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

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

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

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

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

Financial Facts Rural/Metro’s publicly audited financials show that ACTUAL cash collections are far below projected collections in the TriData “pro-forma” Expense data cited in the TriData “pro-forma” are far below RMA’s ACTUAL per transport costs. RMATriData Eg. Supplies per transport $15$5 Fuel per transport$3.60$0.60 Unit Hours (payroll)55,00020,616

Patients First In 2007 RMA waited “On Scene”: 1.More than 10 minutes about 60% of the time. 2.Less than 4 minutes about 10% of the time. 3.On average, for all calls, about 12 minutes, 42 seconds. Medical Director protocols currently allow first-responders to transport if the acuity of the patient warrants. In 2006, OCFR exercised that protocol roughly 200 times.

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

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

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