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A seemingly innocuous statement by one of the leading candidates for Honolulu mayor has reignited a blaze of accusations and concerns about a potential merger of the city’s Fire and Emergency Services departments.
The statement — “EMS will benefit by receiving better training and equipment and will work hand-in-hand with the firefighters to save lives” — is buried at the bottom of the second paragraph on the fourth page of Kirk Caldwell‘s “roadmap” booklet of his issue platforms distributed to media and supporters in recent weeks.
Caldwell says in the “Safety First” section that a merger — which he says began during his time as the city’s managing director — needs to be moved forward and “makes critical sense.” But some leaders and paramedics who would be impacted by a merger are incensed at the suggestion that their services are lacking.
“What training does the Fire Department do that relates to EMS? They don’t have a permanent training program,” said paramedic Theresa McGregor.
HFD trains its firefighters at a national standard level, but not at the considerably higher state threshold required for EMTs and paramedics to work on an ambulance in Hawaii. Medics with advanced life support training can insert breathing tubes, administer medications in the field and perform other interventions that EMTs with less training cannot.
McGregor also said the two departments have the exact same oxygen tanks, oxygen masks, breathing assistance tools and backboards.
“So I don’t understand what equipment they’re talking about,” she said. “If you’re talking about ambulances, our ambulances are top of the line. They’re awesome.”
McGregor and ESD supervisors Laurie Grace and David Mower explained in an interview with Civil Beat that they believe the merger is poorly thought out and politically motivated. They called it “cloak and dagger” stuff and a “hostile takeover.” Careful to say the working relationship with firefighters in the field remains strong, all three said they think HFD leadership wants to take on more responsibilities so it can maintain or grow its annual budget.
In particular, they said a report prepared last summer for HFD by a merger-friendly consultant connected to the International Association of Fire Chiefs is full of holes when it comes to specifics about how operations might be coordinated and what the impact would be for public safety. A full merger of the two departments would also include the Ocean Safety program under the ESD heading, though much of the debate has centered on EMS.
Honolulu Fire Chief Kenneth Silva said he sees the report as merely a recommendation and not as gospel that needs to be followed to the letter. But he said he and his team are “chomping at the bit” to get things moving on a merger despite potential hurdles.
“We’re not naive in that sense. We know that any idea that’s worthwhile should be done correctly and should be done in a period that makes sense,” he said. “I’m convinced that a fire-based EMS service is the way to go. … We’re not going to force this on anybody, if it gets to that point.”
In particular, Silva said he was sensitive to concerns from some paramedics that got into the field specifically to help sick or injured people with medical care and not to fight fires. The physical and emotional demands of the jobs are different, and both McGregor and Grace said a firefighter-EMT position might not be as attractive for many women as a paramedic career.
“I think if you look at the cultural differences, you have a lot of pride in what people do. … Absolutely, it’s something that’s always there,” Silva said. “What we’ve been saying from the beginning though is that there’s a place at the table for everybody from the get-go. Nobody will lose their job if we merge as long as they have satisfactory job performance. … If you’re an existing employee, whether you’re in fire or EMS, and you don’t want to be a cross-trained worker, you don’t have to be.”
That could represent a deviation from the consultant’s report, as could Caldwell’s suggestion that every fire station on Oahu — some 40 in all — would house an ambulance. Currently, there are around 20 ambulance units. The report, in contrast, said rural ambulance units might be moved into the busier downtown area to create some cost savings.
The most highly publicized finding in the report was that a full merger could save the city $10 million per year. But the operational details, whatever they turn out to be, would have an impact on the bottom line.
Linda Rosen, chief of the Hawaii Department of Health Emergency Medical Services and Injury Prevention System Branch, says some of the report’s conclusions “weren’t completely substantiated.” She and the rest of the DOH would play a key role in determining if a merger would provide adequate public service — and if the city would continue to receive state funding with a new system.
“I think it is a trend that you see across the country because of tightening budgets and the public asking how are these dollars being spent and could it be done more efficiently,” Rosen said of the merger idea. “It’s not the most important consideration for EMS. It’s a very important medical mission that you have to take seriously. It’s not just a matter of which is cheaper.”
Caldwell said the purpose of a merger would be to improve public safety and save lives — not to save money. He said quicker response times are an important goal for EMS and pointed to an audit released last December showing only three of 21 ambulance units met response time guidelines at least 90 percent of the time over the preceding years.
Caldwell became defensive when asked whether an endorsement by the Hawaii Fire Fighters Association — which could see an increase in membership should a merger be undertaken — played a role in his advocacy.
“I supported a merger, I put the working group together and I was ready to take the next step, and that was before I was running for mayor. Now why would I do that if I was only doing it for an endorsement?” he said. “I did it because I believe it’s about saving lives. It’s the right thing to do, whether I was running for mayor or not, and I find the question offensive, really, to tell you the truth.”
He noted that he was also endorsed by the United Public Workers union that includes EMS workers, and that UPW is larger than HFFA. (McGregor, Grace and Mower are all UPW stewards.) He also said he’s heard similar concerns and gotten questions about job loss from EMS personnel during stops on his island-wide listening tour.
“I don’t know where they’re getting this from,” he said. “I recognize the differences. I recognize your high level of training. I appreciate the hard work you’re going through. I’m trying to see if we can’t make it better, improve patient care and save more lives. And then they go, ‘OK.’ They walk away feeling better.”
Dr. James Ireland, director of the Emergency Services Department and a member of Carlisle’s Cabinet who could lose his job under a merger, said his workers want to know more about the model before deciding whether they support it. Pending that further information, he’s personally opposed to the idea.
“I want to work more with them,” Ireland said, referring to the Fire Department. “But right now, to merge based on this report, at this point in time, is just not right.”
The ball, for now, is in Mayor Peter Carlisle‘s court.
Silva, the fire chief, has lobbied in favor of the merger and said he’s frustrated not in Carlisle’s leadership but in his own inability to educate the new administration about the important benefits of combined operations. Ireland has, to this point, been more successful in convincing Carlisle to keep the report on a shelf and the merger on the back burner pending further information.
“It’s coming closer and closer to the front burner,” Carlisle told Civil Beat this week. The sudden shutdown of emergency rooms on the Leeward side drew attention for a while, but Caldwell’s statement inflamed some frustrations.
“Any suggestion that they are not adequately equipped and not adequately trained and not doing their job well, which is what the implication of any such statement is, is first false and second, extremely alarming to those people who do this work,” he said, referring to Caldwell’s statements. “As a matter of fact, it’s taken as an insult.”
Carlisle said he hasn’t ruled out the idea of a full merger but at this point wants to move “thoughtfully” to avoid the pitfalls that doomed three previous failed efforts to merge the two departments here. He said combining dispatch operations could be among the “low-hanging fruit” that’s targeted sooner rather than later.
“If you wanted to do this merger, it could be done tomorrow,” he said. “That kind of brash, un-thought-out, unstructured, ‘let’s just do it and let’s just have a merger and figure out what’s going to happen after we have a merger’ is in my opinion poor management and verging on mismanagement considering the history.”
Carlisle said in his State of the City address in February that he’d be convening a “working group of key stakeholders to decide whether and how a merger could work.” Both HFD and ESD have given Carlisle some potential names, but he has yet to form the group and said it’s still two or three months away.