For more than a year, there has been little news regarding the possibility of Vashon’s paramedics combining with those of the South King County Medic One system, but that changed last week when a county official presented a draft operating proposal to Vashon’s fire commissioners.

James Fogarty, division director of King County’s Emergency Medical Services, provided an overview of the plan last Tuesday in a sometimes contentious public meeting. The plan includes a response model for paramedics serving Vashon, as well as a variety of operational details, ranging from on-call pay to ferry ticket reimbursement. Fogarty noted the plan has the support of several of the county’s medical leaders, but on Vashon it has been received with mixed reviews: Vashon’s fire district chiefs say they believe it is the best path forward, while others, including some of the island’s paramedics, disagree.

Fogarty noted it was Vashon Island Fire & Rescue (VIFR) that requested assistance two years ago with concerns about its paramedic system, setting the process for change in motion.

“We are here because you asked us to be here,” he told those gathered.

The roots of this proposal go back to March of 2014, when Mark Brownell, the battalion chief of emergency medical services at VIFR, and Dr. Sam Warren, Vashon Island Medic One’s medical program director, sent a letter to Fogarty and the medical director of Medic One, outlining their concerns about advanced life support (ALS) care provided on Vashon. In particular, the letter noted that instead of conducting hospital transports in two-person paramedic teams — per Medic One’s guidelines for best outcomes — Vashon completes transports with one paramedic, a highly trained professional who responds to the most serious injuries and illnesses, and an emergency medical technician (EMT), a responder with less training. While this practice leaves a paramedic available to tend to another critical island emergency, it also potentially compromises patient care, Brownell and Warren said.

Of additional concern, they noted, is that Vashon paramedics go on far fewer calls than recommended to maintain their skills in working with critical patients.

“We think it is time to revisit the question of how Vashon Island ALS care can evolve into a bona fide two-paramedic system,” they wrote.

In the summer of 2014, following a public meeting on the issue, VIFR’s fire commissioners voted to move forward with a plan to combine its paramedics with those of south King County. The operational plan presented last week, drafted by management and labor officials from King County’s Emergency Medical Services, is the result of that directive.

Guiding the plan, Fogerty said, was the intent to improve clinical care and operational efficiencies on Vashon — which receives 400 to 500 ALS calls annually — while adhering to a set $2 million budget.

If the new plan is adopted, VIFR would no longer contract with King County Medic One to provide paramedic services on Vashon. Instead, a rotating crew of south King County paramedics would serve the island, with two medics stationed on Vashon at all times.

The plan, as Fogarty presented it, relies on two models for patient transport, depending on whether patients are stable or unstable. Vashon medics currently transport, on average, three patients needing ALS care a week; about 90 percent of them are considered stable, according to Assistant Chief George Brown.

With stable patients, the paramedics would have all the options they have now, Fogarty said, including calling Airlift NW, and splitting teams, with a paramedic and EMT taking the patient. In the new plan, however, backup paramedics would be called from one of two stations closest to the Fauntleroy dock as soon as the possibility of a transport is known — as early as when the initial call comes in. The plan then calls for the on-island paramedic and EMT to transfer the patient to the medic crew on the Fauntleroy dock and return to Vashon. Such a step would save the three-hour round trip to a Seattle hospital, Fogarty noted, and could also be conducted on the Vashon dock and at Point Defiance.

In the case of an unstable patient, if paramedics decided to rely on ground transport, both on-island medics would take the patient to the hospital, forgoing a transfer, but backup medics from the closest station would be called to Vashon.

“This plan takes what you have now and builds on it,” Fogarty said. “It allows for what happens to still keep happening.”

Some in the room expressed strong reservations, however, including commissioner Brigitte Schran Brown, who noted there can be long waits between ferries, and Vashon could be left vulnerable while waiting for an oncoming crew.

“You have medics leaving the island, but you are going to have a huge lag of a rig coming on. I am still seeing enormous gaps … leaving this island on a two-medic transport with essentially no coverage,” Brown said. “That worries me.”

The two paramedics on duty that evening, Mike Garvey and Myron Hauge, attended the meeting and also expressed concerns.

“These options you are proposing are taking away the personal care I provide,” Garvey said, noting the proposed transfer of care. “That is not what I do as a medic. When I see a critical patient, I take that patient to the hospital.”

Both Garvey and Hauge, longtime paramedics, also disagreed with the notion of degrading skills among the island’s medics.

“I’m a better medic here than I ever was in Seattle,” Hauge said. “I have to be.”

Garvey also said, based on his experience, that he believes Vashon’s system is efficient.

I can’t see where there’s a real problem, where we’ve got to fix this problem,” he said.

At the end of his presentation, Fogarty noted his support of the proposal.

“I think it’s a plan that meets most — not all — but most of the things we set out to achieve,” he said.

Following the meeting, both George Brown, who is retiring next week, and Chief Hank Lipe, said they believe the draft plan is strong, though needs some minor modifications.

“This is about better service, not a reduction of service,” Lipe said.

Brown agreed, noting that while the concerns Brownell and Warren raised were about splitting paramedic teams and the impact of low call volume, he has concerns about the extensive overtime the department faces with its paramedics. Because Vashon is thinly staffed — and cannot afford to hire more paramedics — any time a medic cannot fill his or her shift, it means overtime for somebody else. Elsewhere in the Medic One system, it is typically not allowed for paramedics to work as long as 48 hours in a row, Brown said, but that is a standard shift on Vashon. With overtime, shifts can far exceed that.

“In the event a medic is at the end of a busy 72-, 96- or 120-hour shift versus a fresh medic, who do you want responding to your emergency?” he said.

Overtime statistics he provided indicate that 52 times last year paramedics worked 72 hours with no break; 14 times they worked 96 hours straight, and four times they worked 120 hours straight. Additionally, he said, the three paramedics who logged the most hours last year put in 785, 819 and 889 hours of overtime, nearly 30 percent above and beyond the 2,532 hours of a full-time schedule. Similar patterns held true in previous years.

“The crux of this is we are trying to improve the system,” Brown said.

Lipe noted in the nearly 25 years he has been a fire chief, he has changed an emergency medical response system twice, and neither of them worked the first time, a situation he says happened because he did not test the new systems first. After fine tuning and re-implementing the systems, they worked well, he added. On Vashon, Lipe said he would propose to the county that they beta test the proposal as a table top exercise with computers, using current and former calls to determine where the weaknesses of the plan are and how they might be addressed.

“I am extremely confident if we beta test it and look at best practices, we will be able to identify any gaps in the plan and make adjustments accordingly,” he said.

While the challenges of navigating emergency care with the ferry system are evident, both Brown and Lipe say those challenges exist in the current system as well, but with no backup to call on. Twice in the past six months, both paramedics were off-island on two different hospital transports, Brown noted. And just last week, both on-duty paramedics were busy with simultaneous island calls. Had a third ALS call come in, the district would have had to put out a request for one of the two medics who lives on the island to come in, and if neither was available, EMTs would have had to respond initially.

The proposal, Brown said, improves on that picture.

Lipe agreed.

“This plan provides a direction to position ALS service on Vashon for many years to come,” he said.

VIFR board chair Candy McCullough said she expects fellow commissioners to spend the next couple weeks thinking about the plan and asking questions of Fogarty and other officials and then resuming conversation at the next meeting. She noted she wants public and fire district member input and stated at the meeting that the board would not rush the process and would take time to talk to stakeholders and get the decision right.

Following the meeting, she added that the commissioners would base their decisions on facts, not emotion.

“The bottom line is are we actually going to be without paramedics for a longer time or less with this plan?” she said. “It is a logistics problem; we will sort it out. I hope sooner rather than later.”

The next fire board meeting will be at 6:30 p.m. Tuesday, March 29, at Station 55 on Bank Road.