Report Prepared by: Casey Wilson, Interim Fire Chief, Fire Department
Title
SUBJECT: Acceptance of the 2024 Interfacility Transport Ambulance Feasibility Study, Accepting a Report on Advanced Life Support First Response, Approving the Addition of One Fire Battalion Chief 40-Hour Position, and Approving the Supplemental Appropriation for the Purchase of One Vehicle and Three (3) Advanced Life Support Cardiac Monitors
REPORT IN BRIEF
Present City Council a report on the 2024 Interfacility Transport Ambulance Feasibility Study, provide an update on first responder advanced life support, and request additional resources to support the implementation of the first responder advanced life support program.
RECOMMENDATION
City Council - Adopt a motion:
A. Accepting the Merced Fire Department 2024 Interfacility Transport Ambulance Feasibility Study; and,
B. Accepting a report on First Responder Advanced Life Support (FRALS) as information only; and,
C. Approving Resolution 2024-104, a Resolution of the City Council of the City of Merced, California, Amending the Classification Plan by Updating the Personnel Allocation in the Fire Department by Adding One Fire Battalion Chief-40 Position; and,
D. Approving a supplemental appropriation in the amount of $50,000 from the unencumbered, unreserved fund balance of Fund 2003-Measure Y Fire; and,
E. Waiving the City’s competitive bidding requirement as permitted by Merced Municipal Code Section 3.04.210 for standardization of equipment in purchasing three (3) Advanced Life Support LIFEPAK LP35 Cardiac Monitors in the amount of $145,021; and,
F. Authorizing the City Manager to execute the necessary documents; and,
G. Authorizing the Finance Officer to make the necessary budget adjustments.
Body
ALTERNATIVES
1. Approve, as recommended by staff; or,
2. Approve, subject to conditions other than recommended by staff’ or,
3. Deny; or,
4. Refer to staff for reconsideration of specific items; or,
5. Continue to a future meeting.
AUTHORITY
Charter of the City of Merced, Section 1105.
CITY COUNCIL PRIORITIES
Public Safety, as provided for the in 2024-25 Budget.
DISCUSSION
History
The Merced Fire Department (MFD) released their first Paramedic feasibility study October 1974. The study recommended the implementation of Firefighter Paramedics which would go into effect January 1976.
Fast forward to 2019, Fire Chief Billy Alcorn brought an EMS Program update and request for approval to implement a Rescue Paramedic Program citing a need to advance the level of care to our community from Basic Life Support (BLS) to Advanced Life Support (ALS).
The 2018 Merced Fire Department Standards of Cover Assessment recommendation #9 states, “The City and Department should consider expanding current EMS capacity to include ALS (paramedic) services as strategic planning and funding permit.”
In 2022 the MFD applied for, was awarded, and city council accepted a FEMA Assistance to Firefighter Grant (AFG) to provide the funding to send 12 MFD firefighters to Paramedic School.
The 2023 Merced Fire Department Strategic Plan key goal is to expand EMS in the Community. It is cited in the strategic plan, “Effective EMS response in the community is essential in today’s environment. Providing Advanced Life Support (ALS) capabilities through the fire department engines, trucks and squads close a key link the AHA’s Links of Survival”.
As of October 2024, MFD currently has seven (7) licensed paramedics, three (3) pending licensure, three (3) in final stage of training, and six (6) are beginning training.
2024 Interfacility Transport Ambulance Feasibility Study
Over the past several years, the MFD has witnessed an ever-decreasing level of ambulance service being provided by the county contracted ambulance provider. A variety of reasons for the decline have been presented by both the ambulance provider and the Local EMS Authority (LEMSA). The MFD with a focus on improving the level of EMS service being provided, has started work on several initiatives aimed at addressing the EMS system challenges as they have been presented. One such initiative is the creation of a Interfacility Transport (IFT) ambulance. Robert Smith was hired as an EMS consultant to perform a feasibility study on interfacility transport using our existing ambulance. The task of this report was to provide a practical and experience-based study of the program’s feasibility. In summary, the basic life support (BLS) interfacility transport (IFT) ambulance is both operationally and fiscally feasible and may have positive impact on the level of EMS service provided to the residents of Merced. To be fiscally feasible and operationally effective it would require MFD to enter into an IFT agreement with Mercy Hospital. Currently, there are multiple private ambulance providers in this space. Although it is feasible, it is staff recommendation to not pursue BLS IFT ambulance staffing currently. A single ambulance would not be sufficient to support the amount of IFT’s out of Mercy Hospital. This could negatively impact the private ambulance sustainability and potentially have negative impact on the through-put of the hospital, thus increasing Ambulance Patient Offload Times (APOT).
First Responder Advanced Life Support
In an effort to implement First Responder ALS the MFD has:
• Contracted with a medical director
• Developed a controlled substance plan
• Developed an EMS quality improvement plan
• Developed and implemented continuing education and an EMS training plan
• Acquired and implemented an Electronic Patience Care Reporting (ePCR) program
• Acquired ALS equipment
• Received tentative approval and developed a draft agreement with Merced County EMS agency for First Responder Advanced Life Support provided status
First Responder Advanced Life Support Program Needs
To be a paramedic service provider in California, Title 22 CCR 100168 states that a provider shall:
1. Provide emergency medical service response on a continuous twenty-four (24) hours per day basis, unless otherwise specified by the LEMSA, in which case there shall be adequate justification for the exemption. (e.g. lifeguards, ski patrol personnel, etc.)
2. Utilize and maintain telecommunications specified by the LEMSA.
3. Maintain a drug and solution inventory specified by the LEMSA of equipment and supplies commensurate with the basic and local option scope of practice of the paramedic.
4. Have a written agreement with the LEMSA to participate in the EMS system and to comply with all applicable State regulations and local policies and procedures including participation in the LEMSA’s EMSQUIP as specified in chapter 12 of this division.
5. Be responsible for assessing the current knowledge of their paramedics in local policies and procedures and protocols and for assessing their paramedics’ skills competency.
In an effort to maintain compliance with California Title 22 CCR 100168 and LEMSA requirements, the MFD requires an additional Battalion Chief 40-hour position to provide adequate oversight and compliance of the ALS program. The total compensation package for this position is approximately $232,540. The cost for this position in FY24/25 will be covered by salary savings.
The position would also require the addition of a command vehicle with an estimated purchase cost of $105,000.
Additional equipment needs include three (3) ALS cardiac monitors with a cost of $145,021. The MFD is requesting to waive the competitive bidding process and purchase through Stryker. Stryker is the sole-source provider for LIFEPAK LP35 ALS Cardiac Monitors. Funding for the command vehicle will be funded by utilizing $200,000 previously allocated for apparatus refurbishment. After assessing the cost/benefit of the refurbishment of one of our apparatus, we have determined this is not the most beneficial use of resources and recommend using this funding to support ALS advancement.
IMPACT ON CITY RESOURCES
There is no impact on city resources for the acceptance of the 2024 Interfacility Transport Ambulance feasibility study.
The addition of one Fire Battalion Chief 40-hour position will result in a fiscal impact of approximately $232,540 annually including total compensation. For the remainder of FY24/25 the cost is approximately $167,111. For FY 24/25 the cost will be covered with salary savings within the General Fund.
The command vehicle to support this position will result in a $105,000 one-time purchase and ongoing operating costs for gas and maintenance. The addition of three (3) Advanced Life Support Monitors will result in a $145,021 one-time fiscal impact. This one-time cost will be funded by utilizing $200,000 previously budgeted for apparatus refurbishment and a supplemental appropriation in the amount of $50,000 from the unencumbered, unreserved fund balance of Fund 2003-Measure Y Fire.
Staff will come back at a later date for Council approval to purchase the vehicle.
Recommendation D and G will require an affirmative vote of 5 Council Members to pass.
ATTACHMENTS
1. EMS Ambulance Feasibility Study
2. ALS Monitor Quote
3. Stryker Sole-Source Letter
4. Resolution 2024-104
5. Council Presentation