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WE'RE GOING TO OPEN THIS SESSION UP AT NINE O'CLOCK.[1. CALL TO ORDER]
THANK YOU.GOOD MORNING, MAYOR AND COUNCIL AT THIS TIME, THAT BRINGS US TO SECTION TWO REPORTS AND PRESENTATIONS.
JUST FOR A NOTE OF PROCEDURE TONIGHT.
I'M SORRY THIS MORNING I'M USED TO BEING HERE AT NIGHT, GUYS.
THIS MORNING, WHAT WE'LL DO IS I'LL CALL FORWARD THE ITEM, I'LL CALL FORWARD THE PRESENTER.
AFTER ALL, PRESENTATIONS ARE MADE IF I HAVE ANY SPEAKER CARDS AT THAT TIME, I'LL CALL FORWARD ANY SPEAKERS FROM THE AUDIENCE.
[A. Receive a report and hold a discussion regarding MedStar emergency transport services. (Presenter: Ken Simpson, CEO of MedStar)]
AT THIS TIME, WE'LL CALL FORWARD ITEM 2 A, WHICH IS TO RECEIVE A REPORT AND HOLD A DISCUSSION REGARDING MEDSTAR EMERGENCY TRANSPORT SERVICES.THE PRESENTER TODAY LISTED IS KEN SIMPSON WITH CEO OF MEDSTAR.
MAYOR AND COUNCIL, THANK YOU FOR HAVING US HERE THIS MORNING.
MY NAME IS KEN SIMPSON, MATT ZAVADSKY, OUR CHIEF TRANSFORMATION OFFICER, AND DR.
VEER VITHALANI ARE GOING TO DO OUR FORMAL PRESENTATION THIS MORNING.
WE'LL ALL BE AVAILABLE FOR QUESTIONS DURING OR AFTER THAT, IF THAT'S OK.
AND THEN JUST PRESS ANY BUTTON.
CITY COUNCIL MEMBERS, GOOD MORNING AND THANK YOU FOR INVITING US TO BE PART OF THIS COMMUNITY CONVERSATION.
WE KNOW THAT YOU ARE ALL BEING ASKED TO MAKE A VERY, VERY DIFFICULT DECISION, ONE THAT SEEMS TO BE ON THE FAST TRACK AND ONE THAT PLACES EACH OF YOU IN THE DIFFICULT POSITION OF HAVING TO LEARN MORE ABOUT AMBULANCE SERVICE DELIVERY THAN YOU EVER THOUGHT YOU WOULD.
KEN SIMPSON, OUR CEO WHO YOU JUST MET, DR.
VITHALANI, WHO MANY OF YOU KNOW, THE EMS SYSTEM MEDICAL DIRECTOR AND I HAVE DECADES OF EXPERIENCE PROVIDING EMERGENCY MEDICAL SERVICES.
AND FRANKLY, THERE ARE CHANGES EVERY DAY THAT STILL BEFUDDLE US.
WE CAN IMAGINE HOW DIFFICULT IT IS FOR YOU ALL TO TRY AND ASSIMILATE A DELUGE OF INFORMATION FROM OUTSIDE CONSULTANTS, FIRE AND CITY LEADERSHIP AND NOW MEDSTAR LEADERSHIP.
WE CAN ALSO IMAGINE THAT SOME OF THE INFORMATION MAY SEEM DIFFERENT DEPENDING ON THE SOURCE, WHICH MAKES YOUR DECISION EVEN MORE DIFFICULT.
WE ARE FULLY COMMITTED TO FACILITATING WHATEVER PUBLIC POLICY DECISIONS THE COUNCIL MAKES REGARDING THE HIGHEST QUALITY, LOWEST COST AND MOST OPERATIONALLY EFFICIENT AMBULANCE PROVIDER FOR BURLESON RESIDENTS AND VISITORS.
THE EMS AUTHORITY THAT BURLESON IS AN OWNER OF WAS DESIGNED ON THE FOUNDATION OF CLINICAL EXCELLENCE, OPERATIONAL EFFECTIVENESS AND FINANCIAL EFFICIENCY, ABOVE ALL, THE AUTHORITY WAS DESIGNED TO BE COMPLETELY TRANSPARENT WITH GOVERNANCE FROM ALL THE MEMBER OWNER CITIES, WITH ALL INFORMATION ABOUT THE AUTHORITY'S CLINICAL, OPERATIONAL AND FINANCIAL PERFORMANCE PROVIDED TO THE AUTHORITY'S OWNER CITIES.
FOR THE PAST 33 YEARS, BURLESON HAS BEEN AN OWNER MEMBER CITY OF THE EMS AUTHORITY AND WE'VE ENJOYED A GREAT PARTNERSHIP.
WE WERE JUST TALKING ABOUT THAT EARLIER TODAY.
WE'VE DEVELOPED EXCELLENT RELATIONSHIPS WITH CHIEF FREEMAN AND CHIEF DAVIS.
AT CHIEF FREEMAN'S REQUEST WE WORKED WITH BURLESON FIRE TO REDUCE THE NUMBER OF EMS CALLS THAT BURLESON FIRE RESPONDS TO.
WHEN HE AND CHIEF DAVIS CAME TO US TO HELP BURLESON FIRE DEPARTMENT SET UP A COMMUNITY PARAMEDIC PROGRAM LIKE THE ONE MEDSTAR HAD BEEN DOING USING A SQUAD THAT WOULD DO HOME VISITS FOR FREQUENT 9-1-1 CALLERS AND PREVENT HOSPITAL READMISSIONS.
WE TRAINED THEIR MEDICS TO BE COMMUNITY PARAMEDICS.
WE PROVIDED FIELD CLINICAL TRAINING FOR THEIR COMMUNITY PARAMEDICS AND EVEN INTRODUCED THEM TO THE LEADERS OF HUGULEY HOSPITAL WHO COULD HELP SUPPORT AND FUND THEIR PROGRAM.
AND THEY EXPLAINED THAT THE SQUADS WOULD BE USED TO HELP WITH THE ASSEMBLY OF FIRE PERSONNEL WHEN NEEDED FOR AN ACTUAL FIRE CALL, HELPING ASSURE THEY MEET THE NEED FOR CRITICAL FIRE PERSONNEL ON THE SCENE OF A FIRE.
WHEN BURLESON FIRE WANTED TO INTEGRATE BURLESON AND MEDSTAR'S COMPUTER AIDED DISPATCH SYSTEM TO MAKE THE DISPATCHING PROCESS MORE EFFECTIVE AND EFFICIENT, WE FACILITATED THAT EVEN INVESTING FIFTY THOUSAND OF MEDSTAR'S MONEY TO HELP MAKE THAT INTEGRATION HAPPEN.
WHEN CHIEF DAVIS WANTED TO START USING THE AUTHORITY'S ELECTRONIC PATIENT CARE REPORTING SYSTEM FOR BURLESON FIRE, WE FACILITATED THAT.
AND TO THIS DAY, MEDSTAR PAYS FOR BURLESON FIRES PATIENT CARE REPORTING SYSTEM.
WHEN THEY ASKED US TO CONSIDER HOUSING AN AMBULANCE AT YOUR NEW STATION 16, YOU MADE THAT HAPPEN AND IT'S HAPPENING TODAY.
THIS RESPECTFUL, COLLABORATIVE AND GET IT DONE RELATIONSHIP HAS ENHANCED THE EMS SERVICES PROVIDED TO BURLESON RESIDENTS, AND AGAIN, IT'S BEEN VERY COLLABORATIVE,
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FRIENDLY AND MUTUALLY BENEFICIAL.FOR THE PAST SEVERAL YEARS, THERE HAVE BEEN VIRTUALLY NO COMPLAINTS OR CONCERNS EXPRESSED BY BURLESON CITY MANAGEMENT OR THE FIRE DEPARTMENT ABOUT MEDSTAR SERVICE DELIVERY, PATIENT CARE, OR RESPONSE TIMES.
THAT IS WHY WE WERE SO PUZZLED BY THE OUTCOME OF THE CONSULTANT'S REPORT, RECOMMENDING THAT BURLESON FIRE DEPARTMENT CONSIDER STARTING THEIR OWN AMBULANCE SERVICE.
OUR INITIAL REACTION, AND ONE THAT WE STILL ASK TODAY, IS WHY? THAT'S WHY WE APPRECIATE THE OPPORTUNITY TO OUTLINE HOW THE CURRENT SYSTEM WAS DESIGNED AND ADDRESS WHAT WE FOUND INTERESTING ABOUT THE FITCH REPORT AND THE SUBSEQUENT DIALOG THAT OCCURRED DURING THE NOVEMBER 8TH CITY COUNCIL MEETING.
WHEN BURLESON AND 14 OTHER CITIES CAME TOGETHER TO CREATE THE METROPOLITAN AREA EMS AUTHORITY IN 1988, IT WAS TO MEET THE GOALS YOU SEE HIGHLIGHTED HERE IN THE PREAMBLE OF THE INTER-LOCAL AGREEMENT THAT BURLESON EXECUTED WITH THE 14 OTHER CITIES THAT, ALONG WITH BURLESON, ARE OWNERS OF THE EMS AUTHORITY.
IT IS AN AGREEMENT BETWEEN THE MEMBER JURISDICTIONS WITH EACH OTHER, NOT BETWEEN THE CITIES AND MEDSTAR.
THE FITCH REPORT WAS CRITICAL THAT THERE WAS NO CONTRACT BETWEEN THE CITY AND MEDSTAR.
THE BELIEF THAT THERE SHOULD BE AN AGREEMENT BETWEEN THE CITY AND MEDSTAR APPEARS TO BE AN ESSENTIAL MISUNDERSTANDING OF THE FUNDAMENTAL SYSTEM DESIGN OF THE EMS AUTHORITY.
NOTE THIS SPECIFIC HIGHLIGHT DUE TO EXTREMELY HIGH STARTUP AND FIXED OPERATING COSTS OF A STATE OF THE ART PRE HOSPITAL EMERGENCY MEDICAL SERVICES SYSTEM A SINGLE PROVIDER IS NECESSARY TO MAXIMIZE CLINICAL PROFICIENCY, ENHANCE OPERATIONAL EFFECTIVENESS AND MAXIMIZE ECONOMIES OF SCALE.
ESSENTIALLY, THE SYSTEM WAS DESIGNED TO SIMULTANEOUSLY ACHIEVE THREE MAIN GOALS CLINICAL EXCELLENCE, OPERATIONAL EFFECTIVENESS AND FINANCIAL EFFICIENCY.
A KEY COMPONENT OF THE FINANCIAL EFFICIENCY CONTEMPLATED BY THE INTER-LOCAL AGREEMENT IS THE USE OF EXISTING RESOURCES TO PROVIDE MEDICAL FIRST RESPONSE FOR HIGH ACUITY EMS RESPONSES.
MANY OF THE MEMBER CITIES USE FIRE ENGINES, WHICH ARE ALREADY ON DUTY FOR FIRE CALLS TO FIRST RESPOND TO EMS CALLS.
SOME MEMBER CITIES USE POLICE OFFICERS TRAINED AS MEDICAL FIRST RESPONDERS BECAUSE THE MARGINAL COST OF SENDING THE ON DUTY POLICE OFFICER IS A MARGINAL EXPENSE, AND IT'S THE MOST OPERATIONALLY EFFECTIVE AND FINANCIALLY EFFICIENT MODEL.
SINCE THE FIREFIGHTERS AND EQUIPMENT NEED TO BE ON DUTY FOR FIRE CALLS, WHICH THANKFULLY IN MOST COMMUNITIES ARE VERY INFREQUENT.
SENDING A FIRE ENGINE TO FIRST RESPOND ON A MEDICAL CALL WITH A TYPICAL TASK TIME TIME THAT THEY'RE COMMITTED ON THE CALL OF LESS THAN 20 MINUTES IS A BARGAIN FOR THE TAXPAYER.
IT'S ONLY THE MARGINAL EXPENSE OF GOING ON AN ADDITIONAL CALL, WHICH IS A FEW PINTS OF DIESEL FUEL AND SOME MEDICAL SUPPLIES.
MR. LANGLEY COMMENTED DURING A RECENT MEETING THAT BURLESON DEPLOYMENT OF THE SQUAD IS A MILLION DOLLAR SUBSIDY TO MEDSTAR.
I SEEM TO RECALL HIS RESPONSE TO OUR QUESTION REGARDING HIS IDEAS TO ENHANCE AMBULANCE SERVICE IN BURLESON WAS THAT WE'D NEED TO DEDICATE TWO AMBULANCES TO BURLESON AND WRITE US A CHECK AND WRITE BURLESON A CHECK FOR A MILLION DOLLARS.
WE FOUND THAT COMMENT INTERESTING BECAUSE WE DID NOT ASK BURLESON TO USE A SQUAD FOR EMS CALLS.
IT ADDS COST TO A SYSTEM THAT FOR 30 YEARS PRIOR TO THAT FUNCTION VERY EFFECTIVELY USING EXISTING RESOURCES, FIRE ENGINES THAT HAD TO BE ON DUTY FOR THE INFREQUENT FIRE CALLS TO RESPOND TO EMS CALLS.
YOU MAY HEAR THAT THE SQUADS ARE A SUBSIDY TO MEDSTAR.
CLINICAL EXCELLENCE, WE OFTEN HEAR THE TERM QUALITY MENTIONED AS THE MOST IMPORTANT FACTOR IN EMS CARE DELIVERY.
MEDSTAR IS RECOGNIZED NATIONALLY AND INTERNATIONALLY FOR ITS FOCUS ON QUALITY.
DR. VEER VITHALANI THE EMS SYSTEM MEDICAL DIRECTOR WHO HOLDS DUAL BOARD CERTIFICATIONS IN EMERGENCY MEDICINE AND EMERGENCY MEDICAL SERVICES, WOULD LIKE TO SHARE SOME INFORMATION REGARDING THE CLINICAL QUALITY OF THE CURRENT SYSTEM.
AND MANY OF YOU MAY RECALL DR.
VITHALANI AS HE PROVIDED YOU INFORMATION ABOUT THE COVID 19 PANDEMIC WHEN IT WAS FIRST STARTING.
THANKS, MATT, AND I APPRECIATE YOU ALL HAVING ME.
YOU KNOW, AS A MEDICAL DIRECTOR, I SIT IN SORT OF AN ODD POSITION, ESPECIALLY WITH THE WAY THAT THIS SYSTEM IS DESIGNED.
THE SORT OF ROLE OF THE MEDICAL DIRECTOR IS MEANT TO BE AN INDEPENDENT MEDICAL OVERSIGHT FOR THE SYSTEM.
AND SO THAT'S WHY MY REPORTING STRUCTURE GOES TO THE BOARD OF DIRECTORS AS OPPOSED TO ANY OTHER CHANNEL THROUGH EMS OR FIRE CHIEFS.
MY ROLE IS TO BE THAT INDEPENDENT CLINICAL OVERSIGHT TO MAKE SURE THAT
[00:10:03]
WHOEVER IS RUNNING THE SYSTEM IS HELD ACCOUNTABLE TO HIGH QUALITY CLINICAL CARE, AS MATT HAS EXPLAINED.AND SO, YOU KNOW, WHEREAS I PROVIDE MEDICAL DIRECTION AND OVERSIGHT FOR NOT JUST MEDSTAR, BUT ALL THE FIRE DEPARTMENTS WITHIN THE SYSTEM, I THINK IT'S IMPORTANT TO UNDERSTAND THE POSITION I COME FROM IN TERMS OF WHAT MY RESPONSIBILITY IS TO THIS SYSTEM.
AS MATT MENTIONED, WE DO FOCUS A LOT OF ENERGY ON CLINICAL EXCELLENCE AND CLINICAL QUALITY.
IT'S ONE OF THE THE BEST ASPECTS OF THIS SYSTEM.
AND YOU'LL HEAR ME USE THIS TERM SYSTEM A LOT.
THE SYSTEM, IT'S ACTUALLY DEFINED IN THE INTER-LOCAL, IT'S ALL THE PLAYERS TOGETHER THAT MAKE UP AN EMS RESPONSE.
SO IT IS NOT JUST MEDSTAR, AND IT'S NOT JUST THE FIRE DEPARTMENT, IT'S EVERYONE WORKING TOGETHER TOWARDS TAKING GREAT CARE OF A PATIENT WHO'S ACTIVATED 9-1-1.
AND THAT'S THE VIEWPOINT THAT I COME FROM.
I COME FROM A VERY PATIENT CENTRIC VIEWPOINT.
THERE ARE A NUMBER OF PIECES TO THIS PUZZLE.
I'M ONLY ONE PART OF IT AT THE HIGHEST LEVEL UNDER THE MAEMSA BOARD THERE'S WHAT'S CALLED AN EPAB IN EMERGENCY PHYSICIANS ADVISORY BOARD.
IT'S A STANDARD PART OF A TYPE OF SYSTEM LIKE WE HAVE.
THE EMERGENCY PHYSICIANS ADVISORY BOARD IS MADE UP OF EMERGENCY AND NON-EMERGENCY PHYSICIANS THAT ARE REPRESENTATIVES OF NOT JUST THE HOSPITALS WITHIN THE SERVICE AREA.
SO THAT'S THE NINE HOSPITALS IN FORT WORTH, BURLESON, ET CETERA, THAT ARE IN THE SERVICE AREA, AS WELL AS SEVEN APPOINTEES BY THE TARRANT COUNTY MEDICAL SOCIETY, TWO FROM THE TWO HIGH LEVEL TRAUMA CENTERS IN THE DOWNTOWN HOSPITALS AND THEN SOME COMMUNITY PHYSICIANS.
I BELIEVE, YOU KNOW, DR. MARTIN, WHO'S PROBABLY BEEN THE LONGEST STANDING BOARD MEMBER IN THE HISTORY, HAS BEEN THERE SINCE DAY ONE AND WAS CHAIR FOR OVER 30 YEARS AND HAS BEEN A VALUABLE ASSET TO THE SYSTEM.
SO AS YOU CAN SEE, THE LISTED BOARD MEMBERS HERE AS PART OF OPERATIONALIZING THE CLINICAL ASPECTS OF THE SYSTEM, THE THE AUTHORITY DEDICATES A LOT OF RESOURCES.
I AM BOTH NOT ONLY REMINDED OF BUT CONSTANTLY AWARE OF THE FACT THAT MY OFFICE, THE OFFICE OF THE MEDICAL DIRECTOR, IS PROBABLY ONE OF THE BEST FUNDED AND WELL RESOURCED MEDICAL DIRECTORS OFFICES IN THE COUNTRY.
MOST CITIES, MOST SYSTEMS DON'T HAVE AN OFFICE OF THE MEDICAL DIRECTOR.
THEY DON'T NECESSARILY HAVE A STRUCTURE BY WHICH THE MEDICAL DIRECTOR IS INDEPENDENT AND IS ABLE TO AFFECT CHANGE ON A SYSTEM IN COLLABORATION WITH THE LEADERSHIP AS OPPOSED TO ANY SORT OF MORE, YOU KNOW, OTHERWISE CONTRACTUAL RELATIONSHIP.
TO THAT EFFECT, WE HAVE THIS IS MY ORG CHART THAT'S UP HERE ABOVE ME BEING THE MAEMSA BOARD, MYSELF AS [INAUDIBLE] MEDICAL DIRECTOR.
WE TEND TO HOUSE OUR STAFF IN TWO MAIN CAMPS.
ONE IS WHAT WE CALL CLINICAL QUALITY, AS YOU'LL SEE TO THE LEFT.
WE DEDICATE RESOURCES TO MEDSTAR AND THE FIRE DEPARTMENT TO ENSURE HIGH QUALITY'S OF CLINICAL CARE.
SO WHAT DOES THAT MEAN? WE LOOK AT INDIVIDUAL CASES IN A QUALITY PROTECTED FASHION TO MAKE SURE THAT CARE THAT HAS BEEN DELIVERED ON AN INDIVIDUAL CASE BASIS IS MEETING THE STANDARDS AND IF NOT, WE WILL PROVIDE INDIVIDUALIZED EDUCATION AND REMEDIATION TO THOSE CREWS.
AND THEN WE HAVE WHAT'S CALLED THE CQI OR CONTINUOUS QUALITY IMPROVEMENT PROCESS.
FOR THOSE OF YOU FAMILIAR WITH PDSA CYCLES, WHICH REALLY SPANS OUTSIDE OF MEDICINE TOO.
WE TAKE VERY SPECIFIC AREAS OF CARE THAT WE CAN MEASURE AND DEVELOP PROCESSES TO TRY AND IMPROVE THEM IN A MORE CONTINUOUS FASHION.
AND THEN WE HAVE THE CLINICAL PRACTICE SIDE, WHICH IS WHERE THE WHAT WE CALL CREDENTIALING, TRAINING AND EDUCATION COMES IN.
ONE THING THAT'S IMPORTANT TO UNDERSTAND, YOU KNOW, SORT OF OUTSIDE THIS DISCUSSION.
BUT SINCE YOU ARE LEARNING EVERYTHING ABOUT EMS IN THE STATE, IN THE STATE OF TEXAS, THERE'S ONLY ONE TYPE OF PROFESSION THAT'S ALLOWED TO PRACTICE MEDICINE.
AND FOR ALL, PRACTICING MEDICINE IS ACTUALLY DEFINED IN THE STATE LAW AS EVALUATING A PATIENT, COMING UP WITH A TREATMENT OPTION, TO TRY TO DETERMINE WHAT'S WRONG WITH THEM AND DELIVERING CARE.
AND THAT IS QUITE LITERALLY WHAT EMS AND FIRE DEPARTMENTS DO.
AND IN THE STATE OF TEXAS, THAT IS A RESPONSIBILITY OF A PHYSICIAN.
AND THERE'S REALLY ONLY A PHYSICIAN THAT'S ALLOWED TO INDEPENDENTLY USE THOSE SKILLS, BUT OBVIOUSLY, WE DON'T HAVE ENOUGH PHYSICIANS AND WE NEED ALL ASPECTS OF CARE TO WORK TOGETHER, AND SO PHYSICIANS ARE ABLE TO WHAT'S CALLED DELEGATE THAT ABILITY TO DIFFERENT TYPES OF PROVIDERS.
SO THERE ARE NPS AND PAS AND THEN REALLY THERE IS EMS. AND SO THE WAY THAT THIS SYSTEM WORKS IS THAT I HAVE A RESPONSIBILITY NOT JUST TO MAKE SURE THAT THE PROVIDERS IN THE SYSTEM HAVE BEEN TRAINED IN A SCHOOL AND HAVE BEEN CERTIFIED BY THE STATE AS HAVING BEEN TO SCHOOL.
I HAVE TO MAKE SURE THAT THEY ARE ACTUALLY ABLE TO PROVIDE THAT QUALITY OF CLINICAL CARE THAT I EXPECT TO OUR ACTUAL PATIENTS.
AND SO WE HAVE AN ENTIRE ARM DEDICATED WHAT'S CALLED CREDENTIALING, WHICH IS THE PROCESS BY WHICH WE TAKE A NEW PERSON AND EVALUATE AND TRAIN THEM TO THE LEVEL THAT THIS SYSTEM EXPECTS.
ONE OF THE THINGS THAT'S ALSO GREAT ABOUT THE WAY THAT EMS IS DONE IN TEXAS IS THAT WHEREAS ON A NATIONAL LEVEL, YOU HAVE A STANDARD SCOPE THAT WHAT A LET'S SAY, AN EMT IS ALLOWED TO DO.
IN TEXAS IF I FEEL THAT IT'S NECESSARY FOR OUR SYSTEM, WE CAN INCREASE THAT SCOPE AS LONG AS I'M WILLING TO SHOULDER THAT RESPONSIBILITY.
SO ONE OF THE EXAMPLES THAT WE STARTED SEVERAL YEARS AGO WAS YOU PROBABLY HEARD OF
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NALOXONE.SO OR NARCAN IS THE BRAND NAME.
SO OPIATE OVERDOSES, THOSE WHO ARE EITHER ILLICIT OR PRESCRIPTION MEDICATIONS, AND THEY STOP BREATHING.
TYPICALLY, AN EMT IS NOT ABLE TO ADMINISTER A LIFESAVING MEDICATION UP SOMEONE'S NOSE.
WE FELT LIKE IT WAS IMPORTANT TO IMPLEMENT THAT SKILL, AND SO WHAT WE DID WAS WE INCORPORATED THAT INTO OUR EMT LEVEL PROTOCOL.
WE USE THE CLINICAL PRACTICE STAFF TO TRAIN THE ENTIRE SYSTEM AS PART OF OUR PROTOCOL ROLLOUT, AND NOW EVERY EMT IN THE SYSTEM IS ALLOWED TO DO THAT.
AND THAT'S JUST AN EXAMPLE OF WHAT THE CLINICAL PRACTICE SIDE DOES.
WE ALSO DO ALL THE CONTINUING EDUCATION IN TERMS OF TAKING SOMEONE WHO'S ALREADY BEEN CREDENTIALED AND TRAINING THEM ON NEW ITEMS AND ALSO SORT OF KEEPING THEM UP TO DATE WITH THINGS THAT THEY DON'T DEAL WITH VERY OFTEN.
SO THAT IS THE OVERLAY OF WHAT OUR OFFICE IS RESPONSIBLE FOR.
AND AGAIN, THAT IS THE RESPONSIBILITY OF US NOT JUST TO MEDSTAR, BUT TO THE ENTIRE SYSTEM, FIRST RESPONDERS AND ALL.
THIS IS JUST A YEAR ON YEAR GRAPH TO UNDERSTAND THE SHEER VOLUME OF CASES THAT WE LOOK AT FROM A QUALITY PERSPECTIVE, 2019 SEEM TO HAVE BEEN A HORRIBLE YEAR AND FEELS LIKE IT DIDN'T FEEL LIKE IT WAS THAT BAD.
BUT AS I MENTIONED, THIS IS CASES PER YEAR.
YOU KNOW, RIGHT NOW WE'RE RUNNING AT PROBABLY ABOUT NINE HUNDRED OR SO FOR THE REST OF THIS YEAR.
AND THESE CASES ARE INDIVIDUALLY REVIEWED.
ALL OF IF YOU'VE HEARD OF THE CONCEPT OF A ROOT CAUSE ANALYSIS, A ROOT CAUSE ANALYSIS IS DONE ON EVERY ONE OF THESE CASES.
AND OFTENTIMES, IT RESULTS IN AN INDIVIDUALIZED MEETING BETWEEN EITHER THE MEDICAL DIRECTOR OR OMD STAFF AND THE PROVIDERS ON SCENE, OFTENTIMES TOGETHER IN TERMS OF FIRE AND EMS. THAT'S BEEN AN AREA THAT WE'VE BEEN WORKING ON.
ONE OF THE THINGS THAT COMES UP A LOT IS, WELL, HOW DO YOU KNOW IF YOU'RE A GOOD SYSTEM? FOR YEARS AND YEARS, EMS HAS ACTUALLY BEEN PLAGUED WITH THE FACT THAT WE DIDN'T HAVE NATIONALLY RECOGNIZED QUALITY METRICS, WHICH THOSE OF US WHO REALLY CARE ABOUT CLINICAL QUALITY FOUND VERY FRUSTRATING.
AND SO THERE'S A GROUP CALLED NEMSQA THE NATIONAL EMS QUALITY ALLIANCE.
IT'S MADE UP OF EMS PROVIDERS, PHYSICIANS, OTHER HEALTH CARE SPECIALTIES, AND THEY PUT TOGETHER A SERIES OF CLINICALLY APPROPRIATE QUALITY METRICS THAT WERE EASILY EVALUATED FOR ALL SYSTEMS ACROSS THE COUNTRY AND ACROSS THE STATE.
I'VE BEEN RECENTLY WORKING ON A PROJECT TO MAKE SURE THAT WE ARE ACTUALLY MEETING THE BAR OF THE NEMSQA MEASURES, AT LEAST COMPARED TO OUR PEERS.
SO WHAT YOU'LL SEE HERE IS THE METRICS ACROSS THE BOTTOM, THE RED BAR REPRESENTING WHAT THE MAEMSA SYSTEM DOES.
AND I WANT TO BE CLEAR ABOUT THAT.
THIS IS A SYSTEM LEVEL REVIEW AS MUCH AS IT CAN BE.
I CAN'T SPLIT THIS OUT BY WHETHER A FIRST RESPONDER DID IT OR MEDSTAR DID IT, WHETHER IT HAPPENED IN THIS CITY OR ANOTHER CITY.
THIS IS HOW THIS SYSTEM THAT WE ARE ALL A PART OF PERFORMS. JUST BY WAY OF EXAMPLE, THE ONE ON THE LEFT HYPOGLYCEMIA IS IF YOU SHOW UP AND YOUR BLOOD SUGAR IS LOW, HOW GOOD ARE WE AT RECOGNIZING THAT AND TREATING YOU WITH SOME SORT OF TREATMENT FOR THAT, SUCH AS SUGAR THROUGH THE VEINS TO INCREASE YOUR BLOOD SUGAR? HOW OFTEN DO WE ASSESS OUR KIDS APPROPRIATELY, MAKING SURE THAT THEIR OXYGEN LEVELS ARE GOOD? THAT'S NUMBER ONE, MAKING SURE THAT WE GIVE THEM BREATHING TREATMENTS IF THEY'RE HAVING WHEEZING, THAT'S NUMBER TWO.
SEIZURES IN TERMS OF HOW OFTEN WHEN WE SHOW UP AND SOMEONE'S ACTIVELY SEIZING ARE WE ABLE TO IMMEDIATELY RECOGNIZE IT AND GIVE THEM THE EXACT RIGHT MEDICATION THAT WILL STOP IT AS FAST AS POSSIBLE? HOW OFTEN DO WE RECOGNIZE STROKES AND PERFORM A STROKE SCALE? AND THEN TRAUMA IS ABOUT ESSENTIALLY TREATING PAIN APPROPRIATELY AND TAKING THEM TO THE CORRECT FACILITY? WHAT YOU'LL SEE THERE IS PRETTY CONSISTENTLY ACROSS THE BOARD.
THE MAEMSA SYSTEM MEETS OR EXCEEDS THAN BOTH NATIONAL AND WHAT WE'VE CALLED THE SIMILAR.
SIMILAR BEING SYSTEMS OF A SIMILAR RESPONSE VOLUME AND A SORT OF URBAN SUBURBAN QUALITY AS OPPOSED TO FAR RURAL OR WILDERNESS.
AND SO THAT'S THE SORT OF COMPARATOR THERE.
DR. VITHALANI, CAN I ASK REAL QUICK ON THIS COMPARISON? DOES THIS COMPARE TO OTHER PUBLIC UTILITY PROVIDERS FOR EMS AND OR DOES IT ALSO INCLUDE CURRENT FIRE DEPARTMENT EMS SERVICES? SO THIS ESSENTIALLY DOES INCLUDE SO THE NATIONAL INCLUDES, SO LET ME TAKE A STEP BACK.
THERE'S THIS THING CALLED NEMSIS.
NEMSIS IS THE NATIONAL EMS INFORMATION SYSTEM.
EVERY EMS PROVIDER AND BY PROVIDER I MEAN, AN AMBULANCE SERVICE IN THE COUNTRY USES AN ELECTRONIC.
WHEN THEY USE AN ELECTRONIC CHARTING SOFTWARE, IT'S WHAT'S CALLED NEMSIS COMPLIANT.
EACH QUESTION HAS A CODE WITH A NATIONALIZED DEFINITION AND LIST OF OPTIONS.
ALL OF THAT INFORMATION IS COLLATED TO EACH STATE.
SO WHEN WHEN MEDSTAR OR BURLESON WRITES A CHART WHEN THEY FINALIZED IT, IT GETS SENT EVERY NIGHT TO THE STATE.
THE STATE DATABASE IS THEN UPLOADED TO A NATIONAL DATABASE, AND SO WE'RE ACTUALLY ABLE TO LOOK AT THINGS FROM A NATIONAL LEVEL, REGARDLESS OF WHETHER YOU'RE A SMALL FIRE DEPARTMENT OR A LARGE PUBLIC UTILITY MODEL.
IT'S ALL INCLUDED IN THAT NATIONAL BAR THERE.
THERE ARE WAYS TO TRY AND SEGREGATE IT OUT A LITTLE MORE.
IT'S A LITTLE CUMBERSOME TO WEBSITES LIKE YOU'VE GOT TO CLICK A BUNCH OF BOXES AND DO THINGS.
SO I JUST PICKED SIMILAR SIZED AGENCIES JUST BY WAY OF COMPARISON.
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BUT YOU KNOW, THE HARD PART IS THERE ARE BOTH GOOD AND BAD SYSTEMS OF ALL TYPES.AND THAT'S WHY, YOU KNOW, I THINK A NATIONAL COMPARISON IS PROBABLY THE BEST ONE TO MAKE IS THAT WHEN YOU COMPARE TO ACROSS THE BOARD, HOW ARE WE DOING AS A SYSTEM COMPARED TO ALL OTHER SYSTEMS IN THE COUNTRY? THAT'S WHAT THAT REPRESENTS.
SO DR. JUST TO JUST TO MAKE SURE I UNDERSTOOD THAT CORRECTLY, THIS CHART INCLUDES THE WORK OF OUR FIRST RESPONDERS AND FIREFIGHTERS.
SO, YES, AND YOU KNOW, LIKE EVERYTHING, THERE'S A LITTLE BIT MORE NUANCE TO IT.
SO I'M GOING TO I'M GOING TO EXPLAIN ONE OTHER SORT OF POINT.
MOST OF OUR EVALUATION OF AN INDIVIDUAL PATIENT IS OFTENTIMES SPLIT ACROSS TWO PATIENT CARE REPORTS.
OK, SO ONE BY THE FIRST RESPONDER.
SO IF BURLESON DOES A CHART ON THE FIRST RESPONDER, THEN THERE'S THE CARE THAT'S PROVIDED THERE AND ONE THAT'S PROVIDED BY MEDSTAR.
THERE IS AN INTERFACE BETWEEN THEM WHEN A FIRST RESPONDER UPLOADS A CHART AND IT GETS DOWNLOADED INTO THE OTHER CHART IT CAPTURES THAT DATA, AND SECONDARILY, WHEN A AMBULANCE PROVIDER IS DOING THEIR DOCUMENTATION, IF A FIRST RESPONDER HAS DOES SOMETHING BEFORE THEY GOT THERE, THEY'RE ALSO ABLE TO CHART THAT.
SO WHAT I WILL SAY IS WITHIN THE BOUNDS OF DOCUMENTATION COMPLIANCE, YES, BUT I THINK THIS IS A YEAR'S WORTH OF DATA.
I DON'T THINK IT WOULD MAKE ANY SUBSTANTIAL DIFFERENCES.
BUT YES, THIS INCLUDES THE WORK OF THE ENTIRE SYSTEM, YOUR AND OTHER FIRST RESPONDERS AND THE MEDSTAR PROVIDERS.
I UNDERSTAND YOUR NUMBERS, AND I'M GOING TO ASK A REAL SIMPLE QUESTION HERE, ARE YOU BASICALLY SAYING THAT BURLESON CAN'T MEET THOSE STANDARDS? OH NO, NO.
WHAT I'M SAYING IS THIS IS HOW THE SYSTEM PERFORMS RIGHT NOW.
THIS IS WHAT THE CURRENT SYSTEM THAT WE ARE A PART OF IS REPRESENTED IN THAT RED BAR.
AND THE BLUE BAR IS NATIONAL AND THE GREEN BAR IS SYSTEMS OF A SIMILAR SIZE AND RESPONSE VOLUME.
YOU KNOW, AND I SEE MY RESPONSIBILITY AS SAYING, HEY, HERE'S I HAVE A VERY INTENSE SENSE OF OWNERSHIP OF THE CLINICAL CARE THAT'S PROVIDED IN THE SYSTEM.
IT'S NOT ONLY MY LEGAL RESPONSIBILITY, BUT I TAKE INTENSE MORAL RESPONSIBILITY.
IN THE EYES OF THE LAW THESE ARE MY PATIENTS, SO EVERY TIME WE DON'T MEET A METRIC I TAKE PERSONAL RESPONSIBILITY FOR THAT.
ALL I CAN TELL YOU IS HOW THIS SYSTEM IS PERFORMING RIGHT NOW, AND I'LL BE HONEST WITH YOU, I SEE THESE BARS AND I SEE TONS OF ROOM FOR IMPROVEMENT, NOT JUST FOR US, BUT FOR EVERYONE, RIGHT? WE DEDICATE THE RESOURCES TOWARDS IMPROVEMENT.
THAT DOESN'T MEAN THAT ANY OTHER SYSTEM CAN'T OR WON'T.
IT JUST MEANS THAT THIS IS HOW WE'RE PERFORMING AND WE CARE ABOUT THIS.
I'M NOT MAKING ANY COMMENTARY ABOUT ANYTHING ELSE.
I THINK JUST TO KIND OF I WANT TO REITERATE MAYBE A LITTLE BIT OF WHAT COUNCIL MEMBER STANFORD SAID THIS IS IN COLLABORATION WITH YOUR PARTNER CITIES, THESE NUMBERS THAT YOU'RE PROVIDING US.
SO THAT'S BECAUSE OF THE WORK THAT YOU GET WITH THESE PARTNER CITIES AND THE FIREMEN SHOWING UP EARLY.
THEIR PARAMEDICS STARTING ON THINGS.
AS A BUSINESS OWNER, I'M STRUGGLING TO SAY I WOULD NEVER SHOW A CHART WHERE I'M THE HIGHEST BAR IN EVERY SINGLE AREA.
I MEAN, I'M HAPPY TO SEND THE UNDERLYING DATA.
YOU KNOW, I DON'T KNOW WHAT TO SAY ABOUT THAT.
ONE OF THE THINGS THAT I LOVE THE MOST ABOUT THIS SYSTEM IS THAT EVERYONE THAT I'VE WORKED WITH IN THIS SYSTEM CARES A LOT ABOUT CLINICAL QUALITY.
IT'S BUILT INTO THE FOUNDATION OF THIS SYSTEM, AND IT'S WHY THE SYSTEM IS NATIONALLY RECOGNIZED AND CAN HAVE A GRAPH WHERE WE ARE DOING REALLY WELL.
THIS IS JUST THE SAD REALITY OF EMS. IT IS NOT THE REALITY ACROSS THE COUNTRY.
AND THAT'S REALLY WHAT I'M TRYING TO SHOW HERE IS THAT THIS SYSTEM DOES REALLY WELL, AND THAT'S NOT THE CASE EVERYWHERE.
THAT'S I SEE MY RESPONSIBILITY TO SHOW YOU THE SYSTEM YOU HAVE NOW.
AND YET AND BUT TO YOUR POINT, YOU KNOW, AND I UNDERSTAND WHY SOME OF THESE ARE NOT QUITE AT 90 PERCENT, BECAUSE THAT'S WHERE I REALLY LIKE THEM TO BE.
SOME OF THEM ARE THE DOCUMENTATION ITEMS. BUT EVERY SYSTEM, AS EVIDENCED BY THE BLUE BARS, EVERY SYSTEM HAS ROOM TO IMPROVE.
IT'S JUST WHETHER OR NOT THEY CARE ENOUGH TO DO IT.
IF YOU HAVE PEOPLE THAT CARE AND THAT HAVE THE RESOURCES AND THE MINDSET AND ARE WILLING TO PUT IN THE WORK, YOU KNOW YOU CAN BE AS GREAT A SYSTEM AS YOU WANT.
IT'S ABOUT MAKING SURE THAT YOU HAVE FOLKS THAT ARE DEDICATED TO IMPROVING EMS QUALITY, TO PROVIDING GREAT CLINICAL PATIENT CARE AND FOCUSED ON THE TASK AT HAND WHEN THEY'RE THERE.
AND THAT'S REALLY WHAT'S BEEN GREAT ABOUT THIS SYSTEM IS THAT IT ATTRACTS PEOPLE LIKE THAT BECAUSE OF THE HISTORY.
IT'S BEEN 30 YEARS THAT THIS SYSTEM HAS BEEN A HIGH PERFORMANCE EMS AGENCY, AND
[00:25:05]
IT'S SORT OF A, YOU KNOW, JOKED ABOUT TERM.BUT I REALLY DO SORT OF BELIEVE IT.
LIKE I TRAINED EMERGENCY MEDICINE RESIDENTS AT JPS.
I WAS A RESIDENT THERE MYSELF, AND I'VE TRAINED OVER 10 YEARS OF NEW EMERGENCY PHYSICIANS.
THESE ARE PHYSICIANS THAT HAVE THEY WENT TO MED SCHOOL.
THEY DIDN'T DO A LOT OF EMERGENCY MEDICINE.
THEN THEY COME AND THEY DO THREE YEARS OF DEDICATED EMERGENCY MEDICINE AT JPS, AND THEY PRIMARILY INTERFACE WITH MEDSTAR AND THE SYSTEM FIRST RESPONDERS.
AND THEN THEY GO AND GET JOBS, OTHER PLACES.
SOMETIMES THEY GET THEM HERE LOCALLY AND SOMETIMES THEY GO TO OTHER PARTS OF THE COUNTRY.
IT IS PROBABLY EVERY YEAR THAT SOMEBODY I SEE THEM AT A CONFERENCE OR THEY TEXT ME AND THEY GO, OH MAN, I DID NOT REALIZE HOW GOOD I HAD IT.
LIKE, THAT'S YOUR SYSTEM WORKS REALLY WELL BECAUSE NOW I'M OVER IN LARGE CITY EAST OF US, AND THEY JUST COULD NOT PERFORM AT THE SAME LEVEL.
AND AGAIN, IT'S ABOUT THE PEOPLE AND ABOUT THE CARE, AND THAT'S REALLY WHAT IT BOILS DOWN TO.
SO I DEFINITELY SEE YOUR POINT ABOUT PUTTING A GRAPH UP LIKE THAT.
ALL I SEE IS ROOM FOR IMPROVEMENT BECAUSE THAT'S WHAT WE FOCUS ON.
HAVING SAID THAT, IT'S BUILT INTO THE FOUNDATION OF THE SYSTEM TO DO REALLY WELL.
WE ARE SORT OF PART OF OUR NICHE OR PART OF OUR SPECIALTY IN OUR OFFICE IS IDENTIFYING THINGS THAT ACTUALLY NATIONALLY HAVE GONE UNRECOGNIZED AND WE SHED LIGHT ON THEM.
AND A LOT OF PEOPLE GET CONCERNED BECAUSE WE'RE SHOWING DIRTY LAUNDRY.
BUT I WOULD RATHER POINT OUT A PROBLEM AND SHOW HOW WE FIXED IT SO THAT EVERY AGENCY IN THE COUNTRY WHO IS INTERESTED IN DOING SO CAN DO THAT CAN ALSO MAKE AN IMPROVEMENT BECAUSE THAT'S THE MINDSET.
THAT'S THE ETHOS OF, YOU KNOW, EMS FOCUSED INDIVIDUALS AND THEY CAN WORK FOR ANY TYPE OF AGENCY IT'S JUST YOU'VE GOT TO HAVE, YOU KNOW, YOU'VE GOT TO HAVE THAT INPUT AND YOU'VE GOT TO HAVE THE RESOURCES TO PUT INTO IMPROVEMENT.
DOCTOR, I HAVE ANOTHER QUESTION.
AT THE BOTTOM, I SEE THE NUMBERS ONE TO THREE.
IS IT SAFE TO SAY THAT ONE IS THE MOST SEVERE THEN TWO THAN THREE? OR AM I NOT THOSE ARE THE NAMES OF THE METRICS YOU CAN GOOGLE, YOU KNOW, NEMSQA IS THE NAME AND YOU CAN PULL UP THE QUALITY METRICS.
AND THOSE ARE THE ONES THAT IF YOU WENT IN, YOU CAN FIND THE DEFINITION.
I BET I COULD REMEMBER MOST OF THEM, BUT FOR EXAMPLE, HYPOGLYCEMIA 01.
IF THEY WANTED TO ADD A SECOND HYPOGLYCEMIA MEASURE, THEY WOULD CALL IT HYPOGLYCEMIA 02.
THERE'S NO SEVERITY ASSOCIATED WITH THAT.
HYPOGLYCEMIA 01 IS JUST THE FIRST METRIC OF THE HYPOGLYCEMIA SECTION, IF THAT MAKES SENSE.
I NOTICED THERE WAS NO SEIZURE 01, SO I DIDN'T KNOW SO SPEAKERS].
SO INTERESTINGLY, I DON'T WANT TO BORE YOU WITH THE HISTORY HERE.
BEFORE NEMSQA, THERE WAS A GROUP CALLED EMS COMPASS.
EMS COMPASS WAS ANOTHER NATIONAL BODY THAT GOT PUT TOGETHER.
EMS COMPASS CAME UP WITH A SET OF METRICS AND THEN LONG STORY SHORT, AFTER IT WENT OUT TO PUBLIC COMMENT, IT EITHER LOST FUNDING OR SOMETHING HAPPENED.
THE METRICS NEVER GOT PUBLISHED.
WHEN NEMSQA PICKED IT UP, THEIR JOB WAS TO TAKE THE EMS COMPASS MEASURES, MAKE SURE THEY WERE STILL CLINICALLY APPROPRIATE AND THEN PUT THEM OUT.
WHAT THEY DETERMINED WITH SEIZURE 01 WAS IT WAS NO LONGER A CLINICALLY RELEVANT METRIC, SO THEY DELETED IT.
YEAH, SO SO THERE ARE LIKE A COUPLE OTHER METRICS THAT I DIDN'T PUT UP HERE.
ONE OF THEM WAS BECAUSE I COULD NOT GATHER THE DATA BASED ON THEY DIDN'T PROVIDE THE DEFINITION OF WHERE TO PULL THE CODES FROM AND THE OTHER ONES ARE OPERATIONAL.
AND I SEE IT MY RESPONSIBILITY TO SHOW YOU THE CLINICAL METRICS.
AND YOU KNOW, I AGREE IT'S THIS TRAUMA 02 IS SIMILAR.
AND ACTUALLY THERE IS LIKE THERE'S A TRAUMA 04, BUT THEY HAVEN'T PUT OUT THE DEFINITION FOR HOW TO ACTUALLY DO THE CALCULATION YET.
SO I WASN'T ABLE TO MEASURE THIS.
WHEN YOU HAVE A DEFICIENCY, ARE YOU THE ONE THAT RECOGNIZES IT AND SETS THE PLAN FORWARD? SAY THAT AGAIN, SIR.
WHEN YOU SEE A DEFICIENCY AND SOMETHING, THAT NEEDS TO BE CORRECTED ARE YOU THE ONE THAT DECIDES THAT IDS THAT AND MOVES FORWARD ON IT.
SO, I WOULD LOVE TO BE ABLE TO TAKE THAT CREDIT.
SO AS I MENTIONED ON OUR ORG CHART WE HAVE BUCK GLEASON, WHO'S OUR QUALITY MANAGER, AND THEN FOUR STAFF WITH HIM, WE MEET REALLY EVERY WEEK MULTIPLE TIMES TO GO OVER FOR INDIVIDUAL ITEMS. SO WE HAVE A PROCESS CALLED SELF REPORT.
ONE OF THE THINGS I'M MOST PROUD OF IS IN THIS SYSTEM, OUR PROVIDERS, WHEN THEY RECOGNIZE THAT THEY'VE MADE A CLINICAL ERROR, THEY ACTUALLY REPORT THAT TO US AND THAT ACTUALLY REPRESENTS ABOUT 50 PERCENT OF THE CASES THAT WE REVIEW IS A CREW EMAILING US AND SAYING, HEY, I THINK I COULD HAVE DONE BETTER ON THIS CASE.
CAN WE SIT DOWN AND GO OVER THIS AND [INAUDIBLE].
WE HAVE A COUPLE OF STAFF DEDICATED TO THE MEDSTAR AND FIRE SIDE OF THAT PROCESS, WE HAVE ONE DEDICATED TO OUTCOMES OUR CARDIAC ARREST REGISTRY, AND THEN WE HAVE ONE DEDICATED TO OUR AIRWAY AND SOME OTHER SORT OF CQI PROJECTS.
AND SO SOMETIMES I'M THE ONE TO IDENTIFY IT.
MOST RECENTLY, KIRBY JOHNSON, WHO'S OUR ONE OF OUR FOLKS WHO LOOKS
[00:30:01]
AT ALL OF OUR CARDIAC ARRESTS, ACTUALLY IDENTIFIED AN ISSUE THAT WE'RE HAVING SYSTEM WIDE WITH THE MECHANICAL COMPRESSION DEVICES THAT WE'VE ROLLED OUT IN THE SYSTEM.AND SO THEY WORK, YOU KNOW, WITH BURLESON AND SAGINAW AND LAKE WORTH TO DEVELOP A CHANGE MANAGEMENT PROCESS TO IMPROVE THAT.
AND SO IT SOMETIMES IT'S ME, SOMETIMES IT'S THE STAFF, SOMETIMES IT'S OPERATIONS OR FIRE, YOU KNOW, IT'S REALLY ANYONE.
THE IMPORTANT THING IS WE WORK COLLABORATIVELY TO IMPROVE IT BECAUSE THE REALITY OF IT IS NO MEDICAL DIRECTOR CAN ACCOMPLISH ALL THE FEATS ASSIGNED TO THEM BY THE STATE ALONE.
AND REALLY, YOU CAN'T AFFECT CHANGE IN AN EMS OPERATION WITHOUT COLLABORATION FROM THE OPERATIONS SIDE.
WE HAVE SEEN IN OTHER AND THIS SYSTEM TIMES WHERE OPERATIONS AND MEDICAL DIRECTION DON'T GET ALONG AND CAN'T WORK TOGETHER AND CAN'T MAKE IMPROVEMENT.
AND I THINK THAT WE ARE IN A GREAT PLACE WHERE WE'RE ABLE TO MAKE THOSE CHANGES.
SO WHETHER I SEE THE IMPROVEMENT OR SOMEONE ELSE WE WORK TO TO IMPROVE THAT.
SO DUE TO THE SIZE OF YOUR COMPANY, WHEN Y'ALL HAVE TO MAKE A CHANGE OR DO AN IMPROVEMENT THING THAT TAKES YOU QUITE A WHILE TO DO THAT, DOESN'T IT.
SO WE TYPICALLY HAVE, DEPENDING ON THE AGENCY WE'RE WORKING WITH, WHETHER IT'S MEDSTAR, OR ONE OF THE FRO'S, WE HAVE DIFFERENT WAYS TO ACCOMPLISH THAT.
SOMETIMES IT'S US INDIVIDUALLY TRAINING, SOMETIMES IT'S A VIRTUAL DISTRIBUTED SORT OF LECTURE.
SOMETIMES IT IS GOING TO THE STATIONS AND DOING HANDS ON WORK.
THE TRAINER, A LOT OF TIMES WITH THE FIRE DEPARTMENTS, WILL DO A TRAIN.
THE TRAINER WILL DEVELOP THE CONTENT, TEACH SOME OF THEM AND THEY'LL GO OUT AND TEACH IT TO THEIR FOLKS.
WE'VE DONE LIVE STREAMS AND DISTRIBUTED CLASSES.
WE DO ALL SORTS OF DIFFERENT, OPTIONS.
YOU KNOW, I ALWAYS SORT OF JOKE AROUND LIKE THE SYSTEM IS A BIT OF A CRUISE SHIP LIKE IT TAKES A LITTLE WHILE TO TURN.
BUT THE FOCUS THERE, TOO, IS THAT WE ALSO HAVE THE CALL VOLUME TO ACTUALLY IDENTIFY AND MAKE THE CHANGES OR TO IDENTIFY THE CHANGES AND TO SEE IF OUR CHANGES ARE WORKING.
SO, YOU KNOW, ONE OF THE THINGS I'VE NOTICED REALLY ACROSS SYSTEMS IS THAT YOU CAN DEFINITELY BE A SMALL, NIMBLE SYSTEM, BUT YOU MAY NOT ENCOUNTER THE ISSUE AS OFTEN.
YOU CAN BE A LARGE SYSTEM AND ENCOUNTER ISSUES A LOT, BUT IT TAKES A LONGER TIME TO CHANGE IT.
NEITHER ONE IS BETTER OR WORSE.
IT'S JUST AGAIN, IT'S ABOUT KNOWING THAT THERE'S SOMETHING THERE AND WORKING TO CHANGE IT.
OK, SO OUR JOB HERE TODAY, AND I'M QUALIFYING MY QUESTION HERE IS TO STICK WITH YOU GUYS OR TO GO WITH THE NEW SYSTEM.
TELL ME SOMETHING THAT MAKES US FEEL LIKE OUR CITY COULDN'T HANDLE THIS.
YOU SEE WHAT I'M SAYING YOU QUOTED ALL THESE NUMBERS AND EVERYTHING, BUT I HADN'T SEEN ANYTHING THAT'S PERTINENT TO THE OPERATION OF OUR FIRE DEPARTMENT.
SO IN REALITY, IT WOULD BE IMPOSSIBLE FOR ME TO PREDICT THAT BECAUSE NONE OF THE CURRENT FIRST RESPONDERS TRANSPORT PATIENTS ON THE AMBULANCE AS PART OF THEIR STANDARD PRACTICE, I WOULDN'T HAVE ANYTHING TO MEASURE IF THAT MAKES SENSE.
THERE'S MORE TO JUST THE TRANSPORT SIDE, TO BE CLEAR, LIKE A LOT OF PATIENT CARE HAPPENS IN THE HOME.
THERE'S NOT A WAY TO BE CLEAR FOR LET'S TAKE THESE METRICS AS AN EXAMPLE.
THERE'S NOT A WAY FOR ME TO PICK OUT HYPOGLYCEMIA 01 AND SAY, WELL, WE'RE NINETY TWO PERCENT COMPLIANT.
YOU KNOW, 50 PERCENT OF THAT IS MEDSTAR, AND 50 PERCENT OF THAT IS A FIREFIGHTER.
I CAN'T DO THAT BECAUSE IT'S DOCUMENTED IN A CHART AND IT GETS ROLLED UP AS, HEY, WE TREATED THIS PATIENT APPROPRIATELY.
IT'S ACTUALLY PART OF THE MINDSET AS TO WHY WE OPERATE AS A SYSTEM, BECAUSE ONE OF THE THINGS I SAY AND THESE GUYS HEAR ME SAY IT ALL THE TIME IS FROM A CLINICAL PERSPECTIVE, I DON'T CARE WHAT SHIRT YOU WEAR.
I LITERALLY DON'T, BECAUSE FROM MY PERSPECTIVE, AS THE MEDICAL DIRECTOR WRITING THE PROTOCOLS AND THE REASON WE HAVE UNIFIED PROTOCOLS AND IN THE EYES OF THE LAW, IT DOESN'T MATTER IF YOU WORK FOR BURLESON FIRE DEPARTMENT OR MEDSTAR OR LAKE WORTH OR FORT WORTH POLICE.
WHEN YOU TAKE CARE OF A PATIENT, IT'S LIKE I'M STANDING THERE TAKING CARE OF THE PATIENT.
WHEN I EVALUATE CARE, I EVALUATE THE CARE OF THE PATIENT AND REALLY, I HOLD EVERYONE ACCOUNTABLE TO POOR CLINICAL CARE WHEN WE HAVE SOMEONE WHO'S RUSHED OFF SCENE AFTER INAPPROPRIATE STABILIZATION AND THEY GO INTO CARDIAC ARREST IN THE BACK OF THE AMBULANCE.
I BRING IN THE ENTIRE SYSTEM BECAUSE EVERYONE KNOWS WHAT THEY'RE SUPPOSED TO DO.
EVERYONE'S THERE TO HOLD EACH OTHER ACCOUNTABLE ON SCENE.
AND I CAN'T SAY, HEY, YOU'RE THE GUY THAT MESSED UP OUT OF THE EIGHT PEOPLE HERE.
I'M GOING TO TRAIN YOU, BUT EVERYONE ELSE DOESN'T NEED IT.
RISING TIDES, YOU KNOW RAISE ALL SHIPS.
THAT'S THE MENTALITY I'VE ALWAYS TAKEN.
I CAN'T AND I'LL BE TOTALLY CLEAR, NOT EVEN POLITICALLY.
OK, I'M GOING TO PUT ALL THAT ASIDE IF YOU ASKED ME AS A MEDICAL DIRECTOR OF THE SYSTEM.
IS THIS POSSIBLE WITH JUST BURLESON, I CAN'T TELL YOU THAT BECAUSE I'M A DATA DRIVEN PERSON, I LIVE AND I ANSWER THINGS OFF DATA.
I DON'T HAVE DATA TO ANSWER THAT QUESTION.
AND SO ALL I CAN TELL YOU IS THE SYSTEM RIGHT NOW WORKS LIKE THIS THAT IS DUE TO MEDSTAR AND THE FIRST RESPONDERS WORKING TOGETHER AS A SYSTEM.
[00:35:02]
ANYBODY ELSE.I THINK WE'RE GOOD, THANK YOU.
I THINK MY SLIDES WERE DONE, OH, SORRY, YOU ALL.
JUST BY WAY OF EXPLANATION, WHEN SOMEONE STOPS BREATHING, YOU CAN BREATHE FOR THEM IN THREE WAYS.
YOU CAN TAKE A SORT OF FOOTBALL OF AIR AND PUT A MASK ON THEM AND BREATHE FOR THEM.
THAT'S DIFFICULT AND TEMPORARY AND HAS SOME ISSUES, BUT IS AN IMMEDIATE TREATMENT THAT YOU CAN DO.
YOU CAN USE A ESSENTIALLY A CAMERA WITH A BLADE THAT LIFT THE THROAT AND ALLOWS YOU TO PUT A BREATHING TUBE DIRECTLY INTO THE WINDPIPE AND BREATHE FOR THEM USING THAT SAME FOOTBALL, ACTUALLY.
AND THAT IS A VERY DIFFICULT SKILL THAT DOESN'T HAPPEN THAT OFTEN, AND SO IT REQUIRES A LOT OF SKILL TO DO SO.
AND THEN THERE'S BECAUSE OF THOSE TWO POLAR OPPOSITES, COMPANIES HAVE MADE THIS MIDDLE GROUND WHERE BASICALLY YOU CAN TAKE A TUBE AND SORT OF BLINDLY INSERT IT INTO THE THROAT AND IT'LL LAND IN A PLACE WHERE YOU'RE ABLE TO BREATHE FOR THEM UNTIL YOU CAN GET THEM TO THE HOSPITAL.
WHEN I GOT HERE FIRST AND MY PREDECESSOR WAS HERE, WE IDENTIFIED A PROBLEM WHERE WE THOUGHT WHEN WE PUT IN THOSE TUBES, THEY WERE WORKING WELL.
BUT WE HAD OBJECTIVE DATA TO SHOW US THAT ABOUT 15 PERCENT OF THE TIME THEY WERE NOT IN AND WE WERE NOT VENTILATING THOSE PATIENTS.
AND AGAIN, THAT IS, EVERYONE WAS PUTTING THEM IN BOTH MEDSTAR AND FIRE, AND EVERYONE WASN'T USING THE TOOLS APPROPRIATELY TO RECOGNIZE THAT THAT WAS A PROBLEM.
THIS IS A GRAPH WE'RE ACTUALLY ABOUT TO PUBLISH THIS PAPER OF FIVE YEARS OF DEDICATED WORK TO ENSURE THAT THE RATE OF THAT OCCURRING IS VERY, VERY LOW.
RIGHT NOW, IT'S LESS THAN ONE PERCENT OF THE TIME.
ALL OF THOSE CASES ARE VERY NUANCED AND REVIEWED.
THIS WAS ACTUALLY NEVER TALKED ABOUT IN THE LITERATURE EVER BEFORE, AND MOST SYSTEMS IN THE COUNTRY HAD NO IDEA THAT IT WAS EVEN POSSIBLE.
AND NOW WE ARE QUOTED AS THE PEOPLE WHO BROUGHT THIS QUALITY ISSUE TO LIGHT AND HAVE FIXED AND SAVED TONS OF LIVES IN OTHER CITIES BY THE WORK THAT WE DID.
I'M NOT A VERY BIG PERSONAL TOUTING PERSON, BUT THIS IS LITERALLY MY CROWN JEWEL I'VE SPENT SO FAR MY ENTIRE CAREER HERE TRYING TO FIX THIS.
I'LL LET MATT TALK ABOUT THIS PART, BUT I'M HAPPY TO ANSWER ANY QUESTIONS NOW OR AFTER, BUT THANK YOU ALL.
VITHALANI SAY THAT THE OFFICE OF THE MEDICAL DIRECTOR HAS 14 AND YOU SAW IT ON THE SCREEN 14 FULL TIME PEOPLE, INCLUDING ONE FULL TIME AND TWO ASSOCIATE MEDICAL DIRECTORS RESPONSIBLE FOR THE TRAINING, CREDENTIALING AND QUALITY ASSURANCE OF MEDICAL CARE ADMINISTERED BY THE EMS SYSTEM.
OMDS BUDGET IS TWO POINT FIVE MILLION DOLLARS ANNUALLY.
WE'VE HEARD LIKE PEOPLE LIKE TO HAVE.
CAN YOU TELL THE GENERAL PUBLIC WHAT OMD IS? I'M SORRY.
THERE'S A LOT OF ACRONYMS USED IN THIS STUFF.
AND IT'S NOT JUST FOR THE PEOPLE WHO ARE HERE, BUT THE PEOPLE WHO WILL WATCH THIS LATER ON RECORDING.
THEY'RE GOING TO GO, WHAT DOES THAT MEAN? AND YOU GUYS GET IT? AND SOME OF US CAN REMEMBER SOME OF IT, BUT NOT ALL OF IT.
SO THE OFFICE OF MEDICAL DIRECTOR AT TWO POINT FIVE MILLION DOLLAR BUDGET ANNUALLY.
YOU'VE HEARD, WE'VE HEARD, AND YOU LIKELY HAVE AS WELL THAT MEDSTAR'S PERSONNEL ARE YOUTHFUL.
SOME OF OUR PERSONNEL ARE YOUNG, BUT OTHERS HAVE BEEN WITH MEDSTAR FOR DECADES.
IN FACT, WE RECENTLY RECOGNIZED SEVERAL OF OUR TEAM MEMBERS FOR OVER 30 YEARS OF SERVICE.
MEDSTAR PARAMEDICS GO THROUGH A TRAINING AND CREDENTIALING PROCESS ABOVE AND BEYOND THAT REQUIRED OF OTHER PARAMEDICS.
THIS ENSURES THEY HAVE THE EXPERTISE NECESSARY TO MEET THE HIGH CLINICAL STANDARDS THAT ARE OFTEN EXPECTED OF HOSPITAL CLINICIANS, INCLUDING THE REQUIREMENT TO MAINTAIN ADDITIONAL CERTIFICATIONS SUCH AS ADVANCED CARDIAC LIFE SUPPORT, ADVANCED MEDICAL LIFE SUPPORT, PEDIATRIC ADVANCED LIFE SUPPORT AND PREHOSPITAL TRAUMA LIFE SUPPORT.
IN FACT, KEN JUST FINISHED HIS PHD [INAUDIBLE] YESTERDAY.
DID YOU GET YOUR TEST RESULTS.
YOU'VE ALSO PROBABLY HEARD THAT MEDSTAR CURRENTLY HAS A HIGHER TURNOVER RATE THAN BURLESON FIRE.
OUR FULL TIME TURNOVER RATE LAST YEAR WAS ABOUT 16 PERCENT.
EMTS AND PARAMEDICS ARE ATTRACTED TO MEDSTAR BECAUSE OF OUR REPUTATION FOR CLINICAL QUALITY AND HIGH CALL VOLUME.
THEY RAPIDLY GAIN EXPERIENCE BECAUSE OF THE HIGH UTILIZATION OF AMBULANCES IN THE MEDSTAR SYSTEM.
MANY OF OUR TEAM WILL STAY AND MAKE THIS THEIR CAREER JOB.
BUT THE KNOWLEDGE AND EXPERIENCE THEY GAIN WITH US MAKES THEM ATTRACTIVE TO OTHER
[00:40:01]
AGENCIES.FIRE DEPARTMENTS HIRE A LOT OF OUR PEOPLE, AND FOR SOME OF OUR EMTS AND PARAMEDICS, THEY GO ON TO THE FIRE SERVICE BECAUSE IT'S AN ATTRACTIVE CAREER.
DUE TO THE LOWER RESPONSE VOLUME, LESS DAYS WORKED EXCELLENT BENEFITS SUCH AS HEAVILY FUNDED PENSIONS.
OUR FIELD PERSONNEL ALSO GO ON TO HIGHER CAREERS IN HEALTH CARE, SUCH AS NURSING, PHYSICIAN'S ASSISTANT NURSE PRACTITIONERS OR EVEN PHYSICIANS.
ONE OF OUR PAST MEDICAL DIRECTORS WORKED AT MEDSTAR AS AN EMT, WENT TO MEDICAL SCHOOL, CAME BACK AS OUR MEDICAL DIRECTOR.
BECAUSE OF THE WAY MEDSTAR DEPLOYS AMBULANCES OUR MEDICS HAVE MORE PATIENT CARE EXPERIENCE THAN IS FOUND IN MOST OTHER AGENCIES.
IN ROUGH NUMBERS, MEDSTAR PARAMEDICS PROVIDE ADVANCED LIFE SUPPORT INTERVENTIONS ABOUT 16 TIMES MORE FREQUENTLY THAN MOST FIRE FIRST RESPONSE PERSONNEL.
THE PATIENT CARE EXPERIENCE IS WHAT REALLY MATTERS, NOT THE LENGTH OF TIME THAT SOMEONE HAS BEEN IN THE SYSTEM.
MEDSTAR ALSO PROVIDES CRITICAL CARE PARAMEDICS IN THE SYSTEM.
THESE ARE THE HIGHEST LEVEL CREDENTIALED PROVIDERS IN THE EMS SYSTEM.
THESE CRITICAL CARE PARAMEDICS RESPOND IN SPECIALLY EQUIPPED QUICK RESPONSE VEHICLES TO THE HIGHEST ACUITY CALLS AND CAN IMPLEMENT ENHANCED LIFESAVING PROTOCOLS THAT NO OTHER EMS SYSTEM PROVIDER CAN IMPLEMENT.
OUR CRITICAL CARE PARAMEDICS ARE ALSO PART OF OUR NATIONALLY RECOGNIZED COMMUNITY HEALTH PROGRAM, DELIVERING PREVENTIVE CARE TO PATIENTS ENROLLED IN OUR COMMUNITY HEALTH PROGRAM, WHICH CURRENTLY SERVES RESIDENTS IN BURLESON.
IN FACT, FIVE HUNDRED AND TWELVE BURLESON RESIDENTS HAVE BEEN ENROLLED IN MEDSTAR'S NATIONALLY RECOGNIZED COMMUNITY HEALTH PROGRAM.
I'M SORRY CRITICAL CARE PARAMEDICS HAVE RESPONDED TO FOUR HUNDRED AND SEVENTY CALLS IN BURLESON SINCE OCTOBER OF 2019.
EIGHTY FIVE OF THOSE WERE 9-1-1 CALLS HIGH, VERY HIGH ACUITY 911 CALLS.
ONE HUNDRED AND THIRTY SEVEN WERE COMMUNITY HEALTH PROGRAM HOME VISITS AND TWO HUNDRED AND FORTY EIGHT WERE CRITICAL CARE INTER FACILITY TRANSPORTS ORIGINATING IN BURLESON.
BUT HOW ELSE IS QUALITY DEFINED.
ACCREDITATION IS A VALUABLE EXTERNAL VALIDATION THAT AN AGENCY PROVIDES QUALITY SERVICE.
FEW AGENCIES SEEK EXTERNAL VALIDATION FROM AN ACCREDITING BODY, WHICH IS WHY WE WERE IMPRESSED BY THE BURLESON POLICE DEPARTMENT, WHICH WAS THE FIRST POLICE DEPARTMENT IN TEXAS TO BE ACCREDITED BY THE COMMISSION ON ACCREDITATION FOR LAW ENFORCEMENT AGENCIES.
BURLESON PD HAS BEEN REACCREDITED 10 TIMES SINCE ORIGINALLY ACCREDITED IN 1987.
MEDSTAR HOLDS A DUAL ACCREDITATIONS BOTH IN 911 DISPATCH AND AMBULANCE OPERATIONS.
WE ARE ONE OF ONLY 30 ONE OUT OF THE APPROXIMATELY 17000 AGENCIES IN THE COUNTRY TO HOLD THIS DUAL ACCREDITATION.
OUR 911 CENTER IS AN ACCREDITED CENTER OF EXCELLENCE WITH THE INTERNATIONAL ACADEMIES OF EMERGENCY DISPATCH AND ACCREDITATION THAT WE HAVE CONTINUALLY EARNED SINCE 2002.
WE ARE ONLY ONE OF ONE HUNDRED AND THIRTY SIX COMMUNICATION CENTERS IN THE COUNTRY TO HOLD THAT ACCREDITATION.
OUR AMBULANCE OPERATION IS ACCREDITED BY THE COMMISSION ON THE ACCREDITATION OF AMBULANCE SERVICE AND ACCREDITATION THAT WE'VE CONTINUALLY HELD SINCE 2009.
OF THE APPROXIMATELY SEVENTEEN THOUSAND AMBULANCE AGENCIES IN THE COUNTRY, ONLY 220 ARE ACCREDITED BY CAAS AND AGAIN, ONLY THIRTY ONE AGENCIES IN THE COUNTRY ARE DUAL ACCREDITED.
YOU'RE GOING TO HEAR A LOT ABOUT RESPONSE TIMES.
FOR YEARS, THERE HAVE BEEN VERY, VERY FEW CONCERNS RAISED BY BURLESON FIRE, THE CITY MANAGER'S OFFICE OR ANYONE IN BURLESON ABOUT RESPONSE TIMES.
IN 2016, THE EMS AUTHORITY BOARD, INCLUDING BURLESON APPROVED SYSTEM RESPONSE TIME GOALS AS RECOMMENDED BY THE EMS SYSTEM PERFORMANCE COMMITTEE, WHICH IS A COMMITTEE ESTABLISHED BY THE INTER LOCAL THAT BURLESON IS PART OF, AND THEY RECOMMEND CLINICAL AND OPERATIONAL STANDARDS FOR THE EMS AUTHORITY.
AND AGAIN, BURLESON HAS REPRESENTATION ON THAT BOARD.
THE EMS AUTHORITY CHANGED THE START OF THE RESPONSE TIME CLOCK TO START WHEN MEDSTAR ANSWERS THE 911 CALL, OFTEN REFERRED TO AS FIRST KEYSTROKE AND ENDS WHEN THE AMBULANCE ARRIVES ON SCENE.
THIS MEANS THAT THE CALL PROCESSING TIME, THE TIME FROM THE MOMENT THE 9-1-1 CALL IS ANSWERED IN OUR ACCREDITED DISPATCH CENTER TO THE TIME AN AMBULANCE DISPATCHED IS INCLUDED IN THE RESPONSE TIME CALCULATION.
VERY FEW SYSTEMS USE THIS HIGHER MORE TRANSPARENT CLOCK START MEASURE.
WE FOUND IT INTERESTING THAT FITCH USED A 90 PERCENT FRACTILE OR RELIABILITY MEASURE.
THANK YOU FOR THAT AGAIN REMINDER.
WHEN THE SYSTEM GOAL WAS EIGHTY FIVE PERCENT AGAIN, AS APPROVED BY THE EMS
[00:45:04]
AUTHORITY AT THE RECOMMENDATION OF THE SYSTEM PERFORMANCE COMMITTEE.CAN I STOP YOU FOR JUST A SECOND I SHOULD HAVE GRABBED YOU BEFORE YOU MOVED FORWARD ONTO THIS.
I WANTED TO TALK ABOUT STAFFING REALLY QUICK AND YOU WERE TALKING ABOUT THE FACT THAT THEY SEE A LOT MORE CALLS THAN, YOU KNOW, A NORMAL FIRE DEPARTMENT WOULD, POSSIBLY BECAUSE THEY'RE ARE ONLY SEEING CALLS FOR ONE CITY AND YOU GUYS ACTUALLY ARE OVER FORT WORTH AND THEY'RE YOUR PRIMARY CITY.
WHAT ARE THE HOURS, THE SHIFTS THAT THEY WORK AND HOW MANY DAYS IN A ROW DO THEY WORK? SURE.
SO THE TYPICAL SHIFT PATTERN IS A 12 HOUR SHIFT, AND THEY WORK BETWEEN THREE AND FOUR OF THOSE SHIFTS PER WEEK, DEPENDING ON THE SCHEDULE THAT THEY CHOOSE TO WORK.
THEY RARELY WORK MORE THAN 12 HOURS UNLESS THEY GET A LATE CALL, AND THEY TYPICALLY HAVE AT LEAST THREE DAYS A WEEK OFF SO THAT THEY CAN DO THAT.
WE HAVE NEVER, I KNOW, NEVER SAY NEVER.
IT WOULD NOT BE REASONABLE WITH OUR ACTIVITY LEVEL FOR A PROVIDER TO WORK A TWENTY FOUR HOUR SHIFT, RIGHT? BECAUSE THEY WOULD JUST SEE WAY TOO MANY PATIENTS AND THEY DON'T SIT IN STATIONS AND THEY DON'T SLEEP AT NIGHT.
THEY ARE POSTED ON STREET CORNERS, READY TO RESPOND TO CALLS.
SO IT'S A 12 HOUR SHIFT, TYPICALLY, AND THEY WORK THREE TO FOUR OF THOSE PER WEEK.
AND TYPICAL TWO WEEKS OFF KIND OF A YEAR THING LIKE NORMAL.
THEY HAVE PTO BANK THAT THEY CAN TAKE DAYS OFF.
THEY CAN TAKE WEEKS OFF WHATEVER THEY WOULD LIKE.
SO WHAT ABOUT BURNOUT? BECAUSE THE DIFFERENCE IN GOING TO A FIRE DEPARTMENT MODEL IS THE GUYS ROTATE OFF THE BOX AND HAVING A HUSBAND WHO'S A FIREFIGHTER, I CAN TELL YOU THAT BURNOUT IS DEFINITELY SOMETHING THAT HAPPENS IN THE AMBULANCE SERVICES FIELD.
SO, YOU KNOW, BURNOUT AFFECTS IT AFFECTS ALL OF US NUMBER ONE.
BUT WHEN YOU'RE DEALING WITH BURNOUT AND MEDICAL SERVICES, YOU KNOW, THEY DON'T HAVE ANYWHERE TO FALL BACK TO.
THE THING ABOUT ROTATING OFF THE BOX AND GOING BACK INTO THE ENGINE, BEING ON THE ENGINE OF THE TRUCK FOR A COUPLE OF SHIFTS, EVEN, YOU KNOW, THAT ALLOWS THEM TO KIND OF REFRESH AND NOT HAVE TO, ESPECIALLY WHEN YOU'RE SEEING SOME OF THE, YOU KNOW, YOU GO ON A REALLY BAD WRECK OR SOMETHING AND YOU'VE GOT A CHILD THAT DIED OR JUST SOME OF THAT HORRIFIC THINGS THAT THESE GUYS SEE.
HOW DO YOU DEAL WITH THAT AND KEEP THEM EMPLOYED? SURE, WE HAVE A NUMBER OF PROGRAMS THAT ONE IT, AND WE MAKE A HUGE INVESTMENT IN HELPING TO PREVENT BURNOUT AND GIVING PEOPLE JOY AT WORK.
WE HAVE A HOPE SQUAD THAT IS A PEER SELECTED, SPECIALLY TRAINED GROUP OF PEOPLE THAT DO THINGS TO HELP PEOPLE RELIEVE STRESS AND TO HAVE JOY AT WORK, AND TO BE ABLE TO IDENTIFY WHEN PEOPLE MIGHT BE STRUGGLING OR THAT PEOPLE CAN GO TO IF THEY'RE HAVING SOME OF THOSE BURNOUT ISSUES.
DID I MENTION THAT A LOT OF OUR WORKFORCE IS RELATIVELY YOUNG? PEOPLE WHO DO THIS FOR A LONG TIME MAY GO INTO AN EMERGENCY ROOM TO WORK.
BUT THERE ARE PEOPLE IN OUR SYSTEM, JUST LIKE THERE ARE PEOPLE IN SYSTEMS ACROSS THE COUNTRY WHO STAY WORKING WITH HIGH VOLUME EMS AGENCIES BECAUSE THEY LOVE THE PATIENT EXPERIENCE.
THEY LOVE THE PATIENT CONTACTS, THEY LOVE CARING FOR THOSE PEOPLE AND THEY DON'T MIND THE ACTIVITY AND THEY REALLY JUST ENJOY IT.
THOSE PEOPLE THAT HAVE TROUBLE WITH THAT, WE CAN IDENTIFY IT.
WE CAN GIVE THEM SOME RESOURCES, WE CAN CHANGE THEIR SHIFT PATTERN.
OR THEY, LIKE WE SAID EARLIER, COULD GO TO WORK FOR A FIRE DEPARTMENT BECAUSE THE CALL VOLUME IS LESS, THE SHIFTS ARE EASIER, IT'S LESS TIME ON THE JOB AND THEY CHOOSE TO DO THAT.
BUT THE ONES THAT STAY REALLY ENJOY IT.
I HAD ONE QUICK QUESTION I'M SORRY I SHOULD HAVE ASKED WHENEVER.
YOU DIDN'T BREAK FOR US, I APOLOGIZE.
SO ON THE PERSONNEL, I'VE HEARD YOU SAY THAT A LOT OF YOUR STAFF IS YOUNG AND THAT TYPICALLY YOU BRING IN PEOPLE YOUNG AND THEY GET A CHANCE TO GET A LOT OF REALLY GOOD QUALITY TRAINING BECAUSE THEY'RE IN A BIG CITY AND EVERYTHING ELSE.
BUT THEY TAKE THAT TRAINING AND THEY GO ON TO FIRE DEPARTMENTS.
YOU SEE A LOT OF A YOUR PERSONNEL, AS I UNDERSTAND WHAT YOU SAID, THAT A LOT OF YOUR PERSONNEL DO GO ON TO BECOME FIREFIGHTERS ONCE A FIRE DEPARTMENTS OR WHATEVER ONCE THEY GET THAT LEVEL OF EXPERTISE AND KNOWLEDGE.
AND THEY BRING THAT LEVEL AND EXPERTISE OF KNOWLEDGE WITH THEM.
BUT NOW THEY DON'T HAVE TO TREAT AS MANY PATIENTS.
THEY DON'T HAVE TO DO ALL THOSE THINGS BECAUSE THEY WERE WORKING IN A DIFFERENT ENVIRONMENT.
BUT THEY ALSO GO TO WORK IN ERS AND THEY GO POLICE DEPARTMENTS.
THEY GO, YOU KNOW, DIFFERENT PLACES.
SO WE FIND THAT INTERESTING IN THE REPORT THAT IT LOOKS LIKE THEY THE FITCH GROUP TOOK THE AVERAGE AND FRACTILE RESPONSE TIME DIFFERENCE OF ALL OF MEDSTAR'S RESPONSES IN BURLESON, INCLUDING THE PRIORITY THREE LOW ACUITY CALLS THAT MEDSTAR RESPONDS TO WITHOUT THE USE OF LIGHTS AND SIRENS.
AND UNTIL RECENTLY, WITHOUT A BURLESON FIRST RESPONSE UNIT.
DURING THE TIME OF THE ANALYSIS AND ANALYSIS, BURLESON FIRE ONLY RESPONDED TO A PERCENTAGE OF THE EMS CALLS IN BURLESON THE HIGH ACUITY CALLS, LEAVING THE PRIORITY
[00:50:01]
THREE LOW ACUITY, NON LIGHT AND SIREN RESPONSES FOR A MEDSTAR RESPONSE ONLY, WHICH IS ENTIRELY APPROPRIATE AND A BENEFIT OF BELONGING TO THE SYSTEM.A DESIGN OF THIS SYSTEM IS THAT FIRST RESPONSE UNITS SHOULD BE AVAILABLE TO RESPOND TO THE HIGH ACUITY CALLS WHEN THEIR RESPONSE MAY MAKE A DIFFERENCE IN THE PATIENT'S OUTCOMES, LIKE A CPR CALL NOT BEING TIED UP ON LOW ACUITY CALLS IN WHICH THEIR RESPONSE WILL LIKELY NOT MAKE A DIFFERENCE IN THE PATIENT'S OUTCOME.
COMPARING THE RESPONSE TIMES FOR ALL CALLS THAT BURLESON RESPONDED TO THE HIGH ACUITY CALLS TO ALL THE CALLS THAT MEDSTAR RESPONDS, WHICH INCLUDES THOSE NON LIGHT AND SIREN LOW ACUITY CALLS MAY NOT PROVIDE AN ACCURATE PICTURE OF THE RESPONSE TIMES.
USING THE SAME DATA THAT WE SUPPLIED TO FITCH WE LOOKED ONLY AT THE CALLS THAT BURLESON AND MEDSTAR RESPONDED TO.
THOSE ARE THE HIGH ACUITY, BOTH RESPONDED LIGHTS AND SIREN.
THE TIME DIFFERENCE BETWEEN BURLESON FIRE AND MEDSTAR'S ARRIVAL IN THAT DATA SET IS FIVE MINUTES AND 20 SECONDS, NOT THE EIGHT MINUTES AND 30 SECONDS AS STATED IN THE REPORT, AND I BELIEVE THE CONSULTANT INDICATED THAT A FIVE MINUTE TIME DIFFERENCE BETWEEN THE ARRIVAL OF A FIRST RESPONSE UNIT AND THE ARRIVAL OF THE AMBULANCE IS REASONABLE AND WITHIN THE NATIONAL STANDARD.
WE ALSO LOOKED CLOSELY AT THE DISPATCH TIME METRIC, AS REPORTED IN THE REPORT OF FOUR POINT NINE MINUTES IN THE FITCH REPORT.
WE COMPARED THAT TO OUR 90 PERCENT FRACTILE METRIC FOR THE CALL PROCESSING TIME FOR OCTOBER 2021.
YOU'LL SEE THAT THE 90 PERCENT FRACTILE THAT RELIABILITY MEASURE FOR CALL PROCESSING TIME IS CURRENTLY TWENTY SEVEN POINT FOUR SECONDS.
WE BELIEVE THE FITCH ANALYSIS MAY HAVE EITHER INCLUDED THE TIME FROM THE BURLESON 911 CENTER PROCESSING THE CALL BEFORE IT WAS TRANSFERRED TO MEDSTAR, OR MAY NOT TAKE INTO ACCOUNT THAT MEDSTAR'S 9-1-1 CALL TAKERS OFTEN STAY ON THE PHONE WITH CALLERS AFTER UNITS HAVE BEEN DISPATCHED TO PROVIDE PRE-ARRIVAL MEDICAL INSTRUCTIONS.
WE ALSO FOUND IT INTERESTING THAT ALTHOUGH WE PROVIDED RESPONSE TIME, DATA AND RESPONSE DATA IN GENERAL FOR FOUR YEARS FROM 2017 TO 2020, THE REPORT ONLY USED THE DATA FROM THE PANDEMIC YEAR FOR THE RESPONSE TIME ANALYSIS.
AND THERE ARE TWO PROBLEMS WITH USING DATA DURING A PUBLIC HEALTH EMERGENCY CALL VOLUME AND RESPONSE TIMES.
WHEN THE COVID 19 PANDEMIC WAS DECLARED IN MARCH OF 2020, THE FIRST RESPONDER ORGANIZATIONS ASKED MEDSTAR, HOW COULD WE HELP THEM PROTECT THEIR FIRST RESPONDERS AND THE EMS PERSONNEL.
TO ADDRESS THIS CONCERN MEDSTAR PROPOSED USING A PROTOCOL ESTABLISHED BY THE INTERNATIONAL ACADEMIES OF EMERGENCY DISPATCH CALLED PROTOCOL THIRTY SIX.
PROTOCOL THIRTY SIX IS AN INFECTIOUS DISEASE CALL PROCESSING PROTOCOL DESIGNED TO ASK ADDITIONAL QUESTIONS DURING THE CALL TAKING PROCESS TO IDENTIFY IF A PATIENT IS EXHIBITING SIGNS AND SYMPTOMS OR HAS A MEDICAL HISTORY WHICH INDICATES THE PATIENT HAS A HIGH LIKELIHOOD OF HAVING COVID 19.
USING THIS PROTOCOL ALLOWS THE 9-1-1 CENTER TO NOTIFY RESPONDING FIRST RESPONDERS OF THE POTENTIAL SCENE SAFETY ISSUE OF A LIKELY COVID 19 PATIENT ON SCENE.
UPON THIS NOTIFICATION, RESPONDING PERSONNEL CAN ASSURE THE PROPER USE OF PERSONAL PROTECTIVE EQUIPMENT AND PERHAPS FOR NON-LIFE THREATENING CALLS, MEET AT THE SCENE TOGETHER AND DECIDE WHO AND HOW MANY PERSONNEL ACTUALLY MAKE PATIENT CONTACT.
THIS LIMITS EXPOSURE TO THE RESPONDING PERSONNEL AND HELPS PRESERVE CRUCIAL PERSONAL PROTECTIVE EQUIPMENT, WHICH AT THE TIME WAS IN LIMITED SUPPLY.
AS YOU MIGHT IMAGINE, THE USE OF THIS PROTOCOL MAKES THE CALL PROCESSING TIME LONGER BECAUSE OF THE ADDITIONAL QUESTIONS BEING ASKED TO ASSURE RESPONDER SAFETY.
IN FACT, WE HAVE FOUND THAT THE CALL TAKING PROCESS UNDER PROTOCOL THIRTY SIX IS ABOUT 90 SECONDS LONGER THAN NOT USING PROTOCOL THIRTY SIX.
THE EMS SYSTEM PERFORMANCE COMMITTEE, THE FIRST RESPONDER ADVISORY BOARD, WHICH IS CHAIRED BY CHIEF CASEY DAVIS AND THE EMS AUTHORITY BOARD, ALL APPROVED THE USE OF THIS CALL TAKING PROTOCOL TO HELP ASSURE RESPONDER SAFETY.
AND THEY DID SO KNOWING THAT THE USE OF THIS PROTOCOL WOULD ADD AN AVERAGE OF 90 SECONDS TO THE RESPONSE TIME, BUT EVERYONE AGREED THAT WAS VALUABLE TO PROTECT RESPONDERS.
IN ESSENCE, MEDSTAR'S RESPONSE TIMES WERE LONGER DURING 20 AND 21 BECAUSE WE WERE USING THIS PROTOCOL WITH THE APPROVAL OF THE FIRST RESPONDER ADVISORY BOARD AND THE EMS AUTHORITY BOARD.
AS YOU CAN SEE, THIS CHART SHOWS OUR RESPONSE TIME RELIABILITY FROM
[00:55:08]
JANUARY OF 2019 THROUGH NOVEMBER OF 2021.THE FIRST ARROW DEPICTS WHEN THE INFECTIOUS DISEASE CALL TAKING PROCESS PROTOCOL THIRTY SIX WAS IMPLEMENTED.
THE BLUE LINE IS OUR RELIABILITY RESPONSE TIME THAT EIGHTY FIVE PERCENT MEASURE FOR BURLESON AND THE ORANGE LINE IS THAT SAME MEASURE FOR THE WHOLE SYSTEM.
NOTE THAT WHEN WE STARTED USING THAT PROTOCOL, THE RESPONSE TIME COMPLIANCE DROPPED.
WE KNEW THAT WAS GOING TO HAPPEN.
BURLESON KNEW THAT WAS GOING TO HAPPEN.
EVERYBODY KNEW THAT WAS GOING TO HAPPEN, BUT WE WERE DOING IT TO PROTECT THE WORKFORCE, TO PROTECT THE PEOPLE THAT WERE PROVIDING CARE IN THE STREET.
THAT PROTOCOL STOPPED BEING USED IN THE BEGINNING OF MARCH 2021.
BECAUSE WE ALL THOUGHT FOOLISHLY, PERHAPS, THAT THE PANDEMIC WAS OVER AND WE DIDN'T HAVE TO DO THAT CALL SCREENING ANYMORE.
AND WHEN WE ELIMINATED THE USE OF THAT PROTOCOL, THE RESPONSE TIME STARTED TO GET BETTER AND GO BACK TO NORMAL COMPLIANCE, WHICH IS WHAT WE WOULD EXPECT UNTIL AUGUST AND SEPTEMBER, WHEN THERE WAS A PHENOMENAL INCREASE IN 911 EMS RESPONSE VOLUME ACROSS THE COUNTRY.
EMS AGENCIES FROM SAN DIEGO TO MAINE, ALABAMA HERE, PEOPLE WERE PLEADING WITH THE PUBLIC DON'T CALL 9-1-1 UNLESS IT'S REALLY AN EMERGENCY.
THE MOBILE ALABAMA FIRE CHIEF, THE SEMINOLE COUNTY, FLORIDA FIRE CHIEF.
WE WERE EDUCATING PEOPLE, HEY, CALL VOLUME IS THROUGH THE ROOF AND AT THE SAME TIME, BECAUSE THE DELTA VARIANT, WE AND MANY OF THE FIRST RESPONDERS, A LOT OF OUR EMPLOYEES WERE OUT OF WORK BECAUSE THEY GOT THE DELTA VARIANT.
SO WE HAD TO PRIORITIZE CALLS AND DO THE BEST THAT WE CAN WITH THE RESOURCES THAT WE HAD GIVEN A 12 PERCENT SUSTAINED INCREASE IN OUR RESPONSE VOLUME.
WE SHARED THAT WITH EVERYBODY IN THE SYSTEM, THEY UNDERSTOOD IT.
WE WORK TOGETHER TO DO SOME ADDITIONAL THINGS TO MAKE THE SYSTEM WORK MORE EFFICIENTLY.
AND NOW THAT MOST OF THAT HAS SUBSIDED, WE ARE NOW BACK TO BEING RESPONSE TIME COMPLIANT WITH THE GOALS ESTABLISHED BY THE AUTHORITY.
SO AS YOU CAN SEE BY THIS DATA, MEDSTAR WAS REQUESTED TO IMPLEMENT A CALL PROCESSING PROTOCOL BY BURLESON FIRE AND THE OTHER FIRST RESPONSE AGENCIES TO ASSURE THE SAFETY OF ALL EMERGENCY RESPONDERS.
A PROTOCOL THAT EVERYONE KNEW WOULD MAKE US NON-COMPLIANT WITH THE RESPONSE TIME GOALS.
AND NOW IT IS SOMEHOW BEING DEPICTED AS A FAILURE OF THE AMBULANCE RESPONSE SYSTEM, WHEN IN REALITY, IT'S A REPRESENTATION OF THE COLLABORATIVE APPROACH TO SYSTEM DELIVERY THAT THIS SYSTEM WAS BUILT ON.
IF I CAN ASK A QUESTION REAL QUICK ON THAT SLIDE, REAL QUICK, IF YOU DON'T MIND.
SO I NOTICED ON THERE THE SYSTEM BEING THE ORANGE LINE.
IT DIDN'T DIP THE SAME WAY BURLESON'S DID, AND THAT I ONLY SEE BURLESON NUMBERS INCREASING ONCE A DISCUSSION STARTS TO HAPPEN ABOUT SWITCHING FROM MEDSTAR TO FIRE THAT OUR NUMBER DOESN'T SPIKE UNTIL THAT DISCUSSION HAPPENS.
CAN YOU EXPLAIN THAT? THANK YOU FOR ALLOWING US THE OPPORTUNITY TO EXPLAIN THAT.
THE SYSTEM HAS A LOT OF CALLS.
THEREFORE, THE PERCENTAGES ARE MORE NORMALIZED.
WHEN YOU HAVE A SYSTEM THAT HAS FEWER CALLS, THERE'S HIGHER VARIATION, EITHER POSITIVELY OR NEGATIVELY IN THE RESPONSE TIME COMPLIANCE, JUST BECAUSE THERE ARE SMALLER NUMBERS, WHICH LEADS TO GREATER VARIATION.
NOW, GRANTED, THERE ARE MORE CALLS IN BURLESON THAN THERE ARE, SAY, IN LAKE WORTH OR IN LAKESIDE.
BUT PART OF THAT VARIATION IS BECAUSE OF THAT.
TO SAY THAT THE PANDEMIC STARTED TO END AND THE CALL VOLUME NORMALIZED AT ABOUT THE SAME TIME THAT BURLESON STARTED TO TELL US THAT THEY WERE THINKING ABOUT GOING INTO ANOTHER TYPE OF SYSTEM.
I THINK IT'S A LITTLE BIT CHALLENGING BECAUSE THE WHOLE SYSTEM'S RESPONSE TIMES GOT BETTER BECAUSE WE WERE NO LONGER DELAYING RESPONSE TIME OR CALL TAKING PROCESS AND THE CALL VOLUME NORMALIZED AND THE SYSTEM RETURNED TO HOW IT'S SUPPOSED TO OPERATE.
HAD NOTHING BECAUSE WE HAVEN'T CHANGED ANYTHING IN REGARD TO ALL OF THIS, EXCEPT SEVERAL MONTHS AGO WHEN KT WANTED US TO PUT AN AMBULANCE IN THE FIRE STATION.
WE DID, AND THAT HAD BEEN PLANNED FOR A YEAR AND A HALF.
WE WERE JUST WAITING FOR THE STATION TO BE FINISHED.
BUT THANK YOU FOR THE QUESTION.
LET'S TALK ABOUT THE NUMBER OF AMBULANCES.
MEDSTAR HAS BEEN ABLE TO MAINTAIN PROVIDING VALUABLE SERVICES WITHOUT TAXPAYER SUBSIDY FOR YEARS BY USING BIG DATA TO EFFECTIVELY BALANCE RESOURCES TO MEET DEMAND.
WE'VE BEEN PROVIDING SERVICE IN BURLESON FOR 33 YEARS, SO THE DATA THAT WE'VE
[01:00:01]
ACCUMULATED IS EXCEPTIONAL.WHAT YOU SEE ON THE SCREEN IS AN ANALYSIS OF RESPONSE VOLUME IN DEMAND IN BURLESON FROM OCTOBER 2020.
LET'S GO BACK TO THE BIG ONE OCTOBER 2020 THROUGH SEPTEMBER 2021.
SO REALLY KIND OF A MORE RECENT TIME SLICE, BUT LET'S LOOK AT FRIDAYS FOR A MINUTE.
WHAT YOU SEE ON THE SCREEN IS THAT ON FRIDAYS DURING THAT TIME PERIOD, FROM OCTOBER THROUGH SEPTEMBER OF 2021.
THE GREEN LINE IS THE AVERAGE NUMBER OF CALLS PER HOUR.
THE BLACK LINE REPRESENTS THE MAXIMUM NUMBER OF CALLS PER HOUR NOTE, THE MAXIMUM AT ONE PARTICULAR POINT WITH SIX CALLS IN BURLESON IN ONE HOUR AND ONE OF YOU WHEN YOU CAME TO VISIT, ASKED FOR THAT DATA AND WE ACTUALLY SENT IT TO YOU TO SHOW WHAT WAS GOING ON DURING THAT TIME FRAME.
INDUSTRY BEST PRACTICE IS TO STAFF ENOUGH AMBULANCES TO COVER TWO TIMES THE STANDARD DEVIATION OF THE AVERAGE CALL VOLUME.
THIS HELPS ASSURE A NINETY FIVE PERCENT RESPONSE COVERAGE BY ON DUTY UNITS, SO YOU ALWAYS WANT TO STAFF MORE THAN YOUR AVERAGE NUMBER OF CALLS AND TWO TIMES THE STANDARD DEVIATION GIVES YOU THAT RELIABILITY.
TWO TIMES THE STANDARD DEVIATION OF THE AVERAGE HOURLY RESPONSE VOLUME IS REPRESENTED BY THE YELLOW LINE ON THE CHART.
NOTE THAT BETWEEN THE HOURS OF 9:00 A.M.
AND 5:00 P.M., MORE THAN FOUR AMBULANCES ARE NECESSARY TO PROVIDE COVERAGE AT THE 95 PERCENT LEVEL FOR BURLESON RESIDENTS.
DURING THE COUNCIL MEETING ON NOVEMBER 8TH, CHIEF FREEMAN AND OTHERS STATED THAT MEDSTAR ONLY HAS ONE AMBULANCE FOR BURLESON.
AND THIS SORT OF PUZZLED US, SINCE WE HAVE DATA THAT SHOWS THE FREQUENCY AT WHICH MULTIPLE AMBULANCES RESPOND TO CALLS AND BURLESON.
IN FACT, ON FRIDAY, NOVEMBER 19TH, WE RESPONDED TO FOUR ACTIVE CALLS IN BURLESON SIMULTANEOUSLY, AND ONE OF YOU WAS AT OUR HEADQUARTERS WHEN THAT WAS HAPPENING AND WE SHOWED IT TO YOU.
THE THIRD CALL WAS A CARDIAC ARREST AT STAMPEDE HARLEY-DAVIDSON.
THE AMBULANCE ARRIVED IN SEVEN AND A HALF MINUTES AND THE PATIENT WAS SUCCESSFULLY RESUSCITATED BECAUSE OF THE TEAMWORK BETWEEN BURLESON FIRE AND MEDSTAR, JUST LIKE ON ALL OF OUR CALLS.
THE BELIEF STATED BY CHIEF FREEMAN AT THE COUNCIL MEETING THAT ONLY ONE AMBULANCE IS ASSIGNED TO BURLESON'S RESIDENTS IS PERHAPS A COMMON MISPERCEPTION OF HOW WE DEPLOY OUR RESOURCES.
ONE AMBULANCE MAY BE POSTED IN BURLESON, BUT IF THAT AMBULANCE IS DISPATCHED TO A CALL, A BACKFILL AMBULANCE IS TYPICALLY SENT TO REPLACE THE ONE DISPATCHED ON THE CALL, AND WE DO HAVE SEVERAL RECENT EXAMPLES THAT WE WON'T SPEND A LOT OF TIME GOING THROUGH.
BUT THESE ARE JUST EXAMPLES THAT YOU'LL HAVE IN YOUR HANDOUT THAT YOU CAN SEE THERE ARE MULTIPLE AMBULANCES ON CALLS.
THESE WERE ALL WITHIN THE LAST MONTH OR TWO, BUT WE CAN GO BACK AS FAR AS YOU'D LIKE TO SEE.
NOW THIS DOESN'T HAPPEN ALL THE TIME.
THE SYSTEM IS DESIGNED TO FLEX AND AND BACKFILL AS NEEDED, BUT PRETTY TYPICALLY THIS IS HOW THE SYSTEM IS DESIGNED TO WORK.
UNIT GOES ON A CALL GETS BACK FILLED, ANOTHER CALL BACK FILLED.
THAT'S THE WAY IT'S SUPPOSED TO WORK.
CAN I GET A CLARIFICATION ON SOMETHING.
WHEN YOU GO BACK, IF YOU DON'T MIND, GO BACK TO YOUR AMBULANCE DEPLOYMENT SLIDE WHERE YOUR BAR GRAPH SHOWS THE LEFT HAND SIDE AS THE NUMBER OF AMBULANCES.
DO YOU AT WHAT POINT? LET'S SAY YOU, LET'S SAY YOU HAVE TWO AMBULANCES WITHIN THE REGION THAT WOULD NORMALLY RESPOND TO BURLESON AND THEN OTHER AMBULANCES ARE DETAILED AT OTHER LOCATIONS.
ASSUMING AND I'M REACHING OUT HERE, I'M ASSUMING THAT WHEN THE FIRST AMBULANCE IS DEPLOYED TO A CALL IN BURLESON AND THE SECOND ONE GETS THE CALL, THEN AT THAT POINT, YOU KNOW THAT ALL THE COVERAGE YOU HAVE THAT'S ABLE TO RESPOND TO A POTENTIAL THIRD EVENT IN BURLESON ARE TAKEN UP.
AT THAT POINT, I'M ASSUMING, AND I'M GUESSING THAT YOU'D SEND ANOTHER AMBULANCE DOWN THAT WAY TO BE ON STATION NEARBY.
AS FAR AS ASSEMBLING THIS GRAPH, DO YOU CONSIDER THAT TO BE ONE OF THE AMBULANCES THAT'S ASSIGNED TO BURLESON BECAUSE IT'S COMING IN TO BACKFILL THE FIRST TWO? OR WHEN DOES THAT, WHEN DOES THAT THIRD AND FOURTH AMBULANCE WHEN IS IT COUNTED TO BE ALLOCATED TO BURLESON.
AS SOON AS IT ARRIVES WITHIN THE BURLESON CITY LIMITS AND GOES TO A POST THAT'S IDENTIFIED AS A BURLESON POST? OK, SO YOU MAY HAVE TWO CALLS WITH ACTIVE AMBULANCES ON THEM, BUT YOU'LL SAY YOU HAVE THREE AMBULANCES ASSIGNED TO BURLESON BECAUSE YOU SENT THE OTHER ONE DOWN TO BACKFILL AND BE ON POST.
RIGHT? THAT'S WHAT I'M GETTING AT.
I JUST WANTED TO KNOW AT WHAT POINT IN THE PROCESS THAT BECOMES AN AMBULANCE DEDICATED TO ACTIVITY WITHIN BURLESON AS FAR AS YOUR GRAPHING GOES.
NOW BECAUSE OF THE WAY THE SYSTEM WORKS IT MAY BE THAT IF WE'RE DOWN TO FOUR
[01:05:04]
AMBULANCES FOR THE ENTIRE SYSTEM, THE AMBULANCE THAT MIGHT BE COVERING THE FIFTH BURLESON CALL, THE FOURTH BURLESON CALL MIGHT BE POSTED AT THE QUICK TRIP UP AT 1187 AND 35 BECAUSE WE'RE TRYING TO COVER AS MUCH AREA AS WE CAN.BUT THAT UNIT IS GOING TO BE THE CLOSEST UNIT SENT TO A CALL ON THAT FOURTH OR FIFTH OR SIXTH CALL THAT COMES IN TO BURLESON.
AND FOR THIRTY SIX YEARS THAT'S HOW WE'VE MANAGED THE SYSTEM TO REALLY ACHIEVE THE THINGS THAT WE'VE BEEN TALKING ABOUT WE'RE ACHIEVING.
THIS IS ON A FRIDAY DURING A VERY A PEAK TIME.
THIS ONE EXAMPLE IS ON A FRIDAY.
HOW FREQUENTLY HAS THIS HAPPENED? LET'S JUST SAY IN THE TIME FRAME THAT YOU'RE COVERING.
I'M NOT SURE WE KNOW THAT FOR SURE, BUT WE CAN CERTAINLY GET YOU THAT DATA.
YEAH, BUT CERTAINLY IF YOU LOOK AT THE AVERAGE AND TWO TIMES THE STANDARD DEVIATION.
FOUR IS THE ABSOLUTE MINIMUM YOU SHOULD HAVE.
QUICK QUESTION ON THIS, SO AS I SAY, AND I HEAR YOU TELLING US THAT FOUR IS WHAT WE'RE GOING TO NEED FOR OUR CITY.
BEING THAT THIS IS A SYSTEM WITH OTHER MEMBER CITIES, THEY WOULD ALSO HAVE THE SAME NEED.
AM I CORRECT TO UNDERSTAND THAT? SO IN OTHER WORDS, OUR AMBULANCES MAY HAVE TO LEAVE OUR AREA AND WE MAY NOT HAVE ANY SHOULD ANOTHER MEMBER CITY ACHIEVE THE SAME NUMBERS.
THE SYSTEM IS VERY FLUID, AND IT'S DESIGNED TO BE FLUID FOR THE CLINICAL PROFICIENCY, FOR THE ECONOMIC EFFICIENCY AND FOR THE OPERATIONAL EFFECTIVENESS.
SO OUR GOAL AND WHEN WE GO THROUGH STAFFING, SOMEBODY ASKS THE QUESTION EARLIER ABOUT STAFFING, THE REASON THAT WE HAVE SHIFTS THAT START EVERY 15 MINUTES AND END EVERY 15 MINUTES IS WE CONTINUALLY OVERLAY OVERLAY, OVERLAY MORE RESOURCES TO COVER WHAT WE KNOW ARE GOING TO BE THE BUSIER TIMES.
WE'LL GIVE YOU AN EXAMPLE HERE RECENTLY WHERE SOMETHING HAPPENED THAT WE COULDN'T PREDICT AND WE WERE ABLE TO MANAGE IT BECAUSE THE SYSTEM HAD TWO TIMES THE STANDARD DEVIATION TO ACCOMPLISH THAT.
BUT IF YOUR POINT IS, ARE THERE TIMES WHEN WE'VE GOT TWO AMBULANCES AVAILABLE IN THE SYSTEM AND ONE IS IN THE NORTH SIDE OF FORT WORTH AND ONE IS IN THE SOUTH SIDE OF FORT WORTH COVERING THAT? YES, THAT DOES HAPPEN.
WE HAVE FIRST RESPONDERS TO GO TO THE HIGH PRIORITY CALLS TO DELIVER THAT GOOD FIRST RESPONSE CARE UNTIL WE CAN GET THERE.
AND BEING A MEMBER CITY SHOULD WE DECIDE TO GO WITH THE FIRE DEPARTMENT MODEL AND SHOULD WE GET TO SIX OR SOMETHING LIKE THAT OR WHATEVER NUMBER THAT WE CANNOT ACHIEVE? THOSE INTER-LOCAL AGREEMENTS WILL STILL BE THERE.
YOU ALL WOULD STILL BE ABLE TO ASSIST IN THAT REGARD.
WE'RE GOING TO TALK ABOUT MUTUAL AID HERE IN A MOMENT.
IF YOU DON'T MIND, I'D LIKE TO ANSWER THAT QUESTION WHEN WE GET TO THAT SECTION.
IS THAT FAIR? OK, THANKS, JIMMY.
SO I WANT TO MAKE SURE WE GIVE KT AND HIS TEAM ENOUGH TIME.
OUR ANALYSIS, BASED ON CURRENT DATA AND DECADES, SAYS IT WILL TAKE ABOUT FIVE TO SIX AMBULANCES DURING PEAK TIMES.
WE JUST WANT TO MAKE SURE THAT THERE'S ENOUGH RESOURCES BEING ASSIGNED TO THE CITY.
THE SYSTEM WAS DESIGNED TO MR. STANFORD'S QUESTION TO BE ABLE TO PROVIDE SURGE COVERAGE WHEN NEEDED.
AN EXAMPLE OF THE SURGE CAPACITY AND RESOURCES IN THE MEDSTAR SYSTEM WAS DEMONSTRATED THE MORNING OF FEBRUARY 11TH 2021.
WHEN THE SYSTEM EFFECTIVELY MANAGED A ONE HUNDRED AND THIRTY THREE CAR MULTIPLE CASUALTY INCIDENT WITH TRAGICALLY FIVE FATALITIES AND TRANSPORTING THIRTY SIX PATIENTS TO THE HOSPITAL, WE RESPONDED 11 AMBULANCES TO CRITICAL CARE PARAMEDICS AND MEDSTAR'S AMBUS.
THE USE OF MUTUAL AID IMPACTS CLINICAL QUALITY WHEN YOU RUN OUT OF AMBULANCES AND ANOTHER CALL COMES IN.
IF MUTUAL AID IS AVAILABLE THAT RESPONSE IS GOING TO COME FROM MUCH FARTHER AWAY.
A MUTUAL AID PROVIDER DOES NOT PREPOSITION AMBULANCES IN BURLESON TO WAIT FOR ANOTHER CALL LIKE YOU'VE SEEN THE CURRENT SYSTEM DOES.
THE USE OF MUTUAL AID ALSO IMPACTS REVENUE SINCE AMBULANCE SERVICES GENERALLY REIMBURSED FOR TRANSPORT EACH CALL THAT YOU MUTUAL AID, IN ADDITION TO THE CLINICAL QUALITY ISSUES, YOU LOSE POTENTIAL REVENUE.
MEDSTAR CAPTURES NINETY SEVEN PERCENT OF THE EMS RESPONSES IN BURLESON.
WE ONLY MUTUAL AID THREE PERCENT OF OUR CALLS.
THIS IS ONE OF THE REASONS WE'RE ABLE TO PROVIDE THESE SERVICES WITHOUT TAXPAYER SUBSIDY.
YOU SAID, HOW MANY AMBULANCES DID YOU HAVE ON SCENE FOR THAT.
YOU'RE IN FORT WORTH, WHICH IS WHERE YOUR MAIN CITY IS.
THE CITY WITH THE HIGHEST CALL VOLUME.
CORRECT? RIGHT? BUT IF THAT CALL HAD OCCURRED AT 35 AND RENFRO, YOU WOULD HAVE HAD 11 AMBULANCES THERE AND AMBUS AND TWO CRITICAL CARE PARAMEDICS.
YEAH, I THINK THAT ANY CITY, OUR SIZE THAT DOESN'T HAVE THEIR OWN AMBULANCE SERVICE OR EVEN ONLY HAS THREE WOULD STILL IN A CASE LIKE THAT HAVE HAD TO CALL MUTUAL AID NO MATTER
[01:10:01]
WHAT.SO I ALMOST DON'T THINK THAT'S CORRELATIVE, IN MY OPINION.
BECAUSE YOU'RE TALKING ABOUT YOU WERE IN THE CITY, THAT'S YOUR PRIMARY CITY, SO YOU CLEARLY HAD 11 AMBULANCES VERY CLOSE IN THAT.
WELL, FORT WORTH, YOU PROBABLY HAVE 11 AMBULANCES ALL THE TIME RUNNING IN FORT WORTH OR MORE, BUT THE SYSTEM HAS 51.
SO IF THAT CALL AGAIN HAD OCCURRED AT 35 AND RENFRO, THOSE 11 AMBULANCES WOULD HAVE COME FROM WHEREVER TO GO TO THAT CALL, INCLUDING OUR AMBUS, INCLUDING THE CRITICAL CARE PARAMEDICS.
BECAUSE YOU'RE OUR OWNERS, WE SERVE YOU.
LIKE IF WE HAD TWO DOWN HERE, YOU HAD TO PULL NINE FROM SOMEWHERE ELSE.
AND IF WE WERE CALLING MUTUAL AID, THOSE NINE WOULD COME FROM SOMEWHERE ELSE AS WELL.
SO AT LEAST THEY'RE PART OF YOUR OWN SYSTEM.
YOU DON'T HAVE TO DO DIAL UP AND AMBULANCE.
ARE YOU AVAILABLE? I WILL SHARE WITH YOU THAT THAT MORNING, WHICH WAS DURING THE MAJOR WINTER WEATHER THAT WE WERE HAVING, EVEN IF WE HAD REQUESTED MUTUAL AID.
WE PROBABLY WOULD NOT HAVE GOTTEN IT BECAUSE EVERYBODY WAS BUSY.
BUT OUR SYSTEM WAS ABLE TO SERVICE THAT CALL AT 35 AND RENFRO BECAUSE WE ALREADY HAD SURGE CAPACITY BUILT INTO THE SYSTEM, INCLUDING THE AMBUS AND THE CRITICAL CARE UNITS.
SO HOW MANY AMBULANCES WOULD YOU REDUCE IF YOU LOST US AS ONE OF YOUR CLIENTS? IT'S A REALLY GOOD QUESTION.
WE'VE DONE A LITTLE BIT OF THAT ANALYSIS, BUT WE'RE NOT REALLY PREPARED TO SAY YET BECAUSE WE HAVEN'T DONE THAT FULL ANALYSIS BECAUSE WE'RE HOPING HOPE IS NOT ALWAYS A GREAT STRATEGY.
PLUS, WE'VE GOT TWO YEARS BEFORE, EVEN IF YOU WERE TO DECIDE TODAY THAT YOU'RE GOING TO DO IT, IT'S GONNA BE A COUPLE OF YEARS FOR THE SYSTEM TO CHANGE.
AND BASED ON WHAT WE'VE SEEN IN THE FLUCTUATION AND THE CALL VOLUME FROM COMPLETELY DEPRESSED TO COMPLETELY OUT OF CONTROL, IT'S REALLY HARD TO TELL UNTIL WE GOT CLOSER.
NOW WE'RE GOING TO TALK MORE ABOUT THE REVENUE AND COST THING HERE IN JUST A MINUTE, THEN WE'RE GOING TO CLOSE SO THAT KT AND HIS TEAM CAN COME UP.
COST OF SERVICE DELIVERY, MEDSTAR IS THE MOST COST EFFECTIVE PUBLIC AMBULANCE PROVIDER IN THE STATE OF TEXAS, AS DETERMINED BY AN INDEPENDENT CONTRACTOR APPROVED BY THE STATE OF TEXAS FOR MEDICAID COST REPORTING.
THAT INDEPENDENT AGENCY JUST REPORTED MEDSTAR'S EXPENSE PER TRANSPORT AS THREE HUNDRED AND NINETY SIX DOLLARS, WHILE THE AVERAGE EXPENSE FOR A FIRE BASED AMBULANCE PROVIDER IS 26 HUNDRED DOLLARS.
IN BETWEEN 2008 AND THE CURRENT REPORTING PERIOD, MEDSTAR'S EXPENSE FOR TRANSPORT ACTUALLY WENT DOWN ONE POINT SIX PERCENT, BUT THE AVERAGE FIRE PROVIDER'S COSTS WENT UP TWENTY ONE PERCENT.
MEDSTAR'S A PUBLIC UTILITY MODEL SYSTEM AT THE TIME THAT BURLESON JOINED THE EMS AUTHORITY, THERE WERE EIGHT OTHER PUBLIC UTILITY MODEL SYSTEMS CREATED.
IN FACT, THE CONSULTANTS FROM FITCH WERE PART OF THAT OF ONE OF THESE SYSTEMS. THESE SYSTEMS ENJOY THE REPUTATION OF BEING THE HIGHEST PERFORMING, HIGHEST VALUE EMS SYSTEMS IN THE COUNTRY, AND ALL BUT TWO HAVE EXISTED FOR OVER 30 YEARS.
THE FIRE DEPARTMENT IS GOING TO SHOW YOU A LIST OF CITIES THAT HAVE FIRE BASED AMBULANCE SERVICE.
WE CAN TELL YOU THAT NONE OF THOSE SYSTEMS ARE GENERATING MORE REVENUE THAN IT IS COSTING THEM TO PROVIDE THOSE SERVICES.
THEY'RE ALL HEAVILY TAX SUBSIDIZED.
WE CAN ALSO TELL YOU THAT IN MOST CASES, THEY'VE ALWAYS HAD FIRE BASED AMBULANCE SERVICES.
SEVERAL OF THE CITIES ARE FEELING THE STRESSES OF TRYING TO HIRE AND RETAIN FIREFIGHTERS, AND SOME HAVE BEGUN LOOKING AT OTHER OPTIONS, INCLUDING USING OUTSIDE AGENCIES OR EXPLORING REGIONAL SERVICE DELIVERY MODELS TO RETAIN FIREFIGHTERS AND IMPROVE MORALE.
WE CAN TELL YOU THAT NONE OF THOSE CITIES EXITED A PUBLIC AUTHORITY TYPE EMS SYSTEM THAT WASN'T COSTING THEM ANYTHING TO START THEIR OWN FIRE BASED AMBULANCE SERVICE.
WE CAN SHOW YOU 15 CITIES IN THE METROPLEX THAT ARE RECEIVING STATE OF THE ART AMBULANCE SERVICE WITH EXPERT EXTERNAL MEDICAL OVERSIGHT BY A PROVIDER THAT HOLDS DUAL ACCREDITATION AND IS NOT USING ANY TAXPAYER FUNDS TO SUBSIDIZE THE SYSTEM.
THOSE CITIES ARE LISTED ON MEDSTAR'S OWNERSHIP STATEMENT AS OWNERS OF THE EMS AUTHORITY.
THERE ARE, HOWEVER, TWO HIGH PROFILE EXAMPLES WHERE A CITY CHOSE TO LEAVE AN EMS AUTHORITY AND GIVE AMBULANCE SERVICE TO THEIR FIRE DEPARTMENT.
KANSAS CITY, MISSOURI, ON THE PROMISE FROM THE FIRE CHIEF AND CITY MANAGER OF BETTER, FASTER, CHEAPER, THE FIRE DEPARTMENT TOOK OVER AMBULANCE SERVICES FROM THE AUTHORITY.
WITHIN TWO YEARS, THE SYSTEM WAS MILLIONS OF DOLLARS IN THE HOLE, AND RESPONSE TIMES WERE WORSE THAN WHEN THE EMS AUTHORITY WAS PROVIDING THE SERVICE.
ON THE PROMISE FROM THE FIRE CHIEF WITH BETTER, FASTER, CHEAPER, THE FIRE DEPARTMENT TOOK OVER AMBULANCE SERVICE FROM A LONG TERM PROVIDER CONTRACTED TO THE EMS AUTHORITY.
THE SYSTEM WAS FIVE HUNDRED THOUSAND IN THE HOLE.
RESPONSE TIMES WERE WORSE THAN UNDER THE AUTHORITY'S CONTRACTOR, AND THE CITY HAD
[01:15:04]
TO BRING IN A PRIVATE AMBULANCE PROVIDER FOR BACKUP SERVICE.THE LEADERS IN KANSAS CITY AND LINCOLN DID NOT SET OUT WITH A FINANCIAL LOSS AND RESPONSE TIME CHALLENGE IN MIND.
BUT IT DOES NOT TAKE MANY MISTAKES, NO MATTER HOW WELL-INTENTIONED, TO CREATE A SIGNIFICANT FINANCIAL AND SERVICE DELIVERY ISSUE.
EACH ADDITIONAL AMBULANCE COSTS AROUND A MILLION DOLLARS A YEAR TO OPERATE.
CHANGES IN PAYER MIX, MEDICARE PAYMENT CHANGES THAT ARE LOOMING EVEN AS WE SPEAK ARBITRARY CHANGES BY COMMERCIAL INSURERS CAN RESULT IN SIX FIGURE REVENUE FLUCTUATIONS.
SOME OF THE FINANCIAL PROJECTIONS IN THE BURLESON FIRE DEPARTMENT PROPOSAL HAVE CHANGED ALREADY SINCE THE NOVEMBER 8TH COUNCIL MEETING.
WE'LL CLOSE OUR TIME WITH THESE THOUGHTS AND QUESTIONS FOR THE COUNCIL TO CONSIDER.
ONCE AGAIN, WE WILL SUPPORT AND FACILITATE WHATEVER DECISION THE COUNCIL MAKES.
WE JUST WANT TO PROVIDE THE INFORMATION THAT WE FEEL THE COUNCIL NEEDS TO MAKE AN INFORMED DECISION.
TO BASE A DECISION LIKE THIS ON PANDEMIC DATA WHEN RESPONSE VOLUME WAS DEPRESSED AND WERE MUTUALLY AGREED UPON, CHANGES THAT WERE MADE AFFECT THE RESPONSE TIMES REALLY IS AN INJUSTICE TO THE PEOPLE WHO STAFFED THESE AMBULANCES DURING THE PANDEMIC, INCLUDING THE DOZENS WHO CALL BURLESON HOME.
THE AUTHORITIES TWO POINT FIVE MILLION DOLLAR ANNUAL INVESTMENT IN CLINICAL QUALITY, LED BY A MEDICAL DIRECTOR WITH DUAL BOARD CERTIFICATIONS IN EMERGENCY MEDICINE AND EMERGENCY MEDICAL SERVICES, IS EXTREMELY RARE IN EMS AND DEMONSTRATES MEDSTAR'S COMMITMENT TO CLINICAL EXCELLENCE.
OUR DUAL ACCREDITATION IN DISPATCH AND AMBULANCE OPERATIONS IS A TESTAMENT TO OUR COMMITMENT TO OPERATIONAL EXCELLENCE.
BEING THE LOWEST PUBLIC AMBULANCE PROVIDER IN THE STATE IS A TESTAMENT TO OUR FISCAL EFFICIENCY.
MEDSTAR WORKS EVERY DAY TO DIVERSIFY REVENUE STREAMS AND IMPLEMENT NEW SERVICES THAT CHANGE THE ECONOMIC MODEL TO HELP ASSURE SELF-SUFFICIENCY WITHOUT THE NEED FOR TAXPAYER SUBSIDY.
WE HAVE HEARD FROM ALL OF OUR MEMBER CITIES THAT THEY REALLY DON'T EVER WANT TO HAVE TO SUBSIDIZE US.
AS A REGIONAL PROVIDER, WE DO ONE HUNDRED AND SEVENTY THOUSAND RESPONSES ANNUALLY, AND WE'RE ABLE TO LEVERAGE THAT VOLUME WITH THE PAYERS TO NEGOTIATE MORE ADVANTAGEOUS REIMBURSEMENT FOR THE SERVICES WE PROVIDE.
RECENT EXAMPLES INCLUDE A NEW PAYMENT MODEL FOR BLUE CROSS BLUE SHIELD MEMBERS THAT PAID MEDSTAR A FLAT MONTHLY FEE FOR ALL EMS AND COMMUNITY HEALTH SERVICES, AND WE NO LONGER BILLED INDIVIDUAL PATIENTS FOR THE SERVICES.
A NEW PAYMENT MODEL WITH CIGNA THAT PAYS US FOR THE RESPONSE, NOT THE TRANSPORT PREVENTING PATIENTS FROM GETTING A BILL FOR A NON-COVERED SERVICE.
MEDSTAR IS ONE OF ONLY 30 AGENCIES IN THE COUNTRY TESTING A REVOLUTIONARY NEW MEDICARE PAYMENT MODEL FOR EMS DELIVERY.
MEDSTAR WAS INSTRUMENTAL IN THE DEVELOPMENT OF THAT MODEL.
CONSULTING WITH MEDICARE OFFICIALS AND MEDICARE OFFICIALS ACTUALLY CAME TO MEDSTAR TO SEE FIRSTHAND SOME OF THE INNOVATIVE THINGS THAT WE WERE DOING, AND WE HELPED THEM BUILD THIS MODEL.
BURLESON'S RESIDENTS HAVE BENEFITED FROM THIS NEGOTIATING STRENGTH BY HAVING MORE OF THEIR AMBULANCE FEES COVERED BY INSURANCE AND HAVING LESS OUT-OF-POCKET EXPENSE.
IF WE ONLY DID THREE OR FOUR THOUSAND RESPONSES, WE WOULDN'T HAVE THAT NEGOTIATING STRENGTH.
A MEDSTAR OFFICIAL HAS RECENTLY BEEN NOMINATED TO SERVE ON A BLUE RIBBON COMMITTEE ESTABLISHED BY CONGRESS TO MAKE RECOMMENDATIONS TO THE MEDICARE PAYMENT ADVISORY COMMISSION REGARDING AMBULANCE REIMBURSEMENT AND BALANCE BILLING.
THIS NOMINATION HAS BEEN ENDORSED BY THE NATIONAL ASSOCIATION OF EMERGENCY MEDICAL TECHNICIANS, THE AMERICAN AMBULANCE ASSOCIATION AND THE INTERNATIONAL ASSOCIATION OF FIRE CHIEFS.
WE'VE ACCOMPLISHED THESE HIGH VALUE SERVICES WITHOUT ANY FINANCIAL RISK TO THE CITIZENS OF BURLESON AND AT NO COST TO THE CITY.
TAKING ON AMBULANCE TRANSPORT IS COMPLICATED AND RISKY.
ANY SLIGHT DEVIATION IN COST AND REVENUE CAN HAVE A SIGNIFICANT IMPACT ON THE TAXPAYERS IN BURLESON A RISK THAT THEY DON'T BEAR TODAY.
IF THE SQUAD CONCEPT WAS VALUABLE ENOUGH FOR THE CITY TO INVEST MILLIONS OF DOLLARS IN A RESOURCE THAT IS ON A CALL SEVEN PERCENT OF THE TIME THAT THEY ARE ON DUTY, THREE AND A HALF PERCENT OF THE TIME, IF THERE ARE TWO OF THEM, WHY DO AWAY WITH IT? IF THE FIRE DEPARTMENT STAFF'S AMBULANCES, WILL THEY BACKFILL THE SQUADS? IF NOT, DOES THAT MEAN THE SQUADS WERE UNNECESSARY? WHAT IMPACT WOULD AMBULANCE DUTIES HAVE ON ONE OF THE MAIN REASONS THE SQUAD WERE IMPLEMENTED THE ASSEMBLY OF PERSONNEL FOR A FIRE CALL.
IF BURLESON FIRE PLANS ON USING AMBULANCE PERSONNEL FOR MEETING THE ASSEMBLY STAFFING GOAL FOR A FIRE WHO WILL BE PROVIDING AMBULANCE SERVICE DURING THAT TIME?
[01:20:03]
IF THE AMBULANCE PERSONNEL ARE COMMITTED ON AN AMBULANCE CALL, WHICH IS FOUR TIMES LONGER THAN THE SQUAD TIMES, THAT THEY'RE DOING NOW, HOW WILL THEY ASSEMBLE FOR A FIRE CALL? YOU'RE GOING TO HEAR THAT BURLESON FIRE AMBULANCES WILL BE ABLE TO SERVE MULTIPLE ROLES.FIRE SCENE, RAPID INTERVENTION TEAM, FIREFIGHTER REHAB, OTHER RELATED DUTIES WHEN BURLESON AMBULANCES ARE ON A FIRE CALL DOING ALL THOSE THINGS, WHO'S RESPONDING TO THE AMBULANCE CALLS IN BURLESON? IT SEEMS THAT PROVIDING AMBULANCE SERVICE WOULD REALLY BE AN ADDITIONAL ROLE FOR THE FIRE AMBULANCES, BUT FOR US IT'S OUR ONLY ROLE.
IF THE SQUADS ARE REASSIGNED FOR AMBULANCE SERVICE, DOES THAT ALSO MEAN THAT THE ENGINES GO BACK TO DOING MEDICAL FIRST RESPONSE LIKE THEY DID FOR 30 YEARS BEFORE THE SQUAD CONCEPT WAS INITIATED? IF THE ENGINES GO BACK TO DOING MEDICAL FIRST RESPONSE AND THE FIRE DEPARTMENT RUNS THREE AMBULANCES IN THE CITY IN ESSENCE, YOU HAVE THE EXACT SAME SYSTEM THAT YOU HAD PRIOR TO 2016 THAT DIDN'T COST THE CITY ANYTHING.
BUT NOW YOU'D BE USING A TAXPAYER SUBSIDY TO FUND A $1.2 MILLION DOLLAR ECONOMIC LOSS TO THE FIRE DEPARTMENT BASED AMBULANCE SYSTEM.
THAT IS, BY THE WAY, STAFFING FEWER AMBULANCES THAN YOU HAVE AVAILABLE WITH THE CURRENT SYSTEM.
WHAT'S BROKEN WITH THE CURRENT SYSTEM? AS WE SAID, THERE ARE VIRTUALLY NO COMPLAINTS AT ALL AND WHAT OTHER SERVICE OPTIONS SERVICE ENHANCEMENT OPTIONS HAVE BEEN CONSIDERED.
AND FINALLY, AS WE CLOSE, WHAT IS THE WHY FOR THE PROPOSAL BY THE FIRE DEPARTMENT? IS IT BECAUSE OF CONCERNS ABOUT CLINICAL CARE? YOU'VE HEARD FROM DR. VITHALANI THAT THE CARE DELIVERED IN THIS SYSTEM IS EXCEPTIONAL AND LIKELY AMONG THE BEST IN THE COUNTRY.
IS IT BECAUSE OF RESPONSE TIMES? THE CURRENT SYSTEM IS MEETING THE NATIONAL STANDARD FOR AMBULANCE ARRIVAL AFTER FIRST RESPONSE ARRIVAL, THE RESPONSE TIMES BEING SHOWN ARE LONGER FOR THE REASONS THAT WE'VE ALREADY TALKED ABOUT.
IS IT BECAUSE MEDSTAR HAS A HIGH TURNOVER RATE? OUR FOLKS DO A LOT OF CALLS.
SIX TO SEVEN CALLS PER 12 HOUR SHIFT, THEY GO ON TO OTHER CAREERS TO GO TO FIRE DEPARTMENTS.
IS IT TO MAKE MONEY? THE FIRE DEPARTMENT'S OWN FINANCIALS SHOW THEIR SYSTEM WILL COST THE TAXPAYERS $1.2 MILLION ANNUALLY FOR FEWER AMBULANCES THAN WE THINK THAT THEY NEED.
SOME OF YOU MAY HAVE BEEN TOLD THAT THE ONLY REASON WE WANT TO KEEP BURLESON IN THE EMS AUTHORITY IS BECAUSE OF THE REVENUE.
NOTHING COULD BE FURTHER FROM THE TRUTH.
BECAUSE OF HOW THE SYSTEM IS STRUCTURED, WE SIMPLY REDUCE THE STAFFED AMBULANCE UNIT HOURS TO MATCH THE CURRENT CALL VOLUME AND BALANCE THE FINANCIALS, WE'D BE FINE.
THE REASON WE'RE HERE IS BECAUSE WE WANT THE BEST SYSTEM DELIVERING THE BEST CARE FOR BURLESON'S RESIDENTS.
WE KNOW THE QUALITY OF CARE BEING GIVEN BY THE CURRENT AWARD WINNING, NATIONALLY ACCLAIMED EMS SYSTEM, SUPERVISED BY 14 FULL TIME TRAINING AND QUALITY ASSURANCE EXPERTS.
SUPERVISED BY A PHYSICIAN MEDICAL DIRECTOR WHOSE EXPERIENCE IS AMONG THE BEST IN THE NATION.
THAT'S WHAT WE WANT TO SEE CONTINUE TO BE AVAILABLE TO THE RESIDENTS OF BURLESON, AND WE'RE NOT SEEING THOSE THINGS IN THE OTHER OPTIONS BEING PROPOSED.
CONVERSELY, WE'VE HEARD A WHOLE LOT ABOUT THE FINANCIAL REASONS FOR BURLESON FIRE TO START AN AMBULANCE SYSTEM IS IT TO PROVIDE A MORE SEAMLESS TRANSITION OF CARE FROM FIRST RESPONDERS TO THE AMBULANCE PERSONNEL.
HAS THIS BEEN A PROBLEM IN THE PAST, AS YOU HEARD, DR.
VITHALANI EXPLAIN, THE ENTIRE SYSTEM OPERATES ON THE SAME PROTOCOL, SAME OVERSIGHT, SAME MEDICAL DIRECTION, SAME EQUIPMENT AND EVEN [INAUDIBLE] DOCUMENTS ON THE SAME PATIENT CARE REPORTING SYSTEM.
SOME WOULD SAY THAT HAVING TWO DIFFERENT PROVIDERS FROM DIFFERENT AGENCIES PROVIDING CARE TO THE PATIENT PROVIDES BETTER CARE WITH A FRESH PERSPECTIVE ON CLINICAL NEEDS OF THE PATIENT.
AGAIN, VIRTUALLY NO COMPLAINTS.
IS THE PROPOSAL BY THE FIRE DEPARTMENT TO REPLACE MEDSTAR WITH A FIRE BASED AMBULANCE SYSTEM A SOLUTION TO A PROBLEM OR IS IT A PROBLEM IN SEARCH OF A SOLUTION? BASED ON THE CONSULTANT'S FINDINGS THAT THE CURRENT SQUAD PROGRAM COULD BE REASSIGNED FOR OTHER THINGS.
WHAT'S THE PUSH TO RUSH THE COUNCIL TO MAKE A DECISION? THIS IS A DECISION YOU ALL HAVE TO MAKE A DECISION WITH LIFE OR DEATH IMPLICATIONS AND SIGNIFICANT FINANCIAL RISK TO THE RESIDENTS AND VISITORS OF BURLESON.
IT'S A DECISION THAT SHOULD BE RESEARCHED MORE DEEPLY, WITH OTHER OPTIONS BEING CONSIDERED.
WE'VE MET WITH ALMOST ALL OF YOU AND THOSE WE'VE MET WITH SAID THAT THIS IS A VERY COMPLICATED DECISION.
WE RECOMMEND THE COUNCIL MEMBERS TAKE THE TIME THAT YOU FEEL NECESSARY TO FULLY VET THE INFORMATION YOU'RE BEING PROVIDED AND PERHAPS CONSIDER OTHER POTENTIAL OPTIONS SO THAT YOU ARE VERY COMFORTABLE WITH THE DECISION THAT YOU WILL BE MAKING ON BEHALF OF YOUR CONSTITUENTS.
THANK YOU AGAIN FOR YOUR TIME THIS MORNING, DR.
[01:25:02]
VITHALANI, KEN AND I ARE AVAILABLE ANY TIME TODAY, TOMORROW, LATER TODAY TO ANSWER ANY QUESTIONS THAT YOU FOLKS MAY HAVE.I DID HAVE A COUPLE OF QUICK QUESTIONS, IF YOU DON'T MIND.
SO YOU MENTIONED FINANCES AND EVERYTHING.
SO WHAT IS THE PERCENTAGE OF PAY? I DON'T KNOW THE EXACT TERMINOLOGY, SO EXCUSE ME ON THAT, BUT THE AMOUNT OF PATIENTS THAT ARE PAYING THEIR BILLS FROM BURLESON VERSUS OUTSIDE THE SYSTEM.
IT'S A LITTLE BIT HIGHER IN BURLESON.
BUT THE RATES THAT ARE REIMBURSED ARE LOWER IN BURLESON BECAUSE THE MEDICARE ALLOWABLE RATE, WHICH MANY OF THE PAYERS FOLLOW, IS ACTUALLY LOWER IN BURLESON THAN IT IS THE REST OF THE CITY, REST OF THE SYSTEM.
AND DO YOU ASSIGN FOUR AMBULANCES TO BURLESON ON FRIDAY? BECAUSE THAT WAS WHAT YOUR CHART SHOWED? WELL, WE WILL.
I'M SORRY THAT'S A I MEAN, IN THE PAST HAVE YOU? AS AMBULANCES ARE DISPATCHED TO CALLS.
I'M ASKING THOUGH, ARE THEY STATIONED HERE ALREADY? BECAUSE THAT WAS TALKED ABOUT WHAT YOU SAID OF THE IMPORTANCE OF HAVING AMBULANCES HERE.
SO DO WE ALREADY HAVE THE FOUR ON FRIDAYS? I'M SORRY IF YOU MISUNDERSTOOD WHAT I SAID, SIR.
THE SYSTEM WOULD NEED FOUR AMBULANCES AT LEAST WE DEPLOY AMBULANCES INTO BURLESON EVERY TIME ONE IS SENT ON A CALL BY SYSTEM DESIGN.
SO WE COULD ON THOSE SIX CALLS HAVE SIX AMBULANCES IN BURLESON, BUT NOT SIX HANGING AROUND CONSUMING ECONOMIC RESOURCES WHEN THEY'RE NOT NEEDED.
SO THEY'RE COMING FROM OUTSIDE.
THEY'RE BEING POSITIONED IN BURLESON WAITING FOR ANOTHER CALL IN BURLESON BECAUSE THE OTHER AMBULANCE THAT WAS IN BURLESON IS NOW ON A CALL IN BURLESON AND WE JUST, IT'S LIKE A STRING.
SO AS YOU PULL THE STRING MORE RESOURCES ARE COMING DOWN.
I UNDERSTAND THAT I WAS JUST YOU HAD MENTIONED THAT WE HAD TO HAVE FOUR IN BURLESON NEEDED.
SO THAT'S THE REASON I WAS ASKING THAT QUESTION.
IT TAKES AT LEAST FOUR AMBULANCES TO COVER THE CALL DEMAND IN BURLESON.
ONLY ON CERTAIN DAYS, THOUGH NOT EVERY DAY.
MOST WEEKDAYS BETWEEN NINE AND FIVE.
SO I WAS READING AN ARTICLE ON EMS WORLD ONLINE THAT TALKED ABOUT THE PUBLIC UTILITY MODEL, AND IT SPECIFICALLY STATED THAT IT'S THE PAYER RATES ARE LOWER, THE LARGER THE CITY.
SO THERE'S NO DOUBT THAT AS WE ARE A SMALLER CITY, YOU HAVE A HIGHER PAYER RATE FROM US THAN YOU WOULD FROM FORT WORTH.
WHEN YOU SAY PAYER RATE WELL, THE AMOUNT OF PEOPLE ACTUALLY PAYING THEIR BILLS OUTSIDE OF THE MEDICARE, MEDICAID AND THEIR INSURANCE PAYING CASH.
SO THE PERCENTAGE OF PEOPLE WHO PAY THE BILL IS DEPENDENT ON WHO THEIR INSURER IS, WHAT THEIR INSURER DETERMINED TO BE MEDICALLY NECESSARY.
COMMERCIAL INSURANCE VERSUS WHATEVER.
IN LARGER CITIES OFTEN YOU HAVE PATIENTS WHO CALL 911 WITH A LOWER ACUITY RATE, AND SOMETIMES THE INSURERS WILL DENY THAT FOR LACK OF MEDICAL NECESSITY.
BUT IT HAPPENS IN BURLESON AS WELL.
SO WHEN WE LOOK AT THE OVERALL COLLECTION RATE AS A BUNDLE, BURLESON HAS A SLIGHTLY HIGHER COLLECTION PERCENTAGE.
BUT THE DOLLARS COLLECTED PER SERVICE TEND TO BE LOWER BECAUSE BURLESON HAS A LOWER MEDICARE ALLOWABLE RATE THAN THE REST OF THE SYSTEM.
WHAT IS THE REASONING FOR THAT.
I CAN SEE IT BECAUSE OF FORT WORTH, BUT YOU KNOW, LAKE WORTH, WHAT ELSE IS UP THERE NORTH THAT YOU GUYS? HASLET.
YEAH, WHY? WHAT'S THE REASONING FOR THAT? WE'VE ASKED MEDICARE THAT QUESTION, AND THEY SAY IT HAS TO DO WITH A RURAL OR DIFFERENT TYPE OF DESIGNATION.
AND WE SAID, WELL, RURAL DESIGNATIONS TEND TO GET A HIGHER REIMBURSEMENT RATE, NOT A LOWER REIMBURSEMENT RATE, AND THEY'VE NEVER GIVEN US A GOOD ANSWER.
BUT WHEN WE LOOK AT OUR FEE SCHEDULE FROM MEDICARE AND EVEN FROM MEDICAID, IT SHOWS EVERYWHERE ELSE AND BURLESON.
REIMBURSEMENT RATES ARE LOWER FROM THOSE PAYERS THAN THE REST OF THE SYSTEM.
WE CAN PROVIDE YOU THAT DATA IF YOU LIKE.
AND THAT'S MEDICARE, RIGHT? THAT'S NOT ALL INSURED.
IT'S NOT ALL INSURERS, BUT IT'S THE LARGEST PAYER.
AT THIS TIME, I HAVE NO SPEAKERS FOR ITEM 2A, IS THERE ANYBODY IN THE AUDIENCE THAT WOULD LIKE TO SPEAK ON ITEM 2A? OK, SEEING, NONE, WE'LL MOVE ON TO ITEM 2B, RECEIVE A REPORT, HOLD A DISCUSSION
[B. Receive a report, hold a discussion, and provide staff direction regarding emergency medical service options within the City of Burleson. (Staff Presenter: K.T. Freeman, Fire Chief)]
AND PROVIDE STAFF DIRECTION REGARDING SERVICE OPTIONS WITHIN THE CITY OF BURLESON.THE STAFF PRESENTER THIS MORNING IS KT FREEMAN, FIRE CHIEF.
DOES ANYBODY NEED A BREAK? EVERYBODY GOOD.
LET'S TAKE A BREAK FOR ABOUT FIVE MINUTES, IF YOU DON'T MIND.
WE'LL TAKE A FIVE MINUTE BREAK.
[01:30:04]
MAYOR, IF YOU WOULD CALL US BACK INTO SESSION, WE WILL CONTINUE WITH ITEM 2B AS IN ITEM 2A.ALL SPEAKER CARDS THAT I'VE BEEN HANDED WILL BE ANNOUNCED AFTER STAFF PRESENTATION.
WE'RE BACK IN SESSION AT 10:38.
GOOD MORNING, MAYOR AND COUNCIL KT FREEMAN, FIRE CHIEF AND MATT, THANK YOU FOR YOUR PRESENTATION AND WE CERTAINLY AGREE THAT WE ARE HERE TO HAVE A THOROUGH PUBLIC POLICY DEBATE DISCUSSION.
BECAUSE IT IS IMPORTANT NO ONE UNDERSTANDS THAT MORE THAN US THAT ARE IN THIS BUSINESS AND IT'S OUR JOB TO GIVE YOU, AS I'VE SAID MANY, MANY TIMES BEFORE YOU, AS BEST AS I POSSIBLY CAN THE FACTS, JUST THE FACTS AND THEN THE IMPACTS THAT THESE THINGS CAN HAVE ON OUR PUBLIC.
SO I WANT TO MAKE JUST A COUPLE OF OBSERVATIONS, MAKE A FEW COMMENTS THAT I FEEL THAT'S OUTSIDE OF MY PRESENTATION.
AND MATT, I DON'T KNOW HOW SOME OF OUR COLLEAGUES ARE GOING TO BE WHEN YOU CALL IT DIAL UP MUTUAL AID.
BUT AND PART OF THE PLAN WOULD BE IF THE COUNCIL ULTIMATELY DECIDES TO GIVE US THE GREEN LIGHT TO TRANSITION MEDSTAR IN OUR PLAN AND OUR PLAN WOULD INCLUDE MEDSTAR TO BE ONE OF OUR MUTUAL AID PARTNERS.
AND SO I WANT TO MAKE THAT VERY, VERY CLEAR AND I'M NOT GOING TO WE'RE NOT HERE TO GET IN A TIT FOR TAT WHATSOEVER.
THERE'S BEEN MADE, THERE'S BEEN SOME COMMENTS MADE THAT QUESTION FITCH'S ANALYTICS OR FITCH'S DATA.
I'M NOT GOING TO SPEAK TO THAT.
IF THE COUNCIL SO DESIRES, THAT'S GOING TO BE YOUR PURVIEW.
AND WE STAND BEHIND FITCH'S DATA AND WE STAND BEHIND.
IT'S NOT FITCH'S DATA, AND I'LL GET INTO A LITTLE BIT MORE OF THAT IN JUST A LITTLE BIT.
BUT WE STAND BEHIND THEIR ANALYTICS AND AGAIN, WE'RE NOT GOING TO GO BACK AND FORTH.
ONE OF THE OBSERVATIONS THAT MATT SPOKE ABOUT BROUGHT TO YOUR ATTENTION IS PROTOCOL THIRTY SIX.
I THINK IT'S VERY, VERY IMPORTANT FOR THIS COUNCIL AN THIS COMMUNITY TO UNDERSTAND.
AND MATT, I'M GOING TO GIVE YOU A GREAT DIFFERENCE.
EITHER YOU MISSPOKE OR YOU MISUNDERSTOOD.
YOU SPECIFICALLY SPOKE TO CASEY OR ABOUT CASEY, ABOUT BEING THE CHAIR OF THE [INAUDIBLE].
BUT WHEN THIS CONVERSATION CAME UP, CASEY MADE IT CLEAR AND IT WASN'T A VOTE, ACCORDING TO OUR RECOLLECTION, WAS NOT A VOTE.
IT WAS A DISCUSSION ABOUT WHETHER TO ALLOW SOME ADDITIONAL TIME TO THE INTENTION WAS CORRECT TO GIVE PEOPLE TIME IT WAS A NEW DISEASE AND TO GIVE MORE TIME FOR FIRST RESPONDERS TO BE PREPARED AND VETTED.
BUT BURLESON DID NOT AGREE WITH THAT.
BURLESON SAID WE'RE NOT GOING TO SLOW DOWN OUR DISPATCH TIMES.
WE'RE NOT GOING TO SLOW DOWN OUR CURRENT PROCESSES.
WE DID WHAT WE CALLED A PRE ALERT AND WE WENT.
AND SO I THINK IT'S FAIR TO HAVE THAT CONTEXT THAT, AS MATT SAID, HE SPECIFICALLY MENTIONED BURLESON AGREED.
BURLESON DID NOT AGREE TO THIS.
AND NOT ONLY DID WE NOT AGREE TO IT.
WE WERE DISPATCHED IMMEDIATELY.
AND I THINK THIS IS ANOTHER EXAMPLE ABOUT BURLESON CENTRIC THAT I'M GOING TO REALLY BE SPEAKING ON IN DETAIL LOCAL CONTROL VERSUS DOES A SYSTEM CONTROL YOU? BUT WE DID TAKE ISSUE WITH THAT, AND I CAN TELL YOU THIS THAT OUR LEVEL OF SERVICE DURING THE PANDEMIC, IT NEVER DECLINED TO OUR CITIZENS.
OUR RESPONSE TIMES DIDN'T DECLINE.
WE GOT ON THE SCENE JUST AS FAST AS WE ALWAYS HAVE.
WE BUILT OUR OWN SYSTEM, SO TO SPEAK, OUR OWN WORK AROUND ABOUT A SYSTEM THAT WAS, IN MY OPINION, KIND OF DRAGGING DOWN THE RESPONSES.
WE HAVE ALWAYS BEEN NIMBLE AND WILLING AND ABLE TO CREATE A RESPONSIVE SYSTEM THAT'S RIGHT FOR BURLESON, AND I'M GOING TO TALK MORE ABOUT THAT IN MY PRESENTATION.
BOTTOM LINE IS WE MANAGED OUR INCREASE IN CPR, AT THAT TIME WE HAD ABOUT A 40 PERCENT INCREASE IN CPR.
UNFORTUNATELY, ONE OF THE MOST LIFE THREATENING EVENTS YOU CAN HAVE WHERE TIME MATTERS.
WE DID NOT HAVE THE 90 SECOND DELAY.
WE WENT AND RESPONDED IMMEDIATELY TOOK THE PROPER PPE.
MATT HAD MENTIONED THAT THERE WAS SOME DELAYS THAT CAUGHT THAT WASN'T HIS WORDS, BUT HIS WORDS WERE DELAYS IN PPE.
WE DIDN'T GET CAUGHT BEHIND THE EIGHT BALL FOR COVID 19.
WHEN COVID STARTED FIRST HITTING BACK IN LATE DECEMBER CASEY AND I AGAIN IMMEDIATELY TOOK VERY AGGRESSIVE AND PROACTIVE ACTIONS, AND THE COUNCIL HAS HEARD THIS BEFORE AND IT WAS A DIFFERENT COUNCIL.
BUT WE IMMEDIATELY TOOK PROACTIVE ACTIONS TO ORDER AS MUCH PPE AS WE COULD RESPIRATORS.
AGAIN, THAT'S AN ADVANTAGE OF YOUR BURLESON TEAM FORECASTING AND PREDICTING.
WE DID NOT GET CAUGHT WITH NOT HAVING THE PROPER PPE OR THE AMOUNTS OF IT.
FROM DAY ONE, WE WERE ABLE TO EQUIP OUR FIREFIGHTERS WITH PROPER PPE.
[01:35:03]
GO INTO A VERY DANGEROUS ENVIRONMENT, PROVIDE VERY QUICK CARE, AND WE'RE ABLE TO TRANSPORT BECAUSE WE HAD WHEN NECESSARY.BUT THE BOTTOM LINE IS THE PANDEMIC DID NOT IMPACT THE QUALITY OF THE LEVEL OF CARE THAT WE WERE ABLE TO PROVIDE TO OUR CITIZENS.
AND I THINK THAT'S A VERY IMPORTANT DISTINGUISH AS WE LOOK FORWARD ABOUT WHAT SYSTEM IS GOING TO BE BEST TO SERVE THIS COMMUNITY.
AND I WANT TO SAY THIS PUBLICLY TO OUR FRIENDS.
I HAVE RESPECT, LIKE I SAID BEFORE, FOR MATT KEN SIMPSON, THE MEDSTAR TEAM.
THIS IS NOT A DEBATE ABOUT PEOPLE.
THIS IS NOT A DEBATE ABOUT THEIR THEIR CREWS.
AND I WANT TO MAKE THAT VERY CLEAR.
THIS IS A POLICY DEBATE THAT IS IN A PUBLIC FORUM THAT IS NOT A FUN ONE OR AN EASY ONE TO HAVE, BUT I THINK IT'S ABSOLUTELY ONE OF THE MOST CRITICAL DEBATES DISCOURSES WE WILL HAVE, PERHAPS IN THIS CITY'S HISTORY.
I ALSO WANT TO SLIGHTLY TOUCH ON THE SUBSIDIZING.
I HAVE HEARD THERE IS NO PLAN RIGHT NOW, BUT I WANT FOR FULL DISCLOSURE TO THIS COUNCIL.
I HAVE HEARD FROM FORMER CEO AND THIS CURRENT MANAGEMENT TEAM THAT AT SOME POINT SUBSIDIES, IF THINGS DON'T CHANGE, SUBSIDIES WILL HAVE TO BE CONSIDERED BY CITY.
SO AGAIN, I'M NOT IMPUGNING I'M NOT SAYING IT'S COMING, BUT THAT CONVERSATION HAS BEEN HAD, AND I THINK IT'S IMPORTANT JUST FROM A PERSPECTIVE THAT WE GET EVERYTHING ON THE TABLE IN A TRANSPARENT MANNER.
I ALSO WANT TO FIND OUT A LITTLE BIT MORE ABOUT SINCE I WAS NAMED SPECIFICALLY VIRTUALLY NO COMPLAINT.
MATT, BEFORE I GIVE MY RESPONSE TO THAT, I WOULD REALLY LIKE TO KNOW THE SOURCE OF THAT.
DID THAT COME FROM THE BOARD WHO DID THIS COME FROM? ABOUT VIRTUALLY BURLESON HAS NOT COMPLAINED ABOUT ANYTHING.
IT CAME FROM OUR RECORDS OF RECEIVING COMPLAINTS OK.
SO IT'S JUST TO MAKE CLEAR FOR THE PUBLIC DISCUSSION IT WAS, YOU'RE BASING THAT BASED ON I DID NOT SEND WHATEVER SYSTEM YOU'VE GOT FOR A COMPLAINT.
IS THAT CORRECT? OR LET US KNOW ABOUT A COMPLAINT.
WELL, LET ME GIVE YOU SOME ACTIONS THAT I THINK IN MY MIND IT CLARIFIES WHATEVER VIRTUALLY NO COMPLAINT MEANS.
I SPOKE WITH THE FORMER CEO, CASEY AND MYSELF DID ABOUT A YEAR AND A HALF COULD BE TWO YEARS AGO.
BUT SOMETIME AGO, CERTAINLY WITHIN THE TIMESPAN THAT WAS ALLUDED TO THAT MEDSTAR HAD VIRTUALLY HAD RECEIVED NO COMPLAINT.
SOME TIME AGO CASEY AND MYSELF WENT TO MEDSTAR BECAUSE THE SQUAD WAS IN PLACE, BUT WE WERE STILL HAVING PROLONGED RESPONSE TIMES.
WE WERE STILL HAVING ONE AMBULANCE, AND I'M GOING TO MAKE A CLEAR DISTINCTION ONCE I GET INTO MY PRESENTATION BECAUSE I THINK IT'S AN IMPORTANT DISTINCTION ABOUT, AGAIN, THE SYSTEM AND THEN ABOUT THE SYSTEM THAT WE'RE DESIGNING AND THAT WE CAN PROVIDE.
I WENT TO THE FORMER CEO AND WE HAD A CONVERSATION ABOUT SOME OF THE NEEDS DOWN HERE THAT WE FELT WAS NOT ADEQUATE AND WAS NOT SERVING THE BEST INTEREST OF OUR COMMUNITY.
AND WE ASK ABOUT USING THE SQUAD TO FLIP IT OVER AND TURN INTO AN AMBULANCE TO GET RID OF THE SQUAD CONCEPT AND TURN IT OVER TO AN AMBULANCE.
BECAUSE WE WERE HAVING DELAY SOME THINGS WE'RE TALKING ABOUT, WE'RE GOING TO GO INTO DETAIL HERE.
AND THAT DISCUSSION LASTED ABOUT FIVE SECONDS.
AND VERY SHORT CONVERSATION AND WE'VE GOT A RESOUNDING NO.
AND MATT, YOU WERE IN THAT CONVERSATION, AT LEAST PART OF IT FROM FORMER CEO.
AND SO I WANT TO BE CLEAR, THIS DID NOT COME FROM MATT ZAVADSKY.
ACTUALLY, THIS CAME FROM THE HIGHEST LEVEL OF MEDSTAR.
AND WE'VE GOT A RESOUNDING NO THAT THAT WOULD NOT BE POSSIBLE.
WHY WOULD YOU? WE KIND OF GOT A DOWN TALK.
WHY WOULD YOU EVEN CONSIDER THAT YOU CAN'T DO THAT? WE'RE THE ONLY WE'RE THE SOLE PROVIDER INTER-LOCAL.
SO I WANT TO MAKE IT CLEAR TO THIS COMMUNITY AND THIS COUNCIL GOING BACK SOME TIME.
WE HAVE ALWAYS BEEN COMMITTED WHEN WE SEE AN ISSUE OR A GAP IN THIS SYSTEM TO TRY TO BE EXTREMELY CREATIVE AND RESOURCEFUL AND ENGAGED, WE ARE AND WE HAVE BEEN AND OUR INTENTIONS IS OR ARE TO CONTINUE TO BE A WILLING AND COOPERATIVE PARTNER WITH MEDSTAR.
AND WE HAVE DEMONSTRATED THIS SOME MORE EXAMPLES THAT I'M ABOUT TO GIVE TO YOU.
THAT CLEARLY, IN MY MIND, IS A CLEAR EXAMPLE THAT WE HAVE NOT BEEN SILENT.
WE ALSO HAVE BEEN VERY TRANSPARENT WITH KEN.
AGAIN, I HAVE THE UTMOST RESPECT FOR HIM AND MEDSTAR, AND WE WORK AND WE LIVE IN A TRANSPARENT ENVIRONMENT.
WE OWE THAT TO OURSELVES AND IT'S OUR DUTY TO THIS COMMUNITY.
[01:40:01]
WE MET WITH MEDSTAR ABOUT TRANSFERRING CALLS THE INTER-LOCAL AND PAUL BRADLEY IS GOING TO TALK TO YOU MORE ABOUT THIS.BUT TRANSFERRING CALLS HAS ALWAYS BEEN A PROBLEM IN THIS SYSTEM, AND WE'VE ONLY BEEN ABLE TO TRY TO WORK AROUND IT.
WE STILL CAN'T RESOLVE IT BECAUSE WE'RE MANDATED BY THE INTER-LOCAL THAT WE HAVE TO TRANSFER CALLS AND THE CAD2CAD.
WE INITIATED THAT BECAUSE THERE WAS SUCH A LONG GAP IN OUR CALL PROCESSING TO GET THE INFORMATION BACK TO GET US DISPATCHED.
AND WE WENT TO MEDSTAR AND WE DID ASK THEM AT ONE POINT THAT COULD WE CEASE TO TRANSFER CALLS? WE'VE GOT A RESOUNDING NO, NO, YOU CAN'T WE WON'T SUPPORT IT AGAIN, WE'LL SUPPORT A WORKAROUND AND THEY DID PAY 50,000.
I THINK WE PAID 20 OR 30, SO IT WASN'T IN MY RECOLLECTION IF I MISSPOKE [INAUDIBLE].
BUT WE HAD SOME SKIN IN THE GAME.
MEDSTAR CARRIED THE LOAD ON THAT.
IT WAS A WORKAROUND BECAUSE CALL PROCESSING AS PAUL WILL SAY IT IS NOT A BEST PRACTICE.
IT'S RIDDLED WITH ALL KINDS OF PROBLEMS. MOST IMPORTANTLY, IT DELAYS RESPONSE, AND IT DOES NOT, IN MY OPINION, PROVIDE THE MOST EFFECTIVE AND EFFICIENT PATIENT CARE SERVICE TO OUR CITIZENS.
SO ANOTHER REASON WE WERE TOLD NO ON THE WHEN WE TRIED TO MITIGATE THE THE MANDATE TO CALL PROCESS, WE WERE TOLD IT WOULD AFFECT THEIR ACCREDITATION.
MATT, I AM PROUD OF Y'ALL'S ACCREDITATION, BUT WHEN IT COMES TO COMPROMISING AND DELAYING RESPONSE CALLS TO OUR CITIZENS, THAT ACCREDITATION DOESN'T MEAN MUCH TO ME.
WHAT MEANS MOST TO ME IS THAT OUR CITIZENS ARE ABLE TO GET THE CARE THAT THEY NEED AS FAST AS POSSIBLE.
SO IT WAS MORE ABOUT LOSING THEIR ACCREDITATION OR BEING POTENTIALLY COMPROMISED VERSUS TO WHAT WE WERE SHARING THEM AND WHAT OUR NEEDS WERE AND WHAT THE PROBLEMS WERE.
AND HOW IT WAS IMPACTING OUR CITIZENS AND OUR CUSTOMER EXPERIENCE.
I MET WITH KEN AGAIN, VERY TRANSPARENT WHEN COUNCIL AND AGAIN, I'M GOING TO ADDRESS THIS LATER WHEN COUNCIL APPROVED FOR US TO HAVE A MASTER PLAN STUDY BACK IN NOVEMBER OF 2020.
WE LAID IT OUT ON THE TABLE AND WE SAID, WE DON'T KNOW WHERE THIS IS GOING, BUT KEN WE CONTINUE TO HAVE PROBLEMS? WE GOT TO KNOW WHAT'S, YOU KNOW, WE'VE GOT TO KNOW WHAT'S BEST FOR OUR COMMUNITY.
THIS HAS NOT BEEN THIS HAS BEEN AT THE HIGHEST LEVEL OF OUR CONCERNS, CREW CONTINUITY, SCENE CONFLICTS THAT I'LL BE TALKING MORE ABOUT IN A LITTLE BIT.
BUT WE HAVE BEEN TRANSPARENT WITH MEDSTAR'S LEADERSHIP ABOUT THAT.
CHIEF, IF I MIGHT JUST I WANT TO ADD ON WHAT YOU'RE STATING HERE WITH THE TIME FRAME, BECAUSE I'VE HEARD FROM SEVERAL CITIZENS REGARDING THE EXPEDITING THIS WHOLE THING.
AND WHEN I WAS RUNNING, I WAS NOTIFIED THE SUMMER OF 2020 THAT THIS WAS SOMETHING THAT WAS POTENTIALLY COMING UP AND THAT WAS BEFORE I WAS EVER ELECTED.
AND THEN IN OCTOBER OF 2020 IS WHEN IT WAS APPROVED TO GO AHEAD AND DO THE FITCH STUDY OR DO THE STUDY.
THEN AFTER I WAS ELECTED IN NOVEMBER, WAS WHEN FITCH WAS ACTUALLY CHOSEN FROM THE.
SO THIS HAS BEEN AROUND FOR WELL OVER A YEAR, MAYBE A YEAR AND A HALF, A DISCUSSION AMONGST THE CITY STAFF AND THE FIRE DEPARTMENT.
AND COUNCIL AND I'M GOING TO ADDRESS THAT HERE IN JUST A LITTLE BIT WHEN I GET TO MY OPENING COMMENTS.
BUT YES, COUNCIL MEMBER PAYNE.
BUT WHEN WE MET WITH KEN IN FULL TRANSPARENCY ABOUT WHY WE WERE GOING FOR THE STUDY, PART OF THE THINGS WE TALKED ABOUT WAS NO DEDICATED UNIT AND I'M GOING TO WHEN I GET INTO MY PRESENTATION, I'M GOING TO DRAW A CLEAR DISTINCTION ABOUT FROM MY PERSPECTIVE AND I THINK, A CUSTOMER SERVICE PERSPECTIVE WHAT POSTING MEANS VERSUS DEDICATED VERSUS ASSIGNED.
I THINK THAT IS A CLEAR DISTINCTION FOR OUR COUNCIL MEMBERS AND OUR PUBLIC TO UNDERSTAND.
AND THEY ARE APPLES TO ORANGES.
REGARDING STATION 16, MATT, YOU'RE ABSOLUTELY CORRECT ON THAT.
I MET WITH KEN PRIOR TO STATION 16 OPENING AND AGAIN IN AN EFFORT TO ADDRESS THE PROBLEMS THE CONTINUED PROBLEMS THAT WE HAD ALREADY SPOKE ABOUT WITH THE FORMER CEO DISPATCH LETTING KEN KNOW THE STUDY WAS COMING.
I MET WITH KEN, CASEY AND I MET WITH KEN PRIOR TO 16'S OPENING AND WE DISCUSSED THE
[01:45:06]
SAME THING.CONTINUED DELAYS, NOT GETTING AN AMBULANCE ON SCENE AS QUICK AS WE BELIEVE AND NEEDED IT.
AGAIN, I'LL TALK LATER ABOUT THAT.
HOW TO IMPROVE THE FOCUS WAS HOW COULD WE IMPROVE THE SERVICES TO OUR CITIZENS? AND WE SHARED VERY OPENLY AND TRANSPARENTLY THAT STATION 16 BASED ON OUR OWN ANALYSIS, IT WAS A FANTASTIC STRATEGIC LOCATION AND THAT WE'D ALREADY DONE OUR OWN ANALYSIS FOR OUR RESPONSES AND THAT THEY COULD BENEFIT THE SAME QUICK RESPONSE CAPABILITIES.
I SUGGESTED IT, AND I OFFERED IT TO HIM TO PUT AN AMBULANCE AT STATION 16 TO ADDRESS THE ISSUES THAT I'VE JUST SHARED AND HAVE BEEN SHARED THAT IT WOULD PROVIDE A HIGHER LEVEL OF SERVICE TO OUR COMMUNITY BECAUSE OF THE RESPONSE TIMES AND THE TRAVEL TIMES THAT WE GET AND THE EFFICACY OUT OF STATION 16, AND I DID THAT SIMPLY FOR THE SAME REASON THAT I DO EVERYTHING AS YOUR FIRE CHIEF OF THIS COMMUNITY.
IT'S BECAUSE I WANT WHAT'S BEST FOR OUR COMMUNITY AND I'M ABLE TO THINK OUTSIDE THE BOX AND WE'RE WILLING TO THINK OUTSIDE THE BOX.
YOU HAVE A LEADERSHIP TEAM THAT HAS DEMONSTRATED YEAR AFTER YEAR THAT WE CAN DO BURLESON HOMETOWN DONE RIGHT BECAUSE WE HAVE THE ABILITY TO BE FLEXIBLE AND INNOVATIVE AND USE TECHNOLOGY.
I THINK ALL THE THINGS ANY COUNCIL WOULD EXPECT OUT OF STAFF AND WE TAKE CARE OF OUR PROBLEMS, WE TAKE CARE OF BUSINESS AND IT ALL BOILS DOWN TO PROTECTING OUR CITIZENS, PROTECTING OUR COMMUNITY.
SO THERE'S ONE MORE POINT THAT I WANT TO SHARE.
ACTUALLY, TWO MORE THAT'S BACK TO THE STATION 16.
THAT'S BEFORE IT WAS EVER OPENED.
WE INITIATED THAT CONVERSATION AND WE ASKED MEDSTAR WE REQUESTED THEM TO STAY THERE, TO BE LOCATED THERE.
GIVE US THE CHANCE FOR THE CREWS TO WORK TOGETHER, TO GET TO KNOW EACH OTHER, TO HAVE THAT CONTINUITY, THINGS THAT WE'RE GOING TO TALK ABOUT LATER ON.
WHEN WE GOT THE STUDY, WE WENT TO KEN ONE OF THE FIRST PERSONS I TALKED TO BESIDES BRYAN AND WE WEREN'T GETTING AHEAD OF THE COUNCIL, WE KEPT IT VERY, VERY HIGH LEVEL AND WE WENT TO HIM AND WE SHARED WITH HIM THAT WHAT THE RESULTS WERE, WE'D TALK TO HIM A YEAR EARLIER SAID WE HAD NO IDEA WHERE THIS THING WAS GOING TO LEAD, BUT WE'RE GOING TO FOLLOW THE DATA WE'RE GOING TO FOLLOW.
YOU KNOW, THE ANALYTICS OF IT.
AND IN FACT, HE I THINK I PAID FOR IT, BUT WE WENT TO THE CHICKEN.
HE DID OFFER WHAT'S THE NAME OF THE CHICKEN PLACE.
BEST CHICKEN SANDWICH I'VE EVER EATEN.
AND WE'RE GOING TO GO BACK TO THAT.
BUT I'VE GOT A FEW MORE THINGS TO SAY.
AND THEN AFTER LUNCH, BUT AGAIN, OUT OF RESPECT FOR MEDSTAR LEADERSHIP, OUT OF RESPECT FOR OURSELVES AS LEADERS OF THIS COMMUNITY, OUT OF RESPECT FOR THE SYSTEM, WE WENT TO KEN AND I SHARED IT WITH HIM FIRST.
HEY, THIS IS LOOKING VERY, VERY FAVORABLE AND I WANT TO BE TRANSPARENT WITH YOU.
AND WE LAID IT OUT AND WE SAID, KEN.
IT'S NOT PERSONAL, BUT THE ANALYTICS, AND WE'RE GOING TO BE BRINGING THIS FORTH TO THE COUNCIL.
SO I JUST WANT TO GIVE THAT PERSPECTIVE TO THE COUNCIL AND THE COMMUNITY THAT I DON'T KNOW WHAT VIRTUALLY NO COMPLAINT MEANS, BUT I'M TELLING YOU, I HAVE TALKED AT THE HIGHEST LEVEL OF MEDSTAR LEADERSHIP NUMEROUS TIMES ABOUT THE CHALLENGES THAT WE HAVE HAD AND WE CONTINUE TO HAVE IN THE SYSTEM.
I'D LIKE TO HAVE A COUPLE OF OPENING COMMENTS THAT REGARDING OUR PRESENTATION, AND I DO THINK COUNCIL MEMBER PAYNE, AS YOU SHARED, AND THIS WAS SOMETHING THAT IT DID NOT HIT ME UNTIL RECENTLY, THAT THIS CONVERSATION, ONE MANNER OR ANOTHER, HAS BEEN GOING ON FOR A YEAR AND A HALF, EVEN PRIOR TO THAT, ABOUT THE SQUAD'S ABOUT POTENTIALLY TRANSITIONING TO A TRANSPORT SERVICES.
AND I DO UNDERSTAND THAT THIS IS A DIFFERENT COUNCIL AND I DIDN'T REALLY GET THAT UNTIL I DID SOME, YOU KNOW, REFLECTING.
BUT I'D LIKE TO BRIEFLY RECAP SOME OF THE PRESENTATIONS THAT I'VE GIVEN TO PREVIOUS COUNCILS OVER THE STRATEGIC PLANS AND DISCUSSIONS OVER THE PAST YEAR AND A HALF.
[01:50:05]
MAY OF 2020, I GAVE A STRATEGIC OVERVIEW TO COUNCIL AND I DISCUSSED THE SUCCESS OF THE SQUADS OR SQUAD THERE IS ONE SQUAD, AND IT HAD BEEN IMPLEMENTED IN 2018.NOW THIS IS IN MAY OF 2020, SO THIS WAS ABOUT A YEAR AND A HALF INTO IT.
AND AS I SHARED WITH THE COUNCIL THAT TIME, THE SQUAD CONCEPT WAS MEETING OUR EXPECTATION.
AND EVEN GOING BACK TO WHEN I GOT HERE IN 2016, THE FORMER CHIEF HAD A SQUAD CONCEPT ON THE TABLE.
AND THE CHALLENGE WITH THAT WAS AND I COULD NOT AND DID NOT SUPPORT IT, AND I WENT TO THE CITY MANAGER AT THE TIME AND I SAID, I CAN'T SUPPORT THIS BECAUSE THE PLAN WAS TO PULL FIREFIGHTERS OFF THE TRUCK TO A LEVEL THAT WOULD ONLY HAVE ONE TO TWO FIREFIGHTERS ON AN APPARATUS.
AND I SAID, I CANNOT SUPPORT THAT MINIMUM OF THREE TWO ON THE SQUAD, AND THAT'S FINE.
BUT SO THIS SQUAD CONCEPT GOES BACK WAY BEFORE I GOT HERE.
AND I SAID TO THE COUNCIL AT THAT TIME, THERE WOULD BE SOME POINT I UNDERSTOOD THE CONCEPT AND I SAID, THERE'S NO DOUBT IN MY MIND THAT AS WE GET STAFFING, WHEN I TOOK THE REINS HERE, WE HAD NINE PEOPLE ON DUTY TO SERVE THIS WHOLE COMMUNITY NINE PERSONNEL.
AND I SHARED WITH THE COUNCIL AT THAT TIME, MY FIRST AND FOREMOST RESPONSIBILITY AND COMMITMENT WAS WE GOT TO GET STAFFING UP.
WE'VE GOT TO GET STAFFING UP AND THEN WE'LL BE ABLE TO FIGURE OUT THE MODELS I WAS NEW TO THIS CITY I HAD TO FIGURE OUT THE RISK PROFILES HAD TO DO A LOT OF, YOU KNOW, ANALYSIS.
SO DURING THAT 2020 MEETING MAY OF 2020 MEETING, I SHARED THAT SQUAD CONCEPT WAS MEETING OUR EXPECTATIONS.
AND THAT LOOKING FORWARD, I HAD NO DOUBT THAT WE WOULD PROBABLY GO WITH A SECOND SQUAD CONCEPT AND IT WOULD TAKE SEVEN FIREFIGHTERS, VERY EXPENSIVE HUMAN CAPITAL.
BUT I SAID I WASN'T READY AT THE TIME TO MAKE THAT RECOMMENDATION.
AT THE TIME, I SAID I WOULD LIKE TO HAVE A THIRD PARTY CONSULTANT COME IN BECAUSE I DON'T WANT TO MISS THIS.
WE HAD ANECDOTAL, WE HAD OUR OWN ANALYSIS, BUT I DIDN'T FEEL COMFORTABLE, ESPECIALLY AT THE AMOUNT OF EXPENSES THAT WE WERE, THAT I ANTICIPATED WE WERE GOING TO BE COMING TO THIS COUNCIL AND ASK THE COMMUNITY TO SUPPORT, FUND.
I DIDN'T FEEL COMFORTABLE WITH JUST MY ANALYTICS.
I BELIEVED IT BASED ON MY EXPERIENCE AND EVERYTHING.
SO I SHARED WITH THE COUNCIL AGAIN WHAT I BELIEVED WAS GOING TO BEST SERVE OUR CITY TO REALLY DEFINE THIS FROM AN ANALYTICAL STANDPOINT, THE LEVEL THAT WE COULD NOT PROVIDE.
I SHARED AT THAT MEETING THAT IT COULD BE TWO SQUADS.
I SAW CLEARLY THAT WE NEEDED MORE STAFFING, MORE FLEXIBILITY FOR OUR SYSTEM AS IT WOULD UNFOLD.
IT COULD BE ONE SQUAD AND ONE AMBULANCE.
I ALSO SAID IT COULD BE TWO AMBULANCES AND NO SQUADS, DEPENDING ON WHAT THE RISK WAS IN THE CITY AND WHAT THE NEEDS WERE.
I INTRODUCED THAT AT THAT TIME THAT THIS IS VERY DYNAMIC AND WE NEEDED I WANTED AND NEEDED AND THE CITY, NEEDED SOMEONE TO COME IN TO HELP US FIGURE OUT WERE WE ON THE RIGHT TRAJECTORY.
AND ONE OF THE THINGS THAT I SHARED WAS WE HAD THE FIRST RESPONDER PORTION DOWN, CORRECT, AND THAT IF WE EVER TRANSITION TO THE AMBULANCES IT WOULD NOT BE, THE MONEY WOULD NOT DRIVE IT, BUT THERE WOULD BE AN OPPORTUNITY FOR COST RECOVERY.
WE'RE ALREADY I KNOW MEDSTAR'S POSITION WE DON'T SUBSIDIZE THEM, BUT THERE IS A COST AND WE'RE GOING TO SEE HERE IN A LITTLE BIT.
BUT SO I SHARED THAT WITH THE COUNCIL AT THE TIME AND ALSO SHARED THAT IT WOULD BE IRRESPONSIBLE FOR ME NOT TO BRING THIS SUBJECT MATTER FORWARD FOR FUTURE DISCUSSIONS AND FUTURE POTENTIALLY POLICY DISCUSSIONS ABOUT THAT ON MANY, MANY LEVELS.
LATER THAT YEAR, I REQUESTED FOR COUNCIL TO APPROVE A MASTER PLAN STUDY FITCH AND ASSOCIATES WAS AWARDED.
THEY WERE THE COUNCIL, APPROVED IT AND AWARDED THE CONTRACT TO FITCH IN 2020.
ONE OF THE REASONS THERE ARE SEVERAL OF THE REASONS WHY WE SELECTED FITCH WAS THAT THIRTY FIVE YEARS OF EXPERIENCE, THEY GOT MORE NOW THEY WERE INTERNATIONALLY RECOGNIZED AS A LEADER IN EMERGENCY SERVICES.
THEY'VE PROVIDED SIMILAR PLANNING ANALYSIS TO OVER A THOUSAND CITIES IN THE U.S.
AND ALL 50 STATES, AND THEY'RE KNOWN FOR THEIR PROCESSES OF A COMPREHENSIVE, QUALITATIVE OR QUANTITATIVE DATA ANALYSIS AND MULTIPLE VALIDATIONS AND VERIFICATION CHECKS.
AND AGAIN, I'M NOT HERE TO DEFEND FITCH'S CLAIMS AGAINST MEDSTAR, BUT IF THE COUNCIL HAS ANY QUESTIONS ABOUT FITCH'S PROCESS, THEY'RE HERE TO ADDRESS THAT.
[01:55:01]
AND MAY 17TH OF THIS YEAR, I BRIEFED COUNCIL ABOUT THE DELAY IN THE STUDY.WE WERE REALLY HOPING TO HAVE THIS STUDY WRAPPED UP GOING INTO BUDGET, BUT WE DIDN'T.
AND DURING THAT MEETING, I HAD COME TO THE CONCLUSION THAT WE WERE I FELT COMFORTABLE ENOUGH THAT WE WERE GOING TO NEED AT LEAST A SECOND SQUAD FROM A STAFFING STANDPOINT AND AN OPERATIONAL STANDPOINT AT THAT TIME UNTIL WE GOT THE DATA BACK, THE ANALYSIS FROM FITCH, AND I FELT COMFORTABLE GOING AHEAD AND ASKING THE COUNCIL TO APPROVE THAT BECAUSE THEN WE WOULD HAVE THE STAFFING.
I ALSO SHARED IN THAT MEETING THAT ONE OF THE KEY COMPONENTS THAT HAD TO BE ADDRESSED FROM FITCH WAS IF WE SHIFTED TO A TRANSPORT MODEL, WOULD IT HAVE A NEGATIVE IMPACT ON FIRE DEPARTMENT OPERATIONS AND CAUSE INEFFICIENCIES? OR WOULD IT PROVIDE SOME ENHANCEMENTS? THAT WAS A VERY SPECIFIC DIRECTIVE GIVEN TO FITCH THAT WE HAD TO KNOW ANALYTICALLY AND ALSO SHARED WITH THEM THAT WE HAD TO KNOW AND I SHARED WITH THE COUNCIL AT THE TIME, WE HAD TO KNOW THE FISCAL IMPACTS THAT IF WE WENT DOWN THAT THE TRANSPORTATION MODEL, WE HAD TO KNOW AS BEST AS WE COULD.
ARE WE JUMPING OFF INTO A CLIFF BECAUSE WE NEED TO KNOW WHERE THE BOTTOM IS? AND IN NO WAY WOULD I EVER RECOMMEND OR SUPPORT OR THE CITY MANAGER, BUT I WOULD NEVER STAND BEFORE THE COMMUNITY KNOWINGLY TAKING US DOWN THE ROAD.
THAT WOULD CAUSE JUST PHYSICAL CALAMITY OR BE FISCALLY IMPRUDENT.
I WOULD NEVER DO THAT, AND WE'RE NOT DOING THIS TODAY.
WE ALSO DISCUSSED STATION FOUR IN THE FUTURE.
AND AT THAT TIME, I SAID WE WOULD ALSO NEED TO ANTICIPATE A TWO PERSON CREW FULLY STAFFED HAVE SIX PEOPLE THERE.
IT WOULD BE ON A QUINT, FOUR PERSONS ON THE QUINT AND THEN I SAID WE WOULD NEED TWO PERSONS FOR EITHER A SQUAD OR AN AMBULANCE, DEPENDING ON WHAT THE MODELING IS FOR OUR COMMUNITY.
SINCE NOVEMBER 8TH PRESENTATION, CASEY AND I HAVE POURED OVER THIS REPORT AND POURED OVER IT.
AS YOU KNOW, IT'S GOT A LOT OF TECHNICAL TERMS, BUT WE HAD TO GET OUR HEADS WRAPPED AROUND IT NEVER DOUBTED IT, BUT WE HAD TO GET OUR HEADS WRAPPED AROUND THE RECOMMENDATION TO WHAT WOULD THAT? WHAT DOES THAT REALLY LOOK LIKE? HOW WOULD WE DO IT AND SO ON AND SO FORTH, THE THINGS WE'RE GOING TO BE TALKING ABOUT TODAY AND HOW IT WOULD BENEFIT THIS COMMUNITY FIRST AND FOREMOST.
WE MET WITH OUR BATTALION CHIEFS, OUR LIEUTENANTS, ALL OF OUR LIEUTENANTS, ALL OF OUR CHIEF OFFICERS.
CASEY AND I MADE AS MANY ROUNDS AS WE COULD AND TALKED TO MANY, MANY FIRE PERSONNEL.
AND ONE HUNDRED PERCENT OF OUR MEMBERS, SOME OF THEM ARE HERE TODAY.
ONE HUNDRED PERCENT OF OUR MEMBERS BELIEVE THAT IF THE FIRE DEPARTMENT AND THE COUNCIL ULTIMATELY MAKES THE DECISION TO ALLOW US TO ASSUME RESPONSIBILITY FOR THE TRANSPORTATION PORTION OF OUR EMS MODEL, IT WILL PROVIDE A HIGHER LEVEL SERVICE TO OUR COMMUNITY AND WE'RE GOING TO AGAIN SHOW YOU WHY WE BELIEVE THAT.
WE ALSO PARTICIPATED IN NUMEROUS MEETINGS WITH THE CMO'S OFFICE, OUR FINANCE DIRECTOR, MARTIN AVILA, WHO'S GOING TO BE PRESENTING LATER ON, OUR FLEET SERVICES LEGAL.
WE'VE DONE AN IN-DEPTH INTERNAL ANALYSIS BEYOND THE NOVEMBER 8TH MEETING, AND I'VE ASKED MYSELF, WE'RE GETTING DOWN UP TO THE WHY.
I'VE ASKED MYSELF THE QUESTION MANY TIMES OVER THE LAST MONTH AND A HALF AND WHAT I'VE CONCLUDED THAT I'M GOING TO SHARE WITH YOU AND THE COMMUNITY, OBVIOUSLY IS WHY SHOULD WE ASSUME THE TRANSPORTATION SERVICES IN OUR EMS SYSTEM? AND MY ANSWER TO THAT QUESTION AS YOUR FIRE CHIEF IS BECAUSE I HAVE FAITH IN AND I TRUST FIRST AND FOREMOST OUR FIREFIGHTERS WHO HAVE CONSISTENTLY DEMONSTRATED A WILLINGNESS AND ABILITY TO PROVIDE EXCEPTIONAL SERVICES TO OUR COMMUNITY, AND THEY WILL DO THE SAME IF GIVEN THE OPPORTUNITY THIS LEADERSHIP TEAM LEADS FROM THE FRONT, THEY WILL DO THE SAME IF ALLOWED TO TAKE THE TRANSPORTATION ASPECT OF OUR CITIZENS.
I BELIEVE IN OUR TRUST AND THE WORK AND THE ANALYSIS OF OUR OTHER CITY STAFF AND DEPARTMENTS THAT HAVE PROVIDED US INFORMATION AND ANALYSIS DURING OUR INTERNAL REVIEW PROCESS.
I BELIEVE AND I TRUST IN THE ACCURACY, THE VALIDITY AND ACCURACY OF THE ANALYSIS, WHICH CAME FROM THE DATA VERY IMPORTANT PROVIDED TO FITCH FROM BOTH THE CITY AND MEDSTAR, AS MEDSTAR SAID.
THAT HAS LED TO FITCH'S RECOMMENDATION FOR THE CITY TO ASSUME EMS TRANSPORT.
THIS IS MEANT TO BE TOTALLY TRANSPARENT FROM MY HEART OF HEARTS THAT I HAVE FAITH IN, AND I BELIEVE IF THE CITY SUPPORTS AND IT'S YOUR DECISION.
WE RESPECT THAT, AND WE WILL HONOR AND WE ARE PROFESSIONALS AND WE WILL
[02:00:04]
CARRY OUT THE MARCHING ORDERS GIVEN TO US AT ALL TIMES.BUT IF THE CITY COUNCIL SUPPORTS TO TRANSITION OVER THE NEXT TWO YEARS TO ASSUME OUR EMS TRANSPORTATION PORTION SERVICES, WE WILL IMPROVE THE SAFETY OF OUR CITIZENS AND OUR FIREFIGHTERS BY PROVIDING AN ENHANCED LEVEL OF SERVICE THROUGH EMERGENCY RESPONSE AND IN THIS CASE, TRANSPORTATION AS WELL.
QUESTION BEFORE US IS WHY NO QUESTION ABOUT THAT? THE PURPOSE OF OUR PRESENTATION TODAY IS I KNOW DURING OUR NOVEMBER 8TH MEETING, COUNCIL HAD SOME QUESTIONS THAT WE'RE HERE TO ANSWER AGAIN.
AND WE THINK WE PROVIDED SOME SOME ANSWERS TO THOSE QUESTIONS.
WE'RE ALSO HERE TO PROVIDE A FRAMEWORK TO DISCUSS THIS WHERE WE CAN PROVIDE NOT JUST OFFER, BUT WE CAN PROVIDE, WE BELIEVE, A BETTER AND A FASTER AND A SEAMLESS EMS SYSTEM.
WE'VE GOT A FINANCIAL ANALYSIS, A PRO FORMA.
AND THEN IT'S ALSO WE'RE HERE TO ALLOW AND RECEIVE COUNCIL'S FEEDBACK ON WHAT YOUR PREFERENCES ARE AND WHEN ON HOW TO MOVE FORWARD.
MISSION OF THE BURLESON FIRE DEPARTMENT, WE'RE HERE TO SERVE ONE MISSION AND ONE MISSION ONLY.
EVERYTHING IS FOCUSED ON THIS AND IT'S TO IMPROVE THE QUALITY OF LIFE AND SAFETY OF OUR CITIZENS THROUGH OUR SERVICES.
AND IN THIS CASE, WE HAVE A RESPONSE.
IF THE COUNCIL CHOOSES FOR US TO TAKE OVER THE TRANSPORTATION.
TRANSPORTATION WILL BE IN THAT AS WELL.
WE'RE NOT HERE TO HAVE STATUS QUO.
WE'RE NOT HERE TO PROVIDE UNDER SERVING SERVICE OR UNDERPERFORMING SERVICE IF WE'RE NOT GOING FORWARD, STATUS QUO IS NOT ACCEPTABLE IN AN EMS AND A FIRE BUSINESS, AND OUR STANDARD IS TO IMPROVE THE QUALITY OF LIFE AND SAFETY, NOT TO JUST MAINTAIN IT, BUT TO IMPROVE IT.
AND I HAVE NO DOUBT WHATSOEVER THAT IF WE'RE ALLOWED, AS I SAID EARLIER, THIS IS AN OPPORTUNITY FOR US TO IMPROVE, TO ACCOMPLISH OUR MISSION STATEMENT.
SO WHAT DO WE DO? MAYOR PRO TEM, I THINK YOU SAID IT BEST IN OUR LAST MEETING.
WE HAVE BEEN IN THE EMS BUSINESS FOR QUITE SOME TIME, BUT I DO THINK IT'S ONE OF THOSE THINGS THAT JUST DOESN'T RESONATE UNTIL WE REALLY TALK ABOUT IT.
SO WE ARE IN THE EMS BUSINESS.
IT'S THE MAJORITY OF WHAT WE DO IT'S THE MAJORITY OF WHAT WE WILL BE DOING.
AND BECAUSE OF THAT, IT IS OUR RESPONSIBILITY TO CONTINUALLY MONITOR AND TO CONTINUE TO COME UP WITH STRATEGIES AND PROGRAMS AND POLICIES THAT FOCUS ON PROVIDING EXCELLENT EMS SERVICE DELIVERY DOESN'T MAKE FIRE ANY LESS, BUT THIS IS OUR CORE RIGHT HERE.
AND I THINK IT WOULD BE AN UNDERSTATEMENT TO SAY THAT WHEN I SAY THAT WE'RE NOT THE SAME CITY.
WE'RE NOT THE SAME DEPARTMENT.
WHEN MEDSTAR FIRST BEGAN PROVIDING EMS TRANSPORT SERVICES.
THEY'RE NOT A BAD PARTNER NOW I'M TALKING ABOUT A SYSTEM, A SYSTEM.
MEDSTAR HAS PROVIDED A SERVICE THAT PREVIOUSLY THE CITY COULD NOT EVEN CONTEMPLATE OFFERING AN ALTERNATIVE BECAUSE WE DIDN'T HAVE THE MEANS FOR A MULTITUDE OF REASONS, AND THAT'S REALLY UP TO LIKE THE LAST COUPLE OF YEARS AND CERTAINLY TO THIS POINT, WE COULD NOT OFFER A BETTER SERVICE THAN WHAT WE WERE GETTING FOR MEDSTAR WITH ALL OF THE CHALLENGES AND THERE'S NO PERFECT SYSTEM, BUT WE COULD NOT DO BETTER BECAUSE WE COULD NOT FOR, FOR MANY, MANY REASONS, WE JUST DIDN'T HAVE THE PEOPLE IN PLACE.
WE DIDN'T HAVE PROCESSES IN PLACE.
AND WITH THAT SAID, THIS IS AN OPPORTUNITY FOR THE DEPARTMENT AND THE CITY TO HAVE A COMPLETE POLICY SHIFT TO REALLY FOCUS ON WHAT WE'RE DOING, IT WOULD BE A COMPLETE PARADIGM SHIFT, AS I'VE ADDED.
WE'RE WILLING TO CHANGE FROM AND WE NEED A CHANGE FROM THE BURLESON FIRE DEPARTMENT TO BURLESON FIRE RESCUE.
THIS IS AS I SEE IT, WE'RE AT A CROSSROADS AND OUR POLICY DISCUSSIONS IN OUR CITY ABOUT WE'RE NO LONGER A FIRE DEPARTMENT AND THAT'S NOT DEMEANING.
WE ARE BURLESON FIRE RESCUE AND WE NEED TO, I THINK, ACCURATELY REPRESENT TO OUR COMMUNITY AND OURSELVES WHAT WE DO IN THE MAJORITY OF TIMES.
EMS. SO WHAT CAN WE DO? WE CAN OFFER AND PROVIDE OFFERING DOESN'T DO IT.
I MEAN, WE CAN OFFER YOU ALL KINDS OF THINGS.
[02:05:01]
SO THIS ISN'T JUST AN OFFER.WE HAVE THE ANALYTICS AND WE HAVE THE ABILITY WE BELIEVE TO NOT ONLY OFFER BUT TO PROVIDE A SIGNIFICANTLY MORE ROBUST.
AND I'M GOING TO TALK MORE ABOUT THAT IN A LITTLE BIT ABOUT THE DEPLOYMENT FOR FIRE AND EMS. AND MATT, THANK YOU FOR YOUR ANALYSIS OF THE FIRE DEPARTMENT.
WE WILL BE ABLE TO PROVIDE A MORE ROBUST RESPONSE FOR FIRE.
WE HAVE THE CAPACITIES AND AGAIN, WE WILL TALK MORE ABOUT THAT AND ANSWER ANY QUESTIONS THE COUNCIL MAY HAVE.
BUT WE CAN'T PROVIDE A MORE ROBUST FIRE AND EMS SERVICE DELIVERY THAT'S BURLESON CENTRIC.
AND AS I'VE ALREADY SAID, IT'S EXTREMELY IMPORTANT IN MY MIND AND I WANT TO PRESENT THIS TO THE COUNCIL IS WHAT ONCE WORKED, IT'S NOT NECESSARILY THE RIGHT FIT ANYMORE.
OUR STRUGGLES ARE OUR SYSTEM IS DESIGNED AROUND 14 OTHER CITIES.
AND WE CAN DESIGN A SYSTEM, AND MY PROPOSITION AND POSITION IS BURLESON CENTRIC IS BETTER LOCAL RULE VERSUS A SYSTEM RULE, SO TO SPEAK.
AND IT WOULD BE DESIGNED TO ENHANCE THE SAFETY OF ALL PUBLIC SAFETY PERSONNEL.
TALK ABOUT MORE ABOUT THAT AND WHY I SAID ALL PUBLIC SAFETY PERSONNEL.
I DIDN'T KNOW UNTIL OUR BOND COMMITTEE MEETING THAT CHIEF CORDELL HAD HAD THREE OFFICERS SHOT HERE.
EVERY LIFE IS VALUABLE, BUT WHENEVER WE HAVE THOSE PRIORITY ONE CALLS LIKE MATT ALLUDED TO, WE WANT TO GET SOMEBODY IN AN AMBULANCE AS QUICK AS POSSIBLE, STABILIZE AND HEADED TO THE HOSPITAL.
AND THAT'S THE FACT WHETHER IT IS PD FD COMMUNITY VISITOR.
SO RESPONSE AND TRAVEL TIMES DO MATTER, AND WE BELIEVE THAT BY DOING THIS, WE'LL BE ABLE TO ENHANCE THE SAFETY OF THE COMMUNITY.
AND ANYTIME YOU CAN PROVIDE ENHANCEMENT, YOU HAVE A HIGHER PROBABILITY AND POSSIBILITY OF HAVING BETTER PATIENT OUTCOMES.
WE BELIEVE WE'LL HAVE A CONTINUITY OF CARE AND SERVICES CRITICALLY IMPORTANT IN ANY SYSTEM.
WE'RE GOING TO TALK ABOUT THAT.
WE WERE ABLE TO PROVIDE FASTER RESPONSE TIMES, TRAVEL TIMES, SEAMLESS, INCREDIBLY IMPORTANT.
WE'LL BE TALKING ABOUT THAT IN DETAIL AS TO WHY AND HOW IT BENEFITS THE COMMUNITY, HOW IT BENEFITS OUR CUSTOMER EXPERIENCE, WHICH IS WHAT WE'RE HERE AGAIN TO TALK ABOUT.
ALL THIS WOULD BE UNDER ONE AGENCY, BURLESON FIRE RESCUE THE CITY IT WOULDN'T BE TRYING TO SERVE, SO TO SPEAK, TWO BOSSES.
TWO MASTERS, IT'D BE UNDER ONE.
SO WHAT ARE OTHER FIRE DEPARTMENTS IN OUR AREA DOING? WELL, THEY'RE DOING WHAT WE'RE NOT DOING, LOOKING AT THIS PIE CHART.
SIXTY FIVE PERCENT OF THE FIRST RESPONDERS IN THE DFW METROPLEX AREA AND THIS INFORMATION CAME FROM NORTH CENTRAL TEXAS TRAUMA REGIONAL ADVISORY LONG ACRONYM COUNCIL.
BUT AS YOU CAN SEE, IT ILLUSTRATES SIXTY FIVE PERCENT ARE FIRE BASED.
TWENTY FOUR PERCENT PRIVATE, 11 PERCENT MEDSTAR.
AND AS WE LOOK AT THIS SLIDE, LET ME WALK YOU THROUGH THIS SLIDE THAT REPRESENTS THERE'S LIKE 78 OR 79, THERE'S ACTUALLY 84.
I DIDN'T WANT TO PUT THE OTHER ONES BECAUSE THE SLIDE WOULD BE AT THE BOTTOM 84 FIRE DEPARTMENTS IN THE DFW AREA PROVIDE FIRE BASED TRANSPORT EMS AND AS YOU WILL SEE THAT WITHIN THE DFW AREA ALONE WERE THE EXCEPTION AND NOT THE RULE.
THIS IS NOT REINVENTING THE WHEEL AT ALL.
IT'S NOT AS COMPLICATED AS WE'RE GOING TO, I THINK, SHOW YOU VERY CLEARLY HERE IN JUST A LITTLE BIT.
THESE DEPARTMENTS VARY FROM SIZE, TO SIZE.
SOME ARE LARGE LIKE DALLAS FIRE RESCUE, VERY LARGE METROPOLITAN DEPARTMENT.
THERE'S MEDIUM SIZE DEPARTMENTS UP THERE.
DEPARTMENTS OUR SIZE CITIES, OUR SIZE, AND THERE ARE CITIES THAT ARE SIGNIFICANTLY SMALLER THAN US UP THERE.
FOR EXAMPLE, ADDISON'S GOT TWENTY THOUSAND.
KENNEDALE TEN THOUSAND APPROXIMATELY.
AND THEN MANSFIELD SEVENTY FIVE THOUSAND AND SACHSE 30,000.
EIGHTY FOUR PEOPLE IN THIS AREA HAVE HAVE GOT IT RIGHT IN THE SENSE THAT THEY HAVE FIGURED OUT THAT THEY CAN DO IT AND PROVIDES THE LEVEL OF SERVICE THAT'S ACCEPTABLE IN THEIR COMMUNITY AND THEIR POLICY MAKERS.
ARE THERE ANY QUESTIONS FROM COUNCIL? CHIEF, YES, SIR.
I WASN'T CHECKING UP ON YOU OR ANYTHING, BUT I'VE GOT SOME NEW FRIENDS SINCE I'VE GOT THIS JOB, BUT SOME OF THEM ARE MAYORS AND I WANT TO TOUCH BASE WITH ONE THING THAT THEY SAID.
JOHN HUFFMAN FROM MAYOR HUFFMAN FROM SOUTHLAKE JUST WENT OFF THE CHARTS ABOUT
[02:10:02]
HOW THEY LOVED THEIR FIRE RESCUE SITUATION.AND HE BROUGHT UP ONE THING AND I'LL FINISH THE OTHER TWO OSCAR TREVINO FROM NORTH RICHLAND HILLS THEIR THERE.
AND MICHAEL EVANS FROM MANSFIELD.
ALL OF THEM ARE FOR THE SYSTEM WE'RE GOING TO OR WANT TO GO TO BUT ONE OF THE THINGS THAT I BELIEVE IT WAS.
IT WAS OSCAR, MAYOR TREVINO WAS TALKING ABOUT THE RELATIONSHIP BETWEEN HIS FIRE DEPARTMENT AND THE LOCAL HOSPITAL, AND HE MADE A STATEMENT THAT LITERALLY THE HEART PROBLEMS COULD COMMUNICATE WITH THAT HOSPITAL, THAT WHEN THEY PULLED UP, THEY'RE LITERALLY READY TO GO TO SURGERY.
YOU HAVEN'T BROUGHT THAT UP, BUT WE'RE NOT GOING TO HAVE THAT.
AND LET ME PUT IT IN A CONTEXT RIGHT NOW.
FIFTY THREE ISH PERCENT OF ALL OF OUR TRANSPORTS GO TO HUGULEY, AND HUGULEY HAS GOT AN EXCELLENT HEART CATH LAB.
AND SO THE GOAL IT WOULD BE TO REACH OUT.
LET WE PUT IT IN CONTEXT HERE TOO.
WE ARE NOT GETTING AHEAD OF COUNCIL.
AND SO WE ARE NOT TAKING STEPS TO TRY TO GET THINGS IN PLACE.
BUT IF WE'RE GIVEN THE GREEN LIGHT TO GO, WE ALREADY HAVE A VERY STRONG AND SUSTAINED RELATIONSHIP WITH HUGULEY.
THEY HELPED US AND WERE GREAT PARTNERS WITH OUR VACCINE PROGRAM AND OUR DRIVE THRU TESTING.
PENNY JOHNSON AND THEN THEIR CHIEF MEDICAL OFFICER THERE ARE GREAT PARTNERS, AMONGST OTHER PEOPLE.
BUT ONE OF THE THINGS THAT WE WOULD DO AND WE'VE TALKED TO DR.
MARTIN ABOUT THIS IS WE WOULD ENGAGE CONVERSATIONS WITH THEM, LETTING THEM KNOW ONCE THE COUNCIL DECIDES IF THE COUNCIL DECIDES TO MOVE FORWARD WITH OUR RECOMMENDATION.
WE ALREADY HAD THOSE RELATIONSHIPS.
WE BUILD ON THEM AND WE WOULD BUILD ON THEM FROM A TRANSPORT SIDE TO WHERE WE WOULD HAVE THAT LINE OF COMMUNICATION WE ALREADY DO, BUT WE WOULD DRILL IT DOWN EVEN FURTHER.
MATT MENTIONED OUR COMMUNITY PARAMEDIC.
WE WOULD DRILL DOWN ON THAT AS WELL.
SO OUR GOAL IS THAT WE WOULD PRIMARILY FOCUS ON HUGULEY SINCE THEY'RE SEVEN MINUTES AWAY, THREE MILES FROM THE MAJORITY OF THE CITY.
THAT'S WHERE THE MAJORITY, IF NOT ALL, OF THE CARDIAC ARRESTS WOULD GO.
GET THEM IN THAT CATH LAB, ESPECIALLY IF THEY'RE HAVING A HEART ATTACK.
AND THEN, OF COURSE, WE CAN DO THE SAME THING FOR THR DOWNTOWN, WHICH IS OUR SECOND HOSPITAL TO GO TO FOR OUR TRANSPORTS BAYLOR SCOTT AND WHITE JPS.
HUGULEY IS A STRATEGIC PARTNER IN LOCATION AND RELATIONSHIPS THAT WE HAVE ALREADY HAD SUSTAINED RELATIONSHIPS WITH THEM.
SO DOES THAT ANSWER YOUR QUESTION? YEAH, BUT THIS DOESN'T.
I MEAN, THIS COULD BE UTILIZED FOR WHAT ELSE I MEAN.
HUGULEY IS OUR CLOSEST HOSPITAL, AND I USE THE CARDIAC AS AN EXAMPLE.
THERE ARE OTHER LIFE THREATENING EVENTS THAT CAN TAKE PLACE.
BUT TO YOUR POINT THAT THE OTHER MAYOR SHARED, HUGULEY HAS AN EXCELLENT CATH LAB SEVEN MINUTES AWAY THAT WOULD BE OUR PRIMARY DESTINATION.
YEAH CHIEF? SO LET'S I WANT TO TALK ABOUT THE SQUAD A LITTLE BIT BECAUSE A LOT OF PEOPLE ARE HAVING QUESTIONS ABOUT WHY WE HAVE A SQUAD.
A LOT OF OTHER CITIES HAVEN'T DONE A SQUAD.
SO ONE OF THE THINGS THAT I THOUGHT ABOUT IN KNOWING WHAT I KNOW ABOUT PARAMEDICS, THE SQUAD CARRIES MEDICATION, RIGHT? AND IT'S REFRIGERATED AND IT'S OR COOLED.
EXCUSE ME FOR THAT, AND THE PARAMEDICS CAN PUSH CERTAIN MEDICATIONS.
IF WE HAD NOT IMPLEMENTED THE SQUAD CONCEPT AND THESE GUYS WERE STILL RUNNING FROM THE TRUCK.
THERE'S PARAMEDICS, PROBABLY ON YOUR TRUCKS, RIGHT? THERE WOULD BE NO MEDICATIONS ON THE TRUCK FOR THEM TO OR WHAT MEDICATIONS ARE ON THE TRUCK? OUR TRUCKS CARRY THE SAME MEDICATIONS, AND TO YOUR POINT, THE SQUAD GOING BACK TO THE ORIGINAL CONCEPT THE SQUAD PROVIDES STILL DOES REDUNDANCY AND I SHARED THIS IN PREVIOUS MEETINGS.
SO NOW WE HAVE A SQUAD THAT'S AVAILABLE TO GO IF OUR OTHER RIGS ARE OUT ON ANY TYPE OF CALL.
SO INSTEAD OF THREE, WE HAVE FOUR.
WE HAVE A TWENTY FIVE PERCENT INCREASE IN RESPONSE CAPABILITIES THAT ARE ABLE TO PROVIDE ALS SERVICES.
ALS MEANING? ADVANCED LIFE SUPPORT.
I JUST WANT TO KEEP REPEATING IT.
SO YEAH, WE DO HAVE THE CAPABILITIES.
BUT AGAIN, THE SQUAD IS STRATEGIC.
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WE'VE GOT TO BE VERY NIMBLE, VERY, VERY FLEXIBLE.IT PROVIDES THE ABILITY TO PROVIDE ADVANCED LIFE SUPPORT.
AND IT'S ANOTHER PIECE OF APPARATUS.
SO AT THE TIME WHEN THE SQUAD WAS INITIATED, IT WAS CHEAPER TO DO A SQUAD THAN TO GET A WHOLE NEW FIRE TRUCK AND ENGINE.
AND THERE WERE AT THAT TIME WITH AN UNPROVEN PRO FORMA TO GET AN AMBULANCE OR RIGHT? YEAH.
AND AS I SAID, AT PREVIOUS COUNCILS WITHOUT AN OUTSIDE CONSULTANT, WE AND I WENT TO HALTOM HIGH SCHOOL.
BUT WE DON'T HAVE AND DIDN'T HAVE THE ABILITY TO GO TO THE HIGH LEVEL ANALYTICS TO TAKE ALL OF MEDSTARS, CAD DATA AND OURS.
I MEAN THAT TAKES, YOU KNOW, PHD CAPABILITY.
BUT THE SQUAD FROM THE VERY, VERY BEGINNING WAS THE MOST COST EFFECTIVE AND EFFICIENT.
I COULD NOT BRING TO COUNCIL AND ASK COUNCIL AND THIS COMMUNITY TO SUPPORT A FULLY STAFFED FIRETRUCK TO BUY A THREE QUARTER OR ONE MILLION DOLLAR FIRE TRUCK, TO PUT FOUR FIREFIGHTERS ON THERE TO BASICALLY TEND TO AN EMS PROBLEM.
AND WE WENT WITH THE MOST COST EFFECTIVE AND EFFICIENT MODEL, AND IT DID HAVE SOME BENEFITS.
AND TO MATT'S POINT EARLIER THAT WE'VE NEVER SAID OUR TRUCKS WOULD NOT RESPOND.
OUR TRUCKS RESPOND AND THEY ALWAYS HAVE RESPOND.
OUR SQUAD AND THIS IS OUR ANALYSTS WOULD DO THE SAME.
OUR SQUADS RESPOND TO THE LOW ACUITY THEY RESPOND TO THE HIGH ACUITY, THE LIFE THREATENING.
BUT WE'VE NEVER SAID THE SQUAD WOULD GO ONLY WE WOULD NEVER SEND A FIRE TRUCK.
IT WON'T BE OUR MODEL BECAUSE THERE'S A LOT OF REASONS MEDICALLY WHY YOU SEND A TEAM FOR THE WORST CASE SCENARIO.
SO I HOPE THAT ANSWERS YOUR QUESTION.
DID [INAUDIBLE] WE'RE GOING TO BREAK THIS UP, PAUL BRADLEY IS GOING TO BE COMING UP TO GO OVER THE COMMUNICATIONS SECTION AND THEN I'LL BE PRESENTING AFTER THAT, I BELIEVE, AND THEN CASEY.
AND SO WE'VE GOT IT SEGMENTED.
SO THERE WAS ONE OTHER THING THAT WAS MENTIONED TO ME THAT YOU HAVE IF WE GO TO THIS MODEL, WE'RE GOING TO HAVE A HARD TIME HIRING FIREFIGHTERS BECAUSE THEY DON'T WANT TO BE IN THE AMBULANCE.
IS THAT THE CASE? I MEAN, AND THE MAYOR'S SAYING THEY DON'T SEE A PROBLEM LIKE THAT.
I WILL GIVE YOU MY RESPONSE BASED ON BURLESON'S EXPERIENCE.
WE JUST HIRED THREE PARAMEDICS.
WE'VE NEVER HAD A PROBLEM WITH HIRING.
WE HAVE THE ABILITY THAT WE'RE SENDING SOME OF OUR OUR FIREFIGHTERS TO SCHOOL.
WE ARE ONE OF THE BEST PAID DEPARTMENTS NOW.
WE'RE ONE OF THE MOST ATTRACTIVE DEPARTMENTS NOW.
PARAMEDICS LOOK TO GOOD FIRE DEPARTMENTS TO GO TO, AND I SUSPECT IF WE GO TO THIS MODEL, WE WILL CERTAINLY SEE SOME OF MEDSTAR'S.
IT WOULDN'T SURPRISE ME TO SEE SOME MEDSTAR'S PERSONNEL APPLYING.
I HAVE NO CONCERN ABOUT US BEING ABLE TO ATTRACT AND CERTAINLY RETAIN THE NUMBER OF PEOPLE THAT WE NEED PARAMEDICS OR NOT.
THAT DOES NOT GIVE ME ANY CONCERN.
WE HAVE GOT A SOLID PLAN IN PLACE ON HOW TO STAFF THESE AMBULANCES AND THE LEVEL OF SERVICE THAT THEY WOULD PROVIDE.
OK, DO WE NEED A BREAK OR GO INTO PAUL? OK, PAUL BRADLEY.
GOOD MORNING, MAYOR AND COUNCIL I'M PAUL BRADLEY, THE PUBLIC SAFETY COMMUNICATIONS MANAGER FOR THE CITY OF BURLESON, AND I APPRECIATE THE OPPORTUNITY TO BE HERE THIS MORNING TO SPEAK WITH YOU ALL.
I'M GOING TO OUTLINE HOW OUR PROCESSES AND PUBLIC SAFETY COMMUNICATIONS IMPACT EMS SERVICES HERE IN BURLESON.
I'M GOING TO START OUT BY OUTLINING OUR CURRENT PROCESS, HOW IT WORKS ON MEDICAL CALLS THAT ARE ANSWERED IN THE CITY OF BURLESON.
WE ANSWER THE 9-1-1 CALL WHERE PRIMARY PSAP, SO ANY 911 CALL PLACED IN BURLESON COMES TO US AND WE ANSWER THAT CALL.
WE OBTAIN THE BASIC INFORMATION FROM THE CALLER, WHICH INCLUDES THEIR ADDRESS, PHONE NUMBER AND THE NATURE OF THE EMERGENCY.
WE ENTER THE CALL INTO OUR COMPUTER AIDED DISPATCH OUR CAD SYSTEM, AND WE CUE IT UP FOR DISPATCH.
ONCE WE GET THAT MOST BASIC INFORMATION, THE MINIMUM AMOUNT OF INFORMATION THAT WE NEED TO SEND UNITS TO RESPOND TO AN EMERGENCY.
WE THEN IMMEDIATELY DISPATCH OUR FIRE DEPARTMENT PERSONNEL.
WE THEN MUST MANUALLY INITIATE A CAD2CAD TRANSFER TO MEDSTAR TO SEND THEM THE
[02:20:01]
CALL DATA, AND THEN WE GET MEDSTAR ON THE LINE.SO WE TRANSFER THE CALLER OVER TO MEDSTAR.
MEDSTAR THEN ANSWERS THE CALL.
THEY OBTAIN THE SAME INFORMATION AGAIN, AND THEN THEY GO THROUGH THE EMERGENCY MEDICAL DISPATCH PROTOCOL TO PROVIDE THE PRE-ARRIVAL INSTRUCTIONS.
THEY THEN DISPATCH THEIR AMBULANCE TO THE CALL.
SO AS YOU CAN SEE, OUR CURRENT PROCESS IS RELATIVELY INEFFICIENT.
IT'S VERY FRUSTRATING FOR CALLERS TO EXPERIENCE THESE TRANSFERS, HAVING TO REPEAT TIME AND TIME AGAIN AND EXPERIENCING A DELAY WHEN HAVING TO TRANSFER A PHONE CALL.
AND WHAT I ASK OF YOU IS JUST TO IMAGINE IF YOU'RE EXPERIENCING THE WORST DAY OF YOUR LIFE, A LOVED ONES NOT BREATHING THEIR LIFE IS IN JEOPARDY.
FROM A CUSTOMER EXPERIENCE THIS IS NOT PROVIDING THE BEST SERVICE TO OUR COMMUNITY.
I WANT TO MAKE CLEAR THAT THIS PROCESS ISN'T MEDSTAR'S FAULT.
BUT IT'S AN ISSUE THAT WE CAN SOLVE, AND I'M GOING TO PROPOSE HOW WE DO THAT.
SO AS YOU CAN SEE, OUR CURRENT SYSTEM IS NOT SEAMLESS, TRANSFERRING CALLS IS NOT A BEST PRACTICE, AND I'LL GO OVER THAT HOW THAT'S BEEN SAID TIME AND TIME AGAIN BY DIFFERENT CONSULTING FIRMS AND PEOPLE IN THE INDUSTRY.
WE'VE BEEN EXPERIENCING SIGNIFICANT HOLD TIMES WHEN TRANSFERRING CALLS TO MEDSTAR, SO WE ANSWER OUR CALL QUICKLY.
WE INITIATE THE CALL TRANSFER OVER TO MEDSTAR, BUT IT OFTEN TAKES UP TO ONE MINUTE BEFORE THEY ANSWER THE PHONE.
AND DURING THAT TIME, THAT'S TIME THE CALLER IS NOT RECEIVING ANY LIFE SAVING INSTRUCTIONS.
NO AMBULANCE, IS ON THE WAY TO THE CALL.
LIKE I SAID BEFORE, IT'S VERY FRUSTRATING FOR THE CALLERS AS WELL.
THEY MUST REPEAT THE EXACT SAME INFORMATION THAT WE ALREADY OBTAINED.
AGAIN, THAT'S NOT MEDSTAR FAULT.
THE PROTOCOL REQUIRES THAT IT'S JUST A PROCESS ISSUE THAT WE CAN SOLVE.
THERE CAN BE A SIGNIFICANT AMOUNT OF TIME THAT ELAPSES BETWEEN BURLESON ANSWERS THE PHONE AND THOSE EMERGENCY MEDICAL DISPATCH INSTRUCTIONS ARE PROVIDED.
FOR EXAMPLE, THERE'S AN INCREASED AMOUNT OF TIME BETWEEN THE ACTUAL CARDIAC ARREST AND HANDS ON CHEST FOR CPR.
SECONDS COUNT WITH THAT, WE NEED TO MAKE SURE THAT WE GIVE THOSE BYSTANDER INSTRUCTIONS AS SOON AS POSSIBLE.
AS SOME OF YOU ALL MAY RECALL, WE HAD MISSION CRITICAL PARTNERS BEFORE I CAME HERE AND DID AN ORGANIZATIONAL ASSESSMENT FOR THE PUBLIC SAFETY COMMUNICATIONS CENTER, AND THEY MADE THE SAME RECOMMENDATION THAT FITCH AND ASSOCIATES MADE.
AND THAT'S THAT TRANSFERRING CALLS IS NOT THE BEST PRACTICE AND THAT THAT'S THE ISSUE.
MCP MISSION CRITICAL PARTNER SPECIFICALLY RECOMMENDED THAT PUBLIC SAFETY COMMUNICATIONS HANDLE THE EMERGENCY MEDICAL DISPATCH PROTOCOL RATHER THAN TRANSFER THE CALLER OVER.
SO I WANT TO GO SOMEONE'S NOT BREATHING.
OUR AVERAGE ANSWER TIME IN OUR COMMUNICATIONS CENTER IS FOUR POINT EIGHTY FIVE SECONDS FROM THE SECOND YOU DIAL 9-1-1 TILL WE ANSWER THE PHONE.
WE GET THE BASIC INFORMATION, THEN TRANSFER TO MEDSTAR.
I WANTED TO OUTLINE WITH YOU A LITTLE BIT ABOUT OUR PERFORMANCE AND MEDSTAR'S PERFORMANCE.
AS FAR AS CALL ANSWER TIMES GO.
AND SORRY, THERE ARE A LOT OF ACRONYMS HERE, BUT I'LL OUTLINE THOSE CLEARLY SO EVERYONE KNOWS WHAT THEY ARE, AND I'LL TRY NOT TO GET TONGUE TIED ON THEM.
THERE ARE A COUPLE INDUSTRY STANDARDS THAT FORTUNATELY ARE ALL ALIGNED.
THERE'S THE NATIONAL EMERGENCY NUMBER ASSOCIATION, THE ASSOCIATION OF PUBLIC SAFETY COMMUNICATIONS OFFICIALS, AND THEN, AS THE FIRE DEPARTMENT STATES, THE NATIONAL FIRE PROTECTION ASSOCIATION.
SO THEIR STANDARDS ARE ALIGNED, THEY'RE THE SAME, AND THEY STATE THAT 90 PERCENT OF ALL 9-1-1 CALLS SHALL BE ANSWERED WITHIN 15 SECONDS.
NINETY FIVE PERCENT OF ALL 9-1-1 CALLS SHALL BE ANSWERED WITHIN 20 SECONDS.
TO TALK ABOUT OUR PERFORMANCE IN BURLESON.
WE ANSWER CALLS WITHIN 15 SECONDS, NINETY NINE POINT ONE, NINE PERCENT OF THE TIME, WE ANSWER CALLS WITHIN 20 SECONDS, NINETY NINE POINT FOUR NINE PERCENT OF THE TIME, SO WE'RE FAR EXCEEDING THOSE STANDARDS.
I PULLED INFORMATION FROM OUR CALL TRANSFERS TO MEDSTAR FOR THE LAST FOUR MONTHS.
THEY ANSWER CALLS WITHIN 15 SECONDS, EIGHTY TWO POINT SEVEN PERCENT OF THE TIME, AND WITHIN TWENTY SECONDS EIGHTY FIVE POINT FOUR SIX PERCENT OF THE TIME.
THEIR AVERAGE CALL ANSWER TIME IS ELEVEN POINT THIRTY THREE SECONDS.
SO THEY MIGHT HAVE A GOOD HELLO TO DISPATCH TIME, BUT THAT'S NOT FACTORING IN THAT HOLD TIME WHERE WE'RE TRANSFERRING THE CALLER OVER TO THEM.
WE HAVE HAD CALLS THAT TAKE ONE HUNDRED AND FOURTEEN SECONDS FOR THEM TO ANSWER MULTIPLE OF THOSE.
IT'S ALMOST TWO MINUTES WHERE WE'RE ON THE PHONE WITH THE CALLER AND IT'S JUST RINGING.
SO I WANTED TO TALK ABOUT OUR PROPOSED ENHANCEMENT FOR BURLESON PUBLIC SAFETY COMMUNICATIONS.
OUR PROCESS WOULD BE TO IMMEDIATELY DISPATCH UNITS PER THE NFPA STANDARDS, PROVIDE IMMEDIATE EMD LIFE SAVING PRE-ARRIVAL INSTRUCTIONS AND HAVE A VERY SEAMLESS PROCESS.
CALL TAKING, CALL PROCESSING DISPATCHER AND BYSTANDER INSTRUCTIONS ALL PROVIDE
[02:25:05]
RIGHT AWAY VERY TRANSPARENT OR ACTUALLY INVISIBLE TO THE CALLER WHERE WE GET UNITS ON THE WAY AND THEY DON'T REALIZE ANYTHING ELSE IS GOING ON IN THE BACKGROUND.WE GET THEM THE HELP THAT THEY NEED IMMEDIATELY AND GIVE THEM THE INSTRUCTIONS TO HELP THE PERSON THEY'RE CALLING ABOUT.
ONCE WE KNOW THE LOCATION AND NATURE OF THE EMERGENCY, WE DISPATCH UNITS IMMEDIATELY AND THEN WE GO STRAIGHT IN THE PRE-ARRIVAL MEDICAL INSTRUCTIONS.
LIKE I SAID BEFORE, BOTH CONSULTANTS I MENTIONED HAVE RECOMMENDED THAT WE ELIMINATE CALL TRANSFERS AND IMPLEMENT IN-HOUSE EMERGENCY MEDICAL DISPATCH PROTOCOL THAT WOULD ENHANCE THE SERVICE TO OUR CITIZENS, IMPROVE THE CALL PROCESSING TIME BY NOT DELAYING RESPONSE WITH CALL TRANSFER ACTIVITIES.
IT ENHANCES THE ACCURACY OF OUR CALL METRICS, OUR CALL ANSWERING TIMES AND DISPATCHING TIMES.
AGAIN LIKE IT'S BEEN MENTIONED AND LIKE FITCH MENTIONED IN THEIR REPORT.
IT'S NOT A CLEAR PERSPECTIVE OF HOW THE PERFORMANCE IS GOING.
THEIR HELLO TO DISPATCH TIME DOES NOT COUNT THAT TRANSFER IN THERE.
WE WOULD ELIMINATE THE TRANSFERS ALTOGETHER.
I ALSO WANT TO LET YOU ALL KNOW THAT I'M EXPERIENCED AS AN EMERGENCY MEDICAL DISPATCHER AS ON LINE LEVEL AND AS MANAGING A CENTER THAT HAS EMERGENCY MEDICAL DISPATCH.
I KNOW THAT ON THIS SIDE OF THE METROPLEX, THE MEDSTAR MODEL IS PRETTY COMMON.
IT'S NOT COMMON IN OTHER PARTS OF THE METROPLEX.
IT WAS STRANGE FOR ME TO COME HERE HAVING THIS KIND OF MODEL.
I'M USED TO DOING THE OTHER WAY.
SO I DO HAVE EXPERIENCE IN DOING THAT.
SO AGAIN, I'M GOING TO GO OVER A LITTLE BIT OF OUR CALL PROCESS AND CONCERNS AS THEY ARE RIGHT NOW.
THE INTER-LOCAL MANDATES THAT THE INITIAL PRIMARY PUBLIC SAFETY ANSWERING POINT, THE PSAP WE MUST TRANSFER THE CALL TO MEDSTAR.
WE THEN MUST WAIT FOR MEDSTAR TO ANSWER THE CALL TRANSFER.
THE CALLERS MUST REPEAT THE EXACT SAME INFORMATION THAT WE ALREADY OBTAINED, AND ULTIMATELY, THE PROBLEM IS THAT THE BYSTANDER INSTRUCTIONS ARE DELAYED.
THE OVERALL RESPONSE IS DELAYED FOR THE AMBULANCE AS WELL.
THE POOR CALL ANSWER TIMES NOT ONLY DELAY LIFESAVING MEDICAL INSTRUCTIONS, BUT THEY IMPACT THE OVERALL RESPONSE TIMES OF THE AMBULANCE.
OUR UNITS ARE OFTEN ALREADY ON THE WAY BEFORE MEDSTAR ANSWERS THE PHONE.
OUR CALL PROCESSING WOULD BE LIKE THIS, WE'D HAVE THAT SEAMLESS PRIMARY PUBLIC SAFETY ANSWERING POINT.
PROCESSING THOSE CALLS FROM THE INITIAL ANSWER UNITS ASSIGNED AND DISPATCHED AND BYSTANDER INSTRUCTIONS ALL RIGHT AWAY.
WE FOLLOW THE BEST PRACTICES AND THE NFPA STANDARDS.
WE WOULD HAVE A TRANSPARENT AND ACCURATE HELLO TO DISPATCH TIME TO PROVIDE.
WE ALREADY EXCEED THE PERFORMANCE STANDARDS SET FORTH BY LEADING PUBLIC SAFETY ORGANIZATIONS.
AND AS YOU ALL MAY RECALL THAT I PRESENTED BACK IN MAY FOR THE AUTOMATED FIRE STATION ALERTING SYSTEM THAT'S IN PLACE.
THAT'S GOING TO MAKE A GREAT IMPACT ON OUR TIMES AND ON THE TRANSPARENCY OF OUR PERFORMANCE AND THE FACT THAT WE WON'T HAVE TO INTERRUPT EMERGENCY MEDICAL DISPATCH INSTRUCTIONS TO DISPATCH UNITS.
IT CAN DO THAT IN THE BACKGROUND FOR US.
WE START GIVING THE CALLERS THOSE INSTRUCTIONS RIGHT AWAY.
AND JUST TO SUMMARIZE SIDE BY SIDE WHAT OUR CURRENT PROCEDURES ARE WITH THE PROPOSED PROCEDURES TAKES OUT A LOT OF GAPS.
CURRENTLY, AGAIN, WE ANSWER THE CALL, WE OBTAIN THE BASIC INFORMATION, WE ENTER IT INTO OUR CAD SYSTEM.
WE QUEUE IT UP FOR DISPATCH AND SEND OUR UNITS RIGHT AWAY.
WE THEN HAVE TO TRANSFER THE CALL TO MEDSTAR IN MULTIPLE WAYS.
WE HAVE TO SEND IT THROUGH THEIR CAD.
WE MUST TRANSFER THE PHONE CALL TO THEM.
THEY MUST ANSWER ALL THE INFORMATION REPEATED AGAIN.
THEN THEY START THE EMERGENCY MEDICAL DISPATCH PROCESSING AND SEND THEIR UNITS.
WHAT WE WOULD DO IF WE HAD ALL OF THIS IN-HOUSE ANSWER 9-1-1, GET THE INFORMATION LIKE WE ALREADY DO ENTER IT, LIKE WE ALREADY DO QUEUE IT FOR DISPATCH.
AND THEN ALL THOSE OTHER STEPS ARE TAKEN OUT.
WE IMMEDIATELY DISPATCH BURLESON FIRE RESCUE PERSONNEL AND GIVE THOSE EMERGENCY MEDICAL DISPATCH INSTRUCTIONS TO THE BYSTANDER.
CAN I ASK A QUESTION REAL QUICK ON THE QUEUE FOR DISPATCH? WOULD YOU USE THE AUTOMATED SYSTEM NOW THAT WE'VE PUT INTO PLACE WHERE IT'S THE, I DON'T KNOW, RECORD IT.
I DON'T KNOW WHAT IT IS, BUT THAT AUTOMATED VOICE THAT GOES TO THE FIRE DEPARTMENT, IT SAYS YOU HAVE THIS CALL HAPPENING, THAT'S HOW IT WOULD WORK.
SO WHEN I SAY QUEUE, WE PUT INTO THE CAD SYSTEM THE ADDRESS AND THE NATURE.
WE HAVE ALL OF OUR FIRE AND EMS CALL SET TO AUTO FAST FORWARD, MEANING THE SECOND THE DISPATCHER TYPES THAT NATURE CODE, IT AUTOMATICALLY THROWS IT IN THE QUEUE.
THE PERSON DISPATCHING THE FIRE DEPARTMENT GRABS IT FROM THE QUEUE AND SENDS IT SO THEY PULL IT FROM THE QUEUE.
CLICK DISPATCH AND THAT'S WHEN THE AUTOMATED VOICE TAKES OVER AND DOES EVERYTHING.
BASED ON OUR SIZE OFTENTIMES, THE CALL TAKER IS ALSO THE DISPATCHER.
THEY ARE OK, SO THEY CAN CLICK THAT AND KEEP ON TALKING, AND THERE'S NO INTERRUPTION AT ALL.
[02:30:01]
SO AGAIN, FOR CITIZENS LISTENING WHAT THEY DON'T UNDERSTAND BY HAVING THIS SYSTEM IS THAT WE DON'T HAVE TO HAVE TWO PEOPLE NECESSARILY TO DISPATCH LIKE THEY KEEP ACQUIRING INFORMATION WHILE THE CALL HAS ALREADY BEEN DISPATCHED AND THEY'RE GETTING MORE AND MORE INFORMATION OR GUIDING THEM THROUGH POSSIBLY SOME EMERGENCY STEPS THAT THEY MIGHT NEED TO DO.YES, IT TAKES CARE OF DISPATCHING IT.
SO WE THERE'S NO BREAK IN CPR OR WHATEVER INSTRUCTIONS WE'RE GIVING TO THE CALLER.
IF YOU ALL HAVE ANY QUESTIONS FOR ME.
I DON'T NECESSARILY EXCUSE ME, I DON'T NECESSARILY I HAVE A QUESTION MORE OF A COMMENT.
YOU KNOW, I RETIRED FROM LAW ENFORCEMENT FORT WORTH AFTER ALMOST 30 YEARS.
ONE OF THE BIG THINGS I SEE IN DISPATCH MEDSTAR RESPONSE AND NOT A KNOCK ON MEDSTAR.
IT'S ALL OUTSIDE AGENCY RESPONSES.
AND IT DOESN'T LEND ITSELF TO ANALYTICS.
AND THIS IS SOMETHING THAT WON'T SHOW UP ON THIS BECAUSE IT DOESN'T.
THERE'S NOT A WAY TO ACTUALLY GET NUMBERS.
BUT THE WAY THE ACCIDENT SCENE WORKS, ESPECIALLY ON A FREEWAY OR SOMETHING, IS THE POLICE AND FIRE ARRIVE FIRST, THEY PARK A VERY EXPENSIVE PIECE OF FIRE EQUIPMENT.
I THANK THEM FOR IT AS A POLICE OFFICER BECAUSE THAT FIRE EQUIPMENT UNFORTUNATELY HAS BEEN HIT A FEW TIMES.
I KNOW IT'S A MULTIMILLION DOLLAR PIECE OF EQUIPMENT, BUT RATHER IT GET HIT THAN AN OFFICER OR FIREMAN THAT IS TRYING TO RENDER MEDICAL ASSISTANCE.
THAT SCENE CANNOT BE CLEARED UNTIL THE AMBULANCE ARRIVES.
NOW, IN ANY TYPE OF ACCIDENT SCENE, THERE'S A LOT OF TRAFFIC, THERE'S A LOT OF EVERYTHING GOING ON.
LOTS OF SIRENS DON'T WORK VERY WELL WHEN THE FREEWAY STOPPED AND AND EVERYTHING'S BLOCKED UP, SO IT TAKES A VERY LONG TIME TO CLEAR THAT SCENE.
THOSE AMBULANCES ARE OFTEN CALLED LATER THEY ARRIVE LATE.
THAT LEADS TO SECONDARY ACCIDENTS, AT LEAST THE MORE DANGER THAT LEADS TO, YOU KNOW, LIKE I MENTIONED, THAT I THANK THE FIRE DEPARTMENT FOR HAVING THAT BIG FIRE TRUCK, KEEPING THE FIRST RESPONDERS SAFE.
WHAT IT DOESN'T KEEP SAFE IS THAT MOM WITH HER KIDS STUCK IN TRAFFIC.
I KNOW WE TALKED EARLIER ABOUT, WELL, WE'RE SHAVING MINUTES HERE AND THERE.
EVERY SECOND COUNTS, AND IT'S CRITICAL BECAUSE THAT COULD BE THE DIFFERENCE BETWEEN A MOM AND HER KIDS MAKING IT HOME OR SOMEBODY ATTENDING HER FUNERAL.
WHILE THEY'RE SITTING IN TRAFFIC.
SO I THANK EVERYBODY FOR COMING FORWARD SHARING ALL THIS, BUT I WANTED TO MAKE THAT CLEAR BECAUSE THIS IS NOT SOMETHING WE CAN QUANTIFY IN NUMBERS.
I SAW THIS NUMEROUS TIMES THROUGHOUT MY CAREER AND THESE FIREMEN AND IF THE POLICEMEN WERE IN HERE THEY WOULD BACK ME UP ON THIS BECAUSE THIS IS A REGULAR OCCURRING.
THANK YOU, AND I AGREE WITH YOU.
HOW DOES THIS INTERFACE WITH THE POLICE? JIMMY'S POINT IS WELL TAKEN, BUT HOW DOES THAT INTERFACE, LIKE IS THE POLICE DEPARTMENT, NOTIFIED WHEN WE'RE GOING OUT ON A CALL OR IS IT NECESSARY? I MEAN, I DON'T HAVE 30 YEARS LIKE JIMMY SO.
IT'S DO YOU INTERFACE WITH THE POLICE DEPARTMENT ON SOME OF THIS STUFF.
WELL WE DISPATCH THE POLICE UNITS HERE IN BURLESON, SO THERE ARE MANY CALLS THAT BOTH POLICE AND FIRE RESPOND TO TOGETHER.
AND THE GOAL, ESPECIALLY IN THAT KIND OF INSTANCE, IS FOR FIRE TO BEAT POLICE OUT THERE.
JUST FOR THAT BLOCKING CAPABILITY, I HOPE I UNDERSTAND THE QUESTION CORRECTLY.
WE DO SOMETIMES RUN INTO AN ISSUE IF IT'S A CALL WHERE IT'S INVOLVING POLICE, FIRE AND EMS, AND WE HAVE TO GET MEDSTAR ON THE LINE.
FOR EXAMPLE, LET'S SAY THAT THERE WAS AN ACTIVE SHOOTER CALL.
WE ARE KIND OF DISCONNECTED FROM IT AT THAT POINT.
THEY TAKE OVER THE MEDICAL PART OF IT, BUT WE ALSO HAVE TO ASK SCENE SAFETY QUESTIONS.
SO, YOU KNOW, WE SHOULD ALWAYS FOLLOW EMD PROTOCOL NO MATTER WHAT.
BUT HAVING THAT EXTRA ELEMENT IN THERE CREATES PROBLEMS FOR US WITH THOSE TYPES OF CALLS.
ANYBODY ELSE? APPRECIATE GOOD JOB, THANK YOU.
MAYOR AND COUNCIL KT FREEMAN, AGAIN, FIRE CHIEF, AND NOW WE'RE GOING TO BE LOOKING AT OUR RESPONSE AND TRAVEL TIMES.
HOW FAST ARE OUR TRAVEL TIMES RESPONSE TIMES COMPARED TO OUR CURRENT PROVIDER? WELL, YOU'VE ALREADY HEARD IT FROM BOTH MEDSTAR AND OURSELVES.
MINUTES MATTER IN A PRIORITY ONE CALL WHERE LIVES ARE AT STAKE.
AND ONE OF THE THINGS LIKE I SAY, WE'RE NOT GOING TO QUIBBLE OVER WHETHER IT'S 15 MINUTES, 17 MINUTES.
THIS IS THE DATA THAT FITCH, THROUGH THEIR ANALYSIS HAS PROVIDED MEDSTAR'S AT THEIR 90TH PERCENTILE IS 18.9.
WHATEVER IT IS THAT DOES NOT INCLUDE, AS PAUL MENTIONED, THAT DOES NOT INCLUDE FROM HELLO
[02:35:01]
ON OUR END TO THE WAIT TIME.AND I THINK AGAIN, WHEN YOU LOOK AT A SCENE LIKE THIS, THIS IS DEFINITELY A PRIORITY ONE TYPE CALL WHERE THERE'S AN IMMINENT THREAT TO LIFE, SECONDS AND MINUTES COUNT.
WE HAVE TWICE AS FAST THE TRAVEL TIMES AND WE HAVE ALMOST, YOU KNOW, ONE AND A HALF TIMES, AT LEAST FOR OUR RESPONSE TIMES.
SO WE BRING THIS UP BECAUSE IT DOES MATTER NOT TO NIT PICK, BUT IT IS CLEAR THAT OUR TRAVEL TIMES ARE FASTER AND OUR RESPONSE TIMES ARE FASTER.
AND AT SOME POINT THAT CERTAINLY DOES AND CAN HAVE AN IMPACT ON PATIENT OUTCOMES.
SO LET'S LOOK AT BURLESON'S TRAVEL TIMES OPTIONS THAT WE'RE LOOKING AT.
WELL, HOW WOULD WE PROVIDE FAST TRAVEL TIMES AND OPTIONS FOR OUR AMBULANCE SERVICE? THEY'LL BE OUT OF OUR FIRE STATIONS AND WE HAVE THIS IS OUR NEWEST, YOU KNOW, NUMBER 16.
OUR FIRE STATIONS CURRENTLY ARE STRATEGICALLY LOCATED STATION FOUR WHEN IT COMES ONLINE.
WE'LL DO A FINAL ANALYSIS TO MAKE SURE IT'S STRATEGICALLY LOCATED BECAUSE AGAIN, IF WE'RE IN THE AMBULANCE TRANSPORT BUSINESS, WE WANT TO MAKE SURE THAT WE'VE COVERED THAT BASE.
OUR FACILITIES ARE SUSTAINABLE.
THEY ARE GEOGRAPHICALLY LOCATED.
AND ONE OF THE THINGS AND THIS IS WHERE WE WOULD RESPOND OUT OF.
ONE OF THE THINGS THAT I WANT TO DRAW TO COUNCIL'S ATTENTION TO THIS BECAUSE OUR MODEL OF DEPLOYMENT CONTRASTS TO WHAT YOU SAW WITH MEDSTAR'S.
AND IT CONTRASTS AGAIN, BECAUSE OUR MODEL IS BURLESON CENTRIC, IT'S NOT TRYING TO FEED A SYSTEM OF 14 OTHER SYSTEMS. AND IT'S IMPORTANT AGAIN.
AND THAT'S WHY I'M STRESSING THIS ABOUT BURLESON CENTRIC LOCAL CONTROL VERSUS A SYSTEM THAT IS HUGE.
FOR EXAMPLE, WHEN WE LOOKED AT THE SLIDE THAT MATT SHOWED WHERE UNITS ARE POSTED OR THEY'RE ASSIGNED, AND THEY'RE SOMEWHERE EITHER IN BURLESON OR AROUND BURLESON, IT IS NOT THE SAME AS OUR UNITS THAT WILL BE DEPLOYED IN OUR FIRE STATIONS BECAUSE OUR UNITS WILL BE ASSIGNED DEPLOYED FOR HERE.
AND ONE OF THE SLIDES WHERE IT SHOWED A COUPLE OF DIFFERENT ONES, THOSE UNITS AND ONE OF THE COUNCIL MEMBERS ASKED ABOUT IT.
THEY'RE IN THE AREA, BUT AT 11:23.
ONE TWO, HOWEVER MANY THEY CAN BE TAKEN OFF INTO THE DISPATCH TO THE OTHER PART OF THE SYSTEM.
SO AND I THINK THAT'S A DISTINCTION THAT WE'VE GOT TO WEIGH AND TAKE INTO CONSIDERATION IS THAT OUR UNITS WILL BE HERE PRIMARILY ASSIGNED AND READY TO RESPOND IN BURLESON, NOT JUST POSTING WITH THE INFERENCE THAT THEY'RE AVAILABLE FOR HERE, BUT THEY'RE NOT SOLELY DEDICATED HERE.
THEY WILL GO OFF AT ANY MOMENT TO WHEREVER THAT SYSTEM DEMAND IS.
WILL THEY SEND OTHER PEOPLE DOWN OR ANOTHER UNIT DOWN OR UNITS WHEN THEY CAN WHEN THE SYSTEM ALLOWS IT? SO I THINK IT'S A CLEAR DISTINCTION ABOUT HOW OUR MODEL IS BUILT AND THE ADVANTAGES THAT IT WOULD PROVIDE FOR THIS COMMUNITY.
SO I WANT TO TAKE YOU BACK TO OUR HEAT MAP THAT FITCH SHOWED.
AGAIN, YOU CAN SEE THIS IS THE AREA.
I DON'T HAVE A CURSOR, BUT BASICALLY UP 174.
YOU CAN SEE THAT MAJORITY OF OUR EMS CALLS HISTORICAL EMS CALLS LAST YEAR BETWEEN STATION 1, STATION 16 AND STATION THREE, AND IT'S IN THE CENTER OF THE CITY.
SO I JUST WANTED TO TAKE YOUR ATTENTION BACK TO THAT TO GIVE YOU AN IDEA OF REALLY WHAT GOES ON AND WHERE IT GOES ON IN THE CITY.
ONE OF THE PROPOSALS THAT WE ARE BRINGING FORTH IS WE WILL NOT HAVE TWO AMBULANCES WE'RE NOT PROPOSING TWO AMBULANCES.
CASEY'S GOING TO TALK IN MORE DETAIL ABOUT THAT, ABOUT THE ANALYTICS.
BUT AS YOU CAN SEE ON THIS SLIDE, IF WE POSTED ONE AMBULANCE AT 16S, IT CAPTURES ALMOST 80 PERCENT OF THE HISTORIC CALLS EMS CALLS IN THE CITY.
AND THESE COLORS DEPICT THE AREAS HOW LARGE OF AN AREA IN THE CITY A NINE MINUTE TRAVEL TIME CAN CAPTURE.
WE HAD A SECOND AMBULANCE WE WOULD POST IT AT STATION ONE, WHICH THEN WE'D CAPTURE NINETY TWO PERCENT OF OUR EMS CALLS AND THEN IF WE POSTED A THIRD AMBULANCE AT STATION THREE WITH A NINE MINUTE TRAVEL TIME.
AND THIS IS THE MINIMUM THAT WE WOULD HAVE BECAUSE WE ARE ACTUALLY GOING TO DISCUSS A FOURTH AMBULANCE, BUT I'M NOT GOING TO GET AHEAD OF CASEY.
BUT WITH A THIRD AMBULANCE, WE WOULD BE ABLE TO CAPTURE ALMOST NINETY FOUR PERCENT FOR EMS CALLS FROM THESE THREE LOCATIONS.
[02:40:01]
AMBULANCES DEDICATED FOR HERE NOT POSTING SOMEPLACE ELSE.ON A 10 MINUTE TRAVEL TIME, AS YOU CAN SEE, IF WE PUT OR WE WOULD HAVE AN AMBULANCE AT STATION 16, YOU CAN SEE THE STRATEGIC EFFECTIVENESS THERE AND THE EFFICACY.
92 PERCENT OF CALLS WITH A 10 MINUTE TRAVEL TIME WOULD BE CAPTURED IN AMBULANCE STATION ONE.
97 PERCENT OF CALLS CAPTURED AND A THIRD AMBULANCE AT STATION THREE WOULD CAPTURE NINETY EIGHT PERCENT OF OUR HISTORICAL EMS CALLS.
THE YELLOW IS JUST SO YOU CAN MAKE IT A LITTLE BIT EASIER AND THEN YOU SEE THE OVERLAPS.
BUT NINETY EIGHT PERCENT OF THE CITY AND THE HISTORICAL CALLS ARE CAPTURED WITH THE DEPLOYMENT MODEL THAT WE ARE BRINGING FORTH FOR CONSIDERATION.
ALL RIGHT, I THINK ANY QUESTIONS ON THAT, I'M GOING TO HAND IT OFF TO CASEY.
THANK YOU, MAYOR AND COUNCIL FOR AN OPPORTUNITY TO COME BEFORE YOU AND SPEAK, I'M CASEY DAVIS, THE ASSISTANT FIRE CHIEF.
SO I'M GOING TO WALK THROUGH A FEW SLIDES WITH YOU HERE, EXPLAIN A FEW AREAS.
I WANT TO START OFF WITH THE NATIONAL FIRE PROTECTION AGENCY, OR NFPA 1221.
WE ARE AN ACCREDITED ISO ONE CLASS ISO ONE FIRE DEPARTMENT AND BEING A PART OF THAT REQUIRES THAT WE RESPOND IN AN APPROPRIATE, TIMELY MANNER TO CERTAIN CALL TYPES.
AND THEY DEFINED BROADLY SEVERAL CALL TYPES AS IMMINENT THREAT TO LIFE.
AND SO IN OUR SYSTEM, WE USE A PRIORITY RESPONSE SYSTEM.
AND SO WHEN NFPA 1221 IS TALKING ABOUT THAT, THEY'RE TALKING ABOUT THESE PRIORITY ONE CALLS AND PRIORITY ONE CALLS ARE ACUTE LIFE THREATENING INJURY OR ILLNESS.
SO THIS IS SOMEONE THAT COULD BE EXPERIENCING CPR, NOT BREATHING, CHOKING, SOMEBODY HAVING CHEST PAIN, SOMEONE THAT WAS SHOT OR STABBED.
YOU KNOW, THINGS OF THAT NATURE, SOMEONE EXPERIENCING AN ANAPHYLACTIC REACTION OR AN ALLERGIC REACTION, THINGS LIKE THAT WHERE THE TIME MATTERS.
SO IT'S IMPORTANT THAT YOU UNDERSTAND THE DIFFERENCE IN THESE PRIORITIES BEFORE WE MOVE ON TO THE NEXT FEW SLIDES.
PRIORITY TWO THAT'S NOT WHAT NFPA 1221 IS TALKING ABOUT.
THEY'RE TALKING ABOUT THE PRIORITY ONE, BUT THE PRIORITY TWO ARE EXTREMELY IMPORTANT AND WE NEED TO RESPOND TO THOSE AS QUICKLY AS POSSIBLE AS WELL.
THESE ARE PATIENTS THAT ARE CURRENTLY STABLE, BUT THE CONDITION COULD PROGRESS TO A LIFE THREATENING INJURY OR ILLNESS.
AND THESE COULD BE THINGS LIKE THINK OF SOMEONE THAT'S HAVING A DIABETIC EMERGENCY.
YOU KNOW, THEIR BLOOD SUGAR IS REALLY LOW.
BUT IF WE DON'T CORRECT THAT IN A TIMELY FASHION, THEN IT COULD PROGRESS TO A WORSE OUTCOME OR EVEN DEATH.
A CAR ACCIDENT, A LOT OF TIMES COULD BE A PRIORITY TWO JUST DIFFERENT, TYPES OF MEDICAL EMERGENCIES LIKE THAT.
SO AGAIN, THESE PATIENTS AT THE MOMENT ARE STABLE, BUT THEY COULD PROGRESS TO A LIFE THREATENING INJURY OR ILLNESS.
PRIORITY 3S THESE ARE PATIENTS THAT NEED A MEDICAL EVALUATION AND ARE NOT EXPECTED TO BE EXPERIENCING A LIFE THREATENING INJURY OR ILLNESS.
AND THE REASON WHY I WANT TO BRING THIS TO YOUR ATTENTION BEFORE WE MOVE ON TO THE NEXT FEW SLIDES IS BECAUSE WE'RE GOING TO TALK ABOUT PERFORMANCE.
YOU KNOW WHERE OUR SYSTEM IS RIGHT NOW AND WHERE WE THINK WE CAN GO.
SO HOW WELL IS OUR CURRENT EMS PROVIDER PERFORMING MEASURED AT THE EIGHTY FIFTH PERCENTILE? NOW THIS IS MEDSTAR'S SYSTEM PERFORMANCE MEASURES FOR 2021.
THIS DATA IS NOT INCLUDED IN FITCH'S REPORT.
THIS IS MEDSTAR'S DATA THAT THEY REPORT TO THEIR BOARD MONTHLY FOR THEIR BOARD PACKETS.
THAT'S WHERE WE RECEIVED THIS INFORMATION FROM.
SO THIS IS INDEPENDENT FROM THE STUDY AND THIS IS CURRENTLY FOR 2021.
SO THE WAY YOU READ THIS HERE IS AGAIN, THIS IS PRIORITY ONE CALLS THOSE ACUTE LIFE THREATENING INJURY OR ILLNESS CALLS WHERE SOMEONE NEEDS CPR, NOT BREATHING.
YOU KNOW, WE HAVE REASON TO BELIEVE THAT A LIFE THREATENING INJURY OR ILLNESS IS IMMINENT.
SO IF YOU LOOK AT JUST HOW PERFORMANCE HAS BEEN IN 2021, THE GOAL IS TO BE THERE IN 11 MINUTES OR LESS EIGHTY FIVE PERCENT OF THE TIME.
I'M PART OF THE SYSTEM PERFORMANCE COMMITTEE FOR MEDSTAR, FOR THE MEDSTAR SYSTEM.
WE SAT DOWN AS A GROUP TO AFTER THE FIRST INTER-LOCAL CHANGE TO REDEFINE THESE PERFORMANCE MEASURES.
AND AT THAT TIME IT WAS BASICALLY, YOU KNOW, AND I'M RECALLING THE MEETING WAS
[02:45:08]
THAT THESE PERFORMANCE MEASURES WERE PRESENTED AS REALISTIC AND ACHIEVABLE, THAT MEDSTAR BELIEVED THAT THEY COULD HIT THESE ON A RELIABLE, YOU KNOW, TIME FRAME ONGOING.YOU KNOW THAT THESE WERE REALISTIC FOR THEM.
AND AS MATT SAID, THIS IS SUPPOSED TO BE FROM WHEN THEY HAVE THAT FIRST KEYSTROKE TILL THEY'RE ON SCENE.
SO THE COMMITTEE SAID, OK, 11 MINUTES EIGHTY FIVE PERCENT OF THE TIME FOR THE HIGHEST PRIORITY CPR, NOT BREATHING CALLS IN OUR SYSTEM.
AND AS YOU CAN SEE HERE, THE TREND LINE FOR 2021 IS DOWN.
THEY'RE NOT MEETING THE PERFORMANCE FOR OUR HIGHEST PRIORITY CALLS, AND WE BELIEVE IT'S DUE TO THE WAY THE SYSTEM IS SET UP, THE WAY THAT THE TRUCKS HAVE TO POST, AND THE SYSTEM GETS BUSIER AND IT MOVES TRUCKS CLOSER TO THE CORE OF THE CITY AND THINGS OF THAT NATURE.
SO IF YOU LOOK IN JUST OCTOBER, THERE WAS ONE HUNDRED AND FORTY OF THESE CALLS AND FORTY FOUR TIMES THEY WERE LATE TO ONE OF THOSE CALL TYPES.
AND NOTHING REALLY CHANGES WITH THE GRAPH HERE OTHER THAN THESE ARE JUST THOSE PRIORITY TWO CALLS.
SO THESE ARE CALLS WHERE THE PATIENT IS CURRENTLY STABLE, BUT THEY COULD PROGRESS TO A LIFE THREATENING INJURY OR ILLNESS.
BUT WE GIVE 13 MINUTES, EIGHTY FIVE PERCENT OF THE TIME TO HIT THOSE AND AGAIN IN 2021, THERE WASN'T ONE TIME THAT THIS GOAL WAS HIT AND THIS IS IN BURLESON.
I WANT TO BE VERY WALK THAT BACK.
THEY REPORT FOR EACH MEMBER CITY IN THEIR PACKET, AND THIS IS SPECIFICALLY FOR BURLESON.
SO, YOU KNOW, AGAIN, THE TREND LINE HERE FOR PRIORITY 2S IS DOWN.
SO PRIORITY THREES, THESE CALLS FOR SERVICE THAT HAVE 17 MINUTES TO GET THERE EIGHTY FIVE PERCENT OF THE TIME.
NOW THEY START HITTING SOME OF THESE GOALS.
SO FOUR OUT OF 10 TIMES FOR FOUR MONTHS, OUT OF 10 MONTHS, THEY WERE ABLE TO HIT THIS GOAL.
AND YOU CAN SEE THEY HAD 17 MINUTES.
SO THE MORE TIME THAT THEY HAVE TO GET TO THE CALL, THE MORE LIKELY THEY ARE TO HIT THAT GOAL.
AND WE THINK THIS IS CONSISTENT WITH FITCH'S ANALYSIS OF MEDSTAR'S DATA, AND WE THINK THIS IS REAL WORLD SHOWING WHERE THE PERFORMANCE OF THE SYSTEM IS RIGHT NOW.
EARLIER, MEDSTAR'S GUYS ATTRIBUTED PART OF THIS TO PROTOCOL 36.
DO YOU CONCUR WITH THAT? WAS THIS AFFECTED BY THE COVID PROTOCOL, OR DO YOU THINK THERE'S MORE OF AN UNDERLYING CAUSE.
SO MATT ALLUDED TO THAT THAT PROTOCOL STOPPED IN MARCH OF 2021.
AND SO IF THAT PROTOCOL STOPPED IN MARCH OF 2021 I DON'T KNOW HOW IT EXPLAINS.
I THOUGHT THEY RESTARTED IT IN AUGUST AND SEPTEMBER.
IS THAT NOT CORRECT? NO, THAT'S NOT MY UNDERSTANDING.
THE PROTOCOL ALL RIGHT I MISUNDERSTOOD.
AND I WANT TO SPEAK SPECIFICALLY TO THE PROTOCOL FOR A MOMENT.
I RECALL BEING A PART OF A DISCUSSION ABOUT THAT.
AND IN THAT MEETING, I SAID, YOU KNOW, AT THE TIME, BURLESON WAS PRE ALERTING WHENEVER WE HAD THESE HIGH ACUITY CALLS.
OUR DISPATCHERS BEFORE THEY TRANSFERRED THE CALL OVER TO MEDSTAR WOULD JUST IMMEDIATELY DISPATCH US AND WE WOULD GO AND I TOLD THEM THAT THAT'S EXACTLY WHAT WE WOULD CONTINUE TO DO THROUGH THE PANDEMIC, AND THAT IS EXACTLY WHAT WE CONTINUED TO DO THROUGH THE PANDEMIC.
I DIDN'T SEE A NEED FOR US TO DELAY.
WE HAD A SCREENING TOOL THAT WHEN WE GOT ON SCENE WITH A PATIENT THAT WE THOUGHT COULD HAVE COVID, WE SCREENED RIGHT THERE IN REAL TIME.
WE SENT JUST ONE RESPONDER UP FIRST TO DO THE SCREENING AND THEN THE REST OF THE RESPONDERS CAME UP AS NEEDED.
SO WE TRIED EVERYTHING WE COULD TO MAKE SURE OUR RESPONDERS WERE SAFE DURING THAT TIME AS WELL.
WE PROVIDED THEM WITH ALL THE PROPER PPE AND TRAINING THAT THEY NEEDED TO DO THAT.
BUT FOR BURLESON, THAT'S HOW WE HANDLED THAT, SITUATION.
SO THAT'S REALLY ALL I CAN SPEAK TO ON THAT PROTOCOL.
SO LET'S TALK ABOUT SOME OPTIONS FOR BURLESON.
FITCH RAN SOME DEMANDS VERSUS STAFFING ANALYSIS FOR US, AND THAT'S WHAT THIS SLIDE HERE SHOWS.
SO THIS IS THERE'S A LOT GOING ON HERE, SO I'M GOING TO TRY TO SLOWLY WALK YOU THROUGH THIS SLIDE.
OK, SO THE RED LINE REPRESENTS TWO TWENTY FOUR HOUR AMBULANCES.
IF YOU LOOK AT THE VERY BOTTOM OF THE SLIDE, YOU'LL SEE ALL OF THESE NUMBERS.
THAT IS EVERY HOUR OF THE DAY, BASICALLY.
SO YOU START OVER HERE ON THE VERY FAR LEFT OF THE SLIDE AT ZERO, THAT'S
[02:50:02]
MIDNIGHT AND YOU GO TO THE RIGHT TO THE NEXT ZERO, THAT'S MIDNIGHT TO MIDNIGHT.SO THAT'S TWENTY FOUR HOURS, RIGHT? SO THAT'S A REPRESENTATION OF SUNDAY.
SO AS YOU CAN SEE, THERE'S A PATTERN TO OUR EMERGENCIES FROM DAY TO DAY.
SO THE NEXT ZERO TO ZERO IS MONDAY TUESDAY, WHEN ALL THE WAY THROUGH SATURDAY, RIGHT? SO THIS IS 2020 DATA OF EMS CALLS, ALL THE EMS CALLS THAT HAPPENED IN BURLESON AND WHAT WAS THE CAPACITY TO TAKE CARE OF THOSE SO A TWO AND THE LET ME BACK UP JUST QUICK.
THE BLUE REPRESENTS GEOGRAPHICAL NEED TO GET TO ALL OF THESE CALLS WITHIN TEN MINUTES, RIGHT? SO THE GREEN REPRESENTS THE CALL VOLUME.
THE BLUE REPRESENTS, YOU KNOW, KIND OF HOW THE CALLS ARE DISPERSED THROUGHOUT THE CITY.
SO THIS SHOWS THAT, YOU KNOW, THERE ARE TIMES THAT THE CAPACITY WOULD GO OVER TO AMBULANCES.
WHEN YOU BUILD AN EMS SYSTEM, YOU BUILD IT TO THE 90TH PERCENTILE.
CAN YOU ACHIEVE WHAT YOU NEED TO ACHIEVE THE MAJORITY OF THE TIME THAT 90TH PERCENTILE? AND THAT'S WHAT THIS REPRESENTS HERE.
SO THOSE YELLOWS ARE WHEN THE CAPACITY WOULD HAVE BEEN MORE THAN TWO AMBULANCES WHERE YOU WOULD NEED MUTUAL AID OR, YOU KNOW, HANDLE THAT SITUATION DIFFERENTLY.
SO THAT'S JUST WITH TWO AMBULANCES AND WE'RE NOT RECOMMENDING THAT.
SO WHAT WOULD TWO TWENTY FOUR HOUR A DAY AMBULANCES AND A THIRD AMBULANCE ONLY DURING PEAK HOURS? SO OUR PEAK HOURS ARE CLEARLY DEFINED HERE.
OUR BUSIEST TIME OF DAY IS 9:00 A.M.
THE CALL VOLUME DIPS OFF QUITE CONSIDERABLY.
SO WITH A [INAUDIBLE] THIRD THAT'S JUST DURING THE PEAK HOURS.
YOU CAN SEE WITH THIS SLIDE HERE THAT YOU GET GREAT CAPACITY AND DEMAND WITH THAT WITH JUST TWO AND A HALF AMBULANCES, WE WOULD BE ABLE TO TAKE CARE OF, YOU KNOW, THE CALL VOLUME.
SO WE EVEN RAN THE MODEL, WHAT IF WE DID THREE TWENTY FOUR HOUR AMBULANCES AND A FOURTH AMBULANCE ONLY DURING THE PEAK HOURS AND AGAIN HERE THE CAPACITY IS, AS YOU CAN SEE, IS VERY WELL TAKEN CARE OF.
SO THIS WAS ADDITIONAL DATA THAT THAT WE HAD FITCH RUN FOR US TO BE ABLE TO SHOW THIS CAPACITY AND EXPLAIN THIS TO YOU.
I THINK IT'S A GOOD VISUAL REPRESENTATION OF WHAT THE AVAILABILITY OF THE UNITS WOULD BE BECAUSE THEY'RE NOT ON A CALL THE WHOLE TIME.
AND WHENEVER YOU HAVE THREE OF THEM DEDICATED TO BURLESON, YOU'RE GOING TO BE ABLE TO TAKE CARE OF THE VOLUME OF NEED.
SO WE TOOK IT A STEP FURTHER WITH FITCH, AND WE SAID, OK, HOW MANY TIMES ARE WE HAVING MORE THAN ONE CALL? YOU KNOW, WE WENT AND LOOKED AT MEDSTAR'S 2020 DATA FOR THE EMS CALLS AND BURLESON AND FIFTY FOUR POINT FOUR PERCENT OF THE TIME.
YOU KNOW, THAT'S PRETTY STANDARD FOR US, AND THE EMS CALL COMES IN.
WE GO HANDLE THE EMS CALL, THE SYSTEM RESETS AND WE'RE READY TO GO.
SO 30 PERCENT OF THE TIME, WE NEED TWO AMBULANCES.
THREE AMBULANCES, WE NEED 11 PERCENT OF THE TIME.
SO RIGHT THERE YOU'RE AT NINETY SIX PERCENT OF ALL THE CALLS FOR 2020 THAT YOU NEEDED THREE AMBULANCES.
SO YES, ON A FRIDAY, COULD WE HAVE A PEAK WHERE WE NEED SIX UNITS? ABSOLUTELY AND THIS SHOWS THAT WE HAD FIVE TIMES LAST YEAR WHERE WE NEEDED FIVE AMBULANCES.
SO YOU TAKE THAT A STEP FURTHER.
YOU LOOK AT HOW OFTEN YOU NEED FOUR UNITS, THREE PERCENT OF THE TIME AS YOU GO THROUGH THIS HERE.
SO AGAIN, WE CAN HANDLE OVER 90 PERCENT OF THE CALLS, EVEN OVERLAPPING CALLS WITH THREE UNITS.
I MEAN, YOU KNOW, JUST LOOKING AT THIS DATA BY ITSELF, IT'S NINETY SIX PERCENT OF THE TIME.
CHIEF, CAN I HOLD YOU UP JUST [INAUDIBLE].
MEDSTAR, BY THEIR OWN NUMBERS, EARLIER SAID THEY WERE ONLY ABLE TO FULLY MEET OUR NEEDS NINETY SEVEN PERCENT OF THE TIME.
THREE THREE PERCENT OF THE TIME THEY HAD TO GO OUTSIDE OF MEDSTAR.
SO LOOKING AT THIS CHART, IT LOOKS LIKE THE SAME THRESHOLD GETS MET AT THREE UNITS.
I BELIEVE BOTH ARE CONSISTENT WITH THAT ANALYSIS.
ABOUT THREE TO FOUR PERCENT A MONTH FOR MUTUAL AID.
SO, YOU KNOW, WHAT CAN BURLESON FIRE RESCUE DO? YOU KNOW? BURLESON CAN PROVIDE AN EXCEPTIONAL AND ROBUST RESPONSE CAPABILITY THAT MEETS THE DEMAND FOR TRANSPORT, WITH APPROXIMATELY TWICE AS FAST TRAVEL TIMES.
YOU KNOW, FITCH'S MADE THAT DATA CLEAR TO US.
WE ANECDOTALLY BELIEVE THAT WE WERE GETTING THERE MUCH QUICKER THAN MEDSTAR THE MAJORITY OF THE TIME AND THAT FARES OUT.
SO I KNOW THERE'S BEEN LOTS OF DISCUSSION ABOUT WHAT THE SQUADS WERE FOR AND WHY WE HAD THE SQUADS AND, YOU KNOW, AS WE'VE BEEN BUILDING THIS MODEL AND CHIEF HAS, YOU KNOW, TALKED TO COUNCIL BEFORE.
[02:55:01]
THERE WAS A TIME WHEN WE WERE GOING TO COME BACK AND TALK ABOUT THE SQUADS, YOU KNOW, BEING AMBULANCES, BEING ABLE TO INCREASE THAT CAPACITY OF WHAT THEY CAN DO, ENHANCE OUR SYSTEM AND WITH THREE AMBULANCES YOU CAN STILL USE.SO I SHOWED YOU THE MAJORITY OF THE TIME WITH TWO AMBULANCES, YOU CAN HANDLE EVERYTHING.
SO THAT THIRD AMBULANCE CAN DO A LOT OF THE SAME FUNCTIONS THAT OUR SQUAD DOES TODAY BECAUSE IT'S NOT GOING TO BE ON CALLS ALL THE TIME.
ALL OF THEM ARE NOT GOING TO BE ON CALLS TWENTY FOUR HOURS A DAY.
WE KNOW WE CAN DO THIS WITH A RESPONSIBLE CAPACITY.
YOU KNOW, WE DIDN'T JUST FEEL THAT OR THINK THAT WE GOT A THIRD PARTY CONSULTANT WITH FITCH TO FARE THAT DATA OUT FOR US.
SO WE KNOW THAT WE CAN CONTINUE TO DO THE SAME PROGRAMS THAT WE'RE DOING WITH THE SQUAD NOW.
WE'RE VERY SMALL AGENCY IN A LOT OF WAYS.
WE'RE VERY NIMBLE AND FLEXIBLE AND WE CAN BE CREATIVE WITH OUR WITH OUR RESPONSES AS WE SEE A NEED TO BE.
SO BURLESON AMBULANCE CAN FUNCTION ON A FIRE SCENE.
IT CAN BE RIT FOR US, A RAPID INTERVENTION TEAM, BECAUSE IT'S STAFFED WITH FIREFIGHTERS THAT ARE ALSO PARAMEDIC AND EMT TRAINED, SO IT GIVES US MORE FLEXIBILITY THERE.
WE'RE NOT GOING TO STRIP THE ENTIRE CITY AND NOT HAVE EMS COVERAGE DURING A FIRE.
WE'RE ENHANCING BY ADDING THESE AMBULANCES SO THAT WE CAN CONTINUE TO HAVE THAT BECAUSE WHEN WE GET A FIRE, NOW WE ARE LIMITED IN OUR CAPACITY.
SO ADDING THESE AMBULANCES INCREASES AND ENHANCES OUR SYSTEM.
WE'LL BE ABLE TO MEET THE EMS NEED AND DEMAND BE ABLE TO ENHANCE OUR FIRE AND NOT TAKE AWAY FROM WHAT THE SQUAD IS CURRENTLY DOING.
THESE AMBULANCES CAN PARTICIPATE IN ALL OF OUR PROGRAMS. OUR COMMUNITY RISK REDUCTION PROGRAMS, OUR, YOU KNOW, FIRE PREVENTION PROGRAMS AT THE SCHOOL, OUR HANDS ONLY CPR, OUR STOP THE BLEED PROGRAMS THAT WE DO.
YOU KNOW, THEY'LL BE JUST LIKE ANY OTHER CREW THAT IS LIKE AN ENGINE CREW.
THEY'RE GOING TO BE AVAILABLE FOR CALLS WHILE THEY'RE DOING THOSE PROGRAMS. WE DO THAT NOW EVERY DAY WITH OUR REGULAR CREWS, SO THEY'RE GOING TO BE ABLE TO PARTICIPATE.
WE'RE GOING TO BE ABLE TO ROTATE THOSE CREWS FROM THE ENGINE TO THE AMBULANCE TO KEEP THEIR SKILLS UP, TO MAKE SURE THAT EVERYBODY'S NOT GETTING BURNED OUT, YOU KNOW, AND TO MEET THE COMMUNITY RISK REDUCTION NEEDS FOR OUR COMMUNITY.
SO WE BELIEVE THAT BURLESON AMBULANCE IS SIGNIFICANTLY ENHANCE OUR FIRE AND EMS SYSTEM BY HAVING THREE TRANSPORT UNITS LOCATED IN BURLESON FIRE STATIONS THAT ARE FULLY DEDICATED TO SERVE THE PRIMARY NEEDS OF THE COMMUNITY AND DEPARTMENT.
SO THIS NEXT SLIDE IS JUST OPTIONS TO CONSIDER.
WE KNOW THAT THIS IS FULLY COUNCIL'S DECISION AND WE WILL SUPPORT WHATEVER YOUR DECISION IS.
WE JUST WANT TO BRING THE FACTS BEFORE YOU AND TELL YOU WHAT WE BELIEVE IS THE RIGHT THING FOR THE COMMUNITY FROM THE ANALYSIS THAT WE'VE SEEN IT AND SHARE WITH YOU THE RECOMMENDATION THAT WE BELIEVE WOULD BEST FIT OUR NEEDS.
SO OPTION A IS CURRENT BUDGET.
CURRENT BUDGET AND STAFFING LEVELS WILL ALLOW FOR THE DEPLOYMENT OF TWO AMBULANCES.
YOU KNOW THIS LAST-- THE BUDGET YEAR WE'RE IN NOW, WE GOT THE STAFFING TO BRING ON THE SECOND SQUAD.
SO WE HAVE THE STAFFING AND CAPABILITY TO DO TWO AMBULANCES NOW.
OPTION B IS AN ENHANCED STAFFING MODEL WHERE WE COULD HIRE FOR FIREFIGHTERS AND IMPLEMENT AN ALTERNATIVE STAFFING PLAN WITH THREE AMBULANCES DURING PEAK HOURS NINE A TO NINE P AND THAT'S A MINIMUM RIGHT BUT WE'RE JUST SAYING THAT, THAT'S A MINIMUM OPTION IF WE HIRE THOSE FOUR FIREFIGHTERS AND SO WE WOULD-- IT DOESN'T GIVE US QUITE THE FLEXIBILITY AS THE NEXT OPTION, BUT IT DOES ENHANCE OUR SERVICE TO OUR CITIZENS.
IT DOES PROVIDE FOR THREE AMBULANCES IN THE SYSTEM AND IT INCREASES THE SERVICE LEVEL THAT WE PROVIDE NOW.
OPTION C THIS IS AN ENHANCED STAFFING MODEL THAT HIRES SIX FIREFIGHTERS AND IMPLEMENTS AN ALTERNATIVE STAFFING PLAN THAT PROVIDES FOR THREE AMBULANCES DURING PEAK NINE A TO NINE P AND THE FOURTH FIREFIGHTER-- IF YOU TURN THAT PEAK AMBULANCE OFF, YOU COULD PUT A FOURTH FIREFIGHTER BACK ON ENGINE ONE AND ENGINE THREE AFTER THE PEAK.
ENGINE 3'S OUT THERE, KIND OF ON THE FRINGES OF THE SYSTEM.
SO THAT'S ALWAYS IMPORTANT FOR US TO TRY TO KEEP FOUR FIREFIGHTERS OUT THERE.
OPTION D IS AN ENHANCED STAFFING MODEL WHERE WE HIRE EIGHT FIREFIGHTERS AND IMPLEMENT AN ALTERNATIVE STAFFING PLAN THAT PROVIDES FOR FOUR AMBULANCES DURING PEAK NINE A TO NINE P AND THREE AMBULANCES TWENTY FOUR HOURS A DAY.
FOURTH FIREFIGHTER CAN GO BACK TO ENGINE ONE AND ENGINE THREE AFTER THE PEAK.
NOW THE STAFF IS RECOMMENDING OPTION C.
WE BELIEVE THAT GIVES US THE MOST FLEXIBILITY THAT WE NEED TO STAFF EVERYTHING APPROPRIATELY AND PROVIDE THE RIGHT LEVEL OF SERVICE.
THE THING THAT-- WE'RE GOING TO GO THROUGH THE PRO FORMA AND WE'RE GOING TO TALK ABOUT CAPITAL CAPITAL LAYOUT WITH MARTIN HERE SHORTLY.
[03:00:01]
WHEN WE'RE TALKING ABOUT HAVING THREE AMBULANCES, WHEN WE GET TO TALKING ABOUT CAPITAL, THAT'S THREE AMBULANCES DEDICATED TO SERVICE AND THAT'S A FOURTH AMBULANCE AS A RESERVE UNIT.OK, SO US BEING FLEXIBLE AND NIMBLE SYSTEM LIKE WE ARE, CHIEF AND I HAVE DISCUSSED, IF WE GO WITH OPTION-- IF WE GO WITH ANY OF THE OPTIONS, OBVIOUSLY, ONE OF THE THINGS THAT WE CAN DO WITH THAT FOURTH AMBULANCE WHENEVER IT'S NOT BEING USED IN RESERVE CAPACITY IS WE'LL HAVE THAT LICENSED, STOCKED, READY TO GO AT ONE OF THE FIRE STATIONS AND IT CAN BE CROSS STAFF JUST LIKE WE CROSS STAFF A BRUSH TRUCK TODAY OR A RESCUE.
SO IN THE TIMES WHEN WE GET INTO THOSE RARE OCCASIONS WHERE WE NEED MORE THAN THREE AMBULANCES, WE'LL HAVE AN ALTERNATIVE OPTION TO BE ABLE TO CROSS STAFF THAT AMBULANCE AND IMMEDIATELY RESPOND IT TO A CALL AND WE'RE STILL GOING TO HAVE THE ABILITY TO HAVE MUTUAL AID WITH OUR PARTNERS AROUND US, AND WE HOPE AND EXPECT TO STILL BE ABLE TO HAVE MUTUAL AID WITH MEDSTAR AS PART OF OUR PLAN AS WELL.
SO WE THINK THAT WE CAN DO THIS.
WE THINK THAT WE CAN PROVIDE A BETTER SERVICE HERE WITH THE QUICKER TIMES AND SEAMLESS, YOU KNOW, TRANSITION FROM WHEN SOMEBODY CALLS UNTIL WE GET THERE.
YOU KNOW, WE'RE DOING THIS BECAUSE WE BELIEVE IT'S THE RIGHT THING TO DO AND I'M HAPPY TO ANSWER ANY QUESTIONS YOU MAY HAVE ABOUT THE SLIDES THAT I WENT OVER.
SO YOU WILL STAFF THE BOXES WITH TWO PARAMEDICS? SO IT'LL BE AN EMT AND A PARAMEDIC BECAUSE WHAT WE WANT TO DO IS WE WANT TO LEAVE PARAMEDICS ALSO ON OUR FIRST RESPONDING UNITS AS WELL.
SO WHEN WE HAVE A NEED FOR AN ENGINE TO GET THERE BEFORE THE AMBULANCE, THAT IT'S NO DIP IN THE LEVEL OF SERVICES, YOU KNOW, NO CHANGE IN THE LEVEL OF SERVICE.
SO I SHOULD HAVE SAID THIS WHEN CHIEF FREEMAN WAS UP THERE, BUT I'M GOING TO TELL YOU, I DON'T CARE FOR THE BURLESON FIRE AND RESCUE NAME.
I THINK RESCUE KIND OF HAS A DIFFERENT MINDSET TO IT.
I LIKE FIRE AND [INAUDIBLE] EMS, EXCUSE ME, I THINK RESCUE YOU THINK OF SWIFT WATER, YOU THINK OF OTHER MORE TRAUMATIC THINGS, AND I DON'T THINK IT'LL LAND VERY WELL.
BUT I ALSO THINK JUST KEEPING IT BURLESON FIRE DEPARTMENT IS ALSO FINE.
QUITE FRANKLY, I MEAN, THAT'S A LOT OF OTHER FIRE DEPARTMENTS.
THEY ALL PROVIDE THEIR AMBULANCE SERVICES AND THEY'RE JUST, YOU KNOW, WHATEVER FIRE DEPARTMENT KIND OF THING.
SO THAT'S MY TWO CENTS ON THAT AND I APPRECIATE THAT.
YOU KNOW, AND I THINK REALLY WHAT WE'RE TRYING TO SAY IS WE'RE JUST TRYING TO SHOW THAT, YOU KNOW, THE MAJORITY OF WHAT WE DO IS THE EMS AND SO HOW WE REBRAND THAT I THINK IS OBVIOUSLY UP FOR DISCUSSION, YOU KNOW BUT.
[INAUDIBLE] DO, I'M GOING TO POINT OUT, ACTUALLY CLIMB UP TOWERS TO DO RESCUES AS WELL.
ANY OTHER QUESTIONS? JUST ONE QUICK QUESTION.
IF WE GO TO THIS FIRE-- GO TO THE AMBULANCE SERVICE.
I KNOW THAT ON SWAT CALLS ON STRUCTURE FIRES.
THE HOPE AND DESIRE IS THAT NO ONE GET INJURED.
BUT I KNOW THE FLIP SIDE OF THAT IS THAT WHEN SOMEBODY DOES GET INJURED, IT'S USUALLY A QUICK RUSH TO THE HOSPITAL BECAUSE IT GOES FROM NOTHING TO VERY SEVERE.
IF WE GO TO THIS MODEL, WE WILL HAVE AMBULANCES AVAILABLE THAT CAN RESPOND RIGHT THERE ON THE SCENE AND BE AVAILABLE FOR IMMEDIATE TRANSPORT SHOULD THAT BE NECESSARY.
DIDN'T YOU BRING A BUDGET ON THIS BEFORE? YES, SIR.
THAT'S WHAT WE'RE GOING TO GO INTO THAT HERE SHORTLY.
SO WHENEVER WE GET TO THE PRO FORMA IT WILL HAVE-- IT'LL LAY OUT EACH ONE OF THOSE OPTIONS IN THE PRO FORMA.
ANY OTHER QUESTIONS? THANK YOU ALL.
HELLO AGAIN, MAYOR AND COUNCIL.
KT FREEMAN, FIRE CHIEF, AND I MIGHT ADD TO CASEY'S POINT WHEN HE WAS TALKING ABOUT HAVING-- PULLING IN A RESERVE AMBULANCE, THAT FOURTH AMBULANCE.
OUR PLAN WOULD BE TO HAVE THAT AT STATION THREE AND IT WOULD BE ABLE-- WE WOULD BE ABLE TO ACCOMPLISH THAT LEVEL OF SERVICE WITH THE SIX FIREFIGHTERS, NOT THE EIGHT FIREFIGHTERS.
OUR RECOMMENDATION WE GO FORWARD WOULD BE THE SIX FIREFIGHTERS AND WE WOULD BE ABLE TO GET THAT FOURTH AMBULANCE IF NEEDED BY CROSS STAFF.
LIKE, HE SAID, JUST LIKE WE DO IF A GRASS FIRE COMES IN AT STATION THREE, WE CROSS STAFF AND THEY TAKE IT AND THEY WOULD RUN TOGETHER THE ENGINE AND THE AMBULANCE.
SO JUST WANT TO HAVE THAT CLARIFICATION AND THAT WOULD BE, I THINK, AN EXTREMELY EFFICIENT AND EFFECTIVE MODEL, FINANCIAL EFFICIENCY.
SO I'M GOING TO WRAP UP HERE WITH THE SEAMLESSNESS BECAUSE I DO THINK IT IS CRITICALLY IMPORTANT ABOUT ANY SYSTEM AND WE'RE SPECIFICALLY TALKING ABOUT OUR CURRENT SYSTEM IN THE SYSTEM THAT WE ARE IN RIGHT NOW CAN'T OVER OVEREMPHASIZE CONTINUITY OF WORKFORCE AND
[03:05:03]
THE CONTINUITY OF ANYTHING, CHAIN OF COMMAND, WHATNOT.IN ORDER TO GET THE MOST EFFICIENT AND EFFECTIVE, BASED ON MY EXPERIENCE RESULTS, YOU'VE GOT TO HAVE CONTINUITY AND THIS IS ONE OF THE THINGS THAT WE BELIEVE STRONGLY IN THAT WILL PROVIDE AN ENHANCEMENT TO THIS AND WE'LL ADDRESS A LOT OF THE ISSUES THAT WE HAVE HAD AND CONTINUE TO HAVE.
ONE OF THE ADVANTAGES, OBVIOUSLY IN ANY TYPE OF ORGANIZATION IS WE CURRENTLY DON'T HAVE THIS AND WE'RE PROPOSING WE WILL GET THIS.
WE WILL BE ABLE TO ACHIEVE THIS.
SINGLE POINT OF AUTHORITY, AS I SAID EARLIER, YOU REALLY CAN'T SERVE TWO BOSSES.
IF WE GO TO THIS, WE'LL BE ABLE TO PROVIDE A SINGLE POINT OF AUTHORITY, SINGLE POINT OF MANAGEMENT.
SO WHEN THINGS COME UP, WE IN OUR DEPARTMENT NOW, WE MANAGE THEM, WE MANAGE THEM VERY EFFECTIVELY, CONSISTENTLY AND TIMELY AND SO THAT BUILDS INTO THAT ACCOUNTABILITY IF YOU'RE GOING TO HAVE A HIGH FUNCTIONING ORGANIZATION.
ALL THREE OF THESE HAVE TO BE IN PLACE AND THEY HAVE TO BE IN PLACE IN A TIMELY MANNER.
BY HAVING THIS, IT WILL ELIMINATE OUR ON SCENE CONFLICTS.
NOW, IN FAIRNESS TO OUR FRIENDS, SOMETIMES FIREFIGHTERS, [INAUDIBLE] GOING TO SAY NOT IN OUR WORLD, BUT COULD BE FOR JUST FOR THE SAKE OF DISCUSSION.
SOMETIMES THERE'S CONFLICTS OVER PERSONALITIES, AND IT IS WHAT IT IS, IN THE SENSE.
I'M NOT TALKING ABOUT AN ATTITUDE, SO TO SPEAK.
I'M TALKING ABOUT PERFORMANCE THAT CAN IMPACT PATIENT OUTCOMES AND SO THIS IS WHERE IT STILL HAPPENS.
IT'S HAPPENED HERE IN THE LAST, WE'VE HAD SEVERAL SIGNIFICANT-- A COUPLE OF SIGNIFICANT CONFLICTS OVER STANDARD OF CARE FOR PATIENTS.
I'M NOT HERE TO AIR OUT DIRTY LAUNDRY, BUT I'LL TELL YOU THAT TWO OF THEM HAVE BEEN SIGNIFICANT JUST HERE RECENTLY.
ONE OF THEM INVOLVED WERE ONE OF OUR PARAMEDICS WHO WAS A COMBAT MEDIC IN AFGHANISTAN, WAS ON SCENE WITH AN UNCONSCIOUS YOUNG LADY.
THERE WAS-- IT WAS JUST KIND OF BY THE INFORMATION THAT'S GATHERED ON SCENE.
THERE'S A STRONG INDICATION BASED ON HER CLINICAL PRESENTATION THAT SHE HAD OD'D, PROBABLY ON AN OPIOID.
MEDSTAR CREW WAS THERE ASSESSING AND DOING WHAT THEY DO, AND THERE WAS A SIGNIFICANT CONFLICT OVER THE RECOMMENDATION OF OUR PARAMEDIC TO PUSH NARCAN.
THIS YOUNG LADY WAS CRASHING AND SHE WAS NOT BREATHING.
SHE WAS IN RESPIRATORY ARREST.
THERE WAS SOME EXCHANGE BETWEEN MEDSTAR'S CREW AND OUR CREW AND THIS IS ALL DOCUMENTED, AND OUR MEDIC BASICALLY SAID, I'M DOING WHAT I BELIEVE IS BEST FOR THIS YOUNG LADY.
HE POPPED HER WITH NARCAN AND ABOUT 15 OR 20 SECONDS.
SHE STARTED BREATHING ON HER OWN.
NOW THAT'S SERIOUS AND SO THESE ARE THE KIND OF THINGS, IT DOESN'T HAPPEN EVERY DAY, BUT WHEN IT HAPPENS, THESE ARE THE TYPES OF SITUATIONS THAT I'M NOT TALKING ABOUT PERSONALITIES.
THESE ARE THE TYPE OF THINGS THAT MANIFEST OUT OF MEDSTAR IS ULTIMATELY IN CHARGE OF THE SCENE.
THERE'S BEEN INSTANCES WHERE OUR BATTALION CHIEFS WHO ARE HIGHLY TRAINED, TRY TO MANAGE THE SCENE AND AT THE END OF THE DAY ARE OVERRULED AND IN SOME INSTANCES NOT JUST OVERRULED BUT HAVE BEEN PUT IN A SITUATION THAT THEIR REQUEST-- THEIR MEN ARE TO RUN THE SCENE WAS TOTALLY DENIED BY MEDSTAR.
THIS ELIMINATES THAT BECAUSE AT SOME POINT WE WOULD BE FOOLISH TO THINK IT DOES NOT IMPACT PATIENT CARE.
IT DOES AND IT CERTAINLY IMPACTS THE.
PEOPLE THAT ARE IN THESE SITUATIONS THAT IF THEY'RE WITNESSING THIS AND THEY'RE HEARING THIS, SO AGAIN, IT'S A CUSTOMER SERVICE EXPERIENCE AS WELL.
SO IF WE'RE ABLE TO DO THIS ONE POINT OF AUTHORITY, ONE POINT OF MANAGEMENT ACCOUNTABILITY AND THE SCENE CONFLICTS ARE ELIMINATED.
WE HAVE ACCOUNTABILITY IN OUR DEPARTMENT.
WE HAVE HIGH EXPECTATIONS NOT TO SAY MEDSTAR DOESN'T, BUT I'M VERY, VERY CONFIDENT IN THIS.
AT THE END OF THE DAY, OUR PATIENT CARE AND OUR CITIZENS WILL NOT HAVE TO DEAL WITH SOMETHING LIKE THIS.
BURLESON TURNOVER RATE, WE BELIEVE THAT'S INCREDIBLY IMPORTANT.
WE HAVE A FOUR PERCENT TURNOVER RATE, AND THE REASON WHY THAT IS SIGNIFICANT IS BECAUSE YOU DO GET THAT CONTINUITY OF CARE.
YOU DO GET THOSE [INAUDIBLE], YOU DO GET THAT EXPERIENCE AND I THINK IT'S VERY IMPORTANT IN ANY SYSTEM, BUT ESPECIALLY IMPORTANT IN AN EMS SYSTEM.
AS THE NEXT POINT CONSISTENT, WE WILL HAVE OUR-- CONSISTENT OUR FIREFIGHTERS WILL BE CONSISTENT, PROVIDING CARE TO OUR CITIZENS.
WE GET THE SAME GROUP OF FIREFIGHTERS OVER AND OVER AND OVER.
[03:10:02]
SO WE'RE ALREADY DOING THIS.WE ALSO ARE TRUSTED AGAIN, NOT A SLAM.
OUR FIREFIGHTERS, AND FIREFIGHTERS IN GENERAL, HAVE GAINED AND EARNED THE TRUST OF THEIR COMMUNITIES, AND OURS IS NO EXCEPTION AND THEN WE HAVE CLOSE TIES WITH OUR COMMUNITY.
WE HAVE CLOSE TIES TO IT THROUGH OUR DROWNING PREVENTION THROUGH OUR BURLESON PUBLIC HEALTH EFFORTS WHERE WE'VE VACCINATED, WE PARTNERED UP WITH HUGULEY, LIKE I SAID EARLIER, BUT WE VACCINATED, GIVEN OVER FIFTY FIVE THOUSAND DOSES, OVER TWENTY THOUSAND TESTS.
WE STILL CONTINUE TO DO THOSE THINGS.
SO WE'RE IN THE COMMUNITY, OBVIOUSLY, AND HAVE A RELATIONSHIP AND THEY'RE IN WITH US, SO TO SPEAK.
WE, THE OPEN HOUSES, STATION TOURS WERE VISIBLE TO OUR COMMUNITY AND WE'RE KNOWN SAME FACES OVER AND OVER AGAIN, AND WE BELIEVE THAT IS AN ABSOLUTE CRITICAL ASPECT OF A HIGH PERFORMING EMS SYSTEM.
OUR MEDICAL DIRECTOR, EVERYTHING YOU HEARD FROM DR.
EVERYTHING FROM THE CLINICAL, EVERYTHING THAT HE SAID I ABSOLUTELY AGREE WITH.
VITHALANI TO COMMENT, BUT I BELIEVE THAT HE WOULD NOT HESITATE TO SAY, CAN WE REPLICATE TO A SCALE THAT'S NECESSARY FOR BURLESON? ABSOLUTELY, WE CAN.
OUR PROPOSAL IS WE WOULD HAVE OUR OWN MEDICAL DIRECTOR IF THE EPAB ADVISORY BOARD, OUR PLANS ARE AGAIN, WE HAVE NOT GOTTEN OUT AHEAD OF THE COUNCIL.
WE CAN REPLICATE IT WITH CONFIDENCE.
ALL THE QA QI, EVERYTHING THAT CURRENTLY WE'RE A PART OF IN THIS SYSTEM AND WE'VE BEEN PERFORMING, OUR DEPARTMENT IS LIKE YOU SAID, WE'RE PART OF THAT HIGH PERFORMING SYSTEM.
IT WOULD BE [INAUDIBLE] TO BURLESON AND BE BURLESON CENTRIC.
WE COLLABORATE AND HAVE COLLABORATED WITH DR.
VITHALANI AND THE OFFICE OF THE MEDICAL DIRECTOR AND HIS STAFF.
WE'RE KIND OF THE GUINEA PIGS.
WE SAY THAT WITH TONGUE IN CHEEK BECAUSE THE OMD OFFICE OF MEDICAL DIRECTOR AND DR.
VITHALANI, THEY HAVE FAITH IN US.
WE HAVE A DEMONSTRATED TRACK RECORD THAT WE ARE A HIGH PERFORMING EMS GROUP, NOT ONLY WITH THE LEADERSHIP, BUT ULTIMATELY WHERE THE RUBBER MEETS THE ROADS, OUR FIREFIGHTERS.
I THINK WE'RE ONE OF THE BEST OF THE BEST AND AGAIN, I'M NOT GOING TO ASK FOR ANY KIND OF COMMENT, BUT WE BELIEVE THAT WITHOUT HESITATION, THIS IS ALL REPLICABLE AND WE WILL BE SUCCESSFUL WITH THIS.
OUR MEDICAL-- ONE OF THE CHALLENGES I'LL SAY PROBLEM IS THAT MEDICAL DIRECTOR IS GREAT.
WE HAVE UTMOST RESPECT FOR HIM, BUT HAS ALREADY MENTIONED FORT WORTH IS THE LARGEST MEMBER.
HE HAS TO SPLIT HIS TIME AND HIS RESOURCES TO 14 OTHER MEMBER CITIES.
OUR MEDICAL DIRECTOR, OUR GOAL WOULD BE TO HAVE A SINGLE MEDICAL DIRECTOR FOR US ONLY AGAIN WHERE IT CAN BE BURLESON CENTRIC.
THEY WOULD DO THE SAME THING DR.
OUR MEDICAL DIRECTOR WOULD ESTABLISH OUR PATIENT STANDARDS AND FOR ALL MEDICAL SERVICES PROVIDED FOR BURLESON EMS. AGAIN, SAME THING HE DOES.
OUR MEDICAL DIRECTOR WOULD DEVELOP PROTOCOLS, CREDENTIALING REQUIREMENTS, QA QI, THE POLICIES FOR ALL THE MEDICAL SERVICES THAT WOULD BE PROVIDED BY OUR OWN EMS SYSTEM AND THEN OUR OWN MEDICAL DIRECTOR WOULD BE ABLE TO DEVOTE THE TIME TO PROVIDE CUSTOMIZED TRAINING SPECIFICALLY FOR OUR EMS SYSTEM.
AGAIN, THAT WOULD BE CENTRIC TO BURLESON'S STANDARDS AND NEEDS AND I HAVE NO DOUBT THIS IS AN ENHANCEMENT THAT, AS WE'VE ALREADY SEEN, THE SYSTEM IS PERFORMING, BUT WE CREATE OUR OWN SYSTEM, WILL BE OUR STANDARD AND IN OUR METRICS AGAIN.
WE APPRECIATE THE MEDICAL DIRECTION THAT DR.
VITHALANI AND HIS STAFF HAVE GIVEN, AND JUST AGAIN, WE CAN REPLICATE IT AND IT'LL BE FOR OUR COMMUNITY.
ANY QUESTIONS AT THIS TIME THAT I MIGHT ANSWER.
AT THIS POINT, WE'RE GOING TO TURN IT OVER TO MARTIN FOR THE PRO FORMA DISCUSSION.
ANY QUESTIONS? OK, I'M SORRY BEFORE BEFORE YOU CONTINUE, I THINK WE'RE GOING TO-- IF COUNCILS, OK, TAKE A SMALL BREAK, WE'VE ORDERED JUST SOME FOOD.
YOU CAN GRAB A PLATE AND MAYBE EVEN EAT AT YOUR PLACE.
I KNOW IT'S A LITTLE AWKWARD, BUT I KNOW I DON'T WANT TO KEEP PEOPLE IN THE AUDIENCE EITHER WAITING FOR US.
I THINK WE COULD EITHER DO THAT NOW.
I THINK MARTIN HAS A FEW SLIDES TO GO THROUGH ON THE PROFORMA.
IF YOU'D RATHER HAVE A BREAK AT THE END OF THAT, WE COULD DO IT THAT WAY TOO.
SO JUST AS AN OPTION FOR THE COUNCIL OR WE CAN KEEP GOING WHATEVER YOU PREFER.
[03:15:27]
WE GOT A BUNCH OF I DON'T CARES AND A COUPLE OF LET'S KEEP GOING, SO I GUESS I DON'T CARE AS GOES WITH LET'S KEEP GOING.MARTIN, WE ARE ONLY GIVING YOU FIVE MINUTES, THOUGH.
[LAUGHTER] MARTIN, YOU GOT TO SPEAK FAST.
I GO WITH 20 SLIDES IN FIVE MINUTES.
I GUARANTEE YOU I COULD DO THAT.
THERE'S A LOT OF INFORMATION THAT'S BEEN PROVIDED TODAY AND.
COUNCIL MEMBER STANFORD, YOU MAKE A POINT IN REGARDS TO YOU CAN'T PUT DOLLARS TO THIS TYPE OF SERVICE, YOU REALLY CAN'T AND SO DOLLARS, AS I GO OVER TO THIS PRO FORMA IT IS A SECONDARY DISCUSSION IN REGARDS TO THE SERVICE THAT'S BEING DISCUSSED TODAY.
BUT ONE OF THE THINGS THAT'S IMPORTANT TO YOU IS WE DO HAVE, AS CITY STAFF, A FISCAL RESPONSIBILITY TO SHOW WHAT IS THAT PROJECTION IN REGARDS TO THAT TRANSITION FROM, YOU KNOW, SQUAD TO TRANSPORT AND OR IN ESSENCE, INCORPORATE THE TRANSPORT SERVICES? NOW ONE OF THE THINGS THAT I WANTED TO TALK ABOUT IS THE PRO FORMA AND AGAIN, PRO FORMA IS A PROJECTION.
THERE ARE SO MANY DIFFERENT WORDS THAT YOU CAN USE FOR THAT.
BUT AT THE END, WHEN YOU TALK ABOUT PRO FORMA, THERE'S NUMBERS INVOLVED WE GUARANTEE YOU.
SO THERE'S FOUR OPTIONS THAT CHIEF CASEY TALKED ABOUT AND SO IN THE DISCUSSIONS THERE, WHAT WE TALKED ABOUT IS ONE OF THE THINGS TOO IS WHAT IS THE CITY CURRENTLY HAVE AS IT RELATES TO THE SQUADS THAT ARE ACTUALLY IN SERVICE? SO IT'S TAKING THE PIECE OF OUR GENERAL FUND PROJECTIONS AND REALLY JUST FOCUSING ON THE OPERATIONS OF FIRE, MORE SPECIFICALLY AS IT RELATES TO THE SQUADS.
SO IN OUR PROJECTIONS, IN OUR FIVE YEAR PROJECTIONS THAT WE TALKED ABOUT WHEN WE WENT THROUGH OUR BUDGET, WE CURRENTLY IN OUR BUDGET FOR 2022 HAVE TWO SQUADS AND SO RIGHT NOW WE'RE OPERATING UNDER THOSE TWO SQUADS AS PART OF THE FIRST RESPONDERS AND SO RIGHT NOW ON A BUDGET OVERVIEW IN OUR BUDGET PROJECTIONS, IT'S ABOUT ONE POINT THREE MILLION DOLLARS.
SO THAT IS THE IMPACT RIGHT NOW WITH TWO SQUADS.
SO GOING INTO TWENTY, TWENTY THREE, TWENTY FOUR, TWENTY FIVE, THAT'S IN ESSENCE PRETTY MUCH STABLE.
YOU WILL HAVE THOSE TWO SQUADS PROJECTED GOING FORWARD.
ON TWENTY SIX WE HAD PROJECTED AT THAT POINT, ADDING A THIRD SQUAD AND SO ALL OF THAT HAS BEEN CAPTURED IN OUR PROJECTIONS THAT WE'VE HAD DISCUSSIONS ON IN REGARDS TO THE GENERAL FUND.
SO AGAIN, AND THE REASON WHY I PUT THAT NET COST IN RED, THAT IS IN ESSENCE WHAT THE CITY IS CURRENTLY SPENDING IN REGARDS TO THAT TO THOSE, YOU KNOW, THAT SERVICE THERE AND AGAIN, IN REGARDS TO TRANSPORT REVENUE, THERE ISN'T ANY BECAUSE THAT TRANSPORT CURRENTLY IS OUTSOURCED TO A THIRD PARTY.
SO IN OPTION A WE TALKED ABOUT IN HOUSE, WE TALKED ABOUT JUST BRINGING WHAT WE HAVE IS A TWO SQUADS AND IN ESSENCE, YOU KNOW, TRANSFERRING THEM TO BECOME TO AMBULANCES SERVICES.
SO IF YOU LOOK AT THAT, THEN YOU'RE LOOKING AT AGAIN, WE'RE LOOKING AT TWO YEAR TRANSITION TO BE ABLE TO FIGURE OUT HOW WE'RE GOING TO DO THAT AND AGAIN, THESE ARE THE COSTS.
YOU HAVE AMBULANCE ONE, AMBULANCE TWO AND THE OPERATING COSTS NOW THE OPERATING COST INCREASES, SO YOU GO FROM A THIRTY SEVEN THOUSAND TO ONE HUNDRED AND THIRTY TWO.
SO IN THE BOTTOM YOU TALK, YOU KIND OF SEE WHAT THOSE ADDITIONAL COSTS WILL BE.
YOU TALK ABOUT AGAIN, PUTTING THE AMBULANCES AS PART OF THE REPLACEMENT SCHEDULE, THAT'S A BIG ONE.
SO, THE DIFFERENCE THAT WE TALK ABOUT HERE IS NOW NOW YOU ARE IN A TRANSPORT OF TRANSITION OR YOU'RE PROVIDING THAT SERVICE, SO THEREFORE NOW THERE IS REVENUE THAT'S GOING TO BE INCLUDED IN THERE.
THAT ONE POINT SIX BILLION DOLLARS IS A VERY CONSERVATIVE DOLLAR AMOUNT.
IT ALL DEPENDS ON THE CAUSE THAT WE'RE GOING TO GET DEPENDS ON THE SERVICES.
BUT THE DOLLARS AND WHERE THAT DOLLAR CAME FROM IS REALLY LOOKING AT SOME OF THE INFORMATION THAT THE IS IT [INAUDIBLE]? [INAUDIBLE] PROVIDED, AS WELL AS SOME OF THE INFORMATION THAT I SAW AS IT RELATES TO WHAT
[03:20:01]
MEDSTAR PROVIDED AS WELL.IT'S A VERY CONSERVATIVE NUMBER.
BUT THE POINT IS, IS THAT IF YOU LOOK AT YEAR 2024, THE NET COST IS THREE HUNDRED AND FORTY SIX THOUSAND DOLLARS VERSUS IN 2024, YOU'RE STILL AT ONE POINT THREE.
THAT'S THE WHOLE BASIS OF WHAT WE'RE LOOKING AT IS THAT IN ESSENCE, GOING FORWARD, YOU HAVE THE TRANSPORT REVENUE THAT WILL IN ESSENCE ABSORB A LOT OF THE ADDITIONAL COSTS, OPERATING COSTS THAT IS BEING TAKEN FROM THERE AND AGAIN IT PERTAINS TO THE IDEA OF THAT FISCAL IMPACT IS A SECONDARY COMPONENT TO THIS, BUT WHAT I WANTED TO MAKE SURE IS THAT THERE IS A BENEFIT AS WELL.
THERE IS A FISCAL BENEFIT TO ABSORBING THAT TYPE OF SERVICE INTO THE CITY'S OPERATIONS.
OPTION B TALKS ABOUT THREE AMBULANCES, BUT ONLY ADDING FOUR NEW FTES TO THAT THIRD SQUAD AND AGAIN, YOU LOOK AT THAT NET COST THAT IS THE SAME NET COST THAT YOU HAVE IN EACH OF THE.
THIS IS IN ESSENCE WHAT THE CITY IS CURRENTLY ABSORBING AND PAYING FOR THE TWO SQUADS AND THEN THE THIRD SQUAD COMING IN, IN FISCAL YEAR, 2026 AND AGAIN, NOW YOU'RE SHOWING ON YEAR 2024, YOU ARE SHOWING THE ADDITIONAL PERSONNEL COST OF FOUR FTES, ALONG WITH THE ADDITIONAL OPERATING COST OF ONE HUNDRED AND THIRTY TWO THOUSAND.
AND AGAIN, THE MAJORITY OF THAT IS THE EQUIPMENT REPLACEMENT FUND OF THE AMBULANCES AND THE EQUIPMENT THAT GOES WITH THAT.
SO WHAT YOU NOTICE, THOUGH, IS THAT AGAIN, THERE'S MORE COST INVOLVED BECAUSE NOW YOU HAVE A THIRD SQUAD AND THE WHOLE BASIS TO THIS IS THAT KEEP IN MIND THAT IN THE ORIGINAL PROJECTIONS, WE HAVE THAT THIRD SQUAD IN 2026.
SO NOW WHAT WE'RE DOING IS WE'RE BRINGING IT FORWARD TO 2024 IF THAT TRANSITION HAPPENS IN REGARDS TO THE TRANSPORT SERVICES.
SO AGAIN, WHAT YOU SEE THERE IS, YOU KNOW, FIRST TWO YEARS, YOU'RE STILL PAYING THE ONE POINT THREE, THEN YOU COME IN AND THEN YOU START UTILIZING THAT TRANSPORT REVENUE TO COVER THOSE COSTS, BUT AGAIN, IF YOU LOOK AT WHAT WOULD YOU BE PAYING IN 2024, YOU'RE STILL PAYING THE ONE POINT THREE.
BUT IN THIS PARTICULAR SCENARIO, YOU'RE ONLY PAYING EIGHT HUNDRED AND EIGHTY SIX THOUSAND DOLLARS.
SO THAT IS THE WHOLE BASIS OF THIS PROFORMA, THIS ANALYSIS THAT WE DID IN REGARDS TO THE TRANSPORT SERVICES AND YET WHAT IS THAT FISCAL IMPACT COMPARED TO WHAT THE FISCAL IMPACT IS IF YOU DON'T GO IN THAT DIRECTION AS WELL? OPTION C, WHICH IS THE ONE THAT CHIEF CASEY HAD RECOMMENDED IN REGARDS FROM THE FIRE DEPARTMENT AND AGAIN, THIS IS THREE AMBULANCES, BUT INSTEAD OF FOUR FTES, IT IS NOW SIX FTES AND AGAIN, SAME COST COMPARED TO WHAT WE'RE AT.
BUT NOW WHAT IT IS, IS THAT, YOU'RE SHOWING ON THE AMBULANCE THREE, YOU'RE SHOWING THE SAME SIX HUNDRED AND TWELVE THOUSAND DOLLARS FOR THE PERSONNEL COSTS, YOU'RE SHOWING ONE HUNDRED AND THIRTY THREE THOUSAND FOR THE OPERATING COSTS AND THEN EVERYTHING ELSE IS THE ADDITIONAL COST THAT IT WOULD TAKE TO BRING IN THE OPERATIONS AND YOU STILL, WHAT'S IMPORTANT, THOUGH, IS WHEN YOU LOOK AT ALL THAT, WHEN YOU LOOK AT EACH OF THESE ITEMS, YOU SEE THAT BENEFIT.
THE CITY NET BENEFIT IN HOUSE, THAT FOUR HUNDRED AND THIRTEEN THOUSAND, FOR EXAMPLE, AND THEN FOR TWO OPERATIONS, NINE HUNDRED AND FIFTY THREE THOUSAND FOR YEAR 2024.
WHAT THAT IS, IS IT'S COMPARING WHAT WE'RE PAYING AND WHAT WE'RE PAYING NOW WHEN YOU BRING IN THE OPERATIONS.
SO AS YOU INCREASE THE FTES, THEN YES, THE BENEFIT STARTS REDUCING, BUT YOU'RE INCREASING THE SERVICE IN THE OPERATIONS OF THE TRANSPORT AND SO THAT IN ESSENCE IS OPTION C.
SO YOU GET TO OPTION D AND YOU PUT FOUR AMBULANCES AND THEN YOU BREAK THOSE TWO SQUADS INTO FOUR FTES EACH AND AGAIN, WHAT THAT DOES IS IT SHOWS THAT AT THAT POINT, THAT'S WHEN YOUR ADDITIONAL DOLLARS ARE BEING ABSORBED AND SO NOW THIS SEVENTY SEVEN THOUSAND WHAT THAT IS SAYING IS THAT NOW AT THAT POINT, YOU ARE NOW PAYING AS A CITY, YOU HAVE TO SUBSIDIZE THAT OPERATIONS BASED UPON WHAT WE'RE DEALING WITH THE TRANSPORT REVENUES OF ONE POINT SIX.
KEEP IN MIND THAT SEVENTY SEVEN THOUSAND AGAIN, WHEN YOU PUT DOLLARS IN THAT AND YOU LOOK AT PER CAPITA TO THAT, THAT IS ABOUT MAYBE A DOLLAR FIFTY PER CAPITA PER YEAR AND SO THAT'S IN ESSENCE WHAT YOU'RE LOOKING AT WHEN YOU ARE MAKING A DECISION TO
[03:25:03]
PROVIDE THAT SERVICE IN HOUSE AND ADDING ONE MORE AMBULANCE INTO THE ACTUAL PLAN ITSELF.THEN WE TALK ABOUT, OK, HOW DO WE PAY FOR THE CAPITAL COSTS? THERE'S A CAPITAL DISTRIBUTION OF, YOU KNOW, YOU'VE GOT AMBULANCES, YOU'VE GOT $300000 PER AMBULANCE AND SO RIGHT NOW TO BE ABLE TO BRING THIS OPTION C INTO FRUITION, WE HAVE A ONE POINT ONE SEVEN, FIVE MILLION DOLLARS WORTH OF CAPITAL.
HOW DO WE PAY FOR THAT? AND ONE OF THE RECOMMENDATIONS RIGHT NOW THAT I HAVE IS, THE CITY RECEIVED ELEVEN POINT NINE MILLION DOLLARS IN AMERICAN RESCUE PLAN OR AMERICAN RELIEF PLAN ACT, AND SO A LOT OF THAT AND WHAT THAT PARTICULAR ARPA FUNDING HAS DONE IS GIVEN CITIES THE OPPORTUNITY TO REALLY LOOK AT THE OPERATIONS AND PROVIDE THAT BETTER EFFICIENCY OF THE OPERATIONS AND ONE OF THE RECOMMENDATIONS THAT I WOULD DO IF IT WOULD GO THAT ROUTE IS TO UTILIZE SOME OF THOSE ARPA FUNDINGS TO BE ABLE TO ESTABLISH THAT CAPITAL TO MOVE FORWARD AND SO WITH ALL THAT, THOSE ARE THE NEXT STEPS AND EITHER HOLD A FUTURE WORKSHOP.
IF YOU WANT TO TAKE THAT ONE OR YOU WANT ME TO, I CAN, I CAN READ.
ASK FOR COUNCIL DIRECTION OR TIMELINE.
MARTIN, I GOT A QUICK QUESTION.
SO LOOKING AT THAT, WE'LL BE ABLE TO USE THE ARPA FUNDS.
SO BECAUSE OF YOUR FISCAL PRUDENCE AND EVERYTHING ON THE GENERATOR FOR THE BRICK, WE'RE NOT GOING IN THAT DIRECTION.
WE NOW HAVE THESE FUNDS AVAILABLE FOR THE AMBULANCES.
I DO WANT TO POINT OUT A LITTLE ODDITY THAT I SEE.
SO IF WE LOOK AT OUR TRANSPORT REVENUES OF ONE POINT SIXTY FIVE ON THE TWO AMBULANCES, SO YOU'VE GOT TO GO BACK TO WHERE WE WOULD START.
YOU HAVE THE SAME REVENUE NUMBER FOR THREE AMBULANCES.
SO I WOULD LIKE TO POINT OUT THAT IT WOULD BE VERY, VERY DIFFICULT FOR US TO HAVE A $1.6 MILLION REVENUE FROM ONLY TWO AMBULANCES RUNNING.
SO I WOULD, YOU KNOW, BEG TO, YOU KNOW, POINT OUT HERE THAT IF WE RUN WITH A SMALLER AMOUNT OF AMBULANCES, WE WOULD HAVE TO MUTUAL AID TO MEDSTAR QUITE A BIT AND SO I DON'T THINK THAT WE'RE LOOKING AT THE CORRECT NUMBER ON THAT.
I THINK THE IDEA TOO, THOUGH, IS THAT, THE POINT THAT WE'RE TRYING TO MAKE IS THAT REGARDLESS OF THE REVENUE THAT'S GOING TO BE GENERATED IS THAT REVENUE THAT'S GENERATED WOULD PRETTY MUCH COVER THE COST OF THOSE AMBULANCES IN THE OPERATIONS OF THAT.
SO YOU'RE RIGHT, WE COULD HAVE LEFT IT AND, YOU KNOW, TAKEN A PERCENTAGE DOWN.
BUT AGAIN, IT IS A CONSERVATIVE NUMBER TO BEGIN WITH.
I'VE SEEN NUMBERS 2.1 MILLION AS REVENUES AS WELL, BUT WE WANTED TO MAKE SURE THAT WAS A CONSERVATIVE DOLLAR AMOUNT GOING FORWARD AND AGAIN, THIS IS TWO YEARS FROM NOW.
SO POPULATION IS GROWING AND SO THAT COULD BE A LOT MORE IN REGARDS TO THAT AS WELL.
I JUST IF PEOPLE LOOK AT THIS AND THEY GO, WAIT, THAT DOESN'T MAKE SENSE.
YOU KNOW, ANYBODY IN BUSINESS GOES, WELL, IF I ADD ON, I'M GOING TO MAKE MORE REVENUE.
SO I THINK WE SHOULD HAVE LOWERED THAT NUMBER.
I THINK ANOTHER QUESTION THAT WE FREQUENTLY I'VE GOTTEN A FEW TIMES AGAIN IS TO GO BACK TO THE SQUAD CONCEPT.
IT'S LIKE, GIVE ME THE UNDERSTANDING.
I SAID, HAVE CHIEF REITERATE WHY WE NEEDED THE SQUAD, RIGHT? AND BECAUSE IF WE DIDN'T HAVE A SQUAD RIGHT, WE WOULDN'T HAVE AN OUTLAY OF COST.
SO A LOT OF PEOPLE ARE WONDERING, WHY DID WE EVEN PUT THE SQUADS INTO PLACE? SO WHEN YOU'RE LOOKING AT THESE NUMBERS AND YOU'RE GOING, WELL, IF WE DIDN'T HAVE A SQUAD, THEN WE WOULD BE A COMPLETE OUT OF POCKET COST.
SO CLARIFY THAT OR GO OVER THAT AGAIN.
EXCELLENT POINT GOING ALL THE WAY BACK TO WHAT I HAD SHARED EARLIER WHEN I GOT HERE, THE SQUAD CONCEPT WAS ALREADY GOING DOWN THE TRACK SQUAD CONCEPT PROVIDES THE MOST EFFECTIVE AND EFFICIENT SERVICE LOOKING AT TWO PERSON BECAUSE THE ONLY OTHER OPTION AND IT WAS AT THAT TIME AS WELL IS YOU PUT FIREFIGHTERS ON AN EXPENSIVE THREE QUARTER MILLION, ONE MILLION DOLLAR FIRE TRUCK TO GO AND RESPOND TO THE MAJORITY OF OUR CALLS HAVE ALWAYS BEEN AND AT THE ORIGINAL CONCEPT WAS, IS EMS. SO TAKING US ALL THE WAY BACK, IT WAS THE MOST EFFICIENT AND EFFECTIVE THING THAT I COULD BRING FORWARD AT THE TIME THAT I BELIEVE THAT THE CITY MANAGER AT THE TIME WAS GOING TO
[03:30:01]
SUPPORT AND THAT IT WOULD BE THAT FIRST STEP INTO GETTING OUR STAFFING UP.WE WERE SO UNDERSTAFFED AND IF YOU RECALL, FOR SOME OF YOU THAT WERE ON THE COUNCIL AT THE TIME, ANOTHER THING THAT WE DID THAT ALLOWED US TO DO THAT WAS WE APPLIED FOR A SAFER GRANT.
WE HAD TO GET MORE THAN NINE FIREFIGHTERS RESPONDED TO THIS CITY ON THREE APPARATUS BECAUSE IT DIDN'T MATTER WHAT THE CALL WAS.
WE COULD HAVE THREE EMS CALLS AND IT COULD BE MY STOMACH'S HURTING OR SOMETHING SERIOUS OR SOMETHING LOW ACUITY.
WE HAD NO RESOURCES AVAILABLE, SO IT WAS A VERY COST EFFECTIVE INITIAL STEP TO GET US REDUNDANCY AND I MADE THAT CLEAR OVER AND OVER THAT IT WAS COST EFFECTIVE TO GET US REDUNDANCY.
AND THEN GOING BACK TO THE BRIEFING THAT I SHARED IN 2020 AS WE HAD SOME TIME ABOUT A YEAR AND A HALF OF ANECDOTAL AND WE FELT LIKE, HEY, WE'RE ON TRACK WITH THIS MODEL TO BRING TWO PEOPLE ON A VEHICLE.
IN THIS CASE, IT WAS A PICKUP TRUCK.
WE CHOSE THAT BECAUSE IT WAS THE MOST COST EFFECTIVE.
IT COULD HAVE BEEN A SOMETHING MUCH MORE EXPENSIVE.
BUT THE MODEL HAS ALWAYS BEEN, THE STRATEGY IS GET THE LEAST AMOUNT OF FIREFIGHTERS YOU CAN AND THEN MAKE POSITIVE STEPS TOWARDS ENHANCEMENT INSTEAD OF HAVING TO COME TO THE COUNCIL, COME TO THE COMMUNITY AND SAY, HEY, INSTEAD OF A TWO PERSON SQUAD, I'M ASKING YOU, I'M GOING TO PUT THE COUNCIL AND THE COMMUNITY IN A FISCAL SITUATION THAT COSTS TWICE AS MUCH AND WE'RE ASKING TAXPAYERS TO PAY FOR WHERE IT'S GOING TO RESPOND TO OUR EMS PROBLEM OR ISSUE.
DOES THAT PROVIDE CLARITY? YEAH, I THINK I JUST WANT TO MAKE IT REALLY CLEAR TO THE PUBLIC THAT, YOU KNOW, THE TWO MOST EXPENSIVE THINGS IN OUR GENERAL FUND AND CORRECT ME IF I'M WRONG IS POLICE AND FIRE AND IN ALL REALITY, IF WE WERE TO PULL THEM OUT, PEOPLE WOULD BE SO UPSET, RIGHT? PULLING THAT OUT AND SAYING, OH, WELL, WE'RE JUST NOT GOING TO DO THIS.
THE FACT OF THE MATTER IS THAT POLICE AND FIRE ARE THE ONES THAT KEEP US SAFE WHEN WE NEED THEM.
HELP US WHEN WE'RE SICK, WHEN WE NEED THEM, YOU KNOW, BRING US COMFORT IN TIMES OF CRISES AND SO THE REALITY IS THAT WHILE WE LOOK AT THIS AND SAY, YES, IT'S GOING TO SAVE US IN OUR NET COST, YES, IT IS A COST.
SO I WANT TO I JUST FROM ME, AS A COUNCIL MEMBER, I WANT TO SAY I'M FULLY AWARE OF THE FACT THAT THIS IS A COST THAT THIS WILL COME OUT OF TAXPAYER MONEY PER SAY, QUOTE UNQUOTE RIGHT.
BUT WE'VE BUDGETED FOR THESE THINGS ALREADY.
THERE IS GOING TO BE MORE MONEY OBVIOUSLY NEEDED.
BUT WE NOW WILL HAVE A REVENUE INCOME THAT WE DIDN'T HAVE BEFORE.
IS IT POSSIBLE THAT SOMEWHERE DOWN THE LINE, YOU KNOW, WE COULD BE UPSIDE DOWN AND IT'S A STRAIGHT UP COST? I'M NOT GOING TO LIE AND SIT HERE AND SAY, NO, I'M NOT GOING TO SAY THAT BECAUSE WE DON'T REALLY HONESTLY KNOW WHAT'S GOING TO HAPPEN TO THE PAYER MIX ONCE WE TAKE THIS OVER.
IF WE TAKE THIS OVER, EXCUSE ME.
BUT AS I'VE LOOKED INTO KANSAS CITY AND I'VE LOOKED INTO SOME OF THE OTHERS THAT WERE BROUGHT TO ME, I THINK IF WE LOOK AT PLACES THAT LEFT AND WENT AND TOOK IT OVER THEMSELVES, YOU CAN SAY THIS EVEN ABOUT PUBLIC UTILITY MODELS, BY THE WAY, BECAUSE I'VE LOOKED AT THOSE, IT COULD BE MISMANAGEMENT EASILY.
I MEAN, BUSINESSES OPEN AND FAIL ALL THE TIME BECAUSE OF MISMANAGEMENT.
BUT REMEMBER, TOO, THIS IS A SERVICE TO OUR COMMUNITY AND A SERVICE TO OUR PEOPLE AND I'VE LOOKED AT ALL ANGLES HERE AND I HAVE LOOKED AT AND I'VE READ SO MANY ARTICLES ABOUT THE NEGATIVES AND POSITIVES TO A PUBLIC UTILITY MODEL.
THE FACT OF THE MATTER IS THAT I WOULD RATHER HAVE OUR FIREFIGHTERS BEING THE ONES THAT ARE THERE PROVIDING THAT SEAMLESS SERVICE AND THEN YOU GUYS PROVIDING THE SEAMLESS OVERSIGHT.
IF I WERE TO SAY YES, GO WITH THIS.
MY BIGGEST THING THAT I'VE LEARNED THROUGH ALL OF THIS IS THE AMOUNT OF DATA THAT I'M GOING TO REQUIRE YOU GUYS TO ANALYZE FROM A MEDICAL SERVICES PERSPECTIVE IN WHAT YOU'RE PROVIDING AND HOW WELL THE FIREFIGHTERS ARE DOING AND ASSESSING SITUATIONS POST JUST TO MAKE SURE WHAT WENT WRONG, WHAT WENT RIGHT, WHERE COULD WE IMPROVE? NOTHING WENT WRONG.
BUT WHERE COULD WE IMPROVE? IT WOULD BE PART OF OUR [INAUDIBLE] PROCESS AND JUST TAGGING ON [INAUDIBLE] WHAT
[03:35:02]
YOU WERE SAYING, COUNCIL MEMBER PAYNE, I RECOGNIZE WHERE WE WERE GOING BACK IN 2020, AND THAT'S WHY I BRIEFED THE COUNCIL THAT IT IS A FACT AS OUR COMMUNITY CONTINUES TO GROW AND IT'S GOING TO CONTINUE TO GROW, BOTH FIRE AND POLICE HAVE TO HAVE ADDITIONAL.EVERYONE HAS TO HAVE ADDITIONAL RESOURCES.
AND AS I SAID THEN AND I'M RESTATING TODAY, IT'S EXPENSIVE AND WE'RE GOING TO HAVE TO BRING ON FIREFIGHTERS AND THEY'RE EITHER GOING TO BE ON SQUADS OR THEY'RE GOING TO BE IN AMBULANCES AND WE'VE DISCUSSED THE REASONS WHY.
SO THAT'S WHY WE BELIEVE THERE'S AN ENHANCEMENT OF SERVICES AND AS I SAID THEN KNOWING THAT MORE IS GOING TO HAVE TO COME HERE AND IT IS NOT MONEY DRIVEN, BUT MONEY IS A PART OF THIS AS THAT THIRD LEG AS A CITY AND OUR TAXPAYERS CONTINUE TO FUND OUR EXPANSION, CURRENTLY, WE GET NO REVENUE COST TO RECOVER AND IT'S NOT ABOUT THE MONEY; IT'S ABOUT THE LEVEL OF SERVICE AND WE ARE GOING TO HAVE TO CONTINUE TO INCREASE OUR RESPONSE CAPABILITIES FOR EMS AND SOME FOR FIRE.
CHIEF, I GREATLY APPRECIATE YOU PRESENTING.
ONE OF THE BIG DRIVING FACTORS FOR ME IS HEARING ABOUT PROTOCOL 36.
YOU KNOW, PART OF BEING A PART OF A SYSTEM IS PROS AND CONS.
ONE THAT YOU GET TO BE PART OF A LARGE GROUP; CON BEING THAT YOU'RE A PART OF A LARGE GROUP AND WE DIDN'T WANT ANY PART OF PROTOCOL THIRTY SIX, BUT BECAUSE WE'RE A PART OF A GROUP, WE'RE JUST ONE.
OUR CITIZENS, AS I'VE HEARD, WEREN'T ABLE TO GET THE KIND OF SERVICE THAT WE EXPECT.
THAT'S WHAT I HEARD FROM THE MEDSTAR.
I LIKE THE FACT OF LOCAL CONTROL.
I LIKE THE FACT THAT YOU KNOW WHAT WE'RE GOING TO DO, WHAT'S RIGHT FOR OUR CITIZENS, NOT FOR WHAT'S RIGHT OF THE WHOLE SYSTEM, BUT FOR OUR CITIZENS.
I THANK YOU FOR STEPPING OUT AND PRESENTING THAT TO US.
CAN I SAY ONE MORE AS A FOLLOW UP [INAUDIBLE] LUNCH? COUNCIL MEMBER PAYNE I FOLLOWED UP WITH CHIEF CASEY, AND ONE OF THE THINGS IN REGARDS TO A TWO AMBULANCE SERVICE IS THAT EACH AMBULANCE HAS THE CAPACITY TO TAKE TWENTY FIVE HUNDRED CALLS AND SO THE IDEA IS THAT IF YOU TAKE BOTH AMBULANCES AND THEY HAVE THE CAPACITY FOR FIVE THOUSAND CALLS, AND I THINK WE SAW A SLIDE FROM MEDSTAR, THEIR CHARGE WAS ABOUT NET ABOUT THREE HUNDRED AND NINETY FIVE DOLLARS OR FOUR HUNDRED, AND THAT WILL BE A $2 MILLION POTENTIAL AND SO AGAIN, WE WENT VERY CONSERVATIVE.
BUT THE MAIN FOCUS IS THAT THE DOLLARS THAT WILL BE GENERATED WITH THAT TYPE OF SERVICE, IT'LL BE ABLE TO ABSORB THAT COST.
ON THAT NOTE, HANG ON,, DON'T LEAVE YET, BECAUSE MATT, YOU MENTIONED IN YOUR PRESENTATION IT WAS A COST OF TWENTY THOUSAND SIX HUNDRED DOLLARS FOR FIRE DEPARTMENT COMPARED TO THREE NINETY SIX FOR MEDSTAR.
WAS THAT COST OR WAS THAT REVENUE? THAT WAS EXPENSE TO THE SYSTEM TO PROVIDE THE AMBULANCE.
EXPENSE TO THE SYSTEM TO PROVIDE--IS THAT PER CALL? PER CALL.
AND CAN YOU TELL ME HOW YOU CAME UP WITH THAT? WE DID NOT; IT WAS THE OUTSIDE AUDITOR THAT THE STATE USES FOR MEDICAID COST REPORTING, WHO IDENTIFIES WHAT THE AGENCY HAS IN TERMS OF THE COSTS THAT THEY HAD TO DELIVER THAT LEVEL OF SERVICE, THAT ONE CALL TO A PATIENT.
SO AND WE'LL SEND YOU THE WHOLE SPREADSHEET.
I THINK WE MAY HAVE ALREADY, BUT WE'LL SEND IT AGAIN IF WE HAVEN'T.
IT LOOKS AT WHAT DID IT COST PER CALL FOR A BUNCH OF DIFFERENT FIRE DEPARTMENTS, CITY SERVICES, PUBLIC UTILITIES, ET CETERA.
WHAT WAS THE EXPENSE TO THE SYSTEM FOR THAT RESPONSE? NOT WHAT WAS THE REVENUE? WHAT DID IT COST TO DO THAT? REVENUE IS TOTALLY SEPARATE AND NOT EVEN CONSIDERED THERE BECAUSE IT'S A COST REPORT.
I WOULD REALLY LIKE TO SEE THAT BECAUSE THAT IS SO DRAMATICALLY DIFFERENT, IT IS, AND CONSIDERING THAT YOU GUYS HAVE SUCH A MUCH LARGER EMPLOYEE BASE, AS WELL AS WEIGH MORE COSTS INVOLVED BECAUSE OF HOW MANY AMBULANCES YOU'RE RUNNING AND ALL THE OTHER ADDITIONAL SERVICES THAT YOU'RE DOING, I'M STRUGGLING TO WRAP MY BRAIN AROUND THAT.
SO THE COST PER CALL IS A BASIC FUNCTION OF WHAT IS YOUR TOTAL COST? HOW MANY CALLS DO YOU DO? SO, YES, YOUR TOTAL COSTS ARE MUCH HIGHER, BUT YOU'RE DOING MUCH MORE CALLS.
THE CONCEPT THAT THE STATE HAD USED FOR THIS PROCESS USED TO BE THAT FIRE
[03:40:02]
DEPARTMENTS WOULD GET REIMBURSED FROM THE STATE FOR MEDICAID DOLLARS BASED ON THE DIFFERENCE BETWEEN WHAT IT COSTS TO PROVIDE THE SERVICE AND WHAT THEY WERE PAID BY MEDICAID.WE SHOWED LAST YEAR WE SHOWED MEDICAID THAT IN ESSENCE DOING THAT, HAVING A COST BASED REIMBURSEMENT INCENTIVIZES INEFFICIENCY.
SO DALLAS FIRE WOULD GET TWENTY EIGHT MILLION DOLLARS FROM THE STATE BECAUSE THEIR COST PER AMBULANCE CALL WAS TWENTY EIGHT HUNDRED DOLLARS.
WE GOT ONE POINT TWO MILLION BECAUSE OUR COST PER AMBULANCE TRIP AT THE TIME WAS FOUR HUNDRED AND ONE DOLLARS, AND WE POINTED OUT TO STATE THAT'S NOT REALLY FAIR.
IT SHOULD BE BASED ON WHAT DID MEDICAID PAY VERSUS WHAT DOES THE AVERAGE COMMERCIAL PAYER PAY FOR THAT SERVICE.
SO ACTUALLY, MEDICAID AGREED, AND NOW THEY FLIPPED THAT.
SO THEY'RE NO LONGER GOING TO PAY BASED ON COST, WHICH REWARDS THAT HIGH COST.
THEY'RE GOING TO BASE IT ON COST EFFECTIVENESS.
SO THIS IS ON MEDICAID CALLS ONLY THAT YOU'RE REFERENCING IN PARTICULAR RIGHT NOW AND THEN YOU'RE TALKING ABOUT A SUPPLEMENT FROM THE GOVERNMENT, FROM THE STATE BASED OFF OF MEDICAID.
THAT IS WHY THE COST REPORTING IS DONE.
SO THE COSTS ARE DONE BY THESE OUTSIDE ACCOUNTANTS, CERTIFIED PUBLIC ACCOUNTANTS BECAUSE THE STATE DOESN'T ACCEPT THE AGENCY'S OWN REPORTING OF WHAT THEIR COSTS WERE.
THEY HAVE AN OUTSIDE AGENCY THAT DOES THAT BASED ON CRITERIA.
IT'S BASED ON, YOU KNOW, HUNDREDS OF AGENCIES IN THE STATE THAT PARTICIPATE IN THAT MEDICAID COST REPORTING.
BUT THE COST ANALYSIS IS VERY CONSISTENT ACROSS ALL THOSE PROGRAMS. I'M STILL STRUGGLING TO I WOULD LOVE TO SEE THAT BECAUSE I MEAN, SEVERAL OF THE COSTS THAT WE WOULD HAVE INVOLVED IN TAKING THIS ON, I THINK WOULD STILL BE SPREAD DISPATCH.
IT'S GOING TO BE SPREAD AMONG THE POLICE DEPARTMENT AND OK, I JUST I WOULD LOVE TO SEE THAT.
MATT, ON THAT, SHE'S REFERENCING, AS IT WAS MENTIONED, THIS IS MEDICAID ONLY, WHICH IS A VERY SMALL SEGMENT.
I KNOW A LOT OF THE PRESENTATION ABOUT MEDICARE.
ALSO, IT GOES INTO ACCOUNT FOR THE ENTIRE STATE INSTEAD OF PULLING INTO OUR REGIONS.
SO IT DOES INCLUDE THE DIFFERENT FIRE RESCUES THAT ARE OUT IN VERY RURAL AREAS THAT REQUIRE A LOT OF HELICOPTER TYPE AMBULANCES, AND THOSE ARE CERTAINLY MORE COSTLY.
IS THAT GROUND-ONLY? YEAH, OK.
I WANTED TO CLARIFY THAT, BUT IT IS MEDICAID ONLY, THOUGH.
THE REIMBURSEMENT OF THE COST THAT THE STATE UNDERPAID IS BASED ON MEDICAID, HOWEVER, THE OVERALL ANALYSIS IS PAYER-AGNOSTIC.
I GOT A COUPLE OF QUESTIONS FOR YOU.
I KNOW WE'VE ALREADY BEEN HERE A LONG TIME, AND BELIEVE ME, MY GRANDKIDS ARE WANTING TO GO SEE SPIDER-MAN TODAY, SO THAT'S A PRIORITY.
WHEN HE GETS WHEN COUNCIL MEMBER JOHNSON GETS BACK, I'VE JUST GOT A BRIEF COMMENT THAT RELATES TO THE QUESTION YOU HAD AND MASS RESPONSE.
I'M SORRY, CHIEF, WHILE WE WERE ON THE SUBJECT OF COST PER CALL, I WONDER WHAT OUR COST PER CALL IS RIGHT NOW TO RESPOND AS A SQUAD WITH NO COMPENSATION.
YEAH, I JUST LIKE TO POINT OUT THAT, YOU KNOW, IN THE CASE OF MEDSTAR, AND I'M JUST TRYING TO BALANCE BOTH SIDES HERE, EVERYTHING THEY DO IS A REVENUE CALL.
NOTHING THAT WE DO RIGHT NOW IS A REVENUE CALL, AND THAT SITUATION WOULD CHANGE.
THAT IS CORRECT, AND IT'S ABSOLUTELY FAIR TO SAY THAT WE DO HAVE THE COST.
THERE'S A LOT OF DETAIL THAT I WOULD LIKE TO RESPOND, NOT TODAY, BUT TO PREPARE THE RESPONSE TO MEDSTAR'S ASSERTIONS WITH THAT SLIDE, BECAUSE THERE'S A LOT OF DETAILS THAT I THINK ARE NOT APPLES TO ORANGES, AND WE ARE NOT IN A POSITION THAT THIS PERHAPS TOOK INTO ACCOUNT.
WE'VE ALREADY GOT A LOT OF SUNKEN COST IN THAT, SO I WANT TO MAKE SURE THAT THE COUNTY AND THE COUNCIL AND THE COMMUNITY UNDERSTANDS THAT AND THAT IT IS ACCURATE DATA AND WE'LL BE GLAD TO HAVE A RESPONSE TO THAT AS WELL.
I'D LIKE TO BECAUSE I THINK I'VE DUG DEEPER INTO THIS CONSIDERATION THAN I HAVE ANYTHING WITH THE POSSIBLE EXCEPTION OF A CELL PHONE TOWER OVER BEHIND HOBBY LOBBY.
[03:45:01]
[LAUGHTER], BUT THAT WASN'T BY MY CHOICE.YOU READY TO BUILD YOUR OWN? I THINK I COULD.
[CHUCKLING] ADD ANOTHER THOUGHT TO THAT--CHIEF, I MIGHT JUST ASK IF YOU COULD KIND OF WRAP UP ON THE TIMELINE, PERHAPS I DON'T KNOW IF WE REALLY ARTICULATED THE MARCH 1ST TIMELINE.
WHAT WE'RE ASKING COUNCIL DIRECTION TO GIVE US DIRECTION FEEDBACK IS WHAT WOULD YOU LIKE TO SEE FOR POTENTIAL FUTURE WORKSHOP(S)? AND THEN WE ALSO ARE ASKING THE COUNCIL THAT BY MARCH 1ST THAT WE WOULD RECEIVE CLEAR DIRECTION FROM YOU FROM AN ACTION ITEM BECAUSE IF WE MOVE IN THIS DIRECTION, THERE'S A LOT OF THINGS THAT WE WILL NEED TO DO OVER THE NEXT 18, 19 MONTHS OR WHATEVER IT ENDS UP BEING AND WE FEEL LIKE THAT MARCH 1ST DEADLINE WILL IS WILL POSITION US TO BE ABLE TO PUT EVERYTHING INTO PLAY, PROVIDE TREMENDOUS AMOUNT OF FEEDBACK AND WORK WITH THE COUNCIL TO GET YOUR DIRECTIONS BECAUSE THIS WOULD BE AGAIN BURLESON CENTRIC AND SO THAT'S WHY WE'RE ASKING FOR THE MARCH 1ST DEADLINE AND THEN I THINK THIS IS SOMETHING THAT NEEDS TO BE SAID THAT I'VE ALREADY SAID THAT WE'RE ALREADY HAVING A COST TO YOUR POINT, MAYOR PRO TEM THAT WE'RE NOT HAVING A COST RECOVERY AT ALL AND I'M NOT GOING TO SIT HERE AND DEBATE OR DEFEND WHAT RATHER FIRE BASED EMS IS MORE EXPENSIVE OR IT'S NOT.
IT VERY WELL COULD BE, AND WE'RE GOING TO BE VERY OPEN AND TRANSPARENT ABOUT THAT.
BUT WHAT I NEVER PUT A COST OWN IS THE LIVES.
RIGHT NOW, OUR CITIZENS ARE PAYING A COST AND IN THE TRAVEL TIMES, THE LENGTHY TRAVEL TIMES AND THE RESPONSE TIMES.
SO I JUST WANT TO MAKE SURE THAT THOSE INTANGIBLES THAT WE BELIEVE WE WILL BRING TO THIS SYSTEM AND TO THIS COMMUNITY, THERE'S NOT A COST TO THAT.
NO AMOUNT OF MONEY CAN PAY FOR THAT AND WE'RE PAYING FOR IT AGAIN IN THE AREAS THAT I'VE ALREADY TALKED ABOUT.
SO I'D JUST ASK THE COUNCIL AS WE HAVE THIS DISCUSSION, WHAT IS IT WORTH AND WHERE ARE WE PAYING FOR IT? BECAUSE WE ARE PAYING FOR IT.
THERE IS A COST IN OUR CUSTOMER EXPERIENCE WITHOUT A QUESTION.
SO COUNCIL MEMBER GREEN DID YOU HAVE A--I HAD LOOKED AT THE FINANCIAL PROJECTIONS, AND IS THERE A REASON WHY PERSONNEL COSTS STAY THE SAME EVERY YEAR WHEN WE HAVE STEP PLAN INCREASES IN THERE ALSO? WE DID THAT.
WE DID NOT FACTOR IN EVERY NUANCE TO IT.
NUMBER ONE, THIS IS A GENERAL.
THIS IS NOT TO BE AN EXACT AGAIN, WE WERE NOT GOING TO GET AHEAD OF COUNCIL.
WE'RE NOT GOING TO MAKE ALL THESE ASSUMPTIONS.
WE'LL BE GLAD TO COME BACK WITH YOU WITH ANY KIND OF DETAIL WHERE WE CAN PUT THOSE IN.
THE SQUADS WOULD BE STAFFED BY FIREFIGHTERS AND SO WE WOULD ONLY BE DEALING WITH THE STEPS AND THEN THOSE ARE TIMELINES.
WE'LL BE GLAD TO DO OUR BEST IF WE WANT TO GET DOWN TO THAT [INAUDIBLE] OR OTHER LEVEL, WE'D BE GLAD TO DO THAT FOR YOU.
WE TRIED TO MAKE IT TRANSPARENT REPRESENTATIVE, NOT JUST A BROAD BRUSH, BECAUSE THERE'S A LOT OF DETAIL IN THERE AND WE FEEL CONFIDENT THAT THIS IS REFLECTIVE OF AS CLOSE TO REALITY AS WE CAN WITH DEALING WITH SOME UNKNOWNS ABOUT, YOU KNOW, WE DO ANTICIPATE CALL VOLUME, TRANSPORT VOLUMES WILL GO UP.
WE DO ANTICIPATE ALL OF THAT, BUT WE TRIED TO BE VERY CONSERVATIVE AND VERY FAIR TO THIS DISCUSSION.
OK, SO THIS I MEAN, THIS IS PRETTY MUCH THE SAME THING HERE, PROBABLY.
BUT THE FIRST NUMBER THAT I SAW FOR REVENUE WAS ONE POINT THREE MILLION ON NOVEMBER THE 8TH.
THEN IT WENT TO ONE POINT FIVE MILLION AND NOW IT'S ONE POINT SIX MILLION.
WHY DOES IT KEEP CHANGING? WELL, PART OF THAT IS BECAUSE AS WE HAVE ASKED FOR DATA FROM MEDSTAR, WE'VE GOTTEN DIFFERENT NUMBERS STARTED OFF WITH TWO POINT ONE MILLION AND THEN I'VE SPOKEN WITH THE CEO, IT'S GONE DOWN TO ONE POINT EIGHT MILLION.
WE HAVE OUR STUDY FROM FITCH THAT COMES IN AND COMES UP WITH THE DIFFERENT NUMBERS.
SO WE HAVE DONE WHAT WE BELIEVE IS A PRUDENT ESTIMATION TO SAY, WE DON'T KNOW EXACTLY WHAT THOSE NUMBERS ARE BECAUSE WE'VE ASKED, WE DON'T KNOW WHAT THE PROFITS ARE FROM MEDSTAR.
WE'VE ALSO ASKED FOR INFORMATION THAT WE DON'T HAVE.
[03:50:02]
SO THAT NUMBER HAS BEEN EXTRAPOLATED FROM CONVERSATIONS AND THE DATA THAT WE HAVE.I ALSO HAD A BILLING COMPANY LOOK AT FITCH'S DATA OR MEDSTAR'S DATA BASED ON THE RUNS CURRENTLY AND PUT VERY CONSERVATIVE FIGURES IN THERE FOR WHERE WE WOULD BE IN THE NEXT COUPLE OF YEARS.
SO ONE POINT FIVE, SOME ODD MILLION, RIGHT, AT ONE POINT SIX MILLION.
SO AGAIN, I DON'T THINK IT'S UNREALISTIC TO ANTICIPATE, AS WE'VE ALREADY SAID, WE'RE CLOSE.
WE DO NOT HAVE AN EXACT BULLSEYE, BUT WE FEEL THIS ACCURATELY REPRESENTS GOING BACK TO A PROFORMA.
WE KNOW WHAT OUR COSTS ARE NOW AND OUR REVENUE COST RECOVERY IS ZERO.
SAME ALONG THE SAME LINE THE CONSULTANT'S REPORT SAID THAT EACH ANALYST WOULD COST ONE HUNDRED AND TWENTY FIVE THOUSAND.
NOW WE'RE AT THREE HUNDRED THOUSAND.
WHICH ONE IS IT? WELL, TO ADDRESS THAT, GOOD QUESTION, I THINK WHAT THE REPORT SAID WAS THEY WERE ESTIMATING ABOUT ONE HUNDRED AND TWENTY FIVE TO--I DON'T HAVE THE REPORT IN FRONT OF ME--I THINK THAT WAS ONE TWENTY FIVE AND THERE WAS MAYBE ONE FIFTY AND THE CONSULTANTS ARE HERE, BUT I'LL GO OFF OF MY MEMORY.
THAT NUMBER WAS BASED ON ADDITIONAL COST TO THE SEVENTY SOME ODD THOUSAND DOLLARS FOR THE SQUAD.
SO YOU ADD THOSE NUMBERS UP, IT'S TWO HUNDRED AND WHATEVER IT IS AND THEN OUR THREE HUNDRED THOUSAND DOLLARS AGAIN IS A VERY CONSERVATIVE NUMBER.
WE'VE TALKED TO LOCAL FIRE DEPARTMENTS THAT ARE PAYING ANYWHERE FROM TWO HUNDRED AND THIRTY THOUSAND TO THREE HUNDRED THOUSAND.
SO WHAT WE DID AGAIN, TO BE FAIR TO THIS COUNCIL, AND THIS COMMUNITY, NOT KNOWING EXACTLY WHAT THE NUMBERS WOULD BE.
WE DID A HIGH INSTEAD OF COMING IN LOW AND TRYING TO BALLPARK LOW BALL AND SO I THINK THAT'S WHAT THE REPORT SAYS THAT IT'S NOT AND IF THAT WAS THE INTERPRETATION, THAT'S NOT THE INTENT.
BUT I DON'T THINK THE REPORT, THE ONE TWENTY FIVE OR ONE FIFTY IS IN ADDITION, YOU ADD WHAT WE'RE SPENDING ON THE SQUAD ON TOP OF THAT, WHICH IS CONSISTENT WITH WHAT OTHER FIRE DEPARTMENTS ARE PAYING FOR AMBULANCES, BUT WE WENT EVEN ABOVE THAT.
IS THAT AN ADEQUATE ANSWER TO YOUR QUESTION? THE LAST QUESTIONS I HAVE HERE FOR MATT.
ONE OF THE THINGS THAT I LOOKED AT IS YOUR COLLECTION RATE.
WHAT IS YOUR CURRENT COLLECTION RATE? SO SYSTEMWIDE OUR CURRENT COLLECTION RATE IS ABOUT TWENTY THREE POINT EIGHT EIGHT PERCENT ON THE DOLLARS THAT WE COLLECT.
IF YOU BILL FOR A MILLION DOLLARS, YOU'RE GOING TO COLLECT ABOUT TWENTY THREE THOUSAND DOLLARS OF THAT MILLION DOLLARS.
IS THAT RIGHT? TWO HUNDRED AND THIRTY THOUSAND.
BURLESON PROJECTIONS SHOW REVENUE AT ONE POINT SIXTY FIVE.
COULD WE REALLY COLLECT THAT REVENUE IF WE WERE ONLY RUNNING TWO TO THREE AMBULANCES? AS WE SAID EARLIER, THE NUMBER OF CALLS THAT YOU DON'T DO IS REVENUE THAT YOU CAN'T COLLECT.
SO WE WOULD ENCOURAGE FLEXIBLE STAFFING, ALL SORTS OF THINGS TO TRY AND MAKE SURE THAT THEY ARE ABLE TO COLLECT AS MUCH OF THE REVENUE AS THEY CAN FOR COST OFFSET.
BUT MORE IMPORTANTLY, TO MAKE SURE THAT THEY DON'T HAVE RESPONSE DELAYS FOR THE CALLS THAT THEY CAN'T RESPOND TO BECAUSE THEIR UNITS ARE TIED UP ON OTHER CALLS.
UH, BASED ON WHAT YOU KNOW ABOUT EMS FINANCIALS AND YOU'VE BEEN DOING THIS A LONG TIME.
WHAT WOULD BE THE ECONOMIC IMPACT ON THE FIRE DEPARTMENT TAKING OVER AMBULANCE SERVICES IN BURLESON? THE ECONOMIC IMPACT ON WHOM? ON THE FIRE DEPARTMENT.
I MEAN, THEIR OWN PROJECTIONS SHOW THAT THE BOTTOM LINE IS THAT IT'S GOING TO BE TAX SUBSIDIZED.
THE QUESTION IS, IS THE TAX SUBSIDY THAT'S BEING ADDED TO THE SYSTEM BY ADDING PERSONNEL TO THE DEPARTMENT OFFSET BY THE REVENUE THAT'S ACTUALLY COLLECTED AND DEPOSITED INTO THE BANK ACCOUNT AT THE END OF THE DAY.
AND I THINK, YOU KNOW, EVERYBODY NEEDS TO HAVE A VERY CLOSE LOOK AT THAT.
WE HAD ACTUALLY SUGGESTED AS PART OF THIS PROCESS THAT THIS VENTURE ON THE PART OF THE FIRE DEPARTMENT WOULD PROBABLY BE BEST SERVED TO HAVE AN ENTERPRISE FUND SO THAT ALL COSTS RELATED TO AMBULANCE SERVICE DELIVERY AND ALL REVENUES RELATED TO AMBULANCE SERVICE DELIVERY CAN BE TRANSPARENTLY REPORTED TO DETERMINE WERE THE PROJECTIONS CLOSE.
DO WE NEED TO MAKE CHANGES? DO WE NEED TO FIGURE OUT SOME OTHER ADDITIONAL FUNDING MECHANISMS TO REALLY HAVE THAT TRUE TRANSPARENCY? SO I DON'T KNOW IF I'M READING THIS RIGHT, BUT I KNOW TAMARA KIND OF ASK SOMETHING TO THIS QUESTION, BUT THE AVERAGE FIREBASE SERVICE COSTS TWENTY SIX HUNDRED AND TWENTY SEVEN DOLLARS PER RUN, WHICH I'VE ALREADY SAID, BUT ONLY BRINGS IN THIRTEEN HUNDRED
[03:55:02]
AND NINE IN REVENUE.SO WHAT DOES THAT MEAN TO TAXPAYERS THAT THEY WOULD BE PAYING FOURTEEN HUNDRED DOLLARS EVERY TIME AN AMBULANCE GOES OUT? YES, IT WOULD, BUT THAT DATA IS BASED ON TRANSPORTS, NOT RESPONSES, BUT THAT IN ESSENCE, THE DIFFERENCE BETWEEN THE COST OF PROVIDING THE SERVICE AND THE REVENUE THAT COMES IN FROM THE SERVICE IS HAS TO BE MADE UP SOMEHOW, WHETHER THAT'S GOING TO BE THROUGH SUBSIDY, WHETHER THAT'S ANOTHER REVENUE STREAM THAT WE WORK ON ALL THE TIME TO MAKE SURE THAT IF OUR NUMBERS GET TOO CLOSE, WE'VE GOT ADDITIONAL REVENUE STREAMS THAT WE'RE DOING, LIKE OUR COMMUNITY HEALTH PROGRAMS THAT BRING IN REVENUE THAT HELPS PREVENT US FROM HAVING THE LINES CROSS BETWEEN COST AND REVENUE.
SO YOUR AVERAGE COST WAS THREE HUNDRED AND NINETY SIX DOLLARS? CORRECT AND OUR AVERAGE REVENUE IS ABOUT FOUR HUNDRED AND TWENTY.
SO IT SEEMS LIKE A LOT OF THIS COMES DOWN TO THE NUMBER OF AMBULANCES FOR ME IS WHAT I'M LOOKING AT.
IF WE DON'T HAVE ENOUGH, IT WILL BE CHEAPER, OF COURSE, BUT THE QUALITY OF CARE WILL SUFFER.
IF WE HAVE FIVE TO SIX AMBULANCES, OUR QUALITY OF CARE WILL BE FINE, BUT WE'LL BE SPENDING MILLIONS OF DOLLARS EVERY YEAR.
SO IT SEEMS LIKE A BAD SITUATION EITHER WAY.
WELL, IT'S A DIFFICULT DECISION AND I THINK PART OF THE GREAT THING ABOUT THE RELATIONSHIPS THAT WE HAVE ALREADY WITH THE AGENCIES IS WE ARE GOING TO BE VERY TRANSPARENT AND IF WE'VE GIVEN DIFFERENT NUMBERS OR THEY'VE BEEN INTERPRETED DIFFERENTLY, YOU'VE GOT TIME BEFORE MARCH 1ST TO REALLY VET A LOT OF THAT OUT AND SIT DOWN TOGETHER AND PUT STUFF UP ON THE SCREEN AND TO SHARE IT TO KIND OF SAY, WHAT DOES THIS REALLY LOOK LIKE? FOR EXAMPLE, THE RESPONSE TIMES AND WE'RE GOING TO EMAIL THIS BECAUSE WE DIDN'T PUT IT INTO THE PRESENTATION, BUT WHEN YOU LOOK AT OUR RESPONSE TIME COMPLIANCE, NOT JUST FOR THE LAST 12 MONTHS, BUT SINCE TWENTY SEVENTEEN, WE HAVE HAD SO MANY MORE MONTHS THAT WE'VE BEEN RESPONSE TIME COMPLIANT THAN WE HAVEN'T UNTIL THE PANDEMIC HIT.
AND THAT HASN'T REALLY COME OUT.
SO WE'LL MAKE SURE THAT THE COUNCIL AND STAFF HAVE THAT, THAT TRUE ANALYSIS OF WHAT HAS THE LAST THREE YEARS BEEN, NOT THE LAST 12 MONTHS, BECAUSE IT'S AGAIN WHEN YOU LOOK AT 2020 RESPONSE DATA AND I'M SURE THAT ANYBODY WHO LOOKS AT IT NATIONALLY, EMS RESPONSES IN 2020 WERE WAY DOWN AND WE'RE SEEING IN 2021 RESPONSE VOLUME GOING TO RECORD LEVELS THAT EVERYONE'S HAVING A HARD TIME MEETING WITH BURLESON GROWTH.
IF YOU'RE NOT GOING TO START PROVIDING AMBULANCE SERVICE UNTIL 2024, WE'RE PRETTY SURE THE CALL VOLUME IS GOING TO BE A LOT HIGHER THAN IT WAS IN 2020.
SO WHAT DOES 2024 LOOK LIKE AND WORKING WITH EVERYBODY TO MAKE SURE THAT, HEY, IF THERE'S MORE RESOURCES NEEDED, WHAT'S THE MOST APPROPRIATE WAY TO DO THAT AS PART OF THE SERVICE OPTIONS FOR THE FUTURE.
SO CLEARLY, MEDSTAR CAN PROVIDE TRANSPORT SERVICES AT A LOWER COST THAN THE CITY, HAS BURLESON APPROACHED YOU ON ANY ALTERNATIVES? TO WHAT? THE AMBULANCE AND STATION 16, WHICH WAS ONE THAT WE DID COLLABORATIVELY TRYING TO FIGURE OUT A BETTER DISPATCH PROCESS.
WE HAVE BEEN PROPONENTS OF A CONSOLIDATED REGIONAL DISPATCH CENTER FOR YEARS SO THAT INSTEAD OF HAVING THE FIFTY TWO THAT WE HAVE NOW ACROSS THE COMMUNITY HAVE ONE OR HAVE THREE THAT SHARED GOVERNANCE, SHARED OWNERSHIP, ALL CALLS GO TO ONE PLACE.
THAT'S THE PANACEA IS INSTEAD OF HAVING INDIVIDUAL CITY PSAP, YOU HAVE A COUNTY PSAP LIKE THEY DO IN MANY ADVANCED COUNTIES.
IN FLORIDA, WHERE YOU'VE GOT A COUNTY DISPATCH CENTER, ALL CALLS FOR ALL CITIES ARE HANDLED BY THAT SAME GROUP AND THEY JUST IT'S VERY SEAMLESS, IT'S STRONGLY FUNDED AND THEY WORK VERY, VERY EFFECTIVELY.
SO WHAT WE WOULD PROJECT IS WORKING TOGETHER TO FIGURE WHAT THOSE ARE.
WE'VE DONE A NUMBER OF ENHANCEMENTS ALREADY.
ONE OF THE THINGS THAT WE TALKED ABOUT AND THAT I DID WHEN I WAS IN ANOTHER SYSTEM IS CAN WE WORK TOGETHER TO TAKE PERSONNEL THAT ARE ALREADY ON DUTY AT BURLESON FIRE AND STAFF ONE TWO THREE OF OUR AMBULANCES ALREADY.
THAT CUTS DOWN ON YOUR CAPITAL COSTS.
WE PAY FOR SOME OF THE STAFF OR MAYBE ALL OF THE STAFF WE DO REVENUE SHARE, BUT THOSE CONSIDERATIONS HAVEN'T BEEN TAKEN INTO ACCOUNT YET, AND HOPEFULLY BETWEEN NOW AND MARCH 1ST, WE CAN HAVE SOME OF THOSE CONVERSATIONS TO LOOK AT ARE THERE OTHER OPTIONS THAT ARE LESS RISKY FOR THE CITY? SO MAYBE THERE IS A MIDDLE GROUND THAT WE CAN GET TO? ABSOLUTELY.
ONE OF THE THINGS THAT YOU BROUGHT OUT BEFORE WAS THAT WHEN YOU GUYS BILL, IT ACTUALLY COMES WITH MEDSTAR ON TOP OF THAT BILL, RIGHT? SO IF WE GO TO THE FIRE BASED EMS, WHO'S THAT BILL GOING TO COME FROM? MAYBE KT CAN ADDRESS THAT.
CITY OF BURLESON, PROBABLY, OR THE BILLING CONTRACTOR.
BUT LIKE US, WE'VE OUTSOURCED OUR BILLING, BUT IT STILL SAYS MEDSTAR ON IT.
YEAH, IT'D SAY BURLESON FIRE PROBABLY, RIGHT? YES, COULD SAY MEDSTAR IF YOU WANT.
[04:00:01]
SO THAT'S A REAL CONCERN WITH ME, THOUGH, BECAUSE IF IT'S COMING FROM THE CITY OF BURLESON, PEOPLE ARE ALREADY PAYING TAXES TO THE CITY OF BURLESON, AND NOW WE'RE CHARGING THEM FOR AN AMBULANCE SERVICE THAT IS AND THE BILL IS ACTUALLY COMING FROM THE CITY OF BURLESON INSTEAD OF MEDSTAR.I CAN SEE SOME REAL PROBLEMS WITH THAT.
I MEAN, I THINK PEOPLE WILL THINK, WELL, I'M ALREADY PAYING TAXES.
YOU KNOW, WHY AM I HAVING TO GO AND PAY FOR THIS SERVICE TOO? YOU KNOW, ARE YOU GOING TO CHARGE ME FOR ONE OF MY HOUSE CATCHES ON FIRE? I MEAN, YOU KNOW, I CAN SEE A LOT OF THAT STUFF GOING ON.
COUNCIL MEMBER GREEN, THOSE ARE FAIR COMMENTS, AND THAT'S BEEN SHARED FROM COUNCIL MEMBER JOHNSON AS WELL.
I'VE TALKED TO SIX OR SEVEN FIRE CHIEFS LOCALLY, AND I ASKED THEM THAT SPECIFIC QUESTION AND THEY SAID THEY FIELD AT LEAST ONE NO MORE THAN ONE CONCERN OUT OF A CITIZEN, AND ALTHOUGH IT IS FAIR, IT IS NOT AN ISSUE IN ANY OF THE CITIES.
I'VE TALKED TO CEDAR HILL, I'VE TALKED TO CROWLEY, I'VE TALKED TO [INAUDIBLE].
FAIR COMMENT, FAIR CONCERN AND WHAT THEY SHARED WITH ME AND I PERSONALLY HOLD THIS VIEW AS WELL.
I THINK OUR CITY CITIZENS AND CITY LEADERS WE'RE RESPONSIBLE FOR PROVIDING A STATE OF READINESS AND THEN WHENEVER A SERVICE IS PROVIDED, THERE ARE CERTAINLY INDIVIDUALS THAT COULD CERTAINLY EXPECT AND BELIEVE THAT THEIR TAXES PAY FOR THAT.
WE HAVE WATER SERVICES THAT OUR CITIZENS EXPECT TO HAVE A SERVICE READY, BUT WHEN THEY USE IT, THEY PAY FOR IT AND AGAIN, THE COUNCIL WOULD BE COMPLETELY IN CHARGE OF HOW THE BILLING SERVICE IS BILLED.
OUR FRIENDS DOWN SOUTH, THEY DO NOT SEND A BILL TO COLLECTIONS, SO THEY SHARED WITH ME THEY HAVE A GENTLEMAN THAT OWED LIKE $300 OR WHATNOT.
HE PAYS $5 A MONTH, SO THE COUNCIL GETS TO DETERMINE THAT AND I'D ALSO LIKE TO LEGITIMATE CONCERN, BUT THE CHIEFS THAT I HAVE TALKED TO IT HAS NOT BEEN AN ISSUE AND THERE'S CITIES AT ALL.
ANOTHER THING WHEN YOU'RE TALKING ABOUT THE REVENUES.
WE GOT DATA FROM MEDSTAR THAT SHOWS THEIR CASH COLLECTIBLES.
THAT'S CASH COLLECTED AND NO MATTER WHAT THE BILL IS, IT BOILS DOWN TO AT SOME POINT, WHAT DO YOU COLLECT? THEY COLLECT FOUR HUNDRED AND TEN DOLLARS IS WHAT THEY COLLECT THEIR SYSTEM.
FIRE DEPARTMENTS THROUGHOUT THE U.S., WE WOULD ALSO BE IN THIS GROUP.
YOU WRITE OFF A TREMENDOUS AMOUNT OF CHARGES, BUT AT THE END OF THE DAY, MEDSTAR IS SHOWING A MINIMUM OF FOUR HUNDRED AND TEN DOLLARS CASH COLLECTIONS AND THEN IT DEPENDS ON YOUR CALL VOLUME.
SO I HOPE THAT SHEDS A LITTLE BIT MORE LIGHT ON SOME OF THE COMMENTS AND QUESTIONS YOU HAD.
IT'S STILL COSTING MORE FOR US TO DO THE SERVICE.
I'M NOT GOING TO STAND HERE BEFORE YOU OR ANYONE ELSE AND SAY IT'S WE'RE NOT MORE EXPENSIVE, BUT RIGHT NOW WE GET ZERO REVENUE FOR THE SERVICES THAT WE ARE ALREADY PROVIDING AND THERE IS A COST TO THE COMMUNITY FOR--THE PEOPLE IN THE COMMUNITY PAY FOR THE SERVICE RIGHT NOW FOR TO MEDSTAR, I MEAN, ONCE ONCE THAT COST IS PASSED ON HERE, I MEAN, AND WITH YOUR AMOUNT THAT YOU'RE GOING TO BE CHARGED PER RUN AND THAT SORT OF THING, IT'S GOING TO BE WAY OUT OF WHACK FROM WHAT I SAW.
WELL, WE WOULD BILL ACCORDING TO WHAT THE LAW ALLOWS.
SO OUR BILLING WOULD BE NO DIFFERENT THAN MEDSTAR BILLING.
WE WOULD BILL ACCORDING TO WHAT THE LAW IS PRESCRIBED.
BUT IT'S GOING TO BE A LOT MORE, BECAUSE THEY'RE CHARGING THREE POINT NINETY SIX AND FROM WHAT YOU SAID, THERE'S TWENTY SIX HUNDRED AND TWENTY SEVEN DOLLARS [INAUDIBLE] THAT'S NOT WHAT I SAID.
I THOUGHT THAT'S WHAT THE SLIDE SAID WAS.
WELL, THAT WAS THE DATA THAT MEDSTAR PROVIDED FROM A THIRD PARTY CONSULTANT SPEAKERS] MEDICAID CALLS.
JUST LIKE COMMAS ARE WHEN YOU [INAUDIBLE]? BUT SO THE COST REPORT THAT WE REFER TO AND THAT WE'LL PROVIDE TO COUNCIL IS WHAT IT COSTS THE EXPENSE TO THE AGENCY FOR DOING THAT CALL.
IT IS NOT THE BILL THAT THEY SEND OUT BECAUSE OUR AVERAGE BILL IS SIXTEEN HUNDRED DOLLARS OF THAT SIXTEEN HUNDRED WE COLLECT FOUR HUNDRED AND TEN.
MEDICARE AND MEDICAID AND UNINSURED.
BUT AT LEAST WE'RE ABLE TO COLLECT MORE THAN IT COSTS US TO DO THE CALL.
[04:05:06]
THAT'S HOW WE'RE ABLE TO MAINTAIN THE TAX SUBSIDY.THE COST VERSUS HOW MUCH YOU'RE ABLE TO BILL, WILL WE HAVE TO BILL THREE TIMES WHAT OUR COST IS TO TRY AND REACH AND CAPTURE A PERCENTAGE OF WHAT THEY DO? MEDICAL BILLING IS COMPLICATED, AND THE MAJORITY OF THE PEOPLE WHO RECEIVE AMBULANCE SERVICE WE'LL JUST STICK TO AMBULANCE SERVICE FALL INTO THREE FOUR TYPES OF PAYER GROUPS.
MEDICARE PAYS A FIXED AMOUNT AND THEY DON'T CARE WHAT YOU BILL, SO YOU COULD BILL THEM TEN THOUSAND.
THEY'RE PAYING THREE HUNDRED DOLLARS.
MEDICAID DOESN'T CARE WHAT YOU BILL, THEY PAY A FIXED AMOUNT TWO HUNDRED AND EIGHTY DOLLARS.
COMMERCIAL INSURERS, TYPICALLY IN THE PAST HAVE PAID 80 PERCENT OF WHAT THE USUAL AND CUSTOMARY FEE IS FOR THE REGION.
BUT THE DETERMINATION OF WHAT'S REASONABLE AND CUSTOMARY OR USUAL AND CUSTOMARY IS MADE BY THE PAYER.
SO THE PAYER COULD SAY, HEY BURLESON FIRE YOU'RE BILLING THE SAME AMOUNT AS MEDSTAR.
THAT'S SIXTEEN HUNDRED DOLLARS PER TRIP, BLAH BLAH.
BUT WE THINK THAT THE USUAL AND CUSTOMARY IS EIGHT HUNDRED, SO WE'RE ONLY GOING TO PAY EIGHT HUNDRED DOLLARS AND THOSE ARE THE CALLS THAT WE GET FROM A LOT OF OUR PATIENTS WHEN THEY'RE BLUE CROSS BLUE SHIELD OR THEIR UNITED HEALTH CARE AND WE'VE BILLED THE INSURANCE COMPANY SIXTEEN HUNDRED.
THE INSURANCE COMPANY CHOOSES TO PAY EIGHT HUNDRED.
THEN WE BALANCE BILL THE PATIENT AND THE PATIENT SAYS, WAIT A MINUTE, I PAY TAXES.
I SHOULDN'T HAVE TO PAY THIS BILL AND WE EXPLAIN, HEY, WE'RE NOT TAX SUPPORTED, INDEPENDENT GOVERNMENTAL AUTHORITY, BLAH BLAH BLAH.
THEY GET IT AND A LOT OF THOSE PEOPLE SAY, OK, YEAH, NOW I GET IT.
NOW, DALLAS, A LOT OF THE OTHER AGENCIES ARTIFICIALLY REDUCE THEIR BILL BECAUSE THEY DON'T WANT CITY COUNCIL MEMBERS, DON'T WANT TO GET PHONE CALLS FROM PEOPLE SAYING, WHY DID I GET A SIXTEEN HUNDRED DOLLAR BILL FROM THE FIRE DEPARTMENT FOR AN AMBULANCE CALL? SO THEY CHOOSE TO BILL ONLY WHAT THEY THINK THE INSURANCE COMPANY MIGHT PAY, WHICH NOW DRIVES DOWN THE REVENUE PRETTY SUBSTANTIALLY JUST TO PREVENT PEOPLE FROM CALLING AND COMPLAINING.
WE DID A LOT OF WORK AT THE REQUEST OF DALLAS AS AN EXAMPLE, WHEN WE FIRST STARTED WORKING WITH THEM ON SOME OF THEIR PROGRAMS, THEY WERE BILLING SIX HUNDRED DOLLARS, BUT IT WAS COSTING THEM AT THE TIME, TWENTY SEVEN HUNDRED AND WE SAID, WHY ARE YOU BILLING LESS THAN IT'S COSTING YOU? AND THEY SAID, WELL, BECAUSE THE COUNCIL DOESN'T WANT TO GET PHONE CALL COMPLAINTS.
TODAY, DALLAS FIRE IS BILLING EIGHTEEN HUNDRED DOLLARS A CALL BECAUSE IT INCREASED THEIR REVENUE.
A LOT OF CALLS, ACTUALLY, BUT EMS ECONOMICS AND SPECIFICALLY REVENUE IS VERY, VERY COMPLICATED AND JUST TO KNOW, I THINK I READ SOMETHING JUST A WHILE BACK THAT UNITED CAME OUT AND SAID THEY WERE NOTORIOUSLY UNDERPAYING, PURPOSELY UNDERPAYING SAFETY NET PROVIDERS LIKE EMS, LIKE E.R.
DOCS TO SEE IF ANYBODY COMPLAINED.
IF THEY COMPLAINED, THEN THEY WOULD PAY A HIGHER RATE, RIGHT? I HAD A GLIMPSE INTO THE HEALTH CARE INDUSTRY WHEN I WORKED FOR THE HOSPITAL FOR A COUPLE OF YEARS, AND IT WAS A HUGE COMPLAINT AS BEING LIKE THERE WAS A LOT OF TURNOVER IN BILLING STAFF.
YOU HAD THE PHYSICIAN OFFICES, COULDN'T HIRE ENOUGH BILLING STAFF BECAUSE THERE'S SO MANY NUANCES AND QUIRKS WITH EVERY SINGLE INSURANCE COMPANY.
THIS ONE WANTS YOU TO JUMP THROUGH THREE HOOPS AND THIS ONE WANTS YOU THIS AND SO AND I APOLOGIZE, I'VE SO MANY QUESTIONS, AND I WAS WAITING TO HEAR THE END OF BOTH PRESENTATIONS, SO I KNEW WHAT WOULD BE COVERED AND WHAT WOULDN'T.
SO I APOLOGIZE FOR TRYING TO SHUFFLE THINGS AROUND.
I'LL TRY AND BE AS BRIEF AS I CAN.
ONE, MARTIN, I WANT TO GO TO SLIDE FORTY SEVEN ABOUT--NOW, MY IPAD IS FROZEN.
SO FORTY SEVEN, NEXT ONE, OH, ON THE PREVIOUS.
THIS IS FOR WHAT AMBULANCE FOR FOUR AMBULANCES ON THE PREVIOUS THREE TWO YOU HAD LISTED IPAD'S FROZEN FLEET REPLACEMENT FUND RESERVE AND RESERVE AMBULANCE FUEL, BUT THAT'S NOT LISTED ON THE FOUR AMBULANCE SLIDE.
SO WE'RE MISSING WHAT, FIFTY THOUSAND THERE? I CAN ANSWER THAT QUESTION BECAUSE IT'S NOT GOING TO BE A RESERVE; IT WOULD BE PART OF THE AMBULANCE ITSELF.
SO WE ACTUALLY INCREASE THE REPLACEMENT COST TO THE $70000 FIGURE, I BELIEVE.
[04:10:02]
OK AND THE OTHER THING IS HOW ON 2025 DO WE GO FROM SEVENTY SEVEN IN THE RED TO FIVE HUNDRED AND TWENTY SEVEN IN THE BLACK? ON 2026, WE ARE INTRODUCING THE THIRD SQUAD.SO NOW THE COST AT THAT POINT GOES FROM ONE POINT THREE TO ONE POINT NINE AND SO THAT IS IN ESSENCE WHAT WE'RE PROJECTING WITHOUT DOING ANY TRANSPORT SERVICES, THAT IS IN ESSENCE, THE PROJECTION THAT WE HAVE AS IT RELATES TO INTRODUCING A THIRD SQUAD IN 2026, SO WHAT THAT DOES IS THEN YOU ARE NOW INCREASING YOUR COSTS, BUT HERE YOU STILL NOW HAVE REVENUES THAT ARE ABSORBING THOSE COSTS.
OK, LET'S SEE WHERE I CAN GO FROM HERE.
I WANT TO TALK ABOUT RESPONSE TIMES.
THAT'S A TOPIC THAT WE'VE TALKED ABOUT A LOT TODAY, AND I REALLY JUST WANT TO UNDERSTAND THE SYSTEM DESIGN.
IT'S MY UNDERSTANDING THAT THE SYSTEM IS DESIGNED THAT THE FIRE DEPARTMENT IS ON SCENE BEFORE MEDSTAR.
THIS IS CAN I UNDERSTAND THIS SYSTEM BETTER AND OUR MOST SYSTEMS DESIGNED THIS WAY? THE SYSTEMS WERE THE FIRST RESPONDERS, THE SYSTEM THAT WE'RE IN, WHERE WE HAVE MEDSTAR.
IT IS DESIGNED FOR FIRST RESPONDERS TO BE ON SCENE FIRST AND I'VE SHARED THIS WITH COUNCIL THAT'S THE WAY THIS SYSTEM IS DESIGNED.
BUT I WOULD SAY, BASED ON THE HOW MANY FIRE BASED EMS DEPARTMENTS THERE ARE IN THE UNITED STATES, GOING BACK TO THE 84 DEPARTMENTS IN THE DFW AREA, THEY'RE NOT DESIGNED LIKE THAT.
THEY ARE DESIGNED FOR A COMPLEMENT OF THE ONES THAT ARE PROVIDING FIRE AND EMS, JUST LIKE WITH US, IT'S HOW QUICK IS THEIR SYSTEM GOING BACK TO THAT TRAVEL TIME? WHAT'S THE RISK LEVEL? WHAT'S THE FISCAL AMOUNT OF RESOURCES THAT THE COUNCILS ARE WILLING TO PROVIDE.
SO HERE, THE LOCAL CONTROL HAS MORE HAS ABSOLUTE CONTROL OVER WHAT METRIC DO YOU WANT TO USE? JUST LIKE GOING BACK TO A DISCUSSION THAT I WANT TO MAKE SURE I HEARD MATT SPEAK CORRECTLY, DID YOU SAY THAT YOU ALL ARE BRINGING IN MORE REVENUE AND BURLESON THAN YOUR EXPENSES? OH, SYSTEMWIDE, OK, THANK YOU FOR THAT.
BECAUSE KEN SIMPSON HAD SAID IN CONVERSATION WITH ME IN THE EMAIL THAT THEIR EXPENDITURES WERE EXCEEDING THEIR REVENUES HERE IN BURLESON.
SO I WANTED TO MAKE SURE THAT WE UNDERSTOOD THAT.
YEAH, SYSTEMWIDE, OKAY, THANK YOU.
SO DOES THAT ANSWER YOUR QUESTION? SO WE'RE VERY FORTUNATE TO HAVE OUR FIRE EMS PARAMEDICS ON SCENE PROVIDING THE NECESSARY LIFE SUPPORT, BUT THEY'RE NOT TRANSPORTING CURRENTLY.
SO I UNDERSTAND THAT THERE CAN BE SOME THESE CONFLICTS THAT YOU'VE TALKED ABOUT.
SO INITIALLY, LIKE, FOR INSTANCE, I RECENTLY HAD TO CALL 911 IN THE FIRST INDIVIDUALS THAT WERE THERE.
SO FIRE IS ASSESSING ME AND I DID NOT INTERACT WITH MEDSTAR UNTIL WE CAME TO THE AGREEMENT THAT I NEEDED TO BE TRANSPORTED.
SO I'M TRYING TO UNDERSTAND LIKE, WHO TRUMPS WHO LIKE, IS IT ONCE MEDSTAR GETS ON SCENE, THEY NOW HAVE CONTROL? EXACTLY AND TO MY POINT, EARLIER AGAIN, WE'RE NOT HERE TO SLING MUD.
WE'RE HERE TO GIVE YOU A CLEAR, TRANSPARENT PICTURE OF WHAT HAPPENS.
NOT JUST ONE OFFS, BUT MOST RECENTLY, THE NARCAN EXPERIENCE WHERE THE YOUNG LADY WAS NOT BREATHING AND MEDSTAR HAS CONTROL OVER THAT SCENE MEDICALLY.
OUR MEDIC WENT AGAINST PROTOCOL, WENT AGAINST MEDSTAR'S POSITION, AS YOU'RE NOT GOING TO DO THAT, WE DON'T APPROVE THAT, AND OUR PARAMEDIC MADE A LIFE SAVING DECISION.
HE WAS WILLING TO OWN THE CONSEQUENCES AND HE SAVED HER LIFE.
SO WE DO NOT HAVE NO MATTER WHAT THE SITUATION IS.
WE'VE HAD A BATTALION CHIEFS OVERRULED WHEN MANAGING THE SCENE, GIVING CLEAR DIRECTIVES THAT ARE IN SYNC WITH OMD THEN, AND THEY WEREN'T BEING FOLLOWED.
HE OR SHE--WE DON'T HAVE A FEMALE BATTALION CHIEFS, BUT THEY HAVE NO AUTHORITY.
THEY HAVE LIMITED AUTHORITY AND THEY DO NOT HAVE THE ULTIMATE AUTHORITY TO MAKE A
[04:15:02]
DECISION THAT IMPACTS PATIENT CARE.EMS IS A TEAM SPORT, JUST LIKE HEALTH CARE IS A TEAM SPORT, AND THE GOAL WOULD BE THAT EVERYBODY ON SCENE WORK TOGETHER TOWARDS THE BENEFIT OF THE PATIENT.
THE WAY THE PROTOCOL IS SET UP, THE PARAMEDIC WITH THE HIGHEST CREDENTIALING LEVEL ON SCENE IS TECHNICALLY THE PARAMEDIC IN CHARGE FOR LACK OF A BETTER TERM, HATE THAT TERM, BUT IN ESSENCE THEY'RE SORT OF THE FINAL DETERMINER BECAUSE THEY HAVE A HIGHER CREDENTIALING LEVEL, BECAUSE THE OFFICE OF THE MEDICAL DIRECTOR HAS CREDENTIALED THEM AT A HIGHER LEVEL AND THERE ARE ALL SORTS OF REASONS WHY THAT HAPPENS.
SO IT SHOULD NEVER BE THAT THERE IS A DISPUTE ON SCENE ABOUT PATIENT CARE.
THERE HOPEFULLY WOULD BE COLLABORATION DISCUSSION.
DO YOU AGREE? NOT AGREE? AND NINETY NINE POINT NINE PERCENT OF THE TIME? THAT'S WHAT HAPPENS IN THOSE RARE CASES WHERE THERE MAY BE A DIFFERENCE OF OPINION, THE AMBULANCE PARAMEDIC, THE MEDSTAR PARAMEDIC, TYPICALLY WILL HAVE SORT OF THE FINAL SAY BECAUSE A THEY'RE CREDENTIALED AT A HIGHER LEVEL AND QUITE FRANKLY, THEY'RE GOING TO BE WITH THE PATIENT LONGER IN MOST CASES.
VITHALANI TO COMMENT ON, YOU KNOW, THE WE DIDN'T WANT TO BRING UP SPECIFIC CASES BECAUSE WE JUST DON'T THINK IT'S A PLACE TO SLING MUD, AS KT SAID.
BUT YOU KNOW, AND HE CAN MAYBE ASK OR ANSWER A QUESTION SPECIFICALLY ABOUT HOW OFTEN DO THOSE TYPES OF CONFLICTS OCCUR? HOW OFTEN DO THEY GET QA REQUESTS FROM DIFFERENT AGENCIES, WHATEVER? MOST OF THE TIME, IT'S PEOPLE SAYING, HEY, I THINK I COULD HAVE DONE A BETTER JOB.
CAN YOU HELP ME LEARN ABOUT-- OK, FINE, THAT'S WHERE A LOT OF THE SELF-REPORT COMES FROM.
SO THAT'S HOW THE SYSTEM IS STRUCTURED AND TO THE EXTENT THAT FIRST RESPONSE, WHEN YOU HAVE AN AMBULANCE, GENERALLY, YOU'RE GOING TO HAVE FEWER AMBULANCES IN AN EMS SYSTEM THAN YOU HAVE FIRST RESPONSE RESOURCES.
SO EVEN IF IT'S BURLESON FIRE, THEIR AMBULANCES ARE GOING TO BE COMMITTED ON CALLS MORE THAN THE ENGINES ARE GOING TO BE.
SO IF THEY'VE GOT TWO CALLS AND THEY'RE COMMITTED ON THOSE CALLS, THERE'S ONE AMBULANCE AVAILABLE, THE CALLS ACROSS TOWN.
I'M ASSUMING THE FIRE ENGINE IS STILL GOING TO RESPOND TO FIRST RESPOND, RIGHT? NOT NECESSARILY.
IT WILL DEPEND ON LOW ACUITY CALL.
SO MUCH LIKE THEY USED TO DO IS THAT THE FIRST RESPONDERS WOULD ONLY GO ON THE HIGH ACUITY CALLS AND THE AMBULANCE WOULD GO ALONE ON THE LOWER ACUITY CALLS, WHICH MAKES SENSE AS THAT'S HOW IT SHOULD WORK.
DR. VEER, ARE YOU STILL WITH US GOING KIND OF IN LINE WITH THE OUR FIREFIGHTERS ARE PROVIDING THAT FIRST RESPONSE.
THEY'RE TRAINED EMTS AND PARAMEDICS.
I'D LIKE SOME MORE INSIGHT INTO THE MEDICAL SIDE OF THE SERVICE.
I KEEP HEARING ABOUT THE IMPORTANCE OF RESPONSE, BUT I'VE ALSO HEARD THAT IN LIKE ONE PERCENT OR LESS THAN ONE PERCENT OF THE CASES DOES THE TRAVEL TIME-- LIKE, WE'RE NOT GOING TO TRANSPORT A PATIENT THAT ISN'T STABLE? CORRECT.
SO THAT RESPONSE TIME OF THE AMBULANCE ONLY MATTERS IN A SMALL PERCENTAGE OF CASES.
THOSE THAT ARE, I'M SURE YOU CAN GIVE ME SOME EXAMPLES, BUT I JUST WANT TO MAKE SURE I UNDERSTAND THIS.
AND YEAH, I'LL TRY NOT TO GET TOO NERDY WITH IT, WHICH IS MY HABIT.
THERE'S DEFINITELY A WIDE VARIETY OF FOLKS WHO ACTIVATE 9-1-1.
IT EXISTS ACROSS THE SPECTRUM FROM VERY LOW ACUITY TO VERY, VERY HIGH ACUITY.
THE HIGHEST ACUITY IS THOSE PATIENTS WHOSE HEARTS HAVE ALREADY STOPPED, AND WE ARE GOING TO ATTEMPT TO RESTART THEM FOR LACK OF A BETTER TERM.
BEFORE WE PUT THEM IN AN AMBULANCE? BEFORE WE PUT THEM IN AN AMBULANCE IN THIS SYSTEM.
YES, BECAUSE THAT IS THE SCIENTIFIC EVIDENCE BASED THING TO DO.
THERE ARE OTHER SYSTEMS THAT WOULD SCOOP THEM UP AND RUSH THEM TO THE HOSPITAL, WHICH IS NOT THE SCIENTIFIC APPROVED WAY TO DO IT.
BUT IT IS-- OLD SCHOOL IS NOT THE RIGHT TERM.
IT IS THE PREVIOUS WAY OF TAKING CARE OF CARDIAC ARREST VICTIMS. IMMEDIATELY LOWER THAN THAT ARE THE PATIENTS WHO ARE CRITICALLY UNSTABLE FOR ONE REASON OR ANOTHER.
THEY'RE NOT BREATHING AS AN EXAMPLE.
THEY ARE HAVING A ACUTE HEART ATTACK THAT REQUIRES GOING TO A CARDIAC CATHETERIZATION LAB IMMEDIATELY.
THEY HAVE A STROKE WITH A TIME SENSITIVE WINDOW IN WHICH THEY CAN GET CLOT BUSTERS OR INTERVENTION IN A NEUROLOGY SUITE AND A HANDFUL OF OTHERS THAT ARE SORT OF LUMPED AS SORT OF THE HIGHEST ACUITY POSSIBLE.
IDENTIFYING THOSE CASES IS ACTUALLY THE ENTIRE REASON FOR ANY SORT OF EMD PROCESS, AS HAS BEEN DISCUSSED BY BOTH GROUPS HERE.
THE PURPOSE IS TO TRY AND IDENTIFY THOSE CASES AND GET YOUR RESOURCES TO THEM IN A HIGHER PRIORITY FASHION THAN THAN ANYONE ELSE.
[04:20:01]
THOSE ARE THE CASES WHERE ALL THE SCIENCE ABOUT RESPONSE TIME MATTERS BECAUSE YOU ONLY HAVE MINUTES TO SECONDS TO INTERVENE ON THOSE PATIENTS BEFORE THEY'RE NO LONGER RECOVERABLE.THAT IS THE RESPONSE TIME COMPONENT.
THERE ARE OBVIOUSLY A LOT OF NON-MEDICAL REASONS FOR CARING ABOUT RESPONSE TIME FROM A CUSTOMER SERVICE AND EXPECTATION PERSPECTIVE.
BUT FROM A MEDICAL PERSPECTIVE, YOU'RE REALLY CONCERNED ABOUT PATIENTS WHOSE HEARTS HAVE ALREADY STOPPED, WHO HAVE A TIME SENSITIVE CONDITION THAT REQUIRES A INTERVENTION THAT EMS CANNOT DO AND THOSE THAT HAVE AN INTERVENTION THAT EMS CAN DO AND NEED TO BE ACTED ON IMMEDIATELY ON ARRIVAL.
THAT IS A-- IT IS A SMALL PERCENTAGE.
I WOULD SAY, YES, SOMEWHERE IN THE ONE TO TWO PERCENT RANGE OF THE OVERALL CALL VOLUME OF ANY SYSTEM IS THOSE MOST CRITICAL PATIENTS.
THERE ARE SORT OF THE MIDDLE RANGE ONES, THOSE WHO WE CAN RELIEVE PAIN AND SUFFERING.
THERE'S THE ONES WHO NEED EVALUATION BECAUSE THE IMPORTANT THING HERE IS YOU OFTENTIMES DON'T KNOW THAT YOU'RE IN THAT ONE TO TWO PERCENT UNTIL YOU GET THERE AND ARE ABLE TO EVALUATE THAT PATIENT.
AND THEN TO ANSWER YOUR QUESTION, YES, THERE IS TYPICALLY A MINIMUM SET OF ACTIONS OR A MINIMUM LEVEL OF STABILITY THAT NEEDS TO BE DETERMINED BEFORE WE WOULD CONSIDER IT SAFE TO MOVE THAT PATIENT INTO THE AMBULANCE AND THEN ON THE WAY TO THE HOSPITAL.
THE ONLY REAL EXCEPTIONS TO THAT ARE THOSE TIME SENSITIVE CONDITIONS THAT CAN ONLY BE TREATED IN THE HOSPITAL, NAMELY STEMI STROKE, MAJOR TRAUMA.
THOSE ARE REALLY THE BIG ONES THAT WE WOULD TALK ABOUT.
ALL THE OTHER ONES WE TALK ABOUT, AT LEAST USING SOME ELEMENT OF THE PREHOSPITAL TOOLBOX IN TERMS OF THE EQUIPMENT AND THE MEDICATIONS THAT WE CARRY TO STABILIZE THAT PATIENT PRIOR TO LOADING THEM UP AND MOVING.
I THINK IT'S AN IMPORTANT AND INTERESTING POINT THAT, YES, THE RESPONSE TIME OF THE FIRST ARRIVING CREW, WHICH IN MOST SYSTEMS IS REALLY ACTUALLY DOESN'T MATTER WHETHER IT'S A BLS OR AN ALS PROVIDER, WHETHER IT'S AN EMT OR A PARAMEDIC, SOMEONE WHO'S ABLE TO SHOW UP AND START DOING CHEST COMPRESSIONS OR START BREATHING FOR A PATIENT OR ADMINISTER NALOXONE OR WHATEVER IT IS, THAT TIME SENSITIVE CONDITION REQUIRES IS REALLY THE IMPORTANT PIECE OF GETTING THEM THERE QUICKLY.
AS I MENTIONED, IF YOU IMMEDIATELY IDENTIFY A PATIENT WHO HAS SOMETHING THAT NEEDS TO GO OFF TO THE HOSPITAL, YOU KNOW, I'LL TAKE THE EXAMPLE OF A STEMI.
SO THE STEMI, WHICH IS A TERM FOR AN ACTIVE ACUTE HEART ATTACK THAT NEEDS TO GO INTO A CATH LAB WITH A WIRE PUT UP INTO THE HEART TO EVACUATE A CLOT.
THE TYPICAL SORT OF GOLD STANDARD METRICS ARE YOU'D WANT TO GET TO THOSE, YOU KNOW, AS FAST AS POSSIBLE IN A PRIORITY ONE FASHION AS HAS BEEN MENTIONED.
YOU WOULD TYPICALLY TRY AND OBTAIN A 12 LEAD EKG, WHICH IS A HEART TRACING WITHIN 10 MINUTES OF THAT FIRST CONTACT ARRIVAL.
TO TRANSPORT THEM OFF SCENE AS FAST AS POSSIBLE ONCE YOU'VE IDENTIFIED THAT, THAT'S WHAT'S HAPPENING.
AS LONG AS THEIR OXYGEN LEVELS AND THEIR BLOOD PRESSURE ARE OK.
THE, WHAT WE CALL THE FIRST MEDICAL CONTACT TO NEEDLE WINDOW, WHICH IS FROM FIRST TIME ANYONE MEDICAL TOUCHES THEM TO THE TIME THAT THEY'VE FIXED IT, IS ROUGHLY 90 MINUTES.
AND THE PREHOSPITAL COMPONENT OF THAT IS DEFINITELY AS SHORT AS POSSIBLE IN THE SORT OF 30 MINUTE RANGE.
AND SO YES, YOU DON'T YOU DON'T SHOW UP AND IMMEDIATELY THROW A PATIENT INTO AN AMBULANCE AND RUSH OFF WITH THEM.
THAT IS NOT THE STANDARD UNLESS THEY ARE SO ROCK-SOLID STABLE THAT IT WOULD BE SAFE TO DO SO.
BUT IF THEY'RE CRITICALLY UNWELL, IT'S THE REASON THAT EMS EXISTS IS BECAUSE YOU CAN SAVE THESE FOLKS RIGHT THERE WHERE YOU SHOW UP AS OPPOSED TO HAVING TO RUSH THEM OFF TO THE HOSPITAL.
ARE THERE INSTANCES WHERE WE COULD IMPROVE TRAINING TWO PARAMEDICS TO BE MORE BENEFICIAL TO THE PATIENT OUTCOMES? OH, THAT'S LIKE MY ENTIRE JOB.
THERE, YOU KNOW, AS I MENTIONED, THERE'S ALWAYS ROOM TO IMPROVE.
THERE'S-- AND THAT'S OUR SYSTEM AND EVERY OTHER SYSTEM IN THE COUNTRY.
I CAN'T, YOU KNOW, IDENTIFY ANYTHING SPECIFIC THAT I'M EXTREMELY CONCERNED ABOUT NOW OR, YOU KNOW, UNDERSTAND EXACTLY THE GOAL OF THE QUESTION, BUT THERE'S ALWAYS THINGS THAT WE CAN LOOK AT TO TRY AND WORK ON.
I DON'T KNOW THAT THOSE THINGS WILL CHANGE BASED ON WHO THE PROVIDER IS.
THERE'S ALWAYS GOING TO BE AREAS TO IDENTIFY TO IMPROVE ON.
YEAH, I KNOW EVERYONE'S HUNGRY AND MY IPAD KEEPS FREEZING ON ME.
IS THERE ANY WAY WE COULD PROCEED WITH THAT BREAK AND HAVE LUNCH AND COME BACK? IT'S UP TO I MEAN, [INAUDIBLE] WANT TO STAY OR WHAT, YOU WANT TAKE A BREAK.
IS EVERYBODY OK WITH STAYING? YOU OKAY? YOU NEED TO GO.
Y'ALL WANT TO TAKE A BREAK NOW.
CAN WE PLEASE JUST TAKE A BREAK?
[04:25:01]
LET'S TAKE A BREAK.HOW LONG Y'ALL WANT IT TO BE? 15 MINUTES? OR LESS.
I CAN INHALE SOMETHING TO STOP SHAKING.
WE'RE GOING TO START BREAKING AT 1:33.
WE'RE GOING TO OPEN THE SESSION BACK UP AT 1:52.
MR. FLETCHER, MAY I-- JUST ONE QUICK COMMENT.
MY GRANDDAUGHTER IS GETTING DROPPED OFF AT MY OFFICE AT 2:30 AND I LOVE YOU ALL, BUT I LOVE HER MORE SO I'M GOING TO LEAVE.
KEN AND DR. VITHALANI OBVIOUSLY WILL STAY HERE.
[LAUGHTER] WE'D WORRY ABOUT YOU IF YOU DIDN'T LOVE YOUR GRANDDAUGHTER MORE THAN YOU DO US.
MY WIFE REMINDS ME WHERE MY PRIORITIES ARE ALL THE TIME, SO IT'S REALLY HARD.
THANKS FOR YOUR PATIENCE WITH US.
DR. VEER AND I WERE JUST TALKING ABOUT SOMETHING GOING BACK TO THE SPREADSHEET, I SAW THAT WE HAD OUR FLEET MAINTENANCE PERSON DOWN FOR 80 THOUSAND, BUT OUR MEDICAL DIRECTOR FOR 50.
AND I'M JUST WONDERING HOW IS THAT POSSIBLE? YES, THIS IS ALWAYS A FUN TOPIC.
I WILL SAY THAT PART OF WHY WE HAVE THE MEDICAL OVERSIGHT INFRASTRUCTURE HERE IS BY DESIGN.
IT WAS SET UP THAT WAY IN NINETEEN EIGHTY SIX AND IT JUST SORT OF CARRIED FORWARD.
THERE ARE A LOT OF WAYS TO HIRE A MEDICAL DIRECTOR ACROSS THE COUNTRY.
AND I THINK MY COLLEAGUES IN MEDICAL DIRECTION WOULD AGREE IF I GENERALIZE MOST AND I SAY THIS MOST.
MOST EMS SERVICES IN THE COUNTRY, UNLESS MANDATED BY LAW, FREQUENTLY SEE MEDICAL DIRECTORS AS LIKE ANNOYING NECESSITY AS OPPOSED TO SOMETHING THAT THEY'RE REALLY INTERESTED IN HAVING LIKE, YOU KNOW, CONSTANT PHYSICIAN INVOLVEMENT IN THINGS, THAT IS A WIDE GENERALIZATION ABOUT THE PREDOMINANCE OF SYSTEMS, NOT THIS SYSTEM AS IT STANDS RIGHT NOW.
I DO THINK PART OF THAT IS BECAUSE IT'S WRITTEN INTO THE INNER LOCAL, BUT THE MEDICAL DIRECTOR IS A PERSON THAT IT'S INDEPENDENT, THAT THERE IS FUNDING FOR AN OFFICE TO PROVIDE OVERSIGHT.
THE SMALLER THE SERVICES YOU GO, THE LESS TIME YOU TYPICALLY BUY FROM A MEDICAL DIRECTOR.
AND YOU KNOW, YOU CAN GET MEDICAL DIRECTORS OF ALL TYPES.
YOU CAN GET A FAMILY DOC WHO'S DOING IT VOLUNTARILY.
YOU CAN GET SOMEBODY LIKE ME WHO'S FULL-- LIKE FELLOWSHIP TRAIN, BOARD CERTIFIED AND DOES IT FULL TIME AND YOU CAN HAVE ANYTHING IN THE MIDDLE.
IF I COULD MAKE ANY COMMENTARY ABOUT MEDICAL DIRECTION, MY MAIN, MAIN POINT IS TWO THINGS.
ONE, I FIRMLY BELIEVE THAT MEDICAL DIRECTION SHOULD BE INDEPENDENT, AND WHAT INDEPENDENT MEANS IS REPORTING IN THE SAME BUT SEPARATE CHANNEL AS WHATEVER ORGANIZATION THEY'RE WORKING WITH.
SO, FOR EXAMPLE, IN MY ROLE, I REPORT TO THE MAEMSA BOARD OF DIRECTORS THE SAME WAY THAT KEN REPORTS THE MAEMSA BOARD OF DIRECTORS.
AND MY OFFICE REPORTS TO ME THE WAY THAT MEDSTAR REPORTS TO KEN.
AND SO, YOU KNOW, WHETHER THAT'S YOU ALL OR WHOMEVER YOU WOULD HAVE THAT STRUCTURE GO THROUGH, THERE IS A HEALTHY TENSION BETWEEN MEDICAL DIRECTORS AND WHAT WE REFER TO AS GENERICALLY OPERATIONS IS BASICALLY EVERYONE OVER HERE.
AND THAT'S ON PURPOSE BECAUSE PART OF BEING A MEDICAL DIRECTOR IS HOLDING PEOPLE ACCOUNTABLE AND PART OF BEING A OPERATIONS PERSON IS MAKING SURE THAT YOU ARE OPERATIONALLY MEETING YOUR OBJECTIVES, WHICH IT'S A BALANCE.
YOU KNOW, THE GOAL IS TO HAVE THE TEETER TOTTER IN THE MIDDLE, BUT SOMETIMES IT LEANS IN EITHER DIRECTION.
HAVING INDEPENDENCE ALLOWS FOR HEALTHY DISAGREEMENT WHERE IT CAN BE HASHED OUT, NOT WITH SOMEONE PUTTING THEIR FOOT DOWN AND SAYING, YOU KNOW, I HAVE AUTHORITY OVER YOU BECAUSE THE STATE GIVES THE MEDICAL DIRECTOR OR AUTHORITY, BUT AN EMPLOYMENT CONTRACT GIVES, YOU KNOW, EMS CHIEF OR FIRE AUTHORITY.
IT WOULD BE IN SOME WAY OR ANOTHER BE IDEAL FOR THEM TO BE INDEPENDENT.
I CAN'T REALLY COMMENT IF $50000 IS APPROPRIATE WITHOUT KNOWING WHAT THE FTE IS.
THERE IS ACTUALLY THE RESULTS ARE NOT OUT, BUT THERE IS A FIRST EVER NATIONAL ASSESSMENT OF EMS MEDICAL DIRECTOR PAY THAT'S BEING DONE BY NAEMSP, WHICH IS OUR NATIONAL ASSOCIATION.
BUT I WOULD SAY THAT, YOU KNOW, FOR FULL TIME OR I'M SORRY FOR PART TIME, DEPENDING ON WHAT YOU'RE LOOKING FOR, IT'S THERE.
THE OTHER THING TO NOTE WE HAVE A STAFF, AN OFFICE OF THE MEDICAL DIRECTOR STAFF WHO SOLE JOBS ARE TO HELP ME WITH THE OVERSIGHT AND AT LOT OF SMALLER AGENCIES IT IS NORMAL TO GIVE THOSE TASKS TO SOMEONE WITHIN THE OPERATIONS, AND SOMETIMES THAT WORKS REALLY WELL.
SOMETIMES THAT DOESN'T WORK VERY WELL.
THE FOLKS IN MY OFFICE, FOR EXAMPLE, APPLIED TO BE IN THAT ROLE BECAUSE THEY WANT TO DO THAT JOB.
WHEN YOU GIVE IT TO SOMEONE WHO WANTS TO DO ANOTHER JOB, BUT YOU KNOW, ISN'T INTERESTED IN WHAT YOU'RE GIVING THEM.
SOME PEOPLE ARE STILL JUST GREAT AT IT, AND THAT'S HOW THEY RISE TO THE RANKS OF
[04:30:01]
STUFF.OTHER PEOPLE SEE IT AS A, BY THE WAY, AND THEY DON'T PUT AS MUCH EFFORT INTO IT.
SO AS I THINK SOMEONE MENTIONED BEFORE, A LOT OF IT'S ABOUT THE PEOPLE AND ABOUT THE MANAGEMENT AND ABOUT THE LEADERSHIP, NOT NECESSARILY ABOUT, YOU KNOW, THAT EVERY CITY DOES IT THE SAME WAY.
BECAUSE I WENT AND TOURED ONE DEPARTMENT THAT IS-- THE EMS TRANSPORT IS WITHIN THE DEPARTMENT.
AND THEN I'VE ALSO SPOKE TO A NUMBER OF DIFFERENT ONES THROUGHOUT OUR METROPOLITAN AREA.
AND I LEARNED THAT LIKE SOMETIMES THEY USE LIKE ALMOST LIKE A CONGLOMERATE LIKE THERE ARE SEVERAL COMMUNITIES THAT ARE ALL USING THE SAME MEDICAL DIRECTOR.
SO I GUESS THAT PERSON'S NAME HELPS TO DRIVE DOWN THAT COST BECAUSE THE CASE HAS BEEN MADE THAT YOU'RE LOOKING AT YOUR TEAMS LOOKING AT OVER CALLS OF 15 COMMUNITIES.
SO POTENTIALLY DEPENDING ON WHAT KIND OF AGREEMENT YOU GO IN WITH OTHER COMMUNITIES, YOU COULD BE IN THE SAME BOAT? YES.
SO TO BE CLEAR, MY ONLY EMS JOB IS WITH THE AUTHORITY, AND SO THOSE 15 COMMUNITIES ARE THE COMMUNITIES THAT OWN THE AUTHORITY.
SO I PERSONALLY AND MY STAFF ARE NOT INVOLVED IN ANY EMS ORGANIZATION OUTSIDE OF THE MAEMSA SYSTEM.
SO I THINK THE POINT THERE IS.
WHEREAS A MEDSTAR AMBULANCE CAN RESPOND TO A CALL IN ANY CITY, A INDIVIDUAL FIRE DEPARTMENT RESPONDS TYPICALLY WITHIN THEIR OWN CITY, WE DO OUR BEST TO TRY AND STANDARDIZE OUR TIME AS MUCH AS POSSIBLE ACROSS THE WAY.
THE CHIEFS HAVE MENTIONED WE'VE ACTUALLY WORKED A LOT WITH BURLESON ON PILOT PROJECTS BECAUSE THEY ARE VERY NIMBLE ORGANIZATION AND VERY INTERESTED IN NEW THINGS.
AND I WOULD LIKE TO SAY THAT, YOU KNOW, IT ALL WASHES OUT IN THE END.
BUT IT'S TRUE WE DON'T DO-- WE DO HAVE TO SPLIT THE TIME ACROSS THE ENTIRE SYSTEM.
AND SO BUT WHAT WE ALSO ATTEMPT TO DO IS, YOU KNOW, VERY MUCH LIKE YOU HAVE THE FLEX STAFFING AND EVERYTHING ELSE THAT'S BEEN TALKED ABOUT.
SO WE HAVE A COUPLE OF PEOPLE DEDICATED TO THE FIRST RESPONDERS.
IF A INDIVIDUAL FIRST RESPONSE ORGANIZATION REQUIRES MORE STAFF ON A GIVEN DAY, WE WILL ADD EXTRA STAFF FROM OUR OFFICE TO HELP THAT TEAM DO THE TRAINING, FOR EXAMPLE, AND THEN THEY'LL GO BACK TO THEIR REGULAR DUTIES THE DAY AFTER.
BUT THAT'S JUST, AGAIN, THAT'S JUST THE ONE MODEL IN WHICH WE DO OVERSIGHT.
AND THEN THE SECOND POINT I WAS JUST GOING TO MAKE IS THROWING IN A PLUG FOR DUE PROCESS FOR MEDICAL DIRECTORS BECAUSE THAT'S A SORELY LACKING AREA AND IS JUST SOMETHING TO KEEP IN THE VERY BACKS OF YOUR MINDS IF YOU REACH THAT POINT, IS THAT GOES INTO THAT SAME INTERPLAY BETWEEN MEDICAL RECORD OPERATIONS.
IT IS A, YOU KNOW, IT'S A PURPOSEFULLY TENSE RELATIONSHIP, AND MOST OF THE TIME IT WORKS REALLY WELL.
AND THE TIME IT COMES TO BLOWS, YOU WANT EVERYONE TO BE ON EQUAL FOOTING TO BE ABLE TO PRESENT THEIR CASE FOR WHATEVER IT IS YOU'RE TRYING TO DO.
THE CONCEPT OF SHARING A MEDICAL DIRECTOR, THOUGH, IS NOT UNHEARD OF.
HOME HEALTH CARE AGENCIES DO IT.
YEAH, AND-- IT'S DONE IN MULTIPLE OTHER, YES, MEDICAL ARENA.
YOU'RE RIGHT, AND I APOLOGIZE.
I FORGOT TO ADDRESS THE QUESTION ENTIRELY.
WE ONLY WORK HERE, BUT THERE ARE PLENTY OF EMS PHYSICIANS OR CONGLOMERATES OF EMS POSITIONS THAT DO CARRY CONTRACTS FROM MULTIPLE ORGANIZATIONS.
SO LOCALLY, THE TWO MOST COMMONLY TALKED ABOUT ONES.
THERE'S THE BIOTEL SYSTEM IN THE DALLAS SIDE.
BIOTEL IS ACTUALLY PART OF PARKLAND HOSPITAL.
THEY, AS PART OF UT SOUTHWESTERN DEPARTMENT OF EMERGENCY MEDICINE, THEY HAVE A DIVISION OF EMS. THEY WORK THROUGH BIOTEL AND THEY HAVE A NUMBER OF CONTRACTS IN THE DALLAS AREA.
THERE'S A GROUP CALLED BEST EMS, WHICH IS BASED OUT OF BAYLOR GRAPEVINE, AND THEY HAVE A NUMBER OF CONTRACTS THAT SURROUND BAYLOR GRAPEVINE.
AND SO YES, THEY WILL HAVE MULTIPLE SMALL DEPARTMENTS AND IT'S THE SAME THING IN THAT RESPECT.
SOMETIMES THE PROTOCOLS ARE THE SAME AND THEY SAY, HEY, IF YOU WANT TO BE PART OF, YOU KNOW, BEST EMS, I KNOW THE BEST EMS GUYS.
I USED TO WORK WITH THEM LIKE THERE.
BUT SO I ACTUALLY DON'T KNOW EXACTLY HOW THEY DO THINGS.
SO I'M GOING TO USE THIS AS AN EXAMPLE IF THEY SAID, HEY, THESE ARE OUR PROTOCOLS.
YOU COME ON BOARD AND THESE ARE GOING TO BE YOUR PROTOCOLS.
BUT SOMETIMES THEY'LL SAY, OK FOR THIS CONTRACT.
IF YOU NEED THIS SPECIFIC THING, WE'LL DO THAT FOR YOU.
BUT FOR THIS OTHER CITY, WE'LL DO THIS OTHER THING.
TYPICALLY, I WOULD LIKE TO SAY THAT THE DELIVERY OF MEDICAL CARE SHOULD BE THE SAME ACROSS THE REGION.
BUT YOU KNOW, IF YOU LOOK IN OUR EIGHTY FOUR, YOU KNOW, FIRE DEPARTMENTS OR WHATEVER, THERE'S PROBABLY EIGHTY FOUR DIFFERENT SETS OF PROTOCOLS AND MEDICATION AND EQUIPMENT, AND IT'S A SAD REALITY OF-- IT HAS PROS AND CONS AS TO HOW WE DO EMS IN TEXAS.
IT IS COMMON FOR MEDICAL DIRECTORS TO HAVE MULTIPLE CONTRACTS.
IT IS ALSO COMMON FOR MEDICAL DOCTORS TO HAVE ONE CONTRACT.
IT IS NOT COMMON TO HAVE A FULL TIME MEDICAL DIRECTOR UNTIL YOU REACH A LARGE ENOUGH AGENCY-- POPULATION.
AND MOST PART TIME EMS MEDICAL DOCTORS ARE ALSO PRACTICING EMERGENCY PHYSICIANS OR PRACTICING PHYSICIANS IN THE COMMUNITY IN ONE WAY OR ANOTHER, OR THOSE ARE THEM THAT END UP PICKING UP ENOUGH THAT THEY DO EMS OR PUBLIC HEALTH OR SOMETHING ELSE AS A FULL TIME SORT OF CAREER.
SOMETHING I WAS IMPRESSED ABOUT IS YOUR BUDGET AND HOW YOU'RE ABLE TO ALLOCATE THAT TWO AND A HALF MILLION.
HOW WOULD WE REPLICATE SOMETHING? I'LL LET YOU GO.
BUT YOU KNOW, HOW DO WE REPLICATE SOMETHING LIKE?
[04:35:02]
THERE'S A COUPLE OF THINGS I'LL SAY, YOU KNOW, PHYSICIANS ARE EXPENSIVE AND WE HAVE BASICALLY IN OUR OFFICE, WE HAVE 2.2 FTES OF PHYSICIAN TIME.SO THAT'S MYSELF AS A FULL TIME MEDICAL DIRECTOR AND TWO POINT SIX FTE, THREE DAY A WEEK ASSOCIATE MEDICAL DIRECTORS.
AND THEN PAYROLL IS EXPENSIVE, RIGHT? SO THE MAJORITY OF OUR BUDGET IS PAYROLL.
SO THOSE 14 STAFF, WHICH GO THROUGH A COMPENSATION ANALYSIS ALONGSIDE WHEN MEDSTAR DOES THEIR COMPENSATION ANALYSIS, THOSE SALARIES ARE SET THROUGH THAT.
SO THEY LOOK AT ALL THE JOB DESCRIPTIONS, THEY LOOK AT THE RESPONSIBILITIES AND THEY SHARE THAT OUT.
AND THE REST OF OUR BUDGET IS, YOU KNOW, SOME COUPLE OF CONFERENCES AND TRAVEL WHICH USUALLY GETS RECOUPED AND THEN A LITTLE BIT OF SIMULATION EQUIPMENT OR [INAUDIBLE] BUDGETING TIME, THAT SORT OF STUFF.
THERE'S NOT-- IT'S MOSTLY PAYROLL.
AND YOU'RE RIGHT, WE ARE VERY BLESSED WITH THE AMOUNT OF STAFF AND RESOURCES THAT WE HAVE.
ONE THING I ALWAYS TELL PEOPLE WHO I TALKED TO ABOUT THIS ROLE IS THAT I WOULD SAY THAT IF YOU READ TEXAS ADMIN CODE TEXAS MEDICAL BOARD RULES ONE NINETY SEVEN, WHICH IS OUR LAW THAT COVERS WHAT MEDICAL DIRECTORS DO.
IT GIVES YOU A LIST OF RESPONSIBILITIES AND THERE ARE LONG LIST.
THERE'S ACTUALLY A LOT OF THINGS THAT YOU ARE BOTH PERSONALLY AND PROFESSIONALLY RESPONSIBLE FOR.
YOU'RE ALLOWED TO GET HELP TO DO THAT WORK.
THE MAEMSA SYSTEM FROM NINETEEN EIGHTY SIX FORWARD HAS BEEN SPECIFICALLY DESIGNED TO ENSURE THAT MEDICAL DIRECTORS ARE ABLE TO MEET ALL THE REQUIREMENTS IN ONE NINETY SEVEN.
THERE'S ACTUALLY AN OUT CLAUSE IN 197 THAT SAYS IF YOUR EMS OPERATION DOES NOT GIVE YOU THE RESOURCES NECESSARY TO MEET THESE OBJECTIVES, THEN WE'RE NOT GOING TO HOLD YOU LIABLE.
AND I KNOW SOME BIG CITY AND SMALL CITY MEDICAL DIRECTORS THAT WRITE A LETTER TO THEIR AGENCY EVERY YEAR THAT SAYS, BECAUSE YOU HAVEN'T GIVEN ME THE RESOURCES NECESSARY, I'M DOING THE BEST I CAN.
BUT YOU KNOW, THIS IS IN RELATION TO ONE NINETY SEVEN DOT FOUR DOT WHATEVER.
AND I DON'T THINK THIS IS APPROPRIATE.
SO THERE ARE DEFINITELY SMALL TO MEDIUM SIZED CITIES THAT DEDICATE RESOURCES TO MEDICAL [INAUDIBLE] AND CLINICAL QUALITY.
YOU NEED A MEDICAL DIRECTOR, BUT YOU DON'T NECESSARILY, YOU KNOW, THE REST OF MY STAFF ARE PARAMEDICS, THEY'RE SENIOR PARAMEDICS WHO HAVE BEEN IN THE SYSTEM THAT WE WORK CLOSELY ENOUGH TOGETHER EVERY DAY THAT THEY CAN REPLICATE WHAT I SAY AND WE WORK TOGETHER ON PROJECTS THAT YOU DON'T NEED A GROUP OF DOCTORS TO DO ALL THE MEDICAL DIRECTION.
BUT PHYSICIAN INVOLVEMENT, ESPECIALLY BECAUSE OF THE LEGAL SIDE OF HOW WE DO THINGS IN TEXAS, IS IMPORTANT.
HOW YOU CAN REPLICATE IT, I CAN'T SPEAK TO, YOU KNOW, IT'S OBVIOUSLY A MUCH BIGGER AND DIFFERENT CONVERSATION.
BUT IF ANYONE'S EVER INTERESTED IN THE MORE NUANCED ASPECTS OF WHAT WE DO OR ANY ASPECT OF MY BUDGET OR OUR STAFF, I'M HAPPY TO DESCRIBE IT.
THE ONE OTHER COMMENTARY I'LL MAKE, THOUGH, IS THAT SOME OF THE HISTORY OUR BUDGET-- MEDSTAR USED TO HAVE A CLINICAL OFFICE AND THE MEDICAL DIRECTOR HAD A MEDICAL DIRECTOR'S OFFICE.
THEY WERE SEPARATE AND IT SORT OF HARKS BACK TO WHEN MEDSTAR HAD A CONTRACTOR PROVIDING SERVICES A COUPLE OR A HANDFUL OF YEARS AGO.
WE INTEGRATED THOSE OFFICES AND SO CERTAIN TASKS THAT A EMS AGENCY NORMALLY RUN THEIR SELVES OUR OFFICE DOES ON BEHALF OF MEDSTAR, WHEREAS SOME OF THE FROS, FOR EXAMPLE, DEDICATE STAFF ALREADY TO THOSE FUNCTIONS.
AND SO IN THAT TWO AND A HALF MILLION, THERE'S A CHUNK OF THAT, THAT IF, FOR EXAMPLE, YOU KNOW, I DON'T HAVE A GREAT EXAMPLE, IF MEDSTAR STILL HAD A CLINICAL OFFICE, THOSE TASKS WOULD BE PUSHED OFF TO THEM AND WE WOULDN'T HAVE THAT STAFF.
AND THE SAME COULD BE SAID FOR ANY FRO OR ANY FIREBASE EMS ORGANIZATION IS IF YOU'RE DEDICATING STAFF TO TAKE CARE OF, YOU KNOW, CAR COURSES OR FIELD TRAINING OR SOMETHING LIKE THAT, WE DO THAT FOR MEDSTAR AND WE COORDINATE IT FOR THE FIRE DEPARTMENTS, IF THAT MAKES SENSE.
IT'S A LOT MORE NUANCED, I GUESS.
I KNOW WE'RE BUDGETING FOR A MEDICAL DIRECTOR.
HOW DO-- WHAT ABOUT THE ADDITIONAL PIECES THAT A STAFF OF 14 IS PROVIDING TO THE SYSTEM? EXCELLENT QUESTION, AS I SAID EARLIER, IS SCALABLE.
WE DON'T NEED 14, RIGHT? WE'RE ALREADY DOING IT.
WE'RE ALREADY DOING THOSE FUNCTIONS.
AS DR. VEER SAID INTERNALLY, AS FAR AS THE QA, QI.
WE JUST PROMOTED OUR LIEUTENANT, THE POSITION THAT WAS BUDGETED, THAT LIEUTENANT IS A PARAMEDIC.
HE WILL BE PART OF OUR TRAINING PROGRAM NOT ONLY FOR THE FIRE SIDE, BUT THE EMS SIDE QA, QI.
WE SPOKE WITH-- THE $50000 IS BASED ON WE SPOKE WITH THREE OR FOUR DEPARTMENTS AND I THINK I KNOW THE ONE DEPARTMENT YOU ARE REFERRING TO AROUND $8000.
WE SPOKE TO DEPARTMENTS THAT HAVE THEIR OWN MEDICAL DIRECTOR SOLELY FOR THEM, $30000.
[04:40:01]
SO WE DID SOME CHECK AROUND.AGAIN, WE'VE TRIED TO BE VERY REALISTIC AND VERY TRANSPARENT WHEN WE PUT THESE PROJECTIONS IN THERE.
WE FEEL $50000 IS FROM WHAT THE FEEDBACK THAT WE'RE GETTING FROM OTHER DEPARTMENTS THAT HAVE THEIR OWN MEDICAL MEDICAL DIRECTOR IS ADEQUATE.
WE SPOKE WITH MANSFIELD AGAIN, COMPARABLE CITIES, COMPARABLE WORKLOAD AND YOU HAVE TO HAVE SUPPORT STAFF AND WE HAVE NOT, AGAIN, WE HAVE NOT ENGAGED BECAUSE WE'RE NOT GOING TO GET AHEAD OF THIS COUNCIL.
BUT AS I SAID EARLIER, THAT IS A VERY IMPORTANT FUNCTION FOR US.
IT WILL BE SCALABLE, BURLESON CENTRIC.
AND AGAIN, DR. VITHALANI AND HIS TEAM DO A GREAT JOB, BUT IT TAKES THAT MANY TO RUN A SYSTEM THAT'S MAKING 125-130000 CALLS A YEAR IN FORT WORTH AND ALL THE NUMBER OF PARAMEDICS AND EMS OR EMT PEOPLE.
IT'S A HUGE SYSTEM, SO WE FEEL CONFIDENT.
AGAIN, WE'VE GOT ENOUGH DETAILS THAT I FEEL COMFORTABLE STANDING BEFORE YOU AND OUR COMMUNITY NOT TO JUST SAY THAT IT'LL WORK, BUT IT'S GOING TO WORK AND WE WILL.
WE WILL MAKE IT WORK BECAUSE AGAIN, WE'RE ALREADY DOING A LOT OF THIS AND IT IS REPLICABLE.
WE JUST GOT TO GET IT DOWN TO OUR SCALE.
IF SQUAD BECOMES AN AMBULANCE, WON'T THAT DRASTICALLY AFFECT OUR CURRENT RESPONSE TIMES? NO.
I'M HAVING A HARD TIME PICTURING THIS.
OK, IF WE GO-- IT BECOMES AN AMBULANCE AND IT'S NOW RESPONSIBLE FOR TRANSFERRING THE PATIENT.
I SPOKE YESTERDAY AS I WAS DECORATING MY KIDS CLASSROOM WITH AN ER NURSE AND SHE SAID, AND THERE ARE A LOT OF TIMES THAT AMBULANCES ARE STACKED UP.
JUST JUST THIS LAST WEEK, SHE HAD SIX STACKED UP AND SHE HAD FIRE CHIEFS CALLING THEIR TEAM LEAD AND SAYING, WE NEED YOU TO RELEASE OUR, YOU KNOW, TAKE THE PATIENT, WE NEED YOU TO RELEASE THE AMBULANCE.
AND SHE SAID, WELL, WE DON'T HAVE ANYWHERE TO PUT THE PATIENTS, SO WE CAN'T TAKE THEM ON YET.
SO, I THINK THERE'S VARIABLES THAT WE REALLY CAN'T EVEN LIKE-- I USED TO WORK AT A HOSPITAL AND I TOTALLY FORGOT ABOUT HOW I WOULD SAY I THOUGHT BEFORE.
MAYBE THEY'RE SITTING AROUND HAVING COFFEE.
NO, I GUESS THAT'S NOT WHAT THEY'RE DOING.
THEY CAN'T OFFLOAD THEIR PATIENT BECAUSE THERE'S NOT ANY SPACE IN THE ER OR, YOU KNOW, WHEREVER THE NEXT STEPS ARE GOING TO BE.
SO HOW CAN WE PREDICT SOME OF THAT STUFF? WELL, GREAT QUESTION, AND WE HAVE THE ANSWER TO THAT.
RATHER, WE HAVE A SQUAD OR WE HAVE AN [INAUDIBLE] TRAVEL TIME AND A RESPONSE TIMES.
THEY'RE REPRESENTATIVE OF THE SLIDE THAT I SHOWED EARLIER OUT OF OUR FIXED LOCATION, OUT OF OUR HISTORIC CALLS, OUT OF THE AMOUNT OF PERCENTAGE THAT WE'RE GOING TO BE ABLE TO CAPTURE.
SO THAT'S WHAT WE REFER TO AS A RESPONSE TIME AND TRAVEL TIME.
WE'RE TALKING ABOUT [INAUDIBLE] ON THE SEVENTY SEVEN MINUTES, WHEN WE LOOKED AT THE DATA FROM MEDSTAR'S DATA AND THAT'S BEEN CALCULATED IN THE CHARTS THAT YOU SHOW THAT CAPACITY.
WE CALL THAT THE TRAVEL TIME TO THE HOSPITAL, THE WALL TIME, THE TURNAROUND TIME.
IS IT TASK TIME? THE TASK TIME, THE OVERLAPPING, THE REDUNDANCY, THE RESILIENCY THAT WE HAVE IN OUR SYSTEM.
ALL OF THAT HAS BEEN IDENTIFIED AND THAT'S PART OF WHAT WE'VE ILLUSTRATED TODAY.
ALSO WANT TO BRING US BACK TO A POINT THAT MEDSTAR HAD SAID EARLIER THAT IN THE DISCUSSION THAT FOUR AMBULANCES IS WHAT THEY SAID WE WOULD NEED.
WELL, WE'RE IN AGREEMENT WITH THAT.
AND THERE'S ALWAYS THE ONE OFFS WHEN WE LOOK AT THE FOUR AMBULANCE MODEL THAT WE CAN GET BY HAVING THAT CROSS STAFF [INAUDIBLE] STATION THREE, IF WE GO WITH THE SIX FIREFIGHTERS THAT MEETS OUR NEED.
SO, WE'RE IN AGREEMENT WITH MEDSTAR SAYING YOU NEED FOUR AMBULANCES.
WELL, WE PROVIDED THAT AND THEN WE TALK ABOUT-- WE GET INTO SOME OF THE OTHER NUANCES.
BUT THROUGH THE ANALYTICS, THE ANALYSIS OF THE DATA PROVIDED FROM US AND MEDSTAR, WE HAVE THE RESILIENCY, WE'VE IDENTIFIED THE OVERLAP.
WE'VE IDENTIFIED HOW MANY TIMES IT'S ONE AMBULANCE, THE PERCENTAGE FIFTY FOUR, HOW MANY TIMES TWO HOW MANY TIMES THREE, HOW MANY TIMES FOUR.
AND AT THAT FOURTH, IT WAS ABOUT ONE HUNDRED PERCENT.
WELL, WE'VE GOT THAT CAPACITY AND WE'RE PROPOSING THAT WITH THE SIX FIREFIGHTERS TO CHANGE THIS MODEL.
MEDSTAR AND US ARE IN TOTAL AGREEMENT WITH THAT.
AND WHEN YOU GO BACK AND YOU LOOK AT THAT SLIDE ONE AMBULANCE, THAT FIRST BAR THING WAS GREEN.
WE NEED ONE AMBULANCE MOST OF THE TIME, THEN WHEN WE GET UP TO THAT TWO.
[04:45:01]
SO.MAYBE WE SHOULD PULL THAT BACK UP.
I NEED TO SEE THINGS AS TALKING ABOUT IT.
BECAUSE I JUST I'M HAVING A REALLY HARD TIME.
LIKE I KNOW AT SOME POINT, MEDSTAR, OR SOMEONE I SPOKE TO THAT KNEW OF MEDSTAR, THEY WERE COMMUNICATING THAT.
WELL, THIS I THINK THIS IS A SLIDE THAT TALKS TO OUR CAPACITY-- SPEAKERS] SPEAKS TO THAT.
WELL, THIS IS CALLS, THOUGH IT'S NOT-- LIKE HOW IS IT ACCOUNTING FOR WHEN YOU'RE GOING TO GET HUNG UP, WHEN YOU WHEN HUGULEY IS NOT THE PREFERRED HOSPITAL OR HUGULEY'S FULL AND YOU HAVE TO TRANSPORT TO FORT WORTH? AND THEN IF IT'S PRIME TIME TRAFFIC TIME, YOU DON'T GET BACK IN SERVICE UNTIL-- AND THAT'S, YOU KNOW, I TALKED TO EULESS.
EULESS WAS THE DEPARTMENT, I WENT AND THEY WERE JUST PHENOMENAL.
THEY PROVIDED MORE INFORMATION THAN I COULD HAVE EVER IMAGINED, ASKING.
SO I REALLY APPRECIATE THEIR TIME AND MIKE JONES FOR TAKING ME OUT THERE BECAUSE IT'S INTERESTING TO HEAR FROM THEIR PERSPECTIVE.
BUT I'M JUST I CAN'T PICTURE SEEING HOW THEY CAN GET BACK AND SERVE-- I DON'T THINK.
AND I THOUGHT IT WAS INTERESTING THAT THE CONSULTANTS IS TWO.
WHEN I BROUGHT UP LAST MEETING CROWLEY HAS A POPULATION OF 15000 AND THEY HAVE TWO WE HAVE A POPULATION OF 50000.
I JUST DON'T SEE HOW TWO IS GOING TO DO IT.
I DON'T SEE HOW THREE IS GOING TO DO IT.
I JUST-- I THINK THAT THERE'S VARIABLES HERE THAT WE CAN'T EVEN PREDICT YET.
BUT WHAT I DON'T AGREE WITH IS THAT THE ANALYSIS DOES SHOW, AND EVEN MEDSTAR SHOWED THAT WHEN WE LOOK AT THAT GRAPH, THREE CAPTURES NINETY SEVEN PERCENT OF THE CALLS, AND IT'S BASED ON THE ANALYSIS.
IT CAME FROM MEDSTAR DATA AND OUR DATA.
AND IN MY MIND, THEY CLEARLY SHOW AND THEY SHOW THE CAPACITY.
I'M NOT BEING ARGUMENTATIVE, BUT I'M JUST SAYING RESPECTFULLY, THE DATA SHOWS THAT AND MEDSTAR HAS SAID THAT-- WE THE FOUR AMBULANCES, WHICH WE CAN PROVIDE, MEETS THE DEMAND OF THE SEVENTY SEVEN MINUTE TURNAROUND.
I KNOW IT'S HARD TO GET OUR MINDS WRAPPED AROUND ABOUT THIS.
THIS IS MEDSTAR'S-- THIS IS MEDSTAR TURNAROUND TIME.
RIGHT? AND THERE'S ALL KINDS OF THINGS THAT CAN IMPACT THAT.
SO WE TOOK A SEVENTY SEVEN MINUTE AND WE'RE NOT GOING TO IMPUGN THEM, BUT WE BELIEVE OUR FIREFIGHTERS WILL GET TURNED AROUND QUICKER BECAUSE THERE'S WHAT THEY CALL WALL TIME.
SOMETIMES THERE'S WAIT TIME THAT THEY CAN'T MANAGE.
BUT IT'S WHEN DOES A UNIT GO BACK INTO SERVICE? RIGHT.
THAT ADDS TO THAT SEVENTY SEVEN MINUTES NOW, WE'RE NOT GOING TO SPECULATE, BUT WE TOOK THEIR SEVENTY SEVEN MINUTES.
IF YOU WANT FURTHER DISCUSSION ABOUT IT, ALL OF THAT IS FACTORED IN ON OUR UNIT CAPACITY, OUR OVERLAP, REDUNDANCY, UNIT HOUR UTILIZATION.
ALL OF THAT HAS BEEN FACTORED IN AND THIS IS THE RESPONSE MODEL.
I'M SO SORRY, RICK, AND I CUT IN ON YOU AND I APOLOGIZE.
I WAS JUST GOING TO ASK IN RELATION TO THAT, WHAT ABOUT NONEMERGENCY TRANSFERS? I SEE MEDSTAR STOPPING BY NURSING HOMES AND STUFF LIKE THAT TO HELP.
THAT'S SOMETHING THAT-- I'M SORRY, SIR.
BRING THE ELDERLY BACK TO THE HOSPITAL.
OR MAYBE THEY HAVE, YOU KNOW, SURGERY OR SOMETHING LIKE THAT.
AND TO KIND OF PIGGYBACK ON THAT TOO, IT'S KIND OF A TWO PART QUESTION.
BUT AS FAR AS YOU KNOW, HAVING ENOUGH AMBULANCES THERE IN THE EVENT THAT WE HAVE ONE OUT THAT NEEDS TO BE SERVICED OR WE HAVE ONE OUT, WE WENT TO MEDSTAR AND SAW THAT THEY HAD A ONE TOTALED.
OF COURSE, THEY HAVE 51 DIFFERENT AMBULANCES, BUT WE ARE ONLY GOING TO HAVE TWO TO THREE, MAYBE FOUR ON DOWN THE ROAD.
I MEAN, WHAT DO YOU DO IN THE CASES OF BOTH OF THOSE INSTANCES? OUR PLAN IS TO HAVE FOUR.
WELL, WE WOULD GO IN WITH FOUR-- IF THE COUNCIL-- IF WE ARE APPROVED WITH WHAT WE'RE RECOMMENDING, WE'RE RECOMMENDING A PLAN THAT WILL PROVIDE FOUR AMBULANCES, THE TRANSFERS AGAIN, HIGH LEVEL THE COUNCIL GETS TO DECIDE.
YOU WOULD DECIDE WE WOULD GIVE YOU FEEDBACK, WE WOULD GIVE YOU RECOMMENDATIONS, TRANSFERS WE CAN OR WE CANNOT DO THEM.
WE COULD DO A TRANSFERS ON ONE DAY.
AGAIN, WE'VE GOT THE ANALYTICS.
ON MONDAY, AS CHIEF DAVIS SAID, WE'VE GOT SOLID ANALYTICS THAT AGAIN, WE'RE GETTING TO BE A VERY SOPHISTICATED FIRE DEPARTMENT THAT'S RUN BY TECHNOLOGY AND ANALYTICS INNOVATION.
MOST OF THOSE TRANSFERS THEY CALL, THEY SCHEDULE.
SO AGAIN, DEPENDING ON WHAT DIRECTION, IF WE GO IN THIS, THE COUNCIL WOULD DECIDE.
AND EITHER YOU WOULD GIVE US THE ABILITY TO MAKE THE DECISION, DEPENDING ON THE
[04:50:02]
DEMAND, DEPENDING ON WHETHER.THERE'S SO MANY FACTORS THAT COULD COME INTO PLAY THAT WE MANAGE EACH AND EVERY DAY WITH OUR RESPONSE CAPABILITIES WHEN WE GO INTO WHAT WE CALL STORM MODE.
CHIEF? YES, SIR? TO FOLLOW ON TO VICTORIA'S COMMENTS ABOUT CROWLEY HAVING TWO AMBULANCES FOR 15000 POPULATION AND WHAT DOES THAT MEAN IF WE HAVE 50000? I DON'T KNOW THAT MEDSTAR IS A GOOD COMPARISON TO THE NUMBER OF AMBULANCES PER POPULATION DENSITIES, JUST SIMPLY BECAUSE THEY'RE ONLY PROVIDING ONE SERVICE AND THAT'S TRANSPORT, NOT EMT FIRST RESPONSE, ET CETERA.
COULD YOU PERHAPS ASSEMBLE A LITTLE BIT OF DATA ON SOME OF THE OTHER FIRE BASED AMBULANCE MUNICIPALITIES AS TO HOW THEIR AMBULANCE FLEET RELATES TO THEIR POPULATION SIZE BECAUSE THEY'RE PROVIDING BOTH TRANSPORT AND PRESENCE OR WHAT DID YOU CALL IT A WHILE AGO? THE NOT-- THE AVAILABILITY.
AVAILABILITY? YES, I'LL BE GLAD TO DO THAT.
AND EACH, AGAIN IT'S VERY EASY WHEN WE HAVE THESE DISCUSSIONS TO COMPARE ONE CITY TO THE OTHER, AND THAT'S ONLY AT A HIGH LEVEL BECAUSE EVERY CITY HAS DIFFERENT DEMANDS AND NOT ALL CITIES ARE CREATED EQUALLY.
SO TO TRY TO COMPARE A CITY THAT HAS FIFTEEN THOUSAND, ANECDOTALLY, YES, THAT WORKS.
BUT WHEN YOU LOOK AT THE DATA AND ALL OF THE SPECIFICS FOR THAT CITY, THAT'S WHAT DETERMINES WHAT THEY HAVE, SHOULD HAVE, CAN HAVE.
SO AGAIN, I CAN'T SPEAK TO WHAT ANOTHER CITY HAS OTHER THAN A GENERAL TERM.
BUT WE HAVE THE SOLID ANALYTICS AND WE'RE COMFORTABLE AND CONFIDENT IN IT.
THAT SHOWS BASED ON THOSE ANALYTICS, WHAT WE NEED.
AND AGAIN, WE WOULD NOT HAVE A SYSTEM DESIGN WITHOUT MUTUAL AID.
SO, I WANT TO KIND OF CHIME IN JUST TO OFFER AGAIN A THIRD PARTY PERSPECTIVE FROM SOMEBODY WHO'S, YOU KNOW, LIVED WITH SOMEONE FOR 29 YEARS WHO'S A PARAMEDIC, BUT IN ALL THE TIME, HE'S NEVER-- I'VE NEVER HEARD OF HIM EVER GOING TO AN E.R.
AND IT BEING STACKED UP UNLESS HE WAS GOING TO DALLAS.
AND WHAT'S THE ONE IN DALLAS THAT'S LIKE JPS, WHICH IS THE--? PARKLAND.
AND BECAUSE PARKLAND JPS ARE THE ONES THAT GET THE MOST CRITICAL, THEY'RE TRAINED TO HANDLE THE MOST CRITICAL CALLS AS WELL AS THEY DEAL WITH MOST OF THE INDIGENT CITIZENS AS WELL.
BUT IT'S VERY-- I MEAN, HONESTLY, TWICE I MAY HAVE HEARD IT IN 29 YEARS.
I MEAN, HE HASN'T BEEN A PARAMEDIC THE WHOLE TIME, BUT YOU KNOW, THAT'S NOT GOING TO HAPPEN.
AND WE'RE ALSO IN A DIFFERENT TIME FRAME RIGHT NOW WHERE PEOPLE ARE SCARED.
THEY'RE CALLING 9-1-1 AND GETTING TRANSPORTED OUT OF FEAR OF COVID AND THINK, YOU KNOW, AND THEN YOU DO HAVE ACTUAL COVID PATIENTS AS WELL.
I'M STRUGGLING TO UNDERSTAND WHY WE ARE FOCUSED SO MUCH ON THIS-- ONLY THE MONEY ASPECT AND NOT THE CARE FOR OUR CITIZENS.
SO I'LL SPEAK FOR MYSELF AS A COUNCIL PERSON, BUT AS A CITIZEN.
I'M BEFUDDLED AS TO WHY WE WOULD ARGUE THAT IT'S OK FOR US TO INCREASE A TAX RATE SO WE CAN GET A SPLASH PAD OR A PARK, OR EVEN THOUGH IT COMES OUT OF A DIFFERENT FUND.
BUT WHY WE'RE ARGUING FOR AMENITIES AND THINGS THAT ARE FLUFFY, PRETTY STUFF, AND WE'RE NOT ARGUING FOR CRITICAL CARE FROM THE PEOPLE WHO SERVE OUR CITY.
AND IF WE'RE GOING TO FUND OR IF WE END UP MAKING ANY MONEY ON THE DEAL, WHICH I'M NOT EVEN WORRIED ABOUT, YOU KNOW, WHY WOULDN'T IT BE THE PEOPLE WHO HAVE BEEN SERVING US AND WILL CONTINUE TO SERVE US AND GIVE US, I DON'T WANT AND I HATE TO SAY BETTER CARE BECAUSE I'M NOT SAYING YOU'RE NOT GIVING US GREAT CARE, BUT I'M SORRY.
I JUST KNOW FROM MY OWN HUSBAND THAT, YOU KNOW, THERE'S THIS-- I KNOW THIS WOMAN.
I'VE BEEN TO HER HOUSE MULTIPLE TIMES.
THERE'S ONLY THREE SHIFTS, YOU KNOW, AND SO THEY ALL WORK THEIR AREA OF A CITY.
THEY TEND TO KNOW THE NEIGHBORS AND THE PEOPLE IN THEIR BACKYARD, SO TO SPEAK.
SO I'M STRUGGLING WITH AND I HAVE NO DOG IN THIS HUNT.
I JUST DON'T UNDERSTAND THAT THESE ARE CRITICAL SERVICES A CITY PROVIDES.
AND IF IT'S WORKING FOR, I DON'T KNOW HOW MANY OF THE EIGHTY FOUR CITIES OR WAS IT EIGHTY FOUR? IF IT'S WORKING FOR THEM, THEN I'M CONFUSED.
[04:55:01]
I THINK ALL THESE QUESTIONS ARE REALLY VALID AND IMPORTANT.WE HAVE TO LOOK AT ALL OF THE ANGLES AND ASKING YOU GUYS THESE QUESTIONS IS IMPORTANT BECAUSE THE DATA IS CRITICAL AND MAKING SURE THAT WE KNOW WHAT DATA TO ASK MOVING FORWARD IF WE DID GO WITH THIS.
BUT I JUST STRUGGLE WITH ARGUING OVER HEALTH AND THE WELLNESS OF OUR PEOPLE, BUT WE'LL FUND ANY OTHER AMENITY AND LET'S BUY A CHRISTMAS TREE.
AND LET'S I MEAN, THIS IS CRITICAL STUFF.
I'M SORRY, THIS IS WHAT-- WE ARE MORE, THIS IS MORE IMPORTANT THAN ANYTHING ELSE.
IF YOU GO BACK 50 YEARS AGO, THIS IS WHAT COUNCIL MEMBERS VOTED ON.
THIS IS WHAT'S THE IMPORTANT STUFF, ALL THE FLUFF AND STUFF THAT CITIZENS DEMAND FROM US.
THAT'S ALL THIS NEW AGE 10 YEARS NOW THAT THE EXPECTANCY OF WHAT A CITY SHOULD PROVIDE, WHAT WE SHOULD EXPECT AS CITIZENS IS THAT THEY PROVIDE GOOD STREETS, GOOD INFRASTRUCTURE, POLICE AND FIRE THAT CARE FOR US.
YOU KNOW, I'M GOING TO WEIGH IN MY TWO CENTS ON THIS.
HOWEVER, I WILL ALWAYS SUPPORT OUR PUBLIC SAFETY AND I BELIEVE PUBLIC SAFETY IS CRITICAL AND IT MUST BE SUPPORTED.
THIS BOILS DOWN SIMPLY TO PUBLIC SAFETY.
THIS BOILS DOWN TO BEING ABLE TO RESPOND TO OUR CITIZENS AND PROVIDE THEM THE QUALITY OF CARE THEY NEED IN TIMELY MANNER.
WE'VE HEARD FROM MEDSTAR THAT THERE ARE MORE EXPERIENCED PEOPLE ON THEIR TRUCKS.
WHEN THEY GET THAT LEVEL OF EXPERIENCE THEY NEED, THEY COME JOIN FIRE DEPARTMENTS.
SO DO I HAVE A CHOICE? YEAH, I HAVE A CHOICE.
I CAN EITHER TAKE THE YOUNG KID THAT'S LEARNING ON THE JOB OR I COULD TAKE THE ONE THAT'S EXPERIENCED.
I WANT THE ONE THAT'S EXPERIENCE SHOWING UP TO MY FAMILY.
EVERY MINUTE COUNTS, JUST LIKE I MENTIONED EARLIER, YOU KNOW, THE DIFFERENCE BETWEEN ONE MINUTE, MAYBE EVEN A MINUTE CAN MEAN THE DIFFERENCE BETWEEN LIFE AND DEATH, BETWEEN PERMANENT DAMAGE AND SOMEBODY BEING TO BE ABLE TO SURVIVE.
THIS IS-- I AGREE WITH TAMARA.
THIS IS-- I DON'T KNOW WHY WE'RE SITTING HERE QUIBBLING OVER MONEY.
AND WHEN WE TALK ABOUT THE MONEY ON THIS, LET'S BE REAL.
WE'VE BEEN TOLD ABOUT DALLAS, WE'VE BEEN TOLD ABOUT FORT WORTH, BOTH OF WHICH HAVE A VERY HEAVY TRANSIENT POPULATION.
I SPENT 30 YEARS IN FORT WORTH.
LET ME TELL YOU SOMETHING, AND MEDSTAR.
THERE ARE A LARGE NUMBER OF TRANSIENTS THAT USE THE MEDSTAR TAXI SYSTEM.
THEY CALL IN, THAT THEY ALLEGE SOME KIND OF ILLNESS SO THEY CAN GET THEIR LITTLE SELF DRIVEN ALL THE WAY FROM ARLINGTON OR WHEREVER THEY'RE AT THE JPS, BECAUSE THAT'S WHERE THE HOMELESS SHELTERS ARE A BLOCK OR TWO AWAY.
THEY UTILIZE IT AS A TAXI SERVICE ALL OF THE CITIZENS THEN GET A CONTRIBUTE AND PAY THAT $1600 FOR THAT WHATEVER THE NUMBER WAS SUBSTANTIALLY LESS OF WHAT THE ACTUAL MEDICAL.
WE OWE IT TO OUR CITIZENS TO PROVIDE A GOOD QUALITY SERVICE.
AS FAR AS THE BILL COMING FROM THE CITY OF BURLESON.
I GET A WATER BILL EVERY MONTH AND I HAVE YET TO COME DOWN HERE AND THROW A FIT ABOUT IT.
IT SAYS CITY OF BURLESON ABOUT TOP OF IT.
BUT IF YOU DON'T PAY YOUR WATER BILL, IT DOES GET CUT OFF.
I WANT TO SAY THAT MY QUESTIONS ARE GEARED TOWARD THE QUALITY OF SERVICE.
IF THE VALUE AND LIKE THE CARE THAT WE WANT TO PROVIDE, AND I'M SAYING TWO IS NOT GOING TO CUT IT.
I DON'T SEE HOW-- [INAUDIBLE] IF WE'RE WANTING TO KEEP OR IMPROVE THE QUALITY OF CARE THAT WE'RE PROVIDING TO OUR CITIZENS.
IF THAT'S TRULY THE ARGUMENT, THEN I DISAGREE THAT I THINK WE'RE JUST DOING THE BARE MINIMUM.
WHERE DOES, AND MAYBE MEDSTAR NEEDS TO COME BACK UP, AND I HATE THAT MATT'S GONE, BUT MAYBE WE COULD-- THE STANDARD DEVIATION IS TWO TIMES THE AVERAGE.
SO WOULDN'T THAT MEAN WE NEED SIX? I THINK IT'S CLEAR AND WE'LL PULL THAT BACK UP.
WE DO NOT NEED SIX, THAT IS REPRESENTATIVE OF ONE-- WE HAVE TO GET THE CONTEXT AND CONTEXT IS EVERYTHING.
THE SIX THAT WAS SHOWN WAS AT A MOMENT IN TIME, ON A SPECIFIC DAY.
OUR DATA SHOWS AND THEIRS DOES, TOO.
AND THE NUMBER OF AMBULANCES IS FOUR.
THAT WAS THEIR RECOMMENDATION, AND WE BELIEVE BURLESON NEEDS FOUR.
BASED OFF OF LAST YEAR'S CALL VOLUME AND LAST YEAR'S POPULATION? BASED ON THE DATA-- BECAUSE WHAT'S GOING TO HAPPEN? WE'RE ABOUT TO GROW SIGNIFICANTLY WITH CHISHOLM SUMMIT, SO IT TAKES TWO--
[05:00:01]
YOU AND CASEY HAVE TOLD ME IT TAKES 18 MONTHS TO ORDER ANOTHER AMBULANCE.SO IF WE GET STARTED, WE'RE ALREADY BEHIND? I'M NOT REALLY-- I JUST-- KEN CAN YOU EXPLAIN THE STANDARD DEVIATION THING TO ME, PLEASE? YES, MA'AM.
SO, THE MODEL THAT WE SHOWED YOU ALL IT IS-- THIS IS A DIFFERENT PROGRAM MOST LIKELY.
BUT WE USE TWO STANDARD DEVIATIONS.
IT GIVES YOU ABOUT NINETY FIVE PERCENT COVERAGE.
WHAT THE GRAPH SHOWS IS UP TO FOUR BETWEEN FOUR AND FIVE AMBULANCES, AND THERE ARE A COUPLE OF PLACES WHERE IT PEAKS TO FIVE.
THE REASON, SEVERAL OF YOU HAVE ASKED WHY THE DATA IS DIFFERENT, WHY THESE CHARTS ARE DIFFERENT AND TO CHIEF FREEMAN'S POINT, WE GENERALLY AGREE THAT FOUR TO FIVE IS PROBABLY GOING TO BE THE RIGHT NUMBER.
THIS DATA WAS TWENTY TWENTY DATA.
I WAS ACTUALLY TALKING WITH CASEY, WHEN EVERYBODY'S EATING LUNCH, IN THE DATA THAT WE PULLED THAT WE RAN OUR DEPLOYMENT OFF OF WAS FROM OCTOBER OF TWENTY UNTIL I THINK SEPTEMBER OF TWENTY ONE.
SO, IT'S MORE RECENT DATA, WHICH IS WHY THE CALL INCREASES ARE-- WHY THE NUMBERS ARE A LITTLE BIT LARGER TO YOUR POINT, BY THE TIME WE GET TO TWENTY TWENTY FOUR? IS THAT RIGHT? TWENTY THREE? ABOUT BY OCTOBER TWENTY THREE, YOU KNOW, YOU'RE PROBABLY LOOKING AT ANOTHER THREE TO FIVE PERCENT GROWTH.
THAT'S WHAT-- IF YOU TAKE COVID OUT OF IT, THAT'S WHAT WE'VE LOOKED AT.
WHEN WE WERE IN DEPLOYMENT FOR THIS BUDGET YEAR, WE ACTUALLY LOOKED AT 2019 DATA AND ADDED GROWTH FACTORS ONTO IT.
THE POINTS THAT YOU'RE TALKING ABOUT ARE, YOU KNOW, IT'S THE DETAILS THAT YOU HAVE TO GET DOWN TO.
THE OTHER THING THAT WE WERE TALKING ABOUT IS ALL OF THIS REALLY COMES DOWN TO THE MODEL YOU WANT TO RUN.
I MEAN, AT THE END OF THE DAY.
YOU KNOW, WE RUN A SYSTEM STATUS MODEL.
YOU KNOW, WE'VE BEEN ADVISED THROUGHOUT OUR HISTORY THAT THE CITIES ARE, YOU KNOW, THEY WANT TO MINIMIZE THE SUBSIDY.
AND SO THAT SYSTEM STATUS MODELS WORKED RELATIVELY WELL.
THAT'S WHY WE'RE MORE EFFICIENT.
AS I TOLD SEVERAL OF YOU, THERE'S A LOT OF MATH AND SCIENCE THAT GOES INTO IT.
BUT THE LONG AND SHORT, IS WE FLEX STAFFING UP AND WE FLEX STAFFING DOWN DEPENDING ON THE PREVIOUS CALL VOLUME.
AND IT'S 12 MONTHS OF PREVIOUS DATA, PLUS ESSENTIALLY A FUDGE FACTOR THAT THEN WE SCHEDULE TO TRY TO COVER THAT WHEN IT SPIKES UP TO SIX AND THINGS LIKE THAT.
AND THOSE ARE SIX EMERGENCY CALLS BECAUSE SOMEBODY ASKED FOR THAT DATA, WHICH I PULLED IN AND SENT AS WELL.
BUT IT'S THOSE DETAILS THAT YOU HAVE TO GET INTO TO REALLY MAKE SURE YOU'VE GOT THE RIGHT COVERAGE, YOU KNOW, FOR THE CITIZENS AND FOR THAT KIND OF STUFF, AND TO MAKE ACCURATE PREDICTIONS AS FAR AS YOU KNOW WHAT THE COST IS BECAUSE THERE ARE A SMALL PERCENTAGE OF THE CALLS THAT WE RUN THAT ARE TIME DEPENDENT, A LARGE PERCENTAGE OF THEM, YOU KNOW, AS DR. VEER KIND OF TALKED ABOUT AREN'T NECESSARILY SO TIME DEPENDENT.
WE HAVE TRANSIENT PEOPLE ALL THROUGH OUR SERVICE AREA, TO BE CLEAR.
SO THERE, BELIEVE IT OR NOT, THERE'S A COUPLE IN BURLESON, TOO.
SO THOSE ARE THINGS THAT WE DEAL WITH THROUGHOUT THE SYSTEM.
AND I THINK THAT'S REALLY KIND OF, IF I COULD PARAPHRASE A LITTLE BIT, I THINK THAT'S WHAT YOU'RE TRYING TO GET AT IS, IS A LEVEL OF COMFORT AND CERTAINTY WITH, YOU KNOW, WHAT THE MODEL IS WITH A FIRE BASED MODEL BECAUSE GENERALLY IT'S RELATIVELY STATIC AND FIGURING OUT THE RIGHT NUMBER OF RESOURCES AND WHAT ALL GOES INTO THAT IS WHAT YOU REALLY NEED TO BE ABLE TO MAKE A GOOD FINANCIAL DECISION WITH BECAUSE THERE ARE A MILLION DIFFERENT MODELS OUT THERE.
WE'RE RUNNING A SYSTEM STATUS WITH NO FINANCIAL DIRECT TAX SUBSIDY.
THIS IS-- THIS IS A SIGNIFICANT [INAUDIBLE]-- COULD HAVE A SIGNIFICANT FINANCIAL IMPACT.
AND IT'S A-- THAT TAXPAYERS ARE CURRENTLY NOT SUBSIDIZING RIGHT NOW.
BUT THERE WILL BE PEOPLE WHO WANT TO KNOW WHAT IS THIS GOING TO COST ME? WE HAD-- THIS COUNCIL APPROVED A TWO AND A HALF CENT TAX DECREASE AND APPRAISALS JUST CAME OUT AND PEOPLE ARE UPSET BECAUSE LIKE THEY'RE HIGH, EVEN THOUGH WE AND MANY OTHER TAXING ENTITIES DECREASE THEIR TAX RATES.
THE AMOUNT OF MONEY THAT THEY'RE STILL GETTING IS GOING UP AND THERE IS A BIG MOVEMENT, ESPECIALLY LOCALLY, TO ELIMINATE PROPERTY TAX OR, YOU KNOW, RESTRUCTURE IT.
I FEEL LIKE THERE ARE SO MANY THINGS THAT WE-- I DON'T WANT TO-- WE'RE GOING TO HAVE TO JUSTIFY THIS TO THE TAXPAYERS.
AND WHILE OF COURSE THE CARE OF OUR CITIZENS IS FIRST AND FOREMOST, WE STILL HAVE TO ANSWER FOR HOW WE PAY FOR IT IN THE LONG RUN.
AND IT'S ONE THING TO LOOK AT CAPITAL EXPENSES, BUT YOU LOOK AT THE ANNUAL OF ADDING, YOU KNOW, THE COST TO THE CITY AND I THINK I'VE BIT OFF ENOUGH HEADS ABOUT THE WORD REVENUE BECAUSE THAT'S AN ASSUMPTION.
YOU HAVE BEEN IN BUSINESS FOR 33 YEARS AND THERE'S A NUMBER OF PEOPLE SITTING UP
[05:05:02]
HERE THAT HAVE BUSINESSES WHO STARTED BUSINESSES.YOUR FIRST YEAR IT'S NOT OUT OF THE CHUTE.
WHAT ANOTHER COMPANY IS-- MS. PAYNE HAD A VERY GOOD POINT EARLIER.
EVEN IF YOU HAVE A FRANCHISE AND YOU'RE LIKE, WELL, THE ONE IN FORT WORTH DOES THIS.
SO SURELY IN MY FIRST YEAR, I'M GOING TO DO THIS.
I, YOU KNOW, LIKE YOU HAVE AN ESTABLISHED PROGRAM AND PEOPLE KNOW AND ANTICIPATE LIKE THEY SEE THE MEDSTAR, OK, LIKE I'M GOING TO GET A BILL FOR THAT.
IT WILL BE A DIFFERENT-- IT WILL BE A MINDSET TRANSITION FOR THE CITIZENS OF THIS TOWN.
WE'VE HAD THIS SERVICE FOR THIRTY THREE YEARS AND NOW ALL OF A SUDDEN, WE'RE SWITCHING IT.
THERE ARE-- THERE'S NOT A DAY AND OVER THE LAST MONTH SINCE THESE CONVERSATIONS STARTED THAT I HAVEN'T TALKED ABOUT, I HAVEN'T MENTIONED THE WORD AMBULANCE AND I'VE SPOKE TO PARENTS AT THE SCHOOL.
AND PEOPLE, WHILE I'M GETTING MY COFFEE AND THERE'S-- I'M JUST GETTING A GOOD, I FEEL LIKE I'VE TRIED TO GET A PULSE OF WHAT THE COMMUNITY WOULD THINK IN THE EVENT THAT WE MAKE THIS TRANSITION.
AND AN ER NURSE TELLING ME THIS DOES HAPPEN, IT JUST HAPPENED.
SHE HAS NO-- AND SHE WORKS FOR A THR HOSPITAL.
AND SO I HAVE NO-- I MEAN, LIKE SHE HAS NO DOG IN THIS FIGHT.
SHE'S JUST A TAXPAYING CITIZEN AND A MAMA WHO WAS HELPING ME DECORATE FOR CHRISTMAS YESTERDAY, AND I WAS ALSO DECORATING CONVENIENTLY WITH AN NP.
AND, YOU KNOW, THAT'S SOMETHING I REALLY WANTED TO TALK ABOUT, AND I FEEL LIKE WE'VE JUST BEEN HERE FOR SO LONG.
BUT THE FUTURE OF EMS. YOU KNOW, I'VE SAID I HAVE HAD LIKE AN INKLING OF TIME IN THE HEALTH CARE INDUSTRY.
AND WHILE I WAS THERE, WE HAD TO TALK ABOUT THINGS LIKE, HOW DO WE BRING DOWN COST? HUGULEY IS A NONPROFIT HOSPITAL, AND SO, YOU KNOW, THERE'S ONLY SO MUCH YOU CAN WRITE OFF AND STILL GET.
YOU HAVE TO PAY PEOPLE AND SO WE WERE TALKING ABOUT THINGS LIKE, YOU KNOW, AND THIS WAS EIGHT YEARS AGO OR SO.
[INAUDIBLE] WHAT? TREATING PEOPLE AT HOME, MORE CONCIERGE CARE.
YOU KNOW, WHERE DO WE SEE-- I SEE DOWN THE LINE MAYBE IT'S STARTING WITH THE GROWTH OF SIX ADDITIONAL FIREFIGHTERS, BUT THERE'S GOING TO BE MORE.
I THINK, MY PERSONAL OPINION, JUST IN THE INKLING OF INFORMATION I HAVE FROM WORKING IN THE HEALTH CARE INDUSTRY FOR TWO YEARS WAS LIKE, YOU'RE GOING TO WANT PEOPLE AND NEED PEOPLE THAT CAN TREAT AT HOME OR DO THOSE HOUSE CALLS TO REDUCE HOW MANY PEOPLE ARE BEING SHUTTLED TO HOSPITALS AND THE RISING COST OF HEALTH CARE.
AND HOW-- WHERE DO YOU SEE EMS GOING? YES.
SO, THAT'S A, YOU KNOW, I TALK TO A LOT OF YOU ALL THAT CAME OUT TO SEE US INTO THE BUILDING AND THINGS LIKE THAT ABOUT THE FUTURE OF EMS AND A LITTLE BIT OF WHAT COUNCIL MEMBER STANFORD SPOKE ABOUT IS CORRECT.
WE PICK UP A LARGE PERCENTAGE OF PEOPLE THAT JUST USE US FOR A BUS RIDE THROUGHOUT THE ENTIRE-- OR HOT MEAL, OR TO GET WARM IN THE WINTER.
OR TO GET WARM IN THE WINTER OR JUST FOR COMPANIONSHIP SOMETIMES.
AND THAT'S WHAT WE TALK A LOT ABOUT.
AS YOU KNOW, CHIEF FREEMAN MENTIONED, WE'VE LOOKED AT FUTURE REVENUES AND THERE'S A POINT AT WHICH THOSE LINES CROSS OR REVENUES AND EXPENSES.
I SHARED WITH A LOT OF YOU AND ACTUALLY, I THINK WHAT HE WAS REFERENCING IN THE EMAIL WAS LAST YEAR WE ACTUALLY LOST MONEY AS A SYSTEM.
WE DECIDED TO INVEST IN OUR PEOPLE AND WE DIDN'T DO MANDATORY OVERTIME.
WE DID A LOT OF SHIFT INCENTIVES AND THINGS LIKE THAT.
BUT AS WE LOOK FORWARD ON HOW WE ADDRESS THAT BECAUSE WE KNOW THAT'S NOT SUSTAINABLE, YOU CAN'T CONTINUE LOSING MONEY EVERY YEAR.
IT'S REALLY BEING ABLE TO TRIAGE THOSE PATIENTS, YOU KNOW, AND THE ONES THAT JUST NEED A RIDE TRYING TO FIGURE OUT WHY.
SOMETIMES IT'S LITERALLY AS EASY AS THEY WANT A WARM PLACE TO GO AND HOOKING-- ATTACHING THEM WITH COMMUNITY RESOURCES AND THINGS LIKE THAT.
IT'S BEING ABLE TO, AS MATT TALKED ABOUT, WORK WITH THE COMMUNITY PAYERS OR THE LARGE PAYER SYSTEMS AND HAVE CONVERSATIONS ABOUT, HEY, WHY WILL YOU PAY ME TO TAKE A PATIENT TO THE HOSPITAL? OR THEN THE E.R.
IT'S GOING TO TURN AROUND AND BILL AND ALL THAT KIND OF STUFF.
WHY WOULDN'T YOU JUST PAY US TO GO OUT AND TRIAGE THIS PATIENT? TAKE CARE OF THEM ON SCENE? TREAT WHAT WE CAN ON SCENE, THE HYPERGLYCEMIC PATIENTS THEY WERE TALKING ABOUT, GENERALLY THOSE FOLKS CAN BE TREATED ON SCENE AND RELEASED.
I USED TO SIT AS I WAS A PARAMEDIC AND I GIVE BACK.
THEN WE GAVE [INAUDIBLE] AND I'D SAY I MAKE SURE THEY ATE A PEANUT BUTTER AND JELLY SANDWICH.
SO THEY HAD SOMETHING THAT STUCK WITH THEM, BUT IT SAVED THEM GOING TO THE ER.
UNFORTUNATELY, THE DOWNSIDE OF IT WHEN I DID IT WAS THEY WOULD GET A BILL FOR THE TREATMENT THAT WE RENDERED FROM THE AMBULANCE.
AND INSURANCE TYPICALLY WOULDN'T PAY FOR THAT.
WE ARE MAKING SOME HEADWAY WITH THAT.
WE'VE SIGNED WITH A COUPLE OF COMMERCIAL PAYERS AND WE'RE WORKING THROUGH THAT FOR THAT TO BE A VIABLE OPTION GOING FORWARD.
SO ALL THESE FOLKS WON'T HAVE TO GO TO THE HOSPITAL BECAUSE WE ARE RELATIVELY LUCKY IN THIS AREA AND THAT THE HOSPITALS TYPICALLY TURN OUR FOLKS OVER PRETTY QUICK AS FAR AS GETTING THEM BACK OUT.
AND BY QUICK, I SAY WE TRY TO KEEP OUR HOSPITAL TIMES AROUND TWENTY FIVE MINUTES, THERE ARE METRICS THAT WE MONITOR.
BUT THERE ARE HOSPITALS AND THERE ARE TIMES THAT THEY GET BACKED UP AND THEY SIT
[05:10:02]
ON THE WALL AND THEY WAIT AND WE SEND SUPERVISORS AROUND TO CHECK ON THEM.BUT THAT'S UNNECESSARY CALL LOADS FOR THE HOSPITALS AND TRYING TO FIND BETTER WAYS TO TREAT THEM AND INGRAIN IN THE HEALTH CARE SYSTEMS IS REALLY WHERE THE FUTURE OF EMS IS GOING TO GO.
WE THINK, AND THOSE ARE AREAS THAT WE'RE WORKING VERY HARD TOWARDS, AND THAT'S ONE OF THE VALUE PROPOSITIONS THAT WE THINK MEDSTAR BRINGS.
TO BE PERFECTLY HONEST WITH YOU, IT'S, YOU KNOW, AS EVERYBODY'S TALKED ABOUT.
WE'VE HAD A GREAT RELATIONSHIP WITH BURLESON.
THERE'S BEEN SOME THINGS THAT HAVE BEEN SAID THAT EITHER I CLEARLY DIDN'T HEAR OR THERE WAS SOME SORT OF MISUNDERSTANDING.
WE WORK HARD TO TRY TO BRING VALUE TO THE BURLESON.
FIREFIGHTERS DO A WONDERFUL JOB.
OUR FOLKS DO A WONDERFUL JOB AND WE HAVE A LOT OF PEOPLE THAT ARE WELL TENURED WITH US.
YOU ALL HAVE MET SOME OF THEM.
AND PERSONALLY, I THINK WE'RE BETTER TOGETHER IN THIS.
BUT THAT'S MY, YOU KNOW, BUT THAT'S MY OPINION.
LIKE I SAID, AT THE END OF THE DAY, IT REALLY COMES DOWN TO A MODEL DECISION FOR YOU ALL.
THERE ARE A LOT OF RISK ASSOCIATED OR THERE ARE SOME RISKS ASSOCIATED WITH THE, YOU KNOW, WITH THE FIRE DEPARTMENT BASED MODEL.
BECAUSE IF YOU'RE PAYER, MIX THIS OFF.
AS WE'VE TALKED ABOUT, IF YOU'RE PAYER, MIX IS OFF, YOU KNOW, YOUR COST CAN CAN SKYROCKET PRETTY QUICK.
IF YOUR DEMAND GETS OFF, YOUR COST CAN SKYROCKET PRETTY QUICKLY.
THE LARGE DEVELOPMENT THAT THEY'RE TALKING ABOUT PUTTING OVER ON CHISHOLM TRAIL, YOU KNOW, THOSE ARE ALL THINGS THAT FACTOR IN AND THAT WE WORK THROUGH AND, YOU KNOW, WE WORK WITH THROUGHOUT THE SYSTEM.
STEP IN HERE FOR A SECOND BECAUSE WE'RE GOING TO BE HERE TILL MIDNIGHT IF I DON'T.
OK, LET'S LET'S TRY TO GET OUR ANSWER-- OUR QUESTIONS AND OUR ANSWER WAS SIMPLE.
BUT ONE OF THE THINGS I WANT TO RECOMMEND THE GUY THAT DID THE NUMBER FOR THE CITY.
DR. KNIGHT, YOU GOT ANY INPUT ON THIS BECAUSE I FEEL LIKE WE'RE KIND OF GOING BACK AND FORTH ON SOME OF THIS STUFF.
COULD YA KIND OF SETTLE SOME OF THE NUMBERS AND WHILE YOU'RE COMING UP ON TO MAKE A STATEMENT.
THE QUALITY OF SERVICE IS KEY HERE.
THE START UP OF THE MONEY IS IMPORTANT, TOO, BUT BEING IN A LOT OF STARTUPS, DAN KNOWS THIS.
THERE ARE SEVERAL PEOPLE HERE THAT KNOW THIS.
YOU'RE GOING TO HAVE BUMPS IN THE ROAD AND WITH THE QUALITY OF STAFF THAT WE HAVE WITH, WITH MARTIN AND JOHN, IT'S JUST BUMPS IN THE ROAD.
KEN, ONE OF THE QUESTIONS I HAD FOR YOU AND I SHOULD ASK YOU, SOONER, THEY-- GET UP.
OK, SO BRINGING UP WHAT JIMMY SAID ABOUT THE INDIGENCE AND DOING A BUS SERVICE.
SO YOUR COST PER UNIT PER CALL IS TAKING IN EFFECT OF EVERYTHING THAT YOU BILL THAT YOU DON'T GET NOTHING.
THE EXPENSE IS SYSTEM WIDE EXPENSE ACROSS THE BOARD.
SO LAST YEAR WE SPENT $52 MILLION, FIFTY TWO MILLION DIVIDED BY JUST ROUGH NUMBERS, ONE HUNDRED AND SEVENTY THOUSAND OKEY DOKE.
SO THIS WOULDN'T HAVE AN IMPACT ON OUR NUMBERS HERE IN BURLESON, THOUGH, CORRECT? I MEAN, WE DON'T HAVE THE INDIGENT TRAFFIC LIGHT LIKE FORT WORTH STUFF THAT NATURE SO, AND WE DON'T KNOW HOW TO FIGURE THAT.
THAT'S THE REASON I ASKED DR. KNIGHT COME UP.
WE HAD SOME VERY CANDID TALKING JOY AND LOVE THAT VIEW FROM YOUR CONFERENCE ROOM WHERE YOU'RE LOOKING DOWN THE RUNWAY OF LOCKHEED.
SO AND I APPRECIATE THAT, BUT THIS IS ABOUT THE SERVICE.
AND OUR STARTUP, BECAUSE ONCE WE GET OUR STARTUP, I THINK WE CAN HANDLE ANYTHING ELSE.
AND I WANT TO MAKE CLEAR THAT THERE'S NOT A PROPERTY TAX INCREASE FOR THIS.
OUR TAXES AREN'T COMING UP ON THIS BECAUSE I GOT AN EXCELLENT FINANCE DIRECTOR THAT SAYING IT'S NOT.
SO I'M GOING ALL OVER THE ROOM HERE.
KNIGHT WOULD YOU COME FORWARD AND KIND OF VISIT WITH US A LITTLE BIT [INAUDIBLE] VICTORIA, YOU GOT EVEN MORE QUESTIONS WE MIGHT WANT TO ASK HIM TOO.
[INAUDIBLE], I [INAUDIBLE] ANYTHING I'D LIKE TO MAKE A STATEMENT.
I'VE LIVED HERE 50 YEARS AND TO THINK THAT I WOULD DO ANYTHING THAT DID NOT-- WASN'T IN THE BEST INTEREST OF OUR CITIZENS IS ABSOLUTELY CRAZY.
I THOUGHT WHAT WE WERE DOING HERE TODAY IS MAKING AN OBSERVATION OF TWO SYSTEMS AND WHAT WE WERE TRYING TO DO IS WE KNOW AND WE'RE VERY FORTUNATE IN THAT WE HAVE A CHOICE.
WE HAVE TWO SYSTEMS AND THEY BOTH ARE GOOD SYSTEMS. AND DO I HAVE CONFIDENCE IN THE FIRE DEPARTMENT? WELL, ABSOLUTELY.
DO I KNOW PEOPLE IN THE MEDSTAR? ABSOLUTELY.
THEY'RE SOME OF THE FINEST PEOPLE HAVE EVER KNOWN.
OH, WELL, IT'S JUST Y'ALL TAKING MONEY.
I'M NOT TAKING THE MONEY ISSUE.
[05:15:01]
I'M TRYING TO FIGURE OUT WHAT OUR BEST OPTION IS.IS THERE ALTERNATIVES? IF THERE ARE ALTERNATIVES THAT WOULD HELP BOTH SIDES AND HELP US FINANCIALLY? THAT'S THE DIRECTION I'M HEADED.
BUT AS FAR AS ME SAYING, WELL, BECAUSE [INAUDIBLE], I DON'T CARE.
SO PLEASE, I DON'T THINK THAT, I'M TALKING ONLY FOR MYSELF, THAT I WOULD EVER PUT ANYBODY IN HARM'S WAY OVER MONEY.
I'M SIMPLY TRYING TO FIGURE OUT WHAT'S THE BEST SYSTEM FOR US.
IS THERE ALTERNATIVES? IF THERE ARE? HECK, LET'S DO IT AND WE CAN STILL WORK TOGETHER? ABSOLUTELY.
LIKE I SAID, THERE'S A MILLION DIFFERENT EMS SYSTEMS. THERE ARE ALTERNATIVES.
IT'S JUST WE'VE, YOU KNOW, THE DIRECTIVE HAS ALWAYS BEEN THAT NONE OF THE CITIES WANT TO SUBSIDIZE ANYTHING AS LOW COST AS POSSIBLE.
YOU KNOW, IF WE HAD THIS CONVERSATION, A BRIEF CONVERSATION EARLY ON WHEN THIS REPORT FIRST CAME OUT, YOU KNOW, IF THE CITY AND THE CITY COUNCIL HAS THE BIG TARGET THEY WANT US TO HIT, LET'S SIT DOWN AND HAVE THOSE CONVERSATIONS.
AND TO YOUR POINT, WE'LL SEE WHAT OPTIONS THERE ARE.
YOU KNOW, ALONG THOSE LINES, WE'LL HAVE THE CONVERSATIONS WITH THE BOARD AND WITH YOU ALL AND SEE WHAT'S THERE.
IF YOU ALL DECIDE, YOU KNOW, HEY, WE WANT TO GO ALL [INAUDIBLE] AND THAT'S GOING TO BE IT.
AND AS I'VE TOLD ALL OF YOU THAT CAME TO TALK WITH US, THIS IS NOT AN INDICTMENT ABOUT FIRE.
I WOULD HOPE THEY'D SAY THE SAME THING ABOUT OUR FOLKS ON MEDSTAR.
I KNOW CASEY AND KT TEND TO AGREE WITH THAT AS WELL.
IT'S REALLY ABOUT WHAT MODEL WORKS, WHAT THE CITY'S-- EACH CITY INDIVIDUALLY WANTS AND WHAT WE CAN WORK THROUGH TOGETHER TO FIGURE OUT.
SO I KIND OF AM AGREEANCE WITH THAT OF LIKE, IS THERE A WAY TO DIP OUR TOE IN AND START LIKE BEING ABLE TO HAVE SOME DATA? AND LIKE CASEY MENTIONED, THAT HE HAD APPROACHED THE IDEA OF HAVING AN AMBULANCE HERE.
I MEAN, MAYBE WE LEASE ONE AND MAYBE IT RESPONDS TO THE MOST CRITICAL OF CRITICAL AND THEN THAT GIVES US LIKE, I JUST FEEL LIKE THIS IS, JUST LIKE RONNIE JUST SAID, THERE'S TWO SYSTEMS AND THEY BOTH PROVIDE A SERVICE TO THIS COMMUNITY.
I KNOW IT'S NOT ABOUT THE PEOPLE.
I KNOW OUR FIRE DEPARTMENT WOULD MAKE IT WOULD TAKE EXCEPTIONAL CARE OF OUR PATIENTS.
THEY DO AT ANY SERVICE THAT THEY ADD.
ONCE WE GO THIS ROUTE, THERE'S NO TURNING BACK.
WE'RE NOT GOING TO HIRE EIGHT AND THEN FOUR MORE AND THEN SIX MORE AND THEN SIX MORE FIREFIGHTERS AND THEN RANDOMLY ONE DAY GO, THIS DOESN'T WORK OUT.
WE'RE GOING TO LAY ALL OF YOU OFF.
NO ONE WANTS TO LAY OFF FIREFIGHTERS, NO ONE.
IF WE MAKE THIS TRANSITION, I WANT IT TO BE SET UP FOR SUCCESS AND I DON'T WANT TO GO, OK.
THREE AMBULANCES LOOKS GOOD ENOUGH, BUT THEN WE NEED TO HURRY UP AND ORDER TWO MORE.
AND BY THE TIME THEY GET HERE, THOSE MAY BE PAST THE POPULATION AND CALL VOLUME.
I JUST, I THINK A LOT OF OUR FIRE DEPARTMENT AND I'VE SAID THIS AND I FEEL LIKE I'M BEING VERY PROTECTIVE OF LIKE I WORKED FOR A HOSPITAL AND I HAD AND I'VE WORKED IN COMMUNICATIONS AND I'VE CLEANED UP MESSES, AND I JUST WANT TO MAKE SURE THAT ANY MOVES WE MAKE, WE SET UP FOR SUCCESS AND LOOKING OUT FOR OUR CITIZENS AND LIKE WHETHER OR NOT PEOPLE WANT TO TALK ABOUT IT, THAT THERE IS A FINANCIAL IMPACT TO THIS AND IT.
DO WE SCARE OFF CITIZENS THAT ARE ON FIXED INCOMES THAT WORRY ABOUT WHETHER OR NOT THEY'RE GOING TO SEE-- US IF THEY GET TRANSPORTED BY A BFD NOW IS THAT COST THREE-- DO THEY SEE A BILL FOR THREE THOUSAND INSTEAD OF SIXTEEN HUNDRED BECAUSE WE HAVE TO TRY AND RECOUP SOME OF OUR COSTS, BUT-- IT REALLY, I MEAN, THOSE KIND OF THINGS, REALLY.
I MEAN, IN ALL HONESTY, WHAT HAPPENS IS IT GETS I'M NOT.
WHAT HAPPENS IS IT ENDS UP GETTING PASSED LONG AND MORE OFTEN THAN NOT WOULD BE IN SOME SORT OF ADDITIONAL SUBSIDY FROM TAX DOLLARS AND THINGS LIKE THAT.
SO BECAUSE TO KT'S POINT, IT'S MEDICARE IS GOING TO PAY WHAT MEDICARE IS GOING TO PAY, MEDICAID IS GOING TO PAY.
THE COMMERCIAL INSURERS ARE THE ONES THAT HISTORICALLY HAVE PAID MORE, AND THEY'RE NOT DOING THAT AS MUCH ANYMORE, WHICH IS THE WHOLE FUTURE OF EMS CONVERSATION.
AND THERE'S PEOPLE THAT ARE GOING TO LIE AND SAY THAT THEY DON'T HAVE INSURANCE BECAUSE THEY WANT TO TRY-- BECAUSE THEIR DEDUCTIBLES ARE SO HIGH AND THEY WANT TO TRY AND NOT COME OUT OF POCKET VERY MUCH FOR THIS.
VICTORIA WHERE DID THE QUESTION OF PEOPLE NOT GETTING AMBULANCE SERVICE BECAUSE THEY CAN'T PAY? IS THAT IS THAT AN ISSUE? IS THAT BEING BROUGHT UP SOMEWHERE? WHAT YOU JUST SAID? I JUST SAID, I DON'T WANT THEM TO HAVE STICKER SHOCK OF THEY ONCE HAD
[05:20:04]
ONE SERVICE, AND IT GENERALLY COSTS THIS MUCH.BUT IF WE TOOK THIS OVER, I ASKED THIS EARLIER OF MEDSTAR BILLS THREE TIMES WHAT IT COSTS YOU IN HOPES OF RECAPTURING WHAT? CLOSE TO FOUR.
FOUR TIMES IN HOPES OF RECAPTURING WHAT IT COSTS THEM.
SO HOW MUCH WILL WE HAVE TO BILL IN HOPES OF RECAPTURING? BUT THAT'S NOT AN ISSUE THAT NOT ANY SERVICE IS DOING.
ALL THESE TOWNS THAT'S USING THIS IS GOING THROUGH THE SAME THING.
AND THE GUYS THAT I'VE TALKED TO AND SAID IT'S MANAGEABLE.
I HAVE SPOKE TO DEPARTMENTS AND INDIVIDUALS.
I HAVE FRIENDS AND TONS OF-- IN FORT WORTH THAT I HAVE A FRIEND WHO WORKS FOR FORT WORTH FIRE DEPARTMENT, AND HE WORKED FOR CROWLEY A NUMBER OF YEARS AGO AND HE WAS LIKE, I WAS SO EXHAUSTED WE COULDN'T RUN CALLS ENOUGH.
I CAME HOME AND HAD WANTED NOTHING TO DO WITH MY FAMILY BECAUSE I WAS JUST THAT RUN DOWN, AND HE WENT TO FORT WORTH BECAUSE HE DIDN'T HAVE TO DO AMBULANCES.
WELL, AND HERE'S THE ONLY THING I CAN SAY IS THE QUALITY OF PEOPLE WE GOT, AND I AGREE WITH THAT.
I KNOW YOU THINK THE WORLD [INAUDIBLE].
I'M NOT DEGRADING ANY OF THIS, BUT IN ANY STARTUP, YOU'RE GOING TO HAVE PROBLEMS AND WE'RE GOING TO DEAL WITH THOSE ON THE FLY.
I'M NOT MAKING THE DECISION YET.
I THINK WE NEED TO MAYBE HAVE ANOTHER WORKSHOP, YOU KNOW, KIND OF.
KNIGHT TO ADDRESS THIS LAST ISSUE THAT WE HAD.
IF I COULD, BEFORE WE GO TO THAT JUST TO ADDRESS THE REVENUE QUESTION.
ALL EMS PROVIDERS ARE GOING TO BASICALLY CHARGE SOME NEIGHBORHOOD OF THE SAME COST SO THAT FOUR TO ONE, THREE TO ONE, WHATEVER, IT'S GOING TO BE BASED ON THE LEVEL OF SERVICE THEY'RE RECEIVING.
THERE'S SOME ADDITIONAL CHARGES BASED ON ADVANCED LIFE SUPPORT OR ADVANCED LIKE SUPPORT TWO.
YOU'LL HAVE THOSE COSTS, BUT THAT 14 TO SIXTEEN HUNDRED DOLLARS COST IS PRETTY CONSISTENT ACROSS THE METROPLEX.
WE'LL GIVE YOU SOME INFORMATION AND KIND OF SHOW WHAT THAT IS, BUT TO GIVE YOU A COMPARISON FOR THE BURLESON COSTS WHAT I'D GOTTEN FROM KEN, THEY BILL ABOUT $8 MILLION TO COLLECT ABOUT TWO MILLION? MOST OF THE OTHER COSTS IS WRITTEN OFF AT SOME POINT.
THAT WOULD BE SIMILAR TO WHAT WE WOULD HAVE TO DO AS WELL.
AND I WANT TO APPRECIATE VICTORIA'S PASSION.
I MEAN, I REALLY DO LISTEN TO YOU.
I KNOW YOU DON'T THINK I DO ALL THE TIME, BUT I REALLY DO.
SO JUST SO I'M CLEAR ON THE LANE, YOU JUST KIND OF WANT A BROAD OVERVIEW FROM OUR PERSPECTIVE, LISTENING FOR THE DAY OR? OK, WE'D BE HAPPY TO DO SO.
SO JUST FOR THE RECORD, MY NAME IS STEVE KNIGHT AND I'M A PARTNER WITH FITCH AND ASSOCIATES THAT DID THE ORIGINAL STUDY.
WHAT'S UNIQUE ABOUT OUR FIRM IS WE'VE GOT A STRONG FOOTHOLD IN ALL ASPECTS OF THE DIALOG.
TODAY WE ARE FOUNDING PARTNERS.
ACTUALLY, WE'RE AT THE FOREFRONT OF DESIGNING PUBLIC UTILITY MODELS.
WAY BACK IN THE 80S, AND MOST OF THAT LIST THAT THEY SHARED OF PUBLIC UTILITY MODELS ARE EITHER CURRENT OR PAST CLIENTS, AS WELL AS A REALLY LARGE, FIRE BASED EMS PRACTICE.
SO WE HAVE A FIRM UNDERSTANDING OF BILLING.
WE HAVE A FIRM UNDERSTANDING OF ALL THE SYSTEMS STATUS MANAGEMENT AND WHAT PUBLIC UTILITY MODELS LOOK LIKE AND HIGH EFFICIENCY EMS, AS WELL AS FIRE BASED MODELS.
SO WE KIND OF BRING A VERY BALANCED APPROACH.
AND FROM OUR FIRM, WE'VE RECOMMENDED JUST ABOUT EVERY SCENARIO THAT YOU COULD PUT ON THE TABLE BASED ON THE CONDITIONS IN THE LOCAL ENVIRONMENT.
WHAT WAS THE POLITICAL WILL AND DESIRE? WHAT WAS THE ECONOMIC AND FISCAL RESTRICTIONS? YOU KNOW, WHAT WAS THE BEST PRACTICE FOR THE QUALITY OF CARE AND THE CONDITIONS THAT EXISTED? SO WE TRY TO TAILOR OUR RECOMMENDATIONS TO WHAT MAKES SENSE.
AND A LOT OF THE DIALOG THAT WE HEARD TODAY, TO BE FAIR, MANY OF THE COMPARISONS WERE ALMOST DISTRACTORS, RIGHT? BECAUSE THEY AREN'T NECESSARILY APPLES TO APPLES COMPARISONS TO TRY TO PROMPT THE CONVERSATION.
AND I UNDERSTAND THE SENSITIVITIES ON BOTH SIDES ON THAT.
BUT ONE EXAMPLE IS LIKE WHEN YOU TRY TO PUT A LENS ON THE SYSTEM DESIGN AND POTENTIAL COSTS, YOU KNOW, FIRE DEPARTMENTS ARE WHAT WE DESCRIBE AS READINESS MODELS.
YOU KNOW, YOU HAVE RESOURCES IN PLACE, YOU HAVE HIGHER READINESS COSTS AND SUNK COSTS TO MAKE SURE THAT THEY'RE AVAILABLE.
BUT IT'S NOT A BUSINESS ENDEAVOR WHERE THEY'RE TRYING TO CREATE CALLS, RIGHT? THEY ONLY RESPOND TO THE COMMUNITY WHEN THE COMMUNITY REQUESTS THOSE INCIDENTS.
SO THINGS LIKE A PER CALL COST, WHILE YOU CAN CALCULATE THAT DOESN'T NECESSARILY HAVE GREAT MANAGEMENT APPEAL TO MAKE A DECISION ONE WAY OR THE OTHER, WHAT YOU WANT TO DO BECAUSE THAT READINESS PRESERVES YOUR ABILITY TO RESPOND WITH THE RIGHT
[05:25:01]
RESOURCES AND THE RIGHT AMOUNT OF TIME THAT MEET YOUR LOCAL POLICY CHOICE, RIGHT? SO THAT'S THAT.MEDSTAR OR A PUBLIC UTILITY MODEL, WHATEVER THEY ARE HIGH EFFICIENCY CONTRACT AMBULANCE PROVIDER BENEFITS FROM THOSE LOCAL SUNK COSTS AND INVESTMENTS BECAUSE THEY CAN OPERATE ON WHAT WE CALL A DEMAND MODEL SO THEY CAN RESTRICT AND FINE TUNE THEIR HOURLY DEPLOYMENT.
THE NUMBER OF RESOURCES THEY HAVE IN ALL THOSE ELEMENTS TO GET DOWN TO A PRICE POINT WHERE THEY CAN ATTEMPT TO NOT HAVE A TAX SUBSIDY, RIGHT? SO THEY HAVE THEIR BILLABLES AND THEY HAVE THEIR ACTUAL COSTS AND THEY'RE TRYING TO LIVE MUCH LIKE MATT SUGGESTED EARLIER, LIKE AN ENTERPRISE FUND WHERE EVERYTHING'S ENCAPSULATED IN THAT ONE VALUE.
SO SOME OF THOSE COMPARATORS DON'T REALLY RESONATE ACROSS THE TWO LINES WHEN YOU TRY TO BALANCE THOSE.
SO REALLY, WHAT DOES IT COME DOWN TO FOR YOU AS A BOARD? FROM OUR PERSPECTIVE, LISTENING TO ALL THE DIALOG, IT'S BEEN VERY GOOD.
IS REALLY A LOCAL POLICY CHOICE.
WHAT WE SEE BEFORE YOU IS AN OPPORTUNITY BECAUSE YOU ALREADY HAVE THOSE COSTS.
AND WHEN YOU THINK ABOUT THINGS LIKE FUTURE GROWTH WITH THE CHISHOLM DEVELOPMENT AND WHATEVER ELSE IS ON THE HORIZON THAT YOU'RE GOING TO EXPERIENCE, AS BURLESON.
PUBLIC SAFETY IS GOING TO HAVE TO GROW TO MEET THAT, WHETHER IT'S EMS OR NOT.
SO ADOPTING A MODEL SIMILAR TO YOUR EXPLORING TODAY, WHILE THERE WILL BE SOME UPFRONT COSTS, YOU ALSO HAVE A COST RECOVERY ASPECT.
BUT AS YOU MOVE FORWARD, HOW DO I BEST SAY THIS, IF YOU'RE SEPARATING OUT TO SOME DEGREE, WHICH YOU ARE YOUR EMS RESPONSIBILITIES, WHICH ARE AROUND SEVENTY FIVE TO 80 PERCENT OF YOUR CALL VOLUME AS YOU GROW, THE EMS CONTINGENCY IS GOING TO GROW.
SO WHAT YOU'RE CONTEMPLATING AS A BOARD IS REALLY ESTABLISHING A COST AVOIDANCE MODEL BECAUSE YOU'RE NOT INVESTING IN ANOTHER LARGE FIRE APPARATUS LIKE AN ENGINE COMPANY OR A TRUCK COMPANY TO RESPOND TO A GROWING EMS NEED.
SO FROM THAT PERSPECTIVE, YOU'RE REALLY STRUCTURING YOURSELF IN A SOUND MANNER.
SO AS YOU EXPAND, YOU'RE REALLY COST AVOIDING, YOU KNOW WHAT MODEL THEY PROBABLY HAD IN TWENTY FOURTEEN OR WHATEVER I HEARD WHERE IT WAS MORE ENGINE BASED.
SO BECAUSE YOU HAVE THOSE SUNK COSTS IN YOUR DEPLOYMENT DESIRES FROM A LOCAL POLICY DECISION, TRANSFERRING OVER TO A TRANSPORT MODEL ACTUALLY MAKES A FISCAL BENEFIT CASE FOR YOU WHILE YOU IMPROVE THE LEVEL OF SERVICE.
SO AGAIN, AT THE THIRTY THOUSAND FOOT LEVEL, WHAT I WOULD SUGGEST IS A LOCAL POLICY OPTIONS ARE HOW MUCH RISK DO YOU WANT TO COVER? AND I KNOW THERE'S BEEN DIALOG BETWEEN TWO UNITS, THREE UNITS, FOUR UNITS, AND IT REALLY COMES DOWN TO WHAT YOUR EXPECTATIONS ARE.
A TWO UNIT MODEL WOULD WORK WITH A REALLY ROBUST AUTOMATIC AID AGREEMENT WITH MEDSTAR STILL, RIGHT? NOBODY'S SAYING THAT THE MEDSTAR PERFORMANCE IS THE ROOT CAUSE.
YOU HAVE AN OPPORTUNITY TO IMPROVE YOUR LEVEL OF SERVICE AS A COMMUNITY FOR YOUR CITIZENS.
SO THE CONVERSATION KIND OF ANCHORS AROUND THE CITIZENS LENS, IF YOU WILL, BUT THREE UNITS WILL ABSOLUTELY DO IT TO NINETY SIX PERCENT OF THE TIME AND THEN THE LEVEL OF INVESTMENT FOR A FOURTH UNIT, YOU JUST GET A LITTLE LESS RETURN ON INVESTMENT.
SO REALLY, THE BIG PICTURE IS CAN THE FIRE DEPARTMENT PROVIDE HIGH QUALITY SERVICES AND LISTENING TO THE MEDICAL DIRECTOR AND ALL THE DATA, YOU CURRENTLY PARTICIPATE IN ALL THAT TODAY, THERE'S NOTHING-- THERE'S NO EVIDENCE TO PROVE WHAT YOU'LL LOOK LIKE TOMORROW, BUT THERE'S CERTAINLY NO EVIDENCE TO SUGGEST THAT YOU WOULDN'T BE ABLE TO CONTINUE THE HIGH QUALITY SERVICES THAT YOU HAVE TODAY.
SO FROM THAT PERSPECTIVE, THE QUALITY OF CARE WILL ONLY IMPROVE FOR THE RELATIONSHIP THAT YOU HAVE WITH CONTINUITY OF CARE OF YOUR PATIENTS.
AND FOR THAT SMALLER PERCENTAGE OF CALLS WHERE TIMELINESS IS IMPORTANT AND YOU'RE GOING TO BE ABLE TO DELIVER, YOU KNOW, A BETTER LEVEL OF SERVICE ON THAT ASPECT.
THE COST RECOVERY PIECE IS I AGREE WITH MUCH OF WHAT I'VE HEARD FROM THE COUNCIL TODAY IS A NICE BENEFIT FOR YOU, BUT IT IS COST RECOVERY.
YOU'RE NOT TRYING TO MAKE MONEY.
AND IN THE BILLING WORLD, EXPONENTIALLY RAISING YOUR BILLING RATE STRUCTURE STILL DOESN'T GET PAST THE ALLOWABLE COSTS, SO YOU COULD BILL FIFTY THOUSAND.
YOU'RE STILL GOING TO GET THE MEDICARE ALLOWABLE RATE FOR THAT CALL SO.
IT NORMALIZES THAT EXPERIENCE SO THAT, YOU KNOW, TO YOUR EXAMPLE, YOU WON'T HAVE A THREE THOUSAND DOLLAR BILL FROM ONE FIRE DEPARTMENT AND 16-- EVERYBODY LIKE MR. LANGLEY SAID.
EVERYBODY'S GOING TO LAND AROUND THAT RANGE THAT GETS THE RIGHT MIX OF RECOVERY DOLLARS WITH ALL THE LIMITATIONS THAT EXIST IN THE ENVIRONMENT FOR HEALTH CARE.
SO, ONE OF THE THINGS I WANT TO ASK YOU.
ANY KIND OF STARTUP YOU'VE GOT GRAY AREAS IN YOUR PROGRAM THAT YOU WATCH.
[05:30:02]
WE CALL THEM RED FLAGS.WHAT RED FLAGS? IF WE GO TO THIS, WHAT RED FLAG SHOULD WE WATCH FOR? I MEAN, NOT BEING ABLE TO GET PAID BY BEING ONE OF THEM.
BUT YOU KNOW WHAT RED FLAGS DO WE WATCH FOR IN THIS SCENARIO? SURE.
SO IF I PUT IT IN CONTEXT OF IMPLEMENTING THE PROGRAM, I WOULD PUT IT FROM THIS PERSPECTIVE, YOU--, THE DATA ANALYZES AND ACTUALLY SOME OF WHAT YOU KNOW, MEDSTAR PUT UP ARE REALLY ALIGNED.
WE HAVE A DIFFERENT METHODOLOGY, BUT THEY ALIGN WELL ABOUT HOW MUCH EXPOSURE, YOU KNOW, DO YOU WANT TO COVER 90 PERCENT OF YOUR CALLS? NINETY SIX PERCENT OF YOUR CALLS OR PUSH TOWARDS ONE HUNDRED PERCENT OF YOUR CALLS? BUT HAVING THE RIGHT EXPECTATIONS FOR SERVICE AND UNDERSTANDING WHAT ALL OF THE HISTORICAL DATA HAS TOLD US ABOUT YOUR ABILITY TO RESPOND, IT WILL BE IMPORTANT FOR A BOARD AND AN ORGANIZATION TO HOLD THE LINE ON THAT RIGHT, BECAUSE THERE'S ALWAYS GOING TO BE THOSE TIMES WHERE YOU HAVE THE SIXTH, SEVENTH AND EIGHTH CALL.
IT JUST HAPPENS ZERO POINT ZERO FIVE PERCENT OF THE TIME.
BUT MURPHY'S LAW, THAT MAY HAPPEN YOUR FIRST WEEK, RIGHT? SO YOU JUST, YOU WANT TO TAMPER DOWN THE PUSHBACK ONE WAY OR THE OTHER FOR THE DEPLOYMENT AND JUST DESIGN IT WELL AND ADJUST IT JUST LIKE YOU DO IN ALL YOUR MYRIAD OF GOVERNMENT SERVICES THAT YOU PROVIDE.
YOU HAVE HIGH QUALITY PEOPLE, YOU HAVE HIGH QUALITY CHIEFS AND THEY'LL MAKE ADJUSTMENTS AS THEY GO.
WHEN IT COMES TO THE COST RECOVERY.
AND I THINK, YOU KNOW, COUNCILPERSON JOHNSON MENTIONED THAT WHEN YOU STARTED UP, YOU'RE LIKELY GOING TO HAVE AN AR LAG IN ACCOUNTS RECEIVABLE LAG.
IT MAY BE A SIX MONTH LAG BEFORE THOSE CALLS OR BEFORE THE BILLABLES START COMING IN AND THINGS LIKE THAT.
SO YOU MIGHT HAVE TO BUILD IN A FEW CONTINGENCIES AND WORK OUT ON THE IMPLEMENTATION, HOW AND WHEN YOU START THAT AND ROLL THE BUDGET DOLLARS BACK AND FORTH.
BUT IT'S NOTHING THAT YOU PROBABLY HAVEN'T EXPERIENCED IN OTHER AREAS OF INVOICING AND BILLING THAT YOU THAT YOU HAVE IN THE CITY UMBRELLA.
MARTIN, YOU SAID THAT YOU PLANNED ALL THIS OUT.
YOU SHAKE YOUR HEAD, YES OR NO? VERY CONSERVATIVELY, RIGHT? MAYOR, THAT IS CORRECT.
KNIGHT IS SAYING IS A STARTUP AND LAG IN REVENUE WHEN WE RECEIVE REVENUE.
THAT'S NOT A PROBLEM FOR US, IS IT? WELL, I THINK THE IDEA TOO, IS WHEN YOU'RE PLANNING, YOU START LIKE ANY IMPLEMENTATION, YOU PLAN OUT THE TIMELINE.
SO YOU KNOW THAT AT A CERTAIN POINT YOU'RE GOING TO GO OUT.
WE'RE GOING TO START PROVIDING THAT SERVICE.
WELL, THERE ARE THIRD PARTY SERVICES THAT ALSO DO MEDICAL BILLING.
MEDSTAR MENTIONED THEY OUTSOURCE THEIR MEDICAL BILLING.
WELL, THAT IS THE TIMELINE AS WELL.
WE START LOOKING FOR A CONTRACTOR OR A BILLING COMPANY TO START, SO IT'S ALL ABOUT THE PLANNING PART AND THEN COORDINATING WHEN THAT INFORMATION IS BILLED, MAYBE 30 DAYS.
IT ALL DEPENDS ON HOW YOU SET UP THE TIME.
TO GO LIVE, THAT IS MY-- THAT WOULD BE MY THOUGHT IN PREPARATION FOR THAT.
SO I'M GOING TO ASK YOU THE SAME QUESTION.
I ASKED DR. KNIGHT, WHAT IS YOUR FLAGS TO WATCH FOR ON THIS? SAY THAT AGAIN MAYOR? I'M SORRY.
WHAT'S YOUR RED FLAGS TO WATCH FOR ON THIS? I MEAN, WHAT-- TO GO DOWN THE ROAD IF WE GO, I GUESS WE'RE GOING OVER BUDGET OR THIS I THINK THE IDEA FOR ME IS IT'S THE RED FLAG IS ENSURING THAT WE'RE ALWAYS PLANNING AHEAD.
WE FEEL THAT THE PROJECTIONS ARE THERE FOR THE PLANNING AND FOR THE DOLLARS FOR THE IMPLEMENTATION.
IT'S JUST SETTING THE DATES ON WHEN WE'RE GOING TO GO LIVE AND THAT EVERYTHING IS SET ACCORDINGLY AS WELL.
THE SAME THING FROM THE FINANCE SIDE TO MAKE SURE THAT WE HAVE THE ABILITY TO GET TO THE DOLLARS AND THE RECONCILIATIONS AND ENSURING THAT WE'RE GETTING THAT DATA FORWARD.
BUT FROM THE STANDPOINT OF A FINANCIAL PERSPECTIVE, LOOKING AT THE INFORMATION, I AM NOT SEEING ANY RED FLAGS AS OF TODAY.
NOW SOMETHING ELSE CAN HAPPEN LATER.
BUT RIGHT NOW I'M NOT SEEING ANY OF THE RED FLAGS.
I UNDERSTANDING THAT, AND I FEEL LIKE I CAN'T TAKE EVERYTHING AWAY FROM VICTORIA.
VICTORIA, YOU GOT ANYTHING? YOU SURE? I'M SORRY IF I DID THAT.
RICK? ANYBODY ELSE GOT ANY QUESTIONS? I GOT SOME COMMENTS BECAUSE I HAVEN'T SAID A WHOLE LOT TODAY, BUT YOU KNOW, I THINK THIS WOULD BE A GOOD ISSUE FOR A LAW SCHOOL TO USE FOR DEBATE CLASS BECAUSE I THINK I COULD TAKE EITHER SIDE OF THIS ARGUMENT, ARGUE IT VERY PERSUASIVELY THAN SIT DOWN, TAKE A SIP OF WATER, JUMP BACK UP AND ARGUE THE OTHER SIDE EQUALLY WELL.
BUT WITH THAT SAID, THERE ARE SOME FACTORS TO THIS THAT TEND TO MAKE ME TAKE A SIDE AND I'M GOING TO GO OVER THESE.
[05:35:01]
I DON'T EXPECT TO EXPLAIN THESE IN DETAIL, AND I'M GONNA TRY TO BE BRIEF BECAUSE I THINK IT'S TIME WE PASSED THE PLATE, SAID THE [INAUDIBLE] AND GOT OUT OF HERE.BUT THE ONE THING I THINK IF WE GO WITH THIS MODEL, I THINK WE WILL ACHIEVE A BETTER QUALITY OF RESPONSE.
AND I THINK THAT'S BASED ON THE ABILITY TO RESPOND QUICKER WITH BETTER EQUIPMENT.
AND I'M GOING TO GO AHEAD AND STEP OUT A LITTLE BIT AND SAY WITH PEOPLE WHO ARE MORE CAPABLE.
AND NOT ONLY THAT, WE HAVE THE ABILITY TO CHANGE THE CAPABILITY OF THOSE PEOPLE IF WE WANT TO.
IF WE HAVE LOCAL CONTROL OF THE AMBULANCE SERVICE, WE CAN FINE TUNE THAT WE CAN TRAIN OUR PEOPLE BETTER.
WE CAN UP THE GAME IF THAT'S WHAT WE CHOOSE TO DO.
I THINK IT'S INARGUABLE THAT THE 9-1-1 DISPATCH SYSTEM THAT WE'RE CURRENTLY USING WITH THIS DOUBLE CALL HANDOFF IS NOT ONLY MUCH LESS EFFICIENT AS FAR AS RESPONSE TIME, BUT ALSO AMONG THOSE THINGS THAT MUST BE EXTREMELY ANNOYING TO THE PEOPLE THAT WE'RE TRYING TO SERVE WHEN THEY'RE ON THE PHONE WITH ONE 9-1-1 OPERATOR GIVING A BUNCH OF INFORMATION, THEIR HUSBAND IS SITTING OVER THERE ON THE FLOOR, PASSED OUT WITH CHEST PAINS.
[EXPLETIVE], THEY DON'T WANT TO SAY IT AGAIN.
THEY WANT TO GET IT OUT, GET THE THING GOING.
SO I THINK IT'S PRETTY MUCH GOT TO BE A GIVEN THAT GOING INTO THIS STREAMLINED SYSTEM OF ONLY ONE 9-1-1 CALL RESPONSE HAS GOT TO BE A BETTER THING FOR THE CITIZENS THAT ARE AFFECTED BY THIS.
I THINK FOLLOWING ON IN THE VEIN OF LOCAL CONTROL, WE ACTUALLY HAVE NO LOCAL CONTROL WHEN WE DEAL WITH MEDSTAR.
THEY'VE DONE US A WONDERFUL JOB, BUT THEY HAVE TO DO THE SAME JOB HERE THAT THEY DO ANYWHERE ELSE.
SO OUR QUALITY OF RESPONSE AND SPEED OF RESPONSE IS GOING TO BE PREDICATED ON THE QUALITY AND SPEED OF RESPONSE OF THE ENTIRE SYSTEM, NOT ANYTHING THAT WE CAN STEP IN AND DECIDE WE WANT TO EITHER IMPROVE OR LET OFF ON.
SO ONCE AGAIN, CONTROL BECOMES THE DECIDING FACTOR.
NEXT THING I GUESS IN ORDER OF PRIORITY NECESSARILY IS THERE'S BEEN A LOT SAID ABOUT THE NOT ECONOMIC THING, AND VARIOUS PEOPLE UP HERE HAVE MADE THE COMMENT THAT WE'RE GOING TO SPEND A LOT OF MONEY OR WE'RE GOING TO HAVE TO COME UP.
EVERYTHING THAT I'VE READ IN THE PRO FORMA INDICATES THAT IF WE GO FORWARD WITH THIS, THAT OUR EXPENSES WILL BE REDUCED OVER TIME.
NOW YOU CAN TAKE ISSUE WITH THOSE PREDICTIONS GO RIGHT AHEAD.
WE PAID SOME PRETTY DARN TALENTED PEOPLE, SOME PRETTY GOOD SALARIES TO COME UP WITH THOSE NUMBERS, AND MY PREDILECTION IS THAT I'M GOING TO LISTEN TO THEM AND BE SATISFIED BY THAT.
BUT I BELIEVE THAT THE OVERALL RESULT OF THIS CHANGE IF WE CHOOSE TO MAKE IT, IS GOING TO BE A LESSENING OF OUR OVERALL EXPENDITURES ON MEDICAL RESPONSE AND NOT AN INCREASE.
BUT THEN LASTLY, AND PERHAPS MOST IMPORTANTLY, THE MAYOR MADE SOME COMMENTS ABOUT START UP BUSINESSES.
I'VE PERSONALLY BEEN INVOLVED WITH ABOUT AN EVEN DOZEN OF THOSE, INCLUDING MY OWN COMPANY, INCLUDING COMPANIES I OWN PART OF, INCLUDING COMPANIES I ONLY ASSISTED IN GETTING OFF THE GROUND.
SOME OF THEM MADE IT, SOME OF THEM DIDN'T.
BUT THE ONE THING THAT MOST DETERMINED THE OUTCOME OF THE STARTUP WAS THE ABSOLUTE DEDICATION OF THE PEOPLE THAT WERE GOING TO BE ACTUALLY PUTTING IT TOGETHER AND DOING THE WORK.
NOW I'VE WATCHED THIS CITY TRANSITION SOME MAJOR SERVICES IN THE PAST.
THE LAST TIME WE DID SOMETHING LIKE THIS THAT I RECALL THAT WAS THIS WAS THIS BIG A CHANGE IN OUR OPERATING FUNCTION WAS WHEN WE OUTSOURCED OUR GARBAGE.
AND I KNOW GARBAGE AND AMBULANCES AREN'T THE SAME DAMN THING, BUT BEAR WITH ME.
WHAT I'M TRYING TO SAY IS WE HAD DIFFICULTY WITH TRASH PICKUP.
IT WAS A DIFFICULT THING TO MANAGE TO ADMINISTER.
THE MAIN PROBLEM WAS NOBODY IN THE PUBLIC WORKS DEPARTMENT WANTED TO PICK UP THE [EXPLETIVE] GARBAGE.
AND AS LONG AS THEY REALLY DIDN'T WANT TO DO IT, IT WAS NOT GOING TO BE SUCCESSFUL.
I DON'T KNOW HOW HARD, YOU KNOW, CARE HOW HARD YOU TRY.
SO JUST IN KEEPING WITH THE PRIVATE ENTERPRISES THAT I'VE DONE AND NOW WE'RE TALKING ABOUT A PUBLIC ENTERPRISE, THE ENTHUSIASM OF THE PEOPLE THAT ARE GOING TO BE DOING THE FUNCTION IS WHAT DETERMINES THE OUTCOME.
AND I KNOW THAT'S VERY HIGH LEVEL THINKING, BUT THAT'S HOW I THINK.
I BELIEVE THAT STAFF FROM THE CITY MANAGER THROUGH THE FIRE CHIEF DOWN TO THE FIREFIGHTERS THEMSELVES WANT THIS TO WORK.
AND MY EXPERIENCE WITH BUSINESS STARTUPS IS AND THAT'S WHAT I'M GOING TO CALL THIS.
I DON'T CARE WHAT PROFIT MAKING ENTERPRISE OR NOT.
[05:40:02]
THAT'S MY FIRM BELIEF, AND I CAN'T WORK OUT AT THIS STAGE OF THE GAME, FAR AHEAD OF WHEN WE EVER SEND OUR FIRST AMBULANCE OUT ON A RESPONSE JUST EXACTLY WHAT ALL THOSE PROBLEMS ARE GOING TO BE.I CAN'T ANSWER ALL OF THAT RIGHT NOW.
IF WE COULD DO THAT, IF I COULD DO IT, YOU ALL COULD DO IT.
THEN YOU HAVE YOUR MINDS MADE UP.
WE'RE JUST GOING TO HAVE TO TAKE IT ON FAITH THAT THIS GROUP OF MEN AND WOMEN THAT ARE MAKING THIS FIRE DEPARTMENT FUNCTION NOW CAN MAKE THIS FUNCTION TOO.
AND I THINK THEY WANT TO DO IT BADLY.
AND MY PREDISPOSITION IS TO LET THEM HAVE A SHOT AT IT.
ANYBODY HAVE ANY OTHER COMMENTS OR QUESTIONS OR ANYTHING [INAUDIBLE].
FIRST OF ALL, I JUST WANT TO THANK EVERYONE FOR THEIR TIME TODAY.
I KNOW THIS HAS BEEN A VERY LONG DAY WITH A LOT OF INFORMATION I KNOW WE HAVE SOME SPEAKER CARDS.
BUT WHAT WE'RE PLANNING TO DO IS TO COME BACK TO YOU IN JANUARY WITH ANOTHER WORK SESSION, WITH SOME MORE INFORMATION.
I THINK THAT'LL PROBABLY BE JANUARY 10TH OR THE 18TH.
WE'VE GOT TO GET THIS DATA TOGETHER FOR YOU SO WE CAN COME BACK WITH A SECONDARY CONVERSATION.
IF THERE'S ANY ADDITIONAL INFORMATION ANY OF YOU WOULD LIKE TO SEE, PLEASE LET US KNOW.
WE'LL BE GLAD TO PULL THAT BACK TOGETHER AND WE'LL HAVE ANOTHER CONVERSATION WITH YOU.
SO AGAIN, APPRECIATE YOUR TIME.
AT THIS TIME, WE DO HAVE TWO SPEAKER CARDS.
THE FIRST SPEAKER IS TIM [INAUDIBLE].
THE NEXT SPEAKER CARD IS MIKE JONES.
MAYOR AND COUNCIL I'M MIKE JONES, PRESIDENT OF LOCAL 4025 OF THE BURLESON PROFESSIONAL FIREFIGHTERS ASSOCIATION.
WE KNOW EVERYBODY'S BEEN HERE LONG, BUT WE STAND TODAY ON BEHALF OF THE MEN AND WOMEN OF THE BURLESON PROFESSIONAL FIREFIGHTERS ASSOCIATION IN STRONG SUPPORT OF FIRE CHIEF FREEMAN SENIOR MANAGER, LANGLEY FIRE ADMINISTRATION, CITY ADMINISTRATION IN THEIR EFFORT TO MOVE TO FIRE BASED EMS. WE DO BELIEVE THAT THIS WILL PROVIDE THE BEST AND SAFEST CARE FOR OUR CITIZENS, FIREFIGHTERS AND POLICE OFFICERS IN MY ALMOST TWENTY THREE YEARS WITH THE CITY OF BURLESON.
IT'S ALWAYS BEEN THAT WE CAN DO IT AND WE CAN DO IT BETTER ATTITUDE.
AND IF 84 OTHER, WE FEEL THAT IF 84 OTHER CITIES CAN MAKE IT WORK, THEN WE CAN TOO.
AND MAYOR PRO TEM, WE APPRECIATE WHAT YOU SAY.
THAT'S THE WAY WE FEEL THAT WE CAN DO IT BETTER.
NOTHING TO [INAUDIBLE] MEDSTAR, BUT I THINK IF YOU SEEN IN THE CROWD TODAY, WE'VE HAD MEMBERS OF OUR ASSOCIATION IN THIS FIRE DEPARTMENT HERE BECAUSE THEY CARE, BECAUSE THEY WANT TO DO THIS BECAUSE WE KNOW WE CAN DO IT BETTER BECAUSE WE'LL GET THE RESPONSE TIMES.
SO LIKE I SAID, I WANT TO KEEP IT BRIEF, BUT YOU KNOW, THIS COUNCIL HAS ALWAYS STRIVED TO MAKE SURE THAT YOU GUYS PROVIDE THE BEST 9-1-1 COMMUNICATION.
TOP NOTCH POLICE DEPARTMENT AND EVEN HELP THE FIRE DEPARTMENT AND MADE VOTES TO MAKE THE FIRE DEPARTMENT THE TOP ONE PERCENT IN THE NATION.
WHY WOULD WE NOT STRIVE TO DO THE SAME FOR EMERGENCY MEDICAL CARE FOR OUR CITIZENS? BECAUSE WHEN SECONDS COUNT, THAT'S WHAT THEY NEED IS THEY TRUST US TO COME THERE, TAKE CARE OF THEM.
SO WHY WOULD WE NOT ALLOW OUR CITY OF BURLESON CAREER EMPLOYEES TO TAKE CARE OF THEM FROM 9-1-1 ON THEIR POTENTIALLY WORST DAY OF THEIR LIFE TO THE TIME THEY'RE DELIVERED TO EMERGENCY CARE FACILITY? WE APPRECIATE YOU GUYS TIME.
WE APPRECIATE ALL THE SPORTS YOU'VE ALWAYS GIVEN US, BUT WE ARE ASKING YOU GIVE US THE CHANCE.
LET US SHOW YOU WHAT WE CAN DO.
TRUST OUR CITY MANAGER THAT WE CAN DO IT BETTER.
MAYOR, AT THIS TIME, I HAVE NO OTHER SPEAKER CARDS, HOWEVER, WE DO HAVE ONE OTHER SECTION OF THE AGENDA, WHICH IS THE CITIZENS APPEARANCE.
AT THIS TIME, IF THERE'S ANYBODY IN THE AUDIENCE THAT WOULD LIKE TO SPEAK ON ANY ITEM THAT WAS NOT LISTED ON TODAY'S AGENDA.
SEEING NO SPEAKERS, WE DO NOT HAVE A NEED FOR EXECUTIVE SESSION, SO MAYOR, IF YOU COULD ADJOURN THE MEETING BY CALLING FOR A MOTION, A SECOND AND NO VOTE ON ADJOURNING THE MEETING.
WE USING THE SCREEN? IS THERE A MOTION ON THIS? THERE'S NO SCREEN.
I GOT A MOTION BY JIMMY IN A SECOND BY DAN.
WE'RE OUT HERE AT 3:11.
* This transcript was compiled from uncorrected Closed Captioning.