If you remember the independent study commissioned by the Board of Supervisors seeking remedies for the Contra Costa County Fire District's financial woes, you already have been introduced to Fitch & Associates LLC.

Their 13-month, fact-gathering, data-crunching exercise produced a 150-page report that came up with recommendations for just about everything except what was needed. It said four, three-person firefighting teams could be turned into six, two-person medical response units. (My fourth-grade granddaughter confirms that the math is correct.) It said dispatch protocol could be improved. It said response times could be better.

What about the district's budget problems? The report said to get more revenue.

Thanks, that's a big help.

Now comes the sequel, Fitch Report II: The Contra Costa County Emergency Medical Services Project Report. I opened it with exceedingly low expectations, so I was surprised at what I found.

The report said the county's emergency medical response operation would benefit by limiting all dispatchers to 8- to 10-hour shifts rather than the standard 48-hour shifts that lead to weariness.. It said a better job can be done of distinguishing severe from less urgent calls. Sending advanced life support teams for basic life support needs is inefficient and costly.

The report also urged the implementation of community paramedics who can supply on-site treatment for lesser ailments and refer patients to treatment centers. In other words, not every medical emergency call needs to end with an ambulance trip to acute care.


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Fitch also recommended that the county improve its medical data collection and sharing capabilities so that all dispatchers, responders and caregivers can access the same patient information.

The system in place now has grown randomly as needs have changed -- 14 communication centers, 11 fire agencies, three emergency ambulance providers and nine acute care facilities are in the mix -- so this pause to assess and coordinate makes some sense. Fitch estimates that $3 million could be saved if every one of the suggestions in its report is implemented.

That's not to suggest, however, that Fitch II answered every question that needs answering. Clayton City Manager Gary Napper, who serves on the Emergency Medical Care Committee, brought one to the fore at a town-hall meeting last week. He wanted to know if Fitch had examined the option of dispatching only medical teams -- paramedics in ambulances -- to emergency calls, without involving other first responders.

Put another way: Does the fire department need to be involved in every medical emergency?

"One of the invisible gorillas in the room," Napper said, "is the finance component. I don't know if we can resolve this problem without blending the first responders with the emergency medical system agency.

"We have a platform that relies upon first responders coupled with ambulance response. What I don't see here is the capability of the EMS to provide first responder emergency medical services without the benefit of (fire department) responders."

Fitch II, the Sequel, was better than the original. It stirred some thought, made some good suggestions, and at 91 pages was a quicker read.

It will be interesting to see how county supervisors react. They're the ones who authorized $400,000 for the two studies.

Contact Tom Barnidge at tbarnidge@bayareanewsgroup.com.