Grant County officials are faced with a dilemma. Who can provide the best and most cost-effective ambulance service to its citizens?

TransCare, a joint effort between St. Luke and St. Elizabeth Hospitals, announced on March 1 they were cutting service to one ambulance on duty 24 hours a day, seven days a week in Grant County. They have provided two ambulances in the county since 1998.

TransCare officials said they are losing $300,000 by staffing t2wo ambulances and two paramedics in Grant County.

While TransCare is a not-for-profit corporation, they must break even, said Coleman Sachs, TransCare business director.

Following that announcement, Rural/Metro, an ambulance service headquartered in Scottsdale, Ariz., came to a meeting of citizens, firefighters and ambulance personnel on March 7 to discuss providing ambulance service in Grant County.

"We're here to gather information from Rural/Metro," said Grant County Judge-Executive Darrell Link. "Right now I'm struggling. I sure don't have the answer."

Link said the county doesn't plan to contribute money to a private ambulance service.

Daniel Brenyo Jr., operations manager for Rural/Metro, said the company has a requirement that would have to be met before coming to Grant County.

"This is a for-profit company. I want to be clear about that," said Brenyo. "We, at least, have to break even."

Brenyo made a formal proposal to Link on Tuesday, March 14 to provide ambulance service to the county.

The Rural/Metro proposal would provide an ambulance staffed with a paramedic and an EMT, 24 hours a day, 7 days a week. They would also provide a chase vehicle in the county for eight hours a day, five days a week for backup.

After making the presentation, the end result was Rural Metro could not staff two ambulances in the county because the profit margin is not there.

Brenyo said Rural/Metro would fall approximately $100,000 short of breaking even.

TransCare is keeping its options open at this time concerning a counter-proposal.

"To the best of my knowledge, I'm sure we're reviewing the offer and taking a close look at it," said Sachs.

Sachs added there is no time line for coming back to the table to discuss service in the county.

The Dry Ridge City Council agreed to apply for a Certificate of Need at its March 6 meeting. They agreed to spend $300; refundable if council should change its mind. (See side bar)

Link supports the Dry Ridge proposal but wants to see the numbers for ambulances, equipment and payroll.

"What they have shared with us thus far, I feel good that we're moving in the right direction," said Link.

"I plan to work with the Northern Kentucky Area Development District and have them look at the information and make an independent assessment," added Link. "I've done that before on other matters and it seems to work well."

The process is start your own ambulance service is not a quick one.

A letter of intent must be filed with the Cabinet for Health and Human Services in Frankfort as the first step to begin a fire-based ambulance service. Then the city has 30 days to file a Certificate of Need application.

The next deadline for Certificate of Need applications is July 2. Approval or denial of the application will not be made until Dec. 20.

Jerry Hunt, the accountant for Dry Ridge, has been authorized by the mayor and council to gather information and begin the paperwork.

"I've done the groundwork and now I'll present the letter of intent to the mayor on March 22," said Hunt. "He will have to present it to council."

The cost for the Certificate of Need is $300; refundable if council should change its mind.

Dry Ridge Volunteer Fire Department Capt. Jeff Nantz spoke to the Dry Ridge City Council on Monday, Feb. 28 about this possibility for the city of Dry Ridge and the area served by the Dry Ridge Fire Dept. This size of the total coverage area is approximately 100 square miles.

He feels this would be the best course of action to provide citizens with emergency care.

"If the county contracts with a service and it's not good, wečre stuck with it," he said. "I want someone that knows the county and knows the people."

Nantz estimated a start-up cost of $315,000. The service would then bill people who use the service, just as TransCare does now.

"Once it's running, it will cost the city nothing," said Nantz. "This will generate revenue."

The ambulance would be staffed with a paramedic and an emergency medical technician, 24 hours a day, seven days a week. A back up ambulance would be staffed with volunteer EMTs.

The cost to operate the ambulance service can run from $150,000 to $180,000 per year. Nantz estimates a fire-based service could make $70,000 over operating costs per year, taking five to six years to pay off the start-up loan.

Hunt thought council would have to borrow approximately $100,000 up front to fund a fire-based ambulance, but said the city had ample borrowing power.

"The way I see it, if council decided there is a need, then council will have to decide if they want to pursue this," said Hunt.

Council voted unanimously to approve the application for a Certificate of Need.