A year after Vashon’s fire board approved an overhaul of the island’s paramedic program, the changes have not yet happened and there are growing concerns that the plan might compromise public safety.
Vashon Island Fire & Rescue (VIFR) paramedics say they are open to the plan, which will make the island responders a part of the larger South King County system. However, several of them, as well as other VIFR staff, say that without knowing more details, they’re worried that the new system will actually leave the island at times without paramedics to respond to the most serious medical emergencies.
“The irony is that in order to bring the quality of care up to King County standards, King County appears to be willing to reduce the level of service, which is a disgrace,” said paramedic Steve Palmer.
What’s more, it’s unclear who will have final approval of the controversial transition, and there’s no plan for public outreach on Vashon before the change takes place.
“The longer this goes, I just keep thinking they still aren’t forthcoming with the plan, and we’re getting so far down the road on this thing,” said Andy Johnson, another paramedic. “I think it’s reasonable for the public to have an idea before it happens and perhaps a little bit of a voice to influence it.”
Meanwhile, officials with VIFR as well as King County Medic One, the countywide paramedic program, say that while the
change is slow in coming, they believe it will only be a boon to emergency services. There’s been little public outreach, some say, because they don’t expect Vashon residents will see a change.
“The plan is that there’s not a reduction in service,” said VIFR Commissioner Rex Stratton, “and there will be an opportunity to actually have more flexibility in service.”
For years, Medic One has contracted with VIFR to provide paramedics on the island. Vashon’s eight paramedics have the same training as those in the rest of the county, but work under the island agency, which receives about $2 million in annual county levy funds. The station also uses island levy funds to employ firefighters and emergency medical technicians (EMTs), who respond to less serious emergencies.
In recent years, however, calls for medical emergencies on Vashon have risen, as have ambulance transports to hospitals. During a transport for a more serious call, considered an advanced life support (ALS) call, one paramedic and one EMT will take a patient on the ferry, leaving the island with just one paramedic for about three hours or more. A second ALS call receives one paramedic and at least one EMT. There are about 120 ALS transports a year.
Officials have said the situation isn’t ideal, as studies show patient outcomes are best when two paramedics work together. The current system is also technically against Medic One protocol, and in the rest of the county paramedics stay together.
Also considered a weakness in the system is that Vashon’s paramedics respond to far fewer calls than those on the mainland and therefore have fewer opportunities to practice their skills. For this reason, VIFR typically hires seasoned paramedics, but some have now worked on the island for 10 years or more.
The topic became a subject of focus last year, when head paramedic Mark Brownell, the battalion chief for emergency medical services (EMS) at VIFR, and Dr. Sam Warren, VIFR’s medical program director, outlined their concerns about the paramedic program in a formal letter to King County Medic One, prompting both VIFR and Medic One to reexamine it.
Last summer, VIFR’s board approved a plan 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 will see a changing crew of 80 responders. Paramedics will also stay in two-person teams.
George Brown, who was assistant chief at VIFR when the change was approved and is now interim acting chief, filling in while Chief Hank Lipe is on leave, said he believes the plan will improve paramedic service. Another, benefit, he noted is there will be a larger crew for Vashon to pull from. Currently when paramedics are sick or on vacation, others work long hours to fill in.
“My biggest reason I want to see things change is our lack of depth, sheer numbers,” Brown said. “It’s dangerous to have guys working four, five and six days in a row.”
The VIFR board voted to move forward with the plan at a public meeting last August. While officials and paramedics alike expressed optimism, most also said some crucial details still needed to be worked out.
Of utmost concern is that under the new system, two paramedics will leave the island together on ALS transports, possibly leaving Vashon without paramedics for a time. Officials have discussed a working plan where as soon as Vashon paramedics believe they’ll have to take a patient off-island, the mainland paramedics closest to Fauntleroy will then head toward the ferry. Ideally, they will be on the island by the time the Vashon paramedics leave.
When ferries are delayed, officials have discussed using a boat or a helicopter to move paramedics. A patient could also be flown off the island in order to keep paramedics, and Brown noted that in a worst-case scenario paramedics could split up like they do now.
“Everything we have today is in our court to use,” he said.
However, some VIFR staff members have said that while the plan sounds good on paper, in reality it won’t work when there are ferry delays or mainland paramedics are busy on other calls or far from the ferry. It’s been suggested that a third paramedic should be permanently stationed on Vashon, but Medic One officials say there isn’t funding for the extra position.
Late last month, Brigitte Brown, a 30-year EMT and longtime VIFR volunteer, forwarded to The Beachcomber a two-page letter she said was written by a group of VIFR responders, both career and volunteer.
The letter was not signed, but the
writers also raised concerns about gaps in coverage, noting that sometimes emergency calls come in clusters.
“In instances where someone is having a heart attack, an allergic reaction, is critically injured in an accident, or when a baby stops breathing — seconds count, and those seconds in which ALS care is needed can mean the difference between life and death,” the letter reads.
The letter goes on to note that Vashon paramedics currently act as limited firefighters and sometimes respond to the less serious basic life support (BLS) calls as well, while other paramedics presumably would not.
Brown, who sent the letter, thinks the public is unaware of the potential problems.
“I fear for my family’s safety,” she said. “I would like to see a plan in writing to the community saying this is what’s going to happen.”
The concerns aren’t new. Commissioner Ron Turner raised some of the same questions at the meeting last August, though he ultimately voted for the transition.
“It’s your program,” he told Medic One officials at the August meeting. “If you feel that you can do it, then make it happen.”
Since then, Medic One officials have been taking the steps needed to make the change possible at the county level, and negotiations between Vashon and South King County’s unions have taken place. Medic One had originally hoped to transition by January of this year, then aimed for this summer, but missed that goal as well.
Negotiations between the Medic One agency and the South King County paramedics’ union are now slated to begin on Aug. 3, according to John Herbert, Chief of King County Medic One, who said he hopes the change can happen by early 2016.
Herbert said he understands there are concerns but believes Medic One has a plan for coverage that will not be considered a risk. However, he was unable to share details until negotiations wrap up.
“I wish I had a plan that had been signed and sealed and ready to deliver. … Really I’m at the beginning and I’m optimistic,” he said.
Randy Tonkin, the current union president and a firefighter/EMT on Vashon, also expressed optimism.
“They’re still the same (number of) people that are going to be here, only a different chain of command,” he said. “The county has a pretty successful program.”
Paramedics, however, say they have doubts. The Beachcomber reached out to all eight Vashon paramedics and spoke with five. Of those, one declined to comment and four — including Johnson, Palmer and Bill Buchanan — said they want to see a detailed plan before they may feel comfortable with the transition. Even Brownell, who penned the letter to Medic One, said he’s frustrated that some serious questions are still unanswered.
“I’m not content to say we’ll be fine, we’ll figure it out when we get there,” he said.
VIFR Commissioner Candy McCullough said she, too, has heard worries, but feels the board made its decision last year based on concerns that paramedics’ skills are deteriorating and the advice of VIFR chiefs and Medic One officials.
“If we re-voted tomorrow or today, I would say I would still have to lean toward the subject matter experts, who say it is the best thing for our community, even though it’s unpopular,” she said.
McCullough and commissioners Turner and Stratton they, too, would like to see a detailed plan, buy they don’t believe they’ll have a say in whether it goes forward.
“I think that train has left the station,” McCullough said. “We’ve already given them permission to go ahead and do the negotiations.”
Herbert, however, said a plan will be presented to Vashon’s board. The transition must be approved by either the King County Council or Executive Dow Constantine, he said, and must be signed off by VIFR commissioners, as well. Ending VIFR’s current contract with Medic One in a timely manner requires board approval, he noted, adding that he thinks the island commissioners also play a role in assuring the plan is acceptable for Vashon.
“This is really in their court,” he said. “We’re making them a proposal, but it’s up to them to decide if it’s the right thing for their community.”