TRAA will cover costs of paramedics on fire engines under agreement

FORT WAYNE, Ind. (WANE) – Fort Wayne’s ambulance service will stay with the Three Rivers Ambulance Authority. The Fort Wayne Fire Department and TRAA announced a compromise plan Thursday.

“This is a reasonable compromise for what we are trying to accomplish,” fire chief Eric Lahey, said. “Our goal has always been making a significant improvement in the delivery of care at no extra cost to the citizens.”

Starting in January, the fire department will start having a paramedic on the engines to provide more advanced medical care at the scene before the TRAA paramedics arrive. To cover the cost of that change, the department said it needed to acquire the entire ambulance service.

“Putting advanced life support (ALS) on every engine comes at a cost. In order to recoup those costs, we have to absorb the entire system. We cannot get revenue from delivering ALS care. You have to transport the patient in the eyes of Medicare and Medicaid and insurances providers to collect revenue, Lahey explained.

Now, under the new agreement, TRAA will cover the costs of equipping the engines, training the firefighters and staffing the engines with ALS level of care. Lahey said that will be about $400,000 a year and will come out of TRAA’s reserve fund, which currently has around $5 million in it. The agreement is for three years and either side has to give two-year’s notice if they want to end it. That means it will last for at least five years.

“The reserves will be replenished through revenue streams,” Lahey said. “There are also controls in place that if at any point the reserves aren’t being kept where they should be, we can dissolve the agreement.”

Lahey said the reserve fund was built over the last few years from Medicare and Medicaid payments that made up for previous under-reimbursing and the Department of Veterans Affairs made up payments they owed to the system.

“The community still gets the excellent care that TRAA has provided for over 30 years and it still gets the excellent first responders from the Fort Wayne Fire Department,” TRAA’s executive director, Gary Booher, said. “There are times when the fire department is on the scene for an extended amount of time, so this enhances that care. It’s a win for the community and that’s the important part.”

The fire department will often arrive at a scene before the TRAA ambulance.

“When we looked at the data, we did it faster 76 percent of the time and about 2.5 minutes faster than they did,” Lahey said. “There are times that 2.5 minutes are four minutes, eight minutes, 12 minutes and that’s what we’re really focusing on.”

Booher said the system is designed for firefighters to arrive first and the system is working well. He also disputes those numbers, saying most of the time the difference in arrival is less than a minute.

“Studies in the 1970s said to get basic life support first responders to a scene within four minutes and advanced life support there within eight minutes and if you do that, you give patients in cardiac arrest the best chance of survival and we are doing that,” he said.

Firefighters are trained to provide basic life support, or BLS, which includes things like CPR and controlling bleeding. They can also give a patient glucose and recently started carry Narcan to reverse heroin overdoses. It’s done that 104 times this year alone.

But, sometimes a patient needs advanced life support, or ALS, which is what paramedics provide, right away.

“We’re basically treading water waiting for TRAA to arrive,” Lahey said.

To bridge that time gap, Lahey wants to staff every fire engine with an advanced EMT or paramedic.

“That way we don’t have to reach the end of our BLS protocol and wait for an ambulance to arrive. We can continue that care to the ALS level,” he said.

But the proposal to take over the entire ambulance service was met with resistance from TRAA and Paramedics Plus, which is the actual ambulance provider based in Texas.

“You’re putting a change in the hands of someone who hasn’t done full ambulance service. They do first responders and do it well, but you question if there’s not a problem, why are you changing,” Booher said.

To see first-hand how the two agencies respond to medical calls, 15 Finds Out rode along with the fire department and TRAA. While with the fire department at Station 11, the TRAA ambulance was already positioned outside the station. So, when a call came in, the ambulance and fire truck basically caravanned to the scene.

While riding with TRAA, the ambulance was already halfway to the scene before the fire department was dispatched. The engine was leaving the station as the ambulance passed it and they essentially arrived together.

“There are times when there’s additional information that’s needed through the call taking process before [the dispatchers] can determine if it’s a priority one run [and the fire department would be dispatched] or not,” Lahey said.

Both of the runs 15 Finds Out went on were in the heart of the city and firefighters said the big arrival time gaps are usually in the suburbs. But now, when those gaps happen, advanced life support care can start while TRAA is still en route.

FWFD’s first class of firefighter paramedics will graduate next week. The 11 paramedics will still go through their year of training in different stations across the city before they are permanently assigned to be paramedics on an engine. The department already has 23 firefighters who are also paramedics. Starting in January, Station 5 will be equipped with ALS on the engine followed by Station 12 and will continue being expanded until eventually every station has a firefighter paramedic and ALS supplies on the engine.

The TRAA board still has to approve the agreement with the fire department to offset the costs of ALS care on the fire engines. Booher said the board should vote on the proposal on Friday.