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Retired Alexandria Fire Department EMS Director and Assistant Chief for EMS (1990-2008), Vince Whitmore, writes in about the service delivery change being proposed by Alexandria Fire Chief Robert Dube. Mr. Whitmore says the change will be far costlier for the City than people realize and why.
Mr. Whitemore writes:
“The City of Alexandria’s model for emergency medical services—staffing medics on ambulances and firefighters on fire engines—has for many years been the envy of most surrounding jurisdictions, and many others nationwide. If the Fire Chief gets his way, however, that will no longer be the case. Instead, Alexandria residents will see increased costs and decreased service when it comes to the emergency medical care provided in the City.
As Chief of the Alexandria EMS division for over 20 years, I fielded constant inquiries from the leadership of other fire-based systems near and far, who looked at our model and desired to implement the same innovative approach to providing emergency medical services in their communities. Now, because the Fire Chief’s real agenda is to increase the number of firefighters—both on fire engines and also ambulances—the Alexandria Fire Department is blindly headed where other systems have gone before, to the detriment of City residents.
It is not my intent to bash the Fire Chief, our neighboring jurisdictions, or the “firefighter medic” model for EMS they have chosen—which staffs firefighters on ambulances and medics on fire engines. I do know, however, that if the people who manage the EMS systems in those jurisdictions were allowed to speak openly—as we did on many occasions regarding the issues that exist in the “firefighter medic” model—they would tell you that such a model inevitably leads to significant problems in EMS delivery that often negatively affect patient care. Problems such as an inability to retain skilled medics or even maintain their skills continue to plague these systems, as they have since their inception.
Despite over three decades of high-quality EMS delivery in Alexandria, it seems the goal now is just to be like everyone else—because if it’s good enough for other jurisdictions, then certainly it must be good enough for the City. This could not be further from the truth. The distinct difference between Alexandria and neighboring jurisdictions is that none of the other jurisdictions have ever had anything better. Alexandria has, and still does, but the Fire Chief now seems intent on throwing it all away—along with some of the best trained, highly-experienced, and most professional EMS providers that you will find in any system in the country.
What the Alexandria Fire Department has always had are medics who come to work here because they want to focus exclusively on providing the highest level of pre-hospital emergency care—just as many of their counterparts in the firefighting division make a decision to focus on the significant demands of firefighting. Indeed, when we advertised for paramedic openings during my time as head of the EMS division, we routinely had over 30 applicants for every open medic position and therefore could pick from the best of the best. As a result, Alexandria’s single-role medic “specialists” have been able to excel in patient care and implement innovative and life-saving procedures—often years in advance of neighboring jurisdictions.
The Fire Chief’s arguments for changing the City’s EMS delivery model ignore the fact that the emergency medical care provided to Alexandria residents will change drastically once the City’s single-role medics are chased from their jobs—and not for the better. Ambulances staffed with two firefighters (only one a medic, the other a driver) will simply not be able to achieve the same standard of care currently provided by staffing two medics on an ambulance. Anyone who says otherwise is simply not being truthful. Instead, the Fire Department will rely on sending a “firefighter medic” on a fire engine to make up for the shortfall—a poor substitute for a skilled team of two single-role medics, working seamlessly to provide the highest level of care. The days of having two experienced and professional medics deliver emergency medical care to City residents will end, and this will ultimately translate into a decreased level of care. Indeed, the new “firefighter medics” the Fire Chief is hiring to replace single-role medics on City ambulances will be much less experienced—as will the new firefighter “EMS captains” promoted to supervise them, who will only have a fraction of the experience needed to be effective in that role. In my view, this is a recipe for problems.
Let’s not forget about the impact of the Fire Chief’s plan on the dedicated group of single-role medics who have devoted their careers—and themselves—to providing the best emergency medical care for the citizens of Alexandria. They are being forced out in no uncertain terms. Women who have comprised as much as 50% of the City’s EMS division, along with other highly skilled medics, will vanish, all because they cannot do—or do not wish to do—a job (firefighting) that they were never hired to do. Those who decide to stay will be faced with a stark choice: work longer shifts, for less hourly pay, and take on additional responsibilities as firefighters; or stay on medics alongside their former EMS officers (now demoted), with no job security, no opportunity for promotion or career advancement, and increasing ostracism by the newly-arrived leader of an organization that they have faithfully served for decades.
The Fire Chief’s assertion that “firefighter medics” are a cost-effective move for the City fails to explain the full fiscal impact of the program he seeks to implement. Alexandria’s “firefighter paramedics” are set to make significantly less than those in the neighboring jurisdictions the Fire Chief seeks to copy. The result will be that the City will soon find it necessary to undertake a significant (and not budgeted) increase in pay for these positions—thereby defeating much of the proposed savings. Alternatively, Alexandria will simply become the training ground for “firefighter medics” in the region, who will seek better pay next door after obtaining credentials and experience at the City’s expense. This is the same situation that the City recently found itself in with respect to its police officers, and look at what it cost (and will continue to cost) taxpayers to fix that disparity in pay.
These are just a few of the costly impacts of the Fire Chief’s plan. Any proposed savings are simply a farce. As a subject matter expert when it comes to the City’s EMS budget, I can confidently state that the Fire Chief’s plan will not only cost City taxpayers more money but—more importantly—it will result in a severe degradation in the standard of emergency medical care that they have come to expect for their tax dollars.
Since the EMS division’s inception in 1976, tens of thousands of City residents (and visitors) have benefited from the care delivered by Alexandria’s single-role EMS “experts.” Many literally owe their lives to these dedicated public servants. I can only hope that City residents find their voice and—rather than accept the Fire Chief’s plan for an EMS system that is just “as good as the others”—demand that the City commit to a system that far excels the others: the one it already has.”