First responder cutback likely as ambulance deal arranged

Wednesday, March 13, 2013

A three-hour discussion over the Barry-Lawrence Ambulance District's proposed memorandum of understanding (MOU) brought representatives from four fire departments together to discuss concerns with the proposal.

After months of impasse, issues were voiced and addressed. While not every problem reached resolution, a spirit of compromise prevailed as all parties made an effort to find common ground.

The Barry-Lawrence Ambulance District Board of Directors proposed new terms for a written working relationship with firefighters in the territory who serve as first responders. Only the Monett City Council approved the MOU after five months.

A number of problems emerged as the MOU was discussed. The board's action in proposing a new MOU with all departments nullified the previous agreement arranged with former Barry-Lawrence Operations Director Jim Liaromatis. That agreement, while meeting standards set by state officials, was unknown to the Barry-Lawrence Board until about six months ago.

Rick Mercer, chief for the Pierce City Rural Fire Association, said he never received the protocols proposed under the new MOU. He could not endorse signing a document blindly.

Moreover, Mercer said state law required first responders to act under the authority of a medical director. Following protocols approved by Barry-Lawrence's medical director was not the same as saying the first responders are acting under the medical director.

Without a medical director, Mercer said oxygen cannot be administered nor can a defibrillator be used, even if the first responder has training.

"I'll have to tell my people, 'you can go [to a medical call], but you can't do anything. You're not covered.' I can't risk the liability of going without some direction," Mercer said.

By declaring the old agreement void, Mercer said first responder activity might have to stop. Pierce City Mayor Allen Stockton, representing the city fire department, expressed similar concern.

The question of training arose. Under a proposal offered by Barry-Lawrence, passing an emergency responder course would be part of the requirements, an expense that could cost as much as $940 per person.

Mercer said the price was prohibitive. His department, which presently operates entirely on memberships, barely has enough funds to cover a year's expenses. He said he could not ask volunteers to absorb such an expense, whereas Barry-Lawrence had the ability to bill customers for extra costs. The fire department could only bill non-members.

Mercer and Mike Redshaw, chief for the Purdy Fire District, recalled that in past years the ambulance district provided training. Books were made available in a circulating library and could be returned at no cost if used without wear. Redshaw argued the district was not giving away its services, contrary to concern raised by Barry-Lawrence Board Chairman Marty Newman.

"This is a mutual exchange of services," Redshaw said. "We just want that mutually beneficial and cooperative environment again."

"I see nothing wrong with meeting in the middle," Newman said. "We could provide the instructor."

With further discussion, the ambulance board began looking favorably on re-establishing an available library of textbooks. The workbooks were deemed unnecessary, since much of the exercises were done online.

In the past, Barry-Lawrence offered continuing education credits through classes taken by its staff. Invitations to participate in that training had ceased. At the firefighters' suggestion, the Barry-Lawrence Board agreed to reopen the opportunity for training again.

A review of firefighters in need of emergency medical responder training identified about 20 in the two Pierce City departments and in Purdy who would need to take the course. That meant at least two sessions would be needed and could take two years for the departments to budget enough for the classes.

With the cost of the instructor and books covered, the Barry-Lawrence Board agreed to offer the needed training at about $36 per person for tuition only. Firefighters who had previously gone through training would be grandfathered and not required to take the course over.

Mercer said the price was fair, but it would still be a challenge to find the money.

A major component of the MOU involves replacing supplies used by first responders. Mercer said when another ambulance service, like Aurora, answers a call on mutual aid, he could not go to Aurora on a later day to get replacements.

Daryl Fenski, Barry-Lawrence Board vice chairman, said first responders should try to get replacements off the ambulance whenever possible. He said Barry-Lawrence had no problem replacing materials that the ambulance crews would have used had they been the first on the scene.

There appeared to be agreement that Barry-Lawrence would replace materials, even when a mutual aid service responded, as long as all materials used were documented on a run sheet.

A break was taken midway through the meeting to adjust language in the policy covering basic life support response by first responders.

The MOU with the Purdy Fire District had to also address advanced life support. As an Emergency Medical Response Agency (EMRA), Purdy has its own paramedics and uses supplies, such as narcotics, that other departments did not administer.

Redshaw described two situations where Purdy responded to heart attack cases and used a significant amount of supplies to the point where the Barry-Lawrence crews had very little to do except transport the patient. Because the Barry-Lawrence Board decided not to replace supplies without a signed MOU, Purdy incurred significant expense. Redshaw was displeased that Barry-Lawrence could bill for the use of Purdy's supplies then ignore Purdy's request for replacement.

The ambulance board agreed to look at the situation and review Redshaw's documentation.

Because Purdy has several paramedics on staff, training was not an issue. The department has its own medical director as well. Redshaw asked if having the same medical director might resolve some of the differences in protocols.

Redshaw submitted a draft of an MOU addressing Purdy's concerns and modifying language on a number of points. Some of the language from the state template had been removed by Barry-Lawrence's attorney, James Kelley. Redshaw pressed the board to take immediate action to resolve the differences. Newman said no action on the MOU could be taken that night. He agreed to call a special meeting once Kelley had reviewed both documents.

Mike Bennett, the Barry-Lawrence board member representing Purdy, weighed in as well. Bennett serves as chairman of the Purdy Fire District, and he asked if the ambulance district simply wanted Purdy to cease making medical calls.

"We can't decide that for you," Newman said.

Contrary to Kelley's opinion that Bennett had a conflict on interest and could neither speak on the Purdy Fire District's behalf or vote, Bennett said he was doing both. His legal counsel said both positions were voluntary and represented no conflicts. Bennett said it would be up to the ambulance district to file a complaint with the Missouri Ethics Commission to prove otherwise.

Without an agreement in place, Redshaw insisted that ground rules of some sort be established, at least over the use of supplies. Newman said he would support an exception to Barry-Lawrence's policy.

The board voted unanimously to replace any supplies used by the Purdy Fire District in responding to calls for Barry-Lawrence until the MOU issue is resolved.

The documents were sent to Kelley on Feb. 20 with a request for action as soon as possible.

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