Partnership for the People
People are so angry today. Angry at the president, angry at Congress, angry about the war, angry about their health insurance and angry about the economy. Worst of all, they're angry at each other. When you enter almost any blog about anything, you can't help noticing their unprecedented disrespect.
Of course, bloggers are like radio talk-show hosts. They know they can say (or misspell) just about anything they like without accepting responsibility for it. But talk to just about any EMSer from just about anywhere, and they'll tell you that kind of anger (and disrespect) has been common for many years between EMS agencies and fire departments--even where both functions are performed by the same agency. These are people who have been dying alongside one another for years, yet in so many ways they act like enemies--afraid of one another. What a shame.
Brighton's a little town 20 miles north of Denver, where the absence of that kind of fear has had a powerful effect on the relationships between the town's BLS first responders and ALS transporters--and on their relationships with the public. You talk to chiefs or line workers on both sides, and the impression you'll get is, there don't seem to be any sides.
The Brighton Fire Protection District is a mostly paid, tight little organization with five current stations and a sixth one pending. Mark Bodane, formerly of the Carol Stream, IL, Fire Protection District, has led this department for the past three years. His style is casual, straightforward and respectful, and that's pretty much how his 70-some subordinates treat one another. More than that, they clearly care about the public. And, they're nice.
With half as many personnel as the fire district, Platte Valley Ambulance Service is Brighton's ALS transport provider. Chief Paramedic Carl Craigle oversees that service as a department of Platte Valley Medical Center, based on a contract with the fire district. His people also enjoy a relaxed environment, despite his use of military supervisory titles that parallel those of the fire department. Responding from four locations, they field two 24-hour crews and a 12-hour day crew seven days a week, along with a paramedic captain in a fly car. They keep six clean, ALS-stocked ambulances. If something big happens, like an incident at nearby Denver International Airport, they can split their crews and pair them with firefighters to double the number of available medic units.
Brighton's fire, ambulance and police departments use NIMS in their daily operations, and all three are dispatched (along with services from other municipalities) by ADCOM, the Adams County Communications Center. They're all capable of 800-Mhz communications with just about anybody they need to contact.
On-duty EMT/paramedic crews from Platte Valley Ambulance have been "living" in Brighton's fire stations since September 1, 2009. That was Bodane's idea, and when he first proposed it, not everybody was thrilled. But when the EMS contract came up for renewal last year, he also proposed a 10-year term. The hospital read that as evidence he wasn't just trying to build an empire.
The reason for the move-in was that Brighton had been growing. Once a whistle-stop for farmers along the front range of the Rockies (the eastern side), the city's shape has changed from small and round to long and rectangular. The ambulance service's central "big-barn" deployment became obsolete enough that the hospital had to consider building not one but two new stations at once. Beset by a recession and transport collection rates of less than 33%, that seemed impossible.
Craigle worried that moving crews into fire stations would destroy his department's camaraderie and weaken its identity. Bodane had similar concerns on behalf of his own people. But the public's need was clear and growing, and the solution seemed inevitable.
People aren't perfect, and neither are departments. But eight months later it seems to be working. The ambulance service pays for its fair share of living supplies and goods. And people generally try to treat one another with respect. Of course, many were friends to begin with. For one thing, they had already shared a common schedule for years. For another, nobody was making a profit. Both agencies belong to the community.
Fire and ambulance personnel here train together six times a month on EMS topics chosen to match National Registry requirements. Skill competencies are assessed by means of annual refreshers mandated by a common medical director furnished by the hospital.
As a Colorado-certified Continuing Education Group, the ambulance service provides enough sanctioned CE so anybody in the system can maintain their National Registry levels, mostly while on duty. Their own EMTs and paramedics alike complete PALS and ACLS every two years, and are required to attend at least 30 additional hours of medical in-services besides. The ambulance service's education coordinator signs firefighters' recert apps and maintains the EMS training records for both departments. In addition, transport EMTs and paramedics are welcome to attend all fire department training, including specialized rescue classes on ice rescue, swiftwater rescue, auto extrication, hazmat, residential extrication and even fire suppression topics.
The ambulance service's turnover consistently runs about 10%, so paramedics and EMTs alike tend to be seasoned caregivers. They average no collisions, two service complaints and two critical vehicle failures a year. They stock fire and police units with all the medical equipment they need, and the fire district reciprocates with MDTs, tollway fares and numerous other concessions.
Medics and firefighters alike submit reports called PEAT reports--that stands for Physical Environment Assessment Tool--to focus attention on safety hazards, nutritional needs and social gaps they identify in people's homes. The ambulance service then conducts what they call Re-PEATS: return visits to check the welfare of people with special needs, and in some cases to physically install safety modifications at no charge to anyone.
The collective commitment of these agencies to the people of Brighton is not lost on the public. Brighton is a town that likes its parades, and when emergency vehicles go by it's common for people to cheer not only for their firefighters and cops, but also the crews in their blue-and-white ambulances.
If all of this sounds like puffery, it's probably more like poor writing. But this story needs to be told somehow, and right now. There are no perfect systems, and this one demands constant hard work--especially from its leaders. There are countless evening meetings, weekend training sessions, public events, lectures and CPR classes just in this little town, not to mention the needs of surrounding jurisdictions. It never ends. You go home at the end of each day, and you're whipped. Then the phone rings to tell you there's something else to do.
If it seems like Craigle's just being naive, and the fire department's just planning to take over the system 10 years from now, you may be right. That could happen if he and his people don't stick to the knitting. But for now, they're all too busy doing what we all should be doing: Namely, focusing their energy on the needs of the people who own their stations, their equipment and their certificates.
Thom Dick has been involved in EMS for 40 years, 23 of them as a full-time EMT and paramedic in San Diego County. He is the quality care coordinator for Platte Valley Ambulance Service, a community-owned, hospital-based 9-1-1 provider in Brighton, CO. Thom is also a member of EMS Magazine's editorial advisory board. Reach him at boxcar_414@yahoo.com.
