seems like the exact opposite is happening.

The fire department is realizing finally that they cannot handle the volume that they are facing.  AMR is now taking a nibble at the lower priority stuff.  Before long, once long response times continue to occur, AMR will point out that they still have ambulances available that could make those calls, easing more of the burden that DCFEMS has taken on.  The nibble will turn to bigger bites, and before you know it, we might see the first takeover of a major 911 contract by a private provider.  Although I do not know much about the economic status of DC, I cannot help but think that it is the kind of system that could exist on what is called a “zero bid” or at least a minimal subsidy by the city.  Essentially, what that means is that AMR will do the medical work virtually for free putting the weight of funding the system by billing those who utilize it.  While I am sure like most inner cities, DC has a high Medicare/Medicaid population, without enough of a volume and the correctly structured system, they could thrive on the quantity of calls they will receive rather than the quality of the billing.  It seems like they are ready to do that with the low priority work they are being promised now.

Say what you want about AMR, I know that there are many who view some of their business practices negatively, but they have done a lot for our industry, and have saved or created many, many jobs and while I once “drank the AMR Kool-Aid” also keep in mind that I promptly walked away from the punch bowl when I realized that it was not for me anymore.  With the purchase of Rural/Metro, and the rumor of their move for assets left without coverage by Transcare’s departure from Maryland, AMR is positioning themselves to hold an even more enormous share of the market.  They are giving those in DC all brand new straight out of the box equipment to play with, and are poised to put on quite a show to the city about what they are capable of.  Conversely, without changing much about how they train their medics, DCFEMS is getting ready to take on a greater level of responsibility in field triaging patients to hand over “lower priority” patients to AMR units instead of their own.  It is a novel idea that could certainly work, but I fear that based on the inside view that we received from Dr. Saussey when she resigned her position with the department, I cannot help but question if this is going to be something that they can handle.

To Mark Nuessle and the rest of the AMR team in DC, I wish you the best of luck!  Many of us are rooting for the success of a long overdue project like this one as it could help pave the way for the future of emergency response throughout the country.

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