I can not believe this is a surprise to Vern and Tibbs. This turf war has been a long time coming.
http://www.boiseweekly.com/boise/double-ems/Content?oid=1044426

Kuna’s decision had more merit than Boise’s reasons for doing the same. I highly doubt transit times will change with Boise taking over that location. In fact, level of service may decrease with that large of area to cover.

I thought the city was broke! Several city departments laid off workers and eliminated positions, but the fire department gets to increase staff to run a service that already exists?

Wow. How big is the chief’s ego?

The fight for control of ADA County EMS started before this, its just stepped up a notch now. Maybe control of Ada County Fire is next?.

EDITOR NOTE– Lisa, you got it right. Boise FD runs the Whitney District and is poised to take over the North Ada FD as well. That will mean Boise provides protection to the “planned community” at Hidden Springs.

I will be posting a comment in the next couple of days. In this expose’-like comment, Boise residents will be extremely surprise at what the ‘Public Servants’ are doing in their behalf.

I’m a 20 year firefighter/paramedic in Southern California, a friend who lives in the area asked for my 2 cents on the issue. I don’t know the players in the Boise area really or the history of services.

I have seen the same type of fights here in California from both sides, ALS and BLS, public and private.

Here the courts have ruled in favor of the existing service provider continuing to keep the service contract, saying that an agency has the right to change “Level of Service” (for example, Fire can offer paramedic service) but they have no legal right to assume a new “Type of Service” (taking over transport and associated revenue stream) UNLESS they had historically provided that service. (I our case prior to July 1st, 1980 with the start of div 2.1 of the EMS act)

Case law can be found searching Apple Valley FPD V. Valley Medical Transport or San Bernardino City V. San Bernardino County and Courtesy Ambulance Service.

Either way I would hope a cooperative solution can be achieved. These cases, while providing considerable legal opinion, ended up costing millions for the agencies concerned and made no remarkable improvement in patient care. They bred animosity between former close friends and agencies and resulted in many families being driven to bankruptcy as they were hired and laid off to meet staffing changes.

Undoubtedly there are impassioned, talented and dedicated people on both sides. You do not come to this profession without those traits. I pray that all involved may find a way to leverage their fundamental desires for excellence and keep this battle from tearing apart lives, careers and friendships that while difficult to measure, are empirically far more valuable and important to the patients, than what color rig shows up.

ANthony ,

Kudos for a very well written, thoughtful reply.
I don’t think the fire side of this debate cares for the relationships, families, or impact to the public that you described. Its all about the “short game” to them.

If you want to save money and fix the problem have the Firefighter’s stop going to all of the medical calls. Its the biggest scam in government. They get their funding based on how many calls they go on, so they have been riding/encroaching on the paramedics turf for years. Do we really need 2 cops, three firefighters, and 2 paramedics to respond to every fender bender victim with a hurt neck? Even if a police officer calls for paramedics and specifically tells dispatch their is no need for fire to respond, It is their policy to come anyways.(Tax dollars well spent)48 hour shifts, pay me to eat, sleep, and workout? Where do I apply?

Clancy,

Your reference to the Boise Weekly “double-ems” is an eye opener. I am an Idaho/Boise tax payer. And frustrated that with the current economic crises, the mayor that was elected by the people/for the people would even think of throwing hundreds of thousands of tax dollars that would be coming from an already tight budget, into a new service that is already given to the citizens of Boise.

As to Mayor Bieter, worry on serving the people that elected you into office and perhaps put our hard earned money into things that need improvement. Not to fight your own personal battles with other politicians.

To the men and women on the ambulances and fire trucks upholding your commitment/services to the citizens… continue the good work. I apologize to you all, it seems you are the ones that have fallen victim. Your services and commitment do not go unnoticed. Perhaps Mayor Bieter can learn from your example.

P.S. The care my sister was given the other day by Ada County Paramedics was outstanding! Why tax more to change that?

So now we will get double taxed and both agencies will complain about the other taking business. Kinda like St. Lukes’s and St. Al’s fighting over $10,000 an outing helicopter flights.

I am not surprised about team Dave doing their own thing. I think you asked the wrong city council memebers. Jim and Vern are the last ones team Dave would include in his strategy sessions.

Double Taxes,, This is what Ada County is still doing in Kuna. I have to pay taxes for a service that has come to Kuna only a handful of times this year. I support Boise Fire in the venture of getting ambulances staffed and in place. Fire-Medics have been around since 1972, Boise is just doing what has been happening around the country for almost 4 decades. Way to go Boise fire for stepping up and bringing it to the plate. I do feel for the Paramedics for Ada County, they are the best part of the service and I love working everyday with them in the field. It’s just sad when the big fish in the water just can not play well with others.

EDITOR NOTE–You are correct about the double taxation. City residents in Boise pay for the sheriff, but he never responds in the city. However you can’t keep him out if he chooses to respond. Can you tell us if Kuna FD makes anything off the service?

Sara,

Boise firefighters work 48 hours on, 96 hours off. The firefighters changed their schedule so they didn’t have to drive to work 8 days a month (save gas/money when it was $4/gallon). This schedule flies in the face of all scientific work studies that indicate shorter work periods are SAFER for employees. Kind of ironic, the ones that are supposed to save you are the ones putting themselves and taxpayers at greater risk and liability. Numerous large-size FD’s work a split schedule of 10’s/14’s. Usually two day shifts of 10 hours, followed by two 14 hour night shifts. Keeps employee fatigue to a minimum. Keeps people safe.

This question to the firefighters/city counsel: Is it safe and reasonable to have a fire department member working on you or your family at hour 47 of their shift…. with no sleep or down time in the previous 47 hours? What if they traded shifts and are pulling a 96 hour shift? Not a good management decision to allow employees to work for 96 hours straight. Lawyers would love a medical malpractice case due to fatigue. The City of Boise would be out millions of dollars in legal and settlement fees. Medical residents have been barred from working extended hours due to medical errors. Should the fire department be held to the same standard, or are their shifts sacred?

The police have an ombudsman… maybe the fire department needs an independent watchdog over them to question their practices and techniques instead of accepting the union voice as gospel!

Sara…I believe that BFD runs a 48/96 shift rotation (48 hrs on, 96 off) that was negotiated by the union. I don’t have anything against unions in the fire service but when a training event (mall shooter) is scheduled for a sunday night at a local mall but it has to be approved by the ff’s union then something is wrong. Either the Chief has no cajones to stand up to the union or he’s all in favor of union approval from being past local president (dot, dot, dot).

Nemo…Thats what ya get from the “New” Chief managing the mayor’s re-election campaign (I guess Doan had some management experience lol). Dave sure didn’t blindly reach down into BFD and picked a engine captain who’s management skills were limited to managing 2 firefighters, bypassing several Deputy Chiefs with much more leadership experience for a new Chief, those dots were already connected and the players involved didn’t even flinch.

Well, obviously I stand corrected on the 24 v 48 hour shifts. I guess the greenness of driving to work less overcomes any objections to a 48 hour shift. That seems like the only “benefit” the City would have gotten from this negotiation of hours.

However, I think everything else I said still stands. The shopping using public rigs and diesel, the training past 5pm etc.

This does beg the question that Bob already asked. If most of their calls are medical and their shifts are 48 hours (or longer with OT) would I, as a citizen, feel ok with relying on an emergency medical provider to provide excellent service knowing that he/she (right, there are a lot of she’s in the fire dept) is maybe at the end of that 48 hour or longer shift which may have been busy and therefore they are not rested? Doubtful.

Honestly, my views on the union are on thing, but every one here should be concerned about three big points of BGs article:

1- BFD replacing an ACP ambulance with their own without any good reason. This is fragmenting a system in the heart of where the system works best.

2- This was done with out any input, advice , consultation with the medical experts in the community,the ones who recieve the patients EMS brings, and has to deal with the consequences of a fragmented EMS system and its impact on patient care.

3. This does increase the tax burdon on the public. Directly or indirectly.

In short I get the impression of a spoiled child throwing a hand grenade in the middle of a room just because hes mad.

Part 1-The questions needing asked. Answers will be forthcoming.
Questions Needing Answered

1) What is the motivating reason behind Boise Fire wanting to do transport? Money? Control? Pt care? Why did they turn down ACEMS recent offer of having 1-BFD Medic ride with 1-ACEMS Medic and gain experience and share in interagency training?
2) Why did Mayor Bieter authorize this without public input or other City Council member’s knowledge?
3) How does Dr Kartel (BFD’s Medical Director) believe that this will enhance Pt care?
4) Given the current economic status, how does Mayor Bieter and Boise Fire justify this action?
5) How does Mayor Bieter think this will benefit Boise City taxpayers?
6) How did Boise Fire obtain their ALS transport license despite a recent law change (SB1108)? How did that new law come about? How does the State of Idaho EMS Bureau Chief, Dia Gainor, feel about giving Boise Fire their ALS transport license?
7) Given the wording of SB1108, how does BFD Chief Dennis Doan believe that they will be ‘better, faster, and cheaper’?
8) Does the fact that Boise Fire PAC giving Mayor Bieter and 3 Council Members large financial contributions have anything to do with this?
http://www.cityofboise.org/Departments/City_Clerk/PDF/CampaignReports/firefighters2007_5.pdf

9) How does the Idaho EMS Physician Commission feel about this? How do other portions of the medical community feel about it?
10) How will this effect current programs in place (i.e. STEMI)? How do the Idaho Cardiologists feel about this?
11) Given the success rate of intubations by Fire Medics, how do anesthesiologists feel about this?
12) Why were local hospitals and physicians not included in this decision?
13) How will this affect ACEMS? If allowed, this FIRST ambulance will eliminate roughly 9 positions for ACEMS personnel (5 of those are women). Roughly 33% of ACEMS is women. Can Boise Fire report the same? Why not?
14) Starting wage: $15.30/hr vs. $17.06. While the argument is made that these persons are ‘dual-role’, they are only filling 1 position on an ambulance-the role of a transport paramedic. Therefore, this argument has no merit. Will they be paid less when on an ambulance?
15) Where is the money coming from to staff the 2 new proposed stations that Boise plans with Federal Stimulus monies?
16) Will this decision negatively impact ACEMS’s community involvement?
17) What is Boise Fire Department’s current budget? What does the average taxpayer pay? How does this compare to ACEMS?
18) Is it true that Boise Fire doesn’t charge for its services? There is ALWAYS a fee for service. Whether its 100% tax based, partially tax based, or completely fee-for-service. So…does Boise Fire charge for its services?
19) Given Pt care and fiscal responsibility, what is in the BEST interests of Boise City residents? How about public involvement on a Fire/EMS commission?
20) Why do ACEMS paramedics charge for their services? Is it reasonable? Do they offer any program to off-set this concern?

Further questions…
21) In 2004, the Boise City Council requested a ‘Study on the Functional Consolidation’ between ACEMS and Boise Fire. What happened to change this attitude?
22) Given their recorded EMS educational hours from 2004-2007, which vary from 2.5% to 17%, how is Boise Fire in any position to offer EMS transport transport services? FYI…all the training ACEMS does is EMS related.
23) While ACEMS personnel appreciate what firemen do best, why is this attitude not given back?
24) Does Boise Fire pad their response numbers with calls they never even go out on? What would ACEMS numbers be if they were to include all false alarms and fires?
25) How many times (daily) do ACEMS personnel cancel Boise Fire response to a call? FYI, that’s because ACEMS get there first.
25) What about saving tax-payer dollars by having a TRUE priority dispatch? The Oregon Trail Fire was an example of this. While virtually all the Firemen in Ada County were fighting that blaze, who took care of the 911 service? Therefore, can monies be saved by limiting the calls that firemen respond to?
26) Can the general public force a consolidation and, thereby, eliminate this problem and wasted tax-payer dollars?

It all boils down to this one thing… We all just need to work together. The proposal made by the County to Boise and Meridian Fire was this: Co-staff ambulances with a Fire medic and an Ada County medic. The County actually offered to contract with the fire departments to pay them for the use of the personnel (fire medics). This is the true win-win situation.

Boise Fire says that they need an ambulance because their medics aren’t getting enough exposure on the engines. Ada County’s proposal would accomplish that and more. The other side of the proposal is the fact that the County would PAY them for the use of the personnel. The City wouldn’t have to spend a dime on ambulances, equipment, added personell, etc. Instead they have thumbed their noses at the proposal and are chosing to go forward with putting an ambulance at the station currently served by medic 57 (Ada County).

Sad part of this is that I have heard that Meridian Fire wants to participate in the proposed cross staffing, but if Boise puts on an ambulance the money that would pay for it (cross staffing) would go with it.

I, personally, was excited to hear about this cross-staffing proposal. I really think that this is the right thing to do for our patients. It gets the fire medics more time with the patients, doesn’t cost them money, and they would be working side by side with a medic from the county as a partner. This would truly take the steam right out of this whole, “who’s the better medic” fiasco we’ve been living with for the past 4-5 years.

We’re all in this profession to help people! Let’s do it together instead of working against eachother!

So, this is what I get from a friend who claims to be in the know.
The fire chief got his appointment, in spite of his lack of degree and credentials, because he and Mayor Dave are personal friends. When he got the chief job he appointed, as his right hand man, the union’s vice president. This is the same union that supported Mayor Dave.
The ambulance thing is all about ego and turf wars, and really has nothing to do with sick people. And, yes, we will be double taxed.
As for Tibbs and Bisterfeld claiming to be unaware, Tibbs would say anything if it made Mayor Dave look bad. And poor old Vern, he might have been at a meeting where all this was duiscussed and just doesn’t remember.

Is it really any surprise that Bieter and the man he appointed Fire Chief are now wanting to be the big ambulance chiefs. I personally am satisfied with things as they are. Maybe the Northenders are pitching a hue and cry. County Comissioners stand your ground and take Bieter and his cronies to the Surpreme Court if you have to. I will not hue and cry about my share of the cost

I would further like to comment on the following statement:
EDITORS NOTE: “…… EVERYONE supports the concept of paramedics on some pumpers, but we find little support for ambulances. No bash on our part.”

I’m certain this is just syntax and the Editor is referring to “everyone” that shares his/her ideology.

I have been doing some medical literature and can not find any “evidenced based medicine” articles that profoundly support the use of paramedics (or advanced life support personnel) on fire engines in a system that uses similar personnel on the ambulances. In fact, there is questionable evidence to whether or not a paramedic needs to respond to every 911 medical call. This forces the question of the usefulness of paramedics on the fire engines and whether or not every ambulance needs a paramedic on board to adequately mitigate the incident.
http://www.usatoday.com/news/health/2005-03-01-ems-cover_x.htm
The article is a few years old but certainly brings up some very good points regarding how tax dollars are best spent.
I just read on the Ada County Paramedics website under their FY2008 report that nearly 20% of their call volume is non-emergent. It would seem appropriate than any additional expansion of the local EMS system (by which ever entity) would be in the form of basic life support EMT ambulances and a review of whether or not all of the current paramedic-level responders are needed. This would include both fire engines and ambulances. I would suspect that an EMT ambulance is a lower cost to staff and equip than a paramedic ambulance. This would hopefully translate to either a tax payer saving or a health care user saving.

EDITOR NOTE–We were trying to make the point that the “principals” in this debate
are not about to complain about having a paramedic vs EMT on a fire truck. There IS disagreement over the issue of BFD entering the transport business. And once again, we don’t bash firemen.

Hello UnTaxMe…..I found these articles to be interesting.

http://www.usatoday.com/news/health/2006-05-21-paramedics_x.htm

http://www.jems.com/news_and_articles/columns/Werfel/The_Two-Medic_Dilemma.html

Can someone please educate me on this link from a previous post. I believe this shows how much each fire union member gave in political contributions. Do I understand this correctly? And….At the bottom of the post, Vern Biterfeldt and Jim Tibbs are NOT listed as recipients of any money. If I am reading this correctly….They don’t get any money….and they don’t get to know plans about the Fire Department? Am I understanding this correctly???

http://www.cityofboise.org/Departments/City_Clerk/PDF/CampaignReports/firefighters2007_5.pdf

EDITOR NOTE– Tibbs is a lame duck councilor. HE ran for mayor and lost against Bieter and as a rule he is not an “insider.” Vern has a heart of gold, but it is easy to slip things past him in massive computer files, memos, consent agendas, and reams of computer generated information–he is a guy that prefers paper when it comes to reading and there isn’t much PAPER generated these days. He also trusts his fellow city councilors and department heads for the most part.

Another point about these so called informational news sources is that there is nobody behind the article. They write whatever they like and don’t even put a name or contact to it.

This article is so one sided and biased that it’s not even worth the power it takes to put it up on your screen.

Get A Clue….you should get one. So far you ave not offered a single peice of data…very unlike most of the other posts here. Your pen name on this blog is very appropriate for you.

Answers-Part 2

RE: Question 1)
This is NOT about Pt care. How so? Fact: Their education and training standards are not up to ACEMS. Fact: There QA/QI process is not even remotely up to ACEMS standards. Fact: While their medics get ‘cleared’ in some 4-5 shifts with another medic, our medics are still in their 6 week orientation class. This does not include several ‘phases’ that a new paramdedic must pass before being allowed to work on their own. Hmmm….which would you like working on you and your family? Fact: Our testing/interview process is so hard that they can’t make it here. Yes, their’s is more physically challenging…and it should be. But we don’t need buff persons to work here. We need highly educated and motivated ones. We don’t want mediocre medics in Ada County. We only want the best medics for the citizens here. This is in the BEST interests of the County residents. FACT: ALL of our training is EMS related, theirs is not. FACT: There have been multiple incidents of poor Pt care on behalf of their medics which, unfortunately, the general populice is unaware. Only our respective administrations, medical directors, and individuals (like myself) are aware. While it is taking great restraint for me not to name names and incidents, know this happens. This issue is also NOT about money. OR…it shouldn’t be. Of the 2008-2009 ACEMS budget ($13,614,496.00), only $4,882,736.00 went to ‘Other Expenses.’ Out of these funds, we have to purchase medications, other supplies, clothing, budget for new ambulances, budget for new stations,and other misc items. All said and done, there is little to no money to be ‘made.’ Take into consideration how many homeless and un-insured persons we pick up. Do we get paid for them? Where does that money come from? Given Boise Fire’s current budget and the difference in starting wages–no, this isn’t about money. IT’S ABOUT CONTROL. Take time to research this yourself and you will find that Boise Fire is slowly taking over everything they can. What they can’t take over, they try to hire out, puchase, or intimidate. Whitney Fire is now gone (independent). NACFR Fire-Soon to be gone. Eagle-likely soon. Mayor/City Council-See question #8. A notable example is when Boise Fire tried unsuccessfully to woo Rural Metro into Boise. This attitude is exactly the reason that the 2006-2008 EMSS district commission failed and Dia Gainor, State of Idaho EMS Bureau Chief pushed for SB1108 (see Boise Weekly comments for Chief Doan’s reply). Boise Fire doesn’t want to ‘play nice.’ Nor do they want to be held accountable to anyone for anything. Some will say this is bashing–IT’S NOT. ALL OF THIS CAN BE VERIFIED. Do yourself a favor and start your own research. Review the other questions that were posed. It’s you, your family, and your friends that will be affected financially and physically.
P.S. Future answers coming.

It was incorrect of me to include Eagle as future expansion of Boise Fire. I seriously doubt this would ever happen. That department does a nice job in taking care of themselves, keeping up on their skills, and getting along.
Also…is it true that Boise Fire is planning on laying off their 12 new recruits after they get out of the academy? Hmmm…..

Clueless…What little “Facts” you have come up with add up to much. Ren Ross and Dennis Doan have both stated that Boise Fire is one of the most progressive fire departments in the country…YOU might want to “Research” that. Apparently you aren’t really informed on the fire service in Idaho, there are some very progressive departments in the state, both career, combination and volunteer departments.
I’m not a big fan of ACEMS due to Troy Haggen’s attempt to take control of all EMS in Ada County then again I’m not a big fan of Dennis Doan and his back room politics with Dave B either. You said BFD has no intention of doubling EMS or Taxing well research this.
1. Cost to place say 6 ALS Fire Based Ambulances in service @ $100K per ambulance (conservative figure).
2. Cost to hire/train 18 FF/PM’s (3 shifts) @ $50K/yr (consevative figure), city contribution to state retirement, liability insurance ect.
Just minimal figures would be close to $1 million for start up costs.
PS: I tried to call Dave, he’s busy

Get-A Clue….May I please ask you a question…
You wrote ‘Idaho is 20 years behind the times’…Please read these two articles (I have recently found more I can reference if you would like) and give me your opinion…..Maybe Boise is not behind the eight ball, but rather has been able to stay ahead of it. Read the articles at these links and explain why the most recent data seems to suggest that Paramedics on Fire Engines is a “bad thing”. Please let me know what I am missing. However, if you refuse to comment on the links, please refrain from writing things like “Idaho is 20 years behind” Thank you.

http://www.usatoday.com/news/health/2006-05-21-paramedics_x.htm

http://www.jems.com/news_and_articles/columns/Werfel/The_Two-Medic_Dilemma.html

Get a clue-

The article written is not one-sided at all. Everything written in that article is FACT and can be verified. What seems to be getting you upset is that the truth did make the Mayor and Chief Doan look bad. The reasoning behind this shoot from the hip reaction was personal and political. There is a better way to handle it then getting mad and throwing your weight around. Maybe they should think about what is best for the Medics that are employed by Ada County and the citizens of Boise. And maybe you should do your research and find out the real reason the Mayor decided and said “How quick can you get them (meaning Ada County) out of my city”. Maybe he should think before he speaks.

I have been reading all the posts and have trying to do a little fact checking of my own…..I have been contacting different city offices for information…AND I have been learning a lot. I do have a question for people here who appear to be “in the know”….The city rep I spoke with could not answer ‘why’ to this question. I was asking about information with regard to the number of 911 calls the city/county responds to each year. The city rep told me for Boise City Fire Department, they count the number of vehicles that respond to the a call. For example, if a fire engine, a fire truck, and a chief all repsond to a 911 call, that is counted as three calls….not one. Am I wrong in thinking that is a way to “pad” the number of calls it appears your department is responding to. Please someone tell me I am misunderstanding many of the things I have been told/hearing/learning. Can anyone shed some light on this?!?!?

Dear City Watch,
Yes you are correct in your interpretation of how the numbers are padded. However, be advised that there is more to it. If fire cancels EMS which does happen, EMS still has a ‘call’ numbered, but not a patient trasport. If the patient calls back and requests an ambulance later in the day/night, that generates another number. Also any call that is to a health care facility is given a FIRE dispatch number, even though no fire truck is dispatched. This means the majority of the time, when EMS is dispatched to an assisted living facility, mental hospital, doctor’s office, medical clinic, dialysis center, nursing home there is a fire number. EMS does frequently have fire dispatched to medical clinics ETC, as listed above when the call sounds as though it may need more hands or help that the facility can provide. This has to do with how dispatch is set up. All EMS calls have to be entered into a fire district, I.E. Boise FD, Meridian FD, North Ada Co. FD, Eagle FD, Star FD, Kuna FD, Whitney FD and my favorite the Other FD (FD being fire district). The people that live in the Other FD are the ones whose houses burn to the ground, because they do not live in a fire taxing district. I do not know if they can opt into or out of a near by Fire District or not. Now that that is all cleared up…….

Sam,

There have been many good facts and points made throughout most of these posts. If you read the comments posted by Work Together, this person brought forth the very same idea that you have suggested (which is a Metro system). Ada County Paramedics offered to work in conjunction with the local Fire Departments to improve care by all paramedics through a joint venture on the ambulances. This venture would reduce personnel and EMS training costs for the Fire Departments and create a step toward a unified Metro system. A true Metro system would require cooperation with all public safety agencies and a consolidation of the administrations. There are currently 7 fire districts, 4 law enforcements agencies (not including troopers), and 1 EMS agency in Ada County. The Treasure Valley is certainly getting large enough to support a Metro system but the concept requires the number of chiefs/directors to be reduced and therefore SHARE power. This is where a major sticking point has occurred. Like you, I am not native to this area and have been blown away by the good ole boy politics which ignores their constituents wishes. I do not know a single person that has contacted his/her elected official and stated that he/she wants taxes raised. On the contrary, ALL elected or appointed officials should be diligently looking for ways to decrease costs and save tax payer dollars. If government agencies were required to run more like a business, they would certainly be more diligent about watching every dollars and constantly looking for ways to do more with less.

I am saddened to see a good EMS system with the high number of experienced paramedics being torn apart based SOLELY on politics. In all of the information I have researched, read or am aware of, there is not one shred of consideration by BFD or Mayor Beiter in regards to patient care. This so unfortunate as the patient is the one who will lose in the end. As a patient advocate, I am squarely AGAINST any changes to a system that will decrease the quality of the care received. The patient is the one footing this bill in two ways, through taxes and the bill for service.

Sam,

Our department and director believe a SINGLE SYSTEM approach is what is desired, and contrary to the other sides opionon, this is what was being attempted with the EMS ord. issue a few years back, a SYSTEMS approach, like they have in Seattle. One true set of protocols, one QA, one charting system, one Medicial director …it had nothign to do with “control”, only making sure we were all held to the same standard medically…and worked togther. SOmehow this was offensive to the FD.

Unfortunately, the FDs wont go for a single county wide Fire-EMS agency. Their (well stated) idea of the perfect EMS system is a fragmented system, with each FD does their own transport. This is the “solution” they offered the Blue Ribbon Task Force some years ago.
When ever you mention consolidation, the FDs only believe that should be breaking up ACP and splliting the revenues among the FD, not true Consolidation.

SO I agree that we should be able to do it, but the FDs wont.

And BTW, LAFD cardiac arrest survival rate and intubation rate is one of the worst in the country… LAFD is a great example of how NOT to do an EMS system in many ways, but that said, I agree with the heart of your point. Seattle/King County Medic One better illustrates what you , and “we” desire….IMHO

To Get a clue: You state “they write whatever they like and don’t even put a name or contact on it.”
Is “Get a Clue” truly your name? Then you call people out on not using spell check. Spell check doesn’t pick up grammatical errors. Exactly what does “The hard part is that they a hidden” mean? I assume it was meant to read that they are hidden. “Than you” should be then you. “Than your wrong” should be then you’re wrong. Darn that old spell check and darn you people for offending Get a Clue with your poor writing skills.

I apologize for continually asking people for a little education, however I am finding I did not know as much as I thought I did about a 911 system.

Question 1. Bill Nye…you wrote “Also any call that is to a health care facility is given a FIRE dispatch number, even though no fire truck is not dispatched.” Why does a fire engine respond to a persons home, but not to any of these facilities…and, if Boise Fire Department adds an ambulance…will they start to respond to them….there are a few of those types of facilities in the proposed coverage area of a Boise Fire Department Ambulance… 🙂

Question 2. Mr. Turner…I believe you bring up an interesting point!! Has there never been any type of proposed merger/cooperative agreement to have a city/county wide system…and if so, why not? And Mr Turner, do you know how the taxing system is set up in areas like the ones you mentioned?

Question 3. – I thought Mr. Turner brought up an interesting point. I contacted LA County Office of Emergency Management. I spoke with some public relations representative (I was not expecting to speak with the director, so I understand any information I received was very general) and they told me there are some systems which operate under different medical orders…..what does that mean?

I appreciate the people on this forum taking the time to educate me. It seems that people here know more than the actual city/county agencies I contact.

Thank you in advance.

Nemo…You have any hard facts to back up your statement about LAFD?, I’ed like to see something on that. I’m sure LACO Paramedics don’t measure up to You and your ACEMS Standards but on your comment I have to call BS. I know from past issues you’re not hip on ANY Fire Agency doing ALS.

CW,
Answer to #1: BFD does not respond (or most other fire agencies for that matter) because these agencies already have medical staff on location (i.e. a Nurse, Doctor, PA, etc).

Answer to #2: I think this has already been answered

Answer to #3: LAFD and the system it works in is actually very fragmented. This has been discussed in some of the studies on their intubation success rates.

Not to be disrespectful , but why so hung up on LAFD. Austin travis County, Boston EMS, and the Seattle KIng COunty Systems are all far better EMS systems to study from a pure patient care point of view.

Wow, let the games begin…..again. Just to clarify, if three BFD resources respond to a call, ie, engine, truck, BC, etc, it DOES NOT count as three calls. They, all of the units that respond to the same incident, receive the same incident number. For example, if 7 resources respond to a building fire, and that incident is assigned, lets say, incident number 202, than all seven of those resources are assigned incident number 202, not incident 202, 203, 204, 205, 206, etc.

One other thing. I have read much debate on the 48/96 schedule from the well informed, and how bad it is for those receiving care from those that are on the last of their shift. I believe the majority of the crews on the Oregon Trail Fire were on the last half of their 48, and if I remember correctly, they all, along with PD performed very admirably.

WOW it does not count as another call, but the numbers MOST often cited by Fire Departments are response numbers which are always higher than the number of calls for the year. EMS always has MORE call #’s than any of the FD’s but Boise has more response #’s because they count each vehicle going when they report response numbers. Incident #’s are far less than response #’s. I some how doubt that the FD’s go back through and deduct all of the medical calls that are to the medical centers that Fire does not respond to and subtract that number from their calls. Neither does EMS I suspect if they are canceled prior by fire prior to arriving on scene.

Lisa..you seem to know a lot about this subject (I will assume you research quite a bit along with family members in the industry). I was hoping you could answer three quick questions for me.

1. Your financial estimates for starting an ambulance service were very interesting! Would a fire department have to raise taxes or start to bill for a servive if they start an ambulance?

2. I have been trying to educate myself on this subject, and thanks to Mark, I now know what medical orders are. I found Ada County Paramedics medical orders online. I have not been able to find Boise Fire Department’s. Do you know where I could find them? After reviewing the orders of Ada County, I can’ imagine “filling in” when a paramedic is needed like your Brother. I don’t mean any disrespect with that comment (truely)! Does he find it hard to “fill in”, or are his medical orders different. What would their take be on all this?

3. After reviewing the medical orders online of Ada County Paramedics (not understanding all the terms…lol) I find that this discussion does need to involve more than just taxes….there does need to be a discussion on medical ability as well. Do you agree?

Thank you.

It appears an earlier post of mine did not go through…Here it is again. BG, please feel free to not post if you posted my earlier, identical one…
Lisa,

I think you misunderstand me seriously. You can break down my opposition to Fire based EMS into two issues. When you understand those issues you will see its not opposition to Fire based EMS, its opposition to characteristics that Fire Based EMS seems to most often demonstrate, if you can appreciate the difference. . I am equally opposed to those characteristics in ANY model of EMS provided.

First, attitude toward EMS. Second: Deployment of paramedics in an EMS system (ALS First response). Both of these have been discussed extensively.

A GREAT overview of that debate is HERE:
http://www.emsnetwork.org/artman2/publish/article_28849.shtml

But all of this is not new to these boards.

I promise you LISA, If there was a County Wide EMS system, that embraced the “high acuity” approach (ACP..locally… is closer to this than anyone else currently but not perfect), even if it was a fire based systems, I would by everyone on this board a round at Old Chicago, including you Lisa. I would party up and shout to the heavens…FINALLY!!!!

TO answer your questions on evidence for LAFD:

Out-of-hospital pediatric airway management
Annals of Emergency Medicine, Volume 44, Issue 2, Pages 181-182
M.Eckstein

Regional Variation in out of hospital cardiac arrest incidence and outcome , JAMA. 2008 Sep 24;300(12):1423-31

And then there is this discussion as well:
http://www.emsonline.net/tuesday.asp?date=12-08&whichVid=TS_12-08_Eisenberg_Cardiac.flv

Please, Lisa, watch the entire video. Notice that the most important things in the first 4-6 minutes isn’t Paramedics, but EMTs doing CPR with an AED (a defibrillator used by EMTs not Paramedics). Not to say that paramedics are not important, but not in the first 4-6 minutes. (So why run paramedic engines? Hmmmmm……)Also please note the “frame of accountability”. This is where most systems, including fire based systems, including BFD, LAFD, and many many others…are short on.

Honestly, if you really wanted to affect patient care, you would simply equip EVERY cop car with AEDs, Every cop would be CPR trained and dispatched with ECHO responses. And you could do that COUNTY WIDE for the cost of the two or three ambulances that BFD wants to add. So why are we wasting taxpayer money on replacing an existing ACP ambulance with a BFD ambulance in the exact same spot??? make I might add, at the expense of ACP. A system with over 36% arrest save rate. Compared to LAFDs rate of 7%.
Lets spend that $$ better perhaps?

Cyclops,

You are correct. The other issues just make the average joe public eye cross, unfortunately.

BG,

I know you normally don’t post full replies on here, saving your opinion to the articles, but what is your take on these “meetings”. Especially since they are “one on One”. Sounds fishy to me.

EDITOR NOTE–“Briefing” is probably a better term. Probably fair to say there is some damage control being undertaken in the area of public relations. Council has NOT done anything we can find with regard to AMBULANCE service and they do need to address it in a public forum.

Where have our elected officials taken us? They are allowing a massive waste of resources go by the wayside and yet no one cries out in dismay.

Having been in EMS since Johnny and Roy and having worked in every model known in the US (fire-based, private, public utility model, failsafe franchise, third service, and even law enforcement based) and in a variety of positions from EMT on up – they all have their weaknesses and strengths, and there are good examples and bad examples for each.

Neither Boise FD nor Ada County has proven their case. From what I have seen – it is questionable whether BFD meets or exceeds NFPA response time standards, and frankly ACEMS stopped publicly distributing their annual operations reports because they proved how mediocre they were. Whatever solution is determined to be the best situation for the community, by the community – the prevailing agency must be held accountable – a.k.a. a $2 million dollar performance bond for breach of contract, $10 per minute over the response time requirement, etc. This way they know we are serious about the level of service, care, and caring is received. Enough of the back room deals that leave the taxpayers holding the tab for duplication of services via taxing districts, and pretty hefty ambulance bills in addition.

This should be a call for our elected leaders to seek national expertise and fix our very expensive, very fragmented non-system. We are wasting huge amounts of money that could be better managed to save lives. I have been through similar crises in other communities – and the best end result has always favored the street level paramedics and left a few Directors/Chiefs drinking their blues away with their brethren at AIG and WaMu. “They aren’t getting it” – and if the Chrysler and GM of EMS in Boise don’t get it figured out – the leaders should be sent on their way and fresh blood be brought in.

My t.c.w.

Nemo, historically, one on one’s are not designed for input. They are geared more toward “here is what we have decided and you need to get on board” type conversations. The result of an “elitist” attitude.
Lisa,you are coming across as an exceptionally informed and intelligent person. Thank you for the background.I believe it is exactly what is needed to open some eyes. I share your desired outcome of this debacle.

Holy smoke, Dave. You have some really smart and informed readers. I mostly have no idea what anyone is talking about but was amazed anyway. You have created something with a life of its own. Good for you.

BG – thank you for the update….do you know if these meetings are going to be open to the public…why or why not? Also…based on the “under the radar” meetins/proposals…do you think the meetings should be open…is there a way/place/person we as the public can contact at city hall to put in requests for the meetings to be open…

EDITOR NOTE– We just talked to another newsie who tells us the county (Commish Sharon) is proposing a joint city/county public meeting in the North End to get it before those who will be most affected. No word on time, date or “IF.”

Thank You.

I think a Metro System in Ada County wouldn’t work for numerous reasons.

1. Who would be in charge?. sure all participants would be represented on a board or commission but the Big Dogs of the pack would be calling all the shots hence the lower food chain would jump ship and go it on their own. Back to the Turf Wars.
2. Who would pay what percentage of a Metro System?. Somebody no matter what will fell they’re getting the short end of the stick and jump ship.
3. Too many players involved with a Metro System. Who will write the Medical Directives?…Gonna have some Pissed Off Docs. This probem goes from the elected people (and their minions), Fire Chiefs, Medical Directors, Emergency Managers.
4. Bottom linwe is that a Metro System wouldn’t work because in Ada County Politicos, Chiefs, Managers, those who think they’re in charge of something but aren’t, can’t share a ham sandwich let alone work together for the good of the public.

Mike…Its MS not BS, Master of Science Degree, duel degrees actually Nursing and Business. Politics? no thanks I co-own a very profitable business that deals in emergency services.

Fire Does well to pad their stats when it comes to calls run. How do you explain that when Ada County is dispatched to a medical facility and no fire truck/engine is dispatched that they still generate a call number, hence showing another call run when they never leave their station?

On Channel 2 last night D. Doan stated that he wants to shorten response times by adding an ambulance. As “City Watch” noted how will is decrease times if that new ambulance would be placed in the same station that currently has an ambulance running out of it??? And his comment about wantintg to work with Ada County? Again if that were true Boise Fire would have accepted Ada Counties offer to work and train together. Meridian Fire thought it was a great offer and loved the idea. They realize out there how important it is to work together and get transport experience to their medics because often times most of the pt care is done enroute to the hospital, not on scene. If Fire based ambulances being added to an area already wel covered by a top notch service is such a good idea then why is Meridian Fire not interested in it??? Maybe D. Doan should answer that question.
The most confusing issue though is how from the same station already staffed with an ambulance, that Boise fire can get to calls faster than Ada County currently does. Maybe they will have turbos in their ambulance 😉

CW,

To answer your question #2, the proposal was not a simple collaborative agreement, but would have even PAID HARD CASH for BFD to participate, helping to pay the wages of 3-6 BFD positions to boot, and provide experience for the BFD medics who are getting very little, and hopefully ease the tensions between ACP and BFD by getting to know each other more.
While it is a win win..(we still get 3-6 positions filled)BFD and to a lesser extent Meridian FD definitely would have gotten the better end of the deal.

Considering other FDs are laying off people, you would think that they would want the extra job security this offer would bring…
I think we all can guess the underlying reasons for their refusal to cooperate.

Good job, Dave. I think your original story caused the Channel 2 story. Although their reporter is obviously an amature, the story will get more people talking. This whole thing is B.S., back-door politics. If we had a city manager, and did a national search for a fire chief, none of this would happen.
Where else but Idaho can someone be appointed to a $100K in charge of a $30 million budget job with no degree, simply because the mayor is their friend? Well, New Jersey, I guess.

CityWatch,
I certainly don’t have all the answers and I’m as perplexed by the Boise Fire Department philosophy as you. As far as your point #1: I understand that State Law changed this past year which requires an agency/corporation, etc to prove a NEED for additional EMS services to a geographical location instead of a WANT. The BFD no doubt was aware of this pending legislation and submitted an EMS advanced life support transport license prior to the final passage of this law. In order to have this license approved, they need an ambulance – so the fable of the response times, etc is just a cover of the true motive of power and want. In addition, the 9 minute response time is a benchmark time that EMS services compare/measure themselves to. It was derived primarily from the study of cardiac arrests and therefore really bares not meaning other than a benchmark response time. Many national agencies have adopted this as a “standard.” Also in this standard is a basic life support recommendation of 5 minutes – again from cardiac arrest studies. The Boise Fire Department is the BLS responder (even when they have a paramedic on board) and therefore have a goal that is different from the ambulance service. Therefore, the Boise Fire Department is supposed to arrive within 5 minutes and Ada County within 9 minutes – a tiered response. Ada County does list the response time numbers for each agency on their website.
#2. I’m not sure the chief wants to cooperate with anyone at this point. It does sound like he has not consulted with either major hospital, neighborhood associations, emergency physician groups, City Council, and certainly not Ada County. Again, the entire philosophy of more and more paramedics has been studied and is not the answer to better pre-hospital care – not with the City, not with the County.

In addition, maybe someone can answer a few questions I have:
1. If the City does take over in the northend, what will they charge?? I would like to know their ambulance fee schedule and who will do their billing? I pay a fraction of my property taxes to the ambulance district compared to Boise Fire – why should they charge anything?
2. Dual – role personnel – fire fighter / paramedics.?? Can they do both jobs simultaneously? It makes no sense at all. If a person is assigned to an ambulance, that is his/her job for the day, the same with the fire truck. I think what you are left with here is a an overstaffing of paramedics which is expensive in initial training and continuing education. This eventually leads to fewer patient contacts, fewer patient assessments, fewer critical paramedics skills per paramedic that leads to poor quality pre-hospital health care providers and more expensive for tax payers to maintain in the long term.

The Boise Fire Department is wasting tax dollars on this venture, fragmenting an ambulance system, and potentially placing the innocent public at risk.

PS: BFD’s Ambulance Licence was held up until more staffing level and other data could be obtained and verified, according to the state ems board.

Lisa,
My job doesnt hinge on either Ada County or Boise City- or any other Fire / EMS agency. I have my biases but I try to look at the issue objectively and here is my two cents regarding your last posting.

As both the County EMS Director and the City Fire Chief are both appointed positions, if their bosses told them to work something out, I”m certain simple scheduling would be the least of the worries. However, because of overtime and tax purposes, the firemen can work 52 hours w/out being paid overtime and the paramedics can work 40. So, yes, there would be some logistics but a metro based system with mostly single role and a few select multi-role personnel should be easy to manage.

I don’t think medicine would suffer in a single role metro system with cohesive medical direction, quality assurance and a demonstrated need for change. Ada County employs physicians from both major emergency physician groups (St.Lukes – EMI, St.Als IEP) to be certain that medical needs are being met from both hospitals perspectives. This could continue in a larger metro system.

I believe the creation of an emergency medical services system was the undertone of the prior ems litigation that failed against Kuna. The law suit was initiated in order to avoid exactly what we have right now – people wanting an ambulance license just because.

As far as fire peeps not coming on here smacking down EMS types – I think you should read “Get a Clues” posting. I think EMS has a legitimate gripe on this occasion and I would be offended too. The fire chief and his cronies started this mess and certainly have NOT been a solution to anything!

In closing, I would like to say that the Chief and EMS Director probably have both the citizens and their department personnel in mind. I would look at elected officials to place the blame.

I’ve talked to both sides of the issue.
Off the record Dennis Doan said that the only net benefit would be saving administrative costs. But, he forgets that Boise Fire only added paramedics or EMTs (Brandon correct me on this one) a year ago. The duplication of administration is on Boise Fire’s side. The Bieter Council needs to be replaced for this and their other power grabs.

Answers-Part 2

RE: Questions 4-7, 9-12, 15, and 21…

The answers required can only come from specified individuals. Speculation has no merit in this discussion. If, indeed, a public meeting is scheduled with the Boise City Council over this matter, it is my suggestion that those named individuals be present (or a representative from their department) to give valuable testimony.

TO THE EDITOR:

When and where are the public meeting(s) going to held? This would very informative to the general public. Thank you.

EDITOR NOTE– All we got from a councilor was, “soon.”

I just wonder if Vern Bisterfeldt and Jim Tibbs will object to the awarding of the bid for a new ambulance? They should since the issue for buying one has never been discussed with them in the first place….they claim. Talk about arrogance on the part of Team Dave. I think it is time for a new Mayor.

I have a great photo to share. It consists of a BFD ladder truck, BFD engine, and BFD Batallion Chief vehicle (and the 10-12 personnel that they sleep) parked at Edwards 21 last week for a couple of hours (of course, while ON DUTY) so that all the tax-funded heroes could play sand volleyball. Here are a couple of things to ponder:
1) Were all these vehicles in their response areas? If so, need I say more about waste?
2) If someone twists an ankle during this beach festival, will the taxpayers pay work comp until they are back to duty? Of course, this is the fire union, dummy!
3) What is the cost for fuel to run these vehicles around to local recreation spots and grocery stores? Should we be paying for it?
4) What is the cost for personnel per hour of beach volleyball? Hint: its the fire union, dummy! These are some of the highest-paid and most benefit-rich jobs in the WORLD.

We currently enjoy outstanding EMS at a reasonable rate. We are fortunate to have medics who devote all of their time and talents to our medical needs (not the 10% of training time that the FD currently devotes to medical training).
As far as fee-for-service, I am all for it. I currently pay less than $80 per year for ACEMS. I have never used an ambulance and don’t anticipate the need anytime soon. However, I want to know that the best-trained people will arrive should I need to call.
In contrast, my fire taxes are approximately $800 per year. I have never used their services and also don’t anticipate the need anytime soon. No matter, I am still paying out the nose every year. Why? It’s the fire union, dummy!
I guess we are all dummies, as this attempt to fragment and duplicate the EMS service has reared its head in virtually every possible political venue in this state over the past 10 years. A great deal of tax money has already been spent to scheme and study this issue. It seemed that nobody noticed or cared, perhaps until now. Now is the time to let Mayors and Fire Chiefs know that we don’t intend to fund their endless quest for money and power and we refuse to let our EMS system become its latest victim!