CARS not budget beneficiary

When Charlottesville announced its biggest-ever budget, the city pointed out that close to $1 million would be used to supplement the Charlottesville Albemarle Rescue Squad with an ambulance and staff. CARS president Larry Claytor called a press conference today to announce that the longtime rescue organization had not been involved in city plans to improve response times until a meeting last night, and that the $966,122 earmarked for EMS in the budget would not be coming into CARS' coffers. "We had no input into any of the budget process," says Claytor, who is running for Albemarle sheriff.

"We're not trying to take over the rescue squad," says Charlottesville fire Chief Charles Werner, who was present at the announcement. Instead, he pointed to Albemarle County, which can no longer depend on the strictly volunteer model, a staffing phenomena that's happening around the country.

The city is also looking to "enhance revenues" by charging $400 for each ambulance call, says Werner, who says the current budget allocation would allow for 24-hour ambulance service. And he notes that CARS has never asked the city for money.

CARS board member Jay Levine did not seem convinced there's a problem with the response times of CARS, which runs 5,000 calls a year, and says it's a good idea to look at whether there's a system-wide problem.

There's still time for citizen input on the budget: A budget forum will be held at 10am Saturday morning at Buford Middle School. Light refreshments will be provided.

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13 comments

I would like to respond to some of the points made in the "CARS members"
letter. I have been a member of CARS for over 5 years, and see a very
different side of a truly amazing organization. Here are some of my
observations:

- The letter indicates that CARS should accept the
cities assistance in the same way they have accepted the
counties. The difference is that the county has worked in a
team approach with the EMS system- the city has not. Any of the changes
initiated by the county has been done working closely with CARS. CARS
is very willing to work with the city to incorporate their assistance as
part of the larger EMS system. To date this has not happened, even
though Dr. Richard Crampton and Larry Claytor initiated a dialogue with
the Mayor in the fall of 2006.

-I think that Joel Cochran's (founder of CARS) comments indicate his
awareness that CARS and the EMS system need to be responsive to changes
in the community. CARS has shown a willingness to do this. The fact
that the county now provides services to a northern section of the
county, provides personnel assistance to the day crews, and provides
financial support demonstrates the willingness of CARS to adapt and
provide the needed services to the community. These changes are the
result of planning and cooperation between the CARS and the county.
CARS welcomes engaging in a similar process with the city.

-The city justifies their proposal by saying that CARS failed to meet
response times in 16% of calls run in a short period in the city. As a
previous email noted, the fire department is the first responder in
serious medical/trauma calls. Also, the system for recording response
times is not perfect. If the primary concern of city officials is
response times then they should sit down with CARS and figure out a
system wide approach to solving any issues that involves all components
of the system, not just the transport unit. CARS has never said the city
cannot establish a paid ambulance if it decides to do that.

-The comment concerning CARS finances has little relevance to this
discussion. I do know that running a rescue squad where the patient is
not charged for any of the services provided is an exceedingly expensive
proposition. The fact that the city plans on spending a million dollars
for two trucks with 8 EMS providers, and in addition, plans on charging
patients for transport services is indicative of this fact.

-CARS does not have all of the answers, nor does the city or county.
However, in the past all entities have worked together to solve the EMS
needs of the greater community. Having the city provide greater
assistance in this process is welcomed, but it has to be done in concert
with the other members of the EMS system. It would make sense for the
city leaders to ask for CFD to meet with CARS and county EMS personnel
to address any concerns and to come back to the city council with a
unified approach. Hopefully this process will begin with the meeting on
April 2nd between CFD, Albemarle County Fire/Rescue and CARS.

The City's motivation is suspect at best, IMHO. Larry Claytor, the President of CARS, has stated that the city didn't even consult with CARS in formulating its budget request. If that's the case, what's really going on here?

The City's numbers are also questionable. They expect to run 1500 calls in the city. They're budgeting (i.e. trying to "sell" to the citizens) that they'll recoup $400 per call. How will this work? Will the other 3000 calls that CARS runs in the city be free, while city fire charges? Will citizens be able to request only the free service? But, if the city is going to be part of the existing EMS system that's been in place for decades (and which it is already an integral part due to its first responder status), then the city will also have to run calls in the county when it's needed and it should have to run calls into the county if it is the closest available ambulance (such as out Fifth St Ext). Those calls cannot generate a bill. So, these numbers are bogus. Plus, only patient transports can be billed, not incidents merely with a response, an assessment and a return to the building.

Besides, if the City has identified response time problems, why wouldn't that have been discussed with CARS first to attempt to resolve the problem? The DP reports today that the problem was something in the area of 200 or so calls that were above 8 min in response time from CARS. What were those calls? Were they life threatening calls or BLS (basic life support calls)? Were first responders already on the scene? Many, many questions need to be answered before jumping into the patient transport business. 200 or so calls represents a small percentage of the number of total calls that CARS runs.

So, what's really going on here? Are city fire numbers down? Do they need something to justify themselves? Is Julian empire-building? As I understand it, the county's contract with the city will be over after this year. I believe the city runs about 1700 calls in the county and the city gets paid for it by the county. That contract is up this year, I believe. Is this designed to replace that money -- not to mention the loss of activity?

I say more dialogue with CARS is necessary, and more truth in advertising to the community.

I hope there is more reporting on this story. CARS is a fantastic service and what is being related does NOT make sense at all.

Communicate people!

The City Fire Department, and Chief Werner, are struggling to prove their own relevancy. Julian Taliaferro is full of bluster as always and, I suspect, working to build a legacy. City Fire leadership fears the fire/rescue consolidation study findings which will remind many that CARS and the County Fire Rescue Department are larger and more progressive. Rather than empire building at the expense of we taxpayers, Cville Fire should be looking to the county and CARS and examples. CARS has already shown that the fire department is not being truthful and fully disclosing the facts, but rather using suspect statistics to make their arguement. Both CARS and the City surely have their own isolated issues with response times in our growing urban areas, but I am sure a careful study would show that it's nowhere near as dire as the City would lead us to beleive.

I would much rather the City actually give CARS some funding for once. It's insane that the city has never agreed to CARS requests for funding. I'm sure that CARS could take $250,000 from the City of Charlottesville and do more than the City Fire Department could do with $1,000,000. And don't forget, this duplication of services would just be the start. Every year (just as in the county) the cost of these municpal services would go up.

Shame on your Charlottesville. We won't sit idly by and let you besmirch our honorable volunteers!

The city has so much money these days they don't know what to do with it all. They would be far better off dedicating a fraction of that money to CARS and let the squad make any necessary improvements. Since its inception, CARS has proven itself to be an efficient, dedicated organization that has provided EMS services for nearly fifty years without charging a dime. The city should conduct a better study to verify the response times. Why was there a delayed response? How urgent was the call? Was a first responder already on scene?

If the city manages their ambulance service like they manage everything else, they'll end up paying twice as much as CARS to cover an area fifty times smaller.

I am very disappointed.

test

While many are offering their emotional responses and rhetorical questions. I have done my best to provide answers to these and other common questions as they relate to the CFD EMS proposal with factual information and documentation.

To access these downloadable files, visit the following website:
http://www.cfdonline.org/cfdems.htm

Respectfully submitted,

Charles Werner, Fire Chief
Charlottesville Fire Department

Maybe you are just the front man, a puppet in a larger play set here in our ââ?¬Å?world class” city, or perhaps you believe the arguments you are putting forth. Either way, shame on you, Mr. Warner for your closed door-tactics and mud-slinging accusations against an organization that has served a community as CARS has for 5 decades. Show us a single provider on your payroll that has not directly been trained or precepted by a CARS member. You even go as so far as to claim in your FAQ that you had hoped this change would be made ââ?¬Å?absent public debate”. Of course! Why would the public need to be involved in the decision to use tax dollars to duplicate a system they already receive for free? Citywide ââ?¬Å?Mrs. Smiths” will even get to pay several times for it; once in taxes, once from your bill, and likely again from their increase in insurance premiums. Why would this senselessness make anyone emotional?
But since you prefer to deal in fact, let me address the ââ?¬Å?fact” that seems to be the root of your argument: Response Times. The definition and AHA guidelines actually refer to the time from the 9-1-1 call is made to the arrival of advanced life support care. In the current C'ville EMS system, that responsibility actually falls on the fire department. That is why your engines are dispatched to -first respond- to life-threatening emergencies. The thought being that providers from the engine provide life saving care until the ambulance arrives. There is no guideline or expectation in any document to date that sets a standard for the -transport- vehicle. Besides, even if you put an ambulance at all three of your stations and map out their 7 minute response areas, there would still be parts of the city left out. But that is not even the current plan, is it?
This is not about response times, it is not about your concern for the city's ââ?¬Å?Mrs. Smiths” welfare, I think it is becoming clear what this is about. Rook: it's not just a card game anymore.
Shame on you.

Hey MRS.Smith there are firefighters at CFD that were never trained by CARS nor precepted by cars.
It baffels me as to why so many people are upset that the City Fire Department is wanting to place an ambulance in service to assist Cars in covering calls no one has said were not allowing you to run calls any longer in our city. In regards to EMS billing. Once the county begins billing for calls which they will, the county medics that ride the Cars ambulances and run calls in the city will be billing city residents for the service which they render and that money will then be spent in the county on there citizens. So if city residents or going to be billed for EMS service who would there money rather benifit, city residents or county residents. The addition of more units to the system is not a bad thing. The community is growing faster than the infrastructure and the emergency services. The county police are down forty yes forty police officers, The county Fire Departmnet is strapped during the day time hours, there are less and less volunteers avaiable to assist with calls for service. That is no different at Cars during the weekdays. CARS is lucky to have three ambulances running and that is with the two medics the county provides for them. In the evenings they sometimes can manage four but to often the are just BLS units due to the lack of Medics. The new state certifiactions are harder to obtain and even harder keep the amount of people wiiling to give that time is declining and waiting for the situation to become dire is to late. CARS's biggest problem is a membership that swells during THe UVA term and declines when there gone and that is no way to consistently cover an area that is growing faster then the volunteer sysytem can keep up with it.

There is a need for balance. I wrote this same letter to Rob Schilling in hopes that a negative debate would not follow but not so. Many at CARS are not aware of the debate because our leadership is not sharing and in many ways they continue to do things the way they have always been done. Its time to change AND I am really frustrated that CARS will not accept assistance from the City the same way that we have from the County - WHY IS THAT? Does the City have to pay ransom money first? Every CARS member that reads this knows when all of our units are busy - IS THAT OK? Lets do the right thing and accept the help that will make our system better and serve the people as they should be.
Dear Rob,

I want to thank you for your continued efforts in our community and your past service on City Council. It was always nice to have a balancing voice present.

I am writing to share some very personal thoughts and concerns about what is happening. Unfortunately because of the internal politics I cannot reveal my name as I would be persecuted but I needed to share before I think this gets worse.

I am a life member of CARS (that means at least 10 years of service). I joined this organization to make a difference. I have enjoyed it immensely and have helped many people. It is one of the most rewarding things that I have ever done.

I am troubled as I see such venom that is spewing here at CARS about the City's proposal to put a career FD ambulance into the system. While I do not like the situation, it has risen to the point that this assistance IS needed. One thing that I learned from Joel Cochran (one of the founding fathers of CARS) is that we need to serve our community - thats what CARS was organized to do. Joel told me on numerous occasions that there would come a day like this but that we would fill that void for as long as we could. Joel also told me that when that day came, it would be time to let the paid professionals do the job. While I do not want to close up shop, there is some wisdom to his words.

There are many things that people do not see because they are not in the system but let me say this - while your intentions are good, they may be more damaging than what good they do. The fire department has been silent on this issue (I have asked many of their people) and tried to do this with CARS but our organization has blocked it. Sorry but even for us its a turf issue rather than a patient care issue which is what must remain the focus. CARS initiated a press conference on Friday of last week which is what initiated this public debate which is not good for CARS. First hand, I can tell you that we do have response time problems, many of our members are no longer long time community members and they do not know their way around, regularly during the week - our resources are all busy (none left for other calls anywhere). Often we call upon UVA's ambulances (which are often delayed too) and the County's ambulance from the airport to cover the City. The patient care has also become not as good as their is such a transient membership that once people get really good, they leave because many are students.

There are many horror stories that I hope will not see the light of day as they would truly injure our organization. Additionally, I have been very frustrated at the statements about the fact that the City has not given any money to CARS. What most do not know is that the charter members of this organization made a specific policy not to accept money from any government agency so that we would never have to listen or be influenced by any organization. I have been frustrated because I have asked on a number of occasions to know the financial situation of CARS and it is kept secret which I have found troubling. One of the top people did tell me one time that CARS has millions in the banks all over Charlottesville, and CDs and mutual funds. Its been so secretive that they hand out financial statements then ask for them all to be returned (only select individuals). If you dont believe me ask them for a copy of the financial statement and find out for yourself.

For many years the Charllottesville Fire Department has provided drivrers, attendants, medics - whatever needed for us to get people to the hospital. At first, many of us were opposed to that too but it was a godsend. Our response times are getting longer and you can look at them yourself on the CARS website.

The bottom line is that we need help to insure that the patients are served. The County has done it too and at first we were opposed to it but it has turned out to be a good thing but its still not enough. The County provides 3 paid medics at CARS now and they added a fulltime career medic ambulance at the airport (future Hollymead Station).

If this becomes more of a discussion:

Many of the patient care issues may come to light. Response times will become even more highlighted
The financial situation of CARS will be revealed as being a "very wealthy" organization and negatively affect the fund raising.

Whatever you do, stay focused on the care of the patient not CARS, not the Charlottesville Fire Department and not just the issue of taxes.

A long time and caring CARS member. Please be true to yourself and the citizens of this great community. Stay on facts not emotion - there is too much of that which is standing in the way of doing what is needed.

I am curious as to all those that would provide such enlightened comments without actually putting your real name. Such cowards - its easy to criticize others without your showing your identity.

Well - Curious - it looks as though you exercise the same "cowardess" that you accuse others of. I can almost picture
you sitting in a corner - sharpening your knives to stick in the back of those who do leave their names.
The real problem here is that CARS is unable to fight the statistics, so they sling mud. I have not read any
document or interview that the City has slung any mud - they seem to be genuine in wanting to support CARS, but
more importantly, they want to be certain that all City residents and visitors have the best pre-hospital care (which
includes transportation to a medical facility) as possible. Common sense tells you that you cannot mesh any program
in with an existing pre-hospital program without funding. What I can't figure is why the City is the target. Albemarle
County started all this! They have quite the budget that Albemarle County taxpayers are carrying for EMS - and it will
only continue to grow. They have an ambulance(s) with Albemarle County Fire Rescue on them - NOT CARS - parallel
system - I don't know what the County plans, and I can tell ya one thing, they won't tell ya either!

The City has proof of what they are saying .. those CARS "power players" should be careful about what the deny - as
it is hard to argue with dated documents - especially if any of those players have a desire to serve the public in
another capacity. Voters don't forget. Especially Democrats!

Important to note: CARS is not now, and has NOT been an ALL volunteer department for a very long time now.
Albemarle County has had paid people running EMS calls for a very, very long time. The only reason you haven't known
that - if you didn't know that - is you haven't gotten a bill ... YET! The County was the first to discuss revenue
recovery - charging city residents for calls run with the funding going to the County, will CARS benefit from this too?
Educate yourself without bias. This is about the citizens and visitors of the City of Charlottesville and the city's desire
to supplement CARS to serve our community. Another important note: Money does not drive ambulances - people
do.

By the way, the only person so far to leave their real name in order to share the truth: Charles Werner, Fire Chief