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HomeMy WebLinkAboutCouncil March 22 20051 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 DISCLAIMER: This document contains the Whatcom County Council or Committee minutes, as approved. However, unless an attested signature page is attached, they are not the final approved minutes. WHATCOM COUNTY COUNCIL Special County Council March 22, 2005 Council Chair Laurie Caskey- Schreiber called the meeting to order at 11:30 a.m. in the Council Chambers, 311 Grand Avenue, Bellingham, Washington. Present: Barbara Brenner Seth Fleetwood Sharon Roy L. Ward Nelson Dan McShane Absent: Sam Crawford 1. DISCUSSION REGARDING EMERGENCY MEDICAL SERVICES Dewey Desler, Deputy Administrator, presented a power point presentation (on file). The administration will ask the Council to consider a resolution regarding emergency medical services (EMS). The administration has been working since last summer with people on the future of EMS in the community. He read the list of the EMS Working Group members and the group's principles and objectives, the realignment timeline, and the Medic One countywide call volume projections. Call volumes for Medic One would rise at six percent per year under the current service. That's been the case for the past 20 years. It's a level that's difficult to sustain. The proposal is to drop the level below 11,000 by the year 2010 using a two tier system. Medic One's paramedics would respond to the most critical advanced life support (ALS) calls throughout the county. Fire districts would transport and respond to basic life support (BLS) calls. The system would create a rise in BLS transports provided by fire districts and fire departments and a drop in ALS response. When the levy went before the voters in 2003, the plan was to provide ALS response to all calls. In this case, they are talking about a different method for response. Train paramedics who will respond to ALS calls, and districts will respond to the BLS calls. Brenner asked who makes the decisions on whether a call is ALS or BLS. Desler stated calls come into 911. The dispatchers will ask a series of key questions to determine whether the caller needs basic life support (BLS) or advanced life support (ALS). If there is a question, ALS unit will be dispatched. Special County Council 1 - EMS, 3/22/2005, Page 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 DISCLAIMER: This document contains the Whatcom County Council or Committee minutes, as approved. However, unless an attested signature page is attached, they are not the final approved minutes. Roy asked how they know that one -third of the calls now could be handled by BLS. Desler stated they have the evidence to support that assumption. The working group went through all calls that occurred over the last several years in every community. Roy stated her concern is not the volume of calls. She asked if there is information on when Medic One was sent out when a lesser service would have sufficed. She asked how they know that reducing this service by one -third is realistic, based on the kinds of calls, not the number of calls. Desler stated the National Academy of EMS has a protocol in which all the dispatchers have been trained to respond. If an emergency medical technician (EMT) shows up at BLS call and determines the situation as more serious, the EMT would immediately dispatch an ALS unit. Bill Boyd, Bellingham Fire Department Chief, stated they have being doing this call triage for past two years. They've been sending the same response since they implement the program because they wanted to make sure the current system is effective and works. They did not want to send a lesser response to a situation that requires a paramedic. When they send out a BLS response, they are finding that most situations don't require a paramedic and can be handled by a BLS unit. They are now prepared to take next step and send only BLS units to those calls. They have to find the resource to send out the BLS units alone. They have to build the BLS transport capacity in the county. The system is starting with a few select fire districts in the county. The Bellingham Fire Department will be ready in about a month. The new system will delay the need to add an additional Medic One unit. He is highly confident they can triage BLS calls effectively. Brenner asked for an example of a situation when BLS is adequate. She asked who decides between no response, BLS, and ALS. Boyd stated one example is that they respond often to the Northwest soccer field to attend to soccer injuries. A fractured ankle or leg would receive a paramedic response. Under the new system, those injuries will receive a BLS response, with just a Ferndale Fire District BLS unit to split and transport that patient. Certain types of fractures would get a paramedic level of response, such as a femur fracture. Keep in mind that the first responders can upgrade a call at any time. Nelson stated the triage system includes a team of responders. Even if a BLS unit responds, it doesn't mean the continuum of care won't start so that damage is prevented. A paramedic may be called, but care begins when the BLS unit arrives. Boyd stated that is correct. It goes both ways. If a paramedic arrives and its determined as not necessary, the paramedic will tell the fire district to do the transport and put the medic unit back in service. Caskey- Schreiber asked if there are areas in the county where the fire districts aren't able to meet the BLS demand. Boyd stated few east county fire districts can do BLS transport. Medic One will have to do BLS transport in those areas. The small fire districts don't have the volunteer capacity. Special County Council 1 - EMS, 3/22/2005, Page 2 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 DISCLAIMER: This document contains the Whatcom County Council or Committee minutes, as approved. However, unless an attested signature page is attached, they are not the final approved minutes. Caskey - Schreiber asked if Medic One will have a BLS unit for those weaker areas of support. Desler stated the projection represents the BLS calls provided by Medic One. Some service would still be provided for BLS level of support from Medic One. Brenner stated there are many people now living in the eastern part of the county. The projection doesn't rise at all. She asked if the projection is realistic. Caskey- Schreiber asked if the projections would be thrown off as the County considers allowing 500 homes to Kendall. She asked if they need to keep those things in mind while making planning decisions. Desler stated the projection is based on all the information they have to -date, including potential growth in that area. Desler continued the presentation on the average age of patients, the change in age of the population served, and the fee - for - service revenue. Caskey- Schreiber asked if the capped amounts for Medicaid and Medicare meet the cost. Desler stated they do not. Medicaid pays about $.33 on the dollar for the cost of service. Medicare pays about $.75 on the dollar for the service. The private pay /uninsured folks pay about $.29 on the dollar for the service. They have to figure out where to cover the cost. In the past few years, they have used general fund money from the County and City. Caskey- Schreiber stated a criticism is that the City and County are not living within their budgets. This is a situation that shows they can't because of the rising costs due to population growth. Desler stated Congress requires that this service be provided to those with Medicare and Medicaid, with a cap in reimbursement. That reimbursement continues to drop, and is scheduled to continue to drop. He continued the presentation on paramedic training requirements and costs of a county -only system. Brenner asked the cost of time and training for BLS support. Desler stated EMT training is three months. Boyd stated there are about 500 EMT first responders in the county. Almost all are volunteers. The cost of employees is different by about 14 to 15 percent. The majority of BLS responders now are volunteers. In those districts that are doing the transports now, the majority of the response is done with volunteers, who are struggling. They're getting tired. Brenner asked if the working group considered training other fire districts to respond to BLS calls in the east county, and pay them a certain amount for going to the east county. Desler stated they are working with all districts that want to begin Special County Council 1 - EMS, 3/22/2005, Page 3 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 DISCLAIMER: This document contains the Whatcom County Council or Committee minutes, as approved. However, unless an attested signature page is attached, they are not the final approved minutes. an BLS transport service. A group is working with private ambulance service to help districts develop a primary or secondary capacity to provide BLS transports. Desler continued the presentation on a county -only service with one and a half units, without a subsidy. The working group rejected the options. It would leave many people stranded who need the service and care. Desler continued the presentation on a unified system with all jurisdictions. The resulting demand for ALS services can be met through 2009. Then, the intent is to hire, train, and deploy District 7, the largest fire district, to provide the service. Caskey- Schreiber asked about excluding the City of Lynden. Desler stated part of the unification is to use the same system for processing insurance payments. Lynden is the only district that said it wants to process payments on its own. This model reflects the revenue and expense for a portion of BLS running through the budget. Caskey- Schreiber asked the ramifications to calls from Lynden. Desler stated there is no change in service. Lynden's finance and expense will not be run through this system. Desler continued the presentation on the EMS community information and education and the Emergency Medical and Ambulance Advisory Board. A series of people need to be involved in and informed of EMS. He proposes to reactivate this advisory board and focus on certain needs. The City unanimously supports reactivating the board. The fire districts are forming themselves into regions. One idea was for one commissioner from each region to serve on the board. Additional members could be advisory, including the private ambulance service. Focus the membership of the board on the leadership of the county. Brenner asked about the type of service the private ambulance carrier would provide. Desler stated the private ambulance service handles a lot of frail people and transports the elderly from one nursing home to another. Because they have EMT's on staff, the private service could provide assistance to some districts for BLS transport delivery. The working group is currently working with the one private ambulance company in the community. The owner of that service has participated in some of these working group meetings. Boyd stated the owner of the private ambulance service has offered his service to all small fire districts that don't have the capacity to do BLS transport. Brenner asked if first responders in those areas would be either the fire district or the private service, before the ALS service. Boyd stated that would have to be worked out. He assumes the first responders would still go from the local fire district because there must still be a timely response. The east county area has the Special County Council 1 - EMS, 3/22/2005, Page 4 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 DISCLAIMER: This document contains the Whatcom County Council or Committee minutes, as approved. However, unless an attested signature page is attached, they are not the final approved minutes. lowest call volume and the lowest population. A unit placed in the east county will be seldom used compared to the Interstate 5 corridor area. Brenner stated that if the small fire districts did a deal with the private ambulance service, the ALS wouldn't need to come out right away. Boyd stated that is correct. Desler stated a committee is meeting with the private ambulance service to figure out how the private service can be involved as a primary or secondary service. Desler continued the presentation on EMS funding options. There is no recommendation yet. Most interest has been on the last two items, regarding a sales tax or an EMS levy, similar to what went before the voters in the past. One idea is for a citizen commission to look at funding issues from the perspective of the citizens. There would need to be a long -term interlocal agreement among all the jurisdictions to make sure the revenue is focused and delivered on EMS. An EMS levy proposal would require the approval of and an agreement with the City of Bellingham. Thus far, the discussion is about putting forward a measure to the voters in 2006. Caskey- Schreiber asked about the City Council voting to extend the three - month agreement. She asked how that would work out if they wait until 2006 to solve this. Desler stated to retain the four existing units, the plan was to retract the Grandview Station back into Bellingham. The staff from the station that is being retracted will fill positions that are filled now by firemen who will retire soon. In the meantime, the City has to figure out how to pay overtime for existing personnel to cover the shifts. (Clerk's Note: End of tape one, side A.) Desler stated the proposal is to maintain a Medic One four -unit system throughout the county under the current budget, with all money the County has allocated. There will still be a deficit. The proposal is to use the fund balance, which is owned 50 percent by the County, to cover the deficit in 2005. There is about $980,000 in that fund balance now. At the same time, the working group is currently discussing how to meet the fund balance requirements in 2006. Caskey- Schreiber stated that the County will have to take action if the levy fails. Desler stated they will have to find another approach. The working group is grappling with those options. Brenner asked how they'd increase insurance and fee revenue. Desler stated that item was listed on the presentation for discussion purposes. However, it's not really an option. There aren't a lot of choices. Special County Council 1 - EMS, 3/22/2005, Page 5 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 DISCLAIMER: This document contains the Whatcom County Council or Committee minutes, as approved. However, unless an attested signature page is attached, they are not the final approved minutes. Roy stated increasing insurance revenue isn't possible, but they can charge more from the user. Caskey- Schreiber stated it may come down to that. The County will have to figure out what to do with people who can't afford the service. Desler stated that to receive Medicare revenue, the federal government said, by law, the service will only receive what the government pays, and the service will not bill the user for the difference. The amount the federal government pays is declining. The same thing applies with Medicaid. For that 65 percent of the population with Medicare and Medicaid, the service is not able to collect any more fee. The uninsured amounts are billed, but get written off, even though they have a successful billing service. Desler continued the presentation on the key outcomes of realignment, the new EMS Working Group charge, and next steps in progress. People have asked how the County Council feels on this. He drafted a proposed resolution for the Council to consider to give support for this direction (on file, AB2005 -155). It would start to generate a lot more enthusiasm. McShane stated he would support the resolution. Nelson stated he supports the resolution, although he won't be at the next Council meeting. Brenner stated it would be an amazing feat if they can all work together to hold this together. Roy stated she supports the resolution. OTHER BUSINESS Dewey Desler, Deputy Administrator, asked if the councilmembers want the Washington Community Economic Revitalization Team (WA -CERT) application presentations before the Council. Caskey- Schreiber stated they do. She would like presentations after the councilmembers receive the rating sheets. ADJOURN The meeting adjourned at 12:34 p.m. Jill Nixon, Minutes Transcription Special County Council 1 - EMS, 3/22/2005, Page 6 1 2 3 4 5 6 7 8 9 10 DISCLAIMER: This document contains the Whatcom County Council or Committee minutes, as approved. However, unless an attested signature page is attached, they are not the final approved minutes. The Council approved these minutes on April 12 , 2005. ATTEST: WHATCOM COUNTY COUNCIL WHATCOM COUNTY, WASHINGTON Dana Brown - Davis, Council Clerk Laurie Caskey- Schreiber, Council Chair Special County Council 1 - EMS, 3/22/2005, Page 7