glendale~~ CITY OF GLENDALE, CALIFORNIA REPORT TO THE: Housing Authority D Successor Agency D Oversight Board D calendar

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1 Joint D City Council [g] ~0 glendale~~ california~ CITY OF GLENDALE, CALIFORNIA REPORT TO THE: Housing Authority D Successor Agency D Oversight Board D January 29, 2013 AGENDA ITEM Report: Fire Department one year review of the BLS ambulance program COUNCIL ACTION Public Hearing D Ordinance D Consent Calendar D Action Item D Report Only 1Zl Approved for ~f\ tJ / ~ l calendar ADMINISTRATIVE ACTION Signature Submitted by: Harold Scoggins, Fire Chief Prepared by: Julie Schaeffer, Public Safety Business Coordinator Approved by: Scott Ochoa, City Manager Reviewed by: Yasmin K. Beers, Assistant City Manager Michael J. Garcia, City Attorney Robert Elliot, Director of Finance Michele Flynn, City Auditor 8 B I

2 RECOMMENDATION This report provides an overview of the impacts, effects, enhancements and challenges encountered in the first year since implementing the Paramedic Engine/Basic Life Support (BLS) ambulance program. BACKGROUND/ANALYSIS In 2011,, Inc. was retained to conduct an evaluation of several alternative EMS delivery models. The goals of the EMS service delivery change were to continue to offer the highest level of service to the citizens of Glendale and maintain staffing levels on fire engines while reducing overall costs. The analysis provided three service delivery options. Option one was to continue the same ambulance transport staffing model with paramedic firefighters on four rescue ambulances and maintain one BLS ambulance staffed with two hourly non-sworn Emergency Medical Technicians (EMT). Option two converted the four existing Advanced Life Support (ALS) rescue ambulances (each staffed with two sworn paramedic firefighters), into four BLS transport ambulances and retain the original single BLS unit for a total of five BLS transport ambulances. Option three added a sixth BLS ambulance to the second option. It was determined that option two was best suited to meet the EMS needs of the community and was the option put into service. On January 9, 2012, the Glendale Fire Department implemented the paramedic engine/bls ambulance program. Under this new response model, the Fire Department operates nine paramedic engines that respond along with a BLS ambulance to emergency medical calls for service. There are two highly trained paramedic firefighters on each of the nine fire engines. The BLS ambulances are staffed with two hourly non-sworn EMT's. There are BLS ambulances strategically placed throughout the day at stations 21, 22, 25, 26, 27 and 29. During the slower call load periods, we have four BLS ambulances deployed and up to six deployed at staggered intervals during the peak times of the day (BLS 22 and BLS 27 are on swing shift schedules). Additionally, the Los Angeles County Emergency Medical Services Agency has authorized our ladder trucks to serve as Paramedic Assessment Units (PAU) when staffed with one paramedic. Combined, these units provide ALS service to all areas of the city. Response Impacts The analysis assumed certain outcomes would occur as a result of the adoption of the paramedic engine/bls ambulance program. For example, the average paramedic response time would improve city-wide; in some districts this improvement would be as much as three or four minutes faster. One of the primary goals of the adoption was to continue the highest level of service to the community through enhanced ALS service delivery. In the BLS model (see Table 1), response times remained about the same in the three busiest fire districts (21, 25 and 26) and improved in the other six districts. Paramedics are arriving on scene nearly four minutes faster in Engine 23's district as predicted by the analysis. The improvement in 27 and 28's districts is nearly three minutes. It cannot be overstated that any improvement in response times to critical EMS events that progresses the initiation of CPR, defibrillation, intubation and administration of medication is significant and successful for improving patient outcomes. 2

3 (Min:Sec) Average Paramedic Unit Response Time Management Partners Actual Actual Predicted Improvement District 21 4:39 4:08 4:34 0:05 District 22 5:44 4:07 4:12 1 :32 District 23 10:09 5:32 6:14 3:55 District 24 6:54 4:56 5:30 1 :24 District 25 4:36 4:27 4:45 (0:09) District 26 4:53 4:20 5:04 (0:11} District 27 7:38 4:36 4:51 2:47 District 28 7:48 4:30 4:55 2:53 District 29 5:03 4:35 4:38 0 :25 Table 1 Impacts on the Busiest Units assumed engine companies would be committed on EMS incidents for a longer duration each day due to the increased number of transports to hospitals. The five busiest engine companies (21, 22, 25, 26 and 27) would be committed to emergency incidents at least one additional hour per shift. The data (see Table 2) presented clearly supports the prediction that the busiest engine companies are being impacted. The number of hours an engine company is committed to incidents per 24-hour shift has increased. The busiest engine is committed to incidents 44 minutes longer per day; on average 3 hours and 36 minutes today compared to 2 hours and 52 minutes prior to the implementation of this program. The five busiest engine companies are located in the areas of Glendale with the highest population density. The analysis recognized various issues associated with the extended BLS program call durations. As a result; the Fire Department has implemented appropriate protocols to manage daily operations. The department alters training and mandatory meeting schedules to meet call volume needs during peak times. Additionally, the department has also adopted move-up protocols when warranted to cover committed engine companies when resources are depleted in high density districts. Average Total Time Per Shift Engines are Committed to Emergency Incidents Management (Min:Sec) Partners Improvement Actual Actual Predicted Engine 21 2:51:56 3:51:44 3:36:05 0:44:09 Engine 22 2:07:48 3:01:53 2:58:35 0:50:47 Engine 23 0:19:11 0:22:59 0:24:17 0:05:06 Engine 24 0:56:58 1:13:06 1:19:02 0:22:04 Engine 25 2:40:37 3:47:52 3:20:29 0:39:52 Engine 26 2:29:00 3:25:00 3:06:56 0:37:56 Engine 27 2:05:18 2:45:26 2:47:03 0:41:45 Engine 28 0:38:03 0:50:32 0:55:21 0:17:18 Engine 29 0:55:41 1:19:09 1:11:50 0:16:09 Table 2 3

4 Number of Paramedics Required The previous ALS rescue ambulance model required a minimum of 24 paramedics, 8 on duty each day times three platoons (A platoon, B platoon, and C platoon). assumed the Paramedic Engine/BLS delivery model would provide more than twice as many paramedics on duty each day. T<;>day, we have at minimum 18 paramedics on duty each day serving the community. Our total numbers of paramedics overall are gradually increasing and we expect to see this number rise over the next two years. The objective is to fulfill minimum paramedic staffing requirements without use of promoted rank paramedics. (see Table 3) The Los Angeles County staffing requirement maintains that ALS response resources must be available seven days a week, 24 hours per day. Thus, the paramedic engine program calls for 54 total paramedic firefighters within the department to staff nine ALS engine companies for three platoons (18 per platoon). In order to provide adequate staffing on a daily basis and cover departmental activities such as training, fire prevention, public education, station and apparatus maintenance, medical appointments, vacation and sick leave, etc., the analysis required each platoon to be staffed with a minimum of 22 assigned paramedics per shift or 66 in total. Sending additional firefighters to paramedic school has allowed us to fulfill this goal. We will need to continue this practice on a regular basis in order to ensure adequate paramedic numbers are maintained in spite of natural attrition and unforeseen causes (retirements, illness, injuries, etc.). FF/Paramedics Promoted Ranks Total Paramedics January 1, January 1, Table 3 Number of EMT's The number of part-time hourly employees required to staff five BLS ambulances was determined by Fire Department staff and deemed by to be a conservative approach. This number was estimated to be 60 part-time employees and an additional 15 part time employees to fill in vacant positions when they occur. When the program began on January 9, 2012, there were a total of 49 ambulance operators. From January 10, 2012 to January 9, 2013, the department hired an additional 30 ambulance operators. The maximum number of full-time and part-time ambulance operators maintained since program inception was 66 during the months of April 2012 and October The goal of the ambulance operator program is to provide the employee with an opportunity to work as an EMT for a maximum of three years with the department to develop the knowledge, skills, and abilities necessary to succeed as a future firefighter. The ambulance operator program has assisted many candidates in obtaining a position in the fire service. A total of 54% of our ambulance operators who are no longer with the department have promoted to a first responder position with other fire, military, or law enforcement agencies. An additional 17% left to attend school. The program currently has a 36% turnover rate in staff. Impact on Mutual Aid The Glendale Fire Department participates in the Unified Response automatic aid system with 11 other local cities where the closest apparatus and personnel are dispatched to certain types of incidents regardless of city jurisdiction. Glendale Fire also participates in mutual aid with the 4

5 Los Angeles Fire Department, Los Angeles County Fire Department and the Angeles National Forest. commented that the impact of implementing a paramedic engine program on mutual and automatic aid was unknown. The analysis assumed there would be enough capacity in the system to absorb the impact of engines being committed to responses for longer periods of time. The department has not seen an increase in the number of mutual aid responses into Glendale from neighboring jurisdictions (see Table 4). In fact, between 2010 and 2012 there has been a 27% reduction in ambulances dispatched into Glendale to assist with Glendale incidents. There has also been a reduction in Glendale ambulances being dispatched to provide aid in other jurisdictions (see Table 5). Glendale ambulance dispatches outside the city represented 3.5% of all ambulance dispatches in 2010, compared to 2.3% in Conclusion Outside Ambulances Dispatched into Glendale Responses by: Burbank LA City LA County Pasadena Table Glendale Ambulance Dispatches Outside the City Responses into: Burbank LA City LA County Pasadena Table The conversion to the Paramedic Engine/BLS Ambulance Program has undoubtedly enhanced ALS delivery to the community. Each year there are increased demands on EMS service delivery (see Table 6). Under this new model we have been able to enhance our EMS service delivery to the community by providing at least one paramedic on virtually every fire company in the city. Glendale Incidents Category Fire 1,421 1,433 Medical 13,480 13,855 Service Other 11 7 TOTAL 15,578 15,888 Table 6 On average, two paramedics are arriving on scene at an emergency one minute and four seconds sooner (see Table 7). The primary source of this improvement is the change from five ALS ambulances with two paramedics, to nine fire engines with two paramedics; travel time has been reduced because paramedics generally don't have to travel as far. This allows for ALS service to be provided to citizens at the quickest rate possible. We also have additional Truck PAU's available for medical response where none had existed before. 5

6 Average Response Time 2 Paramedics Arriving On scene (Min:Sec) Previous EMS Model New EMS Model Improvement Table 7 5:49 4:45 1:04 In addition to enhancing medical response to the community, we have reduced the demand for surrounding jurisdictions to provide ambulance services to Glendale incidents. We have also developed a program which has successfully produced skilled ambulance operators; the majority will find success in first responder career tracks. While the benefits of this program are many, there have been a few challenges. Maintaining staffing levels of ambulance operators has at times been a challenge. This has been due to the turnover rate of AOs and the conflicts (school, other employment, testing... ) in scheduling AO work shifts. In conjunction with maintaining staffing levels, we have challenges with ambulance operator work schedules. Current work schedules are based on hiring ambulance operators for 12 hour shifts. Because of the 12 hour shift model, the Glendale Fire Department is required to hire four AOs per 24 hour shift. Creating a modified 24 hour shift schedule is a possible solution to this challenge. This would reduce the number of daily contacts made to staff the units and create more crew continuity in the fire stations. An additional challenge has been during major incidents when resources are limited. Currently, the Verdugo Fire Communications Center (VFCC) dispatches the closest resources to major incidents. If a major incident (2nd alarm brush and 3'd alarm structure) occurs in Glendale, Glendale ALS resources will not be available to respond to medical emergencies. ALS resources from a neighboring agency will be dispatched into Glendale by our automatic aid agreements. This occurred four times in 2012, during three second alarm brush fires and one third alarm structure fire. It should be noted that these resource issues occurred in the former Rescue Ambulance model as well, the difference being the rescues were staffed with ALS personnel. Our final challenge will be the future implementation of the Affordable Health Care Act (AHCA). The AHCA when fully implemented will add additional cost to the management of this program; we wi ll be required to provide health care insurance to eligible hourly employees. FISCAL IMPACT To date, the costs incurred for the implementation of this program (Fire Paramedic Fund ) involved initial equipment costs for the ambulance operators and apparatus and those fees associated with staffing the ambulance operator program (hourly wages, overtime, the costs for exams, int rviews, testing, backgrounds, polygraphs, medical exams and uniforms). Other expenses outlined in the cost of adopting option two are associated with staff for the management of this program. The Emergency Medical Technician Coordinator manages the ambulance operators' hiring process, training, and continuing education, and one Office 6

7 Services Specialist II assists the EMT Coordinator and the EMS section with day~to-day administrative duties required to maintain this program. The Paramedic Fund is a special revenue fund that has historically derived its revenue from both the General Fund (through annual transfers) and the revenue generated through billing for emergency medical services. The General Fund transfer has been substantially ~educed over the past two fiscal years due to BLS program cost reductions which includes eliminating firefighter positions in the Paramedic Fund. As a direct result of the BLS program, in the upcoming fiscal year 13/14, the General Fund transfer will be eliminated (see Table 8). Revenues EMS System Billing $ 13,283,168 $ 14,971,519 $ 14,137,797 $ 15,920,116 Insurance Write Down1 (7,332,485) {8,357,512) (7)28)77) (8,995,959) Uncollectible Accountst (1)40,000) ( 1,326,121) ( 1,284, 736) (1,521,690} Net Collections 4,610/684 5,287,886 5,124,784 5,402,467 Paramedic Membership Fee 130, , , ,240 Misc. Revenue 3,500 3,887 City Wide Collection Revenue 2 28,529 Total Revenues s 4,744,807 $ 5/440,355 $ 5,248,324 Expenditures Salaries and Benefits $ 5,023,865 $ 5,537,829 $ 4,725,478 $ 2,076,033 M&O 841,191 1,617,544 2,122,846 2,408,170 Capital Outlay 101, ,788 Total Expenditures 5,966,099 7,306)60 6,848)24 4,484,203 Gain/( loss) $ (1,221,292) $ (1,865,805) $ (1,600,000) $ General Fund 'Fransfer Amounts $ 2,100,000 $ 1,600,000 $ 1,600,000* $ lncrease/(decrease) in Fund Balanc $ 878,708 $ (265,805) $ $ 1,041,504 * Data from Wittman **Transfer has since been reduced by $866,376 1 These items are normally found in the M&O section of budget 2 Sequoia Table 8 7

8 ALTERNATIVES Alternative 1: Continue with the Paramedic Engine/BLS ambulance program Alternative 2: Return to traditional paramedic staffing model Alternative 3: The City Council may consider any other alternative not proposed by staff. CAMPAIGN DISCLOSURE Not applicable EXHIBITS Exhibit One:, Inc. Business Plan for Fire Emergency Medical Services 8

9 M 0 I! 0 N Moved by Council Member seconded by Council Member ' that the Report to Council dated January 29, 2013, regarding the Fire Department's one year review of the BLS Ambulance Program, is hereby noted and filed. Vote as follows: Ayes: Noes: Abstain: Absent: ~~ -. DATB z; I J:\FILESIDOCFJLESIFACTFIND\Nole & File repo r1 Fire RLS 2013.doc 8 1

10 City of Glentlale ". ' '. Business Plan for IHte Emergency Medical Services, April 2011 MANAGEMENT PARTNERS I NCORI'ORATED

11

12 MANAGEMENT PARTNERS INCORPOR. ATED April29, 2011 Mr. James Starbird City Manager Oty of Glendale 613 E. Broadway Glendale.~ CA Dear Mr. Starbird: is pleased to Lransmit this business plan which discusses proposed changes in the provision of fire emergency medical services (EMS). The business plan outlines how the Fire Department can tailor its EMS responses by 11sing an engine apparatus staffed with alleast two paramedic firefighters, engineers or captains and then handling transport with a BLS ambulance transport unit staffed with non-sworn emergency medical technicians. This approach separates the provision of the initial medical tesponse from the subsequent transport service and would allow for some staffing efficiencies. The business plan is the resull of various m<~nag~ment and analytical techniques, jncluding a comprehensive review of documents and service delivery reporls provided by the City. ' team members also reviewed financial models based on Lhe proposed change in EMS services developed by the Fire Deparlment and conducted interv.iews with four peer agencies that are using the modified EMS approach proposed by the Fire Department. Our analysis indicates that the conversion of ALS rescue ambulances to BLS units and tl1e deployment of paramedic engine companies will generate significant cost savings (between $2 million and $2.5 million per year) without compromising service level quality or responsiveness for emergency medical incidents. Staff members from both the Fire Department and the Finm1cc Department were extremely helpful and forlhcoming with information throughout our analysis. We appreciate their efforts to provide professional and timely responses to our queslions and requests for information. Sincerely, AndrewS. Belknap Regional Vice President 2107 North foirst Street Suite 470 San Jose, CA H 4~ liax 45~ 6 191

13

14 13usiness Plan for Fire Emergency Medicrtl Services Table of Contents Mrtnrtgement Partners Table of Contents Executive Sunttna.ry... 1 Background... 3 Proj ect Approach... 5 Docun1ent Revievv... 5 Interviews and Peer Jurisdictions... 5 Analysis of Service Delivery Options... i Number of Paramedics Required for Implementation Number of Emergency Medical Technicians Required Impacts on the Busiest Engines Impacts on Rescue Ambulance Mutual Aid Number of Ambttlance Units Required...,, bnpacts on FiJ:e Apparatus ln1pletncntation Considerations..., Summary of Service Deli very Impacts Analysis of Fi nancial Impacts Option 1 (Four A LS Rescue Ambulances, One BLS Unit)... 16, C)ption 2 (Five BLS Units) Option 3 (Six BLS Units) Oppoihttlities to Enhance EMS Cost Recovery :. 21 Conduct Aggressive Pre-Billing Activilies Institute Care Facility Fees Increase Param~dic Subscription PTOgram Marketing Impacts of Medicare and Medi-Cal Best Piactices from Peer Agencies Limited-Term Employment Conti acts T.owcr Hourly Ambulance Operator Sal<Hy Rates Comprehensive Ambulance Operator Training Ambulances Equipped with ALS Supplies No Rank Paramedics Conclusion... 28

15 Business Plan for Fire Emergency Medical Services T<1ble of Contents Tables Table 1. Glendale Fire Department FullMTime and P;ut-Time Staffing... 4 Table 2. Comparison of Glendale with Peer Agencies Intervicwed... 6 Table 3. Comparison of Service Impacts for EMS Ambulance Options... 9 T<1ble 4. Average Time Per Day Glendale Fire Units Are Commitl:ed to Responses Table 5. Rescue Ambulance Unit Responses Outside of Glendale During :. 12 Table 6. Number of Responses p er Ambulance Unit in Table 7. Comparison of Average Responses Per Am.bulance Unit Table 8. Projected Revenues and Expenditures for the Current EMS Delivery Model Table 9. Projected Revenues and Expenditures for a Five-Ambulance EMS Model Table 10. Projected Revenues and Expenditures For a Six-Ambulance EMS Model Table 11. Comparison of Projected Net Gains or Losses For Options 1, 2, and Table 12. Comparison of Paramedic Subscription Programs ii

16 Business Plan for Fire Emergency Medical Services Executive Summary. E~.ecutive Su~mary ;~ This report outlines a business plan for altering the staffing and response profile for emergency medical service (EMS) calls. The basic concept behind the service delivery modification is to respond to en1ergency medical services calls with fire engine companies staffed with at least two certified paramedics (a total of four sworn staff), instead of an engine and rescue ambulance staffed with a total of six swom personnel Rather than being staffed with paramedics, the City's resci.te ambulances would be staffed. with non-sworn emergency medical technicians (EMTs) to provide basic life support (BLS) and LTansport services. The goal of this service delivery change is twofold: to alter the basic response profile for emergency medical responses to maintain appropriate stafling and service levels while reducing the cost for this type of call (relative to other fire and rescue czllls to which the department must respond). According to the Glendale Fire Dc:parhnent's 2010 Annual Report, 82.7% of fire Dcparhnent responses are for medical assistance. Currently these calls <U"e responded to in much the same way as other calls for service; by dispatching an engine or truck company and ambulance tmit. This report outlines hm v the department can tailor its response by converting its existing engines to paramedic engine companies and using non-swom staff for ambulance h ansport. This approach separates the initial medical response from the subsequent h ansport service and would allow for some staffing efficiencies. A ter outlining the new service delivery approach, this analysis evaluates the impact on response capacity, estimates the number of paramedic firefighters required and those available, identifies the necessary EMT labor resources, quantifies capacity impacts on the busiest engine units, identifies the necessary ambulance tmits, and describ~s mutual aid irnpacts and phasing considerations. The analysis concludes that a shift in service delivery as proposed is feaslblc and would have some beneficial impacts while presenting moderate, but accomplishablc, implementation challenges. 1

17 Business Plan for Pire En1ergcncy Medical Services Executive Smmnary The financial analysis section of the report shows thal by reducing fire operations staffing it would be possible for the City to hire additional EMT labor resources Lo implement the new service system and aehi.eve cost reductions compared with the current service delivery approach. Cost reductions arc estimated to be between $2 million and $2.5 million annually. This report also outlines additional EMS cost recovery actions the City of Glend(;lle may adopt as well as other best practices observed in other comparable jurisdictions using a similar service delivery approach. The report is divided into the following sections: e Background ProJect Approach Analysis of Service Delivery Options e Analysis of Financial Impacts and Cost Recovery Options., Opportunities to Enhance EMS Cost Recovery Best Practices from Peer Agencies., Conclusion E<'lch is discussed in detail below. 2

18 Business Phm for Fire Emergency Medical Services Backgr01md Backgro~nd During calendar year 2010, the Glendale Fire Department responded to 15,796 dispatched calls for service. Of these, 13,073 calls, or 82.7% were for medical response. The deparhnent's EMS program offers both advanced life support (ALS) and basic life support services. The deparhnent operates four, 24-hour, ALS rescue ambtllances and two, 12- hour BLS ambulance units. The four rescue ambulances are staffed with two sworn patamedic firefighters, while the BLS units are staffed with two non-sworn, hourly emergency medical technici<ms. In addition, the deparhnent has four paramedic assessment engines, each staffed with one paramedic firefighter, a firefighter, an engineer and a captain. When responding to medical calls the ambulances are always accom pariied by an engine or truck company with additional personnel. All sworn fire personnel arc trained and certified as einergency medical technicians. Approximately 60 personnel also possess paramedic certification. in an effort to lower the cost of service delivery and free more ALS personnel to respond to calls, the departmei1t made changes to the BLS transportation component in January This change.has resulted in using BLS personnel (hourly contract workers w ith an EMT certification who cost less than fully LTained paramedic firefighters) to transport non-critical patients to hospitals, enabling the ALS unit to return to service more quick! y. Table 1 shows the total sworn and civilian staffing for the Glendale Fire Department as of January 20J J. Part-time classifications have been converted to full-time equivalent (FTE) positions. 3

19 - Business Pian for Fire F:mergency Medical Se vices Background Manngement Partners Table 1. Glendale Fire Department Full-Time and Part-Time Staffing. ~ - -- ll :11] ll'l ~Jill'l!l{iJ:ll ~roth}:- 7,~, "Jl".1\:.l~l~W.~r --, Fire Chief 1 Deputy Fire Chief 1 Battalion Chiefs 6 Captains 39 Engineers 37 Firefighters 96 Total Sworn 180 Civilian 46 Total Full-time 226 Part-Time Positions (FTE)* Fire Cadets (15) 2:4 Ambulance Operators {20} 12.0 Other (5) 2.2 Total Part Time 16.6 Source: Clendnle Fire Department "Numbers in parentheses reflect the total mtm/jer of part-time. employees per classificatioll. To reduce costs and provide improved ALS dish ibution and responsiveness throughout the City, the Glendale Fire Department is intcre_sted in expanding the conversion of ALS tescue ambulances to BLS units staffed by hotuly EMTs. was retained by the City to analyze the proposed paramedic engine conversion to identify the potential irnpacts to service delivery/ response effectiveness, cost savings, and revenue genemlion, as well as other potenlia1 consequences associated with the proposed 1nodel. Man.agement Partners was asked to develop a business plan documenting the operational and budgetary impacts to assist the City of Glendale in determining whether to proceed with implernentation for FY 2011/12. 4

20 Business Plan for foire Emergency Medical Services Projecl Approach Document Review used various management and analytical techniques in conducting this analysis. We examined documents and a variety of service delivery reports provided by the City. We also reviewed financial models for the pr:oposed EMS change developed by the Pirc Department and conducted interviews with four peer agencies that are providing ALS response via paramedic engine companies. The following sections surrunarize the docmnents reviewed and interviews conducted. During the course of this project m1alyzed numerous documents related to the Glendale Fire Department and its EMS functions. These included organization charts; staffing lists; deployment schedules; labor agreements; personnel policies; revenue and expenditure histories for PY 2007/08 to 2009/10; EMS call volumes, average response limes, mutual aid responses and other service delivery meh ics; and paramedic subscription program data. ln"terviews and Peer Jurisdictions Throughout this project Management Parh1ers worked with City staff in both the finance and Fire Departments to obtain detailed information, ask questions, and confirm our understanding of the Glendale Fire Department's EMS service dejivery system and associated costs. In addition, Mm1agement Parh1ers conducted interviews with four agencies that have implemented EMS delivery m.ode]s similar to that proposed for Glendale. The pmpose of these interviews was to draw upon the experience of these agencies to identify potential impacts on coverage, workload, cost containment m1d cost recovery as well as industry best practices. At the commencement of the project the City suggested seven jurisdictions that are providing advm1ced life support services with paramedic engine companies. Of thes1~, three jurisdictions from southern 5

21 Business Plan for fire Emergency Medical Services Project Approach California (Anaheim, Huntington Beach and Scmta Monica) were selected to be interviewed based on slmllarities in service delivery to Glendale's proposed model, Although it follows a different emergency medical service delivery approach, Phoenix, Arizona was included in the interviews because it achieves an 84% billing collection rate, which is significantly higher than most agencies. In Phoenix, emergency medical services are provided through a combination of paramedic engine companies and ALS ambulances staffed with one paramedic and one EJviT. This staffing model is not an approved model for Los Angeles Cotmty. Table 2 compares demographic and service delivery information between Glendale and the peer agencies interviewed. Of the agencies studied, Huntington Beach appears to be n<osl similar to Glendale. Because Phoenix is an obvious outlier in terms of population served and because it is in a state other than California, only infonnation related to billing colleclion from the Phoenix interview has been utilized in our analysis. *Depending on lime of day 6

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