Skagit commissioners, EMS director explain fast-track structure change

July 29, 2018

The Skagit County Board of Commissioners’ decision July 25 to revamp the emergency medical services system came rather abruptly, or so it may seem to some county voters.

There was little public discussion ahead of the commissioners’ 2-1 vote, which was less than a week after local voters received ballots asking for a new and higher EMS levy. Some of those votes have already been cast; others will roll in until the Aug. 7 primary.

The two commissioners who supported the system change, Lisa Janicki and Ron Wesen, said the levy request and the structure change are not connected. The money is needed whether or not the structure stays the same, they said.

“It was a pretty compressed time frame,” Janicki said of the decision, but the subject had been discussed for years. “... The cities have aligned in a way that wasn’t present before.”

Dissenting Commissioner Ken Dahlstedt protested that the timing was wrong with levy ballots already out, less than six months to make the switch and details of how to do it still up in the air.

“Just to jump off the cliff not knowing if the parachute will work, that’s why I voted against it,” he said.

From slow to fast track

The vote dissolves the Central Valley Ambulance Authority, the rural area’s primary ambulance provider, and will put its territories under control of the cities via contract. The plan is to move to a fire-based system with the city’s fire departments leading the way and ambulance service working within them.

Structural change has been needed for years, according to consultant studies, a state audit and in multiple discussions among emergency officials who provide care to the region’s residents.

Central Valley serves over 80 percent of the county’s rural residents, but it is an entity created by the county with board members representing other government entities, including several cities. It provides EMS services and operates with a board, but some of the decision-making on how to run it remains with the county.

Officials on all sides have long been frustrated with the inefficiencies. Just how to make the system better never came together, though, until very recently.

Opportunity knocked on July 17 in the form of a letter from the four largest cities in Skagit County. Janicki and Wesen opened the door, supporting the change in a vote one week later.

“This is the quickest 17-year decision that ever happened,” said EMS Director Jeff Sargent. He’s been at the job less than a year but is well aware of Skagit’s EMS history. “It’s been brewing for 17 years.”

Sargent had offered a proposal to the stakeholders at a June 12 meeting. It was a framework built from a survey they participated in during the spring that asked them about their needs and goals. In that survey, some recurring themes were more training, better communication and a shared vision.

Sargent suggested eight initiatives as a proposal for moving forward during the next six-year levy cycle. Among them were use of Basic Life Support (BLS) services allowing nonparamedics to transport less critical patients, having dispatch send the closest unit to a call no matter its department or service area, and revamping the way in which the providers are compensated for services — a plan that looks beyond how many patients are transported.

Just over a month later, the cities of Anacortes, Burlington, Mount Vernon and Sedro-Woolley sent their July 17 letter saying that the cities wanted to take over the majority of the EMS operation. They also asked that the EMS office start working with them within two weeks on a plan and start preparing contracts for the four cities and Aero Skagit (to continue serving the east county).

Why now?

Asked why the change could not have happened a year ago, providing more time for a transition, Janicki said it wasn’t an option because the cities were not united. That is no longer the case, but the matter cannot wait until next year with contracts looming, she said.

“It had to be now because the cities needed a definitive answer for budget season so they could actually plan for it,” she said.

Dahlstedt has spent many years studying these issues as a commissioner, and he’s seen the disagreements. He sees complications in getting the transition done effectively in less than six months and in figuring out how to divide the money and provide the needed equipment.

He worries rural residents won’t be as well-served and that there were no hearings on the issue once it was formally proposed.

“We just got this letter last week,” Dahlstedt said. “... It’s a timing thing. In government, to make that sort of a major shift takes time. In 12 to 18 months, you can maybe make whatever change you hope to achieve.”

Wesen said the county has discussed the EMS situation publicly for years and encouraged input.

“I made it known at those meetings that we were available to listen to them. I believe there was adequate input on how to make the system better,” he said.

The change will mean building contracts with each city — as it has for years with Anacortes — instead of Central Valley, Wesen said.

“The level of service in the contracts will still be there,” he said.

The cities will still need paramedics to do the work done now by the 37 paramedics at Central Valley, and those paramedics can apply for those jobs, he said.

Dahlstedt expressed concern that the paramedics would not stick around to seek those jobs. He said it would be most efficient to have one EMS provider for the entire county instead of the divided system that contracts out the work.

“Politics and money kept that from happening,” he said. Anacortes didn’t want to become part of a countywide service, and smaller cities like Burlington and Sedro-Woolley that are just miles apart aren’t interested in sharing either, he said.

Despite his concerns, Dahlstedt said the EMS levy is still needed for the coming year.

“My hope would be that the voters will support a levy because without the funding, there won’t be any support for an ongoing system,” he said.

If the levy fails during the primary, the county would have to ask again in November, though probably at a lower price point.

“The need for the levy is still there, and it’s real,” Janicki said. “Our county has had the benefit that when people dial 911, they get an ambulance and sometimes an aid unit at their doorstep as quickly as possible. We don’t want that to change.”

– The Skagit Valley Herald will pursue another story this week concerning the change to a fire-based EMS system, with the perspective of the cities and emergency service providers.

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