HomeMy WebLinkAbout06/02/2009 08 Firefighter/Paramedic Issue•
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C7
BUSINESS OF THE CITY COUNCIL
YAKIMA, WASHINGTON
AGENDA STATEMENT
Item No. g
For Meeting Of June 2, 2009
ITEM TITLE: Consideration of Firefighter /Paramedic Issue
SUBMITTED BY: Dick Zais, City Manager
Charlie Hines, Fire Chief
CONTACT PERSON/TELEPHONE: Dick Zais, 575 -6040
SUMMARY EXPLANATION:
Please see attached information.
Resolution Ordinance Other (Specify)
Contract Mail to (name and address):
Phone:
Funding Source
APPROVED FOR SUBMITTAL:
STAFF RECOMMENDATION: This is a council policy issue.
BOARD /COMMISSION /COMMITTEE RECOMMENDATION:
COUNCIL ACTION:
OFFICE OF THE CITY MANAGER
129 North Second Street
CITY HALL, Yakima, Washington 98901
Phone (509) 575 -6040
MEMORANDUM
March 27, 2009
TO: The Honorable Mayor and Members of the City Council
FROM: -Dick Zais, City Manager
EMS Paramedic Issue
In the aftermath of the failure of the EMS levy a number of concerns have arisen from Council
members, the media and the public regarding the status of the paramedic issue within the fire
department. In particular, there have been concerns raised about the direction given to the staff
and approvals sought this past year with respect to the department's preparations for the
submittal and potential passage of the EMS levy by the voters as well as a threshold question on
whether or not there should be any form of paramedic assistance in the Fire Department in the
future, within existing resources.
We have researched the minutes of all of the Council Public Safety Committee meetings and
Council Study Sessions on this issue. The meetings that were held provided background from the
Chief and the Department on the issue. Many updates were also provided by the Chief during
the course of the year on this subject. However, there was not an explicit, formal motion from
either the Public Safety Committee members or the Council itself which gave authorization and
direction `to the department or Chief to proceed with the approval and licensing process to enable
the paramedic program to proceed should the levy be passed by the voters. What did occur in .
these meetings was a presentation from Chief Hines on the proposal and what it would take from
other emergency agencies to prepare for such a program, together with a message from him that
he would go forward with this process to be ready for the potential passage of the levy. In the
absence of any formal direction, Chief Hines felt the Council Public Safety Committee and
Council members overall were ok with him at least proceeding with the licensing /approval
process, and took the initiative and acted in good faith to secure the needed Emergency Agency
approvals and license to be able to start the program if the levy should pass.
I supported the Chief in his efforts noted above to prepare for the passage of the levy. However,
in hindsight, given the concerns and questions that have emerged, it is also clear to me that we
should have asked the Council for more formal direction on the process that was pursued by
Chief Hines to secure the approvals and licenses from the respective emergency agencies that
govern a paramedic program.
Since the levy failure, and media coverage, together with communications from Council
members, the Chief has endeavored to clarify and address this issue in several memo's to the
Council. Clearly the rejection of the levy has eliminated the funds for both the start-up of the
paramedic program and the resources to hire additional personnel for the department. However,
there are lingering questions about this issue for the future which need clear policy direction
from the Council. This is the purpose of the EMS discussion at the City Council meeting on
April 7, 2009 and for which the attached information packet has been prepared for your review,
and policy direction.
Yakima
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•
Administration
Fire Suppression
Fire & Life Safety
Division
Investigation
Division
Training
Communications
Date:
To:
Cc:
From:
Subject:
March 30, 2009
City of Yakima Fire Department (509)575 -6060
401 North Front Street, Yakima, WA 98901 Fax (509)576 -6356
Phone (509)575 -6140 (Investigation) www.yakimafire.com
Honorable Mayor, Members of City Council
Dick Zais, City Manager
Charlie L. Hines, Fire Chief
MAXIMIZING YFD RESOURCES FOR EMS
The result of the February 3, election made clear that a sufficient majority of the voters
participating in that election did not support an. increase the EMS levy to hire 12 firefighters and
provide that up to 18 department firefighters also be trained as certified paramedics. Though
much can be said about what led to the outcome of the election, given the result, the concerns
which prompted the City Council to place the EMS measure on the ballot remain unabated.
With respect to the central and most costly aspect associated with the levy proposal, that being
adequate coverage through the hiring of 13 FTEs (12 firefighters and 1 dispatcher), the outcome
of the election effectively eliminates additional EMS funding as a means by which the City could
address the problem. As an agency tasked in large part with providing emergency medical
services to members of our community who are in medical distress it is appropriate now to assess
and consider options.
Without significant additional funding to the department, addressing the coverage issue is not
possible. However on a very small scale, conditions are such that there exists an opportunity
with respect to the enhancement of emergency pre - hospital care to community members in need
of such services. In considering this opportunity the benefits must be weighed against any costs,
even if nominal.
As you are aware, two Firefighters are also certified Paramedics. This presents us an excellent
opportunity to maximize our resources. In addition, this will ensure that a Paramedic gets to the
patient faster, regardless if they arrive by private ambulance, or fire engine. This is critical to the
survivability of those citizens who are in acute medical distress.
From a cost - standpoint, this proposal would be very cost effective; in fact all costs anticipated
with this proposal can be easily absorbed within the current EMS budget.
One Time Start-up Costs
• Monitor/Defibrillator, charger, extra battery, carrying case ...............$20,000*
• Equipment/Meds ............. ............
........................... .......$5,000*
• Miscellaneous (double lock safe, storage unit etc.) .........................$5,000
Annual Costs for Two Firefighter /Paramedics
• Replenish equipment/ meds ........................... .........................$3,000
• Skill pay (negotiated) per. yr. x 2 * * .......................... .................$5,000 -$7,200
* Medical Salesperson just called me this morning stating that their original quote was too high.
They will be sending a revised quote (seems like they are anxious to make a deal).
** This proposal is to allow our two certified Firefighter /Paramedics to administer their life-
saving skills on our citizens. There are currently no Firefighter openings in the YFD. Typically,
one or two Firefighters retire per year. A recent survey indicated that no one is planning on
retiring in `09 or '10. There are not sufficient funds currently in the budget to hire any additional
personnel. Consequently, YFD is unable to send any Firefighters to Paramedic school.
Each Firefighter/Paramedic will be assigned to an engine company on a different shift. They will
share the same Paramedic equipment (similar to the way they share air packs, hose, axes etc.).
All projected costs with this proposal can be absorbed within the current EMS budget. As you
recall, EMS funds are restricted to EMS services, and as such are separate and apart from the
city's general fund.
The public benefit of utilizing the advanced life - saving skills of the two Firefighter /Paramedics
on staff will be apparent at each incident to which one of these employees responds where these
skills are required, particularly at events where the YFD engine is the first to arrive or multiple
casualties exist.
This will significantly improve the chances of survival of those residents to whom a YFD
Firefighter/Paramedic responds.
This is an example of increasing efficiency and delivering better results to the customer (tax
payers) without increasing taxes.
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With all other approvals obtained, and the question of funding from additional EMS levy
revenues decided, the only issue to decide is the use of the two Firefighter/Paramedics, and
within that issue there are but two alternatives:
1. Utilize and maximize all available resources by allowing our two Paramedic
certified Firefighters to administer their life- saving skills on our citizens. This will
significantly improve the chances of survival of those residents to whom a YFD
Fir efighter/Paramedic responds.
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2. Require that the two certified Firefighter/Paramedics on staff refrain from
administering life- saving paramedic skills to patients during critical emergencies
and instead, wait for the ambulance to arrive.
As a 33 year Fire Service professional (13 as a Paramedic) and your. Fire Chief, I have a moral
and ethical obligation to take advantage of all resources available to the department in providing
the greatest possible benefit in terms of service to the public. I strongly recommend
implementing the first alternative.
I will continue to evaluate and explore alternatives that will maximize and enhance our ability to
efficiently serve the public. We are anxiously awaiting clarification and direction from the
council on this important matter.
•
To: Mayor Dave Edler
Councilmember Maureen Adkison
Councilmember Micah Cawley
Councilmember Kathy Coffey
Councilmember Rick Ensey
Councilmember Bill Lover
Councilmember Sonia Rodriguez
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June 1. 2009
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Subject: City of Yakima EMS Levy Results and Fire Fighter / Paramedics Proposal
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We thank you for Yakima Fire Chief Hines letter response dated May 5, 2009 which addressed
some of our questions to you in our recent correspondence but left many questions unanswered.
SOAR remains steadfastly opposed to expanding Yakima Fire Department services at this time
to include paramedics on fire engines. Please be reminded once again of the February 3, 2009
EMS levy proposal which failed by a substantial margin with over 591/6 NO votes.
Even though Chief Hines continues to seek City Council approval to "just" allow the Yakima
Fire Department to utilize the paramedic services of two current fire fighters, Chief Hines May
5, 2009 letter to SOAR clearly states his goal is "to place a Firefighter/Paramedic on every
neighborhood fire engine." What is the start up cost and ongoing cost for his clearly stated goal
?? Can the City of Yakima afford this goal ?? Please refer to our previous correspondence in
which we stated our strong belief that Chief Hines proposal with the two current fire fighters is
just the "nose of the camel in the tent."
We believe that our City currently has an EMS system that works with private ambulance
services and a user pay system. Our City cannot afford to be and do everything for everybody.
We must use our limited resources in the most cost effective manner. During times that the City
is discussing closing parks and pools due to shortage of resources, it appears unwise to be
considering expanding fire department services.
Chief Hines included his August 4, 2008 letter to Bob Hall in his response to our concerns. It is
interesting to note that year 1987 to 2007 statistics are used by Chief Hines to show that fire calls
of an emergency medical nature increased by over 4001/o during this time period These same
statistics can show an almost 20% decrease in non - medical emergency calls ( we presume fire
related calls ) during this same time period as shown below:
1987 - 3,189 responses X 0.48 = 1531 / 49.6K = 31 calls per 1000 population
2007 - 9,000 responses X 0.24 = 2160 / 85.OK = 25 calls per 1000 population
P.O. Box 1288 - Yakima. Washin *ton 98907 • ww%v.savcouramcricanria,hts.com
We encourage the City Council to look very carefully at all the statistics being presented to you
as very different messages can be delivered from the same raw data.
SOAR continues to respect our Yakima Fire Fighters and the job they are paid to perform. We
believe the City Council should direct the Yakima Fire Department to focus on vital fire fighting
services and let the private ambulance services do their job.
Very truly yours,
M $'- el) Tanass , st end"
Save Our American Rights c SOAR
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Yakima City Council Meeting, June 2, 2009
Public Meeting — Item #8: Consideration of Firefighter/EMS issues
When put before the citizens of Yakima, the EMS levy failed. Some say it
was a rejection of the paramedic program while others say it was a no new
tax vote. No one will ever really know the reason for the failure other than
that it failed. To quote the Yakima Herald Republics article in today's paper
"Despite the setback, the fire department wants permission to start a more
limited program using two firefighters on staff who are already certified as
paramedics." As I have stated to you at your April 21 sc Council Meeting - It
is my recommendation that you find a way to keep both of the trained
Firefighter/Paramedic's on staff and utilize their skills and training to better
serve the citizens of Yakima. This, as our Fire Chief has already stated, he
can do within his existing budget.
Also, as the levy did fail, I urge you to stipulate in any vote you may take on
this issue that no new firefighter /paramedics be added to staff until such time
as the voters of the City of Yakima have a voice in the matter.
Thank you,
William R (Bill) Duerr
3206 W Yakima Ave
Yakima, WA 98902 -2765
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Dan Mohrbacher
From: Dan Mohrbacher [dan @aedadvocates.comj
Sent: Tuesday, June 02, 2009 3:14 PM
To: maureen _adkison @ci.yakima.wa.us'; 'dave_edler @ci.yakima.wa.us';
'micah_cawley @ci.yakima.wa.us'; 'son ia _rodriguez @ci.yakima.wa.us';
'bill _lover @ci.yakima.wa.us'; 'rick_ensey @ci.yakima.wa.us'; 'kathy_coffey @ci.yakima.wa.us';
'chines @ci.yakima.wa.us'
Subject: FW: My testimony for Agenda Item 8 6/2/09
I am forwarding this written version of my testimony since I am not sure I can be at the meeting tonight. I have been in
the hospital pretty much since May 3 with a few brief attempts at discharge without success ( leg infection that kept
recurring) and was just discharged this afternoon. I will try to make the meeting but if not please consider this
comment.
Dan
From: Dan Mohrbacher [mailto:dan @aedadvocates.com]
Sent: Tuesday, June 02, 2009 1:40 PM
To: 'dzais @ci.yakima.wa.us'
Subject: My testimony for Agenda Item 8 6/2/09
Good afternoon Mr. Zais, Chief Hines, Honorable Council members:
My name is Dan Mohrbacher. I reside at 1506 S. 27`h Ave. Yakima, WA 98902. 1 am President of AED Advocates, Inc a
Washington State Non Profit corporation. I am a retired paramedic and former legislative liaison for the Oregon State
EMT Association and former President of the Washington State EMT & Paramedic Association. I am not in any way
financially involved with the Yakima Fire Department nor any private ambulance service in Washington State. I am a
former firefighter with Yakima County FPD# 10 and a former owner of an ambulance service in California. By way of
disclosure I will be responding to any bid requests for equipment in this project but am asking for no special
considerations.
I have remained neutral during all the previous conversations about the Fire Department ALS issue I know Chief Hines
and I have trusted the Council would do the right thing based on the will of the people. Just this morning I read the
Chief's letter to you, Mr. Zais. I think I may be in a position to offer advice that may save the Department at least 15,000
dollars immediately while still allowing the Department to maximize the use of iYs two paramedics. I have confirmed
that the advice I am about to give meets the requirements of all WACs and RCWs appropriate and this can easily be
verified thru your normal channels.
I fully agree with the Chief that it would not be in the public interest to not utilize to the maximum allowable by the law
and the budget. It is also important that doing so not expose the City to greater liability then necessary. It is my
understanding that 78% of the calls in the City the ambulance is there within 30 seconds before or after the engine
company. That leaves 22% that there is a delay that can go either way. The Chief is correct that ANY delay in necessary
patient care could be life threatening. On the other hand that must be balanced by the fact that the Department only
has two paramedics in a three platoon system so 33% of the time or more there will be no paramedic on the ALS engine
or Rescue. Under the WACs to operate a verified ALS provider you must provide 24/7 coverage. If that is the intent of
the Chief, he will have to acquire at least one additional paramedic foroperate as an enhanced BLS provider who can be
authorized to provide advanced life support when appropriately staffed and equipped. I would advise to remain at the
BLS provider level with enhanced orders from the County Program Medical Director, as is allowed under the regs. If you
desire to go full verified ALS provider you will need an additional FTE firefighter /paramedic.
The Chief, in an abundance of caution, is budgeting a full 12 lead cardiac monitor /defibrillator /pacemaker such as is
carried on all ALS ambulances in the City and County. The cost of this device is 20 -30 thousand dollars depending on the
whistles and bells added to the base unit that costs 15 to 18 thousand dollars. If you are running the enhanced BLS /ALS
option you cold buy a professional AED that shows the patient's EKG so it could be read and treated by the paramedics.
Cardiac Science, Phillips, and Zoll all make units that could provide this function and replace the full ALS monitor /12
lead /pacer /defibrillator.
The paramedics on the engine could still utilize all the PMDs ALS orders prior to arrival of or augmenting the arriving
ambulance paramedic to include intubation, IVs, cardiac and advanced life support medications. The only things they
could NOT do is pace or send a 12 lead EKG to the hospital both of which can wait even minutes till the arrival of the
transport paramedic who would usually be only seconds behind.
I would also suggest getting bids on the ALS equipment. It may be there can be a cost savings with a competitive bid.
If I can answer any specific questions please feel free to call me at my office 594 -4107 or on my cell phone at 307 -6415.
As a suggestion for the saved money I would love to see support provided for bystanders who do CPR, a very emotional
task even if the outcome is good, which it is not 85 -98% of the time. The Department, to it's credit, has a Department
Chaplin who does this task on an anecdotal basis. It should be done on each call where bystanders have done CPR.
It would also be good for somebody to collect data on cardiac arrest save rates currently and what skills are working
and what are not since I am told by the EMS office this data is not collected for budgetary reasons.
Dan Mohrbacher
AED Advocates, Inc
(509) 307 -6415
is f-r i .I
Moore, Debbie
From: Zais, Dick
Sent: Tuesday, June 02, 2009 2:50 PM
To: Moore, Debbie
Subject: FW: My testimony for Agenda Item 8 6/2/09
Importance: High
Please make copies for distribution this evening.
Thanks.
From: Dan Mohrbacher [mailto:dan @aedadvocates.com]
Sent: Tuesday, June 02, 2009 1:40 PM
To: Zais, Dick
Subject: My testimony for Agenda Item 8 6/2/09
Good afternoon Mr. Zais, Chief Hines, Honorable Council members:
Page 1 of 2
(oZ %q nt
My name is Dan Mohrbacher. I reside at 1506 S. 27th Ave. Yakima, WA 98902. 1 am President of AED
Advocates, Inc a Washington State Non Profit corporation. I am a retired paramedic and former legislative
liaison for the Oregon State EMT Association and former President of the Washington State EMT & Paramedic
Association. I am not in any way financially involved with the Yakima Fire Department nor any private
ambulance service in Washington State. I am a former firefighter with Yakima County FPD# 10 and a former
owner of an ambulance service in California. By way of disclosure I will be responding to any bid requests for
equipment in this project but am asking for no special considerations.
I have remained neutral during all the previous conversations about the Fire Department ALS issue I know Chief
Hines and I have trusted the Council would do the right thing based on the will of the people. lust this morning 1
read the Chief's letter to you, Mr. Zais. I think I may be in a position to offer advice that may save the
Department at least 15,000 dollars immediately while still allowing the Department to maximize the use of it's
two paramedics. I have confirmed that the advice I am about to give meets the requirements of all WACs and
RCWs appropriate and this can easily be verified thru your normal channels.
I fully agree with the Chief that it would not be in the public interest to not utilize to the maximum allowable by
the law and the budget. It is also important that doing so not expose the City to greater liability then necessary.
It is my understanding that 78% of the calls in the City the ambulance is there within 30 seconds before or after
the engine company. That leaves 22% that there is a delay that can go either way. The Chief is correct that ANY
delay in necessary patient care could be life threatening. On the other hand that must be balanced by the fact
that the Department only has two paramedics in a three platoon system so 33% of the time or more there will
be no paramedic on the ALS engine or Rescue. Under the WACs to operate a verified ALS provider you must
provide 24/7 coverage. If that is the intent of the Chief, he will have to acquire at least one additional
paramedic for operate as an enhanced BLS provider who can be authorized to provide advanced life support
when appropriately staffed and equipped. I would advise to remain at the BLS provider, level with enhanced
orders from the County Program Medical Director, as is allowed under the regs. If you desire to go full verified
ALS provider you will need an additional FTE firefighter /paramedic.
The Chief, in an abundance of caution, is budgeting a full 12 lead cardiac monitor /defibrillator /pacemaker such
as is carried on all ALS ambulances in the City and County. The cost of this device is 20 -30 thousand dollars
6/2/2009
Page 2 of 2
depending on the whistles and bells added to the base unit that costs 15 to 18 thousand dollars. If you are
running the enhanced BLS /ALS option you cold buy a professional AED that shows the patient's EKG so it could
be read and treated by the paramedics. Cardiac Science, Phillips, and Zoll all make units that could provide this
function and replace the full ALS monitor /12 lead /pacer /defibrillator.
The paramedics on the engine could still utilize all the PMDs ALS orders prior to arrival of or augmenting the
arriving ambulance paramedic to include intubation, IVs, cardiac and advanced life support medications. The
only things they could NOT do is pace or send a 12 lead EKG to the hospital both of which can wait even
minutes till the arrival of the transport paramedic who would usually be only seconds behind.
I would also suggest getting bids on the ALS equipment. It may be there can be a cost savings with a competitive
bid.
If I can answer any specific questions please feel free to call me at my office 594 -4107 or on my cell phone at
307 -6415. As a suggestion for the saved money I would love to see support provided for bystanders who do
CPR, a very emotional task even if the outcome is good, which it is not 85 -98% of the time. The Department, to
it's credit, has a Department Chaplin who does this task on an anecdotal basis. It should be done on each call
where bystanders have done CPR.
It would also be good for somebody to collect data on cardiac arrest save rates currently and what skills are
working and what are not since I am told by the EMS office this data is not collected for budgetary reasons.
Dan Mohrbacher
AED Advocates, Inc
(509) 307 -6415
6/2/2009