MFD EMS DELIVERY
2024 Interfacility Transport Ambulance Feasibility Study Merced County EMS Ambulance RFP Update
First Responder Advanced Life Support (FRALS) Update
Staff Request
2024 Interfacility Transport
Ambulance
Feasibility Study
2024 IFT Ambulance Feasibility Study
▪ Feasibility Study overview
▪ Cost Assessment
▪ Feasibility Summary
▪ Staff Recommendation
2024 IFT Ambulance Feasibility Study
Comprehensive twenty six page system assessment .
Detailed financial review and cost assessment.
Conducted by a local EMS system expert.
2024
Interfacility Transport Ambulance
Feasibility Study
Ambulance Transport - Cost
Ambulance Operations Cost
Call Volume Requirements
Shift/
Coverage
Daily
Deployment
Cost
Annual Deployment
Cost
Amortization
Schedule
Days of
Operation
Annual Required
Call Volume
Daily Required
Call Volume
BLS
8 hrs $ 970.03 $ 339,511.20 $ 41,344.00 350 1,174 3.4 4 8/16 hrs $ 1,940.06 $ 679,022.40 $ 41,344.00 350 2,220 6.3 7 8/24 hrs $ 2,910.10 $ 1,018,533.60 $ 41,344.00 350 3,266 9.3 10 12 hrs $ 1,697.56 $ 594,144.60 $ 41,344.00 350 1,958 5.6 6 12/24 hrs $ 3,395.11 $ 1,188,289.20 $ 41,344.00 350 3,789 10.8 11 Feasibility Summery
Conclusion
Is it feasible? YES
- Operationally YES
- Financially YES
Is it right for Merced?
Staff Recommendation
Although it is feasible, staff recommendation is to not pursue BLS IFT ambulance staffing at this time.
Reasons:
• A single ambulance will not be sufficient to support the amount of IFT’s out of Mercy Hospital.
• Negative impacts on private ambulance sustainability. • Overall, potential negative impact on the through-put of the hospital thus increasing APOT.
Additional Ambulance Opportunities
Fireline Paramedic Assignments - 2025
Incident Ambulance “Responding to State OES Request” State OES ALS ambulance unit reimbursement rates:
$2,848 unit rate per day
14-day deployment $39,872
Personnel cost reimbursement
Community Event Stand-By
Surge Capability
Merced County EMS
Ambulance
RFP Update
Merced County EMS Ambulance RFP
▪ Merced County Emergency Ambulance Service is administered through an Exclusive Operating Agreement (EOA)
▪ 5 Year agreement awarded via competitive bid process
▪ Current agreement set to expire June 2025
▪ RFP scheduled for release Q4 2024
▪ 5-year Term beginning July 2025
Merced County EMS Ambulance RFP
Can MFD bid?
Typical requirements include?
▪ The Bidder must have existed and continuously provided Prehospital Emergency Medical Services for at least the last five (5) years in the United States. ▪ Each of the Bidder’s Key Personnel shall be regularly and continuously engaged in the business of providing or directly overseeing the provision of emergency medical services for a minimum of two (2) continuous years within the last five (5) years. ▪ Bidder’s estimate of working capital needed to fund implementation, start up and ongoing operational costs, and methods and sources of funding. ▪ Estimated Cost
▪ Capital Investment (Start-up) Cost - $15 Million
▪ Lead time for equipment estimated 4 – 6 months
First Responder
Advanced Life Support
(FRALS)
Update
Problem Statement
Current contracted provider is in breach of contract and has not met response time requirements. (10:59 90% of the time)
2024 Q2 Merced County EMS Agency reported 975 late responses for High Call Density areas.
2024 Q2 Merced County EMS Agency reported 14/27 measures failed on contracted providers clinical performance.
First Responder ALS
▪ What is First Responder
ALS (FRALS)?
▪ Paramedics on:
Fire Engines
Ladder Trucks
Squads
EMT vs. Paramedic – What is the difference?
▪ EMT
▪ Basic Life Support
▪ 170 hours of training
▪ Min. training for MFD
firefighters
▪ Basic airway management
▪ Basic patient stabilization
▪ Paramedic
▪ Advanced Life Support
▪ 1200 - 1800 hours of
training. (Approx. 2-year
process)
▪ Advanced Airway
Management
▪ Cardiac monitoring
▪ Medication
administration
▪ Pain management
First Responder ALS
▪ Current Program Progress
Contract with Medical Director
Controlled Substance Plan
EMS Quality Improvement Plan
CE/EMS Training Plan
ePCR Program Acquired
FF/Paramedic Job Classifications
Licensed Paramedics Hired/Trained
Merced County EMS FRALS Provider
Designation
▪ Tentative Approval Received (July 22, 2024)
▪ Draft Agreement Under Review (Estimated
completion November 2024)
First Responder ALS – What have we invested?
▪ What have we invested so far?
▪ Paramedic Training - $500K
▪ 7 - Fully Licensed Paramedics
▪ 3 - Pending Licensure
▪ 3 - Final Stage of Training
▪ 6 - Beginning Training
▪ Ambulance - $300K
▪ ALS Equipment/Supplies - $80k
▪ Medical director - $24K
▪ ePCR Program - $8K
▪ Controlled Substances - $3k
First Responder ALS
FRALS Implementation Plan
1st ALS Company – Jan 2025
2nd ALS Company – July 2025
3rd & 4th ALS Company – July 2026
First Responder ALS
▪ Current Program Needs
Permanent EMS Program Manager
Three ALS Cardiac Monitors
Command Vehicle for EMS Program Manager
Regulatory Requirements
California Code of Regulations – Title 22. Social Security Division 9. Prehospital Emergency Medical Services Chapter 4. Emergency Medical Technician – Paramedic Article 7. System Requirements ▪ § 100168. Paramedic Service Provider
▪ An approved paramedic service provider shall:
▪ (1) Provide emergency medical service response on a continuous twenty-four (24) hours per day basis, unless otherwise specified by the LEMSA, in which case there shall be adequate justification for the exemption (e.g., lifeguards, ski patrol personnel, etc.). ▪ (2) Utilize and maintain telecommunications as specified by the LEMSA. ▪ (3) Maintain a drug and solution inventory as specified by the LEMSA of equipment and supplies commensurate with the basic and local optional scope of practice of the paramedic. ▪ (4) Have a written agreement with the LEMSA to participate in the EMS system and to comply with all applicable State regulations and local policies and procedures, including participation in the LEMSA's EMSQIP as specified in Chapter 12 of this Division.
▪ (5) Be responsible for assessing the current knowledge of their paramedics in local policies, procedures and protocols and for assessing their paramedics' skills competency.
Council Action Items
A. Adopt 2024 Interfacility Ambulance Feasibility Study as information only.
B. Accept First Responder ALS update as information only.
C. Approve the staff recommendation of Resolution 2024-104 adding 1 Battalion Chief position for ALS Program Management.
D. Approve supplemental appropriation of $50,000 from unencumbered Measure Y funding to purchase additional needed equipment.
E. Waive the competitive bidding requirements to purchase 3 ALS Cardiac Monitors.