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Editorial: Automatic Response Units a casualty of city’s politics

Sat., Aug. 1, 2015

Spokane’s Automatic Response Units were caught in a terrible accident this week. They were rear-ended by the City Council, pushed into the mayor’s office and sidelined for the foreseeable future.

The breakdown in communication and cooperation in City Hall could not be more complete, with City Council President Ben Stuckart accusing Mayor David Condon of lying about a restart of ARU service, which has been suspended since May. The one-man medical response vehicles were supposed to roll again Monday. They’ll remain in the firehouses, and it’s a shame for the citizens of Spokane.

The ARU program was launched in 2013 as an experiment. If the solo responders could provide timely, appropriate care, the city would be able to stretch its limited firefighting resources further and minimize the wear on trucks unnecessary for medical calls. As can be expected with a new venture, there were problems that needed to be resolved, hence the suspension in May.

In a particular case cited by Stuckart, the ARU was unaware of the severity of a patient’s condition. She died. A few ARU drivers have been assaulted.

Condon said additional dispatcher training, and self-defense instruction for the drivers, was sufficient to put the units back on the streets. But Stuckart used the isolated problems to rally the council supermajority behind an ordinance that will require two firefighters to be aboard the ARUs.

How do we know they are isolated? We asked the program’s medical director, Dr. Joel Edminster, which none of the program’s critics thought to do.

Edminster, who is also an emergency room doctor at Providence Sacred Heart Medical Center, reviews every cardiac case handled by the ARUs, intubation cases and any involving “penetrating trauma” – stabbings, gunshots, etc. He performs the same services for the Spokane Valley Fire Department.

He sees hundreds, if not thousands, of files.

For starters, he said none of the ARU drivers brought to his attention any concerns about the cases cited by Stuckart. The care provided by single responders is as good as the care delivered when firetrucks are rolled.

In response to doubts raised about information provided by dispatchers, Edminster said the city follows widely used protocols, a random set of questions.

The Spokane effort to streamline delivery of emergency services is one of many that cities have undertaken to implement community paramedic programs that are innovative and efficient. “It’s an evolving process,” Edminster said.

The process is suspended in Spokane pending delivery Aug. 17 of a third-party review of efforts to date. That’s just two weeks.

Imagine if the mayor had delayed restart until then – although there might be grant money imperiled – and the council had not stepped in with its two-firefighter mandate. Firefighters are expensive, and using them more effectively was one of the ARU goals.

What’s been lost here is the focus on the most important consideration: patient outcomes. Those that go beyond anecdotes.

Can we get back to that, please?