07-31-17 EMS Subcommittee Work Session Agenda and MaterialsCITY COUNCIL
EMS SUBCOMMITTEE
AGENDA
Monday, July 31, 2017, at 6:00 p.m.
City Hall Council Chambers, 201 First Avenue East
A. CALL TO ORDER
B. DISCUSSION ITEMS
1. Emergency Medical Services (EMS) Funding Discussion
C. PUBLIC COMMENT
Persons wishing to address the council are asked to do so at this time. Those addressing
the council are requested to give their name and address for the record. Please limit
comments to three minutes.
D. ADJOURNMENT
UPCOMING SCHEDULE / FOR YOUR INFORMATION
Next Regular Meeting — August 7, 2017, at 7:00 p.m. — Council Chambers
Next Work Session — August 14, 2017, at 7:00 p.m. — Council Chambers
Coffee with the Chief — Tuesday, August 15, 2017, at 5:30 p.m. — Lewis & Clark Room at
Sykes Diner, 202 2nd Avenue West
Reasonable accommodations will be made to enable individuals with disabilities to attend this meeting.
Please notify the City Clerk at 758-7756.
Watch regular City Council sessions live on Charter Cable Channel 190 or online at the Meetings.
Demand tab at www.kalispell.com.
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City of Kalispell
Post Office Box 1997 - Kalispell, Montana. 59903
Telephone: (406) 758-7701 Fax: (406) 758-7758
MONTANA
MEMORANDUM
To: EMS Subcommittee
From: Doug Russell, City Manager
Re: EMS Subcommittee meeting
Meeting Date: July 31, 2017
BACKGROUND: As part of the FY2018 budget review process, the City Council is poised to
adopt the appropriations necessary to continue funding EMS at its current operational level. This
is a point of discussion as fee revenues for the EMS fund came in 20% under budgeted amounts,
in spite of an adopted increase in 2016 that was supposed to eliminate the transfer from the
general fund. With the shortfall in fee revenue, it is projected that the FY2018 budget will need
a $350,000 transfer from the general fund.
During the budget discussions for FY2018, it was decided to establish an EMS Subcommittee to
review options related to the EMS operations. This agenda memo and materials are presented
for the first meeting for this subcommittee. To start the process, we will review the following
documents as a summary of the recent history and relevant information related to the EMS
operation:
1) The EMS Funding Report from 2014
2) The adopted rate resolution from January 2016
3) Budget for FY2018
4) Report of the last fiscal year revenues by type
5) Call reports for EMS and Fire Services
Following review of these materials, we anticipate the following discussion items:
1) Discussion regarding the current state of Fire and EMS provision in Kalispell and
Flathead County
2) Additional information members would like to have provided for future discussion
3) Additional parties that may need to be at the table
4) Date and agenda for the next meeting
ATTACHMENTS:
EMS Funding Report
Rate Resolution
FY2018 Preliminary Budget
Rate Report
Call Reports (Calls by type- 2015 and 2016, graph of calls by day and time, multiple call
frequency)
EMS Funding Report and
Recommendation
The City of Kalispell
4/24/2014
Produced by:
Doug Russell
Dave Dedman
Jon Campbell
F. Ray Ruffatto
Doug Schwartz
Greg Daenzer
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Executive Summary
As part of the Fiscal Year 2014 budget process, it was identified that there would be financial
difficulties with several of the funds in the City of Kalispell budget. One of those funds
identified was the Emergency Medical Service fund. This fund provides ambulance response
and transport within the City of Kalispell.
During the budget discussions, it was noted that we were doing an internal analysis of options
that can be found in the industry, options that have been suggested, and options that other
communities in Montana have undertaken for funding of emergency response. Through this
process, working with the local unit of the International Association of Fire Fighters, we have
reviewed 6 different options and are recommending an alternative that we believe provides the
best service to the residents of the City of Kalispell. This recommendation also provides the
residents of Kalispell a direct opportunity to agree or disagree with this recommendation as it
involves an election for a dedicated mill levy for the provision of Emergency Medical Services.
After almost a year of meeting and reviewing funding alternatives, the committee is
recommending that the Kalispell City Council pass ballot language to give the residents of
Kalispell an opportunity to vote on a dedicated mill levy of 18.4 mills. This would remove the
general fund subsidy that is stressing general fund operations, provide for capital equipment
replacement, and provide an increase in staffing to reduce the amount of calls that are being
covered by neighboring jurisdictions.
While this is not an easy request to make, it is an option that other municipalities in Montana
have made for the provision of various aspects of emergency response (see option 4). Most
importantly, this option provides the community an opportunity to participate in deciding the
level of service they would like to see in their community.
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Introduction/Background
During the Fiscal Year 2014 budget development process, it was identified that the current
appropriation process provides a general fund subsidy of approximately $268,000. This subsidy
impacts the City of Kalispell in 2 ways:
1) General fund operations are being required to defer capital and operational
improvements as general fund revenues are being transferred to the EMS special
revenue fund
2) It is difficult to divert additional funding to the EMS fund for capital and operating costs
when it is already placing a burden on the general fund departments
These two realities leave both entities lacking in resources that could be put to use to enhance
both general fund and EMS operations.
Since the development of the FY2014 budget, we have been working with the Fire Department
and local IAFF employee union leadership to identify options for addressing this situation,
knowing that the longer we delay, the more difficult it will be to implement any potential
strategies. As such, we have looked at multiple options in operational activities and funding
strategies with the hope of presenting a mutually acceptable road map for the future.
As part of this review, and to begin the analysis, it is important to understand our current
funding and staffing activities.
FUNDING
The EMS fund is considered a Special Revenue fund as it derives the majority of its funding from
operational activities. The total budget for expenses in Fiscal Year 2014 is $968,919. Of that,
about $590,000 comes from fees for service, $110,000 from the County EMS levy (which is
based on call numbers as a percentage of all calls in the County), and about $260,000 from the
general fund.
An important aspect to note is that currently about 50% of our fees for service are considered
uncollectible as they either exceed maximum allowable charges from Medicaid/Medicare, or
are from uncollectible private payers. The uncollectible component makes it difficult to simply
raise rates, as that will not coincide with a proportionate revenue increase to cover
expenditures.
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The expenditures in the Fiscal Year 2014 budget do not include any capital expenses. With an
estimated cost for an ambulance being $170,000, the only way to pay for this would be through
additional subsidies from the general fund, which would place additional pressure on the
general fund services. It is this awareness that has initiated this collaborative effort to find
options for the future and to help define the service levels that the community may desire.
STAFFING
Staffing for the City of Kalispell Fire and EMS entails employees that provide services in both the
fire department and the EMS department. This provides an opportunity to create efficiencies
through the joint provision of service. For example, we estimate that we would need a
minimum of 9.5 personnel to operate an effective EMS operation. This would include 8 EMS
personnel to operate as emergency responders, a manager, and billing operation. By having 8
responders also capable of providing fire services, our department can be staffed with
additional personnel. For example, we may have 7 people on shift, instead of 5, which would
provide for additional members of the department to respond to a fire call than would
otherwise be available. This, of course, fluctuates with EMS calls that are received throughout
a respective shift. However, having the additional personnel provides for an enhanced
emergency service response.
We currently operate 3 shifts of personnel, two staffed with 10 responders and 1 staffed with 9
responders. The challenge of the department is to be able to account for accrued and sick
leave with a 10 member shift and have a desired staffing of 8 personnel, minimum staffing of 7
personnel, on duty for each 24 hour shift that is worked. During 2013, the average staffing per
shift was approximately 7.5 personnel for all shifts, with the shift breakdown as follows:
• A shift average with 10 personnel = 7.67217630854
• B shift average with 10 personnel = 7.72301912568
• C shift average with 9 personnel = 7.25853825137
The breakdown for personnel assignments for staffing of 7 or 8 responders is listed below.
Appendix A provides a visual staffing breakdown for staffing of scenarios including 5-10
responders.
A 7 member shift provides the following distribution
Station 61: Staffing of a fire engine
Station 62: Cross -staffing the ladder truck, two ambulances, or the water tender (depending on
what is called out first)
An 8 member shift provides the following distribution
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Station 61: Staffing of the Fire Engine and staffing one ambulance
Station 62: Cross -staffing of the ladder truck, one ambulance, or the water tender (depending
on what is called out first)
STAFFING AND CALL RESPONSES
Having the minimum staffing level in place is an attempt to provide a department response for
calls within the jurisdiction. While mutual aid is a benefit in the jurisdiction, it also means that
there is likely a longer response time to initiate care when calls are being responded to from a
unit in another jurisdiction. Below is a table identifying the number of times a mutual aid
response was dispatched to the City of Kalispell for an EMS call in accordance with the
respective staffing level that was on duty.
Staffing
Mutual aid call out
Slow period (8pm to
%overall
%8pm-
Frequency of staffing
Sam) mutual aid call
Sam
(percentage and
out
number of days)
10
3
1
2% (3)
1% (1)
1% (4)
9
6
3
4% (6)
8% (3)
10% (38)
8
41
10
29% (41)
27% (10)
29% (106)
7
80
23
57% (80)
62% (23)
9% (217)
6
10
1
7% (10)
3% (1)
0 (note that some
calls occurred at
specific times when
staff was at 6 even
hough not
cheduled)
(As a point of reference, the department had 3058 total calls during this time period.)
PUBLIC SERVICE
Throughout the discussions that have been held, a primary discussion point has continued to
emerge in that we are discussing a public service. This has several important aspects to it that
should be discussed, and have been discussed in the past, as evident by the passage of the levy
for the North Fire Station in 2004. The questions that we have tried to identify and thus create
a roadmap for conversation and strategy in the future include: 1) what level of service does the
community desire for its EMS operations, 2) what is the community willing to pay for EMS
operations, 3) and, what is the best way to provide that level of service?
It is understandable that these are difficult questions, and every individual has an opinion when
establishing service levels. Our goal was to address some of the suggested alternatives that
arise when discussions of EMS funding are brought to the surface, and provide a platform for
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initiating discussion and a long-term solution related to the 3 questions listed above. As such,
the options that follow are presented with the thought of eliminating some of the alternatives,
and further pursuing the recommended alternative.
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Options
This review identified 6 options for consideration. While it is not exhaustive, it did look at the
most likely options for our community based on professional experience in the field. Each
option tried to provide comparable jurisdictions, a summary review of the option, pros and
cons, and a recommendation.
It is important to note that the alternatives were reviewed with an objective of eliminating
some options prior to further review, knowing that extensive analysis could be spent on an
option that will likely be dismissed at the onset. Thus, our effort was to provide a
recommendation to move forward without spending considerable time on the research of
some options, as the surface review appeared to be enough to make a recommendation.
The options that were reviewed were as follows:
1. Combining emergency services (Fire, EMS, and Law Enforcement) into one department
2. Privatizing EMS services
3. Maintaining current level of services and budgetary appropriations
4. Increase service delivery and improve budgetary appropriation subsidy through a voter
approved mill levy ballot issue
5. Incorporate dynamic staffing techniques to improve service delivery and/or reduce
expenditures in personnel costs
6. Reduce operating costs through the closure of Station 62
Each option is discussed more thoroughly in the following pages.
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Option 1
Option: Department of Public Safety
Description: Establish a multi -service department for emergency responders with employees
serving roles throughout the emergency service spectrum including police, fire and medical
response.
Comparison Jurisdictions: Ashwaubenon, WI; Beverly Hills, MI; Farmington, MI; Oak Park, MI;
Kalamazoo, MI; Sunnyvale, CA
Synopsis: A public safety department would combine fire, police, and ambulance response into
one entity. It may by comprised of personnel serving different functions (e.g. dedicated to
police work, firefighter, or EMS) with one public safety director, or it may consist of public
safety personnel who each perform all three jobs interchangeably. In order to implement the
second type of Department of Public Safety in Kalispell, all fire and police personnel would need
to be cross -trained in all three fields. The comparison jurisdictions noted above do not provide
ambulance transport, unlike the City of Kalispell. That issue alone makes it difficult to compare
with these jurisdictions.
In 1971, a study by W.M. Cunningham showed no known jurisdictions have actually reduced its
total fire and police budget through consolidation. Furthermore, a Ryland Research study of
consolidated departments showed higher fire loss, more civilian injuries or death per fire, more
fires per capita, and more uniformed injuries and death per fire. In looking at these reports,
combining emergency services departments into one entity has not proven to be a money saver
for communities.
When it comes to "more service," consolidation seems to be a roadblock to efficiency more
than anything. The resulting combined agency may suffer from inadequate training as training
demands for non -convergent job skills compete with one another. Public safety personnel may
also succumb to insufficient on-the-job experience. Fire safety programs for the public are
generally reduced or eliminated, as found by the Ryland Research study. In the end, the
community suffers from a failure to meet the demands for fire and police services.
Consolidation increases training costs for all personnel, especially during implementation.
Studies have shown that cities fail to recuperate these up -front costs over time.
Peoria, IL adopted the program in 1962. They abandoned it in 1970.
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Dayton Beach, FL realized an increased cost of $908,000 in total public safety costs over seven
years of consolidation in 1979 and abandoned the plan.
Durham, NC abandoned their consolidated department in 1985 after 14 years, citing longer
response times, inadequate in-service training, and insufficient pre -fire planning.
The International Association of Fire Fighters, the International Association of Fire Chiefs, the
National Fire Protection Association, and the International Union of Police Associations have all
come out publically against public safety departments.
Pros:
Cons:
- Cross -trained personnel
- Potential cost savings- a much more detailed analysis would need to be performed
to address this
- Higher costs of training Fire/EMS Personnel in Law Enforcement and Law
Enforcement in Fire and EMS.
- Challenge to allocate timing for maintaining the higher level of specialized training
for the respective services.
- Potential higher costs, as seen in cited municipalities
- Potential to be understaffed as an ambulance transport call could take out a
responding unit for a significant period of time.
Conclusion: Merging the operations of Fire and EMS with Law Enforcement is a complicated
effort, especially with our level of EMS response. Analysis of the financial impacts would
require additional study and review which surpasses the scope of this analysis. On the surface,
it appears that consolidation would not provide desired results and would have additional
negative impacts in service delivery. Consolidation of Fire and EMS with Law Enforcement
presents a challenge to the effective completion of any of the three duties that would be
identified in Kalispell. In many jurisdictions Fire and EMS exist as separate entities. In Kalispell,
having these two departments together provides for some of the benefits of consolidation.
However, combining this with Law Enforcement would require a substantial amount of training
for the respective duties and take away from the actual field based application of duties.
There are no known Fire/EMS/Law Enforcement operations in Montana at this time. This
would be a dramatic shift in service delivery, which may be unnecessary depending upon the
feasibility of other options.
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Recommendation: It is not recommended that Kalispell pursue a consolidation of Law
Enforcement with our Fire and EMS operations.
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Option 2
Option: Privatization of EMS transport services
Description: Instead of operating an Emergency Medical Response transport service, this
operation would be left to the private sector or contracted out to an outside service providers.
Comparison Jurisdictions: Numerous
Synopsis: When researching this option it was found that privatization of the EMS transport
service works in many jurisdictions. However, it is also important to look at our specific
demographics and how they compare to the successful jurisdictions. The City of Kalispell and
surrounding area are designated as a super -rural area. The city population is estimated at
20,000 individuals per the last Census, with an overall population of Flathead Valley at 80,000
individuals. There are unique challenges for rural communities that are important factors in the
overall EMS system design. Compared to urban locales, rural communities are characterized by
large geographical density, lower call volume and larger travel distances. While rural providers
generally have lower cost per unit hour than their urban counterpart's for a variety of reasons,
their cost of readiness is an even greater mainly due to the fact that EMS responses and
transports will take the responding unit out of service for a greater amount of time. According
to the American Ambulance Association report, "EMS Structured for Quality," even the best
managed EMS systems need a minimum population base of 200,000 users to reach the
breakeven point, mainly due to the reduced ability to collect fees for service, whether private
pay or government un-subsidized fee payment structures such as Medicare.
If the city of Kalispell was to use a private or contracted EMS transport service, it would affect
the Fire Departments ability to staff accordingly. We would lose approximately $600,000 in
revenue used to pay full time employees which are cross -trained and job share fire department
duties. Without the added, cross -trained personnel funded from the EMS budget, the fire
department would have fewer people to respond to and operate a fire response event, which
in turn would lower the level of service to the community.
For example, if we were able to find a private operation to offer services, we would still need to
provide fire protection. Assuming we need to man the two fire stations, we would need a daily
staffing of 8 people per shift to account for vacation and sick days. This would provide for a
geographic response of an apparatus that can prepare the scene for attack upon arrival of the
manpower on the second unit, thus leveraging each station's response to limit staff at each
station, yet reduce the overall response time from each station.
This scenario would allow us reduce overall staffing by 5 responders and 1 administrative
personnel for a total of 6 people. As we are currently allocating 9.5 people to the ambulance
fund, based on what it would take to operate two responding units, we would end up adding
3.5 people to our fire department allocation. Assuming a total personnel cost of $81,000
(based on FY2014 averages) per person, the additional cost to the fire department budget
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would be $283,500 per year. This would be higher than the current subsidy of the ambulance
fund ($264,000), which demonstrates an approximate equal financial component based on
current staffing measures. Adding in the capital component to the current subsidy ($48,500-
two apparatus on a 7 year rotation), the subsidy increases to $312,571. Thus, if we could find a
provider to take over EMS operations, without any subsidy from the government, the annual
savings would be estimated at $29,071.
Pros:
Cons:
- Savings of approximately $29,000 per year (assuming there wouldn't be any fiscal
guarantees associated with a contracted service arrangement.)
- Plus, Reduced Workers Compensation- savings not calculated yet (likely won't be
significant
- National research indicates it may be difficult to find a purely market driven
operation for a community of our population. There would likely be a lack of
competition for the service.
- Profit driven enterprise would strive to reduce expenditures, not as a measure of
efficiency, but as a profit motive- (it would remove the consideration of EMS service
as a public good). This could yield reduced level of care.
- Reduced personnel for fire response
- Increased dependence on mutual aid
- Reduced ability to staff a timely and effective response for the Hazardous Materials
Response Team (we would likely have to forfeit the team which would mean no
coverage for our part of the state.)
- Reduced ability to staff a response for Technical Rescue Operations (such as
confined spaces, which requires 7 members) while maintaining standard operating
response
Conclusion: If a provider could be engaged that would offer the service on a purely market
driven approach, privatization would result in the City of Kalispell removing this cost center and
the general fund transfer. However, the reduction would not exist in a vacuum. The City of
Kalispell Fire Department would absorb some of the costs in order to staff both stations.
Because of this, the net savings to the general fund would not be $260,000 per year, but rather
$29,000 per year. Should this be privatized, the City of Kalispell would lose control over the
operations, which are now considered a public good and operates in a fashion to provide
citizen/community satisfaction versus a private operation which operates on a net profit
benchmark.
Recommendation: It is recommended that the EMS operations remain under the City of
Kalispell as the savings that could be achieved under the best circumstances would be minimal,
and potential costs, both financially and from a service delivery perspective could be
detrimental.
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Option 3
Option: Maintain current level of service resources
Description: Continue operating our EMS program with the current level of resources available
Synopsis: In an attempt to look at the option of leaving the service delivery model as it stands
today there are some key factors that need to be considered. The purpose for entertaining the
idea of changing the funding mechanism would suggest that there is something in need of
change. Included below are mostly reasons why going forward without a "fix" would provide
additional challenges in the future.
Currently KFD is operating at a level that allows for response to the majority of its emergency
calls. With that said, there are a number of instances where outside aid is required to fulfill
needs of the public. In 2013, 140 calls with 96 transports, were dispatched to adjacent
jurisdictions to respond within the City of Kalispell. If the Kalispell Fire Department maintains
its current level of service, the frequency of calls covered by outside aid will likely increase with
the increased populations and call volume. This requires Kalispell to rely more on outside
service providers, including volunteer agencies in surrounding jurisdictions. Every transport
that is not provided by Kalispell is revenue that is lost to another service provider. While it is
difficult to identify the exact amount that is lost due to the nature of the call, capped
reimbursements, and uncollectible accounts, it is estimated that the 96 transports would have
generated an additional $50,000 when taking these factors into account.
The ambulance fund is considered a special revenue fund and relies heavily on its ability to
generate revenue to continue its operations. This is made difficult by its ability to charge and
collect fees for service. The balance of the funding needed to operate the ambulance service
comes from the general fund. Approximately 63% of its billable revenue comes from
government subsidies which only pay a portion of the bill. Approximately 17% are private pay
with no insurance. Approximately 20% of revenue comes from private party insurance.
Another downside to continuing the current model is the impact of capital costs. It is very
difficult to include an adequate and realistic budget figure for capital in a budget that is going to
end up in the red at year end. The current model's option of funding capital costs is to rely on
the resources of the general fund, which stresses the other departments of the municipality. A
revenue source that would take into account a capital outlay component would give more
certainty and reliability to maintaining the proper equipment needed to provide services.
Pros:
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- Maintaining the current service level provides the opportunity to avoid the anxiety
related to change in the areas of revenue generation or service level provision
- Current budget processes accounts for subsidy
Cons:
- Continued subsidy from the general fund
- Capital equipment will likely depreciate at a higher level than replacement occurs
- 140 calls in 2013 were responded to by neighboring agencies, including 96 transports,
with a potential loss of $50,000 in revenue
Conclusion: While it is anticipated that the next budget cycle or two will have to maintain the
operation in its current form, it is viewed as being insufficient to fund the costs associated with
the operation, as evident by the subsidy of the general fund. Changes will have to be made in
the funding formula or in the level of service delivery.
Recommendation: Consider additional options for the City of Kalispell for the provision of Fire
and EMS funding and/or service delivery.
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Option 4
Option: Establish additional revenue source for improved Emergency Medical Service
operations through a dedicated mill levy.
Description: Establish a dedicated mill levy for Emergency Medical Services that covers the
shortfall between costs and expenditures within the EMS fund to provide for equipment
replacement and enhance staffing levels for each shift.
Comparison Jurisdictions: Billings, Belgrade, Bozeman, Whitefish
Synopsis: With Kalispell's service delivery model of a combined service of fire and EMS, there
are few exact comparison municipalities in Montana to identify funding models for this activity,
though the City of Whitefish comes close to a similar service delivery model. However, there
are several municipalities that have gone before the voters to establish a mill levy to support
emergency response activities.
In 1999 and 2004, voters in the City of Billings passed ballot issues to support police and fire
operations.
In 2008, voters in the City of Whitefish passed a ballot issue to provide 24 hour fire and
ambulance services through a levy of 24 mills.
In 2007, voters in the City of Bozeman passed a ballot issue to provide for additional police
officers, additional firefighters, and equipment replacement through levies of 30 mills.
In 2007, voters in the City of Belgrade passed a ballot issue to provide for additional police
officers and police operations through a levy of 34 mills.
A dedicated mill levy to sustain and enhance operations in the Emergency Medical Services
appears to be the most advantageous effort for establishing additional revenue for these
operations. As EMS billing is a mixture of reimbursements with procedure type rate caps and
industry wide write off expectations, it is understood that simply raising rates for EMS activities
may yield at best a 50% return for the amount or rates increased. The question for Kalispell
comes to the view of asking if EMS services are a public good, and at what level they desire to
see this good provided. A benefit to the Kalispell community is that any enhancement to the
EMS fund provides increased capabilities for the fire suppression activities as well.
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Assuming this operation continues as a City of Kalispell function, a future funding analysis takes
into account our current revenue streams and adds a dedicated mill levy to remove the general
fund subsidy, provide for capital equipment replacement, and account for additional staffing.
The current subsidy from the general fund to the Ambulance fund is approximately $268,000
with staffing at 9.5 people. Ideally, staffing would be increased to an 11 responder shift, which
would place 9 responders on duty for the majority of time and would provide an additional
ambulance being able to be called into service if needed. This would likely lower the number of
calls that currently can't be covered by the City of Kalispell and are turned over to another
provider, which equated to 140 calls and 96 transports in 2013. This would cost approximately
$320,000 to increase this staffing effort. Equipment within the ambulance fund centers around
two apparatus at a cost of approximately $170,000/unit- with a life span of 7 years. This
amounts to a capital need of $24,500 a year for one apparatus, and $49,000 a year for two
units (the third ambulance would be a reserve unit, capable of being placed into service, but
not required to be on the regular rotation schedule).
In total, to remove the subsidy currently provided from the general fund, incorporate
replacement funding for a 7 year rotation on ambulance units, and increase staffing levels, an
estimated 18.4 mills12 would need to be generated to enhance the service operations. To
maintain current staffing levels and incorporate equipment replacement, the mills would be
approximately 9.8.
The recommendation on this option is to enhance the staffing to reduce the amount of calls
within the City of Kalispell that are rolled to another agency because the Kalispell units are
currently occupied on a previous call.
Pros:
- Increases the probability that EMS calls will be handled by Kalispell EMS, versus rolling
to another jurisdiction
- Provides a dedicated revenue source to be used for EMS operations
- Enhanced EMS staffing also enhances fire department operations based on the service
delivery model for the City of Kalispell
1 Mills for the prospective levy are calculated for an average on a 10 year horizon, assuming increases in personnel
costs and a mill value of $40,000. The current (2014) mill levy for removal of the general fund subsidy, capital
equipment replacement, and enhanced staffing would be 16.2 mills.
z 18.4 mills would equal $24.09 for a $100,000 house; $48.17 for a $200,000 house, and $72.26 for a $300,000
house.
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- Funds that have previously been used to subsidize EMS operations can be redistributed
for other needs (such as fire department apparatus, law enforcement staffing and
equipment replacement, or be used for property tax reduction, or a split between uses)
- Service delivery level is established by the voters, reflecting the actual desires of the
community for the services provided
- Ballot issues provide for a means of dialogue within the community related to services
provided
Cons:
- Additional tax on City of Kalispell residents
- Vote not to adopt the mill levy may require a transition toward reducing the level of
services provided as the community is identifying the level of service desired
Conclusion: A dedicated mill levy for EMS operations is an option that would allow the
community to decide the level of service it desires. It is a route that other cities in Montana
have used for law enforcement and fire operations. The dedicated mill would remove the
general fund subsidy, provide for future capital replacement, and improve staffing for enhanced
response capabilities.
Recommendation: It is recommended that a dedicated mill levy be considered for EMS
operations.
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Option 5
Option: Incorporate Dynamic Staffing to either reduce expenditures in the Emergency Medical
Service program or enhance service response.
Description: As a significant component of the department expenditures are made up of
personnel costs, this review focuses on implementation of dynamic staffing as a response
component. Dynamic staffing can be described as a staffing matrix that coincides with
fluctuations in call or work demand. A higher staffing number is on duty at the highest work
volume hours and a decreased staffing number on duty when the work volume decreases.
Additionally, dynamic staffing, in larger departments, uses geographic dispatching and
placement within the community based on times and historic call frequency with the goal of
having an ambulance unit effectively patrolling a neighborhood in anticipation of a call.
Comparison Jurisdictions: During the review, we could not find a comparable jurisdiction that
uses dynamic staffing in the purest sense of the practice. Dynamic staffing options are typically
seen in an urban environment with a greater population and a larger departmental work force.
The City of Kalispell is considered super -rural with the population base of 20,000. The larger
communities have the resources that can handle the fluctuations in higher call load to be able
to staff in this fashion. In their respective situations, understaffing leads to a slightly longer
delay in responding. In our situation, understaffing leads to calls and transports that are
dispatched to other jurisdictions.
Synopsis: Upon gathering information in regards to call volume and time of call, we can see
fluctuations in the frequency of calls for service and the respective time of day. Notably, we
see an increase in work load from the hours of 8 am to 8 pm. Though this information identifies
the probability of a prospective call, strictly applying this data will by its very nature lead to
occasional understaffing as emergency occurrences are not tied to probability curves, but
rather to random occurrence.
181Page
0.6
0.5
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0.3
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2013 Probability for Calls for Service by Hour of
the Day
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The following scenarios are simply examples of the application of dynamic staffing. More
data analysis would be necessary to comfortably apply any scenario, be it an increase in staff,
or a reduction in staffing.
Scenario 1: As an example of dynamic staffing, personnel could be reduced during the hours of
8 PM to 8 AM, or during days with a historical call load. Currently the fire department will
attempt to schedule 8 personnel and staff down to 7 personnel on duty. This allows us to have
a dedicated fire engine company staffed at Station 61 and staffing at station 62 to facilitate a
ladder company response and also cross staff 2 ALS transports.
Should the decision be made to reduce staffing and apply a dynamic staffing principle and we
move to a duty staff of a 6 person minimum, we would have the dedicated fire engine company
at Station 61, a ladder company response at Station 62, and the ability to cross staff 1 ALS
Transport. Looking at the response history, there would be a 20% chance of seeing an ALS call
at 1-2 AM. Depending upon how the call is dispatched and the nature of the call(motor vehicle
accident would take both units to aid in medical care and scene security), both the engine and
the ambulance may respond. If a second call were to occur, however, it would be responded to
by a different agency.
While the probability graph provides a visual representation of the ability to predict calls, it
must be understood that even with the call presentation charted above, there were 140
19 1 'age
occurrences in 2013 where a call for mutual aid was requested for the EMS responses. These
calls resulted in 96 transports within the City of Kalispell being handled by a non -Kalispell
agency. Implementation of the dynamic staffing philosophy would likely create a more efficient
manpower to call probability effort. However, it would also likely increase the occurrences of a
non -Kalispell agency responding to a call within the City of Kalispell.
Scenario 2: Increase staffing to support the need of added work load between the hours of 8
AM and 8 PM. Personnel could work a 12 hour shift to help with the daily duties and also to
assist with 911 responses. This would bring staffing levels to 9 personnel during the busiest
hours when it is most needed. This would require the equivalent of 3 full time personnel versus
6 full time personnel under the 24 hour structure offering a 50% savings in personnel cost for
the additional day time staff. The 9-member shift would provide for staffing of the engine at
Station 61, an ambulance at Station 61, cross staffing for the ladder truck and two ambulances
at Station 62.
Pros:
- Allocation of resources to heaviest call volume periods
- Has the potential to maximize the scheduling effectiveness of personnel
- Has the potential to enhance operational response at lower costs
Cons:
- Smaller departments that schedule exclusively according to probabilities will find
themselves understaffed at respective times and dependent upon neighboring
jurisdictions.
- Acceptance of a level of risk by the community
- Smaller departments may be unable to implement true dynamic staffing components as
there is not an inter -departmental backup resource to cover shortfalls
Conclusion: Dynamic staffing is a system to allocate staffing based on probabilities of call
volumes. There are potential components that are available to the City of Kalispell even though
dynamic staffing is more advantageous in larger departments.
Recommendation: Assuming that changes will be incurred within the department with either
additional financial resources, or reduced financial resources, dynamic staffing may provide for
potential cost savings and/or enhanced staffing additions to provide more service capabilities
within the City of Kalispell at reduced costs by analyzing call loads and scheduling accordingly.
201 Page
Option 6
Option: Reduce expenditures in the current Emergency Medical Service through closure of the
North Station.
Description: Staffing two stations places an increased cost factor on the program through
staffing related functions. This option reviews the potential impacts of closing the north
station.
Synopsis: The closure of Station 62 as a means of cost savings has two potential routes of
implementation.
1. Close the station by moving all personnel, operations, and response capabilities to Station 61.
Closure of 62 by moving all personnel, operations, and response capabilities to 61 would result
in a reduction in operating costs of the facility. However, these cost savings would be minimal
as the facility would still require utilities and upkeep.
Moving all operations out of this station would have three primary effects on the operations of
the department. Closure of 62 would increase response times, change the department's ISO
rating, and possibly alter the department's perception within our community.
Increased response times would result due to a lack of personnel in 62's area due to the
extended travel time from 61.
The Insurance Service Organization rating would likely change the next time the ISO evaluation
is conducted. Many factors go into this evaluation including staffing, response times, and
proximity of fire stations to the area served. A potential outcome could be an overall change to
the ISO rating for the entire City. Another potential outcome could be a split rating with 61's
response area receiving one rating and 62's response area receiving another. ISO ratings are
used by insurance companies in the evaluation of risk for property owners. A better ISO rating
is sometimes used for the calculation of insurance costs for property owners. This typically
impacts larger commercial and industrial facilities greater than residential properties.
It is not possible to fully evaluate the effects the closure of station 62 would have on the
public's perception. However, some factors can be identified. The voting public approved a
special assessment for the construction of the station, and they have benefited from the
increased service that it provides. Altering our model for emergency services could be
perceived as service reduction, increased response time, and reduction in public safety in
contrast to a measure that was voter approved.
Pros for implementation model 1:
21 1 Page
- Reduced operating costs for the facility
Cons for implementation model 1:
- Increased response times
- Likely impact to ISO Rating
- Direction opposite of the voter approved project to construct Station 61.
Model 2. Close the station and reduce the work force.
Closure of station 62 would have the same pros as in implementation model 1 with the added
financial benefit of reducing payroll. From a strictly financial perspective, implementation
model 2 would have measurable monetary benefits in tandem with the number of positions the
City was willing to eliminate.
The cons for implementation model 2 are the same as for model 1 with several important
additions. Any reduction in staffing will result in a reduction in service. On a given day,
Kalispell Fire Department endeavors to staff a fire engine and 2 ambulances. The personnel
staffing the ambulances are used to cross staff a ladder truck. This staffing configuration is
designed to utilize the abilities of our Firefighter who are also EMTs or Paramedics to respond
to calls for service of various types with the apparatus, tools, and equipment they may be
required to use for mitigation of the emergency. A reduction in staffing would mean fewer
available resources to respond to calls for service. Fewer resources would reduce the number
of ambulance transports the Department would be able to perform, and that would reduce the
revenue from these transports.
In 2013 we had 140 EMS calls for service within city limits that generated a response from
emergency service providers other than Kalispell Fire Department due to a lack of available
resources. A reduction in staffing will result in a higher number of incidents requiring mutual
aid for calls in the City of Kalispell.
Pros for implementation model 2:
- Cost savings in operations and personnel
Cons for implementation model 2:
- Increased response times
- Likely impact to ISO Rating
- Direction opposite of the voter approved project to construct Station 61.
- Lost revenue for call going to alternate agencies
- Increase in calls within Kalispell city limits that are not handled by the Kalispell Fire/EMS
department
22 1 Page
Conclusion: With continued growth on the north end of Kalispell, reducing coverage capacities
does not seem to be the best service delivery model. Moreover, the major cost savings would
be in the form of personnel reductions, which would decrease the calls being handled by the
Kalispell Fire/EMS Department, thus reducing the service delivery and cost recovery for the
department.
Recommendation: While closing the second station and eliminating the personnel with that
station would create cost savings, this option is not recommended as it would directly impact
the service delivery that the voters of Kalispell previously voted to achieve.
231Page
Recommendations
The goal of this review was to find a strategy to lead the community of Kalispell into the future
in respect to EMS service delivery. The initiating factor of this review is the financial pressures
on both the general fund and the EMS fund, especially considering the need for replacement of
ambulance units within the EMS operations. In order to come to a funding solution, the first
decision is how to approach the provision of service.
Provision of service recommendation:
Based on the options reviewed, we think the best option is to continue providing services with
the combined departments of Fire and EMS. We think this presents the best and most efficient
method of service provision for the residents of the City of Kalispell as there is a professionally
trained department staffed to respond to emergency calls in an expedited fashion, with public
oversight.
Should this be the option, we then need to look at the funding related issues, and determine
how to identify a funding mechanism to meet the service delivery recommendations.
Staffing Recommendation:
Staffing Alternative 1
The first option that presents itself in the management of emergency response is to incorporate
a component of Dynamic Staffing and match call loads with staffing levels. Currently, with
average staffing being approximately 7.5 personnel, the option would be to reduce staffing
during the slower periods where it is not anticipated that two EMS calls would occur. However,
it is difficult to say if that would be acceptable to the community, knowing that emergencies are
not scheduled and that removing an EMS unit from rotation during these periods would create
that situation where a second call would have to be responded to by a neighboring agency.
Knowing that we already have a number of calls that are responded to by neighboring agencies
demonstrates that this is a reality we are facing. And while introducing dynamic staffing to
reduce personnel would provide a data driven staffing, it is likely that additional calls would be
outsourced to neighboring jurisdictions.
Staffing Alternative 2 (Recommended staffing alternative)
A second option is to increase staffing in an attempt to provide services to a level that provides
a City of Kalispell EMS response to a resident of the City of Kalispell. In looking at the data,
increasing staffing levels to an 11 responder crew with a 9 member shift would increase the
241Page
probability of having an EMS unit available for second call. The worst case scenario in this
staffing model would have 272 shifts with two ambulances staffed and 93 shifts with three
ambulances. This would, however, more than double the department's ability to staff a third
ambulance versus the 2013 model in which we had three ambulances staffed on 42 days, or
11.5% of the time. Realistically, using the statistics from 2013, it is likely that our ability to staff
a third ambulance would increase to as high as 50% of the year. Under the best scenarios, this
model would create only 33 shifts out of the year with only two ambulances staffed, which
increases the likelihood of staffing a third ambulance to 73%.
Staffing Alternative 3
The final staffing option is to continue with the status of staffing as it is and accept the response
levels where they are. While this is an option to consider, it is not the ideal standpoint from a
service delivery organization as we know that we are not responding to all the calls in our
jurisdiction with one of our response units.
Funding Alternatives
The alternatives for funding are associated with the options above and are based initially on the
combination of looking at the current state of funding, which is what drove us to the review.
With the need of additional revenue for the capital replacement and to remove the subsidy
from the general fund, it is recommended that a dedicated mill levy for Emergency Medical
Service be proposed to the voters with either staffing levels to remain where they are or to
increase staffing levels to a position where we would have a greater frequency of being able to
respond to call within the city of Kalispell.
The City and leadership of the local IAFF have discussed the response should a proposed mill
levy fail to pass in an election. A reduction in staffing would be the likely result in order to ease
the burden on the general fund. This would have to be coordinated over time with attrition of
current employees and an implementation of scheduling to some of the dynamic staffing
principles.
Alternative 1 (Current Staffing with removal of subsidy)
This alternative would provide for the staffing levels to remain as they currently are, yet
provide revenue to remove the subsidy and provide funding for capital replacement. With an
operating subsidy of $268,000 in FY 2014, and ambulance replacement costs at $170,000 per
unit, a mill levy could be initiated in the amount of 9.8 mills a year to cover costs over a 10 year
horizon.
25 1 Page
Alternative 2 (Increase Staffing and remove subsidy- Recommended alternative)
This alternative provides for removing the general fund subsidy, replacing capital equipment,
and increasing staffing.
The current subsidy from the general fund to the ambulance fund is approximately $268,000.
By adding an increase of four responders, we would likely lower the amount of calls that
currently can't be covered by the City of Kalispell and are turned to another provider, which
equated to 140 calls and 96 transports in 2013. This would cost approximately $320,000 to
increase this staffing effort. Equipment within the ambulance fund centers around two
apparatus at a cost of approximately $170,000/unit- with a life span of 7 years. This amounts
to a capital need of $24,500 a year for one apparatus, and $49,000 a year for two units.
In total, to remove the subsidy currently provided from the general fund, incorporate
equipment replacement funding for a seven year rotation for ambulance units, and to increase
staffing levels, an estimated 18.4 mills would need to be levied to enhance the service
operations.
Overall Recommendation:
In respect to providing the level of service that is most likely to provide a City of Kalispell
response to an EMS call, it is recommended that a mill levy election be held to dedicate funding
to EMS operations to remove the general fund subsidy, replace ambulances on an appropriate
schedule, and hire four additional personnel. The total of this levy would be 18.4 mills.3
3 18.4 mills would equal $24.09 for a $100,000 house; $48.17 for a $200,000 house; and $72.26 for a $300,000
house.
261 Page
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RESOLUTION NO.5751
A RESOLUTION AMENDING RESOLUTION NO. 5352 SETTING THE FEES FOR EMERGENCY
MEDICAL SERVICES PROVIDED BY THE CITY OF KALISPELL FIRE DEPARTMENT AND
DECLARING AN EFFECTIVE DATE.
WHEREAS, the City of Kalispell Fire Department maintains an emergency medical service that provides
treatment and transport of the sick and injured residents and nonresidents of the city; and
WHEREAS, the City of Kalispell currently charges the recipients of these services based upon a rate
structure adopted by the City Council when it passed Resolution No. 5352 on April 6, 2009;
and
WHEREAS, from time to time, due to increases in costs for fuel, wages and medical supplies, it is
advisable to revise the rates that are charged for emergency medical services; and
WHEREAS, the current fee schedule does not generate the revenue to pay all of the expenses of operating
and maintaining the emergency medical services and therefore an annual transfer from the
general fund, primarily generated by city property taxes, is made to pay the deficit; and
WHEREAS, the City of Kalispell does not currently charge a higher fee for its emergency medical
services to recipients of these services who are not city residents who contribute to the
general fund; and
WHEREAS, it is equitable and fiscally prudent to charge a higher fee to recipients of Kalispell City Fire
Department emergency medical services who are not city residents.
NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF KALISPELL AS
FOLLOWS:
SECTION I. That Resolution No. 5352 is hereby amended as set forth in Exhibit "A" attached
hereto and incorporated fully herein by this reference.
SECTIONII. This Resolution shall become effective immediately upon its passage by the City
Council.
PASSED AND APPROVED BY THE CITY COUNCIL AND SIGNED BY THE MAYOR OF THE CITY
OF KALISPELL, THIS 19TH DAY OF JANUARY, 2016.
Mark John o
Mayor
`OIII111Zifiile`i
ATTEST: ��®� 1'��AL/��p��i�®�®//
Ai e Brunckhorst, CMC = EAL =
City Clerk = 1892
OWN
f11IM
Exhibit A
Resident Fee
Non Resident
Schedule
Fee Schedule
Current Fee
Effective
Effective
Schedule
1/19/2016
1/19/2016
Advanced Life Support 2
$1,032.00
$1,072.77
$1,322.77
Advanced Life Support 1
$880.00
$1,072.77
$1,322.77
Advanced Life Support Non -
Emergency
$880.00
$1,072.77
$1,322.77
Basic Life Support Emergency
$700.00
$913.54
$1,163.54
Basic Life Support Non -
Emergency
$700.00
$913.54
$1,163.54
No Haul
$0.00
$101.30
$351.30
Treat No Haul
$0.00
$101.30
$351.30
Oxygen
$0.00
$74.78
$74.78
Loaded Mile
$0.00
$21.25
$21.25
Defibrillation Pads
$0.00
$74.24
$74.24
IV Supply
$0.00
$63.48
$63.48
General Good Medical Administration -
BLS
$0.00
$85.59
$85.59
General Good Medical Administration-
ALS
$0.00
$64.03
$64.03
12 Lead with Interpretation
$0.00
$13.45
$13.45
3 Lead
$0.00
$13.45
$13.45
Advanced Airway
$0.00
$91.46
$91.46
Extra Attendant
$0.00
$50.00
$50.00
Medications and Supplies
Cost
Cost + 15%
Cost + 15%
Nonresident billing can be waived by proof of residency in the City of Kalispell or individual (non-
commercial or business) land ownership within the City of Kalispell. Individuals wishing to
protest nonresident billing will have 15 calendar days from time of initial billing to provide proof
of residency to billing staff for adjustment.
Charges will increase automatically on July 1 of each year in the same amount as the most recent
annual Consumer Price Index (All Urban Consumers- Medical Care Services)
AMBULANCE FUND
FUND: 2230-440-420730
PROJECTED REVENUE AND FUND SUMMARY
ACTUAL
BUDGET
ACTUAL
BUDGET
FY15/16
FY16/17
FY16/17
FY17/18
BEGINNING CASH
10100 CASH: operating
$121,349
$215,749
$215,749
$2,229
Total Cash Available
$121,349
$215,749
$215,749
$2,229
REVENUES
342050 Services billed
$1,173,253
$1,650,000
$1,710,618
$1,700,000
Write - offs, uncollectible Medicare, etc. 54 %-a/r change
($539,696)
($759,000)
($1,000,460)
($950,000)
Net collections
$633,557
$891,000
$710,158
$750,000
342070 County EMS Levy
$106,444
$110,000
$101,734
$110,000
Transfer from General Fund
$380,000
$150,000
$230,000
$350,000
Total
$1,120,001
$1,151,000
$1,041,892
$1,210,000
Total Available
$1,241,350
$1,366,749
$1,257,641
$1,212,229
EXPENSES
Ambulance Service
$1,025,601
$1,116,239
$1,085,704
$1,163,097
Capital
$0
$170,000
$169,708
$0
Total
$1,025,601
$1,286,239
$1,255,412
$1,163,097
ENDING CASH
Operating cash available
$215,749
$80,510
$2,229
$49,132
AMBULANCE FUND
FUND: 2230-440-420730
EXPENDITURE DETAIL
ACTUAL
BUDGET
ACTUAL
BUDGET
FY15/16
FY16/17
FY16/17
FY17/18
Personal Services: FTE's
9.50
9.50
9.50
9.50
110
Salaries & Wages
$590,109
$608,459
$612,770
$640,748
114
Comp Time Buyout
$0
$3,500
$2,168
$3,500
115
Out of Rank Pay
$1,028
$1,000
$1,602
$2,500
121
Overtime
$16,513
$50,000
$54,478
$30,000
153
Health Insurance
$136,350
$159,142
$144,880
$156,265
155
Retirement
$77,722
$80,552
$83,219
$85,036
Subtotal
$821,722
$902,653
$899,117
$918,049
Materials and Operations
210
Office Supplies/equip/computer
$1,144
$1,000
$844
$1,400
218
Equipment - Non -Capital
$2,103
$4,000
$4,108
$4,200
231
Gas
$3,753
$7,560
$5,796
$7,560
241
Consumable Tools/uniforms
$2,342
$4,000
$332
$4,000
312
Postage & printing
$1,048
$1,500
$32
$1,500
345
Telephone & Communications
$1,240
$1,200
$1,812
$1,700
354
Contract services
$17,441
$17,800
$14,718
$18,690
355
911 Center contribution
$33,145
$34,000
$34,000
$34,500
359
Collection Serv./Credit Card Fees/audit fees
$1,345
$1,400
$3,448
$1,650
362
Equipment maintenance & radio maint.
$3,650
$5,000
$5,000
$5,000
373
Dues & Training
$3,473
$5,000
$2,666
$5,000
388
Exposure Testing/hnmun.
$968
$2,500
$0
$2,500
391
Treatment -Medical Supplies
$42,278
$46,000
$31,205
$48,300
510
Property & Liability Ins.
$8,215
$7,614
$7,614
$25,886
521
Central Garage Transfer
$15,903
$16,229
$16,229
$18,070
522
Administrative Transfer
$39,213
$42,099
$42,099
$48,407
528
Information Tech. Transfer
$16,750
$16,684
$16,684
$16,684
821
Transfer to fund 2956 Grant Match
$9,868
$0
$0
Subtotal
$203,879
$213,586
$186,587
$245,047
Capital
940
Ambulance
$0
$170,000
$169,708
$0
Total
$1,025,601
$1,286,239
$1,255,412
$1,163,097
AMBULANCE
ACCOUNT # 2230-440
PURPOSE OF THIS DEPARTMENT: Why does this department exist
The Kalispell Ambulance provides Advanced Life Support medical response, treatment and transport of the
sick and injured, and public safety education.
DEPARTMENT PERSONNEL: Chief, Assistant Chief, and Clerk split (50%) with the Fire department,
and 8 Firefighters.
GOALS OF THIS DEPARTMENT:
The goal of the Kalispell Ambulance Department is to provide effective medical response and educate the
community on safe living practices.
INTENDED OUTCOMES FROM BUDGET EXPENDITURES:
The primary outcome of the FY2018 budget is the continuation of emergency medical response and
outreach services. Focus will be on internal and external communication improvements and operational
accountability.
The table below represents the number of calls
for respective categories, the amount charged
on those calls, and the total amount billed for
all calls.
Charge Code
Clients
Charges
ALS2 -Non Resident
2
2,479.39
ALS2 -Resident
5
5,551.60
ALS1E -Non Resident
156
182,783.67
ALS1E -Resident
298
330,875.36
Ambulance Standby -Fair
1
1,180.00
BLSE -Non Resident
239
238,138.04
BLSE -Resident
895
846,231.45
BLSNE-Non Resident
5
4,986.30
BLSNE -Resident
6
5,673.06
MPT ALSE -Non Resident
2
2,738.14
MPT ALSE -Resident
1
1,110.32
MPT BLSE -Non Resident
7
7,653.57
MPT BLSE -Resident
7
6,618.57
No Haul -Non Resident
1
363.60
No Haul -Resident
60
6,186.15
Treat/NT -Resident
8
838.80
Base Rates
1693
1,643,408.02
Mileage
-
52,095.49
Medication/Supplies
-
15,114.42
Non Billable
815
-
Total Clients
2508
-
Total Charges
$1,710,617.93
The following table represents revenue
received based upon the above charges. With
82% of the services provided to a client covered
by a limiting payer source, the revenues are
much lower than the total charges.
Description
Credits
Amount
*Detention Center
24
13,440.38
*Indian Health Services
9
9,444.24
Insurance -Auto
16
16,306.70
Insurance -Primary
134
117,254.82
*Insurance -Secondary
425
46,588.99
Mastercard/Visa
44
10,497.20
*Medicaid
308
69,821.87
*Medicare Co -Pay from Patient
175
18,621.66
*Medicare -Part B
861
310,680.87
Private -Check
176
23,893.81
Special Source
38
35,186.67
*TriCare/TriWest
4
1,580.84
*Veterans Administration
40
25,644.43
*Workers Compensation
6
3,178.92
Medicare Sequestration Amount
861
(5,921.51)
*Mandatory Assignment
Total Credits
696,219.89
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Multiple Call Probabilities for Kalispell Fire Dept.
2016
911 calls for service from Kalispell Fire Dept., at times, occur prior to the termination of the
previous call. This demonstrates a demand on the system based on community need. Essentially,
someone calls for help, and before Kalispell Fire is done with that response another 911 call occurs.
We'll define that occurrence as a double tap with subsequent definitions for a triple and quadruple tap.
Double Tap: when a second call for service originates within the time frame of the previous call.
Triple Tap: when a third call for service originates within the time frame of the previous two calls.
Quadruple Tap: when a fourth call for service originates within the time frame of the previous 3 calls.
In 2016, KFD responded to 3367 calls with an average call time of 32 minutes from dispatch to
clear of the call. Of the 3367 responses, 704 may be classified as double taps. In other words, in 2016 it
happened that a call for service came in while KFD was already on another call 704 times (20.9% of
calls). The probability of a double tap was 20.9%. Frequency per call volume shows that a double tap
occurred roughly every 5 calls.
The probability of a triple tap was contingent on a double tap occurring. In 2016, 77 responses
may be classified as triple taps (2.3% of total calls). In other words, of those 704 times KFD was on two
calls at once it happened 77 times that a third call occurred. The probability of a triple tap was 0.5%.
Frequency per call volume shows that a triple tap occurred roughly every 43 calls.
The probability of a quadruple tap was contingent on a triple tap occurring. In 2016, 9 responses
may be classified as quadruple taps (0.27% of total calls). In other words, of those 77 times KFD was
on three calls at once it happened 9 times that a fourth call occurred. The probability of a triple tap was
0.0001%. Frequency per call volume shows that a quadruple tap occurred roughly every 343 calls.
2016
Double Tap
Triple Tap
Quadruple Tap
Quantity
704
77
9
Percentage of calls
20.9%
2.3%
0.27%
Frequency per calls
4.77
43.08
343.44
Probability
20.9%
0.5%
0.0001%