Emergency services feel strain of growth

By JOHN STANG

The Daily Inter Lake

Last year, Marion Ambulance moved a couple of ambulances from Marion into the Smith Valley Fire Department's main Whalebone Drive station.

The reason: Kalispell's Fire Department had opened a new northside station and moved most of its ambulances there - farther away from the Smith Valley district that straddles U.S. 2. southwest of the city.

Kalispell's ambulances have been serving Smith Valley for years.

Kalispell moved its primary ambulances to its north station to improve response times throughout the town.

But Smith Valley fretted that Kalispell's move would increase its response times to emergencies along the U.S. 2 western corridor. So it asked Marion Ambulance to move part of its operation east to Whalebone Drive last September.

One result: Sometimes both Kalispell and Marion ambulances show up at the same accidents. Sometimes they don't.

To Kalispell Fire Chief Randy Brodehl, that creates confusion over who is ultimately responsible at an emergency scene.

Also, Kalispell's ambulances are always staffed with two full-fledged paramedics. The majority, but not all, of Marion Ambulance's responders are paramedics with the rest trained to a lesser level. To Brodehl, a Smith Valley resident in an emergency might expect a full-fledged paramedic and end up with a lesser-trained medical technician.

To Smith Valley Fire Chief Randy Feller, it's a case of getting the speediest response to an accident.

Smith Valley Fire Captain Doug Scarff said: "It's not about territory or anything like that. It's about patient care."

In November, the Kalispell and Smith Valley fire departments plus Marion Ambulance signed an agreement.

The agreement says Kalispell's ambulances handle all of Smith Valley calls needing paramedics; Marion Ambulance handles the rest.

A dispatcher at Flathead County's 911 center decides whether paramedics are needed at an emergency.

The problem is that the dispatcher - for many reasons - may not have all the knowledge and expertise to decide correctly.

All this illustrates the confusion among Flathead County's ambulance services - a more-or-less adequate safety net that is frayed in several places.

The most frayed aspect of the local ambulance services is that they are a patchwork network with iffy overall coordination.

These coordination problems include:

. Flathead County has four 911 centers. Columbia Falls, Whitefish and Kalispell's centers handle only police calls in their jurisdictions. The Flathead County 911 center handles the sheriff's deputies plus all fire and ambulance calls everywhere in the county. Sometimes, time is lost as 911 calls are transferred to the appropriate dispatch center.

. Ambulance service areas don't always neatly follow the borders of the Flathead's full-time and volunteer fire department districts.

. Different ambulance services differ in what they can guarantee will show up during an emergency run.

The fundamental difference in skill levels is "basic life support" and "advanced life support." "Advanced life support" means a full-fledged paramedic. Some local ambulance providers can guarantee a paramedic on every run. Others cannot.

The Kalispell Fire Department provides paramedic responses to several surrounding rural fire districts, who don't have that capability.

. Tension exists over turf among the area's fire departments and ambulance providers.

Everyone says that a patient's safety is the prime concern of his or her agency. No one will directly say why tension exists between the Kalispell Fire Department and some rural operations. But everyone admits the tension is there. Second-hand speculation usually zeros in on turf jealously and revenues.

. No Flathead agency has a legitimate grasp of all the county's 19 rural fire departments and the public and private agencies providing at least six ambulance services, their boundaries, their capabilities, their training and their people. No bureaucracy is in place to gather and coordinate that information - as well as deciding what to do with it.

. Flathead County's 911 dispatch center does not have the equipment to quickly sort out boundaries and capabilities to let dispatchers immediately know - in some cases - which ambulance to send to which accident.

The Flathead City-County Health Department's emergency medical services committee met once in December to begin trying to figure out how to transform this patchwork into a solid network. The committee's next meeting date has not been set yet.

"We have to have a shared vision," said Lisa Durand, director of Flathead County's emergency dispatch center.

"Currently, we have no organizational chart for emergency medical services in Flathead County," Kalispell Chief Brodehl said. "Everyone thinks they are the boss. It can't work that way. The organizational chart needs to be developed with everyone's fingerprints on it."

This organizational patchwork can be linked to Flathead County's rapid growth in people and homes.

"It's a growth issue. It's a growth problem," said Dr. Rob Bates, the county's emergency medical director.

The county's population has grown from roughly 59,000 in 1990 to approximately 89,000 permanent residents today. That does not count the people with second homes here.

Roughly two-thirds of the county's population lives outside the three incorporated cities of Kalispell, Whitefish and Columbia Falls.

That means those people are served by rural fire departments, some private ambulance services and a few areas that can only provide first responders while waiting for a Kalispell ambulance to drive out - with a wide range of emergency medical capabilities and some fuzziness on boundaries of who is responsible for where.

"We have to guess who to ask for," Brodehl said. "We don't know what's where."

That frustrates Durand.

Flathead County's 911 dispatch center is where those decisions must be made quickly and accurately. But the 911 center's computer-aided-dispatch equipment has limited capabilities and needs significant improvements.

Ideally, when someone calls Flathead County's emergency dispatch center, information should automatically show up on a computer screen with the caller's location and which fire department or ambulance service that is supposed to reply.

But the Flathead County system does not have that capability.

Consequently, dispatchers have to remember or guess which fire departments or ambulance services to call if an accident occurs near the borders among Kalispell, Whitefish, Columbia Falls and the rural jurisdictions. Another wrinkle is that the 911 center does not have legitimate computer records of who has the best response times to specific areas.

This problem mainly involves ambulance runs, which outnumber fire calls. For example, about 69 percent of Kalispell Fire Department calls in 2006 were for medical runs.

This becomes more confusing because the dispatch center has to keep track of which ambulances are on calls, which are on standby, and which have advanced life-support and which have basic life-support people on duty at a specific time.

For example, Kalispell's fire department has four ambulance and all of its firefighters are also paramedics with advanced life-support training. The question arises of who to call if all four Kalispell ambulances are busy - which sometimes happens.

But emergency officials are trying to find the money needed to upgrade the computer-aided-dispatch equipment required to efficiently sort out who responds to what emergencies.

Meanwhile, efforts are in their infancy to consolidate the Kalispell, Whitefish, Columbia Falls and Flathead County 911 dispatch centers.

The Kalispell City Council recently voted to support merging those 911 centers. The Whitefish and Columbia Falls city councils are scheduled to vote on similar resolutions Monday.

On Jan. 29, the Flathead County commissioners and three city councils met to discuss mutual concerns, which included consolidating the four 911 centers.

A big concern was how much money would be needed and where it would be found.

"We've still got to do our due diligence, but that's our goal," Mike Pence, Flathead County administrator, said.

Columbia Falls Mayor Jolie Fish said: "I don't know anyone on [the Columbia Falls] council that will vote for it until we know where the money will come from."

"We've been talking about this for years," County Commissioner Gary Hall said. "As the community is growing, we have to provide better services for all."

As Kalispell council member Duane Larson put it: "Eventually, legality-wise, we're gonna drop a call. Then we'll wish we've done it."

Reporter John Stang may be reached at 758-4429 or by e-mail at jstang@dailyinterlake.com