2,305 square miles 4,005,526 residents 58 district cities and unincorporated areas 8081 fire incidents 277,122 EMS calls 22 battalions 171 fire
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2 2,305 square miles 4,005,526 residents 58 district cities and unincorporated areas 8081 fire incidents 277,122 EMS calls 22 battalions 171 fire stations
3 67 Paramedic Squads 5 Paramedic Engines 4 Lifeguard Units (2 Boats, 2 Squads) 3 Air Squad Units 3 Medic Ambulances 4,663 total personnel 1,614 Emergency Medical Technicians (EMT) 1,274 Paramedics: 764 in a post-position
4 Engine Strike Team - PM USAR Task Force PM USAR CATF 2 - PM
5 1969: Dr. Walter Graf, Daniel Freeman Hospital, two paramedics, and the heart car July 14, 1970: Wedsworth Townsend Paramedic Act January 15, 1972: Emergency airs on TV James O. Page i.e., Johnny Gage Fire Station 127, Squad : LA County BOS adopts the ALS staffing policy with two paramedics
6 Los Angeles County Fire Department EMS is committed to providing prompt, clinically skilled, and caring medical service to ensure positive outcomes for everyone, every time
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9 Engine: Captain, FFS, FF, FFPM Squad: 2 FFPM Paramedic Engine: Captain, FFS, 2 PMs PAU: Captain, FFS, FF, FFPM
10 2 Accredited paramedics 6 months of training/1090 hours Radio person Patient person Does not transport ALS and BLS equipment
11 7 Exclusive Operating Areas (EOA) 4 Contracted Ambulance Companies BLS vs ALS Reimbursement Ambulance Company Bills ALS Pass-Through Fee
12 Standards of coverage Contract cities Wall time Burn-out Recruitment Retention
13 epcr elearning SIM-LAB
14 Regional EMS Captains Loop Closure Peer-to-Peer Training PMAC DHS AUDIT
15 Captains Academy ESU / Rehab Expansion PM Reactivation PM Enrichment
16 Tiered Dispatch Call type algorithm Sick A and B Injury A and B Retrospective review Interrogation process No response change
17 elearning Database Instructor-Based CE Tracking / Recertification Reimbursement (JAC) College of the Canyons
18 Electronic Patient Care Record (epcr) Grant Funding ($1.8 million) Contract Finalization (Sansio) Proposed Roll Out (Late 2015)
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20 Battalion Chief Kevin Klar (323) Captain Dave Gillotte (310)
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22 City of Miami Fire-Rescue Response Model Presented By Christian F. Guzman, Captain Jose L. Siut, EMS Instructor "Excellence through Service"
23 Delivering Extraordinary Service Objectives Overview City of Miami Department of Fire-Rescue Response Plan Historical Perspective Current Practice Benefits Obstacles Strategic Plan Future "Excellence through Service" 2
24 Delivering Extraordinary Service CITY OF MIAMI "Excellence through Service" 3
25 Delivering Extraordinary Service Response Area 35.6 Sq. Miles miles of coastal waterways Population approximately 500,000 Over 1 million during business hours Major areas Industrial, residential, commercial, tourism Our City "Excellence through Service" 4
26 Delivering Extraordinary Service DEPARTMENT OF FIRE-RESCUE "Excellence through Service" 5
27 Delivering Extraordinary Service Brief History Established in 1898 Pioneers in the 60s Team of Paramedics Telemetry/Two-Way-Radio Defibrillation "Excellence through Service" 6
28 Delivering Extraordinary Service Department of Fire-Rescue 723 sworn members (EMT-Ps); 34 (EMT-Bs) Daily manning (3 response districts) 200 personnel per shift (minimum 150 on duty) 15 Fire Stations 12 multi-company, 2 single Company Marine Housing Unit 48 Staffed Apparatus 3 Senior Aerials, 3 Quints, 11 Engines, 3 District Chiefs (BLS) 24 ALS Rescues, 1 Rescue Battalion Captain 3 Special Operation Units, Air Truck Operating budget 14 Million in 2014 "Excellence through Service" 7
29 Delivering Extraordinary Service Department Organizational Chart Fire Chief Director Deputy Chief of Operations Deputy Chief of Administration Asst. Chief Fire Marshall Asst. Chief Emergency Response Division Asst. Chief of Training Asst. Chief of Communicati ons Asst. Chief of Management Services Asst. Chief of Emergency Management Asst. Chief of Technical Services Asst. Chief of Logistics Asst. Chief EMS Support Division "Excellence through Service" 8
30 Delivering Extraordinary Service EMS Support Division "Excellence through Service" 9
31 Delivering Extraordinary Service Department of Fire-Rescue Response Statistics Total Alarms 89,778 Fire related 7,138 EMS Related 77,811 Ambulance 1,224 Responses 2014 EMS FIRE Ambulance "Excellence through Service" 10
32 Delivering Extraordinary Service RESPONSE PLAN "Excellence through Service" 11
33 Delivering Extraordinary Service Historical Perspective Pre Largely Fire Based Response Plan Mostly BLS Fire Apparatus ; Few ALS Transport Rescues Use of Private Ambulance all transports Post-1995 Changes Suppression units reduced; Increased ALS Transport units; 2-man BLS Squads introduced No more use of Private Ambulance All 2-man Squads converted to 3-Man ALS Transport Units Financial landscape Continued Increase in EMS calls; Decrease in fire calls "Excellence through Service" 12
34 Delivering Extraordinary Service Response Plan GOAL? Meet the response needs of the community Provide efficient Service Increase Revenues "Excellence through Service" 13
35 Delivering Extraordinary Service Needs Assessment Response Plan Collaborate with City officials Re-allocation of resources Personnel Procured additional Equipment Continuous Review Needs Assessment Need for Cross Training Fire/EMS Need for additional EMS resources Maintaining fire capabilities "Excellence through Service" 14
36 Delivering Extraordinary Service Response Plan How do we provide EMS today Dispatch (MPDS) Medical Priority Dispatch System Quality Assurance Staffing 15 stations 2 Stations single ALS Rescue Company 2 Stations 1 ALS Rescue and 1 ALS Suppression All others: 2 ALS Units and 1 BLS Suppression Unit 24hr shifts; 12 hr rotation between ALS units "Excellence through Service" 15
37 Delivering Extraordinary Service Response Plan Alarm Response ALS Rescues 3 man crew with a minimum 2 EMT-P; on all EMS and fire alarms BLS Suppression: 4 man crew with a minimum 1 EMT-P Single Company A/B MVA; Assist Citizen responses. Multi-company if closest ALS unit is > 12 min or if responding to Highway incident With ALS unit and EMS Batt Capt for Cardiac Arrest Anytime ALS units request for manpower. "Excellence through Service" 16
38 Delivering Extraordinary Service Response Plan Private ambulance Dispatched on low priority responses Directly dispatched by the Department Dynamic response Other EMS Services Provided SWAT Medics 15 Paramedics/Reserve officers Special Events Sporting Events Mass gatherings 364 events 1,234 Alarms "Excellence through Service" 17
39 Delivering Extraordinary Service Benefits of a Fire Rescue Dept Collaborative work environment Effective communications Increased assembly of manpower to fires and other emergencies More effective response (rescue units have firefighting equipment) Improved efficiency- One all hazards response organization Better use of resources "Excellence through Service" 18
40 Delivering Extraordinary Service Obstacles Initial Dept Morale- Change is usually received with pessimism at its inception Cross training Riding assignment policy "Excellence through Service" 19
41 Delivering Extraordinary Service STRATEGIC PLAN "Excellence through Service" 20
42 Delivering Extraordinary Service Our Future ALS certify all Suppression Units Rate of 5 per year Determined need for increase in ALS manpower Implement more training Addition of 26 Firefighter/Paramedics to staffing Determined need for increase in fleet Add 2 additional ALS Rescue trucks Strategically plan for additional growth "Excellence through Service" 21
43 Delivering Extraordinary Service Our Future Working with planning Dept to address future needs and growth Working on a Public/Private venture with developers of large projects to build stations within those structures Official City Bird: Tower Crane Facilitates rapid and easily accessible EMS response to area Facilitates additional stations to ease response loads of surrounding stations as well as improve response times in the area "Excellence through Service" 22
44 Delivering Extraordinary Service Conclusion The City of Miami Fire-Rescue Department response model currently in use has been effective and provides for a timely response and Excellence through Service to the citizens of Miami. "Excellence through Service" 23
45 Delivering Extraordinary Service Contact Information Christian F. Guzman, Captain Deputy, EMS Support Division FF. Jose L. Siut, NREMT-P EMS Instructor "Excellence through Service" 24
46 Delivering Extraordinary Service Thank You!!!! "Excellence through Service" 25
47 Fire-Based EMS
48 Fire Service / EMS History Way back when Fire Department Primary Focus on Fire Suppression EMS Secondary or Non-existent EMS Delivery Community-based EMS Only Hospital-based Emergency Medical Response Third Party Service (Private Transport)
49 Fire Service / EMS History Today s Fire Service Fire-based system using personnel not crosstrained in suppression and EMS Fire-based system using cross-trained multi-role firefighters Cross trained firefighters with third service provider for transportation support.
50 Fairfax County FRD At-a-glance 38 Fire and Rescue Stations serving: 400 square miles 1.2 million residents Staffed Frontline Apparatus: 38 Engine Companies 42 Paramedic Units 14 Truck Companies 8 Heavy Rescue Companies 2 HazMat Response Units 7 Battalion Chiefs 7 EMS Supervisors 3 Safety Officers
51 Fairfax County EMS Snapshot 1912 First County Fire Department 1932 McLean purchased the first ambulance 1949 First 10 career firefighters hired 1976 EMS plan for ALS personnel with 30 CCT s trained 1978 Medic 1 and Medic 9 placed in service 1994 Paramedic Engine Companies introduced ambulances minimally-staffed ALS Truck and 2 Rescue Companies ALS staffed 2016 All staffed FRD apparatus staffed ALS
52 Current Fire-Based EMS Delivery Model All operational personnel staffed to a minimum of Firefighter II and EMT/B or EMT/P 38 Four-person Engines minimally staffed with 1 ALS firefighter 42 Two-person ambulances staffed with 1 ALS & 1 BLS firefighter 14 Truck companies 8 Four-person companies minimally staffed with 1 ALS Firefighter 6 Three-person companies optionally staffed with 1 ALS Firefighter 8 Heavy Rescue Companies 2 Four-person companies minimally staffed with 1 ALS Firefighter 6 Four-person companies optionally staffed with 1 ALS Firefighter
53 Future Fire-Based EMS Delivery Model Consideration for additional minimally staffed units to meet the service needs of the county with a minimum of: 38 - Four-person ALS engine companies staffed with 1 ALS Firefighter 42 - Two-person ambulances staffed with 1 ALS & 1 BLS firefighter 14 - Four-person ALS Truck companies staffed with 1 ALS Firefighter 8 - Four-person ALS Rescue companies staffed with 1 ALS Firefighter Implementation of: Mobile Integrated Healthcare Community Paramedicine Program
54 Keys to Fire-Based EMS Success A defined Strategic Plan Community Assessment Community Outreach System Wide Understanding Operational Structure Training Hospital Coordination OMD Support Quality Management Protocols Culture Mutual Aide Data Analysis
55 Community Outreach "Prevent the 911 call" SIOC WIOC Hands-only CPR Heart Safe Community Wellness checks Most Loyal Customers
56 FRD Partners Fairfax County Agencies Health Department Community Services Board Law enforcement COG Regional Partners NOVA Regional Partners Health Care Systems & Facilities INOVA, Kaiser. Other regional facilities
57 Situational Awareness, Analysis, and Planning. Fire Based EMS Service Delivery in 2020
58 Affordable Care Act (ACA) Considerations Reducing Hospital Readmissions Reduction of hospital visits, treatment, care and stays. Impact on Fire-Based EMS?
59 Random Thoughts & Considerations What can Fire-Based EMS offer? Fire Based EMS Systems have the capacity to provide great support to MIHC programs staffing care, treatment and transport capability
60 Considerations What is permissible prior to the 911 call? Medical diversion? Alternative transports? State and local codes and regulations VAOEMS regulations and home health care practice.
61 Potential Fiscal Impact Revenue Medicare Medicaid Treatment versus transport
62 Summary Sustain relationship with health care system. Ongoing research and planning. Identify the need or gaps in service Build and maintain partnerships. Questions?
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