New EMS agreement discussed with council

Cary Ashby • May 2, 2019 at 9:00 PM

An extended agreement involving emergency medical services was the major topic of discussion during Norwalk council’s work session Tuesday.

Law director Stuart O’Hara said the three-year agreement would provide 24/7 ambulance service for the city. According to city hall documentation, “this agreement shall automatically renew for periods of one year each, commencing April 21, 2022 and April 21, 2023, respectively.”

O’Hara told council the agreement took many months of cooperation among the city, North Central EMS, Fisher-Titus Affiliated Services and the Norwalk Fire Department with an eye toward offering quality emergency medical services. The previous EMS agreement was 10 years.

The proposed agreement calls for the creation of a “joint quality assurance control board” with representatives from the city, North Central, Fisher-Titus Affiliated Services, the Norwalk Fire Department and MetroHealth. O’Hara said the board will set the quality standards, review how each party is doing and see how the services can be improved.


‘Back-up ambulance’

As part of the agreement, a “back-up ambulance” will be housed at the fire station and its maintenance will be the only cost to Norwalk. O’Hara said the squad will respond when North Central EMS cannot arrive in a time set by the board and also will be able to resupply medical supplies of the medical truck used by the fire department.

Council members had several questions about the ambulance and its use.

“It’s not going to be there for an ambulance that normally responds. It is there for that unusual circumstance where everything is going to heck in a hand basket,” fire Chief John Soisson said. “If it happens a couple times a month, I’d be surprised.”

Firefighters would run the ambulance in those cases. The vehicle will bear the number “511.”

“All our guys are EMT trained,” Soisson said, referring to emergency medical technicians. “We have seven paramedics.”

Paramedics handle advanced life support.

“They are allowed to operate on scenes to the level of their training. The crews work really well together; we’ve been doing that for years,” Soisson told council. “At the crew level, we are not changing a whole lot of things.”

Councilwoman Samantha Wilhelm asked about the maintenance expense to the city.

“The vehicle that is being given to the city to use and, in essence sold to them, is one of our vehicles that … has about 150,000 miles on it. We maintain our own vehicles, so we will work with the city on keeping that cost to a minimum,” said Steve Fries, chief financial officer of Fisher-Titus Affiliated Services.

“Again, we’re not in the business of trying to sell you a white elephant or anything. If there are any problems with the vehicle, we will figure that out. … We will work with the fire department and John and his team to insure that those costs don’t become excessive.”

Fries also said given that it’s expected for the ambulance to run only a few times a month, “there shouldn’t be a lot” of maintenance costs, aside from fuel. O’Hara said the title of the vehicle will stay with North Central EMS during the agreement in order to correspond with Medicare and Medicaid reimbursement rules.

Councilman Dave Wallace, a retired Norwalk firefighter, asked about how billing will work.

As a legal matter, O’Hara said firefighters will be listed on the North Central EMS employees roster for those who would go on squad runs “so they’re covered for the Medicare and the Medicaid billing.”

Councilman Matt Doughty asked about how firefighters manning the reserve ambulance will impact overtime.

Until the fire department and North Central experience those situations, Soisson said he wouldn’t have any definitive answers.

“If it’s going to happen a couple times a month, it’s going to be a lot,” added the chief, referring to how often the ambulance at the station might be used. “It depends; if the system is taxed within the city of Norwalk, … yeah, we’ll probably have to bring some extra guys in.”

Also, the chief said North Central dispatchers will notify firefighters if they “don’t have a squad available.”

“North Central has made some really positive changes in its staffing levels in the city. For the most part, we are responding together to … what we’d call life-threatening calls,” Soisson told council.

“In the emergency business, you can go hours without a call and then have five in a row. So this (ambulance) is the stop-gap for when their system gets totally taxed and they would have to call (for) mutual aid. So instead of calling for mutual aid from Huron or Wakeman or bringing an ambulance from Bellevue, we would have one.”


Looking toward the future

An annual “availabilty fee” for the first year will cost the city $85,500, $90,000 the next year and $95,000 in the third year, according to the agreement. The fee will be billed by North Central EMS and paid by Norwalk “on a monthly basis commencing May 1 of each contract year.”

Wilhelm asked if council would have access to quarterly or annual review reports from the board.

“The joint quality assurance control board has already met. … They’ve already established protocols and standards and so on,” O’Hara said in response. “I’m sure once they’ve been formalized, they would be able to share that with council with what they are.

“The contract does call for annual reports to council from the director of North Central EMS as to what’s going on underneath the agreement. They’ll also be able come to council’s requests.”

Also on Tuesday’s agenda was a proposed ordinance about the city entering into a lease agreement with Fisher-Titus Affiliated Services and North Central EMS for “the city ambulance barn” at 42 Woodlawn Ave.

“Everything we are looking at, we are looking at from the citizen’s aspect — what’s best for that person?” said Soisson, who is excited to have a medical director on the quality control board.

“We want to improve our quality (of service) from both ends and with the quality control meetings, they’ve already been productive. Sometimes those conversations can be uncomfortable, but at the end of the day we want to provide the best patient care and get them to the hospital as quickly as we can.” 

Upon hearing no further questions from council members, president Steve Euton placed the extended agreement resolution and lease agreement ordinance on the agenda for the next meeting.

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