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Home My WebLink AboutMINUTES - 05251999 - D3 t TO BOARD OF.SUPE PvisoRS trt; Keith B. Richter, Fire Chief&William B. Walker, MD, Health Officer May 25, 1999 DATE: cost SukWitc-r; Report on Integration of c1t:CFPD Fire Paramedic Program and the ty American Medical Response (AMR)Paramedic Services SPECIrIC (S) PIR RECIM-OAY IONS { } a, BAC KGROUND ATV JUST I r I CA'T I ON RECOMMENDATION: ACCEPT status report on current provision of Advanced Life Support services within the Contra Costa County Fire Protection District and the overall impact on ambulance services within the American Medical Response contract area. REASONS: On February 2, 1999, the Board of Supervisors received a status report on the integrated fire based paramedic program and the feasibility of establishing paramedic licensure as a minimum qualification for firefighters. The Board directed staff to come back in 90 days with a progress report and directed the District to proceed with developing recommendations on the feasibility of requiring paramedic licensure for firefighters. This report fulfills that request. On February 1, 1999, the Fire District began integrating paramedic services with AMR by adding three additional paramedic stations (Stations 3, 9, 11) for a total of seven (7) operating paramedic stations. An eighth station (Station 2), also slated to come on line, has encountered delays that have withheld its opening. These delays are based on the lack of availability of field internships as well as limitations on the availability of state licensing exams leaving the District with insufficient paramedic personnel to staff the eighth station. Concurrent with this integration was an amendment to the existing ambulance contract with American Medical Response that adjusted the ambulance response criteria to 10 minutes on 90% of all emergency calls (the criteria is 10 minutes 95% in other areas) in Central County. East and Nest County responses remained unchanged. The integration of the Fire District's and AMR's paramedic services is aimed at improving patient care and increasing system efficiency through the use fire-based paramedics who arrive ahead of the ambulance to initiate lifesaving or stabilizing medical care. Using data collected from both AMR and the Fire District, we have compared response times, on-scene times, and transport times before and after the program integration. As the year continues, we will gather additional information to document improvements to the system. CONTINU= ON ATTACHMKN'rJ YUS <J ...o �et�tsAYtsns: -- _.__ RrCcratcsN�Ar t ON or COUNTY ADM i!s t sx'RA9`oR � ' — AtliltL�7/� — RCCpl4tii ttCXAY 1 ON OP IBOARiS COMM t TTitcl ,..,` OTHlCR I ACT I ON sipxKloAlti3 ON A1rt►ROV�ti AS PtXCimMKN0XO XX matter ; Miguel Mendonca, 21019 Athene give , Concord , commented on the oT►act� �. Following testimony and Board discussion, IT IS BY THE BOARD ORDERED that the shove recommendation is APPROVED. VC4Z OF SUPEWISORS X X UNAN I MOUS (ABSENT H DM 13Y CERT I ry THAT THIS IS A TRUE AYES• r AND CORRECT CCVY CSF' AN AC'TIaN 'TAKEN Ate+ AI38TA TI AND ENTERM ON THE M I WTES Op THE SoApm I N H CSP' SLIPERV i SOBS ON TM DATE SH'JYrN. Cbnt=t't: Fire Chief Reith Richter & EMS Director Art ya.throp CC;: Co=ty Ac1�st>oator AT'TIfSTED Ma v 25 1999 .� .._ PHIL BATCHELOR. CLERK 'OF THE BOARD Op SUPERVISORS AND COUNTY ADMINISTRATOR DEPUTY BACKGROUND: The Fire District's paramedic program began in August 1997 with three paramedic units in Lafayette and. Walnut Creek. In February 1998, a fourth unit in Martinez was implemented. During 1998, the Fire District, the Emergency Medical Services Agency, and. AMR worked to develop a method of integrating the fire-based paramedic program within the confines of the existing ambulance contract. On November 3, 1998, the Board of Supervisors accepted a status report on such an integration and approved moving forward with the program. STATUS: Data has been collected on the paramedic program's first four engine companies. However, as of this report, only two months of data (Feb. & March 99) is available for use in evaluating the impacts of the expanded fire paramedic program on the current EMS system. An analysis of the preliminary data concludes that the integration of fire-based paramedic services (from four units to seven units) combined with the modification to the AMR response times in Central County has not delayed the time spent on scene treating patients. There was a 30 second increase in "on-scene times" from 1 st quarter 1998 to 1 st quarter 1999. This reflects the same increase from 1st quarter 1997 to 1st quarter 1998 prior to the program expansion. A comparison of all transports over the first quarter of the previous three years indicates that overall system times in the West Bounty have slightly improved, The following is a summary of system impacts. Overall System Times (avg. Jan-March) Time spent on scene(avg. Jan-March) (Time of dispatch to arrival at hospital) West County decreased by 24 sec. West County decreased by 24 sec. Central County increased by 48 sec. Central County increased by 30 sec. East County decreased by 24 sec. East County no changes According to information from the County EMS Agency, we can estimate (with minimal data) that while there were no changes to the East and Nest County responses, the Central County experienced a six second improvement in ambulance responses, a thirty second increase in scene times and a twenty four second increase in transport time to the hospital. These times are consistent with increases from 1997 to 1998 as well as from 1998 to 1999. Therefore, the fire- based paramedic program has had no impact on the ambulance responses while having delivered aramedic services from firefigbter paramedics approximately two minutes sooner on all responses. Additionally, an overall analysis of the Fire District's paramedic units indicates that Advanced Life Su ort Services` are at the scene on 57% of all EMS calls prior to the arrival of AMR units On 17% of all EMS calls, advanced procedures were implemented; while on 3% of the calls the patient's condition warranted two paramedics attending the patient enroute to the hospital. Since January 1998, the fire-based paramedic program has responded to over 3400 calls for service, resulting in 2886 trips to the hospital of which fire-based ALS services were provided to 1959 of these cases. During the next quarter, we will have implemented a comprehensive electronic system for collecting patient data which will broaden our ability to review performance. Relative to the task of conducting a firefighter job analysis, a request for proposal was awarded to a contractor who is in the development stages of preparing a work plan that will develop alternatives and recommendations regarding any changes to the firefighter qualifications. This may present some opportunities to provide a cost effective method of adding paramedics, through attrition, within the current fiscal constraints. Lastly, during this quarter, we will begin the process of meeting with all County fire districts/agencies to begin work on developing a proposal for a countywide integration of fire-based paramedic services. 1 IALS services are defined by the County EMS Agency as the performance of any procedure identified in the pararredic scope of practice. —m=.s includes EKG monitoring and/or the delivery of any advanced procedures or medications. 2 SUMMARY: The analysis of the fire-based paramedic services system indicates a significant improvement in the response times for Advanced Life Support service. On average, patients had ALS-level care available to them two minutes sooner than the system provided prier to this change. This improvement has occurred without any increase to the response time of the ambulance transport. This would indicate an improved quality of care within the overall Emergency Medical Services system.. ADVANCED LIFE SUPPORT PROGRAM RESPONSE SUMMARY - 1998/99 Medic Eng Eng Eng Eng Eng Eng Eng I TOTAL 115 3 1 ' 14 5 9 11 2 Total Calls 668 1272 701 432 157 110 69 0 3409 100% of Pt. 613 1270 694 431 155 109 60 0 3332 Contacts 98% of Pt. 514 1164 549 P 372 133 96 58 0 12116 Transported 85% ALS care prior to amb. i 326 844 372. 243 83 50 41 0 1959 is ostic .5N ALS care prior to amb, 112 185 115 98 27 14 22 0 573 (Procedural) 17% P1v1iFF ride to , 16 47 18 23 6 7 0 0 117 hospital j � 3'° Medic 115 in service-8/1/97 Engine 5 in service-2/1/99 Engine 3 in service-8/1197 Engine 9 in service-211199 Engine 1 in service-9/1/97 Engine 11 in service-2/1/99 Engine 14 in service-2/1/98 Engine 2 not in service-est. 71`99 ixz- uj rl— C140 0 m co 0) m � c) � Lo N :` to co t3 a C-i C6 C6 c r c E � In C; co v- N C� Ct: co m I- _N 0 t� � Qt iia. Cil to CM? C`'3 C"5 .' did E E YC � �sW^ «d E 0 w 2M U ✓s M C 0 G G} r- e O C� r 0 Cif 0 CL CL M CN CN r- Qf ' CL Z Cl` USS ® , 00 co C, ' to M � s - co '�'• c rl-3 - Ui to t �e- � o U. CO 40 to Violw ep U AINIR Emergency Ambulance Response Times .January-February 1997, 1998, and 1999 Central County 40 35 30 T_*�nspnY. x�pott Tu a 11 Time Timm- J 25 333 j S 20Time on Time on J 15 Scare, ss seem 1Q 5 Xr an-Fab 1997 Jen-Feb 1998 Jan-Fab 1999 West Country 40 35 30F 7_ 7 25 Time Time TLne, 29 15 Tune Q. Tints on Time,on 10 = smote Seas-Feb 1997 Jan-Feb 1995 en-Feb?999 East County Oft 35 30 TMap- Time Time t 25 120 (_ Tune atx JJ Tim rnr 15 # acersaTuaem 3# gcerm; :� .. 19 � 5 Jan-Feb 1997 Jan Feb 1998 Jan-Nair 1899 Source: Contra Corsa En'argtncy Medical Services Agency. REQUEST TO SPEAK ?ORE TMMC 3 X11=Z hIKIT Complete this form and place it in the box near the speakersi rostrum before addressing the board. Name: Phone: y, Address: IL A'q -city: �a I.am speaking for myself , or organization: (now of orwfisci«n) +SCE ONE s I wish to speak on Agenda Item # Date My comments will be: general _ for against- I wish to speak on the subject of . I do not wish to speak but leave these comments for the Board to consider: