EMS Department Creating More Efficient System for Wash. County

Sept. 20--Two years after Skagit County disbanded the Emergency Medical Services Commission and replaced it with the Skagit County Emergency Medical Services Department, local officials are saying the switch is paying off.

The county has a new system to track important data, and are experimenting with ways to free up paramedic units for the most important emergency calls.

The county eliminated the EMS commission in September 2013 after several years of upheaval and three studies that looked at ways to improve the fragmented system. One of the studies said the old management structure lacked direction.

Now, the EMS department that was formed in April 2014 is making real progress, said EMS department Director Mark Raaka.

A new pilot program to explore emergency transport options is underway in Sedro-Woolley. The goal is to see if paramedics are necessary to transport all patients or if emergency medical technicians will suffice.

EMTs take a 160-hour course that teaches basic, noninvasive life support skills such as bleeding control, and they can use automatic defibrillators and distribute about seven medications, Raaka said.

Paramedics know advanced life support skills and complete a minimum of a 1,600-hour course, he said. Paramedics can perform advanced procedures such as administering IVs, putting in breathing tubes and using manual defibrillators, and can distribute about 36 medications.

In Sedro-Woolley, the county sends paramedics to 911 calls, but it also sends the fire department, whose personnel have EMT training. When appropriate, the fire department transports less seriously injured patients to free up paramedics for other calls, Raaka said.

"Skagit County still sends paramedics to every single 911 call," he said. "Close to 40 percent of those callers could be transported by EMTs, freeing up paramedic units and making them available for other emergencies.

"As a system, we're trying to make paramedic units more available to paramedic-level situations, since studies back up that the best paramedics are ones that regularly respond to paramedic-level calls. If all goes well, we'd still be sending out paramedics, but they wouldn't be transporting."

Down the road, the program being tried in Sedro-Woolley could help the county decide if it can one day go to a criteria-based dispatch system that is being used in surrounding counties. Criteria-based dispatch uses specific questions to determine if an EMT unit is sufficient for a given emergency or if paramedics are necessary.

The county would like to expand the program being used in Sedro-Woolley into Mount Vernon and Burlington in the next year, but is still far from instituting criteria-based dispatching, Raaka said.

A challenge of criteria-based dispatching is that cities must agree on the criteria, Skagit County Commissioner Ken Dahlstedt said.

"We've discussed creating a committee of cities, but each municipality must agree on criteria, and that's been the challenge," he said.

Another significant change the department has made is the creation of a single electronic patient care reporting system, which allows officials to track data countywide and create reports.

As of July, all transport agencies in the county are using the system, Raaka said.

There are three major transport agencies in the county: the Anacortes Fire Department, Aero Skagit Emergency Service and Central Valley Ambulance Authority.

Several other agencies in the county, including fire districts, can also respond to emergencies, but of those, only the Sedro-Woolley fire department currently transports patients.

"There are more than two dozen agencies in the county, and when you try to gather countywide data, one system with a single standard cuts down on confusion," Raaka said.

The new system, which is paid for by the countywide EMS levy, is a vast improvement over the free state-supplied database the county once used, Raaka said.

The electronic reporting system allows the county to keep data on medical supply purchases and create standardized financial reports. It also lets paramedics and EMTs in the county to track their training.

The EMS department is responsible for the ongoing training for EMTs and paramedics, as well as public classes on first aid and CPR. The department hosts about 280 trainings a year, Raaka said.

"In the past we had a system that we couldn't give medical personnel access to," he said. "Now, they can go on and see their own records, making it easier for them to keep up with their training."

The shift from an unwieldy EMS commission to a county department has been going well, Dahlstedt said.

One of the county's goals in making the switch was to eliminate the fragmentation of the previous system, he said. Creating one standard electronic system is progress toward that goal, he said.

"We're always looking at efficiency," he said. "With good info, hopefully you make better decisions."

Mount Vernon Mayor Jill Boudreau said the new department is making strides, but still has a lot of work to do.

Boudreau represented the county's municipalities on the EMS commission and frequently voiced annoyance with the commission's inaction.

"The electronic reporting system is really huge, and I'm glad we're looking at the division of advanced life support and basic life support (Sedro-Woolley pilot program)," she said. "That said, the most recent report asked us to look at different possible structures for EMS, and we haven't explored that."

The report suggests alternative structures for EMS, including basing some EMS responsibilities out of fire departments and fire districts to make transport more efficient.

Anacortes already does this, and Boudreau said the county should look at using the same structure for the area serviced by the Central Valley Ambulance Authority.

Raaka said change is always difficult, and county EMS has seen a lot of it in the last two years.

"A lot has been going on, even just in the structure of EMS, and we've taken on a lot of tasks," he said. "But all in all, it's been good and I'm looking forward to the future of county EMS."

Reporter Shannen Kuest, 360-416-2145, skuest@skagitpublishing.com, Twitter: @Shannen_SVH, Facebook.com/ShannenReporter

Copyright 2015 - Skagit Valley Herald, Mount Vernon, Wash.