The Press has learned that Dr. David Miramontes, Northwood’s EMS medical director for nearly 10 years, wrote a letter to Mayor Mark Stoner on April 16 in which he made 14 recommendations for adequate staffing, supervision and deployment of resources in the fire department.

The letter was written following the death of resident Tim Mix, who had waited 28 minutes for a rescue squad to arrive at his home on Parc Rue after his wife called 9-1-1 three times on the morning of March 3.

Among Miramontes’ recommendations:

• hire a full-time fire chief who is a firefighter level II, a certified paramedic and fire inspector. The chief should be available for response during daytime hours, Monday through Friday as a chief officer/supervisor for fire and EMS response as well as offering additional paramedic resources;

• Start a paid two-member EMS crew, one of which shall be a certified paramedic from 6 a.m. to 6 p.m. Monday through Friday to cover day time staffing deficits;

• Lift the previously instituted hiring freeze for firefighter-EMTs and establishing a significant fund of at least $20,000 to allow for adequate training of new recruits and training of existing members to the paramedic level over the next 18 months;

• Hire or promoting one part-time deputy chief or other senior officer to be charged with EMS oversight, Quality Assurance (QA) Billing and EMS Logistics;

• Establish a yearly fire-EMS specific capital improvement fund so that EMS and fire vehicles can be replaced in a planned replacement schedule. The funds could come from a combination EMS fire billing, fire inspection fees/fines and General Fund sources. A set budgeted amount should be deposited in this fund yearly without exception;

• Soft-bill homeowner insurance companies for structure fire responses, automobile insurance for motor vehicle response and responsible parties for hazardous material incident response. Such funds should be targeted to fire and EMS specific capital and/or improvement projects.

• Train all city employees in CPR and in the use of the Automated External Defibrillator (AED) for EMS response when on the city payroll;

• Dispatch the closest on duty city personnel capable of EMS duties to EMS and fire responses while staffing levels remain low;

• Train all police officers within the next 12 months to the level of first responder; they should be certified by the state of Ohio and a continuing education plan should be initiated;

• Equip all on duty police vehicles with an AED and first responder bag to include oxygen once appropriate training and licenses are completed;

• Appropriately staff and train police and fire dispatchers so as to allow an enhanced EMS and fire dispatch service to include use of the Fire and EMS Medical Priority Dispatch System with an established medical protocol with Quality Assurance (QA) and medical oversight. The Computer Aided Dispatch (CAD) based program with Pro QA software is recommended. Use of regional dispatch resources or funding may offset increased costs. Such medical priority dispatch software actually decreases caller interrogation time and provides over the phone medical instructions;

• A review by the Safety Committee of response metrics of police, fire and other city responders with a goal that someone is on the scene providing CPR or patient assessment within six minutes of the call to 9-1-1 90 percent of the time.

• Institute CPR programs in all schools in the 5th, 7th and 9th grades. Public courses should be sponsored to enhance citizen CPR rates in the city;

• Resuming contracted payments, if funds become available, for medical director services to offset malpractice risk costs. Miramontes had deferred the payments during the budget crisis for 2010 and 2011.

Liability
He further states in the letter that he has made many of the recommendations in the past.

“These recommendations will require an increase in the fire and police department budgets but with many of these programs being offset by new income sources. Many of these recommendations have been proposed in the past and are yet to be implemented. Many can be implemented with resources already available in the city,” he said.

“Your liability as a city, with current staffing and deployment, should be of great concern, especially when you consider the events as of late,” Miramontes continued. “The citizens of Northwood deserve a more enhanced, organized, and integrated EMS-fire response.”

Miramontes attended a Safety Committee meeting on March 24 in which he discussed the recommendations he would later send to Stoner in the letter.

Council, however, has approved few of his recommendations. To date, council has agreed to hire a part-time deputy chief to be charged with EMS oversight; train city employees in CPR and the use of the AED; lift the hiring freeze for firefighter-EMTs, and allocate $20,000 for adequate training of new recruits and training of existing members to the paramedic level over the next 18 months; and soft-bill homeowner insurance companies for structure fire responses, automobile insurance for motor vehicle response and responsible parties for hazardous material incident response. While council did not approve Miramontes’ recommendation for a paid two member EMS crew, one of which would be a certified paramedic on daytime hours, it agreed to bring back a two member crew, one of which would be an EMT or paramedic, during the day.

Full-time chief
Miramontes was particularly disappointed that council, contrary to his recommendation, made the full-time fire chief position part-time following Fire Chief Tim Romstadt’s resignation in April.  The position has not yet been filled.

“They need to hire a full-time fire chief now,” Miramontes told The Press last week. “It is just ridiculous. They need to grow as a department. They are pinching pennies without thinking about the long-term effects. It is going to take two years to build manpower. They don’t have time to wait and see what happens with a part-time chief. You need a full-time chief who is a paramedic.”

And while he is pleased council agreed to bring back the two firefighters to cover the daytime hours, he doesn’t think it goes far enough.

“There is no guarantee there will be a paramedic on during those times,” he said.

Councilman Dave Gallaher asked members of council at a meeting on April 28 before they were about to vote on an ordinance to compensate the part-time deputy fire chief $18 per hour whether they had read Miramontes’ letter. Few had. Some said it would have no effect on their vote anyway.

Gallaher then asked for a first reading on the ordinance so that everyone could have a chance to read his letter.

“I don’t have a problem in voting on this tonight if we could have some discussion concerning the communication the city received from the medical director,” said Gallaher.

Council President Ed Schimmel, who is also chairman of the Safety Committee, said he learned of Miramontes’ recommendations at the March 24 Safety Committee meeting. He said he was ready to vote to compensate the part-time deputy chief right away.

“I really want to see this passed tonight,” said Schimmel. “I have not seen [the letter], but I’ve heard what’s in it. I think it’s pretty much saying what he said at the safety committee meeting.”

“This is what frustrates me,” said Gallaher. The letter is here. And there isn’t any council member here who is ready to talk about it.”

Gallaher adds that it won’t hurt council to “take our time” on the ordinance.

“I question why we are doing it,” said Gallaher. “It has a lot to do with money, and that is something we certainly have to be aware of. Except that the last time we made a major change in the fire department because of money, it ended up costing us dearly.”

Schimmel said by making the full-time fire chief position part-time, the city will be able to use the savings to pay the two member crew that council recently agreed to reinstate during the daytime hours. Romstadt’s annual salary as chief was $66,000.

Councilman Jim Barton said he was ready to vote, even though he had not read the letter.

“I’m in favor of moving forward with this. The letter will have no impact on me whatsoever,” said Barton.

Council member Connie Hughes agreed.

“The letter would not have an impact on me,” she said.

Councilman Mike Myers said he would like to read the letter, as well as the minutes of the Safety Committee meeting, before he votes on the ordinance.

Hughes agreed that it would be better to wait until the next meeting so everyone would have a chance to review the letter.

Stoner questioned Miramontes’ experience in financial affairs in making his recommendations.

“As much as I agree I would not be the one to go out and be the doctor, I’m not sure he’s the one who should be coming in here directing the city on how to spend its money here,” said Stoner. “I’m not qualified to be the doctor. I don’t know if he’s had a lot of experience in city finance.”

Council then agreed to give the ordinance a first reading.

Miramontes told The Press on Wednesday that he will no longer be Northwood’s medical director because he was just appointed as the full-time EMS medical director of Washington D.C.

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