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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.