HomeMy WebLinkAbout7B - Ambulance Study Report
AGENDA #:
PREPARED BY:
SUBJECT:
DATE:
INTRODUCTION:
STAFF AGENDA REPORT
78
Ambulance Study Committee
Ambulance Study Report
November 21, 1994
Over the last several years the number of ambulance calls responded to
by the forty m.ember Prior Lake Volunteer Department has increased
significantly. Shown below is a chart comparing the total calls for 1990
through 1994:
Ambulance Fire Total
1990 313 250 563
1991 424 258 682
1992 428 238 668
1993 496 276 772
1994 653 317 970
(As of 10/31/94)
The most dramatic increase has occurred for ambulance calls.
Ambulance 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
and without diminution of service.
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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
..__._________"~---...o-....--.--..--..--.....o-o-..-...-.-..-........ ....
BACKGROUND:
DISCUSSION:
Study participants included the following individuals and organizations:
Prior Lake Fire Department - David Chromy, Larry Stier
-- St. Francis Hospital - David Borrett
Spring Lake Township - Barbara Johnson
-- Credit River Township - Val Zweber
Dakota Community - Janice Badmoccasin
Little Six, Inc. - Joe Budzak
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 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. For many calls, service is
duplicated
The problems of the existing service delivery system were identified as:
1. Too much workload volume for a volunteer department
to handle. - On the average, two medical calls per day are
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 low and sometimes slow volunteer
response rate to calls.
2. 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.
3. Increasing OSHA requirements place heavy training
burdens on the department - Training associated with
ambulance service constitutes an increasing proportion of
weekly department activities. The increasing training burden
for ambulance is in direct conflict with the additional training
required in the fire service.
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4. 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 under-attended.
5. 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.
6. 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.
ALTERNATIVES:
Neither response time nor quality of service were seen as
problems. Rather, 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 from
the fire department to supply this service except for major
medical and rescue.
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.
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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 except for major medical
and rescue.
Hire full-time or part-time personnel to provide ambulance
service during the day.
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.
Option Expenditures Revenues Net Difference
1. Status Quo $ 45,255 $108,660 +$63,405
Current System
of Ambulance Delivery
2. Initiate Chaska $11 ,31~ $ 39,000f +$ 126
Type System, Where 27.560
PLFD Responds Off-peak. $ 38.874
All Transport by St. Francis
3. Shift to Single Tier $ 27,560 $ 39,000 +$11,440
Advance Life Support
System by Others
4. Hire Full or Part-time $ 22,665~ $108,660 +$ 2,956
Personnel to Provide $ 5,646
Service During the Day $ 77.393e
PLFD Continues During $105,704
Evening
5. Join an Existing $ 27,560 $ 39,000 +$11 ,440
Joint Powers Organization
Such as Savage and Shakopee
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ISSUES:
a. Assumes that fire department would respond to only 25% of the
total calls.
b. Represents per capita quotation which St. Francis has used in
existing contracts.
c. Represents current expenses for PLFD for vehicle, etc.
d. This is one fourth of the 1994 fire department personnel costs.
e. Total full-time and part-time ambulance personnel costs including
benefits.
f. 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
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.
HealthSpan and St. Francis Ambulance have merged. HealthSpan is no
longer requesting a per capita contribution from the City and townships in
exchange for service. Nor are they seeking a contractual arrangement.
Instead they would provide service with revenues provided through user
costs.
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.
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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?
RECOMMENDATION:. The alternative that best fulfills these criteria is Alternative 5 - Shift to
Single Tier Non-City ALS Service. St. Francis/HealthSpan have agreed
to enter into a letter of understanding with the City through which they will
respond to all calls from Prior Lake, the townships and the Dakota
Business and Tribal Community. The letter would outline that the
response times on the average must be equal to or better than that which
is received today (Le., 13 minute response time for 90% of the calls). The
City ambulance service would continue to respond to major medicals
(heart attacks and multiple persons injured) and personal injury vehicular
accidents (Le. rescue). We expect that between fire calls and these
major medicals that the fire department response, including fires would be
about 300 per year rather than the existing 1000.
HealthSpan provides ambulance service in over fifty cities. They have
substantial expertise in the field including computer aided dispatch and an
ability to provide their own backup in areas experiencing substantial
activity. Since they will be incorporating St. Francis Ambulance
equipment and employees on their system, users of the service in our
area should notice little if any change in service.
Anticipating that the City would be dramatically reducing its role in
ambulance service, the 1995 City budget and agreements with the
Townships reflect reduced revenues and expenses. The Dakota
Community contract likewise anticipates this service delivery change.
On November 9 the Ambulance Study Committee met with HealthSpan
representatives. Bill Rudnicki representing the Dakota Community, Bill
LaRogue representing Little Six and Betty Erickson representing Spring
Lake Township concurred that the transition proposed herein should take
place.
We agreed that complete changeover would occur on January 1, 1995.
Between December 15 and December 31 ambulance service would be
duplicated between St. Francis and the City as means of testing for
problems before total change over.
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Anticipating these changes articles would be placed in the Prior Lake
American, the Little Six employee newsletter, the Tribal newsletter and
the City's Wavelength announcing the change. During the time period
prior to January 1, St. Francis and City officials would continue to meet to
prepare and execute a letter of understanding and to establish a protocol
for response to serious medicals and rescues. Plans would also be made
to sell one or both of the existing ambulances. Finally the Dakota
contract would be revised through negotiation to be valuation based
rather than incident based. This agreement would then be consistent with
the Township agreements. We will maintain our BLS State Certification
until September of next year. Just in case service reverts back to the City
in a worst case scenario.
FINANCIAL IMPACT: Reduced revenues and expenditures have been incorporated into the
proposed 1995 budget anticipating this change.
ACTION REQUIRED: Motion and second to approve this report and implement its
recommendations.
AMBREP.CC
..
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EXHIBIT I
PRIOR LAKE AMBULANCE STUDY
11 /1 /93
PURPOSE: - To determine how ambulance services should be delivered to residents
and businesses in Prior Lake, Credit River and Spring Lake Townships in a manner
which provides quick, competent and economical service with the capacity to serve as
demand increases over the next five years.
Participants:
2 Prior Lake Fire Department - Dave Chromy, Larry Stier
1 Prior Lake City Manager - Frank Boyles
1 St. Francis Hospital - Dave Borrett
1 Spring Lake Township - Barb Johnson
1 Credit River Township - Val Zweber
1 Dakota Community - Bill Rudnicki
1 Little Six, Inc. - Bill Johnson
1 Prior Lake Police representative - Rob Boe
Total...................................... .9
Study Timeline:
No more than three (3) months.
Study Steps:
1) Define the problem:
-- Advantages of current system.
Disadvantages of current system.
Future community growth.
2) Brainstorm alternative service delivery options.
3) Establish criteria for evaluating alternatives.
4) Evaluate alternatives on at least the following criteria:
-- Quality of service received.
-- Cost of service.
Response time.
Range of services provided.
Duplication of service.
Equipment needed to deliver service.
-- Supervision/Command structure needed.
Ease to initiate service.
5)
6)
7)
8)
Select top two or three final options.
Solicit public input.
Modify based upon input received and determine
final recommendation.
Report to governing bodies:
-- City Council
County Sheriff
-- Tribal Council
Implement
9)
STUDY,WRT
T Lt
EXHIBIT II
PRIOR LAKE AMBULANCE STUDY
JANUARY 1994
OPTIONS FOR DELIVERING AMBULANCE SERVICE
I.
STATUS QUO
..f.
..Q..
-- Cost effective
-- Good quality
-- Good response time
-- Have equipment
-- Have training
-- Least change to everyone
-- Strong community connection
-- ALS still available
-- Highest revenue
-- Volunteer burnout
-- Manpower needs to be increased
-- Limited growth capacity
-- Limited capacity to meet existing calls
-- More training requirements
-- Duplication with St. Francis continues
-- Accelerated cost I.e. building/equipment
-- Undermines fire operation
(training & competing calls)
-- Billing/record keeping
II.
HIRE FT/PT EMT'S TO TAKE DAYTIME CALLS. EVENING & WEEKENDS
...E...
.c...
-- Improve response time
-- Improve volunteer firefighter morale
-- Relieves daytime strain
-- Perception of better service by consumer
-- Lower liability/higher employee safety
-- Readily upgradable as needed/desired
-- Improved policies & procedures
-- Added personnel + training costs
-- Accelerated equipmentlbuilding depreciation
-- Could lead to more expensive e.g. ALS service
-- Added supervisory responsibility
-- Morale problems by blending FT/PT & volunteer
-- Next step to FT
-- More policies & procedures to administer enforce
-- If ALS sign licensing issues
III.
CREATE VOLUNTEER CITY/COMMUNITY AMBULANCE SERVICE (SEPARATE BODY FROM PR
LAKE FIRE DEPARTMENT) ALS/BLS
...E...
.c...
-- Could use old building as
base
-- Solves F.F. burnout
-- City has equipment (ambls)
-- Potential manpower cross-
over with Fire Department
-- Community based
(control pride)
-- Cost effective compared to
full time
-- Better quality control
(manpower/training/mgrnt)
-- More opportunity for female
participation
-- May be limited to BLS (would
require license petition)
-- May require additional volunteers
-- Would have to negotiate ISN Agreement
(Insurance payment per run)
-- Less revenue
-- More training
-- Additional supervisors, policies
-- More costly than status quo
-- Difficult to sustain as a
volunteer service
(1 )
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IV.
Service Delivery Option
(continued)
CHASKA SYSTEM - BlS BY CITYITRANSPORT BY ST. FRANCIS
EITHER (1) AT ALL TIMES OR (2) DURING SPECIFIC HOURs/DAYS
..E...
-- 5ame/better response time
(one backs up the other)
-- Calls match P.L. manpower
strengths
-- Time per call reduced for
P.L. - burnout/cost
-- P.L. Vol. keep skills
-- Added depth for peak service times
-- ALS mutual aid included
-- Maximum city flexibility
(entails least change)
-- Good customer service
(city as customers)
-- No billing
-- City has option to transport at
select times of the day or week
v.
SHIFT TO SINGLE TIER ALS (NON CITY)
..E...
-- Better response times
-- Eliminates duplication
-- No license issue
-- No ISN negotiations
-- No city responsibility
-- Solves burnout
-- Disposes of equipment
-- No city billing responsibility
-- Low subsidy
-- No city Mgmt/sup responsibility
(more time for fire issues)
-- Continued patient choice regarding
hospital desired
-- Capacity to serve growing community
-- AL5 service given to all patients
-- Easier for dispatcher
(2)
..c..
-- Duplication of cost
- Increase in consumer cost
-- Added cost (subsidy) to city & township
cost both for P.L.F.D. & 51. Francis
- No billing revenue
..c..
-- Monopoly (lost controVnot
community based)
-- Consumer service cost higher
-- Potential increase in cost (subsidy)
to participating agencies
(e.g. $2.12 per capita)
-- Lost revenue against expenses
VI.
VII.
AMBl120WRT
..f...
JOIN EXISTING JOINT POWERS (A.LF.)
-- Eliminates duplication
-- Documents exist
-- Solves burnout
-- Disposes of equipment
-- Improves Credit River
response time
-- No responsibility for
supervision, training,
etc. of employees or
this service
-- Greater financial capacity
for growth
Service Delivery Option
(continued)
.c..
- Do they want us?
-- Raises license & PSA issue
(litigation)
-- ISN issues
-- Continued City responsibility
(cost, sup of joint powers agree)
-- Cost (?)
- Deployment of rigs (i.e.
larger cities with greater
activity get the equipment)
-- loss of controVservice flexibility
-- Potential service degradation to
casino
.E..
ESTABLISH NEW JOINT POWERS (AlS OTHER THAN ST. FRANCIS)
.c..
-- Better response time
-- Eliminates duplication
-- Easier for dispatcher
-- Solves burnout
-- Capable of growing
-- Greater controVownership
(3)
-- license issue (litigation?)
-- ISN Issue
-- Expanded city role & responsibility
-- Who belongs
-- legal costs
-- Higher cost (?)
-- Greatest change from status quo
-- Establishes need for equipment,
creating new full time organization
-- Necessity to rewrite existing
mutual aid agreements
EXHIBIT II
JANUARY 5, 1994
AMBULANCE STUDY MEETING
PREFERRED ALTERNATIVES
I. Status Quo 0
II. Hire Full Time/Part Time EMT's during the day 3
III. Create City/Community Ambulance separate from 1
Prior Lake Fire Department
IV. Chaska System - P.L.F.D. part days, St. Francis 8
the remainder
V.
Shift to Single Tier A.L.S. - St. Francis only
7
VI.
Join Another Joint Powers Group
1
VII.
Establish New Joint Powers Group
1
21
The seven Task Force members had three votes each for their top three choices (two
votes could be cast for most desired choice.)
AMBl14.WRT
4629 Dakota St. S.E., Prior Lake, Minnesota 55372-1714 / Ph. (612) 447-4230 / Fax (612) 447-4245
AN EQUAL OPPORTUNITY EMPLOYER
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