An Analysis of Oologah-Talala Emergency Medical Services in Rogers County, Oklahoma

Transcription

1 An Analysis of Oologah-Talala Emergency Medical Services in Rogers County, Oklahoma Oklahoma Cooperative Extension Service, Oklahoma State University Oklahoma State Department of Health, Office of Rural Health & EMS Division July 2000

2 AE-0076 An Analysis of Oologah-Talala Emergency Medical Services in Rogers County, Oklahoma Cheryl F. St. Clair - Assistant State Extension Specialist, OSU, Stillwater (405) Sarah Trzebiatowski, Student Assistant, OSU, Stillwater (405) Gerald A. Doeksen - Extension Economist, OSU, Stillwater (405) Jack V. Frye - District R. D. Specialist, OSU, Ada (405) Vernon L. Scogin - Rogers County Extension Director, Claremore (918) Ronald McCummins, Director, EMS Division, OSHD, Oklahoma City (405) Rick Bronson - N. E. Field Coordinator, EMS Division, OSHD, Grove (918) RURAL DEVELOPMENT COOPERATIVE EXTENSION SERVICE OKLAHOMA STATE UNIVERSITY July 2000

3 An Analysis of Oologah-Talala Emergency Medical Services in Rogers County, Oklahoma The Oologah-Talala area has formed an emergency medical service district in a recent vote. Currently, EMS services for the Oologah and Talala area are being provided by the surrounding EMS services: Collinsville, Chelsea, Claremore, etc. In order to assist the newly formed EMS district to provide timely EMS service to the Oologah-Talala EMS district, an analysis of the Oologah-Talala EMS calls has been completed and the data has been utilized to prepare budget alternatives with revenue estimates. An Analysis of the Oologah-Talala Area Ambulance Calls for 1998 The combined calls of the Oologah and Talala area represent the total calls of the Oologah-Talala District EMS provider in Rogers County. This analysis will review the EMS calls for the period from January through December The calls are grouped into the type of ambulance call: auto accidents, hospital transfers, "other" medical calls, nursing home transfers, and community service calls. Auto or vehicle accidents are any accident occurring on Federal, state, and county roads that involve a motor vehicle such as a car, motorcycle, truck, etc. Hospital transfers are transporting patients from one hospital to another. "Other" medical calls include heart attacks, strokes, other illnesses, injuries of all kinds, etc. Nursing home transfers are non-emergency calls involving the pickup or delivery of patients to or from a nursing home. Community service calls are standby calls at football games, rodeos, and other various community activities. The Oologah-Talala area had approximately 140 total calls for the twelve-month period from January through December in 1998 (Table 1). Of this total, thirty-four calls were responding to auto accidents (24%); eighty-nine (89) calls were "other" medical calls (64%); 1

4 Table Oologah-Talala Ambulance Calls Type of Ambulance Calls by Month Other Nursing Community Percent No Auto Hospital Medical Home Service of Month Report Accidents Transfers Calls Transfers Calls Totals Total No Report % January % February % March % April % May % June % July % August % September % October % November % December % Totals % Percent 2.0% 24.0% 0.0% 64.0% 0.0% 10.0% 100.0% 2

5 fourteen (14) calls were community services calls (10%); and three (3) calls had missing data and did not indicate the type of call (2%). The busiest months were April (15 calls, 10.7%) and September (15 calls, 10.7%). The next busiest months included June (14 calls, 10%), July (14 calls, 10%), and October (14 calls, 10%). Table 2 shows the number of calls by day of week and time of day for the Oologah- Talala area ambulance calls; this table does not include community service calls. Twenty percent (20%) or 25 calls were received between 8 am and noon and another 20% or 25 calls were received between 8 pm and midnight. Nineteen percent (24 calls) were received between noon and 4 pm and another 19% or 24 calls were received between 4 pm and 8 pm. A total of 78% (98 calls) were received between 8 am and midnight. Table 2 also shows that 17% or 22 calls each were received on Mondays and Fridays and another 17% or 21 calls were received on Thursday. Saturday was the next highest with 15% or 19 calls. Table 3 shows the type of ambulance calls by the day of the week for all calls. Friday was the day of the week with the most calls with 29 calls or 21%; of these calls, the majority (15 calls) were for "other" medical calls and another 7 calls each were for auto accidents and community service calls. The next busiest day of the week was Thursday with 24 calls (17%); of these calls, the majority (11 calls) were auto accidents and another 9 calls on Thursdays were "other" medical calls. The third busiest day of the week was Monday with 23 calls (16%) and 15 of these calls were "other" medical calls. The day of the week with the least amount of calls was Tuesday with only 11 calls, representing 8% of the total calls. Of these 11 calls, ten (10) calls were "other" medical calls. 3

6 Table Oologah-Talala Ambulance Calls Ambulance Calls by Day of Week and Time of Day Time No Day of Week Percent of Day Report Sunday Monday Tuesday Wednesday Thursday Friday Saturday Totals of Total No Report % Midnight - 4am % 4am - 8am % 8am - Noon % Noon - 4pm % 4pm - 8pm % 8pm - Midnight % Totals % Percent of Total 0.0% 13.0% 17.0% 9.0% 12.0% 17.0% 17.0% 15.0% 100.0% 4

7 Table Oologah-Talala Ambulance Calls Type of Ambulance Calls by Day of Week Other Nursing Community Percent No Auto Hospital Medical Home Service Of Month Report Accidents Transfers Calls Transfers Calls Totals Total No Report % Sunday % Monday % Tuesday % Wednesday % Thursday % Friday % Saturday % Totals % Percent 2.0% 24.0% 0.0% 64.0% 0.0% 10.0% 100.0% 5

8 Table 4 shows the age of patients by type of call; this table does not include community service calls. The largest age group was the under age 20 with over 19% of the calls (24 calls); fourteen (14) of these calls were "other" medical calls and ten were auto accidents. The next largest age group was the age 80 and over with 20 calls, representing almost 16% of the total calls. All 20 of these calls were "other" medical calls. The over age 65 age group represents 32.5% or 41 calls; of these calls the majority (38 calls) were "other" medical calls. The sex of the patients by type of call is illustrated in Table 5. Over half of the patients were female (51.6%, 65 calls); of these 65 calls, the majority (48 calls) were "other" medical calls. Over 8% of the calls showed the sex of the patient was not reported. Of the almost 40% male patient calls (50 calls), "other" medical calls were the majority (36 calls). The location of the origin of the patient is shown in Table 6. The majority of the calls originated in towns and their rural areas. Over half (52.4% or 66 calls) were located in the local Oologah area with another 17.5% or 22 calls located in the rural Oologah area. Talala was the next largest origination point with 21 calls, representing 16.7% of the total calls. The patient destinations are shown in Table 7. The majority of the patients were taken to hospitals (60.3% or 76 calls). The hospitals receiving the most patients were St. John's Medical Center (20 calls, 15.9%) and Claremore Regional Medical Center (20 calls, 15.9%). the next most frequented hospital was St. Francis Hospital with 17 calls, representing 13.5% of the total calls. The "Other" category was the next most frequented patient location with 38.9% or 49 calls. Of this "Other" category, the "No Treatment, No Transport" was the largest category with 15 calls or 11.9% of the total calls. Next was the category "Patient Treated, No Transport" with 11 calls or 8.7% of the total calls. 6

9 Table Oologah-Talala Ambulance Calls Number of Calls by Age of Patient Other Nursing Percent Age of No Auto Hospital Medical Home of Victim Report Accidents Transfers Calls Transfers Totals Total No Report % Under Age % Age % Age % Age % Age % Age % Age % Age % Age % Totals % Percent of Total 2.4% 27.0% 0.0% 70.6% 0.0% 100.0% 7

10 Table Oologah-Talala Ambulance Calls Number of Calls by Sex of Patient Other Nursing Percent Sex of No Auto Hospital Medical Home of Victim Report Accidents Transfers Calls Transfers Totals Total No Report % Male % Female % Totals % Percent 2.0% 27.0% 0.0% 71.0% 0.0% 100.0% 8

11 Table Oologah-Talala Ambulance Calls Number of Calls by Patient Location Percent by Patient Location Number of Calls Percent Subcategories Hospitals: 0.8% St. Francis Hospital (Tulsa) 1 0.8% Rehabilitation Centers: 0.0% None Nursing Homes: 0.0% None Doctors' Offices 0.0% None Towns and their Rural Areas 98.5% Oologah (Local) % Oologah (Rural) % Talala (Local) % Talala (Rural) 4 3.2% Vera % Skiatook 1 0.8% Other: 0.8% CALL CANCELLED ENROUTE 1 0.8% Totals % 100.1% 9

12 Table Oologah-Talala Ambulance Calls Number of Calls by Patient Destination No. of Percent By Patient Destination Calls Percent Subcategories Hospitals: 60.3% Hospital (Undesignated) 6 4.8% St. John's Medical Center (Tulsa) % Tulsa Regional Medical Center 5 4.0% St. Francis Hospital (Tulsa) % Hillcrest Medical Center (Tulsa) 2 1.6% Claremore Regional Medical Center % Claremore Indian Hospital 3 2.4% Bartlesville ER 2 1.6% Nowata General 1 0.8% Nursing Homes: 0.0% None Doctors' Offices 0.0% None Towns and their Rural Areas 0.8% Oologah 1 0.8% Other: 38.9% Unknown 2 1.6% Care transferred to Other Ambulance 5 4.0% Patient Transferred by TLF 4 3.2% No Patient Found 5 4.0% Patient Treated, No Transport % No Treatment, No Transport % Call Cancelled Enroute 5 4.0% DOA 2 1.6% Totals % 100.0% 10

13 Time to scene for ambulance calls in Oologah-Talala are shown in Table 8. Only 80 calls or 63% of the total of 126 calls reported the time to scene; approximately 37% or 46 calls did not report or show the time to scene. Of the calls showing this information, the 6-10 minutes time lapse was the largest represented category with 30 calls (37.5%); next was the minutes time lapse with another 28 calls (35%). Ten (10) calls (12.5%) had a time to scene time lapse of minutes and seven (7) calls (8.8%) had a time to scene time lapse of 0-5 minutes. Total time for calls is illustrated in Table 9. Total time of the call is only available for 85 of the total 126 ambulance calls in the Oologah-Talala area; this represents 67% of the total calls. The majority of the calls (80%, 68 calls) indicated a total time for the call of 31 minutes or longer. Table 10 shows the total mileage per call per month for those calls that reported total mileage. Several months, January, March and April, had no mileage reported on the run reports. For the remaining 9 months, only 50 calls had the total mileage reported; this represents only about 40% of the total calls of 126. For these 50 calls, the total miles were 1,335, for an average per call of 26.7 miles. For the purposes of the study, a total of 140 EMS calls for the Oologah-Talala EMS districts will be used for estimating budgets. Of the total of 140 calls, it is estimated that 61 of the total calls are emergency calls, another 42 calls are estimated to be non-emergency calls, and 37 of the total calls are considered as non-billable EMS calls. Mileage will be based on an estimate of 50 miles per call, for a total of 7,000 miles driven. Historically speaking, when we establish a new ambulance service in a previously underserved area, the call volume typically increases. 11

14 Table Oologah-Talala Ambulance Calls Time to Scene for All Calls Elapsed Time Number of Calls Percent of Calls 0-5 Minutes 7 8.8% 6-10 Minutes % Minutes % Minutes % Minutes 3 3.8% Minutes 2 2.5% Totals % Only 80 calls showed the time to scene; this is 63% of the total calls of

15 Table Oologah-Talala Ambulance Calls Total Time for All Calls Reported Number Percent Time of Calls of Calls 0-5 Minutes 3 3.5% 6-10 Minutes 3 3.5% Minutes 4 4.7% Minutes 1 1.2% Minutes 6 7.1% 31+ Minutes % Totals % Only 85 of the calls showed total time of call; this represents 67% of the total of 126 calls. 13

16 Table Oologah-Talala Ambulance Calls Average Miles by Month for All Calls Number Average Total Month of Calls Miles Mileage January February March April May June July August September October November December Totals ,335 Only 50 calls reported mileage, out of a possible

17 Estimated Costs of Funding Alternative Delivery Systems Three alternative EMS systems will be illustrated. Alternative 1 is based on a round the clock, 24 hours/day, 365 days/year paramedic system, with two two-member crews at each station, and with the assumption that there will be two EMS station buildings purchased. Alternative 2 is also based on a round the clock, 24 hours/day, 365 days/year paramedic system, with one Paramedic at each station, and with the assumption that there will be two buildings rented to house two EMS stations. Alternative 3 is based on a round the clock, 24 hours/day, 365 days/year paramedic system, with one EMS station with one two-member crew, and with the assumption that the EMS station building would be rented. Blank forms to develop another budget alternative at the convenience of the decision makers are available in Appendix A. These alternatives are not recommendations but rather an analysis of different methods for funding the Oologah-Talala EMS system in Rogers County. 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.). 15

18 Alternative 1 - Oologah-Talala EMS System with Two 2-Member Crews and Two Purchased EMS Stations Alternative 1 is based on estimated costs for an EMS system that would provide paramedic level service, 24 hours a day, 365 days per year, with two 2-member crews and with the assumption that two EMS stations will be purchased. Costs are based on research [1,2]. The estimated cost of the capital equipment items needed for Alternative 1 are included in columns 2, 3, and 4 of Table 11. Two buildings will be purchased at an estimated cost of $60,000 each, for a total of $120,000. It is estimated that three Type III ambulance vehicles will be needed; one for each EMS station and one for a backup. The ambulance vehicles are all estimated at a cost of $75,000 per vehicle, for a total of $225,000 for 3 vehicles. Each vehicle will be equipped with advanced life support equipment (ALSE), at a cost of $47,000 per vehicle, for a total of $141,000 for the 3 vehicles. The advanced life support equipment needed is described in detail in Appendix B. The advanced life support equipment includes rear radio control, cardiac monitor and defibrillator, and heart lung resuscitator. A vehicle radio will be needed for each of the 3 vehicles, at an estimated cost of $2,500 each, for a total of $7,500. Oxygen sets will be stocked and at a cost of $1,000 each, a total of $6,000 would be spent to stock 6 sets, allowing 2 sets per vehicle. Communications are very important to an EMS system. It is estimated that approximately $40,000 will be needed to develop appropriate communications at the 2 EMS stations. Portable radios will also be needed to facilitate communications and it is estimated that 12 portable radios will be needed; at a cost of $600 each, the total cost would be $7,200. The total capital costs for Alternative 1 are estimated to be $546,700. A sinking fund or capital equipment replacement fund is necessary to provide for the long-term needs of an EMS system. For the Oologah-Talala EMS system providing paramedic 16

19 Table 11 Oologah-Talala EMS District Estimated Capital Expenditures ALTERNATIVE 1 ALTERNATIVE 2 ALTERNATIVE 3 Total Total Total Unit Capital Unit Capital Unit Capital Capital Items Cost No. Costs Cost No. Costs Cost No. Costs Building Expense $60,000 2 $120,000 $60,000 0 $0 $60,000 0 $0 Type III Vehicles $75,000 3 $225,000 $75,000 3 $225,000 $75,000 2 $150,000 ALSE $47,000 3 $141,000 $47,000 3 $141,000 $47,000 2 $94,000 Vehicle Radios $2,500 3 $7,500 $2,500 3 $7,500 $2,500 2 $5,000 Oxygen Sets $1,000 6 $6,000 $1,000 6 $6,000 $1,000 4 $4,000 Communications $20,000 2 $40,000 $20,000 2 $40,000 $20,000 1 $20,000 Portable Radios $ $7,200 $ $7,200 $600 8 $4,800 Total Capital Costs $546,700 $426,700 $277,800 17

20 service round the clock, the annual capital costs (or annual replacement costs or depreciation) are shown in Table 12, columns 2, 3, and 4. For Alternative 1, the two buildings are assumed to be financed at 13% for 25 years, at an annual cost of $16,371. According to [1], ambulance vehicles are depreciated based on 75,000 miles or seven years, whichever comes first. The annual depreciation cost for the ambulance vehicles are based on annual total miles of 7,000, which averages 2,333 miles per vehicle per year (7,000/3 = 2,333). With 2,333 miles per vehicle per year and a maximum recommended mileage per vehicle of 75,000 or seven years, the vehicle turnover rate is every 7 years. This results in an estimated annual replacement cost of $32,143 for the 3 ambulance vehicles ($225,000/7 = $32,143). The advanced life support equipment is depreciated over a five-year period, resulting in an annual replacement cost of $28,200. The radios, oxygen sets, and portable radios are also depreciated over five years, resulting in annual replacement costs of $1,500, $1,200, and $1,440, respectively. The communications system is estimated to need replaced in ten years, for an annual replacement cost of $4,000. The estimated total annual capital costs for the Oologah-Talala EMS system under Alternative 1 are $84,854. The annual operating expenses for Alternative 1 for the Oologah-Talala EMS system are illustrated in columns 2, 3, and 4 of Table 13. Telephone expenses are estimated at $75 per month for 24 months (2 EMS stations for 12 months each), for an annual cost of $1,800. Utilities include water, sewer, and trash at $75 per month, heating/cooling at $300 per month, and maintenance at $75 per month, for annual totals of $1,800, $7,200, and $1,800, respectively. Building insurance is estimated at $900 per building, for a total cost of $1,800. Vehicle expenses will vary based on the total miles driven. The Oologah-Talala EMS system will expend approximately $1,575 per year for gas, based on total miles of 7,000, eight 18

21 Table 12 Oologah-Talala EMS District Estimated Annual Capital Expenditures ALTERNATIVE 1 ALTERNATIVE 2 ALTERNATIVE 3 Annual Annual Annual Capital Capital Capital Capital Items Yrs. Costs Yrs. Costs Yrs. Costs Building Expense $16,371 $0 $0 Type III Vehicles 7.00 $32, $32, $21,429 ALSE 5 $28,200 5 $28,200 5 $18,800 Vehicle Radios 5 $1,500 5 $1,500 5 $1,000 Oxygen Sets 5 $1,200 5 $1,200 5 $800 Communications 10 $4, $4, $2,000 Portable Radios 5 $1,440 5 $1,440 5 $960 Total Annual Capital Costs $84,854 $68,483 $44,989 19

22 Table 13 Oologah-Talala EMS District Estimated Annual Operating Expenses ALTERNATIVE 1 ALTERNATIVE 2 ALTERNATIVE 3 Unit Annual Unit Annual Unit Annual Cost Category Cost No. Costs Cost No. Costs Cost No. Costs Telephone $75 24 $1,800 $75 24 $1,800 $75 12 $900 Building Expenses Rent $450 0 $0 $ $10,800 $ $5,400 Water, Sewer, & Trash $75 24 $1,800 $75 24 $1,800 $75 12 $900 Heat/Cool $ $7,200 $ $7,200 $ $3,600 Maintenance $75 24 $1,800 $75 24 $1,800 $75 12 $900 Building Insurance $900 2 $1,800 $900 0 $0 $900 0 $0 Vehicle Expenses Gas $ $1,575 $ $1,575 $ $1,575 Maint/Repairs/Insps. $4,750 $4,750 $3,200 Insurance $6,700 3 $20,100 $6,700 3 $20,100 $6,700 2 $13,400 Billing Expense $ $1,120 $8 140 $1,120 $8 140 $1,120 Vehicle Radios $50 3 $150 $50 3 $150 $50 2 $100 Portable Radios $30 12 $360 $30 12 $360 $30 8 $240 Licensing Expense $720 $0 $720 $0 $720 Medical Supply Exp. $3,135 $0 $3,135 $0 $3,135 Waste Allowance $2 140 $280 $2 140 $280 $2 140 $280 Labor Costs $369,776 $0 $199,584 $0 $180,312 Office Supplies $50 12 $600 $50 12 $600 $50 12 $600 Car Allowance $ $2,400 $ $2,400 $ $2,400 Uniform Allowance $ $3,800 $ $3,800 $200 9 $1,800 Training Expense $ $3,800 $ $3,800 $200 9 $1,800 Wrkrs Cmp/ Ins/Bens 30% $110,933 $0 30% $59,875 $0 30% $54,094 Miscellaneous $2,500 1 $2,500 $2,500 1 $2,500 $2,500 1 $2,500 Total Annual Operating Costs $540,399 $328,149 $278,975 Total Annual Capital & Operating Costs $625,252 $396,632 $323,964 Cost Per Call $4,466 $2,833 $2,314 20

23 mpg for Type III vehicles, and an estimated cost of $1.80 per gallon of gas. The maintenance, repairs, and inspections of the vehicles also vary based on mileage. The annual estimated cost for maintenance, repairs, and inspections for the three ambulance vehicles are $4,750. Vehicle insurance is estimated at a cost of $6,700 per vehicle, for an annual cost of $20,100 for the three vehicles. Billing expenses are based on a cost of $8 per EMS call. The annual billing expense are estimated to be $1,120 (140 calls). Maintenance of vehicle radios and portable radios are estimated yearly at $150 and $360, respectively. Licensing expenses are estimated to be $720 annually. Medical supply expenses vary with the number of total calls and the number of emergency calls, based on a $11.50 fee for every call and a $25 fee for emergency calls only. The Oologah-Talala EMS system has an estimated 140 total calls and an estimated 61 emergency calls, for an annual total medical supply expense of $3,135. Labor costs for Alternative 1 for the Oologah-Talala EMS system are included in Table 14a, colums 2, 3, and 4. For the Oologah-Talala EMS system, a working EMS Administrator (Paramedic) will be employed, with a $3 per hour differential in pay annually. Total annual cost is $6,240. There will be a two-person crew at each station, 24 hours/day, 365 days per year. The two-person crew will consist of one Paramedic and one EMT-Basic or EMT- Intermediate. The cost for two Paramedics (one at each EMS station) (at $10.00/hour) for 24 hours per day, 365 days per year, will be $175,200. The cost for two EMT-Basics or Intermediates ($8.00/hour) for 24 hours per day, 365 days per year, will be $140,160. One fulltime dispatch clerk is estimated for a 40-hour week; based on $7 per hour, the annual salary is $14,560. The total base salaries are estimated to be $336,160. Overtime pay is estimated to be 21

24 Table 14a Oologah-Talala EMS District Alternative 1 Based on Oologah-Talala EMS District with Two Substations (Two Crews) Providing Paramedic Service, 24 hours/day, 365 days/year FTE's Description Labor Costs Working EMS Administrator (Add $3/hour Differential) $6,240 Two Crews, 24 hrs./day (1 Paramedic & 1 EMT Basic or Int. per Crew) 8.4 Paramedic ($10/hr., 2 persons, 24 hrs./day, 365 days/yr.) $175, EMT Basic or Intermediate ($8/hr., 2 persons, 24 hrs./day, 365 days/yr.) $140,160 1 Full-Time Dispatch Clerk ($7.00/hr., 1 person, 8 hrs./day, 260 days/yr.) $14, TOTAL FTE's TOTAL BASE SALARIES $336,160 Overtime Pay $33,616 TOTAL BASE SALARIES AND OVERTIME $369,776 BENEFITS $110,933 TOTAL LABOR COSTS FOR ALTERNATIVES 1 $480,709 22

25 10% of total base salaries, for a total of $33,616. The total of base salaries and overtime pay is $369,776 for the Oologah-Talala EMS system for Alternative 1. Benefits are estimated at 30%, for a total of $110,933. The total labor costs for Alternative 1 are estimated to be $480,709. Returning to Table 13, the base salaries and overtime pay ($369,776) are included under labor costs and the 30% benefits ($110,933) are included under workers compensation/ insurance/benefits. The remaining annual operating expenses are described here. The office supplies are based on $50 per month, for an annual total of $600. A car allowance has been allowed for the EMS administrator, based on $200 per month for an annual total of $2,400. A uniform allowance of $200 per person for 19 persons totals $3,800 annually. Training expense of $200 per person for 19 persons totals $3,800. Benefits, including workers compensation and insurances, are based on 30% of base salaries, for an annual total of $110,933. A miscellaneous amount is included for each satellite station totaling $2,500 annually to cover any unexpected expenses. The total annual operating expenses for the Oologah-Talala EMS system for Alternative 1 are $540,399. The total annual capital and operating expenses for Alternative 1 are $625,252. The cost per call for Alternative 1 is estimated to be $4,466. Alternative 2 - Oologah-Talala EMS Service One-Person at each of the Two Stations, Rent Buildings The second funding alternative (Alternative 2) would also provide paramedic service, 24 hours a day, seven days a week, with one Paramedic at each station, and with the assumption that two buildings would be rented for the 2 EMS stations. In Table 11 the capital equipment items for Alternative 2 are estimated in columns 5, 6, and 7. The remainder of the capital 23

26 equipment items for Alternative 2 are the same as Alternative 1; therefore, these items will not be listed again. The total annual capital costs for Alternative 2 are estimated to be $426,700 for the Oologah-Talala EMS service. The estimated annual capital costs for Alternative 2 are shown in columns 5, 6, and 7 of Table 12. The annual capital costs for Alternative 2 are exactly the same as Alternative 1, except that there is no building expense. The annual capital costs for Alternative 2 are estimated to total $68,483 for Oologah-Talala EMS service. The annual operating costs for Alternative 2 are illustrated in Table 13. Only those cost categories that are different from Alternative 1 will be reviewed here. There is rent for the two buildings of $450 per month, for an annual total of $10,800. There is no insurance since the buildings are rented. The only other difference is in the labor costs. The labor costs (Table 14b) are based on a working EMS administrator (Paramedic) with the same hourly differential as Alternative 1. This system is set up with one Paramedic located at each EMS station. When a call comes in, both Paramedics respond to the call. The cost for the two Paramedics, based on $10 per hour, 24 hrs/day, 365 days/year, is estimated to be $175,200. Overtime pay is estimated at 10% of total base salaries, for a total of $18,144. The total of base salaries and overtime is $199,584. Benefits are calculated at 30%, for a total of $59,875. Total labor costs for Alternative 2 are $259,459. Returning to Table 13, the base salaries and overtime pay ($199,584) are included under labor costs and the 30% benefits ($59,875) are included under workers compensation/ insurance/benefits. The remaining annual operating expenses are the same as Alternative 1. The total annual operating expenses for Alternative 2 are estimated to be $328,149. The total 24

27 Table 14b Oologah-Talala EMS District Alternative 2 Based on Oologah-Talata EMS District with Two Substations (One-Person Per Station) Providing Paramedic Service, 24 hours/day, 365 days/year FTE's Description Labor Costs Working EMS Administrator (Add $3/hour Differential) $6,240 One Crew, 24 hrs./day (Paramedics) 8.4 Paramedic ($10/hr., 2 persons, 24 hrs./day, 365 days/yr.) $175, TOTAL FTE's TOTAL BASE SALARIES $181,440 Overtime Pay $18,144 TOTAL BASE SALARIES AND OVERTIME $199,584 BENEFITS $59,875 TOTAL LABOR COSTS FOR ALTERNATIVE 2 $259,459 25

28 annual capital and operating expenses for Alternative 2 are estimated to be $396,632, representing $2,833 fee per call for Alternative 2. Alternative 3 - Oologah-Talala EMS Service Two-Person at One Station, Rent Building The third funding alternative (Alternative 3) would also provide paramedic service, 24 hours a day, seven days a week, with a two-person crew (one Paramedic and one EMT-Basic or Int.) at one station, and with the assumption that the building would be rented. In Table 11 the capital equipment items for Alternative 3 are estimated in columns 8, 9, and 10. This alternative assumes that only two vehicles will be needed for a total cost of $150,000. The advanced life support equipment totals $94,000, based on a cost of $47,000 per vehicle. Two vehicle radios total $5,000. Four oxygen sets, at a cost of $1,000, will be needed, for an annual cost of $4,000. The communications system cost remains the same. Only 8 portable radios are estimated at a cost of $4,800. The total annual capital costs for Alternative 3 are estimated to be $297,800 for the Oologah-Talala EMS service. A sinking fund or capital equipment replacement fund is necessary to provide for the long-term needs of an EMS system. The estimated annual capital costs for Alternative 3 are shown in columns 8, 9, and 10 of Table 12. The annual capital costs for Alternative 3 show no building cost, because the building is assumed to be rented. According to [1], ambulance vehicles are depreciated based on 75,000 miles or seven years, whichever comes first. The annual depreciation cost for the ambulance vehicles are based on annual total miles of 7,000, which averages 3,500 miles per vehicle per year (7,000/2 = 3,500). With 3,500 miles per vehicle per year and a maximum recommended mileage per vehicle of 75,000 or seven years, the vehicle turnover rate is every 7 years. This results in an estimated annual replacement cost 26

29 of $21,429 for the 2 ambulance vehicles ($150,000/7 = $21,429). The advanced life support equipment is depreciated over a five-year period, resulting in an annual replacement cost of $18,100. The radios, oxygen sets, and portable radios are also depreciated over five years, resulting in annual replacement costs of $1,000, $800, and $960, respectively. The communications system is estimated to need replaced in ten years, for an annual replacement cost of $2,000. The estimated total annual capital costs for the Oologah-Talala EMS system under Alternative 3 are $44,989. The annual operating expenses for Alternative 3 for the Oologah-Talala EMS system are illustrated in columns 8, 9, and 10 of Table 13. Telephone expenses are estimated at $75 per month for 12 months (1 EMS station for 12 months), for an annual cost of $900. Rent is estimated at $450 per month, for an annual total of $5,400. Utilities include water, sewer, and trash at $75 per month, heating/cooling at $300 per month, and maintenance at $75 per month, for annual totals of $900, $3,600, and $900, respectively. Vehicle expenses will vary based on the total miles driven. The gas cost for Alternative 3 is the same as the other two alternatives. The maintenance, repairs, and inspections of the vehicles also vary based on mileage. The annual estimated cost for maintenance, repairs, and inspections for the two ambulance vehicles are $3,200. Vehicle insurance is estimated at a cost of $6,700 per vehicle, for an annual cost of $13,400 for the two vehicles. Billing expenses are based on a cost of $8 per EMS call. The annual billing expense are estimated to be $1,120 (140 calls). Maintenance of vehicle radios and portable radios are estimated yearly at $100 and $240, respectively. Licensing expenses are estimated to be $720 annually. 27

30 Medical supply expenses vary with the number of total calls and the number of emergency calls, based on a $11.50 fee for every call and a $25 fee for emergency calls only. The Oologah-Talala EMS system has an estimated 140 total calls and an estimated 61 emergency calls, for an annual total medical supply expense of $3,135. Waste allowance is calculated at $2 per call for a total of 140, for a total of $280. Labor costs for Alternative 3 for the Oologah-Talala EMS system are included in Table 14c. For the Oologah-Talala EMS system, a working EMS Administrator (Paramedic) will be employed, with a $3 per hour differential in pay annually. Total annual cost is $6,240. There will be a two-person crew, 24 hours/day, 365 days per year. The two-person crew will consist of one Paramedic and one EMT-Basic or EMT-Intermediate. The cost for the Paramedics (at $10.00/hour) for 24 hours per day, 365 days per year, will be $87,600. The cost for one EMT- Basic or Intermediate ($8.00/hour) for 24 hours per day, 365 days per year, will be $70,080. The total base salaries are estimated to be $163,920. Overtime pay is estimated to be 10% of total base salaries, for a total of $16,392. The total of base salaries and overtime pay is $180,312 for the Oologah-Talala EMS system for Alternative 3. Benefits are estimated at 30%, for a total of $54,094. The total labor costs for Alternative 1 are estimated to be $234,406. Returning to Table 13, the base salaries and overtime pay ($180,312) are included under labor costs and the 30% benefits ($54,094) are included under workers compensation/ insurance/benefits. The remaining annual operating expenses are described here. The office supplies are based on $50 per month, for an annual total of $600. A car allowance has been allowed for the EMS administrator, based on $200 per month for an annual total of $2,400. A uniform allowance of $200 per person for 9 persons totals $1,800 annually. Training expense 28

31 Table 14c Oologah-Talala EMS District Alternative 3 Based on Oologah-Talata EMS District with One Station Providing Paramedic Service, 24 hours/day, 365 days/year FTE's Description Labor Costs Working EMS Administrator (Add $3/hour Differential) $6,240 One Crew, 24 hrs./day (1 Paramedic & 1 EMT Basic or Int. per Crew) 4.2 Paramedic ($10/hr., 1 person, 24 hrs./day, 365 days/yr.) $87, EMT Basic or Intermediate ($8/hr., 1 person, 24 hrs./day, 365 days/yr.) $70, TOTAL FTE's TOTAL BASE SALARIES $163,920 Overtime Pay $16,392 TOTAL BASE SALARIES AND OVERTIME $180,312 BENEFITS $54,094 TOTAL LABOR COSTS FOR ALTERNATIVE 3 $234,406 29

32 of $200 per person for 9 persons totals $1,800. Benefits, including workers compensation and insurances, are based on 30% of base salaries, for an annual total of $54,094. A miscellaneous amount is included for each satellite station totaling $2,500 annually to cover any unexpected expenses. The total annual operating expenses for the Oologah-Talala EMS system for Alternative 3 are $278,975. The total annual capital and operating expenses for Alternative 3 are $323,964. The cost per call for Alternative 3 is estimated to be $2,314. A set of blank forms are included in Appendix A for the decision makers to build their own budget alternatives, if desired. An Analysis of Alternative Revenue Sources Decision makers for the Oologah-Talala 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. 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, user fees, millage levies from formation of a special taxation district, mileage fees, and sales taxes are presented. Tables 15a, 15b, 15c, and 15d illustrate these revenue methodologies. Table 15a shows the revenues possible for user fees with alternative collection rates. Base rates for ambulance user fees, starting at $200, and continuing with $250, $300, $350, $400, $450, $500, and ending with $600, are shown. These are shown based on emergency calls and non-emergency calls, so that an EMS service could charge different rates for these two 30

33 EMERGENCY CALLS Table 15a Oologah-Talala EMS District in Rogers County Estimated Revenues - User Fee Per Call Total Calls 140 Emergency 61 Total Miles 7,000 Non-Emerg. 42 Non-Billable 37 Total Calls 140 Estimated User Fee Per Call $200 $250 $300 $350 $400 $450 $500 $600 Emergency Calls 61 $12,200 $15,250 $18,300 $21,350 $24,400 $27,450 $30,500 $36,600 90% Collections 90% $10,980 $13,725 $16,470 $19,215 $21,960 $24,705 $27,450 $32,940 80% Collections 80% 9,760 12,200 14,640 17,080 19,520 21,960 24,400 29,280 70% Collections 70% 8,540 10,675 12,810 14,945 17,080 19,215 21,350 25,620 60% Collections 60% 7,320 9,150 10,980 12,810 14,640 16,470 18,300 21,960 50% Collections 50% 6,100 7,625 9,150 10,675 12,200 13,725 15,250 18,300 NON-EMERGENCY CALLS Estimated User Fee Per Call $200 $250 $300 $350 $400 $450 $500 $600 Non-Emerg. Calls 42 $8,400 $10,500 $12,600 $14,700 $16,800 $18,900 $21,000 $25,200 90% Collections 90% $7,560 $9,450 $11,340 $13,230 $15,120 $17,010 $18,900 $22,680 80% Collections 80% $6,720 $8,400 $10,080 $11,760 $13,440 $15,120 $16,800 $20,160 70% Collections 70% $5,880 $7,350 $8,820 $10,290 $11,760 $13,230 $14,700 $17,640 60% Collections 60% $5,040 $6,300 $7,560 $8,820 $10,080 $11,340 $12,600 $15,120 50% Collections 50% $4,200 $5,250 $6,300 $7,350 $8,400 $9,450 $10,500 $12,600 31

34 Table 15b Oologah-Talala EMS District in Rogers County Estimated Revenues - Millage Levies TOTAL NET THREE TWO ONE VALUATION MILLS MILLS MILL FY1999 & 2000 Oologah-Talala School District $87,357,681 $262,073 $174,715 $87,358 32

35 Table 15c Oologah-Talala EMS District in Rogers County Estimated Revenues - Mileage Fees Mileage Fees $3 $4 $5 $6 $7 For One-Way Miles 3,150 $9,450 $12,600 $15,750 $18,900 $22,050 90% Collections 90% 8,505 11,340 14,175 17,010 19,845 80% Collections 80% 7,560 10,080 12,600 15,120 17,640 70% Collections 70% 6,615 8,820 11,025 13,230 15,435 60% Collections 60% 5,670 7,560 9,450 11,340 13,230 50% Collections 50% 4,725 6,300 7,875 9,450 11,025 33

36 Table 15d Oologah-Talala EMS District in Rogers County Estimated Revenues - Sales Tax FY Sales Subject ¼ ½ ¾ 1 1 ¼ 1 ½ 1 ¾ 2 to Sales Tax Sales Tax Sales Tax Sales Tax Sales Tax Sales Tax Sales Tax Sales Tax Sales Tax City of Oologah $4,491,167 $11,228 $22,456 $33,684 $44,912 $56,140 $67,368 $78,595 $89,823 City of Talala $1,380,350 $3,451 $6,902 $10,353 $13,804 $17,254 $20,705 $24,156 $27,607 TOTALS $5,871,517 $14,679 $29,358 $44,037 $58,716 $73,394 $88,073 $102,751 $117,430 34

37 types of calls. Alternative collection rates are shown: 90%, 80%, 70%, 60%, and 50%. Table 15a shows the Oologah-Talala calls, with a total of 140 calls; 61 emergency calls, 42 nonemergency calls, and 37 non-billable calls. Table 15b illustrates the estimated revenues that would be generated from millage levies through the creation of a special taxation district. The total net property valuation for the Oologah-Talala school district is estimated to be $87,357,681. This includes FY 1999 amounts for the public service utilities and FY 2000 amounts for the personal property, real estate, and homestead exemption. The FY 2000 public service amounts were not available at this time. Three mills would generate $262,073, two mills $174,715, and one mill $87,358. Mileage charges (Table 15c) are shown for $3 per mile, $4 per mile, $5 per mile, $6 per mile, and $7 per mile for one-way (loaded) miles. For Oologah-Talala, one-way miles are approximately 45% of the total miles, for a total of 3,150 miles (7,000 x 45% = 3,150 miles one-way) for the proposed Oologah-Talala EMS service. Calculations are shown on how much revenue could be generated if 50, 60, 70, 80, or 90 percent of the total fees are collected. Another revenue option is to pass an additional sales tax (Table 15d). If a $0.25 (¼ ) sales tax, the amount of $14,679 is estimated to be generated. For ½ sales tax, $29,358 is the estimated total. A ¾ sales tax would result in $44,037 and 1 in $58,716. For 1 ¼, 1 ½, 1 ¾, and 2, the amounts generated are estimated to be $73,394, $88,073, $102,751, and $117,430, respectively. To illustrate how to utilize the revenue tables, Alternative 1 (Table 11, column four) needs revenues to cover the estimated $625,252 in total annual capital and operating expenses. One method to fund Alternative 1 could be to charge an emergency call fee of $600 (70% collections) to generate $25,620, a non-emergency fee of $600 (70% collections) to generate 35

38 $17,640, and a mileage fee of $7/mile (70% collections) to generate $15,435, and to form an EMS district and collect three mills to generate $262,073. The total of these fees is $320,768 which leaves a large deficit of $304,484 (Table 16, Alternative 1). To illustrate how to fund Alternative 2, see Table 16, Alternative 2. This alternative assumes that a 1% sales tax is passed and would generate $58,716. It also assumes the same user fees and mileage fees as Alternative 1. The total generated is estimated at $117,411. This leaves a huge deficit of $279,221 for Alternative 2 (Table 16, Alternative 2). To fund Alternative 3, Table 16, Alternative 3 illustrates one methodology to cover the total annual capital and operating expenses of $323,964. If an EMS district is formed and generates three mills, the amount is estimated to be $262,073. Assuming 70% collections, a mileage fee of $7/mile would bring in $15,435, an emergency fee of $500 would generate $21,350, and a non-emergency fee of $500 would generate $14,700. Total revenues equal $313,558, which almost cover all of the costs with a small deficit of $10,406. The Creation of an EMS District The State of Oklahoma allows for the formation of a special EMS District for the purpose of raising funds to support EMS. Table 17 outlines the procedures involved in creating an EMS District and the powers and responsibilities of its Board of Trustees. In brief, the County commissioners must call for a special election to create the district. The district may encompass one or more counties, incorporated cities, a township, school districts, or parts of a school district that lie within the borders of a county. The district may assess up to three mills of ad valorem taxes to support the operation of the EMS system. The total net assessed valuation for the Oologah-Talala school district was $87,357,681 (a 36

39 Table 16 Oologah-Talala EMS District Possible Funding for Alternatives 1, 2, and 3 ALTERNATIVE 1 ALTERNATIVE 2 ALTERNATIVE 3 Costs: Costs: Costs: Total Annual Capital Total Annual Capital Total Annual Capital & Operating Expenses $625,252 & Operating Expenses $396,632 & Operating Expenses $323,964 Revenues: Revenues: Revenues: ER Fee, $600 (70%) $25,620 Form an EMS District Non-ER Fee, $600 (70%) $17,640 Sales Tax (1%) $58,716 Three Mills $262,073 Mileage (70%) $15,435 Mileage (70%) $15,435 Mileage (70%) $15,435 Form an EMS District (3 Mills) $262,073 ER Fee, $600 (70%) $25,620 ER Fee, $500 (70%) $21,350 Non-ER Fee, $600 (70%) $17,640 Non-ER Fee, $500 (70%) $14,700 Total Revenues $320,768 Total Revenues $117,411 Total Revenues $313,558 Difference -$304,484 Difference -$279,221 Difference -$10,406 37

40 Table 17 A Summary of the Procedures to Create an EMS District and the Powers and Responsibilities of its Board of Trustees I. Creation of a District A. Special election called by the County Commissioners or through them as called for by a petition of greater than 10 percent of the registered voters of the affected area. II. Affected Area A. One or more counties or portions of counties (must follow school district lines). B. Incorporated cities. III. The Election and Ad Valorem Tax Levy A. Both capital and operational millage levy must be approved by a majority of the voters. B. The operational millage levy cannot exceed three mills and the capital millage levy cannot exceed three mills. C. The operational millage levy continues until voters change it; the capital millage levy is in effect until bonds are completely repaid. IV. The Board of Trustees A. Appointed by the County Commissioners. B. Powers and Responsibilities: 1. Make necessary rules, procedures, and contracts. 2. Hire appropriate personnel. 3. Issue bonds upon approval by a majority of the voters at a special election. Bonds are paid for out of the capital millage levy. 4. Responsible for the economical expenditure of funds. 5. Can charge additional fees for services. 6. Can sue and be sued. 38

41 combination of FY 1999 and FY 2000). For a more up-to-date valuation, decision makers should contact the Rogers County Assessor's Office. If an EMS District were created, a three mill tax levy (Table 15b) for the Oologah-Talala school district would raise $262,073 annually ($87,357,681 x.003), a two mill tax levy, $174,715, and a one mill tax levy, $87,358. Contracting for EMS Services The Oologah-Talala EMS Board may set up a contractual arrangement for EMS coverage. Upon review of the costs illustrated here, the Board should review and use their own local costs to determine their own budget totals. A contractual arrangement could be advantageous if the Board can contract for less than the total costs determined. However, no recommendations are made here; the decision is in the hands of the decision makers at the Oologah-Talala EMS service. Conclusion The analysis of the Oologah-Talala EMS calls and EMS costs and funding alternatives presented in this paper are designed to aid local decision makers as they determine the kind of EMS system best suited to the Oologah-Talala area. 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. If further analysis is desired, contact your County Extension Director. Personnel in the EMS Division of the Oklahoma State Health Department and Office of Highway Safety are also willing to help in any way they can. 39

42 References [1] Sloggett, Gordon R., Doeksen, Gerald A., Hays, Marvin, and Larsen, Sam. "A Community Development Guide for Emergency Medical Services: A Systematic Approach to Funding and Administration." EMS Division, State Health Department; Oklahoma Highway Safety Office; Oklahoma Cooperative Extension Service, Oklahoma State University, MP-126, July [2] Kleinholz, Sharon, Doeksen, Gerald, Henderson, Ed, Bullard, Vernon, et.al. "A Guidebook for Rural Fire Protection Services." Oklahoma Cooperative Extension Service, Oklahoma State University, MP-131, November

43 APPENDIX A

44 Table 11 Oologah-Talala EMS District Estimated Capital Expenditures ALTERNATIVE 1 ALTERNATIVE 2 ALTERNATIVE 3 Total Total Total Unit Capital Unit Capital Unit Capital Capital Items Cost No. Costs Cost No. Costs Cost No. Costs Building Expense Type III Vehicles ALSE Vehicle Radios Oxygen Sets Communications Portable Radios Total Capital Costs A-1

45 Table 12 Oologah-Talala EMS District Estimated Annual Capital Expenditures ALTERNATIVE 1 ALTERNATIVE 2 ALTERNATIVE 3 Annual Annual Annual Capital Capital Capital Capital Items Yrs. Costs Yrs. Costs Yrs. Costs Building Expense Type III Vehicles ALSE Vehicle Radios Oxygen Sets Communications Portable Radios Total Annual Capital Costs A-2

46 Table 13 Oologah-Talala EMS District Estimated Annual Operating Expenses ALTERNATIVE 1 ALTERNATIVE 2 ALTERNATIVE 3 Unit Annual Unit Annual Unit Annual Cost Category Cost No. Costs Cost No. Costs Cost No. Costs Telephone Building Expenses Rent Water, Sewer, & Trash Heat/Cool Maintenance Building Insurance Vehicle Expenses Gas Maint/Repairs/Insps. Insurance Billing Expense Vehicle Radios Portable Radios Licensing Expense Medical Supply Exp. Waste Allowance Labor Costs Office Supplies Car Allowance Uniform Allowance Training Expense Wrkrs Cmp/ Ins/Bens Miscellaneous Total Annual Operating Costs Total Annual Capital & Operating Costs Cost Per Call A-3

47 Table 14a Oologah-Talala EMS District Alternative 1 FTE's Description Labor Costs TOTAL FTE's TOTAL BASE SALARIES Overtime Pay TOTAL BASE SALARIES AND OVERTIME BENEFITS TOTAL LABOR COSTS FOR ALTERNATIVES 1 A-4

48 Table 14b Oologah-Talala EMS District Alternative 2 FTE's Description Labor Costs TOTAL FTE's TOTAL BASE SALARIES Overtime Pay TOTAL BASE SALARIES AND OVERTIME BENEFITS TOTAL LABOR COSTS FOR ALTERNATIVE 2 A-5

49 Table 14c Oologah-Talala EMS District Alternative 3 FTE's Description Labor Costs TOTAL FTE's TOTAL BASE SALARIES Overtime Pay TOTAL BASE SALARIES AND OVERTIME BENEFITS TOTAL LABOR COSTS FOR ALTERNATIVE 3 A-6