BACKGROUND: (CONT'D)
The Contra Costa County Fire Protection District (CCCFPD) is proposing an innovative alternative service delivery solution that will provide residents in areas that are affected by fire station closures with emergency medical response and care. This is an opportunity to develop partnership with other stakeholders (e.g., County Emergency Medical Services Agency, affected cities) to collaboratively protect the community.
The residents of our communities have expressed high expectations for levels of service. At the same time, a number of residents have expressed concerns regarding the cost of delivering essential services. CCCFPD has identified a means to provide a first response capability for medical emergencies that will not only provide rapid response and treatment, but will also demonstrate our ability to offer alternative service delivery and staffing configurations at a reduced cost.
Approximately 80% of the District’s responses are related to emergency medical services (EMS). However, it is important to note that the EMS-only pilot program provides a very targeted response capability and will not provide fire and rescue capabilities. This proposed pilot program is designed to provide a targeted response capability during peak service demand time periods.
Objectives
The Fire District plans to achieve the following objectives if the pilot proposal comes to fruition:
• Provide essential emergency medical assessment and treatment
• Reduce response times to medical incidents that occur in areas affected by station closures
• Demonstrate innovation and flexibility by addressing concerns from the community regarding alternative service delivery models
• Assist in meeting state/county requirements for indigent care as outlined in the California Welfare and Institution Code
• Meet performance standards that are defined in CCCFPD’s interagency agreement with Contra Costa County EMS
• Evaluate initial steps toward alternative community-based health care systems that are being mandated by health care reform
• Evaluate the effectiveness of smaller, less expensive response vehicles for emergency medical incidents
• Enhance the recruitment and diversity of applicants to the District and provide a potential career path
Civilian EMS-Only Concept of Operations Proposal:
The Fire District proposes to hire civilian EMS-only (non-firefighter) personnel and manage the deployment of two non-transport medical response units. Each unit will be staffed by one (1) certified paramedic and one (1) certified emergency medical technician (EMT). The units would operate Monday through Saturday from 8:00 A.M. to 8:00 P.M. during peak call volume hours. The units will provide timely delivery of advanced life support services.
The pilot program units will provide coverage at Station 11 in the City of Clayton and in the area of Station 16 in the City of Lafayette. Both units will fill a void in service and response time coverage due to recent fire station closures in the communities.
For standard medical emergencies, the units will be dispatched singularly, or in conjunction with a transport unit operated by American Medical Response (AMR). Upon arrival, the crew will assess the situation and determine if other resources are necessary. If not, the transport unit will be placed in service thus reducing the demand on the response system. The crew will then begin emergency care and management of patient(s) until the arrival of the transport unit. Units will be committed to their respective first-due areas but will be subject to being accessed for other areas in the event of multiple incidents or a large scale event. These units will respond to other emergency incidents (e.g. fire, rescue) in their respective first-due areas to assess the situation and provide a size-up report. However, they will only participate in activities to provide medical care or standby at such events.
The time frame for the proposed pilot program will be two (2) years with ongoing evaluation of performance measures and outcomes. At three (3) month intervals, Fire District staff will meet with representatives from County EMS, AMR, and other partners to discuss the efficacy of the program and determine if any adjustments need to be made. At the conclusion of one year, a stakeholders group will convene to perform further analysis of data that will include, but not be limited to, response times, call volume, adherence to protocol and procedure, patient outcomes, and other measures. At that time, it will be determined if significant programmatic changes are necessary for the second year of the pilot program.
Capital Costs:
It is anticipated that there will be minimal need for capital expenditures.
• 2 – CPR-assist devices @ $20,000 each = $40,000
• 2 – small SUV response vehicles with emergency warning device package @ $40,000 each = $80,000
• 2 – mobile radios @ $6,000 each = $12,000
• The Fire District will provide all of the necessary EMS-related equipment (e.g., 12-lead heart monitors/defibrillators and portable radios to outfit these units)
Staffing:
To staff these new positions the Fire District will hire four (4) personnel with paramedic qualifications and four (4) personnel with EMT qualifications, creating eight (8) new full-time equivalent (FTE) positions within the Fire District.
This pilot program is predicated on the use of civilian EMS providers and not firefighter paramedics. As such, the District will need to establish new job classifications and specifications within the merit system. However, there are a number of existing examples from different jurisdictions to expedite the process. The District would explore alternative hiring processes (e.g., temporary, project, or contractual) on an interim basis to facilitate implementation of the pilot program. Once hired, the new personnel will only need to be trained on local medical protocols and policies since they are required to be certified as a paramedic or EMT to apply.
Personnel Costs: See Attachment B
Annual Operating Costs:
• Supplies – $6,700
• Fuel - $36,200
• Maintenance - $12,400
• Continued Education Training - $7,500
• Total = $62,800
Total Pilot Program Costs:
Based upon staffing, operating expenses, and one-time start-up costs, the District estimates the total programmatic costs below:
Total Operating Cost for First Year per Unit (including startup capital costs) = $409,400
Total Operating Cost for Second Year per Unit = $343,400
Cost Share and Scalable Options:
In order to implement this innovative EMS response concept, it may be possible to share the cost between the various stakeholders. In spite of our challenging fiscal situation, the District may be able to contribute partial funding if other stakeholders (e.g., County EMS, cities that will benefit from the service, or health care organizations) are interested in contributing to the initiative. It is also possible to scale the number of units or hours of coverage to match available funding.
Summary
The Fire District has been severely impacted by the ongoing recession and has closed four (4) fire stations in addition to the two (2) companies that were de-staffed previously. In order to maintain acceptable response times and provide critical medical care to residents in our communities, it is imperative that alternative service models be implemented. The proposed EMS-only concept has the potential to leverage partnerships and accomplish the goal of providing critical service to our residents in a cost-effective manner.
CONSEQUENCE OF NEGATIVE ACTION:
The report on the EMS-only pilot program will not be accepted.
CHILDREN'S IMPACT STATEMENT:
Not applicable.
CLERK'S ADDENDUM
Speaker: Vince Wells, President, Firefighters' Local 1230.
The Board of Directors requested the Fire Chief to return to the Board with a more direct cost comparison to the American Medical Response (AMR) system of operation with the understanding that they are different levels of service. The Board also requested the Fire Chief to include the word "status" in the agenda language in reference to future reports on this matter.