Several sources close to the situation say there is fundamental disagreement within Austin-Travis County EMS over how

to solve crucial problems that originate from lack of accountability and direction from management. Members of the Public Safety Commission and EMS have been putting pressure on the Austin City Council to make changes because they have doubts about how the current system is operating. Opponents of EMS management are in favor of a merger because doing so would consolidate Austin-Travis County EMS management with the Austin Fire Department management. Others think that approach is too drastic and are searching for less dramatic ways to improve the situation. David M. Williams, a consultant group owner and former Austin-Travis County paramedic, says replacing current EMS management is one of the motivations of those in favor of revamping the system. Opponents main argument for solving the management issues is to merge with the Austin Fire Department, but Williams says doing so would be a mistake, not only because recent history shows lack of success with such mergers, but because the system doesnt need that dramatic of a change. Williams, who has a doctorate in organizational systems, says sometimes when stakeholders say the system is broken, they are advocating for change. I never advocate for changing the system design unless its completely unsustainable, says Williams.

In an article written by Williams titled Is Austins EMS System Broken? which was published this year in JEMS, a journal written specifically about EMS issues, he concedes that the system shows clear signs of distress, mainly political. But he says if people are critical of management, it makes more sense to change personnel in leadership rather than abandon the design of the system. A lot of the detractors are frustrated with the management team and theyre taking it out on the system, says Williams, If I were them, I would make an argument to sayI want new leaders. Williams also makes a point to say that some of the detractors he speaks of do not necessarily have the knowledge to make the suggestions they have been making, and he worries that this public pressure will force the hand of City Council. I was becoming increasingly concerned that there were stakeholders that dont really understand EMS systemsthat were making suggestions that could have dramatic impacts on the community, says Williams. Although Williams says that Austin-Travis County EMS has an overall positive reputation, there are still several big problems within the system, none bigger than scheduling, according to a source who requested to remain unnamed because it is against EMS policy to speak to the media. He says that management does not focus on the care of their employees and eventually, low worker morale and fatigue will begin to affect the quality of patient

care. The source says it is common for tired paramedics to forget essential equipment at the hospital or station. He attributes this problem to the way that management handles shifts. Ive worked 25 years and Ive never had an issue going to work, yet since weve started these new shiftsthis is the first time in my career Ive experienced this kind of fatigue. This source says that a typical week includes two 12-hour shifts followed by a 24hour shift. On a week where medics have mandatory overtime (which is usually 24 hours and occurs twice a month), they work four days in a row, with one day off, and then another three consecutive days. He says he has a difficult time recovering from that eight day stretch. Tony Marquardt, president of the Austin-Travis County EMS Association, agrees that shift scheduling is a top priority. [One] of the immediacies is dealing with our shift schedule, says Marquardt. With the explosive population growth in the Austin and Travis County area, we are seeing increasing work loads on our medics. According to an audit conducted by the Office of the City Auditor this month, 88 percent of staff workers said they feel fatigue often, very often, or always. In the same survey, 85 percent said fatigue was occurring more often than the previous year.

The anonymous source fears that management will have a hard time handling these issues because they have lost connection with the day-to-day operations of the system. They cant lose touch with reality. Their job is to manage the way we do things. If you lose touch with that reality, how do you effectively lead us? He says that he personally favors merging with the fire department because changing management has not worked for the system in the past and in his opinion, the potential reward is well worth the risk. Others in the EMS community agree that these problems are getting so extreme that a merger is the only adequate way to fix them. In an email, Michael R. Levy, vice chair of the Austin Public Safety Commission, says he believes a merger is the only solution. He says he believes that there is a major malignancy in the management of Austin-Travis County EMS. Levy says, They have forgotten their mission: Serving the patients and the paramedics while spending the taxpayers dollars wisely and effectively. Instead, they have made themselves the mission. Levy also showed a concern with how all of these problems are affecting the final product: patient care. Obviously paramedics being tiredwith low morale is affecting the quality of patient care, beyond a degree that you could possibly believe, he says.

There was an attempt to get a comment from EMS management regarding these controversies, however after scheduling an initial interview, Chief of Staff James Shamard declined to speak. Marquardt says his association has had to step up and take on a more active role because management does not seem to have a clear direction for solving problems. The association is considering all possible solutions, including a merger, along with removal of management. Through all of this though, Marquardt makes it a point to say that he wants to keep this a productive conversation without getting caught up in the hyperbolic irrelevancies. As of now, Marquardt says a merger is merely an idea, and that until the fire department works out their own contract, it is not anything that will happen anytime soon. Marquardt says he still has confidence in front line workers who strive to make this a successful system, but low morale and fatigue can easily change that, which is why leaders are trying to solve these issues before they become too difficult to overcome. Our medics function well in disaster, says Marquardt. Our people are dedicated and focused on getting the job done, but there comes a breaking pointwhere it begins to become unsustainable.