Ambulance Pact Benefits Town

Oak Bluffs Fire Department Owns Franchise for Off-Island Runs; Special Fund Helps Purchase Police Cruisers, Fire Trucks

By BRIEN HEFLER

If a patient at the Martha\'s Vineyard Hospital needs to go off-Island for further treatment at a mainland hospital, chances are the Oak Bluffs fire department will provide the lift. For more than 12 years the town fire department has been the primary transportation provider for the hospital, ferrying patients via ambulance to hospitals throughout New England and beyond. The off-Island transports provide both a vital service to the hospital and a financial boon to the town through a special purpose fund that is used to buy equipment and pay personnel.

Since 1993 the fund has accumulated hundreds of thousands of dollars and has been used by the town to buy ambulances, police cruisers, fire trucks and build an addition onto the Oak Bluffs fire station, among other things.

The fire department officially became the primary off-Island transportation agency for the hospital in 1993, but in fact began transporting patients several years earlier. Fire chief Dennis Alley said the department transported a Vineyard Haven woman from the hospital to her home in the early 1990s and quickly recognized a need for a reliable, Island-based transportation service for the hospital.

\"Years ago, we did one little transport on-Island where we took someone from the hospital to another town,\" he said. \"Then we started to think that we should look at it on an off-Island basis because people were always waiting to get off the Island and maybe we would save a couple of lives along the line.\" He said since the hospital is located in Oak Bluffs, it made sense for the department to handle its transport needs.

Before the fire department took over the job, the hospital would contact ambulance providers on the mainland, who would then come over on the next ferry, if possible, pick up the patient at the hospital and take a ferry back to the mainland. The use of mainland ambulances made scheduling difficult for hospital staff, who also have to make sure patients have a bed at the receiving hospital before they can be transported. Using Island-based ambulances streamlined the operation.

\"It was always tough for the hospital with the boat schedules, so we took it on,\" said John Rose, captain of the Oak Bluffs ambulance squad, \"The hospital thought it was the greatest thing since sliced bread.\"

All of the money earned from the ambulance runs goes into a specially created account, called the ambulance reserve fund, which in turn is used by the town fire and police departments to purchase new equipment. The special purpose fund was approved by an act of the state legislature in 1993; the fund was originally created as a way for the fire department to purchase a new ambulance for the burgeoning transport program.

Since then the reserve fund has grown to the point where the town police and fire departments are essentially self-sustaining when it comes to purchasing new equipment and vehicles.

\"It\'s become the sole funding base for public safety,\" Chief Alley said. \"What it does is it takes a tremendous amount of burden off the taxpayers if they don\'t have to front the money for these large expenditures - and they still know everyone is safe.\"

Earlier this summer the fire department bought its third ambulance for $111,000, paid in full through the reserve fund. Past major purchases include a custom-built street pumper in 2004 with a price tag of $304,000 and a medium heavy rescue truck for $187,000. Other equipment purchased through the reserve fund includes:

* The fire department\'s three ambulances, for $566,000.

* Eight police cruisers for $160,000.

* An addition to the fire station for $65,000.

* Twenty self-contained breathing packs for firefighters valued at $72,000.

Chief Alley said the department is saving up for a new 105-foot aerial ladder truck for $750,000 to replace the department\'s outmoded 1958 model. The high sticker price means the department will need to do a lot of transports; the current reserve fund balance stands at about $214,000. However, if the trend from previous years continues, the fund is likely to accumulate enough money soon for the new ladder truck.

Transport numbers provided by the fire department for the last two years show off-Island transports increased from 428 in 2003 to 552 in 2004.

The numbers are incomplete for this year, but the fire department has already transported 238 patients from January to June, up from 49 during the same period last year. Judy Amaral, who coordinates transports for the fire department, said the department is averaging eight to 10 transports a week, including patients who are transported from the hospital to the airport for Med flights, which requires picking up the flight crew, bringing them to the hospital and returning to the tarmac with the patient.

Chief Alley said the ambulance transports operate similar to a taxi service, with a base cost that factors in whether the transport requires basic life support or advanced life support, which involves additional equipment and sometimes a paramedic. Once the base price is determined, patients are billed for mileage. Chief Alley would not release base prices or the mileage rate, citing it as proprietary information.

Patient insurance companies pay for most of the costs associated with the runs, Chief Alley said. This means the payments often take three to four months to be processed. Billing is handled by Comstar Ambulance Billing Service in Rowley.

Transporting a patient from one point to another, whether it is Beth Israel Hospital or Massachusetts General, is a complicated process. First, hospital staff must find a bed for the patient and then notify the ambulance department. The ferry reservation must be secured. Gail Croft, a social worker at the hospital, helps coordinate the transports. She said the switch from relying on mainland ambulances to Island-based transporters has helped streamline the process, but can make for some close calls.

\"Your identified patient has to have an accepting position and most importantly, a bed. Then you have to look at the timeline: can you get the patient across and the ambulance back before the last boat,\" she said.

If Oak Bluffs is involved in another transport or unable to make the last boat, mainland ambulance services are sometimes used. Other Island departments may perform transports if needed or send personnel on runs.

Oak Bluffs has a yearly letter of agreement with the hospital which grants the town a right of first refusal on all ambulance runs, according to Tim Walsh, chief executive officer for the hospital.

\"I think it\'s an evergreen, it kind of keeps going,\" Mr. Walsh said of the agreement. \"We basically call them first and if they can handle it they take it. I think in the early days they were the ones that were always willing and able to do it and it\'s evolved over time to an agreement. Oak Bluffs has always done it so well. I think it\'s a great relationship, like the one we have with all the ambulance services.\"

Mr. Walsh said the Tisbury ambulance squad also performs some off-Island ambulance runs when Oak Bluffs is unavailable.

While owning the franchise for off-Island ambulance runs has proven to be a financial boon, Chief Alley was quick to point out that money is not the motivating factor.

\"Our number one concern is the life of the patient - no matter what it takes, the patient is going to get the ultimate best,\" he said, \"This is a service that we provide to the town and the main concern is the patient and patient care. The actual money that is made is secondary to me.\"

So is the equipment. While Chief Alley said the new ambulance will help the department better serve the community and the hospital, the real force behind the success of the program are the dedicated personnel.

\"The people we have on our EMT squad are excellent, they go the extra mile,\" he said. \"I call them minutemen because they\'ll get a call and, bang, before you know it they\'re on the boat.\"