Doctor stands behind requirements for Paramedics

[VentMedic]

Some of the readers' comments are interesting as well.

Doctor stands behind requirements for fifth Medic One unit

http://www.bellinghamherald.com/2010/03/05/1324731/doctor-stands-behind-requirements.html#ixzz0hhSC8sON

Facing public criticism and political pressure, the doctor in charge of approving paramedics to work in Whatcom County is maintaining his requirement that the staff of a fifth Medic One unit complete field evaluations before operating.

Dr. Marvin Wayne says to do otherwise would undermine his standards for medical excellence for Medic One, and go against decades-long requirements he's had.

Fire District No. 7, which covers Ferndale and surrounding areas, will staff the fifth unit. The five paramedics completed training at Harborview Medical Center in Seattle last summer, as well as a protocol exam and skills tests that Wayne requires for paramedics trained outside the county.

The final hurdle to operating is Wayne's approval on field evaluations, and delays in getting those are costing taxpayers, said District 7 Fire Chief Gary Russell.

Due to a long-running union dispute, the paramedics could not get the field evaluations locally and are doing them with a private ambulance company in Wenatchee. The union local representing Bellingham Fire, which is different from the union representing District 7 employees, argued its staff should man the fifth unit, and have refused to assist in the evaluations.

The calls District 7 firefighters need to be evaluated on have been infrequent - as of last month, they had only three out of the 25 calls they need - but they continue to go to Wenatchee at a mounting cost to taxpayers in District 7.

Russell estimates it costs $2,600 per week each week they're in Wenatchee. He said approving the paramedics to work would not compromise Medic One's standards of excellence.

"He doesn't need to lower his standards," Russell said of Wayne. "He just has to be flexible."

Bellingham Fire Department staffs the other four Medic One units. The fifth unit's creation was called for in the 2005 emergency medical services plan that voters approved to fund through a sales-tax initiative.

The plan calls for the fifth unit to operate on a part-time basis in 2010. Paramedics handle the most life-threatening 911 calls.

Bellingham Fire Chief Bill Boyd said he supports Wayne's position.

"Marv's getting a tremendous amount of pressure to change his standards on how these guys get certified, and I just think that's wrong," Boyd said. "It's pretty rare to hear someone say they need to lower their medical standards."

Whatcom County Council President Sam Crawford has conditionally proposed pursuing a split system - one that serves Bellingham and one that serves the rest of the county - in July 2011 if the unit isn't operating by then. But the contract between the city and the county that sets up how Medic One is funded and governed requires three years to elapse before one entity can pull out of the system, Boyd said.

WAYNE'S STANDARDS

Paramedics work under Wayne's license, issued by the state Department of Health, so he's liable for their performance. He has long required additional training for paramedics who are trained outside of the county, to ensure they know medical protocols used here.

Wayne said he requires this because the county's paramedic service is largely protocol-driven. With one hospital and a limited number of doctors to consult, paramedics frequently have to make decisions on how to treat patients, based on those protocols and their experience, he said.

"My job is to validate that the services are quality," Wayne said. "I don't feel that we have to defend giving good care."

The paramedics for the fifth unit have completed two of three requirements - a written exam to ensure they know the county's protocols, and a skills test - but each still has to complete field evaluations on five calls with a patient suffering a life-threatening injury or illness.

"The easy way out would be to put a stamp on these people," Wayne said. "I have one vested interest, and that's that we continue to care for patients."

SEATTLE EVALUATIONS

Russell, the fire chief, contends Wayne should give the paramedics credit for some of the 60 calls on which they were field-evaluated while training in King County.

But Wayne said Seattle operates a different system that allows paramedics more access to doctors to consult, and has shorter ride times with patients.

"Seattle was radically different than Bellingham," Wayne said. "It's a physician-dependant program. Ours is 90 percent protocol-driven. We have 45-minute medics that have patients a lot longer than other medics."

Jerry Martin, District 7's division chief of medical services and a former Bellingham paramedic, said Wayne's contentions are off base.

"We're asking him to look at these books (of the Seattle calls)," Martin said. "He hasn't even acknowledged this data."

Martin said paramedics trained in King County work in Mason, Kitsap and other large counties in Washington that have longer ride times without problems. In Whatcom County, paramedics have the option to consult a doctor at St. Joseph Hospital, he said.

District 7's paramedics know the protocols - they passed the tests. The field evaluations in Wenatchee, which Wayne approved and which show a paramedic's ability to lead and apply skills, are on protocols used in Chelan and Douglas counties, Martin said.

Wayne approved the Wenatchee evaluations because the protocols are similar to this county's, and the area is similar geographically, which would equate to similar ride times.

"These should be screaming that these people know how to do it," Martin said.

WENATCHEE

The District 7 paramedics have been working with Ballard Ambulance in Wenatchee since last November, said Shawn Ballard, a co-owner of the company.

Ballard said he's one of several people evaluating the paramedics and estimates he has ridden with them on 30 to 40 calls. In a letter to Martin, he gave his impression of their abilities and performance.

"From the beginning each of them has operated above that of an entry level medic," Ballard wrote. "The consensus of the other medics I talked with is they are street ready."

Ballard said each paramedic comes over and works three 24-hour shifts, answering all calls while awaiting one of the calls that fits Wayne's criteria before returning to Whatcom County.

"I think we are in some ways wasting their time waiting for them to see all the patients necessary to meet the criteria," Ballard wrote. "Actually, if you want my humble opinion, we are probably hurting them in the long term by delaying them getting out on the street and ... doing what they already know."

At a County Council finance committee hearing, Russell could not offer a timetable for how long it will take for the paramedics to get the calls they need to meet Wayne's approval.

He said he hopes Wayne will show flexibility in approving the paramedics to work here.

"We're just up against this one final hurdle," Russell said. "Give us credit for the calls in Seattle, give us credit for the calls over there (in Wenatchee) and let us operate."

Wayne said Russell agreed at the beginning to continue the Wenatchee evaluations until they met his criteria.

"The fact that they're not getting enough calls - why am I the bad guy?" Wayne asked. "I'm being singled out as the obstructive force here, and I'm not."

Bellingham Assistant Chief Roger Christensen credits Wayne for standing by his requirements.

"He's shown incredible fortitude and courage in sticking to his guns," Christensen said.

THE FUTURE

Christensen called for the labor groups at the heart of the union problems - the International Association of Fire Fighters local representing Bellingham Fire Department employees, and the union representing District 7 employees - to end their dispute.

"The labor groups have to resolve this," Christensen said.

Boyd cautioned that a fractured Medic One system would violate the voter-approved initiative, and perhaps invalidate the city and county governments' abilities to collect the sales tax revenue to pay for services.

"We're the envy of a lot of counties because we're not fractured," he said.

Russell agreed.

"We're not trying to compete with Whatcom Medic One," Russell said. "We're trying to support Whatcom Medic One."

Wayne said he will maintain his standards.

"Let's get this resolved," he said. "I'm not going to be the one to resolve it, but I am going to be the one who follows the rules."

Read more: http://www.bellinghamherald.com/2010/03/05/1324731/doctor-stands-behind-requirements.html#ixzz0hhSzPDLw

[spenac]

Even though his standards are to low I applaud him for not allowing the pressure to cause him to lower them further. Honestly this is another example of the public having no real clue what EMS should be they think of us as taxi drivers not as medical professionals.

[HERBIE1]

And the age old battle continues. This is the usual turf war- nothing more. The medical director is in charge of patient care within an EMS system. If he has questions about the training, skills, or competency of anyone who works under his license, he would be a fool NOT to require them to demonstrate a certain level of competency.

The article said that last month, the firefighter medics only had 3 of the 25 calls they needed to be evaluated on. How do you evaluate someone's skills unless they actually get a chance to perform them?

[JakeEMTP]

"Sigh". Here we go again. This is nothing more than a pissing contest. The IAFF local 106 doesn't think they need to pony up to the Medical Director's standards. The Medical Director requires that they do. What is the problem? Either measure up or move on. This is eerily similar to the debacle that is Collier County FL, same debate, different coast, same players.

Some of the comments are hilarious! It is not difficult to tell which posters are the hose monkeys.

[HERBIE1]

"Sigh". Here we go again. This is nothing more than a pissing contest. The IAFF local 106 doesn't think they need to pony up to the Medical Director's standards. The Medical Director requires that they do. What is the problem? Either measure up or move on. This is eerily similar to the debacle that is Collier County FL, same debate, different coast, same players.

Some of the comments are hilarious! It is not difficult to tell which posters are the hose monkeys.

The IAFF- and most unions- are not used to answering to anyone but themselves. The difference is, these days, many unions are being demonized because of their greed and inability to compromise. Think UAW and the airline mechanics. The legacy costs alone the employer is responsible for buried many airlines and GM. Many unions are faced with new problems- give backs and renegotiation of their CBA's, but for many businesses, these compromises come too late. Obviously public safety is a scad more important than something like making a new car, and as such should be the last to endure cuts, but the arrogance of the IAFF is a difficult thing to change.

[funkytomtom]

That's funny that they see what he's doing as a problem. While I read it I was thinking to myself "I wish we did that here." There's a huge difference between passing the in-class stuff or managing a patient for a short period of time and applying your knowledge in real life, providing care for a long period of time. I can't believe they're really bitching and asking him to lower the standards. Suck it up and meet the standards fellow healthcare professionals.

[AnthonyM83]

Who would be the contact person if someone from the public wanted to give an opinion on the issue?

[funkytomtom]

Who would be the contact person if someone from the public wanted to give an opinion on the issue?

good call I'd love to voice my opinion.