Wednesday, September 15, 2010

Ambulance Fees

One of the biggest issues that many residents have is the concept of ambulance fees. El Segundo residents have always benefited from an unofficial city policy not to pursue remuneration beyond what the resident's insurance is willing to pay. If a resident calls 911, the response to the residence or business is free. Any medical services administered on scene of the emergency are free. Once the patient is transported, then the billing starts.

Ambulance transport billing rates are regulated by the L.A. County EMS Department, ordinance 7.16.280 and 7.16.310. These  rates apply to all public and private entities, which they cannot exceed. The current ambulance transportation billing rates in El Segundo are broken up into 5 parts:

  1. ALS (advanced life support) service = $1,146 (1,232.50 maximum rate)
  2. BLS (basic life support) service = $802.75 (863.25)
  3. Code 3 (lights and sirens) Transport = $109.75 (118.00)
  4. Oxygen Therapy = $55.00 (59.25)
  5. Mileage = $15.75/mile (17.00)
You are either charged for ALS or BLS, never both together. You only get charged "Code 3" if they transport you "Code 3."

The city outsources to a billing company to handle and generate invoices. Once payment is received by the city from the billing company the process is finished, no matter what percentage of the bill was paid by the insurance company. And, if the resident has no insurance, the city will not pursue payment and subsidize the cost. Plainly stated, whatever the city does not receive from the insurance company it will subsidize the remainder. This is not true for non-residents. The City will pursue non-residents for full payment.

For the time period 8/01/09 through 7/31/10, the city subsidized $84,000. This number has relatively been the same through the years. 

The major issue for concerned residents is they are worried that if L.A. County were to take over jurisdiction they would use private ambulance companies to transport to the hospitals, thereby voiding the unofficial contract with the city to subsidize any individual costs. I completely understand this plight shared by many residents who frequently rely on transport to the hospital. If suddenly they are forced to pay the remainder of the ambulance bill then it would dramatically effect how they are able to survive, and may even put them under.

The concept is, the city already subsidizes the ambulance fees. If they currently factor this into their budget, why can't the city simply continue to pay the resident's portion of the bill? The rates for public and private are regulated the same. McCormick will bill your insurance then send you a bill for the remainder. Simply send the bill to the city, and they should be willing to continue to pay for your ambulance fees.

This should not be a hard concept for the City Council to understand, nor should it be a platform for them to argue against L.A. County and private ambulances. It is merely a different way of doing business to reach the same objective: do not charge El Segundo Residents for ambulance transport.

Tuesday, September 14, 2010

Meeting the Standards

The NFPA (National Fire Protection Association) was established to answer the questions asked by cities on how to run a fire department. It is a compilation of standards that are recognized by the American National Standards Institute and are regarded as a legitimate blueprint for local government. "Most importantly, it will provide the body politic and the citizens a true picture of the risks in their community, and the fire department's capabilities to respond to and manage those risks." - NFPA 1710.

NFPA 1710 is the Organization and Deployment of Fire Suppression Operations, Emergency Medical Operations, and Special Operations to the Public by Career Fire Departments.

Why is this standard important to me?

This standard clearly defines what type and how many personnel are needed to perform certain operations safely and efficiently. As residents, we have certain expectations from our local safety organizations. We expect the best quality employees and expect that our city meet and exceed the minimum standard of safety.

As El Segundo expanded throughout the years, so did its hazards and complexity. Therefore, the fire department expanded as well; not just staffing levels, but scope of practice and training requirements. Currently El Segundo houses 21 high rises buildings, an oil refinery with over 150 fuel storage tanks, Aerospace, Boeing, Northrop, Raytheon, an Air Force Base, multiple hotels, a dense industrial row nicknamed "smokey hollow", scatter-good plant, an energy plant (NRG), and all adjacent to one of the largest target hazards; LAX Airport. Can anyone really compare our city to surrounding cities?

We may call it Mayberry, but the farms and strawberry fields are gone. El Segundo is a potentially volatile city with many liabilities. These factors dictate how a city determines its fire personnel staffing levels. Under the current circumstances, the El Segundo City Council has decreased the staffing level of your local fire department. This is unacceptable and burdens the citizen and firefighter for reasons that are unfounded and can be construed as political malfeasance.

NFPA 1710 clearly outlines in of the code that "On-duty fire personnel shall be comprised of the numbers necessary for fire fighting performance relative to the expected fire fighting conditions. These numbers shall be determined through task analyses that take the following factors into consideration:"
  • Life hazard to the populace protected (17,000 to 100,000 people)
  • Provisions of safe and effective fire fighting performance conditions for the firefighters
  • Potential property loss (billions of dollars)
  • Nature, configuration, hazards, and internal protection of the properties involved (listed above)
  • Types of fire ground tactics, apparatus and results expected to obtain on fire ground.
With this understanding the code continues to define how many firefighters should staff certain apparatus. through states:
  • Engine companies shall be staffed with a minimum of 4 on-duty personnel
  • Truck companies shall be staffed with a minimum of 4 on-duty personnel
Furthermore, section outlines the minimum initial full alarm assignment, (a first alarm in El Segundo):
  • This determines that a minimum of 15 firefighters shall constitute a first alarm assignment (a basic single family dwelling structure fire would require a first alarm assignment; a commercial or high-rise fire require much more personnel)
The current City Council wants to reduce the daily staffing to 14 firefighters per day, thereby condoning substandard working conditions, jeopardizing the safety of its employees and citizens.

So your next question might be, how do Manhattan Beach and Hermosa Beach get away with having low staffing levels?

Lets compare them:

This graph indicates the size of the city as well as its residential, commercial and industrial zones as a percentage of that size.

El Segundo is primarily commercial and industrial, housing some of the most dangerous radiological, chemical and biological contaminants within its borders making them prime terrorist targets. The percentage that is not displayed for any of the cities is attributed to parks, open lots, beach, religious buildings and schools.

This graph compares the personnel level with the number of high rise buildings and target hazards within the corresponding city. A target hazard is defined as "any occupancy type or facility that presents a high potential for loss of life or serious impact to the community resulting from fire, explosion, or chemical release."

El Segundo is at a higher risk for disaster. With more than two or three times the target hazards and 21 high rise buildings, El Segundo demands a heavier work force. These are direct reasons why the El Segundo Fire Department is staffed higher than the neighboring cities. In fact, Manhattan and Hermosa Beach Fire Departments have publicly stated that their staffing levels are below standard.

Appropriate staffing is the argument. Whether it's L.A. County Fire or El Segundo Fire, the city needs to be adequately staffed to meet the level of fire fighting conditions. In my previous posts I laid out the numbers for L.A. County Fire. Even though they would staff El Segundo with 12 firefighters, their efficient integrated response system allows them to staff an area with less personnel because they have a greater pool of nearby firefighters to pull from. El Segundo, as an isolated municipal city, needs to compensate for the lack of resources and meet the necessary standards of fire protection.

Sunday, September 5, 2010

County Personnel and Apparatus In Relation to El Segundo

The two graphs convey L.A. County personnel and apparatus resources within a specified distance from the city of El Segundo. These visual aids should give a clear understanding that by buying into the County system, we are acquiring more than just our local staffing. El Segundo would be covered by a more comprehensive insurance plan for a cheaper price, without sacrificing service or response times. Both graphs do not include the 12 firefighters that would be staffed in El Segundo. Again, these numbers are a statistic of what would be available to the City if under the County system.



Response Numbers: A Big Difference

Graphs compare personnel response to types of emergency calls between El Segundo at 14 and L.A. County Fire Department. The numbers denote how many emergency responders arrive on scene to the emergency. Realize that El Segundo's numbers for a 2nd and 3rd Alarm require mutual aid from neighboring cities with different communications, equipment and training. Whereas, L.A. County is one contiguous agency without the above delays, increasing efficiency and response times.