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.

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!

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 😉

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.

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.

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.

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.

“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.

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.

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?