Cap Haitien’s Fire Department Has One More Ambulance than Peoria’s Fire Department--June 5, 2018
Cap Haitien is located on Haiti’s northern coast. It is Haiti’s second largest city with a metropolitan and surrounding area population of 250,000 people (2009). On the nearby coast, Christopher Columbus founded his first community in the New World, the short-lived La Navidad.
In the Cap Haitien municipal fire department, there are three fire trucks that look like they might work. There were several smashed up fire trucks that obviously don’t work.
Interestingly, the Cap Haitien Fire Department has one more ambulance than the Peoria Fire Department (PFD), and you are looking at it in the photo above. This Haitian ambulance hasn’t seen much duty lately, but I am sure it would have many stories to tell if it could talk.
So why wouldn’t the PFD have an ambulance? Cap Haitien has one. It might not be in top shape, but it is nestled comfortably among the fire trucks.
For the past 25 years, Peoria’s three hospitals have supported Advanced Medical Transport (AMT) as the one and only Advanced Life Support and transport agency in Peoria. (The PFD cannot transport.) All three hospitals have people well placed on AMT’s board of directors. The AMT Corporate Medical Director is George Hevesy. When George was acting Project Medical Director in the Peoria area, George received a salary from AMT and from OSF. Over the years, George and Andrew Rand spoke many times to the press and to the Peoria City Council stating that there was no need for the PFD to move from Basic Life Support to Advanced Life Support (Paramedic).
An interesting paper was published last year in the Journal of Prehospital Medical Care. The abstract is below, but if you don’t want to read the abstract, I don’t blame you and I will summarize below the abstract.
Effects Of Emergency Medical Services Agency Ownership Status On Patient Transport Deziel, J., Prehosp Emerg Care 21(6):729, November-December 2017
BACKGROUND: Various patient demographic characteristics have been reported to influence the unnecessary use of emergency medical services (EMS) for ambulance transport of non-acute conditions. Structural factors such as generation of revenue may also be a factor. Private EMS agencies have a stronger incentive than publicly-funded EMS services to transport patients to receive insurance reimbursement.
METHODS: This retrospective study from Western Carolina University School of Health Sciences analyzed all 9-1-1 ambulance call data for the state of Virginia during 2009-2013 to assess differences in patient transport decisions between privately funded versus publicly funded EMS agencies.
RESULTS: Data included more than 4.6 million emergency ambulance requests during the study period; patients were 45% female and 36% male (19% unknown) and had a mean age of 52 years. Responding agencies were publicly funded in 70% of cases (primarily fire departments) and privately funded in 30% (mainly nonprofit organizations). Public organizations had transport rates of 56.5% for fire departments and 61.8% for government non-fire organizations, while rates for private agencies were 73.6% for nonprofit EMS, 89.5% for for-profit EMS, and 80.0% for hospital-based EMS. In adjusted analyses with fire departments as the reference group, all other EMS entities were more likely to transport patients, with odds ratios of 1.25 for government non-fire, 2.12 for private nonprofit EMS, 4.56 for private for-profit EMS, and 4.06 for private hospital-based EMS (all comparisons, p<0.0001). An estimated 5.8% of all transports were decided by agency ownership status.
CONCLUSIONS: EMS agency ownership status appears to significantly influence patient transport decisions, with private PROFIT-GENERATING AGENCIES (my capitalization) most likely to transport.
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It appears that publicly funded organizations, such as municipal fire departments, transport about 56% of patients. And for hospital-based EMS, such as AMT and Peoria’s three hospitals, the transport rate is 80%.
It makes sense to me why Peoria’s three hospitals would want a higher transport rate to their respective Emergency Departments. Money is made with transport to Emergency Departments. If EMS in Peoria followed the same trend as in the above study, and for the sake of discussion, if the PFD could transport, 25% LESS patients would be transported by the PFD than by AMT. I don’t think the three hospitals are trying to be “good neighbors” to AMT or are supporting AMT to be Christian. Most likely there is a PROFIT-GENERATING reason pushing policy in Peoria.
Haiti is considered one of the most corrupt countries in the world. But its second largest city has one more ambulance than Peoria. Go figure.
John A. Carroll, MD
www.haitianhearts.org