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Highlights of CAG report on Fire and EMS integration

Feel like some light reading? The 117-page CAG Report on Possible Integration of EMS and Fire can be downloaded from the San Juan County #1 Public Hospital District's website.

The five-member Citizens Advisory Group (CAG) presented an abbreviated version of the report at a joint meeting of the PHD Commission and San Juan Island Fire and Rescue Commission at the Mullis Street Fire Station Tuesday evening. The commissioners praised George Johnson, Dan Paulson, Chuck Dahlford, Rick Frazer and Mark Tompkins for their dedication and the hard work they have done over the past year. PHD staff member Nathan Butler received accolades for the work he did helping the group. And Karin Agosta was thanked for her help with organizing all the pieces.

Both boards passed motions to accept the report and to form a task force to figure out the implementation of combining the two agencies. The task force will include the Fire Chief, the EMS Chief, a representative from the Fire Board of Commissioners, a representative of the Hospital District, and a representative from the Town of Friday Harbor. A discussion of whether the meetings will be open to the public, like all the CAG's meetings were, ended with the decision to let the task force decide. The majority of both boards were not in favor of having all the meetings open to the public.

San Juan Islander will post an article on Wednesday with quotes from the meeting. Here are the highlights of the report. 

RECOMMENDATION: Within the next two years, the two Boards (SJCPHD #1 and FD #3 and the Town of Friday Harbor, with the support of the San Juan County Council, will integrate SJEMS and FD #3 into one organization with a single leadership structure. 

ABSOLUTE CONDITIONS OF THE RECOMMENDATION: 

1. Cross-Trained Paid Personnel: All paid full-time staff, except for the administrative support, must be dual-qualified as either firefighter/paramedic or firefighter/EMT. A short grace period should be provided to existing staff to achieve the required training and certifications.

2. In-house Staffing Paid Personnel: All paid personnel should be based at a station when on duty within the highest call volume timeframe or population area based on data. A team of EMS and Fire personnel should be based together so responding equipment may be chosen for the type of call. The team should consist at a minimum of a firefighter/paramedic and a firefighter/EMT.

3. Capital Equipment Plan: A capital expenditure plan needs to be developed for a minimum of a five-year projection that is budgeted, approved and funded each year.

4. Key Performance Indicators:  Metrics with key performance indicators must be established for financial, managerial, and operational oversight for both EMS and Fire. These metrics should be used to make decisions on how the organization is directing itself. These metrics should be measured on a monthly basis and reported at regular Board meetings. A formal presentation of the metrics should be presented annually to the community.

5. MPD/MPDD involvement: Each of these individuals (depending on design) need to have a close relationship with the Board when it involves medical/response decisions. At a minimum, the MPD/MPDD should attend quarterly Board meetings to report and participate with the Board. [The MPD is the county's Medical Program Director. Currently it is Dr. Michael Sullivan]

6. Operational Budgets: Fire and EMS operational revenue and expenditures must be budgeted and tracked separately to measure the financial performance of each operation (i.e., EMS or Fire). Doing so will allow costs to be monitored and compared against the specific call volume. The financial performance should be reported to the Board monthly.

7. Board Expansion: With the addition of EMS, the Fire District should expand the number of elected commissioners from three to five members.

 BENEFITS OF THE RECOMMENDATION:

1. Improved Response Times: By basing paid personnel at the appropriate station 24/7, response times should decrease for a majority of calls. This is a key element to be measured.

2. Depth of Volunteer Resources: Better than 50% of the volunteers support both organizations but need to divide their time when supporting a non-integrated system. While on duty, volunteers will only be assigned to one. The integration will allow for better scheduling and higher availability to meet each response appropriately.

3. Unified Command Structure: On many emergency calls, both EMS and Fire respond due to the nature of the call or the need to have extra manpower to accomplish the tasks. When this occurs, two command structures are employed, one for EMS and one for Fire. These separate command systems can lead to confusion at the scene, potential safety issues and the risk of poor outcomes. By combining both services, there will be a single point of command for EMS and Fire.

4. Simplified Levy Management: Currently, if either EMS or Fire requires a levy change, the organization must bear the expense and effort itself. After integration, a single EMS/Fire levy will simplify that process.

5. Financial Benefits: Financial benefits should be recognized in multiple areas of the budget. Initial consolidation may take some additional expenditures to accomplish the integration but moving forward, the budget should be reduced to a sustainable operation. Cost savings should be recognized as follows: • Reduction in total staff numbers between the two organizations • Reduction in duplication of expenses in both the administrative and operational budgets • Reduction or consolidation of professional services provided.

6. Unified Training Program: Under a unified training program, staff (paramedics, EMT’s, and firefighters) will train together, improving emergency response. Training, continuing education (CE), call review and QA will be closely monitored and coordinated. In addition to improving emergency response, this has shown to improve departmental morale and has helped with the recruiting of volunteers.

 CONCERNS OF THE RECOMMENDATION

1. Loss of EMS or Fire Primary Focus: While the idea of emergency response may be a joint approach for both EMS and Fire, the actual operations of each are very different. As a combined Board, there is now a constituent consideration to address with two distinct focuses.

2. Personnel Concerns:

With paid personnel being based at a station while on duty, the Collective Bargaining Agreement will need to be reviewed.

Transferring all EMS personnel into Fire District.

Cross-training EMS personnel as fire fighters and vice-versa.

Requiring new paid staff to be dual-qualified (firefighter/paramedic or firefighter/EMT).

IMPLEMENTATION RECOMMENDATION

1. Annex of the Town of Friday Harbor into Fire District #3: This was a recommendation during the 2010 integration of the Town of Friday Harbor Fire Service with Fire District #3. Annexation will allow FD #3 to manage the revenue of both EMS and Fire under one levy. It will also provide Town residents the opportunity to vote for Fire District Board members and hold those elected officials responsible for the emergency services they are supporting. A plan should be developed to encourage Town of Friday Harbor residents to support the move to a single levy for EMS/Fire.

2. Conduct a lid lift for FD #3 levy to support EMS operations. It is recommended that FD #3 ask for a lid lift to its current levy to include EMS operations. If this is determined not to be the best course of action, then a new EMS levy under the Fire District may be the solution. With the integration of services for EMS/Fire, a new operating and capital budget should be developed to determine the amount of the new levy. This budget should be presented to the community with justifications for the amount. In no case shall the lid lift or new EMS levy under the Fire District exceed the amount currently collected by the Hospital District for EMS services. 

3. SJCPHD #1 EMS Levy Take $0.00: Reduce the Hospital District’s EMS Levy to zero dollars as soon as the Fire District’s new levy rate (or new levy) takes effect. Allow the EMS levy to sunset on it’s scheduled end date.

4. Outer Island Determination: Because of the different district boundaries that define the EMS and Fire levies, a determination needs to be made by the community and each of the Boards on a strategy to deal with the different boundaries. One of the main objectives of the CAG was to avoid any reduction of services currently provided. It was very difficult to accurately describe the services provided to these islands, as there appears to be no clear expectations regarding levels of service. The islands included in each of these Levy Districts are: i. FD #3: San Juan, Brown, Pearl ii. SJIEMS: San Juan, Brown, Pearl, Henry, Spieden, Stuart, Dinner, O'Neal, Cactus, Satellite, Johns, Cemetery, Gossip (aka George), Goose, Sentinel, Turn, Flattop, Low, Battleship, Barren, Posset, Pole, Ripple, Gull Rock, Danger Rock, Happy, Guss, and Reef Point.

IMPLEMENTATION ISSUES AND CONCERNS

1. EMS Licensing (Local, Regional, State): The EMS license cannot be transferred from SJIEMS to FD #3. Therefore, FD #3 should immediately apply for a new State license to provide EMS services in the same service area. A new license will also be needed for Medicare/Medicaid provider numbers.

2. CMS Provider Numbers: Provider numbers will either need to be transferred or new provider numbers obtained so that FD #3 can bill for EMS services. 

3. Transfer/Hold/Sell EMS Building: FD #3 must decide if -- and when -- to consolidate EMS operations into the Fire District’s building. If the current EMS building stays with SJCPHD #1, the Board will need to determine how to finance the property since the bond must be paid off when the EMS levy revenue ends.

4. Accounts Receivable: Any outstanding accounts receivable (fee for service) after the transfer will need to be managed until the accounts are closed.

5. EMS Outstanding Levy Collection: How will levy collections be received and managed during the transition?

6. System Design Services: Transfer of billing operations from EMS to Fire.

7. Budget Development: A new budget will need to be developed for the combined organization.

8. State Investigations: Any ongoing State investigations will need to be worked through during the transition.

9. Inventory and transfer of all assets: An inter-local agreement is needed to transfer EMS assets from SJCPHD #1 to FD #3.

10. Liabilities: Any SJIEMS liabilities incurred prior to the date of service integration remain with SJCPHD #1.

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