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HomeMy WebLinkAbout1976-06-15; City Council; 3600-1; Paramedic ServicesCITY OF CARLSBAD AGENDA BILL NO. J60- y��,i f #� Initial:`'" Pr Dept.Hd. DATE: June 15, 1976 C. Atty.\ DEPARTMENT: City Manager C. Mgr. Subject: PARAMEDIC SERVICES Statement of the Matter At the March 16, 1976 City Council meeting, the Council heard from a resident regarding the establishment of paramedic "a service. The Council requested the staff to obtain cost information on the paramedic service in other agencies and develop a preliminary cost estimate for providing the service a in Carlsbad. Exhibit Report on paramedic service including preliminary cost estimates. Recommendation This is an information report only and the staff has no recommendation. If it is the Council's intent to proceed with active consideration of the matter, the staff can prepare further detailed studies regarding the funding and operation of such a program. Council action 6-15-76 The Council discussed the information received, and the possibility of conducting a survey to learn the desires o'f the public on this and other matters. It was agreed that a Council Committee be formed to develop a format for a survey, and the staff be requested to return with more information. The Mayor appointed Councilmen Packard and Skotnicki to serve as the committee to pursue this concept, with staff participation. DATE: MAY 25, 1976 TO: CITY MANAGER FROM: Administrative Assistant SUBJECT: PARAMEDIC SERVICES Information has been gathered concerning the cost of paramedic services provided by various public agencies. In San Diego County, only three agencies currently provide such service; the City of Oceanside, County Service Area 17 (in the San Dieguito area), and County Service Area 69 (in the Santee and Lakeside area of the East County). In order to develop information more representative of cities, the paramedic program in orange County was also surveyed. In addition, cost figures on providing paramedic services in the City of San Diego were also reviewed, although San Diego voters rejected the service at the polls. Evaluating the Cost of Paramedic Service When evaluating the cost of any service and making comparisons amongst various providers of service, in addition to the readily apparent differences, two improtant points should be kept in mind. First, the level of service may vary significantly from agency to agency. Secondly, the total cost of providing the service is not always allocated to a single budget account and significant cost factors may therefore be difficult to identify. For the purpose of this report, it will be assumed that the level of paramedic service provided is relatively uniform. This is probably a safe assumption in that there are definitive standards to be followed by the providers of the service and a comprehensive training program must be completed in order to qualify as a paramedic. However, research has revealed .gat there is a significant deviation among providers of the service on how costs are stated. Therefore, cost information should be used with caution since there is little agreement among the various agencies providing paramedic services as to which expenses should be included in the cost of operating a paramedic unit. Some agencies consider the cost of operating the paramedic program to be only the most obvious additional costs of providing the service, and other agencies allocate all direct, as well as any indirect costs, to the operation of the service. May 25, 1976 Page 2 Subject: Paramedic Services Proposed Paramedic Budgets in San Diego County Information was obtained on the proposed 1976-77 budgets for paramedic service by the following agencies and is summarized as follows: County Service Area 17 $226,6001 County Service Area 69 $221,202 City of Oceanside $ 40,0222 Orange County Paramedic Costs The Orange County Health Department provided information on the cost of providing paramedic service in that County. A total of 22 units provides service in 12 cities and the unincorporated areas of Orange County. For the 1975-76 fiscal year, a survey conducted by Orange County revealed a cost range from $125,000 to $205,000 per paramedic unit, with the average being approximately $170,000 per unit. Paramedic Cost Estimates by the City of San Diego In a report prepared in July, 1975 for the San Diego City Council, the cost of providing paramedic service through the San Di=jo Fire Department was analyzed. The cost of providing paramedic service, once the 20 unit system was fully imple- mented in the 1977-78 fiscal year, was approximately $165,0003 per unit. Possible Methods of Providing Paramedic Service in Carlsbad There are, theoretically, a number of possible methods of supplying paramedic services to the residents of Carlsbad. Naturally, there are relative advantages and disadvantages to each method, but it is important to be cognizant of the possiL a alternative methods of supplying service. A few possible alternatives are summarized on the following page. lIncludes $21,200 in County overhead, service area administration, office rental, and contingency reserves. 20ceanside operates two paramedic units. 3All costs expressed in fiscal year 1976 dollars includes no increase in salaries or fringe benefits. FA May 25, 1976 Page 3 Subject: Paramedic Services City of Carlsbad Fire Department - The most common approach in Southern California has been for City Fire Departments to provide paramedic services. In many cases, the Fire Department was already supplying emergency ambulance service and it appeared logical to supply paramedic services through this department. Private Service - There are private firms in the ambulance business who have expressed an interest in providing para- medic service to a city on a contract basis. The private firm would derive part of its income from user fees and the remainder from a city funded operating subsidy. Tri-City Hospital District - The hospital district,as an existing subregional agency, currently supplies emergency medical services. The possibility of expanding such emergency room service to include paramedic service deserves serious consideration. Subregional Joint Power Authority - It would be possible to join with other cities or agencies in a joint exercise of powers agreement to supply paramedic service. Through this method, a number of agencies could obtain paramedic services. Join County Service Area 17 - The existing San Dieguito paramedic service could be expanded and allowed to operate in the City of Carlsbad. All or a portion of the City might obtain paramedic service in this manner. Although the above possibilities may be .feasible legally and administratively, the economic advantages and disadvantages would have to be carefully weighed. In addition, there may be practical political problems which would have to be evaluated. The above summarized alternatives are designed merely to be illustrative of what may be possible. An exhaustive investigation of each alternative, if that is desired, would be necessary to determine the optimum method of delivering paramedic service to Carlsbad residents. However, regardless of the service delivery system selected, there are certain identifiable costs involved in supplying paramedic service. An estimate of the cost of supplying such service has been calculated. The estimate assumes that the service would be provided through the City of Carlsbad Fire Department. May 25, 1976 Page 4 Subject: Paramedic Services ESTIMATED COST OF PARAMEDIC SERVICE - CARLSBAD FIRE DEPARTMENT The estimated cost to the City of Carlsbad of providing one paramedic unit is summarized as follows: Personnel Servicesl First Year Second Year Salaries $ 93,091 $ 93,091 Overtime $ 66,384 $ 1,2004 Subtotal $159,475 $ 94,291 Materials, Supplies, Services Medical Spplies $ 21000 $ 2,000 Insurance $ 51000 $ 51000 Equipment Main & Operation $ 51500 $ 6,000 Subtotal $ 12,500 $ 13,000 Capital outlay Capital Reserves for Replace- $ 6,000 ment of Medical Equip. and Vehicles Communication Equip. Subtotal $ 6,000 TOTAL $171,975 $113,291 1Assumes no premium or incentive pay for fire fighters assigned as paramedics. 2Allocating 60% of the time of eight fire fighters as paramedics. 30vertime to replace eight fire fighters during 5 month training program. 4Annual refresher training 18 hours per man. 5Anticipated increase in liability insurance. 6Assumes that existing ambulance equipment can be upgraded for paramedic use. 7Grant funding is available to purchase and equip a paramedic unit or purchase equipment necessary to upgrade the existing ambulance. Approximately $10,000 would be needed to upgrade the existing ambulance. May 25, 1976 Page 5 Subject: Paramedic Services The cost estimates assumed that there will initially be no increase in personnel. it is assumed that the fire fighters assigned as paramedics will initially be available at least 40% of the time for fire suppression activities. However, as the frequency of calls for paramedic service increases, it will be necessary to establish additional fire fighter positions to maintain an adequate fire suppression staffing level. As the demand for paramedic services increases, it should be recognized that it may be necessary to add additional para- medic units to maintain an adequate service level and to cove,: all geographical areas of the City. It should be noted that there is no charge made for adminis- trative overhead or the cost of supervision. All costs are stated in 1976 dollars and no incentive or premium pay or salary adjustments are included for those fire fighters serving as paramedics. To initiate a paramedic program, it would be necessary to train sufficient personnel to provide 24 hour a day, seven days a week service. To provide such coverage, it will be necessary to train 8 fire fighters as paramedics. The training program runs for five months and while the fire fighters are undergoing training, it would be necessary to bring in off duty personnel at overtime rates so as to be able to maintain an adequate staffing level. The direct cost of the training program, approximately $2,000 per trainee, is funded jointly by the County of San Diego and the Department of Health, Education and Welfare. The City would still be responsible for paying the cost of salaries and benefits for each trainee during the training program. Potential Program Revenue it is anticipated that a user fee will be established for para- medic serN-ICe. The fee most likely would be established somewhat above the current charge for ambulance service. Assuming a fee of $40.00 is established for paramedic service, potential revenue is estimated as follows: Calis where paramedic services are provided 500 calls X $40 Revenue $20,000 If the present ambulance bill collection rate of 62% were applied to potential paramedic revenues, annual program revenue would be approximatelyqAN $12,400../ F 4NK N. MN Administrative Assistant FNM:ldg 4,