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HomeMy WebLinkAboutAGENDA REPORT 1991 0515 CC REG ITEM 11D >Ic I .`di c) ITEM) 14 rare •pot' F°` 0\ MOORPARK :ram \-P�:1 799 Moorpark Avenue Moorpark, California 93021 (805) 529-6864 Ep J ARK. CA GCGNI.. City Council Meting To: The Honorable City Council of 5// 1991 From: The Budget and Finance Committee ACTION: nri6ca r S' Date: May 10, 1991 - BY - - ,� Subject: Enhancement of Emergency Medical Services For some time now, the members of this committee have been endeavoring to identify ways to enhance emergency medical services and improve response times in our city. The ultimate objective of both members has been to have a fully staffed paramedic operation within the community. Last November, the full Council formally assigned this Committee to bring forward recommendations to provide enhanced emergency medical services within the city. Many possible scenarios have been explored including a paramedic pilot program in our local fire stations, expansion of the County's contract with Pruner to house a paramedic unit locally and a continuing dialogue with Supervisor Vicky Howard and Simi Councilmember Bill Davis searching for cooperative solutions. This memo summarizes some of the potential enhancements and provides an interim report of the committee's progress to date. Since the ultimate objective is to provide full paramedic services to the community with the shortest possible response time, the committee focused on a local station/provider using qualified paramedic personnel. Following are the current options being studied: 1. EMS Station in Moorpark - Working with Pruner Health Services, several locations in the downtown area were surveyed as sites for a station. This option would provide a paramedic ambulance in a central location with a response time in the 3 to 6 minute range. Cost for the service, as an enhancement to the County EMS System, would be approximately $270, 000 per year. The EMS System would provide backup services when the local unit was busy or transporting a patient out of the area. 2 . Paramedics In Fire Stations - Capt. Ken Maffei, President of the Firefighter's Association Local 1364, has provided a proposal which would place a paramedic at Stations 40 and 42 in Moorpark as a pilot program to evaluate the concept of paramedic services in the County Fire Protection District. PAUL W. LAWRASON JR. BERNARDO M. PEREZ SCOTT MONTGOMERY ROY E. TALLEY JR. JOHN E. WOZNIAK Mayor Mayor Pro Tern Councilmember Councilmember Councilmember The firefighter position on each engine would be reclassified to firefighter/paramedic and the engine would be equipped with the necessary paramedic apparatus. There are presently fifteen firefighters in the County who are certified or near certified as paramedics who would be assigned to Station 40 and 42 for this purpose. Response times would also be in the 3 to 6 minute range. Cost for the service, to include paramedic bonuses and equipment, would be approximately $70, 000 for a one year trial period. This alternative may have additional costs associated with County and Fire Protection District (FPD) support and is not endorsed by either the County or the FPD at this time. 3. EMS Station Co-Located At Fire Stations - Preliminary discussions with Pruner and the Fire Protection District have indicated support for this idea. Both services are administered by the County and the use of common facilities appears to have some advantages. Response times should also be in the range of 3 to 6 minutes. No estimate of costs is available. Any of the above proposals would improve response times in the city, which are currently running about 8 to 9 minutes. Discussions are continuing with County and local officials in joint meetings chaired by Supervisor Howard and in separate meetings to address the individual approaches. There are several actions currently underway to study the EMS provision of services. Among them are the following: a. A pilot program by the County EMS to evaluate Advanced Life Support services using a paramedic and an EMT in each ambulance is now in progress. Results should be known in the Fall of 1991. b. The FPD is implementing a computer aided dispatch (CAD) system to improve efficiency of the EMS services delivery by the FPD, who are usually the first providers in an EMS emergency. Others involved in EMS are watching the results of this system with an interest to coordinate all dispatches in the in the most timely and efficient manner. c. The FPD has established a Paramedic Research Task Force to study and evaluate implementation of a fire department operated paramedic service county-wide. All aspects of the proposed system are being researched at this time. There is no published schedule established for completion of the study. d. The Board of Supervisors has approved purchase of equipment and implementation of an Emergency Medical 2 Technician - Defibrillator (EMT-D) system for use in the fire department. This system will allow the current firefighter personnel who are qualified as EMT's to use automatic defibrillators as a part of their EMS first provider service once trained as EMT-D's. This is a major increase in capability proven to increase chances for survival from cardiac arrest. This system will hopefully be in place in the near future as a substantial enhancement of the EMS. As can be seen from the above narrative, a great deal of activity is now in progress to study and improve the current EMS and much is needed to bring the system to an optimum configuration. This committee requests that the Council endorse our continuing study and monitoring of EMS activities with an objective of eventually implementing whatever system or enhancement will yield the most cost efficient benefit to our city. RECOMMENDATION Direct the Budget and Finance Committee and staff to continue evaluating alternatives and report back to the full Council. 3 - COUNTY OF VENTURA PUBLIC HEALTH DEPARTMENT EMERGENCY MEDICAL SERVICES PILOT PROGRAM PROPOSAL SUMMARY PRUNER HEALTH SERVICES ALL ADVANCED LIFE SUPPORT PROVISION OF CARE (Using EMT-P/I Staffing) Introduction Pruner Health Services, Inc. , (PHS) has proposed a pilot program which would provide the availability of Advanced Life Support (ALS) care on all ambulances by using EMT-Paramedic (EMT-P)/ EMT-IA staffing on each ambulance. Policy 501 : ALS Provider Criteria requires two EMT-P's per ALS ambulance. The usual ambulance coverage pattern is one ALS ambulance with two EMT-P's and one Basic Life Support (BLS) ambulance with two EMT-IA's. The EMT-IA's to be paired with EMT-Ps will receive additional training according to Policy 505: Alternative Staffing. PHS has elected to train the EMT-IA's to the EMT-IA-- Defibrillation (EMT-ID) level. Paul David, M.D. has been approved as EMT-D Medical Director. This pilot program will take place in Ventura County Ambulance Areas 3 (Simi Valley) and 4 (Thousand Oaks) . The duration of the pilot program is a minimum of six months. Evaluation Focus The primary question to be answered by this pilot program is: Will a change in staffing level from two EMT-P's per ambulance to one EMT-P and one EMT-ID have a negative effect on delivery of patient care? Type of Study The study will be prospective/retrospective. Patients for a calendar period of December 1 , 1990 - May 31, 1991 will be compared with patients from December 1 , 1989 - May 31 , 1990 . The patients will be from Ventura County Ambulance Areas 3 and 4. The patient field condition categories to be studied will be multi-casualty incidents and medical cardiac arrest. Other areas to compare include: number of patients who received BLS responses when ALS intervention was needed 1989-90 vs. 1990-91; time/procedure factor; BH orders given vs. procedures completed. G. B. Krishnamurty, PhD, a biostatistician from Cal State Northridge will be involved in determining the sample size required, data comparisons, and devising the reports to be generated. PILOT PROGRAM PROPOSAL SUMMARY Page 2 • Data Collection A database has been designed to collect information from Ventura County Prehospital Field Reports (PFR) , Base Hospital/EMT-P Communication Forms (BH reports) , and Central Dispatch printouts. Data from the 1989-90 information will be incomplete. Information will be entered onto the PFR's and BH reports by field personnel and Mobile Intensive Care Nurses (MICN)/Base Hospital physicians (BHMD) . An effort will be made to provide times of procedures performed, but it is recognized that these are estimates in most cases. A data entry operator will transfer data to the database. Medical information will be coded by a coder who is familiar with Ventura County forms and procedures, for entry into the database. Time-line 1 . Submission to EMS b/q0 Approval by EMS MedDir (OW 2 . Projected Start Date (yilIgo 3 .Field Observation Dates • 4. Interim Report Due /oh(de Iei-/iw 5. Projected Completion 6 . Data Analysis `4 7. Final Report k PILOT PROGRAM PROPOSAL SUMMARY Page 3 Additional Comments If the pilot program does not show a negative effect on delivery of patient care, the primary beneficiary of this pilot program would be the citizen requiring prehospital care. Under the usual staffing pattern of ALS and BLS ambulances , circumstances occurred where a citizen with an illness or injury requiring ALS care could have a BLS ambulance responded. Field operations would benefit by giving prehospital care providers the ability to increase the number of ambulances providing ALS services. Field personnel would benefit by providing increased exposure to emergency responses for BLS personnel. ALS personnel would have increased patient exposure and increased opportunity to perform ALS skills. The Base Hospitals and EMS agency will be given the ability to more easily identify "weak" EMT-Ps and provide them with education and training sessions to improve performance. FIRE PROTECTION DISTRICT county of vEntura April 5, 1991 /F-e- (4.i s 41P — /-J Emergency Medical Services/Paramedic Meeting Supervisor Howard' s Office 3 : 00 p.m. AGENDA ITEM: II CAD Prioritization System A. Emergency Medical Dispatch COMPUTER AIDED DISPATCH: The Fire District is in the early phases implementing a computer aided fire dispatch and records management system. The main benefit of the computer aided dispatch system to the delivery of EMS services by the Fire District is the potential to decrease dispatch times and consequently, reduce apparatus response times. Additionally, the level of information that the system will place at the finger tips of the dispatcher will allow for the timely dissemination of this information to the first responders. EMERGENCY MEDICAL DISPATCH PROTOCOLS: EMD or Emergency Medical Dispatch, was developed for two primary purposes. 1) To prioritize the dispatch of EMS resources. This would provide the proper level of EMS resources for the reported situation. It would also ensure, for example, that a full cardiac arrest would result in the dispatch of advanced life support personnel, while a simple non life threatening injury may only require the response of basic life support care. 2) The development of pre-arrival instructions. The system allows the dispatcher to dispatch the appropriate resources and while holding the reporting party on the line, provide instructions for intermediate care pending the arrival of the EMS resources. This is done by the dispatcher asking the reporting party a series of questions, following a flow chart that would lead to a logical conclusion as to the basic medical problem which exists. 395 Willis Avenue, Camarillo, CA 93010-8598 (395) 3384230 PROVIDING PROTECTION TO: The Cities of Camarillo, Moorpark, Ojai, Port Hueneme, Simi Valley, Thousand Oaks. and the unincorporated areas of Ventura County Emergency Medical Services/Paramedic Meeting April 5, 1991 Agenda Item II The computer aided dispatch system will lend itself to the automation of these protocols. The Fire District is currently in the process of seeking approval of the EMD protocols currently being used in Los Angeles County. Respectfully submitted GEORGE LUND, Fire Chief RIICHARD CA. PERRY, Assistant Chief GEL:RAP:kd VENTURA COUNTY PROFESSIONAL FIREFIGHTERS' ASSOCIATION IAFF LOCAL 1364 OPTION NO. 1 Reclassify firefighter position at Stations 40 and 42 to firefighter/paramedic. Assign existing paramedics to fill firefighter positions. Staffing costs: 6 firefighters (3 each at Stations 40 & 42) Assuming 10% paramedic bonus Total annual cost $22,600 personnel Cost would be incurred due to bonus only. There would be no additional personnel assigned within this proposal. Equipment costs: $20,000 - $25,000 per apparatus to fund equipment Engine 40 and 42. Equipment costs remain constant. Total $50,000 equipment approximate. OPTION NO. 2 Assign 1 paramedic firefighter to each shift at Stations 40 and 42. This is in addition to Captain, Engineer, Firefighter current minimum daily staffing. Staffing costs: 6 additional firefighters/paramedics (3 each at stations 40 and 42). Includes: Salaries Paramedic Bonus Benefits Overtime Total Annual Cost $400,000 In addition to equipment cost • OPTION NO. 3 Staff a 2 firefighter/paramedic squad which would respond in addition to first in engine to all EMS incidents in the City of Moorpark. Squad could be located at Station 40 or 42. There is currently a squad vehicle located at Station 42 that is used for utility work only. Staffing costs: 6 additional firefighter/paramedics (2 each shift) Includes: Salaries Paramedic bonus Benefits Overtime Total annual cost $380,000 In addition to equipment cost Proposal\ rt ct L 1/2140/9 I This is a preliminary report of the Paramedic Research Task Force. As of this writing, the task force completed only very preliminary research. More work still must be accomplished to make this a complete report. Background-Mission The Paramedic Research Task Force was constituted on August 31, 1990 to research and present information on the opportunities and problems associated with implementation of fire department-operated paramedic services within Ventura County. Battalion Chief Dave Festerling and Capt Jim Arledge were assigned to accomplish the mission (see Appendix A, mission statement) . The task force met on three occasions to set objectives and review progress in this matter. Objectives The initial objectives of the task force were to research: service delivery options current rescue response frequency personnel costs equipment costs funding options impacts on department operations Service Delivery Options The following service delivery options are defined. Fire Department - Dual Role/Cross Trained This delivery option utilizes fire department responders trained as both firefighters and EMTs (basic, intermediate or advanced) , using the same personnel to perform both fire protection and EMS. A major local example of this system is seen in Los Angeles County. Fire Department - Separate Service This delivery option utilizes fire department responders who may be sworn or uniformed personnel (who may be classed as civilians) , but who have no direct fire-suppression responsibility. A major local example of this system is seen in Los Angeles City. Private Systems This delivery system is provided entirely by private enterprise either operating as free enterprise or as a public utility model wherein the provider is a regulated monopoly ambulance system that selects the exclusive provider based on a competitive procurement process. A major local example of this delivery system is found in the City of San Diego. Private-Fire Department These systems employ a combination of fire department and private services. Each entity contributes part of the system. A local example is Ventura County. pnort4 nor,- Third Service This delivery system is funded and operated by a county or city government (utilizing local government employees) and not administered by the fire or police department. A major regional example of this system is found in San Francisco. Within the top 200 cities in the U.S. (by population) the type of service delivery is broken down as follows: Fire Department (Separate Service & Dual Role) 35% Private (private/fire combination and wholly private) 39.5% Third Service 15.5% Source: Journal of Emergency Medical Services, January, 1991 Staffing Configurations One further parameter of service delivery systems is the configuration of the delivery team. There are two main team configurations: 2 paramedics per team and one paramedic teamed with an EMT specially trained to assist in ALS calls. There is a high level of controversy surrounding the propriety of each method. Although no one seriously contends that the one-and- one staffing configuration is as effective as the two-paramedic team, it has been argued that paramedic services can be extended further with the one-and-one configuration with only an acceptable loss in effectiveness. No significant conclusion can be drawn without further detailed study of the matter over a larger population base than is available locally. No task force effort has been expended toward determining any relative merits or drawbacks of a particular system. It may be assumed that each type has its place in a specific circumstance. This is born out by the fact that, of the 200 major U.S. cities, each category of delivery system is well-represented. A serious consideration of implementation of paramedic services in Ventura County will require careful review of the most appropriate service delivery method. Research into the service delivery options was conducted through a survey which attempted to contact most of the Paramedic Service providers in the greater Southern California area. A copy of this survey form is included in Appendix B. Compilation of the results of this survey has yet to be accomplished. Response Frequency A review of statistics was conducted to map the frequency of response to requests for medical assistance by the Ventura County Fire Department. Appendix C contains the results of that review. The resultant map illustrates: a three year average (1988, ' 89, ' 90) of all responses which fall under the rescue category of the CFIRS. calls which occur in one square mile subdivisions as determined by the Thomas Bros. Map Book. . . u i L. YL 4 No conclusions have been drawn from the data. The representation is used to provide the reader with a generalized view of service demand. Personnel Cost Information Personnel Cost Units A Personnel Cost Unit can be defined as the funding required to maintain one paramedic on duty 24 hours per day 7 days per week for on year. This cost includes salaries, benefits, and overtime costs for constant staffing. The Cost Unit can be easily used to determine total personnel costs for a variety of service delivery options. Personnel Cost Units are further defined by rank. For instance a Firefighter/Paramedic, an Engineer/Paramedic or a Captain/Paramedic. Firefighter/Paramedic Cost Unit Salaries and benefits for one firefighter are $56, 105. 00 per year. Constant staffing requires 3 firefighters for one full-time position. The figure above is multiplied by 3 yielding a base cost of $168, 315. 00 per year. Constant staffing requires an average of 53 additional shifts to be covered at 150% (time and one-half) or $493 . 00 per shift for a total of $26, 129.00 per year. The total cost for one position fully funded will be $194,444.00 per year. Hourly overtime costs for this position are $20 .54/hour. Engineer/Paramedic Cost Unit Salaries and benefits for one engineer are $62 , 029. 00 per year. Constant staffing requires 3 firefighters for one full-time position. The figure above is multiplied by 3 yielding a base cost of $186, 087. 00 per year. Constant staffing requires an average of 53 additional shifts to be covered at 150% (time and one-half) or $553 . 32 per shift for a total of $29, 326. 00 per year. The total cost for one position fully funded will be $215,413.00 per year. Hourly overtime costs for this position are $23.05/hour. Captain/Paramedic Salaries and benefits for one engineer are $71, 199. 00 per year. Constant staffing requires 3 firefighters for one full-time position. The figure above is multiplied by 3 yielding a base cost of $213 , 597. 00 per year. Constant staffing requires an average of 53 additional shifts to be covered at 150% (time and one-half) or $642 . 24 per shift for a total of $34 , 039. 00 per year. The total cost for one position fully funded will be $247,636.00 per year. Hourly overtime costs for this position are $26.76/hour. Additional Costs The following additional costs must be factored into the total costs for personnel. These costs are subject to variables which will be determined through negotiation or circumstance prior to program implementation. Some costs are associated with the addition of personnel to accomplish program goals. Other expenses will still be encountered even using current personnel. Bonus Costs The addition of paramedic services to the fire services has traditionally entailed the payment of a "paramedic bonus" . It would be highly inconceivable that a paramedic service could be implemented in the Ventura County Fire Protection District without the cost of this bonus. This is particularly true in that most fire agencies in the local southern California area pay some bonus. Bonus costs may range from 5% to 15%. The significance of this cost would be directly proportional to the size of paramedic system implemented. Training costs Initial training may be required depending on the number of paramedic positions authorized and the number of currently certified paramedics in the Department willing to participate. Major initial training costs may entail tuition and other educational costs, and coverage for personnel during training. These costs are one-time expenses. Recertification training on a bi-annual schedule will entail either a negotiated fixed amount or an hourly payment for each hour of CEU and testing. These expenses are directly related to the number of paramedic personnel in the program and are on-going. Medical Director Costs Implementation of a quality paramedic service delivery program will entail the employment, at least part-time, of a medical director. A survey of the 200 most populous cities in the U.S. indicates that 95% of the ALS systems employ a medical director either full- or part-time. Direct costs for such a position would be open to negotiation. Field Supervisor Costs Depending upon the size of the program implemented, it is reasonable to assume that there may be required field supervision at some level for the paramedics. Although this position may evolve only as the system matures, it should be addressed and understood at this time. Miscellaneous costs There will be a variety of expenses associated with the addition of personnel . The most significant of these are discussed here. The expense of the sixteen-week Firefighter Academy for each addition to the current allocation will have to be considered. Overtime costs associated with employee education and training outside of certification maintenance could be expected. These expenses, although minor per individual, could be significant in a larger operation. Funding Options Implementation of a paramedic system in today's economic environment would certainly require some form of funding other than traditional tax subsidy. Although the task force has not studied any options in depth, the following funding schemes are found in existing systems. Billing/Collections This method is the most conventional option. It merely passes the costs of goods services through to the individual or an insurance company. Desired results are payment in full for services. Collection rates will vary with local. Additionally, a significant cost for staff and supplies is associated with successful collections. Special Taxes Special taxes supporting a paramedic service delivery system are possible. However, given the tax climate in the region it would be a difficult task to mount a campaign to implement a new tax. Individual city funding support may also be an option. FireMed FireMed is a subscription style funding scheme in which patrons re charged a fixed fee. In return for the fixed fee, typically $30 - $40 per year, the EMS provider waves the deductible on the user's insurance policy and accepts whatever the insurance pays as payment in full. This option appears to be growing in popularity and may warrant serious research into its potential. Flat Fees Some agencies charge flat fees per call to offset the cost of full subsidy. Most flat fees are associated with transportation to a receiving facility. Equipment Costs At the time this report was compiled, equipment costs had not been researched. This will be done in the near future. Impacts on Department Operations Implementation of a paramedic program would impact several areas of Department operations. Most notably, and depending upon the system implemented, the move-up plan and the constant staffing program would have to be adjusted to accommodate a partial program implementation. • Assuming paramedics were engine-based, move-up plans would have to take into consideration coverage of paramedic service areas. Assuming the call load will not be consistent, transfer policies would need to be modified to take into consideration the need to provide a reasonable level of activity for all paramedics deployed in the field. Precautions would need to be in place to ensure enough qualified and experienced paramedics were in the pool to prevent overloading due to constant staffing, potential illnesses and long-term injuries. il A�EN�J u H • Ventura County Fire Department MEMORANDUM To: Deputy 1 & 2 August 31 , 1990 From: George Li Subject: Paramedic research task force - Mission Statement We need to begin researching the feasibility of paramedics in the Fire District. Keith has identified Jim Arledge as the VCPFA representative. Festerling will assume the chair and Broughton will participate as the fiscal specialist. Liaison must be established and close communication/participation maintained with Emergency Medical Services of the County Health Care Agency. They will determine to what extent they want to participate in this research. All research information will be provided to them for review and appropriate feed back to the task force . March 1 , 1991 will be the target date for concluding this research. ' The first action for the task force will be to develop goals, objectives, identify task and to develop a budget for this process. Once this has been done and the task force budget approved we will go forward. The following are my thoughts on a Mission Statement for the research task force. Thoroughly research the costs, the potential funding sources, the methods and options of providing paramedic services by the Ventura County Fire Protection District. 4 "WEALD/X r.4 --- _,../ . • , - V • i s 1..-- --- --.. I. __ i 'ima: t - _ _ , I , ....... t;li.i. ir .....„..• • ;A , . T. a _____ - r 1 A, .:. • •• ikkil / . i . ' !!fralg . .:::: 't c ‘‘t Cl- Jki zit as. NJ i•!rpll (J 0 (3-- li.i. iii - 1,‘, L ./rit.-- -• .i.-..x # • • 1 - V _ en v) :-.-410 . 44 • ... .. .04:10L. ' -9 il 'cE it. ,:' r--gaidlittelk4 1 ra ` ci. .1".- I vz. 0 lc) ,.`;% •• •. '6 - lay v -, vi - .--si c.) c) Iv --- , ...... - .... . .:t CQ -- Li) ---> --, •/ ' -* V.: VI 4... 2 ,`--2— • 1. CY) IL k p. i ..c zs.• 41...—: -- •. • - ‘IL41.& t -i-.‘ (1: ,•iik‘bNlibrir •b:3 ....v.L. wq. I .-..- ,. kW •,,t ,.., "Sr' \ '' •1 4 ,gru V4;• v-,N,,, . : filliClak 'c , , • iii... jlipirdrom c. ;NV; -1111111.‘MIMI ,44 z 4n1 III ION qt." box - 1 . , 2. 440/I II 441.4 10 ..., (A 411" fw,4:.--- --.6 03 I 0 1 kVt. 4.•..Vii!_d•-•""-t;„7" :- 4;1111011V ,..e, M .. If i e ! 004 Al2i) 141) h( e) / • . / lRe. 44 4F teF,. Ventura County Fire Department Paramedic Survey DEpl Questionnaire The following questions will be used to establish a reference database. The database will become part of a study to determine the potential delivery methods,costs,and funding methods of paramedic service.The study is to be used to assist the Fire Chief and the County policy makers in determining the most effective method of providing public Emergency Medical Services. Please be courteous and forthright in your approach to the contacts you make. Ask your questions as they are presented on the sheet. Clarify any issues on page two. Indicate further clarification by placing an asterisk next to the answer on page one. 1. Are paramedic services provided to the public in your jurisdiction? (if no,thank the contact; move on). 2. Is the paramedic service provided in your jurisdiction public or private? 3. If public,is the paramedic service provided by the fire department? (if not,what agency provides it?) 3a. Who transports the patients? 4. Is your paramedic program dual-paramedic or single-paramedic? 5. Are your paramedics dual-role (ff/pm) or single role? 6. Is there a pay bonus for paramedics? If yes, how much? 7. Is there a PM requirement for hiring at F/f level? If so, what is it? .• 1 •••0 8. Please draw a short organization chart showing the flow of authority from the fire chief to the paramedic. 9. What service Ievel criteria(if any)have been established for your system? 10. What criteria is used to determine addition of services? 11. Does your system charge for paramedic services or make any cost recovery attempts? 12. Is there a FireMed program or other type of subscription service in effect in your system? 13. What type of vehicle do you use (if other than a fire truck) to transport your paramedics? 14. Is there a person we may contact to set up a visit to your agency for further review?