Advanced Life Support Committee Report

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Advanced Life Support Committee Report

• For the Wayland
• Board of Selectmen
• January 12, 2009

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Public Perception Heart Attack

• 911 call for ambulance
• Local resources respond to solve the problem.
• Fire department response
• Fire engine
• Ambulance
• Two paramedics
• Overall local response
• Quick, professional, effective, efficient.

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The Reality

• 911 call for ambulance
• Local resources respond to solve the problem
• Fire department response
• Fire engine
• Ambulance
• Another agency is called for assistance
• Semi-public or private organization
• Decreasing availability
• Less and less seamless integration
• Vehicle and two paramedics meet the local
  ambulance
• Overall response
• Usually
• Quick, professional, effective, and efficient.
• Sometimes ALS not available.

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Traditional Fire Department Responsibilities

• Fire suppression
• Fire prevention
• Inspections
• Permits
• Code enforcement
• Hazardous materials planning response
• Emergency medical service

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Wayland Fire DepartmentMission Statement.From
the Town of Wayland web site.

• Our mission is to provide the finest possible
• fire, rescue, and emergency medical
• services to all those that reside in, work in,
• or visit the Town of Wayland.

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EMS 101

• Basic life support (BLS) Emergency medical
  technician (EMT).
• All Wayland firefighters are EMTs
• Ambulance is always staffed with two EMTs
• Have skills for the less serious
  injuries/illnesses
• Adequate for 50-65 of all ambulance calls

• Advance life support (ALS). Paramedic
• Paramedics are available from outside
  organizations.
• Have skills for the more serious
  injuries/illnesses.
• Needed for 35-50 of all ambulance calls

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Emergency Medical Services Within the Fire
Department

• 1899 Fire department organized
• 1910 Emergency medical services start
• Oxygen is carried on fire engines
• 1960 Ambulance service starts
• With a hearse-like vehicle
• 1972 Paramedics introduced to the U.S.

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Emergency!An NBC TV Show1972

• Paramedic advanced medical training
• Close relationship with emergency department
  staff
• Training, treatment, telemetry
• Merging paramedics into the fire service
• Fast response
• Strategic station and personnel location
• Public policy

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Emergency Medical Services Within the Fire
Department

• 1899 Fire Department Organized
• 1910 Emergency Medical Services Start
• Oxygen is carried on fire engines
• 1960 Ambulance Service Starts
• With a hearse-like vehicle
• 1972 Paramedics introduced to the U.S.
• 1975 - Modern basic ambulance service
• True ambulance and credentialed personnel
• 1982 Hospital-based ALS service starts

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ALS Paramedics1982 - 2003

• Two hospital-based paramedic services available
• Local ambulance services maintain basic level of
  training and transportation
• ALS service was prompt, efficient, effective
• Wayland was geographically lucky

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Outside Resources

• ALS resources available from outside the local
  fire department
• Hospital based ALS teams (vehicle and 2
  paramedics)
• Dedicated to area
• Good response times
• Relatively seamless service integration
• Public policy integration

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During this time.
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Maximus Study

• From the Town wide Study of Organization and
  Operations prepared for the Town of Wayland, by
  the Maximus Company of Waltham, MA. May 13,
  2002. Page 124.
• Consider increasing the internal level of
  emergency medical services (EMS) provided to the
  Advanced Life Support Level. It is clear that
  the town is at a disadvantage in relying on this
  level of care from outside the community
  (response times are longer than the national
  standard because these units are coming from
  elsewhere).

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ALS Problems Appear on the Horizon

• Long term, continuing problem (many years)
• Medicare reimbursement for ambulance fees
  decreasing steadily
• Aging population increasing dramatically
• Aging population generally need more medical
  care, including ambulance transportation
• Makes ALS service less attractive when profit is
  the bottom line

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Master Plan

• From the Wayland Town Master Plan Final
• Report, August 2004. Page A-5,
• demographic profile
• According to MAPC (Metropolitan Area Planning
  Council) population forecaststhe proportion of
  persons aged 65 and older is projected to
  effectively double by 2020, growing from 14 of
  the Towns total population to 28.

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More ALS Problems on the Horizon

• 1990s - Hospital budget problem rumors persist
• ALS service(s) may be in jeopardy
• 1993 Fire department proposes plan for ALS
  training for firefighters
• Not acted on
• 2003 Natick hospital-based ALS service closed
  with 90 days notice
• Short notice
• Affects 84 of Wayland ALS calls

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Since 2003, A Partial Solution

• Local ambulance company American Medical Response
  (AMR) helps out.
• If ALS is needed, we request an AMR response. If
  an AMR ALS crew is available, they are sent.
• For every ALS transport, they charge Wayland
  250. flat fee.
• Paid from ambulance receipts.

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A Partial Solution The Benefits

• When ALS is available, patient benefits
• Except for flat fee, no other charges incurred
  for Wayland

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A Partial Solution The Limitations

• High unavailability
• ALS units are not stationed in or dedicated to,
  the area
• ALS crews continue their normal business and are
  often out of the area for long periods of time
• Little or no control over personnel and policy
• Multi-agency responses lead to delays,
  miscommunications, and misunderstandings
• Response times do not meet national standards
• No cost control measures are possible

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ALS Problems on the Horizon

• Hospital budget problem rumors persist
• ALS service(s) may be in jeopardy
• 1993 Fire department proposes plan for ALS
  training for firefighters
• Not acted on
• 2003 Natick hospital-based service closes with
  90 days notice
• 2004 - Wayland ALS Committee issues report to
  Board of Selectmen.

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The 2004 ALS Committee Report

• Recognized multi-town area that needs better ALS
  service.
• Proposed a regional service shared between towns.
• No action taken.

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Since the 2004 Report

• ALS availability (especially on the south side)
  continues to decrease (unavailable 1/3 to 1/2 of
  the time)
• Emerson Hospital recognizes ALS financial woes.
• ALS fee increases but guarantees service until
  September 2010.
• Emerson area collaborative formed.
• Proposing a fundamental change in the way ALS is
  delivered in the 13-town region.
• MetroWest Health Care Foundation grant
• 2nd agency issues

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The Importance of ALS and Paramedics
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The Importance of ALS and Paramedics
Beth Zeeman, M.D. Staff in Emergency
Medicine MetroWest Medical Center Medical
Director Wayland Fire Department Emergency
Medical Service

• Mark Neuman, M.D.
• Staff in Emergency Medicine
• Childrens Hospital, Boston
• Assistant Professor of Pediatrics
• Harvard Medical School

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The Importance of ALS and Paramedics

• Emergency medical literature (see printed report
  footnotes)
• Personal experiences of fire department members

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Elements of the 2009ALS Service Proposal

• Proposed service added to the existing ALS
  services (not a replacement)
• Flexible and scaleable
• Funded by the Town of Wayland

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Elements of the 2009ALS Service Proposal (more)

• ALS services sold to surrounding communities
  who also need it
• Part-time employees used
• Partial day coverage (8 hours/day) to start

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Elements of the 2009ALS Service Proposal (more)

• Based in Wayland, committed to the area
• Easily replaced by, or made a supplement to, any
  other acceptable ALS delivery system proposed

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After Proven Success (Future)

• 24 hour/day coverage will be a goal
• Interested Wayland Fire Department personnel
  should be given the opportunity to train to the
  paramedic level
• Fire Department hiring practices should change so
  that through attrition, some firefighter/paramedic
  s would be hired.

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2009 Proposal - Goal 1

• Provide an additional ALS service in the area to
  improve availability.
• Provide a prompt, efficient, and effective
  paramedic service for the people who live in,
  work in, or travel through the town of Wayland as
  soon as possible.

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2009 Proposal - Goal 2

• Be prepared if either existing ALS service stops
  providing service.
• Have enough flexibility in the plan to absorb
  additional geographic areas and additional
  patients if either existing ALS service is unable
  to continue providing paramedics.

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2009 Proposal - Goal 3

• Be prepared helpful if other ALS plans for the
  area are adopted.
• Be prepared (for merging or replacement) if the
  MetroWest Health Care Foundation ALS study or the
  Emerson collaborative designs a new, acceptable
  ALS model for the area.

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2009 Proposal - Goal 4

• Decrease the paramedic response time within the
  primary service area by an average of 50, to 6-7
  minutes, well within the national standard.

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2009 Proposal - Goal 5

• Help guarantee long term program viability and
  high quality paramedic service for all.
• Not just for the residents of Wayland, but also
  provide some assistance to Sudbury, Weston, and
  Lincoln.

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2009 Proposal - Goal 6

• Consolidate the entire suite of pre-hospital
  emergency medical care services into a single
  local agency, managed by public policy.

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Cost/Benefit
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Cost Categories

• Start up
• After success, possible expansion

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Start-Up Costs

• Equipment Supplies
• 28,198
• Perspective
• Percentage of current yearly ambulance revenue
  (net)
• 12
• Percentage of Town Center gift
• lt1

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Operational Cost (Per Year)

• Operational
• 57,074 Per Year
• Perspective
• Percentage of current yearly ambulance revenue
  (net)
• 24.4
• Percentage of Town Center gift
• 1.9

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Potential Future Program Expansion (Long Term)

• After success (future)
• Possible Expansion
• Equipment Supplies
• Operational
• Wayland Fire Department paramedics
• Hire a percentage of Firefighter/Paramedics
  through attrition.
• Training interested existing personnel

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Benefit

• Provide an additional paramedic team
• Within the fire service
• Committed to the emergent care needs in the area
  (3-4 towns)
• 8 hours/day coverage
• Centrally located short response time, meeting
  response time standards.

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Benefit

• Preserves and continue BLS ambulance services at
  local (town) level.
• Shares specialized services with surrounding
  communities
• Service supported with public policy
• Additional protection for a vulnerable population

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What Were Asking of the Selectmen

• Endorse the 2009 ALS Committee Report and
  associated policy
• Authorize/provide funding
• Start up
• Operational
• After success (future)
• Possible Program Expansion

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What Were Asking of the Selectmen

• Endorse the delivery of ALS services part of the
  day, with part time employees of the Wayland Fire
  Department

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What Were Asking of the Selectmen

• Start Up
• Work with the ALS Committee/Fire Chief to
  identify/provide start-up funding.
• Operational funding
• Authorize and provide operational funding.

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What Were Asking of the Selectmen

• After success
• Possible Program Expansion (future)

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Conclusion - Recognize that a Proper ALS Service

• is a valuable, life saving service and needs to
  be supplemented in our area as soon as possible.
• should be provided by local government operated
  under public policy.
• satisfies recommendations of past town management
  and operational studies.
• is perfectly aligned with the mission of the
  Wayland Fire Department.

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And therefore

• The recommendations found in the 2009 ALS
  Committee Report should be endorsed and
  implemented as soon as possible.

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The Advanced Life Support (ALS) Committee

• Committee members
• Douglas Leard
• Fire Chief Robert Loomer (advisory member)
• Mark Neuman, M.D.
• Michael Patterson
• Vincent Smith (Chair)
• Elizabeth Sweitzer
• Beth Zeeman, M.D.

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Questions? Comments?
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