Emergency Service

EMS Losing Ground In Turf War?


A reader directed us to the the Idaho Code and it looks like the cities–not the county holds the high ground in this turf battle.

31-3905. AMBULANCE SERVICE — OPERATION DEPENDENT UPON RESOLUTION OF EACH CITY — RIGHT TO TAX UNAFFECTED BY NONSERVICE. “All cities and villages within the county, upon resolution duly passed and approved and presented to the board of county commissioners, may authorize said ambulance service to operate within the boundaries of said city or village, but the failure of any such governing body to authorize said ambulance service to operate within the
limits of said village or city, shall not affect the right of the board of county commissioners to levy the tax as hereinbefore provided.”

Ada County finally came up with a press release about the EMS proposed ordinance at close of business Monday–a mere 17 hours before the Tuesday Commission meeting and two full weeks after the GUARDIAN broke the story.

Fire chiefs are opposed to the authority sought by EMS and we figure it will end up with either a judicial review or at least an opinion from the Idaho Attorney General. It would be foolhardy to pass the ordinance as it is written.

Here is a direct quote from the release and Director Troy Hagen:

“This ambulance-taxing district means we are required, by law to respond to EVERY emergency medical call no matter where it is in Ada County.”

“On the flip side, a 911-ambulance service provided by a Rural Fire Taxing District is limited to the boundary of the district, not to mention the ambulance service could be considered double taxation since property owners within the fire district would pay both the Rural Fire District Tax and taxes levied by the ambulance taxing district.”

The GUARDIAN suggests that if Kuna and Star wish to pay extra for their own service it would save the Ada EMS a lot of manpower and and expense while providing an increased level of service to residents of those fire districts.

The Ada Sheriff is the supreme lawman of the county, but he gladly steps aside for police departments in Boise, Meridian, and Garden City while providing back up when needed. Residents are double taxed, but they get increased service.

Still looks like a turf battle to us.

Comments & Discussion

Comments are closed for this post.

  1. I think the commissioners might have finally recognized that this is a big issue – the agenda now says the meeting will be held in the first floor hearing room. Regular Tuesday Open Business Meetings are normally held in the commissioners’ smaller conference room on the third floor.

  2. Common Sense
    Dec 12, 2006, 9:58 am

    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?

  3. It should be made clear at some point in time that fire service may be quicker….but it is NOT less expensive. I would encourage those who seek truthiness in all of this to pull all budget/overtime records for both agencies and do a side by side comparison. Just because firefighters are there, and have to be there waiting to be engaged (or engaged to wait)does not mean they are cost effective.

  4. 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.

  5. Clancy–
    No correction needed. G has it right in my book. I don’t know what your source is, but here is what Idaho Code says:

    Irrespective of police powers vested by statute in state, county, and municipal officers, it is hereby declared to be the policy of the state of Idaho that the primary duty of enforcing all the penal provisions of any and all statutes of this state, in any court, is vested in the sheriff and prosecuting attorney of each of the several counties. When in the judgment of such county officers, they need assistance from municipal peace officers
    within the county, they are authorized and directed to call for such and such local officers shall render such assistance.

    Sounds pretty clear to me.

  6. 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.

  7. Mr. Logic, Sorry I should of said Article XII, Section 2 of the Idaho State Constitution. It reads: LOCAL POLICE REGULATIONS AUTHORIZED. Any county or incorporated city or town may make and enforce, within its limits, all such local police, sanitary and other regulations as are not in conflict with its charter or with the general laws.

    I am no legal eagle, so I can’t tell you how one relates to the other. But Article XII, Section 2 should allow the cities to set up there own ambulance services irregardless of what the county does. Nampa ran into this same situation with Canyon County in 2003. Kuna’s name came up as they were in violation of Canyon County’s new ordinance, since they are a dual county municipality. Here is a link to the meeting notes, I do not know the outcome. Pages 5,6,7 http://www.healthandwelfare.idaho.gov/_Rainbow/Documents/medical/emsac_09_25_03.pdf

  8. 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.

  9. I’m surprised that the county has not done a better job of researching the law prior to trying to pass this ordinance.

    Not only do cities have the power to provide their own emergency services, exclusive of county control, but fire districts may be out of reach of the county also. i.e.

    “31-1416. FIRE PROTECTION DISTRICTS ARE GOVERNMENTAL SUBDIVISIONS OF IDAHO AND BODIES POLITIC AND CORPORATE. Every fire protection district upon being organized as provided by this chapter shall be a governmental subdivision of the state of Idaho and a body politic and corporate, and as such has the power specified in this chapter. Its powers can be exercised only by the fire protection board or by agents and officers acting under their authority, or authority of law.”

    If our elected officials were truly interested in comprehensive, effcient, effective emergency services, they would lay down their egos! The fire departments are in some ways “a resource without a mission and EMS has a mission without sufficient resources”.

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

  10. “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.

  11. Efficiency???
    Dec 13, 2006, 11:08 am

    Tam – The facts do speak for themselves.
    The following testimony was provided to the, “Ada County Blue Ribbon Task Force” in 2004. The numbers may be slightly different because it has been almost three years.

    System cost

    ACEMS vs. Fire-based (Consolidated)

    1 Paramedic vs. 1 Dual-role FF/Paramedic
    $28,500 starting sal. vs.$ 0 salary
    $ 8,835 benefits (31%)vs.$ 4500 Paramedic Pay
    $ 0 additional benefits

    $ 37,335 / 4,500 = 8.29
    Without even considering vehicle and station costs, you can put 8 dual role firefighter paramedics in service for the price of one Ada County Paramedic. This savings is realized because the fire employee already exists and the salary is already paid for by the fire departments. By utilizing this personnel resource, that the taxpayers have already paid for, you get the most out of their investment.

    This type of fiscal and operational efficiency is one of the reasons that the following recommendations were made by the County’s own, “Blue Ribbon Task Force”.

    1. Unified Agency, 2. Mixed Sytem (Ambulance & Fire Paramedics), 7. Co-location of facilities, 8. Increased Utilization of Advanced Firefighter Skills, 9. Single Training Program, 13. Review of Structure (ACEMS being top-heavy).

    Interesting side note:
    Recommendation fifteen was for Ada County to remove itself from the regulation of private ambulance in Ada County.

    Croaker– it certainly would be best for all of the fire agencies to consolidate but let us not forget; it is not the fire agencies having funding problems and proposing an invasive and divisive ordinance. The County should take the lead in reaching out to all jurisdictions within its boundaries capturing efficiencies that they have been offered. Blaming it on the fire agencies is a cop-out.

  12. 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.

  13. I see it is the old “they are waiting to be engaged” so let’s not count their salary. The bottom line is Fire Services aren’t free and for constant manning, I can’t see the fire department just leaving be with the staff they have on hand to handle every medical call without assistance.

    I know why George and the IAFF want EMS within the fire service. It isn’t because it’s cheaper.

  14. 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!

  15. Tam AKA the “voice of Reason”! You, me and the Fire union (IAFF) know why they want EMS…. so they can continue the propogation of the Fire mission which they have all but put themselves out of business on.

    The issue isn’t about the Fire Dept however and we have digressed, but it’s hard to understand one without knowing the other. Fire should take care of Fire and EMS should take care of EMS. It’s done that way in a lot of places because Fire really doesn’t want to do medicine when you get down to the hard brass tacks. Read EMS magazine’s web site and their are a few honest FF’s out their that break ranks and say it loud and proud. I respect that. It’s marketing the profession, achieving another bargaining chip come contract time and being the only game in town and driving a red truck.

    ACP is trying to secure the future of the most widely used public service in the county which is EMS …. 20,000 times or more by the end of this year. Right now of the 30+ million dollar budget that BFD has they run statistically 30% fire calls and 70% medical calls on paper. Of their 30% fire calls exclude automatic false alarms and then tell me how many working structure fires they had that actually used water…. and this year they have had the most in a long time. It’s still far less than 1% out of what will be about 17000 calls for BFD for 2006. In fact I’d be surprised if they had 25 actual structure fires this year. If you took their entire budget you could easily pay to rebuild every house that burned to the ground and still have money left over.

    If you want to dissolve the Fire Depts and put that money into EMS hey, I’m all for it. Saving lives anymore isn’t about pulling people from burning buildings, it’s about showing up, knowing how to treat their Inferior wall myocardial infarction with Right sided ventricular involvement and when to give vasodilatory medications as well as knowing how to maintain hemodynamic homeostasis with low ventricular output so as to maintain coronary perfusion while minimizing myocardial oxygen demand. This is what we’re talking about and ACP is the best way to ensure that AND make sure others do as well.

  16. 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.

  17. Jason, you clearly have an ego problem.

    Blue Ribbon Task Force recommendation number 13 was a review of the structure of ACEMS. It speaks specifically to ACEMS being top heavy.

    I can’t speak for the fire department but your emotionally charged comments about the fire departments seem short-sighted and innacurrate.

  18. 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;)

  19. Mr. Efficiency or whatever…. it always seems that rebuttle in a competent manner directs shots towards “Ego”. The Blue Ribbon Task Force was a joke and nothing more. It was a mechanism of delay for EMS and time wasted that could have been spent in other ways improving daily life for the field crews.

    In the end, the Blue Ribbon Task force could agree that they couldn’t agree. Also the Chairperson of that esteemed group did an about face at a public hearing as I recall. Made him look confused… poor guy. I hope his buisiness does better than he did for his employees’ sake. Good day “Mr. Efficiency”.

  20. 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?

  21. Oh Jason…your arrogance is only surpassed by your ignorance. Does the term “exposures” mean anything to you? I’m guessing not since you tested for King County FIRE several years ago, and were passed over for a more qualified candidate. If you had been hired by a FIRE DEPT in that particular county, perhaps you would be more familiar with this concept of exposures. Since you are not I will attempt to enlighten you. The term exposures roughly translates into the practice of limiting fire spread to the property of origin.

    In other words what you failed to consider during your ludicrous comments regarding BFD’s budget… is the fact that for most single homes that are, “burned to the ground”, in reality the entire neighborhood was most likely saved from total destruction…and please for God’s sake spare us all your rantings about pathophysiology and pharmacodynamics. I’m sure this will come as a shock to you…but you are not the only paramedic in the valley that is knowlageable about such things simply because of the patch on your sleeve.

    Besides no matter how hard you wish or try will NEVER be a cardiologist or Dexter Hunt so stop trying its so annoying to listen to.

  22. 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?

  23. I love it when the firefighters’ wives begin to play defense. Anything that puts those OT checks in jeopardy will bring out the wives. Too funny. Dot, thou doth protest too much!

  24. 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.

  25. Tam that’s too funny…you have absolutely no clue who I am or what I am…and that’s just making this even funner…;-)

  26. 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.

  27. There is an easy solution to budget problems eliminate ACEMS and allow a private ambulance to take over – They will even pay for Paramedics to be on the fire trucks and collect revenue strictly from patient transports. I highly doubt the Fire departments really want to get in the business of 9-1-1 taxi drivers.

  28. 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.

  29. I forgot one final component of quality EMS…better resource deployment- ALS AND BLS (and thus avoiding paramedic over saturation and skill degradation). This topic needs to be discussed in extensive detail by all parties after the ordinance too.

  30. 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.

  31. I’m saddened to see that Ada County’s proposed EMS ordinance has now (re-)ignited a firestorm of antagonism between local fire and EMS providers.

    As a member of this community, I value and appreciate all of you and what you do, whether you consider yourselves primarily medics or firefighters. Thanks to all of you, this a safer place to live and raise our children.

    It is my hope that all of you will take a couple of steps back and regroup for a little while, before irreparable damage is done to the sometimes tenuous relationship that already exists between fire and EMS. Does anyone “win” by continuing these attacks on each other?

    It might be the time for you to be the example for your administrators to follow. How about coming to the table and having a constructive discussion about how the proposed ordinance itself can be improved? A seamless EMS delivery system is a worthy goal. Do any of you have any constructive suggestions for changes that could be made to the proposed ordinance that will help make it acceptable to everyone affected by it?

    Let’s go one step further: I CHALLENGE all of you to work out language for a new Ada County ambulance service ordinance that is acceptable to all seven fire districts and Ada County EMS. Even better would be to make the private providers happy too. I believe it can be done and those of you who care so passionately about this situation are just the people to make it happen. How about it?

  32. 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.

  33. Well Jason we finally seem to have found some common ground. It would be impossible to even attempt to quantify the number of human beings that have had their lives literally saved…if not at least greatly improved, simply due to the fact that certain incredible individules were in the right place in the world with regard to the space/time continuum. I do regret in my last comment that I failed to also mention some of these people, the likes of: Doug Jay, Jim Limeux, Phil Norris, Randal Feaster, Barb and the late Bob Jackson(my sincerest apologies for missing the others). Those that were fortunate enough to have worked with these folks and learned from them, no doubt knew they were in a unique and special position. One thing I do disagree with is the continuous mention of the, “high standards”, ACP’s FTO program allegedly holds its new members to. This was of course very much the case ten years ago and prior. However lets all try to put our egos aside (I know I have one as well) for a moment and be honest with ourselves here…that era is gone and people are being pushed through regardless of their competency or skill level. I’ve seen it first hand from a variety of angles. In response to someone’s (I forget whom) earlier comment about local FD’s having no such program, well that’s just not the case. MFD has such a program and the three FTO’s utilized have 35 plus years of combined experience. They have worked in a variety of EMS systems including ground, air-medical etc, and are highly qualified for the mentoring positoins for which they are appointed. I’m all for a county wide system with a singular medical direction as long as their is a consortium of physicians involved with equal input. 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.

  34. “…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.

  35. What a bunch of whiners!

  36. 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.

  37. “The GUARDIAN suggests that if Kuna and Star wish to pay extra for their own service it would save the Ada EMS a lot of manpower and and expense while providing an increased level of service to residents of those fire districts”.

    This reader suggest that the “Boise Guardian” focus on Boise and not, Kuna and Star.

    EDITOR NOTE–Those districts obviously wish EMS would do the same. Don’t know your point, but brass at both those districts are eager to be heard on the GUARDIAN.

  38. 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.

  39. Croaker hit the nail on the head.

  40. Thomas the tank
    Dec 17, 2006, 7:58 pm

    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.

  41. How often do Boise Fire Medics ride in on ALS transports? I am looking for a rough percentage here. If ACEMS has a EMT/Medic staffing on an ALS call, assuming the EMT is driving the AC medic and a Boise Fire medic in the back does not seem at all like overkill. I don’t know if this is standard procedure or not. Many Fire Depts staff two medics per engine. Also I am not factoring in supervisor response/assistance.

  42. 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.

  43. Jim Lemieux
    Dec 31, 2006, 7:22 pm

    Folks, how about knocking off the personal slams and emotion charged retoric. It will never improve or fix anything.

    I think this whole thing unfortunately is in large partdue to prior Ada County administration…not just the EMS portion, by the way…..who failed to plan/staff EMS appropriately for adequate response times. There have indeed been poor response times, with staffing dictated by numbers of calls more than the potential. Too late to go back now, just go ahead.

    I have seen many EMS systems, from coast to coast, over the years. I truly believe it matters less who (read agency)provides the service than the system design, which should incorporate not only staffing levels, response times, etc, but training, oversight,AND FUNDING etc.

    It seems logical to me that something like the Sheriff’s office does in Eagle, Star, and Kuna could work. The local entity…..could even work in Boise…would provide either some additional funding, or maybe ambulances and 1 person, with the county providing the paramedic. That would help the funding issue, and keep the medics to one set of standards, training, oversight, etc. Has anyone ever seriously looked at this as an option?

    By the way, a single, county wide fire agency would seem to make a lot of sense. Please tell me the real reason why this can’t be done?

    Editor note–Jim, the problem with a county-wide district is that so much of the county has NO PROPERTY TAX BASE. If we had county-wide fire then Boise Stage Stop for example would be entitled to the same fire service as Flying J on Federal way, but there are no neighbors to share the tax burden. This will change with “planned communities” populating every inch of the county.

Get the Guardian by email

Enter your email address: