HomeMy WebLinkAbout20- City Administrator CITY OF SAN BERN/..__tDINO - REQUEST Frl COUNCIL ACTION
a
r: Peggy Ducey, Assistant to the Subject: Proposed City Fire Department
City Adminstrator Emergency Transport Services
Dept:
Adminstration
Date:
July 23 , 1993
Synopsis of Previous Council action:
July 19 , 1993 - Mayor and Common Council continued the item until
August 2 , 1993 to allow the City Adminstrator to
prepare a written rebuttal; and direct staff to
meet with Courtesy Ambulance to develop a solution.
Recommended motion:
1 . Receive and file report from City Administrator;
- and -
2 . Approve the operations plan as presented July 19 , 1993 ;
- or -
3 . Continue item to first Council meeting in October to allow staff
to pursue discussions with Courtesy Ambulance.
X19 An�e
nature
Contact person: Peggy Ducey Phone: 5122
Supporting data attached: yes Ward:
FUNDING REQUIREMENTS: Amount:
Source: (Acct. No.)
(Acct. Description)
Finance:
incil Notes: .Z 3 S-
CITY OF SAN BERN! DINO - REQUEST FC ; COUNCIL ACTION
STAFF REPORT
On July 19, 1993, the Common Council held a hearing on the proposed
City Fire Department emergency transport services. After hearing
testimony from Mr. Steve Rice, Courtesy Ambulance, Council directed
City staff to respond to the statements made by Mr. Rice.
CITY OVERPROJECTED REVENUES FOR THE PARAMEDIC MEMBERSHIP PROGRAM.
Mr. Rice stated that the projected revenue for the paramedic
membership program was $610,000 annually. Actual revenue for FY
91/92 was only $178,000, and actuals for FY 92/93 were only
$310,500.
Initial revenue projections were based on current and projected
medical aid call loads, collection rates as provided by Courtesy
Ambulance, and performance figures from other cities with paramedic
membership programs. These initial projections were realistic,
however, a number of unanticipated events have affected actual
collections, including the County EMS lawsuit, paramedic double-
billing, and a change in billing companies from Courtesy Ambulance
to Advanced Billing Concepts (ABC) .
When the Paramedic Membership Program began in July, 1991, the City
contracted with Courtesy for billing services because of their fee
collection experience as well as the established working
relationship between the Fire Department and Courtesy. In August,
1991 after investigating complaints regarding field medical aid
charges, City staff discovered that Courtesy was charging for
paramedic services even in cases where only City paramedics
provided medical care. Over the next few months, staff attempted
to negotiate a resolution to the billing issue. During the
negotiations, Courtesy expressed strong concerns about the legality
of the membership program and ability of the City to charge for
Fire Department services. Because of this, City staff felt that
Courtesy had a conflict of interest regarding City paramedic
billing and was granted approval by the Common Council to contract
with an independent billing firm. This change was a sound
administrative decision but hurt program revenues in the short
term. Any fee-for-service program takes 4-6 months for revenues to
reach projected levels. Courtesy handled billings for the first
six months of the program but just as fee collection was
increasing, it became necessary to change billing companies.
Records turned over by Courtesy to ABC, the new billing company,
were incomplete and collection rates dropped for six months.
However, collections have increased in the last fiscal year. While
its true revenues for FY 91/92 were only $178, 000, revenues almost
doubled for FY 92/93 , to $340,000.
Another reason projected revenues have not been realized is that
the City cannot collect fees from Medi-Care and Medi-Cal. Initial
information given to City staff indicated that the City could
collect from these providers and these revenues were incorporated
75-0264
into the projections. However, once the program was implemented it
was confirmed that program regulations require an ambulance
transport identification number for reimbursement. This decreased
the original projections by 33-40%. If the City could have
collected these, revenues would have increased last year to almost
half a million dollars. If the City does begin to provide
transport services, these revenues would become collectable.
REVENUE PROJECTIONS FOR CITY AMBULANCE SERVICE ARE OVER-ESTIMATED.
Mr. Rice states that the revenue estimates for City ambulance
transport services are too high.
When developing an implementation plan, staff acknowledged that
ambulance collections were a specialized field and revenue
estimates needed to be done by someone knowledgeable in the field.
Wittman Enterprises, an ambulance billing and consulting service,
was hired to perform the initial projections. Wittman currently
bills for the following clients:
Ace Medical Transport Waterford Ambulance
Elk Ambulance Paradise Ambulance
Monterey Park Fire Dept. Ramona Muni Water Dist
Indio Ambulance Sanger Fire Dept
Mono County Emergency Med Svs. Special Services Amb.
West Side Ambulance Marin County
Patterson Ambulance Basis Life Support
Selma Fire Dept. Bridgeport Fire Dept.
Tri-County Ambulance Huntington Beach Fire
Wittman estimated user fee gross revenues would be $4 , 180, 564 , with
net revenues reflecting a 62% collection rate. Staff was concerned
that these projections did not reflect the socio-economic
conditions of San Bernardino, and requested that Advanced Billing
Concepts (ABC) , the City's current billing company, review the
projections. ABC confirmed that the gross projections were
accurate, but that the collection rate should be dropped to 55%.
At one time, Courtesy Ambulance cited a 55% collection rate to
administration staff, so ABC's review was reasonable. However, to
be conservative, administration staff dropped the rate to 52% of
gross billings when completing its cost/benefit analysis.
CITY'S TRANSPORT CHARGES ARE VIRTUALLY THE SAME AS COURTESY.
Courtesy argues that City transport rates are the same as Courtesy
ambulance.
City transport rates will be lower than Courtesy because itemized
fees such as unscheduled emergencies, night and weekend charges,
etc. , will not be charged. Courtesy also has had a rate increase
pending since September, 1991 that was deferred until the City
resolved the paramedic double billing issue.
For comparison purposes, Courtesy rates and City proposed rates are
as follows:
1991
COURTESY COURTESY CITY
CURRENT PROPOSED PROPOSED
Basic Life Support (BLS) * $ 178 . 84 $ 214 . 60 $ 238. 00
Advanced Life Support (ALS) 272 . 00 315.93 351. 00
All-Inclusive ALS 403 .75 468. 84 0
Unscheduled Emergency 81. 24 85. 50 0
Night Charge (7 am -7 pm) 52 . 18 60. 60 0
Weekend Charge 52. 18 60. 60 0
Mileage 8 . 94 8.98 8 . 98
Oxygen 22 .37 50.98 23 . 00
EKG Monitoring 37. 25 43 . 25 0
* NOTE: Courtesy does not charge Basic Life Support fees on 9-1-1
calls. All 9-1-1 calls are charged the paramedic ALS rate.
Based on these rates, an average ambulance bill would be as
follows:
Courtesy Ambulance: All 9-1-1 calls (Note: Courtesy charges ALS rates for all 9-
1-1 calls).
Current Proposed
Ilk All-Inclusive ALS
$403 .75 $ 468.84
Night Charge 52 . 18 60. 60
Mileage 27 . 00 27. 00
Oxygen 22 . 37 50. 98
TOTAL $505. 30 $ 607.42
Proposed City Rate: Heart Attack Victim - ALS
Proposed
Advanced Life Support $ 351. 00
Mileage 27 .00
Oxygen 23 . 00
TOTAL $ 401. 00
Proposed City Rate: Broken Arm - BLS
Basic Life Support $ 238. 00
Mileage 27. 00
TOTAL $ 265. 00
Based on the current and proposed rate schedules, City transport
services would be $100 - 250 less than Courtesy. Furthermore,
residents would not be responsible for paramedic charges for both
Courtesy Ambulance and the Fire Department. This would decrease
bills by another $100 - 200, making a total reduction in fees of
$200 - 450 per medical incident.
THE CITY WOULD PUT COURTESY AMBULANCE OUT OF BUSINESS.
Courtesy argues that eliminating emergency paramedic ambulance
transport would close their business.
By eliminating Courtesy's emergency transport, there is no doubt
Courtesy would change the way it operates its business. However,
Courtesy would still keep all routine transport, which is the more
lucrative service, as well as emergency transport for unincorporated
county areas and surrounding cities.
Another issue that must be addressed is that the San Bernardino City
Council never formally authorized Courtesy to begin providing
paramedic services but Courtesy, on its own initiative, chose to
expand its services when the City did not need them. In 1975, the
San Bernardino Common Council considered the provision of paramedic
services in the City. A motion to designate Courtesy as the primary
provider failed by a vote of five to two. A motion to designate the
Fire Department as the primary provider then passed by a vote of six
to one.
Since the City does not have a written operating agreement with
Courtesy, it is unclear when paramedics were actually put on
Courtesy ambulances. When questioned by Jim Page, the City's EMS
consultant, Mr. Rice stated that he first employed paramedics in the
mid-1970's but did not become an all-ALS paramedic provider until
October, 1990. We can infer that Courtesy did not staff and bill
for paramedic services until late 1990. This was the same time that
the County adopted an EMS plan that identifies private paramedics as
a major component of this County wide plan. When interviewed by Jim
Page, the former County Health Officer stated that the County
considers it important for private paramedics to exist in the City
to serve residents of the unincorporated areas. In essence, city
residents pay for the duplication of paramedic services to subsidize
service in the unincorporated areas.
Courtesy has provided ambulance transport services for the Fire
Department for over forty years. However, they did not begin
charging paramedic fees on 9-1-1 calls until October, 1987 . Prior
to that time, Courtesy charged a differential between non-emergency
calls vs. emergency calls, but this equates to the "unscheduled
emergency" charge they have now. Courtesy has argued that the City
approved its ambulance rate schedule, including the ALS paramedic
charge and by doing that approved the staffing of private
paramedics. However, there is some confusion regarding the fees
approved by Council and the application of those fees by Courtesy.
It is unlikely that the Council knowingly approved the imposition of
a fee for paramedic services when that service was not actually
provided by Courtesy. It is also unlikely that Council would have
approved the operation of private paramedics when the Fire
Department had already been designated as the paramedic provider for
the City. Because the City does not and has not have the authority
to audit Courtesy's billings or accounting books, Courtesy's billing
or staffing practices did not come to light until 1991.
THE CITY'S NUMBER OF PROPOSED AMBULANCES IS TOO LOW.
Mr. Rice argues that six ambulances and two reserves is not enough
to cover the number of calls the City has.
Courtesy states they responded to 19, 000 medical calls last year.
According to Fire Department dispatch records, City Fire only
responded to 14,500 medical aid calls last year. The remaining
4,500 calls Courtesy responded to must be for service calls other
than 9-1-1 emergency calls, such as routine inter-facility
transport, non-emergency transport, and emergency transport in
unincorporated areas. Some may also be emergency calls where the
patient has called Courtesy directly rather than 9-1-1. In these
cases, Courtesy is supposed to call the Fire Department to respond,
but has not done so in all emergency cases.
Staff based its recommendation of number and location of City
ambulances on an analysis of the total number of 9-1-1 calls and
their distribution throughout the City. The City's EMS consultant
reviewed the number of calls, peak times, and average time needed
for an entire medical aid call, and documented that six ambulances
would be more than sufficient to staff the City. This number is
reasonable since the City currently has five paramedic teams that
provide services on all medical aid calls. Adding one more
paramedic team would add a more comfortable service level for peak
times. Two reserve ambulances would allow for coverage when
vehicles are being serviced as well as major medical emergencies.
For comparison purposes, Courtesy reports that they operate 12
ambulances at peak periods, with ten designated for San Bernardino.
Staff reviewed Fire dispatch log books which reflect daily reports
given by Courtesy regarding the number of ambulances available.
For the month of June, 1993, statistics were as follows:
Range - # Average #
Ambulances Available Available
11:00 p.m. - 7:00 a.m. 2 - 5 3.46
7:00 a.m. - 12:00 p.m. . 7 - 10 7.91
12:00 p.m. - 5:00 p.m. 5 - 7 6.00
5:00 p.m. - 11:00 p.m. 5 - 6 5.66
During peak morning hours, it seems that more than six ambulances
may be needed, however, further analysis of these statistics
revealed that Courtesy covers the Cities of Highland and Colton
with only one ambulance during these same peak periods. It is
likely that some ambulances "officially" designated for San
Bernardino are actually providing service to Colton and Highland.
Also, morning hours are peak times for routine transport and San
Bernardino are ambulances providing routine and inter-facility
transport as well as emergency response. The San Bernardino
ambulances are also serving the unincorporated areas of the City as
well. So the 7-10 ambulances operating during peak hours are
actually fulfilling a number of different duties besides 9-1-1
service to San Bernardino.
Mr. Rice questions whether minimum ambulance coverage will lead to
call screening, and the poor will be selectively served. As shown
above, six ambulances are more than adequate to cover medical aid
calls. However, dispatch policies of the San Bernardino Fire
Department requires that staff respond to all 9-1-1 calls no matter
what the situation. Fire stations are strategically located
throughout the City to equally serve the entire community and in
fact, if approved, 4 out of the 6 ambulances would be stationed in
areas considered low income.
CITY FIRE DEPARTMENT PARAMEDICS ARE MUCH MORE EXPENSIVE THAN
COURTESY PRIVATE PARAMEDICS.
Mr. Rice cited that City paramedics are paid $69, 000. Actually,
City medic pay and benefits ranges from $56, 000 - $64,000, $5, 000 -
13 , 000 less than cited by Courtesy. Also, city paramedics are
multi-function staff, trained not only for medical aid, but fire
suppression, hazardous materials response, search and rescue, and
heavy rescue. By comparison, Courtesy paramedics salary and
benefits are $39, 000 - 45,000, but Courtesy staff provides only
medical aid response.
NECESSITY OF TWO PARAMEDICS VS. ONE PARAMEDIC AND AN EMT.
Mr. Rice argues that it is not necessary to have two paramedics to
provide good medical care.
Courtesy Services staffs its ALS units with one paramedic and one
EMT, while the Fire Department staffs with two paramedics. Eighty
percent of all Fire Departments and sixty-seven percent of primary
paramedic providers for the nation's most populous 200 cities staff
ALS units with two paramedics, and there is sound medical reasons
for doing so. Two-person medic teams specifically divide
responsibilities to allow for optimum patient care. On medic,
called the "patientman" takes and monitors vital signs and
administers treatment to the patient, while the other "radioman"
interfaces by radio with the hospital doctor to exchange
information regarding the patient's condition and medical treatment
per the doctor's orders. The "radioman" also prepares any drugs
necessary to stabilize the patient's condition and directs the
"patientman" to administer the drugs and other treatments. More
importantly, two paramedics act as a check and balance system for
each other to ensure that no fatal mistakes are made in the field.
A 1980 study performed by the Philadelphia Department of Public
Health reviewed 200 consecutive prehospital heart attack incidents
where half were handled by two paramedics and half were handled by
an EMT and one paramedic. Researchers found that there were no
survivors among patients treated by only one paramedics, while 16%
of patients treated by two paramedics survived. Furthermore, the
American Heart Association took a formal position in October, 1992
advocating for the staffing of two-paramedic teams.
PATIENT DIED OF HEART FAILURE AND COURTESY TOOK 18 MINUTES TO
ARRIVE ON-SCENE BECAUSE THEY WERE DISPATCHED "CODE 219.
Mr. Rice stated that a good friend recently had a heart attack.
The Fire Department dispatched Courtesy "Code 201, without red
lights and sirens, and it took them 18 minutes to arrive on-scene.
Administration staff has reviewed both the Medical Aid report as
well as the dispatch tapes to determine specifics of the incident.
Events happened as follows:
6:47 9-1-1 call from patient's wife reporting that her husband
is having convulsions. First-responder engine company and
paramedic engine are immediately dispatched.
6:48 Courtesy ambulance is dispatched by phone, "Code 2" (no
lights and siren) . Courtesy reports their location at
the Crosstown (30) Freeway and Del Rosa.
6: 51 First-responder engine arrives on-scene. Takes vital
signs, which are strong. Patient is able to converse
with Firefighters.
6: 54 Paramedic engine arrives on scene.
6: 55 Vital signs taken again. Patient's condition is
deteriorating.
6: 56 Paramedics hook patient up to heart monitor. Indicates
third-degree heart blockage. Paramedics ask dispatch to
upgrade Courtesy to "Code 311 .
6: 59 Courtesy is upgraded by dispatch to "Code 311 , red lights
and siren.
7: 01 Dispatch calls Courtesy with directions to incident.
7:03 Dispatch calls Courtesy requesting an estimated time of
arrival and again gives directions to the scene.
Courtesy reports location and dispatch realizes Courtesy
has headed in the wrong direction to get to this address.
Dispatch again gives directions to Courtesy.
7 : 06 Courtesy arrives on scene.
Initially Courtesy was dispatched Code 2 , but was upgraded to Code
3 within minutes after paramedics arrived on-scene. Courtesy
low
reported that they were at the 30 Freeway and Del Rosa. The
incident was located less than four miles away. Traveling within
the posted speed limit, it should have taken Courtesy less than six
minutes. When Courtesy did not arrive within ten minutes, Fire
dispatch called to determine the problem. When Courtesy reported
its location, dispatch realized that they were traveling on a
street that dead-ended and they would not be able to reach the
incident location. Dispatch radio'd directions three times to
Courtesy. Courtesy arrived on-scene 18 minutes after being
dispatched because they were lost, not because they were dispatched
Code 2 .
The controversy regarding "Code 3" dispatch began in August, 1991
when Fire Department began dispatching Courtesy "Code 211 , rather
than Courtesy automatically responding "Code 3" on every incident.
The reasoning behind this is that emergency vehicles responding
through the City with red lights and sirens pose a safety hazard to
pedestrians and vehicles on the street. Since Fire Department
emergency medical personnel arrive on scene in four minutes or less
on average, there is no need to jeopardize the safety of City
streets. This dispatch policy is actually routine for most Fire
Departments, including those cities in the Inland Empire. Courtesy
objected and in fact, until the lawsuit judgement came out, ignored
Fire Department orders and continued to respond "Code 311 . Numerous
studies and reports, including those done by the U.S. Department of
Transportation and the National Association of Emergency Medical
Services Physicians, indicate that routine use of red lights and
sirens represent an unacceptable and preventable safety hazard.
CITY OF SAN BERNA-MINO - REQUEST F( I COUNCIL ACTION
Peggy Ducey, Assistant to the City
Subject: Public Hearing for Proposed City of
Administrator San Bernardino Fire Department Emergency
Dept: Administration Transport Services
Date: July 7, 1993
Synopsis of Previous Council action:
May 24, 1993 - Mayor and Common Council directed the City Administrator and Fire
Chief to develop a plan for the provision of City Fire Department
emergency transport services and present the plan in a public
hearing scheduled for July 19, 1993.
Recommended motion:
That the Mayor and Common Council:
1. Close the public hearing;
2. Approve the operating plan for City Fire Department emergency transport services
as submitted by the City Administrator's office;
3. Set a public hearing for August 16, 1993 to establish a rate schedule for
City Fire Department emergency medical transport.
G
Signature
Contact person: Peggy Ducey Phone: 5122
Supporting data attached: yes Ward:
FUNDING REQUIREMENTS: Amount:
Source: (Acct. No.)
(Acct. Description)
Finance:
L it Notes: 7 /3
- 7�
CITY OF SAN BERNkaADINO — REQUEST F_ ,A COUNCIL ACTION
STAFF REPORT
On May 24, 1993 , the Mayor and Common Council directed the City
Administrator and Fire Chief to develop a plan for the provision of
City Fire Department emergency transport services and present the
plan in a public hearing scheduled for July 19, 1993 .
BACKGROUND
In June, 1990, the City of San Bernardino implemented a paramedic
membership program which authorized a fee to be charged for
paramedic services. The City contracted with Courtesy Ambulance to
provide billing and collection services. In August 1991, citizens
began complaining about being "double billed" for paramedic service
on medical aid calls. As staff investigated the complaints, it
became apparent that both City Fire and Courtesy Ambulance were
charging for paramedic services and that Courtesy Ambulance was
charging a paramedic fee even in cases where only City Fire
paramedics actually treated the patient.
Over the next few months, the City held a number of meetings with
Courtesy Ambulance, the County Health Care Agency, and ICEMA to
work out a solution to this "double billing" issue. The position
of both the County and Courtesy was that the County controlled all
pre-hospital care and Courtesy was authorized under County
regulations to staff and bill for paramedic level services on all
medical aid call in San Bernardino. The last meeting was held
on November 25 1993 On December 10, 1993, the County and ICEMA
filed suit agar st the City for declaratory relief regarding
authority over pre-hospital care. Soon afterward, Courtesy
enjoined the lawsuit against the City. Once the lawsuit was filed,
the City ended all negotiations regarding double billing so as not
to affect the progress of the suit.
The suit took over a year to work its way through the judicial
system. During that time, City staff began to explore other ways
to provide emergency medical services. It became apparent that the
current operational configuration was a duplication of services and
citizens were paying higher costs because of this duplication.
Staff began to explore the costs and benefits of a municipal
transport service. The Mayor and Council directed staff to wait
until the lawsuit was actually decided before proceeding with an
implementation plan.
On March 29, 1993 , Superior Court Judge E. Michael Kaiser issued
the final judgement in County of San Bernardino et.al. vs. City of
San Bernardino, et.al. The judgment is on appeal. In essence, the
judgement provides that the City of San Bernardino retains control
over the administration of all pre-hospital emergency medical
services and the County only has authority over medical control.
In specifically addressing the issue of ambulance transport, the
judgement cited Government Code sections 38794 and 54980 which
expressly authorize cities to provide ambulance transport and cited
the Emergency Medical Services Act which does not expressly or
impliedly repeal those government code sections. The final
judgment did not specifically authorize the City to provide
emergency medical transport. However, an inference can be drawn
that the City has not been limited by the judgment.
CURRENT AMBULANCE BILLING PRACTICES
Though the final judgement has been released, the issue of double
billing of paramedic services has yet to be resolved. Citizens are
still being charged two separate paramedic charges, which can
increase an ambulance bill to $400 - $600 per incident (see below) .
Courtesy also has a rate increase that was tabled by the Council in
September, 1991, which would increase current rates by an
additional $100 - $200, raising charges to $500 - $800.
AVERAGE PARAMEDIC/AMBULANCE BILLS
Example A Courtesy Proposed
9/91 Rate Increase
Advanced Life Support (ALS) $272 . 00 $315.93
Unscheduled Emergency 81.24 85.50
Night/Weekend Charge 52 . 18 60.60
Mileage 27. 00 28. 00
Oxygen 22 . 37 50.98
TOTAL COURTESY AMBULANCE 454 . 79 541. 01
FIRE DEPARTMENT PARAMEDIC CHARGE 200. 00 200. 00
TOTAL FIELD MEDICAL CHARGES 654.79 741.00
Example B
All-Inclusive ALS $403 .75 $468.84
Night/Weekend Charge 52 . 18 60. 00
Mileage 27. 00 28. 00
Oxygen 22 . 37 50. 98
TOTAL COURTESY AMBULANCE 505. 30 608.42
FIRE DEPARTMENT PARAMEDIC CHARGE 200. 00 200. 00
TOTAL FIELD CHARGE $705.30 $808.42
Because of these still unresolved issues, the Mayor and Common
Council requested that City staff develop an implementation plan
for City operated emergency medical transport. The following is
the proposed operational plan for City-operated emergency medical
transport services. Also attached is a cost/benefit analysis of
other operational profiles, including the use of private
paramedics.
CITY OF SAN BERNARDINO FIRE DEPARTMENT
EMERGENCY MEDICAL TRANSPORT
After reviewing a number of operational modes, staff of the Fire
Department have recommended a service delivery model that increases
and upgrades the City's medical aid and fire response coverage,
uses state-of-the-art equipment, and generates enough revenue to
fully support the emergency medical response program.
CURRENT FIELD MEDICAL AID RESPONSE
Currently, when a 9-1-1 medical aid call comes in, the Fire
Department will respond with a paramedic engine or an engine
company and paramedic engine, depending upon the location of the
call. Firefighter/EMTs act as first responders to begin
stabilization of the patient. A two-person paramedic team then
takes over to further treat and stabilize the patient, under the
radio supervision of a base station hospital. Once the patient is
stabilized, he is loaded into a private ambulance and one or two
paramedics accompany the patient to the hospital and continue
treatment. Once the patient is handed off to hospital staff, the
engine company will pick up the paramedics at the hospital and
transport them back to the station. Because of this operational
mode, the engine company is out of service for the entire medical
aid call.
PROPOSED CITY EMERGENCY TRANSPORT OPERATIONAL PROFILE
The proposed plan would remove paramedics from the engine company,
place them in a separate vehicle, and backfill the two vacant
paramedic positions on the engine with one Firefighter/EMT. To
keep staff increases at a minimum, one of the Department's two
truck companies would operate as an either/or vehicle with staff
manning either an ambulance or a truck company, depending on the
type of call. A total of six ambulances would be staffed with two
paramedics, and two ambulances would be held in reserve for major
medical emergencies.
This system would increase Fire safety coverage because the
paramedic team would be able to operate independently of the engine
companies. Currently, the engine company crew is tied up for the
entire medical aid call because paramedics act as dual
Firefighter/Paramedics on the engine companies. In this profile,
the engine company will act as first responders and assist the
paramedic team in the field, but when the patient is transported by
the medic ambulance, the engine company is free to respond to other
safety response calls.
PROPOSED FIELD MEDICAL AID RESPONSE CONFIGURATION
In the proposed configuration, a typical medical aid call would be
as follows:
When a citizen needs emergency medical assistance and calls 9-1-1,
an Emergency Medical Dispatcher (EMD) answers the call at the fire
department dispatch center. All EMDs will be trained in emergency
medical dispatching, a process which includes questioning of
callers using skilled interrogation techniques and medically
approved protocols so that the relative urgency of the call can be
determined and more detailed information can be relayed to the
responding safety personnel. Based on this information, the EMD
will determine whether to dispatch a first-responder unit for a
Basic Life Support (BLS) call, such as a broken bone, or paramedic
responders for an Advanced Life Support (ALS) call, and dispatch
the nearest available engine. While safety personnel are enroute
to the emergency scene, the EMD may continue to instruct the caller
on first aid steps, CPR, or other vital actions while emergency
units are mustering and responding.
All fire engines and ladder trucks are staffed with three cross-
trained firefighter/Emergency Medical Technicians (EMTs) . The
purpose of first responders is to provide basic life support to the
emergency victim as quickly as possible. First responders will
arrive at the scene within 3-5 minutes, on average. Six stations
would serve as bases for paramedic ambulances, staffed by two
firefighter/paramedics. If the ambulance is in the district where
the emergency call originates, they will also arrive on scene
within 3-5 minutes. If they are outside the district of the call,
they will arrive on scene within six minutes. However, a first
responding team will already be treating the patient and begin
stabilization.
The fire department's ambulance system is designed primarily for
emergency transportation. Therefore, if the first responders or
paramedics confirm that the patient does not require emergency
transportation, they have the option of transporting themselves to
appropriate medical care or calling for a unit from the local
private ambulance provider. The private ambulance company also
serves as back-up in the event of a major medical emergency and all
fire department ambulances are in use.
FIRE VEHICLE NEEDS
Except for the leasing of eight ambulances (six in service, two in
reserve) , this plan would utilize all existing Fire Department
apparatus. In fact, there would be less wear on engine and truck
companies since they would not be accompanying the patient to the
hospital. Current and proposed vehicle configuration are as
follows:
VEHICLE CONFIGURATION
Vehicles Current Proposed
Paramedic Engine 5 0
EMT Engine Company 6 11
EMT Truck Company 2 2 (1-truck or ambulance)
Paramedic Ambulance 0 6
0 0
STAFFING NEEDS
The Fire Department currently has 162 field positions that are
authorized and budgeted for, however, eleven have been held vacant
and have been filled using overtime. The proposed plan would also
require 162 positions, as delineated below:
STAFFING CONFIGURATION
Field Staffing Current Proposed
Battalion Chief 6 6
Firefighter 40 42
Engineer 45 39
Captain 39 39
Paramedic 32 36
Total 162 162
Admin Staff Current Proposed
EMS Coord/Capt 0 1
Accountant 0 1
Administrative Analyst 0 1
Clerk 0 1
COST ANALYSIS
It is projected that revenues from the emergency transport service
would completely offset the cost of the operation of the entire
Emergency Medical Services program.
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