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HomeMy WebLinkAboutAgenda - 09-15-1998 - 8dt ORANGE COUNTY BOARD OF COMMISSIONERS ACTION AGENDA ITEM ABSTRACT Meeting Date: September 15, 1998 Action Agenda Item No. $ - d SUBJECT: Reallocation of Capital Funds for Purchase of 12-Lead Monitor Defibrillators DEPARTMENT: Emergency Management PUBLIC HEARING: (Y/N) "`` BUDGET AMENDMENT: (Y/1~ ATTACHMENT(S): INFORMATION CONTACT: 9/10/98 Memo from Emergency Management Nick Waters, ext 3030 Director TELEPHONE NUMBERS: Hillsborough 732-8181 Chapel Hill 968-4501 Durham 688-7331 Mebane 227-2031 PURPOSE: To consider approving a reallocation of 1998-99 capital funds to purchase 12-lead monitor defibrillators for use by EMS personnel. BACKGROUND: The 1998-99 approved CIP includes $80,000 in funding to purchase a replacement ambulance. During formulation of the 1998-99 capital and operating budgets, serious consideration was given to including funding for the lease or lease purchase of six new monitor defibrillators for use by County paramedics. These devices reflect the newest technology in the treatment and monitoring of cardiac patients by paramedics in out-of hospital situations (on scene and during ambulance transport). Given overall budget constraints, funds were ultimately not included in the 1998-99 recommended budget for these machines. The Director of Emergency Management and the EMS Medical Director have recommended that the funding budgeted for ambulance replacement be reallocated to allow the purchase of four (4) 12-lead monitor defibrillators, which would be assigned to the County's Initial Response Vehicles (IRVs). It is their assessment that the enhanced diagnostic and treatment capabilities that will be realized through the use of these machines will lead to better overall outcomes for cardiac patients in Orange County, which is consistent with the main objective of the County's EMS Strategic Plan. They therefore recommend that the planned ambulance replacement be postponed, and plans to acquire four new monitor defibrillators be initiated. The EMS Advisory Council concurred with this recommendation at their August 26, 1998 meeting. Funding for ambulance replacement and two additional monitor defibrillators will be considered during the development of the 1999-2009 CIP later this fiscal year. Explanation of the medical benefits of this acquisition and the rationale for the proposed reallocation of funds are presented in the attached memorandum. If the Board approves this request, staff will proceed with the process to acquire these machines, which would include review and approval at a future meeting of the Board of the purchase agreement. No budget action will be required, as the funds are already appropriated in the 1998-99 Equipment and Vehicle Capital Project Ordinance. RECOMMENDATION(S): The Manager recommends that the Board approve the reallocation of capital funds for the purchase of four monitor defibrillators, and authorize the Purchasing Director to prepare the necessary documents for approval by the Board at a future meeting. MEMO TO: Rod Visser, Assistant County Manager FROM: Nick Waters, Director of Emergency Management DATE: September 10, 1998 RE: Reallocation of Funds to Purchase 12-Lead Defibrillators Emergency Management (EM) staff and Dr. Greg Mears have spent a considerable amount of time evaluating the need for new defibrillators as compazed to the need for a replacement ambulance. As you recall, in 1990, EM staff recommended changing the type ambulances from vans to modular units (patient care compartments can be removed and placed on different chassis). It was predicted that by making this change and by going to diesel engines instead of gasoline engines, that a greater life expectancy for units would be obtained, thereby decreasing the frequency of unit replacement. The modular type ambulances would also allow for unit refurbishment (for example, replacement of the chassis) instead of always replacing the whole ambulance. A total refurbishment would cost approximately one third the cost of purchasing a new unit. Between 1991 and 1994, EM replaced two ambulances a year and now has a total of six modulaz ambulances. The County has not replaced any ambulance since 1994. Prior to this change from vans to modulaz ambulances, the County was purchasing two ambulances per yeaz. An evaluation of the current fleet shows the ambulance mileage ranges from 75,000 to 186,000. All vehicles aze in sound mechanical condition and staff feels we can operate another yeaz without major mechanical problems or excessive down times. The unit scheduled for replacement this yeaz can last another year, as a special event and back up response unit to cover when others aze off line for maintenance. This unit is one of the van type units that EMS will continue to operate since it fits in tight places, more readily than the modulaz type, and is used to cover special events, ball games, automobile races, or for special responses in off-road situations. Dr. Mears and staff believe that use of the approved capital funds to acquire four monitors will have a more positive influence on overall patient outcomes than will an ambulance replacement, at this time. Delaying that replacement by one year should not have an adverse effect on the long-term replacement or refurbishment of the EMS fleet. Paramedics now use monitor defibrillators that aze known as LifePak l Os. These units are limited to 3-lead electro-cazdiograms (ECG) with single lead tracing and monitoring, and to the defibrillation. This means that the paramedics aze precluded from performing additional diagnostic and life support skills on patients suffering from cazdiac events, because of the limitations inherent in the older technology that is currently available to them. 3 The newer technology (12-lead monitor defibrillators) has the capability of performing many more functions. These new machines can have options that allow for external cardiac pacing in certain dysrhythmias and the ability to monitor oxygen saturation in the blood through a pulse oxymeter. These machines can perform a 12- lead ECG (the same as you receive in the hospital) and provide the ability to see more than one lead simultaneously. The new machines are expandable; and future technologies that are being developed include COZ detection in the blood stream, non- invasive blood pressure monitoring and later, bi-phasic defibrillation, and invasive central monitoring. One of the outcomes of the County's multi-year strategic planning process was to improve our capability to manage the cardiac patient in anout-of-hospital setting. These new type machines will allow the paramedics to be trained in additional skills and will allow for the expansion of the cardiac treatment protocols. By having the ability to do 12-lead ECGs, and the other described options, EMS will establish a more accurate base line of cardiac activities for both out-of-hospital treatment and provide valuable data to medical professionals providing in-hospital treatment to patients. Cardiac emergencies are just one aspect of EMS where paramedics can potentially have a clear positive impact on the final outcome of many patients. This new technology will enhance our cardiac treatment capabilities, in keeping with the goals of the strategic plan. The new machines also provide documentation of assessments including oxygen saturations used in the referral or denial of transport to the hospital by ambulance. From a Risk Management standpoint, the need to objectively document vital signs and pulse oxymeter will provide a greater validation for patient treatment and release protocol. Some patients are still being transported by ambulance because paramedics cannot relay vital determinants to the physicians -for example, because our current equipment does not have the ability to measure oxygen saturation within the patient's bloodstream. Some of these transports would likely not be necessary if better on- scene vital measurements could be relayed to emergency room doctors who in some cases will then be able to determine that in-hospital treatment is not necessary.