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The Seven Regional EMS Agencies

The Seven Regional EMS Agencies. A Growing Fiscal Crisis. EMS Act - 1981. Legislative Intent – “ To provide the state with a statewide system for emergency medical services .” (H&S Code 1797.1). EMS Act - 1981.

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The Seven Regional EMS Agencies

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  1. The Seven Regional EMS Agencies A Growing Fiscal Crisis

  2. EMS Act - 1981 • Legislative Intent – “To provide the state with a statewide system for emergency medical services.” (H&S Code 1797.1)

  3. EMS Act - 1981 • Requires each county to have a local EMS agency (LEMSA) to develop, implement and monitor the EMS system

  4. EMS Act - 1981 • To ensure EMS was providedthroughout the state, not just in the urban pockets, the EMS Act, “Provides for special funding to multi-county EMS agencies (LEMSAs) which serve rural areas with extensive tourism to reduce the burden of providing the increased services due to that tourism.” (H&S Code 1797.108)

  5. Responsibilities of The LEMSA: • Plan & Implement the EMS System • Coordinate & Regulate EMS Personnel and Resources • Provide Local, Independent Medical Oversight for the EMS System • Set Local Medical Protocol and Policy • Approve EMT & Paramedic Training Programs & Continuing Education • Issue State EMT Certifications

  6. LEMSA Responsibilities (cont.): • Approve ALS Ground and Air Operations • Designate Base Hospitals, Trauma Centers, Specialty Centers • Oversee Quality of Patient Care & Evaluate the EMS System • Develop EOAs, Ambulance Service Contracts, and Trauma, Quality Improvement, Multi-Casualty / Disaster Plans • Resolve Local EMS System Issues

  7. California Has 31 LEMSAs • 24 Single County LEMSAs • 7 Regional LEMSAs

  8. The Seven EMS Regions include 58% of the Counties in California: • 34 of 58 Counties are in EMS Regions • 91% of the Counties with Less Than 100,000 Residents are in EMS Regions • 93% of the Counties with Less Than 200,000 are in EMS Regions • EMS Regions are Predominantly Rural / Remote/ Wilderness Areas

  9. Combined Regional Static Population is Second Largest in the State #1. Los Angeles County = 9.94 Million #2. Seven Regions = 6.68 Million #3. Orange = 2.97 Million #4. San Diego = 2.93 Million California Totals 35.89 Million Residents

  10. Benefits of Multi-County Agencies (EMSA #104): • Reduced administrative and program costs • Standardized system coordination of emergency response and patient flow • Focus on regional EMS development / concerns • Sharing of limited EMS resources among multiple counties • More effective impact of smaller counties at the state level • Matching administrative boundaries with natural response and patient flow systems

  11. State Funding Eligibility for Regional EMS Agencies: • Rural multi-county agencies with heavy Non-Resident EMS system use • Three counties or more • Matching funds of at least $1 for each state dollar received (6 Regions); or, regions with less than 300,000 provide a cash match of $.41 per capita or more (1) • Delegation of specific H & S Code responsibilities by the contract counties • EMS Plan on file with the EMSA • Must follow all state and federal statutes, regulations and guidelines

  12. State GF Funding for EMS Regions: • Formula is Based on # of Counties & Population • 2007-08 Total Allocation = $ 2.42 Million • Current # of Counties & GF Distribution: • Nor Cal 11 22% • Central Cal 4 16% • SSV 5 15% • Mt. Valley 5 14% • Coastal 3 12% • ICEMA 3 12% • North Coast 3.3 9%

  13. Is State Funding continuing to support the legislative Intent of providing and maintaining a statewide EMS system?

  14. State Support for Regions (1998 to 2007) • FY 1998-99 was the Last State General Fund Augmentation • Since 1998-1999 : - Basic Inflationary Costs have Increased 78% WHILE: - The State has Cut Regions 4% Annually since 2001 - Special Project Funds have been Completely Eliminated

  15. Combined Regional Workload Increase 1998-2007 = 114.6% (Estimated combined program Increase) • Ambulance Volume = +86% • Certified Personnel = +25.5% • Contracts = +114.5% • EOAs = +462.5% • Trauma Centers = +233.3% • Training Programs = +65.8% • New State/Regional Programs = +140%

  16. In Addition: • Actual Operating Expenses Increased 80% • Local Funding for Regions has Increased 51% to try to offset the growing deficit • Regional staffing (FTEs) have only Increased 3.8%

  17. Why can’t local funding simply be increased to offset the growing deficit? • Regional funding requirements pursuant to H&S 1797.108 requires a dollar per dollar local match (50% / 50%). (Smaller counties were originally able to participate in a statewide EMS system because of this 1 to 1 match.) • Since 1998, local funding has continually increased in all regions while state funding has been reduced. • Current match: • Local - 73% • State’s 27%

  18. Can county contributions and fees be further increased to off-set the growing deficit? • Fees:Fees (e.g. certification) have been increased to a maximum. Increasing fees beyond current levels will significantly reduce the number of responders (many of which are part-time volunteers) in the system and undermine the response system. • County Contributions: The majority of counties in EMS regions are small counties with limited tax bases relative to a small static resident population.

  19. How does the state expenditure for Regions compare to other governmental agency per-capita expenditures?

  20. EMS Regions at the Cross Roads • State GF Dollars have Decreased • Special Project EMS Funds have Dried Up • Little or No Post 9-11 Disaster Funding Available • Fiscal Burden Shift to Local Sources has been Maximized • Operating Costs and Workload have Sky-Rocked • EMS Staff Size is Stagnant or Decreased

  21. Well, it can’t get any worse can it?

  22. Well, it can’t get any worse can it? The state has proposed an additional 10%cut in regional contributions for FY 2008/09!

  23. A Failing State/Local Partnership? The 1981 State Fiscal Commitment to Regional EMS has helped establish Advanced EMS Systems in most of the Rural Counties in California The lack of continued commitment over the past ten years is placing Regional EMS Systems in jeopardy.

  24. A State GF Regional Augmentation of $1.4 Million is Essential To: • Prevent Existing Regions from Weakening or Collapsing • Maintain Over 30 Years of Multi-County EMS System Continuity • Continue Administrative Cost Savings • Ensure that 25 Rural Counties Maintain Effective EMS Systems for Residents & Visitors

  25. If EMS Regions Disappear Due to State Fiscal Cuts: • Established EMS Systems in Over 2/3s of the State and in 34 Counties will be Jeopardized • The Cost for Abandoned Counties to Continue EMS will Increase 3 to 4 Fold just for Minimal Services • Smaller Rural Counties will NOT be able to Support the Existing EMS Systems • Cost to the State will increase due to more LEMSAs • Small County EMS Influence at the State Level will be eroded • Up to 6 million Residents and 10s of Millions of Tourists will be Less Likely to Survive a Medical Emergency

  26. Increased State Funding for Regional EMS Agencies: • Ensures Continuation of Effective EMS Systems throughout 2/3s of California • Maintains Multi-County Management of 9-1-1 Medical Emergencies, MCIs and Disasters in 34 of 58 Counties • Increases Chances of Surviving a Medical Emergency in the Majority of Rural Areas of the State

  27. A additional10% Decrease in State Funding for Regional EMS Agencies next FY will result in: • An Immediate Reductions or Elimination of: • Public Information & Education Programs • System Monitoring (Training Programs, Ambulance Services, etc) • Data Collection / Reporting / Analysis • Quality Improvement Programs • Training and C.E. Programs • Disaster / WMD Preparedness Planning / Drills

  28. How Can You &/or Your Organization Help? Join the Seven EMS Regions by writing letters of support for long overdue State General Fund Augmentation Support for the EMS Regions is vital to the future of the California EMS System!

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