` June 27, 2016 EMERGENCY MEDICAL SERVICES STUDY Madison County Wampsville, NY Prepared by: FITCH & ASSOCIATES, LLC 2901 Williamsburg Terrace #G . Platte City . Missouri . 64079 816.431.2600 . www.fitchassoc.com Madison County, NY © Fitch & Associates, LLC Emergency Medical Services Study i June 2016 Madison County, NY Emergency Medical Services Study Table of Contents EXECUTIVE SUMMARY_________________________________________________________________________________ 1 KEY RECOMMENDATIONS INCLUDE: ________________________________________________________________________ 1 METHODOLOGY ____________________________________________________________________________________ 2 INTRODUCTION _______________________________________________________________________________________ 4 Figure 1: Madison County _______________________________________________________________________ 4 THE REGION ________________________________________________________________________________________ 4 NEW YORK PREHOSPITAL CARE _____________________________________________________________________ 5 PRE-HOSPITAL CARE IN MADISON COUNTY _____________________________________________________________ 7 Figure 2: Ambulance Districts ____________________________________________________________________ 7 County Office of Emergency Management (MCOEM) __________________________________________________ 7 KEY CONTEXT AND CURRENT NATIONAL TRENDS _________________________________________________________ 8 THE OPTIMAL EMS SYSTEM ___________________________________________________________________________ 8 EMS DESIGNS, BEST PRACTICES AND BEST PRACTICE SYSTEMS ____________________________________________ 9 PROCESS AREA SUMMARIES___________________________________________________________________________ 11 9-1-1 AND COMMUNICATIONS _______________________________________________________________________ 11 Description of Best Practices ______________________________________________________________________ 11 Figure 3: Typical EMS Call Processing Flow-Chart____________________________________________________ 12 OBSERVATIONS AND FINDINGS ___________________________________________________________________________ 13 Public Access to EMS _____________________________________________________________________________ 13 Radio Communications ___________________________________________________________________________ 14 Digital Data _____________________________________________________________________________________ 14 EMS workload - countywide _______________________________________________________________________ 15 Figure 4: EMS responses per month ______________________________________________________________ 15 Figure 5: Responses by Day of Week _____________________________________________________________ 15 Figure 6: EMS Response by hour of day - combined__________________________________________________ 16 RECOMMENDATIONS __________________________________________________________________________________ 16 MEDICAL FIRST RESPONSE___________________________________________________________________________ 17 Description of Best Practices ______________________________________________________________________ 17 OBSERVATIONS AND FINDINGS ___________________________________________________________________________ 17 Medical First Responders _________________________________________________________________________ 17 Figure 7: First responder response times __________________________________________________________ 19 City of Oneida – Paramedic 1st responder___________________________________________________________ 20 Figure 8: City of Oneida Rescue 295 ______________________________________________________________ 20 Community Volunteer Fire departments: Training, Staffing and Distance _______________________________ 20 Madison County, NY © Fitch & Associates, LLC Emergency Medical Services Study i June 2016 Figure 9: AHA System of Care ___________________________________________________________________ 21 RECOMMENDATIONS __________________________________________________________________________________ 21 MEDICAL TRANSPORTATION_________________________________________________________________________ 22 Description of Best Practices ______________________________________________________________________ 22 OBSERVATIONS AND FINDINGS ___________________________________________________________________________ 22 Certification Training Access and Success ___________________________________________________________ 23 Density and Response Times ______________________________________________________________________ 25 Figure 10: Urban areas ________________________________________________________________________ 25 Figure 11: 2015 EMS Incident Heat Map___________________________________________________________ 26 Figure 12: NFPA 1720 Response Times ____________________________________________________________ 27 Figure 13: Urban and Suburban communities ______________________________________________________ 27 Response to second EMS call in Town of Sullivan _____________________________________________________ 28 DESCRIPTION OF EACH AMBULANCE SERVICE PROVIDERS________________________________________________________ 29 Figure 14: 2015 Responses per EMS Service________________________________________________________ 29 Figure 15: Time-on-Task by EMS service___________________________________________________________ 30 Commercial Ambulances: Vineall, Rural/Metro and Smith ____________________________________________ 31 Figure 15: Type II Ambulance - Vineall ____________________________________________________________ 31 Figure 17: Vineall 14:59 minute travel time map ____________________________________________________ 31 Figure 18: Rural Metro 14:59 minute travel time map ________________________________________________ 32 Figure 19: Smith Ambulance 14:59 minute travel time map ___________________________________________ 33 Not-For-Profit Ambulance Services: SOMAC, SEVAC, WAVAC, CAVAC and GLAS __________________________ 34 Figure 20: SOMAC 14:59 minute travel time map ___________________________________________________ 34 Figure 21: SEVAC 14:59 minute travel time map ____________________________________________________ 35 Figure 21: Type I Ambulance - CAVAC_____________________________________________________________ 36 Figure 23: CAVAC 14:49 minute travel time map ____________________________________________________ 36 Figure 23: Type III Ambulance - GLAS _____________________________________________________________ 37 Figure 25: GLAS 14:59 minute travel time map _____________________________________________________ 37 Figure 26: WAVAC 14:59 minute travel time map ___________________________________________________ 38 Volunteer Fire Department Affiliated Ambulances: Georgetown, Eaton, Madison, Bridgewater, Sherburne and West Winfield ___________________________________________________________________________________ 39 Figure 27: Georgetown EMS 14:59 minute travel time map ___________________________________________ 39 Figure 28: Eaton 14:59 minute travel time map _____________________________________________________ 40 Figure 29: Madison 14:59 minute travel time map __________________________________________________ 41 Figure 30: Bridgewater Ambulance 14:59 minute travel time map ______________________________________ 42 Figure 31: Sherburne Ambulance 14:59 minute travel time map _______________________________________ 43 Figure 32: West Winfield 14:59 minute travel time map ______________________________________________ 44 MASS CASUALTY SURGE CAPABILITY _______________________________________________________________________ 45 College Campus EMS _____________________________________________________________________________ 46 Low airmedical utilization_________________________________________________________________________ 46 Determining Appropriate Response Times __________________________________________________________ 47 RECOMMENDATIONS – _________________________________________________________________________________ 47 MEDICAL ACCOUNTABILITY__________________________________________________________________________ 47 OBSERVATIONS AND FINDINGS ___________________________________________________________________________ 48 RECOMMENDATIONS __________________________________________________________________________________ 49 CUSTOMER AND COMMUNITY ACCOUNTABILITY_______________________________________________________ 49 OBSERVATIONS AND FINDINGS ___________________________________________________________________________ 49 RECOMMENDATIONS __________________________________________________________________________________ 49 PREVENTION AND COMMUNITY EDUCATION __________________________________________________________ 50 Madison County, NY © Fitch & Associates, LLC Emergency Medical Services Study ii June 2016 OBSERVATIONS AND FINDINGS ___________________________________________________________________________ 50 RECOMMENDATIONS __________________________________________________________________________________ 52 ORGANIZATIONAL STRUCTURE AND LEADERSHIP_______________________________________________________ 53 OBSERVATIONS AND FINDINGS ___________________________________________________________________________ 53 Human Resources________________________________________________________________________________ 53 Business Planning and Measurement_______________________________________________________________ 54 Figure 33: Proposed Retrospective QI process ______________________________________________________