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MELISSA BLOCK, host:

From NPR News, this is ALL THINGS CONSIDERED. I'm Melissa Block.

MICHELE NORRIS, host:

And I'm Michele Norris.

Last week we told you how the city of Tracy in California's Central Valley is starting to charge when its fire department responds to medical emergencies. Officials say the city needs the extra revenue to balance its budget during the recession. Well, it turns out this practice isn't unique to Tracy, or even California. As Capital Public Radio's Ben Adler reports from Sacremento, it's raising questions about whether it's a good policy and who really gets stuck with the bill.

(Soundbite of sirens)

BEN ADLER: When you hear this sound coming from a fire engine these days, chances are it's not heading towards a burning building. It's responding to a medical emergency, like this response a few days ago. A patient needed to get to a hospital, 911 was called and five minutes later, firefighters were on the scene.

The patient was a man probably in his 60s apparently suffering from chest pains, but he was conscious and alert. As the crew wheeled him down the hall on a stretcher, he looked up and said: Call me a cab it's cheaper. Fact is it's pretty darned expensive to get a ride to the hospital in some cases, more than $1,000.

Now, here's where the whole Tracy situation comes in. There's a general consensus that in most cases the firefighters tend to arrive first. That means they're the first ones to treat the patient. Sacramento-area fire captain Roy Cameron says that treatment has become far more sophisticated over his 30 years on the job.

Mr. ROY CAMERON (Fire Captain): When I started, we're doing CPR on people we had no drugs to push onto them, no monitors. It was all just everything by hand. It's gotten a lot better. A lot more life-saving techniques make a big difference.

ADLER: What used to be called basic life support is now advanced life support, or ALS. Cameron says the number of calls have gone up and so has the cost.

Mr. CAMERON: But to me, if it's going to save a life, it's worth a million dollars. You can't put a price on it.

ADLER: But some fire departments do exactly that: They charge several hundred dollars for treating medical emergencies.

Mr. JOHN SINCLAIR (Fire Department Chief, Ellensburg, Washington): Typically, what these types of programs are doing is simply recovering the cost of augmenting the service to the community.

ADLER: John Sinclair is the chief of a fire department in Ellensburg, Washington, and the go-to expert on emergency medical services for the International Association of Fire Chiefs. He says it's easy to forget that ALS is part of the health care system, just like an ambulance ride. Fire departments have to pay for it somehow.

Mr. SINCLAIR: As local communities' public safety budgets are being squeezed, I believe we're going to see more and more systems that historically may have done it for free, that can no longer do it for free.

ADLER: And faced with a choice between dropping ALS or charging a fee, well, Sinclair's pretty sure Tracy won't be the last city to start hunting for cash. But while health insurance almost always covers ambulance rides, it doesn't always pick up ALS fees. For example, California's Medicaid program doesn't cover them at all.

Georgia insurance agent Russ Childers, who heads the National Association of Health Underwriters, says companies will have to respond somehow if more fire departments start charging.

Mr. RUSS CHILDERS (Insurance Agent): If this is a trend that adds cost to the system, then premiums would have to be adjusted to reflect those costs, it wouldn't have a tremendous effect on premiums, but it has the possibility of having that effect.

ADLER: Or, Childers says, insurers could choose to not cover ALS fees at all. Jamie Court with the group Consumer Watchdog says that might make patients think twice before calling 911.

Mr. JAMIE COURT (Consumer Watchdog): If you need advanced life support, you shouldn't be worrying about whether to make a call that's going to cost you hundreds of dollars. You should just make that call.

ADLER: There aren't any hard figures on how many fire departments are charging this fee across the country. What we do know is emergency medical systems vary widely. And as one fire fighter puts it, when you've seen one EMS system, well, you've seen one EMS system.

For NPR News, I'm Ben Adler in Sacramento.

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