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4. Ordinance 1594 - Advanced Life Support - 2nd ReadingKALISPELL FIRE DEPARTMENT 11/29/2006 TO: Mayor Pamela B. Kennedy and Kalispell City Council FROM: Randy Brodehl, Fire Chief James H. Patrick, City Manager SUBJECT: Advanced Life Support Ordinance COUNCIL MEETING DATE: 1 21412DD6 BACKGROUND: On September 25 , Council reviewed a letter from Fire Chief Randy Brodehl to city Manager James H. Patrick. This letter outlined ambulance response changes in the Smith Valley community. Until that time, all ambulance service provided to this area was by the Kalispell Fire Department advanced life support (ALS) service. Now, as noted in the letter, Marion Ambulance Service, an for profit company, has moved a basic life support (BLS) ambulance into a Smith Valley fire station, and has begun responding to all medical emergencies in the Smith Valley community, including BLS and ALS emergencies. Marion Ambulance Service does not have paramedics, and is not certified to provide ALS service. All of Kalispell Fire Department operations personnel are certified paramedics and the Department is certified to provide ALS and BLS service. It should also be noted that the decision whether an emergency ambulance call is ALS or BLS is made by a dispatcher, based on the information that is provided by the caller. Since neither the caller not the dispatcher is a paramedic or medically trained person, calls can receive inappropriate responses. This can mean that patients are without paramedic care for an immediately life threatening situation. These changes and issues in the Smith Malley community have made it very evident that an ambulance service, regardless of their medical training and certification, could begin responding into any area now served by the Kalispell Fire Department. This could easily mean that patients could receive a significantly less qualified response, without the full advance life support capabilities currently provided by the Kalispell Fire Department. The quality of treatment would be compromised and confusion would reduce response capabilities. Without an ordinance defining emergency medical response criteria, the State of Montana becomes the default regulator of ambulance service providers in the City_ Since by law, the state limits it's responsibilities to certification of services as either BLS or ALS, and does not establish minimum response capabilities, a lesser provider is not restricted from responding, unless the local authority having jurisdiction, requires a Certain standard. Recommendation To assure the current level of service, Council should consider an ordinance requiring that all emergency ambulance services in the City of Kalispell be certified by the State of Montana as Advanced Life Support Service providers. This will assure that the quality of ambulance service is not compromised and that city residents can expect the same emergency medical care that they currently receive. Fiscal Impact The Kalispell Fire Department provides an ALS paramedic ambulance service that operates as an enterprise fund. This means that the ambulance service does not received tax funds to operate. Twenty percent of personnel costs and a portion of all facilities and administrative costs t have been assigned to this fund. Should the number of medical responses by the department decreases, the funds available for personnel, facilities, and administrative casts would be reduced commensurately. rA -AL-aft Ran B odehl, Fire Chief Ages H. Patrick, City Manager [$TV� I�Ii�;l Z[�_ Do Z[$W &1 . ] AN ORDINANCE ESTABLISHING THAT THE MINIMUM STANDARD OF EMERGENCY MEDICAL SERVICES THAT MAY BE PROVIDED IN THE CITY OF KALISPELL SHALL MEET ALL OF THE NATIONAL STANDARDS OF ADVANCED LIFE SUPPORT SERVICES AND DECLARING AN EFFECTIVE DATE. AREAS, the City of Kalispell currently provides emergency medical services to its citizens that meets all of the national standards of an Advance Life Support Service; and WHEREAS, the Advance Life Support Service that the City of Kalispell provides to its citizens is the best level of service that can be provided and meets all of the paramedic care required in all immediately life threatening situations; and WHEREAS, it is anticipated that private ambulance services may wish to provide emergency medical services within the City of Kalispell, but which may not be certified to meet the national standards of an Advance Life Support Service; and WHEREAS, the Kalispell City Council finds that it is in the best interests of the health and safety of its citizens that it establish that the minimum standards required for any emergency medical service provided in the City of Kalispell shall meet or exceed the national standards of an Advance Life Support Service. BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF KALISPELL, MONTANA, AS FOLLOWS: SECTION I No emergency medical services may be provided within the city limits of the City of Kalispell unless the provider of those services has provided adequate proof to the City of Kalispell Fire Chief that the provider and all personnel employed by and providing emergency services for that service hold current national certifications of an Advance Life Support Service; EXCEPT that the ALS level of service will not be required for basic medical transportation services of a nonemergent nature; AND EXCEPT that in a mutual aid event, a Basic Life Support Service provider may be called upon by the Flathead County 911 dispatch center to provide mutual aid to augment an AI.S service. SECTION II In the event that an emergency medical service violates the above -described standard, the City may seek relief from the District Court to enjoin such non -authorized provision of emergency medical services and obtain a cease and desist order. SECTION III This Ordinance shall be effective thirty (30) days from and after the date of its final passage and approval. PASSED AND APPROVED BY THE CITY COUNCIL AND SIGNED BY THE MAYOR THIS 4TH DAY OF DECEMBER, 2006. Pamela B. Kennedy Mayor Attest: Theresa white City Clerk Flathead County EMS 103 5 1"Avenue west Kalispell, MT 59901 -5607 751-8190/9191 October 231 26 Dispatch Instructions for the Smiths valley Area Marion Ambulance will now be dispatched to the BLS area. of Smith valley per the amended BLS map. A single dispatch will be done for this area for both Nfarion. Ambulance and Smith Valley Fire Department (the non-tr&ftsporting BLS service). Smith valley area BLS is an addition to the BLS area Marion. Ambulance presently responds to in the Marion area.. Kalispell Fire Department ambulance will continue to be the ALS responding ambulance to the Smith Valley area per the existing ALS map. Any request for downgrade of a ca U from ALS to BLS (i.e. cancellation of KFD) nuw be done through medical control at KRMC and should not involve the 911 Dispatzh Center. Mmion Ambulanoe/Snuth Valley Fire while on a BLS call may request ALS through. the Dispatch Center just as any unit does now. To avoid any confusion, Marion Ambulance has a license for BLS with ALS authorzation which means they potentiaUy may have an ALS responder with them on any given run in the future (at this time they do not have a y responding paramedic). This does not have any bearing on the ALS ice area dispatch but the Dispatch Center needs to understand this potential service may be available if ALS is not available from either 1FD or ALERT. Additionally, Marion Ambulance runs the BLS unit that assists ALERT and should continue to be dispatched to back-up and assist ALERT. Sierely, Robert Bates, MD Flathead County EMS Medical Director Manomndum of UndamWnding This Memorandum of Undustmfing is entcred into by and between. Kalispell Medical Directm Richard. Briles, Marion Ambulance Medical Director Scott Rundle, and Fladwad County Emergency Media Services Director Rob Bates, MD and will clarify the provision of Emergency Medical Services in the Smith Valley Fire piste strict)_ WH , won has established emergency medical services in the Smith Valley Fire District, Medical Director Rundle has determined that Marion may operate as a ILLS with an authorintion for ALA tansporting unit at this time, and, Kah'spell is ficensed as an ALS Emergency Medical service ftuasporting unit and provides aaq ALS And Kalispell Regional. Hospice and their emergency kcal staff is medical control for Kalispell and Marion.. TIMFWFORE� let it be undffskood that the intent of is to pmvide opu pre w hospital pent care and will be as follows: Marion will operate as a BLS with an authorization for ALS- FPS Transporting unit within the District., and, KahspeU will continue to pnMde ALS service with ALERT and BLS service as necessary to the District, and, There may be ciwumstances when won may respond to a caff when ALS has been dispatched. In cases mere this occurs, it is expectedthat Marion will follow medical protocol established by their Media Director to stabilize and rrady a pffsm to be ftangorted by KalispelL and, On-line me cal control must authorize any ALS hwasport by Ma doh and 'spell shall replace any meal goods Marion ufiliwd dudng their care of the patient, and, Marion must proms their staffs as to unit aval-WAW and cwreat sem-ce level to dispatcI4 and, The legally identified Incident Commander shall be responsible for upgpding or downgu&ng the level of EMS r m consultation with. Medical. Control. Approved on OcWbe43 1 2 Rob Baws, M.D. Richard Briles, Ni.D. le, M.D. FCEMS Director Kalispell F&A lied. Director Marion Amb. MedL beam 7/ 25/20Vf To: James H. Patrick, City Manager From: Randy Brodehl, Fire Chief Re: Marion Ambulance response in the Smith and West Valley areas On August 31, 2006, I received an email from Randy Feller, Fire Chief of Smith Valley Volunteer Fire District, informing me that effective 12:01 AM, on September 23, 2006, Marion Ambulance would be housing an ambulance in a Sarri%th Valley Fire Station, and would be taking all BLS and ALS calls in that area. Dr. Bates, Flathead County Medical Control, called a meeting between the above responders, himself, Flathead County Dispatch, and County EMS officials. During this meeting, he reviewed the medical response capabilities of Kalispell Fire Department and Marion Ambulance. He directed Marion Ambulance to not change their response lines, and directed Flathead Dispatch to not dispatch Marion Ambulance to any calls outside of their current response areas, unless they were requested for mutual aid. He has also been in contact with the State Board of Medical Examiners and requested their assistance through their control of state licensing. On September 22, Marion Ambulance contacted the Kalispell Fire Department and told us that they would be monitoring our frequency, and would respond to those calls within the Smith and West Valley areas. To date, there have been two calls in this area. Marion Ambulance responded, without being dispatched, to both of these calls. The first was for an ALS medical response. Their ambulance arrived with one BLS employee, and no other person. We also arrived with two paramedics. The patient refused transport and was taken to the hospital by private vehicle. The second call was for a three vehicle crash. Smith Valley Volunteer Fire District canceled us before our arrival. So, neither response had an impact to patient care. However, this will not always be the case. There is no current limiting ordinance that would prevent this from occurring within the city limits. I will be meeting with the City attorney to review an ordinance that would designate the Kalispell Fire Department as the provider of BLS and ALS ambulance service within the city limits. The need for excellent patient care, the community's expectation, and the stability of our ambulance service, clearly indicate a need for consistency in response. I will update you as additional information is available. Please contact me if you have questions. Randy Brodehl, Fire Chief