holyoke firefighters ambulance proposal 2014

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Holyoke Firefighters I.A.F.F. Local 1693 January 2014 Proposal for the EMD & BLS Ambulance Service

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A proposal from the Holyoke Firefighters, I.A.F.F. Local 1693 covering the benefits, costs and equipment needed to establish the EMD, a backup BLS transporting ambulance and the ultimate long term goal is to provide the primary BLS transporting ambulance within the HFD.

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  • PDF Documents

    Holyoke Firefighters

    I.A.F.F. Local 1693

    January 2014

    Proposal for the EMD &

    BLS Ambulance Service

  • INTRODUCTION

    The Holyoke Firefighters I.A.F.F. Local 1693 is proposing to provide the citizens of

    Holyoke with a full service, pre-hospital emergency medical care system. Local

    1693 plans to do this with a three phase plan. The Crawl phase consists of

    obtaining and operating the Emergency Medical Dispatch (EMD) within Holyoke

    Fire Department (HFD). Phase 2, the Walk phase, consists of operating a backup

    transporting Basic Life Support (BLS) ambulance within the department. Finally,

    the Run phase is that HFD will operate the primary BLS transporting ambulance

    for the City of Holyoke. This plan will include the provision of rapid response,

    treatment, and transport; for the purpose of improving the quality of community

    based patient care. Through employee teamwork and a distinctive command

    structure, this proposed Fire Department based system will deliver the optimum

    level of EMS response and patient care, including transport.

    Scope of the Proposal

    This proposal will cover the benefits, costs and equipment needed to establish the

    EMD, a backup BLS transporting ambulance and the ultimate long term goal is to

    provide the primary BLS transporting ambulance within the HFD.

  • 3

    Phase 1 Crawl (Immediate)

    Emergency Medical Dispatch (EMD) refers to a system that enhances services provided

    by Public Safety Answering Point (emergency) call takers, such as municipal emergency

    services dispatchers. It does so by allowing the call taker to quickly narrow down the

    caller's type of medical or trauma situation, so as to better dispatch emergency services,

    and provide quality instruction to the caller before help arrives.

    Based on specific question-and-answer logic trees ("systematized interrogation"), the

    dispatcher is able to determine a problem type and priority for the call, and use that

    information to:

    provide systematized Pre-Arrival Instructions, including o Dispatch Life Support (DLS), which gives phone instruction to aid the

    patient until help arrives o provide other information to the caller

    activate appropriate protocols o dispatch the appropriate resources o dispatch using the appropriate modes (emergency mode or normal

    driving) o activation of secondary protocols, such as notifications

    What are the benefits?

    Control of assets whether private or public Dispatching of the appropriate resources according to the emergency Better accountability Better response times Better familiarity with the geographic layout of the City of Holyoke Financial compensation for dispatching outside resources. Eligible for limited secondary Public Safety Answering Point (PSAP) Grant Funds

    What do we have now?

    Fully operational emergency dispatch center providing service 24 hours a day throughout the year

    Alarm room currently has 8 EMD certified dispatchers Fully equipped for interagency communications

  • What do we need?

    Contract between the City of Holyoke and an EMS ambulance service Equipment, including software & hardware, provided by a contracted EMS

    service to dispatch and track their units Establish an EMS enterprise fund Hire additional EMD dispatchers Agreement with Holyoke Firefighters I.A.F.F. 1693

  • 5

    Phase 2 Walk (Short term)

    Backup BLS ambulance is the level of medical care which is used for victims of life-threatening illnesses or injuries until they can be given full medical care at a hospital. BLS is generally used in the pre-hospital setting,

    What are the benefits of a backup BLS ambulance?

    Community based service

    Decreased response times

    Promotes continuity of care for the patient

    Reduces the need for out of city resources

    Provides experience & training with the goal of becoming the primary BLS

    ambulance Service for the City of Holyoke

    Grant possibilities

    What do we have now?

    HFD currently has 65 EMT Basics, 3 EMT Intermediates, 4 EMT Paramedics

    2 Class 5 ambulance licenses

    Holyoke Firefighters are long term career minded workers dedicated to the City

    of Holyoke

    Holyoke Firefighters know about the needs in their communityand are highly experienced emergency medical care providers

    Currently respond on average to over 4000 EMS calls a year and receive No

    Revenue for the service

    EMS provider agreement with Medical Control

    What do we need?

    Two fully equipped ambulances

    o Purchased or Leased

    o New, Used or Refurbished

    Billing company with guaranteed recovery

    Change Class 5 license to a Class 1 License

    Establish an EMS Enterprise Fund

    Have Medical Control agreement updated

    Agreement with the Holyoke Firefighters I.A.F.F. Local 1693

  • What are the numbers?

    Private Insurance will be billed at approximately $697.93. This is the average billing rate

    for fire department ambulances in the surrounding area. See attached ambulance fee

    schedule for reference.

    *Medicaid / Masshealth reimbursement rates are the lowest reimbursement rate paid

    by all insurance providers. Refer to 114.3 CMR 27.03, code A0429

    **Based on Holyoke Medical Center EMS Run Data, 2012

    Estimated % of

    Reimbursements Paid by Medicaid / Masshealth*

    BLS Emergent Rate of

    $236.27 x 500** Estimated Back Up Transports

    100% $118,135

    75% $88,601

    50% $59,068

  • 7

    What are the start up costs?

    Two ambulances - $130,000 - $300,000

    o Ambulance cost variables

    Type I, Type II or Type III

    New, Used or Refurbished

    Purchased or Leased

    Engine / Fuel Type

    Equipment & Supplies - $45,000 - $75,000

    o OEMS required equipment & supplies

    o Electronic Patient Care Reporting (EPCR) Hardware & Software

    Training - $10,000 - $15,000

    o Estimated 40 hour ride time per Firefighter/EMT

    o Overtime cost for Field Training Officers (FTO)

    License & Agreements - $800 +

    o Class I ambulance fee -$800

    o Medical Control Agreement - Unknown

    What are the operational costs?*

    Routine Maintenance - $1575

    Oxygen Cylinder Refills - $250

    Ambulance Supplies - $4050

    Fuel - $2900

    CMED Charges - $1790

    EPCR Maintenance Fees - $4500

    Billing Company - $4200

    BLS Ambulance License and Inspection Fees - $800

    Total - $20,065

    *Based on Holyoke FD & Chicopee FD current EMS operational costs.

  • What is the potential revenue?

    BLS Emergent Rate of

    $236.27 x 500 estimated back up transports

    % reimbursed

    Revenue minus

    estimated operational cost of $20,065

    100% / $118,135

    $98,070

    75% / $88,601

    $68,536

    50% / $59,068

    $39,003

  • 9

    Phase 3 Run (Long term)

    What are the Primary BLS ambulance benefits?

    Holyoke Firefighter/EMTs are all trained responders, prepared to handle any

    situation that may arise at a scene including patient care and transport

    Treatment and transportation by Holyoke Firefighter/EMTs is seamless &

    promotes continuity of community based care for the patient

    Effective & efficient pre-hospital emergency response

    Revenue generation

    Reduces the need for out of city resources

    Increased grant possibilities

    What do we have now?

    HFD currently has 65 EMT Basics, 3 EMT Intermediates, 4 EMT Paramedics

    2 Class 5 ambulance licenses

    Holyoke Firefighters are long-term career minded workers dedicated to the City

    of Holyoke

    Holyoke Firefighters know about the needs in their community and are highly experienced emergency medical care providers

    EMS provider agreement with Medical Control

    What do we need?

    An additional fully equipped ambulance to allow for two Primary BLS ambulances

    City of Holyoke agreement declaring HFD will be the primary emergency

    ambulance service

    Have Medical Control agreement updated

    Obtain agreements for ALS intercept services

  • What are the numbers?

    Holyoke Medical Center EMS Run Data

    Medicaid / Masshealth Reimbursement

    for the year 2012

    Total EMS patients

    transported

    2010

    2011

    2012

    2013 (As of Sept.)

    6448 6706 6570 5014

    Estimated % of

    reimbursements paid by Medicaid / Masshealth

    BLS Emergent Rate of

    $236.27 x 6570 transports

    100% $1,552,293.90

    75% $1,164,220.43

    50% $776,146.95

  • 11

    What are the start up costs? Most costs associated with the Primary BLS service would be already covered in the start up costs of the Backup service. One additional ambulance with equipment would be needed. Full staffing would be needed to run a Primary BLS transporting service. There would be the option of paying for salaries with the revenue generated from the ambulance service. What are the operational costs?*

    Routine Maintenance - $20,700

    Oxygen Cylinder Refills - $3000

    Ambulance Supplies - $50,000

    Fuel - $37,500

    CMED Charges - $23,500

    EPCR Maintenance Fees - $4500

    Billing Company - $85,000

    BLS Ambulance License and Inspection Fees - $1200

    Total - $225,400

    *Based on Holyoke FD & Chicopee FD current EMS operational costs.

    What is the potential revenue?

    BLS Emergent Rate of $236.27 x 6570 estimated transports % reimbursed

    Revenue minus

    estimated operational cost of

    $225,400

    100% / $1,552,293.90

    $1,326,893.90

    75% / $1,164,220.42

    $938,820.42

    50% / $776,146.95

    $550,746.95

  • Conclusion

    The men and women of the Holyoke Firefighters I.A.F.F. Local 1693 have been

    preserving life and property since 1851. This mission is accomplished through fire

    prevention, public education, firefighter safety, fire rescue operations, emergency

    medical services, technical rescue operations and disaster management.

    The vision for this service is one of growth and adaptation, necessary to maintain

    and enhance the quality and level of community based services delivered to the

    citizens of Holyoke. This continual improvement will facilitate safe, efficient and

    effective emergency response and patient care; leading to positive outcomes for

    those requiring emergency medical services in the city of Holyoke.