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HomeMy WebLinkAboutAgenda Report - August 17, 2005 K-04AGEIOA ITEM AA CITY OF LODI COUNCIL COMMUNICATION ' TM AGENDA TITLE. Receive Report on Request for Proposals for Emergency Ambulance Services MEETING DATE: August 17, 2005 PREPARED BY: Jere Kersnar, Interim Deputy City Manager RECOMMENDED ACTION: Receive report; no City Council action is required. BACKGROUND INFORMATION: The Emergency Medical Services (EMS) Agency of San Joaquin County, operating under authority of State law, has released a Request for Proposals (RFP) for emergency ambulance services throughout the County. The purpose of this report is to update the City Council on this process and to advise the Council of City staff's actions to date. Pre -hospital emergency care has three major components, namely dispatch, on -scene care, and transport to the hospital. Each County in California has arranged these components differently, and the State laws governing pre -hospital emergency care recognize these differences by granting authority to the County EMS Agencies to establish standards and levels of care. Currently, pre -hospital emergency care in Lodi is handled in the following manner: DisIttch--The Lodi Police Department is a designated primary Public Safety Answering Point (PSAP, pronounced "p -sap"), that is, they receive the initial 911 call from the public. If the emergency is medical, they transfer the call to Stockton Fire dispatch (a secondary PSAP), which dispatches all fire agencies in the County. Lodi Fire Department will be dispatched as the first responder in the City, and American Medical Response or Priority -1 Medical Transport will be dispatched to provide paramedic and ambulance transport services. It is important to note that a 911 call can only be transferred once (that is, from a primary to a secondary PSAP) before a dispatch is made. 2. On -scene Care—Lodi Fire currently guarantees what is called Basic Life Support (BLS), which is provided by Firefighters certified as Emergency Medical Technicians (EMTs). As first responders, EMTs can perform many, but not all, crucial on -scene medical procedures. Paramedics are certified to provide Advanced Life Support (ALS); the prime example of this is the ability to inject drugs, under medical supervision. Although Lodi Fire has had as many as four paramedics on staff, most times the first paramedic on scene arrives with the ambulance, which typically trails the first -responding fire engine by 3-5 minutes. 3. Transport—Transportation to the hospital, if required, is provided by the responding ambulance. It is crucial to note that billing for pre -hospital emergency care can only be done by the transporter, that is, the ambulance company. There is no way for Lodi Fire (or other first responders) to bill directly for any level of emergency care. In an attempt to coordinate the pre -hospital emergency care currently provided by 19 different first responders (fire agencies), and six different ambulance companies, among others, the County EMS Agency has issued an RFP for exclusive ambulance services. APPROVED: 7 Blair King, C' anager Proposals are due by September 22, with final approval by the Board of Supervisors in January 2006; service is scheduled to begin on May 1, 2006. Fire Chief Mike Pretz has been following the development of the RFP, and he and Interim Deputy City Manager Jere Kersnar attended a Bidder's Conference on August 4, which was attended by several different potential ambulance providers, and representatives of many of the first responder fire agencies in the County. The RFP asks for bids on exclusive ambulance service to three zones in the County; Zone A is centered on Lodi, with Zones B and C for the Stockton} and Tracy areas, respectively. The providers must propose for ALS ambulance services in one or more zones, with emergency response times in urban areas of eight minutes or less, 90% of the time. In addition, the proposers may include an option of first responder (fire) ALS services; it should be noted that Lodi Fire has no agreement with any ambulance providers to be included in their proposal, at least to date. The fire agencies in the County, including Lodi Fire, have two major concerns with the RFP, as it is currently structured. The first relates to dispatch. The RFP requires that the ambulance company provide for a secondary PSAP, with those costs included in the total proposal. If that secondary PSAP is Stockton Fire dispatch, as currently, there is no problem; if, however, the ambulance provider chooses to establish their own secondary PSAP, there is no guarantee the first responders will be dispatched in a timely manner, or at all. Since, under the current arrangement, Lodi Fire typically arrives on scene within five minutes, but the ambulance does not arrive until several minutes later, staff joins other first responders in objecting to the potential lowering of the service level included in the RFP. Staff feels that any proposal that does not adequately address this issue would be fatally flawed, and should be rejected. Staff intends to review the submitted proposals carefully, to insure that this problem is corrected. The second concern fire agencies have with the RFP relates to the involvement of first responders (i.e. fire agencies) only as an option. A few fire agencies in the County provide paramedic services on the first - responding engine; as noted earlier, Lodi is able to do so only occasionally. In no case, however, can a fire agency recover any of the costs associated with providing this higher level of service. The selected ambulance provider could enter into agreements with all the fire agencies to include these additional charges in their billing, and reimburse the fire agencies. In this way, ALS/paramedic services could be provided countywide by first responders, with equivalently shorter response times. This approach would provide a higher level of service than currently enjoyed since, like Lodi, most fire agencies in the County only provide BLS service on (at least most of) their first -responding fire engines; the approach would allow the marginal costs of providing paramedic service, such as training costs and salaries, to be billed to the person (and the insurance company) receiving the service. However, the RFP only provides for this system design as an option. Lodi Fire may be approached by one or more of the prospective providers to include that option but, to date, only informal contacts have been made and no agreements have been reached. Staff will continue to advise the Council of the status of these matters. In response to the two concerns explained above, staff has sent the attached letter to the County Administrative Officer. The purpose of the letter is to alert County staff that, in the worst case, the City could be requesting that all proposals be rejected, and the system re -designed with first -responder involvement. City staff hopes of course for the best case, that is, a proposal that preserves, or even enhances, the current level of pre -hospital emergency care for the citizens of the County, and the City of Lodi, in the most cost-effective manner. City staff would endorse such a proposal. Staff intends to return to Council as appropriate with updates as this matter progresses. FISCAL IMPACT: There is no immediate fiscal impact from this report. The ultimate system design for pre- hospital emergency care could, however, have significant net positive or negative fiscal impacts_ More will be known as proposals are developed and analyzed. FUNDING AVAILABLE: No funding is req fired for is repo . J re A. spar, Interim Deputy City Manager Attachment Ybsn .soman MAYOR [snaan-XICAM04 MAYOR PRO TIEMPORE 'Garry `T 3fdw", COUNCIL MEMBER `& 1q0sn ron COUNCIL MEMBER YbJ7nne'e- -or nee COUNCIL MEMBER Mr. Manuel Lopez S. J. County Administrator 222 E. Weber Ave. Stockton, CA 95202 Dear Manuel, Gi 4 iGotf CITY HALL., 221 WEST PINE STREET LODI, CA 95240 (209) 3336700 FAX (209) 333-6807 August 11, 2005 .fair .y CrrY MANikGER C5".n y-W""/0.n CITY CLERK a. cSfepsee csys.ua- CrrY ATTC*NEY The City of Lodi staff has reviewed the Request for Proposals {RFP) for Exclusive Emergency Ambulance Service, sent out by the Emergency Medical Services Agency. Responses to the RFP are due by September 22. We believe the RFP is seriously flawed in two ways, first, with respect to the issue of emergency medical dispatching and, second, in regard to the role of first responders. The issue concerning emergency medical dispatching appears to be a change in well-established public policy. In our c iment situation, primary Public Safety Answering Points (PSAPs) receive 911 calls, and transfer medical emergencies and fire calls to a public -sector -operated secondary PSAP, namely, the Stockton Regional Emergency Communication Center. The RFP (Section 4.2.2) contemplates the use of private sector PSAPs as a means of dispatching emergency ambulances, and does not explicitly require the private sector PSAP to notify the fire department dispatching center within any specified time or, indeed, at all. The RFP world apparently allow current first responses to medical emergencies to be at worst eliminated, or at least delayed. If this is permitted, the proposal would be unacceptable to the City of Lodi and, we believe, to the other fire agencies in the County. Second, during the formation of the RFP, the Lodi Fire Chief met with the consultants to discuss several issues that were important to the overall operation of the Emergency Medical System and to the City of Lodi. Included was the recognition of first responders as viable partners in the overall pre -hospital medical care system. The RFP provides, as an option only, a proposal for a coordinated system between the fust responders and the ambulance providers for Advanced Life Support (ALS/paramedic) care. We believe such a coordinated system, as mandated and operated in many other Counties throughout the State, should be required in San Joaquin County as well. In this way, our citizens could enjoy a higher level of service (that is, first -responder ALS) in a cost-effective manner, while providing a method for users (and their insurance companies) to cover the costs. The City of Lodi has been actively engaged in this process to date, and will continue to closely monitor the progress of the RFP and subsequent proposals. In the best case, a proposal that responds to our concerns described above will be submitted and accepted. In the worst case, we might be forced to oppose the acceptance of any of the proposals, and to ask that the RFP be re - crafted. We look forward to continuing to work with the EMS Agency staff to ensure that does not happen, and that the concerns of Lodi and other first responders are adequately addressed. If you would like to discuss this matter Rather, 1 welcome a phone call or a meeting with other fire agency represcmathms. Thank you for your attention to this matter. Sincerely, Blair King . City Manager CC' Mayor and City Cauncii City Managai's, Sap Joaquin County Dan Bloch, EMS Adknini&dor