The Columbian | Serving Clark County, Washington

Just a few minutes after one of the fire department’s engines screeches to a halt at the scene of a heart attack or stroke, another emergency vehicle, one belonging to privately-owned American Medical Response, will also arrive.

The fire department finishes up its first response work and transfers the patient to AMR paramedics, who continue care and transport the victim to the nearest hospital.

It’s been done this way for 18 years in Clark County EMS District No. 2, which includes the cities of Vancouver, Ridgefield, Battle Ground and La Center.

But as Vancouver begins to restructure its budget — along with many of the ways things are done — City Manager Pat McDonnell said it’s also time to examine how the city delivers emergency services.

That doesn’t mean there’s necessarily a better way to do it, but it won’t hurt to study the issue, he said.

“We absolutely need to look at that,” McDonnell said Thursday. “Everybody is under significant pressure, public and private, and I just welcome the opportunity.”

One option that has some support is a publicly-run ambulance system like the one in Camas, but officials say that method has its own set of perks and downfalls.

Fire Chief Don Bivins said the reason Vancouver teams with AMR is simple: Vancouver’s fire stations are set up so that in the case of both fire and medical emergencies, an engine can respond within five minutes 90 percent of the time.

That five-minute mark is critical in both preventing fires from spreading and in preventing brain death, he said.

AMR does not have the resources to get there so quickly — their contract requires they arrive within 7 minutes and 59 seconds in urban areas or face fines.

Bivins said the setup works because it would cost the city more to buy ambulances and transport patients itself, and the city would have to pay AMR a lot to get them to do it alone.

“I think that the system Clark County has is one of the best systems in the nation,” he said. “It’s a pretty solid package.”

It costs the city $800,000 a year to provide first-response services.

AMR doesn’t get any public money for its service, instead earning its profits from billing insurance.

But that isn’t as lucrative as it sounds — or once was — said Dave Fuller, AMR general manager for Southwest Washington.

Between October 2008 and September 2009, AMR collected just 44.8 percent of its billing costs on 32,224 calls, he said.

“Times are hard,” Fuller said.

Medicare and Medicaid — which represents 51.2 percent of AMR’s transports — have drastically cut the flat rate they pay for ambulance reimbursement, he said.

Also, the bad economy means fewer people have insurance, and fewer uninsured patients are able to pay their bills, which average $753 per trip, Fuller said.

Ambulance rides are expensive due to the staffing, training, medication and medical supplies that go into supporting the units, he said.

And because collection rates are so low, AMR is in early negotiations to extend the amount of time it has to respond to calls where medical transports are not time critical, he said.

Still, he said the bonding of private-public money works well, even if both sides are struggling.

“We’re not in direct competition for same revenue dollars,” Fuller said. “We’re able to get some synergy.”

Vancouver Firefighters’ Union President Mark Johnston, however, said the city should move to a public-only response and transport.

Though it would require more money on the city’s side, Johnston said, patients would receive continuous care from door to door from firefighter/paramedics who also have more experience in general than their privately employed counterparts do.

“One agency and paramedic is absolutely the best system for patient care,” he said.

Johnston cited the system in Camas, which has been funding ambulance transport through a levy since the mid-1970s.

Camas Fire Chief Leo Leon said his city’s system has “been working out for 30 years.”

Voters pay 35 cents per $1,000 assessed value on their homes. Between that and the billing collections, the city gets about $3 million to fund its ambulances.

“We live within that $3 million and we have a couple hundred thousand in reserves,” Leon said.

But without a levy, cities struggle with the same funding issues that currently plague AMR: The cities of Eugene and Springfield, Ore., merged their fire and EMS districts last fall as a way to staunch the money their public ambulance transport was hemorrhaging there.

Bivins said he has not studied how much it would cost to move the city to an city-run ambulance system.

Leon acknowledged that while he was satisfied with the way Camas provides emergency care, it may be difficult to get the same results in Vancouver.

Camas doesn’t have a lot of retirement and care homes, where patients are on Medicare and Medicaid, meaning that more of its bills are paid in full by insurance companies, he said.

Vancouver would have to stock up on more ambulances, which cost about $175,000 each, he noted. Also, “asking the citizens to pay … on an additional brand new tax would be extremely difficult” in this economy, Leon said.

Johnston said it’s still the right time to at least look at making a change.

“I think it’s worth the city looking at and talking about that,” Johnston said. “All kinds of options are on the table now.”

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