Medical Services Council

Transcription

1 Thurston County Emergency Medical Services System Study A Report prepared for the Thurston County Emergency A Report prepared for the Thurston County Emergency Medical Services Council

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3 The Report Contents Findings Strength Observations: numbered and highlighted in green. Challenge Observations: numbered and highlighted hl h in red. Recommendations are numbered, shown in Recommendations are numbered, shown in bold following the related observation. Included in strengths and challenges where appropriate.

4 FINDINGS: 1. Funding 2. EMS System Delivery Model 3. System Performance 4. Governance 5. Planning Observations and Recommendations

5 1.1 Observation: TC Medic One operates the region s public EMS system with a single permanent countywide EMS property tax levy that finances the vast majority of its services and functions. Funding Strengths

6 1.2 Observation: Nearly 90 percent of TC Medic One s budget is programmed for operations, training, EMS support and public education. Less than 5 percent is used for administration, and the remaining is for equipment repair and replacement. $10,000,000 $9,000,000 $8,000,000 $7,000,000 $6,000,000 $5,000,000 $4,000,000 $3,000,000 $2,000,000 $1,000,000 $ % 4.3 % 3.8 % 10.5% 5.6 % Funding Strengths

7 1.3 Observation: TC Medic One expanded countywide EMS levels of service through the region s worst economic recession since the program was created. Funding Strengths

8 1.4 Observation: The ALS contract agencies provide a 20 percent match for ALS personnel costs when operating within their jurisdiction. Recommendation TC Medic One staff and the ALS contract agencies should closely monitor system costs, maintain a dialog, and develop a long-term strategy to manage EMS provider personnel costs. Funding Strengths

9 1.5 Observation: The TC Medic One System does not rely on user fees for system operation. Patients are not charged for ALS transport services. Funding Strengths

10 1.6 Observation: TC Medic One provides a fair and equitable distribution of EMS levy revenues and support services to all fire service agencies in the county based on service demand. In 2012: BLS Direct Support, $880,529 Training Support, $472,563 Indirect Support, $721,442 Total: $2,084,534 Funding Strengths

11 1.7 Observation: Expenditures are exceeding revenues. As of 2011, the County EMS Levy rate is insufficient to generate the revenue necessary to fund TC Medic One s projected expenditures. Recommendation To help meet rising expenditures, a levy lid lift campaign to restore the original levy rate should be pursued before the state s imposition of a 1 percent annual property tax increase limit (RCW ) stymies the levy s capacity, without voter approval, to keep pace with the program s expenditures. TRPC Report Funding Challenges

12 1.8 Observation: It does not appear that a voter approved levy lid lift (restoration of $0.50/$1000 assessed value) by itself would produce sufficient revenue to eliminate the growing deficit between revenue and projected expenditures. Recommendation The EMS Council must identify additional revenue to sustain existing service levels or prioritize which program expenditures to maintain or cut to balance the budget with existing revenues. Funding Challenges

13 Actual ( ) 2012) and Projected ( ) 2017) EMS Levy and TC Medic One Expense Budget Year Year Total Year over Average Property EMS TC Medic over Expense over Tax Assessed Year % New Tax Taxes Levy One Taxes Year % Budget Year % Year Values* Assessed Construction Rate/ Levied Rate/ Levied Levy (millions) Expense (billions) Value Growth $1,000 (millions) $1,000 (millions) Growth Growth 2003 $ $ $ $6.162 $5.805 Deficit (millions) 2004 $ % $ $ $ % $ % 2005 $ % $ $ $ % $ % 2006 $ % $ $ $ % $ % 2007 $ % $ $ $ % $ % 2008 $ % $1.1 billion $ $ % $ % 2009 $ % $ $ $ % $ % 2010 $ % $ $ $ % $ % 2011 $ % $ $ $ % $ % 2012 $ % $ $ $ % $ % 2013 $ % $287 million $ $ % $ % $ ?????? % $ % $ ?????? % $ % $ ?????? % $ % $6.127 Assumption: Voter approved levy lid lift and necessary fair market value assessment growth Total Deficit $ $ % > $ % $ % $0.000 Sources: Thurston County Office of the Assessor; TC Medic One Levy/Expense Projections

14 1.9 Observation: TC Medic One lacks a clear budget policy on the establishment, maintenance, funding level, and use of a reserve account for contingency operations and expenditures. Recommendation The EMS Council should consider establishing a long-term contingency reserve account. Thurston County is a safe place, but it is not immune to the catastrophic effects of natural disasters, mass casualty incidents, or catastrophes that may arise in or around Thurston County. TRPC Report Funding Challenges

15 1.10 Observation: Fire Protection District operations are challenged by diminishing revenues. The risk of EMS service degradation in rural communities could threaten the efficacy of the TC Medic One program. Recommendation The region s EMS participants should develop a countywide framework for evaluating present and future BLS demand and service capacity to better understand the overall financial and operational impacts to the EMS system. The success of the ALS system rests on the capacity of BLS services. TRPC Report Funding Challenges

16 Summary of Fire District Levy Revenues, 2012 to 2013 Fire District Percent Change District 3 (Lacey) $10,822,116 $11,011, District 5 (Black Lake) $943,307 $895, District 6 (East Olympia) $1,913,446 $1,807, District 7 (North Olympia) $689,315 $702, District 8 (South Bay) $1,658,859 $1,490, District 9 (McLane) $2,444,689 $2,271, District 12 (Tenino) $537,920 $504, District 13 (Griffin) $1,265,979 $1,281, District 16 (Gibson Valley) $48,386 $40, District 17 (Bald Hills) $471,658 $416, SE Thurston RFA $2,699,395 $2,411, West Thurston RFA $2,460,962 $2,259, Data Source: Thurston County Office of the Assessor, Report of 2012 Assessments for Taxes Payable in 2013

17 1.11 Observation: There is disagreement among stakeholders about the flexibility of the EMS levy to serve TC Medic One and multiple taxing districts. Recommendations The EMS Council should establish clear funding priorities for TC Medic One programs. 1112Should state legislation ever increase the levy rate limit, the EMS Council, TC Medic One staff, and the fire service agencies should convene discussions on negotiating a potential levy-sharing strategy. Funding Challenges

18 2.1 Observation: TC Medic One is a regional centralized EMS program that delivers a standardized high level of emergency medical care to anyone, anywhere, at any time throughout Thurston County. In Washington State, if you have seen one EMS system, you ve seen one. - Michael Lopez, EMS Section Supervisor, Washington State t Department of Health EMS System Delivery Model Strengths

19 2.2 Observation: System wide, TC Medic One ALS units are staffed with two paramedics. This configuration arguably provides a superior level of medical care at the unit level and an overall increase in countywide ALS system readiness. Recommendation TC Medic One should continue exploring and testing a supplemental EMS unit configuration as an intermediate to the standard two-paramedic unit. For example, enabling Advanced EMTs to serve the system in more rural fire districts could improve patient outcomes in areas with longer ALS response time intervals. EMS System Delivery Model Strengths

20 Simplified Cost Comparison between a Two Medic vs. a One Medic plus EMT ALS Unit Configuration Two Medic ALS Unit Medic plus EMT ALS Unit Medics Medic Total EMTs EMT Rate Medics Medic Total Agency Unit FTE Rate Wages FTE 12% Less FTE Rate Wages OFD TFD LFD3 M/4 9 $100,081 $900,729 4 $88,071 5 $100,081 $852,690 M/10 9 $100, $900,729 4 $88,071 5 $100, $852,690 M/5 9 $103,339 $930,051 4 $90,938 5 $103,339 $880,448 M/14 8 $108,361 $866,888 4 $95,358 4 $108,361 $814,875 M/2 8 $96,390 $771, $84, $96,390 $724,853 M/3 9 $93,761 $843,849 4 $82,510 5 $93,761 $798,844 M/6 6 $93,761 $562,566 3 $82,510 3 $93,761 $528,812 EMSO 1 $122,748 $122,748 1 $122,748 $122,748 Total Medics: 59 Cost $5,898, $5,575,960 Total Savings: $322,720 (6%)

21 2.3 Observation: Every community in the region stands to benefit from being part of the TC Medic One system. EMS System Delivery Model Strengths

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23 2.4 Observation: TC Medic One staff provides a comprehensive range of administrative and support service functions that strengthen EMS service delivery. EMS System Delivery Model Strengths

24 2.5 Observation: TC Medic One s provision of initial BLS training, continuing education, in-service paramedic training, and EMS quality assurance activities establish a high standard of first responder EMS care throughout the system that improves patient outcomes. EMS System Delivery Model Strengths

25 25 n Survived to Discharge Witnessed Arrest, VF on Arrival, Cardiac Origin

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27 2.6 Observation: The nature of ALS services delivery through contract agencies creates discontent and mistrust among some of the system s stakeholders. Recommendation TC Medic One system stakeholders should visit the office of King County Medic One to learn about their system. A series of similar site visits to other neighboring EMS systems could offer local participants with valuable insight as to how Thurston County could improve its system. EMS System Delivery Model Challenges

28 3.1 Observation: When people dial for help, the EMS system responds: it saves lives and assists and transports people who are seriously sick or injured. Recommendation Beyond the traditional benchmarking focus on cardiac arrest survival rates and response time interval performance, TC Medic One staff in consultation with the Medical Program Director, should continue considering, evaluating, and implementing other appropriate metrics to measure the system s prehospital emergency medical and trauma care across the entire county. System Performance Strengths

29 3.2 Observation: Three agencies provide ALS service countywide, regardless of what jurisdiction a call comes from. Any upgrade to an existing medic unit or the formation of a new unit, regardless of its principal duty location, is an upgrade to the entire county s EMS system Daily ALS Unit Response Volumes and Statistics Primary Medic Zone Unit Percent In Percent Out Medic % 12.2% Medic % 28.5% Medic % 32.5% Medic % 26.7% Medic 6* 74.4% 25.6% Medic % 29.0% Medic 14* 94.0% 6.0% Countywide Total 74.7% 25.3% System Performance Strengths

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33 3.3 Observation: The system currently has ample response capacity to fulfill ALS service demands for the next several years Daily ALS Unit Response Volumes and Statistics Medic Units M2 M3 M4 M5 M6 M10 M14* Total Response Days Zero Response Days 6.0% 0.8% 0.8% 3.6% 9.9% 3.3% 5.8% 1-2 Calls Per Day 51.8% 16.2% 17.5% 25.8% 40.3% 23.8% 68.5% 3-4 Calls Per Day 33.2% 38.9% 41.4% 42.2% 35.3% 40.5% 23.0% 5-6 Calls Per Day 7.9% 31.0% 29.0% 21.1% 12.3% 24.9% 2.5% 7+ Responses Per Day 1.1% 13.2% 11.2% 7.4% 2.2% 7.4% 0.3% Total Responses Average Daily Responses Maximum Daily Responses System Performance Strengths

34 3.4 Observation: ALS response time intervals are well within the State s and TC Medic One s adopted level of service goals countywide. Recommendation TC County Medic One has valuable response time data that should be presented, when appropriate, in a format that is accessible and readily understood by a broader audience. System Performance Strengths

35 Thurston County Mean ALS Response Time Intervals by Fire Service Agency Jurisdictions, Average ALS Response Time Interval in Minutes Agency FD #1 - Rochester FD #11 - Littlerock FD #12 - Tenino FD #13 - Griffin FD #16 - Gibson Valley FD #17 - Bald Hills FD #2 - Yelm FD #3 - Lacey FD #4 - Rainier FD #6 - East Olympia FD #7 - North Olympia FD #8 - South Bay FD #9 - Black Lake FD #9 - McLane Bucoda Fire Department Olympia Fire Department Tumwater Fire Department Countywide

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37 3.5 Observation: More work is necessary to standardize the capture, retrieval, and dissemination of EMS data throughout the system, particularly for BLS response activity data. Recommendations TC Medic One should take a lead role to foster greater EMS data interoperability and information exchange. 352TC Medic One should coordinate with fire service agencies to develop an agreed upon comprehensive EMS service demand projection for system planning. System Performance Challenges

38 4.1 Observation: Policy makers, staff, and stakeholders care about the system. The roles and responsibilities for each participant should be organized in a manner that ensures that every component of the system contributes to the effectiveness of the system as a whole, without conflicts in roles and responsibilities. NFPA 450: Guide for Emergency Medical Services and Systems Governance Strengths

39 4.1 Observation: EMS Council members have expressed feelings of mistrust, frustration, and dissatisfaction over recent decision making processes of the TC Medic One system. Recommendation The EMS Council should identify deliberate activities to foster trust among members, learn each other s strengths, and celebrate the Council s successes. With so many participants, it can be very challenging at times for EMS stakeholders in the Thurston County region to reach consensus on key decisions. TRPC Report Governance Challenges

40 4.2 Observation: Rural stakeholders have expressed frustration that the composition of the EMS Council is biased toward the urban communities. Recommendation The EMS Council should review Article IV. Composition i and Membership of the Bylaws to consider amending the membership to: 1. Include the City of Lacey 2. Add a fourth Citizen-at-Large i Physician i to eliminate i potential appointment conflicts with existing Citizen-at-Large members Encourage the Thurston County Commissioners to expand Citizen- at-large outreach efforts to fill positions with members from rural county communities. Governance Challenges

41 4.3 Observation: Information about the proceedings of the EMS Council is not readily available to the public. Recommendation TC Medic One staff should post and update the following content on its website in an easily accessible format: EMS Council meeting schedule, a list of EMS Council members, meeting agendas, minutes, TC Medic One Budget, and EMS Council Bylaws. Governance Challenges

42 5.1 Observation: TC Medic One does not have a single comprehensive planning document that describes its mission, policies, budget, service delivery model, system performance, future service levels, and strategic initiatives. Planning Challenges

43 295, ,167 8,554 0,589 Historic and Forecast Thurston County EMS Call Volumes and Population, 1990 to , , ,000 24, ,853 23,790 24,146 25, , , , , ,402 9,105 31,693 34, ,000 36, ,000 30,000 25,000 20,000 15,000 10,000 5, ,000 9, ,238 10, ,,663 10, ,425 11, ,058 13, ,715 14, ,419 15, ,409 15, ,440 16, ,435 16, ,167 17, ,355 19, ,102 19, ,139 20, ,264 20, ,065 21, ,286 22, ,083 24, ,570 26,0 26,2 2 0 EMSVolume Population 200, , ,000 50,000 0

44 Mean Annual Utilization Actual Incidents Rate Incidents Projected Incidents Age ,057 1,093 1, ,091 1,262 1,369 1, ,313 1, , ,107 1,529 1, ,070 1,168 1,346 1,752 1,778 Total 8, ,551 9,810 11,187 12,709 13,573 Percent Change, All Ages Since 2010 ALS 2.9% 18.1% 34.6% 53.0% 63.4% Summary, People ,599 4,083 5,006 6,084 7,274 7,771 Percent Change Since 2010 N/A 13.4% 39.1% 69.0% 102.1% 115.9% Portion of Total Incidents, % 47.7% 51.0% 54.4% 57.2% 57.3% Projected ALS Incidents by Age Cohort,

45 Historic and Forecast Thurston County ALS Incidents, 1990 to ,080 3,416 7,496 4,853 3,388 8,,241 4,7093,599 8,308 4,436 3,479 7,915 4,474 3,628 8, 102 4,468 4,083 8,551 4,804 5,006 9,810 5,102 6,084 11,187 5,435 7,274 12,,709 5,802 7,771 13,573 16,000 14,000 12,000 10,000 8,000 6,000 4,000 2, Incidents 64 or Younger Incidents 65 or Older Total ALS Incidents

46 5.1 Observation: TC Medic One does not have a single comprehensive planning document that describes its mission, policies, budget, service delivery model, system performance, future service levels, and strategic initiatives. Recommendations TC Medic One should compile its existing plans into a single cohesive document that outlines its current course of action. This product should serve as a baseline for a strategic planning process with all system stakeholders The EMS Council should identify an appropriate planning process and forward a recommendation and planning timeline to the Thurston County Commissioners TC Medic One should convene a planning process and seek adoption on a preferred alternative prior to running an EMS levy lift. Planning Challenges

47 What s Next? Stakeholders should read the report It will be made available online TRPC can return to a future ft meeting to respond to questions TRPC can present to the County Commissioners YOU DECIDE