Problem Identification:
The City’s EMS system is overwhelmed. Additionally, the BCFD provides selected services which could be provided by alternative ambulance providers.

Recommended Actions:
Explore mutual aid agreements with the University of Maryland Medical System (UMMS) and Johns Hopkins University to provide additional equipment and personnel backup for the City’s EMS system.

Cost Savings, Service Improvements

Functional/Operational Area:

Estimated Annual Impact:
While the immediate financial input cannot be estimated, implementation of this recommendation would expand the City’s level of EMS response capabilities.

Estimated Implementation Costs:

Barriers to Implementation:
Potential unwillingness of educational institutions to participate due to public cost and indemnification issues.

Projected Implementation:
180 – 270 days

Next Steps:
The City should meet with Johns Hopkins and UMMS to discuss the development of mutual aid agreements. The scope of responsibility and service needs to be determined (first responder, transport, etc.). Training and indemnification issues need to be fully explored as well.

Hospital-based ambulances should have radio links to the City’s 911 system. Some means of identifying the availability and status of the personnel should be established so that the 911 dispatches can determine whether those resources are available or not. This needs to occur on a real-time/continuously updated basis.

A review of BCFD EMS traffic indicates that there are significant numbers of EMS requests which originate from the campuses of The Johns Hopkins Medical Institutions, the Hopkins Bayview campus and the University of Maryland, Baltimore campus. When campus clinics and physicians offices have a need to move patients to their affiliated hospital, BCFD EMS is often requested to transport that patient. This is entirely appropriate when there is a life-threatening emergency or there is no other means of responding to the needs of the patient. However, this is not an optimal response considering that both Johns Hopkins and University operate critical care transport programs which are capable of providing first responder and transport services.

Furthermore, EMS is a public safety service and analogous to police and security functions. Both University and Johns Hopkins have made investments and provisions for public safety and police functions. While Baltimore City Police are available to respond to these campuses when the need arises, each institution has assumed primary responsibility. The same should be true with EMS. Johns Hopkins and University should each develop means for responding to the EMS and medical transportation requests on their respective campuses. They should be encouraged to meet their non-emergency medical transportation needs during the Monday-Friday business hours when their out-of-hospital clinics and offices are open.