EMERGENCY SERVICES COMMITTEE

Notice of Public Meeting Thursday, December 13, 2012 EMERGENCY SERVICES COMMITTEE Door County Government Center Chambers Room, 1st floor 421 Nebraska Street Sturgeon Bay, WI 1 of 35 Oversight for Door County Emergency Services & Emergency Management AGENDA I. Call Meeting to Order at 10:00 a.m. II. Establish a Quorum - Roll Call III. Adopt Agenda / Properly Noticed IV. Approve Minutes: November 8, 2012 V. Communications VI. Public Comment VII. Old Business Christensen Leave Truck Update Mutual Aid Agreements Narrow Banding Billing Procedures Quarterly Budget Update Power Point Presentation VIII. New Business (Review/Action) State Operational Plan Operational Planning Group Operations Manager Position Image Trend Software IX. EM/EPCRA (Emergency Management/Emergency Planning and Right to Know Act) Emergency Management Update Grant Application with Hospital for Exercise - 2013/2014 X. Matters to be Placed on a Future Agenda XI. Monthly Reports XII. Vouchers, Claims and Bills XIII. Next Meeting Date: January 10, 2013 XIV. Adjourn Deviation from the order shown may occur. In compliance with the Americans with Disabilities Act, any person needing assistance to participate in this meeting, should contact the Office of the County Clerk at (920)746 2200. Notification 48 hours prior to a meeting will enable the County to make reasonable arrangements to ensure accessibility to that meeting. Posted December 6, 2012 L. Hasenjager

2 of 35 MINUTES EMERGENCY SERVICES COMMITTEE Chambers Room, 1st Floor November 8, 2012 These Minutes have not been reviewed by the oversight committee and are subject to approval or revision at the next regular committee meeting. I. Meeting was called to order at 1:00 p.m. by Chairman Dale Wiegand. II. III. IV. Establish a Quorum Committee members present: Dale Wiegand, Charles Brann, Joel Gunnlaugsson, and Tim O Connor. Richard Haines, excused. Others present: County Administrator, Maureen Murphy, Finance Director, Shirley Scalish, Ashley Bittorf, Ann DeMeuse, Brian Geibel, Steve Haberli, Laurie Hasenjager, Chris Hecht, Chris Jeanquart, Aaron LeClair, Tim Nowak, Bev Wautier, and public. Adopt Agenda/ Properly Noticed Motion by Brann, second by O Connor to adopt the agenda. Motion carried. Approve Minutes Motion by O Connor, second by Gunnlaugsson to approve the October 11, 2012 Minutes. Motion carried. V. Communications Wiegand informed the Committee that Director Eric Christensen is part of the National Integration Center, which is a branch of FEMA. He has been called to active duty to assist with Hurricane Sandy. He is temporarily stationed on the East Coast. Wiegand reported that the EMS Operations Manager position has been approved by County Board and will be advertised in the near future. Wiegand introduced the new County Administrator, Maureen Murphy. VI. VII. VIII. IX. Public Comment Tim Nowak briefly commented on the positive progress Emergency Services has made in the past months. Old Business Truck Update/Action Hecht spoke about the recent trip to Florida for the pre-inspection of the new trucks. After learning more details about the two truck styles, type one (1) pick up and type three (3) van, Christensen, Hecht and LeClair are requesting consideration to amend the signed contract. After much discussion, Motion by Gunnlaugsson, second by O Connor to amend the contract to upgrade the truck styles from type three (3) to type one (1) for an estimated savings of $2,000.00 per truck with additions and deletions, move the penalty clause back to May 15 th, 2013, from the approximate date of March 1 st, 2013, with a delivery date on or before May 15 th, 2013. Motion carried. Brann not in favor. Mutual Aid Agreements Wiegand stated that Christensen has several agreements ready for signature, and continues to work on the remaining agreements. EMS Patch Update LeClair introduced the new Emergency Services patch. Narrow Banding Hecht informed the committee that Door County will be Narrow Banded County-wide by the end of December, 2012. Vendors are waiting for frequencies to finish spreadsheets. Narrow Banding is required by January 1, 2013. New Business Billing Procedures Hasenjager gave a brief explanation of billing procedures. Christensen will bring recommended changes to next months meeting. EM/EPCRA (Emergency Management/ Emergency Planning and Right to Know Act) DeMeuse gave a report on the Household Hazardous Waste collection which was recently held. She briefly spoke on the 2012-2013 Plan of Work, and the strong winds that Door County recently experienced.

3 of 35 X. Matters to be Placed on a Future Agenda Update on Christensen s leave and associated pay, New trucks, Mutual Aid Agreements, Narrow Banding, Billing Procedures, Quarterly Budget, Power Point Presentation by Brandon Schopf. XI. XII. XIII. XIV. Monthly Reports No discussion. Vouchers, Claims and Bills Motion by Gunnlaugsson, second by Brann to approve vouchers in the amount of $15,622.17. Motion carried. Next Meeting Date: December 13, 2012 @ 10:00 a.m. Adjourn Motion by Gunnlaugsson, second by Brann to adjourn. Motion carried. Time: 1:53 p.m. Recorded by Laurie Hasenjager.

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13 of 35 Emergency Services of Door County 2013 EMS Operational Plan Emergency Services of Door County 319 South 18 th Street Sturgeon Bay, WI 54235

14 of 35 EMS Operational Plan Summary Prepared by Eric Christensen, Director Revised November/December 2012 PURPOSE: The purpose of Emergency Services of Door County is to provide prompt, professional pre-hospital emergency medical services and specialized rescue for the citizens and visitors of Door County. The core objectives are as follows: 1. To preserve life and reduce morbidity 2. To operate in the most efficient and effective service model to deliver that care. 3. To provide the most up-to-date and effective clinical medical care with known best practices. 4. Integrating, educating and contributing to the community in all preventive health and safety issues. 5. Partnering with when possible, and working in conjunction with key community health care systems to ensure all aspects of patient care can be met. 6. To protect patient confidentiality and act as a neutral advocate in patient care decisions. 7. To safely facilitate the continuity of patient care to the appropriate medical health facility.

15 of 35 Overview Emergency Services of Door County (EMSDC) functions at the Advanced Life Support Level and is certified by the State of Wisconsin Department of Health and Family Services to operate and provide patient care within the Paramedic scope of practice. All operations of EMSDC function under Administrative Rule Chapters HFS 110, HFS 111, HFS 112 and s. 146050 and 146.55 as well as Wis. Trans. 309. EMSDC is a 3 rd county municipal service operated by Door County. Funding is made of tax support by a tax levy basis as well as financed by user fees. EMSDC has an EMS oversight committee with the Director reporting to the County Administrator. Operationally EMSDC is divided into two (2) operational divisions: Emergency Management and Emergency Medical Services. Emergency Services of Door County averages 2,100 calls per year with support from local EMR groups and Fire Departments. EMSDC employs: 1 Full-time Director, 1 Full-time Operations Manager, 12 full time Paramedics, 1 full-time billing specialist, 1 part-time billing specialist, 6 part-time paramedics, 30 paid on-call EMT-B. EMSDC operates from 4 locations within the county including Washington Island. Two advanced life support (ALS) ambulances are staffed with full or parttime paramedics and are located in Sturgeon Bay and Sister Bay. A basic life support ambulance (BLS) is located in Brussels and is staffed by paid on-call EMT s. A BLS ambulance is also staffed with paid on-call EMT s on Washington Island. First out 911 calls from both Sturgeon Bay and Sister Bay respond with two paramedics. An ALS ambulance is also dispatched with the BLS ambulance with the Brussels station. All patient care guidelines fall within the approved State of Wisconsin Paramedic scope of practice and curriculum.

16 of 35 SERVICE INFORMATION Emergency Services of Door County State License Number # 60-00019 319 S. 18 th Ave Main Office FEIN # 39-6005686 Sturgeon Bay, Wisconsin 54235 CLIA # 52D0930744 Office - (920) 743-5461 DEA # BK7639896 Fax (920) 743-4917 Contacts: County Administrator Billing and Administrative Support Maureen Murphy Laurie Hasenjager and Sue Ploor 421 Nebraska Street 319 S. 18 th Ave Sturgeon Bay, WI 54235 Sturgeon Bay, WI 54235 Office (920) 746-2303 (920) 743-5461 Director Eric Christensen WI State License Number # 7009271 319 S. 18 th Ave Sturgeon Bay, Wisconsin 54235 Office - (920) 743-5461 Fax (920) 743-4917 Medical Direction WI State License Number # 22014-020 Dr. Eugene Kastenson, MD 319 S. 18 th Ave Sturgeon Bay, Wisconsin 54235 Office - (920) 743-5461 Fax (920) 743-4917 Insurance Information: Wisconsin County Mutual Insurance Corporation Policy Number# 11505 22 E. Mifflin Street Suite 900 Madison, WI 53703

17 of 35 Service Area See Attachment for Detailed Map Type of Service Provided 911 Response TEMS Special Events Level of Service Advance Live Support - Paramedic EMT- Intermediate Technician EMT Intermediate EMT- Basic EMR

18 of 35 ANNUAL RESPONSES The following are the total annual response for EMSDC since 2002: Year: 2002 2003 2004 2005 2006 2007 2008 2009 2010 2111 Total: 1950 1999 2009 2090 1981 2000 2143 2068 2166 2101 These include all medical, rescue and standbys for either fire operations or mutual aid request. EMSDC has seen an increase of 10 % from 2002 to 2012 in total EMS run volume. These numbers do not reflect other calls of service which include community standbys for public events, and other public education programs. The northern part of the county has seen the biggest annual increase of volume on average each year at approximately 5% increase. GEOGRAPY/DEMOGRAPHICS: Door County is a Wisconsin County in Northeast Wisconsin made up of 19 municipalities (14 towns, 4 villages, and 1 city). The County is bordered to the west, north and east by the waters of Green Bay and Lake Michigan, and to the south by the towns of Red River, Lincoln and Ahnepee in the County of Kewaunee. The county is 492 square miles making one of the largest counties in the state and according to census there are 57 people per square mile. Washington Island is also part of Door County, has a year round population of about 800 residents with about 2500 summertime residents. There is also several other islands surrounding the peninsula where visitors and campers frequent. Additional Community Impacts Door County has over 300 miles of shoreline, five state parks, and nineteen county parks. 3 Licensed Nursing Homes with over 200 beds combined 7 CBRF Facilities with over 130 residents Over 60 scheduled weekend events such as festivals, marathons and other weekend events through-out the County drawing hundreds of thousands of participants and visitors. 2,173 employers with 17, 811 employees of which over 1,000 commute into Door County. Four-lane highway now enters the county with double digit growth seen in two southern townships.

19 of 35 Service Demographics Door County has a year round population of 27,785 (2010 census), this population swells to approximately 250,000 between Memorial Day and Labor Day. Door County has over a million visitors through-out the year. The following is percentage of growth for areas covered by EMSDC from 2000 and 2010: Municipality 2010 Census 2000 Census % Change Baileys Harbor 1022 1,003 2% Brussels 1,136 1,112 2% Clay Banks 382 410-7% Egg Harbor (Town) 1,342 1,194 12% Egg Harbor (Village) 201 250-20% Ephraim 288 353-18% Forestville (Town) 1,096 1,086 1% Forestville (Village) 430 429 0% Gardner 1,194 1,197 0% Gibraltar 1,021 1,063-4%

20 of 35 Jacksonport 705 738-4% Liberty Grove 1,734 1,858-7% Nasewaupee 2,061 1,873 10% Sevastopol 2,628 2,667-1% Sister Bay 879 886-1% Sturgeon Bay (Town) 818 865-5% Sturgeon Bay (City) 9,1744 9,437-3% Union 999 880 14% Washington Island 708 660 7% County Total 27,785 27,961-1%

21 of 35 Organizational Chart: Director Medical Billing Operations Manager Admin Support Staff ALS Division BLS Division Special Operations ERU Dive Public Education Station Locations Brussels - 9683 State Hwy 57, Brussels, WI 54204 Central - 319 South 18 th Ave, Sturgeon Bay, WI 54235 North - 2258 Mill Road, Sister Bay, WI 54234 Washington Island 1721 Airport Road. Wash. Island, WI 54246 EMS Operations With the exception of Washington Island, all first-out 911 calls will be made with two paramedics from either Sister Bay (North /Central County) or Sturgeon Bay (Central and South) stations. For all 911 calls in the south county, a BLS crew station in Brussels will dual respond with the Sturgeon Bay ALS unit. Backup calls will be answer with any combination of ALS/BLS combination when a second scheduled back-up is not on duty. During known peak hours and scheduled special events the following may occur in personnel and unit coverage.

22 of 35 ALS/BLS Combinations: Medic/EMT Split If the north or central stations decides to split the crews (MEDIC/EMT) then to meet state guidelines, 1 st out (680 north, or 650 central) should acknowledge as being en-route. 640 and 620 respectively should follow preferably in a non-emergent manner. 640/620 may cancel ONLY when the 1 st arriving truck makes scene and determines if 1 medic is sufficient to handle the call. *Split ALS/BLS Crews, including back-up calls will operate under the EMT-Intermediate Scope of Practice. See Medical Guidelines Dual/Tiered Response (Medic/Medic) with (EMT/EMT) back-up If the first arriving ALS ambulance (the one originally assigned to the incident) determines that a back-up BLS unit is capable of transporting, the transporting unit with the patient should mark en-route to the hospital with their call number designee for record tracking purposes. i.e. if 640 called to transport then reassign the call to 640 and keep 680 available. If a BLS back-up needs an ALS intercept while transporting they can advise dispatch to send the nearest available ALS unit to intercept. This includes 670 transporting to Green Bay should one be required. If 2 Paramedics are needed for transport and if available, EMR/FD personnel on scene should drive both to the hospital allowing a BLS unit to stay available. Chase Vehicle Operations (QRV) The QRV will respond to all 911 emergencies in conjunction with any combination of back up calls or where a medic/emt unit is en-route or EMT/EMT unit is en-route to a back-up, and any ALS intercepts requested by outside EMS agencies. The QRV will serve as Shift Lead during their assigned shifts and should be responsible for matters of response and staffing coordination during their assigned shift.

23 of 35 SPECIAL OPERATIONS All rescue personnel will hold a basic certification for each discipline of rescue they participate in. These basic certifications will meet all NFPA guidelines. If staffing levels allow, EMSDC will have a cleared paramedic accompany the rescue team to provide rehab and medical assistance for team members. Any ALS needed for EMSDC rescue members maybe initiated by the EMSDC paramedic and transportation provided by the EMS unit on standby. EMSDC Tactical Medic All EMSDC assigned Paramedics to the Door County Sheriffs Emergency Response Team will obtain a State of Wisconsin TEMS endorsement. All medics selected will respond with the ERU team and provide medical care under the established medical care guidelines. Each medic selected will train and operate with the sheriffs department when utilized. Medics selected will undergo additional tactical training prior to being cleared to operate. NIMS / INCIDENT COMMAND: EMSDC along with other public safety agencies will follow all National Incident Management System (NIMS) during Mass Casualty and multi-agency operations. Joint Incident Command maybe established by EMSDC along with any public safety agency such as fire which is maybe involved in the incident. Coordinators, when on scene may assume overall authority for scenes for EMS and Rescue operations and any member of EMSDC may take operations sector and/or IC in conjunction with other public safety agencies. Coordinators, when in the absence of the Director and Operations Supervisor do not have administration jurisdiction as implied by the SOG s and do have any disciplinary powers or duties that imply the same. SHIFT AND CREW CONFIGURATION: Full-time paramedics work 24 and 12 hour shifts are available for peak hours and special events. The primary ambulance in Sister Bay and Sturgeon Bay consists of two Paramedics. For back-ups, all calls, and MCI incidents (2) EMT-Basic and/or one (1) EMT-Paramedic may respond or be assigned a shift. In some cases, these positions may overlap. Members should be certified to drive or will achieve their EVOC certification as soon as possible. Upon occasions there may be only a released EMT and Paramedic available. Washington Island has a BLS crew of (2) EMT s and respond in conjunction with EMR s. ALS can be provided upon request with the Nurse Practitioners with an

24 of 35 agreement with Ministry North Shore Clinic. All ALS care under the NP will be at the EMSDC ALS level. Arraignments may be made to have the ALS crew from Sister Bay brought to the Island. Brussels Station is staffed with (2) EMT s and respond with ALS from Sturgeon Bay for calls in South County. Brussels may be called upon for back-up 911 calls anywhere in the County. Once an ALS assessment is made by the first-out ALS unit, the BLS crew may transport patients under the BLS scope of practice. FIRST RESPONDER (EMR) ORGANIZATIONS EMSDC is affiliated with and/or utilizes the following First Responder Organizations. EMSDC provides medical direction and oversight to the following: Sturgeon Bay Fire Department Operates under EMSDC BLS medical guidelines and QA/QI program. Contact: Kaitlin Montevideo Union Brussels EMR Operates under EMSDC EMR medical guidelines and QA/QI program. Contact: Bev Wautier Southern Door EMR Operates under EMSDC EMR medical guidelines and QA/QI program. Contact: Richard Olson Jacksonport EMR Operates under EMSDC EMR medical guidelines and QA/QI program. Contact: Aaron LeClair Baileys Harbor EMR Operates under EMSDC EMR medical guidelines and QA/QI program. Contact: Vicky Prust Egg Harbor EMR Operates under EMSDC EMR medical guidelines and QA/QI program. Contact: Dan Kiehnau Northern Door EMR Operates under EMSDC EMR medical guidelines and QA/QI program. Contact: Chris Hecht Washington Island EMR Operates under EMSDC EMR medical guidelines and QA/QI program. Contact: Linda Taylor

25 of 35 Gilbraltar EMR Operates under EMSDC EMR medical guidelines and QA/QI program. Contact: Jayson Merkel Sevastopol EMR Operates under EMSDC EMR medical guidelines and QA/QI program. Contact: Justin McDonald Gardner EMR Operates under EMSDC EMR medical guidelines and QA/QI program. Contact: Andy Rutz Incident Response Goals Based on national response guidelines and geographical response area, EMSDC has opted to utilize the following response guidelines and goals for medicals in each zone of its primary service area. The goal is to meet each criteria 90% of the time for EMSDC 1 st out 911 incident and 80% second out 911. Turn-out time (TOT) is the time from notification to being en-route. Response time (RT) is enroute to being on scene. Weather, traffic conditions and other factors will be considered when monitoring times. Times do not include any 1 st responders that may respond and are based solely on EMSDC ALS and EMS response. 1st Response Area TOT RT Southern Door 2 Minutes 6 Minutes City of Sturgeon Bay 2 Minutes 6 Minutes Central Door 2 Minutes 6 Minutes Village of Sister Bay 2 Minutes 6 Minutes Northern Door 2 Minutes 6 Minutes 1 st -Out ALS Ambulance Area TOT RT Southern Door 2 Minutes 10 Minutes 59 Seconds City of Sturgeon Bay 2 Minutes 8 Minutes 59 Seconds Central Door 2 Minutes 11 Minutes 59 Seconds Village of Sister Bay 2 Minutes 8 Minutes 59 Seconds Northern Door 2 Minutes 11 Minutes 59 Seconds The above mentioned times reflect those calls which are considered emergent in nature. Internal response guidelines dictate that some calls, primarily fire alarms and other incidents in which it is confirmed that no patients are present and/or a qualified party is on scene requesting a non-emergent response will be honored and applied.

26 of 35 Special Events Standby EMSDC can provide medical standby for events held within its primary service area. Coverage type can include an EMT-Basic to ALS coverage with an ambulance on site depending on the type, location and number of people expected for the event. All coverage will be with added personnel and not utilized with the primary crew. Some events can have on-site coverage with a nondedicated crew. Specialized rescue response and standby is permitted within all of EMSDC mutual-aid agreements. VEHICLES AND RESPONSE LEVEL: Depending on the type of incident and what assets might be needed, EMSDC may respond in one or more of the following vehicles. 650: Primary ALS ambulance primarily staffed by two Paramedics. 620: Back-up ALS ambulance requiring staffing by any combination of certified personnel response and patient transport. 680: Primary ALS ambulance primarily staffed by two Paramedics. 640: Back-up ALS ambulance requiring staffing by any combination of certified personnel response and patient transport. 610: ALS equipped SUV used for quick response, ALS intercepts and supervisory roles. 670: Brussels. BLS and/or Intermediate Life Support ambulance containing medical equipment for BLS and ALS intervention used for patient transport. 630: Washington Island. BLS and/or Intermediate Life Support ambulance containing medical equipment for BLS and ALS intervention used for patient transport. 660: Washington Island. BLS and/or Intermediate Life Support ambulance containing medical equipment for BLS and ALS intervention used for patient transport.

27 of 35 Controlled Substances See attachment All controlled substances are kept under lock and key and are tracked individually. Each ambulance, including the QRV s has a double locked box in which all controlled substances are stored. An inventory is kept for each and is counted at each shift. In addition, EMSDC keeps a locked safe for overflow and stores additional controlled substances and each are monitored at each shift and a flow and tracking sheet is kept for each individual unit. Each distribution of narcotics is recorded on the patient document and any wasting is witnessed by two members and signed and turned in. Each medic is assigned their personal key code with user ID and password to gain access to the narcotic box. A computerized tracking device can look up history of dates, times when the narcotic box was utilized. A spare entry key with a coded number system is also in each vehicle should a lock failure occur. Infection Control See attachment EMSDC has an infection control policy that is maintained by the operations manager. Training and updates are on an annual basis, plan updated in June which includes all required immunizations and records of such. The plan follows all Federal (29CFR1910.1030 and 29CFR1910.134) and state guidelines (Admin Code Comm30 and 32) Any exposures are administered at Hudson Hospital. All necessary paperwork, logs are kept at the ED at HMC then brought to EMSDC if an incident occurs. Each response vehicle has all necessary PPE equipment on board as well as needed forms. A copy of the plan is kept at the main station. Medical Direction All medical direction and medical care guidelines will be under the administration of Dr. Eugene Kastenson, MD. The Operational Medical Director will also ensure all competencies are met and will ensure continuing education, quality assurance and mandatory skills assessment and educational requirements. All Medical Patient Care Guidelines have standing orders with the exception of highlighted treatments. Medical Control Door County Ministry Health will serve as EMSDC medical control facility by providing on-site clinical and 24-7 medical control by Wisconsin Board Certified Physicians operating in the emergency department. All communications with DCMC are radio based with all State of Wisconsin frequencies between all EMSDC units, including portable radio transmission to DCMC Hospital Emergency Room. A back-up and alternate communications plan will be utilized with cellular phones.

28 of 35 EMSDC can also utilize Aurora Bay Care Medical Center in the event it transports patients to hospitals within the Green Bay metro area. This center is staffed 24-7 by Nationally Certified EMS personnel. Medical Care Guidelines See Attachment All medical care guidelines have been approved by the EMSDC Commission, EMS Director and the Operational Medical Director, and will serve as prehospital patient care guidelines and administrative procedures directly related to patient care. All medical care guidelines follow accepted DOT, AHA, including BLS, ACLS, BTLS and PALS. They are formulated to meet the specific and sometimes unique needs of the EMSDC. They were also incorporated to serve as a master plan for a standardized minimal level of patient care that can be delivered on a regular basis. All care is standing order with consultation for specific situations as outlined. Continuing Education All personnel, including affiliated First Responders will meet all continuing education requirements as required by the State of Wisconsin and National Registry of Emergency Medical Technicians on a bi-yearly basis. All requirements, including recertification classes will be provided by Northeast Wisconsin Technical College with certified instructors. In-house continuing education will be provided on a monthly and quarterly basis. All continuing education classes will be approved by the EMSDC Operational Medical Directors for such purposes. Communications -See attachment Per Wisconsin Administrative Code HFS 110.08 (2) (f and g), HFS 111.07 (2) (f and g), and HFS 112.07 (2) (f and g) all communication for EMSDC meets the State and Federal Standards set forth by the WI State EMS Communications plan. Each vehicle, including the water craft has a permanently mounted twoway radio and adequate portable two-way communication. In conjunction with the Door County Emergency Communication Center all elements outlined in the WI State Communications guidelines are met. Contact with the communications center and area hospitals can also be established by cellular phone and are also available in each vehicle. Interagency operability is also available within these radios. Frequencies and tones are available in all EMSDC vehicles and portables

29 of 35 Infection/Exposure Control Plan See attachment Emergency Services of Door County is committed to providing a safe and healthful work environment for our entire staff. In pursuit of this endeavor, the Following exposure control plan (ECP) is provided to eliminate or minimize occupational exposure to Bloodborne pathogens in accordance with OSHA standard 29 CFR 1910.1030, "Occupational Exposure to Bloodborne Pathogens." The ECP is a key document to assist our County in implementing and ensuring compliance with the standard, thereby protecting our employees. This ECP includes: Determination of employee exposure Implementation of various methods of exposure control, including: Universal precautions Engineering and work practice controls Personal protective equipment Housekeeping Hepatitis B vaccination Post-exposure evaluation and follow-up Communication of hazards to employees and training Recordkeeping Quality Assurance See attachment The EMSDC quality assurance (QA) program will continuously monitor all patient care issues, including patient satisfaction by run report audits, skill tracking and patient surveys. Any substandard event will be followed up in the appropriate manner by the Operational Medical Director. The QA program will be under the guidance of the Operational Medical Director, EMS Director and Operations Manager. The objectives of EMSDC QA/QI program are as follows: 1. To assure optimal pre-hospital care and optimal clinical performance of all personnel within EMSDC. 2. To develop, implement, and evaluate clinical indicators and standards that measure the delivery of EMSDC health care services. 3. To develop, implement, and evaluate QA activities according to purpose, goals and objectives of this plan, and revise as necessary. 4. To collect, review, and analyze data to identify both problems and opportunities for improved patient outcomes.

30 of 35 5. To collect effective systems for problem assessment, identification, selection, study, corrective action, monitoring, evaluation, and reassessment of EMSDC practices and pre-hospital healthcare delivery. 6. To promote individual professional accountability by providing an environment that facilitates participation in QA activities. 7. To develop effective verbal/written information systems to communicate QA activity outcomes to appropriate individuals and any committees formed. 8. To correlate the findings of QA activities with the content of EMSDC the continuing education program. 9. To coordinate and integrate all EMSDC operations to the EMSDC QA program. Door County Emergency Communication Center EMSDC is currently dispatched by the Door County Emergency Communication Center located in Sturgeon Bay. This county wide communication center dispatches all of the public safety agencies within Door County. EMSDC receives notification via a paging system then communicates via a two-way radio either by mobile or portable. The communications center has an enhanced 911 system and does not require their personnel to be medically trained either by in-house or by National Emergency Medical Dispatch requirements. Pre-arrival instructions are given and any further action is relayed to the responding EMS responders. During disaster and mass casualty incidents, EMSDC may request Door County Emergency Management. EMSDC has two-way communications on the 155.340 and 155.400 frequencies in all vehicles as well as portable radio back-up as well as cellular phone capabilities. MUTAL AID AGREEMENTS See attachment EMSDC has signed mutual aid agreements with area ambulance services located in Door, Kewaunee and Brown Counties. RTAC Affiliation EMSDC is affiliated with the Northeast Wisconsin Wisconsin Regional Trauma Advisory Council (NEWRTAC) and is an active member of the group. Training Center Affiliation Northeast Wisconsin Technical College will serve as EMSDC primary Training Center.

31 of 35 HOSPITAL DESTINATION EMSDC will generally transport patients to their choice of hospital. However, some patient conditions will dictate that a patient be transported to a hospital that can appropriately handle that patients given condition. Acceptable transport sites that patients can be transported to following a 911 activation are Door County Medical Center, and to hospitals the Green Bay area. All category I and II trauma patients should ultimately be transported to the nearest trauma center. Aurora Bay Care Hospital and St. Vincent s Hospital in Green Bay is the closest from EMSDC coverage area. There are cases when direct transport to Door County Ministry Health Emergency Department for ALS care, beyond the capabilities of EMSDC, is warranted. All Category I and II patients should be transported to DCMC for advanced care (such as airway stabilization) if unable to stabilize in the pre-hospital setting, or aero-medical transport cannot be utilized. St Vincent Regions Hospital operates a Level II Trauma Center. Such designation means that the emergency department is appropriately staffed and equipped to handle major trauma patients 24 hours per day. The medical center also operates specialty units for pediatric ICU (NOTE) - any major trauma with patients under the age of 5 must be transported here, cardiac, stroke, and numerous other specialty medical services. Aurora Bay Care Medical Center Aurora Medical Center operates a Level II Trauma Center. Such designation means that the emergency department is appropriately staffed and equipped to handle major trauma patients 24 hours per day. The medical center also operates specialty units for cardiac, stroke, and numerous other specialty medical services. AERO-MEDICAL TRANSPORT OPTIONS Eagle III - is a medical flight helicopter, located in Green Bay, is staffed with a Flight nurse and Paramedic Based on the severity of patient condition and prolonged extrication for MVAs, availability and weather will determine the utilization of this resource. Theda-Star - is a medical flight helicopter, located in Appleton and is staffed with a Flight nurse and Paramedic. Based on the severity of patient condition and prolonged extrication for MVAs, availability and weather will determine the utilization of this resource. Flight for Life - is a medical flight helicopter, located in Fon Du Lac. It is staffed with a Flight nurse and Paramedic Based on the severity of patient condition and prolonged extrication for MVAs, availability and weather will determine the utilization of this resource.

32 of 35 County of Door Emergency Services 319 S. 18 TH Avenue Sturgeon Bay, WI 54235 TO: FROM: CC: Emergency Services Director Laurie Hasenjager, Patient Account Specialist Shirley Scalish, Finance Director DATE: November 12, 2012 SUBJECT: October 2012 Financial Report Summary and Run Report Totals October Charges Billed: $104,584.74 Payments Receipted: $119,015.24 Required Adjustments: $37,213.33 Active Accounts: $379,966.17 Inactive Accounts: $175,420.95 Outstanding Accounts Receivable: $555,387.12 208 Run Reports for October 2012: North Station 65, Central Station 129, South Station 11, W.I. Station 3

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