As the turf war between Ada County EMS and the fire departments heats up again, it would be appropriate for the fire departments to take stock of their evolving role as providers of essential services.
Under a well intended plan to get medical aid quickly to those in need, three firefighters aboard a $275,000 fire truck respond along with an ambulance on most emergency medical calls. Costly, inefficient, and cause for endless “code 3” responses all over town as one station responds to cover for those not available.
Since fully 70% of all calls are for medical assistance, it seems wasteful to send 100% of the aid in the form of a truck loaded with hose, ladders, and pumps. The fire departments need to be staffed–and equipped–for firefighting, but that duty comprises merely 30% of their actual responses.
The GUARDIAN thinks local fire departments need to rethink their equipment investments. We think in the city of Boise for example, they could purchase 5 medical vans for the cost of a single fire engine. With the capability of transporting patients if needed, these quick response or “squad” cars could supplement the ambulance service in the event of disasters, save wear and tear on pumper trucks, and provide efficient medical service to residents. They could also eliminate the need for county ambulance service within the city.
We figure staffing levels could be increased by 15 firefighters to provide paramedic/firefighter coverage at five stations and cover all shifts. One member of the three-man crew from the pumper could be assigned to the medical response unit, freeing the pumper from responding to medical calls, thus eliminating 70% of the wear and tear on a truck designed to fight fires.
Instead of having a truck with three guys respond to 70% of the alarms (medical) it makes more sense to have the cheaper medical van respond to ALL calls with two firefighters (one would also be a paramedic). That way, the fire truck is not overworked, and if there is an actual fire both the medical van and fire truck respond, which places four people on scene at the outset.
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Nov 30, 2006, 4:37 pm
Sounds like a good idea to me. I’ve always wondered why they send a fire truck when someone’s just having a heart attack.
Nov 30, 2006, 5:49 pm
Messing with the Fire Dept. staffing, scheduling and/or equipment dispatch is stabbing a sacred cow, no matter how nicely you try to approach it. It’s long been known that by far the majority of the calls are medical. Some have felt that 24 on and 48 off scheduling with Kelly Days, Book Time, Regular Duty Trades, Overtime, and a myriad of other throwbacks to the early 1900s is an antiquated and expensive way to douse fires and provide emergency medical assistance. I don’t know any Cities or Fire Districts who’ve been successful in making meaningful change. Because other than the NEA, the IAFF is one of the last bastians of hardcore union left in the US, it will likely take someone with bigger “cannon balls” than current administration to effectively excise this one.
Nov 30, 2006, 6:23 pm
Very good reasoning ,Guardian. Why have a fire engine, with all it’s substantial equipment , be put out of service so it can answer an emergency medical call. The Fire dept. needs to purchase ,say, five emergency medical vehicles,each staffed by two paramedics so that fire trucks are used for fire emergencies only.
Ada county ambulance and paramedics have complained vocally of a lack of funding for their much needed services over the past year. Wouldn’t this help to alleviate the problem while saving the county money on emergency vehicle wear and tear?
Lets use our resources best by cooperating with each other’s facilities and resources, regardless of the locality an emergency situation pops up in. Using our ” Smarts” to allocate needed resources while not having every town duplicate each other’s resources at great expense would be a big step forward.
We already have school, highway and CCDC districts. Why not have emergency response districts that can answer medical,police,fire, or rescue calls with the appropriate vehicles and services and save all localities money by avoiding duplication?
Nov 30, 2006, 7:42 pm
Here’s another idea. The Fire Department doesn’t have to buy anything! We just give them all the EMS equipment and all the line personnel. The direct money we will save is all the duplicating, bureaucratic overhead managers that we will no longer need.
We have got to quit making these idiotic decisions based on someones little “kingdom” that they have carved out of the tax base in the past.
Nov 30, 2006, 8:26 pm
Sounds good in writing, but have you ever attempted to work a code blue with only two people? I have, and its not easy. Granted they may be over staffed on many of the calls they go to, but when my life is in on the line, I would rather they have too many, rather than too little.
Nov 30, 2006, 10:50 pm
And the funniest part about it all is….Ada County EMS is NOT a contracted provider of ambulance services to Ada County Employees’ Health Insurance!!!
Can you believe it? How in the hell is that fair?
Thanks Ada County for sticking me with a $800 ambulance bill. I appreciate it! (Now back to the part where government is supposed to–by law–operate in an efficient manner!)
Dec 1, 2006, 7:39 am
I am reminded of the arguments you hear when talking about the family farm. It’s sacred and “if you mess with it we are going to starve.”
Same thing seems to apply to fire services. “If you mess with it we are going to lose our property to fire or die.”
Dec 1, 2006, 8:20 am
Ada County Employee and other posters; I believe Voltaire who lived a long time ago said it well;
“It is dangerous to be right when the government is wrong”
Fits pretty well I think……
Dec 1, 2006, 10:00 am
Firemen, because of their widespread locations, aim for an average response time of 4 minutes, where the average for EMS is 8 minutes. When it comes to a cardiac arrest, time is both muscle (heart function) and grey matter (brain perfusion).
I still think firemen need to respond, particularly if they are trained in CPR and automatic defibrillator use, but I agree with the Guardian that a medical truck makes much more sense than an engine.
Dec 1, 2006, 10:18 am
What happens to the old engines? Do the stations keep them and maintain both the engines and medical van(s)? When ever I look in those roll up doors I see at least 2 engines and assumed that fire fighters needed both to effectively fight large fires. It seems “bad” to make them give up an engine and expensive if they keep it but maintain another vehicle with maintenance, parking, and increased personnel.
Perhaps a reorganization of the districts that allows smaller fires to be “two alarm fires” would be almost as effective with just slightly longer response times.
EDITOR NOTE–Our plan would not effect fire engines at all. For the most part the extra space on the apparatus floor is for “reserve” rigs and are not staffed. The exceptions are stations with both a pumper and a ladder company.
Dec 2, 2006, 1:48 am
It’s not just about the waste of money going to medical calls. Has anyone asked about where the Boise Fire Department is placing the new truck company? It is going in at Station #5, about 1.5 miles from Truck Company at Boise Station #1. Yet there is no truck company in Northwest Boise. Way to go.
And answer this, why does it take 3 fire engines and truck company to drive with their lights and siren through town for every automatic fire alarm? Talk about a waste. Couldn’t one guy go look and call the others if it was actually on fire? That same guy could turn the alarm off when he found out it was yet another false alarm.
EDITOR NOTE–I don’t speak on behalf of the FD, but downtown is the logical place for ladder trucks because they have tall buildings! No problem w/ that one. I agree on the automatic alarm problem, especially in occupied buildings where people can easily confirm if there really is a fire, smoke, etc.
Dec 2, 2006, 1:20 pm
Fire Department responses to automatic alarms were reduced earlier this year, in some cases cut in half. Certainly, most alarms are false, but the F.D. still responds with enough equipment to get started on a fire should one be discovered.
Dec 2, 2006, 4:19 pm
I hear ada county whining about how the fire department’s are wearing and tearing the fire truck’s by responding to medicals but just to day I saw ada county with their gurney’s in a parade. They were riding them, spinning them around, and jumping on them.
These were new or newer gurney. I guess that is ok to do right? Or do we need to through a fit like they are with the fire departments? I think ada county EMS over the year’s their heads have got tooo big, and now is the time to put them in their place! I hope that all of the fire departments get to together and make ada county extinct. I thought that we were hear for Pt. care. NOT B.S.
Dec 2, 2006, 4:27 pm
Bull says: “I hear ada county whining about how the fire department’s are wearing and tearing the fire truck’s by responding to medicals but just to day I saw ada county with their gurney’s in a parade. They were riding them, spinning them around, and jumping on them.”
Yeah, cuz a new Truck cost about the same as a new gurney! HAHAHAHAHLOL
Not defending Ada County, but the Fire Service is not a picture of efficiency by any stretch. I guess this would be borne out by your post.
Dec 3, 2006, 10:44 am
As a ACP paramedic…I certainly agree that the use for a fire engine on medical calls is a waste….but I like having the fire guys there to help lift, do CPR, bag a patient while I set up a med or prepare to tube, spike a line, look menacingly at some rowdy drunk, or just to share a joke.
I get along on scene…is my head to big. Its idiots like Bull that want to make “Ada County Extinct” that makes life hard on me in the street. How can I trust someone to “get my back” when peopel like you are telling BFD personnel to hang me out to dry?
I want to focus on patient care…I shouldnt have to worry about my safety or my partners safety at the same time…Thanks a lot.
Anyway back on topic..BFD has a number of “brush trucks”, as well as other support vehicles that would be excellent in this response. For at least 9 years the Eagle Fire department (and I would assume the Star Fire Department as well..but I don’t know when they started doing it)have had common sense and sent a medically equiped suburban to medical calls, getting all the personnel and equipment to a call..a potentially critical call…with out putting themselves and the public at risk by driving a $250,000 (or more) HEAVY WATER FILLED TANK when they didnt need to. Face it..a suburban is a lot safer to run a call in ..stops quicker, and handles better, thus is cheaper than a fire truck and safer too!
But at least one BFD captain I asked about this once said…”well, what if we have a fire”. Always planning for the “big one” (a fire), not paying attention to the “big one” (a medical ) in some ones home….thats the problem with the fire service nationally. Fires Happen…but medical calls are at least 70% of the calls..which one do you want to plan your response around?
But as long as we have an IAFF we will have the “heroes” on one side and struggling paramedics on the other.
Ever notice how we get along so much better with Eagle Fire..we train together, talk, etc…and there is no fire union?
Want to improve ACP-Fire relations? Maybe the union should butt out and let the real people on the street do their jobs!
Having been around a while ,and seen a lot of systems….the people in Ada County have a top tier service..although the fire service want to put everything in the big red empire…maybe the separation of church and state..or EMS and fire…is the right balance to keep things good for the patient.
Ask yourself…why does Fire want EMS? It’s not patient care.
Dec 3, 2006, 12:38 pm
You make some very good points, but you seem like a guy who would starve with a pantry full of food for lack of a key ingredient.
One has to use the ingredients at one’s disposal in order to cook a meal and the same is true for your current dilema. Firemen outnumber paramedics, they have more money to spend, they have unions, and they have existing infrastructure (stations and vehicles).
For whatever reason the voters mistrusted having an unelected ambulance driver handle millions of dollars and also be the supreme commander of medical services. Even doctors have financial staff.
You can’t blame the firemen for getting rid of Commish Judy and Commish Rick is sure to go with his financial reputation as well.
You blame your troubles on, voters, Big Blue, medicare, firemen, unions. A mirror might be in order.
Dec 3, 2006, 2:27 pm
“One has to use the ingredients at one’s disposal in order to cook a meal and the same is true for your current dilema.”
Certainly true. But not every ingrediant is needed for every dish, and too much of one and two little of another will also ruin a dish as well. Imagine if I made my peanut butter sandwich with fire fighter red hot sauce every day? It would be a waste of hot sauce and be a crummy sandwich.
Evidently you LOVE hot Sauce.
” Firemen outnumber paramedics, they have more money to spend, they have unions, and they have existing infrastructure (stations and vehicles).”
So what you are saying, is “might makes right”? Just becasue your bigger, stronger, shiner, and have a uniojn…you MUST be the correct answer..or what? You will roll over anyone who disagrees?
“For whatever reason the voters mistrusted having an unelected ambulance driver handle millions of dollars and also be the supreme commander of medical services. Even doctors have financial staff.”
How is our director different than your fire chief. He was not elected either. Our director has a degree in business as well as many years experience as a paramedic. Assuming your refereeing to Boise, I am sure Chief Ross is well qualified…does he have a business degree? I don’t know. A far cry from the “ambulance driver” comment..which you obviously know is an insulting term in our industry…thanks again.
“You can’t blame the firemen for getting rid of Commish Judy and Commish Rick is sure to go with his financial reputation as well.”
Not sure of your point, other than the fact that the IAFF lobby here pulls weight , regardless of the public interest.
“You blame your troubles on, voters, Big Blue, medicare, firemen, unions. A mirror might be in order.”
I stand by my comments. By the way, have you in your post addressed either:
1- Fire Departmet assistance to EMS on scene….
2- Using fire trucks on medical calls?
3- Fire Service Deployment?
4- EMS-Fire relations….
I have in my previous post discussed all of these…Seems to me we are off topic…
Dec 3, 2006, 5:27 pm
Croaker, you seem an angry lad. You appear to have just lost two supporters with your comments–Ms. Ullman and me.
My message–I will try again–is, “Play the cards you are dealt.” Instead you seem to attack the dealer, the card manufacturer, the players, et al.
Your comments about liking to have extra hands around to “help YOU” is an attitude problem. If you were to say, “the patients are better served” with extra hands, we would understand. You clearly view the first responders as inferior and subject to your “command.”
For the record, the fire department does not charge fees for the service and there is no attempt to have it turn a profit. It is a government service.
To tell Ms. Ullman–or anyone that’s the way it is “PERIOD” leaves little room for civil discourse. I think G has gone beyond the call to allow you so much space, but it will probably prompt more comments so he won’t mind.
Dec 3, 2006, 6:06 pm
This “give and take” has probably been the best discussion this blog has ever had. Croaker and Mr. Logic, I admire you both! You both obviously have great pride in your professions, and you have both thought out your positions on this subject. Croaker, if I were ever to need EMS, I certainly hope it is you. From a “civilian’s” point of view, I don’t think it matters if you are in a ACEMS or ACFD uniform. I will just be thankful that you know what you are doing. From a taxpayers standpoint,I simply want to see the departments that I pay for run efficiently. It seems to make sense to bring the EMS effort under the umbrella of the fire department.If we can relieve the taxpayer of “overhead duplication” it should be done. I am sure the details could be worked out between the two efforts that will continue to supply us with first rate emergency care. You both have to admit that when we, as taxpayers, drive by a scene that has a fire truck (or two) an EMS vehicle(or two), private service ambulances, A fire department supervisors vehicle and two, or three, police vehicles, when the “problem” doesn’t appear to be catastrophic, it makes us wonder if we are spending our resources wisely. I would ask if there are other issues, beside the “turf” problems that need to be addressed?
Dec 3, 2006, 6:19 pm
Cyclops, for the record I am NOT a fireman. I try to be well informed and admit to reading everything the G has posted. I realize you were not speaking literally in your comments, but there is NO county fire department and the privates are prohibited by law from emergency responses.
Dec 3, 2006, 7:21 pm
Thank you for your comment. I especially enjoyed the comment of ‘play the hand you are dealt’. Very true.
I have to disagree with your comment about fees for service:
Mr. Logic said: “For the record, the fire department does not charge fees for the service and there is no attempt to have it turn a profit. It is a government service.”
The fire department does charge for its service. Its called taxes!!! No government service is ‘free’. All government agencies charge for services. Get a property tax bill in the mail? That’s the government charging a fee for service.
I happen to live in the Star Fire District. This year, my fire dist. tax increased nearly two fold. Why do they need additional tax money (a profit margin, perhaps) to continue operation? The answer is they need to expand services to meet the needs of a growing population.
As far as I have been educated, the EMS department is trying to do exactly the same thing –> Meet the needs of a growing population. They are attempting to expand service to underserviced areas of the ENTIRE county. They are trying to raise additional capital (through fees for service, taxes, ect…) so that they can expand the service in the county.
As a taxpayer, I’m disturbed by the adversarial actions by other government entities with regards to blocking EMS’s attempt to provide the service for which they have been charged with. The EMS department is understaffed, under-budgeted, and underpaid. I for one would gladly see my taxes raised for EMS to fire district tax levels to provide adequate EMS service to the WHOLE County.
Guardian plan: Why add more layers to the city fire department. Why not direct funds away from the fire department and direct them towards the county for a ‘enhanced service contract’. Saves money, cuts duplication, and cuts FTE’s from the city’s payroll.
BTW, why do we have 7 fire departments. In my old hometown, the Fire Department and EMS department were together –> county wide. It was structured as a Fire Division, and an EMS division. No conflicts, everyone got along. And everyone was properly funded and covered across the WHOLE County. Food for thought.
Profit: Public company vs government
Public/private company = dividends to shareholders
Government = bigger bureaucracy
Editor Note–Thanks for your thought provoking comments. EMS gets taxes AND charges fees. If the commishes let the new guy–Paul Woods–have a voice instead of rushing an ordinance through it would be nice.
Dec 3, 2006, 7:34 pm
Just a quick clarification. Mr. Logic wrote, “Croaker, you seem an angry lad. You appear to have just lost two supporters with your comments–Ms. Ullman and me.”
Croaker – you have not lost my support. I simply disagree with some of the things you have written. I know the recent history of Ada EMS and the medics have every right to be frustrated.
I do not fault you for your frustration or your feelings and I appreciate your willingness to express your opinion here. It is unfortunate that the environment provided by the County is such that it is necessary for you to use a pseudonym to express your feelings.
I am grateful this discussion is taking place (thanks Guardian!) but it is regrettable it is taking place on an internet blog rather than in a roomful of EMS, fire, and taxpayer representatives.
Dec 3, 2006, 11:41 pm
In the event that that is a thinly veiled plea to get me to identify myself, just ask.
“croaker” is the name I am known by under every major EMS forum, including EMSvillage, firehouse, GhettoMedic, EMSlive, and EMTcity. Its well known to my co-workers..including my director. I could go into its origins,but no one would really care and it would identify me as more fo a EMS geek than I already am..suffice to say it is NOT a fish, nor a reference to a naval vessel. Free junior paramedic sticker to the one who gets it though.
As for my real name..its Steve Cole. Don’t wear it out. I’m not afraid to show it, nor afraid of my comments, when the tick off my director (which I have done numerous times) or others. I just say what I feel needs to be said, and I wont let bullies tell me otherwise, regardless of uniform.
ANd Mr. Logic, your interpretation of my comments is a stretch at best. Talk to anyone who knows me and you will be very hard pressed to find someone who has spent more of their time or effort to educate and assist the FD, nor will you find someone who doenst say the thank yous and such on scene, who tries to educate after a call the details of a medical condition, or gotherwise try to educate all co-rsponders as much as I do…..except maybe the late Dave Ockerman (RIP).
I have a lot of beefs with the FD, but you wont find a single person who will say I let it effect my on scene performance, nor find someone who will say I have ever treated the FF’s as if I was holier than thou either. Not a one. Even “Brother Hummel” would have to admit that. My beefs are personal only because I take my profession personal…I however don’t lower my self to voice them.
Dec 4, 2006, 8:22 am
Nope. It wasn’t a veiled attempt to get you to reveal your identity. It was more a statement about the culture of employment at Ada County. Depending on the department, employees of Ada County can suffer repercussions for voicing their opinions, up to, and including, being fired. This practice is illegal and I have spoken out against it on numerous occasions. Unfortunately, in many Ada County departments, this “culture” still exists.
Dec 4, 2006, 10:16 am
I would have to agree with sharon on this point. As the employee that spoke up and was fired for it I think that many things that could be done to improve life quality at ACEMS. Steve is one of the greatest supporters of “work with what we have if we have to, but lets all get along”. He is always the first to jump into a conversation and try to come to a neutral decesion that makes everyone ‘happy’. I hope that something can be done on both sides of the fence to make this all work out. For the time being though I for one, am not going to be holding my breath. (unless holding my breath makes the leadership change their outlooks)
Dec 7, 2006, 12:05 pm
Isn’t this whole County ordinance power play a rerun of what prompted the blow-up a couple years back? The BOCC appointed a, “Blue Ribbon Task Force” to study EMS and their funding problems. I think that this was a result of concerns with their proposed ordinance. If my memory serves, the Statesman reported that concerns were expressed by numerous EMS stakeholders like FDs, hospitals, private ambulance companies, Life Flight. Their proposed ordinance would have given the County authority to regulate other stakeholders.
A year or so later after their task force gave their recommendations, it seemed like their guidance was cooperation with other stakeholders like merging with the fire departments. Has anything been done to implement the recommendations? Why is the BOCC now back to passing a trump ordinance instead of listening to the very people they appointed to give them recommendations? Did they not like what they had to say?
Dec 8, 2006, 12:15 pm
To food for thought. Yes the recommendation from the Blue Ribbon Task Force was for Fire and EMS to merge. However it was for ALL of Fire and EMS to merge. Then once there was a countywide fire service, then combine the two. Since the BFD and Whittney example was posted earlier, lets point out that it took 2-3 years for the 2 unions to come to an agreement.
I think sometime in the very very distant future there will be one countywide service for Fire and EMS, but until then there has to be something done to protect the EMS system and prevent having 7 separate systems.
Dec 8, 2006, 7:28 pm
Many of the other recommendations of that same task force are also addressed in the ordinance, including a true medical directorate that all the ALS providers fall under.
“Cooperation” has been honestly attempted by ACP and honestly ignored by many of the FD’s, and paid only lip service by the others. Everything from medications carried (i.e. the Brethine debate) a standardized test to be a paramedic in the system that all paramedics in Ada county (regardless of uniform) would have to take have been fought by the FDs.
Again, the FD’s wont work with ACP willingly, ever. They have shown time and time again that they will back out of cooperative agreements, and seek to take advantage at every turn. In addition, many aspects of this ordinance only solidify the steps ACP has taken to try to implement the recommendations of the blue ribbon task force…the very recommendations the fire department is claiming to say we must devolve and merge with the individual fire departments.
The ordnance is based on sound principles of EMS systems development used successfully by the other leading EMS systems in the US. The FDs don’t want to be “regulated”, but due to union politics, labor issues, and cultural conflicts , they cant(or more likely wont) appropriately manage their own EMS activities. This wasn’t as big of an issue at the BLS level, but as more departments try ALS, this literally becomes a matter of life and death.
Remember, no one is saying they cant have ALS, just that they MUST have ALS that is FULLY at all levels (SWO, training, QA, etc) part of the system, and the medics who are in the ALS system must go through the same training, have the same monitoring the same transparency,and the same hiring test/FTO program that our medics go through to practice as medics. This means also that medics who do NOT meet the standards do not practice…also regardless of uniform. This is another thing the FD is afraid of I think.
Lets face it, the only one who benefits there is the patient and taxpayer. Quality, not quantity, is where you make the most of your tax payer dollars.
Anyone who wants a better EMS system, and better providers on all sides, should support the ordinance.
Dec 8, 2006, 9:26 pm
I just can’t agree that people who want a good or better EMS system should support the proposed ordinance. The assertion that this ordinance will ensure better service, when it stands to significantly extend response times for ALS and transport services in Kuna, and soon Star, is simply not logical.
If there is a concern or problem with the quality of care being delivered in Kuna, and proposed in Star, then those issues should be addressed. That still does not necessitate the proposed ordinance.
Kuna’s first two paramedics were trained by a highly competent Ada County paramedic/trainer and I’ll bet a lot of the other firefighter/paramedics in the area have been through the same program. Does anyone have any evidence that they or any of the other firefighter/paramedics provide substandard service?
It is true that some EMS/fire relations are strained, but this ordinance will do nothing to improve things. In fact, it’s no wonder it is having the opposite effect. The Kuna Fire District is to be commended, not chastised and penalized, for their willingness to step up to the plate, dedicate the resources, and send firefighters for more advanced medical training, so they can provide higher level emergency medical care in the Kuna area.
The goal of the proposed ordinance appears to be to protect the income stream generated by medical calls for Ada County EMS. That problem should be addressed separately. I am a staunch fiscal conservative (I don’t want to see public funds wasted) but Ada County EMS does not receive adequate property tax funding. The fire districts receive much higher levels of property tax support.
Perhaps it is time to form a new panel, made up of representatives of the fire districts, EMS, the Sheriff (who oversees dispatch) and members of the community, to work on creating a consolidated fire/EMS system. The goal should not be “to protect the EMS system”. The goal should be to protect the public.
Dec 8, 2006, 10:42 pm
I cannot speak to the fiscal issue. I do not have an MBA. But, I do know what makes a goo dmedic, and what makes a good EMS system… and I have seen the worst of all types of EMS, so I know the components of a bad EMS system…that is what the most important part of the ordinance is addressing. Building a better EMS system, a sustainable one. …and thats what the FDs are afraid of… this brave new world.
Now, I have not said that one department or any individuals are providing substandard service….but a SYSTEM cannot and should not rely on the strength of any individuals if it is to be sustained. It must have belt in safeguards for future generations of patients and medics alike, to ensure that the medics of the future are as competent as the medics of today. The King County Medic One system that I mention so frequently is the result of 30 plus years of rigid almost fanatical to the highest medical standards in the industry. The result was worth it there, and should be worth the cost here.
I am not chastising Kuna or anyone for “stepping up to the plate”. I just think that there are better ways to do it. I also dont think oversaturating the area with medics, having a medic on every street corner (figuratively speaking) is the way to improve patient care (and that IS where the FDs are heading, make no mistake).
If there is any chastising to be done it is the fact that the FDs (not naming any one in particular) don’t want to work with in the existing system using key elements that have been proven to work. Elements as far as training program, FTO programs, medical competence based hiring practices, or any number of practices that help insure competent medics.
I could go on and on, but it comes down to this:
Both before or after employment none of the departments providing ALS or proposing to provide ALS have any credentialing process (FTO, skills testing, etc) that approaches ACPs process in length, complexity, or intensity. That is understandable as none of the departments have either the patient contact time with a patient, not the volume of calls, compared to ACP. But none of the departments are, INHO, even addressing the issue, none care. Instead we see FDs hiring people who are good firefighters, assuming that alone is enough to ensure that someone will be a good medic. It would seem that it is enough to have a paramedic patch, little more, as long as you can be a good Firefighter. Lets be sure they are both.
This training, evaluation, QA/QI, and patient contacts that I mention are essential to any quality system. It is this that makes, and maintains a competent medic. ACP has multiple programs that address these issues. The ordinance will help make sure that all get the same opportunities, and meet the same responsibilities.
With out the ordinance the fire departments do not have to hold them selves to the same standard. They have no incentive to, and some pressure not to (union politics, fiscal pressures, competing training priorities).
Basically, it is my understanding that the area fire departments want to run their own game to their own standards. This is the first step to breaking apart the system we have now.
The ordinance assures the patient, the medical community, and the tax payer that the medic will be held to the highest, not the lowest common denominator. The ordinance make sure that all medics will fall under the same standards, both now and in the future, regardless of uniform. And just as importantly those that wont, don’t play as medics.
Sure there will be great medics over there (in the FD) with or with out the ordinance, but shouldn’t we want to KNOW..not hope..that ALL…not some..of the medics regardless of the uniform meet the highest possible standard?
This is the most important part of the ordinance, and the most important part of building an EMS system. We are not talking about protecting a system… we are talking about building a better one.
Dec 8, 2006, 10:51 pm
One final thought, at least for this 12 hours….
Perhaps we should divert talk of the ordinance to the article that speaks to the ordinance, also on this site. We lost the original topic, speaking to the use on fire engines on EMS calls when other vehicles may make more sense…like what they do in Eagle and Star.
Dec 9, 2006, 10:52 am
You make some excellent points and this is a valuable discussion. The biggest problem I see is that this discussion should have taken place BEFORE a new ordinance was proposed and it needs to include the whole community – at the very least all of the players involved – and not just you and me. Some other points that perhaps you can help address:
• When I was a commissioner, training was NOT a high priority for the EMS director although I agree that it should have been. Has that changed?
• Is it true that turnover in Ada EMS has been so high that testing standards for new hires have been significantly lowered just to have enough employees? It is my understanding that the County used to only hire a small fraction of those who tested, whereas now, they are hiring a much larger percentage. Is that true?
• Is it true that despite the limited EMS budget, thousands of dollars of new office furniture have been purchased for Ada EMS administrators?
• Since the County has a PR person who puts out news releases about topics such as choirs singing at the Courthouse, why has there not been a single news release put out about this proposed ordinance?
• Once word leaked out that there was a new EMS ordinance being proposed, it WAS finally posted on the main page of the County’s website. Why, then, did it disappear and then later reappear?
• Why is the hearing on this very controversial ordinance being held at 9:00 a.m., in downtown Boise, at the Courthouse, where parking costs money? At the very least, the hearing ought to be held in the evening so those of us with jobs or young children at home could more easily attend. Better yet would be evening hearings in Star and Kuna, as well as in downtown Boise.
The article on this site that addressed the EMS ordinance appears to have moved off the front page, and all these issues are related, which is why I have continued the discussion here.
Dec 10, 2006, 4:07 pm
This has been an interesting discussion to say the least. I have sat by idly reading the concordance of points and counter points. I truly hope no one out there in the blogosphere is buying what the County is shoveling. Their alleged motivation in drafting this ordinance is to bring all EMS agencies under one giant umbrella.
Sharing SWO’s (standing written orders), medical direction, testing practices etc. I have worked on the west side of Washington and seen first hand the famed King County Medic One system. It is with out question an outstanding achetype of what an EMS system can aspire to. This system however is NOT what the County is attempting to emulate. If this were the case the commissioners and ACP’s administration would have requested an audience with their counter parts in the fire service, to discuss these issues.
Instead They formulated this sneaky underhanded plan in a dimly lit back room somewhere and thrust it upon the local fire chiefs in a routine meeting. It was not a matter of sheer coincidence of course that this left very little if any time for discussion, ponderings or debate. So what is there true intention? A monopoly of course. To make every EMS agency in this valley subjugated to ACP authority.
That my friends makes the hair on the back of my neck stand up. They told the public they would be forced to lay off multiple personnel if the over ride levy failed over a year ago. Hmm…last I checked they have been hiring as many brand new totally inexperienced Paramedics they can find (not laying anyone off mind you). Hmm…thats what they claim everyone else in this valley is supposedly doing,
unlike the drummed up rhetoric and scare tactics the county used in the failed attempt to pass the levy.
If this ordinance passes, three Kuna Firefighters WILL be layed off. The County knows this and could care less…Hypocricy at its finest. By the way Croaker, Eagle Fire is joining the IAFF thought you’d like to know 😉
Dec 12, 2006, 12:29 am
Well Dorothy, you’re not in Kansas anymore and you’re not in West Washington either. Curious to know what capacity you were in while being there though. Anyhoo…. do you think ACP didn’t try and work together with the Fire Depts’ when they first brought medics on? Of course they did and got a kick in the teeth over it.
Should we waste more time with another panel of IAFF reps and citizens that we have to spend another year on educating how the “System presently works” and then they still don’t get it? Business moves forward and the business of taking care of people in Ada County (ACP) is doing the same. I believe ACP has tried to play nice and it’s time for them to take control over their destiny and ensure that ceratain parameters are in place for oragnizations that are taking on a huge responsibility.
Fire’s done it, why are you all so worried about the EMS / Paramedic transport agency regulating EMS transport as allowed by state statute. If the comissioners allow it, so be it. I’m sure the Eagle Fire guys will all be getting a raise soon since they joined the union. What is BFD’s annual now 6-7%? the average county medic got about 3%. $ well spent I’d say…. not!
Dec 13, 2006, 2:54 am
Well Jason that’s got to be the most predictable and cliched comeback I’ve ever heard.
Anyhoo, that’s Ms. Purser to you. I’ll give you a little hint regarding the “capacity”, under which I served while in Washington, due to your obvious lack of imagination…it wasn’t as a janitor. Hopefully you can read between the lines. Yes your right about one thing, ACP did try very hard to work with the fire service prior to the various agencies implementing ALS programs.
They in fact made every attempt to thwart their efforts and keep the same old status quo antiquated system in place. Everyone is so worried about ACP regulating the entire valley’s EMS practices simply because they have a narrow minded vested interest and sense dogmatism that blinds their vision…and frightens me quite frankly.
There is an ideology that seeks to acquire and firmly maintain total control of a populace…sense you have shone a clear lack of imagination previously I’ll give you another little hint…it starts with the letter…Marxism. Perhaps instead of complaining about the lack of compensation the medics at the county are receiving for their arduous work…you should rejoice that the IAFF you so vehmently condem has brought better paying paramedic positions with increased longevity, better benefits, working condions and the absense of fear from an oppressive administation.
According to the Idaho Constitution, City’s have the right to provide ambulance service if they see the need arise. By the way another little pearl regarding the King County Medic One system everyone keeps referring to. They do NOT have anything to do with non-emergent transfers and do NOT infringe upon free enterprise as ACP is currently doing…and doing very well I might add, forcing the local privates to lay off a significant portion of their staff. You failed to respond to the fact that three Kuna personnel WILL also be layed off if the ordinance passes. Therefore I can only assume you, ACP and the BOCC could care less about anything but a singular objective…total control.
The pay percentages you refer to are what’s keeping and will continue to keep experienced medics in this valley…instead of being forced out of the profession altogether; secondary to sheer attrition due to lack of pay and burn out. Money well spent…absolutely if its my family member that is sick or injured. There is a better world out there if you have the courage to take a chance. Fraternally, Ms Purser.