City approves amendments to emergency medical code
City Commissioners unanimously approved amendments to the city’s emergency medical services code during their Oct. 17 meeting.
Staff recommended several changes to the code that hasn’t been substantially changed since it’s first adoption in 2008.
Great Falls Fire Rescue staff discussed the proposed changes with commissioners during both of their September work sessions and the changes were accepted on first reading during their first October meeting with a public hearing set for Oct. 17.
The section of the code, Title 8, Chapter 5, pertains to emergency medical services and makes the city responsible for the EMS system, which includes fire, medical, hazmat and more.
GFFR Chief Jeremy Jones said it’s an all hazardous force and the code makes the city, specifically GFFR, responsible.
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The only area they contract out is ambulance transportation, since they don’t have enough staffing or vehicles to take that on entirely. GFFR does have some ambulances and will provide transport when necessary.
During the Oct. 3 meeting, City Manager Greg Doyon said that this is the policy that the city sets for ambulance transport and that’s he’s tried to steer comments from GFES into a public setting, such as the work sessions and commission meetings.
During the meeting, Commissioner Rick Tryon said that he wanted more context but was unclear on what he was looking for specifically.
Doyon said to let staff know if they had substantial questions or changes that would require resetting the hearing.
“This ordinance is your expectation of how it’s going to be laid out,” Doyon said.
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GFES has expressed concern over using competitive bids for the performance contract since staff is recommending striking grandfathering from the code.
Jones said there are still two ways to do performance contracts in the proposed code through competitive bids or renewal of existing contracts, based on staff recommendations to the commission and commissions have the final say.
He said those options aren’t changing in the proposed code updated.
Bill Bronson is representing GFES and that after discussions with the deputy city attorney, they were comfortable with the ordinance change since it retained the option to extend contracts and that though staff would make recommendations, commissioners had the ultimate decision on an ambulance performance contract.
Commissioner Joe McKenney said he was expecting opposition from GFES and since they were supportive during the Oct. 17 meeting, he didn’t have further questions.
Every fire engine is staffed with a paramedic and the other firefighters are EMTs.
When GFFR personnel arrive on scene for a medical call, they provide care on site and if needed, will ride in the GFES ambulance to the hospital.
In 1994, GFFR began responding to all emergency medical calls and commissioners formally established the city’s EMS system in 2007, according to GFFR’s annual report.
City code establishes the provisions used to develop an ambulance performance contract.
At the time, there were multiple ambulance companies in town and there were issues getting the appropriate resources to an emergency in a timely fashion, according to GFFR officials. That lead the city to establishing the EMS system that currently exists.
The city has a performance contract with Great Falls Emergency Services for ambulance transport. That contract expires in May 2024.
As the contract expiration nears, GFFR officials said it’s time to update the current city code to address current needs and reality.
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The code changes are separate from the performance contract itself.
GFES officials have indicated concern about the possibility of opening that contract to a request for proposals process, but city officials have not publicly made an indication how they intend to proceed with the ambulance contract, which expires in May.
In a letter to commissioners, GFES said that if it appears their contract may be in jeopardy through an RFP process, they may have trouble staffing.
When the code and contract were first established in 2008, every ambulance was required to have a paramedic onboard, making it an Advanced Life Support apparatus.
Since GFFR staffs paramedics on their engines, they are also ALS level apparatus.
The previous code does not allow for Basic Life Support ambulances, which means they don’t have a paramedic onboard and are staffed entirely by EMTs.
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Great Falls Emergency Services came to the city in 2018 and again in 2022 for amendments to their contract to allow for BLS ambulances in the system since they were having trouble staffing paramedics to meet the ALS requirement in their contract and the city code.
GFFR officials proposed a code change that would allow for BLS ambulances to be in the system, as outlined in the performance agreement, which is reviewed and by commissioners.
Several commissioners seemed unclear on how the current system works or why the code change was being proposed based on their questions of Jones and Virts during September work sessions.
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All current commissioners voted on an a memorandum in September 2022 to allow BLS ambulances into the system through the contract expiration in May 2024.
Commissioner Rick Tryon asked if the change was recommend due to a change in state law.
Jones, GFFR fire chief, said no, it was because the system doesn’t currently allow for any BLS ambulances.
Commissioner Eric Hinebauch asked if that meant the current contract wouldn’t work with the proposed code change.
Jones reminded commissioners that they approved a memorandum last year allowing BLS ambulances to operate in the city, though it’s not allowed under city code or the existing performance contract with GFES. But once that agreement and contract expire, everything reverts back to the existing city code with out an amendment.
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The code changes include clarifying language on the system medical director, who has oversight for anything within the public emergency response system, but not privately contracted ambulance transport services who often provide interfacility transport such as from a nursing home to a hospital.
GFFR officials proposed updating the code so only an ambulance company operating with the 911 EMS system need a performance contract with the city, which regulates requirements such as how many ALS ambulances, response times, personnel and patient care and more. Those providing only privately contracted transports wouldn’t need such a contract under the proposed change.
Standards, requirements and performance measures aren’t delineated in the code other than criteria to be considered for a contract, but are addressed in the performance contracts.
There are also provisions in the code dealing with breach or default of the contract.
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The proposed EMS code changes are scheduled to be on the Oct. 3 commission meeting agenda for a first reading and to set a public hearing for Oct. 17. If the changes are adopted, they’d go into effect 30 days later on Nov. 16.
Earlier in September, Jones walked commissioners through how the city’s 911 EMS system works.
Under city code, GFFR is designated to perform and oversee the emergency medical system in the city.
For a decade, only Advanced Life Support service was allowed in the system, meaning a paramedic was onboard.
In 2018, GFES asked to use Basic Life Support ambulances because of staffing challenges. That agreement was extended last year through the contract expiration in 2024.
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When no private ambulances are available, GFFR will intervene and transport patients to the hospital using their ambulances.
“This redundancy allows the EMS system to be reset” and provide services, Jones said.
Ambulance transports for GFFR have been increasing in recent years when private ambulances weren’t available or there was a surge in EMS calls.
In 2015, GFFR transported five patients. In 2022 that number grew to 141.
So far, in 2023, GFFR had already transported 117 patients, as of Oct. 16, according to Virts.
Jones said the if commissioners adopt the code changes, it will impact the framework of the performance contract.
In years past, the city has negotiated the contract with GFES, but Jones told commissioners to consider whether they want to issue an RFP for the new contract.
City Manager Greg Doyon said “this is going to be an interesting journey,” of updating the EMS code and developing a new ambulance transport contract.
“People just kind of take it for granted that when there’s a 911 call, someone shows up,” he said.
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Getting to the initial EMS ordinance in 2008 was “quite a process,” Doyon said of the situation with multiple providers in the city and it was “chaotic to get ambulances to 911 calls.”
Doyon said the city extended the existing GFES contract before, but hasn’t looked at the original ordinance and what’s working and what’s not since it was established in 2008.
Doyon said the city isn’t prepared to fully take over ambulance transport services, but has to be prepared to provide backup.
He told commissioners it was ultimately up to them what kind of quality of care they want the citizens to have.
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Jones explained that GFFR is responsible for EMS in the city, but contracts out for ambulance transport to the hospital.
He said that they respond to medical calls with a fire engine since there are paramedics and EMTs on that engine and it saves time, especially if a fire call comes in while they’re out of the station, rather than having to take an ambulance back to the station and switch to an engine.
Jones and other GFFR staff have worked to adjust staffing to send two firefighters in an ambulance to medical calls when appropriate rather than an engine crew and part of their public safety levy request is to establish a medical squad out of Station 1 to handle more medical calls, leaving an engine available.
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In 2021, GFFR stopped responding to minor medical calls due to limited resources and an increasing call volume.
Those types of calls include minor injuries like broken fingers and toes, minor cuts with controlled bleeding, fever/cough, headaches, nausea, vomiting and diarrhea. Those calls are still handled by the dispatch center, but will be routed to the private ambulance service instead of GFFR.
Jones told commissioners in June 2021 that decision has been made to ensure GFFR personnel and equipment are available for major medical calls including unconscious or not breathing, signs of shock, respiratory distress, chest pain, decreased level of consciousness, gunshot wounds, stabbings and penetrating injuries, as well as fires and hazardous materials calls.
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Virts, GFFR’s deputy chief for EMS, told commissioner during the Sept. 19 work session that he sees allowing BLS ambulances on the street beneficial for several reasons. It allows the BLS crew to take minor calls, keeping ALS crews available for major calls. It also allows those EMTs to get more experience and hopefully at least some of them will eventually become paramedics, he said.
During the Sept. 19 work session, Justin Grohs, GFES manager, said they were in favor of updating the ordinance to allow for BLS ambulances.
“That’s definitely in our opinion a good idea,” he said.
