Think About It: Who does 911 call?

The reward for good work is usually more good work. This is certainly the case for Fire District 3 providing emergency services to greater Sequim, meaning just about everything from 3.5 miles west of the Jefferson County line to 6 miles east of the Port Angeles boarder.

The volume of calls increased 33 percent over the last seven years. During 2011, the district was responding to an average of 15 calls per day; 2017 calls averaged 20 calls per day. That’s a call of nearly one every hour. One hundred percent of those calls received a response. Eighty-six percent of those calls were for medical needs as defined by whomever called.

The increase is easily explained by the population growth and average resident’s age in our area. Greater Sequim’s population has increased by 28-30 percent since the year 2000, according to the Washington State Office of Financial Management population estimates of our school and fire districts. The average age of a resident in Greater Sequim is 52.

We have a significant population increase which includes an increase of the so called aging cohort. I, along with many of you, are doing our best to raise the average age of our community.

The problem that Ben Andrews, chief of District 3 Fire Department, has is that the increase in volume and/or intensity of service has not been accompanied by a corresponding increase in capacity. He says that they have not increased staffing levels since 2008.

So, the chief and the board of Fire District 3 are running up the yellow flag warning that trouble is ahead. I don’t even want to imagine what it would be like if I or my husband experienced cardiac distress or respiratory failure and the other called 911 only to hear a recorded message advising us to be patient, we were fifth in line for emergency service.

Always available when no one else is

911 always answers the phone. And, unless there is an apparent alternative or wrong number, a medic unit arrives to help. Beyond the facts of population and volume growth, our fire district has taken on more and more work to fill gaps in the community’s medical services. For example, Chief Andrews explains that a shortfall in primary care providers results in more people using 911 as their primary care provider.

The need was particularly acute when a major provider of physician services left the community leaving a huge gap in services. OMC and the Jamestown S’Klallam Tribe have been diligent in recruiting primary care providers, and the free clinic has met some of the need. Still, there are not enough.

OMC and Jamestown have built amazing medical offices and diagnostic services facilities in Sequim which is very attractive to new retirees coming into the area. In one of those twists of intention, enhanced accessible medical services are a stimulus for population growth which means more 911 calls.

The fallout, besides more population to serve, is more in-town 911 calls from medical and nursing services to manage emergency situations. Medical outpatient services, skilled nursing facilities, the Free Clinic, YMCA, school district, Costco, Walmart, a home care nurse and the pedestrian on the street in Sequim do not provide sustained emergency services.

Someone may successfully start CPR or, even, apply a defibrillator. As good as that is, it only buys time, so who does provide sustained emergency services?

Fire District 3 and the OMC emergency department in Port Angeles.

A Fire District 3 medical unit which consists of one Emergency Medical Technician (EMT) and one paramedic or an Olympic Ambulance with two EMTs and the fire district’s paramedic, if the patient has a life-threatening condition that requires continuous monitoring by the paramedic, transport the patient to OMC’s emergency department. If not life-threatening, the paramedic is not required during transport.

The problem for Chief Andrews is that one half of one unit is out of service during the transport, not able to respond to another emergency, for up to one hour. The concern of Fire District 3 is not being available when no one else is either.

In other words, revenues and spending are at the bone and the fire district is beginning to cut into the bone by going into reserves to maintain this level of service.

911 calling

District 3 knew it was time to be proactive in defining the problems and solutions and commissioned a consultant to help objectively analyze the issues involved in increasing capacity, especially those not involving increasing staff.

Short- and long-term approaches came out of that study. In the short run, 911 is calling us, the taxpayers to approve a general levy of up to $1.50 assessed per $1,000 property assessment in the November election. The last levy occurred in 2004 (That levy was also for $1.50; the current levy rate is $1.26).

In early June, we will receive the Fire District 3 newsletter in which Chief Andrews details the request.

Long-term, 911 is calling for an exploration of providing some sort of emergency medical and/or stabilization unit in Sequim to increase response capacity without increasing staff.

Turns out they weren’t the only ones thinking about the value of an emergency medical facility. The City Council of Sequim listed such a facility last fall as a long-term goal (3-5 years). They did not know all the issues of the fire district; but they had experienced the loss of one of their own, Sequim City Councilor John Miller last November, which they believe may have been prevented if medical intervention had not been delayed by a trip to PA.

Sequim City Councilor Ted Miller explains, “The lengthy delay resulted in his condition steadily deteriorating, and Harrison surgeons were unable to save him. What went wrong?

Surprisingly, the answer is Nothing! The patient, District 3, OMC, Olympic Ambulance, and Harrison Medical ALL apparently acted properly in accordance with established protocols. The problem is that everyone was focused on doing his part, and no one had the holistic overview to determine what was best for the patient – or for the dozens of other Sequim area patients who may be dying unnecessarily because of delays in obtaining time-critical surgical intervention.”

Independent of each other and coming from different directions, the City of Sequim and Fire District 3 realized they were on the same road and would be most purposeful if they worked toward their shared goal together. It only remains to begin the conversation with OMC.

Such an idea as recreating an emergency room in a community without a nearby hospital causes heartburn about patient safety, quality, regulations, risks, costs, staffing, duplication to those of us in or has-beens in health care administration. As a has-been, I understand the terror response and I think Fire District 3 and the City of Sequim do too.

Chief Andrews seemed to know what he doesn’t know. Sequim City manager Charlie Bush expects progress toward the goal to be “incremental.”

Chief Andrews, fire district Commissioners, Bush and the city council want to open the discussion around what is possible and would not proceed without talking with the experts to drill down on what’s safe, added value and reasonable cost.

OMC’s CEO Eric Lewis is interested in having a joint meeting with Chief Andrews and Charlie Bush, according to Bobbie Beeman, OMC spokeswoman. She explained that a Sequim emergency facility of any kind was not currently in OMC’s plan, but OMC officials are committed to talking about it.

It would not be the first out-of-the-box, unexpected thing that OMC has ever done. Everyone needs the time and thought to develop the right answer to a difficult problem.

Bertha Cooper spent her career years as a health care organization and program administrator and consultant and is a featured columnist in Sequim Gazette. Cooper has lived in Sequim with her husband for nearly 20 years.