CCMSD looks at restrictions on ambulance duties

If a Sundance ambulance is asked to stand by at an event, or is called out multiple times by a commercial entity to assist a person who has fallen, Crook County Medical Services District (CCMSD) is considering whether it should reserve the right to assess a charge.

The Board of Trustees considered two policy changes at last week’s regular meetings, both suggested by EMS Director Antony Vopat.

“One of the things our EMS director is wanting to do is to have the option to charge for standby services,” said CEO Micki Lyons, introducing the first.

“They’re there all day and he has to get an extra crew in to do that.”

Standby services involve a staffed ambulance attending an event in order to be on scene should medical assistance be required. Because a second ambulance must still be available for other callouts, the district is paying two crews during that time.

The district often provides standby services for large gatherings, such as the Sundance Winter Festival, or sporting events such as a rodeo or football game.

“As we should,” said Trustee Mark Erickson of the latter example. “It’s a community service – that’s our kids.”

However, not all events are created equal. The board considered that, while some are designed to be of benefit to the community, others are held for profit purposes.

The board agreed that CCMSD should not necessarily be contributing to those profits, but should still support events that are meaningful to the community.

“I think there are a lot of things…that, to me, are our civic duty, in a sense,” said Erickson.

Erickson listed examples such as the county fair and school events, or the aforementioned winter festival, all of which are for the benefit of the community, among those he feels should not be charged.

On the other hand, he supported the idea of a charge for an event promoted by a private entity.

“We need to have something in place so that if it’s…really somebody trying to personally benefit from putting on an event, then I think we need to charge for it,” he said.

The proposed charge would be $150 per hour with a minimum of two hours. This would cover an ambulance, driver and paramedic or EMT.

It’s not legally required that an ambulance be on scene for most events, Lyons clarified in response to a question from Trustee Sandy Neiman. However, said Erickson, it is often required for insurance purposes – especially in situations where seconds or minutes can make the difference, such as an accident during rodeo.

The change in policy would only affect Sundance’s ambulance service and would not apply to the independent services in the other towns.

As the district is countywide, its ambulances could theoretically offer standby services in the other communities. However, explained Lyons, each community generally seeks standby services from its own crews, though, “…If we were asked to stand by at an event in Moorcroft, we would absolutely try to accommodate that.”

While generally happy with the policy, Erickson questioned who should make the final decisions about what should or should not count as a community event. He wondered if the board should be involved.

However, Lyons suggested that it could prove inefficient for someone applying to standby coverage to then wait for the next board meeting to hear the district’s response.

“You also hired me for a reason, so do you really want to get into the nitty gritty of making these decisions and me having to come to the board every time we have one of these?” Lyons asked.

Board Attorney Kara Ellsbury further pointed out that this could put the board in the position of having to call special meetings every time a request is received. Erickson respectfully disagreed, expressing his belief that arrangements for events should be made in plenty of time.

“What’s that old saying? ‘Lack of planning on your part is not an emergency on mine’,” he quoted.

As the discussion drew to a close, the board agreed it was in favor of supporting community by not charging for events in which governmental agencies are involved, but that the final decision should rest with the CEO rather than the ambulance director.

Lift Assists

Another common situation encountered by Sundance’s ambulance crews is a request for assistance from a person who has fallen and cannot get back up without assistance. No further care is required, so the patient is not then transported to the hospital for treatment.

The proposed policy would not affect calls from private patients who needed assistance. However, it would tackle situations in which the ambulance is being called out multiple times to an address belonging to a for-profit commercial entities, such as an assisted living facility

Some entities are calling on CCMSD rather than having their own members of staff perform the service, said Erickson, describing it as a “continuing trend”. He questioned why CCMSD should be subsidizing these businesses.

“You are taking people from my staff, who are supposed to be there in case something happens on I-90…because you don’t want to handle it yourself at your for-profit place,” he said.

It’s not simply a matter of financial strain, he said. What happens if the ambulance is responding to a call from a for-profit entity when a vehicle crashes on I-90?

“I don’t have a problem with this lift assist policy. I think it’s something we should have been doing for some time,” said Erickson.

Neiman asked if there might be a possibility that CCMSD could enter into a contract with a commercial facility to provide these services, which would cover the costs for such things as time and fuel.

Erickson pointed out that the draft policy does already perform the function of a contract in that it spells out what the fees would be for the entity making the call.

At Neiman’s suggestion, the board considered whether the policy should simply refer to a “call out charge”. In other words, the charge would apply to any situation where the ambulance is called out to a private business to perform a service that does not result in the patient being transported to hospital.

Trustee Brent Fowler expressed concern that the businesses will simply pay the fee and pass this cost on to the customer, which will not make them any more responsible about offering the service themselves. While she acknowledged this was likely, Lyons argued it is not the district’s place to subsidize the business’s customers.

“We’re doing a job that somebody else is getting reimbursed for, in a sense, but we’re having to do the work for free,” added Erickson. “I don’t think that’s right.”

Due to potential changes to the wording, the board chose to table this policy for further consideration.