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County discusses who should provide ambulance services

County discusses who should provide ambulance services

This article originally appeared in the Teton Valley News.

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WHO ‘YA GONNA CALL?

County discusses who should provide ambulance services

Scott Stuntz TVN Staff

When someone in Teton County dials 911, the ambulance that responds to that emergency could be staffed by either the Teton County Fire District or Teton Valley Health Care (the hospital).
However, that could soon change. Last week the Board of County Commissioners heard a proposal from the fire district on ways to restructure how emergency services are provided.

That proposal was in response to a request made by BOCC chairman Bill Leake last July. According to the minutes of the July 13 meeting, he asked the fire district to “analyze their staffing and budget needs and provide a detailed proposal within the next few months.” Leake stressed that no major changes would take place soon and said all aspects would be reviewed carefully before a decision is made to disband the Ambulance Service District (ASD) and transfer all assets to the Fire District.

The hospital asked for $200,000 more than the Ambulance Service District had in funds for the year. Leake said he asked for the proposal from the fire district after he asked those at the table for a solution and was met with silence.

“When there’s a funding problem I have to do something to address it,” Leake said.

The fire district presented its proposal at a meeting of the Ambulance Service District on Jan. 25. Teton Valley Heath Care responded to the proposal by taking out ads in a recent edition of the Teton Valley News. One featured a letter from doctors endorsing hospital involvement in emergency services and the other was an ad rebutting the financial claims made in the fire district’s proposal.

The two sides vary widely in their views on how much the different options would cost, with fire saying the savings would be in the hundreds of thousands and the hospital saying they would be far smaller, less than $10,000.

Leake said that it is much too early to be batting around those huge overall numbers.

“Arguing about the numbers right now won’t get anyone anywhere,” he said.

He said the county first needs to sit down and lay out what services they are legally obligated to provide and what other services they can afford.

Hospital CEO Keith Gnagey said the hospital would probably be able to shoulder some of the extra costs this year, as it was forced to last year, in order to pay for ambulance service.
Gnagey said the main issue is quality and that in order to ensure a high level of care, the hospital needs oversight over ambulance services. He said quality links directly to the financial sustainability of the system; how hospitals are paid for the care they provide is changing rapidly.

Under traditional payments, providers were paid for the services they provided, such as for the casts they put on or the cuts they stitched up. Gnagey said the industry is shifting to paying for “outcomes,” meaning preventative care and in-home treatment, the kind provided by ambulances, is key. He said to thrive in this new philosophy, the hospital needs to be able to manage all types of clinical care, including emergency services.

“It’s not about the money, it’s not about who [the fire district is] is, it’s about the hospital’s mission of providing the best health care we can, all the other issues are secondary,” he said.
Gnagey said of course the financial picture is important, but the value the county gets for the money it’s spending is vital as well. He said the hospital doesn’t want to take over the operation of the ambulances in the county, but to maintain the current joint operation that he said is working quite well.

“Now, how can we make it better?” he said.
The ambulance service district will take up the matter again at a county meeting this Monday, Feb. 8.

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Good Choice, Bad Choice: Things that go THUMP in the night

Ann Loyola

Ann Loyola

Anyone can come up with at least one thing that wakes them up in the middle of the night. Barking dogs, thunderstorms, nightmares and so on.

I recently had an unusual wake-up call at 5:15 a.m. when I opened my eyes to a sudden painful scrunching in my left chest area. Not wanting to disturb the peaceful slumber of the two cats and husband beside me, I told myself to breathe calmly, deeply, and (hopefully) continuously. I soon felt a mighty thump in my chest, a release of the squeezing feeling and a burst of warmth flowing to the ends of my toes and fingertips.

So I rested there for about an hour, telling myself to relax relax relax, there was nothing to be concerned about, no need to elbow my husband or nudge the drooling cats off the side of the bed. After all, it was highly unlikely that I was having a heart attack of any type because – well – because I don’t have heart attacks. Then I started ticking off the facts of my basic profile:

  1. I’m 54. Certainly old enough.
  2. Overweight? Check.
  3. Exercise regularly? No.
  4. Family history of heart disease? Yes.
  5. Any chronic issues that could negatively impact my heart? Yes, lupus can affect heart tissue.

That’s five out of five. What would an intelligent person do at this point of realization?

I decided to ignore all of the medical information about heart attack symptoms that I know very well because I’m a healthcare marketer so it’s my job to tell people to get immediate medical assistance if there’s even a miniscule chance that they’re having a heart attack. I fell into the high percentage pool of people who think that it would be terribly embarrassing to call 911 or be driven to the ER, only to discover that the problem was a panic attack or heartburn. After all, what could be worse: dying of a heart attack or having a doctor tell you that you’re not having a heart attack? Ummm …

Anna Gunderson PA-C chastised me gently but thoroughly during my clinic appointment at 10am that morning, reminded me that “time is muscle” and that I should have come to the ER via driver or ambulance, and by the way, shouldn’t I know better?

At the end of the day, my lab tests, an EKG and chest X-ray indicated that I hadn’t suffered a cardiac event. My rheumatologist suspected pericarditis brought on by systemic lupus. While I felt somewhat relieved, I was also smacked with the reality that I could have a heart attack and that in fact, many of my friends and acquaintances could have a heart attack at any moment and need to have their lives saved by the very people with whom I work.

I’m making a donation today to our hospital foundation’s campaign to raise funds to buy a Zoll defibrillator unit for our ambulance and a cardiopulmonary DASH monitor for our E.R. I discovered that last year alone, our current E.R. DASH monitor system assisted 126 people in cardiac distress and almost 500 people with respiratory ailments.

Please consider supporting this campaign for acquiring this essential equipment and who knows? It just might save your life.

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