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HomeMy WebLinkAboutMINUTES - 08021988 - I.O.12 BOARD OF SUPERVISORS I . 0. 12 FROM: C lta INTERNAL OPERATIONS COMMITTEE CWIa DATE: July 25, 1988 C J* SUBJECT: Contracts with Many Hands, Inc. and Contra Costa Community Recycling Center SPECIFIC REQUEST(S) OR RECOMMENDATIONS) & BACKGROUND AND JUSTIFICATION RECOMMENDATIONS: 1 . Authorize the Director of Community Development to negotiate a contract with Many Hands, Inc. for the period July 1, 1988 through December 31, 1988 in the amount of $2500 to operate the recycling center in Pacheco, said contract to be returned to the Board of Supervisors for approval. 2 . Authorize the Director of Community Development to negotiate a contract with Contra Costa Community Recycling Center for the period July 1, 1988 through December 31, 1988 in the amount of $2500 to design and implement a recycling awareness and promotion program similar to that outlined in their letter to the Board dated July 21, 1988, said contract to be returned to the Board of Supervisors for approval. 3 . Urge Many Hands, Inc. and the Contra Costa Community Recycling Center to submit a joint proposal to the Delta Diablo Sanitation District and Central Contra Costa Sanitary District to continue the operation of the recycling center and the recycling awareness and promotion program after December 31, 1988, and advise the Board of Supervisors by December 1, 1988 of the status of their proposal and request for funds. BACKGROUND: As a part of our Committee' s review of recycling programs, we have met with representatives from the Contra Costa Community Recycling Center and Many Hands, Inc. The Contra Costa Community Recycling Center is interested in re-focusing their attention from the direct operation of a recycling center to a more broadly based recycling awareness and promotion program. The Contra Costa Community Recycling Center has outlined in a letter to the Board a budget of $5000 a year to operate this program which will be more along the line of a public education and advocacy program. At the same time, Many Hands, Inc. has indicated to our Committee their willingness to take over the direct operation of the recycling center in Pacheco. CONTINUED ON ATTACHMENT: _ YES SIGNATURE: RECOMMENDATION OF COUNTY ADMINISTRATOR X RECOMMENDATION OF BOARD COMMITTEE X APPRO OTHER unne W. �ak Tom Torlakson SIGNATUREIS1: I1 pp ACTION OF BOARD ON August 2, 1900 APPROVED AS RECOMMENDED X OTHER VOTE OF SUPERVISORS 1 HEREBY CERTIFY THAT THIS IS A TRUE X UNANIMOUS (ABSENT II AND CORRECT COPY OF AN ACTION TAKEN AYES: NOES: AND ENTERED ON THE MINUTES OF THE BOARD ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN. cc: Listed on Page 2 ATTESTED t-= =A �C.s.Cr d�� /9,?o PHIL BA HELOR, CLERK OF THE BOARD OF SUPERVISORS AND COUNTY ADMINISTRATOR M382/1-83 BY ,DEPUTY Page 2 The County currently funds the Community Recycling Center at a level of $6, 900 ( includes $.5000 for an operational subsidy and $1,900 for utilities and equipment) per year. Both the Contra Costa Community Recycling . Center and Many Hands, Inc. need the $5000 a .year. appropriation made by the County in order to carry out the programs they have recommended. Rather than requesting additional funds from the Board, our Committee is recommending. that the existing $5000 appropriation' be split between the two organizations to maintain their respective programs for the first half of the 1988-89 fiscal year. We have further suggested to both organizations, when we met with them on July 25, 1988, that they jointly approach Delta Diablo Sanitation District and Central . Contra Costa Sanitary District with a request for funds to continue these programs for the last half of the 1988-89 fiscal year. Both organizations indicated agreement with the above recommendations and we, therefore, recommend them for the Board' s consideration. • cc: County Administrator Director, Community Development County Counsel Marilyn McKinney, President, . CC Community. Recycling Center Norton Ryne, Exec. Dir'. , Many Hands, Inca General Managers: Delta Diablo Sanitation and Central Sanitary' Districts Chair, Solid Waste Commission TO BOARD OF SUPERVISORS Finance Committee c trd July 2b, 1988 Coos C DATE; V "1 SUBJECT; • PARAMEDIC AMBULANCE SERVICES SPECIFIC REQUEST(S) OR RECOMMENDATION(S) & BACKGROUND AND JUSTIFICATION RECOMMENDATIONS: 1. Refer the proposal of Regional Ambulance for a change in their staffing complement and hours for their ambulances to the Health Services Department for further review and report back to the Finance Committee. 2. Consider placing on the November ballot an advisory measure asking the voters whether they would be willing to accept a parcel tax to enhance emergency medical services in the County. FINANCIAL IMPACT: Regional Ambulance's proposal would cost an additional $200,000 per year. In addition, there are other impacts to other health care providers, such as base station hospitals, which need to be evaluated. A funding source has not been formally '. identified, but a parcel tax might be one alternative. BACKGROUND: Earlier this year, the Board referred the issue of ambulance protection and services to the Finance Committee. Concern had been expressed about the timeliness of response and the level of training of respondents in several publicized cases in West County. Regional Medical Systems has proposed to the Finance Committee that the present system, under which two paramedics are available in some areas for advance life support 'services, and two EMT's are available for basic life support services, be changed so that one paramedic and one EMT be in each ambulance, and that the hours be varied to increase availability during peak workload hours. The Health Services Department has asked for additional time to review the proposal and view it from not only an organizational point of view but from a medical point of view. The Finance Committee agrees that the department should be given more time to look at this proposal. The issue of emergency medical care has long been in the headlines. It is the Finance Committee's feeling that a parcel tax of, for instance a maximum of $10 per parcel, might be acceptable to the voters of the County. Such a tax could raise millions of dollars which could be used to enhance emergency medical services. For that reason, we recommend that the Board consider putting an advisory measure on the November ballot, asking the voters if they would be willing to have the Board enact such a parcel tax. A copy of proposed ballot language is attached to this Committee report. CONTINUED ON ATTACHMENT; _ YES SIGNATURE: RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF _ ARS,, OMMITTEE I _ APP-ELOYE �jO�T�H�ER��� SIGNATURE s : upervisor Nancy Fanden S Jervis r Tom powers ACTION OF BOARD ON Augiis t 2 ., 1988 APPROVED AS RECOMMENDED OTHER X REFERRED Regional Ambulance proposal to the Health Services Director for review and report; and DECLARED intent to place on the November ballot an advisory measure relative to a parcel tax to fund enhanced emergency medical services and REQUESTED Health Services Director to provide further information on allocation of revenues received and budget of proposed emergency care system improvements. VOTE OF SUPERVISORS 1 HEREBY CERTIFY THAT THIS IS A TRUE X UNANIMOUS (ABSENT �' ) AND CORRECT COPY OF AN ACTION TAKEN AYES: NOES. `� AND ENTERED ON THE MINUTES OF THE BOARD ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN. CC: Health Services Director ATTESTED .(, m{ 9 O' County Administrator County Counsel PHIL B CHELOR, CLERK OF THE BOARD OF SUPERVISORS AND COUNTY ADMINISTRATOR Elections .Supervisor BY 'DEPUTY M382/1-83 OFFICE OF COUNTY ADMINISTRATOR CONTRA COSTA COUNTY Administration Building Finance Committee Martinez, California To: Supervisor Nancy Fanden Date: July 19 , 1988 Supervisor Tom Powers Kerry Harms-Taylor, Assistan' t PARAMEDIC AMBULANCE PROPOSAL From: County Administrator - Finance Subject RECOMMENDATION• As recommended by Health Services Department staff, refer the proposal for additional paramedic support to the Health Services Department for further review and report back to the Committee. FINANCIAL IMPACT: If Regional Ambulance' s paramedic enhancement proposal is accepted, additional annual costs would be $200,000. Two other alternatives are outlined which would range in cost from $378,060 to $601,817. BACKGROUND: Earlier this year, the Board referred the issue of ambulance protection and services to the Finance Committee. Concern had been expressed about the timelines of response and the level of training of respondents in several publicized cases in West County. Regional Medical Systems asked the Finance Committee for time to develop alternatives to their current operating system. That report is attached for your review. The Health Services Department has asked for additional time to review the proposal and develop recommendations. , The Administrative Office supports this request. It should be noted that the Administrative Office has concern about all of the alternatives as they now stand because they would all require County dollars which are not available. If the- Finance Committee recommends any of the proposals, either an additional funding source will need to be identified, or another program reduced to pay for the additional ambulance services. Additionally, it is an undesirable precedent for the County to begin subsidizing a service which it has not subsidized in the past, especially without an ' identified new funding source. These factors should be. considered in any recommendations the Finance Committee develops. KH-T:gm Enclosure �;� - -E Health Services Department OFFICE OF THE DIRECTOR EMERGENCY MEDICAL SERVICES 50 GLACIER DRIVE - ,�� Martinez, CA 94553 (415)646-4690 Coun To: Kerry Harms Date: July 15, 1988 County Administrators Office From: Ar , L r , EMS Director Subject. Regional Medical Systems Paramedic Ambulance Proposal Attached is a proposal from Regional Medical Systems to the Board of Supervisors ' Finance Committee recommending an approach to increasing paramedic coverage by changing existing paramedic ambulance staffing requirements. Specifically, the Regional Proposal recommends: (1) That the County EMS Agency review proposed staffing changes ; (2) That the Board appropriate $200,000 to subsidize Regional ' s costs of implementing their proposed system; (3) That Regional' s existing contract be extended for two years beyond the April 30 , 1989 termination date; and (4) That a timetable be adopted to begin implementation of the proposal within six months. RECOMMENDATION EMS staff have been working with Regional on this proposal and have scheduled a presentation by Regional to Health Services Department staff on July 22nd. We recommend that the Finance Committee refer this matter to the Health Services Department for review and report back to the Finance Committee by August 8 , 1988. Attachment cc: Mark Finucane William B. Walker, M.D. Dan Bergman AL:pb i . REGIONAL MEDICAL SYSTEMS CORPORATE OFFICE: • 41300 CHRISTY STREET• P.O.BOX 7780 • FREMONT,CALIFORNIA 94537-7780 • [415)657-9999 • [415[676-7979 I I 1 July 13 , 1988 , j To: The Honorable Nancy J. Fanden & Tom Powers, Finance Committee, Contra Costa County Board of Supervisors From: Earl Riggs, President, Regional Ambulance, Inc. i SUBJECT: ADDITIONAL PARAMEDIC AMBULANCES FOR CONTRA COSTA COUNTY I I The Committee has requested input relative to the cost of i adding two additional paramedic units to West Contra Costa County. The following information is submitted for discussion 1 and review. i OVERVIEW ALTERNATIVE 1. At an annual cost of $601, 817 two (2) additional Advanced Life Support (ALS) paramedic ambulances can be placed into service-24 hours per day, 7 days per week. At the Board's direction, these units may either be primarily based, or specifically based in the western end of the County. ALTERNATIVE 2 . At an annual cost of $378, 060 three (3) ALS units, 10 hours per day - 5 days per week each, can be placed into service at strategic locations in the western portion of the County. ALTERNATIVE 3 . With the existing resources in the County EVERY ambulance in the County could be turned into a paramedic ambulance by changing our staffing patterns to one paramedic and one emergency medical technician (EMT) instead of 2 paramedics. Increased operational and equipment costs would amount to $200, 000 per year. RECOMMENDATION ALTERNATIVE 3 offers the best response times and level of service to ALL the citizens of the County. It also offers the lowest cost alternative. Currently more than one out of every seven patients in a potentially life threatening situation go without paramedic services. At the same time, responding units from a maximum of 10 locations in the County, as opposed to the proposed 20+ locations, unnecessarily lengthens response times. a division of REGIONAL AMBULANCE, INC. PARAMEDIC & NON-EMERGENCY AMBULANCE SERVICE • CHAIR-A-VAN • MEDICAL EQUIPMENT/SUPPLIES Finance Committee July 13, 1988 Contra Costa County Board of Supervisors Page 2 The change in the staffing will have no measurable deteriorating effect on medical performance. The "on-scene consultation" of complex cases would be shifted from the paramedic partner to the ALS Base Hospital Nurses (MICN's) and . Physicians who appropriately direct the paramedics' activities. An overwhelming benefit of the split-team approach to ambulance services is that all patients in the community receive access to Advanced Life Support intervention early on in the field setting where it is most appropriately administered. Therefore, it is our recommendation that the Committee recommend to the Board of Supervisors: 1. That the EMS Office develop recommendations on the medical and operational efficacy, complete with pros and cons, of changing the EMS system to one of total Advanced Life Support ambulances using the recommended staffing patterns. 2 . That the Board appropriate $200, 000 to be applied totally to these system enhancements. 3 . That the current contract with Regional Ambulance be extended for two years to allow for the necessary planning and implementation of the system. 4. That a timetable for approval and implementation be developed which would, barring unforeseen obstacles, facilitate the transition to begin within 6 months. These recommendations can only move forward when there is clear consensus between the County, the medical community, the Emergency Medical Care Committee, and the provider and field personnel. Thus, all of these groups and interests must be contacted to insure that all issues and concerns are met. Your Committee might even desire that monthly status reports be submitted by either ourselves or the EMS office on current developments in the implementation. DISCUSSION ALTERNATIVE 1. Two (2) additional 24 hour paramedic units could be placed into service in the West County area at an annual cost of $601,817. The positioning of the units could take on several different approaches. The units could be based in E1 Cerrito and Rodeo, thereby offering better response times and paramedic coverage to the low call volume areas such as Kensington, Crockett, Port Costa, and Rodeo. They could then be moved to the busier areas Finance Committee July 13, 1988 ' Contra Costa County Board of Supervisors Page 3 when paramedic resources are depleted in Pinole, San Pablo, and Richmond, thereby improving both ALS coverage and response times to some degree. The alternative would be to infuse one or two of the additional units into the higher call volume areas, such as Richmond and San Pablo, reducing the overall response times more dramatically in those areas, which would have a greater overall impact on response times. While this would not improve response times to Kensington and Crocket overall (it currently takes a minimum of 10 minutes to Kensington and 8 minutes to Crockett) , it would improve the ALS response capability because ALS resources would not be pulled into those heavy call volume areas as often. ALTERNATIVE 2. "Peak Load" staffing is a better, more cost effective approach, to provide ambulance services than simply placing more 24 hour units in service at fixed locations. By working units 10 hours per day, five days per week, they can be placed in locations where calls are anticipated to occur, rather than some fixed base. For instance, certain calls tend to occur around the freeways a Spm while other types of calls occur in neighborhoods a Bpm. If you base the units for the former you will have longer response times for the latter. Therefore, by adding additional equipment commensurate with demand patterns, much like the police departments, we achieve better coverage for the resources available. This is accomplished by basing the unit in a freeway access location at peak traffic periods, and near neighborhoods in the busy evening hours. Three. such units can be added to the West County system for $378, 060 per year. ALTERNATIVE 3 . Currently over 1 out of 7 patients (14% to 20%) in Contra Costa County go without ALS care on potential life threatening emergencies. The numbers break down as follows: West County - 22% * Central County - 8% * East County - 11% * * May Figures Also, approximately 236 patients each month do not receive a paramedic response because they are not perceived to be in a potentially life-threatening situation. While this latter category are not "life-threatening", many of them would benefit from ALS level care, including being stabilized for transport to a hospital of their choice, often avoiding subsequent transfers. Finance Committee July 13, 1988 Contra Costa County Board of Supervisors Page 4 We propose that ALS be provided to every patient in Contra Costa County at an annual cost to the County of $200, 000. This would be accomplished by converting our current fleet of over 20 ambulances into ALS units and staffing units in relation to the demand patterns of both emergency and non-emergency services. The units would be staffed with .one paramedic on each ambulance instead of 2 paramedics on some of the ambulances, as is currently the case. We now staff 10 paramedic units and 8 Basic Life Support (BLS or EMT) ' units 24 hours per day, 7 days per week; and 8 BLS units 10 hours per day 5 days per week. We operate, effectively, 2 separate services with the ALS units primarily responding to emergency calls for service and the BLS units primarily responding to non-emergency calls for service. The BLS non-emergency services heavily subsidize the ALS emergency services. In addition, the BLS services "back-up" or support the ALS services by: a. Responding to non-life-threatening medical emergencies (Code 2 urgent requests) . These are mainly psychiatric patients, but often are more medical in nature. Many of these patient would benefit from ALS intervention in the field, particularly drug overdoses and diabetic cases that begin as non-critical or are misdiagnosed by the dispatchers. A small percentage of these patients become critical and receive a Code 3 transport to the hospital b. Responding to life-threatening medical emergencies (Code 3) when ALS units are not in position to respond. c. BLS units are being asked to transport patients with an increasingly unstable medical condition between medical care facilities. The shortage of paramedic units and the lack of supporting nursing staff, coupled with the nature of sub-acute care in-"today's medical care, causes these patients more and more often to be diverted; or not be moved at all to more appropriate care because of, transportation limitations. Also, paramedics are better trained to monitor patients over long distances, often-times allowing patients to be admitted closer to family, physician, and loved ones. During our presentation to the Committee we will be demonstrating the actual response demand patters in Contra Costa County, and what impact this recommendation will have on these issues. During the review phase, should the Board choose to move forward, the following legitimate issues must be addressed: 1. Can a single paramedic perform at a medically acceptable level in Contra Costa County in the absence of a paramedic partner? While this staffing pattern exists throughout the Finance Committee July 13, 1988 Contra Costa County Board of Supervisors Page 5 state and the nation, perhaps the medical standard in the County is justifiable, and therefore justifying the existing system. Many of our own personnel have voiced concern about their capability, and the capability of their co-workers, to perform at the same level of medical proficiency without a paramedic partner. Because of this, their concerns and confidence levels, as well as that of the medical community (particularly the base station hospitals) must be addressed before we can even begin to implement such a program. At the same time some of our personnel voice concern about the proposal, others with experience in single paramedic systems voice no reservations at all. To the contrary, based on their experience they say there are no medical issues of consequence at all. Thus, what we clearly need is a thorough review of this issue from all sides. If there are, in fact, clear medical issues, they must be addressed before we could ever implement such a program. If we have more of an educational issue based on a lack of experience by those involved in our system it, too, must be approached with equal vigor. The first rule of EMS is "to do no greater harm" . It would be ludicrous to try to help 15% of our patients while causing harm to the other 85%. Therefore, we must have clear consensus on this issue, and still remain committed t to meeting the needs of the individual paramedic. 2 . Can EMT's be trained to the level necessary to assist paramedics in the field? Certainly, and without a doubt. In addition, this is one of the primary benefits of the system as proposed. EMT's today respond to so few life-threatening emergencies that, by the time they attend paramedic school, they simply do not have the experience they used to get when there were fewer paramedic units. This system will allow Contra Costa County to attract and retain the highest trained and most proficient EMT's in the Bay area, thereby ultimately producing the best and most proficient paramedics. A complete training and orientation program to our system will be developed and put into place that assures competency in those areas that an EMT can assist with care. 3 . Protocols and Communications must be addressed. Currently we have a paramedic to talk to the base station hospital and one to perform patient care. No longer will a paramedic be free to return to the ambulance or go to another location to use the phone to contact the "base" . Finance Committee July 13, 1988 Contra Costa County Board of Supervisors Page 6 Therefore, we will, at our expense, provide each paramedic with portable radio and mobile phone capability so they can contact the base from the patient's side. Additionally, protocols must be developed that allow paramedics the maximum, medically appropriate, latitude to treat life threatening patients before contacting the base. Appropriate protocols are currently in effect throughout California, but must be reviewed for appropriateness in our County. - 4 . Dispatch. The appropriate movement and placement of units is as much a part of the delivery of care as is the staffing of the units themselves. We have already contacted both Richmond Police Department and Consolidated Fire Department concerning interfacing our dispatch centers to eliminate time delays and having to make telephone contact prior to ambulances being dispatched. In addition, we plan to contact the County Sheriff to perform the same interface with the new CAD system so all calls can be entered and tracked in the County's computer without the need for the existing radio traffic. Also, we are considering the purchase of the top rated EMS Computer Aided Dispatch (CAD) system in the nation. This could eliminate the need for the Sheriff's Dep't to monitor ambulance responses, as it would be performed automatically, thereby reducing department man-hours dedicated to this task. We believe that we are prepared to launch a new era of higher . quality EMS in Contra Costa County, and believe that Alternative 3 best meets those needs. It would take millions of dollars and an extended time period to implement this same level of service with the existing staffing patterns, with no measurable difference in patient outcomes. We are committed to continuing toofferupgrades to our system as resourges and service options become available to us. Please continueo call on us with issues and options that are viewed as eitheiconcerns or opportunities. Re epltfully ubmitted, arl Rigg President WER:drb cc: Emergency Medical Services COUNTY OF CONTRA COSTA MEASURE Advisory Vote Only (Suggested Language) COUNTYWIDE EMERGENCY MEDICAL SERVICES: Shall a Countywide service area be established in Contra Costa County to finance improved paramedic service, trauma care, and other emergency medical services in accordance with needs and priorities to be identified as a result of a comprehensive review of emergency medical services in the County performed by the Health Service Department and subject to a maximum assessment on real property of ten dollars annually for each single family residence or benefit unit as defined in Resolution No. a copy of which is contained in the Voter Information Pamphlet? °`-nt�--� ARGUMENT IN SUPPORT OF THE u u u PROPOSED EMS BENEFIT ASSESSMENT DISTRICT A "yes" vote on Measure would advise the county Board of Supervisors and the city councils of each Contra Costa city to establish a countywide benefit assessment district to finance improvements in our paramedic, trauma, and other emergency medical services. Currently, the number of paramedic-staffed ambulance units is sufficient to cover only about 85 percent of emergency medical calls . The communication system which links paramedics with base hospitals providing on-line medical direction in the care of critical patients is antiquated and insufficient for the volume of calls. Medical dispatchers in many areas of the county are not trained in priority dispatching or in providing medical assistance to .9-1-1 callers while 3 waiting for help to arrive. Most firefighter first responders are not trained to the EMT-I level. The establishment of a countywide EMS benefit assessment district would provide the funding necessary to increase the number of paramedic units to ensure adequate coverage for all victims of medical emergencies, to provide additional medical training and equipment for firefighter first responders, to upgrade paramedic communications and dispatch, and to provide a high level of trauma care in all parts of the county. While the general areas of need for upgrading our EMS system have been well identified, a detailed plan for expenditure of funds will be approved by the Board of Supervisors following a comprehensive review of the EMS system by the Health Services Department and the Emergency Medical Care C_=mittee . TME BOARD OF SUPERVISORS OF CONTRA COST/ COUNTY, CALlronNIA Adopted this Order on , by the lullowing vole: AYES: NOES: p D ABSENT: ABSTAIN: SUBJECT: Emergency Medical Services Resolution Number 881 WHEREAS, this Board of Supervisors proposed to establish,, with the concur- rence of each city council, a County Service Area for the provision of paramedic service, trauma care, emergency medical services on a county- wide basis; and WHEREAS , a county may levy an assessment upon each property within a service area to pay for cost of the services; and each assessment may be determined by apportioning the total cost of the service, not otherwise offset by other available revenue, to each property in proportion to the estimated benefits to be received by each property from the service; and WHEREAS , a special advisory election will be held to determine whether this Board of Supervisors should undertake the formation of an emergency medical services area and the levy of an assessment; and WHEREAS , a schedule of benefit units reflecting the degree to which different kinds of properties according to use would benefit from the service has been established, and the estimated dollar value of the benefit unit necessary to defray the cost of the service has been set at a maximum of ten dollars per unit; i NOW, THEREFORE, BE IT RESOLVED that this Board of Supervisors adopts the Schedule of Benefit Units for the different kinds of properties within the County as a guideline for purposes of the advisory election as follows : SCHEDULE OF BENEFIT UNITS Categories of Improved Property Benefit Units Assigned Residential Single Family 1 Small Multiple (2-4) 2 Large Multiple (5 or more) 6 Commercial and Industrial (To be developed) BE IT FURTHER RESOLVED that the dollar value of each benefit unit shall not exceed ten dollars annually without further voter approval. Orig. Dept.: cc: • A r, PROPOSED EMS BENEFIT ASSESSMENT DISTRICT i p Budget Illustration @ $9.00/Benefit Unit EXPENDITURES 1. Paramedic ambulance coverage $ 500,000 2. Fire first responder training and equipment EMT-I training and equipment 250,000 First responder defibrillation program (training and equipment) 200,000 3. Dispatch and communications Sheriff's dispatch (ambulance dispatch and tracking) 350,000 Priority dispatch training 200,000 Paramedic-to-hospital communications, 550,000 4. Trauma care 200,000 5. Base hospital medical direction 100,000 6. EMS Administration ' 552,257 TOTAL 2,902,257 REVENUE 322,473 benefit units x $9.00/unit $2,902,257 Estimate of benefit units: Benefit Units Total Benefit Parcels Per Parcel Units Residential property Single family 227,659 1 227,659 Small multiple (2-4) 5,674 2 11 ,348 Large multiple (5+) 1,673 6 10,038 Commercial' and industrial 18,357 4 (average) 73,428 TOTAL BENEFIT UNITS 322,473 7/26/88