Loading...
HomeMy WebLinkAboutEMS Grant ApplicationEMS MATCHING GRANT APPLICATION FLORIDA DEPARTMENT OF HEALTH Bureau of Emergency Medical Services Complete all 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 Department of 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) Name: Robert Ruano Position Title: Director of Grants Administration Address: Cit of Miami 444 SW 2 nd Ave, th Floor __,' City: Miami County: Dade State: Florida Zip Code: 33130 Telephone: (305) 416-1532 Fax Number: (305) 416-2151 E-Mail Address: rruano@miamigov.com 3, Contact Person: (The individual with direct knowledge of the project on a day-to-day basis and responsibility for the his person may sign project reports and may request project changes. The signer and Captain Ruben Bargueiras implementation of the grant activities. the contact person may be the same.) Name: Position Title: Executive Assistant to the Fire Chief Address: 1151 NW 7 St, 3rd Floor City: Miami County Miami -Dade State: Florida Zip Code: 33136 Telephone: (305) 416-5430 Fax Number: (305) 400-5280 E-mail Address: rargueiras ai?miamigov.com DH Forrn 1767, Rev, June 2002 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/Town/Village (4) ❑ County (5) ❑ State (6) E Other (specify): 5, Federal Tax ID Number (Nine Digit Number). VF 596000375 6. EMS License Number: 2276 Type: XX Transport ❑Non -transport ❑Both 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.] Signature: Date: 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 sklp 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 10. Justification Summary: A) Problem description: The objective of CPR is to provide sufficient circulatory support to a patient in cardiac arrest (SCA) to restore spontaneous circulation. The cornerstone of this approach is maintenance of an adequate blood pressure and vital organ perfusion pressure when the heart is incapable of providing the essential cardiac output on its own. In spite of the many advances in medical care, there has not been a significant improvement in the survival rate from cardiac arrest in 30 years. Although survival from sudden cardiac arrest (SCA) in a US hospital is 3 times greater than for patients who suffer an arrest at home, consider that: (1) survival after in -hospital arrest is only 16%1; (2) In the vast majority of cases, the presenting rhythm is not chockable (VFNT), so drugs and compressions are the only viable treatment. For cardiac arrests where shock is not indicated or defibrillation is delayed, adequate cardiac tissue perfusion and circulation are crucial in providing a successful defibrillation2. Recent studies have shown that even mildly excessive ventilation rates and incomplete chess wall recoil during, CPR can be lethal. Conventional manual CPR is inherently inefficient and provides only marginally adequate coronary perfusion pressures due to the sub -optimal pressure gradient between the aorta, the right atrium'and left ventricle in the heart. During the decompression phase of CPR, a small intrathoracic vacuum (relative to atmospheric pressure) develops with each chest wall recoil, promoting blood flood back to the heart. Myocardial perfusion predominantly occurs during this key decompression phase of CPR. The difference between diastolic aortic and the right atrial pressures (CPP) is a critical determinant of CPR efficacy. Much of the potential hemodynamic benefit of this intrathoracic vacuum is lost when respiratory gases enter the lungs during the decompression phase of CPR. As a result, less venous blood goes back into the heart, cardiac preload and cardiac output is decreased reducing blood pressure and limiting vital organ perfusion. The intracranial pressure is higher during the decompression phase of CPR, which combined with decreased cardiac output results in lower cerebral perfusion. In an effort to improve outcomes in cardiac arrest patients a new technology has been developed that rediscovers and works to maximize the most important principles surrounding optimization of blood flow during resuscitation, however, due to fiscal constrains it has proven difficult to Miami Department of Fire Rescue (MFR) to take advantage of this technology and ameliorate working conditions encountered in a cardiac arrest situation. Miami is the poorest large city in the State and the 3rd poorest in the US. It continues to be a gateway for poor immigrants. Low-income families and the elderly are the city's most vulnerable groups. In 2002, Miami's median income was $20,883, well below the national average of $50,046, and 31 % of its residents lived in poverty. Seventeen percent (17%) of its population was of 65 years of age or older and 40% of them lived in poverty. This percentage increases dramatically between November and April of each year as older adults known as "snow -birds" migrate down to Florida from colder climates. The lack of preventative health care exacerbates the problem as well. This annually migration causes a significant increase in the amount of EMS calls leaving fewer MFR personnel per capita to respond to EMS/Fire related emergencies. This group's special needs routinely put heavy demands on MFR's 911 system. MFR serves the EMS requests of approximately 365,000 residents, and over 1.2 million people who commute to work, visit and/or do business on an everyday basis within city limits. Last year, MFR's 54 units (23 ALS Rescues, 1 ALS Pumper, 4 Supervisors, 16 Fire Suppression units and 10 ALS Special Event units) handled more than 86,000 calls for assistance, of which 621 were classified as possible Cardiac Arrest Calls. MFR attempted to resuscitate 243 patients. B) Present situation: The current method of delivering CPR on our residents may have a negative impact on Quality Patient Care, which could subsequently increase the morbidity and mortality rate in the City. Presently, our EMS personnel deliver CPR by using emergency transport ventilators (ETV) and by homodynamic performance of manual chest compression until a second unit arrives on the scene and a pneumatic chest compression device (Thumper) can be applied. EMS crews need to accomplish many task to effectively resuscitate a cardiac arrest patient (e.g., intubating, IV, medications, defibrillating, packaging, etc). New technologies that will indeed double both blood flow to the heart and increase blood pressures will be much more efficient. It will improve the circulation to the brain and significantly increase the chances of survival after an out -of -hospital cardiac arrest. C) Proposed solution: MFR proposes to equip its ALS units with a ResQPOD or equivalent Impedance. Threshold Devices (ITD) and train all Paramedic(s)/EMT(s) in its use. This new technology combined with CPR or Active Compression Decompression (ACD CPR) has shown markedly higher blood flow to the heart and brain compared with either method alone. By greatly increasing circulation during CPR, the ITD helps to improve the deliver of vital nutrients to the patient's organs, thus increasing the efficacy of the intravenous vasopressor therapy. The early application of this device complies with the new changes to the CPR guidelines from the America Heart Association (AHA) which emphasizes CPR prior to providing electrical shock, drug and/or intubation therapy of a cardiac arrest patient. As a result of the increased circulatory pressure, the ResQPOD or equivalent device will help to better visualize and palpate veins, thus enhancing the initiation of an IV and improving the circulation of fluids and drugs. D) Consequences if not funded: The lack of this enhanced technology could have significant negative consequences to the residents and visitors of the City. MFR will continue to utilize its current practice of delivering Tess effective CPR, which may result in a decreased circulatory pressure and decrease the viability of a SCA patient. E) The geographic area to be addressed: This grant will serve the entire 34.5 square miles of the City of Miami, The City hosts 365,000 residents, and welcomes over 1.2 million people daily. 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, equipment installation plan, and training curriculum. Months 3 to 6: purchase devices and set up training schedule. Month 6 to 12: equip . -aa devices on rescue units; implement training, document personnel trained. G) Data Sources: 1) Kaye,W. et al, J Am Coll. Cardiol 39(5), Suppl A. 2) Cobb, L. et al, J Am Med Assoc 281(13): 1182 —1188 3) Wigginton, J; The Inspiratory Impedance Threshold Device for Treatment of Patients in Cardiac Arrest; Business Briefing: Long Term healthcare 2005 and the 2000 U.S. Census data for the City of Miami, 2005 City of Miami Management Information Systems Department, 2005 City of Miami Department of Fire -Rescue Incident Report System, 2002 City of Miami Department of Fire -Rescue 5 Year Strategic Plan. H) Statement attesting no duplication: The City of Miami MFR project to purchase and install ResQPOD or equivalent ITDs into rescue units does not duplicate any previous efforts or activities on another grant under this grant program. 11.Outcome For Projects That Provide or Effect Direct Services To Victims: A) Quantification of the situation in the most recent 12 months: From January 1, 2005 to December 31, 2005, MFR responded to 86,318 calls (alarms) for assistance which resulted in over 243 patients requiring CPR. One Hundred and Eighty Eight patients died, while 55 cardiac arrest cases arrived to the hospital with a pulse rate. B) Estimate of what the above numbers should become in the 12 months after this project's resources are on-line: Based on the projected increase in the City's population the number of alarms are expected to increase to 90,634 or (5%) over the previous year. Due to this anticipated increase in alarms MFR can expect at least 255 patients will require CPR intervention. As a result of implementing this program the Department anticipates its success rate will improve by 15%-20%. While studies using ITD have indicated a significant improvement (more than double) in the survival rates in cardiac arrest patients with pulseless electrical activity (PEA)3, MFR expectations in the field are much more conservative (15%-20%). C) Justification and explanation of how above numbers are derived: The projected alarm number increase to 90,634 is based on the 5% increase over Year 2005 alarms coupled with the Year 2006 Residential and Commercial building projections by the City's Planning Department. The increased number of mechanical ventilation and cardiac arrest patients is due proportionately to the 5% increase in total alarms. The increased save rate of 15%- 20% is a conservative estimate based on the report put out by the American Heart Association in 2003. D) Other outcomes expected of this project: MFR anticipates that by implementing this new technology there will be an increase in the viability of patients treated for Cardiac Arrest. The use of the Impedance Threshold Device, will improve circulation to the heart and brain thus increasing not only the patient's survivability but also improve his or her quality of live after recovery. 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 Department's Goal #13 to "Improve operations throughout the department by researching and implementing new techniques and/or equipment to effect better delivery of service and quality patient care." 15. Statutory Considerations and Criteria A) Serve the requirements of the population upon which it will Impact: As detailed in the application, Miami is a geographically small but densely populated urban area with a significant proportion of its residents who are vulnerable and disadvantaged. Seventeen percent (17%) of all City residents are 65 years of age or old and of those, thirty one percent (31 %) live in poverty, Most of these residents don't have health insurance or the resources to pay for health care. Subsequently, these residents rely on MFR not only for Fire/EMS emergencies but also for their basic medical needs, making us one of the busiest Fire/EMS Departments in the country. This grant, will allow MFR to better meet its 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." MFR's critical patients will be served well by implementing a new medical technology which will improve the Cardio-Pulmonary Resuscitation (CPR) MFR currently provides. 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. C) Enable the vehicles of your organization to contain at least the minimum equipment and supplies as .4 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. NA E) Enable your organization to Improve or expand the provision of: 1) EMS services on a county, multi county, or area wide basis: ResQPOD or an equivalent Impedance Threshold Device (ITD) will improve services throughout the City of Miami. 2) Single EMS provider or coordinated methods of delivering services: Providing for EMS personnel ResQPOD or equivalent ITD will expand the advanced medical techniques that MFR can offer to its community at the same time raising its quality of service resulting in better patient care. 3) Coordination of all EMS communication links, with police, fire, emergency vehicles, and other related services; The ITD will allow MFR to work seamlessly with other Hospitals that utilize MFR for inter -facility transports of critically ill/injured patients. This new technology will improve MFR's medical treatments when responding to cardiac arrest calls with our local police department, Miami Dade Fire Rescue and Police. 16, Work activities and time frames: Indicate the major activities for completing the project (use only the in Tess than six months and if it is a purchasing certain makes of ambulances, is let. space provided). Be reasonable, most projects cannot be completed communications project, it will take about a year. Also, if you are it takes at least nine months for them to be delivered after the bid 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 technology to be purchased 2 3 Develop and implement training curriculum 2 3 Purchase and distribute technology 4 6 Begin training 5 6 Complete training 7 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. N/A DH Form 1767, Rev, 2002 18. Budget: Salaries and Benefits: For each position title, provide the amount of salary per hour, FICA per hour, fringe benefits, and the total number of hours. TOTAL: Expenses: These are travel costs and the usual, ordinary, and incidental expenditures by an agency, such as, commodities and supplies of a consumable nature, excluding expenditures classified as operating capital . utlay (see next category), .se DH Form 1767, Rev, 2002 TOTAL: Costs Costs: List the price and source(s) of the price identified, Justification: Provide a brief justification why each of the positions and the numbers of hours are necessary for this project. Justification: Justify why each of the expense items and quantities are necessary to this project. Vehicles, equipment, and other operating capital outlay means equipment, fixtures, and other tangible personal property of a non consumable and non expendable nature, and the normal expected life of which is 1 year or more. Costs: List the price of the Item and the source(s) used to identify the price, Justification: State why each of the items and quantities listed is a necessary component of this project. ResQPOD or equivalent ITD 30 Boxes (10 / Box) @ $890,00 = $26,700.00 A quantity of 30 Boxes of ResQPOD or equivalent ITDs will supply for 25 ALS Rescues, 1 ALS Pumper and 1 spare, thus allowing system wide implementation TOTAL: $26,700.00 FINAL TOTAL: $26,700.00 State Amount (CheckBapplicable program) XX Matching: 75 Percent ❑ Rural: 90 Percent Local Match Amount (Check applicable program) XX Matching: 25 Percent ❑ Rural: 10 Percent Grand Total $ 20, 025.00 $ 6,675,00 $ 26,700.00 DH Form 1767, Rev, 2002 19, Certification: My signature below certifies the following. I am aware that any omissions, falsifications, misstatements, or misrepresentations in this application may disqualify me for this grant and, if funded, may be grounds for termination at a later date. I understand that any information I give may investigated as allowed by law. I certify that to the best of my knowledge and belief all of the statements contained herein and on any attachments are true, correct, complete, and made in good faith. I agree that any and all information submitted in this application will become a public document pursuant to Section 119.07, F.S. when received by the Florida Bureau of EMS. This includes material which the applicant might consider to be confidential or a trade secret. Any claim of confidentiality is waived by the applicant upon submission of this application pursuant to Section 119.07,F.S., effective after opening by the Florida Bureau of EMS. 1 accept that in tip best interests of the State, the Florida Bureau of EMS reserves the right to reject or revise any and all grant proposals or waive any minor irregularity or technicality in proposals received, and can "exercise that tigh 1, the undersigned, understand and accept that the Notice of Matching Grant Awards will be advertised in the Florida Administrative Weekly, and that 21 days after this advertisement is published l waive any right to challenge or protest the awards pursuant to Chapter 120, F.S. I certify that the cash match will be expended between the beginning and ending dates of the grant and will be used in strict accordance with the content of the application and approved budget for the activities identified. In addition, the budget shall not exceed, the department, approved funds for those activities identified in the notification letter. No funds count towards satisfying this grant if the funds were also used to satisfy a matching requirement of another state grant. All cash, salaries, fringe benefits, expenses, equipment, and other expenses as listed in this application shall be committed and used for the activities approved as a part of this grant, Acceptance of Terms and Conditions: If awarded a grant, I certify that I will comply with all of the above and also accept the attached grant terms and conditions and acknowledge this by signing below. / Signature of Authorized Grant Signer MM / DD / YY ;Individual Identified in Item 2) DH Form 1767, Rev. June 2002