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Rescue effort
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| Columbia County paramedics Brandon Reid (from left) and Lt. Alice Duncan assist Columbia County firefighter Trevor Caslin in a mock resuscitation of fellow firefighter Matt Herndon. The county is looking at the feasibility of combining the county’s Emergency Medical Service with the county fire department in order to possibly save money. JASON MATTHEW WALKER/Lake City Reporter |
County continues to pursue consolidation of EMS and fire department services.
By MICHAEL MITSEFF
mmitseff@lakecityreporter.com
The idea of consolidating two of Columbia County’s emergency services is being pursued as a way to save money, but for some Emergency Medical Service paramedics, it’s a matter of life and death.
County Manager Dale Williams and his staff have been studying the feasibility of combining the county’s Emergency Medical Services with its fledgling county fire department as it prepares to enter its third year of operation.
County: It’s about cost
“The reason for the study is the hope that we can find a way to provide both services at a reduced cost,” Williams said, adding that county revenue is expected to decrease for the foreseeable future and Fire and EMS consolidation is just one area being studied for possible cost savings.
In addition to the lost revenue from the passage of Amendment One and the Florida Legislature’s 2007 Property Tax Reform Act, shared revenue from the state has declined and is expected to continue that downward trend for the near future, according to Williams.
“Even if the study were to show efficiency gains several years after implementation of a Fire Rescue, the initial start-up costs are what concerns the county,” he said.
“The problem is if the study says that you must put in additional money in the early years to get there, is it the right time to do that?” Williams asked. “These next few years are going to be extremely difficult and we are not going to propose anything that is going to cost the county additional money.”
Paramedics: It’s about life
Though the county is focused on cost, the men and women who are paid to save lives have a different perspective.
“We are only asking to provide a more efficient level of service as we respond to the emergency needs of the residents and visitors of Columbia County,” said Columbia County Paramedic Anthony Davis.
The “efficient level of service” would allow firefighters, who are also trained and certified as paramedics to perform both jobs as necessary. The same applies for paramedics who are also trained and certified as firefighters, according to Davis.
“If there is a firefighter/paramedic on that engine and he gets to the scene 15 minutes ahead of the ambulance, he can check that patient and possibly get a refusal (from the patient for further treatment), or clear that scene without EMS or any other units needing to come to the scene,” Davis said.
Other benefits to consolidation of services may reveal intangibles that only become apparent after implementation, according to Davis.
“It would make the county a safer place for my family and eventually it may mean a pay raise for me sometime down the road,” said Paramedic Jim White. “A fireman can currently give oxygen to a patient, stabilize and make them comfortable until paramedics arrive, if they are trained as an Emergency Medical Technician.”
An EMT is trained in basic life support where a paramedic is trained in advanced life support.
Advanced life support for all
“If it’s a trauma patient that has anything cardiac going on, a fireman — even a fireman/paramedic — doesn’t have a monitor to put on the patient except for an automatic defibrillator, and that’s only good if a patient is in cardiac arrest,” White said.
Currently, even if a fireman/paramedic is on an engine, he or she is restricted by county policy from performing anything more than basic life support. If the county consolidated services, a fireman/paramedic could not only stabilize the patient but they could also start advanced life support while waiting for EMS.
“If the patient’s heart is in a rhythm that’s likely to go into cardiac arrest in the next few moments, they don’t have any way of knowing that because they don’t have a monitor to put that patient on. Even if they did have the monitor, they are not allowed to put the patient on it even if they are fireman/paramedics — because they are under the fire department and not EMS,” White said.
In a combined Fire Rescue service, advanced life support could be administered by anyone trained as a paramedic, whether assigned to fire or rescue, it wouldn’t matter, White said.
“They would have a monitor with them and then they might see that the patient is in a dangerous rhythm and they could administer drugs or pace his or her heart or do something other than just giving them oxygen,” he said.
No one in leadership of the Fire or EMS services or the county disputes that combining services appears to have definite benefits, but the issue for the county is the initial startup costs, among other considerations.
One of the problems with combining services is that EMS cannot be funded from non-ad valorem fire assessments and that is one of the items that the county’s feasibility study is examining, Williams said.
“A special assessment — by court ruling — can only be used to benefit the property of the owner, not the owner,” Internal Auditor Judy Lewis said.
“There’s a lot of law about how a local government can fund fire and how they can fund EMS,” Williams said.
“If you combine the two, the law doesn’t provide that you can just start mixing and matching the money, so there has to be a separation of funding sources and expense tracking — that’s a big issue.”
Rescue calls outnumber fire calls
Another issue brought up by the EMS employees is the proportion of calls that EMS fields compared to fire calls.
“We run about 3,200 to 3,500 fire calls per year, of which 60 percent are medical-type calls, whether it be a motor vehicle accident or assisting EMS with a cardiac or breathing problem,” County Fire Chief Tres Atkinson said.
On the EMS side, they field anywhere from 11,000 to 12,000 emergency calls per year, according to Williams.
“We’re looking at some of the leanest budget years that we’ve ever had,” EMS Director Rusty Noah said. “We have to evaluate all of the possibilities and consolidation of services is just one of the possibilities that’s being looked at as a way to combine services that would result in a financial savings and response efficiency.”
Noah said that it would create the potential for people to work both roles but that some of those things can be achieved without combining the departments.
“It may not be a financial efficiency to do that but it may be an operational efficiency to allow firefighter/paramedics to work on the EMS side and allow paramedics that are also trained as firefighters to work on the fire side,” Noah said. “So those may be operational efficiencies that we can achieve whether we combine the departments or not.”
The issue for the county and those in leadership of EMS and Fire is not whether a combination of services is a good or bad thing, the ongoing issue is affordability.
“Can the county combine the services and comply with the legal aspects because of the way revenue is generated, and if so can they do it and save money?” Williams asked. “Even if the study says that this is the right thing to do for all of these reasons, is it something the county can do in a down economy?”
Though Williams and his staff are not yet ready to make a recommendation to the board of county commissioners, the issue of consolidation is still under study.
“As it stands now, we have not been
able to combine the two services without an initial increase in overall costs,” Williams said.
County Manager Dale Williams and his staff have been studying the feasibility of combining the county’s Emergency Medical Services with its fledgling county fire department as it prepares to enter its third year of operation.
County: It’s about cost
“The reason for the study is the hope that we can find a way to provide both services at a reduced cost,” Williams said, adding that county revenue is expected to decrease for the foreseeable future and Fire and EMS consolidation is just one area being studied for possible cost savings.
In addition to the lost revenue from the passage of Amendment One and the Florida Legislature’s 2007 Property Tax Reform Act, shared revenue from the state has declined and is expected to continue that downward trend for the near future, according to Williams.
“Even if the study were to show efficiency gains several years after implementation of a Fire Rescue, the initial start-up costs are what concerns the county,” he said.
“The problem is if the study says that you must put in additional money in the early years to get there, is it the right time to do that?” Williams asked. “These next few years are going to be extremely difficult and we are not going to propose anything that is going to cost the county additional money.”
Paramedics: It’s about life
Though the county is focused on cost, the men and women who are paid to save lives have a different perspective.
“We are only asking to provide a more efficient level of service as we respond to the emergency needs of the residents and visitors of Columbia County,” said Columbia County Paramedic Anthony Davis.
The “efficient level of service” would allow firefighters, who are also trained and certified as paramedics to perform both jobs as necessary. The same applies for paramedics who are also trained and certified as firefighters, according to Davis.
“If there is a firefighter/paramedic on that engine and he gets to the scene 15 minutes ahead of the ambulance, he can check that patient and possibly get a refusal (from the patient for further treatment), or clear that scene without EMS or any other units needing to come to the scene,” Davis said.
Other benefits to consolidation of services may reveal intangibles that only become apparent after implementation, according to Davis.
“It would make the county a safer place for my family and eventually it may mean a pay raise for me sometime down the road,” said Paramedic Jim White. “A fireman can currently give oxygen to a patient, stabilize and make them comfortable until paramedics arrive, if they are trained as an Emergency Medical Technician.”
An EMT is trained in basic life support where a paramedic is trained in advanced life support.
Advanced life support for all
“If it’s a trauma patient that has anything cardiac going on, a fireman — even a fireman/paramedic — doesn’t have a monitor to put on the patient except for an automatic defibrillator, and that’s only good if a patient is in cardiac arrest,” White said.
Currently, even if a fireman/paramedic is on an engine, he or she is restricted by county policy from performing anything more than basic life support. If the county consolidated services, a fireman/paramedic could not only stabilize the patient but they could also start advanced life support while waiting for EMS.
“If the patient’s heart is in a rhythm that’s likely to go into cardiac arrest in the next few moments, they don’t have any way of knowing that because they don’t have a monitor to put that patient on. Even if they did have the monitor, they are not allowed to put the patient on it even if they are fireman/paramedics — because they are under the fire department and not EMS,” White said.
In a combined Fire Rescue service, advanced life support could be administered by anyone trained as a paramedic, whether assigned to fire or rescue, it wouldn’t matter, White said.
“They would have a monitor with them and then they might see that the patient is in a dangerous rhythm and they could administer drugs or pace his or her heart or do something other than just giving them oxygen,” he said.
No one in leadership of the Fire or EMS services or the county disputes that combining services appears to have definite benefits, but the issue for the county is the initial startup costs, among other considerations.
One of the problems with combining services is that EMS cannot be funded from non-ad valorem fire assessments and that is one of the items that the county’s feasibility study is examining, Williams said.
“A special assessment — by court ruling — can only be used to benefit the property of the owner, not the owner,” Internal Auditor Judy Lewis said.
“There’s a lot of law about how a local government can fund fire and how they can fund EMS,” Williams said.
“If you combine the two, the law doesn’t provide that you can just start mixing and matching the money, so there has to be a separation of funding sources and expense tracking — that’s a big issue.”
Rescue calls outnumber fire calls
Another issue brought up by the EMS employees is the proportion of calls that EMS fields compared to fire calls.
“We run about 3,200 to 3,500 fire calls per year, of which 60 percent are medical-type calls, whether it be a motor vehicle accident or assisting EMS with a cardiac or breathing problem,” County Fire Chief Tres Atkinson said.
On the EMS side, they field anywhere from 11,000 to 12,000 emergency calls per year, according to Williams.
“We’re looking at some of the leanest budget years that we’ve ever had,” EMS Director Rusty Noah said. “We have to evaluate all of the possibilities and consolidation of services is just one of the possibilities that’s being looked at as a way to combine services that would result in a financial savings and response efficiency.”
Noah said that it would create the potential for people to work both roles but that some of those things can be achieved without combining the departments.
“It may not be a financial efficiency to do that but it may be an operational efficiency to allow firefighter/paramedics to work on the EMS side and allow paramedics that are also trained as firefighters to work on the fire side,” Noah said. “So those may be operational efficiencies that we can achieve whether we combine the departments or not.”
The issue for the county and those in leadership of EMS and Fire is not whether a combination of services is a good or bad thing, the ongoing issue is affordability.
“Can the county combine the services and comply with the legal aspects because of the way revenue is generated, and if so can they do it and save money?” Williams asked. “Even if the study says that this is the right thing to do for all of these reasons, is it something the county can do in a down economy?”
Though Williams and his staff are not yet ready to make a recommendation to the board of county commissioners, the issue of consolidation is still under study.
“As it stands now, we have not been
able to combine the two services without an initial increase in overall costs,” Williams said.
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d wrote on Dec 21, 2008 5:24 AM: