Double EMS 

County, cities battle over paramedic dollars

Ada County has rejected overtures from the Boise Fire Department to coordinate paramedic services despite apparent duplication of services across the county.

The fire department, which carries paramedics on several of its trucks, wants to make sure it and Ada County don't station paramedics right next to each other, but instead spread them out so they can cover the city better. But the county isn't biting, despite claims that it would be cheaper, faster and more effective.

"Ada County has no interest in relocating ambulance services away from Boise Fire stations," Ada County Commissioner Sharon Ullman wrote in an e-mail.

The Boise Fire Department has had emergency medical technicians on its fire engines for a long time, but started carrying paramedics--who are qualified to do more medical procedures, such as cardiac monitoring, intubation and administering drugs-- three years ago to better meet the city's needs.

"There were gaps in the city where Ada County was taking too long to get there," Fire Chief Dennis Doan said.

Expansion has been slow because the fire department is adding paramedics by attrition so it doesn't have to pay for paramedic training. By the end of the year, Boise Fire expects to have paramedics at five stations.

But Ada County doesn't take the fire department's paramedics into account when it decides where to station ambulances, Doan said.

After the fire department stationed a paramedic near the Hillcrest Country Club, Ada County Paramedics put an ambulance right next to it, in the same building. And that's just one instance of overlap; there are at least three more that are co-located.

Meanwhile, there are other places in Boise where an Ada County Paramedics station would do more good, Doan said.

"If we had no ambulance system in the county, how would we build it?" Doan said. "We wouldn't build it this way ... I don't want to have a turf war, but what's happening right now is it's two different systems growing side-by-side, rather than together ... What I would like to do is build our system together. I would like to build a deployment model together."

Ada County has its reasons for stationing ambulances where it does, according to county spokeswoman Laura Wylde. It measures how long it takes for emergency personnel to arrive on the scene and how long it takes to transport patients to the hospital. Although working with the fire department could improve arrival times, it wouldn't improve transport times, she said.

But Doan said the Boise Fire Department would like to start a program to transport patients to the hospital, like Kuna already has.

In fact, the Kuna Fire Department performs all of that city's ambulance services. But Kuna residents are still paying for ambulance service from Ada County, even though they rarely, if ever, receive it.

Like all county residents, Kuna homeowners pay ambulance district taxes when they pay property taxes and license plate fees, Kuna Fire Chief Doug Rosin said. Ada doesn't reimburse the Kuna Fire Department, so Kuna Fire has drafted a proposal for the 2010 Legislature that would force Ada County to turn over a portion of the ambulance district funds to Kuna and to all other emergency medical service providers in the county.

Kuna had to start its own paramedic program, Rosin said. In 2004, the closest ambulance to Kuna was stationed at St. Luke's West, in Meridian, he said. There were delays of 20 minutes or longer before Ada paramedics could show up to start advanced medical procedures. That was too long, Rosin said.

So Kuna applied to the state for a license to start offering paramedic and transport services. "[Ada County] immediately put a paramedic in our station and tried to convince us not to go for licensure," Rosin said. But at that point, Kuna was fed up with service from Ada. The city got its license in 2004, trained its paramedics, and started offering full paramedic service two years later.

That's when Ada County's strong-arm tactics began. The county passed an ordinance requiring all paramedics in the county to be licensed not only by the state, but by Ada County Paramedics, Rosin said. Ada County then sued Kuna under the new ordinance.

Kuna countersued, and the courts sided with the city. The lawsuit paved the way for Kuna to provide its own emergency services, and Rosin said Kuna is eager to recapture funds from the county that are going to a service the city doesn't need.

Ada County, however, claims the city of Kuna is the one providing the redundant service and duplicate costs.

"Kuna is still within the Ada County EMS District, and their decision to start their own ambulance service essentially duplicates services provided by Ada County," Wylde said. "The ambulance services that Kuna Fire provides is funded by user fees and fire district dollars, but since Kuna remains in the Ada County EMS district, Ada County Paramedics will still respond to calls when asked." If Kuna's legislative efforts meet with success, they could help Boise as it looks to expand its paramedic program.

For now, Boise will continue negotiating with Ada County in hopes of reaching some solution, Doan said, but if Ada is unwilling to work with Boise, Boise Fire will continue to take care of its citizens through its own program.

That may mean putting more paramedics on fire engines, he said.

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