Hello, I'm Council Member Justin Olsen. Welcome to this month's council update. I'm happy to be here today to talk about an important topic with our very own fire chief, John Pritchard. Chief Pritchard, welcome. >> Thank you for having me, council member. Yes, we are here today to talk a little bit about the Cottage Grove Fire Department. Uh how EMS works, what it does, five-year strategic plan. We could probably be here all day, but we're going to try to keep this uh relatively short so that we can inform the community about exactly what's going on with the fire department. We want to engage. We want to educate, make sure that we give all the information that we can, but obviously it's important for people to know what it is that you do, why you do it, how we train and prepare, all of those things. Okay? So, uh, one question that has come up, at least to me several times this month, uh, has to do with EMS services. Some people may not know that while we're ready to put a fire out, there may be medical calls. And by far the most common type of call we go on is a medical call. So what can you tell us about EMS services in Cottage Grove? >> Thank you again, council member, for having me. And actually EMS is one of our most proudest areas and services that we provide. Uh the fire department responds to tons of different emergencies including structure fires like you alluded to, but we also respond to what we call BLS and ALS calls. If you're like me, I don't like jargon, so we'll just cut through that. So EMS, what we say is emergency medical services. So the ambulance and then ALS is advanced life support and BLS is basic life support. So we run those ambulances when folks call 911 with a medical emergency and we're there to help you out whether it's a structure fire or if you fell down and broke your leg. We're there to help you at any time. >> Okay. So you mentioned ALS and BLS. Tell me a little more about that. I know that, you know, when we outfit our ambulances, we outfit those for uh ALS service in case that's necessary, but uh BLS seems to be somewhat more common. Can you just briefly explain the difference? >> Yeah, so BLS, basic life support, and then ALS, advanced life support. So, one of the things we're proud of in this community is that we provide a paramedic on every emergency call that we go to. Okay. So we're every call we go to we're ready to be advanced life support providers like you alluded to that basic life support [snorts] you know it is probably you know a good chunk of our calls and that might be something where somebody doesn't have a life-threatening emergency but they need to go to the hospital. So um advanced life support is what we is a paramedic and so an advanced life support provider can be up to 1500 hours of training. >> Oh my goodness. >> Yeah. Years um of just getting that experience. They can do anything from giving you pain medication to putting a breathing tube down your throat. So truly they're like critical care on wheels. Now on the other hand, basic life support, it's incredibly important, but it's usually what we consider an EMT and they have about 150 hours of training. So when you compare the two, advanced life supports 10 times as much training. >> And then that basic life support provider can use things like an AD to restart your heart. They can help with breathing, but truly those ALS providers are what provide that critical link and that critical care between your medical emergency at home and to the emergency department. >> Wow, that's incredible. So, I think what I'm hearing is if you're going to have a problem, you want to have a problem in Cottage Grove because you're going to get advanced life support in addition to basic life support. Now, do all ambulance services provide that? Is that common? >> So, some ambulance services what we call a tiered response. So, if they you call dispatch and or 911 and they hear them like, "Oh, that doesn't sound like a life-threatening emergency." They'll send out a BLS ambulance. >> Okay. >> But the problem though is that BLS ambulance gets there and all like, "Oh, this is a really much more severe emergency. Now, we have to wait even a longer time to get an ALS ambulance there." Now, for Cottage Grove, you're going to get that ALS ambulance right away. So, we're we're ready to take care of like things that aren't life-threatening to somebody that's hardest stop. So, that's a big benefit of our system is we're going to give you a paramedic right away. Where other systems you might get that BLS ambulance first with two EMTs and then you might have to wait longer to get that ALS ambulance. And I think that's what makes our service very unique and exceptional service to our community. >> Boy, that sounds like a game changer to me. uh not only the fact that you get the care that you need immediately, but the response time for waiting on another ambulance after the first one is going to be significantly greater than if you actually had a Cottage Grove Fire Department ambulance show up because they're ready to go right there. Absolutely. >> Now, that has to require a lot of training and planning and equipment and all of that. And I've seen a lot of questions about sort of the cost related to all of those things. Let's start a little bit with equipment. We have three ambulances, >> correct? >> What does an ambulance really cost these days? And then you mentioned if you have ALS service, you have all these other duads on the on the ambulance. So, what does it cost to outfit that ambulance? >> And great question, and I think it's going to shock some folks at how much it does cost to um outfit an ambulance. So, the ambulance alone, regardless of what type of care, is about $300,000. And that's for your base model basic ambulance with no frills. >> Okay. >> Then on top of that, just to get a stretcher system in is another $75,000. >> And now we start talking about advanced life supports. So things like cardiac monitors, that's about $50,000. A stretcher system, $75,000. >> And then some of the other advanced life support things. We carry ultrasound. We can literally look at your heart if it's beating or not. That's about $3,000. Okay, since our um paramedics really are cutting edge, we actually have ventilators to help people breathe and provide extra breathing support. That's $15,000. And so all said and done, you're looking that $300,000 base ambulance plus well over $150,000 of equipment, medications, and all that other type of equipment. >> Well, then knowing all of that, let's talk a little bit about billing. So, I assume when an ambulance actually shows up, their job is, you know, let's help me out. Let's get me feeling okay and let's get me to the hospital. Now, you and your staff go on that trip as well, right? So, you're out of service for a period of time and then you have to come back and do all those things. So, how do you bill all of that? What does that cost? And you know in the United States of America it's really the system of EMS ever since its beginnings in the late in the 60s is that we bill for services that we go on. So of course our paramedics don't leave you an invoice at your house. We provide care >> and we provide care to anyone regardless of their ability to pay. >> Okay. But after that service, like you alluded to, we create we document it and then we send a bill to somebody's insurance company and then that's whether your insurance is through a big provider, Medicare, Medicaid, and then those insurance com companies pay the city >> uh for the services that we provided for them. Unfortunately, a lot of those costs are not completely recuperated because of different insurance companies don't actually pay the full rate of what it costs to provide an ambulance. And unfortunately that creates some shortfalls. >> Okay. Now, you mentioned Medicare, Medicaid. Uh it's been in the news quite a bit that some of those reimbursements uh have been lacking. They've been falling short. And in fact, there's even been some chats about I believe Medicare cuts at some point. So, how does that impact our billing? >> Yeah. So, Medicare, Medicaid, I mean, they're good programs. It gets our older folks and our older neighbors making sure they have access to care and those disadvantaged folks to have access to care. However, Medicare, Medicaid, they haven't >> in terms of what they pay for services. Sure. >> They haven't kept up with what it costs to provide medical care. And whether you're a hospital or an ambulance, it's just not providing the reimbursements to cover the cost of care. >> I see. And is that just a cottage grow thing or is that sort of national? >> Great question. That's national and it's becoming a crisis for a lot of EMS agencies, hospitals, clinics everywhere around the United States. It's a major problem. So from a council member's perspective, what that means, and correct me if I'm wrong, John, is when we sit down to do our budget each year, we take more and more of our budgeted funds to contribute to maintaining the ambulance service or the EMS service because the cost to run that service is what it is. There's no negotiating that. And then when the reimbursement rates don't catch up, that creates more of a burden for the taxpayer uh to to really help fund that service. But the whole thing is very complex, right? And and it requires a lot of uh study and and a lot of information on the part of the staff and and your team to give to the council to make sure that we, you know, keep the boat afloat, as it were. I can tell you that when I was first a council member and uh I started in 2008, the majority of our our funding for the ambulance service came out of what's called a uh EMS fund, which is an enterprise fund. That means it's dedicated to that one thing. And about 75% of the funding for the service came out of that one fund and the remaining 25% came out of the general fund that all the all of us who live in Cottage Grove including me and you as taxpayers uh contribute each year. And now that ratio has shifted closer to 50/50. And without some changes in the way that billing is done or perhaps some help from the state or federal government, that is going to continue to tip the wrong way. Does that sound accurate? >> That's accurate. And to your point, um, council member Olsen, other cities and suburbs that run ambulances service through their fire department are seeing the same thing and the same issue. So, we are definitely not alone with it. And as we face those challenges with this under reimbursement for Medicare, Medicaid and those other insurance companies, it does create challenges for local governments to keep up with that funding the programs and the everexpanding cost of providing highquality EMS care to the community. The fact of the matter is it's an amazing service. It is a huge benefit for the residents of our community. You mentioned they get that ALS care. They get that BLS care on the spot. And I know the city council is 100% committed to maintaining that service. No matter how complex, no matter how challenging the issue is, no matter how difficult something is for you or a family member, we are going to make sure that that service exists because to me it is absolutely a critical service that we provide to our residents. Now, the last thing I want to ask you is medics. You said you have medics on on every ambulance, and medics aren't easy to find. So, what are some of the things that we're doing in the city to make sure that we have those highly trained, professional medics? I think you said 1,500 hours of training approximately. How do we make sure that we have those folks available to do the things that need to be done when they need to be done because you can't go without, you have to have them. >> And that's a great question. And you know, as EMS needs have been growing, it's harder to find paramedics. So, one of the things we're very proud of, we've created a program called, it's called an accelerated recruitment program. >> Okay? >> So, we'll hire folks that are firefighter EMTs. And some of our best candidates actually come from our part-time system throughout the years. Folks that don't work full-time for us. We hire them full-time. We get them in a paramedic program and in about 15 months are full-fledged paramedics. And I'm happy to say our first two folks that went through that program just passed their paramedics. How amazing. So great. >> It's success and we're so happy to have them and they're already working as paramedics. So, we're incredibly proud of that program. >> I can tell you as a business operator myself, growing your talent from within is absolutely the best way. I know we've had a lot of success with our police department doing the same thing. So, it sounds like you're following a similar model. Great. >> Well, John, that's so amazing that we're doing that. And congratulations to the two who went through and I think we might have one in >> we have two more starting in January. So they have our full support. >> Outstanding. Well, thank you for joining me today. You're a wealth of information. I very much appreciate the time that you've given. And for the folks at home, I hope you've learned a little bit more about the ambulance service that uh John and his team operate and they do a great job with that. the benefits of having that ALS and BLS uh service available the minute they hit your house and uh all of the complexities that go around with running that service. Everything from, you know, buying uh ambulances to putting the equipment on to billing, etc. So, for this month's council update, again, I am council member Justin Olsen. Thank you, Chief Pritchard. Great having you here and we will see you all next time. Thank you.