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HomeMy WebLinkAboutAgenda - 12-04-2000-8eORANGE COUNTY BOARD OF COMMISSIONERS ACTION AGENDA ITEM ABSTRACT Meeting Date: December 4, 2000 Action Agenda Item No. ~~ SUBJECT: Classification Plan Amendment -EMT Paramedic DEPARTMENT: EMS and Personnel PUBLIC HEARING: (Y/N) No ATTACHMENT(S): 1 -New/Evolved Duties and Responsibilities for EMT-Paramedics 2 -Class Specifications - EMT-Paramedic - Assistant EMS Supervisor INFORMATION CONTACT: Nick Waters, Emergency Management Director, 968-2050 Elaine Holmes, Personnel Director Extension 2550 - EMS Supervisor TELEPHONE NUMBERS: Hillsborough 732-8181 Chapel Hill 968-4501 Durham fi88-7331 Mebane 336-227-2031 PURPOSE: To consider amending the Orange County Classification and Pay Plan by: • Changing the salary grade of the existing class of EMT-Paramedic from Salary Grade 66 to Salary Grade 67. • Establishing a new class of Assistant EMS Supervisor at Salary Grade 68. • Changing the title and salary grade of the existing class of EMS Field Supervisor from Salary Grade 68 to EMS Supervisor at Salary Grade 69. BACKGROUND: The Emergency Management Director requested that Personnel complete a current classification and pay study of 19 (15 EMT-Paramedic and 4 EMS Field Supervisor) positions to assess changes in duties and responsibilities since the last classification review in 1990. These changes resulted from a strategic planning process leading to restructuring of the emergency medical program beginning in 1996. EMS Program Changes The EMS program restructuring changed the program from a focus based solely on response time to a focus on appropriate treatment and transportation for each patient. EMS took paramedics out of ambulances and placed them in Initial Response Vehicles (IRV). When one calls 9-1-1 for emergency medical assistance, an ambulance may or may not show up depending on the call type, but an IRV Paramedic always will respond. The IRV Paramedic will make a decision whether to assess and release the patient; assess and treat the patient; assess and refer the patient or, if ambulance transport is necessary, assess and treat the patient while an ambulance is dispatched, if one was not dispatched initially. The Paramedic Initial Response Program has allowed paramedics to manage resources better. Other success measures include: • The cardiac arrest save rate has increased from 6 percent to 20 percent since program implementation. • Response time for emergency calls has decreased on average by 1.5 minutes, or 22 percent. • The number of light and siren responses decreased by 60 percent, thereby reducing the County's liability risk. • Based on call volume and population, EMS estimates that under the old EMS system the County would have had to invest in three new ambulances, 18 new full-time employees and two new emergency medical service bases. Costs for these components come to $870,000 in capital costs over three years and an annual investment of $1.04 million. The Paramedic Initial Response Program saves the County over $1.25 million a year by those standards. Classification of EMT-Paramedic Personnel has completed the classification study of the Paramedic and Paramedic supervisory positions to take account of the duty changes resulting from the restructuring of the program. The study included employee interviews to assess the duty changes and telephone interviews with managers in EMS offices in other counties to obtain comparative labor market information. Based,on the classification study, Personnel has identified a number of new and/or evolved duties and responsibilities that have resulted from the new IRV system. These are listed in Attachment 1. The new and/or evolved duties and responsibilities have impacted on the EMT-Paramedic and EMS Field Supervisor positions, including an increase in the level of decision-making; independence of action and overall impact on end results. In addition to the changes in duties and responsibilities since the last study, the County presently and for the past several years has been experiencing significant difficulty in recruiting the trained, experienced EMT-Paramedics necessary to effectively staff the IRV system. Presently four of the 15 EMT-Paramedic positions are open. Based on the significant increase in responsibility, the available labor market data and the County's recruitment experience in trying to fill Paramedic positions, it is recommended the salary grade for EMT-Paramedic be increased from grade 66 to grade 67. Classification of Assistant EMS Supervisor and EMS Supervisor An additional change in the Emergency Medical Services Unit is the development of an Assistant Shift Supervisor role under the EMS Field Supervisor. Specifically, the Assistant Shift Supervisor is responsible for the following: • In the absence of the Shift Supervisor, the Assistant Shift Supervisor supervises the work of employees engaged in emergency medical care, including providing instructions to employees on the shift and communicating any changes in polices and procedures. • When the Shift Supervisor is present, the Assistant Shift Supervisor works in conjunction with the Shift Supervisor. This includes significant time in orienting. and training new employees; observing work performance and giving feedback on progress. The Assistant Shift Supervisor's role is recognized at a higher level than the existing EMT- Paramedic class due to judgment and discretion exercised with the supervisory responsibilities. It is recommended this classification be added at salary grade 68. To maintain the appropriate salary relationship between the new Assistant EMS Supervisor class and the existing class of EMS Supervisor, it is recommended that the EMS Supervisor class be moved from grade 68 to grade 69. FINANCIAL IMPACT: Funds to implement the results of the EMS classification and pay study are available within the approved budget for 2000-01. The estimated increase in cost is up to $28,000 for the remainder of this fiscal year and up to $48,000 on an annual basis. RECOMMENDATION(S): The Manager recommends that the Board amend the Classification and Pay Plan by: • Changing the salary grade of the existing class of EMT-Paramedic from Salary Grade 66 to Salary Grade 67. • Establishing the new class of Assistant EMS Supervisor at Salary Grade 68. • Changing the title and salary grade of the existing class of EMS Field Supervisor at Salary Grade 68 to EMS Supervisor at Salary Grade 69. 4 Attachment 1 New and/or Evolved Duties and Responsibilities For Orange County EMT-Paramedics • Assesses the patient and decides whether to release the patient; treat and release the patient; treat and refer the patient or treat and transport the patient by ambulance. • Exercises judgment and upgrades and/or downgrades the type of call given from the Telecommunicatorcuch as whether to dispatch or not dispatch an ambulance, air medical care or other. • Responds to calls in an Initial Response Vehicle without a partner rather than on an ambulance as part of a paramedic crew. In this way is responsible for independently making care determinations in accordance with protocols and consultation with the medical director. • Based on the Paramedic's assessment, may decline to provide transportation to patients who do not require follow-up treatment at the hospital. When needed, offers patients other transportation alternatives rather than ambulance transport. • Instead of immobilizing every patient after a car crash, identifies spinal injuries through advanced assessment techniques and decides whether or not to immobilize the patient through the use of backboards and collars. • Visits the homes of newborn babies to conduct safety inspections and provides parents with information on how to ensure safety in their homes. • Provides grief counseling to bereaved persons and remains on scene until Medical Examiner or law enforcement arrives. • Provides a variety of advanced life support procedures (i.e. surgical airway procedure, thyroid membrane incision, cervical spine injury assessment and the like). • It now is required that employees receive the following certifications after being hired with Orange County: / ACLS (Advanced Cardiac Life Support), / PALS (Pediatric Advanced Life Support), and / BTLS (Basic Trauma Life Support) or PHTLS (Pre-Hospital Trauma Life Support). Due to the IRV system Paramedic responsibilities, EMS also now prefers that an applicant have the certifications prior to employment. Attachment 2 EMERGENCY MEDICAL TECHNICIAN -- PARAMEDIC GENERAL DEFINITION OF WORK: Performs difficult technical work operating an IRV (Initial Response Vehicle); assessing, treating and releasing patients; administering emergency medical care at the paramedic level; and referring or transporting patients; does related work as required. Work is performed under general supervision. TYPICAL TASKS: Responds to calls in IRVs (Initial Response Vehicles); Provides initial medical assessment and treatment to persons, including advanced life support procedures; Determines if patients need transportation to medical facilities and if so, determines the appropriate method of transportation based on medical need; Declines transportation of patients to medical facilities, if transportation is not needed; Performs emergency medical care in accordance with established guidelines and written and verbal instructions from the Medical Director and staff; Dispenses medication to patients according to protocols; Supervises the emergency management scene, including EMS crews, rescue personnel, volunteers, transportation personnel, etc.; Provides grief counseling to bereaved persons and remains on scene until Medical Examiner or law enforcement arrives; Visits homes of newborn infants to conduct safety inspections and provides parents with information on how to ensure safety in their homes; Provides emergency medical care at special events (i.e. festivals, fairs, and races); Provides outreach education at schools and in the community; Performs related tasks as required. KNOWLEDGE, SKILLS AND ABILITIES: Thorough knowledge of the principles and techniques of emergency care, including diagnosis, proper treatment and transportation; general knowledge of the geographic layout of the County; ability to establish and maintain effective working relationships with physicians, associates, patients and their families, other emergency service agencies and the general public; ability to understand and follow oral and written instructions; mechanical aptitude; physical endurance and agility. EDUCATION AND EXPERIENCE: Any combination of education and experience equivalent to graduation from an accredited college or university with a Bachelor's degree in Emergency Science, Emergency Care or related field and at least 1 year emergency medical experience as a Paramedic or experience in a related medical profession; OR graduation from an accredited community college with an Associate's degree in Emergency Science, Emergency Care or related field and at least 3 years emergency medical experience as a Pazamedic or experience in a related medical profession OR graduation from high school and at least 5 years emergency medical experience as a Paramedic or experience in a related medical profession. SPECIAL REQUIREMENTS: Possession of an appropriate driver's license valid in the State of North Carolina. Must obtain and maintain North Carolina certification as an Emergency Medical Technician at C7062-12/00 EMS ASSISTANT SUPERVISOR GENERAL DEFINITION OF WORK: Performs difficult technical work and responsible administrative work on an assigned shift supervising emergency medical care in the absence of the EMS Supervisor and participating in the assessing, treating, referring, transporting or releasing of patients; does related work as required. Work is performed under general supervision. TYPICAL TASKS: Supervises the work of employees engaged in emergency medical care which includes assessing, treating, referring, transporting and/or releasing patients; Trains new employees on County policies and procedures; observes performance and gives feedback on progress; Issues oral and written instructions to personnel on shift; relays directives regarding changes in policies and procedures; Provides initial medical assessment and treatment to persons, including advanced life support procedures; Determines if patients need transportation to medical facilities and if so, determines the appropriate method of transportation based on medical need; Declines transportation of patients to medical facilities, if transportation is not needed; Performs emergency medical care in accordance with established guidelines and written and verbal instructions from the Medical Director and staff; Supervises the emergency management scene; Provides grief counseling to bereaved persons and remains on scene until Medical Examiner or law enforcement arrives; Performs related tasks as required. KNOWLEDGE, SKILLS AND ABILITIES: Thorough knowledge of advanced emergency medical procedures and practices; thorough knowledge of the geographic layout of the County; thorough knowledge of all rules, regulations, applicable State laws and protocols dealing with emergency vehicle operations and patient care; ability to supervise the work of others; ability to deal tactfully and courteously with the general public and other County officials. EDUCATION AND EXPERIENCE: Any combination of education and experience equivalent to graduation from an accredited college or university with a Bachelor's degree in Emergency Science, Emergency Care or related field and at least 2 years emergency medical experience as a Paramedic or experience in a related medical profession; OR graduation from an accredited community college with an Associate's degree in Emergency Science, Emergency Care or related field and at least 4 years emergency medical experience as a Paramedic or experience in a related medical professional OR graduation from high school and at least 6 years emergency medical experience as a Paramedic or experience in a related medical profession. SPECIAL REQUIltEMENTS: Possession of an appropriate driver's license valid in the State of North Carolina. Must maintain North Carolina certification as an Emergency Medical Technician at the Paramedic level. C7065-12/00 EMS SUPERVISOR GENERAL DEFINITION OF WORK: Performs difficult technical work and intermediate administrative work supervising emergency medical care on an assigned shift and participating in the assessing, treating, referring, transporting or releasing of patients; does related work as required. Work is performed under general supervision. TYPICAL TASKS: Supervises the work of employees engaged in emergency medical care which includes assessing, treating, referring, transporting and/or releasing patients; Trains new.employees on County policies and procedures; observes and evaluates performance; Issues oral and written instructions to personnel on shift; relays directives regarding changes in policies and procedures; Reviews all written call reports for completeness and accuracy and discuss needed changes with the Medical Director and Training Coordinator; Receives, investigates and documents complaints; Provides initial medical assessment and treatment to persons, including advanced life support procedures; Determines if patients need transportation to medical facilities and if so, determines the appropriate method of transportation based on medical need; Declines transportation of patients to medical facilities, if transportation is not needed; Performs emergency medical care in accordance with established guidelines and written and verbal instructions from the Medical Director and staff; Supervises the emergency management scene; Performs related tasks as required. KNOWLEDGE SKII.LS AND ABILITIES: Comprehensive knowledge of advanced emergency medical procedures and practices; thorough knowledge of the geographic layout of the County; comprehensive knowledge of all rules, regulations, applicable State laws and protocols dealing with emergency vehicle operations and patient care; ability to supervise the work of others; ability to deal tactfully and courteously with the general public and other County officials. EDUCATION AND EXPERIENCE: Any combination of education and experience equivalent to graduation from an accredited college or university with a Bachelor's degree in Emergency Science, Emergency Care or related field and at least 3 years emergency medical experience as a Paramedic or experience in a related medical profession, including at least 1 year supervisory experience; OR graduation from an accredited community college with an Associate's degree in Emergency Science, Emergency Care or related field and at least 5 years emergency medical experience as a Paramedic or experience in a related medical professional, including at least 1 year supervisory experience; OR graduation from high school and at least 7 years emergency medical experience as a Paramedic or experience in a related medical professional, including at least 1 year supervisory experience. SPECIAL REQUIREMENTS: Possession of an appropriate driver's license valid in the State of North Carolina. 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