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HomeMy WebLinkAboutMINUTES - 11031998 - D5 D-6 TO: BOARD OF SUPERVISORS t'`'".' COCltl'a k t p F FROM: Phil Batchelor, County Administrator - Costa November 3, 1998 County DATE: STATUS REPORT ON PROPOSED INTEGRATION OF CON COSTA SUBJECT: COUNTY FIREPROTECTION DISTRICT (CCCFPD) PARAMEDIC PROGRAM, AND AMERICAN MEDICAL RESPONSE (AMR) PARAMEDIC SERVICES - tCONTiINUED FROM SEPTEMBER 22, 1`998) SPECIFIC REOUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION RECOMMENDATION: CONSIDER status report from Supervisor Donna Gerber on the proposed integration of Contra Costa County Fire Protection District(CCCFPD)Paramedic Program and American Medical Response (AMR) Paramedic Services - (continued from September 22, 1998). REASONS FOR RECO?MMENDATIONIBACKGROUND: Supervisor Gerber has advised that she met with representatives of the Professional Fire Fighters Union Local 1230 and the Paramedics Union Local 250 to discuss the proposed integration of paramedic response services as outlined in the attached reports dated October 13, 1998 and September 22, 1998. The October report was not considered by the Board on the 13th because it was removed from the agenda to allow time for interested parties to pursue further refinements to the proposal As a result of the meeting with Supervisor Gerber, the two labor organizations have apparently reached agreement regarding the operational and service aspects of the proposal. The agreement is conditional upon a revision to one of the plan elements specified in the background of the September 22, 1998 report to the Beard. This change would be part of an amendment to the contract with AMR that would reduce AMR's response time in Central County. CONTINUED ON ATTACHMENT: YES SIGNATURE: s y` �w,C�✓ G w✓ RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE APPROVE OTHER SIGNATURE(S): ACTION OF BOARD ON N Oy e mb e i 3, 19 9 S APPROVED AS RECOMMENDED XX OTHERXX VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE UNANIMOUS(ABSENT ) AND CORRECT COPY OF AN ACTION TAKEN AYES: T=,TTL CIT & T NOES: V AND ENTERED ON THE MINUTES OF THE BOARD ASSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN. ATTESTED_ M-Ammber 3,9998 Contact: Scott Tandy (925) 335-1087 PHIL BATCHELOR,CLERK OF THE BOARD OF cc: See Page 2 SUPERVISORS d COUNTY ADMINISTRATOR Z BY' ,DEPUTY ............................................................... ...................................................... ..................... it is now proposed that Item E on page two of the September report be revised to read as follows: The County would modify the existing AMR ambulance response standard. The existing standard calls for a 10-minute response to 95 percent of emergency calls throughout AMR's service area. The new standard would maintain the 10-minute 95 percent standard in East and West County, but set a 10-minute 90 percent standard,with no exemptions,forCentral County. (Underlining indicates modification.) The proposed change is acceptable to the Fire District,the County EMS Agency and AMR. cc: Report only: County Administrator Contra Costa County Fire Protection District Contra Costa County Fire Advisory Commission Contra Costa County Taxpayers' Association County Grand Jury Local 1230 Loca1250 American Medical Response Health Services Department City of Clayton City of Concord City of Lafayette City of Martinez City of Pleasant Hill City of Walnut Creek Phone for referenced background reports, if needed. -2- ADDENDUM TO HIEM D.5 November 3, 1998 Agenda On September 22, 1998, the Board continued to this date a status report on the feasibility of integrating fire paramedics and private ambulance services into a single system in the County. Supervisor Donna Gerber presented the status report, and noted that there was a suggested modification to the response standard for service with regard to the existing American Medical Response Paramedic Services (AMR). Scott Tandy, Chief Assistant County Administrator; Art Lathrop, Emergency Medical Services Director; Contra Costa Fire Chief Keith Richter; Fire Chief of Emergency Medical Services Stephen Maiero; Dr. Barger, Emergency Physician at the Contra. Costa Regional Medical Center; and Dr. William Walker, Director of Health Services were present. A slide presentation was given by the Fire Chiefs in support of the proposed service. The Board discussed the issues involved. Supervisor Canciamilla stated that he could not see how integration would occur, or how the paramedic program would be assisted by the integration of services. He fi ther stated that he was in agreement with the objectives of the program, but that the report was not fully evaluated. Dr. Walker and Dr. Barger stated that it was difficult to obtain and relate definitive data to the Board since such information was not available. Supervisor Gerber moved the staffs recommendations (as stated in the October 13, 1998, Board Order which was not on the agenda, and is attached as background). Supervisor Rogers seconded the motion. Art Lathrop and Dr. Barger responded to Supervisor Canciarnilla's inquiries about the level of care paramedics could offer versus EMTs during emergency situations, and what happens when the patient is transported to a hospital. Supervisor DeSaulnier inquired if there had been communication with the various affected cities. Scott Tandy related that reports have been provided to the cities, but he had not received any feedback. The Board inquired about a timeline for hiring, and Chief Richter responded that it should be ready by January. Supervisor DeSaulnier requested an amendment to the motion that a report come back to the Board in three months rather than six months. And the maker of the motion and the seconder responded in the affirmative. Chief Richter stated that was fine. Dr. Walker stated that getting a paramedic to a situation quicker is going to be better, and what should be monitored is ambulance transport times. Scott Tandy requested affirmation from Supervisors Gerber and Rogers if the September 22, 1998, recommendations on the Board Order were part of the motion today, and they both responded they were part of the motion. Following fi ther discussion, the Board took the following action: AOCMM the status report on the feasibility of integrating the CDnitm Costa Fire Protection District P,aua nedic Program and the American Medical Response (AMR) arannredic Service into a single service; APPROVED the reconanendations on the September 22, 1998 Board Order(as ached); DEURNWOD du t the AN R an"dance response staff stated in Paragraph E of Item D.9 on the September 22, 1998>Board Order is modified with no exen dons for service response; and.REQUESTM that the County Administrator's staff and the Contra Costa County Fire Protection District provide an interim report to the Board in three nvnths. i j I [*C*nl ticipates"ttrganh atfons i Contra C�counter i 4 � E protection Dict nty Adbulnis'trator stwice I ra Cosh County Fire Prot.Dist, I ra Costa County 00 Agency i rican Medical Response 1 �P i United Professional Firegters, i A�mertca e+ ical hi+ spoase 123#1 k*Employees International n,Local 2910 � I � I I 1Services efthe More W be I ! Future - afsed heatth I t �S tench for the � ca► a►�tf b _ nonage eat that Is raft integrated the avera� I It s health care System. NatlouaUlgh � Amb edo� 1 4 s I f I � j 666MMS new enatAbe i and WM be tnte�rated With' ", dere u bcwa►�cn. uther hea��th cove ! pru dery and pablic refttrtbit�os of ���t� h+�ath ax�td p�tbl�ic sett health care resources..... f { 1 ! # III III { a 1 NWA LJ CURRENT SERVICE PROVIDERS � CURRENT'SERVICE PROVIDERS ah � ! s na A_mJkmt� f .� j *AMR # ) ♦San Ramoara�'Valley F.P.U. *MorMp-O da FPD (pins) *Mo ga tlrtmla F.P.D. •fta Raa en Vo t y FPU ("Me) 1 •Bethel Maud F.P.U. 11 ., a AmR East Diable area (private) I •All fire eaac1es fAthe coa�ty •Contra aCos at County F.P.U. I 1 .. [01blectives for Improvement 1 CM ! goo - I mot 1 i Et"ting Paramedic Stations � 'p Addidonal P�ara�a+e+al�c Stations Le#�U►et#ae � •aCgayton • show 15,16 a 17 .s't hexa 11-t7la aa►5tciad •(1 pen" coa ftaparattow �►Pacheco Walnut Creek � f a swdow9-C oeurAv"'Ae +► +oma 1-toxic DA" .stetiea�3 itfmnnox thr rkMnttr a Pleasant RM •Utti m 5-Boyd Bead ■Ma�x"t)tnteta •statioaa 3 Raid • stattan 1lE�leae<esSttraet 1 i � j i _ f # CURRENT RESEARCH � 1 EN Studies focus on zz E DOES EMf 1 C�iac Arrest Trauma I Measures onlyE I j { Prefficting survive I �� THE SURVIVAL FORMULA out of Hospital�CarOac � a Survival Rates decrease b�• Amt ►2. �3%per min.to CPR a Larson,MP,Eisenberg,et al � ►jj%per min.to tetbrlltatioa «►2.1%per min.mo AdvWe Saxppo 1 a Annals of Emergeney Medlclne, i Now1993 *Addt 1 min iorch proc edwm for wetap. tv z 22.Ne,xx *,xs�ra.}* •8emstcastescealcm 67%VaRgr aGda res occur shnahattetr usly { #E 4 f i E Sysfie]gglt EKltple: ■ 67X. a 67% a 5 Minute s to CP R t -2.3x6 = -134 a 6 Min>etes t*CPR t -2.3x6 = -13.8 a 6 Minutes to fib:-1.1x 7 =» 7.7 e 6 Minutes to llenb-.-tax 7 =• 7.7 a 10 Minutes to ALS: -2 lxl O =-21.0 a 7 Minutes t*ALS-. -.".1x7 =-14.7 Survival Rate sh*Wd bet 2x4.9% � � Surdval Rate should bet 30.3% {6.3'K int�ert�tse} 4+te ssureditom time ofCa ac Arrest . E Snrdval lucrt�T 1*Wmin. i ANN Percent Survival [hie A Reiter. ;�o ea 20 rapeattc Care. {{ �c jtomer Expectation � 40 rrmtntive Ca�r+c; I i I ef on E.R.worldoa ds Time in Mfuutes So-urca:CGC fM51.�an 1 l 1 F based Paramedics ^� a C j a ge t lterk+etey Mar Co.FD COIP"a�R W a FaIrB+t�td a Son Mateo County a Bora-Plesaab ► u Santa t Tara F.P.D. ■salmn esto ■Sarthraulec#sau •Santa q;rra a sa cirameantrl i a Sawn loft Salt Itarwa f A .RRSMNS$TnU Amb Mauls Responses-1997 :Ccc sftenCy _ C.C.C.F.P.D.-Code 3 Responses by Area eovlvT�r Min. -Pct. __ Wu-� 10 °lo East/WestCom Costa-r w _ 10 95°l0 39.6% 1 C•ntra CxrsRa• 10 90% Central I Santa Cllwra:wl##vt►IYI 12 �W/o � 60.4% Sant a Clams w10 WOM ~40 90% San fromfeco 10 90% 11 Total.22862 lliian lNxtaa_ _.__ _ 13 9'°°._ i 1 I i Ambulance Response Time [��804 l County-TrampOrts Intervals ( j AMR Coda 3 Transports•1991 Code 2 i 53,8% 80 lN Transport to Hasp. so $1 Time On Sens f t Response to Scene i lrarws.7.$°�uAR Trauma � soAvg ccc i:as Agency Total: 13817 Avg f eaR iktte: 34,8 mitt bass..se. j i [ 77- ARM.COVERAGE ISSUES 1 Reduction i • of 94 unit/hra/wk- 3% Less Trans "ours TEMD'AC": i ■Increase of 13" uniVbrs/wk of �a�ramee�i+�t�vver�e 489E MoreParamedicuours I � � 1 E p AIM.COVERAGE ISSUES � CONTINUING SAFEGUARDS 1I 3 II a inC„rewad during c hours. i a AMR provides ,'�,�� menitO ig i ■D during -- k hours � ■E ,Agee cy ur onitors mandft ALS Engines gro+vide more ( Penalties for respo»se time failure paramedics hours in the system. 4 I . I . QUESTIONS/CONCERNS ounn 3NS I CONCERNS •Increased time to hospital? •system impacts. East&West? i 3 r 8.4% (1162)are critical calls E •Avg.on-scene time for Criticalcritica All times are monitored —1�0 RESPONSE TIME CHANGES calls is 17 min, ! • .�AMR TO MAINTAIN COVERAGE 1 •TraElning wiilfocns ora i m1nimizing scene tunes I I [res �TIONS/CONCERNS I I ! summary at about longer ambuli � a Public-Private Partnership ponses In centrad county? j ■Increased access to paramedics j improved trabit"�n transfer ( � z f care ■1�Iore>efti+�ient use of Measure n ans�tw th s wound ngorntiesand indgstry trends ■Renets outweigh the asks month report to the Board 4 t 1 � (condoned) � Summary � I [Dn,,o nitoring-monthly re�riew � � a The best nay to one limited I►�� predict th+a SUM fatu a into ortunities in healthcare create It. F ce w/Industry trends Peter Thacker } i Contra TO: BOARD OF SUPERVISORS Costs. County FROM: PHIL BATCHELOR, County Administrator CHIEF KEITH RICHTER, Contra Costa County Fire Protection District WILLIAM WALKER, Health Services Director DATE: October 13, 1998 SUBJECT: PROPOSED INTEGRATION OF CONTRA COSTA COUNTY FIRE PROTECTION DISTRICT (CCCFPD) PARAMEDIC PROGRAM AND AMERICAN MEDICAL RESPONSE (AMR) PARAMEDIC SERVICES- (CONTINUED FROM SEPTEMBER 22, 1998) Specific Request(s)or Recommendation(s) & Background &Justification RECO MENDA ISA ONS: 1. CONSIDER presentation by the Contra Costa County Fire Protection District based on additional information developed by the Fire District, the County EMS Agency and AMR on the objectives of the proposed integration plan; deployment of the additional four paramedic engine companies; the impact of early paramedic response and comparative information on EMS agencies in other jurisdictions. 2. CONSIDER presentation by Dr. Barger, Contra Costa County EMS MedicalDirector. 3. ACKNOWLEDGE that the Paramedics' Union, Local 250 has opposed the integration plan because of the perceived impacts of the proposal as outlined in the attached position statement which has been circulated to area health care professionals. , 4, CONSIDER approving recommendations in the September 22, 1998 report from County Administrator, Fire Chief and Health Services Director(attached). ,TIZ411�, )-.7" Continued on Attachment:--X YES Signature: Recommendation of County Administrator Recommendation of Board Committee Approve Other Signature(s): Action of Board on: Approved as Recommended—Other -- Vote of Supervisors: I HEREBY CERTIFY THAT THIS IS A TRUE AND CORRECT COPY OF AN ACTION TAKEN Unanimous(Absent ) AND ENTERED ON THE MINUTES OF THE Ayes: Noes: } BOARD OF SUPERVISORS ON DATE SHOWN. ATTACHMENT Contact: Scutt Tandy(825)335-1087 Attested: cc: County Administrator Phil Batchelor,Clerk of Contra Costa County Fire Protection District the Board of Supervisors Contra Costa County Fire Advisory Commission and County Administrator Contra Costa County Taxpayer Association County Grand Jury By: , DEPUTY local 1230 Local 250 American Medical Response Health Services Department City of Clayton City of Concord City of Lafayette City of Martinez City of Pleasant Hill City of Walnut Creek REASONS FOR RECOMMENDATION/BACKGROUND: On September 22, 1998 the Board of Supervisors considered the report and recommendations of the County Administrator, the Fire Chief and the Health Services Director regarding the proposed integration of the fire district paramedic program and the private ambulance service (AMR). The recommendations in the September 22, 1998 report were developed through a work group in a series of meetings involving the County Administrator's Office, the Contra Costa County Fire Chief, EMS agency staff, the Professional Fire Fighters Union Local 1230 and the Paramedics Union Local 250 representing AMR's field personnel. The recommendations in the report were agreed to by all of the participants of the integration work group. During the discussion of this issue at the September 22, 1998 Board meeting, two members of the Paramedics Union Local 250 expressed their concerns about the element of the plan that would allow for increased ambulance response times in central county. As a result of the opposition expressed by the Local 250 members and in response to the request for additional information by Board members, this matter was continued to October 13, 1998. County Fire District Chief of Emergency Medical Services, Stephen Maiero will present additional comparative information and Dr. Barger will discuss the benefits of early paramedic intervention. Dr. Barger is an emergency physician at the Contra Costa Regional Medical Center and is the President of the Emergency Medical Directors' Association of California (EMDAC). September 28, 1998 Dear Health Care Professional, We are writing you this letter on behalf of the Paramedics and EMT's in Local Union 250 who need your support. Recently a proposal has been put forward with regards to The Contra Costa County Fire Department's First Responder Paramedic Program that we strongly believe will affect the citizensof Contra Costa County. Due to budgetary constraints within the fire department, The Board of Supervisors froze further development of the fire department's paramedic program until they could find additional funding. A proposal was put forth that would use a portion of the Measure H money currently being used by AMR West, to fund this program. And in exchange, AMR's compliance time to arrive on the scene of a call in the central county area would drop from a 10 minute limit 95% of the time, to 10 minutes 90 percent jofthe time. What this means to AN1R paramedics is a reduction of FOUR full time Paramedic positions and the elimination of the TWO 24 hour paramedic stations currently operating in Walnut Creek. The paramedic stations would be replaced with shorter hour cars which would roam throughout the entire county and no longer be limited to central county. It is our experience that these type of cuts in personnel and 24 hour units will increase response times and delay transport times for patients throughout the county. We as health care professionals are very concerned about these proposed changes and brought this issue t7o the attention of the Board of Supervisors at its meeting on September 22nd. We raised some valid concerns and the Board delayed implementation of the proposed program until the fire department could provide them with further information. The Centra Costa County Fire Department as well as the Emergency Medical Services Director, Art Lathrop, state that since there will be ALS paramedics on some of the fire engines, there would be no expected delays in transport. We feel this argument has no validity because the majority of patient care occurs during transport to the hospital. In addition, they contend that the fire department paramedics first on scene would be able to "package"the patient for the ambulance paramedics, shortening the time the transporting paramedics are on scene. Since implementation of this program, we as transporting paramedics have seen no evidence of quicker on scene times. Furthermore, we find it hard to believe that the patients will be ready to go when the ambulance arrives, considering that AMIt,carries the gumey and other equipment necessary for transport. .............................................................. ....................................................... ....................................... As I am sure you are well aware, early ALS interventions along with rapid and timely transport is a very important aspect of care of a critical patient in the field. And the paramedics working for AMR firmly believe in any program that provides better patient care. What we disagree with is the idea that early intervention replaces timely and rapid transport to the hospital. We also believe changing the response times in central county will affect patient care in all parts of the county since ambulances from other areas will be needed to make up the decreased availability in central county. We strongly believe that critical trauma patients and medical patients having a massive MI or CVA Oust to name a few) need to be transported in a early and rapid fashion in order to save lives. We as paramedics working in the county believe that our patients will be affected by these changes. We ask for your help and knowledge as health care professionals in supporting our position. Local 250 has presented other options to the EMS Office which would help to fund the fire department's program without causing changes in current ambulance response times. We ask you to please show your support and express your concerns on October 13th at the Board of Supervisors Meeting or to write to the City Council and Board of Supervisors members opposing the proposed plan to fund the fire department's program by cutting ambulances and delaying response times. Thank you for your time. Board of Supervisor Members Jim Rodgers Mark Desaulnier District I District 4 (510)374-3231 (925)672-2812 Fax(510) 374-3429 Fax(925) 646-5763 Gayle Ulkema Joe Canciamilla District 2 District 5 (925) 335-1046 (925) 427-8138 Fax(925) 335-1076 Fax(925)427-8142 Donna Gerber District 3 (925)825-8683 Fax(925) 820-6627 ............. .......- .............. ..............- .............................................................................. ................................................................... Contra Costa TO: BOARD OF SUPERVISORS +,,, FROM: PHIL BATCHELOR, County Administrator Co CHIEF KEITH RICHTER, Contra Costa County Fire Protection District WILLIAM WALKER, Health Services Director DATE: September 22, 1998 SUBJECT: STATUS REPORT ON INTEGRATION OF CONTRA COSTA COUNTY FIRE PROTECTION DISTRICT(CCCFPD)PARAMEDIC PROGRAM AND AMERICAN MEDICAL RESPONSE (AMR) PARAMEDIC SERVICES Specific Request(s)or Recommendation(s) & Background &Justification RECOMMENDATIONS: 1 ACCEPT the report of the County Administrator, the County Fire Chief and the Health Services Director on the status of the proposed integration of the fire paramedic program and the private ambulance service. 2. REVISE the current paramedic program to integrate on a limited basis the CCCFPD paramedic program with the AMR paramedic service beginning December 1, 1998 for one year. 3. AUTHORIZE deployment of four additional paramedic engine companies. 4. AUTHORIZE the Health Services Director to execute an amendment to the Emergency Ambulance Agreement with AMR providing for a $14,550 reduction in monthly subsidy to AMR beginning December 1, 1998 and ending on December 31, 1999 and a reduction in AMR's ambulance response requirement for the central county portion of the CCCFPD beginning January 4, 1999. 5. AUTHORIZE a shift in payment to CCCFPD in the amount of$189,150 (13 months) from County Service Area EM-1 in Measure H funds for increased paramedic first responder services beginning December 1, 1998. 6. DIRECT the Health Services Director and the Fire Chief to evaluate the fiscal, operational, and service impacts of the integrated pilot paramedic program and repo back to the Board in July 1999. Continued on Attachment—X— YES Signature: Recommendation of County Administrator Recommendation of Board Committee Approve — Other Signature(s): Action of Board on: 1 as RUC01111viel —Other X CONTINUED TO 00tober 13, 1998 at 2:30 p.m.; The Health Services Director and the Fire Chief are DIRECTED to provide the Board information as requested on issues including op evaluation of the fiscal, operational, and service impacts of the integrated pilot rAramedic program, the implementation plan of the program, an evaluation of the effect- iveness of the program to date, and inftceittion on ambulance return times when assistance Vote of Supervisors: is utilized Unanimous(Absent Ayes:— Noss: Contact:Terry McGraw(335-1055) cc: County Administrator I hmby ce"Ihat#*is a tft md correct cop Contra Costa CounWFIre Proteoting­District copy of sa &00" OnAred w to mitua of Contra Costa County Fire Advisory Commission 90W.O1 Onto 40 31*". 87 '.'I 1 1. Contra Costa County Taxpayer Association ATft MI: (k own 64 6 County Grand Jury 'PHI BAT04r-MR f Local 4230 ­iELOR,Clafk1taBoid Of 84WANis and C0WWA&nWshWr Local 250 American Medical Response Health Services Department BY 'Deputy Status Report on Integration of Contra Costa County Fire Protection District (CCCFPD) Paramedic Program and American Medical Response (AMR) Paramedic Services September 22, 1998 Page 2 7. DIRECT the County Administrator, Health Services Director and Fire Chief to continue working with AMR and with other fire agencies within the County to determine the feasibility of further integration of public and private paramedic services, conditioned upon the identification of new or existing funding sources. REASONS FOR EIECOMMENDATIONISACKGROUND: On August 4, 1998, the Board of Supervisors approved recommendations from the Finance Committee that the CCCFPD pilot paramedic program be frozen at the current level of four units and that deployment of the remaining four pilot units be deferred until program funding is identified. In addition the County Administrator, the Fire Chief and the Health Services Director were directed to work with AMR to prepare and submit a plan to the Board'for the integration of fire district paramedics and the private ambulance system into a single system, conditioned upon the identification of viable, realistic funding and to report back to the Board any progress toward that objective in September. This is a report on the progress to date of the work group appointed by the Board. The work group has held three meetings including two meetings with representatives of the Professional Fire Fighters Union Local 1230 and the Paramedics Union Local 250 representing AMR's field personnel. As a result of these meetings,AMR has developed a plan which would shift from AMR to CCCFPD some Measure H subsidy money, along with responsibility for providing faster paramedic response. The proposed plan includes the following elements: A. The plan meets the Board's condition of added funding to offset added cost. B. CCCFPD would continue to operate its existing four paramedic units (engine companies) and would implement an additional four paramedic units effective January 4, 1998. The eight units would be operated with firefighter paramedic staffing on a 24-hour/7-day per week basis. C. AMR would reconfigure its ambulance deployment resulting in a minor reduction in coverage in central county. This reconfiguration would result in a cost reduction to AMR of$174,60€1 annually. This reduction in subsidy demand would be shifted to offset costs of the CCCFPD paramedic'program. D. AMR would provide an additional $14,550 by accepting a subsidy reduction one month prior to implementing a reconfiguration of services. This would provide funding to cover the start-up period for the additional'fire paramedic'personnel prior to their assignment to single-paramedic units. E. The County would modify the existing AMR ambulance response standard. The existing standard calls for a 10-minute response to 95 percent of emergency calls throughout AMR's service area. The new standard would maintain the 10-minute 95 percent standard in east and west county, but set a 10-minute 90 percent standard for central county. F. CCCFPD will deploy its additional paramedic units at stations within central county in a manner to optimize response times to areas with reduced ambulance coverage. CCCFPD and AMR have worked together to develop complementary deployment plans for both fire and AMR paramedic units. This plan will provide for an earlier arrival of paramedic personnel, while having a negligible effect on the overall time a patient waits for a transport unit. G. Both CCCFPD and AMR will provide training and supervision to its personnel to assure a smooth and efficient transition of care from first responder to transport paramedics. H. The EMS Agency will work with CCCFPD and AMR to establish a mechanism for evaluating the impact of the integrated firelprivate paramedic system on patient care. 1. The $14,550 monthly subsidy shift exceeds the marginal costs of the additional paramedics, as well as funding up to 75% of the differential costs of the eight paramedic units. During the course of the one-year pilot paramedic program, the County Administrator, the County Fire District,the Health Services department and AMR will continue to pursue ways to further integrate the fire district and the private ambulance company services and report back to the Board of Supervisors in July 1999.