ALS PROGRAMS IN KING COUNTY HISTORY OF ALS IN KING COUNTY HIRING PRACTICES STAFFING CONFIGURATIONS EMPLOYEE ADVANCEMENT & UTILIZATION STRENGTHS & WEAKNESSES THINGS TO WORK ON
HISTORY OF ALS IN KING COUNTY Started originally in Seattle in the late 1960 s Migrated out to King County and Bellevue in the early 70 s, then to Evergreen Hospital and Shoreline in the late 70 s. Always has maintained one of the highest cardiac arrest survival rates from VF of anywhere. Historically a 2-Medic, EMS unit, deployment model, that was officially adopted by contract w/ KCEMS in the mid 1990 s
HISTORY OF ALS IN KING COUNTY South King County Medic One merged separate programs into one in the 1980 s, and Evergreen (Hospital) Medic One (M23, M19, M35, M47) was absorbed by Redmond & Shoreline Fire agencies in 2002. At that time a total of 6 ALS providers across the county. 2017 Vashon Medic One merged into King County Medic One reducing the total number of providers down to five. Long history of a regional approach for solving ALS delivery issues
HIRING PROCESSES Bellevue: Applicant pool is Bellevue Fire personnel only 3 years as a FF/EMT (under discussion currently) 15% premium pay above top step Firefighter Considered an Assignment not necessarily a Promotion Job Description is Firefighter/Medic, requires maintaining firefighter skills and mandatory training Ability to promote out of ALS program into other leadership positions in agency Move freely between Suppression and ALS Divisions
HIRING PROCESSES Redmond: Applicant pool is fire agencies within their ALS consortium Redmond, Kirkland, Woodinville, Duvall, and Fall City 3 years required as an EMT, not necessarily required with the agency Ability to hire Lateral medics who were trained by the UW/HMC Employment transfers at the completion of PM school. The costs are reimbursed by Redmond to their employer during PM training. 15% premium pay above top step Firefighter Seniority of original agency transfers with employee into Redmond Considered a new hire, not necessarily a promotion
HIRING PROCESSES Shoreline: Applicant pool is Shoreline, Northshore, and Bothell Fire Depts. Requires completion of 4-years with agency at time of application, with a 2-year eligibility list (currently under discussion) Considered a promotion within agency and a protected process by the CBA No ability to hire Laterals unless there are no internal qualified applicants 17% premium above top step firefighter + longevity with home agency Employment transfers at start of Paramedic School, OT for extra hours (550+) in school One year right to return clause in the event they don t complete training Outside applicants are given time in grade for longevity toward vacation etc. but not seniority. Currently, must walk away from accrued benefits from previous employer. Move freely between Suppression and ALS Divisions (PM- Driver/Engineer)
HIRING PROCESSES King County Medic One: Applicant pool is National 3 years required as EMT with minimum 12-month field experience No firefighting requirement Lateral paramedic hiring process for UW trained medics Pay is not based on firefighter wage, contract is typically used as a comparable and close in total compensation package Students while in school receive a training stipend at about 60% starting wage plus OT for any hours above 40/week. Much cheaper than any of the fire agencies. Job description is Paramedic, no firefighting training or certifications required No ability to promote outside of Medic program for advancement
HIRING PROCESSES Seattle: Applicant pool is Seattle Fire employees Minimum 3.5 years as EMT by start of PM school New compensation package put together for PM Students 15% premium pay above Top Step FF Job Description is Firefighter/Medic, requires maintaining firefighter skills and mandatory training Considered a promotion within the agency Able to move out of Medic program for advancement
STAFFING CONFIGURATIONS Bellevue: 4 Medic units + one additional 12-hour unit currently, 1-MSO Three Platoon work schedule (A-B-C shifts) 12 FTE positions per shift 36 Full Time Medic positions 1-24-hour MSO, non-paramedic certified position (3 FTEs) 1- MSA 1- Administrative MSO position 1- EMS Training Lieutenant (not funded through the ALS contract) 42 Total ALS program operational positions
STAFFING CONFIGURATIONS Redmond: 3 Medic units, 1 MSO Three Platoon work schedule (A-B-C shifts) 9 FTE positions per shift 27 Full Time Medic positions 1-24-hour MSO, Paramedic certified position (3 FTEs) 1- MSA 31 Total ALS program operational positions
STAFFING CONFIGURATIONS Shoreline: 3 Medic units, 1-MSO Four Platoon work schedule (A-B-C-D shifts) 6 FTE positions per shift 26 Full Time Medic positions 1-24-hour MSO, Paramedic certified position (4 FTEs) 1- MSA 1- Administrative MSO position 1- EMS training position (70% funded through ALS contract) 33 total ALS program operational positions
STAFFING CONFIGURATIONS King County Medic One: 9 Medic units, 1 Shift MSO Four Platoon work schedule (A-B-C-D shifts) 18 FTE positions per shift 72 Full Time Medic positions 1-24-hour MSO, Paramedic certified position (4 FTEs) 1- MSA 4 - Administrative MSO positions 81 Total ALS program operational positions
STAFFING CONFIGURATIONS Seattle: 7 medic units, 1 Shift MSO Four Platoon work schedule (A-B-C-D shifts) 16 FTE positions per shift 64 Full Time Medic positions 1-24-hour MSO, Paramedic certified position (4 FTEs) 1 - MSA 4 - Administrative MSO position 73 total ALS program operational positions
EMPLOYEE ADVANCEMENT Each agency differs slightly Fire agencies have normal promotional processes after set years with agency. Bellevue has ability to move out of ALS program and then return as MSO without the requirement to retain PM certification. Seattle, Redmond & Shoreline require their MSOs to be ALS certified. No current agreements to return to previous home agency for employment or advancement for Redmond or Shoreline. King County Medic One has no ability to promote out of agency other than to separate employment (i.e. Fire Chief s, DC, or AC s job)
STRENGTHS & WEAKNESSES Common funding source (regional EMS Levy) Consistent ALS unit funding level for contracted agencies (per-unit formula) Mandatory University of Washington training program for all Medics Strong evidence based medical direction & involvement from MPD group Strong tie to HMC Paramedic Training program for ALS providers Borderless ALS programs forcing regional solutions and common response parameters
STRENGTHS & WEAKNESSES Common funding source (regional EMS Levy) A county wide one size fits all formula can be difficult to sell to a large region. All or nothing 6-year levy makes it very difficult to plan for long-term. Consistent ALS unit funding level for contracted agencies (per-unit formula) The smaller agencies do not have the same economy of scale so the cost per unit is typically higher than the larger unit agencies. Being attached to a larger parent agency allows cost & resource sharing rather than duplication of some facilities & resources.
STRENGTHS & WEAKNESSES Mandatory University of Washington training program for all Medics. This can limit the desire of outside applicants to seek employment due to the requirement to complete our (one year) ALS training program. (Not much different then requiring a FF to attend the Academy if they just graduated from one, other than time commitment). Strong evidence based medical direction & involvement from MPD group. Strong tie to HMC paramedic training program for ALS providers Borderless ALS programs forcing regional solutions and common response parameters.
AREAS TO WORK ON Stable funding source. Three major dispatch centers, two completely different dispatch guidelines. There are two different interpretations of the KCEMS Dispatch Guidelines Each ALS agency has their own philosophy on who should receive treatment, but more importantly ALS unit transport. This creates a big discrepancy in unit utilization and perception of standard of care. We need a common treatment & transport guideline across the region. Equal access to ALS employment for existing professional FF/EMTs in the region. Ability for ALS personnel to transfer out of established programs to further their career as well as better support the non-als agencies in the regions.