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EMS ‘going backwards’

ST. THOMAS — The merger of the V.I. Fire Service and the V.I. Health Department’s Emergency Medical Services Division that has been years in the making is moving forward, despite concerns from lawmakers and emergency medical technicians over the process and lack of detailed plans.

The younger brother of Gov. Albert Bryan Jr., a paramedic by training and a former firefighter with the V.I. Port Authority, has also expressed concerns. In a personal campaign via social media, Robert Bryan uploaded several memes, including one that depicts the planned merger as a shotgun marriage, to voice his frustrations about the process.

Under Gov. Bryan’s fiscal year 2020 budget, $4.2 million will be transferred from Health to the Fire Service to integrate personnel. During a budget hearing before the Finance Committee last month, Fire Service Director Daryl George Sr. said the funding transfer is the first “phase” of the plan. The only change at the outset, however, will be that EMS staff, including the medical director, will then report to George, who is said to have little to zero EMS training.

The second phase, George said, is the strategic plan for what he calls the “collaboration and integration.” During the budget hearing, some senators expressed concern that the plan was not already prepared nor shared with them.

‘Absent’ plan

Sen. Kurt Vialet, chairman of the Finance Committee, told George that “no one is knocking the merger … we’re looking at your integration plan that is now absent.”

Sen. Donna Frett-Gregory echoed Vialet, saying she was troubled there was not already a “clear, laid-out plan” and requested one “as soon as possible.”

George told The Daily News after the hearing that the strategic plan is being worked on “right now.” He said part of the plan is to move some ambulances to “strategic” locations such as Frederiksted and Hotel Company on St. Thomas, “sooner rather than later.”

“The V.I. community will have more responders, and with quality care,” George said. “A good product is going to come out.”

Concerns about the process

The merger of the two agencies has been in talks as far back as the 29th Legislature and since the administration of former Gov. John de Jongh Jr. — in office for eight years — and at the time championed by George.

The plan resurfaced when Gov. Bryan, a former Labor commissioner in the de Jongh administration, announced in February of George as his choice to lead the Fire Service, as well as his plans to make the merger happen.

“This collaboration will move the merger of Fire and EMS forward, and to improve our emergency response times and overall efficiency within our VIEMS and VIFS,” Gov. Bryan said at the time.

Some other government officials, however, do not think it will be that simple.

During the 30th Legislature, then Sen. Clarence Payne, chair of the Senate Committee on Health, Hospitals and Human Services, along with then-senator Positive Nelson, now Agriculture commissioner in the Bryan administration, and Sen. Novelle Francis Jr., were among those who initially questioned the process for the merger when it first came before lawmakers and was stymied.

It was viewed as a setback for the de Jongh administration, which for more than a year had set up monthly task force meetings with stakeholders, including top officials at Health and the Fire Service and representatives from Government House to bring the merger — touted as a “legacy” item for de Jongh — to fruition.

Last week Francis, now president of the 33rd Legislature, told The Daily News that he is not against the merger, but wants to ensure that there is a “smooth transition.”

“I’m concerned that we’re not just housing them together,” Francis said, adding the merger should provide an “opportunity to supplement each other.”

Sen. Kenneth Gittens, who in the 30th Legislature drafted the bill for the merger, now has a different take, telling The Daily News that he was “dissatisfied” about the manner in which the merger is being planned.

“This is a process that has to be well thought out and planned,” Gittens said, “and it’s not just a matter of transferring a budget to another agency and saying, ‘They’re yours.’ ”

Rather, Gittens noted, it’s about “saving lives.”

“We have to be staffed up,” he said. “We have a staffing problem.”

Gittens added he has yet to see a plan in writing. His proposal for the merger, according to legislative records, was settled on May, 17, 2013.

“Until such time, I will not just support moving the entity just because … we might be doing more harm than good,” Gittens said last week, adding that he does support the merger “in and of itself.”

Health officials in the meantime are optimistic about the plans.

V.I. Health Commissioner Justa Encarnacion, on the job for seven months, said in a phone interview that as a “clinical person,” she supports the merger, “especially the manner in which it’s being done.”

“In the past it was not structured,” she said.

Now, Encarnacion said, the project team has done “extensive research” into cities and counties that have done similar EMS-Fire Service mergers.

Encarnacion did not immediately share the jurisdictions, but said later via email through a spokeswoman that the team studied mergers in Seattle, Washington; Washington, D.C.; Memphis, Tenn.; Montgomery County, Md.; and Scottsdale, Ariz.

Like George, Encarnacion pointed out that under the planned merger, “response times should be drastically reduced,” noting that places like the East End on St. Thomas and Coral Bay on St. John will see faster response thanks to new ambulance placements.

She added that the Omar Brown Sr. Fire Station has “already” provided space for EMS to be there.

Nicole Craigwell-Syms, the Health Department’s deputy commissioner said in the joint phone interview with Encarnacion, that EMS’ goal is a response time of “no more than two minutes.”

Encarnacion was quick to caution, however, that “what we see as a goal isn’t what’s going to happen the first day that the integration takes place.”

According to the Health Department, the current average amount of time it takes from when EMS receives a call to when an ambulance is en route is 3.32 minutes.

When asked for the average time it takes for EMS to arrive on the scene, Health Department spokeswoman Jahnesta Ritter said via email that “types of calls received can vary.” She added that the minimum average is 10 minutes and the maximum average is 20 minutes.

Ritter said any outliers can “be due to ambulances dispatched to other calls or severity of dispatch; for instance major response required which requires all hands on deck.”

Decades of

manpower shortage

While both George and Encarnacion have discussed the merger as a cure-all to improve ambulance responses, their predecessors have said differently. The de Jongh administration also placed ambulances at fire stations, but that measure failed within months because of the manpower changes.

Steve Brow, the then-Fire Service director, testified at a June 26, 2013, budget hearing that his agency was preparing to absorb EMS by October. The latter month is the start of the new fiscal year for the V.I. government. At the time, Brow testified that the goal was to cross-train firefighters as EMTs. Once in place, he said, the change should allow for faster response time and more efficient operations.

Brow’s optimism, however, was doused by Andre Smith, the St. Thomas-St. John Fire Chief, who testified that he supported the merger but warned that cross training was no substitute for sufficient funding and personnel.

“What needs to be understood is both Fire Service and EMS are understaffed right now,” Smith said at the time, adding that while cross training will improve efficiency and help spread around staffing and first responders, a firefighter cannot do both jobs at the same time, so both will often be needed.

“As much as we think we can do both disciplines at once, you just can’t,” Smith said.

The de Jongh administration, prior to that hearing, attempted to solve the EMS shortage issue by hiring EMTs in much the same way the government recruits officers for the V.I. Police Department — launch a paid EMT training program.

In May 2012, then-Health Commissioner Dr. Mercedes Dullum said via press release that the paid program, due to begin that summer, was one of two priorities to bolster emergency medical response in the territory.

At the time, Health officials said that ideally it takes 11 EMTs to staff a 12-hour rotating shift, which must include higher-ranking EMT positions such as a paramedic.

Both Dullum, a renowned cardiothoracic surgeon, and then-EMS Director Dr. Selwyn Mahon, who also expressed qualms about the merger, eventually resigned. Mahon, also renowned in his field of emergency medicine and who was hired in 2004 as EMS medical director, has been serving as the director of International EMS Fellowship at Harvard University since 2015. Among those he mentored and supervised were Robert Bryan and Jacqueline Greenidge-Payne, a paramedic by training and now the EMS training director at the Health Department.

Perspectives

from paramedics

The Daily News reached out to Robert Bryan after he began posting his concerns on social media. He clarified he was expressing his personal views as a paramedic and not as a member of the EMS staff at the Health Department.

“We’ve been at this for more than 10 years,” he said, “and the fact of the matter is that the EMTs have always stressed the importance of ensuring that we continue to bring the community the same level of care.”

The differences in training between a firefighter and an EMT might affect that level of care after the merger, Robert Bryan said.

“I will tell you, by experience, that’s a whole other job in itself, and both jobs require a certain level of discipline, skill, training — and it’s kind of very, very hard to master both,” Robert Bryan said. “That is one of our main concerns, that having an EMS-Fire merger, where you have EMT firefighters, or paramedic firefighters, that you won’t be getting the same level of care because you’ll be getting an individual who is torn between totally indistinct occupations.”

He also addressed the much-touted outcome of increased response times, cautioning that “getting there is not always the only factor.”

“For us in EMS, even though we try to get to scenes expeditiously, it doesn’t make any sense if we get there and don’t know what to do, or provide the wrong treatment, or forget to provide the right treatment,” he said.

Robert Bryan said that he and other EMS staff have offered alternative solutions, one of which is to train firefighters “to at least be first responders,” which the paramedic describes as a “tiered response.”

“Whereas your lower level of care, which is closer, gets to the patient first, maintains the patient until a higher level of care can get there, similar to what happens in the hospital,” he said. “We’ve always offered that solution.”

Like Robert Bryan, Greenidge-Payne has a distinct perspective, as both an EMS member and former firefighter. She helped train Robert Bryan from his start as an entry-level EMT or EMT-Basic, to EMT-Intermediate and EMT-Paramedic or the highest level of pre-hospital care provider. Since Robert Bryan was first certified, the progression for responders has been adjusted to EMR, or Emergency Medical Response; to EMT; Advanced EMT; and Paramedic-NRP, a national certification.

In addition to training officer, Greenidge-Payne holds many different roles within EMS, but like Robert Bryan, she said that she would not speak on behalf of the agency. Rather, she shared her thoughts with The Daily News as a member of The National Association of State EMS Officials.

Greenidge-Payne said that as a member, she “understands and is part of many of the other associations that is setting the agenda for the future of EMS nationwide.”

“When I hear the word merger, I have to stop and I have to think because we are not advancing the EMS system here in the territory with the merger,” Greenidge-Payne said. “We’re going backwards.”

Greenidge-Payne said that she does want to see the firefighters trained to be able to assist EMS during emergencies and, like Robert Bryan, is supportive of a tiered-system approach.

“But we don’t need to merge with the fire department to do that,” she added. “Because we don’t have enough staff. So even taking our staff and putting our staff with them is not going to increase the numbers, is not going to increase the amount of EMTs that we have, so then we’re still not gonna be able to strategically locate units to have people responding.”

Greenidge-Payne also discussed the training differences, noting that EMTs have to recertify biannually.

“This is not a training that you get and you get it for your lifetime on a job,” she said. “You’ve gotta be continuously training, you’ve gotta be continuously practicing your skills. And that’s where the true performance measures come in.”

These training requirements are crucial, Greenidge-Payne said.

“We’re not working in a grocery store where if you drop a jar of mayonnaise, then I can say, ‘Boss, take it out my pay,’” Greenidge-Payne said. “When you get it wrong, it needs to be wrong in a classroom. It can’t be wrong on a patient.”

“But you gotta find what’s going to be best for your area,” she added. “And what’s happening now in our area is gonna be quickly training them and putting them out there. That’s my fear.”

Greenidge-Payne said that because of these training and staffing concerns, the planned merger is not going to cure everything.

“Because if you don’t have enough staff, who is gonna be able to relieve those individuals?” she said. “The individual needs to be relieved. Because in this field, when you become fatigued, it makes you indecisive, and indecisive means that you make wrong decisions.”

She added, “Yes, I want the ambulance to get to you — so do you want me to send an ambulance, but then you don’t have the right person in there to take care of you? What’s the purpose of the ambulance getting there on time?”

Greenidge-Payne said that above all, she wants “to keep the health in health care.”

“As a government agency,” she said, “it is all of our responsibilities to take care of the community.”

Next steps

Despite all of these concerns, the territory’s planned EMS-Fire Service merger is moving along. Sen. Vialet said during the June budget hearing that the enabling legislation for the merger should arrive by August.

As for Robert Bryan, he said regardless of how the plans take shape, “the EMTs have always been there for the community and we’re willing to work.”

“I mean, we work at the behest of the governor, so if that’s what he wants, that’s what we have to do. We don’t intend to be obstructionists, but we will let them know that there are alternative methods to providing rapid, good medical response,” he said.


Marie Jeanne Raoul Hermann


Granville E. Harrigan