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Peoria Fire
Overview of the Peoria Fire Medical Department
by
TweetGary Bernard
on 14 March 2017Transcript of Peoria Fire
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
FS194
FS 191
FS 193
FS 192
FS 195
FS 197
FS 196
FS 199
185 sq. Miles
166,900 Population
15 sq. Mile Lake
City of Peoria
E191
L191 -
BC191
E192
E193
HazMat 193
E194
E195
T195
BR195
BC192
E196
E197
S197
L197
E199
FireBoat 199
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
Technical Rescue
30 Technicians
200 Hour Initial Certification Course
64 Hours of Annual Continuing Education
12 Air Rescue Technicians
Rope Rescue
Confined Space Rescue
Trench Rescue
OSHA 1910.146
Structural Collapse
Construction and Demolition Projects
Weather
Fire
Helicopter Operations
Swift Water Rescue
Flooding In All Types of Waterways
Vehicles Swept Off Roads
People "Tubing" In Running Washes
South Battalion
North Battalion
Vistancia
West Wing
Sonoran Mountain Ranch
Terramar
Technical Rescue
3000 Gallon Capacity
3000 Gallon Porta-Tank
15 Sq. Miles Of Open Water
2 Marinas
700,000 Visitors / Year
Hazardous Materials Response Team
Rail Emergencies
BNSF Rail-Line Crosses Downtown Peoria With Daily Rail Traffic
Natural Gas Emergencies
Major Natural Gas Pipelines
Commercial and Residential Service
Our Most Frequent Type of Hazmat Call
Chlorine
Inhalation Hazard
Water Treatment Facilities
24 Well Sites and Facilities with 150lb Chlorine Cylinders
Over the Road Delivery
CBRNE
Phoenix Urban Area Rapid Response Task Force
Grant Funded
Regional and Statewide Response
All Hazard
Fire-Medical Department
Lake Operations
13 Technicians Currently Trained
48-Hour Initial Certification Course for Rescue Swimmer
Program in Continual Development and Refinement
Rescue Swimmer
Program Targeted To Save Lives On The Water
Marine Fire Fighting
Pleasant Harbor Marina
Scorpion Bay Marina
Open-Water Boat Fire Operations
Fire and EMS
State Route-74 Motor Vehicle Accidents
Sparse Rural Resident Population
Marina Communities / RV Park
Dry Boat Storage
Wildland Fire Response Team
25 Member team
Annual refresher training
Positive revenue
Urban Interface
Homes Bordering Open Spaces
Critical Assets
Scenic Areas
Urban-Interface
Skill Development
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
Area of Coverage
Acacia
Ironwood
Palo Verde
Pine
Willow
Mesquite
Mesquite
Mesquite
Anatomy of a Fire
First Rescue Swimmers
21 Technicians
200 Hour Initial Certification Course
64 Hours of Annual Continuing Education
Property Conservation
Investigation
Incident Management System
Phoenix Fire Alarm Headquarters
Water Treatment Plants
General Industry
Public Works
Peoria Fire - Medical
Staffing Model Overview
Fire Operations
Emergency Medical Services (EMS)
Ambulance
Sept. 29, 2015
The Laughlin Express rolls on State-Route 74 near Lake Pleasant with 40 seniors on board.
Expanding Trail System
Many Square Miles of Open Space Recreation Area
Core of Special Operations
Fire Operations
Fire Attack
Search and Rescue
Ventilation
Property Conservation
OSHA 1926
subpart P
New Construction
Utility Repairs and Upgrades
Other Types of Excavation Hazards
4 Full-Time Ambulances
2 Peak-Time Ambulances
2 Backup Ambulances
Ambulance Personnel
Support Personnel
Billing Outsourced
Peoria Fire-Medical
Ideal Ambulance Service Model
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
Public/Private Partnerships
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
The CON Process
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
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)
Current Status
Contract with Rural Metro (PMT) To Provide Ambulance Transportation Services
Contract Extended thru February 2016
Current Status
Recent Ambulance Industry Decisions
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
Paramedic / EMT
Paramedic / Paramedic
Paramedic / Nurse
Paramedic / Nurse Practitioner or Physician’s Assistant
MIHC Models
States That Have Legislation -
Or Are Considering Reimbursement For MIHC Services
Med Star – Texas
Minneapolis, Minnesota
Johnston County, North Carolina
Redmond, Oregon
Rio Rico, Arizona
National Models
Growing Trends 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
Growing Trend of Re-Admissions
Service Delivery Connections
Pilot Program with ARV
Gather and Analyze Data -
BLS Call Data for FY'15
Pilot Proposal
Paramedic and EMT
Respond In a SUV Or Similar Vehicle
Full Complement of ALS Equipment
Respond To
Low Acuity
Calls
Alternative Response Vehicle
(ARV)
Alternative Response Vehicle (ARV) – Low Acuity Response
Right Resources To Match The Call Type
Cost Efficient
Mobile Integrated Health Care
“Community Paramedicine”
“EMS Prevention”
Responding to the Change
Data on Automatic-Aid Received and Given
First Due Calls Missed
Future Models
History of EMS Models
Minimally Interrupted Cardiac Resuscitation (MICR)
"Pit Crew Approach"
12 Lead EKG Demonstration
EMS Equipment Demonstration
Electronic Documentation
Regional and National Performance Measures
Benchmarks
Outcomes
Evidence Based Medicine
Drives Training
Quality Assurance
Pharmaceuticals
Intubation
IV Therapy-Including Intraosseous Infusion
12 Lead EKG-With Fax Capabilities
CPAP
Pulse Oximetry
Carbon Monoxide Monitoring
Electronic Documentation
EMS Equipment Includes
We Are Seeking Council Concurrence To Fully Analyze EMS Delivery and Ambulance Service Options For An Optimal Implementation Of Ambulance Service.
Summary
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.
Next Steps
Full Program Start-Up
4 Full-Time Ambulances
2 Peak-Time Ambulances
2 Backup Ambulances
Ambulance Personnel
Support Personnel
Billing Outsourced
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?
History of Current Ambulance Contract
2010 -2015
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.
Future Model
Ambulance Service
Mesa
Chandler
Tempe
Scottsdale
Buckeye
North County
(The Fire District formerly known as Sun City West)
Local Models
Matching Community Resources to Patient Needs
Community Health Service Delivery Model
“
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
Mobile Integrated Community Healthcare Concept
Mobile Integrated Community Healthcare (MIHC) -
“Community Paramedicine”
Possible Partnerships:
Hospitals
Health Insurance Providers
Community Health Care Providers
Home Health
Community Health and Welfare Partnerships
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
ARV Pilot Proposal
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
What Will Change 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
What Changed and Why
Civilian Decon Response
Mass Casualty Response
Additional Resources
On-Line vs. Off-Line Medical Direction
66 Off-Line Protocols and Guidelines
Adult
Pediatric
Toxic Exposures
Treatments
Overview of Medical Services
Treat and Release
Treat and Refer
Follow-Up Care
Reduce Emergency Department Visits
Reduce Hospital Re-Admissions
Reduce Demands On The 911 System
Goals of Community Paramedicine (MIHC)
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
Partnerships
EMS Division
Technical Rescue
1. Scene Size-Up.
2. Request appropriate
resources.
Assign Sectors:
Triage
Extrication
Treatment
Transportation
Landing Zone-Helicopters
Coordinate With Fire Alarm Headquarters For Hospital Availability and Resource
Grow The Command Structure To Fit The Incident
1
2
3
LZ
Airway Management
Diabetic
Allergic Reaction
Poisoning / Overdose
Obstetrics
Pain Management
Paramedic Medications
Respiratory
Cardiac
Adenosine
Amiodarone
Aspirin
Atropine Sulfate
Calcium Chloride
Diltiazem
Dopamine
Epinephrine
Furosemide
Lidocaine
Morphine
Nitroglycerin
Sodium Bicarb
Albuterol
Ipratropium Bromide
Magnesium Sulfate
Dextrose
Glucagon
Etomidate
Succynilcholine
Phenylephrine
Morphine
Epinephrine
Diphenhydramine
Methylprednisolone
Activated Charcoal
Narcan
Thiamine
Atropine Sulfate
Cyanokit
Magnesium Sulfate
Oxytocin
Anxiety / Delirium / Seizure
Diazepam
Lorazepam
Midazolam
Valley Computer-Aided Dispatch Consortium
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
Partnership with
Command Van
Toxicology Drug Box
Pharmaceuticals Carried / Amount -- Toxicological Syndromes Treated
Organophosphate/Nerve Agents
Organophosphate/Nerve Agents
Organophosphate/Nerve Agents
Methemoglobanemia
Toxic Exposures to the Eyes
Hydrogen Sulfite
Cyanide, Methemoglobinemia
Cyanide
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
Fire Chief
Bobby Ruiz
Deputy Chief
Gary Bernard
Operations / Training
Deputy Chief
Stacy Irvine
Human Resource / Administration
Deputy Chief
Jim Bratcher
Emergency Medical Services
Deputy Chief
Rick Picard
Fire Marshal / Emergency Mgt.
Battalion Chief
Ron Singleton
191 A
Battalion Chief
Mike Moore
191 B
Battalion Chief
Roger Russell
191 C
Battalion Chief
Billy Morris
192 A
Battalion Chief
Steve Kelley
192 B
Battalion Chief
Robert Brewster
192 C
Supervisor
Support Services
Captain
Training
EMS Coordinator
EMS Training
Supervisor
Prevention /
Investigations
Inspections
Investigations
Plans Review
Fire Code
Maintenance on 65 Vehicles
Maintenance on 128
SCBA
Maintenance on 180+ Turnouts
Fire PIO
Early Efficiency Model
History of EMS Models
1979
- Paramedic Engine Company
Trending Calls for Service Analysis
History of EMS Models
Adaptive Response Unit
1990
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
High Acuity
Low Acuity
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
Fire doubles every 30 seconds
Fire Prevention
32
Payroll
Admin
Human Resources
Admin
Budget
Admin
Accreditation
Admin
CON
EMS
Emergency Management
Inspections
Code Enforcement
Investigations
Plans Review
Ambulance Service
Build Out Options
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)
Implementation Option
Implementation Option
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
Emergency Transport
Services
Full transcriptand Visitors of Peoria Since 1984
Overview of Equipment, Treatments & Capabilities
Demonstration of EMS Equipment
Alternative Response Vehicle - ARV
Community Paramedicine
Ambulance Response
FS194
FS 191
FS 193
FS 192
FS 195
FS 197
FS 196
FS 199
185 sq. Miles
166,900 Population
15 sq. Mile Lake
City of Peoria
E191
L191 -
BC191
E192
E193
HazMat 193
E194
E195
T195
BR195
BC192
E196
E197
S197
L197
E199
FireBoat 199
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
Technical Rescue
30 Technicians
200 Hour Initial Certification Course
64 Hours of Annual Continuing Education
12 Air Rescue Technicians
Rope Rescue
Confined Space Rescue
Trench Rescue
OSHA 1910.146
Structural Collapse
Construction and Demolition Projects
Weather
Fire
Helicopter Operations
Swift Water Rescue
Flooding In All Types of Waterways
Vehicles Swept Off Roads
People "Tubing" In Running Washes
South Battalion
North Battalion
Vistancia
West Wing
Sonoran Mountain Ranch
Terramar
Technical Rescue
3000 Gallon Capacity
3000 Gallon Porta-Tank
15 Sq. Miles Of Open Water
2 Marinas
700,000 Visitors / Year
Hazardous Materials Response Team
Rail Emergencies
BNSF Rail-Line Crosses Downtown Peoria With Daily Rail Traffic
Natural Gas Emergencies
Major Natural Gas Pipelines
Commercial and Residential Service
Our Most Frequent Type of Hazmat Call
Chlorine
Inhalation Hazard
Water Treatment Facilities
24 Well Sites and Facilities with 150lb Chlorine Cylinders
Over the Road Delivery
CBRNE
Phoenix Urban Area Rapid Response Task Force
Grant Funded
Regional and Statewide Response
All Hazard
Fire-Medical Department
Lake Operations
13 Technicians Currently Trained
48-Hour Initial Certification Course for Rescue Swimmer
Program in Continual Development and Refinement
Rescue Swimmer
Program Targeted To Save Lives On The Water
Marine Fire Fighting
Pleasant Harbor Marina
Scorpion Bay Marina
Open-Water Boat Fire Operations
Fire and EMS
State Route-74 Motor Vehicle Accidents
Sparse Rural Resident Population
Marina Communities / RV Park
Dry Boat Storage
Wildland Fire Response Team
25 Member team
Annual refresher training
Positive revenue
Urban Interface
Homes Bordering Open Spaces
Critical Assets
Scenic Areas
Urban-Interface
Skill Development
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
Area of Coverage
Acacia
Ironwood
Palo Verde
Pine
Willow
Mesquite
Mesquite
Mesquite
Anatomy of a Fire
First Rescue Swimmers
21 Technicians
200 Hour Initial Certification Course
64 Hours of Annual Continuing Education
Property Conservation
Investigation
Incident Management System
Phoenix Fire Alarm Headquarters
Water Treatment Plants
General Industry
Public Works
Peoria Fire - Medical
Staffing Model Overview
Fire Operations
Emergency Medical Services (EMS)
Ambulance
Sept. 29, 2015
The Laughlin Express rolls on State-Route 74 near Lake Pleasant with 40 seniors on board.
Expanding Trail System
Many Square Miles of Open Space Recreation Area
Core of Special Operations
Fire Operations
Fire Attack
Search and Rescue
Ventilation
Property Conservation
OSHA 1926
subpart P
New Construction
Utility Repairs and Upgrades
Other Types of Excavation Hazards
4 Full-Time Ambulances
2 Peak-Time Ambulances
2 Backup Ambulances
Ambulance Personnel
Support Personnel
Billing Outsourced
Peoria Fire-Medical
Ideal Ambulance Service Model
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
Public/Private Partnerships
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
The CON Process
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
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)
Current Status
Contract with Rural Metro (PMT) To Provide Ambulance Transportation Services
Contract Extended thru February 2016
Current Status
Recent Ambulance Industry Decisions
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
Paramedic / EMT
Paramedic / Paramedic
Paramedic / Nurse
Paramedic / Nurse Practitioner or Physician’s Assistant
MIHC Models
States That Have Legislation -
Or Are Considering Reimbursement For MIHC Services
Med Star – Texas
Minneapolis, Minnesota
Johnston County, North Carolina
Redmond, Oregon
Rio Rico, Arizona
National Models
Growing Trends 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
Growing Trend of Re-Admissions
Service Delivery Connections
Pilot Program with ARV
Gather and Analyze Data -
BLS Call Data for FY'15
Pilot Proposal
Paramedic and EMT
Respond In a SUV Or Similar Vehicle
Full Complement of ALS Equipment
Respond To
Low Acuity
Calls
Alternative Response Vehicle
(ARV)
Alternative Response Vehicle (ARV) – Low Acuity Response
Right Resources To Match The Call Type
Cost Efficient
Mobile Integrated Health Care
“Community Paramedicine”
“EMS Prevention”
Responding to the Change
Data on Automatic-Aid Received and Given
First Due Calls Missed
Future Models
History of EMS Models
Minimally Interrupted Cardiac Resuscitation (MICR)
"Pit Crew Approach"
12 Lead EKG Demonstration
EMS Equipment Demonstration
Electronic Documentation
Regional and National Performance Measures
Benchmarks
Outcomes
Evidence Based Medicine
Drives Training
Quality Assurance
Pharmaceuticals
Intubation
IV Therapy-Including Intraosseous Infusion
12 Lead EKG-With Fax Capabilities
CPAP
Pulse Oximetry
Carbon Monoxide Monitoring
Electronic Documentation
EMS Equipment Includes
We Are Seeking Council Concurrence To Fully Analyze EMS Delivery and Ambulance Service Options For An Optimal Implementation Of Ambulance Service.
Summary
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.
Next Steps
Full Program Start-Up
4 Full-Time Ambulances
2 Peak-Time Ambulances
2 Backup Ambulances
Ambulance Personnel
Support Personnel
Billing Outsourced
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?
History of Current Ambulance Contract
2010 -2015
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.
Future Model
Ambulance Service
Mesa
Chandler
Tempe
Scottsdale
Buckeye
North County
(The Fire District formerly known as Sun City West)
Local Models
Matching Community Resources to Patient Needs
Community Health Service Delivery Model
“
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
Mobile Integrated Community Healthcare Concept
Mobile Integrated Community Healthcare (MIHC) -
“Community Paramedicine”
Possible Partnerships:
Hospitals
Health Insurance Providers
Community Health Care Providers
Home Health
Community Health and Welfare Partnerships
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
ARV Pilot Proposal
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
What Will Change 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
What Changed and Why
Civilian Decon Response
Mass Casualty Response
Additional Resources
On-Line vs. Off-Line Medical Direction
66 Off-Line Protocols and Guidelines
Adult
Pediatric
Toxic Exposures
Treatments
Overview of Medical Services
Treat and Release
Treat and Refer
Follow-Up Care
Reduce Emergency Department Visits
Reduce Hospital Re-Admissions
Reduce Demands On The 911 System
Goals of Community Paramedicine (MIHC)
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
Partnerships
EMS Division
Technical Rescue
1. Scene Size-Up.
2. Request appropriate
resources.
Assign Sectors:
Triage
Extrication
Treatment
Transportation
Landing Zone-Helicopters
Coordinate With Fire Alarm Headquarters For Hospital Availability and Resource
Grow The Command Structure To Fit The Incident
1
2
3
LZ
Airway Management
Diabetic
Allergic Reaction
Poisoning / Overdose
Obstetrics
Pain Management
Paramedic Medications
Respiratory
Cardiac
Adenosine
Amiodarone
Aspirin
Atropine Sulfate
Calcium Chloride
Diltiazem
Dopamine
Epinephrine
Furosemide
Lidocaine
Morphine
Nitroglycerin
Sodium Bicarb
Albuterol
Ipratropium Bromide
Magnesium Sulfate
Dextrose
Glucagon
Etomidate
Succynilcholine
Phenylephrine
Morphine
Epinephrine
Diphenhydramine
Methylprednisolone
Activated Charcoal
Narcan
Thiamine
Atropine Sulfate
Cyanokit
Magnesium Sulfate
Oxytocin
Anxiety / Delirium / Seizure
Diazepam
Lorazepam
Midazolam
Valley Computer-Aided Dispatch Consortium
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
Partnership with
Command Van
Toxicology Drug Box
Pharmaceuticals Carried / Amount -- Toxicological Syndromes Treated
Organophosphate/Nerve Agents
Organophosphate/Nerve Agents
Organophosphate/Nerve Agents
Methemoglobanemia
Toxic Exposures to the Eyes
Hydrogen Sulfite
Cyanide, Methemoglobinemia
Cyanide
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
Fire Chief
Bobby Ruiz
Deputy Chief
Gary Bernard
Operations / Training
Deputy Chief
Stacy Irvine
Human Resource / Administration
Deputy Chief
Jim Bratcher
Emergency Medical Services
Deputy Chief
Rick Picard
Fire Marshal / Emergency Mgt.
Battalion Chief
Ron Singleton
191 A
Battalion Chief
Mike Moore
191 B
Battalion Chief
Roger Russell
191 C
Battalion Chief
Billy Morris
192 A
Battalion Chief
Steve Kelley
192 B
Battalion Chief
Robert Brewster
192 C
Supervisor
Support Services
Captain
Training
EMS Coordinator
EMS Training
Supervisor
Prevention /
Investigations
Inspections
Investigations
Plans Review
Fire Code
Maintenance on 65 Vehicles
Maintenance on 128
SCBA
Maintenance on 180+ Turnouts
Fire PIO
Early Efficiency Model
History of EMS Models
1979
- Paramedic Engine Company
Trending Calls for Service Analysis
History of EMS Models
Adaptive Response Unit
1990
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
High Acuity
Low Acuity
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
Fire doubles every 30 seconds
Fire Prevention
32
Payroll
Admin
Human Resources
Admin
Budget
Admin
Accreditation
Admin
CON
EMS
Emergency Management
Inspections
Code Enforcement
Investigations
Plans Review
Ambulance Service
Build Out Options
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)
Implementation Option
Implementation Option
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
Emergency Transport
Services