Rule changes increase costs for ambulances

Tuesday, September 27, 2011

By Kathryn Lucariello

Carroll County News

HOLIDAY ISLAND -- Changes to the way medical oxygen cylinders are handled have resulted in the Western Carroll County Ambulance District (WCCAD) approving payment Sept. 20 for testing and refilling cylinders that each of the Emergency Medical Responders (EMRs) carries.

EMR Alliance Chairman Lynn Palmer said the alliance was told by Eureka Springs Fire Chief Rhys Williams that the present cylinder filling system can no longer be used.

Eureka Springs has a contract with Airgas, who informed them that under new FDA guidelines, medical oxygen has been classified as a "drug," and anyone filling cylinders has to have a license to do so.

Eureka Springs was filling all the cylinders they and the rural EMRs had, using a "cascade" system, which is no longer compliant with FDA rules.

They refilled the rural cylinders at no charge, as they were able to recoup costs in their billing for ambulance calls.

Now, Airgas will swap out empty cylinders and replace them with filled ones at a cost of $7 per cylinder. Eureka Springs has bought all its own cylinders.

In addition, it will cost $18 apiece to have each cylinder tested once every 15 years.

"All the O2 cylinders in Holiday Island, Inspiration Point, Grassy Knob and rural Eureka Springs need to be hydrostatically tested," Palmer told the WCCAD board.

She said testing and filling will be contracted with the Holiday Island Fire Department, and the exchange of empty and full cylinders will take place at the Eureka Springs fire station.

Costs for filled cylinders could add up to almost $3,000 per year. She said all the rural departments together use about seven to eight bottles per week, or roughly about $50, in addition to the cost of hydrostatic testing.

At issue is whether a cylinder put on a patient at the scene of a medical call goes with the patient in the Eureka Springs ambulance or the ambulance crew changes it out and puts one of their own cylinders on the patient when they transport.

WCCAD commissioners expressed concerns about committing funds. It pays for EMR supplies, equipment and training. But the issue becomes complicated when supplies used in treating a patient at the scene go with them in the ambulance and Eureka then bills for the ambulance call in addition to receiving contract payments from WCCAD for ambulance service.

"I'm OK with doing this for the short term, but I feel there might be some double-dipping, and I'm not comfortable with that," said Joe "Sonny" McClung. "Our taxpayers are being billed and then paying for it again."

Commissioners went ahead and approved payment for testing and filling the cylinders through June 2012, when the ambulance contract is up for renewal. The issue will be revisited at that time, unless an alternative can be found before then, Chairman John Dolce said.

In other business, WCCAD:

* Discussed hiring an attorney to advise on the upcoming contract renewal and ambulance performance specifications.

* Approved purchasing a $140,000 15-month certificate-of-deposit with Cornerstone Bank at an interest rate of .95 percent. Community First offered a 13-month CD at .71 percent, and Arvest a one-year CD at .4 percent or a two-year at .6 percent.

* Heard Palmer report that county dispatch will automatically tone out a helicopter for trauma, strokes and chest pain at the same time it tones out EMRs and the ambulance instead of waiting for an EMR to arrive on the scene and call for a helicopter. The Air Evac company, which handles most of the airlift calls in the Western District, is promoting this procedure and has said they will not charge for the lift-off if the helicopter is not needed and turned back.

* Approved the treasurer's report. As of the meeting date, WCCAD had around $16,000 in its checking account, $13,000 in money market funds and $206,000 in CDs, for a total of about $236,000.

* Approved Eureka Springs ambulance performance reports. For July and August, there were a total of 112 WCCAD calls: 70 in Holiday Island, 16 in Grassy Knob, three in Inspiration Point, 12 on Ark. Hwy. 23 South, none on Ark. Hwy. 23 North, nine on U.S. Hwy. 62 East and two on U.S. Hwy. 62 West. Twenty calls took more than 15 minutes to reach: 15 due to distance, two due to bad directions, two due to non-emergency and one out-of-area.

WCCAD is next scheduled to meet Nov. 15 at 4 p.m. at the Holiday Island district office at 110 Woodsdale Drive. It may also hold a special meeting in December to handle a contract payment due Eureka Springs before the end of the year.

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