EagleTribune.com, North Andover, MA

March 31, 2013

Editorial: Andover shouldn’t mess with ambulance service success

The Eagle-Tribune

---- — At a time when there is increasing pressure on every public dollar, it is hard to justify a community’s abandoning an effective, efficient regional service and striking out on its own.

But that is happening in Andover as town leaders are considering dropping an advanced life support ambulance service provided by Lawrence General Hospital in favor of starting its own such service.

The proposal comes with considerable financial risk for Andover taxpayers in return for marginal gains in response times. In fact, Lawrence General argues that dropping the service provided by its highly trained and experienced personnel in favor of less experienced town staff may put patients’ health at risk.

Andover selectmen should keep these concerns in mind when they take up the proposal again tomorrow night.

Fire Chief Michael Mansfield wants to upgrade the town’s ambulance services from basic life support to advanced life support.

Emergency medical technicians are trained to provide basic life savings care and transport patients to the hospital as quickly as possible. But when a patient is suffering a more serious medical crisis, he or she needs the services of paramedics, who are trained to provide a higher level of care than EMTs. A paramedic is able to administer intravenous fluids and medications, insert breathing tubes, read electrocardiograms and provide other such advanced treatments.

In a presentation to selectmen, Mansfield said having its own advanced life support ambulance service would allow Andover to cut response times by 20 to 25 percent over ALS crews dispatched from Lawrence General.

Mansfield is asking selectmen to fund the first-year start-up cost of just under $146,000. Mansfield said the cost would increase slightly year by year, but the revenue generated by the service each year through 2017 would cover the full cost of the program.

The ALS service provided by Lawrence General comes at no cost to the community, hospital representatives countered.

Lawrence General representatives in their presentation to the selectmen questioned Mansfield’s assumptions on the call volume a town-based service would handle. This is important both for the amount of revenue the service would generate and for the experience gained by the town paramedics.

Lawrence General representatives said that, while Mansfield projects handling 1,000 to 1,050 ALS calls per year, their figures show the town averages only 480 such calls per year.

That could possibly place patient outcomes at risk, LGH Advanced Life Support Services Director Paul Brennan said.

“We believe medicine is competency based, and you get that at every single level, from physicians and anesthesiologists, all the way down,” Brennan said. “There is solid evidence, there is solid studies, that more experience — not the number of years necessarily as a paramedic, but the more patient interactions you have — patients have a better outcome.”

Mansfield countered that his paramedics would have plenty of experience, not only from town calls but from working their other paramedic jobs as well.

Lawrence General’s ALS paramedics serve Andover, North Andover, Methuen and Lawrence. Clearly, the hospital has a financial interest in continuing to provide its services in Andover. But as Brennan notes, the hospital could redeploy its resources to another community to make up part of the loss.

We are not aware of any great volume of complaints from Andover or anywhere else about the quality of Lawrence General’s ALS service. In fact, the service has a track record of exceptional clinical results, performing successful intubations 98 percent of the time, compared to a national average of less than 80 percent. The LGH crews arrived on the scene in Andover in an average of less than 8.5 minutes.

It seems to us that starting a new ambulance service at a time when health care reimbursements to providers are being ratcheted down by national legislation is an unnecessary risk for taxpayers, particularly when a no-cost regional service already serves the community so well.