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Emergency Ambulance Service

Business Plan for

The City of Germantown

February 22, 2011

Germantown Fire Department Louis Correale, Battalion Chief

Jeff Beaman, Lieutenant-Paramedic

Mark Carter, Lieutenant-Paramedic

7766 Farmington Blvd

Germantown, TN 38138-2902

(901) 757-7268

(901) 757-7290 - fax

lcorreale@germantown-tn.gov

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jbeaman@germantown-tn.govmcarter@germantown-tn.gov

I. Table of Contents

I. Table of Contents 2

II. General Company Description 5

III. Products and Services11

IV. Marketing Plan 13

The Marketing Plan: 13

Revenue Forecast 18

V. Operational Plan 19

Provision of service 19

Location 19

Legal Environment 19

Personnel 20

Credit Policies 22

VI. Management and Organization 23

Professional and Advisory Support 23

VII. Financial History and Analysis 25

VIII. Financial Plan 26

Seven-Year Revenue and Expense Projection 26

IX. Appendices 27

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Executive Summary

The Germantown Fire Department mission is to provide timely and effective

response to fire and medical emergencies for the protection of life and

property in Germantown. The Fire Department is in the business of saving

lives, protecting property, educating the public on issues of fire and home

safety, responding to a wide range of emergencies, solving problems, and

preparing the community to be able to respond to disasters. As the primary

provider of Advanced Life Support services to the community since 1979,

the Fire Department proposes to establish an emergency ambulance

transport service that will serve as the gateway for the sick and injured into

the local health care system.

The number of calls for emergency medical services, historically, has

increased each year. In 1987, the department responded to 546 EMS calls.

In 2008, the department responded to 1,632 EMS calls. The reason for this

increase is closely related to the development of the medical corridor on

Wolf River Boulevard and the increasing age of the residents. For over 50

years, the Germantown Fire Department has been an innovative leader in

the fire and emergency services. The men and women are well trained and

have demonstrated time after time their ability to plan and adapt to the

changing needs of the community. The number of calls for medical

emergencies will continue to increase and the department is continuing

meet this changing demand.

The City of Germantown currently participates with Shelby County and the

cities of Arlington, Collierville, Lakeland, and Millington in a contract with

Rural Metro Ambulance service to emergency ambulance service in these

cities and the unincorporated areas of Shelby County. Many of the past

problems with the ambulance transport service have been alleviated, but

unfortunately, some of those problems persist today. The average

ambulance response time has improved, but not to the time frame

recommended by the American Heart Association which is five minutes.

The Fire Department’s response time is five minutes. On medical

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emergency calls, fire department paramedics initiate advanced patient care,

and then turn the patient over to the third party ambulance service for

transport. The care of the patient will be interrupted during this process

and some information is lost regarding the patient or patient care during

the transfer. The knowledge, skills, abilities, and standard of care of

Germantown Fire Department personnel is a known quantity. Even though

the private ambulance personnel are licensed, their knowledge, skills, and

abilities are not known. The fire department will have full control of patient

care from the time a person calls 911 for help until they are transferred at

the emergency room for definitive treatment.

The public only has to dial 911, and not matter what the emergency is, the

fire department responds. The Fire Department is equipped and trained to

handle that emergency. Whether it is a fire, a call for a medical emergency,

a hazardous materials incident, extrication, rescue, or anything else, the

Fire Department will take care of the emergency. The Fire Department is

naturally deployed for rapid response and if the response is not fast, it isn’t

an emergency response. There are no other systems, except for the Fire

Department, that respond with a complete toolbox to handle any incident

that is out of a hospital, which requires emergency medical care.

The population of Germantown is approximately 41,000 people with a total

area of 19 square miles. The median age is 41.3 years, higher than the

national average of 35.3 years. The largest age group in Germantown is

between the ages of 45-54 and in the near future the largest group will be

55 and older. It is foreseen that Germantown will need to provide medical

and other services to seniors sooner than other communities. The most

common calls for medical services associated with an older population are

breathing problems, chest pain, cardiac arrest, stroke, diabetic

emergencies, and falls.

The socioeconomic environment in Germantown and the surrounding areas

indicate a high potential for collecting revenues for transport services.

Service fees have been established based upon transport categories

determined by Medicare. A billing vendor will be selected by competitive

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bid to handle all aspects of billing. This is more cost effective than an

internal billing clerk hired by the City. Fire Department personnel will

work closely with the billing vendor to monitor revenues and expenses.

The major capital cost is the purchase of four Type I ambulances that will

be strategically placed at two of the four fire stations. Thirteen personnel

will be hired, with at least 6 paramedic/firefighters and the rest fire

fighter/EMTs. An EMS Supervisor position will be established to manage

the day-to-day ambulance operations, supplies, in-house CEU training, and

be the point of contact between the department and the billing vendor.

Policies will be established to provide mutual aid requests for an

ambulance, transport geographic boundaries, and to request mutual aid for

an ambulance in the event there are no ambulances available.

Transporting the sick and injured is the only part of emergency services not

provided by the Germantown Fire Department. By providing ambulance

transportation, the Fire Department will have total control and involvement

from the time a person dials 911 until they enter the healthcare system.

The City is financially able to provide this service and utilizing the

S.A.F.E.R. grant, many of the initial costs can be off-set or reduced. The

department enjoys an excellent reputation in the community and scored

very well in past community surveys. This business plans meets the goals

outlined in Vision 2020. When a citizen dials 911, it may be the worst day

of the patient’s life, and it is essential that the EMS response be at its best.

The best product is a fire-based emergency ambulance service provided by

the Germantown Fire Department.

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II. General Company Description

Mission statement: The mission of the Germantown Fire Department is to

provide timely and effective response to fire and medical emergencies for

the protection of life and property in Germantown.

We carry out our mission through primary and other businesses, which are

as follows. Core businesses are designated with an asterisk.

PRIMARY BUSINESSES

Suppress Fires*

Treat Patients with Medical Emergencies*

Educate Community on Fire, Health and Safety*

Rescue People and Provide Specialized Rescue Services*

Develop and Enforce Fire-Related Laws and Codes*

Handle HAZMAT Emergencies

OTHER BUSINESSES

Serve as Lead Agency for Emergency Management

Advocate for Fire Service and Life Safety

Respond To and Solve Community Problems – “Ghostbusters”

Pursue Business Opportunities under Managed Competition

The City of Germantown is driven by its core beliefs, which were

established through a community-wide consensus process that created

Vision 2020. The philosophy of the City of Germantown is that we, the

Germantown managers and employees, strive for Service excellence,

Produce “‘A+” results, take the Initiative, are Responsible, are Innovative,

and practice Teamwork. This reflects the S.P.I.R.I.T. of Germantown.

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The Germantown Fire Department’s core beliefs were developed through a

department-wide consensus process that produced the Germantown Fire

Department's strategic plan. The Fire Department's core beliefs are

reflected in the following statement: We, the employees of the Fire

Department, demonstrate Responsibility, Effectiveness, Service,

Productivity, Effort, Caring and Teamwork. In summary, the business

philosophy of the Germantown Fire Department is that we demonstrate

RESPECT for each other and for our customers. The Vision 2020

philosophy and the Fire Department’s core beliefs interconnect on

responsibility, service, productivity, and teamwork, with the added values of

effort and caring.

The Fire Department is in the business of saving lives, protecting property,

educating the public on issues of fire, emergency medicine, and general

safety. The Fire Department responds to a wide range of emergencies,

solves problems, and prepares the community to be able to respond to a

disaster. Our mission reflects on five major public safety goals in Vision

2020, specifically, making Germantown the safest city in the southeast,

taking a proactive approach to community safety, providing an effective

emergency response, providing safe buildings and homes, and maintaining

a top-quality fire workforce.

For the purpose of this business plan, our target market for an emergency

transport ambulance service is the residents and visitors to the City of

Germantown and our principle objective is the maintenance of life and relief

of suffering.

Providing fire, medical and other emergency response services to a

community has historically been the duty of local government. Very few

private companies offer municipal fire services, but there are many private

companies that offer emergency ambulance service. The Germantown Fire

Department is the primary provider of advanced life support (ALS) services

to the community with paramedics, and began providing ALS service in

1979. In 1975, three Germantown fire fighters became licensed as

Emergency Medical Technicians and the department placed a basic life

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support (BLS) response truck in service. Before 1975, fire fighters trained

in first aid responded to calls for medical assistance. The number of

emergency medical services (EMS) calls in Germantown has increased

every year. In 1987, for example, the department responded to 564 EMS

calls. Twenty years later, in 2007, the department responded to 1,617 calls,

and in 2009 the department responded to 1,657 calls. The majority of this

growth is attributable to the increase in medical facilities in Germantown.

A medical corridor has developed along Wolf River Boulevard and south on

Germantown Road from Wolf River Boulevard. Germantown is home to

several world-class medical facilities providing specialized services, such as

cardiac and orthopaedic care, to residents of Germantown and the region.

Four major hospitals are located within 7 miles of Germantown’s city hall,

which makes Germantown attractive for doctor’s offices, medical clinics,

and specialized medical service facilities such as diagnostic imaging and

out-patient surgery. We foresee a continued increase in the number of

medical responses in Germantown.

Form of ownership: The Germantown Fire Department is a key business

unit of the City of Germantown, a political subdivision and municipal

corporation in the State of Tennessee.

Company history: The Germantown Fire Department has provided fire

protection and increasing levels of emergency medical care for the city over

50 years, first as a volunteer department and progressing to a mostly-paid

combination department. On October 15, 1977, the department began 24-

hour staffing with career fire fighters and EMTs, and added paramedics in

1979.

Even though the department is young in terms of a career fire department,

the men and women of the department are well trained and provide a wide-

range of emergency and non-emergency services. These services range

from fire suppression, EMS and fire inspections to responding to hazardous

materials (Hazmat) incidents and responding with Tennessee Task Force 1

(TN-TF1) to national emergencies including the Pentagon on 9/11 and

Hurricane Katrina. The department’s Hazmat Team was the first team in

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Tennessee to be certified by the Tennessee Emergency Management

Agency. These examples illustrate the leadership ability of the department,

the department’s ability to provide a wide variety of services in an effective

and efficient manner, and the ability to plan for and adapt to the changing

needs of the community.

Members of the command staff possess academic degrees and professional

certifications that reflect on the department’s commitment to stay current

on all aspects of leading and managing a full-service fire department.

The department enjoys an excellent reputation in the community, having

scored as the top city department on the last two citizen satisfaction

surveys. The department has been innovative in securing grant funding for

many projects, including the Learning About Fire Safety (LAFS) program, a

live fire training simulator, CERT training, and a state-of-the-art

communications van.

Throughout the years, the department has met and solved problems

through innovation and adapting to changes in the emergency services

environment. This experience has taught the department that Germantown

residents take pride in their community and expect exceptional service. As

indicated above, the Fire Department has met this challenge with programs

tailored to the risks present in the community. Emergency medical calls

account for over 60% of the total emergency incidents and this is the

largest emergency service we provide. Yet, emergency medical service is

the only service we provide where we lack total control over the service. A

critical success factor in the emergency response strategy in Vision 2020 is

for the City to have total control for patient care.

Most important strengths and core competencies: The Germantown

Fire Department has always been innovative and adaptive. For example, in

the early 1980s the department followed a detailed plan of improvement

and improved the department’s ISO rating from Class 5 to Class 3, which

significantly reduced the cost of insurance for Germantown residents and

business owners. Long-range planning identified a major risk to the

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community from a transportation accident involving hazardous materials, so

Germantown created a Level A (able to respond to the highest hazards)

Hazmat team and was the first team in Tennessee to achieve certification

from the Tennessee Emergency Management Agency (TEMA). The

Germantown Fire Department’s major competitive strengths are its

strategic plan, its continued focus on providing its core businesses and,

most importantly, the highly skilled professional workforce that constantly

demonstrates a commitment to service excellence. The Fire Department

consistently demonstrates the ability to provide an exceptionally high level

of emergency and non-emergency services to the community, which is our

strongest core competency.

The department’s ability to serve is reflected in the response to the City’s

third community survey in 2005. The purpose of the survey was to measure

how satisfied residents were with current services, to obtain their input on

specific issues, and to find out what residents like best and least about

living in Germantown. The city mailed a 100-question survey to 13,814

households and received 4,798 completed surveys. This is a 35% response

rate (5-10% is typical), which is exceptional for a survey of this type and

complexity and provides a 95% confidence level for the results. Such a high

response rate indicated that Germantown residents do care about city

services and do have strong opinions about issues facing the city.

Fifty-eight questions pertained to resident satisfaction with city services.

Six of those questions (10.3%) related to Fire Department services. All six

of the fire department measurements fell within the top-scoring 15

questions (top 25.8%). The fire department was the only department to

have a very satisfied score above 70 on any item in the survey. The results

confirmed that the response of the city’s fire fighters and paramedics is

professional, effective, and timely. Residents feel confident in the fire

department’s ability to protect them from loss of life or property due to fire

and to respond to their needs in a medical emergency. The fire department

is doing a good job because of the continuous, professional effort shown

every time fire personnel roll out the door on a call or interact with the

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public. We build this high level of community trust and satisfaction one fire

call at a time, one EMS call at a time, one fire station tour at a time, one

public education talk at a time, one phone call at a time, one little extra

effort at a time. The men and women of the Fire Department built this level

of trust and satisfaction by consistently doing their job well, one day at a

time, and this level of care, concern, and compassion will carry over to a

transport ambulance service.

Significant EMS challenges the community faces now and in the near

future: In the evolution of a community, the City of Germantown is

approaching build-out, which means the rapid growth and increasing

revenues enjoyed in the previous two decades has slowed. The next stage

after build-out is a maturing community where the revenues will stabilize

but the cost of services will continue to increase. The City has developed a

Smart Growth Plan to renew the community with a focus around the current

center business area to bring together commercial, residential, and open

green areas that will renew growth within the City. The City must make

decisions to avoid having the cost of city services exceed revenues while

still maintaining the high level of service the residents of Germantown

desire. Germantown is using managed competition to reduce the cost of

service delivery without sacrificing quality and accountability. The City’s

Directors have been tasked with maintaining service levels without the

traditional use of a tax increase.

Germantown currently participates with Shelby County and the cities of

Arlington, Collierville, Lakeland and Millington in a contract with

Rural/Metro Ambulance Service for emergency ambulance service in these

cities and the unincorporated areas of Shelby County. Each entity pays a

portion of the cost of the contract based upon use. Germantown’s portion

for 2009 was $404,477. Under the current Shelby County Ambulance

Contract, most of the problems of the past that plagued the ambulance

transport service have been alleviated. However, there are still some issues

with the current vendor. This includes lack of equipment on the

ambulances, the vendor charging patients for supplies and medical

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procedures provided by fire department personnel, and the overall lack of

accountability and control by the Germantown Fire Department. The

average response time of the ambulances has improved to a contract

required 9 minutes, 90% of the time. Many injuries and medical conditions

are time sensitive, and there are very few minutes available for patient

treatment to prevent continued suffering. The American Heart Association

recommends a response time of five (5) minutes for people suffering from a

heart attack. The Fire Department’s response time is 5 minutes.

The Germantown Fire Department is well suited to provide emergency

ambulance service to the residents of Germantown. The department has

been providing advanced life support for 30 years and serves as the entry

point for patients into the local healthcare system when they call 911. Fire

Department personnel have been professionally trained to operate within

the time critical windows common to medical emergencies. For example, in

cardiac arrest, brain death typically occurs within 6-8 minutes. The time

between cessation of the heartbeat and initiation of CPR, defibrillation, and

advanced cardiac life support determines the patients chances for survival.

Currently, at emergency medical incidents, Fire Department paramedics

and EMTs provide patient treatment and then turn patient care over to the

third-party ambulance service. When patient care is turned over to the

private ambulance service, Germantown relinquishes a large amount of

accountability and control. At this time, the care provided by Fire

Department personnel is interrupted and some information regarding the

patient’s chief complaint, condition, and treatment is lost during the

transfer. In addition, the knowledge, skills, and abilities of Germantown

Fire Department personnel, along with the Germantown standard of care, is

a known quantity when care is provided by the Fire Department. Even

though the personnel on the private ambulance are licensed, Germantown

does not know or control the level of knowledge, skills and ability of the

private company’s employees. To address this, Fire Department personnel

accompany the patient to the emergency room for major medical and

trauma transports or when the fire department paramedic has administered

a narcotic drug for patient treatment. The International Association of Fire

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Chiefs has stated that the documented survival rates are markedly higher

for patients served by cross-trained, multi-role fire fighters than for those

victims served by providers of non-fire service based systems. The Fire

Department proposes to gain full control and accountability for all

emergency medical services in the City by operating an emergency

ambulance service with Germantown Fire Department personnel. It simply

makes sense for the EMT or paramedic who initiates patient care to provide

seamless care until the patient reaches the hospital.

Long term: The Fire Department proposes to operate an emergency

ambulance service for the City of Germantown. This service meets the

immediate need of providing exceptional patient care and having full

control of the EMS system. Under this business plan, the Fire Department

will operate a primary emergency ambulance service that provides ALS

response to 911 calls.

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III. Products and Services

The Germantown Fire Department provides an ALS first responder service

within the corporate limits of Germantown and serves as the entry point for

patients into the local healthcare system for EMS calls. The department

operates four fire engines, one truck company and one rescue squad, all

staffed with licensed medical personnel. All of these apparatus are

equipped to provide both ALS and BLS emergency medical care. The

department staffs, as a minimum standard, each engine company with a

paramedic for the provision of ALS. The truck company, at most times, is

also staffed with paramedic.

Factors that give the Germantown Fire Department a competitive

advantage include the department’s strategic plan, its understanding of

Vision 2020, its experience in providing EMS services in the community,

response capabilities, and the commitment of the men and women of the

department.

The fire chief is a licensed paramedic with 34 years of EMS experience, 32

of those years as a paramedic, and has completed the Management of

Emergency Medical Services course at the National Fire Academy. He has

been involved in drafting past county ambulance contracts and representing

Germantown’s interests on ambulance contract committees dating back to

the early 1980s. He has served on the Mid-South EMS council, and

currently represents Germantown on the Shelby County Emergency Medical

Response Oversight Committee (EMROC), charged with administration of

the Shelby County Ambulance Service Contract. He has served on Mayor

Wharton’s Shelby County Blue Ribbon Committee for Emergency

Communication and Shelby County’s Emergency Response Subcommittee,

and holds professional accreditation as a Chief Medical Officer (CMO) from

the Commission on Professional Credentialing.

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The EMS Coordinator is a licensed paramedic with over 27 years in EMS,

including service as a supervisor with a private ambulance company. He

represents Germantown’s EMS interests on the Mid South EMS Council and

oversees the quality assurance (QA) program for the Fire Department. He

regularly communicates with our physician medical director to keep Dr.

Holley informed, to receive feedback on the QA program, and to maintain

inventory and accountability of controlled substances used in providing

emergency medical care. He is responsible for inventory control and

oversees the program to provide the training and education necessary so

EMS personnel can recertify every two years.

Other key staff personnel are licensed paramedics or EMTs and have been

involved in the delivery of emergency medical care for decades. The most

important key factor Germantown brings to the table is desire: the men and

women of the Germantown Fire Department want to provide this service to

the community. They have witnessed the quality of service from the current

and past providers of ambulance service, and this is not what they want for

Germantown. Following the department’s strategic plan, they reflect the

S.P.I.R.I.T. of Germantown in the performance of their duties and serve the

community with R.E.S.P.E.C.T. Fire Department personnel providing a

transport ambulance service within the Fire Department is logical since fire

personnel initiate patient care through the first responder program. The

most important product the Germantown Fire Department has to offer in

creating a fire-based ambulance service is a quality and effective emergency

response by highly skilled, professional employees dedicated to serving the

community.

For the public, it means they only have to dial “911” and no matter what

their emergency is, the fire department responds. The Fire Department is

equipped and trained to handle that emergency. Whether it is a fire, a call

for a medical emergency, a hazardous materials incident, extrication,

rescue, or anything else, the Fire Department will take care of the

emergency. The Fire Department is naturally deployed for rapid response

and if the response is not fast, it isn’t an emergency response. There are no

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other systems, except for fire serviced based medical services, that come

with a complete toolbox to handle any incident out of a hospital that

requires emergency medical care.

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II. Marketing Plan

The Marketing Plan:

Economics and Research In Tennessee, only one county and five cities use a fire department

based ambulance service as the primary provider of emergency ambulance service for their local community, which represents just 1.5% of all ambulance services in Tennessee. Two of those six ambulance services are in Shelby County (Memphis and Bartlett).

The total size of the market in Germantown is 41,011 people and 19 square miles. The Germantown Fire Department is the primary provider of first responder advanced life support and has access to 100% of the EMS market in Germantown.

The current demand for service in the target market area of Germantown 1,650 EMS calls annually with approximately 1,350 actual transports.

Requests for emergency ambulance service response in Germantown increase annually. The growth of Germantown’s medical community will result in an increase in emergency ambulance responses to these facilities. Current customers include one rehabilitation hospital, three assisted care living facilities, and numbers physician’s offices and specialty care clinics.

An aging population indicates a growth in the need for emergency medical services.

o During the next 10 years, the majority of the baby boomer generation will reach 67 years of age

o It is projected that between now and 2020, the growth rate for persons over 65 will be twice the growth rate for the general population

o Germantown’s median age is 41.3 years, which is higher than the median age of the US population, which is 35.3 years.

o Germantown is growing at a faster rate than the national average. The largest age group in Germantown is between the ages of 45 to 54 (21.7%). In four years, the largest group will be 55 and older

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o Germantown will need to provide medical (and other) services to seniors sooner and at a much higher rate than in many other communities.

o The number of medical responses the Fire Department makes to elderly residents is increasing.

o The most common medical calls in Germantown associated with the elderly include respiratory problems, chest pain, cardiac arrest, stroke, diabetic emergencies, general illness, and falls.

o In Tennessee, residents seek hospital services at a higher rate than the national average because of a lack of primary care providers leading these patients to use the EMS system as a substitute for a primary health care provider.

The socioeconomic environment in Germantown and the market area indicates a high potential for collecting revenue for services provided. The market area contains many third-party payers.

o The vast majority of Germantown residents are well educated: over 40% are college graduates and over 22% have postgraduate degrees. This educational level indicates the probability that most residents have jobs or careers that provide medical benefits and/or they understand the need for comprehensive health insurance.

o Over 89% of the households in Germantown report annual salary and wage earnings.

o Over 81% of households in Germantown report annual earnings of $50,000 or more. Over 46% of households report annual earnings of $100,000 or more.

o The median household income in the US is $49,538 and in Shelby County, it is $47,613. In Germantown, the median household income is $113,769

o The per capita income in Germantown is $44,021 and ranks 6th in Tennessee. By contrast, the per capita income in Memphis is $17,838 and ranks 129th in Tennessee out of 382 ranked cities. The national per capita income is $21,587.

Cost factors for the Germantown Fire Department Ambulance Service

o Capital Costs – Four Type I ambulances will be purchased. Two new ambulances will be used for front-line service and two used will serve as back-up ambulances.

o Personnel costs – Germantown will continue to hire personnel that are cross-trained fire fighters. Thirteen (13) personnel will be hired. A minimum of six (6) of these personnel will be

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paramedic/fire fighters and the remaining personnel will be fire fighter/EMTs.

o Marketing costs – The Germantown Fire Department is well known in the community. Any marketing costs to establish a presence in the community would be minimal.

o Consumer acceptance/brand recognition – The Germantown Fire Department enjoys an exceptional reputation in the community for fast, professional response, quality personnel, excellent equipment, and premier service.

o Training/skills – In cooperation with a local community college, an in-house training program has been developed to deliver state approved training to provide the quality training the paramedics and EMTs need to stay current on treatment protocols and recertify every two years.

o Start-up costs – The Fire Department administration will oversee and manage the ambulance service operation. Since management and oversight is already in place for the first responder program, there will be minimal increased costs for overseeing the ambulance operation. Housing the crews and ambulances in fire stations eliminates the need to rent space for quarters. The cost for purchasing ambulances is included in the capital costs. The selected billing contractor will charge a flat percentage rate of the transport revenue.

o Germantown is one of only a few cities in the nation to have a triple-A bond rating from both Moody’s and Standard & Poor’s. Germantown should get excellent rates, should the decision be made, to lease or lease-purchase ambulances and equipment.

ProductsThe Germantown Fire Department’s product is a consistently high quality,

professional emergency medical response with the best equipment in good

working order. This is what the customer expects when they dial 911 for a

medical emergency. On what may be the worst day of the patient’s life, and

in the life of the patient’s family, it is essential that the EMS response be at

its best. This is the product the Germantown Fire Department will provide

through a fire based emergency ambulance service.

Primary research has shown that the number one issue with users of the

EMS system and an ambulance service is quality service and a quick

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response by medical personnel. Excessive response times for a transport

ambulance negate the benefits of a quality paramedic first response

program. Customers can be distressed over ambulances that respond

without the proper equipment or basic amenities such as sheets and

blankets. Fire department personnel have witnessed firsthand ambulances

arriving lacking critical equipment such as the way to measure a diabetic

patient’s blood glucose level or working equipment such as an EKG monitor

for a heart patient, and getting lost responding to calls.

Features and BenefitsThe Germantown Fire Department will provide a professional, well-

managed emergency transport ambulance service with the best paramedics,

EMTs and equipment, responding in a timely and efficient manner,

committed to saving lives and to ease pain and suffering. The City of

Germantown retains total control over patient care from the initial contact

until the patient is admitted to the emergency department.

Two items mentioned in the Germantown Vision 2020 document are

“safety” and “access to premier healthcare.” Premier healthcare includes

emergency ambulance service as this serves as the point of entry into the

healthcare system. For a private contractor, a major motivator to serve

Germantown is profit. Unlike a private contractor, the major motivator for

the Germantown Fire Department to provide emergency ambulance service

is desire: The men and women of the Germantown Fire Department want to

provide this service to the community because it meets the S.P.I.R.I.T. of

Germantown and we serve with R.E.S.P.E.C.T. for the community.

Compliance with Vision 2020.

Safest City in the Southeast

o People are safe and feel secure

Proactive Approach to Community Safety

o Awareness of national trends and “Best Practices” and how they apply to our community

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Effective Emergency Response

o Meeting response time standards: EMS 5 minutes

o Response by highly trained, professional public safety personnel prepared to handle the emergency

o Right equipment and resources available to handle the emergency

o Emergency medical transport ambulance service with state-of-the-art patient care operated by the City

o Effective communications and dispatch facilitating the emergency response

o Retaining total control for patient care from the emergency scene to the hospital

Top-quality workforce

o Hiring and retaining the “best public safety employees”

o Highly skilled, professional workforce dedicated to serve the community

o Training and educational opportunities available to develop knowledge, skills and abilities

CustomersOur customers include the residential population of the City of Germantown

(approximately 41,000 people) plus daily visitors to the area. We estimate

that 80% of Germantown’s EMS customers are residents of Germantown.

Germantown itself is roughly rectangular with a network of several major

streets to facilitate ease of movement in the community. Ninety percent of

patients transported from within Germantown go to four hospitals that are

located within 7 miles of the intersection of Germantown Road and

Farmington Boulevard, which means the ambulance is able to return to

service in Germantown in a minimal amount of time once the patient has

been accepted by the hospital.

Page 23 of 43

More and more of our customers are located in medical facilities at the time

of the request for service. These facilities include residential care facilities,

physician’s offices, specialty clinics, and outpatient surgery facilities.

The population in Germantown is affluent and well educated. This infers an

understanding of the benefits of good health care and a personal emphasis

on the importance of having access to prompt emergency medical care and

transportation.

In Germantown, over 52% of the residents work in management,

professional and related occupations and over 30% are employed in sales

and office occupations. This economic statistic indicates a high likelihood

that the majority of the residents have well paying jobs with medical

benefits.

Competitive AnalysisThe Germantown Fire Department is intimately familiar with the EMS

market in Germantown, is adept at providing exceptionally good service,

has an excellent reputation in the community, has fire stations strategically

located to provide rapid response to all portions of the city, has a strategic

plan that envisions the department providing transport ambulance service,

and has the desire to provide the service. The City of Germantown is

financially sound and able to fund the cost of providing a transport

ambulance service. The service provided will be exceptional, with control

and accountability that cannot be matched by contracting with a for-profit

company.

PricingTransport fees have been established based upon the level of service

provided to the patient. The different levels of service are ALS1, ALS2,

BLS, and non-transport. These categories were developed utilizing the

Medicare reimbursement rates for ambulance transport as a guide. All

billing vendors interviewed, expressed that private medical insurance

companies utilize Medicare’s classification of patient transport services.

The billing vendors also suggested when billing for transport service, to bill

Page 24 of 43

a flat rate fee versus itemized billing. The Medicare reimbursement base

rates and mileage are established by the Federal Government annually.

Utilizing the private billing vendor to handle all billing aspects the following

rates will apply:

ALS2 - $750 Medicare ALS2 - $542.38

ALS 1 - $650 Medicare ALS1 - $374.73

BLS - $550 Medicare BLS - $315.56

Treatment and No Transport - $450 Medicare Treatment and Non

Transport – 0

Mileage - $12.50 per loaded mile Medicare Mileage - $6.87 per

loaded mile

A non-transport fee will be assessed when a call for emergency services is

made from a specific address by the patient or by the patient’s immediate

family, who is located at the same address as the patient, and the patient

then decides not to be transported against medical advice from the fire

department paramedics. This covers the cost of the emergency response to

the patient, the ALS patient assessment, and any interventions performed

until the patient refuses transportation to an emergency room.

A non-transport fee will not be assessed when a third-party caller makes the

911 call for an emergency response and the patient refuses treatment and

transportation.

Revenue Forecast

Transport Rate – 88% Collection Rate – 85% Transport Rate –

78%, Collection Rate – 85%

Page 25 of 43

Year 1 - $659,613 Year 1 -

$585,368

Year 2 - $673,787 Year 2 -

$596,950

Year 3 - $695,650 Year 3 -

$608,756

Year 4 - $717,512 Year 4 -

$620,791

Year 5 - $739,375 Year 5 -

$633,059

Year 6 - $761,238 Year 6 -

$645,564

Year 7 - $783,100 Year 7 -

$658,312

Page 26 of 43

Operational Plan

Provision of service

The Germantown Fire Department will respond to calls for emergency

ambulance service made within the service area. The dispatch office

Germantown will process the request and dispatch the appropriate first

responder fire company and ambulance(s). The department will use its

existing quality improvement program to monitor the service provided and

ensure that all patient care meets state standards and follows approved

protocols. A written policy will be established to handle mutual aid

requests for an ambulance. The EMS Supervisor will provide daily

supervision of the ambulance service. Existing, proven inventory control

procedures for equipment and medications will be used to maintain a

sufficient stock of medical supplies and accountability for controlled

substances. Revisions to operating procedures will be made as needed after

review and evaluation of the first quarter of operation of the service and

thereafter as needed. A quality review council (QRC) will be established

with Fire Department representatives to oversee operation of the service.

Location

The Germantown Fire Department has four fire stations strategically

located to provide rapid response to all portions of the city. Ambulances

will be strategically placed at Fire Stations 3 and 4 to provide the best

coverage and response times for the service area. These stations offer

living quarters for the ambulance crews and bay space to house

ambulances, along with the infrastructure for dispatching the ambulances

and space for storage, recording keeping and related activities, which keeps

ambulances from having to travel to a “home office” for paperwork and re-

supply. The fire stations are well maintained and present a positive public

image, which will match the image projected by the ambulances and crews.

Page 27 of 43

Legal Environment

The Germantown Fire Department will apply to the Tennessee Department

of Health, Emergency Medical Services Division for a Class A ambulance

service license. A Class A license indicates that the service provides

advanced life support or critical care service. A license is required to

operate an ambulance service in Tennessee. The license is renewed

annually and expires on June 30 of each year. The initial license fee is

$5,000. The annual renewal fee is $500.

The City will be required to have each ambulance inspected and permitted

by the state before placing the ambulance in service. Ambulance permits

expire annually. Regional EMS consultants inspect ambulances annually.

The annual permit fee for each ground ambulance is $250.

Regional EMS consultants conduct annual service audits. The service audit

demonstrates that the ambulance service complies with pertinent federal

and state laws and regulations.

All personnel providing emergency medical care must be licensed to

practice in Tennessee. The department will investigate all potential

employees to ensure they possess a valid license. Paramedics must obtain

30 hours of approved continuing educational units (CEU) and EMTs must

obtained 20 hours of CEU in order to apply for renewal of their license. The

Fire Department’s EMS training program provides sufficient hours so

personnel can comply with this requirement.

The City of Germantown carries appropriate insurance for its ALS first

responder program and insurance to cover the care provided by paramedics

and EMTs. The City will provide the required liability insurance for

operating an ambulance service and insurance on the ambulances.

Tennessee is a TOSHA state. The department has and enforces infection

control and contaminated waste polices in compliance with federal and

state laws. The department offers Hepatitis A and B vaccinations to all

employees.

Page 28 of 43

Personnel

The Germantown Fire Department has 68 full-time employees, 4 part-time employees, and 25 reserve employees (Of the 25 fire reserves; 19 are seeking full-time employment with the Germantown Fire Department. Of these personnel; two are paramedics, three are currently in paramedic school, and eleven are EMT’s)

The department provides highly specialized and technical services requiring skilled, professional employees. Many of the fire department’s paramedics and EMTs have vast experience providing ambulance transportation services which will streamline the transition from providing only ALS first responder service to an ALS ambulance transportation service. The employees will alsobe required to acquire and maintain special certifications or state licenses.

The department will recruit new employees first from the current Germantown Fire Department Fire Reserve Program, second from the local Fire/EMS market, and third from the region by advertisement. The service will require seven (6) EMTs and six (7) paramedics.

The quality of existing staff is exceptional. The department will use proven hiring techniques to ensure that personnel hired for the ambulance service meet the same high standards as existing personnel.

The personnel required to staff the ambulance service will be compensated based upon the Fire Department’s Career Development Program. Since ambulance personnel will be public safety employees, they will receive the same benefit package as police officers and fire fighters.

All new personnel will complete an orientation program before going to work. Personnel will adhere to the existing policies and procedures of the Fire Department. Personnel will participate in the EMS training program, which is well established and provides continuing education units (CEUs) needed for license renewal.

Fire Fighter/Paramedics and Fire Fighter/EMTs will staff fire apparatus and ambulances utilizing an approved rotating schedule.

Page 29 of 43

Credit Policies

The Fire Department will provide transport ambulance service on an as-

needed credit basis. Although payment will be due when service is

rendered, the ambulance crew will transport the patient without regard to

collecting the service fee before providing emergency medical care or

transport. Fire Department personnel will not collect money for patient

transports. The ambulance crew will collect pertinent information utilizing

an electronic patient care report and the selected billing vendor will

execute the billing services for patient transport and treatment services.

The emphasis will be on patient care regardless of the patient’s ability to

pay.

Other than providing emergency medical services in arrears, the

department does not extend credit. The Fire Department administration

will carefully manage the budget by monitoring department expenditures

and will stay in constant communication with the billing contractor to

monitor revenue.

The Fire Department will use a contact service for billing. This is more

effective than hiring a billing clerk and then having them to continually

train on changes in Medicare and Medicaid rules and regulations. The

billing contractor will be diligent in collecting outstanding bills and in

keeping delinquent accounts receivables to a minimum. Accounts

receivable aging will be done on a monthly basis. Once a billing contractor

is selected, policies will be established to manage collections from

delinquent customers.

Page 30 of 43

III. Management and Organization

The fire chief will lead and manage the ambulance service operation. Fire

Department staff possesses the knowledge, skills, ability and experience to

operate an ambulance service. If this plan is adopted, the 8-hour EMS

Supervisor position will be created and staffed. The department’s EMS

Battalion Chief will provide daily supervision of the ambulance service.

The Fire Chief will promote a qualified Lieutenant-Paramedic to the position

of EMS Supervisor.

Professional and Advisory Support

Fire Department staff

o Dennis Wolf, Fire Chief

o John Selberg, Assistant Fire Chief

o Edgar Babian, Deputy Fire Chief

o Mark Carter, EMS Coordinator

City Attorney

o C. Thomas, Cates, Burch, Porter and Johnson

Finance

o Kristen Geiger, Assistant City Administrator

Risk Manager/Treasurer

o Michael Stoll

Medical Director

o Joseph Holley, MD

Page 31 of 43

Proposed Organizational Chart

Daily Operational Plan

Page 32 of 43

The Germantown Fire Department will place two full-time ambulances into service

daily. These will both be staffed by a paramedic/fire fighter and a fire fighter/EMT.

In the event an additional ambulance is needed for response to an emergency

incident, personnel can be reallocated from Engine 93 or Truck 41 to staff the

reserve ambulances. In the event, the need for ambulances exceed the number of

available ambulances, a mutual-aid request for additional ambulances can be made

from the Memphis and Shelby County Fire Departments or even from a private

ambulance service. The Memphis and Bartlett Fire Departments have established

agreements with private ambulance services, at no cost, to provide additional

ambulances in the event their present call volume exceeds their current transport

capability.

IV. Financial History and Analysis

The Germantown Fire Department’s operating budget comes from the

general fund of the City of Germantown. The operating budget for FY2010

is $7,087,281. Small grants are sometimes used to fund special projects,

but grant funding is inconsistent and unreliable for operational funding.

The City has a triple-A bond rating from Moody’s and from Standard &

Poor’s. The city has adequate reserves and a sound financial history.

The Fire Department’s FY2011 operating budget does not contain funds for

the establishment of an ambulance service. This possibility was not

foreseen when the budget was created starting in January of 2010, because

of the desire to have total control over emergency medical services and the

uncertain future of the Memphis\Shelby County consolidation referendum

currently being proposed.

If this plan is adopted by the BMA, this plan will call for the service to be in

place by October 1, 2010. There are many things that must be done

between the adoption of the plan and the start date, including hiring and

training personnel, purchasing ambulances and equipment, selecting a

billing contractor, and getting the required licenses.

Page 33 of 43

V. Financial Plan

5-Year Revenue and Expense Projection

Revenue FY 12 FY 13 FY 14 FY 15 FY 16

Transport Fees 0$564,

505

$575,

670

$587,

050

$598,

651

Non-Transport

Fees0

$20,8

63

$21,2

80

$21,7

06

$22,1

40

Total Revenue 0$585,

268

$596,

950

$608,

756

$620,

791

Expenses1st

Year

2nd

Year

3rd

Year

4th

Year

5th

Year

Personnel$153,

702

$585,

231

$638,

062

$661,

379

$710,

708

Related Personnel

Costs

$90,7

76

$240,

138

$261,

270

$270,

597

$290,

328

Vehicle Expense 0$29,0

00

$31,0

00

$33,0

00

$35,0

00

Equipment*$98,0

00

$41,5

00

$41,5

00

$41,5

00

$41,5

00

Insurance 0$10,0

00

$10,1

60

$10,3

23

$10,4

88

Billing Service

Fee0

$58,5

37

$59,6

95

$60,8

76

$62,0

79

Capital Outlay$500,

0000 0 0 0

Page 34 of 43

Page 35 of 43

Appendices

Appendix A Germantown - Sex by Age (census data)

Appendix B Germantown - Sex by Educational Attainment for Population 25

Years and Over (census data)

Appendix C Germantown - Household Income in 1999 (census data)

Appendix DGermantown - Earnings in 1999 for Households (census data)

Appendix E Germantown - Year Structure Built (census data)

Appendix F Seven-Year History of Ambulance Responses in the Market Area

Appendix G Collierville – Household Income for 1999 (census data)

Page 36 of 43

Appendix A

Sex by Age – Universe: Total population. Data Set: Census 2000 Summary File (SF1) 100% Data

 Germantown,

Tennessee PercentCumulative

Percent

Male:      

Under 5 years 994 5.46% 100.00%

5 to 9 years 1,449 7.96% 94.54%

10 to 14 years 1,692 9.30% 86.57%

15 to 17 years 1,167 6.41% 77.27%

18 to 20 years 659 3.62% 70.86%

21 to 24 years 479 2.63% 67.24%

25 to 29 years 477 2.62% 64.61%

30 to 34 years 650 3.57% 61.98%

35 to 39 years 1,230 6.76% 58.41%

40 to 44 years 1,644 9.04% 51.65%

45 to 49 years 1,939 10.66% 42.62%

50 to 54 years 1,996 10.97% 31.96%

55 to 59 years 1,405 7.72% 20.99%

60 to 64 years 864 4.75% 13.27%

65 to 69 years 626 3.44% 8.52%

70 to 74 years 399 2.19% 5.08%

75 to 79 years 305 1.68% 2.89%

80 to 84 years 154 0.85% 1.21%

85 years and over 66 0.36% 0.36%

Total Male: 18,195 48.72% 48.72%

Female:      

Under 5 years 957 5.00% 100.00%

5 to 9 years 1,384 7.23% 95.00%

10 to 14 years 1,672 8.73% 87.78%

15 to 17 years 1,151 6.01% 79.05%

18 to 20 years 534 2.79% 73.04%

21 to 24 years 478 2.50% 70.25%

25 to 29 years 518 2.70% 67.75%

30 to 34 years 824 4.30% 65.05%

35 to 39 years 1,477 7.71% 60.75%

40 to 44 years 1,966 10.26% 53.04%

45 to 49 years 2,195 11.46% 42.77%

50 to 54 years 1,989 10.38% 31.31%

55 to 59 years 1,270 6.63% 20.93%

60 to 64 years 839 4.38% 14.30%

65 to 69 years 621 3.24% 9.91%

70 to 74 years 480 2.51% 6.67%

75 to 79 years 426 2.22% 4.17%

80 to 84 years 217 1.13% 1.94%

85 years and over 155 0.81% 0.81%

Total Female: 19,153 51.28% 51.28%

Page 37 of 43

Grand Total: 37,348 100.00% 100.00%

Appendix B

Sex By Educational Attainment for Population 25 Years and Over

 Germantown,

Tennessee PercentMale:    

No schooling completed 2 0.02%Nursery to 4th grade 0 0.00%5th and 6th grade 29 0.25%7th and 8th grade 5 0.04%9th grade 18 0.15%10th grade 36 0.31%11th grade 37 0.31%12th grade, no diploma 86 0.73%High school graduate (includes equivalency) 891 7.55%Some college, less than 1 year 437 3.70%Some college, 1 or more years, no degree 1,766 14.97%Associate degree 438 3.71%Bachelor's degree 4,812 40.78%Master's degree 1,950 16.53%Professional school degree 931 7.89%Doctorate degree 362 3.07%Total Male: 11,800 47.65%     

Female:    No schooling completed 17 0.13%Nursery to 4th grade 9 0.07%5th and 6th grade 6 0.05%7th and 8th grade 55 0.42%9th grade 23 0.18%10th grade 38 0.29%11th grade 32 0.25%12th grade, no diploma 90 0.69%High school graduate (includes equivalency) 1,840 14.19%Some college, less than 1 year 907 7.00%Some college, 1 or more years, no degree 2,426 18.71%Associate degree 714 5.51%Bachelor's degree 4,506 34.76%Master's degree 1,826 14.08%Professional school degree 377 2.91%Doctorate degree 99 0.76%Total Female: 12,965 52.35%     Grand Total: 24,765 100.00%

Page 38 of 43

U.S. Census Bureau Census 2000

Page 39 of 43

Appendix C

Household Income in 1999 – Universe: Households

Data Set: Census 2000 Summary File 3 (SF3) – Sample Data

IncomeGermantown,

Tennessee Percent

Cumulative Percent -

Increasing

Cumulative Percent -

DecreasingLess than $10,000 246 1.86% 1.86% 100.00%$10,000 to $14,999 159 1.20% 3.06% 98.14%$15,000 to $19,999 132 1.00% 4.06% 96.94%$20,000 to $24,999 268 2.03% 6.08% 95.94%$25,000 to $29,999 240 1.81% 7.90% 93.92%$30,000 to $34,999 324 2.45% 10.35% 92.10%$35,000 to $39,999 367 2.77% 13.12% 89.65%$40,000 to $44,999 323 2.44% 15.56% 86.88%$45,000 to $49,999 434 3.28% 18.84% 84.44%$50,000 to $59,999 906 6.85% 25.69% 81.16%$60,000 to $74,999 1,486 11.23% 36.92% 74.31%$75,000 to $99,999 2,157 16.30% 53.22% 63.08%$100,000 to $124,999 1,767 13.35% 66.58% 46.78%$125,000 to $149,999 1,255 9.49% 76.06% 33.42%$150,000 to $199,999 1,277 9.65% 85.72% 23.94%$200,000 or more 1,890 14.28% 100.00% 14.28%TOTAL 13,231 100.00%    

U.S. Census Bureau Census 2000

Appendix D

Earnings in 1999 For Households - Universe: Households

Data Set: Census 2000 Summary File 3 (SF 3) - Sample Data

 Germantown,

Tennessee PercentTotal: 13,231  With salary and wage earnings 11,860 89.63%Other earnings/No earnings 1,371 10.37%

U.S. Census Bureau Census 2000

Page 40 of 43

Page 41 of 43

Appendix E

Year Structure Built

Data Set: Census 2000 Summary File 3 (SF3) – Sample Data

Germantown, Tennessee

Total: 13,703

Built 1999 to March 2000 460

Built 1995 to 1998 1,329

Built 1990 to 1994 1,270

Built 1980 to 1989 4,375

Built 1970 to 1979 5,030

Built 1960 to 1969 879

Built 1950 to 1959 204

Built 1940 to 1949 62

Built 1939 or earlier 94U.S. Census Bureau Census 2000

Appendix F

Page 42 of 43

Page 43 of 43

Appendix G

Household Income in 1999 – Universe: Households

Data Set: Census 2000 Summary File 3 (SF3) – Sample Data

IncomeCollierville, Tennessee Percent

Cumulative Percent -

Increasing

Cumulative Percent -

DecreasingLess than $10,000 194 1.88% 1.88% 100.00%$10,000 to $14,999 248 2.40% 4.28% 98.12%$15,000 to $24,999 539 5.22% 9.50% 95.72%$25,000 to $34,999 704 6.82% 16.32% 90.50%$35,000 to $49,999 956 9.26% 25.58% 83.68%$50,000 to $74,999 2,098 20.32% 45.90% 74.42%$75,000 to $99,999 1,920 18.60% 64.50% 54.10%$100,000 to $149,999 2,209 21.40% 85.90% 35.50%$150,000 to $199,999 773 7.49% 93.38% 14.10%$200,000 or more 683 6.62% 100.00% 6.62%Total 10,324 100.00%    U.S. Census Bureau Census 2000