Enfield Emergency Medical Services January 2019 Overview Erin

Enfield Emergency Medical Services January 2019 Overview Erin Riggott, Chief Jonathan Morisset, Captain

The EMS System in Enfield Who Are the Players? ? ?

A designated EMS Provider is assigned to each Municipality in the State, determined by the Office of Emergency Medical Services (OEMS), based on: Size of population of area to be served Ability of Provider to effectively serve communitygeographical location, response time, appropriate level of licensure or certification Each Primary Service Area (PSA) shall be assigned to only one response service OEMS makes PSAR assignments that are in the best interests of patient care. Any change would require demonstration that safety, health, and welfare of citizens are in jeopardy Primary Service Area Responder Enfield EMS

Certificate of Operation A Brief Regulatory Review EMS in Connecticut is Highly Regulated by the Department of Public Health All Services Providing EMS transport must be certified or licensed. Enfield EMS is a certified service. What Does this Mean: -We can only operate out of 1296 Enfield Street or 293 Elm Street -We can only operate 7 ambulances and 3 non transporting Emergency Medical Services Vehicles, based on OEMS inspections -Numbers and Training of personnel meet CT EMS regulations -Record Maintenance and Mandatory Data Submission

Every EMS Service in Connecticut is regulated by the Department of Public Health and a Sponsor Hospital Medical Oversight Enfield EMS’s Sponsor Hospital is Johnson Memorial Medical Center. - Quality Assurance and Quality Improvement related to patient care and outcomes Sponsor Hospital provides: - Reviews and Approves the Emergency Medical Dispatch Guidelines - Authorizes a Paramedic to practice medicine under the EMS Medical Director’s license

First Responder Agency. Enfield Police Department In the early 2000’s, Enfield EMS was developed and the Police Department turned over the ambulance transport service. EPD remains the Town’s First Responder Agency and hold the PSAR This is ideal, as the Police post in Districts 24/7/365, and can quickly and easily be deployed as the First Responder for an initial response Enfield PD responds to all EMS calls CERTIFICATE OF OPERATION 0492 FR

Supplemental First Responders- FD The Town has 5 Separate and Distinct Fire Districts 2 of the 5 Districts are Full-Time (Paid) departments and provide supplemental first responder service 24/7 3 of the 5 Districts provide supplemental first responder Service between 8 a-5 p. Significant events, nights, and weekends, are covered by volunteer members or a Duty Officer. FD will respond to calls coded as “HOT” responses i. e. unresponsive, chest pain, shortness of breath, trauma.

The 911 call is received at the Dispatch Center What Happens when 911 is Activated? ? The Dispatch Center performs Emergency Medical Dispatching (EMD)- a Series of Questions that determines what resources are sent based on the callers answers BASED ON CT REGULATION- ENFIELD POLICE DEPARTMENT RESPONDS AS THE FIRST RESPONDER AND ENFIELD EMS RESPONDS AS THE AMBULANCE PROVIDER EMD determines whether we respond “HOT” or “COLD”, and whether the Fire Department is sent.

Patients are transported based on their wishes, and Hospital Capabilities. We evaluate and treat the patient(s) as needed What Happens when we arrive at a call? We transport to: Hartford Hospital Baystate Medical Center St. Francis Hospital UCONN Health Center Mercy Medical Center Connecticut Children’s Medical Center Rockville General Hospital Manchester Memorial Hospital Johnson Memorial Medical Center Ambulance turns over care and returns to town for the next call

Specifics about Enfield EMS

Advanced Life Support or Basic Life Support (ALS vs. BLS) ALS Ambulance- staffed with a Paramedic and EMT BLS Ambulance- staffed with two EMT’s What’s the Difference? ? EMT’s perform basic assessments and initial treatments. A Paramedic is able to perform additional treatments- including IV’s, Administration of Medications, Breathing Tubes, and Cardiac Monitoring. Paramedic’s have significantly more classroom and clinical educational requirements

Staffing Model Employee Breakdown: What this means: - 11 EMT’s - 11 Paramedics -3 to 4 ALS Trucks on during Peak day hours - 4 Shift Supervisors (Paramedics) -2 ALS Trucks on during overnight hours - Captain (Paramedic) -Supervisor in SUV 24/7/365 - Chief (Paramedic) - Captain and Chief can be deployed as Paramedic resources as well

Enfield Operates an ALS Service We staff mostly all ALS Ambulances Bigger “bang for your buck” Eliminates the need for additional Vehicles- BLS Ambulances should be “backed up” with Paramedic’s in SUV’s Caller information is not always the most reliable- this ensures that highest level of care arrives at bedside initially as to not delay appropriate care

Every EMS System has periods of “excessively high call volume” that are unpredictable When this happens: And when it’s “extra busy”… Enfield EMS has Mutual Aid agreements with - East Windsor Ambulance Association (ALS service) - Suffield Volunteer Ambulance Association (ALS Service) - Somers Fire Department Ambulance (BLS Service) - The Shift Supervisor (Paramedic) will also respond to initiate care while the mutual aide ambulance is responding

Call Volume 2016 -2018 2016 2017 2018 Mutual Aid In 267 341 378 Mutual Aid Out 77 82 78 Total Calls 6840 7429 7325

EMS Billing Review All EMS TRANSPORTS are billed through a 3 rd party billing agent due to the complexity of medial billing. COMSTAR was awarded the contract through the RFP Process in 2013. Billing rates are set annually by the State of Connecticut to Bill Medicare or Medicaid, you must be an “approved provider”- You agree to take a reduced rate (and can not charge an individual for the “difference”); this rate is about 1/3 of the set rate

Fiscal Year 2018 - Billing Residents: Collections Rates FY 2018 Billed: 3, 951 transports Enfield CT New England Medicare 94% 97% 96% Medicaid 99% 99% Other Insurance 93% 94% 95% Self-Pay 8% 20% 21% Overall 84% 85% Insurance Collection Rate: about 95% Total Collection Rate: about 84 -85% Non-Residents: Billed: 960 transports Insurance Collection Rate: about 94% Total Collection Rate: about 75% Total Collected: $2, 507, 556. 89 Possible Collection: $3, 081, 984. 18 81% Collection

Budget vs. Reimbursement Collected $2. 5 million of a possible $3. 1 million Enfield EMS budgeted $3 million for FY 2018 Enfield EMS recoups 81% of its budget Enfield EMS costs the town of Enfield less than $600, 000 to operate.

Community CPR classes offered quarterly at a very low cost The Extra’s. Community Outreach by Enfield EMS Business CPR and Emergency Response planning assistance to Town Businesses; CPR Training for Town Staff including School Nurses EMS Standby’s at Football Games (required for High School games), standbys at 5 K Run’s and Community walks EMS Tours and Show and Tell’s College Connections- Enfield EMS is a “Field Internship” site for Springfield College, Capital Community College, and Asnuntuck Community College