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Managing Ambulance services in the county

Managing Ambulance services in the county.
As you know from the article last week, things are getting heated up again or still as critical decisions are made related ambulance services in the county.  It’s hard to understand the position we are in unless you have a little historical background.  Here is some information that will give you a little more perspective on the problem.  Keep in mind that it would take the whole front page to cover it completely.

How did we get here? 
The State of Utah allows Counties to control the license to operate an ambulance service in their jurisdiction. The County can choose how best to serve the public with that license. For years, the County allowed the local ambulance service to operate through the Heber Valley Hospital.  EMTs were hired by and paid through the hospital.  Ambulances were purchased and housed by the county. Personnel and medical management by the hospital was very limited. We had administrative management and a medical director provided through the hospital.  I was an EMT at the time.  We had very little contact with the medical director.  Most of the time, I didn’t know who the medical director was. I think the hospital assigned the local doctors to be the director on a rotating basis. The EMT group mostly managed itself. It ran much like a club.  Once hired, EMTs participated in group training, continuing education classes and helped in regular minor rig and building maintenance duties.  Wasatch County public works took care of most major ambulance repairs.  That was before 2000.

Why things changed:
In 2000, due to additional revenue requests by the hospital and potential for financial benefit, the County decided to take the license back and run it as a semi private county organization.  I was one of the three commissioners at the time.  The EMTs were no longer employees of the hospital but for a time, the hospital still ran payroll.  Ambulance personnel and operations continued to run as an internally organized, semi-private group under the county. The ambulances were housed in the County’s Emergency Services building on 100 South in Heber. To keep separation from the Counties other employee groups, the EMTs hired an employee leasing company to run payroll but were covered under the county’s general liability insurance. Since then, EMTs have taken care of everything except major repairs and purchase of the ambulances. But, as the ambulance had more runs, more exposure and occasional turf battles with fire for space in the building, the county manager was asked to step in and help.  That’s where the Murdock’s come in.  There have been many many very special people from the community participate as EMTs over the years.  To name them all would take the whole page and I would obviously miss some. However, in order to understand where we are, I think it’s important to understand the Murdock’s part in this picture.  The Murdock’s didn’t just participate as EMTs; they made it their family’s hobby and passion.  It was their goal to become the best trained EMT’s anywhere.  Dr. Murdock specialized in emergency medical care and service as that passion carried on.   Once he became the medical director, he made it his goal to train our EMT’s so that Wasatch County would have the best emergency medical care anywhere. Doug has spent countless hours and personal resources in this endeavor and the effort has succeeded.  When a Wasatch County ambulance is called, the patient will get care unrivaled by any community, no matter the size.  Dr. Murdock hasn’t done this by himself.  There have been dozens of dedicated people who put some of their personal lives on hold to serve the community as EMTs.  Many are very dedicated to Dr. Murdock because of his efforts in their behalf. The EMTs know who the medical director is now.

Over time, as the number of calls has increased, (1350 last year) liability exposure and litigation potential has also increased requiring more oversight.  Another major change happened when the form of government in the county changed from a three member commission who were in charge of all legislative and administrative activities to the present council/manager form of government.  Under the new form, finances, personnel and day to day management of all county operations falls under the manager, Mike Davis including EMS personnel and the medical director.  The council is charged with making legislative decisions and giving Mike Davis direction on general policies.  The County Council is also the supervisory board over the fire district. It’s a little confusing.  Add to that the addition of an ambulance to operate from the Jordanelle station in which and the mix gets more interesting.     

How do we stop this fight? 
First, our EMTs have been self managed as a group for years and many, particularly the Murdock’s, are not very happy about stricter management by Mike Davis.  Friction is especially high between Mike Davis and Dr. Murdock.  Simply put, Mike is ultimately responsible for operations and must have management control.  Dr. Murdock is responsible for medical protocols provided by our EMTs and EMT safety.  Doug is highly trained, very confident and does not take kindly to being told what to do or questioned about anything regarding EMS.  Essentially, we have two strong willed men but one is the boss of the other. Mike Davis has stated that his only option to get control is to replace Dr. Murdock with someone more manageable.  Attending the meeting (last week’s report) was an attempt by me to breach the impasse and get Mike and Doug talking again.  At the meeting, I told Dr. Murdock that he must be more “flexible” and “manageable” if he is going to be included in future emergency management decisions.  I did not suggest that Mike Davis should be fired.  His is so exasperated with the present quandary that he feels he has nowhere else to turn.

Second, the council is divided on the subject of EMS and Fire responsibilities.  Some would give all EMS service delivery to the fire district immediately.  However, others consider the present delivery method to be very cost effective and efficient.

My opinion:  It is my opinion that if Dr. Murdock is to remain the medical director, and there are many reasons why I think he is the best choice, he must reach a workable truce with Mike Davis, and he must do it very soon. It is in Dr. Murdock’s court to choose.

It is my opinion that ambulance services should retain responsibility for extrication the way it is now. Also, that we should dispatch fire personnel when fire concerns are present and that all should work together in whatever capacity they might find themselves on the scene including extrication.   This plan gives the public the benefit of years of extrication experience and a cost effective, incident driven service as well.  There will be more discussion on this in the next few weeks. 

In the mean time, remember:
No matter what the leadership decides to do, whether they work for the ambulance or the fire district, we have the best EMTs anywhere.  It’s time to get inflexible personalities out of the way and work together in the best interest of the public.
As usual, I invite your comments mikekohler2009@gmail.com


BY MIKE KOHLER   08/26/2010



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