HomeMy WebLinkAboutItem 4 - Additional Information
March 23, 2021
To: Honorable Mayor and City Councilmembers
Via: Maria V. Kachadoorian, City Manager
From: Harry Muns, Fire Chief
Subject: Fire Department Based Ambulance Transport System (ATS) Overview & Update
This is an update on the transition of the City’s Fire Department Based Ambulance Transport
System (ATS). To date, all critical and major portions of the system are on track for an on-time
start for Friday, April 9, 2021 at 7:30 a.m.
The goal of the City’s ATS is to effectively provide the highest level of service to the residents of
Chula Vista. The system described below has been developed to accomplish this goal. As with
any new system, we will be closely monitoring the performance and make necessary modifications
as we move forward.
Contracts and Lease
On October 3, 2020, the City noticed American Medical Response (AMR) of our intent to
terminate the South Bay Exclusive Operating Area (EOA). This notice detailed the City’s intent
to exercise its right to terminate the contract for convenience on April 9, 2021 at 7:29 a.m. Fire
Station 6 (605 Mt. Miguel Rd) which currently houses an AMR ambulance via a lease agreement
has also been terminated.
The notice also terminated our EOA with the
Bonita Fire Protection District and the Imperial
Beach Fire Department effective April 9, 2021
at 7:29 a.m. Due to our proximity to Imperial
Beach and Bonita and our nearly 40-year
history the City entered into a new contract to
maintain operational service delivery. We
believe this is a win-win situation for all three
jurisdictions. We anticipate that both Bonita
and Imperial Beach will see an increase in
service delivery due to our commitment to
maintain an ambulance in their jurisdiction
even when they have back-to-back calls for service. This arrangement is also a benefit to the City
of Chula Vista by increasing the in-service number of ambulances, which allows for system
resiliency during high call volume times.
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Ambulance Transport Launch
On April 9, 2021 at 7:30 a.m. Fire Department Based Ambulance Transport System (ATS)will
begin with the deployment of ten ambulances. Eight will be stationed within the City of Chula
Vista, one in Imperial Beach and one in Bonita.
Six of the eight ambulances will be placed into service 24 hours a day, 365 days per year. The
remaining two ambulances will be placed into service 12 hours a day (9 a.m. to 9 p.m.), 365 days
per year. Each ambulance will be staffed with one Paramedic (PM) and one Emergency Medical
Technician (EMT).
Direct supervision will be provided by station Fire Captains for both administrative and operational
work assignments. Overall responsibility of the ambulance crews is assigned to the EMS Battalion
Chiefs. There will be an EMS Battalion Chief (EMS1) assigned to work 24-hour shifts that will
be stationed at Fire Station 5 on April 9, 2021 for the initiation of the system. EMS1 will move to
the new fire station located at 100 Moss St. upon its completion in May/June 2021.
Additional Information
The Fire Department has conducted various public meetings on the transport program. The
department engaged in providing information to stakeholder and Council along with receiving
feedback, direction, and authority in the past 15 months:
• January 28, 2020 City Council meeting - Action Item
• May 6, 2020 Public Workshop
• May 12, 2020 City Council meeting - Action Item
• June 11, 2020 Measure A Citizens Oversight Committee - Presentation
• June 23, 2020 City Council meeting - Action Item
We recognize that there is some communication/misinformation in the community regarding the
new Chula Vista transport program. Following are key facts that are important to keep in mind:
• Chula Vista’s emergency medical services system consists of two major parts:
1. First Responders: Fire Department first responders usually arrive on the scene
first and initiate medical care, stabilize the patient, and prepare them for transport.
2. Ambulance Transport System: Once an ambulance arrives on scene, the
Paramedic and EMT assume patient care and transport to the appropriate hospital.
Transferring care from first responders to ATS This allows the first responders to become
available for the next response. With the City’s ever-increasing call volume, this system
provides the most resilient and cost-effective service delivery. Additionally, this is an
industry best practice utilized in similar size and type communities.
• With the implementation of Chula Vista’s emergency medical services, patients will have
an uninterrupted continuum of care from the first arriving personnel until the patient is
delivered safely at the hospital. Patient care is further enhanced by having all medical
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personnel guided under the same Medical Director, receiving consistent training, and using
the same medical equipment.
• An important benefit is that 911 emergency medical calls resulting in a response will have
a total cost that combines the first responder and ambulance transport costs. It is important
to note that these two parts are what make the City’s emergency medical services system.
The Chula Vista Fire Based Ambulance Transport System is the funding mechanism for
the City’s emergency medical services system. The base transport rate was approved at
$2,800 which is lower than the current rate the patient is charged. Staff will return to the
City Council after 18 months in service to review and reassess the transport base rate and
medical transport ancillary fees.
• Another advantage of the Fire Department based ATS, is that being a public provider
allows access to federal reimbursement programs. Specifically, this system is focused on
IGT (Intergovernmental Transfer) program that will be implemented June/July 2021;
however, funding to our ATS will become available in January 2022. The Fiscal Year 2022
budget and future forecasts already take into account that the IGT funds will be received
in January 2022 versus June 2021. Due to conservative projections, we do not expect a
funding gap in the ATS program. Legislatively known as AB 1705, this bill creates a
sustainable reimbursement program to ensure local government fire agencies recover from
the federal government the actual cost of service when providing medical transport to
Medi-Cal beneficiaries. It is intended to recover both first responder (Fire Engine &
Personnel) and transport costs.
• The Chula Vista Fire Department ATS is based on historical calls for service. After
reviewing eight years of data, a trend for increasing volume and concurrent calls was
established. The number of ambulances (10 in our ATS plan) in service is right sized for
these trends and have been validated by third party subject matter experts. The current
contractor provides six ambulances continuously and peak demand 12-hour units to service
our area, and then supplements with mutual aid from other contracted areas. The ATS plan
provides more ambulances and more coverage.
Ambulance Locations
Ambulances will be housed in eight of the ten Chula Vista fire stations, one in the Bonita fire
station, and one in the Imperial Beach fire station.
City of Chula Vista:
• Fire Station 1-CVM51 (Medic 51)
• Fire Station 2-CVM52 (Medic 52-12-Hour Ambulance)
• Fire Station 3-CVM53 (Medic 53)
• Fire Station 4-CVM54 (Medic 54- 12-Hour Ambulance)
• Fire Station 5-CVM55 (Medic 55), CVM62 (Medic 62- Reserve Ambulance)
• Fire Station 6-CVM56 (Medic 56)
• Fire Station 7-CVM57 (Medic 57)
• Fire Station 10-CVM60 (Medic 60), CVM63 (Medic 63- Reserve Ambulance)
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• Public Works/Fire Warehouse-CVM64 (Medic 64- Reserve Ambulance)
City of Imperial Beach
• IB Fire Station 39-CVM39 (Medic 39)
Bonita Fire.
• Bonita Fire Station 38-CVM38 (Medic 38)
System Design/Size/Mutual Aid
Currently, the system transports approximately 50 patient transports per day. Each 24-hour
ambulance has the capacity to transport approximately 8 patients per day while the 12-hour
ambulances have approximately half that capacity. With eight, 24-hour and two, 12-hour
ambulances in-service daily, we have a system capacity of 72 patient transport per day. The extra
22-patient transport capacity is built in to accommodate concurrent calls for service. Peak call
volume within the system has been between 9 a.m. to 9 p.m. Concurrent calls for service are
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expected to occur and supports two 12-hour ambulances are placed in service during this time.
The system has an average peak volume of six concurrent calls for service at any given time. Ten
ambulances in service each day will leave three units available for additional calls for service. An
average of six concurrent calls means that there are days were there are more than six calls per
day. When this number of calls exceeds 10, our system will rely on mutual aid. This is a common
practice with all systems and is a requirement by the County of San Diego EMS authority.
We currently have a signed agreement with Mercy Ambulance that provides service to the east of
the City and at the detention facilities in Otay Mesa. We are in discussions with Coronado Fire
Department to establish an agreement that would support our partner City of Imperial Beach. We
have reached out to AMR to discuss entering into a mutual aid agreement in order to share
resources with National City and the City of San Diego. We have submitted a written request but
have not received a response in writing. We have received indications verbally that AMR is not
interested in participating with us in a mutual aid agreement. We have also reached out to Falck
Ambulance to discuss establishing a mutual aid agreement. Falck has been awarded the City of
San Diego Ambulance contract from the recent RFP process. San Diego has not transitioned from
AMR to Falck as of this update, but it is expected to occur in a few months. Informally, Falck has
expressed interest in developing a mutual aid agreement which will add to the overall capacity in
the South Bay.
We recognize that call volume
has been increasing and we are
focused on the potential impacts
to the system. We are prepared to
respond accordingly by analyzing
system performance. As call
volume continues to increase and
leads to additional concurrent
calls, we will adjust by adding
additional units into service at
identified trigger points. We
have the capacity to add three
more ambulances into service
should the need arise within 24
hours. This need would most
likely be driven by concurrent
calls for service and we would
therefore lean toward placing additional ambulances into service on 12-hour shifts during our peak
volume time. This would add an additional 12 patient transports, expanding our overall capacity
to 84 transports per day.
With assistance from Human Resources and Finance, we are poised to hire staff and order
equipment rapidly to satisfy long-term growth. This is done by maintaining eligibility lists with
qualified PM and EMT candidates and ensuring purchasing contracts are in place to order
ambulances and equipment.
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ATS Staffing
Staffing for this system includes the addition of 54
new positions in the Fire Department and one in
Human Resources. The positions added to the Fire
Department include 24 PM and 24 EMT positions.
The PM positions started on March 12, 2021. This
marked the beginning of a four week on-boarding
process where they will be introduced to the City
of Chula Vista by Human Resources, oriented to
Fire Department operations, and then evaluated in
the field on calls for service prior to the system
start date of April 9, 2021. The EMT positions will
undergo the same orientations and evaluations
beginning March 26, 2021 for two weeks.
A Senior Management Analyst was added to the Fire Department to perform and manage payroll,
budget analysis/management, system billing management, assist with RFP development, and EMS
related contract oversight.
Three EMS Battalion Chiefs were promoted and assigned to the ATS in December of 2020 to
finalize the details of system development. The areas of focus included staff on -boarding/initial
training/orientation, technology acquisition/functionality, and equipment
acquisition/assembly/supply chains.
A Delivery Driver was added to
support the existing Fire
Department warehouse and
inventory supply specialist
position. Finally, an EMS
educator position will be filled
once the recruitment is initiated
and completed in April/May
2021. This position will focus on
quality improvement and clinical
education for all PM and EMT
positions.
A Human Resources Analyst
was added to Human Resources
Department to accommodate the
initial and ongoing impacts of hiring and maintaining the ATS Paramedics (PM) and Emergency
Medical Technicians (EMT). This position was approved in July 2020 and has been busy with the
various recruitment and onboarding efforts.
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Dispatch and Technology
Currently, when a 911 emergency medical call for service is received by San Diego Fire-Rescue
Department’s Emergency Communication & Data Center, which is our current fire dispatch
contracted service, their computer aided dispatch system (CAD) auto dispatches the closest fire
department resource according to GPS location. This is referred to as auto-dispatching and takes
less than 60 seconds on average. The call for service must then be transferred to AMR’s dispatch
center where an ambulance unit is manually selected and dispatched by AMR to the same call for
service. This results in a two-step dispatch process.
When the Chula Vista Fire Department ATS goes live, the initial 911 call will continue to be
received by San Diego’s Fire-Rescue Department’s Emergency Communication & Data Center
and our ambulance units will now be auto dispatched. This is the same way that our current fire
units and resources are dispatched (closets unit according to GPS location). This streamlines the
ambulance dispatching process by adding them to auto-dispatching system. It eliminates
transferring the call to a separate ambulance dispatch center as required under the current contract
with AMR. This is a more simplified approach and reduces call processing time, resulting in
shorter response times.
The City is also using a CAD drawdown module to automate the recognition of coverage gaps as
concurrent calls for service take place. This module automatically notifies EMS1 when a certain
number of ATS ambulances are unavailable. This notification from CAD, coupled with a third-
party resource management application called Intterra will allow EMS1 to make real-time
adjustments with available ambulances. Intterra provides a live map of ambulance locations in the
service area. It identifies if there is a gap in coverage and the EMS1 can respond by moving the
most appropriate ambulance to maximize response times. Below is an example of what Intterra
provides EMS1 and all other Chula Vista Fire Department Chief Officers allowing them to
recognize coverage gaps and adjust as necessary.
Intterra Coverage Mapping
Intterra provides the Fire Department ATS with information regarding where coverage gaps may exist at any point in
time. The system provides live information and will be used to move ambulances various locations to ensure adequate
coverage.
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EMS Supply Warehouse
In order to support this system, additional warehouse space was necessary to centralize all Fire
Department logistical needs. For several decades, supplies have been received and distributed
from Fire Station 2 located at 80 East J Street. With the addition of new or expanded fire stations
coupled with the addition of the Ambulance Transport System, additional space was sought out at
the Public Works Yard at 1800 Maxwell Road. Working with the Department of Public Works,
we were able to double our current storage capacity. This new storage location is approximately
50 percent set up and will support current Fire Department operations and is expected to be at full
capacity by April 1, 2021 prior to the Transport System going live.
Ambulances & Durable Medical Equipment
All 13 ambulances have been ordered and received from Medix Ambulance located in Elkhart, IN.
Seven of those are fully outfitted with gurney systems, cardiac monitors, and communications
(radios and tablets) equipment. Two notable functions of these ambulances that will limit injuries
are the power load gurneys and oxygen tank lift mechanisms. Both systems will handle all the
daily heavy lifting of patients and the large main supply oxygen tanks into the ambulances.
Billing
Transports within the service area (Chula Vista, Bonita, and Imperial Beach) will be billed by
Wittman Enterprises. Wittman participated in an RFP process and was awarded a four-year
contract. Per the contract, they earn 3.25% of all net collections. Fire Administration and staff in
the Finance Department have been working diligently with Wittman to ensure all systems are
properly set up across several platforms. We are currently on track to have all billing systems set
up prior to the April 9th launch date.
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Conclusion
The Fire Department is looking forward to providing increased and improved ambulance transport
services to the community. I would like to thank the City Council for their support in bringing the
transport program into the City of Chula Vista. I would also like to thank the Fire Department
staff, City Manager’s Office, City Attorney’s Office, Human Resources and Finance Departments
who have put in a tremendous amount of work over the past few years. Without their support, we
would not have been able to transition so quickly and efficiently.
The Fire Department website has a dedicated section to ATS, where a brief overview can be found
along with supporting documentation such as the independent report prepared by AP Triton. As
we begin our transition, the Fire Department will be providing periodic updates to the City Council
and to the community. The Fire Department will also be compiling monthly data and statistics
that will be available on the website. If you have any questions, please contact me at 619-409-
5836.
Item 4 - Additional Information - 3/23/2021