Fire officials want transportation procedure restrictions
loosened on STAR vehicles
Gilroy – Firefighters said Thursday that changing the county’s emergency response procedures to allow them to transport injured patients will save lives without making the services more expensive for county taxpayers.
Under state law, Santa Clara County can negotiate an ambulance service contract for all the cities within its borders. The current contract, with American Medical Response, allows that company to transport all patients except in extreme circumstances.
Fire officials in many cities in the county want that changed. Particularly those in Gilroy, San Jose and Santa Clara, where expensive transport vehicles known as STAR cars often sit unused.
“We’ve got units that are underutilized,” Gilroy Division Chief Phil King said. “We realize there have to be some restrictions, but we think we can serve the county better [if the restrictions are loosened].”
That’s the position of the county’s fire chief association, which is pressing county officials and AMR to give firefighters more latitude in using STAR vehicles. The contract doesn’t expire until June 2006, but the fire chiefs are already negotiating. In a position paper, the chiefs say that the contract’s “highly restrictive language regarding activation of STAR resources” reduces their effectiveness.
The Supplemental Ambulance Transport Resource Vehicles may only be used in cases where AMR can not meet its eight and 12-minute response times and the patient’s life is in grave and immediate danger. Since it acquired a STAR vehicle in early 2004, at a cost of $260,000, Gilroy has used the vehicle just once to transport a patient, though the truck does respond to fires in the Sunrise district in northwest Gilroy.
King said that AMR vehicles are deployed an average of six times a day in town, and that patients in severe pain and in need of critical medical attention often wait for 20 minutes because they don’t qualify for STAR service.
“We’re always discussing how we can improve the system,” King said. “If there were fewer restrictions, maybe we can serve the community better.”
But AMR and County Supervisor Don Gage, say that sending AMR ambulances on fewer calls will disrupt the system and drive up the price of emergency services.
“In order to make AMR cost-effective, it has to be a countywide service,” Gage said. “It would leave gaps in service and AMR would have to raise rates to compensate.”
AMR transports between 4,500 and 5,000 patients a month. About 60 percent of those patients are in San Jose. Wayne Davis, AMR’s director of operations, said allowing San Jose to use its five STAR cars more often will have a damaging ripple effect on the company and the county, with layoffs and more expensive service.
“I think you have to look at the financial viability of the system before you make any changes like that,” Davis said. “Anytime you change the financial structure, there may be a downside for the end user.”
AMR has held the ambulance contract in the county since 1979. It was last renewed in 2001, after two years of occasionally contentious negotiations. The city of Santa Clara unsuccessfully sued the county at one point seeking to get out of the contract.
“There’s a long history here,” County Executive Pete Kutras said. “Some of the fire departments have purchased auxiliary ambulances that they would like to use and earn revenue. But if you start carving into the revenue of [AMR] patient transport, you’re creating a situation where we may not be able to maintain service countywide.”
When they purchased the STAR car, Gilroy officials expected to pocket only about $9,000 a year through transporting one or two patients a month. And AMR’s response efficiency – it meets its response goals more than 90 percent of the time – means that opportunities for city vehicles to transport more patients will be limited. At that level of service, King said, it’s unreasonable to expect that AMR will suffer financially.
“It’s a large exaggeration,” King said. “San Jose may take more patients, but the percentage is still very low.”
Ultimately, the county will work out the contract with AMR. Bruce Lee, director of emergency medical services, said that all residents are better off with the current situation.
“The contract may need a few tweaks, but the STAR car program has worked,” Lee said. “But it’s premature to talk about ‘what if’ situations. This is a natural time to begin discussion to make sure all the stakeholders are comfortable with the performance of the provider and agreements of the extensions.”
