A Council committee voted to recommend that Watertown’s Fire Department should have a second ambulance after hearing about the alternatives and cost of running the second in-house ambulance.
Watertown Fire Chief Ryan Nicholson said having a second ambulance would not just provide quicker response for patients in emergency situations, but would also increase the morale of the WFD’s paramedics. He gave his presentation to the Committee on Budget & Fiscal Oversight on April 29.
At a prior meeting, Nicholson told the committee about how calls handled by the contracted private ambulance service, Pro EMS, often does not meet the National Fire Protection Association’s standards of providing emergency medical services within 9 minutes 90 percent of the time.
For calls handled by the contracted ambulance, the NFPA’s standard is met 44 percent of the time, Nicholson said in March, while when Watertown’s ambulance responds the standard is met 96 percent of the time.
On April 29, Nicholson said there is a shortage of paramedics, so Cambridge-based Pro EMS has fewer trucks on the road.
“Their trucks are now further into Cambridge or busy or they’re coming from hospitals, as opposed to being closer to the line at Star Market on the Mt. Auburn Street line, where they would have someone before,” he said.
Nicholson said that the Watertown Fire Department he is worried about the workload for the current paramedics on Watertown’s lone ambulance.
“I don’t want to lose sight of, really to me, the crux of the problem is the staffing issue that we have,” he said. “As it is, the program is failing, and so something needs to be done: either the City is going to watch it fail, or we’re going to invest in it. And I think now is the right time to invest.”
The number of calls that the ambulance has to respond to is leading to burnout for Watertown’s paramedics, and many have resigned, Nicholson said.
“That is, kind of a crazy number to think about,” he said. “Before ALS came about, I can’t think of maybe one or two in my 20 years before that, but to have 12 since 2017 I think says a lot.”
When an ambulance transports a patient to hospital, the entity providing the service gets reimbursed by insurance for a portion. The revenue from the transports by a second ambulance would provide about $400,000, while hiring eight paramedics would cost about $855,000. The cost to the City for staffing the ambulance would be an estimated $455,000, Nicholson said.
About 30 percent of the reimbursements come from Medicaid or Medicare. With possible cuts in these areas on the horizon the financial forecast for the ambulances is not certain, said Ari Sky, Assistant City Manager for Finance.
“The future of Medicare and Medicaid reimbursement rates is very much in question,” he said. “So if you’re getting into a situation where you are basically it would be, in my mind, misplaced to get into a situation where you’re making a decision based on the assumption that this is the number you’re going to get.”
Nicholson provided analysis of other ways to provide ambulance service, besides the current model or having two Watertown-run ambulances.
Communities have a variety of ways of providing paramedic services, Nicholson said. In Cambridge, they have paramedics in a squad vehicle to start caring for patients, and the private ambulance transports them to the hospital, if necessary. All the money from reimbursements goes to the private company. Nicholson noted that morale would be higher for Watertown’s paramedics because they would provide initial care, but would not have to transport patients to hospital.
In Waltham and Newton they use private ambulances for all their calls, and they have a contract with trucks dedicated to their cities. The cities do not receive reimbursement, and they do not have much control or oversight over the service, Nicholson said.
Nicholson also looked at having a dedicated backup ambulance provided by a private company. This would cost about $600,000 a year.
He also looked at different levels of staffing for a second Watertown ambulance. One way to do it is having an “impact shift” where paramedics work the busiest time of day, between 8 a.m. and 4 p.m. when 46 percent of the calls come in. Nicholson said he worries that would create silos within the Fire Department between ambulance staff and the rest of the department.
“I think this would be extremely detrimental to morale and the ability to recruit and retain because that shift work schedule, that eight-hour shift schedule, is not a desirable one in the fire service, in our profession, people want to work the 24 hour shift,” Nicholson said.
After hearing Nicholson’s report, and from the public, the Committee voted to recommend that Watertown not only staff the second ambulance, but to set a goal for ambulance response for the Fire Department.
Council Vice President Vincent Piccirilli, who chairs the Budget & Fiscal Oversight Committee, proposed that the Committee recommend that the City administration make the NFPA standard for responding within 9 minutes for 90 percent calls a goal.
He added that while the second ambulance would cost the City $400,000 to $500,000, it would be a good investment.
“It also adds tremendous value to people who live, work or visit Watertown,” Piccirilli said. “I am of the opinion that the second Watertown ambulance is the most cost effective way to achieve this goal.”
Councilor Emily Izzo agreed.
“I think it makes sense,” she said. “I see it as a long-term solution to an issue and at the same time adds value. It seems like a low cost for saving a life.”
Councilor Nicole Gardner said she concurred with her colleagues.
The Committee voted 3-0 to recommend both the new goal of meeting the NFPA standard, and to ask the administration to find the best way to staff the second ambulance.
City Manager George Proakis said he thinks it is good to have a goal to measure progress, and added that he will come back in the near future with an option or options for staffing the second ambulance. He added that he is determined to do it in a way that would not require going to taxpayers to ask for revenue beyond what is allowed by Proposition 2-1/2, such as an override.