Fleet Management

11 Fleet Management

Learning Objectives 11.1 Discuss various considerations for calculating the cost of an EMS service. 11.2 Distinguish between functional and direct services for operating budgets. 11.3 Describe the inspection processes for equipment.

Learning Objectives (Cont.) 11.4 Compare and contrast the concepts of unit-hour utilization and in-service ratios when determining workload. 11.5 Calculate cost per capita and cost per response for EMS runs. 11.6 Apply cost-out strategies for a variety of EMS system components.

Learning Objectives (Cont.) 11.7 Track and apply costing mechanisms for soft supplies. 11.8 Understand the types of inventory systems and replacement plans. 11.9 Track fleet maintenance and vehicle cost including failure rates.

Learning Objectives (Cont.) 11.10 Determine the equipment needed in the system and the specifications of that equipment. 11.11 Understand and apply federal, state, and local specifications and procurement processes for ambulances, biomedical equipment, and durable equipment.

Fleet Management and Equipment • The delivery of EMS services cannot be accomplished without technologically sophisticated medical equipment and state-of-the-art emergency vehicles

Fleet Management and Equipment (Cont.) • A number of factors must be considered in order to establish the cost of operating an EMS system • Direct services are the services provided to the public • This includes patient-care activities, public-education programs, preventive-maintenance programs, and special events

Fleet Management and Equipment (Cont.) • A number of factors must be considered in order to establish the cost of operating an EMS system • Functional services are those provided to the agency within and can include such services as yearly physicals, EAP, training, uniforms, office support, and utilities

Fleet Management and Equipment (Cont.) • A number of factors must be considered in order to establish the cost of operating an EMS system • An EMS manager must identify all the services provided by the organization as the first step in identifying and costing out each key aspect of the operation

Fleet Management • Fleet administration requires EMS managers to supply vehicles and services to support fire and EMS activities • These services cover a wide range of job tasks • Logistics chief officer or front-line supervisor

Fleet Management (Cont.) • An EMS manager must consider replacement policies, contracting and government bidding standards, whether to purchase or lease apparatus and equipment, and replacement criteria • A contingency plan should be put in place to provide reserve equipment or equipment on loan during planned and preventive maintenance

Fleet Management (Cont.) • In the event that there is equipment failure, a procedure should be put in place for using reserve equipment, such as borrowing an ambulance or cardiac monitor from a neighboring department or perhaps a local vendor who will loan you a demo unit if your reserve unit is unavailable or you need additional resources

Verifying and Maintaining Checkout • Accountability for the inspection and inventory of equipment and vehicles should be imbedded as part of an organization’s culture • It is important for EMS leadership to instill in the company officers, paramedics, and EMT’s that regular inspections need to be conducted every shift, cycle, and monthly by on-duty EMS personnel

Verifying and Maintaining Checkout (Cont.) • Equipment check should be established as the first action at the start of the shift • Ensuring the equipment is ready for service should be reinforced during employee orientation, taught during in-service training, and included in management objectives as the very first thing to be done at the start of a shift

Verifying and Maintaining Checkout (Cont.) • Routine inspections should be conducted every day, on every shift and equipment not used very often should be inspected monthly • Vehicle checkouts should be completed during every shift on mechanics as well as fluids, belts, and tires

Verifying and Maintaining Checkout (Cont.) • Vehicles should be inspected on the outside for damage and leaks, and to ensure working lights and warning devices • Mileage and engine hours should be recorded daily

Verifying and Maintaining Checkout (Cont.) • Critical medical equipment should be included on the vehicle-checkout list including oxygen, backboards, and soft supplies • Any equipment that requires batteries, such as suction devices, laryngoscope handles, and cardiac monitors must be checked before any vehicle is made available for a call

Verifying and Maintaining Checkout (Cont.) • Responding to a call without working equipment has resulted in significant litigation and financial losses for EMS organizations • Two of the first items usually requested by attorneys in medical malpractice cases are the prehospital care reports and the vehicle checkout report

Verifying and Maintaining Checkout (Cont.) • Regulatory inspections are inspections conducted by the government authority that licenses ambulances • The regulatory agency inspects the vehicles for items mandated by law or regulation • Frequently, expired drugs or equipment that is on a state inventory, yet rarely used within the agency, are found to be missing

Verifying and Maintaining Checkout (Cont.) • Regulatory inspections also verify insurance coverage, proper licensing, and personnel certification • EMS employees should have their driver’s licenses inspected regularly to identify those whose licenses who have been reported revoked or suspended • Any of the inspections can occur on a random basis

Verifying and Maintaining Checkout (Cont.) • As a management tool, EMS leadership should conduct random audits or inspections to ensure compliance with check out procedures • Most accreditation agencies will conduct spot checks when conducting a site visit • Management must establish the importance of checkout procedures to avoid any errors or interruptions in EMS service

Ambulance Specifications • EMS managers and the organization should create specifications for EMS vehicles within the system • An ambulanceis defined as a vehicle for emergency medical care that provides a driver’s compartment; a patient compartment to accommodate an emergency medical technician or paramedic, and two litter patients so positioned that the primary patient can (Cont.)

Ambulance Specifications (Cont.) (Cont.) be given intensive life support during transit; equipment and supplies for emergency care at the scene as well as during transport; two-way radio communication; and, when necessary, equipment for light rescue/extrication procedures

Ambulance Specifications (Cont.) • Local health departments often have standards for EMS vehicles and mandated equipment, usually listed in the local board of health regulations or in an operating agreement • State EMS authorities usually have specifications for EMS vehicles that are reflected in state law or state statue

Ambulance Specifications (Cont.) • Federal Specification for the Star-of-Life Ambulance (KKK-A-1822E), prepared by the Government Services Administration in June 2002

FIGURE 11.4AMD and NTEA Activities.

Ambulance Types, Classes, Configurations • The Federal standard uses three ambulance types, with further divisions into classes and floor configuration • Type I conventional truck, with cab chassis and a modular ambulance body • Type I ambulance can have an additional-duty (AD) unit when modified for neonatal, critical-care transports, and rescue or fire suppression package

Ambulance Types, Classes, Configurations (Cont.) • The Federal standard uses three ambulance types, with further divisions into classes and floor configuration • Type I conventional truck, with cab chassis and a modular ambulance body • This is often referred to as a “medium duty” rescue in the fire service; The vehicle types are divided into class I or class II, representing two-wheeled and four-wheel drive, respectively

Ambulance Types, Classes, Configurations (Cont.) • The Federal standard uses three ambulance types, with further divisions into classes and floor configuration • The Type II is a standard van with an integral cab-body ambulance • A type III ambulance is a cutaway van, cab-chassis with integrated modular ambulance body

Ambulance Types, Classes, Configurations (Cont.) • The Federal standard uses three ambulance types, with further divisions into classes and floor configuration • The type III ambulance can also have a classification of additional duty (AD) • It is recommended in the federal standard that ALS ambulances be either type I or type II • Type I and III ambulances also have two standard configurations in the federal specification: “A” for ALS and “B” for BLS

Specification Processes • The first step in purchasing or leasing equipment is to create a procurement process for your agency, whether for a new ambulance or a cardiac monitor • Defining the specifications for the vehicle or equipment is really one small part of the process

Specification Processes (Cont.) • More ownership and pride in the equipment when employees have input into the design and construction • Vendors normally provide a set of specifications and place in those specifications conditions or statements designed to exclude other vendors

Specification Processes (Cont.) • Rarely is that set of specifications designed to a performance standard • In many cases, the vendors reserve the right to substitute or change the specifications • It is important to use the request for proposal (RFP) process and include key performance criteria and penalties if the equipment fails to meet those standards

Specification Processes (Cont.) • Similar to construction contracts, bid specifications can include monetary penalties for late delivery or for not meeting performance criteria

Specification Processes (Cont.) • When purchasing equipment, EMS managers ask for several different requests for proposals or contracts used by other agencies for purchases, and employ a committee to review the content and use the best of the content to create a custom request for proposal

Procurement Process • A simple approach to procurement is to apply the incident management system under the title of a procurement or specification committee • The committee will have an EMS leader that manages the process • The operations person will supervise, research and evaluation of the products

Procurement Process (Cont.) • A planning section will create the request for proposal (RFP)or bid request • The logistics person will arrange for the testing and demonstration, and will make sure that coordination of facilities is achieved

Procurement Process (Cont.) • Lastly, a finance person will qualify bidders, account for cost, monitor budgeting, and ensure payment and transfer of money • Each of these sections needs to be populated with field personnel and end users of the equipment

Procurement Process (Cont.) • Timeline should be established and a budget arranged with a 10% to 15% emergency allocation or reserve fund for unforeseen issues • Notes and records need to be kept on the decision-making process

RFP Construction • Vendors should be qualified by the committee or the EMS manager overseeing the process • A stable operational history, solid customer support, FDA approval, and up-to-date technology are important in a profile of a vendor

RFP Construction (Cont.) • Most companies should support your product for its life cycle • Seven years for vehicles and eight years for medical equipment • An EMS manager should contact the vendor’s most recent customers and at least three other customers who have used their product for several years

Scoring and Evaluating Bids • An easily understood scoring process is beneficial • A simple 100-point scoring system that weighs the specifications from most important to least important helps secure the best vendor

Scoring and Evaluating Bids (Cont.) • A point system needs to reflect each area, including finance, operations, background with customer service, vendor presentation, and functional ability • Field evaluations of equipment must be part of the process

Vehicle Inspections • When accepting delivery of an ambulance, a series of procedures is recommended • A source inspection should be completed by EMS management or leadership prior to shipment from the manufacturer and should include workmanship, quality conformance, and a first-production inspection • First-production inspections ensure the manufacturer is conforming to the standards

Vehicle Inspections (Cont.) • This should be done at the manufacturing plant, and the cost of getting EMS managers to the factory should be borne by the manufacturer • A destination examination also should include a check of all ambulance controls, electrical systems and devices, door, windows, cabinets, and accessories, as well as a road test at highway speeds, a brake test, and a test for rattles and squeaks

Vehicle Inspections (Cont.) • Road test of new vehicles involves driving a total of 150 miles, with 75 miles of that on highways at a speed of 70 mph; 30 miles on city streets at 30 mph, 15 miles on gravel or dirt roads at 35 mph, and 5 miles on cross-county operations that are muddy or open field areas • A water spray test subjects the vehicle to a water spray at 25 psi for 15 minutes in order to look for any evidence of a leak

Vehicle Inspections (Cont.) • Oxygen-system testmust be tested and the system should be pressurized to 150 psi with dry air or nitrogen and be able to hold that pressure for four hours • Have a checklist prepared in advance that details the tests and inspection points to be completed before acceptance of the vehicle

Vehicle Inspections (Cont.) • If a vehicle fails any of these tests and the vendor cannot fix the vehicle after a reasonable number of attempts, the EMS leadership should have the option to terminate the contract

Training and In-service • When a new vehicle arrives, EMS personnel should receive appropriate education and training • This should also include how the vehicle is to be checked out and maintained according to manufacturer’s specifications • EVOC and CEVO are two programs designed to help train EMS personnel to operate emergency vehicles

Training and In-service (Cont.) • Crashes are a common cause of litigation and risk for an EMS agency • Emergency-vehicle collisions are often serious, and some court cases have resulted in criminal charges being levied against EMS workers involved in them

Fleet Management