Two years after the idea first came up, the Platteville Common Council is expected to vote next week on Southwest Health’s taking over Platteville’s EMS services.
An informational meeting on the proposal will be held in the Municipal Building council chambers Thursday at 6 p.m., five days before the Common Council’s May 26 meeting.
Information on the proposal, including the proposed agreement between the city and Southwest Health and Frequently Asked Questions, can be found at www.platteville.org/?post=18447.
In the proposed agreement between the city and Southwest Health, the hospital would upgrade EMS service to paramedic level, with a combination of paramedics and EMTs staffing the service, within two years of approval. Southwest Health would build a new ambulance garage and take possession of Platteville EMS ambulances and equipment.
Under the terms of the proposed agreement through 2034, the city and the seven towns in the EMS district will pay Southwest Health $100,000 in 2016, up to $150,000 in 2017, and from $130,000 to $150,000 per year between 2018 and 2024. Annual reimbursement could increase annually by the Consumer Price Index from 2025 to 2034 at Southwest Health’s discretion.
Southwest Health estimates in the contract that paramedic service would cost about $200,000 per year, including construction and ambulance replacement costs.
“You can look at that as Southwest Health is upgrading paramedic service on our dime,” said Southwest Health CEO Dan Rohrbsach. “Basically we’re shouldering that paramedic increase,” with the municipalities paying for an EMS building and equipment over the term of the agreement. “Cost is always an issue; we’re very conscious at that.”
“I believe that we should act like we are — a regional center that is progressive and looking forward,” said District 3 Ald. Barb Daus. “By moving to paramedic-level it will serve our citizens better. It will provide a type of care that isn’t available elsewhere in the area.”
Common Council president Eileen Nickels said Platteville EMS service now is “great; it’s awesome … but realistically we’re going to need a new building, and the cost of equipment is going up; it’s not going down. … It wasn’t an easy decision, but I think it’s a good decision … for all of the area we serve.”
In addition to the City of Platteville, Platteville EMS provides service by annual contract for all or part of the towns of Platteville, Belmont, Elk Grove, Ellenboro, Harrison, Lima and Smelser. The city and the towns would have to approve Southwest Health’s taking over EMS services, or if not find a new EMS provider.
City Attorney Brian McGraw said May 12 that the towns “seemed to view it positively” in initial discussions. McGraw said the agreement “puts the hospital in the position of serving customers, and customers include the city and participating townships.”
Platteville EMS serves about 17,000 people, with the City of Platteville totaling 77 percent of the EMS district and the Town of Platteville 10 percent. About 85 percent of Platteville EMS’ calls are within the city boundaries.
The annual costs to the EMS district municipalities of up to $150,000 were reduced from initial projections of $200,000 to $250,000 per year when the subject first came up in 2013.
The City of Platteville’s 2015 budget estimates $475,288 in EMS-related expenses, offset by $473,788 in EMS-related revenues. Platteville EMS has essentially broken even the past few years, according to city officials.
EMS costs are not just part of municipal budgets, though.
“For individual patients being transported, most services are covered by insurance,” said Rohrbach Tuesday morning. “Where they are not, they are billed per the specific service each patient receives. The charges for basic services are no different with or without paramedics. Of course, for those who require additional higher levels of more advanced services, it follows that those instances would come at a greater expense. But, who would argue against the benefit of some added cost in specific instances if the services needed to save a life were available?
“As for transfers, the same cost structure applies, so patients should not notice any increased expenses there either.”
The discussion was spurred in part by the need for a new EMS facility to replace the EMS garage on Furnace Street under the city’s old water tower. The city had included $500,000 in a previous Capital Improvement Plan for a new EMS garage, but later construction costs were estimated at up to $1.5 million. The city also planned to spend $250,000 for a new ambulance in the near future; the city has $150,000 to $160,000 in a ambulance replacement fund.
The EMS garage discussion took place at the same time as discussions about expanding the fire station, possibly including ambulance parking, or building a new fire station.
State law requires every municipality to either provide emergency medical service, or contract with a provider for EMS service. In addition to providing basic first aid, EMT–Basic services can provide aspirin, albuterol, Atrovent for asthma or Chronic Obstructive Pulmonary Disease, epinephrine and glucagon to increase blood glucose levels.
Platteville EMS is classified as an EMT–Intermediate Technician service, which is able to provide IVs and more medications than an EMT–Basic service, including nitroglycerin for chest pain, Narcan for narcotic overdoses, and 50-percent dextrose for diabetics.
According to the Wisconsin EMS Association, EMT–Basics are certified after 140 hours of training. EMT–Intermediate Technicians require another 100 hours of training. EMT–Intermediates require another 335 hours of training, and Advanced EMTs require an additional 170 hours of training beyond that.
Paramedics require 1,000 hours of training to get a license. Paramedics can administer 40 or more medications, and perform some procedures, including sedating a patient to insert a breathing tube.
Platteville EMS currently has 26 EMTs, including three paramedics, after two recent resignations. In 2014 Platteville EMS had 1,165 calls — an average of three per day — but 2015 call volume so far projects to an 11 percent increase over the year.
Even though Platteville EMS is not a paramedic-level service yet, a memo from at-large Ald. Ken Kilian indicates the city may move toward instituting paramedic-level service even without an agreement with Southwest Health.
The memo also indicates concern over ability to find EMTs, particularly during daytime hours, when Platteville EMS now is staffed by UW–Platteville students.
“These staff are paying thousands of dollars a semester to obtain an education and they are constantly being called out of class to answer 911 calls and provide the services that we do provide,” said EMS administrator Brian Allen in Kilian’s memo. “Without these students, Platteville EMS would likely not be able to provide transfer services, let alone 911 services to the area.”
Another city concern is replacing the current EMS building. According to Kilian’s memo, a 7,000-square-foot EMS garage — about 2½ times the size of the current garage, but a building that would “very strongly resemble the existing facility” — was estimated to cost $814,000, not including furnishings, emergency power, or a vehicle exhaust removal system.
The memo says the city would not be able to build as much facility as Southwest Health could build “because the city must currently pay prevailing wages as required of a government agency by state law.”
The closest paramedic services in Wisconsin are several Madison-area EMS services and Tri-State Ambulance in La Crosse. Paramount Ambulance in Dubuque is also a paramedic service.