PowerPoint PresentationParamedic Levy Proposal April 16, 2019 C R E
AT E D A N D P R E S E N T E D BY YO U R
D U P O N T P R O F E S S I O N A L F I R E F I G H T E R S
F O R
T H E C I T I Z E N S O F T H E C I T Y O F D U P O N T
Your Fire Fighters • DuPont Professional Fire Fighters are
responsible for Fire and Emergency Medical Services to the City of
DuPont and surrounding area. • Also, host City events such as our
annual
Pumpkin Patch and Santa Run and have been a multiyear sponsor for
the Patriot Baseball League.
• We are members of the International Association of Fire Fighters
Local 3829 – 501(c)(5) Non-profit Labor Organization • Affiliated
with the AFL-CIO, the Washington
State Council of Fire Fighters, Washington State Labor Council and
the Pierce County Central Labor Council.
• We currently have 12 members spread across 3 shifts working a 48
hours on/96 hours off schedule. • 3 Captain/EMTs • 8 Fire
Fighter/EMTs • 1 Temporary Fire Fighter/EMT
Terminology • "Emergency medical technician (EMT)" means a person
who has been examined and certified by the secretary as an EMT to
render prehospital EMS care as defined in RCW 18.73.081. - WAC
246-976-010 • “Basic Life Support” (BLS) means that level of care
that justifies ambulance transportation but requires
only basic medical treatment skills. It does not include the need
for or delivery of invasive medical procedures/services.” – WAC
182-546-0001
• "Paramedic" or "physician's trained emergency medical service
paramedic" means a person who has been trained in an approved
program to perform all phases of prehospital emergency medical
care, including advanced life support, under written or oral
authorization of an MPD or approved physician delegate, examined
and certified by the secretary under chapter 18.71 RCW. - WAC
246-976-010 • “Advanced Life Support (ALS) means that level of care
that calls for invasive emergency medical services
requiring advanced medical treatment skills.” – WAC
182-546-0001
• Rover – personnel not assigned to a specific shift that work in
place of individuals on leave (sick/vacation/Kelly day) in order to
maintain minimal overtime and provide safe and adequate daily
staffing
Current Level of Service: Fire Fighter/EMT (BLS)
• What is considered BLS in accordance with the 2017 Pierce County
EMS Patient Care Protocols? oWarm, dry, pink skin at rest o Resting
heart rate of 60 – 130, peripheral pulses present o Respiratory
Rate 10 – 30 at rest o Systolic Blood Pressure between 100 – 180
and Diastolic less than 120 o Awake, alert, or at baseline mental
status o No chest pain/no shortness of breath/no signs of a
stroke/TIA. o No drug overdose o No suicide attempt requiring ALS
interventions o No significant mechanism of injury resulting in ALS
symptoms. o No impending or current childbirth associated with
complications. o Patients with Ventricular Assist Device (VAD) not
requiring ALS interventions o Patients with medical
devices/equipment managed by the patient/caregiver requiring no
medical
intervention or monitoring.
Proposed Level of Service: Fire Fighter/Paramedic (ALS)
•What is considered ALS in accordance with the 2017 Pierce County
EMS Patient Care Protocols? o Cool, clammy skin o Resting heart
rate <60 or >130 at rest, in adults o Respiratory Rate <10
or >30, shallow or labored at rest o Systolic Blood Pressure
<100 or >180 and/or Diastolic >120 if symptomatic due to
blood pressure o Altered Level of Consciousness or confirmed loss
of consciousness now or prior to arrival o Chest pain/shortness of
breath/signs of a stroke/TIA. o Impending/recent childbirth/neonate
care. oMedication reaction/drug overdose/suicide attempt resulting
in ALS symptoms, requiring ALS
intervention or if decompensation may occur o Severe bleeding,
amputation; including fingers/toes resulting in shock o Significant
mechanism of injury resulting in ALS symptoms o Supra-Umbilicus
abdominal and/or back pain when atypical cardiac origin is
suspected.
Level of Service Comparison: Asthma Patient (Adult) – Mild/Moderate
Distress
EMT IN PIERCE COUNTY
• Assist patient to position of comfort. Consider early
transport.
• May assist with patient’s own inhaler; total 5 doses, then call
base station for med. direction
• Monitor pulse oximetry, EtCO2, temperature
• Consider CPAP • Continuous Positive Airway Pressure – is a form
of positive airway
pressure ventilator, which applies mild air pressure on a
continuous basis to keep the airways continuously open in people
who are not able to breathe spontaneously on their own.
PARAMEDIC IN PIERCE COUNTY
• Everything listed under EMT
• Monitor ECG
• Give albuterol 2.5mg with Atrovent 0.5mg in 3mL NS via SVN; may
repeat combination once
• Additional doses of albuterol 2.5mg in 3mL NS can be given
continuously
• Give methylprednisolone 125mg IV or dexamethasone 0.6mg/kg PO/IV
up to 10 mg
Level of Service Comparison: Pain Management (Adult): Non-Acute
Coronary Syndrome
EMT IN PIERCE COUNTY
• Acetaminophen 500-1000 mg PO
PARAMEDIC IN PIERCE COUNTY
• Everything listed under EMT
• Morphine sulfate up to 0.1 mg/kg every 5-10 minutes titrating to
effect, to a maximum dose of 20 mg, IM/slow IV push / IO, or
• Fentanyl 25 mcg to 100 mcg increments IN/IM/IV/IO every 5-10
minutes titrating to effect, to a maximum dose of 300 mcg.
• Ketamine 0.2 mg/kg IN/IM/IV/IO every 10 minutes as needed for
refractory pain.
• Nitrous Oxide
Level of Service Comparison: Pain Management (Adult) - Acute
Coronary Syndrome (ie. Heart attack)
EMT IN PIERCE COUNTY
• Nothing for pain • *Aspirin can be administered to inhibit
platelet
aggregation in patients with suspected acute MI. • **Nitroglycerin
can be given but we must use
the patient's own nitroglycerin and is used to dilate veins and
arteries, dilate coronary arteries, and dilate smooth muscle, and
improves cardiac output in patient with congestive heart
failure.
PARAMEDIC IN PIERCE COUNTY
• STEMI: • Morphine sulfate 2-4 mg IV; may give additional
doses of 2-8 mg IV at 5-15 minute interval up to 10 mg if
BP>100/s; or
• Fentanyl 25-50 mcg IV; may repeat every 5-10 minutes, or 50 mcg
IN every 5 minutes up to 100 mcg if BP>100/s
• NSTEMI-ACS: • Morphine sulfate 1-5 mg IV only if symptoms
not
relieved by nitrates or if symptoms recur up to 10 mg if
BP>100/s; or
• Fentanyl 25-50 mcg IV; may repeat every 5-10 minutes, or 50 mcg
IN every 5 minutes up to 100 mcg if BP>100/s.
Learning from the Past • In 2017, a city levy measure was run to
add Advanced Life Support (ALS)/Paramedic services to the Citizens
of DuPont. o The levy fell short by not receiving the 60% super
majority required; a 29 vote difference.
•The levy would have added 6 Fire Fighter/Paramedics, 4 Fire
Fighter/EMTs, and supervisory/support personnel. o The proposed
cost was $1.02/1000 plus the $.50/1000 EMS Levy with the intent to
combine the levies
into a single $1.52/1000.
252
143
621
325
214 188
100 55
Total EMS Calls Total Patient Transports ALS Transports by DuPont
Fire 2017 2018 2019 - 1st qtr
146
2017 2018 2019 - 1st qtr
Current Staffing and Operations • 4 personnel per shift
• 3 person minimum staffing per shift. • If one person is off for a
shift due to vacation, sick leave, Kelly
day, etc. it is not filled with overtime
• 2 EMT minimum on all transports. • RCW 18.73.150 • 3 EMTs needed
for CPR, “Sick” patient, behavioral
emergency, etc.
• Approximate transport times are the time to and from the hospital
plus the time at the hospital to transfer patient care, complete
reporting, and place the ambulance back in service. Total time at
hospital could be 20-25 minutes.
• As of March 26, 2019 @ 15:30 • Madigan: 13 Minutes via I-5 or
Clark Rd • St. Clare: 17 Minutes via I-5 • St. Peters: 19 Minutes •
Mary Bridge/TG: 28 Minutes via I-5 to Sprague Ave • St. Joseph: 25
Minutes via I-5 to Sprague Ave
Current Staffing Model
Mutual Aid Agreements • Joint Base Lewis-McChord Fire and Emergency
Services
• “… secure for each the benefits of mutual aid in fire prevention,
the protection of life and property from fire and firefighting to
include emergency services, including basic medical support, basic
and advanced life support, hazardous materials containment and
confinement, and special rescue events involving vehicular and
water mishaps, and trench, building, and confined space
extractions.” • Part C. “The rendering of assistance under the
terms of this agreement shall not be mandatory, but the party
receiving the request
for assistance should immediately inform the requesting department
if, for any reason, assistance cannot be rendered.
• Pierce County Fire Districts, City and Town fire departments, and
military departments • “Each of the parties owns and maintains
equipment for the suppression of fires and for the supplying
of
emergency medical services and responses to other situations or
events which are, or may be, hazardous to the public.
• “Each party further agrees that when the requesting agency has
demonstrated by its recent history that it is not capable of
responding or willing to respond mutually or the frequency of
requests could be construed as supporting or supplementing service
to such agency, then the providing agency may seek compensation for
the services provided.
Current Cost of Services Comparison
$3.25
$0.77
Cost per $1000 Taxable Assessed Valuation
West Pierce Graham Anderson Is. Orting Gig Harbor Lacey Roy Ashford
DuPont
Developing Your Paramedic Program • November 2019 Ballot Measure
for a Paramedic Program Levy
• Hire 5 City of DuPont Fire Fighter/Paramedics • Providing
Advanced Life Support services to the Citizens of DuPont, students
in our schools, friends and
family, and visitors to our City.
• Invest in sending 3 City of DuPont Fire Fighter/EMTs to Paramedic
School • Create a retention program that allows invested personnel
professional growth and development to
provide needed services to the community they have sworn to
serve.
• Hire a City of DuPont Medical/Training Officer • Provides needed
oversight for the implementation and management of the City of
DuPont
Paramedic/EMS Program, Fire Department Training Program, and
Incident Command support.
Building Phase 1 2020/2021
• Hire 5 Fire Fighter/Paramedics • Hire a Medical/Training Officer
• Send 2 FF/EMT to Paramedic School
Chief
Fire Fighter/ Paramedic
Fire Fighter/ Paramedic
Fire Fighter/ EMT
Fire Fighter/ EMT
• 2 Paramedics Students Placed on Shift • Send 1 FF/EMT to PM
School
Building Phase 2 2021/2022
Proposed Staffing Model – 2022
Cost of Fire Based Paramedic Services
**This would be in addition to the voter approved $.50/1000 EMS
Levy**
• Total cost of the current EMS Levy in addition to the proposed
Paramedic Levy. • Current $.50/1000 plus the proposed $.65/1000
Paramedic Levy for a total of $1.15/1000.
•The Proposed Paramedic Levy would hire 5 Fire Fighter/Paramedics,
hire 1 Medical Safety/Training Officer, allow 3 of your current
Fire Fighter/EMTs to attend Paramedic School, and cover ancillary
expenses for training, school, and any needed equipment for the
City of DuPont Fire Department Paramedic services.
Cost per Household
Cost and Timeline for Paramedic School • Tacoma Community College –
Paramedic Certificate Program
• “This 61-credit program starts summer quarter and is completed
over four consecutive quarters.” • Tuition cost for one Paramedic
Student:
• $5,812.60
• Additional Miscellaneous Costs (approximate). “Due to variations
in books, disposables, and other associated costs, prices are
subject to change without notice”. • $1,500
• Testing, Certification and Graduation Costs: • $800
• Total Approximate cost for one individual to attend Paramedic
School at Tacoma Community College is $8,113.
• The timeline for completion is one year starting in the Summer
quarter.
• https://www.tacomacc.edu/academics-
programs/programs/ems/paramedic_program_curriculum_and_costs
Paramedic Continuing Education • Continuing Medical Education (CME)
vs. Ongoing Training & Evaluation Program (OTEP)
• WAC 246-976-162: The CME method for recertification is the
completion of education courses after initial certification to
maintain and enhance skill and knowledge to meet educational
requirements, both annual and per certification period, for
recertification. • Personnel would need to complete the required
CEUs through classes, lectures, and base station training prior to
the recertification
exam. • Requires the successful completion of a written and
practical skills certification examination as part of the
recertification
requirements.
• WAC 246-976-163: The OTEP method for recertification is a program
of education for EMS personnel, approved my the Medical Program
Director and the Department of Health to meet the education
requirements and core topic content for recertification. OTEP
includes cognitive, affective, and psychomotor evaluations
following completion of each topic presentation to determine
student competence of topic content. • Developed and approved
training program to complete required training topics and skills
evaluations • DuPont Fire Department currently utilizes the OTEP
Method for it’s EMS Program.
Paramedic Continuing Education • First recertification period
(First 3 years) using OTEP Method for recertification
• Must meet annual and certification period educational
requirements • a. Cognitive, affective and psychomotor topics for
the level of certification being taught in the following core
content areas:
• 1) Cardiovascular • 2) Airway /ventilation • 3) Medical
emergencies/behavioral • 4) Trauma • 5) Obstetrics and pediatrics.
• 6) Operations.
• b. County medical program director (MPD) protocols, regional
patient care procedures, and county operating procedures. • c. OTEP
must include evaluations to determine the student competence of
those cognitive, affective and psychomotor covered,
following the completion of each topic presentation.
• 12 IVs and 4 Endotracheal tubes per year.
Proposed Cost of Services Comparison
$3.25
$1.42
Cost per $1000 Taxable Assessed Valuation
West Pierce Graham Anderson Is. Orting Gig Harbor Lacey Roy Ashford
DuPont
Thank You For Your Time And Support
Paramedic Levy ProposalApril 16, 2019
Your Fire Fighters
Level of Service Comparison:Asthma Patient (Adult) – Mild/Moderate
Distress
Level of Service Comparison:Pain Management (Adult): Non-Acute
Coronary Syndrome
Level of Service Comparison:Pain Management (Adult) - Acute
Coronary Syndrome (ie. Heart attack)
Learning from the Past
Where We Are Now
Where We Are Now
Current Staffing and Operations
Developing Your Paramedic Program
Cost per Household
Paramedic Continuing Education
Paramedic Continuing Education
Thank You For Your Time And Support