Vital Services. REM SA s Re p o rt to t h e C o m m u ni ty. Regional Emergency Medical Services Authority

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1 Vital Services REM SA s Re p o rt to t h e C o m m u ni ty Regional Emergency Medical Services Authority

2 Proud to Serve the Community Advanced Life Support Ground Ambulance Services Medical Helicopter Service Special Events Medical Service Educational Services and Classes Child Car Seat Safety Services Tactical Emergency Medical Support and Much More

3 When people hear the name REMSA, they usually think of ambulances. However, REMSA (Regional Emergency Medical Services Authority) is much, much more. REMSA is a private, non-profit organization that not only provides paramedic ambulance services to Washoe County, but also emergency medical helicopter service (Care Flight) to thousands of square miles of service area, plus a nationally accredited medical emergency dispatch center, community education and outreach services, and more all with no tax dollars paid to REMSA. As a non-profit, REMSA has no shareholders and all profits are reinvested in the emergency medical services (EMS) system for the benefit of the community. REMSA is closely monitored and regulated for its ambulance response times, and also for the cost of the average bill that patients receive. REMSA is nationally acclaimed for its high performance, quality and innovation. And even as a non-profit, REMSA still gives a great deal back to the community; with its provision of charitable and uncompensated care, and its community service and outreach, it provided more than $39 million in community benefit in How does REMSA do all of this? Learn how in this report. Thank you to the volunteer members of the REMSA board of directors, who provide governance, accountability, oversight and critical connections to our healthcare partners and general community: Jim Begbie, Chairman, Retired Director of Washoe County Health District Greg Boyer, CEO, Renown Regional Medical Center Dick Barnard, CPA, Barnard Vogler & Co., Immediate Past Chair Tiffany Meert, COO, Northern Nevada Medical Center Steven Brown, Treasurer, Former County Commissioner Helen Lidholm, CEO, Saint Mary s Regional Medical Center Louis Test, Esq., Hoffman, Test & Collier, Secretary Ex-Officio Member: Kevin Dick, Interim District Health Officer, Washoe County Health District

4 Why REMSA Was the Answer to a Previously Troubled System The History and Structure of REMSA Prior to REMSA being formed in 1986, the ambulance service in Washoe County was in chaos. There was poor patient care, poor response times for critical emergencies, poor equipment, poor quality, no accountability and high rates. Additionally there was no oversight or reporting for patient care standards, response times, quality or rates. At times, providers would not respond at all if they thought it was a no-pay patient. The hospitals, the three local governments and business leaders realized this was a dangerous situation and they evaluated many different models for a new ambulance service. They chose a sound model and created an ambulance authority, which was granted an exclusive franchise to provide all ground ambulance service, but with heavy oversight and many accountability measures and checks and balances to a medically focused unit of local government the District Board of Health (DBOH). REMSA was created as the regional ambulance authority, and they also folded the air ambulance authority (which managed Care Flight) under the same umbrella. The REMSA system design brought the following benefits to the region: Strict response time requirements and performance, and average bill controlled and monitored by the District Board of Health (which represents the three local governments through an inter-local agreement). Every ambulance staffed at the paramedic level with monitored performance. Advanced medical equipment required in every unit. Multiple levels of independent oversight unmatched by any other provider (Washoe County District Health Department, District Board of Health, REMSA Board of Directors, Pre-Hospital Medical Advisory Committee). This results in complete accountability and transparency for the medical services that REMSA provides. Assured continuation of REMSA s services by owning all of the equipment and revenue. A private, non-profit structure, providing the high performance ambulance services with no tax dollars. Nationally & Internationally Accredited REMSA is one of only three emergency medical service agencies in the world to be continuously accredited by Commission on Accreditation of Ambulance Services, the Commission on Accreditation of Medical Transportation Systems, and also the National Academies of Emergency Dispatch as a Center of Excellence in Emergency Medical Dispatch. Federal Health Care Innovation Award REMSA received a rare Federal Health Care Innovation Award in July 2012 to create a new program that could truly revolutionize how medical care is provided. The program improves patients healthcare experience while reducing unnecessary ambulance responses, and hospital admissions/readmissions thus helping to reduce health care costs. A central component to the program is the creation of the Nurse Health Line, a new non-emergency phone number ( ) that provides a pathway for patients that need medical care. Another element of the program is initiated after the call is triaged as appropriate for alternative pathways of care provided by a new level of community health paramedic. It is estimated that the program will save $10.5 million in healthcare costs to the region over three years. REMSA s program could be adopted nationwide at the end of the grant period.

5 How REMSA Serves the Community & Region The Paramedic Ambulance Service Vital Statistics: Care Flight Emergency Medical Helicopter Program Other REMSA Facts: A true regional service for this community over the past 27 years REMSA only bills when there is a transport Approximately 64,330 responses and 37,610 transports per year 97% of patients surveyed give REMSA compliments or no suggested changes 42 ambulances available in the REMSA system 431 full and part time employees 6,000 square miles of performance based response coverage, 24 hours per day, 365 days per year by REMSA ambulances Response time for REMSA s paramedic ambulance units are measured automatically by the sophisticated technology in the Medical Dispatch Center located at REMSA. REMSA is held accountable for the actual outcomes of our service Vital Statistics: More than 30 years of serving the region with medical helicopter service More than 40,000 square miles served Services 25 hospitals/clinics (21 of which are rural) and 93 User Agencies (fire departments, law enforcement, ski resort medical corps) Total of three aircraft in service including one in Reno, Nev., one in Truckee, Calif., and one in Gardnerville, Nev.

6 The Community Medical Safety Net REMSA is truly a medical safety net for our community. Anyone - a patient, a family member, a friend, or a bystander - can call 911. We will always respond with professionalism, compassion and high skill levels. During large-scale disasters affecting our communities, REMSA is the regional medical disaster coordination center. For example, our disaster responses in the past two years alone have included: Reno Air Race plane crash in which REMSA transported 54 patients in just 62 minutes IHOP shooting in Carson City where three Care Flight helicopters responded and transported patients Provide stand-bys at evacuation centers and provided rehabilitation services to the firefighters Amtrak train crash in Churchill County where REMSA dispatched its ambulance strike teams of five ambulances and two Care Flight helicopters Caughlin Ranch fire and the Washoe Drive fire, where REMSA s Manager served as the Medical Unit Leader, while REMSA continued to respond to other medical calls REMSA handling all the medical needs during large fires allows all the fire service personnel to concentrate on the fire suppression REMSA s Medical Dispatch Center REMSA s Emergency Medical of a choking child. REMSA s EMDs Dispatchers (EMDs) are highly trained dispatch REMSA s ground paramedic with paramedic or EMT-Intermediate ambulances and Care Flight, while medical training and EMS experience giving lifesaving instructions to the who utilize state of the art technology caller. to efficiently and quickly answer emergency medical calls and dispatch the appropriate ground or helicopter ambulance. REMSA s medical dispatch center was awarded the Accredited Center of Excellence from the National Academy of Emergency Dispatch in 2001 and REMSA s certified medical dispatchers has undergone three re-accreditations give instructions to help the patient since then. There are very few or bystanders save lives until REMSA dispatch centers across the entire and other first responders arrive on world that have achieved this honor scene. Our pre-arrival instructions can and REMSA is the only accredited include doing CPR, delivering a baby communications center in Nevada. or removing an object from the throat REMSA Fact A third of REMSA s 64,330 ambulance calls for service each year do not end in a patient being transported to a hospital. REMSA evaluates and cares for thousands of patients on the scene, and does not bill for those services or receive any other payment for those services. REMSA has grown as the community has grown, from 12 initial units in the early 1990s to a fleet of 42 ambulances now, to cover the increased population and larger geographical service area.

7 Community Outreach, Education & Safety: REMSA offers so much more than ambulance service, Care Flight and Medical Dispatch Services for the region. REMSA is a key provider of community safety programming, community and professional emergency medical training, and other extensive public service programs, all provided as part of its commitment to the health and safety of our region. REMSA also has the largest medical services training center in the state of Nevada. Value Added Services Provided by REMSA: Point of Impact Child Safety Seat Program (POI) The Northern Nevada Fitting Station Safe Kids Washoe County Other Health and Safety Programs REMSA is Involved With: Nevada State Child Passenger Safety Task Force Immunize Nevada Northern Nevada Maternal Child Health Coalition Chronic Disease Coalition Washoe County Child Death Review Team Assistance with the Boy Scouts Ready Man Program KidCare babysitter safety courses First Aid Kits to youth soccer teams, Little Leagues and other youth groups Automatic External Defibrillator (AED) Program Homebound Flu Shots Special Events Coverage Teams Community and Professional Education: Healthcare Provider CPR Advanced Cardiac Life Support Pediatric Advanced Life Support International Trauma Life Support Advanced Medical Life Support Emergency Medical Patients, Assessment, Care & Transport Electrocardiogram (ECG) and Pharmacology Intravenous Therapy and Procedures Rural Pediatric Education Hospital Partnerships: REMSA remains the contracted education center for professional education for many of the local hospitals. These contracts allow employees from these organizations to take classes through REMSA and obtain professional continuing education credit. Hospitals REMSA provides services to: Northern Nevada Medical Center, Reno/Sparks Renown Regional Medical Center, Reno/Sparks Saint Mary s Regional Medical Center, Reno/Sparks Tahoe Forest Hospital, Truckee, California Veterans Affairs Medical Center, Reno/Sparks TEMS REMSA has trained and made available a highly experienced group of paramedics as part of its Tactical Emergency Medical Support (TEMS) service to local police Special Weapons and Tactics Teams (SWAT). This team is comprised of specially trained tactical paramedics, as well as a team leader and team commander, who operate under an expanded scope of practice, overseen by the REMSA Medical Director. The team provides advanced emergency medical care while on scene during police activities to injured officers, hostages, suspects, and the general public. The TEMS team is integrated into: Sparks Police Department SWAT Washoe County Sheriff s Office SWAT Reno Police Department SWAT Federal Bureau of Investigation (FBI) Drug Enforcement Agency (DEA) Immigration Customs Enforcement (ICE) U.S. Secret Service U.S. Marshall s Service

8 REMSA s Financial Summary 2012: Audited Revenue and Expenses: Total amount billed for all REMSA services Total amount received for all billed services * Other Revenue Sources $67,470,000 (rates are regulated) $30,274,000 $2,196,000 (Subscription Programs, Educational Services, Misc. Income) Total uncompensated care provided to the region by REMSA = over $37 million Total REMSA annual revenue REMSA annual expenses Excess Revenue Over Expenses $32,470,000 ($32,228,000) $242,000 (All net proceeds are reinvested back into the service for the community) REMSA Revenue Result By Pay Source ($67,470,000 Billed): 1% 2% 3% 3% 10% Uncompensated Care 55% Facility Contracts 1% Insurance 26% Medicare 10% 26% Medicaid 2% Direct Bill to Patient 3% Uncompensated Care *Other Sources 3% 55% Note: All numbers include both ground and air transports. *Subscription Programs, Educational Services, Misc. Income REMSA Annual Expenses ($32,228,000): Personnel Salaries & Benefits 62% Vehicles & Fleet Maintenance 21% Building & Facility Costs 8% Administration & Related Costs 2% 4% 2% 8% 2% 1% Per & B Veh Mai Med Med Medical Supplies & Medical Equipment 4% Education & Community Safety Programs 1% 21% Med Cen Medical Communications Center Costs 2% 62% Note: All n Note: All numbers include both ground and air transports. All net proceeds are reinvested back into the service for the community. Regional Emergency Medical Services Authority 450 Edison Way Reno, NV remsa-cf.com

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