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Officials to hold strict standards on municipal ALS

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By Mark Scohier

Officials are still attempting to hammer out the details that would allow Chiefland Fire Rescue to be certified in non-transport advanced life support (ALS), but there’s still concern over cost and whether or not strict standards can be met.
Area medical directors and representatives from the City of Chiefland and Levy County gathered Wednesday at the Levy County Department of Public Safety for about an hour and a half in an attempt to get further in the process. The meeting was the second to happen since a public workshop in Chiefland was held on the matter a few months ago.
“I don’t care what it is,” Chiefland Fire Chief James Harris said about acquiring ALS certification. “I just want our paramedics to operate to their capacity.”
Harris, along with other Chiefland officials and members of the public, have been arguing with the county for months that there’s a need for ALS in Chiefland and that the certification, which would allow Chiefland paramedics to administer certain medications and perform various procedures , would save lives while patients are waiting on ambulances.
The county has been asking for more details on what Chiefland wants to do.
Those in attendance Wednesday all agreed that saving lives was the most important factor, though some stressed more work needed to be done to evaluate whether or not Chiefland having ALS would support that mission.
The biggest issue is providing care, Levy Count System Medical Director Dr. Jason Jones said. “It’s easy to say, ‘We want to start an ALS service,’” but it needs to be done to Levy County standards, not the minimum required from the state.
The service would have to follow one standard, he said, otherwise it could create a “dangerous inequality in care.”
Jones said Chiefland, among other things, would have to employ the use of full-time paramedics to meet that standard.
Currently, according to Harris, Chiefland Fire Rescue has only one full-time paramedic, though it also has several part-time paramedics and two full-time EMTs.
Harris offered, upon approval of Chiefland commissioners, the hiring of three full-time paramedics.
Associate Medical Director Dr. Amit Rawal said that potential new hires would help ensure that the public is getting ‘the best care as fast as possible,” though, according to him and the rest of he medical director team, there’s a list of other items that will need to be followed if ALS in Chiefland is to come to fruition.
In addition to new full-time hires to ensure adequate coverage at all times, Chiefland paramedics would also have to adhere to the same training as the county paramedics and and keep to county standards in choice of medical equipment, he said.
Dr. Christine Van Dillen, also a medical director for Levy and Alachua counties, said there’s a good reason for requiring full-time paramedics: because they’re better at what they do.
“If you do trauma, trauma, trauma, then you get good at trauma,” Van Dillen said.
Harris and Chiefland Vice Mayor Teresa Barron, though stating Chiefland would, ultimately, follow the requirements, questioned the need for some of the standards. For example, Barron said requiring a paramedic to ride for six months (one of the county and medical director’s requirements) as a lead on an ambulance was “a bit much.” She asked if paramedics with previous experience could be exempt from the standard.
Levy County Department of Public Safety Chief David Knowles said all paramedics would be held up to Levy County standards, despite the amount of experience he or she may have at another location. Paramedics will be, and are, required to take tests, he said.
On the issue of part time personnel, Harris said it was better to have a part-time paramedic on scene than no paramedic at all.
Rawal, eluding to what had been expressed earlier, said having half-trained paramedics is potentially dangerous.
“Seven, eight times out of 10, maybe a half-trained medic will be there,” which can be a good thing. “But what happens if it’s a head bleed, they give an Aspirin, and it makes it worse?”
Standards are crucial, he said. Lives can be lost by not having paramedics, but, on the flip side, lives can be lost because standards of care are ignored, he said.
“We want this to work, but it’s got to work right.”
Levy County Commissioner Ryan Bell said another important reason to have standards worked out is because officials in charge now may not always be in office or in the same position a few years down the road.
County coordinator Fred Moody said standards would help prevent every municipality in the county from trying to claim rights to ALS. Strict regulations will help curb what he fears could be a “bidding war for these medics,” he said, adding that he’s already hearing from cities other than Chiefland.
Bell agreed, adding that other cities might have a more legitimate claim than Chiefland.
“Chief Robinson (Cedar Key) probably has the best gripe for ALS non-transport,” because of Cedar Key’s small staff and remote location, he said. The eight municipalities in Levy County are all going to have to be held to the same standard.
And there are other issues, too.
Knowles said he is still waiting to see a plan from the City of Chiefland on how to implement ALS.
Chiefland City Attorney Norm Fugate said a plan, at this point, is “irrelevant” because the city is not seeking a Certificate of Need and is moving toward a system that would fall under the direction of the county.
Knowles disagreed, stating that a plan would be needed to organize and potentially coordinate personnel between the county and City of Chiefland, as well as other numerous details.
Barron had even suggested that the county loan one of its paramedics to the city to help with training and certification, while Chiefland, in turn, would supply one of its emergency rescue workers to the county.
Knowles said that could work for part of the plan. “You give us a firefighter paramedic. We give you a firefighter paramedic.”
Harris said he wasn’t figuring on a trade and thought the county could just afford to give Chiefland a paramedic for a time.
“How are we going to pay for that?” Bell asked.
Funding is another issue because it hasn’t been figured out by either side where the extra money is going to come from. Work will have to be done by an outside firm to determine how, if at all, funds could be split from assessments already collected -- funds to pay for more staff, paramedics and equipment.
Just getting to that point is going to cost about $11,000, according to Bell. And who pays for that, he asked? Does Chiefland pay for it, or does the county, or do the two meet half way? Coordination between both boards would have to happen in upcoming meetings to get that worked out, and that’s just to “get the ball rolling.”
“It’s gonna’ take some significant manpower and financial contribution on both sides,” Bell said. “Obviously, we’re committed or we wouldn’t be here today.”