What Happened to Durham County EMS (North Carolina)?

MMiz

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I was reading an article that said:

About 44 percent of employees in 2016 and 39 percent in 2015 rated staff morale as low, according to EMS staff surveys, and 28 percent in 2016 and 21 percent in 2015 rated it very low.
Only 34 percent of employees said EMS was successful in 2016 in meeting the county’s EMS needs, down from 60 percent in 2015.
What happened?
 

RocketMedic

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The timeline seems more like issues started on his watch. And administrative leave seems more ominous than benign.
 

DrParasite

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I know a little bit, but not what happened with Director Kirkwood (no one seems to be talking about that, and I have asked).....

Skip (who I have met personally, but haven't spoken to in almost two years) is an agent of change; he was brought in to fix a system that was experiencing numerous issues. DCoEMS has been involved in some legal action prior to his arrival, many of their paramedics weren't permitted to intubate as per their medical director, one of their larger contracted EMS agencies was under investigation and in the process of folding due to financial irregularities, and their system had suffered from years of financial neglect (stations were falling apart, not enough units for the call volume, etc). So he inherited a **** show, and was tasked with making things better.

1) Durham County EMS pays less than many of the surrounding counties, at both the EMT and paramedic level. And they run more calls than anyone else in the region (the exception being Wake). So they did experience a seasoned paramedic exodus to other agencies. This has been an uphill battle, and the county FINALLY has approved payrates for all DCoEMS employees.

2) DCoEMS used to have a "hell week" in their schedule system, where you worked three day shifts and then 4 night shifts (at 12 hour shifts, with the flip being on saturday night so it wouldn't be OT), followed by 7 days off. He got rid of the rotating schedule, and set everyone on day or nights, with set 12 hour shifts. And he asked people what they wanted, instead of telling them (which apparently didn't go over well with some people).

3) Their medical director quit, and a new one was hired in 2015, and we all know how much people like change. And I heard through the rumor mill that she kinda sucks as a person, and isn't letting them do anything super progressive.

4) There have been several people that have been terminated (and some that rightfully deserved it), and others that have been disciplined. I got the impression that having a strong leadership presence has been lacking in recent years, so once someone started cleaning house, people got nervous. And I did hear that some of his supervisors fired people who probably didn't deserve a full termination, but I did only hear one side of the story second hand.

5) They purchase a bunch of brand new sprinter ambulances. They were different than what previous administrations purchased, and some liked them, while others didn't

6) They obtained all new uniforms, and redesigned their patch and badges. Some liked it, others not so much. Some asked why they were spending money on this while other items didn't have the funding for.

So I do think in many ways, the deck was stacked against the new administrator, who still had all of the old administrative staff, and now he was telling the county administration that he needed a lot more money to handle the call volume (50% increase in staff), something the department had never asked for previously. And he was enacting changes, cleaning out dead wood, and I do think he was trying to make improvements to a system that had been sorely neglected for years. And besides, agents of change typically only have a 3 to 5 year career span in director roles, compared to those that go with the flow that last 10+ years.

Many of the causes of the low morale (low pay, poor equipment, crappy stations) are improving, and morale will increase, but many of these things do take time and approval above the director level. Give it two years, with the agency getting the funding it needs and deserves, and I bet you will see the numbers increasing, regardless of who is at the helm.

By the way, if "About 33 percent said EMS provided outstanding customer service (down from 60 percent in 2015)", that would reflect more on the field staff than the actual administration.

I will also say that I know of at least one person who worked for DCoEMS, left for a neighboring county EMS agency to be a whiteshirt, and went back to DCoEMS to be a field staffer. So even though it might be bad now, it is still better than other places.

As for the investigation and suspension for the director, I find it interesting that they publicize in the news the announcement of the accusation and that an investigation is underway, but I haven't read anything about the outcome of the investigation, or what he was even investigated for.
 

NomadicMedic

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This story has been pretty quiet, but if you read Skip's posts on FB and LinkedIn, it's pretty obvious he got railroaded.

He posted a great article about having the right staff to back you if you're making change, and while it didn't mention anything specific... the message was loud and clear.
 

agregularguy

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I know a little bit, but not what happened with Director Kirkwood (no one seems to be talking about that, and I have asked).....

Skip (who I have met personally, but haven't spoken to in almost two years) is an agent of change; he was brought in to fix a system that was experiencing numerous issues. DCoEMS has been involved in some legal action prior to his arrival, many of their paramedics weren't permitted to intubate as per their medical director, one of their larger contracted EMS agencies was under investigation and in the process of folding due to financial irregularities, and their system had suffered from years of financial neglect (stations were falling apart, not enough units for the call volume, etc). So he inherited a **** show, and was tasked with making things better.

1) Durham County EMS pays less than many of the surrounding counties, at both the EMT and paramedic level. And they run more calls than anyone else in the region (the exception being Wake). So they did experience a seasoned paramedic exodus to other agencies. This has been an uphill battle, and the county FINALLY has approved payrates for all DCoEMS employees.

2) DCoEMS used to have a "hell week" in their schedule system, where you worked three day shifts and then 4 night shifts (at 12 hour shifts, with the flip being on saturday night so it wouldn't be OT), followed by 7 days off. He got rid of the rotating schedule, and set everyone on day or nights, with set 12 hour shifts. And he asked people what they wanted, instead of telling them (which apparently didn't go over well with some people).

3) Their medical director quit, and a new one was hired in 2015, and we all know how much people like change. And I heard through the rumor mill that she kinda sucks as a person, and isn't letting them do anything super progressive.

4) There have been several people that have been terminated (and some that rightfully deserved it), and others that have been disciplined. I got the impression that having a strong leadership presence has been lacking in recent years, so once someone started cleaning house, people got nervous. And I did hear that some of his supervisors fired people who probably didn't deserve a full termination, but I did only hear one side of the story second hand.

5) They purchase a bunch of brand new sprinter ambulances. They were different than what previous administrations purchased, and some liked them, while others didn't

6) They obtained all new uniforms, and redesigned their patch and badges. Some liked it, others not so much. Some asked why they were spending money on this while other items didn't have the funding for.

So I do think in many ways, the deck was stacked against the new administrator, who still had all of the old administrative staff, and now he was telling the county administration that he needed a lot more money to handle the call volume (50% increase in staff), something the department had never asked for previously. And he was enacting changes, cleaning out dead wood, and I do think he was trying to make improvements to a system that had been sorely neglected for years. And besides, agents of change typically only have a 3 to 5 year career span in director roles, compared to those that go with the flow that last 10+ years.

Many of the causes of the low morale (low pay, poor equipment, crappy stations) are improving, and morale will increase, but many of these things do take time and approval above the director level. Give it two years, with the agency getting the funding it needs and deserves, and I bet you will see the numbers increasing, regardless of who is at the helm.

By the way, if "About 33 percent said EMS provided outstanding customer service (down from 60 percent in 2015)", that would reflect more on the field staff than the actual administration.

I will also say that I know of at least one person who worked for DCoEMS, left for a neighboring county EMS agency to be a whiteshirt, and went back to DCoEMS to be a field staffer. So even though it might be bad now, it is still better than other places.

As for the investigation and suspension for the director, I find it interesting that they publicize in the news the announcement of the accusation and that an investigation is underway, but I haven't read anything about the outcome of the investigation, or what he was even investigated for.
I interviewed here just right before they announced Skip was leaving. From the people I talked to at least, Skip was really good (and part of the reason why I even started to look at them!) The pay issue was a known problem, that they seemed to have been working on for a while, and I'm glad they finally got a bump. From what I heard, the new medical director wants to go back to intubating, but with much more practice for the medics to improve success rates. She apparently worked as a medic for Austin-Travis county for a while before being a doc, and seemed to be looking into some progressive things, from what I heard. I came out of the few days I spent there being really impressed with what I saw, so I was surprised to see this post. But you bring up a lot of good points, especially
"So I do think in many ways, the deck was stacked against the new administrator, who still had all of the old administrative staff, and now he was telling the county administration that he needed a lot more money to handle the call volume (50% increase in staff), something the department had never asked for previously. And he was enacting changes, cleaning out dead wood, and I do think he was trying to make improvements to a system that had been sorely neglected for years."
People don't like change, and especially changes that affect them (scheduling, getting rid of certain employees) I hope they continue to fix things there, from the glimpses I saw, I really liked Durham County.
 

DrParasite

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From what I heard, the new medical director wants to go back to intubating, but with much more practice for the medics to improve success rates. She apparently worked as a medic for Austin-Travis county for a while before being a doc, and seemed to be looking into some progressive things, from what I heard.
My information was mostly second hand from people who worked there; I don't know the woman, never met her, but I hear her personality clashes with people. She might be a good medical director, but I was told she has clashed with people.

I think some people liked Skip, but a lot didn't, because they didn't like change, or they disagreed with the changes that he wanted to implement. I know he wanted to bring in good people from the outside, and get rid of people who should have been gotten rid of years ago. If you were friends with someone he pushed out, it jaded your opinion of him.

I still think that Durham has a lot of potential, but is still under funded and understaffed. Changes are coming, and they will be positive to both the county and the system as a whole, and 5 years from now, things that were initiated during his tenure will benefit the agency in the long term.

I did speak to a few people at Wake EMS after Skip left; they said they were glad to see him go. These were also the same people with a HS diploma, and a paramedic cert (no degree), who think they don't need any fancy education, and we have always done it this way, and we don't need no yankee coming here and telling us how to do things, when we have done it this way for decades. but again, when you bring in an agent of change, you are going to upset people who are content accepting the status quo.

No system is perfect, and no good and effective leader will make everyone happy. I still think if I was looking to relocate to NC (again), and had my paramedic cert, Durham would be on the list of places I wanted to work.
 

VentMonkey

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I know next to nothing about Durham County EMS and its political woes, but when the name Skip Kirkwood comes across even the more proactive providers in my region, and is seen as an "issue", well, that there has some major red flags even all the way on the Left Coast.

That man has, and deserves the respect of many-a EMS providers nationally. He was synonymous with Wake EMS when I was contemplating an uprooting. You don't get many like him anymore, Jarvis either.
 

RocketMedic

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The question is what sort of "issue", and whether the managers in place see it as a threat.
 

DTownMedic

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Durham EMS is now going to be a part of Emergency Management, so the EM director will be in charge. There are plenty of vacancies and lots of money to be made working overtime. Getting released is difficult. The clinical clearance test is really intense, and you have to pass a protocol test every year to maintain your credentials. The protocol test is tough too. Some of the captains had trouble with it. If you don’t pass after a couple of attempts, then you get terminated. Still, if you don’t mind the hard work, there’s plenty of overtime.
 

DrParasite

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Durham EMS is now going to be a part of Emergency Management, so the EM director will be in charge.
So the former director of Orange County Emergency Services, who was never a paramedic, and left Orange County to be the Durham County Emergency management director, is going to increase the size of his department by like 500% (or more), all while never having actually worked as a paramedic on the ambulance. Yet he is going to be in charge of EMS I don't see this as a good thing for Durham County EMS
There are plenty of vacancies and lots of money to be made working overtime.
not really a good selling point, I'm just saying.....
Getting released is difficult. The clinical clearance test is really intense, and you have to pass a protocol test every year to maintain your credentials. The protocol test is tough too. Some of the captains had trouble with it. If you don’t pass after a couple of attempts, then you get terminated.
This tells me one of three things: 1) the previous credentialing process was a joke, and many people working there who passed shouldn't have passed and someone is trying to clean house 2) it's unreasonable to expect field staff to pass an exam that even the experienced field supervisors are having trouble passing or 3) your FTOs suck and haven't been preparing their new orientees well enough so they would be ready for the final exams. Not sure which, all the people i knew from DCoEMS have since moved on to other opportunities (most of them voluntarily and they are in a much better position as a result of it).
Still, if you don’t mind the hard work, there’s plenty of overtime.
I don't have any objections to hard work, but your post really doesn't make me want to go out and apply for Durham o EMS........
 

RocketMedic

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Sounds like a distressed system. Putting in a non-EMS manager tells me the county commissoners don't really get it- they want someone who toes the line and shuts up running the show, not someone who wants to change things or even someone who thinks EMS first.

EM isn't even EMS. It is a niche. EMS is literally a daily demand. Might as well put the sheriffs under EM too...
 

DrParasite

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Sounds like a distressed system. Putting in a non-EMS manager tells me the county commissoners don't really get it- they want someone who toes the line and shuts up running the show, not someone who wants to change things or even someone who thinks EMS first
Not always... In NC, since EMS is a county responsibility, it's actually quite common for Emergency Services to be the department to be in change of the Fire Marshal's office, 911 communications, Emergency Management & EMS; however, its usually those smaller counties, where you have less than 6 EMS units for the entire system, with the ES director typically having a strong EM background....

However, in this case, I think your right. Durham's system is large enough to warrant it's own director, who has a seat at the table alongside the EM director, not reporting to him.
 

DTownMedic

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Sounds like a distressed system. Putting in a non-EMS manager tells me the county commissoners don't really get it- they want someone who toes the line and shuts up running the show, not someone who wants to change things or even someone who thinks EMS first.

EM isn't even EMS. It is a niche. EMS is literally a daily demand. Might as well put the sheriffs under EM too...

It is distressed. Three captains and a major have resigned in the last 3 weeks. The medical director is leaving at the end of August and no one knows who will take her place. I am planning on leaving too. I love my co-workers and my partner, but I need job security.
 

RocketMedic

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I make 25.75 an hour in houston
 

RocketMedic

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9, 1.6 years here
 

FiremanMike

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Didn’t I read a thread on this forum not too long ago that said folks interested in Wake County EMS should look to Durham instead because it was a much better working environment?
 

DrParasite

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Didn’t I read a thread on this forum not too long ago that said folks interested in Wake County EMS should look to Durham instead because it was a much better working environment?
Not likely. What you probably heard (and I was one who said it) was if you are looking at Wake County EMS, look at Durham, Orange, Johnston, and Nash (which are the counties surrounding Wake), because Wake does have some issues (like every system), and if you don't like it at Wake, you have other options, and your pension time and PTO time can come with you. So don't look at others instead of Wake, while you are in the area, look at others in addition to Wake.

4 years ago, Durham EMS was expanding (one of the county franchise agencies had recently crashed and burned), they had just hired a new director, and it looked like things were getting better. Since then, that director has retired, their medical director is leaving, many of their senior personnel are leaving for other positions, and they are changing from a stand alone county department to one under a non-paramedic EM director.

I am planning on leaving too. I love my co-workers and my partner, but I need job security.
If you are a medic, there are plenty of places to hire experienced and competent NC medics . It all depends on how far of a commute you want.

And for the record, It is my personal opinion that no one at Durham EMS will be laid off, but the good people will leave for better options, and conditions will deteriorate further until a strong leader is able to take over running Durham Co EMS.
 

Medic4Lyfe

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It is not a coincidence that people with great jobs and 29 years of experience are leaving. The environment is quickly becoming toxic. Favoritism abounds and it gets harder to care. One operations captain and one lieutenant get private offices while the other 2 captains and 8 lieutenants have to share.
 
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