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When you're working 24-hour shifts on an ambulance crew, there's always plenty of time to kill while waiting for someone to almost get killed. Upstairs at Columbine Ambulance headquarters in Littleton, the restless paramedics hang out in a day room that resembles a college dorm.
On a typical morning, near the end of a shift, some of them sit on a pair of vintage sofas absentmindedly watching exercise shows on ESPN, while others read newspapers or study medical textbooks. There is chat about new golf clubs and new techniques to get an aspirator down a choking patient's windpipe. Some are reminiscing about a grisly accident the night before on C-470 that left two people dead and six seriously injured. Paramedic Andy Fox and his partner, Tony Sheppardson, talk about swinging by the hospital to see how the teenage boy they transported from the accident is doing after back surgery. A speaker mounted on the wall crackles with police and fire chatter. So far, none of the calls are for Columbine crews.
"The best way to get some action is to go pick up a nice meal," says Sheppardson. "You'll sit down, and right as you start eating, you'll get a call. I've lost a lot of good meals that way."
A few minutes later, Columbine gets its first call of the morning. In response to a specific tone from the speaker, two paramedics throw on their jackets and rumble down the creaky stairs to their ambulance. They're responding to a 911 from a woman whose nineteen-year-old daughter, ailing with palsy, is having an allergic reaction.
The rest of the crew looks a little envious, even though this call isn't one of the rare "code threes"--the paramedics' favorite, when the call is serious enough to warrant "running hot" with lights and sirens clearing the way.
"This business is a lot like the Army," says Columbine president Vince Cissell, who's somewhat of a philosopher after decades in the ambulance business. "You hurry up and wait."
But although this morning is a slow one for Columbine's paramedics, they have the satisfaction of knowing that they're still in business. The mortality rate among small ambulance companies in Denver has skyrocketed in the past several years, but Columbine is healthier than the majority of the patients it transports. Occupying the same two-story building in Littleton it has since the day it opened in the early Sixties, Columbine remains the last of the old guard. It's run by the Cissell family, which dispatched the company's first ambulance on February 22, 1963. And it's still a mom-and-pop operation: Wife Shaaron and son Kevin are dispatchers, while Vince runs the show.
Vince Cissell's first two decades in the field were the days he refers to as the "ambulance wars," featuring a collection of small independents fighting over the city's injured and ailing. "I remember this ambulance company that worked out of Denver when I first got started," recalls Cissell. "The company was run by this seventeen-year-old kid in his mom's station wagon. He had a red light on top, a phone, and his girlfriend's thirteen-year-old brother as his assistant."
Those days are long gone. "When I got into this business, there were about thirty companies operating in the metro area," Cissell says. "By 1975 that number was down to six." Now Columbine is the oldest local ambulance company in metro Denver, as well as the last that is family-owned.
The disappearance of the mom-and-pop companies can be attributed to the arrival of ambulance corporations that Cissell says operate like fast-food chains. One of the biggest of these national conglomerates is American Medical Response (AMR), a publicly traded company that recently relocated its corporate headquarters to Aurora from Boston. AMR has helped transform the ambulance industry nationwide by buying up smaller operators in many major cities and consolidating: AMR currently employs more than 12,000 people in 27 states.
In the early Nineties AMR made its move into metro Denver and snapped up, among others, the Ambulance Service Company (ASC), which had been operated by the Unrein family for three generations. ASC sold its sixteen metro-area dispatch stations to AMR in December 1992. Carl Unrein, who was ASC's CEO at the time of the sale and had worked for the family company in some capacity all his life, says that it was a family decision to sell.
Unrein, now the senior vice-president of AMR's Midwest operations, explains that the business has changed. "The key to being successful now is efficiency," he says, "and to do that, you must hold costs down." To do so, AMR employs what it calls "staffing by demand," scheduling paramedics by determining peak times for work. The Cissells follow their own system, allowing that AMR's is efficient but noting that accidents aren't that predictable.
Neither are the Cissells. AMR could not have predicted, for example, the family's resistance to being bought out. More than once, AMR has made an offer to buy Columbine, but the Cissells have turned it down. Shaaron Cissell explains that the decision to keep Columbine independent was based on personal, not financial, reasons.
"It was a lifestyle choice," she says. "We didn't want to retire, and when buyouts occur, people may get new positions and a wage, but the positions aren't as important. It's like getting put out to pasture."