City of Boise,Boise, IDID Emergency Medical Services Master Plan January 2011 Presented by: Emergency Services Consulting International 25200 SW Parkway Ave. Suite 3 ● Wilsonville, Oregon 97070 www.ESCI.us ● 800-757-3724 City of Boise Fire Department – Emergency Medical Services Master Plan Table of Contents Table of Figures ................................................................................................................................iii Acknowledgements ...........................................................................................................................v Executive Summary............................................................................................................................1 Section I – Evaluation of Current Conditions .....................................................................................11 Organizational Overview ..............................................................................................................11 Boise Fire Department ........................................................................................................................12 Ada County Paramedics ......................................................................................................................14 The City of Boise EMS System.............................................................................................................16 Governance and Lines of Authority ....................................................................................................18 Planning for Emergency Medical Services......................................................................................24 Planning for System Design.................................................................................................................24 System Financing..........................................................................................................................28 System Revenue..................................................................................................................................28 Ambulance Rates ................................................................................................................................30 Capital Assets ......................................................................................................................................37 Staffing and Personnel Management ............................................................................................41 Staffing Resources...............................................................................................................................41 Qualifications and Credentialing Requirements.................................................................................42 Training Programs...............................................................................................................................43 Health, Wellness, and Safety Programs..............................................................................................44 Communications and Dispatch ...........................................................................................................45 Emergency Medical Service Delivery and Performance..................................................................48 Service Demand ..................................................................................................................................49 Resource Distribution .........................................................................................................................57 Reliability.............................................................................................................................................61 Response Performance.......................................................................................................................63 Medical Direction................................................................................................................................68 Section II – Future Service Demand Projections.................................................................................71 Population Growth Projections.....................................................................................................73 Service Demand Projections .........................................................................................................74 Community Risk Analysis and Standard of Cover...........................................................................76 i City of Boise Fire Department – Emergency Medical Services Master Plan Section III – Future Delivery System Models .....................................................................................79 Emergency Medical Service Deployment Plan Development..........................................................79 Critical Issues Affecting the Provision of EMS Services...................................................................82 Critical Issue 1 – EMS System Fragmentation.....................................................................................83 Critical Issue 2 – Lack of Clear, Coordinated, Governmental Oversight .............................................83 Critical Issue 3 – Inefficiency of Ambulance Transport System ..........................................................84 Critical Issue 4 – No coordinated measures of system performance or performance definitions.....84 Critical Issue 5 – Inequitable Financial Structure................................................................................85 Critical Issue 6 – No single medical authority for the system.............................................................85 Critical Issue 7 – Lack of integrated quality assurance methods........................................................86 Summary of System Redesign Options ..........................................................................................87 Option 1: Modified Current Model.....................................................................................................88 Option 2: Competitive Bid for Ambulance Service .............................................................................89 Option 3: Fire-Based Transport Model ..............................................................................................91 Option 4: Establish a local or regional ambulance authority.............................................................99 Long-Term Recommendations ....................................................................................................102 Method of Developing Recommendations.......................................................................................102 System Design Recommendations....................................................................................................103 How the Options Resolve the Critical Issues.....................................................................................106 Ease of implementation....................................................................................................................110 Implementation .........................................................................................................................112 Short and Mid-Term Recommendations......................................................................................113 Priority 1 – Immediate Internal Safety..............................................................................................113 Priority 2 – Legal or Financial Exposure ............................................................................................113 Priority 3 – Corrects a Service Delivery Issue....................................................................................113 Priority 4 – Enhances the Delivery of a Service.................................................................................115 Priority 5 – A Good Thing To Do........................................................................................................116 Conclusion .................................................................................................................................117 Appendix A....................................................................................................................................119 ii City of Boise Fire Department – Emergency Medical Services Master Plan Table of Figures Figure 1: BFD Organizational Structure ......................................................................................................13 Figure 2: ACP Organizational Structure ......................................................................................................15 Figure 3: Revenue by Service Level - FY 2009.............................................................................................29 Figure 4: 2009 Revenue per Call .................................................................................................................30 Figure 5: Transport Ratio ............................................................................................................................30 Figure 6: Ada County Ambulance Fees .......................................................................................................31 Figure 7: Comparison Jurisdictions .............................................................................................................31 Figure 8: ALS