Tennessee County Races to Resolve Response Time Dilemma

Thirty-one minutes.

That's how long it took last October for a Rural/Metro ambulance to respond to an emergency call at Avenue Carriage Crossing. A shopper had collapsed and the Rural/Metro ambulance stationed in Collierville was on another call.

Collierville's Fire Department paramedics (also called first responders) were there in less than four minutes, but it took a Rural/Metro ambulance 31 minutes to arrive from Lakeland to take the shopper to the hospital. She died.

Emergency medical service (EMS) officials across the country say such response time glitches occur occasionally.

But perception is everything.

Those 31 minutes have brought to the forefront complaints that Shelby County is not getting its money's worth from Rural/Metro.

Those 31 minutes have set off an EMS chain reaction:

Shelby County Mayor A C Wharton decided to opt out of the last year of Rural/Metro's contract and let bids for EMS ambulance service.

Collierville and Germantown are seriously considering partnering to contract for their own ambulance service.

Wharton is pushing a long-range plan for a countywide EMS operation that would include overhauling what he feels is an inadequate EMS dispatch system and hiring more paramedics.

The county's request for proposals (RFP ) for ambulance service is not an indictment of Rural/Metro, Wharton says. But with the contract coming up for renewal and public concerns about service, the mayor felt the time was right to fix the county's EMS system once and for all.

"There was a public outcry. When there's a public outcry, that's how you get things done. I'm into my last term (as county mayor) and I want to get this done before I leave office," he said.

Rural/Metro nationally

Ambulance service in the United States is big business and Rural/Metro is a major player.

How big is the industry? Rural/Metro's Investor Presentation for the fiscal year that ended June 30, 2006, said the medically necessary ambulance market is estimated to be worth $7 billion to $10 billion annually. Rural/Metro is the nation's second largest provider of ambulance service, with 17 percent of the market. American Medical Response is the largest, with 33 percent.

Rural/Metro is in about 40 communities in 23 states. In some communities, they also provide firefighting services, including providing firefighting services for Federal Express in Memphis.

The investor's report shows the company had net revenue for the fiscal year that ended June 30, 2006, of more than $548.5 million. That was up from more than $501.51 million the previous year.

911 and non-emergency, medically necessary ambulance transportation represented 88 percent of net revenue. And, the report states, the future looks bright. Market dynamics such as growing demand for ambulance services beyond EMS and aging baby boomers portend continuing growth.

Rural/Metro locally

Locally, Rural/Metro has a $1.01 million contract with the county to provide ambulance service for unincorporated Shelby County, Arlington, Collierville, Germantown, Lakeland and Millington.

Memphis and Bartlett have their own EMS systems.

The contract calls for Rural/Metro to have six ambulances on duty and three in reserve. The county decides where they're located: On Forest Hill-Irene Road, and in Collierville, Germantown, Arlington, Millington and Northaven.

The ambulances are dispatched through the county Fire Department's 911 system.

Glenn Miller, Rural/Metro division general manager, said Rural/Metro is receiving an undeserved black eye.

"We're doing what we're supposed to do. We've always known what they wanted and we've given it to them. The new RFPs (requests for proposals) are not because of anything we've done or haven't done," Miller said.

Miller and Wharton don't disagree on that point. Based on the number of calls Rural/Metro receives, response-time problems have been few, Wharton said. They also don't disagree on two other points that will be key considerations for companies offering ambulance service proposals to the county.