The post that started it all -- Austin Fire's proposed EMS takeover

April 4, 2002

Dear Ladies and Gentlemen:
While reading the Austin American-Statesman yesterday, I read the article where Austin Association of Professional Firefighter's President Scott Toupin proposed merging Austin-Travis County EMS into the Fire Department. My first impression was that this was a late April Fool's joke. After overcoming my initial shock, I realized that this was a serious proposal. Such a proposal, however ill-intentioned, deserves a serious response.
Before I begin addressing my concerns with Mr. Toupin's ill-conceived proposal, I feel that I should address my ability to tackle this issue. I have a bachelor of arts in government and sociology from the University of Texas, a masters of public administration from Southwest Texas State University, and a law degree (JD) from Texas Tech University. In addition, I have participated in "third-out" rider programs with both Austin and Lubbock EMS as well as a variety of law enforcement agencies. I believe that my combination of academic education with exposure to street-level operations qualifies to speak to Mr. Toupin's idea.
Let me say from the outset that I wholeheartedly oppose a merger of the Austin Fire Department and Austin-Travis County Emergency Medical Services. In the following paragraphs, I intend to explain why such a merger will result in fiasco.

I. The Fire Service traditionally overlooks emergency medical transport operations.
While it is true that many early providers of EMS (e.g., Miami-Dade County and Los Angeles County) were fire services, the history of emergency medical care delivered by the fire service in Texas is fraught with horror stories. Perhaps the most vivid (and recent) of these stories come from the Houston Fire Department. In Houston, firefighters have been suspended for failing to treat a child who later died of an aneurysm. Also, Houston firefighters have been suspended for stopping for doughnuts while transporting a patient to the hospital. Currently, the Houston Fire Department's emergency medical services license is under probation by the Texas Department of Health (TDH) for these, and other violations of TDH rules.
In Dallas, the story is much less horrifying, but shows the lack of commitment to emergency medical care. The Dallas Fire Department requires each of their new employees to become certified as paramedics, and serve a minimum of two years on an ambulance before the employee can transfer to a firefighting unit. Rules such as this lead to a system where emergency medical care is seen only as a stepping stone to being assigned to a firefighting unit.
These instances lead me to the unfortunate conclusion that emergency medical care, as delivered by a fire service, will suffer as a result of being seen as a "sideline business" -- both from a lack of commitment by field personnel as well as a lack of organizational commitment.

II. The current system in Austin is a national model.
Currently, both the Austin Fire Department and Austin-Travis County Emergency Medical Services are recognized as leaders in their field. The Austin Fire Department currently limits its emergency medical delivery to first-response, providing medical care prior to EMS arrival. Austin firefighters are certified at the level of Emergency Medical Technician (EMT), which provides a limited level of care The Austin Fire Department is now fully accredited by the Commission on Fire Accreditation International. This means that an independent group of experts has recognized AFD's high standards. The Austin Fire Department currently limits its emergency medical delivery to first-response, providing medical care prior to EMS arrival.
Field medical personnel within Austin-Travis County Emergency Medical Services are required to be paramedics, the state's highest level of emergency medical certification. Austin-Travis County EMS has been accredited as an Accredited Center of Excellence by the National Association of Emergency Medical Dispatchers. In addition, the STAR Flight program was the first public safety air medical provider to receive accreditation from the Commission on Accreditation of Medical Transport Systems. In addition, the Special Operations unit of EMS (which provides high angle rescue, swiftwater rescue, and hazardous materials rescue) has received many awards both at the national and state level. This is the same section of EMS that Mr. Toupin feels most threatened by. Clearly, it is not a lack of expertise which concerns Mr. Toupin.
Based on the high levels of achievement by both AFD and EMS, the axiom of "if it ain't broke, don't fix it" should apply.

III. It is unclear how this proposal would improve services.
At this early stage of Mr. Toupin's proposal, it is unclear what benefits such a merger would provide. From my initial thoughts on the issue, I am unsure what cost savings would occur as the City of Austin currently handles procurement for both departments and a joint AFD-EMS supply facility already exists. The City of Austin also already has a maintenance facility for both EMS and AFD apparatus.
Further, the standards of care which dictate EMS's treatment are developed in conjunction with the Travis County Medical Society. Such a close relationship has been the fruition of years of effort. It is unclear if the Travis County Medical Society would be equally willing to work with a system under the direction of the Fire Department.

IV. Look at the source of this proposal.
While I do not intend to engage in ad hominem attacks, it is imperative that the source of such a proposal be considered. Mr. Toupin is the elected president of the Austin Association of Professional Firefighters, the local affiliate of the International Association of Firefighters (IAFF), part of the AFL-CIO. Mr. Toupin states about the proposed heavy rescue unit, "Make no mistake about this, it is a threat to our jobs." This came directly from the union website. The IAFF website shows that their organization maintains a paid staff to work on fire-EMS relations. Based on call volumes and types, the fire unions realize that emergency medical care and rescue operations are the majority of responses. To ensure continued funding increases and pay increases, the union feels as if it must get more involved in EMS and rescue operations.

Mr. Toupin must serve his constituency -- the union membership. I am asking that the city leadership considers interests of the public served by Austin-Travis County EMS. Such a proposal should be rejected as little more than a union-backed turf war.