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Fire department debates how best to deploy medics

Vashon’s fire department is split over a move that some say would provide better emergency response to Vashon’s farthest reaches and others say would compromise service to the rest of the Island.

For months, Candy McCullough, chair of Vashon Island Fire & Rescue’s board, has pushed VIFR officials to place one of two paramedics, the most skilled emergency responders, at the department’s new residence in Burton during the night.

VIFR currently stations two emergency medical technicians or EMTs at the house, people who are less trained than paramedics but able to respond to non-life-threatening emergencies.

“As far as I’m concerned, if we save one life it’s worth it,” said  McCullough, a longtime VIFR volunteer who who was elected to the board about a year ago.

McCullough and other board members, however, have been unable to convince VIFR officials, who say they think the current EMT response out of Burton is enough for now.

Last week, Chief Hank Lipe, who said he was open to the idea but wanted a medical expert to weigh in, brought a high-ranking official into the discussion. Jim Fogarty, director of the King County EMS program, visited a board meeting last Tuesday and advised against moving a paramedic to Burton.

According to Fogarty, the county-wide emergency response system requires two-person paramedic teams to respond together. Paramedics have worked solo in the past, and the current system has had the best results, Fogarty said at the meeting, which several Islanders, VIFR employees and volunteers attended. In fact, Fogarty said, King County boasts a 52 percent cardiac survival rate — the best in the country.

What’s more, Forgarty said, splitting the paramedics would violate VIFR’s contract with King County EMS, which provides half of the department’s funding, and the county is not likely to renegotiate.

“There’s no better place we can see for that aid unit to be,” Fogarty said.

Dr. Sam Warren, VIFR’s medical program director who is based in Seattle, came to the meeting as well and also advised against the move, explaining that adding a paramedic in Burton wouldn’t change EMT response time, the greatest predictor of survival.

While VIFR officials were pleased with the men’s presentation, at least two board members contend that the county doesn’t understand Vashon and say they will continue to push to see a paramedic placed in Burton at night.

McCullough, who called the presentation “a dog and pony show,” said she’s considering approaching the King County Council next.

“I’m frustrated, and I don’t think I can just let it go,” she said.

Ron Turner, who was reelected last November, said he, too, was “profoundly disappointed” with the meeting and didn’t want to give up on the idea.

“I didn’t hear one good argument for not doing it,” he said. “Should I just roll over and play dead because a couple bureaucrats came over and said you have to do it our way?”

VIFR purchased the Burton residence in 2010, and for about a year the department has stationed two firefighter/EMTs there at most times to provide faster response to Burton, the south end of Vashon and Maury Island. In life-threatening situations, two paid paramedics respond out of the main station in town, usually arriving to the southern parts of Vashon several minutes after the EMTs.

Fogarty came to Tuesday’s meeting armed with the latest statistics on Vashon’s emergency response. A map of calls across the Island over the past three years shows that the vast number of health-related calls come from areas directly surrounding Vashon town, with high numbers of calls also coming from Vashon Community Care and the heath care center two miles south of town.

Another map showed VIFR’s average response times to those areas, with spots closest to town averaging just a few minutes. Many areas on the south end and Maury, however, were marked orange and red, showing average response times longer than 10 and 12 minutes. (See sidebar, next page.)

A computer-generated model, on the other hand, showed that should medics respond from Burton, their response times to the south end and Maury would fall by several minutes.

“By splitting the unit, you’ve virtually eliminated all the red,” noted commissioner David Hoffman at the meeting.

Warren, however, said the situation is more complex that than. Placing a paramedic in Burton, he explained, wouldn’t actually shorten response times because EMTs already respond out of there. Warren said studies have shown that the greatest indicator of survival after a cardiac emergency isn’t paramedic response time but EMT and civilian response. EMTs, he said, are skilled enough to take initial, life-saving steps such as CPR or defibrillation.

The debate was complicated by the fact that paramedics on Vashon operate slightly differently than in the rest of the county, where two-person paramedic teams respond to calls together in an ambulance. On Vashon, paramedics respond in separate aid cars, as one is sometimes needed to transport a patient on the ferry while the other stays behind.

McCullough argued that since Vashon’s paramedics already respond in separate vehicles, placing one medic in Burton wouldn’t be a significant change. Sometimes one paramedic will be out of the station when a call comes in, she noted, placing him or her several minutes ahead of or behind the other.

“We don’t have a medic unit like the rest of the county. We never have,” she said at the meeting.

And while McCullough said she agreed paramedic response time isn’t tied to survival rates, she still believed getting a paramedic to the scene faster would be a benefit in some emergencies on the south end.

“It’s going to improve the level of care,” she said after the meeting. “If someone needs advanced life support (ALS )care, they need it soon, otherwise they don’t need ALS care.”

Warren, however, said providing the southern part of the Island quicker paramedic response would compromise care to the rest of the Island. Since Vashon town and the surrounding areas receive more calls, he said, most often a Burton paramedic would be several minutes behind the other. What’s more, he said, studies have shown paramedics operate best when they’re together as a team.

Moving a paramedic, Warren said, would mean a greater number of life-threatening emergencies would see only one paramedic at first, with another minutes behind. “I think that’s a greater cost,” Warren said.

After the meeting, Lipe and his top assistant, George Brown, both said they agreed with the officials.

“(The system) continues to work, and the data reflects that,” Lipe said. “If it’s not broken, don’t fix it.”

Brown noted that about a third of the Island’s calls are from the south end, and only a fraction of them require paramedic response.

“Why would I want to delay keeping my medics together on most of my calls?” he asked.

Rex Stratton, a commissioner, said the presentation on Tuesday made a lot of sense. More importantly, he added, it’s not the role of the board to direct VIFR’s operations.

“Our job is to set policy,” he said. “The chief and assistant chief determine the best way of providing medical service.”

McCullough and Turner, meanwhile, say they’re considering their next moves. If county officials understood that Vashon’s paramedics already don’t respond together, McCullough said, they might see the advantage of placing a paramedic in Burton at night, which is statistically when most cardiac emergencies occur.

“If we use our resources effectively, we can make it work,” she said.

 

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