PSAPs and private ambulance contracts

Big Blue TO/\/\ · Post by **Big Blue TO/\/\** » Thu Jan 29, 2004 9:19 pm

Any of you wonderful dispatch supervisor types out there, I have a little research project, and need hard information. If you know the workings of the following, please email me direct...

a] legality of a PSAP charging the ONLY ambulance provider in town to tone them out and keep their times (not even well but that's another story)
b] the going rate for above
c] what could we demand of them for free
d] probably some other ?? once we start talking.

Thanks
Tom
Wyoming Medical Center
Life Flight
Etc.

Gerbil · Post by **Gerbil** » Thu Jan 29, 2004 9:56 pm

whats a psap?

Big Blue TO/\/\ · Post by **Big Blue TO/\/\** » Thu Jan 29, 2004 10:10 pm

Public Service Answering Point

aka : 911 Center

911_guy · Post by **911_guy** » Thu Jan 29, 2004 10:46 pm

The PSAP that I work in covers EMS/Fire dispatching for our county is actually a county entity at the rate of about 45000 calls/year, and provides the service to city and county agencies for no cost to said agencies. They happen to get very good service, and very little negative feedback from the field units.

If the PSAP in question is a private organization, they are well within their rights to charge, and are under no obligation to provide any services without cost. If, however, they are a public agency, things become very different, because they are funded by the appropriate government.

As for demanding/requiring certain services from them, that is pretty much contingent upon the public/private aspect.They can decide to provide or not provide any or all of their services to the user agency in question.

This is, for me, a good insight as to how other centers/ agencies interact. Keep us informed as to the progress, and any other updates you get.

Big Blue TO/\/\ · Post by **Big Blue TO/\/\** » Thu Jan 29, 2004 11:26 pm

OK, a little more info...
The PSAP is a City/Municipality run/funded organization.

The ambulance (and flight service) is technically the County Hospital, sort-of privately run.
We are charged an EXORBITANT amount of money for them to push a button, say a few words, and track times on a screen for the short duration of our calls. If we pick up the ring-down and they have to answer any questions, that is subject to charge. If we call on the phone, same thing.

We are seriously pushing to initiate our own dispatching, in-house. we already have all the equipment. Personnel is truly the only issue. Calls would still ring into the PSAP, but we would no longer require them to tone us, or track times. We would not communicate to them except via our dispatcher. Fire and/or PD go to 100% of our calls, so we would get the info from the dispatch of those units.

This is how many in-house privates operate, some very large ones in-fact do what I call Monitored Dispatch. Scott & White in Temple, TX, Albuquerque Ambulance, to name 2
We want a general idea of what others who may do things this way are paying for it, if at all.

As pointed out, it's a tax-funded municipality, and we are the only game in town, and not expecting much, and soon will expect even less.

I don't want to get into the reasons why we want to do this, other than to increase safety, efficiency, and solve an interoperability problem.

Thanks.

Gerbil · Post by **Gerbil** » Thu Jan 29, 2004 11:52 pm

i was going to ask, what the feasability of just taking over your own dispatch would be.

that tends to solve alot of issues.

another thing is co-locating one of your dispatchers there with the equipment.

Big Blue TO/\/\ · Post by **Big Blue TO/\/\** » Fri Jan 30, 2004 12:11 am

The idea IS to take over our own dispatching, we just don't want to pay the HORRENDOUS fees they are insisting we still pay.

The co-locating idea actually did come up. The center has only 4 stations, and 3 of the 4 are "behind the line" so to speak in that they can "see" the NCIC screens which means if any of our people were on any of those stations, they'd have to go thru the full rigamoral for it, even if they dont ever use it.
Additionally, there is terrible politics and some bad blood, that would pre-clude it.

If the center cant' afford to pay staff to staff their own center (never more than 3 controllers on at once...) it will look weird with one of ours there. There are perceived risk management issues as well. key word is perceived.
Also, in the job description we have written for our dispatcher, there's a ton of stuff that can be done "locally" like administrative things to justify the position in the 1st place that they could not do if they were downtown.

Good ideas tho...I can see it working for some areas where things are not as oil/water

911_guy · Post by **911_guy** » Fri Jan 30, 2004 2:15 am

What type of call load and area does your air ambulance cover? If you could justify keeping 1 or 2 dispatchers on at a time, it would be a smart idea, for simplicity's sake. You could have your dispatcher right there at your base, and everything would probably run much smoother. And you could get better service, because your dispatchers could/should have some medical/EMD background.

Oh, and by the way, let me know when you post the job opening.

Big Blue TO/\/\ · Post by **Big Blue TO/\/\** » Fri Jan 30, 2004 3:11 am

we cover pretty much the whole state, give or take.
The ground service is a smaller region, but can go far, due to weather, etc.
We are looking at 4.5 FTE's to staff the thing 24x7 in 8 hour shifts.
The EMD will be covered by the PSAP (they will require that they stay on the line if they txfr a call, and even without the txfr, they are an Apcor center, so the EMD EVERY call.)
We will require EMT-B at minimum to work ours, and use it as a breeding ground for future medics.
We do about 3,000 calls a year, + flight volume
Yep, we are thinking along those lines....yes... do it ourselves. just have to figure out how to cut the cord and not continue to pay...

I certainly will post the info. Casper is a nice place to live, if you can take the wind (keep in mind we have a different scale... up to 35mph it's just a breeze! )

911_guy · Post by **911_guy** » Fri Jan 30, 2004 3:17 am

I would think that the first step in cutting the cord, so to speak, would be to perform your own EMD on calls for service. The only true way to get the service youwant is to build it up from the ground level and do it yourself. The PSAP performing APCO EMD is all well and good, but you have no control of the QA/QI, and can not control how it is done.

Just my thoughts, take them with a grain of salt.

Gerbil · Post by **Gerbil** » Fri Jan 30, 2004 11:44 am

Three shifts.
A shift: 0800-1800
B shift 1000-1800
C shift 1800-0800

Thats how the company i used to work for did it.
That way you have two dispatchers on during peak hours.
The 1800-0800 graveyard shift had less calls, and their policy allowed the dispatcher to sleep if there were no units out.

The company was the ems provider for the county, as well as covered in city transfers and city 911 overflow.

The 911 call would come into the county dispatch center (usually. every now and again, it would be routed to the city 911 center, then transfered back out to the county) The call taker would take the call, the dispatcher would monitor the call as needed, determine that it was an EMS call, page out the correct fire district, complete the card, and then call the ambulance dispatch.
The ambulance dispatcher, as well as the 911 stations had all-call pagers, so they got the initial dispatch when SO sent it. The SO dispatcher would relay any additional information to the amblance dispatch, she'd enter it into the computer. If the unit was already mobile, she would broadcast the call over the air to them, which gave them the official "respond" command. If the unit was not mobile she'd send the alarm to the station, they had 60 seconds to get out to the unit and respond to the radio call. If the ambulance dispatch needed more info she could either call back the caller's landline directly or call the SO office for more information.
In the event of a non-secure call, ie an assult or gsw, the SO office would remain on the line with the ambulance dispatcher untill the call is secured.

They had a dispatch center in their primary station. It had the computers they used for call control and monitoring, a dedicated computer for sending text messages to the employee and emergency pagers, etc.

Let me know if you want more info then that.

bjlf · Post by **bjlf** » Fri Jan 30, 2004 2:48 pm

What would the staffing charges,benefits for employees ect. be compared to what you are paying now?

You, like someone said would have to staff 24x7x365. That would be alot of payroll.

Big Blue TO/\/\ · Post by **Big Blue TO/\/\** » Fri Jan 30, 2004 3:04 pm

Our new director is writing into the budget for 4.5 FTE's
That doesn't cover it 100% but we have a staff (ft and pt) of like 34 people, virtually all of whom are willing to pull an 8 in dispatch. There are 2 of us medics who are planning on moving into dispatch for some time to get it up and running.

We will likely add the requirement to pull a mandatory D shift every 4 weeks or something (we're all OT hungry anyway)

The positions will be FT so the employees who are hired just for D will get bennies, etc.

All the staff is very supportive and willing to help because we need to do this so badly.

Even with the PSAP doing everything they do now, we still have someone sitting at our console all the time (unless all units are out) to write all the call info in the log, take the pt report over the phone, call trauma teams, and flight track. Downtown does NOTHING with the flight side of things. Right now, if all the 911 trucks were out, and a flight team launched, the only radio covereage we would have with the aircraft would be an ER nurse walking by hearing it squawking, and/or the unit secretary who has a remote mic/speaker on her end, if it's turned up. Yes, I really said this, we somethimes DONT have anyone watching our own butts... hence teh reason for change!

The mechanics of scheduling, and how to do the dispatching is covered, with experienced folks on our end. My biggest hurdle I am researching is the whole "contractual obligation" thing. And of course the political can of worms. I have a feeleing there will be newspaper coverage before it's all over. Heck, they won't even give us tapes of air which we need to prove the points to both the City manager, and our Hospital ceo/board. I've now got to find the old recorder we have, and start recording stuff on my own, for safety's sake. There's a system that was routed to the old directors office, gotta figure it out and get access to it now that she got on her broom and left.

Bikemedic · Post by **Bikemedic** » Fri Jan 30, 2004 3:50 pm

Two issues that you might use in your favor. One is HIPPA. the other is Medicare and Medicaid. In the later no one can sell , buy or charge for the referal of Medicare and Meidicaid Patients. Now they can say that they are charging for a service, but hen hey would have to justify the charge.