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HomeMy WebLinkAboutAgenda - 03-25-2010 - 2 1 ORANGE COUNTY ASSEMBLY OF GOVERNMENTS ACTION AGENDA ITEM ABSTRACT Meeting Date: March 25, 2010 Action Agenda Item No. SUBJECT: Emergency Medical Services Delivery Report DEPARTMENT: Emergency Services PUBLIC HEARING: (Y/N) No ATTACHMENT(S): INFORMATION CONTACT: PowerPoint_Presentation F. Rojas Montes de Oca, Jr., Emergency 3/16/10 Memo — Municipal Fire and Services, 919-245-6100 Emergency Services Perspective PURPOSE: To present an update to Assembly of Governments members regarding the delivery of emergency medical services (EMS) and the impact on stakeholder agencies particularly in the Towns of Carrboro, Chapel Hill and Hillsborough. BACKGROUND: During the mid-1990's, the Department of Emergency Services 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 service. 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. INCREASED CALLS FOR SERVICE REQUIRE INCREASED RESOURCES Since 2000 emergency medical services (EMS) calls for service have increased from 6,864 to the current calls for service workload of 11,500+. In 2000 there were 3 (24-hour) ambulances and 1 peak-load (12-hour) ambulance. In 2010 there are 4 (24-hour) ambulances and 1 (12- hour) ambulance. Although the population has increased by 13% since 2000, the calls for service have increased 68%. In 2000 there were 6.25 telecommunicators (dispatchers) assigned to each 12-hour shift. In 2010 there are 6.5. The telecommunications phase of the call is critical to ensuring the request (911 call) is processed quickly and effectively. The goal is to process and push the call to the first response agencies within 90 seconds of receipt, but due to added workload and flat resources, the current average process time is 135 seconds. Emergency Services is failing to meet performance goals established in 2001. At that time, the Department set a goal of 12 minutes for a paramedic to reach every patient. Today the time to 2 reach a patient is 17 minutes. This increase in response times impacts area first response agencies, which provide the immediate care to the victim prior to transferring the patient to EMS for definitive care and transport to area hospitals. The unintended consequences of increasing EMS response times is extending the time that a resident having a medical emergency must rely only on basic life support capabilities of fire department personnel. This occurred 220 times in 2009 when an ambulance was not available. This places a burden on fire suppression units and their resources. Vital patient information that should be relayed to first responders is being delayed due to the increased workload and call-stacking by telecommunicators. The State of North Carolina best practice benchmark is 90 seconds for call processing. Orange County has an overall process time of 135 seconds. Performance goals cannot be accomplished without additional resources including communications personnel. While improved technology can address these gaps, personnel are still vitally important. Appropriate resources must be available to assure an equitable, high-performance service delivery system. Those resources include: medical, supervisory, communications, logistical and planning personnel; and a reliable fleet commensurate with advances in medical treatment to maintain high levels of system fidelity. An effort to bring the system up to a moderate level of performance will require additional resources to maintain pace with growth and system needs. RESOURCES NEEDED UNDER IDEAL CONDITIONS • 4 paramedics to address shortages created by the system merge in 2005** • 4 emergency medical technicians (EMTs) to address shortages created by the system merge in 2005** • 5 paramedics for a new ambulance • 5 EMTs for a new ambulance • 1 telecommunicator to balance shifts • 8 telecommunicators add an additional position to handle increased call load • Transport unit: fully stocked and operational ambulance **These staffing gaps are currently filled with part-time temporary employees. FINANCIAL IMPACT: The cost to fully implement an additional unit and added telecommunicators is $1.2M annually and $325,000 for vehicle, equipment, training and support. RECOMMENDATION(S): The Managers recommend Assembly of Government members accept the report from the Director and provide feedback and guidance on incorporating these recommendations for FY2010 -11 and future budget cycles. Current economic realities dictate that a full implementation of these improvements must be phased over several County budget cycles. However, it should be recognized that equipment, staffing and the communications elements are key components to improving emergency medical service response times as they now exist. 3 Critical Mass The impacts of resource limitations of EMS delivery throughout Orange County Colonel F.Rojas Montes de Oca,Jr. Orange County Emergency Services Director March 25, 2010 A Changing Community • Increases in overall population • Increases in chronic disease • Growth in traditionally rural areas • Population is aging 40K �, t � �,• . 36,852 2 a5x did 35K d s• 30.746 25K. ..... 24.680 :" 20K—_.19,550 ' ,, rc. a ,..,... n•. �, 2000 2005 2010 2015 Population 55+Years Old from the OC Master Aging Plan Demographic - increasing demands for 1 4 Increasing Call For Service Demand 'on 2008 165,400 Handled by 6.5 1 � Telecommunicators Handled by 6.25 Telecommunicators Handled by 6.25 Telecommunicators Incidents requiring Orange County 9-1-1 processing. -k¢k-Inc1uW:Lwi E A---L Me ,Fre.C-dy"e Ji p.Wt d 1Mdph Cmge C-ty 914 • demand has increased dramatically •service Increasing Call For Service Demand 2009 Phone Transactions Incidents requiring Orange County 9-1-1 processing. -b.0-ns hek d:I Erd--.K MWleel,P r.Commu dy S.M d"Mo w U-Wh 0-P C-my 91-1 Calls 1,172 . e. D- 2 Extended Call Processing Time Incidents increased by 38% 30 7:40 20 7:12 '■ ■ ■ �■ ■ E3 2008 Incidents Response Response time increased by 17% Increased 9-?-7 service demand has led to increased call processing times. These incidents represent the nurnber of times increased processing times contributed to ra.�nnn.ce tirne.e of nraatar than five minute_v fnr Chanel Nil/Fire t Jnitc Increasing EMS Demand EMS ..nses(2i00 i0• 16000- 68% Percentage . From 2000-2009 11000- 9000- 4.5 ,,, 2009„ 2000 2 02 2003 2004 2006 2006 2007 2008 2009 Ambulances Available The community needs us more than ever and we can't provide those services with existing resources and staffing Below the Bar Paramedic response . .. response time Response times are above accepted standards for an EMS system in National Fire Protection Association Standard 1790 and 1720 Longer Wait Tires , , : 2009 These numbers represent a 74 % increase in the number of times an EMS unit harl a resnnnse time of> 15 minutes in Chanel Hill from 200913 to 2009 7 Impacts on Partner Agencies • There were 56 total 60 incidents in 2009 of scene so "' times of > 40 minutes for CHFD. 40 „ ' °Total • 29 of those incidents 30 incidents occurred because Orange ■Units Waiting County did not have an 20 w ..; ■>49 ambulance available. 10,_ Minutes . 6 of these incidents 0 V resulted in scene times On-Scene > 49 minutes. Times respond These incidents impact our partner agencies by reducing their ability to Impacts ! FDs . Ave Time on Scene 72008 2009 %change Carrboro Chapel Fl�ll Q053 ;;,0.58 8l0 5 8 Below the Ba Ell I The number of times in 2009 that a community member called 9-1-1 for an ambulance and none was available. • s Decrease Re • l - Times • Increase Personnel —4 Paramedics and 4 EMTs (right-sizing) — 6 Paramedics and 6 EMTs (added unit) • Improve 9-1-1 Center Process — 1 Telecom m un icator (right-sizing) — 8 Telecommunicators (decrease stacking) • Equipped Ambulance Additional ambulance will be requested in FY 2011 or FY 2012 6 9 Projected Funding .e "Add ftIkkI $1 ,200,000 in personnel • $325,000 for equipped ambulance 10 MEMORANDUM TO: Roger Stancil, Chapel Hill Town Manager Steve Stewart, Carrboro Town Manager FROM: Dan Jones, Chapel Hill Fire Chief Travis Crabtree, Carrboro Fire Chief SUBJECT: Municipal Fire and Emergency Services Perspective for Orange Assembly of Governments Agenda Item on EMS for 3/25/10 DATE: March 16, 2010 Per your request, we have reviewed the Orange County abstract and power point presentation concerning the Emergency Medical Services Delivery Report prepared by Director Montes de Oca and intended for the Assembly of Governments joint meeting on March 25. We(Jones, Crabtree, and Fire Chief Jeff Cabe of Hillsborough/Orange Rural) actually worked with Director Montes de Oca and his staff in the development of this report and we are in support of the data and numbers presented. However,we want to share some of the material we submitted for inclusion in the report that was not used. We do believe the delivery of emergency medical services is a significant issue and warrants attention as soon as possible. The problem of deficient resources for emergency medical services (EMS) and emergency communications (911 Center) in Orange County is not new and has been developing for a long period of time. System modifications (QRV response), an active first responder system of fire departments, support from volunteer rescue and EMS squad, an old radio dispatch system, and lack of data all combined disguised the depth of the issue. In a bullet point list below we would like Orange County officials to consider some immediate needs of the system as it relates to responsiveness to residents and visitors, detrimental impacts the EMS system is having on other emergency services and the frequency of incidents when emergency coverage of Orange County is placed in jeopardy by these issues. • To ensure quick service during medical emergencies, the municipalities have taken the lead by providing first responder or other medical services through their fire departments to assist in protecting the lives of residents and visitors. Each fire department has a mission statement to protect lives and property and wants to be a good partner with the County. However,the county is charged by state statute with the obligation to provide EMS. • If the fire departments were unable to provide first responder services,there would be even more concern about the delayed responses of County EMS units. • As an example the increasing pressure on Orange County EMS resources directly impacts the fire departments due to an increase in on-scene times of fire units that have arrived as first responders and then the delayed arrival of EMS means those fire units must be committed longer and are unavailable for their primary charge of fire protection responses. From 2008 to 2009, data show a 74%increase in the number of times an EMS unit had a response time in Chapel Hill greater than 15 minutes." 1 11 Fire Chief's memo to Town Managers on EMS Report 3/16/10 • Another impact is the increasing percentage of emergency medical calls in the total call volume of the fire departments. Chapel Hill is up nearly 9.5% in four years at 44.5 %of total volume compared to 35% in 2005. Carrboro is at 52%. The result is less availability of fire units for the community and campus when fire protection and hazard abatement are the fire department's primary functions. The increasing demand for medical calls may negatively impact fire response and all of the fire departments' insurance ratings. • On February 22, 2010 Orange County EMS ran out of available ambulances five times during the 24-hour shift. While this is just one example and not a normal day, it is also not that unusual. This type of situation is happening with increasing frequency, thus leaving residents and visitors more vulnerable. • On February 23, 2010 a Town of Carrboro employee came to the Carrboro Fire Department complaining of breathing problems. The firefighters treated the employee with their basic emergency medical technician (EMT) skills just like they would any other citizen in the county. When they called 911 to request a paramedic ambulance,the 911 telecommunicator stated that they already had four calls stacked and they would be the fifth waiting in line. • Potentially lifesaving medications can only be administered by Orange County paramedics who arrive with the EMS unit or Carrboro EMT's. The expectations of citizens in a true life threatening emergency may not be met when fire department first responders are asked by the victim or family members with increasing frequency, "what is taking the ambulance so long?". • Due to simultaneous incidents and multiple agencies reporting to one telecommunicator,the 911 center should utilize the higher level of technology it has for dispatching services. The fire departments have increas ing concerns about the dispatch resources at the 911 center when these have not kept pace with increasing call volume. The fire departments are dispatched much the same as 15 to 20 years ago despite the increased call volume, a new 911 center, a new 800 MHz radio system, and service delivery advances. This results in greater call processing time and overall response time for all first responders. The telecommunicators' stressful job is performed by a dedicated staff who work extremely hard to obtain quality information from frantic citizens during emergencies.. When obtained in a timely manner, this ensures our first responders and the public's safety. • We encourage the County to consider adding more EMS units in the field ASAP. All three municipalities are willing to work with the County to identify places to park EMS units. Additional dispatch personnel are also needed to separate the 12 fire,EMS, and rescue agencies into more manageable groups—these are currently handled by one telecommunicator. While we understand the budgetary constraints faced by all local governments, we believe this to be an urgent public safety resource need. -Attached to this memo is a chart that demonstrates levels of EMS resources and populations covered in surrounding areas. 2 ,SON.MARCH 200 S SYSTEM COMPAR stem Calls Per Year EM size of Area Tiered SY 13,000 Served Yes Units per daY 401 sq miles staffed 31,012 Served #of 4.5 Ambulances Yes pop. 2g8 miles Agency 126,532 sq 24,000 11 ambulances' IRV orange Yes 262,715 435 sq miles 10,000 Durham 7 Ambulances,31R V's Yes 148,053 es plus 6 Al-S 31.8 sq miles Ala 72,233 4.5 ambulanc 47,000 fire engines Yes ?2,233 658 sq miles 5760 16 Ambulances plus 7 Greenville Yes Green IR�s miles 245 sq 5588 472,216 3 ambulances I.Io Guilford 44,000 s 2 more 4p4 sq miles 4000 3 Ambulance Yes Vance ordered. 428 sG miles 35,623 2 5 ambulance person 3700 23,501 Yes Caswell 83 sq rniles 1 ,000 residents, 7,00 8 50,000 during 3 ambulances Yes mi ess hours 709 sq miles 18( basin V,s No Sthfield Ambulances,31R miles 4.5 Am 78,65 sq 49,329 2 ambulances Chatham 20,000 Washington