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