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HomeMy WebLinkAboutMINUTES - 03142000 - SD.14 TG1. BOARD OF SUPERVISORS ,FROM: William B.Walker,M.D.,Health Services Director Contra DATE: March 14,2400 Costa County SUBJECT: Report on Fire Paramedic Services and AMR Contract SPECIFIC REQUEST(S)OR RECOMMENDATIONIS)&BACKGROUND AND JUSTIFICATION RECOMMENDATION: I. DIRECT the Health Services Department to continue to assist the County Fire Chiefs' Association in development of a plan for a countywide paramedic first responder program. 2. AUTHORIZE continuation of the AMR contract changes initiated February 1, 1999 for central county under which a$14,550 monthly reduction in AMR's subsidy is used to partially fund Contra Costa County Fire's paramedic first responder program and AMR's response time requirements in central county are changed from ten minutes for 95 percent of emergency calls to ten minutes for 90 percent of calls. 3. AUTHORIZE the Health Services Department to negotiate with AMR to achieve a subsidy reduction to be used for partial funding of a pilot paramedic first responder program to serve El Cerrito and Kensington similar to the program approved by the Board on September 22, 1998 which serves central county. 4. AUTHORIZE the Health Services Department to negotiate with AMR to achieve subsidy reductions and/or payments to the County to support or partially support countywide paramedic first responder services and to fund additional staff positions that may be required within the EMS Agency to oversee this program. FISCAL IMPACT: No County General Fund impact. Additional costs for expanding paramedic first responder services in El Cerrito and Kensington will be covered through CSA EM-I (Measure H)by shifting funds from the AMR subsidy and/or from other non-County sources. The full countywide implementation of first responder paramedic services will result in significant new costs for the EMS Agency and for those fire agencies undertaking or expanding paramedic services. EMS is working together with the fire services and with AMR to identify the amount of additional cost and to identify sources of funding. BACKGROUND: Fire Paramedic Services On September 22, 1998,the Board of Supervisors approved an amendment to the Emergency Ambulance Agreement with AMR enabling Contra Costa Fire to expand its paramedic first responder program with funding obtained by a reduction in the AMR subsidy. AMR,in return,was allowed to reduce its paramedic ambulance coverage in the central county area receiving expanded fire paramedic coverage. The Board also directed the County Administrator,the Health Services Director,and the Contra Costa County 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 identification of new or existing funding sources. On February 1,2000,the Board directed Health Services to report back to the Board"with a plan and a time table regarding the American Medical Response contract,in order to give the County flexibility in developing a county-wide engine-based paramedic system." Since September 1998,Contra Costa Health Services EMS staff has worked closely with Contra Costa Fire and with AMR on the expanded fire paramedic services in central county and is currently working with the Contra Costa County Fire Chiefs Association in the preparation of a plan for countywide paramedic first responder services. The fire chiefs are supportive of the concept of engine-based paramedic services,but details of the program's operation and estimated cost are still being resolved. A report and recommendation from the Fire Chiefs'Association is expected to be completed by May 2000. CONTINUED ON ATTACHMENT: YES SIGNATURE RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE APPROVE OTHER SIGNATURE(S): ACTION OF BOARD ON March 14, 2" APPROVED AS RECOMMENDED xx OTHER VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE — —UNANIMOUS {ABSENT— — — — 4 AND CORRECT COPY OF AN ACTION TAKEN AYES:1,�,TV & TTT NOES: V AND ENTERED ON THE MINUTES OF THE BOARD ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN. Orig Dept:Emergency Medical Services 646-4590 CC: County Administrator ATTESTED March 14, 2000 County Counsel PHIL BATCHELOR,CLERK OF THE BOARD OF Auditor-Controller SUPERVISORS AND COUNTY ADMINISTRATOR Health Services Administration Contra Costa County Fire Protection District City of El Cerrito Fire Department By -,DEPUTY Contra Costa County Fire Chiefs Assn American Medical Response T- 2 , In addition to working with the Fire Chiefs' Association,EMS has also worked with individual fire service agencies interested in pursuing paramedic services. Currently,El Cerrito Fire,due to openings within the department,has an opportunity to hire sufficient paramedic firefighters to initiate one paramedic engine,which would be able to respond to medical emergencies in Kensington and El Cerrito. Having a paramedic engine able to respond to medical emergencies in El Cerrito and Kensington would be particularly advantageous due to the long ambulance response times experienced in parts of this area. The following is a list of fire services within the county and their current paramedic status. Note that all fire services in Contra Costa County have been trained and equipped to provide first responder defibrillation. Bethel Island Fire—paramedic first responder service on most shifts Contra Costa County Fire—paramedic first responder service in central county areas Crockett-Carquinez Fire—no paramedic service East Diablo—paramedic first responder service provided by AMR covering Byron,Discovery Bay,and surrounding areas El Cerrito Fire—no paramedic service Moraga-Orinda Fire—paramedic ambulance and paramedic first responder service Oakley Fire---no paramedic service Pinole Fire--no paramedic service Richmond Fire—no paramedic service Rodeo-Hercules Fire—no paramedic service San Ramon Valley Fire—paramedic ambulance and paramedic first responder service Plan and Timetable Regarding AMR Contract The following plan and timetable is recommended with respect to the AMR contract: February—May 2000 Completion of Fire Chiefs' report, identification of costs for countywide engine-based paramedic services,negotiations with AMR regarding service delivery model and funding. May—June 2000 Presentation of recommendations to Board of Supervisors and governing bodies of non-County fire services. July 2000 Recommendation to Board of Supervisors regarding AMR contract/ decision to re-bid ambulance services. The existing AMR contract is for a five-year period from November 3, 1997 through November 2,2002. County payments to AMR for ambulance services amount to$1,913,220 annually. This figure does not include$232,840 annual payments to AMR for maintaining a non-transporting first responder paramedic unit at the East Diablo Byron fire station or$174,600 annual payments diverted from the AMR subsidy to support the four-unit expansion of the Contra Costa County Fire paramedic program. The subsidy does include coverage for ambulance services,primarily to indigents,provided under the Contra Costa Health Plan and services to inmates of the county jail. The cost,calculated at the MediCal rate,of providing these services amounts to about$493,000 annually. Three contract provisions relevant to EMS system redesign include(1)contractor's agreement"to participate and assist in the development of system changes subject to negotiated costs," (2)contractor's agreement to"participate in those pilot emergency response programs which from time to time are established by the Contract Manager,"and(3)County's right"at its sole discretion[to]terminate the contract by giving twelve months advance notice,when said termination is made in conjunction with any redesign of the County's existing EMS system." AMR is currently working with Health Services EMS staff to identify a subsidy reduction to support implementation of first responder paramedic services in El Cerrito and Kensington and has indicated its commitment to work with EMS and the fire services in the development of countywide first responder paramedic service. It may be more advantageous to the County to continue to work with AMR in implementation of incremental changes to the EMS system than to re-bid ambulance services at this time. Should the decision be made to re-bid ambulance services,EMS estimates that the bid process would require about 15 months. Months 1 -3 Preparation of RFP, including discussions with non-County fire services and approval by Board of Supervisors. Months 4 6 Proposal preparation, including bidders conference. Months 7-9 Proposal analysis,selection committee review and recommendation,contract negotiation,approval by Board of Supervisors. Months 10- 15 Startup period allowed for new provider. If a decision is made to re-bid the ambulance service contract,notice to AMR should be given at the time the Board approves an RFP,if approval of an RFP occurs prior to November 2001.