The issue

A rural fire district relied on distant ambulance providers and sought to establish local emergency medical transport services. However, laws and regulations restricted changes in providers when established response time standards were being met.

The situation

Jefferson Rural Fire District covers approximately 100 sq mi of the Willamette Valley in Oregon, with about 14 miles of the I-5 highway running through the middle. The fire district had several EMTs and Paramedics who responded to each medical emergency, but they were not authorized to transport patients. Instead, they could only attend to and hope to stabilize patients until an ambulance from a distant provider could transport them to a hospital.

The story

The Fire Chief and members of the Fire District Board asked if I could research the viability of providing 24/7 ambulance services. I conducted a thorough analysis, considering startup costs, potential revenue and expenses, staffing requirements, and all the regulatory mandates. I determined that we could provide full-time ambulance services, which would significantly reduce patient transport times to the hospital.

To begin transporting patients, we needed to:

• • • Negotiate with current ambulance providers to assume each Ambulance Service Area (ASA).
    • Obtain authorization from Linn County.
    • Acquire a new ambulance and necessary equipment and supplies.
    • Obtain state licensure.
    • Gain DEA approval for purchasing and storing medical drugs.
    • Develop operational policies and procedures.
    • Secure an approved operating budget.
    • Hire personnel and create schedules.

Upon receiving the approval from the County Board to provide ambulance services, I faced the challenge of negotiating with the current ambulance providers to assume control of the 4 ASAs that the district was divided into. I engaged in extensive negotiations with each provider, presenting a strong case for how our services would benefit the community and improve patient care. Furthermore, I sought and gained approval from the neighboring county to ensure our ambulance service covered the entire district. Despite some initial reluctance from certain providers, I persevered and eventually secured the necessary agreements to assume control of each ASA.

As our launch date approached, I led the development of our ambulance service by coordinating and implementing various critical aspects. I organized a team to determine ambulance specifications, gathered operating procedures from other agencies, established billing agreements with insurance companies, and secured an agreement with a physician to serve as our Medical Director. Additionally, I applied to the DEA for our agency to stock and administer necessary drugs, evaluated RFPs, and signed interagency agreements, among other crucial tasks. This comprehensive planning and execution demonstrated my ability to manage complex projects effectively.

The result

Within just over a year, we achieved our goal, and I was promoted to Battalion Chief/Ambulance Manager, receiving an award for my efforts. Transport times to hospitals decreased significantly, improving patient outcomes. The ambulance service continues to grow and receives strong support from the district’s residents.

Reasons for success

• • Thorough assessment and analysis: A meticulous evaluation of the project’s feasibility, including startup costs, potential revenue and expenses, staffing requirements, and regulatory mandates, helped ensure its viability.
  • Accurate forecasting: Realistic projections allowed for better planning and management of the ambulance service.
  • Timely need for local ambulance service: The growing population, development, and traffic in the area made it an opportune time to establish a local ambulance service.
  • Patient-focused approach: By emphasizing the benefits to patients and the community, negotiations with existing ambulance providers and local governments were more successful.
  • Persistent and professional negotiations: The ability to negotiate effectively and professionally with existing ambulance providers played a critical role in securing the necessary ASAs.
  • Comprehensive planning and execution: A thorough analysis and step-by-step implementation of various aspects of the project demonstrated strong project management skills.
  • Community support: The ambulance service received strong backing from the district’s residents, which contributed to its ongoing growth and success.