HomeMy WebLinkAbout8G - Ambulance Study ReportSTAFF AGENDA REPORT
AGENDA#:
PREPARED BY:
SUBJEC~
DATE:
BACKGROUND:
DISCUSSION:
ISSUES:
RECOMMENDATION:
ACTION REQUIRED:
FRANK BOYLES, CITY MANAGER
PRELIMINARY REVIEW OF AMBULANC~STUDY
AUGUST 1, 1994
REPORT
In November, 1993 an Ambulance Study Committee was created
consisting of representatives from the Townships, Dakota Community,
Little Six Bingo, Inc., City Police and Fire Departments and St. Francis
Hospital. The Committee has completed its draft report and is prepared
to present the draft document for City Council information.
Attached is a copy of the draft Ambulance Study Report for City Council
review. At the August 1 meeting I would like to review the contents of the
Study Report to solicit City Council input on the Study recommendations
as well as direction on any other lines of research which should be
included.
The Council should determine whether all reasonable service delivery
alternatives have been considered. Council should also provide direction
if additional inquiry is desirable, or if other considerations should be
incorporated in the analysis. I am still expecting that members of the
ambulance committee will provide additional input into this draft report.
Based upon input received by the members of the Committee and City Council,
the report would be finalized and formally submitted for City Council
consideration at the September 6 meeting. By then, the final cost information
should be available from St. Francis.
Review and provide direction on revisions to be made in the draft report.
AG8G.WRT
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4629 Dakota St. S.E., Prior Lake, Minnesota 55372-1714 / Ph. (612) 447-4230 / Fax (612) 447-4245
AN EQUAL OPPORTUNITY EMPLOYER
Attachment for
August 1, 1994
INTRODUCTION:
Over the last several years the number of ambulance calls responded to
by the forty member Prior Lake Volunteer Department has increased
significantly. Shown below is a chart comparing the total calls for 1990
through 1993:
Ambulance Fire Total
1990 313 250 563
1991 424 258 682
1992 428 238 668
1993 496 276 772
1994 392 164 556
(As of July 19,1994)
The most dramatic increase has occurred for ambulance calls.
Ambulance and rescue calls are now the leading activity for our
department. As the activity level has increased, department members
have become increasingly vociferous that some action has to be taken to
dramatically reduce or preferably eliminate the number of ambulance
calls which fire fighters are expected to respond to.
This report is a result of a cooperative effort between representatives of
the City of Prior Lake and its Police and Volunteer Fire Department, St.
Francis Hospital, the Dakota Community, Little Six Bingo Inc., Spring
Lake Township and Credit River Township.
The recommendations herein represent a realistic and economical means
by which ambulance services can continue to be provided to the
Townships, Dakota Community and City with minimal City involvement.
BACKGROUND:
Study participants included the following individuals and organizations:
-- Prior Lake Fire Department- David Chromy
-- St. Francis Hospital - David Borrett
-- Spring Lake Township - Barbara Johnson
-- Credit River Township - Val Zweber
-- Dakota Community- Janice Badmoccasin
-- Little Six Bingo, Inc. - Joe Budzek
-- Prior Lake Police Dept. - Rob Boe
-- City of Prior Lake - Frank Boyles
When the Committee first assembled on November 1, 1993, it established
a set of study steps which would provide an orderly means through which
the ambulance issue could be examined, alternatives evaluated and final
recommendations made. Attached as Exhibit I is the Study outline.
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4629 Dakota St. S.E., Prior Lake, Minnesota 55372-1714 / Ph. (612) 447-4230 / Fax (612) 447-4245
AN EQUAL OPPORTUNITY EMPLOYER
When the Committee first assembled on November 1, 1993, it established
a set of study steps which would provide an orderly means through which
the ambulance issue could be examined, alternatives evaluated and final
recommendations made. Attached as Exhibit 1 is the Study outline.
The first step in the study was to examine the advantages, disadvantages
and capacity of the existing ambulance service delivery system to cope
with increasing call volume.
Ambulance service to residents of the Dakota Community, Spring Lake
and Credit River Township and the City of Prior Lake is presently
delivered through the actions of three agencies: Scott County provides
dispatching services, St. Francis Hospital provides Advanced Life
Support (ALS) services, the City of Prior Lake Volunteer Fire Department
provides Basic Life Support (BLS) services.
DISCUSSION:
The problems of the existing service delivery system were identified as:
Too much workload volume for a volunteer department
tO handle. - On the average, over one medical call per day
is received. At worst, the number of calls per day can be
seven or more. Most often calls occur when most volunteers
are at work. This results in a Iow volunteer response rate to
calls.
Heavy work load occurs in conflict with the normal
business day - Normally ambulance calls peak at the
beginning of the work day (6:00 a.m. to 9:00 a.m.), as well
as, at the end of the work day (3:00 p.m. to 6:00 p.m.).
Calls occurring at these peak times directly conflict with the
Volunteer Firefighter's normal full time work. Firefighters are
concerned about the security of their full-time work because
of the many disruptions created by ambulance calls.
Increasing OSHA requirements place heavy training
burdens on the department - Training associated with
ambulance service constitutes an increasing proportion of
the training provided to the Department each week. The
increasing training burden for ambulance is in direct conflict
with the additional training required in the fire service.
The existing system creates duplication of service -
Commonly, St. Francis and Prior Lake respond to the same
calls. Consequently, twice the cost is experienced. Two
ambulances in service in one part of the community may
leave other parts of the service area underattended.
Ability to respond to increasing service demands -
Development in the Townships and City of Prior Lake,
coupled with the success of the Casino and additional
Dakota facilities and services, portend a substantial increase
in future service demands. Because the existing system is
largely based upon volunteer efforts, there is not sufficient
capacity for accommodating such increases.
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ALTERNATIVES:
o
Billing process - The paper work associated with the billing
and the limited time available for volunteers, sometimes
results in bills never being generated or collected.
There are also major strengths associated with the existing
ambulance delivery system: Cost is a major advantage.
Because the system is volunteer, the cost is minimal.
Revenues associated with the service help defray fire
system costs.
Neither response time nor quality of service were seen as
problems. Instead, both were seen as strong points. The
problem with the existing service delivery system is not a
problem perceived by the customer. From the customer's
perspective, the ambulance staff is very competent,
response time is appropriate and the cost reasonable.
The essence of the problem is that the forty member
volunteer department no longer believes that it can respond
to the rapidly escalating number of ambulance calls.
Having identified the issues associated with the existing system the
Committee attempted to brainstorm alternate service delivery options
which might resolve present difficulties. Numerous alternatives were
suggested including:
-- The status quo.
-- Hire full time or part time emergency medical technicians to
provide BLS or ALS service from Prior Lake.
-- Create a separate volunteer ambulance service aside fr°m
the fire department to supply this service.
-- Shift to a single tier system using St. Francis or some other
hospital as a provider.
-- Consider a Chaska type system which continues shared
responsibility with BLS provided by the City and all transport
done by St. Francis.
-- Join an existing joint powers provider such as ALF or
Savage.
-- Create a new joint powers provider.
Each of the above seven options was discussed and a list of strengths
and weaknesses prepared. The committee agreed that for any option to
be further considered, it must provide service equal to or better than the
present service delivery system. The attached Exhibit 2 lists the strengths
and weaknesses of each alternative.
From the seven alternatives identified the committee narrowed the
possible choices to three. The three final choices were:
-- Initiate a Chaska type system through which the Prior Lake
Fire Department responds during non-peak hours. St.
Francis would do all transport and be the exclusive provider
during peak hours.
-- Shift to a single tier ALS system which eliminates the Fire
Department Ambulance service.
-- Hire full-time or part-time personnel to provide ambulance
service during the day.
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ISSUES:
To assure that all reasonable options had been considered and to have a
benchmark, the Committee then added a fourth and fifth option. They
are:
-- Join an existing Joint Powers Group to receive ambulance
service.
-- The status quo.
The financial impacts of each option was evaluated and is shown on the
table below.
Status Quo
Current System
of Ambulance Delivery
Initiate Chaska
Type System, Where
PLFD Responds Off-peak.
All Transport by St. Francis
.E~ Revenues ~
$ 45,255 $108,660 +$63,405
11,31,~ $ 39,000f
38.874
+$ 126
Shift to Single Tier
Advance Life Support
System by Others
$ 27,560 $ 39,000 -$11,440
Hire Full or Part-time
Personnel to Provide
Service During the Day
PLFD Continues During
Evening
$ 22,665~c
$ 5,646u
$ 77.393e
$105,7O4
$108,660 -$ 2,956
Join an Existing
Joint Powers Organization
Such as Savage and Shakopee
a
b
C
$ 27,560 $ 39,000 $11,440
Assumes that fire department would respond to only 25% of the
total calls.
Represents per capita payment requested by St. Francis to respond
to all calls.
Represents current expenses for PLFD for vehicle, etc.
This is one fourth of the 1994 fire department personnel costs.
Total full-time and part-time ambulance personnel costs including
benefits.
Dakota police and fire agreement revenues.
The Committee then discussed the viability of each option based upon
the data which had been generated.
The status quo option is clearly the most cost effective. The committee
entertained the thought of establishing a separate division of the fire
department to provide ambulance service. From informal discussions
with existing firefighters it became clear that the work load has simply
exceeded the capacity of the existing volunteer body. Some discussion
occurred about recruiting new members to provide this service. This
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RECOMMENDATION:
option could be explored but would take a long time to implement with no
guarantee of success. It would also further delay the implementation of a
permanent solution from the firefighter's point of view.
The Chaska system wherein the volunteer fire department responds to
off-peak calls and St. Francis to all peak hour calls represents only a
partial solution. The fire department would continue to be involved in
ambulance service, therefore, the City continues to experience the
personnel, training and equipment costs with a substantially reduced
revenue stream. From the fire department perspective this is not an
adequate solution. In the Committee's opinion this is a good transitional
solution until a more permanent resolution can be implemented.
The third option, shift to single tier ALS system, succeeds in removing the
fire department from ambulance responsibility. It also eliminates
duplication in service delivery. The cost is a per capita fee with primarily
revenues provided by patients using the service. This option also allows
the city to dispose of one ambulance. This "donation" could be used to
satisfy the per capita contribution which the hospital has requested.
Hiring full-time or part-time personnel to provide day service and
volunteer firefighters to provide evening service is the fourth option. The
biggest advantage of this system is it allows the City to retain the
considerable ambulance revenues. Unfortunately, it also entails a
substantial cost increase. Under this option the City would continue to
experience volunteer personnel, training and equipment costs coupled
with similar costs for full or part-time personnel. It is likely that this option
would result in the creation of a new essential employee union
representing the part-time or full-time ambulance attendants. It may also
pave the way for a full-time department where a volunteer organization is
preferable. The volunteer department would perceive this as a partial
solution only.
The final option is joining an existing Joint Power Organization. The
committee checked with Savage and Shakopee and was invited to join
the system. The costs for this option are virtually identical to a direct
agreement between the City and St. Francis Hospital. An added benefit
to the Joint Powers Agreement is potentially better bids since providers
may be more inclined to provide a proposal for a larger contiguous
service area.
To make a final selection a number of criterion should be evaluated:
-- Will the alternative provide ambulance service as good as or
better than the present service level?
-- Is the service capable of responding to the increase in calls
expected in this growth area?
-- Will the service be affordable to taxpayers?
-- Will the solution be cost effective?
-- Does the solution provide the city with a reasonable
alternative if it fails or becomes to expensive?
The alternative that best fulfills these criteria is Alternative 5 - Join an
existing Joint Powers Agreement. The City Council should discuss this
study including any questions on additional alternatives you believe
should be considered. If the City Council concurs with the
recommendation then direction needs to be provided to staff to:
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Work with Savage and Shakopee to be included in the Joint
Powers Agreement.
Work with St. Francis Hospital to resolve funding issues.
Transition should take place on a gradual basis during the last
three months of this year to ensure that St. Francis has the
capacity to provide quality service within time limits. This will
also provide hospital staff with the ability to assess the need
for additional personnel and manpower to provide the service
to an expanded client base.
Evaluate the impact of the elimination of ambulance service
on the size of the fire department and its building and
equipment needs.
The Council should also direct the staff to convey this report
to the Townships and Dakota Community and Little Six to
solicit their comments.
AMBREP. CC
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MEMORANDUM
TO:
FROM:
DATE:
SUBJECT:
David Chromy, David Borrett, xl~arbara
Badmoccasin, Joe Budzek and Rpb Boe
Boyles, City Manager ~ ...Il"~
Frank
July 21, 1994 ~
DRAFT REPORT
Johnson, Val Zweber, Janice
Attached at long last is a copy of the draft Ambulance Study Report for your review. I have
embellished upon some aspects of our analysis since I have had the opportunity to think about
the issues. Please review the report and provide me with your comments. It is my intent to
present the draft report to the Prior Lake City Council at their August I meeting to determine
whether they wish to see additional alternatives evaluated or information considered.
Thank you so much for your participation in this important study and your patience in seeing it to
its conclusion. Feel free to call me with your comments at 447-4230.
FBME21.CM
4629 Dakota St. S.E., Prior Lake, Minnesota 55372-1714 / Ph. (612) 447-4230 / Fax (612) 447-4245
AH EQUAL OPPORTUNITY EMPLOYER
Ill I ; ~
July 25, 1994
Mr. Don Liverman
.Chief Executive Officer
St. Francis Hospital
325 West Fifth Avenue
Shakopee, MN 55379
SUBJECT:
PROVISION OF AMBULANCE SERVICE TO THE CITY OF PRIOR LAKE,
SPRING LAKE TOWNSHIP, CREDIT RIVER TOWNSHIP AND THE
DAKOTA COMMUNITY
Dear Mr. Liverman:
Ambulance services for the above political subdivisions are presently provided on a basic
life support basis through the Prior Lake Volunteer Fire Department. Calls for ambulance
service collectively to these subdivisions has increased dramatically over the last few
years. Attached is a graphic which shows the total calls for service versus ambulance calls
for the period 1990 through 1994.
As service call totals have increased so to has the burden on our volunteer fire
department. Volunteer firefighters have been required to respond to multiple calls per day,
often requiring disruption of their full-time employment. In response to these frustrations
an ambulance study committee was created in 1993 to investigate alternate methods of
providing ambulance service in the coming years. I have attached a copy of that report for
your information.
After reviewing seven alternatives the report recommends that the most viable means of
providing ambulance service in the future is through a contract with St. Francis. At Dave
Borrett's instructions I am sending you this request to provide advanced life support
-services to individuals within Prior Lake, Credit River Township, Spring Lake Township,
and the Dakota Community. Pertinent information is shown below:
Schedule for Implementation - St. Francis would become responsible for the
service in two steps. Step 1 begins October 1, 1994 through December 31,
1994. During this period St. Francis would be responsible for response and
transport from 6:00 a.m. to 7:00 p.m. Monday through Friday. During these
hours the Prior Lake Fire Department would be available as an emergency
backup only. During all other hours Monday through Friday and on weekends
Prior Lake Fire Department would continue to respond as is the practice today.
That is, Prior Lake responds to Basic Life Support (BLS) calls and St. Francis
to Advanced Life Support (ALS) calls.
4629 Dakota St. S.E., Prior Lake, Minnesota 55372-1714 / Ph. (612) 447-4230 / Fax (612) 447-4245
AH EQUAL OPPORTUNITY EHPLOYER
Mr. Don Liverman
Page 2
July 25, 1994
This three month trial period will provide the opportunity to work out logistical,
personnel and equipment problems which may become evident in serving this
larger area.
Commencing January 1, 1995, St. Francis would become the sole provider for
both BLS and ALS service.
Term of Contract - The contract term would be five years commencing October
1, 1994 and terminating December 31,2000.
performance Criteria - During the first year, response times would be required
to be equivalent or better than that presently provided by the City and St.
Francis within the City, townships and the Dakota community. Commencing
January 1, 1995 the performance standards would be 90% of the calls
responded to in less than 10 minutes within the City and Dakota community and
90% of the responses in less than 12 minutes within the townships.
Revenues - St. Francis would be responsible for establishing and collecting
revenues from the individuals served on a call-by-call basis. This would be the
only charge for the service. The Dakota community will not be billed for service
for residents of the Dakota community. Patrons of the casino if they are not
Dakota community members may be billed.
There will be no per capita fees against the participating subdivisions in
recognition of the donation of one 1985 ambulance the city and townships will
make to St. Francis on January 1, 1995, and in acknowledgement of the
ongoing availability of an ambulance crew living quarters and heated
ambulance garage stall in the Prior Lake Fire Station at 16776 Fish Point Road.
In the event that St. Francis is unable to meet the performance criteria set forth
above or defaults in the satisfactory provision of such service during the
contract period, the ambulance shall revert to the ownership of the City of Prior
Lake with no payments due to St. Francis Hospital.
Please provide me with your response to this proposal at your earliest convenience so that
I can submit it for City Council consideration. The Prior Lake Council, respective
townships boards and Dakota Tribal Council will make the final determination regarding
the p<ml~psal. '
~incetely,
Fra/rll~ BO~es,
~_~anager
FB:aw
cc: Dave Borrett
Ambulance Study Committee Members
FBLTSg. CM
T T ~ .
TOTAL AMBULANCE CALLS
BY YEAR
CALLS BY TYPE 1990 1991 1992 1993 1994'
Ambulance 313 424 428 496 392
Non-Ambulance 250 258 238 276 164
TOTAL CALLS 563 682 668 772 556
*The 1994 calls are for the period January 1, 1994 through July 19, 1994.
CALL~.WRT