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Home My WebLink About2013/05/07 Item 04 - EOA FINAL PRESENTATION FIRST RESPONDER ADVANCED LIFE Dave Hanneman SUPPORT Fire Chief PARAMEDIC FIREFIGHTERS FIRST RESPONDER ADVANCED LIFE SUPPORT STEPS TO PROVIDING FD ALS 2005 –Consultant Report Chula Vista Fire Department ‣ Fitch & Associates, LLC 72 November 2005 “Aspartofthatexpansionandserviceimprovement initiative,theCityandthedepartmenthaveconsidered enhancingthefiredepartment’sroleinemergency medicalservices.Thisreportreviewsanumberof optionsforthedeliveryofthoseservices.Oneoption clearlysurpassesothersatthistimeforChulaVista.This optionistheimplementationofanALSEngineFirst Responseprogramcitywide” FIRST RESPONDER ADVANCED LIFE SUPPORT STEPS TO PROVIDING FD ALS 2007 –Consultant Report Chula Vista Fire Department ‣ Emergency Services Consulting/Health Analytics, June 2007 “Thecurrentdeliverysystemprovidesserviceswithinthe performancemeasuresestablishedbytheEOAcontract. Theopportunitythatexistsintermsofsystem enhancementistohavefiredepartmentresources arrivingwithinsevenminuteswherethecurrentstandard withAMRistenminutes.Byfrontloadingthedelivery systemwithparamedics,advancedassessmentandcare canbeginsooneroncriticalpatientswhichshould increasepatientsurvivability.” FIRST RESPONDER ADVANCED LIFE SUPPORT STEPS TO PROVIDING FD ALS 2009 –Internal EMS Committee directed to develop ALS ‣ Plan. Committee members made up of existing department Paramedics. •Fire Chief charged the committee to develop a comprehensive plan to move the service delivery from Basic Life Support to First Responder Advanced Life Support, to include training, materials, capital, and personnel costs. FIRST RESPONDER ADVANCED LIFE SUPPORT TOTAL $ 878,407 STEPS TO PROVIDING FD ALS 2011 –The Exclusive Operating Area (EOA) agreement ‣ with AMR was extended, Sept. 2011 •A new agreement with AMR was negotiated that extended the current agreement for three years and included several cost recoverable items. This set the stage for this amendment to include First Responder ALS. Dispatch$ 391,000 BLS Equipment and Supplies$ 54,000 Defibrillators$ 214,000 Contract Administration$ 219,407 TOTAL $ 878,407 FIRST RESPONDER ADVANCED LIFE SUPPORT TOTAL $ 878,407 STEPS TO PROVIDING FD ALS 2011 –Consultant Report Chula Vista Fire Department ‣ CitygateAssociates LLC. February 2011 Citygatewas asked to conduct a review of the ‣ proposed ALS plan and analyze the fiscal impacts. They were also asked to provide recommendations to improve the revenue to expenditure balance. FIRST RESPONDER ADVANCED LIFE SUPPORT TOTAL $ 878,407 STEPS TO PROVIDING FD ALS 2011 –2013 Public Outreach Pubic Safety Sub-Committee meetings • Chula Vista Civic Associations • Council meeting updates • Chula Vista Rotary Club • FIRST RESPONDER ADVANCED LIFE SUPPORT STEPS TO PROVIDING FD ALS 2012 –An agreement was made between the City and ‣ Local 2180 on personnel costs associated with the First Responder Advanced Life Support program. September 2012 This agreement provided for the negotiated issues involving ‣ the ALS program including personnel costs, training, and working conditions. FIRST RESPONDER ADVANCED LIFE SUPPORT TOTAL $ 878,407 STEPS TO PROVIDING FD ALS 2010-2013 –Providing a cadre of trained Paramedics ‣ for the program. 1 FF/Paramedic hired in 2010 and 9 recently in 2013. ‣ Along with 15 Paramedics that already work for department hired throughout the past decade. This group of 18 Firefighters, 4 Engineers, and 3 Captains will allow us to start implementation with 5 Engine companies providing ALS service. FIRST RESPONDER ADVANCED LIFE SUPPORT AMENDING AGREEMENT WITH AMR •This program is referred to as First Responder Advance Life Support, or “FRALS.” This item presents for City Council consideration an amended agreement with AMR that would implement the FRALS program starting July, 2013. •This amended agreement, among other things, would provide a quarterly reimbursement payment to the City for a portion of its FRALS services costs, and allow an increase in AMR’s maximum allowed rates to cover such costs. This Council action also appropriates funds for the program start up costs. FIRST RESPONDER ADVANCED LIFE SUPPORT AMENDING AGREEMENT WITH AMR 2.3PaymentAllocation.TheAnnualSupportServicesPaymentforthefirst yearofthetermhasbeenallocatedbythepartiesamongtheSupportServices providedbyCityasfollows: Dispatch$391,000 BLSEquipmentandSupplies$54,000 Defibrillators$214,000 ContractAdministration$219,407 FRALSServices$1,690,860 TOTAL $2,569,267 FIRST RESPONDER ADVANCED LIFE SUPPORT Chart 2, AMR Transport Rate AMENDING AGREEMENT WITH AMR ALS Transport Rate 10/1/2012 7/1/201310/1/20137/1/2014 CVCVCVCV Description AMR Base Rate $921.17$921.17$985.65$985.65 First Responder -577.75577.75618.19 Monitor Lease 118.58118.58118.58118.58 Dispatch Fees 246.84246.84246.84246.84 BLS Equipment Costs 34.0934.0934.0934.09 City Contract Admin 138.51138.51138.51138.51 $2,141.8 Total Base Amount $1,459.19$2,036.94$2,101.426 FIRST RESPONDER ADVANCED LIFE SUPPORT Chart 3, Comparison Rates in County Chart 3, Comparison Rates in County Chart 3, Comparison Rates in CountyChart 3, Comparison Rates in County AMENDING AGREEMENT WITH AMR San Diego County Rates with AMR $2283.24 Lemon Grove San Miguel FPD /Cal Fire$2107.95 $2036.94 Chula Vista Alpine$1964.57 $1844.20 La Mesa $1828.16 National City Imperial Beach$1792.56 $1167.26 Bonita FIRST RESPONDER ADVANCED LIFE SUPPORT Current Year Start-Up Costs Appropriations FY 12-13 EMS Staff$38,312.00 ALS Study$167,000.00 Cont. Educ./ Recert. Fees$115,820.00 Paramedic Training Program$48,365.00 ALS Equipment$255,556.40 Simulators and Manikins$13,082.63 Equipment Replacement$281,721.65 Vehicle Acquisition$72,000.00 Vehicle Maintenance$3,420.00 Total$713,556.03 FIRST RESPONDER ADVANCED LIFE SUPPORT TOTAL $ 878,407 FINAL FISCAL ANALYSIS 2013 –Consultant Report Chula Vista Fire Department ‣ Citygate Associates LLC. March 2013 •Provide a review of the City’s methodology applied in calculating City costs to provide FRALS services to AMR, •Determine whether the proposed reimbursement that the City would receive for providing FRALS under the pending contract with AMR is equal to or less than the costs the City is incurring in providing FRALS. FIRST RESPONDER ADVANCED LIFE SUPPORT TOTAL $ 878,407 FINAL FISCAL ANALYSIS 2013 –Consultant Report Chula Vista Fire Department • Citygate Associates LLC. March 2013 continued Determine if the amount paid to the City for FRALS and • the rates charged to customers for FRALS are “fair market rates” within similar San Diego County Exclusive Operating Areas (EOAs). When conducting the fair market analysis, determine if the • rates charged are for comparable services provided within similar San Diego County EOAs. FIRST RESPONDER ADVANCED LIFE SUPPORT LEGAL ANALYSIS Application of Proposition 26 – Application of Federal Anti Kick-Back Statutes – Required CVMC Section 5.10.340 – Waiver Regarding “Prevailing Rates” – Key Contract/Risk Management Provisions – FIRST RESPONDER ADVANCED LIFE SUPPORT TOTAL $ 878,407 FIRST YEAR IMPLEMENTATION ALS/BLS Response Areas 6 8 4 1 2 7 9 3 5 4 BLS Units (E51, E52, E54, USAR53) 5 ALS Units (E55, E56, E57, E58, E59) FIRST RESPONDER ADVANCED LIFE SUPPORT TOTAL $ 878,407 IMPLEMENTATION PHASE 1 FIRST RESPONDER ADVANCED LIFE SUPPORT TOTAL $ 878,407 IMPLEMENTATION PHASE 2 FIRST RESPONDER ADVANCED LIFE SUPPORT TOTAL $ 878,407 IMPLEMENTATION PHASE 3 FIRST RESPONDER ADVANCED LIFE SUPPORT TOTAL $ 878,407 IMPLEMENTATION PHASE 4 FIRST RESPONDER ADVANCED LIFE SUPPORT ALS (PARAMEDIC) BLS (EMT) Training 1500 hrs Training 150 hrs •Interpret 12-lead EKGs. •Provide basic life support. •Administer an extensive list of •Administer oxygen Meds •CPR including •Endotracheal Intubations, needle decompression •AED •Synchronized cardioversion, •Spinal immobilization, splinting. defibrillation, and transcutaneous pacing. •Vital signs •IVs, IOs FIRST RESPONDER ADVANCED LIFE SUPPORT Allergic Reaction / Anaphylaxis BLS (EMT)ALS (PARAMEDIC) EKG CAB’s IV Oxygen Epinephrine IM Vital Signs Saline fluid bolus Benadryl IM/IV Albuterol HHN Dopamine IV drip FIRST RESPONDER ADVANCED LIFE SUPPORT STROKE, SEIZURE, DIABETIC BLS (EMT)ALS (PARAMEDIC) EKG CAB’s IV C-Spine Glucometer Oxygen *Narcan Vital Signs DW 50 *Glucagon *Versed FIRST RESPONDER ADVANCED LIFE SUPPORT Chest Pain (Cardiac) BLS (EMT)ALS (PARAMEDIC) EKG (12 lead) CAB’s IV Oxygen ASA Vital Signs NTG Morphine *Fluid bolus *Dopamine FIRST RESPONDER ADVANCED LIFE SUPPORT Cardiac Arrest ALS (PARAMEDIC BLS (EMT) ) EKG / Defibrillate CAB’s IV / IO Oxygen Fluid bolus Vital Signs Epinephrine AED *Amiodarone *Atropine *Adenosine ET Intubation EtCOmonitoring 2 FIRST RESPONDER ADVANCED LIFE SUPPORT Difficulty Breathing BLS (EMT) ALS (PARAMEDIC ) CAB’s EKG Oxygen EtCO 2 Vital Signs IV *ET Intubation *NTG CPAP Albuterol Atrovent Epinephrine FIRST RESPONDER ADVANCED LIFE SUPPORT TRAUMA ALS (PARAMEDIC) BLS (EMT) IV / IO CAB’s Fluid bolus Oxygen EtCO Vital Signs 2 *Calcium Chloride C-Spine *Sodium Bicarb Splinting *Needle Thoracostomy *Tourniquet EKG *Morphine FIRST RESPONDER ADVANCED LIFE SUPPORT CONCLUSION •Two studies conducted on enhancing EMS services in Chula Vista •Agreements completed with AMR and Local 2180 •First Responder Advanced Life Support program developed •Paramedics hired •Two fiscal impact studies conducted. •All reports conclude providing First Responder Advanced Life Support is the best option for Chula Vista •Staff recommends approval of the resolution. FIRST RESPONDER ADVANCED LIFE SUPPORT Questions? FIRST RESPONDER ADVANCED LIFE SUPPORT | DAVE HANNEMAN, FIRE CHIEF