Oceanside-County Trauma Transport Fight Ends in Pact

A temporary truce in the battle between the city and county over the transportation of trauma patients was approved unanimously Wednesday by the Oceanside City Council.

The tentative accord requires the county to station a Life Flight helicopter at either Oceanside Airport or at Palomar Airport in Carlsbad. No Life Flight helicopter currently is stationed in North County.

In return, the City of Oceanside will allow its paramedics to transport patients to trauma-care centers outside city limits if no alternative form of transportation is available.

Key to the agreement is the rescinding of county disciplinary action against an Oceanside paramedic who refused to transport a patient to a hospital outside Oceanside.

Mayor Larry Bagley said the agreement was reached at a meeting Tuesday night with county Supervisors Paul Eckert and George Bailey.

Oceanside has been feuding with county emergency medical care system staff who have required city paramedics to transport persons in life-threatening situations to county-designated trauma centers, which are outside the city limits. Tri-City Hospital in Oceanside was refused designation as a trauma center.

Oceanside councilmen responded by ordering paramedics not to transport patients outside the city limits. Oceanside paramedic David Snyder was suspended by county officials for acting under the city’s policy and disobeying a trauma physician’s order Aug. 5 to transport an accident victim to Palomar Hospital in Escondido, the nearest trauma center.

Bagley said that the “one non-negotiable part” of the city-county agreement was the requirement that the county rescind Snyder’s job suspension and remove mention of the suspension from his personnel record. But David Janssen, assistant county administrative officer, said that county trauma-care officials have not agreed “formally” to drop charges permanently against the Oceanside paramedic, although the county did promise “to do what we could” to resolve the situation.

Janssen said that the disciplinary suspension was meted out to warn the paramedic and the city not to repeat their actions. If the city signs an agreement committing it to work with county officials in the trauma-care system, “there may be no need to take it further,” he said.

The City Council’s approval of the agreement was subject to county action expunging Snyder’s suspension from his record.

Despite the unanimous vote, there was considerable grumbling by Councilmen Sam Williamson and Walter Gilbert that the proposal might force Oceanside paramedics to leave the city for extended periods to transport patients 18 to 22 miles to Palomar Hospital or Scripps Memorial Hospital in La Jolla, the closest trauma centers.

“That is exactly what we decided not to do,” Williamson complained. And Gilbert agreed that the new accord “would open the door to allowing one or both of our ambulances” beyond city limits and making them unavailable for emergencies within the city.

Councilman Ted Marioncelli also stressed that the council vote was not an endorsement of the county’s trauma-care system, which he called “ill-conceived.” Marioncelli said the emergency medical system should be “sent back to the drawing board to draw up a better plan.”

Under the agreement, which, Bagley said, must be approved by the county Board of Supervisors by Sept. 11, trauma physicians first would call on a Life Flight helicopter to transport an accident victim to a trauma center. Sheriff’s Department helicopters would be called as backup if the Life Flight helicopter was busy elsewhere.

If a helicopter was unavailable, a “roving” ambulance, arranged by the county and stationed in the Tri-City area (Oceanside, Vista, Carlsbad), would be called to take Oceanside patients to a trauma center. If none of the three transports are available, the agreement calls for the trauma center physician to give “specific consideration” to sending the patient to Oceanside’s Tri-City Hospital, rather than to a distant trauma center.

A fifth choice would be to call a “critical care unit,” to be formed at Scripps’ Encinitas hospital, to take the patient to a trauma center. Only after all the other five alternatives were tried would Oceanside paramedics be sent outside the city limits, councilmen were told.

“Rarely, if at all, would our units be required to leave the city,” Bagley stressed. Both units would not be dispatched outside the city at the same time unless city officials gave the go-ahead, he said.

The mayor hailed the agreement as “a way to get our paramedics out of the middle of this fight” and to clear the record of Oceanside paramedic Snyder.

He criticized the attitudes of trauma center doctors “who tend to treat paramedics as delivery boys,” causing morale problems among paramedic personnel.

Although Oceanside officials stressed the need for approval of the agreement by county supervisors, Bailey said the pact “needs no action by the board.” Supervisors act only on selection of trauma-care centers, he said.

He said that Tuesday’s meeting of supervisors and Oceanside officials was merely a formality because “county staff already had put this agreement together” during two weeks of talks with municipal emergency care officials.

He predicted that the agreement would be implemented without major hitches because “no community wants its paramedics to leave the city” to transport patients to distant hospitals.

Oceanside City Manager Suzanne Foucault called the agreement “a six-month experiment” to determine if the trauma transport system will work. If it does, it would become the “temporary solution” for the area during the next two years or so. By then, she said, population growth and advances in trauma-care technology will require a different solution.

Until May, the county stationed a Life Flight helicopter at Tri-City Hospital. When the hospital, which is suing the county to win designation as a trauma center, began charging the county rent for use and upkeep of the helipad, the helicopter was removed from the city.