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Fire board approves change to island emergency medical system

Vashon’s fire district will move forward with a plan to incorporate its paramedic program into the south King County emergency medical system, a transition that could happen as soon as January of next year.

The board of Vashon Island Fire & Rescue voted on Tuesday, Aug. 19, to go ahead with the plan, which will absorb Vashon’s eight paramedics into the south King County Medic One program. Many say they expect the move will improve island response to serious medical emergencies by providing Vashon paramedics more experience in busy south King County.

In return, Vashon will no longer contract with King County Medic One, the county’s paramedic program, to provide paramedic services on Vashon. It will instead see a rotating crew of south King County paramedics, and two-paramedic teams will no longer split up, a practice that’s also considered a weakness in Vashon’s current program.

“I applaud you. It’s a tough decision to make, but it’s an important one,” said John Herbert, chief of King County Medic One, at Tuesday’s meeting after the board voted.

Several people at the meeting from both VIFR and King County said there is still some question over how paramedics under the new system will respond to second calls on Vashon. However, they still called the new plan an improvement over Vashon’s current system and said would spend the following months attempting to work out some of the details.

“We have time to collectively work on those challenges,” said Hank Lipe, chief of VIFR, who noted he will also consider in the coming months how to reorganize the fire department in light of the new paramedic system.

“It’s not a perfect plan, but it’s hard in emergency medicine to plan for everything because it’s the nature of the job,” said Mark Brownell, a paramedic and the battalion chief for emergency medical services at VIFR.

Officials with VIFR and King County Medic One have been considering the move since earlier this year, when Brownell and Dr. Sam Warren, VIFR’s medical program director, outlined their concerns about Vashon’s current paramedic program in a formal letter to King County. They said they believed Vashon’s paramedics would benefit from responding to a greater number of emergencies. What’s more, they said the program would be stronger if it followed Medic One’s model in which two-paramedic teams stay together. While studies have shown patient outcomes are better when two paramedics work together the entire time, Vashon’s paramedics currently split up when one paramedic is required to take a patient on the ferry or one must respond to another serious medical emergency, considered an Advanced Life Support (ALS) call.

“Many smart folks before us have looked at this,” said Jim Fogarty, director of Medic One, referring to past attempts by Medic One to craft a new plan for paramedic response on Vashon. Fogarty said past proposals haven’t seemed financially feasible.

This time, however, officials with both Medic One and VIFR agree that Vashon should give up its $2 million annual contract to provide paramedic services on the island and instead become part of south King County’s Medic One program. VIFR will continue to employ emergency medical technicians (EMTs), who respond to less serious medical emergencies, and firefighters, positions that are funded through the district’s local levy.

Some VIFR staff have expressed concern, however, that the proposed system could at times compromise Vashon’s response to emergencies.

When paramedics take ALS patients on the ferry, something that happens an average of nearly three times per week, Medic One will rely on off-island paramedics to provide backup on Vashon. Under the proposal, either a paramedic supervisor or a two-paramedic team will head to Fauntleroy the ferry as soon as Vashon paramedics know that a patient will be transported. Should off-island paramedics be unavailable, or should ferry problems cause delays, the county may rely on helicopters or the sheriff’s office’s boat stationed in Des Moines to transport either paramedics or patients to and from the island.

Some say they worry such a response system could fail when off-island paramedics are busy or problems with ferries or weather come into play.

At the meeting, Fogarty and Herbert said they agree the plan isn’t perfect. However, Medic One will continue to plan, they said, and may do tests before the transition. And if needed Medic One will make changes to the plan after it is implemented. Built into the plan are formal reviews at 30, 60 and 90 days.

Fogarty also noted a couple other possible response strategies. Vashon paramedics could transfer patients to off-island paramedics at the dock, or when necessary they could revert to the old system, where one paramedic transfers a patient with an EMT while the other stays on the island.

“We have to iron out all the details,” Herbert said. “We’re going to spend all our time now looking at how we will address that second call.”

The plan was unanimously approved by the three VIFR board members present  — Camille Staczek, Rex Stratton and Ron Turner — at Tuesday’s meeting, a week after the plan was formally introduced.

The meeting, which was also a public hearing, was attended by three of Vashon’s paramedics, several other VIFR staff members and a paramedic from south King County. No members of the public attended.

Turner, who at the previous meeting expressed skepticism about the proposal, introduced the motion to approve it.

“It’s your program,” he told Medic One officials at this week’s meeting. “If you feel that you can do it, then make it happen.”

Stratton, who also serves on King County’s EMS Advisory Committee, said he was unsure if the board would vote that night, but he felt confident approving it.

He noted that in the south King County system, paramedics typically work fewer hours than they do on Vashon, something many consider a benefit. For some time there has been concern that the long hours Vashon paramedics work when overtime is needed could lead to fatigue and problems on the job. While at VIFR paramedics are regularly on duty for 48 hours straight, in south King County paramedics work a maximum of 24 hours, and 36 hours only when necessary.

Under the new plan, Vashon could also call for extra help from Medic One in the case of a major emergency.

“I have my concerns about some of the hiccups that we will incur going forward that will have to be solved,” Stratton said, “but in the long run I think this will be very beneficial for Vashon Island Fire & Rescue.”

The proposal must also be approved by King County Executive Dow Constantine and is subject to union agreements, something county officials said they were not concerned about.

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