Proposal to Upgrade the Town’s Emergency Medical Care

By Joan Bowen

Fire Chief David Grunes presented a proposal to enhance the Town’s level of emergency medical care at the Selectmen’s meeting last week (May 12).  Consistent with the Fire Department’s objective to provide the highest quality response to medical emergencies, the recommendation is to increase on-duty staffing to meet current demand during peak hours and to enhance the level of care.  Grunes assured the Selectmen that the department would “use an efficient financial business model that minimizes the impact on the tax levy.”

The Fire Department has identified an emerging trend of increased demand for emergency services as well as multiple simultaneous and sequential emergencies. While the number of fires per year has remained relatively level at 40, calls for emergency medical service have increased with a growing residential and day-time population.

Coupled with this local trend, has been the movement of many fire departments to provide advanced life support (ALS) programs.  Bedford’s current level of service is identified as basic life support which is staffed by an emergency medical technicians (EMTs), qualified on the basis of 140 hours of training.  Paramedics who have received 1200 hours of training provide the advanced life support level of service.

Grunes provided examples of the differences in the limitations to emergency responses by EMTs and the more significant responses paramedics can provide.  For instance, an EMT is authorized to provide no more than five medications (baby aspirin, EpiPen, Albuterol, oral glucose and nasal Narcan).  The paramedic is authorized to administer approximately 44 medications, advanced intravenous and intraosseous placement (IV & IO) and advanced diagnostic capabilities.

Committed to best practices, the Fire Department developed a plan to upgrade to ALS service. The recently completed contract was negotiated to include these provisions to enable implementation:  a stipend for firefighter paramedics, an incentive to existing firefighters who train to the paramedic level and the recognition of the requirements of different staffing levels to address peak service demand if the upgrade is implemented.

Throughout the presentation, Captain Mark Sullivan, Lieutenant Scott Ricker and firefighter Joe Barilla provided information on issues related to the current level of service including response times and difficulties initiating treatment of medical emergencies as early as possible. They told the Selectmen that failing to implement the proposal will be cheating the citizens of Bedford of the level of care that will provide optimal emergency care.

Grunes told the Selectmen that full transition will take eight years.  It will require hiring four new firefighters/paramedics to increase on-duty staffing during peak hours as of February 2015, training four current firefighters to the paramedic level and through attrition replacing current firefighters with firefighters/paramedics.  He provided a financial model to demonstrate the incremental costs, reductions of expenses based on a declining use of external services and potential increases in revenue.

During FY ’15, the incremental costs are projected to be $187,134.  This cost would be offset by an approximate $30,000 reduction in costs and a potential increase in rates.  The potential revenue increase is projected at approximately $66,000 based on an assumed rate increase.  The estimated budget impact in FY ‘15 will be approximately $90,500.  Financial projections were provided for the first five years.

The presentation concluded with a timetable for securing approval for implementation.   Grunes will meet with the Finance Committee on June 5.  The plan is to return to the Selectmen on June 9 to answer remaining questions and to request approval to move forward with full implementation.

Selectman Bill Moonan suggested that there is a need for an additional meeting prior to June 9.  It was agreed that Grunes would attend the Selectmen’s meeting on May 27.  The Selectmen will provide Town Manager Rick Reed with their questions prior to that date.  Appreciation for the background materials and the presentation was expressed by all the Selectmen.