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HomeMy WebLinkAboutMinutes - January 27, 2004 SSCITY OF LODI INFORMAL INFORMATIONAL MEETING "SHIRTSLEEVE" SESSION CARNEGIE FORUM, 305 WEST PINE STREET TUESDAY, JANUARY 27, 2004 An Informal Informational Meeting ("Shirtsleeve" Session) of the Lodi City Council was held Tuesday, January 27, 2004, commencing at 7:00 a.m. A. ROLL CALL Present: Council Members — Beckman, Hitchcock, Howard, Land, and Mayor Hansen Absent: Council Members — None Also Present: City Manager Flynn, Interim City Attorney Schwabauer, and City Clerk Blackston ANNOUNCEMENTS Mayor Hansen reported that the advertisement for the position of Lodi City Attorney would be forwarded to the League of California Cities Western City magazine today for publication. He recalled that on January 21, 2004, Council had voted to increase the salary of Interim City Attorney Schwabauer to step A of the City Attorney's salary range. It was subsequently brought to his attention that there is no specified range for the position. He suggested that Mr. Schwabauer's pay be increased 10%. No objections were expressed by Council. B. CITY COUNCIL CALENDAR UPDATE City Clerk Blackston reviewed the weekly calendar (filed). C. TOPIC(S) C-1 "Fire Department Paramedic Program, County Emergency Medical Services RFP, and partnership update" With the aid of overheads (filed), Ty Mayfield, Emergency Medical Services (EMS) Coordinator, provided Council with statistical information related to emergency calls. He reported that the Fire Department would be organizing its resources for the worse case scenario on a day to day basis. On average, two to three calls are received per hour and one CPR is conducted approximately every ten days. Mr. Mayfield stated that he had prepared a written plan and budget for the Department's first response program, which was being reviewed by senior staff. A phased -in implementation is planned. He stated that currently there is no recognition of the economic value of the Fire Department first response. Staff is working to correct this through the county system redesign process, as well as establishing a formal relationship with a transport agency. Mr. Mayfield reported that commercial ambulance companies are competing for patients, which is evident by the ambulance maneuvering often seen along Kettleman Lane. The county has recently hired a consultant to develop Requests for Proposals (RFP) for ambulance service. Based on documents originated at the county EMS, it appears its intent is to have a single ambulance provider for the entire county, i.e. in the zones that are not already designated as exclusive. Mr. Mayfield stated that this was not in the best interest of Lodi. He stated that with regard to oversight and quality management, the dispatch center is not being utilized or supported to its full potential. The existing system is oriented toward finding and fixing individual mistakes, rather than examining production processes in aggregate to improve the entire system. In answer to Council Member Hitchcock, Mr. Mayfield explained that the county designates geographic areas and assigns them individual units. The marker for identifying the areas is the intersection of Kettleman Lane and Stockton Street. The unit to the west will be closest to the activity center and therefore will get the most calls. Continued January 27, 2004 Fire Chief Pretz reported that in November 2003 the county EMS agency hired a consultant to redesign the EMS ambulance transport system. Within the next 12 to 18 months the county will be changing from non-exclusive zones to exclusive operating areas. There are five ambulance zones, in which Lodi is designated as zone four. The RFP process will culminate with the county EMS agency awarding a contract to a single provider for ambulance transport services. Chief Pretz stated that the Lodi Fire Department will be working in partnership with the Stockton Fire Department and American Medical Response (AMR) to provide a consortium/joint venture to bid on the entire process. AMR would be the transport agency. He stated that there needs to be recognition of, and revenue for, providing first responder level of service and there should be local control over the placement and number of ambulances. The county will also be asked to take into consideration the population densities for ambulance placement. Chief Pretz asked Council for a consensus to continue working on the draft joint venture agreement. He anticipated returning to Council at a regular meeting within two to three weeks with the final agreement. He commented that the Department is only "budget support away" from having the paramedic program in place. If funds became available, the Department could start hiring paramedics beginning in the next fiscal year and have paramedics on board engine companies by the end of the year. NOTE: Council Member Land left at 7:46 a.m. In reply to City Manager Flynn, Chief Pretz explained that Ripon, Escalon, Manteca, and Lathrop are already in exclusive operating zones and are not a part of the overall redesign of the system. In answer to Council Member Howard, Chief Pretz believed that all concerns from the Lodi Professional Firefighters Association and other interest groups would be addressed in the joint venture agreement and corresponding operating agreement. D. COMMENTS BY THE PUBLIC ON NON -AGENDA ITEMS None. E. ADJOURNMENT No action was taken by the City Council. The meeting was adjourned at 7:56 a.m. ATTEST: Susan J. Blackston City Clerk 2 Mayor's & Council Members' Weekly Calendar WEEK OF JANUARY 27, 2004 Tuesday, January 27, 2004 7:00 a.m. Shirtsleeve Session 1. Fre Department Paramedic Program, County Emergency Medical Services RFP, and partnership update (FD) 5:45 p.m. Sister City Committee Meeting, Election of Officers, Camegie Forum, 305 West Pine Street. Wednesday, January 28, 2004 Thursday, January 29, 2004 Reminder League of California Cities Personnel and Employee Relations Seminar, Brea. 7:00 p.m. Hansen and Hitchcock. Lodi Chamberof Commerce's81st Annual Membership Celebration, Hutchins Street Square, 125 South Hutchins Street. Friday, January 30, 2004 Noon Grand Opening and Ribbon Cutting of Delta Physical lherapy, 2401 West Turner Road, Suite 250. Saturday, January 31, 2004 3:00 p.m. Hitchcock. Eagle Scout Awards Ceremony, St. Paul's Lutheran Church, 701 South Pleasant Avenue. Sunday, February 1, 2004 Reminder Hansen. American Public Power Association 2004 Legislative Rally, Washington D.C. 2/1 —2/4/04. Monday, February 2, 2004 Disclaimer. This calendar contains only information that was provided to the City Clerk's Office. CADocuments and Settings\jperrin\Local Settings\Temporary Internet Files\OLKC4\Mcalndrl.doc CITY OF LODI FIRE DEPARTMENT MEMORANDUM DATE: January 23, 2004 TO: City Council through Dixon Flynn FROM: Michael Pretz SUBJECT: Supplemental information on Public/Private Partnership On Friday, January 23, 2004, Ty Mayfield and I met with members of the Stockton Fire Department and American Medical Response to discuss the elements of a partnership with the Lodi Fire Department. After a long and fiuidW discussion, I believe it is in the best interest of the Lodi Fire Department to enter into a partnership with the Stockton Fire Department and AMR. I will be happy to discuss the change in recommendations with Council during the January 27th shirtsleeve meeting. CITY OF LODI FIRE DEPARTMENT MEMORANDUM DATE: January 27, 2004 TO: Dixon Flynn FROM: Michael Pretz SUBJECT: County Wide EMS Redesign San Joaquin County EMS Agency has recently embarked upon the process to establish Exclusive Operating Areas (EOA's) throughout the county. Because this is a change to the current practice of allowing ambulance providers to work in a zone as long as they meet state/county criteria, I believe it is essential to the provision of Emergency Medical Services in the City of Lodi that you and Council are engaged in the process of redesigning the EMS system. I have included a copy of a letter to the EMS consultants that explains the positions of the County Fire Chiefs Association. The positions of the fire chiefs in this letter were reached after much discussion. The fire departments in San Joaquin County are an integral component to the provision of emergency medical care. In fact, without fire department involvement, no private provider would be able to bear the financial burden of providing fire responder services in a timely manner. The fire departments in the county effectively subsidize private providers for the provision of basic medical services. I cannot stress enough the importance of Council and City Management engagement in this process. There will be few opportunities to have input in the redesign of the current system. Moreover, the municipalities, where the major populations in the county live, have the ability to exert influence on the Board of Supervisors. It is of the utmost importance that the EMS system meets the needs of the City's as well as those of the rural areas. To that end, I have outlined areas that I believe are important to a well designed system. • The County is divided into 8 ambulance zones, 5 of which are non-exclusive. The City of Lodi operates in Zone 4. The Board of Supervisors has indicated they would like to see multiple providers within the different zones. The City of Lodi should insist upon this provision. • Cities should receive revenue for first responder services. The fire departments throughout the County generally arrive first and begin care long before the arrival of an ambulance. Recognition of and payment for first responder costs must be included in the RFP and final agreement. County Wide EMS Redesign Page 2 • Municipal governments should have control over response time criteria and the number of available transport vehicles. In addition, unit location should be developed using population density not travel time or distance. • Penalties for failure to meet response time criteria should be sufficient to not lower levels of service. • These are a few of the necessary reforms that should be included in the redesign of the EMS system. There are additional components that are included in the memo enclosed. The City of Lodi and San Joaquin County are at a unique point in time regarding the provision of Emergency Medical Services to our community. The County has hired a consultant who is in the process of gathering information with which to make recommendations on the design of the EMS system. I would like Council to adopt the suggestions I have put forward and will be discussing them when we meet January 27t . If I can be of any further assistance, please do not hesitate to contact me. To: Chico Research Foundation Dr. Richard Narad Ms. Diane Ackers From: Michael Pretz, City of Lodi Gary Gillis, City of Stockton Vic Soled, Linden Peters Fire District Terrell Estes, City of Tracy Re: Re -design of County EMS System Date: December 19, 2003 The San Joaquin County Fire Chiefs Association has established a committee to represent their interests in the redesign of the current EMS system through the RFP process. Fire departments play a major role in the delivery of first responder EMS both as an ALS and BLS provider. While we acknowledge and respect the County's responsibility to regulate ambulance services, the County's fire departments still have the responsibility to provide services to their respective communities. In fact, the only constant in the EMS system is the fire department's capability to provide continued service in spite of the private provider service level changes. As such, we believe the redesign of the EMS system through the RFP process should include the following points: • The Board of Supervisors has indicated publicly they would like to see multiple providers within the different Zones. Therefore the County should be divided into three service areas; Greater Stockton (Zones 1, 2, 3), Greater Lodi (Zone 4) and Greater Tracy (Zone 5). • A revenue stream for ALS and BLS first responders must be established. Revenue should be sufficient to cover marginal costs for providing services. • Fire Departments should be allowed to bid on the RFP process and/or not excluded by credentialing. • City governments should have control of response time criteria and the number of available transport vehicles within their respective communities. • Any private provider must demonstrate the ability to increase ambulance staffing by 20% within 20 minutes and have sufficient reserve units available for rapid response to major incidents. • The RFP should include both emergency and non -emergency services, subcontracting would be allowed. Critical care units and out of county responses should be treated as additional services and not be a part of transport criteria. Re -design of County EMS System Page 2 • Response time criteria should be developed using population density not travel time. Arrival of transport vehicle, not first responder stops the clock. • Penalties for failure to meet response time criteria should be sufficient to not lower levels of service. We are looking forward to meeting and discussing these issues with you. If we can be of further assistance, do not hesitate to contact us. Edi Fire De ?aramedl'wc Prog ➢ Current Performance ➢Needs Analysis ➢County Issues ➢LFD Solutions Ilo = 4 a v 2 111 Current Performance Combined Average Maximum Calls/hour 2002 & & & & & & & & 0 o• (b• co• (:b• V!�i ' ,��• C^• (v Time ■ EMS ■Fire ❑Other 5 4 = 3 a V 2 1 0 Current Performance Daily Maximum EMS Calls/hour 2002 & & R & I �&. & & 0 (Z)* (b* (b* 0) * i V�). ��$ ry (V Time * Mon = Tue Wed x Thu )K Fri a Sat f Sun . RT'• 5 4 = 3 a V 2 1 0 Current Performance Combined Maximum EMS Calls/hour 2002 & o0 00 & &. &. & & 0 O. Cb. �. 0). Vry/ . Vim. rye. �Vb. Time *- Max/max T Avg/max .& Max/avg EM" EM29 EM16 EM09 EM26 EM24 EM06 EM30 EM12 EM20 EM28 EM08 EM21 EM01 EM03 EM11 EM02 EM04 EM10 EM31 EM22 EM17 EM07 EM13 EM18 EM14 Current Performance EMS Responses by Chief Complaint 0 100 200 300 400 500 EM23 Respiratory EM29 Unconscious EMi6 Fall EMo9 Choking EM26 Stroke EM24 Seizure EMo6 Bleeding EM30 Unknown Problem EM12 Diabetic Problem EM20 Overdose/ Ingestion EM28 Trauma EMo8 Cardiac Arrest (36) Needs Analysis Commun i*cat i*ons/ D i*spatch ?Accuracy of Chief Complaint ? Dispatch Process Data EMS Chief Complaint Code ? Cancelled Calls/Units First -due, Second -due, etc. Emergency, Non -emergency Needs Analysis ➢First Response ?ALS Application ?Phased Implementation ? Distribution ? Equity Needs Analysis ➢Transport ? Business Practices Competing for Patients ? Ignoring Value of First Response ? Operational Issues Accountability Customer Service County Issues ➢Exclusi*ve Operating Areas ?RFP/Contract ?System Design ➢Oversl*ght/Quall*ty Management ? Dispatch ? Status Quo LFD Solutions ➢Paramedic First Response ➢Customer's Perspective ➢Community Benefit ➢Quality Management San Joaquin County EMS Agency System Redesign and Ambulance Contract System Redesign ➢Operating Areas ?Current Ambulance Zones (non- exclusive) ? 1> 2, 3, 4 (Lodi), 5 ➢Exclusive Operating Areas ? Single Zone ? Multiple Zones System Redesign ➢Fl*rst Responder Fee ?Advanced Life Support ? Basic Life Support RT i.s System Redesign ➢ Resource Allocation ? Response Times ?Available Units System Redesign Performance Accountability ?Equitable Service Delivery ?.Meaningful Penalties for Non- compliance ins'. . F_ Ambulance Contract ➢Bidder Credentials Emergency and Non -emergency Reserve Capacity ➢Changi*ng Environment Edi Fire De 5 s 4 R.T. �..•. L3 v -I t,% I "i e -I / E Jnvv+",r a History ➢October 2002; Council directs FD to develop paramedic program ? Council further directs formation of public/private partnership ➢September 2003,10 partnership proposals returned and evaluated ➢January004Y2 Here we are ! Options ➢Remai*n independent (No Partnership) ➢Negotl*ate with AMR ➢Negoti*ate with FREMS ➢Negotiate with Stockton FD Independent (Pro) i r'•. ➢ Program development outside of partnership needs ➢Mavbe other partners out there County RFP 2 years out Independent (Con) ➢No offsetting revenue ➢Learni*ng opportunities reduced ➢Parti*ci*pati*on constraints ➢Level of service enhancement delayed aRTit AMR (Pro) ➢Labor cost reimbursement approximately $15o 000 ➢Large national company ➢Experienced in RFP process ➢Impressive ally AMR (Con) ➢Not local ➢Proposal elements not integrated ➢Agreement will require monitoring ➢Some elements economically neutral FREMS (Pro) ➢Vest control with Fire Department ➢View partnership as relationship ➢Offers service enhancements ➢Growth thru operations, not acquisition FREMS (Con)4 r. Small company ➢LI*arni*ted experience in county -wide RFP Some elements vague Stockton FD (Pro) ➢Stable, local, lire service organization ➢Has long-term agreements with L F DI ➢Economies of scale Stockton FD (Con) ➢Narrow perspective ➢Multl*ple partners %" f Council Action ➢Councl*l Engaged in System Redesign/RFP ➢Consensus on Partnership ➢ Budget Support for Program CITY OF LODI FIRE DEPARTMENT MEMORANDUM DATE: January 27, 2004 TO: City Council, thru Dixon Flynn FROM: Michael E. Pretz, Fire Chief SUBJECT: Ambulance Public/Private Partnership Council approved the Lodi Fire Department Paramedic Program in October 2002, and we are moving forward with implementation during the 2004-05 fiscal year. For the past several months the Fire Department has been seeking and evaluating partnership opportunities and have undertaken this task with due deliberation. In evaluating a partnership, control by the Fire Department of the overall Emergency Medical Service System (EMS) in the City of Lodi was paramount. Of equal importance were marginal cost recovery to offset Fire Department costs and the ability of the Fire Department and its partner to meet excess capacity service demands. Fire Department staff sent letters of inquiry to American Medical Response (AMR), First Responder Emergency Medical Services Inc. (FREMS), and Priority One Medical Transport. We received responses from AMR and FREMS. I have enclosed a summary from both proposals. The City of Lodi has four options to evaluate; 1) Remain independent (no partnership), 2) Partner with American Medical Response (AMR) 3) Partner with First Responder (FREMS). 4) Partner with Stockton Fire Department. (SFD) Option 1. Remain Independent: By remaining independent the Lodi Fire Department may be able to take advantage of partnerships with other agencies not currently providing service in San Joaquin County. The Board of Supervisors recently approved the consultant agreement to develop a Request for Proposal for exclusive operating areas in Ambulance Zones 1-5. The RFP will take between 18 and 24 months to develop and implement. During the intervening months ambulance operations will continue unchanged. During the next several months the EMS system will be redesigned by the consultant with input from system stakeholders. At this point in time we have no idea what the Ambulance Public/Private Partnership Page 2 EMS system will look like nor do we know if a partnership will be allowed to continue beyond the implementation and awarding of exclusive operating contracts. Independence may allow our fire department to be in a better bargaining position for future contracts. Recently, I have been appointed as the County Fire Chiefs Association's representative to the Ambulance Steering Committee. This committee is very important to the redesign of the EMS system, as such, the formation of a partnership at this time may jeopardize my participation on the steering committee. With these elements in mind, we recommend Option 1. Option 2. Partner with American Medical Response (AMR): The AMR proposal is written in the form of an agreement which implies there are few, if any, substantive issues to address. The AMR proposal has not varied significantly since first proposed in April 2001. The LFD-RFP clearly states "a contract ... will be very detailed." Nevertheless, the proposal/agreement prepared by AMR is not detailed. The proposal/agreement appears to go into effect after a county contract is awarded and assumes AMR will be awarded that contract (paragraph 1, Items 1 & 2). Item 2 is the only component of the proposal to identify direct reimbursements to the city and only refer to "labor costs directly associated to the provision of ALS first response." There are additional costs LFD will incur (e.g., the EMS Coordinator, fuel and maintenance, dispatch) that are a part of the marginal cost of providing paramedic services to the community that will have to be addressed. Items 3, 4, and 5 propose in-kind exchanges which may or may not have economic value to LFD. For example, Item 4 has no economic value as most CE is available at no cost, nor is Item 5; LFD can attach to any number of agencies' purchasing agreements. Item 6 completely ignores 1/3 of patient contacts. The only organizational interaction mentioned in the proposal is the "Deployment Committee" which will recommend to the Fire Chief the number and placement of ambulances (Item 7). Although the AMR proposal includes provisions for each of the three areas (incremental cost recovery, minimum number of ambulances, and ambulance provided to the city) listed in the RFP, those provisions are presented as isolated elements to meet the conditions of the RFP document rather than as components of a coordinated, cooperative partnership. As an organization, AMR is large, sophisticated, and experienced. The company can bring to bear significant resources pursuing its perceived interests. This makes AMR an impressive ally and a formidable opponent. Any organization choosing to align its interests with AMR will have to be very careful regarding terms and conditions as well as extremely vigilant in monitoring performance and compliance. Ambulance Public/Private Partnership Page 3 For several years AMR and its parent corporation have been under severe financial pressure and the parent corporation has only recently emerged from bankruptcy protection. This makes them fiscally vulnerable, subject to sudden withdrawal from a market, and requires them to ship a significant fraction of local earnings to its out-of- state headquarters. Option 3. Partner with First Responder Emergency Medical Services: The FREMS proposal is written in a manner that articulates its qualifications, its intended relationship with the city, and its ideas for creating community benefit. It is also sufficiently vague in that the proposal does not explicitly state the manner in which it would meet the three requirements listed in the RFP. However, FREMS does state it will vest control of the relationship with the City of Lodi. The proposal includes various enhancements which indicate a willingness to take a coordinated approach to aligning service delivery methods to the needs of the community as well as sharing administrative, operational, and financial expertise. FREMS has proposed an oversight committee to monitor the new system and a steering committee to develop a curriculum for training FREMS personnel to create a pool of paramedics eligible for consideration for employment by LFD. The FREMS proposal identifies programs for community education, preparedness, and self-help as well as specialized skills for field personnel. The community education and training elements of the proposal address skills training, wellness, and business opportunities (not related to transport) which may create additional revenues to supplement cost -recovery efforts. FREMS is a company founded in Northern California that appears to attain its growth through operational efforts rather than through acquisition. Its executive management mixes a concern for community expectations with a progressive business philosophy. Option 4. Partner with Stockton Fire Department: The Stockton Fire Department has expressed an interest in a partnership with the Lodi Fire Department. A partnership with the Stockton Fire Department would allow independent operations of the Lodi Fire Department with the added benefit of purchasing power of a larger city. The relationship between municipalities is very strong and operationally similar. A partnership could develop into a Joint Powers Authority Agreement with other municipal entities. A partnership with Stockton Fire would entail using AMR as the transport agency until the RFP process has been finalized. Ambulance Public/Private Partnership Page 4 EVALUATION American Medical Response AMR is an aggressive, smart organization that has secured agreements with other fire departments in the county—presumably as part of its efforts to secure the ambulance contract for the entire county. If this is their strategy, an agreement with LFD would mean AMR has partnerships in at least four of the five non-exclusive zones. Assuming AMR is awarded an ambulance contract for Zone 4, partnering with AMR would minimize transition problems when the county contract goes into effect. AMR will comply with the letter of the agreement, but the city should not rely on anything not explicitly contained in the partnership agreement. That means there will be fewer opportunities for organizational learning on LFD's part and the possibility LFD's position will be weakened or diminished depending on the terms of the County contract. First Responder Emergency Medical Services FREMS has taken a more neighborly approach to the partnership by offering to let LFD be the lead agency in any agreement, to provide resources not included in the RFP, and to create community benefit directly as well as in conjunction with LFD. FREMS is a relative newcomer to San Joaquin County, which makes it somewhat of a dark horse in the pursuit of a county ambulance contract. Nevertheless, there appear to be more opportunities for organizational learning by LFD and a better chance the agreement will be more of a partnership than a mere contract of performance and consideration. Stockton Fire Department Although no written proposal was submitted, the Lodi Fire Department and the Stockton Fire Department have held several discussions on this subject for the past two years. One of the original proposals was to form a Joint Powers Agreement (JPA) and submit a formal bid to the County to provide ambulance service. Without city -owned ambulances, service delivery would have been difficult. A partnership with Stockton Fire Department would provide the Lodi Fire Department with all the necessary elements to make the LFD paramedic program successful. Afterword Council should be aware that any proposed partnership may only last until San Joaquin County EMS Agency awards an exclusive operating contract to a private provider. The award of exclusive operations may include one of our proposed partners or a contractor not currently operating in the County. SJEMS has just awarded a consultant contract to California State University Chico Research Foundation. The consultants have started to collect data and meet with the stakeholders to discuss the redesign of the EMS system. The first draft of the RFP is scheduled to be released in May 2004. After the draft RFP has been released we will have a better idea on the direction the County will take. At that time we will return to Council with a partnership proposal. DRAFT `6-`°j '-a-7.o4 JOINT VENTURE AGREEMENT January 23, 2004 The purpose of this document is to establish a Joint Venture Agreement between the City of Stockton, specifically the Stockton Fire Department (SFD), the City of Lodi, specifically the Lodi Fire Department (LFD, the City of Tracy, specifically the Tracy Fire Department (TFO), American Medical Response (AMR) Incorporated and A -One Ambulance Service (A -One). The terms will be refined into a joint venture agreement and corresponding operating agreement between these respective parties. 1. The parties of this agreement will enter into a "joint venture" for the purpose of jointly submitting a response to the County of San Joaquin pe-AiGipating ka a Request For Proposal (RFP) pFeGess for the award of exclusive rights to emergency and non- emergency ambulance transportation within the area known as Ambulance Zones 1, 2, 3, 4, and 5 of the County of San Joaquin. The program is administered through the San Joaquin County Emergency Medical Services Agency (SJCEMSA). Our unified response to the RFP will pFoyide 9XGIW6iYitY f49F the allow each signatory to provide non- emergency ambulance transportation within their own zones. AMR and A -One will be exclusively responsible for non -emergency interfacility transfers, critical care transfers, long distance transfers, scheduled wait and returns and HMO/PPO contractual agreements. The parties to this agreement may all participate in the following non -emergency activities: a. City sponsored events, b. Memorials, c. Emergency Department Requests, d. Requests from fire department members and families, city employees and families, e. AMRIA-One Requests, f. Police and Fire Events, g. Sporting and entertainment events. 2. The following parameters will be a part of the operating agreement between these parties in the final RFP proposal submitted by the joint venture; a. The parties to this joint venture shall jointly recommend to the respective Fire Chiefs of each city the minimum number of dedicated 911 ambulances required to service that zone and the placement of ambulance stations throughout their respective areas currently known as Ambulance Zones 1, 2, 3, 4, and 5. The Fire Chiefs shall not unreasonably reject the recommendation of the parties. b. The implementation schedule of 9-1-1 dedicated emergency ambulances specifically within the areas known as Ambulance Zones 1, 2 and 3 by SFD, AMR, and A -One will be as follows: i. Initially and continuing, SFD and AMR shall each place into service an equal and even number of ALS ambulance units. A -One shall place one ALS ambulance unit in service. DRAFT. itional increase in emergency ambulance resource needs shall be alternated between the three parties for implementation with SFD having the first right of refusal, AMR having the second and A -One having the third. This schedule of increased resource alternation will continue through the life of the operating agreement between each provider. The order of the right of refusal will rotate between the parties to maintain parity. A -One ambulance service will expand to a total of two (2) ambulance units. 3. The number of non -emergency ambulance resources within the area known as Ambulance Zones 1, 2, 3, 4, and 5 will be determined by need. 4. With respect to the joint venture, the parties shall equally participate in the RFP process. If any party withdrawals from the joint venture prior to an award of contract from the SJCEMSA or accepts an offer from another bidder to compete for the same service area, that party is precluded from bidding in the San Joaquin County RFP for ambulance services. 5. Any disagreements arising from interpretation or implementation of the operating agreement between the parties shall be resolved by expedited mediation/arbitration before a mutually agreed-upon neutral party following efforts between parties to resolve the dispute informally. fi. All parties of this agreement agree to include as part of the RFP proposal fee structure, Advanced Life Support (ALS) and Basic Life Support (BLS) first responder funding and regional emergency medical dispatch funding when a party of this agreement provides such services. 7. All emergency calls for service shall be turned over to the 911 -dispatch center for Emergency Medical Dispatch (EMD) and the call will be assigned to the closest ambulance es ata. , 'ate -to the response area. 8. AMR, through its Northern California Training Institute (NCTI), will provide three (3) annual tuition scholarships to employees of the parties of this agreement. In addition, AMR a nd S FD w ill a ssist L FD a nd T FD i n the field i nternship phases of paramedic training. 9. As may be desired by LFD, AMR shall provide a Supplemental Transportation ftaourgv (STAR) Unit to be manned by LFD personnel in accordance with an agreed upon criteria and reimbursement rate for unit activation. AMR will initially prOVide a predetermined amount of ambulance units in service in the area known as Ambulance Zone 4. Should the Lodi City Council direct the LFD to provide emergency ambulance transportation, and if additional ambulance resources are needed after review, additional ambulance resources shall be alternated between LFD, AMR and A -One Ambulance, LFD having the first right of refusal. This schedule of increased resource alternation will continue throughout the life of the operating agreement between each provider. 10. As may be desired by TFD, AMR shall provide a Supplemental Transportation Resource (STAR) Unit to be manned by TFD personnel in accordance with an agreed 2 DRAFT nd reimbursement rate for unit activation. AMR will initially provide a predetermined amount of ambulance units in service in the area known as Ambulance Zone 5. Should the Tracy City Council direct the TFD to provide emergency ambulance transportation, and if additional ambulance resources are needed after review, additional ambulance resources shall be alternated between TFD, AMR and A - One Ambulance, TFD having the first right of refusal. This schedule of increased resource alternation will continue throughout the life of the operating agreement between each provider. 11. All parties of this agreement will make available to all employees of the parties, their San Joaquin County continuing education (CE) training classes. 12. AMR, through its national network of vendors for medical supplies and durable medical equipment, will extend its pricing, to all parties of this agreement. 13. All parties of this agreement who provide ambulance transportation services will restock first responder engine's medical supplies on a one-for-one exchange basis following each response. 14. It is understood that this joint venture agreement takes effect upon signing the below signature line. This agreement will remain in effect (1) if the joint venture is awarded the San Joaquin County contract for exclusive ambulance services, and (2) for the duration of the San Joaquin County contract for exclusive ambulance services. THE FOREGOING IS ACCEPTED: DATED DATED DATED DATED DATED AMERICAN MEDICAL RESPONSE, INC. MEDICAL TRANSPORTATION, INC. DBA A -ONE AMBULANCE SERVICE CITY OF STOCKTON CITY OF LODI CITY OF TRACY 0 - 1 Chief Exe(-ubve Officer Fax: 925-454-6008 Noithern Pacific Region September 22, 2003 Michael E. Pretz, Fire Chief City of Lodi Fire Department 25 Ea.st. Pine Street Lodi, California 95240 Ike: Public/Private Partnership Proposal Dear Mike, I am in receipt of year Request for Proposal — Public/Private Partnership, dated September 12, 2003. 1 have jade some minor changes to my previous proposal submittal in response to your requests. frisk forward to working with you as this process moves forward into the development of a Public/Private PaAnership that maximizes the prehospital medical services to the citizens and visitors of Lodi. If you should need any additional information, please don't hesitate to contact me direct at 925-454-6020 or via Cell at 209-652-9592. Sincer ly, Z.. ,or i t ._ `. eyer Cbzef Executive Officer Northern Pacific Region enclosure 7575 Southfront Road Livermore, CA 94551 CONFIDE'NTIAL & PROPRIETARY PUBLIC / PRIVATE PARTNERSHIPPROPOSAL Between The `ity of Lodi and American Medical Response onse est gme Zmm2 f (?3 The County of Sart Joaquin will be engaging in a Request for Proposal (RFP) process for the award of exclusive rights to emergency and non-ernergency ambulance transportali.on within Ambulance Zone 4 of the County of Satz Joaquin, administered through the Sara. Joaquin County Finergency Medical Services Agency (SlCEMSA). American Medical Response West (AMR) will participate as Ea bidder in the RFP process. The: City of L,,)d.i (City), through its Fire Department (LFD), desires to upgrade its first response services from Basic; Life Support (BLS) to Advajxcecl Life Support (ALS) in order to. maximize prehospit,, l niedical services to the citizens and visitors of Lodi, establish a partnership that allows for incremental cost recovery by the City, ensure that the limaricial needs of said partner are fulfilled, and create a synergistic entity that can bid success fill l.y for Sara Joaquin Coutaty Ambulance Zone 4. Aine ican Medical Response believes that the following proposal meets the goals of both AMR and the Lodi. City Fire Department as described in the City's Request for Proposal for a Public/Private Partnership, dated September 12, 2003. Proposed components of a Public/Private Partnership: 1 a The patties to this proposal shall maintain its ter -tris and conditions as confidential.. AMR and the City shall not disclose the terins and. conditions of this proposal to any entities not a party to the proposal, It is further understood that any Agreement t dev€;loped as part of this response to the City's Request for Proposals shall remain in effect through the RFP selection and the duration of a bid award by the SJCEMSA. AMR shall, as part of its response to the RFP, propose funding to assist in the offset of the differential paid by the City to LFD AHS accredited personnel, including other labor costs directly associated to the provision of ALS first response services, AMR and the City will meet and confer in good faith to establish tlae amount: of the offset prior to RFP submission, 3. AMR, through its Northern California Training Institute (N1CTI), will provide; up to a maximum of three (3) tuition scholarships to LFD personnel tier paraill.edic trralmiig annually. In addition, NMR will assist. 1-F.D personnel in the clinical In.temship phases of paramedic training. Public I Private Partnership between "C.'he City of Dodi and American Medical Response l 4, NMR, will. make its local San Joaquin County (2ontinuing Education (CE) training; class schedule available to the L `D. LF -D personnel may attend at no cost to the LFII. 5. AMR, though its national. network of vendors for medical supplies and durable i edical equipment, will extend its pricing to the City, 6. AMR shall restock the: LFD BLS and ALS First Responder Engine's medical supplies on a one -for -ono exchange basis, following each response that results in an ambulance transport, 7. AMR and the City shall fora -n an EMS Deployinent Committee, which shall jointly recorn nerd to the Lodi +`ire Chief the minimun-z number of dedicated 911. ainbulances and the placement of ambulance stations throughout the City of Lodi, 8, AMR shall provide, and the City of Lodi shall allow to be housed, a Supplemental Transportation Resource (STAR Unit) to be Manned by Fire Department personnel in. time of systern overload, in accordance with agreed upon criteria and an agreed upon mate for Unit activation, THE FOREGONG IS ACCEPTED: D: Dated City of Lodi iS,._. w- �- r°n Dated -- �_� zica e ica response West Public; / Private Partnership between The City of Lodi and American IVtedical Response 2 1-i"I", MI Emergency Medical Services Ambulance Transportation Proposal FLR ,aT RESPONDER EMS MISSION STATEMENT The mission of First Responder is to provide medical transportation solutions to the communities in which we serve. Our employees will practice honestly, clinical excellence, response time reliability economic efficiency, and quality customer service. We will build solid relationships with Fire Departments, Hospitals, Local Government Agencies, Law Enforcement, and the Business Community, Our philosophy is to deliver our multitude of services, Right Time, First Time, We will strive to be technologically innovative while maintaining economic efficiencies. We will treat every person we come in contact with compassion and a caring attitude. A. PROPOSAL, S` `' '.................a..................,.W....®.....®....1.... B. NIS & NECESSITIES ®.... .>...... ..®....®...®...........®...®.....®.....W........ C. CREDENTIALS & QUALIFICATIONS............... __ ....a.s...Wa.oeo¢.o...lb ff3 COMMITTEE y _ E. SYSTEM I N...........a..................... ...a........ ......... .®.®g®..b...,.®. F. CLINICAL SOPHISTICATION ISTICATION.................................................... G. TRAINING ACADEMY...........................®....,...............®.............. H. COMMUNITY EDUC'A'TION TRAINING... ................................. 9 1. ADDITIONAL IN—HOUSE TRAINING...W.....................__ ............. J. VEHICLES& EQUIPMENT— ...................................W................ 10 L. PROGRAM P N I"TURES...................................................... 1 . SCT ........... .................... ............ ...................W........... 12 First responder EMS, lnc. is a high -duality, integrated community unity provider of emergency and non -emergency medical transportation services. Our company was formed five years agcy with the objective of creating a trip quality, innovative and customer service oriented organization, establishing partnerships throughout the ccs unity to improve patient care at every level. The City of Lodi has expressed an interest in improving its response and readiness to respond to medical emergencies throughout the community. The growth projections for Lodi and the surrounding areas require a proactive plan, creating a solid, self sustaining EMS system from which all members of the community can benefit. First Responder EMS, Inc. respectfully submits a proposal to form a public-private partnership with Lodi Fire Department to combine the strengths of both entities to create the most fluid, flexible and supportive system available. B. NEEDS & NECESSITIES Summa - Current System Does Not Meet Needs - Existing ambulance Response Times Have Increased Over Years Lack of Local Control Lodi Fire Department currently provides Basic Life Support (BLS), initial response services to medical and traumatic emergencies. American Medical Response (AN) independently provides Advanced Life Support (ALS) and medical transportation services. This system has been in place for many years, and despite numerous opportt hies has not improved or significantly changed to meet the increasing demands of the chizem, of LoU in fact, the Lodi Lire Department recently evaluated the current ambulance transportation program and concluded that the lack of control from the City provides less than acceptable results in service, noting that AMR has eliminated dedicated 9-1 -1 ambulances to the City of Lodi. A response time study, Fused on years 1.995-2001 shows an increase in response times by AMR and a reduced number of ambulances serving the Lodi area as vae]L A public-private partnership with First Responder EMS, Inc. would provide the City and its residents with full control of a progressive and innovati D. JOtNT POWERS COMMITTEE(JPQ summmy Expert Oversight and Direction Controlled by City Council and Fire Department m Numerous Benefits One of the first steps in creating a model for public-private partnerships is establishing ars oversight committee of experts in the field of EMS including representation from the Lodi Fire Department, the Lodi City Council and from First Responder EMS -Lodi. The Lodi Fire Department will chair the Joint Powers Committee (JPC), while its focus and authority will fully encompass all operational, procedural and financial matters in the development and ongoing oversight of the proposed new system.. The JPC will regularly report to the City Council to provide status reports and updates as to the effectiveness of the system. E. SYSTEM S G Summary - Progressive, System Design Proposed Training Academy Integrated EMS Delivery System Utilizing State -of -the Art l ech ologies F Cost Recovery Urogram The Joint Powers Committee (,]PC) will develop the system design, which will be implemented by the public-private partnership of First Responder EMS -Lodi, and the Lodi L=ire Department, The Lodi Fire Department shall chair the JPC and direct the system designq while First Responder EMS -Lodi will provide ambulance services, ar bulance personnel, vehicles, equipment, maintenance, liability, and cast recovery services, it is cur vision that, together, we can create a comprehensive, integrated emergency response system that supports the growth of the City of Lo& A key component to the success of this program is the development of a Training Academy to cross -train First Responder EMS -Lodi paramedics, which will enhance their eligibility for future full-time employment with Lodi Fire Department. The goal is to establish firing criteria. for First Responder EMS -Lodi paramedics, which are equivalent to the current Lodi Fire Department requirements. After one year of service with First Responder EMS -Lodi, paramedics would be qualified for selection for full-time employment with Lodi Fire Department. As a result, the City of Lodi would be assured tufa continuous pool of highly trained and experienced paramedics to support the EMS needs of the citizens, Cast recovery programs would be established to provide for adequate funding of the newly established system, tither innovations that may be brought forward through the public-private paitnership include new programs targeted toward industry (i.e. General Mills) to integrate training and services; raral agricultural EMS, which would provide assistance and training to outlying areas (i.e. wineries); the development of procedures for improving and expanding coordination of air support for rural emergencies. In addition a rrew Disaster Training program which is targeted toward localbusinesses, Skilled and Assisted Diving Facilities to create abetter state of emergency preparedness will be incorporated, For Multi Casualty Incidents and MCI trailer would be created to response to assist in supplies and equipment in such circumstances. This partnership will provide a flexible and dynamic system that will be a model for balancing the need for local control over EMS services, and shifting the risk of providing advanced paramedic transport services from the City of Lodi, while providing significant enhwicements in service and reliability. F. CLINICAL SOPHISTICATION Summary m Experience Emergency Medical physician Interactive audit Processes, including prospective, concurrent and retrospective indicators Supportive program the encourages continuous growth First Responder EMS -Lodi will be dedicated to selecting and maintaining quality employees with ars emphasis on compassion and customer service. Under this proposal, First Responder .EMS, Inc. offers our current Medical Director to assist in clinical oversight ol`the quality outcomes the system will provide. This physician is highly spilled in emergency services and will oversee all continuous training and education for the public --private partnership. peer -driven process approach to Quality Improvement provides powerful clinical motivation to our personnel. We have carefully integrated this approach with multiple interactive audit processes tomeasure key performance. The performance indicators are prospective, concurrent and retrospective in design. The overall goal of the continuous Quality Improvement process is to encourage quality and to promote continuous growth, Another aspect of Quality Improvement that is addressed in our program is recognizing and responding to the stress levels of the emergency responders. One goal will be to establish a process to create an active Critical Incident Stress Debriefing Team specific to emergency responders, with activation standards and procedures to ensure employees of both the Lodi Fire Department and. First Responder EMS -Lodi have access to these service& Collectively, the partnership will fine-tune the best system to be put in place for the City of Lodi. G. TRAINING ACADEMY urnm ry Establishes a Joint Steering Committee Sets standards to meet cross -training Doses Provides quality candidates for Dire to Lodi Fire Department It is proposed that a Steering Committee be formed that reports to the JPC, which is comprised of representatives from First Responder LMS -Lodi and the Lodi Fire Department, to develop the curriculum for a Training Academy, A representative from the Lodi Fire Department shall chair the Steering Committee. The Steering Committee will establish a comprehensive, orae -year program for training, educating and evaluating the employee's skills, understanding, knowledge and application of firefighting and EMS policies, procedures and standards as defined by the 3FC. The Steering Committee will also recommend initial hiring criteria. for First Responder EMS -Lodi paramedics who will participate in the rraining Academy. Upon successful completion of the aeade y the First Respotider EMS -Lodi paramedics will be eligible for consideration for full -thee employment by the Lodi Fire Department as openings occur. Surerry Coordinated and Enhanced Community Education Programs Expanded services for Seniors Improved Coordination and Communication with Local Business First Responder EI S- will provide in-home risk assessments for seniors to reduce the incidence of falls resulting in fi-actured hips, which is a debilitating condition for this population. FRE MS has extensive experience with the senior population and will provide and support training to Lodi area Assisted Living and Skilled Living facilities to improve the care and compassion provided to our seniors. First Responder EMS -Lodi will. also conduct a series of traininas to the public, including CPR, First Aid and Fire Safety. By integrating with efforts currently underway by the Lodi Fire Department, a full continuum of training will be provided, I® ADDITIONAL IN-HOUSE TRAINING Summary T Innovative Training Programs Specific focus on Disaster Management and Weapons of Mass Destruction Certified Memory Impairment Specialist (Dementia) Program First Responder EMS -Lodi will provide a variety of training programs to the employees that are selected to work in the new system. Each individual will receive the additional training areas during their first year- pjsqat T m4pelugnt o Incident Command System (ICS) a, Multi -Casualty Incident (MCI) o Weapons of Mass Destruction (WMD) Seniors * Certi.fied Memory Impairment Specialists (CMIS) * Geriatric Emergency Medical Services (GEMS) * Anatomy of an Assisted Living/Skilled Nursing Facility * Non-verbal Communication for the Geriatric Patient � edits * Advanced Cardiac Life Support (ACLS) * Basic Trauma Life Support (BTLS) o Pediatric Advanced Life Support (PLAS) ftyghLatric * Psychiatric Emergency Medical Management (PEMM) * Critical Incident Stress Debriefing (CISD) a Public Education o Fall Prevention o Risk Assessment o Access to Emergency Services a Agricultural EMS Procedures o Industrial EMS Procedures o Evens Standby Procedures * Paramedics or) Bikes * Medical Trailer NOTE: Other Fire Department training requirements will be incorporated into the curriculum at the direction of the JPC to ensure the objectives of the Training Academy armee achieved. First Responder EMS -Lodi will be committed to providing state -of -the art vehicles, equipment and the technology necessary for the provision of the best possible service to the citizens of Lodi. First Responder E.MS-Lodi will request reconm-nendations from the JPC for specifications for all vehicles and equipment. Maintenance on the vehicles and equipment will be provided by First Responder EMS -Lodi and shall meet the highest standards of the industry. K. COST RECOVE RY PROGRAM Suwzmary - Accounts Receivable services provided under contract Local dollars stay local Training programs provide diversified cost recovery funds Accounts Receivable services for ambulance billing are complex and specific to the industry, First Responder EMS -Lodi will propose selecting and managing the coast recovery for transportation and sharing in the returns from said recovery as identified by the VC. Other cast recovery programs, which will assist in the funding of the new system design include education and training to local businesses, industry and senior facilities, events coverage, e, regional training sessions (including CPF, First Aid and AED), and ambulance subscription programs. L. PROGRAM I U S Summary Improved System Control l acrd Performance No Fiscal Impact to the City of Lodi Budget Approved by the Joint Powers Committee (JPQ The frail bud et for this newly developed partnership will be identified after consultation and direction from the ,JPC. The objectives of the program are to be self-sufficient and to keep the dollars generated within the city's control to provide for continued operations arzd enimneements. SUMMARY M. Today's EMS systems must be built with tomorrow in mind. Constant charges in reimbursement for transportation services, new technologies, innovations and programs that improve patient care continue to advance from the horizon. We must be prepared to meet the challenges before us as our communities grow and our populations age. public-private partnership between the Lodi Fire Department and first Responder EMS -Lodi provides a solution to the cert issues and fiscal demands, as well as providing a path for continued improvement and enhancement of services to the citizens of Coat. Under this proposal, the City of Lodi will have control over dedicated paramedic ambulance resources for the first time. Through a relationship based on teamwork, continuity and a training program that will provide qualified and experienced candidates for the Lodi Fire department as the city grows, the best services will be provided in the snost cost-effective manner. er. We hope you agree that this proposal warrants serious consideration. We would appreciate the opportunity to tneet with the City Council and/or representatives from the Lodi fire Department to discuss this proposal, and to enact an action plan for implementation.