Ala. First Response Reverses Course

Aug. 12--A unilateral decision Friday by First Response Ambulance to discontinue emergency calls into much of Morgan County ran afoul of the state Emergency Management Service agency.

First Response reversed course Monday, although its director of operations said its Friday policy had been "misconstrued."

In a letter delivered to Morgan County 911 at noon Friday, First Response announced that in 12 hours it would only respond to 911 calls in Decatur and its police jurisdiction, which includes Trinity; in Priceville; and on calls to which Decatur Fire and Rescue was dispatched.

On Monday, Dennis Blair, director of the state EMS agency, said he had talked to First Response's owner.

"Anybody that's licensed with us has to respond to a call that they get in the county in which they're licensed." Blair said. "If you get a call, you've got to go."

Blair said that if an EMS provider refuses to respond to a call within its county, the state can revoke its license.

Later Monday, First Response delivered another letter to Morgan County 911, which it labeled as an "addendum" to the Friday letter. The second letter left out the term "only" when listing the geographical areas to which First Response would respond. It also included a new sentence, underlined: "First Response Ambulance will response (sic) to ALL 911 requests. As well as mutual aid requests."

In both letters, First Response said it would discontinue posting ambulances at Big A gas station on U.S. 31, north of Hartselle. Blair said the ambulance's license with the state does not require it to place ambulances in particular places to lower response times, only to respond to calls.

Reached by phone, First Response director of operations David Childers said he was in Mexico and would respond by email.

In his email, Childers said there are better ways to handle calls in Morgan County.

"The system that is in operation for the county is not working properly and the 911 center has to rely on First Response for backup coverage, which at peak call times can deplete our units in the city of Decatur," Childers wrote. "We want the citizens and residents of all of Morgan County to know that First Response is here to serve."

Childers said there was no change in policy between First Response's Friday and Monday letters.

"The word 'only' was taken out because it was misconstrued," Childers wrote. "First Response will always answer requests for service."

Decatur Fire and Rescue Battalion Chief Ted McKelvey, the EMS coordinator, said First Response had three basic ambulances and seven paramedic ambulances running Monday morning, well over the number required by its license with Decatur. Since Decatur Emergency Medical Services Inc. went bankrupt in February, First Response has had a monopoly on 911 calls and the more lucrative transports within the city.

Expressed interest

McKelvey said some ambulance services have expressed an interest in entering the Decatur market and ending First Response's monopoly, but none has submitted an application.

James Wessel, director of not-for-profit Samaritan EMS -- which is the primary service in parts of Morgan County, including Hartselle -- said he was not surprised First Response had to reverse its decision. He said he was shocked, however, that the ambulance service initially proposed declining calls outside the Decatur and Priceville police jurisdictions.

"It was an unprecedented and dangerous move that I've not seen in my 20 years of EMS in Morgan County," Wessel said. "We've been through some extraordinary lows in ambulance coverage in Morgan County over the years, but it's never been at a point that a service said they would refuse to provide service to a citizen having a medical emergency."

Wessel said Morgan County 911 sent him a copy of the first letter Friday, so Samaritan could help fill any coverage gaps. It added an ambulance near Danville.

Morgan County 911 Director Ryan Welty said First Response verbally clarified Friday that, while it would not respond to emergency calls in the county, it would still handle non-emergency transports.

Almost all transports are covered by either private insurance or Medicare. On emergency calls, ambulance services have no way to determine in advance whether they will get paid.

"That really shocked me," Wessel said. "They were publicly saying that, if you have a dialysis appointment or need an X-ray and we know we're going to get paid, we'll be there. But if you fall off a ladder and break your neck, you're on your own. You'll have to get an ambulance from somewhere else."

Plenty of problems

Wessel said First Response's initial proposal, to only respond to emergency calls in Decatur, its police jurisdiction and in Priceville, would have caused serious problems. Formal and informal mutual aid agreements allow 911 dispatchers to call in ambulances from other coverage areas in the event of disasters that overwhelm the primary ambulance service.

"You don't want First Response representing the city regionally and saying, 'We won't help you under any circumstances.' It just doesn't build the goodwill that you need," Wessel said. "Does it make me angry that First Response would do this to a citizen of Hartselle or a citizen of Morgan County? It makes me furious. Does it make me so furious that I would in turn try to punish an innocent person like they are doing? Absolutely not. You're making innocent people pawns when you play games like that."

Wessel said First Response's policy, if not challenged, could have cost lives.

"Were it not for somebody notifying the state, likely this would have been an ongoing thing," Wessel said. "It might not have made the news until somebody in Hartselle or Somerville died because of it. You just can't do stuff in this business that costs people's lives."

Welty said he was surprised to get First Response's letter, and it prompted him to contact the state EMS agency and to notify other ambulance services that they might not be able to count on Decatur ambulances for mutual aid.

"They send us this memo saying they will only respond in Decatur, Trinity and Priceville," Welty said. "They were trying to refuse county calls, but it seems the state Department of Public Health overrode them on that."

EMS is a part of the Department of Public Health.

Welty and Blair said neither the county nor the state has the authority to require First Response to post an ambulance at Big A gas station. Welty said he requested First Response place an ambulance there whenever Samaritan's Hartselle and Falkville ambulances were occupied on runs. Typically, he said, that happens four or five times per week.

"You're going to see an increased response time into the Hartselle area when Samaritan ambulances already are committed to other calls," Welty said.

Chief James Poole of the Punkin Center Volunteer Fire Department said First Response's policy could have affected parts of his department's coverage area that lie outside Decatur's police jurisdiction. He said he was worried concerns about profit motivated First Response to say it would not respond to calls in the county.

"Dollars and cents are one thing, but once you lose the essence of what you're really there for, something needs to change," Poole said. "It's all about the people. The quicker I can get an ambulance to help the people that call 911, the better it is. Time matters. Every second counts."

Eric Fleischauer can be reached at 256-340-2435 or eric@decaturdaily.com. Follow him on Twitter @DD_Fleischauer.

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