The Gristle
Emergency forewarned is forestalled
EMERGENCY FOREWARNED IS FORESTALLED: In an early triumph for their respective administrations, Whatcom County Executive Jack Louws and Bellingham Mayor Kelli Linville made good on their promises of effective collaboration and helped save unified emergency medical services. On successive evenings, city and county councils unanimously approved a revised operational model and framework for countywide EMS.
“The mayor and I pledged to sit down together and work through problems that are in the mutual benefit of the county and the city to solve,” Louws explained.
In December 2010, Whatcom County Council—frustrated by the county’s inability to contain costs and influence certain technical aspects of unified emergency medical care—announced that they would discontinue agreements for the unified EMS approved by voters in 2004. Yet the roots of the county’s dissatisfaction lead back to the very inception of unified EMS, when the county and its cities and fire districts temporarily laid aside their differences in a united effort to pass the levy that funded the system. Almost immediately upon passage, the fractures and fissures of disagreement reasserted themselves: At issue was the City of Bellingham’s intention to operate a first-class modern municipal emergency medical response service, one that would improve at a clip commensurate with the growth and prosperity of the state’s eighth largest city, versus the county’s requirement to match funding for that service while having little control over costs or management, hamstrung by a much more challenging pathway to growth and prosperity.
Operating the system was Bellingham Fire District and Medic One—the largest, best-equipped and most robustly staffed (and busiest) of the county’s busy fire and emergency responders. From the standpoint of costs and management, the alternatives were frankly unthinkable: Either a freshly created independent emergency management administration redundantly staffed and running in parallel to Medic One; or a series of fiefdoms established among Whatcom’s smaller fire districts. The first might effectively double COB’s costs (while admittedly providing the county better control of their costs); while the latter simply defeated the point and purpose of unified EMS from the standpoint of staffing, training, equipment and response protocols. The fracture occurred where all involved knew it inevitably would: When a fifth medic unit was added in 2010 to serve the Ferndale area, staffed by paramedics from Whatcom County Fire District 7.
County administrators cagily empowered and supported Fire District 7, and its splinter union, as a means to exert greater control and leverage over bargaining for costs and management. A debate over the supply of emergency medical service to Point Roberts increased the fissures and widened the divide.
Always lurking in the background was whether policymakers—and particularly Whatcom County Council—really understood the nature of the brinskmanship, that the county was vastly better off with unified EMS if the administration could secure better controls on costs. This uncertainty was made considerably worse by a poor working relationship between former city and county administrations, between the mayor and executive. When the working relationships improved with new administrations, the brinksmanship eased.
The proposed framework introduces a more potently empowered oversight board. A technical advisory board will assist in the planning and delivery of advanced life support (ALS) service, the most costly aspect of emergency medical care, providing treatments to serious events such as cardiac arrest, uncontrollable bleeding, major trauma or complex pediatric emergencies.
The agreement to pursue unified EMS changes the uncertainty and the dynamic that County Council would retire agreements and effectively break up the system by the end of this year. In that scenario, the county and its fire districts and residents would undoubtedly have suffered the greater challenge: Bellingham is already well served by Medic One and, frankly, would save money if no longer obligated by agreements to provide emergency medical services to outlying areas.
The county, by contrast, would be required to fill in services in unincorporated urban growth areas; its districts would have to redundantly staff technical and administrative positions currently provided by Medic One and What-comm dispatch.
While the proposed framework is only a step toward resolving cost and management issues related to unified EMS, it gives the county a greater voice in those costs and management while acknowledging the excellent service history provided by Bellingham and Medic One, Louws said.
“Is it perfect? No,” he said. “But I do think it is a victory for our ability to solve problems.”
“We made a commitment to keep the system together if we could,” Linville agreed. “We focused on sevice level, cost and transparency.”
Problems are not easily solved, however; and particularly when the faction howling for solutions is contributing full bore to the causes.
Decades of poor land-use decisions by County Council have opened up large swaths of the rural county to low-density residential development and created distant communities that will continue to drive system costs. There is a price, frankly, to living in remote areas that is not factored into the humane aspects of the delivery of advanced emergency medical care. This cost gets distributed in other ways, whether by costs of the entire system continuing to rise or through the erosion of quality care throughout the system.
Cities, by their very charters under Washington law, are able to collect fees and utilities counties cannot. Bellingham thus has tools to keep pace with inflation the county does not. The city charges impact fees, which help fund improvements to public safety; the county does not. Even the levy on sales taxes that funds unified EMS operates more robustly in Bellingham than in the quieter rural county. Yet a dwindling percentage of residents live in Bellingham—only about 38 percent, where in past years the county seat was nearer to 50 percent of county population.
The emergency is eased through better cooperation, but hardly averted.
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