GFFR ambulance transports up

Great Falls Fire Rescue set a record in December with ambulance transports.

In December, GFFR transported patients 33 times when private ambulances weren’t available.

During the Jan. 3 commission meeting, City Manager Greg Doyon said that number exceeds some prior year totals.

The city contracts with GFES for ambulance transport services of 911 medical calls for those in the city limits and the contracted fire districts that Great Falls Fire Rescue protects.

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Doyon told commissioners that GFFR backfills when the private company is unable to provide transport.

Jeremy Virts, GFFR deputy chief of EMS, said that December had a higher overall call volume, which impacted the number of transports, but they’ve still been increasing for GFFR in recent years.

For all of 2022, GFFR provided ambulance transport 141 times, up from 74 in 2021. In 2020, GFFR provided transport 41 times and in 2019, it was 63 times, according to GFFR data.

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The system is overloaded, Virts and GFFR Chief Jeremy Jones said, and there aren’t enough ambulance transports available.

In 2008, the city adopted an ordinance providing the city with formal authority to manage the city’s 911 emergency medical service. At the same time, the city began negotiating a performance contract with GFES.

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The version of the GFES contract that was adopted in 2014 required that all ambulances in the city 911 EMS system be staffed with a paramedic to provide Advanced Life Support services during patient transport. The agreement didn’t specify how many ambulances will be staffed in the city EMS system, but that a paramedic must be on the ambulance.

The original agreement did not allow for Basic Life Support ambulances, those with two emergency medical technicians and not paramedics, to operated within the city 911 system.

Paramedics have higher levels of training and certifications, which come at a higher cost, and are able to perform more medical services on a scene and during transport.

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ALS calls range from falls to cardiac arrest, stroke or seizures.

In 2018, GFES approached the city for an amendment to the agreement since the agency was having trouble staffing paramedics. That amendment allowed GFES to operate BLS ambulances in the city 911 system through May 2019.

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GFFR Chief Jeremy Jones told commissioners in 2022 that GFES had again approached the city requesting an amendment since “they are once again having staffing issues in regards to retention and recruitment of paramedics.”

The amendment approved by commissioners during their Sept. 20 meeting is similar to the previous amendment and allows GFES to provide a minimum of two ALS staffed ambulances, meaning paramedics are onboard, at all times and any additional ambulances above the minimum to be staffed at the BLS level and those can take non-emergent calls, according to GFFR.

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The amendment is in effect through May 2024.

Virts told The Electric that during the month of December, there were 47 times when no GFES ambulance was available, meaning patients had to wait longer for transport.

Justin Grohs, GFES manager, said there were more calls in December than normal and they are also short on paramedics.

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Grohs said another factor for the increased transports is that previously, GFES had units preparing to clear a call but GFFR would respond in the meantime until GFES could respond, but now once an ambulance starts to respond, they stay on the call.

He said he wants to hire three to four more paramedics but recruiting is a challenge.

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Grohs said they used to hire locally from students in the Great Falls MSU paramedic program, but the volume of students there has decreased.

He said they have three current EMTs preparing to start paramedic school and the company has an option to subsidize the cost for a service commitment from the employee.

Grohs said he thinks the call volume will drop after the holidays so GFFR won’t have to pick up so many transports.

“Our goal is they don’t transport at all, but we do need to get our staffing up,” Grohs said.

Jones said that GFFR cross-staffs an engine and ambulance out of Station 4, but when those crews spent time responding for ambulance transport, it takes an engine out of service.

Virts said GFFR can put EMT firefighters on BLS calls, and their paramedics on ALS calls to provide the higher level of care.

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GFFR won’t sent an BLS ambulance to a call that needs an ALS level of service, but that will typically take an engine company out of service as all engine companies require a paramedic, Jones said.

Under the performance contract, GFES is fined $500 for every transport conducted by the city, with some exceptions, and Virts said the December fine will total about $17,000.

GFFR staff is also reviewing calls to check response times as the contract requires GFES to arrive within nine minutes 90 percent of the time.

Jones said GFFR works to maintain a four-minute response time, as in medical and fire calls, time is of the essence.

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Virts said that according to the American Heart Association, after four to six minutes in cardiac arrest, brain death can occur.

If a patient is waiting on ambulance transport in an emergency, it lessens their chance of recovery or survival, Virts and Jones said.

That’s why GFFR has paramedics on all engines, “so we’re staffed to handle any emergency that might be presented when the tones go off,” Jones said.

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The city purchased a second ambulance and both Virts and Jones, who are both paramedics, have taken it on calls when the system is overloaded and no other ambulances are available.

During business hours when Virts is at Station 1, he can bring that ambulance to a scene since other personnel will be onsite and provide care and transport.

Battalion commanders can also take that ambulance out for transport after hours, but that ties up a battalion commander in the event of a fire and there’s no incident commander.

“We’re playing risk management to the highest level,” Jones said.

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Jones said he created the EMS deputy chief position that Virts fills to improve GFFR’s medical training and operations for better performance on the street.

“It’s our responsibility to bring the highest level of service. The struggle is transport right now,” Jones said.

Before the city adopted the EMS ordinance, it was “the wild west,” Jones said, with multiple ambulance operators competing for transports. That led to a study, the ordinance and the performance contract that dictates standards.

Jones said other Montana cities have modeled their EMS systems off Great Falls since then.

GFFR currently has 27 paramedics, a significant increase in recent years but the call volume has continued to increase with limited additions in staff or equipment.

Last summer, GFFR stopped responding to minor calls and allowed GFES to inject their BLS ambulance into the system.

The call volume for 2022 was about 7,000 and as the first full year of not responding to minor calls, it cut 23 percent of GFFR’s total calls, according to Virts.

GFFR will still respond to minor calls if private ambulances aren’t available to respond, Virts and Jones said.

In his Good+ public safety levy proposal, Jones included a fully staffed city ambulance out of Station 1 so they don’t have to cross staff and can keep an engine company in service.