Ada Wants Ambulance Monopoly

Ada County officials are flexing their paramedic muscles with a proposed ordinance that attempts to prohibit fire departments in the county from providing ambulance service to citizens.

That will be devastating to Kuna’s Fire Dept. which already operates an ambulance with trained paramedics.

Star wants to offer similar ambulance service 24/7 which they fail to get from Ada County EMS at present. Star Fire Commission Chairman Steve Edgar notes the 911 dispatch system is already in place and his department wants to provide an increased level of service to residents. The closest ambulance to Star responds from Eagle, but only 12 hours a day. Ada opposes the Star plan to provide their own ambulance and staff.

Monday all the fire chiefs in the county met with the county Emergency Medical Services director to discuss the proposed amendments to the EMS ordinance. None of them favor the changes which pretty much put the sole authority for all medical services under the county.

Most fire departments have medical supervision from a doctor, but under the proposed ordinance only the county medical directorate (including a doctor) would have authority over training and protocol.

Boise Deputy Fire Chief Dave Hanneman said while the fire chiefs were unanimous in in their opposition to the proposed ordinance changes, their reasons were varied. He cited a licensing authority of the EMS to collect fees from each emergency medical technician in the department.

Ada County EMS previously has pretty much limited private ambulance service to non-emergency runs, transporting patients between hospitals and nursing homes. Earlier this year Ada County EMS entered into that business with county assets competing directly with the private services. Now they want to curtail public competition as well.

All this comes after voters turned down a tax hike 18 months ago. The County has struggled to run the service as a business. Meanwhile, thanks to growth, a healthy economy, and eager firefighters, the fire services have added paramedics to some of their fire engine crews and in the case of Kuna even offered paramedic ambulances.

The county attempt to establish a monopoly on EMS care and transport short-changes many citizens, is ill advised and likely will end up in court if the ordinance is passed. We all live in Ada County and all deserve a certain level of EMS service from the county.

If, however, a fire district or city wishes to offer more and quicker services to citizens they should have the right to do so.

That is what we do with police. The sheriff provides a minimum level of law enforcement in the county and if cities wish to create their own police departments to deliver increased service at taxpayer expense, they are free to do so. Boise, Meridian, and Garden City do just that.

Competing to offer emergency medical services is ludicrous. The GUARDIAN thinks there are only losers when the county tries to operate as a business. Hopefully citizens will demand–and offer some common sense that is so far lacking at the government level.

Comments & Discussion

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  1. Everyone loses when our government engages in “turf wars”. The provision of emergency services should not be about empire building, competition, or turf. It should be about providing the best care and service to the public in the most cost effective and efficient manner.

    In this case, Ada County needs to back off and the commissioners should direct Ada County EMS to work WITH the local fire districts to create a plan for working together to meet the emergency medical care and transport needs of the County’s residents. If the people in the City of Star and the Star Fire District want to purchase, maintain and staff an ambulance in order to provide a higher level of service to their constituents, the Ada County commissioners should not pass an ordinance to prevent them from so doing.

    To even consider passing an ordinance that would require the Kuna Rural Fire District to reduce its level of service and prevent the other fire districts from increasing service is diametrically opposed to what the commissioners should be doing – protecting public health and safety. Hopefully common sense will prevail and this proposal will be pulled off the commissioners’ agenda without even being given serious consideration.

  2. Our experience here in Kootenai County with a County managed EMS and ambulance system was a disaster bordering on fraud. The solution was to send the EMS and ambulance responsibilities back to the local Fire Departments with funding coming from the County wide EMS district. Now instead of duplicative facilities and personnel we simply base our ambulances at fire stations and cross train firefighters and EMS personnel. So far so good.

  3. Actually, Kuna and Eagle have chosen to increase their police protection, too… by hiring the Sheriff’s office. And BSU hires the BPD to enhance their service. I have never been a fan of public entities contracting for services like a private firm, but the precedent certainly exists. BPD provides lousy traffic enforcement, but can find extra officers to patrol BSU. When the large annexation took place in SW Boise, the BPD claimed to be understaffed to handle the area, but they had enough for contracted service.

  4. There exists an opportunity for the Board of County Commissioners to provide effective, efficient ambulance service to the citizens of Ada County. They will have to step outside of their current protection of the status quo however and focus on the delivery of service.

    State law 31-3901 allows them to create an ambulance district; “The boards of county commissioners in the several counties are hereby authorized, whenever existing ambulance service is not reasonably available to the inhabitants of the county or any portion thereof, to procure an ambulance and pay for the same out of any funds available and to establish an ambulance service to serve the areas, which do not have an existing ambulance service reasonably available, both within and outside the cities and villages in their respective counties”.

    State law 31-3903 gives them power as follows; “The board of county commissioners shall determine the manner in which said ambulance service shall be operated”. “ Section 31-3908 states, “The board of county commissioners shall be the governing board of an ambulance service district created pursuant to this section, and shall exercise the duties and responsibilities provided in chapter 39, title 31, Idaho Code.”

    I don’t think that this gives them unilateral power to exclude other services. i.e. “31-3905 All cities and villages within the county, upon resolution duly passed and approved and presented to the board of county commissioners, may authorize said ambulance service to operate within the boundaries of said city or village”. Conversely, absent this authorization from the city the county cannot provide ambulance service within the city!

    Fire districts also seem to have authority independent of the board of county commissioners. State law 31-1416 states “Every fire protection district upon being organized as provided by this chapter shall be a governmental subdivision of the state of Idaho and a body politic and corporate, and as such has the power specified in this chapter.” Section 31-1401 defines the purpose of fire districts as “The protection of property against fire and the preservation of life”.

    If the commissioners choose to ignore the fire departments and cities and insist on maintaining a monopoly on ambulance service the courts may have to intervene. As a taxpayer I would prefer a solution that maximizes service at the least cost without a court battle. The county and cities can work together without egos causing court battles!

    State law allows the commissioners to craft a system utilizing all resources. i.e. “31-3906. The board of county commissioners of any county wherein such ambulance service has been established is authorized in its discretion and under such terms and conditions as it deems appropriate to enter into a cooperative agreement with adjacent counties and for private individuals and corporations to provide ambulance service for such county or counties or a portion thereof”. State law 31-868 also addresses the same issue “The boards of county commissioners in their respective counties shall have the authority and power to enter into contracts with a city or a fire protection district for the provision of fire or life protection services, or both of them, in areas of the county not otherwise receiving fire or life protection.”

    Finally, state law 67-2326 seems to indicate that public agencies should operate in an efficient manner. “It is the purpose of this act to permit the state and public agencies to make the most efficient use of their powers by enabling them to cooperate to their mutual advantage and thereby provide services and facilities and perform functions in a manner that will best accord with geographic, economic, population, and other factors influencing the needs and development of the respective entities.”

  5. I guess that Ada county officials don`t like to have competition and fear the loss of revenue.
    Having the EMS folks in with the fire department does appear to be the best solution. I have noticed though that the powers to be in the county
    don`t understand what might be best for the people.Let each city in Ada country decide for themselves what is best.

  6. To do anything but put the EMS capability in the Fire Department is just stupid! When will these maniacs get the message?

  7. BoiseCitizen
    Nov 30, 2006, 2:05 pm

    How about Ada County EMS using the Fire Dept. to assist with a hospital to home non emergency transfer? To my knowledge this has never happened with Ada Boi or NPA. Is that legal?

  8. The proposed ordinance by Ada county EMS services is greedy and stupid and shows the mind set of our County Commishes which seems to be ” lets make more money,even at the expense of answering medical emergencies effciently.

    Having the local fire depts. of each community combine fire relief with the ability to answer medical emergencies is smart and provides the best emergency services to the People. I would just like to see cooperation between communities,when possible, in using their resources to answer all area emergencies.

    Our division of govt. into city,county, state and federal depts., each using it’s own resources, is expensive and more than 200 years old. Why not create an emergency needs district that uses the resources of all four divisions? This would cost the taxpayer less while providing them with the best emergency services 24/7 and doing away with financial turf wars!

  9. I have to ask why can’t Ada County Paramedics have a monopoly? All the Fire Departments do. Kuna and Meridian are fighting over area. North Ada County Fire is losing ground every year to the City of Boise.

    The Rural Fire Districts are trying to pass legislation to prevent cities from taking all of their tax dollars. It’s all about the money and turf.
    Ada County Commissioners are not trying to set up a monopoly. They are setting standards for the future. Standards that the Fire Departments don’t want to meet. Do you know that Boise, Meridian and Kuna Fire Departments will not let their Paramedics take the Ada County Paramedic hiring test? Why not? Which Paramedic do you want to see walk through your door?

    Joe has the right idea. You want to save some tax dollars and increase the service to Ada County? Combine all of the Fire Departments and Ada County Paramedics into one. Why can’t we do that? Too many turfs. No one wants to give up their piece of the pie.

    The Blue Ribbon Task Force that evaluated EMS in Ada County made that recommendation. So did the BSU study that was done in the early 90’s. I don’t see any one of the Fire Departments opening that door. If fact there wasn’t a single Fire Department that would go at least try to put out a house fire in rural Ada County this summer. Why? He didn’t live in Fire Dist. What does that have to do with anything? Ada County Paramedics are the only agency in Ada County that covers ALL of Ada County.

    We need to push the issue of countywide consolidation of the Fire Departments and EMS. We need to have a vote and force the issue. If the taxpayers do not demand this, it will NEVER happen.

  10. EMS Insider
    Dec 2, 2006, 11:26 am

    Ada EMS needs to manage the EMS “system” and not just their department. Their myopic, self-centered approach is based out of fear rather than focused on what is best for the citizen patient.

    If you manage the “system”, you are managing the entire EMS response capabilities for the county. What makes the most sense? Put a EMS paramedic on every engine and allow a private service to transport the patient with the medic. The private service would have minimially trained EMTs. Everyone wins: Minimal investment by the county & cities for doing this.

    And this is from an EMS insider. Manage the “system”…not just the individual departments. Don’t let turf wars CONTINUE to affect patient care. (that’s right, I am saying it IS affecting patient care now)!

  11. Ada County Voters sent a message that they will not support ACP through taxes. This was in large part due to the fire services vocal opposition with the intent to make ACP (as one FF said on this very website) “extinct”.

    The only option was to run more like a business. I don’t like it as a field paramedic…I juts want to do my job. I don’t like the patch changing after 20 years, I hate the new emblems…I hate that we have a membership program to make up the difference..and I hate the way the fire departments keep trying to kick us when we are down….but my boss is doing what any BUISNESS would do, improving marketing…I don’t blame him, I blame the taxpayers that left me twisting in the wind yet demand the same level of service ..and I place some blame on the FD’s for their mis-information campaign and refusal to work with us on the blue ribbon committee recommendations.

    HERE is the bottom line:
    The situation today is the natural result of the efforts of the FD and their fear tactics.
    So lets look at the proposed ordinance and put it in perspective with what most agree is the best EMS system in the nation. Possibly the world. The Seattle/King County Medic One (KCM1) program.
    In the KCM1 system, all fire departments answer to ONE medical director ..The county one. SOUND FAMILIAR? The ordinance speaks to this. This is one of the goals of the ordinance.

    In the KCM1 system, all paramedics go through the same training, take the same test to be a paramedic, and run under the EXACT same standards regardless of employer, fully accountable for their mistakes as well as their successes. SOUND FAMILIER? That’s what the commissioners are trying to do. Why don’t the FD’s want their medics to be subject to the same QA standards that ACP paramedics are? What are they afraid of?

    In the KCM1 system, the privates are strictly regulated. So will the privates be in this ordinance, although not as much as in King County.
    In the KCM1 system, if you don’t want to play under the SYSTEM rules…you don’t play. SOUND FAMILIER? That’s what the county commissioners want, a SYSTEM..not a bunch of empires stabbing each other in the back. They want to ensure that all of Ada county gets the same level of care… That’s the crux…Kuna and Boise don’t want to play to the same standards as ACP and the rest of the county. They don’t want someone else looking over their shoulder. They want their own system…their own empire…not be a part of a larger mutually supporting system. The ordinance make all players, including ACP , part of the system. Makes them all on the same sheet of music..and improves the care provided by all medics, regardless of uniform?

    Here is the nutshell, The best thing for all citizens of Ada County is a SYSTEM EMS approach. Until the fire departments can merger, the only entity in Ada County to manage such a system is Ada County Paramedics. They are the only entity that is not biased by the national fire service agendas, The only one that encompasses ALL of Ada County, and the only one that has a legal grounds to do so.

    The county commissioners looked at the best EMS systems in the nation.. Boston EMS and KCM1 and Austin-Travis County being the top three that come to mind. They all has common themes…a SYSTEM approach…and that is what we are trying to do here.

    If this is what works in the best EMS systems nationally, ask yourself why the fire service opposes this.

    The fire service doesn’t like it then they should merge together with ACP to form a county EMS and fire….until then they should shut up and work with us instead of trying to make us “extinct” as Cyclops would recommend.

    P.S. I would address the Paramedic engine concept with the BLS transport some other time..I don’t want to get too far off topic of systems EMS approach by talking about the concept of paramedic over saturation and skill maintainability.

  12. p/s. I just want to make a correction to the above post…Bull..not cyclops made the extinct comment…although from Cyclops postings I bet he shares the sentiment.

  13. Croaker,
    You will find few people in Ada County as supportive as I am of our medics – as well as of emergency personnel in general. I have to disagree with a few of your observations, however.

    I do not believe the override failed because the public is not supportive. I believe it failed, in large part, due to a lack of confidence in the elected officials who are in charge, specifically, the Ada County commissioners. You might recall that their first plan was to disband the district and reform it so they could raise the levy higher than state law allowed. This was a bad approach and all it did was serve to decrease the public’s confidence in our elected decision makers.

    I recognize that there is some animosity between Boise Fire and Ada County EMS, and it is time to put it behind us and for ALL of the fire districts and Ada EMS to work together. Continuing to dwell on the animosity, without providing a viable solution for fixing things, is counterproductive.

    The ordinance currently being proposed by Ada EMS is not about working together. It is about turf. Working together will require that the concerns of the fire districts be taken into consideration, which is not now happening. The needs of the public must drive the process.

    Because of budget constraints and the way the population is disbursed in Ada County, it is not possible for Ada EMS to provide the same level of service (response times) to all residents. In some cases, such as Kuna and Star, the fire districts are choosing to increase service above and beyond what Ada EMS is able to provide.

    That is not a bad thing. Unless or until fire and EMS services are consolidated on a countywide basis, any ordinance proposed and ultimately adopted by the Ada County Commission must take into consideration the desire of the fire districts to provide enhanced service.

  14. Sharon…

    Two simple comments…

    Quality of Service and response times are not the same thing. Period. As you have sat in on the discussions on this during your time as a commissioner, I hope you can recall that PARAMEDICINE is far beyond rapid transport and quick response. those are in fact only part of the system…and a small part at that.

    Anyone who is honest will tell you that a good EMT is better than a BAD paramedic any day of the week. Good EMT’s save lives..bad paramedics take them. Period. Good medicine is far beyond who gets their the quickest. This is backed up by medical SCIENCE , by the new AHA CPR and ACLS standards focus on Basic life support…not advanced life support…Obviously this goes against IAFF political and labor agendas.

    And that is what this is about, bringing a system…not a department…to the patient when they need them.

    The ordanance is the first step to a solution…and the only step to a system approach.

    Because there are only three things that will make the fire departments work together….

    1- Legal action mandating it

    2- Union interest

    3- Hatred of Ada County Paramedics.

    #1 is the ordanace, # 2 is the union, and they wont support it, and since they already hate ACP, that leaves only OPTION #1.

  15. Sorry, forgot to add my closing statement:

    Yes we need to work together, but they will NEVER do it willingly. Only by giving them NO CHOICE will this system move forward.

    I dont care how they do their fire protection. Hoestly chances are very slim I will ever need it. Chances are I will need a quality EMS.

    There is one here now. Will there be in 5 or 10 years?

    Not if we let it desolve into seven different EMS services.

  16. Thanks for your rapid response, Croaker! 😉

    I was not talking about, nor did I say, “Quality of service equals response times”. I was talking about the level of service available. Ada County EMS cannot get an ambulance with an EMT and paramedic to Kuna or Star as rapidly as they can to most (or all?) parts of Boise.

    There IS a direct relationship between outcomes and response times. If there wasn’t, we could have one centralized EMS station and there would be no Code 3 calls! There is also a direct relationship between outcomes and quality of care. I cannot stress enough the significance of the role you folks play in bringing about positive outcomes.

    That is one of the many reasons I believe that the County’s medics should be provided more-than-adequate training, and be treated fairly and with respect at all times.

    I would rather have an Ada paramedic (a good, well-trained, one) working on me than a firefighter providing Basic Life Support. I admit that I am not an expert on the details, but my understanding is that paramedics have more training and are able to do things like administer meds. That CAN mean the difference between life and death.

    For folks in Kuna and Star, Ada paramedics are not nearby to provide that service. If the fire districts (their taxpayers) are willing to pay for ambulances, equipment, training, etc. for paramedics to be stationed in the immediate area rather than miles (and added time) away, then I think they should be able to do so without being told by the Ada County commissioners that they cannot.

    Quality of service is a huge concern. If the State’s training and licensing requirements are inadequate, those issues should be addressed at the State level.

    I sound like a broken record but believe it is imperative that Ada EMS and the County commissioners work WITH the fire districts if there is a desire to create uniform medical standards or procedures, (Standard Working Orders), above and beyond the State’s basic training requirements.

    I am troubled by your list of the three things you believe will cause the fire districts work together. I think what is required is checking the egos at the door. This has been done successfully between Boise Fire and the Whitney Fire District for two reasons. Former Whitney Chief Bill Squires was willing to let go — and that was admittedly easier when he retired. 🙂

    The biggest problem I see with the current situation is the County’s desire to mandate to the fire districts what they can and cannot do. I do not want to see Ada EMS devolve into seven different systems. That would be a step backwards. So, again, I believe the County needs to back off and bring reps of the fire districts into the equation before they pass any re-write of the ordinance.

  17. I think this whole issue is the fact that Ada County EMS is worried that they are going to lose $$. The fact is, like others have stated, combining fire and EMS is the best answer. If you look at fire departments nationwide, the trend is for fire departments to provide the paramedic coverage for their areas. As a matter of fact, look at Pocatello and Idaho Falls Fire Departments, they both provide paramedic ambulance coverage as does Lewiston. Do you hear and grumbling from the Bonneville, Bannock and Nez Perce counties?? I didnt think so, maybe Ada County should look to see how these agencies provide service. I am a 100% supporter of fire based EMS.

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