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Orange County Emergency Transportation Services

This presentation outlines the findings of the TriData Emergency Transport Study conducted in Orange County, Florida. It evaluates the current EMS transportation model and provides recommendations for improvements. The presentation also discusses the options available for Orange County in terms of public/private partnerships and transitioning to an in-house EMS transportation system.

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Orange County Emergency Transportation Services

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  1. Orange County Emergency Transportation Services Presented to the Board of County Commission October 9, 2007

  2. Presentation Outline • Introductions • TriData: Emergency Transport Study • Rural Metro Presentation • Board Action

  3. Presentation Outline • Introductions • TriData: Emergency Transport Study • Rural Metro Presentation • Board Action

  4. Presentation Outline • Introductions • TriData: Emergency Transport Study • Rural Metro Presentation • Board Action

  5. Presentation on the EMS Transportation Study Orange County, Florida October 9, 2007 Dr. Harold C. Cohen

  6. What was TriData asked to do? • Review EMS in the geographical area served by the Orange County Fire Department (OCFRD) and Rural Metro Ambulance (RMA). • Evaluate OCFRD’s ability to provide EMS transport services in the stated area. • Analyze other EMS models to determine strengths and weaknesses.

  7. What was TriData asked to do? • Provide a fully loaded cost accounting approach that included the American Ambulance Association (AAA) model and the International Association of Fire Chiefs (IAFC) model. • Determine the options available to Orange County for ambulance transportation in the RMA geographical area.

  8. Current EMS Transport Service Areas

  9. Process and Methods • Risk and demand analysis • Inter-jurisdictional comparisons • A review of EMS models • A comparison of three EMS revenue/costing models • Identification of organizational implications • Options and recommendations

  10. What were our key findings? • The current OCFRD/RMA model is redundant. • OCFRD is capable of assuming EMS transport in the area served by RMA. • The current contract performance requirements are unclear, making performance measurement and enforcement difficult.

  11. What were our key findings? • RMA’s service to the City of Orlando is efficient and should continue. • RMA does not respond to all requests 100% of the time. • OCFRD’s take over of EMS transportation could generate additional revenue by FY 2009.

  12. What choices does Orange County have? • Option 1: Continue the public/private partnership. • Option 2: Upon expiration of RMA’s contract, have OCFRD assume EMS transportation in RMA’s unincorporated Orange County area by January 1, 2008 • Option 3: Extend RMA’s contract at least July 1, 2008, at which time the OCFRD would assume EMS transportation in the former RMA area.

  13. Option 1: Public/Private Partnership • Negotiate a contract that has clearly defined performance and enforcement parameters. • Whatever is negotiated should be enforced! • Provide for strong oversight by the Orange County EMS Office.

  14. Option 1: Re-bid issues • Could not be accomplished by January 1, 2008. • May lead to unhealthy competition that could effect emergency and non-emergency services. • System size precludes most commercial EMS agencies from bidding.

  15. Option 2: OCFR to takeover RMA area on January 1, 2008 • The transition will be rushed. • May lead to an implementation schedule that is less efficient. • Does not allow RMA time to make adjustments for a new operational model.

  16. Option 3: OCFRD to takeover RMA transport area on or after July 1, 2008 • This is the most viable option for all constituent groups. • OCFRD will have the opportunity to plan for the most efficient transition of service. • RMA will have lead time to make operational adjustments.

  17. What will OCFRD need to make this plan operational? • Three additional full-time rescue units (Stations 72, 42, and 51) • Four additional peak-load units, in-service from 10 AM to 10 PM. • Two covering the first due areas of Stations 30, 40, 41, 42, and 43 • Two covering the areas of Stations 50, 51, and 53

  18. What will OCFR need to make this plan operational? • 44 additional personnel (worst-case scenario) • Possible negotiation of a 48-hour shift to cover peak-load units • All personnel should continue to be dual-role/cross-trained for fire and EMS • Rescue units should be equipped to perform multiple EMS and fire functions as is presently the case

  19. Additional full-time rescue units

  20. Additional Peak-Load Units

  21. Benefits to Orange County • Faster response times for EMS service • A consolidated/organized approach to EMS delivery • The ability for Orange County to realize a positive cash-flow

  22. Financial Benefits to Orange County

  23. Conclusion • Option 3 is the best choice. OCFRD should take over the area currently served by RMA on or after July 1, 2008. • OCFR will need three additional full-time rescue and four peak-load units. • OCFR will need a maximum of 44 additional personnel. • Significant revenue enhancements should occur in FY 2009.

  24. Presentation Outline • Introductions • TriData: Emergency Transport Study • Rural Metro Presentation • Board Action

  25. Presentation to Orange County Board of Commissioners October 9, 2007 Presenter: Robert “Boo” Heffner, President West Emergency Services Group, Rural Metro Corporation

  26. Rural/Metro Central Florida Division CFL PRESENCE • CON Emergency – Orange County • CONs Non-Emergency – Orange, Osceola, Seminole STAFFING • Employs 137 EMTs and 115 Paramedics • Maintains a Fleet of 45 Ambulances 911 SERVICE IN 2006 • Responded to over 72,000 requests for service • Transported nearly 47,000 patients of which 21,000 were in Orange County.

  27. Contract History & Payer Mix • Served Orange County and the City of Orlando for OVER 25 Years without public subsidy. • The October 2002 contract prescribed the following reductions in Rural Metro territory: • 1) 10/2002 Station 58 or Hunter’s Creek • 2) 10/2003 Station 59 Meadow Woods • 3) 10/2004 Station 54 Sea World

  28. Operational Performance The current contract requires Rural/Metro to arrive on scene within 10 minutes 90% of the time.

  29. Operational Performance In 2006, OCFR transported 392 patients in Rural/Metro territory due to system overload. • 392 of 32,814 requests for service is 1.19% • 392 of 20,628 transports is 1.90% In 2007, through September 30, OCFR transported 153 patients in Rural/Metro territory due to system overload. • 153 of 22,014 requests for service is 0.69% • 153 of 14,521 transports is 1.05%

  30. Financial Facts Rural/Metro’s publicly audited financials show that ACTUAL cash collections are far below projected collections in the TriData “pro-forma” Expense data cited in the TriData “pro-forma” are far below RMA’s ACTUAL per transport costs. RMA TriData Eg. Supplies per transport $15 $5 Fuel per transport $3.60 $0.60 Unit Hours (payroll) 55,000 20,616

  31. Patients First • In 2007 RMA waited “On Scene”: • More than 10 minutes about 60% of the time. • Less than 4 minutes about 10% of the time. • On average, for all calls, about 12 minutes, 42 seconds. Medical Director protocols currently allow first-responders to transport if the acuity of the patient warrants. In 2006, OCFR exercised that protocol roughly 200 times.

  32. Non-Emergency Ambulance Transportation in CFL Significant Partnerships Include: • Orlando Regional Healthcare • St. Cloud Regional Medical Center • South Lake Hospital • Numerous Skilled Nursing Facilities

  33. Track Record of Successful Partnerships in Emergency Transportation • San Diego Medical Services Enterprise • Salem Medical Services Enterprise (Oregon) • Seattle-Tacoma, Washington • Aurora, Colorado • County Service Area 17 – Southern Californian Coast

  34. Recommendation • The TriData report does not adequately explore alternatives. • Response information cited in the TriData report conflicts with Rural/Metro’s audited response reports as submitted monthly to the Office of the Medical Director. • Significant property tax reduction proposals have yet to be resolved leaving impact on local services unknown. • Clear conflict exists between Rural/Metro’s publicly audited financials and TriData’s “pro-forma” assumptions. • Given these circumstances, it is recommended that the Rural/Metro contract to be extended to 12/31/2008, allowing sufficient time to reconcile facts, explore alternatives, and conduct an RFP for services.

  35. Presentation Outline • Introductions • TriData: Emergency Transport Study • Rural Metro Presentation • Board Action

  36. Board Action Three Options: • Continue current public/private EMS Transport model • Allow expiration of the current contract with RMA • Extend the existing provider contract with RMA for a specific time period

  37. Orange County Emergency Transportation Services Presented to the Board of County Commission October 9, 2007

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