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Home » Archives » April 2019 » SJI Fire & SJC Hospital Boards Vote To Become One

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04/02/2019: "SJI Fire & SJC Hospital Boards Vote To Become One"


ig_FIRE_EMS_Combined-001 (87k image)
(Fire & Hospital District Commissioners on Tuesday -IG photo)


A year ago the boards of San Juan County Public Hospital District No. 1 (SJCPHD #1), San Juan County Fire Protection District #3 (FD #3), and the Town of Friday Harbor (“Town”), appointed a Citizen’s Advisory Group (CAG) to study and make a recommendation as to the wisdom of combining the fire department and the Emergency Medical Services (EMS).

Three days ago the two District Commissioners were presented with a 117 page comprehensive report, that made the following recommendation:

Within the next two years, the two Boards (S]CPHD #1 and FD #3) and the Town of Friday Harbor, with the support of the San Juan County Council, will integrate S]IEMS and FD #3 into one organization with a single leadership structure.

On Tuesday the two boards held a public meeting and voted to accept the recommendation in the report. The following is a short summary of the “CAG Report on Possible Integration of EMS and Fire:


CAG RECOMMENDATION

1.1 RECOMMENDATION:

Within the next two years, the two Boards (S]CPHD #1 and FD #3) and the Town of Friday
Harbor, with the support of the San Juan County Council, will integrate S]IEMS and FD #3 into
one organization with a single leadership structure.

1.2 REPORT TO THE BOARD:

1.2.1 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 rnetrics
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) needEach 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.

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.

1.2.2 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. \V'hile 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. \\!hen 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.

1.2.3 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).

1.2.4 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.
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).


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:

1. FD #3: San Juan, Brown, Pearl

12. 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.

1.2.5 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.



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