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WVN # 264: Emergency response lags behind standards

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  • waylandvoters1
    Dear Wayland Voter, After a serious accident, a stroke or a heart attack, a few minutes can make a big difference for the patient. Advanced  Life Support
    Message 1 of 1 , Oct 20, 2008
      Dear Wayland Voter,

      After a serious accident, a stroke or a heart attack, a few minutes can make a big difference for the patient. Advanced  Life Support services in Wayland often fail to meet accepted standards. Efforts are under way to find solutions. 

      Also in this newsletter:

      -- The School Committee looks at the next fiscal year. The view isn't pretty.

      -- Residents join the selectmen in opposing Question 1 on the Nov. 4 ballot.

      -- It's official: The initial permits for the Town Center project won't include land for a municipal building.

      Wayland depends on contractual agreements to provide its residents with emergency advanced life support (ALS) services. In 14-16 percent  of calls for ALS, residents  do not receive these services, according to Fire Chief Robert Loomer.

      All Wayland fire fighters are trained Emergency Medical Service providers at the basic level, which does not allow invasive treatments provided by ALS. Wayland EMTs administer epinephrine and  antihistamines,  test for blood glucose, apply splints,
      extract people from wrecked autos, and maintain  other skills. (See  HYPERLINK "http://www.wayland.ma.us/firedept/EMS.html" http://www.wayland.ma.us/firedept/EMS.html for more information). 

      But they cannot provide treatments such as intravenous fluids,  injections, and  inserting tubing by mouth, nose or trachea. Those in need of such Advanced Life Support include not only victims of heart attack and stroke but also those injured in
      accidents and sports. One member of the Board of Health is a physician in Children's Hospital emergency room who became interested in the situation in Wayland and joined the Board when he realized he was seeing Wayland children who would
      have been in better shape if they had received fluids before arriving at the ER.

      The area north of Route  20 receives ALS from Emerson Hospital in Concord. The area south of Route 20, which generates 80 percent of all ambulance calls, depends on "when available" service from the commercial ambulance service AMR. This
      area includes four of the five schools, as well as all  housing and nursing facilities for seniors. Both areas are subject to nonresponse by their ALS contractors .


      The standard of care for emergency response is within four minutes for basic care and eight minutes for ALS, Chief Loomer told Wayland's ALS committee. Wayland never meets the 8 minute standard, and averages 13 minutes, he said.  

      The town recently agreed to continue  Emerson ALS service for two years, with the understanding that Emerson may want to discontinue it after that. The town has also agreed to reimburse Emerson up to $250 per Medicare and Medicaid call to
      help compensate for the skimpy government payments. This means a potential reduction in ambulance fees that accrue to the town.

      The general trend is for hospitals to eliminate such `outbound' ambulance services, the chief observed.

      When Leonard Morse Hospital in Natick  ceased providing ALS to Wayland south of Route 20 in June  2003, the town obtained "when available" service from AMR. Often, the AMR ambulance "intercepts" the Wayland ambulance at a point close to the
      destination hospital. Clearly this is less than ideal. For many emergencies, prompt administration of ALS services is critical. 

      There has been a Wayland  ALS committee since 2003, consisting of  Selectman and former firefighter Doug Leard, Dr. Beth Zeeman, Betty Sweitzer and Mike Patterson. But no clear action plan has emerged, in part because many potential partner
      communities were being served by Emerson.   

      Earlier this year, the possibility of losing  Emerson ambulance service provided more incentive to think about creating a regional ALS capability. But recently Emerson said it would offer service for two more years, which may have removed some
      impetus for regional collaboration that could provide adequate coverage for the whole town and potential partners.

      One obstacle to towns implementing an ALS service is a  regulation requiring two ALS paramedics in a vehicle. Other regions in the state are required to have only one. Also, paramedics need to keep their skills current, so generally a larger
      population is desirable.

      Fire Captain Vinny Smith told the committee that if Wayland had begun a regional effort four years ago to staff an ALS, Wayland  would "be in good shape" and he thought it could turn a profit eventually. 

      The West Suburban Managers Group has received a grant from the Metrowest Healthcare Foundation to study EMS in Metrowest, but the participating communities are a disparate group, some of which have their own ALS capabilities. 

      The solution will most likely require two elements: one or more community partners, and an outlay of initial funding.

      Leard has asked the Board of Selectmen to allocate $1 million of the  $3 million gift from the Town Center developer to unanticipated needs, which could include ALS.

      Perhaps with citizen involvement and urging, the Board of Health, the Board of Selectmen and the Finance Committee will work toward a solution to  protect the health of all town residents and provide equal services to all parts of town. 

      -- Molly Upton


      There was a palpable sense of fear in the room as the School Committee initiated its 2009-2010 budget discussions on Oct. 6.  Superintendent Gary Burton asked what the stock market had done that day, and was told it had dropped another 400
      points or so. There is no guideline from the Finance Committee yet, but Burton is assuming there will be no tax override for next fiscal year. There is also a strong suspicion that state aid will drop. If Question 1 (elimination of the state income tax)
      passes, Wayland may lose state aid entirely. Wayland receives only a small portion of its budget in state aid, but some older economically depressed cities and towns get most of their funding from the state and would presumably be a higher
      priority in a scenario requiring drastic cuts.

      Chairman Louis Jurist commented that a significant capital investment in technology will be needed no matter what. Several members of the Technology Committee (full disclosure: that includes this reporter) believe that properly targeted
      technology investments can have an immediate positive return. Burton acknowledged the comment.

      Member Deb Cohen said that this is a year that the committee may have to make decisions about what's most important. Member Heather Pineault commented that they should ask the school communities for input on what is most critical to
      maintain programs. Member Barbara Fletcher told Burton that the School Committee is ready to help the administration examine priorities.


      Burton presented his draft goals for Fiscal 2009 which were edited and approved by the Committee. The 13 goals emphasized new initiatives including closing the achievement gap, introducing Chinese, a new health and wellness initiative, full-day
      kindergarten, and more training for teachers and administrators. Pursuit of user fees, grants, donations, and possibly advertising was mentioned. Another goal is to produce a "district report card" that "promotes the reputation of the district".

      The only goal directed to reducing costs or improving efficiency is the "greening initiative" which will "result in documented efforts to control and curtail material and energy consumption".


      "The elementary staff has real issues", said Burton. Apparently some teachers are having trouble adjusting to the half-closing of Loker School and the new distribution of classes and students, not knowing where supplies are kept or where other
      classes are in their new locations.

      The administration is still investigating the need for more school security. Most bus problems are now resolved, Burton said. And no complaints regarding lunches were received in the previous week. In a discussion of safety of the Happy Hollow
      pickup it was mentioned that parents are still complaining, but there may not be any real problem.

      In the ensuing public comment period, however, a parent described walking the Happy Hollow pickup area with Police Chief Bob Irving and quoted him as saying, "It is not safe". She said it is not clear where to cross the street in front of the school.

      -- Tom Sciacca

      QUESTION 1

      The Board of Selectmen set aside an hour on Oct. 14 for a public discussion of Question 1, which would eliminate the state income tax. But nobody spoke in favor of the proposal and the discussion among a handful of citizens ended far ahead of
      schedule, a rarity for the selectmen.

      The Board had scheduled the forum after the lead proponent, Wayland resident Carla Howell, criticized the Board for unanimously taking a position against the question before hearing arguments.

      Though Howell didn't attend the forum, she emailed the  Wayland Town Crier, saying that "holding of an alleged public 'forum' after they already took a vote is a sham, a betrayal of Wayland voters and a disgrace to the town of Wayland."

      On Tuesday night more than one selectman said Howell's absence "speaks volumes."  Peter Meade of Boston, head of the statewide effort to defeat the question, spoke briefly, calling the measure "risky, radical and reckless." He quoted proponents
      as saying that private donations would replace taxpayer funding for vital services, then noted that opponents include religious and secular charities and social service agencies.

      Question 1 is predicated on the theory that about $12 billion in current state spending is wasteful and unnecessary. Opponents predict devastating cuts in essential services that would reduce Massachusetts to junk bond status and drive
      businesses away. By opponents' reckoning, income taxes make up nearly 40 percent of state revenue. 

      Question 1 would deprive the state of 20 percent of its revenue in eight weeks, Meade said. It would phase out the 5.3 percent tax over two years. Because the state must continue such things as debt and Medicaid payments, Question 1 would
      force severe cuts in discretionary areas, such as education, roads and bridges, health and public safety. Cities and towns depend on significant funding from the state.

      Also speaking were Louis Jurist of the Wayland School Committee, Jim Bryant of the Wayland Public Schools Foundation, and two leaders of the override support group SOSWayland, Lisa Valone and Cynthia Lavenson. 

      Proponents  and opponents disagree on almost everything (the  size of the total budget, for example) except the approximate amount that would be cut.  Analysis of the measure shows that eliminating the income tax could have a
      disproportionate effect on the less affluent, particularly in relatively wealthy cities and towns with high property taxes such as Wayland.  Though proponents say that on average Question 1 would save a family $3,700 annually, the progressive
      effect of the tax skews saving toward the wealthy, who pay the highest state income taxes.

      For example, the state taxes capital gains and dividends but not Social Security income. A taxpayer with relatively low income might receive a break from Question 1 of a few hundred dollars (some opponents say less than $100) but would be
      subject to any increases in local property taxes. Thus, a high-income Wayland resident might enjoy a tax break of well over $10,000, enough to offset almost any property tax increase. A property owner of low to moderate income, on the other
      hand, could be hit with property tax increases far higher than the saving from Question 1.

      In addition, if the state loses an anticipated $12  billion to Question 1, there will be efforts to create or increase other taxes. At present, sales taxes are low and somewhat progressive by national standards (exemptions for groceries and some
      clothing, for example) and there is no state property tax.

      Wayland has a history of passing property tax overrides. SOS has attracted  considerable money and volunteer help to maintain that status, and recently announced a fund drive to fight Question 1. If Question 1 passes, and the Legislature actually
      carries it out, relatively wealthy communities will undoubtedly seek to replace as much of the lost revenue as politically feasible. 

      Campaign and finance reports filed in March and May 2008 show that the SOS Ballot Question Committee supporting a  successful $1.9 million override campaign raised more than $13,000.  There were 9 contributions of $500 to $1000 and 12
      between $200 and $500.

      For arguments pro and con, see www.smallgovernmentact.org and www.votenoQuestion1.com. The latter lists projections of lost revenue for every municipality. 

      A precursor to Question 1 six years ago drew  45 percent of the statewide vote. Wayland  selectmen say they fear that too few voters around the state are fully informed about Question 1. The Boston Globe and Boston Herald, among a number of
      newspapers, have editorialized against it. Both candidates for the Wayland-Sudbury-Lincoln state representative seat oppose it.

      The Question 1 discussion came the night before the state announced plans to cut about $1 billion from  current spending. How this will affect municipalities remains to be seen, but the outlook for the next fiscal year is expected to be grim.
      Wayland residents who have been worrying about  the emerging pattern of biennial  override requests might one day look back on 2008 as the good old days.

      -- Michael Short


      In a  Sept. 29 letter to the Board of Selectmen the developer of the Town Center project removed  land for a town building from the permitting process.

      Article K2 of the development agreement between the selectmen andTwenty Wayland states that if the developers did not get "complete construction specifications" in a Parking Lot Election Notice within a  certain time limit, the Developer would
      give "$120,000 to Wayland to assist Wayland with costs of future construction of such parking lot  and Developer will have no obligation to construct such parking lot."

      Twenty Wayland claimed that the Parking Lot Election Notice from the town on Sept. 2 directing the developer to proceed  with the design and construction of the municipal parking lot was  deficient in design detail. This was cited as a reason for
      Twenty  Wayland to "cease any design and permit efforts relating to the  Municipal Parcel area."

      Article K2 in the Development Agreement addresses only the parking lot, not the municipal building or associated structures.

      However, the consequence of this letter is that all features in the municipal parcel are to be permitted and constructed separately and later by the town, not the developer. Accordingly, the revised Notice of Intent plans submitted to the
      Conservation Commission have no structures in the municipal parcel area.


      The consultants hired by the town to advise about conservation concerns in the $140-million commercial-residential project on Route 20 are Ben Gould of CMG  Environmental, Inc. and David Faist of Faist Engineering Inc. Gould has been a
      consultant to the town for at least six years  regarding environmental remediation undertaken by Raytheon, the former tenant of the 57-acre property.

      One concern of the Commission is the interaction of stormwater infiltration with existing ground water contamination and its potential for negative impacts on the drinking water supply. This makes knowledge of the    Raytheon environmental
      remediation especially valuable.

      At the Conservation Commission hearing on Oct. 16, Frank  Dougherty of Twenty Wayland strongly objected to the use of Raytheon environmental  remediation data or the use of the data from the Final Environmental  Impact Report to the state
      and the  comments submitted to that report. He stated emphatically that he  would not provide documentation in this area.

      However, this is unlikely to have any effect as the consultant is  well-versed in the Raytheon data and the FEIR material is linked to  the Wayland Planning Board webpage.


      The  Commission has agreed to an  aggressive new schedule of hearings to speed permitting. By Oct. 24 the consultants are to present a letter   to the Commission identifying deficiencies in the plans   submitted by Twenty Wayland. Much of this
      kind of technical   problem has already been treated by the Commission in previous interactions with the applicant.

      For example, earlier versions of   the plan had the wrong scale and unclear boundary lines of resource areas, technical points which have since been resolved.

      The technical issues regarding deficiencies in the plans will be resolved in meetings and correspondence involving the conservation administrator, the consultants and Twenty Wayland. A letter will be sent to the  Commission by Oct. 31 outlining
      these discussions.

      By Nov. 7 a draft report will identify areas of compliance and non- compliance. This is expected to be two weeks after the consultants have a complete document package (i.e. two weeks after all technical issues have been resolved).

      On Monday Nov. 10 a special meeting of the full  Commission and the consultants and Twenty Wayland devoted only to the Town Center project will take place. The draft report will be discussed at this meeting.

      Within one week of the comments on the draft report,  the final report is to be submitted. If there is no slippage, this is to be due Nov. 21.

      Most of the Conservation Commission meeting on Dec. 4 will be devoted to the Town Center. If necessary it will be extended to Dec. 11. All parties hope to be finished before the holidays.

      -- Betty Salzberg

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      Wayland Voters Network
      Michael Short, Editor
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