Debating the pros and cons of outsourcing ambulance service

There's a no-brainer sitting on the table down at City Hall that could benefit the city's coffers, Las Vegas Fire & Rescue and, of most importance, residents of Las Vegas who require emergency medical service.

The plan, contained in a study conducted by the International City/County Management Association Center for Public Safety Management, is wrapped into a weighty report dealing with cost-efficiency and, in particular, how it could be applied to LVFR.

Eight of the 23 recommendations in the report are referred to as priorities. For the purposes of this column, one recommendation might easily be characterized as a significant priority. That's because it deals with LVFR's medical responsibilities. In that respect, the report suggests, "The city should consider one of two alternatives."

The first would be to discontinue LVFR's emergency medical service as a means of transporting patients to hospitals and rely solely on private ambulance services, such as American Medical Response. "This option would realize a savings to the city of approximately $14 million to $18 million" annually, the report says.

However, "option two is to have LVFR transport all patients, without assistance from the private ambulance company." The report says that annual revenue generated for the city from this alternative would be "$12 million to $14 million."

But Dean Fletcher, who recently retired as president of Las Vegas Firefighters Local 1285 after 20 years, says "those income-producing numbers are a bit flawed. They forgot to add in the $6.1 million our emergency medical service brought into the city for fiscal 2012.

"When you include that amount in the estimated income for the city, if we were to handle 100 percent of the EMS transportation, the city's revenue would increase by $18 million to $20 million a year. In addition, we would be providing the best possible service."

So how does this relate to Summerlin?

Let's go back to an afternoon last October, when firefighters invited Summerlin residents to an ice cream social at Desert Vista Community Center in Sun City. The audience consisted largely of seniors keenly concerned about the quality of emergency response and the speed of transportation to a hospital.

Firefighters from throughout the city were present as their honor guard, including the fife and drum corps, put on a memorable presentation, while ice cream was served to everyone.

Then the firefighters' union, which sponsored the occasion, presented a slideshow that got to the nuts and bolts of things. A summary of the 20-minute presentation stated that "LVFR has one of the best life-saving records in the U.S." And "by working together we win against America's biggest threats ---- heart attack and stroke," when "every minute of delay can result in a 10 percent diminished chance of recovery."

While lauding the skills and national accreditation of Las Vegas firefighters, the presentation claimed that "privitization sounds great, but life-saving is about speed. ... We get there in six minutes," it said, claiming that the private competition "targets 12 minutes." The presentation added that in 2011, the private competition "was late 10,171 times."

"We're looking to the option in the report that would allow LVFR to transport patients 100 percent of the time," Fletcher said.

The report noted that during the ICMA's "analysis period," LVFR made 28 percent of the total transport trips to the hospital, while the private ambulance service made 72 percent. But it went on to state, "The ICMA believes LVFR has the capacity with its current fleet to comfortably handle additional transports any time of the day or night."

Fletcher explained that the 28 percent should not be viewed as a dismal statistic because "in a great many cases, an engine, manned by thoroughly trained LVFR paramedics, was the first-response vehicle, while the private ambulance ended up transporting the patient."

He pointed out that citywide approximately 88 percent of all firefighter responses relate to medical emergencies.

So what does the study recommend on this issue? That in the short term, LVFR should "work closely with AMR ... to improve communications, efficiency and effective service delivery. In the long term, the ICMA recommends LVFR consider a more active role in EMS transport or more fully engage the EMS transport service."

Herb Jaffe was an op-ed columnist and investigative reporter for most of his 39 years at the Star-Ledger of Newark, N.J. His newest novel, "All For Nothing," is now available. Contact him at