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HomeMy WebLinkAbout07/22/2008 00 Emergency Medical Services Levy David Edler, Mayor e 1 % Micah Cawley, Assistant Mayor g Y Kathy Coffey ,l• _;� City Council Norm Johnson Agenda Bill Lover 129 N. 2nd Street,Yakima,WA.98901 Neil McClure . Phone: (509) 575 -6000 • Fax (509) 576 -6614 S City Manager Email: ccouncil @ci.yakima.wa.us • www.ci.yakima.wa.us Richard A. Zais, Jr. Anyone wishing to address the Council, please fill out the form found on the tables and give it to the City Clerk YAKIMA CITY COUNCIL ADJOURNED MEETING PUBLIC HEARING ON PROPOSED EMERGENCY MEDICAL SERVICES LEVY JULY 22, 2008 7:00 P. M. COUNCIL CHAMBERS - YAKIMA CITY HALL 1. Roll Call 2. Public Hearing on proposed Emergency Medical Services Levy 3. Adjournment • Yakima *man City of Yakima Vision Statement: To create a culturally diverse, economically vibrant, safe, and strongYakima •ommunity. I I I I I! Adopted March 2008 1994 YAKIMA CITY COUNCIL 11111 NOTICE OF PUBLIC HEARING Proposed Emergency Medical Services Levy NOTICE IS HEREBY GIVEN that the Yakima City Council will conduct a public hearing to provide an opportunity for citizens to comment on a proposed Emergency Medical Services Levy. As proposed, the City's levy would enhance the current Yakima County EMS levy to assist the Yakima Fire Department in meeting current challenges facing the department such as critical staffing needs and improving the delivery of emergency medical care. The public hearing will be held on Tuesday, July 22, 2008 at 7:00 p.m., in the Council Chambers of Yakima City Hall, 129 North 2" Street, Yakima, Washington. The City Council is seeking feedback to assist them in the decision - making process, which includes placing it on the ballot for the General Election in November 2008. Dated this 9th day of July, 2008. Deborah Moore City Clerk ministration e Suppression ire & Life Safety 01Mq; City of Yakima Fire Department (509)575 -6060 Division 401 North Front Street, Yakima, WA 98901 Fax Investigation ; (9 ,4,,„ (509)576 -6356 Division Phone (509)575 -6140 ( Investigation) www.yakimafire.corn Training Communications :!(ki DE4O July 18, 2008 Honorable Mayor and members of City Council, Subject: Emergency Medical Services (EMS) Levy Proposal The attached report documents the inability of the Yakima Fire Department to currently meet the emergency needs of our citizens, our prospects for doing so in the future, and recommends an alternative plan for enhancements in staffing, training, facilities and equipment that will significantly improve the delivery of emergency medical services to Yakima residents. ilk background, the proposal to present to the voters an EMS Levy was discussed with the Public Safety Committee approximately two years ago. At that time several other issues were before the City Council and electorate. As a result it was determined that the EMS Levy be delayed for a year or so to focus on the Safe Community Action Plan proposal. During the ensuing two years the EMS situation has deteriorated further, call volumes continue to grow, operating costs continue to rise, and resources allocated to Fire and EMS services have declined in buying power. The need to significantly restore and enhance EMS services in our City through an ongoing EMS Levy of $0.25/1000 assessed valuation reflects the opinion of the Fire Chief, Command Staff, Officers of the department, and is shared by numerous experts in the Yakima medical and insurance community. The proposal enjoys strong and growing public support as people begin to understand what is at stake, and the potential costs and risks associated with a failure to act. The EMS Levy statute was created for just such needs /circumstances. ' The levy has a proven and tested track record of voter support in our community. To "Maintain and Improve Public Health and Safety" is one of the six Strategic Priorities adopted by the City Council just a few months ago in March. The EMS Levy, if presented to the voters, affords the Yakima electorate to determine for themselves if they want to invest in the improvement of their own safety and emergency health care. • In my professional opinion, the City of Yakima is not currently providing adequate fire and paramedic safety services and protection to our citizens and that view is strengthened by the recommendations of fire, medical, 0 d insurance. professionals throughout our community. e implementation of the levy would allow the City to add 12 new firefighters, one dispatcher, and provide for • o additional engine companies. These additions bring the City Fire Department staffing level in line with the average for Eastern Washington Metropolitan Fire Departments and provide our citizens with a higher level of public safety. As your Fire Chief, I understand there are several needs in our community being considered, I do not propose to make a judgment on priority, other than to note that EMS Levy has already been through one prioritization process and was delayed in favor of the SCAP election, and I strongly believe that the #1 priority of government at every level is, and always should be, public safety. This same sentiment is reflected throughout the City of Yakima Vision and Mission statements and the adopted Yakima City Council Priorities. Accordingly I urge the City Council to authorize a ballot measure for the November 4, 2008 general election, allowing the Yakima electorate to consider this proposal to restore and enhance Emergency Medical Services to Yakima residents. Your Fire Chief, Charlie L. Hines yAMmg AN t/RE DEQt' EMS Levy Proposal Supplemental Information Packet r Sc 01 e • to 0 VOTE 1 ! NOV `08 { INCOME t -- L -- RECEIVEI) r -- HIRE CROSS TRAINE!) l_ _ -_ —J DUAL ROLE M FIREFIG tiTER PARAMEDICS START RECRUIT C ACADEMY r —_ ] GRADUATE M RECRUIT C ACADEMY CONVERT 2- i 3 PERSON "AID- i_.._ .a 13- PARAMEDIC CAR" INTO 3 - ENGINE PERSON FIRE , . _, - COMPANIES III ENGINE CO. l BEGIN SERVICE - - - - -- � FI REFIGHTERS Z START rF PARAMEDIC FIREFIGHTERS SCHOOL. START • (CLASS #1 ) PARAMEDIC 0 1 SCHOOL (CLASS #2) �. Cl) 0 - - (D GRADUATE PLACE ADDITIONAL CL PARAMEDIC ' .—. 3- PERSON ENGINE SCHOOL (CLASS # 1) _ COMPANY IN (I Year after tatting PM si�ool) SERVICE GRADUATE .7 - . _ SCHOOL (CLASS #2) . (1 Year after stating PM schooO 0 • id M 0 J 25 0 EMS Levy Tax $1.3 Million Generated Revenue $32 5 $975 Equipment /Labor Reserves, 12 New Firefighters • Transforms 2- person "Aid Car" (Rescue 91) into 3- person fire Engine Company (we already own it). • Creates new staffed 3- person Fire • Engine Company (we already own it) • This plan meets current and anticipated future needs try.... Kori riririiwrr, Ir© rirr ir.' rrrirrrr sw rr:0irerr rrir7ririi�riimrir�miri ii rrryar�rrir /r iuc.04, - .r..,41,11/ , 20 EMS Levy Tax . .• Million Generated Revenue $7 011 Equip 4' _I . *, *.. ' 'rv- 8 New FF's • This model does not provide sufficient staffing to meet current or future demands for service. • • • r Yakima County MEDICAL PROGRAM DIRECTOR 5110 Tieton Drive, Suite 370 • Yakima, WA 98908 • (509) 966 -5175 FAX (509) 966 -5176 June 23, 2008 Chief Charlie Hines Yakima Fire Department 104 N. Front Street Yakima, WA 98901 Dear Chief Hines: I am writing this letter in support of your proposal for Yakima Fire Department to upgrade to a non - transport advance life support service. I believe that this upgrade in service will improve patient care and outcome in Yakima. Currently, one paramedic is • responsible for managing all intermediate and advanced interventions which, can lead to long on -scene times. With the addition of paramedics to the Yakima Fire Department I believe advanced level interventions will come earlier to the patient in need, on -scene times will improve and Yakima County as a whole will benefit from the increase in Yakima Fire Department specialized services. Sincerely, Robert E. Johnson, MD Medical Program Director dk • . „ . , . June 25, 2008 Charlie Hines, Fire Chief Yakima Fire Department 401 North Front Street Yakima, WA 98901 Dear Charlie: In follow up to our conversation on June 18 2008 this letter is to confirm the support of American Medical Response (AMR) for your goal of providing Paramedic level of care on your engine companies. AMR acknowledges and respects your actions to provide increased first response capability to the citizens we both serve. We look forward to having an extra set of hands to provide care for critical patients in your community. This is a proven model between public and private service and we look • forward to showing the community how well it works. Additionally, I am available to respond and discuss with you or any of your elected officials the benefits and merit of your goal. Sincerely, Rod Chandler General Manager, Yakima • 13075 Gateway Drive, Suite 100, Seattle, WA 98168 Phone (206) 444 -4440 • Phone (800) 842 -7701 Yakima County EMS and Trauma Care Council c I • 5110 Tieton Drive, Suite 370, Yakima, WA 98908. (509) 966- 5175•FAX (509) 966 -5176 July 14, 2008 Barbara Clarke South Central Region EMS & Trauma Care Council 1776 Fowler, #19 Richland, WA 99352 Dear Barbara: Chief Charlie Hines, Yakima Fire Department presented a proposal to the Yakima County EMS & Trauma Care Council for Yakima Fire Department to become an Advanced Life Support First Aid Agency and to be trauma verified at that level. After a presentation and much discussion the Council voted to approve the upgrade to ALS for Yakima Fire Department and have Chief Hines make his presentation to the South Central Region EMS & Trauma Care Council. If you have any questions or concerns, please contact the EMS Office at (509) 966 -5175. Sincerely, Barb Evans 2008 Chair cc: Chief Charlie Hines Candace Hamilton, Manager Robert Johnson, MD, MPD • LIFE • HOME • AUTOMOBILE VICE MAKES THE DIFFERENCE BUSINESS • FARM I/' insurance service, inc. July 14, 2008 702 NORTH FIRST STREET - (POST OFFICE BOX 1348) YAKIMA WASHINGTON 98907 Tel (509) 248 -7711 Fax (509) 453 -3293 Yakima City Council 129 N. Second St. Yakima, WA 98901 To the Council: As you know, the Yakima Fire Department, along with an ambulance, responds to all potentially life - threatening emergency calls. The YFD arrives first approximately fifty percent of the time with at least one emergency medical technician but without a paramedic. This means that there is often less than optimal expertise at the scene until the ambulance with a paramedic arrives. It is my strong opinion that there should be a paramedic on each YFD unit responding to these emergencies. Two paramedics working together simultaneously with their advanced skills can only work toward speedier stabilization and transportation, if necessary, of the patient. A potential ancillary positive effect of hiring and training firefighter paramedics is a reduction in Yakima's fire protection class. Currently the Washington Surveying and Rating Bureau rates Yakima as PC 4. Lower protection class numbers result in lower insurance premiums. The principal effect would be for commercial and industrial risks. Most cities the size of Yakima carry a PC 3 rating. Having such a rating can only be a plus in attempting to attract new businesses to the area. I hope and trust that the Council will give serious consideration to this need. No doubt there will be a need to place a funding proposal on the November ballot. I I think that with proper explanation, the citizens of Yakima will approve a reasonable levy to support it. Sincerely, A e , A) f ihit.66 p ' chard B. Elliott 1h, PROFESSIONAL INSURANCE AGENTS HIGHEST STANDARDS OF PROFESSIONAL SERVICE ` nO `c` Fc [,¢cediuc % 3 e U liA EL 1 chocardiugraphy YAKIMA HEART CENTER® bora[ory 'NI ASHUTOSH V. BAPAT, M.D. DUANE A. MONICK, M.D., F.A.C.C. ROGER E. VIELBIG, M.D., F.A.C.C. Richard K. Spiegel, M.D., MARK S. BERMAN, M.D., F.A.C.C. DOUGLASS A. MORRISON, M.D., PhD., F.A.C.C. D. GUY GARRETT, M.H.S., P.A. -C. F.A.C.C. OMERA. EL -AMIN, M.D. ROBERT A. ORTIZ, M.D., F.A.C.C. GRETCHEN KAIZER, P.A. -C. Medical Director KEVIN P. FOLEY, M.D., F.A.C.C. A.B. PREACHER, M.D., F.A.C.C. LESLIE MAERKI, P.A. -C. ANATOLE S. KIM, M.D., F.A.C.C. VICTOR V. SHARPE III, M.D. SCOTT MILLER, P.A. -C. Shawnie Haas, R.N., MBA, DAVID W. KRUEGER, M.D., F.A.C.C. RICHARD K. SPIEGEL, M.D., F.A.C.C. BUFFY SAWYER, P.A. -C. Operations Officer R. THOMAS MCLAUGHLIN, M.D., F.A.C.C. RICHARD D. TWISS, M.D., F.A.C.C PATRICIA SNELL, M.S.N., A.R.N.P. July 17, 2008 Charlie Hines, Fire Chief Yakima Fire Department 401 North Front Street Yakima, WA 98901 Dear Chief Hines: Upgrading our emergency medical system with Fire Department paramedics will definitely improve patient care in Yakima. Our cardiology practice hospitalizes a large number of severely and critically ill patients, and this proposal has only positives: faster IIII response time to the scene, more paramedics at the scene, and more experienced paramedics that will stay in Yakima. Seattle adopted this over 25 years ago, and has long been recognized as a national leader in emergency care. What works well in Spokane, Tacoma, Everett, Bellevue, Olympia, and Kennewick and 20 other Washington communities will be effective and worthwhile here in Yakima. Knowing that Yakima is at the bottom of the state's fire personnel per 1000 population only adds impetus to adding paramedic to our Fire Department. The percentage of medical versus fire calls has been a decade -long trend toward increasing medical emphasis. As an 18 -year cardiologist here in Yakima I strongly support this proposal for improving emergency medical services for all of our community. Sincerely, Da W. Krueger, M.D., F.A.C.C. DWK:kh DWK:kh III 406 S. 30th Avenue, Suite 101 SHIP TO DELIVERY ADDRESS Administration Fax 509 - 248 -2890 Yakima, WA 98902 406 S. 30th Avenue, Suite 201 Main Fax 509 - 453 -4319 509 - 248 -7715 Yakima, WA 98902 Purchasing Fax 509 - 574 -0338 What follows are letters written by: ♦ Memorial Hospital Staff ♦ Regional (Providence) Hospital Staff ♦ Yakima Heart Center Staff ♦ Yakima County EMS & Trauma Care Council ♦ Yakima County Medical Program Director That identified a "high /consistent turnover rate ", "inexperience ", "patient care mistakes ", "errors in patient care" from Paramedics. "Overall Paramedic system has deteriorated secondary to fewer experienced Paramedics." And finally, a plea to "do what is necessary to reduce the turnover of Paramedics." f Yakima County MEDICAL PROGR 1 DIRECTOR 104 N. First Street, Ye.k. ma, WA 90901 • Phone: (509) 574 -1930 • FAX: (509) 574 -1931 M E M O R A N D U M TO: Jim Avery, M.D. FR: Jim Perez. M.D. (' , , - ) Medical Program Director • RE: Paramedic Longevity / DATE: January ?6. 1999 I have enclosed the paramedic long.evity study completed on January 12. 1999. I look forward to your groups' comments on the topic of paramedic 1on_evity. I am trying to document the unanimous voice of all the Yakima County EM physicians that churning paramedics is detrimental to patient care. AMR has ;S° o of paramedics with less than ONE year of experience. and -16c Lo with Tess • than or equal to two years excerie!:ce. ALS has 17°0 of the paramedics with less than one year and 32') with .ess than rwo years. I would appreciate a ierter :rem :he physicians at Yakima Valley Nie:nor:al Hospital statinug your concern. I have spoken to Dr. Nania.. and Wayne in Spokane. and \Vhatcom County -espectively, and they are amazed at how inexperienced our paramedics are. We had problems :n the past with intubation skills. and focused CME, i_m_nda:ory) on this skill, and saw the problem improve. It began to return. •.v e 'poked at the issue. and realized that we had. for the most part. replaced about :0' ; of our paramedics with new paramedics straight out of Central Wash:n_ton University. This is all seen as my irrational 7.avinus. and i am :r. ic_g:o show the ENIS community that this isn : my s: c. it is all of ours! It mlaht be your wife. or child. that is being cared or 'a ;. a rookie. when we could have chamted the system and an experienced .. ete. :: would have been at .heir side! Thanks for your assistance. JP•dn • I' Se.- "t t_S t5_, 1 • ,s,,i.,_,, L.41,-- .sx---i- ..4,. Tom Eglin, MD, FACEP Chairman, Emergency Department Yakima Valley Memorial Hospital 2811 Tieton Drive Yakima, WA 98902 Dear Dr. Eglin: The members of the Yakima County EMS & Trauma Care Council would like to thank you for taking the time to write regarding paramedic tenure, and performance. As you mentioned in your letter, the accuracy of the tenure data was questioned. Since that time, the Council has requested current rosters of paramedics and their tenure status from all paramedic ambulance services within Yakima County. After receiving the requested information, the Yakima County Department of Emergency Medical Services verified the data. The tenure by agency indicates a pattern of consistent turnover at the paramedic level particularly in the upper Yakima Valley. After a review of files, a significant increase in paramedic patient care mistakes has been noted. III Like you and your associates we to are very concerned about these findings, and we have received a letter from the Providence Yakima Medical Center Emergency Department Physicians mentioning similar concerns. The Yakima County EMS & Trauma Care Council has developed a committee to work on this problem, a meeting was held recently with representatives from paramedic employers, the Council, and the Department of Emergency Medical Services. This committee will be working on a plan to correct these problems. The Council will be monitoring patient care concerns and paramedic tenure every six months to determine the success of any plan that is implemented. We ask that you and your associates please bring any ideas for a solution directly to this council. With all of the concerned parties working together, we are confident that we will find a proactive solution. We look forward to working with you in the future to improve prehospital emergency medical services throughout Yakima County. Once a plan has been developed, a copy will be provided to concerned parties. Sincerely, Dave Leitch 98 Chairperson • MEMORIAL HOSPITAL YAKIMA VALLEY MEMORIAL HOSPITAL 2811 A DRIVE YAKIMA, A, W WASHINGTON 98902 (509) 575 -8000 Jim Perez, MD Medical Program Director Yakima County Department of Emergency Medical Services 104 N. 1 a` Street Yakima, WA 98901 Dear Jim: Today at our monthly meeting of the YVMH Emergency Department Group we discussed the report regarding paramedic longevity in Yakima County. The group noted that the survey verified statistically the physicians' feelings that we are losing c\rlenenccd paramedics at a rapid rate. m VVakinis County The physicians further agreed ,iur overall paramedic system has deteriorated secondary to le\s r. experienced Unfortunate - ! . .. the physicians had few solutions to this high turnover of paramedics given the current private ambulance system here in the Yakima Valley. • As a u wc are \'er', 'ntcr'is :d it T: `, t'I' ]1:L' t? .! tIL'Ild 11 1( in_ 1'1: need r.: ,ir <. To this end we would support programs through your office or through the county that encourage methods to retain experienced paramedics in Yakima County. If this would mean discussing the situation further with Yakima County Commissioners or others in political authority we would certainly welcome this opportunity. Please feel free to contact me regarding further attempts at correcting the paramedic longevity problem in Yakima County. Sincerely, In/ Jim Avery Yakima Valley Memorial Hospital JKA/lms 'rove. ence 'a ima Medical Center t ' O S. 9th. .venue Te 575.5001 "h. 'Yakima. Wasnmgton 589D2 -3397 EMS & Trauma Care Council t FROM: Robert S. Nesland, M.D., FACEP�,, --s, y�� Medical Director, Emergency Dep ent Providence Yakima Medical Center Paramedic Seniority DATE: November 8. 1997 our department meeting on November 7. 1997. Dr. Perez shared with the physician group the data relating c retention of paramedics by the ambulance ,:ornpanies in Yakima. We are relatively dismayed by the lack of : etentiun of experienced paramedics in our community as reference to the EMS data showing 42% of practicing, full -time paramedics have less than one year experience. - G Impression and impression of others of our professional emergency physician group that there IN el ,Cully decreased quality of care delivery over far past years in the Yakima Valley. In the past years, n standard practice that the new graduating paramedics worked under a seasoned. experienced paramedic ;..fining practice perspective. I do feel that the new graduating paramedics are trained excellently but gained field experience takes a considerable period of time. This is true with many endeavors in medicine even physicians who graduate after four years in medical school cannot be licensed to practice independently. Three years experience is usually required under a structured, supervised training program. I feel that the new paramedics gain perspective in handling patients in the field also need a significant period of proctoring. 1 would hope that your committees explore the causes for the rapid turnover of paramedics in our tuna region and can encourage some remedies. III unman. - NLEAF, - ,37 "Pristine Bardill J. THEODORE DODGE. M.D. DUANE A. MONICK, M.D., F.A.C.C. RICHARD D. TWISS, M.D., F.A.0 Administrator KEVIN P. FOLEY, F.A.C.C. ROBERT A. ORTIZ, M.D., F.A.C.C. ROGER E. VIELBIG, M.D., F.A.C.C. DAVID W. KRUEGER, M.D. RICHARD K. SPIEGEL, M.D., F.A.C.C. D. GUY GARRETT. P.A. -C. Brian Pease R. THOMAS MCLAUGHLIN, M.D. MARK S. BERMAN, M.D. PATRICIA A. SNELL, A.R.N.P. Associate Administrator March 4, 1999 Jim Perez, M.D. Providence Yakima Heart Center Emergency Department 110 S. 9 Avenue Yakima, WA 98902 Dear Jim: This letter is in response to our conversation on 3/3/99 about the possibility of 12 -lead ECGs being done in the field. . As you know, most acute transmural myocardial infarctions are now treated at Providence Yakima Medical Center with acute angioplasty. The quicker that an occluded coronary artery can be opened, the less damage there is to the myocardium. We feel that a 12 -lead ECG done in the field could facilitate getting a patient to the catheterization laboratory in a timely fashion. This is not so much of an issue in the immediate vicinity around Yakima, but is more of an issue in the Lower Valley and at long distances east and west of the Upper Valley. There have already been several cases of ECGs being done in the field in the Lower Valley which had a significant impact on the time to angioplasty. From our conversation, I understand that an ECG machine is being. purchased for an ambulance in the Sunnyside area. Ideally, all ambulances serving areas outside of the immediate Yakima metropolitan area would be equipped with 12 -lead ECG machines. We realize that is an expensive proposition, especially for the companies that have multiple ambulances. You also made me aware of the relatively high turn -over rate for paramedics in this area. You indicated that low salaries were a major contributing factor. Because of the rapid turn -over, and because of the large number of critical skills needed by paramedics, you indicated that training in the performance of 12 -lead ECGs would necessarily be a lower priority than other procedures and skills. • 302 South 10th Ave. (509) 248.7715 P.O. Box S427 Yakima, WA 98902 FAX (509) 453 -4319 Yakima, WA 98909 -:= =- YAKIMA HEART CENTER Perez, M.D. March 4, 1999 • Page 2 It would be desirable to minimize the tum -over of paramedics in the area to allow broadening of skills and expertise, including the performance of in -field ECGs. With this letter, I am adding the support of the physicians of Yakima Heart Center in your efforts to do what is necessary to reduce the turn-over of paramedics. Adequate salaries would be the foremost consideration. Thank you for taking your time to speak with me yesterday. Sincerely, Richard K. Spiegel, M.D., F.A.C.C. RKS:cb • 1 MEMORIAL HOSPITAL YAKIMA VALLEY ,MEMORIAL HOSPITAL • December 5, 1997 Members of EMS Council Yakima County EMS Services 104 North First Street Yakima, WA 98901 Dear EMS Council: I understand a recent study found statistics showing that 420 of the paramedics in Yakima have less than one year of experience. This is thought to be due to the high turnover because of lack of incentive for paramedics and advanced EMS personnel to stay in the Yakima vicinity. Although I understand the percentages have been questioned somewhat, and are perhaps not completely accurate, it does seem to point out a concern that we have had regarding the lack of incentives for retaining the more highly qualified EMS personnel in Yakima. After discussion with the other physicians at Yakima Valley Memorial Hospital there is a consensus among the physicians I here that the number of incidents involving errors with patient care given by Paramedics is increasing. All of the physicians were supportive of the ID idea of trying to retain the more highly qualified paramGdics. We would like to see incentive programs to increase the level of performance of paramedics and advanced EMS personnel in Yakima. This would improve the incentive to stay in Yakima and promote retention of qualified paramedics 2..n: EMS personnel. This should include educational programs on a routine schedule. Also we will be trying to encourage more frequent use of reporting forms when problems are identified so they can be dealt with, and hopefully resolved through education and follow -up with the paramedics involved. Sincerely, ,' / 1 Tom Eglin, M.D. Chairman, Emergency Department Yakima Valley Memorial Hospital TLE:bkc 12/5/97- 12/8/97, 14004 cc Jim Perez Medical physician director Emergency Medicine Services, Yakima County • • 0 • • • i Paramedic Staffing Statistics June 2006 — June 2008 Yakima County ALS Ambulance Company Total EMT -P's Employed 70 33 EMT -P's newly certified or 37 20 newly relocated to our service area Overall Percentage % 52.86% 61% • ST1 ccessfui Programs • • WASHINGTON COMMUNITIES SERVED BY A TEAM OF 2P� EDICS COUNTY DEPARTMENT Benton * Kennewick Fire Department Clark * Vancouver Fire Department King Shoreline Fire Department Bellevue Fire Department Redmond Fire Department Seattle Fire Department Lewis Lewis County FPD #2 (Toledo) * Riverside Fire Authority (Centralia) Pierce * Lakewood Fire Department * University Place Fire Department Pierce County FPD #21 (Graham) * Puyallup Fire Department * Tacoma Fire Department Skagit Anacortes Fire Department * Mount Vernon Fire Department Snohomish Edmonds Fire Department Everett Fire Department Lynnwood Fire Department Marysville Fire Department Spokane * Spokane Fire Department * Spokane Valley Fire Department Thurston Lacey Fire Department Olympia Fire Department Tumwater Fire Department * 1 Private Ambulance Paramedic teamed with 1 Firefighter/Paramedic • a • • • EMS Levy Proposal Presented by: Chief Charlie Hines Current Challenges Facing YFD The Demand for Service is Outpacing our Budget Resources. Response times are getting longer. Ill- prepared to handle even relatively minor emergencies, much less, major disasters. Inability to administer emergency medical care beyond a Basic level. • 2 Goals 1. Hire additional professional firefighters and Communications personnel to meet critical staffing needs. 2. Implement 5 Paramedic Engine Co.'s by certifying 18 cross-trained dual role firefighter /paramedics. Result: Would be a vast improvement in the delivery of emergency medical care to our citizens. Pass an "ongoing" City EMS Levy • On -going levy sustains our needs for the future Pass a "Limited Term" City EMS Levy Do Nothing Yakima County Levy Fact Sheet # OF RESPONSES + ASSESSED VALUATION + POPULATION = EMS LEVY FUNDS "FORMULA" Yakima Co. is currently 25 cents per $1,000 • Spokane County FD #8 = .50 • Benton County FD #2 = .50 • Walla Walla County = .50 Can be raised to .50 per $1,000 (or anything between .25 & .50) It currently funds 8 YFD positions, portions of the Communications Center budget, capital, insurance, equipment /training & information systems. Expires in 2012 Citizens must approve with 60% vote (passed 9/02 with 76 %). rib 25- 24 15 10 0 ® NFPA /FEMA STANDARD YAKIMA • • 0 • Firefighters per / 1 population 1.8 4 c I , Add sal. 43 1 .6 ` ` Aaa.__. . 1 . 8 i 1.4 ., 1 • / � .�. 25 Add -- _n -.�. �' . � r 17� Add �;. . 8.5 1.2 1I 1 1.3 . � - - 0.8 ,ti . — y- ` 1.2 1.1 1.0 0. 6 • • ct 1 C4 = >.1 2006 % of Annual Budget Dedicated to Fire <ocb 0\0 Department Ab• ° \° np \° o \ 30.00% , .__ b'` a °V) ti el t), �° \p 25.00% �. � 9 ° ti ° O \o o \o ° 20 .00% ' NN N A • 1 <� o\o 15.00% N N. 10.00 %' 5.00% ' 0.00 ° /O A r -„, - � � . r o c, , go . . , 4\ ep • �� .„6 6 ) .\G� � � ,\ate � ( � c `� �� mo o\ e ' 1 o \ a f or � �Gr \� �� G ' e Q �5 � 0 � L e i �� `t s -\`' • • • • 0 Volunteer FD Res � into Yakima iso -_ 160 1111.1111 MIIIIII 140 / l iWi ii, 1=1 11 MIN 120 � � 100 11,1 � , imi /1 80 7 1 lik 60 I �1 J it .� t ' i 40 1 162 0 2001 2006 • Without oxygen, Brain Death occurs in 4 -6 minutes. American Heart Association VON • • • • • • Fire Doubles in Size approximately every 1 Minute. National Fire Protection Association • +R • • When the fire extends from the room of origin, you are 10X more likely to die, National Fire Protection Association • For every minute that passes, odds of survival decrease by 10% - American Heart Association Cardiac Survival vs Response Time cu co no Ct 84 C13 60 40 CO 0 1 2 3 4 5 6 7 8 9 10 11 12 13 Response in Minutes • i 1111 • • (sitive Results of Increasing Firefighter Staffing • Faster response times (by placing additional Engine Co's. in service) More efficient and versatile workforce • Decrease reliance on volunteer FD's • Improvement in WSRB FD Rating- resulting in a decrease in insurance premiums Benefits of placing a Firefighter / Paramedic on an Engine Company 497 • Paramedic gets to the patient faster Critical procedures are performed simultaneously /quicker with a team of 2 Paramedics vs. only 1 • More effectively Triage /Treat multiple patient incidents • Firefighter /Paramedic is trained in ICS • FF /PM can access pt. in a dangerous environment (confined space, high angle rescue, swift water rescue, Hazmat, WMD, etc.) • Benefits all of Central Washington by placing FF /PM on Regional "Technical Rescue Team ", "Regional Hazmat Team ", "YPD/YSO SWAT Team" & Mutual -Aid responses Long -term Stability and Experience in Paramedic position • Successful!' utilized in thousands of communities across the country for over 35 years (several in Washington State)* • • WASHINGTON COMMUNITIES SERVED BY A TEAM OF 2 PARAMEDICS COUNTY DEPARTMENT Benton * Kennewick Fire Department Clark * Vancouver Fire Department King Shoreline Fire Department Bellevue Fire Department Redmond Fire Department Seattle Fire Department Lewis Lewis County FPD #2 (Toledo) * Riverside Fire Authority (Centralia) Pierce * Lakewood Fire Department • * University Place Fire Department Pierce County FPD #21 (Graham) * Puyallup Fire Department * Tacoma Fire Department Skagit Anacortes Fire Department * Mount Vernon Fire Department Snohomish Edmonds Fire Department Everett Fire Department Lynnwood Fire Department Marysville Fire Department Spokane * Spokane Fire Department * Spokane Valley Fire Department Thurston Lacey Fire Department Olympia Fire Department Tumwater Fire Department * 1 Private Ambulance Paramedicc teamed with 1 FirefiQhter/Paramerlir. • _y.'J pl W i '� 1 I ',i , .c` r� -' r.I J p V irl a I: II G . 1 ,- r " 1 Paramed i s enough"... . ,_._ l -fir. a� r, -+.,�. F ' / , , __ , . .,..„ 1 J4 7 6. • Pfi At ®� AMBUL NCE 7 if • 0 • • 6 9 - wo Paramedics on scene will fight ov er who's in charge " ... • Each Paramedic has w ell defi roles & protocols • 2 Paramedic system has been around over 35 years PD /FD example INSTABILITY Constant flow of new Paramedics coming through Yakima Yakima is a "training ground" for Paramedics Medical community sounded the alarm: -'99: "Our Paramedic system has deteriorated secondary to fewer experienced Paramedics" (Memorial Hospital ER Physician). -'99: "...the unanimous voice of all the Yakima Co. Emergency Physicians that churning Paramedics is detrimental to patent care...it might be your wife or child that is being cared for by a rookie". ..(Yakima Co. Medical Program Director). - '98: "...a pattern of consistent turnover at the Paramedic level...a significant increase in Paramedic patient care mistakes has been noted" (Yakima Co. EMS & Trauma Council). - '97: "we are relatively dismayed by the lack of retention of Paramedics by the ambulance co's. in Yakima...there is significantly decreased quality of care delivery over the past few years..." (Medical Director, Providence Medical Center) 2006 -2008: Percentage of "ALS" Ambulance Company Paramedics either newly certified (right out of school) or recently relocated to Yakima = 61% FD Paramedic program offers long term stability and experience 0 0 0 "Adding more Paramedics will decrease their skill level "... iii:40, ji , , _ i t .,,,, ,„,„ .„3. 1 4 \ 1 ' " ' i - Institute a Quality Management program Create Partnerships w /Hospitals "Not all calls require Paramedics • Often determined by hindsight only • 911 routinely receives inaccurate /incomplete information • Emergency services respond "assuming the worst" • Tiered dispatch system ID • Ambulance Company's are not dedicated solely to the City of Yakima • Respond to emergencies throughout Yakima County • Inter - facility transfers Seattle, Spokane, Tri- Cities, Vancouver "April 30 = NO AMBULANCES or PARAMEDICS AVAILABLE Unfounded Concerns... This in NOT a Duplication of service! We will NOT be competing with the Ambulance Companies! The Ambulance Co.'s will NOT lose one dime of revenue! They will continue to transport EVERY patient! Goal: form a public - private partnership that IMPROVES the QUALITY of pt. care! • • • • • Life Safet y Investment MINNS Public • Increase of 25¢ • $165,000 (median price of a home in Yakima) • = $3.44 /month • Places a Firefighter /Paramedic on every neighborhood fire engine • Best bargain in health insurance anywhere City Government $20,000 Election Expenses / 1 25 EMS Levy Tax $1.3Million Generated Revenue $325,000 $975,000 Equipment /Operating 12 New Firefighters Reserves , �& 1 New Di spatcher • Transforms 2- person "Aid Car" (Rescue 91) into 3- person fire Engine Company (we already own it). • Creates new staffed 3- person Fire Engine Company (we already own it) • This plan meets current and anticipated future needs • • ZO EMS Le Tax $1.0 Million Generated Revenue $250,000 $750,000 Equipment /Operating 8 New FF's Reserves J & 1 New Dispatcher •This model does not provide sufficient staffing to meet current or future demands for service. VOTE NOV `08 INCOME RECEIVED HIRE CROSS TRAINED DUAL ROLE rn FIREFIGHTER PARAMEDICS START RECRUIT C ACADEMY _._ ._w_ _ r GRADUATE (D RECRUIT ACADEMY CONVERT 2- 3 PERSON "AID- 3- PARAMEDIC 0 CAR" INTO 3 - ENGINE PERSON FIRE COMPANIES CD ENGINE CO. BEGIN SERVICE • FIREFIGITERS START IN+ PARAMEDIC FIREFIGHTERS SCHOOL START • (CLASS #1) PARAMEDIC O SCHOOL (CLASS #2) CD GRADUATE 1PLACE ADDFHONAL CL PARAMEDIC �� 3- PERSON ENGINE SCHOOL (CLASS #1) COMPANY IN ( 1 Ycar after starting PM school) ! SERVICE m GRADUATE PARAMEDIC SCHOOL (CLASS #2) (1 Year aftcr starting PM school) • • • Key Supporters to Date: Yakima County Medical Program Director, Robert E. Johnson, MD AMR Ambulance Company YFD Firefighters Local 469 Elliott Insurance Service, Inc. Yakima County EMS and Trauma Care Council Yakima Heart Center, David W. Krueger, M.D., F.A.C.C. wntsfratemowf =as= J K'V'; , Yakima City Council Strategic Priorities Adopted March 2008 • Maintain and improve Public Health and Safety Promote Economic Development and Diversification • Build and Utilize Strategic Partnerships • Preserve and Enhance Yakima's Quality of Life Efficiently manage Public Resources and Ensure Fiscal Stability • Provide Responsive Customer Service and Effective communication 1111 ID Yakima County MEDICAL PROGRAM DIRECTOR 5110 Tieton Drive, Suite 370 • Yakima, WA 98908 • (509) 966 -5175 FAX (509) 966 -5176 June 23, 2008 Chief Charlie Hines Yakima Fire Department 104 N. Front Street Yakima, WA 98901 Dear Chief Hines: I am writing this letter in support of your proposal for Yakima Fire Department to upgrade to a non - transport advance life support service. I believe that this upgrade in service will improve patient care and outcome in Yakima. Currently, one paramedic is responsible for managing all intermediate and advanced interventions which, can lead to long on -scene times. With the addition of paramedics to the Yakima Fire Department I believe advanced level interventions will come earlier to the patient in need, on -scene times will improve and Yakima County as a whole will benefit from the increase in Yakima Fire Department specialized services. Sincerely, Robert E. Johnson, MD Medical Program Director dk • AMERICAN MEDICAL. RESPONSE!= June 25, 2008 Charlie Hines, Fire Chief Yakima Fire Department 401 North Front Street Yakwna, WA 98901 Dear Charlie: In follow up to our conversation on June 18 2008 this letter is to confirm the support of American Medical Response (AMR) for your goal of providing Paramedic level of care on your engine companies. AMR acknowledges and respects your actions to provide increased first response capability to the • citizens we both serve. We look forward to having an extra set of hands to provide care for critical patients in your community. This is a proven model between public and private service and we look forward to showing the community how well it works. Additionally, I am available to respond and discuss with you or any of your elected officials the benefits and merit of your goal. Sincerely, Rod Chandler General Manager, Yakima • 0 *Owl - MicarlOilut SERVICE ANEE THE DIFFERENCE iliviiillESS • riiafri a:'& insurance service, inc. luly 14. 2008 morarrti r PI el VPILIET - Poor' ctrntar 1030t d'elk. 'AWN, istikPINIGNA MO? VI MOM Wriii T Mitord3.I$10 Ylitima City Council 129 N. Second St. Ytairritt, WA 98901 To the Council; As you 'mow,. the Yakima Fire Deprutrnent, along with tlf3 anibillailte, responds to all potentially life-threatening eniergency calls. The YFD anives ilif.g Bpproximately fifty pervert of the time with till least one emergency medical technician but without a paramedic. This means that time is often lem, than optirnat expertise at the Simite until the ambulance with a aturatordir tirrisimr. It is my grong opinioo that there should be a paramedic on each Y F1.3 unit respctiditig to these emervenciec. Two paramedics working together • simultaneously with their advanced skills can only work toward speedier stabilization and tramspNtation, if necessary, of the patienr. 1 1. potential ancillary positive effect of hiring and training firefighter paramedics is a redaction in Yakima's foe Fut:alien class. Currently the Washington Surveying and Rating Bureau nit Yakima es PC .4% Lower protection class numbers remit in tower insurance premiums. The principal effect wcaild be for commercial and industrial fiSk.t. Wel CiliCa the size of Yakima mull PC 3 rutin. Having such a hating can only be a plus in attempting to attract new businesses to the area I hope and trust that the Council will give serious consideration to this need. Ni doubt there will be a need to place a funding proposal (at the November haiku.. t think that with proper explanation, the cintens of Yakima wili approve a =sociable levy to support ii. Sincerely, t d‘ek filtd \ lechard 1.1. Eill ion — i l k Nom ill .riz 1 ...4 .... Yakailrra C ouoly EMS and 'Trauma Care Council 5110 T u .n Drive, Eunio 370. Yakima. WA 966CS• 1960 1 10613 41 7 5.FAX 1504:, 96E..5176 Jury 14, 23tk9 B arlasd Clarke Sot.rth Contra Ron EM5 & Tr& tine Care Cc,jr tl 177E "Fowler, X19 RIrh3nd, VA 993S2 Dear t36rbrti Chief Charlie Hines, Y.i#jIrna F rt L' partr-wn1 presented a proposal to The Yekirth Count • EMS 6 Trauma dare C jr Yet 11a F•ra Cepa mem# 10 13;xxicnn an Advanced Life 5uppor1 First Aid Agency and to be mums **MEd a1 that tevr: Alter a presentalm and much WiCLIMIll the C urtltt voted 60 ap sruve the updyede to A L5 tar Yakma F re Departmeni arm flaw Chief Hnrs make his p•ezeri13l in t' tl a SOUP) °C n1raI Rego" EIIS • & Trauma Care Council 11 you Nog any gtx:stinns or concerns, please contact the EMS Oft* t3 (509) 966 -5175 5iraarety. 613,0 flvat)1/4.-. Barb Evans 1008 Cha r' Chief Chahir. Hr u_, Candace Harr}ttiri. Manager Robert Johnson, iJ VPD • d � rcn"s.• of 1 ICA k' . 1 � ,.YAKIMA 1 Ar HEART CENTER.=.. ASHUTOSH V. BAPAT, M.D. DUANE A. MONICK. M.D., F.A.C.C. ROGER E VIELBIG. M.O FA C.0 Richard K. Spiegel, M.D., MARK S. BERMAN, M.D., FAC.C. DOUGLAS5 A. MORRISON, M.O. PFD.. F.AC.C. D GUY GARRETT, M.H S. P.A. -C F.A C C OMER A. EL - AMIN, N.D. ROBERT A.ORTIZ M.D., F.A.C.C. GRETCHfN KAl2ER, P.A MaeQa' uppkx KEVIN P. FOLEY. M.D.. F.A.C.C. A.B. PREACHER M.D., F.A.C.C. LESUf MAERKL P.A ANATOLE S. KIM. M.D. FAC.C. VICTOR V SHARPE 111, M.D. SCOTT MILLER. PA. 'C Shawnie Haas, R.N., MBA, DAVID W. KRUEGER, M.D., FAC.C. RICHARD K. SPIEGEL, MD., F.A.C.C. DUFFY SAWYER. PA..0 Operations � R THOMAS MCLAUGHLIN, M.D.. F.A.C.0 RICHARD D TWISS, M.D.. F.AC.C. PATRICIA SNELL. M.S.M., AR.N.P. July 17, 2008 Charlie Hines, Fire Chief Yakima Fire Department 401 North Front Street Yakima, WA 98901 Dear Chief Hines: Upgrading our emergency medical system with Fire Department paramedics will definitely improve patient care in Yakima. Our cardiology practice hospitalizes a large number of severely and critically ill patients, and this proposal has only positives: faster response time to the scene, more paramedics at the scene, and more experienced paramedics that will stay in Yakima. Seattle adopted this over 25 years ago, and has long • been recognized as a national leader in emergency care. What works well in Spokane, Tacoma, Everett, Bellevue, Olympia, and Kennewick and 20 other Washington communities will be effective and worthwhile here in Yakima. Knowing that Yakima is at the bottom of the state's fire personnel per 1000 population only adds impetus to adding paramedic to our Fire Department. The percentage of medical versus fire calls has been a decade -long trend toward increasing medical emphasis. As an 18 -year cardiologist here in Yakima 1 strongly support this proposal for improving emergency medical services for all of our community. Sincerely, I y 1)• W. Krueger, M.D., F.A.C.C. DWK:kh DWK:kh 406 S. 30th Avenue, Suite 101 sigmiguyERYADDRESS Administration Fax 509- 248 -2890 Yakima, WA 98902 406 S. 30th Avenue, Suite 201 Main Fax 509 -453 -4319 509 -248 -7715 Yakima, WA98902 Purchasing Fax 509- 574 -0338 What follows are letters written by: • Memorial Hospital Staff • Regional (Providence) Hospital Staff • Yakima Heart Center Staff • Yakima County EMS & Trauma Care Council • Yakima County Medical Program Director That identified a "high /consistent turnover rate ", "inexperience ", "patient care mistakes ", "errors in patient care" from Paramedics. "Overall Paramedic system has deteriorated secondary to • fewer experienced Paramedics." And finally, a plea to "do what is necessary to reduce the turnover of Paramedics." Yakima County MEDICAL PROGRAM DIRECTOR 104 N. First Street, Yakima, WA 9 6901 • Phone: (509) 57 • FAX: (5C9) 574 -1931 M E M O R A N D U M FR: DATE: 1 have enclosed the paramedic longevity study completed on January 12. 1999. 1 look forward to your groups' comments on the tonic of oararnedic longevity. 1 am olty EM AMR has . and 46 with less than or equal to two years exper;e::ce. ALS has (7 o of :he paramedics with less than one year and :.i? with .ess than two years 1 would appreciate a lecrer from the physicians at Yakima Valle' 4leinorial Hospital sratin_ your concern. I have spoken to Dr. Nana, and Wayne in . and Wharcom Court . • Thanks For our .ts31st3n :: JP do • • • itki A -998." Tom Eglin, MD, FACEP Chairman, Emergency Department Yakima Valley Memorial Hospital 2811 Tieton Drive Yakima, WA 98902 Dear Dr. Eglin: The members of the Yakima County EMS & Trauma Care Council would like to thank you for taking the time to write regarding paramedic tenure, and performance. As you mentioned in your letter, the accuracy of the tenure data was questioned. Since that time, the Council has requested current rosters of paramedics and their tenure status from all paramedic ambulance services within Yakima County. After receiving the requested information, the Yakima County Department of ' mL: �- -:icy \1vdic 11 Services verified the data The tenure by agency indicates a pdrite•rr, :o:t tstent turnover at the ;: :.r.— uedic level particularly to the upper Yakima V.lie reviev, • f f,itn. a significant Mere ze in paramedic patient care mtctakes has been noted Like you and your associates we to are very concerned about these findings, and we have • received a letter from the Providence Yakima Medical Center Emergency Department Physicians mentioning similar concerns. The Yakima County EMS & Trauma Care Council has developed a committee to work on this problem, a meeting was held recently with representatives from paramedic employers, the Council, and the Department of Emergency Medical Services. This committee will be working on a plan to correct these problems. The Council will be monitoring patient care concerns and paramedic tenure every six months to determine the success of any plan that is implemented. We ask that you and your associates please bring any ideas for a solution directly to this council. With all of the concerned parties working together, we are confident that we will find a proactive solution. We look forward to working with you in the future to improve prehospital emergency medical services throughout Yakima County Once a plan has been developed, a copy will be provided to concerned parties. Sincerely, Dave Leitch 98 Chairperson • ch,stne Bare, v _ o_ < ;_ R; Aa,o c - V.155 nammstrsaa ✓ F a_ - R E. ". V: = - R:.,'eR E ' v , 'c rL EP V R H.,P ti SP .. - ".i... ,, ,.. GaRp P . Bran Pease F A MARY;- 9E°h.aN \:C P, RCIAr i___ AF Assc 3tS A s:;w March 4, 1999 Jim Perez, M.D. Providence Yakima Heart Center Emergency Department 110 S. 9 Avenue Yakima, WA 98902 Dear Jim This letter is in response to our conversation on 3/3/99 about the possibility of 12 -lead ECGs being done in the field, As you know, most acute transmura) myocardial infarctions are now treated at Providence Yakima Medical Center with acute angioplasty. The quicker that an occluded coronary artery can be opened, the less damage there is to the myocardium. We feel that a 12 -lead ECG done in the field could facilitate getting a patient to the catheterization laboratory in a timely fashion. This is not so much of an issue in the immediate vicinity around Yakima, but is more of an issue in the Lower Valley and at long distances east and west of the Upper Valley. There have already been several cases of ECGs being done in the field in the Lower Valley which had a significant impact on the time to angioplasty. From our conversation, I understand that an ECG machine is being purchased for an ambulance in the Sunnyside area. Ideally, all ambulances serving areas outside of the immediate Yakima metropolitan area would be equipped with 12 -lead ECG machines. We realize that is an expensive proposition, especially for the companies that have multiple ambulances. ou also made me aware 401 the relatively high (urtru,sr rate for xarc c; . ,11ts area You indicated that low salaries were a major contributing factor Because of the rapid turn - over, and because of the large number of critical skills needed by paramedics you indicated that training in the performance of 12 -lead ECGs would necessarily be a lower priority than other procedures and skins 302 South 10th Ave. (509) 248.7715 P.C. Box 942' Yakima, WA90902 FAX (509) 453.4319 Yaaurca,'WA :: i �YAKIMA HEART CENTER • Perez, M.D. March 4, 1999 Page 2 l would be desirable to minimize the turn -aver or paramedics in the area to allow broadening of skills ark: expertise, including the performance of in -field ECGs. With this letter, I am adding the support of the physicians of Yakima Heart Center in your efforts to what is necessary to reduce the turn-over of paramedics Adequate salaries would be the foremost consideration Thank you for taking your time to speak with me yesterday. Sincerely, Richard K. Spiegel, M.D., F.AC.0 RKS:cb 4110 MEMORIAL HOSPITAL YAICIiMA VALLEY MEMORIAL HOSPITAL • Members of EMS Council Yakima County EMS Services 104 North First Street Yakima, WA 98901 Dear EMS Council: I understand a recent study found statistics showing 'nat 42% of pv amt,lic 1'' >a- d" Y,,; 1QPCe 'hi"- is _t.,curh. tip, , tue 'a - high turnover of lark of inrentave for paramedics and advanced EMS personnel to stay in the Yakima vicinity. Although I understand the percentages have been questioned somewhat, and are perhaps not completely accurate, it does seem to point out a concern that we have had regarding the lack of incentives for ' the more highly qualified EMS personnel in Yakima : „ t i:sa, s :cn wltn the rjr -- u' +- an Hospital there is a consensus amonc . � i5,ry•` , . ,'?. that the iumtt r• of incidents Involving errors }.•a t'. ; a' = r. :•aramad;cs All of the physicians were supportive - to retain the more highly qualified paramedics. We wculo like to see incentive programs to increase the level of performance of paramedics and advanced EMS personnel in Yakima. This would improve the incentive to stay in Yakima and promote retention of qualified paramedics and EMS personnel. This should include educational programs on a routine schedule. Also we will be trying to encourage more frequent use of reporting forms when problems are identified so they can be dealt with, and hopefully resolved through education and follow -up with the paramedics involved. Sincerely, 714 Eglin, M.D. .`hairman, Emergency Department fakima Valley Memorial Hospital TLE:bkc 12 ?5/97 - 12/8/97, 14004 cc Jim Perez Medical physician director Emergency Medicine Services, Yakima County 11111 Providence Ya 'ma Medical Center 0 5 9th ;en ue Te 5'5.5001 Yakima, Wasnington '. -3397 EMS & Trauma Care Council /� FROM: Roben S. NesIand, M.D., FACEP �"' �' ' f Medical Director, Emergency DemirinGit Providence Yakima Medical Center Paramedic Seniority DATE: November S, 1997 our department meeting on November 7. 1997, Dr. Perez shared with the physician group the data relating !o retention of paramedics by the ambulance companies in Yakima. We are relatively dismayed by the lack of • r etentior of experienced paramedics in our community as reference to the EMS data showing 42% of practicing, full -time paramedics have less than one year experience. It is my impression and impression of others of our professional emergency physician group that there is 4ignificancly decreased quality of care delivery over tar past dears in the Yakima Valley. In the past years, it was standard practice that the new graduating paramedics worked under a seasoned. experienced paramedic gaining practice perspective. 1 do feel that the new graduating paramedics are trained excellently but gained field experience takes a considerable period of time. This is true with many endeavors in medicine even physicians who graduate after four years in medical school cannot be licensed to practice independently. Three years experience is usually required under a structured. supervised training program. I feel that the new paramedics gain perspective in handling patients in the field also need a significant period of proctoring. I would hope that your committees explore the causes for the rapid turnover of paramedics in our Y na region and can encourage some remedies. • MEMORIAL HOSPITAL YAKIMA VALLEY MEMORIAL HOSPITAL 2811 TIETON DRIVE YAKIMA, WASHINGTON 98902 (509) 575•B000 Feh ua ♦ 2.2, 1 99 5! Jim Perez, MD Medical Program Director Yakima County Department of Emergency Medical Services 104 N. 1" Street Yakima, WA 98901 Dear Jim: Today at our monthly meeting of the YVMH Emergency Department Group we discussed the report regarding paramedic longevity in Yakima County. The group noted that the survey verified statistically the physicians' feelings that we are losing experienced paramedics at a rapid rate. in Yakima County. The physicians further agreed that our overall paramedic syste i. ' ° ,, r ' secondan n,—t Medics. L?nfortun tc! . the physicians had few solutions to this high turnover of paramedics given the current private ambulance system here in the Yakima Valley. • As a _.roue ;se yen interested In rc^, crsing the trend of losing, :u.rd paramedics. To this end we would support programs through your office or through the county that encourage methods to retain experienced paramedics in Yakima County. If this would mean discussing the situation further with Yakima County Commissioners or others in political authority we would certainly welcome this opportunity. Please feel free to contact me regarding further attempts at correcting the paramedic longevity problem in Yakima County. Sincerely, • Jim Avery . Yikima Valley Memorial Hospital JKAllms 4110 Mike Campbell Yakima County Department of EMS 104 N 1 Street Yakima, Washington 98901 Mike I am have written this letter to offer my opinion on the matter of new Paramedic orientation policy. I hope that some of my personal experience can offer some ideas while the DEMS is re- evaluating the current policy. It has always been my opinion that the current Paramedic orientation process is somewhat flawed. It is very easy for an individual to become certified to work "solo" as a Paramedic in this county with very little orientation time or without any real test of skills. ne Increasing numbers , nrpi.; should he made to ensure the compete. of all Paramedics new to this cnuntv It seems peculiar to me that of all of the health Ware fields that our onentatton time is one of the shortest, especially when contrasted with the responsibilities of the job. In this county a Paramedics can essentially practice on their own, right out of school Currently the county only requires a minimum of 120 hours, the equivalent of 5 shifts. It would not be reasonable to imagine that someone could expect any semblance of competency in such a short period of time. Once a Paramedic has been certified, the education process begins anew. The paramedic program is not an independent study program so neither should the field experience be an independent study Proficiency in • the required skills used to pass the tests does not necessarily mean that the individual can competently function immediately in the field. Nothing of which you see or do is exactly as it was in school. New Paramedics do not have intuition or street smarts, which take time to develop and could lead to trouble. The actual field experience that one receives, as a Paramedic student should be questioned somewhat also, as what a student is actually allowed to do varies so much from service to service. That is why the Paramedics need to spend more time under a watchful eye in a situation in which they have total patient care. 1 know that a significant portion of my "field experience" was usually watching rather than hands -on Due to the lack of calls 1 had to "discussed" the majority of the county checklist rather than actually perform the skills I was allowed to work shortly after completing the minimum amount of time. My saving grace was that my regular partner was a Paramedic and I had the advantage of another 3 months with an experienced partner. In my opinion even 3 months is less than that of which is really needed to become competent enough to work "solo." I was at the top -end of my class along with being one of only 5 in my class to have passed all the tests the first time around out of the 24 in my class. Yet it took me over :gar betwe ' was truly comfonable in my skills as a Paramedic. -,pending time with another Paramedic allows an rndieutual to learn at a ;r orR: rciase t pace and allows them to feel more .2ontfortahle with the tact that they h; • ,ante knowledue and experience around the carnet A1v personal opinion is thief at the v least, a new Paramedic should need to complete tt minunum or rr months o'' 3..ti • • full -time work with a Paramedic partner prior to the point that he or she is released to work on their own That is why t propose the following ortentationtprobation plan With the priority being the desire to provide the best patient care possible, I would suggest the following orientation program that would need to be completed prior to being cleared to work "solo." 1) A period of time in the field with another Paramedic on a full -time basis of no less than 6 months. Upon completion, if approved, in which the opinion(s) of the Paramedic, MPD and county director agree, could be permitted to practice solo or the probation extended to ensure the competency of the individual to work solo or the individual. A) No Paramedic should be allowed to act as preceptor unless the individual Paramedic has completed at least 24 months of continuos, full -time employment in Yakima County. The preceptor(s) should be in good standing and approved by a group involving the MPD, DEMS, company representative, peers etc or whatever is deemed appropriate to facilitate the choosing of quality preceptors. B) In order to further facilitate proper evaluation of new Paramedics, only one or 2 Paramedics should be assigned to each individual as preceptors throughout the probationary period do. This will allow for a more accurate evaluation of skills and knowledge. C) All standards should be somewhat concrete and inflexible as to eliminate the potential accusations of "politics" that would probably naturally follow any decision to extend any probationary period. D) Standards should be set up to designate preceptors officially as "Senior Paramedics" as recognized within Yakima County. There should be no limit to the number of Senior Paramedics as long as they meet the minimum standards and are approved by the appropriate group. The standing of Senior Paramedic could be revoked for cause via standards set by the DEMS By setting up a standard, there would be no ambiguity as to who would be and would not be allowed to precept new Paramedics 2) Revision of the checklist The checklist standards should be set up as to insure competency in all areas that are deemed important enough to place on the list. They could be assessed by a practical skill examination but preferably they should all be performed in the field if possible 3) All tests, practical, written or otherwise should be administered both at the beginning and at the completion of the orientation process prior to obtaining approval to work "solo." Separate tests could also be administered at the beginning and end of each orientation period per DEMS standards • 4) Upon receiving approval to work "solo," the Paramedic will continue on probationary status for an additional 6 months in which the MPD, DEMS, supervisor or designated senior Paramedic continue to monitor progress through run reviews and/or other methods as approved. If necessary they could require additional study, preceptor shifts etc. _upon successful completion the Paramedic will be removed from probationary status. In implementing an orientation/probationary period we can do two things. We can reduce the number of any individuals that could slip through the cracks while ensuring a higher level of competency of the newer Paramedics than we currently have. In implementing this new program or a variation of it, a new status of Paramedic is created within the county. It would be a benefit to both companies to retain these individuals for training purpose It would also benefit the count! as a whole to keep experienced Paramedics working in the county rather t' :., ik 1n _ .. "i: tier that we currenil‘ have Wh ' 7rovr: m or Cr^lihst tr th“. we can ensure a higher level of competency for the new Paramedics prior to their release to work solo. It would also provide an incentive to keep the more experienced Paramedics around which benefit both the companies and the Citizens of Yakima County. Sincerely 7/144 Chris Holt • PO Box 9892 Yakima, Washington 98909 Pager 577 -5650 Home 698 -4312 •