Gem County Emergency Medical Services

Gem County Emergency Medical Services 2013 End-of-Year Report APPROVED BY: Rick Welch, Chief Tina McGuffey, MD Bill Arsenault, EMTP Fire/EMS Chief Medical Director Lead Paramedic 11/30/2013 Date

Introduction Gem County Emergency Medical Services is Gem County s only licensed transport Advanced Life Support EMS agency. We are a Paramedic Level third-service (county government) currently responding to all 911 requests and as-needed inter-facility transfers to other medical facilities surrounding Gem County, Idaho. In the late 1960 s Gem County began providing Basic Life Support service which was previously provided by Beatty s Funeral Chapel. Initially the ambulance department was managed under the Gem County Sheriff s Office until 1993. Over the years, Gem County EMS has progressed care level from Basic Life Support to Intermediate Life Support in 1997, Critical Care/ALS inter-facility in 2011 and finally, Pre-hospital ALS Paramedic level service August 12, 2013. Community members, Gem County Commissioners, Gem Co. Fire Dist. #1, Walter Knox Memorial Hospital, Gem County Emergency Management, Gem Co. EMS, and Chamber of Commerce celebrate Gem Co. EMS becoming a 911 Paramedic Service. Currently Gem County EMS is a fee for service agency receiving 99% of its funding from transports and inter-facility transfers. GCEMS collects approximately $4,000.00 from motor vehicle registration, which equates to less than 1% of its annual operating budget. The Idaho Department of Health and Welfare EMS Bureau currently provide Gem County EMS with a Pre-hospital Electronic Record Collection System (PERCS). During the year of 2012, Gem County EMS had 1,240 response requests. As of September 2013, there have been 1,247 responses to date. These numbers do not include the 60 +/- stand-by activities Gem County provides coverage for during events. These events include; motorcycle sports, rodeos, local sports and triathlons. Emmett City Fire Department became a licensed EMS Basic Life Support non-transport service in 2007. Sweet Ambulance is an affiliate of the Gem County EMS system. In 2010 one ambulance was placed in the Gem County Fire District #2 Sweet Station by then Director Mark Rekow with an understanding that personnel who lived in that area would maintain the vehicle for operation. Gem Co. EMS currently provides licensing of the Sweet/Ola personnel, training, supplies and a Table of Organization to keep

the ambulance service in good working order for the Sweet/Ola area. In FY2013 they received 16 requests for service and unfortunately were only able to respond to seven due to a shortage of volunteers. Based on the 2010 US census report, Gem County has an estimated 16,719 persons who reside within its county boundaries. This is a 10.1% growth from the 2000 estimates. With the current Idaho Highway 16, US 20/26 to Idaho 44 project in its first year of execution and scheduled for full usage by September 2014, Gem County can expect continued growth of its community. Idaho Department of Transportation projects that within a 10 year period full extension all the way to I-84 will be completed. Paramedics Cody Nichols, Janice Willard, and EMT Jerry Prough take a photo moment from the daily ambulance check. Past Mark Rekow served as the Director of Gem County EMS for the last 24 years until he was selected by Governor Otter for a temporary County Commissioner position due to an immediate vacancy in November of 2012. Because of this immediate selection, Mark was released and retired from his position as Director of EMS. Mark later became an elected member of the Gem County Board of Commissioners in January 2013. During Mark s time as EMS Director, he was able to secure grants for new ambulances, acquire an EMS station in the old Circle K building which included an expansive remodel to accommodate growth of the service, hold numerous EMT classes, and upgrade the service twice prior to full pre-hospital Paramedic 911 service in August 2013. Mark was also able to increase funding by hiring a full-time, inhouse medical billing specialist in 2009. This fulltime billing specialist, Joanna Taylor, is also a trained Advanced EMT. Over the years, the 911 ambulance call volume has steadily grown. With growth and increased calls come more responses to illnesses, injuries and significant tragedies which test the strength of the agency and responders. With Mark Rekow leaving his position as EMS Director, full-time Advanced EMT Don Jones stepped up as Interim Director in October 2012. Don joined Gem County EMS 10 ½ years ago as a volunteer becoming full-time in 2008. Don served as the Operations Manager completing many tasks as requested or assigned by Mark Rekow including ambulance and facility maintenance, crew scheduling, and Information Technology. Some of those responsibilities continue today.

Don was relieved of his position as the interim director when Gem County Commissioners and Gem County Rural Fire District #1 Commissioners were able to solidify the management agreement assigning Gem Co Fire District #1 fire chief, Rick Welch, the position as Gem County EMS Director. Present February 20, 2013 Rick Welch officially entered into his position as EMS Director as he continued to fulfill his responsibilities as Fire District #1 Chief. This has also opened the door for future discussions regarding consolidation of services thereby reducing the duplication of services offered by both agencies. April 2013 Chief Welch was then given authority by the county commissioners to hire an individual who had the experience and knowledge to grow the operation of Gem County EMS. After observing what the needs were for a successful change, the position of Lead Paramedic was opened for applications. May 2013 Bill Arsenault, a Firefighter/Paramedic with 25 years of experience relating to EMS, specialized rescue, structural & wildland firefighting, military, aviation, and law enforcement support was hired as GCEMS s Lead Paramedic. Bill s knowledge and desire to help grow Gem County EMS is of significant benefit to Gem County residents and its guests. Since February, Gem County EMS has made great strides in moving the services forward. Growth is not always easy but with a committed team of professionals, the emergency medicine provided to residents and our guests has seen huge improvements. Those changes have included: Increasing efficiency in report writing. o Increased a quick turnaround of billing thereby increasing funding for the agency and decreasing lost reports. Review of mandatory medical training. o Ensures that EMS providers have opportunities to maintain their required skills and material as well as provides updated care information. Moving ambulances to a placement of immediate usage. o Decreased the guess work of response units for the month. Scheduled out medical training for one year. o Helps in planning recertification courses needed for part time staff. Change of scheduled shift time. o Decreased the amount of comp time accrued by full time staff often placing extra strain on part-time staff. Supply room layout. o Enhanced a logical approach to expendable medical supplies and reduced redundant ordering. Station daily duties list. o Each person on duty now has responsibilities taking ownership of the station.

Enhanced medical care equipment on the units o Ensuring care is current to nationally accepted medical standards. Recently Gem County EMS was also able to hire an additional full-time Paramedic, Janice Willard, who is a local Emmett High School graduate from 1997. This addition has allowed a Paramedic to be scheduled 7 days a week; which has helped decreased the pressure on the part time staff and has increased our ability to provide continuity of operation. As the system continues to improve and move forward, the preparation and responsibilities of EMS operations increases. Additional training, staff, and time spent effectively managing the daily operations of Gem County EMS is required. Maintaining the training and our Paramedic level service is very important as more people recognize the beauty and relaxed rural life style Gem County community has to offer. With an increase in population, we can expect an increase in 911 response requests. To bring awareness of the advances in Emergency Care to our community members, we have had the opportunity to meet with local civic groups such as Kiwanis, Lions Club, Senior Citizens, and the Rotary. May 25, 2013, during National Emergency Medical Services Week, Gem County EMS held an open house and provided tours of the ambulances, fire vehicles, and the EMS station. We were very pleased to have over 250 interested visitors. Our providers are very dedicated to our community and will continue educating the public regarding the services Gem County EMS provides. We thank the civic groups listed above as well as the Emmett Messenger-Index for helping us convey our message of dedication and commitment regarding responsible and quality care. Gathering with these groups also provides us the opportunity to answer questions and address concerns. Gem County EMS is proud of its ambulance service. The personnel are highly trained, experienced and skilled providers who enhance the lives of patients each and every day. As an Advanced Life-Support Paramedic level service, the personnel can now initiate Intravenous Fluid (IV) therapy; provide pain management with approved medications, cardiac arrest management beyond just CPR, and cardiac/stroke care. With this advance service, Paramedics are able to ground-transfer patients to Treasure Valley facilities where they receive more advanced specialized care. Having this ability limits the need for air transport, which is a costly mode of transport for patients. Many Gem County EMS personnel have other day-time positions. They are medical providers, law enforcement officials, home-repair/roofing specialists, business owners, and most importantly, mothers, fathers, sons, and daughters to members of the community and Gem County. Gem County EMS also has volunteers who are city and county firefighters. Per policy, an ambulance is on scene for every structure fire prepared to provide medical care to ill/injured civilians and firefighters should the need arise. Many EMS and firefighters are crossed trained which allows for a more rapid response to fire scenes for immediate rescue as EMS has in-house coverage.

Future As Gem County EMS prepares for the future, key questions regarding the changes in healthcare are of great interest to the Future of Gem County EMS. Some of those changes are related to the financial stability, cost containment and succession. Others are more related to the current political environment of emergency services within Emmett and Gem County. The common theme is do more with less. More calls with less reimbursement from insurance companies. More calls with patients not being able to afford the payments. More calls with less parttime day staff to support the need. It is getting more and more difficult relying on volunteers to cover the growing needs. As we continue to prepare and respond for the future we will focus on the following: Continual and on-going public education on what EMS provides Improve day time coverage within the community for EMS response Community outreach for funding sources for EMS within Gem County Planning for future growth and responses as the HWY 16 project is completed Discussion of consolidation of fire/rescue/ems agencies to decrease duplication of services and increase volunteer capabilities by combining staff and resources Quick Response Unit for the Letha area with coverage Staffing of EMS/Fire to cover the growing number of calls Medical Director, Tina McGuffey, MD Dr. McGuffey has served (free of charge) as the Gem County EMS medical director for eight years. This position requires oversight of all medical related training, Standard Written Orders (our scope of practice) and credentialing of employees. Dr. McGuffey also takes the time to train EMTs while working in the emergency department and is available to take phone calls all hours of the night. She has been wonderful to work with and is very excited with the changes Gem Co. EMS is making to enhance the care it provides to the community. Bill Arsenault, Paramedic celebrates the Green Pen Give-way with Dr. Tina Gem County EMS Medical Director

EMT Status Currently Gem County EMS has 40 providers. Of those, four are full-time, 17 are highly active (at different levels) and the rest are part-time individuals who volunteer to fill-in the schedule for shift coverage. To bring additional EMT volunteers to help support coverage, we have scheduled a winter 2014 EMT course, which takes an average of 3 ½ months to complete. Adding these new EMT volunteers will enhance the department s continuous 24-7 availability as well as place more volunteers in the Sweet/Ola area. Our hope is that Emmett Fire Department firefighters/emts will become more active in GCEMS. This will benefit both agencies as well as the community. We are able to offer extensive training and provide them with the experience and tools they need to maintain their level of proficiency in caring for patients. Gem Co. EMS, Gem Co. Fire #1, Gem Co. Sheriff s Dept., Emmett City Fire, and Emmett City Police Dept. attend the Tactical Medical Response Course July 2013. The course was sponsored Gem Co. EMS, hosted by Emmett PD, and taught by Bill Arsenault, Lead Paramedic for Gem Co. EMS. Training Training in the past for Gem County EMS has been difficult to accomplish due to a number of factors. Many of the volunteers had little time to spare, meeting times conflicted with city and county fire drills, and others were not offered the resources and opportunity to enhance their training due to funding. We have moved the meeting night to accommodate fire volunteers and currently have 20-25 attendees for our monthly meeting. These very productive meetings provide supplemental training and drills. Previously, volunteers found continued education outside the community and funded it themselves. The monthly training meeting s attendance has doubled due to the many benefits from training and support from the management team. The effectiveness of these meetings has not only increased the skills, knowledge and confidence of the EMTs, the moral has increased as well. Along with the monthly training meetings, we have added a few more nights to the year to complete courses for the Idaho

State allowed Optional Modules. These modules allow for a larger scope of practice for our EMTs thereby increasing care offered to our patients. We also added monthly articles with a testing component that EMTs are required to complete. These articles provide up-to-date medical standards as well as give the provider another option for maintaining their licenses. The volunteers can complete these tests in the comfort of their own home at their own pace within an allotted time period. This also helps decrease cost to nightly meetings while still getting training accomplished. Some of the trainings we have accomplished in the last five months has been: NEW STANDARD- Bleeding control with tourniquets and Israeli Dressings NEW STANDARD- Vacuum splints for orthopedic injuries NEW STANDARD- Selective Spinal Immobilization for neck/back injuries NEW STANDARD- IV fluid resuscitation, too much to fast NEW STANDARD- Less oxygen is better NEW STANDARD- Cardiac 12 Lead acquisition Courtney Oswald, AEMT, receives the training medication via IM injection. A new skill for EMTs. Tactical Medical Response to Active Shooter situation (30 attendees from city & county fire, EMS, and city/county law enforcement participated; they have requested another one) Heat Related Emergencies Pediatric Assessment and Management EPI Intramuscular Injection for Allergic Reaction & Glucagon for unconscious diabetic In five short months we have completed 27 hours of training that will certainly benefit the community and county as a whole. When an average attendance is calculated at 21 times 27 hours, this equates to 567 man hours of training time in five months. That is HUGE! This has also included one multi-agency Tactical Medical Training Course which gave attendees credit for EMS and Idaho POST hours. Gem County EMS also participated in one major training scenario (train derailment drill) with Boise County and Horseshoe Bend Ambulance. Of course the increased training participation equates to increased training cost for payroll. As mentioned, we are on schedule to also complete another EMT course starting with orientation December 8, 2013. As it currently stands, we have 25 students on the roster. In doing an in-house

course we can save a local EMT student approximately $1000.00 versus attending over the hill. This also provides us additional personnel for coverage as we continue to grow. 2013 Accomplishments Feb 2013- Contract with Gem County Fire Dist. #1 for EMS management/administration May 2013- Hiring of full-time Lead Paramedic to manage EMS operations May 2013- Well attended EMS Week Open House for the community May 2013- Decrease in report writing delays, increase in return funding June 2013- Increase in attendance of volunteer staff for training starting to show June 2013- First structure fire with Firefighter/Paramedic on ambulance for response July 2013- First interagency, combined tactical medical training July 2013- Paramedics in station providing coverage 24/7 Aug 2013- Purchase of Life Pak 12 Cardiac monitors (refurbs) with 12 Lead technology Aug 2013- Upgrade to Advanced Life Support, Paramedic 911 Ambulance service Sep 2013- Successfully secured $15,000.00 in grants for new cot, new splints, new chair Sep 2013- Civic groups meetings well attended at 4 locations Oct 2013- Hiring of 2 nd full time Paramedic May 1, - Oct 2013 Decrease in response times from dispatch to enroute by 37% As you can see from the list above, we have been extremely busy, and we are just getting started. There are many tasks done each day that often go un-noticed by outsiders. Our hope is that our accomplishments are noticed and that the community will feel confident in the hands of our skilled, professional and dedicated team. Consolidation with Gem County Fire Dist. #1 Currently the question is how to accomplish the consolidation of emergency services. Both Gem Co. EMS and Gem Co. Fire Dist. #1 have members who co-respond to calls depending on the priority and need. We would like to re-iterate a few key points that have already been noted. It is now policy to take an ambulance to every structure fire. This serves four purposes: It provides medical care to ill/injured civilians and firefighters should the need arise. We have medical providers who are also trained firefighters. This provides more fire scene staffing for suppression. EMS has in-house coverage on-duty, which allows for a more rapid response to fire scenes for immediate rescue thereby decreasing response delays i.e., saving lives. Cost efficiency allows us to train one person to handle two responsibilities versus training two people to do different jobs when much of it already co-exists.

There are additional gains with consolidation. Many grant funding sources look for agencies/departments who are combing services. Some rational reasoning is listed below: The combination of services often decreases additional taxation Less on-scene turf battling enhances patient care concepts Less doubling of administration due to key Chain of Command principles already wellestablished within the fire service Individuals that are currently trained from both EMS and fire that can complete other tasks, i.e., inspections, public education, community outreach, etc. Agency cohesiveness is increased. We work together. We train together. We hang out together Well-established communication lines enhance effective fire/ems response, i.e., better fire suppression, better patient care Outside grant funding sources will then provide us, as a combined system, more money for training, equipment, and staffing. That assistance will allow us to have a system that is not completely dependent on tax dollars to accomplish the same mission. In essence, we do not have different agency names doing the same thing within the same county, requesting the same dollars - - thereby causing each to get less funding. Conclusion We would like to thank all those who provided information for the FY 2013 End of Year Report for Gem County EMS. Including our volunteer/part-time staff, former Director Rekow (ret.), and many others that have helped compile information. We believe that Gem County is a wonderful community and a great place to work and raise our families. We are dedicated and committed Gem County Emergency Medical Services and are privileged to care for our residents and visitors. We could not have achieved these many accomplishments this year without the support of our staff, Gem County Emergency Management, Gem County Commissioners, and the agencies supporting us on calls in the field. To Gem County Sheriff s Dept., Emmett Police Dept., Gem County Fire Dist. #1, Gem County Fire Dist. #2, and Emmett Fire Dept., we say THANK YOU. We also appreciate Dr. McGuffey for her service and continued support to our agency. Finally, we would like to thank our community, our county residents, and our guests for allowing us to serve them.

The following pages provide information displaying the busiest times, calls per month, call types, interfacility transport counts and 911 responses. Charts Gem County EMS- total calls by month, FY 2013 140 120 100 101 108 95 119 99 97 107 111 106 110 95 99 80 60 40 20 0

Gem County EMS- calls by break-down per month, FY 2013 911 INTER-FACILITY 15 16 10 19 21 14 18 20 19 22 19 8 86 92 85 100 78 83 89 91 87 88 76 91 Gem County EMS- calls by type Out of county transfers, 201 FY 2013-1247 911 calls - transport, 615 911 calls nontransport, 431

Gem Co. EMS- 911 calls by dispatch reason, FY 2013 Stroke related Psychatric (OD, Suicide, Mental) Respiratory compromise Cardiac (arrest, Chest pain) 41 45 57 59 Motor Vehicle Crash 86 Trauma Ground level falls 153 179 General sick person 574 0 100 200 300 400 500 600 700 The Idaho PERCS reports below will demonstrate the extraordinary improvement in response times. The time it takes to reach the patient after the page-out from dispatch has dramatically decreased over a one-year period. October 1, 2012 thru May 30, 2013 demonstrated an average response time of over five minutes, which occurred 49% of the time. Less than 31% of the time was an ambulance enroute within three minutes. From June 1, 2013 thru September 30, 2013 that number has completely flipped. Currently Gem County EMS has an ambulance en-route within three minutes of notification 67.73% of the time. Less than 20% are now over five minutes. That is a HUGE difference.

Busiest Days and Times of the Week Dispatch to Enroute times Oct. 1, 2012 thru May 30, 2013

Dispatch to Enroute times June 1, 2013 thru September 30, 2013 Current percentage of Dispatch to Enroute 1-3 minutes at 42.48%