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EMERGENCY CARE

In rural Columbia County, ambulance crews hold the line on emergencies


by: SUBMITTED PHOTO - CRF&R emergency crews respond to approximately 4,000 calls per year, including events ranging from car crashes to earaches. Response volume is expected to continue trending upward. Health care in Columbia County mirrors the health care landscape for many rural communities. Through a comparison of statistics compiled by the Oregon Office of Rural Health, Columbia County doesn’t have the worst access to health care and emergency services. But it doesn’t have the best, either.

And also like many rural communities, the first line of emergency care falls to ambulance crews — paramedics and emergency response technicians who work 24-hour shifts and respond to emergencies ranging from heart attacks to earaches. For south Columbia County, emergency response duty falls to the firefighter-paramedics with Columbia River Fire & Rescue and Scappoose Rural Fire District.

Collapse of a proposed hospital project in St. Helens in 2011 due to federal rule changes, a veto of the project from the Oregon Department of Human Services and a referendum from local taxpayers that gutted its financial base solidified ambulance response as the top — and only — emergency health care service in Columbia County. Factor in fast-moving, sweeping changes — many restrictive — in the national and state health care programs, and it’s a scenario unlikely to change anytime soon, though mandates could alter the current billing structure.

When it comes to emergency response, for the most part residents in south Columbia County have it as good as most.

“It’s about the same as the first hour they would receive in an emergency department,” said Columbia River Fire and Rescue Division Chief Brian Burright.

It’s not entirely the same, he admits. For one, the environment for care is always shifting — administering emergency procedures to a person who has collapsed in a small bathroom is considerably different than working under well-lit conditions with a staff of trained caregivers and the latest in medical equipment at a state-of-the-art emergency room.

And then there’s the drive. In critical cases, it can mean a high-speed run into Northwest Portland’s Legacy Good Samaritan Medical Center for most south Columbia County residents, with each call resulting in a two-hour commitment from the emergency response crew.

‘Unmet need’ with rising

volume

St. Helens — along with Clatskanie and Vernonia — qualifies on the state statistical spectrum as an area of unmet need based on a complex formula that considers five variables, including the percentage of primary care visits met, travel time to the nearest hospital, mortality ratio, low birth weight and ambulatory care sensitive conditions, the latter also known as preventable hospitalizations.

Of the 4,000 calls CRF&R fields annually, nearly 75 percent — 2,900 — are requests for emergency medical services, Burright said.

Tom Moung, 33, is a seven-year veteran with CRF&R who said one variable almost certain to increase is the number of calls the agency has to manage.

“From an operational standpoint with this department, we will likely run more calls,” Moung said, adding that he has seen the call volume increase by 100 annually since he started.

Most — 65 percent — of the transport calls, in light of Columbia County’s aging population, are reimbursed through Medicare, which pays 80 percent of allowed charges. Burright said there is much that is not recovered, however. Even with the agency’s permanent tax rate that equates to $594 annually for a house assessed at $200,000, he said demand is reaching a point that is putting stress on available resources.

“We’re right on the bubble right now of needing more resources,” he said, adding that the budget has “stabilized” in comparison to recent years.

During a 1.5-hour visit at CRF&R’s stationhouse on Columbia Boulevard in St. Helens, as many as five response requests blared over the station’s loudspeakers. Most, on that given day, responded out of CRF&R’s Rainier station.

Each incoming call is prioritized at Columbia 911 dispatch to assess response level. For each call requiring a response, a staff of at least two cross-trained firefighter-paramedics makes the trip.

Typically an ambulance and a fire engine both respond, a practice sometimes criticized for the added expense but one Burright said is needed to safeguard against lost time should multiple calls demand parallel response. It’s not an unusually occurrence, he said.

Each trip to an emergency room is also part of the funding equation for the service. Medicare and Medicaid, as Burright explained, don’t provide reimbursement for emergency summons that don’t result in an emergency room trip.

“The only time we bill is if we close the back of the ambulance doors and take you to a hospital,” he said. At the high end, an ambulance trip to a hospital costs $1,000, with lower-level emergencies billed at $600, he said.

The billing formula could change, however, as part of Gov. Kitzhaber’s broader statewide health care reform initiatives spearheaded under the title of Coordinated Care Organizations, Burright said.

Under the current system, emergency response for actions such as administration of a glucose shot or for a diabetic is free. Burright said possible state changes could result in a fee attached to that treatment. Exactly how much, and other possible effects from the changes such as greater cooperation between all local health care providers, isn’t clear.

“It’s kind of an unknown,” he said. “Hopefully it’s going to allow us to have better collaborative partnerships.”