Commissioners may consider whether Cape Girardeau County's ambulance services need expansion

Tuesday, February 15, 2011
Cape County Private Ambulance EMTs Grant Pingel and Christina Degenhardt remain on scene at a fire shortly after 8 a.m. Monday on West Cape Rock Drive in Cape Girardeau. Pingel and Degenhardt had just began their 24-hour shift at 7:30 a.m. Monday when they were called to the scene of the apartment fire. (Laura Simon)

Two years after a failed push to get a public ambulance service on the ballot in Cape Girardeau County, Cape County Private Ambulance retains its exclusive $225,000 contract to provide ambulance service throughout the county.

But one county commissioner said he'd like to see the service expand, with facilities in outlying areas of the county, to provide faster service to county residents who complained about response times during his election campaign.

Commissioner Paul Koeper said when he ran for office in 2008, many county residents voiced concerns that they lived too far away from ambulance service. Koeper said he believes the private service needs to expand farther into the county's more rural areas.

While he hasn't done extensive research into public ambulance service or a tax to support it, he said he understands it would take a lot of money to fund an ambulance district. Ideally, he'd like to see ambulance centers in Delta, Millersville and Fruitland, as well as Cape Girardeau and Jackson. He estimates that would cost from $5 million to $6 million a year.

"Part of that would be subsidized from private insurance, part from taxing," he said.

Since forming in 1968, Cape County Private Ambulance has been providing emergency and nonemergency service throughout Cape Girardeau County. With more than 570 square miles in the county to cover, ambulance president Dr. John Russell said knowing where to staff ambulances and personnel is important to ensure quick response times.

"We look at historical models, where calls come from and we try to staff in those areas. It's much more like a police department staffing model than it is a fire department staffing model," he said. "We move them around, depending on day of week and time of day."

The company's headquarters is on Kingshighway in Cape Girardeau, but Russell said typically his ambulances will be placed at a convenience store corner while waiting for the next call.

As expected, the areas with the highest populations, the cities of Cape Girardeau and Jackson, have the most calls.

"The outlying county area is not a very high-volume or a high-visibility area," he said.

If calls in rural areas increased drastically, ambulance staffing would be adjusted to meet the demand.

Other than an annual $225,000 subsidy from the Cape Girardeau County Commission, the private ambulance service doesn't receive tax or public support. It exists with fees collected for services rendered.

"It's volume-driven. The reimbursements for services are dependent upon, frankly, transporting a patient," Russell said.

The ambulance service charges for each trip. Depending on the level of care provided, patients can expect to pay between $365 and $720 for emergency transportation. Mileage charges are also incurred for each ride.

Russell said it costs roughly $500,000 a year to staff one ambulance 24 hours a day, seven days a week. That doesn't include administrative and dispatching costs.

Russell's company has nine ambulances, but depending on the day of the week and the time of day, about four to six are actively staffed.

In the contract the ambulance service has with the county, in order to receive the subsidy, response times for Cape Girardeau and Jackson calls are outlined. The average response for a call in the two cities should be within eight minutes from the time the call is placed to dispatch to an ambulance arriving on the scene. In 2010, the average response time was five minutes and 50 seconds for calls in the two cities.

The county contract does not specify response time to outlying locations, allowing for the county's "diverse nature and geography." Russell said the ambulance service averaged a response time of 13 minutes and 22 seconds for out-county areas.

Despite meeting the requirements of the county contract, Cape Girardeau County commissioners said it is in the county's best interest to regularly evaluate the area's ambulance needs. Even though there are no formal discussions or plans to institute a public ambulance district, Presiding Commissioner Clint Tracy said reassessment is always good.

"The commission is in charge of the health and welfare of the county and public safety comes first," Tracy said.

Tracy said he is always leery when discussing new programs and services that would require additional taxes.

Koeper also said he is sensitive to adding a tax to county residents but that investing in a countywide ambulance service is similar to purchasing insurance.

"Most people buy life insurance, health insurance, home insurance, car insurance," he said. "You pay lots of money for it and hope you never have to use it, but when you need it, it's there."

Neither Koeper nor Tracy has seen recent response times, they said, but per the county's contract, the ambulance service will provide quarterly response times upon request.

Commissioner Jay Purcell said as Cape Girardeau's representative on the commission, he doesn't hear many complaints about the ambulance service. He said he knows there are some county residents who would like to see an expanded service but that additional coverage comes at a cost.

Neither Saint Francis Medical Center not Southeast Hospital has a definite opinion on the merits of a tax-based service versus a private one.

In a written statement, Saint Francis president an CEO Steven C. Bjelich said the hospital is interested in any discussion about a tax-supported ambulance district, particularly as it routinely works with first responders.

Mark Bliss, publications coordinator for SoutheastHEALTH, said the hospital has no position on the topic at this time.


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