SANTA FE -- Seconds sometimes make a difference during emergency calls for help, and when it's a matter of life and death, there's something you should know:
If you live outside the city of Santa Fe's southern and western boundaries, the first ambulance that arrives after you call 911 might not include a crew that is trained to handle every emergency.
Although voters in 2006 approved a tax increase to improve emergency medical services in the growing fringe area, Santa Fe County is struggling to provide enough paramedics to take over the job from city crews.
The county fire station in Agua Fr a answers calls west and south of the city limits. Workers stationed there full time this year have emergency medical technician licenses rather than more advanced paramedic degrees. If the call is serious enough, dispatchers send paramedics from other county stations or from the city.
"If Grandma is having the big heart attack and (an intermediate crew) responds, there is going to be a delay in their advanced cardiac care, which could be fatal," said city Capt. Mark Aragon. "It could go all the way from being no big deal to being major."
Aragon works at the city's southernmost fire station, in Tierra Contenta, part of the crew that is most often called upon to cross into the county with paramedic assistance.
The main difference between paramedic-level "advanced life support" and "intermediate life support" is that paramedics are able to administer a wider variety of drugs, including life-saving nitroglycerin for cardiac patients.
Lt. Josh Duran is the third generation in his family to serve in the county fire department. He loves the feeling he gets from the job and is able to provide much of the emergency care needed by residents.
But he's not happy to ride in an ambulance that says "Paramedic" on the back when the vehicle really contains two EMTs. He feels like that is false advertising.
"When you call 911, you expect the paramedics to arrive. That's what everyone thinks it should be like, and that's what was pushed out there, that this station would be an (advance life support) unit, and it's not," he said.
Duran, like many in the county fire union, went door to door to talk to voters about the tax. His 12-year-old son stood on a street corner with a sign to promote the cause.
"I gave them my word that this is why we were getting the tax," he said. "And all we have done is put a Band-Aid on the problem. We are not living up to our word."
Nevertheless, the level of care available to county residents has improved in recent years. New tax money has flowed into the two fire departments that serve the area. The city department is spending less time outside the city limits because the county is taking care of more calls in its own jurisdiction.
The pace of the changes, however, is slower than some expected. When county officials courted city leaders for support in the tax effort, they promised 24/7 paramedic service at strategic locations along the urban boundary, the area where the well-staffed city department historically picked up the slack for the mostly volunteer county departments. Money from the quarter-cent tax started rolling in last summer, generating for the county $6 million to date.
Delivery of the promised services hit a snag when the county failed to recruit and retain enough paramedics for the expansion. Full-time paramedics started work in the Agua Fr a station in January, but this month Fire Chief Stan Holden said that station likely won't have paramedic-level coverage for the rest of the year.
"The service that we want to provide is advanced-level paramedic service. That is my goal. That is what I see as success," Holden said in a recent interview. "And so, have we reached the pinnacle of success countywide today? No."
Duran knows firsthand about the obstacles to success. During his recent 48-hour shift, a woman in a trailer park, in the county's jurisdiction north of Airport Road, had chest pains. Because of the serious nature of the call, in addition to Duran and his crew mate, a paramedic and two other EMTs from the county's fire station on N.M. 14 were also dispatched.
With two county ambulances tied up at one house, the next call in any of those areas would fall to the city. This time, that didn't happen.
But the city's south-side Station 8 crews are all too familiar with what happens when the dominoes start to fall.
The next day, city Capt. Aragon and other paramedics and firefighters from Station 8 crossed into the county to respond to teenager with convulsions just before dinner time. Earlier in the day, they went to the rural village of Cerrillos to handle a call.
Each time a crew moves out of its district, a hole opens in the safety net, causing the potential for another crew to be displaced.
Everyone from fire administrators to field personnel know that's not an efficient way to operate.
City Fire Chief Chris Rivera said he empathizes with the county's difficulties in growing its department, but he is considering adding another paramedic crew in the city this year.
"We have thought about doing a number of different things," said Rivera. "We can't control what is going on the other side, but at least on our side we can do what we can to try to alleviate some of the problems that may arise from that ripple effect."
The city department got 15 new firefighters last year following budget increases funded by a city property tax. It also benefited from money that was freed up in the city budget when the county agreed to use some of its new revenue to pay for the regional emergency dispatch center. Rivera said his staffing needs have been met at least until the city expands by annexation.
Emergency-dispatch data indicates Rivera's patience is merited. In the first three months of 2006, 6 percent of city calls were to locations outside the city limits. That number dropped to 3 percent this year.
County Chief Holden said his department continues to make progress on its expansion. The paramedic shortage is caused mostly by salary competition from neighboring departments, including the city's, he said.
However, the salary issue might be slow in resolution. The county firefighter's union continues to negotiate with administrators for pay raises.
Lt. Ramos Tsosie is part of the negotiation team. An Agua Fr a native, Tsosie said pay raises are essential to getting a full contingent of paramedics. He says the county Human Resources Department officials in charge of dolling out money are playing hardball with the union. And while they do that, experienced workers quit and potential recruits turn away.
"We really need to stop the bleeding, patch up the holes and keep people from leaving," he said. "It's getting messy."
County Manager Roman Abeyta said he agreed to open negotiations ahead of schedule this year at the request of the union. While he wouldn't divulge the exact offer the union refused, Abeyta said he plans to treat the fire department equal to other unions such as police and corrections, which recently got raises that matched competitors'.
Adding to the staffing shortage is a substandard living situation at the windowless county fire station just east of N.M. 599. The county had planned to build an addition that would contain living quarters for firefighters who work 48-hour shifts. Because of delays in getting a state permit, that has not happened yet.
For Duran, who also works two other jobs to makes ends meet, the frustration is hard to swallow.
"I feel like the county is just not taking care of the people who work here," he said, showing off the blue blankets that make up the front "wall" of his bunk area. A plywood sheet separates the beds from the main room of the firehouse.
Holden said the county plans a cadet training academy in July to add more workers, and another academy is slated to start in January 2009.
Some of those firefighters will also staff a station in La Tierra, on the north end of N.M. 599.
Bids are being solicited for design of the Rancho Viejo station. An addition to the station in Pojoaque also is planned, and a community college paramedic training program that's under way should produce more skilled workers, according to Holden.
"Understand that these processes that we are involved in are not overnight-type operations," said Holden. "They take time to build up."
Contact Julie Ann Grimm at 986-3017 or firstname.lastname@example.org
ABOUT THE CITY DEPARTMENT
* 116 firefighter/EMTs and firefighter/paramedics in the field
* 5 round-the-clock, staffed fire stations, each with an ambulance with most of the capabilities of an emergency room and an engine company for firefighting and rescue and five crew members
* 38 square miles
ABOUT THE COUNTY DEPARTMENT
* Other county fire stations: 35 Camino Justica, N.M. 14 17919 US 84/285, Pojoaque 25 N. Frontage Rd, Edgewood
* 41 firefighter/EMTs and firefighter/paramedics in the field
* 5 round-the-clock stations staffed with 2 personnel and engine, tanker and rescue truck
* 320 volunteers
* 29 fire stations that hold equipment that have an engine and a tanker, some that have a rescue truck or an ambulance
* 2,000 square miles