You said it: One candidate's thoughts on Bay Farm ambulance service

You said it: One candidate's thoughts on Bay Farm ambulance service

Gerard Valbuena Dumuk

Recently I was posed a question by the Harbor Bay Isle board of directors regarding ambulance coverage on Bay Farm Island. The question was as follows:

Since the slow economy has significantly impacted the city’s ability to provide services, there have been various proposals to reduce or eliminate the ambulance service resident at Station 4. The reaction of the residents of Bay Farm Island has been extremely negative due to our natural isolation from the main Island and the large number of seniors that reside here. Currently the service remains unchanged. Do you support the continued permanent assignment of an ambulance to Bay Farm Island?

In order to answer this question appropriately I am going to qualify my answer.

As a firefighter I work for Cal Fire, the the largest multipurpose emergency service and resource protection agency within the United States, with 3,000 employees. My ranger unit alone is responsible for over 1.35 million acres of state responsibility area as well as local responsibility area. Cal Fire is an all risk agency responding to over 300,000 calls for service per year. Along with fire suppression and emergency medical services, we are trained in all aspects of emergency responses.

Formerly a licensed paramedic, I have also spent a number of years working in the private sector for an ambulance company providing advanced life support as well as basic life support transport services to the citizens of Solano County.

And now the answer to a complicated question ...

A delayed response time because of lack of service and coverage to the taxpaying citizens of Alameda's Bay Farm Island is not acceptable. When you call 911 you expect a certain level of response and patient care. The possibility of leaving Bay Farm Island potentially stranded really commands attention.

In the past, as well as in the case of most other communities outside of Alameda, the ambulance service is privatized. In the case of Alameda County the recent contract with Paramedics Plus runs from November 1, 2011 through October 31, 2016. This contract was sent out for bid by Alameda County EMS in the form of a Request For Proposal. Private ambulance companies then bid for the privilege. Alameda County EMS then awarded the contract to the service provider that had terms most favorable to the patient calling 911. The winning provider also pays a response fee for the privilege of transporting the 911 patients. Since November 11, 2011, Alameda County has generated in excess of $2 million in revenue. Paramedics Plus pledges to provide fast response times, a minimum number of ambulances on the road, and a certain level of patient care. Patient care and response times are constantly monitored and fines are levied against the ambulance companies for violations of patient care, and response times. This is incentive for the private ambulance because the "Exclusive Operating Agreement" is performance-based and it hits them where it counts and that is the pocketbook.

The City of Alameda is a "Section 201" city. (Health and Safety Code section 179.201)

In 1980, the state Legislature passed the comprehensive "Emergency Medical Services System and Pre-Hospital Emergency Medical Care Personnel Act ("EMS Act"), codified into the health and safety code, to govern nearly every aspect of the statewide EMS system, at the state, county and local levels. Section 201 was enacted as part of the EMS Act, to protect the right of cities and fire districts to continue the administration of their pre-hospital EMS. Section 201 stipulates that until such time as a city or fire district voluntarily requests to enter into a contract with a local EMS agency (LEMSA) regarding the provision of pre-hospital care services, the city or fire district will retain its administrative authority over these services.

In other words the City of Alameda is exempt from these LEMSA-imposed standards. They have no legal obligation to provide a certain response time, and a certain level of patient care as in the agreement between Alameda County EMS and Paramedics Plus.

However, they do follow the medical protocols when it comes to pre-hospital care, but I must reiterate again that there is there is no county oversight secondary to an agreement with Alameda County EMS. Once again, they are not part of the "exclusive operating agreement." The City of Alameda Fire Department has their own in-house "quality assurance" and is responsible for auditing themselves.

My solution would be to enter into a further-reaching mutual aid agreement with Paramedics Plus, the current ALS transport provider in Alameda County, to cover Bay Farm Island 24/7. As of now they only respond into Alameda on an "as needed" basis, and this results in extended response times to areas left uncovered if one of our ambulances go out of coverage either on a call or because of a brown out.

An agreement can be reached whereas Paramedics Plus can stage at Station 4 to provide mandatory coverage to Bay Farm Island around the clock as well as adhere to a fast response time. This sort of agreement might even be cost beneficial to the City of Alameda. I have the experience and background necessary to negotiate a solution. I would be honored to champion such agreements between our Alameda County EMS, Alameda City Fire Department, and Paramedics Plus that will benefit the residents of Bay Farm Island.

But then I got to thinking about the possibility of our city rescinding our "Section 201" status and allowing for the next “exclusive operating agreement” to extend into the City of Alameda in 2016 when the current one expires. Would this reduce response times while saving the city an astounding amount of money? How much would this relieve us of liability by not transporting patients? How much administrative work does it also relieve the city of by not owning an ambulance company? What do we do with the firefighters assigned to the ambulances and where do they go? And most importantly, how does county medical director oversight improve patient care? I intend to address these things in the next week's paper, as I would need some time to work out some options.

Gerard Valbuena Dumuk is a firefighter and a City Council candidate.