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1988-08-09 PacketIr'-1ESTERFIELD COUN,L( CHESTERFIELD, VIRGINIA 23832 AGENDA BOARD OF SUPERVISORS G. H. APPLEGATE, CHAIRMAN CLOVER HILL DISTRICT C. F. CURRIN, JR., VICE CHAIRMAN BERMUDA DISTRICT HARRY G. DANIEL DALE DISTRICT JESSE J. MAYES MATOACA DISTRICT MAURICE B. SULLIVAN MIDLOTHIAN DISTRICT LANE B. RAMSEY COUNTY ADMINISTRATOR DATE: AUGUST 9, 1989 COURTHOUSE A TIME: 1:00 P.M. 1. Call to Order at 1:00 p.m. County Administration Building Room 502 2. Work Session - Emergency Medical Services Study 3. Resolution Recognizing Mr. Leland B. Anderson Upon Celebrating His 100th Birthday 4. Executive Session for Consultation with Legal Counsel Pursuant to Section 2.1-344(a)(7) of the Code of Virginia, 1950, as Amended, Regarding 1. Martha Grimsley Clodfelter v. Dorothy West; 2. Probable Litigation Relating to Richard Powers, et al. v. Wanda Frazier and County of Chesterfield, 3. Specific Legal Matters _.._ __ Relating to the ScanCenter; and Section .l- a 3 or T�nsideration of the Use and Disposition of Publicly Held Park Property 5. Adjournment 5 q �� MEETING DATE: CHESTERFIELD COUNTY BOARD OF SUPERVISORS AGENDA August 9, 1989 ITEM NUMBER: 2. SUBJECTWORK SESSION - EMERGENCY MEDICAL SERVICES STUDY COUNTY ADMINISTRATOR'S COMMENTS: SUMMARY OF INFORMATION: Staff will review the attached recommendations and implementation schedule for the Emergency Medical Services Study at the August 9, 1989 work session. No formal action on the recommenda- tions will be requested at this time. PREPARED BY: ATTACHMENTS: YES 09 NO 0 SIGNATURE: r1_44e, COUNirY ADMINISTRATOR '`400 PROPOSED PHASING OF TASK FORCE RECOAENDATIONS General Support Increase in County Donation of $5,000 per Squad Hepatitis Vaccines for Volunteers Volunteer Training Coordinator Volunteer Recruitment/Retention Field EMS Supervisor Quality Assurance Analyst Continuing Education Administrative Support Total General Support Operations Costs Ettrick-Matosca Advanced Life Support Manchester - 2-Man Basic Life Support Crew, Monday -Friday Daytime Only Dale Fire Station - 2-Man Advanced Life Support Crew, 24-Hour/Day, 7 Day/Week Forest View Sub -Station - 2-Man Basic Life Support Crew, Monday -Friday, Daytime Only Clover Hill Fire Station - 2-Man Advanced Life Support Crew, 24-Hour/Day, 7 Days/Week Bensley Fire Station - 2-Man Basic life Support Crew, Monday -Friday, Daytime Only Airport Fire Station - 2-Man Basic Life Support Crew, Monday -Friday, Daytime Only Total Operations Total General Support GRAND TOTAL Sources of Funds Reserve for EMS (already appropriated) Anticipated Revenue from Charges for EMS Service** Amount (FY90 Dollars) FY90 FY91 FY92 S 20,000 S 20,000 S 20,000 30,000 13,000 13,000 60,800 42,800 42,800 52,700 w 40,100 40,100 55,400 44,200 44,200 39,100 37,000 37,000 * 169,700 193,500 * 173.400 160.100 258,000 540,200 550,700 * * * * 125,000 125,000 141,700 130,900 130,900 93,800 125,000 125,000 N/A 184,200 130,900 N/A 125,000 125,000 N/A N/A 125,000 235,500 690.100 761,800 258.000 540.200 550,700 $493.500 S1_230.300 51,312.500 $200,000 To be determined through $293,500 Budget Process 00002 * These costs are funded in the FY90 Budget or will be absorbed in the FY90 Budgets. ** Staff is recommending that a fee be charged for EMS services that are provided by paid County providers. in M Connents for Lane - EMS Work Session August 9, 1989 * EMS Study conducted Fall, 1989 '* EMS Study presented to Board January, 1989 * Chairman directed County Administrator to appoint work group to develop Recommendations for Boards' review * Appointed Task Force March, 1989 (has met 20 times in 20 weeks) * Recognition that County already in EMS Business and that demand for services increasing as County grows, Task Force given following objectives: --*- Establish a quality assurance program for delivery of skilled pre -hospital patient care. * Develop programmatic and operational standards which will be followed by both volunteers and County staff in order to most effectively utilize resources and reduce duplication of effort. * Preserve and enhance the EMS volunteer system * Meet the growing demand for EMS services * Establish the County Administrator as responsible for EMS in Chesterfield County * Recognition of Task Forces accomplishments System meeting needs of County A COUNTY AUMINISTRATOk EMS TASK FORCE RECOMMENDATION 08-09-1989 L E5 I BOARD OF SUPERVISORS G. H. APPLEGATE, CHAIRMAN CLOVER HILL DISTRICT C. F. CURRIN, JR., VICE CHAIRMAN BERMUDA DISTRICT HARRY G. DANIEL DALE DISTRICT JESSE J. MAYES MATOACA DISTRICT M CHESTERFIELD COUNTY P.O. BOX 40 CHESTERFIELD, VIRGINIA 23832 (804) 748-1211 August 2, 1989 MAURICE B. SULLIVAN MIDLOTHIAN DISTRICT The Honorable Members Chesterfield County Board of Supervisors Chesterfield, Virginia 23832 Chairman Applegate and Honorable Members of the Board: COUNTY ADMINISTRATOR LANE B. RAMSEY I am pleased to submit to you my Recommendations for changes to Chesterfield County's Emergency Medical Services. As .you know, a comprehensive study was conducted last year by Buracker & Associates. In March 1989, an Emergency Medical Services Task Force was created with representation from the four rescue squads, Police, Fire, and Amy Davis from my staff to study and make recommendations. Most of the recommendations which will be presented on Wednesday are a direct result of the diligent work of the Task Force. We will review these recommendations with you on Wednesday and anticipate asking Board action at the August 23 meeting. You will not be asked to take formal action on Wednesday. In addition, it is my sincere hope that the Board will recognize the commitment of many hours spent by the Task Force in 11L, negotiating and compromising to create this program. Sincerely, Lane B. Ramsey County Administration LBR/le Attachment R 0 TABLE OF CONTENTS Emergency Medical Services Task Force List....................I LRecommendations .............................................III Glossary......................................................V Introduction..................................................1 Patient Care..................................................3 Organizational Structure......................................9 Positions Requests To Be Funded..............................10 Incident Command.............................................13 Appendix I...................................................17 Appendix II..................................................18 Appendix III.................................................19 Appendix IV..................................................20 Appendix V...................................................22 Appendix VI..................................................23 EMERGENCY MEDICAL SERVICES TASK FORCE Amy Davis, Task Force Chairman Executive Assistant Co. Admin. P.O. Box 40 Chesterfield, Virginia 23832 748-1909 F. Wesley Dolezal Assistant Fire Chief Chesterfield Fire Department P.O. Box 40 Chesterfield, Virginia 23832 748-1226 Steve A. Elswick Battalion Chief Chesterfield Fire Department P.O. Box 40 Chesterfield, Virginia 23832 748-1556 Hugh H. Hemsley, Jr. M.D., FACEP Chesterfield Fire Department Medical Advisor 5712 Oak Knoll Road Midlothian, Virginia 23113 320-0070 Earl Lutterman Chief Operations Officer Ettrick - Matoaca Volunteer Rescue Squad 17409 Leamaster Petersburg, Virginia 23803 590-1263 Dennis G. McDonald Captain Chesterfield Police Department P.O. Box 40 Chesterfield, Virginia 23832 748-1256 James P. McGuire, President Chesterfield Rescue Squad Association 7704 Mendota Drive Richmond, Virginia 23229 271-5848 I r.. too LNelson T. Negaard President Manchester Volunteer Rescue Squad 3700 Cottrell Road Richmond, Virginia 23234 275-7040 Stanley Orchel, Jr. President Bensley-Bermuda Volunteer Rescue Squad 13510 Split Creek Drive Chester, Virginia 23831 786-1763 Paul A. Shorter Battalion Chief Chesterfield Fire Department P.O. Box 40 Chesterfield, Virginia 23832 748-1237 Greg Spurlock Chief Operations Officer Forest View Volunteer Rescue Squad 1130 Huntersdell Terrace Richmond, Virginia 23235 282-3114 Consultants Carol Warner EMS Coordinator Chesterfield Fire Department P. 0. Box 40 Chesterfield, Virginia 23832 748-1360 Anne Cochrane Budget & Management Analyst Budget & Management Department P. 0. Box 40 Chesterfield, Virginia 23832 748-1983 Jay Stegmaier Director Budget & Management Department P. 0. Box 40 Chesterfield, Virginia 23832 748-1548 0 II ern' Recommendations 1. It is recommended that the Chesterfield County Y EMS system set as a goal response time for basic life support (BLS) providers at 6 minutes allowing an additional 4 minutes for advanced life support (ALS) providers to arrive on the scene. 2. It is recommended that the resources of rescue and fire combined manpower and equipment to support achievement of the BLS and ALS minute response time goal at the following locations: -Bensley-Bermuda Rescue Squad Station - Jefferson Davis Highway -Ettrick-Matoaca Rescue Squad Station - River Road -Forest View MIDLOTHIAN Rescue Squad Station - Route 60 and Grove Road -Manchester Rescue Squad Station - Route 360 and Courthouse Road -Cloverhill Fire Station - Route 360 and Deer Run Road -Dale Fire Station - Route 10 and Rock Spring Drive -Fire Station 15 - Chesterfield County Airport -A floating crew 3. It is recommended that the response time goals and the capability of the closest available unit will determine what unit is dispatched on Priority I calls. An ambulance only will be dispatched on Priority II and III. If there are no available rescue squad crews, the closest fire engine will be dispatched as the first responder. 4. It is recommended that the Chesterfield EMS system provide the following manpower: a. Monday - Friday 6 a.m. - 6 p.m. 3 Volunteer Crews 5 Salaried Crews b. Monday - Sunday Remaining time periods 6 Volunteer Crews 2 Salaried Crews III R 0 err►' 5. It is recommended that the Volunteer Rescue Squad Operations Office will notify the Fire Department 24 hours prior to each shift as to the number of volunteer crews available. 6. It is recommended that the Volunteer Rescue Squads will provide ambulances at the identified strategic locations. 7. It is recommended that an EMS Training Coordinator position be funded for the sole purpose of coordinating training efforts on all levels for the members of the volunteer rescue squads in conjunction with all other EMS providers. 8. It is recommended that an EMS Field Supervisor position be funded to ensure maintenance of skill proficiency; to supervise application of skills; to identify potential or existing problems; to make recommendations for improvements based on field observations; and to coordinate and maintain communication with the volunteers and career staff. 9. It is recommended that semi -automatic defibrillators be provided at the following locations: Company 8 Matoaca Company 12 Ettrick Company 14 Dutch Gap Company 15 Courthouse Spare Training/Replacement of broken defibrillators 10. It is recommended that a Chesterfield County Emergency Medical Services Advisory Council be established to replace the current Chesterfield Volunteer Rescue Squad Association to provide the EMS system a structure for support, guidance and accountability for a quality pre -hospital patient care. 11. It is recommended that an EMS Recruitment and Retention Coordinator be funded for the development of an aggressive recruitment and retention program for Volunteer Rescue Squad members and Volunteer Firefighters. ' 12. It is recommended that an EMS Systems Analyst position be funded for the development of an EMS database with attention to quality assurance, budgeting, research, audit activities and medical legal consideration. 13. It is recommended that the Incident Command System be adopted by all EMS providers as the comprehensive multi -agency management system for all resources at every emergency incident. IV L *%W -4 Glossary L1. Basic life support is a level of pre -hospital and inter -hospital emergency care which includes the recognition of other life threatening conditions which may result in respiratory and cardiac arrest, and the application of life support functions including cardiopulmonary resuscitation (CPR), use of adjunctive techniques and procedures. 2. Advanced life support is a sophisticated level of pre -hospital and inter -hospital emergency care which includes basic life support functions including cardiopulmonary resuscitation (CPR) plus cardiac monitoring, cardiac defibrillation, telemetered electrocardiography, administration of antiarrythmic agents, intravenous therapy, administration of specific medications, drugs and solutions, use of adjunctive ventilation devices, trauma care, and other authorized techniques and procedures. 3. Emergency Medical Services (EMS) are the services utilized in responding to the perceived individual needs for immediate medical care in order to prevent loss of life or aggravation of physiological or psychological illness or injury including any or all of the services which could be described as basic life support, advanced life support, specialized life support, patient transportation, medical control and rescue. 4. Emergency Medical Services Personnel (EMS Personnel) Persons responsible for the direct provision of emergency medical services in a given medical emergency including any or all persons who could be described as an attendant, attendant -in -charge, or operator. 5. Emergency Medical Services System (EMS System) A system which provides for the arrangement of manpower, facilities, equipment, and other system components for the effective and coordinated delivery of emergency medical services in an appropriate geographical area. 6. Rescue A service which may include the search for persons lost, gaining access to persons trapped, rescue of persons in potentially dangerous situations, and the rendering of assistance to such persons. V R t 6� 4 INTRODUCTION Lane B. Ramsey, the Chesterfield County Administrator, appointed the Emergency Medical Services Task Force in March 1989 to develop an EMS System which would efficiently and effectively utilize County and Volunteer Rescue Squad fiscal and manpower resources in delivering quality pre -hospital patient care and, that would preserve and enhance the viability and integrity of the volunteer system. The work of the Task Force follows months of evaluation of the system by professional consultants and personnel from volunteer rescue squads, police, fire, and the medical community. One of the major accomplishments of the Task Force has been to strengthen communication and working relationships between Volunteers and County staff. Each Task Force volunteer representative has provided information based on their respective squads needs and input. Decisions were made on a consensual basis which supported the constant negotiation process and the willingness for all Task Force members to look at all sides of each recommendation. Throughout this process, the Task Force made decisions based on the County Administrator's clear direction of improving patient care and maintaining the volunteer system. During the months that the Task Force worked on the recommendation, the volunteers expressed a strong desire for the establishment of a separate EMS Service. A third service with infrastructure separate from the Fire Department which would "fir'` '*0 ELEMENTS OF PATIENT CARE The Chesterfield County Emergency Medical Services System's primary goal is provision of quality pre -hospital care. There are several critical elements which impact the system's ability to provide quality pre -hospital patient care. As 6 Chesterfield continues to develop residentially and commercially, � the maintenance and future , planning of the system's operation must encompass State and Regional EMS patient care standards, strategic location of fiscal plants and manpower resources, on -going training and skill development, and the community's �r education and financial support for a viable volunteer system. Response Time Response time is calculated from the time a Chesterfield resident calls 9-1-1 to the time an EMS provider arrives on the scene. Chesterfield's Emergency Communication Center contains trained emergency medical technician dispatchers who are able to provide reassurance and basic life support instructions until an on -site EMS provider arrives. The recommended response time for basic life support providers is 6 minutes allowing an additional 4 minutes for advanced life support providers to arrive on the scene. This is based on response time standards recommended by the American Heart Association. During the assessment of the current EMS system's ability to respond within the 6-10 minutes response range, a natural "urban" corridor was identified which indicated the major growth pattern ,, 3 of residential and business development within the County (see Appendix I). This corridor contains 92% of Chesterfield County's population. The 1988 county emergency medical service call statistics, indicate that 91% of the EMS calls run were in this corridor. As shown in Appendix II, the EMS providers currently are able to reach a large portion of this corridor within a 6-10 minute range. The Task Force is recommending the combined utilization of the Fire Department and the Volunteer Rescue Squad resources to enhance the capability of providing basic life support within 6 minutes and advanced life support within 10 minutes in the majority of the corridor (see Appendix III). Additionally, based on this recommendation, the 6-10 minute response time is expanded into the less populated areas in the western and southern parts of the County. This ultimately decreases the amount of time it takes to respond to areas which are currently less populated and correspondingly where less calls originate. Constant strategic planning of resource allocation must occur to provide standard response times as the County's population and business community grows into the less populated areas. It is recommended that response time goals and the capability of the closest available unit be the criteria for emergency communication's decision as to what unit is dispatched on 4 Priority I calls. An ambulance only will be dispatched on Priority II and III calls. If there are no available rescue squad crews in the immediate area, the closest available fire engine will be dispatched as the first responder. See Appendix IV for definition of Priority I, II, III calls. It is the further recommendation of the County Administrator that the County EMS Coordinator work with the EMS Advisory Council in developing methods to achieve improved response times in all areas of the County as resources become available. Resource Allocation The following facility locations have been identified as strategic locations for placement of ambulances and manpower. These were identified because of the need and the capability of EMS providers meeting the Basic Life Support and Advanced Life Support response time goals. -Bensley-Bermuda Rescue Squad Station - Jefferson Davis Highway -Ettrick-Matoaca Rescue Squad Station - River Road -Forest View MIDLOTHIAN Rescue Squad Station - Route 60 and Grove Road -Manchester Rescue Squad Station - Route 360 and Courthouse Road -Cloverhill Fire Station - Route 360 and Deer Run Road -Dale Fire Station - Route 10 and Rock Spring Drive -Fire Station 15 - Chesterfield County Airport -A floating crew ,W In assessing manpower, the primary focus was determined to be providing the EMS system with qualified, trained individuals who would support quality service levels. Analysis of response time and County wide EMS call load indicates the need for a minimum of 8 crews on a 24 hour basis. A total of 5 career crews ( two of Lwhich will be needed on a 24 hour basis) and three volunteer crews are needed Monday through Friday from 6 a.m. to 6 p.m. 5 This was identified by the squads as a critical need at this time. A minimum total of 6 volunteer crews and two career crews are needed to cover the remaining times during a 7 day period. The operations officers in each rescue squad will notify the Fire Department operations Battalion Chief 24 hours prior to each shift with the number of volunteer crews available. It is recommended that Fire Department and volunteer operational staff workout the details of placement of the crews. Volunteer crews can replace or ride with career crews as they are available. As the Volunteer Recruitment and Retention Program is implemented and the squads' membership grows, the volunteers will replace career staff. The volunteer squads will provide ambulances where needed at the above strategic locations. It is recommended that these arrangements be handled by Fire and Rescue operations personnel. Training Uniformity of training and skills maintenance is vitally important to quality pre -hospital patient care and the overall EMS program quality assurance of Chesterfield's EMS System. It is recommended that an EMS Training Coordinator position be funded for the sole purpose of coordinating training efforts on all levels for the members of the Rescue Squads volunteer in conjunction with all other EMS providers. Please refer to N. A L 1%W Appendix V for levels of training and required man hours. LThis position will coordinate training efforts with the County EMS Coordinator and the Advisory Council. Implementation of this recommendation will ensure consistent, quality training and availability of training to all EMS providers. In addition, it is hoped that this will remedy a current problem of volunteers waiting so long to be trained after initial recruitment. This inturn will increase a new recruit's incentive to maintain his or her active volunteer sta tus. Skill Proficiency A major quality assurance area for patient care is the level and application of EMS skills. It is recommended that an EMS Field Supervisor position be funded to ensure maintenance of skill proficiency; to supervise application of skills; to identify potential or existing problems; to make recommendations for improvements based on field observations; and to coordinate and maintain communication with the volunteers and career staff. In addition, it is felt that the implementation of this recommendation will positively impact Risk Management. Equipment The combined equipment of the Volunteer Squads and the Fire Department provides a satisfactory pool of resources. It is recommended however that all identified strategic locations be equipped with semi -automatic defibrillators which will increase the system's capability of providing advanced life support within 7 L the standard response time. The need for defibrillators has been identified for location within the Fire Department. One of five will be used for training and replacement purposes. As the volunteers have agreed to provide ambulances at all strategic locations, it is recommended that maintenance and equipment replacement schedules be developed and coordinated at the operational level. It is also recommended that the EMS Advisory Council have as a part of their Annual Report to the County Administrator, an accounting of all County and Volunteer ALS/BLS equipment and vehicles for the purpose of financial planning and resource allocation. W L %W *so ORGANIZATIONAL STRUCTURE L Emergency Medical Services Advisory Council Representation 1 person from Bensley-Bermuda Rescue Squad x 1 person from Ettrick-Matoaca Rescue Squad 1 person from Forest View Rescue Squad 1 person from Manchester Rescue Squad 1 person from Chesterfield County Fire Lr Department 1 person from Chesterfield County Police Department ' 1 Board appointed citizen at large r Emergency Medical Services Coordinator Emergency Medical Services Field Supervisor 2 No Vote (Staff Position) area hospital persons (1 Rotating Operational Medical Director, 1 Hospital person ER or administrator, rotating terms of service from the hospitals serving the Chesterfield Area). Choice is at the discretion of the hospital Functions *Strong participatory/advisory structure which provides support and guidance to the EMS System's quality assurance programs. *Provides full representation to all departments within the EMS System (Volunteer Rescue, Police, Fire) *Reviews protocol and operational procedures being applied in the field. Identifies areas needing improvement and proposes solutions. *Provides resolution process for issues which may arise in the EMS System *Prepares annual report to County Administrator regarding yearly activity of EMS System. (See Appendix VI) 9 0 -1ESTERFIELD COUN,;-J CHESTERFIELD, VIRGINIA 23832 AGENDA BOARD OF SUPERVISORS G. H. APPLEGATE, CHAIRMAN CLOVER HILL DISTRICT C. F. CURRIN, JR., VICE CHAIRMAN BERMUDA DISTRICT HARRY G. DANIEL DALE DISTRICT JESSE J. MAYES MATOACA DISTRICT MAURICE B. SULLIVAN MIDLOTHIAN DISTRICT LANE B. RAMSEY COUNTY ADMINISTRATOR DATE: AUGUST 9 1989 COURTHOUSE TIME: 1:00 P.M. 1. Call to Order at 1:00 p.m. County Administration Building Room 502 2. Work Session - Emergency Medical Services Study 3. Resolution Recognizing Mr. Leland B. Anderson Upon Celebrating His 100th Birthday 4. Executive Session for Consultation with Legal Counsel Pursuant to Section 2.1-344(a)(7) of the Code of Virginia, 1950, as Amended, Regarding 1. Martha Grimsley Clodfelter v. Dorothy West; 2. Probable Litigation Relating to Richard Powers, et al. v. Wanda Frazier and County of Chesterfield, 3. Specific Legal Matters Relating to the ScanCenter; and Section . 1 - 3 4ATa-T(-3J-f-d-r--M---Cdhsideration of the Use and Disposition of Publicly Held Park Property 5. Adjournment q�� f. 9 CHESTERFIELD COUNTY BOARD OF SUPERVISORS ' AGENDA MEETING DATE: August 9, 1989 ITEM NUMBER: 2 SUBJECTWORK SESSION - EMERGENCY MEDICAL SERVICES STUDY COUNTY ADMINISTRATOR'S COMMENTS: SUMMARY OF INFORMATION: Staff will review the attached recommendations and implementation schedule for the Emergency Medical Services Study at the August 9, 1989 work session. No formal action on the recommenda- tions will be requested at this time. PREPARED BY: ATTACHMENTS: YES 09 NO ❑ 00001 SIGNATURE: rl_4� COUN ADMINISTRATOR r.19� PROPOSED PHASING OF TASK FORCE RECOMMENDATIONS General Support Increase in County Donation of $5,000 per Squad Hepatitis Vaccines for Volunteers Volunteer Training Coordinator Volunteer Recruitment/Retention Field EMS Supervisor Quality Assurance Analyst Continuing Education Administrative Support Total General Support Operations Costs Ettrick-Matoaca Advanced Life Support Manchester - 2-Man Basic Life Support Crew, Monday -Friday Daytime Only Dale Fire Station - 2-Man Advanced Life Support Crew, 24-Hour/Day, 7 Day/Week Forest View Sub -Station - 2-Man Basic Life Support Crew, Monday -Friday, Daytime Only Clover Hill Fire Station - 2-Man Advanced Life Support Crew, 24-Hour/Day, 7 Days/Week Bensley Fire Station - 2-Man Basic Life Support Crew, Monday -Friday, Daytime Only Airport Fire Station - 2-Man Basic Life Support Crew, Monday -Friday, Daytime Only Total Operations Total General Support GRAND TOTAL Sources of Funds Reserve for EMS (already appropriated) Anticipated Revenue from Charges for EMS Service** Amount (FY90 Dollars) FY90 FY91 FY92 S 20,000 S 20,000 S 20,000 30,000 13,000 13,000 60,800 42,800 42,800 52,700 w 40,100 40,100 55,400 44,200 44,200 39,100 37,000 37,000 * 169,700 193,500 * 173,400 160,100 258,000 540.200 550.700 * 125,000 125,000 141,700 130,900 130,900 93,800 125,000 125,000 N/A 184,200 130,900 N/A 125,000 125,000 N/A N/A 125,000 235,500 690.100 761.800 258,000 540.200 550,700 S493,500 SI 230.300 $1.312.500 $200,000 To be determined through $293,500 Budget Process 00002 * These costs are funded in the FY90 Budget or will be absorbed in the FY90 Budgets. ** Staff is recommending that a fee be charged for EMS services that are provided by paid County providers. 061 M Comments for Lane - EMS Work Session August 9, 1989 * EMS Study conducted Fall, 1989 '* EMS Study presented to Board January, 1989 * Chairman directed County Administrator to appoint work group to develop Recommendations for Boards' review * Appointed Task Force March, 1989 (has met 20 times in 20 weeks) * Recognition that County already in EMS Business and that demand for services increasing as County grows, Task Force given following objectives: --*- Establish a quality assurance program for delivery of skilled pre -hospital patient care. * Develop programmatic and operational standards which will be followed by both volunteers and County staff in order to most effectively utilize resources and reduce duplication of effort. -- * Preserve and enhance the EMS volunteer system .- * Meet the growing demand for EMS services * Establish the County Administrator as responsible for EMS in Chesterfield County * Recognition of Task Forces accomplishments System meeting needs of County A COUNTY ADMINISTRATOR EMS TASK FORCE RECOMMENDATION 08-09-1989 I M In I BOARD OF SUPERVISORS G. H. APPLEGATE, CHAIRMAN CLOVER HILL DISTRICT LC. F. CURRIN, JR., VICE CHAIRMAN `'- BERMUDA DISTRICT HARRY G. DANIEL DALE DISTRICT 'r JESSE J. MAYES MATOACA DISTRICT CHESTERFIELD COUNTY P.O. BOX 40 CHESTERFIELD, VIRGINIA 23832 (804) 748-1211 August 2, 1989 MAURICE B. SULLIVAN MIDLOTHIAN DISTRICT The Honorable Members Chesterfield County Board of Supervisors Chesterfield, Virginia 23832 Chairman Applegate and Honorable Members of the Board: COUNTY ADMINISTRATOR LANE B. RAMSEY I am pleased to submit to you my Recommendations for changes to Chesterfield County's Emergency Medical Services. As .you know, a comprehensive study was conducted last year by Buracker & Associates. In March 1989, an Emergency Medical Services Task Force was created with representation from the four rescue squads, Police, Fire, and Amy Davis from my staff to study and make recommendations. Most of the recommendations which will be presented on Wednesday are a direct result of the diligent work of the Task Force. We will review these recommendations with you on Wednesday and anticipate asking Board action at the August 23 meeting. You will not be asked to take formal action on Wednesday. In addition, it is my sincere hope that the Board will recognize the commitment of many hours spent by the Task Force in L negotiating and compromising to create this program. Sincerely, AA� Lane B. Ramsey County Administration LBR/le Attachment I TABLE OF CONTENTS Emergency Medical Services Task Force List....................I Recommendations .............................................III Glossary......................................................V Introduction..................................................1 Patient Care..................................................3 Organizational Structure......................................9 Positions Requests To Be Funded..............................10 Incident Command.............................................13 Appendix I...................................................17 Appendix II..................................................18 Appendix III.................................................19 Appendix IV..................................................20 Appendix V...................................................22 Appendix VI..................................................23 0 EMERGENCY MEDICAL SERVICES TASK FORCE Amy Davis, Task Force Chairman Executive Assistant Co. Admin. P.O. Box 40 Chesterfield, Virginia 23832 748-1909 F. Wesley Dolezal Assistant Fire Chief Chesterfield Fire Department P.O. Box 40 Chesterfield, Virginia 23832 748-1226 Steve A. Elswick Battalion Chief Chesterfield Fire Department P.O. Box 40 Chesterfield, Virginia 23832 748-1556 Hugh H. Hemsley, Jr. M.D., FACEP Chesterfield Fire Department Medical Advisor 5712 Oak Knoll Road Midlothian, Virginia 23113 320-0070 Earl Lutterman Chief Operations Officer Ettrick - Matoaca Volunteer Rescue Squad 17409 Leamaster Petersburg, Virginia 23803 590-1263 Dennis G. McDonald Captain Chesterfield Police Department P.O. Box 40 Chesterfield, Virginia 23832 748-1256 James P. McGuire, President Chesterfield Rescue Squad Association 7704 Mendota Drive Richmond, Virginia 23229 271-5848 I 0 wr, Nelson T. Negaard President Manchester Volunteer Rescue Squad 3700 Cottrell Road Richmond, Virginia 23234 275-7040 Stanley Orchel, Jr. President Bensley-Bermuda Volunteer Rescue Squad 13510 Split Creek Drive Chester, Virginia 23831 786-1763 Paul A. Shorter Battalion Chief Chesterfield Fire Department P.O. Box 40 Chesterfield, Virginia 23832 748-1237 Greg Spurlock Chief Operations Officer Forest View Volunteer Rescue Squad 1130 Huntersdell Terrace Richmond, Virginia 23235 282-3114 Consultants Carol Warner EMS Coordinator Chesterfield Fire Department P. 0. Box 40 Chesterfield, Virginia 23832 748-1360 Anne Cochrane Budget & Management Analyst Budget & Management Department P. 0. Box 40 Chesterfield, Virginia 23832 748-1983 Jay Stegmaier Director Budget & Management Department P. 0. Box 40 Chesterfield, Virginia 23832 748-1548 9 II %A✓ `04 Recommendations 1. It is recommended that the Chesterfield County EMS system set as a goal response time for basic life support (BLS) providers at 6 minutes allowing an additional 4 minutes for advanced life support (ALS) providers to arrive on the scene. 2. It is recommended that the resources of rescue and fire combined manpower and equipment to support achievement of the BLS and ALS minute response time goal at the following locations: -Bensley-Bermuda Rescue Squad Station - Jefferson Davis Highway -Ettrick-Matoaca Rescue Squad Station - River Road -Forest View MIDLOTHIAN Rescue Squad Station - Route 60 and Grove Road -Manchester Rescue Squad Station - Route 360 and Courthouse Road -Cloverhill Fire Station - Route 360 and Deer Run Road -Dale Fire Station - Route 10 and Rock Spring Drive -Fire Station 15 - Chesterfield County Airport -A floating crew 3. It is recommended that the response time goals and the capability of the closest available unit will determine what unit is dispatched on Priority I calls. An ambulance only will be dispatched on Priority II and III. If there are no available rescue squad crews, the closest fire engine will be dispatched as the first responder. 4. It is recommended that the Chesterfield EMS system provide the following manpower: a. Monday - Friday 6 a.m. - 6 p.m. 3 Volunteer Crews 5 Salaried Crews b. Monday - Sunday Remaining time periods 6 Volunteer Crews 2 Salaried Crews III I 5. It is recommended that the Volunteer Rescue Squad Operations Office will notify the Fire Department 24 hours prior to each shift as to the number of volunteer crews available. 6. It is recommended that the Volunteer Rescue Squads will provide ambulances at the identified strategic locations. 7. It is recommended that an EMS Training Coordinator position be funded for the sole purpose of coordinating training efforts on all levels for the members of the volunteer rescue squads in conjunction with all other EMS providers. 8. It is recommended that an EMS Field Supervisor position be funded to ensure maintenance of skill proficiency; to supervise application of skills; to identify potential or existing problems; to make recommendations for improvements based on field observations; and to coordinate and maintain communication with the volunteers and career staff. 9. It is recommended that semi -automatic defibrillators be provided at the following locations: Company 8 Matoaca Company 12 Ettrick Company 14 Dutch Gap Company 15 Courthouse Spare Training/Replacement of broken defibrillators 10. It is recommended that a Chesterfield County Emergency Medical Services Advisory Council be established to replace the current Chesterfield Volunteer Rescue Squad Association to provide the EMS system a structure for support, guidance and accountability for a quality pre -hospital patient care. 11. It is recommended that an EMS Recruitment and Retention Coordinator be funded for the development of an aggressive recruitment and retention program for Volunteer Rescue Squad members and Volunteer Firefighters. 12. It is recommended that an EMS Systems Analyst position be funded for the development of an EMS database with attention to quality assurance, budgeting, research, audit activities and medical legal consideration. 13. It is recommended that adopted by all EMS multi -agency management emergency incident. the Incident providers as system for all IV Command System be the comprehensive resources at every `%W Glossary 1. Basic life support is a level of pre -hospital and inter -hospital emergency care which includes the recognition of other life threatening conditions which may result in respiratory and cardiac arrest, and the application of life support functions including cardiopulmonary resuscitation (CPR), use of adjunctive techniques and procedures. 2. Advanced life support is a sophisticated level of pre -hospital and inter -hospital emergency care which includes basic life support functions including cardiopulmonary resuscitation (CPR) plus cardiac monitoring, cardiac defibrillation, telemetered electrocardiography, administration of antiarrythmic agents, intravenous therapy, administration of specific medications, drugs and solutions, use of adjunctive ventilation devices, trauma care, and other authorized techniques and procedures. 3. Emergency Medical Services (EMS) are the services utilized in responding to the perceived individual needs for immediate medical care in order to prevent loss of life or aggravation of physiological or psychological illness or injury including any or all of the services which could be described as basic life support, advanced life support, specialized life support, patient transportation, medical control and rescue. 4. Emergency Medical Services Personnel (EMS Personnel) Persons responsible for the direct provision of emergency medical services in a given medical emergency including any or all persons who could be described as an attendant, attendant -in -charge, or operator. 5. Emergency Medical Services System (EMS System) A system which provides for the arrangement of manpower, facilities, equipment, and other system components for the effective and coordinated delivery of emergency medical services in an appropriate geographical area. 6. Rescue A service which may include the lost, gaining access to persons trapped, in potentially dangerous situations, an assistance to such persons. U 0 search for persons rescue of persons d the rendering of INTRODUCTION Lane B. Ramsey, the Chesterfield County Administrator, appointed the Emergency Medical Services Task Force in March 1989 to develop an EMS System which would efficiently and effectively utilize County and Volunteer Rescue Squad fiscal and manpower resources in delivering quality pre -hospital patient care and, that would preserve and enhance the viability and integrity of the volunteer system. The work of the Task Force follows months of evaluation of the system by professional consultants and personnel from volunteer rescue squads, police, fire, and the medical community. one of the major accomplishments of the Task Force has been to strengthen communication and working relationships between Volunteers and County staff. Each Task Force volunteer representative has provided information based on their respective squads needs and input. Decisions were made on a consensual basis which supported the constant negotiation process and the willingness for all Task Force members to look at all sides of each recommendation. Throughout this process, the Task Force made decisions based on the County Administrator's clear direction of improving patient care and maintaining the volunteer system. During the months that the Task Force worked on the recommendation, the volunteers expressed a strong desire for the establishment of a separate EMS Service. A third service with infrastructure separate from the Fire Department which would L report directly to the County Administrator. The Task Force members acknowledge the County's resources are not able at this time to support implementation of a third system. There is the need for further research and design. However, the Task Force has requested that the EMS Advisory Council further explore this option. It is the sincere hope that volunteers will again become the sole providers of emergency medical services. This is the motivation behind the recommendations in this document. It is felt that through the initial utilization of the existing County infrastructure, the creation of support positions, and the establishment of a Chesterfield EMS Advisory Council that this can be accomplished. It is further recognized that the recommendations here in meet the County's emergency medical service needs of today. The recommendations lay the groundwork for a conscientiously well coordinated quality assurance program for pre -hospital patient care and it establishes the County Administrator as accountable for EMS services in Chesterfield County. The following are major areas containing recommendations which have been adopted by each member of the EMS Task Force and presented to the County Administrator: -Critical Elements of Patient Care -Facilities and Equipment -Organization Structure -Incident Command System -Recruitment and Retention of Volunteers -Personnel 2 i ELEMENTS OF PATIENT CARE The Chesterfield County Emergency Medical Services System's primary goal is provision of quality pre -hospital care. There are several critical elements which impact the system's Lability to provide quality pre -hospital patient care. As Chesterfield continues to develop residentially and commercially, the maintenance and future planning of the system's operation must encompass State and Regional EMS patient care standards, ► strategic location of fiscal plants and manpower resources, on -going training and skill development, and the community's education and financial support for a viable volunteer system. Response Time Response time is calculated from the time a Chesterfield resident calls 9-1-1 to the time an EMS provider arrives on the scene. Chesterfield's Emergency Communication Center contains trained emergency medical technician dispatchers who are able to provide reassurance and basic life support instructions until an on -site EMS provider arrives. The recommended response time for basic life support providers is 6 minutes allowing an additional 4 minutes for advanced life support providers to arrive on the scene. This is based on response time standards recommended by the American Heart Association. During the assessment of the current EMS system's ability to respond within the 6-10 minutes response range, a natural "urban" corridor was identified which indicated the major growth pattern 3 0 of residential and business development within the County (see Appendix I). This corridor contains 92% of Chesterfield County's population. The 1988 County emergency medical service call statistics, indicate that 91% of the EMS calls run were in this corridor. As shown in Appendix II, the EMS providers currently are able to reach a large portion of this corridor within a 6-10 minute range. The Task Force is recommending the combined utilization of the Fire Department and the Volunteer Rescue Squad resources to enhance the capability of providing basic life support within 6 minutes and advanced life support within 10 minutes in the majority of the corridor (see Appendix III). Additionally, based on this recommendation, the 6-10 minute response time is expanded into the less populated areas in the western and southern parts of the County. This ultimately decreases the amount of time it takes to respond to areas which are currently less populated and correspondingly where less calls originate. Constant strategic planning of resource allocation must occur to provide standard response times as the County's population and business community grows into the less populated areas. It is recommended that response time goals and the capability of the closest available unit be the criteria for emergency communication's decision as to what unit is dispatched on 4 L Priority I calls. An ambulance only will be dispatched on Priority II and III calls. If there are no available rescue squad crews in the immediate area, the closest available fire engine will be dispatched as the first responder. See Appendix IV for definition of Priority I, II, III calls. It is the further recommendation of the County Administrator that the County EMS Coordinator work with the EMS Advisory Council in developing methods to achieve improved response times in all areas of the County as resources become available. Resource Allocation The following facility locations have been identified as strategic locations for placement of ambulances and manpower. These were identified because of the need and the capability of EMS providers meeting the Basic Life Support and Advanced Life Support response time goals. -Bensley-Bermuda Rescue Squad Station - Jefferson Davis Highway -Ettrick-Matoaca Rescue Squad Station - River Road -Forest View MIDLOTHIAN Rescue Squad Station - Route 60 and Grove Road -Manchester Rescue Squad Station - Route 360 and Courthouse Road -Cloverhill Fire Station - Route 360 and Deer Run Road -Dale Fire Station - Route 10 and Rock Spring Drive -Fire Station 15 - Chesterfield County Airport -A floating crew In assessing manpower, the primary focus was determined to be providing the EMS system with qualified, trained individuals who would support quality service levels. Analysis of response time and County wide EMS call load indicates the need for a minimum of 8 crews on a 24 hour basis. A total of 5 career crews ( two of which will be needed on a 24 hour basis) and three volunteer crews are needed Monday through Friday from 6 a.m. to 6 p.m. 5 This was identified by the squads as a critical need at this time. A minimum total of 6 volunteer crews and two career crews are needed to cover the remaining times during a 7 day period. The operations officers in each rescue squad will notify the Fire Department operations Battalion Chief 24 hours prior to each shift with the number of volunteer crews available. It is recommended that Fire Department and volunteer operational staff workout the details of placement of the crews. Volunteer crews can replace or ride with career crews as they are available. As the Volunteer Recruitment and Retention Program is implemented and the squads' membership grows, the volunteers will replace career staff. The volunteer squads will provide ambulances where needed at the above strategic locations. It is recommended that these arrangements be handled by Fire and Rescue operations personnel. Training Uniformity of training and skills maintenance is vitally important to quality pre -hospital patient care and the overall EMS program quality assurance of Chesterfield's EMS System. It is recommended that an EMS Training Coordinator position be funded for the sole purpose of coordinating training efforts on all levels for the members of the Rescue Squads volunteer in conjunction with all other EMS providers. Please refer to Appendix V for levels of training and required man hours. This position will coordinate training efforts with the County EMS Coordinator and the Advisory Council. Implementation of this recommendation will ensure consistent, quality training and r availability of training to all EMS providers. In addition, it is hoped that this will remedy a current problem of volunteers waiting so long to be trained after initial recruitment. This inturn will increase a new recruit's incentive to maintain his or her active volunteer status. Skill Proficiency A major quality assurance area for patient care is the level and application of EMS skills. It is recommended that an EMS Field Supervisor position be funded to ensure maintenance of skill proficiency; to supervise application of skills; to identify potential or existing problems; to make recommendations for improvements based on field observations; and to coordinate and maintain communication with the volunteers and career staff. In addition, it is felt that the implementation of this recommendation will positively impact Risk Management. Equipment The combined equipment of the Volunteer Squads and the Fire Department provides a satisfactory pool of resources. It is recommended however that all identified strategic locations be equipped with semi -automatic defibrillators which will increase the system's capability of providing advanced life support within 7 L L the standard response time. The need for defibrillators has been identified for location within the Fire Department. One of five will be used for training and replacement purposes. As the Lvolunteers have agreed to provide ambulances at all strategic locations, it is recommended that maintenance and equipment replacement schedules be developed and coordinated at the operational level. It is also recommended that the EMS Advisory Council have as a part of their Annual Report to the County Administrator, an accounting of all County and Volunteer ALS/BLS equipment and vehicles for the purpose of financial planning and resource allocation. P P M 11 ORGANIZATIONAL STRUCTURE Emergency Medical Services Advisory Council Representation 1 person from Bensley-Bermuda Rescue Squad 1 person from Ettrick-Matoaca Rescue Squad 1 person from Forest View Rescue Squad 1 person from Manchester Rescue Squad 1 person from Chesterfield County Fire Department 1 person from Chesterfield County Police Department 1 Board appointed citizen at large Emergency Medical Services Coordinator Emergency Medical Services Field Supervisor No Vote (Staff Position) 2 area hospital persons (1 Rotating Operational Medical Director, 1 Hospital person ER or administrator, rotating terms of service from the hospitals serving the Chesterfield Area). Choice is at the discretion of the hospital Functions *Strong participatory/advisory structure which provides support and guidance to the EMS System's quality assurance programs. *Provides full representation to all departments within the EMS System (Volunteer Rescue, Police, Fire) *Reviews protocol and operational procedures being applied in the field. Identifies areas needing improvement and proposes solutions. *Provides resolution process for issues which may arise in the EMS System *Prepares annual report to County Administrator regarding yearly activity of EMS System. (See Appendix VI) 01 POSITIONS REQUESTS TO BE FUNDED RECRUITMENT AND RETENTION RECOGNITION The Task Force strongly supports that early in the implementation of the recommendations significant emphasis should be placed on the development of a progressive and aggressive recruitment program for volunteer rescue squad and fire fighters personnel. The major premise of the Task Force efforts is to support the concept that volunteers are vital to the provision of public safety services in Chesterfield County. It is recommended that the recruitment and retention coordinator work with the volunteers in the following areas: 1. Explore other systems which have pension plans for volunteers. 2. HB 1463 (See appendix) 3. Annual Fire/Rescue Appreciation Days 4. Reimbursement of tuition and book/supplies expenses from training. 5. Through resolution the Chesterfield County Board of Supervisors formally set aside a day of recognition for volunteer EMS providers. RECRUITMENT AND RETENTION COORDINATOR Responsible for: Promotion of interest and participation of the community at large in volunteer EMS and Fire activities. Promotion of minority recruitment and EEO standards. Reports to: EMS Coordinator Interacts with: Chesterfield County schools, colleges and community groups; volunteer rescue squads and fire department; EMS Advisory Committee. Qualifications: BS degree in Marketing. Pay grade: To be determined. FMERGENCy MEDICAL SERVICES COORDINATOR Position to be upgraded from existing EMS Coordinator's position within the Department. 10 0 Responsible for: Overall coordination of volunteer and career providers; projection of future EMS needs and strategic planning; establishment of policies, procedures, and protocols. Budget preparation and monitoring. Supervision of EMS staff positions; establish and monitor a quality assurance program and coordinate research and legislative activies. Reports to: Assistant Chief of Fire Department Interacts with: Volunteer Rescue Squads, Fire Suppression Battalion Chiefs, Police, Medical Directors, EMS Advisory Council, County Budget Department, County Administration and other related agencies. EMERGENCY MEDICAL SERVICES FIELD SUPERVISOR Responsible for: Day to day field EMS operations. Reports to: EMS Coordinator Interacts with: Volunteer Rescue Squads, Fire Suppression Battalion Chiefs, Police, Medical Directors, EMS Advisory Council and other related agencies. Qualifications: NREMT-P with 4 years ALS. Experience: BS Degree; experience with general and personnel management; experience with quality assurance activities desired. Pay grade: To be determined. SYSTEMS ANALYST Responsible for: Development of an EMS database with attention to quality assurance, budgeting, research, audit activities and medical legal consideration. Compliance with State regulations related to reports and records. Reports to: EMS Coordinator Qualifications: Two years college level computer course work; experience as an ALS provider; t, experience with database design on IBM PC. Program experience. Pay grade: To be determined. �, 11 0 EMERGENCY MEDICAL SERVICES TRAINING COORDINATOR Responsible for: Coordination of volunteer EMS related training programs, as well as continuing education and clinical rotations for all County volunteer EMS providers. Identification and utilization of available educational resources on a local, regional and national level. Reports to: Chief of Training Division Interacts with: EMS Coordinator, Fire Department training staff, State Division of EMS, area volunteer EMS agencies, area Medical Directors, EMS Advisory Committee. Qualifications: Knowledge of adult educational principles; pre -hospital ALS experience, previous experience as an EMS educator; experience with course coordination and program design; BS degree desired. Pay grade: To be determined. 12 a INCIDENT COMMAND The Incident Command System (ICS) establishes a comprehensive multi -agency management system for all resources at every emergency incident. ICS is a model command system that is Lbecoming widely accepted by state and federal agencies dealing with emergency incidents. The Governor's Task Force on Emergency Medical Response Disaster Planning supports that rescue squads adopt and use the Incident Command System. The Task Force recommends that the Incident Command System be adopted for use by all County emergency medical service providers. In addition, it is recommended that all EMS providers be trained and become proficient in the system's application. The ICS will allow the EMS providers (Fire, and Rescue) to function in their area of technical expertise under the direction of a unified command structure, incorporating common functions such as safety, communications, planning and logistical support. There is an integrated chain of command built into the ICS recognizing the authority and responsibility based upon pre -determined position functions. This will provide a standard management system for every type of emergency on a daily basis. It promotes the cooperative and coordinated efforts of all agencies to perform in a safe, effective and efficient manner. 13 I a 0 RM Advantages of ICS: 1. Provides a clearly defined command system at all emergency incidents that uniformly manages resources necessary for the specific situation. 2. Allows all fire and rescue personnel, regardless of rank, to fill the required functional positions. 3. ICS recognizes the "rank" structure and technical expertise already established by various agencies. 4. ICS does not supersede state/local medical protocols. 5. EMS standard operating procedures would be easily integrated into ICS. 6. The system would be easily adopted and implemented because it is already designed and training is presently being delivered to rescue squads. 14 Operational Impact: There will be a positive impact on EMS field operations with the use of ICS. Fire and rescue will participate equally within the system. It is recognized by the Task Force that patient care and vehicle extrication are the Volunteer Rescue Squads' area of expertise and fire fighting is the Fire Department's. Rescue squad officers will fill command positions in ICS as required by the incident. ICS will allow rescue squad and Fire Department personnel to be integrated into one common management system. A single unified command structure, using the resources of all agencies, will establish one clearly understood emergency action plan. It will not be disruptive to the goals and objectives of each organization. The resources of all agencies will be safely and effectively managed to provide the best possible service to County citizens. Elimination of conflicting orders and redundant resource allocation will promote a cooperative coordinated effort by all agencies. Recommendations for Implementation: 1. A policy statement agreed to by all agencies to adopt and Limplement ICS. 2. The Emergency Communications Center is currently working on common radio tactical subfleet assignments for Fire and Rescue Squad units responding to the same incident. 3. Universal training for all fire and rescue personnel. 15 4. EMS Advisory Council to develop a recognizable rank structure insignia for the volunteers. It is recommended that there be unilateral acceptance of the operational rank structure of all EMS providers. 5. Fire and rescue jointly develop and implement ICS standard operating procedures. ,, 16 17 c.1 a. CIS L<c 4CC x C..� L uj caw 'w Sk" y to sz, X-4 w A n APPENDIX IV PRIORITY I CALLS Unconscious patient, altered Level of consciousness, syncope Complaints of chest pain, or symptoms suggestive of MI (Heart Attack, Myocarial Infartion) Shortness of breath- including asthma, COPD, chocking, airway obstruction, hyperventilation, pneumonia, inhalation injury Drug overdose and poisonings, suicide attempts, ingestion toxic substances Drownings Stroke Diabetic emergencies Seizures Electrical injury Hypothermia or hyperthermia Trauma with potential loss of life- pedestrian, shooting, stabbing, falls, multiple trauma, blast injury, amputation or trapped limb Multiple patient accidents Severe allergic reactions Severe burns Head injury with loss of consciousness or altered level of conscious Abdominal pain age> 50 Impending delivery Severe bleeding other D.O.A. 20 L PRIORITY II CALLS Head injury stable Non life threatening allergic reactions Trauma to arms or legs Febrile child Alcohol intoxication Rape Animal and insect bites Bleeding from minor wounds Ocular injury including caustics Abdominal pain <50 Minor burns Radiation exposure PRIORITY III CALLS Isolated injuries to hand/wrist; foot/ankle Routine transportation to hospital Sick cases -flu, upset stomach, kidney stone, diarrhea Back pain not related to trauma Minor infections Nervous disorder not suicidal Rash no fever tooth pain 21 APPENDIX V REQUIRED CERTIFICATION TRAINING Emergency Medical Technician - 110 hours minumum Cardiac Technician - 162 hours minimum Paramedic - 385 hours minimum OLD DOMINION EMS COUNCIL CONTINUING EDUCATION Emergency Medical Technician - Cardiac Technician - 40 hours recertification 59 hours/Every 2 years Paramedic - 69 hours/Every 2 years National Registry Certified Paramedic - 109 hours/Every 2 years 22 APPENDIX VI Task Force Recommended Bylaws ARTICLE I Name The name of the society shall be the Chesterfield Emergency Medical Advisory Council. (Hereafter called the Council) ARTICLE II Object The object of the Council shall be to provide representation for all providers in the EMS community and to provide support, guidance, and advice to ensure quality patient care, efficient utilization of resources and to preserve and maintain the volunteer system for the County of Chesterfield's emergency medical services system. ARTICLE III Members Section 1. The membership shall be limited to ten members and shall be appointed by the following pp organizations: Bensley-Bermuda, Ettrick-Matoaca, Forest View and Manchester Volunteer Rescue Squads. One from Chesterfield Police Department, the EMS Coordinator, and a citizen at large (appointed by the Chairman of the Board of Supervisors), one from the Chesterfield Fire Department, one rotating Operational Medical Director and one area hospital person from either the Emergency Room or Administration. 23 L'#4W �%d Section 2. Each representatives term shall be for two years. Section 3. Resignations of any members shall be filled by the organization they represent. 11 ARTICLE IV officers Section 1. The officers of the Council shall be a Chairman, a Vice -Chairman, a Secretary, a Treasurer and eight Directors. These officers, with the exception of the Directors, shall be elected at the Annual Meeting and shall hold office for one year or until their successors are elected. These officers shall perform the duties prescribed by these by-laws and by the parliamentary authority adopted by the Council. Section 2. A nominating committee consisting of three members elected at a regular meeting in November, whose duty it shall be to nominate a candidate for each office to be filled at the annual meeting. Additional nominations may be made from the floor and voting shall be by ballot. Section 3. A vacancy in an office shall be filled, until the next annual meeting, by the Council members. The election shall be by ballot. Section 4. No officer shall be eligible to serve more than two consecutive terms in the same office. 24 ARTICLE V Meetings Section 1. The regular meeting of the Council shall be held on the fourth Wednesday of each month unless otherwise ordered by the Executive Board. Section 2. The regular meeting on the fourth Wednesday in January shall be known as the Annual Meeting. Section 3. Special meetings can be called by the Chairman or upon written request of five members of the Council. Except in case of emergency, at least seven days notice shall be given. Section 4. A quorum shall be defined as five members of the Council, including two officers. ARTICLE VI Executive Board Section 1. The officers of the Council shall constitute the Executive Board. Section 2. The Executive Board shall have general supervision of the affairs of the Council between its business meetings, fix the hour and place of meetings, and perform such other duties as are specified in these by-laws. It is subject to the orders of the Council and none of its acts shall conflict with action taken by the Council. Section 3. Regular meetings of the Executive Board shall be held once a month. Special meetings may be called by the Chairman, and shall be called upon request of two Board Members. 25 ARTICLE VII Committees Section 1. A) The Finance Committee shall be composed of the Treasurer, a representative from each rescue squad, the Fire Department and the EMS Coordinator, and the systems analyst. B) This Committee shall be appointed by the Chairman and have a budget request completed and submitted to the County Administrator no later than the first of October. Section 2. An Audit Committee of three members, the Vice -Chairman, one County representative and one citizen at large shall audit the Treasurer's accounts at the close of each fiscal year and to report at the annual meeting. Section 3. The Medical Control Committee shall consist of r the Operational Medical Directors of the four volunteer rescue squads and the County Fire Department. The EMS Coordinator and Field Supervisor shall be assigned to committee for staff support. It shall be their duty to control the supervision and accountability of the pre -hospital emergency medical services system serving the County of Chesterfield. Section 4. Such other committees, standing or special, shall be appointed by the Chairman of the Council as he shall, from time to time, deem necessary to carry on the work of the Council. The Chairman shall be an ex -of ficio a member of all Committees, except the nominating committee. I� 26 n n MAJOR CONSIDERATIONS FOR FINANCING TASK FORCE RECOMMENDATIONS 1. Existing services will be continued and significant cost will have to be covered in the current budget. 2. Recommended services to be phased over three years. 3. System designed to allow flexible use of volunteers when possible. 4. Efficiencies available from using existing fire protection resources are identified. 5. Uncertainties mean that estimated costs for Years 2 and 3 may change. SERVICES CURRENTLY PROVIDED BY COUNTY Costs Not Funded Funded in FY90 in FY90 Contributions Operating Fund $ 60,000 $ - Education/Conferences 10,000 - Dollar for Life Funds 38,000 - 108,000 Ettrick-Matoaca Advanced Life Support ALS Providers 112,400 - ALS Supplies - 16,000 Medflight 193,000 Manchester Rescue Squad BLS Crew - 125,000 On -Call Support for Volunteers - 60,000 Continuing Education/ Training for Current County ALS Providers - 136,400 TOTAL $413.400 $337.400 n E5 PROPOSED PHASING OF TASK FORCE RECOMMENDATIONS o Each year will continue the current agreements and services Year 1 o Increase in County Donation to Rescue Squads o Hepatitus Vaccines for Volunteers o Volunteer Training Coordinator o Volunteer Recruitment/Retention Coordinator o Field EMS Supervisor o Quality Assurance Analyst o Dale Fire Station 2-Man Advanced Life Support Crew, 24-Hour/Day, 7 Day/Week o Forest View Sub -Station 2-Man Basic Life Support Crew, Monday -Friday, Daytime Only TOTAL $493,500 Year o Continuation of Year 1 Recommendations o Continuing Education and Training Support for ALS o Administrative Support o Clover Hill Fire Station 2-Man Advanced Life Support Crew, 24 Hour/Day, 7 Days/Week o Floating Crew 2-Man Basic Life Support Crew, Monday -Friday, Daytime Only TOTAL $1,230,300 Year 3 o Continuation of Year 2 Recommendations o Airport Fire Station 2-Man Basic Life Support Crew, Monday -Friday, Daytime Only TOTAL $1,312,500 cdl:47/4 61 i/DY m SERVICES CURRENTLY PROVIDED BY COUNTY Contributions o Operating Fund o Education/Conferences o Dollar for Life Funds Ettrick-Matoaca Advance Life Support o ALS Providers o ALS Supplies Manchester Rescue Squad o BLS Crew On -Call Support for Volunteers Medflight Continuing Education/Training for Current County ALS Providers PROPOSED PHASING OF TASK FORCE RECOMMENDATIONS General Support Amount (FY90 Dollars) FY90 FY91 FY92 Increase in County Donation of $5,000 per Squad $ 20,000 $ 20,000 $ 20,000 Hepatitis Vaccines for Volunteers 30,000 13,000 13,000 Volunteer Training Coordinator 60,800 42,800 42,800 Volunteer Recruitment/ Retention 52,700 40,100 40,100 Field EMS Supervisor 55,400 44,200 44,200 Quality Assurance Analyst 39,100 37,000 37,000 Continuing Education * 169,700 193,500 Administrative Support * 173.400 160,100 Total General Support $258,000 $ 540,200 $ 550,700 * These costs are funded in the FY90 Budget or will be absorbed in the FY90 Budgets. PROPOSED PHASING OF TASK FORCE RECOMMENDATIONS .Operations Costs Ettrick-Matoaca Advanced Life Support Manchester 2-Man Basic Life Support Crew, Monday -Friday Daytime Only Dale Fire Station 2-Man Advanced Life Support Crew, 24-Hour/Day, 7 Day/Week Forest view Sub - Station - 2-Man Basic Life Support Crew, Monday -Friday, Daytime Only Clover Hill Fire Station - 2-Man Advanced Life Support Crew, 24-Hour/Day, 7 Days/Week Floating Crew 2-Man Basic Life Support Crew, Monday -Friday, Daytime Only Airport Fire Station - 2-Man Basic Life Support Crew, Monday -Friday, Daytime Only Total Operations Amount (FY90 Dollars) FY90 FY91 FY92 * 141,700 93,800 N/A N/A 125,000 130,900 125,000 184,200 125,000 N/A N/A $235,500 $ 690,100 125,000 130,900 125,000 130,900 125,000 125,000 $ 761,800 * These costs are funded in the FY90 Budget or will be absorbed in the FY90 Budgets. ** Staff is recommending that a fee be charged for EMS services that are provided by paid County providers. 9 PROPOSED PHASING OF TASK FORCE RECOMMENDATIONS Totals and Sources of Funds Amount (FY90 Dollars) FY90 FY91 FY92 Total Operations $235,500 $ 690,100 $ 761,800 Total General Support 258,000 540,200 550.700 GRAND TOTAL $493,500 $1,230,300 $1,312,500 Reserve for EMS (already appropriated) $200,000 To be determined through Budget Process Anticipated Revenue from Charges for EMS Service** $293,500 To be determined through Budget Process ti • 4) RI � C N � A\ O` Nom rJl 9 oV u ;R rho :�:}ii r� in �oy a m a71,n �Mrc� rn�"n y •W` rV q r:n<nN � fi � ."") a � •t-. 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Fri fTj ril i. ;.� IJ lD n D 7 co 0 I-o uI ul Lq W CHESTERFIELD COUNTY BOARD OF SUPERVISORS AGENDA MEETING DATE: August 9, 1989 ITEM NUMBER: 3. 5UBJECT RESOLUTION HONORING LELAND B. ANDERSON COUNTY ADMINISTRATOR'S COMMENTS: SUMMARY OF INFORMATION : Leland B. "Doc" Anderson of Midlothian District will be celebrating his 100th birthday on August 21, 1989. Mr. Anderson is the last known surviving resident who worked in Chesterfield's coal mines. This resolution, honoring him on his 100th birthday, will be presented by Mr. Sullivan at Mr. Anderson's birthday party on August 21 at Winfree Memorial Baptist Church. PREPARED BY: Pauline A. Mitchell ATTACHMENTS: YES Cr' NO ❑ SIGNATURE: CW COUNTY ADMINISTRATOR 00003 ` iso RECOGNIZING LELAND B. ANDERSON WHEREAS, LELAND B. ANDERSON has today reached the impressive age of 100 years; and WHEREAS, Mr. Anderson, among his numerous lifetime activities, was once employed in the Grove Shaft Coal Mines, whose closing in 1924 marked the end of a two -century coal -mining industry in Chesterfield County; and WHEREAS, Mr. Anderson has earned the friendship and respect of his Midlothian friends and neighbors, through his membership and activities at Winfree Memorial Baptist Church, where he is a senior deacon and even now regularly folds all the church bulletins each week; and WHEREAS, Mr. Anderson served our nation as a soldier during World War I, has been an active member of American Legion Post #186 and the Midlothian Masonic Lodge, and as a faithful member for many years of the Midlothian Ruritan Club he earned the nickname "Doc;" and WHEREAS, for 26 years he served also as a productive member of the community through his employment at Defense General Supply Center, prior to his retirement; NOW, THEREFORE, BE IT RESOLVED that the Chesterfield County Board of Supervisors does invite all citizens of Chesterfield to join with Mr. Anderson's three children, seven grandchildren and ten great-grandchildren to wish him a happy 100th birthday, and does declare August 21, 1989 as LELAND B. ANDERSON DAY, in recognition of his status as a living symbol of the famous Coal Miner of Chesterfield County. 00004 CHESTERFIELD COUNTY BOARD OF SUPERVISORS AGENDA MEETING DATE: August 9, 1989 ITEM NUMBER: 4 SUBJECT EXECUTIVE SESSION COUNTY ADMINISTRATOR'S COMMENTS: SUMMARY OF INFORMATION: Executive Session for consultation with legal counsel pursuant to §2.1-344(a)(7) of the Code of Virginia, 1950, as amended, regarding (1) Martha Grimsley Clodfelter v. Dorothy West, (2) probable litigation relating to Richard Powers, et al. v. Wanda Frazier and County of Chesterfield, (3) specific legal matters relating to the ScanCenter; and Section 2. 1-344 (a)(3) for (4) consideration of the use and disposition of publicly -held park property. ATTACHMENTS: YES Z 7'. ■ PREPARED BY: V-S even L. Micas County Attorney SLM/nwp3568:C37 D0W SIGNATURE: COUN Y ADMINISTRATOR MOTION: SECOND: DATE: RE: CERTIFICATION OF EXECUTIVE SESSION HELD IN CONFORMANCE WITH LAW WHEREAS, the Board of Supervisors has this day adjourned into Executive Session in accordance with a formal vote of the Board, and in accordance with the provisions of the Virginia Freedom of Information Act; and WIIEREAS, the Virginia Freedom of Information Act effective July 1, 1989, provides for certification that such Executive Session was conducted in conformity with law; and NOW, ThEREFORE, BE IT RESOLVED that the Board of County Supervisors does hereby certify that to the best of each member's knowledge, i) only public business matters lawfully exempted from open meeting requirements under the Freedom of Information Act were discussed in the Executive Session to which this certification applies, and 11) only such public business matters as were identified in the Motion by which the Executive Session was convened were heard, discussed or considered by the Board. No member diosents from this certification. VOTE: (by roll call) 1. AYES: NAYS: ABSENT DURING VOTE: ABSENT DURING MEETING: **CERTIFIED** CLERK TO THE BOARD SLM/nwp3356:N13 00006 CHESTERFIELD COUNTY BOARD OF SUPERVISORS AGENDA MEETING DATE: August 9, 1989 ITEM NUMBER: 4 SUBJECT EXECUTIVE SESSION COUNTY ADMINISTRATOR'S COMMENTS: SUMMARY OF INFORMATION: Executive Session for consultation with legal counsel pursuant to §2.1-344(a)(7) of the Code of Virginia, 1950, as amended, regarding (1) Martha Grimsley Clodfelter v. Dorothy West, (2) probable litigation relating to Richard Powers, et al. v. Wanda Frazier and County of Chesterfield, (3) specific legal matters relating to the ScanCenter; and Section 2.1-344(a)(3)for (4) consideration of the use and disposition of publicly -held park property. ATTACHMENTS: YES W( NO O PREPARED BY: I4-t- O-Steven L. Micas County Attorney SLM/nwp3568:C37 00005 SIGNATURE: COUN Y ADMINISTRATOR CHESTERFIELD COUNTwr BOARD OF SUPERVISORS AGENDA MEETING DATE: August 9, 1989 ITEM NUMBER: SUBJECT EXECUTIVE SESSION COUNTY ADMINISTRATOR'S COMMENTS: SUMMARY OF INFORMATION: Executive Session for consultation with legal counsel pursuant to §2. 1-344 (a) (7) of the Code of Virginia, 1950, as amended, regarding (1) Martha Grimsley Clodfelter v. Dorothy West, (2) probable litigation relating to Richard Powers, et al. v. Wanda Frazier and County of Chesterfield, (3) specific legal matters relating to the ScanCenter, (4) probable litigation with the School Board relating to after -school day care and the construction• management program; Section 2.1-344(a)(3) for (5) consideration of the use and disposition of publicly -held park property; and Section 2.1-344(a)(1) regarding (6) personnel matter relating to public safety. ATTACHMENTS: YES O NO O SLM/nwp3568:C37 SIGNATURE: PREPARED BY: �/" u'Q Steven L. Micas County Attorney COUNTY ADMINISTRATOR f �'+,� °:. �4�r�' 1'�1�?� ' '�'� i� ' �•'��. i '{c: .;r, C- v AN ion . �/�/��- . � . \� ��«� y.�: _ , .� �.3� /\�.\ \. ,� � \ rw If m In F-I wt 71' Azl-, st T-gl te, 'F 7t of I c t I