County fire & rescue system to use triage system for transport

When you call an ambulance, do you want to go to the hospital?

That’s the question at the center of a new call response model Valencia County Fire Chief Matt Propp hopes will lead to system-wide efficiencies for emergency medical calls throughout the county.

“We want AMR to be the ones taking people from Valencia County to Albuquerque. That keeps our fire department units in their home units,” Propp said, “and if you have an emergency, it puts a unit at your house a lot faster.”

The chief said it’s a kind of “shotgun” response to calls where AMR, the ambulance transport company serving Valencia County, often answers calls where patients decline transport.

“In the meantime, you have two or three fire department rescues from various agencies taking people to the hospital in Albuquerque,” he said.

The new model will have responders establish within the first 10 minutes of arriving on a scene whether a patient wants to be transported. Propp was clear this protocol would only be used on low and medium acuity calls.

“Say you broke your ankle and want to go to the hospital, but you’re alone or don’t have a car. Now the fire department says, ‘Send us an AMR unit. We have a patient who we have verified needs to go to the hospital by ambulance.’ An AMR unit gets there, picks up that patient and goes to the hospital,” the chief said. “The goal is, by identifying those patients, we keep the ambulances available for the transports instead of this chaotic, everybody goes everywhere and half the time AMR doesn’t transport. With a more triage-focused system, we’re hoping we can increase the efficiency of the whole system.

“We’ll be tracking that and, hopefully, we can say we’ve reduced our transports. What we’re anticipating as an agency is making more scenes and reducing the times we’re in Albuquerque,” the chief said. “Say we take five calls in a district that are 15 minutes each. That still saves us 45 minutes of out-of-service time because we’re not on a transport to Albuquerque for two hours.”

Propp added he was confident patients would understand the triage practice.

“I think enough of us have been to the ER that we understand they look at you and prioritize patients,” he said. “If we go on a call and you’re really sick, our unit will still put you in our truck and take you to a hospital. We’re not increasing risk to patients. We just want to increase efficiency in the system.”

Propp said AMR has proven to be a good partner in the county.

“I know people like to bash AMR but the best thing for the county is for them to be successful,” he said.

One problem AMR and other private ambulance companies face is Medicare reimbursement rates, which haven’t changed since 2008, the chief said.

“Factor into that, there’s an additional Medicare reimbursement for government entities,” he said. “So AMR is reimbursed 35 percent (by Medicare) for a transport. Once we have our DOT certificate and can bill, we will be reimbursed closer to 90 percent because we’ll get the 35 percent from the federal government and the state has a stand-alone find that basically helps buffer the difference for governments. That’s why you’re see the private ambulances struggling so much. We’ve put them in a position where they can’t be successful.”

Changing the Medicare reimbursement rate for ground transport has to happen at the federal level, Propp said.

“That is out of their control,” he said. “This is a tough Rubik’s cube to figure out. There’s so many moving parts and so many things against us.

“If we can get our system more efficient I think that will take us in the right direction and be impactful. Now, is it going to fix the problem? Absolutely not. The fix to the problem is a whole lot more ambulances in the county.”