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Wednesday, March 01, 2006

Ambulance Monopoly Unhealthy for City

PJS Forum letter

Ambulance monopoly unhealthy for Peoria

Saturday, April 23, 2005

Now I know why I must not have the misfortune of having a heart attack in the city of Peoria.

If the Peoria Fire Department arrives to help me before Advanced Medical Transport (AMT), which they usually do, the firefighters are not permitted to transport me to the hospital. They can do nothing to help me except basic life support, and then they must stand by and wait for AMT to arrive at the scene. Many of the firefighters have advanced level training and are paramedics, but because AMT has a monopoly on patient transport and paramedic care, valuable time is wasted. When every second can be a matter of life and death, the stricken patient pays the price.

Unbelievable, right? Believe it.

In Peoria (as opposed to East Peoria, Morton and Pekin), money is apparently more important than lives. We had better heed Dr. John Carroll's concerns. He's been right all along.

Rose Kelley


Peoria City Council Citizen Forum–July 5, 2005

I had the opportunity to speak to the City Council when citizens have their forum at the end of the open session. Here are some comments that I made from that meeting to the Council members:

Background of Emergency Medical Services (EMS) in Peoria … some key vocabulary: The physician in charge of all pre hospital care in Peoria is called the project medical director. This physician is Rick Miller. Miller is an ER physician at OSF and was director of the ER for many years, stepping down in August. 2001. The base station for all pre-hospital (EMS) in Peoria is OSF. Miller’s immediate supervisor is Dr. George Hevesy who is Director of the ER at OSF. Hevesy also holds the position as corporate medical director of AMT. Hevesy was project medical director for approximately a decade before Miller and Hevesy was on AMT’s payroll and OSF’s payroll. The project medical director is in charge of approximately 70 pre-hospital EMS agencies in Central Illinois. Heresy and Miller have controlled EMS in this region for the majority of the past 20 years.

AMT is Peoria’s private ambulance company. It is supported by Peoria’s 3 hospitals. Administrators from all three hospitals sit on the AMT board of directors along with very influential members of Peoria’s business community. (Administrators from all 3 hospitals attend City Council meetings when AMT looks like they might not obtain a contract.) AMT has the only paramedics that are permitted to give advanced life support and transport the patient in Peoria. Several years ago AMT grossed over $7,000,000 for their services in the Peoria area.

The PFD responded to greater than 9,000 health-related 911 calls in 2003. They can provide only BLS at the scene and cannot transport. Even though the PFD has paramedic firefighters, they are not allowed to use their skills in Peoria. With that background, consider the following vignette and put yourself in this patient's place and see what you think:

Several weeks ago, a man in Peoria who was eating in a Peoria restaurant, collapsed, and bystander CPR was started. 911 was called. The PFD arrived and shocked the patient who was pulseless His pulse returned. AMT arrived and attempted to place a breathing tube to help the man breathe and protect his airway. For one reason or another, this was not accomplished. Insertion of tubes can be very difficult in emergent situations. The PFD firefighter on the scene was not allowed to attempt the tube-a memo had been released that very morning stating that firefighters can only provide basic life support even if they are paramedics. Another firefighter had been placed on a 90 day suspension when he put a tube in another patient several weeks prior to establish the airway for the patient. The patient described above in the restaurant died.

Just think if that man were you or a family member of yours?

Here are questions that the family of this gentleman or anyone with an interest in EMS in Peoria could ask at a neighborhood meeting:

1. Why wasn’t the PFD paramedic allowed to help with his ALS skills in Peoria but can do so in surrounding areas?

2. The family of the deceased man should ask Andrew Rand, Director of AMT, why he stated in a PJS article (Dec. 8, 2002) that they did not want the PFD in the ambulance business for years. (When the PFD shows up earlier than AMT at the scene, shouldn’t they be able to offer the best possible care to the patient?)

3. Miller and Hevesy need to be asked why Joliet, Rockford, and Springfield firefighters can act as paramedics while at work and the firefighters in Peoria cannot.

4. The family of the man that died needs to review the run sheets concerning the care given to their father. We all need to ask how Peorians are doing over the last 13 years since AMT was formed and supported mainly by OSF and OSF physicians. We need to know health care statistics. When I called the EMS office at OSF, I was told by the director that there were no aggregate data. When I called the district office of IDPH in Peoria told that they had no generalized data from AMT. When two FOIA requests were made to IDPH in Springfield, no meaningful help was given me from the Stature. The $79,000 consulting study from California (Matrix) reported no meaningful health care statistics regarding how AMT and Peoria are doing when they reviewed AMT last summer. Dr. Miller and Hevesy need to be asked about this. Do these data exit? If not, why not?

5. On page 52 of the Matrix report, they state that studies have shown that paramedic care is proven to be statistically significant in improving positive outcomes in patients with chest pain and problems breathing. As mentioned earlier, the PFD responded to more than 9000 calls in 2003. Interestingly, 1900 of these calls were for breathing problems and 900 were for people with chest pain. The PFD responded an average of almost 2 minutes quicker to life threatening emergencies than did AMT, yet the PFD cannot offer advanced life support.

In conclusion, valuable time should not be wasted at the scene of a 911 call while a firefighter paramedic is prevented from using his/her advanced life support skills.

John Carroll, MD - Journal Star Opinion
Let Peoria firefighters give enhanced aid at emergencies
Thursday, July 14, 2005

Re. July 7 article, "Rescue services get some criticism":

Dr. Rick Miller, OSF emergency physician and medical director of emergency response services in Peoria, should allow the Peoria Fire Department to use its advanced life support skills at the scene of an emergency. This is such a basic public service issue, it shouldn't be a point of debate.

Contrary to what the Journal Star led readers to believe, firefighter/paramedics cannot protect the patient's airway with a breathing tube or administer advanced life support medications to the critically sick or severely injured. With Dr. Miller's support, Advanced Medical Transport, (AMT) the private ambulance company that is the only provider of paramedic and transport services in Peoria, can do both.

I don't believe that the director of AMT, Andrew Rand, has to worry about losing his company's lucrative monopoly on patient transport. Does Mr. Rand realize that for each minute a critically injured patient is not transported from the scene, the patient's chances for survival decrease by 5 percent? Those minutes can add up quickly. Hopefully, a mass casualty will not occur in Peoria which would overload our deficient emergency medical system.

With the intense local corporate support of AMT and the Journal Star's inadequate reporting of the real problems, our local health care leaders will probably tweak the system, but I doubt change will occur that will significantly help Peorians who suffer a prehospital emergency.

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