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Productivity Committee EMSAC Subcommittee Minutes 08/08/2008 EMERGENCY MEDICAL SERVICES ADVISORY COUNCIL (EMSAC) SUB-COMMITTEE AND PRODUCTIVITY COMMITTEE SUB-COMMITTEE Friday August 8, 2008 COLLIER COUNTY EMS HEADQUARTERS 2705 South Horseshoe Drive,Naples, Fl 34104 9:30 A.M. EMSAC District 1—Victoria DiNardo, Absent EMSAC District 4—Nancy Lascheid, Absent Productivity Committee—Janet Vasey, Chairman, Present Productivity Committee— Steve Harrison, Absent Productivity Committee—Joe Swaja, Absent Productivity Committee—Gina Downs, Present Staff Present: Jeff Page, Chief Artie Bay, Operations Analyst Dave Stedman, Database Administrator Jennifer Florin, Administrative Assistant Audience Present: Jorge Augilera,NNFD Ilene Stackel,NDN Meeting was called to order by Chairman Janet Vasey. There was no quorum present so the idea of postponing the meeting was discussed. It was determined that we could still go thru some ideas and plan on meeting again at the end of the month when we can be sure to have a quorum. Copies of the final consolidation report have been handed out and Janet stated that she wanted to see what EMSAC thought about it and if they wanted to pursue reviewing it themselves, or if they wanted this subcommittee to do that. She also stated that if this subcommittee doesn't go into the consolidation report that she would like to finish up in the next month or so with a final report. Janet asked Chief Page if anything was happening with the revenue sources that have been previously brought up. Chief Page stated that just recently Winter Haven had enacted a user fee for responding to car crashes. They are billing the at-fault driver, regardless if they are a tax payer for their county or not, for everything from EMS to fire and police involvement. They figured the fee to be around $800. He also added that some cities and counties in Florida have decided to charge a similar fee to drivers who are not tax payers in their respective city or county. However the attorneys in Winter Haven thought there might be some legal issues with that so they decided to charge the at-fault driver in all instances regardless of where they are from. He added that would be something we could add in the EMS user fees. However this wouldn't be able to address the fire districts. They would have to create a Page 2 user fee for their own district if they wanted. Chief Page also stated that we try and add anything that we want to the EMS user fee ordinance, but it will ultimately depend on the Manager and the Board supporting it. He stated that once we receive a recommendation from this subcommittee and from EMSAC we can then take it to the attorneys and the Manager's office. Janet stated that if we all agree we can submit it as part of the report and be prepared to discuss it with them. A concern that was brought up was the thought that this might be considered another tax. Chief Page brought up that there was a bill (which eventually died) that stopped fire departments from adding additional fees in lieu of the tax reform. Janet stated that was one idea she will be putting into the final report. Also she will be adding the hazardous materials fee. She stated that she wanted to go over the methodology of adding EMS units that was mentioned in the Master Plan today. Because that was one main topic the Productivity Committee wanted to review. Janet stated that she feels any methodology that doesn't include ALS engines in it somewhere is incorrect. She added that they do make a difference and they should be counted in some capacity. She felt that the methodology given in the Master Plan will not work. She added that she doesn't know that the correct number should be, but feels we are close with what we have now. She feels that it does need to be calculated by the population, but the main driver should be the current response times in reference to the goal. Unfortunately we can't really budget according to response times for years in the future, but it really shows your demand and that is what's important. Chief Page stated that in the end it has to be tied to population because that is what triggers the need for units. However you can back-door, so to speak, to include the response times and ALS engine impact. We did something similar to that last year and that's how we got the 16,400 number. He added that if we continue to use that number it immediately takes down the two units that we talked about in earlier meetings and it doesn't call for.a growth unit until 2010. Additionally we meet the national average of 7.7% using the 16,400 figure. He stated that he is comfortable using this same figure again; however this number may need to be reevaluated every year because of the ever changing population in Collier County. Chief Page also added that we have to take into consideration what the public can handle. He stated that if a response time of 12 minutes in the rural area is acceptable, then you gear for that. In some counties around the country there are 3 or 4 different sets of response times. They might have urban, rural, suburban, and wilderness; and in some cases the reasonable response time could be an hour. Dave Stedman stated that in the past we added and moved units based on the amount of calls in an area and/or the increased amount of time it takes to respond to an area; whereas now that we have defined the areas as being urban or rural we have to base our response times on the definition of whether an area is urban or rural. This means that even if a rural area becomes more populated to the point of being an urban area, we can't count on an 8 minute response time because it is still located and considered to be rural. Janet stated that she doesn't have a problem using the 16,400 figure; she just wants to come to an agreement that it is the correct figure and that it is the figure to be used in the AUIR calculations. She stated that she wanted there to be a method to count ALS engines, and also a method to change the calculation if another district decides to add ALS engines. She stated that if in the next year Golden Gate and Big Corkscrew add ALS engines that might indicate the need for less ambulances in the area. Chief Page stated that there will still be a need for transports regardless of how many ALS engines there are. He added that what he would recommend that each year the number be looked at and if we are in great shape one year then we adjust the number • Page 3 and don't add another unit. He stated that he feels we have the flexibility to change that number yearly if we feel there's a need to. Janet added that one of the things they wanted to look at in these subcommittee meetings is the calculations in the Master Plan and decide if we agree with them. She stated that she doesn't follow their methodology; however that doesn't mean that we might not come to a similar number using a methodology that includes the ALS assets. Gina agreed that the ALS engines need to be figured in to the figure. While Artie was getting copies of a graph of response times Ilene Stackel from the Naples Daily News had a question. She asked how we calculate response times for highly congested road construction areas, like Rattlesnake Hammock Road. Chief Page stated that the response times are what they are, and we notice fluctuations all over the county for construction and also season versus off season. Dave added that we look at the response times factually because of that reason. When we look at them by zone we can tell if there is a significant increase in a zone from quarter to quarter, and quite often it is because of congestion or construction. Chief Page added that just recently he had situation come up and he pulled all the reports to see why, and it ended up being because that unit was going out to Alligator Alley. He stated that is something that we look at regularly and try to figure out what is happening in each zone to account for the increased times. Once Artie came back with the graphs for everyone Dave stated that currently we are not making our performance goal of 90%. He stated that we recently decreased the performance measure to make the goal easier to attain, and we still aren't making it. We are close, but still not there. He then added that we are talking about getting rid of two units, which will make a significant impact on these percentages, and at what point are we going to look at the goal and determine that close is still not making it. Gina asked what he meant by making it easier to make the goal. He stated that 12 minutes in the rural areas is easier to make than 8 minutes countywide. Janet stated that looking at the graph she didn't see a significant change from last year to cumulative this year. She also stated that 88% or 87% is still very close to the goal. Dave stated that yes, we are close but his point is that we are still not meeting it, and why would we take units down if the performance measure is important. Chief Page stated that we have to take them down for budgetary reasons. He also added that it is understandable that there will be some impact and the graphs will be coming in less, we just don't know how much yet. Janet asked Dave if he was able to break the times down by urban and rural. Dave stated that he hasn't been able to do it yet and the problem he's having is that some zones have both. He did say that what he did do was extend the fractals out to 12 minutes instead of 10, and this way you can pull out the zones that are mostly rural and get an idea. He stated that the county defines rural as anything east of Collier Blvd, which is not the best definition because you have pockets of population that could be considered urban, Immokalee for example. Janet asked which of the zones would be considered mostly rural. Dave stated that those zones would be: 10, 30, 31, 32, 60, 61, and 71. There may be some others that have a portion east of Collier Blvd, but those are the ones with the most. Janet stated that looking at the fractals of both EMS and ALS engines some of the rural zones are not even coming close to 12 minutes. However some of the zones that are skewing the results are zones that respond mostly out of zones, or have very few calls. Page 4 Janet asked Chief Page if he can change schedules instead of downing two units. He stated he will have union issues if he tries to change someone from a 24/48 shift to a 12/24 shift. One thing he did think of is eliminating one medic on the helicopter. Currently we have two medics per shift, but we are only required to have one. So that may be a way to help with downing units. The pilots like having two medics with them to help watch for power lines or safety hazards. He added that we are trying everything we can think of to prevent layoffs because we want to limit the negative effect on the public. The staff realizes that they will be working harder and will be responding to more calls per unit due to this. Janet asked if there was anything in Master Plan that would help with this situation. She brought up the idea of prioritizing and organizing who goes on what calls. Chief Page stated that something like that would certainly help, however we have tried for years to do that and it hasn't been welcomed by the fire districts. He stated that he has a hard time because they are their own governments and can do what they want. Dave added that the Sheriff's Office has resisted also because of the dispatch confusion. Chief Page added that dispatch would be easier if we were allowed to have fire and EMS people in the dispatch center who know how to move units around as needed. That is something that was addressed in the consolidation report. Jorge Augilera from North Naples Fire stated that there are some departments that are willing to implement a call prioritization but the hesitation is how you implement it without the support of dispatch. He added that they realized there are ways to be more efficient, but no way to safely implement it without dispatch. Janet stated that she hesitates to make a lot of recommendations if the idea of consolidation is around the corner. Then the thought is that if you wait for consolidation to make recommendations and it gets pushed back and pushed back, at what point do you go ahead and build an EMS station, or add additional units. Dave stated that there still is the possibility that the individual district board can pull the plug and say no to the report. Janet asked if it would be a county wide vote on consolidation or if it would be the individual boards. Jorge stated that there is a way to have a county wide vote to give the individual boards the authority to voluntarily dissolve without another vote. Janet asked Chief Page if there was anything that he wanted the committee to look at before we write a final report. He stated that he does want some recommendations on the funding issues and also the AUIR calculations. Janet stated that again she doesn't see the 16,400 as a bad number. Chief Page stated that he feels it's a good number also because it allows us to go to 24 units instead of 26 and it doesn't account for another unit until 2010. However he does feel that the number should be looked at each year. Janet stated that she can support the 16,400 number to be used for the AUIR. Gina asked Chief Page what would happen if Alligator Alley becomes privatized what would be the impact. Chief Page stated that we would still be covering it, and we have provided them with a figure that we would require to cover it. He stated that he would send a copy of that figure to both Gina and Janet. Gina asked if the bills would go directly to the state. Chief Page stated that it doesn't prevent us from billing the individual; it just allows us to ramp up coverage there. It would go for unit and station costs. Janet asked if we planned to put a station there. Chief Page stated that we had been talking about it for awhile to speed up responses however the challenge now is we don't have a unit or personnel to put there. Janet stated that there were also some Page 5 recommendations for additional staff, like an Assistant Chief, and more Battalion Chiefs. She asked if that would be something he would be interested in. Chief Page stated that most fire districts have an Assistant Chief even if there are small departments. We don't have one so there really isn't a second in command. We have two Deputy Chief's that work in the office, and right now they are covering everything. In the past the County Manager has been supportive but there really isn't any money to do it. He stated that it not really hurting now, but when he retires there needs to be someone who is ready to fill the spot. Janet added that she has noticed also that the fire districts are a bit top heavy. Chief Page stated that in the past when we needed more positions they always went to the road because that was where you made the biggest impact to the public. He stated that he pretty much agreed with all the recommendations they made, but the financial situation has changed drastically since the report was done. Janet stated that next meeting we should decide if we are going to wrap it up with a final report or go into the consolidation study. She stated that she wants to see how EMSAC wants to address the consolidation study first. They may want to review it themselves versus having a small group do it. Also we need to see what the Productivity Committee wants to do with it. Gina asked if there was any movement on the topic of adding fees to tickets. Chief Page stated that he will try to get the actual Ordinance from Hernando County and maybe we can piggy-back off it. Chief Page also brought up the hazardous materials fee that was talked about earlier. He asked if the group would want to make it just a county ordinance, or write it so the fire districts could join in also. Janet stated that she felt we should write it as broad as we could. Janet stated that at the next meeting she will have a draft final report that addresses each issue and we can go through it and finalize it. Public comment No additional public comment General committee comment No additional committee comment Respectfully Submitted, Jennifer Florin Date Adopted: Chairman/ SubCommittee Member Signature