Tuesday night there was a smaller crowd at the CCHD meeting, but it was clear that the spotlight that was shining on the Healthcare District made a difference. The outcome of the two and a half hour meeting was a “win” for Cambrians, mostly. Instead of approving a letter responding to the “attack” by the CCSD, they voted to reestablish the joint ad-hoc committee with the CCSD to consider how the two districts might better serve the community. The committee members will be Runo Lemming, John Headding (CCHD Board), Muril Clift, Allan MacKinnon (CCSD Board), Don Melendy (District Administrator CCHD), and Tammy Rudock (General Manager CCSD).
According to CCHD Board President Frank Fratto, who suggested the action, a motion was made and passed to reestablish the ad-hoc committee that had been dissolved last year in July. The first item of business will be to finalize the ALS equipment utilization agreement by examining six specific concerns. These include: EMSA approval, worker’s compensation, liability insurance, chain of command (since fire and CCHD have their own hierarchies), how “fully equipped” each of the four ambulances needs to be and what the financial implications may be for changes to the current agreements.
Some of the information gathering is already in process. The committee will report back to the Board at the April meeting on those issues and the best approaches for cooperation. Reestablishing the committee is a good step in the right direction. The community pressure clearly had an impact. But that doesn’t mean the road forward will be easy or smooth sailing. I am a bit concerned that President Fratto appointed Lemming and Headding to be on the committee. Lemming, in particular, could be a barrier to effective cooperation. He had written a response letter to the Board of the CCSD and was clearly disappointed when President Fratto tabled action on the letter and instead led the Board get back to working with the CCSD. He seems to consider this a personal attack on him and the CCHD and strikes me as someone likely to take the ball and go home if he’s not winning. I hope that impression is wrong.
District Administrator Don Melendy clearly doesn’t like the implications for the District’s future he sees developing out of the ad-hoc committee’s work. In making his report, he explained that his information gathering had focused on the CCSD purchasing their own ALS equipment for the firetruck, not moving the current equipment back. Authority to provide ALS treatment comes from the County Health Department. Trustee Greg Bates expressed concern that because Melendy doesn’t support the ALS on the fire truck, he won’t present a strong case to the County for allowing the fire department to provide this service. Melendy replied, as he would several times during the evening, “I’m not here to set policy, but to carry out the policies of the Board.”
At the first CCHD meeting this month, Jason Melendy (operations director for the district) stayed quiet. Tuesday night, however, he felt he had to stand up and set straight some of the misconceptions that have developed during this hullabaloo. He was clear and well-spoken, starting off by explaining that this area has the best care and the best paramedics in the county and although he has some strong feelings about what’s been going on the past month or so, he was going to stick to facts. Melendy explained the “Time is Muscle” concept. The longer muscle is deprived of oxygen, the worse the damage. Melendy explained, “The reality on the ground during an incident is that protocol is to provide 2 minutes of CPR only before any ALS intervention. In most cases, the first 1-3 minutes is all getting patient history, medications, assessment of baseline status and such.” These facts weakens the argument that the fire truck arrives a just a few short minutes before the ambulance. When coupled with the fact that the one full time paramedic firefighter is only in duty 1/3 of the time, it seems much less life threatening to have the ALS arrive on the ambulance, even if it’s few minutes later.
Jason Melendy’s strongest point was that the arguing needs to stop. He related an anecdote about a woman in need of care who argued with him the entire way to the hospital rising in the back of the ambulance. Her anxiety and concern about the issue was affecting her blood pressure and making it difficult to treat her. His opinion was that this shouldn’t be done all out in the open. Out in the open is precisely where it needed to be to get the process moving forward again. Without all the public attention and pressure, the committee wouldn’t have been reestablished. So, while it may make their jobs a little more uncomfortable or difficult, its part of the democratic process. Most of the time, agencies like CCHD and CCSD and others chug away in relative obscurity, providing good services when needed by go unnoticed otherwise.
Jason Melendy raised some interesting questions before he sat back down, including:
- Why is there only a paramedic available on the fire truck part of the time – not all the time?
- Has the Cambria Fire Department looked into becoming an ALS provider on their own?
- CalFire is an ALS provider for the county. Has anyone spoken to them about this issue?
I say, good questions, Jason. Now that the committee has been reestablished, we will hopefully hear almost nothing form either agency…. a sign that the our agency Boards and staff are doing their jobs effectively and efficiently. It’s important to keep your eyes open for clues that trouble is brewing, and to speak up to pressure our elected officials to act in the best interest of the community and not just to further their own agenda or to please just a few.
AboutCambria.com will be following this story, so check back here for updates.
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Last 5 posts by Amanda Rice
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The re-establishment of the Ad-Hoc committee is a positive step. While I share Amanda’s concerns that Mr. Lemming’s appointment to this committee may be counter productive, I have faith that John Headding and the CCSD committee members will work out a positive solution for what’s in the best interest of the community.
A few things that Jason Melendy stated during the meeting concerned me. He implied that Basic Life Support is established and carried out before Advanced Life Support intervention therefore it doesn’t matter if the ambulance is a few minutes behind the fire department.
This is misleading and even Amanda stated in her piece, “these facts weakens (sic) the argument (benefit) that the fire truck arrives before the ambulance”.
Often, if the first arriving Paramedic believes that ALS intervention is required, the field protocol is not linear as Jason suggested. At the same time as BLS is established it takes Paramedics a minute or two to set up the ALS gear. So while BLS is taking place, the Paramedic may be setting up the laryngoscope, stylette and syringe getting ready to intubate. These are done nearly simultaneously if the patient presents signs that ALS is required. Therefore, in my opinion it is important to begin ALS immediately if required and not wait the 1-3 minutes as Jason implied.
Also, Jason did not address medical emergencies other than cardiac arrest. Many true medical emergencies require rapid ALS intervention. Examples are Anaphylactic shock, status seizures, ventricular trachycardia and other cardiac arrhythmias. These are examples where immediate ALS intervention can make a big difference.
Hopefully, I have convinced you that time is everything and if a fire department Paramedic arrives 1-3 minutes before the ambulance Paramedic, it could save a life. BLS is not always performed in a vacuum then followed by ALS, frequently they are simultaneous.
Let’s hope the Ad Hoc Committee resolves the issues, ALS equipment and supplies (owned by CCHD or CCSD) is placed back on the fire engine, and someday we can work toward the ambulance being relocated to the fire station, possibly using a Joint Powers Authority structure.
All will be well in paradise.
Michael Walsh
If the ambulance crews are moved to the fire station it will require a major remodel costingas much as a million dollars. As I see it the issue is getting a medic to the emergency scene as quickly as possible. If Cambria Fire has medics at scene prior to the arrival of the ambulance, than why spend the $ for this major remodel. Let the ambulance crews stay where they are at. They just spent tax payers $ doing a remodel on the CCHD buildings to sleep the 2 different ambulance crews.