HomeMy WebLinkAbout1977-01-04; City Council; 3600-2; Paramedic Service. _ � : • j" �1tiyy
/ CITY OF CARLSBAD
AGENDA BILL 110. �(p � d -- � #� Initial:
Dept. Rd.:;/�
DATE: January 4, 1977
C. Atty.
DEPARTMENT: City Manager C. Mgr. [_
Subject:
PARAMEDIC SERVICE
Statement of the Matter
At the December 7, 1976 Council meeting, the City Council
directed the staff to prepare a report concerning the
implementation of paramedic service in Carlsbad.
The attached report has been prepared to indicate what action
is necessary to initiate paramedic service for the City of
Carlsbad.
Exhibit
Report from Fire Chief dated December 29, 1976
Recomn,endation
if Council desires to initiate paramedic sQa-vice in September,
1977, Council action would be to approve the recommendations
in the attached report.
Council action
1-4-77 It was agreed that the Council set in motion the process as outlined
by Chief Thompson to initiate a paramedic service by September, 1977,
and approved the recommendations in the reportwith the alternative
recommended on Attachment "D". -
It was further agreed that staff return to City Council with
alternative plans to provide service to the southern portion of
the City.
DATE: DECEMBER 29, 1976
TO: CITY MANAGER
FROM: Fire Chief
SUBJECT: PARAMEDIC SERVICE
a Information concerning implementation of a paramedic service
i has been gathered through talking with representatives of
San Diego County Office of Emergency Medical Services and
{ from the Oceanside Fire Department.
According to the County office of Emergency Medical Services,
we are told that at this time there are no longer any grant
funds available for the purchase of a mobile intensive care
unit. There are however, funds available to purchase the
equipment necessary to convert our ambulance to a mobile intensive
care unit. The cost to convert our ambulance would be approxi-
mately $13,000. The County has presently commitk;ed all of its
grant funds for the purchase of ambulance equipment to com-
munities that are anticipating the initiation of paramedic
service. If, subsequently, these communities fail to initiate
service, there may be funds available for the purchase of an
additional ambulance unit to be used in the Carlsbad paramedic
program.
It is proposed that paramedic service be initiated in Carlsbad
utilizing one paramedic unit which would be based at the head-
quarter station. County paramedic standards require that
paramedic units be able to respond within ten minutes in urban
areas. It is not likely that with one unit the City would be
able to meet this service criteria in the La Costa area. Since
paramedics are basically an extension of the emergency room
service provide:; by a hospital, in the La Costa area it would
probably be wiser to transport patients immediately to the
closest hospital (San Dieguito) than to wait for the paramedic
unit to arrive.
This difference in service level, may create immediate pressure
for the additon of a second paramedic unit. However, rather
than add a second unit, it may be more feasible to provide for
a more centrally located base for a single paramedic unit that
would be able to cover the entire city within the parameters of
the County service criteria. This may not be feasible until
fire fighting facilities are established in the vicinity of
Palomar Airport.
December 29, 1976
Page 2
Subject: Paramedic Service
It is generally recommended that 8 or 9 men be trained to
staff one paramedic unit. After studying our manning
situation, we feel we can satisfactorily start the program
by training 7 men and sending 1 or 2 through training at
a later time. The training of 7 paramedics would provide 3
on each shift and 1 paramedic coordinator.
Paramedics would continue to be used in a dual capacity. Even
in a dual role, it will be necessary to hire additional personnel
in order to maintain the present manning levels in fire suppression.
The reason for additional personnel is that we presently staff the
ambulance service with fire fighters. When a fire call is received,
these personnel. are called back to man the ambulance. The County
paramedic standards require that the paramedic unit be constantly
manned and we would not be able to use this call back ystem to
man the paramedic unit. In addition, all fire fighters would not
be trained as paramedics and it would not be possible to call
back paramedics to man the paramedic unit in any case.
In some types of paramedic calls it is necessary that 3 people
be committed to providing emergency medical service. In addition
to the paramedics, it would be necessary to have a driver to trans-
port the patient to the hospital. In order to continue the present
level in fire suppression and provide adequate staffing for a para-
medic unit, it is recommended that 4 additional positions be
created in the Fire Department. These would be a Captain/paramedic
coordinator, and 3 fire fighter positions.
The Country Emergency Medical Service office indicates that there
are funds currently available to cover the cost of training of
paramedics. The office is not sure how long these funds will be
available for training. If the City wants to be certain that
these grant monies are available, we should initiate training
activities this fiscal year. The initial training program takes
five months. If fire fighters begin training in April, 1977, the
City would be able to begin the paramedic service in September,
1977. in order, to provide adequate manning while 7 fire fighters
are in paramedic training, it will be necessary to cancel days off
and call back personnel on an overtime basis to provide an adequate
manning level or to hire additional personnel and have them
trained prior to the date the paramedic training begins.
1-11 R' '1
December 29, 1976
Page 3
Subject: Paramedic Service
Attachment 'D' discusses the alternate staffing methods and
it is my recommendation that 4 additional fire fighters be
hired at least 30 days prior to the initiation of paramedic
training as indicated.
Implementation of a paramedic service will require the following:
1. Indicate in writing to the San Diego County Public Health
Officer the desire of the City of Carlsbad to enter into
a paramedic program. We should indicate to them that we
are planning to train fire fighters as paramedics and
initially start with one mobile intensive care unit and
when we wish to become operational (9-1--77). (Attachment 'A')
2. A contract with the County of San Diego to provide paramedic
service within the City of Carlsbad is required. The con-
tract establishes guidelines of responsibilities for both
the City of Carlsbad and the County of San Diego.
3. Establish an eligibility list for the selection of paramedic
trainees using the County's criteria for selection.
(Attachment 'B')
4. Establish a promotability incentf.ve for paramedics.
(Attachment 'C')
5. Establish a procedure for staffing the Fire Department during
the paramedic training program.
(Attachment 'D')
6. Establish the position of Paramedic Coordinator/Fire Captain.
(Attachment 'E')
7. An annual operating budget would be pre,-ared as part of the
1977-78 fiscal year budget.
Recommendations
If it is the City Council's desire to begin paramedic service in
September, 1977, it is recommended that the following steps be
taken immediately:
1. That 4 additional positions be added to the Fire Department
budget effective March 1, 1977.
0—\ Poj�
December 29, 1976
Page 4
Subject: Paramedic Service
2. Staff be directed to prepare a letter indicating the
City's intent to begin operation of a paramedic service
in September, 1977. The Council agrees in concept to
provide a promotability incentive for paramedics as
indicated in Attachment 'C'.
JAMS-THOMPSON
Fire Chief
JT:ldg
Atts.
I
r41�1 #ION
PARAMEDIC PROGRAM - ATTACHMENT "A"
CRITERIA FOR AGENCY APPROVAL TO PROVIDE PARAMEDIC SERVICES
I. Offer 24 hour, 365 day service.
2. Agree to provide sufficient manpower for 24 hour service.
3. Be selected by a local jurisdiction as the agency to provide
Paramedic services for that jurisdiction.*
4. Agree to abide by County Paramedic Program Standards.
5. Agree to respond only to emergency calls.
6. Insure that a back-up system of basic life support will be
available to the Mobile Intensive Care Units.
7. Enter into mutual aid agreements with adjoining Paramedic
units.
8. Guarantee a maximum response time of 15 minutes in rural
areas and 10 minutes in urban areas.
9. Agree to continuing education responsibilities as established
by the program.
10. Insure that Paramedic services will continue to be provided
as stipulated for a minimum of two years following certifi-
cation.
11. Submit a feasible plan of promotability (vertical ladder) to
provide incentive for Paramedics to remain in the program.
12. Cooperate with the County in the provision of field intern-
ship locations for future classes.
* local jurisdiction - cities, districts authorized to { provide
emergency medical services.
PARAMEDIC PROGRAM - ATTACHMENT "B"
CRITERIA FOR SELECTION OF PARAMEDIC TRAINEES
APPROVED BY THE EMERGENCY MEDICAL CARE C014MITTEE - JUNE 19, 1975
1. Candidate must be a permanent member of an agency approved
by the County Health Officer to operate an MICU.
2. Candidate must have at least one year experience in rescue
and/or emergency medical work.
3. Candidate must have satisfactory departmental performance
evaluations and be recommended by supervisor (with emphasis
on maturity, common sense, judgement, and performance under
emergency conditions).
4. Candidate must have volunteered for the program, and be
willing to commit 100% of his/her time and effort to the
program. (Must be in a position to forego overtimes, holi-
days, and vacation time for the duration of the training
program).
5. Candidate mist satisfactorily pass preliminary screening for
elementary reading, comprehension, and mathematical skills.
5. Candidate must hold current CPR certification from the San
Diego County Heart Association or. the American Red Cross.
Qualified candidates will be interviewed and trainees selected
by an Oral Examining Board appointed by the County Health Officer,
consisting of a representative of the Paramedic Program and one
representative of any two of the following organizations not
-^-Iv involved with the Paramedic Program:
1. Health care organizaticn.
2. Public service organization.
3. Public educational institution.
4. The medical community.
PARAMEDIC PROGRAM - ATTACHMENT 'C'
In order to meet County's criteria for agency approval, we
are to submit a feasible plan of promotability to provide
incentive for paramedics to remain in the program. The
following is a suggested proposal for paramedic pay:
After successful completion of paramedic training (5 months)
and a total of one year as a paramedic in the Carlsbad Fire
Department and upon recommendation of the paramedic coordinator
and the Fire Chief, an increase in salary of 5% of base salary
be granted.
Should, at any time after the first year, a paramedic either
by choice or departmental direction, return to his previous
position as a fire fighter, his salary would be adjusted
accordingly.
PARAMEDIC PROGRAM - ATTACHbIENT "D"
INTERIM STAFFING
During the five month training period it will be necessary
to replace these firefighters who volunteer and are selected
to train as paramedics.
If we elect to send seven firefighters to paramedic school
and staff with off -duty personnel it will require 9,555 mail
hours of overtime at a cost of $81,217.
Upon completion of their training it would be recommended
that we hire four• additional firemen to staff the fire
apparatus. Our present operating policy is to use the men
on the ambulances to respond to fires and call in off -duty
to man the ambulance. This is not practical with paramedics
as we are required to have constant manning with two certified
paramedics at all times. This unit would respond to fires
and the personnel could assist the fire crews in fire suppression
duties as long as the unit remains in service, ready to respond.
An alternative, and the one I would recommend, would be to hire
four additional fire r,20ruits 30 days prior to sending person-
nel to paramedic training and have limited recall on overtime.
The cost of hiring four firefighters for six months would be
approximately $32:160 and the additional overtime would be
$31,212 for a total personnel start-up cost of approximately
$63,372.
Ago., 014
PARAMEDIC PROGRAM - ATTACHMENT "E"
PARAMEDIC COORDINATOR
The Paramedic Coordinator (Fire Captain) is considered very
necessary to insure the harmonious operations among fire
paramedics and fire department personnel, personnel of police
services, emergency ambulance personnel, hospitals, and any
other person or persons charged with or involved with de-
livering emergency medical aid to the citizens served by
the Carlsbad Mobile Emergency Medical Care System.
The Paramedic Coordinator would establish and maintain a
uniform method of operations on rescue and medical aid
emergencies, to which rescue units and fire department units
respond.
The Paramedic Coordinator would have the responsibility to:
1. Establish and maintain procedures for procurement of
supplies and equipment for all rescue units.
2. In coordination with the Carlsbad Mobile Emergency Medi-
cal Care System and the San Diego County Paramedic Train-
ing Division, supervise the continuing paramedic training
program including structured classes, hospital experience,
critiques, to increase the medical knowledge and skills,
and insure the retention of certified paramedic status of
each paramedic.
3. Supervise and evaluate any paramedic trainee during the
internship portion of training.
4. Establish and maintain a program to upgrade the emergency
medical aid knowledge of all fire department personnel.
5. Establish and maintain an effective liaison between the
City of Carlsbad and San Diego County Emergency Health
Services.