GEMS shares its story and life-saving record

FI-Letter-to-the-EditorTo the Editor

Greenwich Emergency Medical Service (GEMS) is an essential part of the town’s public safety infrastructure.

GEMS was established in 1986 after an exhaustive, six-year Department of Health-sponsored study of residents’ emergency medical service needs and the most efficient and effective way to provide them on a superior basis. GEMS was deliberately created from the outset as an independent, 501(c)(3) not-for-profit organization in order to contain costs, maximize resources, facilitate fund raising, and coordinate then fragmented services.

The position of executive director was established to assure that the person leading GEMS would answer to an independent board responsible solely for providing emergency medical services. Among the most critical underlying assumptions about GEMS was that the new organization’s funding going forward would come from a combination of third-party reimbursement, town payment for services, Greenwich Hospital contribution, and private fund raising.

GEMS has established itself as a recognized national leader in its field. Medical advances and prudent investment therein have made GEMS’ ambulances literally “emergency rooms on wheels.” GEMS responds to over 6,000 calls per year. Of these, 4,300 patients are transported, mostly to Greenwich Hospital. Approximately two-thirds of these patients receive advanced life support services. GEMS routinely deals with neck and cervical trauma cases.

A recent national study (which did not include GEMS in its sample) reported the average national cardiac save rate (defined as a patient being subsequently discharged with no permanent neurological damage) is 8% and the highest respondent in the study was Seattle with a save rate of 16%. GEMS’ cardiac save rate is 35%-40% annually.

Because of town payments under its contract with GEMS, GEMS is able to provide 24/7 coverage from four stations. Consequently, GEMS responds to 75% of calls within five minutes and 95% of calls within eight minutes. When emergency medical services are required, the speed of the response can be a crucial factor in the outcome for the patient.

Since its inception, GEMS has raised over $7 million and has paid for all of its capital expenditures, including the ambulances and their equipment, one of which must be replaced each year at a fully loaded cost of $325,000. We are mindful of the need to be, and be seen as being, good fiscal stewards. Our staffing and organizational structure reflect this.

Our ratio of field supervisors to staff is at a minimum one to eight, and can range as high as one to 16. GEMS makes as much use as possible of per diem employees in order to reduce permanent staffing costs, and our administrative staff is very lean, consisting only of the executive director and five other people.

GEMS is efficient and effective. Our bad debts ratio of 12% is significantly lower than that of our peers. GEMS’ outside auditor has not seen fit in several years to issue a so-called management letter (a report noting administrative issues of concern to the auditor), a fact the auditor cites as being both highly unusual and very positive about GEMS’ management.

GEMS is transparent to the community it serves. The first selectman and director of health are ex-officio members of the board and receive all information that board members do. GEMS provides financial reports on a regular, periodic basis to the BET and the Board of Health, and GEMS’ annual budget is subject to review and approval by the BET and the RTM. As part of this year’s budget process, the BET requested for the first time ever that GEMS re-format its budget submission to be similar to town departments. GEMS did so, quickly and in time for the BET’s decision-day deliberations.

While GEMS must, of course, be sensitive to the privacy concerns of our patients and our own staff, we will provide answers to all legitimate and reasonable requests for information about how we serve the residents of Greenwich.

GEMS has a great story to tell, and we are proud to tell it.


Charlee Tufts
John Raben

The authors are GEMS’ executive director and chairman of its board, respectively.

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