City board to vote on tiered services for LR ambulances

The Little Rock Board of Directors will decide next week whether to permanently change the way Metropolitan Emergency Medical Services responds to some 911 calls after a pilot program that officials described as successful.

City Manager Bruce Moore asked that the board grant approval, which would make Little Rock the first city in the state fully authorized to dispatch less- equipped ambulances for less- severe calls while the state Health Department finalizes a rule to permit the practice statewide.

The change builds on a nearly year- old trial that allowed MEMS to respond to more than 2,500 911 calls with basic life- support ambulance crews rather than sending advanced life support to all calls, as the nonprofit agency has done since it was established 35 years ago.

Ambulances providing advanced life support must have at least one paramedic, who is licensed to do more for patients than the emergency medical technicians who can provide the alternative, basic life support.

City directors have the final say on the proposal and are scheduled to vote on the matter at their 6 p. m. meeting next Tuesday.

The board authorized the pilot program last June in an 8- 0 vote, with two city directors, Dean Kumpuris and Ken Richardson, absent from the meeting. City directors didn’t talk about the proposal during Tuesday’s agenda meeting.

The Arkansas Health Department, which licenses ambulance services, signed

off on the change and expects to finalize a new rule by early fall that would allow the rest of Arkansas to follow suit, said Greg Brown, the department’s branch chief over trauma, preparedness and emergency medical services.

“This system has been around for decades, but for whatever reason Arkansas never moved in that direction,” Brown said, noting Baton Rouge used a tiered approach three decades ago.

As it stands, an emergency provider in Arkansas cannot send basic life- support units until all of its advanced units are occupied, Brown said. He said that could result in a betterequipped unit responding to a patient with a broken toe while someone with severe chest pain is waiting for advanced life support.

Advanced support largely builds on the fundamentals of basic support by letting providers do more to treat patients. For instance, basic skills include maintaining a clear airway for patients, but paramedics can intubate patients while technicians cannot. Advanced life- support skills also include administering IV fluids and medication, according to state rules distinguishing the two tiers.

MEMS, a nonprofit agency, serves about 530,000 residents of Pulaski, Faulkner, Grant and Lonoke counties. The proposed change, like the trial, is exclusive to Little Rock.

Jon Swanson, the agency’s executive director, said the permanent change would result in more ambulances on the street. Rather than reducing the number of units with paramedics, the agency would increase how many basic-support units it has active on any given day, from six to 10, he said. Before the pilot program, basic units were used solely for transport purposes, not for responding to 911 calls.

“The reason for doing so is to add more resources, to improve the response times, and that’s the bottom line,” Swanson said.

Because emergency management services agencies are reimbursed based on the care given to a patient — rather than the personnel in the vehicle — the change itself will not significantly affect revenue, Swanson said.

Swanson said before the pilot program that basic life support is appropriate in about 17 percent of MEMS’ 911 calls. During the pilot, the agency used basic support for 7.7 percent of its calls, according to a presentation he gave Monday.

“They’re much more conservative on when they would send a [ basic- support] ambulance first than most of your national models,” Brown said.

Basic support was dispatched to 2,553 calls during the trial period, and in 14 cases, advanced life support was then called to the scene, Swanson said.

One of those 14 so- called intercepts was because a patient had low blood pressure, one was because the patient started having a seizure after the medics’ arrival and a third was because a patient reported chest pain after the medics arrived, Swanson said. The other 11 cases were related to the patients’ need for medication, he said.

“To say that the patient was in some jeopardy these 14 times, that’s not the case,” Swanson said.

Dispatchers start by assuming advanced support is necessary until the boilerplate questions they ask lead them to evidence suggesting basic support is appropriate, Swanson said. Most commonly during the pilot program, the lower- level ambulances were dispatched for reports of general sickness, he said.

During the pilot, the agency only sent basic life support to calls that rated on the lowest of a six- tier priority system, though national standards allow its use in some second- level calls. It’s possible MEMS will expand the variety of calls technicians can respond to in the future, Swanson said.

The statewide rule — which has not drawn opposition at public hearings — would require participating emergency management services agencies to provide additional training to dispatchers and to meet other standards, Brown said. He said he expects more heavily populated areas, like Northwest Arkansas, to adopt the tiered approach before smaller, rural areas do.

“There’s very few services that could turn the key tomorrow and make that happen,” Brown said.

MEMS, a nonprofit agency, serves about 530,000 residents of Pulaski, Faulkner, Grant and Lonoke counties. The proposed change, like the trial, is exclusive to Little Rock.