The Matrix Report and Firehouse Forums
The Matrix Report
On September 28, 2004, The Matrix Consulting Group presented its findings to the Peoria city council regarding Emergency Medical Services (EMS) in Peoria. The city hired Matrix for $79,000. Currently, Peoria has two EMS responders: the Peoria Fire Department (PFD) and Advanced Medical Transport (AMT) a private, ambulance company co-owned by the three Peoria hospitals. AMT responds to 911 calls, provides three levels of life support: basic, intermediate, and advanced (paramedic), and transports all Peoria patients. The PFD responds to 911 calls and is only permitted to provide basic life support. They are not allowed to transport patients.
Two gentlemen from the California-based firm made a very polished PowerPoint presentation accompanied by an impressive-looking 149 page report. The presentation covered issues ranging from PFD organizational issues to paramedic and transport services provided in Peoria by AMT. Matrix’s primary recommendation, after all was said and done, was for Peoria to make no changes in ambulance service. How and why they arrived at this conclusion remains a mystery. Their report contains evidence that suggests changes to ambulance service could be beneficial to Peorians. Furthermore, data crucial to evaluating EMS and ambulance service is no where to be found in the report.
According to the report, the current EMS system in Peoria is supervised by the Illinois Department of Public Health (IDPH), which maintains a district office in Peoria. When I spoke to a representative from the office, he stated that he was unaware of the contents of the Matrix study and had only general data from AMT. He was unable to answer my specific questions regarding how Peoria pre-hospital patients suffering from chest pain, breathing problems, cardiac arrest, or trauma had done over the last decade.
The Matrix report states that AMT’s performance data was also submitted to the project medical director (the doctor in charge of all EMS and ambulances in central Illinois) who is located at OSF St. Francis Medical Center. When I spoke with the emergency services manager in the EMS office at OSF, she stated they had no aggregate data regarding how AMT performed in 2003 or for any year. How could the project medical director not have this data? Data that normal EMS systems collect would include: successful cardiac resuscitation in the field, survival to hospital admission, survival to hospital discharge, etc. Where is Peoria’s data?
Consistent with my conversations, the Matrix report contains absolutely no data about patient outcomes. The report states that performance data is provided to IDPH and the project medical director, but my conversations with individuals from these offices indicates that this data has not been compiled or analyzed.
The Matrix report continues with a chart depicting the average response time by the PFD and AMT to life-threatening emergencies. The PFD arrival is almost two minutes quicker than AMT. The consultants go on to explain how medical research shows that advanced life support (ALS) may help people with chest pain and breathing problems. Indeed, patients suffering severe trauma incur five percent increased mortality for each minute that they are not transported (remember Princess Diana?) The PFD is not permitted to provide ALS or transport patients. Of the more than 9,000 EMS calls the PFD responded to in 2003, 1,800 were for breathing problems, 900 for chest pain, and 1,700 for trauma. Based on the above, Matrix outlined a plan that would “increase the level of service” by allowing four fire department engines to be staffed with paramedics to respond to “targeted areas” in Peoria. If the PFD could provide ALS, lives would be saved as Matrix notes that “early establishment of intravenous fluids and certainly advanced airway management will be beneficial in certain cases.” The seriously ill or injured patient would no longer have to wait for AMT to arrive for advanced interventions.
Matrix then did a cost analysis of the above and stated that for a “relatively low cost of approximately $100,000 per year . . .the city could move to a four company ALS engine company system.” What Matrix overlooked was the fact that the PFD firefighters who are currently paramedics could provide their expertise for the four engines if only the project medical director would agree. This may be difficult because the medical director’s supervisor at OSF is the corporate medical director at AMT.
The Matrix report states that the PFD recently acquired a transport capable ambulance. They state that since there are no “service gaps” (i.e. AMT is always available) the PFD ambulance is not necessary. Many EMS providers in the Peoria area and families I have spoken with give numerous examples of “service gaps.” Patients and Peoria firefighters have waited precious minutes for AMT to arrive at the scene. AMT has even called the PFD for help when AMT finds themselves overextended responding to emergencies. Matrix notes that AMT maintains the “proprietary nature” of its staffing and financial information and so this information was not contained in the report. Just imagine if the PFD wouldn’t reveal where they were located or their operating budget.
Matrix’s conclusion that there are no gaps in service is incorrect. However, their advice to sell the only existing PFD ambulance may be sound since it sits unused for emergencies. According to the Matrix report, “the PFD has applied to the project medical director for permission to outfit the ambulance with various basic and life support materials and equipment. This request has been, to this point, denied by the medical director. . .”
In conclusion, evidence and healthcare statistics regarding emergency medical services in Peoria are glaringly absent from the Matrix report. Conclusions based on invisible or non-published data are opinions and nothing more. If leaders are to make credible decisions about Peoria’s EMS and ambulance services, these judgments must be based on complete, unbiased, accurate data. We should ask the question: why is such critical information so hard to come by?
Two gentlemen from the California-based firm made a very polished PowerPoint presentation accompanied by an impressive-looking 149 page report. The presentation covered issues ranging from PFD organizational issues to paramedic and transport services provided in Peoria by AMT. Matrix’s primary recommendation, after all was said and done, was for Peoria to make no changes in ambulance service. How and why they arrived at this conclusion remains a mystery. Their report contains evidence that suggests changes to ambulance service could be beneficial to Peorians. Furthermore, data crucial to evaluating EMS and ambulance service is no where to be found in the report.
According to the report, the current EMS system in Peoria is supervised by the Illinois Department of Public Health (IDPH), which maintains a district office in Peoria. When I spoke to a representative from the office, he stated that he was unaware of the contents of the Matrix study and had only general data from AMT. He was unable to answer my specific questions regarding how Peoria pre-hospital patients suffering from chest pain, breathing problems, cardiac arrest, or trauma had done over the last decade.
The Matrix report states that AMT’s performance data was also submitted to the project medical director (the doctor in charge of all EMS and ambulances in central Illinois) who is located at OSF St. Francis Medical Center. When I spoke with the emergency services manager in the EMS office at OSF, she stated they had no aggregate data regarding how AMT performed in 2003 or for any year. How could the project medical director not have this data? Data that normal EMS systems collect would include: successful cardiac resuscitation in the field, survival to hospital admission, survival to hospital discharge, etc. Where is Peoria’s data?
Consistent with my conversations, the Matrix report contains absolutely no data about patient outcomes. The report states that performance data is provided to IDPH and the project medical director, but my conversations with individuals from these offices indicates that this data has not been compiled or analyzed.
The Matrix report continues with a chart depicting the average response time by the PFD and AMT to life-threatening emergencies. The PFD arrival is almost two minutes quicker than AMT. The consultants go on to explain how medical research shows that advanced life support (ALS) may help people with chest pain and breathing problems. Indeed, patients suffering severe trauma incur five percent increased mortality for each minute that they are not transported (remember Princess Diana?) The PFD is not permitted to provide ALS or transport patients. Of the more than 9,000 EMS calls the PFD responded to in 2003, 1,800 were for breathing problems, 900 for chest pain, and 1,700 for trauma. Based on the above, Matrix outlined a plan that would “increase the level of service” by allowing four fire department engines to be staffed with paramedics to respond to “targeted areas” in Peoria. If the PFD could provide ALS, lives would be saved as Matrix notes that “early establishment of intravenous fluids and certainly advanced airway management will be beneficial in certain cases.” The seriously ill or injured patient would no longer have to wait for AMT to arrive for advanced interventions.
Matrix then did a cost analysis of the above and stated that for a “relatively low cost of approximately $100,000 per year . . .the city could move to a four company ALS engine company system.” What Matrix overlooked was the fact that the PFD firefighters who are currently paramedics could provide their expertise for the four engines if only the project medical director would agree. This may be difficult because the medical director’s supervisor at OSF is the corporate medical director at AMT.
The Matrix report states that the PFD recently acquired a transport capable ambulance. They state that since there are no “service gaps” (i.e. AMT is always available) the PFD ambulance is not necessary. Many EMS providers in the Peoria area and families I have spoken with give numerous examples of “service gaps.” Patients and Peoria firefighters have waited precious minutes for AMT to arrive at the scene. AMT has even called the PFD for help when AMT finds themselves overextended responding to emergencies. Matrix notes that AMT maintains the “proprietary nature” of its staffing and financial information and so this information was not contained in the report. Just imagine if the PFD wouldn’t reveal where they were located or their operating budget.
Matrix’s conclusion that there are no gaps in service is incorrect. However, their advice to sell the only existing PFD ambulance may be sound since it sits unused for emergencies. According to the Matrix report, “the PFD has applied to the project medical director for permission to outfit the ambulance with various basic and life support materials and equipment. This request has been, to this point, denied by the medical director. . .”
In conclusion, evidence and healthcare statistics regarding emergency medical services in Peoria are glaringly absent from the Matrix report. Conclusions based on invisible or non-published data are opinions and nothing more. If leaders are to make credible decisions about Peoria’s EMS and ambulance services, these judgments must be based on complete, unbiased, accurate data. We should ask the question: why is such critical information so hard to come by?
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My Comments in 2021--
The Matrix study in September 2004 stated the following--
"...in areas where there is a pattern of long response times for the ambulance provider, early establishment of I.V. fluids and certainly advanced airway management will be beneficial in certain cases."
This is very interesting. A nurse in a nursing home in Peoria told me that they were instructed to call AMT first in the case of a medical emergency. (This may have been done to allow AMT to get a jump on the PFD at a 911 call.) But what if AMT was even further away than the PFD or was tied up on another call? It could have added minutes on the response time by the PFD to be at the nursing home patient's side due to the delay in contacting them. (And AMT did contact the PFD at times for the PFD's help in arrival.) And so it would have been important that the PFD was functioning at a higher level than Basic so they could provide a higher level of training such as putting in breathing tubes and providing life-saving medications especially in the Peoria system of EMS.
In 2004, Matrix showed in their analysis that the City of Peoria Fire Department could move to a four-company ALS engine company system that would have targeted approach areas of the city with the longest response times in the system and include the stations furthest north in the city.
So why did it take four more years for Peoria to have two PFD Engines advance to Paramedic units (Stations 12 and 20)?
When AMT wanted all the business in the city of Peoria, because the transport business is very lucrative, but does not have all the rigs to cover the area, then the PFD needed to be able to answer this deficit by offering an increased level of care to the people who needed it. This is all I have been saying for the past 20 years. But in the early 2000s, the Project Medical Directors threw their support behind AMT.
In the mid-2000s I was advocating for the PFD to used advanced level SUVs to respond to 911 scenes, assess the situation, and start advanced care as necessary. This was being done in San Diego, San Francisco, and Joliet Illinois. Why couldn't this have worked in Peoria? SUV's don't cost near as much as a big fire ambulance and the box of advanced life support equipment and medications are relatively cheap and could be donated by the three Peoria hospitals and AMT for the public good while they show respect for the fiscal constraints in the City of Peoria.
This was never done in Peoria either. The physicians in charge of EMS in Peoria would never have advocated for this if it took business from AMT in any way no matter how many Peorians could have been helped with this set up. (Ninety percent of 911 calls in the United States do NOT need paramedic care, even though AMT in Peoria was charging for advanced care 55% of the time.)
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Backtracking just a bit to March 2003--
Now read this if you want a great perspective of Peoria's EMS up till this point on the time line...it appeared in Firehouse Forums on March 6, 2003.
The person that posted above is a fire fighter and he has his bias...but he seems pretty fair and objective as he described the situation in Peoria in the early 2000s--
FFMEDIC51
03-06-2003, 05:36 AM
OSF St. Francis and the Management at Advanced Medical Transport of Central Illinois (AMT) will lead people to believe that the Emergency Medical Services (EMS) System in Peoria is one of the best and progressive systems in the nation. The Peoria EMS system is flawed and has been for years. They feel there is no reason that the Fire Department should enter into providing ALS care because it would compromise over all patient care and fracture the great system we now have in place. WOW!!!!! What a load that is. Working in the Peoria area for 15 years as a Paramedic, I worked in the system when the transition was made from Mobile Medics to AMT in 1990. Paramedics who worked in the system, including the Fire Departments (paid and volunteer) were optimistic about the new ambulance service. Some of the reasons that the Peoria hospitals restructured Mobile Medics were because there were only two advanced life support (ALS) ambulances and three basic life support (BLS) ambulances covering the City of Peoria. Peoria County was served by a very small BLS private ambulance service. The advantage to the hospital based Paramedics were the experience that they carried, low turnover, good moral, and patient care was excellent. The problem was not the quality but the quantity of ALS ambulances.
The hospitals then decided to create a third service (non-for-profit) owned by the hospitals and managed using a board of directors. Each hospital would have a representative on the board and the rest would consist of powerful private sector business leaders. AMT was created. One thing that was funny was that the Project Medical Director (PMD) (who was over every EMS provider in the Peoria EMS system) was on AMT’s payroll as their Corporate Medical Director. He has since been promoted to the Director of Emergency Medicine at OSF St. Francis (our system resource hospital) and still holds the title of Cooperate Medical Director with AMT. Isn’t this conflict of interest? I found in the early stages of AMT that management at AMT wasn’t interested in working with other departments within the Peoria EMS system. They were mainly interested in monopolizing every aspect of EMS. They’re only competition was small private services and the Fire Departments. AMT purchased all the smaller ambulance companies, but the Fire Departments would be a thorn in their side causing a threat to always be there. They are currently trying to keep all the fire departments at the basic level and getting in the way of advancing their care.
Three years ago AMT paid out over 3 million dollars to our state and federal governments, because of a settlement, over a charge against them of Medicare/ Medicaid fraud. Talk about screwing the public. Hardly anything was said about this and it was kept quite. The hospitals and private sector did a good job keeping the lid on that whole mess by taking care of the fine. They are currently on probation. Another misconception is the fact that AMT received a perfect score on a national accreditation, which was advertised a great deal in the media. The truth is that they had to pay approximately $20,000 to receive that accreditation and the Medicare / Medicaid fraud was never brought to the surface to the accreditation company.
.
Another problem with AMT is that the workforce doesn’t retain experienced paramedics. The average medic works about one year, gets experience and leaves for other services or fire department jobs. This inexperience causes the EMS system and ultimately the patient to suffer. The PMD doesn’t even trust his medics on the street, making the Peoria area system behind in the times as far as advancement. I found it interesting how fast the system catered to AMT and when the local fire departments wanted to upgrade their services from BLS to ILS (intermediate life support) or paramedic level. The fire department ran into many obstacles because of AMT. It was said that the Fire Department was trying to put AMT out of business. AMT threatened a huge negative smear campaign against Fire Based EMS and Firefighters. They say the fire service wants to justify their existence. The truth is Peoria Firefighters or any Firefighters don’t have to justify their existence or their jobs. The Peoria Fire Department has been providing service to the citizens of Peoria for over 125 years and will be here long after AMT is a memory. There is no reason why the Fire Department shouldn’t be able to provide advanced life support (ALS). They have been trying for the last 12 years. They have Paramedics on staff now and they are in the process of training more.
FFMEDIC51
03-06-2003, 05:36 AM
OSF St. Francis and the Management at Advanced Medical Transport of Central Illinois (AMT) will lead people to believe that the Emergency Medical Services (EMS) System in Peoria is one of the best and progressive systems in the nation. The Peoria EMS system is flawed and has been for years. They feel there is no reason that the Fire Department should enter into providing ALS care because it would compromise over all patient care and fracture the great system we now have in place. WOW!!!!! What a load that is. Working in the Peoria area for 15 years as a Paramedic, I worked in the system when the transition was made from Mobile Medics to AMT in 1990. Paramedics who worked in the system, including the Fire Departments (paid and volunteer) were optimistic about the new ambulance service. Some of the reasons that the Peoria hospitals restructured Mobile Medics were because there were only two advanced life support (ALS) ambulances and three basic life support (BLS) ambulances covering the City of Peoria. Peoria County was served by a very small BLS private ambulance service. The advantage to the hospital based Paramedics were the experience that they carried, low turnover, good moral, and patient care was excellent. The problem was not the quality but the quantity of ALS ambulances.
The hospitals then decided to create a third service (non-for-profit) owned by the hospitals and managed using a board of directors. Each hospital would have a representative on the board and the rest would consist of powerful private sector business leaders. AMT was created. One thing that was funny was that the Project Medical Director (PMD) (who was over every EMS provider in the Peoria EMS system) was on AMT’s payroll as their Corporate Medical Director. He has since been promoted to the Director of Emergency Medicine at OSF St. Francis (our system resource hospital) and still holds the title of Cooperate Medical Director with AMT. Isn’t this conflict of interest? I found in the early stages of AMT that management at AMT wasn’t interested in working with other departments within the Peoria EMS system. They were mainly interested in monopolizing every aspect of EMS. They’re only competition was small private services and the Fire Departments. AMT purchased all the smaller ambulance companies, but the Fire Departments would be a thorn in their side causing a threat to always be there. They are currently trying to keep all the fire departments at the basic level and getting in the way of advancing their care.
Three years ago AMT paid out over 3 million dollars to our state and federal governments, because of a settlement, over a charge against them of Medicare/ Medicaid fraud. Talk about screwing the public. Hardly anything was said about this and it was kept quite. The hospitals and private sector did a good job keeping the lid on that whole mess by taking care of the fine. They are currently on probation. Another misconception is the fact that AMT received a perfect score on a national accreditation, which was advertised a great deal in the media. The truth is that they had to pay approximately $20,000 to receive that accreditation and the Medicare / Medicaid fraud was never brought to the surface to the accreditation company.
.
Another problem with AMT is that the workforce doesn’t retain experienced paramedics. The average medic works about one year, gets experience and leaves for other services or fire department jobs. This inexperience causes the EMS system and ultimately the patient to suffer. The PMD doesn’t even trust his medics on the street, making the Peoria area system behind in the times as far as advancement. I found it interesting how fast the system catered to AMT and when the local fire departments wanted to upgrade their services from BLS to ILS (intermediate life support) or paramedic level. The fire department ran into many obstacles because of AMT. It was said that the Fire Department was trying to put AMT out of business. AMT threatened a huge negative smear campaign against Fire Based EMS and Firefighters. They say the fire service wants to justify their existence. The truth is Peoria Firefighters or any Firefighters don’t have to justify their existence or their jobs. The Peoria Fire Department has been providing service to the citizens of Peoria for over 125 years and will be here long after AMT is a memory. There is no reason why the Fire Department shouldn’t be able to provide advanced life support (ALS). They have been trying for the last 12 years. They have Paramedics on staff now and they are in the process of training more.
The latest act against the Fire Department was the 10-year contract. AMT wanted exclusive transport rights in the City of Peoria good for 10yrs paying only $60,000 a year to the city in exchange for the 911 dispatching and the fire department supplying help to them when it is needed. Also the contract stated that the Peoria Fire Department could in no way upgrade to Paramedic level within the contract (Why not?). There would be no accountability for their poor response times, number of ambulances available for 911 calls, and no penalties if the service were to deteriorate further. The contract didn’t mention that any other private company could come into the city and operate at the paramedic level, but SPECIFICALLY excluded the fire department from doing so. Talk about paranoid. This contract was brought to the Peoria city council with representatives from all three hospital administrations, AMT’s board of directors, Project Medical Director, and Emergency Medical Director. The vote was close but it failed. I am sure that this is not a closed issue. This contract will be modified slightly and brought back to the council.
I really find it a shame… AMT does have the potential to be one of the best EMS providers in the system; the management of that company could work with the fire department, treat their employees better with higher pay and incentives for retention. AMT management made a choice early on to compete with the providers and not work with them. I wish that it was a different situation but unless there is a big change in management and changes throughout the resource hospital, I feel it’s going to get much worse before it gets better. There is no reason the Firefighters should roll over on this issue and keep quite while the system suffers. They have tried on numerous occasions to work with AMT management and OSF St. Francis to improve this situation and ultimately improve overall Pt. care. The Firefighters priority is the Pt. and the community they serve and I’m sure most street Paramedics priorities are the same. I have no doubt the Fire Department will be providing ALS services in some capacity soon. It’s a win win for the city and the citizens. Some forget why we are here in the first place. “It will play in Peoria” It’s just a matter of time…
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A fire chief in a very large city in Illinois told me, “You have a very unfortunate situation in Peoria.” He was referring to OSF’s monopoly of the Paramedic and transport situation in Peoria and OSF’s influence in Springfield at the Illinois Department of Public Health.
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