Board Jonathan Dodge, R.N. Board Vice-Chairman. Director of Finance. Representing Chisago Lakes Area Serving Since 01/01/2000

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1 Board Jonathan Dodge, R.N. Board Chairman Representing Chisago Lakes Area Serving Since 01/01/2000 Peter Overgaard, M.D. Board Vice-Chairman Representing Chisago Lakes Area Serving Since 01/01/2000 Mike Carroll Secretary/Treasurer Business Owner Rush City Member-at-Large Serving Since 05/17/2011 Kathy Blomquist Director North Branch City Council Elected or Appointed Official Serving Since 03/15/2011 Keith Carlson Director Mayor, City of Lindstrom Elected or Appointed Official Serving Since 04/10/2007 Steve Mork Director Dalmark Development Representing North Branch Area Serving Since 10/27/2004 Eugene Olson Director Chair, Lent Township 04/10/ /31/2012 Scott Sellman Director Chisago County Emergency Manager Representing Chisago Lakes Area Serving Since 10/16/2012 Board/staff liaisons Todd J. Fisk Director of Finance Lakes Region EMS, Inc. Scott Johnson, M.D. Medical Director Lakes Region EMS, Inc. Ken Larson Paramedic Lakes Region EMS, Inc. Aarron Reinert Executive Director Lakes Region EMS, Inc. Ben Wasmund Director of Operations Lakes Region EMS, Inc. Your community ambulance service Lakes Region EMS 2012 Annual Report Lakes Region EMS is proud to announce that our and 2011 annual reports designed by Christiansen Creative have received American Graphic Design Awards from Graphic Design USA, a publication for creative professionals. Serving the citizens of Chisago County with State-of-the-Art Patient Care, Outstanding Customer Service, Dedication to the Communities We Serve, and Financial Health and Responsibility.

2 Executive summary I d like to begin my 2012 Executive Summary by sharing a powerful story about community ownership. This story is an incredible example of a community ambulance service creating ownership. In past years, I have talked about building the sense of ownership in the communities Lakes Region EMS serves; however, it has occurred to me that this idea of feeling like an owner may seem, too big. Individuals may struggle with how one person could help an ambulance service like Lakes Region EMS. This story is about how each person in a small rural community played a role in the long-term success of their community ambulance service. The story begins in Jones County South Dakota. Their ambulance service is based in Mudro South Dakota, population 486. The ambulance service responds to around and interfacility responses a year in Jones County, which is roughly 1,000 square miles with a population of 1,003 individuals. Like rural ambulance services all across our nation, the organization struggles with very low call volume, a very large service area, mutual aid services that are 30-plus minutes away, and the inability to recruit and retain paramedics and EMTs. A possible solution was to hire staff and build crew quarters attached to its ambulance garage. Similar to Lakes Region EMS, potential solutions to its challenges were limited by the lack of access to financial resources. As the ambulance service told its story about these challenges and asked community members for financial support for its needed building project, the answer was always a regrettable, no. Community members were themselves struggling with financial stresses, such as the loss of jobs, the depression of the local economy, and the crash of the housing market. One day a community member said, Maybe. The person said they didn t have dollars they could contribute, but their day job was excavation. The person offered to do the foundation work for free. This offer started a ground swell of community support. Someone else volunteered to do brick work, another dry wall, someone else painting. One person even said, I can t even pound a nail, but what I could do is cook. I share this story as an example of something that surely felt too big, like building a multi-thousand-dollar addition. However, with individuals in the community contributing in ways that matched their skills and talents, Mudro Ambulance Service is able to address its challenges in a way that involves the entire community continued to be a year of focused improvements on our journey of the four pillars. Our four pillars, state-of-the-art patient care, outstanding customer service, dedication to the communities we serve, and financial health and responsibility continue to be the goal we reach for and the standard we measure ourselves against. The continued reductions in reimbursement and double-digit increases in our expenses, including fuel, medical supplies, and the cost of state-ofthe-art technology, continue to be the greatest threat to our long-term survivability. As we think deeply about possible strategies to resolve these two challenges, continuing to build the sense of ownership both internally and externally is clearly our path to long-term success. Thank you, Aarron Reinert Executive Director 2 lakes Region EMS 2012 Annual Report 3

3 State-of-the-art Patient Care Four Pillars + State-of-the-art Patient Care + Outstanding Customer Service + Dedication to the Communities We Serve + Financial Health and Responsibility At Lakes Region EMS, we have a philosophy that not only sets the standard for the way we do business, but is the core of our continued success. This philosophy is known as our Four Pillars : State-of-the-Art Patient Care, Outstanding Customer Service, Dedication to the Communities We Serve, and Financial Health and Responsibility. Each pillar drives our commitment to establish ourselves as the premier Advanced Life Support Ambulance service, including day-to-day operational decisions and long-term strategic planning. Arrowhead 2012 In January, Lakes Region EMS again attended the Arrowhead EMS Conference and Expo in Duluth. The Arrowhead EMS Association held its 32nd Annual EMS Conference and Expo at the Duluth Entertainment Convention Center. This event provided continuing education on cutting-edge techniques, protocols and topics of interest for emergency medical providers, and has long been one of the largest and most recognized in the area. Our attending clinicians enjoyed the opportunity to expand their education and meet with providers attending from other services. Each year, Lakes Region EMS brings up staff members to help staff a booth at the Expo, which allows us to share the Lakes Region EMS vision with others in the EMS community. The booth is manned by several members of our front-line staff who were able to participate in discussions with attendees and help answer questions about LREMS, our goals and future plans. Besides their time in the exhibit hall, each staff member has the ability to attend any of the sessions being presented throughout the conference, giving them new and unique perspectives to bring back to the organization. Each year we hope to continue to offer this opportunity to the staff to highlight all of the great work each of them do every day. This was a great opportunity to grow recognition for Lakes Region EMS throughout the area. It is our hope that by promoting our values, and becoming more visible, we will be able to recruit from a larger base of EMS providers who want to be a part of our journey to become a premier ambulance service. Simulation Education In 2012, Lakes Region EMS was able to incorporate simulation training labs to our education curriculum. Adopting a model often used in the military for training, utilizing realistic simulation scenarios for reinforcing concepts learned in the classroom has been found to improve retention of the lessons. In addition to using computerized simulation mannequins, in 2012 we added a simulation ambulance to our education classes to provide a realistic working environment in which to train. This ambulance is kept at our North Branch Base and dedicated for use during training sessions. The lab can be used to simulate any scenario within which to teach needed skills to our staff. It is fully stocked and has been used when training new staff, in our Critical Care classes, and for employee skill training sessions. By using these scenarios and allowing staff the opportunity to respond to them in real time, they gain valuable experience beyond the classroom lessons. It allows them time to practice new skills and to hone their abilities. Many of the scenarios are recorded and then viewed by our quality manager in order to give valuable feedback to our clinicians. The use of the simulation ambulance has become a valuable training method and an integral part of our employee education. STARS In May, Lakes Region EMS was proud to be able to send two of our employees to Washington, D.C., to participate in the annual Stars of Life Celebration, sponsored by the American Ambulance Association. This three-day event recognizes and honors the dedication of ambulance service personnel from around the country. The celebration not only acknowledged these individuals as outstanding members of their profession, but also as ambassadors of the EMS industry, presenting each participant with the Star of Life award. The staff at Lakes Region EMS nominated Paramedic Jon England and Operations Director Ben Wasmund as our 2012 stars. Jon was recognized by his peers for his extraordinary skill as a paramedic. No matter how stressful or difficult the situation, Jon remains grounded and focused on what needs to be done. He is known for his outstanding clinical skills, 4 lakes Region EMS 2012 Annual Report 5

4 dedication to patient care, and positive attitude. For the past several years, Jon has also served as our senior Field Training Officer (FTO), training and supervising new paramedics until they are able to work on their own. His strong teaching and leadership abilities, in addition to his limitless patience, make him a positive role model for our new employees. Other paramedics and EMTs within the company look up to Jon and view him as a mentor, as he exemplifies the high standards of our organization. In addition to holding down his full-time paramedic position, Jon is also going to school to pursue a career as a physician assistant and balances his multiple responsibilities with efficiency and grace. Ben Wasmund began his career with Lakes Region EMS 11 years ago as an EMT, and through the years, he has risen to paramedic, Field Lead, and now serves as the Director of Operations, managing staff and daily operations for the organization. Our staff regards Ben as a manager who exhibits both integrity and solid leadership, and he strives to bring out the best in each employee. In 2011, when Lakes Region EMS was invited to become a partner in St. Croix Valley EMS, and begin providing service in Wisconsin, Ben s patience and dedication to the project was outstanding. All of our staff needed to become licensed in Wisconsin to accommodate the new service area, and Ben s focus and organization helped accomplish that goal in record time. He met with local leaders to build new relationships and worked to make the transition as seamless as possible for the community. Ben s high standards and incredible work ethic set him apart, and our staff was proud to nominate him for this award. Lucas Devices Last year, our organization was fortunate to be able to trial three Lucas Devices. This device provides continuous mechanical chest compressions to patients in cardiac arrest. Research regarding cardiac arrest management is published every fifth year by the American Heart Association (AHA). High-quality CPR is the cornerstone of a system of care that can optimize outcomes beyond return of spontaneous circulation (ROSC) (AHA 2010). Maintaining adequate and continuous chest compressions manually is a strenuous task, even with numerous first responders and clinicians switching out at regular intervals. The Lucas Device ensures proper, uniform chest compressions are performed on the patient and frees up the hands of on-scene EMS personnel so that clinicians can focus on all areas of patient care. During the trial, we found the Lucas Devices to be extremely useful during cardiac arrest calls. Sudden cardiac arrest remains a leading cause of death in the Western world (AHA 2010) and is one of the most difficult emergencies to respond to. It is a priority for Lakes Region EMS to keep up with new technologies that give the best chance of survival to our patients. We set a goal to acquire four of these devices for our service. After careful budgeting, we were able to purchase the devices in March There is now one of these units on each of our primary ambulances, as well as one in our supervisor vehicle. Lakes Region EMS is proud to be able to make this cutting-edge technology available to the patients in our community. Critical Care Classes Lakes Region EMS Critical Care education was created to reflect the needs of our patients. New treatments and philosophies for the care of the acutely dying patient are constantly being developed through research and innovation. Today, new thought is being given to the survivability of conditions that even a few years ago were deemed not viable. This has resulted in an increased need for the transport of patients at an acuity level greater than traditional ALS and BLS transport services commonly offer. Because of our relatively rural location, often our critical transports take place over long distances, with the patients requiring very complex treatments. We came to believe that our clinicians needed specialized education to manage these difficult cases, going beyond typical education levels required of EMTs and paramedics. As our transports of these critically ill and injured patients increased, we identified areas in which our clinicians would benefit from additional education. After reviewing available Critical Care courses, we found that none of them perfectly met the unique needs of our patients. In order to provide education targeted toward the specific needs of our community, we set out to develop our own critical care course. What has evolved is a three-course critical care curriculum that is intensive and challenging, providing training beyond other critical care courses. Critical Care education provides our clinicians the ability to essentially bring levels of care found in a hospital intensive care unit right to the patient. The first class developed was our Critical Care Medic I class. Designed to deal with the numbers of critical care, this course introduces paramedics to the lab values, ABG Analysis, blood pressure control, and other factors common to critical patients. Patient care treatment and decision making during transport is thoroughly examined, as well as important strategies for scene management. In addition, this course offers insight into the teamwork and speed of action required in the management of the acutely dying patient. Critical Care Medic II was later created to complement Critical Care Medic I. This course broadens the framework of critical care management, teaching state-of-the-art treatments and considerations in managing patients who suffer from critical illness and injury. The class focuses on concepts of dealing with the complex patient and examines practical treatment plans, medications, devices and procedures used. This course is taught by physicians and outside instructors who possess specialized knowledge and expertise on the subject matter, as well as inhouse LREMS instructors. Also emphasized is the importance of making personal connections with the patient and taking steps to put them at ease while in our care. New in 2012 is our Basic Critical Care course. This course was originally developed specifically for our EMTs and was the first Critical Care EMT curriculum in the nation, teaching EMTs to work with paramedics as a partner rather than an assistant. However, we found the class had tremendous value for paramedics who may be new to critical care, and now all new employees are required to take this training. The course is flexible and adaptable, with breakout sessions designed to accommodate EMTs and paramedics at various experience levels. Being largely scenario based, it is designed to familiarize clinicians with the equipment and medications often used in critical care transport and provide emphasis on methods that increase speed of care, enhance teamwork and improve choreography. 6 lakes Region EMS 2012 Annual Report 7

5 This successful Critical Care program has truly raised the bar on the care our clinicians are able to provide. In addition, by developing our own program, we are able to customize it to include new protocols and treatments and target the education directly to the needs of our communities. Throughout the courses, we strive to emphasize the importance of wholistic care and understanding our patients and their concerns. We provide our clinicians the knowledge to diagnose, the tools to treat, and stress the necessity of understanding and empathy to ease the fear and anxiety of our patients. We want our patients to feel safe, secure and well cared for while they are with us. Critical Care education ensures that we are able to give them this care and that our clinicians are prepared for the unique challenges faced by our most critical patients. RSI Beginning in 2010, Lakes Region EMS began the training and education to introduce Rapid Sequence Induction into our medical guidelines. Rapid Sequence Induction, or RSI, allows our clinicians to support and control a patient s airway and breathing through the use of medication facilitated intubation. This allows our critical care teams to secure the airway and breathing of critically ill or injured victims who previously would not have had access to this life-saving measure outside of the hospital setting. Additionally, this ability allows us to better serve our in-hospital partners in providing the best possible care to severely ill and injured patients. Lakes Region EMS preparation and staff education for RSI was the most in-depth and extensive pre-hospital RSI training program in the nation. Training took place over a two-year period, from 2010 through This training was implemented at all levels of our critical care education and online education, culminating in every member of the staff participating in full-day simulation training sessions with Lakes Region EMS medical director, Scott Johnson, M.D. While our training was in-depth and intense, it was also an extremely beneficial and successful endeavor. All of Lakes Region EMS ambulances, as well as the supervisor vehicle, are equipped to provide this procedure. Lakes Region EMS implemented RSI in January Outstanding Customer Service At Lakes Region EMS, we believe that caring for our patients involves more than the medical services we provide. Each patient has unique needs that go beyond the immediate health concern, and our staff does everything they can to meet those needs. We strive to hire clinicians who possess excellent medical skills, are empathetic to patients and their families, and believe in our Pillar of Outstanding Customer Service. We emphasize this need to put patients at ease during initial employee training, in our education classes, and also through ongoing performance feedback. Our hope is that our staff will help patients feel as though they are a member of our family while they are in our care. Each month, we call as many of our patients as we can reach to take a brief survey on their experience with Lakes Region EMS. We ask them to rate their ambulance crew in several different categories and encourage them to share stories and comments about the crew who cared for them. We measure the satisfaction levels not only for patients of 911 calls and interfacility transports, but also interview patients who declined transport. This feedback from our customers helps us to better understand their experience with us and in which areas we are meeting or exceeding their expectations. The survey results also help us to identify areas we may need to evaluate for improvement. All of the survey results are compiled into a quarterly report that is presented to management and our Board of Directors. We use the results to look for better ways to connect with our patients. In addition, the patient comments are presented to our ambulance crews, so they are able to receive individualized feedback on their performance. This survey has been an invaluable tool that helps us at Lakes Region EMS consistently improve our customer service skills. It has also provided us the opportunity to listen to our patients and their needs so that we are able to deliver the service they expect and deserve Overall Company Customer Survey Data Averages LREMS receives high marks of satisfaction from customers in the 2012 overall company customer survey, scoring more than 4.5 out of 5 points in all categories Overall Satisfaction Timely Arrival Caring/Compassionate Polite Knowledgeable Did you receive appropriate care? Did they answer questions? Were you comfortable? 8 lakes Region EMS 2012 Annual Report 9

6 Dedication to the Communities We Serve One cornerstone of the Lakes Region EMS Four Pillars philosophy is Dedication to the communities we serve. We never forget that the purpose of our organization is to provide a valuable service to our residents. Because statistics show that only 10% of people will ever need to call an ambulance, Lakes Region EMS is committed to finding additional ways to practice this dedication and to be able to benefit every member of our communities. One avenue of service we have found is in volunteering our time and resources to local causes and benefits. There are many opportunities to volunteer in our area, and we are proud and honored to be able to help with a number of local events. The following are highlights from some of the opportunities that Lakes Region EMS was a part of in Food Shelf Challenge Local businesses came together in March at the 2012 Supermarket Sweep to support the Family Pathways Food Shelf. This friendly completion has become an annual tradition among several area organizations. Lakes Region EMS and the other participating businesses each had teams of two that were given 90 seconds to race through the North Branch County Market to fill carts of groceries. Each team attempted to gather the highest dollar value worth of groceries in their cart, and some teams were able to fill multiple carts in the allotted time. The event is sponsored by Peoples National Bank, which pays for the groceries of the winning team. This year, after finishing for the past three years as a runner up, Lakes Region EMS won the competition with $847 worth of groceries. At the end of the competition, $4,127 worth of food and $1,000 in donations were collected for the local Food Pantry. Adopt-a-Highway Lakes Region EMS is always looking for new ways to volunteer within our community. This year, our employees suggested looking into Adopt-a-Highway. Supervisor Chad Mager, as well as other staff members, worked with MnDOT to obtain a two-mile section of Highway 35 between North Branch and Harris. Chad also worked to coordinate the initial clean up in May, recruiting off-duty personnel to come in to pick up trash. Then in September, EMT Mike Christian volunteered to become our Adopt-a-Highway coordinator and scheduled a second clean-up day. A lot of hard work was put in to pick up our section of highway. But all of the volunteers said it was a great experience, and they will continue to volunteer to keep our roadways clean. Pedal with Public Safety In July, Lakes Region EMS again joined forces with the North Branch Fire Department, North Branch Police Department, and American Family Insurance Rob Sanvik for the annual Pedal/ walk/run with Public Safety event. This familyfriendly event was held at the North Branch Fire Department and included a 5K Run/Walk, and a six-mile bike ride. Both cash and food donations are collected at the event to benefit the local food shelf. Prizes were given out for 5k winners and during drawings held throughout the event. Participants all received a t-shirt, as well as lunch, and free demonstrations were available for local children and their families. Kids were able to test their skills with a fire hose, receive safety information and demonstrations, and interact with local emergency personnel. Lakes Region EMS coordinated the 5K route, and this year, we had our largest participation from the community, including several of our very own staff and their families running and biking in the event. After the event, the $600 in proceeds, along with the collected food, were presented to the North Branch Family Pathways Food Shelf. Although this is only our second year participating in this event, it has quickly become a favorite among our staff, as it is an event that directly impacts our community. Shop with a Cop This year s annual Shop with a Cop event was a great success! Shop with a Cop is run by the Salvation Army and takes place at several metro locations, where children in need are paired with local police, fire and EMS personnel to shop for school clothing. In addition, the Salvation Army also provides school supplies to each child. The North Branch Shop with a Cop event took place August 9th, and Lakes Region EMS had four staff members who participated, along with two volunteers from the Lakes Region EMS Explorer Post. A breakfast buffet was provided for all participants by County Market, during which the children and their volunteers had a chance to become acquainted. After breakfast, the volunteers walked their charges over to Shopko and engaged in a friendly competition to see who could spend the closest to the provided dollar amount without going over. The Salvation Army provides the funds for the event, and each child was able to spend up to $80 on needed clothing. Brian Meyer, a Lakes Region EMT, spent $79.95 on his child, and held the lead until right at the end, when one of the officers took first place with $79.97! Shop with a Cop was a very rewarding experience for all involved. It was a terrific opportunity to make a tangible difference in the life of a child, and also to help kids see police and EMS providers in a positive light. Explorers Living up to our core principles, what we call our Four Pillars, is how we conduct ourselves every day here at Lakes Region EMS. One of those pillars, Dedication to the Communities We Serve, led to the creation of our youth explorer post. While we anticipated being able to influence and guide the lives of young people in our community, what we got in return was so much more. They have challenged us to look at things we do and ask not only why, but why not. Their drive and desire to serve is reflective of many youth in our community and certainly goes against the stereotype of teens today. They demonstrate professionalism, dedication and service not only here at Lakes Region EMS, but in their schools and community. Exploring is part of a national program that allows youth to experience various career fields. The 16 members of the post are local students in ninth through twelfth grade. The Explorer Program focuses on five areas of youth development: Career Opportunities, Leadership Experience, Life Skills, Citizenship and Character Education. Explorers learn about all aspects of Lakes Region EMS operations. They all receive training in CPR and First Aid. Many have taken additional training to become state certified Emergency Medical Responders. Explorers have an opportunity to work a shift with the paramedics and EMTs of Lakes Region EMS to gain further experience and utilize the skills that they have learned. In 2012, the Explorers participated in the planning of a mock crash demonstration for North Branch High School. The demonstration is a full 10 lakes Region EMS 2012 Annual Report 11

7 simulation of a motor vehicle crash and shows the impact of impaired driving. The explorers participated in various roles, including victims and responders. Working with local law enforcement, fire/rescue, EMS, and a helicopter air ambulance, they were able to provide a realistic education experience for their peers at their school. Other activities included extrication training with the North Branch Fire Department, providing first aid coverage at the Hay Days snowmobile racing event, supporting the Pedal with Public Safety Day and 5K run, teaching at safety camp for third and fourth graders, Shop with a Cop, blood pressure screenings, and a number of parades and health fairs. Our explorers provided over 200 hours of community service in SWAT As we enter our sixth year working with the Chisago County SWAT team, our LREMS team of tactical medics and EMTs remain excited and committed to providing emergency medical EMS in unique and potentially high-risk environments.. Our tactical EMS members participate in rigorous ongoing training integrated with SWAT operators to ensure they are prepared to provide life-saving measures during any emergency they might face. This summer, two of our tactical medics were able to test their skills along with the Chisago County SWAT team at the 2012 Can-Am games, held in St. Cloud. This competition is only held every four years throughout North America. Our team was proud to represent Chisago County and were very pleased with a second place finish overall. Also this year, three EMTs were added to the tactical EMS team, bringing the total of EMS personnel up to six. Candidates were put through challenging physical testing, as well as a formal interview and medical scenario, and the final selection was made by the Chisago County Sheriff s Department and Lakes Region EMS. Adding this additional staff brings the tactical EMS squad up to full strength, assuring that the SWAT team will have medical support any time the need arises. Community Education Dedication to our communities is at the heart of our outreach and education programs. When faced with an emergency, having someone who knows what to do can make a significant difference in the outcome for the victim. Having a prepared and trained community provides everyone with a greater sense of confidence and reduces the time it takes to begin caring for those in need. From the bystander or family member to the 911 Emergency Dispatcher, through the local fire & rescue and law enforcement departments and the paramedics and EMTs of Lakes Region EMS, we provide a comprehensive community approach to serving our community. We are all neighbors, and neighbors take care of each other. Supporting our commitment to state-of-the-art patient care, we provide training across all levels that are based on the latest standard of care and research. This includes providing Hands Only CPR training to people throughout the community. Immediate high-quality CPR is the number one factor in surviving sudden cardiac arrest. Lakes Region EMS has committed to providing this training to everyone in our community free of charge. This initiative has led to partnering with local community and business groups to provide training to their members, customers and staff. Hundreds of people will receive training every year. These are the very people who may be the first to witness someone suffering a sudden cardiac arrest. Additional courses are offered throughout the year, including First Aid, CPR for Healthcare Providers, and Emergency Medical Responder and Emergency Medical Technician. Courses are offered at a low cost and with convenient and flexible scheduling, keeping with our dedication to provide outstanding customer service. In 2012, nearly 300 people received training through Lakes Region EMS. Lakes Region EMS provides annual training for 13 area law enforcement agencies and fire & rescue departments. These community-based departments respond to medical emergencies, providing immediate assessment and care. In addition to providing the initial certifications, Lakes Region EMS provides quarterly continuing education for these groups. In 2012, we provided over 100 hours of education at no cost to our partner agencies. Serving the professional Emergency Medical Services community, Lakes Region EMS partners with area Emergency Medical Services training programs to provide clinical internship opportunities to their students. This allows EMT and paramedic students to experience real-world patient encounters with an experienced provider prior to their graduation. Our high level of clinical practice using Critical Care paramedics and EMTs is a unique and valuable opportunity for these students. Financial health and Responsibility Grant for CPR Classes In 2012, Lake Region EMS was honored to be selected to receive a $10,000 grant from the MN Resuscitation Consortium. The purpose of the grant is to support projects that improve the outcome for victims of sudden cardiac arrest. The proposal from Lakes Region EMS was created by our supervisors, John Fox and Ken Larson. The vision was to use the funds to increase and improve our community CPR program. Although we have an active first responder program in our area, the geography and staffing of our mostly volunteer fire/rescue departments in our area increases the response times to many locations. As a result of these longer response times, CPR is often not being performed adequately, if at all, during the first crucial minutes of a cardiac arrest. Bystanders to these events have the potential to make all the difference, and proper CPR training is vital. Lakes Region EMS holds monthly hands-only CPR classes for anyone who wishes to learn, at no cost. Because Lakes Region EMS is a non-profit service, funded only by revenues received from the transporting of patients, and not supported by tax subsidies, it can make it difficult to fund these community programs. This grant will allow us to improve our current offerings by allowing us to purchase training aids that will be given to class participants. These training aids are ambulances made of a dense foam material. This foam is similar in resistance to the practice mannequin used in current classes. At the end of the course, students will be able to keep the ambulance and can use it for continued practice at home, as well as a reminder of what to do in an emergency. Lakes Region EMS is committed to our community CPR program, both to improve outcomes for victims and empower bystanders to make a difference in times of emergency. This grant will allow us to continue with our goal of increasing CPR awareness and providing high-quality education to members of our community. 12 lakes Region EMS 2012 Annual Report 13

8 Spotlight on Retiring Board Members Vice-Chairman Peter Overgaard and his wife Marianna Chairman Jonathan Dodge and his family In 2012, both our Chairman and Vice-Chairman retired from the Lakes Region EMS Board of directors. Chairman Jonathan Dodge and Vice- Chairman Dr. Peter Overgaard have been on the Lakes Region Board of Directors since its inception in 2000, and both have put in countless hours to transform our organization from a struggling ambulance service that lacked direction to the strong, focused organization we have today. We would like to take a moment to thank them for their service, and reflect upon all of the hard work they have done over the years. Chairman Jonathan Dodge has always had a passion for public service. While working as a nurse at Children s Hospital, he was a volunteer EMT with Chisago Lakes Rescue for several years and also served as a fire fighter for Center City Fire. At the time Lakes Region EMS was created, several employees of Chisago Lakes Rescue contacted Jonathan and asked him to consider serving on the board. They had concerns about the direction of the new ambulance service and felt he could provide the strong leadership they were looking for. Jonathan thought long and hard about taking on the responsibility of board service, but ultimately felt that Lakes Region EMS was an important service in the community, and he wanted to be part of the journey. Dr. Peter Overgaard was also recruited for service by our employees. He had an incredible amount of leadership experience from serving on both the local school board and hospital board, and he has always been very vocal on the need to give back to the community. During his medical practice in Chisago Lakes Clinic, he was instrumental in the merger with Chisago Lakes Hospital and familiar with many of the issues in combining two organizations. Because Dr. Overgaard had recently retired from his medical practice, he felt that he would have the time and energy to put into building a quality ambulance service that served the community. When asked about the changes between Lakes Region EMS back in 2000 and the Lakes Region EMS of today, Chairman Dodge feels that our organization is completely different. He recalls that in 2000, employee morale was low and staff turnover was quite high due to the lack of mobility within the organization. Back at that time, there was no future in the organization beyond being an EMT or paramedic, said Chairman Dodge. I am proud that we have been able to involve our line employees in a variety of ways. We now have staff involved in education and outreach, and we created the Field Training Officer (FTO) positions. It is healthy for our staff to be able to develop their interests beyond the ambulance runs and contribute ideas and initiatives. Similarly, Dr. Overgaard recalls some early challenges faced by the Board. We didn t have near the quality of service that we have now. There were a few years where we lost money, and we had to increase our fees. Part of our financial success at this time is due to those increases, and they allowed us to buy good equipment. He also believes that our education has dramatically increased the level of care our clinicians are able to provide to the community. He recalls a time when EMS services basically consisted of volunteer ambulance drivers, and his goal was to be sure that as EMS evolved, his community was getting the best care possible. Because of Dr. Overgaard s vision, Lakes Region EMS was able to budget for and purchase equipment that other services often do not have in order to provide the most advanced care available to the community. As longtime residents in our service area, both Chairman Dodge and Dr. Overgaard are proud of the accomplishments of Lakes Region EMS over the years, and our growth into a strong organization with clearly outlined values. Their leadership and experience helped to shape our service, and both always kept in mind the needs of the communities we serve. We would like to thank Chairman Jonathan Dodge and Dr. Peter Overgaard for their years of dedicated service and for being part of the Lakes Region EMS family. 14 lakes Region EMS 2012 Annual Report 15

9 Lakes Region EMS Then and Now Pre-hospital EMS in Chisago County started very similar to surrounding areas. In the early 1970 s, after the local Funeral Homes were looking to get out of patient transport, a group of dedicated local volunteers, stepped up to fill the needs of their communities and start the first EMS service to provide services to the surrounding communities. Chisago Lakes Rescue, North Branch Area Rescue Squad and Rush City Ambulance were the three communities that began building local EMS as we know it today. Through hours of hard work and dedication, these individuals took on the responsibility of raising money to purchase transport vehicles and train staff to provide immediate care to those who were sick or injured. Often times, a simple first aid class was all that separated these volunteers and the local community members. Notification happened using home phones and a unique collaboration between the local hospitals, police departments and EMS providers. Over the years, the equipment became more advanced, the vehicles grew larger and the training became more developed and collaborative. Communication technology advanced and allowed for faster and more reliable dispatch of the units and common communication amongst all the public safety agencies. From the early days of only around 100 calls a year, the volume and need for EMS began to grow. Each of these services continued to grow and thrive with the addition of more volunteers, additional education and better technology. Eventually, the challenge of increasing call volume and the additional demand on the volunteer professionals, new ideas around collaboration began to take shape. In 1997, North Branch Area Rescue and Chisago Lakes Rescue, the two larger of the three services, came together to merge staff, equipment and resources. A short time later, Rush City Ambulance decided to join the consolidation to create a more efficient and effective EMS service. Three ambulances began working together through common leadership and training standards to better serve the area residents. In 2001, these three services officially combined to create a new organization, Lakes Region EMS. This consolidation created a unified service area of over 450 square miles, and serving over 50,000 residents. Daily operations include three critical care ambulances staffed 24 hours a day from three stations throughout the county. Lakes Region EMS was created as a not-forprofit 501C3, and is governed by a board of directors made up of community members that have a passion for EMS. The board meets regularly throughout the year, and focuses on how Lakes Region EMS can best meet the expectations of our communities. Over the past several years, the concept that helped build the first services still remains today. Highly dedicated individuals and community members are still the core of the continued growth and advancement of the organization. Continued support from our communities, public service agencies and local business continues to help us fulfill our goals to provide the highest level of pre-hospital care available to our communities and other customers. In 2004, a new leadership structure was put into place as the organization continued to grow. New positions and responsibilities were created to help guide and direct the vision through new areas of opportunity. Also at that time, the organization adopted our Four Pillars Philosophy: State-of-the-Art Patient Care, Outstanding Customer Service, Dedication to the Communities We Serve, and Financial Health and Responsibility. This philosophy sums up the core values of our organization and directs all of our decisions, from day-to-day operations to long-term strategic planning. In recent years, we have begun to evolve and expand the way that we practice our Four Pillars. Initially, this philosophy was used to push our organization toward becoming a premier ambulance service, providing the most advanced and compassionate care available to our residents. More recently, we have begun to realize that there are many more services and benefits we can provide beyond simply going out on ambulance runs. Statistics show that only 10% of residents will ever need to call 911 for assistance. However, with over 50,000 residents in our service area, we have 16 lakes Region EMS 2012 Annual Report 17

10 become committed to finding ways to meet the needs of the other 90% of citizens. Our goal is for every member of our community to feel a sense of ownership in our organization and an interest in our long-term success. The dedication of our staff has been instrumental in the success of the organization. Our employees are encouraged to share their ideas and talents, and our staff is actively engaged in helping the organization fulfill its mission. We are proud of the ideas and investments the staff have provided to find unique and creative solutions to encourage the growth and success of the organization. From a clinical perspective, our clinicians are all paid professionals with extensive training. In addition to the certifications required by state and national registries, all of our staff is required to complete additional classes and training through our education program. The Lakes Region EMS education program is comprehensive, beginning with initial training that introduces employees to the high standards of our organization and continuing through advanced critical care classes. The education program has been highly refined over the years and prepares our staff for the long interfacility transports of critically ill patients that are common in this area. In addition to our critical care education for paramedics, Lakes Region EMS is unique in that we have also created a critical care curriculum for EMTs, which is a first in EMS. In 2012, we received requests from established colleges to adapt our critical care classes to the college setting so that this curriculum could be taught to other paramedics and EMTs in Minnesota. We have also implemented a robust quality assurance program. Our Quality Coordinator, Ken Larson, reviews every ambulance call and provides feedback to the clinicians on their performance. He also compiles a variety of statistics and benchmarks into a report that is presented quarterly to our Board of Directors. This report is used to identify both our strengths and areas in which we can improve. In this way, we are able to use our quality information to adapt our training and internal education to directly reflect the needs of our community. By building a strong quality program, we have been able to educate our staff to levels not found at other services. As Lakes Region EMS has grown, we have realized that the role of EMS is changing. Simply responding to emergencies is no longer enough; we need to find ways to benefit all of our residents, not just the ones who call 911. Lakes Region EMS takes great pride in serving the citizens of our local communities. One way we have worked to meet this goal is by becoming involved in a number of local causes and events. Many of our staff live within our service area, and they have been enthusiastic about our increased community involvement, volunteering their time and ideas. Several of our employees participated in the Pedal with Public Safety event, helping with the event organization, or running the 5K and biking in the community bike ride. We have employees that have not only done the legwork with MnDOT to get a two-mile stretch of I-35 as part of the Adopt-a-Highway program, but also volunteer their time to go out and pick up trash. Also popular is the Shop with a Cop event, which pairs children in need with local police, fire and EMS personnel to shop for school supplies. Everyone in our organization has enjoyed the involvement with local causes, and the opportunity to make a positive impact in our community. We have worked to bolster our educational offerings. Our community education program provides a monthly hands-only CPR class that is free to the public. A recent grant that we received from the MN Resuscitation Consortium will allow us to expand and improve this program beyond its current levels. Sudden cardiac arrest is the largest natural cause of death in the United States, and our goal is to use our improved CPR program to empower our residents to make a difference in a cardiac emergency. We are also able to provide additional CPR and First Aid certification for scout leaders, daycare providers, and anyone else who requires certification, and we are happy to customize classes to fit the needs of specific groups. We also provide education to local students and scout groups, giving dozens of tours and talks each year. At both North Branch and Chisago Lakes High Schools, Lakes Region EMS organizes a mock crash demonstration to take place just before prom, which highlights the dangers of impaired driving. Students participate throughout the event as actors who are injured, killed or arrested for impaired driving. Lakes Region EMS provides the staffing, ambulances and supervisors for this event and coordinates the participation of North Memorial Air Care and Life Link III. We also provide EMS education to students who join our Explorers group. These students are given an opportunity to investigate a career in EMS and are offered our classes to become certified First Responders. Then the group is encouraged to find ways to use their newfound skills to benefit the community. The Explorers have volunteered their time at health fairs, safety camps and parades, and it has been a terrific way to help them learn autonomy, confidence and leadership. Whenever possible, Lakes Region EMS believes in supporting the area economy by spending its money locally. All of our ambulance maintenance is now done by North Branch Chevrolet. Many of the supplies for our bases are also purchased from local shops and hardware stores. On a yearly basis, Lakes Region EMS spends over $500,000 dollars at community businesses. Lakes Region EMS is committed to finding our place as a successful, fully-integrated part of our community, benefiting every resident in our service area. We welcome ideas on additional ways we can help meet the needs of the community and encourage feedback on our performance. We want everyone in our service area to feel a sense of ownership in our organization and its future. Currently, many small ambulance services are struggling or closing their doors because of declining reimbursements and dramatic increases in costs. Because we are funded only by the revenues we receive, our financial health is directly tied to our runs. Every year, we strive to find creative ways to do more with less. There may come a time when we look to our community for support. That support may come in a variety of forms, whether it is through the time, talent or financial support of our community members. It can be a challenge to grow and sustain an ambulance service in these difficult times, especially while maintaining incredibly high standards of care, but we believe our community deserves the best that we are able to give them. Throughout all of the growth and expansion of Lakes Region EMS over the past 10 years, the core dedication that helped build the earliest EMS systems remained consistent throughout all of the changes. As a result, it has allowed for a very powerful momentum from the staff and leadership to continue to set the course to meet the demands of the vision and the communities. Lakes Region EMS works hard at selfimprovement and a desire to continue to grow and learn. With the support and commitment of our community, we believe our success is guaranteed. 18 lakes Region EMS 2012 Annual Report 19

11 Outgoing Distribution of Funds 52.1% Salaries and Wages 12.5% Payroll Taxes and Benefits 6.2% Vehicles 29.2% Other 2012 Finances Payors 2012 was a strong year for Lakes Region EMS financially. These positive results were driven in part by the higher patient volumes across the whole organization. An essential part of maintaining and growing the services we provide is the focus on the quality and the efficient manner in which we provide the services. An additional focus is on the expense side, where we will continue to review the effectiveness of our expenditures and allow for more investment in capital equipment, training and retention of highly qualified staff, while at the same time keeping up on technology. In recognizing our local businesses, we purchased services and supplies from local vendors in excess of $350, Year Transport Comparison Transfer Total Calls 2, ,203 2, ,106 2, ,082 2, ,906 2, , Revenue 21.8% Medicare & Managed Care 8.6% Cash 52.2% Insurance Primary 2.8% Insurance Secondary 7.5% MA & Managed Care 7.1% Other Year Ended December 31, 2012 (Unaudited) 57.3% % Transfer 13.6% Other Costs in excess of Medicaid payments $1,193,162 Community services $3,500 Education and work force development $50,943 Research $9,415 Cash and in-kind donations $3,364 Total cost of community benefits $1,260,384 Costs in excess of Medicare payments $2,993,620 Other care provided without compensation (bad debt) $390,704 Discounts offered to uninsured patients $94,738 Total Value of community contributions $4,739, lakes Region EMS 2012 Annual Report 21

12 Call Volume by Day of Week Ambulance Run DATA Call Volume by Hour of Day Times of Calls Time Period S M T W T F S Total Percent % % % % % % % % % % % % Unknown % total % 22 lakes Region EMS 2012 Annual Report 23