EMS service shouldn’t lessen quality at a higher cost

Published 6:18 pm Friday, November 25, 2016

For several decades the City of Washington has provided EMS service for itself and large areas of Beaufort County. In January 2016, the county commissioners began exerting uninvited influence over the operational control and service areas of the city’s ambulance service.

As part of the changes in EMS policies, the commissioners increased the county’s EMS department while expanding paramedic or Advanced Life Support service. They have also decided against renewing the City of Washington’s EMS agreement covering Washington Township. The county intends to provide ambulance service to this district from an EMS station located on N.C. Highway 171 to the east of U.S. Highway 17.

This change in coverage creates two problems.

First, the new EMS facility’s proposed location is further from the main population and traffic areas of Washington Township than the current EMS location at Washington’s Fire House No. 2. This will result in a lengthening of response times for emergency calls. Second, the loss of revenue from the cancellation of the current EMS agreement will cause a $250,000 shortfall in the city’s EMS budget while at the same time requiring a $125,000 to $175,000 subsidy from the general revenues of the county to help partially fund the reorganized ambulance service.

Most of Washington Township will end up with longer response times for emergency calls, while county and city taxpayers will be called upon to pay $400,000 in additional yearly taxes.

Can the switch to paramedic service compensate for the delays in response times? Maybe, not.

In October 2015, Prachi Sanghavi and researchers from the University of Chicago, Harvard University, and Harvard Medical School published the results of a statistical study comparing mortality rates among patients suffering from trauma, respiratory failure, heart attack and stroke when transported to hospitals by Advanced Life Support (ALS) and those transported by Basic Life Support (BLS). The study looked at 7.9 million randomly sampled Medicare patient-ambulance transfers that occurred between 2006 and 2011. The National Science Foundation and the National Institutes of Health funded the study.

The results of the investigation are surprisingly counter-intuitive: “Advanced Life Support is associated with substantially higher mortality for several acute medical emergencies than BLS.”

Although the paper does not attempt to establish a cause and effect relationship for the inferior outcomes that accompanied ALS transport, it does offer several possible explanations for its findings, e.g., ALS involved more complex procedures, more set-up time on site and consequently longer times to hospitals. Prof. Joseph Newhouse, one of the co-authors, commented, “… in medicine costlier isn’t always better, simply transporting the patient to the hospital as soon as possible appears to have a high payoff.”

Outgoing commissioner Robert Belcher has suggested a time-out while concerns over response times from the new EMS facility can be discussed with the residents in the affected community. That’s a good idea. While they’re at it, the commissioners need to sit down with the city’s representatives and negotiate an agreement for EMS service that doesn’t lessen the quality of medical transport as it increases its cost.

Warren Smith is a Beaufort County resident.