After reading numerous articles and submissions in regard to the proposed fire tax, I am concerned just how many people don’t seem to be aware of what emergency medical services (EMS) they have available to them in East Contra Costa. I would like the readers and public out there to know that if they think this tax is necessary in order for them to receive prompt, professional, well trained, emergency medical service, they are mistaken and uninformed.
There are two parts to a response the way the EMS system is set up in Contra Costa County: the first responders (I’ll elaborate more on this in a bit) and the ambulance. With the exception of San Ramon, Moraga and Orinda, ambulance service is contracted by the county to American Medical Response (AMR). Every single ambulance in Contra Costa that responds to an emergency has at least one paramedic (paramedic means they can provide Advanced Life Support, also known as ALS) and one emergency medical technician – basic (EMT); sometimes there are two paramedics in lieu of a one paramedic one EMT configuration.
The AMR ambulances are payed for on a fee-for-use basis only; your tax dollars do not go toward providing ambulance coverage. Simply put, you only pay for the ambulance if you use it, and to elaborate on that, you only pay for its use if you get transported. For the ambulance and its paramedic to show up and evaluate and/or treat you, but not transport, costs nothing and you pay nothing for that service.
Now, the first responder aspect is in addition to the ambulance. Along with the ambulance being dispatched to medical emergencies, first responders are dispatched as well. These first responders typically consist of the fire department and their personnel. The general belief is that in a medical emergency you want trained personnel to get to you as fast as possible to begin providing care while the ambulance is still possibly en route. Also, there are some instances where additional hands are needed, such as moving patients to the ambulance cot or in the event of a cardiac arrest, where multiple hands are needed to perform CPR.
With this tax proposal, East Contra Costa Fire says it will use part of the tax fee to provide paramedic service on its fire engines so the citizens of East County will have fire department paramedic service (currently they staff EMTs).
What I fail to see mentioned time and time again are two things: 1) East County already has paramedic service on every single ambulance that responds to its emergencies, and: 2) as part of its contract with Contra Costa County, AMR already provides experienced paramedic first responders to East County. These AMR paramedic first responders are actually stationed 24/7 at fire stations in East County (station 52 – Brentwood, station 59 – Discovery Bay, station 95 – Bethel Island) and respond in conjunction with the fire department (and the ambulance) to all medical calls.
Additionally, there are two ambulance stations staffed with two paramedics each, 24/7, in the area, one in Brentwood and the other in Antioch just on the Oakley border (there are also many more paramedic ambulances that cover East County in 10-12-hour shift increments, which remain on the road and are not in stations).
East county citizens: these AMR paramedic first responders are provided to you at no cost. They are part of the ambulance contract due to the fact that East Contra Costa Fire does not have paramedics on its fire engines. First responder paramedics and ambulance paramedics are not dependent on this fire tax; you already have them!
Finally, an important thing to note is that these AMR first responder paramedics are dedicated for medical calls regardless of the fire department having to perform fire suppression duties. If this fire tax is passed as is, and paramedics are staffed on the fire engines, two things will happen: 1) the county will no longer require AMR to provide these first responder paramedics and they will be removed, and 2): as a result of the dedicated AMR first responder paramedics being removed, in the event a firefighter/paramedic is performing fire suppression duties when a medical emergency occurs, they will be unable to respond – in contrast to the AMR first responder paramedic, who would have been able to regardless of the existence of a fire incident.
Please don’t be scared into thinking this tax is needed in order to provide paramedic service to East County, because it simply is not.
Gavin Consveer, Oakley
The argument that we should continue to consume resources at the rate we are just because we are paying for them now doesn't make sense to me. Give me the less expensive, 7-paramedic model, even if it means I pay $10 per year in duplicate taxes. Even if it takes 3 more years to get rid of the current tax, (which we will never do if we stay dependent on it) it'll cost us a total of $30 each to shrink government spending by a net $800K per year and get more service at the same time.
I also disagree with the comment "The reason is that if it wasn't for fire departments responding to medical calls then there is absolutely no way they could justify their massive existence today." I think the existing need for trained people to perform rescues, deal with hazardous material spills and put out fires in buildings, wildlands and boats is more than enough to justify their "massive existence." They don't deal with that stuff all the time, so why not utilize this expensive resource more often via medical responses, especially if you can do it by upgrading firefighters for $61K each instead of paying $400K each.
OK Bob this may be your only correct statement yet;
"County Health does not “pay” ConFire, as you state. They are simply the agency responsible for distributing funds collected through other means, in this case Measure H monies".
Stop being idiotic again. Our tax money from County Health services, Measure H, Measure XYZ. So what, a tax is a tax is a tax. The fact is we pay already.
Even if your information is correct for 37K per station (of which I do not believe ), you still have supported my point about redundancy for part of this new tax.
Stop your BS Bob and show some financial common sense. People are tired of paying more taxes for special interest and duplication of services.
We need more firefighters, more stations, District Independence by LAFCO terms. Real solutions before political special interest boondoggle like you are trying to sell.
The district was on the right tract when it was going for an elected board and true independence. I do not know what behind the scenes special interest changed their minds but it was probably the same people who have drove this fire district to insolvency (and the housing crunch). Putting the cart before the horse has been the norm and the failure so far. I do not support that.
Bob you can rant all day long about this area of the new tax. You can't justify it based on the circumstances and facts provided you. Call everyone a liar, an alias, or any other 50 cent word. It does not change the fact people want their taxes spent efficiently and new taxes more efficiently.
You cite opinion based blogs. Two of them this morning. I cited official county documents with actual figures in them that pertain to EMS in East County.
These are your words:
The reason is that if it wasn't for fire departments responding to medical calls then there is absolutely no way they could justify their massive existence today.
So take a shot and point out where in Contra Costa County we are so flush with fire staffing that your words hold water. If that statement does not apply to our situation, then why would you bring it up? Go ahead and point to any fire service agency in the country to which it does.
Did you forget that the third or fourth on an engine is a fireman first? How does removal of his Paramedic certification change the need for his presence on that engine one iota?
You again claim I'm posting misinformation. You make that claim in broad brush, innuendo fashion. Point specifically to what I have said that you have issue with. It appears it is you who's a little shy on supporting your statements.
You have made serious accusations of me and when you opened online, you made some pretty serious ones about fire personnel, presumably in Contra Costa County.
Do you have any information to directly dispute the figures I laid out today or is the ad hominem attempt to discredit the focus for you at this point?
Doesn't exactly sync with the statement you made earlier saying you welcomed civil dialog.
To answer your other question, no, a paramedic arriving in 8 minutes versus 11 minutes to a cardiac arrest doesn't matter. What matters is someone trained in CPR with defibrillation capability responding as fast as possible and hoping that if you do code it is a in public place with a bystander willing to do CPR to keep your brain perfused, otherwise by the time the wheels start turning to get to you you'll be brain dead regardless if they get your pulse back or not.
You may be happy I'm not on the board, and I'm just as happy as your not with false claims and misinformation and using outdate incorrect information to back up. Then when you are called out on it there is no acknowledgement of your error, you smoke screen to another argument, You have no accountability and I guess that means you'd fit right in with the rest of em. I wish I could make it to the meetings but for your information not everyone in this world works a 9-5.
Unfortunately your comment from Walker does no good here. You did not relay the full context or when it was said. For all we know this is an anecdotal comment that was misunderstood. In the past you have cited 7 and 8 year old emails. What is your documented source for the $85k?
Within just the last week County Health/EMS presented to the Board of Supervisors a fairly comprehensive document which covers well the available EMS funding and how it’s distributed to various agencies. County Health does not “pay” ConFire, as you state. They are simply the agency responsible for distributing funds collected through other means, in this case Measure H monies.
I am trying to find out if the document is online and I will post a link if it is, but basically ConFire is receiving $182,951 for BLS services and $1,032,576 for ALS in Measure H monies to fund Paramedic services for 28 stations. For ALS, that’s an average of a little less than $37k/station, John. Far below your claim of $85k. This is a document prepared by Walker’s staff, so the validity and currency is not in question here.
Now by contrast, ECCFPD’s much smaller District is currently receiving $22,999 for BLS and $1,243,005 in equivalent ALS through the QRVs. So for a District that’s 1/3 the size, we’re already receiving more dollar value than the much larger ConFire District.
Clearly a case were privatizing to save costs isn’t working in practice. If you think you’re going to go brow beat County officials for more money on top of these facts, you’re probably going to get some cold stares.
Again, I hate that the focus here has been on QRVs, but since we’re here let’s look at the breakdown.
Today in ECCFPD:
$1,243, 005 for 3 available first responder Paramedics through a private company. No guarantee these QRVs will remain beyond the current contract which expires in 2014 or that the cost for them would not be put directly on taxpayers in the District. Currently they are “sweeteners” to the contract and effectively subsidized to East County residents through patient billing.
Proposed:
Increase of approximately $10/lot or $430k total for the District to roll out Paramedics on 7 or 8 engines(TBD).
Now by my simple math, to pay $430k for 7 or 8 faster responding Paramedics is a better value than to continue to get 3 at a valued cost of $1.243 million.
Gavin, I will take your word until shown otherwise, but I'd expect your name to show up on the voter rolls or for you to weigh in at ECCFPD fire meetings, particularly since they are held in your backyard.
Go ask other countries? Really? So you want ECCFPD to be the guinea pig model for a new approach to EMS response for the whole of the country? But because I'm curious, which other countries did you poll?
I made no claims about skill set comparisons, so I'm unclear where you're going with that tack. But you're distracting from the point. In a full cardiac arrest scenario, are you going to suggest that 11 minutes is better than 8 for a Paramedic response?
Let's say an elderly person goes down in the core downtown area of Brentwood. Who is first on scene? Engine 54, the QRV or the transport Paramedic supported ambulance?
We're an aging population with baby boomers all reaching retirement. I'm simply looking for the most cost effective solution that addresses the needs of the demographic. Nothing more, but nothing less either.
But at least we have you on record of where you stand with fire and it's consistent with comments you made earlier. In order to save a buck, you're perfectly fine cutting to 3 stations and be left with a District that cannot adequately respond to even a single alarm fire.
Thank goodness you're not in a position of authority or a voting member of this Board.
I'll give you some cases for example;
1) cardiac arrest - studies have shown that paramedics dont make much of a difference, if at all. Good CPR and quick defibrillation (can be done via AED) is what matters and makes a difference. A lay person can do this.
2) severe traumatic injury - ALS should never even be initiated on scene. These patients need rapid transport to a trauma center (fire engine can't help with that) and slowing down scene time to do things like start an IV have been proven to increase the mortality on these patients.
3) strokes - prehospital management of strokes is limited to supportive care, as in, if they are not breathing adequately help them breathe which can be done with BLS providers. There is nothing a paramedic can do to stop or slow a stroke. The needed treatment is rapid transport to a hospital so they can receive definitive care.
4) chest pains/heart attack - aspirin administration may the biggest factor in helping these patients and that is something the 911 dispatcher will tell you to do when you call. These patients shouldn't receive much detailed care on scene either as "time is muscle" when it comes to the heart and in a severe heart attack rapid transport with care in transport is the best thing for a patient so they can have more definitive care at the hospital.
I'm not advocating for AMR or any private ambulance company to run this county, but has anyone else ever wondered why if the majority or EMS calls are for medical requests that require transport to the hospital and true fire calls are so low why fire engines and stations out number ambulances 4/5-1? Go ask other countries what they think about the fire dept. responding to every single medical call in this country, they don't get it, and frankly neither do I. The reason is that if it wasn't for fire departments responding to medical calls then there is absolutely no way they could justify their massive existence today.
In terms of what is better from a healthcare perspective I would much rather if the # of fire stations were cut in and with that savings the county ran the ambulances through there EMS office and tripled or even quadrupled the amount of ambulances on the road, that is truly what would improve patient health and longterm outcomes.
I'm curious Bob, you are making it sound like there is a large difference in fire paramedics versus ambulance paramedics here. What do you think is different about them? Do you see a fire paramedic as being more skilled or trained then the other paramedic or do you think they can do more as a first responder paramedic then a, as you put it, "transporting paramedic". I'm not talking about things like fire equipment tools or the "jaws of life" (which btw, I have never seen used in my time in the field), because those things and skills are available wether they are paramedics or not. Simply speaking paramedic skill set and training here.
If the County Weighs in at even only 6 engines x $ 85,000.00 , thats $ 510,000.00. Therefore if it's only .03 cents a day for paramedics( Mr. Mankin's quote). This new tax should could provide another Five new Firefighter Jobs with that 3 cents a day, New Paramedics on engines with the County providing $510,000 minus $423,000 (3 cents a day) = a net gain to the district of $86,450.00 and still have 95% of the tax left over to bring back all the laid off firefighters and open all the stations.
This is exactly why transparency needs to be separated from B.S. Bob. Your sales pitch does not make sense. Based on your words for costing ( 3 cents )there should be paramedics on engines now and left over money ($ 86,450.00) for incidentals from county tax sources.
BTW. How do I know that your Bob Mankin anyway. You could be Gavin Consveer in disguise. You might even be a spokesperson for Piepho under alias. MMmmm
I'm not saying that to summarily dismiss your comments, but in fairness I believe I should know who's attacking me to claim I've posted misinformation. Also if you're going to attack public safety employees with your rhetoric. It would also make clear if you are a registered voter in this County to even have a say at the ballot box on this issue.
But to your question, for 3 cents a day we can upgrade from 3 first responder Paramedics to 8 and those 8 have, on average, shorter response times. In your own words, seconds count. This one statistic, all by itself, decides this issue for me personally.
So for that gain at that cost, why would you take issue?
BTW, I allowed you to confuse the issue earlier when you mixed in TRANSPORT Paramedics which are staffing the ambulances. That's a different animal. In fact, anyone who reads the contract will note that allowable response times for that resource can run as high as 30-40 minutes. It's apples to oranges to compare that to first responder Paramedics, which is what 5% of the proposed tax is intended to address.
I read your link. After you set aside some of the personal pettiness and sniping, I’m not sure I understand why a multi-skilled position of fire fighter/Paramedic is being vilified by the author. Have any thoughts on that? Also, they engage in the same tactic you used here and that’s mixing first responder Paramedics(where time is paramount) with transport Paramedics. They are not the same.
Still not sure why you and John are making this sound like a threat to AMR or the QRVs. Neither is on the table here. The District doesn't negotiate that contract.
Trying to be fair here, but this smacks a bit of someone trying to protect territory.
Unfortunately the general public continues to be brainwashed by mighty fire unions that scare them into thinking they need paramedics on fire engines or else.
http://thehappymedic.com/category/ems-2-0/
(Jun 17 posting)
http://lifeunderthelights.com/2009/08/my-thoughts-on-fire-based-ems/
There's a lot more out there if you care to look around. I'll see if I can find the study that shows more paramedics on scene are actually a detriment to patient care.
If it's truly about fire suppression ( as you so state ) then it should be easy.
Leave the QRV's alone and add another firefighter job. There may be enough for even two or three more firefighters. Maybe enough to open another station that normally will stay closed even after this tax. Bob your trying to defend redundancy of funds when they can actually be used for new firefighter jobs.
A single alarm structure fire requires 15 fire fighters to respond. If we don't pass this tax, we're only going to have 9 on duty at a time.
Simple math problem, folks.
Mr. Johnson, I'd recommend getting more familiar with why there is a $2.6M deficit. It's not due to overspending. It's everything to do with declining property values and prop tax revenue, which make up 94% of this district's operating monies.
It you think AMR does this alone, let me know the next time they respond to an auto accident requiring the jaws of life to extract the patient......or should I say customer?
If you're searching for a solution that fits all scenarios, it simply doesn't exist. There are times now when AMR resources are out of position or on a transport or a number of other possibilities and you get longer response time as a result. When the big one hits, we won't have enough of anything, quite frankly.
Point is you can't cover all things all the time.
My comment;
This is why if a new benefit assessment is going to be placed on existing homeowners to bail out what the county has failed to do , it be spent efficiently and not bypass priority needs before enhanced needs.
Your comment;
" This is not an enhancement "
Then Vince you state " further enhances the fire department "
Thats all I'm saying.
I know this debate will become very controversial and heated by next year. Many citizens will debate it. Many have different views. I respect yours Vince. I hope you will respect mine. I am still weighing in early on seperating all the information that is fact or fiction. The most important thing is we as the taxpayers get all the information, government be very transparent, and weigh the good along with the bad.
As it stands, if what Rick L says;
"All 43,000 parcels (vacant or not) will have to pay"
In addition, IF the county turns over $ 85,000 per engine as soon as they are staffed with a paramedic ( like Con Fire ),
I may reconsider my position. I do have that right I hope.
They will come from roll-ups and mutual aid agreements, just like they have for generations.
Rick, ask the Chief who and from where engines came to cover our stations during the Oakley railroad tracks fire. IIRC, CalFire was covering the one closest to me.
It's in the incident report.