Last week, King County officials presented a plan to integrate Vashon’s paramedics into those of those of South King County Medic One as early as the beginning of next year, and fire commissioners say they will study the proposal and hold a public meeting on Wednesday, Oct. 12.

The plan, presented at the fire board meeting on Sept. 27, covers routine paramedic responses on the island under the new model, transporting of patients and financial aspects of the transition. It also reflects a change from a previous draft that could have left Vashon too long without paramedic coverage during emergency hospital transports. At the meeting, Michele Plorde, director of the county’s Emergency Medical Services, stressed that much would remain the same for island paramedic response after the transition. She was accompanied by John Herbert, retiring chief of South King County Medic One and his successor, Keith Keller.

“The point I want to make very clear is that we all believe this is going to be not much different from current service,” Plorde said. “I think that is an important point for both the commissioners and the people who live here, that the model we are proposing is what the Vashon paramedic program is currently doing.”

She told the commissioners she and her colleagues were hoping to obtain their permission soon to continue the process.

“We are here to present a proposal … for your approval to move forward,” she said.

The plan — with many details yet to be completed — would mean the island’s paramedics would be employed by the county, not Vashon Island Fire & Rescue, and work in a variety of communities, as well as Vashon. Likewise, Vashon would be served by paramedics that rotate through the communities in South King County.

According to the proposal, two paramedics would serve the island at all times, and one previous Vashon paramedic would partner with one King County medic to help ease the transition initially. Although the proposal also calls for paramedics to work in two-person teams, following Medic One’s standard for best patient outcomes, it calls for splitting the teams — combining one paramedic with a lesser-trained emergency medical technician (EMT) — if two critical calls occur simultaneously. Splitting would also occur during transports, leaving one paramedic on the island to respond to another critical call with an EMT. Should both paramedics need to transport a patient off-island at the same time, Medic One would provide back up paramedic coverage to the island, via ferry, King County Sheriff’s Office helicopter or boat, or the South King fire boat.

Following the meeting, VIFR’s interim Assistant Chief Bob Larsen confirmed that while the paramedics themselves would largely be different under the new plan and would arrive to calls in one vehicle instead of two as they do now, the plan is similar to current operations. Larsen was involved in the crafting of the plan during its final stages and said he believes it would serve Vashon well, despite some of the plan’s compromises.

“The main thrust is that we are getting a rotation of medics that are seeing a lot more than the types of calls we have here,” he said.

Concerns about Vashon’s paramedics have previously been raised, including in 2008 during the regional Emergency Medical Services strategic planning process and most recently in 2014 when Mark Brownell, VIFR’s battalion chief of emergency medical services, and Dr. Sam Warren, the medical program director of Vashon’s paramedic program, wrote to county officials regarding their concerns. In particular, they cited the lack of a two-paramedic system on ferry trans-

ports — deviating from Medic One’s standards — and the low number of calls Vashon paramedics receive, potentially leading to a degradation of their skills. That letter spurred this latest effort for change, which has been in the works for more than two years. Plorde, who stepped into her position in May, has made moving it forward a priority.

This plan, too, deviates from the standard two-paramedic system at times, including during transports. Following the meeting, Plorde said abandoning Vashon’s longstanding model of splitting paramedic teams would mean adding staff, which Plorde termed “hugely cost prohibitive,” as hiring another paramedic team for Vashon could cost an additional $1 million per year. She added that those who crafted the latest plan decided to leave the practice of splitting in place as it has been working well overall and solving it had proved difficult in previous attempts.

“We do not love the idea of the split, but it is the best option for Vashon within the cost structure and with patient care at the forefront,” she said.

However, officials looked at other ways to minimize risk, she said, including ensuring that all paramedics who work on the island routinely also work in busy communities and respond to a high volume of calls. And, Plorde said, the conversation evolved to address Vashon’s lack of backup and high levels of overtime in the paramedic program. In the last two years, she said, former Chief Hank Lipe asked the county for assistance in paying paramedics’ overtime costs, which came to more than $200,000 each year.

“We knew we needed to address that and the availability for backup,” she said.

A full paramedic unit is eight people, but when anyone is out for any reason — from extended injury leave to vacation — the others have to work extra. This summer, Vashon’s available paramedics shrunk to six, giving them all considerable overtime. Larsen said the situation has improved some, though he indicated the potential for overtime is always present.

“It stands to reason that if you have a finite number of personnel and they equal the number of shifts in a week, you are going to have overtime,” Larsen said.

Should the proposed plan be implemented, there would be a much larger pool of paramedics to draw from — about 80, Plorde said, ensuring that that there would be sufficient backup for routine needs as well as in emergencies, such as an island landslide or bus crash.

Beyond the operational basics, the plan also considers the financial effects of the transition. Currently, the county contracts with VIFR to provide paramedic services to the island and pays the fire department approximately $2 million a year to do so. At year’s end, Plorde said, VIFR’s paramedic program’s operating and equipment fund balances are estimated to total about $1.3 million. While King County’s policy would typically require that money be returned in situations such as this, it will allow VIFR to keep nearly $408,000 — the balance minus items such as sick leave, vacation time and required equipment purchases. VIFR’s aid vehicle — or ambulance — will also remain with the department, Plorde said, although paramedic program funds helped purchase it.

That money may be particularly helpful for hiring additional firefighters, she said, as VIFR’s paramedics are also firefighters, and South King County paramedics are not. Indeed, Larsen said that he hopes to hire three firefighters, which would give the district the same number of firefighters per shift as there are now, and he hopes to do so soon.

“We would like to make it as seamless a transition as possible,” he added. “Ideally, it would be good to have them ready to go when the transfer happens.”

The money that Medic One leaves the district would be helpful in the short-term, Larsen said, but would not last long.

“There has to be long-term funding, and that will be a board decision,” he said. “We are looking at different avenues of acquiring that.”

Over the course of the more than two years this move has been considered, it has had supporters and critics, including some of the island’s paramedics. For his part, Brownell, one of the co-authors of the letter that started the process in motion, said he is grateful for the people who have worked hard on this proposal and that while it does not address every concern voiced in the 2014 letter, it answers some major issues that face Vashon Medic One. He added that with every transition, there are plusses and minuses.

“Critical patient exposure and access to more frequent critical skills is a definite plus. One of the minuses would be the potential loss of personalized care by a small group of medics who know their patients,” he said. “That being said, King County Medic One paramedics are among the best paramedics in the word. From a care standpoint, islanders would not see any appreciable difference.”

Others close to the situation say that additional concerns include the fire department’s need to hire — and pay for — additional firefighters, as well as the loss of local paramedics who sometimes respond to non-life threatening calls with EMTs. This reportedly occurs fairly routinely, particularly if those EMTs are less experienced volunteers, if they are extremely busy or if the paramedics believe the EMTs simply might benefit from assistance. That practice would likely not continue with rotating King County paramedics.

Between now and potential implementation of the plan, VIFR commissioners want to hear from the public; multiple operating details needs to be worked out; the South King County and Vashon paramedic unions must develop a plan for integration, and the King County Council and Executive Dow Constantine need to approve the final version.

At the end of last week’s meeting and again in a follow-up conversation, fire commission chair Candy McCullough stressed that pursuing this proposed change has never been intended to be a criticism of island paramedics, but is about the best practices for the long-term.

“This is about finding the best plan for the best care for the seriously ill and injured, and that means giving our paramedics, who do a fine job, the opportunity to practice their skills more often and having other paramedics who use those skills more often serve the island,” she said following the meeting. “If we are talking about lives here, it matters.”

The special meeting on the proposed plan will be at 7 p.m. tonight, Wednesday, Oct. 12, at the Penny Farcy Training Center. A vote on the issue is possible, bit not definite.