By Will Dunn
The formal process to merge Western and Eastern Eagle County Ambulance Districts began with a discussion over a beer between the two agency leaders.
Since the founding of the two services, the communities of each district had grown closer and the missions had become very similar. The concept of combining operations would be more fiscally responsible for taxpayers.
However, to understand the merger and the lessons learned from it, we need to first understand how our system developed with two distinct agencies.
Eagle County, home to Vail
You may know Eagle County, Colo. because of the world-renowned ski resorts of Vail and Beaver Creek. Situated in the central Rocky Mountains, some 50,000 people live in the communities in Eagle County. Over one million people visit each year and at times of peak travel, the Eagle County Regional Airport is second only to Denver International as the busiest in the state.
A century before tourism took over as the region’s primary economic driver, it was the mining boom that gave rise to the county and the small towns founded within its borders. Rugged wilderness yields to a long river valley that bisects the county. Along the western edge, mostly in the town of Eagle, families of miners and ranchers have lived for generations.
In the spring of 1962, construction began on a ski resort town in the eastern end of the valley. Seemingly overnight, skiing came to Eagle County, and in December of that year another boom was under way. Vail was an immediate success.
Two EMS systems are born
Both communities, like most of the U.S. during the Vietnam Era, had fledgling EMS systems. Vail Valley Medical Center on the eastern side of the valley ran a hospital-based service that by the 1970s boasted one of the first and only 24-hour paid paramedic services west of Denver.
At the other end of the valley was a community ambulance-provided service. Similar to most rural EMS systems, the service on the west side of the valley wouldn’t have full-time employees or advanced life support capabilities for some years to come.
There were other important differences: Vail’s ambulance service enjoyed a relatively high call volume during ski season months, only to give way to weeks at a time without a patient during the late spring, summer and early fall. To the west, the volunteer ambulance had a scant, but steady call volume where members of the community took care of each other.
Each service becomes a special tax district
In 1981, facing a grim economy, the Vail hospital announced that it could no longer foot the bill for the ambulance service, forcing the community to examine how EMS was provided in the county. Among many of the solutions that were proposed, one got traction: the formation of a special tax district. A levy on property taxes was collected annually to support the year-round paramedic model that had been employed by the hospital.
At the time, it was clear that the formation of a countywide ambulance district based on raising taxes was politically untenable. And in 1982, the formation of the Eagle County Ambulance District (ECAD) was approved, but only in the eastern half of the valley. A five member board-of-directors oversaw the business and budget for an ALS system.
This model proved effective. As the community grew, the district was able to grow with it. Toward the end of the decade, the political winds had changed enough where the tax dollars for EMS seemed to make sense to many who had opposed it before.
With different needs, priorities and ideologies, incorporating the western portion of the county into the existing ambulance district was not feasible. A second special tax district was formed and in 1989, the Western Eagle County Ambulance District (WECAD) was born.
For another two decades, each system continued to mature. There were significant differences, mostly in size of operation and a “big brother, little brother” mentality was evident. By 2010, though, with the same dispatch center, medical director and similar protocols, the agencies were far more alike than ever before. And that’s when Chris Montera, general manager of WECAD, said over a beer to Fred Morrison, long-time general manager of ECAD, “We should talk about merging.”
Planning and executing the merger
It was not a takeover, although it would have been easy for the larger ECAD to consume the smaller WECAD. A Merging was subject to a vote, and therefore had to be done thoughtfully.
To start, key leaders in each organization were told of the concept. In 2011, a test balloon was sent aloft; the training departments of each agency merged. This allowed a quiet, non-operational intermingling of personnel. During this trial period, virtues of each program were identified and cross-implemented. The joint training program was successful and in the spring of 2012, a district-wide merger was announced and the real work began.
In late 2012, leaders announced a new management structure and operations began to merge. The new district name, Eagle County Paramedic Services, along with a new fleet and other branding initiatives were announced at the first joint staff meeting in January 2013. A year later, the merger was formally complete after a ballot measure easily passed.
What we learned
There was no pressure to merge departments. It was important to the leaders in both organizations to truly merge cultures and personnel. A takeover would have been easier, more efficient, less costly and perhaps a disaster.
Board members and district management focused on business decisions like salaries, benefits and retirement. Operational and cultural items, like branding, uniforms and schedules were discussed with joint panels of employees and management.
As we look back, there are seven lessons that we think will benefit any EMS agencies considering or undertaking a merger.
1. Identify the showstoppers
What are the things that would truly prevent peace? There should be very few of them. And if those things can get settled early and moved out of the way, there is more time and energy for decisions that are important, but negotiable.
2. Find the similarities and capitalize on them
With these agencies it was easy. For example, most paramedics from both districts were products of the same initial training programs. The agencies had the same medical director and protocols and also were served by the same dispatch center, so it made sense to start the merging process by combining training departments. It might take some searching but find and capitalize on the similarities that exist in the organizations preparing to merge.
3. Exploit the positives
In our merged system, the young medics who need call volume can rotate through the busy stations and the medics who need a break have an opportunity to work in the slower station. This wasn’t possible before the merger. A larger agency also allows for greater purchasing power, local political capital and promotion opportunities.
4. Focus on best practice instead of tradition
One agency always used green tape to identify pediatric disposable equipment. That seemed like a great idea – so that practice was kept. Video laryngoscopy had been implemented with great success at one agency. By securing more equipment through grants, the merged agency relegated direct laryngoscopy to a backup role as video laryngoscopy became the first choice for intubation.
5. Over-communicate
In the absence of information, crews will make their own. Good communication is crucial. Communicate to personnel frequently with email, blogs, tweets, memos, Q&As, roundtables, and presentations.
6. Get employee perspective and input
Talk to people, and not just the clinical folks. Listen to people. The personnel who will actually be doing the work of merging need to be committed and giving them a voice in the process goes a long way.
7. Give each other the benefit of the doubt
At the management and supervisor levels as well as at the crew level, merging agencies may open previously unseen fault lines. Since too often words and actions can be taken out of context, give the supervisor, field provider or soon-to-be co-worker the benefit of the doubt that their actions or words are genuine. If there is intentional and nefarious words and actions by personnel or stakeholders attempting to undermine the process, you need to act swiftly.
In retrospect, we were fortunate that both organizations had people who could see the big picture. There was no sabotage. In the end, Eagle County got the agency it needed.
About the author
Will Dunn is the clinical manager for Eagle County Paramedic Services, in central Colorado where he oversees the practice of paramedics in a world class ski resort that includes typical 911 response, wilderness and backcountry medicine, as well as a paramedic-based critical care transfer program. Will continues to pursue EMS-related research projects and lectures on EMS topics locally and nationally. Email him at wdunn@ECParamedics.com and follow @dunnww.
