David Rudat
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City Ambulance Service Debate: Private vs. Public Consideration
The fire department is proposing to extend its ambulance services in city.
May 25, 1995

ORANGE - The city fire department's proposal to purchase four ambulances and provide complete accident scene to hospital service to the community has sparked outcry from two private companies serving Orange in what is shaping into a public vs. private battle.

"They're firemen, not health care professional," said Blake MacPherson, a spokesman for CareLine, during a city council review of the proposal. "No offense, firemen, but you don't know what you're doing."

Fir Chief Dave Rudat said: "(The plan) would help improve the quality and continuity of pre-hospital care."

According to Chief Rudat, the Orange Fire Department's proposal would"

  • add ambulances to reduce response times in medical emergencies.
  • expand the number of paramedics responding to calls.
  • provide continuity of care from the scene of an accident to the hospital.
  • reduce the per-capita cost for tax-payers.
  • create revenue, benefiting the city and the fire department's services to the public at no extra cost to the tax-payer.

Councilmembers also heard from private companies.

CarLine California proposes to:

  • keep the fire department as a first response to emergencies.
  • provide a trained paramedic on each ambulance call, with the county's approval (currently, Emergency Medical Technicians staff the ambulances since the county doesn't allow paramedics on private ambulances).
  • bill the advanced life support rate of first-responders to the health insurance companies and the health maintenance organizations, with part of the profits going to Orange.

Medix Ambulance Service, on the other hand, wishes to:

  • keep the system status quo, with no changes to the current practice of paramedics being the first responders to emergencies and private ambulances transporting patients to the hospital.
  • help provide a stream of revenue to the cities for the cost incurred of pre-hospital care for basic and advanced life support systems.

After an informal meeting with Chief Rudat and Medix President Michael Dimas last week, numbers and figures in the fire department's plan were analyzed on an "apples to apples" basis, according to Rudat.

The initial $100,000 revenue first estimated now totals more than $350,000 of surplus money to be given to the city under the fire department's plan, thus reducing the city cost to run the department and its services, said Rudat.

The plan calls for acquiring four ambulances and the hiring and training of six firefighters.

Since the department already provides first-response paramedic care, and has since 1973, the start-up ambulance service would reduce response time by more than 40-percent with minimal cost to the City, according to the chief. He said various health and safety codes specifically allow the city to expand the service without seeking competitive bidding. "The county sanctions our program," he said.

CareLine's MacPherson disputed the $1.4 million start-up cost for the fire department's plan, calling it "grossly underestimated" with a result of having to raise taxes.

"they're going to lose half a million dollars right off the bat," said MacPherson. "Are the citizens willing to pay for it (through taxes)? And they will go up."

MacPherson claimed CareLine's plan will appease HMO providers by working in a managed care contract, not giving unnecessary medical treatment or overcharging the patient.

Representing Medix, Dimas defended the system now in place in Orange.

"Orange County has the best pre-hospital care. Period. It's not the cheapest, but it's the best," he said.

Chief Rudat said the private company wants to exchange patients between paramedics at the accident scene. this isn't done because it disturbs the continuity of patient care, Rudat said.