Peoria Fire

EMS Division

Next Steps

Overview of Medical Services

• Providing Paramedic Services to the Residents

and Visitors of Peoria Since 1984

• Overview of Equipment, Treatments & Capabilities

• Demonstration of EMS Equipment

• Alternative Response Vehicle - ARV

• Community Paramedicine

• Ambulance Response

• Continue with CON Application Status

• Continue to communicate with the private sector with an eye out for collaborative partnerships

• Continue to refine the financial aspects of providing ambulance service and provide regular updates to the Council.

Summary

Trending Calls for Service Analysis

EMS Equipment Includes

We Are Seeking Council Concurrence To Fully Analyze EMS Delivery and Ambulance Service Options For An Optimal Implementation Of Ambulance Service.

• Pharmaceuticals

• Intubation

• IV Therapy-Including Intraosseous Infusion

• 12 Lead EKG-With Fax Capabilities

• CPAP

• Pulse Oximetry

• Carbon Monoxide Monitoring

• Electronic Documentation

• Peoria Fire-Medical Is The First Responder, Providing Both ALS and BLS Medical Care.

• Private Ambulance Will Transport ALS Patients With A Peoria Fire-Medical Paramedic Maintaining Patient Control In The Ambulance.

• Private Ambulance Will Transport Most BLS Patients Without Peoria Fire-Medical Personnel Maintaining Control.

Current Model

MIHC Models

• Paramedic / EMT

• Paramedic / Paramedic

• Paramedic / Nurse

• Paramedic / Nurse Practitioner or Physician’s Assistant

Data on Automatic-Aid Received and Given

Future Model

• Peoria Fire-Medical Transports All ALS Patients.
• Transfer of Care from Peoria Fire-Medical Paramedic (Engine Company) to a Peoria Fire-Medical Paramedic (Ambulance).
• Continuity Of Care and Quality Control Maintained.
• Fully Staffed Engine Company Remains Available In First-Due Area.

First Due Calls Missed

History of Current Ambulance Contract

2010 -2015

• Entered Into Contract With PMT

• PMT Sold To Rural Metro - One Entity To Provide Service

• Rural Metro Declares Bankruptcy

• Rural Metro Emerges From Bankruptcy, Proposes Decreasing Service Levels

• Rural Metro Sold To AMR, One Entity To Provide Service

• Future?

Responding to the Change

Pharmaceuticals Carried / Amount -- Toxicological Syndromes Treated

Atropine Sulfate / 16

Pralidoxime Chloride / 12

Diazepam / 25

Methylene Blue / 8

Proparacaine Eye Drops / 4

Sodium Nitrate / 4

Amyl Nitrate Boxes / 4

Cyanokit Cyanide Kits / 4

Organophosphate/Nerve Agents

Organophosphate/Nerve Agents

Organophosphate/Nerve Agents

Methemoglobanemia

Toxic Exposures to the Eyes

Hydrogen Sulfite

Cyanide, Methemoglobinemia

Cyanide

• Morphine

• Diazepam

• Lorazepam

• Midazolam

Pain Management

Anxiety / Delirium / Seizure

Toxicology Drug Box

• Dextrose

• Glucagon

Diabetic

• Alternative Response Vehicle (ARV) – Low Acuity Response

• Right Resources To Match The Call Type

• Cost Efficient

• Mobile Integrated Health Care

• “Community Paramedicine”

• “EMS Prevention”

• Activated Charcoal

• Narcan

• Thiamine

• Atropine Sulfate

• Cyanokit

Poisoning / Overdose

• Etomidate

• Succynilcholine

• Phenylephrine

Airway Management

Paramedic Medications

32

Allergic Reaction

• Epinephrine

• Diphenhydramine

• Methylprednisolone

• Albuterol
• Ipratropium Bromide
• Magnesium Sulfate

Respiratory

Recent Ambulance Industry Decisions

Obstetrics

• Magnesium Sulfate

• Oxytocin

Cardiac

• Adenosine
• Amiodarone
• Aspirin
• Atropine Sulfate
• Calcium Chloride
• Diltiazem
• Dopamine
• Epinephrine
• Furosemide
• Lidocaine
• Morphine
• Nitroglycerin
• Sodium Bicarb

Ambulance Service

Build Out Options

Treatments

Ambulance Service

Implementation Option

• On-Line vs. Off-Line Medical Direction
• 66 Off-Line Protocols and Guidelines
• Adult
• Pediatric
• Toxic Exposures

Incremental Start-Up

• 2 Full-Time Ambulances
• 1 Backup Ambulance
• Ambulance Personnel
• Support Personnel
• Billing Outsourced

Incrementally phased in a percentage each year (1 ambulance and personnel each year for example)

Full Program Start-Up

• 4 Full-Time Ambulances

• 2 Peak-Time Ambulances

• 2 Backup Ambulances

• Ambulance Personnel

• Support Personnel

• Billing Outsourced

Alternative Response Vehicle

(ARV)

Peoria Fire-Medical

Ideal Ambulance Service Model

• Paramedic and EMT

• Respond In a SUV Or Similar Vehicle

• Full Complement of ALS Equipment

• Respond To Low Acuity Calls

Current Status

• 4 Full-Time Ambulances

• 2 Peak-Time Ambulances

• 2 Backup Ambulances

• Ambulance Personnel

• Support Personnel

• Billing Outsourced

Public/Private Partnerships

Current Status

• Contract with Rural Metro (PMT) To Provide Ambulance Transportation Services

• Contract Extended thru February 2016

The CON Process

• Private sector partner would support a Peoria CON with shared responsibilities

• The City would assume transportation of all Advanced Life Support (ALS) transports and bill for same

• Private Sector partner would assume transportation of all Basic Life Support transports (BLS)

• Both entities would provide backup services to each other

Certificate of Necessity (CON)

• A Number Of Municipalities Are Reconsidering Their Long-Term Approach To Ambulance Transportation Services

• Concerns

• Long-Term Stability

• Lack Of Options For Service

• Local Municipalities Have Applied For, and Been Granted, Certificates of Necessity (CON)

• The Arizona Department of Health Services (ADHS) requires a specific form of business license to provide and bill for ambulances services. This is known as the Certificate of Necessity

• Requires a lengthy application, public hearing, possible administrative hearing and approval by the Director of ADHS

• Application Submitted

• Administrative Review

• Substantive Review (Current phase for COP)
• “Proper and Fit” Approval By DHS

• Public Comment Period

• Intervener – To Administrative Hearing

• No Intervener – To the Director of ADHS

• Director of ADHS Has The Final Say

Quality Assurance

• Electronic Documentation
• Regional and National Performance Measures
• Benchmarks
• Outcomes
• Evidence Based Medicine
• Drives Training

Pilot Proposal

Pilot Program with ARV

Gather and Analyze Data -

BLS Call Data for FY'15

Additional Resources

Civilian Decon Response

ARV Pilot Proposal

Mass Casualty Response

Expected Results:

• Greater Response Percentage in First Due Areas

• Capacity To Meet Increasing Demand For Service

• Right Resource to Patient

• Cost Effective While Maintaining High Quality Service

Partnerships

EMS Premiere Agency

Arizona Department of Health Services

Cardiac Arrest Research

Arizona Department of Health Services and U of A

Traumatic Brain Research

Arizona Department of Health Services and U of A

Community Health and Welfare Partnerships

Mobile Integrated Community Healthcare (MIHC) -

“Community Paramedicine”

Possible Partnerships:

• Hospitals
• Health Insurance Providers
• Community Health Care Providers
• Home Health

Peoria Fire - Medical

EMS Equipment Demonstration

Mobile Integrated Community Healthcare Concept

• “To avoid unnecessary Emergency Department visits and hospital stays while improving patient quality of life.”

• Provide Cost Effective Healthcare
• Proactive Approach Rather Than Reactive
• Frequent Users
• Hospital Re-Admissions
• EMS Prevention

Community Health Service Delivery Model

12 Lead EKG Demonstration

Matching Community Resources to Patient Needs

Service Delivery Connections

Minimally Interrupted Cardiac Resuscitation (MICR)

"Pit Crew Approach"

Growing Trend of Re-Admissions

20 State Survey Including Arizona:

• 20% Of All Hospital Discharges Come Back To

The Hospital ED Within 30 Days

• 65 and Older Most Likely To Be Re-Admitted

• 18 to 44 Year-Olds Had Highest Number of ED Visits

• 89% Of Revisits To The ED Had The Same

Primary Diagnosis As The Initial Visit

History of EMS Models

Early Efficiency Model

Growing Trends of

Re-Admissions

Local Data

• Valley-Wide, the Westside has the highest readmission rates

• The zip codes with the highest readmission rates are located in Peoria and Sun City

• In the West Valley – Readmission after discharge
• 36% - 1 to 7 days
• 25% - 8-14 days
• 19% - 15 to 21 days
• 20% - 22 to 30 days

History of EMS Models

1979 - Paramedic Engine Company

History of EMS Models

Adaptive Response Unit

Goals of Community Paramedicine (MIHC)

1990

• Treat and Release

• Treat and Refer

• Follow-Up Care

• Reduce Emergency Department Visits

• Reduce Hospital Re-Admissions

• Reduce Demands On The 911 System

Future Models

National Models

Low Acuity

High Acuity

• Med Star – Texas

• Minneapolis, Minnesota

• Johnston County, North Carolina

• Redmond, Oregon

• Rio Rico, Arizona

Local Models

• Mesa
• Chandler
• Tempe
• Scottsdale
• Buckeye
• North County (The Fire District formerly known as Sun City West)

What Changed and Why

• Aging Population

• Insurance Coverage

• Advances in Dispatch

• Advances in Data Acquisition and Data Analysis

• Greater Accuracy in Deploying the Right Resources

• Hospital Readmission Rates

States That Have Legislation -

Or Are Considering Reimbursement For MIHC Services

What Will Change and Why

• Aging Population- 65 and Older Is The Largest Segment Of The Population

• 85 to 95 Is The Fastest Growing Segment - (2010 U.S Census)

• Growth Of The Senior Care Housing Industry

• Independent Living - ?

• Assisted Living -110

• Skilled Care Facilities - 7

• Group Homes - 42

8 Fire Stations

8 - Advanced Life Support Paramedic Engine Companies

2 - Basic Life Support

Ladder Companies

1 - Fire Boat

2 - Battalion Chiefs

44 Fire Fighters in the field each day

Lake Operations

• 13 Technicians Currently Trained

• 48-Hour Initial Certification Course for Rescue Swimmer

• Program in Continual Development and Refinement

Fire and EMS

• State Route-74 Motor Vehicle Accidents
• Sparse Rural Resident Population
• Marina Communities / RV Park
• Dry Boat Storage

Rescue Swimmer

Program Targeted To Save Lives On The Water

Marine Fire Fighting

• Pleasant Harbor Marina

• Scorpion Bay Marina

• Open-Water Boat Fire Operations

Technical Rescue

30 Technicians

• 200 Hour Initial Certification Course

• 64 Hours of Annual Continuing Education

• 12 Air Rescue Technicians

• Partnership with

Technical Rescue Technician Matt Gingras joins DPS Air Rescue for a High-Risk SAR Mission to Graham County during Hurricane Odile.

• AZ Department of Public Safety - Air Rescue

Helicopter Operations

Rope Rescue

• Expanding Trail System
• Many Square Miles of Open Space Recreation Area
• Core of Special Operations

Structural Collapse

Swift Water Rescue

• Construction and Demolition Projects

• Weather

• Fire

• Flooding In All Types of Waterways
• Vehicles Swept Off Roads
• People "Tubing" In Running Washes

Trench Rescue

Confined Space Rescue

OSHA 1926 subpart P

OSHA 1910.146

• New Construction

• Utility Repairs and Upgrades

• Other Types of Excavation Hazards

• Water Treatment Plants

• General Industry

• Public Works

All Hazard

Fire-Medical Department

Specialties

• Advanced and Basic Life Support EMS
• 2 - Advanced Technical Rescue Teams
• 1 - Advanced Hazardous Materials Response Team
• 1 - Fire Boat and Rescue Swimmer Program
• Wildland Fire Team

First Rescue Swimmers

E199

FireBoat 199

FS 199

• 15 Sq. Miles Of Open Water
• 2 Marinas
• 700,000 Visitors / Year

Mesquite

Wildland Fire Response Team

North Battalion

• 25 Member team

• Annual refresher training

• Positive revenue

Urban Interface

Skill Development

Homes Bordering Open Spaces

Critical Assets

• 5 Engine Boss
• 4 Strike-Team Leader
• 2 Task-Force Leader
• 1 Base Camp Manager / Facility Unit Leader
• 1 Communication Technician
• 1 Division Supervisor
• 1 Liaison Officer

• Scenic Areas

• Urban-Interface

Anatomy of a Fire

Area of Coverage

Mesquite

Fire doubles every 30 seconds

Technical Rescue

E196

Mesquite

E197

S197

L197

FS 196

Vistancia

FS 197

• West Wing
• Sonoran Mountain Ranch
• Terramar

FS 195

E195

T195

BR195

BC192

3000 Gallon Capacity

3000 Gallon Porta-Tank

Willow

Ironwood

E192

FS 192

Fire Prevention

South Battalion

• Inspections

• Code Enforcement

• Investigations

• Plans Review

E193

HazMat 193

FS 193

Palo Verde

Acacia

Fire Operations

Technical Rescue

E191

L191 -

BC191

FS 191

Fire Chief

Bobby Ruiz

Pine

Valley Computer-Aided Dispatch Consortium

Deputy Chief

Stacy Irvine

Human Resource / Administration

Deputy Chief

Jim Bratcher

Emergency Medical Services

Deputy Chief

Rick Picard

Fire Marshal / Emergency Mgt.

Deputy Chief

Gary Bernard

Operations / Training

• Staffing Model Overview

• Fire Operations

• Emergency Medical Services (EMS)

• Ambulance

Sept. 29, 2015

FS194

Fire PIO

Payroll

Admin

Captain

Training

Battalion Chief

Ron Singleton

191 A

EMS Coordinator

EMS Training

E194

Emergency Management

Supervisor

Prevention /

Investigations

• Fire Attack

• Search and Rescue

• Ventilation

• Property Conservation

Inspections

CON

EMS

Supervisor

Support Services

Battalion Chief

Mike Moore

191 B

Human Resources

Admin

Emergency Transport

Services

Investigations

Budget

Admin

• Phoenix Dispatch Center
• 28 Member Departments
• Automatic-Aid
• Regional Standards
• Shared Assets
• Command Vans
• Rehab Unit
• Haz-Mat Teams
• TRT Teams
• Utility Trucks
• Command Officers
• Safety Officers
• MMRS
• UASI RRTF

Battalion Chief

Roger Russell

191 C

Maintenance on 65 Vehicles

Accreditation

Admin

Battalion Chief

Billy Morris

192 A

Plans Review

Maintenance on 128

SCBA

Fire Code

Battalion Chief

Steve Kelley

192 B

Maintenance on 180+ Turnouts

Battalion Chief

Robert Brewster

192 C

Phoenix Fire Alarm Headquarters

Coordinate With Fire Alarm Headquarters For Hospital Availability and Resource

LZ

The Laughlin Express rolls on State-Route 74 near Lake Pleasant with 40 seniors on board.

3

1. Scene Size-Up.

2. Request appropriate

resources.

2

1

Assign Sectors:

• Triage
• Extrication
• Treatment
• Transportation
• Landing Zone-Helicopters

Grow The Command Structure To Fit The Incident

Command Van

Incident Management System

Hazardous Materials Response Team

21 Technicians

• 200 Hour Initial Certification Course

• 64 Hours of Annual Continuing Education

Rail Emergencies

CBRNE

• BNSF Rail-Line Crosses Downtown Peoria With Daily Rail Traffic

• Phoenix Urban Area Rapid Response Task Force
• Grant Funded
• Regional and Statewide Response

Natural Gas Emergencies

Chlorine

• Inhalation Hazard
• Water Treatment Facilities
• 24 Well Sites and Facilities with 150lb Chlorine Cylinders
• Over the Road Delivery

• Major Natural Gas Pipelines
• Commercial and Residential Service
• Our Most Frequent Type of Hazmat Call