Tuesday, November 15, 2011

Travis County EMS Consultant Report

 Travis County EMS Consultant Report

 For those interested, the following link will provide a copy of Travis County's EMS Consultant Report on Existing Ambulance ("EMS") Services and Options to Improve.  The report is a 145 page PDF file.  

Overall, the study offers a balanced assessment of the current problems Travis County has in its inter-local agreement with the City of Austin for ambulance services and medical direction. Two disappointments: it lacks depth in financial modeling which I think is essential in driving home key points and is missing an analysis on the productivity and effectiveness of the City's  "EMS Office of the Medical Director".  Regardless, the report does a decent job laying out the issues, for example:

  • Within the past 5 years costs have sky-rocketed 48%, but ambulance response time continues to average an abysmal 18 minutes and the city ambulance service ("EMS") only solution for their poor performance is for the County to contract for more ambulances at a whopping $1.8 million per ambulance.  
  • The City continues to resist financial transparency or accountability and Travis County has no contractual control over the services it receives or its costs.  
  • The ambulance union and its crony medical director (whose budget is one of the highest in the nation, approaching $1.0 million dollars annually)  fights to keep county fire departments from putting their own paramedics on fire trucks even though it would dramatically improve response time, improve patient care and costs 1/18th the price of an ambulance (for one ambulance you could outfit 18 fire trucks with paramedics, that's a lot better coverage for county residents and a far better deal for taxpayers). 
There are also a few noteworthy  kudos for the City regarding the clinical care the ambulance medics provide (when they finally get on the scene), improvements in bill collection and revenues and improvement in City ambulance response time.   The report also highlights other "EMS systems" to give some comparative perspective and provides a series of options for improving existing services.   




The one option the MAG Consultants prefer and recommend: 

Consolidating all County fire departments (ESD's)  into single county funded fire department and adding EMS services and a dedicated County EMS Medical Director along with merging County Emergency Management, Fire Marshal Services and STARFLIGHT Air Rescue operations into the same operational entity.  

Worth a read.

I'll offer more comments on why I believe its time to  merge county fire departments into one county-wide operation and my preferences on how Travis County should improve its emergency ambulance services in my next post.

Here's the link for your own PDF copy of the EMS Consultant Report:

Saturday, October 8, 2011

The Two Dirty Little Secrets Behind WHY Some Small County ESD Fire Departments are Desperate for AUTO AID with the Austin Fire Department


The Two Dirty Little Secrets Behind WHY Some Small County ESD Fire Departments are Desperate for AUTO AID with the Austin Fire Department

 Last week the American Statesman ran a story on the fragmentation of fire response in Travis County.  It left the impression city and county residences needing help were being harmed because not all fire departments were part of an AUTO AID agreement with the Austin Fire Department.  It painted Austin Fire as unfriendly to those in need and fickle in whom it partnered with.  The story was rift with innuendo, factual errors and played into a cleverly orchestrated game of pubic opinion manipulation by  one or more small county ESD fire departments seeking to force Austin Fire to give them and all unqualified ESD's the full benefits of Auto Aid.

 Let me offer up the real motives (the “dirty little secrets”) behind this game of public opinion manipulation.

Secret # 1:  Auto Aid keeps the poorly performing ESD from being forced out of business because it provides them with all the resources they need but can't pay for themselves.  Essentially its a subsidy using other taxpayer $$$$'s to keep the ESD viable.

Secret # 2:  It's about jobs, protecting vested interestes.  It keeps the ESD in the game so to speak; guaranteeing its staff and Fire Chief an opportunity to be part of any consolidation into a County funded County Fire Department.   


Here are the facts the American Statesman overlooked:

1.     An ESD is a fixed taxing district.   In Travis County
the 13 ESD’s are legacy operations of its 13 volunteer fire departments (when it really was a rural county and one station was enough to manage the occasional grass fire, barn fire, trailer fire or house fire).  The entire county is platted with ESD’s, expansion is not possible unless one ESD folds or merges into another.   
2.     Those ESD’s that touch borders with the City of Austin have one common destiny: oblivion.  This is because over time the City of Austin will annex the ESD out of existence.  Annexation however is a slow death for the ESD because it never involves the entire ESD, just the more valuable taxing areas.  As those are annexed the ESD becomes financially less and less capable of maintaining its basic service level.  For the small ESD, their service delivery is never high, and never up to national standards, so any compromise in funding only tanks service capacity more.   

     Consider this simple example: a structure fire takes, on average, 14-17 fire-fighters to effectively manage and they need to be on-scene within 11 minutes if they want to save lives and more than then foundation of the structure.  Small ESD’s, like ESD 4, has an effective fire-fighting force of 8, two engines and a chiefs truck, no ladder, and their stations are separated so far apart it would take them 20 minutes to reach each other (and that is under lights and siren conditions).  In fire fighting it’s the “effective force” you can mount in 11 minutes that matters.  ESD 4 (and similar small ESD’s) can’t possibly meet that under ideal conditions so as its tax revenues decline due to annexation, it has real issues on how it meets service demand. 

3.     “Mutual Aid” is the current stop-gap used by the small ESD’s to bolster its ability to fight fires it could not otherwise manage and all on the dime of other taxpayers.  They get free services just for yelling “help”.  But Mutual Aid has two conditions for “free help”:  
a.  it requires the ESD to “ask” for it, usually as it is responding to an incident  
b.  it does not guarantee the ESD will get all the help it needs.  Help is offered only if other fire departments can spare resources.

4.     AUTO Aid is considered the gold standard for Mutual Aid because it eliminates the two problems noted with Mutual Aid.  Under Auto Aid a fire department gets the full backing of the other fire department(s) resources without question and without delay.  It happens automatically, hence the term “Auto Aid”.   For the struggling ESD's it is a perpetual life-line that solves their lack of funding and their problems with providing effective services. 

 To fully appreciate how this high stakes game of manipulation is being orchestrated, one only needs to look at the behind the scene maneuvering of ESD 4 Fire Chief.  He pretends to not understand why his ESD can’t have Auto Aid but he understands very, very well why that is so, he is a retired Assistant Austin Fire Department Chief!  This news story was a last ditch effort after a variety of backdoor attempts to get what his ESD could not and should not qualify for.   

ESD 4’s Fire Chiefs first manipulative effort was earlier this year with a good ol boy agreement with an adjacent ESD, ESD 9-Westlake for Auto Aid.  Why ESD 9? Because ESD 9 has Auto Aid with Austin Fire and by default ESD 4 would get Auto Aid.  Auto Aid with ESD 9 by itself offers ESD 4 no strategic advantage, none.  Go look at a map of ESD’s and see for yourself.  This was a calculated effort to get auto aid via the back door.  But Austin Fire stopped it cold because they pointed out to the ESD 9 Fire Chief, a retired AFD former Chief, the deal was being done solely to give ESD 4 something they did not qualify for. 

ESD 4’s Fire Chief’s second manipulation attempt was trying to leverage neighborhood concerns about a cardiac arrest incident in an area off City Park Road that the Austin Fire Department is responsible or but ESD 4 is closer too because of their station.  Even though both departments responded to this incident, several neighbors were conveniently told that ESD 4 might have made the difference had they been sent faster.  Completely untrue since the delay in dispatch was not more than a minute but it created enough community stir for the ESD 4 Fire Chief to suggest the neighbors mount an email campaign with the City Council asking that ESD 4 be granted Auto Aid.

ESD 4’s Fire Chief’s third effort was on the back-end of the email campaign via a back room discussion with a City council member.  The council member attempted to facilitate an agreement with Austin Fire but was pushed back by management and the fire union, which pointed out all the problems and implications of such a back room deal.  The council member, not lacking in smarts, decided the smart move was to back off but encouraged the fire management to better articulate their auto aid / mutual aid policies. 

ESD 4’s Fire Chief’s fourth attempt was manipulating the American Statesman under the pretext he was just concerned about doing right for those in need. 

Factually, ESD 4 can’t provide an adequate level of fire protection and there are others who are just as unprepared to do the same for their ESD, including ESD 12-Manor, ESD 14-Volente, ESD 5- Manchaca, ESD 10-CeBar, ESD-8-Pedernales.  All of these ESD’s are marginal players, and over use Mutual Aid.  They would love nothing more than to get out of Mutual Aid and become part of the Auto Aid club with AFD and AFD's partners (qualified ESD’s with capacity, resources, staff, professional management and financial stability, including ESD 2-Pflugerville, ESD 6-Lake Travis and ESD 11-Southeast) and all the Auto Aid benefits.  But it’s a bad deal for Travis County (and the City of Austin) because it keeps marginal ESD’s on the playing field when they should just go away and be folded into a more functional and competent fire department. 

Travis County is not a rural county anymore (news flash Statesman), it has pockets of rural life, especially to the east, but the majority of its demographics are centered squarely in suburban and urban-suburban areas.  All of which means the public expects public safety services similar to the urban performance level.  Unfortunately, that is not the case for those of us who are serviced by small under resourced ESD’s that cannot manage even the basic fire, let alone the more challenging fire without calling in mutual aid from its neighbors.  I have said it before and will continue to say it again and again Travis County has outgrown its need for 13 ESD’s, and all the duplication in management, and administration.  It needs one County Fire Department.  

None of this is hard to fix, it is simple stuff but it takes county politicians and their administrative managers, and their ESD Board appointees to do what is right by the taxpayers, the folks who count on getting the help they need when it is needed. And right now, not all areas of Travis County are getting decent services.  I’m certainly not getting much quality from my ESD.  It’s time to stop the games, stop the politics, stop the manipulation for personal benefit and take the actions required to assure Travis County has high quality emergency services.  

In the interim I would like to offer some suggestions for managing mutual aid, auto aid and dealing with the under-resourced ESD's that survive off of Mutual Aid and the good will of the larger City / County fire departments:

1.  Austin Fire and the two biggest ESDs in Travis County- ESD 2-Pflugerville and ESD 6-Lake Travis need to ratify a common standard for Auto Aid and Mutual Aid and stick with it.  

2.  Auto Aid should be the gold standard and only offered to truly qualified fire departments.  The reward is once Travis County is able to consolidate its ESD’s into one county fire department, Auto Aid standards between the City and County will be easy to implement and maintain.  Fire Services will become a defacto form of metro government.  

3.  Small ESD’s that continually use mutual aid to offset their lack of ability should be charged a hefty service fee for any mutual aid beyond the closest engine. Period.

4.  ESD 4 continues to survive because the Austin Fire Department generously manages 3 of its 5 response areas.  AFD needs to stop letting ESD 4 play off of its goodwill and return responsibility for these areas to ESD 4.  Granted, ESD 4 is chopped up because of City annexation, but that is part of the natural process and does not make the City responsible for what the ESD can and can’t do.  And lets remember, Austin Fire offered to take over all of ESD 4’s fire protection services for just their tax revenues and they have been repeatedly rebuffed, ignored and demonized for their efforts.

5.  ESD 12-Manor also continues to survive because of the generous support it gets from Austin Fire, ESD 2 and ESD 11.  Its time to stop the free service other than one engine on mutual aid from only one department (the closest station).  I understand the consequences of this suggestion.  It will create the emotional charged accusation of putting people at risk but those who sling such claims are attempting to use emotional blackmail to force support from other taxpayer funded fire departments.     It’s a classic ploy to distract from the reality of a highly dysfunctional ESD that is not serving its residents well and frankly, should be out of the business of doing so.  

ESD Boards that oversee these marginal ESD fire departments have the ability right now to quickly  remedy the problem by contracting out fire services to a better-qualified ESD or with the Austin Fire Department (its called "doing what is right for the community and the taxpayer").  If the ESD Board refuses to make the best decision for the taxpayer, it is Travis County’s fiduciary responsibility to replace the entire ESD Board as soon as possible.  Travis County needs to start acting like a responsible entity that cares for its taxpayers and provide the political leadership necessary to remedy this public safety crisis.
 
Bottom Line:  


I understand the human drama and angst behind the threat of losing jobs, but in public safety, service, high quality service, is always first and foremost because it is all about saving lives.  It is never about employment, or keeping the door open for the possibility of a better employment deal with Travis County or whatever unethical rational some attempt to offer to justify actions contrary to the public good.  In life saving services, which the ESD’s are in, nothing else should trump the priority of providing the taxpayer with the very best of emergency services.  As a career public safety professional I take special offense when another public safety colleague blatantly tries to subvert this priority using public safety as the purported concern, when it is anything but public safety. This Machiavellian “end justifies the means” has no place in public safety.  Fire Chiefs and their ESD Boards are in one business only: serving the tax-payer and that’s what they need to do.  If they can’t serve their constituents appropriately because they lack the resources (for whatever reason) then they need to take the honorable action of stepping aside to allow other more qualified and capable fire departments to step in and provide the appropriate service.   ESD Boards that involve themselves in or tacitly support unethical and public unfriendly endeavors by their management, as highlighted in this post, need to be replaced immediately by Travis County.  In similar fashion, the new ESD Board should immediately replace the offending Fire Chief.  Manipulating public opinion has absolutely no place in the business of public safety.