All Politics Is Local: Or an EMS Labor Union and the Kerfuffle

There’s been a lot of discussion on EMS social media about the contract between the City of Austin and the Austin/Travis County EMS Employees’ Association (AKA: The Union) lapsing. I’m not a medic for ATCEMS, but I feel compelled to wade in as an Austin resident, a paramedic, a public sector employee, a friend of many of the medics in the system, and as someone who was a first responder within the system. I’m going to give this my best effort and will probably not gain any friends as a result. But that’s ok – as the old joke goes – lawyers have feelings.  Allegedly.

This is a system that’s had issues for a while. And this isn’t solely a greedy public employees’ union issue.  Nor is it an issue of terrible management. The truth be told, it’s a horrendous combination of lousy union leadership and equally inept city leadership.  The union leadership has sold its membership one scheme after another as the “one big fix” to the challenges of working in EMS.  I remember several years ago when there was entirely different leadership at the union, EMS management, and even city management.  A paramedic ran for the union presidency on a promise of replacing the current (at that time) 56 hour work week of 24 hours on and 48 hours off with a guaranteed 48 hour work week – for the same pay.  Needless to say, neither EMS nor city management were enamored with the idea of cutting hours for the same pay.  Then the union president raised the issue of “safety.”  That’s an issue that, once raised, can’t be recalled. At that point, the city hired a consulting firm to examine EMS scheduling and the determination was made that many of the stations were too busy to be on 24 hour schedules.  To this date, scheduling and station assignments remain one of the biggest challenges at ATCEMS. A variety of schedules have been tried and active fatigue management policies are now in place.  While the fatigue management policies are welcome and needed (especially after the death of a respected ATCEMS captain who fell asleep while driving), the reality is that all of the scheduling fixes fail to address the underlying problem – a busy EMS system that does not have sufficient staffing or crews, especially in the areas of highest call volume in the center of the city.

The call volume in central Austin also impacts other parts of the system.  Many of the ambulances from the other parts of Austin have to transport to hospitals in central/downtown Austin.  Once those trucks become available as they leave the hospital, they are assigned calls in central/downtown Austin.  The crews call this “getting sucked into the vortex.” Meanwhile, the more outlying areas of the city are without their ambulance – all because no one recognizes the 800 pound gorilla in the room – the central part of Austin with its socioeconomic demographics, the entertainment district in downtown, and two homeless shelters less than two blocks from the entertainment district.  The solution was, is, and remains additional EMS resources in central/downtown Austin.  No other solution is a solution.

And let’s talk about the outlying areas some. Pretty much since the EMS system was created in Austin, Austin has supplied paramedic-level transport for all of Travis County.  Each of the fire departments in Travis County (including Austin FD) have provided first responder services under the protocols and medical direction of ATCEMS. In THEORY, ATCEMS protocols allow for the “credentialing” of these fire departments’ advanced/intermediate EMTs and paramedics to function at their state certification level. The reality is that the credentialing process is very similar (and probably rightfully so) to the field training process that ATCEMS medics go through to be “credentialed” for independent practice.  In actuality, the process exists largely on paper. The process is too long and involved for many departments to commit an employee for this extended period.  And it serves ATCEMS to limit the number of providers above the EMT level.  As a result of this process, its lack of transparency and clear standards, and the underlying motives in limiting the number of advanced providers, ATCEMS has alienated many of the fire departments in the county.  Pflugerville was alienated to the point of creating its own fire-based EMS system and completely separating from ATCEMS.  Two other departments have their own medical direction now for paramedic-level first response.  This failure reflects right back on both ATCEMS leadership and ATCEMS union leadership.  In fact, one union president told Pflugerville that his job was to protect his members. Granted, it’s probably the truth, but at least be politic enough to couch it in terms of patient safety, patient care, and patient outcomes.

If management deals in good faith with employees, there’s little hue and cry for a union, much less civil service protections. Witness the number of Japanese auto plants in the US where workers have actively rejected unionization attempts by the United Auto Workers.  ATCEMS has had a history of employee discontent and morale issues.  I know paramedics from the early 1990s who complained about being assigned to a mandatory overtime shift at the busiest station in the system (and one of the busiest in the US) right after working that same station for the previous 24 hours. As the morale problems continued and several provider suicides occurred, Austin’s previous medical director was replaced by a new medical director who came in from the outside.  One of his first of many arrogant moves was to push for ATCEMS to hire EMTs because he believed that there are too many paramedics in EMS and he didn’t believe there was evidence to support advanced life support providers.  This mindset was that of a physician who seemed to define EMS success by cardiac arrest statistics alone. A new “Medic I” position was created where anyone with an EMT certification or higher would be eligible to apply.  After a period of 1-2 years as a “Medic I,” those with a paramedic certification would be eligible to promote to the “Medic II” position as a paramedic-level provider. Needless to say, this change increased the workload on system-credentialed paramedic providers and also turned off many experienced providers from applying to work for ATCEMS.

While ATCEMS has since replaced the medical director with a much more progressive and aggressive medical director from the Houston area, the Medic I/Medic II model is now virtually codified as a result of ATCEMS moving to civil service. As a result of the continued workplace discontent, the latest “solution” from the union was “civil service.” Civil service would provide for state laws (or a negotiated contract with the city) to govern employee relations including hiring, promotions, and discipline. It has also codified a management team and culture where, other than the department director and medical director, all promotions are from within the department.  And this is a department that is so insular that it still believes its own PR machine about how progressive it is.  In fact, until the mid 2000s, the ATCEMS patch still had “System of the Year 1985” on it.  While other EMS systems have added paralytics for intubation and multiple other drugs and interventions, the bureaucratic inertia of ATCEMS has turned the previous clinical excellence into just another large urban EMS system, albeit without the requirement to become a firefighter. And just like most fire departments where the IAFF rules the roost, the union was created as a result of management strife, but requires on continued strife to justify “this is why we need a union.”

And now the employees are without a contract.  And “this is why we need a union.”  And so it goes.


When both the Journal of Emergency Medical Services and the local alternative weekly newspaper, the Austin Chronicle, run stories on purported issues with the local EMS system, there’s something seriously wrong.   ATCEMS may not truly meet the definition of an EMS system in crisis as defined by the International City/County Management Association, but there’s two indicators to me of trouble. One, the union’s push for civil service, from my sources and own observations, stems from a core lack of trust in leadership’s decisions, particularly in promotions. Second, I remember when this was an EMS system that attracted paramedics from across the country.  Not so much these days, despite being one of the better paying EMS systems.

I don’t have the answers to chic everything or else I’d be a highly paid EMS consultant. But I can start with two suggestions.  One, cut out the paramilitary training academy and FTO process that turns off experienced medics.  Two, bring in some outside people into middle and upper management.  ATCEMS’s operational and clinical management has become too much of an echo chamber of itself.  New ideas never hurt any organization, especially one that’s sadly stagnating. 

As for the issues with the rivalries and turf wars with Travis County, I have a simple solution.  Honesty.  I have no issues with the medical director allowing — or not allowing — first responder agencies to provide patient care above the EMT level.  But if you’re going to allow it, provide for a fair, transparent credentialing process.  If it’s not going to be allowed, just say so rather than hiding behind a vague concept of credentialing that hides the ball from everyone.

I’ve had many great experiences with Austin EMS, both as an EMT first responder and as a family member of patients.  I’ve also been disgruntled by some of their management decisions.  But as a resident of Austin, I truly do hope that we can have a great EMS system again rather than an EMS system that used to be great.

Make a deal with the devil

We all claim to support free enterprise.  Well, most of us do, at least those of us who aren’t college faculty and/or members of the Obama administration.  But do we really?  More importantly, does business support free enterprise?  My answer, based on today’s local news here in Austin, is no, not really.

The local newspaper today reported on a hotel construction project losing its city subsidies over a failure to pay a “prevailing wage.” Apparently, prevailing wages are the new attempt by the Left to ensure “economic justice.”  As you can see, I’m not too supportive of such regulation of the market.  However, here’s the rub. I don’t favor the government getting involved in the affairs of business. But if business comes to government looking for a subsidy, also known as a handout, then you can guarantee its going to come with lots of strings.  It’s like borrowing money from a parent. You’ll get your money, but you know that your parents will also put conditions on the loan.

In other words, don’t go saying you’re for the free market, then suck up government subsidies, then complain when you’re held to your end of the bargain. If you want free enterprise, that means you don’t have to worry about the government interfering in your business.   However, that also means tglove you shouldn’t get any sweetheart deals from the government either. And if you do make a deal with the government, you should expect to be held to it.