First Response 

As Germantown and Collierville prepare to opt out, will county ambulance service become more unwieldy?

Sometimes you're dead if you do and dead if you don't.

As Shelby County citizens have discovered, the split between the county's various emergency response systems has created problems that have residents clamoring for change. And with Collierville and Germantown ready to opt out of the contract with Rural/Metro, local ambulance service looks to become more disjointed.

Municipal fire departments respond to every emergency call throughout Shelby County and can administer medical attention but cannot provide residents transportation to the hospital, regardless of a situation's severity. In Germantown, Collierville, and the unincorporated areas, that's the job of Rural/Metro, the county's ambulance subcontractor with a reputation for lagging response times. The county now plans to let the current Rural/Metro contract expire June 30th and rebid ambulance service.

Joe Phillips, state director of emergency medical services, explains that the county's agreement with Rural/Metro hasn't specified the need for more ambulances. "The demand for service [in Shelby County] has increased, but the contract [with Rural/Metro] hasn't changed," he says.

Ambulance service areas have caused another series of problems. Metropolitan Shelby County is split into three emergency medical service jurisdictions. As the deaths of Jim Wagner in 2003 and former mayor Wyeth Chandler in 2004 demonstrated, this approach creates gray areas large enough to lose lives.

Now Germantown and Collierville plan to explore options for separate ambulance service. A local precedent for the proposed move exists. Bartlett has operated its own ambulance squad for 30 years as a service of the city's fire department. According to Bartlett fire chief Terry Wiggins, Bartlett ambulances average four-and-a-half minutes per response, and he estimates that they answered 2,000 medical calls last year.

"We've had a good thing going for years," Wiggins says.

The question remains whether the increased efficiency of ambulance service will translate into less jurisdictional confusion. Though Wiggins is proud of Bartlett's independent service, the death of Jim Wagner, blocks from the Bartlett city limit, revealed flaws in the system. Bartlett and Memphis emergency dispatchers squabbled over who should answer the 911 call, while Wagner suffered a fatal heart attack.

Jay Fitch, founder of Fitch and Associates, a consulting firm in the emergency medical services industry, says, "It's all community-specific. They have to look at the clinical, operational, and fiscal aspects and ask, 'Is it sustainable?'

"Some communities have overestimated revenue and underestimated costs," he adds. Fitch urges a thoughtful, systematic approach to the problem. Despite the powerful temptation -- and the legal impetus -- to go solo, he says, "Once you fragment, it's very hard to put it back together."

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