Fire protection district mulls the future of EMS in the area

Chief Dell provides overview of services and challenges

The Bishop Rural Fire Protection District met Thursday to discuss the future of emergency medical services in the area in light of Symons

Emergency Services recent notice that it would cease providing services in the near future.

Inyo County and the city of Bishop announced late last month that Symons Emergency Services had given notice to the Inland Counties Emergency Medical

Agency that in the near future it will cease providing advanced life support ambulance services in the exclusive operating area, which encompasses the greater Bishop area.

Bishop Fire Chief Joe Dell provided an extensive update to the district board, which included a look at short-term and long-term challenges and potential solutions.

Dell said while Symons has announced it is withdrawing its services, there is some discrepancies as to when that service will end, which could be as soon as 90 days or it could be longer.

Dell said stated reasons for ending the service are multiple, including cost overruns, poor reimbursement, staffing issues, an aging workforce with fewer younger people pursuing emergency medical technician careers, recruitment challenges in Bishop due to the housing shortage, and the minimum wage increase because Symons typically pays its EMTs minimum wage.

Community loss

Dell said what this means for the community is the loss of a variety of services.

He said these include:

• Ambulance transport for 911 calls

• Airport transfers

• Care facility transports

• Hospital-to-home rides

• Advanced life support intercepts, such as when Symons goes to Benton or Big Pine to assist

• Mental health transports

• Long-distance transfers when patients can’t be cared for at local facilities

• Incident standbys

• Special events

Dell said the Bishop Fire Department already is picking up much of the slack in these areas, including some long-distance transfers when aircraft weren’t available.

What is EMS?

Dell explained that emergency medical services is more than just an ambulance that transports someone to the hospital and goes beyond what most people might be aware of.

He said many pieces of the whole system are community provided, such as public access; communications; dispatch; clinical care; human resources; medical direction from doctors; integration of the different health systems, such as Toiybe, Northern Inyo Hospital, Pioneer Home Health Care, and Inyo County Health and Human Services; computer reporting; regulation compliance; overall finance; among others.

He said many people might not be aware of what the process entails once an EMS incident is recognized.

Dell said this begins with accessing 911, which can be a challenge in the area when inclement weather hits; dispatching first responders; determining the level of service to be provided, whether it is basic or advanced life support; overall transport (ground or air?); emergency department facilities; specialty care for patients who might be suffering from trauma, cardiac arrest, poison, or a stroke or have special needs, as is seen with some older patients; patient rehabilitation, such as for the care center; prevention awareness; and overall public education, including when it’s appropriate to call 911.

Dell said for each EMS call, a “task analysis” also is conducted to not only look at what care a patient needs while collecting vital data but determining if more staffing or special equipment might be needed to reach and transport the patient. Afterward, first responders clean equipment, write reports, address billing and return to be available for the next call, among other activities.

Fire Department staffing goals

Dell said based on task analysis, he has developed staffing goals by incident type. The department’s goal is to have 15 staff at a structure fire, such as a house, 35 staff at a commercial structure fire, 12 staff for vehicle accident extrication, 12 staff on a hazardous materials call and four staff on an emergency medical response, which is the national standard.

Priorities and barriers

Dell said priorities for EMS response should include availability of ambulances, crew safety (back injuries is the most common among EMS and fire responders), patient safety, quality of care and timeliness of care.

The chief said frequent barriers include critical patients; simultaneous calls; stairs, sometimes even four or five stairs can be challenging; mobile homes due to their narrow, confining spaces; “hoarder conditions;” heavy patients; extreme weather; “complex patients;” access issues; uncooperative patients; personnel availability; and cost recovery, among other challenges.

Next steps

Dell said as the district continues to decide how tho handle the pending EMS crisis, he has proposed next steps, some of which already are in the works through the city of Bishop’s administration.

These would include:

• Hire a fire/EMS consultant, which will help in the long term.

• Identify a short-term plan to avoid a disruption in service, especially since the termination of the current service hasn’t been established.

• Identify partners and develop integration plans with Northern Inyo Hospital, Inyo County, the city of Bishop as well as mutual aid partners, such as Mono County, Chalfant, Big Pine, and others.

• Identify equipment and ambulance needs, which is expensive and not readily available.

• Identify crew housing solutions.

• Produce a request for proposals for a long-term solution that looks out over the next 10 years.

District board members at Thursday’s meeting directed Dell to focus on the short-term solutions to ensure there would be no disruption of services.