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HomeMy WebLinkAboutAGENDA REPORT 1990 0627 CC ADJ ITEM 11I06/27/90 17:22 V213 236 2700 BWNS LA 2 / „?i o L^W or1'1Cr -n BuRim WILLIAMS & SORENSEN ONG WILISHIRE BUILDING MARTIN J. CJRKE' G.Re%QRY ”. OIX4.40 62A 30Ujf1 omAwc) A ^JC1iut, X11- rLOOa VENTURA COUNTY OFFICE Jnw.r(. l ORAVONA.. JN.' LULAOLIN L. HANNA 2310 :IONDCROrrA nR1Vr MARK t ALLCN, JR! KATMRYN R• PETERS, LOS ANGELES. CALIFORNIA 90017 MAIIIIN L MUHKL' Lfy.A L, KRANITL 12131 236 -o600 SUITE I CAMARILLO, CALF O"NIA WJUIU CAUL N. NCwT6N' III- C. M,NALLY fifuGl Hyl -J�hN 4. allDIFOI %4AfI11RICK' 06t4WO I. FLOYD NVMMAN t L.AA/II LINDA L. UAVOL Tr f L COraIER: IL 131 L30 -E7GG COWARD M. r6M• M. L06 DOBAK 6eAN6e e6U11TY e•rrlec LM.NNII. N UVLIKL' NUPyHf u WADDEN 4JU4 U011.IVL UVOLLI LLLAwIU L. LKXAA_T' rMARK N. WNIILNLAU, LL 5U11L 04V (:OLIN LLNNAROT SCOTT H. CAMPBELL P9IE-19071 MLrj A. CALMOnN.A 01686 IMUMAI. J. I.LLLLY' MAMVANN LINT( OOOUNWi0 11141 L•111-h4hU NCIL E YeAcEN' TIMOTHY O. M.00KCR nOYAL M. 00RCI4Gn: BRAN A. WERnI' DIANA L FIELD IIOM roD'1I u ARLo -L M. LaLUurufr MnA J. 1AVLOR ,'A"161. PLAZA rLILR M. INVR9VN' 91LVLH J. UAW9UN JJVV CULLCUL &QuLCVA.RO JLWNY M. I/AIILRY,;0N JAM" G RIC;ALf SwTC 190 HAROLD A SRIDOES' JAMES R. FCLT61.1 OVERLAND AIR.. wnNM♦ ee<IV (;WLPYL J. KAfIL' ILRRY q KAVr1AANN 19131 336-0900 nAVMONO J. ruENYC4• DTCIYdN R. ONSTOT June 6 19 9 0 VI VIRGINIA P. PT.'r,.OLA JAIME ARSVALO L , C. INVL DrluCuMA f DATIICLG CITAWrORD, Q N GOVNGGL S. OEREK 6TRAATBMA MARIANNE WOO DWIGHT /1. NCWELL PODULA1j C. IIOLt.r•NO JOHN E. CAVANAU014 0011 O, KIA@IICR MARK p, L1CN1�LLY MICHALQ VA66N AIVERA PETER D. TRCMDLAY WRITER'S DIRLCI DIAL sWOTT r, "ELO G MICHAEL ZWE.sACK 21.3-236-2721 MARY REDUy OAVLV A04CR T. ITQ uUrU5 L TVUrIL. JR- 01359 -001 OUR FILE NO. 4rnvrCC'MO,IAL COP ^O..A,.pw IA WIU /L•-: Nf A.I�ULV1fWN AOIIITTLO VAfIGl.O A MICLOVM 'AM1w,1T1r •wN�wh Mayor and Members of the City Council of the City of Moorpark 799 Moorpark Avenue Moorpark, California 93021 Re: Emergency Medical Services Financing Dear Mayor and Councilmembers: You requested that we provide information on financing should the City decide to provide ambulance and paramedic service ("emergency medical services" or "EMS"). Current estimates of initial costs are approximately $700,000.00, with lesser amounts required in successive years. Because of the relatively small amounts of money involved, we do not believe it is cost - effective to consider issuing bonds for EMS. For that reason, this letter does not discuss bonds; instead, it discusses general taxes, special taxes, thle Mello -Roos Community Facilities District Act, fire suppression benefit assessments, other special districts and the Gann limitation. 1. GENERAL TAX A general tax cannot be earmarked for a specific Purpose. Examples include taxes on sales, utilities, business licenses and documentary transfers. _All revenues .must go into the general fund. Under Proposition 62, adopted by the California electorate on November 4, 1986, the City may not impose a general tax unless the tax is enacted by at least a two- thi.re- vote of the City Council Q6i27i90 17:23 X213 236 2700 Mayor and Members of the City Council of Moorpark June 26, 1990 Page 2 Bar &S LA (Government Code section 53724(b)) and then approved by majority vote of the electorate (Government Code section 53723). Proposition 62 is a statutory initiative; it does not amend the California Constitution. As of this date, the status of Proposition 62 remains unclear. Some cities have ignored the election requirement, taking the position that Proposition 62 violates the California constitutional prohibitiun un subjecting local tax measures to an initiative or referendum (City of Westminster v. County of Orange (1988) 204 Cal.App.3d 623). This issue is currently being litigated. We understand, however, that the issue may become moot, because an initiative to make Proposition 62 part of the state Constitution has been certified for the general election ballot in November. Should this initiative pass, any general tax would almost certainly require a majority vote. 2. SPECIAL TAX A special tax is earmarked for a specific purpose; it is not pldued in Lhe general fund. Such taxes must be enacted by a majority vote of the City Council and then approved by a two - thirds vote of the electorate. (Government Code section 53722)„ Pursuant to Proposition 62, specific statutory authority is required to enact a special tax. (California Building Industry Association v. Newhall School District (1 88) 206 Cal.App.3d 212.) On the other hand, Government Code section 37100.5 gives general law cities the authority to enact any tax that may be enacted by charter cities. Some general law cities have taken the position that t'%is section gives them the ability to enact a special tax '.or EMS without any further statutory authority. A. Police and Fire Protection Statutory authority for a special tax for police and fire protection exists at Government Code section 53970 et seq. However, the statute authorizes use of the U 003 06/27/90 17:23 213 236 2700 BWxS LA Q004 Mayor and Members of the City Council of Moorpark June 26, 1990 Page 3 tax for emergency medical services only in San Bernardino County. B. Mello -Roos Communit y racilities Act of 1982 In addition to its other uses, Mello -Roos provides specific authorization for a City to levy a special tax. A Mello -Roos community facilities district ( "CFD'') may be formed by the City to levy a special tax for ambulance and paramedic services within the district (Government Code section 53313(b)). The tax is levied for the length of time specified in the ballot measure, which may not be more than 40 years. The governing body of a CFD is the City Council. Creation of a CFD involves a multi -step process, initiated by the written request of two members of the City Council or a petition of 10% of the registered voters. Within 90 days after the filing of the request, a resolution of intention to establish the CFD must be adopted, followed by a public hearing. Notice of the hearing is given by mail to each registered voter and landowner within the proposed CFD. Provided there is no majority protest at the hearing, the City Council may adopt a resolution of formation. At the same time, the City Council also adopts a resolution calling for an election on the special tax levy and on any necessary Gann appropriation limit increases, with the election to be held at least 90 but'not more than 180 days after the adoption of the resolution of formation. The election may be by mail ballot and requires an affirmative vote of two-- thirds of the voters voting to levy the tax. Once approved, the tax is set by ordinance and levied yearly by resolution of the City Council. The tax may not be ad valorem, but may be designed in a variety of ways to achieve fa rness (i..e. size of building or type of use). Generally, the tax _s levied on the county property tax roll in the same manner and subject to the same penalties for non - payment as a(l valorem taxes, although the City may choose an aiternat�vF rob lectian mechanism. 06/27/90 17:24 'C213 236 2700 BV &S LA Mayor and Members of the City Council of Moorpark June 26, 1990 Page 4 3. ASSESSMENT An assessment is not a tax because it is based on the benefit received by each parcel of land; it is not bdued on property value or use of services. Goverllinel]t Code section 50078 et sec. authorizes the levying of fire suppression benefit assessments. The statute does not specifically authorize the financing of paramedic services, but an argument can be made that emergency medical services come within the purview of fire suppression. However, this argument loses some of its validity where, as the City proposes, EMS would be provided separately from fire protection services. Also, according to an unpublished opinion of the Sacridmelltu Superior Court, such asscuumente may not be used for ambulance service alone. (Pacific Legal Foundation v. Sloughhuuse Fire Protection District.) Procedurally, ,a report describing the boundaries of the district, the parcels to be assessed, the total cost of the assessment, the amount of the assessment per parcel (or other measure) and the duration of the assessment is prepared, and a noticed hearing is conducted on the report. The hearing is noticed to those to be assessed (generally all property owners) by posting and by mailing. If there are no written protests or protests from less than 5% of the total amount of the expected revenue, the City may approve the assessment without an election. If there are written protests by the holders of property representing more than 5% but less than 3U of the anticipated revenue, the assessment must be approved at an election by a two- thirds vote4 if there are written protests by 33% or more of the property holders, the assessment procedure must be abandoned. The assesswL- it ,lay ue collected on the county property tax roil or in the same ;canner as other City fees and charges. It need not be confirmed yearly and an escalator may be built into the assessment formula. 4. COMMUNITY SERVICES DISTRICT Government Code sectiuil 61100 et seq. provide9 for the creation of a community seivlces district ( "CSD "). Among the authorized purposes f CSD is to contract for NM G 06/27/90 17.25 $213 236 2700 Mayor and Members of the City Council of Moorpark June 26, 1990 Page 5 BFI &S LA ambulance service. Paramedic services are not specifically authorized. A CSD may be proposed by a petition signed by not less than 10% of the registered voteLS residing in the proposed CSD or by a City Council resolution adopted after a public hearing. The petition or resolution must be approved by LAFCO and then submitted to the voters for approval by majority vote. If the CSD is approved, it has the authority to prescribe, revise and collect rates or other charges for the services and facilities it furnishes. A CSD may also impose a special tax pursuant to the requirements discussed above. 5. GANN LIMITATION California Constitution Article Xliil3 limits the City's total annual appropriations, with yearly adjustments for cost of living increases and population changes. Proposition 111, adopted by the California electorate on June 5, 1990, makes substantial changes in Article XIIIB. Because of the urgency of your request, this letter does not discuss the potential effect of amended Article XIIIB on the proposed EMs financing. Should the City proceed, we would further advise you in this matter. CONCLUSION To summarize: 1. A general tax requires a majority vote unless the City follows other cities' lead and determines that Proposition 62 is invalid. 2. A special tax must be approved by a two - thirds vote. Under Proposition 62, specific statutory authority is required for the tax to be unposed. However, some cities have taken the position `hat no such special authority is needed pursuant to Government Code section 37100.5. 3. The Mello -Roos Act provides specific authority to impose a special tax L-ux E149. 0 006 06/27/90 17:25 X213 236 2700 BW &S LA 1 007 Mayor and Members of the City Council of Moorpark June 26, 1990 Page 6 4. A fire suppression benefit assessment would require the City o conclude that paramedic services fall within the scope of fire suppression. 5. A community ser.ices district authorizes ambulance service, but does not specify paramedic services. very truly yours, CHERYL J. KANE CITY ATTORNEY, MOORPARK; and BURKE, WILLIAMS & SORENSEN PDT :apa cc: Steven Kueny, City Manager PDT /WP /LTR01939 PARAMEDIC SERVICES Current BLS: Less than 1.0 minutes Current ALS: More than 15 minutes BLS Standard: 4 -7 minutes ALS Standard: Less than 8 minutes TYPES OF ALS SYSTEMS 1. Fire Department ALS Medic Unit staffed by paramedics: Cost: $600,000 for operations (10 positions) 21,000 for paramedic equipment 45,000 for an ambulance 28,000 per paramedic for 6 months training 2. Fire Department ALS Medic Unit staffed by Fire Fighter Paramedics: Cost: The costs would be the same as above, but there would be less out -of- service time and the benefit of dual use of personnel. 3. Fire Department ALS Reserve Unit staffed by Fire Fighter Paramedics: Cost: $270,000 for operations (10 positions) 21,000 for paramedic equipment 28,000 per fire fighter for training 4. Private Provider ALS staffed by paramedics: Cost: $270,000 for operations 21,000 for paramedic equipment 45,000 for, an ambulance MINIMUM LIFE SUPPORT NEEDS The current pre - hospital EMS system is based on BLS from the Fire Department and ALS from a private provider. The Fire Department Emergency Medical Technicians (EMTs) begin Cardio Pulmonary Resuscitation (CPR) upon arrival to maintain the viability of the patient for a short time until the ALS unit arrives. The present extended response rate is ineffective since it does little to improve the outcome of serious injury or illness. The current BLS and ALS system configuration is unacceptable. At a minimum, there is a need for semi- automated defibrillation units, a 4 to 7 minute BLS response rate, and an ALS response rate of under 8 minutes. The operating costs for improvements in pre - hospital EMS system configuration range from an estimated $162,000 to $360,000 per year. The actual effectiveness of any system depends on siting units to avoid delays caused by traffic, rail crossings, and extended run times. CP:sc 904173.tem T 11 17 CITY 01; cer(:A1 .11�1HNIA CITY HALL • 250 EAST L STREET • BENICIA, CA 94510 • (707) 746.4200 Craig Phillips This is a breakdown of our major costs to run an advanced life support, emergency medical system in the City of Benicia. Firefighter- paramedic at E step $2967 mo. X 12 $35,604 + approx. $12,000 in benefits Total approx. salary package $47,604.00 + Paramedic Continuing Education Pay $5760.00 far the 6 paramedics total + Required overtime pay (FLSA) at 1 and 1/2 pay at approx, 30 -40 hours a year Total estimate for each firefighter - paramedic is around $60,000 per year. Pay increases 6 -1 -90 to $3115 mo. and 6 -I -91 to $3271 mo. All benefits are near 33$ of the salary. We have an operating budget around $25,000.00 per year for the entire E.M.S. program. (this is materials and supplies) I have also attached the current salary schedule which includes the salary for other paramedic ranks, We do not currently have any people in these rauhs• This is just a quick breakdown of our costs. If I can answer any questions please call me 707 - 746 -4273 f � a e t Deputy ire Chief MARILYN CITRON OTOURRE, Afaror Vembers of1He Cif 1, Counell JOHN F. MINA, Mal or F(o Tent • EPNBT F. CIARROCCHI • DIFfi F1.fL,1'U� • kl('fl a 1l%1 SIIAPC(i MICHAEL WARREN, Ct1y Afonagrr PIIYLLIS GARRIGUES. Crrr Treasurer FR4NCES GRECO, 0f) Clerk, 2/6/90 *ier • l) TITLE A B C 0 $ 1683 1767 1855 1948 2891 3037 Graphics Illustrator 1811 1902 1997 2097 2202 Industrial Monitoring Inspect. 2032 2133 2240 2352 2470 Junior Mechanic 1767 1856 1948 2046 2148 Laboratory Technician 1904 1999 2099 2204 2314 Library Assistant I 1210 1270 1335 1400 1470 Library Assistant II 1310 1375 1445 1515 1591 Library Assistant III 1443 1515 1591• 1670 1754 Library Director 3152 3310 3475 3649 3831 Maintenance Custodian 1603 1683 1767 1855 1948 Maintenance Worker I 1767 1855 1948 2045 2148 Maintenance Worker 11 1948 2043 2148 2235 2368 v-4- intenance Worker III 2255 2368 2486 2610 274C . chanic 2258 2370 2489 2613 2744 Operator in Training (WTP) Operator in Training (WWTP) 4Paramedic /Captain � Paramedic /Engineer .Paramedic /Firefighter )Paramedic /Lieutenant Parks & Recreation Director Parks / /Bldg. Superintendent Personnel Technician Planning Director Planning Technician Police Aide Police Chiet Police Captain Police Lieutpna ^4- - c1:{RE DEPARTMENT California's Oldest Fire Department — Formed 1847 707 - 746-4275 250 EASE ..,L. c�REET 707- 746-4212 n; :t1" , `A, C�UFORN1A 9 �5' 0 1603 1683 1767 1855 1948 1603 1683 1767 1855 1948 2891 3037 3188 3347 351° 2571 2699 2834 2975 3124 2440 2563 2690 2825 2967 2758 2894 3039 3191 3351 3687 3871 4065 4268 4481 3027 3178 3337 3504 3675 2026 2127 2233 2345 246 3687 3871 4065 4268 4481 1788 1878 1971 2070 2174 1507 1582 1661 1744 1831 3990 4190 4400 4620 4851 3578 3757 3945 4142 4345 3277 3441 3613 3794 3984 245C 2573 2702 2837 2975 2828 2969 3117 3273 343; 1765 1850 1940 2037 2135 4070 4273 4487 4711 494' 2615 2745 2882 3027 317E 3068 3221 3382 3551 372 174E 1833 1925 2021 212: CITY OF SAN MARINO FISCAL YEAR 1989 - 90 OPERATING BUDGET DEPARTMENT SUMMARY DEPARTMENT: PARAMEDICS ACCOUNT NO.: 4225 COST AREAS PERSONNEL FY 87 -88 ACTUAL FY 88 -89 ESTIMATED FY 89- BUDGE' 138,390 182,300 192, OPERATING 11,816 19,510 20, CAPITAL OUTLAY 3,157 2,090 2, TOTALS: $ 153,363 $ 203,900 $ 215, PROGRAM ACCOMPLISHMENTS Responded to 848 medical assistance calls in 1988, and 8% increase Six paramedics received receftification to perform as paramedics. Improved communications witr: surrounding departments to increase mutual assistance available to San Marino. Conducted CPR classes for Ci,_y employees. PROGRAM GOALS Increase paramedic skill le %,els through training in local hospital emergency rooms. Train all paramedics for CPr certification as instructors. Provide basic CPR training ~;:-ograms to the community. RECEIVED f ii CITY OF SAN MARINO FISCAL YEAR 1989 - 90 OPERATING BUDGET PERSONNEL DEPARTMENT: PARAMEDICS ACCOUNT NO.: 4225 FY 87 -88 ABJECT CODE DESCRIPTION ACTUAL 010 Salary: Full -time 85,021 020 Salary: Part -time 030 Salary: Over time 9,041 040 Salary: Temporary 070 PERS Retirement 37,958 080 Health /Welfare 6,370 TOTALS: $ 138,390 POSITION Fire Fighter /Paramedic STAFFING LEVELS FY 87 -88 ACTUAL 3 TOTALS: 3 I'l,GE FY bb —" ESTIMATED 123,000 10,000 41,000 8,300 I$ 182,300 FY 88 -89 ESTIMATED 3 FY 89 -90 Tl T TT / L1rn 8,OC 43,2` 9,3( FY 89 -9 BUDGET R. CITY OF SAN MARINO FISCAL YEAR 1989 - 90 OPERATING BUDGET OPERATING DEPARTMENT: PARAMEDICS ACCOUNT NO.: 4225 FY 89- ACTUAL OBJECT BUDGE CODE DESCRIPTION 100 Office Supplies 105 Reprographics 205 Equipment Maintenance 210 Vehicle Maintenance 230 Small Tools 300 Uniforms 305 Membership /Dues 310 Publications 315 Travel /Meetings 320 Mileage 325 Staff Development 400 Special Expenses 500 Capital Reserve FY 87 -88 FY 88 -89 FY 89- ACTUAL ESTIMATED BUDGE 333 500 0 200 2,263 3,500 3, 3,641 5,150 4, 0 100 1,816 1,800 1, 0 75 0 330 452 1,955 2, 0 200 1,844 1,200 1, 1,467 2,000 2, 0 2,500 3, TOTAL. $ 11 , X316 $ 19 , 510 $ 20, I CITY OF SAN N,ARINO FISCAL YEAR 1989 - 9C OPERATING BUDGET CAPITAL OUTLAY - NEW DEPARTMENT: PARAMEDICS ACCOUNT NO.: 4225 $' Y 87 -88 �;:_ OBJECT F I '�_'' CODE ri�cr'RTpTTC1N ACTUAL 3,157 TOTALS: $ 3,157 FY 88 -89 ESTIMATED FY 89 -9( BUDGET 2,090 2,0 $ 2,090 $ 2,0 700 Office Furniture 705 Office Equipment 710 Building Improvements 715 Outdoor Furnishings 720 Equipment /Tools 725 Vehicles 3,157 TOTALS: $ 3,157 FY 88 -89 ESTIMATED FY 89 -9( BUDGET 2,090 2,0 $ 2,090 $ 2,0 1 i J Ali -9 0 2 DEPARTMENT: FIRE ACCOUNT NO.: 4220 COST AREAS PERSONNEL OPERATING CAPITAL OUTLAY CITY OF SAN MARINO FISCAL YEAR 1989 - 90 OPERATING BUDGET DEPARTMENT SUMMARY TOTALS: FY 87 -88 ACTUAL 1,167,169 57,282 8,415 $1,232,866 FY 88 -89 FY 89 -90 ESTIMATED BUDGET 1,176,800 1,283,310 101,220 101,690 173,250 1,000 1$1,451,270 j$1,386,00C PROGRAM ACCOMPLISHMENTS Responded to a total of 1,934 alarms during 1988. Finalized automatic aid agreements with Alhambra and Monterey Park. Outfitted and placed into service new fire engine. Adopted updated version of Uniform Fire Code. Prepared a materials vehicle f:;r use in emergencies. Reorganized department for greeter control and increased efficiency. PROGRAM GOALS Develop a comprehensive, annual fire inspection and pre -fire inspection program for all businesses in San Marino. Train all personnel in the use and application of the new Fire Code. Develop training program in thc, methods and guidelines for fire service adopted by the International Fire Service and Training Association. Provide training for disaster response to all employees. Continue to train all personnc in techniques involving heavy rescue F 1I LAM 0.� 1_'- �J CITI OF SAN MARINO FISCAL YEAR 1989 - 90 OPERATING BUDGET PERSONNEL OBJECT CODE - DESCRIPTION FY 87 -88 ACTUAL FY 88 -89 ESTIMATED FY 89 -9( BUDGET 010 Salary: Full -time 756,010 780,200 866,1( 020 0 Salary: Part -time alary: Over time 86,971 70,000 54,7E 040 Salary: Temporary 070 PERS Retirement 272,429 261,400 287,1( 080 Health /Welfare 51,759 65,200 75,3E TOTALS ,$1,167,169 $1,176,800 $1,283,3: POSITION Fire Chief Battalion Chief Captain Engineer Fire Fighter Dispatcher /Clerk ST:_FFING LEVELS TOTALS: PASE 5 FY 87 -88 ACTUAL 1 0 3 6 12 1 I 23 FY 88 -89 ESTIMATED 1 3 0 6 12 1 23 FY 89 -9( BUDGET i l: 9 r CITY OF SAN MARINO FISCAL YEAR 1989 - 90 OPERATING BUDGET OPERATING DEPARTMENT: FIRE ACCOUNT NO.: 4220 OBJECT CODE DESCRIPTION 100 Office Supplies I 105 Reprographics 125 Telecommunications 130 Water 135 Gas 140 Electricity 200 Building Maintenance 205 Equipment Maintenance I 210 Vehicle Maintenance 230 Small Tools 300 Uniforms 305 Membership /Dues 310 Publications 315 Travel /Meetings 320 Mileage 325 Staff Development 400 Special Expenses 415 Professional Services 460 Outside Services 500 Capital Reserves TOTALS: FY 87 -88 ACTUAL 2,061 0 3,805 766 360 f 3,378 998 15,162 i f 4,913 i 501 � 11,477 i 369 0 3,122 i 0 2,259 5,258 I 35 2,818 0 $ 57,282 C, I? 26 FY 88 -89 ESTIMATED 3,000 300 7,900 1,850 900 7,900 2,500 7,000 17,500 1,000 13,000 385 450 4,035 500 4,000 3,000 0 6,000 20,000 $ 101,220 FY 89 -90 RTTnr,RT 2,80( 20( 5,00( 1,50( 80( 7,90( 1,50( 7,00( I 17,00( 50( 12,00( 65( 45( 2,05( 30( 4,54( 3,00( 4 , 50( 30,00( 101 . (,C)( a nt� Y'.r. . h• CITY OF SAN MARINO FISCAL YEAR 1989 — 90 OPERATING BUDGET CAPITAL OUTLAY — NEW P: _jai 2.7 FY 87 -88 ACTUAL FY 88 -89 ESTIMATED FY 89 -90 BUDGET 2,148 814 2,850 1,000 5,453 170,400 $ 8,415 $ 173,250 $ 1�000 P: _jai 2.7 ELOISE BROWN Mayor BERNARDO M. PEREZ Mayor Pro Tem CLINT HARPER, Ph. D. Councilmember PAUL LAWRASON Councilmember SCOTT MONTGOMERY Councilmember RICHARD T. HARE City Treasurer t FROM: DATE: M E M O R A N D U M The Honorable City Council Steven Kueny, City Manage"--?2y-- October 4, 1989 SUBJECT: Ambulance Response Time STEVEN KUENY City Manager CHERYL J. KANE City Attorney PATRICK RICHARDS, A.I.C.P. Director of Community Development R. DENNIS DELZEIT City Engineer JOHN V. GILLESPIE Chief of Police Mayor Brown and I met with Supervisor Dougherty and County Emergency Services staff concerning ambulance response time in Moorpark. The attached materials were provided by the County. Under the contract, Moorpark currently has a 15 minute response time. It was our positon that we should have the same response time as Simi Valley and Thousand Oaks, which is ten minutes. Supervisor Dougherty requested the.County staff person to research this matter and report back to him. We will keep you abreast of ne�y information on this matter as it is provided to us. SK:sc 891043 Attachments I M � 799 Moorpark Avenue Moorpark, California 93021 (805) 529 -6864 Occurrances by Response Time: 8 RESPONSE TIMES TO MOORPARK 16 min: 5 9 min: JUNE 1989 -JULY 1989 min: 4 10 Page 2 of 2 5 18 11 min: 7 min: 0 October 4, 1989 Thos. Bros Occurrances Average Minimum Maximum Median Reference 13 min: 11 64A1 4 13.5 12 15 14.5 64A2 4 14.5 13 15 15 64B1 1 1.3 13 13 13 64B2 1 11 11 11 11 64C1 1 1:3 13 13 13 64C2 1 13 13 13 13 Occurrances by Response Time: 8 min: 1 16 min: 5 9 min: 5 17 min: 4 10 min: 5 18 11 min: 7 min: 0 19 min: 1 12 min: 8 22 13 min: 11 min: 2 24 min: 1 14 min: 3 25 15 min: 6 min: 1 27 min: 1 SUMMARY INFORMATION RESPONSE TIMES TO MOORPARK JUNE 1898 -JULY 1989 Information Source: Ventura County Prehospital Field Reports referencing Moorpark CALLS AVG CALLS /MONTH TIMES Tot ALS BLS Tot ALS BLS Avg Min Max Median Within City 43 17 26 22.5 8.5 13 13.8 9 13 13 Outside City 18 7 11 9 3.5 5.5 15.1 8 25 15 U CONTRACT COMPLIANC # Calls o <15 min Complian 37 860 9 50 RESPONSE TIMES TO MOORPARK OCTOBER :987- FEBRUARY 1988 Page 1 of 2 October 4, 1989 Thos. Bros Occurrances Average Minimum Maximum Median Reference Outside City Limits 42E4 1 23 23 23 23 53A3 2 12 12 12 12 53A4 1 11 11 11 11 53B1 1 15 15 15 15 53C5 1 16 16 16 16 53D6 4 12 10 13 12.5 53E2 1 19 19 19 19 53E6 3 14.3 13 16 13 61F4 1 � 5 5 5 63D1 1 19 19 19 19 63D2 2 11 10 12 11 63E1 2 12.5 11 14 12.5 64D2 1 11 11 11 11 64E1 1 16 16 16 16 Within City Limits 53F5 1 10 10 10 10 53F6 7 12.4. 9 15 13 54A2 4 L3.4 9 15 15 54A5 1 11 11 11 11 54A6 15 11.9 8 18 12 54B2 7 13.8 11 16 14 5484 1 9 9 9 9 54B5 29 L2.1 7 16 12 54B6 37 11.9 7 20 11 54C5 3 i4 12 18 12 54C6 7 9.4 5 12 10 Occurrances by Response Time: 5 min: RESPONSE TIMES TO MOORPARK min: 2 7 min: OCTOBER 1987- FEBRUARY 1988 8 min: Page 2 of 2 9 min: 11 10 min: 17 11 min: 38 October 4, 1989 Thos. Bros Occurrances Average Minimum Maximum Median Reference min: 16 15 min: 14 54D3 1 15 15 15 15 54D4 8 13.1 10 16 13 54D5 9 9.8 6 13 11 54E3 2 12 11 13 12 54E4 8 8 6 17 11 54F3 2 13 12 14 12 54F4 4 9.8 9 11 9.5 63F1 2 11.5 11 12 11.5 64A1 8 13.6 8 19 12.5 64A2 3 15.3 13 19 14 64B1 5 15.3 12 17 17 64B2 2 13.5 12 15 13.5 64C1 4 11.8 10 14 11.5 Occurrances by Response Time: 5 min: 2 6 min: 2 7 min: 5 8 min: 7 9 min: 11 10 min: 17 11 min: 38 12 min: 33 13 min: 21 14 min: 16 15 min: 14 16 min: 10 17 min: 3 18 min: 3 19 min: 9 20 min: 1 23 min: 1 SUMMARY INFORMATION RESPONSE TIMES TO MOORPARK JUNE 1898 -JULY 1989 Information Source: Ventura County Prehospital Field Reports referencing Moorpark CALLS AVG CALLS /MONTH TIMES Tot ALS BLS Tot ALS BLS Avg Min Max Median Within City 159 67 92 26.5 11.2 15.3 12.2 5 35 12 Outside City 34 19 15 5.6 3.2 2.5 13.6 5 23 14 l otci 1 Brea 7 CONTRACT COMPLIANCE # Calls % <15 min Complianc 139 87.4% 27 79.4% 0 G VAL zi AA&uLtton Pk W&Nff,DG ce .1. 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PAR, MALIBU WESMAND $EACH rr DULff SlArl P•Al PL Durne 06, vc* I L A(;REEMENT FOR EMERCENCY AMBULANCE SERVICE AND TRANSPORT ,'1r INDIGENT PATIENTS THOUSAND )AKS SERVICE AREA Section 4.a. of the Agreement for Emergency Ambulance Service and Transport Of Indigents is amended, effective September 1, 1987, to read as follows: 4. CONTRACTOR shall: a• Provide ambulance unit(s) for the Thousand Oaks Ambulance Service Area, for emergency response as authorized by Central Dispatch, so that the following maximum response times shall be met at least 85% of the time: METROPOLITAN: Any incorporated area with a population in 0 excess of 500,000 and a population density ox 1,000 or more persons per square mile. URBAN: All census places with 10 MINUTES Population density of 400 to 999 persons per square mile; or census tracts and enumeration districts without census tracts wr.ich which have a population density of 400 to 999 persons per ,quare mile. SUBURBAN All census places with i 15 MINUTES population density of 100 to 399 persons Per square mile; or census tracts and enumeration districts without census tracts which which have a population density of 100 to 399 persons per square mile. RURAL: All census places with `25 MINUTES populaton density of 50 to 99 persons Per square mile; or cen:,,,s tract; and enumeration districts without census tracts which whici: nave a population density of 50 to 99 persons per square mile- SEMI-RURAL: All census places with a o 25 MINUTES per square mile; or pulat on density of 10 to 49 persons census tracts and enumeration districts without census tracts wh :.h whic`;, have a population density of 10 to 49 persons per square i1 REMOTE: Census tracts and enumer:!i „t die INUTES which have a population nsit_v c rids witout census tracts mile. 5 to 9 persons per square WILDERNESS: 60 MINUTES Census tracts and enumeration districts without census tracts which have a population ien.,;ity of less than 5 persons per square mile. Response times exceeding the above sha_l be reported to Ventura County Emergency Medical Services by the fifth day of the following month. Ambulance dispatch records may be reviewed by E`o, staff at any reasonable time. IN WITNESS WHEREOF, the parties heret, have executed this contract. Dated: Zr -6-- C 7 Dated: l' Attest: RICHARD D. DEAN, County Clerk, County of Ventura State of California, and ex officio Clerk of the Board of Supervisors. BY / Deput Cler V � BY i, i, � � // // Donald M. Pruner, President Pruner Health Services, Inc. BY / :hairman, Board of Supervisors � O R� I HCAC]/'r' Ventura County ® M V' Health Care Agency PnEFIOSPITAL FIELD REPORT INCIDENT LOCATION: ❑ Hume ❑ P.r.Ji, PLnr ❑ ti!—.l 1 tarn„ Cl t1'urk Q \Irdi. al F-uon, ❑ OWcr ADDRESS: ---- ----- - - - --.. Awh \�� CITY: PT. NAME: _ - -- HOMEADDRESS. CITY: _ .. -- AKe: DOB: i _.. ❑ ',I ❑ 1- Approximate Weight: Appnrs nnu 4• Hri;h l: Type of Incident: ❑ %lydis_J ( , -- — ❑ Imu, I .ill ❑ r „ n. ❑ In wsl it 1 -0-11t ut Unit Nu.: Run Type: ❑ Lmci GCnis C3 Tran,l- ❑ Der Run ❑ DOA ❑ P.i!irnt Re l uud• Tc ❑ Pr la, nt AMA U nc: ❑ BLS ❑ Care Prior Arrival: TIMES ❑ \., ❑ ) ,> p t-T: i, PR ❑ CT2 RECD. ❑ FD BLS El '.ID E3 ?D C3 O:ner DISP. First Symp.: Min. _ Iir,. pas> ❑ Burn> Faun Cumpleied -. - -- -- -- ❑ 0; n. A R V' D. Complaint, Mcdicul Hx. - MCLhanism m Inlun Alle,ocs: DEPT'D. - -- - --- - ---- -- - - -- --- AVAIL. Communications: __-_— - -_-- _ _- - _-- _ - -_ -- ❑Cn Radio ❑ Pt1 Radio ❑ Telephone --- ._ _._ _. - - -. - -- ---- - -- -- -- 0 Xut Attempted ❑ Failed - - - -- - -- — - -- jForm Cumplei Base Hosp. Cont. ❑ 1 "es ❑ No -- - Facilits Severity of Distress: p Nun, ❑ MJd Q MoalCUre ❑ Snen• Pl M.U.: TRAUl`1A SCORE: NEURO: SKIN VITALS: PUPIL. Safety Devices (Accident) : Rec. Hosp.: Oriented To: Resp. To Pam: Color: Moisture Temp : ❑ I' t F.I- f_i P -oim ❑ I_w Brit ❑ Shoulder Belt ❑ Musl. A-e>s ❑ PL R ❑ Person p Place ❑ Purposeful ❑ N-ro'l ❑ \Lnm.d ❑ � \.�;ma. t] '.. ,lu �I (._ i_IVOint ❑ \unc Q Time ❑ Nun Purposeful ❑ Pal, "Ashen ❑ Dry Q H -1 [_] Cot RCS` aunt ❑ B•ce Hu>p. Rry. ❑ ll. ❑ Purpusc ❑ No Respun>c ❑ Cs -unc - - (. U 'alrJ Q lh-e on E71 Not App. _aoie ❑ Moi,t ❑ C. ul ._ ❑ fL,M. �] Q Hrimct ❑ Disoriented ❑ Un.unuiuus ❑ F lu>hcd ❑ PiiJ U>r Q C 1,1 ❑ Olncr __. __ Time Blood Pulse Rate RespuaUOn EKG Rhythm Del -s �llaho r Lme Pressure Descripnon pate /Lung Sound y Drug or Solution Route Dose Effect RELEASE FROM LIABILITY /AMA FORM hereby release _ EMS Provider and _ Hospit 3I _ _ -- from any liability of medical claims re,ultint, Irom my refusal of emergen,, care and/or transportation to the Hearst rrcummendrd medic.il Licilit� I further understand that I have been directed to toniact my per >on''! - "- - -- - — -- — — -- physician as to my present condition as iron is possible. I hale wLeivc,l -- - - -- - -- — _— an explanation of the potential consequence, of this rir(usal. Patient Signature /Authorized Signature Dare Witness Basic Life Su V PPOrt: ❑Sandbag Q KI D ❑ A--,, Lstablished ❑ 0,s,en L-,,w, _- ❑ Bn.rtJ Patent ❑ Icared f] C.ullar ❑ De.,,e Iriseucd -- ❑ : ol",nng p Resuuiiatur p Suuiun ED 7 r.i,lion Splint Q E>unauon /Rexur ❑ Other - __ - -. ❑Band ai; urti ❑ { oni-II'd Blrcdlnp ❑ CPR ❑ Arlilic ial Vrntilati,in 8 ivance,:l Life Sur,po I Condition on Arrival at Hospital: A .`� ❑ InipiuvCd ❑ Unchanged 111. 5 d.il .,n - -��- ❑ DctcnuraieJ ❑ AI`parcnt DOA V.- l Tcl� -� •r�.• 1 D fl r udul DISTRIBUTION: J White -- Ambul,nrc Canary - He.dlh Care A4cnec Pink Il�npil,il Goldenrod O.ix Sl.rl nn liu,;i. TEAM MEMBER N0, 1 TEAM MEGI BE N0. 2 T TEAM MEPAHE F) - 3 - - -- i r �� •.uu, r_; RV. HCA -15:0 IRe, . 12 851 VEWURA COU1,ITY EIICITM,_ FIELD REPORT MOORPARK PAUL W. LAWRASON, Jr. Mayor SCOTT MONTGOMERY Mayor Pro Tern ELOISE BROWN Councilmember CLINT HARPER, Ph.D. Councilmember BERNARDO M.PEREZ Councilmember LILLIAN KELLERMAN City Clerk February 26, 1990 Ms. Barbara Broadfuehrer Health Care Agency 350 Hillmont Avenue Ventura, CA 93003 Dear Ms. Broadfuehrer: STEVEN KUENY City Manager CHERYLJ.KANE City Attorney PATRICK RICHARDS, A.I.C.P. Director of Community Development R. DENNIS DELZEIT City Engineer JOHN V. GILLESPIE Chief of Police RICHARD T. HARE City Treasurer Pursuant to Page 5 of the County's current contract with Pruner Ambulance for Emergency Ambulance Service and Transport of Indigent Persons, it appears that the City of Moorpark is entitled to a ten minute maximum response time. According to Article 4.a., Moorpark would fall into the urban category based upon its 12.44 square mile area and its 26,000 population. This equates to nearly 2100 persons per square mile. Page 6 of the same document discusses how the EMS Medical Director may waive response time requirements for any operator for a prescribed period. The Medical Director must make a finding that certain conditions prevent the operator from satisfying the response time requirements. Mr. Pruner indicated to the City that he has not requested a waiver for the City of Moorpark. As you know from our October 4, 1989 meeting, the City believes it is entitled to a ten minute ambulance response time. You may contact either myself or Craig Phillips if you have any questions about this letter. 799 Moorpark Avenue Moorpark„ California 93021 (805) 529 -6364 .1 M Ms. Barbara Broadfuehrer February 26, 1990 Page 2 I would appreciate a reply as soon as possible since the Council is expected to review this matter again at its next meeting. Sincerely, Steven Kueny City Manager SK:sc wp902261.tem Encl. Pages 5 & 6 of County - Pruner Contract cc: The Honorable City Council Supervisor James Dougherty Interim Administrative Assistant / AGREEMENT FOR EMERGENCY AMBULANCE SERVICE AND TRANSPORT OF / INDIGENT PERSONS PAGE 5 OF 11 f. Pay 75 percent of BLS rates as established by the County Board of Supervisors, upon submission of a claim, for prisoners transferred by CONTRACTOR for which COUNTY is responsible pursuant to Penal Code 4011. g. Pay claims of CONTRACTOR within 15 working days of receipt of claims by COUNTY. 4. CONTRACTOR shall: a. Provide ambulance unit(s) for its Ambulance Service Area, for emergency response as authorized by Central Dispatch, so that the following maximum response times shall be met at least 90% of the time. METROPOLITAN: 10 MINUTES Any incorporated area with a population in excess of 500,000 and a population density of 1,000 or more persons per square mile. URBAN: 10 MINUTES All census places with a population density of 400 to 999 persons per square mile; or census tracts and enumeration districts without census tracts which which have a population density of 400 to 999 persons per square mile. SUBURBAN 15 MINUTES All census places with a population density of 100 to 399 persons per square mile; or census tracts and enumeration districts without census tracts which which have a population density of 100 to 399 persons per square mile. RURAL: 25 MINUTES All census places with a population density of 50 to 99 persons per square mile; or census tracts and enumeration districts without census tracts which which have a population density of 50 to 99 persons per square mile. SEMI- RURAL: 25 MINUTES All census places with a population density of 10 to 49 persons per square mile; or census tracts and enumeration districts without census tracts which have a population density of 10 to 49 persons per square mile. IVAGREEMENT FOR EMERGENCY AMBULANCE SERVICE AND TRANSPORT OF INDIGENT PERSONS PAGE 6 OF 11 REMOTE: 45 MINUTES Census tracts and enumeration districts without census tracts which have a population density of 5 to 9 persons per square mile. WILDERNESS: 60 MINUTES Census tracts and enumeration districts without census tracts which have a population density of less than 5 persons per square mile. The EMS Medical Director may waive, in writing, one or more response time requirements for any operator for a prescribed period. In determining whether to grant any such waiver, the EMS Medical Director must find that one or more of the following geographic or special or unusual conditions for which the waiver is sought prevent the operator from satisfying the response time requirements: (/ 1) Physicial isolation of an area 2) Topographical condition 3) Road conditions Waivers shall be requested in advance and shall be reviewed annually. Response times exceeding the above limits shall be reported to the local Emergency Medical Services agency monthly by the fifteenth day of the following month. Ambulance dispatch records may be reviewed by EMS staff at any reasonable time. b. Dispatch and respond an ambulance to all requests made by Central Dispatch. The armulances shall be enroute to the requested destination within two (2) minutes. Central Dispatch shall be notified of inability to respond within the stated time. I� • r f I Chapter 1 fraction, and the presence of complex ventricular ectopy (greater than or equal to 10 PVC's /hour or three or mor( repetitive ectopic beats) were each independent predlc tors for a subsequent episode of cardiac arrest.9 ,r Unfortunately, neither the presence or absence of these factors is sufficiently specific or sensitive to be useful ir• accurately characterizing individual patients. Prospects for the Future: Success and Potential of CPR and ACLS Mortality frorn cardiovascular disease will be reduced when a significant decrease in the incidence and severity of coronary artery disease has occurred. However this long -term objective will not obviate the immediate prob- lem of death from acute myocardial infarction and unheralded "sudden death ". The approach to preventing cardiac arrest and resuscitating a cardiac arrest victim must involve a team effort that begins outside the hospital with the patient, bystanders trained in CPR, and the prompt and appropriate response of trained rescue personnel. It must be continued in the emergency department and hospital setting. An effective resuscita- tion commonly occurs through a coordinated team effort in which each member of the team anticipates the next step in the procedure and complements the efforts of the others. The standards and guidelines for CPR and ECC have served as the framework for a coordinated approach that reflects extensive consideration of clinical and laboratory studies, education precepts, and the practicality of procedures advocated. 2.3.5.6 All were developed by consensus of an interdisciplinary group of experts to provide a reasoned and uniform approach to preventing and treating cardiac arrest. They represent the work of many distinguished clinicians and investigators — from the pioneers in resuscitation to those who have followed and have contributed by implementing, complementing, and broadening earlier achievements. Reports from communities that have both large numbers of laypersons trained in BLS –CPR and an emergency medical services (EMS) system with a rapid response time have demonstrated that up to 30-40% of patients who receive bystander- initiated CPR and prompt defibrillation (ACLS) can survive an episode of cardiac: arrest due to ventricular fibrillation. 52-59 When bystand- er- initiated CPR is delivered in a situation in which defibrillation is not immediately available, resuscitation and survival rates are still higher than when there is no bystander CPR. (Only one of the many studies in this area has failed to demonstrate improved survival or better neurological outcome in patients after bystander - initiated CPR.'!() Thus, teaching citizens to recognize cardiac emergencies quickly, to provide CPR promptly and appropriately, and to know how to access the EMI systern are uncontroversial benefits of cornmunily C[,'[ Programs. To maximize chances of survival, the delay •.• . -... .... a w.il. a:ua.l��i1%''.'1et - 11� ' l(y �'' 1e1��:x- IyVS�. FinLiS1 � _ Table 4 Survival ( %) Relatecl :u Nlcspunse T Hies Time to Time !o icl_ -S (m +n 1 -6 � - CPR (min) a is _ - — - o -a 4.8 s °. o., Adapted Irom Eisenberg 70 from onset of cardiac arrest until CPR and definitive care Should be kept as short as possible, ideally to less than 4 and 8 minutes, respectively (Table 4). Based on these types of data, it has been estimated that full implementation of these potentially lifesaving resources in the community may save between 100,000 and 200,000 lives per year in the United States. There are several additional benefits associated with public enthusiasm for CPR. BLS –CPR programs in- corporate education in both primary and secondary prevention of coronary heart disease, which results in a heightened awareness of coronary heart disease preven- tion, recognition, and - early treatment .61-65 Signals and action for survival are taught, which prompts lay res- cuers to recognize the early warning signs of a cardiac emergency and tells them how to gain quick access into the EMS system. Given the increasing aggressive management of acute coronary emergencies, an even greater emphasis by physicians to patients and their families on how and when to seek emergency help is clearly mandated. Most studies show that patients with recognized heart disease delay longer before seeking emergency care than those who are not aware of their heart disease.66.67 There are three areas that deserve special attention during the next five years. The first is in targeting future layperson CPR efforts; the second, the need for early definitive care — specifically defibrillation; the third, ch inges in out -of- hospital care and the management cf 3cute lnvocardial infarction (MI). ;:�tgetlnq CPR Trainees I r surveys evaluating the demographics of laypersons taking CPR training in self - solicited community pro- grams, trainees tended to be younger, more often male, and less often from a family with a known coronary heart disease victim than did persons who did not receive the tralnrng.h" 13" However, 700% of the time, cardiac arrest occurs at home: and most often, an older male is the vlrt m. To take full advantage of community educational programs, family members of persons at risk for cardiac arrest need to be targeted to receive CPR training. This (x us d be achieved by a greater involvement of healthcare pion iders in identifying and teaching the families of Vr iln(zed cornmunily efforts should try to ct olu('r women to sign up for CPR courses, and r�l'F sh0wd he made a parr of school curricula_ ACLS in Perspective Early 1:1eI`lhrili,,o, riven iirii tR��:� . e I i I V _, . ns there is an inherent delay unt1l thl` lt:lik,n outcome for cardiac arrest, whether crr 11:)l :iy st:;n er ;PR has been applied, is dismal if (dc.i!I)r 0 ling it s delayed beyond 8 minutes (Figure! ?) 7 1 I t it f last decade, we have under - emphasized It1e role o prompt defibrillation. CPR should be initiated only when a cefibrillator is not imme- diately at hand or after initial shocks have failed to restore spontaneous circulation. CPR should never be used as a substitute for definitive care. Efforts to provide a cadre of lesser- trained first responders with the training and equipment to administer early defibrillation have been initiated and should be aggressively sup- ported. 72. 74 In the future this trend of training first - arriving rescuers in defibrillation should include the training of fire, ambulance, and police personnel in tiered EMS systems — as well as, possibly, security and building attendants in public places and, finally, even family members of patients at risk for cardiac arrest.? x.76 Devices that will facilitate this effort of "early defibrilla tion" are known as "automatic (or semi- automatic) external defibrillators ". Unlike conventional defibrillator - monitors, the automatic external defibrillator requires no rhythm recognition skills, is simpler to operate, and can be used by those less sophisticated in ACLS after only five hours of training. (The training required for first responders to use conventional defibrillators is two- to threefold greater, initially, and requires more extensive continuing education efforts to maintain satisfactory skill levels.77-79) Automatic devices should permit most small communities with volunteer emergency care providers, as well as most of all other first responding emergency care providers, to have enhanced lifesaving potential.. Second, it may be a more fiscally responsible way to improve outcome after cardiac arrest in areas where the costs of paramedic services are prohibitive. Changes in Oift -of- Hospital Care and the Management of Acute N11 Emergency medical services systems have to deal with the problem of providing the best and most rapid care possible for patients with chest pain and acute coronary thrombosis. The evidence to date clearly shows that the greatest benefits of measures aimed at restoring blood flow to an acutely thrombosed coronary artery are realized when the delay from onset of chest pain to delivery of therapy is brief, suggesting that our pre - hospital care system should consider a return to the former "scoop and run" procedures in which only essential efforts were made in the field. This might shorten the delay until hospifai arrival. On the other hand, it Is recogn12ed that to prevent cardiac arrest, patients with chest pain, especially those with concomitant pulmonary r.:jnq(­s;ron ,and/or shock, '10 D 1 -30- ° -20- to- -0- 1 -3 4 -6 7 -10 .to- Response Time of Rescuers Trained to Defibrillate (min) 1978 -82 Figure 2. Survival rates for all patients (witnessed and unwit- nessed) initially discovered in cardiac arrest. The response time was known in 942 of 1,122 consecutive cases. (From Weaver WD, Cobb LA, Hailslrom AP, Fahrenbruch C, Copass MK, Ray R: Factors intluencrnq survival after out -of- hospital cardiac arrest. J Am Coll Cardrol 7:754. 1986.) should be stabilized at the scene of the incident prior to transport Pain relief needs to be initiated, an intravenous line started, and the cardiac rhythm stabilized. If neces- sary, blood pressure and ventilatory support should be ensured prior to initiating and during transport.BO-82 Because the anxiety induced by excessively rapid transportation may contribute to arrhythmias and in order to Ensure the safety of the providers, the decision to provide high-speed transportation using a siren must be considered carefully. Substantial additional research is necessary to optimize care during helicopter transport. The feasibility of having EMT's and /or paramedics deliver thrombolytic therapy in the field must also be considered. The ability of the out -of- hospital team to make the diagnosis of acute myocardial infarction properly and to exclude patients with other emergencies that could be complicated or exacerbated by thrombolytic treatment is uncertain However, EMS systems will be increasingly under pressure to rethink their organizations to minimize the delay in delivering definitive care to patients with chest pain and acute coronary thrombosis. I here the several obvious partial solutions to this delay. Ti e patient must more promptly recognize the problem tend seek help, transportation to the hospital n�u ;t t,,e t icilitated, and the time from hospital admission uut I trca' rent must be reduced. Transport lime is, in n o ;l ra. r,s only a minor proportion of the total delay ntr symptoms to . File del<rys encoun- tt , `t- I )e patient .irnvi.s ,iI the hospllal more often Ch:rhlc•i I are far longer. The hospital emergency department should be prepared, using standing orders and guide- lines, to quickly mobilize the personnel and resources needed to provide rapid pharmacological and/or invasive coronary reperlusion during the early hours of myocar- dial infarction. A Systems Approach to Emergency Cardiac Care Systems Concept uajjza[10 C1 Sudden arrhythmic death is the first manifestation of underlying coronary heart disease in approximately 15-25% of patients.113 The majority will develop cardiac arrest outside the hospital without any, or with insignifi- cant, premonitory symptoms.84 Accordingly, the effective treatment of cardiac emergencies in the community requires a stratified or "systems" approach. This should begin with the instruction of the public in recognizing the manifestations of ischemic heart disease and an appro- priate approach, by laypersons, to emergencies such as chest pain and cardiac arrest. Initial efforts need to be followed by a rapidly responding emergency medical services system with ACLS capability. In 1986, in Belfast, Ireland, the 20th year of out -of- hospital coronary care was celebrated. It was here that the concept of mobile coronary care was pioneered.B5 Now, every major city in the United States has paramedic level care, and almost all communities have some form of organized system for responding to emergencies. In addition to the obvious benefit of these systems in the management of patients with cardiac arrest,70.71 patients with acute myocardial infarction also benefit from organized systems.e6.e7 Early prophylactic antiar- rhythmia therapy is safe and results in a 50% reduction in the incidence of ventricular fibrillation en route to the hospital." In the setting of cardiac arrest, provision for defib- rillation must be made for all prehospital emergency systems. When only CPR can be delivered initially and definitive therapy occurs only after arrival at the hospital, survival rates of 5% or less are usual. On the other hand, when prehospital defibrillation is available, survival rates for patients discovered in ventricular fibrillation range from 15 to 30 %. The high rates of success in some communities are due in large part to widespread recognition of the problem, delivery of BLS —CPR by laypersons, plus a well - organized, rapidly responding EMS system (3 -8 minutes) that provides ACLS (pre- dominantly (Jefibrillation). ACLS will not be fully effective until it is delivered almost inunediately and is complemented by the prompt initiation of CPR. CPR is only a holding action to main- tain the vitlbility of the patient for a limited time until ACLS with °c;rrly defibrillation" is implemented. An EMS system reflects coordination of the resources necessary to optimize the care required by an acutely ill or Injured patient from the time the problem is recognized to the time he or she is discharged from the hospital and rehabilitation has been completed. Although this text deals primarily with advanced cardiac life support, the benefit of the EMS system to the victim of any kind of physical trauma is indisputable. Dispatch of emergency care teams must be efficient and timely. Rapid response is facilitated through a widely publicized telephone number; all communities should adopt the 911 number for emergency assistance. It offers the advantage of ensuring prompt access to the system not only for the person familiar with the area but for transient populations as well. In some areas, advanced computerized systems now automatically provide the location of the caller, further facilitating the arrival of life support units. The Emei,gency Cau Systen-i The EMS system should consist of primary response vehicles that are equipped and staffed to render both BLS and ACLS and to transport stabilized patients to better equipped facilities. In some areas, a tiered emergency response vehicle may be equipped and staffed to render only first aid and defibrillation. A limited number of secondary response vehicles may be simul- taneously dispatched or summoned, with staff who are trained to provide full emergency care. The configuration of the specific emergency care system may vary from region to region since the best system will reflect the effective use and coordination of available resources. Standing orders or protocols for ACLS providers are mandatory in order to minimize the delay until delivery of initial definitive care (ACLS). The initial management of cardiac arrest is straightforward and patients and condi- tions change so rapidly that efforts to communicate these changes to the hospital frequently only interfere with the delivery of lifesaving care. Therefore, initial procedures need to be defined and implemented by first - responding providers in order to maximize success rates. These initial steps must be defined by standing orders of the supervising physician; subsequent efforts not defined by standing orders must be supervised by the physician. Medical Control of Prehospita! Activity Prehospital care is a logical extension of the hospital into the community. In this country rescue vehicles are rarely staffed by physicians. In most communities, nurses, emergency medical technicians (EMT's), and paramedics are trained to act as agents of the physician in the field. Every prehospital program must be super - vised closely by a physician who provides direction and Table 5. Medical Directors' Authorities, Responsibilities, and Roles 1. The adequate training and continuing education of providers of all care beyond first aid. Q. Cnloha and policies for the certification and recertification of providers. 3. Gurdelint -s for the management of all patients cared for by these providers. 4. Medically related dispatch procedures and transportation policies. 5. Criteria for patient disposition. 6. Oualily assurance, including systematic audits. 7. A mechanism to allow supervision of all medical care delivered. leadership and assumes responsibility for the emergency care team (Table 5). The physician must be thoroughly familiar with the local and regional EMS system and with the principles of advanced cardiac care as defined in the "Standards and Guidelines for Cardiopulmonary Resus- citation (CPR) and Emergency Cardiac Care (ECC) ".6 The system's medical director must ensure that both the on -site provider and the immediate medical supervisor are proficient in ACLS, and the medical director is u.timately responsible and should review the care given within the system.88 Direct involvement of the physician in virtually all aspects of care is mandatory. With the widespread pro- vision of early defibrillation by first providers, there will be even more of a need to review the care delivered by these providers. It cannot be over - emphasized that out - of- hospital systems can be neither self- sustaining nor self - accountable. The use of a device or a drug is but a small portion of total patient care, and it is the evaluation of this total system of health care for which the medical director must be accountable. In addition, the physician should provide innovation and translate newly acquired medical knowledge into prehospital care. The director should set the expectations and criteria for performance of the providers. The most successful community emer- gency medical systems are in many ways a tribute to the extent of physician involvement, training, and supervision. Voice communication from providers at the scene and to the supervising physician is mandatory and should be Provided in every system. The need for telemetry of the electrocardiogram (ECG) will vary depending on the degree of training of the field personnel. It should be noted that the telephone is an inexpensive and readily accessible instrument that can be used to transmit the ECG. Protocols and cAan,(,Wff; t,rclt:rs All systems must have protocols for handling the most common emergencies.58 These protocols are also es- sential for training prehospital personnel. In the cardiac arrest protocol, it is the option of the medical director to determine how much protocol should be followed before communication with the physician becomes obligatory The use of standing orders is appiopnate for only a few well- defined conditions, such a<, c<arclrjc Firresl ACLS in Perspective For most other cardiac emergencies, the physician should be contacted prior to the initiation of invasive treatment by field personnel. The physician should be given a description of the patient's problem, the vital signs, and other information obtained during a brief physical assessment of the patient. Field personnel may suggest a plan for treatment that should be approved or modified by the consulting physician. Patient manage- ment protocols are predicated on a precise knowledge of the individual patient's condition as well as a clear recognition of what can and should be accomplished by treatment.89 Therefore, the use of standard written orders for use by nonphysicians is appropriate for only a few well- defined conditions where therapeutic strategy is narrow and straightforward. The broad range of complex medical issues encountered by an EMS system does not lend itself to interventions based on an array of written standing orders. In addition, the communication process itself between physician and paramedic serves as a stimulus for careful thought and assessment of the patient's condition. Issues relevant to urban -based EMS systems are, in principle, no different for rural areas; however, there are certain important modifiers. They include distances, resources available, economic /political aspects of hos- pital destination, the complexity and expectations of people living in the community, and the likelihood that multiple hospitals and multiple physicians will be involved. If a physician is on the scene and willing to help and supervise, he or she should assume responsibility for the management of the patient by providing his/her identity and accompanying the patient to the receiving facility. If a physician has not been responsible, a retrospective review of each treatment record and other documents (voice or ECG tape recordings) is a means of quality assurance. In addition, personal observation of para- medic performance by the supervising physicians or their delegates should be accomplished periodically. Tabulations of procedures and performance carried out by each individual need to be made in order to establish constructive recommendations for continuing education. Patient Disposition. The physician directing an emergency call must ecide, based on the condition and medical needs of the atient, when and where the patient should be trans - orted. The medical director should provide guidelines ,tat consider the patient's prior medical care, the roblem at hand, and the resources available in the r mmunity. Patients with suspected acute myocardial ifarction, as well as other acute life- threatening cardiac onditions, should be closely monitored in a coronary are unit or its equivalent. Acutely ill or unstable cardiac alienis should not be transported to a facility without tis capability. If the need for an emergency cardiac wicterizason or cardiopulmonary bypass is anticipated, ANALIZING A PARAMEDIC SERVICE FOR THE CITY OF MOORPARK Factor 1 Pruner Ambulance Service inequities; 1. Paramedics are transient, due to lower wages and benefits compared to civil servants. Private ambulance paramedics usually move on to persue a career in the public sector, for better wages, benefits and career opprotunities. 2. Paramedics lack needed experience because of high attrition rate, and frequent employee turnover. It takes 3 to 5 years for a paramedic to become a quality, and proficient advanced life support provider. 3. Because of high attrition rate, it is not uncommon for a Pruner Paramedic Ambulance to operate with only one paramedic, assisted by a E.M.T., and working a Mobile Intensive Care Unit. This practice directly affects quality care, and ultimately patient outcome. 4. Pruner Ambulance is a profit organization, therefore patient incurrs high fees. 5. The Department of Transportation (D.O.T.) has established minimum recommendations of one paramedic unit per 50,000 capita. Pruner has one paramedic unit in Simi Valley with a population of 102,000, plus, Moorpark with, 27,000. Pruner also has one paramedic unit in Thousand Oaks with a population of 120,000, plus, Westlake with 25,000. Total population= 274,000 or one paramedic unit per 137,000. (Los Angeles has an extreme coverage problem, and has one paramedic unit per 72,727 capita). 6. Coverage further compromised by inter- facility critical care transfers (C.C.T.'s), where a paramedic ambulance transfers a patient who needs paramedic monitoring, from a local hospital, to an out of town facility. Paramedic ambulance is out of town. for several hours. 7. All conditions being stagnate, Pruner has a response time to Moorepark of 15 minutes. In a respiratory gar cardiac arrest, irreversible brain damage occurs in 4 to 8 minutes. iruner's response time is twice that figure, putting cardio or pulmonaa;. arrest patients in an increasingly I Factor 2 grave situation. (See Americarl Heart Association, Advanced Cardiac Life Support manual). I. Professional Fire Fighter /Paramedics provide a greater quality of patient care, because they are not transient. Will be on the department for 20 to 30 years, therefore, experience gained is not experience lost. 2. 80% to 85% of fire department responses are emergency medical service calls, therefore, at least equal emphasis should be placed on adequate E.M.S., versus fire suppression, 3. Ventura County Fire is one of the only fire departments in southern California, that does not provide a paramedic service. 4. Single function paramedics, versus dual function fire fighter /paramedics. A. Single function paramedics, have to be compensated with a relative public servants salary and benefits. Single function paramedics only provide a sole service ()f patient care, and usually do not perform in hazardous envirorunent.s consistent with rescue operations. B. Dual function fire fighter /paramedics are far more beneficial, especially economically. They can perform a multitude of functions for a single relative salary and benefits, with an average paramedic bonus of 13% to 17%. The advantage of being able to treat or stabilize patients in hazardous rescue situations, inherent with the job of a fire fighter. Concept 1 Implementation of Paramedic Rescue Mnbul.ance- Material; Rescue Ambulance Paramedic Equipnent Manpower; 6 new Personne, and Paramedic Training I Figure lA Start -up costs for 1st year = $589,440 Figure 1B Ongoing costs annually = $358,008 salaries Note; Start -up costs for 1st year, utilizing exsisting trained personnel. Use Figure 1B = $358,008 salaries $ 45,000 rescue ambulance $ 21,000 paramedic equipment $424,008 Total Start -up Cost Advantages Self contained unit, independent and does not effect fire suppression coverage while transporting patient to a hospital. Can transport immediately, without depending on other resources. In a critical trauma situation, rapid transport is imperitive where immediate surgery is needed. Unit provides added manpower where needed. Can help subsidize service, by charging a fee for patient transportation. Disadvantage Extensive costs in added manpower and training. 1 Paramedic Rescue Ambulance = 7.6 Paramedic Engine Companies. Concept 2 Implementation of Paramedic Engine Company- Material; Paramedic Equipment Manpower; 3 new Personnel and Paramedic Training 3 exsisting Personnel and Paramedic Training Figure 2A Start -up costs for 1st year, adding 1 fire fighter /paramedic to increase manpower from a 3 man engine, to a 4 man engine = $304,836 Figure 2B Ongoing costs annually == $161,846 salaries Note; Start -up costs for 1st yeas, utilizing exsisting trained personnel. Use Figure 2B = $161,846 salaries $ 21,000 paramedic equipnent $182,846 Total Start -up Cost -14 Advantages Has best economical advantages, because of utilizing exsisting personnel. The only ongoing cost is for the paramedic bonus. Unit can provide both rapid fire suppression and advanced life support, either independently or simultaniously. In non -life threatening situations, unit can turn patient over to arriving ambulance, therefore, becoming available for another response. Disadvantage Does not have transport capability, and is dependent on exsisting ambulance for patient transportation. When stabilizing a seriously ill or injured patient, unit is out of service for both fire suppression and rescue, until complete at hospital. Concept 3 Implementation of Combination Engine /Paramedic Rescue Ambulance _ Material; Rescue Ambulance Paramedic Equipment Manpower; 3 new Personnel and Paramedic Training 3 exsisting Personnel and Paramedic Training Figure 3A Start -up costs for 1st year, adding,l fire fighter /paramedic to increase manpower- from a 3 man engine, to a 4 man engine = $304,836 $ 45,000 rescue ambulance $349,836 Figure 3B Ongoing costs annually = $161,846 salaries Note; Start -up costs for 1st year utilizing exsisting trained personnel. Use Figure 2B = $161,846 salaries $ 45,000 rescue ambulance $ 21,000 paramedic equipment $227,846 Total Start -up Cost -5- Advantages Has good economical advantages, because of utilizing exsisting personnel. Ihe only ongoing cost is for the paramedic bonus, and rescue ambulance maintenance. Can provide rapid fire suppression and advanced life support, either independently or simultaniously. Can transport at will, which. is important in a critical trauma situation. Can help subsidize service, by charging a fee for patient transportation. Disadvantage When rescue ambulance is transporting, both engine and ambulance are out of service. This is due to lack of manpower to perform effective fire attack, although engine could still provide a limited service, until rescue ambulance becomes available. Considerations: When starting a new paramedic program, Expect possible equipment failure. A onetime purchase of a backup card iac/def ibri la tor and telemitry equipment must be considered. This can be done by purchasing new or used equipment, or by borrowing equipment from another paramedic provider. All the figures in this report, are consistent with the Los Angeles Fire Department. The salaries and benefits are higher than those of the Ventura County Fire Department. The L.A.F.D. Ikiramedic bonus is 16 %, of base salary. To send a fire fighter to paramedic school for 6 months, costs $27,572. This includes salary, benefits and tuition. VCMC Ventura County Medical Center Associated with the UCLA School of Medicine A Division of the Ventura County Health Care Agency F MEMORANDUM TO: A. Hooper, M.D. Barbara Brodfuehr r FROM: Nat Baumer, M.D. David Chase, M.D. Director of Assistant Director Emergency Services Emergency Services SUBJECT: Agenda Item Emergency Medical Care Committee Meeting February 21, 1990 Ventura County is a rapidly grc)wing and increasingly sophiscated urbanized area. Because of these changes the Health Care Agency needs to carefully review the number of fully staffed Advanced Life Support units available to Emergency Medica: Services on an hour by hour basis relative to the number of 911 and other emergency calls to a spe- cific region and population. Based on this data a minimal stand- and needs to be developed for 7�dvanced Life Support response. If private industry in a particular area is unable to adequately meet this standard then public sector response needs to be explored. CC: Supervisor Jim Dougherty ' Councilwoman Eloise Brown/ 3291 Loma Vista Road, Ventura Cali'ornia 93003, (805) 652 -6058 C COOB 3 \/BH I CL-ES 1887 LALJFRBiL W000 THCDL -JE ANC OAKS, CA 91362 805- 492 -0393 ASHLBY AMBIJLANCB�- 'TYPB 18 I I I TORO TYPE I OR I I I 142" BOX $59,995 F=0F40 TYPE I OR I I I 142" BOX 4X4 $64,995 POFRO TYPE I I I 158" BOX $62,995 ROFRO TYPE I I I 158" BOX 4X4 $67,995 C HEVY TYPE I 142" BOX $59.200 C HEt/Y TYPE I BOX 142" 4X4 $61,500 STANDARD BQL.J I PMENT CAB • XL TRIM LEVEL • HIBACK BUCKET SEATS • HAND HELD SPOTLIGHT • AM RADT_0 • DRIVERS CONSOLE • BACK UP ALARM • ENGINE HIGN IDLE • TILT AND CRUISE CONTROL PAT IENT AREA • LOCKING DRUG BOX • INSIDE /OUTSIDE COMPARTMENT • ACTION WALL ATTENDENT SEAT • EIGHT INTERIOR LIGHTS HI /LOW • SPLIT SQUAD BENCH • 2 OHIO 02 OUTLETS • 110 OUTLET • ELECTRIC SUCTION • HEAVY DUTY VENTILATION FAN • PATIENT RESTRAINT STRAPS • ATTENDENTS PANEL O P T I O N S AVA I L AB L B • CURBSIDE WINDOW $250 • WINDOWS LOWER REAR DOORS $125 • DIAMOND PLATE IN COMP. $250 • AM/FM/CASS RADIO $150 • COT PLATES $150 • BATTERY CHARGE /CONDITION $325 • BATTERY CHARGER/TRICKLE $125 • INVERTER 1000 WATT $1.000 F—='><-T- E F2 I O R * 5 LARGE COMPARTMENTS * OUTSIDE BACKBOARD STORAGE * OUTSIDE ACCESS TO MEDICAL EQUIPMENT * 2 SCENE LIGHTS / SIDE * REAR LOADING LIGHT * HEAVY DUTY STEP BUMPER WAR N I N G SYSTEM * 9 FLASHING RED LIGHTS 3 FRONT 2 SIDES 8 REAR * GRILL MOUNTED RED LIGHTS AND SIREN SPEAKERS * FEDERAL PA 300 SIREN * CODE III LIGHT BAR • INTERSECTION LIGHTS $150 • WIG —WAG HEADLIGHTS $100 • FOG LIGHTS HELLA $175 • AIR HORN GROVER $975 • AIR HORN BUELL $775 • AIR HORN TRAFFIC $475 • TOMAR STROBE PACK $1,900 • HANGING HARDWARE $125 ReCCf VED aexn City Of i:9cOtpti MAL_ONF=-Y I NCl_fSTR I ES 1887 L_AL.JFREL- WOOED THOIJSANED OAKS, CA 91362 805 -492 -0393 MASS CASIJAI_TY MEN I CAL_ CACHE TRA I L- FE FR THE MASS CASUALTY MEDICAL CACHE WAS DESIGNED TO MEET YOUR I'EDICAL AND EXTRICATION NEEDS WHEN DISASTER STRIKES_ IT IS DESIGNED TO STORE AND TRANSPORT THE FOLLOWING • JAWS OF LIFE * NAT JACKS • TRIAGE SHELTERS * GENERATORS • TRIAGE KITS * SEARCH & RESCUE KITS • ROLL -A- STRETCHERS * PATIENT PACKS • BACK BOARDS * BACK UP SUPPLIES • EXTRICATION EQUIPMENT * LIGHTING • "H" TANK 02 SUPPLY * HEAVY RESCUE & SHORING IDEAL FOR: * MULTI- VEHICLE ACCIDENTS * PLANE CRASHES • TRAIN ACCIDENTS * BUS ACCIDENTS • EARTHQUAKES * FLOODS • TORNADOES * HURRICANES OTHER TRAILER DESIGNS AVALIABLE • FIRE CAMPS * COMMAND POST • SEARCH & RESCUE * LIGHT AND AIR • DIVING TEAriS * HEAVY RESCUE & SHORING TRAILER FEATURES: * LIGHT WEIGHT CAN BE * WATER PROOF PULLED BY ANY SIZE OF * DUST PROOF VEHICLE * VARI`lINT PROOF * NO MAINTANCE REQUIRED LIKE A MOTORIZED VEHICLE. * CAN BE STORED INSIDE OR OUT. * NO ADDITIONAL INSURANCE * COST EFFECTIVE •• _ s '�" ''�' �} .5, : -y ff fir''. t' � , ♦i r :. �f. • e y ✓ r ..n k h 1 A: A y^•. - : t sirr �. r' � -.r t..-Q`tlAi�j 4''a� � f- -1,;.•�^�` � 'w �"„yr,,,. , .. �" �s►��7',v.�`� �- 1 f rSr• y [ ' '�i f- I �b ' ..r�l�% ..Tree[ �:, �.r� -: i�,� r�•�_ --_ •C'_r� -six �( `d `!4r!` N YY G ta' .: xl+lak� '' ... j 'i�'•rai.%�+,a•: ,'r �'. -•rfit. 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ASHLEY TYPE III MODULAR AMBULANCE ti l< AMBULANCE PREP - PACKAGE in- cludes Diesel 7.3 Liter V8 engine, E40D transmission, 138" wheel base with 158" wheel base available as a factory option, 10,500 lbs. GVW, Limited slip rear axle, 165 amp L/N alternator, Super cooling radiator, Auxiliary transmission oil cooler, Handling package, Tilt Wheel with Cruise Control and Dual Captain's Chairs and XL trim level. REMOUNTABLE MODULAR BODY of RUSTPROOF welded Aluminum with Stainless Steel door hinges, carries a STRUCTURAL WARRANTY. Five exterior compartments and one interior /exterior compartment. Fold - up step bumper at rear entrance. RUGGED WIRING SYSTEM with simplified design avoids complicated, breakdown -prone elements, makes repairs less frequent. Console panels and wiring harness trunk are easily accessible. CHOOSE YOUR FLOORPLAN AND CABINET LAYOUT from several standard ALS AND BLS configura- tions, or work with our staff to custom - design a layout to your spe- cial needs.. PAINT, STRIPES and LETTERING to your specifications. �V��1 EMERGENCY VEHICLES & EQUIPPlENT P.O. BOX 766, JEFFERSON, N.C. 286,10 REPRESENTED IN YOUR AREA BY FR E=-: �FD-CLJ` V 188? LAURELWOOD THOUSAND OAKS, CA 9136. 805 -- 492-03:3 ME [O I CAI_ =SAS -'MFR F:=>FRl= FPAFRF=M"f -- S °F?OGRAM FREE- E- N -TEE LD BY C-D 1SES F= FR PFRE=-:F=>AF C�Ct- F=- #2400 TRAI_.)MA K I -I- THE TRAUMF: KIT IS DESIGNED FOR USE BY YOUR IRS'i RESPONDEkS, IT CONTAINS MEDICAL SUPPLIES TO STOP BLEEDING, FOR BURNS, DFi;SINGS 3 BANDAGES, TO CLEAN WOUNDS, SPLINTING AND COLD PACKS. THE KIT WILL TREAT 5 TO 10 PATIENTS. CONTENTS LISTED ON PRICE LIS`: THE KIT IS DESIGNED FOR THE QUICK ASSESSMENT OF THE PATIF "NT, TREATING LIFE THREATENING INJURIES AND REMOVAL OF THE PATIENT TO A SAFE AREA #2050 T FR I AGE K I T #2200 TFR 2 AGE K I T THE TRIAGE KIT CONTAINS THE MEDICAL SUPPLIES FOR TREATING THE PATIENT AFTER THEY ARE REMOW.71 -) TO A SAFE AREA. THE KIT WILL TREAT 100 PLUS PATIENTS. THE CENTER COMPARTMENT CONTAINS ALL THE DRESSING RIND BANDAGING SUPPLIES. THE OUTER POCKETS CONTAIN ITEPIS SUCH AS COLD PACKS BURN DRESSINGS, WIRE SPLINTS AND OTHER SUPPLIES. THE CONTENTS ARE LISTED ON THE PRICE LIST le THE 'TRAMUA & TR I AGE KITS SHOULD BE STOREp AWAY F= ROM THE fV1A :I fu `=TF=R I_JCT'UFRE. # 2 600 EDEP,ARTME"T K I T THE DEPi1RTmZ.14T KIT IS DESICNED TO BE LOCATED THRU OUT THE BUILDING FOR IMMEDIATE TREATMENT OF PATIENTS #-3 -'00 F=;�OL FR E=-:TCHI =R 3700 THE ROLL -A- STRETCHER OPENS UP INTO A SOFT STRETCHER. IT IS PADDED TO MAKE THE PATIENT MORE COI-IFORTABLE AND TO INSULATE THEM FROM GROUND THERMAL PROBLEMS IT IS EASIER TO HANDLE THAN A WOODEN BACKBOARD, LIGHTER WEIGHT AND -REQUIRES LENS STORAGE SPACE. #3 6 7 5 PAT I I=N T- PAC K THE PATIENT PACK IS DESIGNED TO USE IN THE TRIAGE AREA. IN THIS AREA IT IS NECESSARY TO LAY THE PATIENT DOWN FOR TREATMENT AND TO HELP PREVENT SHOCK. THIS CREATES SEVERAL PROBLEMS. THE 3675 SURFACE IS HARD AND UNCOMFORTABE THE PATIENT WHICH WILL CAUSE THEM TO MOVE AROUND. SECONDLY THE TEMPERTURE OF THE GROUND CAN CAUSE THE PATIENT TO BECOME EITHER HYPERTHERMIC OR HYPOTHERMIC. THE PATIENT PACK HELPS SOLVE THOSE PROBLEM BY PADDING THE PATIENT AND INSOLATING THE PATIENT FOR GROUND TEMPERTURES. IT CAN ALSO BE USE FOR TREATING BURN PATIENTS AND HELPS TO MAINTAIN BODY TEMPERTURE ;ley #-3 -'00 F=;�OL FR E=-:TCHI =R 3700 THE ROLL -A- STRETCHER OPENS UP INTO A SOFT STRETCHER. IT IS PADDED TO MAKE THE PATIENT MORE COI-IFORTABLE AND TO INSULATE THEM FROM GROUND THERMAL PROBLEMS IT IS EASIER TO HANDLE THAN A WOODEN BACKBOARD, LIGHTER WEIGHT AND -REQUIRES LENS STORAGE SPACE. #3 6 7 5 PAT I I=N T- PAC K THE PATIENT PACK IS DESIGNED TO USE IN THE TRIAGE AREA. IN THIS AREA IT IS NECESSARY TO LAY THE PATIENT DOWN FOR TREATMENT AND TO HELP PREVENT SHOCK. THIS CREATES SEVERAL PROBLEMS. THE 3675 SURFACE IS HARD AND UNCOMFORTABE THE PATIENT WHICH WILL CAUSE THEM TO MOVE AROUND. SECONDLY THE TEMPERTURE OF THE GROUND CAN CAUSE THE PATIENT TO BECOME EITHER HYPERTHERMIC OR HYPOTHERMIC. THE PATIENT PACK HELPS SOLVE THOSE PROBLEM BY PADDING THE PATIENT AND INSOLATING THE PATIENT FOR GROUND TEMPERTURES. IT CAN ALSO BE USE FOR TREATING BURN PATIENTS AND HELPS TO MAINTAIN BODY TEMPERTURE : LIGHT WEIGHT * HOLDS ENOUGH MEDICAL SUPPLIES TO TREAT 500+ PATIENTS * ALSO CAN BE USED FOR CO?M'IAND POST SECURITY FOOD & WATER STORAGE * PROVIDES SECURE STORAGE AWAY FROM MAIN BUILDING =CD I CAL CAC Ham/ ' I AGE T'FRA I L F=r FR THE 45000 MEDICAL CACHE /TRIAGE TRAILER IS LOCKABLE, DUST AND MOISTURE PROOF AND IS EASILY !`LOVED FROM WHERE YOU STORE IT TO IJHERE YOU NEED IT BY TWO PEOPLE. T'FR 2 AGE TcN-T- #6000 TRIAGE TENT PROVIDES SHADE Fen THOSE PAIENTS THf. NEED TO BE KEPT IN PRONE POSITION. THERE ARE ALSO SIDES AVAILABLE FOR MORE FROTECTION_ 'N BE SET UP IN SECONDS AILABLE IN i0' X 10' 10' X 15i' 10' X 20' FRt =SCLJt= U MANIJRACTI__!R I:VC 1887 tLALJF:RE-=LL WOOED T�- IOLJSAN� OAKS, CA. 805 -A02 -0353 PRIG t_IST EFFECTIVE 1 -1- -89 ITEM NO. DESCRIPTION PACK PRICE TRALJe r1A BAGS 2400 FIRST RESPONDER PACK 1 $ 95.00 2450 TRAUMA PACK 1 $ 95.00 2550 PEDI--PACK 1 $ 95.00 2600 JUMP KIT 1 $ 65.00 SF:> =C 2 At- I Z1 =ED BAGS 2700 ADULT ANTI -SHOCK PANTS SOFTPACK 1 $ 59.95 2750 PED ANTI -SHOCK PANTS SOFTPACK 1 $ 59.95 2800 LIFE PAK 5 COVER 1 $149.95 2850 RADIO COVER MOTOROI.,(i 1 $149. SS 2900 RADIO COVER MCI 1 $149.95 SPI=ED = Al. I E=- ED PAT I t =NT PROCLJCT� 3600 EMERGENCY il-:DICAL ['PICK 1 $259.95 3650 DISPOSABLE PATIENT r'ACK 1 $ 59.95 3675 BAG FOR DISPOSABLE ATIENT PACK 1 $ 20.00 3700 ROLL -A- STRETCHER ? $199.95 3750 ROLL- A- STRETCHER/PA� IEI4T PACK 1 $259.:95 (YlE-=p I CAI_ Rt =!E_�CLJE=-: f�ACt -G� 4100 CARRYING CASE WITH POCKETS 1 $450.00 ROLL -A- STRETCHER & PATIENT PACK 2050 CARRYING CASE WITH POCKETS ONLY 1 $199.95 2150 CARRYING CASE WITHOUT POCKETS ONLY 1 $ 99.95 2200 MEDICAL DISASTER PACK 1 $149.95 2300 EXTRICATION PACK EMPTY 1 $ 99.95 (PACKED) #2350 DEPARTKENT PACK 1 $159.95 #2400 TRUAMA PACKS 1 $285.00 42050 TRIAGE KIT i $735.00 #2200 DISASTER MEDICAL CAf-HE 1 $750.00 ED I STEFR -r FR I I =FRS 5000 6' DISASTER TRAILER $1,300.00 5500 7' DISASTER TRAILER $2,000.00 6000 6' MASS CAUSILTY TF:.AILER $2,000.00 6500 7' MASS CAUSILTY TRAILER $2,200.00 R F- (,-D L_J E= LJ ED I ST�`=-R F=> iF=F=>ARED=CD f',1EZ:E�—E5 PROGRAM THE RF= SCL.JH= L; DISASTER P P.EPPJ EDHNESS PROGRAM HAS BEEN DEVELOPED TO "KEET YOUR MEDICAL, NEEDS 1N A TIME OF CRISIS. DURING THE PAST TEN YEARS WE HAVE DISASTER TRAINING, DRILLS THAT HAVE BEE COUNTY AND STATE ACE LIES ALL FIVER THE FROM THE DRILLS, TvZ HAVE LF.ARIN ED WHAT .'ROBL i-f3 k1RE. FROM OUR E>U ERIENCE, WE TO HELP ELIN!NATL• THE PROBLEiiS. OBSERVED NUi 1ERI OUS N CONDUCTED BY CITY, STATE OF CALIFOR�NHIA_ WORKS AND i-F HEP.E THE HAVE DEVELOPED PRODUCTS ?HE PROBLEM THAT WE HAVE OBSE VED IS HAVING ENOUGH 1IEDICAL SUPPLIES TO PROVIDE CONTINUING CAPE FOR THE INJURED. !i" A ?'ifI OR EARTIIOUiIKE IT WILL BE AT LECIST 72 HOURS BEFORE YOU C,f -iN E:- ECT HELP FROM TAE OU'l -SIDE. TEATS OF E: LP LOYEES SHOULD ORC'ED 2 PER TEAM) TO CONDUCT THE SEARCH A:041D RESCUE OPERATION THEY SHOULD BE VERY FAMILIAR WITHI THE AREA _TN WHICH THEY ARE 30ING :'0 SEARCH. THEIR PRIiW ODJECTTVE WILL BE TO FINE .H: I ;JUnED, A QUICK ASSESMNT OF THE INJURIES, STOP BLEEDING, SPLINT = R1- CTURElS AND REMOVE THE PATIENT TO TIHE TRIAGE AREA AS SOON AS POSS15LE. THE RE= SCLJF= V 92400 KIT AND THE ROLL- A- STRi:TC:{ER i, i-ERL DESIGNED FOR THE SEARCH AND RESCUE TEAI"HS. THE Ki CONTCiINS THE SUPPLIES THAT SIR£ NEEDED AND THE POLL- A- STIRETi'AER PROVIDES AN EASY METHOD 10 REMOVIE THE PATIENT. THERE D BE Ga RESTOCK AREA FOR THE SUPPLIES !F T-;?-:°E flRE NUIE21OU.`I INJUR_I:'S IN THERE AREA. TR =.�.GE= faRE =A THE TRIAGE AREA SHOULD BE WtiERE MCST OF THE MEDICAL TREATMEN`1 IS DONE. THERE ARE: SF: "JERAL "KINGS THAT NEED TO BE CONSIDERED WHEN PLkNNING YOUR 'Fi-' IAGF. 1 . ) THE TRIAGE AREA SHOULD i',E IN ii SAFE AREA iAG;AY FROIi BUILDINGS, PO WER = IE i NTIA! FIRE HAZZARDS 2.) WEERL= ARE YOU GOIIIG :'C) ;TORE: ;11E ?IEDICAL SUPPLIES 3. ) HOW Wll.L. YOU PROTECT ': PATIENT FROM GROUND THERMAL PR'OBLE;IS. PROVIDE A CLEAAN AIt-En 1Iv WHICH TO 7REAT THE PATIENT- S. ) PROVIDE SHADE THE THEN PfiTIENT. lk'E LJ SY`� ?-�M PROVIDES THE SOLUTIONS TO THESE PROBLEMS. 1.) STORAGE OF SUPPLIES. THE RESCUE U IIEDICAL CACHE TRAILER PROVIDES A MOISTURE, DUST AND RODENT PROOF STORAGE OF ALL OF YOUR SUPPLIES AlvD EQUIPMENT. IT IS L GI:T WEIGIiT AND C *f-LN DE .EASILY PUSHED FROM !T'S STORAGE LOCATION T() WHERE YOU SET UP YOUR TRIAGE AREA. �.) SEARCH AND P.P.SClUE THE FESCUE U n24O0 SEARCH AND RESCUE KIT CONTAINS ALL O THE :'1ED1Crli.. SUPPLIES NEEDED : OR THIS aPE RAT _T O\'. THE. RESCUE U #3700 ROLL -A- STRETCHER PROVIDES AN EP-SY AND COMFORTABLE MET HOD TO TRANSPORT THE PATIENT TO THE TR±: (IGE AREA. 3.) TRIAGE AREA THE RESCUE U #2050 f4NND 42200 WI RE DESIGNED TO PROVIDE LARGE QUANTITIES OF MEDICAL SUPPLIES t'0R HE TRIAGE AREA- THEY BOTH I,;ILL TREAT A 100 PLUS PATI=ENTS. j THE RESCUE U n36715 PATIENT PAC-"',S PROVIDE A CLEAN j AREA IN WI -1ICH TO TREAT THE PATIENT, PADS THE PATIENT TO illf-I .E THEM AS CO[ r'ORTABLE AS POSSIBLE, HELPS INSULATE THE PATIENT FROM GROUND THE PROBLEMS, HELPS MAINTAIN BODY TEMPERTURE AND IN i CA BE USED TO -TREt ?T BUPvN PATIENTS. i A0 L7 1:T IONS = -,L_ PrFROCLJC --F 1.) #4000 P�R�C�NAL_ = "ACK� THAT ARE KEPT AT 'iHc EMPLOYEES DESK_ 2. ) n410O ME= FPAFR-T"ML_NT PACK, DESIGNED FOR USE IN A GIVEN ARE j4. 3- ) #4200 CAFE PAC K: =� fiND 44300 1 —iC)f' l= PAC K� FOR EMPLOYEE PURCHASE E'Lt()C3tni-LS. _r FR I AGE=— K_ I -T- FR E—= S C_- L-i E—= (-1 #2050 �i1 rk y ;. iii CD1 =F AFRT1 -1E=-:fVT K S TS Ri =�CUE=-: t_J 1$2600 TREATS 5 PATIENTS ) i YELLOW BLANKET 1 CPR NICROSHIELD MASK 2 ROLLS OF 1" T 14PE 6 ROLLS OF STRETCH BANDAGE 2 ROLLS OF MEDIRIP 2 TRIANGULAR BANDAGES 25 4X4 DRESSINGS 3 5X9 J&J DRESSINGS 1 BOX OF ASSORTED BANDAIDS 3 FERNO ARTIC COLD WRAP 1 FERMI COLD BURN DRESSING 10 ZEPHRINE WIPES Pt'lCKS OF WIRE SPL f NTS LYE PAC.K_, 2 !'AIR OF GLOVES 1 PARAMEDIC, SHEARS LIGHT STICKS ti ' tc TT FR A l.J fYt ,o, K I T FR E—::-- !E_�(-- I -1E-L l) #2400 cTREATS 5 TO 10 PATIENTS ) 1 CPR 111CROSHIELD 2 ROLLS OF 1" TAPE 1 YELLOW BLANKET 6 FERNO ARTIC COLD WRAPS 12 'LOLLS OF STRETCH BANDAGES 50 4X4 DRESSINGS 4 ROLLS OF 1 EDIRIP 5 Jai 5X0 EYE PACKS 3 FERNO CLOD BURN DRESSINGS 2 PAIR OF GLOVES 25 ZEPR:RINE WIPES 1 BOTTLE OF 3EDADINE 4 PACKS OF WIRE SPLINTS 2 SAi'i SPLINTS 3 TRIriNGULAR BANDAGES 1 Pf"!R PARAMEDIC SEiEARS 1 FL.ASl l LIGHT °'ter JR L.-J1= tJ #2200 (TREATS 100 PLUS PATIENTS) 1_2 ROLLS OF 1" TAPE 24 FERNO ARTIC COLD WiZ PS 46 ROLLS OF STRETCH BANDAGES 12 ROLLS OF MEDIRIP 200 PkCKAGES OF 4X4 DRESSINGS 50 J&J 5X9 DRESSINGS 1 BOY. OF ASSORTED BANDAIDS 10 EYE P AC K.S 6 4 OZ BOTTLES OF EYE SOLUTION 12 FERNO COLD BURN DRESSINGS 100 ZEPHRINE WIPES 3 BOTTLES OF BEDADINE 20 PACKS OF WIRE SPLINTS 4 S,_fl SPLINTS G PARAMEDIC SHEARS 2 MOUTH TO [TASK KITS F. OSF{ LIGHTS 1 BOX OF GLOVES 2 BOTTLES (100) TY-"ENOL �i1 rk y ;. iii CD1 =F AFRT1 -1E=-:fVT K S TS Ri =�CUE=-: t_J 1$2600 TREATS 5 PATIENTS ) i YELLOW BLANKET 1 CPR NICROSHIELD MASK 2 ROLLS OF 1" T 14PE 6 ROLLS OF STRETCH BANDAGE 2 ROLLS OF MEDIRIP 2 TRIANGULAR BANDAGES 25 4X4 DRESSINGS 3 5X9 J&J DRESSINGS 1 BOX OF ASSORTED BANDAIDS 3 FERNO ARTIC COLD WRAP 1 FERMI COLD BURN DRESSING 10 ZEPHRINE WIPES Pt'lCKS OF WIRE SPL f NTS LYE PAC.K_, 2 !'AIR OF GLOVES 1 PARAMEDIC, SHEARS LIGHT STICKS ti ' tc TT FR A l.J fYt ,o, K I T FR E—::-- !E_�(-- I -1E-L l) #2400 cTREATS 5 TO 10 PATIENTS ) 1 CPR 111CROSHIELD 2 ROLLS OF 1" TAPE 1 YELLOW BLANKET 6 FERNO ARTIC COLD WRAPS 12 'LOLLS OF STRETCH BANDAGES 50 4X4 DRESSINGS 4 ROLLS OF 1 EDIRIP 5 Jai 5X0 EYE PACKS 3 FERNO CLOD BURN DRESSINGS 2 PAIR OF GLOVES 25 ZEPR:RINE WIPES 1 BOTTLE OF 3EDADINE 4 PACKS OF WIRE SPLINTS 2 SAi'i SPLINTS 3 TRIriNGULAR BANDAGES 1 Pf"!R PARAMEDIC SEiEARS 1 FL.ASl l LIGHT °'ter March 1990 To Moorpark City Council Member: Eloise Brown We are writing this letter in order to inform you of an issue that is currently under discussion in your community. In the local newspaper, you the City Council have publicly voiced your concern over ambulance response times into the Moorpark area. We would like to give you some additional information on this matter that may open your eyes to the depth of the problem. Hopefully this will encourage you to ask more direct questions. Some of us are close to the Emergency Medical :system (EMS) in eastern Ventura County. All the information given here is fact and not fiction. There are many inadequacies i[u the county EMS that are now surfacing. These problems have jeen with us for many years but with the recent death of a Beverly Hills Police Officer, these problems have now reached the limelight, As public officials it is your duty to act to protect the Ives of your constituents. And see that the best in emergenc-, services are provided to the taxpayers. Paramedic services are complet,_,Ly inadequate for the Moorpark area. Pruner Health Services provides ambulance services to Moorpark, Simi Valley, Thousand Oaks, Camarillo and the unincorporated areas between and around these four cities. These four cities combined have a tct:al population of 286,709 people within 114.88 square miles. he numbers you see here only represent what is within the Actual city limits. The large unincorporated areas around an; between these cities are not included in these figures. Alth(;.gh thE, population outside of the city limits is not as large, it til somewhat substantial when you consider it's size. These areas include the rural a:-(?as around Moorpark such as Home Acres and north of the city Owards Grimes Canyon. Between Moorpark and Camarillo the Santa Rosa Valley and the community of Somis must also be consider_ec when talking about population numbers. -- RECEIVED -- MAR 1 4 1990 City of Moorpark RE: Emergency Medical System Taking into account the amount of people involved, "close to 300,000 ", there is a major problem. There are only 5 ambulances, 3 paramedic and 2 EMT -non paramedic to provide coverage for this area. Pruner Ambulance does have two additional units in Los Angeles County, each one in Agoura and Malibu areas. However this is a separate contract and the Los Angeles County Fire Department provides paramedic service via ground units or a helicopter air squad. Pruners units can respond into Ventura County, but consider the distance involved! As with any emergency service there will be times when responses can and will be delayed. However, the average response times Pruner uses do not always reflect what really happens. Pruner Ambulance operates in order t:o make a profit and in many circumstances profits come first and emergency service second. One way to do this is to transfer patients from one hospital to another, often with a paramedic ambulance out of the county. When this happens that ambulance is no longer able to respond to emergencies. With close to 300,00 people it is common for 2 or 3 medical emergencies to take place at one time. Some emergencies such as traffic accidents often require more than one ambulance. What if this happens and a paramedic ambulance is transferring someone to neighboring counties Long Beach? How often does a pruner ambulance have to respond to Simi Valley from Los Angeles county. We know it happens. Has response delay in Moorpark been a result of out of county responses? When there is a request for an ambulance, there is no guarantee that a paramedic ambulance will respond. Many people feel that the Ventura County Fire Department provides a paramedic service, it does not. All firefighters are trained Emergency Medical Technicians to provide advanced first aid, take vital signs and administer oxygen. EMT's cannot provide advanced life support measures, such as starting IV s::lutions, administer cardiac and other drugs, use a cardiac mon.tor or contact a hospital base solution. Fire department EMT's -annot transport patients to the hospital. The fire department has 30 fire serves, including 2 in Moorpark Moorpark in 10 minutes or less. on scene, firefighters try to fi. they do, they can stop bleeding, oxygen and perform CPR, but littl help except when a patient must_ �^ minutes for advanced life support no guarantee. stations throughout the area it tiith 3 more able to respond into When the fire department arrives .:i out what the problem is. When splint: broken bones, administer more. All of this can be great Lt arrcther 5, 10, 15, or even 20 if it does. There is Paq(: RE: Emergency Medical System According to Ventura County policy, when the "private" ambulance arrives the ambulance crew takes control of the patient. If this a paramedic unit, this makes sense. However, if a EMT unit arrives instead of a paramedic unit they also take charge. In many cases two 19 year old's with sometimes as little as six months experience between the two, make up the ambulance crew. Most often the fire department crew has many years experience among them. The lack of experience and maturity among the ambulance crews often shows up in excitability and indecision. In many ways, by allowing the policy of career fire department personnel to turn control of patients over to private EMT ambulance crews, is the same as professional police officers turning over their duties to a security guard. In Los Angels County there is a vastly superior public paramedic program that is not motivated by profit. Ventura County is a middle to upper class community that deserves the best. We all live here because there is a better life style than there is in Los Angeles. Why is our emergency medical system lagging far behind? Why does our emergency medical system places profits before people? Barbara BrodfuE1'r1rer. of County Health Service, states that a 15 minute response '_.ime to Moorpark is acceptable. She also states that 10 minutes into Simi Valley is acceptable. It looks like the people in Simi Valley are more important than those in Moorpark. Remember that these times must be met 85% of the time, what about the other. 1,)%'? Did the people of Moorpark ever have a say in this? What world happen if the sheriff stated that they would respond to robb,ries in 15 minutes 85% of the time? Would this be acceptable Pruner Ambulance states in a January 27, 1990 article in Tl-,e Enterprise, that financially Moorpark does;not merit an ambula- :Ce. Are profits more important than a good emergency medical sy;:fem for the people of Moorpark? Do the people of your city know t;_3 In years past some fire departm =at people have brought up the ideas of a public paramedic progr;n. It is most unfortunate that they were told to remain silent. Mr_. Pruner has every right to make a profit but how far does t. };,, right to make a profit reach? Pruner Ambulance is powerful at E, county level and has a great deal of influence. We are sending you this letter ,__th hope that this information will urge you look into this mz,,ter. Many people wish to do something about this matter, but. ire afraid, or just don't know where to turn. I am also sendin.i ' tiis letter to the local news media in hopes that they will a :ik E•STAO; s in all directions. Page 3 RE; Emergency Medical System At this time we wish to remain anonymous because our sources have some fear of retribution from many different levels. We assure you that this information is accurate because of the fact that reliable, knowledgeable and very sincere people have assisted me with this letter. We will be contacting you in the near future to answer any questions you might have. Not only ourselves but many people hope something will be done about this matter. Thank you, Concerned Citizens for a better EMS 1'ayc- 4 R��Ct_1E 'v ED I!E:-3AE5T'E=R PRE = PAP':- :s��f��i =�� PR(�GRAfVI T 'r!E F21ESCUEE Li DISilSTl,.k P c:EPAREDNIESS PROGRf -iM HAS BEEN Ii'_EUELOPED TO IE ?_'I YOUR MEDICAL. NI ED:> 11N F4 TIME OF CRISIS. DURING THE PAST TEN YEARS WE. riAVE DISASTER TtWiIIvINr3 DRILLS THAT HAVE BEE COUNTY AND STATE AGENCIES ALL ijVER THE FROf'I THE DRILLS. : i HAVE?. LEARN E;) WHAT I'ROBLE "IS ARE. FROM OUR EXPERIENCE, WE TO HELP ELIMINATE THE PROBLE`LiLS. OBSERVED NUPIERIOUS N CONDUCTED BY CITY, STATE OF CALIF jPlNli3. WIORKS AND i -THERE THE PnVE DEVELOPED PRODUCTS THE M7JOR 'PROBE EM THAT WE HAVE OBSERVED IS HAVING ENOUGH !'lEDICAL SUPPLIES TO i'ROViDE CONTINUING CANE FOR THE INJURED. I ;r A I*AJOR :EARTHQUtIKE IT WILL BE AT LEAST 72 HOUR: BEFORE YOU C. iN EXPECT HELP FROM T. -iE TEAMS OF E-ri LOYEES SHOULD 'OR['ED (Z PER TEAM) TO CONDUCT THE SEARCH 1:iND RESCUE OPERATION. TI-iEY SHOULD BE VERY Ff :lMILIAR WITH THE AREA IN WHICH THEY ARE GOING TO SEARCH. THEIR PRIME ODJECTIVE WILL BE TO FINE THE=. INJURED, A CLUICK ASSESI'ENT OF THE INJURIES, STOP BLEEDING, SPLINT Fl-<: CTURES AND REMOVE THE PATIENT TO TiIE TRIAGE AREA AS SOON AS POSSIBLE. THE Rf =SCLJF=' LJ #2400 KIT AND THE ROLL - A- STRETCHE Z itiIERE DESIGNED FOR THE SEARCH AND RESCUE TEAMS. THE KI ; CONTAINS THE SUPPLIES THAT :iRE NEEDED AND THE ROLL -A- STRETCHER PROVIDES AN EASY I'IETHOD C) RIENOVE THE PATIENT. THERE SHOULD BE A RESTOCK AREA FOR THE SUPPLIES IF THERE ARE NUME IOUS tNJURIFES IN THERE AREA. -T-FR I AGE ARt=--A THE TRIAGE AREA SHOULD BE- WHERE MOST OF THE MEDICAL TREATMENT IS DONE. THERE Alin. F_VERAL THINGS. THAT I',EED TO BE CONSIDERED WHEN PLi- INNING YOUR TRIAGE AR A. THE TRIr'IGr AREA SHOULD t: F• SAFE AREA (�U;AY FROIi ;BUILDINGS, PO'vJERL , NE;E r"D FIRE HAZZARDS 2.) WHER ARE YOU GOifl: united amencan - insurance company �" A Twct -w* Cp wy 2909 NORTH BUCKNER BOULE VARD )r f ( E BOX 810 • DALLAS, TEXAS 75221 EXPLANATION OF YOUR INSURANCE BENEFITS JANUARY 26, 1990 CHECK NO. 4712430 LORENE GARTNER 148 MOORPARK AVE MOORPARK CA 93021 POLICY NUMBER 4358165 BENEFITS FOR LORENE GARTNER YOU HAVE MET $ 163.98 OF YOUR EXCESS DEDUCTIBLE FOR 1989. OUR CHECK PROVIDES BENEFITS FOR SERVICES PAID BY MEDICARE UNDER THEIR CLAIM CONTROL NO. 9353827090 ON 01/08/90 FOR SERVICE FROM 1ii30/89 TO 11/30/89. BILLED $ 12.00 APPROVED $ .00 ELIGIBLE $ .00 NOTE *1 $ 12.00 $ 12.00 $ 12.00 $ 30.00 $ 26.00 $ 30.00 $ 90.00 $ 72.80 $ 90.00 $ 482.50 $ 285.57 $ 428.35 NOTE *2 TOTALS $ 626.50 $ 396.37 $ 560.35 YOUR POLICY PROVIDES BENEFITS OF $ 85.90 AS CALCULATED BELOW. UNDER AMOUNT MEDICARE 2APPROVED $OL396.37 DNELIGIBLE EXPENSE D$ POLICY LESS AMOUNT PAID BY MEDICARE $ 310.47 LESS MEDICARE APPROVED $ 396.37 LESS MEDICARE DEDUCTIBLE $ .00 LESS POLICY DEDUCTIBLE $ 163.98 BALANCE S 85.90 BALANCE S .00 WE PAY 100 PERCENT $ 85.90 WE PAY 80 PERCENT $ .00 *1 YOUR POLICY PROVIDES BENEFITS FOR-THIS EXPENSE ONLY IF IT HAS BEEN APPROVED BY MEDICARE. *2 CHARGES EXCEEDING 150 PERCENT OF THE AMOUNT APPROVED BY MEDICARE ARE NOT ELIGIBLE FOR REIMBURSEMENT UNDER YOUR POLICY. THE INFORMATION USED TO PROCESS THIS CLAIM WAS RECEIVED DIRECTLY FROM MEDICARE. IT IS NOT NECESSARY TO SEND US YOUR EXPLANATION OF MEDICARE BENEFITS FOR THIS CONTROL NUMBER. DETACH THIS PORTION BEFORE. _POS'TING CHECK DATE 01--26 90 CHECK N0. 4712430 UNITED AMERICAN INSURANCE POST OFFICE BOX 810 DALLAS, TEXAS 75221 -0810 L LORENE GARTNER 4358165 DATE OF LOSS 11 -30 -89 PAY TO THE ORDER OF: PRUNER AMB MOORPARK * * * * * * ** *$85.90 ** TEXAS COMMERCE BANK-ODESSA ODESSA, TEXAS C A 93021 ALOrHORIZED SIGNATURE �I' �+�1243011' x:1163225 31�: 15 0251 �,��� I LORE14E GARTNER 148 MOORPARK ROAD MOORPARK CALIF 93021 .' 1�le�en.,+.:- faeY: tli:' rira' awHrx•' s.seci:�.�_i�.<viw.c�.�.�c,._.r .,:.�. A077778 (805)529 -1540 GARTNER, LORENE GARNER 9 -1 -1 VC EMERGE 3984 11/30/89 06:20 PM 148 MOORPARK AVE LOS ROBLES HOSPITAL ILLNESS 1 482.50 ADVANCE LIFE SUPPORT BASE RATE = 482. 90 5C 0( 10.0 9.00 ADVANCE LIFE SUPPORT MILEAGE _ C . /., J 30. OC 1 30.00 OXYGEN ��^ 12. O C 1 12. 00 OXYGEN MASK & TUBING � , 12. Or 1 12.00 DISPOSABLE LINEN TO AVOID SERVICE CHARGES, ACCOUNT MUST BE PAID WITHIN 30 DAYS. 2EDICARE POLICY - IF YOfl WILL "TURN � YOUR PAYMENT WE WT RECEIPT TURN TIIIS BILL, VT N TAKING WII-L ALSO INCLUDE A FI O AND RET� IT TO YOU TO SEEK ANY OUT MEDICARE CLAIM FOgM KE HAVE ANY ANY RE�S SENT DUE YOU FROM MEDI FOR YOU HESITATE TO CARDING OUR POLICY CARE. IF YOU PATgN�,' S CALL US. PLEASE DO NOT CARE SIGNATURE: Q �4E STICKER IF NOT MEDICARE NUMBER: DATE OF BIRTH: r RE'T`URN THIS NOTICE ALONG -- ��SE ALLOW 7 I WITH YOUR PAYMENT. BE MAII�D TO WORKING DAYS FOR YOUR ?'-DIC YOU * *INCLUDE PHOTOCOPY RE F0" TO OCOPY OF MEDI -CAT CARD ** Y k G 26. 5 _ i a 'H CHI=CK YOUR EXPLAN ATION OF MEDICARE BENEFITS ABOVE AND CASH I'- PROMPTLY READ THIS NOTICE CAREFULLY AND KEEP IT FOR YOUR RECORDS '''�5275 HEALTH CARE FINANCING ADMINISTRATION THIS IS NOT A BILL- 331* LORENE E GARTNER 148 MOORPARK AVE MOORPARK CA 93021 -1845 Jan 08, 1990 Need help? Contact: TRANSAMERICA OCCIDENTAL LIFE INSURANCE 1149 South Broadway +�.0. Box 30540 Los Angeles, CA 90030 -0540 Phone: 213 Area: 748 -2311 Other Areas: 1 -800- 252 -9020 Participating doctors and suppliers always accept assignment of Medicare claims. See the back of this notice for an explanation of assignment. Write or call us for the name of a_participating doctor or supplier or for a free list of _participating doctors and suppliers. Your doctor r supplier did no�ce t assignment -of your claim (s) totalling $626.50. ; (See I tem 4 on bac c. 9 PRUNER AMB -At L -awe Approved amount limited by item 5b on back:. Ambulance Approved amount limited by item 5c on back. Ambulance Approved amount limited by item 5b on bac,. Billed Approved Nov 30, 1989 $ 482.50 $ 285.57 Nov 30, 1989 $ 9o.00 $ 72.80 Nov 30, 1989 $ 30.00 $ 26.00 'Ambul'ance Nov 30, 1989 $ 12.00 $ 12.00 Ambulance Medicare does not pay for these services ty thisov 30, 1989 $ 12.00_ -$ -- 0.00 This is Page 1 2 Pages. Medicare Claim No. 308 03 3509 D 1� Claim Control No. 9353 827 090 NTo 535907270 t A l \� 1 HEALTH INSURANCE CLAIM FORM FORM APPROVED (CHECK APPLICABLE PROGRAM BLOCK BELOM OMB NO. 093"DO8 1 MEDICARE MEDICAID CNAMPUS )MEDICARE NO IMEOICAIO NOJ �� (SPONSOR'S SSN) C FVA 'ILE FILE . NO 1 =FECA BLACK LUNG �� OTHER PATIENT AND INSURED SUBSCRIBER INFORMATION ISSN( (CERTIFICATE SSN) I, PATIENT'S NAME (LAST NAME, FIRST NAME. MIDDLE INITIAL) 2. PATIENT'S DATE OF 91RTH 1 INSURED'S NAME (LAST NAME. FIRST NAME. MIDDLE INITIAL) I 1. PATIENT'S ADDRESS (STREET, CITY, STATE, ZIP CODE) 5. PATIENT'S SEX 6. INSURED'S I.D. NO. IFOR PROGRAM CHECKED ABOVE, INCLUDE ALL +L - I.;i: r .,t{ r n,1D MALE �.'l FEMALE LETTERS) 'CS -00- 3509 — , ' 7. PATIENT'S RELATION':: 11P TO INSURED 8. INSURED'S GROUP NO (OR GROUP NAME OR FECA CLAIM NO.) SELF SPOUSE CHILD OTHER TELEPHONE NO. .,1 _=. 7 -" : J I� - I�j INSURED IS EMPLOYED AND COVERED BY EMPLOYER HEALTH PLAN 9. OTHER HEALTH INSURANCE COVERAGE IENTER NAME OF POLICYHOLDER AND PLAN NAME AND ADDRESS AND POLICY OR MEDICAL ASSISTANCE 10. WAS CONDITION RE, I' ED TO 11. INSURED'S ADDRESS (STREET, CITY, STATE, ZIP CODE) NUMBER) A. PATIENTS EMPLOYMII n 1 YES ! �. X NO TELEPHONE NO. B. ACCIDENT 11, A. CHAMPUS SPONSOR'S: AUTO 111 Ex X OTHER ACTIVE DECEASED STATUS ACTIVE O BRANCH OF SERVICE RETIRED _ _ ti. PATIENT'S OR AUTHORIZED PERSON'S SIGNATURE (READ BACK BEFORE SIGNING( I AUTHORIZE THE RELEASE OF ANY MEDICAL INFORMATION NECESSARY TO PROCESS THIS CWM. I ALSO •+v ! iVEST PAV ME NT 13. OF GOVERNMENT BENEFITS EITHER TO MYSELF7ORI TO THE F AUTHORIZE PAYMENT OF MEDICAL BENEFITS TO UNDERSIGNED PHYSICIAN OR SUPPLIER FOR SERVICE DESCRIBED PARTY WHO ACCEPTS ACS�SIGNM ENT BELOW EELOW. SIGNED}�.1 .,.: i.!_. '�0.�!f'tl h�l`_.v iVJ THE DTFOVILC1`� P', / [[ 1`-.. C G r\ . SIGNED (INSURED OR AUTHORIZED PERSON( O R SUPPLIER INFORMATION 11. GATE OF: ILLNESS (FIRST SYMPTOM) OR INJURY (ACCIDENT) OR PREGNANCY (LMP) CONDITION 16 IF P TIENT HAS HAD SAME OR 16. a. IF EMERGENCY SIMILAR ILLNESS OR INJURY, GIVE DAFES CHECK HERE 17. GATE PATIENT ABLE TO RETURN TO WORK 18 . DATES OF TOTAL DISABILITY f 1 DATES OF PARTIAL DISABILITY FROM THROUGH FROM THROUGH 19. NAME OF REFERRING PHYSICIAN OR OTHER SOURCE (e.g. PUBLIC HEALTH AGENCY) _ /` \ L : • • 20- FOR SERVICES RELATED TO HOSPITALIZATION GIVE HOSPITALIZATION DATES ADMITTED i DISCHARGED 21, NAME AND ADDRESS OF FACILITY WHERE SERVICES RENDERED (IF OTHER THAN HOME OR OFFICE) - 22. WAS LABORATORY WORK PERFORMED OUTSIDE YOUR OFFICE' YES Z3 A. DIAGNOSIS 011 MATURE OF 1l1KE53 OR 1MJlIRT, RELATE DIAGNOSIS TO ►110CEWAE IN COLUMN 9 1T REFE9EIICE AIIMtE85 1.747. ETC 011 pT CODE == NO CHARGES: - 2 L)1 s— 1Csr I 'EteEEi;S T)NG FOE �r.�•: �i,`( -N OXYGEN DUR TIN,- 3 T LOS Ror-:1, _- ' TRANSPORT` i-RQWL —Y PLANI(7IN6 f. rH, Ti Y-1 � E -O «o -' v`iFITAL, THOUSAND OAI' � r C >-�. 'SAL `D -, PRIOR 21. A- B . C. FULLY DESCRIBE PROCEDURES, MEDICAL SERVICES OR SUP! f. GATE Of SERVICE S AUTHORIZATION NO PUCE FURNISHED FOR EACH DATE GIVEN OF H. LEAVE BLANK F. FROM TO 1 PROCEDURE CODE SERVICE (IDENTIFY ) (EXPLAIN UNUSUAL SERVICES OR . ":VMSTA.NCES) DIAGNOSIS DAYS I E. Oq G CODE CHARGES I UNITS TOS I v 1 v �- i11�� = x0. G MILES .JJI 1 SC i 71 x DXYGEN \i._ C EDEN SIGNATURE A LOSHI CERTIFIY iHOAT THE EPSTAi EMEN (INCLUDING TO HE REVFE R$E APPLY TO 26. ACCEPT ASSIGNMENT IGOVE RNMENT THIS BILL AND ARE MADE A PART THEREOF) CLAIMS ONLY(SEE BACn YES= L NO JO YOUR SOCIAL SELURI1v ^,. OATS J1 YOUH PATIENT S ACCOUNT NO 13. YOUR EMPLOYFP - c�C PJ•i;E t'E i .`,ERCE AND REMARKS -El OS $ ON ILOO� lr,t R VI AGA -- Oh N! f 1 AI E •.. I I 7 TOTAL CHARGE ' 78 AMOUNT PAID ' 10 BALANOF 011f E_ 02 6 � I PHYSICIAN'$, SUPPLIERS, ANDIOR GROUP NAME, ADDRESS, ZIP CODE AND TELEPHONE NO D IJDY COUR -1 T IL r:o FORM HCFA I;oo(c z(�) sad F0RfA OwCP.,soo FORM CHAMPUS -501 FORM RRB ' ,00 I ORM AMA OP 503 Y(-)-"' _XP"'_ANA_710r\ VEDI 1ARE BENEFITS REAL THIS (NOTICE CAHEFULL1l A(' ) K: -P IT FOR YOUR RECORDS THIS I, N(' E FILL 331 ** *5275 HEALTH CARE FINANCING ADIIIINI'STRATION LORENE E GAR 'FNEF 148 MOORPAR< AVE MOORPARK CA 93C21-1845 .J _n )S, 1990 Ne,�d help? Contact: TRANSAMERICA OCCIDENTAL LIFE INSURANCE 11 +9 South Broadway P. ) . Bl-- x 30540 Loy Angeles, CA 90030 -0540 Phone: 213 Area: 748 -2311 Ot'ier Areas: 1 - -800- 252 -9020 This is Page 2 : ' "agers. Total approved arnc,jnt. . . . . . . . . . $396.37 Medicare payment 1;80% of the approved amot.nt minus 2.092 %) . . . . . . S310.47 We are paying a total of r'S310.44 to you on the attached check. Please detach and cash it as soon as po h -Tble. If you have other insurance, it may help with the part Medicare did not pay. This information has been sent to your supplementai carrier for further consideration. Under the current law, we have reduced yoL.r Medicare payment by 2.092 percent for services you received between October '7, 1989 and September 1990. You are responsible for a total of $316_'3, the difference between the Billed amount and the Medicare payment (this nc -des ser\ -ices that Medicare does not cover - shown as''$0.00' in the approved .-Iumn). You could have avoided paying $218.13, the difference between the Billed and Approved amounts for all covered services„ if the claim had been assigned.' (You have met the deductib -- for 1989) If you need to call, may we suggest that � u avoid the peak hours from 11:00 a.m. through 1:30 p.m.. IMPORTANT; If you do not agree with the amounts approved you may ask for a review. To do this you must write to us be *ore Ju' 08, 1990. (See item 1 on the back.) -- DO YOU HAVE A QUESTION ABOUT THIS NOTICE? f �o;, t_:lieve Medicare paid for a service you did not receive, or there eior, Intact us immediately. Always give us the: Medicare Claim No. 303 03 3509 D C11 r- Control No. 9353 827 090 I` .72 fipCr,v �-OL-'r i . Tt:Ci L- :_;. 17106S 05/11/90 03:15 PM 13931 E LOS ANGELES LOS ROBLES HOSPITAL ILLNESS I. R. S. ID. 952632001 SO FiLV;, vCE LIFE SUPPORT BASE RAT" 10.0 9.00 ADVANCE LIFE SUPPORT MILEAGE 1 34.50 NIGHT CHARGE 1 30.00 OXYGEN 1 25.00 INFECTION C014TROL 1 12.00 OXYGEN MASK & TUBING 1 12. 00 DISPOSABLE LINEN TO AVOID SERVICE CHARGES, ACC01j, f MUST BE PAID WITHIN 30 DAYS. 1 MEDICARE POLICY - IF YOU WILL 'RETURN 'ZEIS BILL WHEN MAKING YOUR PAY T, WE WILL RECEIPT AND 'RETURN IT TO YOU. WE WILL A.I.SO INCLUDE A FILLED OUT -2-EDICLRi., CLAIM FORM FOR YOU TO SEEK AM REI213URSEMENT DUE YOU FROM: MEDICAR E. IF YOU H_�Vr NY QUESTIONS REGARDING OUR POLI PLEASE DO NOT . S1 tt44 ��..lE_l:. _v ycaLi, LJ.- GL50 If (, - PATIENT' S SIGNATURE: .'-EDICARE NUMBER: DATE OF BIRTH: 14 RETURN THIS NOTICE ALONG WITH YOUR PlYMENT. PLEASE ALLOW 7 WORKING DAYS FOR Y0U-F tH' -; DI CARE FORM TO BE MAILED TO YOU. T4 r n�`v rr � � � }? �✓ii�/!/ �'L.� -'lit