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contracted statewide all the services and donated vehicles to the <br />department with the understanding that the department provides the EMS <br />service. In the 1980s, the department started to develop the <br />compensation packages for the EMS personnel. Proficiency pay or <br />propay is an hourly rate compensation differential provided to the <br />employees who run the ambulance at the time so right now with the roll <br />out of the EMS Career Ladder, thatproficiency pay is eliminated. The <br />employees that continue to receive proficiency pay are EMTs assigned <br />when they are running on ambulance. Back in 1981, was the creation of <br />the EMS Captain position which eventually evolved into the Battalion Chief <br />position. In the early 1980s,the dept created relief positions and <br />designated positions. Designed MICT or paramedics who were <br />permanently assigned to a unit and running with that unit everyday. The <br />department also had a number of relief positions which were those who <br />were licensed MICTs that would be used to fill in on personnel shortage <br />on a daily basis. The difference between the two is that the designated <br />MICTswould receive their propay even if they were on vacation or sick <br />leave, the relief MICTs would only receive their propay when they were <br />actually working. Those positions were later morphed into permanent <br />designated positions. In 1995, the department became the only municipal <br />organization across the state to create an air medical program. Between <br />1995 and 2002, the department was the only air medical program in the <br />state dedicated and operated by the government to provide response to <br />the community. The air medical program is a 24 hour operation that is <br />funded 60/40 split, the state provides 60% of the funding and the county <br />provides40% of the funding. In 1996,the state cut their funding sothe <br />department has been operating it using personnel from the ground <br />medical unit in S. Kohala. It would be more appropriate to have dedicated <br />crew but it becomes a funding issue. <br />Organizational Structure -today the department runs15 advance life <br /> <br />support units, the helicopter, one EMS BC, one EMC Captain and 45 <br />designated MICTs positions. Dr. Judith Fitzgerald is the department’s <br />medical director whichis a contract employee.The EMS budget also <br />provides funding for some of the dispatchers, mechanics, a store keeper <br />and a portion of the funding for the department’s administrative staff. <br />Structure of the EMS Program -Prior to August 1, 2010, this was the <br /> <br />ladder of the EMS program. One BC, one Captain and all EMS personnel. <br />Now the EMS BC and Captain are Bureau positions tasked with program <br />management oversight <br />Goals of EMS Career Ladder <br /> <br />Sustain the established superior quality EMS program and quality of <br /> <br />o <br />services provided to the community. The program works real well <br />because the patient care is seamless.The challengeswith <br />maintaining the program islosing trained personnel for a number of <br />reasons -either choosing to go out of the EMS program because of a <br />lack of opportunity or quit out of burn out because of a lack of <br />opportunity for relief -dead end career prior to this. <br />7 <br /> <br />