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.

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.

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.

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.

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.

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)!

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.

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!