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Paramedic proposal met with optimism, some concern
By NATALIE MARTIN
A proposal to absorb Vashon’s paramedics into the south King County paramedic system is garnering mixed responses at Vashon Island Fire & Rescue (VIFR).
While many at VIFR say the proposal would address weaknesses in Vashon’s current medical response, some are concerned that the change could mean the island would at times be left without paramedic coverage or that VIFR’s response to other emergencies may be compromised.
“It’s not a perfect system, but I think what they’re planning to do is worth pursuing, and they’ll have to make adjustments as time goes on,” said VIFR Chief Hank Lipe.
The proposed plan was presented to Vashon’s fire board on Tuesday, Aug. 12, and also discussed at a public hearing it called for at 6:30 p.m. Tuesday, Aug. 19, after The Beachcomber’s press deadline. Jim Fogarty, director of King County Medic One, planned to attend that meeting to answer questions.
“This is an issue that’s been around for a long time, and we’re trying to come up with a long-term solution,” Fogarty said in an interview last week.
For years, Medic One, King County’s paramedic program, has contracted with VIFR to provide paramedic services on the island. Vashon’s eight paramedics — highly trained responders who handle the most serious medical emergencies — have the same training and follow the same protocols as those in the rest of the county, but work under Vashon leadership and out of the Vashon station. VIFR receives about $2 million in annual county levy funds to provide the service. The station also uses Vashon levy funds to employ emergency medical technicians (EMTs), who respond to less serious medical emergencies, and firefighters.
In recent years, however, calls for medical emergencies on Vashon have risen, as have medical transports to off-island hospitals.
During a normal transport for a more serious call, considered an Advanced Life Support (ALS) call, one paramedic and one EMT take a patient on the ferry, leaving the island with just one paramedic for about three hours. A second ALS call receives one paramedic and at least one EMT. Officials say the situation isn’t ideal, as studies have shown patient outcomes are better when two paramedics work together at all times. It also isn’t how Medic One operates in the rest of King County, where paramedic teams never split up.
Also considered a weakness in the program is that Vashon’s paramedics respond to far fewer calls than those on the mainland and therefore have fewer opportunities to practice their skills. Several of Vashon’s paramedics have worked on the island for 10 years or more.
“I think that we all are not as sharp,” said paramedic Steve Palmer at last week’s board meeting.
The plan presented at the meeting calls for Vashon’s eight paramedics to be absorbed into south King County’s system of 72 paramedics who work on rotation in areas such as Burien, Kent and Renton. In return, the island would see a changing crew of 80 paramedics. The proposal also calls for paramedics to stay in two-person teams at all times.
“This is a really important step in providing the same level of service that the entire rest of the county gets from paramedics,” Palmer said in an interview.
Leslie Pohl, another paramedic, agreed. She said she is confident in Vashon paramedics’ skills, but she’d like to see more calls, and in some situations, such as a cardiac arrest, it can be challenging to work without another paramedic.
“That in itself is such a huge benefit,” she said of the proposal.
However, some have concerns about what would happen when paramedics do take ALS patients to the hospital, something that happens an average of 2.7 times a week.
Under the current proposal, King County paramedics working off-island would be called to provide backup as soon as Vashon paramedics know they will need to transport a patient. In such a case, either a south King County paramedic supervisor or an aid car based in SeaTac or Renton would head to the Fauntleroy ferry. The proposal also calls for adding a second paramedic supervisor position in south King County to help cover the island, something Fogarty said Medic One has a need for anyway.
Ideally, the supervisor or a paramedic team would be on the island by the time Vashon’s paramedics leave, Fogarty said. And during the late-night hours when the ferry doesn’t run regularly, a supervisor would be stationed on-island to provide backup.
When no off-island paramedics are available as backup, or problems with the ferry prevent them from coming over, the county would rely on helicopters from Airlift Northwest or a boat based at the station in Des Moines to transport paramedics or patients.
Fogarty said the plan may result in more helicopter transports, but Medic One has already made steps to allow paramedics to ride in the sheriff’s office helicopter as well and to certify the Vashon Airport for helicopters to land in bad weather using on-board flight instruments.
“That makes it even less likely that Airlift Northwest couldn’t fly,” he said.
VIFR commissioner Ron Turner said at last week’s meeting that he is skeptical the plan would work well, saying a number of things could go wrong. Off-island paramedics could be occupied on other calls when needed, he said, or ferry problems or bad weather could cause delays.
“There are too many obstacles. We’re at sea,” Turner said. “This is going to end up being a service reduction.”
Myron Hauge, another paramedic who attended the meeting, voiced similar concerns. He said that while he agrees the current system should be improved, he believes the proposed plan may not always work when there is a second ALS call.
“I worry about a lapse in care over here,” he said.
“We’re talking about someone possibly getting hurt or worse,” he later added.
Several VIFR officials, in fact, said the response plan may not work well in some circumstances, but Vashon should still implement it and then make any necessary changes.
“On paper it looks like a reasonable plan. I’m not convinced it’s going to work,” said Mark Brownell, a paramedic and the battalion chief for emergency medical services at VIFR.
While concerns about Vashon’s paramedic response have been raised for years, earlier this year Brownell and Dr. Sam Warren, VIFR’s medical program director, outlined those concerns in a formal letter to King County Medic One, spurring an attempt by both VIFR and Medic One to come up with a better system.
“We raised issues and concerns, and this is a solution to that,” Brownell said. “Do I think the solution is perfect? No. Do I think it is worth trying? I do.”
Brownell and others emphasized that the station already constantly plans its medical responses around off-island transports, ferry problems, helicopter transports and other obstacles. They also pointed out that built into the proposal are reviews at 30, 60 and 90 days.
“The method of providing coverage is still an ongoing dialogue,” said Palmer, who is also president of Vashon’s firefighters union. “I think it’s quite possible that they determine the gaps in coverage are too significant not to come up with (a new) method.”
Fogarty said Medic One would be able to tweak the new response plan after it is put in place, though adding a third paramedic on the island full-time is out of the question. He noted that when the agency added a new paramedic unit based in Enumclaw, it made adjustments every 30 days and took six months to settle on a final operating plan.
“We’re going into this with the approach that maybe we haven’t thought of everything and maybe what looked good on paper isn’t working so well,” Fogarty said.
George Brown, assistant chief of operations at VIFR, said the proposed system would also benefit the station by providing more paramedics that could work on the island. For instance, two of Vashon’s paramedics are currently unable to work, and the remaining paramedics have been putting in long hours to fill in, something Brown said could affect their performance.
“That’s puts them at risk,” he said. “It’s a safety issue.”
Some board members questioned what the change would mean for VIFR’s response to fires as well as its ability to respond to less serious medical emergencies, called Basic Life Support (BLS) calls. Unlike in the rest of King County, Vashon’s paramedics are trained as firefighters. They also respond to BLS calls when EMTs are occupied or extra help may be needed, and they help with training the EMTs as well.
“We’ve still got to put out fires and deal with band aids,” Turner said.
Fogarty, however, said paramedics would still respond to BLS calls when needed. And Brown has been working with Medic One to develop a transition plan that he said would assure EMTs continue to get the proper training and oversight.
“The long and the short of it is this is going to be an improvement of the services to our citizens,” Brown said.
While Lipe said he would miss having paramedics trained as firefighters, he was note concerned. He noted that only one paramedic at a time can go into a fire anyway, and all King County paramedics are trained to perform support jobs at fires. He said thinks other factors such as volunteer firefighter numbers make a greater difference at fires.
“There are a lot of variables in that capacity,” he said.
The paramedic transition, if approved, would be a significant change for the department, Lipe said, and would require reworking VIFR’s annual budget. The department has been getting $2 million a year to provide paramedic services, approximately $1.6 million of which goes to paramedic salaries. The remaining $400,000 has been used to cover overhead involved with managing the paramedic program.
Although he hasn’t planned a new budget yet, Lipe said he doesn’t expect the department would have to seek more local tax money for fire and EMT response. In fact, he hopes that ultimately VIFR could put more resources into training its EMTs, though he is unsure how it will play out.
“I have to adjust the operations side to try to come within budget, and I think we have to have a concerted effort to do that before we can think about going out for more tax money,” he said.
Fogarty called the plan more or less financially neutral for King County, and said that if anything, the county will pay a bit more to make the transition.
“We are trying to respond to their request to improve service, and we think we can,” he said. “If it’s doesn’t seem that way, I’m comfortable leaving things the way they are.”
The fire board is expected to vote on the proposal in early September. If VIFR moves forward, the plan would require final approval by King County Executive Dow Constantine and could be implemented as soon as January of 2015.