If the Fox News story that aired the other night was correct, citizens in Kuna pay an average of $460 less per emergency transport than if Ada County EMS was to transport them. Looking at my property tax bill, I pay about $18 a year for ACEMS. The County is saying they are concerned that the public is being double taxed?

I would gladly pay the $18 a year while having BFD transport me if it was going to save me $460. Like the Guardian says; the Ada County Sheriff provides back up to BPD. It seems like $18 per year is a bargain for backup while receiving quicker and less expensive service from area fire departments.

I wish both sides, Fire and EMS, would quit playing the turf battle. Have area fire departments or their elected officials done anything to propose a joint transport or consolidated service? If the County was truly looking out for the patients best interest, not their empire, they would get on board with their Task Forces’ recommendations and start cooperating with other agencies rather than trying to control them.

Isn’t the State Bureau of EMS the agency charged with regulating emergency medical services not individual counties?

Guardian a correction on your comment “Ada Sheriff is the supreme lawman of the county, but he gladly steps aside for police departments in Boise, Meridian, and Garden City.” Under 12-2 Sole and Separate Sovereignty. Cities and Counties have equal policing powers. Ada County deputies can only respond in city limits because of mutual aid agreements.

However I believe the BOCC/ACEMS are wrong in trying for this power grab. If citizens want to pay for two services and quicker response times, then let them. Where this conversation should be going, is a “standard operating procedures” that all jurisdictions should follow. This would include paramedics vs. EMT, medical directorates and shared cost/taxes.

Report from 12/12/06 BOCC meeting:

I estimate about 150 people attended the hearing. The three commissioners voted unanimously to table a decision on the proposed ordinance until 9 a.m. on December 19.

Fire departments were well represented as well as Ada County’s EMS director, two medical directors (doctors), a handful of medics, and Dia Gainor, the EMS Bureau Chief for the State of Idaho, also attended. Most of the local media outlets also attended. The 9 o’clock meeting didn’t end until about 12:30.

Ada County EMS staff and members of the County’s EMS Advisory Board, as well as Dia Gainor, testified in support of the ordinance. The rest of the testimony was in opposition. Ms. Gainor wants Ada County to pass the ordinance in order to serve as a model for the rest of the state to show how a consolidated system should be run.

The County’s testimony focused on standards and quality of care. They want a unified EMS system.

Commissioner Peavey-Derr’s questions focused on the issue of double taxation. She asked whether people in Meridian, Star and Kuna want to pay Ada County EMS to provide a service and then pay the fire district as well. She failed to take into consideration the significantly quicker response times often made possible by fire districts that have more money, more people and more stations.

Commissioner Fred Tilman’s questions tended to focus on the legal issue of who has the authority to control the delivery of EMS and ambulance service in the County. He wants a definitive answer whether Ada County has the legal authority to do what it is proposing.

Commissioner Rick Yzaguirre, in his final remarks, recognized the need to bring elected officials from the various cities and fire districts into the discussion.

My take: It would be best to have a consolidated EMS system that shares Standard Written Orders, etc. Instigating a turf war (even unintentionally) was not a good way for the County to accomplish this goal. It is not necessary for Ada EMS’s doctors to have “final authority” over medical protocols. The decisions about medical direction and protocols that cannot be reached through consensus can be decided by vote. It is, after all, called “practicing” medicine.

The double taxation issue is secondary to the provision of rapid, high quality emergency medical care and transport.

There is no need to determine whether Ada County has the authority to rule over the provision of emergency medical care in the County if a reasonable agreement is reached through discussion and consensus.

The County seems to expect to either take the issue of authority to a judge, or pass the ordinance and end up in litigation. It is not in the best interest of the taxpayers of Ada County to have one of our taxing districts suing another taxing district. We are paying for both sides of the dispute.

Commissioner Yzaguirre is correct that better communication and inclusion of the other elected officials in the County is a good idea. Better late than never to recognize this need!

If a new group is formed to work on a better EMS ordinance, it should include members of the public, who are stakeholders as well.

I would be happy to volunteer my time to serve on such a committee and I am sure others would be willing to do so as well.

Addendum:

I just confirmed with Kuna Fire District Chief Doug Rosin that the Fire District has been providing ambulance service since the early 1960’s. That would mean that back in 1975 when Ada County’s Ambulance (taxing) District was formed, the County commissioners illegally included Kuna in the District. Talk about double taxation! 🙂

Idaho Code 31-3901. AUTHORIZATION TO ESTABLISH AMBULANCE SERVICE — SPECIAL LEVY says (I have capitalized the most relevant phrases, below):

“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, and to levy a special tax not to exceed two hundredths percent (.02%) of the market value for assessment purposes on all taxable property within the county to support the same. Providing ambulance service is a governmental function.

“Reasonable people would combine the two. But then not much reason has been demonstrated in this whole sordid affair.”

Just to clarify, we are not talking about the “two”…we are talking about seven or eight , depending on how you count districts, all of which want to merge with EMS but not each other…in other blunter terms…split up EMS.

Get the fire departments to merge, then the EMS issue will get simpler. Merge EMS before then, and all you have is seven departments without a common enemy, who now have no reason to work together.

Efficiency…. i have nothing but sorrow for you as you are on crack and need medical attention / counseling… or at least remedial math. a FF is not free. let’s get that out of the way right now and anyone that thinks they are is stupid.

The fire union negotiates very well on an anuual basis to achieve a salary for a starting FF with no Paramedic licensure and no real responsibility that is about $10K above what a starting medic makes. It only goes up from there and if you include bennies… well now you’re talking 15-20K more.

Now make them a Paramedic-FF and you’ve just gone up to 20-25K. In no way is this a free service. The fire guys want EMS so bad they can taste it but haven’t said why. I wonder… is it so they can say they have something concrete to do other than automatic false alarms? Get real. They don’t have a single ambulance nor the equipment to put in it if they did have one and now you want to spend 180K per ambulance stocked to duplicate an existing quality service (to put 5 ambulances in the city of Boise right now would cost around 900K – 1 mill and that doesn’t include anyone to staff it. how does that save money again?).

The Fire Dept doesn’t want to be regulated because they don’t know how to regulate paramedics and that is simply unpallatable for them to have ACP make them do it. It’s pride. Where are the FF chart reviews, who does their QA, do they have a preceptor program in place to train supervise their new paramedics, and what about continuing education? Do you think this is free too! Right now you have duplication of services with added equipment (10-15K per defibrillator of the ALS variety and another 10-15K per FF medic with 6 or 7 medics in Boise) and what do you have to show for it on an acutal economic return as being an added tangible benefit to the public? How many lives have they saved or made a difference in? How many advanced skills have they performed? How many meds have expired because they haven’t been used? How much longer are the citizens of Boise going to allow themselves to stick their heads in the sand and say it’s dark outside? Fire has a new play toy (expensive by the way) and now they have to justify it. It isn’t getting cheaper and the only way to really do that is transport and transport revenue.

George Webb said it yesterday in the public meeting. Have no illusions that is where this is headed. Fire Depts don’t want to do transport just like they were going to support the ACP tax levy over ride. We all saw how that turned out didn’t we. If you’ve read about other Fire / EMS takeovers it usually turns out bad for the Fire Dept. because of billing issues, reimbursement, staffing (because they don’t hire straight medics on w/ FF union bennies and then they treat them like red-headed step children)and when they find out they can’t afford to do it because it cuts in on their fire budget….. well that ambulance service thing has to go.

The only mixed agency arond here is the Fire Dept. They are Boise, Meridian, Eagle, Star, Kuna, NACFR and of course the consumed Whitney Dept. ACEMS is Top Heavy???!!!!! Really …. 1 director, 2 deputy chiefs and 7 supervisors (that’s 2 a day for the entire county). BFD alone has 1 chief, more deputy chiefs than I can shake a stick at (5 or 6 I honestly can’t remember) and 3 battallion chiefs every day just to cover the city of Boise! now multiply this times 7 and that ‘s the top heavy Fire Dept looks like. Who should be consolidating…. Mr Efficiency…. is that what you call yourself? If the public only knew how they were really getting screwed by the Fire Dept they’d revolt. ISO ratings of 1 or 10…. doesn’t matter. My house brns down completely I get another one from my home owners insurance which would only go up $100 per year with an SIO rating of 10 from the 2 that it’s at now. Not paying fire taxes…. $350 / year. A savings of $150 / year.

Assuming the cities prevail with their argument that the county cannot prevent them from providing EMS service: Consider this,

2005 Census numbers show that 344,727 people lived in Ada County. 287,083 lived within the 6 incorporated cities. That leaves 57,644 people that Ada county can “control”.

What happens when and if the 287,083 taxpayers being double taxed decide they don’t need an “ambulance district”?

Ada county leadership might want to try a little harder at consensus building rather than control by ordinance!

I hope this isn’t the Jason that sat at the kitchen table at the fire house two days ago and had a nice civil talk with the fire crew. It makes hard feelings when the every day paramedics and firefighters disrespect each others jobs and aren’t correct about facts.Both sides! I say this to everyone. Type with control in mind. Please let the top fight it out. I know you love your job and I hope you know I love mine. The Fire fighting part and the medical part. Medics and firefighters BOTH are there to help save lives. I know as an EMT I can’t do what you do, but please don’t belittle the role I play. I feel we work rather good together when the chips are down. It’s easy to get caught up and throw statements out( steve atleast puts a disclaimer at the end that he can’t be held responsible, nice). For example, we both know it’s hard to compare wages and benifits because fire and Medics work a different hourly scheduele Just remember one thing, the firefighter you see everyday are NOT plotting to stab you in the back. Come back to the kitchen table anytime.

It is apparent that there are more than enough “ego problems” to go around on this one. I don’t know of many public agencies, safety ones included, which would stand up well to scrutiny by a “blue ribbon task force”. Maybe it’s time to turn one loose on the fire service and see what shakes out.

I really think this is culture clash as much as it is anything else. And Efficiency, I guess we all know that nothing emotionally charged ever emits from the BFD;)

I really wanted to stay focused on the EMS ordinance and pushing a better EMS system, but Matts post really rubbed me wrong. So I have written a rebuttal, but it ended up being about a page long in of itself.
I will sum it up with the last few sentences of my rebuttal:
I definitely wouldn’t have said what Jason said the way it was said, but I certainly agree with the underlying sentiment.. and that is that We (EMS collectively) are tired of playing second fiddle in the public eye when we work so hard to do good medicine, and we are tired of fire trying to keep us in that position. And we are tired of literally risking our lives, our health, and our careers trying to do a good job the way we feel it needs to be done, while at every turn it seems the FDs are trying to pull the rug out from under us.

If not for us, then for the public, Quality EMS needs to be a priority.
“… ( steve at least puts a disclaimer at the end that he can’t be held responsible, nice).”
All I did was put a disclaimer that since I wasn’t in the inner circle, I stand by my comments, I just was letting you know the source.
“…Just remember one thing, the firefighter you see everyday are NOT plotting to stab you in the back. …”
It is hard to remember that when on an everyday basis your actions in the political area, by every day firefighters (like Cyclops and Bull, and other “brothers” ) are hampering a vital revision of EMS in this area.

Everyone agrees that the best thing would be for all of the fire services to consolidate. But we all know that won’t happen. Until then the Ordinance is not a turf battle, it puts us all on one turf. It mandates a functional consolidation of the EMS activities in this county to one standard, one practice, one set of rules of accountability. With the growth of advance life support by every body and their brother here, we need this now more than ever.

The ordinance makes it possible to implement best practices in the EMS industry, including QA/QI , revision of protocols, standardization of training, FTO programs, and mandatory hiring standards for paramedics, that will directly impact patient care. Direclty impact patient care. If we don’t have these things, quality of care will decrease, if we do, care will get even better. Notice I didnt mention uniforms or departments, If ACP didn’t have these things internally, our own care would decrease as well.

As I said in the BOCC meeting, I want to work for a service I can be proud of, and I want to have all the tools (i.e. protocols, equipment, and training) I need to give the best care possible. I think that other medics, regardless of uniforms, should have the same training opportunities, and standards, that I have. The medical directorate, and the functional consolidation of EMS, free of inappropriate influences, is key to this. The ordinance is the only effective way this will ever realistically become a reality.

The state EMS director supports this concept. The hospitals support this concept, why doesn’t the union?

And why isn’t the BG really addressing why the fire services haven’t moved toward a merger as was also recommended inthe Blue ribbon task force?

To continue this discussion is pointless. The paramedics who have contributed will obviously say whatever and they claim firefighters do the same and yet neither will decide the future of EMS. The system is in obvious need of review and possibly redesign. It doesn’t make sense to pass an ordinance so that taxpayers have to pay for another long and expensive court battle.

The ordinance should have been developed by a consenus of all the players in the system and not just ACEMS. It is obvious to me that ACEMS is trying to avoid the discussion and review of the system by anyone. Interesting that they would take this on in the last month before a new Commissioner comes on board?

Dorothy. I’ll say the following and let the blogging go on. Yes, I did test for King county Medic One, South King County – a 3rd service part of the Fire based system that did not include fire fighting (I’m from Seattle also so go figure). 2 others tested from this area and did well but didn’t go all the way, testing is something that I have done several times, encourage others to do because something is learned from every testing. No excuses, no REGRETS.

As for the Fire Depts budget, I stand by what I say. It’s great for them and the rest of the “Others” meaning paramedics everytime we’re mentioned in the media, are simply envious because unfortunately it takes money to provide this service. The Lions share doesn’t go to the agancy that is dedicated to this sole function. The $ dedicated to the Fire Depts goes toward the support of their established mission does it not? But now they’re wanting to take on another mission and if anyone thinks that’s going to be better, faster or cheaper they are in need of time in Intermountain.

If they have so much free time and money on their hands why don’t re readjust thir respective mil levies? As for my arrogance, apparently synonymous with self confidence, self assurrance in your vacabulary… OK whatever – it’s not derived from the patch on my sleeve, but having received training from cardiologists’ and people like Dexter Hunt. As well as having worked years with other great Medics like Dexter, Phil Norris, Doug Jay, et al. I make no apologies… not to you anyway or your “exposures”. Maintaining a standard of care is something that is done through a system. A group without oversight that doesn’t welcome oversight or want to participate in it(and they’ve been invited many times) doesn’t really hold much weight now does it.

What I do have a clue to is that if your name is Dorothy and you are female, the overwhelming odds are that you are NOT a firefighter with BFD.

1st , How many times must the FFs on her esay they want to elliiminate ACP before the public realizes that that, not public safety, is one of their top goals? Matt, understand why ots difficult to believe the FF were not all trying to stab us in the back?

2- There are very very few places that the privates actually pay for the paramedics, and in those cases they don’t pay for a whole paramedic, they pay a very small subsidy. The legality and logic behind this is complex, and in some cases questionable because of kick back rules..or so I heard. I dont claim to be a legal eagle. The places that do it do it as part of an exclusive contract for the area…a monopoly…hmmm isnt that what you guys are against?

3- The thread has nosedived. Lets get it back on track….

In another thread related to this topic, someone mentioned King County Medic One as a true archetype of excellent EMS service. That type of excellence is what we are looking for here. Ac cross all services, across all providers. Yet the fire service opposes it. The poster said while KCM1 is a great system, ACP is not trying to improve local EMS or to model itself after it. therefor I offer the following discussion:

Let me ask you this, in the past 5 years, what if any advancement of medical care has the fire service sponsored? The only one I can think of that some might consider an advancement is paramedic engines, and that is considered by many to be more of a self serving move than anything, an extension of the ego-centric hatred of ACP.
On the other hand, ACP has:
1- taken the lead in establishing the EMD (priority dispatch) program
2- Provided FREE CEU’s to the the first response community for at least 5 years, on a monthly basis. In five years, I cant recall one , not even one, BFD member has shown up for this FREE education to help him maintain his certification. NACFR has, MFD had when they let us bring it out to them. Even first responders from Micron but not BFD.
3- Provided EMT and Paramedic refresher courses on a yearly basis for reduced or no cost depending on department.
4- Provided support for regional EMS conferences
5- Assisted Star FD, Kuna FD, and Micron MFR program with implementing Epi Pen training to improve patient care.

Hmmm….looking at this it would seem that ACP has a better track record of trying to work with other agencies, and work for the public good and improve EMS in the Ada County Area than the other stake holders..at least from a medical point of view. Why is it so hard to believe that we are once again trying to improve EMS service here? And why is fire fighting it?

I said this at the BOCC meeting, and this should be the topic of discussion (but I think the IAFF wants to make this a turf issue and not a medical issue..because they would lose on those grounds….Thats why none of the FFs on here are willing to discuss the medical issues in detail.).
The ordinance is not the final stage in creatng a better EMS system, it is the first, and there fore the most crucial. No other plans, visions, or concepts can go forward if the fire service doesnt go along, and they have proven they wont unless they are compelled to. The commissioners must remain educated on best practices in EMS (and it is NOT paramedic engines), and therefore keep the pressure to keep moving in that direction.

Let me say it again loud and clear…Higher hiring standards, Better FTO programs, Better ongoing training, thorough QA and transparency, as well as uniform and aggressive SWO’s, are the essential components of improving EMS in Ada COunty. And it is on these issues the FDs should be forced to comply and improve. ACP sets the standard on this in Ada County, (yet there is always room for improvement there too). Therefore this is why ACP is leading the charge for change. Past interactions clearly point that unless the FDs are compelled to implement these practices, they wont. Too many conflicting interests and agendas.
That is why the ordinance is imprtant. It is about medical issues. I have not heard a single alternative plan from the FDs to firmly implement the changes that are needed. Not one. Its not like this hasn’t been discussed. It has.

It wont happen unless the ordinance passes. Cant you see that? Why is the FD afraid of medical progress. Can it really be so bad from a union or administrative point of view? Improving the quality of medical care has to be a priority across the board.

Jason, FYI BFD has been responding on medical calls since the 1930s, almost fifty years before ACEMS was even born, it is hardly taking on a new mission for us.

While that may be true to some degree, since ACP was adopted they did not respond on every medical call. In fact not until around 1988-89? (I have heard the date before but can’t be exact) BFD responded on select medical calls when they were asked to for certain circumstances. Most BFD personnel pre this newer era, hated medical calls and resented them. I witnessed that first hand. If it wasn’t on fire the view was they didn’t need to be there. I will say that most of that has changed and the attitude and willingness to help from the present FD personnel is good and as stated before, I think they are good guys individually. My only beef is that there is a hidden agenda here that is being played politically by the union and the administration for transport “options” shall we call them. That’s the reason this ordniance is being questioned, it’s political and monetory driven. In fact since you brought it up, BFD was offered paramedic transport prior to ACP inception in the early 70’s. They were given the opportunity then and refused it, thus ACP.

And a side note to the private service thing mentioned before. In those cities where private ambulance services transport $2000 + ALS transports are not uncommon. And that’s a starting point… it only goes up from there. While ACP has rasied rates, they aren’t neear that high. Be careful what you ask for and who you ask for.

“…Instead of one agency’s physician medical director having the ultimate authority over someone’s career. Which I feel is one of the proposed ordinances main objectives and flaws. Unfortunately the crews in the street have little chance of influencing such decisions, which frustrates and saddens me….”

Well, Dot, I can see your concerns..however this is mine on the same topic….remember I am not part of the inner circle but definitely an interested party.

I have a huge beef with IAFF influenced physicians being able to vote down the one doc who is not influenced by labor/union politics to keep a crappy medic on the streets…and that is what I would be afraid of. I am not talking individuals here, but I really think safeguards need to be in place that prevent union politics and policy out of the medical arena…period.
I can easily see the Fire Docs..with the pressure of the IAFF behind them, ganging up on the ACP doc just like the For departments with the IAFF pressure are ganging up on ACP today…on all matter of medical issues, including keeping bad medics who happen to be good firefighters and good union members …on the street.

this same concern is true of all sorts of medical issues, and how the IAFF may use the “medical directorate” to reduce ACP to a taxi service while they expand.

If you can think of a better safe guard for quality medical care, and making sure ACP remains a stake holder….than having a non union affiliated doc have the final vote, then please speak up.

Dot: While Meridian does have some very talented medics at one time all of the present FTO’s were ACP medics except for Omid, but his credentials certainly hold their own without that. I have no issues with THEIR abilities. Precepting a new medic on an Engine however with limited patient exposures and time with each patient (10-15 minutes on average)doesn’t lend itself to much more than a snapshot of time. You would nearly have to precept someone for a year if they were brand new to get any sort of feel for what they would do medically. My opinion only. As for ACP’s precepting program, I stand behind our FTO’s and the FTO process. The rest of that equation is admin. The medical directorate, regardless of the language of the ordinance, when physicians get together (at least with ER docs anyway) they treat one another with a fair amount of respect and allow for input. They’ll take the time to educate one another where something needs to be debated. I don’t see them not being able to reach a consensus on such issues and then having to pull the “Power Card” so ACP could get it’s figurative way. They’ve done that on some issues already. I think that oversight on all bases is a good thing for fire and ACP alike. Anytime there is more physician involvement EMS systems only benefit from this. KCM1 – Dr. Copass is proof of that and the system he has created is where I would hope we would be someday. None of the physician medical directors presently on either side of the ball is going to go after someones’ livelihood because of the agency they work for. The ordinance suggests annual competency standards and testing with physician oversight for ALL paramedics practicing withing Ada County. I would take that to mean ACP medics too. Everyone gets sharper if they know a test is coming related to a paycheck.

It’s called passion for something one believes in…JACK…something all of the thinking parties on this blog do in fact have in common. If you don’t have the courage to state and defend an opinion you are of no use to the world.

Fire departments helping and commenting on the direction of Emergency MEDICAL services makes as much sense as Emergency MEDICAL services giving input on how to put out fires or run Fire Departments. Oh wait that makes no sense.

Boise Fire Medics usually NEVER ride in to the hospital with ACEMS. Most are not good medics and we don’t want them touching our patients with a 20 foot pole. If there is an EMT and a Paramedic on the ambulance and it’s a critical call the fire department will drive ACEMS in.

The firemedics just don’t have enough experience to be trusted with patient care. I would not let a Boise Fire Medic provide Advanced Life Support to my family members. There are however 2 Meridian Fire Medics I would trust to take care of my family…and they both worked for ACEMS.