An Analysis of Emergency Medical Services for the Rush Springs EMS in Grady County, Oklahoma

Transcription

1 An Analysis of Emergency Medical Services for the Rush Springs EMS in Grady County, Oklahoma Oklahoma Cooperative Extension Service Rural Development Oklahoma State University EMS Division Oklahoma State Department of Health December 2002

2 AE An Analysis of Emergency Medical Services for the Rush Springs EMS, in Grady County, Oklahoma Website: Kirk D. Christie - Assistant State Extension Specialist, OSU, Stillwater (405) ; Fax: (405) Cheryl F. St. Clair - Assistant State Extension Specialist, OSU, Stillwater (405) Gerald A. Doeksen - Extension Economist, OSU, Stillwater (405) Stan R. Ralstin, - District R. D. Specialist, District Extension Office, Enid (580) Ron G. Justice - Grady County Extension Director, Chickasha (405) Shawn R. Rogers - Director, EMS Division, OSHD, Oklahoma City (405) Jay C. Mitchell - Field Coordinator, OSHD, Oklahoma City (405) RURAL DEVELOPMENT COOPERATIVE EXTENSION SERVICE OKLAHOMA STATE UNIVERSITY December 2002

3 An Analysis of Emergency Medical Services for the Rush Springs EMS, Grady County, Oklahoma The Rush Springs community and surrounding area is serviced by the Rush Springs EMS. The EMS system is currently a volunteer system and is a 522 EMS District managed by a 522 Board. The system currently receives financial assistance from a 3 mill funding through the 522 District. The Rush Springs EMS also recently passed a vote for a 1% sales tax subsidy. In order to provide more timely and cost effective service to the Rush Springs EMS service area, an analysis of the Rush Springs EMS is being included in this report. The objectives of the study will include: 1) analysis of the 2001 EMS calls, 2) three different funding alternatives including total capital expenditures and annual capital and operating expenses, and 3) analysis of different revenue options. Through this analysis, the Cooperative Extension Service is not advocating any of the alternatives presented. This report is not in the form of a recommendation. This report is provided for informational purposes only. An Analysis of the Rush Springs EMS Calls for 2001 Data was provided by the Rush Springs EMS that is currently providing EMS services to Rush Springs and the surrounding area. EMS call data is for the 2001 year and is summarized in the next ten tables. The Rush Springs EMS responded to 276 EMS calls in 2001 (Table 1). An analysis of these run reports showed that the category of transported calls was the most frequent type of call with 145 calls (52.6%). A total of 34 calls (12.3%) refused treatment and transport. There were 1

4 Table 1 Rush Springs EMS EMS Calls for 2001 Type of EMS Calls Type of Call Number Percent of Calls of Calls Transports % Transfers % Cancelled Calls 8 2.9% Refused Treatment % Treated, No Transport Calls % False Calls 1 0.4% Treated, Transported by P.O.V % No Patient Found 2 0.7% Mutual Aid 2 0.7% Standby 0 0.0% Community Service % D.O.A % Total % 2

5 31 calls (11.2%) where the patients was treated but refused transport and 22 calls (8.0%) for patients transferred to another care facility. The Rush Springs EMS responded to 18 calls (6.5%) dedicated to community service. A total of 8 calls (2.9%) were cancelled en-route, another 7 calls (2.5%) the patients were found dead on arrival, and 6 calls (2.2%) the patients were treated but transported by privately owned vehicle (P.O.V.). There were 2 calls (0.7%) that the Rush EMS responded and provided mutual aid to another EMS and another 2 calls (0.7%) where no patients were found at the scene. There was one call (0.4%) recorded as a false call. Of the total 276 calls, only 167 calls actually resulted in a transport; this represents 60.5% of the total calls that resulted in actual transports. Table 2 shows the number of EMS calls by day of week and time of day for the Rush Springs EMS. Of the 276 total EMS calls, there were 132 EMS calls (47.8%) received between 8 a.m. and 4 p.m. and 57 calls (20.7%) between 4 p.m. and 8 p.m. There were 189 combined calls, representing 68.5% of total calls, received for the time period from 8 a.m. to 8 p.m. Also, 42 calls or 15.2% of the total calls were received between 8 p.m. and midnight and another 30 calls or 10.9% of the total calls between midnight and 8 a.m.. Therefore, a total of 72 calls or 26% of total calls were received between the hours of 8 p.m. and 8 a.m. Fifteen calls (5.4%) did not report time of day. Table 2 also shows that 47 calls (17.0%) were received on Fridays, another 45 calls (16.3%) on Wednesdays, and 44 calls (15.9%) on Thursdays. Another 40 calls (14.5%) were received on Tuesdays while Sundays reported 36 calls (13.0%). Also, Saturdays and Mondays recorded 32 calls (11.6%) each. Table 3 presents the emergency vs. non-emergency mode of the calls at both the initial response and at the scene. At the initial response to the call, 204 calls or 82.9% of the calls were 3

6 Table 2 Rush Springs EMS Calls for 2001 EMS Calls by Day of the Week and Time of Day Time of Day Midnight - 8:00 AM 4:00 PM 8:00 PM 7:59 AM 3:59 PM 7:59 PM 11:59 PM No Total Percent Day of Week Report Calls of Calls No Report % Sunday % Monday % Tuesday % Wednesday % Thursday % Friday % Saturday % Total % Percent of Calls 10.9% 47.8% 20.7% 15.2% 5.4% 100.0% 4

7 Table 3 Rush Springs EMS EMS Calls for 2001 Emergency vs. Non-Emergency EMS Calls, Initial Response Mode and From Scene Response Mode Initial From Scene Response Mode a Response Mode b Number Percent Number Percent Emergency % % Non-Emergency % % Totals* % % a "Initial" Response Mode reflects total calls minus community service calls (18), cancelled calls (8), and walk-ins (4). b "From Scene" Response mode reflects only transport calls (145) and transfer calls (22). 5

8 considered to be emergency calls. At the scene the response mode for emergency calls decreased to only 38 calls or 22.8% of the calls. Table 4 shows median elapsed response times (in minutes) for each point in the calls and a median response time and median total time per call. The median elapsed time for calls received en-route was 4 minutes, to the scene was 3 minutes, at the scene was 16 minutes, to the destination was 25 minutes, and at the destination was 76 minutes. The median elapsed response time per call was 10 minutes and the median total time per call was 117 minutes. Table 4 also shows the number of calls that reported times and the percent of those calls based on the total possible calls. Table 5 shows the call pick-up locations or patient origination locations as indicated on the reports received from the Rush Springs EMS. The majority of the EMS calls originated in the category of Cities/Towns with 87.6% or 242 calls recorded in those areas. The Rush Springs area had the largest number of calls with 227 calls or 82.2% of the total calls. The next largest category of call pick-up locations was Hospitals with 29 calls or 10.5% of the total calls. Of the 29 hospital call originations, a total of 24 calls (8.7%) were from the Grady Memorial Hospital located in Chickasha, Oklahoma. The category of Doctor s Offices had 4 calls (1.5%) and the category of Other Medical Facilities had 1 call (0.4%). In Table 6, the data are shown according to type of incident. The greatest number of calls was for medical/illness (130 calls, 58.9%). There were 32 calls (14.1%) for motor vehicle collision (MVC) and 12 calls (5.4%) for vehicle rollover. The incident of significant fall recorded 14 calls (6.4%), while other trauma received 9 calls (4.1%) and 8 calls (3.6%) were logged as fire/burn. The incident of assault had 7 calls (3.2%). There were 3 calls (1.4%) 6

9 Table 4 Rush Springs EMS EMS Calls for 2001 Response Times Median Response Time Elapsed Possible Percent of Response Mode Time Reported Number Reported (Minutes) Calls of Calls Calls Received Enroute % To Scene % At Scene % To Destination % At Destination % Median Response Time % Median Total Time Per Call % 7

10 Table 5 Rush Springs EMS EMS Calls for 2001 Call Origination Locations Locations Number No. of Calls Percent Percent of Calls by Category of Calls by Category Hospitals Chickasha - Grady Memorial Hospital % Duncan - Duncan Regional Hospital 2 0.7% Oklahoma City Area Hospitals 3 1.1% Subtotal % Doctor's Offices Chickasha, Grady County 1 0.4% Rush Springs, Grady County 3 1.1% Subtotal 4 1.5% Other Medical Facilities Cleo Craig Cancer Research Center, Lawton 1 0.4% Subtotal 1 0.4% Cities/Towns Cement, Caddo County 1 0.4% Chickasha, Grady County 1 0.4% Marlow, Stephens County 9 3.2% Ninnekah, Grady County 4 1.4% Rush Springs, Grady County % Subtotal % Total % 100.0% 8

11 Table 6 Rush Springs EMS Calls for 2001 Type of Incident Type of Call Number of Calls Percent of Calls Assault 7 3.2% All Terrain Vehicle (ATV) 2 0.9% Bicycle 3 1.4% Bite/Sting 0 0.0% Ejection 0 0.0% Electrical 0 0.0% Explosion 0 0.0% Fire/Burn 8 3.6% Motorcycle 1 0.5% Motor Vehicle Collision (MVC) % Vehicle Rollover % Pedestrian 1 0.5% Shooting 1 0.5% Stabbing 1 0.5% Near/Drown 0 0.0% Occupant (Death) 0 0.0% Significant Fall % Medical Illness % Other Trauma 9 4.1% Total % A total of 221 calls were reported out of a possible 225 calls. 9

12 involving a bicycle and two calls (0.9%) reported all terrain vehicle accidents. There was one call each (0.5%) for motorcycle, pedestrian, shooting, and stabbing. Table 7 illustrates the type of medical illnesses for the 130 medical illness calls. The medical condition of other had the most calls (30, 23.2%) and the second highest category was breathing difficulty with 29 calls (22.3%). There were 17 calls (13.1%) for chest pain, while another 7 calls (5.4%) were recorded as abdominal pain. Five calls (5.1%) were reported each for seizure, pain, and unconscious. The medical illnesses of cardiac symptoms and hypo/hyperglycemia recorded 4 calls (3.1%) each. There were 3 calls (2.3%) each for cerebral vascular accident (CVA), dizziness, hypo/hyperthermia, nausea/vomiting, and weakness. Obstetrical, poisoning/ingestion, and respiratory arrest each received 2 calls (1.5%), and behavioral, cardiac arrest, and paralysis each had 1 call (0.8%). Table 8 gives a summary of the reported medical conditions that may indicate a need for paramedic level service. A total of 63 calls of the 130 medical illness calls (Table 7) reported medical conditions that appear to fit this category; these calls represent 48.5% of the total calls reporting medical conditions. The medical conditions of breathing difficulty had the most calls (29, 46.1%). Chest pains received 17 calls (27.0%), with seizure recording 5 calls (7.9%), and cardiac symptoms along with hypo/hyperglycemia had 4 calls each (6.3%). The medical illness of cerebral vascular accident (CVA) received 3 calls (4.8%) and 1 call (1.6%) was recorded as cardiac arrest. Table 9 shows the destination location for the Rush Springs EMS calls. The category of hospitals received 145 calls (86.8%) of the 167 total transported calls. The Grady Memorial Hospital received the largest number of transports with 86 calls or 51.5% and the next largest number of transports went to the Duncan Regional Hospital with 47 transports (28.1%). The 10

13 Table 7 Rush Springs EMS Calls for 2001 Medical Illness Summary of EMS Calls Medical Condition Number Percent of Calls of Calls Abdominal Pain 7 5.4% Airway Obstruction 0 0.0% Allergic Reaction 0 0.0% Behavioral 1 0.8% Breathing Difficulty % Cardiac Arrest 1 0.8% Cardiac Symptoms 4 3.1% Chest Pain % Cerebral Vascular Accident (CVA) 3 2.3% Dehydration 0 0.0% Dizziness 3 2.3% Gynecological 0 0.0% Hypertension 0 0.0% Hypo/Hyperglycemia 4 3.1% Hypo/Hyperthermia 3 2.3% Nausea/Vomiting 3 2.3% Obstetrical 2 1.5% Pain 5 3.8% Paralysis 1 0.8% Poisoning/Ingestion 2 1.5% Respiratory Arrest 2 1.5% Seizure 5 3.8% Shock 0 0.0% Unconscious 5 3.8% Weakness 3 2.3% Other % Total % 11

14 Table 8 Rush Springs EMS Calls for 2001 Summary of Reported Medical Conditions that May Indicate Need for Paramedic Level Service Number of Percent of Paramedic Level Medical Condition Paramedic Paramedic Level Calls Level Calls Breathing Difficulty % Cardiac Arrest 1 1.6% Cardiac Symptoms 4 6.3% Chest Pain % Cerebral Vascular Accident (CVA) 3 4.8% Hypertension 0 0.0% Hypo/Hyperglycemia 4 6.3% Seizure 5 7.9% Shock 0 0.0% Total % Of the 130 medical illness calls, 63 calls (48.5%) indicated paramedic level service. 12

15 Table 9 Rush Springs EMS EMS Calls for 2001 Call Destination Locations Destination of Calls Number No. of Calls Percent Percent by of Calls by Category of Calls Category Hospitals Chickasha - Grady Memorial Hospital % Duncan - Duncan Regional Hospital % Lawton - Southwestern Medical Center 2 1.2% Norman - Norman Regional Hospital 1 0.6% Oklahoma City Area Hospitals 9 5.4% Subtotal % Retirement/Nursing Home, Assisted Living Chickasha - Chickasha Nursing Center 1 0.6% Chickasha - Shannon Springs Nursing Home 2 1.2% Chickasha - Sterling House 1 0.6% Mountain View - Mountain View Nursing Home 1 0.6% Subtotal 5 3.0% Doctor's Office Oklahoma City 1 0.6% Subtotal 1 0.6% Other Medical Lawton - Cleo Springs Cancer Research Center 1 0.6% Subtotal 1 0.6% Residences Chickasha, Grady County 1 0.6% Ninnekah, Grady County 1 0.6% Rush Springs, Grady County % Subtotal % Total % 100.0% 13

16 second largest destination category was residences with 15 calls (9.0%). Of those calls, 13 patients (7.8%) were transported to the Rush Springs area. The destination category of retirement/nursing home/assisted living facilities received 5 calls (3.0%). Table 10 illustrates the age and sex of patients for the Rush Springs EMS calls. The age category had the most calls with 47 patients or 19.6%. Of this age group, approximately 76.6% of the patients were male. The second most EMS calls were for the age categories of 19 and under and 80 and over with 38 calls each (15.8%). There were 84 patients (35.0%) in 2001 who were 65 years of age and older. Based on total patients, 50.8% were male and 48.4% were female. There was 1 call (0.4%) that did not record age or gender, 2 calls (0.8%) that recorded gender with no age, and 1 call (0.4%) that recorded age with no gender. To summarize the call data, the Rush Springs EMS system received 276 calls (Table 1). The majority of the calls (189 call, 68.5%) were received between the hours of 8 a.m. and 8 p.m. (Table 2). The majority of the calls (204 calls) had the initial response mode of emergency (82.9%) and the 167 transported calls from the scene had the majority response mode of nonemergency (77.2%), as shown in Table 3. The median elapsed response time per call was 10 minutes, while the median total time per call was 117 minutes (Table 4). Of the 276 total calls, there were 242 calls that originated in the category of Cities/Towns and 29 calls from Hospitals (Table 5). The majority of EMS calls were for medical illness (130 calls, Table 6). Of the 130 medical illness calls (Table 7), it was estimated that 63 calls (48.5% of the medical illness calls) may have needed paramedic level service (Table 8). The majority of call destinations was Hospitals (145 calls, 86.8%) from Table 9. From the date in Table 10, the highest percentage of patients was in the age range of (19.6%) and the patients age 60 and over accounted for 94 calls or 39.2% of total calls. 14

17 Table 10 Rush Springs EMS EMS Calls for 2001 EMS Calls by Age and Gender of Patient Unavailable Female Male Total Age Group Number Percent Number Percent Number Percent Number Percent Unavailable 1 0.4% 0 0.0% 2 0.8% 3 1.2% 19 and Under 0 0.0% % % % % % % % % % % % % % 8 3.3% % % 6 2.5% % % % 4 1.7% 6 2.5% % % % 4 1.7% % % % % % % % % % Totals 2 0.8% % % % 15

18 The Rush Springs EMS recorded total mileage of 9,400 miles in Transported miles were determined by estimating distance from call originations to call destinations. Transport miles are estimated to be 3,342 miles, which is approximately 35.6% of the total annual miles. The call data and mileage will be utilized to build the following funding alternatives. Estimated Costs of Funding Alternative Delivery Systems Three alternatives for the Rush Springs EMS system will be illustrated. The first alternative (Alternative 1) is based on a volunteer basic life support (BLS) EMS service provided 24 hours per day, 365 days per year. The second alternative (Alternative 2) is based on a partly paid and partly volunteer basic life support (BLS) EMS service provided 24 hours per day, 365 days per year. The third alternative (Alternative 3) is based on a partly-paid and partly-volunteer advanced life support (ALS) EMS system providing 24 hours per day, 365 days per year service. A fourth column (Alternative 4) is left blank for the convenience of the decision-makers to add another budget alternative, if desired. These alternatives are not recommendations but rather an informational analysis of different methods for funding the Rush Springs EMS system. Capital and operating budgets are developed based on information derived from Sloggett et al. (1988) [1] and information derived from Kleinholz et al. (1990) [2]. Capital and operating costs are based on the average known replacement or operating costs. Annual capital costs are defined as the annual depreciation of the capital equipment (ambulance, radios, equipment, buildings, etc.). These annual capital costs are important since they act as a sinking fund to replace worn capital items and are needed to purchase additional capital items in the future. Annual operating costs are the day-to-day expenses of operating the EMS system (salaries, benefits, fuel, oil, maintenance, supplies, insurance, etc.). 16

19 Alternative 1 - Rush Springs Basic Life Support - Volunteer Service Alternative 1 is based on estimated costs for a basic life support (BLS) EMS system that would provide one non-working EMS administrator and two volunteer crews 24 hours a day. The capital equipment items needed for Alternative 1 are included in the first column of Table 11. Presently, the Rush Springs EMS system owns a building, which includes 2 vehicle bays, an office, and living quarters. The building does not currently have a mortgage but this study includes the building as a capital item to determine replacement costs. It is estimated that it would cost $45,000 to replace the building. The EMS system currently has two Type III ambulance vehicles with an estimated replacement cost of $75,000 each, for a total of $150,000. The vehicles are equipped with basic life support equipment, at a cost of $15,000 per ambulance, for a total of $30,000. The BLS equipment necessary to equip an ambulance is listed in Appendix A. The EMS service may desire to contract with a neighboring EMS service for backup support in the event both ambulance vehicles are not available. A vehicle radio for communications will be needed for each ambulance at an estimated cost of $1,000 per radio. Oxygen sets will be stocked at a cost of $1,000 each; a total of $4,000 will be spent to stock two oxygen sets for each ambulance vehicle. Communications between the dispatcher and the EMS staff are of utmost importance; portable radios/phones/pagers will be needed to facilitate these communications. It is estimated that 15 portable radios/phones/pagers will be needed. At a cost of $600 each, the total cost is estimated at $9,000. Total capital costs for Alternative 1 for the Rush Springs EMS are estimated to be $240,000. A sinking fund or capital equipment replacement fund is necessary to provide for the long-term needs of an EMS system. For Alternative 1, the annual capital costs (or annual 17

20 Table 11 Rush Springs EMS Service Estimated Capital Expenditures Alternative 1 Alternative 2 Alternative 3 Alternative 4 Total Total Total Total Unit Capital Unit Capital Unit Capital Unit Capital Capital Items Cost No. Costs Cost No. Costs Cost No. Costs Cost No. Costs Building $45,000 1 $45,000 $45,000 1 $45,000 $45,000 1 $45,000 Vehicle - Type I Vehicle - Type III $75,000 2 $150,000 $75,000 2 $150,000 $85,000 2 $170,000 Vehicle Basic Equip. $15,000 2 $30,000 $15,000 2 $30,000 Vehicle ALS Equipment $47,000 2 $94,000 Vehicle Radios $1,000 2 $2,000 $1,000 2 $2,000 $2,500 2 $5,000 Oxygen Sets $1,000 4 $4,000 $1,000 4 $4,000 $2,000 4 $8,000 Portable Radios/Phones/Pagers $ $9,000 $ $9,000 $ $12,000 Total Capital Costs $240,000 $240,000 $334,000 18

21 replacement costs or depreciation costs) are shown in Table 12. To keep the building facilities updated according to local and state codes, a building replacement/improvement fund needs to be established for the future. Depreciating the building over 20 years results in an annual operating expense of $2,250. According to Sloggett [1], ambulance vehicles are depreciated based on 75,000 miles or seven years, whichever comes first. Annual depreciation cost for the ambulance vehicle is based on annual total miles of 9,400 as reported by the Rush Springs EMS for the year Over a seven-year period, the total miles driven will be approximately 65,800 (9,400 miles x 7 years = 65,800 miles). Therefore, the vehicle will be depreciated over 7 years, based on the maximum of number of years. This results in an estimated annual replacement cost of $21,429 for both Type III ambulance vehicles. The BLS equipment is also depreciated over a seven-year period, resulting in an annual replacement cost of $4,286 for the two ambulances. The vehicle radios, oxygen sets, and portable radios/phones are all depreciated over five years, resulting in annual replacement costs of $400, $800, and $1,800, respectively. The estimated total annual capital costs for Alternative 1 are $30,965. Annual operating costs are the day-to-day expenses of operating the EMS system (salaries, benefits, fuel, oil, maintenance, supplies, insurance, etc.). The annual operating costs for Alternative 1 are shown in Table 13. Currently, the Rush Springs EMS has a $20,000 loan in need of repayment. There are no terms associated with the loan, but the EMS system is allocating funds for repayment. Although this is a short-term loan, the EMS system may continue allotting funds after repayment to a replacement or sinking fund. Over the long term, this allotment may be used to cover unexpected expenses that may occur. Alternative 1 allocates approximately $6,061 for repayment of the loan. The note will be paid in full the 19

22 Table 12 Rush Springs EMS Service Estimated Annual Capital Expenses Capital Items Alternative 1 Alternative 2 Alternative 3 Alternative 4 Annual Annual Annual Annual Unit Capital Unit Capital Unit Capital Unit Capital Cost Yrs. Costs Cost Yrs. Costs Cost Yrs. Costs Cost Yrs. Costs Building Replacement/ Improvement $45, $2,250 $45, $2,250 $45, $2,250 Vehicle - Type I Vehicle - Type III 7 $21,429 7 $21,429 7 $24,286 Vehicle Basic Equip. 7 $4,286 7 $4,286 Vehicle ALS Equip. 7 $13,429 Vehicle Radios 5 $400 5 $400 5 $1,000 Oxygen Sets 5 $800 5 $800 5 $1,600 Portable Radios/Phones/Pagers 5 $1,800 5 $1,800 5 $2,400 Total Annual Capital Costs $30,965 $30,965 $44,965 20

23 Table 13 Rush Springs EMS Service Estimated Annual Operating Expenses Alternative 1 Alternative 2 Alternative 3 Alternative 4 Annual Annual Annual Annual Unit Operating Operating Unit Operating Unit Unit Operating Costs Operating Expense Items Cost No. Costs Cost No. Cost No. Costs Cost No. Costs $20, $6,061 $20, $9,615 $20,000 $10,000 Loan 2 12 $300 $1,800 Insurance (bldg., veh., & liab.) $1,000 $12,000 $1, $12,000 $1, $12,000 Utilities $ $2, $3,600 $ $3,600 Maint & Upkeep $ $1,800 $ $ $1,800 Central Dispatch $ $1,500 $ $1,500 $ $1,500 Pager Lease $ $1,000 $ $1,000 $ $1,350 Vehicle Expenses Fuel $1.50 1,175 $1,763 $1.50 1,175 $1,763 $1.50 1,175 $1,763 Maint/Repairs/Insps. $ $2,300 $ $2,800 $ $2,800 $480 Vehicle Radios (ALS only) $0 $0 $40 12 Portable Radios/Phones $ $ $3, $4,200 $3,200 $200 $160 Licensing Expense $160 $775 Medical Supply Exp. $2,692 $2,692 $5,470 Labor Costs $66,738 $208,278 $251,622 Office Supplies $ $1,200 $ $1,200 $ $1,200 Training Expense $ $4,500 $ $4,500 $ $6,000 Wrkrs Cmp/ Ins/Bens 20% $13,348 25% $52,070 25% $62,906 Miscellaneous $2,600 1 $2,600 $3,000 1 $3,000 $3,000 1 $3,000 Total Annual Operating Costs $123,462 $309,178 $370,466 Total Annual Capital & Operating Costs $154,427 $340,143 $415,431 Cost Per All 276 Calls $560 $1,232 $1,505 Cost Per 167 Transport Calls $925 $2,037 $2,488 21

24 fourth month of the third year (3.3 years). The annual capital expenditure for the building of $2,250 may need to be deferred until the building loan is repaid. The combined insurance expense for the building, vehicles, and liability is approximately $12,000 per year, for a monthly cost of $1,000. Insurance may be acquired at a lower cost by checking with appropriate insurance carriers or by contacting the Director of the EMS Division, Oklahoma State Department of Health, at (405) Utilities are budgeted at $ per month, for a yearly total of $2,600. Building maintenance and upkeep is estimated to cost $150 per month, for a yearly total of $1,800. Central dispatch costs the service $125 per month, for an annual total of $1,500. The monthly fee for communications is estimated to be $83.33, for an annual cost of $1,000. Vehicle expenses include fuel being purchased at an estimated cost of $1.50/gallon. Based on 8 mpg and total mileage for the year estimated to be 9,400 miles, the total gallons estimated to be needed is 1,175 (9,400/8 = 1,175). The annual cost for gas is estimated at $1,763 ($1.50 x 1,175 = $1,763). Fuel may be obtained at a lower cost from local government officials if local arrangements can be made. The vehicle maintenance, repairs, and inspections are estimated to cost $ per month or $2,300 annually. Maintenance and repair expenses include tires, oil, filters, and lubrications, vehicle licensing, and all other maintenance and repairs on the vehicle. The portable radios/phones/pagers are important for effective communications and are estimated to cost $200 per unit per year to maintain (based on $7/mo./pager), for an annual total expense of $3,200. Licensing expenses are estimated to be $160 per year. These include the license for a Basic Life Support EMS system and the EMT s licenses. The medical supply expenses are based on a cost of $7.00 per call for all 276 calls ($7 x 276 = $1,932) and a cost of 22

25 $20.00 per call for each of the 38 emergency calls ($20 x 38 = $760), for the combined medical supply expense of $2,692 annually ($1,932 + $760 = $2,692). The labor costs for Alternative 1 are detailed in Table 14. The EMS Director has a wage rate of $10.50 per hour and works 40 hours per week. Total annual salary for the administrator is $21,840. Administrator duties are to oversee the day-to-day operations of the Rush Spring EMS. There will be two volunteer crews staffing the Rush Springs EMS. The staff will consist of one EMT Basic and one EMT First Responder 24 hours a day. These volunteers are being paid $1 per hour while on duty and an established fee per transport call. A total of $35,040 is required to pay for the volunteers. Each volunteer crew member is also paid a fee for each transported call. It is estimated that a cost of $20 per crew member per transport call will be paid. There were 167 transports for 2001 resulting in an estimated total volunteer transport fee expense of $6,680. The total expense of base salaries, volunteer pay per hour, and volunteer transport pay is estimated to be $63,560 for Alternative 1. An additional 5% of base salaries will be added to allow for overtime pay, for an annual overtime pay total of $3,178. Benefits are calculated at 20% of total base salaries and overtime. Therefore, benefits are estimated to cost $13,348 annually. The total labor costs for Alternative 1 for the Rush Springs EMS are estimated to be $80,086. Returning to Table 13, the total of base salaries and overtime of $66,738 ($63,560 + $3,178 = $66,738) are included under labor costs and the 20% benefits ($13,348) are included under workers compensation/insurance/benefits. Office supplies are estimated at $100 per month, for an annual expense of $1,200 for Alternative 1. Training expenses are estimated at $300 per person for 15 persons, for an annual training expense of $4,500. A miscellaneous 23

26 Table 14 Rush Springs EMS System ALTERNATIVE 1 - LABOR COSTS Based on providing Basic Life Support (BLS) Service, with Two Volunteer Crews, 24 hours/day, 365 days/year (Minimum of one EMT Basic and one First Responder per Crew) Description Estimated Cost Paid EMS Director EMS Director, to work M - F, from 8 a.m. - 4 p.m. Full-Time Non-Working EMS Director (EMT Intermediate or Basic) $21,840 (1 person, $10.50/hr., 40 hrs./wk., 52 wks./yr.) Volunteer - Pay Per Hour 2 Volunteer Crews, 24 hours/day 2 Crews with One EMT Basic and one First Responder Each $35,040 (4 persons, $1/hr., 24 hrs./day, 365 days/yr.) Volunteer - Pay per Transport Call $6,680 Pay per call for the 167 transport calls ONLY (2 crew members, $40/call, 167 calls) TOTAL BASE SALARIES $63,560 Overtime Pay (5%) $3,178 TOTAL BASE SALARIES AND OVERTIME $66,738 BENEFITS (20%) $13,348 TOTAL LABOR COSTS FOR ALTERNATIVE 1 $80,086 24

27 $2,600. The total annual operating costs for Alternative 1 for the Rush Springs EMS are estimated to be $123,462. The Rush Springs EMS total annual capital and operating costs for Alternative 1 are estimated to be $154,427, representing a cost of $560 per all EMS calls and a cost of $925 per transported calls. Alternative 2 - Rush Springs Basic Life Support Partly-Paid/Partly-Volunteer Service The second funding alternative (Alternative 2) would provide basic life support service, 24 hours a day, seven days a week and illustrates a partly-paid/partly-volunteer service. Only the differences between Alternative 1 and Alternative 2 will be discussed in the text. The estimated capital expenditures (Table 11) are the same for Alternative 2 as Alternative 1, for an estimated total of $240,000 for Alternative 2. The estimated annual capital costs (Table 12) are also the same for Alternative 2 as Alternative 1, for a total estimated annual capital costs of $30,965 for Alternative 2. The estimated annual operating costs for Alternative 2 are illustrated in Table 13. The building loan repayment is based on $800 per month for an annual repayment of $9,615, to pay off the loan in just over 2 years. Alternative 2 also shows an increase of $1,000 for utilities as compared to Alternative 1. The added cost for utilities is to cover the possible increased use of the station utilities that could occur based on a paid EMS staff 12 hours per day. Vehicle expenses for maintenance/repairs/inspections have been increased $500 per year, for a total of $2,800 per year, as compared to Alternative 1. Historically, other EMS studies have shown this cost to be higher as compared Alternative 1. The estimated labor costs and benefits for Alternative 2 are illustrated in detail in Table 15. The duties and salary for the EMS Director are the same as Alternative 1. Again, the Rush Springs EMS will employ a non-working EMS administrator at the wage rate of $10.50 per hour 25

28 and will work a standard 40-hour week. This crew will also consist of one EMT Basic and one EMT First Responder. The first crew member will be an EMT Basic at a wage rate of $9.50 per hour; therefore, the annual labor expense will be $83,220. The second crew member will consist of an EMT First Responder. The wage rate for the First Responder will be $8.50 an hour for an annual cost of $74,460. There will be one full time volunteer staff as the second crew. The volunteer crew will be paid wage rate of $1 per hour for an annual expense of $17,520. Transport pay will also supplement the volunteer wages. Assuming 20% of the total transported calls will be transported by the volunteer crew, a total of 33 calls will be transported by the volunteer crew at $40 per call results in a cost of $1,320 annually. The total of base salaries, on-call pay, and transport pay for Alternative 2 is $198,360. An additional 5% of base salaries is added to allow for overtime pay, for an annual overtime pay total of $9,918. Total base salary and overtime pay amounts to $208,278 per year. Benefits in the amount of 25% are added to the base salaries for a total benefit expense of $52,070. The total labor costs for Alternative 2 are estimated to be $260,348. Referring back to Table 13, the base salaries and overtime pay ($208,278) are included as labor costs and the 25% benefits ($52,070) are included as workers compensation/ insurance/ benefits under Alternative 2. With a partly-paid staff, miscellaneous expenses were increased $400 per year, for a total of $3,000, to cover the expenses that may occur with the additional personnel at the station. Total annual operating expenses for Alternative 2 are estimated to be $309,178. The total annual capital and operating expenses for Alternative 2 are estimated to be $340,143, representing a cost of $1,232 per call for all calls or $2,037 per transport call for Alternative 2. 26

29 Table 15 Rush Springs EMS System ALTERNATIVE 2 - LABOR COSTS Based on providing Basic Life Support (BLS) service, with Two Crews (partly-paid and partly-volunteer), 24 hours/day, 365 days/year (Minimum of one EMT Basic and one First Responder per Crew) FTE's Description Labor Costs Paid EMS Director EMS Director, to work M - F, from 8 a.m. - 4 p.m. Full-Time Non-Working EMS Director (EMT Intermediate or Basic) $21,840 (1 person, $10.50/hr., 40 hrs./wk., 52 wks./yr.) Paid Staff One Full-Time Paid Crew, 12 hrs./day 1st Crew member - EMT Basic $83,220 (1 person, $9.50/hr., 24 hrs./day, 365days/yr.) 2nd Crew member - First Responder $74,460 (1 person, $8.50/hr., 24 hrs./day, 365days/yr.) Volunteer Staff One Full-time Volunteer Crew, 24 hours/day 2 Crew members - EMT Basic and First Responder $17,520 (2 persons, $1/hr., 24 hrs./day, 365 days/yr.) Volunteer - Pay per Transport Call $1,320 Pay per call for estimated 33 transport calls paid to Volunteers only (2 crew members, $40/call, 33 calls) (Assume back-up crew is called for 20% of the total 167 transport calls or a total of 33 calls) TOTAL BASE SALARIES $198,360 Overtime Pay (5%) $9,918 TOTAL BASE SALARIES AND OVERTIME $208,278 BENEFITS (25%) $52,070 TOTAL LABOR COSTS FOR ALTERNATIVE 2 $260,348 27

30 Alternative 3 Rush Springs ALS Service Partly-Paid/Partly-Volunteer Staff The third funding alternative (Alternative 3) would provide advanced life support (ALS) service, 24 hours a day, seven days a week. This alternative will be based on the same staffing shifts of 12 hours per day as Alternative 2 with a 2-person crew, consisting of one Paramedic and one EMT Basic or Intermediate. In Table 11 the estimated capital expenditures items for Alternative 3 are shown. For Alternative 3, it is assumed that two Type III ambulance vehicles at a cost of $85,000 each will be utilized for an annual capital cost of $170,000. This is an additional $10,000 per ambulance vehicle in Alternative 3, which may be required to accommodate the ALS equipment. To equip the ambulances with advanced life support equipment will cost an estimated $47,000 per ambulance, for an annual total of $94,000. An annual total of $5,000 is necessary to purchase upgraded vehicle radios for the ALS system, based on $2,500 each for two. Upgraded oxygen sets will be purchased at an expense of $2,000 each for 4 sets, for an annual total of $8,000. All personnel will be supplied a portable radio/phone/pager. Based on 20 total staff members and $600 per unit, the annual cost is estimated at $12,000 for Alternative 3. The total annual capital costs for Alternative 3 are estimated to be $334,000 for the Rush Springs EMS system. The estimated annual capital costs for Alternative 3 are shown in Table 12. The depreciation on the vehicle is based on the same method as Alternative 1 and Alternative 2. The vehicle will need to be replaced every 7 years; the annual replacement cost for the Type III vehicles will be $24,286 annually. The advanced life support equipment is also depreciated over 7 years based on a straight-line depreciation methodology, for an annual cost of $13,429. The vehicle radio, oxygen sets, and portable radios/phones are all depreciated over five years, resulting in annual replacement costs of $1,000, $1,600, and $2,400, respectively. The total 28

31 annual capital costs for Alternative 3 are estimated to be $44,965 for the Rush Springs EMS system. The annual operating costs for Alternative 3 are illustrated in Table 13. The building loan repayment is based on 2 years for an annual total payment of $10,000. Pager lease increased due to the increase in total units to 20. Based on a monthly lease payment of $112.50, the annual total is estimated to be $1,350. An annual maintenance contract has been added to cover the vehicle radios. Based on $40 per month, the total annual cost is estimated to be $480. With the increased number of portable radios/pagers/phones needed, Alternative 3 includes an additional $1,000, for an annual total of $4,200. The licensing expense to pay for an ALS system and Paramedic and EMT licenses is estimated to be $775 per year. The medical supply expense for an ALS system will be much higher than for a BLS system. The total medical supply expense is estimated to be $5,470 per year. The medical supply cost is based on a base fee of $15 per call for all 276 calls ($4,140) and an additional fee of $35 per call for the 38 emergency transport calls ($1,330), for a combined total of $5,470 annually. Labor costs and benefits for Alternative 3 are shown in detail in Table 16. The Rush Springs will employ a non-working EMS administrator at the wage rate of $13.50 per hour and will work a standard 40-hour week. The paid crew will work a 12-hour shift during highest call period hours of 8 a.m. to 8 p.m. (Table 2). This crew will also consist of one EMT Basic and one EMT First Responder. The first crew member will be an EMT Paramedic at a wage rate of $12 per hour, therefore annual labor expense will be $105,120. The second crew member will consist of an EMT Basic. The wage rate for the Basic will be $10 an hour for an annual cost of $87,600. There will be volunteer staff as the second crew. The volunteer crew will be paid wage rate of $1 per hour for an annual expense of $17,520. Transport pay will also supplement 29

32 the volunteer wages. Assuming 20% of the total transported calls will be transported by the volunteer crew, a total of 33 calls will be transported by the volunteer crew at $40 per call results in a cost of $1,320 annually. Total base salaries amount to $239,640 annually. Overtime is estimated at 5% of the total base salaries and resulting in an expense of $11,982. Benefits are also estimated at 25% of total base salaries and overtime expense. A total of $62,906 is estimated to pay for personnel benefits. The total labor costs for Alternative 3 is $314,528 annually. Referring back to Table 13, the base salaries and overtime ($251,622) are included as labor costs and benefits ($62,906) are included as Workers Compensation/Insurance/Benefits under Alternative 3. Training expenses are increased $1,500 to cover the added cost for training the increased number of personnel, for a total annual cost of $6,000. Total annual operating expenses for Alternative 3 are estimated to be $370,466. The total annual capital and operating expenses for Alternative 3 are estimated to be $415,431, representing a cost of $1,505 per call for all calls or $2,488 per transport call for Alternative 3. Alternative 4 - Blank A blank column is available in Tables 11, 12, and 13 for the local decision-makers to build their own funding alternative. Also, blank forms are included in Appendix B to be utilized for the same purpose. An Analysis of Alternative Revenue Sources Decision makers for the Rush Springs EMS service have several ways to raise revenues. Some of these ways, like community fund-raisers, are commendable but not reliable. More reliable sources are user fees, sales taxes, subscription/membership fees, third party reimbursement, fee collected on local utility bill, and special taxation districts. 30

33 Table 16 ALTERNATIVE 3 - LABOR COSTS Based on providing Advanced Life Support (ALS) service, with Two Crews (partly-paid and partly-volunteer), 24 hours/day, 365 days/year (Minimum of one Paramedic and one EMT Intermediate) FTE's Description Labor Costs Paid EMS Director EMS Director, to work M - F, from 8 a.m. - 4 p.m. Full-Time Non-Working EMS Director (EMT Intermediate or Basic) $28,080 (1 person, $13.50/hr., 40 hrs./wk., 52 wks./yr.) Paid Staff On Full-Time Paid Crew, 24 hrs./day 1st Crew member - Paramedic $105,120 (1 person, $12/hr., 24 hrs./day, 365days/yr.) 2nd Crew member - EMT Basic $87,600 (1 person, $10/hr., 24 hrs./day, 365days/yr.) Volunteer Staff One Full-time Volunteer Crew, 24 hours/day 2 Crew members - Paramedic and EMT Basic $17,520 (2 persons, $1/hr., 24 hrs./day, 365 days/yr.) Volunteer - Pay per Transport Call $1,320 Pay per call for estimated 33 transport calls paid to Volunteers only (2 crew members, $40/call, 33 calls) (Assume back-up crew is called for 20% of the total 167 transport calls or a total of 33 calls) TOTAL BASE SALARIES $239,640 Overtime Pay (5%) $11,982 TOTAL BASE SALARIES AND OVERTIME $251,622 BENEFITS (25%) $62,906 TOTAL LABOR COSTS FOR ALTERNATIVE 3 $314,528 31

34 User fees are generally charged for EMS services; however, these fees generally do not cover costs and have not kept up with EMS costs and inflation. Thus, they are often supplemented with other forms of revenues. For this study, mileage and user fees, millage levies from formation of a special taxation district, sales tax, and fee per utility bill are presented in the next 5 tables. Mileage charges (Table 17a) are shown for $4.50 per mile, $5.00 per mile, $5.50 per mile, $6.00 per mile, and $6.50 per mile for one-way (loaded) miles. For Rush Springs, estimated one-way miles are approximately 35.6% of the total miles, for a total of 3,342 miles (9,400 x 35.6% = 3,342 miles one-way). Calculations are shown on how much revenue could be generated if 30, 40, 50, 60, or 70 percent of the total fees are collected. Table 17b shows the revenues possible for user fees with alternative collection rates. Base rates for ambulance user fees, starting at $300, and continuing with $350, $400, $450, $500, $550, $600, and ending with $650, are shown. These are shown based on transported emergency calls (Table 3) and transported non-emergency calls (Table 3), so that an EMS service could charge different rates for these two types of calls. Alternative collection rates are shown: 70%, 60%, 50%, 40%, and 30%. For the Rush Springs EMS service, there were 167 billable calls, of those calls, 38 were considered emergency calls and 129 were non-emergency calls (refer to Table 3). Rush Springs is currently receiving $72,000 in millage revenues through Grady County EMS district. The amount of revenue that Rush Springs receives is pro-rated based on the call data from each of the EMS providers within the district. Table 17c illustrates the estimated revenues that would be generated from millage levies through the creation of a special taxation district for the Rush Springs school district. The total net property valuation for the Rush 32

35 Table 17a Rush Springs EMS System Estimated Revenues - Mileage Fees Mileage Fees $4.50 $5.00 $5.50 $6.00 $6.50 For One-Way Miles 3,342 $15,039 $16,710 $18,381 $20,052 $21,723 70% Collections 70% $10,527 $11,697 $12,867 $14,036 $15,206 60% Collections 60% $9,023 $10,026 $11,029 $12,031 $13,034 50% Collections 50% $7,520 $8,355 $9,191 $10,026 $10,862 40% Collections 40% $6,016 $6,684 $7,352 $8,021 $8,689 30% Collections 30% $4,512 $5,013 $5,514 $6,016 $6,517 33

36 Table 17b Rush Springs EMS System Emergency and Non-Emergency User Fees Per Call Total Calls 276 Emergency 38 Total Miles 9,400 Non-Emergency 129 Ave. Miles/Call 34 Non-Billable 109 Total Calls 276 NON-EMERGENCY CALLS Estimated User Fee Per Call $300 $350 $400 $450 $500 $550 $600 $650 Non-Emerg. Calls 129 $38,700 $45,150 $51,600 $58,050 $64,500 $70,950 $77,400 $83,850 70% Collections 70% $27,090 $31,605 $36,120 $40,635 $45,150 $49,665 $54,180 $58,695 60% Collections 60% $23,220 $27,090 $30,960 $34,830 $38,700 $42,570 $46,440 $50,310 50% Collections 50% $19,350 $22,575 $25,800 $29,025 $32,250 $35,475 $38,700 $41,925 40% Collections 40% $15,480 $18,060 $20,640 $23,220 $25,800 $28,380 $30,960 $33,540 30% Collections 30% $11,610 $13,545 $15,480 $17,415 $19,350 $21,285 $23,220 $25,155 EMERGENCY CALLS Estimated User Fee Per Call $300 $350 $400 $450 $500 $550 $600 $650 Emergency Calls 38 $11,400 $13,300 $15,200 $17,100 $19,000 $20,900 $22,800 $24,700 70% Collections 70% $7,980 $9,310 $10,640 $11,970 $13,300 $14,630 $15,960 $17,290 60% Collections 60% $6,840 $7,980 $9,120 $10,260 $11,400 $12,540 $13,680 $14,820 50% Collections 50% $5,700 $6,650 $7,600 $8,550 $9,500 $10,450 $11,400 $12,350 40% Collections 40% $4,560 $5,320 $6,080 $6,840 $7,600 $8,360 $9,120 $9,880 30% Collections 30% $3,420 $3,990 $4,560 $5,130 $5,700 $6,270 $6,840 $7,410 34

37 Table 17c Rush Springs EMS System Estimated EMS District Revenues - Millage Levies TOTAL NET THREE TWO ONE VALUATION* MILLS MILLS MILL FY 2002 Rush Springs School District $14,820,097 $44,460 $29,640 $14,820 * Based on Total Net Valuation of $15,600,102, which includes personal, real, and public property, LESS 5% adjustment for collections. Information received from Grady County Assessor's Office at

38 Springs school district for FY 2002 was $14,820,097. Three mills would generate $44,460, two mills $29,640, and one mill $14,820. This table shows only revenue generated from the Rush Springs school district. This information is provided so that the Rush Springs decision makers can see the difference in millage collections from the Grady County EMS district as compared to what the millage collections would be from a Rush Springs (School District-based) EMS district.- Table 17d illustrates the revenue from a sales tax collection. The table shows the revenues resulting from a ¼, ½, ¾, 1, 1½, and 2 sales tax based on FY 2001 sales tax collection from the Oklahoma Tax Commission. The sales tax collections were $193,110, resulting from a 3.5% sales tax in Rush Springs. The sales subject to sales tax totaled $5,517,428. A 1 sales tax would result in an estimated $55,174 in revenues. Rush Springs recently voted a 1 sales tax dedicated to the Rush Springs EMS system. These estimates are based on historical data and are only intended to estimate future revenues. Table 17e illustrates the revenue from a fee per utility billing. The table shows the revenues resulting from a $2.50 per month fee up to a $12.50 per month fee. If a $2.50 per month utility fee were initiated, each household would pay a total of $30 per year. With an estimated total of 490 households in Rush Springs, the annual resulting revenues are estimated to be $14,700, assuming 100% of the households are currently paying utilities. The table illustrates the annual total revenues based on 95%, 90%, 85%, 80%, 75%, and 70% utilization rates. The number of households was estimated from the 2000 Census population of Rush Springs of 1,278 and the estimated number of persons per household of 2.61, also from the U.S. Census ( = 490). 36

39 Table 17d Rush Springs EMS System Estimated Revenues - Sales Tax Collection Sales Subject to 1/4 1/2 3/4 1 11/2 2 Sales Tax* Sales Tax Sales Tax Sales Tax Sales Tax Sales Tax Sales Tax Rush Springs (FY 2001) $5,517,428 $13,794 $27,587 $41,381 $55,174 $82,761 $110,349 * Based on 2001 Rush Springs Sales Tax of 3.5% and Sales Tax Collections of $193,110, from Oklahoma Tax Commission,

40 Table 17e Rush Springs EMS System Estimated Revenues - Fee per Utility Billing Fee/Month $2.50 $3.00 $4.00 $5.00 $6.00 $7.50 $10.00 $12.50 Fee/Year $30 $36 $48 $60 $72 $90 $120 $150 Households* 490 Total Utility Fees $14,700 $17,640 $23,520 $29,400 $35,280 $44,100 $58,800 $73,500 Utilization of 95% $13,965 $16,758 $22,344 $27,930 $33,516 $41,895 $55,860 $69,825 Utilization of 90% $13,230 $15,876 $21,168 $26,460 $31,752 $39,690 $52,920 $66,150 Utilization of 85% $12,495 $14,994 $19,992 $24,990 $29,988 $37,485 $49,980 $62,475 Utilization of 80% $11,760 $14,112 $18,816 $23,520 $28,224 $35,280 $47,040 $58,800 Utilization of 75% $11,025 $13,230 $17,640 $22,050 $26,460 $33,075 $44,100 $55,125 Utilization of 70% $10,290 $12,348 $16,464 $20,580 $24,696 $30,870 $41,160 $51,450 * Number of households is based on the Rush Springs population of 1,278 and the average number of persons per household of Source: U.S Census,

41 To illustrate how to utilize the revenue tables, Table 18 presents 2 funding options fro each budget alternative. Alternative 1 would need an estimated $154,227 for total annual capital and operating expenses. One method to fund Alternative 1 is shown in Funding Option #1; to charge a flat mileage fee of $4.50 with an assumed collection rate of 40% to generate $6,016 in revenues, to charge a non-emergency call fee of $300 at 40% collections to generate $15,480, to charge an emergency call fee of $400 at 40% collections to generate $6,080, to collect the EMS District millage from the county of $72,000, and to collect the 1 sales tax from Rush Springs, estimated to total $55,174. The total estimated revenues are $154,750, which leaves a surplus of $323 for Alternative 1, Funding Option #1 (Table 18). Another method to fund Alternative 1 would be to increase the collection rates while maintaining the same mileage fees and user transport fees. Table 18, Alternative 1, Funding Option #2, shows the increased revenues for these fees; $7,520 would be generated from mileage fees of $4.50 with an increased collection rate to 50%, $19,350 would be generated from a non-emergency fee of $300 with a 50% collection rate, and $7,600 would be generated from an emergency call fee of $400 with a 50% collection rate. These three fees plus a 1 sales tax and 522 district tax would total $161,644, which covers the total annual capital and operating costs of $154,427, leaving a surplus of $7,217 for Alternative 1, Funding Option #2 (Table 18). To fund Alternative 2, Funding Option #1 requires an increase in revenues to cover the increased total annual capital and operating expenses of $340,143. Assuming 50% collections, a mileage fee of $5.50 would generate $9,191, a non-emergency fee of $500 at 50% collections would generate $32,250, and an emergency fee of $600 at 50% collections would generate $11,400. Additional revenues in the form of a utility fee of $150 at 90% collections would generate $66,150. Assuming the revenues from the 1 sales tax and the EMS 522 District remain the same, 39