1. Durham County Government Durham County Emergency Medical Services Budget Presentation and Request to Establish 10 Paramedics, 4 EMT- Intermediates and a Clerk IV Position FY 2012/2013 “ENHANCING THE HEALTH AND WELFARE OF DURHAM COUNTY CITIZENS”

2. Durham County Emergency Medical Services Overview In North Carolina, County government is responsible for EMS In Durham County, the County has ultimate responsibility for all EMS operations and provides it with its own staff or through contract Durham County has 15 ambulances that it runs itself or through contract Durham County is also responsible for Medical Control, physician oversight “ENHANCING THE HEALTH AND WELFARE OF DURHAM COUNTY CITIZENS”

3. Durham County Emergency Medical Services Overview Durham County contracts with Bahama, Bethesda, and Redwood Fire Departments for EMS services through the Durham County Franchise process – County provides a paramedic and funding to the fire department to provide an EMT-Basic driver for each 12 hour shift Durham County EMS Supervisor is responsible for the paramedic Fire Chief is responsible for the driver and the ambulance “ENHANCING THE HEALTH AND WELFARE OF DURHAM COUNTY CITIZENS”

4. Durham County Emergency Medical Services Overview Parkwood Fire Department – Franchised by County to provide, charge and collect for EMS services – Billing provided by 3 rd party vendor and the County provides money to make up difference in operating cost – Parkwood hires and provides all EMS staffing “ENHANCING THE HEALTH AND WELFARE OF DURHAM COUNTY CITIZENS”

5. Durham County Emergency Medical Services Overview Although there is a request for 15 additional positions, there is a net savings of $95,600 due to increases in EMS collections and cancelling of fire department EMS contracts. “ENHANCING THE HEALTH AND WELFARE OF DURHAM COUNTY CITIZENS”

6. Durham County Emergency Medical Services July 2011 to February 2012 Unit Hour Utilization 7a – 7p “ENHANCING THE HEALTH AND WELFARE OF DURHAM COUNTY CITIZENS”

7. Durham County Emergency Medical Services July 2011 to February 2012 Unit Hour Utilization 7p – 7a “ENHANCING THE HEALTH AND WELFARE OF DURHAM COUNTY CITIZENS”

8. Durham County Emergency Medical Services Issue # 1 – Current Staffing (Chart represents an example of how the number of authorized staff on one shift compares to the number of staff needed to fully staff one shift) This example illustrates that there are not enough authorized positions in each shift to fully staff the number of ambulances needed to adequately cover the county each shift. (EMS contains 4 shifts so the total shortage is 16 positions) Solution – To begin addressing this issue, authorize an additional 6 paramedic positions as a part of FY 2012-2013 Budget (there will still be shortages on shifts, but it will be much more manageable due to an increase in staff) “ENHANCING THE HEALTH AND WELFARE OF DURHAM COUNTY CITIZENS” UnitStaff NeededCurrent Staff Available Supervisor11 DCEMS 122 DCEMS 222 DCEMS 322 DCEMS 422 DCEMS 522 DCEMS 622 DCEMS 722 DCEMS 820 DCEMS 920 Bahama1 1 Paramedic provided by DCEMS & Driver provided by Bahama Bethesda1 1 Paramedic provided by DCEMS & Driver provided by Bethesda Redwood1 1 Paramedic provided by DCEMS & Driver provided by Redwood Total2218

9. Durham County Emergency Medical Services Issue # 1 – Current Staffing 22 employees are needed to fully staff ambulances and provide 1 supervisor for each shift Staffing shortages are caused by: – Increased call volume with no increases in staffing for over 20 years – Vacation – Sick leave/Workers Comp/FMLA “ENHANCING THE HEALTH AND WELFARE OF DURHAM COUNTY CITIZENS”

10. Durham County Emergency Medical Services Issue # 1 - Current Staffing Many times, Supervisors have to be assigned to an ambulance to make sure all ambulances have a paramedic – When supervisory staff is assigned to an ambulance, they are not able to: Assist with difficult calls Provide quality assurance and quality improvement oversight Offer real-time coaching and useful feedback to the less experienced providers No additional County funding required to add the 6 paramedics due to increased EMS collections “ENHANCING THE HEALTH AND WELFARE OF DURHAM COUNTY CITIZENS”

11. Durham County Emergency Medical Services Issue # 2 EMS Operations at Bethesda and Redwood Bethesda and Redwood Fire Departments have asked Durham County EMS to take over their EMS operations effective July 1, 2012 8 new positions are needed to cover the new staffing requirements at Bethesda and Redwood – 4 Paramedics – 4 EMT-Intermediates “ENHANCING THE HEALTH AND WELFARE OF DURHAM COUNTY CITIZENS”

12. Durham County Emergency Medical Services Advantages of Assuming Full EMS Operations at Bethesda and Redwood Better system-wide utilization/flexibility of ambulances Improved accountability of providers on ambulance Decrease unit hour utilization for other units by better spreading of the call load EMS assumes ambulances and equipment “ENHANCING THE HEALTH AND WELFARE OF DURHAM COUNTY CITIZENS”

13. Durham County Emergency Medical Services Advantages of Assuming Full EMS Operations at Bethesda and Redwood County already funds EMS operations through payments to the fire departments so it is cost neutral Addresses Strategic Plan Goal 3, Safe and Secure Community – Initiative 4 - Increase efficiencies and streamline operations within Durham County public safety functions – Initiative 5 – Standardize response capabilities to improve outcomes “ENHANCING THE HEALTH AND WELFARE OF DURHAM COUNTY CITIZENS”

14. Durham County Emergency Medical Services Issue # 3 – Customer Service and Support 1 Clerk IV position to assist with: – EMS clerical responsibilities currently not available for management team – Call volume continues to increase and as a result billing volume continues to increase (Estimate of 1,100 additional calls this year which resulted in an additional 500 transports). Additional staff will help guarantee a continued high collection rate Addresses Strategic Plan Goal 5, Accountable, Efficient, and Visionary Government – Objective 2 – Provide exceptional customer service “ENHANCING THE HEALTH AND WELFARE OF DURHAM COUNTY CITIZENS”