Could the Rochester Fire Department take over ambulance service in the city?  A new report suggests it could but it would come at a significant cost to taxpayers. City Hall released a report this week that it commissioned to evaluate the city’s EMS system.

Using five years of historical data from 2017 to 2021, Fitch Solutions compiled the report, which provides an assessment of the current EMS system, perspectives on contractual compliance performance objectives, and a comparative analysis with similar communities.  In addition, the report includes an evaluation of seven alternative EMS models for the city’s consideration. 

Right now, only about 30% of calls to 911 from people in the City of Rochester are life-or-death situations. In those cases, EMT-trained Rochester firefighters are typically first on scene.  They start care right away until a crew from AMR arrives. How quickly AMR shows up is largely dependent on how many crews are working that day and what else is going on.

“Our call volumes are now back to well above pre-COVID levels, our workforce is stabilizing a little bit more, we’re not hemorrhaging as many providers as we did toward the middle and end of COVID,” explains Dr. Jeremy Cushman, the EMS Medical Director for the City of Rochester. 

The city’s current contract with AMR calls for an ambulance to be at the most urgent calls within 9 minutes but the new Fitch report shows, without any taxpayer subsidies, that is a difficult benchmark to hit consistently.  Moving forward, the report recommends the city allow a 13-minute response time for the most urgent cases.

“The reality is that 10 minutes, versus 15 minutes, versus maybe even 20 minutes is unlikely to have any significant difference in their clinical outcome,” Dr. Cushman says, “and I say that I guess very comfortably from this office and recognize that when it’s your emergency, it’s your emergency but at some point in time as a community, we have to acknowledge the fact that if we want an ambulance to every part of our community in 9 minutes, there’s going to be a cost to that.”

The Mayor has said he wants to maintain an unsubsidized ambulance model.

Jennifer Lewke (News10NBC): “How do we, as a community, if we’re going to stick with AMR, hold them accountable to ensure that they are offering the best service they possibility can?”

Dr. Cushman: “Obviously, my focus is on the patient, right, and working with EMS providers around this community, I’m not aware of any EMS provider or any EMS agency that is not making every effort to respond to that call for service in as timely a fashion as possible. … To my knowledge, there are no other communities in our immediate area that have not only a contract with performance measures but a contract with performance measures and financial penalties for not meeting those other than the city of Rochester.”

The Fitch report shows that the city currently relies on AMR to manage its own compliance, which could lack full transparency. The report recommends new contractual language and processes to better allow the city to provide contractual oversight and compliance.  News10NBC has requested information from the City of Rochester on how often, over the course of the current AMR contract, the agency has actually paid a fine for failing to meet the metrics outlined, we are still awaiting the data. 

AMR is also footing the bill for the Nurse Navigator Program, which connects 911 callers who don’t really have a true emergency to a nurse who can provide care over the phone or online or line-up transportation to an urgent care instead. “I think what nurse navigation has taught us is that our community is open to accessing means of care when they call 911 that do not involve an ambulance,” Dr. Cushman says. “Our next challenge with that is making sure that our community’s health needs for non-scheduled care are met at 10 o’clock at night or 4 o’clock in the morning the same way they’re met at 2 o’clock in the afternoon.”

The Rochester Mayor’s office says it has reviewed the report and intends to follow several of the recommendations outlined, including maintaining the current unsubsidized EMS model; better aligning turnout time performance with best practices; beginning response time for staging calls only after a scene is declared clear to enter, and enabling computer-aided dispatch (CAD) adjustments. 

AMR’s current contract with the City of Rochester expires in November 2024 but contains renewal options that could maintain the relationship through 2026.