HomeMy WebLinkAboutAgenda - 11-17-2011 - 3ORANGE COUNTY
BOARD OF COMMISSIONERS
ACTION AGENDA ITEM ABSTRACT
Meeting Date: November 17, 2011
Action Age ~a
Item No.
SUBJECT: Discussion with the Board of County Commissioners Regarding Plans to
Improve the Emergency Medical Services Delivery System
DEPARTMENT: Emergency Services
PUBLIC HEARING: (Y/N) No
ATTACHMENTS:
1) Ambulance Mileage Comparison
2) Ambulance Accident Disposition
3) EMS Response Zones Map
INFORMATION CONTACT:
F. R. Montes de Oca: 919-245-6100
Michael Talbert: 919-245-2153
PURPOSE: To receive background and historical information regarding the County's
Emergency Medical Services System and to authorize the Manager to contract with a
consultant to assist the department with development of a multiyear strategic plan.
BACKGROUND: The Orange County Emergency Medical Services System provides
prehospital care and transport to residents and visitors throughout the County. Originated from
volunteer services, Orange County Emergency Medical Services (EMS) began providing
advanced life support ambulances in the 1980's. Emergency Medical Services is a branch of
Orange County Emergency Services Department (OCES) and is staffed by dedicated
paramedics and Emergency Medical Technicians around the clock. The EMS branch is the
largest and highest-profile group within the department providing emergency response, patient
care and patient transport from 400 square miles covering densely-populated urban settings to
rural areas throughout the County. In addition to responding to 13,000+ calls annually, EMS
must be able to address extraordinary events such as multi-casualty incidents (MCIs), large
sporting events, stock car races and mass gatherings, assist at fires, evacuations and other
disaster situations affecting public safety.
The following is a history of the achievements within the EMS System supported by the Board
of County Commissioners. The Emergency Medical Services delivery system evolved from two
"divisions" -the career County paramedic (treatment) division and the volunteer EMS (transport)
squads in 2005. Prior to that, the County provided funding to the volunteer squads to cover
fuel, supplies and other operational costs. As the costs rose, the County decided to join the two
divisions into one EMS delivery system.
1968: Orange County Rescue Squad was established
1971: South Orange Rescue Squad was established
1980's: Orange County Emergency Medical Services Hired Permanent Paramedics
1993: Orange County Adopted a Franchise Ordinance
1993: Orange County franchises convalescent ambulance services
1995: Orange County adopts the Initial Response Vehicle EMS System
1999: Two Rescue Squads Merged into Orange County EMS and Rescue Squad, Inc.
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2002: Squads separate into South Orange Rescue Squad and Orange EMS and Rescue
2005: County merges treatment and transport and rescue squads granted BLS non transport
2008: The Franchise Ordinance was revised.
2008: Emergency Services Director recommends ambulances be increased from 3'/i to eight
2009: Initial Response Vehicle program shifted to ambulance-based system
On May 5, 2009, the Emergency Services Director reported to the Board a need for additional
resources including staffing and equipment to improve response times, which at the time were
17 minutes rather than the goal of 12 minutes and resulted in 235 instances when an
ambulance was not immediately available to respond.
On March 25, 2010, the Director of Emergency Services reported to the Assembly of
Governments on the continued need for resources to reduce increasing response times (over
17 minutes).
In early 2011, the department entered into an innovative partnership with Durham Tech. With
ten available paramedic positions, a "Paramedic Academy" was created with the goal of training
up to ten field-ready paramedics in a shorter time than normal recruitment and hiring processes
typically take. When a vacancy occurs, it can take up to six months to recruit, interview,
process and hire a candidate. Following the County's vetting process, it then takes an
additional 4-6 months to field train and clear the medic through required testing and
credentialing. The plan was to begin training personnel already hired and vetted and develop
Orange County paramedics able to operate within the County's medical protocols and
departmental policies and procedures. An additional benefit was employee loyalty, which would
help to stem the revolving-door process that many employees undertook when a competitive
salary was offered elsewhere.
With the addition of up to eight additional paramedics, the department will be able to staff
another peak load unit (12-hour) with permanent employees. This was achieved by giving up
senior management positions and did not increase the department's personnel line costs. This
initiates the process of "right sizing" the EMS branch to accomplish the goal of reducing
overtime expenditures. As this was accomplished, immediate deficiencies were addressed;
however, the department was unable to add additional ambulances to reduce the growing
response time or improve service.
Current and Future Stations
Currently, the department operates from five stations:
Station 1 -Revere Road, Hillsborough: This is the only station that is wholly owned and
operated by Orange County and was realized following refurbishing the old Animal Services
Building. It is minimally furnished, it does not have backup power to accommodate disaster
operations, and units are stored outside in the weather. The station opened for business in
2009.
Security is adequate, but not excellent, the surrounding parking access parking lot is littered
with potholes, and ingress/egress is challenging due to its blind-spot access onto Revere Road.
This station renovation was the result of BOCC budgetary support during FY 2008/2009.
Station 2 -Robeson Street, Carrboro: OCES has operated from this station, which is owned
and operated by the South Orange Rescue Squad, for over twenty years. It has served the unit
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well, but there are challenges operating out of a facility not owned by the County. The facility is
filled to maximum capacity with South Orange vehicles and equipment so much that the County
ambulance must park outside in the elements. It is not in an optimal location as growth in that
area is moving north and west. The area can be served much better from the UNC (Medic 5)
station and deserves relocation to another site within the Carrboro area with quick access to
Highway 54.
Station 3 -Mason Farm Road, Chapel Hill (UNC): The University of North Carolina and
Orange County worked for two years to secure a facility maximizing service to the UNC
campus, Chapel Hill a.nd parts of southern Orange County. This location's close proximity to
the UNC Medical Center and campus and south-central Chapel Hill is a strategic for improving
response times. The station opened for business in 2011 with the support of the Board of
County Commissioners in an effort to continue reducing response times. This facility does not
have a structure that facilitates keeping the ambulance out of the elements.
Station 4 -Mount Willing Road, Efland: Owned by the former Efland Rescue Squad, it is
managed by the Efland Fire Department with OCES operating from it since 1985. It was
cleaned and cosmetically renovated for approximately $5,000 in 2009 and offers basic comfort
and convenience to the crews. It is a metal skin butler building served by a forty year plus
septic system, has no parking for the crews, and does not include a structure that
accommodates an ambulance. The one room station is minimally furnished, it does not have
backup power to accommodate disaster operations, and units are stored outside in the weather.
The one room crew quarters does not lend itself to adequate living conditions. It is in an
excellent location to serve the west side of the County both north and south of its location due
to its proximity to I-85/140. The building is a metal skin over metal frame building that will
need significant upgrading should the County wish to continue operating from it in the
near future. It does not provide shower facilities, requiring the crews to stop into another
station should they need to decontaminate following a significant event or call.
Station 5 -Eubanks Road, North Chapel Hill: This station opened for business in 2011 and
the unit currently operates 12 hours daily, seven days a week from the Operations Base of the
Solid Waste Department. It is an excellent site strategically serving the New Hope, Orange
Grove and North Chapel Hill areas. The site is used simply as a rest area for the crews
allowing them to stop in between calls, catch up on incident and patient reports and fix a light
meal. This is another example of innovative use of County assets supported by the Board to
further serve the public need.
Response is impacted by call processing time, distance to the call and readiness of the
resources to respond. A robust roadway system in Orange County does not exist, with reliance
on two major thoroughfares (Old Highway 86 and New Highway 86) for north-south access and
two major thoroughfares(I-40 and I-85) for east-west access to access the bulk of the
population. Therefore it is necessary to develop and maintain a system of strategically placed
points of delivery -EMS stations -throughout the community served.
Staff recommends additional resources to reduce response times and recommends that a
consultant be engaged to review and determine feasibility of those recommendations to assist
the.department in the development of a strategic plan.
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To address the growing need to provide upgraded service to the northern and western areas of
Orange County, the department needs to establish stations strategically located to adequately
serve the community. Stations should be established north of US 70 and in the southwest area
of Orange County to address rising response times. Whenever practical, new stations should be
co-located with VIPER tower locations to share backup generation systems, safe traffic access.
Not including the land cost, a station is estimated to cost between $500,000 and $600,000. The
attached map indicates general areas where stations should be placed to best serve the
County. The limited roadway system in the rural areas necessitates the distribution of stations
to adequately deliver acceptable response times while partnering with first responders for their
immediate basic care skills.
An adequate matrix of stations allows for system flexibility to address call surges, crew and unit
transfers supporting personnel development and sufficient resources to accommodate MCIs
and disaster event response. Further, placing additional units in strategic locations helps to
reduce response times to allow for fire departments to clear medical scenes, provide assistance
necessary during fires, evacuations, extended events, hostage situations and mass gatherings.
Growth of the system allows for backup capability to provide for first responder support and
protection as necessary during fires, evacuations, extended events, hostage situations and
mass gatherings.
Equipment Needs
The department has very limited capabilities to manage amulti-casualty incident (MCI) or
significant surge in activity with current equipment. A 1990 converted delivery truck has been
used in the past as a hazardous materials/command unit, but its extended wheelbase and
mechanical and electrical issues make it difficult to use. Current trends in the industry are to
design multi-use (MCI/Rehab/Evacuation) capable units to handle multiple uses.
In the event EMS had to treat 25-50 trauma patients as would be seen at a school bus accident,
the department would be hard-pressed to safely or effectively accommodate this need.
Concurrent with the need to "treat" trauma victims, as the population ages more events
surrounding nursing and assisted care facilities will be experienced. Whether to cool or heat
evacuees or rehabilitate first responders at all types of events, a replacement of the
department's multi-purpose vehicle is warranted. Cost is estimated at $50,000 for converting
(re-tasking) an older F450 ambulance.
Cardiac monitor-defibrillators currently in the department's fleet are rapidly nearing their life
expectancy. In 1999, Orange County paramedics were trained to record and interpret 12 lead
electrocardiograms and to thus recognize acute heart attacks. Medtronic Lifepak 12s were
purchased and have since been the standard of care. These units are 12 years old and must
be replaced within the next 12-18 months. The Medtronic Lifepak 12's are no longer
manufactured and are replaced by the newer model Lifepak 15's, which cost approximately
$36,000 each to provide excellent standards of patient care. These monitors allow paramedics
to monitor critical vital signs during treatment and transport. The entire fleet of fourteen (14)
needs to be replaced and an additional six (6) should be added to accommodate additional
medic units and the increasing numbers of special events. At the current per unit cost, the total
would be $720,000.
Laptops are used to record patient data at the scene; securely submit patient reports; and
incorporate Global Positioning System (GPS) "reckoning" for responding units. Units must be
rugged enough for field use, but expandable for longevity of life. Current models are $3,000 per
unit, although cheaper tablets may be worth consideration.
Depending on the number of additional stations needed based on the consultant's
recommendation, an ambulance will need to be added to the fleet of frontline units. Backup
ambulances are needed to ensure system reliability (the typical schedule is one backup for
every three frontline units).
FY 2012/13
(10) Medtronic Lifepack 15 $36,000 $360,000
The current models have reached the end of their
useful life and will no longer be serviceable
after 2016.
(20) Replacement Panasonic Tough books $3,000 $60,000
The current models have reached the end of their
useful life and their "no fault" warranty has expired
should any unit break they are very costly to repair
because the model is no longer supported. All patient
care reporting and billing is generated from the tough
book.
(2) Replacement Ambulance $230,000 $460,000
These ambulances replace the aging 2005 F-450
models which are twice as costly to operate per
mile as compared to the new medium duty chassis
model.
EMS Equipment Funding Requested FY 2012/13 $880,000
FY 2013/14
(10) Medtronic Lifepack 15 $36,000 $360,000
The current models have reached the end of their
useful life and will no longer be serviceable
after 2016.
(2) Replacement Ambulances $230,000 $460,000
These ambulances replace the aging 2005 F-450
models which are twice as costly to operate per
mile as compared to the new medium duty chassis
model.
~) Mass Casualty/Rehab Response Unit $50,000
This unit replaces the F800 1990 unit to provide vital
surge and rehabilitation equipment to mass casualty
scenes, special events, and extended emergency
responses.
EMS Equipment Funding Requested FY 13/14 $870,000
FY 2014/15
(4) Replacement Tough books $3000 $12,000
The current models have reached the end of their
useful life and their "no fault" warranty has expired
should any unit break they are very costly to repair
because the model is no longer supported. All patient
care reporting and billing is generated from the tough
books.
(1) Replacement Ambulance $230,000
This ambulance replaces the aging 2006 F-450
model which is twice as costly to operate per
mile as compared to the new medium duty chassis
model.
(2) Remount MD Ambulances $110,000 $220,000
To replace the aging chassis and to extend the life
of the box up to four times at one half the original cost
of the new ambulance.
EMS Equipment Funding Requested FY 2014115 $462,000
Staffing Needs:
To allow for employee leave, illnesses/injuries and other absences, a unit requires replacement
staffing equivalent to about 40% more than the eight personnel necessary to staff the unit 24
hours per day. Therefore, each unit's staffing should represent 11.2 personnel. Although there
has been no definitive staffing matrix established yet, current authorized positions allow the
EMS Branch to field five twenty-four hour units every day and one 12 hour unit daily.
Ambulances are staffed with one paramedic and one emergency medical technician (EMT) as a
minimum. In some cases there may be two paramedics, but this is usually to accommodate the
training or skills upgrading for an individual.
In the early 2000's the call volume began to outpace available EMS resources because staffing
was not adequately addressed. Orange County relied on temporary staff and the use of
overtime to add an additional 12 hour transport unit to increase the number of transport units to
3'/2. In 2008 the addition of 4 permanent EMTs allowed the department to increase the number
of ambulances to 4. In May of .2009 after the redeployment of the Initial Response Vehicle
(IRV) paramedics, the department increased the number of ambulances to 4'/z. The
department operates a mixed shift system with a 24/72 rotation and a modified 12 hour DuPont
schedule. The 24/72 shift means an individual is on for one 24 hour period and is then off for
72 hours. This requires four shifts to provide around the clock coverage. The 12 hour modified
DuPont schedule requires two shifts to provide peak load coverage seven days a week.
Currently there are four 24 hour units and one 12 hour unit serving the County seven days a
week. The department is currently training staff to add at least one additional 12 hour unit to
the system to address peak workloads and better manage personnel costs. This addition will
also increase unit availability.
In 2007/2008 the system utilized the 24/48 staffing model to place more units on the road, but
the impact to overtime spending was severe. This increased workload on staff led to increased
worker's compensation claims, increased turnover within the department and early retirements.
In fiscal year 2007/2008 overtime (department wide) was $663,360.
A common myth is that adequate staffing negates the need for overtime. Although overtime is
reduced when sufficient numbers of units are fielded to address system needs, overtime is
necessary to accommodate absences due to employee leave, illnesses and mandatory training.
Most EMS systems utilizing best practices address these issues by having sufficient resources
that allow staffing above the critical level. For example, a neighboring system deploys as many
as seventeen ambulances but identifies minimum staffing at thirteen units before overtime is
utilized to re-staff above critical levels.
Over the years, overtime has been reduced by nearly ten percent per year since
2007/2008. In fiscal year 2010/2011, overtime expended to maintain EMS, E911 and
mandatory support coverage was $484,290 department wide, a 27% reduction in overtime
spending since FY 2007/08. This reduction in overtime was achieved by re-tasking available
assets, flexibly redeploying resources, and working diligently with Human Resources to reduce
recruitment and hiring timeframes.
In addition, staffing needs were being addressed to begin right-sizing the system. Those efforts
are still underway to further reduce overtime spending. Additional staffing is necessary to
improve EMS response time and reduce overtime spending by putting additional ambulances
into the system. To accomplish this with the Boards support, the EMS system needs to add
staff.
FINANCIAL IMPACT: The approval of these recommendations will have a financial impact on a
multi-year basis regarding capital and equipment additions and improvements and additions in
staffing.
(Agenda Item #5 for this November 17, 2011 meeting provides a summary of the potential costs
associated with Emergency Services Coverage, Capacity and System Improvements addressed
in this and other agenda items.)
RECOMMENDATION(S): The Manager recommends that the Board authorize the Manager to
contract with a consultant to assist the department with the development of a multi-year
strategic plan addressing EMS station locations, equipment and personnel needs. The purpose
of the study is to provide a comprehensive and scheduled approach with associated costs for
Board review and approval.
A ~'ach n'>e~ ~ '--
Orange County Emergency Services, with the assistance of Orange County Asset
Management Services -Fleet Management, analyzed mileage and service cost data for
the Wheeled Coach Ford F450 Light Duty Ambulances and the Excellance Freightliner
M2 Medium Duty Ambulances.
Miles per Gallon (First Six Months of Service):
Light Duty Ambulances: 8.573 Miles/Gallon
Medium Duty Ambulances: 9.140 Miles/Gallon
(Calculated using the total miles driven in the first 6 months of service and dividing by
the total gallons of fuel purchased for the given vehicle in the same time period.
Ambulance 714 was omitted from this dataset because the data fell beyond two
standard deviations of the mean. Ambulance 792 was omitted because a full set of
data was not available as it was taken out of service for repairs due to a collision.)
Service Cost per Mile (First Six Months of Service):
Light Duty Ambulances: 8.91 Cents/Mile
Light Duty Ambulances (w/o units 714): 7.02 Cents/Mile
Medium Duty Ambulances: 5.39 Cents/Mile
(Calculated using the total cost of service/maintenance on the units within the first 6
months of service divided by the number of miles driven in the same time period.
Ambulance 714 was omitted from the second run of the light duty ambulances because
of major service required immediately after it was placed in service. The service cost
per mile for 714 in that time period was 20.26 cents/mile. Ambulance 792 was omitted
because a full set of data was not available because it was taken out of service for
repairs due to a collision. Ambulance 715 was omitted from the dataset because the
data fell beyond two standard deviations of the mean.)
919-245-6100 (office) 919-732-5063 (24-hour) 919-732-8130 (fax)
PO Box 8181, Hillsborough, North Carolina 27278
Care• Serve• Survive
8
On March 12, 2011, Medic 1 was transporting a patient from the northern end of the
county to UNC Hospital in an Excellance Freightliner Medium Duty Ambulance. On
Highway 86 south, the truck's right tires went off the road. The driver of the vehicle over
corrected, which resulted in the ambulance crossing the center line and rolling over 1.5
times and came to a halt upon striking a tree. Both the box and chassis were not
significantly damaged. The truck is currently with the manufacturer in Alabama. The
box will be reused on a new chassis. The old chassis has been scrapped by the
insurance company for various reasons. The "new" truck will be back in service at the
beginning of November.
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On April 1, 2011, a Medic unit responded to a patient for seizures in a Wheeled Coach
Ford F450 Light Duty Ambulance. Upon arriving on the scene, it was obvious the
patient was a threat to both the crew and himself. As the crew stepped back to ensure
their safety, the patient ran out of the garage and jumped in the ambulance. The patient
then proceeded to drive the ambulance around his neighborhood striking multiple
vehicles. Before coming to stop at a dead end, the ambulance side-swiped a tree. This
cracked the box of the ambulance from the site of impact and across the top of the
ambulance. The box on this ambulance is in an irreparable state. This vehicle has
been totaled by the insurance company because of the extent of repairs needed on the
box of the truck.
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919-245-6100 (office) 919-732-5063 (24-hour) 919-732-8130 (fax)
PO Box 8181, Hillsborough, North Carolina 27278
Care• Serve• Survive
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