The Chief's perspective on Advanced Life Support in Medfield

After attending the joint Warrant Committee/Board of Selectmen meeting on Monday, 4/10, I followed up with Medfield Fire Chief, Bill Kingsbury one day later with questions to gain a better understanding of his perspective on the Advanced Life Support (ALS) issue facing the Town of Medfield.

Chief Kingsbury has been on the MFD for 45 years and has been Chief for 28 of those years and has announced that he will be retiring in a few months. In discussing the ALS concerns, which will be addressed at Town Meeting, it was obvious to me how passionate he is about this issue and how long he has been suggesting the hiring of full-time paramedic level of service.

Currently the Town of Medfield does not have ALS service. The current lack of Advanced Life Support service facing the Town of Medfield is a hot topic and a Warrant Article at Town Meeting (on April 24th) will be proposed to the residents of Medfield. They will be asked to vote on what the next step should be.

At the 4/10 meeting, after the Warrant Committee gave their report first, Fire Chief, Bill Kingsbury spoke briefly with his proposal and answered questions. The Board of Selectmen chose to listen to the questions before giving their opinion.

I, like many people in town, were unaware of how medical emergencies were handled in regard to the staffing and services Medfield provided when a call comes in for an ambulance.

I knew that if I were to dial 911, someone would respond! What I didn’t know is that the Medfield Fire Department does not provide its own in-house Advanced Life Support (ALS) - Paramedics on an ambulance. What we had in place was ALS intercept service (a contracted private ALS provider would meet Medfield ambulance at the location of the patient and take over the patient’s care when needing paramedic care). But right now, we don’t have that either.

We have used several private ALS intercept services for many years. However, this service, most recently provided by “Events EMS” (private firm), ceased in the fall of 2016. Since that time, Medfield emergencies that require paramedic service now rely on ambulances staffed by paramedics from a few neighboring towns, most especially Westwood and Walpole (both of whom are in-house ALS certified).

At the 4/10 meeting, the Warrant Committee and the Board of Selectmen often referred to this neighboring town assistance as “mutual aid”, but Chief Kingsbury did not agree with that statement.

When I spoke to Kingsbury the day after the meeting he quoted a fellow Chief with similar issues saying, “Mutual Aid is a network of sharing, with resources flowing back and forth across jurisdictional borders, and should not routinely benefit one partner in the form of subsidized services by the taxpayers of another community”. He added, “When it benefits one town, at the expense of another, that’s not mutual aid!”

Kingsbury went on to say that the intercept service that had been in place for many years worked just fine, but he also pointed out that over the past 10 years he has made mention that looking to hire full-time Paramedics and provide our own Advanced Life Support to the residents of Medfield is the direction he wanted to go. In referencing Chief Kingsbury’s Letter published in the year ending 2014 Annual Report, he states “As I have stated many times, all new full-time hires for the foreseeable future would be Paramedics, which would enable us to provide Advanced Life Support (ALS) services.” In the year ending 2011 Annual Report, his letter states “As I have stated in previous reports, there will come a time when more full-time staffing will be added. The demands of being an On-Call Firefighter make it difficult to recruit new members. With the hiring of more full-time staff, we will move towards providing a paramedic level of service.”

At the 4/10 meeting Chief Kingsbury said, “Intercept service has been here for a long time, but for the past 10 years I have mentioned in my reports that we need to hire 6 full-time people and run it ourselves. He went on to say that he has not hired any additional full-time staff in 13 years. When asked what that cost would be, he stated “$573,000”.

In my discussion with Kingsbury he gave me a breakdown of that cost, shown here:

6 FF/Medics - $483,336

Equipment - $90,400

Total Request - $573,336

New hires would be licensed Paramedics on date of hire & they would need to go thru the Fire Academy if they haven't already.

There is no fee for the Academy; they will be paid their salary while attending. We would attempt to schedule it so there would be minimal shifts to be covered.

The 4 options offered by the Warrant Committee are as follows. The estimated financial impact is stated with each option. However the financial listed with Option #3 Hire ALS, estimated by the Warrant Committee is higher than the amount Chief Kingsbury proposed.

• As Is – Rely on mutual aid to provide ALS intercept (while long term solution evaluated). Financial: Potential $25K to study committee. Service: Same as we have been receiving for several months. Uncertainty: Not a long term solution.
• Contract ALS – Hire a service to dedicate ambulance and medic to Medfield. Financial: $600K budget. Service: Equivalent to hiring medics. Uncertainty: Control of resources, Potential cost/service sharing.
• Hire ALS – Hire medics and equipment current ambulance to accommodate ALS Service. Financial: $750K budget (cost of hiring plus $90K to equip ambulance). Service: Response time fast (assuming no concurrent calls), utilization low. Uncertainty: number of hires/level of coverage, who hires/trains, cost estimates (benefits/OPEB).
• Regionalize ALS – Share resources (either hired or contracted ALS) with other towns locally. Financial: Unknown – but lower than other long term options. Service: Response time fast (assuming no concurrent calls), utilization higher. Uncertainty: Partners, cost sharing, location of ambulance.

The Warrant Committee and the Board of Selectmen agreed with each other saying their preference was Option #1 “As Is” for now, and create a study committee, and put off any decisions until early 2018. The Warrant most likely will ask the voters to agree to a study. The voters may also be asked to vote to fund $650,000 in order to implement a decision after the study, and may further be asked to vote to allow the Board of Selectmen to make the final decision, rather than bring the study results back to the 2018 Town Meeting.

The Board of Selectmen showed much interest in Option #4 Regionalize ALS. However throughout discussion, Chief Kingsbury commented, “Towns are not looking to regionalize as most already provide or are in the process of establishing their own in-house ALS service.”

If the town votes to stay “As Is”, that would mean if an ALS need should arise in Medfield, it would require the aid of the Westwood or Walpole departments (ALS capability) for as long as it takes to make a permanent decision on how we will deal with the ALS issue. Kingsbury made the point, once again, that the continued aid given to us by Westwood and Walpole could become a concern for the townspeople of Westwood and Walpole who are paying to have that service “on the ready” in their own town, and they paid for it, stating, “We’re talking about an estimated 200 times a year.”

One Board of Selectman member also pointed out that Chief Kingsbury will be retiring soon. With that in mind, Kingsbury was asked what he thinks a new Chief would prefer have done and Kingsbury responded, “Prefer it be done!”

To further understand why we find ourselves without intercept service anymore, he explained that the most recent firm we contracted with had a 90 day trial and they ceased that service after two weeks because they were not getting the calls to sustain their business plan.

In my discussions with Chief Kingsbury, he said, “I proposed this 6 person full-time hire to get to the Advanced Life Support (ALS) level and to provide the service the townspeople are accustomed to. It is better in-house because you get ALS resources to the patient’s side the fastest way possible when time is of the essence. We will also have cross-trained Firefighter/Paramedics that will respond to any emergency not just medicals.”

Only a few towns in Norfolk County do not have their own in-house ALS service. Millis and Medway are both working toward in-house service, so only Dover and Medfield have none.

The following towns provide in-house ALS service:

Norwood

Westwood

Hopkinton

Bellingham

Franklin

Norfolk

Canton

Foxboro

Stoughton

Sharon

Natick

Sudbury

Wayland

The Warrant Article is currently being written regarding this issue. Our Town Moderator has mentioned that the Warrant will be very lengthy, but it is the responsibility of the residents of Medfield to be as informed as possible before Town Meeting.

What is the best choice for Medfield? Town Meeting is Monday, April 24th, be prepared to vote on this issue.