On Friday, the nation marked the second anniversary of the Affordable Care Act, sometimes referred to as Obamacare. Both reveled and reviled, the legislation and the campaign to pass it ushered in a new era of dialogue where both the Left and the Right focused on making healthcare affordable. However, in Murrieta, the fire chief and city council are discussing a new tax that could increase the cost of paramedic services for everyone – a tax that would impact those on Medi-cal or Medicare particularly hard.

The issue arises from how residents in Murrieta receive emergency medical services. Murrieta officials are unhappy with the county’s contract with American Medical Response – an agreement that gives the state’s largest ambulance service provider exclusive rights to Riverside County.

“When someone calls 9-1-1, our fire crews are arriving on scene first,” said Murrieta Fire Chief Matt Shobert. “Then we administer our care and our training and the ambulance company bills the patient for services we rendered.”

According to city officials, those services are draining the city’s fire department budget and the only option is to either approve a new tax or cut services.

According to Chief Shobert, the city fire department arrives on scene within 6 minutes, 90 percent of the time. AMR is required to respond within 9 minutes and 59 seconds. During an interview with PublicCEO, Shobert cited the city’s average response time as 6:04.

However, the comparison – MFD’s average response time to the contract response time for American Medical Response – may not accurately represent real-world scenarios.

“It is like comparing melons to prunes,” says Jason Sorrick from American Medical Response.

According to information reviewed by PublicCEO, the actual response times for American Medical Response was far different from a contracted maximum of 9 minutes 59 seconds. The average response time was 6 minutes 48 seconds.

The exclusion of real response times instead of contracted times has allowed Murrieta officials to draw a drastically different picture.
What’s more, Sorrick said, those response times include different factors. American Medical Response doesn’t include responses to cancelled calls, which can be as short as 60 seconds, unlike the Murrieta Fire Department. Inclusion of those calls helps drive down the city’s response times.

“We include all 9-1-1 calls,” said Chief Shobert when asked about the inclusion of cancelled calls in the city’s reported response times.

Sorrick provided PublicCEO with additional “scrubbed” data that removes cancelled calls from the MFD response time calculations. That data shows a real-world, actual response times for the Murrieta Fire department of time of 6 minutes and 51 seconds – three seconds slower than AMR.

The three-second advantage is often and easily erased by an arcane dispatch system that AMR and MFD both agree is at least 20 years out of date.

When a 9-1-1 call is placed, it goes from the 9-1-1 operator to the fire department. They interview the caller and the information is relayed into the dispatch system. Engines and/or trucks begin moving. A phone call is then placed to American Medical Response ambulances in the field. The process of forwarding the information from the Fire Department to AMR averages 1 minute 38 seconds.

In other parts of Riverside County, including every city but Murrieta, a new Computerized Ambulance Dispatch Link has been established, allowing the seamless and simultaneous download of data to both AMR and the local fire department.

CAD links feed real-time information to the ambulance units in the field. Instead of having to confirm details including the nature of the emergency and the address, EMS crews can begin responding to a call before the full details are known.

“It allows us to get our ambulances in motion first, and then learn about what they’re going to face on scene while they are en route,” said Sorrick.

Technology such as the CAD offers the ability to reduce response times and thereby improve services.

Updating the system could also allow the MFD to prioritize dispatches, only sending their trucks and engines to emergency calls that are necessary. Currently, MFD regularly responds to emergencies with multiple units, such as a fire truck and a fire engine.

However, most 9-1-1 calls are for minor or non-life threatening injuries like broken bones. By prioritizing and categorizing calls, they could save on fuel, maintenance, and labor by only sending multiple units when necessary.

Until such a change is made, the city has proposed a fee to help recover the costs associated with MFD’s operations.

The proposed subscription/fee structure would give residents the option to pay $48 per year or $350 per medical 9-1-1 call.

“If a resident pays the annual subscription of $48, then they wouldn’t be charged for our services,” Chief Shobert continued. That subscription-based service would also cover any visitors to their home during the year.

If they elect not to subscribe, they would be sent a bill for $350 each time the city rendered emergency medical services. That bill, however, would not be covered by insurance, including safety net programs like Medi-Cal or Medicare.

Paramedic care rendered in the ambulance is an important stage in urgent care. In certain situations – such as stroke or heart attack – minutes are vital to recovery. American Medical Response points to their system for training and certification as proof that their services save lives.

“Our paramedics and emergency medical technicians go through extensive training and at times have been asked by the communities we serve to train other fire fighters or paramedics,” says Sorrick.

At last week’s city council meeting, AMR Paramedic and Murrieta resident Shelly Hudelson was reported as saying “The fact is some of your guys (the fire department) were trained by these guys.”

In addition to the training and the new CAD system, Sorrick said that AMR is working to update lifesaving medical equipment on every ambulance, and is working with the County’s EMS Agency to develop a new, robust, two-way radio communication system for EMS crews to enhance radio communications countywide.

The Riverside County Emergency Medical Services Agency did not return calls seeking comment for this story.