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HomeMy WebLinkAboutEmergency Services Committee Minutes 06.28.2010 MINUTES EMERGENCY SERVICES COMMITTEE JUNE 28, 2010 5:30 P.M. COUNCIL CHAMBERS Members Present: Doug Poehls Chuck Dickerson Norm Stamper Emelie Eaton Dick Fritzler Pat Kimmet Others Present: Bill Sheridan Brent Peters Jan Faught Job Descriation: Chief-Emeraency Medical Services Chairman Doug Poehls announced that the topic of discussion on the agenda was the job description for the Chief-Emergency Medical Services. The public who were attending the meeting would each have three minutes to talk if they wished. He explained that this job description and another job description for a Health and Safety Officer were presented at the previous council meeting. The council approved the job description for the Health and Safety Officer, which is a new position. However, the council approved a motion that the position of Chief-Emergency Medical Services not be voted on until it was presented to the Emergency Services Committee for discussion. At the City Council meeting, it was learned that the Mayor had a discussion with AMR. At first it was thought that it was to replace the Laurel Ambulance Service, but the Mayor was investigating the City of Laurel's options if there were not enough ambulance attendants to service the ambulance. Mayor Olson had asked AMR regarding the criteria for them to answer ambulance calls in Laurel. Doug pointed out that this was only an investigation and there was nothing before the council to cancel the Laurel ambulance. He explained that tonight's discussion was only on the job description. He handed out copies of the current job description for Jan Faught's position and copies of the new job description with the changes to the ambulance director's position. The major difference is the requirement that the director be a paramedic instead of a basic ambulance attendant. Jan Faught, Ambulance Director, spoke to the committee. She handed out a statistic report that is kept for all the calls and responses that are made by the department. She has a crew of 26 well-trained EMT's and they all contribute time. She said there is not anything in the State of Montana that requires an EMS director to have any medical training. Jan said that Ken Threet is head of the EMS department and Board of Medical Examiners and anyone could call him. She works with him often and also the Department of Public Health and Human Services because they oversee the transporting licenses, with which she has to be in compliance. The Board of Medical Examiners is in charge of the EMT license and she is up to date with the state rules and regulations. Jan said she has not been spoken to by the Mayor or CAO about issues with the ambulance. She said there has not ever been talk in the past about having someone come in and take over in any case. She said that when a call cannot be met now, AMR comes in and takes the calls. She explained this is not because there is not anyone on duty, but because there may be two ambulances out already and they get a third call. The multiple calls are going up because of the call volume. This would be the only time they need AMR. She said the department is running with ALS (Advanced Life Support) skilled endorsements. The department is licensed as a Basic Life Support (BLS) but has the option of running as an advanced life support. The option is offered by the state. It took the department at least one year of intensive training for the crew to get the endorsements and each new person is trained by the training officer, who is a paramedic. Therefore, the job description has no basis for the director to be a paramedic. If the city does decide to go to an advanced level of transport, then the training officer would be the one in charge of the skills. She explained that the medical duties are separate from the administrative duties. Jan stated that this job description is similar to ones that she has given to the Mayor and CAO because the old one was in place before she even started. She has requested a new and updated job description several times. The duties of the job have completely changed from what they once were. This new job description is the one she has asked to be put in place for this position without the word "paramedic", which is the only difference she can see. She works with other agencies on a continual basis, which is part of the job. She knows where her resources are in case of a disaster. She knows the other EMS directors in the county, including Carbon and Stillwater Counties, and these are the people she will call on for extra help. She has tried for several years to get mutual aid agreements in place with no success from the city. When the ones with Park City and Joliet expired, she had never been able to get them renewed. She stated that Park City is only seven miles away and Laurel should be calling on them when needed. Joliet is just as close as Billings, and Billings can be at least a half hour if they have a rig available. Their main concern is covering the city of Billings and not assisting other calls. She believes the best service is what the city has now, which could include better recognition and stipend for the training they put in. She pointed out there is not anything in this job description that would need to be filled by a paramedic. Jan said if this job description is passed, chances are there wouldn't be any paramedics applying. There would be no way a paramedic could keep up their skills. They have to be recertified every two years with so many credit hours, training, and be affiliated with a service that can sign off for them. Laurel is not an ALS service and they would not be able to get signatures to renew their licenses. It would not be a position that is interesting to someone in the paramedic field because it is a basic level service. Jan pointed out, with the training officer and crew that the city has and with the endorsement levels already learned, the Laurel Ambulance Service is only a step away from becoming an ALS service. Because of the training officer, there are minimal charges to the city for the training courses needed. The department is very close to moving to an Advanced Life Support, with little cost and with the same volunteers. She said when looking at this, she cannot think there would be any major change to the service itself. She cannot see why the job she has done for twelve years is now in question and that she cannot fill it. Jan clarified that the only problem she sees with the job description is the requirement for the director to be a paramedic. She also answered that no surrounding services require a paramedic to be in charge. Her training officer is a paramedic and works for AMR and volunteers for the City of Laurel. He operates as a basic service for the city and cannot use his paramedic skills. Laurel also has another ambulance attendant that is a paramedic. They are able to keep this status because they are working with an ALS service. A question was asked what it would take to have these attendants run as a paramedic for the city. The answer was to switch from a basic life support transporting license to an advanced life support transporting license and have a medical director sign off on that. She also answered that the city does not have a medical director at this time. She pointed out that she had a medical director lined up for the city from the Billings Clinic ER, who was willing to sign paperwork that was required. He was asking for compensation for his liability insurance. Jan said she was told by the Mayor that it would be covered if they got an ER medical director and so she requested a letter from the city for the $2,000.00 for his liability insurance. She said she made many requests to Derek Yeager,who was her supervisor at the time. Jan stated she never got this letter so this person lost interest and moved on. She says she has another interested person, but she cannot go forward without the city's help. She had also mentioned it to the Mayor and to Bill at the time she met with them that she had a medical director and needed a guarantee letter. The Mayor then told her there was not going to be a guarantee letter. She said it is difficult when no one communicates. She was told Derek was her supervisor when he was here and now she questions who she answers to. The job description says the mayor is her supervisor but that changed once. Jan was asked if surrounding communities pay for a medical director. Jan referred that question to another ambulance director in the audience and she replied they do not pay for their medical director. The$2000.00 would cover liability insurance and some compensation for them to come to Laurel and join our training. The department is required to run by protocols they set for them. He would get to know the crew and the method by which things are done, and he would advise the crew on any changes. She said most of the time the state protocols are sufficient. Jan stated that while the department is actively seeking a medical director, they are not under a liability issue with running as an ALS. The state gives the department the time to look for a medical director. Emelie Eaton asked if finding a paramedic as an ambulance director would exempt the city from needing to find a medical director. Jan said no, as the medical director has to be an ER doctor if the department wants to go to an ALS service. Jan was asked what services the ambulance cannot provide now because there is not a paramedic. The main difference that a paramedic can provide is first round cardiac medications. The first round medications cannot be given to someone that goes into cardiac arrest, which could make the difference between saving a life or not. The Laurel ambulance service used AMR six times in the last twelve months when medications were needed. The city's reliance on having a paramedic is going to get less and less. Jan was asked if she felt it would be beneficial to the city in expanding services if there was a medical doctor. She said for the City of Laurel to advance at all, an ER medical director is needed. For the city to stay at the current level, the service could have a medical director who is a doctor. She says the city will continue to run on volunteers unless they step up and pay. It gets harder to find a volunteer to fit the higher level of qualifications, as most of the time it would be the person's career. Emelie Eaton asked Bill Sheridan to comment on why this resolution was brought forward. He stated that it is not in the city's best interest not to have a doctor available to the ambulance service. The city has been advised to at least have a paramedic on the service. He was asked who advised the city to put a paramedic in the position of ambulance director. He answered a doctor did. Bill was asked why the city had not accepted the ER doctor that was ready to work with the city. He was not sure and referred it back to Jan. She said it has always been her position to obtain a medical director and she has always done that since she has been working with the service by going out to recruit and fill out the state paper work. The city has not been involved with finding the medical director. She said the medical director is on the side of the state requirements rather than the city's requirements. She mentioned she has been doing her job to find a medical director and had gotten one. She said there is still lack of communication because now she is surprised she heard the city was looking for a medical director. Emelie asked Bill if the city checked into the state protocols with Ken Threet, of the Board of Medical Examiners, in regards to changing to a paramedic. Bill was not aware of it. He said that the city talked to two doctors, and they recommended that the city have a paramedic as the ambulance director operating the service to properly provide the emergency medical service to the community. Emelie asked the difference in the amount of pay between what Jan makes as the director of a volunteer service and what a paramedic would make. Bill did not have any information about that but thought the amount of pay that Jan makes would be offered. Chairman Poehls opened comments to the public. Susan Huntoon, 501 Cottonwood, Laurel: She said Jan has been making money for the city while working the past twelve years. The service makes money for the city and does not cost money for the city. Jan does a good job with her job description. The city already has two paramedics and maybe should spend money to train all the rest of them to paramedic statues. It would cost less than paying what it would pay somebody to come in. The $2,000.00 a year for an ER doctor would be good fiscal responsibility. She is appalled at what the city is trying to do to the wonderful ambulance service there is already at a minimal cost. Terry Obritschkewitsch, 4255 Wheat Ridge Road, Molt: She has been an attendant for a year and says Jan has done a wonderful job. The last year has been very stressful because of supervision changes. She believes it is Dr. Louis that the Mayor has been talking to. He is in charge of AMR, which is a conflict of interest. That will help AMR if Dr. Louis becomes the medical director. She asked why our director is not able to find a medical director instead of the Mayor, who does not have a lot of medical background. Her question is why this job is being switched. Jan has been the director for twelve years and it has been run really well. So why is the job description being switched to take her out of her job and not to do her job. Phyllis Bromgard, 216 Yellowstone, Laurel: She said what if the Laurel ambulance is no longer here, and what if the people have to rely on someone else. She said Laurel can beat out Billings any day. She belonged to Search and Rescue and they beat Billings to their own incident. So do not take our ambulance away. We need them here. If our ambulance is gone, we won't be able to get Billings here fast enough. If Billings has two or three calls, it will go to their calls first before it comes here and then who will be responsible. Chuck Dickerson reminded the audience that this meeting is to discuss the job description and not to get rid of the ambulance service. Elliott Grayson, 600 Byam Road, Laurel: He has been a part of ambulance service committees in Billings and has been an EMT for ten years, and has fourteen years of professional fire experience and volunteer backing him. He has talked to four or five counties surrounding Laurel who have paramedics running their ambulance. AMR of Billings ran with an EMT basic for four and half years while they searched for someone qualified higher. Lockwood Fire currently runs with an EMT basic as head of their paramedic department. AMR is not the only paramedic department around. There are doctors that are willing to do what we need to take this service the next step. We need a city that is going to back us up and take us to that next step. He said we currently have the paramedics to run the service. We have people in training to become paramedics through the college at their own expense to serve the city better as a volunteer. He said there is a lot not being said here. He stated this job description is just another why to get them out. Its consequences are irrevocable. Once they lose their volunteers, they are gone for life. What they need is the city to back them. It does not need a paramedic to do the paper work. They have people to do the job of pushing paper right now at a decent cost to the city. If the city wants to hire that position, be ready to open up to $100,000.00. A paramedic that works the street today in Billings is $37,000.00. Not even close to what our director makes. The current paramedic director of AMR makes almost $125,000.00 a year and $125,000.00 a year would put five or six full-time people on the street here in Laurel. They do not teach you in paramedic school how to push paper. They teach how to save lives. Nothing about that job description has anything to do with what you will find. Chuck commented that Elliott talked about this job description and that they are on their way out. Elliott said he was not talking on the job description his director wrote but was talking about it after the word "paramedic" was put in. Elliott then explained that a paramedic has to work under a doctor. Under state guidelines, an ALS service has to work under an ER doctor. This job description does not get them an ER doctor. They can get an ER doctor today who oversees them and still let them run as an ALS for little or no cost to the city. The cost the city is talking about for this position would pay for a dozen medical directors. He clarified that according to this job description, they do not need a paramedic, but they do feel they need a medical director. He said the ambulance attendants see the doctors and interact with them on a daily basis. The doctors know their skills, but the Mayor or Bill does not know their skills. They do not see the patients they bring in or the lives they save by getting them there in a timely manner. Norm stated that this job description came to the council two weeks ago for the first time. Nothing was known about it until that time and some had a problem with it. That is why the council made a motion to bring it before this committee for discussion. Elliott asked why this committee did not know the city was in contract negotiations with AMR. Chairman Poehls stated the city was not in contract negotiations. They were doing investigation work on AMR. Elliott said that AMR just employed eleven people to cover another shift to Laurel. Chairman Poehls commented that is AMR's choice. There was no contract with AMR or it would have gone before the council. Elliott said this is his point with the job description. The job description would have left them high and dry for months, if not years, without someone to run it. He works with emergency services and AMR and knows the directors and who they have been talking to. What the directors would like to see, if they continue with them at a basic level, is to have AMR respond on every call they go on to decide whether a paramedic is needed or not. What they do not say, under state law, if a paramedic leaves and transports on a basic ambulance, their license is done because they abandon a patient. Also AMR has protocol; if they are called, they will take you out, rain or shine, of Laurel's ambulance on the side of a busy road, anywhere, and put you in their truck. Chuck Dickerson said the council members are on the committee to do what is right and best for Laurel. It is in the best interests of everyone, including the volunteer ambulance service, that this meeting was scheduled for everyone to be able to express their opinion. There have been a lot of rumors. He has been asked why all the councilmen were not showing for the meeting, which is because they all serve on different council committees. Pat asked for clarification, the city does not have a medical director. Elliott verified the city can get a medical director. He clarified the term BLS (Basic Life Support) and ALS (Advanced Life Support). The city of Laurel is BLS, but they are trained to do ALS skills. In other words, Laurel is basic with endorsements. Laurel cannot do the endorsements without a medical director. However, since Laurel is in the process of actively looking for a medical director, they are allowed to do them. At some point, this would stop and they would go back to a basic level. What the state has been looking into is a state-wide medical director, because so many services are having the problem of finding an ER doctor to help run with these endorsements. This is three to four years out. Pat asked what the things were that Elliott said were not being stated here tonight. Elliott said the issue is this position leaves them without anybody. They are concerned with losing their service and if this position is filled, it still does not cure their problems. It still means they rely on AMR to come in and take the patient away from them. Doug asked what would prevent that from happening. Elliott said a medical director to let them keep practicing at their current levels and allowing them to advance. They have two paramedics and two intermediates, which is the step above the basic EMT, with endorsements that are full-time ALS. Doug asked if the paramedics could operate at a paramedic level in our ambulance if they had a medical director. Elliott stated they could with the medical director's blessing and changing their license to an ALS. The equipment on the truck would be a little different, which would be a problem, because they have nowhere to secure the drugs. If they go to a paramedic level, they are going to need over three-fourths of that building just in storage and locked rooms. Emelie asked for clarification. She asked if the ambulance service could support the individual if a paramedic was brought in at a director level. Financially not, and with six calls in twelve months, one person would never be able to get all their qualifications done. They would not be able to practice enough to have a doctor sign off and say their skills are complete. Kara Hergenrider lives in the community, is a single mother, and gives up time from her children to do what she loves for her community. If it is only$2,000.00 holding them from obtaining a medical director, then they are not above applying for grants or hitting the sidewalks and asking for donations. They will do that year after year if that is all it takes to get $2,000.00 a year. A council member mentioned that he heard at the council meeting the amount was $5,000.00. Kara said whatever the amount, they would be out there doing whatever it took. She said there is grant money out there. Whatever the amount, it is a lot to ask a doctor to put on the line to come out here to our community to do the training needed. There is continual training for basic skills as well as ALS endorsements. It was pointed out that this job description is not impacted by the fee. Bob Alegria, from Park City, and has been on the ambulance crew for twenty-six years and a fire fighter for twenty-two years. He is the director of ambulance service for a BLS. He stated that a paramedic is not needed. He has worked with Jan for at least fifteen years and she has done a fantastic job as a director. She does EMT classes and they have had their EMT's trained by her. As someone from outside of the community and a volunteer who does not get paid, he believes getting someone that gets paid does not mean they are a better person. He has dealt with AMR, who are paid professionals, but would rather deal with the basics than with these professionals. Eric Frank, from Park City, was an EMT there for about 15 years and was fire chief there for several years. He is now the disaster emergency services coordinator for Stillwater County. The coordinator, as what Jan is doing, is an administrative role. She does the job of encouraging the staff, who this city has protecting this community as well as doing paper work and other skills. If the city brings someone else in that the team does not know or trust, you will not have twenty-six people on the staff in this community. The trust will have to be built, and Jan had done that from six people to twenty-six. He said he has helped and been involved with some of her EMT classes and has done one refresher course. He says she puts on an excellent program by keeping the staff motivated and gives excellent service to the community, along with helping and supporting some of the smaller communities around here. Park City has sometimes needed extra help and having the local communities around to work with is a big consideration. He asked would the city have that if we have someone coming in that does not have that same small town attitude and wants to work with those surrounding communities. It works both ways, as Park City has come this way as fire fighters or EMT's to assist. He expressed the importance of being there to assist each other. There is that community involvement. He said he thinks it is an administrative rule of having that level of paramedic, but does not think it is a necessary responsibility of someone, as administration, doing the paper work. Alyssa Francis lives on Rock Hill Drive in Billings and is an out of district volunteer. She said she heard someone from the audience ask for clarification of a medical director and ambulance director. She said the medical director is the one that gets paid the $2,000.00 and would be a physician. The ambulance director would be Jan's position. Emelie Eaton asked Bill about the statement someone made that Dr. Louis is the AMR doctor. She asked him if he was the doctor the city was speaking with, and Bill's answer was yes. Emelie asked if this is the doctor that advised the city to get a paramedic in the director's position. Bill said Dr. Louis specifically did not say we needed a paramedic, but another doctor suggested it. Emelie stated that then the city has spoken with two doctors, one being Dr. Louis and the other is the one that recommended the city to get a paramedic. Bill said that was correct. Emelie questioned if Dr. Louis didn't say to get a paramedic. Bill said he did not say yes or no. It wasn't an issue he brought forward. A person from the audience asked if the other doctor was Dr. Bush. Bill replied no, and that he was not at liberty to say at this time because he was asked not to mention it. After commotion from the audience, Chairman Poehls said it was understandable that a doctor did not want his name a part of this right now. Emelie spoke to Jan in regard to a line in the job description under minimum qualifications where it says candidates with experience in fire based EMS services will receive higher consideration. She asked Jan if she has experience in fire based EMS services. Jan said one year since they put her under the fire department last May. If they are not going to be under the fire department, it would be irrelevant to have any experience in fire. She said they do two different jobs but have always worked with the fire department. Emelie clarified that a fire based EMS service is just someone that accompanies the fire department when they go out in case there is a need for an ambulance. Jan said yes, and replied that before Derek Yeager was hired by the city, the two departments were separate departments until then, when they put the ambulance department under the fire department. Emelie said then the words "fire based" means being under Derek Yeager, who was the fire chief. Jan replied maybe. She said to be honest she did not know what it means because they do work with the fire department very well and always have. They have to be a team when they are on a scene. Jan said no one offered or asked her to move up to a paramedic position. She said that was something else that could have been discussed. Pat Kimmet asked Jan if she supported the job description if the one sentence was removed, Must have a certificate of currency as a nationally and Montana registered Emergency Medical Technician Paramedic. Jan replied yes,just the one word, Paramedic. Actually it does not need the wording Emergency Medical Technician Paramedic at all. This is not an administrative managerial position and does not have anything to do with medical training. No medical training is needed to do the administrative part of it. What she feels is necessary is that they are still a volunteering service. She is still out there answering calls as if she was a volunteer, so she is a valuable person in that aspect in keeping the calls answered. That is different than being a chief of EMS. It would be her recommendation to strike the work paramedic. Emelie asked Bill Sheridan why Jan was not asked to become a paramedic to fill this position if a doctor advised the city to have a paramedic in this position. Bill replied that he did not think anyone checked into her becoming a paramedic or told them she was interested in being a paramedic. If she is willing they would support her in becoming a paramedic. A question was heard, financially? Bill said it would have to be within the scale of pay that she is now at. The city does not have the extra money to put into that. Emelie wanted to clarify a statement from before that the city would expect to bring a paramedic in at the level of pay that Jan is making right now, and Bill replied yes. Emelie then asked if the city is not prepared to pay any more. Bill said it is not that they cannot, perhaps there are funds for that, but they would like to stick with what that pay rate is. Emelie asked Jan what it takes to become a paramedic in regards to time and cost. Jan said it is a two-year course at the COT and a cost of$10,000.00 a year. An associate's degree is necessary. In the year 2013, there are other courses available that are a little cheaper, but just as time consuming to finish these courses. If the courses are not finished by 2013, one would not be able to be licensed as a paramedic. So the best bet is to go through the College of Technology's program and it could be more than $10,000.00. It would be very difficult to do her job and go to school full time. It would also be difficult because she is not making that much. Norm Stamper clarified that any decision the committee makes tonight is just a recommendation to the council. Norm moved that they recommend to council that they do not pass the job description as written and also request that this committee be involved in further work for a medical director and where to go to dissolve the issue. Motion was seconded by Chuck Dickerson. Norm said in regard to EMT's being involved in the Emergency Services Committee, Jan Faught is always welcomed and expected to be there. It is an open forum of business and they are always welcome and the committee looks forward to their recommendations. Chuck Dickerson said the committee meets on the fourth Monday of each month at 5:30 p.m. The Emergency Services Committee is for emergency providers and is also open to the public. Meeting adjourned. Respectively submitted, Neva Hall