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HomeMy WebLinkAboutEMS Matching Grant Application 2EMS MATCHING GRANT APPLICATION FLORIDA DEPARTMENT OF HEALTH Bureau of Emergency Medical Services Complete al! items unless instructed differently within the application Type of Grant Requested: Rural XX Matching iD. Code (The State Bureau of EMS will assign the ID Code — leave this blank) 1. Organization Name: City of Miami Fire -Rescue 2. Grant Signer: (The applicant signatory who has authority to sign contracts, grants, and other legal documents. This individual must also sign this application) Narne: Robert Ruano Position Title: Grants Administrator Address: City of Miami 444 SW 2 nd Ave, 5`" Floor City: Miami County: Dade State: Florida Zip Code: 33130 Telephone: (305) 416-1532 Fax Number: (305) 416-2151 E-Mail Address: rruano aoci.miami.fl.us 3. Contact Person: (The individual with direct knowledge of the project on a day-to-day basis and of the grant activities. This person may sign project reports and The signer and the contact person may be the same.) Captain Allen Joyce responsibility for the implementation may request project changes. Name: Position Title: Executive Assistant to the Fire Chief Address: 1151 NW 7 St. 3ra Floor Cty: Miami County Dade State: Florida Zip Code: 33136 Telephone: (305) 416-5430 Fax Number: (305) 400-5029 E-mail Address: ajoyce@ci.miami.fl.us arm 1767, Rev. June 2002 1 a 4. Legal Status of Applicant Organization (Check only one response): (1) ❑ Private Not for Profit [Attach documentation-501 (3) ©] (2) ❑ Private For Profit (3) XX City/Municipality/TownNillage (4) ❑ County (5) ❑ State (6) ❑ Other (specify): 5. Federal Tax ID Number (Nine Digit Number), VF 596000375 6. EMS License Number: 2276 Type: XX Transport ❑Non -transport DBoth 7. Number of permitted vehicles by type: BLS 34 ALS Transport 1 ALS non -transport. 8. Type of Service (check one): Rescue XX Fire Third Service (County or City Government, nonfire) ❑Air ambulance: ❑Fixed wing ❑Rotowing ❑Both ❑Other (specify) 9. Medical Director of licensed EMS provider: If this project is approved, I agree by signing below that I will affirm my authority and responsibility for the use of all medical equipment and/or the provision of all continuing EMS education in this project. [No signature is needed if medical equipment and professional EMS education are not in this project.] 7-- Signature: 1 G .-- .t.�..� �.�_.�- ,tCt ate: % 15� Print/Type: Name of Director Kathleen Schrank FL Med. Lic. No. ME 39896 Note: All organizations that are not licensed EMS providers must obtain the signature of the medical director of the licensed EMS provider responsible for EMS services in their area of operation for projects that involve medical equipment and/or continuing EMS education. If your activity is a research or evaluation project, omit Items 10, 11, 12, 13, and skip to Item Number 14. Otherwise, proceed to Item 10 and the following items. 10. Justification Summary: Provide on no more than three one sided, double spaced pages a summary addressing this project, covering each topic listed below. A) Problem description (Provide a narrative of the problem or need); B) Present situation (Describe how the situation is being handled now); C) The proposed solution (Present your proposed solution); D) Consequences if not funded (Explain what will happen if this project is not funded); E) The geographic area to be addressed (Provide a narrative description of the geographic area); F) The proposed time frames (Provide a list of the time frame(s) for completing this project); G) Data Sources (Provide a complete description of data source(s) you cite); H) Statement attesting that the proposal is not a duplication of a previous effort (State that this project doesn't duplicate what you've done on other grant projects under this grant program). DH Form 1767, Rev. 2002 2 10. Justification Summary: A) Problem description: The City of Miami's Department of Fire -Rescue (MFR) current operation conditions may have a negative impact an Quality Patient Care, which could subsequently increase morbidity and mortality rate. Two of the causes that lead to this problem are: Radio Communications and Incident Times: MFR's Dispatch Center is frequently overwhelmed and at Critical Mass in trying to deal with the large amount of radio traffic involving the 82,393 annual alarms we are responding to. In addition to relaying the alarm address, alarm type and pertinent information, the operators and officers are continually on the radio updating their status (acknowledging responding, scene arrival, patient arrival, hospital transport, scene secured, return to service, return to station, etc.) Due to the excessive radio traffic, CRITICAL alarm information is placed on hold (causing delayed response), vital alarm information is lost or mis-understood and incident times are not consistently accurate,. Data Collection, Transmitting, Referencing. Compliance and Billing: MFR does not have the capability of efficiently collecting data at patient side, relaying completed/finalized data to hospitals upon transfer of the patient, or easily referencing Department Protocols, Policies and Procedures in the field and at patient side. The use of a handwritten abbreviated run report (field copy), results in not having all applicable data fields (from Fire Station based software program) at patient side, this can lead to incomplete data gathering in the field which may result in discrepancies (liability concern) when the final report is completed at the station, In addition, filed copies are handwritten (sometimes in adverse conditions) and can be very difficult for hospital staff to read, which could result improper patient care decisions. Our current processes diminish our compliance with gathering all required local, state and federal data fields (this includes the National EMS Incident System that the State has committed to comply with). MFR does not have the ability to properly reach the State EMS Office's goal to 'develop an integrated data system for use in research and validation of EMS delivery systems, including evaluation of service delivery and patient outcomes." Finally incompletelconlicting data also lowers our ability to maximize our EMS billing revenue. MFR has 54 units (23 ALS (Advance Life Support) Rescues, 1 ALS Pumper, 4 Supervisors, 16 Fire Trucks and 10 ALS Special Event units) serving the EMS needs of approximately 365,000 residents, and over 1.2 million people coming to work, visiting and doing business an an everyday basis within city limits. Miami continues to be a gateway for poor immigrants. Low income families and the elderly are the City most vulnerable groups. In 2002 Miami's median income was $20,833, and 31 % of its residents lived in poverty. Seventeen percent of its population is age 65 and older, and 40 % of them live in poverty. They don't have health insurance or the resources to pay for health care. By relying on MFR for their basic medical needs, they routinely put heavy demands on MFR's resources, which handled 82,393 calls for assistance in 2004, 3 B) Present situation: Presently, the City utilizes radio communication and station printout to dispatch units to alarms (82,393 in 2004). All updates of information (change in patient status/location, times, unit status, etc.) are done via radio communications. Congested airways results in delayed response. Due to the excessive radio traffic, CRITICAL alarm information is placed on hold, vital alarm information is lost or mis-understood and incident times are not consistently accurate,. Pre -designed forms (field copies) are handwritten by the Officers in the field to document every alarm their unit is requested to assist. Upon transporting the patient to a local care facility, the Officer issues the top page of their field copy. After returning to the Fire Station (sometimes up to 8 hours due to additional alarms after the original call) the Officer transposes the information from the field copy manually into a desktop computer at their station for data management, medical reporting and patient billing. If the Officer had multiple calls (which quite frequently is the case) their recollection may blend multiple alarm information together. In addition, it is very time consuming (over 30 minutes) to input the required data on a single report. C) Proposed solution: MFR proposes to improve its delivery of EMS by implementing a Wireless Data Collection (WDC) System through the purchase of Mobile computers and accessories, MFR wilt purchase and place 54 wireless data collection devices (tablets/laptops for our 23 ALS Rescues, 1 ALS Pumper, 4 Supervisors, 16 Fire Trucks and 10 ALS Special Event units) and 35 portable printers (for our 24 ALS units, 6 hospitals and 5 spares). The associated hardware needed to support this program will be installed in the above units and hospitals, along with our 14 Fire Stations serving the City residents. Dispatch information (location, type call, change in patient status, tunes, unit status, etc) will be sent wirelessly to and from these devices. The Officer on the scene will be prompted, via existing software program, to gather all pertinent data at patient side. Information can then be transmitted to assist in compiling patient care data, and provide hard -copy -patient -run -reports upon arrival at the hospital. At any location during the alarm MFR units will have full access to the City's server, including Department Protocols, Policies and Procedures, specific and aggregate data to be shared with the State/Federal government and also to be stored for historical, billing and liability protection purposes. In summary, our "WDC" System will allow the City to collect, enter, store, and analyze EMS data in the field at patient side, facilitating the reduction of morbidity and mortality rate. D) Consequences if not funded: If not funded, the lack of this enhanced technology could have negative consequences in the morbidity rate of the City residents and visitors. MFR will continue to utilize its current practice of radio dispatching, data entry and management. This will result in delayed response and mis-understanding of Critical Alarm information. Overwhelmed radio communications provides for inaccurate times being collected and delayed treatment, creating negative effects in delivering quality patient care. Not having wireless data capability in the field will result in Officers continuing to omit pertinent data on the field copies. Hospitals will continue to have difficulty reading handwritten field copies, which could lead to improper patient care. 4 Conflicting information between the field copy and station report will continue to exist and restrict our capability to gather and submit all required local, state and federal data fields including the National EMS Incident System. Without the WOG system, Officers will be unable to reference up to date Department Policies, Procedures and Protocols in the field which could lead to improper scene actions, injuries to personnel or improper patient care. MFR will continue to have an insufficient return on patient billing and most important, will not have the ability to properly reach the State EMS Office's goal to "develop an integrated data system for use in research and validation of EMS delivery systems, including evaluation of service delivery and patient outcomes." E) The geographic area to be addressed: This grant will serve the entire 34.5 square miles of the City of Miami. The City has 365,000 residents, and welcomes over 1,2 million people coming to work, visiting and doing business on an everyday bases within city limits. Among large cities, Miami is the poorest in the State and the 4th poorest in the US. It continues to be a gateway for poor immigrants, and its one-sided economy relies heavily on tourism. Low-income families and the elderly are the city's most vulnerable groups. In 2002 Miami's median income was $20,883, and 31 % of its residents lived in poverty. Seventeen percent of its population was aged 65 and older and 40% of them lived in poverty. Their special needs routinely puts' heavy demands on MFR's 911 system, which handled 82,393 calls for assistance in 2004. F) The proposed time frames: Months 1 to 3: present award to the City commissioners for approval, research supply, meet with sales representative, write specifications for the equipment to be purchased, plan equipment installation, and develop training curriculum. Months 3 to 6: purchase equipment and set up training schedule. Month 6 to 12: configure and install equipment, begin training, document personnel trained. G) Data Sources: 2000 U.S. Census data for the City of Miami, 2004 City of Miami Management Information System, 2004 City of Miami Department of Fire -Rescue Incident Report System, and 2002 City of Miami Department of Fire -Rescue 5 Year Strategic Plan. hl) Statement attesting no duplication: The City of Miami MFR project to purchase and install WDC devices into the entire fleet of Fire Rescue units does not duplicate any previous efforts or activity on another grant under this grant program, 5 11. Outcome For Projects That Provide or Effect Direct Services To Emergency Victims: A) Quantification of the situation in the most recent 12 months: From January 1, 2004 to December 31, 2004, the City of Miami Fire -Rescue (MFR) responded to 82,393 alarms for assistance which resulted in over 1 million radio transmissions including dispatch, acknowledgment, scene arrival, patient arrival, hospital status, hospital transport, hospital arrival, scene secure, and return to quarters. Of the 82,393 alarms that we responded to 16,200 were ALS patients (388 needing incubation), 12,320 were trauma related, 7,260 were cardiac related, 1,254 were stroke related and 540 were Dead on Arrival. The average Total Response Time from receipt of 911call to arrival on scene was 6.8 minutes; with the lack of ability for us to specifically measure the time from Dispatch to time apparatus begins movement to scene. MFR crews were not able to reference any Protocols, Policies and Procedures while away from the unit at patient side, since wireless communication is non existent. Over 80% of the patient care reports left at hospital during patient transfer were inconsistent with the final EMS report generated in some cases 8 hours later, raising our liability concerning conflicting data. B) Estimate of what the above numbers should become in the 12 months after this project's resources are online: The number of alarms is expected to increase to 86,512 (5% increase) based on the projected increase in the City's population. The number of radio transmissions is expected to improve by decreasing 80% to about 200,000. Due to the anticipated increase in alarms we can expect 12,936 to be trauma related, 7,623 are expected to be cardiac related and 1,316 are expected to be stroke related. We do however estimate that the amount of patients needing more advanced ALS treatment (including Intubation) will improve by decreasing some 38 patients due to shaving .7 minutes off of the Total Response Time,. The average Total Response Time is expected to improve by decreasing 10% to 6.1 minutes. The most up-to-date Protocols, Policies and Procedures are expected to be capable of being reviewed 100% of the time (when needed) during the alarm which will improve scene operations. The amount of billing revenue is expected to improve by increasing 12% to $5,814,452. Less than 1 % of the reports given to the hospitals will conflict with the Final EMS report, which is a major improvement over the existing numbers. C) Justification and explanation of how above numbers are derived: The alarm number increased to 86,512 is based on the 5% increase over Year 2003 alarms coupled with the Year 2005 Residential and Commercial building projections by the City's Planning Department. The reduction in radio transmissions is due to the fact that by having wireless mobile data devices in the units will eliminate the need for the Officer to communicate via radio the following; responding, scene arrival, patient arrival, hospital status, transporting to hospital, arriving at hospital, scene secure and back in quarters. The decrease in Total Response Time is due to the fact that the wireless data devices will eliminate the need for the dispatchers or officers to wait on busy radio traffic to clear to give a radio dispatch transmission or a report of the unit's status. By shortening the Total Response 6 Time the crews will be able to begin assessing patients quicker and render ALS treatment that will stabilize the patient sooner. This practice will avoid such drastic and advance treatments such as incubation (this should lower the number of patients intubated from 388 to 350). The increased number of trauma, cardiac and stroke related alarms, is due proportionally to the 5% increase in total alarms. With the capability to input the unit's status into the wireless mobile data device and for this information to be immediately transmitted into the Computer Aided Dispatch (CAD) System, we will see much more accurate times. The Department's up to date Protocols, Policies and Procedures can be accessed at all times via the wireless device, The increase in billing revenue is due to the fact that the wireless mobile EMS computers will have software loaded onto them that will prompt the officer to enter all pertinent information at patient side. This will allow for more correct and complete information to be gathered and entered in a timely manner while the information is fresh in the officer's mind. The end result will be more accurate reports that will allow for more justifiable billing of EMS care. The elimination of the field copy along with the help of the mobile software will result in only one well written report being produced at the hospital and being loaded into the records system. D) Other outcomes expected of this project: The doctors and nurses at the receiving hospitals would have access to completed patient information in reduced time, Patient care reports will be 100% readable and accurate, decreasing by 90% the potential to render improper patient care based on a hard to read hand written report. The crew would be better able to operate in the field by having 100% of the times direct access to Department Protocols, Policies and Procedures. The Department would be better able to monitor Turn Out times of crews, and decrease response time by'/% minute. Through increase billing revenue by 12 % the Department would become less dependant on Federal, State and local funds to meet its obligations. E) Integration Into agency's five year plan: This project integrates well into the Five Year Strategic Plan of the City of Miami. Specifically it addresses the 1st and 8th Goals & Objectives of the Emergency Response Division in the following manner: Improve the average emergency response time to comply with National Fire Protection Association (NFPA) by purchasing systems that can measure the time from Dispatch to time apparatus begins movement to scene, and travel time. Improve apparatus laptop computer performance and usability by identifying, field testing, purchasing and installing the appropriate equipment and components into all apparatus. 7 �.S 15. Statutory Considerations and Criteria A) Serve the requirements of the population upon which it will impact: Miami is a geographically small but densely populated urban area with a significant proportion of residents who are vulnerable and disadvantaged, as detailed in the application. Because of the high poverty, many residents (particularly the 17% of residents 65+ and the 31 % who live in poverty) don't have health insurance or the resources to pay for health care, so they rely on MFR for their basic medical needs, which make us one of the busiest EMS agencies in the country. This grant if funded will allow us to better meet our Mission to "Serve the Citizens of Miami in a professional manner by providing rapid emergency response and other services to save lives and protect property." B) Enable emergency vehicles and their staff to conform to state standards established by law or rule of the department: Covered in Florida Statute 401 and Chapter 64E-2.003. By acquiring the requested equipment we will be able to collect more accurate data which will greatly enhance the quality of aggregate data that the State requires. C) Enable the vehicles of your organization to contain at least the minimum equipment and supplies as required by law, rule or regulation: Covered in Florida Statute 401 and Chapter 64E-2.003 D) Enable the vehicles of your organization to have, at a minimum, a direct communications linkup with the operating base and hospital designated as the primary receiving facility. The requested equipment will allow us to wirelessly link up with the base hospital (and other hospitals) concerning patient and care data, hospital status, Mass Casualty Incident Alerts and bed counts. E) Enable your organization to improve or expand the provision of: 1) EMS services on a county, multi county, or area wide basis: MFR will dramatically improve communications throughout the City, and will be able to report accurately and timely statistics to the County and the State. 2) Single EMS provider or coordinated methods of delivering services: Using wireless capability in the field will allow for coordination of patient care data between on scene units, alarm (dispatch) office and hospital, This will result in quicker responses, fewer mistakes, better reports/communications and better patient care. 3) Coordination of all EMS communication links, with police, fire, emergency vehicles, and other related services: Using wireless capability will allow us to have the Computer Aided Dispatch (CAD) information sent wirelessly to the unit in the field. Our new CAD (Go Live Sept. 05) will incorporate Police and Fire -Rescue which will allows us to be interoperable with the Police Dept. In addition Miami -Dade County recently switched to the same CAD vendor which we plan to utilize interoperability to help in our Mutual Aid response with the County and other area departments. 16. Work activities and time frames: Indicate the major activities for completing the project (use only the in less than six months and if it is a purchasing certain makes of after the bid is let. space provided). Be reasonable, most projects cannot be completed communications project, it will take about a year. Also, if you are ambulances, it takes at least nine months for them to be delivered Work Activity Number of Months after Grant Starts Begin End Present award to the City commissioners for approval 1 2 Research supply and final prices, meet with sales representatives, and write specifications for the equipment to be purchased 2 3 Develop training curriculum 2 3 Purchase equipment 4 6 Set up installation schedule 5 6 Begin installation 7 10 Complete installation 10 12 17. County Governments: If this application is being submitted by a county agency, describe in the space below why this request cannot be paid for out of funds awarded under the state EMS county grant program. Include in the explanation why any unspent county grant funds, which are now in your county accounts, cannot be allocated in whole or part for the costs herein, NA DH Form 1767, Rev. 2002 9