HomeMy WebLinkAboutAgenda - 05-05-2009 - 7bORANGE COUNTY
BOARD OF COMMISSIONERS
ACTION AGENDA ITEM ABSTRACT
Meeting Date: May 5, 2009
Action Agenda
Item No.
SUBJECT: Emergency Services Annual Report: Performance Update and
Recommendations for Continuous Improvement
DEPARTMENT: Emergency Services PUBLIC HEARING: (Y/N) No
ATTACHMENT(S):
1. Performance Charts and
Recommendations Presentation
INFORMATION CONTACT:
F. Rojas Montes de Oca, Jr.
Emergency Services, 245-6100
PURPOSE: To inform the BOCC of changes made within the Emergency Services Department
to improve performance and enhance safety throughout Orange County along with projected
costs to support and sustain continuous improvement.
BACKGROUND: Emergency Services has an outstanding history in the protection of Orange
County and the communities within. During the 1960's through the mid-1990's the Department
focused primarily on civil defense preparation, emergency communications, fire prevention and
coordinated the efforts of area volunteer emergency service organizations. The structure was
typical of most county emergency management organizations within North Carolina.
During the mid -1990's the Department began to evolve as a result of the changing
demographics and increased urbanization within Orange County. The calls for emergency
medical treatment and transport continued to increase making apparent changes needed to
continue providing reliable, consistent emergency medical services. Two significant changes
occurred: 1) An Initial Response Vehicle or IRV service was implemented in 1995 to rapidly
deploy paramedics with their advanced training and skills to patients; and 2) The volunteer
medical transportation service merged with the County-operated treatment (paramedic) services
in 2003 to create the current Orange County Emergency Medical Services system. At the time
both initiatives were necessary and served a community well with limited resources.
Improvements Made
Emergency Services is changing the way it conducts business. More structure has been added
to the daily management of operations; personnel have taken on a renewed enthusiasm for
doing things from a different perspective; procedures are being written to ensure compliance
2
with state and federal requirements; operations at all levels are being reviewed to ensure they
reflect best practices; and a staff of future leaders is developing.
In 2008 the new Orange County Emergency Services Headquarters and Emergency 9-1-1
Communications Center, which houses the County's Emergency Operations Center, opened in
the Meadowlands. The 800 MHz VIPER radio system continues to be implemented for the
majority of emergency responders within the community. The three municipal police
departments were the first to execute the changeover with the new system being adopted by the
fire and rescue agencies within the next 30-60 days. The radio project had been a priority for
the Department since 2002 and with the concerted efforts of all Department members the
system will be fully functional and providing a greatly enhance level of interoperability in 2009.
Emergency Services must look to the future to ensure its ability to address increasing demands
for service both internally and externally. In order to assure a strategic path is set, the
Department initiated the Prometheus Process; a .planning process to develop strategies for
addressing current and future challenges. The process includes input at all levels of the
organization, allowing vetting by management and staff to address current and future issues.
Improvements Needed
Since 1995 emergency medical services (EMS) calls for service have increased from 6,000 to
the current calls for service workload of 13,000+. What has not changed commensurate with
steady increases in call volume is the amount of resources available to Emergency Services. In
2005 there were 3'~2 transport units and in 2009 there are 4 units. In 2006 it was estimated that
at least 5 transport units should be available 24/7. As the population continues to increase in
size, age, and physical condition the need for transport units, emergency medical technicians
(EMTs), paramedics and supporting infrastructure becomes more acute. The need exists today
for six paramedic-level transport units.
Response times do not meet targets set in the Department's system plan. In 2001 the
Department set a goal of 12 minutes for a paramedic to reach every patient. Today the time to
reach a patient is 17 minutes and rising. Information relayed to responders has become
truncated due to mounting call volume and worker fatigue. A 90 second "out of chute" time is the
State EMS standard -meaning from communicator receipt of the 911 call to communicator
contact to the EMT or Paramedic is not to exceed 90 seconds. Orange County cannot sustain
this standard without additional communications personnel.
Appropriate resources must be available to assure an equitable and high-performance service
delivery system. Those resources include: medical, supervisory, communications, logistical and
planning personnel; a reliable fleet; safe, clean facilities to house personnel; training
commensurate with advances in medical treatment to maintain high levels of system fidelity;
equipment to protect personnel and basic needs such as patient supplies and equipment;
uniforms and personal protective equipment.
Additional investment in the 800 MHz radio system is necessary for reliable interoperability and
countywide reception fidelity. While it possesses many advantages over the current mixed-
spectrum system, full utilization of 800 MHz technology and adequate field personnel safety
depend upon continued investment.
To reverse structural erosion and enable the Department to reset its performance fidelity
commensurate with constantly increasing calls for service, several actions must be taken.
2
• Update the organizational table to reflect a modern, National Incident Management
System (NIMS)-compliant, flexible agency capable of addressing the needs of the
community whether day-to-day or during disaster operations.
• Invest in field personnel and support staff, facility upgrades and support programs.
• Invest in facilities the department operates and/or co-locates with other agencies.
• Provide funding for essential needs such as uniforms and protective equipment.
Although the County is initiating Phase One of a study identifying component needs that support
a robust fire/rescue/emergency medical services system throughout the County, immediate
changes are warranted within the Department to address current and significant service delivery
challenges. The costs, while substantial, can be prioritized and implemented over a series of
fiscal years.
The presentation to be made at the Board meeting will highlight organizational and operational
upgrades currently underway, illustrate an integrated solution approach, identify funding needs,
and seek input and feedback for moving ahead.
FINANCIAL IMPACT: The total cost for full implementation of Departmental recommendations
is estimated at $2,315,000. ($1,040,000 in Personnel and $1,275,000 in Facilities, Fleet and
Support) Careful planning and prioritization will be required over a series of fiscal years to meet
Departmental objectives within County resource projections.
RECOMMENDATION(S): The Manager recommends the Board accept the report from the
Director and provide County Management with feedback and guidance on incorporating
Departmental recommendations for performance improvements in FY 2009-10 and future
budget proposals.
A Year in Review
A Presentation to the Board of Orange County Commissioners
Highlighting the Accomplishments and Immediate Challenges Facing
Orange County Emergency Services
F. Rojas Montes de Oca, Jr.
Orange County Emergency Services Director
A t ~ i' ~ ~.
A Dedicated Staff
- Taking on New Responsibilities
- Developing New Leadership Skills
- Planning for Future Community Needs
- Creating Succession Planning
- Addressing Partner Needs
0
Facility Upgrades
- New 911 Communications Center
- Enhanced Emergency Operations Center
- Updated Department Headquarters
- Efland Rescue Station/EMS Station 4
- County Warehouse
c
Operational Improvements
- IRV to Traditional EMS Delivery System
- Countywide EMS Training Program
- 800 MHz System Cutovers
- Safety Monitoring of Radio Traffic
- Customer-Focused Planning
0
Project Successes
- VIPER Radio System
- Address Mapping Updates
- Special Operations Teams
- CAM ETS
- Community EMS Station Location Plan
0
• Growth in traditionally rural areas • Population is aging
P~rcentag~ Growt~i
From 1990-200a
40K
35K
30K
25K
20K
Population 55+ Years Old
from the OC Master Aging Plan
0
• Increases in overall population • Increases in chronic disease
Total incidents requiring 9-1-1
dispatch in Orange County
*Incidents include: Law Enforcement, Medical, Fire, Community Service dispatched through OC 9-1-1
0
EMS Responses (2000-2009)
17000
15000
13000
11000
9000
7000
5000
o°
ti°
# Paramedics
# Ambulances
o'` o`~ o`~ o°` o`' o`O o1 00 ~~a
~o ~o ~o ~yo ~yo ~o ~yo ~o ~~
Q~o~
o°'
~~
10
9
8
7
6
5
4
3
2
1
0
Percentage Growth
From 2000-2008
Projected Growth
From 2008-2009
Paramedic response goal
Current paramedic
response time
The number of times in 2008 that the
community called 9-1-1 for an ambulance and
none was available.
Provide the highest standard of care and
customer service when citizens and visitors call
9-1-1.
Response Time
Outstanding Medical Care
Full Operational Safety
Monitoring to Citizens
and Responders
12 Minute Paramedic 00:00:45 Dispatch Time
Operations Staff
Support Staff
Equipment & Technology
t 1: ,: ,~
~F~1'',{.~~F! +`i( ~~rd1t`'~~'if:"~ g',~~y f.~..#+r ~i{~~~?~ )f`~f °~/di~ y 11i~ .,` ~t~?~<~'>°~~ k; t~~f{~ {~f~~ftli!{~~1aj~`i.
Operations Staff
Support Staff
Equipment & Tech
( ~
Operations
uipment
Support
0
Operations Staff
Equipment
Support Staff
0
0
Add ~?~~
Stiff
Add
q c~~ rya ~r~ t
5~~~~rt
Staff
12 minutes
O
~11~ Q~~
~t~'
No
~~c~~,~rrt~r~t
No ~u~~ort
Staff
17+ minutes
i 4` b j 1 ~ ((/€ ~ r S'~lj~ l ~ /(
(~~ ~ ~ 1 ~.~ s l ~f ~`t ({ 1~;' ~ (/ ! C~ ~! ;` . `4 (~. 1 } ~ f ~ . 4~,, f t 1 1 ~ t .~ 1..~ f t .~ 1 ~ ~ ~ ~' \. ^~ ~ ~
• 24/72 (Current)
- 24 hours on/72 hours off
- On-Call Consistently Needed
- Reduces Available Units
- Maintains High Response Times
0
• 24/48 KD (Kelly Day)
- On 24 hours/Off 48
-Off Every 5t" Shift
- Decreases Staff Recovery Time
-Increases Resource Availability
- Reduces OT
-Requires More Staffing
-Costs More
0
• 24/72 PL (Peak Load)
- Hybrid of Current Model
-Allows Staffing When/Where Needed
-Allows Staff Recovery
-Allows Appropriate Supervision
- Up to 2 More Units Without Added Cost
- Could Reduce OT Costs
0
• Longer EMS response times
• More calls with no resources
• Poor patient outcomes
• Loss of public confidence
• Continued drop in morale
• Reduced field unit safety monitoring
• Increased injuries and workers comp
• Increased overtime
• Increased sick time
• Continued employee turnover