HomeMy WebLinkAboutMINUTES - 05142013 - SD.1RECOMMENDATION(S):
RECEIVE Emergency Medical Services (EMS) staff report on the impact of Fire Station closures on distribution of County Service Area (CSA)
EM-1 funding of Fire Agencies and APPROVE recommendation to modify the funding formula to support Fire First Medical Response
throughout the EMS System.
DIRECT EMS staff to implement the alternative formula beginning in fiscal year 2013-2014 and to proceed with written agreements to allow for
distribution of funds.
FISCAL IMPACT:
No General Fund Impact. These changes, if adopted, would modify the formula used for determining CSA EM-1 Zone B (Measure H) EMS
first responder funding among fire jurisdictions.
BACKGROUND:
CSA EM-1 (Measure H) is a countywide benefit assessment district under which the Board of Supervisors (BOS) has established charges on real
property to support EMS. The CSA was established in 1990 following a countywide advisory election demonstrating voter support for a benefit
assessment with annual parcel charges of up to 10 dollars per single-family residential unit to support enhancements to the county’s EMS
System, including expanded paramedic services, EMS communications, medical training and equipment for fire fighter first responders. The
CSA EM-1 has two Zones: Zone A covers the San Ramon Fire District service area, and Zone B covers the rest of the county.
The major impetus for establishing CSA EM-1 was the need recognized by the County BOS to expand paramedic ambulance coverage in order
to assure paramedic response to all potentially life-threatening 9-1-1 calls. CSA EM-1 funds have been used to enhance the EMS system for
different purposes over the years. Fire District CSA EM-1 funding allocations were established in 2004 as part of the May 18, 2004 Board order
for ambulance services. The funding levels represented $30,000/engine to support expanding fire paramedic first response for participating
agencies in Zone B. Engine based funding does not exist under CSA EM-1 Zone A (San Ramon Valley Fire Agency) therefore a funding
allocation modification is not required.
The “per engine” formula established by the 2004 Board order is used by the EMS Agency to distribute funding to fire agencies in the following
areas:
APPROVE OTHER
RECOMMENDATION OF CNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE
Action of Board On: 05/14/2013 APPROVED AS RECOMMENDED OTHER
Clerks Notes:See Addendum
VOTE OF SUPERVISORS
AYE:John Gioia, District I Supervisor
Candace Andersen, District II
Supervisor
Mary N. Piepho, District III
Supervisor
Karen Mitchoff, District IV
Supervisor
Federal D. Glover, District V
Supervisor
Contact: Patricia Frost
925-313-9554
I hereby certify that this is a true and correct copy of an action taken and entered on the minutes of the Board
of Supervisors on the date shown.
ATTESTED: May 14, 2013
David Twa, County Administrator and Clerk of the Board of Supervisors
By: June McHuen, Deputy
cc:
SD.1
To:Board of Supervisors
From:William Walker, M.D.
Date:May 14, 2013
Contra
Costa
County
Subject:Report on CSA-EM-1 Funding for Fire Districts with Recommendation for Modified Allocations
Since 2009, twelve fire stations throughout the county have closed. Each fire station closure represents one “engine” company. As fire stations
close “per engine” funding is reduced. These reductions have affected fire agencies at both the basic life support emergency medical technician
(EMT) level and advanced life support (Paramedic) level throughout the EMS System.
Given the number of fire station closures affecting the EMS System countywide and the unpredictability of future fire station closures, EMS
staff, propose that a “population based” formula for Zone B distributions be created to preserve fire first medical response.
The integrity of the EMS System relies on prompt fire first medical response. Recent statutory changes have expanded all fire first responder’s
scope of practice at both the EMT and paramedic level to further enhance the EMS System. Pre-hospital evidence based patient outcome studies
have also consistently demonstrated the importance of first medical response.
All Contra Costa Fire agencies participating in the EMS System, at either the EMT level or paramedic level are known to enhance the EMS
system by making significant contributions to patient survival.
The current and alternative funding formula, distribution and impact is illustrated below:
A population based allocation formula has several advantages:
BACKGROUND: (CONT'D)
Assistance for fire first medical response known to enhance the EMS System.1.
Adjustment for population growth over time.2.
Recognition of “intensity” of fire first medical response service delivery to communities with higher
population density and EMS service utilization.
3.
Continued differential funding support for Fire ALS (paramedic) service.4.
Fixed funding levels are established for budget planning from year to year.5.
While these changes will result in reduced funding for some fire agencies, all agencies will continue to receive a
substantial benefit from CSA-EM1 (Measure H). In addition to these distributions, CSA-EM1 is a source of seed
money for new programs and projects supporting EMS system oversight, equipment and systems of care known
to improve patient outcomes. Examples of these programs include the ST Elevation Myocardial Infarction
(STEMI) System, Trauma System, Stroke System, 12-lead cardiac transmission program and pre-hospital
electronic patient care records.
EMS staff respectfully recommends adoption of the new formula to allocate future Zone B Measure H funding as
a means to enhance fire first medical response for all communities and requests direction to proceed with the new
funding allocation formula and necessary written agreements.
CONSEQUENCE OF NEGATIVE ACTION:
Fire agencies with fire station closures would experience significant reductions in annual funding impacting their
ability to participate in the enhancement the EMS system. Funding supporting equipment, training, patient safety,
medical and statute required operational oversight will be reduced.
CHILDREN'S IMPACT STATEMENT:
Ten percent of all emergency medical services are delivered to children less than 15 years old. Reductions in fire
first medical response affect all populations including children.
CLERK'S ADDENDUM
ADOPTED the recommendations; and REQUESTED additional information be provided when this matter
returns to the Board on June 4, 2013, in regards to cash flow amounts in relation to the proposed deletion of
positions identified in the Contra Costa Fire Protection District.
ATTACHMENTS
Fire EMS Measure H Funding Formula Slideshow
County Service Area‐EM1 Fire‐EMS Funding Measure HPatricia Frost RN, MS, PNPDirector Emergency Medical ServicesContra Costa Health Services
Engine Based Allocations•Under a 2004 Board Order, allocations for Measure H funds for Fire agencies (in Zone B) are based on a “per engine” formula.•The formula affects funding in three areas:•Paramedic First Responder Fund•$ 1,845,760•First Responder EMS equipment Fund•$267,000•Paramedic Oversight Funding•$218,374•A funding allocation of : $2,331,134 per year
The ProblemFire Station Closures = Less EMS Funding •With each fire station closure “per engine” EMS support funding is reduced•Unnecessarily penalizes fire agencies suffering closures •Affects both Fire BLS and ALS agencies•Unintended Consequences
County EMS ProposalA “Population‐Based” AllocationAgencyPopulation PercentCURRENTEngine Based Funding FY 2013‐14Population Based Allocation (populationallocation + 25% ALS Differential )DIFFERENCEPopulationvsEngine AllocationRichmond Fire (BLS)11.4% $26,323 $223,022 $196,699 El Cerrito &Kensington Fire (ALS)4.5% $137,676 $111,012($26,664)Pinole Fire (ALS)2.0% $68,838 $49,437($19,401)Rodeo‐Hercules Fire (ALS)3.6% $68,838 $88,004 $19,166 Crocket‐Carquinez Fire (BLS)0.4% $7,000 $7,063 $63 Moraga Orinda Fire (ALS/Transport)3.8% $172,095 $92,748($79,347)East Contra Costa Fire (BLS)11.6% $18,802 $226,125 $207,323 Contra Costa Fire (ALS)62.7% $757,218 $1,533,722 $776,504 Total100% $1,256,790 $2,331,134 $1,074,344
Population‐Based Allocation Advantages •Assists ALLfire first responder agencies•Adjustsfor population growth over time•Recognizes the intensityof fire first medical response for communities with higher population density and EMS utilization•Continues legacy of support for paramedicservice levels•Establishes fixed funding levels for budget planning
Supports EMS System Enhancement•Relies on the integrityof prompt fire first medical response regardless of level.•Recent statutory changes have expanded fire first responder’s scope of practice at both the EMT and Paramedic level to enhance the EMS System.•Pre‐hospital evidence (the science of EMS) demonstrates the importance of first medical response.•ALLContra Costa fire agencies enhance the EMS system by making significant contributionssupporting patient survival.
Recommendation(s)•Adopt alternative population based Fire‐EMS funding formula for Measure H Zone B.•Direct EMS Staff to adopt the alternative formula, beginning in FY 2013‐2014 and to proceed with written agreements to allow for distribution of funds.