Emergency Medical Services Budget Unit 4200 Department Head: Ross Elliott, Appointed

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1 Emergency Medical Services Budget Unit 4200 Department Head: Ross Elliott, Appointed SUMMARY OF EXPENDITURES AND REVENUES APPROPRIATIONS: Salaries and Benefits Services and Supplies Fixed Assets TOTAL EXPENDITURES FY Actual FY FY Approved Budget Estimated Actual Department Requested CAO Recommended Incr/(Decr) From Budget $800,171 $586,582 $747,639 $790,169 $626,083 $39, , , , , ,735 (295,912) 0 10, (10,000) $1,129,890 $1,364,229 $1,475,568 $1,127,471 $1,097,818 ($266,411) REVENUES: Licenses and Permits $140,598 $161,960 $144,625 $316,478 $134,284 ($27,676) Use of Money/Property Intergovernmental 461, , , , ,967 (271,161) Charges for Services 145, , , , ,120 0 Miscellaneous 10, Other Financing Sources: Emergency Medical Services Fnd 0 304, , , ,235 15,644 TOTAL NET REVENUES $758,368 $1,322,419 $1,435,221 $1,127,470 $1,039,326 ($283,093) NET GENERAL FUND COST $371,522 $41,810 $40,347 $1 $58,492 $16,682 Authorized Positions: Funded Positions: OPERATIONAL SUMMARY Mission: Fundamental Functions & Responsibilities: Facilitate the delivery of high quality emergency medical services to those people in Kern County facing immediate lifethreatening illness or injury in order to decrease instances of death and disability. Optimal, high quality patient care Timely responses to emergencies Timely payment of EMS Fund claims Maintain preparedness for disaster response PROGRAM DISCUSSION The recommended budget provides sufficient funding to support the department s functions at existing service levels. The recommended budget will also allow the department to ensure that patients receive optimal, high quality, and timely emergency medical care to improve survival of sudden injury or illness. The recommended budget includes the planned use of $282,000 in Budget Savings Incentive (BSI) credits and services and supplies expenditures were decreased by $295,912 to enable the department to offset negotiated salary increases of $39,501 and a reduction in revenue of $283,000. The department will continue to manage the Emergency Medical Payments budget unit 4201 and Ambulance Service Payments budget unit Associated with the goal of providing quality emergency medical services and response, the department will conduct work in the following major areas in FY : Ongoing monitoring of ambulance service performance standards to ensure compliance with contract requirements will remain a high priority. County of Kern Recommended Budget 187

2 Ongoing department functions including coordination of multiple committees and task forces; and accrediting and certifying County pre-hospital personnel, emergency medical dispatchers, and mobile intensive care nurses. Case reviews and incident investigations; administration of the trauma system and State trauma funding; oversight of medical dispatch advancement; and collection of over 140,000 patient records generated annually. Participation in Homeland Security and disaster preparedness planning and drills as part of the department s efforts along with those of the Public Health Department, Kern County Emergency Council, City of Bakersfield, and all hospitals to ensure disaster readiness. POSITIONS DISCUSSION The recommended budget includes no position additions or deletions. DIRECTOR S DISCUSSION The department is in agreement with the County Administrative Office s recommended budget. GOALS & PERFORMANCE MEASURES Performance Measure #1: Percentage of paramedic compliance with treatment protocols. 96.6% 98.28% 95 to 100% 96.79% 95 to 100% This indicator measures ambulance field personnel s (EMTs and paramedics) compliance with treatment protocols for pharmacology, medical intervention, and documentation. Random samples of records from each ambulance service are audited annually to determine compliance. Field personnel provide specific medical treatments dependent upon the signs and symptoms a patient is displaying. Compliance with the treatment protocols ensures appropriate medical care is provided. The measurement is an indication of the department s ability to oversee and monitor the EMS system and ensure compliance with policies and procedures. The FY actual mid-year results (July -Feb) are on target and within the acceptable range; compliance is being achieved. 218 records were randomly selected and reviewed, with 211 records being fully compliant. The department began tracking this indicator in FY allocation of 2.2 FTE. These activities are partially funded by service fees to ambulance companies, hospitals, and EMS personnel, special purpose EMS (Maddy) Fund (a portion of the discretionary segment of the fund), accumulated BSI credits, and a small segment of the General Fund. County of Kern Recommended Budget 188

3 Performance Measure #2: Percentage of Emergency Medical Dispatcher accuracy in following interrogation protocols and giving instructions. Dispatch Center FY Actual Results FY Actual Results FY Mid-Year Results Adopted Goal Emergency Communications Center 98.9% 99.06% 98.88% 97 to 100% Ambulance Company Dispatch Operations N/A 96.57% 96.37% 95 to 100% This indicator measures the emergency medical dispatcher s overall accuracy rate in following the required caller interrogation protocol, providing appropriate post-dispatch and pre-arrival instructions to callers, and providing appropriate customer service. Random samples of records are audited monthly to determine compliance; the results are reported to the department. The measurement is reported separately for the Emergency Communications Center (ECC) and the aggregate of the individual ambulance dispatch operations. Local statistics on ambulance company dispatch operations were collected for the first time in FY Dispatchers send specific types of emergency personnel, resources, and equipment based on the information they extract from the caller regarding the patient s condition. Compliance with emergency medical dispatch protocols ensures appropriate medical care is provided. The measurement is an indication of the department s ability to oversee and monitor the EMS system and ensure compliance with policies and procedures. The FY actual mid-year results (July-Dec) are on target and within the acceptable ranges; compliance is being achieved. Both the Emergency Communications Center (ECC) and the aggregated scores for the ambulance dispatch operations are meeting the performance targets. ECC is an Accredited Center of Excellence (ACE), and the national average of all ACEs for the same time period is 97.62%, and ECC is well above the national average. allocation of 0.9 FTE. These activities are partially funded by service fees to ambulance companies, hospitals, and EMS personnel, special purpose EMS (Maddy) Fund (a portion of the discretionary segment of the fund), accumula ted BSI credits, and a small segment of the General Fund. County of Kern Recommended Budget 189

4 Performance Measure #3: Percent of instances in which ground ambulances arrive on the scene within the required response time of Priority 1, Priority 2, and Priority 3 calls. 96.5% 94.51% 90 to 100% 96.91% 90 to 100% This indicator measures the percentage of time ambulances arrive at the scene of emergencies within the required response times. Each ambulance provider reports to the department the number of emergency calls per month for each response time zone and the number of emergency calls per month for each response time zone that are on time (i.e., 8 minutes in a designated metro area for a Priority 1 call). The indicator being reported is the overall compliance rate for all ambulance providers countywide annually. Ambulances are required to respond to the scene of emergencies within a certain amount of time from the time the call is received. Compliance must be achieved 90 percent of the time, per month, per time zone. Survival rates for many types of medical emergencies increase if patients receive appropriate care rapidly. Establishing time standards helps ensure care is provided as quickly as possible most of the time. The measurement is an indication of the department s ability to oversee and monitor the EMS system, establish time zone standards, and ensure compliance with policies and procedures. The FY actual mid-year results (July -Feb) are on target and within the acceptable range; compliance is being achieved. As many as 10 percent of the calls are allowed to be late, yet only 3.09 percent of the calls are late; response time compliance is very high. allocation of 1.1 FTE. These activities are partially funded by service fees to ambulance companies, hospitals, and EMS personnel, special purpose EMS (Maddy) Fund (a portion of the discretionary segment of the fund), accumulated BSI credits, and a small segment of the General Fund. County of Kern Recommended Budget 190

5 Performance Measure #4: Average number of days after valid EMS Fund claims were made that physicians were paid. 47 days 23 days 15 to 45 days 17 days 15 to 45 days This indicator shows the average number of days for physicians to be reimbursed for emergency medical care they provided to nonpaying patients (i.e., indigent, poor, or uninsured) through the EMS (Maddy) Fund. A total of 180 days has been deducted from the total elapsed time in accordance with State regulations for this program. The measure is showing the timeframe for which the County has discretion. The EMS Fund is the payor of last resort. When a physician has rendered emergency medical care, invoiced a patient twice, definitively determined that the patient has no insurance of any kind, and determined that the patient is not going to make any payments, the physician may file a claim to the EMS Fund. This measure is an indication of the effectiveness of the department at processing claims. The FY actual mid-year results (July -Feb) are on target and within the acceptable range; compliance is being achieved. Over the past five years, there has been a steady decrease in claims processing times, resulting in faster payment to physicians each year. The number of claims in FY (15,252) has more than doubled compared to the estimated FY volume of some 37,000. The department s workload has doubled; yet the claims are being paid faster each year. FY = 55 days; FY = 47 days; FY = 23 days; and FY = 17 days allocation of 1.6 FTE. These activities are partially funded by special purpose EMS (Maddy) Fund (administrative co sts reimbursement plus a portion of the discretionary segment of the fund), and accumulated budget savings incentive credits. County of Kern Recommended Budget 191

6 Performance Measure #5: Hours annually devoted to disaster preparedness activities. N/A 3,563 3,000 Est. 3,545 3,500 The level of disaster preparedness is not something easily measured. In prior performance measures, a narrative was used to describe major preparedness activities for the year. However, a narrative description does not provide the ability to quantify performance, or to measure one year against another. The proposed performance measure is an output measurement; simply the hours devoted to the activity. This allows a side-by-side comparison of one year s level of effort to another. Most of the disaster preparedness activities are based on grant funding. The amount of staff time devoted to disaster preparedness activities is largely a result of fulfilling an obligation to implement the grant program. If grant funding for disaster preparedness increases, so will the level of effort. Conversely, as grant funding diminishes it can be anticipated that disaster preparedness activities will, too. Measuring hours rather than measuring grant dollars gives a more accurate assessment of the department s effort inasmuch as most of the grant funds are used to purchase supplies and equipment. Equipment inventory in itself does not give a meaningful measure of preparedness. The department began collecting detailed staff time records in October Consequently, there is not a long history of the data available for this measurement. During the 2007 calendar year, the department devoted 3,949 hours directly on disaster preparedness activities. Grant funding for FY was anticipated being reduced; therefore the target hours was lowered accordingly. In the course of the year, some of the grant funds were unexpectedly replaced, there increasing hours devoted to this activity. allocation of 2.5 FTE (including overhead costs). These activities are largely funded by the Regional Disaster Medical Health Specialist grant, bio-terrorism grant through Public Health Department, and four federal HRSA grant programs. A small portion of these activities are funded by special purpose EMS (Maddy) Fund (a portion of the discretionary segment of the fund), accumulated budget savings incentive credits, and a small segment of the General Fund. County of Kern Recommended Budget 192