BY KAREN GERHARDINGER | MIRROR REPORTER — When a serious medical emergency or accident occurs, it’s the paramedics in the white and orange Life Squads who arrive on the scene to render advanced life support (ALS).
Since 1992, this service has been operated by Lucas County, funded by a .25-percent sales tax that, this year, brought in over $20 million. While Lucas County commissioners have talked about getting out of the EMS business in the decades since, discussions have become more focused in the last six months and could result in a change as soon as January 1, 2024, said Matt Heyrman, deputy county administrator for the board of commissioners.
“Counties, by state code, are not required to fund EMS systems,” Heyrman said. “It isn’t clear that anyone has to provide it.”
All area fire departments offer Basic Life Support (BLS) with a combination of emergency medical technicians and paramedics. An ALS unit is equipped with more specialized equipment and staffed with two paramedics to respond to a higher level of need, able to provide intubation, catheters, intravenous medication and electrocardiograms while en route to a hospital or trauma center.
Until 1991, the Regional Emergency Medical Service of Northwest Ohio (REMSNO) provided ALS service, but a property tax that funded the private entity failed after firefighters alleged poor service. REMSNO failed in 1991 and, in need of an ALS system, the Lucas County EMS was formed, funded by a sales tax.
Life Squads – the name for the ALS units – are stationed in 10 area fire stations, including five in Toledo and one each in Maumee, Oregon, Sylvania Township, Springfield Township and Whitehouse. These 10 stations hire the personnel, while the county provides the vehicles and maintenance, countywide protocol, medical director and training. Each department housing a Life Squad is provided funds from the county to pay for this service. The last contract, in 2018, set that amount at $804,000 a year.
As negotiations are underway, the county is looking at providing funding for personnel, but turning over the cost of owning and maintaining vehicles, training and protocols to each of the communities that hosts the Life Squad.
Last year, more than 25,000 calls for EMS were received by the 911 Call Center. Once a call comes in, the call taker immediately dispatches a basic life support (BLS) unit and transfers the call to a trained emergency medical dispatcher, who determines whether an ALS unit is needed, and stays on the phone until someone arrives. Based on the conversation, the response might be upgraded to ALS or downgraded to BLS. As a result, the call for ALS might be canceled. Last year, the county had 7,310 cancellations.
Heyrman points to inefficiencies that he thinks would be corrected by turning over EMS to the municipalities.
He notes that many local fire departments already have paramedics on board a BLS unit and might show up on the scene first; but currently, they have to wait for a Life Squad to transport.
“What if the county provided the same money and allowed them to distribute those same paramedics in different vehicles?” he asked.
By federal billing laws, only the entity that owns the ambulance can bill an insurance company for service, so turning over ownership of the vehicles would allow Maumee and Whitehouse, for example, to recoup enough revenue to cover the cost of the vehicle, Heyrman believes.
“I do think there are operational inefficiencies in our current system that need to be addressed,” said Whitehouse Fire Chief Josh Hartbarger, who met this week with Heyrman and commissioner Pete Gerken to discuss the proposal. “I do think there there is an opportunity to achieve a very good outcome. As with any new idea, it depends on how conversations go, and collaboration will be paramount.”
He acknowledged a major concern – whether the county would provide enough funding to cover the costs. Currently, the county provides $804,000, but that doesn’t cover the costs of housing a Life Squad in Whitehouse. The village contributes an additional $150,000 to $300,000 a year for operating costs, including fuel, uniforms and housing for nine paramedics filling three shifts.
Maumee also receives $804,000 but spends $1.6 million to send a Life Squad to not just Maumee, but also areas of Toledo and Monclova Township.
“About 50 percent of our runs are in Toledo, and 20 percent are in Monclova Township and Springfield Township,” said Maumee Mayor Rich Carr.
The county and fire chiefs are discussing the creation of districts, such as pairing Maumee and Monclova Township, and giving $400,000 a year to each one to operate the Life Squad, Carr said.
“It still costs $1.6 million because we still need the same number of people. We don’t have that kind of money,” he said.
Carr is aggravated that the county has $20 million in revenue but only uses less than half of that to fund the EMS system. He believes he knows the reason why.
“It’s all about the jail – for the county commissioners to stand up and say they can build it with no new taxes. Everyone should ask where that money is coming from,” Carr said.
He warns of a scenario in which the county would keep the $20 million in revenue and pay the communities less or nothing. That would leave local entities scrambling to pay the increased cost of funding an ALS system.
“We have to provide that coverage. When someone calls 911, they expect a paramedic at their door within seconds,” Carr said.
Even though a contract is not yet signed, Carr believes that Maumee should be prepared for the loss of revenue. That’s one of the reasons Maumee is putting a 5.6-mill levy on the ballot this May.
“We can’t sit around and wait. If the property tax passes, it takes a year to collect money,” he said. “The conversations our administrator had with them said 2024. If the money goes away now, there’s no way we can absorb that.”
Maumee Fire Chief Brandon Loboschefski said if Life Squad goes away, it will force area departments to work together more efficiently to make sure calls are covered.
“The county has their priorities and challenges just as all communities do,” he said. “We all have to come together to find a solution.”