LT: LineTime and its readers are concerned about some of the procedures involved in the Ferry's response to emergency calls after hours. Apparently there was a problem not too long ago when you reported that you couldn't raise any of the crew to respond to a late night emergency call. First of all, is this report true?

SC: The call out for the crew was completed approximately 50 minutes after the initial callout due to the manager not being able to contact a Master to operate the vessel. Upon a third round of telephone calls, a master responded and the rest of the crew was put together.

This was a very unusual circumstance. This is the first and only time this has happened and occurred prior to the completion of training of additional personnel as masters. With all now in place, the chances of this happening again are vanishingly small.

LT: You said it took approximately 50 minutes to contact a Captain to operate the vessel, I'm wondering why it took so long, were they all out of town or would they simply not answer the phone late at night?

SC: It took so long because there was no telephone response by the Captains I thought were available. After the initial phone calles I made the additional rounds of calls at which time a Captain responded.

LT: Secondly, is the County mandated to provide emergency ferry service for aid vehicles? If not, what prompted the County to provide this service in the past?

SC: The ferry provides service for emergencies as a long standing tradition of service by the ferry.

LT: Who or what agency is responsible for providing emergency medical transportation to Guemes?

CM: The Skagit County Med One through the Anacortes Fire Department.

LT: We know that the caller in an emergency need only dial 911 to start the procedure, but can you lead us through the chain from there to the emergency vehicle's arrival on the Guemas Island side?

SC: 911 contacts the ferry manager who then calls out the crew based on who is available to be called. The crew then assembles at the ferry, sets down the ramp, and activates the ferry. The emergency vehicle comes on board and the ferry proceeds to Guemes where the ramp is lowered on the Guemes side after a deckhand climbs up a ladder to the dock.

LT: What is the procedure or steps involved for handling emergency calls?

CM: The person in need of emergency services calls 911. The 911 operator simultaneously calls the Anacortes Fire Department and the Guemes Fire Department and the Guemes ferry. The Guemes Fire Department personnel respond to the person involved. 911 calls the ferry manager who begins calling the ferry crew to get ferry transportation arranged. While the ferry crew is not compelled to do emergency runs, they have always provided very good service.

It has only been in the last couple of years that there have been a few problems getting immediate response. The Guemes Fire Department emergency medical service provides basic life support while the Anacortes Fire Dept Med One ambulance provides advanced life support including medications. Guemes emergency crew stabilizes the patient until the Med One ambulance arrives to provide advanced life support if necessary and possible transportation to the Anacortes Hospital.

LT: After the aid vehicle has been off-loaded on the Guemas side who makes the decision as to whether the ferry waits for the aid vehicle to return, and how long it waits, or to return to the Anacortes side? Is this handled the same during regular hours as it is after regular hours?

SC: The Master of the vessel is at the disposal of the emergency service personnel and does not leave until released by emergency service personnel.

LT: What, if any, backups are in place should the ferry be unavailable for an after-hours emergency run?

CM: A helicopter is always available, weather permitting. One of the problems with the helicopter, besides weather issues, is the cost, which may run up to $3,000 and may not be covered by the patient's health insurance. The ferry, on the other hand, is provided at no cost to the patient. The patient always has the choice of care and/or transportation: he may choose to stay on Guemes, provide his/her own transportation to the Anacortes Hospital, or be transported by the Med One ambulance, which also has a cost.

The Guemes Fire Dept. medical vehicle cannot transport a patient by law, unless no other reasonable option exsists and withthe approval of a medical control; the on-call physician.

LT: How do you determine which members to call for after hour emergencies? Or is there a rotational log of ALL qualified crew members
with time frame scheduling to insure availability of emergency crews?

SC: Crew members are called in rotation based on seniority.

LT: What kind of emergencies pose a life or death threat if there is an delay in providing transport, and what length of delay would make the crucial difference? Has the above situation occurred, and if so, how many times?

CM: No data readily available.

LT: Is there a pay incentive available to the crew for after hour calls, or to be on an assigned stand-by status?

SC: There is incentive pay of 3 hours of overtime to respond.

LT: What were the response times on the after-hours medical calls last year?

CM: Guemes Fire Dept has the raw data, but not compiled. 911 could provide this
information.

LT: I'm assuming from your response you feel that the problem is now solved, can you tell us what changes were made to insure a solution? You said that there are now more Captains available for duty, but this doesn't seem to be a problem of scale as much as a breakdown in policy procedure. Can you, please address this concern? Also, how many new captains have been hired?

SC: The changes made were that we now have additional Captains available along with additional deckhands plus with the shifts for the full time personnel now being only 10 hours, they have the ability to respond, provided, they dont work more than 12 hours in any 24 hour period (Coast Guard Rule). There were some out of town. I cannot answer the question as whether some one would choose not to answer. I have two additional Captains now available.

LT: What would be the ideal procedure for providing emergency medical response from your perspective?

CM: A standard operating procedure, in the form of a written document, for emergency response. The persons/agencies involved in developing this SOP would include, but not be limited to the following entities: Skagit County Public Works Dept., Guemes & Anacortes Fire depts., 911 , Dept. of Emergency Management, the Sheriff's Dept., Washington State Patrol.

The availability of a compelled on-call ferry crew, equipped with pagers.

Ferry crew dispatched by 911.

Ferry directly accountable to Guemes Command, and have proper radio equipment to do this.

Clear definition of what constitutes a medical emergency.

A standby launch needs to be in place for both planned and unexpected ferry outages.

The ferry crew needs both the accolades and responsibility for being an integral part of the emergency medical system.

As a member of the Guemes Ferry crew, are you available for after hours, emergency ferry runs?

Is this a mandantory part of your employment or union contract?

Has anyone ever declined to go on an after hours emergency run, once notified?

Do you think a scheduled (and compensated), standby arrangement is necessary to ensure prompt availability of crew members for after hours emergency runs?

Am I available? Sometimes.

Contract, no. Job description, implied.

Once notified, have I refused a medical response? Never.

Do I think a standby and compensated arrangement is necessary for prompt
availability of a crew? No.

I would also like to point out, that any requirement to wear a pager or be on standby after-hours must be negotiated between the County and the Inlandboatmen's Union. This would be at an added cost to current wages, and would have to be approved by the majority of IBU members.

Steve Cox's answer to the question "How do you determine who to call for an after-hours emergency?" was incomplete. Anyone booked out on sick leave or vacation is not to be called. As I said before, prior to the new 10 hour shifts, anyone who had worked the day before the emergency, or was scheduled to work the day after the emergency was not to be called unless there was no other choice, due to the Coast Guard 12 hour rule. Any of us who have consumed alcohol within
a few hours of a call-out are acting prudently by declining a run. We average 45 hours work a week at the present time. I would suggest that requiring a pager is an over reaction to an isolated incident. I agree with Mr. Cox that this was a rare event and that with proper planning on his part, and better middle-of-the-night communication, this incident should not be repeated.

A little advance planning on the part of the manager, and a more clear exchange of information from him, would pretty much eliminate any delayed medical response. Now that we no longer work 131/2 hour days, we have doubled the pool of available crew and operators.

At least two of our on-call people live so far from the ferry, that they are virtually not available for after-hours call outs. Management should follow it's own policy of requiring employees to live within a ten or fifteen minute drive of the dock.

At some point, island residents might consider coming to terms with the fact that island living puts them at greater risk for a delayed medical response from Anacortes. We are very lucky to have an outstanding volunteer medical/fire group on the island. Many people call 911 and ask for a ferry but decline the services of the volunteers, which is a mistake. Islanders need to understand that even when dispatch works like clockwork, they can expect at least a 20-30 minute delay before the ferry manager is notified, a crew is called out, the boat is prepared for service and a medical team arrives. Unfortunately, this is one of the downsides of island life.

I would like you to interview the crew who responded the night of the delayed run. I would like you to interview all captains and crew who were available that night, and find out who was called and who was passed over.

I would like the people who were left messages on their answering machines to tell you what kind of message Mr. Cox left them. My personal experience is that he is vague about the reasons for his calls, or he doesn't leave a message, or he says he called, when in fact he didn't.