How Do You Change 30 Years of EMS Failure?

The state of EMS in San Diego County is a disastrous mess, as the embezzled public funds that were to be realized as part of the City's failed "public-private enterprise", continue to be unaccounted for. But the problems in the City of San Diego, are only one small symptom of a much larger problem that has surrounded the ability to provide EMS transportation in San Diego County, for more than 30 years.

In the Beginning...

San Diego County was selected to participate in a federal EMS "Demonstration Project", by the Dept of Health, Education and Welfare in 1972. During that period, many of the local communities around the City of San Diego (such as Poway, Vista, Escondido, etc) sent firefighters for training as paramedics, while the county set up trauma centers and EMT training at community colleges.

Prior to this point, the was not allot of training or certification required to work on an ambulance. When I originally began, all that was required was an advance first-aid card that was provided by the American Red Cross upon completion of a 16 hour course. I can recall owners placing ads in the paper with a caption of "No Experience Required".

While the communities of the county embraced what was coming, the City of San Diego was slow to respond. The City had SDPD officers assigned to Dodge vans. The patrol vehicles would double as an ambulance, should the need arise. Hartson's Ambulance, a local company owned and operated by Bob and Juanita Hartson, would run almost as many ambulance calls as the police department, but it was the San Diego Police who were charged with providing ambulance transportation services by the city.

Initially, when the "paramedic" concept arose, San Diego Fire Administration wanted no part of the EMS delivery system. The "old school" philosophy within the fire administration was one of "I don't want men who fight fires, sticking needles into the arms of citizens". The police department also wanted to get out of the transportation business, because they saw it as a service that was in conflict with the original duties of serving and protecting the citizens from crime.

In 1979, the San Diego City Council decided to let the "genie-out-of-the-bottle", and awarded the city's first Paramedic Services contract to a company called "Medevac". Today, "Medevac is out of existence.(see:  "San Diego EMS History" )

And Now, The Rest of the Story....

The documented history of San Diego County's EMS system is for the most part accurate, but for those that were here and suffered through it all, quite incomplete. There are several elements of significance to many who paid and sacrificed their families and careers over the years to keep us all from traveling down a path that was not only not fair-handed to all who wanted to participate in the EMS system here, but that created significant barriers of entry to mere paramedic trained in other regions of the country, as a means of outright elimination from any possibility of participation in an ALS role. 

In July of 2010, the State of California changed the rules on local EMS agencies. For 30 years, the San Diego Division of EMS charged HUGE fees and created outrageous hurdles to block paramedics from coming into the county EMS system. But that's not to say that they couldn't, you just had to have the right "sponsor" agency, or enough money to survive the test. In the proceeding paragraph, I will provide you an example;

• In 1988, a close friend of mine decided that he wanted to come back into San Diego to work for San Diego's EMS provider (Hartson). He had been told during a preliminary interview that  if he could pay for and pass the cross certification process to obtain a license in the county he would be interviewed and hired by the provider. He packed his home in Riverside County, and moved into San Diego County and began the process.                                                                                                                    

• The fee for cross certification into San Diego County in 1988 was $350.00, and consisted of skills lab stations, a written test, and some class room instruction on the EMS protocols used in San Diego County. Quite like the National Registry testing used today. 

• Once this was accomplished, they were required to ride on a paramedic ambulance for a minimum of 10 (24 hour) shifts with a paramedic preceptor, to be evaluated as to the candidates "suitability" to participate as a paramedic in the county.

• In those days, 10 shifts with a preceptor amounted to roughly one month of work without a paycheck. needless to say, the financial strain was crushing... but, he made the cut and was hired by Hartson. But, he told me that there were about 20 that had begun the cross-certification process and only 4 or 5 had finished.

But this is only the beginning of the tale... In my next piece, I will tell you what the nurses in the county REALLY thought of all of US paramedics... It is a piece of our history that MUST be told.