Fire districts air concerns over Medix emergency response

After sounding the alarm over staffing and communication concerns, local fire districts are beginning to work with Medix Ambulance Service to navigate gaps in Clatsop County's emergency response system.

Medix is a private ambulance contracted by the county. In July, the Clatsop County Fire Defense Board, which includes 11 fire departments and fire districts, sent a letter to county Emergency Management Director Justin Gibbs expressing frustration over what they described as "disturbing and alarming" incidents involving the company's ambulances. The county's Ambulance Service Area Advisory Committee convened with Medix owner J.D. Fuiten and general manager Thomas Krokoski for a special meeting on Tuesday to discuss those frustrations.

'We never know'

Marc Reckmann, the chief of the Cannon Beach fire district, said one of his biggest concerns is a lack of communication between Medix ambulances and local fire departments.

Under the dispatch system, 911 calls initially go to a public safety answering point in either Astoria or Seaside. The local dispatcher takes down basic information about the nature and location of the call and notifies the appropriate fire department. Then, they transfer calls for medical emergencies to Medix dispatchers, who go through a more specific list of protocols to determine what kind of ambulance unit should respond to the situation.

Ideally, local dispatchers would stay on the line with Medix so they can update the fire departments as they get more information — but that hasn't been the reality.

As a result, Reckmann said they're often left in the dark about what type of call they're responding to, when an ambulance will be coming and how it will be staffed.

"I think probably my No. 1 issue is I don't know — we don't know — what we're going on," Reckmann said at Tuesday's meeting. "Ninety percent of the time we don't know what the medical call is ... it's actually a stroke, and we never know it is. It's cardiac arrest, and we never know it is until we're there. That's a huge problem."

Part of the issue is that the county doesn't have a single repeater that reaches the entire area. Without a standard frequency, not all fire units can reach Medix on the radio, making it difficult for the two systems to talk to one another.

For decades, the county has engaged on and off in conversations around a consolidated 911 system, but has been unable to find the support and funding to create a countywide call center. Although the Astoria and Seaside dispatch centers are planning to upgrade their computer-aided dispatch systems in the next year to increase accuracy and efficiency, at this point they have no plans to merge the two answering points.

Reckmann said he sees the upgrade as a necessary step toward addressing concerns.

"I don't think this problem is solvable until we get a CAD system," he said.

Staffing challenges

Communication is only part of the problem, though. The Fire Defense Board also identified concerns over staffing levels.

Under the county's ambulance service area contract, Medix must have a minimum of two paramedic-staffed ambulances available for core coverage areas at all times. In 2022, the company amended the contract to allow them to add ambulances to the system staffed by responders with a lower level of training, including advanced and intermediate emergency medical technicians. According to the July letter, the fire departments believed these vehicles would be in addition to rather than instead of the two required paramedic ambulances — but in many instances, only an intermediate ambulance has been available.

Reckmann said he's specifically concerned about interfacility transports, where a local ambulance might be used to bring a patient to an area like Portland to receive care that isn't offered in the county. If both paramedic-staffed ambulances are being used for transports, that limits the trained staff available for emergencies closer to home.

To Fuiten, those concerns beg a question of what counts as meeting the two-ambulance minimum. Often, interfacility transports are emergencies that require a paramedic onboard. At the same time, not every local call will required advanced training.

"If it's life-threatening, we're gonna put that at the top of the list," Fuiten told The Astorian. "And you know, if it's in a hospital, because the service isn't available at the hospital, we'll take them to one that is, and that's going to be a top priority. The point of origin does not determine the priority."

To help supplement coverage, Medix, which is owned by Metro West Ambulance in Hillsboro, has sent in Metro West ambulances from a neighboring county and called in the Seaside Fire Department, which owns an ambulance vehicle. Those options have their limitations, too. Metro West ambulances, for example, do not have radio communication with fire units or Medix dispatch, and the Seaside Fire Department does not run 24-hour operations.

The Knappa Fire District also owns an ambulance. Fire Chief Kurt Donaldson said he would be hesitant to pull resources to help fill gaps, however, given the number of moving parts in his district.

"I can't just say I'm going to bail out Medix because Medix is down to zero staffing," he said. "That's where I'm coming from. This district is my No. 1 priority, and every decision I have to make is in the best interest of the patrons of my district."

The challenges with Medix are not new.

Last year, The Astorian reported that Medix routinely failed to meet response time requirements for emergency medical calls for more than a year. The company cited a nationwide paramedic shortage compounded by issues brought on by the coronavirus pandemic as factors.

Next steps

In many ways, concerns over staffing and communication are interconnected. In order to gauge staffing levels and respond appropriately, fire units need a reliable channel for communication with Medix. Gibbs, the county emergency management director, sees the challenges highlighted by the Fire Defense Board as part of a broader system design issue.

"It's a systemic problem — it's not an individual provider problem," he said. "It's something that needs to be addressed at a higher level."

In addition to meeting with local dispatchers to discuss potential solutions, Gibbs is working to form an EMS peer review committee to review specific calls of concern. The hope is to have the committee running by later this year.

As officials work through larger systemic challenges, they're also not leaving shorter-term solutions off the table. At Tuesday's meeting, Warrenton Fire Chief Brian Alsbury agreed to try communicating directly with Medix for a month to see if it improves coordination. Unlike some areas of the county, Warrenton can easily be reached by Medix via radio, making it an easier starting point for fixing a bigger problem, Krokoski said.

Krokoski added that Medix has also been working to address staffing concerns through an emergency medical technician training program, where the company pays for local people to receive 12 weeks of training and testing in exchange for a year of service with Medix. From there, they can continue to advance their skills and pursue paramedic training.

"The real solution to Astoria, Warrenton, Clatsop County having paramedics and EMTs is really home-raising paramedics and EMTs," he told The Astorian.