Loading...
4. Advanced Life Support OrdinanceKALISPE FIRE DEPARTMENT 111812000 TO: Mayor Pamela B. Kennedy and Kalispell City Council FROM: Randy Brodehl, Fire Chief James H. Patrick, City Manager SUBJECT: Advanced Life Support within the City of Kalispell WORKSHOP DATE: 11 /13/2006 BACKGROUND: On September 25t', 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 provided by the Kalispell Fire Department advanced life support (ALS) ambulance. Now, as noted in the letter, Marion Ambulance 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. Since that time, a memorandum of understanding has been signed by the medical directors of Marion Ambulance, Flathead County, and Kalispell Fire Department. Respectively, these individuals are Dr. Scott Rundle, Dr. Robert Bates, and Dr. Richard Briles. (See attached MOU). As agreed by the three medical directors, Marion Ambulance will only be dispatched to BLS calls in the Smith Valley area, and Kalispell Fire Department will only be dispatched to ALS calls in this area. This is because Marion Ambulance Company does not have paramedics, and is not certified to provide advanced life support service; and, all of Kalispell Fire Department operations personnel are certified paramedics. It should also be noted that the decision about what type of medical expertise is sent is made by a dispatcher, based on the information that is provided by the caller. Since neither the caller nor the dispatcher is a paramedic or medically trained person, calls can receive inappropriate responses, leaving the patient without paramedic care for an immediately life threatening situation. The Smith Valley community averages 158 calls annually. Of these, 00-70 percent are dispatched as advanced life support calls. In spite of the memorandum of understanding, and in spite of only Kalispell Fire Department being dispatched, Marion Ambulance continues to monitor the radio and self -dispatches to ALS calls in this area, and then attempts to cancel the Kalispell Fire Department ambulance response. Additionally, the Fire Chief of Smith Valley also attempts to cancel the response by Kalispell Fire Department by ordering the dispatcher to cancel Kalispell and have Marion Ambulance respond instead. Kalispell Fire Department continues their response on these calls, because the only entity having the legal responsibility to make this kind of change is the Medical Control Physician (the physician working in the KRMC emergency room who has the ultimate responsibility for treatment of the patient in the field). Because of this, multiple calls have had two ambulances on scene. As can be imagined, the patients and families are confused by this, and response capabilities for other emergency calls are shorted. Dr. Bates, Flathead County Medical Director, has been unable to farce either Marion Ambulance or Smith Valley Fire Department to stop this action, and there is a continued threat to response capabilities in this community. These changes and issues have made it very evident that an ambulance service could come into any area now served by the ALS service of the Kalispell Fire Department and begin responding to all medical calls. This could easily include any part or all of the City of Kalispell, regardless of staffing qualifications or capabilities. Without full advance life support capabilities as is currently provided by the Kalispell Fire Department, the quality of treatment would be compromised and confusion would reduce response capabilities. The city of Kalispell does not require a business license for ambulance services, leaving the State of Montana as the default regulator of ambulance service providers in the City. Recommendation To assure the current level of service, Council should consider an ordinance requiring that all ambulance service response in the City of Kalispell be certified by the State of Montana as Advanced Life Support providers. This will assure that the quality of ambulance service is not compromised and that residents can expect the same emergency medical response that they currently receive. Fiscal Impact The Kalispell Fire Department provides an ALS ambulance service that operates as an enterprise fund. This means that the ambulance service does not receive tax funds to operate. Twenty percent of personnel costs and a portion of all facilities and administrative costs have been assigned to this fund. Should the number of medical responses by the department decrease, the funds available for personnel, facilities, and administrative costs would be reduced commensurately. Respectfully submitted, r� Aa dy rodehl, Fir Chief J mes H. Patffck, City Manager Flathead County EMS 103 5 1 "Avenue West Kalispell, MT 59901-5607 751- 8190/8191 October 23, 2006 Dispatch Instructions for the Smith 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 bath Marion Ambulance and Smith Valley Fire Department (the non -transporting 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 call from ALS to BLS (i.e. cancellation of I FD) must be done through medical control at I RMC and should not involve the 911 Dispatch Center. Marion Ambulance/Smith 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 authorization which means they potentially may have an ALS responder with them on any given run in the future (at this time they do not have a regularly responding paramedic). This does not have any bearing on the ALS service area dispatch but the Dispatch Center needs to understand this potential service may be available if ALS is not available from either KFD or ALERT. Additionally, Marion Ambulance remains the BLS unit that assists ALERT and should continue to be dispatched to back-up and assist ALERT. Sincerely, Robert Bates, MD Flathead County EMS Medical Director Memorandum of Understanding This Memorandum of Tend ding is entered into by and between Kalispell. Medical Director Richard Briles, Marion Ambulance Medical Director Scott Rundle, and Flathead County Emergency Medical Services Director Rob .Bates, MD and ,will clarify the provision of Emergency Medical Services in the smith valley Fire District (District). REAS, Marion has established emergency medical services in the smith valley Fire District, and, Medical Director Rundle has determined. that Marion may operate as a BLS with an authorization for ALS transporting unit at this time, and, Kalispell is licensed as an ALS Emergency Medical Service transporting unit and provides an ALS Services, and, Kalispell Regional. Hospital and their emergency medical staff is medical control for Kalispell and Marion.. THE EFORE, let it be understood that the intent ofthi.s agreement is to provide optimum pre - hospital patient care and will be aministered as follows: Marion will operate as a BLS with an authorization for ALS- EMS Transporting unit within the District, and, Kalispell win continue to provide ALS service with ALERT and BLS service as necessary to the District, and, There may be circumstances when Marion may respond to a call ,where ALS has been dispatched. In cases where this occurs, it is expected that Marion will follow medical protocol established by their Medical Director to stab i ze and make ready a person to be transported by Kalispell, and, On. -line medical control must authorize any ALS transport by Marion, and Kalispell shall replace any medical goods Marion utilized during their care of the patient, and, Marion must provide their- status as to unit availability and current service level to dispatch, and, The legally identified Incident Commander shall be responsible for upgrading or downgrading the level of EMS response in consultation with Medical Control. r 3Aproed t. v on October-, 2 0D6, b .p� Rob Bates, M.D. Richard Briles, M.D. FCEMS Director Kalispell FA. Med. Director le, M.D. Marion Amb. Me& Director KALISPELL FIRE DEPARTMENT Randy Brodehl Fire Chief _ 312 First Avenue East Daniel Diehl — Assistant Chief/Operations _==__- -= _ Kalispell, Montana 59941 Brent Christopherson - Assistant ChieMevention - _ - Phone: (446) 758-7760 - FAX: (406) 758-7952 9/25/2006 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 Smith 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 "Assisting our community in reducing, preventing, and mitigating emergencies. "