The Gristle

Emergency Dispatch
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EMERGENCY DISPATCH: Ending their legislative year in one of their most engaged and thoughtful discussions of their year, a deeply conflicted Bellingham City Council under severe deadline last week approved 4-3 a new agreement for coordinated countywide emergency medical services (EMS). Whatcom County Council approved their end of the three-year agreement earlier this month.

Voters in 2004 approved a sales tax levy to fund unified countywide response to medical emergencies, extending and enhancing ambulance services that had provided residents basic life support services since 1974. For 39 years, the City of Bellingham and Bellingham Fire Department controlled the delivery of those services through Medic One. The system is funded by that sales tax levy, along with user fees and—in rising measure—out of the general operating funds of local governments.

The agreement narrowly approved by City Council last week subtly changes Medic One from a unified system controlled by Bellingham to a coordinated service operated by the county through an administrative board advised by a technical board on the operation and logistics of the service. Bellingham Fire Department no longer controls or coordinates the service, becoming instead one service provider among several in the county.

“Think of it like a wheel,” Bellingham Fire Chief Roger Christensen told council last week. “Bellingham is no longer the hub of that wheel. Bellingham is like a spoke in that wheel.”

Importantly, the agreement helps stabilize costs of countywide EMS by perceptibly diminishing the delivery of the five-star emergency life support services to Bellingham residents, dropping the number of Medic One paramedic units operated by Bellingham to four, a reduction of 1.5 available advanced life support units. In order to preserve emergency services to the county, an aggrieved Bellingham City Council had to agree to service in Bellingham reduced by about one-quarter of its former capacity.

A review and some observations:

In December 2010, chafing under mounting costs of a system the county did not control, Sam Crawford—then-chair of Whatcom County Council—resolved to terminate the agreement for unified countywide EMS. Council’s decision triggered a scramble among various stakeholders—quarrelsome fiefdoms of fire chiefs and fire unions, medical service providers, and system administrators—to address county concerns of costs and controls. County Council’s negotiating position and, indeed, reasons for even seeking a confrontation were weak throughout, since the costs of developing and operating a duplicate, parallel system to deliver emergency care to the unincorporated county would have dwarfed the sums they complained of in the existing service (this is in fact the overriding reason the county had been a partner in unified EMS for four decades). Meanwhile, Bellingham was largely satisfied with the level of service and associated costs on the city’s end.

City Council member Stan Snapp, a veteran fire chief and tireless advocate for public safety and quality emergency care, sat through many of those working group meetings. The agreement he believed the stakeholders had arrived at last spring—which would have preserved service in Bellingham while building new service and control for the county—was not the agreement presented to council last week, he complained.

“What came out of our package of agreements was that our four medic units the city provided would stay intact,” he said. That the Ferndale unit would—as they got more experience, more funding, and increased call loads—gradually become the fifth medic unit, and that future units would be located elsewhere in the county. What we have in this agreement is quite different from that.

“We weren’t the ones who threatened to blow up the system,” Snapp fumed. “Bellingham was satisfied to hold up our end of the agreement for unified service. Yet here we are facing a loss of service in Bellingham. How did this happen?”

Bellingham, he noted, pays taxes to both the city and the county, and ends up with diminished services. County residents pay only county taxes.

Aggrieved the EMS agreement came to them on the last day of their legislative year, with destruction of the system immediate in 2014 without their consent to approve it, “I would like to see this agreement improved to the Bellingham side of the equation,” Snapp noted. His complaint was echoed by a plurality of Bellingham City Council.

County Executive Jack Louws expressed some frustration as City Council balked on the precipice of agreement, pointing out that the council had already unanimously approved the contract in early August, essentially unchanged from the document before them in December. If council had concerns, the administrations might’ve had time for response, he said.

Several on council could not recall the issue coming in front of them in August, embroiled as they were in debating master planning for the central waterfront. So we must consider a diminished EMS agreement City Council finds unsatisfactory as yet another casualty in the haste to approve the waterfront plan before the end of this year.

Like the waterfront plan, the EMS agreement was debated and approved through lengthy public process, before submerging for administrative review. And like that plan, what resurfaced on the other side was markedly different than what the lengthy process had approved—with no time left to address its policy deficiencies.

Finally, it’s worth noting that the rising costs associated with delivering advanced life support services to the rural county are a direct consequence of County Council’s unwillingness to plan and direct (and pay for) where residential growth occurs in the county. There are consequences that arise from large numbers of people choosing to live in remote areas distant from metropolitan services, perhaps most egregious among them is the cost of delivering quality response to emergencies.

’Hamsters—who approve their levies and support their public services—are again roadkill to county red-light emergency dispatch.

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