Idaho looks to reform EMS mess

BOISE - Idaho’s emergency medical services are a disjointed patchwork of cities, counties, ambulance districts, fire departments, private firms and others that’s led to duplication, gaps in service and possible risks to patients, according to a new state report issued Tuesday afternoon. The problems have been debated for years, but the various entities involved never could come to agreement on changes. Now the state Legislature is preparing to step in. “Let’s try to weed through the politics so that we can get to what’s best for Idaho,” said Sen. John McGee, R-Caldwell, who serves on both the Senate Health and Welfare Committee - which has wrestled with the issue for the past four years - and the Joint Legislative Oversight Committee, which commissioned the new report. “It’s a turf war - and they’ll tell you that,” McGee said. Uniformed paramedics, firefighters and others were among those in the audience as the joint committee unveiled the report, which recommends a shift to countywide systems with state oversight. “Someone has to be in charge,” the report found. The joint committee voted unanimously to work with the House and Senate Health and Welfare committee chairs to introduce legislation to change the system in the legislative session that starts in January. Over the years, the turf wars have gotten so bad that when the Sagle Fire District passed a resolution in 2000 to start transporting patients when needed, a private ambulance firm in the area sued. Though it lost, the firm appealed to the Idaho Supreme Court in 2004, where it lost again. When Ada County passed an ordinance in 2007 to regulate emergency medical services in the county and set standards for those services, it also sued the Kuna Fire Distict for expanding its level of service without the county’s permission; the court sided with the fire district, and told the county that under current laws, it couldn’t regulate the services in cities or other governmental subdivisions within the county, just in between them. Currently, there are about 200 licensed EMS agencies in Idaho with roughly 4,500 emergency medical workers, 60 percent of whom are volunteers. They responded to 143,000 calls for service last year. The 60-page report was prepared by the Idaho Legislature’s Office of Performance Evaluations, and included reviews of how other states handle some of Idaho’s problem areas. “I think they have identified the central issue,” said Dick Schultz, Idaho Department of Health and Welfare deputy director for health services. “You’ve got three different entities right now which can provide EMS services in any jurisdiction. The bureau currently has no authority to identify which of those three entities should be providing care.” The report’s recommendations call for a new framework for EMS, to be established by the Legislature and based around countywide EMS systems that leave no gaps in coverage. They also call for creating local or regional governing authorities and a medical director to coordinate the local systems; an increased role for the Idaho Emergency Medical Services Bureau, which does the licensing; and revisions in the funding structure for EMS, all to be developed in concert with stakeholders including the current agencies and providers. Gov. Butch Otter backed the move. “The Department of Health and Welfare has been fulfilling its legislative mandate of regulating these services for over 30 years, but times have changed, and so must our regulatory approach,” Otter wrote in a later dated Tuesday. “I look forward to collaborating with the Legislature on finding an appropriate governance system for EMS agencies in Idaho.”