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Home My WebLink AboutAgenda - 10-03-2013 - 11 ORANGE COUNTY BOARD OF COMMISSIONERS ORANGE COUNTY CHIEF'S ASSOCIATION JOINT MEETING ABSTRACT Meeting Date: October 3, 2013 SUBJECT: Joint BOCC /Chief's Association Meeting Discussion Items DEPARTMENT: Emergency Services PUBLIC HEARING: (Y /N) No ATTACHMENT(S): INFORMATION CONTACT: AS NOTED IN BACKGROUND BELOW Jim Groves, 919 - 245 -6140 PURPOSE: To review and discuss with the Orange County Chief's Association the topics listed under BACKGROUND below. BACKGROUND: The BOCC has met with the Fire and Rescue Chiefs in previous years in order to discuss ongoing emergency service operations, budgets, initiatives, etc. This meeting will enable those conversations to continue between the BOCC and the Chiefs. The agenda includes the following item updates: 1. Orange County Chief's Association Strategic Plan Update A) Goals Attachment 1 -A — Orange County Chief's Association Strategic Plan for the Provision of Emergency Services B) Modified Fire Service Agreement/Contract Attachment 1 -B -1 — Strikethrough- Highlighted Sample Fire Protection and Emergency Services Agreement Attachment 1 -B -2 — Clean Sample Fire Protection and Emergency Services Agreement Attachment 1 -B -3 — Orange Rural Fire Protection and Emergency Services Agreement 2. Orange County Emergency Services Update A) Comprehensive Assessment of Emergency Medical Services & 911/ Communications Center Operations Assessment Report Attachment 2 -A — Comprehensive Assessment of Emergency Medical Services & 911/ Communications Center Operations Assessment 2 B) 9 -1 -1 C) EMS D) Viper Tower Study Attachment 2 -D — Draft Orange County Radio Communication Tower and System Infrastructure Upgrade — RF Site Coverage and Sites /Towers 3. Open Discussion A) Field Relationships B) Radio Communications C) Unmet Needs D) Unified Development Ordinance Change E) Other FINANCIAL IMPACT: This is no financial impact anticipated as a result of these conversations, this meeting is informational only. RECOMMENDATION(S): The Interim Manager recommends that the Board meet with the Chiefs and receive updates on the identified plans and reports. ATTACHMENT 1 -A Orange �..VUIILy VIIIWI s Association 12012 Strategic Plan for the Provision of Emergency Services March 2012 2 Orange County Chief's Associatior EXECUTIVE SUMMARY The Orange County Chief's Association (OCCA), a 501(c)(3) organization, represents the united voice of the volunteer and professional fire and rescue chiefs serving Orange County. This strategic plan, the first one ever produced for emergency services in the county, introduces OCCA's vision for opportunities for the future of the emergency services delivery system. As Orange County looks forward to smart growth, the OCCA feels the time is right for a coordinated, long -range plan. We hope to use this plan to help us work in partnership with Orange County and other key stakeholders to enhance life safety services. The Orange County Chief's Association is dedicated to providing the most effective, efficient, and compassionate emergency response services for the residents of and visitors to Orange County. BACKGROUND Since its formation in the late 1970s, the Orange County Chief's Association has fostered better relationships among the fire and rescue services in Orange County by establishing a forum that promotes a venue for airing shared concerns, developing mutual respect and familiarity, and fostering cooperative relationships. The OCCA strives to provide for policy and resource planning and sharing of best practices for safe, effective, and efficient response and mitigation of emergencies. The Orange County Chief's Association is a member - supported cooperative group of the ten fire chiefs and one rescue squad chief that provide service within Orange County. Two fire departments located outside of Orange County that directly serve portions of the county also participate, but are not dues - paying members. Figure 1: OCCA Membership Full Members Adjunct Members Caldwell Fire Department Mebane Fire Department Carrboro Fire - Rescue Department North Chatham Fire Department Cedar Grove Fire Department Chapel Hill Fire Department Efland Fire Department Eno Fire Department New Hope Fire Department Orange Grove Fire Department Orange Rural Fire Department White Cross Fire Department South Orange Rescue Squad (SORS) Aside from Chapel Hill and Carrboro, every other department serving Orange County is either fully volunteer or a mix of volunteer and paid staff. Volunteer fire and rescue departments have historically been the norm in places like North Carolina, which only recently has begun to experience significant urbanization. Volunteer emergency service personnel represent the best of our citizens, those friends and neighbors who not only willingly answer calls during the middle of the night, but also risk their lives to save life and limb. 2 Orange County Chief's Association 12012 Broad demographic trends have made recruiting and retaining volunteers more challenging for some departments, as fewer residents have the time to dedicate to increased training and response requirements. Even so, the volunteer force remains the core of the fire and rescue service for most of Orange County, and is expected to remain so for the foreseeable future. This arrangement has always been extremely beneficial for taxpayers in Orange County. Especially in the current times of greater financial constraints, volunteer services provide a significant value to the county. To replace volunteer services in Orange County with paid staff at current staffing levels would cost taxpayers at least $17 million per year.' This figure jumps to at least $27 million within the next few years once seven anticipated station sz are completed.' The needs of the emergency services system have recently come to the forefront in Orange County. The OCCA supports the creation and continued work of the Emergency Services Work Group, which is beginning to address many of the concerns outlined in this report. A HISTORY OF PROGRESS The OCCA is proud of its accomplishments in service to the residents of Orange County. Thirteen independent departments work together to form the core of fire and rescue services for Orange County. Together, the OCCA has worked tirelessly to promote best practices, accountability, and cost savings. Group Gear Purchases & Equipment Standardization: Departments have banded together for group purchases on many occasions, saving money for taxpayers as well ensuring interoperability of equipment. a. Standardized hose connections: (all departments) b. Radios C. Breathing apparatus d. Protective clothing4 e. Tanker trucks: five departments purchased tankers together in 2009 f. Reflective vests: 2006 and 2008 (all departments) g. Velcro helmet tags: 2002 -2011 (all departments) • Active Pursuit of Grants: Grant funding allows fire and rescue departments in Orange County to save taxpayer money. The OCCA serves as a forum for sharing successful strategies in this often lengthy and complicated process. Many of these grants required at least a partial match of additional departmental funds, and all applications were strengthened by the cooperative spirit and diligent work efforts resulting from the Orange County Chief's Association. 1 Base salary of entry level firefighter (plus benefits) times 15 per truck; NFPA 1710 recommends a staff of 15 firefighters per fire truck to keep it fully operational 24 hours per day, year- round. The Department of Insurance requires two trucks, an engine and a tanker, for a station to be certified in rural areas. Times 13 stations (MMA Consulting Group, 2011, p. 13) minus existing paid staff working at volunteer fire departments. 26 full -time personnel work for volunteer fire departments and 15 part -time paid employees; the latter were calculated at half a position (MMA Consulting Group, 2011, p. 12). Z Future stations: Caldwell (1), Efland (2), Orange Grove (2), Orange Rural (1), White Cross (1) 3 Current local salaries range from a base firefighter salary of $31,500 ($48,000 with benefits) in Mebane to $34,736 ($49,325 with benefits) in Cary. These conservative calculations assume only 2 trucks per station and every firefighter earning an entry-level salary. ° NFPA 1851 recommends replacing protective clothing (turnout gear) every 10 years, or sooner if contaminated. 3 Orange County Chief's Association 12012 Figure 2: Examples of Grants Awarded to OCCA Members Year Department Purpose Amount FEMA Assistance to Firefighters Grant Program (AFG) 2001 Chapel Hill Replaced breathing units $183,375 2002 Chapel Hill Repaired training facility $9,993 2002 Orange Rural Thermal imagers $18,450 2003 Carrboro Vehicle exhaust system $40,590 2003 Orange Rural 800 MHz radios $152,280 2003 North Chatham Breathing units $112,590 2004 Chapel Hill 800 MHz radios $345,120 2004 New Hope Breathing units & rescue clothing $195,000 2004 Orange Rural Breathing units $65,286 2004 New Hope Hurst rescue tools $44,000 2006 Carrboro 800 MHz radios $84,012 2007 Cedar Grove 800 MHz radios $118,000 2007 Orange Grove Facilities upgrades $40,649 2007 Orange Grove 800 MHz radios $16,845 2007 Orange Grove Air packs w/ spare cylinders $85,000 2007 North Chatham Vehicle exhaust system $158,753 2007 White Cross Radios and mobile repeater $124,117 2008 Cedar Grove Air packs $35,000 2008 Cedar Grove Air compressor & refilling system $28,000 2008 Orange Rural Exhaust system & other equip. $76,266 2008 White Cross Breathing units & compressor $85,430 2010 White Cross Thermal imager $8,550 2011 Carrboro Automatic sprinkler system $67,950 FEMA SAFER 2006 Chapel Hill 12 Positions $1,240,748 2007 Carrboro 3 Positions $314,262 2008 Carrboro 6 Positions $646,075 2009 Orange Grove 4 Positions $404,364 Firehouse Subs 2009 Chapel Hill Breathing unit upgrades $14,000 NC Division of Forest Resources 2007 Carrboro Forest fire protective clothing $670 2009 Carrboro Forest fire equipment $416 North Carolina Office of State Fire Marshal 2005 SORS Protective equipment & radios $12,480 2007 SORS Rope rescue equipment & radios $12,497 2008 SORS Water rescue equipment & radios $24,994 2008 White Cross Protective clothing & headsets $10,490 2009 SORS Technical rescue gear & radios $24,900 2009 White Cross Protective clothing $4,400 2010 SORS Rescue gear, AEDs, & radios $19,117 2010 White Cross Protective clothing & equipment $16,925 2011 Caldwell Breathing units & pagers $54,400 2011 SORS Rescue gear, AED, & radios $25,000 2011 White Cross Rescue saw & other equipment $12,767 Strowd Roses, Inc. 2004 SORS EMS equipment & radios $15,000 2005 SORS Community CPR & first aid program $10,385 2007 SORS Community CPR & first aid program $10,000 2010 SORS Community CPR & first aid program $10,000 2011 SORS Community CPR & first aid program $10,000 US Smokeless Tobacco 2009 Orange Rural Polaris ATV $11,500 OCCA members have collaboratively obtained grants in excess of $5,000,646 5 Declined by Carrboro due to lack of certainty about future tax revenue to sustain positions 6 Declined by Orange Grove for the same reason: cautious financial stewardship 7 Orange County Chief's Associatior Local Spending Initiative ( "Buying Local "): The OCCA has always prioritized local and in -state vendors on equipment purchases, when possible. Newton's Fire & Safety Equipment, Inc. in Swepsonville has been the primary vendor for OCCA purchases. CW Williams and Co., LLC, of Rocky Mount, and Municipal Emergency Services, Inc., of Charlotte, have been other major vendors. Children's Fire Safety House: After a coordinated fundraising effort involving all departments, the OCCA purchased an educational fire safety trailer in 2005. The Children's Fire Safety House is available for use in community events countywide. Establishment & Enhancement of Countywide Mutual Aid System: The OCCA spearheaded the original countywide mutual aid system in 1994. This ensured a standardized, multi - departmental response to fires outside of municipal boundaries. a. In 2005, the OCCA signed an upgraded mutual aid compact, which provides for a three - department response to areas outside of municipal areas. • Policy Development: As independent corporate entities, the fire and rescue departments have relatively independent operational authority. Nevertheless, departments have found it beneficial to unify and develop shared response policies to streamline operations and mutual aid. Standard Operating Procedures (SOPS) represent the daily guidelines for departmental operations. Coordinated standards benefit departments by ensuring functional operations at mutual aid scenes. Residents in turn benefit from greater effectiveness. Major accomplishments are highlighted below, but a number of other practices have been initiated by one department and adopted by others through sharing in the OCCA. a. Station Numbering and Resource Typing, mid 1990s: Systematic identification of assets b. Plain Language Radio Communication Procedures, 1992: The OCCA mandated the use of "clear text" on the airwaves to replace 10- codes, a decade before this became a DHS mandate in the wake of September 11tH C. 2 in, 2 out SOP, 1998: The OCCA recommended this best practice response to structure fires. d. ICS protocols SOP, 2011: The Incident Command System (ICS) has been a standard procedure in the fire service for years, and forms a standardized, recognizable frame for organizing a response to major incidents. This policy standardized ICS protocols across departments. e. Accountability SOP, 2011: This allows for Incident Commanders from any agency to track all responders at an emergency scene using the same protocols. f. Mayday SOP, in progress: The OCCA is standardizing the way firefighters from all departments call for help in a life- threatening situation to ensure a consistent response. Major Resource Sharing: Around the country, many fire departments suffer from "one upsmanship," in which departments strive to outdo each other in equipment. The Orange County Chief's Association is proud of the quality apparatus and rescue equipment throughout Orange County, but has cooperatively planned to share major resources like air trucks, ladder trucks, and a heavy rescue truck. This restraint has allowed the fire and rescue departments to provide quality service at reasonable tax rates. Departments also use both the Caldwell training tower and the Chapel Hill training facility to conduct equipment testing and other training. 5 E Orange County Chief's Associatior 1 2012 Hardship fund: In 2009, the OCCA established a fund where firefighters in distress can apply for small grants of emergency financial assistance. The OCCA believes in taking care of their respective personnel, and is mindful of the sacrifices that many personnel, especially volunteers, make in order to contribute to the greater good. Such assistance helps retain valuable trained firefighters. Outside Speakers Forum: The Orange County Chief's Association brings in speakers periodically to share lessons learned. In November 2010, the OCCA hosted Worchester, Massachusetts Fire Chief John Sullivan, who has spoken nationally about line -of -duty deaths. In January 2011, a representative from Salisbury, NC spoke about losing two firefighters in 2008. THE STRATEGIC PLANNING PROCESS The Orange County Chief's Association engaged the UNC School of Government in August 2011. School of Government faculty and staff work with local boards, managers, department heads, and nonprofit groups to help them set priorities, plan and manage work towards those priorities, and evaluate results. Lydian Altman, Director of the Strategic Public Leadership Initiative, worked on this project with Master of Public Administration student Jake Pflepsen, who has worked as an emergency service provider for almost ten years in two municipalities and is a Nationally Registered EMT. Lydian and Jake developed a work plan for the overall project, drafted agendas and a discussion exercise, facilitated discussions, and documented the decisions of the group into this final report. Summary of the Work: 1. Individual Interviews: October - November 2011 • School of Government representative conducted individual interviews with each OCCA member to discuss concerns and priorities. 2. First Retreat: Saturday, November 19th, 2011 • Initial retreat focused on airing concerns and developing a shared vision. 3. Evening Planning Session: Tuesday, January 17th, 2012 • Progressive goal formulation and agreement 4. February Retreat: Saturday, February 11, 2012 • Retreat finalized goals and objectives, discussed strategies for moving forward. 5. Final plan review: Tuesday, February 28, 2012 • OCCA representatives met and edited final strategic plan. 11 Orange County Chief's Associatior , GOALS The Orange County Chief's Association recognizes the important interdependencies that exist to provide emergency services to the citizens of Orange County. These goals are a mix of work that the OCCA can complete independently and with others. Therefore, successful implementation of this plan and completion of each objective often requires cooperation and communication with other key stakeholders. The OCCA recognizes that the importance of keeping in mind the "big picture," and has supported adopting specific standards and identified timeframes for doing so throughout this plan. The OCCA encourages its key partner agencies to do the same. The Orange County Chief's Association invites and encourages the Orange County Board of Commissioners to carefully consider the goals and objectives in this plan and how they can positively impact the citizens of Orange County. GOAL I: Ensuring Viable and Reliable Voice and Data Communication Objective A: To work with Orange County, relevant law enforcement agencies, the North Carolina Highway Patrol, and outside experts to apply technology solutions to insure 99% radio coverage throughout Orange County with building penetration by July 2013. The MMA Report acknowledged these deficiencies, noting that "dead spots and poor building penetration place responders at risk when operating under emergency conditions. "' Background: Currently, the VIPER (Voice Interoperability Plan for Emergency Responders) digital 800MHz system provides inadequate radio coverage for emergency services personnel across Orange County. VIPER was originally designed for use at street level by the North Carolina Highway Patrol. Fire and rescue providers often respond to calls beyond the highways, creating substantial safety hazards. As Orange County Emergency services notes: "The current system does not provide 100% coverage — there are "dead spots. "$ VIPER has problems with coverage, capacity, and building penetration. Construction of new towers in strategic locations may be required to address this problem. Some fire departments in the county, including Chapel Hill, Efland, and White Cross, have already purchased mobile repeaters to partially address this issue. These repeaters are vehicle based, and cost approximately $20,000 each, and are not considered adequate substitutes for a full tower.9 The VIPER system is strained from its use by all Orange County public safety agencies. Due to the increased usage, users are sometimes confronted with "busy bonks," a beeping when trying to transmit due to system overload. The problem and the solution have been acknowledged by Orange County. "Adding channels to existing towers will improve system capacity. The cost of one channel added to one tower is approximately $30,000 and multiple channels will be needed on multiple towers. "10 7 MMA Consulting Group, April 2011, p. 78 8 Orange County Board of Commissioners, November 17, 2011 Action Agenda Item #8 -d Abstract: Review of VIPER 9 Adapted from Orange County Board of Commissioners, November 17, 2011 Action Agenda Item #1 Abstract: VIPER io Orange County Board of Commissioners, November 17, 2011 Action Agenda Item #1 Abstract: VIPER 7 10 Orange County Chief's Associatior_ 12012 Lastly, building penetration is minimal in large structures, including commercial buildings, schools, and university facilities. The fire and rescue services often respond to these areas, operating without radio communication. The aforementioned mobile repeaters partially improve building penetration; however, the OCCA encourages Orange County to adopt legislation mandating repeaters to be placed inside large structures, as some other local North Carolina jurisdictions have required. Local examples include the municipalities of Cary, Chapel Hill, Durham, and Raleigh. Objective B: To advocate for the continued and ongoing support of the radio paging system with consistent use of audible call information beginning in 2012. Background: The VHF /UHF repeater system forms the backbone of the radio paging system used by all departments throughout Orange County. Individual departments issue pagers to emergency responders because it would be impractical to purchase take -home radios and require continuous monitoring. Emergency responders have repeatedly been paged and not received follow -up audible call information. This small step is vital to correctly routing personnel when seconds count. The OCCA encourages Orange County Emergency Services to immediately apply appropriate policy and training steps to correct this common oversight. Cell phones and digital text pagers have repeatedly proven inadequate as sole communication devices for emergency call outs due to coverage and network issues; however, they are still important secondary communication devices used by emergency responders. Objective C: To encourage the continued development of a robust mobile data network throughout Orange County by January 2014. Background: Cell phone data networks form the third leg of the emergency communications network, and will be a vital component to the future mobile data network (Goal II, Objective B). The expansion of the existing capacity of this network benefits not only emergency responders, but also citizens with increasing digital connectivity demands. GOAL II: Improving the 9 -1 -1 Telecommunications System and Center Objective A: To work with Orange County to ensure the deployment of a state -of- the -art 911 Telecommunications Center that is able to dispatch emergency calls within 90 seconds or less 90% of the time by January 2014. Background: "The Telecommunications Center is the public safety answering point and is the link for citizens to access law enforcement and emergency service agencies. "11 The OCCA seeks to ensure consistent and reliable dispatching by supporting and encouraging the Orange County 911 Telecommunications Center to fully adopt additional nationally recognized standards 12 and measureable benchmarks for public safety call taking and dispatching. Orange County itself has long- acknowledged "the goal is to process and push the call to the first response agencies within " http: / /www.co. orange .nc.us /emergency /About.asp 12 NFPA 1221: Standard for the Installation, Maintenance, and Use of Emergency Services Communications Systems, 2010 Edition, & APCO Recommended Best Practices PSAPs /Telematics Call Processing, 2009 11 Orange County Chief's Associatior 90 seconds of receipt, but due to the added workload and flat resources, the current average process time is 135 seconds." 13 Objective B: To support the acquisition by January 2014 of a Computer Aided Dispatch (CAD) network with live links to Mobile Data Terminals (MDTs) in the field. Background: CAD networks with live links to MDTs offer system managers the ability to remotely supervise an entire emergency services network, while freeing up valuable radio airtime. Responders in the field appreciate the push button status changes, as well as the ability to know exactly what dispatchers know in real time. This two -way information sharing promotes accountability, and some emergency systems have even opened up their CAD systems (in a view -only mode) to online public viewership. Live CAD systems run off wireless networks. Durham County already supports a live CAD network, as do many jurisdictions around the state and the country. This technology has existed for decades, and proven invaluable in public safety applications. Both Carrboro and Chapel Hill already have static MDTs on their fire apparatus, and these mobile computers will be configured to support online capabilities. The OCCA envisions Orange County Emergency Services developing the network and providing ongoing technical support, but allowing individual departments to purchase the equipment on their own following the system roll -out by January 2014. This approach, taken in Durham County, has allowed for a phased -in approach to better suit the financial planning needs of individual departments. The OCCA encourages each member department to purchase equipment within a year of the system becoming operational. Goal III: Encouraging the Adoption of Measureable Emergency Response System Benchmarks and Reporting Norms Objective A: To establish transparent and measurable benchmarks for EMS service delivery to ensure continuous quality management by January 2013. Background: Due to differences in how data is collected and measured between the fire and rescue departments and Orange County EMS, benchmarking is currently impossible. The public has a right to be able to assess the quality and effectiveness of the emergency services response network. The Orange County Chief's Association desires transparent and available information regarding EMS response times and coverage. The OCCA seeks routine reporting to the Orange County Board of Commissioners and support agencies of such commonly used benchmarks as call volume and type, normalized response times, unit availability, unit downtime due to maintenance, time on scene, transport times, Advanced Life Support vs. Basic Life Support cases, delays between first responder and ambulance arrival times, cost per response, third party collection rates, personnel vacancy rates and turnover, training time per employee, and numbers of medical protocol violations. 13 Orange County Board of Commissioners, March 25, 2010 Action Agenda Item #2 Abstract: EMS Delivery Report PJ 12 Orange County Chief's Associatior The live CAD system should facilitate easy and instantaneous reporting of this data in the future; however, the OCCA looks for weekly reports of existing available information in the meantime. Goal IV: Setting Service Standard Goals for Volunteer Fire Departments Objective A: To ensure all Orange County residents can receive the maximum fire protection and homeowners' insurance savings available by improving individual departments' ISO ratings 14 in the following manner: Figure 3: Timeline for ISO Applications Goal Date for ISO Application ISO Rating of 8 July 2013 ISO Rating of 6 July 2016 Background: Numerous members have already lowered their ISO ratings, and the OCCA has provided a collaborative forum in which fire chiefs share strategies and concerns in their pursuit of this goal. For the first time ever, OCCA members have agreed that all volunteer fire departments will work towards achieving an ISO rating of 6 for residences within a five mile district of fire stations. The OCCA has undertaken this goal by itself, mindful of the significant challenges it will pose to some departments in terms of upgrading water hauling capabilities, equipment, and personnel training. By working together in a collaborative fashion with Orange County planners and educating citizens about the benefits of lower insurance ratings, the OCCA looks to accomplish this major initiative. The Orange County Chief's Association also acknowledges the link of ISO ratings to commercial development, and the critical role that water supply plays in those calculations. As Orange County looks to foster sustainable growth, the OCCA recognizes the potential for shared solutions. Objective B: To ensure that all fire and rescue departments in Orange County have sought to adequately implement nationally recognized consensus standards. Background: The NFPA has established national consensus standards of best practices for emergency responders with training and operational guidelines that exceed ISO's standards. NFPA 171015 and NFPA 172016 specify best practices for career and volunteer fire departments, respectively. NFPA 167017 establishes standards for technical rescue disciplines of the sort provided by South Orange Rescue Squad. OCCA members will research, discuss, and consider the full implications of attaining these standards. The OCCA encourages all its member 14 "ISO's expert staff collects information about municipal fire protection efforts in communities throughout the United States. In each of those communities, ISO analyzes the relevant data and assigns a Public Protection Classification (PPCTM) — a number from 1 to 10." A grade of 6 represents the maximum insurance savings that can be achieved by a fire department for residential properties. (http://www.iso.com/faq/ISO- FAQ/The -Pu bl ic- Protection - Classification -PPC- Program. html) 15 NFPA 1710: Standard for the Organization and Deployment of Fire Suppression Operations, Emergency Medical Operations, and Special Operations to the Public by Career Fire Departments, 2010 Edition 16 NFPA 1720: Standard for the Organization and Deployment of Fire Suppression Operations, Emergency Medical Operations, and Special Operations to the Public by Volunteer Fire Departments, 2010 Edition 17 NFPA 1670: Standard on Operations and Training for Technical Search and Rescue Incidents, 2009 Edition 10 Orange County Chief's Associatior 1 2012 departments to implement a plan for compliance with their applicable NFPA standards by January 2014, with a goal to meet these standards by January 2016. GOAL V: Planning for a Countywide Training Facility Objective A: To work with Orange County to provide a modern, centrally located training facility for firefighters and emergency personnel. Background: Caldwell Fire Department built the first training facility in Orange County in 1981, a drill tower that is still used frequently. Chapel Hill opened a training facility in the mid -1980s that provides a classroom, drafting pit, drill tower, and burn building. Both facilities are open for shared multi - departmental use; however, they are older and not easily accessible for all departments. The Orange County Chief's Association would like to work towards finalizing a plan for a modern replacement facility by January 2016, with a goal of completion by January 2018. GOAL VI: Preparing a Multi- Hazard Risk Assessment Plan Objective A: To work with Orange County to prepare a Multi- Hazard Risk Assessment Plan by January 2013. This plan will establish: a. Specific inventory of target hazards and infrastructure protection needs b. The frequency, probability, and history of events C. The types of responses that are needed in the county d. Who is /can be prepared to offer that response, e.g., swift water rescue, mass casualty incidents e. Training needs for various departments f. Adequate legal protection to the organizations providing the services g. That fire protection and emergency service needs shall be considered in the development review and approval processes Background: Risk assessment plans are proven emergency management tools that integrate GIS based mapping with hazard projections. A comprehensive Multi- Hazard Risk Assessment Plan has never been completed in Orange County, but these plans are required by FEMA for disaster reimbursements. 18 The OCCA would like to be involved in the development of the initial plan and subsequent 5 -10 year updates done to maintain the plan. GOAL VII: Building Better Relationships with Key Stakeholders Objective A: To ensure sustainable services and recognize the nature of long -term partnership between the Orange County Board of Commissioners and volunteer fire and rescue services by instituting five- year coverage contracts with annual review and extension by January 2013. Background: Most volunteer fire departments in Orange County operate on old contracts with automatic one -year renewals. This means that either party could decide to terminate the contract, leaving only one year to scramble to find solutions. The North Carolina State Legislature has recognized a five -year contracting period with rural fire departments as an '8 http: / /www.fema.gov /plan /mitplanning/risk.shtm 11 13 Orange County Chief's Associatior _ _ _ appropriate time frame to allow for adjustments in purchasing, planning, and borrowing.19 Annual review and renewal at the time of budget allocations would in effect extend the contract for another five years, safeguarding the interests of both parties. Neither party benefits when the ability to provide emergency services is jeopardized, or when the viability of long -term and expensive capital planning remains tenuous. Objective B: To engage in a conversation with the Orange County Board of Commissioners for reimbursement for the provision of first responder EMS services. Background: Providing emergency services is not free, even when volunteers are used. Orange County, like all other counties in North Carolina, has a legal responsibility to provide emergency medical services. Fire departments are under no obligation to provide these services, yet they are dispatched to and expected to perform first responder services at medical aids. OCCA members expect that fire departments be compensated for the marginal cost of providing first responder service. These costs of doing business include fuel for transport to non -fire calls, additional training for firefighters expected to perform emergency medical services, and medical supplies. These costs incurred in the provision of first responder service are all currently borne by individual departments. Orange County collects substantial fees for EMS services, though fire departments are not reimbursed for their contributions. Objective C: To have a joint discussion with Orange County Emergency Services and the Medical Director to develop strategies to adequately use EMT -based Basic Life Support (BLS) capabilities within the county. Background: South Orange Rescue Squad is a valuable force multiplier for Orange County, with a large base of Emergency Medical Technicians (EMTs). Many fire departments also have members who are EMTs. These employees are dissuaded from career progression and higher certification because of limited career opportunities with Orange County Emergency Services, the only Advanced Life Support (ALS) provider in the county. The Orange County Chief's Association expects to use this discussion to review criteria for first responder dispatch. If necessary, limits should be negotiated for first responder dispatch to preserve fire protection coverage, the top priority for fire departments. The OCCA expects to always be involved in the decision making process. GOAL VIII: Fostering Increased Public Awareness Objective A: To develop ongoing strategies to foster greater public awareness of how emergency services are delivered and to highlight the role volunteers play in providing services. Background: As the MMA Consulting Group noted in their recent report, "Orange County has a complex and sophisticated fire and rescue system. "20 The OCCA looks to proactively engage members of the public and elected officials to better convey the roles and responsibilities of the fire and rescue services in Orange County. 19 G.S. § 160A -57.58 20 MMA Consulting Group, April 2011, p. 1 12 14 15 Orange County Chief's Associatior , Prior to this time, no community expectations have been established for what Orange County citizens want in emergency services. Decisions are made through year -to -year budget requests based on the professional recommendations of emergency services leaders to boards or appointed managers. The Orange County Chief's Association welcomes a public discussion regarding service level expectations, and hopes to provide accurate information to advance this conversation. Key points to address in public outreach • What does "response time" mean and who /what agencies are involved in the equation? Explain any existing gaps. ( "Why does the fire truck /ambulance take so long ? ") • The value of leveraging paid staff with volunteers. Explain how much money Orange County saves by using volunteer fire and rescue departments. • The value of the levels of service and training offered in departments, along with the number of hours donated through volunteer fire departments and South Orange Rescue Squad. • ISO ratings and insurance link: how marginally higher taxes help homeowners save significant amounts of money. • The 2012 OCCA Strategic Plan as a foundation for noting past successes and direction for future progress. CONCLUSION With Orange County's "changing demographics and increased urbanization "21 comes the responsibility for quality fire protection and life safety services. The Orange County Chief's Association urges thoughtful public consideration and discussion of the goals contained in this report, and looks forward to a future of collaborative progress built on our tradition of past successes. As noted by Orange County Emergency Services, "appropriate resources must be available to ensure an equitable, high - performance service delivery system ."2' The Orange County Chief's Association is committed to working with all stakeholders to ensure this vision of emergency services delivery becomes a reality. 21 Orange County Board of Commissioners, March 25, 2010 Action Agenda Item #2 Abstract: EMS Delivery Report 22 Orange County Board of Commissioners, March 25, 2010 Action Agenda Item #2 Abstract: EMS Delivery Report 13 16 Orange County Chief's Association 12012 Caldwell Fire Department Orange Grove Fire Department Chief Brad Allison Chief Tommy Holmes Carrboro Fire - Rescue Department Orange Rural Fire Department Chief Travis Crabtree Chief Jeff Cabe Cedar Grove Fire Department White Cross Fire Department Chief Jeff Borland Chief Jerry Lloyd Chapel Hill Fire Department South Orange Rescue Squad Chief Dan Jones Chief Matthew Mauzy Efland Fire Department Mebane Fire Department Chief Kevin Brooks Chief Bob Louis Eno Fire Department North Chatham Fire Department Chief Bryan Baker Chief John Strowd New Hope Fire Department Chief Mike Tapp �NTY CH o �� Cz 14 17 ATTACHMENT 1 -B -1 STATE OF NORTH CAROLINA ORANGE COUNTY FIRE PROTECTION AND EMERGENCY SERVICES AGREEMENT THIS AGREEMENT (this "Agreement), made and entered into this day of 2013 by and between Orange County, hereinafter referred to as the "County" and , hereinafter referred to as the "Fire Department ", referred to herein as "Party" and /or collectively as the "Parties ". WITNESSETH: County created the Fire Protection District (the "District ") as a special tax district pursuant to Chapter 69 of the North Carolina General Statutes and desires to contract with Fire Department for fire protection and other services as set out herein. 2. Pursuant to §NCGS 69 -25.4 the County agrees that it will cause to be assessed or levied a special tax of not more than fifteen cents ($.15) per one - hundred dollar ($100) valuation of all real and personal property in the District unless otherwise limited or prohibited by law or a vote of the people, and will collect said tax as a part of the ad valorem taxes of Orange County; provided however, the amount levied annually shall be based on the needs projected in the budget estimate submitted by the Fire Department to the County as approved by the County. 3. That a special or separate fund shall be maintained by the County for funds collected as a result of said special tax. 4 That from. said Special tw ninety eight and ono half 504) "f a Irront ;;nrj Pornont (99 and ninety eight and one half nornont (99 5,0 ) of kinds; nollontead nn motor yehinloc Art4 _I _.. _L 1V_ That from said special tax district the Board of County Commissioners will approve a Fire Protection District tax rate and Annual Budget for the fire Department. The County agrees to remit quarterly payments, by the 15`h day of the first month of each quarter. The total quarterly payments to the fire department will equal the annual budget. The Fire Department shall provide and furnish adequate fire protection services and shall provide the necessary equipment, personnel, and other resources as determined by the North Carolina Department of Insurance, Fire and Rescue Service Division, and the Insurance Service Office for all persons and property located within the District. Fire Department currently has an insurance rating of , and during the term of this Agreement will maintain at least a 9E insurance rating. Fire Department will furnish fire and rescue services free of charge to all persons and individuals within the District (excluding non - public commercial transportation). Fire IN Department shall strive to achieve an insurance rating of 8 (or better) by July 2014 and 6 (or better) by July 2016. This section does not preclude the Fire Department from charging a pre- arranged nominal fee when standing by for special events. 6. That all funds paid to the Fire Department by the County shall be used exclusively by the Fire Department to provide fire protection services within the District (See Exhibit 1), and the Fire Department may also use said funds to provide Medical Responder and rescue services within the District, and to pay other legitimate fire, rescue, and Medical Responder expenses attributable to the services rendered within the District. This does not preclude mutual aid agreements. 7. The Fire Department shall provide Medical Responder Services within the District. Medical Responder Services are defined as the provision of Basic Life Support treatment as needed until such time as more highly trained personnel arrive on scene. Such Medical Responder Services may be provided through mutual aid agreements or through third party contracts The Fire Department shall provide Hazardous Materials Response Services at the North Carolina Department of Insurance "Operations" Level within the District. Hazardous Materials Response Services are defined as defensive actions necessary to protect life, property and the environment from the effects of the release. 9. The Fire B,epaFt 'IeRt shall rye - +� CorVinoc tG all Pe FGGnc and inrl i4Airl11;;Ic t#i�t Bast �Ress Sep %;ses �Pe#ined tyre A14; ;1 ^r freeing G# Rdi -als; from nnnfinernein4 eir danger anrd innli irdo1 extFiGati6T,66nr."i s�wc o GTTIITTGT o 0 , 0 str. t ruellapse tFeRGh- resound �1� ve- resoQe— S�- h- Reso�er�s The Fire Department shall provide Rescue Services to all persons and individuals within the District. Rescue Services are defined as the removal, extrication, or freeing of individuals from vehicle confinement or danger. Such Rescue Services may be provided through mutual aid agreements or through third party contracts. 10. Notwithstanding Section 6 above Fire Department may provide fire protection services outside the District subject to the following terms and conditions [This section applicable only to departments authorized to provide fire protection services outside their districts. Remove or strike where not applicable]: A. That Fire Department is authorized to provide primary fire protection services in the area of the District shown in Exhibit 1. B. Fire Department shall not expend any funds or resources appropriated for the use of persons and individuals in the District for the primary fire protection services outside the area of the District shown in Exhibit 1. In the event any such expenditure occurs for primary fire protection outside the area shown in Exhibit 1 Fire Department shall immediately notify the County and Fire Department shall take corrective measures to rectify the expenditure and to ensure such expenditure shall not be repeated. PJ 19 C. That Fire Department shall enter into an agreement with the Department in which Fire Department shall provide compensation to Fire Department for Fire Department's availability and service in providing primary fire protection services in the area of the District shown in Exhibit 1. 11. In providing the services contemplated herein the Fire Department shall operate in compliance with all applicable State and local laws and regulations including, but not limited to the North Carolina Fire Incident Reporting System (G.S. 58- 79 -45, NC Administrative Code, §.0402). The Fire Department shall submit electronic incident reports on a quarterly basis to the Orange County Fire Marshal . The Fire Department further agrees to file with the Fire Marshal Office a current list of its Board of Directors, and a roster of its fire department personnel, an annual training report, and a list of apparatus including pump and tank size, and specialized fire suppression equipment, no later than July 31s' of each year. The County shall have the right to inspect all books and accounts for the Fire Department at any time. Said inspection shall be conducted by the Orange County Fire Marshal and /or Orange County Finance Office and /or their designee. The following minimal performance standards are agreed upon by the County and the Fire Department and are a part of this contract: A. Response Time. Fire Department should have the goal of having an average response time (time of dispatch until time of arrival) of _16_ minutes or less for structural fire calls within the recognized Insurance District. Fire Department should have the goal of having an average response time of _16_ minutes or less for Medical Responder and Rescue Services. B. Manpower on Scene. Fire Department should have adopted standard operating guidelines that address the appropriate number of firefighters needed on all type fire calls. The National Incident Management System shall be used at all incidents to manage personnel. C. Training. Fire Department shall have the minimum standard training requirements set forth by the State of North Carolina and NC Department of Labor for providing fire and emergency services provided by the Fire Department. For purposes of this agreement emergency services includes both Medical Responder services, hazardous materials services, and rescue services. D. Fire Investigations. The Fire Department officer in charge at all fire scenes shall attempt to determine the cause and origin of every fire. When the officer in charge cannot determine the cause and origin of the fire, or if the cause is suspected to be of an incendiary nature, the officer in charge may request assistance from the Orange County Fire Marshal. E. Reports. Fire Department shall keep all records for a minimum period of seven (7) years. All State and county required reports and rosters shall be submitted by the applicable deadlines. F. Fire Hydrants. The Fire Department should coordinate with the owners of the water distribution system so that every hydrant in the District is flushed and checked for accessibility, functionality, visibility, and operation at least annually. If the hydrant is owned by a municipality or special water district, testing and maintenance should be handled as agreed upon by the County and the system operator. The Fire Department should report any malfunctions or damage to hydrants to the owner of the water distribution system. G. Emergency /Disaster Response. Fire Department shall follow the Orange County Emergency Operation Framework (EOF) Policy when responding to an emergency or disaster. H. State of Emergency. County requests that Fire Department, when available, assist with the following services, but not limited to, before, during, and following times of emergency /disaster: 1. Debris Clearance; 2) Traffic Control; 3) Alert and Warning; 4) Search and Rescue; 5) Evacuation Notification and Coordination; and 6) other life- saving and property protection measures as necessary. All operations shall be in accordance with the Orange County Orange County Emergency Operation Framework (EOF) Policy. Medical Responder Services. When Fire Department provides Medical Responder Services assistance, it shall be done in accordance with the rules set forth by the Orange County Medical Director. 12. The Fire Department shall submit to an audit by a Certified Public Accountant, which will be paid for by the County, and shall be in conformity with General Accepted Accounting Principles. If an audit has already been performed by a certified entity, the Fire Department shall present the County with a copy of that audit. Such audit to be provided on or before December 31St of each year beginning in 2014, and to be in conformity with the most recent audit policies of the County and the North Carolina Local Government Commission. Further, the Fire Department agrees to comply with County budgeting procedures including a mid -year financial statement and other procedures provided for by State Law and agree to submit budget estimates to the Board of Commissioners on the standard forms used by County departments. The Fire Department also agrees to use standard line items for accounting as requested by the County Finance Department. 13. The Fire Department shall comply with the County budgeting procedures, and shall submit annual budget estimates in accordance with established County budget timetables. A supporting letter of request for the proposed tax rate shall be signed by the Fire Department's president upon approval of its Board of Directors. The County will provide the Fire Department with standard forms for budget submission and the Fire Department shall use such standard forms. 14. The Fire Department shall comply procedures for local governments a s procedures provided for by state law. rd with the State of North Carolina purchasing identified in Attachment #1, as well as other KE 21 15. The Fire Department shall file with the County Fire Marshal a true copy of its Articles of Incorporation, Bylaws, and shall furnish any changes made thereto not less than thirty (30) days prior to their effective dates. Further, the Fire Department agrees to amend its Articles of Incorporation and Bylaws as necessary to meet all minimum legal requirements for a North Carolina nonprofit corporation, as required by the provisions of Chapter 55A of the General Statutes of North Carolina. Should Fire Department be notified that it has failed to meet all minimum legal requirements for a North Carolina nonprofit corporation and /or failed to maintain its federal, state, or local tax - exempt status the Fire Department shall, within thirty (30) days of such notification, begin taking appropriate steps to remedy said failure. Should said failure not be appropriately remedied within ninety (90) days after such notification County may withhold special district tax revenues until such time as the Fire Department meets all minimum legal requirements of Chapter 55A of the General Statutes of North Carolina and /or until such time as the Fire Department's tax - exempt status is restored. 16. In the event the Fire Department dissolves then the Fire Department shall deliver, release, and convey to the County all of its equipment, cash, or other assets to be used by the County exclusively for the provision of fire protection services, rescue services, or Medical Responder services within the District. Any such dissolution shall comply with applicable laws of North Carolina. If Fire Department ceases to provide either fire protection services, rescue services, or Medical Responder services within the District Fire Department shall deliver, release, and convey to County all of its equipment, cash, or other assets used for those specific services the Fire Department has ceased to provide, to be used by the County exclusively for the provision of fire protection services, rescues services, or Medical Responder services within the District. Should the terms of this paragraph conflict with Fire Department's Articles of Incorporation the Articles of Incorporation shall control. 17. The Fire Department agrees to hold harmless and indemnify the County from and against any and all liability and expenses including attorney fees, court costs and other costs incurred by the County caused by any act or omission of the Fire Department, its agents and employees. The Department shall purchase and maintain, during the term of this Agreement, and any extension hereof, at least the following insurance coverage: A. Comprehensive Automobile Liability Insurance with combined single limits of at least one million dollars ($1,000,000) per occurrence. Coverage shall be provided under a symbol 1 ". Coverage shall apply, on an excess basis for hired, borrowed and non -owned vehicles. Coverage shall apply, on a primary basis, for commandeered vehicles. Volunteers or employees shall be considered insureds and volunteers and employees shall have coverage in excess of their personal auto liability limits when they are using their vehicles on behalf of the Fire Department. Fellow member liability shall be provided. Auto pollution liability shall be included in the coverage. B. Auto physical damage shall be provided on an agreed value basis. Coverage shall be included for hire, borrowed or commandeered vehicles without a limit of liability. Coverage shall be provided to bring replacement vehicle up to the most current national standards, such as NFPA or DOT. 22 C. Comprehensive General Liability Insurance with limits of at least one million dollars ($1,000,000) per occurrence and two million dollars ($2,000,000) aggregate. The aggregate shall apply per named insured and per insured location. The policy shall include the following coverage: Volunteers or employees as insureds, Medical Malpractice, Good Samaritan Liability Coverage, Intentional Acts Coverage for both bodily injury and or property damage, Fellow Member Liability, Non -owned Watercraft, Fire Damage Legal Liability with limits of one million dollars ($1,000,000), Pollution Liability arising out of emergency operations, training activities or equipment wash downs. D. Directors and Officers Liability Insurance with limits of at least one million dollars ($1,000,000) per occurrence with two million dollars ($2,000,000) aggregate. This policy shall include coverage for prior acts. The insureds shall include current volunteers and employees, former volunteers and employees, and any persons or organizations providing service to the Department under a mutual aid or similar agreement. Coverage shall include civil rights type suits such as discrimination and sexual harassment; liability arising out of the administration of benefit plans for employees or volunteers and employment related practice suites. Coverage shall include claims made for future compensation and benefits lost from wrongful termination of an employee. E. Umbrella Liability Insurance with limits of at least one million dollars ($1,000,000) per occurrence and one million dollars ($1,000,000) aggregate. The umbrella policy shall provide excess coverage over the Auto Liability Policy, General Liability Policy, and the Employer's Liability Section of the Workers' Compensation Policy. Volunteers and employees shall be included as insureds. F. The Department shall maintain Property Insurance protecting against the risk of direct physical loss or damage. The policy covering the building shall be written on a Guaranteed Replacement Cost Basis, with coverage included for Building Ordinance, Flood, and Earthquake. Coverage shall include Commandeered Property in the amount of two - hundred fifty thousand dollars ($250,000). Contents coverage shall be provided on a replacement cost basis. Coinsurance penalties shall not apply. G. Portable Equipment Coverage shall be provided protecting against the risk of direct physical loss or damage, including electrical surges. Coverage shall be provided on a Guaranteed Replacement Cost Basis. H. The Automobile Liability Policy, General Liability Policy, Umbrella Liability Policy and Management Liability Policy shall name the County as an additional insured. The Department shall furnish the County with Certificates of Insurance showing the type of policy, limits of liability, name of insurance companies, policy numbers, effective dates and expiration dates of policies. 31 23 I. Workers' Compensation Insurance covering all volunteers and salaries firefighters meeting statutory limits in compliance with applicable State and Federal Laws. Each policy shall also contain a ten (10) day notice to the County in the event of cancellation or modification of any stipulated insurance coverage. 18. In connection with the performance of this Agreement, the Fire Department agrees not to discriminate against any employee, member, or applicant for employment or membership because of race, color, national origin, religion, creed, ethnicity, sex, sexual orientation, age, disability, political affiliation, and Vietnam -Era or disabled veteran status. Employees, members and applicants must however, be competent and capable to perform the requirements of the job. The Fire Department agrees to take all reasonable measures to insure that applicants are employed, and that employees are treated appropriately, during their employment, without regard to their race, color, national origin, religion, creed, ethnicity, sex, sexual orientation, age, disability, political affiliation, and Vietnam -Era or disabled veteran status. 19. This Agreement shall continue for a term of five (5) years unless terminated as hereinafter provided. This Agreement may be renewed for two additional five -year terms upon mutual agreement of the Parties. Either Party may terminate this Agreement effective at the end of any fiscal year by giving the other Party notice at least one (1) year in advance of the end of the fiscal year that the Agreement is to terminate. 20. This Agreement sets forth the entire understanding of the parties and supersedes any and all prior agreements, arrangements, and understandings related to the subject matter hereto. This Agreement may not be changed or terminated except in writing and as provided herein, and no notice shall be effective unless evidenced by a written instrument duly executed by the Party or Parties, hereto. 21. Any notice required under this Agreement will be in writing, addressed to the appropriate party at its address identified on the signature page of this Agreement and delivered either in person, by email, by facsimile, by registered or certified mail, or by commercial courier service. All notices shall be effective upon the date of receipt. 22. Any provision or part of this Agreement held to be void or unenforceable under any Laws or Regulations shall be deemed stricken and all remaining provisions shall continue to be valid and binding upon the Parties. The Parties agree that the Agreement shall be reformed to replace such stricken provision or part thereof with a valid and enforceable provision that comes as close as possible to expressing the intention of the stricken provision. 23. That this Agreement shall be binding upon and inure to the benefit of the parties and their respective successors, legal representatives and assigns, but this Agreement may not be assigned by either party without prior written consent of the other party, which may be withheld in the sole discretion of a party. 7 /.' 24. No act or failure to act by the County or the Fire Department shall constitute a waiver of any right or duty granted to the Parties by the terms of this Agreement. Nor shall any act or failure to act constitute any approval except as specifically agreed to in writing. 25. In order to fully comply with the terms of this Agreement Fire Department shall have a grace period commencing on the date of signature, and for the duration as stated below before full compliance with the certain sections is mandated. A. Section 5; ninety (90) days. B. Section 9; one hundred eighty (180) days. C. Section 11; ninety (90) days. D. Section 13; thirty (30) days. 26. This Agreement shall be governed by and construed in accordance with the Laws of the State of North Carolina. IN WITNESS WHEREOF, the County has caused this instrument to be executed by the Chairperson of the Board of County Commissioners and attested by the Clerk to the Board of County Commissioners, and the Fire Department has caused this instrument to be signed in its corporate name by its President, attested by its Secretary, and its corporate seal hereto affixed, all by order of its Board of Directors. Acknowledged and agreed to the day and date first above recorded. ORANGE COUNTY BY: Chair Address: Contact Person: Telephone No.: FIRE DEPARTMENT 1W President Address: Contact Person: Telephone No.: ATTEST: ATTEST: E'? Clerk Board of Commissioners Secretary (County Seal) Attachment 1 (Corporate Seal) 25 26 Dollar Thresholds in North Carolina 2 � UNG Public Contracting Statutes Dollar lim its and statutory authority current as of September 1, 2013 Formal bidding festimated cost ofmvrtraco = cnstructionor repair cantracrs $SGD,000aado6ove G-5. 143-129 Pircha5e of apparatus, supplies, materiais, and equipment $9,004 ondabove GS_ 143.124 Informal bidding Awtudrostofcontract) Construction or repaircanrtacrs $30,000 tofom►al limit W& 143 -131 Purchase of apparatus, supplies, materials, and equipment $3,000 toformal limit GS_ 143 -131 Constructlon methods authorized for build kagprojects Over$300,000 G5.143- 128fa11 Separate Prime (ertimaredmst ofprgSc0 Single Prime Dual Bidding Construction Management at Risk (G.S. r43 - ?28J1 Design -Build and Design -Build Bridging i iS. ?43- J28.r8-GS- ?43- 128.fB) Public Private Partnership (P3i fG5. 143 - 128. ?Q Historkally UndenRilzed Business (HUB) requirements Building construction or repair projects - Projects vridr state funding iver &ble?0%9oa1regrnr4 $100,DDDormxe G- 5.143- 128.2ial - Locally funded projects ffomhalHOrequirerrmW $30D,000ormore G5-143- 128.2(j) - Projects it informal bidding rartge (utformalHIM regeika7xrrW $30,000 to $500,1)00` G R 143- 131(b) ' 7?te: Formaf HLRmgruremerrts should be used f&Mforrru,* Grdpropects ov0W lretrveefu 534o,00947rrd i560,XU Limit on use of own forces (force account w oriq {motto exceed] &S. 143-135 Construction or repair projects $125,000 FftXdprayertcw0ar $50,0000P 010fpcustl Bid bond or deposit Construction or repair contracts (atfeast 5%a(brd amount) Formal bids jS_w 00o and ob6 ve G.5.143 -12"., Purchase contracts Not mquired Performance+Paymerrt bands Construction or repair contracts f ?00%dcontractamount) Each contract over $50.000 of 65.143- 12yi_. project costing over $300,000 G-S.4 ,26 FUrchas.- contracts Mot required General contractor's license required $30,ODO andabove 6587 -1 xemption Force account workiseeabove) 1_.wn=r- builderatf davit reqLired Force account work( see above) G587- 14(x](1} U se of licensed architect or eng I neer required Nonstructural work MOOO andabove G5. 133- 1 -1jal Stnrctural repair, additions or new construction $135,001) and oboes Repair work affecting I ife safety systems $100,1)D0 and abowe Selection of architect, engineer, surveyor, construction manager at risk, or design -build cantrador 'Quakfication Based Selection procedure (QB51 AH carmacts unless exempted G.5 -143 -64.31 Exemlitima• Only projects where estimated &S. 143-64.32 fee is less than $50,000 From A f egaf Guide m Arrrhasingaad Controamg for Month Carolina Loral Gotermrents Std ed., by Frayda S. Bluestein, v 3004 by the School d Govermrent, The University of North Carolina at Chapel Hi AI rights reserved- 10 27 ATTACHMENT 1 -113-2 STATE OF NORTH CAROLINA ORANGE COUNTY FIRE PROTECTION AND EMERGENCY SERVICES AGREEMENT THIS AGREEMENT (this "Agreement), made and entered into this day of 2013 by and between Orange County, hereinafter referred to as the "County" and , hereinafter referred to as the "Fire Department ", referred to herein as "Party" and /or collectively as the "Parties ". WITNESSETH: County created the Fire Protection District (the "District ") as a special tax district pursuant to Chapter 69 of the North Carolina General Statutes and desires to contract with Fire Department for fire protection and other services as set out herein. 2. Pursuant to §NCGS 69 -25.4 the County agrees that it will cause to be assessed or levied a special tax of not more than fifteen cents ($.15) per one - hundred dollar ($100) valuation of all real and personal property in the District unless otherwise limited or prohibited by law or a vote of the people, and will collect said tax as a part of the ad valorem taxes of Orange County; provided however, the amount levied annually shall be based on the needs projected in the budget estimate submitted by the Fire Department to the County as approved by the County. 3. That a special or separate fund shall be maintained by the County for funds collected as a result of said special tax. 4. That from said special tax district the Board of County Commissioners will approve a Fire Protection District tax rate and Annual Budget for the fire Department. The County agrees to remit quarterly payments, by the 15th day of the first month of each quarter. The total quarterly payments to the fire department will equal the annual budget. The Fire Department shall provide and furnish adequate fire protection services and shall provide the necessary equipment, personnel, and other resources as determined by the North Carolina Department of Insurance, Fire and Rescue Service Division, and the Insurance Service Office for all persons and property located within the District. Fire Department currently has an insurance rating of , and during the term of this Agreement will maintain at least a 9E insurance rating. Fire Department will furnish fire and rescue services free of charge to all persons and individuals within the District (excluding non - public commercial transportation). Fire Department shall strive to achieve an insurance rating of 8 (or better) by July 2014 and 6 (or better) by July 2016. This section does not preclude the Fire Department from charging a pre- arranged nominal fee when standing by for special events. 6. That all funds paid to the Fire Department by the County shall be used exclusively by the Fire Department to provide fire protection services within the District (See Exhibit 1), and the Fire Department may also use said funds to provide Medical Responder W and rescue services within the District, and to pay other legitimate fire, rescue, and Medical Responder expenses attributable to the services rendered within the District. This does not preclude mutual aid agreements. 7. The Fire Department shall provide Medical Responder Services within the District. Medical Responder Services are defined as the provision of Basic Life Support treatment as needed until such time as more highly trained personnel arrive on scene. Such Medical Responder Services may be provided through mutual aid agreements or through third party contracts The Fire Department shall provide Hazardous Materials Response Services at the North Carolina Department of Insurance "Operations" Level within the District. Hazardous Materials Response Services are defined as defensive actions necessary to protect life, property and the environment from the effects of the release. 9. The Fire Department shall provide Rescue Services to all persons and individuals within the District. Rescue Services are defined as the removal, extrication, or freeing of individuals from vehicle confinement or danger. Such Rescue Services may be provided through mutual aid agreements or through third party contracts. 10. Notwithstanding Section 6 above Fire Department may provide fire protection services outside the District subject to the following terms and conditions [This section applicable only to departments authorized to provide fire protection services outside their districts. Remove or strike where not applicable]: A. That Fire Department is authorized to provide primary fire protection services in the area of the District shown in Exhibit 1. B. Fire Department shall not expend any funds or resources appropriated for the use of persons and individuals in the District for the primary fire protection services outside the area of the District shown in Exhibit 1. In the event any such expenditure occurs for primary fire protection outside the area shown in Exhibit 1 Fire Department shall immediately notify the County and Fire Department shall take corrective measures to rectify the expenditure and to ensure such expenditure shall not be repeated. C. That Fire Department shall enter into an agreement with the Department in which Fire Department shall provide compensation to Fire Department for Fire Department's availability and service in providing primary fire protection services in the area of the District shown in Exhibit 1. 11. In providing the services contemplated herein the Fire Department shall operate in compliance with all applicable State and local laws and regulations including, but not limited to the North Carolina Fire Incident Reporting System (G.S. 58- 79 -45, NC Administrative Code, §.0402). The Fire Department shall submit electronic incident reports on a quarterly basis to the Orange County Fire Marshal . The Fire Department further agrees to file with the Fire Marshal Office a current list of its Board of Directors, and a roster of its fire department personnel, an annual training INJ CO report, and a list of apparatus including pump and tank size, and specialized fire suppression equipment, no later than July 31St of each year. The County shall have the right to inspect all books and accounts for the Fire Department at any time. Said inspection shall be conducted by the Orange County Fire Marshal and /or Orange County Finance Office and /or their designee. The following minimal performance standards are agreed upon by the County and the Fire Department and are a part of this contract: A. Response Time. Fire Department should have the goal of having an average response time (time of dispatch until time of arrival) of _16_ minutes or less for structural fire calls within the recognized Insurance District. Fire Department should have the goal of having an average response time of _16_ minutes or less for Medical Responder and Rescue Services. B. Manpower on Scene. Fire Department should have adopted standard operating guidelines that address the appropriate number of firefighters needed on all type fire calls. The National Incident Management System shall be used at all incidents to manage personnel. C. Training. Fire Department shall have the minimum standard training requirements set forth by the State of North Carolina and NC Department of Labor for providing fire and emergency services provided by the Fire Department. For purposes of this agreement emergency services includes both Medical Responder services, hazardous materials services, and rescue services. D. Fire Investigations. The Fire Department officer in charge at all fire scenes shall attempt to determine the cause and origin of every fire. When the officer in charge cannot determine the cause and origin of the fire, or if the cause is suspected to be of an incendiary nature, the officer in charge may request assistance from the Orange County Fire Marshal. E. Reports. Fire Department shall keep all records for a minimum period of seven (7) years. All State and county required reports and rosters shall be submitted by the applicable deadlines. F. Fire Hydrants. The Fire Department should coordinate with the owners of the water distribution system so that every hydrant in the District is flushed and checked for accessibility, functionality, visibility, and operation at least annually. If the hydrant is owned by a municipality or special water district, testing and maintenance should be handled as agreed upon by the County and the system operator. The Fire Department should report any malfunctions or damage to hydrants to the owner of the water distribution system. G. Emergency /Disaster Response. Fire Department shall follow the Orange County Emergency Operation Framework (EOF) Policy when responding to an emergency or disaster. 30 H. State of Emergency. County requests that Fire Department, when available, assist with the following services, but not limited to, before, during, and following times of emergency /disaster: 1. Debris Clearance; 2) Traffic Control; 3) Alert and Warning; 4) Search and Rescue; 5) Evacuation Notification and Coordination; and 6) other life- saving and property protection measures as necessary. All operations shall be in accordance with the Orange County Orange County Emergency Operation Framework (EOF) Policy. I. Medical Responder Services. When Fire Department provides Medical Responder Services assistance, it shall be done in accordance with the rules set forth by the Orange County Medical Director. 12. The Fire Department shall submit to an audit by a Certified Public Accountant, which will be paid for by the County, and shall be in conformity with General Accepted Accounting Principles. If an audit has already been performed by a certified entity, the Fire Department shall present the County with a copy of that audit. Such audit to be provided on or before December 31St of each year beginning in 2014, and to be in conformity with the most recent audit policies of the County and the North Carolina Local Government Commission. Further, the Fire Department agrees to comply with County budgeting procedures including a mid -year financial statement and other procedures provided for by State Law and agree to submit budget estimates to the Board of Commissioners on the standard forms used by County departments. The Fire Department also agrees to use standard line items for accounting as requested by the County Finance Department. 13. The Fire Department shall comply with the County budgeting procedures, and shall submit annual budget estimates in accordance with established County budget timetables. A supporting letter of request for the proposed tax rate shall be signed by the Fire Department's president upon approval of its Board of Directors. The County will provide the Fire Department with standard forms for budget submission and the Fire Department shall use such standard forms. 14. The Fire Department shall comply with the State of North Carolina purchasing procedures for local governments as identified in Attachment #1, as well as other procedures provided for by state law. 15. The Fire Department shall file with the County Fire Marshal a true copy of its Articles of Incorporation, Bylaws, and shall furnish any changes made thereto not less than thirty (30) days prior to their effective dates. Further, the Fire Department agrees to amend its Articles of Incorporation and Bylaws as necessary to meet all minimum legal requirements for a North Carolina nonprofit corporation, as required by the provisions of Chapter 55A of the General Statutes of North Carolina. Should Fire Department be notified that it has failed to meet all minimum legal requirements for a North Carolina nonprofit corporation and /or failed to maintain its federal, state, or local tax - exempt status the Fire Department shall, within thirty (30) days of such notification, begin taking appropriate steps to remedy said failure. Should said failure not be appropriately remedied within ninety (90) days after such notification County may withhold special district tax revenues until such time as the Fire Department meets all minimum legal requirements of Chapter 55A of the General Statutes of rd 31 North Carolina and /or until such time as the Fire Department's tax - exempt status is restored. 16. In the event the Fire Department dissolves then the Fire Department shall deliver, release, and convey to the County all of its equipment, cash, or other assets to be used by the County exclusively for the provision of fire protection services, rescue services, or Medical Responder services within the District. Any such dissolution shall comply with applicable laws of North Carolina. If Fire Department ceases to provide either fire protection services, rescue services, or Medical Responder services within the District Fire Department shall deliver, release, and convey to County all of its equipment, cash, or other assets used for those specific services the Fire Department has ceased to provide, to be used by the County exclusively for the provision of fire protection services, rescues services, or Medical Responder services within the District. Should the terms of this paragraph conflict with Fire Department's Articles of Incorporation the Articles of Incorporation shall control. 17. The Fire Department agrees to hold harmless and indemnify the County from and against any and all liability and expenses including attorney fees, court costs and other costs incurred by the County caused by any act or omission of the Fire Department, its agents and employees. The Department shall purchase and maintain, during the term of this Agreement, and any extension hereof, at least the following insurance coverage: A. Comprehensive Automobile Liability Insurance with combined single limits of at least one million dollars ($1,000,000) per occurrence. Coverage shall be provided under a symbol 1 ". Coverage shall apply, on an excess basis for hired, borrowed and non -owned vehicles. Coverage shall apply, on a primary basis, for commandeered vehicles. Volunteers or employees shall be considered insureds and volunteers and employees shall have coverage in excess of their personal auto liability limits when they are using their vehicles on behalf of the Fire Department. Fellow member liability shall be provided. Auto pollution liability shall be included in the coverage. B. Auto physical damage shall be provided on an agreed value basis. Coverage shall be included for hire, borrowed or commandeered vehicles without a limit of liability. Coverage shall be provided to bring replacement vehicle up to the most current national standards, such as NFPA or DOT. C. Comprehensive General Liability Insurance with limits of at least one million dollars ($1,000,000) per occurrence and two million dollars ($2,000,000) aggregate. The aggregate shall apply per named insured and per insured location. The policy shall include the following coverage: Volunteers or employees as insureds, Medical Malpractice, Good Samaritan Liability Coverage, Intentional Acts Coverage for both bodily injury and or property damage, Fellow Member Liability, Non -owned Watercraft, Fire Damage Legal Liability with limits of one million dollars ($1,000,000), Pollution Liability arising out of emergency operations, training activities or equipment wash downs. 32 D. Directors and Officers Liability Insurance with limits of at least one million dollars ($1,000,000) per occurrence with two million dollars ($2,000,000) aggregate. This policy shall include coverage for prior acts. The insureds shall include current volunteers and employees, former volunteers and employees, and any persons or organizations providing service to the Department under a mutual aid or similar agreement. Coverage shall include civil rights type suits such as discrimination and sexual harassment; liability arising out of the administration of benefit plans for employees or volunteers and employment related practice suites. Coverage shall include claims made for future compensation and benefits lost from wrongful termination of an employee. E. Umbrella Liability Insurance with limits of at least one million dollars ($1,000,000) per occurrence and one million dollars ($1,000,000) aggregate. The umbrella policy shall provide excess coverage over the Auto Liability Policy, General Liability Policy, and the Employer's Liability Section of the Workers' Compensation Policy. Volunteers and employees shall be included as insureds. F. The Department shall maintain Property Insurance protecting against the risk of direct physical loss or damage. The policy covering the building shall be written on a Guaranteed Replacement Cost Basis, with coverage included for Building Ordinance, Flood, and Earthquake. Coverage shall include Commandeered Property in the amount of two - hundred fifty thousand dollars ($250,000). Contents coverage shall be provided on a replacement cost basis. Coinsurance penalties shall not apply. G. Portable Equipment Coverage shall be provided protecting against the risk of direct physical loss or damage, including electrical surges. Coverage shall be provided on a Guaranteed Replacement Cost Basis. H. The Automobile Liability Policy, General Liability Policy, Umbrella Liability Policy and Management Liability Policy shall name the County as an additional insured. The Department shall furnish the County with Certificates of Insurance showing the type of policy, limits of liability, name of insurance companies, policy numbers, effective dates and expiration dates of policies. Workers' Compensation Insurance covering all volunteers and salaries firefighters meeting statutory limits in compliance with applicable State and Federal Laws. Each policy shall also contain a ten (10) day notice to the County in the event of cancellation or modification of any stipulated insurance coverage. 18. In connection with the performance of this Agreement, the Fire Department agrees not to discriminate against any employee, member, or applicant for employment or membership because of race, color, national origin, religion, creed, ethnicity, sex, sexual orientation, age, disability, political affiliation, and Vietnam -Era or disabled veteran status. Employees, members and applicants must however, be competent and capable to perform the requirements of the job. The Fire Department agrees to 31 33 take all reasonable measures to insure that applicants are employed, and that employees are treated appropriately, during their employment, without regard to their race, color, national origin, religion, creed, ethnicity, sex, sexual orientation, age, disability, political affiliation, and Vietnam -Era or disabled veteran status. 19. This Agreement shall continue for a term of five (5) years unless terminated as hereinafter provided. This Agreement may be renewed for two additional five -year terms upon mutual agreement of the Parties. Either Party may terminate this Agreement effective at the end of any fiscal year by giving the other Party notice at least one (1) year in advance of the end of the fiscal year that the Agreement is to terminate. 20. This Agreement sets forth the entire understanding of the parties and supersedes any and all prior agreements, arrangements, and understandings related to the subject matter hereto. This Agreement may not be changed or terminated except in writing and as provided herein, and no notice shall be effective unless evidenced by a written instrument duly executed by the Party or Parties, hereto. 21. Any notice required under this Agreement will be in writing, addressed to the appropriate party at its address identified on the signature page of this Agreement and delivered either in person, by email, by facsimile, by registered or certified mail, or by commercial courier service. All notices shall be effective upon the date of receipt. 22. Any provision or part of this Agreement held to be void or unenforceable under any Laws or Regulations shall be deemed stricken and all remaining provisions shall continue to be valid and binding upon the Parties. The Parties agree that the Agreement shall be reformed to replace such stricken provision or part thereof with a valid and enforceable provision that comes as close as possible to expressing the intention of the stricken provision. 23. That this Agreement shall be binding upon and inure to the benefit of the parties and their respective successors, legal representatives and assigns, but this Agreement may not be assigned by either party without prior written consent of the other party, which may be withheld in the sole discretion of a party. 24. No act or failure to act by the County or the Fire Department shall constitute a waiver of any right or duty granted to the Parties by the terms of this Agreement. Nor shall any act or failure to act constitute any approval except as specifically agreed to in writing. 25. In order to fully comply with the terms of this Agreement Fire Department shall have a grace period commencing on the date of signature, and for the duration as stated below before full compliance with the certain sections is mandated. A. Section 5; ninety (90) days. B. Section 9; one hundred eighty (180) days. 7 34 C. Section 11; ninety (90) days. D. Section 13; thirty (30) days. 26. This Agreement shall be governed by and construed in accordance with the Laws of the State of North Carolina. IN WITNESS WHEREOF, the County has caused this instrument to be executed by the Chairperson of the Board of County Commissioners and attested by the Clerk to the Board of County Commissioners, and the Fire Department has caused this instrument to be signed in its corporate name by its President, attested by its Secretary, and its corporate seal hereto affixed, all by order of its Board of Directors. Acknowledged and agreed to the day and date first above recorded ORANGE COUNTY BY: Chair Address: Contact Person: Telephone No.: ATTEST: Clerk Board of Commissioners FIRE DEPARTMENT 1W President Address: Contact Person: Telephone No.: ATTEST: Secretary (County Seal) (Corporate Seal) E'? 35 Attachment 1 Dollar Thresholds in North Carolina LJNQ Public Contracting Statutes Uolllar Gm its and statutory authority current as of September 1, 2013 formal bfdding ferrimatedcr�talmvrtrac Construction or repaircorYUacts $5O0,0G0andabove &.5.143 -129 = urchase cf apparatus, suppies, —W iak, and egtipmerst $90,004 andabove CL& 143 -129 Informal bidding 4WMA0rrastOfcanftC) -_instruction or rEpaircontracls $30,000 toformal limit GS. 143 -41 Furchaw of apparatus, supplies, rr3 -.erlal -, and egripment $30,000 toforrnal limit G5. 143-131 Construction methods authorized for building pro)eeis Owa5300,000 GS 143- 128(alI Separate Prime Jeaimatedcost ofprgiec0 Single Prime Dual Bidding Construction Management at Risk lGS_ r43428J) Design -Build and Design -Build Bridging �US P43- J28.rq GS. P43428.1`13i Public Private Partnership (P3) fGS. 143- r28.?Q Hlstorkally Underutfised Business {HUB) requirements E,Lilding construction or repair projects - Projects with state funbngfverifrabfel0 %_gDaimquired) $100,D00orrrrune &S. 143- 128.2(al - Locallyfundedprojects (formalHUBrequiremena) $300,000ormore CL5.143- 128.2(j) - Projects in informal bidding range (inforroalHUB requ rementy) $30,000 to $500,000' 6.5. 143- 131(b) '4nteFarrrtaf INJBrequrrenrerrts shau(d beusedJavMkarmaVy 6tdpro�lgtts aosfNtg between S3� odlPand ikJ0.000 Limit on use of awn forces ( farce account work) (nortoexceed) G5. 143 -135 Canstruction or repair pr.-jects $125.000 ftorarprojeet cis@ or $511,000 (labor crsfy cOa) Bid bond ordeposit Construction or repair contracts (atfeast5 %of bidomoun() Formal bids f$5i0Q, Wandabove) G-S.143 -11M., Purchase contrwt5 Not req u ired Performance+Payment bonds Construction or repaircontractsf?00 %ofcontradarnoan(r Each contract cva•$50.000of G-5. 143-129(c),- project costing over 5300,000 G5. 44A -26 Purchase rnntrwts Not raq u ired General contractors license required $30,000 andcbove G5 87 -1 E:emption Force account work.see obasvF 0wrPer- builder affidavit required Force account work (see abase) GS_ 87- 14(x](1} Use of licensed architect or eng I neer required Nonstructural work $300,000 ondabove G5. 133 -1 -Kati Stnsetural repair, additions or new conshvcti n $135,000ardaboie Repair work affecting I ife safety systems $100,00o andabtiow e Selection of archltett, engineer, rurveyar, construction manager at risk, or design -build contractor v!Lalificatian -Based Selection" procedure (QBSI all contracts unless exempted G.5.143 -64.31 verrption authorized Only projects where estimated G.5.143 -64.32 fee is less than $SQoU0 From A iPgaf Guide to fVrrrhmmg Grid Contnocting for North Carolna (noal Govemrnents 2nd ed., by Frayda S. Bluestein. 0 2M by the Sdwol of Govenrnent, The University of North Carolina at Chapel Hil I. Al I rights reserved. 36 ATTACHMENT 1 -113-3 STATE OF NORTH CAROLINA ORANGE COUNTY FIRE PROTECTION AND EMERGENCY SERVICES AGREEMENT THIS AGREEMENT (this "Agreement), made and entered into this day of 2013 by and between Orange County, hereinafter referred to as the "County" and Orange Rural Fire Department, hereinafter referred to as the "Fire Department ", referred to herein as "Party" and /or collectively as the "Parties ". WITNESSETH: 1. County created the Fire Protection District (the "District ") as a special tax district pursuant to Chapter 69 of the North Carolina General Statutes and desires to contract with Fire Department for fire protection and other services as set out herein. 2. Pursuant to §NCGS 69 -25.4 the County agrees that it will cause to be assessed or levied a special tax of not more than fifteen cents ($.15) per one - hundred dollar ($100) valuation of all real and personal property in the District unless otherwise limited or prohibited by law or a vote of the people, and will collect said tax as a part of the ad valorem taxes of Orange County; provided however, the amount levied annually shall be based on the needs projected in the budget estimate submitted by the Fire Department to the County as approved by the County. 3. That a special or separate fund shall be maintained by the County for funds collected as a result of said special tax. 4. That from said special tax district the Board of County Commissioners will approve a Fire Protection District tax rate and Annual Budget for the fire Department. The County agrees to remit quarterly payments, by the 15th day of the first month of each quarter. The total quarterly payments to the fire department will equal the annual budget. The Fire Department shall provide and furnish adequate fire protection services and shall provide the necessary equipment, personnel, and other resources as determined by the North Carolina Department of Insurance, Fire and Rescue Service Division, and the Insurance Service Office for all persons and property located within the District. Fire Department currently has an insurance rating of , and during the term of this Agreement will maintain at least a 9E insurance rating. Fire Department will furnish fire and rescue services free of charge to all persons and individuals within the District (excluding non - public commercial transportation). Fire Department shall strive to achieve an insurance rating of 8 (or better) by July 2014 and 6 (or better) by July 2016. This section does not preclude the Fire Department from charging a pre- arranged nominal fee when standing by for special events. 6. That all funds paid to the Fire Department by the County shall be used exclusively by the Fire Department to provide fire protection services within the District (See Exhibit 1), and the Fire Department may also use said funds to provide Medical Responder 37 and rescue services within the District, and to pay other legitimate fire, rescue, and Medical Responder expenses attributable to the services rendered within the District. This does not preclude mutual aid agreements. 7. The Fire Department shall provide Medical Responder Services within the District. Medical Responder Services are defined as the provision of Basic Life Support treatment as needed until such time as more highly trained personnel arrive on scene. Such Medical Responder Services may be provided through mutual aid agreements or through third party contracts The Fire Department shall provide Hazardous Materials Response Services at the North Carolina Department of Insurance "Operations" Level within the District. Hazardous Materials Response Services are defined as defensive actions necessary to protect life, property and the environment from the effects of the release. 9. The Fire Department shall provide Rescue Services to all persons and individuals within the District. Rescue Services are defined as the removal, extrication, or freeing of individuals from vehicle confinement or danger, rope rescue, vehicle and machinery rescue, farm machinery rescue, and confined space rescue. Furthermore, the Fire Department shall provide structural collapse rescue services by January 1, 2014, and water rescue by July 1, 2014. Such Rescue Services may be provided through mutual aid agreements or through third party contracts. 10. Notwithstanding Section 6 above Fire Department may provide fire protection services outside the District subject to the following terms and conditions [This section applicable only to departments authorized to provide fire protection services outside their districts. Remove or strike where not applicable]: A. That Fire Department is authorized to provide primary fire protection services in the area of the District shown in Exhibit 1. B. Fire Department shall not expend any funds or resources appropriated for the use of persons and individuals in the District for the primary fire protection services outside the area of the District shown in Exhibit 1. In the event any such expenditure occurs for primary fire protection outside the area shown in Exhibit 1 Fire Department shall immediately notify the County and Fire Department shall take corrective measures to rectify the expenditure and to ensure such expenditure shall not be repeated. C. That Fire Department shall enter into an agreement with the Department in which Fire Department shall provide compensation to Fire Department for Fire Department's availability and service in providing primary fire protection services in the area of the District shown in Exhibit 1. 11. In providing the services contemplated herein the Fire Department shall operate in compliance with all applicable State and local laws and regulations including, but not limited to the North Carolina Fire Incident Reporting System (G.S. 58- 79 -45, NC Administrative Code, §.0402). The Fire Department shall submit electronic incident PJ W reports on a quarterly basis to the Orange County Fire Marshal. The Fire Department further agrees to file with the Fire Marshal Office a current list of its Board of Directors, and a roster of its fire department personnel, an annual training report, and a list of apparatus including pump and tank size, and specialized fire suppression equipment, no later than July 31St of each year. The County shall have the right to inspect all books and accounts for the Fire Department at any time. Said inspection shall be conducted by the Orange County Fire Marshal and /or Orange County Finance Office and /or their designee. The following minimal performance standards are agreed upon by the County and the Fire Department and are a part of this contract: A. Response Time. Fire Department should have the goal of having an average response time (time of dispatch until time of arrival) of _16_ minutes or less for structural fire calls within the recognized Insurance District. Fire Department should have the goal of having an average response time of _16_ minutes or less for Medical Responder and Rescue Services. B. Manpower on Scene. Fire Department should have adopted standard operating guidelines that address the appropriate number of firefighters needed on all type fire calls. The National Incident Management System shall be used at all incidents to manage personnel. C. Training. Fire Department shall have the minimum standard training requirements set forth by the State of North Carolina and NC Department of Labor for providing fire and emergency services provided by the Fire Department. For purposes of this agreement emergency services includes both Medical Responder services, hazardous materials services, and rescue services. D. Fire Investigations. The Fire Department officer in charge at all fire scenes shall attempt to determine the cause and origin of every fire. When the officer in charge cannot determine the cause and origin of the fire, or if the cause is suspected to be of an incendiary nature, the officer in charge may request assistance from the Orange County Fire Marshal. E. Reports. Fire Department shall keep all records for a minimum period of seven (7) years. All State and county required reports and rosters shall be submitted by the applicable deadlines. F. Fire Hydrants. The Fire Department should coordinate with the owners of the water distribution system so that every hydrant in the District is flushed and checked for accessibility, functionality, visibility, and operation at least annually. If the hydrant is owned by a municipality or special water district, testing and maintenance should be handled as agreed upon by the County and the system operator. The Fire Department should report any malfunctions or damage to hydrants to the owner of the water distribution system. 39 G. Emergency /Disaster Response. Fire Department shall follow the Orange County Emergency Operation Framework (EOF) Policy when responding to an emergency or disaster. H. State of Emergency. County requests that Fire Department, when available, assist with the following services, but not limited to, before, during, and following times of emergency /disaster: 1. Debris Clearance; 2) Traffic Control; 3) Alert and Warning; 4) Search and Rescue; 5) Evacuation Notification and Coordination; and 6) other life- saving and property protection measures as necessary. All operations shall be in accordance with the Orange County Orange County Emergency Operation Framework (EOF) Policy. Medical Responder Services. When Fire Department provides Medical Responder Services assistance, it shall be done in accordance with the rules set forth by the Orange County Medical Director. 12. The Fire Department shall submit to an audit by a Certified Public Accountant, which will be paid for by the County, and shall be in conformity with General Accepted Accounting Principles. If an audit has already been performed by a certified entity, the Fire Department shall present the County with a copy of that audit. Such audit to be provided on or before December 31St of each year beginning in 2014, and to be in conformity with the most recent audit policies of the County and the North Carolina Local Government Commission. Further, the Fire Department agrees to comply with County budgeting procedures including a mid -year financial statement and other procedures provided for by State Law and agree to submit budget estimates to the Board of Commissioners on the standard forms used by County departments. The Fire Department also agrees to use standard line items for accounting as requested by the County Finance Department. 13. The Fire Department shall comply with the County budgeting procedures, and shall submit annual budget estimates in accordance with established County budget timetables. A supporting letter of request for the proposed tax rate shall be signed by the Fire Department's president upon approval of its Board of Directors. The County will provide the Fire Department with standard forms for budget submission and the Fire Department shall use such standard forms. 14. The Fire Department shall comply with the State of North Carolina purchasing procedures for local governments as identified in Attachment #1, as well as other procedures provided for by state law. 15. The Fire Department shall file with the County Fire Marshal a true copy of its Articles of Incorporation, Bylaws, and shall furnish any changes made thereto not less than thirty (30) days prior to their effective dates. Further, the Fire Department agrees to amend its Articles of Incorporation and Bylaws as necessary to meet all minimum legal requirements for a North Carolina nonprofit corporation, as required by the provisions of Chapter 55A of the General Statutes of North Carolina. Should Fire Department be notified that it has failed to meet all minimum legal requirements for a North Carolina nonprofit corporation and /or failed to maintain its federal, state, or local tax - exempt status the Fire Department shall, within thirty (30) days of such rd M notification, begin taking appropriate steps to remedy said failure. Should said failure not be appropriately remedied within ninety (90) days after such notification County may withhold special district tax revenues until such time as the Fire Department meets all minimum legal requirements of Chapter 55A of the General Statutes of North Carolina and /or until such time as the Fire Department's tax - exempt status is restored. 16. In the event the Fire Department dissolves then the Fire Department shall deliver, release, and convey to the County all of its equipment, cash, or other assets to be used by the County exclusively for the provision of fire protection services, rescue services, or Medical Responder services within the District. Any such dissolution shall comply with applicable laws of North Carolina. If Fire Department ceases to provide either fire protection services, rescue services, or Medical Responder services within the District Fire Department shall deliver, release, and convey to County all of its equipment, cash, or other assets used for those specific services the Fire Department has ceased to provide, to be used by the County exclusively for the provision of fire protection services, rescues services, or Medical Responder services within the District. Should the terms of this paragraph conflict with Fire Department's Articles of Incorporation the Articles of Incorporation shall control. 17. The Fire Department agrees to hold harmless and indemnify the County from and against any and all liability and expenses including attorney fees, court costs and other costs incurred by the County caused by any act or omission of the Fire Department, its agents and employees. The Department shall purchase and maintain, during the term of this Agreement, and any extension hereof, at least the following insurance coverage: A. Comprehensive Automobile Liability Insurance with combined single limits of at least one million dollars ($1,000,000) per occurrence. Coverage shall be provided under a symbol 1 ". Coverage shall apply, on an excess basis for hired, borrowed and non -owned vehicles. Coverage shall apply, on a primary basis, for commandeered vehicles. Volunteers or employees shall be considered insureds and volunteers and employees shall have coverage in excess of their personal auto liability limits when they are using their vehicles on behalf of the Fire Department. Fellow member liability shall be provided. Auto pollution liability shall be included in the coverage. B. Auto physical damage shall be provided on an agreed value basis. Coverage shall be included for hire, borrowed or commandeered vehicles without a limit of liability. Coverage shall be provided to bring replacement vehicle up to the most current national standards, such as NFPA or DOT. C. Comprehensive General Liability Insurance with limits of at least one million dollars ($1,000,000) per occurrence and two million dollars ($2,000,000) aggregate. The aggregate shall apply per named insured and per insured location. The policy shall include the following coverage: Volunteers or employees as insureds, Medical Malpractice, Good Samaritan Liability Coverage, Intentional Acts Coverage for both bodily injury and or property damage, Fellow Member Liability, Non -owned Watercraft, Fire Damage Legal Liability with limits of one million dollars 5 41 ($1,000,000), Pollution Liability arising out of emergency operations, training activities or equipment wash downs. D. Directors and Officers Liability Insurance with limits of at least one million dollars ($1,000,000) per occurrence with two million dollars ($2,000,000) aggregate. This policy shall include coverage for prior acts. The insureds shall include current volunteers and employees, former volunteers and employees, and any persons or organizations providing service to the Department under a mutual aid or similar agreement. Coverage shall include civil rights type suits such as discrimination and sexual harassment; liability arising out of the administration of benefit plans for employees or volunteers and employment related practice suites. Coverage shall include claims made for future compensation and benefits lost from wrongful termination of an employee. E. Umbrella Liability Insurance with limits of at least one million dollars ($1,000,000) per occurrence and one million dollars ($1,000,000) aggregate. The umbrella policy shall provide excess coverage over the Auto Liability Policy, General Liability Policy, and the Employer's Liability Section of the Workers' Compensation Policy. Volunteers and employees shall be included as insureds. F. The Department shall maintain Property Insurance protecting against the risk of direct physical loss or damage. The policy covering the building shall be written on a Guaranteed Replacement Cost Basis, with coverage included for Building Ordinance, Flood, and Earthquake. Coverage shall include Commandeered Property in the amount of two - hundred fifty thousand dollars ($250,000). Contents coverage shall be provided on a replacement cost basis. Coinsurance penalties shall not apply. G. Portable Equipment Coverage shall be provided protecting against the risk of direct physical loss or damage, including electrical surges. Coverage shall be provided on a Guaranteed Replacement Cost Basis. H. The Automobile Liability Policy, General Liability Policy, Umbrella Liability Policy and Management Liability Policy shall name the County as an additional insured. The Department shall furnish the County with Certificates of Insurance showing the type of policy, limits of liability, name of insurance companies, policy numbers, effective dates and expiration dates of policies. I. Workers' Compensation Insurance covering all volunteers and salaries firefighters meeting statutory limits in compliance with applicable State and Federal Laws. Each policy shall also contain a ten (10) day notice to the County in the event of cancellation or modification of any stipulated insurance coverage. 18. In connection with the performance of this Agreement, the Fire Department agrees not to discriminate against any employee, member, or applicant for employment or membership because of race, color, national origin, religion, creed, ethnicity, sex, 31 42 sexual orientation, age, disability, political affiliation, and Vietnam -Era or disabled veteran status. Employees, members and applicants must however, be competent and capable to perform the requirements of the job. The Fire Department agrees to take all reasonable measures to insure that applicants are employed, and that employees are treated appropriately, during their employment, without regard to their race, color, national origin, religion, creed, ethnicity, sex, sexual orientation, age, disability, political affiliation, and Vietnam -Era or disabled veteran status. 19. This Agreement shall continue for a term of five (5) years unless terminated as hereinafter provided. This Agreement may be renewed for two additional five -year terms upon mutual agreement of the Parties. Either Party may terminate this Agreement effective at the end of any fiscal year by giving the other Party notice at least one (1) year in advance of the end of the fiscal year that the Agreement is to terminate. 20. This Agreement sets forth the entire understanding of the parties and supersedes any and all prior agreements, arrangements, and understandings related to the subject matter hereto. This Agreement may not be changed or terminated except in writing and as provided herein, and no notice shall be effective unless evidenced by a written instrument duly executed by the Party or Parties, hereto. 21. Any notice required under this Agreement will be in writing, addressed to the appropriate party at its address identified on the signature page of this Agreement and delivered either in person, by email, by facsimile, by registered or certified mail, or by commercial courier service. All notices shall be effective upon the date of receipt. 22. Any provision or part of this Agreement held to be void or unenforceable under any Laws or Regulations shall be deemed stricken and all remaining provisions shall continue to be valid and binding upon the Parties. The Parties agree that the Agreement shall be reformed to replace such stricken provision or part thereof with a valid and enforceable provision that comes as close as possible to expressing the intention of the stricken provision. 23. That this Agreement shall be binding upon and inure to the benefit of the parties and their respective successors, legal representatives and assigns, but this Agreement may not be assigned by either party without prior written consent of the other party, which may be withheld in the sole discretion of a party. 24. No act or failure to act by the County or the Fire Department shall constitute a waiver of any right or duty granted to the Parties by the terms of this Agreement. Nor shall any act or failure to act constitute any approval except as specifically agreed to in writing. 25. In order to fully comply with the terms of this Agreement Fire Department shall have a grace period commencing on the date of signature, and for the duration as stated below before full compliance with the certain sections is mandated. A. Section 5; ninety (90) days. 7 43 B. Section 9; one hundred eighty (180) days. C. Section 11; ninety (90) days. D. Section 13; thirty (30) days. 26. This Agreement shall be governed by and construed in accordance with the Laws of the State of North Carolina. IN WITNESS WHEREOF, the County has caused this instrument to be executed by the Chairperson of the Board of County Commissioners and attested by the Clerk to the Board of County Commissioners, and the Fire Department has caused this instrument to be signed in its corporate name by its President, attested by its Secretary, and its corporate seal hereto affixed, all by order of its Board of Directors. Acknowledged and agreed to the day and date first above recorded. ORANGE COUNTY BY: Chair Address: Contact Person: Telephone No.: ATTEST: Clerk Board of Commissioners FIRE DEPARTMENT AN President Address: Contact Person: Telephone No.: ATTEST: Secretary (County Seal) (Corporate Seal) E'? M Attachment 1 Dollar Thresholds in North Carolina LJNQ Public Contracting Statutes Uolllar Gm its and statutory authority current as of September 1, 2013 formal bfdding ferrimatedcr�talmvrtrac Construction or repaircorYUacts $5O0,0G0andabove &.5.143 -129 = urchase cf apparatus, suppies, —W iak, and egtipmerst $90,004 andabove CL& 143 -129 Informal bidding 4WMA0rrastOfcanftC) -_instruction or rEpaircontracls $30,000 toformal limit GS. 143 -41 Furchaw of apparatus, supplies, rr3 -.erlal -, and egripment $30,000 toforrnal limit G5. 143-131 Construction methods authorized for building pro)eeis Owa5300,000 GS 143- 128(alI Separate Prime Jeaimatedcost ofprgiec0 Single Prime Dual Bidding Construction Management at Risk lGS_ r43428J) Design -Build and Design -Build Bridging �US P43- J28.rq GS. P43428.1`13i Public Private Partnership (P3) fGS. 143- r28.?Q Hlstorkally Underutfised Business {HUB) requirements E,Lilding construction or repair projects - Projects with state funbngfverifrabfel0 %_gDaimquired) $100,D00orrrrune &S. 143- 128.2(al - Locallyfundedprojects (formalHUBrequiremena) $300,000ormore CL5.143- 128.2(j) - Projects in informal bidding range (inforroalHUB requ rementy) $30,000 to $500,000' 6.5. 143- 131(b) '4nteFarrrtaf INJBrequrrenrerrts shau(d beusedJavMkarmaVy 6tdpro�lgtts aosfNtg between S3� odlPand ikJ0.000 Limit on use of awn forces ( farce account work) (nortoexceed) G5. 143 -135 Canstruction or repair pr.-jects $125.000 ftorarprojeet cis@ or $511,000 (labor crsfy cOa) Bid bond ordeposit Construction or repair contracts (atfeast5 %of bidomoun() Formal bids f$5i0Q, Wandabove) G-S.143 -11M., Purchase contrwt5 Not req u ired Performance+Payment bonds Construction or repaircontractsf?00 %ofcontradarnoan(r Each contract cva•$50.000of G-5. 143-129(c),- project costing over 5300,000 G5. 44A -26 Purchase rnntrwts Not raq u ired General contractors license required $30,000 andcbove G5 87 -1 E:emption Force account work.see obasvF 0wrPer- builder affidavit required Force account work (see abase) GS_ 87- 14(x](1} Use of licensed architect or eng I neer required Nonstructural work $300,000 ondabove G5. 133 -1 -Kati Stnsetural repair, additions or new conshvcti n $135,000ardaboie Repair work affecting I ife safety systems $100,00o andabtiow e Selection of archltett, engineer, rurveyar, construction manager at risk, or design -build contractor v!Lalificatian -Based Selection" procedure (QBSI all contracts unless exempted G.5.143 -64.31 verrption authorized Only projects where estimated G.5.143 -64.32 fee is less than $SQoU0 From A iPgaf Guide to fVrrrhmmg Grid Contnocting for North Carolna (noal Govemrnents 2nd ed., by Frayda S. Bluestein. 0 2M by the Sdwol of Govenrnent, The University of North Carolina at Chapel Hil I. Al I rights reserved. ATTACHMENT 2 -A 45 Orange County, North Carolina FINAL REPORT October 2012 Prepared by: Solutions for Local Government, Inc. Comprehensive Assessment of Emergency Medical Services 46 and 911 /Communications Center Operations Study TABLE OF CONTENTS Section /Subsection Page SECTION 1- INTRODUCTION ...................................................... ............................... 3 SECTION 2- EMERGENCY MEDICAL SERVICES ...................................................... ............................... 5 2.1 Historical & Statutory References ...................................................... ............................... 5 2.2 Existing Conditions ...................................................... ............................... 7 2.3 Performance & Costs ...................................................... ............................... 20 2.4 Issues of Concern ...................................................... ............................... 25 2.5 Recommendations ...................................................... ............................... 50 SECTION 3- COUNTY POPULATION ...................................................... ............................... 55 SECTION 4- 911 /COMMUNICATIONS CENTER ...................................................... ............................... 59 4.1 Historical & Statutory References ...................................................... ............................... 59 4.2 Existing Conditions ...................................................... ............................... 61 4.3 Performance & Costs ...................................................... ............................... 70 4.4 Issues of Concern ...................................................... ............................... 76 4.5 Recommendations ...................................................... ............................... 81 SECTION 5- PROBABLE COSTS ...................................................... ............................... 83 SECTION 6- IMPLEMENTATION SCHEDULE ...................................................... ............................... 88 SECTION 7- APPENDIX ...................................................... ............................... 90 A. 10A NCAC 13P.0201 B. County Grid Map C. County EMS Agency Survey D. PSAP Operating Standards E. 911 Process Maps F. NFPA 450 -6; Essential (Communications System Analysis Components Solutions for Local Government, Inc. 2 Comprehensive Assessment of Emergency Medical Services and 911 /Communications Center Operations Study STUDY SCOPE During November 2011, Orange County representatives met with and subsequently requested a proposal from Solutions for Local Government, Inc. to study and produce, as a single report: • A Comprehensive Assessment of Emergency Medical Services; and • A 911 Communications Center Operations Study The proposal was presented to the Board of County Commissioners in late December 2011 and forwarded to the "Emergency Services Work Group" (an advisory committee) for review and further study. It was forwarded to the Board and approved March 22, 2012; wherein the first project related meeting took place the next day. With regards to the Emergency Medical Services (EMS) portion of the study, the County requested that it address at least the following topics: • Call volume(s) • Call distribution & demographics • Unit response times & workload • Base locations & conditions • Level of service being provided • Rural vs. urban characteristics impacting service delivery • First response capabilities • Staffing • Performance criteria • Annual operating costs • Annual billings & revenue • Fleet & equipment condition In turn, the study of the County's 911 /Communications Center was to focus on the following topics: • Center staffing 0 Dispatch costs • Performance & workload 0 Existing CAD capabilities and /or • Data availability shortcomings THE PROCESS The County's Emergency Services Department was of course central to the study. EMS and Communications Division chiefs as well as numerous staff and administrative personnel provided volumes in terms of information and reports and many hours of their time attending meetings regarding the many topics that were ultimately addressed. Significant also were the meetings held with and /or presentations provided to various stakeholder groups wherein input and comments were solicited and discussed regarding the County's EMS and 911 /Communications Center operations. These groups included representatives from the Carrboro, Chapel Hill and Hillsborough municipal Police Departments, The Carrboro, Chapel Hill and Hillsborough /Orange Rural Fire Departments, The Orange County Fire Chiefs Association; which included the volunteer departments discussed in this report, and the general public. The Emergency Services Work Group and its appointed membership, together with various public visitors who attended the meetings, made significant contributions during six separate meetings in which the study, study progress, and draft report findings were discussed. These contributions, particularly during the June, July and August extended meetings involved some very substantive comments and suggestions regarding requests for additional information, formatting of presentation Solutions for Local Government, Inc. 3 47 Comprehensive Assessment of Emergency Medical Services 48 and 911 /Communications Center Operations Study materials, and data clarification. Many, if not all of these suggestions were ultimately addressed in the report that follows and, frankly, made the report better for it. Following the initial draft reviews by the Work Group, the changes called for were addressed and represented by the consultant. A final draft was prepared by the consultant and copies provided to the members of the Board of County Commissioners. Following which, at their August 30th meeting, they were presented with a formal presentation of the study's findings, recommendations, and probable costs. Finally, through announcements via local media outlets, the general public was invited to an open meeting where they could receive and comment on the same findings, recommendations, and costs presented previously to the Board. This meeting was held the evening of September 27th REPORT ORGANIZATION The narrative and accompanying graphics and illustrations that make up this document are organized into seven (7) major report sections as follows: Section 1- Introduction Section2- Emergency Medical Services (EMS) Section 3- County Population Section 4- 911 /Communications Center Section 5- Probable Costs Section 6- Implementation Schedule Section 7- Appendix Of course the majority of the almost 100 pages that follow are comprised of discussions regarding Emergency Medical Services (Section 2) and the 911/ Communications Center (Section 31. Subsequently, these two Sections are organized similarly and include the following sub - section headings: • Historical & Statutory References • Existing Conditions • Performance & Costs • Issues of Concern • Recommendations SUMMARY OBSERVATIONS The Issues of Concern identified and addressed for both EMS and the Communications Center are in fact "existing problems" that are impacting the level of service offered the Public Safety community and ultimately the citizens of the County, every day. They did not develop overnight. Hopefully, however, the work begun by the Emergency Services Work Group has perpetuated a more serious look at these issues. Hopefully as well, this report has begun to identify specific priorities that the County will now begin to address; "begin" is the key. While numerous recommendations are offered, together with a plan for implementation, neither can be said to be "etched in stone ", nor should they be. These recommendations will inevitably (as they should) be massaged, word - smithed, and perhaps re- prioritized. The challenge the County faces now -is to act, and do so as expeditiously as possible. Solutions for Local Government, Inc. 4 Comprehensive Assessment of Emergency Medical Services 49 and 911 /Communications Center Operations Study 2.1 HISTORICAL & STATUTORY REFERENCES As a means of introduction to the information and issues discussed in this report section, the references that follow are provided for context and background. They are excerpted from several sources; including the North Carolina General Statutes EMS In 1971 the General Assembly directed the Legislative Research Commission to study emergency medical care in North Carolina. The Commission's study resulted in the Emergency Medical Services Act of 1973 (G.S. 143, Article 56). The Act established the State's Emergency Medical Services (EMS) Program within the State Department of Human Resources (now the Department of Health and Human Services). The Office of Emergency Medical Services administers the State's EMS program, which is placed in the Division of Facility Services of the Department of Health and Human Services (G.S. 143- 508). Two state agencies regulate the program. The North Carolina Medical Care Commission adopts the rules and standards that govern ambulance licensure and basic life support services, and the North Carolina Medical Board adopts rules and standards governing advanced life support services.' The Office of Emergency Medical Services (GEMS) is responsible for ensuring that emergency treatment centers are available throughout the state, inspecting and permitting ambulances, licensing ambulance service providers, certifying ambulance personnel, designating trauma centers and a state poison - control center, and assisting in the development of a statewide EMS communications system. Neither the State nor the regional EMS offices are engaged in the actual delivery of emergency medical services in North Carolina. That responsibility is taken on by agencies and organizations at the local level, the principal being County government. G.S. 153A -250 identifies County responsibilities and authority in this regard. Counties may franchise ambulance services via adopted ordinance(s), or operate its ambulance services directly. The following North Carolina Administrative Code subsections provide the most current definition and explanation of EMS System Requirements. .0102(25) EMS System- a coordinated arrangement of local resources under the authority of the county government (including all agencies, personnel, equipment, and facilities) organized to respond to medical emergencies and integrated with other health care providers and networks including public health, community health monitoring activities, and special needs populations. G.S. 143 -517 Each county shall ensure that emergency medical services are provided to its citizens. 10A NCAC 13P.0201 EMS SYSTEM REQUIREMENTS .0201(a) County governments shall establish EMS Systems. Each EMS System shall have: • A defined geographical service area for the EMS System. • The minimum service area for an EMS System shall be one county. • There may be multiple EMS Provider service areas within the service area of an EMS System. • The highest level of care offered within any EMS Provider service area must be available to the citizens within that service area 24 hours per day. 1 A. Fleming Bell and Warren Jake Wicker; County Government in North Carolina; Inst. of Government, UNC at Chapel Hill; 1998. Solutions for Local Government, Inc. 5 Comprehensive Assessment of Emergency Medical Services 50 and 911 /Communications Center Operations Study The actual operation of local services is financed entirely at the local level. If the County operates an ambulance service as a line department, it may establish rates, fees, and charges to be collected by the service and it may appropriate County funds to the service (G.S. 153A -250). By statute, all ambulance service providers in North Carolina must be licensed by the State (G.S. 131E - 151.1), each vehicle that is operated as an ambulance must be permitted by the State (G.S. 131E -156), and all assigned ambulance personnel must be certified by the State (G.S. 151E -158). Medical Direction "Medical Oversight" refers to the responsibility for the management and accountability of the medical care aspects of an EMS System. Medical Oversight includes physician direction of the initial education and continuing education of EMS personnel or medical (responder) crew members; development and monitoring of both operational and treatment protocols; evaluation of the medical care rendered by EMS personnel or medical (responder) crew members; participation in system or program evaluation; and directing, by two -way voice communications, the medical care rendered by the EMS personnel or medical (responder) crew members. Subsequently, the County's "Medical Director" is the physician responsible for the medical aspects of the management of an EMS System, or Trauma Center. Subsequently, the Medical Director in Orange County is a licensed, practicing physician whose responsibilities with regards to the County's EMS operation ultimately include certification, medical control, and the continuing education of its employees. Level of Care "Level of Care" refers to the level of training and legal certification held by the caregiver or responder. Individuals are certified based on their highest completed level of training. 10 NCAC 3D and 21 NCAC 32H are quite specific with regards to the type of care, procedures, and medications that can be administered by individuals at each level of certification. In North Carolina there are four (4) levels of certification assigned to EMS providers. The brief descriptions provided below are those defined by the North Carolina Office of Emergency Medical Services (NCOEMS). The Medical Responder (MR) and Emergency Medical Technician -Basic (EMT -B) levels are referred to as "Basic Life Support' or BLS. The remaining levels of care, EMT -1, and EMT -P, are referred to as "Advanced Life Support' orALS. Medical Responder (MR): Assists pre - hospital technicians in providing basic life support (BLS) care; follows training guidelines of first responders per USDOT. Emergency Medical Technician -Basic (EMT -B): Second level of BLS; individuals trained in advanced first aid, measuring vital signs, CPR, oxygen therapy, etc. intended to take advantage of automatic and semi - automatic external cardiac defibrillators for on -scene defibrillation of patients risking sudden death from ventricular defibrillation; additional training includes advanced airway and administration of epinephrine. Emergency Medical Technician - Intermediate (EMT -1): Allowed to use advanced airway devices, provide intravenous fluid replacement, administer various medications used to correct diabetic, narcotic overdose, respiratory emergency, allergic reactions, and use of automatic and semi- automatic defibrillators. Emergency Medical Technician - Paramedic (EMT -P): In addition to all previous skills, trained in techniques of cricothyrotomy, needle chest decompression, urinary catheter insertion and nasal intubations; in addition to administration of a broad range of medications. Solutions for Local Government, Inc. 6 Comprehensive Assessment of Emergency Medical Services 51 and 911 /Communications Center Operations Study 2.2 EXISTING CONDITIONS Organizationally, Emergency Medical Services (EMS) in Orange County is provided as a major division within the Orange County Emergency Services Department. Subsequently, the EMS "system" designation as registered with the North Carolina Office of Emergency Medical Services (OEMS) is "Orange County ". The requirements that must be met to become certified as an "EMS System" in North Carolina are identified in Administrative Code Section 10 NCAC 13P .0201; which is included in the Appendix section of this report. The system response area consists of the 398 square miles (US Census Bureau) that lie within and comprise the boundaries of Orange County. According to the North Carolina Office of Management and Budget, the estimated July 2012 County population was 137,760 residents. EMS services, per statute, are available 24 hours per day, 365 days per year. The EMS Division is managed on a day -to -day basis by an Operations Manager, with the rank of Captain, who currently reports directly to the Emergency Services Department Director. Additional full -time administrative personnel include a Training Officer, and a Staff Operations Officer. Technical support within the department is provided as needed by personnel currently assigned to the Planning & Logistics Unit. Operations personnel include four (4) Shift Supervisors, 36 certified Paramedics and 23 certified Emergency Medical Technicians (EMT's); including the Division Manager, the Operations Officer, and the Training Officer, a total of 66 full -time employees at the present time. In addition, EMS also has access to a small contingent of certified part -time employees that are able to fill in during staff vacations, absences, or when position vacancies occur. Orange County EMS is certified as a "Paramedic" level agency by the State, which designates them as an advanced life support (ALS) provider. This system certification level requires that any time an ambulance responds to a medical emergency, it must have at least one (1) certified Paramedic level EMT on board. The County is a single EMS district which comprises the referenced 398 square miles of the County. The County's current EMS Plan on file with the State OEMS, states that a minimum of five (5) EMT - Paramedic ambulances, will be staffed and available within the County 24 hours per day. Currently, the highest concentration of population within the County, and subsequently the highest percentage of EMS calls occur within and proximate to the adjacent, south county municipalities of Carrboro and Chapel Hill. Personnel & Vehicle Deployment During the period of this study, EMS employees worked either 24 -hour or 12 -hour shifts. The 24 -hour schedule includes one (1) 24 -hour shift followed by 72 hours off plus mandatory call -back duty 1 -2 times per month. The 12 -hour schedule utilizes an alternating two and three day sequence of days worked and days off; i.e. 2 -days work, 2 -days off, 3 -days work, 3 -days off, 2 days work, etc. And, as stated, each on -duty ambulance must be staffed with no less than two (2) certified EMT's -at least one of which must be certified at the Paramedic level. NOTE: The EMS Division, effective July 27th, is transitioning to all 12 -hour shifts. Solutions for Local Government, Inc. 7 Comprehensive Assessment of Emergency Medical Services 52 and 911 /Communications Center Operations Study Shift Supervisors, are certified EMT - Paramedics, and are on duty during every shift. And, although having numerous administrative, oversight, and quality assurance responsibilities as the senior member of the shift, they are also, by virtue of the vehicle that they are assigned, able to respond to any medical emergency if needed. Their vehicle, while not OEMS certified as a transport vehicle, is equipped with the necessary equipment, medications, and supplies to enable the responding Paramedic Supervisor to initiate treatment in any incident to which they may be called The ambulances assigned to EMS shift personnel are referred to by their "unit" designation; for example, "Medic 1 ". Medic 1, Medic 2, Medic 3, and Medic 4 are currently designated as 24 hour units, while Medic 5 (6am -6pm) and Medic 8 (6pm -6am) combine to provide the fifth 24 -hour ambulance referenced in the EMS System Plan. In addition, two (2) "prime- time" ambulances; Medic 6 (9am -9pm) and Medic 7 (12 noon - midnight) are assigned to the Chapel Hill and Carrboro area seven days per week. Figure 1 EMS Unit Assignments Unit Hours Location Medic 1 24/7 Revere Rd. Hillsborough Medic 2 24/7 Roberson St. Carrboro Medic 24/7 Mason Farm Rd. Chapel Hill Medic 24/7 Mt. Willing Rd. Efland Medic 5 12/7 6am -6pm [Phelps Rd. Location Pending] N. Orange Co. Medic 12/7 9am -9pm Eubanks Rd. Chapel Hill Medic 7 12/7 12pm -12 am TBD Chapel Hill Medic 8 12/7 6pm -6am Roberson St. Carrboro EMS Response Zones The diagram that follows identifies the currently designated EMS District boundaries within Orange County as well as the vehicle and staff staging locations referenced above. As the County has grown in population and the corresponding EMS annual call volume has grown with it, EMS has evolved, out of necessity, from a traditional "static" model of ambulance location and deployment to a modified "system status" model of vehicle deployment in an effort to keep pace with call demand as well as citizen expectations of providing timely response. It is not unusual during the busiest hours of the day, however, for EMS to be down to one (1) or "no" ambulances available to respond to the next incoming 911 call requesting emergency medical assistance somewhere in the County. For example, referring to the County EMS map that follows, say that Medic 1, 6, and 7 are each on scene at three separate emergencies, Medic 4 and 8 are each at different hospitals with recently transported victims, Medic 2 is enroute to a hospital with a victim, and Medic 3 has just been dispatched to a highway accident with injuries. At this point, Medic 5, normally staged in the northern area of the County, would be directed to "move -up" to either the Hillsborough or the Hampton Point area to be closer to the center of the County and in turn more readily available to respond in any direction if called; at least until another ambulance becomes available. Medic Units were directed to "move -up" to address ambulance shortages 2,360 times in 2011. Solutions for Local Government, Inc. 8 Comprehensive Assessment of Emergency Medical Services 53 and 911 /Communications Center Operations Study Figure 2 Existing EMS Districts & Staging Locations Solutions for Local Government, Inc. Comprehensive Assessment of Emergency Medical Services 54 and 911 /Communications Center Operations Study Training & Certification In North Carolina, the successful completion of established minimum training requirements must occur before an individual can be certified to work as a Medical Responder (MR), Emergency Medical Technician (EMT), or Paramedic. This applies to both volunteer and paid /career participants. The current training hours that must be successfully completed to receive certification at either level are as follows: Figure 3 Minimum Training Hours Required per Level of Certification Certification Level Hours Medical Responder 69 EMT -Basic 169 EMT - Intermediate; in addition to "Basic" hours 256 EMT - Paramedic; in addition to all "Basic" & "Intermediate" hours 1,096 In addition to the minimum hours required for certification, continuing education is also required of all Department field personnel. The current minimum requirement is 36 hours per year, per employee. While EMS is not currently allocated designated Field Training Officer (FTO) positions, newly hired employees, particularly trainees, are assigned to work with a senior Paramedic who will serve as such for at least the employee's orientation and /or initial probationary period. The EMS Division Training Officer is responsible for organizing, implementing, certification, oversight and documentation of all training activities within EMS as directed by the EMS Operations Supervisor. In addition to direct training responsibilities for department personnel, the Training Officer is also responsible for re- credentialing (per state requirements) all personnel every four (4) years, providing continuing education annually to each certified fire department or rescue squad medical first responder, as well as serving as the principal contact and liaison with the State Office of Emergency Medical Services (NCOEMS) with regards to medical protocols, agency and individual licensures, and the receipt and implementation of new /updated EMS practice policy as it is issued by the State. The Training Officer will also work closely and coordinate activities with the Medical Director. Communications & Dispatch While the emergency medical operations discussed in this report section address predominately those activities that require the movement of personnel with special vehicles, skills, and equipment to the scene of the emergency reported, it is the actual reporting of that emergency which gets everything started. In this instance, the County's 911 /Communications Center is also an operational division of the Orange County Emergency Services Department. It is located on the second level of the Emergency Services Administration building at 510 Meadowlands Drive in Hillsborough. In the professional terminology of the communications industry, the Communications Center is the designated public safety answering point, or PSAP, for emergency communications in Orange County. The Center operates 24 hours per day and is continuously staffed by Telecom municators who receive and dispatch calls for not only EMS, but Fire, Rescue, and Law Enforcement throughout the County. Solutions for Local Government, Inc. 10 Comprehensive Assessment of Emergency Medical Services 55 and 911 /Communications Center Operations Study In the case of EMS calls, once the Dispatcher ( Telecommunicator) receiving the 911 call is able to verify the location of the incident being reported, he /she will notify (dispatch) the EMS team /station that is responsible for responding to that call's location. "Emergency Medical Dispatch" (EMD) is a level of certification that enables Telecommunicators that answer 911 medical emergency calls to, while simultaneously dispatching an ambulance, offer the caller instructions in first aid; e.g. CPR, compression /abatement of serious bleeding, making the victim comfortable, etc; while also obtaining information from the caller as to circumstances and medical indications that then can be communicated to the EMS responders on their way. These procedures require the activation of medical protocols that must be approved by the County's Medical Director and must be reviewed per State requirements for quality assurance on a regular basis. In a County the size of Orange with EMS response times as they are, these capabilities can and often do prove valuable at the very least in initiating patient care. The Communications Center also maintains call log reports, on every call received and dispatched which include the type of incident being reported, the agency(s) dispatched, location of the incident, and dispatch and response activity interval times. First Response In general terms EMS Division employees are considered "first responders" to any emergency to which they are dispatched; as are fire, specialized rescue, and law enforcement personnel. Realistically, however, an EMS ambulance may in fact not be the first unit or service on the scene of a medical emergency. In Orange County's case, a "first responder" in medical emergencies could best be described as; The first EMS, Rescue, Fire service person to arrive at the scene, with or without an ambulance, and initiate medical assistance in an effort to stabilize the patient until advanced life support capabilities arrive to administer additional aid and /or transport. Of course under the County's EMS System Plan and State regulations the individual responding in these instances and the agency the individual represents must be certified as Medical Responders. In Orange County, the identified first responders to medical emergencies include the ten (10) volunteer or combination paid /volunteer fire departments within the County, the two career /municipal fire departments and South Orange Rescue Squad. • Caldwell Fire Department 0 Hillsborough /Orange Rural Fire Department • City of Carrboro Fire Department 0 Mebane Fire Department • Cedar Grove Fire Department 0 New Hope Fire Department • City of Chapel Hill Fire Department 0 North Chatham Fire Department • Efland Fire Department 0 Orange Grove Fire Department • Eno Fire Department 0 White Cross Fire Department Currently Carrboro Fire Department is certified at the EMT level while the remaining departments are certified at the Medical Responder (MR) level. Solutions for Local Government, Inc. 11 Comprehensive Assessment of Emergency Medical Services 56 and 911 /Communications Center Operations Study In addition to these identified Fire Departments, the South Orange Rescue Squad (SORS) is also available for dispatch to medical emergencies and is certified at the EMT level. The Squad shares a unique relationship with Orange County EMS both in that 36 of its 57 certified members are also listed on the Orange County EMS roster on file with the NCOEMS and, that members share duties with EMS employees on Medic Unit 8 on an alternating 3 -4 -3 day schedule which also includes the use of SORS' 2 BLS ambulances. Two significant factors necessitate the need for agencies, in addition to EMS, to provide medical first response; ■ First, the obvious; time is critical in medical emergencies; and, ■ Second, during peak daytime hours there may be seven (7) staffed ambulances with transport capabilities based at but five (5) designated staging locations throughout the County's 398 square mile area. Compare this with the combined (potential) capabilities of the 12 Fire departments and one Rescue Squad that are (or could be) available to respond from 22 additional station locations within the same 398 square miles as EMS. It becomes an issue of proximity if nothing else. Subsequently, in as much as time is critical, first responders with basic skills, once on the scene can offer significantly to the stabilization of the victim until paramedic level responders arrive; i.e..... "get there fast and stabilize the victim until advanced life support assistance arrives ". z Dispatchers as First Responders In significant medical emergencies, the Telecommunicator (Dispatcher) handling the call will simultaneously answer the call, solicit vital information, alert and dispatch the appropriate EMS unit, maintain communications with the caller and initiate medical instructions, all while also maintaining ongoing communications with the EMS unit responding. Typically, in a serious emergency situation, this communication with the caller /victim will continue until the responding EMT's (paramedics) have communicated that they are on the scene and have assumed patient care. "Emergency Medical Dispatch" (EMD) certification is required before a Telecommunicator can issue treatment instructions of any kind to a victim or caller. This is a significant designation which requires that a specific set of protocols be followed when receiving and handling emergency medical calls. In calls involving medical emergencies, a significant responsibility of the Telecommunicator relates specifically to these EMD protocols. In this instance the Telecommunicator will remain on the line with the caller to obtain as much additional patient /victim information as possible since they must simultaneously and continuously communicate with the responding Paramedics as to the patient's condition, physical characteristics, scene circumstances, etc.; and to provide actual medical /first aid instructions to the caller in an effort to help the victim; i.e., emergency medical dispatch (EMD). In most people's eyes, once the Telecommunicator alerts the appropriate law enforcement agency, EMS unit, or fire station of an emergency and provides dispatch information and general instructions their job is over. Not so in the case of medical emergencies. In many instances, Telecom municators continue to monitor and support the call and the responding service unit by maintaining on -going z A. Fleming Bell, and Warren Jake Wicker; County Government in North Carolina; Institute of Government, University of North Carolina at Chapel Hill; 1998. Solutions for Local Government, Inc. 12 Comprehensive Assessment of Emergency Medical Services 57 and 911 /Communications Center Operations Study communications and following the efforts of those responder(s) enroute to the incident and throughout the on -site incident activities that follow. (More detailed discussion will be provided in Section 4 of this report, The 911 /Communications Center). Mutual Aid As stated in the County's EMS System Plan; Orange County Emergency Medical Services is party to the North Carolina Statewide Emergency Management Mutual Aid and Assistance Agreement. Reports & Reporting The record keeping system for EMS providers in North Carolina is "PreMIS ", the Pre - Hospital Medical Information System. Under the North Carolina EMS Rules and Regulations, every EMS System is required to collect and submit (electronically) EMS data based on the North Carolina College of Emergency Physician's Standards for Medical Oversight and Data Collection.' PreMIS provides a method for each EMS provider in North Carolina to enter patient care data into a central database. Other components of PreMIS include: billing export capabilities, technician and provider tracking, and an extensive quality management toolkit.4 Orange County EMS personnel currently input Patient Care Reports (PCR's) into individually issued laptop computers. Data is transferred to PreMIS as soon as possible and no less than on a daily basis except during weekends after which data is transmitted the following Monday. EMS Facilities Currently the four (4) 24 -hour Medic Units and four (4) 12 -hour Medic Units and their assigned 2- person Paramedic Teams operate from five (5) designated staging locations within the County. Note that the term "staging locations" is used versus the more common "EMS Base" because in reality none of the staging "areas "; i.e. facilities available; were originally built or intended to accommodate EMS operations. Space has essentially been found, donated for use or assumed for use as the space became available. Furthermore, none of the current staging areas; i.e. facilities; can accommodate a Medic Unit; i.e. ambulance, in a temperature controlled, enclosed and securable environment. Figure 4 EMS Unit Staging Locations Unit Location Medic 1 Revere Rd. Hillsborough Medic 2 Roberson St. Carrboro Medic Mason Farm Rd. Chapel Hill Medic Mt. Willing Rd. Efland Medic 5 [Phelps Rd. Location Pending] N. Orange Co. Medic Eubanks Rd. Chapel Hill Medic TBD Chapel Hill Medic 8 Roberson St. Carrboro 3 Pratt, Drexdal; "Required EMS Patient Care Reporting'; NCOEMS Memorandum; 2004 4 North Carolina EMS Performance Improvement Center website; 2007 Solutions for Local Government, Inc. 13 Comprehensive Assessment of Emergency Medical Services 58 and 911 /Communications Center Operations Study EMS Vehicles EMS currently maintains an inventory of 11 transport vehicles; eight (8) of which are in service 12 -24 hours per day. The remaining three (3) transport vehicles, not currently assigned, are reserve back -up units for use when a vehicle is down for repairs or service or otherwise unavailable for use. EMS Division management personnel and the designated in -field Shift Supervisors drive either sedan or SUV type vehicles up- fitted to accommodate their respective assigned responsibilities. As noted in Figure 5 recent year ambulance purchases signify a significant shift to the Freightliner M2, medium duty type ambulance from Ford F -450, light duty ambulance that was prominent in the past and of which several are still in service. While the cost of the newer ambulances were considerably more than the previous models; $94,575 in 2005 & 2007 for the Ford vs. $186,900 in 2012 for the Freightliner; the decision was not made in haste. Available documentation indicates that the issue was researched and studied jointly by personnel representing Emergency Services, Asset Management Services, and Fleet Management and determined that the new units provided a number of advantages over the current fleet vehicles: ■ Cheaper to operate; first -year mileage of medium duty @ 9 miles /gallon vs. light duty @ 8.6 miles /gallon; first year service cost of light duty @ 8.92 cents /mile vs. medium duty @ 5.98 cents /mile; ■ Better survivability in an accident; illustrated during /after actual rollover experienced in 2010; ■ Better field of vision- safer scene approach and driver visibility during both emergency response and normal driving conditions; ■ Better internal vehicle systems; braking, cooling, transmissions, chassis, electrical; ■ Overall dimensions offer better internal maneuverability and patient access ■ On -going maintenance advantages cited included serviceability, reliability, and quality of design and construction. Figure 5 EMS Fleet Vehicles* Vehicle Number Model Year Model Maufacturer 633 2005 Ford F -450 XLT Super Duty Ambulance Wheeled Coach 634 2005 Ford F -450 XLT Super Duty Ambulance Wheeled Coach 714 2007 Ford F -450 XLT Super Duty Ambulance Wheeled Coach 715 2007 Ford F -450 XLT Super Duty Ambulance Wheeled Coach 793 2011 Freightliner M2 Ambulance Excellance 794 2011 Freightliner M2 Ambulance Excellance 813 2011 Freightliner M2 Ambulance Excellance 840 2012 Freightliner M2 Ambulance Excellance 842 2012 Freightliner M2 Ambulance Excellance 843 2012 Freightliner M2 Ambulance Excellance 845 2012 Freightliner M2 Ambulance Excellance *The Emergency Services Department is anticipating the replacement of Vehicles 633 and 714 during FY 2012 -2013 and 2013- 2014. Engines were replaced in Units 634 and 715 in 2011; each are expected to remain in the fleet for several more years. Solutions for Local Government, Inc. 14 Comprehensive Assessment of Emergency Medical Services 59 and 911 /Communications Center Operations Study Call Volume During calendar year 2011, Orange County EMS units were dispatched a total of 10,719 times. In addition to these incidents, Medic Units were ordered into "move -up" status 2,360 times. Figure 6 EMS Annual Call Volume 11,000 -----1----------1-----r-----r-- ' 10'719 1 I I I I 1 1 I � 1 I I I I 1 1 1 1 I 1 I I 1 1 1 10 +420 ' 1 I I I I I I I 1 I I I I I I I I 1 I 1 I 1 I 1 1 1 1 I 1 I I I 1 1 1 1 I I I 1 1 1 1 10,000 ---- - - - - -- - - - -�,> 33- - - - - -- 9 74 -- - - -- - - -- - - - -- - - - -- 1 I �I I I I 1 I 1 I I I 1 I I I I I I I 1 I 1 1 1 1 1 1 1 9,500 -- -9,69 - ----- ; - - - - - T - - - - - r ----- r - - - -- i - - - - - = - - - - - = ----- I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I 9,000 _____ _____I 1_____1 L_____L____ J I _____J_____ I I I 1 1 I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I 8,500 2009 2011 "Move -ups" occur when the number of ambulances available to respond to a call is down to one (1) and that ambulance, regardless of where it is normally assigned, will be directed to "move -up" to a location generally towards the center of the County to be accessible to respond in any direction. If there comes a point that "no" ambulances are available (which does occur) South Orange Rescue and /or one or more of the County Fire Departments will be alerted to stand -by or, if available, to "move -up" to a specific staging location. It is a practice common in the industry often referred to as "modified system status management" as it provides a means of spreading thin resources strategically in an effort to provide the greatest range of coverage during peak call periods. Type of Call The type of calls to which EMS is dispatched will of course vary. A review of those calls dispatched during 2011 identified more than twenty call classifications. Of the 10,719 calls dispatched during 2011, almost 90 percent were listed in one of the 18 categories identified in Figure 7 which, as noted, included any call type representing more than one percent of the total. And, while they are not emergency dispatches per se, 2,360 "move -ups" were directed for strategic purposes; primarily to enhance coverage when the number of available ambulances to respond to an emergency was down to one (1). While the NCOEMS and the Performance Improvement Center have recommended that any EMS Unit activity be recorded in PreMIS in order that unit hour utilization rates can be (eventually) accurately determined, they are not included in this table or in the previous Call Volume table as emergency dispatches. Solutions for Local Government, Inc. 15 Comprehensive Assessment of Emergency Medical Services 60 and 911 /Communications Center Operations Study Figure 7 Ems Calls by Type Condition Code Frequency Percent Sick Person SICK 1322 12.3% Fall FALL 1117 10.4% Transfer Interfacility Palliative Care TIPC 1111 10.4% Breathing Difficulty BREA 795 7.4% Unconscious UNCO 747 7.0% Chest Pain CHES 716 6.7% Accident w /Personal Injury ACPI 713 6.7% Convulsion CONV 472 4.4% Hemorrhage HEMO 376 3.5% Trauma TRAU 354 3.3% Overdose OVER 336 3.1% Abdominal Pain ABDO 322 3.0% Unknown UNKN 292 2.7% Stroke STRO 245 2.3% Diabetes DIAB 209 1.9% Allergy /Allergic Reaction ALLE 172 1.6% Assault AS LT 158 1.5% Heart Problem HEPR 147 1.4% 9,604 89.6% 10,719 100% Call Distribution The green dots on the map that follows represent the more than 30,000 calls to which EMS units were dispatched during 2009, 2010, and 2011. As stated previously, the most significant clusters of calls were in the Carrboro and Chapel Hill areas. Smaller, yet still significant call clusters were also noted in and around Hillsborough and a number of the County's major roadways; i.e. 1 -85, SR 70, and 86, etc. [The remainder of this page intentionally left blank. Solutions for Local Government, Inc. 16 Comprehensive Assessment of Emergency Medical Services 61 and 911 /Communications Center Operations Study Figure 8 2009 -2011 Cumulative EMS Call Distribution Solutions for Local Government, Inc. 17 Comprehensive Assessment of Emergency Medical Services 62 and 911 /Communications Center Operations Study Calls Dispatched per Hour Among the significant County concerns presented to the consultant as an impetus for this study was the apparent increasing frequency during which EMS units were often out of service; albeit on an active call; or out of the County transporting a victim to a medical facility when emergency calls from within the County continued to be received and dispatched. Subsequently, a look at the "calls received per hour ", plotted for an entire year, will identify both the peak and approximate time frame of the busiest call periods during any given day and of course the times when EMS personnel are most likely to be needed. In order to ascertain whether these periods of activity were unique or consistent in their occurrence, the most recent three (3) years of data was reviewed and plotted. The results, illustrated in Figure 9 for 2009, 2010, and 2011 were very consistent Based on the illustration, the busiest hour of the day during 2011 was between noon and 1:00 pm wherein 754 calls were received. The least busy hour of the day, based on this illustration appears to be between 3:00 am and 4:00 am and is generally consistent for the years studied. Subsequently, the daily "prime- time" hours; the busiest 12 hour period of the day (give or take); appears to be between 9:00 am and 9:00 pm or, between the numbers 9 and 21 on the horizontal axis. This of course then will be the time period when EMS ambulance units will be in greatest demand. Figure 9 EMS Calls per Hour /Year 800 r11- 1- rT1- l- rrTl- l- I- rT l- 1- rr-I -I - I- r7154 -I - rrT-I- I -rrT -I rT-i - I -rri-i III II II II II III II II II II II 11111111111111111111111 11111111111111111111111 11 111 111111111111111 700 iii- I- F + {- I- I- I- +i- I- I- F +-I -I- Ffi +i- I- I- f +ii -F 1. -1. I 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 I I I I 1 1 1 I I I I I 1 1 1 1 1 1 1 ( I I I I I I I I I I I I I I I I I I I I I I I I I I I I 1 1 1 1 1 1 1 600 11 J_I_ L 11 _I_I_ L I J- I_I_LI _L L 1 J 1J -1- -1 1J 1- I 1 1J 1- LLJJ -- I I I I I I I I I I I I I I I I I I I I 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 I I I I I I I I 1 1 1 1 1 1 I I I 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 I I I I I I I I I I I I I I I I I I I I I I I I I 500 r11-I- rT1- I- I- IT1 -1 -I- T1 - rII1 -I -r I11 -1-r TI -I -I -r 1 -1 T1 -1 1 -1 -I I I I I I I I I I 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 I I I I I I I I 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 I I I I 400 ii 1- 1- +4 - I -I -F +i f +-11-1-4- 4_q 1- 1-i-1 1- +i-I- 1- F +ii- I -f +-I -I -I I I I I I I 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 I I I 1 1 1 1 1 1 11 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 I 300 1 x_1_11 _1_11 J_L 1 j _1_L 1 i_1_L 1 x_1_11 j_1_11 j_L 1 i__1 i 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 200 r T-I r -- rT1- 1- 1- rT1 -1 -rr T-I rr11- 1- rT1- 1- 1- rT1 -1 -1 -r T-1 rr1-1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 111111nn1pp11111111111111111111111111111111111111111 100 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 —V'— 2009 —'*'— 2010 • 2011 Note: the number `1' on the horizontal axis represents 1:00 am; the number 12 represents noon, the number 18, 6:00 pm, etc. Emergency vs. Non - Emergency Response When the average citizen calls 911 -it IS an emergency. Medical dispatch protocols have been developed, however, that dictate, based on the condition identified, how the response is to be coded; i.e. Alpha -least serious, non - emergent through Echo -most serious, emergent. In turn, the response code identified and broadcast to responding units will dictate the "status" of their response; i.e. "lights and sirens ", or "no lights and sirens ". Solutions for Local Government, Inc. 18 Comprehensive Assessment of Emergency Medical Services 63 and 911 /Communications Center Operations Study For the most part these response codes are universal and well known to emergency medical and first responder agency personnel. The table that follows identifies the medical dispatch response codes, the condition identified and associated with that code, the agency /unit dispatched and the level (status) at which they are expected to respond. Figure 10 Medical Dispatch Response Codes Response Code Condition Identified Agency /Unit Dispatched Response Status 330 Non -life threatening, Initial No Lights or Sirens, Upgraded to Lights & Sirens 111 ALPHA Lights & Sirens Ambulance only Non - Emergency No Lights & Sirens low priority assessed 61.7% Total Responses 10,494 Non -life threatening, BRAVO Ambulance only Emergency but more serious First Responders Emergency CHARLIE Potentially life threatening Ambulance Non - Emergency DELTA Life threatening All Units Emergency All Units; including ECHO Circling the drain Emergency Law Enforcement The distribution of emergency to non - emergency medical calls has changed significantly since 2009 when the "response determinants" were adjusted to reflect more closely those recommended by the National Academy of Emergency Medical Dispatch (NAEMD). The distribution of emergency and non - emergency medical calls dispatched during 2011 is illustrated in Figure 11. This issue will also be addressed further in Section 4- 911 /Communications Center. Figure 11 Medical Call Response Levels -2011 Respnse Level Number of Responses Percent of Total Initial Lights & Sirens, Downgraded to No Lights or Sirens 330 3.1% Initial No Lights or Sirens, Upgraded to Lights & Sirens 111 1.1% Lights & Sirens 3,577 34.1% No Lights & Sirens 6,476 61.7% Total Responses 10,494 The non - emergency to emergency call ratio of 2 -to -1 is not unusual among North Carolina EMS agencies. In fact, it could be expected to remain close to these percentages for the near future. The first two Response Level categories listed in Figure 11 may result as the EMD (Emergency Medical Dispatcher) continues their questioning of the 911 caller following the actual dispatch of the response units. As such, the patient's condition may worsen from that initially reported; i.e. "Initial No Lights or Sirens, Upgraded to Lights & Sirens "; or, improve or through further questioning be determined to not be as serious as initially reported; i.e. "Initial Lights & Sirens to No Lights or Sirens ". Solutions for Local Government, Inc. 19 Comprehensive Assessment of Emergency Medical Services 64 and 911 /Communications Center Operations Study Emergency Transports Tracking the number of emergency victims transported, together with the number of emergency incidents to which ambulances are dispatched, becomes important when later analyzing average call duration together with call volume during "prime- time" hours to determine the basis for ambulance availability. Patients transported by EMS are billed for the service, which in recent years has generated considerable revenue to offset the County's operating costs. With the exception of 2009, the ratio of EMS patient transports to total EMS calls dispatched has shown to be increasing at a relatively steady rate between 2007 and 2011. The 5 -year average ratio of transports to total EMS calls is just under 70% at 69.92. Figure 12 Annual Emergency Transports Year EMS Calls Dispatched Number Transported Percentage 2007 9269 6171 66.6% 2008 9833 6631 67.4% 2009 9749 7330 75.2% 2010 10420 7284 69.9% 2011 1 10719 1 7562 1 70.5% Transport Destinations There were a total of 10 transport destinations listed on the NCOEMS /CIS website for Orange County EMS during calendar year 2011. Of the 7,562 transports made, 87.6% were to the first five destinations identified in this table. It is significant to note that of the state's six (6) certified Level I Trauma Centers, two (2); UNC Hospitals and Duke University Hospital; are within minutes of most areas of Orange County. As well, a third Level I Trauma Center: Wake Med; can generally be reached within 40 -50 minutes depending upon the point of origin within Orange County. 2.3 PERFORMANCE & COSTS Figure 13 EMS Transport Destinations Facility N Number P Percent UNC Hospital 4 4,875 6 64.5% Duke Univ. Medical Center 1 1,125 1 14.9% Durham Regional Hospital 4 438 5 5.8% Alamance Reg. Medical Center 1 129 1 1.7% Durham VA Medical Center 6 61 0 0.8% 6,628 I 87.6% UNC Healthcare Chapel Hill UNC Heart Center UNC Student Health 934 12.4% Carillon Assisted living Carol Woods Retirement Comm. 7,562 1009/. Response Time An EMS Ambulance /Unit's response time is: the time from the initial alert or announcement by the Communications Center (also called "tone' "page'; or "dispatch ") of the reported emergency, to the time that the service vehicle and appropriate personnel arrive on the scene. Why is time so important? According to the National Emergency Number Association (NENA), "The most elementary explanation of why time is important in a medical emergency has to do with the obvious; "... it may mean the difference between life and death".' 5 NENA; "911 System Survey and Resource Guide'; 2002 Solutions for Local Government, Inc. 20 Comprehensive Assessment of Emergency Medical Services 65 and 911 /Communications Center Operations Study Factors impacting response time include of course the distance that must be covered, but also specific and /or unique area characteristics such as road conditions, geography, and development density. Factors influencing the quality of the response have to do with not only the time it takes to get to the scene of the emergency but also the information communicated to the responding service unit, the skill of the personnel responding, and the availability of the proper equipment to adequately address the emergency at hand. Of course, the emergency service agency must be prepared to address the most serious emergency every time that they are dispatched. Call data for the years 2007 -2011 were extracted from the Communications Center's CAD system for both the "Turn -Out" and "Travel Time" intervals. For purposes of this report the terms Turn -Out Time and Travel Time are described as follows: • Turn -Out Time - represents the time from when the radio announcement and request for assistance is received at the EMS Unit "start" location by the EMT's on duty, until the wheels on that response vehicle (ambulance) are moving; i.e. and is announced as enroute. • Travel Time -is the time interval between that when the ambulance's wheels are moving with EMT's on board, to the time it arrives on the scene and the vehicle's wheels have stopped; i.e. "travel time ". The numbers listed represent the average times, in minutes and seconds, of all calls dispatched during each of the corresponding years. As previously described, the Total (average) Response Time for each year, is the sum of the average Turn -Out and the average Travel Time for that year. Figure 14 EMS Interval & Total Average Response Times /2007 -2011 Year Total Units Dispatched Turn -Out Time Travel Time Total Resp. Time 2007 9,269 1:41 7:41 9:26 2008 9,833 1:38 8:15 9:56 2009 9,749 1:29 9:15 10:49 2010 10,420 1:27 9:47 11:14 2011 10,719 1:16 9:30 10:47 5 Year Average: 0:01:30 0:08:53 0:10:26 Subsequently, the average Turn -Out Time for the years studied was 1 % minutes. The average Travel Time was just under nine (9) minutes. And, the average Total Response Time for the five years studied was 10 minutes and 26 seconds. As illustrated, although the Total Response Time average for 2011 decreased (improved) by 27 seconds over that documented for 2010, the trend is definitely "upward" and appears to be increasing. Prominent industry standard setting organizations, such as NFPA, NCOEMS /PreMIS and others, in recent years have emphasized and defined new standards for measuring response time performance that no longer consider average times but rather 'fractile" times as a percentage of all calls for response performance measurement. For example, "that 90% of all calls dispatched be responded to in "x" minutes or less". Solutions for Local Government, Inc. 21 Comprehensive Assessment of Emergency Medical Services 66 and 911 /Communications Center Operations Study Historically response times have been the most readily measured performance indicator for EMS and that measurement has been the "average ". This method however results in highlighting the problem of inequity of service because, theoretically, 50% of the patients experienced response times longer than average. To ensure more equitable service to all areas of the community; i.e. County; fractile response time measurement was introduced and is now commonly used by EMS systems throughout the Country.6 Figure 15 Average vs. Fractile Time Intervals The previously referenced NCOEMS Performance Improvement Center runs periodic "performance toolkits" based on actual samples of an individual EMS system's call data. The Center, in Interval # Calls Average 90% Turnout Time Travel Time 3,517 3,445 0:00:55 0:08:31 0:02:00 0:15:00 addition to "average" times also runs the calculations based on the 90% fractile suggested by NFPA for Fire and EMS systems. The Orange County EMS calls identified in this table (Figure 15) were selected from 2011 call data and run for average and 90% fractile times for both Turn -Out Time and Travel Time. Of course, analysis of the average and 90% fractile times identified do little more than prove the point already stated; 50% of the patients experienced response times that took longer than the "average ". This will continue to be the case until the paradigm is changed which, in this case, will be the performance standard regarding response time(s) and the manner by which these response times are measured and assessed. Total Event Duration The total event duration is the time from the initial announcement of the call (dispatch) for service to the time the EMS Unit that responded to that dispatch is back in service and available to take another call. While the Turn -Out Time and Travel Time are the first two time intervals of consequence in this regard, the time on scene with the patient, transport time to the appropriate medical facility, and time at the medical facility until release, are significant as well. Cumulatively they combine to result in the total event duration time. EMS Operations and Medical personnel familiar with EMS operations that were queried indicated that travel distance; i.e. travel time, as well as the number and rate of admissions to the emergency rooms of the destination hospitals are have - ing an impact these times. Note: Preliminary numbers from the first quarter of 2012 indicate that the total average event duration times have again increased by several minutes. Figure 16 Total Average Event Duration 2007 -2011 0:48:58 ------------- - - - - - -- ------i------,-- 0:47:44 0:47:53 0:47:31 -------- ------ - - - - - - -- *---- ---- - - - -- ------ ----- - -- - - - - -� j 0:46:05 --- --- ------ - - - - -- '------- ------ '-- - - - -'- -- -- � ------ L------ '-- - - -- ' 0:44:38 - --- - --- ---- -------- ------- r----- --- --- - ---- ---- r------ r------ --- -- - - - � 0:43:12 ------ `- ----- ---- -- -- '-- ----- ;--- --- ----- ------- `------ ---- --- -- - - - - -' 0:41:52 ' 0:41:46 0.41:21 _` -- - - -- - - -- - -- -r- -- r------ 1------ _1 ------- r--- ---- r------ -- -- - - -� i I __ 0.40.19 - -- - - -- --------------- �-- --- --- ----------------------- -- -- � - --- � - -- 0:38:53 '-- - ' i - - i- -=— -- I I 0:37:26 2007 2008 2009 2010 2011 6 American College of Emergency Physicians; Principals of EMS systems; 2006 Solutions for Local Government, Inc. 22 Comprehensive Assessment of Emergency Medical Services 67 and 911 /Communications Center Operations Study Expenses & Revenue Orange County EMS is funded with General Fund (tax) dollars within the County Budget. The table below illustrates the total annual expenditures approved for EMS for the fiscal years 2008 -2009 through 2011 -2012. Figure 17 Annual EMS Budget Allocations /FY 2008 -2011 Account FY 2008 -09 FY 2009 -10 FY 2010 -11 FY 2011 -12 Actuals Actuals Actuals Actuals PERSONNEL SERVICES PERM SALS $ 1,714,386 $ 1,707,256 $ 1,777,621 $ 2,125,380 OT $ 488,184 $ 441,054 $ 407,296 $ 411,056 TEMP $ 267,873 $ 78,615 $ 131,519 $ 111,068 HOLIDAY $ 92,905 $ 92,336 $ 98,924 $ 124,305 SOC SEC $ 157,258 $ 138,261 $ 145,180 $ 163,856 MEDICARE $ 36,778 $ 32,413 $ 33,953 $ 38,321 MED INS $ 322,839 $ 329,134 $ 346,366 $ 455,629 RETIRE $ 113,483 $ 108,953 $ 147,524 $ 184,889 PERS -OTHER $ 56,655 $ 21,401 $ 38,226 $ 88,791 SUBTOTAL - PERSONNEL SERVICES $ 3,250,362 $ 2,949,423 $ 3,126,609 $ 3,703,295 OPERATIONS TRAINING $ 4,971 $ 1,325 $ 1,410 $ 980 CERT &LICSN $ (252) $ 359 $ 810 $ 1,527 TELEPHONE $ 30,017 $ 19,858 $ - $ 3,323 VEH MAINT $ 110,466 $ 131,932 $ - $ - GAS &OIL $ 4,973 $ 99 $ - $ - MOTOR POOL $ 77,866 $ 37,438 $ - $ - EQUIP RPR $ 35,662 $ 28,947 $ 33,518 $ 43,735 EQUP RENT $ 46,438 $ 12,600 $ 12,600 $ 12,600 DUES $ 750 $ 690 $ 1,080 $ 1,032 SUBS $ 215 $ 259 $ 269 $ 269 MED SUPS $ 170,600 $ 176,139 $ 214,356 $ 251,644 CONTSVS $ 50,609 $ 54,462 $ 58,970 $ 63,747 ELECTRICIT $ 24,150 $ 12,600 $ 12,600 $ 12,600 SUP -ED, OFF, DEP, OTH $ 8,989 $ 10,024 $ 2,362 $ 3,700 OP -OTHER $ 26,449 $ 26,650 $ 4,235 $ 285 SUBTOTAL - OPERATIONS $ 591,903 $ 513,381 $ 342,210 $ 395,442 RECURRING CAPITAL EQUIPMNT $ 5,130 $ - $ - $ - ITEQUIP $ 1,197 $ - $ - $ - VEHICLES $ - $ - $ - $ 612,946 SUBTOTAL - RECURRING CAPITAL $ 6,327 $ - $ - $ 612,946 ITOTAL: EMERGENCY MEDICALSERVICES $ 3,848,591 $ 3,462,804 1 $ 3,468,819 $ 4,711,683 Solutions for Local Government, Inc. 23 Comprehensive Assessment of Emergency Medical Services 68 and 911 /Communications Center Operations Study The largest expense category is of course personnel. Although major capital expenditures, in this case typically vehicles, may alter the percentage somewhat from year to year; the average annual costs of personnel as a percentage of the total budget for the years studied was 84.5 %. it is significant to note, and should signal concern, that the expense category "Training" averaged but 3 110ths of one percent per year, of the total annual budget allocations, for the past three years. Revenue Orange County EMS is able to generate revenue to offset its operating costs by billing the recipients of the services delivered. Most often Medicaid, Medicare and private insurance will pay for significant portions of the amounts billed. The more significant charges are of course assessed and subsequently collected for patients that are "transported" typically to a designated medical facility. The current list of fees charged by the Orange County EMS includes the following: Figure 18 EMS Fee Schedule Activity /Response Annual Charge Basic Life Support (Non- Emergency) $ 300 Basic life Support (Emergency) $ 375 Advanced life Support (Non- Emergency) $ 400 Advanced Life Support (Emergency) $ 475 Advanced Life Support (Non- Transport) $ 150 Mileage $7.50/mile- Billing & Collections Since January of 2010, the County has contracted with a private firm that specializes in providing EMS billing services. Prior to that time the County (Tax Office) handled EMS billing and collections responsibilities. Although the billing contractor handles the bulk of the monthly EMS billing, collections and required legal bookkeeping, the County continues to monitor and pursue collection of delinquent accounts. Figure 19 FY EMS Budget & Collections (Revenue) Fiscal Annual Collections (Revenue) Collections Year Budget as % of Budget FY 08 -09 $ 3,848,591 1,862,114 48.4% FY 09 -10 $ 3,462,804 2,001,204 57.8% FY 10 -11 $ 3,468,819 2,246,517 64.8% FY 11 -12 $ 4,711,683 2,266,940 48.1% For calendar years 2010 and 2011 the percentage of net collections to total billings was 65.7% and 59.6% respectively. Note also, however, that FY 2011 -2012 Collections (Revenue) as % of Budget are incomplete. That is, they will continue to increase as payment of bills that have recently been sent out, as well as those as long as a year or more in arrears are paid. Solutions for Local Government, Inc. 24 Comprehensive Assessment of Emergency Medical Services 69 and 911 /Communications Center Operations Study 2.4 ISSUES OF CONCERN This section discusses the significant EMS issues of concern identified during the analyses of the various data collected, the visual study of conditions found to exist, and numerous conversations and formal interviews conducted over the course of the study. The determination of whether or not an "issue" was identified as such was based on the assessment of current operations and performance discussed in subsections 2.2 and 2.3. The issues identified as being of significant concern with regards to EMS involved the following topics: • Availability of ALS Ambulances • Response Times • EMS Facilities Issue: Availability of Ambulances During 2011 ambulances were directed to "MOVE" 2,360 times from their identified staging area or location to another point in the County because; a. The number of ambulances immediately available was down to one (1) and the subject remaining ambulance was directed to move to a location typically near the center of the County in anticipation of being able to respond in any direction the next call may direct; or, b. In tracking the status of multiple ambulances, the Communications Center and /or EMS Supervisor(s) noted significant area gaps in coverage and redirected movement of ambulance(s) accordingly. The practice itself is not uncommon and is referred to as system status management; locating /moving ambulances to address the current level of coverage or lack thereof. The risk, however, of being down to one (or "no ") ambulances is that the next emergency medical call that comes in to the Communications Center may not have an ambulance available to respond. Granted first responders fill a significant and vital role at this point, however, without an ambulance available there is likely no ALS level of service available and in turn no means of transport available. EMS Call Scenarios While monitoring EMS radio traffic during onsite time in the County over the months during which this study occurred, the actual announcement that "we are out of ambulances ", or "we have one ambulance left" was heard numerous times. In an effort to understand the specific circumstances that were resulting in such conditions, EMS call logs were reviewed over several months during 2011 to identify the specific conditions that occurred and the circumstances that contributed to them. On several occasions, typically during the busiest hours of the day previously noted, a closely bunched series of calls could be identified, each call was reviewed individually, and the "dispatch" and "available" (back in service) times were documented, as was the type of call; i.e. Chest Pains, Diabetic, Fall, etc. Solutions for Local Government, Inc. 25 Comprehensive Assessment of Emergency Medical Services 70 and 911 /Communications Center Operations Study For purposes of the diagram that follows, the average call duration calculated for 2011 (48 minutes) was used for each call recorded. Figure 20 Actual Ambulance Demand Profile -23 May 2011 MAY 23rd 5:00 PM 6:00 PM 7:00 PM 8:00 PM 9:00 PM 10:00 PM The five (5) hour period depicted includes the actual calls and the times that they were dispatched. The duration of the individual calls varied from 18 minutes to 1 -hour and 44 minutes, and for all 18 calls noted the average duration was 51 minutes. The "Available Units: 7" notation is the number of Medic Units on duty during the referenced 5 -hour time frame. Note that during this five hour period there were three (3) instances where 6 of the 7 on duty ambulances were in service simultaneously; resulting in the circled number "1" referring to the last available ambulance. Subsequently, the remaining ambulance was in all likelihood directed to "move" to a location that would permit the most flexible response should another call come in before another ambulance was available. This scenario was found to occur many times during the review of the 2011 EMS call records. Solutions for Local Government, Inc. 26 Comprehensive Assessment of Emergency Medical Services 71 and 911 /Communications Center Operations Study Issue: Response Time For the purposes of this report and as referenced in Subsection 2.3, EMS ambulance response time is: The time from the initial alert or announcement by the Communications Center (also called "tone', "page"; or "dispatch ") of the reported emergency, to the time that the service vehicle and appropriate personnel arrive on the scene. The factors that most commonly impact response time include: • The time required to access and engage the vehicle, • The speed at which the emergency vehicle is able to travel, • The distance that must be covered to the incident dispatched, and • Under what conditions. Consequently, the basis upon which pre - hospital emergency medical response criteria has been established is medical case history data regarding the body's need for oxygen. Simply, the human body needs oxygen to survive. While some cells may tolerate short periods without oxygen, most require a constant supply of oxygen to survive. Figure 21 illustrates the significance of time in this equation. Figure 21 Concerns and subsequent standards regarding emergency medical response times are based on the findings of various significant medical organizations and professional associations. Among these, the American College of Emergency Physicians (ACEP) and the American Heart Association has each similarly stated: "The most important factor in successfully resuscitating a patient in cardiac arrest is the speed of response. The survival rate from untreated ventricular fibrillation decreases up to 10% for every minute that passes and definitive care is not provided." minute; cardiac irritability minutes; brain damage not likely minutes; brain damage possible 1 minutes; brain damage very likely minutes; irreversible brain damage The American Heart Association, ACEP, and other respected organizations recommend that EMS vehicles should respond to deliver BLS (basic life support) skills within 3 to 4 minutes, with ALS (advanced life support) skills available within 6 to 8 minutes. The ALS- within -8- minute concept was developed from research that showed the survival rate of cardiac arrest victims decreases significantly with each passing minute, and that optimal probabilities for survival increase when BLS has been provided within 4 minutes followed by ALS within 8 minutes. "' In addition, ■ The American Association of Orthopedic Surgeons (source of Figure 21) suggests that "in an incident involving lack of oxygen, brain damage is very likely at 6 to 8 minutes; irreversible after 10 minutes." ■ The National Fire Protection Association states in NFPA 1710 that AED (BLS) capabilities must arrive within a 4- minute response time to 90% of the incidents; and that ALS capabilities shall be deployed to arrive within an 8- minute response time to 90% of the incidents. 7 American College of Emergency Physicians; "Principles of EMS Systems "; 2006 Solutions for Local Government, Inc. 27 Comprehensive Assessment of Emergency Medical Services 72 and 911 /Communications Center Operations Study Ultimately then, someone with at least basic life- saving skills (BLS) needs to be on the scene of the emergency within 4 minutes; and, someone with advanced life- saving skills (ALS); i.e. Orange County EMS; within 8 minutes. And, according to NFPA, those response times are to be achieved in at least 90% of all calls dispatched. The concern in this regard is that the years of data gathered and analyzed for this report showed that the total average response time intervals, both turn -out time and travel time, for Orange County EMS exceeded the time standards recommended; consistently. Figure 22 EMS System Annual Average Response Times As illustrated, the 5 -year average turn -out time of 1 minute -30 seconds exceeds the recommended standard of "no more than one (1) minute ,8; as well, the 5 -year average Total Response Time, of 10 minutes -30 sec- onds exceeds the recommended standard by almost 2 % minutes. Year Total Units Dispatched Turn -Out Time Travel Time Total Resp. Time 2007 9,269 1:41 7:41 9:26 2008 9,833 1:38 8:15 9:56 2009 10,614 1:29 9:15 10:49 2010 11,893 1:27 9:47 11:14 2011 13,079 1:16 9:30 10:47 SYearAverage: 0:01:30 0:08:53 0:10:26 Turn -out time is an issue that must be studied internally and specifically, often times by studying the patterns of individual crews. The focus of the discussion that follows focuses on First Responder and EMS Total Response Time. As stated, standards also suggest that basic life support (BLS) capabilities; i.e. "first responders "; arrive on scene in no less than four (4) minutes. As previously addressed, the Orange County EMS System Plan filed with the State identifies 12 Fire Departments within the County that support EMS as Medical First Responders. In 2011 the medical calls recorded to which these Fire departments responded were as follows: 2500 2000 1500 1000 500 0 Figure 23 Fire Department Medical Call Responses -2011 ' \Z %, � �cb So �� e e/ 8 NFPA 450 Guide for Emergency Medical Services and Systems; Subsection 5.6.8 Turnout (Activation) Interval Solutions for Local Government, Inc. 28 Comprehensive Assessment of Emergency Medical Services 73 and 911 /Communications Center Operations Study The total medical calls to which the Fire Departments responded was 5,990; which represents approximately 56% of the emergency calls to which EMS was dispatched. The concern, however, with regards to the response time standards cited is illustrated here: Figure 24 Fire Dept. Average Response Times Figure 25 to Emergency Medical Calls EMS & Fire Average Response Times vs. AECP & NFPA Standards Department Avg. RT Caldwell 9:38 Carrboro 5:10 CedarGrove 9:31 Chapel Hill 4:48 N. Chatham 12:00 Efland 7:05 Eno 8:46 Hillsb /Orng. Rural 5:24 Mebane 7:12 New Hope 7:10 Orange Grove 6:49 White Cross 8:19 14:24 , , , ,--7 , , 1 12 :00 1 1 I I I I I I I I I I 1._�__�_ a__4_ a__�_ __�_a__ I 1 I I I I I 1 I I 1 1 1 1 1 1 1 1 1 1 1 1 O_ra_nlLe Avgl1_0:47L —6 .I � I. i i J � I. i I I I I 1 1 I I I � 1. 1 1 _o._E_S_20_11_ � I I I I I I I I 1 I I I 9:36 - -,- - - -,- - - -,- - - -� ALS%AIdEF 7:12 I - 4 :48 I I 1 1 1 1 1 1 1 1 �__�_ __�_�__�_ _L_�__L_�__1__�__I__ I I I I I I I I I I 1 1 1 1 1 1 1 L _1 1 1 1 __,__1__I__1____I__1_ I I I I I I I I I I I I BLS /N FPP 2:24 1 r---r- --r----r-T--r--- 1 r- z-- ,-- z-- r- r-- 1-- r-- r- r --r-r- 0:00 • I I I I I , �H , , I `\ o e `` a o &a` a�rad` Q, efface `tole �`oJe `to5y CP La `aaac Lra �Lr \Oto� lei �rwe `acute O Moving upward from the horizontal axis in Figure 25 the first horizontal red line represents four (4) minutes; the second horizontal red line represents eight (8) minutes. The horizontal red - dashed line represents the total average response time for EMS in 2011. Based upon the response time standards cited, at the very least the Fire Department /BLS response times should be below the 4- minute line and the EMS /ALS response times should be below the 8- minute line. On the basis of the numbers and times illustrated, none of the Fire Departments who serve as BLS level medical first responders meet the 4:00 minute BLS response time standard called for; albeit several are very close and several certainly meet the criteria much of the time assuming that +/- 50% of the "average" responses are in fact less than the average. At the same time, the 2011 EMS average response time is nearly 3:00 minutes greater than the 8:00 minutes suggested for ALS response. NOTE: This issue is about EMS "response time ", and as an issue it very much needs to be addressed. However, time of response is not the only factor that ultimately will determine the quality if the response. The role of the Communications Center in Medical emergencies is extremely important; in fact vital, if the "correct" response to a medical emergency is going to occur. The efforts to adequately triage a call based on the NAED and EMD protocols can many times provide valuable advise and /or verbal assistance in initiating basic care for the patient; can identify the specific conditions and /or symptoms to determine the level of response to be dispatched and can keep responders informed of any changes in the patient's condition or scene circumstances as they are enroute. Solutions for Local Government, Inc. 29 Comprehensive Assessment of Emergency Medical Services 74 and 911 /Communications Center Operations Study The medical dispatch response codes used by Communications Center Telecommunicators (see Figure 10, page 18) will identify for first responders and EMS Medic personnel the initially identified condition identified and the Response Code as well as the Response Status recommended; i.e. "DELTA" = "life threatening ", First Responders respond Emergency Status; i.e. "lights & siren ". Proper triaging of an emergency medical call is vital and can go a long way to assuring the responder dos not run over a pedestrian at a crosswalk on the way to an incident that is not an emergency. This said; response "time" in Orange County must still be addressed. The professional organizations that have spoken to and suggested the time standards referenced have identified their basis for doing so. In many discussions of the topic with local EMS professionals in North Carolina, ALS response objectives are typically established at between 8:00 -9:00 minutes. On the basis if the organizations that have endorsed this standard it merits attention and until the North Carolina Medical Board which is responsible for adopting the rules and standards governing advanced life support services says otherwise, the standard; albeit its potential consequences, need to be considered seriously. Vehicle Speed & Distance to Incident Location For reference, the following formula can be used to calculate the average travel time, particularly for major emergency vehicle; i.e. ambulances and Fire trucks; between two points; (NFPA 1720- A.4.3.2): 1.7 x Distance + 0.65 = Travel Time For example, if the distance to the scene of an incident is known to be five (5) miles; (1.7 x 5) +.65 = 9.15; a Travel Time of 9 minutes and 12 seconds This travel time equates to an average speed of 33 -34 miles per hour, which actually is not unusual for fire, rescue, and EMS vehicles for this distance considering acceleration, deceleration, time of day, road conditions, other traffic, etc. Reversing this formula, using the 2011 EMS average Travel Time of 09:30, and converting the 32 seconds to hundredths of a minute, would result in the following: 9.50 minutes Travel Time = 1.7 times Distance "x" +.65 or (7.53 -.65)/1.7 = 4.2 miles traveled This being the case, the distance that Medic Units could travel and still meet the objective of an 8:00 minute total response time is 4.2 miles. However, were this to be the case; i.e. ALS ambulances never responding to incidents further than 4.2 miles from their assigned base -in order to meet the 8:00 minute Total Response Time objective; the area within which the existing EMS units could effectively travel would leave the majority of the County essentially "uncovered ". The pages that follow include a sequence of County maps that illustrate the concern associated with this issue. Solutions for Local Government, Inc. 30 Comprehensive Assessment of Emergency Medical Services 75 and 911 /Communications Center Operations Study Map #1 is that previously shown on page 8; it identifies the existing EMS district boundaries and the staging locations of the current EMS Medic units. Map #2 outlines in various colors the 4- mile /8- minute drive time road -based limits from each Medic location. Note that the boundaries for Medic 1, Medic 4, and the temporary location of Medic 5 overlap one another somewhat. Also, the south County locations identified for Medic 2, 3, 6, 7, and 8 overlap to such an extent that the outermost distances of each were used and combined in order to determine the extent of area covered. Map # 3 shows the same 4- mile /8- minute road -based boundaries as Map #2, however, this time overlain onto the map illustrating the county -wide distribution of EMS call locations over the past three years; 2009 -2011. Map #4 includes shading over the areas of the County that currently lay outside the limits of the 4- mile /8- minute ALS response perimeter(s). Map #5 is a duplicate of Map #4, however, this time it also includes red dots at the approximate locations of each of the 20 Fire Department stations within the County; and as is the case with Mebane and North Chatham Fire Departments -very near; the County. Comments re: Maps ■ While the maps emphasize significant characteristics impacting ALS response time, they (collectively) also exacerbate somewhat the previous issue having to do with ambulance availability. ■ The areas of the County identified wherein ALS Medic Units should be able to travel within the 4- mile /8- minute time standard are, in fact centered within the more populated areas of the County and, for the most part, proximate the major highways corridors. However, there are still many hundreds of EMS calls that have been dispatched beyond these areas of coverage over the past three years that have not received the same level of response. ■ A visual estimate of the shaded area noted in Map #4 would suggest that as much as 55 -60% of the County is outside the 4- mile /8- minute ALS response perimeter. ■ As previously stated, the combined (potential) capabilities of the 12 Fire Departments that are available to respond from 22 additional station locations could provide some assurance to areas of the County that take longer than 8 minutes for EMS /ALS Units to access; however, to get to the incident scene within the 4- minutes suggested for a BLS response, would mean a 2- mile /4- minute Total Response Time. A response time that, as an overall or individual department average, has yet to be accomplished. Solutions for Local Government, Inc. 31 Comprehensive Assessment of Emergency Medical Services 76 and 911 /Communications Center Operations Study Solutions for Local Government, Inc. 32 Comprehensive Assessment of Emergency Medical Services 77 and 911 /Communications Center Operations Study MAP #2 Solutions for Local Government, Inc. 33 Comprehensive Assessment of Emergency Medical Services 78 and 911 /Communications Center Operations Study Solutions for Local Government, Inc. 34 Comprehensive Assessment of Emergency Medical Services 79 and 911 /Communications Center Operations Study MAP #4 Solutions for Local Government, Inc. 35 Comprehensive Assessment of Emergency Medical Services 80 and 911 /Communications Center Operations Study MAP #5 49 Solutions for Local Government, Inc. 36 Comprehensive Assessment of Emergency Medical Services 81 and 911 /Communications Center Operations Study Average vs. Fractile Response Time Performance Criteria It is has been a common practice in the past to report response times by using averages. This is an easy - to- understand methodology that calculates response times by adding all individual call response times together and then dividing the total number of minutes by the total number of responses to come up with an average. Unfortunately, measuring and reporting average response times is inadvisable because one -half of the patients may receive the required response time, while the other half will not. Given what has been discussed about the need for an eight- minute response to maximize survivability from cardiac arrest, an average eight- minute response, by definition, means that one -half, or more, of the service's patients are not reached within that critical time. Many high - performance emergency ambulance services use a different methodology to measure response times to ensure service equality to all patients: fractile distribution; in most instances as suggested by NFPA and others, reported at the 90`" percentile. This methodology places each response within the minute it is achieved and stacks the minutes in ascending order to establish a fractile response -time distribution. The point at which the fractile response time crosses the percentile measures the point of the service's response -time reliability. For example; the current Orange County EMS response time objectives, as published in the Orange County EMS System Plan on file with the State Office of EMS, states that: For Emergency Responses; ..... A Paramedic be on scene within 12 minutes 90% of the time For Non - Emergency Responses; ..... A Paramedic be on scene within 15 minutes 90% of the time Figure 26 Annual Average Response Time - Emergency vs. Non-Emergency-All Calls 2009 -2011 90% Fractile Times - Emergency vs. Non-Emergency-All Calls 2011 0:12:23 - -- r----------- r----- - - - - - - - 0:12:0b ----------------------------------------------- ai , 90% @22 Minutes 0:11:48 ------- - - - - -- --- s - - - -- - 0:11:30 '------------------------------ 0:10:57 -------- -� -- --------- O:1Q:37 : 90% @18 Minutes 0:10:39 - - -- - - - -' -- Q �- 0:10:22 o:1p:15 0:10:05-----------'----------- L----------- 1---------- - - - - -- - -. .. -- ' 0:09:48 .............................. ------------ ------------ 0 :04:34 -- -- - -- -1 --- 1 - - -- - - - - - - - - - - - - - --- - - - - -- - - -- --- -- - - - - -- -- - - - - -- 0:09:13 2009 2010 +Emergency +N on- Emerge ncy Solutions for Local Government, Inc. 37 Comprehensive Assessment of Emergency Medical Services 82 and 911 /Communications Center Operations Study Highlighting the 2011 numbers; while the emergency and non - emergency overage response times were less than the 12- minute and 15- minute objectives established for each; the 90 %fractile response for the non - emergency calls was 22 minutes vs. the 15 minute objective , and the 90% fractile response for the emergency calls was 18 minutes vs. the 12 minute objective. Response Time by Area of the County During the initial presentation of study findings to the Emergency Services Work Group it was suggested that it had long been the perception within the County that rural areas did not receive as rapid a response as the more urban and populated areas of the County. And, that it would be helpful to see and assess what those actual call numbers and corresponding EMS response times actually were. In doing so, a second series of County maps follows. Map #6 -is again a map of Orange County; in this instance, divided into 2 -mile square, numbered grids. The map was developed by Emergency Services Department personnel. Map #7 -color codes each grid on the basis of the average EMS response times recorded for the calls responded to within it during calendar year 2011. The number of calls per grid ranged from '0' to 1,505. The color key located at the bottom of the page provides an explanation of the colors used: • The average response time into red grid squares was greater than 20 minutes • The average response time into green grid squares was between 16 -20 minutes • The average response time into blue grid squares was between 12 -16 minutes • The average response time into orange grid squares was between 8 -12 minutes • There were no EMS calls dispatched during 2011 into those grids that were left white Note also that the Appendix Section of this report includes a larger scale County Grid Map (Map #6) together with the number of EMS calls dispatched into each grid and the average response time for those calls; for the years 2009 -2011. Map #8- identifies the boundaries (in blue) of the existing designated EMS districts. Within each district there are notations that indicate the number of EMS calls and the average response time to those calls for the calendar year 2011. District 5 appears to be the largest in land area followed by District 4 and District 1. District 7 is the smallest. Map #9- divides the County into hypothetical "zones' based upon the study of EMS call volume, response time, area accessibility, and population. Then, calculating the number of calls and corresponding average response times that occurred within each zone to provide a look at the response time issue from another perspective. For example EMS District 2, in Map 8 showed 2,400 calls with an average response time of 08:37 to all calls. When dividing that District and considering the grid characteristics of "Zone 8" , which includes the western half of District 2, there is a dramatic decrease in the number of calls and significant increase in the average response time. [The remainder of this page intentionally left blank] Solutions for Local Government, Inc. 38 Comprehensive Assessment of Emergency Medical Services 83 and 911 /Communications Center Operations Study MAP #6 Solutions for Local Government, Inc. 39 Comprehensive Assessment of Emergency Medical Services 84 and 911 /Communications Center Operations Study Solutions for Local Government, Inc. 40 Comprehensive Assessment of Emergency Medical Services 85 and 911 /Communications Center Operations Study MAP #8 Solutions for Local Government, Inc. 41 Comprehensive Assessment of Emergency Medical Services 86 and 911 /Communications Center Operations Study MAP #9 Solutions for Local Government, Inc. 42 Comprehensive Assessment of Emergency Medical Services 87 and 911 /Communications Center Operations Study The responsibility for determining what the EMS system response time objective(s) should be is clearly the County's, in that it is the County that must define the level of care that it intends to provide. 10A NCAC 13P.0201 EMS SYSTEM REQUIREMENTS .0201(a) County governments shall establish EMS Systems. Each EMS System shall have: • A defined geographical service area for the EMS System. • The minimum service area for an EMS System shall be one county. • There may be multiple EMS Provider service areas within the service area of an EMS System. • The highest level of care offered within any EMS Provider service area must be available to the citizens within that service area 24 hours per day. Issue: EMS Base Facilities When conducting space needs assessments to determine the requirements for an EMS building that is to house and secure an ambulance or ambulances and provide for the needs of the personnel assigned to them, one must begin by considering and discussing at least: the size of the vehicles to be housed, the type of support spaces required, the policy and legal requirements that will dictate specific utilitarian, safety, health, hazard prevention and decontamination procedures, the adjacency of and circulation between the individual spaces to be provided, and the overall security requirements of the facility. After which, the architectural details will follow. The Existing Conditions sub - section did not alluded to physical EMS "bases" or "stations ". Rather it referred to EMS "staging "locations. This is because there are no EMS bases or stations; at least none that are in buildings that were ever planned, built or intended for the purpose of accommodating EMS ambulances or EMS personnel. Of significant concern, particularly in view of their cost, is that none of the staging locations available now can offer or assure EMS that it can house an assigned and equipped ambulance inside a code compliant, temperature controlled, securable building as suggested by NCOEMS guidelines. Staff may have seating and work areas available to them but not always adequate restroom, meal preparation, respite, or specifically required OSHA and /or OEMS decontamination facilities. The ambulance staging areas currently assigned have essentially come to EMS by default. There is no evidence that current staging area locations were strategically planned, but simply that space that was available via recent vacation or not otherwise being used, was offered as a location, for the most part, near the more populated areas of the County. There are currently areas of the County essentially uncovered and without any visible evidence that Orange County EMS has a presence in the area or community. Orange County EMS, like Law Enforcement is an on -going and at times almost continuous service that functions 24 hours a day throughout the entire County. Its services are far from occurring on a casual "periodic" or "sporadic" basis. This concern must be addressed as a long term issue. And, it must (in the long term) dovetail with the Response Time and Ambulance Availability issues previously addressed. Solutions for Local Government, Inc. 43 Comprehensive Assessment of Emergency Medical Services 88 and 911 /Communications Center Operations Study EMS area base facilities, built to accommodate the needs of personnel, daily operations, equipment and vehicles, adequately staffed, and strategically located within the County, can significantly impact the response time concerns addressed. An EMS facility must include, at the very least, the following type of space: • Indoor, temperature controlled vehicle bays with exhaust ventilation and recharging stations • Secure equipment, materials and medication storage • Special storage for certain narcotics and refrigerated medical supplies • Decontamination showers for personnel • Decontamination /wash areas for equipment • Space for air drying decontaminated equipment • Storage accommodations for contaminated clothing, waste, sharps, etc. • Accommodations for the handling of medical gases (oxygen) • Laundry facilities • Food preparation and dining space • Common /dayroom space • Multipurpose storage space • Staff restrooms • Technology to permit wireless internet capabilities, phone, radio, and pager communications • Public entrance and space to accommodate visitors There have been those quick to suggest that EMS should "share space" with the Fire Departments. And there are those that have been just as quick to suggest that, "no, it would never work -Fire and EMS could never get along ". The fact is, Fire and EMS personnel work together throughout the County every day ... and get along just fine. The actual issue of Fire and EMS "sharing" facilities is more complex: • The ultimate purpose (mission) of each is different • Fire Department service areas are specific and limited • EMS' service area is the entire County • The schedules of each are different • EMS may run continuously for extended periods of time • Fire will more often respond to "periodic" incidents ■ The work habits of each are different • The facility requirements of each are different • Fire Departments are visible within their respective communities; few know where EMS is. • Existing Fire station locations are not strategically located to adequately address the deployment of EMS vehicles; to continue to push the "sharing" of these facilities with their respective requirements so different, would simply continue a practice; i.e. discussion; that has worn out its welcome several times over. Solutions for Local Government, Inc. 44 Comprehensive Assessment of Emergency Medical Services 89 and 911 /Communications Center Operations Study EMS Base Location Scenarios Again, prompted by discussions during presentations to the Emergency Services Work Group regarding EMS response times and the lack currently of adequate EMS base facilities, two (2) hypothetical facility location scenarios were developed to enable a more in -depth discussion and subsequent assessment of options that might be available to the County. As noted previously, prominent national organizations have suggested that an ALS ambulance be on the scene of a medical emergency within eight (8) minutes of being dispatched. In turn, Orange County EMS has established a response time objective of 12- minutes, to 90% of all emergency calls dispatched. Therefore, utilizing a "blank slate" approach and looking at a map of the County without regard to existing EMS district boundaries or existing ambulance staging locations; measurements were taken and calculations run to determine the number of EMS base facilities that would be required, together with their respective (approximate) locations, that would be able to provide: 1. An OCEMS ambulance on scene anywhere in the County within eight (8:00) minutes. 2. An OCEMS ambulance on scene anywhere in the County within twelve (12:00) minutes. In reality it took the development (and redevelopment) of many trial- and -error partial scenarios to eventually achieve the objective set for each; the fewest number of EMS stations that would provide the maximum possible coverage. The results are illustrated on the maps that follow. • MAP #10 -8:00 Minute Response Time (RT) Coverage Scenario -A; identifies 19 EMS station locations • MAP #11 -8:00 Minute Response Time (RT) Coverage Scenario -B; identifies (in red) remaining "pockets" of land not accessible within the 8:00 minute response time limitation • MAP #12 -12:00 Minute Response Time (RT) Coverage Scenario -A; identifies nine (9) EMS station locations • MAP #13 -12:00 Minute Response Time (RT) Coverage Scenario -B; identifies (in red) remaining "pockets" of land not accessible within the 12:00 minute response time limitation Scenario Personnel Costs As a means of comparison, the number of stations and the corresponding number of FTE's required to staff a single 24 hour ambulance in each proposed station, and the estimated personnel costs of each coverage scenario were assessed against existing FY 2011 -2012 budget figures. 12:00 Minute Response Time Coverage 8:00 Minute Response Time Coverage 19 Stations 204 FTE's 9 Stations 97 FTE's ve rs us ve rs us 6 Locations 63 FTE's 6 Locations 63 FTE's $ 10,135,976 Total Personnel Cost Total Personnel Cost $ 4,818,233 Less Existing Budget Pers. Cost $ (3,703,295) Less Existing Budget Pers. Cost $ (3,703,295) Less Est. Overtime Savings [1/2] $ (200,000) Less Est. Overtime Savings [1/2] $ (200,000) Total Net CostAddt'I. Personnel $ 6,232,681 Total Net CostAddt'I. Personnel $ 914,938 Solutions for Local Government, Inc. 45 Comprehensive Assessment of Emergency Medical Services 90 and 911 /Communications Center Operations Study MAP #10 Solutions for Local Government, Inc. 46 Comprehensive Assessment of Emergency Medical Services 91 and 911 /Communications Center Operations Study Ii7/rel2311 Solutions for Local Government, Inc. 47 Comprehensive Assessment of Emergency Medical Services 92 and 911 /Communications Center Operations Study MAP #12 Solutions for Local Government, Inc. 48 Comprehensive Assessment of Emergency Medical Services 93 and 911 /Communications Center Operations Study MAP #13 Solutions for Local Government, Inc. 49 Comprehensive Assessment of Emergency Medical Services 94 and 911 /Communications Center Operations Study 2.5 RECOMMENDATIONS Issue: Availability of Ambulances Recommendations: R -1. OCEMS should adjust Medic 5 and Medic 8 coverage hours. As an initial but immediate response to improve ambulance availability, adjust the assigned hours of available ambulances to more heavily load the prime time block of hours from 9:00 am -9:00 pm when many of the "move -ups" occur. Specifically: • Move Medic 5 from 6:00 am -6:00 pm to 9:00 am -9:00 pm • Move Medic 8 from 6:00 pm -6:00 am to 12:00 noon -12:00 midnight The blue bars in Figure 27 represent the eight (8) Medic Units and their currently assigned shift hours. Figure 27 Current nanlnvmant of Amhulanras The red bars in Figure 28 represent the coverage of the eight Medic Units once the changes to Medic 5 and * have been made. Figure 28 Recommended Deployment of Ambulances Solutions for Local Government, Inc. 50 Comprehensive Assessment of Emergency Medical Services 95 and 911 /Communications Center Operations Study The objective of course in adjusting the coverage hours of Medic 5 and 8 is to increase the availability of ambulances and decrease the number of "move -ups' that must be ordered on a daily basis. Call data and corresponding move -up information will need to be closely monitored in order to assess the effectiveness of the shift adjustments. The data collected will need to include information specific to each individual Medic Unit. The minimum information collected, collated and distributed for review on at least a monthly basis should include at least: • The number of calls dispatched per day, week, and month • The total event time of each call • The number of times "move -ups" were ordered per day, week, and month • The time of day that each move -up was ordered and its duration Monthly summary reports of Medic Unit activities should be reviewed by at least the EMS Operations Director, the Medical Director, and the Emergency Services Director. A comprehensive assessment of the progress made towards improving ambulance availability should occur no later than the end of the 6th month to determined if the coverage adjustments are having effect. R -2. OCEMS should add an additional AILS Ambulance 9:00 am -9:00 pm, 12 hours /day, 7 days /week. Adjusting the coverage hours of two Medic Units will certainly help reduce the number of "move- ups "; i.e. the number of times per day that available ambulances are down to one (1) or "no" ambulances. If, however, after no more than six (6) months of the enhanced prime -time coverage the number of "move -ups has not been reduced by at least two - thirds (from an average of 6.5 /day to no more than 2 /day) efforts should be made to immediately bring on -line a fully staffed and equipped ALS ambulance assigned to the 9:00 am -9:00 pm hours, 7 days /week. R -3a. Utilize available SORS /BLS ambulance for non - emergency patient transports. R -3b. OCEMS should bring on line and staff a BLS ambulance to provide non - emergency patient transports. The concept suggested by this recommendation utilizes a BLS staffed ambulance to provide patient transportation (via ambulance) in non -life threatening circumstances. The basis being that ALS Medic Units would of course respond to all calls dispatched, however, rather than then having to transport the patient; i.e. travel to the hospital with the patient, and spend time at the hospital until released, they could return to "in- service" status and be available to respond to another call much sooner. The reason for there being a "part a" and a "part b" to this recommendation is that they represent two options to accomplish this time saving effort to increase ambulance availability. If South Orange Rescue Squad (SORS), which is essentially a volunteer organization, cannot provide an ambulance and certified EMT personnel, and the concept is considered viable by the County, OCEMS should provide the ambulance and personnel to do so. Note that while not addressed specifically in the wording of the recommendation it is assumed that the referenced prime -time hours would be the target time this BLS unit would be assigned. However, should EMS recognize that factors such as call time, call volume or other noticeable trends regarding patient transports vary from those hours, it should be able to assign and schedule the unit(s) accordingly. Solutions for Local Government, Inc. 51 Comprehensive Assessment of Emergency Medical Services 96 and 911 /Communications Center Operations Study Issue: Response Time Recommendations: R -4. Assess Fire Department capabilities to meet BLS First Responder response time objectives. This recommendation calls for an independent, objective assessment of existing Fire Department capabilities and the actions, procedures, and associated costs -if any, to address the Medical First Responder response time objectives not yet established by the County. The information to be reviewed and assessed for each department will include at least, but not be limited to the following: • Department roster /membership • Number of paid vs. volunteer personnel • Available vehicles & relevant equipment • Station location(s) • Recent year call volume & type • Past call locations • Included map grids • Existing funding • Anticipated performance requirements R -5a. Schedule and implement Fire Department MFR initiative which includes performance objectives. R -5b. Staff and equip four (4) EMS Quick Response Vehicles (QRV's) for assignment, initially, 12 hours /day, 7 days /week with shift start /end times to be determined by EMS. Should the findings and recommendations identified in the Assessment of Fire Department Capabilities recommended in R -4 be approved by the County, R -5a the implementation of the individual and collective Fire Department initiatives should take place as soon as possible following approval. Granted all actions and recommendations approved may not be able to occur at the same time for various reasons; i.e. logistics, funding, availability of personnel, etc. Note that specific performance objectives, particularly with regards to response time, have not been defined at this time. This issue should be addressed during the Assessment (R -4) process, with every Fire Chief individually and with every Department having an opportunity to provide input. In the event that the findings and recommendations identified in the Assessment of Fire Department Capabilities recommended in R -4 not be acceptable to the County, an alternative means of providing a medically trained and certified first responders on the scene of a medical emergency "fast "; i.e. much faster than the EMS average response times recorded in recent years; is critical. Subsequently, the alternative recommendation in this case is that stated in R -5b. While not as widespread as 12 fire departments, four (4) single - person ALS Quick Response Vehicles (QRV's), appropriately deployed and monitored with regards to directing placement, can go a long way towards improving the initial first response to medical emergencies which is currently averaging 2 -3 times that established by NFPA and others as the recommended standard for medical emergencies. Note that this concept does not take an EMT out of an ambulance and put them in a car instead. It places an EMT in a vehicle with the single purpose of improving the Medical First Responder times to medical emergencies ... "get there fast, assess the situation, stabilize /treat the patient, communicate the conditions found and await an ALS Medic Unit to arrive to transport the patient if necessary ". The EMT does not leave his /her vehicle to ride in the ambulance. Once control is assumed by the Medic Unit, the assigned EMT will be "in service" and resume the duties assigned. Solutions for Local Government, Inc. 52 Comprehensive Assessment of Emergency Medical Services 97 and 911 /Communications Center Operations Study R -6. Staff & equip six (6) 12 hour /7 day ALS ambulances at appropriate staging /base facility locations within (1) Zones 1 & 2, (2) Zones 7 & 5, and (3) Zones 6 & 8. If Orange County intends to work towards addressing its statutory responsibility of providing the same level of EMS care to all areas of the County 24 hours per day, this recommendation, once acted upon, will demonstrate a significant step in that direction. And, while the EMS Base Facilities issue will be addressed specifically in recommendations R -8 through R -12, the strategic placement of those facilities will need to coincide closely with this recommendation. Ultimately, it will be recommended that the County provide no less than nine (9) EMS base station facilities, preferably one within each of the nine zones identified in this map and in larger scale on page 41. The basis for suggesting that the additional ambulances along with accompanying personnel and equipment be provided within each of 3 "pairs" of two zones each included that: ■ Each of the total of six zones identified have among if not the slowest EMS response times in the County. • Each of the "paired" zones is adjacent to one another. • The location of an EMS station within one of the two adjacent zones initially, will improve response times to incidents in both zones, (although perhaps only "somewhat" improved in the zone without the station). • As will be noted in Section 6- Implementation Schedule, the development of the EMS stations will require careful study as to location as well as scheduling of the capital and operating costs identified; these initially "shared" EMS base stations will permit the County to phase the development of future stations. R -7. Hire a Paramedic Level Shift Supervisor @ 24/7. The additional EMS personnel to be hired that correspond with the recommendations presented thus far, to address the Availability of Ambulances and Response Time issues discussed, will warrant an additional 24 hour /7 day Shift Supervisor position by Year 4 as identified in the Implementation Schedule provided in Section 6. The relief factor calculations in Subsection 4.4, page 76, identified a multiplier of 5.1 per 24 hour position to enable 8,760 hours of coverage 24/7/365. In addition to personnel, a vehicle (typically SUV) up- fitted to provide two -way radio and computer communications with the Communications Center and on -duty Medic Units in the field, and GPS and AVL equipment will be required as well. Solutions for Local Government, Inc. 53 Comprehensive Assessment of Emergency Medical Services 98 and 911 /Communications Center Operations Study Issue: EMS Base Facilities Recommendations: R -8. Prepare a detailed Space Needs Assessment that addresses the essential building and site requirements to accommodate a stand - alone, functional, code compliant EMS base facility that can serve as a prototype for all future facilities. The recommendation suggests that the County contract for professional services, working directly with the County and EMS personnel, to detail and document the space and site requirements for an EMS Base facility. Once the essential space needs are identified various options can be refined based upon the specific type(s) of facilities needed; for example a station that would accommodate a single ambulance, a station that would accommodate multiple ambulances, etc. The benefit of such an assessment and the documentation of the specific space and site requirements could serve the County in multiple ways; • As a conceptual "pattern" it could be utilized as the prototype facility concept to be built at multiple locations. • As a "test template ", were a building identified in a strategic location, the information detailed with this document could be utilized to evaluate the building in question as to its applicability for reuse as an EMS facility. R -9. Identify a minimum of nine (9) strategic locations, preferably no less than one (1) location within each major zone previously identified, for the potential location in each of a future EMS base. The criticality of the location of EMS base facilities in an area as large, and as varied as Orange County cannot be over emphasized. As alluded to in R -8 above, while the "ideal" situation would be available property on which a "build -to- suit" new building could be located, the eventual option that presents itself may in fact be an existing building that may be appropriate for reuse as an EMS facility. Regardless of the approach, the previous EMS discussion of issues made clear the need for these facilities in locations in addition to only the most concentrated areas of population in the County. R 10. The County should purchase /obtain identified sites (and /or buildings) for development. The completed Space Needs Assessment suggested in R -8 should provide the criteria for evaluating the potential of any site or building considered. R 11. Procure EMS base planning and design services. Depending upon the level of detail provided in the referenced Space Needs Assessment, planning and design of a single EMS base facility could take 4 -6 months, particularly considering the various regulatory requirements imposed on "public building" projects. R 12. Advertise, bid, and commence construction on designated EMS base facilities. Once the design is completed and approved, the bidding and construction of this type of building could take 6 -8 months depending upon whether it is to be new construction on a "clean" site or renovation and a building addition to an existing structure. Of course any number of additional options (and benefits) could be realized if for example, a single contractor (or designer) was selected to do more than one facility at a time; i.e. a "package deal ". Solutions for Local Government, Inc. 54 .. Comprehensive Assessment of Emergency Medical Services and 911 /Communications Center Operations Study This section briefly examines Orange County's recent past and projected future populations. The relevance of the County's resident population to the future demand for EMS services will be considered in an effort to project future demands and in turn needs of both operations. The source of the material presented in this section is the North Carolina Office of Budget and Management (NCOBM). Figure 29 Orange County Experienced & Projected Populations 200,000 -- -- -- - - -r- 177,418 180,000 - - - -- - - - - - -- - ; - - - - -; 167,503 % Change 1 1 1 1 1 1 1 1 157:588 , 1 160,000 - -- ---- ,---- ; ---- ; ---- ; ---- ;- 147;675; -... - -- - -L - - -- 0.03% 1 ' 0.10% 137,760 ; 1 140,000 19.1% -127j2 7--_- i ____1____1_____ _-- _r__-- r_- __r____ Durham 119,329 312,265 13.2% 1 I 1 I 1 120,000 *---- 1 1 r_.- 1 1 -• - - -- 1 1 ---- Y- __ -y- --- ----- ----- 1 1 1 i 1 1 1 f I 1 1 1 100 ,000 f 1 -- L---- 1 f 1 L--- 1 1 1 -1 - - -- 1 1 1 1 1 ---- J__-- J__-- J_ -__- 1 1 1 I 1 12•6% 80,000 1 1 - ---T-- 1 1 --T--- 1 1 1 -T- --- 1 4 14.4�i - - -r 1 1 1 1 --- r- - - -r -- 1 1 60.000 -- 15.4% - - -- ; - - - -- ------------------------------ 1 1 1 1 i 1 40,000 ; 1 - - - -; --- -; - - -- - - -- ; - - -- ; - - -- ; - - - -- - - - -� - - -; - - - -; - 20,000 I f---- 1 T--- 1 -T - - -- 1 1 ---- 1---- 1---- 1 - - - -- ----r----r----r- 1 1 f 1 1 2002 2007 2012 2017 Rzz 2027 2032 1 SoLme: NC Office of Budget & Management These figures indicate that over the past 10 years the County's population has increased 15.4 %. The projected July 2012 resident population is 137,760. Over the next decade the County's population is projected to increase by just under 20,000 residents; 14.4 %. The following decade, 2022 -2032, although increasing at a lower percentage; i.e. 12.6 %; will still experience an increase in population of yet another 20,000 residents. In turn, as a means of comparison, the counties adjacent to Orange are expected to experience the following in terms of growth over the next 20 years: Figure 30 Adjacent County Projected Populations /2012 -2032 County Jul -12 Jul -22 % Change Jul -32 % Change Total % Change Alamance 153,498 163,168 6.30% 172,841 5.93% 12.23% Caswell 23,727 23,733 0.03% 23,756 0.10% 0.12% Chatham 65,814 78,411 19.1% 91,011 16.1% 35.21% Durham 275,946 312,265 13.2% 348,584 11.6% 24.79% Orange 137,760 157,588 14.4% 177,418 12.6% 26.98% Person 1 40,247 45,0101 11.8% 1 49,7761 10.6% 1 22.42% Solutions for Local Government, Inc. 55 Comprehensive Assessment of Emergency Medical Services 100 and 911 /Communications Center Operations Study The experienced EMS call volumes and the corresponding EMS calls per 1,000 resident population has been identified for the years 2000 -2011 and will provide the basis for future year call volume projections. Figure 31 Experienced EMS Call Volume /2000 -2011 12,000 -- r- -r - -r- r- r-- r-- r-- r-- r - -r -- 10'489-- 1- -, - -, - ,-- , - -,14, 19 1 1 1 1 1 1 1 1 1 1 1 I I I I I I I 1 1 1 1 1 1 1 1 1 1 1 1 1 1 11 10,040 -- r- -r - - -- -r - r-- r-- r-- r- -r - -r- I - -r - -I - �-- �---- - - - - -- I-- �-- � - -� - -; 1 I I I I I I I I 1 I I I I I I I I 1 1 1 1 1 I I I I I 1 1 J69:g, X311 11 I 9, I 1 B Doti _____L__ ___ 1___ 11 11 r�L__L .L 1__1 1__1__1__1__1__1__1__1 7 1 1 I 1 I I 1 1 1 - -I - -1 I - -I I I I 1 I I I I 1 1 1 1 I I I I I I 1 I I I I I 1 1 1 I I I I 1 1 1 1 1 I I I I I 1 I I I I I 1 1 I I I I I I 1 1 1 I I I I I I 1 I I I I I 1 1 1 I I I I I 1 I 1 1 1 I I I I I I I I I I I 1 1 1 I I I I I 1 1 1 1 1 I I I I 1 I I I I I 1 1 1 I I I I I 1 I 1 1 I I I I I 1 1 I I I I I 1 I I I I I I 1 1 1 I I 1 I I I 1 1 I I I I 1 1 1 I 1 I I 1 1 I 1 1 I I I I I I 1 I I I I I 1 1 1 I I I I I 1 1 1 1 I I I I I 1 I I I I I 1 1 I I I I I I 1 I 1 I I I I I I 1 I I I I I 1 1 1 I I I I I 1 1 1 I I I I I I 1 I I I I I 1 1 1 I I I I 1 1 4,000 1 1 1 I I I I I 1 I I I I I 1 1 I I I I I 1 1 • 1 1 I I I I I I 1 I I I I I 1 1 I I I I I I 1 2,000 _I I 1 1 I I I 1 I I I 1 I I I I I 1 1 1 I I I I 1 I 1 1 1 1 I I I I 1 1 I I I I I 1 1 I I I I I 1 I 1 1 1 I I I I 1 I I I I I 1 t I 1 I 1 I I 1 • 101 ^' rya °� Figure 32 Annual EMS Calls per 1,000 Population /2000 -2011 lqb - - - r - ,--i- -r r r-- T-- , - --1- 1 1 1 1 1 1 I 1 1 1 1 1 I 1 1 1 I 1 1 I 1 1 1 1 1 1 1 1 1 ' ' ' ' $k) I I 1 I I y7 I I 1 I I 1 I 1 I 1 I �1 so -- - ,--- I 1 1 I - - -r- 1 1 -7# 1 1 -; X5__1 - 1 1 - -- - - 1- I 1 1 - - 1 1 =- T,6 r 1 -' -- �4 I I - -, - -L--:- -- 70 1 1 1 I I 1 I I 1 1 1 1 I 1 I 1 1 I 1 I I I I 1 I I I I 1 I I I 1 I 1 I I I I I• I I I I I I I I I 1 I I I I I I I I I I I 60 I I 1 I I I I 1 I I I 1 I I I I I 1 1 I 1 1 1 I 1 1 I I 1 I I 1 I I 1 I 1 1 1 1 1 1 1 I 1 1 �0 I I I _ I I 1 - r-- t-- ---- I 1 1 I I 1 1 r-- r-- 1 1 I I 1 1 r-- 1-- 1 1 I I 1 1 �-- �--- 1 I I I 1 1 r-- r-- I I I I 1 1 T I I I I 1 1 - - - - r-- 1 1 I 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 r- - r -- i - - - - I- - - r -- r - -� - -- 1 1 I I I 1 1 1 I I I I I I I I 1 I I 1 I I I I I 1 I 1 I I I I I 1 I I I I I I 1 I I I 1 1 1 1 1 I I I 1 1 1 1 1 I 1 I 1 1 1 1 I I I I 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 I I I I 1 I I I • I 1 I 1 I I I 30 I I I ----- ' - -' - I 1 1 I 1 -' --'---'---'--'--'---'---'---'--'--'---'---'---1--'--'--'---'--- 1 1 I 1 I I 1 I I 1 1 I 1 1 1 I 1 1 I I 1 1 I 1 I I I I 1 I -- - -- 1 1 1 1 I 1 1 1 20 I 1 1 1 __t__ y__ y___ I I 1 I I 1 I I r__ r__ I 1 I 1 I I r__ y__ I I I I I I y__ y___ I I I I I I r__ r__ I I I I I I 1 i__ y__y___ I I 1 I I I I I I I I I I 1 I I I I I 1 I 1 1 1 1 1 1 I I I I I 1 I 10 I I 1 I I I I 1 I 1 I I 1 1 1 I 1 1 I I 1 1 1 I 1 1 I I 1 1 I I I I 1 I 1 I 1 1 1 1 1 1 1 1 I 1 1 1 1 I 1 1 I I I I I I 1 1 1 1 I I 1 1 1 1 1 1 q .60 40 40 AP Solutions for Local Government, Inc. 56 Comprehensive Assessment of Emergency Medical Services 101 and 911 /Communications Center Operations Study The methodologies used to project future needs; whether people, workload, or in this instance EMS call volume; will typically involve an examination of recent year trends of those same characteristics. Today of course the application of technology and various software programs are available as well; all of which also, however, will typically require historical data to feed their formulas. Subsequently, the starting point for these calculations will be the experienced (known) annual EMS call volumes for 2000 -2011 and noted in Figure 31, together with the annual County populations as documented by the North Carolina Office of Budget & Management for the same years. Between 2000 (116,106) and 2011 (135,776) the County's population increased 16.9 percent. Between 2000 (9,231) and 2011 (10,719) the County's annual EMS call volume increased 16.1 percent. While the County's total annual population figures are important, the correlation of the number of EMS calls per unit of population served; in this case the number of calls per 1,000 residents; is the variable that will be incorporated into the calculations of future annual EMS call volumes; Figure 34. As illustrated in Figure 32 the number of EMS calls per 1,000 residents of course varied from year -to- year. The ratio increased during eight (8) different years and decreased during three (3) different years. In this case the average annual change in the ratio of EMS calls /1,000 was + 3 /10ths of 1 %. This ratio was the applied to the projected future annual populations, the results of which are identified here. Figure 33 Projected Annual EMS Calls /1,000 County Population /2012 -2032 88 - -- ... - =- 1 '1-7-r-r-i -I-�-Y-r-r-i-r I � � -r -i - r�-Y-r-r-r-I-�-7-Y-Y-r-r-1 r 1 r- r- r -1 --i-i 1I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I 1 1 I 1 1 1 1 I I I I 1 1 1 i l 1 l l l l i I I I I I I I I I I I I 1 I I I I I I I I I 1 1 1 1 1 1 1 1 l l l l l l 1 1 I I I I I I I 1 I I 1 I 1 1 1 1 1 1 1 1 1 1 l 1 1 1 1 1 I I 1 1 1 1 1 P6: 6 86 I I I I I I I I I I I -1-1. 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I I I I I I 84 _ I_ J_ J_ 1_ L_L_I_J_J_1_1_L_L_I_J_J_1_1_L_L I I I I I I I I I I _I_Jy.�I,41 �L3-L_I_!_J_ I I l I l l l 1 1 _ _ _I_J_1_1_L_L _I_J_J I 1 I I I I r I I 1 I I 1 1 1 1 1 1 1 1 1 1 1 I I I I I I I I I I 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 i $� I I I I 1 1 1 1 8�2 I I 1 1 1 1 1 E2 I 1 I I I I 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 I� �2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 82 I I I I 1 1 1 1 1 i I 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 CI I I I I I I 11Q11 I I I I Q 1 1 1 so I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I 1 1 I 1 1 I 1 1 1 1 I I I I I I I I so I I I I I I I I I I I I I I I 1 1 I I I I I I I I I I I I I 1 1 I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I l I l 1 78 /P I I 1 1 1 I 1 1 I I I I 1 I 1 I I I I 1 I I - 1_ 4_4 _4 _ 4_ i_ 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 I I I I I I I I I I I I I I I I I I I I I I I 1 I I I I 1 I I I I I 4_ 4 _ F _4_H_I_4_4 _ 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 I I I 1 I I I I I I I I I I I I I I 1 I 1 I I 1 I 1 I I I I 1 I I I I 1 4_1 _4_1 _H _I_1_4 _4_F_F 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 76 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 I I I 1 I I 1 I 1 ITI - Y- Y- rt- t- r- 1- Y- Y- 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 I I I I 1 I 1 I I 1 I I I I 1 Y-♦•- h- h- 1- Y-- 1- Y- Y- f- rY- Y- Y- �- 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 I 1 I I 1 I 1 I h- r- I- Y- Y- rt- 1•- F-t- 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 I I 1 I I- y- Y- ♦--h -h -1 -Y I I I I I I I I I 1 1 1 1 1 1 I I I I I I I I I I I I I I I I I I I I I 1 1 1 1 7 IT TO$ le Isp Solutions for Local Government, Inc. 57 Comprehensive Assessment of Emergency Medical Services 102 and 911 /Communications Center Operations Study Now, of course, knowing the future year EMS call /1,000 population ratios and the projected annual County populations for 2012 -2032 per Figure 29; future year EMS call volumes can be calculated. The results are as follows: Figure 34 Projected Annual EMS Call Volumes /2012 -2032 16,000 � -r -1- - Y-r -1- - T - . . . I -f- . - . . �--T - ; - - ON IMF } k a ♦ } a a a � • III! pill at a4 a4 Figure 35 Projection Summary Factor 2012 % Change 2022 % Change 2032 Co. Population 137,760 14.4% 157,588 12.6% 177,418 EMS Calls 10,913 18.5% 12,927 16.6% 15,071 When tracked over the years to come the numbers certainly will not fall into a straight line and at times may vary considerably. In all likelihood, however, the most significant indicator in the years ahead will be the County's general population and its subsequent demographic sub - groups. As an example, one of those demographic subgroups very likely to have an impact are those in the age group bracket of 65 and over. According to the North Carolina Office of Budget & Management's demographics section the projected numbers are as follows: Age Group 65 yrs. & older -2012 Age Group 65 yrs. & older -2032 10.6% of County's Population 18.2% of County's Population Age Group's Total Increase: 121% Solutions for Local Government, Inc. 58 When tracked over the years to come the numbers certainly will not fall into a straight line and at times may vary considerably. In all likelihood, however, the most significant indicator in the years ahead will be the County's general population and its subsequent demographic sub - groups. As an example, one of those demographic subgroups very likely to have an impact are those in the age group bracket of 65 and over. According to the North Carolina Office of Budget & Management's demographics section the projected numbers are as follows: Age Group 65 yrs. & older -2012 Age Group 65 yrs. & older -2032 10.6% of County's Population 18.2% of County's Population Age Group's Total Increase: 121% Solutions for Local Government, Inc. 58 Comprehensive Assessment of Emergency Medical Services 103 and 911 /Communications Center Operations Study 4.1 HISTORICAL & STATUTORY REFERENCES Emergency communications in the mind of both citizens and public safety professionals is synonymous with "911 "; the number dialed in an emergency. Since this concept deals essentially with telephone communications, the federal government, particularly the Federal Communications Commission (FCC) has played a significant role in its development. In 1967 the President's Commission on Law Enforcement and the Administration of Justice recommended that a "single number" be established for nationwide use to report emergency situations. On March 22, 1974, the Office of Telecommunications Policy issued National Policy Bulletin Number 73 -1, the National Policy for Emergency Telephone Number 911 ". This policy stated that: 1. It is the place of the Federal Government to encourage local authorities to adopt and establish 911 emergency telephone services in all metropolitan areas, and throughout the United States. 2. Responsibility for the establishment of 911 services should reside with the local government. 3. The cost for basic 911 service should not be a deterrent to its establishment [Paragraph 3(c)] By 1996 cellular and commercial mobile telephone service had become so popular and widespread that the FCC issued a report (CC Docket No. 94 -102; July 26, 1996) calling for the requirement that 911 service be available to wireless phone users in two phases; phase I would provide calling party's number and cell tower location; phase II would provide calling party's number and location of the mobile phone by latitude and longitude. The Wireless Communications and Public Safety Act of 1999 was subsequently signed by the President on October 26th, of that year. North Carolina Public Safety Telephone Act In 1989 the North Carolina General Assembly passed the Public Safety Telephone Act recognizing 911 as a toll free number through which an individual in the State can gain rapid, direct access to public safety aid. The Act became law as North Carolina General Statute Chapter 62A. Local governments were to set a rate and collect a 911 service fee to pay eligible costs associated with providing that direct access to Public Safety Answering Points (PSAP). When wireless phones became popular, they did not fit the wireline model for providing location information, so in 1998 the Legislature adopted NC Senate Bill 1242 providing for a 911 Wireless Fund and creation of the Wireless 911 Board. This bill defined the composition of the fund and the requirements for participation. It became law as Article 2 of §62A. During the 2007 legislative session House Bill 1755 was introduced "to modernize and improve the administration of the State's 911 system through a statewide 911 Board by ensuring that all voice services contribute to the 911 system and by providing parity in the quality of service and the level of 911 charges across voice communications service providers." The bill was passed as Session Law 2007- 383, and took effect January 1, 2008. It requires all voice communications service providers to collect a single rate 911 service fee and remit collections to the State 911 Board rather than to the local governments. The State 911 Board distributes funds to the PSAPs based upon criteria set forth in the new law. Solutions for Local Government, Inc. 59 Comprehensive Assessment of Emergency Medical Services 104 and 911 /Communications Center Operations Study The duties and responsibilities of the 911 Board are significant. While GS 62A -42 appears to emphasize the Board's duties regarding the collection, management and distribution of 911 funds, an additional, long overdue, and very important responsibility of the Board is the establishment of performance, reporting, operational, and technical capability standards for all certified Communications Centers (PSAP's) throughout the State. At this time, the standards are expected to go into effect in January 2014. A draft of those standards as they currently exist is included in the Appendix of this report. As well, a major initiative, underway since February 2012, is the provision to each County and established PSAP in the State, the installation of "Emergency Call Tracking System" (ECaTS)" capabilities which is expected to greatly enhance , make uniform, and formalize the complex tasks of collecting, reporting and managing 911 call statistics. 2.1.2 62A -42. Powers and duties of the 911 Board. (a) Duties. — The 911 Board has the following powers and duties: (1) To develop the 911 State Plan. In developing and updating the plan, the 911 Board must monitor trends in voice communications service technology and in enhanced 911 service technology, investigate and incorporate GIS mapping and other resources into the plan, and formulate strategies for the efficient and effective delivery of enhanced 911 service. (2) To administer the 911 Fund and the monthly 911 service charge authorized by G.S. 62A -43. (3) To distribute revenue in the 911 Fund to CMRS providers and PSAPs in accordance with this Article and advise CMRS providers and PSAPs of the requirements for receiving a distribution from the 911 Fund. (4) To establish policies and procedures to fund advisory services and training for PSAPs, to set operating standards for PSAPs, and to provide funds in accordance with these policies, procedures, and standards. (5) To investigate the revenues and expenditures associated with the operation of a PSAP to ensure compliance with restrictions on the use of amounts distributed from the 911 Fund. (6) To make and enter into contracts and agreements necessary or incidental to the performance of its powers and duties under this Article and to use revenue available to the 911 Board under G.S. 62A -44 for administrative expenses to pay its obligations under the contracts and agreements. (6a) To use funds available to the 911 Board under G.S. 62 -47 to pay its obligations incurred for statewide 911 projects. (7) To accept gifts, grants, or other money for the 911 Fund. (8) To undertake its duties in a manner that is competitively and technologically neutral as to all voice communications service providers. (8a) To design, create, or acquire printed or web based public education materials regarding the proper use of 911. (9) To adopt rules to implement this Article. This authority does not include the regulation of any enhanced 911 service, such as the establishment of technical standards for telecommunications service providers to deliver 911 voice and data. (10) To take other necessary and proper action to implement the provisions of this Article. Solutions for Local Government, Inc. 60 Comprehensive Assessment of Emergency Medical Services 105 and 911 /Communications Center Operations Study 4.2 EXISTING CONDITIONS Orange County's emergency services network, which includes virtually all of the public safety agencies operating in the County, could not exist; i.e. could not begin to approach the general public's expectations of it, without a sophisticated emergency communications system. While there is no doubt that much credit is due the many Fire, Rescue, EMS, and Law Enforcement personnel that respond with special vehicles, skills, and equipment to the scenes of countless reported emergencies, it is the actual reporting of those emergencies which gets everything started. In this instance, the County's Communications Center; or "911 Center" as it is often called; is an operational component of the Orange County Emergency Services Department. It is located on the upper level of the Department's headquarters facility at 510 Meadowlands Drive in Hillsborough, together with the offices of the Emergency Services Director, EMS Administration, Planning & Logistics, and Life Safety Divisions of the Emergency Serviced Department. The personnel who work in the Center are of course employees of the County. In the professional terminology of the communications industry, the Communications Center is referred to as the primary public safety answering point, or PSAP, for emergency communications in Orange County. On duty personnel receive, handle and dispatch calls for Fire, Rescue, Emergency Medical Services (EMS), and Law Enforcement throughout Orange County. While generally referred to as "dispatchers" the position classification of the employees who work within the Center answering and dispatching calls is "Telecom municator ". During the period of the study, the Center was staffed with four (4) 12 -hour shifts, each having five (5) assigned Telecom municators. The variance in the number of staff on duty at one time, and the Center having to frequently work "short" was most frequently due to staff illness, vacation, approved personal leave, off - site training, or position vacancies. The Process The essential functions involved in the emergency communications process are illustrated in the diagram that follows (Figure 36). The time intervals identified as 'a', 'b', 'c', and 'd' represent significant activity periods identified for the purposes of this study, particularly with regards to performance. In real life these activities will vary somewhat from call to call and certainly from service to service. The involvement of Communications Center staff will also vary depending upon the type of call or emergency initially reported and the number of units or agencies dispatched. In some instances, the Telecom municator may terminate the call when the dispatched agency has been notified, or when they respond via radio "on- scene ", in others they will continue to monitor and communicate as necessary with some or all of the units /agencies responding to the emergency for the duration of the call; i.e. until the responding units are "back in service ". The diagram will be repeated later in the report with additional information regarding the Center's performance relative the specific time intervals. Solutions for Local Government, Inc. 61 Comprehensive Assessment of Emergency Medical Services 106 and 911 /Communications Center Operations Study Figure 36 The Emergency Communications Process F I ® F CT D No. G -► 1 1 CHUTE + TRAVEL TIME TIME 'a' Ring -to -Call Taker (CT) Answers I 'b' CT Answer -to- Dispatch 'c' Announcement /Tone to "Vehicle Moving' (VM) 'd' Emergency Unit Travel Time Unit Arrives "RESPONSE TIME" The significant activities illustrated and undertaken by Communications Center staff include: 1. The telephone is answered in the Communications Center (now) by a Telecommunicator who: ■ Follows initial question protocols; verification of address, phone number, immediate circumstances, etc. and either; • Determines that the emergency is a significant event requiring that a Fire, Rescue, EMS, or law enforcement agency or unit be dispatched, Or • Determines that the call is not an emergency, is a duplicate call, or is one describing an incident already reported, and terminates call. 2. The call is dispatched ■ The dispatch is official once the "tone" or page has been sent and the announcement has been made via radio in the station or vehicle of the service agency to be assigned the call; this announcement of course will include the initial incident description, victim information, reported status /condition, and address. ■ A Telecom municator may maintain communications with units dispatched and responding to the reported incident via radio (versus telephone) oftentimes for indeterminate periods until the full extent and nature of the incident can be personally observed by the responders and the need for additional resources, personnel or information is determined. 3. During calls involving medical emergencies a significant responsibility of the Telecom municator continues after the call has been dispatched, and relates specifically to "emergency medical dispatch" (EMD) protocols. In this instance the Telecom municator will remain on the line with the caller to obtain as much additional patient /victim information as possible as they will then (oftentimes) simultaneously and continuously alert the responding Paramedics as to patient condition, physical characteristics, scene circumstances, etc.; and as appropriate provide First -aid instructions to the caller in an effort to help the victim; i.e., "emergency medical dispatch ". Solutions for Local Government, Inc. 62 Comprehensive Assessment of Emergency Medical Services 107 and 911 /Communications Center Operations Study Emergency Medical Dispatch (EMD) Orange County is a licensee of the National Academies of Emergency Dispatch (NAED) "ProQA" automated emergency medical dispatch program. NAED's EMD standard medical protocols are the accepted national standard for EMD providers. EMD is based on the premise that a fire engine or ambulance does not have to be the first unit on the scene of a medical emergency. Once a caller reaches a Telecom municator, that Telecom municator can, almost immediately, begin providing medical information and pre - arrival instructions via phone. Subsequently, EMD consists of three key components: First, is triaging the in- coming call request for medical assistance to determine the level of response required; i.e., no response, non - emergency transport, emergency transport. Second, is providing pre - arrival instructions so the caller can immediately help the victim. The level of telephone assistance can vary from just simple advice to complete instructions for CPR. This is the most visible component of EMD and, in the eyes of some, its most valuable feature in that it can very well save a life. Pre - arrival instructions are based on the concept that Telecom municators are the victim's first medical contact and can provide basic first -aid via telephone, by asking specific questions and giving the caller instructions. The questions and instructions - "protocols" in medical parlance -are predetermined, given in a structured sequence, and specially designed to be effective when given to a third party over the telephone. The intended result is a dramatic decrease in the time it takes to begin administering emergency care. Third, and perhaps the most critical feature of EMD, is quality assurance. State law requires that each EMD program -and each aspect of the EMD protocol -must be reviewed, revised as needed and approved by the local or regional EMS agency; in Orange County, that authority is the Medical Director; a licensed physician. This ensures that the information and procedures being given by the dispatchers is correct, and appropriate for the incident. In addition, there must be an on -going review of the use of EMD protocols by Communications Center Telecommunicators to ensure that the protocols are continually followed correctly, and that application of the protocols contributes to a positive patient outcome. Call Codes In their communications regarding medical emergencies, Telecom municators will utilize call codes in radio communications with responding agencies to indicate both the severity of the situation reported and the associated level of response; i.e. emergency, or non - emergency. The codes utilized are those approved by the National Academy of Emergency Medical Dispatch (NAEMD) and range from the least severe; i.e. not life threatening: ALPHA; to the most severe; i.e. "circling the drain ": ECHO, which calls for an "all units" emergency status response. The table that follows identifies the Condition Identified, Agency /Unit, and Response Status protocols for each of the five Response Codes. Solutions for Local Government, Inc. 63 Comprehensive Assessment of Emergency Medical Services 108 and 911 /Communications Center Operations Study Figure 37 Medical Dispatch Response Codes Response Code Condition Identified Agency /Unit Dispatched Response Status Non -life threatening, ALPHA Ambulance only Non - Emergency low priority assessed Non -life threatening, BRAVO Ambulance only Emergency but more serious First Responders Emergency CHARLIE Potentially life threatening Ambulance Non - Emergency* DELTA Life threatening All Units Emergency All Units; including ECHO Circling the drain Emergency Law Enforcement Note the asterisk ( *) next to "Non- Emergency" in the Response Status column in the CHARLIE row. In a potentially life threatening emergency, First Responders (typically the closest Fire Department) will be dispatched to respond with lights & siren; i.e. emergency status; while the ambulance (Medic Unit) will be dispatched at the same time, however, in non - emergency status... initially. The assumption being that First Responders, assumedly first on the scene, will be able to assess and confirm (or not) the level of severity of the patient's condition. If First Responders in fact confirm the condition to be life threatening, the Medic Unit will (typically) immediately upgrade to emergency status and respond accordingly. Should the condition be determined to not in fact be life threatening, the Medic Unit will, in most cases, continue on to the scene to confirm the condition of the patient and if necessary provide transportation to a medical facility. Note Regarding the Communications Process The above narrative explanation of Response Codes focuses on medical emergencies and EMS response; albeit the stated focus of this study. Of course Communications Center personnel must also deal with Fire and Law Enforcement emergencies on a daily basis as well. Subsequently, the Appendix of this report includes process maps outlining examples of the call processing, dispatch, and ongoing communications activities that will typically occur not only with EMS, but with Fire and Law Enforcement as well. Communications Center Staff The individuals who occupy the workstations or "consoles" in the County's Communications Center are classified as "Telecommunicators ". At present there is one (1) Shift Supervisor (Lieutenant), one (1) Lead Telecommunicator /Assistant Shift Supervisor (Sergeant), one (1) Communications Training Officer, and two (2) Telecom municators assigned to each shift. While the designated Supervisors will carry additional responsibilities, they are expected to handle them in addition to receiving, dispatching and monitoring 911 emergency and administrative calls received as the call volume dictates. In this and similar County facilities, the principal activities occurring on the call center floor are those directly involved with the processing of calls received. In this regard, while the position title "Telecommunicator" is totally appropriate, the functional responsibilities of the position may vary Solutions for Local Government, Inc. 64 Comprehensive Assessment of Emergency Medical Services 109 and 911 /Communications Center Operations Study somewhat between "call- taking" and "dispatching ", depending on the call volume occurring or whether the Communications Center is working "short ". ■ A Calltaker's primary responsibility is answering 911 and administrative calls coming into the Center, recording essential information in the computer aided dispatch (CAD) system, and (ideally) transmitting that information to a Telecommunicator. ■ A Telecommunicator's primary responsibility is to dispatch the call to the appropriate agency and handle on -going responding agency communications and radio traffic. In Orange County all Telecom municators have been trained and are certified as "Emergency Medical Dispatchers" or EMD's. During the course of this study, the Communications Center was operating with a total allocation of 30 full -time positions, plus the Communications Center Operations Manager. However, it should be noted that during that time eight of those positions were either vacant (4) or in training (4) and therefore unavailable for duty. Figure 38 illustrates the current organization and position designations. Figure 38 Orange County Communications Center Organization Operations Manager SHIFT #1 SHIFT #2 SHIFT #3 SHIFT #4 Shift I I Shift I I Shift I I Shift Supervisor Supervisor Supervisor Supervisor (Lieutenant) (Lieutenant) ( Lieu to nant) (Lieute nant) Lead Lead I Lead I I Lead I I Lead Telecommunicator Telecommunicator Telecommunicator Telecommunicator (Sergeant) (Sergeant) (Sergeant) (Sergeant) Communications I I Communications I I Communications I I Communications Training Officer Training Officer Training Officer Training Officer Telecommunicator I I Telecommunicator I I Telecommunicator I I Telecommunicator Telecommunicator Telecommunicator Telecommunicator Telecommunicator Solutions for Local Government, Inc. 65 Comprehensive Assessment of Emergency Medical Services 110 and 911 /Communications Center Operations Study Shift Schedules Communications Center employees currently work 12 hour shifts on a rotating "2 -days on, 2 -off, 3 -on, 2- Off, 2 -on, 3 -off" schedule. In addition to permanent employee salaries, annual budget allocations are also included for overtime and part -time employees to assure continuous coverage of the Center. Training & Certification The current formal classroom hours that an employee candidate must complete to work as a Telecom municator include the following: Figure 39 Telecommunicator Minimum Classroom Training Hours for Certification Certification /Training Hours North Carolina Sheriff's Training Standards Certification 47 North Carolina State Bureau of Investigation DCI Certification 24 Emergency Medical Dispatch (EMD) Certification 32 Communications Center Operations 160 Following successful completion of the training classes referenced, the candidate will begin work in the Communications Center under the supervision of the shift Communications Training Officer to whom they are assigned for a minimum of three (3) months before they are released to work independently. In addition to their initial certification, Telecom municators must maintain their certifications by participating in continuing education classes each year. For example; : NC Sheriff's Training & Standards @ 16 hours per year; NAED /EMD @ 24 hours every 2 years; and recently, the NC 911 Board has passed mandatory training of 16 hours per year for any agency that receives 911 funding. It is also mandated by Title II ADA 28 C.F.R. Part 35, that Centers (PSAP's) train on TTY /TDD calls twice a year. Call Volume & Distribution For the calendar years 2009 -2011, Communications Center records reflect that a total of 746,037 calls of all types were received; an average of 248,679 calls per year; on average, approximately 681 calls per day. These call totals are not all 911 /emergency calls, however. The total call numbers include what are referred to as Administrative calls as well as 911 /Emergency calls. Depending upon a jurisdiction's population, the number of service agencies and the geographic area served, Communications Centers such as Orange County's will generally find that anywhere from 55 -65 percent of all calls received are administrative calls; while 35 -45 percent are 911 /emergency calls. It must be recognized that administrative calls are a very important responsibility of the Telecom municators assigned to the Communications Center. While the calls may not be emergencies per se, they may be calls from law enforcement or first responders asking for back -up, assistance, or other information relevant their immediate incident or emergency. Of course from time to time calls are received that are duplicate calls or calls that have nothing to do with an emergency. The determination of a call's status alone is a significant responsibility. Examples of incoming "administrative" calls will include: • License tag checks • Inquiries regarding outstanding warrants • Request for information; directions, phone numbers, names, etc. Solutions for Local Government, Inc. 66 Comprehensive Assessment of Emergency Medical Services 111 and 911 /Communications Center Operations Study • Requests for assistance at a crime or accident scene • Duplicate calls • Nefarious or misplaced calls • Incoming administrative calls: • Alarms; i.e. fire, burglar, medical lifelines, etc. • Operator transferred calls (they can't connect calls to 911 - only to a ten digit number.) • Non - emergency calls which a citizen did not want to report on a 911 line. The following table identifies the total 911 /emergency and administrative calls received for each of the years 2009 -2011. Figure 40 Total Calls Received by Type 2009 -2011 300.000 ------------- � ------------- r------------ - ---------- --- r------------- -------- - - - - - i 258;222 261y049 245 ;582 250,000 ------ - - - - -- -- ----- - - - - -- ------------ --------- - - - - -, 200,000 --------- } r--------- 1}_________r ____________l_____________I 158;782 I 150,000 ____________ _____________ ________ ____ _____________1____________ I I _____________� 88,471 I I 88 066 =- 86 $00 100,000 --- -- --------- -------- - - - - -- ---- - - - - -- ------------ -I------------i------------- I I 501000 .!------------ J_____________ IL ____________ J__________ ___L____________J ------------- 1 I I 1 I 2409 2010 2011 —4-911 Calls —4—Admin. Calls —4—Total-All Calls For the 3 -year period addressed, the average annual 911 calls received was 88,186 and the average annual administrative calls received was 167,933; 34% and 66% respectively. Agencies Dispatched The agencies currently dispatched by the Orange County Communications Center include: Law Enforcement Orange County Sheriff's Department Chapel Hill Police Department Carrboro Police Department Hillsborough Police Department Medical Rescue Orange County EMS South Orange Rescue Squad Solutions for Local Government, Inc. 67 Fire Departments Caldwell Fire Department Carrboro Fire Department Chapel Hill Fire Department City of Carrboro Fire Department Cedar Grove Fire Department City of Chapel Hill Fire Department Efland Fire Department Comprehensive Assessment of Emergency Medical Services 112 and 911 /Communications Center Operations Study Eno Fire Department Hillsborough /Orange Rural Fire Department Mebane Fire Department New Hope Fire Department North Chatham Fire Department Orange Grove Fire Department White Cross Fire Department "Other" agencies that are listed to receive after -hour call -outs: NC Department of Transportation Orange County Public Works Animal Control Orange County Probation /Parole Utility Companies OCDSS /Child & Adult Services Distribution of Calls by Agency /Service Type Collecting, organizing, and assessing incoming call data received at the Communications Center becomes very important to not only the Communications Center but also to the various responding agencies and, ultimately the entities that are responsible for funding both the Communications Center as well as the various emergency services and public safety response agencies. For example, for responding fire, rescue, medical, and law enforcement agencies keeping track of where the calls came from and being able to plot or track the "patterns" of those high (and low) call areas can aid agency managers significantly when planning for the deployment of personnel and equipment throughout their respective jurisdictions and throughout the County generally. The total calls per year, by agency type; i.e. Law Enforcement, EMS, Fire and Other; were collected for the calendar years 2009- 2011 and averaged. The chart that follows illustrates the average annual distribution of these calls for the referenced 3 -year period. The breakdown of these calls is clear from the illustration. Figure 41 The actual percentages by agency type are as follows: Call Distribution by Agency Law Enforcement 87.3% EMS 8.4% Fire 4.2% Other .14% Distribution of Calls by Hour of Day When considering staffing requirements and the assignment of personnel, it is the call data itself and the processing of that data that becomes important. In this case, the distribution of incoming calls by "Hour of Day" is quite significant. The tracking of incoming calls by hour of day per year becomes critical when anticipating staff assignments ultimately not only to make sure that all emergency calls for assistance get answered, but that they also get answered quickly. Figure 42 illustrates the total calls received by hour of day for the calendar years 2009 -2011. Solutions for Local Government, Inc. 68 Comprehensive Assessment of Emergency Medical Services 113 and 911 /Communications Center Operations Study Figure 42 Call Rate per Hour of Day /Year 14,009 -t- r-t - rT- r-T - rT- r7 --q-r-i - ri- r-1-rl -r-1 -. 1 I . I I I I I I I I 2,586 12,000 ! 1 I I, I ,, 1, 1, I., 1 1, 1 Y I ! 1 1 1! ^,^ y 1; 1 F -1 1, 1 4 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1, 1 1 1 1 + . -1 4 -1 IrI 16,0011) 1 1 •1 � 1 1 1 1 1 1 1 1 1 1` I L I I 1�! I TI 1 1 1 1 1 1, 1 • 1 1 1, 1 1 1 1 I 1 1 • - 1 1 1 1 1 I I 1 1 80000 4000 ♦ ; , Busiest 12 -Hours ; 1 4,000 -~ - -Fi -Fi -F LJ -♦-a -M1 a -. - La -�J_I 1 1 1 1 1 1 1 1 1 I I I, I I( 1 1 1 1 1 1 1 1 1 1 1 1 1••• 1 1 1 1 1 1 X 1 1 1 1 1 r 1 1 1 1 1 1 1 1 1 1 r l r 1 1 1 1 1, 1 1 1 1 1! 1 1 1 1• -, I I I I I��/ I I Y X000 JAL 2 964 , LJ- �J- 41'LJ- �J- LJ- IJ.IJ.L� -4J -, LJ_rJ.IJ.� �LJ�L I I 1 1 1 I 1 1� 1 1 1 1 1 1 1 1, 1, 1 1 1• 11, 1, 1� 1 1 1 11 . ,11111 11111111,1,111 I. 11,111 .I I. YI 1,11111 1 111111,1 I ,lf.. . 1111 1 I 11111 11 Y 1 1 Ir 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 16 19 28 21 22 23 24 The "hour of day" is indicated along the bottom of the graph by the numbers "1" through "24 ". As an example, all calls received between 11:00 pm and Midnight are indicated on the vertical axis extending upward from "24 ". Based on these findings the lowest call volume per hour /year has consistently been between 4:00 am- 5:00 am (2,964 in 2011). The highest call volume per hour has consistently been between 5:00 pm -6:00 pm (12,586 in 2009 and 2010). Not surprisingly, the busiest 12 -hours of the day for the Communications Center is the same as that identified for EMS; 9:00 am -9:00 pm. For all 3 of the years considered, the call volume between 9:00 am -9:00 pm was never less than 8,000 calls per hour. Peak Hour Call Load Again, an important variable in calculating eventual staffing and subsequent work- load requirements is the total number of calls received during the busiest hour of the day. While the average peak call load per hour over the past three (3) years has been 200 calls or 3.3 calls /minute; the peak hour call load for the 36 months studied was 247 calls, a rate of 4.1 calls per minute. Figure 43 Peak Hour Call Load /Month Sao 247 237 233 250 220 226 219 199 197 203 204 204 202 200 ; -- -r ........•...I.. ; loo - F-- ;-- ;- -; - - -, -- F - -' --' ' ' - - -, I _, so 0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec t2009 — 2010 -x2011 Solutions for Local Government, Inc. 69 Comprehensive Assessment of Emergency Medical Services 114 and 911 /Communications Center Operations Study 4.3 PERFORMANCE & COSTS Ask the average citizen what they expect when they call 911 and they will inevitably say "they want help... FAST "! Ask them to think about it a minute or two and they might add that they want, "qualified personnel, with the proper equipment... FAST!" In either case, it is the end result; i.e., the arrival on scene and the effectiveness of the action taken that is what the average citizen will be most concerned with, and for obvious reasons. How well informed those actually responding to the incident are with regards to what to expect at the scene, or how effectively the emergency response process was implemented are less frequently considered outside of professional circles. A number of professional organizations offer significant commentary and /or specific, documented performance standards in which emergency communications plays some role. They include: • National Academy of Emergency Dispatch (NAED) • Association of Public- Safety Communications Officials (APCO) • National Emergency Number Association (NENA) • National Fire Protection Association (NFPA) • Insurance Services Organization (ISO) • Federal Communications Commission (FCC) • Federal Emergency Management Agency (FEMA) • Commission on Accreditation for Law Enforcement Agencies (CALEA) While the citizen is immediately concerned with how long it takes from the time they call 911 to the time the responding agency vehicle arrives on the scene, the emergency responder(s) will be concerned with the steps it will take to mobilize once they have received the dispatch, and the time it will take to travel to the scene of the emergency. Thus, making the process of answering the 911 call, obtaining the necessary information needed to initiate dispatch, and activating the dispatch itself as promptly and efficiently as possible, extremely important. Figure 44 is essentially the same as Figure 36, previously shown. In this case, however, with added emphasis as to who bears the responsibility for the various critical time intervals. Figure 44 Critical Emergency Communications & Response Intervals Communications Center Responsibility Responding Agency Responsibility 1 1 a I a I o ------ 00. G ------ 0. DO ------ 0. IS -------- 1 1 CHUTE + TRAVEL TIME TIME 'a' Ring -to -Call Taker (CT) Answers 'b' I CT Answer -to- Dispatch 'c' Announcement /Tone to "Vehicle Moving' (VM) 'd' Emergency Unit Travel Time Unit Arrives _ "RESPONSE TIME" Solutions for Local Government, Inc. 70 Comprehensive Assessment of Emergency Medical Services 115 and 911 /Communications Center Operations Study Time Interval 'a' = the time from first ring to answer Time Interval ' b' = the time from answer to dispatch Time Interval 'a' +'b' = The Communication Center's principal call taking and dispatch responsibilities, except: • When the responding agency requests that additional units, ambulances, or engine companies be dispatched to assist at a scene or, for assistance enroute with directions, for example, to the location of the incident. In these instances, communications with the Center will continue and be via radio versus the telephone; or, • A 911 call that is a medical emergency wherein the certified EMD Telecom municator will stay on the telephone with the caller after they have dispatched the ambulance to ask the caller a series of "medical condition" questions, based on established medical protocols, to identify the extent and circumstances of the injury or condition, that they in turn then can communicate to the EMS responders enroute while also proceeding to offer instructions to the caller to assist the victim; for example, CPR, "continue to apply pressure to the wound ", "keep them warm and still ", etc. In this instance the Telecom municators total "call time" may in fact include time intervals 'a' +'b' +'c' +'d' From the responding service agency's perspective the critical time interval for them becomes 'b'; based on the premise that they cannot begin to respond until they are notified of the incident. Why time is important The most elementary explanation of why time is important in a police, fire, or medical emergency has to do with the obvious; serious injury and /or the potential of loss of life and property. Of course not all 911 calls are going to be that serious. Also, the variety, type, and circumstances faced with a single service agency will vary considerably from call to call; even more so between those calls placed to police, fire, and emergency medical services. Of course too, the agency or service must be prepared to address the most serious scenario each time they are dispatched. Critical of course, and a factor that neither dispatchers nor responders can do anything about, is the time between when an event actually "begins" and the time it is reported or 911 is dialed. For example, the time between the fire actually starting and the time it is discovered and reported, the length of time an individual had not been breathing before being discovered, or the delay between a crime occurring and it being discovered and reported. Additional factors that can impact the time it takes the call -taker between answering the call and dispatching it include: • The state of mind or hysteria of the caller • A "silent" call - wherein TTY /TDD is attempted, however questioning can only begin if there is a response • Non - English speaking or speech impaired calls Solutions for Local Government, Inc. 71 Comprehensive Assessment of Emergency Medical Services 116 and 911 /Communications Center Operations Study Police While a great deal has been written with regards to law enforcement response times there is no identifiable time standard with which to judge performance or efficiency using only time as a basis. Urban or rural setting, nature of the offense, method of notification and personnel and equipment availability only begin to describe the variables that will inevitably effect police response time to an emergency situation to which they are called. "Ideally, if the police are notified as a crime is in progress, they have a good chance to arrive before the perpetrators leave the scene. If police do not arrive at the scene within a few minutes, but still arrive while witnesses remain and are able to talk with them while the crime is still fresh in their memory, then they have a high probability of being able to solve the crime ". (NENA; 911 System Survey and Resource Guide; 2002) Fire The National Fire Protection Agency (NFPA) states that if a fire is not suppressed in eight to 10 minutes from the time of ignition, it will flashover, spreading outside the initial area or room of origin. "As a rule of thumb, first responders should arrive on the scene in less than five minutes, 90% of the time." (National Institutes of Health) "The fire department shall establish a response time objective ... of four minutes or less for the arrival of the first arriving engine company at a fire suppression incident, for not less than 90% of all incidents" [NFPA Standard 1710 for the Organization and Deployment of Fire Suppression Operations; Section 4.1.3.1.1.]. Note that "response time" in this standard is expressed as the time from "wheels are rolling" to "wheels stopped" at the scene. Medical The same NFPA Standard (1710) also states that "deployment objectives for the first responder /AED level to arrive within four minutes for 90% of all calls ". "For cardiac arrest, the highest hospital discharge rate has been achieved in patients for whom CPR was initiated within 4 minutes of arrest and advanced cardiac life support within 8 minutes ". (American Heart Association) In an incident involving lack of oxygen, brain damage is very likely at 6 -10 minutes; irreversible after 10 minutes. (American Association of Orthopedic Surgeons) Emergency Communications The aforementioned NENA publication, 911 System Survey and Resource Guide states that: "An important unit of measurement for primary public safety answering points (PSAP's) is average call length. Calltakers and dispatchers must try to minimize call length while at the same time processing all of the information required to dispatch a call." The study found that the average call length decreased as PSAP size increased. Average call length was 91 seconds for emergency calls in small PSAP's, 74 seconds for medium PSAP's and 66 seconds for large PSAP's, as defined in the survey. Solutions for Local Government, Inc. 72 Comprehensive Assessment of Emergency Medical Services 117 and 911 /Communications Center Operations Study The National Fire Protection Association's (NFPA) Standard 1221, Section 7.4.1 states; ""Ninety-five percent of alarms (911 calls) received on emergency lines shall be answered within 15 seconds, and 99 percent of alarms shall be answered within 40 seconds ". Further, NFPA Standard 1221, Section 7.4.2 states; ""Ninety-five percent of emergency call processing and dispatching shall be completed within 60 seconds, and 99 percent of call processing and dispatching shall be completed within 90 seconds ". Based upon the time standards suggested, and with reference to the time intervals identified in the Call Process diagram, the most important performance criteria were determined to be "first ring -to- answer" (time interval 'a'), "answer -to- dispatch" (time interval 'b') and the total Communications Center "response time" which was the combination of time interval 'a' plus time interval V. The results of these analyses are included in the tables that follow. The Communications Center's telephone vendor allows access to the active data base which records and stores all incoming call times, first ring -to answer, and call duration. The first report generated, "Call Count per Range ", identified the range in seconds from first ring to call answer for all incoming 911 calls. Figure 45 identifies the number of 911 calls received per month during 2011 and the range of time in seconds it took to answer those calls. Subsequently, 94.8% of all incoming calls were answered within 7 seconds and 99.5% of all calls were answered within 14 seconds not only compatible but well within the referenced NFPA standards. Figure 45 First Ring -to- Answer Times /Annual 911 Calls (2011) Month #911 0 -7 sec. 7 -14 sec. < 15 sec. January 6,472 90.3% 8.6% 98.9% February 6,376 88.8% 9.8% 98.6% March 6,989 95.9% 3.8% 99.7% April 7,343 96.0% 3.6% 99.6% May 7,507 96.2% 3.7% 99.9% June 7,261 95.3% 4.2% 99.5% July 7,275 96.1% 3.6% 99.7% August 7,714 96.0% 3.7% 99.7% September 7,586 96.2% 3.5% 99.7% October 7,750 95.6% 4.1% 99.7% November 7,376 95.6% 4.0% 99.6% December 7,201 96.1% 3.7% 99.8% Total Answered 86,850 Total Avg. @ 99.5% The same data base was able to provide individual monthly average Call Answer -to -Call Termination times for all incoming 911 calls. Figure 46 Average Call Answer -to -Call Termination /Month & Year - 2009 -2011 Year Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Ann. Avg. 2009 0:01:43 0:01:44 0:01:44 0:01:48 0:01:44 0:01:44 0:01:40 0:01:39 0:01:42 0:01:40 0:01:45 0:01:47 0:01:43 2010 0:01:40 0:01:44 0:01:42 0:01:43 0:01:42 0:01:41 0:01:46 0:01:42 0:01:42 0:01:46 0:01:48 0:01:47 0:01:44 2011 0:01:49 0:01:41 0:01:41 0:01:38 0:01:33 0:01:38 0:01:37 0:01:35 0:01:37 0:01:35 0:01:37 0:01:35 0:01:38 Solutions for Local Government, Inc. 73 Comprehensive Assessment of Emergency Medical Services 118 and 911 /Communications Center Operations Study The average annual Call Answer -to -Call Termination times ranged from a low of 01:38 (98 seconds) in 2011 to a high of 01:44 (104 seconds) during 2010. Keep in mind; however, this is telephone Call Answer -to -Call Termination time with the 911 caller. It is not the Call Answer -to- Dispatch time referenced for which time interval standards have been established. Emergency response agencies are dispatched via radio, not by telephone. Subsequently as is often the case, the Telecom municator may in fact dispatch the response agency while on the phone with the caller before, or sometimes well before, they terminate the conversation with the caller; in which case the call answer -to- dispatch time may be less than the Call Answer -to -Call Termination time; which then might suggest that the Call Answer -to- Dispatch interval objectives suggested were achieved. Figure 47 Call Answer -to -Call Dispatch Call Answer -to- Dispatch Times The sub - section that follows briefly addresses the data issues encountered during the conduct of this study. Despite repeated efforts by Emergency Services personnel, this specific time interval (Call Answer -to- Dispatch) proved the most elusive in terms of the data available and its reliability; i.e. lack of reliability. This table represents the latest effort to retrieve this data Not only are the Year 50% 90% 2009 0:00:55 0:03:00 2010 0:00:56 0:02:54 2011 0:00:53 0:02:42 times excessive, they are 2 -2 1/2 times what the referenced performance standards suggest that they should be. In lay terms, the problem appears to be an issue of how the incoming calls are coded and the current CAD system's capabilities to (or not) sort 911 calls from all calls. Many hours of monitoring Communications Center activity via radio and in the Center itself has demonstrated repeatedly that 911 calls ore being dispatched in far less than the 2 -3 minutes indicated in Figure 47. Considering the County's recent approval to purchase new CAD system software, and its (hopefully) expedient arrival and installation, it was determined that further efforts by staff to assess this issue would be non- productive. The Data The availability of and accessibility to useable data from the Communications Centers CAD system was a concern expressed from the very outset of this study by the County itself. Typically a jurisdiction's 911 Center's Computer Aided Dispatch (CAD) data base serves as the foundation of useable emergency call and response data for any and all emergency service agencies, and system managers and is the basis upon which they base performance assessments, resource deployment, staffing, and budget decisions. The data must be easily accessible, up to date, user (especially service agency) friendly, and its accuracy; i.e. reliability; assured. This was not found to be the case in Orange County. Why? For one, the CAD system currently in place was originally purchased and installed in 1992. Many "patches" and "parts" have reportedly been added since that time. The fact remains that the technology used for collecting and analyzing emergency services call and incident response data is twenty (20) years old! While Emergency Services staff labored repeatedly to access, reformat if necessary, interpret and make countless runs of data fields to get to the information required for this study, the efforts should not have had to take the time it did had the system been even modestly up to date. Solutions for Local Government, Inc. 74 Comprehensive Assessment of Emergency Medical Services 119 and 911 /Communications Center Operations Study The good news is that the County has recently (June 2012) approved the purchase of new Communications Center CAD technology and accompanying software which, by all reports, will offer a vast improvement for not only the Communications Center but also the emergency services agencies that respond to the emergency alarms to which they are called. Expenses & Revenue Figure 48 identifies the total ( "actual ") annual budgets of the Communications Center for fiscal years 2008 -2009 through 2011 -2012. Not, unexpectedly, the major percentage of the total Communications budget for these years was personnel; which averaged 91.3% of the total annual budget. it is significant to note, and should signal concern, that the expense category "Training" averaged but 9 110ths of one percent per year, of the total annual budget allocations, for the past three years. Figure 48 Annual Communications Expenditures /FY 2008 -2011 Solutions for Local Government, Inc. 75 FY 2008 -09 FY 2009 -10 FY 2010 -11 FY 2011 -12 Account Actuals Actuals Actuals Actuals PERSONNEL SERVICES PERM SALS $ 1,162,148 $ 1,137,277 $ 1,041,197 $ 1,039,840 OT $ 121,819 $ 117,000 $ 76,995 $ 130,883 TEMP $ 11,420 $ 22,128 $ 32,816 $ 13,237 HOLIDAY $ 54,001 $ 52,718 $ 52,657 $ 56,482 SOC SEC $ 82,788 $ 80,994 $ 73,487 $ 75,903 MEDICARE $ 19,362 $ 18,942 $ 17,187 $ 17,751 MED INS $ 178,809 $ 177,453 $ 173,620 $ 186,475 RETIRE $ 66,426 $ 63,044 $ 76,783 $ 86,729 PERS -OTHER $ 51,590 $ 32,004 $ 33,444 $ 55,574 SUBTOTAL - PERSONNEL SERVICES $ 1,748,363 $ 1,701,560 $ 1,578,187 $ 1,662,873 OPERATIONS TRAINING $ 584 $ 2,100 $ 764 $ 1,950 CERT &LICSN $ 700 $ 1,520 $ 1,452 $ 918 TELEPHONE $ 96,519 $ 108,722 $ 69,714 $ 59,477 MOTOR POOL $ 158 $ 450 $ - $ - EQUIP RPR $ 54,127 $ 34,285 $ 35,003 $ 39,644 EQUP RENT $ 6,039 $ 13,997 $ 2,151 $ 5,400 DUPLICATIN $ 423 $ 423 $ - $ - DUES $ 1,685 $ 1,012 $ 2,074 $ 1,575 CONT SVS $ 2,021 $ 22,210 $ 587 $ 1,230 SUP- DEPT,ED,OFF,COMP,OTH $ 5,315 $ 4,067 $ 24,096 $ 5,216 OP -OTHER $ 5,422 $ 5,819 $ (10) $ (190) SUBTOTAL - OPERATIONS $ 172,993 $ 194,605 $ 135,831 $ 115,219 RECURRING CAPITAL EQUIPMNT $ 19,068 $ - $ - $ - IT EQUIP $ - $ - $ - $ - FURNISH $ - $ 2,658 $ - $ - SUBTOTAL- RECURRING CAPITAL $ 19,068 $ 2,658 $ - $ - TOTAL: COMMUNICATIONS $ 1,940,423 $ 1,898,823 $ 1,714,018 $ 1,778,092 Solutions for Local Government, Inc. 75 Comprehensive Assessment of Emergency Medical Services 120 and 911 /Communications Center Operations Study In North Carolina owners of cellular and land -line telephones are assessed a monthly "911 Service Fee ". These funds are collected by the State and /redistributed to the 128 certified PSAP's (Communications s Centers) in the State for specifically designated (allowable) purposes; i.e. typically technical or phone system equipment or upgrades within the Communications Center. The amounts received by Orange County as identified in the published annual budget summaries for FY 2008 -09 through 2011 -12 are identified here. Figure 49 Annual Budget & Surcharge Revenue Summary Fiscal Annual Surcharge Collections (Revenue) Year Budget Revenue as % of Budget FY 08 -09 $ 1,940,423 $ 659,799 34.0% FY 09 -10 $ 1,898,823 $ 658,184 34.7% FY 10 -11 $ 1,714,018 $ 657,050 38.3% FY 11 -12 $ 1,778,092 1 $ 506,348 28.5% 4.4 ISSUES OF CONCERN This section discusses the significant Communications Center issues of concern identified during the analyses of the various data collected, the visual study of conditions found to exist, and numerous conversations and formal interviews conducted over the course of the study. The determination of whether or not an "issue" was identified as such was based on the assessment of current operations and performance in discussed in Subsections 4.2 and 4.3 The issues identified as being of significant concern with regards to EMS involved the following topics; • Staffing • Data Operations Issue: Staffing Manager The current staffing configuration of the Communications Center consists of SHiF` #1 SHiFr #2 SHIFT #3 SHiFr #4 the Operations Manager and four (4) Shift Shift Shift Shift shifts of five (5) positions each; the supervisor supervisor supervisor [Supervisor 5th position (Telecommunicator) as of (Lieutenant) (Lieutenant) (Lieutenant) (Lieutenant) this writing is and has been in training for several weeks. Lead Lead Lead Lead Telecommunicator Telecommunicator Telecommunicator Telecommunicator Obviously, with the exception of (Sergeant) (sergeant) (sergeant) (Sergeant) the Operations Manager, each position currently is expected to be communications communications communications communications occupied 24 hours per day, 365 days Training Officer Training Officer Training Officer Training Officer per year by appropriately certified personnel. Telecommunicator Telecommunicator Telecommunicator Telecommunicator Relief Factor Since the Communications Center requires continuous coverage of Telecommunicator Telecommunicator Telecommunicator Telecommunicator Solutions for Local Government, Inc. 76 Comprehensive Assessment of Emergency Medical Services 121 and 911 /Communications Center Operations Study each designated post position, it is important that the number of people required to man each position be accurately determined. These coverage requirements are generally calculated using what is called a "Relief Factor ". The Relief Factor is the ratio between the number of hours a position is "open "; i.e., needs to be covered; and the number of hours of employee time required to fill that position during those open hours. Since the position must be filled each hour that it is open, additional employee time, or "relief" time, must be considered in order to cover for sick leave, vacation schedules, and time away from the position for such things as legal holidays and required training. Theoretically, a position that is open 24 hours per day, 7 days per week will require 8,760 hours of coverage per year. Communications Center personnel currently work 12 hour shifts. Which, in actuality, based upon their rotation schedule, amounts to a total time assigned of fourteen, 12.2 hour shifts every 28 days; or 2,226.5 total hours assigned per year. From this total must be subtracted annual holidays, vacation time, sick leave, and required training time spent "out of position" in order to determine the total hours a single staff member is available to cover a given position. Figure 50 identifies the calculations used to determine an individual Telecommunicator's annual availability in hours. Figure 50 Annual Available Hours per Officer a. Total Assigned Hours /Year 2,226.5 No. Days Allowed /Year b. Sick Hours /Year Hours /day Hrs. Deducted From Hrs. Assigned 146.4 12.0 12.2 C. Annual 15.7 12.2 191.5 d. Holidays 11.0 12.2 134.2 e. Training 3.0 12.2 36.6 Total Available Hours /Year; a- (b +c +d +e) 1,717.8 Note that the Hours /Year are based on the accrual rate of second year employees, per Human Services, at the rate of 3.7 hours /pay period for sick leave (12 days /year), and 4.84 hours /pay period for annual leave (15.7 days /year). The Relief factor for a 24 hour per day position, open 365 days per year would be 8,760 hours (number of hours position is open) divided by 1,717.8 hours (the number of hours an individual is available per year); the result being, the Relief Factor = 5.10. Figure 51 illustrates the subsequent calculations for both 24 hour and 12 hour shift positions. Figure 51 Shift Relief Factor Calculations Position Annual Hours Hours Avaiable /Yr. Relief Coverage Required /Position Per Employee Factor 24 Hrs. /7 Days 8,760 1,718 5.10 12 Hrs. /7 Days 4,380 1,718 2.50 Solutions for Local Government, Inc. 77 Comprehensive Assessment of Emergency Medical Services 122 and 911 /Communications Center Operations Study Determination of Communications Center Staff Requirements First, the obvious; what the above calculations just shown illustrate is that four (4) Shift Supervisors, four (4) Lead Telecommunicators /Assistant Shift Supervisors, and four (4) Communications Training Officers cannot cover their respective positions 24/7/365 without some or all of them working a lot of overtime or, working short staffed, or a combination of the two; i.e. it takes 5.10 bodies to cover one 24/7/365 position, there are currently four (4) assigned to each position. Subsequently, in this instance staffing requirements will be calculated two ways: The first method will include a calculation of the requirements on the basis of the staffing configuration currently in place. Note that "in place" is emphasized here in that the basis for the number of positions and in turn the number of personnel filling those positions is essentially, based on "history" versus the calculation of needs based on call data or work load. The second method, which will utilize the Relief Factor calculations identified in the first method, will calculate the Communications Center staffing requirements based on an industry accepted formula matrix that is based on the County's peak call volume and call duration data identified during this study. In -Place Position Requirements Once the current Telecommunicator trainees have completed their training the Communications Center will be able to provide an additional Telecommunicator to each existing shift; bringing the total positions assigned per shift to six (6). With existing Staffing Configuration, at six (6) positions per shift, the minimum number of personnel required to cover each position 24 hours /day, 365 days /year would be: Position Title # Positions Per Shift Relief Factor # Required per Position Shift Supervisor 1 5.10 5.10 Lead Telecommunicator 1 5.10 5.10 Communications Training Officer 1 5.10 5.10 Telecommunicator 3 5.10 15.30 6 30.60 This number (30.6) corresponds very closely to the number of employees currently allocated to the Communications Center (30), not including the Operations Manager, there are still five (5) vacant positions including, most critically, an Assistant Shift Supervisor and a Shift Communications Training Officer. Also, this staff requirement is based on the number of positions "in place" versus the number calculated as "needed ". Determination of Positions Needed The methodology used to determine the level of staffing required for a primary PSAP such as Orange County's was one initially developed by the U.S. Department of Justice, and since utilized by agencies and organizations such as FEMA, the National Emergency Number Association (NENA), and the Assoc- iation of Public Safety Communications Officials (APCO). Solutions for Local Government, Inc. 78 Comprehensive Assessment of Emergency Medical Services 123 and 911 /Communications Center Operations Study It utilizes a matrix format that considers two principal criteria: ■ The average call -taker "busy time" in seconds; i.e., average call duration, and ■ The peak call rate per hour. The average telephone call duration was calculated using the three years of call - processing data previously referenced for 2009 -2011. Call duration information is recorded automatically for every call received. While the computer printouts and call data reviewed for this purpose did not indicate the type of call or specific emergency service requested, it was generally assumed that total call durations of two minutes or more involved an EMD response. Call data analyzed identified that the average call duration was 102 seconds. This was the average of the entire sample studied; from the one -ring, 6- second hang -up to the 13 minute medical emergency, EMD response. Based on the numbers illustrated in Figure 42, on page 68, the busiest hour of the day with regards to call volume for each of the calendar years reviewed was consistently between the 5:00 pm and 6:00 pm. Logically, it was found that the peak call rate did indeed come from this hour of the day. The average peak rate per hour identified for the three years studied was 236 calls; 3.9 calls per minute. Applying these numbers to the nearest like numbers on the staffing matrix, illustrated in the Figure below, identifies '100' as the number closest to the Communications Center's average busy time of 102 seconds along the top line. The number 230 in the column (below the number 100) is the closest to the Center's peak call rate per hour of 236 Now, following the line of numbers to the left from the number 230, results in the number of "required call - takers" required, in this case, ten (10). Figure 52 Staffing Matrix Average Call Duration @ 102 seconds Required Average Call -Taker Busy Time, In Seconds Call- Takers 30 35 40 45 50 55 60 65 70 75 80 85 90 95 100 105 110 115 120 1 16 13 11 9 8 7 6 6 5 5 5 4 4 4 3 3 3 3 2 77 64 54 47 42 37 34 31 28 26 24 23 21 20 19 18 17 16 16 3 157 131 112 98 87 78 70 64 59 55 51 48 45 42 40 38 36 34 33 4 247 206 177 154 137 123 111 102 94 87 81 76 71 67 64 60 57 55 52 5 343 287 248 215 191 171 156 142 131 122 113 106 100 94 89 85 80 77 73 6 443 371 318 278 247 222 202 185 170 158 147 138 130 122 116 110 105 100 95 7 545 457 393 344 306 275 250 229 211 196 182 171 161 154 152 136 130 124 214 8 650 545 469 411 365 329 299 274 252 234 218 205 192 182 172 163 155 148 142 635 546 479 426 384 349 319 295 273 265 239 225 212 191 181 173 165 (�756 4230 219 208 199 190 973 818 705 618 550 496 451 413 381 354 330 309 291 275 247 235 224 214 12 1082 911 785 689 614 553 503 461 425 395 368 345 325 307 2 0 278 262 250 239 13 1193 1005 866 761 678 611 555 509 470 436 407 382 359 339 3 1 305 290 277 265 14 1304 1099 948 833 742 669 608 558 515 478 446 418 393 371 3 2 334 318 303 290 Peak Call Rate @ 236 /hour - Staffing Matrix Source: U.S. Department of Justice Solutions for Local Government, Inc. 79 Comprehensive Assessment of Emergency Medical Services 124 and 911 /Communications Center Operations Study Applying the Relief Factor to these findings; ten (10) Telecom municator positions at 5.10 "bodies" per position, equals 51 personnel; considerably higher than what the Center is working with currently. More importantly, four (4) more positions than the Communications Center is operating with now. And, not surprisingly, during various audits of the Communications Center activities, both day and evening shifts, it was noted that staff did not take actual meal breaks, but ate at their work stations while continuing to answer calls. As well, they were not taking any noticeable form of breaks; for example, getting up from their workstation, leaving the call center area and going somewhere for a legitimate and restful "break "; both of which are addressed in FLSA literature for shift work hours of this duration. Finally, the most blatant "gap" observed in the staffing configuration of the Communications Center, particularly for a Center with the call volume and current number of positions, was the absence of an assigned, dedicated, full -time Data System Manager, a dedicated Quality Assurance Officer, and a full - time Training Officer. These are critical needs. And, while data /technical support is available on an as needed basis from the Planning & Logistics Unit of the Emergency Services Department this is not an adequate substitute for permanently assigned personnel; particularly, considering the Communications Center's position at the very center of the Emergency Services and Public Safety entities in operation in Orange County. Issue: Data As discussed briefly in Subsection 4.3, the availability of easily accessed, workable, reliable, and user friendly data, which would normally be available in the Communication Center's CAD system, was not. The information was there! However, it was found many times that it was neither easy to find or access nor in a user friendly format when it was finally obtained; albeit, requiring more work to make it so. A major reason, also previously addressed, was that the technology is 20 years old. During the early phases of this study, interviews and meetings were conducted with Fire Department, Law Enforcement, and Emergency Services personnel. Though "opinions" flowed freely, and occasional personality "differences" were volunteered in often less than subtle terms, little actual, specific criticism of the Communications Center (or EMS) were offered. The one consistent and oft repeated "concern" had to do with "the call numbers ", or the manner in which service agencies were dispatched (or not), the timing of the agency's "page" or dispatch versus the time the call was originally recorded; in other words the data, and the data system capabilities. The Communication Center's; i.e. the County's technical capabilities were not up to speed, nor apparently have they been up to speed with the expectations of the various agencies served. Much of this will (hopefully) be resolved with County having recently, after many months, finally approved the purchase of new CAD software for the Communications Center; although completion of installation and access to its on -line capabilities remains several months away. It represents the proverbial light at the end of the tunnel. This combined with the NC 911 Board's installation of their new ECatS (Emergency Call Tracking System) data access and reporting system in Orange County and the other 127 PSAP locations in the State. A year from now, the Data Issue will hopefully have "gone away ". Solutions for Local Government, Inc. 80 Comprehensive Assessment of Emergency Medical Services 125 and 911 /Communications Center Operations Study The essential remaining effort to be undertaken will involve the methodology used by Communications Center and Emergency Services personnel in the orientation and training of the County's Emergency Service users as to the new software's capabilities and the reports it can be expected to provide for those agencies. 4.5 RECOMMENDATIONS Issue: Staffing Recommendations: R -13. Hire a full -time, dedicated Data System Manager to be located as close as possible, preferably adjacent to the Communications Center, and answerable first to the Communications Center Operations Manager. This position is a priority and efforts to identify and place a qualified person in this role should begin immediately. In turn, the coordination, installation and implementation of the new CAD system software should be at the very top of this individual's 'to-do" list. R -14. Hire a full -time, dedicated Training /Quality Assurance Officer to be located as close as possible, preferably adjacent to the Communications Center, and answerable first to the Communications center Operations Manager. This position is as important as that of the Data System Manager in that accountability and the adherence to EMD protocols is vital to an effective emergency Communications operation. R -15. Anticipating increasing responsibilities due to the number of new personnel forthcoming, hire an additional full -time Training /Quality Assurance Officer no later than the end of year -3. This recommendation anticipates that by the end of year -3 of the Implementation Schedule identified in Section 6 that the combined Training /Quality Assurance Officer position will evolve with the addition of personnel and require a transition to a full -time Training Officer and a full -time Quality Assurance officer. R -16. Prepare a schedule for the hiring and training of the identified Telecommunicator positions and identify the date to begin solicitation and acceptance of applications. The Communications Center is currently deficient of resources; i.e. personnel, in key positions; subsequently it will be important to have The Data System Manager and the Training /Quality Assurance Officer in place prior to the hiring of the personnel to fill the recommended Telecom municator positions. Subsequently, the designated Telecom municator positions, particularly the vacant Assistant Shift Supervisor and Communications Training Officer positions will be critical to an effective and efficient hiring timeline. Delays will prolong and exponentially prolong the problem of lack of staff. R -17. Hire 17 new, full -time Telecommunicators. The Implementation Schedule suggested in Section 6 identifies a suggested timeline for hiring of these positions. It is important to recall that hiring a "position" in the Communications Center means providing the responsibilities of that position 24 hours /day, 365 days /year. Subsequently, that "position" will require five (5) bodies to fill it. Therefore the sequence for hiring suggests that these Telecom municators be hired in groups of no less than five (5) at one time; versus, for example, approving funding for two (2) people, "one in July and one (1) in January ", which is very inefficient. Solutions for Local Government, Inc. 81 Comprehensive Assessment of Emergency Medical Services 126 and 911 /Communications Center Operations Study Issue: Data Recommendations: R -18. Purchase necessary AVL vehicle hardware for each new EMS vehicle purchased to enable compatibility with newly purchased CAD software and existing AVL system hardware. Automatic Vehicle Location (AVL) hardware has already been purchased and is installed in current EMS vehicles. The equipment is compatible with the newly purchased CAD system software and the AVL "package" that is included within it. This recommendation is simply to continue with the purchase and installation of this important hardware into each new EMS vehicle as it comes on line. R 19. Following the installation of recently purchased Communications Center software and the training of in -house personnel; organize and provide informational meetings to emergency service system members, particularly Fire Departments and Law Enforcement, with regards to the system's capabilities and the information that will be available to them for their use. [The remainder of this page intentionally left blank] Solutions for Local Government, Inc. 82 Comprehensive Assessment of Emergency Medical Services 127 and 911 /Communications Center Operations Study EMERGENCY MEDICAL SERVICES Issue: Availabilitv of Ambulances RECOMMENDATIONS Personnel 1 Adjust Medic 5 and Medic 8 coverage hours 2 Add ALS ambulance 9a -9p @12 hrs /7 days 3a Utilize available BLS ambulance(s) for non - emergency transports 3b Staff BLS ambulance for non - emergency transport @ 12 hrs /7 days REC Personnel Equipment Prof. Services Construction Other Total 1 n/a n/a n/a n/a n/a $ - 2 $ 224,100 $ 228,400 n/a TBD TBD $ 452,500 3a n/a n/a $ 300,000 n/a $ 105,000 $ 405,000 3b $ 205,876 1 (existing) n/a TBD TBD $ 205,876 Notes: Rec 2. Personnel - Includes equivalent of one (1) Paramedic "position" and one (1) EMT "position" @ 12 hours /7 days each = 2.5 FTE Paramedics + 2.5 FTE EMT's. Rec 2. Equipment - Includes estimated cost of one (1) M2 Ambulance, plus equipment, plus first year medical supply costs. Rec 3a. Prof. Services -if SORS /BLS option is implemented, costs identified assume payment for transportation services billed @ OCEMS rates for estimated 1,000 patient transports /year. Rec 3a. Other -If SORS /BLS option is implemented, costs identified assume payment of mileage charges @ OCEMS rates /mile x estimated 14,000 miles /year. Rec 3b. Personnel - Includes equivalent of two (2) EMT "positions" @ 12 hours /7 days each = 5 FTE's to staff BLS ambulance if Rec 3a. cannot be implemented; assumes OEMS will have a vehicle available. Solutions for Local Government, Inc. 83 Comprehensive Assessment of Emergency Medical Services 128 and 911 /Communications Center Operations Study SECTION 5- PROBABLE COSTS EMERGENCY MEDICAL SERVICES RECOMMENDATIONS Personnel 4 Assess FD capabilities necssary to meet MFR -RT requirements 5a Implement FD /MFR initiative w /performance objectives 5b Add four (4) QRV's @ 12 hrs /7 days 6 Add six (6) 12 hr /7 day ALS ambulances; Zones 1/2, 7/5, 6/8 7 1 Hire Shift Supervisor; ALS @ 24/7 REC Personnel Equipment Prof. Services Construction Other Total 4 n/a n/a $ 8,000 n/a n/a $ 8,000 5a TBD TBD n/a n/a TBD TBD 5b $ 484,650 $ 220,000 n/a TBD TBD $ 704,650 6 $ 1,344,600 $1,370,400 n/a TBD TBD $ 2,715,000 7 $ 321,300 $ 45,000 n/a n/a TBD $ 366,300 Notes: Rec 4. Prof. Services - Estimated contracted cost to provide independent assessment of existing Fire Department capabilities and needs to accomplish Medical First Responder response time objectives. Rec 5a. Assumes needs identified and response time objectives resulting from Rec 4 are accepted by the County and Fire Departments respectively and implementation of the initiative is approved. Rec 5b. Personnel- Assumes Rec 5a is not implemented; OCEMS to address critical MFR issue via hire of personnel to staff four (4) Quick Response Vehicles to be staged throughout the County; costs identified to cover one (1) Paramedic "position" per QRV- 12hours /7 days -@ 2.5 FTE's per QRV x four (4) vehicles. Rec 5 b. Equipment- Estimated cost of four (4) SUV type vehicles, including up -fit of communications systems and equipment. Rec 6. Personnel- Assumes one (1) Paramedic "position" and one (1) EMT "position" per 12 hour /7 day ambulance = 2.5 Paramedic FTE's + 2.5 EMT FTE's per ambulance x six (6) ambulances; implemented over first eight (8) years. Rec 6. Equipment- Includes estimated cost of six (6) M2 Ambulances, plus equipment, plus first year medical supply costs for each. Rec 7. Personnel - Includes one (1) EMS Paramedic level Shift Supervisor "position" 24/7/365 @ 5 FTE's. Rec 7. Equipment- Estimated cost of one (1) SUV type vehicle, including up -fit of communications systems and equipment. Solutions for Local Government, Inc. 84 Comprehensive Assessment of Emergency Medical Services 129 and 911 /Communications Center Operations Study SECTION 5- PROBABLE COSTS EMERGENCY MEDICAL SERVICES Issue: EMS Base Facilities RECOMMENDATIONS Personnel 8 Conduct detailed Space Needs Assessment 9 Identify minimum of nine (9) strategic locations 10 Purchase identified site and /or building 11 Procure base design & construction services 12 Construction; nine (9) EMS Bases REC Personnel Equipment Prof. Services Construction Other Total 8 n/a n/a $ 12,000 n/a TBD $ 12,000 9 n/a n/a n/a n/a n/a $ - 10 n/a n/a n/a n/a TBD TBD 11 n/a TBD $1,620,000 n/a TBD $1,620,000 12 n/a TBD n/a $8,064,000 n/a $8,064,000 Notes: Rec 8. Prof. Services- Estimated contracted cost to provide a Space Needs Assessment to address and document building and site requirements for an EMS base facility. Rec 11. Professional Services - Estimated total cost for planning & design services for nine (9) EMS base facilities; assumes design for each facility is contracted for as a single project. Rec 12. Construction- Estimated cost of construction for nine (9) EMS base facilities bid and contracted for as nine (9) separate projects; single facility construction cost based on a current NC County project in final stages of design @ 5,000 square feet x $180 /square foot for pre- engineered steel building. Solutions for Local Government, Inc. 85 Comprehensive Assessment of Emergency Medical Services 130 and 911 /Communications Center Operations Study SECTION 5- PROBABLE COSTS COMMUNICATIONS CENTER Issue: Staffing RECOMMENDATIONS Personnel 13 Hire Full -time Data System Manager 14 Hire full -time Training /Quality Assurance Officer 15 Hire full -time Training /Quality Assurance Officer 16 Prepare schedule for hiring /training of new Telecommunicators 17 Hire 17 full -time Telecommunicators REC Personnel Equipment Prof. Services Construction Other Total 13 $ 74,250 n/a n/a n/a n/a $ 74,250 14 $ 64,800 $ 8,000 n/a TBD TBD $ 72,800 15 $ 64,800 $ 8,000 n/a TBD TBD $ 72,800 16 n/a n/a n/a n/a n/a $ - 17 $ 784,890 TBD n/a n/a TBD $ 784,890 Notes: Rec 13. Personnel- Estimated annual salary + 35 % matching costs for Data System Manager. Rec 14. Personnel- Estimated annual salary + 35 % matching costs for Training /Quality Assurance Officer. Rec 14. Equipment- Estimated first year costs for necessary quality assessment and training materials. Rec 15. Personnel- Estimated annual salary + 35 % matching costs for Training /Quality Assurance Officer. Rec 15. Equipment- Estimated first year costs for necessary quality assessment and training materials. Rec 17. Estimated annual salary + 35% matching costs for one (1) full -time Telecom municator x 17. Solutions for Local Government, Inc. 86 Comprehensive Assessment of Emergency Medical Services 131 and 911 /Communications Center Operations Study SECTION 5- PROBABLE COSTS COMMUNICATIONS CENTER Issue: Data RECOMMENDATIONS 18 19 Purchase AVL hardware -new vehicles LE & FD Software Orientation REC Personnel Equipment Prof. Services Construction Other Total 18 19 n/a n/a $ 60,000 TBD n/a n/a n/a n/a n/a n/a $ 60,000 TBD Notes: Rec 18. Equipment- Estimated cost for vehicle hardware necessary to synchronize with CAD system Automatic Vehicle Location (AVL) software for tracking of EMS vehicles; costs identified are based on estimated cost of AVL hardware per vehicle x number of new vehicles (12) projected for purchase during 10 -year plan implementation time line. Solutions for Local Government, Inc. 87 Comprehensive Assessment of Emergency Medical Services 132 and 911 /Communications Center Operations Study YEAR 1 -5 Solutions for Local Government, Inc. 88 5 -Year No. Recommendation Year 1 Year 2 Year 3 Year 4 Year 5 Total 1 Adjust Medic 5 & 8 coverage $ $ - $ - $ - $ - $ - 2 Add 9a -9p @12/7 ALS $ $ 452,500 $ - $ $ $ 452,500 3a BLS for Non -Em transports @ 12/7 $ $ - $ 405,000 $ $ $ 405,000 3b Staff BLS for NE transports @ 12/7 $ $ $ 205,876 $ $ $ 205,876 4 Assess FD- MFR /RT requirements $ 8,000 $ $ $ $ $ 8,000 5a Implement FD /MFR initiative TBD $ $ $ $ $ - 5b Add four (4) QRV's @ 12/7 $ - $ 704,650 $ $ $ $ 704,650 6 Add six (6) ALS Ambulances @ 12/7 $ $ $ $ 1,357,500 $ $ 1,357,500 7 Hire Shift Supervisor; ALS @ 24/7 $ $ $ $ 366,300 $ $ 366,300 8 Space Needs Assessment $ 16,000 $ $ $ - $ $ 16,000 9 Identify nine (9) base locations $ - $ $ $ - $ $ - 10 Purchase sites /buildings $ TBD TBD TBD TBD $ - 11 Design services- nine (9) bases $ $ $ $ 540,000 $ - $ 540,000 12 Construction /Renovation -9 bases $ $ $ $ - $ 2,688,000 $ 2,688,000 12 Hire Data System Manager $ 74,250 $ $ $ $ $ 74,250 14 Hire Training /QA Officer $ 72,800 $ $ $ $ $ 72,800 15 Hire T /QA Officer $ - $ $ 72,800 $ $ $ 72,800 16 Schedule hiring /training for ne TC's $ $ $ - $ $ $ - 17 Hire 17 new Telecom m u nicators $ $ 230,850 $ $ 230,850 $ 461,700 18 AVL hardware -new vehicles $ $ 40,000 $ 20,000 $ - $ 60,000 19 LE & FD Software Orientation $ TBD $ $ - $ - $ - $ 171,050 $ 1,428,000 $ 683,676 $ 2,283,800 $ 2,918,850 $ 7,485,376 Capital /One -Time Cost $ 24,000 $ 488,400 $ - $ 993,600 $ 2,688,000 $ 4,194,000 Operating Cost $ 147,050 $ 939,600 $ 683,676 $ 1,290,200 $ 230,850 $ 3,291,376 Solutions for Local Government, Inc. 88 Comprehensive Assessment of Emergency Medical Services 133 and 911 /Communications Center Operations Study YEAR 6 -10 No. Recommendation Year 6 Year 7 Year 8 Year 9 Year10 5 -Year Total 1 Adjust Medic 5 & 8 coverage $ $ $ $ $ $ 2 Add 9a -9p @12/7 ALS $ $ $ $ $ $ 3a BLS for Non -Em transports @ 12/7 $ $ $ $ $ $ 3b Staff BLS for NE transports @ 12/7 $ $ $ $ $ $ 4 Assess FD- MFR /RT requirements $ $ $ $ $ $ 5a Implement FD /MFR initiative $ $ $ $ $ $ 5b Add four (4) QRV's @ 12/7 $ $ $ $ $ $ 6 Add six (6) ALS Ambulances @ 12/7 $ $ 1,357,500 $ $ $ 1,357,500 7 Hire Shift Supervisor; ALS @ 24/7 $ $ $ $ $ $ 8 Space Needs Assessment $ $ $ $ $ $ 9 Identify nine (9) base locations $ $ $ $ $ $ 10 Purchase sites /buildings $ $ $ $ $ $ 11 Design services- nine (9) bases $ 540,000 $ - $ $ 540,000 $ - $ 1,080,000 12 Construction /Renovation $ - $ 2,688,000 $ $ - $ 2,688,000 $ 5,376,000 12 Hire Data System Manager $ $ $ $ $ $ 14 Hire Training /QA Officer $ $ $ $ $ $ 15 Hire T /QA Officer $ $ $ $ $ $ 16 Schedule hiring /training for ne TC's $ $ $ $ $ $ 17 Hire 17 new Telecom m u nicators $ 323,190 $ $ $ $ 323,190 18 AVL hardware -new vehicles $ $ $ $ $ $ 19 LE & FD Software Orientation $ $ $ $ $ $ $ 540,000 $ 3,011,190 $ 1,357,500 $ 540,000 $ 2,688,000 $ 8,136,690 Capital /One -Time Cost $ 540,000 $ 2,688,000 $ 685,200 $ 540,000 $ 2,688,000 $ 7,141,200 Operating Cost $ - $ 323,190 $ 672,300 $ - $ - $ 995,490 Solutions for Local Government, Inc. 89 Comprehensive Assessment of Emergency Medical Services 134 and 911 /Communications Center Operations Study Emergency Medical Services (EMS) • 10A NCAC 13P.0201; EMS System Requirements • Orange County Grid Map; w /Number of EMS Calls & Average Response Times per Grid; a. Calendar years 2009 -2011 • County EMS Agency Comparison Survey 911 /Communications Center • Carolina 911 Board PSAP Operating Standards • 911 /Communications Center Response, Dispatch & Communications Process Maps: • Emergency Medical Dispatch (EMS) • Structure Fire (Fire Departments) • Domestic Violence /Disturbance (Law Enforcement) • NFPA 450 Excerpt: Essential (Communications Center) System Analysis Components Solutions for Local Government, Inc. 90 Comprehensive Assessment of Emergency Medical Services 135 and 911 /Communications Center Operations Study APPENDIX A 10A NCAC 13P.0201; EMS System Requirements Solutions for Local Government, Inc. 91 Comprehensive Assessment of Emergency Medical Services 136 and 911 /Communications Center Operations Study APPENDIX B Orange County Grid Map; w /Number of EMS Calls & Average Response Times per Grid; Calendar years 2009 -2011 Solutions for Local Government, Inc. 92 Comprehensive Assessment of Emergency Medical Services 137 and 911 /Communications Center Operations Study APPENDIX C County EMS Agency Comparison Survey Solutions for Local Government, Inc. 93 Comprehensive Assessment of Emergency Medical Services 138 and 911 /Communications Center Operations Study APPENDIX D North Carolina 911 Board PSAP Operating Standards Solutions for Local Government, Inc. 94 Comprehensive Assessment of Emergency Medical Services 139 and 911 /Communications Center Operations Study APPENDIX E 911 /Communications Center Response, Dispatch & Communications Process Maps: • Emergency Medical Dispatch (EMS) • Structure Fire (Fire Departments) • Domestic Violence /Disturbance (Law Enforcement) Note that the call process illustrations that follow are EXAMPLES. Of the many hundreds of emergency calls reviewed and /or audited, no two -even of the same category of call -were ever exactly alike. Should an error or omission be noted, it is due to the consultant's interpretation of the call process described and should not be interpreted as an error or omission by the Communications Center or its personnel. Solutions for Local Government, Inc. 95 Comprehensive Assessment of Emergency Medical Services 140 and 911 /Communications Center Operations Study APPENDIX F NFPA 450 Excerpt: Essential (Communications Center) System Analysis Component Solutions for Local Government, Inc. 96 141 SECTION .0200 — EMS SYSTEMS 10A NCAC 13P.0201 EMS SYSTEM REQUIREMENTS (a) County governments shall establish EMS Systems. Each EMS System shall have: (1) a defined geographical service area for the EMS System. The minimum service area for an EMS System shall be one county. There may be multiple EMS Provider service areas within the service area of an EMS System. The highest level of care offered within any EMS Provider service area must be available to the citizens within that service area 24 hours per day; (2) a defined scope of practice for all EMS personnel, functioning in the EMS System, within the parameters set forth by the North Carolina Medical Board pursuant to G.S. 143 -514; (3) written policies and procedures describing the dispatch, coordination and oversight of all responders that provide EMS care, specialty patient care skills and procedures as defined in Rule .0301(a)(4) of this Subchapter, and ambulance transport within the system; (4) at least one licensed EMS Provider; (5) a listing of permitted ambulances to provide coverage to the service area 24 hours per day; (6) personnel credentialed to perform within the scope of practice of the system and to staff the ambulance vehicles as required by G.S. 131E -158. There shall be a written plan for the use of credentialed EMS personnel for all practice settings used within the system; (7) written policies and procedures specific to the utilization of the EMS System's EMS Care data for the daily and on -going management of all EMS System resources; (8) a written Infectious Disease Control Policy as defined in Rule .0102(33) of this Subchapter and written procedures which are approved by the EMS System medical director that address the cleansing and disinfecting of vehicles and equipment that are used to treat or transport patients; (9) a listing of facilities that will provide online medical direction for all EMS Providers operating within the EMS System; (10) an EMS communication system that provides for: (A) public access using the emergency telephone number 9 -1 -1 within the public dial telephone network as the primary method for the public to request emergency assistance. This number shall be connected to the emergency communications center or PSAP with immediate assistance available such that no caller will be instructed to hang up the telephone and dial another telephone number. A person calling for emergency assistance shall not be required to speak with more than two persons to request emergency medical assistance; (B) an emergency communications system operated by public safety telecommunicators with training in the management of calls for medical assistance available 24 hours per day; (C) dispatch of the most appropriate emergency medical response unit or units to any caller's request for assistance. The dispatch of all response vehicles shall be in accordance with a written EMS System plan for the management and deployment of response vehicles including requests for mutual aid; and (D) two -way radio voice communications from within the defined service area to the emergency communications center or PSAP and to facilities where patients are routinely transported. The emergency communications system shall maintain all required FCC radio licenses or authorizations; (11) written policies and procedures for addressing the use of SCTP and Air Medical Programs within the system; (12) a written continuing education program for all credentialed EMS personnel, under the direction of a System Continuing Education Coordinator, developed and modified based on feedback from system EMS Care data, review, and evaluation of patient outcomes and quality management peer reviews, that follows the guidelines of the: (A) "US DOT NHTSA First Responder Refresher: National Standard Curriculum" for MR personnel; (B) "US DOT NHTSA EMT -Basic Refresher: National Standard Curriculum" for EMT personnel; (C) "EMT -P and EMT -I Continuing Education National Guidelines" for EMT -I and EMT -P personnel; and 142 (D) "US DOT NHTSA Emergency Medical Dispatcher: National Standard Curriculum" for EMD personnel. These documents are incorporated by reference in accordance with G.S. 15013-21.6, including subsequent amendments and additions. These documents are available from NHTSA, 400 7"' Street, SW, Washington, D.C. 20590, at no cost; (13) written policies and procedures to address management of the EMS System that includes: (A) triage and transport of all acutely ill and injured patients with time- dependent or other specialized care issues including trauma, stroke, STEMI, burn, and pediatric patients that may require the by -pass of other licensed health care facilities and which are based upon the expanded clinical capabilities of the selected healthcare facilities; (B) triage and transport of patients to facilities outside of the system; (C) arrangements for transporting patients to appropriate facilities when diversion or bypass plans are activated; (D) reporting, monitoring, and establishing standards for system response times using data provided by the OEMS; (E) weekly updating of the SMARTT EMS Provider information; (F) a disaster plan; and (G) a mass - gathering plan; (14) affiliation as defined in Rule .0102(4) of this Subchapter with the trauma RAC as required by Rule A 101(b) of this Subchapter; and (15) medical oversight as required by Section .0400 of this Subchapter. (b) An application to establish an EMS System shall be submitted by the county to the OEMS for review. When the system is comprised of more than one county, only one application shall be submitted. The proposal shall demonstrate that the system meets the requirements in Paragraph (a) of this Rule. System approval shall be granted for a period of six years. Systems shall apply to OEMS for reapproval. History Note: Authority G.S. 131E - 155(1), (6), (8), (9), (15);143- 508(6), (d)(1), (d)(2), (d)(3), (d)(5), (d)(8), (d)(9), (d)(10), (d)(13); 143 - 509(1), (3), (4), (5);143 -517; 143 -518; Temporary Adoption Eff. January], 2002; Eff. August 1, 2004; Amended Eff. January 1, 2009. .; Ii• 1 LU 9847— • , ll - •: •: ' • :• /:/ Co LU •• I •1 ��.A.. 1 � � _.ice•. . _ _�� •� 1 :� -� �� "� �1 f ,1 —� all _ r •.1111 - 1 � � =_ .- lip WmEM 0,1,60 L�S RD 8481W , ••'• •• / ••• •'•1 : / �� •/ 1.11 • �• � 1 � � • �I 1� V _ `iii � �F �� ►�7 V �,VID7 s��,,�.�.' � ��I _ -�r�r -, �� . y � �� 1 �, . �1 � �• e ms`s � ol lot 144 2009 Mean response times by Grid Report ResponseMinutes Ma Grid Mean N Std. Deviation 803 16.0719 16 5.39154 804 9.7167 7 5.28292 805 17.0563 8 4.99263 806 22.7697 11 7.95000 807 18.5979 16 5.12286 808 23.9611 3 1.80849 809 16.4200 5 9.60452 817 27.5000 1 818 26.9833 1 819 28.6500 2 3.37054 900 27.7583 6 5.29741 9727 19.2500 6 3.66736 9728 18.7405 7 6.30104 9729 19.8250 2 2.18025 9737 18.4917 2 1.30815 9738 18.8286 7 2.64023 9739 16.0870 9 3.67727 9747 15.0514 23 3.72016 9748 15.0278 9 3.15293 9749 15.0413 23 4.24234 9757 11.7630 9 3.74574 9758 13.2075 20 4.17752 9759 12.1222 36 3.44612 9766 12.0000 1 9767 12.1438 72 6.34648 9768 8.1548 328 5.47947 9769 10.8480 59 4.30562 9776 11.6917 2 2.46309 9777 7.8960 279 4.34889 9778 8.6486 488 5.29302 9779 7.7175 221 4.50145 9787 10.6132 116 5.10491 9788 8.6034 1510 5.63910 9789 10.7184 246 4.01976 9797 12.4833 1 9798 10.0880 379 5.00715 9799 11.9254 701 4.76070 145 9820 16.9526 13 4.07751 9821 24.1167 4 5.22375 9822 15.2171 37 9.16496 9823 10.2000 1 9824 16.8119 7 4.71907 9825 12.4429 236 5.86314 9826 17.0949 13 4.41859 9827 16.9833 4 4.85945 9828 22.9833 3 11.76599 9829 33.0806 6 12.46327 9831 17.4083 8 4.02304 9833 13.9633 5 2.55863 9834 13.4532 57 4.44941 9835 14.1671 106 5.64373 9836 17.1123 72 7.77060 9837 18.0907 9 9.94517 9838 16.3471 23 6.36859 9839 18.8367 5 9.55172 9840 18.2274 14 3.88354 9841 11.5703 249 5.06813 9842 20.4056 15 13.70796 9843 14.1190 7 2.73909 9844 9.2255 49 4.58229 9845 14.6884 43 5.76702 9846 15.6565 18 4.43101 9847 19.3817 20 6.65924 9849 19.6384 23 5.24896 9850 15.1132 29 4.66458 9851 9.7778 3 7.07700 9852 13.8458 16 5.35346 9853 12.0417 4 9.03221 9854 11.2393 61 4.88971 9855 22.3917 4 13.01462 9856 11.3500 2 2.89914 9857 22.1592 20 16.07132 9858 21.4233 5 9.11617 9859 18.7083 6 4.33333 9860 11.2174 24 4.98070 9861 10.1397 63 3.82431 9862 13.1792 16 4.93714 9863 9.8274 342 3.92876 9864 11.3687 465 5.16009 9865 14.0020 289 5.66860 9866 17.6599 27 4.35622 BEET 9867 18.2167 1 9868 19.0754 23 6.21317 9869 12.9167 2 16.42845 9870 12.6811 59 5.73348 9871 8.3108 31 4.63862 9872 5.5754 19 3.72764 9873 8.4441 127 4.37947 9874 10.2832 352 4.46731 9875 13.5070 107 4.80491 9876 16.8292 12 5.27800 9877 16.0232 28 4.64288 9878 22.0816 19 6.65777 9879 20.2256 28 6.95287 9880 9.6294 452 4.55767 9881 12.5944 21 4.31822 9882 9.3989 30 3.21580 9883 10.8731 49 3.35630 9884 12.8583 32 3.72818 9885 16.3119 14 3.32453 9886 18.9537 9 3.51674 9887 14.9950 10 6.91733 9888 14.5667 1 9889 27.1233 5 5.91679 9890 13.3353 213 5.20610 9891 16.5182 22 6.39389 9892 12.9205 48 3.83938 9893 10.7229 117 5.70260 9894 18.8750 4 6.25705 9896 18.2611 18 7.79201 9897 19.7389 3 3.33218 9898 21.8583 2 .20035 9899 17.1756 13 5.41925 9920 24.1758 11 3.14239 9930 21.0627 17 7.03374 9940 12.8463 112 5.78734 9950 11.2833 7 7.47855 9970 26.0133 5 10.94525 9990 17.6513 13 20.02915 Total 11.0420 9091 6.03687 147 2010 Mean Response Times by Grid Report ResponseMinutes Ma Grid Mean N Std. Deviation 803 17.9544 15 6.57934 804 13.6542 12 4.48102 805 19.0795 13 5.44293 806 21.3869 14 4.95512 807 19.2385 13 8.47563 808 25.7833 1 809 22.1650 10 7.41286 819 21.9833 1 900 32.8778 12 24.18399 9727 24.9611 3 10.81029 9728 18.5417 6 5.52112 9729 22.2000 1 9737 16.6722 3 7.16396 9738 16.8250 6 2.74671 9739 18.9095 7 4.72876 9747 15.9364 22 3.99475 9748 14.7924 11 3.29011 9749 15.4292 12 6.92996 9757 16.8593 9 13.57322 9758 12.7220 25 4.22902 9759 13.7381 28 5.53460 9767 10.8858 55 5.61815 9768 8.2350 358 5.32306 9769 12.8326 44 5.50949 9776 11.5667 1 9777 8.4145 342 5.03896 9778 8.4312 482 5.88911 9779 8.5348 206 4.88165 9787 10.6969 98 4.52535 9788 8.7870 1376 4.81225 9789 11.9938 206 6.57951 9797 12.7667 1 9798 10.6633 491 5.89673 9799 12.6503 608 5.55325 9820 15.2867 25 6.22534 9821 25.9667 1 9822 12.7109 64 9.36907 9823 15.8593 9 10.47963 9824 13.9067 5 2.41737 W. 9825 12.0662 234 5.90506 9826 16.4061 11 4.29686 9828 22.5222 9 6.05673 9829 24.3071 7 3.32522 9831 20.5897 13 9.12561 9833 14.9611 3 5.89393 9834 12.7324 37 3.74730 9835 12.6305 105 4.93297 9836 15.3060 58 4.18527 9837 15.8347 12 6.42262 9838 16.9433 15 6.82931 9839 24.7967 10 8.12394 9840 15.6889 3 1.37642 9841 10.2671 289 4.78971 9842 13.7078 15 5.42814 9843 14.3222 9 4.96514 9844 10.7271 35 3.73901 9845 12.9590 37 5.65251 9846 16.8333 28 4.76289 9847 22.0900 10 7.09730 9849 22.2933 15 5.12088 9850 14.4000 26 4.43267 9851 17.7024 7 4.78605 9852 17.1467 5 3.94327 9853 13.5067 5 .74457 9854 10.6215 73 5.19454 9855 13.8548 7 5.48095 9856 10.2639 6 2.11973 9857 15.0107 14 8.07952 9858 15.5917 2 5.62150 9859 23.6000 5 8.16488 9860 12.3868 24 1.99704 9861 9.5037 45 4.25942 9862 13.5431 12 6.43246 9863 10.4093 312 4.34488 9864 10.2254 495 5.27758 9865 11.2183 234 6.03463 9866 13.5632 24 4.80884 9867 18.0367 5 5.30011 9868 21.1977 29 10.30323 9869 18.5000 6 4.23404 9870 13.5080 69 3.45151 9871 14.0299 24 5.37480 9872 9.6500 14 4.46447 149 9873 10.6246 122 4.44535 9874 10.0170 339 4.68080 9875 11.3263 107 5.88940 9876 12.9233 5 3.04034 9877 17.6100 25 5.62420 9878 19.1397 26 4.70647 9879 19.3286 32 6.08849 9880 10.5671 482 4.88582 9881 13.5032 26 5.19197 9882 12.3888 49 5.15962 9883 11.7798 62 4.70309 9884 12.8573 16 3.55339 9885 16.8731 13 5.94369 9886 14.5875 8 4.41157 9887 13.9271 8 4.84486 9888 19.9556 3 4.41356 9889 23.3833 2 1.15494 9890 14.4460 276 5.35359 9891 16.9447 25 6.82240 9892 14.3059 45 5.44770 9893 12.8536 134 4.61916 9894 15.8000 1 9896 17.6410 26 6.25187 9898 20.5104 8 5.59862 9899 16.3778 12 5.07598 9920 21.6985 11 4.72393 9930 19.9600 5 1.63612 9940 11.7456 122 5.55307 9950 13.6700 10 4.46909 9960 34.5833 1 9970 18.4333 5 4.25194 9990 25.4617 10 7.35015 Total 11.1346 9010 6.06769 150 2011 Mean Response times by Grid Report ResponseMinutes Ma Grid Mean N Std. Deviation 802 9.8833 1 803 17.1111 6 3.42188 804 15.1778 9 3.14792 805 18.8979 8 1.79811 806 19.9304 17 3.02739 807 21.5711 19 6.10744 808 15.6000 1 809 21.0130 9 3.09744 819 22.2111 3 2.48581 900 22.6306 6 4.52338 9727 17.1889 3 2.83438 9728 14.6611 3 7.46608 9729 24.4667 1 9737 15.2500 2 1.24922 9738 16.4650 10 3.52648 9739 15.6381 7 3.85317 9747 18.1988 14 6.97762 9748 15.4058 23 4.50103 9749 15.5710 23 5.35658 9757 13.9683 20 7.61800 9758 12.8375 36 5.04287 9759 14.1924 35 4.46488 9766 12.2222 3 .94286 9767 9.6217 76 5.36166 9768 8.2320 280 5.67263 9769 12.4742 40 4.27730 9776 10.5000 1 9777 8.0785 398 4.61277 9778 7.8832 543 4.80890 9779 9.6535 218 4.71622 9787 9.9786 123 4.08503 9788 8.2977 1505 4.78933 9789 10.7878 245 5.13426 9796 13.3833 1 9798 10.0108 424 4.94952 9799 11.6270 557 5.11450 9820 18.7691 34 5.37513 9821 17.4444 3 4.16444 9822 10.3950 50 6.96993 151 9823 17.2630 9 10.24150 9824 14.0600 10 7.86517 9825 11.1713 228 5.08586 9826 20.7852 9 6.27824 9828 20.8458 4 4.78441 9829 28.4667 4 6.66337 9830 17.6472 6 4.60731 9831 18.5908 20 4.39228 9832 20.5167 1 9833 13.7958 4 4.13578 9834 10.9923 37 2.99008 9835 12.4015 131 4.58979 9836 15.4237 57 5.94102 9837 20.4028 6 9.71019 9838 16.3657 18 2.60228 9839 21.5896 8 3.77362 9840 19.6621 11 3.88036 9841 9.6755 274 4.09217 9842 16.5295 13 4.78332 9843 12.3825 20 3.17408 9844 10.2844 49 5.57963 9845 10.2672 29 5.39754 9846 15.6231 26 5.00397 9847 16.2333 13 5.01226 9848 19.5533 5 3.72009 9849 20.0155 14 5.74735 9850 16.1708 16 3.64709 9851 20.3600 5 4.48271 9852 11.1139 6 2.97871 9853 13.0513 13 3.35217 9854 11.1720 69 5.49381 9855 11.9450 10 6.68903 9856 14.6333 7 8.94046 9857 18.3833 15 7.19376 9858 16.4889 6 1.68406 9859 18.3267 5 4.09269 9860 13.2914 31 4.35442 9861 10.9511 45 4.75521 9862 13.6014 12 3.12351 9863 9.2247 280 4.32368 9864 9.0440 431 4.85488 9865 8.9562 267 4.80534 9866 11.6730 21 6.97388 9867 14.0850 10 3.88674 152 9868 17.3543 39 6.10225 9869 18.7056 3 4.07984 9870 12.7240 50 4.30114 9871 15.9212 51 4.70769 9872 12.9046 18 4.76630 9873 10.6670 153 4.37199 9874 8.9363 375 4.98699 9875 10.1649 93 5.47788 9876 13.5247 25 3.77994 9877 17.8389 15 12.44244 9878 18.6107 28 4.90477 9879 14.8516 21 5.30634 9880 10.8427 571 5.01346 9881 15.1306 31 3.93494 9882 14.8471 34 5.90992 9883 10.8388 52 5.30661 9884 12.2333 19 2.69820 9885 13.8481 18 4.32574 9886 13.7907 9 3.69808 9887 15.5318 11 3.67117 9888 23.6542 4 12.95470 9889 27.2250 2 4.13657 9890 13.8344 288 5.14901 9891 19.8876 43 5.11612 9892 15.9458 51 5.15671 9893 13.5598 135 4.48104 9894 13.5000 1 9896 16.2820 37 8.76052 9897 18.5000 1 9898 19.9071 7 7.82109 9899 18.7167 14 5.97971 9920 23.0125 4 5.89545 9930 24.6067 5 5.82607 9940 12.2642 120 6.95795 9950 16.3762 7 5.16883 9970 21.8567 5 3.75057 9990 21.3218 13 4.79486 Total 10.6357 9365 5.72339 153 County EMS Comparisons- Summer 2012 County Population No. Number of EMS Calls per 1,000 County Number of Ambulances PT Alamance Response Time Goal 28,000 ** $ 5,705,568 QRV's Stations 40 Durham 7 -24/7 ALS 27,648 $ 8,537,913 102 Alamance 36 3 -24/7 ALS 6 Avg. 8 min. $ 4,711,683 2 -12/5 BLS; Prime Time 66 8 30 6 10 -24/7 ALS 86,945 13,000 51 Durham 8 None 9 0:8:59 @ 90% 1 -12/7 ALS; Prime Time EM 12 min @ 90% Orange 4 -24/7 ALS; 4 -12/7 ALS None 6* Non -EM 15 min. or less County Population 2011 Ems Calls FY 11 -12 Budget Allocation EMS Calls per 1,000 Personnel FT PT Alamance 152,531 28,000 ** $ 5,705,568 184 84 40 Durham 272,314 27,648 $ 8,537,913 102 94 36 Orange 135,776 10,719 $ 4,711,683 79 66 8 ** Alamance County's call numbers include non - emergency /convalescent BLS transports. EMS: County Comparisons- Spring 2011 County Population EMS Disp /Yr Personnel No. Stations FT PT Cleveland 98,628 21,000 63 40 9 Nash 95,804 22,000 68 45 8 Rockingham 91,878 23,000 45 38 5 Burke 89,653 13,000 49 30 6 Moore 86,945 13,000 51 30 8 County Number of Ambulances No. QRV's Response Time Goal Cleveland 9 -24 /ALS 2 -24/7 ALS 8 min. or less @ 90% Nash 8 -24/7 ALS; 4 -12/7 Prime Time ALS 2 -24/7 ALS Avg. of 9 min. or Less Rockingham 6 -24/7 ALS; 1-10/7 BLS 2 -24/7 ALS Less than 8:59 Burke 5- 24 /7ALS; 2 -9/7 Prime Time ALS 2 -24/7 ALS 9 min. or less Moore 6 -24/7 ALS; 2 -12/7 Prime Time ALS 1 4 -24/7 ALS 1 9 min. or less @ 90% 154 D RAFT North Carolina 911 Board Operating Standards — Version 04/14/2011 D RA FT 1 Section 1 Administration 2 1.1 Scope. 3 1.1.1 These standards shall cover the installation, performance, operation, and maintenance of Public 4 Safety Answering Points and the associated emergency communication systems. 5 1.1.2 These standards shall not be used as a design specification manual or an instruction manual. 6 1.1.3 Unless specified otherwise herein compliance with these standards is required by July 1, 2012. 7 1.2 Purpose. 8 The purpose of these standards shall be as follows: 9 1.2.1 To specify operations, facilities, and communications systems that receive emergency calls from 10 the public. 11 1.2.2 To provide requirements for the retransmission of such emergency calls to the appropriate 12 emergency response agencies. 13 1.2.3 To provide requirements for dispatching of appropriate emergency response personnel. 14 1.2.4 To establish the required levels of performance and quality of installations of emergency services 15 communications systems. 16 1.3 Application. 17 These standards shall apply to emergency 911 systems that include, but are not limited to, dispatching 18 systems, telephone systems, and public reporting systems that provide the following functions: 19 1.3.1 Communication between the public and emergency response agencies. 20 1.3.2 Communication within the emergency response agency under emergency and non - emergency 21 conditions. 22 1.3.3 Communication among emergency response agencies. 23 1.4 Equivalency. 24 Nothing in these standards is intended to prevent the use of systems, methods, or devices of equivalent or 25 superior quality, strength, fire resistance, effectiveness, durability, and safety over those prescribed by 26 these standards. 27 1.4.1 Technical documentation shall be submitted to the local authority having jurisdiction to 28 demonstrate equivalency. 29 1.4.2 The system, method, or device shall be approved for the intended purpose by the authority having 30 jurisdiction. Page 1 155 D RAFT North Carolina 911 Board Operating Standards — Version 04/14/2011 D RA FT 1 Section 2 Definitions 2 2.1 General. 3 The definitions contained in this Section shall apply to the terms used in these standards. Where a term is 4 not defined in this Section or another Section within these standards, it shall have the definition provided 5 in the N.C. 911 Board Statutes. Where a term is also not defined by the N.C. 911 Board Statutes, it shall 6 be defined using its' ordinarily accepted meaning within the context in which it is used. Merriam - 7 Webster's Collegiate Dictionary, 11th edition, shall be the source for the ordinarily accepted meaning. 8 2.2 Official Definitions. 9 2.2.1 Public Safety Answering Point (PSAP). As defined in GS 62A- 40(18): The Public Safety 10 Agency that receives an incoming 911 call and dispatches appropriate Public Safety Agencies to respond 11 to the call. See 47 CFR 20.18(b) for basic 911 services, defined as: 12 Basic 911 Service. CMRS providers subject to this section must transmit all wireless 911 calls 13 without respect to their call validation process to a Public Safety Answering Point, or, where no 14 Public Safety Answering Point has been designated, to a designated statewide default answering 15 point or appropriate local emergency authority pursuant to § 64.3001 of this chapter, provided 16 that "all wireless 911 calls" is defined as "any call initiated by a wireless user dialing 911 on a 17 phone using a compliant radio frequency protocol of the serving carrier." 18 See GS 62A- 40(9), Enhanced 911 Service, defined as: 19 Directing a 911 call to an appropriate Public Safety Answering Point by selective routing or other 20 means based on the geographical location from which the call originated and providing 21 information defining the approximate geographic location and the telephone number of a 911 22 caller, in accordance with the FCC Order. 23 24 2.3 General Definitions. 25 2.3.1 Backup Public Safety Answering Point. A structure used to house a part of the control equipment 26 of an emergency reporting system or communications system; also, a normally unattended facility that is 27 remote from the Public Safety Answering Point and is used to house equipment necessary for the 28 functioning of an emergency communications system. 29 2.3.2 Circuit. The conductor or radio channel and associated equipment that are used to perform a 30 specific function in connection with an emergency call system. 31 2.3.4 Communications System. A combination of links or networks that serves a general function such 32 as a system made up of command, tactical, logistical, and administrative networks supporting the 33 operations of an individual PSAP. 34 2.3.5 Comprehensive Emergency Management Plan (CEMP). A disaster recovery plan that conforms 35 to guidelines established by the Public Safety Answering Point and is designed to address natural, 36 technological, and man-made disasters. Page 2 156 D RAFT North Carolina 911 Board Operating Standards — Version 04/14/2011 D RA FT 1 2.3.6 Computer -Aided Dispatch (CAD). A combination of hardware and software that provides data 2 entry, makes resource recommendations, and notifies and tracks those resources before, during, and after 3 emergency calls, preserving records of those emergency calls and status changes for later analysis. 4 2.3.7 Computer Aided Dispatch (CAD) Terminal. An electronic device that combines a keyboard and a 5 display screen to allow exchange of information between a Telecommunicator and one or more computers 6 in the system/network. 7 2.3.8 Control Console. A wall - mounted or desktop panel or cabinet containing controls to operate 8 communications equipment. 9 2.3.9 Coordinated Universal Time. A coordinated time scale, maintained by the Bureau International 10 des Poids et Measures (BIPM), which forms the basis of a coordinated dissemination of standard 11 frequencies and time signals. 12 2.3.10 Dispatch Circuit. A circuit over which a signal is transmitted from the Public Safety Answering 13 Point to an emergency response facility (ERF) or emergency response unit (ERU) to notify the emergency 14 response unit to respond to an emergency. 15 2.3.11 Emergency Call Processing/Dispatching. A process by which an emergency call answered at the 16 Public Safety Answering Point is transmitted to emergency response facilities (ERFs) or to emergency 17 response units (ERU) in the field. 18 2.3.12 Emergency Response Unit (ERU). A first responder to include but not limited to a police vehicle, 19 a fire truck, and an ambulance. 20 2.3.13 Logging Voice Recorder. A device that records voice conversations and automatically logs the 21 time and date of such conversations; normally, a multichannel device that keeps a semi - permanent record 22 of operations. 23 2.3.14 Notification. The time at which an emergency call is received and acknowledged at a Public 24 Safety Answering Point. 25 2.3.15 Operations Room. The room in the Public Safety Answering Point where emergency calls are 26 received and processed and communications with emergency response personnel are conducted. 27 2.3.16 Public Safety Agency. An organization that provides law enforcement, emergency medical, fire, 28 rescue, communications, or related support services. 29 2.3.17 Security Vestibule. A compartment provided with two or more doors where the intended purpose 30 is to prevent continuous and unobstructed passage by allowing the release of only one door at a time. 31 2.3.18 Standard Operating Procedures (SOPS). Written organizational directives that establish or 32 prescribe specific operational or administrative methods that are to be followed routinely for the 33 performance of designated operations or actions. 34 2.3.19 Stored Emergency Power Supply System (SEPSS). A system consisting of a UPS, or a motor 35 generator, powered by a stored electrical energy source, together with a transfer switch designed to Page 3 157 D RAFT North Carolina 911 Board Operating Standards — Version 04/14/2011 D RA FT 1 monitor preferred and alternate load power source and provide desired switching of the load, and all 2 necessary control equipment to make the system functional. 3 2.3.20 TDD /TTY. A device that is used in conjunction with a telephone to communicate with persons 4 who are deaf, who are hard of hearing, or who have speech impairments, by typing and reading text. 5 2.3.21 Telecommunicator. A Telecommunicator shall mean any person engaged in or employed as a full 6 time or part time 911 communications center call taker (emergency communications specialist, 7 emergency dispatcher, etc.) and is engaged in the act of processing a 911 call for emergency assistance by 8 a Primary PUBLIC SAFETY ANSWERING POINT, including the use of 911 system equipment, call 9 classification, location of a caller, determination of the appropriate response level for emergency 10 responders, and dispatching 911 call information to the appropriate responder and 911 System. 11 2.3.22 Uninterruptible Power Supply (UPS). A system designed to provide power, without delay or 12 transients, during any period when the primary power source is incapable of performing. 13 2.3.23 Voice Communication Channel. A single path for communication by spoken word that is distinct 14 from other parallel paths. 15 Section 3 Public Safetv Answering Point (PSAP) 16 3.1 General. 17 3.1.1 Any Primary Public Safety Answering Point, Backup Public Safety Answering Point, or 18 Secondary Public Safety Answering Point that receives funding from the NC 911 Board is required to 19 comply with all NC 911 Board Standards. 20 3.1.2 All equipment, software, and services used in the daily operation of the Public Safety Answering 21 Point shall be kept in working order at all times. 22 3.1.3 The Public Safety Answering Point shall be provided with an alternate means of communication 23 that is compatible with the alternate means of communication provided at the Emergency Response 24 Facilities (ERFs). 25 3.1.3.1 The alternate means shall be readily available to the Telecommunicators in the event of failure of 26 the primary communications system. 27 3.1.3.2 The Telecommunicators shall be trained and capable of using the alternate means in the event of 28 failure of the primary communications system. 29 3.1.4 Each Public Safety Answering Point shall maintain a Backup Public Safety Answering Point or 30 have an arrangement for backup provided by another Public Safety Answering Point. Agencies are 31 encouraged to pool resources and create regional backup centers. 32 3.1.4.1 The Backup Public Safety Answering Point shall be capable, when staffed, of performing the 33 emergency functions performed at the primary Public Safety Answering Point. 34 3.1.4.2 The Backup Public Safety Answering Point shall be separated geographically from the primary 35 Public Safety Answering Point at a distance that ensures the survivability of the alternate center. Page 4 158 D RAFT North Carolina 911 Board Operating Standards — Version 04/14/2011 D RA FT 1 3.1.4.3 Each Public Safety Answering Point shall develop a formal plan to maintain and operate the 2 Backup Public Safety Answering Point or if backup is provided by another Public Safety Answering 3 Point a formal plan that defines the duties and responsibilities of the alternate Public Safety Answering 4 Point. 5 3.1.4.3.1 The plan shall include the ability to reroute incoming emergency call traffic to the backup center 6 and to process and dispatch emergency calls at that backup center. 7 3.1.4.3.2 The plan shall be included in the Comprehensive Emergency Management Plan (CEMP). 8 3.1.5 The Public Safety Answering Point shall be capable of continuous operation long enough to 9 enable the transfer of operations to the Backup Public Safety Answering Point in the event of an 10 emergency in the Public Safety Answering Point or in the building that houses the Public Safety 11 Answering Point. 12 3.1.6 Systems that are essential to the operation of the Public Safety Answering Point shall be designed 13 to accommodate peak workloads. 14 3.1.7 Public Safety Answering Points shall be designed to accommodate the staffmg level necessary to 15 operate the center as required by the Standards set herein. 16 3.1.8 The design of the Public Safety Answering Point shall be based on the number of personnel 17 needed to handle peak workloads as required by the Standards set herein. 18 3.1.9 Each Public Safety Answering Point shall have a written Comprehensive Emergency 19 Management Plan (CEMP). 20 3.1.9.1 Emergency Fire Plan. There shall be a local management approved, written, dated, and annually 21 tested emergency fire plan that is part of the CEMP. 22 3.1.9.2 Damage Control Plan. There shall be a local management approved, written, dated, and annually 23 tested damage control plan that is part of the CEMP. 24 3.1.9.3 Backup Plan. There shall be a local management approved, written, dated, and annually tested 25 backup Public Saftey Answering Point plan that is part of the CEMP and approved by the NC 911 Board. 26 3.1.10 Penetrations into the Public Safety Answering Point shall be limited to those necessary for the 27 operation of the center. 28 Section 4 Power 29 4.5.1 At least two independent and reliable power sources shall be provided, one primary and one 30 secondary, each of which shall be of adequate capacity for operation of the Public Safety Answering 31 Point. 32 4.5.2. Power sources shall be monitored for integrity, with annunciation provided in the operations 33 room. 34 4.5.3 Primary Power Source. One of the following shall supply primary power: Page 5 159 D RAFT North Carolina 911 Board Operating Standards — Version 04/14/2011 D RA FT 1 4.5.3.1 A feed from a commercial utility distribution system 2 4.5.3.2 An engine -driven generator installation or equivalent designed for continuous operation, where a 3 person specifically trained in its operation is on duty at all times 4 4.5.3.3 An engine -driven generator installation or equivalent arranged for cogeneration with commercial 5 light and power, where a person specifically trained in its operation is on duty or available at all times. 6 4.5.4 Secondary Power Source. 7 4.5.4.1 The secondary power source shall consist of one or more standby engine -driven generators. 8 4.5.4.2 Upon failure of primary power, transfer to the standby source shall be automatic. 9 4.5.5 Stored Emergency Power Supply System ( SEPSS) shall be provided for telecommunications 10 equipment, two -way radio systems, computer systems, and other electronic equipment determined to be 11 essential to the operation of the Public Safety Answering Point. 12 4.5.5.1 The SEPSS shall be of a class that is able to maintain essential operations long enough to 13 implement the formal Comprehensive Emergency Management Plan. 14 4.5.5.2 The instrumentation required to monitor power shall be remotely annunciated in the operations 15 room. 16 4.5.6 Power circuits shall include their associated motors, generators, rectifiers, transformers, fuses, 17 and controlling devices. 18 4.5.6.1 The power circuit disconnecting means shall be installed so that it is accessible only to authorized 19 personnel. 20 4.5.6.2 Surge Arresters otherwise known as Transient Voltage Surge Suppression ('IVSS) shall be 21 provided for protection of telecommunications equipment, two -way radio systems, computers, and other 22 electronic equipment determined to be essential to the operation of the Public Safety Answering Point. 23 4.5.7 Isolated Grounding System. Telecommunications equipment, two -way radio systems, computers, 24 and other electronic equipment determined to be essential to the operation of the Public Safety Answering 25 Point shall be connected to an isolated grounding system. 26 4.5.8 Engine -driven generators shall be sized to supply power for the operation of all functions of the 27 Public Safety Answering Point. 28 4.5.8.1 When installed indoors, engine -driven generators shall be located in a ventilated and secured area 29 that is separated from the Public Safety Answering Point by fire barriers having a fire resistance rating of 30 2 hours or better. 31 4.5.8.2 When installed outdoors, engine -driven generators shall be located in a secure enclosure. 32 4.5.8.3 The area that houses an engine - driven generator shall not be used for storage other than spare parts 33 or equipment related to the generator system. Page 6 160 D RAFT North Carolina 911 Board Operating Standards — Version 04/14/2011 D RA FT 1 4.5.8.4 Fuel to operate the engine -driven generator for a minimum of 24 hours at full load shall be 2 available on site. 3 4.5.8.5 Equipment essential to the operation of the generator shall be supplied with standby power from 4 the generator. 5 4.5.8.6 Generators shall not use the public water supply for engine cooling. 6 4.5.9 Uninterruptible Power Supply (UPS) and Battery Systems. A UPS and battery system shall be 7 installed and be sufficient to prevent power surges from damaging equipment in the 911 Emergency 8 Center as well as provide power for all essential 911 Emergency Center operations until the backup power 9 source can be fully activated. 10 4.5.9.1 Each UPS shall be provided with a bypass switch that maintains the power connection during 11 switch over and that is capable of isolating all UPS components while allowing power to flow from the 12 source to the load. 13 4.5.9.2 The following UPS conditions shall be annunciated in the operations room: 14 (1) Source power failure, overvoltage, and under- voltage 15 (2) High and low battery voltage 16 (3) UPS in bypass mode. 17 18 19 5.1 General Section 5 Construction 20 As a condition for receipt of a grant from the North Carolina 9 -1 -1 Board for any type of new 21 construction or for a renovation of an existing structure and/or facility incorporated into the construction 22 agreement(s) shall be the following requirements. 23 5.1.1 The requirements in Section 4 Construction, shall apply only to new construction and 24 construction renovations funded by the North Carolina 911 Board. Existing Public Safety Answering 25 Point facilities are encouraged to meet these standards, but are not required to meet these standards. 26 5.2 HVAC. 27 5.2.1. HVAC systems shall be designed to maintain temperature and relative humidity within limits 28 specified by the manufacturer of the equipment critical to the operation of the Public Safety Answering 29 Point. 30 5.2.2 HVAC systems shall be independent systems that serve only the Public Safety Answering Point. 31 5.2.3 HVAC system intakes for fresh air shall be arranged to minimize smoke intake from a fire inside 32 or outside the building and to resist intentional introduction of irritating, noxious, toxic, or poisonous 33 substances into the HVAC system. Page 7 161 D RAFT North Carolina 911 Board Operating Standards — Version 04/14/2011 D RA FT 1 5.2.4 HVAC emergency controls shall be provided in the operations room to permit closing of outside 2 air intakes. 3 5.2.5 Backup HVAC systems shall be provided for the operations room and other spaces housing 4 electronic equipment essential to the operation of the Public Safety Answering Point. 5 5.2.6 HVAC systems shall be designed so that the Public Safety Answering Point is capable of 6 uninterrupted operation with the largest single HVAC unit or component out of service. 7 5.3 Fire Protection. 8 5.3.1 The Public Safety Answering Point and spaces adjoining the Public Safety Answering Point shall 9 be provided with an automatic fire detection, alarm, and notification system. 10 5.3.2 The alarm system shall be monitored in the operations room. 11 5.3.3 Operation of notification appliances shall not interfere with communications operations. 12 5.3.4 Electronic computer and data processing equipment shall be protected in accordance with the 13 manufacturer's recommended specifications, and common business practices. 14 5.4 Security. 15 5.4.1 The Public Safety Answering Point and other buildings that house essential operating equipment 16 shall be protected against damage from vandalism, terrorism, and civil disturbances. 17 5.4.2 Entry to the Public Safety Answering Point shall be restricted to authorized persons. 18 5.4.3 Entryways to the Public Safety Answering Point that lead directly from the exterior shall be 19 protected by a security vestibule. 20 5.4.4 Door openings shall be protected by listed, self - closing fire doors that have a fire resistance rating 21 of not less than 1 hour. 22 5.4.5 Where a Public Safety Answering Point has windows, the following requirements shall apply: 23 5.4.5.1 Windows shall be a minimum of 4 ft (1.2 m) above floor level. 24 5.4.5.2 Windows shall be rated for bullet resistance to Level 4 as defined in UL 752, Standard for Safety 25 Bullet- Resistant Equipment. 26 5.4.5.3 Windows that are not bullet resistant shall be permitted provided that they face an area that 27 cannot be accessed or viewed by the general public. 28 5.4.5.4 Windows that are required to be bullet resistant shall be configured so that they cannot be opened. 29 5.4.5.5 Walls with bullet- resistant windows shall be required to provide the same level of protection as 30 the window. Page 8 162 D RAFT North Carolina 911 Board Operating Standards — Version 04/14/2011 D RA FT 1 5.4.6 Means shall be provided to prevent unauthorized vehicles from approaching the building housing 2 the Public Safety Answering Point to a distance of no less than 82 ft (25 m). 3 5.4.7 As an alternative to prevent unauthorized vehicles, unauthorized vehicles shall be permitted to 4 approach closer than 82 ft (25 m) if the building has been designed to be blast resistant. 5 5.6 Lighting. 6 5.6.1 Artificial lighting shall be provided to enable personnel to perform their assigned duties. 7 5.6.2 Emergency Lighting. The Public Safety Answering Point shall be equipped with emergency 8 lighting that shall illuminate automatically immediately upon failure of normal lighting power. 9 5.6.3 Illumination levels shall be sufficient to allow all essential operations. 10 5.7 Circuit Construction and Arrangement. 11 5.7.1 As built drawings shall be provided. 12 5.7.2 Circuits shall not pass over, pass under, pass through, or be attached to buildings or property that 13 is not owned by, or under the control of, the PSAP or the entity that is responsible for maintaining the 14 system. 15 5.7.3 Emergency call instruments installed in buildings not under control of the PSAP shall be on 16 separate dedicated circuits. 17 5.7.4 The combination of public emergency services communication and signaling (C &S) circuits in 18 the same cable with other circuits shall comply with the following: 19 5.7.4.1 Other municipally controlled C &S circuits shall be permitted. 20 5.7.4.2 Circuits of private signaling organizations shall be permitted only by permission of the PSAP. 21 5.8 Underground Cables. 22 5.8.1 Underground communication and signal cables shall be brought above ground only at points 23 where the PSAP has determined there is no potential for mechanical damage or damage from fires in 24 adjacent buildings. 25 5.8.2 All cables that are installed in manholes, vaults, and other enclosures intended for personnel entry 26 shall be racked and marked for identification. 27 5.8.3 Cable splices, taps, and terminal connections shall be located only where accessible for 28 maintenance and inspection and where no potential for damage to the cable due to falling structures or 29 building operations exists. 30 5.8.4 Cable splices, taps, and terminal connections shall be made to provide and maintain levels of 31 conductivity, insulation, and protection that are at least equivalent to those afforded by the cables that are 32 joined. Page 9 163 D RAFT North Carolina 911 Board Operating Standards — Version 04/14/2011 D RA FT 1 5.9 Aerial Cables and Wires. 2 5.9.1 Protection shall be provided where cables and wires pass through trees, under bridges, and over 3 railroads, and at other locations where damage or deterioration is possible. 4 5.10 Wiring Inside Buildings. 5 5. 10.1 Conductors at the Public Safety Answering Point shall extend to the operations room in conduits, 6 ducts, shafts, raceways, or overhead racks and troughs of a construction type that protects against fire and 7 mechanical damage. 8 5.10.2 Cables or wiring exposed to fire hazards shall be protected from the hazard. 9 5.10.3 At the Public Safety Answering Point, cable terminals and cross connecting facilities shall be 10 located either in or adjacent to the operations room. 11 5.10.4 All wired dispatch circuit devices and instruments whose failure can adversely affect the 12 operation of the system shall be mounted in accordance with the following: 13 (1) On noncombustible bases, pedestals, switchboards, panels, or cabinets 14 (2) With mounting designed and constructed so that all components are readily accessible 15 5.11 Circuit Protection. 16 5.11.1 All surge arresters shall be connected to earth ground. 17 5.11.2 All protective devices shall be accessible for maintenance and inspection. 18 5.11.3 Surge arresters shall be designed and listed for the specific application. 19 5.11.4 Each conductor that enters a Public Safety Answering Point from a partially or entirely aerial line 20 shall be protected by a surge arrester. 21 5.12 Grounding. 22 5.12.1 Sensitive electronic equipment determined by the PSAP to be essential to the operation of 23 telecommunications and dispatching systems shall be grounded. 24 5.12.2 Listed isolated ground receptacles shall be provided for all cord - and - plug - connected essential and 25 sensitive electronic equipment. 26 5.12.3 Unused wire or cable pairs shall be grounded. 27 5.12.4 Ground connection for surge suppressors shall be made to the isolated grounding system. 28 5.13 Access. 29 5.13.1 All equipment shall be accessible for the purpose of maintenance. 30 Page 10 164 D RAFT North Carolina 911 Board Operating Standards — Version 04/14/2011 D RA FT 1 Section 6 Operations 2 6.1 Management. 3 6.1.1 All systems shall be under the control of a responsible employee or employees of the PSAP 4 served by the systems. 5 6.1.2 The Public Safety Answering Point Emergency services dispatching entities shall have trained 6 and qualified technical assistance available for trouble analysis and repair by in -house personnel or by 7 authorized outside contract maintenance services. 8 6.1.3 Where maintenance is provided by an organization or person other than an employee of the PSAP 9 complete written records of all installation, maintenance, test, and extension of the system shall be 10 forwarded to the responsible employee of the PSAP. 11 6.1.3.1 Maintenance performed by an organization or person other than an employee of the Public Safety 12 Answering Point shall be by written contract that contains a guarantee of performance. 13 6.1.5 The Public Safety Answering Point shall have a written local management approved access 14 control plan. 15 6.1.4.1 Maintenance personnel other than an employee of the Public Safety Answering Point shall be 16 approved by the Public Safety Answering Point pursuant to the approved access control plan as offering 17 no threat to the security of the facility or the employees and equipment within it. 18 6.1.5 All equipment shall be accessible to the PSAP for the purpose of maintenance. 19 6.1.6 At least one supervisor or lead with Telecommunicator certification shall be available to respond 20 immediately at all times 24 hours per day, 7 days per week, 52 weeks per year. 21 6.2 Telecommunicator and Supervisor Qualifications and Training. 22 6.2.1 Telecommunicators and Supervisors shall be certified in the knowledge, skills, and abilities 23 related to their job function. 24 6.2.2 Telecommunicators and Supervisors shall have knowledge of the function of all communications 25 equipment and systems in the Public Safety Answering Point. 26 6.2.3 Telecommunicators and Supervisors shall know the rules and regulations that relate to equipment 27 use, including those of the Federal Communications Commission that pertain to emergency service radio 28 use. 29 6.2.4 Telecommunicators and Supervisors shall be capable of operating and testing the 30 communications equipment they are assigned to operate. 31 6.2.5 Telecommunicators and Supervisors shall receive training to maintain the skill level appropriate 32 to their position. Page 11 165 D RAFT North Carolina 911 Board Operating Standards — Version 04/14/2011 D RA FT 1 6.2.6 Telecommunicators and Supervisors shall be trained in TDD /TTY procedures, with training 2 provided at a minimum of once per year as part of the Annual Training. 3 6.3 Staffing. 4 6.3.1 There shall be sufficient Telecommunicators available to affect the prompt receipt and processing 5 of emergency calls needed to meet the requirements as specified herein. 6 6.3.2 After January 1, 2013 a minimum of two (2) Telecommunicators must be available at all times 24 7 hours per day, 7 days per week, 52 weeks per year to immediately receive and process emergency calls. 8 6.3.3 Where communications systems, computer systems, staff, or facilities are used for both 9 emergency and non - emergency functions, the non - emergency use shall not degrade or delay emergency 10 use of those resources. 11 6.3.3.1 A Public Safety Answering Point shall handle emergency calls for service and dispatching in 12 preference to nonemergency activities. 13 6.3.4 The PSAP and emergency response agencies shall develop standard operating procedures that 14 identify when a dedicated Telecommunicator is required to be assigned to an emergency incident. 15 6.3.5 Telecommunicators shall not be assigned any duties prohibiting them from immediately receiving 16 and processing emergency calls for service in accordance with the time frame specified in the Operating 17 Procedures. 18 6.4 Operating Procedures. 19 6.4.1 Ninety (90) percent of emergency calls received on emergency lines shall be answered within ten 20 (10) seconds, and ninety -five (95) percent of emergency calls received on emergency lines shall be 21 answered within twenty (20) seconds. 22 6.4.1.1 Compliance with 5.4.1 shall be evaluated monthly using data from the previous month. 23 6.4.2 The Public Safety Answering Point is required to provide pre - arrival medical protocols as set 24 forth by the North Carolina Office of Emergency Services, Health and Human Services in the initial call 25 reception or by the responsible EMS provider on behalf of the primary answering point. 26 6.4.3 For law enforcement purposes, the Public Safety Answering Point shall determine time frames 27 allowed for completion of dispatch. 28 6.4.4 When emergency calls need to be transferred to another PSAP, the Telecommunicator will 29 transfer the call without delay. The Telecommunicator will advise the caller: "Please do not hang up; I am 30 connecting you with (name of the agency)." The Telecommunicator should stay on the line until the 31 connection is complete and verified. 32 6.4.4.1 The Public Safety Answering Point shall transfer calls for services as follows: 33 (1) The call for service shall be transferred directly to the Telecommunicator. Page 12 166 D RAFT North Carolina 911 Board Operating Standards — Version 04/14/2011 D RA FT 1 (2) The answering transferring agency shall remain on the line until it is certain that the transfer is 2 affected. 3 (3) The transfer procedure shall be used on emergency 9 -1 -1 calls. 4 6.4.5 All calls for service, including requests for additional resources, shall be transmitted to the 5 identified emergency response units over the required dispatch systems. 6 6.4.6 An indication of the status of all emergency response units shall be available to appropriate 7 Telecommunicators at all times. 8 6.4.7 Records of the dispatch of emergency response units to call for services shall be maintained and 9 shall identify the following: 10 (1) Unit designation for each emergency response unit dispatched 11 (2) Time of dispatch acknowledgment by each emergency response unit responding 12 (3) Enroute time of each emergency response unit 13 (4) Time of arrival of each emergency response unit at the scene 14 (5) Time of patient contact, if applicable 15 (6) Time each emergency response unit is returned to service 16 6.4.8 All emergency response agencies shall use common terminology and integrated incident 17 communications. 18 6.4.9 When the device monitoring the system for integrity indicates that trouble has occurred, the 19 Telecommunicator shall act as follows: 20 (1) Take appropriate steps to repair the fault. 21 (2) Isolate the fault and notify the official responsible for maintenance if repair is not possible. 22 6.4.10 Standard operating procedures shall include but not be limited to the following: 23 (1) All standardized procedures that the Telecommunicator is expected to perform without direct 24 supervision 25 (2) Implementation plan that meets the requirements of a formal plan to maintain and operate the Backup 26 Public Safety Answering Point. 27 (3) Procedures related to the CEMP. 28 (4) Emergency response personnel emergencies. 29 (5) Activation of an emergency distress function. 30 (6) Assignment of incident radio communications plan. Page 13 167 D RAFT North Carolina 911 Board Operating Standards — Version 04/14/2011 D RA FT 1 (7) Time limit for acknowledgment by units that have been dispatched. 2 6.4.11 Every Public Safety Answering Point shall have a comprehensive regional emergency 3 communications plan as part of the CEMP. 4 6.4.11.1 The emergency communications plan shall provide for real -time communications between 5 organizations responding to the same emergency incident. 6 6.4.11.2 This emergency communications plan shall be exercised at least once a year. 7 6.4.12 In the event that an emergency response unit(s) has not acknowledged its dispatch/response 8 within the time limits established by the Public Safety Answering Point, the Telecommunicator shall 9 perform one or more of the following: 10 (1) Attempt to contact the emergency response unit (s) by radio. 11 (2) Re- dispatch the emergency response unit(s) using the primary dispatch system. 12 (3) Dispatch the emergency response unit(s) using the secondary dispatch system. 13 (4) Initiate two -way communication with the emergency response unit's supervisor. 14 6.4.13 The Public Safety Answering point shall develop and implement standard operating procedures 15 for responding to and processing TDD /TTY calls. 16 6.4.14 Calls received as an open -line or "silent call" shall be queried as a TDD /TTY call if no 17 acknowledgment is received by voice. 18 6.4.15. A Public Safety Answering Point must have a written procedure for handling 911 hang -up calls. 19 6.5 Time. 20 6.5.1 The clock for the main recordkeeping device in the Public Safety Answering Point shall be 21 synchronized to Coordinated Universal Time. 22 6.5.2 All timekeeping devices in the Public Safety Answering Point shall be maintained within f5 23 seconds of the main recordkeeping device clock. 24 6.6 Recording. 25 6.6.1 Public Safety Answering Points shall have a logging voice recorder with one channel for each of 26 the following: 27 (1) Each transmitted or received emergency radio channel or talk group. 28 (2) Each voice dispatch call for service circuit. 29 (3) Each Telecommunicator telephone that receives emergency calls for service. Page 14 .: D RAFT North Carolina 911 Board Operating Standards — Version 04/14/2011 D RA FT 1 6.6.2 Each Telecommunicator position shall have the ability to instantly recall telephone and radio 2 recordings from that position as applicable. 3 6.6.3 Emergency calls that are transmitted over the required dispatch circuit(s) shall be automatically 4 recorded, including the dates and times of transmission. 5 6.7 Quality Assurance 6 6.7.1 Public Safety Answering Points shall establish a quality assurance /improvement program to 7 ensure the consistency and effectiveness of emergency call processing. 8 6.7.2 Statistical analysis of emergency call and dispatch performance measurements shall be completed 9 monthly and compiled over a one (1) year period. 10 11 Section 7 Telephones 12 7.1 Telephone Receiving Equipment. 13 The provisions of this Section shall apply to facilities and equipment that receive emergency calls 14 transmitted by public use of commercial telephone systems, cellular or personal communications services 15 systems, and voice over Internet protocol (VOIP). 16 7.2 Equipment and Operations. 17 7.2.1 Telephone lines shall be provided as follows: 18 (1) A minimum of two 911 emergency telephone lines and 911 emergency telephone devices shall be 19 assigned exclusively for receipt of emergency calls. These lines shall appear on at least two telephone 20 devices within the Public Safety Answering Point. 21 (2) Additional 911 emergency telephone lines and 911 emergency telephone devices shall be provided as 22 required for the volume of calls handled. 23 (3) Additional telephone lines and telephone devices shall be provided for the normal business (non- 24 emergency) use as needed. 25 (4) At least one outgoing -only telephone line and telephone device shall be provided. 26 7.2.2 911 emergency lines and emergency telephone devices will be answered prior to non - emergency 27 telephone lines and non - emergency telephone devices. 28 7.2.3 When all 911 emergency telephone lines and emergency telephone devices are in use, emergency 29 calls shall hunt to other predetermined telephone lines and telephone devices that are approved by the 30 Public Safety Answering Point. 31 7.2.4 Calls to the business number shall not hunt to the designated emergency lines. Page 15 169 D RAFT North Carolina 911 Board Operating Standards — Version 04/14/2011 D RA FT 1 7.2.5 When a Public Safety Answering Point receives an emergency call for a location or an agency 2 that is not in its jurisdiction, the Public Safety Answering Point shall transfer the call directly to the 3 responsible Public Safety Answering Point. When possible the call data will be transferred with the 4 emergency call. If the call transfer method is not possible, call information shall be relayed by the 5 Telecommunicator. 6 7.2.5.1 The Telecommunicator shall remain on the line until it is certain that the transfer has been made 7 and the originating Telecommunicator verifies the transfer has been successfully completed by hearing 8 both parties speaking to each other. 9 7.2.6 All 911 emergency calls shall be recorded. 10 7.3 Circuits /Trunks. 11 7.3.1 At least two 911 call delivery paths with diverse routes arranged so that no single incident 12 interrupts both routes shall be provided to each Public Safety Answering Point. 13 7.3.2 Where multiple Public Safety Answering Points that serve a jurisdiction are not located in a 14 common facility, at least two circuits with diverse routes, arranged so that no singular incident interrupts 15 both routes, shall be provided between Public Safety Answering Points. 16 7.3.3 The Public Safety Answering Point shall have sufficient 911 emergency trunk capacity to receive 17 99.9% of all calls during the busiest hour of the average week of the busiest month of the year. 18 7.4 911 Emergency Number Alternative Routing. 19 7.4.1 Public Safety Answering Points shall maintain a written plan as part of the Comprehensive 20 Emergency Management Plan (CEMP) for rerouting incoming calls on 911 emergency lines when the 21 center is unable to accept such calls. 22 7.4.1.1 The Public Safety Answering Point shall practice this plan at least once annually. 23 7.4.2 Where overflow calls to 911 emergency telephone lines and emergency telephone devices are 24 routed to alternative telephone lines and alternative telephone devices within the Public Safety Answering 25 Point, the alternative telephone lines and alternative telephone devices shall be monitored for integrity 26 and recorded as required by these standards. 27 28 Section 8 Dispatching Systems 29 8.1 Fundamental Requirements of Emergency Call Dispatching Systems. 30 8.1.1 An emergency call dispatching system shall be designed, installed, operated, and maintained to 31 provide for the receipt and retransmission of calls. 32 8.2 Telecommunicators that receive emergency calls shall have redundant means within the PSAP 33 premises to dispatch calls. Page 16 170 D RAFT North Carolina 911 Board Operating Standards — Version 04/14/2011 D RA FT 1 (1) The failure of any component of one dispatching means shall not affect the operation of the 2 alternative dispatching means and vice versa. 3 8.3 Primary dispatch paths and devices upon which transmission and receipt of emergency calls 4 depend shall be monitored constantly for integrity to provide prompt warning of trouble that impacts 5 operation. 6 8.3.1 Trouble signals shall actuate an audible device and a visual signal located at a constantly attended 7 location. 8 8.3.2 The audible alert trouble signals from the fault and failure monitoring mechanism shall be 9 distinct from the audible alert emergency alarm signals. 10 8.3.3 The audible trouble signal shall be permitted to be common to several monitored circuits and 11 devices. 12 8.3.4 A switch for silencing the audible trouble signal shall be permitted if the visual signal continues 13 to operate until the silencing switch is restored to the designated normal position. 14 8.3.5 Where dispatch systems use computer diagnostic software, monitoring of the primary dispatch 15 circuit components shall be routed to a dedicated terminal(s) that meets the following requirements: 16 (2) It shall be located within the communications center. 17 (3) It shall not be used for routine dispatch activities. 18 8.4 The radio communications system shall be monitored in the following ways: 19 (1) Monitoring for integrity shall detect faults and failures in the radio communications system. 20 (2) Detected faults and failures in the radio communications system shall cause audible or visual 21 indications to be provided within the Public Safety Answering Point. 22 23 Section 9 Computer -Aided Dispatching (CAD) Systems 24 9.1 General. 25 9.1.1 PSAPs shall use Computer -Aided Dispatch (CAD) systems. These systems shall conform to the 26 items outlined in this Section. 27 9.1.2 The CAD system shall contain all hardware and software components necessary for interface 28 with the 9 -1 -1 system. 29 9.2 Secondary Method. 30 9.2.1 A secondary method shall be provided and shall be available for use in the event of a failure of 31 the CAD system. Page 17 171 D RAFT North Carolina 911 Board Operating Standards — Version 04/14/2011 D RA FT 1 9.3 Security. 2 9.3.1 CAD systems shall utilize different levels of security to restrict unauthorized access to sensitive 3 and critical information, programs, and operating system functions. 4 9.3.2 The PSAP shall have the ability to control user and supervisor access to the various security 5 levels. 6 9.3.3 Physical access to the CAD system hardware shall be limited to authorized personnel as 7 determined by the PSAP. 8 9.3.4 Operation of the CAD system software shall be limited to authorized personnel by log - 9 on/password control, workstation limitations, or other means as required by the PSAP. 10 9.3.5 The CAD system shall provide network isolation necessary to preserve bandwidth for the 11 efficient operation of the system and processing of emergency calls. 12 9.3.5.1 The CAD system shall provide measures to prevent denial -of- service attacks and any other 13 undesired access to the CAD portion of the network. 14 9.3.5.2 The CAD system shall employ antivirus software where necessary to protect the system from 15 infection. 16 9.4 Emergency Call Data Exchange. 17 9.4.1 The CAD system should have the capability to allow emergency call data exchange between the 18 CAD system and other CAD systems. 19 9.4.2 The CAD system should have the capability to allow data exchange between the CAD system and 20 other systems. 21 9.5 CAD Capabilities. 22 9.5.1 The installation of a CAD system in emergency service dispatching shall not negate the 23 requirements for a secondary dispatch circuit. 24 9.5.2 Software that is a part of the CAD system shall provide data entry; provide resource 25 recommendations, notification, and tracking; store records relating to all emergency calls and all other 26 calls for service and status changes; and track those resources before, during, and after emergency calls, 27 preserving records of those emergency calls and status changes for later analysis. 28 9.5.2.1 The Public Safety Answering Point shall put in place safeguards to preserve the operation, 29 sustainability, and maintainability of all elements of the CAD system in the event of the demise or default 30 of the CAD supplier. 31 9.5.2.2 The system applications shall function under the overall control of a standard operating system 32 that includes support functions and features as required by the Public Safety Answering Point 33 9.6 Computer Aided Dispatch (CAD) Performance. Page 18 172 D RAFT North Carolina 911 Board Operating Standards — Version 04/14/2011 D RA FT 1 9.6.2 The Computer Aided Dispatch system shall recommend units for assignment to calls. 2 9.6.2.1 The Computer Aided Dispatch system shall ensure that the optimum response units are selected. 3 9.6.2.2 The Computer Aided Dispatch system shall allow the Telecommunicator to override the CAD 4 recommendation for unit assignment. 5 9.6.2.3 The Computer Aided Dispatch system shall have the ability to prioritize all system processes so 6 that emergency operations take precedence. 7 9.6.3 The Computer Aided Dispatch system shall detect errors and /or faults and failures. 8 9.6.3.1 The Computer Aided Dispatch system shall automatically perform all required reconfiguration as 9 a result of the faults or failures. 10 9.6.3.2 The Computer Aided Dispatch system should queue a notification message to the supervisor and 11 any designated Telecommunicator positions. 12 9.6.4 Under all conditions, the Computer Aided Dispatch system response time should not exceed 2 13 seconds, measured from the time a Telecommunicator completes a keyboard entry to the time of full 14 display of the system response at any position where a response is required. 15 9.6.5 The Computer Aided Dispatch system shall be available and fully functional 99.95 percent of the 16 time, excluding planned maintenance. 17 9.6.6 The Computer Aided Dispatch system shall include automatic power -fail recovery capability. 18 9.7 Backup. 19 9.7.1 The Computer Aided Dispatch system shall include a data backup system, utilizing either 20 removable media or independent disk storage arrays dedicated to the backup task. 21 9.8 Redundancy. 22 9.8.1 The failure of any single component shall not disable the entire system. 23 9.8.1.1 The Computer Aided Dispatch system shall provide switchover in case of failure of the required 24 system component(s). 25 9.8.1.2 Manual intervention by Telecommunicators or others shall not be required. 26 9.8.1.3 Notwithstanding automatic switchover, the Computer Aided Dispatch system shall provide the 27 capability to manually initiate switchover. 28 9.8.1.4 Computer Aided Dispatch Systems that utilize server and workstation configuration shall 29 accomplish automatic switch over by having a duplicate server available with access to all the data 30 necessary and required to restart at the point where the primary server stopped. 31 9.8.1.5 Computer Aided Dispatch Systems that utilize distributed processing, with workstations in the 32 operations room also providing the call processing functions, shall be considered to meet the requirements Page 19 173 D RAFT North Carolina 911 Board Operating Standards — Version 04/14/2011 D RA FT 1 of automatic switchover, as long as all such workstations are continually sharing data and all data 2 necessary to pick up at the point where the failed workstation stopped are available to all other designated 3 dispatch workstations. 4 9.8.2 Monitoring for Integrity. 5 9.8.2.1 The system shall continuously monitor the Computer Aided Dispatch interfaces for equipment 6 failures, device exceptions, and time -outs. 7 9.8.2.2 The system shall, upon detection of faults or failures, send an appropriate message consisting of 8 visual and audible indications. 9 9.8.3 The system shall provide a log of system messages and transactions. 10 9.8.4 At least one spare display screen, pointing device, and keyboard shall be available in the Public 11 Safety Answering Point for immediate change -out. 12 Section 10 TestinE 13 10.1 General. 14 10.1.1 Tests and inspections of all systems shall be made at the regular intervals. 15 10.1.2 All equipment shall be restored to operating condition after each test or emergency call for which 16 the equipment functioned. 17 10.1.3 Where tests indicate that trouble has occurred anywhere on the system, one of the following shall 18 be required: 19 (1) The Telecommunicator shall take appropriate steps within their scope of training to repair the fault. 20 (2) If repair is not possible, action shall be taken to isolate the fault and to notify the official responsible 21 for maintenance. 22 10.1.4 Procedures that are required by other parties and that exceed the requirements of these standards 23 shall be permitted. 24 10.1.5 The requirements of this Section shall apply to both new and existing systems. 25 10.2 Acceptance Testing. 26 10.2.1 New equipment shall be provided with operation manuals that cover all operations and testing 27 procedures. 28 10.2.2 All functions of new equipment shall be tested in accordance with the manufacturers' 29 specifications and accepted Public Safety Answering Point practices before being placed in service. 30 10.3 Power. Page 20 174 D RAFT North Carolina 911 Board Operating Standards — Version 04/14/2011 D RA FT 1 10.3.1 Emergency and standby power systems shall be tested in accordance with the manufacturer's 2 specifications and accepted business practices. 9 4 5 11.1 General. Section 11 Records 6 11.1.1 Complete records to ensure operational capability of all 911 system functions shall be maintained 7 for a minimum of three years. 8 11. 1.2 Compliance with the requirements in this section shall begin with the purchase or lease of all 9 equipment and services after June 30, 2011. 10 11.2 Acceptance Test Records and As -Built Drawings. 11 After completion of acceptance tests, the following shall be provided: 12 (1) A set of reproducible, as -built installation drawings. 13 (2) Operation and maintenance manuals. 14 (3) Written sequence of operation. 15 (4) Results of all operational tests and values at the time of installation. 16 11.3 Electronic Records 17 11.3.1 For software -based systems, access to site - specific software shall be provided to the PSAP. 18 11.3.2 The PSAP shall be responsible for maintaining the records for the life of the system. 19 11.3.3 Paper or electronic media shall be permitted. 20 11.4 Training Records. 21 11.4.1 Training records shall be maintained for each employee as required by the PSAP. 22 11.5 Operational Records. 23 11.5.1 Call and dispatch performance statistics shall be compiled and maintained. 24 11.5.2 Statistical analysis of emergency call and dispatch performance measurements shall be done 25 monthly and compiled over a one (1) year period. 26 11.5.2.1 A management information system (MIS) program shall track incoming emergency calls and 27 dispatched emergency calls and provide real -time information and strategic management reports. 28 11.5.3 Records of the following, including the corresponding dates and times, shall be kept: Page 21 175 D RAFT North Carolina 911 Board Operating Standards — Version 04/14/2011 D RA FT 1 (1) Test, emergency call, and dispatch signals 2 (2) Circuit interruptions and observations or reports of equipment failures 3 (3) Abnormal or defective circuit conditions indicated by test or inspection 4 11.6 Maintenance Records. 5 11.6.1 Records of maintenance, both routine and emergency, shall be kept for all emergency call 6 receiving equipment and emergency call dispatching equipment. 7 11.6.2 All maintenance records shall include the date, time, nature of maintenance, and repairer's name 8 and affiliation. Page 22 911 EMS /EMD Process What do you NO ECHO status (most serious) call codes are dispatched First Responding Unit know? EMD provitles ps- arrival w /Code A-0 only arnves on scene nstructions (PAI's)to caller; EMD identifies CPR, control of blsetling, etc. 911 call is Entry What is the problem; answered (CC) tell me exactly what Is he /she YES completely :address happened? awake? Dispatch What is the phone Patient EMD relays number you are condition calling from? breathing normal) What do you NO Dispatch Unit(s) First Responding Unit know? w /Code A-0 only arnves on scene Ire you with EMD identifies the patient? "Chief Complaint" (CC) Is he /she YES completely EMD provides Post awake? Dispatch Instructions (PDI's) Patient EMD relays Is he /she condition additional information Terminates breathing normal) (changes) to responding units Call Patient Comfort Is he /she changing color Is he /she clammy, have cold sweats? Does he /she have a history of heart problems? Has he /she taken any drugs or medication in the past 12 hours? Solutions for Local Government, Inc. 177 Fire Call- Structure Fire EMERGENCY CALL PROCESS EXAMPLE: FIRE 911 call is " " ° "' answered ob[ainetl Note: The TIC that took call stays on line with caller (providing there is no danger to caller) to obtain as much information as possible vocation is What is the Sends to What is the phone number � tlesigna[etl console verified by you are calling emergency. for dispatch TC from? Caller unsure (wireless) TIC must retry to determine S tructure Fire Almost simultaneous unless problem - with /Mutual Aide - TIC selects CAD TC selects Talk Groups: TC sends recommends MA Depts Primary "Pre-Alert" AHJ manually OCFD (VHF) EMS (VHF) OPS Console: Select Talk Groups: Ops, OCFD, EMS Answer Apparatus & Officers checking enroute Establish Command Provide 20 min. reminders to Command for on -scene time Follow call through completion Select & .activate I I Announcemnet; pagers; 3 FD's + III AHJ, 2 MA's, EMS EMS TIC provides location,type of call, OPS assignment & time out Call Ends Solutions for Local Government, Inc. 178 Law Enforcement Call- Domestic Violence EMERGENCY CALL PROCESS EXAMPLE: LAW ENFORCEMENT 911 call is answered Call Unit & ID Type of Call Call forwarded to Location is Location is Wha[ is [he phone Wha[ is [he TC Dispatches Give location wlcross streets TC assignetl [o Relay intonna[ion Veri�tenu ob[ainetl verifietl by number you are emergency? Law Ativise on weapons agency & tlispa[chetl [o respontling enfrom caller TC calling from? Enforcement Atltli[ional [o follow LEO Time out Caller unsure G Gather additional Information: (wireless) N Names TC must retry S Severity of situation [o tletermine N NC Aware re: warrants location D DCI re:DVO's Criminal history [Note: Multiple tlatabases] TIC remains on phone until units) provitle uptla[es [o arrive ��EnWds uni[(s) enroute as (depending upon volitility of requiretl situation or location of person(s) Depending on severity of call, responding LEDs may request an Ops talk group to move off primary- which means TIC working the call will have to also monitor the Ops talk group while still dispatching any calls coming in on the primary. Solutions for Local Government, Inc. 179 Copyright 2012 National Fire Protection Association INFPA). Licensed, by agreement, tar Individual use and single download on August 10, 2012 to SMP14EN ALLAN of SOLUTIONS FOR LOCAL GOVERNMENT. No other reproduction or transmisslon In any form permitted without written permlasion of NFPA, For Inquires or to roporl unauthoritod use, contact t'rcensing@nfpa . org. 450 -12 LMERGi:NCY MEDICAL SERVICES AND SYSTEMS (10) Exlriralion capability measure. Percentage of calls requir- ing an extrication tool having one delivered to the scene within 8 minutes of call dispatch. (11) A *nbployee illness and injury measure. Percentage of employ- ees acquiring an illness or injury as a result of participat- ing in an EMS call_ (12) Eviplayee turnover measure Percentage turnover of EMS - trained employees per year. (13) Quality pruptirn measure: Determination of whether- an overall quality program, as described in (1) through (12), exists within the EMS system. (14) System userapinion rneasuir• Mail /phone survey to assess the satisfaction of system users with the system's performance. (15) Mullicosualiy event response plan measurr- An established plan to mitigate a multiple casualty disaster while main- taining sufficient resources to respond to the normal vol- ume of emergency calls within the jurisdiction. 5.5.3.2.2 NHTSA. The National Highway Traffic SafetyAdmirt- istration (N141 SA) has published the document EMSPerformanre Measures. Recommended Afeasures for System and Se-mire Performance using a consensus process to develop performance m". ores R-ir EMS, The document contains indicators and attributes that EMS pmCtitioners identified as critical for performance measurement and evaluation of any emergency medical services system. This resource describes the sources of regttired data, the formulas or questions necessary to examine critical components as well as other evaluation criteria parameters. 5.5.3.2.3 Other Measurement Methods. Accrediting bodies such as the Commission on Fire Accreditation International, the Commission on Accreditation ofAmbulance Services, and others have published measurements anti criteria for EMS systems. The nature of time presents a classic problem in semantics: The same term can have different meanings to different people. Additionally, tradition and unique EMS system design have created a language of time incomparability. The NFPA 450 EMS time template, shown in Table 5,6, is an attempt to solve this problem with consensus terms. The key to this time template is to differentiate clearly between discrete points versus intervals of time. Column A repre- sents discrete points in Lime or Lime stamps that occur during an EMS call, Columns B and C label uniquely the elapsed time or intervals between the time stamps. 5.6.1 The lists in Table 5.6 arc nciL exhaustive but represent typical core points in time and common operational situa- tions. it is not expected that every time stamp be reported. Depending on the EMS system's complexity and level of technology, it is understood that a function interval may be long or instantaneous. However, when reporting EMS sys. tem performance, these consensus teens should be used. 5.6.2 Discrete Time Stamp. The term time stamp refers to the historical tradition in EMS during which call events were re- corded by stamping a card that printed the hour and minute that was displayed at that moment on that clock. 'Today, times are often recorded automatically by cofripuLerized dispatch sysLerns in (tours, minutes, and seconds and are synchronized using the U.S. Naval Observatory's atomic clock. These time stamps define discrete moments at which certain events occur, recorded in hour:minute:second [hh:mm:ss] format. Discrete time stamps, collected in this way, allow the user to measure the interval hettveen events. The system must have the ability to capture Linos stamps in a reliable, consistent, and accurate manner. Not all time stamps are available or collectible, while 101 2019 Edilion others are reported with varying degrees of accuracy, Sharing time stamp data across system components and synchronizing time recording devices are critical to establishing an accurate and reliable measurement process. 5.6.2.1 Function Intervals. An interval is the elapsed lime be- tween two discrete Lime stamps. Function intervals are the in- tervals between consecutive time stamps. The function inter- val describes the activity occurring at the task level of a single call. Function intervals allow analysis of each function that is taking place throughout the continuum of the event. Certain groups of consecutive funcLions describe processes. 5.6.2.2 Process Intervals. A process interval is made up of multiple, consecutive function intervals. A process interval is used to describe the elapsed time required to complete the agency's or system's objective. The process interval allows de- cision makers to establish baselines, monitor changes, bench- mark to other systems, and create long; -terin plans, 5.6.3 Reporting System Data. When decision makers com- pare systems to benchmark performance, they must use con- sistent language to describe the function and process inter- vals. For example, the term response lime is commonly used but not commonly defined. "Therefore caution must be exercised to ensure that the term describes the identical functions or processes. Yet even when common definitions are used, re- sponse times may not be accutately compared. For example, some systems report "average" response times, which fail to adequately describe performance. Comparisons should there- fore be based on "fraclile" reporting, which, for example, may describe time performance with 90 percent reliability, 5.6.4 The terms defined in 5.6_4.1 through 5.6.4.3 are used in Table 5.6. 5.6.4.1 Column A Definitions. (1) Incident m- onset tune, The time the incident occurred or the time that the symptoms developed. (2) 1 ime of discovery of met a, The time that a third party or the patient becomes aware of the need for assistance. (3) Call for held. The time that a third party or the patient first attempts to contact outside assistance. (4) First PSAPcall thine. The time the telephone begins to ring in the first public safety answering paint (or other desig- nated entity). (5) Phone "of hook" (answered in first PSAP. The time that the telephone is answered in the first PSAP center. (6) Serorrdary dispatch phone rings — secondwy MAP (ij"rappiro- pfiale). The time the telephone begins to ring in the sec - ond public safety answering point (or the call screener). Many systems will not use secondary dispatch centers. (7) Secondary disjiatrh phone "off =hook "answered (if appmpriate). The time that the second PSAP or second dispatcher answers the phone, begins the interview, collects caller data, begins prearrival instritctions. (8) Inlemiew ends. The time that the PSAP telecommunicator completes the interview with the caller. This time stamp may occur before or after resources are identified, or before or after units arrive on the scene. (9) Response •resazerres are identified. The time that the PSAP telecommunicator, through computer -aided dispatch or other means, identifies the appropriate resources to send to the scene of the emergency, For example, the telecommunicator may identify ambulance, fire appara- tus, quick - response vehicles, police vehicles, specialty ve~ hicles, or other appropriate resources. 180 Copyright 2012 Nroional Fife Pioteetlon AssoclAtton (NrPA). Licensed, 6y agreement, for Individual We and single downtrod on August t0, 2D12 to STEPHEN ALLAN of SOLUTIONS FOR LOCAL GOVERNMENT, No other nifinMuction or transmission In Any form permitted without w ittsn permission of NFPA For Inquires or to report unauthodled use, contact Ilcensing@nfpa,orU. EMS SYSTEM ANALYSIS AND PLANNING: 450 -13 Table 5.6 Essential System Analysis Components Column A Column B Column C Discrete Time Stamps Functional Intervals Process Intervals (1) Incident or omct Iiine (2) Time of discovery of event (3) Call for help (4) First PSAP call time (5) Phone "off- hook" (answered in first PSAP) (6) Secondary dispatch phone rings secondary (PSAP) (if appropriate) (7) Secondary dispatch phone "off- hook" answered (if appropriate) (8) Interview ends (9) Response resources are idenLi III ed (10) Dispatch time (11) Unit acknowledgment (12) Wait en route (13) Unit arrived on scene (wheels stopped) (14) Patient contact (15) First intervention time (16) Time of result of first intervention (17) Unit left scene (wheels turning) (18) Arrived at destination (19) Transfer of care (20) Available for service (1) Recognition interval (1 to 2) (2) System access interval (2 to 3) (3) Switching interval (3 to 4) (4) Answer interval "A" (4 to 5) (5) Routing interval (5 to 6) (6) Answer int.erlvl "li" (6 to 7) (7) In terrogation interval (5 or 7 to 8) (8) Resource selection interval (8 to 9) (9) Alert interval (9 to 10) (10) Acknowledgment interval (10 to 11) (11) Turn -out interval (II to 12) (12) Travel interval (12 to 13) (13) Patient access interval (13 to 14) (14) initial treatment interval (14 to 15) (15) Initial result interval (15 to 16) 06) On- scene patient care interval (16 to 17) (17) Transport interval (17 to 18) (18) Care transfer interval (18 to 19) (19) Unit -ready interval (19 to 20) (10) Dispatch time. The Lime the responding unit was notified by the telecommunicator. (11) Unit achnowkdgment. The lime that the response unit(s) acknowledged that they have received the notification. (12) Unit en. mile. The time that the vehicle first begins mov- ing toward the scene. (13) Unif arrived on .sceru:. The time that the vehicle comes to a complete stop at the scene. (14) Patient rontarl. The time that responding personnel first arrived at the patient's side. (15) First intervemicin time. The time that the first intervention, such as an N defibrillation, CPR, extrication, and so on, is begun_ (16) Thine of msull of fint inlerventimr. The time that the rc sponder first identifies results of the First intervention. Forexample, when extrication occurred,when return of spontaneous circulation occurred, and so forth. (17) Unit left seen. The Lime that the vehicle first begins mov- ing from the scene. (18) Arrived at destination. The time that the responding unit arrived at the hospital or transfer point. (19) 7hansferof'cam The time that responsibility for treatment was transferred from a prehospital provider to another — when the hospital personnel physically take over care of the patient - (20) Available, for service. The 6111c the runt was available for response. 5.6.4.2 Column B Definitions. (1) Recognition interval (1 to 2). The elapsed period starting with (1), Incident or onset time, and ending at (2), Time of discovery of event. (1) Event activation (1 to 4) (2) Citizen reaction (2 to 4) (3) Call processing (4 to 11) (4) System response (4 to 14) (5) Unit response (11 to 14) (6) Patient management (14 to 19) (7) Event to treatment (1 to 15) (8) Scene management (13 to 17) (9) Unit cycle (I 1 to 20) (2) Systan access interval (2 to 3). The elapsed period starting with (2), Time of discovery of event, and ending at (3), Call for help. (3) Sroilching internal (3 to 4). The elapsed period starting with (3), Call for help, and ending at (4), First PSAP call time. (4) Answer interval A' (4 to 5). The elapsed period starling with (4), First PSAP call time, and ending at (5). Phone .off-hook" (answered in first PSAP). (5) Routing interval (S to 6). The elapsed period starting with (5), Phone "off -hook" (answered in first PSAP), and end- ing at (6), Secondary dispatch phone rings. (6) ANSrver interval "B" (6 to 7). The elapsed period starting with (6), Secondary dispatch phone rings, and ending with (7), Secondary dispatch phone "off hook" an- swcred. (7) Inferrognlion interval (S or 7 to 8). The elapsed period start- ing with Phone "ofd hook" answered in primary or sec- ondary PSAP and ending with (8), lnteview ends. (8) Resource sekrtion interval (8 to 9). The elapsed. period start- ing with (8), Interview ends, and ending with (0), Re- sponse resources are identified. (9) Alert interval (9 to 10). The elapsed period starling with (9), Response resources are identified, and ending wide (10). Dispatch time. (10) Acknowledgmmi.1 interval (10 to 11). The elapsed period starting with (10), Dispatch time, and ending; with (11), Unit acknowledgment. (11) 7lirn -out hilmt4l (11 to 12). The elapsed period starting with (11). Unit acknowledgment, and ending with (12). Unit en route. 2013 Edition W 181 Copyright 2012 National Fire Protection Association (NFPA). Licensed, by agreamsnl, for Individual usa and singls dovmtoad on August 10, 2012 to STEPHEN ALLAN of SOLUTIONS FOR LOCAL GOVERNMENT, No other reproduction or tranamissioa In any form permitted without written pctr+tlsalon of W PA. For Inqulree or to teport unanlht>rited use, contact I1censing4n1pa.org. 450 -14 EMERGENCY MEDICAL, SERVICES AND SYSTEMS (12) 7}avel iuierval (12 to 13). The elapsed period starling with (12), Unit en route, and ending with (13), Unit arrived on scene (wheels stopped). (13) Patient access interval (13 to 14). The elapsed period start- ing with (13), Unit arrived an scene (wheels stopped), and ending with (14), Patient contact. (14) Initial treatweia interval (14 to 15). The elapsed period starting with (14), Patient contact, and ending with (15), First intervention time. (15) Initial result interval (15 to 16). The elapsed period start- ing with (15), First intervention time, and ending with (16), Time of result of first intervention_ (16) On -sreNe patieni care intemal (16 to 17). The elapsed period starting with (16), Time of result of first intervention, and ending with (17), Unit left scene (wheels turning), (17) Pransporl interval (17 to 18). The elapsed period starting; with (17), Unit left scene (wheels turning). and ending with (18), Arrived at destination. (18) Garr transfer interval (18 to 19). The elapsed period start- ing with (18), Arrived at destination, and ending with (19) , Transfer of care. (19) Unii -ready inlemal (19 to 20). The elapsed period starting with (19), Transfer of care, and ending with (20), Avail- able for service. 5.6.4.3 Column C Definitions. (1) Even activation (1 to 4). The elapsed time between the event and when the telephone first rings in the first PSAR This process includes the recognition interval, the sys"ein access interval, and (lie switching interval, and is intended to measure a system's ability — using education, technol- ogy, or other means — to recognize that an emergency exists and to take immediate steps to access assistance. (2) Citizen reaction (2 to 4). The citizen reaction process begins when an event is first discovered and ends when the tele- phone rings in the First PSAR The citizen reaction process is intended to measure the system access interval and the switching interval. The process measures the system's abil- ity to reinforce certain citizen behaviors and provides the means for those citizens to make appropriate access. (3) Call processing (4 to 11). The call processing interval is the process that begins when the telephone first rings at the first PSAP and ends when responding units acknowledge that they are aware of the event. The processing interval includes the time required to appropriately answer the telephone in the PSAP, triage and route the call, inter View the caller, provide instructions, identify and alert re- sources, and recognize that the alert has been received, This interval is intended to measure the system's ability to quickly process a request for assistance and notify the ap- propriate responding units. (4) System response (4 to 14). The system response interval is the process that begins when the telephone first rings at the first PSAP and ends when the responders arrive at the patient's side. The system response interval is intended to measure the system's performance in responding to a call for assistance by considering the call processing interval, as well as the turnout, travel, and patient access intervals. (5) Unit response (11 to 14). The unit response interval is the process that begins when the individual unit acknowl- edges that a response is required and ends with patient contact. The unit response interval is untended to mea- sure an individual unit's performance in responding to a call For assistance by considering the turnout, travel, and patient access intervals. 0 2013 Edition (6) Patient inanagemerid (14 to 11)_ The patient management interval is the process that begins when responders First make contact with the patient and ends when responsibil- ity for the patient is transferred to another medical pro- vider. The patient management interval is intended to measure the time committed by the system to meet the needs of the patient and reflects the system's ability to manage and monitor resources. (7) Fvenl to lreahneni (1 to 15). The event to treatment interval is intended to measure the system's ability to initiate treat- ment once an event exists. This interval is intended to measure the process that begins when the event occurs and ends when the first treatment is provided. This pro- cess may measure the time that responders, dispatchers, citizens, or others intervene as part of an organized EMS system design. (8) Scene. managm?.ent (13 to 17). The scene management inter Val begins when the first vehicle stops at the scene of an event, and ends when the last patient leaves the scene:. The interval is intended to measure the time required to manage the logistics of accessing the patient, providing initial treat- ment, packaging For transport, and leaving the scene. (9) Unit cycle (11 to 20). The unit cycle process reflects the cycle time of an individual unit from activation to avail - ability. The unit cycle process measures the time that a unit is assigned to an event and unavailable for other assignments. 5.6.5 Call Processing. System analysis considers call proce-w ing the manner in which calls are processed, as well as evalua- tion of the intervals required to complete the call and notify appropriate providers. 5.6.6 Call Processing Method. Community needs should dic- tate the way that resources are assigned and prioritized. 5.6.7 Call Processing Time Interval Standards. Call process- ing performance objectives should comply with existing stan- dards. For example, NFPA 1221. Standard for Ae Installation., Maintenance, and Use of Emeigeucy Serzrices Communications Sys- tems, has established a standard that 95 percent. of all emer- gency calls must be answered in 30 seconds. Dispatch ofemer- gency response aid should be made within 60 seconds of the completed receipt of an emergency alarm. 5.6.8 Turnout (Activation) Interval. '1'mmout interval perfor- mance objectives should comply with existing standards_ Sys- tem analysis should consider the provider turnout interval, or the interval from response unit notification to movement of that unit to the location of the incident. For example, NFPA 1710, Slanrlrrrcd for the Organization and DeCidoyrneni of Fire Suppression. Operations, l rneWney Medical Operations, grid Special Operations to lire Public by Grneer Fire Departments, establishes turnout time objectives of no more than 60 seconds. 5.6.9 Geography. System analysis should consider geography and the implications of local geography on service delivery. 5.6.9.1 Geographic Response Tools. A geographic informs. tion system (GIS) may be used as a tool to model existing service delivery for each EMS system component, such as first response, BLS orALS care, or patient transportation services. Response capabilities for each mobile system component based on desired wavel intervals can be modeled using a CIS system, identifying underser ved areas of a jurisdiction, for ei- ther current or planned system designs. 182 Copyright 7012 Netlonal Fire Protection Association (NFPA). Licensed, htrp agreement, for Individual use and tingle download on August 10, 2012 to STEPHEN ALLAN of SOLU110NS FOR LOCAL GOVERNMENT. No other reproduction or transmission In any form permitted without written permisslon of NFPA, For Inquires or to report unauthorized use, contact i,censing@nfpa.org. EMS SYSTEM ANALYSIS AND PLANNING: 450 -15 5.6.9.2 Travel Interval. Travel interval objectives examined by a G1S analysis should parallel standards as established by the lead agency, 5.6.9.3 First Response. The community should establish re- sponse intervals for first responders that are appropriate for that community. The standards should be suitable for the local demographics, resources, medical needs, and geography. The intervals should be systematically monitored for compliance with the local standard. 5.6.9.4 Advanced life Support. The community should estab- lish response intervals for advanced life support, where avail- able, that are appropriate for the community. The standards should be suitable for the local demographics, resources, medical needs, and geography. The intervals should be sys- tematically monitored for compliance with the local standard. 5.6.10 Geographic Barriers. A GIS model may also identify potential barriers to delivery of care (for example, intemhp- tion of the road network by construction, flooding, or railroad crossings). 5.6.11 Distribution of Demand. AGIS may also identify die dis- Iribut.ion of calls in a communityyand areas undergoingdevelop- ntent. that would require the expansion of services in the fillure. 5.6.12 Demographics. The system analysis should consider lo- cal demographics and the implications of those demographics on service requirements for a range of constituency groups. 5.6.12.1 Age. Age - related injuries and illnesses (for example, pediatric, adolescent, or getiai ric) should be considered. 5.6.12.2 Socioeconomics. A community's socioeconomic structure and its associated injuries and illnesses (e,g., violent crime, lack of prenatal care, or neglect) should be considered. 5.6.12.3 Gender. Gender - related injuries and illnesses (e.g., disease rates and treatment plans) should be considered, 5.6.12.4 Culture and Ethnicity. Language, cultural diversity, and ethno- specific disease processes should be considered. 5.6.12.5 Local Industry. Industrial area injuries and illnesses (e.g., exposure to ha7tardous materials, injuries from machin- ery) should be considered. 5.6.13 Regulatory Environment. The L19S system should monitor the political and regulatory environments to analyze impacts on operations, funding, and personnel. 5.6.14 Additional System Needs. The system analysis should consider other features unique to the system, such as special hazards, needs, and conditions that will affect service delivery. 5.6.15 Disasters. The potential for disasters as a function of unique jurisdictional features, characteristics, and risks should be considered. 5.6.16 Medical Center Resources, The system analysis should consider resources available through local hospitals (e.g., fre- quency of hospital "diversion" status, resource hospital training, resupply of disposables and medications, ALS quality assurance), 5.7 EMS System Planning. Based on the comprehensive sys- Lem analysis and the identified system priorities, the system should develop a plait for ongoing system design and improve- ments. Plan development should include the components specified in 5.7.1 through 5.7.7.5. 5.7.1 Roles. Identification should be made of the roles and re- sponsibilities of each position type needed for- the EMS system to function, based on the needs and wants of the community. 5.7.2 Financing. Annual operating budgets and capital bud- gets consistent with generally accepted accounting principles should be established. 5.7.3 Resource Allotment. Resources should be allocated ap- propriately between agencies in the system. 5.7.4 Master Planning /Forecasting. A master plan should be available that ensures that the necessary resources are avail- able to the system and will meet the needs of future system requirements. 5.7.5 Disaster /Catastrophe Planning. The system should en- sure that a plan is available to manage overwhelming or cata- strophic events, including coordinating activities between and among providers. 5.7.6 Public Education and Injury /Illness Prevention. The system plan should include component.% required to prevent the need for emergency responses. 5.7.6.1 Traditional Programs. Traditional illness and injury prevention programs such as CPR and "Stop, Drop, and Roll" Should be available and regularly provided Lo citizens in the system_ 5.7,6.2 Other Programs. The prevention and public educa- tion plan should include analysis of the environment and an analysis of the need for special prevention programs such as wal:er /cold safety, immunization, and basic emergency care. 5.7.6.3 Disaster Preparedness. The system should coordinate with emergency management programs to ensure that citizens are prepared. 5.7.7 Provider Support. The system plan should address and consider methods to support individual providers in the sys- tent. 5.7.7.1 Provider TI Wning. Provider training and support pro- grams should ensure that providers receive training sufficient to meet local needs and support to ensure their continued participation, 5.7.7.2 Provider Safety. The following provider safety pro- grams should be in place to reduce the amount and severity of injuries incurred by providers: (1) Equipment (2) Training (3) Accountability systems 5.7.7.3 CISM. Critical incident stress management (GISM) programs designed to reduce acute and chronic effects of stress related to job Functions should be established, 5.7.7.4 Wellness. Health and wellness programs should be in place to ntoni Lor and support die overall wellness of'providers. 5.7.7.5 Emergency Management. Disaster preparedness pro- grams should be in place to meet the unique needs of provid- ers during catastrophic events. 5.8 Continual Risk Assessment and Planning. The system should have in place a comprehensive process, articulated in a risk assessment plan and overall system design that provides continual analysis and mitigation of risk. The primary risk management processes include risk assessment (internal and external), risk elimination, risk avoidance and prevention, risk control, and loss control. 2013 Edilion Q ORD- 2012 -057 COPY ORANGE COUNTY BOARD OF COMMISSIONERS ACTION AGENDA ITEM ABSTRACT Meeting Date: November 20, 2012 Action Agenda Item No. 7 -b SUBJECT: Implementation Strategy from the Emergency Services Workgroup on Recommendations from the Comprehensive Assessment of Emergency Medical Services & 911 /Communications Center Operations Study, and Approval of Budget Amendment #4 -C DEPARTMENT: Emergency Services PUBLIC HEARING: (Y /N) No ATTACHMENT(S): INFORMATION CONTACT: F. R. Montes de Oca, 245 -6100 Michael Talbert, 245 -2308 183 PURPOSE: To receive an implementation strategy from the Emergency Services Workgroup regarding recommendations included in the Comprehensive Assessment of Emergency Medical Services & 911 /Communications Center Operations Study, approve Budget Amendment #4 -C for $414,500 in the current fiscal year, and incorporate the recommendations into the Budget & Capital Investment Plan (CIP) process for Fiscal Year 2013 -14. BACKGROUND: The Orange County Emergency Medical Services (EMS) provides pre - hospital care and transport to residents and visitors throughout the County. Originated from volunteer services, Orange County EMS began providing advanced life support ambulances in the 1980's. EMS is a branch of the Orange County Emergency Services Department 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 10,700 calls annually, EMS must be able to address extraordinary events such as multi - casualty incidents, large sporting events, stock car races and mass gatherings, assist at fires, evacuations and other disaster situations affecting public safety. The Orange County 911 Center is the public safety answering point for residents to access emergency services agencies. It originated in the former Orange County Sheriff's Office at Columbia and Rosemary Streets in Chapel Hill. It is a branch of Orange County Emergency Services and is staffed by dedicated professionals around the clock. On December 13, 2011 the Board discussed the Emergency Medical System Delivery and E911 Communications Center improvements. There was consensus that the County needed to develop a strategic plan to improve the County's Emergency Management Services Delivery System and E911 Communications Center. The Charge for the ESW included reviewing alternatives and making recommendations for the following: :m System improvements for EMS Ambulance response times including but not limited to equipment, staffing, facility's and /or a strategic plan, to define data elements for meaningful analytical data as related to ambulance response time and to discuss and review that data. Improvements for the E911 Communications Center including but not limited to technology, equipment, staffing, training and /or a strategic plan. On March 22, 2012 the Board approved a contract with Solutions for Local Government, Inc. to develop a multi -year strategic plan addressing Emergency Medical Services System and E911 Communications Center needs. At the August 30, 2012 Board Work Session, Mr. Steve Allan presented the final draft of the Comprehensive Assessment of Emergency Medical Services & 911 /Communications Center Operations Study. Mr. Allan held meetings with stakeholders, presented and discussed his report, answered questions and solicited input. This included one meeting for the general public that was held on September 27, 2012. Emergency Services Workgroup is recommending the following implementation strategy from the recommendations included in Comprehensive Assessment of Emergency Medical Services & 911 /Communications Center Operations Study. R -1. OCEMS should adjust Medic 5 and Medic 8 coverage hours. The Workgroup recommends keeping 5 ambulances operational around the clock and add new 12 hour peak load ambulances as new ambulances are staffed and placed in service. R -2. OCEMS should add an additional ALS Ambulance 9:00 am -9:00 pm, 12 hours /day, 7 days /week. The Workgroup recommends a new 9am — 9 -pm peak load ambulance and evaluate after 6 months to verify that the new ambulance has helped bring down the average number of move ups. This ambulance was approved in Fiscal 2012/2013 and will be placed in service as soon as new staff is trained and the new unit is available. R -3a. Utilize available SORS /BLS ambulance for non - emergency patient transports. R -3b. OCEMS should bring on line and staff a BLS ambulance to provide non - emergency patient transports. The Workgroup recommends combining R -3 & R -3b into one recommendation. County staff and SORS are directed to collect & analyze additional call volume data bring back a recommendation to the Emergency Services Workgroup by January, 2013. 185 R -4. Assess Fire Department capabilities to meet BLS First Responder response time objectives. R -5a. Schedule and implement Fire Department, Medical First Responder initiative which includes performance objectives. R -5b. Staff and equip four (4) EMS Quick Response Vehicles (QRV's) for assignment, initially, 12hours /day, 7 days /week with shift start/end times to be determined by EMS. The Workgroup recommends combining R -4, R -5a, and 5b into one recommendation. A working group, comprise of Emergency Services staff, representatives from Chief's Council, representatives from South Orange Rescue Squad and the County Medical Director is directed to discuss these issues and bring back a recommendation to the Emergency Services Workgroup by January, 2013. R -6. Staff & equip six (3) 12 hour /7 day ALS ambulances at appropriate staging /base facility locations within (1) Zones 1 & 2, (2) Zones 7 & 5, and (3) Zones 6 & 8. The Workgroup recommends that EMS staff and the County's Medical Director prepare a detailed 5 year implementation schedule for recommendation R -6 and brings back a recommendation to the Emergency Services Workgroup by December 11, 2012. R -7. Hire a Paramedic Level Shift Supervisor @ 24/7. The Workgroup recommends hiring 4 new Paramedic Level Shift Supervisor positions immediately. The Study recommends 5.1 position for a 24/7 Shift Supervisor, but Emergency Services staff recommended only 4 position. This is recommended to be funded in the current fiscal year, at an estimated annual cost of $267,500. R -8. Prepare a detailed Space Needs Assessment that addresses the essential building and site requirements to accommodate a stand - alone, functional, code compliant EMS base facility that can serve as a prototype for all future facilities. R -9. Identify a minimum of nine (9) strategic locations, preferably no less than one (1) location within each major zone previously identified, for the potential location in each of a future EMS base. R 10. The County should purchase /obtain identified sites (and /or buildings) for development. R 11. Procure EMS base planning and design services. R 12. Advertise, bid, and commence construction on designated EMS base facilities. The Workgroup recommends tabling recommendations R -8, R -9, R -10, R -11 and R -12. EMS staff is directed to proceed with a space needs assessment while simultaneously exploring the :. option of co- locating EMS Ambulances at fire departments. Staff is to bring back a recommendation to the Emergency Services Workgroup by January, 2013. R -13. Hire a full -time, dedicated Data System Manager to be located as close as possible, preferably adjacent to the Communications Center, and answerable first to the Communications Center Operations Manager. The Workgroup recommends hiring a dedicated full -time Data System Manager immediately in the current fiscal year, at an estimated annual cost of $74,250. R -14. Hire a full -time, dedicated Training /Quality Assurance Officer to be located as close as possible, preferably adjacent to the Communications Center, and answerable first to the Communications center Operations Manager. The Workgroup recommends hiring a dedicated full -time Training /Quality Assurance Officer immediately in the current fiscal year, at an estimated annual cost of $72,800. R -15. Anticipating increasing responsibilities due to the number of new personnel forthcoming, hire an additional full -time Training /Quality Assurance Officer no later than the end of year -3. The Workgroup recommends hiring an additional dedicated full -time Training /Quality Assurance Officer during year -2 or Fiscal 2014/2015, at an estimated annual cost of $72,800. R -16. Prepare a schedule for the hiring and training of the identified Telecom municator positions and identify the date to begin solicitation and acceptance of applications. R -17. Hire 17 new, full -time Telecommunicators. The Workgroup recommends combining R -16 and R -17 into one recommendation. The Fiscal 2012/13 Budget includes 4 new full -time Telecommunicators, which are included with the total of 17 recommended by the Study. The Workgroup recommends combining R -16 & R -17 to hire and train 13 new full -time Telecommunicators over 3 Fiscal Years. Recommending that 4 full - time Telecommunicators be added in Fiscal 2013/14, 4 additional Telecommunicators in Fiscal 2014/15, and 5 Telecommunicators in added in Fiscal 2015/16. The total position added over 3 years will be 13 Telecommunicators, with the estimated total cost of $585,000. R -18. Purchase necessary AVL vehicle hardware for each new EMS vehicle purchased to enable compatibility with newly purchased CAD software and existing AVL system hardware. Necessary AVL vehicle hardware already in place, no action needed. 187 R 19. Following the installation of recently purchased Communications Center software and the training of in -house personnel; organize and provide informational meetings to emergency service system members, particularly Fire Departments and Law Enforcement, with regards to the system's capabilities and the information that will be available to them for their use. OSSI Software has been purchased and the 12 month installation process has started. The Workgroup recommends that the 911 Users Group be resurrected to meet at least 6 times per year and provide input for the 911 Communications installation and setup of the OSSI system. R 20. From the Workgroup: The Workgroup recommends that Page Track software, currently in use by the Fire Departments, be incorporated into the OSSI system if possible and utilized by 911 Communications. If Page Track remains a standalone system, it is recommended that 911 Communications use the system to support OSSI when possible. FINANCIAL IMPACT: The Workgroup recommends funding $414,500 as outlined in the recommendations background in the current fiscal year and incorporate the remaining recommendations into the Fiscal Year 2013 -14 Annual Budget & CIP process. RECOMMENDATION(S): The Manager recommends that the Board receive the implementation strategy from the Emergency Services Workgroup regarding recommendations included in the Comprehensive Assessment of Emergency Medical Services & 911 /Communications Center Operations Study, approve Budget Amendment #4 -C for $414,500 in the current fiscal year, and incorporate the recommendations into the Budget & Capital Investment Plan (CIP) process for Fiscal Year 2013 -14. Oran ATTACHMENT 2 -D /_1001 C1'4r\ NC Radio Communication Tower and 'N . Sites /Towers August 23, 2013 Prepared by: "Unleashing the Power of Technology" Federal Engineering® Federal Engineering, Inc. 10600 Arrowhead Dr, Suite 160 Fairfax, VA 22030 703 - 359 -8200 :: MO Orange County NC Radio Communication Tower and System Infrastructure Upgrade RF Coverage and Sites /Towers Table of Contents 1. Introduction ......................................................................... ............................... 4 2. RF Coverage ...................................................................... ............................... 5 2.1 800 MHz VIPER System ..................................................... ............................... 5 2.1.1 Northeast - Caldwell Area Site (Bill Poole Rd) .................... ............................... 5 2.1.2 South - central — GTE Wireless Site ..................................... ............................... 6 2.1.3 Southwest — SBA Site ......................................................... ............................... 7 2.1.4 Southeast — Vilcomm Site (WCHL) ..................................... ............................... 8 2.1.5 VIPER RF Coverage Plots ................................................ ............................... 10 2.1.6 RF Coverage Percentages ............................................... ............................... 18 2.1.7 800 MHz and Microwave Mounting Heights ...................... ............................... 19 2.1.8 Microwave ........................................................................... .............................20 2.2 VHF Station Paging .......................................................... ............................... 22 2.2.1 Cedar Grove Fire Station .................................................. ............................... 22 2.2.2 Orange Grove Fire Station ................................................ ............................... 22 2.2.3 Eno Mountain Site ............................................................. ............................... 22 2.2.4 Chatham Mountain Site .................................................... ............................... 23 2.2.5 VHF Paging Coverage ........................................................ .............................23 2.2.6 RF Coverage Percentages ............................................... ............................... 25 2.2.7 VHF Paging Antenna Mounting Heights ........................... ............................... 27 3. Sites and Towers .............................................................. ............................... 28 3.1 VIPER Sites ........................................................................ .............................28 3.1.1 Northeast — Caldwell area (Bill Poole Rd) ......................... ............................... 28 3.1.2 South - central — Crown Castle Site .................................... ............................... 30 3.1.3 Southwest — SBA Site ....................................................... ............................... 32 3.1.4 Southeast — VilComm Site (WCHL) .................................. ............................... 34 3.2 VHF Paging Sites ................................................................ .............................35 3.2.1 Cedar Grove Fire Department .......................................... ............................... 35 August 23, 2013 Page 2 of 37 G Orange County NC Radio Communication Tower and System Infrastructure Upgrade RF Coverage and Sites /Towers 3.2.2 Orange Grove Fire Department ........................................ ............................... 35 3.2.3 Eno Mountain Site ............................................................. ............................... 35 3.2.4 Chatham Site .................................................................... ............................... 35 Appendix A SBA Colocation Application ........................................ ............................... 36 Appendix B Crown Castle Information and Credit Application ........ ............................... 37 August 23, 2013 Page 3 of 37 T �G 190 Orange County NC Radio Communication Tower and System Infrastructure Upgrade RF Coverage and Sites /Towers 1. Introduction An RF Coverage Workshop was held with Orange County and the law enforcement, fire, and emergency medical services within Orange County on May 20, 2013. At this workshop, FE presented RF coverage from the existing VIPER sites, along with RF coverage improvements from various additional sites. The workshop participants were able to see what RF coverage improvements were produced from multiple sets of site configurations. As a result of this RF Coverage Workshop, Orange County selected a set of four additional sites to improve VIPER coverage within the County. These four sites are existing sites, and colocation was to be investigated. The four sites selected are: • Northeast portion of County — Caldwell area — existing guyed tower • South - Central portion of County — Chapel Hill — existing monopole • Southwest portion of County — Chapel Hill — existing monopole • Southeast portion of County — Chapel Hill — existing monopole (two sites possible in this area, where either site would provide coverage) Fire Station Paging RF coverage was also presented from the existing sites, along with RF coverage improvements from various additional sites. For Fire Station Paging RF coverage improvements, two additional sites were selected to improve coverage within the County. They are: • North portion of County — Cedar Grove Fire Station on Hawkins Road. • Southwest portion of County — Orange Grove Fire Station at 6800 Orange Grove Rd. The Orange Grove Fire Station will require a new tower. August 23, 2013 Page 4 of 37 T �G 191 Orange County NC Radio Communication Tower and System Infrastructure Upgrade RF Coverage and Sites /Towers 2. RF Coverage RF coverage was predicted for each of the additional sites identified, combined with the existing VIPER sites providing RF coverage to Orange County, and plotted. The RF coverage plots are shown below. Additionally, a high - resolution plot has been generated and will be provided as a separate file due to the large file size. 2.1 800 MHz VIPER System RF coverage percentages for Orange County are listed in Tables 1 and 2 below. Table 1 lists the coverage percentages for the existing system, and Table 2 lists the percentages with the four proposed new sites. 800 MHz proposed antenna mounting heights are listed in Table 3 below. 2. 1.1 Northeast - Caldwell Area Site (Bill Poole Rd) This site could provide 800 MHz VIPER coverage in the northeast portion of the County. This site was listed in the Crown Castle database as an existing 400 ft. guyed tower. Investigations have shown that this tower was dismantled. However, a new195 ft. monopole tower is being proposed for commercial use and is in the review /approval process with the County. This new tower is being proposed by American Tower Corporation (ATC) for use by AT &T, and other potential commercial carriers. 800 MHz RF coverage has been predicted from this site, and is shown in Figure 1. Figure 2 is a representation of the previous 800 MHz portable talk -in coverage. The County should consider pursuing use of this tower following its use approval. In the event that there is no space in the shelter, or use of the carrier's shelter is not permitted, Orange County will need to procure and install a shelter for its use. Orange County may also be required to procure a generator with associated fuel tank. Site information is listed below. 2.1.1.1 Site /Tower Details Address: 7444 Bill Poole Rd. August 23, 2013 Page 5 of 37 T �G 192 Orange County NC Radio Communication Tower and System Infrastructure Upgrade RF Coverage and Sites /Towers Coordinates: 36 -11- 25.05, 78 -58 -31.78 Tower Type: Monopole Tower Height: 195 ft. Proposed VIPER antenna heights: • 1 -800 MHz Tx antenna — DB809 (max 12.2 ft.), 130 ft. centerline • 1 -800 MHz Tx transmission line — 1 '/4 inch • 1 -800 MHz Rx antenna — DB809 (max 12.2 ft.), 150 ft. centerline • 1 -800 MHz TTA — 16 "H x 12 "W x 7.5 "D, 39 #, 384 ft. (or close to base of Rx antenna) • 1 -800 MHz Rx transmission line — 7/8 inch • 1- Microwave dish - Comscope WHP6- 65- P1A/K, 6 ft., 177 or 75 ft. level, azimuth [Laws, Eno] • 1- Microwave transmission line — EWP63S jacketed, approx.. 1" x 2" elliptical waveguide Site Contact: American Tower (ATC) 2.1.2 South - central — GTE Wireless Site This site could provide 800 MHz VIPER coverage in the south - central portion of the County. FE investigations have shown that this site, #42 on the County Telcom List, is now owned by Crown Castle. In the event that there is no space in the shelter, or use of the carrier's shelter is not permitted, Orange County will need to procure and install a shelter for its use. Orange County may also be required to procure and a generator with associated fuel tank. 800 MHz RF coverage has been predicted from this site, and is shown in Figure 1. Figure 2 is a representation of the previous 800 MHz portable talk -in coverage. The County should consider pursuing use of this tower. 2.1.2.1 Site /Tower Details Address: 1403 New Hope Trace, Chapel Hill, NC Coordinates: 36 -00 -46.7, 79 -04 -45 August 23, 2013 Page 6 of 37 T �G 193 Orange County NC Radio Communication Tower and System Infrastructure Upgrade RF Coverage and Sites /Towers Tower Type: Monopole Tower Height: 195 ft. Proposed VIPER antenna heights: • 1 -800 MHz Tx antenna — DB809 (max 12.2 ft.), 162 ft. centerline desired (147 ft. available) • 1 -800 MHz Tx transmission line — 1 '/4 inch • 1 -800 MHz Rx antenna — DB809 (max 12.2 ft.), 178 ft. centerline desired (157 ft. available) • 1 -800 MHz TTA — 16 "H x 12 "W x 7.5 "D, 39 #, 157 ft. or close to bottom of Rx antenna • 1 -800 MHz Rx transmission line — 7/8 inch • 1- Microwave dish — Comscope WHP6- 65- P1A/K, 6 ft., 95 or 115 ft., [Chatham, Camden] • 1- Microwave transmission line — EWP63S jacketed, approx.. 1" x 2" elliptical waveguide Site Contact: Crown Castle, Site #817094, Tania Fusco, 704 - 405 -6558, Tan ia. Fusco(a)crown castle. com 2.1.3 Southwest — SBA Site This site could provide 800 MHz VIPER coverage in the southwest portion of the County. There were two possible sites that could provide RF coverage in this area, and both were investigated. Only one has available space on the tower that might be used. Both of the sites investigated are owned by SBA. One was found in the Crown Castle Database, and one was listed on the County Telcom List, #41. The latter site, #41 appears to have tower space available 800 MHz RF coverage has been predicted from this site, and is shown in Figure 1. Figure 2 is a representation of the previous 800 MHz portable talk -in coverage. The County should consider pursuing use of this tower. August 23, 2013 Page 7 of 37 T �G 194 Orange County NC Radio Communication Tower and System Infrastructure Upgrade RF Coverage and Sites /Towers 2.1.3.1 Site /Tower Details Address: 4900 NC 54 W, Chapel Hill, NC Coordinates: 35 -56 -01.4, 79 -12 -55.4 Tower Type: Monopole Tower Height: 199 ft. Proposed VIPER antenna heights: • 1 -800 MHz Tx antenna — DB809 (max 12.2 ft.), 130 ft. centerline • 1 -800 MHz Tx transmission line — 1 '/4 inch • 1 -800 MHz Rx antenna — DB809 (max 12.2 ft.), 150 ft. centerline • 1 -800 MHz TTA — 16 "H x 12 "W x 7.5 "D, 39 #, 150 ft. or close to bottom of Rx antenna • 1 -800 MHz Rx transmission line — 7/8 inch • 1- Microwave dish - Comscope WHP6- 65- P1A/K, 6 ft., 141 or 138 ft., [Chatham, Cane] • 1- Microwave transmission line — EWP63S jacketed, approx.. 1" x 2" elliptical waveguide Site Contact: SBA, Elaine Tarkington, 919 - 868 -0426, etarkington(a-)sbasite.com 2.1.4 Southeast — Vilcomm Site (WCHL) This site could provide 800 MHz VIPER coverage in the southeast portion of the County. This site is owned by VilComm Interactive Media and is used by WCHL AM. Investigations have shown that this is a AM broadcast location, and that the towers themselves are the antenna. This is referred to as a "hot" tower. There are two towers at this location, as the WCHL uses two different radiation patterns, one for daylight hours, and one for nighttime hours. Since the towers are very close to each other, either tower would provide the coverage desired. Since these are "hot" towers, isolation equipment is required between the radio equipment and the transmission lines and antennas that are mounted on the towers. Detailed engineering will be required to use this site, and will include designing the insolation equipment based on specific frequencies to be used, as well as ensuring that the AM broadcast pattern is not affected. August 23, 2013 Page 8 of 37 T �G 195 Orange County NC Radio Communication Tower and System Infrastructure Upgrade RF Coverage and Sites /Towers Contact with the tower owner has been established through the Chapel Hill Police Department, and discussions with the tower owner have taken place. A physical inspection of the tower revealed that it was installed in 1968. Since the tower uses hollow tube steel legs, a structural analysis would need to include inspection of the inside of the tubular tower legs to check for the amount of corrosion. Also, it is Tower Engineering Professional's opinion that the tower would fail the most current TIA/EIA guidelines. Therefore, a structural analysis on this tower at this time is not recommended. Alternate locations in the same area as the WCHL towers should be investigated. 800 MHz RF coverage has been predicted from this site, and is shown in Figure 1. Figure 2 is a representation of the previous 800 MHz portable talk -in coverage. 2.1.4.1 Site /Tower Details Address: E Franklin Street, Chapel Hill, NC Coordinates: 35 -56 -15.9, 79 -01 -35.2, and 35 -56 -19.0, 79 -01 -36.1 Tower Type: guyed Tower Height: 200 ft. Proposed VIPER antenna heights: • 1 -800 MHz Tx antenna — DB809 (max 12.2 ft.), 170 ft. centerline • 1 -800 MHz Tx transmission line — 1 '/4 inch • 1 -800 MHz Rx antenna — DB809 (max 12.2 ft.), 187 ft. centerline • 1 -800 MHz TTA — 16 "H x 12 "W x 7.5 "D, 39 #, 187 ft. or close to bottom of Rx antenna • 1 -800 MHz Rx transmission line — 7/8 inch • 1- Microwave dish - Comscope WHP6- 65- P1A/K, 6 ft., 167 or 157 ft., [Chatham, Camden] • 1- Microwave transmission line — EWP63S jacketed, approx.. 1" x 2" elliptical waveguide Site Contact: Mr. James Davis, Chief Engineer, WCHL 919 - 271 -4133 iwdc(a�nc.rr.com August 23, 2013 Page 9 of 37 196 Orange County NC Radio Communication Tower and System Infrastructure Upgrade RF Coverage and Sites /Towers 2.1.5 VIPER RF Coverage Plots RF coverage plots for both talk -in and talk -out are provided for: • Portables • Portables in 12dB loss buildings =MG771CM August 23, 2013 Page 10 of 37 T �G 197 Orange County NC Radio Communication Tower and System Infrastructure Upgrade RF Coverage and Sites /Towers Figure 1 - Orange County Proposed 800 MHz Portable Talk -In On- Street Orange County, NC - Predicted coverage from VIPER sites and Candidate sites 800 MHz Analog Coverage; Portable Talk -in Radio to Repeater) at Various Quality Levels �_4i-o � August 23, 2013 Page 11 of 37 u .m �"-+, �•L,t'`I-i.y `ge` .*;:•!.r'9,,'�.:fi• ," ,4�' •.✓t•' '•: .1 a4• :�I^ {{ r ..9: �•' �Ir �, ,P; ,sn:... =• ti -�� v sa,,. 31r •� j��1j lx 7 "1r.�1 WA' Olz x,r« — ,Ar� ~`t� ,kx A.,4 fa h;;]� ..�YY.•• `r, ,.�' ?•La.., 44 •i.`; CF L; f �� 1 j '�Cy �S r l a t i ,t,.� , y • . � k ;• v. 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'4+'Y r`: ,� t,1p liY•�► :' •� �1�r�M "• ,•t'�'•' y- t'l.�'�.,,��.- .1.`�t�. � any �� ►' .a :',. •,? - 3/� •i; ^�• t �` s,,��' •Ft�• ?��,]�''�r!" i�,,'. �,lj.� -� •rte ?• _ �r r MA- m Orange County NC Radio Communication Tower and System Infrastructure Upgrade RF Coverage and Sites /Towers Figure 6 - Orange County Mobile Talk -In Orange County, NC - Predicted coverage from VIPER sites and Candidate sites �T 800 MHz Analog Coverage; Mobile Talk -In (Radio to Repeater) -i -7 VIPER Site Proposed Candidate Site C3 Orange County Border Mobile Talk -Out Coverage >= DAQ 2.0 Mobile Talk -Out Coverage >= DAQ 3.0 Mobile Talk -Out Coverage >= DAQ 3.4 August 23, 2013 Page 16 of 37 0 1 2 4 Miles I I I I I I I I I 203 Orange County NC Radio Communication Tower and System Infrastructure Upgrade RF Coverage and Sites /Towers Figure 7 - Orange County Mobile Talk -Out Orange County, NC - Predicted coverage from VIPER sites and Candidate sites _ 800 MHz Analog Coverage; Mobile Talk -Out (Repeater to Radio) f_-1 r I LAWS JMEBANE KTA A'4 k J R VIPER Site Proposed Candidate Site C3 Orange County Border Mobile Talk -Out Coverage >= DAQ 2.0 Mobile Talk -Out Coverage >= DAQ 3.0 Mobile Talk -Out Coverage >= DAQ 3.4 August 23, 2013 Page 17 of 37 4TH 0 1 2 4 Miles I I I I I I I I I 204 205 Orange County NC Radio Communication Tower and System Infrastructure Upgrade RF Coverage and Sites /Towers 2.1.6 RF Coverage Percentages Table 1 - Orange County Existing System Coverage Percentages Existing 800 MHz VIPER 8 0 8 2.0 100 100 98 97 77 73 Existing 800 MHz VIPER 8 0 8 3.0 96 100 69 65 19 18 Existing 800 MHz VIPER 8 0 8 3.4 93 100 55 49 11 11 Table 2 - Orange County Proposed 800 MHz Coverage Percentages * This number includes the VIPER sites that were modeled outside of Orange County which may have impacted the coverage inside Orange County (Existing count increased due to Mebane site being made operational) IN August 23, 2013 Page 18 of 37 206 Orange County NC Radio Communication Tower and System Infrastructure Upgrade RF Coverage and Sites /Towers 2.1.7 800 MHz and Microwave Mounting Heights Table 3 - 800 MHz Antenna Mounting Heights Table 4 - Microwave Antenna Mounting Heights August 23, 2013 Page 19 of 37 Orange County NC Radio Communication Tower and System Infrastructure Upgrade RF Coverage and Sites /Towers 2.1.8 Microwave Microwave paths between the proposed new sites and two existing VIPER sites have been plotted. FE's analysis shows that the paths achieve Fresnel zone clearances for each path plotted, and microwave antenna heights were determined. While only one microwave path is required, paths to two sites were investigated to provide options. Proposed microwave antenna mounting heights are listed by site in Table 4 above. North Carolina State Highway Patrol (NCSHP) has noted that the sites at Laws and Eno are at capacity. This will impact the microwave path from the Caldwell area site, and alternate existing VIPER sites will need to be investigated. August 23, 2013 Page 20 of 37 T �G 207 Orange County NC Radio Communication Tower and System Infrastructure Upgrade RF Coverage and Sites /Towers Figure 8 - Potential Microwave Paths to /from Proposed Sites New Link — Primary Candidate New Link — Secondary Candidate �1 Existing Link New RF Site Cane Mtn. SBA Site — 4900 NC 54 West Laws Mtn New Tower — Bill Poole Rd. OC 911 Eno Mtn. N Chapel Hill Hospital Chatham Mtn. August 23, 2013 Page 21 of 37 Camden Ave. �G M Orange County NC Radio Communication Tower and System Infrastructure Upgrade RF Coverage and Sites /Towers 2.2 VHF Station Paging 2.2.1 Cedar Grove Fire Station There is an existing tower at this location that could be used for a VHF paging station. The tower is approximately 175 ft. tall, and has two antennas and transmission lines installed. The latest information from Orange County has indicated that neither of these antennas or transmission lines is being used. If an existing antenna and transmission line is used for the new VHF paging station, there should not be a need to conduct a structural analysis of the tower. However, depending on the age of the tower, a tower inspection and structural analysis would be recommended. If an existing antenna and transmission line is used for the new VHF paging station, the antenna and transmission line should be tested for acceptable performance. The antenna and line should be "swept" with a time domain reflectometer (TDR). This will provide an indication of acceptable performance as well as provide a baseline for future testing and verification. 2.2.2 Orange Grove Fire Station A new tower is proposed for the Orange Grove Fire Station to provide VHF paging coverage in the central southwest of the County. Based on the RF coverage requirements, a tower height of at least 130 ft. is needed for Fire Station paging. To allow for future expansion and other use of the tower, Orange County may consider a tower of greater height. Initial review of the Unified Development Ordinance has indicated that to meet a 110% fall -zone for the tower, the new tower would be limited to 100 ft. If Orange County could secure approvals from the adjacent land owners, this fall -zone may be extended onto their properties, and the tower height increased. [full UDO report to be added] 2.2.3 Eno Mountain Site The existing Fire Station paging station at this site is retained for use. August 23, 2013 Page 22 of 37 T �G 209 Orange County NC Radio Communication Tower and System Infrastructure Upgrade RF Coverage and Sites /Towers 2.2.4 Chatham Mountain Site Currently the Fire Station paging station and antenna are at the 1000 ft. level on this tower. At this height the RF power output and effective radiated power have been limited by the FCC license. As discussed with Orange County, a height of 150 ft. would be more appropriate for obtaining paging coverage in the southern part of the County. Also, the use of a directional antenna will enhance coverage into Orange County. Orange County should investigate the possibility of placing the antenna at this lower height with the tower owner. Also, a site at StarPoint Storage was reviewed, in lieu of the Chatham site. This site provides better RF coverage into the southeast corner of Orange County, however, RF coverage into the southwest corner is decreased. RF Coverage maps have been prepared for the StarPoint Storage site as well. 2.2.5 VHF Paging Coverage VHF paging coverage has been predicted and plotted, as shown in Figure 9 and 10 below. August 23, 2013 Page 23 of 37 T �G 210 Orange County NC Radio Communication Tower and System Infrastructure Upgrade RF Coverage and Sites /Towers Figure 9 - Orange County Proposed VHF Paging RF Coverage Orange County, NC - Predicted coverage of four VHF paging sites _ VHF Narrowband Paging Coverage; Pager modeled at hip- height fi- August 23, 2013 Page 24 of 37 u 211 Orange County NC Radio Communication Tower and System Infrastructure Upgrade RF Coverage and Sites /Towers Figure 10 - Orange County Proposed VHF Paging Coverage (with StarPoint Site) 2.2.6 RF Coverage Percentages Based on the antenna heights as noted in Table 6, Table 5 indicates the RF coverage percentages obtained using the four site configuration. N August 23, 2013 Page 25 of 37 212 Orange County NC Radio Communication Tower and System Infrastructure Upgrade RF Coverage and Sites /Towers Table 5 - VHF Paging RF Coverage Percentages August 23, 2013 Page 26 of 37 213 214 Orange County NC Radio Communication Tower and System Infrastructure Upgrade RF Coverage and Sites /Towers 2.2.7 VHF Paging Antenna Mounting Heights Table 6 - VHF Paging Proposed Antenna Mounting Heights August 23, 2013 Page 27 of 37 �u Orange County NC Radio Communication Tower and System Infrastructure Upgrade RF Coverage and Sites /Towers 3. Sites and Towers 3.1 VIPER Sites 3. 1.1 Northeast - Caldwell area (Bill Poole Rd) - LEGAL DESCRIPTION 30.0 FT. ACCESS AND •'� LIT Y ASEMENPARCEL "I' , »�• _rt _ ' TL)M1r. Y.fi IOaI ]•Ii :t rYq i�nN R W�rM:..1: •'M�WR1 p•[NYe N I[f..� :.t cam. .rKr .e.• e• r! 6 K• f Mer 6M0+ di �+e .T EM . 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ATC i 240466 x.+.+¢ s ,e,r•.:c m.n:: ds sour. sezr.s' wsr ,. orsr+RC s fsa n, r, w renr: wcvz stun• rss'sr as' • ar -Twee a NEW SHARON CHURCH y •,.r\r c«, r .e•rs nr •wee, a •.t+.r •�..„ eear- ,a.r . ar-,.e tr sn>• e,, .0 ee.i rc.¢ raw wnr r[n . xua er sses r :e • nre nos grin. srmr r[fT .xis.+[[ ar x�• r:. o . rewr: xs x,r se.esa wm n otmrar. K ratr \ • r ».ra •nn+ rsf. >• nse . z,w.a a tcv n to • .,..e 'rw uax .rs, . morn a >m ra r, _ • rant: ,frrQ = m •Df•.q ewm \ !--'�S rnrr K:• . m...e > rr,.s .. +s,eir is . w•ra . •erw.. A . wo•a ....• , `f T.Y rit • osT•.a a �'. Y ' _ re •Idl; �R.a mow 69'6 •[Si . as-.a Q t.: p rt S r¢ ra�� or �srrL •R+• r. �� 4tC (•isra.� �e.vbrT, - / -+rr:s >0. r. ce ?t• •en6 rVre ce.la ,`\ rl�a i�r+e.rr �\ 760KE�IEGEIdO1Ew1 e.+s i of r sca n •tms � \ 4•vr s RLw•r•rG -E` .. r ` / 1,1 �w�.e.� •a'�w.•aa •. enr i 1 rerswaa�.V � ro - '+�.. <. y _�� _�.nr .arriu. •eiva�.Ta K � �• I � � 'C =15[ VG ty�..� _ t'�vCiA •crcai.u'aaza \ _ ! s - ,�,., ns.,n. `der �.. ` AI ..•an we w.r..s `�, X61 \ �-.or•[�d a.► �tu r ;.rss�Z :'�' � 4� ' � � , Oee�•6•M. .t• e.G1en " '16��! y � \ � !Rims yv f,fareYar 4 •tt •fl.. \ \l'• // y u LLGAL DF :CRIF710N Of 1000 X 100.0' w > r b' •e;3S /' �,ry��= AFFA PARCEL'A" �•_ ! {� - r •s: EE:tL r; as_� S' ra`no: c.u�n u'a�.� uxi�.r.t •o ralwsw f °C•soa;;��aat n. ...b „ , L �A [wec°w +�w� +a .io .ss.c .xa• Ro- e� aisiawe: r -w�tii r J r- r K ..�`�•. v .r a S c.+•••.[e°ci+ r act s.a �..•:..c +�a�: auw. ui .w � w u cea0«•Y; r +orr.rr - 1.•lller'. «. L•t�Mt: - fP[]m.f. Tge[x / no- row• tr trr.eratq.* s.ea vsea< cet . asrret ar Y � Q rT U '.S rt. A . M1.i A X ewrrc, _yf(e ? rCtb.t Ke I: r to fT 11 ra• .«e +r a r.« •w •Tree eeew - �N Ty ., i,[.'._ +rlasu za+ .•,ss ssmiu a .�w�tvr. w «rn.r"i new WEFUkUCEEYH.I j • . x• w , qr J v r%o. °+ a rm'•.: 'a'n• Hato.• res- . xrw d cezo •r ,n �g Baer LEGAL OESCR1PTpN5 w r•yar:, ee:.wre . / -:rise m rc w er wwz rsE a ssy sisaw � LEGAL DESCRIPTIONS August 23, 2013 Page 28 of 37 I �G 215 Orange County NC Radio Communication Tower and System Infrastructure Upgrade RF Coverage and Sites /Towers • ATiT t1T. Rl7µJiT ♦!R ■ II.W' A910 MC �81MAOII C7WC11 f • "� � � wlK+•.�A7�11� I y A� lA7A p `� T=C TOWER s ELErAT�oN r s� AMTlNNA i COAX �CI�OULE WMIMQR�Q Iv�Q IrOtt A.�IM alltll. IM•�4b1 1Mn mMl 10 RR IM1 .�� p/ • AIpRl1 Fa+*11010 w ...r •... � slr.• is — -- tw l yl- �i•t•� M / � 1'. O�4 • l�1 .�Tl � IA w1., Diagrams from the ATC submittal to Orange County, titled "American Tower Corporation, Orange County Class B Special Use Permit Application, ATC Site 280486" dated April 25, 2013. August 23, 2013 Page 29 of 37 T �G 216 Orange County NC Radio Communication Tower and System Infrastructure Upgrade RF Coverage and Sites /Towers 3.1.2 South - central -Crown Castle Site U00, �X u• -K - �-� r -r August 23, 2013 Page 30 of 37 �G 217 Orange County NC Radio Communication Tower and System Infrastructure Upgrade RF Coverage and Sites /Towers Diagrams from Crown Castle Sites Database August 23, 2013 Page 31 of 37 T �G 218 Orange County NC Radio Communication Tower and System Infrastructure Upgrade RF Coverage and Sites /Towers 3.1.3 Southwest — SBA Site August 23, 2013 Page 32 of 37 � T �G 219 Orange County NC Radio Communication Tower and System Infrastructure Upgrade RF Coverage and Sites /Towers ® ,� ,m� SBA® 1D FLU[ M4 II � [OY1011b 1t im oftes4a PC i 1 ►+O• sw •1c+ 1w IR711 M rr,00 alai II oorraro �`Gf r•Ir •lu• or A 041II�f IF. • fIMMYIf am: •Y�. 4IN� N i ytl�G1. G..Y�f� Ulf r�tp Hu:( - .w .. August 23, 2013 Page 33 of 37 220 Orange County NC Radio Communication Tower and System Infrastructure Upgrade RF Coverage and Sites /Towers 3.1.4 Southeast - VilComm Site (WCHL) [Possible new site to be investigated] August 23, 2013 Page 34 of 37 T �u 221 I,s r T� �MMAD NOGlil3� S BA -zov- wA �1 1 2 CJNGULAR 1 3 4 AWS NETWORK NEWCC t -14D- -120- -1w- 188' 105' BO- w -w- -4u- -20- #--F WA :...�.c o ► rn. o..wu�c n.-r w., vrvn a, ..awc... rw.T. c..n .:� ..... -... 3.1.4 Southeast - VilComm Site (WCHL) [Possible new site to be investigated] August 23, 2013 Page 34 of 37 T �u 221 Orange County NC Radio Communication Tower and System Infrastructure Upgrade RF Coverage and Sites /Towers 3.2 VHF Paging Sites 3.2.1 Cedar Grove Fire Department 3.2.2 Orange Grove Fire Department 3.2.3 Eno Mountain Site 3.2.4 Chatham Site August 23, 2013 Page 35 of 37 � T �G 222 Orange County NC Radio Communication Tower and System Infrastructure Upgrade RF Coverage and Sites /Towers Appendix A SBA Colocation Application L7 SBA Colloapp - New Leases 12- 12.docx August 23, 2013 Page 36 of 37 �G 223 Orange County NC Radio Communication Tower and System Infrastructure Upgrade RF Coverage and Sites /Towers Appendix B Crown Castle Information and Credit Application • $1000 Application Fee • $2,000 Structural Analysis fee • Construction Installation Fee: Cost + 20% or, if Crown opts to waive the construction installation fee then an inspection fee of $2000 • Closeout Document Fee - $1500 — Only applicable if construction vendor doesn't provide necessary documents. Not applicable at all if Crown manages the construction. • Monthly rental fee: $2,500 a month, this is for the following equipment: o 2 — 12' at separate centerlines with associated coax not to exceed 1 -5/8" o 1 — 40 lb. TMA o 1 — 6' MW dish at a separate centerline with associated line not to exceed 1 -5/8" o 8 x10 Lease Area o 5 x10 — Generator Lease Area • Initial Term: 5 years • Escalation: 3% • Renewals: 4 Automatic Renewals • Renewal Terms: 5 years each Crown Castle Credit Application. doc August 23, 2013 Page 37 of 37 �G 224