Service brings ED to the work site

Ambulance/EMT combo cuts costs, improves care

Any time a workers’ compensation manager can slash medical costs without sacrificing quality of care, it’s bound to put a smile on his or her face. As for Dave Wheeler, he’s no doubt grinning from ear to ear.

Wheeler is workers’ compensation manager for Precision Castparts Corporation, a Portland, OR-based company that manufactures internal body and engine aerospace parts and knee and hip replacements. He has saved his company tens of thousands of dollars a year in medical claims and staffing costs by contracting with American Medical Response Northwest (AMR), a local company that dispatches ambulances and trained EMTs to the worksite, often treating sick or injured employees on site without having to take them to the emergency room.

"We used to have an in-plant nurse who worked one shift a day, five days a week," Wheeler recalls. But the plant runs seven days a week, three shifts a day. "When the nurse was not there, we had to rely on Red-Cross trained volunteers in the work force or ‘911.’ Consequently, many people were transported to the emergency room when it was not medically necessary," he says.

Self-insured Precision has approximately 150 calls per year handled by AMR. About 35% are treated on-site. "The average bill for an emergency room visit is $1,000, so there’s $53,000 [saved] right there," says Wheeler.

In addition, he says, to get the same appropriate medical coverage on-site would require three nurses 24 hours a day. "The average nurse’s station costs well in excess of $100,000 per nurse, when you factor in salary, benefits, malpractice insurance, medical supplies, and equipment," Wheeler says.

The annual fee for AMR’s service is just under $20,000.

Under AMR protocol, when an employee is injured or becomes ill, his supervisor calls the service and follows procedures outlined on a wall placard, including answering prescribed questions. If the needs go beyond AMR’s first-aid service, the problem is immediately turned over to 911. "If it’s a life-threatening situation, the EMTs jump right into the ambulance. Within 30 seconds of making the phone call, we get the proper high-quality medical response."

The EMTs dispatched by the service also clear instructions. For example, they handle cuts that don’t require stitches. For other cuts, they take the employee to the emergency room and then transport him back.

Medical staff always in contact

"Instead of the supervisor taking the employee to the hospital in a taxi, I have medically trained EMTs in a medically equipped van, in radio contact with a dispatcher if the employee goes into shock, or if there is some other complication."

Even though in such cases the company incurs an emergency room bill, money still is being saved overall, and the quality of care remains high, says Wheeler.

Trace Skeen, AMR, CEO, current president of the American Ambulance Association, says, "Workers’ compensation claims need to be controlled but so do loss of productivity and liability. If you send an employee off in a taxi having underestimated the seriousness of the injury and then there’s blood loss and shock, you could have a real problem. If a supervisor loads the employee into his personal car and goes with him to the emergency room, both of them are waiting, and you have a loss of productivity."

Part of a bigger picture

AMR Northwest, Skeen explains, is actually part of a larger company, Aurora, CO-based American Medical Response, which operates in 34 states. The parent firm has an 80-year history strictly as an ambulance company. The Portland operation was acquired in 1993, and its ambulance/EMT combination service is a pilot program.

About 25 Portland-area companies use the service, which now covers about 30,000 employees.

[Editor’s Note: For more information on how the AMR service works, contact: Dave Wheeler, Precision Castparts, 4650 Southwest Macadam Ave. Suite 440 Portland, OR 97201. Telephone: (503) 417-4800.]