“Our day varies from day to day,” says Steve Champagne, a fifty-eight-year-old paramedic with Huron Valley Ambulance. “Monday, we did four calls, which is pretty slow. Then yesterday, we did eleven. And I delivered a baby on the corner of Huron and Glen! It was my fourth baby, and it was like always–messy.
“That’s the way it is in the ambulance service: moments of terror and hours of boredom,” continues Champagne, who looks a bit like Robert Mitchum with an added mustache and soul patch. “When you get into the middle of it, you do what you’ve got to do, and you don’t really think about it–at the time. But when I got to the hospital after delivering the baby, I really needed a drink of water to get my heart to stop pounding!”
I ask Champagne and Leah Harvey, the paramedic who rides with him on Mondays, what they think health care in town would be like if there were no ambulance service.
“Absolute chaos,” they reply, nearly simultaneously.
“You can’t just leave people dead in the streets after an accident,” says Dale Berry, head of HVA. “You can’t just throw people in the car who’ve had a heart attack and hope they survive. If there were no ambulance service, somebody would come forward and start one.”
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That’s pretty much what happened thirty years ago, when Fontana-Taylor, the company hired to provide emergency medical service for Washtenaw County, announced that it was going bankrupt.
“Crisis is a way of putting it,” recalls Berry, then a South Lyon cop who doubled as the head of the town’s volunteer ambulance department. “It came to a head the summer of 1981, when they said they needed $150,000 or they were going to have to close.”
“They were behind in bills,” remembers Bill Fileti, then VP for planning and development at St. Joseph Mercy Hospital. “They’d fully utilized their credit lines, they were unable to meet their payroll, and they were on the hook to federal and state taxing authorities.”
“John Fontana, the owner, was a very controversial person,” Berry adds. “People either loved him or hated him. But when he came to the county for money, a lot of people just plain didn’t believe him. The county said no, and the next day there were headlines that the county would be without ambulance service.”
It wasn’t the first such crisis. “The county was obligated every three years to put the [ambulance] contract out for a bid,” explains Bob Laverty, then St. Joe’s CEO. “And other companies would come in and lowball the bid and get the contract–and then a year later renegotiate the contract because they said they were losing money.”
Not this time. “St. Joe’s said, ‘We’re tired of this,'” Berry recalls. “‘We’re going to fix this.'” So the hospital bought Fontana-Taylor and the county’s only other professional ambulance company. On December 15, 1981, it opened Huron Valley Ambulance with six ambulances and a staff of forty-two people.
To run the new nonprofit, Fileti hired Dale Berry. “The equipment was just about worthless,” recalls Berry, now a large, comfortable man of fifty-nine. “We bought new ambulances, and they came in piecemeal. But we also bought defibrillators–and they came in right away, so we brought the service up to advanced life support within a few weeks of opening.”
St. Joe’s sudden monopoly of emergency transportation didn’t pass unnoticed. “Bob Laverty bought all the ambulances one weekend, and that got the hospitals’ attention!” recalls Will Johnson, then CEO of Chelsea Community Hospital.
“This was a time of tremendous competition between the hospitals,” explains John Forsyth, then the U-M Hospitals’ CEO. “But for ambulance service, competition–multiple ambulance services–wasn’t the answer. A single service well done was the best answer.”
The other CEOs, however, worried that having a single hospital running it “would give us a competitive advantage because they’d bring all the patients to St. Joe’s,” Laverty recalls. “Since we really had no ulterior motive except to stabilize first-responder care in this community,” he says, “I approached the [other] CEOs, and to allay their concerns, I said, ‘Why don’t we jointly own the ambulance [service]?'”
Four other hospitals joined St. Joe’s, and together they put in $2 million to help HVA get going. “We lost money until April 30 of 1984, and we’ve operated in the black ever since,” Berry says. “What we found was that when a community has crummy ambulance service, people don’t use it as much. But when you come in and provide stable service, they use it. It was the case in Washtenaw and later in Jackson and Monroe counties. And that’s what makes a difference financially–everybody using it, so efficiencies and economies of scale can make it successful.”
In 1985, the hospitals forgave the company’s debt and gave HVA to the community. A year and a half later, HVA moved into western Wayne County when Taylor Ambulance pulled out of Belleville. Next, they moved into Plymouth and South Lyon, and a few years after that into Lenawee and Jackson counties, then into Albion and Adrian, and then into Oakland County and Monroe.
From six ambulances and forty-two people, HVA has grown to include six companies, 125 ambulances, and a staff of 550 that covers nine counties and 121 communities. It has an annual budget of $48 million and provides emergency medical services to around a million people.
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HVA’s dispatch center, on State Circle just south of I-94, looks like mission control. Above rows of consoles lined with computer screens, a huge wall monitor pulsing with colors maps the exact location of the fifty or so ambulances currently on the road, as well as the area each can reach within eight minutes of getting an emergency call.
It’s a slow Wednesday in January, and only six dispatchers are on duty. On busy days and during emergencies, there might be a dozen. But for emergency services, “slow” is a relative term.
Mike Hurley has just handled calls about a structure fire west of the city and a person with a back problem needing transport to the hospital when he gets a call from a citizen in downtown Ann Arbor who’s having trouble breathing. Hurley asks in a deep, calming voice where the caller is and what the nearest cross streets are, then asks for his name, cell-phone number, age, a brief medical history, and a description of what he’s wearing. As Hurley types the information into the system, ambulance dispatcher Dale Ost sends a unit to the scene, and resource dispatcher Jeff Buchanan coordinates with the fire and police departments.
Watching over it all is Dale Berry. He’s often in the dispatch center, and when he’s not, he keeps tabs on what’s going on from his office. “My computer screen has all the calls we’re handling on it–at any given time, we’re doing about forty calls–and I glance at it a hundred times a day,” he tells me. When he’s on the road, he keeps up on a two-way radio–“you can hear a lot that way.” And he doesn’t stop even when he gets home. “There was a big fire in my town [South Lyon] a few nights ago at two in the morning, and I went over. We had a crew there to help the firemen if they needed it, and I wanted to make sure everything was all right.”
“The best decision we made was recruiting Dale Berry,” Fileti says. Jim Frenza, HVA’s first board chair after it was spun off from the hospitals, calls him “a brilliant administrator. They’ve never had any of the internal strife and/or other problems that other ambulance services have had. Look at the way the ambulance services in Detroit have had problems over the years. Nothing like that has ever happened here.”
Even as HVA’s service area has grown tremendously, the time it takes an ambulance to reach a person in need has fallen. Berry recalls that in the early 1980s “we had a county-wide average response time of about 8.4 minutes.” By 1992 that fell to 7.6 minutes, and in the first ten months of 2011, to seven minutes even.
Berry says it’s hard to single out the contribution an ambulance service makes to patient survival, because so many other factors are involved. “This is a team effort between HVA and police and firefighters, and organizations like the Red Cross and the American Heart Association which teach people CPR. And the hospitals have a big role.” But he can say that if a local resident goes into “v-fib cardiac arrest,” and someone is there to call 911 and start CPR, they have about a 25 percent chance of surviving, “which is better than many communities.” When everything goes just right, he estimates, between 30 to 40 percent of the victims survive.
Beyond the constant goal of shorter response times and higher survival rates, Berry says the biggest challenge HVA has now is getting paid. Last year, its average emergency-transport bill ran $714. “Today, insurance is unaffordable for some people, and for almost everybody co-pays are higher,” he says. “And when people have to pay all or part out of their own pockets, they tend not to pay the ambulance service.” For them, HVA offers a program called EMSPlus that covers the cost of ambulance transportation for a year at a cost of $32 to $64 per household. So far, 2,300 folks have signed up.
In the future, Berry says, HVA’s biggest challenge will be “coming to grips with being a regional health care organization. We’ve gone from being a tiny local ambulance service to being the largest ambulance operation in Michigan.”
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If HVA’s dispatch center resembles mission control, the garage behind it looks like the hangar bay of a small aircraft carrier. A dozen gleaming ambulances are ranked in two rows, each spotlessly clean and plugged into electrical cables hanging from the ceiling to recharge its equipment.
“We have four vehicles maintenance facilities like this one,” says Berry. “Ambulances can get up to 200,000 miles; then we put the box on top of a new F-450 chassis.” Fully equipped, an ambulance costs about $150,000, so HVA mechanics do everything to extend a vehicle’s life, from changing oil to pulling transmissions.
More important than the ambulances are the people who dispatch and staff them. HVA itself employs forty-two dispatchers and 162 paramedics and other road personnel, including EMTs and supervisors. Partner companies such as Albion Community Ambulance and Jackson Community Ambulance that use its dispatch services and equipment employ another 490 people.
Steve Champagne was a paid on-call volunteer firefighter and the fire chief of Van Buren Township, but when he started as a paramedic with HVA thirty years ago, he stuck. Leah Harvey, thirty-five, spent eight years on the emergency response team at an auto-parts plant in Saline before coming to HVA in 2007. She says she plans to stay as long as her body holds up.
Keeping staff is a perennial challenge in the ambulance business. “The typical paramedic starts in their early twenties, and by the time they’re in their mid-thirties, their back’s hurting them, and there’s really no non-stressful jobs in the company they can be promoted to,” says Berry. “Early on, we decided we can’t just abandon these folks, so we provide 10 percent of their salary for schooling, and many of our people have gone on to become nurses and physicians.”
So far, Champagne’s and Harvey’s backs are fine. “The key thing is communication with your partner when lifting and carrying patients,” says Champagne. “You have to have the technique, you have to be mentally prepared, and you have to be careful. One of my first partners thirty years ago was lifting a ninety-pound woman, and she tore muscles in her back and her career was over.”
Harvey says the most gratifying runs are “when we have a patient in cardiac arrest and we got them into the cath lab so quick they’re able to walk out of the hospital three days later.”
“Time is key for survival for heart attacks,” Champagne concurs. “The sooner we get them in, the better their chances are. I had one in Ann Arbor where we had the patient in cath lab in twenty-seven minutes!”
Other calls are all over the map, both geographically (one January Sunday, Champagne did a pickup in Alpena) and in the nature of the emergency. “It’s timed with the social services checks,” he says. “We get lots of calls to fights early in the month. And Tuesdays and Thursdays are busier than Fridays and Saturdays. I have no idea why.”
“We’re always busy the day following a holiday, particularly if [the holiday] is a Monday,” Harvey chimes in. “And during the full moon, we get a lot more crazy and violent patients. I’ve had everything from the craziest car accidents to a guy telling me he was a werewolf.
“I told him it was his lucky day, ’cause I was a vampire.”
This article has been edited since it appeared in the February, 2012 Ann Arbor Observer. The list of communities served by HVA has been corrected.
