Hiawatha Fire Department

(HFD)

EMS Business Plan

November 2004

The mission of the Hiawatha Volunteer Fire Department is to enhance our community by providing services and programs to protect lives, property, and the environment.

We will accomplish this by being pro-active in providing fire and life safety education and fire prevention programs to reduce the incidence of injury and fire, and by providing emergency response services to reduce losses in life and fire when an event occurs.

INDEX

Executive Summary………………….……..Page 3

Financial Summary………………….……..Page 5

Objectives…………………………………..Page 6

Goals………………………………………..Page 6

Keys to Success……………………………Page 7

Background…………………………………Page 8

Staffingand Level of Care…………………Page 11

Scheduling………………………………….Page 12

Organizational Gaps………………………..Page 14

Statistical Notes…………………………….Page 15

Initial Investment…..…………………….Page 16

Timeline…………………………………….Page 17

Training…………………………………….Page 17

Business Operational Issues………………..Page 18

Billing………………………………Page 18

HIPAA………………………………Page 18

Rate Structure………………….……Page 18

Break Even………………………………….Page 19

Promotional Strategy………………………..Page 19

Exit Strategy………………………………...Page 20

Intangibles…………………………………..Page 20

Summary……………………………….……Page 23

Definitions…………………………………..Page 24/Appendix A

Iowa Paramedic vs. Paramedic Specialist…..Page 26/Appendix B

Fire Department Survey…………………….Page 27/Appendix C

Mayor’s Survey……………………………..Page 29/Appendix D

Paramedic Training Agreement……………..Page 30/Appendix E

Five-Year Budget……………………………Page 32/Appendix F

Executive Summary

Public Safety is the #1 priority of the City of Hiawatha. To maintain this priority it is imperative the City maintains the best possible police and fire departments to protect the lives and property of the citizens and businesses of Hiawatha.

The Hiawatha City Council recently approved an aggressive Police Department Five-Year Plan. The Police Department now has a force of twelve officers or a 50% increase in just two short years. In addition the department will considerably increase the sophistication of its equipment and technology over the next five years. The Police Department is a paid department with a current annual payroll of $523,650.

The mission of the Hiawatha Volunteer Fire Department is to enhance our community by providing services and programs to protect lives, property and the environment. The fire department has an excellent facility as well as an excellent inventory of fire fighting and rescue equipment and vehicles. The City is very fortunate to have a roster of over 39 highly qualified volunteer firefighters with an average tenure of over five years.

Fortunately the number of fires has decreased in the last decade due to increased education, technology and higher building code standards. This has led to a decrease in the workload of the traditional fire department. In addition there have been several studies indicating that volunteer numbers are decreasing. There have also been reports indicating volunteer burnout, frequent supply and equipment replacement, and recruitment difficulties as contributing factors to the decline of volunteers.

The past leaders of the Hiawatha Fire Department, with the support of their City Councils, developed strategic initiatives which have been implemented over the past decade to maintain the viability of the volunteer fire department. The old fire station was upgraded, new equipment and vehicles have been purchased, training programs have been enhanced, and education reimbursement programs have been put in place. These visionary initiatives have lead to a 30% increase in volunteers over the past decade, which is completely counter to the research indicating a statewide decline in volunteerism.

There is no question the primary motivating factor of the strategic initiatives was to enable the department to fulfill its stated mission. However, implicit in the initiatives was to maintain a highly qualified volunteer fire department. The importance of maintaining a volunteer department cannot be overstated from a City budget impact perspective. To put the importance of a volunteer fire department in perspective it would cost the City $2.2 million annually to maintain a 28-man roster of paid firefighters. The critical question is how long can we maintain a highly qualified volunteer fire department to continue saving Hiawatha $2.2 million annually?

The answer to the question requires the same visionary thinking of the current fire department leadership and City Council as demonstrated by past department leadership and City officials. Maintaining the status quo and hoping the City does not experience a decline in volunteerism leading to a paid department is not the answer. The fact is the City is growing and will continue to grow placing increased demands on the fire department as well as the City’s annual budget.

It is interesting to note that the fire department is the only major City department not headed by a full-time, paid department head. Paradoxically, part of the answer to maintaining an unpaid volunteer fire department is making an investment in a full-time paid Fire Chief. A full-time chief could focus on developing innovative retention and recruitment strategies to maintain a volunteer force. In addition a full-time Fire Chief would be able to research and apply for the many grants available to fire departments as additional Homeland Security, FEMA and other funding sources are made available. A full-time Fire Chief has marked potential to secure additional funding to more than cover his salary and benefit package on an on-going annual basis.

The City presently has an unprecedented opportunity to not only partially offset the investment in a Fire Chief but also perhaps provide part of the answer to maintaining a volunteer fire department. The Council has an ambulance service decision to make that represents long-term consequences for the fire department as well as the City. The decision is not simply a decision between a long-term commitment to the Area Ambulance Service or implementing our own Hiawatha Volunteer Fire Department ambulance service. The decision is an integral component of the much larger issue of maintaining a volunteer fire department for as long as possible to continue saving Hiawatha $2.2 million, which would be the annual cost of a paid fire department.

According to the director of the Area Ambulance Service “there has been little of substance changed since the drafts (of the agreement were) provided to you and your legal counsel.” (October 6, 2004 email from Skip Kirkwood) The AAS agreement thus remains the sameagreement the Council unanimously rejected. The agreement calls for a five-year minimum commitment with unknown but nearly certain subsidy payments from all members. The entity currently operates at an annual loss in the hundreds of thousands of dollars, has an extremely low collection ratio of 51.8% and has plans in place for increases in staff and equipment.

Compare the AAS option with the contents of this EMS Business Plan. There will be nosubsidies involved with adding an ambulance service to the Hiawatha Fire Department. The ambulance service will, in fact, defray over 50% of the salary and benefits of a full-time Fire Chief and part-time paramedic specialists. The ambulance service will be based in the fire station, which is in the heart of Hiawatha. This will enable the service to provide faster response times than AAS could possibly provide the City. Contrary to recently received information response time is critical. According to a recent Gazette article “for every minute that passes before a heart responds to treatment, survival chances decrease by nearly 10%.”

Moreover, the start-up costs of an ambulance service are already fully funded and there is space in the fire station to house not just one but two ambulances. The department currently has highly qualified Paramedic Specialists and Iowa Paramedics on its roster. There are also others in the department completing paramedic courses. In addition, new hires contemplated as part of this business plan will be Paramedic Specialists.

AAS has indicated that Iowa Paramedics have considerably less training, knowledge and skill than Paramedic Specialists do. This is simply not the case. When presented with this statement the Fire Chief and Assistant Fire Chief of one of the Metro area’s largest fire departments stated “they could not disagree more…there is virtually little skill difference…and there is no street difference.” In fact the standing orders for their department are the same for both Paramedic Specialists and Iowa Paramedics. Please refer to the Iowa Paramedic vs. Paramedic Specialist Comparison Chart on page 26 (Appendix “B”). You will note that of the seven skill differences, five are not practiced in the Metro area, one of them is only authorized for Rescue 57 and the other is not a life saving skill. Hiawatha, with both Paramedic Specialists and Iowa Paramedics, has highly proficient ambulance personnel already in place on its volunteer roster.

The ambulance service decision is critically important and has long-term implications for the Hiawatha Volunteer Fire Department as well as the City. Considerable due diligence has gone into the development of this business plan. The committee believes the contents of the plan represent factual, unbiased information and data provided to the readership to enable you to make a well-informed ambulance decision. The decision the current Council makes must represent what is in the best interests of the City now and in the future. Please carefully weigh the response times, paramedic proficiencies, current and future economic impact to Hiawatha, and most importantly the best way to serve the citizens and businesses of Hiawatha of both options and cast your vote accordingly. Thank you.

Financial Summary

The following summarizes the financial information:

  • Implementation investment of providing ambulance service is $140, 000
  • First year operating expense $134,923
  • First year ambulance revenue saves City $77,704 in operating expense
  • Net cost to City after income $57,218

By the fifth year, Ambulance Service Expense:

  • Operating expenses projected at $152,226
  • Ambulance revenue saves the City $94,450 in operating expense
  • Net cost to City of $57,775

The numbers above relate strictly to the ambulance and related operations. They account for all of the additional EMS salaries, including part time and paid on call personnel. They also account for 20% of the Fire Chief’s salary. 80% of the chief’s salary would be allocated against the fire department portion of the budget. These numbers take into account both the cost of inflation and the projected growth of the business, thus the reason for the increase in the total budget.

The following summarizes the impact that this would have on the total fire department budget.

At the end of the fifth year, the impact on the total fire department budget is:

  • Total FD and Ambulance budget combined is projected at $362,624
  • This includes 2 ambulances, a full-time Fire Chief, and 40 hours per week of part-time personnel.
  • Income is forecasted at $94,450
  • Total operational expense after income of $268,194
  • 25% of the budget supported by income.
  • By contrast, without the income generated by an ambulance, but still the addition of a paid chief and part-time person, the budget would be more than $300,000

These numbers do not include routine non-emergency transports to and from hospitals. Our intent is to provide emergency ambulance service initially, and then explore opportunities to expand the business both into other geographical areas and functional areas.

The goal is NOT to make money by operating an ambulance. The goal is to provide cost effective and efficient ambulance service to our community. This can be accomplished by utilizing a paid Chief and part-time personnel during daytime hours, as well as volunteer personnel to be paid on-call after hours. This will allow the City of Hiawatha to maintain the high level of public safety the fire department and city already provide, expand on it, and generate a revenue stream to offset the operating cost.

A complete 5-year projected budget is available on page 32 (Appendix “F”).

Page 1

Objectives:

The primary objective is to deliver the appropriate level of care to persons needing emergency medical services. The overriding concern is to provide these services in a fashion that is responsive and economical for our community. Specific objectives are listed below.

  • To have first responders arrive on the scene of 90% of our emergencies within an average of four minutes of being dispatched, and a transporting EMS unit to arrive on the scene of our emergencies within nine minutes as verified in the data processing software utilized at HFD
  • To have Iowa EMT Intermediate level care or greater on 100% of all calls (Refer to “Staffing and Level of Care” on page 11)
  • To have Iowa Paramedic or higher level care respond to 75% of our calls from HFD, and to have all calls requiring ALS, as deemed by our medical director, on 100% of all transports (Refer to “Staffing and Level of Care” on page 11)
  • To maintain high quality care by providing outstanding training opportunities and by participating in quality improvement processes
  • To develop a cost-effective EMS funding operation.

Goals:

In order to do this, operational goals have been set for each year.

  • Goals Year One
  • Gaining majorityCity Council support and financing
  • Obtain first transport unit and equipment
  • Complete training for all current personnel on EMS operations
  • Hire a full-time Fire Chief and part-time staff
  • Revenue of $77,704 helps off-set operating expenses
  • Net cost to Cityof less than $57,218
  • Goals Year Two
  • Increase number of Paramedics to 7
  • Increase coverage of Paramedics to 90%
  • Develop formal partnerships with other communities
  • Develop agreements with local nursing and assisted living facilities to provide non-emergency service to and from metro area hospitals
  • Revenue of $81,589 helps off-set operating expenses
  • Net cost to Cityof less than $57,406
  • Goals Year Three
  • Increase number of Paramedics to 8
  • 100% ALS coverage
  • Addition of second unit
  • Revenue of $85,669 helps off-set operating expenses
  • Net cost to City of less than $57,563
  • Goals Year Four
  • Increase number of Paramedics to 9
  • Revenue of $89,952 helps off-set operating expenses
  • Net cost to City of less than $57,687
  • Goals Year Five
  • Revenue of $94,450 helps off-set operating expenses
  • Net cost to City of less than $57,563

Keys to Success

The successful implementation of the business plan relies on a number of key factors:

  • Gaining City Council support
  • Purchasing appropriate level and quality of capital and minor equipment
  • Recruiting and retaining a qualified Fire Chief, volunteers, and part-time fire/medics
  • Maintaining the current core roster of firefighters, EMT’s, and Paramedics
  • Providing adequate pre-implementation training
  • Developing a group of capable and experienced leaders to form a team to guide the operations
  • Having adequate administrative support from City Administration
  • Continuing to fund and support Paramedic level training to members
  • Receiving support from other county agencies, including transferring dispatch procedures at Sheriff’s department and support of Rescue 57.
  • Cooperating with CRFD, Palo, and Center Point ambulance services
  • Maintaining adequate run volume, collection ratio, and rate structure.

Background:

Over the years, EMS has been provided to Hiawatha in the following fashion. The Linn County Sheriff Department Dispatch (“County”) receives a 911 call. They dispatch the local PD, local first responders (Fire Departments), a Sheriff’s Rescue unit, then notify Area Ambulance who sends an ambulance. The intent of this “tiered” system was to provide early and efficient care to patients.

Police officers function at a basic level of care, providing CPR and early defibrillation. The role of the FD is to provide more advanced care, defibrillation, airway management skills, and oxygen. Sheriff’s Rescue, Rescue 57, arrives and is able to provide a greater level of experience and care. Rescue 57 provides ALS care to all communities in LinnCounty, and will continue to respond on calls and be a supportive resource if HFD operates an ambulance. An ambulance would then arrive and transport the patient to the hospital.

As Hiawatha started to experience rapid growth in the late 80’s and 90’s, so did the fire department. To understand the growth process HFD has experienced with the progression in providing the next stage in EMS care, a review of the department’s history is necessary. In 1994 HFD was providing First Response EMS service to Hiawatha, as well as to surrounding areas. This consisted of responding with a fire engine to all medical calls and providing very basic treatment for injuries and illnesses. This could include CPR, semi-automatic defibrillation, bleeding control, oxygen, and basic airway management techniques.

By 1997, several changes had been made to the way HFD provided service. The majority of the department members had become EMT certified. Additionally, our heavy-duty rescue truck, Unit 281, became utilized for EMS service, because it allowed a more diverse set of equipment to be carried to medical calls.

By 2001, several members of HFD were certified by Iowa Department of Public Health as Paramedics. However, because HFD was not certified as an ALS service, they could not use their skills at HFD. As part of preparations for the next budget year, a formal EMS improvement plan was discussed with the council.

This improvement plan consisted of two steps.

The first step was to increase the level of service provided to our community by certifying with the State as an ALS service. We became certified at the “Conditional” or “Provisional” level in November 2002. This allows our Paramedics to function at the Paramedic level.

The second step was to train additional members to an advanced level. Previously HFD only supported members financially who were training to the EMT-B (Basic) level. Members who wished to receive training to the EMT-I (Intermediate) or EMT-P (Paramedic) level did so at their own cost.