The Emergency Business
55 Years of American Medical Response
The Early Days of AMR
Imagine that you have a business model where you immediately grant your customers thousands of dollars in credit answer your phone in less than 5 rings and deliver your services in less than eight minutes over 90 percent of the time. That may sound like a very risky business model, but it is a model of proven success for American Medical Response in Stanislaus County. What follows is a success story AMR celebrates in now its 55th consecutive year of operation in Stanislaus County.
Beginning in 1959 AMR’s predecessor company Modesto/Ceres Ambulance began operations in Modesto and Ceres. In those days the ambulance calls came into an answering service which located the ambulance crews by phone and sent them on their way to calls, monitoring activities through two-way radio service which, at the time was considered state of the art. Today dispatching of ambulances is provided by a lightning-fast computer aided dispatch system which uses global positioning satellite technology to route the closest ambulance to the call. Clinical care and technology have improved dramatically and AMR’s field medicine is highly ranked by research universities and ambulance industry accreditation organizations.
The general manager in the early days of AMR was Jim Ridenour. Ridenour and many of his family members worked the ambulance service, doing everything from repairing the ambulances to delivering babies in the back of the ambulance. Jim ultimately advanced through the ranks of AMR, having retired after 40 years of service in 1999 as the top operations executive for AMR’s Central Valley operations.
“Back then we really couldn’t do much for the patients”, said Ridenour. “We focused on looking sharp, provided good customer service and got patients to the hospital as quickly as we could. We had competition, so the promptness of our service and our image is what made us successful.” While Ridenour heralds the clinical advances, care-giver training and improvements in technology in the ambulance industry, he feels it is AMR’s continued focus on service and their track record of performance that has sustained AMR in Stanislaus County for 55 years.
In Stanislaus County AMR is contracted to provide emergency ambulance and advanced life support services. The service area AMR handles includes the cities of Modesto, Ceres and Turlock and portions of the surrounding unincorporated areas. AMR employs 180 emergency medical technicians and paramedics who are deployed from their operations facility at 4846 Stratos Way in Modesto and a substation in Turlock.AMR staffs ambulances primarily on 12 hour shifts around the clock. Each advanced life support ambulance is staffed with an EMT and paramedic though some units are staffed by 2 paramedics. At peak deployment AMR operates 21 ambulances and a quick response vehicle. The quick response vehicle is a SUV staffed by a paramedic. The QRV is located in areas to overlap the coverage of ambulances by providing rapid response and care. AMR also provides medics on bicycles for special events and has a specialized response team in a uniquely outfitted modular ambulance to respond to SWAT callouts and other law enforcement incidents.
AMR is required to meet very rigid response times for emergency ambulance service. In fact, only two counties in California have more rigorous response times than does Stanislaus County. Here, AMR must achieve response times of 7 minutes and 30 seconds no less than 90 percent of the time, whereas the national standard is 8 minutes or less 90 percent of the time. AMR achieves this response time standard consistently by better than 92-93 percent compliance. AMR does not report its response time compliance;
the data are extracted by a third party entity which reports to the raw data directly to the Mountain Valley Emergency Medical Services Agency which regulates local ambulance service through a joint powers agreement with Stanislaus County.AMR is able to achieve one of the most stringent response time criteria in the nation because of a proprietary call modeling software application which aids system status management. System status management is a data-drive process which matches call data within a geographic area to response requirements. Using historical data, analysts are able to accurately forecast ambulance needs by hour of day and day of week and match available resources to meet response times. Rather than being assigned to stations, ambulance units are constantly repositioned throughout AMR’s service area.
At its operational facility AMR stocks, cleans and maintains a fleet of 50 ambulances, support vehicles and a disaster medical response unit assigned to Stanislaus County by the State of California. The operations facility has a complete vehicle repair shop staffed by two full time mechanics.
AMR’s general manager is Cindy Woolston. Cindy, a graduate of Leadership Modesto has worked for AMR for 34 years and has been the general manager in Stanislaus County since 1997. She is assisted by four field supervisors, administrative and clinical managers, a physician medical director and 5 support staff. Accounting, financial, human resources and risk management services are provided regionally or through the AMR National Support Center.
Patient Billing Services
AMR operates the Western States Billing Center which provides ambulance billing services for AMR operations west of the Mississippi River. The billing center located at 4701 Stoddard Road in Salida is staffed by 339 employees. The center processes approximately 990,000 ambulance claims per year.AMR utilizes its own comprehensive billing software system, a considerable investment by AMR to maximize reimbursement for services provided. The billing process starts with mobile computers installed in ambulances and response vehicles to gather patient data and signatures required for payment of the bill. Billing technology includes the ability to scan paper patient documents in the field.
While some billing claims may take 50-80 macro steps to properly process a clean claim, this technology reduces some of the steps so that the billing process flows more smoothly. The field software application interfaces information with the computer-aided-dispatch system and blends all field care information in the billing system.
AMR operates the Valley Regional Emergency Communications Center at 4701 Stoddard Road in Salida. VRECC is one of only 133 Accredited Centers of Excellence in the world. AMR received this designation through a rigorous accreditation process administered by the International Academies of Emergency Dispatch. The dispatch center employs 47 emergency medical dispatchers and call takers.Newly constructed in 2006, the dispatch center is a public private partnership between several San Joaquin County fire departments and AMR. The dispatch center serves over 1.2 million residents in Stanislaus and San Joaquin counties, dispatching over 155,000 responses per year to fires, vehicle accidents and emergency medical calls.
The dispatch center provides emergency medical dispatch instructions for all 9-1-1 calls in Stanislaus County. Certified dispatchers follow medical protocols and algorithms to both interview callers and instruct them on how to provide interventional care such as controlling bleeding, opening an air passage or performing CPR.
AMR’s dispatch center utilizes the most current technology available for fire and ambulance dispatching. This includes the most recent iteration of computer-aided-dispatch software, global positioning satellite technology, a bio-terrorism and medical incident trending monitoring program and other enhancements. The dispatch center has two sources of redundant power and in the event of catastrophic failure the dispatch center can be immediately replicated at any one of two offsite locations.