CITY USE ONLY Agreement No. P.O. No. Attorney CIP No. Project Finance Dept. No./MOU Amount City Engineer Code 2X02177.docx SURFACE AMBULANCE TRANSPORT SERVICES FRANCHISE AGREEMENT BETWEEN PARAMEDICS PLUS, LLC AND THE CITY OF SIOUX FALLS, SOUTH DAKOTA THIS FRANCHISE AGREEMENT (hereinafter this “Franchise”) is made and entered into this ____ day of ______________, 2015, by and between the City of Sioux Falls, a municipal corporation of the State of South Dakota (hereinafter the “City”) and Paramedics Plus, LLC, a Limited Liability Company duly and lawfully organized under the laws of the State of Texas (hereinafter the “Grantee”) (individually “Party” and collectively “Parties”). WITNESSETH WHEREAS, pursuant to the City of Sioux Falls’ Surface Ambulance Regulatory Ordinances codified in Sections 124.080 and 124.081 of the Code of Ordinances of Sioux Falls, SD (the “Ordinance”), SDCL 34-11-1, and Section 2.12 of the City Charter, the City is authorized to grant an exclusive Franchise Agreement to operate a Surface Ambulance Transport Service; and City’s scoring and selection process was conducted by emergency medical services industry experts and local community representatives, who reviewed the respective proposers’ ability to demonstrate clinical and operational quality of service and also to demonstrate containment of costs to the public, all in furtherance of promoting the public health, safety, and welfare; and WHEREAS, that the scoring and selection process produced a recommendation to the City’s Public Health Director that Grantee should be chosen as the exclusive surface ambulance transport services provider within the city; and WHEREAS, that the City’s Public Health Director, acting upon the recommendation of the scoring and selection team and also upon her own additional review, has rendered an opinion that granting an exclusive franchise to Grantee for providing surface ambulance transport services within the city is the best proposal to promote the public health, safety, and welfare; and WHEREAS, that the City and Grantee have participated in a process together to negotiate the terms of a Franchise Agreement; and WHEREAS, that the City has determined that this Franchise should be awarded to Grantee, and the award of such Franchise is in the best interests of the public health, safety, and welfare, subject to written acceptance by Grantee; and I:\AD\002\02\2X02\2X02177.docx 1 WHEREAS, that the City has determined that this Franchise should be approved, subject to written acceptance by Grantee, and approval by the City Council for the City of Sioux Falls as evidenced by Ordinance No. 14-___ as adopted on February ____, 2015, and effective on March ___, 2015; NOW, THEREFORE, in consideration of the faithful performance and strict observance by the Grantee of all the terms hereinafter set forth or provided for, and in consideration of the grant to the Grantee of this Franchise by the City, the City and Grantee agree as follows: Section 1 General Provisions For the purposes of this Franchise, “Ordinance” shall mean Sections 124.080 to 124.082 entitled “Surface Ambulance Services” of the Code of Ordinances of Sioux Falls, SD. Capitalized terms used in this Franchise shall be defined as set forth in the Ordinance unless (i) otherwise defined herein, or (ii) the context otherwise requires. A. “City” means the City government of the City of Sioux Falls, SD, as a whole, including its Sioux Falls Regional Emergency Medical Services Authority, unless otherwise specified herein. B. “Grantee” means Paramedics Plus, LLC, a Texas Limited Liability Corporation, or the lawful successor, transferee, or assignee thereof. C. “REMSA” means the Sioux Falls Regional Emergency Medical Services Authority, as established in Sections 92.150 to 92.158 of the Code of Ordinances of Sioux Falls, SD. Section 2 Grant of Exclusive Franchise 2.1 Grant. The City hereby grants to Grantee an exclusive Franchise to provide all surface ambulance transport services as defined by Ordinance which originate and end within the city limits of Sioux Falls, SD, during the term of this Franchise, excluding contracts by or with other governmental agencies within the city limits and contracts covering the ground transportation component of an air ambulance transport, as defined by South Dakota law and applicable rules and regulations. During the term of this Franchise Agreement, City will issue no additional surface ambulance licenses and Grantee will provide the services required herein in accordance with the terms of this Agreement. 2.2 Market Rights. City will not enter into agreements with any other provider for ground response to requests for ambulance service as defined within this Agreement originating and culminating within the city during the term of this Agreement. Furthermore, City will make all reasonable efforts to ensure the Grantee’s exclusivity of nonemergency and interfacility transports originating and culminating within the I:\AD\002\02\2X02\2X02177.docx 2 Exclusive Operating Area as defined in the RFP, Exhibit A, including enforcement of the City’s Ambulance Ordinance. 2.3 Franchise Binding. The Franchise granted hereunder shall be binding upon the Grantee, its successors, lessees, or assignees, and the City. This Franchise shall inure to the benefit of any entity which is controlled by, or under common control with, the Grantee. Section 3 Scope of Services 3.1 Grantee shall provide exclusive ambulance services in accordance with the terms and conditions stated herein and any specifically referenced attachments hereto. Grantee’s services include, but are not limited to, providing the following: A. An emergency medical care and transportation system at an emergency ambulance paramedic “Advanced Life Support” (ALS) level of service; B. Nonemergency ambulance transports (ALS and BLS) originating and terminating within the city; C. Critical Care Transports (CCT) for patients originating and ending in the city; and D. The Grantee has the exclusive right and obligation to: 1) respond to 9-1-1 calls and other emergency or urgent medical call requests made through the City’s PSAPs public safety agencies and other sources; 2) provide care and/or transport patients within the emergency medical services (EMS) system; and 3) provide care and/or transport other patients requiring ambulance service, when the transports originate and terminate within the city. “Medically Necessary” means when a patient’s condition is such that use of any other method of transportation is contraindicated or may endanger the patient’s health. 3.2 In consideration of City’s referral to Grantee of Ambulance Service requests originating and terminating in the city, Grantee shall perform the following services to the complete satisfaction of REMSA: A. Grantee shall provide continuous, around-the-clock surface ambulance services, as defined herein, without interruption throughout the term of the Franchise. B. Grantee shall provide Medically Necessary surface ambulance services without regard to any illegally discriminatory classification, including without limitation: the patient’s race, color, national origin, religious affiliation, sexual orientation, age, sex, or ability to pay. I:\AD\002\02\2X02\2X02177.docx 3 C. The Grantee shall participate in pilot or research programs that the REMSA Medical Director and REMSA Executive Director may authorize from time to time. The Executive Director may waive standards contained in the Franchise in the event that conflicting standard(s) are established for a pilot program. Any such pilot program must be approved by the REMSA Medical Director. Grantee agrees that Grantee’s participation in the pilot projects shall entail no additional cost to City. Grantee further agrees that Grantee’s services provided under pilot projects shall be in addition to the other services described in the Franchise. 3.3 Grantee shall be responsible for furnishing all ambulance services for all residents and other persons physically present in the city. Such ambulance services shall be provided at the paramedic level. 3.4 The following exhibits are specifically incorporated by reference, attached hereto, and made a part hereof, except when in conflict with this Agreement or modified herein: A. Exhibit A—Request for Proposal (RFP) #14-0116 “Surface Ambulance Service-Exclusive Operating Area,” issued July 18, 2014, and related exhibits. B. Exhibit B—Grantee’s Response to City’s Request for Proposal #14-0116 dated October 9, 2014. C. Grantee’s Response to City’s Request for Proposal #14-0116 dated October 9, 2014, as it relates to equipment proposed, such equipment procured shall be functionally equivalent or better than the equipment proposed. If any provisions herein conflict with Exhibits A and B, then the provisions of this Franchise shall prevail. 3.5 Grantee shall provide all licenses, authorizations, software, and any specialized hardware at no cost for the complete access, full integration, and use of Grantee’s Performance Utilization Late-Call System Evaluation (PULSE) system by the City’s 9-1-1 PSAP, Metro Communications, or its successor as designated by the City. The Grantee will utilize Metro Communications or the City-designated successor to receive and dispatch its ambulance requests. As part of Metro Communications or its designated successor’s use of PULSE, Grantee shall provide all maintenance and update costs associated with the PULSE system and shall provide periodic updates to the system as recommended by the manufacturer. Grantee may charge the City a maintenance fee, currently $15.42 per vehicle, per month annually, subject to cost increases (not to exceed 3 percent annually) of outside vendors for full integration and use of PULSE. In the event the public safety software vendor utilized to conduct computer-aided dispatch and mobile data computers in first response vehicles is upgraded and/or replaced during the terms of this Agreement, Grantee is responsible for licensing, programming, software, hardware, training, and maintenance costs needed for I:\AD\002\02\2X02\2X02177.docx 4 compatibility for its own mobile data computers as well as the PULSE system. City will give Grantee necessary access to the City’s computer-aided dispatch system so Grantee can fulfill its data integration obligations in this Agreement. 3.6 Grantee should adhere to technology best practices to maintain a secure and up-todate network integration with the City of Sioux Falls, through regular security updates, operating system upgrades/patches, antivirus updates, CAD (New World) updates, and limited Internet access to mobile computer units. o Work with City of Sioux Falls Information Technology Division to maintain a secure network interface to access CAD (New World) data resources and the local Pulse (PSUB) server. o Grantee will provide all technical support to mobile computer units and the PSUB server at their expense. o Grantee will provide regular (bimonthly) reports on the current status of their technology systems connecting to the City of Sioux Falls network (e.g., version levels of various O/S and software systems). o Grantee will use industry standard and common troubleshooting procedures on diagnosing technical issues with the mobile computer units and the PSUB server. 3.7 Grantee will attempt to source needed services, supplies, and equipment for day-today operations from local vendors as much as possible. 3.8 Grantee shall provide a Medical Priority Dispatch System (MPDS) qualified instructor to teach an MPDS class at Metro Communications or its successor at least once per calendar year without any cost to City or Metro Communications. Metro Communications will be responsible for all other MPDS student registration fees, materials costs, and certification costs for these classes. 3.9 Grantee shall process/call take all nonemergency transfer calls for service via a tollfree telephone number paid for by Grantee. Grantee will provide a CAD to CAD interface with Metro Communications CAD for Metro Communications to dispatch Grantee’s ambulances to these transfer calls. The toll-free number will be assigned to the City in the event Grantee is no longer the EMS provider for the City. Grantee will answer these transfer calls for service using EMS certified personnel. All transfer calls for service received by Grantee will be recorded for quality assurance purposes and those recordings will be kept at least a year and will be made available to REMSA as per the terms of the RFP. Section Four Use of Protected Health Information 4.1 Grantee is required to implement a comprehensive plan and develop the appropriate policies and procedures to comply with the provisions of the Health Insurance I:\AD\002\02\2X02\2X02177.docx 5 Portability and Accountability Act of 1996 (HIPAA) and the current rules and regulations enacted by the U.S. Department of Health and Human Services or its successor. The three major components of HIPAA include, but are not limited to: A. Standards for Privacy and Individually Identifiable Health Information B. Health Insurance Reform: Security Standards C. Health Insurance Reform: Standards for Electronic Transaction Sets and Code Standards Grantee is responsible for all aspects of complying with these rules and particularly those enacted to protect the confidentiality of patient information. Any violations of the HIPAA rules and regulations will be reported immediately to the REMSA executive director along with Grantee’s actions to mitigate the effect of such violations. 4.2 Pursuant to Section IV, F. 5. of Exhibit A, at page 40, any subcontracts entered into by Grantee to effect its performance under this Agreement must be approved by REMSA. Grantee agrees that it shall not transfer or delegate any of its business processes to any external service provider who is an offshore entity and further acknowledges that REMSA will not approve any subcontract which is in violation of this section. A. For purposes of this section, a “business process” shall include, but is not limited to, medical record transcription services, data entry for medical billing, coding, claims review and adjudication, quality assurance, information technology services, and any other business practice that involves the transmission or use of Protected Health Information (PHI) as defined by HIPAA. B. For purposes of this section, an “offshore” entity shall refer to any country that is not one of the fifty United States or one of the United States territories (American Samoa, Guam, Northern Marianas, Puerto Rico, and Virgin Islands). Examples of countries that meet the definition of “offshore” include Mexico, Canada, India, Germany, and Japan. Subcontractors that are considered offshore can be either American-owned companies with certain portions of their operations performed outside of the United States or foreign-owned companies with their operations performed outside of the United States. Offshore subcontractors provide services that are performed by workers located in offshore countries, regardless of whether the workers are employees of American or foreign companies. Section Five Term of Agreement The initial term of the Franchise shall be for a period of five (5) years commencing at 12:01 a.m. on May 21, 2015, and terminating at midnight, May 20, 2020. If, at the sole judgment and discretion of REMSA, the Grantee is deemed to be substantially in compliance with the specifications defined in this Franchise, City/REMSA may grant an I:\AD\002\02\2X02\2X02177.docx 6 extension of the Agreement for up to six (6) additional years. City shall make the offer of extension by formal written notice to the Grantee at least eighteen (18) months prior to the scheduled end of the term of the Franchise. If the Grantee does not want to continue providing services to City as provided in the Franchise after the end of the term, the Grantee must give notice of its intent not to extend the Franchise at least seventeen (17) months prior to the scheduled end of the term of the Franchise. Section Six Compensation The Grantee will operate the EMS system and provide the services as defined herein without any subsidy from REMSA or the City. The primary means of Grantee compensation will be through fee-for-service reimbursement of patient charges. All rates and charges for services by the Grantee shall be approved by the City Council and established by Ordinance. Section Seven Quality of Service Grantee shall perform its services with care, skill, and diligence in accordance with the applicable professional standards currently recognized by such profession, and shall be responsible for the professional quality, technical accuracy, completeness, and coordination of all reports, designs, drawings, plans, information, specifications, and/or other items and services furnished under this Franchise. Grantee shall, without additional compensation, correct or revise any errors or deficiencies immediately upon discovery in its reports, drawings, specifications, designs, and/or other related items or services. Grantee shall perform its services in full compliance with this Franchise and exhibits hereto, including, but not limited to, the response times and penalty requirements in Exhibit A hereto; however, Grantee shall not be subject to the monetary performance penalty provisions relating to response time requirements as contained in Exhibit A, Tables 6 and 7 at pp. 32–33, during its first 90 days of providing services under this Franchise. All other provisions of the Franchise shall remain in full force and effect during the entire duration of Grantee providing services under this Franchise. Grantee shall not be held accountable for response time compliance and/or subject to fines, sanctions, or any other penalties due to errors, omissions, or failures attributable to Metro staff. Any noncompliant call that is a result of a Metro issue/error will be considered a compliant call for Grantee, and shall not be removed from compliant call numbers and shall be reported as a compliant call. Grantee will not be held accountable for late calls where Metro dispatchers fail to complete and submit the necessary case reports by the end of the dispatchers’ shift who dispatched the late call. I:\AD\002\02\2X02\2X02177.docx 7 Section Eight Personal Satisfaction as a Condition Precedent The obligations of City as provided in this Franchise are expressly conditioned upon Grantee’s compliance with the provisions of this Agreement to the personal satisfaction of the City/REMSA. City/REMSA shall determine compliance in good faith as a reasonable person would under the circumstances. Section Nine Performance Security Bond In conjunction with the remedies set forth in Exhibit A and as incorporated herein, Grantee shall furnish performance security in the amount of one million dollars ($1,000,000) in one of the following forms: A. A faithful performance bond issued by a bonding company, appropriately licensed and acceptable to REMSA; or B. An irrevocable letter of credit (ILOC) issued pursuant to this provision in a form acceptable to REMSA and from a bank or other financial institution acceptable to REMSA. C. The bond or ILOC required by this section shall be promptly delivered for filing with the City Finance Officer, the City Purchasing Manager, or his/her designee. Section Ten Default/Termination/Emergency Takeover City shall have the right to terminate or cancel the Franchise or to pursue any appropriate legal remedy in the event Grantee materially breaches the Franchise and fails to correct such default within seven (7) days following the service on it of a written notice by City specifying the default or defaults complained of and the date of intended termination of rights absent cure. A. Definitions of Breach. Conditions and circumstances that shall constitute a material breach by Grantee shall include, but not be limited to, the following: 1. Failure of Grantee to operate the ambulance service system in a manner which enables the City or the Grantee to remain in substantial compliance with the requirements of the applicable federal, state, and City ordinances, rules, and regulations. Minor infractions of such requirements shall not constitute a material breach, but such willful and repeated infractions shall constitute a material breach; 2. Willful falsification of data supplied to the City by Grantee during the course of operations, including by way of example, but not by way of exclusion, dispatch data, patient report data, response time data, financial data, or falsification of any other data required under the Franchise, or a willful I:\AD\002\02\2X02\2X02177.docx 8 refusal to provide such data within a reasonable time when demanded by the REMSA executive director; 3. Chronic and persistent failure by Grantee to maintain equipment in accordance with good maintenance practices; 4. Deliberate, excessive, and unauthorized scaling down of operations to the determinant of performance by Grantee during a “lame duck” period as described in Exhibit A; 5. Deliberately increasing the cost of providing services, failing to maintain positive labor relations, or undertaking any activity designed to make it more difficult of a transition to a new contractor or for a new contractor’s operation in the event of a default or failure of incumbent to prevail during a subsequent bid cycle; 6. Willful attempts by Grantee to intimidate or otherwise punish employees who sign contingent employment contracts with competing proposers during a subsequent bid cycle; 7. Willful attempts by Grantee to intimidate or punish employees who participate in legally protected concerted activities, or who form or join any professional associations; 8. Chronic and persistent failure of Grantee’s employees to conduct themselves in a professional and courteous manner or to present a professional appearance; 9. Failure of Grantee to comply with approved rate setting, billing, and collection procedures; 10. Failure of Grantee to meet response time requirements for three consecutive measurement periods in a single category and after receiving notice of noncompliance from the executive director of REMSA; 11. Failure of Grantee to comply with the vehicle lease provisions; 12. Failure of Grantee to cooperate and assist City in the investigation or correction of any “Minor Breach” conditions; 13. Failure to comply with required payment of fines or penalties within sixty (60) days’ written notice of the imposition of such fine or penalty; 14. Failure to maintain in force throughout the terms of the Franchise, including any extensions thereof, the insurance coverage required herein; 15. Failure to maintain in force throughout the term of the Franchise, including any extensions thereof, the performance security requirements as specified herein; I:\AD\002\02\2X02\2X02177.docx 9 16. Failure to timely prepare and submit the required annual audit; and 17. Any other willful acts or omissions of Grantee that endanger the public health and safety. B. Termination. 1. Written Notice: The Franchise may be canceled immediately by mutual consent. 2. Failure to Perform: City, upon written notice to the Grantee, may immediately terminate the Franchise should Grantee materially breach any of its obligations under the Franchise. In the event of such termination, REMSA may proceed with the work in any reasonable manner it chooses. The cost to REMSA of completing Grantee’s performance shall be partially supported by securing the funds of the performance security bond, without prejudice to REMSA’s rights otherwise to recover its damages or to seek any other remedy. C. Emergency Takeover. In the event REMSA determines that a material breach, actual or threatened, has or will occur or that a labor dispute has prevented performance, and if the nature of the breach is, in the executive director’s opinion, such that public health and safety are endangered, and after Grantee has been given notice and reasonable opportunity to correct deficiency, the matter shall be presented to the Director of Public Health. If the Director of Public Health concurs that a material breach has occurred or may occur and that public health and safety would be endangered by allowing the Grantee to continue its operations, the Grantee shall cooperate fully with the REMSA to affect an immediate takeover by the REMSA of Grantee’s ambulances and crew stations. Such takeover shall be affected within not more than 72 hours after Director’s decision to execute the emergency takeover. In the event of an emergency takeover, the Grantee shall deliver to REMSA ambulances and associated equipment used in performance of the Agreement, including supervisors’ vehicles. Each ambulance shall be equipped, at a minimum, with the equipment and supplies necessary for the operation of ALS ambulances in accordance with REMSA ALS Policies and Procedures. Grantee shall deliver ambulances, dispatch and communications system, facilities, and crew stations to REMSA in mitigation of any damages to REMSA resulting from the Grantee’s breach. However, during REMSA’s takeover of the ambulances and equipment, REMSA and Grantee shall be considered Lessee and Lessor, respectively. Monthly rent payable to the Grantee shall be equal to the aggregate amount of the Grantee’s debt service on facilities, vehicles, and equipment as documented by Grantee at REMSA executive director’s request, I:\AD\002\02\2X02\2X02177.docx 10 and verified by the City Finance Officer (provided that the cost of Grantee debt service does not exceed the fair market value for the rent for the facilities, vehicles, equipment). The City Finance Officer shall cause the disbursement of these payments directly to the Grantee’s oblige. In the event an ambulance is unencumbered, or a crew station is not being rented, REMSA shall pay the Grantee fair market rental based upon an independent evaluation. Nothing herein shall preclude REMSA from seeking to recover from the Grantee such rental and debt service payments as elements of damage from a breach of the Franchise Agreement. However, the Grantee shall not be precluded from disputing the Director’s findings or the nature and amount of REMSA’s damages, if any, through litigation. Failure on the part of the Grantee to cooperate fully with REMSA to effect a safe/smooth takeover of operations shall itself constitute a breach of the Franchise Agreement, even if it is later determined that the original declaration of breach by the Director was made in error. REMSA shall have the right to authorize the use of vehicles and equipment by another company. Should REMSA require a substitute Grantee to obtain insurance on equipment, or should REMSA choose to obtain insurance on vehicles/equipment, the Grantee shall be “Named Additional Insured” on the policy, along with the appropriate endorsements and cancellation notice. REMSA agrees to return the Grantee’s vehicles and equipment to the Grantee in good working order, normal wear and tear excepted, at the end of the takeover period. For any of the Grantee’s equipment not so returned, REMSA shall pay the Grantee fair market value of vehicle and equipment at time of takeover, less normal wear and tear or shall pay the Grantee reasonable costs of repair, or shall repair and return vehicles and equipment. REMSA may unilaterally terminate a takeover period at any time and return facilities and equipment to the Grantee. The takeover period shall last no longer than REMSA judges necessary to stabilize the EMS system and to protect the public health and safety by whatever means REMSA chooses. All of the Grantee’s vehicles and related equipment necessary for provision of ALS services pursuant to this Franchise Agreement are hereby leased to REMSA during an emergency takeover period. Grantee shall maintain and provide to REMSA a listing of all vehicles used in the performance of this Franchise Agreement, including reserve vehicles, their license numbers, and name and address of lien holder, if any. Changes in lien holder, as well as the transfer, sale, or purchase of vehicles used to provide ambulance services hereunder shall be reported to REMSA within 30 days of said change, sale, transfer, or purchase. Grantee shall inform and provide a copy of takeover provisions contained herein to lien holder(s) within five (5) days of emergency takeover. I:\AD\002\02\2X02\2X02177.docx 11 Section Eleven Indemnification 11.1 Indemnify and Hold Harmless. Grantee agrees to indemnify, defend, and hold harmless the City, the City Council, each member thereof, all officers, agents, employees, and assigns, members of boards and commissions of the City, including REMSA, from and against any and all claims, demands, liability, judgments, awards, interest, attorney’s fees, costs, experts’ fees, and expenses of whatsoever kind or nature, at any time arising out of or in any way connected with the performance of this Franchise, whether in tort, contract, or otherwise. This duty shall include, but not be limited to, claims for bodily injury, property damage, personal injury, and contractual damages or otherwise alleged to be caused to any person or entity including, but not limited to, employees, agents, and officers of Grantee. Grantee’s liability for indemnity under this Franchise shall apply to any acts or omissions, willful misconduct, or negligent conduct of any kind, on the part of the Grantee, its agents, subcontractors, and employees. The duty shall extend to any allegation or claim of liability, except in circumstances resulting from any acts or omissions, negligence, or willful conduct of the City or their agents, subcontractors, and employees. This clause for indemnification shall be interpreted to the broadest extent permitted by law. Grantee accepts responsibility for determining and approving the character and fitness of its employees (including volunteers, agents, or representatives) to provide the services required of Grantee under this Franchise, including completion of a satisfactory criminal/background check and period rechecks to the extent permitted by law. Grantee shall reimburse City for any out-of-pocket expenses incurred by City for any criminal/background checks requested by Grantee. Notwithstanding anything to the contrary in this paragraph, Grantee shall hold City, REMSA, and its officers, agents, and employees harmless from any liability for injuries or damages resulting from a breach of this provision or Grantee’s actions in this regard. 11.2 The insurance provisions of Appendix 10 of Exhibit A are specifically referenced and incorporated herein. Section Twelve Records, Information, and Reports Grantee shall maintain full and accurate records with respect to all matters covered under this Franchise Agreement. To the extent permitted by law, City/REMSA shall have free access at all proper times or until the expiration of four (4) years after the furnishing of services to such records, and the right to examine and audit the same and to make transcripts therefrom, and to inspect all data, documents, proceedings, and activities pertaining to this Franchise Agreement. To the extent permitted by law, Grantee shall furnish City/REMSA such periodic reports as City may request pertaining to the work or services undertaken pursuant to this Franchise I:\AD\002\02\2X02\2X02177.docx 12 Agreement. The costs and obligations incurred or to be incurred in connection therewith shall be borne by the Grantee. Grantee shall allow the REMSA executive director complete and unfettered access and use of PULSE and Tableau 8.0 programs and any updates thereto, without cost, pertaining to the provision of services under this Agreement and as part of its compliance with its Data and Reporting Requirements contained in Exhibit A, page 37, et seq. Data access will include Patient Care Records (PCRs) available to REMSA’s medical director and executive director electronically within 24 hours of the call as well as include access to REMSA’s executive director or designee to the PCR database with the ability to write and run reports for purposes of auditing the provided reports. Section Thirteen Franchise Acceptance 13.1 Franchise Acceptance. This Franchise granted by City by its adoption, together with the requirements, rights, privileges, and authority included and granted herein shall take effect and be in force subject to acceptance and compliance by the Grantee with the following: A. By its acceptance, Grantee represents and agrees to and is bound by all the terms and requirements of this Franchise and conditions of the City included with its adoption. B. Grantee shall execute and file this Franchise with the City Clerk’s Office. C. Grantee shall include with the filing of its executed Franchise a certificate of insurance, and such other applicable bonds, financial payments as may be required by this Franchise or by the City as a condition made part of the adoption of this Franchise. 13.2 Inducements Not Offered. Grantee, by its acceptance of this Franchise, acknowledges that it has not been induced to accept this Franchise by an understanding or promise or other statement, whether verbal or written, by or on behalf of the City concerning any term or condition of this Franchise or Ordinance that is not included in this Franchise. Section Fourteen Relationship of Parties It is understood and agreed that Grantee operates as an independent business and is contracting to do work according to its own methods, without being subject to the control of the City, except as to the product or the result of the work. The relationship between the City and Grantee shall be that as between an independent contractor and the City and not as an employer-employee relationship. The contractual interest of City is to ensure that the services covered by this Franchise Agreement shall be performed and rendered in a competent, efficient, and satisfactory manner. I:\AD\002\02\2X02\2X02177.docx 13 It is agreed that no employer-employee relationship is created and Grantee shall hold City harmless and be solely responsible for withholding, reporting, and payment of any federal, state, or local taxes; any contributions or premiums imposed or required by workers’ compensation; any unemployment insurance; any social security income tax; and any other obligations from statutes or codes applying to Grantee, or its employees, if any. It is mutually agreed and understood that Grantee, its employees, shall have no claim under this Franchise Agreement or otherwise against the City for vacation pay, sick leave, retirement or social security benefits, occupational or nonoccupational injury, disability or illness, or loss of life or income by whatever cause. Grantee shall ensure that all its personnel and employees and any individuals used to perform the contracted services are aware and expressly agree that City is not responsible for any benefits, coverage, or payment for their efforts. Section Fifteen Civil Rights Grantee shall be subject to the provisions of Chapter 98 of the Code of Ordinances of the City of Sioux Falls. It is declared to be discrimination for Grantee, because of race, color, sex, creed, religion, ancestry, national origin, or disability, to fail or refuse to hire, to discharge an employee, or to accord adverse, unlawful, or unequal treatment to any person or employee with respect to application, hiring, training, apprenticeship, tenure, promotion, upgrading, compensation, layoff, discharge, or any other term or condition of employment. If Grantee is guilty of discrimination, this Franchise may be terminated in whole or in part by the City, and Grantee shall be liable for any costs or expense incurred by the City in obtaining from other sources the work and services to be rendered or performed or the goods or properties to be furnished or delivered to the City under the Franchise so terminated or canceled. Grantee will permit access to any and all records pertaining to hiring and employment and to other pertinent data and records for the purpose of enabling the City’s Human Relations Commission, its agencies or representatives, to ascertain compliance with the above provisions. This section shall be binding on all subcontractors or suppliers. Section Sixteen Modification of Agreement Notwithstanding any of the provisions of this Franchise Agreement, the Parties may agree to amend this Franchise. No alteration or variation of the terms of this Franchise Agreement shall be valid unless made in writing and signed by the Parties hereto. No oral understanding or agreement not incorporated herein shall be binding on any of the Parties hereto. I:\AD\002\02\2X02\2X02177.docx 14 Section Seventeen Miscellaneous Provisions 17.1 Actions of Parties. In any action by the City or the Grantee that is mandated or permitted under the terms hereof, such Party shall act in a reasonable, expeditious, and timely manner. Furthermore, in any instance where approval or consent is required under the terms hereof, such approval or consent shall not be unreasonably withheld. 17.2 Notice. Unless expressly otherwise agreed between City and Grantee, every notice or response required by this Franchise to be served upon the City or the Grantee shall be in writing or via electronic mail return receipt, and shall be deemed to have been duly given to the required Party when placed in a properly sealed and correctly addressed envelope: a) upon receipt when hand delivered with receipt/ acknowledgment; b) upon receipt when sent certified, registered mail; or c) upon receipt when sent electronic mail return receipt. The notices or responses to the City shall be addressed as follows: Mayor City of Sioux Falls 224 West Ninth Street P.O. Box 7402 Sioux Falls, SD 57117-7402 With a copy to: Director of Public Health City of Sioux Falls 521 North Main Avenue, Suite 101 Sioux Falls, SD 57104-5963 The notices or responses to the Grantee shall be addressed as follows: Paramedics Plus Attention: President 352 South Glenwood Boulevard Tyler, TX 75702 The City and the Grantee may designate such other address or addresses from time to time by giving notice to the other in the manner provided for in this subsection. 17.3 Descriptive Headings. The captions to sections and subsections contained herein are intended solely to facilitate the reading thereof. Such captions shall not affect the meaning or interpretation of the text herein. I:\AD\002\02\2X02\2X02177.docx 15 17.4 Severability. If any provision of this Franchise or the Ordinance is held by any court or by any federal or state agency of competent jurisdiction to be invalid as conflicting with any federal or state law, rule, or regulation now or hereafter in effect, or is held by such court or agency to be modified in any way in order to conform to the requirements of any such law, rule, or regulation, such provision will be considered a separate, distinct, and independent part of this Franchise, and such holding will not affect the validity and enforceability of all other provisions hereof. In the event that such law, rule, or regulation is subsequently repealed, rescinded, amended, or otherwise changed, so that the provision hereof which had been held invalid or modified is no longer in conflict with such law, rule, or regulation, said provision will thereupon return to full force and effect and will thereafter be binding on City and Grantee, provided that City will give Grantee thirty (30) days’ written notice of such change before requiring compliance with said provision or such longer period of time as may be reasonably required for Grantee to comply with such provision. 17.5 Governing Law. This Franchise and the Ordinance are subject to every question arising hereunder and shall be construed or determined according to Applicable Law of the State of South Dakota. 17.6 Freely and Voluntarily Entering Into Agreement. The Parties acknowledge that they are entering into this Agreement freely and voluntarily, that they have the opportunity to be represented and advised by counsel in the negotiations resulting in this Agreement, that they have ascertained and weighed all the facts and circumstances likely to influence their judgment, that they have given due consideration to the provisions contained herein, and that they thoroughly understand and consent to all provisions herein. 17.7 Annual Presentation to City Council. Grantee understands and agrees that its services, technology, equipment, facilities, and other changes, including industrial and legal developments, may occur throughout the term of this Franchise and in order to inform the City and help it keep current with such changes and to be prepared to work together with Grantee to periodically evaluate and agree to modifications or changes needed to address important changes, upon request, Grantee will make an annual presentation to the City Council of the City in addition to providing such other information or materials as it deems appropriate for these purposes. 17.8 Approval of Grantee Agreement with Metro Communications. Grantee must obtain the prior written approval of REMSA before entering into any agreement or amendments thereto with Metro Communications or its successor, which approval will not be unreasonably withheld. 17.9 Entire Agreement. This Franchise, when effective as provided herein, will constitute the entire Agreement between the Grantee and the City. No statement, promises, or inducements made by either Party or agent of either Party that are not contained in this written contract shall be valid or binding. This contract may not be enlarged, modified, or altered except in writing signed by the Parties and endorsed hereon. I:\AD\002\02\2X02\2X02177.docx 16 17.10 Change In Law. Notwithstanding any other provision of this Agreement, if the governmental agencies (or their representatives) which administer the Affordable Care Act (“ACA”), Medicare, Medicaid, any other payor, or any other federal, state, or local government or agency passes, issues, or promulgates any law, rules, regulation, standard, or interpretation, or any court of competent jurisdiction renders any decision or issues any order, at any time while this Agreement is in effect, which prohibits, restricts, limits, or in any way substantially changes the method or amount of reimbursement or payment for the services provided for in this Agreement, changes the model of service delivery under this Agreement, substantially increases the cost to provide the Services provided for in this Agreement, or which otherwise significantly affects either Party’s rights or obligations hereunder, either Party may give the other notice of intent to amend this Agreement to the satisfaction of both Parties, to compensate for such prohibition, restriction, limitation, or change. If the parties are not able to come to agree to an amendment in writing within one hundred twenty (120) days after said notice was given, this Agreement shall terminate as of midnight on the one hundred twentieth (120th) day after said notice was given. This Franchise is hereby accepted this _____ day of __________________, 2015, by an authorized officer of Grantee. MAYOR ATTEST: PARAMEDICS PLUS, LLC Name: Title: City Clerk I:\AD\002\02\2X02\2X02177.docx By: 17 Exhibit A Request for Proposal Surface Ambulance Service Exclusive Operating Area :\AD\002\02\2X02\2X02177.docx City of Sioux Falls, South Dakota Release Date: luly 18, 2014 Proposal Due Date: October 9, 2014 Time: 3:00 PM CDT ReturnLocation: Purchasing Division 224 W. Ninth St. Sioux Falls, South Dakota 57104 Attn: Procurement Manager: Scott Rust REQUEST FOR PROPOSAL 18 REQUEST FOR PROPOSAL REMSA - City of Sioux Falls, SD Surface Ambulance Service - Exclusive Operating Area Request for Proposal Table of Con tents SECTION I. EMS SYSTEM SUMMARY A. FFPOP OVERVIW EXCLUSIVE OPERATING AREA (EOA) BACKGROUND OVERVIEW OF EMS SYSTEM LOCAL EMS AGENCY RESPONSIBILITIES REMSA SYSTEM IMPROVEMENTS RELEVANT INFORMATION REGARDING SERVICE AREAS I. 2. 3. Call Reception, Dispatch and Response Enhancements llse ofthe City's Traf?c light Control System Citywide Response Time Requirements and Non?performance Penalties Established Surplus or Reserve Fleet Requirements Safety Impacts Related to Pro vider Fatigue Recognized Continuation and livpansion of Community Goals Supporting improved Health Status Exclusive Operating Area Enforcement and Other EMS System Chanqu No Direct System Subsidies Historical Service Volume Current Ambulance Service Rates Payer Mix SECTION II. PROCUREMENT INFORMATION papaya? PERFORMANCE-BASED NOTICE TO meosms USE OF OWN EXPERTISE AND IUDGMENT PROCUREMENT TIME LINE PROCESS Sorta-ri- 7. PROPOSAL INSTRUCTIONS 1. 2. Pro-proposal Process Mandatory Proposers' Conference RF Submission Guaranty Required Proposal Submission Public Proposal Opening Additional Proposer Responsibilities Notice oflntent to Award \1 Chase. Proposal Format Required Proposal Format PROPOSAL EVALUATION PROCESS $905)? Proposal Review Panel Proposal Re view Process Method [br Competitive Scoring ofPrice Proposals Post-submission Presentation :\AD\002\02\2X02\2X02177.docx 10. 11. 12. H. SCORING MATRIX SECTION QUALIFICATIONS A. ORGANIZATIONAL DISCLOSURES ln vestiga tion No ti/ication Protest Withdrawal of Proposals Canceling the Procurement Process after Opening Award Scoring Criteria REP Governed by Its Terms Organizational wnership and legal structure 2. Continuity of business 3. Licenses and permits 4. Government investigations 5. Litigation 3. FINANCIAL STRENGTH AND STABILITY 1. Financial Statements 2. Audited Statements 3. Financial Commitments 4. Working Capital 5. Performance Security 6. Financial Interests C. COMPARABLE EXPERIENCE 1. Comparable experience 2. Government contracts 3. Contract Compliance D. DEMONSTRATED RESPONSE TIME PERFORMANCE E. DEMONSTRATED HIGII LEVEL CLINICAL CARE 8: INTERNAL SverMS SECTION W. CORE REQUIREMENTS A. 1. Basic Services 2. Services Description B. CLINICAL 1. Clinical 0 verview 2. Medical Oversight 3. Minimum Clinical Levels and Staj?ng Requirements C. OPERATIONS QCNf?s-w?ifwwr- 9. 10. 11. D. PERSONNEL 1. Operations Overview Communications Relationship Transport Requirement and Limitations Response Time Performance Requirements Noti?cation of Delays for Non-emergency Responses Response Time Measurement Methodology Response Time Exceptions and Exception Requests Response-time Performance Reporting Procedures and Penalty Pro visions Penalty Disputes Fleet Requirement Co verqqe and Dedicated Ambulances, Use ofStations/Posts Treatment of Incumbent Work Force :\AD\002\02\2X02\2X02177.docx Character, Competence and Professionalism ofPersonnel 36 Internal Health and Safety Programs :hSuN Evolving OSHA Other Regulatory Requirements 5. Discrimination Not Allowed E. MANAGEM Izm 1. Data and Reporting Requirements F. EMS SYSTEM AND COMMUNITY Participation in EMS System Development Accreditation ulti-casualty/Disaster Response Mutual-aid and Stand-by Services Permitted Subcontracting Supply Exchange and Restock . Handling Service Inquiries and Complaints G. A MINISTRATIVE PROVISIONS No System Subsidy Contractor Revenue Reco very Federal Healthcare Program Compliance Pro visions State Compliance Provisions Billing/Co llect ion Services 41 41 41 4 1 42 4-2 Market Rights Service Expanson 43 43 Accounting Procedures Insurance Pro visions 1 0. Hold llarmless Defense Indemni?cation Taxes Contributions 1. Performance Security Bond 12. Term of/lgreement l3. Earned Extension to Agreement 14. Continuous Service Delivery 15 Annual Performance Evaluation 16. Default and Provisions for Termination of the Agreement 17. Termination 18 Emergency Takeover 19 Transition Planning 20. Cit 's Remedies 21. Pro visions for Curing Material Breach and Emergency Take Over 22. "Lame-duck Pro visions 23. General Pro visions SECTION V. COMPETITIVE CRITERIA A. CLINICAL Competitive Criterion: Quality Impro vement Competitive Criterion: Clinical and Operational Benchmarking Competitive Criterion: Dedicated Clinical Oversight Personnel Competitive Criterion: Medical Direction and Support for REMSA Medical Control Competitive Criteria: Focus 0 Patients and Other usto mers Competitive Criterion: Continuing Education Program Requirements PERATIONS Competitive Criterion: Dispatch Communications Competitive Criterion: Vehicles Competitive Criterion: Equipment Competitive Criterion: Vehicle and Equipment Maintenance . Competitive Criterion: Deployment Planning ERSONNEICompetitive Criterion: Field Supervision Competitive Criterion: Work Schedules Competitive Criterion: Internal Risk Management/loss Control Program . Competitive Criterion: Workforce Engagement D. NAGI-IM ENT 994$?? 1. Competitive Criterion: Key Personnel E. EMS SYSTEM AND COMMUNITY Competitive Criterion: Working Closely with Hospitals. and other air and gro und providers within the region 2. Competitive Criterion: Supporting lmpro vement in the First Response System 3. Competitive Criterion: Health Status Improvement and Co mmunity Education SECTION VI. BUDGET AND PRICING DOCUMENTATION A. MINIMUM FORMA BUDGETS B. PRICING C. FINANCIAL STATEMENTS SECTION VII. EXECUTIVE SUMMARY 64 65 67 69 69 69 SECTION INSURANCE CERTIFICATES (REQUIREMENTS IN APPENDIX 8) DERARMENT AND SUSPENSION CERTIFICATION (FORM IN APPENDIX 8) REFERENCES (FORM IN APPENDIX C) INVESTIGATIVE AUTHORIZATION-INDIVIDUAL (FORM IN APPENDIX D) INVESTIGATIVE AUTHORIMTION- ENTITY (FORM IN APPENDIX E) RFP SUBMISSION GIIARANTY (SOMETIMES REFERRED To AS A SECTION IX. QUALIFICATION REQUIREMENTS A. ORGANIZATIONAL DISCLOSURES Organizational ownership and legal structure Continuity of business Licenses and permits . Litigation 1 2. 3. 4. Co vernment investigations 5 FINANCIAL STRENGTH AND STABILITY Financial Statements Audited Statements Financial Commitments Working Capital Per?) rmance Security . Financial Interests C. EXPERIENCE AS SOLE PROVIDER 1. Comparable experience 2. Go vernment contracts 3. Contract Compliance D. DEMONSTRATED RESPONSE PERFORMANCE E. DEMONSTRATED HIGII LEVEL CLINICAL CARE 8t INTERNAL SYSTEMS SECTION X. CORE REQUIREMENTS A. FUNCTIONAL RESPONSIBILITIES 1. Basic Services 2. Services Description Lulu? r-i r-l I-i :\AD\002\02\2X02\2X02177.docx 22 B. CLINICAL 1. Clinical Overview 2. Medical Oversight 3. Minimum Clinical Levels and Sta/ling Requirements OPERATIONS Operations Overview Transport Requirement and Limitations Response time Performance Requirements Noti?cation of Delays for Non-emergency Responses Response Time Measurement Methodology Response Time Exceptions and Exception Requests Response Time Performance Reporting Procedures and Penalty Pro visions Fleet Requirement . Co verqqe and Dedicated Ambulances, Use ofStations/Posts PERSONNEL 1. Treatment oflncumbent Work Force 2. Character, Competence and Professionalism of Personnel 3. Internal Health and Safety Programs 4. Evolving OSHA Other Regulatory Requirements 5. Discrimination Not Allowed MANAGEMENT 1. Data and Reporting Requirements EMS SverM AND COMMUNITY Participation in EMS System Development Accreditation ulti-casualty/Disaster Response Mutual Aid and Stand-by Services presets? Permitted Subcontracting Communities May Contract Directly for Level of E?brt Supply Exchange and Restock Handling Service Inquiries and Complaints ADMINISTRATIVE PROVISIONS No Subsidy System Contractor Revenue Recovery Federal Healthcare Program Compliance Pro visions State Compliance Pro visions Billing/Collection Services Market Rights Service Expansion Accounting Procedures meQ9?$9N8 Insurance Pro visions. 10. Hold Harmless Defense Indemni?cation 'i'axes Contributions 1 1. Performance Security Bond 12. Term of Agreement 13. Earned Extension to Agreement 14. Continuous Service Delivery 15. Annual Performance Evaluation 16. Default and Pro visions for Termination of the Agreement 17. Termination 18 Emergency Takeover Transition Planning 20. REMSA 's Remedies 21. Pro visions ,?br Curing Material Breach and Emergency Take Over 22. "Lame duck Pro visions :\AD\002\02\2X02\2X02177.docx 23 A. 23. General Pro visions SECTION XI. COMPETITIVE CRITERIA CLINICAL 1. Competitive Criterion: Quality lmpro vement 2. Competitive Criterion: Clinical and Operational Benchmarking 3. Competitive Criterion: Dedicated Clinical Oversight Personnel 4. Competitive Criterion: Medical Direction 5. Competitive Criteria: Focus on Patients and Other Customers SEPARATE SUBMISSIONS: FINANCIAL AND PRICING DOCUMENTATION ENVELOPE ONE: LABELED 19mm (TEMPLATE IN APPENDIX F. G. APPENDIX 9 COMMUNICATIONS SYSTEM INFORMATION A. B. :97!pr b. Competitive Criterion: Continuing Education Program Requirements OPERATIONS 1. Competitive Criterion: Communications 2. Competitive Criterion: Vehicles 3. Competitive Criterion: Equipment 4. Competitive Criterion: Vehicle and Equipment Maintenance 5. Competitive Criterion: Deployment Planning PERSONNEL 1. Competitive Criterion: Field Supervision 2. Competitive Criterion: Work Schedules 3. Competitive Criterion: Internal Risk Management/Loss Control Program 4. Competitive Criterion: Workforce Engagement MANAGEMENT 1. Key Personnel EMS AND COMMUNITY 1. Area Providers Collaboration 2. Supporting lmpro vement in the First Response System 3. Health Status Improvement and Community Education ENVELOPE TWO: LABELED 1Com ENVELOPE THREE: LABELED mt; (FORM IN APPENDIX 1 1) METRO COMMUNICATIONS IS THE MULTI DISPATCH CENTER DISPATCH CENTER OPERATIONAL EXPECTATIONS 1. Key Elements o/Metm?s EMS Dispatch Activities: CONTRACTOR DEPLOYMENT PLANNING RESPONSIBILITY PERFORMANCE: NOT TO ADVERSELV CONTRACTOR DISPATCII PROBLEM RESOLUTION AND EVALUATION REQUIRED COMMUNICATIONS EQUIPMENT AND DISPATCH AMBULANCE COMMUNICATION COMMUNICATION EQUIPMENT CURRENTLY UTILIZED TABLE 1. 2013 AMBULANCE CALL TRANSPORT VOLUME TABLE 2. ESTIMATED PAYER MIX TABLE 3. SCORING ALLOCATION TABLE 4. PROPOSAL REVIEW SCORING ALLOCATIONS TABLE 5. RESPONSE TIME COMPLIANCE REQUIREMENTS TABLE 6. CITY RESPONSE TIME PENALTIES TABLE 7. OUTLIER RESPONSE TIME PENALTIES OT :\AD\002\02\2X02\2X02177.docx 24 16 16 27 32 33 TABLE 8. BREACH EVENTS AND PENALTIES APPENDICES: 1. Mandatory able of Contents 2. City Ambulance Ordinance 3. City Boundary 8; Fire Battalion Maps 4. Most Recent Three Year Call Volume Information 5. Current Ambulance Rates (3. Procurement 'l?imelinc 7. Pro Forma Budget Templates 8. Required Forms 9. Metro Communications Information and Equipment Information 10. Insurance Requirements 11. Price Sheet :\AD\002\02\2X02\2X02177.docx 25 34 SECTION I. EMS SYSTEM SUMMARY A. Overview Roquestfor Proposals: The City of Sioux Falls (herein "City") is a political subdivision of the State of Sonth Dakota. State law confers on the City the authority to enter into agreements to provide ambulance service (South Dakota 34- l. The City of Sioux Falls through its designated entity the Regional Emergecy Medical Services Authority (REMSA) is conducting this procurement and is seeking a quali?ed ambulance service pmvider to deliver these and certain related services in accordance with the expectations set forth in this Request for Proposals Each entity responding to this RFP (Proposer) shall submit a written response (Proposal) setting forth the Proposer?s quali?cations and plans for meeting or exceeding the pcrlonnance expectations set forth in this RF P. Proposals must be organized to address each of the items and in the exact order shown in the "Mandatory Table of Contents for Proposals? in Appendix 1. The outcome ofthis RFP will be the selection ofa Proposer (Contractor) with whom the will negotiate an exclusive, performance-based agreement (Agreement) for the provision of 1) emergency medical care and transport system at a ?paramedic Advanced Life Support" (ALS) level of service; and 2) non-emergency ambulance transports (ALS and BLS) originating and terminating in the City. This includes the exclusive right and obligation to respond to 9-1-1 calls and other emergency or urgent medical call requests made through the City's PSAP, public safety agencies, and other sources, (ii) provide care and/or transport patients within the emergency medical services (EMS) system, and provide care and/or transport other patients requiring ambulance service, when the transports originate and terminate within the City. The performance expectations set forth in this RFP and the performance commitments set forth in the selected Proposal will be incorporated in the Agreement as mandatory performance standards. Pollcy Goals of the Procurement: The overarching goals in the conduct of this procurement process are to: (1) promote public health and safety by preVenting the loss of life; (2) minimize the physical pain of patients; (3) reduce the costs associated with catastrophic injury or illness; and (4) ensure good value in return for the investments of the customer and the community. To achieve these overarching goals, the is working to promote a quality EMS system that includes the following essential elements: I Prevention and early recognition Bystander action/system access Medical Dispatch Telephone protocols and prearrival instructions First responder and ambulance dispatch First responder services Transport ambulance services Direct (on-line) medical control Receiving facility inte?ace Indirect (oil-line) medical control Independent monitoring Response time for transport capable paramedic ambulances to emergency medical incidents is an inrportant performance measure ofa high quality EMS service that is of particular interest to the public. The is taking a conrprelrerrsive systems approach to the overall EMS system of which ambulance services are one important part. The RF l? accordingly identi?es response times and quality standards that the Contractor must meet in providing ambulance services . :\AD\002\02\2X02\2X02177.docx 26 This approach also calls for the City, through REMSA, to maintain EMS coordination, oversight, and accountability,- while allowing the Contractor the ?exibility to use its expertise and entrepreneurial talent to manage its day-to-day operations. This model is intended to promote high-quality clinical care, ef?ciency, economy, reliability, and operational and ?nancial stability. B. Exclusive OperatingArea (EDA) Proposers shall submit a Proposal for the City's Exclusive Operating Area (FDA) for surface ambulance service as defined by Section 124.080 Revised Ordinances of Sioux Falls, SD (Appendix 2). Proposers must agree to provide the services referred to above for the entire City without any qualification or variation other than as expressly set forth in this RFP. Ambulance services provided pursuant to contracts with other governmental agencies within the City or contracts for the provision of the ground component of an air transport and certain critical care transports as de?ned herein are excluded from the EOA. Contractor may compete or contract for emergency or non-emergency services outside the EDA. C. Background The City established REMSA to facilitate a collaborative eifort between the City and Minnehaha County. The County ultimately did not participate and the agency oversees the ambulance contract and facilitates system improvements on behalf of the City. A single ambulance service (Sioux Falls Ambulance Inc.; d/b/a Rural Metro.) contracts with the City to provide emergency medical and ambulance services within the City. The City has established an ambulance ordinance that establishes broad standards for the operations, equipment, and personnel of pro-hospital emergency care services. Several provisions of this RFP may require amendments to the Ordinance anticipated to be adopted concurrent with the contract approval. As noted above. a copy of the ordinance as it may be amended is re?ected substantially in the form attached hereto in Appendix 2. Additionally, requirements that are more speci?c can be found in REMSA's policies. which will be incorporated into the Agreement. These policies and procedures can be downloaded alwm?a?ma The City?s Fire Department, Sioux Falls Fire Rescue, (SFFR) provides basic life support (BIS) ?rst response services. The City Police Department provides ?rst aid, CPR and AED services. The City comprises a total area of approximately 73 square miles and has a population estimated to be 160,000 people (2012).l It is in Minnehaha and Lincoln counties. The City is the largest population center in the region, comprises nearly 30% of the State of South Dakota?s population, and is one of the fastest growing communities in the region. In conducting a competitive process for the provision of emergency ambulance services, the City of Sioux Falls is seeking to provide its citizens with high quality coshetlectivc services. D. Overview of EMS System Requests for assistance to medical emergencies typically originate through the City's 9-1-1 PSAP, (sometimes referred to herein as Metro Communications) Metro Communications is an accredited Center- Calls are passed by different methods to the ambulance pmvider. The ambulance provider will utilize Metro Communications to receive and process its ambulance requests. 1 :\AD\002\02\2X02\2X02177.docx 27 The current ambulance provider is licensed by the City and operates under a provider agreement with the City and REMSA. The response to a potentially life threatening incident typically includes a BLS ?rst responder unit from the City fire department and a paramedic-stalled ambulance from the provider, Sioux Falls Ambulance, Inc. d/b/a Rural Metro Ambulance. Emergency ambulances are staffed with at least one state licensed and lacally certi?ed paramedic, and an emergency medical technician (EMT), and equipped with advanced life support equipment. Paramedics work under REMSA's guidelines and have access to system medical direction provided by REMSA. REMSA guidelines provide paramedics with standing orders for the appropriate treatment and transport of patients. Patients are transported to appropriate receiving facilities. Hospital destination is based upon patient preference and REMSA guidelines. Critical patients are normally transported to a nearby emergency department, trauma center, or cardiac center, as appropriate. Non-critical patients may be transported to hospitals of choice within reasonable travel time. Medical helicopter service is available but is generally not utilized within the City. E. Local EMS Agency Responsibilities It is the responsibility to: - Select and enter into an Agreement with the Contractor; - Provide contract administration and management services for the Agreement; Monitor the EMS system's performance and compliance with the performance based speci?cations applicable to the Contractor, - Commit to the continued collaboration to provide high quality ?rst response service on life- threatening incidents: Provide medical direction for the system; vaide EMD call screening and dispatch services for the system; Develop and modify EMS system protocols and procedures; Ensure hospitals provide on?line medical control; and Secure or provide, in the event of Contractor's default, an alternative EMS delivery system. F. REMSA System Improvements Its changes and improvements in EMS have occurred during the last 10 years, healthcare changed considerably as has EMS. Numerous studies have been undertaken to ascertain which practices will produce the best patient outcomes and what actions will have minimal positive impacts. Technology has allowed EMS to improve response times and productivity and to provide data for identifying practices that will deliver positive results for the patients and the system. Although it is not intent or desire to create the most expensive, high-performance EMS system in the country, REMSA is committed to ensuring that EMS services are delivered at the comparable level of quality and performance enjoyed by users in other good quality and reliably performing EMS systems. REMSA is pursuing its overall goal to update the local EMS system through incorporating system improvements in this RFP and its resulting Agreement. Changes to the Sioux Falls EMS system are designed to improve care to patients and can be achieved without undue ?nancial or operational hardship on the Contractor. :\AD\002\02\2X02\2X02177.docx 28 1. Call Reception, Dispatch and Response Enhancements The goal for the EMS system is that all 9-1-1 calls for medical assistance be answered. Tile Metro Communications Center is responsible to ensure prioritization of calls as to acuity level according to protocols approved by REMSA. When appropriate, all callers will receive emergency medical prean'ival instructions according to protocols approved by REMSA. All of the dispatch staff members are Emergency Medical Dispatch certi?ed. Non-emergency calls and calls for scheduled transports are to be managed under arrangements with Metro Communications. All local assets are to be "mstered" through Metro Communications and will be dcployed/re-deploycd based on the Contractor?s written plan and while. deployment of resources are to remain fully within the Contractor's control, Metro Communications will dispatch the closest Contractor ambulance to life threatening requests. All units are to be enabled. 2. Use of the City's Traf?c Light Control System The City's traffic light control system will be used by the Contractor to enhance safety of its personnel, citizens and achievement of response times. This system has not previously been available for EMS use. 3. Citywide Response Time Requirements and Non-perfonnanee Penalties Established The requirements are based on an analysis of the historical volume and density of calls. The City will measure compliance citywide bill will also analyze responses in accordance with City Fire. Battalions to ensure response equity. Performance requirements are provided in detail in Section The Contractor?s response time clock begins when the call is time stamped as dispatched by the PSAP. Response time compliance is to be maintained on 90% of all calls. Failure to perform will result in ?nancial penalties and may cause the replacement of the Contractor as described in Section Appendix 3 includes maps indicating the boundaries of the City and the City's Fire Battalions. 4. Surplus or Reserve Fleet Requirements Contractor is to maintain the number of ALS equipped and fully operating ambulances that represent [30% of the peak stalling level. For example, if the Contractor?s peak number of ambulances is six, then, the Contractor is to maintain a fleet of at least eight ambulances (b 130% 7.8 rounded up to 8). ?130% of peak demand equals a fraction, the ?eet requirement should be rounded up to the next whole ambulance. 5. Safety Impacts Related to Provider Fatigue Recognized Provider fatigue and the impairment associated with the fatigue pose a significant saiety risk for patients, caregivers, and others in the community. Cnewmembers working on ambulances in the City shall not be scheduled to work shifts longer than 24 consecutive hours and shall not remain on duty for longer than 36 consecutive hours due to late calls or unscheduled holdovers. A rest period of at least 12 consecutive hours between extended shifts is required. The only exception will be a declared disaster. 6. Continuation and Expansion of Community Goals Supporting Improved Health Status The and its Contractor have made significant investments in CPR training, AED placement, community education, participation in clinical research and speci?c efforts to improve cardiac arrest outcomes CARES). While the specific efforts cannot be outlined at :\AD\002\02\2X02\2X02177.docx 29 this lime. it anticipates continued involvement and engagement by its Contractor related to expanding Mobile integrated Health Programs (MIHP) Community Paramedic progmms and other activities that will improve community health status during the contract term. 7. Exclusive Operating Area Enforcement and Other EMS System Changes The City anticipates changes to the current Ambulance Ordinance that will facilitate enhanced and more rapid enforcement of its decision to contract with a single ambulance service. In addition, "Lift Assists? and "Standby Sen/ices" are anticipated to be clarified. Ambulance sewice expectations evolved to include primaty responsibility for medical alarms and callers that need assistance getting back in bed, regardless of their actual medical needs. Public safety standby requests have expanded to a point where the need to modify these expectations or provide alternate compensation options to ensure they do not negatively impact ambulance coverage requirements. 8. No Direct System Subsidies 'i'he EMS system has operated for decades without direct subsidy to ambulance providers. While the City provides certain infrastructure (cg. dispatch and medical control services) for the contractors use as outlined herein it is the intention that the selected ambulance provider will continue to operate without direct subsidy. 'l?he proposer shall submit its proposal assuming no direct cash subsidies from the City or REMSA. G. Relevant Information Regarding Service Areas REMSA makes no representations, promises. or guarantees concerning the actual number of emergency and non-emergency calls or transports, number of patients or distance of transports associated with this procurement. Every effort has been made to provide accurate information, but Proposers will need to use its own professional judgment and expertise to develop estimates, economic models and operational plans and proposals. 1. Historical Servlce Volume Call volume in the City was collected for the last three years. That information is included in Appendix 4. There were approximately 9,030 patient transports that originated and ended in the City from January 1, 2013 through December 31, 2013. See Table 1. This figure does not include transports by other entities that originated in the City but temiinated outside the City. There has been no independent validation of this data. Proposers are encouraged to use their own professional judgment to analyze the service to determine response and transport volumes. The does not guarantee any nu mberofincidents or transports. :\AD\002\02\2X02\2X02177.docx 30 Table 1. 2013 Ambulance Catt Transport Volume Pro-Hospital Calls Number of Incidents Number of Transports Emergency 4612 Non- Emergency 74 20 3331 Number of Incidents Number of Transports Emergency 0 0 Non-Emergency 1093 1070 Detailed call data was collected for the three-year period and is available upon request and completion of a Business Associate Agreement from the City of Sioux Falls Purchasing Department. This call data includes the date, time. location, and priority of calls under the previous agreement but will not re?ect call priorities that may be required under this 2. Current Ambulance Service Rates Current providers are required to notify and receive approval ol~ rates from the director. The current ambulance service rates are included in Appendix 5. 3. Payer Mix The current provider reports the following transport volume and payer mix information in Table Table 2. Estimated Payer Mix Percent of Transports l\'1edicare 1 8. 00 Medicaid 12.00% Medicare 8: Medicaid 60.00% Insurance 23.00% Private Puy 17.00% Total 100% Since the payer mix determines potential revenue recovery and anticipated healthcare changes may have a significant impact on the payers, the Agreement will provide that should the Contractor demonstrate to the satisfaction that the insured category is at least live percent lower than listed or that the Medicare/Medicaid or sell pay category is at least live percentage points higher than iderrtilied, the variation will be grounds tor a rate adjustment as provided in Section lV.G.3.b. For example, it Medicaid transport percentages exceed 17.00% the Contractor may request a rate adjustment. 31 SECTION II. PROCUREMENT INFORMATION A. Performance-based Contract The result of this procurement will be the award of a pertOrnrance-based contract. The Agreement will require the Contractor to achieve and maintain high levels of performance and reliability. The demonstration of effort, even diligent and well-intended effon, will not suf?ce to meet the requirements of the Agreement with respect to prescribed perfonuance requirements. Failure to meet speci?ed service standards will result in financial penalties and may lead to termination ofthe Agreement. The essential areas where performance be achieved include: Ambulance response times; - Ambulance equipment and supply requirements; 0 Ambulance stalling levels including personnel with current and appropriate levels of cenificalion/licensure; I Clinical performance consistent with approved medical standards and protocols; Comprehensive quality improvement and compliance activities and results; - Dispatch performance standards; Accurate attd titnely reporting; and - Customerand community satisfaction with the services provided. Again, the Agreement is not a level-of-effon contract. In submitting its Proposal, the Proposer is agreeing to employ whatever level of effort is necessary to achieve the clinical, response time, customer satisfaction. quality improvement, and other performance results required by the EMS System Specifications. 8. Notice to Proposers The issuance of this RFP does not commit the to accept proposals, complete the selection process, award a contract, or pay any costs incurred in the preparation of a Proposal responding to this The reserves the right to reject any or all Proposals received at any point in the procurement process, or to cancel the RFP in whole or part if the in its sole discretion, so determines. Submission of a proposal by a l?roposer shall constitute an agreement to the provision for public announcement. Excluding proprietary infomration, the proposal and the professional service contract of the firm awarded the contract are deemed public records and shall be available to the public. In addition. the City shall maintain a "Register of Proposals for a Professional Service Contract" which shall contain the names of all lirms who submitted a proposal and the name of the. firm who was awarded the contract; however, the proposals ofthe. submitting firms not awarded the contract are non-public records and will remain confidential. Submission ofa Proposal to this RFP constitutes a complete waiver ofany claims whatsoever against REMSA or the City that it has violated a Proposer's right to privacy, disclosed trade secrets or caused any damage by allowing the Proposal to be inspected once the Notice of Intent to Award has been published. C. Use of Own Expertise and Judgment Each Proposer use its own best expertise and iudgment in deciding on the methods to be employed to achieve and maintain the perfonnance. required under the resulting Agreement. As used here, "methods" includes. without limitation. compensation programs, shift schedules, personnel :\AD\002\02\2X02\2X02177.docx 32 policies, asset acquisition, supervisory structure, deployment plans, and other business matters that comprise the organizations strategies and activities. D. Procurement Time Line The Procurement Time Line is included in Appendix 6 (the Procurement Time Line). Any changes to the Procurement Time Line will he published on City website and organizations requesting the RFP will he noti?ed by the E. Procurement Process Administrative support for this process will be provided to the City Purchasing Division by REMSA and the City's C0nsultants. 1. Pie-proposal Process Questions regarding this RFP should be submitted in writing to: Mr. Scott Rust Purchasing Manager 224 W. Ninth St. Sioux Falls, South Dakota 57104 srust@siouxfalls.org Questions or requests for clarification regarding the RFP will be accepted prior to the Pmposers' Conference, but no later than 4:00 pm. on the date speci?ed in the Procurement Time Line (Appendix 6). 2. Mandatory Proposers' Conference A PreProposal conference will be held at the Purchasing Division 224 W. Ninth St. Sioux Falls, SD. on August 22, 2014 at 10:00 am. to allow staff and consultants to discuss all relevant issues associated with the Request for Proposal and to permit Proposers an opportunity to ask questions. Each firm will be limited to not more than two (2) representatives in attendance. The Proposcr conference may be attended telephonically with prior arrangements. Please submit, in writing, any questions about the RF that you would like answered at the pre- proposal conference to the Purchasing Manager to the email address as referenced above no later than three (3) working days before the conference. This will allow for a more thorough response. The Pro-Proposal conference may be taped and answers to questions will be posted to the City?s Ollicial Website following the conference. Please contact the City Purchasing Division at the email listed above to confirm your attendance. Oral answers at the conference will not be binding on the tty. 3. RFP Submission Guaranty Required Each proposal must be accompanied by a bid bond, certified check, cashier's check, or bank draft in the amount of$10,000. All guaranties shall be made payable to the City of Sioux Falls. Bonds shall be issued by a surety authorized to do business in this state. Checks shall be certi?ed or issued by a state or national bank. Bid guaranties of unsuccessful proposals shall be retu med within 30 calendar days of the RFP opening. Guaranties other than those mentioned will not be accepted by the City of Sioux Falls. Bid guaranty of the successful bidder shall be retained until the contract is executed and a performance guaranty (ifapplicable) has been submitted. Should a :\AD\002\02\2X02\2X02177.docx 33 successful bidder fail to enter into contract, the bid guaranty shall be forfeited to the City as partial compensation for the administrative expenses of making a re-award or issuing a new request. 4. Proposal Submission Each Proposer must submit one (1) original and ten (10) copies of its Proposal by 2:00 Central Time on the date speci?ed in the Procurement Time Line (the Deadline). A (ID-ROM. or other electronic storage device, of the Proposal and attachments in Microsoft Word or PDF format shall accompany each Proposal. Any Proposals received after the deadline will not be considered. Proposals shall remain in effect for a period of one hundred and twenty (l20) days after the Deadline. Proposals shall be submitted in a sealed container (if multiple boxes list as of X). The outside of the container and each Proposal shall be labeled "Surface Ambulance Service lixlusive Operating Area For the City of Sioux Falls, South llakota"and the Proposer's name. One (1) original and two (2) copies of the required Price Sheets shall be included in the sealed container but placed in a separate, sealed envelope marked with the Proposer's name and labeled "Price Sheets." One original copy of the ?nancial statements and audited ?nancial statements will be placed in a sealed envelope and labeled "Financial Statements." One (1) original and two (2) copies of the pro fomra budgets (Appendix 7) will be placed in a sealed envelope and labeled "Budgets." Proposals shall be delivered to: City of Sioux Falls 3'd Floor Purchasing Ol?ce 224 W. Street Sioux Falls, SD, 57104 Attention: Scott Rust 5. Public Proposal Openlng All proposals received prior to the Deadline shall be marked with a proposal number EMS-2, etc.) and the date and time of receipt and kept unopened and secured in a locked area. Such Proposals shall be publicly opened at the City Purchasing Division Sioux Falls, SD. at the time and date specified in the Procurement Time Line. The number. submission date, general description of service being requested, and name of each Proposer will be recorded and read aloud to the persons present. The contents of the Proposals shall not be reviewed or disclosed at the public opening. Subsequent to the public opening, City Purchasing will examine contents of proposals for completeness. 8. Proposer At any time following the opening of Proposals, City Purchasing may request a Proposer to provide additional information or documentation regarding its Proposal. Proposers will also be requested to make a formal oral presentation to the proposal review panel (the Review Panel] and to respond in person to questions from the panel. Such requests must be ful?lled by the Proposer or its Proposal may be rejected. 7. Notlce of Intent to Award The through Purchasing, will issue a Notice oflntent to Award." At the time ol'the issuance of the Notice of Intent to Award, the identity of all Proposers will beeorue public, non- winning proposers' right to protest will become ripe, and stafl' will begin the :\AD\002\02\2X02\2X02177.docx 34 pr?0cess of placing the contract award on a future agenda of the City Council for approval. Although the Notice of Intent to Award may tentatively identify the City Council meeting date upon which the award recommendation will be considered, such date selection shall not be binding upon REMSA or the City. it" there are any delays in the procurement timeline, all Pmposers will be noti?ed by Purchasing. F. Proposal Instructions 1. Proposal Format Proposals should be concise and directly respond to the required information in this RFP. To facilitate the evaluation process, Proposals shall be limited in size. The entire Proposal and exhibits shall be contained within two (2) 2-inch, three-ring binders. One binder shall contain the narrative (Proposal Narrative] and the second the exhibits (Proposal Exhibits). Excepted from these restrictions are any information submitted in response to Sections 111, IV and below. The Proposal Narrative shall adhere to the following speci?cations: Easily readable font, no smaller than 10 point; Litre spacing no smaller than 1 V1 litres; Single sided page printing; Standard 8 1/z? by 11" paper; Pages must be numbered sequentially; and Pages are limited to 250 pages per binder excluding title page, table of contents, and dividers All attachments and exhibits shall be inserted in the second binder. Each exhibit and attachment shall be labeled and referenced in the narrative. 2. Required Proposal Format 8) Mandatory TabloofContonts The Proposal Narrative shall respond to each topic listed in the Mandatory Table ofContents in the exact sequence that the topics appear in the Mandatory Table of Contents. The Proposal must utilize the stipulated section and heading titles and numbering set forth in the Mandatory Table of Contents. The response to each item must contain all of the information that the Proposer is providing with respect to that topic. The response may incorporate by reference information contained in the Proposal Exhibits. but may not incorporate by reference any information contained in other portions ofthe Proposal Narrative. With the exception of information appearing in a Proposal Exhibit that is expressly referenced in a response, information not set forth in the portion of the Proposal Narrative clearly identi?ed as responding to a specific topic on the Mandatory Table of Contents may be disregarded in the rating of the Proposal. Reviewers may disregard information submitted in the Proposal if it is not included in the mandated location defined by the Mandatory Table of Contents. tr) Required Proposal Sections The Proposal Narrative shall be divided into the following five sections. Section I Executive Summary Section II Required Forms as specified in Appendix 8 ofthis RFP. Section Proposer?s demonstration of the appropriate credentials and ability to meet the minimum qualifications set forth in Section of this RFP Section IV Proposer's response to the basic perfomrance and operational requirements set forth in Section IV of this RFP [the Core Requirements). :\AD\002\02\2X02\2X02177.docx 35 Failure to to each of the Core Requirements nray result in the Proposal being disqualified and deemed unresponsive. Section l?roposer's response to the competitive criteria set forth in Section of this RFP (the Competitive Criteria). The Competitive Criteria will be reviewed, evaluated, and scored in the Proposal review process. Proposals shall provide all information requested in this RFP in the order that it is requested. Performance standards for ambulance service are identi?ed in sections of this RFP and shall be addressed in the manner stipulated for each standard. Proposers may elect to use reference "exhibits" or "attachments" in the Proposal Narratives to provide additional detail. 6. Proposal Evaluation Process 1. Proposal Review Panel The Proposal review process shall be managed by The City Purchasing Division through its Consultant. A mum-disciplinary panel of four (4) disinterested EMS professionals shall be selected by the Consultant with approval to evaluate and rank Proposals. The City Health Director shall appoint three (3) disinterested local members of the review committee to evaluate and rank Proposals. Meetings of the Review Panel will be closed to the public. The orrtcomc of the deliberations of the Review Panel shall be submitted to The lleallh Director. The Director shall review the submission and may consider any and all other pertinent information. To assun' a fair process. members of the Review Panel will be instructed to avoid discussing any Proposal or the RFP process with any Proposer or other individual not present during the evaluation prior to the announcement of the outcome of the deliberation. Until the outcome of the deliberations of the Review Panel has been submitted to the Director, Propose-rs shall avoid arty communications regarding Proposals or the RFP process with arty member of the Review Panel, City Council, REMSA or City staff outside of the formal procurement process during the period commencing with the release of the RFP until either the expiration of the protest period or the resolution of any protest that may he ?led. The names ofthe Review Panel members will not be disclosed prior to the RFP submission deadline. If it is determined that a Proposer attempted or had such precluded communications, or otherwise at any time attenrpted to unduly in?uence the selection process except in a manner explicitly approved in the RFP, Proposer?s Proposal may be disquali?ed. 2. Proposal Review Process The proposal evaluation process will encompass three stages. a) The Review Panel will review the documentation provided in each Proposal to determine if the l?roposer meets the Minimum Qualifications. Each criterion will be scored on a pass/fail basis. The Review Panel will rate the proposcr?s comparable experience providing similar services. If the Reviewers identify a Proposal that does not meet Minimum Quali?cations, the Proposal or Proposals not meeting all Minimum Qualifications will be referred to CPD. CPD will make a recommendation to the lleallh Director for final determination. Proposals that, in the judgment of the Director, do not meet the minimum requirements for experience, qualifications, and financial capabilities will be considered unresponsive and disqualified. b] The Review Panel will then review the documentation in the Proposals related to the Core Requirements. The Proposals must include an affirmative statement agreeing to each Core Requirement without quali?cation. lfany Proposer fails to include af?rmative agreement to the Core Requirements or with the minimum requirements listed in Section the Minimum Requirements), the Review Panel will refer the nonconforming :\AD\002\02\2X02\2X02177.docx 36 C) dl Proposal or Proposals to CPD. CPD will confer with the Health Director and the Director will make a ?nal determination. if the exceptions to the Core Requirements and Minimum Requirements in the Proposal(s) are deemed material in the sole opinion of the Director, the Proposal will be considered unresponsive and disquali?ed. if the exceptions are not deemed material, the Director may waive the irregularity and allow the proposal review to continue or may request additional information from the Proposer to resolve the exception. The Review Panel will then evaluate, compare, and score the Competitive Criteria. After completion of the Review Panel?s review and scorim of the Proposals, the consultants will calculate the points to be awarded for pricing based on the methodology described in Section ?.63 and will present the results to CPD and the Health Director for consideration The responses to the Competitive Criteria set forth in the Proposals shall be reviewed and rated as follows: Each member of the Review Panel shall read each Proposal prior to the convening of the panel. The Review Panel will convene and be provided with an overview of the review and rating process. The information provided to document the Minimum Qualifications will be reviewed and scored as either pass or fail. Comparable Experience will be scored by the Review Panel. The responses to the Core Requirements and Minimum Requirements will be reviewed to con?mr an af?rmative and unquali?ed acceptance ofthe provisions. Each criterion of the Competitive Criteria will be evaluated separately (0.3. Clinical Offerings, Operational Proposals, etc.). After a full discussion is completed for a specific Competitive Criterion, each Review Panel member will complete the individual ranking sheet for that Competitive Criterion using the scoring guidelines set flo below. The ranking sheet completed by each reviewer will be collected by the Consultant, who will enter the ratings into the master score sheet that will be used to the total points awarded to each Proposal. The scores applicable to pricing will be calculated by Consultant and combined with the scores resulting from the panel?s review. Subsequent to the Proposers? presentations to the Review Panel, the Review Panel will reconvene and each Reviewer will be allowed to view and modify any scores awarded to a Proposal if lie or she believes that information presented or answers received in response to Review Panel member inquiries would. in the Reviewer? 5 sole opinion, justify a scoring change for speci?c criteria After the Review Panel has completed the review of the all Pmposals, the scores of the reviewers will be averaged to deternrine the total points awarded to each Proposal for the Competitive Criteria. The results of the Review Panel and the makings of the Proposals will be forwarded to the Health Director. The ?nal decision regarding an award shall rest with the Health Director subject to the approval of the formal contract by City Council. The consulting firm sltall observe and serve as stat?fto the Review Panel. :\AD\002\02\2X02\2X02177.docx 37 3. Method for Competitive Scoring of Price Proposals The comparison of prices proposed for the ambulance transports originating from the i?SAl? is accomplished using the following calculation. Cal's 9-1-15 I Bundled Emergency Base Charge 5 .X. Mileage Charge. multiply the pmposed per-mile charge times the 4 I miles Oxygen Charge: multiply the proposed oxygen charge times 60 5 percent 1 Weighted Charge (A) 5 Other calLs originating and terminating within the City include MS and MS non-emergency calls. The following calculations are used to compare these charges. ALS Ming ALS Non-emergency Base Charge Mileage Charge: multiply the proposed per-mile charge times 1?1- 5 miles Oxygen Charge: multiply the pmposed oxygen charge times 90 5 peltent Weighteciqmrge. LB) Sit?1.1+ BLS non-emergency transports [not originating from 9-1-1) BLS Non-emergency Base Charge 5 Mileage Charge multiply the proposed per-mile charge times 14 I miles Oxygen Charge: multiply the proposed oxygen charge times 30 5 percent Weighted Chat?chC) The ?nal result will use a weighted average charge for the City ambulance transports. The formula will weigh the emergency calls originating from 9-1-1 at 75%, the ALS non-emergency calls at 5% and the 81.5 non? emergency calls at 20%. This will be accomplished by using the following formula. 0.75 A 0.05 0.20 Combined Weighted Charge The proposal with the lowest combined weighted charge will receive the maximum available score assigned to pricing under the RFP. Other proposals will be scored by multiplying the percentage by which their weighted charge exec-eds the lowest proposed weighted charge and subtracting that amount from the maximum available score. For example, the RFP is structured to allow 300 points for price. if the Weighted Charge for Proposal #1 is $1,000, for Proposal #2 is $1,100, and for Proposal #3 is $1,500. Proposal #1 has the lowest charges, so it receives 300 points for pricing. Proposal #2 exceeds Proposal #1 by 10%, so it receives 270 points for pricing. Proposal #3 exceeds Proposal #1 by 50%, so it receives 150 points for pricing. :\AD\002\02\2X02\2X02177.docx 38 4. Presentation Proposers will be asked to meet with the Review Panel to present a brief overview of their Proposals and answer questions. The date of the Proposers' presentations is included in the Procurement Timeline. 5. Investlgatlon Upon completion of Review Panel evaluations, the or its Consultants may undertake additional investigation to verify claims made by the recommended Proposer during the Proposal evaluation process. Such additional investigation nray include, without limitation, site visits, reference checks, ?nancial inquiry, or any other reasonable means of determining the accuracy and completeness of information supplied by the l?roposer. reserves the right to continue its investigation of representations made by a Proposer a?er contract award and throughout the term of the Agreement. The fumishing of false or misleading information during the procurement process may constitute a major breach of the Agreement even if discovered after contract award. 6. Notification Proposers will be noti?ed of the status of their Proposal (recommended for selection, not recommended for selection, or disqualified) following completion of the proposal review process. Noti?cation will be by electronic mail to the address listed in the Proposal. ifa Proposal is disquali?ed, the Proposer will be noti?ed, in writing, ofthe speci?c reason that caused the disqualification. At the completion ofthe Review Panel?s evaluation process and the. Health Director's receipt and consideration of the panel's deliberations. CPD will issue a Notice oflntent to Award. it is not anticipated that there will be a "Best and Final Offer" (BAFO) utilized in this process. 7. Protest Following issuance of the Notice of intent to Award, non-successful Proposers shall have the right to ?le a protest (the Protest). A Proposer ?ling a Protest (Protester) must follow the procedures set forth in Executive Order 05?21. Protests that do not follow these procedures shall not be considered. Notwithstanding any other protest or appeal procedures, the protest procedures herein constitute the sole administrative remedy available to the Protesters under this RFP. Only entities, which were non-successful Proposers, shall have standing to ?le Protests. The general steps are summarized below, however, proposers should review outlined in Executive Order 05-21 for de?nitive information: a) The protesting bidder shall file a written statement with the Purchasing Of?ce. The statement shall generally state the reason for the protest and contain any supporting facts and documents. It shall be received by the Purchasing Of?ce no later than seven calendar days following the City's notice ofthe bid award. The Purchasing Of?ce shall send the protest and all supporting documents to the Finance Director after notifying the Purchasing Manager. b) Upon the Finance Director receiving the supporting documents, the Finance Director shall notify all other bidders of the protest and the general nature of the ?rcts supporting the protest via registered mail return receipt requested. Other bidders shall have seven days front receipt of the Finance Director? 5 notice to provide written comments to the Finance Director. :\AD\002\02\2X02\2X02177.docx 39 c) The Finance Director shall review the information received and render a decision regarding the protest. The decision shall be in writing and shall be reviewed by the City Attomey before being issued. The decision shall be issued not less than 15 business days after receipt of the pmtest. If no decision is rendered within the prescribed time period, the bid protest shall be considered denied. d) The Finance Director?s decision, or a denial, may be appealed by the protesting party or any adversely affected party. The appeal shall be processed as an administrative appeal pursuant to Article VI, Chapter II of the Revised Ordinances of Sioux Falls. 8. Withdrawal ot? Proposals Once submitted, Proposals may be withdrawn by the Pmposer at any time prior to the Deadline for submission by written notice to the CPD 9. Cancellng the Procurement Process after Openlng may, in its discretion, cancel this procurement process at any time up to the formal approval and execution of the Agreement. In the event cancels the procurement, it shall set forth the reasons why the public interest is best promoted by such cancellation. 10. Award The ?nal decision on contract award will be made by the City Council upon the recommendation of the Health Director. If for any reason the selected Proposer is unable to enter into the Agreement in a timely manner in accordance with the time interval identi?ed in the Procurement Time Line for contract negotiation, the Director may proceed toward selection of an alternate Pmposal, cancel the process, seek further input from the Council, or otherwise proceed as may be required in his/ her sole discretion for the public interest. However, the above action does not eliminate the fact that if the initial awarded party does not negotiate in good faith or execute a contract for the services outlined under this RFP then its proposal guarenty shall be for?eted in partial compensation for the City's expenses. 11. Scorlng Crlterla The goal of this procurement is to select the Contractor based on clinical and operational quality of service, while also containing service costs to the public. To achieve this end, the Proposals will be scored on two categories; ?rst, Competitive Criteria, which are designed to objectively identify Proposals that will provide for higher, service quality and cost effectiveness; and, second, Proposals will be scored based on the service charges to be imposed by the Pmposer. Since this process is focused on a comparison of the Proposers' responses to the Competitive Criteria, the review and scoring of the proposals will be based on comparing responses of Proposers to each of the criteria. Each criterion will be allocated a speci?c number of maximum available points. During the deliberations of the Review Panel, minimum requirements for each of the Competitive Criterion will be described to the reviewers and the reviewers will then discuss the item and any offerings that have been presented to exceed minimum requirements. Once the discussion is completed, each Reviewer will independently evaluate the criterion and mark the rating sheet in the applicable category described below. The points awarded for the criterion will be based on the reviewer?s opinion of each proposal's commitment to the relevant item being reviewed Five potential ratings will be available for the reviewer. They are: :\AD\002\02\2X02\2X02177.docx 4O Table 3. Criterion Rating Marginal Rating Above Good Minimum Percentage of total points for 0% 25% 50% 75% 100% criterion Each oi the Competitive Criteria stipulates minimum requirements that must he addressed and accepted by the Proposers. Failure to address and commit to the minimum requirements may result in the disquali?cation of the Proposal as being unresponsive. No points will be awarded to the Proposal that olieis to only meet the minimum requirements. Points are awarded only to Proposals that exceed minimum requirements fora speci?c criterion. 12. RFP Governed by Its Terms This shall be conducted in accordance with the terms set torth within it. It shall be construed in a manner consistent with applicable law and mics, including but not limited to the South Dakota Statutes. City Ordinances and the City's published Terms and Conditions for Such authorities may be consulted for the resolution of ambiguities, and to provide terms not expressly provided herein. H. Scoring Matrix The Competitive Criteria are organized in Section into categories. The maximum points available for each category ol'Compelitive Criteria are set forth below Table 4. Proposal Review Seating Allocations Category Title Total Points 1 Organizational Disclosures 8: Fiscal Stability Pass/Fail 2 Experience Providing Similar Services 100 3 Requirements Agree/Exception fl Competitive Criteria-Minimum Requirements Agree/Exception 5 Competitive Criteria-Commitment to Clinical Qualin 350 6 Competitive riteria-Operations Management 350 7 Competitive Criteria-Commitment to Employees 250 8 Competitive Criteria-Management and Administration 100 I.) Competitive Criteria-Commilmenl to EMS System and 250 Community 10 Proposed Pricing 300 TOTAL POSSIBLE POINTS 1,700 41 SECTION QUALIFICATIONS A. Organizational Disclosures The Proposer must be a single legally established entity. but there are no restrictions against multiple organizations forming an entity to respond to this RFP. If such a ?joint Venture" is proposing on this RFP questions regarding experience, organizational structure, ?nancial strength, and other items in this RFP must be answered for each member of the "joint venture." The Proposer must provide the following information about its organization, experience, litigation, licenses, investigations, and other items: 1. :\AD\002\02\2X02\2X02177.docx Organilatlonal ownership and legal structure The Pmposer shall describe its legal structure including type of organization, its date, and state of formation. Contintu of business The Pi'oposer shall provide the organization's background and number of years under present business name, as well as prior business names. Licenses and permits The Proposer shall provide copies of business or professional licenses, permits or certi?cates required by the nature of the contract work to be perfomied. If Proposer does not have a local operation, examples of state licenses, and local permits for other operational locations may be submitted to ful?ll this requirement. Government Investigations 'l'he Proposer shall provide a listing of all federal, state, or local government regulatory investigations, ?ndings, actions or complaints and their respective resolutions for the Proposei?s organization and any parent or af?liated organization within the last five (5) years. THIS ITEM MAY BE SUBMITTED SEPARATELY IN AN ELECTRONIC FORMAT SUCH AS COMPACT DISK OR USE DRIVE and will not count against the limits on Proposal length set forth in Section Proposer must provide documentation that it has resolved all issues arising from goveniment investigations including any continued obligations of the Proposer or describe status and expected outcome of open investigations. Litigation 'l'lic Proposer shall provide a listing olall resolved or ongoing litigation involving the Proposer's organization including resolution or status for the last five (5) years. This listing shall include litigation brought against the Proposei?s organization or alliliated organization and any litigation initiated by the Pmposer's organimtion or affiliated organization against any governmental entity or competing ambulance service. THIS ITEM MAY BE SUBMITTED SEPARATELY IN AN ELECTRONIC FORMAT SUCH AS COMPACT DISK OR USE DRIVE and will not count against the limits on Proposal length set forth in Section II.F.2. Proposer must provide documentation that it has resolved all issues arising litigation or describe status of open litigation. 42 B. Financial Strength and Stability The Pmposer must provide documentation of its ?nancial strength and stability as a going concern. The Proposer nrust satisfy the that it can ?nancially support the services covered in this RF and be able to afford losses that may arise from inaccurate estimates of revenue, expenses, ?nes, and resource requirements necessary to comply with the performance standards identi?ed in this RFP. Documentation shall include: 1. Financial Statements Provide year-end financial statements for the last three years that support the organization's financial ability to perform the services included in this RFP and the Proposal (submitted in separate envelope labeled "Financial Statements") 2. Audited Statements Provide independently audited ?nancial statements for the most recent fiscal year. (submitted in separate envelope labeled ?Financial Statements?) 3. Financial Commitments Provide a list of commitments, and potential commitments, which may impact assets, lines of credit, guarantor letters or otherwise affect the responder? ability to perform the Contract. 4. Working Capital The Pmposer shall describe its working capital sources and quantify the amount it expects to need for startup and improvements to the City/Ri'IMS/t EMS system. The information shall include the cslimaled amount of start-up capital required to finance administration and ambulance operations for the first six months of the Agreement. Include the source of this capital and ii any part of it will be borrowed, include verification from a financial institution that your organization is approved or pre-qnali?ed to borrow sufficient funds. 5. Performance Security The Proposer shall document its method and ability to provide the required performance security. 6. Financial Interests The Proposer shall disclose and describe any ?nancial interests in related businesses. Compliance for items A 8: above shall be considered on a pass/fail basis. C. Comparable Experience The Propo5er must demonstrate its experience as a sole provider of 911 paramedic ambulance services. Required documentation shall include: 1. :\AD\002\02\2X02\2X02177.docx Comparable experience The Proposer must document the areas in which it has provided comparable services to those outlined in this RFP in the past ?ve (5) years, the locations of these services, population, description of services and a jurisdictional contact. This documentation shall include a letter from a government official con?rming the provision of exclusive ambulance service and the length of time such services have been provided. 43 2. Government contracts The l?roposer shall provide a list of exclusive service area emergency ambulance service contracts completed or ongoing during the last five (5) years including the term or date of termination of the agreement, the services provided, the dollar amount ot'the agreement and the contracting entity. 3. Contract Compliance The Proposer shall detail any occurrence of its failure or refusal to complete a contract with a governmental entity for which the Proposer was providing emergency ambulance services. This shall speci?cally state whether the Proposer or affiliated organization was found in material breach of the contract and the reasons why the contract was terminated. if the l?roposer has been found in material breach of a governmental contract or if the Proposer "walked away? from its obligations under a governmental contract or mutually agreed to terminate a contract "early" within the last ?ve (5) years, that information and all circumstances must be fully documented. D. Demonstrated Response Time Performance The Pmposer must demonstrate its ability to comply with response times by documenting experience in operating and managing an ambulance service that is required to comply with speci?ed emergency response times based upon fractile compliance or otherwise meet response time requirements similar to those required in this Documentation may include repons provided to government oversight entities and letters con?rming compliance with mandated response times. lntemal reports with adequate supporting documentation of the methodology used to create the repons may also be submitted. lithe Proposing organization does not have mandated response times in its exclusive 911 emergency ambulance service area, the Proposer must submit adequate documentation of plans, procedures, and deployment strategies to demonstrate the organization has the knowledge and expertise to comply with mandated response times. E. Demonstrated High Level Clinical Care Sophisticated Internal Systems The Proposcr must provide documentation of its demonstrated ability to provide high-level clinical care. The Proposer shall provide information and documentation of existing clinical strength in order to demonstrate the organization's ability to manage the clinical aspects of the service. The Proposer shall document existing sophisticated internal management systems and programs that facilitate its management of its service. Documentation may include descriptions ofclinical sophistication and high levels of performance in systems in which it operates. The organimtion should describe how it ensures consistent, high quality clinical care and how it is able to verify and document its clinical performance. I :\AD\002\02\2X02\2X02177.docx 44 SECTION IV. CORE REQUIREMENTS A. Contractor?s Functional Responsibilities Contractor shall provide ambulance services. as requested by the City?s designated public safety dispatch center. Such services shall be provided in accordance with the requirements of and City Ordinance 124.080_ and all regulations promulgated there under including arty amendments or revisions thereof. in performing services under the Agreement, Contractor shall work cooperativer with through the REMSA staff member designated from timeto-ttme by the Health Director as the Contract Administrator (Contract Administrator). All references to the Contract Administrator herein shall be construed to also include the Health Director and/or any other or City employee or representative that the ireclor may designate. 1. Basic Services In consideration of REMSA and tlte City's referral to Contractor of Service requests originating and terminating in the City, Contractor shall perform the following services to the complete satisfaction of REMSA: a) Contractor shall provide continuous, around-the-clock. surface ambulance services, as defined herein, without interruption throughout the term of the Agreement. b] Contractor shall provide surface ambulance services without regard to any illegally discriminaton classification, including without limitation: the patient's race, color, national origin, religious affiliation, sexual orientation, age, sex, or ability to pay. c) The Proposal will be retained and incorporated into the Agreement by reference, except that in the case of any conflicting provisions, the provisions contained in the Agreement shall prevail. d) Contractor shall participate in pilot or research programs that the FMS Medical Director [defined below) and Contract Administrator may authorive from time to time. The Contract Administrator may waive standards contained in the Agreement in the event that con?icting standard(s) are established for a pilot program. Any such pilot program must be approved by the EMS Medical Director. Contractor agrees that Contractor's participation in the pilot projects shall entail no additional cost to City or REMSA. Contractor further agrees that Contractor's services provided under pilot projects shall be in addition to the other services described in the Agreement. 2. Services Description Contractor shall be responsible for furnishing all ambulance services for all residents and other persons physically present in the City. Such ambulance services shall be provided at the Paramedic level. Contractor shall be the sole ground ambulance organization authorized by the City in the service area covered under this RFP to provide ground ambulance services, ALS and [31.5 non-emergency ambulance services as defined herein. All requests for ambulance service originating in the City processed through its 91 will be referred to Contractor. Contractor may subcontract services only as provided herein with the prior writ ten approval 8. Clinical 1. Clinical Overview REMSA's goal is to provide a clinically sophisticated system that achieves contemporary benchmarks of clinical excellence and can continue to do so in a sustainable fashion The following system specifications are drawn from applicable reference sources and are generally I :\AD\002\02\2X02\2X02177.docx 45 consistent with the direction provided in the National Highway Traf?c Safety document, The EMS Agenda for the Future, and the core recommendations of the more recent Institute for Medicine report an EMS: Emergency Medical Services: At the Crossroads. The clinical goals of pmgressive EMS systems are guided by the broad outcome measures established by the US Public Health Service. These include discomfort is minimized, disability is reduced. death is minimized, destitution eliminated, dis?gurement is reduced and disease is identified and reduced. in addition, there is a focus on meeting the six aims of the Institute of Medicine report on healthcare quality, Crossing the Quality Chasm: A New Health System [or the lel which that systems should be: safe. effective, patient?ccntercd. timely, efficient, and equitable.T The current level of the scienti?c research and the large number of variables outside the EMS system's control of patient outcomes limits the ability to de?ne realistic and achievable outcome measures. in addition, accessing reliable outcome data is frequently dif?cult. For these masons, EMS systems typically use process measures and process improvement to promote enhanced clinical outcomes. It is anticipated that these measures will be utilized and lumber developed throughout the term ofthe Agreement. 2. Medical Oversight REMSA shall furnish medical control services, including the services of a system EMS Medical Dinector (EMS Medical Director) for all system participants' functions in the EMS System medical communications, first responder agencies, transport entity, online control physicians). EMS Medical Director does not relieve the Contractor from employing its own medical director as may be mandated by state and other requirements. a) Medical Protocols Contractor shall comply with medical protocols and administrative policies established by REMSA, as well as other requirements and standards established by the EMS Medical Director. Contractor shall document compliance with system medical protocols. This documentation shall describe the performance of Contractor as a whole, its component parts communications and transport), and individual system participants (personnel). Medical protocols shall be reviewed and updated by REMSA on a periodic basis with input from system participants Current Medical Protocols are available at the City website. b) Control Contractor personnel functioning under these speci?cations have the right and professional responsibility to interact directly with the system's medical leadership (EMS Medical Director, base hospital physicians and REMSA clinical oversight stall) on all issues related to patient care. This personal professional responsibility is essential. c) Medical Review/Audits The Contractor is required to participate in REMSA's continuous quality improvement (CQI) process. The goal of the medical audit process is to inspect and assure compliance of the care delivered with the system?s established clinical care guidelines. Evaluation of a random sampling of patient contacts provides a measure of the clinical care provided and enables the 2. National Highway Traf?c Safety Administration. (1996). Emergency Medical Future. Washington. DC: United States Department of'l?ransportation. Institute ol Medicine. [2006). Emergency medicalsendtemeit the cross/mills. Washington. DC: National Academies of Science. 5 Insiilute of Medicine. [2001). Crossing the Quality Chusm:/l new Health System for iheZIsi Century. Washington. [12: National Academies ofScicnce. :\AD\002\02\2X02\2X02177.docx 46 3. EMS Medical Director to identify the need fora more targeted or detailed audit. The process also assists in validating the effectiveness of ongoing pmcess measures in monitoring and improving care. it is Contractor?s responsibility to comply with the EMS Medical Director audit/ review process and initiate process measurement and improvement activities based on the results nfthe audit/review. As part ol REMSA processes or incident investigation, the EMS Medical Director may require that any employee ofllre Contractor attend a nredical audit when deemed necessary. Employees, at their option and expense, may attend any audit involving any incident in which they were involved that is being formally reviewed but must maintain the confidentiality of the medical audit process. Attendance of every license holder involved in a case being reviewed is not required, unless mandated by the EMS Medical Director. Minimum Clinical Levels and Staf?ng Requirements 3) Ambulance Stating Requirements It) :\AD\002\02\2X02\2X02177.docx All Ambulances rendering Emergency Ambulance Services under the Agreement shall be staffed and equipped to render paramedic level care and transport with a minimum of one state certified and locally certi?ed Paramedic and one (1) state and locally certi?ed EMT to respond to requests from the City designated PSAP. The paramedic shall he the ultimate responsible caregiVer for all patients and is required to accompany all patients in the back of the ambulance during transport. An "emergency ambulance" is de?ned as transport ambulance responding to requests for emergency medical services staffed with at least one paramedic and one EMT. Non-emergency ambulance (transport) services may be staffed at the BLS level with a minimum of two (2) South Dakota certified EM'l's as long as the patient?s condition does not require ALS monitoring or intervention and the patient's condition is not likely to deteriorate or change which may require ALS evaluation or treatment and according to REMSA policies and procedures. Al Contractor?s sole election and expense, stalling levels on any or all units may be enhanced to higher levels of training. Personnel Lleonsum and and Trahhg Roquhmonts All of Contractor's ambulance personnel responding to emergency medical requests shall be currently and appropriately licensed, accredited and credentialed, as appropriate, to practice in the City. Contractor shall retain on file at all times copies of the current artd valid licenses and/or certifications of all emergency medical personnel performing services under this Agreement. REMSA certification/licensure requirements may be downloaded from the City website. At a nrinitrrunr, the Contractor shall ensure that ambulance personnel receive in addition to the required training defined in State and REMSA policies the following training and/or certi?cations. (1) MW Contractor shall slaffeach ALS ambulance with a minimum ofone paramedic certified in Pre-Hospilal 'l'rauma Life Support lntemational Trauma Life Support the Contractor shall document that each paramedic has satisfactorily completed computable training adequate to ensure competency in the skills included in the or curriculum and approved by the EMS Medical Director. Contractor shall retain on ?le at all times, copies of the current training documentation and valid certi?cations ofall PHTIS or lTl.S quali?ed paramedics performing services under this Agreement. 47 :\AD\002\02\2X02\2X02177.docx (2) (3i (4) Ass ul vo Betta or ?ii Contractor shall properly orient all field personnel before assigning them to respond to emergency medical requests. Such orientation shall include at a minimum, provider agency policies and procedures; EMS system overview:, EMS policies and procedures; radio communications with and between the provider agency, first responders, hospitals, and City communications centers; map reading skills including key landmarks, routes to hospitals and other major receiving facilities within the City and in surrounding areas; and ambulance and equipment utilization and maintenance. In addition, all fronllinc personnel must receive continual orientation to customer service expectations, performance improvement and the billing and reimbursement process. On an ongoing basis Contractor and First Responder personnel will participate in a mandatory joint training event at least four hours annually to address updates in collaborative procedures (eg. "pit crew trauma codes, MCI updates, customer service and problem resolution as approved by REMSA) Preparation for Matti-casan incident Contractor shall train all ambulance personnel and supervisory staff in their respective roles and responsibilities under policy, and prepare them to function in the medical portion of the incident Command System. The speci?c roles of the Contractor and other Public Safety personnel will be de?ned by the relevant plans and command st ruct ure. na omentTrainln Contractor shall provide ambuiarrce personnel with the training, knowledge, understanding, and skills to effectively manage patients with drug/alcohol or other behavioral or stress related problems, as well as di?icu It or potentially difficult scenes on an on-going basis. Emphasis shall be on techniques for establishing a climate conducive to effective ?eld management and for preventing the escalation of potentially volatile situations. DrivorTIalning Contractor shall maintain an on-going driver-training program for ambulance personnel. The program, the number of instruction hours, and the system for integration into the Contractor" operations accident review boards, impact of accidents on employee performance reviews and compensation, etc.) will be reviewed and is subject to approval by REMSA initially and on an annual basis thereafter. Training and skill proficiency is required at initial employment with annual training refresher and skill con?rmation. is) mm Contractor shall create a culture focused on infection prevention that focuses on aggressive hygiene practices and proactive personal protective equipment donning (cg. protection, gloves. etc). The Contractor shall develop and strictly enforce policies for infection control, cross contamination and soiled materials disposal to decrease the chance of communicable disease exposure. Ct?l it a Contractor shall establish a repetitive stress and critical incident stress action plan. included shall be an ongoing stress reduction program for its employees and access to trained and experienced professional counselors. Plans for these programs shall be submitted to the Contract Administrator for approval at (8) Contractor and Contractor's employees shall participate in and receive training in Homeland Security issues, including participating in existing programs available within 48 the City for dealing with ten?orist events, weapons of mass destruction and other Homeland Security issues. (9) Contractor shall provide initial and ongoing training for all personnel regarding compliance with the Health insurance Portability and Accountability Act of 1996 and the current rules and regulations enacted by the U.S. Department of Health and Human Services. Contractor shall provide initial and ongoing compliance training for all personnel. This training shall be in accordance with the Compliance Program Guidance for Ambulance Suppliers" This training is one component of the required Compliance Plan required of the Contractor. Proposer shall describe how it intends to comply with the above training and certi?cation requirements. The Proposer will delineate how these programs will be provided, by whom, and where and other information to help the REMSA understand the Proposer?s commitment to meet these Core Requirements. C. Operations 1. Operations Overview The performance specifications set forth in this RFP encourage continuous improvements in the level of service pmvided in the City. The RFP provides clari?cation of expectations and accountability. The following provisions de?ne these expectations, cone requirements, and activities required of the Contractor. 8) bl cl Emergency and Noll-emergency Ambulance Calls 'i'he RFP is to result in a contract assigning an exclusive operating area provider for all emergency medical calls received through the 9- 1? 1 system as well as those emergency and non-emergency calls received through means other than 9-1- 1. The also includes ALS and 81.5 inter-facility, ALS and BLS non-emergency calls, and provision of/arTangcments for transports originating and terminating in the City but excludes those transports resulting from contracts with other government agencies and those covering the ground component ofan air ambulance transport. Primary Rosponsoto isolated of the City While the Contractor has the exclusive right to all 9- 1-1 calls originating in the City, there are areas on the periphery of the City where the nearest paramedic-staffed ambulance may be located in an adjacent jurisdiction. In the interest of getting the quickest ambulance to the patient, REMSA will approve the me of these closer arnhulances contingent upon the Contractor executing a satisfactory mutual aid agreement with the agencies responding from a neighboring jurisdiction. Substantial Ponaly Provisions for Falluroto Respond The Contractor is to deploy and staff ambulances in a manner that allows for a response to all requests for service. in the event the Contractor does not respond with an ambulance to an emergency medical call, the penalty assessed is substantial, beginning at $10,000 per incident. These are rare and isolated events that may never occur and should not be confused with late or outlier responses. Federal Register Vol. 68. No. 56 Monday. March 24. 2003 :\AD\002\02\2X02\2X02177.docx 49 8) it) c) 4) Metro Communications Relationship As outlined in other sections herein and at Appendix 9. Metro Communications will serve as the PSAP and communications facility for emergency and non-emergency requests for service. Interoperable Communications/ Date Requtroments The City's PSAP will provide use of its radio system infrastructure at no cost. Provider is reponsibie for subscriber equipment (Lag. compulers/ unit and portable radios); pagers, commercial wireless /data access; CAD mobile access fees). Call Recehrt and Dispatch All 91 1 calls will be answered by the Metro and prioritized as to acuity level according to protocols and approved by the REMSA Medical Board. in addition, when appropriate, ail callers will receive emergency medical pre-arrival instructions according to approved protocols. All of the Metro's dispatch staff members are to be Emergency Medical Dispatch certified at the initiation ofthe contract period. AMPDS is required and strict adherence to call prioritization/ intake protocols to facilitate safer responses and fewer "lights and sirens" responses for first responders and ambulances where such a response may not be medically required. Metro dispatch center is accredited as an international Academies of Emergency - Dispatch Center of Excellence. Deployment Phil to be Developed and Kept Current try Contractor Metro Communications will dispatch and move contractor resources in strict accordance with Contractor's written pro-plan for deployment of resources. it is the Contractor's responsibility to develop it?s deployment plan and communicate how it is to be operationalized by Metro. Certain provisions herein protect the Contractor should Metro Communications fail to perform in accordance with the Contractor?s plan Metro Commulcattons costs tor Non-emergency Requests meta Interface to be home by Contractor Metro Communications will provide non-emergency (transfer) call receipt, scheduling and dispatching services for the City's designated contractor at a per unit cost of $5.00 per non- emergency call entered into its CAD system. The payment mechanism will be detemined by REMSA. The data interface made available toC the Contractor shall provide real-time monitoring of the Metro's ambulance data screens and at a minimum provide the location and status of active ambulance calls, pending calls, location and status of ambulances and crews. Any costs of developing a data bridge from the PSAP's CAD to the Contractor for the purpose of monitoring deployment are to be borne by the Contractor. Transport Requirement and Limitations As outlined in greater detail in other sections, Contractor has an obligation to respond to all emergency medical requests in the City and provide ambulanco transport as medically required. However, there are limitations and flexibilities as described herein. a) it) Destinations Contractor shall be required to transport patients front all areas of the City, in accordance with the REMSA Medical Control Destination Protocols included in policies manual. Prohibition agelust Destlratton Decisions Contractor personnel are prohibited from attempting to in?uence a patient's destination selection other than as outlined in the REMSA destination policy. Response Time Performance Requirements "Response times," as defined in subsection 5 below (Response Time Measurement Methodology), are :\AD\002\02\2X02\2X02177.docx a combination of dispatch, operations, and ?eld operations. Because this Agreement is 50 performance based, REMSA will not limit Contractor?s ?exibility in the nretlrods of providing ambulance service. This is based upon Contractor's commitment to conform to the Response Time standards set forth below (the Response 'lime Standards). Therefore, an error on Contractor?s part in one phase of its operation (eg. system deployment plan, ambulance maintenance, etc.) shall not be the basis for an exception to Contractor's performance in another phase of its operation (eg. clinical performance or response time performance). Appropriate Response Time performance is the result ofa coordinated effort of Contractor's total operation and therefore, is solely Cont ractor?s responsibility. Response 'l'inres shall be measured in minutes and integer seconds, and shall be ?time stamped" by the PSAP as to "dispatch time" in combination with any time stamping (if any) of the Contractor?s dispatch or records management system. The City and REMSA will work with the Contractor to assure that the Contractor?s clocks can be to the PSAP. a) of Cal Classification 'l?hese Speci?cations outline ?ve (5) priorities with which Contractor nrust comply by meeting specified Response Times. The call classification as Emergency or Norrf-Inrergency and as Priority 1 through 3 is accomplished by presumptive prioritization in accordance with the then cunent Emergency Medical Dispatching protocols as approved by REMSA. The fourth priority includes MS or BLS non-emergency transfers originating within the City. tr) Rosponsotlmo Portonnaneo Requirements A city-wide response zone will be used for Response Time monitoring, reporting, and compliance purposes. Contractor's Response Time on requests for emergency medical service originating from within the service area shall meet the following performance standards: (1) Potantiall oTlm onlrr mo r: Ros onso Priority 1 responses are defined based on the Medical Priority Dispatch System (MPDS) or protocols approved by REMSA's Medical Director. Contractor shall place a Paramedic Antbulance on the scene of each life-threatening emergency assignment as presumptively designated by the Contractor?s dispatch center as Priority 1 on not less than 90 percent ofall Priority '1 response requests. The applicable Response Time performance requirements are specified in Table 5. For every presumptively de?ned life-threatening emergency call exceeding the Response Time Standard defined herein, Contractor shall document in writing the cause ofthe extended Response Time and Contractor? efforts to eliminate recurrence. (2) on-UfeTtr atont ac on: Prio 2 Priority 2 responses are defined based on the Medical Priority Dispatch System (MPDS) protocols as approved by Medical Director. Contractor shall place an AIS Ambulance on the scene of each non-life threatening emergency assignment as presumptively designated by Contractor's dispatch as Priority 2 on not less than ?30 percent ofall Priority 2 response requests. (3) no 050 3 Priority 3 responses are defined based on the Medical Priority Dispatch System (MPDS) or protocols approved by Medical Director. Contractor shall place an ALS Ambulance on the scene of at least 90 percent of all Priority 3 non-emergency ambulance requests received from the City originating within the City on not less than 90 percent of all Priority 3 response requests as measured within any consecutive 30-day period. 51 (4) lnt_or-facilig and Transports [Priong 4) Priority 4 requests for ambulance service are defined as non-emergency transports at the ALS or BLS level of service. (cg. requests for non-emergency ambulance transportation such as, bill not limited to, emergency department discharges, clinic discharges, hospital discharges, and nursing home discharges.) The City recognizes that the Contractor?s primary responsibility is to meet emergency service demands within the City. As a result, City understands that the Contractor response to nonemergency requests may be occasionally and temporarily delayed until sufficient reserves ofemergency production capacity can be restored to the system. liven so, to provide superior customer service, and to enhance the economic viability of the system, the Contractor shall furnish production capacity and shall manage its available resources so as to provide prompt non-emergency transfer service. Especially in the case of any scheduled non-emergency transfer requests the Contractor shall furnish service on schedule. Contractor?s proposed deployment plan will identify the level at which Contractor will reserve units for emergency responses within the City. (sometimes referred to as "emergency cut-oil levels?) Contractor shall place an ALS or 81.8 ambulance on the scene ol'at least 90 percent ofall Priority 4 scheduled ambulance requests within thirty ruinutcs zero seconds [(30:00) of the scheduled time. This standard shall apply to all requests for service where the scheduled time for patient pickup is greater than two hours from the time the call is received in the Contractor's Dispatch Center. If the. service receives an emergency request for an ALS inter-facility transport, the applicable Response Time requirement will be the satne as that for Priority 2 level requests. if a request for non-emergency is received without a two hour notice the Response Time requirement will be arrival of the ambulance at the patient location within 60 minutes of the time oftlre request. c) Summary of Response Time Roquiornents fable 5 summarizes the Response Time compliance requirements also referred to as the Response Time Standards - lor ambulances within the City for each priority. Table 5. Response Time Conplianco Requirements Priority Compliance Citywide Level Priority 1 90% 8:59 (AMPDS Echo /Delta) Priority 2 90% 5 11:59 (AMPDS Charlie/Bravo) Priority 3 90% 15:59 (AMPDS Alpha) Priority 4 00% 30:00 rnirnrtes (scheduled) or 60:00 minutes (unscheduled) 5. Notification of Delays for Non-emergency Responses Whenever Emergency Ambulance response volume necessitates temporary delays in non? emergency responses, Contractor shall notify the individual or organization requesting such service to explain the reasons for the temporary delay and shall furnish a realistic estimate of :\AD\002\02\2X02\2X02177.docx 52 when service will be available. Notification of the individual or organization does not reduce or eliminate penalties for such delays and the original Response Time requirements will be used to calculate any penalties. Contractor shall make every reasonable effort to reduce and eliminate delays for those utilizing non-emergency services. Response Time Measurement Methodology Contractor's Response Times shall be calculated on a basis to determine compliance with the standards set forth in Table 5 above. The Response Time measurement methodology employed can significantly in?uence operational requirements for the EMS system. The following are applicable: at c) d) 0) :\AD\002\02\2X02\2X02177.docx 'l'he Contractors' Response Time clock begins when the Contractor receives the call (?Call Dispatch") from the PSAP. If the call is received by Contractor directly, "Call Receipt? which is de?ned as when the Contractor's dispatch center receives adequate information to identify the location oflhe call and the priority level, or seconds after the call is answered, whichever is less. "At Scene" time means the moment the ?rst Emergency Ambulance arrives and stops at the exact location where the ambulance shall be parked while the crew exits to approach the Patient and noti?es Dispatch that it is fully stopped. Only the an'ival ofa transport capable ambulance shall constitute "At Scene." This does not include a supervisory or other non- transport capable unit. in situations where the Ambulance has responded to a location other than the scene (cg. staging areas for hazardous materials/violent crime incidents. non- secured scenes, gated communities or complexes, or wilderness locations), arn?val. At scene shall be the time the Ambulance arrives at the designated staging location or nearest public road access point to the patient's location Tlmolntonais The Response Time is defined as the interval, in exact minutes and seconds, between the Call Receipt time and arrival At Scene time, or is cancelled by a public safety agency. Fellini to Report at Scone Tine In instances when ambulance crews fail to report At Scene, the time of the next communication between dispatch and the ambulance crew shall be used as the At-Scene time. However, Contractor may be able to document the actual arrival time through another means leg. First Responder. AVI., communications tapes/ logs, etc.) so long as an auditable report ofany edits is produced. Calculating Upgrades, Downgrades, Tum-around and Canceled Responses From time to time special circumstances may cause changes in call priority classification. Response Time calculations for determination of compliance with Agreement standards and penalties for non-compliance will be as follows: (1) Upggdu lfan assignment is upgraded prior to the arrival on scene of the Emergency Ambulance from Priority 2 to Priority 1), Contractor's compliance and penalties will be calculated based on the shorter of: a) Time elapsed from dispatch to time of upgrade plus the higher priority Response Tittle Standard; or b) The lower priority Response Time Standard For example, a call is initially dispatched as a Priority 3 (non-emergency) and it is upgraded to a Priority 2 (emeigencyi. The applicable response time requirement will be 53 I) II) shorter ofthe Priority 3 Response Time or the sum ofthe elapsed time from Call Receipt to the time of the upgrade plus the Priority 2 Response Time. (2) mm if a call is downgraded prior to arrival on scene of the Emergency Ambulance (egg. from Priority 1 to Priority 2), Contractors compliance and penalties will be determined by: a] If the time of the occurs after the Emergency Ambulance has exceeded the higher priority Response Time Standard, the more stringent higher priority standard will apply; or If the time of the downgrade occurs before the Emergency Ambulance has exceeded the higher priority Response Time Standard, the less stringent lower priority will apply. In all such cases, documentation nrusl be presented for validation of the reason why the priority status was downgraded. if the downgrade was justi?ed. in the sole discretion of REMSA, the longer standard vvillapply. (3) en route "an Emergency Ambulance is reassigned en route or turned around prior to arrival on the scene (eg. to respond to a higher priority request), compliance and penalties will be calculated based on the Response Time Standard applicable to the assigned priority of the initial response. The Response Time clock will not stop until the arrival of an Emergency Ambulance on the scene from which the Ambulance was diverted l4) WIS. lfan assignment is canceled prior to an?ival on the scene by the emergency ambulance, Contractor's compliance and penalties will be calculated based on the elapsed time from dispatch to the time the call was canceled. Response ?utes outside Primary Service Area are excluded Contractor shall not be held accountable for Response Time compliance for any assignment originating outside the City. Likewise, responses to requests for" service outside the City will not be counted in the total number of calls used to determine Each Incident at Separate Response Each incident will be counted as a single response regardless of the number of units that are utilized. The Response Time of the first arriving Emergency Ambulance will be used to compute the Response'l'ime for that incident. Equity In Response ?utes Oly In developing Response Time Slandards. REMSA has aggregated all areas of the City into one response zone. However, the response time compliance for each of the City's ?re battalions shall be calculated and reported independently on a basis. Should the City that non-equitable response patterns become chronic, it reserves the right to require Contractor to meet response tinres measured independently in each of the Battalions. b) addition, REMSA reserves the right to look at any area of the City to identify if there are pockets of poor Response Time performance and refer such ?ndings to the Contractor for mitigation. 7. Response Time aceptlons and Exception Requests Contractor shall maintain mechanisms for backup capacity, or reserve production capacity to increase production should a temporary system overload persist. However, it is understood that from time to time unusual factors beyond Contractor's reasonable control affect the achievement of speci?ed Response Times Standards. In the calculation of Contractor's performance to determine compliance with the Response Time Standards, every request from the City designated PSAP originating from within City shall be included except as follows: I :\AD\002\02\2X02\2X02177.docx 54 al It) 6) a) :\AD\002\02\2X02\2X02177.docx Mum-casualty Disaster The Response Time requirements may be suspended at the sole discretion of REMSA during a declared multi-casualty incident or disaster the City or during a declared disaster in a jurisdiction within the region to which ambulance assistance is being provided as requested by the Good Course The Contract Administrator may allow exceptions to the Response Time Standards for good cause as determined at his or her sole discretion. At a minimum, the asserted ground(s) for exception must have been a substantial factor in producing a particular excess response lime and Contractor must have demonstrated a good faith effort to respond to the call(s). Good cause for an exeeption may include, but is not limited to incorrect or inaccurate dispatch information received from City designated medical dispatch center, disrupted voice or data radio transmission; mobile data terminal failure; material change in dispatch location; inability to locate scene due to non-existent address; or unusually severe weather conditions such that response time is either impossible or could only be achieved at a greater risk to EMS personnel and the public than would result from delayed response; unavoidable delays caused by parked trains; or periods of unusual system overload. Unusual system overload is defined as 200 percent of the average demand for the day of the week and hour of day. The average demand for each day and hour is to be calculated on an annual basis using the prior calendarycar's actual mu volume. Extended delays at hospitals for transferring patients to receiving facility persormel will not be a criterion for except ions. Equipment failure, ambulance failure, lost ambulance crews, extended "chute times", or other causes deemed to be within the Contractor's contml or awareness shall not be grounds to grant an exception to compliance with the Response Time Standard Exception Request Procedure it is the Contractor?s responsibility to apply to REMSA for an exception to a required Response Time. If Contractor feels that any response or group of responses should be excluded from the calculation of Response Time compliance due to unusual factors beyond Contractor's reasonable control, the Contractor must provide detailed documentation for each actual response in question to REMSA and request that REMSA exclude these runs from calculations and late penalties. Any such request must be in writing and receiVed by the Contract Compliance Manager within 10 business days of the end ofthe month ofoccurrencc together with that month's performance repons. A request for an exception received after the. 10 days will not be. considered. The Contract Administrator, will review each exception request and make a decision for approval or denial. Should the Contractor desire to appeal the Contract Administrator's decision, a written request must be subnritted to the Health Director within 10 days after the decision by the Contract Administrator. All decisions by the Health Director shall be considered ?nal. Response-time Performance Reporting Procedures and Penalty Provisions Response Time Performance Reporting Requirements ill The Contractor shall document all times necessary to determine total ambulance Response Time, including but not limited to time call received by the dispatch center, time location verified, time ambulance crew assigned, time en route to scene, arrival at 55 scene time, total on-scene time, time en route to hospital, total lime to transport to hospital, and arrival at hospital time. Other times may be required to document specific activities such as anal at patient side, times of de?brillation, administration of treatments and medications and other instances deemed important for clinical care monitoring and research activities. All times shall he recorded on the Patient Care Report Form (PCR) and in Contractor?s computer aided dispatch system. The Contractor will provide an interface with the computer aided dispatch database and Electronic Patient Care Report Form database for REMSA to independently extract and con'oborate Response Time performance. Contractor may not make changes to times entered into the CAD after the event. Only personnel may make changes to times within the computer. The contractor may request such changes from REMSA when errors or omissions are discovered. REMSA has sole diScretion whether changes to times are acceptable. (2) Response "mo Pertunnanco ?gport Within l0 business days following the end of each month, the Contractor?s dispatch center shall document and report to REMSA and the City, in a manner required by REMSA, information as speci?ed in Section a] Contractor shall use Response Time data in an on-going manner to evaluate Contractor?s performance and compliance with Response Time Standards in an effort to continually improve its Response Time performance levels. Contractor shall identify the causes of failures of perfonuance, and shall document efforts to eliminate these problems on an on-going basis. Contractor shall provide an explanation for every call exceeding the required Response Time interval and describe steps taken to reduce extended responses in the future. bl 0) b) Penalty Ptortstons The would prefer that Contractor performance is such that no performance penalties Would be imposed during the term of the agreement. However. should penalties be imposed they will be utilized to offset system improvement initiatives. :\AD\002\02\2X02\2X02177.docx Isolated instances of individual deviations of Response Time compliance shall be treated as Instances of minor, non-compliance under the Agreement. However, severe or chronic deviations of Response Time compliance may constitute a default of the Agreement as de?ned below. (1) Penglg Failure Rgnort On-sceng um; (2l Contractor shall pay REMSA a $250 penalty each time an ambulance is dispatched and the ambulance crew fails to report and document on-scene time. The Contractor, in order to rectify the failure to report an on-scene time and to avoid the penalty may demonstrate to the satisfaction of the Contract Administrator an accurate on-seenc. time. Where an on- scene time for a particular call is not documented or demonstrated to be accurate. the Response Time for that call shall be deemed to have exceeded the required Response Time for purposes of determining Response Time compliance. Penal for Fallure to Co with Res onse?nme ulromenm Contractor shall pay REMSA a penalty each month that the Contractor fails to comply with the Response Time requirements based on the percentage of compliance for all responses in the categories represented in Table 6 below. Failure of the Contractor to achieve at least 88% Response Time compliance for 0-1-1 calls will require that the Contractor submit and implement a deployment plan that 56 includes additional staffed ambulance hours aimed to achieve 90% compliance with Response Times. Table 6. City Responsoi?ime Penalties 9-1-1 Calls - Priority 1, Zami 3 Responses Compliance ?l/o Penalty 2 89% 90% $5,000 2 88% 89% $7,500 88% $10,000 Non-emergency Responses - Priority 4 Responses Compliance Penalty 2 89% 90% $4,000 2 {No/u $0,000 88% $7,500 t3) Repegtigo Egg-Coming? Penalties are based on measurement of response time performance for all responses within the City and grouped by priority level. Calls originating from 9-1-1 will be grouped for compliance measurement. Priority 4 responses [non-emergency ALS and BLS) will be reported and used for compliance measunement. The Contractor is required to repon performance for each priority level Citywide. Repetitive non-compliance in any given subset is defined as three consecutive months or four instances of non-compliance in any twelve-month period. If the Contractor is lepetitively non-compliant in any subSet measure, the Contractor shall submit a plan of corrective action to within 30 days of being notified of repetitive non- complianCe by Failure to correct repetitive non-compliance may be considened a material breach of the Agreement. (4) MW An "Outlier" Response Time is de?ned as a Response Time that is excessive for the categow, such that it represents a potential thneat to health and safety [Outlier]. A penalty shall be imposed for any call for which the actual Response Time equals or exceeds the applicable "Outlier Response Time? set forth in Table 7. Penalties shall be based on the Priority level assigned to the call. The outlier penalty is in addition to a penalty assessed for failure to meet the Response Time compliance requirements. I :\AD\002\02\2X02\2X02177.docx 57 Table 7. Response Time Penalties Outlier Response Times Priority Level Penalty per Outl ier Citywide Measure Priority 1 $1,500 Priority 2 >17:59 51,000 Priority 3 >205?) S750 . . >605? late for scheduled Pnomy 4 >891?) for non-scheduled SJOO (5) Additional Penalty Provisions may impose ?nancial penalties for minor or major breaches of the Agreement. For example, the Agreement will include penalties relating to the failure to provide reports and information to ltliMSA by speci?ed due dates. failing to give a detailed verbal report or leave l?CRs documenting patient cane at receiving institutions, lailure to respond to a request, and responding and transporting in a BLS unit when the call requires an ALS nesponse and transport. REMSA may impose a line of up to $500 per incident for any minor breach of the Agreement not slwcil'ieally addressed in the following Table 8. The following specific penalties shall be included in the Agreement: The remainder ol?tliis page is intentionally blank I :\AD\002\02\2X02\2X02177.docx 58 Breach Event Table 8. Branch Events and Penalties Criteria Penalty Failure to provide timely operational reports Operational and Response Time reports are due on speci?c date after close of nront It 550 per rcporl per day received after specified due date Failune to leave completed PCR at receiving facility 100 percent of REMSA approved Interim Patient Care Report (an abbreviated patient care report] will be left at the receiving facility prior to departure of the ambulance crew OR a detailed verbal report will be given at the time of handoff. 100 percent of the completed PCRs will be provided to receiving, facility within 24 hours 550 for every instance when the lrrterim Patient Care Report OR a detailed verbal report at a minimum, is not left at the receiving facility prior to crew departure. A penalty 00 for every completed PCR not provided to the facility within 24 hours of patient delivery. Response and transport by a BLS unit when the Priority level calls for the patient to be transported by an ALS unit All 9- l- l/emergency calls shall be responded to by an MS ambulance and the patient transported in the ALS unit $1,000 for every incident in which a BLS ambulance responds and transports a patient that requires an MS anrbularrce. Failure to provide timely quality improvement data a nd re port 5 Quality improvement and clinical data and reports are due on specific date after close of month 550 per report or data submission per day received after speci?ed due date Failure to provide timely unusual occurrence reports Unusual occurrence reports are due within a specific time from dale of the occurrence as de?ned in R15 MSA policies and procedures $100 per report per day received after the speci?ed tinre frame from the date of the occurrence Failure to respond to an emergency request for a response from City The contractor shall respond to all official requests for an emergency response from the City PSAP. Failure to respond is de?ned as the Contractor not Sending an ambulance en route to an emergency request. REMSA shall impose a minimum fine of $10,000 for each failure to respond to an of?cier call by the Contractor: Failure to respond will be defined as any emergency call originating from PSAP for which the Contractor fails to dispatch and no ambulance responds. Prior to imposition of this penalty, REMSA will conduct an investigation of the incident 9. Penalty Disputes Contractor may appeal to REMSA in writing within 10 business days of receipt of notification of the imposition of any penalty or regarding penalty calculations. The Contract Administrator will review all such appeals and make the decision to eliminate, modify, or maintain the appealed penalty. Should the Contractor desire to appeal the Contract Administrator?s decision, a written request be submitted to the Health Director within 10 days or receipt of the Contract Administrator's decision on the appeal. All decisions by the Health Director shall be considered ?nal. I :\AD\002\02\2X02\2X02177.docx 59 10. Fleet Requirement The Contractor is to maintain the number of ALS equipped and fully operating ambulances that represent at least 130% of the peak staf?ng level. For example, if the Contractor's peak number oi'ambulances is five (5), then the Contractor is to nraintain a ?eet of'at least eight ambulances (5 130% 6.5 rounded to 7). if a fraction is derived when multiplying the peak number of units by 130%, the number will be rounded up to the next whole integer. (ie. 6.5 would be rounded to 7). 11. Coverage and Dedicated Ambulances, Use of Stations/ Posts These specifications are for a performance based approach rather than a level of effort undertaking involving defined locations. REMSA neither accepts nor rejects Proposer?s level of effort estimates; rather REMSA accepts the l?roposer?s commitment to employ whatever level of effort is necessary to achieve the Response Time and other perfomrance results required by the terms of the Agreement as outlined in these specifications. Contractor shall deploy ambulance resources in a manner consistent with this goal. D. Personnel 1. Treatment of tneunbent Work Foree A number of dedicated high ly trained personnel are currently working in the REMSA system. in the event the Contractor tums out to be other than the incumbent providers, every effort must be made to ensure a smooth transition and to encourage current EMS personnel to remain with the system. To that end. in the event of a change in providers, all current quali?ed ambulance employees working within the REMSA system (other than owners and executive management) are to be considered for preferential hiring by any new Contractor. A new Contractor is expected to offer quali?ed non-supervisory employees (EM'l's and paramedics) employment in substantially similar positions. A new Contractor will consider current employee scheduling and make reasonable efforts to transition its new employees to its organization as smootth as possible. While a plan for the transition of EM'l's, and paramedics is an element of this RFP, i?roposers are encouraged to exceed the minimum requirements and provide the strongest plan possible for retention of the incumbent workforce. and additional points will be awarded for plans which exceed the minimum requirements. Employment stabilin within the EMS system is an important concem of incumbent employees, City and REMSA. incumbent personnel hired will retain "seniority status" earned while working full-time in the system. Contractor will provide full time employees with a wage and benefit program comparable to the ernployees' current program. lfan incumbent provider is successful, it agrees to tnaintaitt, at a minimum, current salary and bene?t levels for personnel and consistent with offerings included in its proposal. REMSA expects that to attract and retain outstanding personnel. Contractor must utilize reasonable compensation and scheduling methods. Contractor's economic ef?ciencies are not to be derived from the use of sub-standard compensation The system in no way intends to restrict the ingenuity of Contractor and its employees from working out new and creative compensation (salary and bene?ts) programs. The system's goal is simply to ensure that Contractor initially and throughout the term of the Agreement provides a ?nancial benefit to encourage employee retention and recruitment for the system. l?roposer shall describe how it intends to maintain continuity of service in the system by employing current personneland efforts to retain personnel through the term of the Agreement, :\AD\002\02\2X02\2X02177.docx 60 lf the Proposer is the current provider, it shall describe how it intends to retain personnel through the term of the new Agreement. 2. Character, Competence and Professionalism of Personnel The parties understand that ambulance services are often rendered in the context of stressful situations. REMSA expects and requires professional and courteous conduct and appearance at all times from Contractor's Ambulance personnel, support staff, middle managers, and top executives. Contractor shall address and correct any occasional departure from this standard of conduct. All persons employed by Contractor in the performance of its work shall be competent and holders of appropriate licenses and permits in their respective professions and shall undergo a criminal record check in accordance with requirements at Contractor?s expense. Contractor shall ensure that driver?s record checks are conducted at least annually. Contractor must independently judge the employability and potential liability associated with employing any individual with a past history olserious ollenses. 3. Internal Health and Safety Programs The Contractor shall implement multiple programs to enhance the safety and health of the work force. 'l'hese shall include driver-training, safety and risk management training. The Contractor shall provide adequate Personal Protective Equipment (PPE) and other equipment to employees working in hazardous environments such as routine care, rescue operations, motor vehicle accidents, etc. At a minimum, personal protective gear shall include appropriate head, respiratory and ?esh protection for employees. Policies and procedures should clearly describe the routine use of PPF. on all patient encounters. 4. Evolving OSHA Other Regulatory Requirements It is anticipated, during the term of the Agreement that certain regulatory requirements, for occupational safety and health, including but not limited to infection control, blood-borne pathogens and TB, may be increased. It is REMSA's expectation that Contractor will adopt procedures that meet or perform better than all requirements for dealing with these matters. Contractor shall make available at no cost to its employees all currently recommended immunizations and health screening to its high-risk personnel. 5. Not Allowed During the performance of the Agreement, Contractor agrees that it will comply with all applicable provisions of federal, state, and local laws, including Chapter 98 of the Code of Ordinances oi'the City of Sioux Falls and regulations prohibiting discrimination Without limiting this, Contractor warrants that it will fully comply with Title VI and VII of the Civil Rights Act of 1964, as amended, the Americans with Disabilities Act (ADA) and all other regulations promulgated there under. Contractor will not discriminate against any employee or applicant for employment because of race, religion, color, disability, national origin, sex, sexual orterrtation, or age. Contractor will take ai?nnative action to ensure that enrploynrent is oiiered and that employees are treated during employment without regard to their race, religion, color, disability, national origin, sex, sexual orientation or age. Such action shall include but is not limited to the following: employment-upgrade, demotion, or transfer; recruitment or advertising; lay-oli? or termination; rates of pay or other forms of compensation; and selection. including apprenticeship. 61 E. Management 1. Data and Reporting Requirements The long-term success of any EMS system is predicated upon its ability to both measure and manage its affairs. Therefore, the will require Contractor to provide detailed operational, clinical, and administmtiVe data in a manner that facilitates its retrospectiVe analysis. 6) 6) d) :\AD\002\02\2X02\2X02177.docx Dispatch Computer/Data System Interface The data system utilized by Contractor that interacts with Communications CAD shall include security features preventing unauthorized access or retrospective adjustment and full audit trail documentation. REMSA will he provided access to all data maintained by the Contractor" 5 Computer Aided Dispatch (CAD) or Data system as necessary to analyze demand and determine deployment procedures. The Contractor agrees to allow REMSA, at Contractor's expense, to install an interface with the CAD or Data System to collect and monitor computer-aided dispatch information and patient care reports. The Contractor in conjunction with REMSA shall establish procedures to automate the reporting requirements. The Metro interface made available to the Contractor shall provide real-time monitoring of the Metro's ambulance data screens and at a minimum provide the location and status of active ambulance calls, pending calls, location and status of ambulances and crews. Essential Patient Care Record and Assignment Data Contractor shall utilize an electronic patient care record system (PCR) that is and CEMSIS compliant and meets the requirements of the state and approved by REMSA for patient documentation on all EMS system responses including patient contacts, canceled calls, and non-transports. The PCR shall be accurately completed to include all information required by and established according to established REMSA Policies and Procedures. If possible, the Contractor shall leave a copy of the PCR (electronic or printed) at the receiving hospital upon delivery of each patient in accordance with REMSA policy. A detailed verbal report at handoff may substitute for this requirement. with the completed i?Clt delivered to the hospital within 24 hours. Within 24 hours, Contractor shall provide access for the Contract Administrator and receiving hospitals to patient care records in computer readable format and suitable for statistical analysis for all priorities. Records shall contain all information documented on the PCR for all EMS system responses including patient contacts, cancelled calls, non-transports. Contractor shall identify files or PCRs for trauma transports [patients meeting trauma triage criteria). Contractor shall be. required to provide other data points, which may be reasonably requested, including any needed modi?cations to support EMS system data collection. Records Contractor shall complete. maintain, and provide to REMSA, if requested. adequate records and documentation to demonstrate its performance compliance and aid REMSA in improving, modifying, and monitoring the EMS system. Reports Required Contractor shall provide, within 10 business days after the first of each calendar month, computer database data in an electronic format and reports pertaining to its performance during the preceding month as it relates to the clinical, operational, and financial performance stipulated herein. Contractor shall document and report to Contract Administrator in writing in a form required by the Contract Administrator. Response time compliance and customer complaints/ resolutions shall be reported Reports other 62 :\AD\002\02\2X02\2X02177.docx than Response Time compliance and customer contplaints/ resolutions may be required less frequently than At the end of each calendar year, no later than November 30 of the proceeding year, REMSA shall provide a list of required reports and their frequency and due dates to the Contractor. Reports shall include, at a minimum: (1) Clinical Continuing education compliance reports; Summaty ofclinicaJ/servicc inquiries and resolutions; Summary of inten'upted calls due to vehicle/equipment failures; and A list of trauma transports, by city and by hospital, including all times necessary to calculate each Response Time. on-scene time, and transport to hospital time (2) Operational Calls and transports, by priority Citywide and outside the City; A list of each call where there was a failure to properly record all times necessary to determine the Response Time; Documentation of all patients meeting trauma criteria including on-sccne time and transport to hospital time: S'l'ls'Ml patients with EKG ?ndings, treatment provided, scene time and hospital destination; Stroke patients with assessment ?ndings, treatment provided, scene time and hospital ination; ALS intercepts with regional providers; A list of mutual aid responses to and from system; and EMS transports to and from medical aircraft performed by Contractor (3) Wm A list ofeach call dispatched for which Contractor did not meet the Response Time standard and an explanation of why the response was late: Canceled calls; and Exception reports and resolution. (4) Response Time Statistich Data Within 10 business days lollowing the last day oi each month, Contractor shall ensure that ambulance Response Time records are available to REMSA in a computer readable format approved by the Contract Administrator and suitable for statistical analysis for all ambulance responses originating from requests within the City. The records shall, at a minimum, include the following data elements: unit identi?er location ofcall - street address location of call - longitude and latitude nature ofcall (EMD Code) code to scene time call received (or for transfers; time pick-up requested) time call dispatched titne unit en route time unit on-scene time contact with patient time unit en route to hospital time unit at hospital time unit clear and available for next call outcome (dry run. transport) receiving hospital 63 code to hospital major trauma numberof patients transported nu mber oi ?rst responders accompanying if any (5) Ponmnel Reports Contractor shall provide REMSA annually with a list of paramedics, EM'l's and dispatchers currently employed by Contractor and shall update that list whenever there is a change. Alternatively, at Contractor?s option this information may be provided to REMSA via read only access to that database. The personnel list shall include, at a minimum, the name, address. telephone number, paramedic certi?cation and expiration date or EMT certi?cation and expiration date, ACLS expiration date and Driver's License number of each person on the list. (3) Affairs Report - Number of conducted community education events, I Public Relations (PR) activities, ?rst responder recognition, I Government relations contact report. (7) ?gmgicAccesstoRopo? Contractor shall provide access capability to REMSA, at the Contractor?s expense, to provide REMSA access to all PCRs and provide a mechanism to create customized reports for R15 MSA monitoring and review. The electronic access shall also include real- time monitoring of CAD/data interface systems. (8) Other Reports Contractor shall provide REMSA with such other reports and records as may be reasonably required by the Contract Administrator. F. EMS System and Community 1. Participation In EMS System Dereiopment The anticipates further development of its EMS system and regional efforts to enhance disasterand mutual-aid response. The requires that its Contractor actively participate in EMS activities, committee meetings. and work groups. Contractor agrees to pan icipate and assist in the development of system changes. 2. Accreditation Within 24 months following commencement of the term of the Agreement, the Contractor will attain accreditation as an ALS Ambulance Service through the Commission on Accreditation of Ambulance Services (CAAS) or comparable organization The Contractor shall maintain its accreditation throughout the term of the Agreement. 3. Muttl-casuatty/ Disaster Response Contractor shall cooperate with in rendering emergency assistance during a declared or an undeclared disaster or in multi-victim response as identified in the plans. in the event the City declares a disaster within the City, the Contractor will assign a Field or Dispatch Manager/Supervisor to deploy to the designated emergency operations center (when activated) as a liaison upon request. :\AD\002\02\2X02\2X02177.docx 64 in the event the City declares a disaster within the City, or in the event the City directs Contractor to respond to a disaster in a regional jurisdiction, normal operations may be suspended at the discretion of REMSA and Contractor shall respond in accordance with the disaster plan. Contractor shall use best efforts to maintain primary Emergency services and may suspend non- emergency services upon noti?cation and concurrence of REMSA. At a multi-victim scene, Contractor?s personnel shall perform in accordance with appropriate REMSA multi-victim response plan and within the Incident Command System During a disaster declared by the City, REMSA will determine, on a case-by-case basis, if the Contractor may be temporarily exempt lrom response-time criteria. When Contractor is noti?ed that multi-casualty or disaster assistance is no longer required, Contractor shall return all of its resources to its primary area of responsibility and shall resume all operations as required under the Agreement. a) IntarnatDlsastor Response Notllcatlon Contractor shall develop a plan for immediate recall of personnel during multi-casually or widespread disaster. This plan shall include the capability of Contractor to alert off-duty personnel. b) Contractor shall have a mechanism in place to communicate current ?eld information to appropriate REMSA or City staff during multi-casualties, disaster response, hazardous materials incidents, and other unusual occurrences. c) Contractor shall participate in sanctioned exercises and disaster drills and other interagency training upon request. 4. Mutual-aid and Stand-by Services a) MutualAld Contractor shall respond in a mutual aid capacity to other service areas outside of the City if so directed by Contract Administrator or In accordance with Contractor mutual aid agreements. Speci?cally, Contractor shall ruaintain documentation of the number and nature oi?mutual aid responses it makes and nature of mutual aid responses made by other agencies to calls originating within the City. Ir) Standby Sonbe Contractor shall provide, at no charge to City or requesting government agency, stand-by services at the scene of an emergency incident where there may be an imminent life threat as directed by the PSAP. This requirement may be met by transport, non-transport or supervisory unit. A unit placed on stand-by shall be dedicated to the incident. Dedicated stand-by periods exceeding one hour may be billable to the requesting agency. 5. Permitted Subcontracting The Contractor may contract with providers for ALS inter-facility transports/transfers, BLS non-emergency transports, and transports originating within the City. Contractor may also subcontract for its management, administrative services, and billing and collection activities. Such agreements must be approved by REMSA. The sub-contracting entities must meet minimum requirements for ambulance or services. The Contractor remains responsible and accountable to meet Response Time and reporting requirements and the Contractor is liable to pay any penalties for non-performance by the subcontractor. :\AD\002\02\2X02\2X02177.docx 65 6. Supply Exchange and Restoctr The Contractor will restock basic life support supplies on a one- for-one basis based on utilization on calls by SFFR. The preferred restocking mechanism will be jointly developed by the Contractorand SFFR and approved by REMSA. 7. Handling Service Inqulrles and Complaints Contractor shall log all inquiries and service complaints. Contractor shall provide prompt response and follow-up to such inquiries and complaints. Such responses shall be subject to the limitations imposed by patient con?dentiality restrictions. Contractor shall submit to REMSA each month a list of all service inquiries/complaint received and their appropriate disposition/resolution. Copies of any inquiries and resolutions ofa clinical nattrre shall also be referred to the EMS Medical Director or REMSA within twenty-four (24) hours. G. Administrative Provisions 1. No System Subsidy The Contractor will operate the EMS system without arty subsidy from REMSA or the City. RFP specifications are designed to provide increased accountability without undue operational or financial burden for the Contractor. 2. Contractor Revenue Recovery The primary means of Contractor compensation is through fee-for-service reimbursement of patient charges. a) Contractor shall receive income from patient charges. Contractor shall comply with fee schedules and rates proposed in response to this RFP and as subsequently approved by the The current rates are included in Appendix 5. b) The Contract Administrator will review annual increases to patient charges based on changes in the Consumer Price Index for All Urban Consumers. The annual rate increases will be the greater of three percent or the increase of the CPI for any giVen year. All changes in the transport fees must be approved by In the event changed circumstances substantially impact the Contractor's costs of pmviding services or there are substantial reductions in revenue caused by factors that are beyond the control of Contractor, the Contractor may request increases or decreases in charges to patients to mitigate the ?nancial impact of such changed circumstances. No adjustments to patient fees will be allowed during the first twelve (12) months of the commencement of the Agreement. if Contractor believes an adjustment is warranted, the Contractor may apply to the Contract Administrator for a rate adjustment to be effective on or after the ?rst anniversary of the Agreement. Applications be submitted at least sixty (60) days prior to the requested effective date. Requests for changes to patient charges shall only be allowed on an annual basis corresponding to the anniversary of the Agreement. The Contract Administrator shall review the application and forward his or her recommendation to the REMSA Board. who shall have the authority to approve or disapprove the request. Approval of rate changes is required before they can become effect ive. :\AD\002\02\2X02\2X02177.docx 66 3. Federal Healthcare Program Comptlance Provlslons Contractor shall comply with all applicable Federal laws, rules and regulations for operation of its enterprise, ambulance services, and those associated with employees. This includes compliance with all laws and regulations relating to the pmvisiorr oi'setvices to be reimbursed by Medicare, Medicaid, and other government funded programs. 8) It) Medbare and Medicakt compliance Program Requirements Contractor shall implement a comprehensive Compliance Program for all activities, particularly those related to documentation, claims processing, billing and collection processes. Contractor's Compliance Program shall substantially comply with the current guidelines and recommendations outlined in the Ollice of Inspector General Compliance Program Guidance for Ambulance Suppliers as published in the Federal Register on March 24-, 2003 (03 FR 14-255). Contractor will engage a quali?ed entity to conduct a claims review on an annual basis as described in the 016 Compliance Guidance. A minimum of 50 randomly selected Medicare claims will be reviewed for compliance with CMS rules and regulations, appropriate documentation, medical necessity, atrd level ofservice. The Contractor will submit the report to REMSA within 120 days oi?tlre end of each contract year. commence Program Requirements Contractor is required to implement a comprehensive plan and develop the appropriate policies and procedures to comply with the provisions of the Iiealth Insurance Portability and Accountability Act of 1996 and the cun?ent rules and regulations enacted by the US Department of Health and Human Services. The three major components of HIPAA include: 1. Standards for Privacy and Individually Identi?able Health Information 2. Health Insurance Reform: Security Standards 3. Health Insurance Reform: Standards for Electronic Transaction Sets and Code Standards Contractor is responsible for all aspects of complying with tltese rules and particularly those enacted to protect the confidentiality of patient infonuation. Any violations of the HIPAA rules and regulations will be. reponed immediately to REMSA along with Contractor's actions to mitigate the effect ofsuch violations. 4. State Compliance Provisions Contractor shall comply with all applicable state and local laws, rules and regulations for businesses, ambulance services, and those associated with employees. Contractor shall also comply with City and REMSA policies, procedures. and protocols. Collection Services Contractor shall operate a billing and accounts receivable system that is well documented, easy to audit, and which minimizes the effort required of patients to recover from third party sources for which they may be eligible. The billing system shall: 1. electronically generate and submit Medicare and Medicaid claims; 2. item i7.e all procedures and supplies employed on patient bills; and 3. be capable of responding to patient and third party payer inquiries regarding submission of insurance claims, dates and types of payments made, itemized charges, and other inquiries Contractor shall not attempt to collect its fees for local service at the time of service. However, requests for advance payment or down payment of long distance non-emergency transports of more than 50 miles that originate in the City is acceptable. Procedures for any advance collection ol?long distance are to be approved by REMSA. :\AD\002\02\2X02\2X02177.docx 67 Contractor shall conduct all billing and collection functions for the EMS system in a professional and courteous manner. 6. Market shall not enter into agreements with any other provider for ground response to requests for ambulance service as de?ned herein originating within City during the term of this Agreement. Furthermore, will make all reasonable efforts to ensure the Contractor? exclusivity of non-emergency. and inter- facility transports originating within the BOA, including enforcement ofthe City Anrbulanee Ordinance. 7. Service Expanson Should any other contiguous jurisdiction desire to join the REMSA system, Contractor shall provide substantially similar services to the joining jurisdiction on the same terms and conditions. However, should call densities ofthe joining jurisdiction be lower than those ofthe City, then REMSA and Contractor shall negotiate in good faith to provide equitable (but potentially longer) response times in the joining jurisdiction or, alternatively, allow the joining jurisdiction to provide subsidy to achieve response times similar to the City. 8. Accounting Procedures a) trrvoiclngand Services REMSA shall render its invoice for any ?nes or penalties to the Contractor within 30 business days of the REMSA's receipt of the Contractor?s performance reports. The Contractor shall pay REMSA on or before the 30th day after receipt of the invoice. Any disputes of the invoiced amounts should be resolved in this thirty?day period. if they have not been resolved to REMSA or Contractor? satisfaction, the invoice shall be paid in full and subsequent invoices will be adjusted to re?ect the resolution of disputed amounts. Ir) Audits and Inspections Contractor shall maintain separate ?nancial records for services provided pursuant to the Agreement in accordance with generally accepted accounting principles. With reasonable notification and during normal business hours, shall have the right to review any and all business records including ?nancial records of Contractor pertaining to the Agreement. All records shall be made available to at the Contractor? 5 local of?ce or other mutually agreeable location may audit, copy, make transcripts, or otherwise reproduce such records, including but not limited to contracts, payroll, inventory, personnel and other records, daily logs and employment agreements. On an annual basis, the Contractor shall provide witlr audited ?nancial statements by certi?ed public accountants for Contractor's ambulance operations in the City and/or separate business records of ?nancial accounting of any other businesses that share overhead vvitlt the Contractor's ambulance service opemt ion. Contractor may be required by to provide with periodic repor1(s) in the format speci?ed by the Contract Administrator to demonstrate billing compliance with relevant rules and regulations and adherence with approved and speci?ed rates. 9. insurance Provisions Contractor shall obtain and maintain in force and effect throughout the term of this Agreement. and thereafter as to matters occurring during the term of this Agreement, the required insurance coverage is listed itr Appendix 10. :\AD\002\02\2X02\2X02177.docx 68 10. Hold Harmless Defense Indemnification Taxes Contributions 3) Hold Hamretss In General, Contractor has the contracted duty (hereinafter "the duty") to indemnify, defend and hold harmless, REMSA, the City, its City Council, of?cers, employees, agents and assigns from and against any and all claims, demands. liability, judgments, awards, interest, altomey?s fees, costs, experts' fees and expenses of whatsoever kind or nature, at any time arising out of or in any way connected with the performance of this Agreement, whether in tort, contract or otherwise. This duty shall not be limited to, claims for bodily injury, property damage, personal injury, and contractual damages or otherwise alleged to be caused to any person or entity including, but not limited to employees, agents and of?cers of Contractor. Contractor?s liability for indemnity under this Agreement shall apply, regardless of fault, to any acts or omissions, willful misconduct or negligent conduct ofany kind, on the part ofthe Contractor, its agents, subcontractors and employees. The duty shall extend to any allegation or claim of liability except in circumstances found by a jury or judge to he the sole and legal result of the willful misconduct of REMSA or the City. This duty shall arise at the ?rst claim or allegation of liability against REMSA or the City. Contractor will on request, and at its expense, defend any action suit or proceeding an?sing hereunder. This clause for indemni?cation shall be interpreted to the broadest extent permitted by law." it) Empbyee Characterand Fitness. Contractor accepts responsibility for determining and approving the character and ?tness of its employees (including volunteers, agents, or representatives] to provide the services required of Contractor under this Agreement, including completion of a satisfactory criminal/background check and period rechecks to the extent permitted by law. Notwithstanding anything to the contrary in this Paragraph, Contractor shall hold City, REMSA and its of?cers, agents and employees harmless from any liability for injuries or damages resulting a breach of this provision or Contractor? actions in this regard. 11. Performance Security Bond Contractor shall fumish performance security in the amount of one million dollars ($1,000,000) in one ofthe following forms: a) A faithful performance bond issued by a bonding company, appropriately licensed and acceptable to or b) An irrevocable letter of credit issued pursuant to this provision in a form acceptable to REMSA and from a bank or other ?nancial institution acceptable to REMSA. 12. Term of Agreement The initial term of the Agreement ultimately executed by Contractor shall be for a period of ?ve (5) years commencing at 12:01 am. on May 2 l, 2015 and terminating at midnight, May 20, 2020. 13. Earned Extension to Agreement if, at the sole judgment and discretion of REMSA, the Contractor is deemed to be substantially in compliance with the speci?cations de?ned in this RFP and the resulting Agreement, may grant an extension of the Agreement for up to six (6) additional years. shall make the offer of extension by formal written notice to the Contractor at least eighteen (18) months prior to the scheduled end of the term oi'the Agreement. if the Contractor does not want to continue providing services to as stipulated in the Agreement after the end of the Term, the Contractor must give notice ofits intent not to extend the Agreement at least seventeen [17) months prior to the scheduled end of the term of the Agreement. :\AD\002\02\2X02\2X02177.docx 69 14. Continuous Service Delivery Contractor expressly agrees that, in the event of a default by Contractor under the Agreement, Contractor will work with to ensure continuous and uninterrupted delivery of services, regardless ofthe nature or causes underlying such breach. Contractor shall be obligated to use every effort to assist to ensure uninterrupted and continuous service delivery in the event ofa default, even if Contractor disagrees with the determination ofdefault. 15. Annual Performance Evaluation REMSA shall evaluate the performance of the ambulance Contractor on an annual basis. An evaluation report will be provided to the City Council. The following information will normally be included in the performance evaluation: a) Response Time perfonuance standards assessed with reference to the minimum requirements in the Contract; b) Clinical performance standards assessed with reference to the minimum requirements in the Contract; c) initiation of innovative programs to improve system performance; d] Workforce stability, including documented efforts to minimize employee turnover, e] Compliance of pricing and revenue recovery efforts with rules and regulations and the Agreement; and 0 Compliance with information reporting requirements 16. Default and Provisions for Termination of the Agreement shall have the right to terminate or cancel the Agreement or to pursue any appropriate legal remedy in the event Contractor materially breaches the Agreement and fails to correct such default within seven (7) days following the service on it of a mitten notice by specifying the default or defaults complained of and the date of intended termination of rights absent cure. a) De?nitionsofBreaclr Conditions and circumstances that shall constitute a material breach by Contractor shall include but not be limited to the following: 1. Failure of Contractor to operate the ambulance service system in a manner which enables or Contractor to remain in substantial compliance with the requirements of the applicable federal. state, and City ordinances. rules, and regulations. Minor infractions of such requirements shall not constitrrte a material breach but such willful and repeated infractions shall constitute a material breach; 2. falsi?cation of data supplied to by Contractor during the course of operations, including by way of example but not by way of exclusion, dispatch data, patient report data, Response Time data, financial data, or falsi?cation of any other data required under the Agreement, or a willful refusal to provide such data with in a reasonable tirue when demanded by the 3. Chronic and persistent failure by Contractor to maintain equipment in accordance with good maintenance practices; 4. Deliberate, excessive, and unauthorized scaling down ofoperations to the detriment of performance by Contractor during a "lame duck" period as described in Section (3.22; 5. Deliberater increasing the cost of providing services, failing to maintain positive labor relations, or undertaking any activity designed to make it more difficult for a transition to a new Contractor or for a new Contractor?s operation in the event of a default or failure ofincumbent to prevail during a subsequent hid cycle; I :\AD\002\02\2X02\2X02177.docx 70 6. Willful attempts by Contractor to intimidate or otherwise punish employees who desire to sign contingent employment contracts with competing Proposers during a subsequent bid cycle; 7. Willful attempts by Contractor to intimidate or punish employees who participate itr legally protected concerted activities, or who form or join arty pmfessional associations; 8. Chronic and persistent failure of Contractor's employees to conduct themselves in a professional and courteous manner, or to present a professional appearance; 9. Failure of Contractor to comply with approved rate setting, billing, and collection procedures: 10. Failure of Contractor to meet Response Time requirements for three consecutive measurement periods in a single category and after receiving notice of non- compliance from Contract Administrator, 11. Failure of Contractor to comply with the vehicle lease provisions; 12. Failure of Contractor to cooperate and assist in the investigation or correction of any "Minor Breach? conditions; 13. Failure to comply with required payment of ?nes or penalties within sixty (60) days written notice of the imposition of such ?ne or penalty; 14. Failure to maintain in force throughout the terms of the Agreement, including any extensions thereof, the insurance coverage required herein; 15. Failure to maintain in force throughout the term of the Agreement, including any extensions thereof, the perfomtance security requirements as specified herein; 16. Failure to timely prepare and submit the required annual audit; and 17. Any other willful acts or omissions of Contractor that endanger the public health and safety. 17. Termination 3) Written "other The Agreement may be canceled immediately by written mutual consent. It) FoilrrotoPotfonn upon written notice to Contractor. may immediately terminate the Agreement should Contractor materially breach any of its obligations under the Agreettrent. In the event of such termination, may proceed with the work in any reasonable manner it chooses. The cost to of completing Contractor? performance shall be partially supported by securing the funds of the Performance Security Bond, without prejudice to rights otherwise to recover its damages or to seekany other remedy. 18. Emergency takeover In the event determines that a material breach, actual or threatened, has or will occur or that a labor dispute has prevented performance, and if the nature of the breach is, in the Contract Administrator's opinion, such that public health and safety are endangered, and after Contractor has been given notice and reasonable opportunity to correct de?ciency, the matter shall be presented to the Health Director. if the Health Director concurs that a material breach has occurred or may occur and that public health and safety would be endangered by allowing the Contractor to continue its operations. the Contractor shall cooperate fully with the to atTect an immediate takeover by of Contractor's ambulances and crew stations. Such takeover shall be a?ected within not more than 72 hours alter Health Director's decision to execute the emergency takeover. In the event of an emergency takeover, the Contractor shall deliver to the ambulances and associated equipment used in performance of the Contract, including 71 supervisors' vehicles. Each amhu lance shall be equipped, at a minimum, with the equipment and supplies necessary for the operation of ALS ambulances in accordance with ALS Policies and Procedures. Contractor shall deliver ambulances, dispatch and communications system/equipment, facilities and crew stations to in mitigation of any damages to resulting from the Contractor's breach. However. during the takeover of the ambulances and equipment, REMSA and Contractor shall be considered Lessee and Lessor, respectively. rent payable to the Contractor shall be equal to the aggregate amount of the Contractor's debt service on facilities, vehicles and equipment as documented by the Contractor at Contract Administrator's request, and veri?ed by the City Auditor (provided that the cost of contractor debt service does not exceed the fair market value of the rent for the facilities, vehicles and equipment). The City Auditor shall cause the disbursement of these payments directly to the Contractor's obligee. In the event an ambulance is unencumbered, or a crew station is not being rented, shall pay the Contractor fair market rental based upon an independent valuation. Nothing herein shall preclude from seeking to recover front the Contractor such rental and debt service payments as elements of damage from a breach of the Agreement. However, the Contractor shall not be precluded from disputing the Director's ?ndings or the nature and amount of the City REMSA's damages, if arty, through litigation. Failure on the part of the Contractor to cooperate fully with to effect a safe/smooth takeover of operations shall itself constitute a breach oi?the Contract, even it it is later detemtined that the original declaration ofbreach by the Health Director was made in error. shall have the right to authorize the use of vehicles and equipment by another company. Should require a substitute contractor to obtain insurance on equipment, or should choose to obtain insurance on vehicles/equipment, the Contractor shall be "Named Additional Insured" on the policy, along with the appropriate endorsements and notice. agrees to return the Contractor's vehicles and equipment to the Contractor in good working order, normal wear and tear at the end of takeover period For any of the Contractor's equipment not so returned, shall pay the Contractor fair market value of vehicle and equipment at time of takeover, less normal wear and tear or shall pay the Contractor reasonable costs of repair, or shall repair and return vehicles arid equipment. may unilaterally terminate a takeover period at any time and return facilities and equipment to the Contractor. The takeover period shall last no longer than judges necessary to stabilize the EMS system and to protect the public health and safety by whatever means chooses. All of the Contractor's vehicles and related equipment necessary for provision of ALS services pursuant to this Contract are hereby leased to during an emergency takeover period. Contractor shall maintain and provide to a listing of all vehicles used in the performance of this Contract, including reserve vehicles, their license numbers and name and address of lien holder, if any. Changes in lieu holder, as well as the transfer, sale, or purchase of vehicles used to provide ambulance services hereunder shall be reported to within 30 days of said change, sale, transfer, or purchase. Contractor shall inform and provide a copy of takeover provisions contained herein to lien holder[s) within five days of emergency takeover. :\AD\002\02\2X02\2X02177.docx 72 19. transition Planning a) Competitive Proposal Required Contractor acknowledges that intends to conduct a future competitive procurement process for the provision of service within the City prior to the termination of this Contract. Contractor acknowledges and agrees that may select a different ambulance service provider to provide exclusive ambulance services following said competitive procurement process, and to reasonable extension of its obligations hereunder if such extensions are necessary to complete such processes, including not limited to any reasonable decisions to cancel and restart such processes. it) Future Cycles Contractor acknowledges and agrees that supervisory personnel, EMT's, paramedics. and dispatch personnel in the EMS system have a reasonable expectation of long-term employment in the system, even though Contractors nray change. Accordingly, Contractor shall not penali7e or bring personal hardship to bear upon any of its employees who apply for work on a contingent basis with competing Proposers and shall allow without penalty its employees to sign contingent employment agreements with competing Proposers at employees' discretion Contractor may prohibit its employees from assisting competing Proposers in preparing Proposals by revealing Contractor's trade secrets or other information about Contractor?s business practices or field operations. 20. City/ REMSA's Remedies if conditions or circumstances constituting a Default as set forth in Section exist, shall have all rights and remedies available at law or in equity under the Agreement, speci?cally including the right to terminate the Agreement and/or the right to pursue Contractor for damages and the right of emergency takeover as set forth in Section IV.G.18. All remedies shall be non-cumulative and shall be in addition to any other remedy available to 21. Provisions for Curing Material Breach and Emergency Take Over in the event the detenuines that there has been a material breach by Contractor of the standards and performances as de?ned in this specification, which breach represents an immediate threat to public health and safety, such determination shall constitute a material breach and/or default of the Agreement. In the event of a material breach, REMSA shall give Contractor written notice, return receipt requested, setting forth with reasonable specificity the nature ofthe material breach. Contractor shall have the right to cure such material breach within seven (7) calendar days of receipt of such notice and which notice should include the reason why such material breach endangers the public's health and safety unless an immediate and grave threat to public health and safety requires shorter notice or no notice. in cases where notice is given, within 24 hours of receipt ofsuch notice, Contractor shall deliver to in writing. a plan of action to cure such material breach. The acting through its Health Director or the Director's designee, may permit Contractor to implement such a plan of action if the plan is acceptable to the and may set such deadlines for the completion of such actions as the deems appropriate, in its sole and absolute discretion. if Contractor fails to cure such material breach within the period allowed for cure (with such failure to be detenuined in the sole and absolute discretion of or Contractor fails to tinrely deliver the cure plan to may execute an emergency take-over of Contractor's operations. Contractor shall cooperate completely and immediately with to affect a prompt and orderly transfer ofall responsibilities to Contractor shall not be prohibited from disputing any such ?nding of default through appropriate channels. provided, however that such dispute shall not have the effect of delaying, :\AD\002\02\2X02\2X02177.docx 73 in any way, the immediate takeover of operations by These provisions shall be speci?cally stipulated and agreed to by both parties as being reasonable and necessary for the protection of public health and safety, and any legal dispute concerning the ?nding that a Default has occurred, shall be initiated, and shall take place only after the emergency take-over has been completed. Contractor's cooperation with and lull support of such emergency take-over shall not be construed as acceptance by Contractor of the ?ndings and default, and shall not in any way jeopardize Contractor's right of recovery based upon a later finding in an appropriate forum that the declaration of Default was made. in error. llowevcr, failure on the part of Contractor to cooperate fully with to alfect a smooth and safe take-over of operations, shall itself constitute a breach of the Agreement, even if it was later determined that the original declaration ofdefault by REMSA was made in error. For any default by Contractor which does not endanger public health and safety, or for any default by which cannot otherwise be resolved. early termination provisions which may be agreed to by the parties will supersede these speci?cations. 22. "lame-duck" Provisions Should the Agreement not be renewed, extended or if notice of early termination is given by Contractor, Contractor agrees to continue to provide all services required in and under the Agreement until or a new entity assumes service responsibilities, even if reasonable extension of this the Contractor's Agreement with the is necessary. Under these circumstances Contractor will, for a period of several months, serve as a lame duck Contractor. To ensure continued performance fully consistent with the requirements herein through any such period, the following provisions shall apply: a) Contractor shall continue all operations and support services at the same level of effort and performance as were in effect prior to the award of the subsequent Agreement to a competing organization, including but not limited to compliance with provisions hereof related to quali?cations of key personnel; b) Contractor shall make no changes in methods of operation or employee compensation that could reasonably be considered to be aimed at cutting Contractor service and operating costs to maxim 'ue or effect a gain during the final stages of the Agreement or placing an undue burden on the subsequent Contractor; c) recognizes that if another organization should be selected to provide service, Contractor may reasonably begin to prepare for transition of service to the new entity. shall not unreasonably withhold its approval of Contractor?s request to begin an orderly transition process, including reasonable plans to relocate staff, scale down certain inventory items, etc, as long as such transition activity does not impair Contractosz performance during this period; and Should select another organization as a service provider in the future, Contractor personnel shall have reasonable opportunities to discuss issues related to employment with such organizations without adverse consequence. 23. General Provisions Assignment Contractor shall not assign any portion of the Agreement for services to be rendered without written consent first obtained and any assignment made contrary to the provisions of this section may be deemed a default of the Agreement and, at the option of REMSA, shall not convey any rights to the assignee. :\AD\002\02\2X02\2X02177.docx 74 bl 0) d) 0) 8) :\AD\002\02\2X02\2X02177.docx Ponnits and Licenses Contractor shall be responsible for and shall hold any and all required federal, state, or local permits or licenses required to perform its obligations under the Agreement. In addition, Contractor shall maloe all necessary payments for licenses and permits for the services and for issuance of state pennits for all ambulance vehicles used. it shall be entirely the responsibility of Contractor to schedule and coordinate all such applications and application renewals as necessary to ensure that Contractor is in complete compliance with federal, state, and local requirements for permits and licenSes as necessary to provide the services pursuant to this Agreement. Contractor shall be responsible for ensuring that its employee's state and local certi?cations as necessary to provide the services, if applicable, are valid and current at all times. Compilaneo with Laws and Regulations All services furnished by Contractor under the Agreement shall be tendered in full compliance with all applicable federal, state, and local laws, ordinances, rules, and regulations. It shall be Contractor?s sole responsibility to determine which, and be fully familiar with, all laws, rules, and regulations that apply to the services under the Agreement and to maintain compliance with those applicable standards at all times. Private Worir Contractor shall not be prevented from conducting private work that does not interfere with the requirements of Agreement. Rotorrttono?toeords Contractor shall retain all documents pertaining to Agreement for seven (7) years from the end of the fiscal year following the date of service; for any further period that is required by law; and until all Federal/State audits are complete and exceptions resolved for this Agreement's funding period. Upon request, and except as otherwise restricted by law, Contractor shall make these records available to authorized representatives of REMSA, the City, the State of South Dakota, and the United States Government. Any and all records received and manufactured by the City under this Agreement shall be subject to SDCI. ch. 1- 27, which governs the treatment and disclosure of public records, and any other applicable law. Product Museum/Advertising Contractor shall not use the name of REMSA or the City for the endorsement of any commercial products or services without the expressed written permission of the Contract Administrator. Observation and Inspections representatives may, at any time, and without noti?cation, directly observe Contractor's operations of the maintenanCe facility, or any ambulance post location. A REMSA representative may ride as "third person" on any of Contractor's Ambulance units at any time, provided, that in exercising this right to inspection and observation, REMSA representatives shall conduct themselves in a professional and courteous manner, shall not interfere with Contractor employee's duties and shall at all times be respectful of Contractor?s employer/employee relationships. At any time during normal business hours and as often as may be reasonably deemed necessary by representatives may observe Contractor's of?ce operations, and Contractor shall make available to for its examination any and all business records, including incident reports, and patient records pertaining to the Agreement. may audit, copy, make transcripts, or otherwise reproduce such records for to fulfill its oversight role. 75 Ill ii I) ml nl 0) :\AD\002\02\2X02\2X02177.docx Provision Contractor understands and agrees that for seven years following the conclusion of the Agreement it may be required to make available upon written request to the Secretary of the US Department of Health and Human Services, or any other fully authorized representatives, the speci?cations and subsequent Agreements, and any such books, documents and records that are necessary to certify the nature and extent of the reasonable costs of services. Nothing in the Agreement shall be construed to create a relationship of employer and employee or principal and agent, part nership. joint venture or any other relationship other than that of independent parties contracting with each other solely for the purpose of carrying out the provisions of the Agreement. Contractor is an independent contractor and is not an employee of City or Contractor is responsible for all insurance (worker?s compensation, unemployment, etc.) and all payroll related tax. Nothing in the Agreement shall create any light or remedies in any third party. The Agreement is entered solely for the bene?t of the City, REMSA, and Contractor. Rights and Remedies NotWeived Contractor will be required to covenant that the provision of services to be performed by Contractor under the Agreement shall be completed without compensation from or City. The acceptance of work under the Agreement shall not beheld to prevent maintenance of an action for failure to perform work in accordance with the Agreement. Cementmlurisdic?on Contractor shall consent to the exclusive jurisdiction of the courts of the State of South Dakota or a federal court having jurisdiction in Sioux Falls, South Dakota in any and all actions and proceedings between the parties hereto arising under or growing out of the Agreement. Venue shall lie in Sioux Falls, South Dakota. End-innit Provisions Contractor shall have 00 days after termination of the Agreement in which to supply the required audited ?nancial statements and other such documentation necessary to facilitate the close out of the Agreement at the end of the term. Home of iligetiorr Contractor shall agree to notify within 24 hours ofany litigation or signi?cant potential for litigation of which Contractor is aware. Gostof?rtotcement If legal proceedings are initiated by any party to this Agreement. whether for an alleged breach of the terms or judicial interpretation thereof, the prevailing party to such action shall, in addition to all other lawful remedies, be entitled to recover reasonable attorney's fees, consultant and expert fees, and other such costs, to the extent permitted by the court. General Contract Provisions In addition to the speci?c contract provisions listed this document; the written Agreement will include general conditions required by in contracts such as those listed herein. 'i?hose additional general conditions are included in Appendix 10. These provisions will become part of the ?nal agreement with successful i?roposer awarded the proposal. Any exceptions to the requirements, terms and conditions as stated herein, and in the general conditions must be identi?ed separately in the Proposer's response." 76 SECTION V. COMPETITIVE CRITERIA This section sets forth the competitive performance criteria to be competitively assessed and scored by the Review Panel (the Competitive Criteria). For each Competitive Criterion, the narrative below de?nes a base level of performance to which every Proposer must agree (the Minimum Requirements). This agreement must be unquali?ed and expressly stated in the Proposal. lfa Proposer fails to agree to any Minimum Requirement related to any Competitive Criterion, City Purchasing Division (CPD) may, in its discretion, declare the Proposal tlnresponsiVe and disquali?ed. The Proposer must agree to the Minimum Requirements regardless of whether the Proposcr goes on to propose levels ofperformanee that are higher than contained in the Minimum Requirements for a given Competitive Criterion. For Proposers offering to meet but not the Minimum Requirements fora given Competitive Criterion, the Proposal must set forth the information requested below regarding the manner in which the Proposer will meet tlte performance level speci?ed in the Minimum Requirements. For each Competitive Criterion, Proposers are encouraged to propose levels of perfomtance higher than the Minimum Requirements. The narrative describes the policy and operational goals for each Competitive Criterion, which REMSA is seeking to maximize through competition It also provides guidelines arid examples to illustrate how the policy and operational goals might be promoted. However, the speci?c concepts and activities comprising these examples are neither speci?cally required nor exclusive. The Competitive Criteria provide an opportunity for a l?roposer to differentiate its proposed service from that of other Proposers and to demonstrate the organizational capabilities and experience which it would bring to bear if it becomes the Contractor. Because every Pmposer is required to commit to the Minimum Requirements, no points shall be awarded in connection with a Competitive Criterion unless a higher level of performance is proposed. t?oiuts available for each Competitive Criterion for which a higher level of performance is proposed shall be scored as set fonh in Section A goal of this is to increase the levels of communication, cooperation, collaboration, and in some cases functional integration among the different entities comprising the EMS system. This goal is furthered by various provisions in the Core Requirements and in the Minimum Requirentents. In addition, certain of the Competitive Criteria invite Proposers to propose higher levels of collaboration. A. Clinical 1. Competltive Criterion: Quality Improvement Minimum Roqulromonb-Domomtrablo Progressive Clinical Quallv Improvement requires that the Contractor develop and implement a comprehensive quality management program that incorporates assuring compliance with the Agreement. minirnunt performance standards, and rules and regulations. The program shall also include process measurement and process improvement that is integrated with the EMS system's quality management program. The clinical indicators measured by all system participants will be developed through collaborative efforts of the ?rst responder agencies. the Contractor, and REMSA and based on current EMS research and call demand. REMSA ultimately will approve and implement the quality monitoring and improvement plan to be used in the City by all EMS system participants. Proposcrs should review REMSA's quality management program requirements. I :\AD\002\02\2X02\2X02177.docx 77 b) REMSA is not seeking overly complex systems or processes that focus on stipulated categories of patients, EMS calls, or providers. Proposers must commit to a clear, concise, and implementable set of processes and practices designed to produce tangible improvements for the patients and other customers served by the EMS system, the Proposer's employees who serve the City, and the other agencies involved in the system. In addition to generally committing to these Minimum Requirements, Proposers shall illustrate their ability to achieve them by describing their overall approach to comprehensive quality management. Mama-moat in the majority of American EMS systems, "quality management? is limited to a retrospective evaluation of patient care reports. A growing of EMS systems, however, are expanding the scope of their quality management efforts to include clinical performance indicators paired with an education system designed to effect clinical improvements. REMSA is committed to such a comprehensive model of quality management that, while patient centered, encompasses all vital functions within the system. This Competitive Criterion encourages Proposers to join in this commitment. Examples of ways in which a Proposer may demonstrate a higher level of commitment in this area may include but are not limited to those described below. A Proposal might incorporate initiatives suggested by the institute for Healthcare Improvement WWI or the current Baldridge National Quality Program: Health Care Criteria for Performance Excellence. A copy of the Baldrige program can be downloaded at The core areas addressed by this process provide a solid framework for a comprehensive and progressive quality management program. These areas include: I Leadership; Strategic Planning; Focus on Patients, Other Customers and Markets; Measurement, Analysis, and Knowledge Management; Workforce Engagement; Process Management; and Results. The Proposer?s quality management capability could be supported by providing a list of Key Perfomiance indicators for each of the key result areas utilized in Proposer?s operations and proposed for include a specific data de?nition and data source for each KPI. 2. Competitive Criterion: Clinical and Operational Benchmarking it is important for an organimtion to monitor and measure performance in all aspects of its operations. The de?nition of what activities are to be measured and monitored is an essential component. 8) :\AD\002\02\2X02\2X02177.docx Minimum Clinical and Operational Benchmarking of Key Performance indicators (KPls) including focused on clinical care. is required. Some of the measurements may be process oriented in lieu of outcome measurements. It is anticipated that the will evolve with the development of the local EMS system as approved from time to time by the Medical Board. The Contractor shall provide, on a basis, information necessary to benchmark KPls. focusing on clinical activities to be measured will include, at a minimum: 1. Response time performance by priority, and City-wide; 78 It) :\AD\002\02\2X02\2X02177.docx 2. Presumptive impressions at dispatch compared to ?eld intervention; 3. Scene time and total pie-hospital time for time dependent clinical conditions like Acute Coronary (AC5), stroke, and major trauma; 4. Cardiac arrest survival in accordance with protocols; 5. Fractal measurement oftime to ?rst 6. Compliance with protocols, procedures, timelines, and destinations for Sl-Elevation Myocardial Infarction (ST MI) and Acute Coronary (ACS) patients; 7. Compliance with protocols, procedures, and timelines for patients with pulmonary edema and congestive heart failure; 8. Compliance with protocols, procedures, and Iimclincs for patients with asthma or seizures; 9. Compliance with protocols, procedures, and timelines for patients with cardiac arrest; 10. Compliance with protocols, procedures, timelines, and destinations for trauma patients; 11. Compliance with protocols, procedures, and timelines for patients with presumed stroke 12. Compliance with protocols, procedures, and timelines for assessment of pain relief; 13. Successful airway management rate by entire system, provider type and individual, including detection; 14. Successful IV application rate by entire system, provider type and individual; 15. Complaint management; 16. Paramedic skill retention; 17. Use of mutual aid; and 18. Safety. 19. AHA Mission Lifeline quality indicators 20. CARESindicators Contractor will be required to produce a periodic report that describes overall compliance with protocols and provides an analysis of which protocols have the most compliance challenges. Proposers should describe their current and proposed benchmarking, monitoring, and Its method for regularly assessing compliance with EMS Medical Protocols. Levels and Operational Bonelnm?hg Measuring and moniton?ng on a regular and consistent basis promotes an organization's improvement and development. EMS organizations that are committed to lmproventent not only measure and monitor, but use the results to effect change. Proposers can demonstrate a higher level of commitment to measurement, monitoring, benchmarking, and improvement by documenting performance indicators that they measure and describing the use ofthe results. Non-clinical performance indicators are relevant for operational, ?nancial, or organizational advancement. Incorporating such focus areas demonstrates a higher level of commitment to performance and improvement. Examples of ways in which a Proposer may demonstrate a higher level of commitment in this area may include but are not limited to those described below. The Cont mctor? 5 system for benchmarking might include non~clinical such as: employee injuries; I vehicle collisions (>5250 damage) per 100,000 ?eet miles; I critical vehicle/equipment breakdowns (interfering with a response or transport) per 100,000 ?eet miles; 79 I consu mer sat isfac ion; I employee tu mover; and - employee satisfaction Other Ki?i benchmarking might include comparing clinical data published by the National Association of EMS Physicians or other national organizations comparing the system with other similarly designed clinically sophisticated systems. The organization?s approach to learning and performance improvement using industry and non-industry benchmarking can also demonstrate higher levels of capability and commitment. Participation in, or publishing the results of, peer reviewed research is another strong process measure of a system's ongoing commitment to clinical sophistication. 'l'he Proposer might demonstrate a higher level of commitment by describing past participation in and proposed out-of-hospital research projects. For illustration. such projects might include but are not limited to research involving: I impacts of Public Access Defibrillat ion Reduction of"at scene? time; - Reduction of"at patient? status to ?rst shock or MS intervention; I Other research projects as approved by the REMSA Medical Director. 3. Competitive Criterion: Dedicated Clinical Oversight Personnel it is REMSA's goal that all organizations participating in the EMS system have adequate and competent oversight and management of the clinical services and quality improvement activities. a) .I) :\AD\002\02\2X02\2X02177.docx Minimum Requirements?Chisel Leadership Personnel A senior manager shall be responsible for oversight and management of the key performance indicators and ongoing organization-wide quality management programs. The Contractor shall also designate an individual (this could be the senior manager referred to in the preceding paragraph or another individual) to implement and oversee the Contractor's on-going clinical quality program. This individual shall be responsible for the medical quality assurance evaluat ion of all services provided pursuant to this Agreement. Proposers are required to document their commitment to have the senior members of their Sioux Falls operating unit actively participate in the leadership and oversight of the EMS qrralily management system. This commitment includes but is not limited to active participation of Proposer?s senior leadership in meetings related to EMS and public health and safety coordinated by REMSA and the City and actively participating in projects designed to improve the quality of EMS in the REMSA system. The Proposer shall describe its commitment of leadership to clinical quality and describe the individual to oversee its clinical quality program including a job description and reporting relationships. Higher levels leadership Personnel An organization's commitment is demonstrated by the caliber, qualifications, and expertise dedicated to an endeavor. Examples of ways in which a Pmposer may demonstrate a higher level of commitment in this area may include but are not limited to those described below. 1. implementing specific programs and activities to fully engage the workforce in quality management, such as peer review activities, medical audits, etc.; The quality management competencies that members of the leadership team will possess including their ability to analyze performance data and conduct improvement projects; 2. 80 3. Methods used to communicate openly with the workforce and to assess the effectiveness of this communication; 4. Activities used by the organization to communicate performance data to the members of the workforce involved in the process whose peribrrnance is being monitored; 5. Strategies used by the organization?s leadership team to promote legal and ethical behavior for themselves and the entire organization; b. The organization's process for handling breaches of ethical behavior; 7. Activities of the organization?s leadership to promote a culture focused on patient and employee safely; and 8. Procedures used by the organization to handle sittrations that have or may have had an adverse impact on patients or the public. 4. Competitive Criterion: Medlcat Direction atrd Support for REMSA Medical Control Ambulance services employ Medical Directors to lead the clinical care services. The involvement, commitment, and expertise expected from the Medical Director should directly contribute to clinical service levels, quality of care and quality management and improvement 8) It) Minimum Requiremnts?Medical Direction Proposer shall engage a physician as its Medical Director to oversee the Contractor?s clinical activities. The Pmposer shall identity its Medical Director and provide a curriculum vita outlining his or her experience and quali?cations. Higher levels Medical Direction Examples of ways in which a Pmposer may demonstrate a higher level of commitment irr this area may include but are not limited to those described below. 1. Demonstrate higher levels of Medical Direction commitnrent by emphasizing the Medical Director?s qualifications such as Board Certification in Emergency Medicine, completion of the EMS Medical Director? 5 Course, etc. 2. Committing the Medical Director to active involvement with the Contractor and its employees, training, research, ?eld observation, and pledges to work with the EMS System's Medical Director. 3. Committing to its Medical Director in liaising with other members of the area medical community to identify and support the. system's standard of care and to identify and resolve issues that may arise. Competitive Criteria: Focus on Patients and Other Customers Clinical quality is not measured solely by the patient's physical outcome. it is important to monitorand analyze the entire interaction ofthe patient and customers within the EMS system. a) :\AD\002\02\2X02\2X02177.docx Minimum Requirements?Focus on Patient: and Other Customers At a minimum, the Contractor shall have a comprehensive mechanism for handling patient and customer complaints or issues. The Proposer shall describe the organization's mechanism for managing complaints. Include methods for receiving, investigating, resolving, and tracking complaints. include the method for analyzing complaint patterns along with examples of irnprovenrent activities that have resulted from this analysis. Contractor shall establish and publish a Customer Access Hotline giving internal and external custonrers and system participants the ability to contact a designated liaison of the Contractor?s leadership team to discuss recommendations or suggestions for service improvements. The number may either be answered by a designated manager or provide an opportunity for the caller to leave a voicemail message. The hotlinc number will be published in the local telephone directory and on the Contractor website and publicized at local healthcare facilities, tire stations, and public safety agencies. Members of the Contractor?s leadership team are to be automatically noti?ed of any incoming calls. A 81 lI) management designee must return the call to tlte customer within 60 minutes, 00% of the time. Incidents that require feedback are to be attended to by the end of the next business day. Higher tents ofComnItrnent?Focus on Patients and Other Customers Examples ol? ways in which a i?roposer may demonstrate a higher level of commitment in this area may include but are not limited to those described below. 1. Identify how the organization determines the desires, needs, and expectations of patients and other customers. Include a list of key customer groups other than patients. Discuss the mechanisms the organization uses to incorporate the "voice of the customer" in planning processes. Other aspects of healthcare have documented inequalities in diagnosis and treatment based on age, ethnicity, and gender. Describe the organization?s system for assuring and monitoring equitable EMS care to traditionally underserved mtients such as the elderly, substance abusers and mental healtlt patients as well as to all patients based on neighborhood, age, gender, and ethnicity. Describe and provide detailed examples of the methods the organization uses to assess and monitor the effectiveness at meeting the needs and desires of patients and other customers. If possible, provide examples of what you have learned by using these monitoring methods and the action you have taken to improve the service to patients and other customers. Most EMS systems engage in infection control practices designed to protect providers from acquiring infections. Fewer FMS systems engage in hygiene practices that are designed to protect patients from contamination. Describe the mechanism for providing infection control for employees, system partners in healthcare and patients. 9.1 6. Competitive Criterion: Continuing Education Program Requirements 8) Minimum Requirements? Continuing Education Contractor shall provide in? house or sub-contracted in? service training programs designed to meet all state and REMSA licensure/certification requirements at no cost to employees. All in-service and continuing education programs must comply with state regulations. The REMSA Medical Director may mandate specific continuing education programs and content requirements, and REMSA may review and audit any continuing education programs o?ered by the Contractor. Higher Levels ofComnItment?Continulng Education Examples of ways irt which a Pmposer may demonstrate a higher level of commitment in this area may include but are not limited to: l. "targeting educational content to address local system needs; 2. Expanded content of training program offerings; 3. Introduction of innovative educational/ training methods; and 4. Measuring competency with speci?ed skill sets. 5. Establishing a process to provide stall with local, regional and national educational and networking opportunities. B. Operations 1. Competitive Criterion: Dispatch Communications Ambulance Response Times are impacted by the ef?ciency and reliability of the dispatch system referring calls to the sometimes~complex communication chain connecting a local resident or visitor who has just dialed 9-1-1 to the ambulance crew, which is asked to respond to the incident address. :\AD\002\02\2X02\2X02177.docx 82 This RFP is intended to pronrote a higher level of collaboration hetweerr the Contractor and the City's PSAP and public safety agencies to improve the ef?ciency and reliability of communications between those entities. The goal in this Competitive Criterion is to reduce Response Times and promote a seamless dispatch process by minimizing the transfer oi?calls or information from the calls. ll It) Minimum Requirements?Dispatch and Communications Center Interactions The Contractor shall provide and maintain all equipment and software interfaces necessary to receive requests for ambulance services made by City PSA P. Contractor shall be responsible for paying its own subscriber equipment fees required to utilize the City system and for any back-up cell phone or other radio system it requires to receive dispatch data and provide information to the City's PSAP. The system is collaboration among numemus related and unrelated agencies, which are dependent on one another to assure positive outcomes for the individuals being sen'ed. Contractor shall maintain a professional relationship with the City's PSAP. Pmposers shall fully describe how they intend to comply with the minimum requirements listed above and include a description of any additional equipment and technology to be used. itlglior Levels Dispatch and Communications Examples of ways in which a Proposer may demonstrate a higher level of commitment in this area may include but are not limited to those described below. 1. Assist with deployment training of PSAP communications personnel. 2. Developing a problem resolution process to be used throughout the term 3. Provide MPDS qualified instructor to assist with training of PSAP personnel. 3. Other Strategies to Reduce Response 't'imcs: Proposers may propose other reasonably achievable strategies to be undertaken at the Contractor? expense, which would be likely to materially reduce ambulance Response Times across all or any signi?cant part ofthe EMS system. 2. Competitive Criterion: Vehicles Contractor shall acquire and maintain all ambulances and support vehicles necessary to perform its services under the Agreement. All costs of maintenance including parts, supplies, spare parts and costs of extended maintenance agreements shall be the responsibility of the Contractor. 0) :\AD\002\02\2X02\2X02177.docx Minimum Requirements-Volumes At a minimum, the Contractor shall meet the requirements listed below. 1. All ambulances shall meet applicable South Dakota State law and Administrative Rules, including but not limited to SDCL ch. 34-11 and ARSD Article 44:05 et Seq, and all local ordinances and regulations. 1. Ambulance vehicles used in providing contract services shall bear the markings of the REMSA logo and "Regional Emergency Medical Services Authority" in at least four (4) inch letters on botlr sides. Such vehicles shall display the 1" emergency telephone number on both sides. 2. Ambulance vehicles shall be marked to identity the company name, but shall not display any telephone number other than 9-?1-1 or any other advertisement. 3. Overall design, color, and lettering are subject to the approval of the Contract Administrator. 4. Proposer shall describe the ambulance and supervisory vehicles to be utilized for the services covered under the Agreement. 83 Ambulance replacement shall occur on a regular schedule and the Proposer shall identify its policy for the maximum number oi'years and mileage that an ambulance will be retained in the EMS System. Each ambulance shall be equipped with GPS route navigation capabilities and devices to interact with system. It) Higher levels Examples of ways in which a Proposer may demonstrate a higher level of commitment in this area may include but are not limited to: l. Documenting the type, age, mileage, and con?guration of the ambulance ?eet and supervisory vehicles; and conditions under which they are to be removed from service; and Installing equipment and selecting vehicles that provide innovations for safety, "Black Box? driver monitoring and/or behavior modi?cation technology) specialized transport capabilities, reduced environmental impact, etc. Pmposing vehicles with advanced caregiver safety technology Recognizing that there are emerging guidelines for ambulance design, ollering replacement vehicles during the term that nreet the higher standard. 3. Competitive Criterion: Equipment Acquisition and maintenance ofall equipment including parts, supplies, spare parts, and costs of extended maintenance agreements shall be the responsibility of the Contractor. a) Minimum Requirements?Equipment Contractor shall have sole responsibility for furnishing all equipment necessary to provide acquired service. All on?board equipment, medical supplies and personal communications equipment will meet or exceed the minimum requirements of REMSA's Ambulance Equipment and Supply List. A listing of the required on-board equipment, medical equipment, and supplies can be found at Appendix 9. Contractor agrees that equipment and supply requirements may be changed with the approval of the Contract Administrator due to signi?cant changes in technology. may inspect Contractor's ambulances at any time, without prior notice. ?any ambulance fails to meet the minimum requirements contained in the Ambulance Equipment and Supply list as determined by REMSA, REMSA may: 1. 2. 3. Immediately remove the ambulance from service until the de?ciency is corrected if the missing item is deemed a critical omission; Subject the Contractor to a $500.00 penalty; and The foregoing shall not preclude dispatch of the nearest available ambulance even though not fully equipped, in response to a life threatening emergency so long as another appropriately equipped ambulance of at least equal level of service is also dispatched to the scene. REMSA may adopt protocols governing provisional dispatch of ambulances not in compliance with minimum in-sewice requirements and Contractor shall comply with these protocols. it) ofcomnitmont?Equlpmont Examples of ways in which a Proposcr may demonstrate a higher level of commitment in this area may include but are not limited to: :\AD\002\02\2X02\2X02177.docx Providing equipment or technologies above that required by the minimum equipment list. These additional items may include advances in clinical care capabilities, opportunities for increasing safety for cmwmembers and patients, and items to increase ease of work, improve efficiency or make efforts more effective. 84 a) It) Competitive Criterion: Vehicle and Equipment Maintenance Minimum Requirements-Which and Equipment Maintenance Contractor shall be responsible for all maintenance of ambulances, suppon vehicles, and on- board equipment used in the performance of its work. expects that all Ambulances and equipment used in the performance of the Agreement will be maintained in an excellent manner. Any Ambulance, support vehicle, and/or piece of equipment with any deficiency that compromises, or may reasonably compromise its function, must immediately be removed from service. The appearance of ambulances and equipment impact customers' perceptions of the services provided. Therefore, ity/ REMSA requires the Ambulances and equipment that have defects, even signi?cant visible but only cosmetic damage, be removed from service for repair without undue delay. Contractor must ensure an ambulance maintenance program that is designed and conducted to achieve the highest standard of reliability appropriate to a modern high performance ambulance service by utilizing appropriately trained personnel, knowledgeable in the maintenance and repair of ambulances, developing and implementing standardized maintenance practices, and incorporating an automated or manual maintenance program record keeping system. All costs of maintenance and repairs, including parts, supplies. spare parts and inventories of supplies, labor, subcontracted services, and costs of extended warranties, shall be at the Contractor? expense. Higher [ovals and Equipment Maintenance Examples of ways in which a Propos'er may demonstrate a higher level of commitment in this area may include are not limited to: 1. Proposer offers to exceed the maintenance standard as outlined in the Standards?? Accreditation of AmbulanCe services published by the Commission on Accreditation of Ambulance services; and /or 2. The Proposer describes how it will exceed minimum requirements for the testing, monitoring, maintaining, and retaining documentation for all bio-medical equipment such as complying with the then current and applicable joint Commission on the Accreditation of Healtheare Organizations (JCAHO) or equivalent standard. 5. Competitive Criterion: Deployment Planning The Contractor will he expected to work continuously to re?ne and improve its coverage and deployment plans throughout the term of the Agreement. All plan modi?cations will be at Contractor's sole discretion and expense. 8) :\AD\002\02\2X02\2X02177.docx Minimum Requirements?Deployment Ptannhg Contractor shall agree to deploy its ambulances in such a manner to achieve the Response Time requirements. The Contractor shall also commit to modify and adjust its deployment strategies in the event that Response Time performance is not complying with the standards or if it is identi?ed that there are areas of the City, which are chronically experiencing delayed responses. The Proposer shall describe its methods and initial deployment plans to be used in the City, including its "emergency cut-off level" (the level at which non-emergency calls will not be dispatched to ensure adequate emergency ambulance coverage. A description of the methodology used by the organization to monitor and modify its plans will also be documented. 85 h) Higher levels ofComnitmont-Doploymont Plannirg Examples of ways in which a Proposer may demonstrate a higher level of commitment in this area may include but are not limited to: 1. The Proposer describing sophisticated processes it has developed or used to achieve exemplary Response Time performance; and/or 2. The. identification and use of technologies or managerial processes to enhance Response Time performance. C. Personnel recognizes that those employed in the REMSA system ultimately determine the effectiveness and quality of the service. Proposers are encouraged to focus on employees especially as it pertains to safety, workload, advancement opportunities, and compensation. 1. Competitive Criterion: Fieid Supervision REMSA recognizes the Contractor? need to ensure adequate supervision of its personnel and the delegation of authority to address day-to-day operational needs. REMSA also desires that these personnel and operational supervisory responsibilities do not displace the Contractor's provision ofdirecl clinical supervision oflhe Contractor's caregivers. a) Minimum Requirements?Field Supervision Contractor shall provide 24-hours a day omduty supervisory coverage within City. Au on- duty employee or officer must be authorized and capable to act on behalfof the. Contractor in all operational matters. Tire Proposers shall also speci?cally describe how its Supervisors are able to monitor, evaluate, and improve the clinical care provided by the Contractor's personnel and to ensure that on-duty employees are operating in a professional and competent manner. All ?eld supervisory level staff will have successfully completed 100, 200. 300 8: 400, 700 8: 800. h) levels ?Commitment?Field Supervision Examples of ways in which a Proposer may demonstrate a higher level of commitment in this area may include but are not limited to: 1. The provision of a dedicated supervisor and vehicle for City coverage; 2. Specialized supervisors training; (cg. ASM, Strike learn leadership, etc); 3. Exemplary qualification requirements; and 4. Other defined activities to support and supervise field personnel. 2. Competitive Criterion: Work Schedules This is a performance-based Agreement and Contractor is encouraged lo be creative in delivering services. Contractor is expected to support employees by employing reasonable work schedtrles and conditions. a) Minimum Requirements?Work Schedules emphasizes that the Contractor is responsible for conducting the employment matters with its employees, including managing personnel and resources fairly and effectively in a manner that ensures compliance with the Agreement ultimately executed by Contractor. will not otherwise involve itself in Contractor?s management employee relationships. Specifically, patient care must not be hampered by impaired motor skills of personnel working extended shifts, part-time jobs, voluntary overtime, or mandatory overtime without adequate nest. To mitigate fatigue and safety concerns, Contractor's paranredics and EMS :\AD\002\02\2X02\2X02177.docx 86 working on an emergency ambulance or as a ?eld supervisor should work reasonable schedules to ensure that potential fatigue and the resulting safety issues are reduced. Proposer shall describe its policies and procedures used to monitor employee fatigue and in) Higher levels otComnitment?Worlr Schedules Examples of ways in which a Proposer may demonstrate a higher level of commitment in this area may include but are not limited to: The delineation of monitoring mechanisms, procedures, and policies designed to ensure that employees are not overworked or expected to work for extended lime periods that nray cause fatigue and impair the employee's ability to perform safely and appropriately. 3. Competitive Criterion: internal Risk Management/ Loss Control Program Education and aggressive prevention of conditions in which accidents occur are the best mechanism to avoid injuries to Contractor staff and Patients. a) Minimum Requirements?Risk Management REMSA requires Contractor to implement an aggressive health, safety, and loss mitigation program including, at a minimum: Dre-screening of potential employees (including drug testing); Drug free workforce policies and procedures [or covered in Initial and on-going driver training; Lifting technique training; Assaultive Behavior Management Training Review current information related to medical device FDA reportable events, recall, equipment failure, accidents; and Review employee health control related information such as needle sticks, employee injuries. immunizations, exposures and other sa fety/ risk management rssues. Planning for safety and risk mitigation processes will include, at a minimum: 1. 2. 3. 5. Gathering data on ALL incidents that occur among the Contractor?s workforce; Devise policies prescribing safe practices and providing intervention in unsafe or unhealthy work- related behaviors; Gather safety infomration as required by law; training and corrective action on safety related incidents, as required by law; and Provide safe equipment and vehicles. Proposcr shall describe its risk management program. II) Higher Levels of Commitment?Risk Management Examples of ways in which a l?roposcr may demonstrate a higher level of commitment in this area may include but are not limited to those described below. implementation of a comprehensive safety and risk management plan that involves employees, analyzes processes, monitors safety activities, and incorporates all processes into policies, procedures, training programs designed to enhance safety for the workforce and patients. I :\AD\002\02\2X02\2X02177.docx 87 4. Competltive Criterion: Workforce Engagement An experienced, highly skilled, well rested, and satis?ed workforce is essential to the provision of high quality EMS services. Proposers are encouraged to meet with current system employees prior to submitting proposals. a) Minimum Requirements?Workforce Engagement At a minimum, the Proposer shall describe and document the following: 1. 2. 3. 6. Describe the organization's method for providing system and individual performance feedback to employees. Describe the organization's mechanism for involving front line employees in quality and performance improvement projects. Describe the credentialing requirements for the employees including not limited to EMT's, paramedics, dispatchers, billers, and mechanics. Describe the methods to assess, maintain, and develop new skills for employees in the workforce. Describe the organization's practices to ensure diversity in the workforce. Address the organization's level ofdiversity alignment with the communities that you serve. Describe the organization's practices and policies designed to promote workforce harmony and prevent discrimination based on age, national origin, gender, race, sexual orientation, religion, and physical ability. Impaired providers present a significant safety risk for patients, partners, and others in the community. Proposers should describe their commitment to ensuring that providers are free from the influence ofalcolrol and intoxicating drugs. Ir) Higher Levels Workforce Engagement Examples of ways in which a Proposer may demonstrate a higher level of commitment in this area may include but are not limited to the following: 1. D. Management The organization's process for assessing the engagement and satisfaction level of employees. include description of an ongoing process that produces qrralitativc and quantitative for employee satisfaction. The method used by the organization for two-way communication between front line employees and the leadership team. The organization's nrechanism for encouraging, gathering, providing feedback on and acting on employee improvement suggestions. The development of a career ladder and professional development process for members of the workforce. a description of the succession plan for key positions. 1. Competitive Criterion: Key Personnel a) Requirements?Key Personnel Proposers shall identify the individuals who will ?ll the key leadership positions within the REMSA system. Provide resumes for the individuals. If the positions have not been filled for the REMSA system provide the job descriptions that will be used for the positions that include minimum quali?cations and scope of responsibilities. Identify out-of-City leadership personnel who will be actively involved in operations, ifapplicable. Include their resumes, qualifications, and scope of responsibilities. tr) Higher Levels ?Commitment?Key Personnel Examples of ways in which a Proposer may demonstrate a higher level of commitment in this area may include bill are not limited to those described below. I :\AD\002\02\2X02\2X02177.docx 88 1. Provision of on-going training for key managers and development programs for EMS managers and supervisors offered to those personnel at no cost. While there is no speci?c program regarding the exact content of the development program, managers should receive training similar to the content provided in the American Ambulance Association's Ambulance Service Manager Certi?cate Program. 2. Provision of mentoring relationships/programs with other senior leaders of the organization. 3. Stability of the Contractor?s leadership team directly correlates with the continuation of the performance of the EMS system. The i?roposer may describe how it will ensure continuity and reduce managerial ltrmovcr in the system. E. EMS System and Community 1. Competitive Criterion: Working Closely with Hospitals, and other air and ground providers within the region The successful propser is expected to establish positive relationships with area providers to ensure smooth transitions of care, as required. Mutual aid relationships with other providers to ensure over?ow coverage and optimize the utilization of personnel are anticipated The successful proposer will retain ultimate responsibility for any sub-contractor with respect to the performance standards contained herein and in the resulting Agreement with the 8) It) :\AD\002\02\2X02\2X02177.docx Minimum Requirements?Other Providers At a minimum, the Proposer will agree to negotiate in good faith with hospitals, air and ground providers and execute a sub-contract to back-up and mutual-aid ambulance service in the City. Pmposers shall describe in detail how they intend to address the Minimum Requirements listed above. Providers As a higher commitment level, the Proposer may demonstrate a higher level commitment by the proposed provisions of the subcontracts. Such as: 1. Providing access to Contractor training for area hospitals, municipalities or not~for- profit ambulance organizations to assist them in being deeply engaged in a regional system and improvement efforts. 2. Contractor may provide assisislamce to other providers by collaborating in purchasing, medical direction, quality improvement, group purchasing, and other operational and ?nancial opportunities. 3. Collaborative strategies to address call surges that would not otherwise trigger mutrral aid requirements, including possible coordination of responses during peak periods. The successful bidder shall ensure adequate contract termination language in the subcontract with other providers for failure oto meet the Contractor's required performance standards. All bidders shall include in their proposal their commitment to negotiate, in good faith, and their understanding and commitment of the scope of such a subcontract. The final subcontractor agreement must be approved by REMSA prior to its going into effect. 89 2. Competitive Criterion: Supporting Improvement In the Response System The system is a collaboration among numerous related and unrelated agencies, which are dependent on one another to assure positive outcomes for the individuals being served. REMSA's goals regarding this collaborative system include: 1) provide a seamless handoff of patients by ?rst responders to the ambulance service,- and 2) achieve the prevailing industry standard with respect to the provision oi?training to ?rst responders. 'l'he ambulance service is the main ?player? within the pro-hospital EMS system that is concerned with the provision ofemergency medical services to people who are seriously injured or ill. As a result. the ambulance service provider has, in most communities, emerged as the organization charged with facilitating ongoing EMS training within the EMS system. This is a cost of doing business recognized by ambulance providers across the country and the only practical source of such training in most communities. It is also the logical source for such training, because the ambulance provider is the entity with a direct role in the most EMS responses in the City. REMSA and the City desire to increase collaboration between ?rst responders and the ambulance service. This Increased collaboration may take many forms including formal agreements or combined work and training activities. The Proposers are not expected to negotiate formal agreements with other EMS participants prior to the award of the Agreement. If a Proposer proposes to commit to a collaborative arrangement as described in this section, it is only necessary to state that commitment and describe the terms on which the Proposer is willing to collaborate in the Proposal. :\AD\002\02\2X02\2X02177.docx 90 a) Minimum Response Mm Each Proposer must commit to: :\AD\002\02\2X02\2X02177.docx 6. Exercise its best, good faith efforts to maintain positive relationships with all ?rst response agencies; Make Contractor?s continuing EMS education services available without cost to all ?rst responders in the City at the level prevailing in the. industry; at the Contractor?s cost basic life support supplies utilized on a onc-for-one basis, based on utilization on calls by first response agencies; Contractor shall provide up to 4 hours annual REMSA approved continuing education to all City line ?rst responders. Provide internship opportunities for EMT students, giving preference to students from training programs located the area; and Contractor shall designate from among its employees a single individual as its contact person/ liaison for the First Response agencies Proposers shall describe in detail how they intend to address the Minimum Requirements listed above. iilglm Loni Response System Examples of ways in which a Proposer may demonstrate a higher level of commitment in this area may include but are not limited to those described below. Proposcrs may propose strategies to strengthen the collaborative interface between the. Contractor and first responders and to improve the quality and ef?ciency of the EMS response system through support for ?rst responders and other agencies integral to the provision of emergency services. Examples of possible strategies include: 1. 2. 3. 9528.391 Group purchasing arrangements that may allow l?irst Responder agencies to acquire medical equipment and non-exchanged supplies at a lower cost. Collaborative leadership training programs Collaborative strategies to address call surges, including possible coordination of responses during MCI and other disaster events. Coordination between or collaborative continuous quality improvement programming Coordination of public education initiatives and programming Coordination ofinjury and illness prevention programs. Collaborative lleet maintenance activities. Collaborative public information services. Proposers may propose other reasonable achievable strategies to be undertaken at the Contractor's expense, which would be likely to materially expand or enhance the capacity of ?rst responder agencies to provide services more ctiectively or economically. it is recognized that some of the suggestions for a ?higher level of commitment" in connection with this Competitive Criterion "Supporting improvement in the First Response System" may be relevant to a Proposer?s response to other Competitive Criteria or to certain Cone Requirements. As noted above, information provided in response to other requirements or criteria cannot be taken into account when rating the Proposer?s response to this Competitive Criterion. Proposers desiring to offer a higher level of commitment in response to this Competitive Criterion should set forth here a comprehensive description of the collaborative working relationship they intend to offer to local first responder agencies, including a description of each of the speci?c components and commitments, which the Proposer is offering. 91 3. Competitive Criterion: Health Status Improvement and Community Educatlon REMSA desires that its Contractor take signi?cant steps to improve injury and illness prevention and system access through community education programs provided to the school system and community groups. It is REMSA's expectation that Contractor will plan such programs working collaboratively with other public safety and EMS related groups such as the American Heart Association, American Stroke Association, the American Red Cross, and area healthcare organizations. REMSA is an active panicipant in the CARES [Cardiac Arrest Registry to Enhance Survival) program. Initially developed in 2004 by The Center for Disease Control and Prevention (CDC) collaborated with Emory University School of Medicine's Department of Emergency Medicine to develop CARES as an surveillance registry to help communities increase survival rates. CARES is a secure, Web-based data management system in which participating communities enter local data and generate their own reports. Communities can compare their EMS system performance to de identi?ed aggregate statistics at the local, state. or national level and discover promising practices that could improve emergency cardiac careAdditional information about CARES may be found at a) Minimum Requirements?Community Education Contractor shall continue to support REMSA's involvement in CARES. Contractor shall annually plan and implement a de?nitive community education program, which shall include: identi?cation of and presentations to key community groups which in?uence the public perception of the EMS system's performance, conducting citizen CPR training events, panicipation in EMS week and other educational activities involving prevention, system awareness/access, and appropriate utilization of the EMS system. Proposers shall describe their planned community education program. It) level ofcomnitmont?lioalth status thanan and (humanity Educa?on Examples of ways in which a Proposer may demonstrate a higher level of commitment in this area may include but are not limited to those described below. On a national level, the ethnic compositions of the EMT and paramedic workforce does not fully reflect the US. population. As of 2001, ethnic minorities made up 26 percent of the US. population, but only 15 percent of the EMT/Paramedic workforce. This is of some concern because EMTs are frequently involved in situations where cultural understanding is vital, particularly in urban areas. Accordingly, Contractor may collaborate with REMSA and public health officials to develop and facilitate training programs, internships and related opportunities for area residents from racial/ethnic and income groups that are underrepresented among health and emergency medical professionals. Proposer may offer to undertake projects that shall demonstrably improve the health status in the community. llcalth status improvement programs targeted to ?at-risk populations" may include but are not limited to: seat belt use, child safety seat use, bike safety program, participation in NTIISA Safe Communities Program, 9-1-1 awareness, gun safely, hunting safety, drowning prevention. equestrian accident prevention, senior safety program, and home hazard inspection program. :\AD\002\02\2X02\2X02177.docx 92 :\AD\002\02\2X02\2X02177.docx The impact of health status improvement projects should be statistically demonstrable. For example, this includes selecting indicators that can be used to measure the process and outcomes of an intervention strategy for health improvement, collecting and analyzing data on those indicators, and making the results available to the community to inform assessments of the effectiveness of an intervention and the contributions of participating entities. Steps in the health improvement projects may include: - Analyzing the community?s health issues resources - Developing a health improvement strategy Establishing accountability for activities Monitoring process and outcomes Contractor may seek external grant funding for health status impmvement projects. 93 SECTION VI. BUDGET AND PRICING DOCUMENTATION A. Minimum Requirement?Pro Forma Budgets The I?roposer is required to complete a pro lorma budget for the ?rst three (3) years of operation under the Agreement. The template for the pm I'nmia budgets is included in Appendix 7. THE ONE ORIGINAL AND THREE (2) COPIES OF THE PRO EORMA BUDGET MUST BE SUBMITTED IN A SEPARATELY SEALED ENVELOPE MARKED 8. Pricing The Proposer is required to complete and sign the Price Sheet Form. The Price Sheet Form is included in Appendix 12. THREE COPIES OF COMPLETED PRICE SIIEET REQUIRED IN SECTION MUST BE SUBMITTED IN A SEPARATELY SEALED ENVELOPE MARKED 0. Financial Statements As stipulated in Section l-2, three years nflinancial statements and the most recent ?scal year's audited ?nancial statements are submitted separately. ONE COPY OF THE FINANCIAL STATEMENTS AND AUDITED FINANCIAL STATEMENTS MUST BE SUBMITTED IN A SEPARATELY SEALED ENVELOPE MARKED :\AD\002\02\2X02\2X02177.docx 94 Appendix 1 :\AD\002\02\2X02\2X02177.docx Appendix 1 Mandatory Table of Contents In Appendlx B-Exhi'bi'l A) SECTION VII. EXECUTIVE SU MMARY SECTION OF REQUIRED FORMS A. Insurance Certificates Appendix 8. Debarment and Suspension Certi?cation (Form in Appendix 8-Exlilhlt in C. D. Investigative Authorization-Individual (Form In Appendix immune) E. Investigative Authorization-Entity (Form in Appendix s-adiinir Ei F. RFP Submission Guaranty (sometimes reforredto as a ?bid Bond?) SECTION IX. QUALIFICATION REQUIREMENTS A. Organizational Disclosures 1. Organizatlonal ownership and legal structure I 2. Continuity of business 3. Licenses and permits i1) Suppopgng documentation reguireil. 4. I (1) Supporting documentation regulml [May be In electronlc fonnatl. 5. litigatlon :\AD\002\02\2X02\2X02177.docx 96 8. Financial Strength and Stability 1. Financial Statements (1) Supporting documentation reg?red. (Spur-ate sealed envelope labeled ??nancial Statements? 2. Audited Statements [(1)5u orti doc ired. antesea 3. Financial Commitments on etc a eed ?Fl a cial State nix" 4. Working Capital (1) Supporlipg documentation reguired. 5. Performance Security I (1) Supporting documentation legging. 6. Financial Interests W1) Wind. C. EXPERIENCE AS SOLE PROVIDER 1. Comparable experience Li 1) Supporting documentation regulred. 2. Government contracts 3. Contract Compliance I (1) Supporting documentation reguired. D. Demonstrated Response Time Performance (1) Supporting documentation regulred. :\AD\002\02\2X02\2X02177.docx 97 E. Demonstrated High Level Clinical Care Sophisticated Internal Systems SECTION X. CORE REQUIREMENTS A. Contractor's Functional Responsibilities 1. Basic Services 2. Services Description Attestation: Pmposer understands and agrees to comply without quali?cation to provisions, requirements, and contained in Section Pmposer takes exception to provisions contained in Section IVA. as delineated below. Proposer recognizes that taking exception with any provision ofthe Core Requirements may result in ?nding that the Proposal is unresponsive and result in disquali?cation. Except i0 ns: 8. Clinical 1. Clinical Overview 2. Medical Oversight Alteslat ion: Proposer understands and agrees to comply without quali?cation to provisions, requirements, and commitments contained in Section NB. Proposer lakes exception to provisions contained in Section IV.B. as delineated below. Proposer recogniyes that taking exception with any provision ofthe Core Requirements may result in finding that the Proposal is unresponsive and result in disquali?cation. En ?was. :\AD\002\02\2X02\2X02177.docx 98 3. Minimum Clinical Levels and Staffing Requirements (1) WW Attestation: Pmposer understands and agrees to comply without quali?cation to provisions, requirements, and commitments contained in Section IV.B.3. Proposer lakes exception to provisions contained in Section as delineated below. Pmposer recognizes that taking exception with any provision of the Core Requirements may result in ?nding that the Proposal is unresponsive and result in disquali?cation. Excegtinns: c. Operations 1. Operations Overview Attestation: Pmposer understands and agrees to comply without quali?cation to provisions, requirements, and commitments contained in Section Proposer lakes exception to provisions contained in Section lV.C.i. as delineated below. Pmposer recognizes that taking exception with any provision of the Core Requirements may result in ?nding that the Proposal is unresponsive and result in disquali?cation. 22mm. 2. Transport Requirement and limitations Attestation: Proposer understands and agrees to comply without quali?cation to provisions, requirements, and commitments contained in Section Proposer takes exception to provisions contained in Section IV.C.2. as delineated below. Proposer recognizes that taking exception with any provision of the Core Requirements may result in ?nding that the Proposal is unresponsive and result in disquali?cation. Wm. :\AD\002\02\2X02\2X02177.docx 99 3. Response time Pertonnanoe Requirements Attestation Proposer understands and agrees to comply without quali?cation to provisions, requirements, and commitments contained in Section Proposer takes exception to provisions contained in Section as delineated below. Proposer recognizes that taking exception with any provision ofthc Core Requirements may result in ?nding that the Proposal is unresponsive and result in disquali?cation 4. Noti?cation of Delays tor Non-emergency Responses 5. Response Time Measurement Methodology Attestation: Proposer understands and agrees to comply without quali?cation to provisions, requirements, and commitments contained in Section IV.C.4 and Proposer takes exception to provisions contained in Section IV.C.4 and IV.C.5. as delineated below. Proposer recognizes that taking exception with any provision of the Core Requirements may result in ?nding that the Proposal is unresponsive and result in disqualification. Exceptio ns: 6. Response Time Exceptions and Exception Requests Attestation: Proposer understands and agrees to comply without quali?cation to provisions, requirements, and commitments contained in Section IV.C.6. Proposer takes exception to provisions contained in Section as delineated below. Proposer recognizes that taking exception with any provision oftlre Cone Requirements may result in ?nding that the Proposal is unresponsive and result in disquali?cation. a: :\AD\002\02\2X02\2X02177.docx 100 7. Response time Performance Reporting Procedures and Penalty Provisions Attestation: Proposer understands and agrees to comply without quali?cation to provisions, requirements, and commitments contained in Section Proposer takes exception to provisions contained in Section IV.C.7. as delineated below. Proposcr recognizes that taking exception with any provision ofthc Core Requirements may result in finding that the Proposal is unresponsive and result in disqualification. I, 8. Fleet Requirement 9. Coverage and Dedicated Ambulances. Use of Stations/ Posts Attestation: Proposer understands and agrees to comply without quali?cation to provisions, requirements, and commitments contained in Section IV.C. (8-9.) Proposer lakes exception to provisions contained in Section IV. C. as delineated below. Proposer recognizes that taking exception with any provision of the Core Requirements may result in ?nding that the Proposal is unresponsive and result in disqualification. Exceptions: 0. Personnel 1. Treatment of Work Force (1) Attesiation; Proposer understands and agrees to comply without quali?cation to provisions. requirements, and commitments contained in Section Proposer takes exception to provisions contained in Section IV. D. 1. as delineated below. Pmposer recognizes that taking exception with any provision ofthe. Core Requirements may result in ?nding that the Proposal is unresponsive and result in disquali?cation. 101 2. Character, Competence and Professionalism of Personnel 3. Internal Health and Safety Programs 4. Evolving OSHA Other Regulatory Requirements 5. Discrimination Not Allowed [\tteslat ion: Proposer understands and agrees to comply without quali?cation to provisions, requirements, and commitments contained in Seclion l?roposer takes exception to provisions contained in Section N. as delineated below. Proposer recognizes that taking exception with any provision of the Core Requirements may result in finding that the Proposal is unresponsive and result in disquali?cation. Except to ns: E. Management 1. Data and Reporting Requirements Attestation: Proposcr understands and agrees to comply without quali?cation to provisions, requirements. and commitments contained in Section Pmposer takes exception to provisions contained in Section N. E.1. as delineated below. Proposer recognizes that taking exception with any provision ofthe Core Requirements may result in ?nding that the Proposal is unresponsive and result in disquali?cation. -m mar. :\AD\002\02\2X02\2X02177.docx 102 F. EMS System and Community 1. Participation In EMS System Development 2. Accreditation Attestation: Proposer understands and agnees to comply without quali?cation to provisions, requirements, and commitments contained in Section Proposer takes exception to provisions contained in Section as delineated below. Proposer recognizes that taking exception with any pmvision of the Core Requirements may result in ?nding that the Proposal is unresponsive and result in disqualification. Exceptigpg: 3. Multl-casualty/ Disaster Response 4. Mutual Aid and Stand-by Services Attestation: Proposer understands and agrees to comply without quali?cation to provisions, requirements, and commitments contained in Section Proposer takes exception to provisions contained in Section (3.4.). as delineated below. l?roposer recognizes that taking exception with any provision of the Core Requirements may result in ?nding that the Proposal is unresponsive and result in disquali?cation. I. a mums. 5. Permitted Subcontracting 6. Communities May Contract Directly for Level of Effort Attestation: Proposer understands and agrees to comply without quali?cation to provisions, requirements, and commitments contained in Section (5-6.) Proposcr takes exception to provisions contained in Section as delineated below. Proposer recognizes that taking exception with any provision ofthe Core Requirements may result in ?nding that the Proposal is unresponsive and result in disquali?cation. i'o ns: :\AD\002\02\2X02\2X02177.docx 103 7. Supply Exchange and Restoolr 8. Handling Servlee Inquiries and Complaints Attestation: Proposer understands and agrees to comply without quali?cation to provisions, requirements, and commitments contained in Section (7.-8.) Proposer takes exception to provisions contained in Section (7.- 8.). as delineated below. Proposer recognizes that Iaking exception with any provision of the Core Requirements may result in ?nding that the Proposal is unresponsive and result in disquali?cation E. mm 6. Administrative Provisions 1. No Subsidy System Attestation: Proposer understands and agrees to comply without quali?cation to provisions, requirements, and commitments contained in Section IV.G. (1) Proposer takes exception to provisions contained in Section as delineated below. Proposer recognizes that taking exception with any provision of the Core Requirements may result in finding that the Proposal is unresponsive and result in disqualifieat ion. 12W 2. Contractor Revenue Recovery Attestation: Proposer understands and agrees to comply without quali?cation to provisions, requirements, and commitments contained in Section IV.G. 3. Proposer takes exception to provisions contained in Section NC. 3. as delineated below. Proposer recognizes that Iaking exception with any provision ofthe Core Requirements may result in ?nding that the Proposal is unresponsive and result in disqualification. Executions :\AD\002\02\2X02\2X02177.docx 104 3. Federal Healthcare Program Compliance Provisions 4. State Compliance Provisions 5. Billing/Collection Services 6. Market Rights 7. Service Expansion 8. Accounting Procedures 9. insurance Provisions. (1) Insurance documentation uired?See uirementln ?Set: out .ASubnission ofRo uir Ins lance Forms" Attestation: Pmposer understands and agrees to comply without quali?cation to provisions, requirements, and commitments contained in Section Proposer takes exception to provisions contained in Section as delineated below. Proposcr recognizes that taking exception with any provision of the Core Requirements may result in finding that the Proposal is unresponsive and result in disqualification. 10. Hold Harmless Detense/ indemnification Taxes Contributions 11. Performance Security Bond 12. Term of Agreement 13. Earned Extension to Agreement 14. Continuous Service Delivery 15. Annual Performance Evaluation :\AD\002\02\2X02\2X02177.docx 105 Attestation: Proposer understands and agrees to comply without quali?cation to provisions, requirements, and commitments contained in Section [10:15.) Proposer takes exception to provisions contained in Section IV.G. (10.- 15.). as delineated below. Proposer recognizes that taking exception with any provision of the Cone Requirements may result in ?nding that the. Proposal is urmesponsive and result in disquali?cation. I. my. 16. Default and Provisions for Termination of the Agreement 17. Iemrlnatlon 18. Emergency Takeover 19. Transition Planning 20. REMSA's Remedies 21. Provisions for Curing Material Breach and Emergency Take Over 22. "Lame duck" Provisions Attestation: Proposer understands and agrees to comply without quali?cation to provisions, requirements, and commitments contained in Section [16:22.) Proposer lakes exception to provisions contained in Section IV.G. as delineated below. Proposer recognizes that taking exception with any provision of the Core Requirements may result in ?nding that the Proposal is unresponsive and result in disqualification. 23. General Provisions Attestatiom Proposer understands and agrees to comply without quali?cation to provisions, requirements, and commitments contained in Section Proposer takes exception to provisions contained in Section (an) as delineated below. Proposer recognizes that taking exception with any provision ol?the Core Requirements may result in ?nding that the Proposal is unresponsive and result in disquali?cation. It 1,2! Hr. :\AD\002\02\2X02\2X02177.docx 106 SECTION Xi. COMPETITIVE CRITERIA A. Clinical 1. Competitive Criterion: Quality Improvement a) Minimum Requiremnts?Demomtralrle Progressive Clinical Qually improvement Itll Al test at ion: Proposer understands and agrees to comply without quali?cation to provisions, requirements. and commitments contained in Section Proposer takes exception to provisions contained in Section V.A. La. as delineated below. Proposer recognizes that taking exception with any provision oi the Core Requirements may result in finding that the Proposal is unresponsive and result in disqualification. li?e.?vc a . It) Higher Levels otComrrItment?Qualty Management Su ortln narrative nd docu a onr d. 2. Competitive Criterion: Clinical and Operational Benchmarking Minimum Requirements?Chiral and Operational Attestation: Proposer understands and agrees to comply without quali?cation to provisions, requirements, and commitments contained in Section Proposer takes exception to provisions contained in Section as delineated below. Proposer recognizes that taking exception with any provision of the Core Requirements may result in ?nding that the. Proposal is unresponsive and result in disqualification. ii) Higher Levels and Operational Benchmarkhg (1) Supporting narrative and; or documentation re_quired. :\AD\002\02\2X02\2X02177.docx 107 8i 3. Competitive Criterion: Dedicated Clinical Oversight Personnel Minimum Requirements?Clinical leadership Personnel (1) Supporting narrative amigor documentation rggired. Attestation: Proposer understands and agrees to comply without quali?cation to provisions, requirements, and commitments contained in Section Pmposer lakes exception to provisions contained in Section as delineated below. Proposer recognizes that taking exception with any provision of the Core Requirements may result in ?nding that the Proposal is unresponsive and result in disquali?cation. II) Higher levels Leadership Personnel 8) (1) orti rr eenri ordocu ntetion ired. 4. Competitive Criterion: Medical Direction Minimum Requirements?Medical Direction Su 0 errative nd ordoc mentationr uired. (ll Attestation: Proposer understands and agrees to comply without quali?cation to provisions, requirements, and commitments contained in Section Proposer takes exception to provisions contained in Section as delineated below. Proposer recognizes that taking exeeption with any provision oi?the Core Requirements may result in finding that the Proposal is unresponsive and result in disquali?cation. Egrgegtiu n5: lt) Higher Levels Direction :\AD\002\02\2X02\2X02177.docx Su orti narr end dou nt em id in 108 a) 5. Competitive Criteria: Focus on Patients and Other Customers Minimum Requirements? Focus on Patient: and O?rer Customers (1i Attestation: Proposer understands and agrees to comply without quali?cation to provisions, requirements,and commitments contained in Section Proposer takes exception to provisions contained in Section as delineated below. l?roposer recognizes that taking exception with any provision of the Core Requirements may result in finding that the Proposal is unresponsiveand result in disquali?cation. 0) Higher levels otCommitrnont? Focus on Patient: and Other Customers 8) (1) Supporting ngnatire andlor ?summation muirod. 6. Competitive Criterion: Continuing Education Program Requirements Minimum Requirement?Continuing Education (1) Supporting narrative andzor documentation re_quired. Attestation: Proposer understands and agrees to comply without quali?cation to provisions, requirements, and commitments contained in Section Pmposer lakes exception to provisions contained in Section as delineated below. Proposer recognizes that taking exoeption with any provision ofthe Core Requirements may result in finding that the Proposal is unresponsive and result in disqualil'icat ion. I. bl Hist-er Levels Continuing Education :\AD\002\02\2X02\2X02177.docx (1i 109 8. Operations 1. Competitive Criterion: Communications a) Minimum Requirements? Dispatch and 5 rii na mi ordocumenteii ulred. Attestation: Proposcr understands and agrees to comply without quali?calion to provisions, requirements, and commitments contained in Section V.B.l.a. Pmposer takes exception to provisions contained in Section VB. La. as delineated below. Proposer recognizes that taking excaption with any provision of the Core Requirements may result in ?nding that the Proposal is unresponsive and result disqualification. h) Higher levels thatch and Communhatlons (ll a ve doroc tiorui. 2. Competitive Criterion: Vehicles a) Minimum Requirements?Vehich (1) supporting narrative and( or documentation mulled. Attestation; Proposer understands and agrees to comply without quali?cation to provisions, requirements, and commitments contained in Section V323. Proposer takes exception to provisions contained in Section as delineated below. Proposer recognizes that taking exception with any provision of the Core Requirements may result in ?nding that the Proposal is unresponsive and result in disquali?cation. Executions. h) Higher levels Vehicles I (1) :\AD\002\02\2X02\2X02177.docx 1 1 a) 3. Competitive Criterion: Equipment Minimum Requirements?Equipment (1i Attestation: l?roposer understands and agrees to comply without quali?cation to provisions, requirements, and commitments contained in Section V3.33. Proposer lakes exception to provisions contained in Section as delineated below. Proposer recognizes that taking exception with any provision oi?the Core Requirements may result in finding that the Proposal is unresponsive and result In disqualification. b) Higher Levels Equipment a) (ll 4. Competitive Criterion: Vehicle and Equipment Maintenance Minimum Requirements? Vehicle and Equipment Maitlenance Attestation: Proposer understands and agrees to comply without quali?cation to provisions, requirements, and commitments contained in Section V3.42. Proposcr lakes exception to provisions contained in Section as delineated below. Proposer recognizes that taking exception with any provision of the Core Requirements may result in finding that the Proposal is unresponsive and result in disqualification. Exceptions: bl Higher levels ofCommitment? Vehicle and Equipment Maintenance :\AD\002\02\2X02\2X02177.docx (1) Supporting narrative andgor documentation mulled. 111 5. Competitive Criterion: Deployment Planning a) Minimum Requirements? Deployment Planner; (1) Al lestul ion: t?roposer understands and agrees to comply without quali?cation to provisions, requirements, and commitments contained in Section V8.53. Proposer lakes exception to provisions contained in Section as delineated below. Proposer recognizes that taking exception with any provision ot?the Core Requirements may result in finding that the Proposal is unresponsive and result In disquali?cation. h) Higher levels Deployment Planning (1) C. Personnel 1. Competitive Criterion: Field Supervision a) Minimum Requirements? Field Supervision Su 0 a tire doeu tall um. Attestation: Proposcr understands and agrees to comply without quali?cation to provisions, requirements, and commitments contained in Section V.C.l.a. Pmposer lakes exception to provisions contained in Section V.C.1 a. as delineated below. Proposer recognizes that taking exception with any provision oi?the Core Requirements may result in finding that the Proposal is unresponsive and result in disqualification. mm ll) Higher levels otComnitment? Field Su 0 erretiv and ?documentation uired. :\AD\002\02\2X02\2X02177.docx 1 12 2. Competitive Criterion: Work Schedules a) Minimum Requirements? Work Schedules (1) Supporting narrative andlor documentation rguired. Attestation: Proposcr understands and agrees to comply without quali?cation to provisions, requirements, and commitments contained in Section Pmposer takes exception to provisions contained in Section as delineated below. Proposer recognizes that taking exception with any provision of the Core Requirements may result in finding that the Proposal is unresponsive and result in disquali?cation. It) Higher Levels Worlt Schedules 3. Competitive Criterion: Internal Risk Management/ Loss Control Program a) Minimum Requirements?Risk Management (1) Su ortin narr and docu atlon ind. Attestation: Proposer understands and agrees to comply without quali?cation to provisions, requirements, and commitments contained in Section Proposcr lakes exception to provisions contained in Section as delineated below. Proposer recognizes that taking exception with any provision of the Core Requirements may result in finding that the Proposal is unresponsive and result in disquali?cation. ns: ll) Higher levels Risk Management :\AD\002\02\2X02\2X02177.docx (1) Supporting narrative andlor documentation malted. 113 4. Competitive Criterion: Workforce Engagement 8) Minimum Requirements? Woritforce Engagement (1) Al leslat ion: l?roposer understands and agrees to comply without quali?cation to provisions, requirements, and commitments contained in Section Proposer lakes exception to provisions contained in Section V.C.'la. as delineated below. Proposer recognizes that taking exception with any provision of the Core Requirements may result in finding that the Proposal is unresponsive and result in disqualification. h) Higher levels otcomnliment? Workforce Engagement (1) D. Management 1. Key Personnel a) Minimum Requirements-tier Personnel Sun a a done no rure. Attestation: Proposer understands and agrees to comply without quali?cation to provisions, requirements, and commitments contained in Section V.D.1 Pmposer takes exception to provisions contained in Section V.D.l.a. us delineated below. Proposer recognizes that taking exception with any provision of the Core Requirements may result in finding that the Proposal is unresponsive and result in disqualification. intentions. Ii) levels ofCemnitment?itey Personnel Su 0 amtiv and ?documentation uired. :\AD\002\02\2X02\2X02177.docx 1 14 E. EMS System and Community 1. Area Providers Collaboration a) Minimum Requirements-Collaboration with area providers I (1) Supporting narrative andgor documentation rguired. Attestation: Proposer understands and agrees to comply without quali?cation to provisions, requirements, and commitments contained in Section V.F..1 a. Proposer lakes exception to provisions contained in Section as delineated below. Proposer recognizes that taking exception with any provision of the Core Requirements may result in finding that the Proposal is unresponsive and result in disquali?cation. Exec pub :15: It) Higher levels otComnihnent?collaboration mm: Providers I (1) Supporting narrative andgor documentation muimd. 2. Supporting Improvement in the First Response System a) Minimum Requirements?First Response System (1) Attestation: Pmposer understands and agrees to comply without quali?cation to provisions, requirements, and commitments contained in Section V1123. Proposer lakes to provisions contained in Section as delineated below. Proposer recognizes that taking exception with any provision of the Core Requirements may result in finding that the Proposal is unresponsive and result in disqualilicat ion. b) Higher Levels Response System i :\AD\002\02\2X02\2X02177.docx (1) Supporting narrative endgor documentation rgulled. 115 3. Health Status Improvement and Community Education a) Minimum Requirements-Community Education (1) narrative amigo! documentation rguhed. Al lestat ion: Proposcr understands and agrees to comply without quali?cation to provisions, requirements, and commitments contained in Section Pmposer lakes exception to provisions contained in Section as delineated below. Pmposer recognizes that taking exception with any provision of the Core Requirements may result in finding that the Proposal is unresponsive and result in disquali?cation. ii) High: Level: otComultmont?iioat?l Status Improvement and Community Education (1) :\AD\002\02\2X02\2X02177.docx 1 16 SEPARATE SUBMISSIONS: FINANCIAL AND PRICING DOCUMENTATION THREE SEPARATELY SEALED ENVELO PES Envelope One: labeled ?Budgets? 3 Copies (Template in Appendix 7) Complete the Pro Fonna Budgets (Section II.E.3) for the ?rst three years and include in envelope labeled "Budgets." [pm copies of fem meme Included In me sepgm?x sealed envgope labeled ?Budg?g? I F. Envelope No: labeled ?Financial Statements" 1 Copy Insert the required Financial Statements for the last three yeats and the audited ?nancial statements {or the most recent ?scal year. (1) Gene 0 aclaltat adad aca ts st be In: ed I separately aegled envelope labeled ??nancial Statements" G. Envelope Three: labeled ?Price Sheet" 3 Copies (Form in Appendix 11) (1) Sheet" Three coples of the completed fem must be Included In the separately seged envelgpe labeled ?Price :\AD\002\02\2X02\2X02177.docx 1 17 Appendix 2 :\AD\002\02\2X02\2X02177.docx CHAPTER 124: VEHICLES FOR HIRE SURFACE AMBULANCE SERVICES 124.080 DEFINITIONS. For the purposes of this subchapter. the following de?nitions shall apply unless the context clearly indicates or requires a di??erent meaning. PERSON. Any individual, partnership, ?rm, corporation, association or other business entity. SURFACE AAIBULANCE SERVICE. Any transportation service for hire which is required to be licensed by SDCI, ch. 34-? and which utilizes authorized emergency vehicles. (1992 Code, 43-60) (0rd. 33-83, passed 5-16-1983) Cross-reference: De?nitions and rules of construction generally, see 10.002 124.081 GRANT OF EXCLUSIVE FRANCHISE. The city shall grant an exclusive franchise for providing ground ambulance transport services within the city as the of?cial policy and regulatory scheme of the city for ground ambulance services. (1992 Code, 43-61) (0rd 33-83, passed 5-16-1983; 0rd. 74-07, passed 5-21-2007) Cross-rqfaence: Licenses, see ch. 1 I 0 124.082 AMBULANCE SERVICE RATES. Per franchise agreement, rate references within this subchapter shall be adjusted annually the ei council throu ordinance and remain on ?le in the of?ce of the ci cleric :\AD\002\02\2X02\2X02177.docx 1 19 City of Sioux Falls av mu: >??Asn mun-Inn" 6W4 Request 101' Pmposal Appende '3 - Page 1 Assocna'ws. LLC Smface Ambulance Exclusive Operating Area luly 18, 2014 :\AD\002\02\2X02\2X02177.docx 120 i I City of Sioux Falls: Fire Battalion Divlslon (North South) ?-nwv?1u-? MC Requem tor Proposal Appenan 3 - Page ?x nssocta'res. LLC Surface Am bulaucr} Sen'u?e Exclusnw OperalmgArea luly 18, 2014 :\AD\002\02\2X02\2X02177.docx 121 Appendix v.A 2?5 :\AD\002\02\2X02\2X02177.docx Appendix 4 Call Volumes Prehospital Calls 201 1 2012 201 3 Incidents Transports Incidents Transports Incidents Transports Emergency 591 2 3977 6395 4254 6656 461 2 Non-Emerge my 6541 3071 71 39 3086 7420 3331 Transfers 2011 201 2 201 3 Incidents Transports Incidents Transports Incidents Transports Emergency Non-Emergency 884 877 1222 1215 1093 1078 :\AD\002\02\2X02\2X02177.docx 123 Appendix 5 :\AD\002\02\2X02\2X02177.docx Appendix 5 Current Ambulance Rates Advanced Life Support 2 (ALS-Z) Base Rate -- $1,175. Advanced Life Support Emergency (AIS-F.) Base Rate "$993. Advanced I.ife Su pporl Non-Emergency (MS-NF.) Base Rate Advanced Life Support Emergency (AIS-F.) Base Rate Basic Life Support Emergency (BIS-F.) Base Rate "$757. Basic Life Support Non-Emergency (BIS-NF.) Base Rate Mileage per Loaded Patient Milo -- $11.25 :\AD\002\02\2X02\2X02177.docx 125 Appendix 6 :\AD\002\02\2X02\2X02177.docx APPENDIX 6 PROCU REMENT TIME LINE Iuly 18, 2014 Released August 4, 20M Written Questions/Clanlilicutions Due August 22, 20 1'1 l?roposers' Conference August 2014 Clari?cation Addendum to Distributed 0th? 9? 2m 4 duc- at 3 p.m. and Public Proposal October 23, 20 Proposer presentations October 30, 201/} Notice to Award November 14-, 2014 Contract negotiations completed December l, 2014 City Council con?rmation May 2-31, 2015 Startup olncw contract :\AD\002\02\2X02\2X02177.docx 127 Appendix 7 :\AD\002\02\2X02\2X02177.docx APPENDIX 7 PRO FORMA BUDGET THIS FORM I HF COMPIFTFD FOR THE FIRST 7 YEARS ?lt'li?x?l ANI.) Ill:~ I) IN PROPOSED ANNUAL OPERATING BUDGET Year. AN UAL REVEN UES Patient Charges Private payments 8 Mcdi-Cnid 5 Medicare 5 Other third party payments 5 Subtotal Other, Specify: ET INCOM BASIS FOR PATIENT REVENUE PROJECTIONS: Annual Source of number Average paym en t/ Payment tninspurf Annual Revenue I?rwale Metli-Cniil Only $3 Cal \lwlimre Only 5 Othr-r: *3 \0 Payment SOUU TOTAL 5 :\AD\002\02\2X02\2X02177.docx 129 APPENDIX 7 PRO FORMA BUDGET ANNUAL EXPENSES Personnel Paramedics Wages Bene?ts EMT-s Wages Bene?ts Other Personnel Wages Bene?ts Subtotal Vehicles Gasoline, (ii I, tires Repair and maintenance Depreciation Subtotal Medical Equipment/Supplies Supplies Equipment lease/depreciation Maintenance 8: Repair Subtotal Other Rents and leases Insurance Utilities and telephone Of?ce supplies postage Professional Services axes Su hto tal TOTAL EXPENSES :\AD\002\02\2X02\2X02177.docx 130 Appendix 8 :\AD\002\02\2X02\2X02177.docx Appendix 8 Required Forms Exhibit A: General Information APPENDIX 8 - EXHIBIT A FACE SHEET FORM MUST APPEAR AS THE FIRST PAGE OF THE This is a proposal lo contract with City of Sioux Falls EMS Agency to provide emergency medical surface ambulance to pemons requesting said service throughout the City. Na me of Proposer: Dba: TypeOfOrganization: El Corporation LLC El Partnership Other Date Founded Orlncorporatcd: Legal Address: Phone:[ - ext; Fale - Federal Tax Identi?cation Nu mber: Contact person: Title: Phonczl - E-Mail: (required/ornoti?cation) Address For Mailings: (Ifdijferent from above): Authorized Signature: DateSubmitted: 1 Print Name: Title: :\AD\002\02\2X02\2X02177.docx 132 Appendix 8 Required Forms Exhibit B: Certi?cation DEBARMENT AND SUSPENSION CERTIFICATION The Proposer, under penalty of perjury, certi?es that, except as noted below, Proposer, its principal, and any named subcontractor. 1. Is not currently under suspension, dcharment, voluntaly exclusion, or determination of ineligibility by any federal agency; 2. Has not been suspended, debarred, voluntarily excluded or determined ineligible by any federal agency within the past three years; 3. Does not have a proposed debarmenl pending; and, Has not been indicted, convicted. or had a civil judgment tendered against it by a court of competent jurisdiction in any matter involving fraud or of?cial misconduct within the past three years. If there are any exceptions to this certi?cation, insert the exceptions in the following space. Exceptions will not necessary result in denial of award, but will be considered in determining Proposer responsibility. For any exception noted above, indicate below to whom it applies, initiating agency, and dates of action. Notes: vaiding false information may result in criminal prosecution or administrative sanctions. The above certification is part ofthe Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Certi?cation. Proposer Name: Proposer Signature: Title: Date: _Lj_ :\AD\002\02\2X02\2X02177.docx 133 Appendix 8 Required Forms Exhibit C: References Current Business References Proposer Name: Agency Name: Address: City, State. Zip Code: Contact Person: Telephone Number. - Service Provided Dates/Type of Service: Agency Name: Address: City, State. Zip Code: Contact Person: Telephone Number: Service Provided- Dates/l?ype of Service: Agency Name: Address: City, State, Zip Code; Contact Person: Telephone Number. - Service Provided: Dales/Type of Service: :\AD\002\02\2X02\2X02177.docx 134 Proposcr Name: Former Business References Agency Name: Address: City, State, Zip Code: Contact Person: Telephone umber. Service Provided: Dates/l'ype of Service: Agency Name: Address: City, State, Zip Code: Contact Person: Telephone Number. Service Provided: Dates/l?ypc of Service: Agency Name: Address: City, State, Zip Code: Contact Person: Telephone Number. Service Provided: Dates/Type of Service: :\AD\002\02\2X02\2X02177.docx 135 Appendix 8 Required Forms Exhibit D: Release Entity Investigative Releases - Entity The undersigned entity. a prospective Contractor to provide advanced life support ambulance service for the City of Sioux Falls, SD recognizes that public health and safety requires assurance of safe, reliable, and cost-efficient ambulance service. 'l'hat assurance will require inquiry into aspects of entity's operations (letennined relevant by The City of Sioux Falls, or its agents. The entity speci?cally agrees that Vancouver, or its agents may conduct an investigation for the purpose into, but not limited to the following matters: 1. The ?nancial stability of the entity, including its owners and of?cers, any infonuation regarding potential con?ict of interests, past problems in dealing with other clients or cities where the entity has rendered service, or any other aspect of the entity operations or its structure, ownership, or key personnel which might reasonably be expected to influence Vancouver? 5 selection decision. 2. The entity's cunent business pmctices, including employee compensation and bene?ts an?angements, equipment replacement and maintenance practices, in-service training programs, means of competing with other companies, employee discipline practices, public relations efforts, current and potential obligations to other buyers, and general inlemal personnel relations. 3. The attitude of cun?ent and previous customers of the entity toward the entity?s services and general business practices, including patients or families of patients served by the entity, physicians or other health care professionals knowledgeable of the entity's past work, as well as other units oflocal government with which the entity has dealt in the past. 4. Other business(es) in which entity owners and/or other key personnel in the entity currently have a business interest. 5. The accuracy and truthfulness ofany information submitted by the entity in connection with such evaluation. This authorization shall expire six months from the date of the signal are. AUTHORIZATION FOR SUCH INVESTIGATION IS HEREBY EXPRESSLY GIVEN BYTHE ENTITY: Date Entity Name Authorized Representative (Signature) Authorized Representative (Printed) Title ACKNOWLEDGMENT FOLLOWS: :\AD\002\02\2X02\2X02177.docx 136 STATE 55 County of On this day of 20 14, before me, the undersigned, a Notary Public in and for said County and State personally appears _to me known to be the person described herein and who utcd the foregoing Af?rmation Statement, and acknowledged that hc/shc executed the same as his/her {rec act and deed. Witness my hand and Notartal Seal subscribed and af?xed in said County and State, the day and ycarabovc written Notary Public Notary Public Seal Commission Expiration Date :\AD\002\02\2X02\2X02177.docx 137 Appendix 8 Required Forms Exhibit E: Release Individual The undersigned, being (title) for (entity), which is a prospective Contractor to provide advanced ambulance service to the City Sioux Falls, SD, recognizes that public health and safety requiies assurance of safe, reliable, and cost ef?cient ambulance service. 'l'hat assurance will require an inquiry into matters which are determined relevant by the Cit of Sioux Falls or its agents, such as, but not limited to, the character, reputation and competence ofthe entity's owners and key employees. The undersigned spccil?u'ally acknowledges that such inquiry may involve an investigation ol? his or her personal work experience, educational quali?cations, moral character, ?nancial stability. and general background, and speci?cally agrees that the City of Sioux Falls, or its agents, may undertake a personal investigation of the undersigned for the purpose stated. This authorization shall expire six (6) months from the signature dale. AUTHORIZATION FOR SUCH PERSONAL INVESTIGATION IS HEREBY EXPRESSLY GIVEN: Date Individual Name (Printed) Signature WI STATE 55 County of On this day of 2014, before me, the undersigned, a Notary Public in and for said County and State personally appears _to me known to be the person described herein and who executed the foregoing Af?nnation Statement. and acknowledged that he/she executed the same as his/her free act and deed. Witness my hand and Notarial Seal subscribed and af?xed in said County and State, the day and year above written. Notary Public Commission Expiration Date Seal :\AD\002\02\2X02\2X02177.docx 138 Appendix 8 Required Forms Exhibit F: RFP Guaranty Each proposal must be accompanied by a bid bond, ceitified check, cashier's check, or bank draft in the amount All guaranties shall be made payable to the City ofSioux Falls. Bonds shall be issued by a surer authorized to do business in this state. Checks shall be Certified or issued by a state or national bank. Bid guaranties of unsuccessful bidders shall be returned within 30 calendar days ot'the opening. Bid guaranties other than those mentioned will not be accepted by the City of Sioux Falls. Bid guaranty of the successful bidder shall be retained until the contract is executed and a performance guaranty (ifapplicable) has been submitted. Should a successful bidder fail to enter into contract, the bid guaranty shall be forfeited to the City as partial compensation for the administrative expenses of making a re-award or issuing a new request. :\AD\002\02\2X02\2X02177.docx 139 Appendix 9 :\AD\002\02\2X02\2X02177.docx APPENDIX 9 - COMMUNICATIONS SYSTEM INFORMATION A. Metro Communications is the City's uiti Agency Dispatch Center Metro Communications is designated as the City?s PSAP and shall provide call taking and dispatch services and maintain all equipment and software (fixed equipment. telephones, linkages and other infrastructure) necessary to receive requests for emergency and non- emergency ambulance services. The City's PSAP shall establish a dispatch radio communications system including obtaining radio channels and all necessary FCC licenses and other permits as may be required for the operation of said system, which will enable PSAP to effectively dispatch ambulance units throughout all areas of the City. Contractor shall be capable of receiving and replying to such requests for emergency ambulance services by voice and/or data linkage. B. Dispatch Center Operational Expectations PSAP shall adequately train, prepare and provide continuing education for its dispatchers to process emergency medical requests for service utilizing REMSA approved Medical Priority Dispatch protocols and to follow Contractor?s Deployment Plan. Said dispatchers shall be given a orientation as well as a thorough orientation to the City EMS system before being assigned to operate as part of ambulance dispatch system. The PSAP shall use best efforts to maintain Accreditation by the International Academies of Emergency Dispatch. 1. Key Elements of Metro's EMS Dispatch Activities: I The City? PSAP performs the following functions: I Deploy arnbu lances for coverage in accordance with Contractor's written plan I Receive emergency requests and required information in accordance with IAED Protocols/Best Practice Standards I Receive non-emergency requests and required information in accordance with Contractor Protocols I Categorization of response needed I Priority assignment of response needed I Simultaneous assignment of Contractor ambulance resources and ?rst responder resources per REMSA protocol I Provide Dispatch Life Support i?re an'ival instructions to caller as required by REMSA protocol I Caregiver life- safety radio monitoring I Routine communications with caregiVCrs and assigmuent of hospitals frequencies as required I Rc-dcploy ambulance resources for coverage in accordance with Cont rdctor?s written plan or direction front Contractor Supervisor as service requests and assignments ebb and flow throughout the day I Maintain and provide access to all data required for REMSA review and benchmarking of medical dispatch function and Contractor operations. 141 C. Contractor Deployment Planning Responsibility The understands that Contractor will be developing enhanced coverage and deployment plans during its term. Coverage plan modi?cations, throughout the term of the Agreement, including any changes in post locations, prion'ties or hourofday coverage levels, may be made at Contractor?s sole discretion with at least 24 hours notice to PSAP. D. Metro Performance not to Adversely Impact Contractor The Contractor shall not be held responsible for errors and/or omissions of Communications or its failure to follow Contractor deployment plan. Contractor shall not be penalized for any exceptions resulting from said performance. E. Dispatch Problem Resolution and Evaluation The City's PSAP. REMSA and the Contractor shall panicipate in an on-going program for the evaluation of dispatch operations, education and training of dispatchers, and problem identi?cation and resolution. F. Required Communications Equipment and Dispatch City shall provide the primary radio system and access to required data output from its CAD and PSAP. Contractor shall pay for its equipment, and interfaces to Contractor?s computer systems/equipment, its connectivity costs and. if any. for radios, pagers orcomputcrs at its facility. New dispatch system infrastructure costs shall not be imposed upon Contractor by Metro Communications without due regard to cost implications to user fees and the consideration ofsuclr ?nancial impact on the Contractor. G. Ambulance Communication Equipment i) Contractor shall equip all ambulances and supervisory Vehicles used in performance ofservices to with radio equipment for communications with City Radio System and at a minimum providinga mobile trnit and at least one portable radio per unit. il) Contractor shall equip all ambulances and any supervisory used in providing service to the City/ RE MSA with radios for communication with hospital receiving facilities and: Forambulance-to-hospital communications. - Radio equipment used for ambulance-to hospital communications shall be configured so that personnel actually providing patient care are able to directly communicate with base or receiving hospital stat? about the patient. Contractor shall operate the two-way radios in conformance with all applicable rules and regulations ofthe Federal Communication Commission, and in conformance with all applicable City or REMSA System Medical Board nrles and operating procedures. I :\AD\002\02\2X02\2X02177.docx 142 H. Communication Equipment Currently Utilized A general desript ion ofCommunications Equipment tili'Aed and its associated imated costs are provided below: i) ComputerAlded Dispatch System - New World Systems Current versiouofCAD is 10.0 (used in the Ollcenter) Current version of Mobile is 10.0 SPZJ (used by responders in the ?eld) - Software 0 License costs per unit initial license $4,500 one time cost/unit Annual maintenance requirement S780/year/unit - Hardware 0 Sioux Falls Police Department is currently using Getac V200 laptops (est. cost /unlt =55,000) Sioux Falls Fire Department is currently using Getac L110 Rugged 'l?ablct (est. 0 Connectivity is conducted via commeicial network (Verizon) at the user agency?s expense (est. $40/month/unit) Ii) Medical Dispatch System I Medical Priority Dispatch System Accredited Center of Excellence since 2000 Currently at version 3.4.3.33 Card set version 12.2, will be going to 13 next spring Radio System I South Dakota Digital Trunked Radio System lnfrastructu re owned and operated jointly with the State of Soul Dakota - Motorola Vl IF Digital Trunked Radio System System is not currently P25 compatible - Time frame for P25 is 2025. EMS digital talk group currently available on the system Interoperability with police, ?re, EMS, and hospitals Radios - Motorola radios for use as mobile radios. There is a variety of different models and price ranges. (Approx price range $2,000 $5,000) - Motorola APX radios for use as portable radios. There is a variety ot?difl'erent models and price ranges. (Approx price range 31500-55900) - 'l?hc radios must be capable of a minimum of 4 zones. There is a list of required talk groups by the State of SD for interoperability. :\AD\002\02\2X02\2X02177.docx 143 iv) Paging System I Alpha numeric pagers musl be in lhe 151- 159 MHZ range No annual fees I User responsible for purchasc/ programming of devices (est. costs SlGO/device) :\AD\002\02\2X02\2X02177.docx 144 Appendix 10 :\AD\002\02\2X02\2X02177.docx Appendix 10 Insurance Requirements The successful Proposer shall obtain and maintain in full force and effect throughout the term of the Contract, such insurances as set forth herein The successful Pmposer shall assume full ?nancial responsibility for its petsonnel, including all deductions of Social Security and withholding taxes and required contributions to state and federal unemployment compensation funds. The successful Pmposer shall include all Subcontractors as insured under its policies or shall furnish separate or endorsements for each Subcontractor. All subcontractors shall be subject to all of the requirements stated herein. The insurance carrier shall be required to give CITY notice of termination at least 30 days prior to the intended termination of any speci?ed policy. All deductibles and self-insured retentions shall be fully disclosed in the Certi?cates of Insurance and may not exceed $10,000 without the express written permission of the CITY. lf CONTRACTOR has a self- insurance retention (SIR), CONTRACTOR shall be rcquined to provide the entire policy of insurance with which it has a SIR. The successful Proposer shall provide Certificates of Insurance and endorsements for the following types of insurance, and policies and declarations as requested by City, evidencing such coverage to the CITY, Attn: REMSA, with a copy to the Purchasing Division, before the commencement of any work under this Contract. 5.1.1. Commercial General Liability for limits not less than three million combined single limit for bodily injuty, personal injury and property damage for each occurrence and five million dollars ($5,000,000) general aggregate. The policy shall be endorsed with the following speci?c language or contain equivalent Linguage within the policy: "City of Sioux Falls their o/Iicers, qqents, employees and volunteers are named as additional insured using CG 2026 or equivalent broad jbnn, all liability arising out of the operations by or on behalfofthe named insured in the performance of this Agreement. "The inclusion of more than one insured shall not operate to impair the rights ofone insured against another insured, and the coverage afforded shall apply as though separate policies had been issued to each insured, but the inclusion of more than one insured shall not operate to increase the limits of the entity?s Iiubilit y. "The insurance provided herein is primary covertch to the City of Sioux Falls with respect to any insurance or self-insurance programs maintained by the City. 5.1.2 Automobile Liability covering the type of vehicle operated under this proposal for limits not less than three million dollars ($3,000,000) combined single limit for bodily injuty and property damage for each occurrence, which may be satisfied through plus excess and/or umbrella liability insurance as described herein. Coverage shall include owned, non-owned, and hired automobiles. The City and its of?cers, employees and agents shall be endorsed to above policy(ies) as Additional insured using form CG 2026 or equivalent broad form, for such liability as may be incurred in the performance of any Contract resulting from this proposal. :\AD\002\02\2X02\2X02177.docx 146 :\AD\002\02\2X02\2X02177.docx Workers' Compensation Statutory coverage, il'and as required according to the South Dakota statutes, including Employers" Liability limits of $1,000,000.00 per occurrence. The policy shall be endorsed to waive the insurer's subrogation rights against the City. Medical Malpractice?l?rolcssional Liability for all applicable activities of the Contractor arising out of or in connection with this Agreement for limits not less than two million dollars ($2,000,000) per occurrence and four million dollars ($4,000,000) general aggregate, covering Contractor's wrongful acts, errors and omissions. The limits of this policy apply separately to this contract. In the event Contractor cannot provide an occurrence policy, Contractor shall provide insurance covering claims made as a result of performance of this Agreement and shall maintain tail insurance in effect for not less than two years lollowing completion of perfomiance of this Agreement. The City requires insurance carriers to maintain during the contract term, a Best Key Rating ot'A: or higher, which shall be fully disclosed and entered on the Certi?cate of Insurance. Each of the required policies, noted above, shall he endorsed to provide the CITY with thirty (30) days prior written notice of cancellation. The CITY is not liable for the payment of premiums or assessments on the policy. No cancellation provisions in the insurance policy shall be construed in derogation of the continuing duty of successful Bidder to fumish insurance during the term of any contract resulting front this proposal. The insurance requirements and limits of the insurance provisions of this contract/agreement shall not be construed to limit any liability of the CONTRACTOR. Failure to Maintain Coverage: if the CONTRACTOR fails to maintain any of the insurance coverage required herein, CITY may, order the to stop the work, declare the in breach, suspend or terminate the Contract, assess liquidated damages, or may purchase replacement insurance or pay premiums due on existing policies. Cl'l'Y may collect any replacement insurance costs or premium payments made from the contractor. 147 Appendix 11 :\AD\002\02\2X02\2X02177.docx APPENDIX 11 PRICE SHEET: PATIENT CHARGES 1. Patient Charges shall be submitted on this exhibit in Table A as is. Proposed patient charges should take into consideration the cost ofproviding care to indigent patients. No alterations or changes of any kind are permitted. Proposals that do not comply will be subject to rejection in total. The sole means of Contractor compensation is through fee-for?services reimbursement of patient charges. 2. has adopted a "bundled" rate for ambulance services with a single base rate for emergency transports derived from 9-1- 1, whereby most fees for service are included in the base rate. with the exception of oxygen. mileage, and treat with no transport; there is no distinction betwoen the ALS and BLS emergency base rate. 3. Non-emergency base rates are applicable to transports originating from other than 9- 1- 1 sources hospitals, nursing homes, etc). Enter into Table A the base rates applicable for ALS non- emergency transports and for BLS non-emergency transports. 4. The patient charges quoted in Table A shall include all taxes and all fees charged to patients or third party payers. Proposals should re?ect a bundled rate structure and no other charges for supplies, equipment, or procedures. or other services will be accepted. Contractor shall comply with fee schedule and rates proposed in response to this RFP and approved by Table A Proposed Charges Complete the proposed change [or each item listed below: Emergency Ambulance Base Rate (ALS and BLS) ALS Non-emergency Base Rate BLS Non-emergency Base Rate Mileage/loaded patient mile Oxygen Treat, Non-transpon rate? Will ?Treat. Non-transport rate applies to patients who receive a treatment intervention (such as 50% Dextrose) and subsequently re?ise transport. Assessment (vital signs. KG, etc.) does not constitute treatment interventions Proposer agrees that the prices quoted are the maximum that will he charged during the term of any contract awa rded, with the exception of increases or fee adiustments desuribed in the RFP. FIRM: SIGNATURE: DATE: PRINTED NAME: 'l'l'l'LE: :\AD\002\02\2X02\2X02177.docx 149 :\AD\002\02\2X02\2X02177.docx 150 Exhibit TABLE OF Proposal for Su rface Ambulance Service Exclusive Operating Area REMSA City of Sioux Falls, South Dakota Vll. Executive Summary 1 Required Forms 9 IX. Quali?cation Requirements A. Organizational Disclosure 1. Organizational Ownership and Legal Structure '10 2. Continuity of Business 13 3. Licenses and Permits [3 4. Government Investigations l3 5. litigation B. Financial Strength and Stability 1. Financial Statements 15 2. Audited Statements 16 3. Financial Commitments l6 4. Working Capital 17 5. Performance Security 17 6. Financial Interests 17 C. Experience as Sole Provider 1. Comparable Experience 18 D. Demonstrated Response Time Performance 23 E. Demonstrated High Level Clinical Care 25 and Sophisticated Systems X. Core Requirements A. Contractor?s Functional Responsibilities 1. Basic Services 28 2. Service Description 28 B. Clinical I. Clinical Overview 29 2. Medical Oversight 29 3. Minimum Clinical Levels and Staf?ng Requirements 29 C. Operations 1. Operations Overview 7 2. Transport Requirement and Limitations c7 lsuildmo Aw llti?ro?lntilli'j cfdb? System, Paramedics Plus i 151 TABLE OF CONTENTS Proposal for Surface Ambulance Service Exclusive Operating Area RE MSA City of Sioux Falls, South Dakota 3. Response Time Performance Requirements 37 4. Noti?cation of Delays for Non-emergency Responses 37 5. Response Time Measurement Methodology 37 6. Response'l?irne Exceptions and Exception Requests 37 7. Response Time Performance and Penalty Provisions 37 8. Fleet Requirement 37 9. Coverage and Dedicated Ambulances, Use of Stations/ Posts 37 D. Personnel 1. Treatment of Incumbent Work Force 38 2. Character, Competence and Professionalism of Personnel 44 3. Internal Health and Safety Programs 44 4. Evolving OSHA and Other Regulatory Requirements 44 5. Discrimination Not Allowed 44 E. Management 1. Data and Reporting Requirements 45 F. EMS System and Community 1. Participation in System Development 46 2. Accreditation 46 3. Multi-casual ty/ Disaster Response 46 4. Mutual Aid and Stand-by Services 46 5. Permitted Subcontracting 46 6. Communities May Contract Directly for Level of Effort 46 7. Supply [Exchange and Restock 4b 8. landling Service Inquiries and Complaints 46 C. Administrative Provisions 1. No Subsidy System 47 2. Contractor Revenue Recovery 47 3. Federal Healthcare Program Compliance Provisions 47 4. State Compliance Provisions 47 5. Billing/ Collection Services 47 6. Market 49 7. Service Expansion 50 8. Accounting Procedures 50 PAKHMEDICS PLUS Partners In ?wow-Winning EMS Paramedics Plus ii I :\AD\002\02\2X02\2X02177.docx 152 TABLE OF Proposal for Surface Ambulance Service Exclusive Operating Area REMSA City of Sioux Falls, South Dakota XI. 9. Insurance Provisions 50 10. Hold Harmless/ Defense tndemni?cation/ 51 Taxes Contributions 11. Performance Security Bond 51 l2. Term of Agreement 5] 13. Earned Extension to Agreement 51 14. Continuous Service Delivery 5 15. Annual Performance Evaluation 51 16. Default and Provisions for Termination of Agreement 51 17. Terminau'on 52 18. Emergency Take Over 52 19. 'l'ransition Planning 52 20. Remedies 52 21. Provisions for Curing Material Breach and 52 Emergency Take Over 22. "Lame duck" Provisions 52 23. General Provisions 52 Competitive Criteria A. Clinical 1. Competitive Criterion: Quality Improvement 53 2. Competitive Criterion: Clinical and Operational Benchmarking 66 3. Competitive Criterion: Dedicated Clinical Oversight Personnel 85 4. Competitive Criterion: Medical Direction 98 5. Competitive Criterion: Focus on Patients and Other Customers 101 6. Competitive Criterion: Continuing Education Program 108 Requirements B. Operations 1. Competitive Criterion: Communications 112 2. Competitive Criterion: Vehicles 121 3. Competitive Criterion: Equipment 126 4. Competitive Criterion: Vehicle and Equipment Maintenance l29 5. Competitive Criterion: Deployment Plaiming 135 PLUS :\AD\002\02\2X02\2X02177.docx Partners in this Paramedics Plus 153 TABLE OF CONTENTS Proposal for Surface Ambulance Service Exclusive Operating Area REMSA City of Sioux Falls, South Dakota C. Personnel 1. Competitive Criterion: Field Supervisions 151 2. Competitive Criterion: Work Schedules 162 3. Competitive Criterion: Internal Risk Management 165 Loss Control Program 4. Competitive Criterion: Workforce Engagement 179 D. Management 1. Key Personnel 196 E. EMS System and Community 1. Area Providers Collaboration 211 2. Supporting Improvement in the First Response System 213 3. Health Status Improvement and Community Education 219 a??a 5'53? ?(Uri Diff-3 'n wining; Evy/:2 ni EMS Elysee (In; :\AD\002\02\2X02\2X02177.docx Paramedics Plus iv 154 EXECUTIVE SUMMARY I Paramedics Plus 1 :\AD\002\02\2X02\2X02177.docx 155 EXECUTIVE SUMMARY This Request for Proposal process represents a tremendous opportunity for the City of Sioux Falls and for REMSA. For many reasons, Paramedics Plus is con?dent it is the right choice for REMSA and the citizens of Sioux Falls. While each proposer will present a different Vision for your future, the real question to be answered is, which leadership team and culture is the best fit to take your already good EMS system to the next level? It is likely that most companies involved in this process have had success in achieving response time requirements and providing EMS care. Our record for building world-class EMS systems stands up to any competitor?s. EMS, the Commission on the Accreditation Paramedics Plus is clinically excellent, of Ambulance Services. Paramedics Plus will attain CAAS accreditation for the REMSA innovative, tech savvy and complies with every contract requirement, including some of the most stringent response time standards in SYStem' the world. But our experience, reputation and Each of our Systems is also accredited by track record are not what set us apart. What the National Association of Emergency sets us apart 15 Who We are"the Values We hVe Dispatchers, and our Florida operation earned and integrity you can tht' the Florida Governor?s Sterling Award for its We?ve built our reputation around three application 0f the Baldrige quality themes: criteria. This recognition is the highest state . Patients are ?rst quality award given. To our knowledge, no other EMS system has earned a quality award 0 Promises are kept . at this level. 0 Partnerships are strong. While the proposals re?ect our best ideas Focusing on these three things has served for today, you want a partner, not just a our communities and us well. Each of our contractor, that will be ?exible, agile and systems is accredited by the gold standard of willing to work with you to meet your needs P15..szfo EDICS LUS Pas tn-ars Emitting Awardi?.?dinning EMS Systems Paramedics Plus 2 :\AD\002\02\2X02\2X02177.docx 156 :\AD\002\02\2X02\2X02177.docx EXECUTIVE SUMMARY today, tomorrow and ?ve years from now. The truth is that Paramedics Plus doesn?t often engage in requests for proposal processes. We aren?t looking to become the largest or even second largest EMS company in the country. We simply want to partner with communities who share our Vision for clinically excellent and cost effective EMS systems. Paramedics Plus is an organization of proven capabilities, transparency and a passion for doing the right things, in the right ways, for the right reasons. Paramedics Plus is a relatively small organization with a big heart and a reputation for being one of the most sophisticated EMS organizations in the United States. Paramedics Plus is financially sound and has never filed for bankruptcy. We aren?t publicly traded and, although we expect to make a reasonable profit, excessive profit making for our stockholders isn?t a factor. We were created by a not?for-profit hospital, so putting patients before profits is part of our DNA. We operate in systems much larger than the City of Sioux Falls, like Oakland, California, and St. Petersburg and Clearwater, Florida, but we have also excelled in Fort Wayne, Indiana. The size of the service area doesn?t matter. We are capable and we excel in building award- winning EMS systems. We will do the same thing in Sioux Falls, South Dakota. Paramedics Plus 3 157 EXECUTIVE SUMMARY We think the REMSA system is a perfect match for Paramedics Plus and that we can help you take your system to a new level. But we want to "help you? do it your way. We don?t want to impose a large national approach on the City of Sioux Falls. Sure, a few things do bene?t from a national approach like benchmarking and sharing best practices?things we do on a national level. But many others are best left to local discretion. And all are best served when the contractor is a true partner. What else do you get with Paramedics Plus? We are innovative. The systems we run have been the first in the country to adopt such clinical innovations as the use of CPAP, measuring time to and others. We are also innovative in our approach to operations. We created a process that not only helps ensure response time compliance, but also has been studied and adopted by other EMS professionals and recognized by quality organizations. We are innovative in our approach to technology. We developed a state-of-the-art proprietary software tool, an ingenious way to achieve efficiencies in the communications function. No other company, in this country or Europe, offers this cutting edge technology. We share your values. Sioux Falls already seems like home to us. Our Vice President, our only Vice President, grew up in the Sioux Falls area. He went to Harrisburg High School. His parents live in Sioux Falls today and his AA 11 . .I 9 . siblings and their families live in the area. Our President grew up in northeast Nebraska and started his EMS career in South Dakota, so we share your middle-America values. What we propose is what we will do. Promises are kept. That?s not something you can count on with every company. We are experienced and capable. We?ve been operating high performance EMS systems since 1998. You can count on us to be clinically excellent and reliable in response time performance. Our cardiac arrest survival rates are among the top tier in the country. :\AD\002\02\2X02\2X02177.docx -r {?Lc-Ir. Elm-i Paramedics Plus 4 158 EXECUTIVE SUMMARY We partner with the local authority and 0 Enhanced medical equipment including the medical oversight. We thrive under strong EZ-IO, LSP AutoVent 3000 Resuscitator, and medical oversight. Not only do we possess LIFEPAK 15. experience and abilities, but also and even A comprehensive safety and risk program more importantly, we have the will to support that includes policies, equipment, and execute the vision of our oversight technology and actions that support a partners. We want to partner with REMSA to culture of safety One component is the build an award-winning EMS system in Sioux Zoll SafeForce d?vepmom-toring program, Falls' a $65,000 investment in Sioux Falls. Here are a few of the proposed highlights for 0 Local and corporate leadership with the City of Sioux Falls and REMSA: personal integrity as well as varied and 0 A ?eet of all new ambulances with state-of- extensive EMS experience. the?art medical equipment and advanced . A proprietary management_trajning caregiver technology, including power program second_to_none combined StrEtCherS and bariat?c SyStemS_a? part with other professional educational of a $1.7 million capital investment in the REMSA system. opportunities. PARAMEDECS Partners in Budding Awant-Winning EMS Systems Paramedics Plus 5 :\AD\002\02\2X02\2X02177.docx 159 EXECUTIVE SUMMARY 0 Continuing education, offered free to employees, through a relationship with Avera McKennan School of EMS and linked to local system needs. 0 A Clinical Forum to support local medical oversight. The Clinical Forum gives each Medical Director in each Paramedics Plus system the opportunity to share protocols, benchmark against other systems, collaborate for research, and ask and answer questions from other medical directors. 0 A workforce engagement process where front line employees are part of the quality and performance improvement process. 0 A Paramedic and EMT team that is well-trained, credentialed, skillful and encouraged, rewarded and acknowledged. 0 An approach to Quality Management based on our award?winning experience with Baldrige quality criteria. 0 KP15 and benchmarking on clinical and operations variables that truly make a difference. 0 Fact-based decisions supported by an innovative and unique application of Tableau software. 0 Take 10, a new program and approach to increasing the number of citizens in Sioux Falls who can provide CPR when the next cardiac arrest occurs. 0 A focus on what makes a difference in the most important clinical areas: airway management, resuscitation, stroke, respiratory distress, severe trauma, management of pain and discomfort, patient safety and patient satisfaction. 0 Relentless attention to operational variables that impact response times as well as system cost efficiencies through our proprietary, award-winning PULSE process. 0 Our commitment to employ a well-quali?ed EMS Medical Director who is acceptable to the REMSA Medical Director and Medical Board. Paramedics Plus 6 :\AD\002\02\2X02\2X02177.docx 160 EXECUTIVE SUMMARY 0 Inclusion of the Sioux Falls EMS system in our national safety initiative and share best practices?some of which have reduced injuries related to patient movement by 16.8%. 0 Our ?Just Culture? combined with participation in a patient safety organization to encourage reporting of near misses and to improve quality and safety of care . 0 Valuable lessons learned in a similar and successful PSAP dispatch configuration. 0 The PULSE suite of software products, valued at more than $150,000, to monitor system performance in real time, improve adherence to the System Status Plan and provide options for analysis and reports. 0 The daily involvement in PULSE meetings by our experienced and well-qualified Corporate Deployment Director. 0 Field Operations Supervisors supported through technology, training and a foundation for fair and equitable treatment of employees. 0 Insight into employee engagement through a proven employee satisfaction survey. 0 Highly competitive wages and an enhanced benefit program. 0 Support of our partners in First Response through group purchasing discounts, shared field crew training, collaborative leadership training, and coordination of injury and illness prevention programs. :\AD\002\02\2X02\2X02177.docx .- in?. . :1 an). Paramedics Plus 7 161 EXECUTIVE SUMMARY 0 More certi?ed Child Passenger Safety technicians to help at Fire Department CPS events, other community events, and serve as a resource for Sioux Falls families. 0 Active involvement in public health initiatives such as those undertaken by Live Well Sioux Falls. 0 A spirit of collegiality in our interactions with area hospitals, First Responders and other EMS providers. 0 saga SIDED If the City of Sioux Falls wants to be another contract for the biggest provider in the country, Paramedics Plus isn?t the right choice. If the City of Sioux Falls is satis?ed with the status quo, Paramedics Plus isn?t the right choice. If the City of Sioux Falls and REMSA are looking for an organization with integrity, transparency, agility and proven capabilities, Paramedics Plus is the right choice. Paramedics Plus 8 :\AD\002\02\2X02\2X02177.docx SUBMISSION OF REQUIRED FORMS RIP Submission Guaranty Our submission guaranty payable to the City of Sioux Falls, in the amount of $10,000, has been provided to meet the requirement of the lt is enclosed with the original proposal submitted by Paramedim Plus. PARAMEDICS PLUS ~Partners in Building Award~Winning EMS Systems Paramedics Plus 9 :\AD\002\02\2X02\2X02177.docx 163 :\AD\002\02\2X02\2X02177.docx QUALIFICATION REQUIREMENTS ORGANIZATIONAL DISCLOSURES 1. Organizational Ownership and Legal Structure In its legal structure, Paramedics Plus is a Texas limited liability company, operating as an indirect subsidiary of East Texas Medical Center Regional Healthcare System (ETMC) based in Tyler, Texas, and a for?profit, wholly? owned subsidiary of East Texas Medical Center Regional Health Services, Inc. ETMC operates East Texas Medical Center Emergency Medical Services (ETMC EMS), which is the largest ambulance provider in the State of Texas. ETMC is a Texas non?member, non?stock, non?pro?t corporation organized under the Texas Non?Pro?t Corporation Act, and as a 501 organization, is exempt from federal income taxation. In addition to ETMC EMS and Paramedics Plus, ETMC owns and operates 14 non?pro?t, tax-exempt hospitals in the East Texas area and provides other health care related activities through an array of free-standing clinics, as well as treatment and rehabilitation centers. PARAMILMCS "Partners. in grinding llwmuz-V?immag Systems I Paramedics Plus 10 164 QUALIFICATION REQUIREMENTS ORGANIZATIONAL DISCLOSURES A three-person Board of Managers guides the business affairs of Paramedics Plus. The Board of Managers consists of Elmer C. Ellis, Chairman of Paramedics Plus and President and Chief Executive Of?cer of Ronald Schwartz, President of Paramedics Plus and Vice President and Chief Operating Of?cer of and Byron Hale, Chief Financial Officer of Paramedics Plus and Senior Vice President and Chief Financial Of?cer of ETMC. A detailed organizational chart is provided in Appendix 1. Since winning its ?rst contract in 1998, Paramedics Plus has specialized in serving communities that desire that special combination of clinical excellence and economic efficiency. Paramedics Plus is committed to partnering only in those systems where the abilities of our organization match the needs of the communities. We want to build partnerships, notiust acquire another contract. Paramedics Plus is a for-pro?t organization but it was created by a non-profit hospital and an EMS visionary, which gives us a perspective unlike most, a perspective which puts patients and promises before profits. What is more, our organizational structure allows us to be agile and responsive to the communities we serve. The organizational structure of Paramedics Plus supports its focus on providing the highest quality clinical care possible, combined with operational ef?ciencies that keep costs to communities low. In each community where EAST TEXAS MEDICAL CENTER PARAMEDICS PLUS PINELLAS CO. OPERATIONS (SUNSTAR) OPERATIONS (T RAA) ALAM EDA COUNTY OPERATIONS Fmtumt-ittC?S PLUZ: f? u?nvrm Unilatan '\w.usl Whmmo EMS by-zxern . Paramedics Plus 11 :\AD\002\02\2X02\2X02177.docx 165 :\AD\002\02\2X02\2X02177.docx QUALIFICATION REQUIREMENTS ORGANIZATIONAL DISCLOSURES Paramedics Plus is engaged, we have used partnerships to provide compassionate quality care and service built around the needs of the patients and communities we serve. Energized over the past three years with new leadership in the President and Vice President positions, Paramedics Plus is building on its successful history with renewed focus on an even brighter future. As always, the organization is committed to putting patients first, keeping its promises and creating strong partnerships. Care Plus Values emphasize our commitment to patients, employees and the communities we serve through a culture that is accountable, ethical, respectful, safe and just. Paramedics Plus is structured to support local initiatives. The relatively flat organizational structure facilitates unencumbered responsiveness to local operations. While national support is provided for such important functions as clinical benchmarking, the emphasis is on support for bottom up medical direction and data-driven local management decisions. That is how Paramedics Plus builds world?class EMS systems. Paramedics Plus 12 166 :\AD\002\02\2X02\2X02177.docx QUALIFICATION REQUIREMENTS ORGANIZATIONAL DISCLOSURES 2. Continuity ofBusiness Paramedics Plus was created in June 1998 as a Texas limited liability company, as explained above. It has operated under the name Paramedics Plus since that time. In some systems we serve, the public name used is dictated by the contracting agency. For example, in Pinellas, FL the public name of the operation is Sunstar EMS. In Fort Wayne, IN, we operate under the name TRAA or Three Rivers Ambulance Authority. In all contract dealings, we are Paramedics Plus, L.L.C. or Paramedics Plus. The articles of organization for Paramedics Plus are provided in Appendix 2. An example of an "affidavit for registration of fictitious name? is provided in Appendix 3. 3. Licenses and Permits Paramedics Plus does not yet have a Sioux Falls or South Dakota operation and therefore does not have state or local licenses or permits. Paramedics Plus will begin the process of acquiring all necessary licenses and permits as soon as the ?Notice of Intent to Award? is issued. Examples of licenses and permits from other operations are included in Appendix 4. 4. Government Investigations East Texas Medical Center, the parent organization of Paramedics Plus, has not had an investigation from any federal, state or local government regulatory entity in the past ?ve years. One Paramedics Plus operation has had one OSHA investigation during the past five years. The citation and resolution are provided in an electronic format and separate from this document. Paramedics Plus 13 167 QUALIFICATION REQUIREMENTS ORGANIZATIONAL DISCLOSURES 5. Litigation Paramedics Plus seeks to have everything go right all of the time with its customers and patients. Some time we err and or at least our patients think that we do. When complaints are made we do our level best to resolve Uiose complaints to the satisfaction of the complainant. Sometimes we are successful and sometimes not When a complaint isn't resolved, it becomes a claim against the company and its operation. These claims are then filed with our insurance carriers. We have Malpractice, Auto, General Liability, and Worker 's compensation carriers. These insurance companies investigate the complaint(s) and determine whether the patient should be compensated for his or her injury, pain, or loss. Sometimes the claim is determined to be without merit and thus dismissed. When a complaint becomes a claim and our good carriers are unable to resolve it, the claim then becomes a court complaint lodged against us. 'l'here are very few legal claims made against Paramedics Plus. The writer knows of one case and the case is fully covered by insurance and will have no impact on the financial condition of the proposer. There are claims outstanding against the company. They have not yet become settled or resulted in a court filing by a complainant. A few could result in litigation but if our history holds, they are likely to be resolved by the insurance carrier. They are provided on a CD ROM. This information should be kept con?dential and privileged, free From public One other court complaint was lodged against Paramedics Plus in October 2010. This case was resolved in October 2013 in favor of Paramedics Plus. The filing and disposition are included in the appendices as well. f? ofHu?r' to Building 5 yu?u?'n. Paramedics Plus 14 :\AD\002\02\2X02\2X02177.docx :\AD\002\02\2X02\2X02177.docx QUALIFICATION REQUIREMENTE FINANCIAL STRENGTH AND STABILITY The Proposer must provide documentation of its financial strength and stability as a going concern. The Proposer must satisfy the that it can financially support the services covered in this RFP and be able to afford losses that may arise from inaccurate estimates of revenue, expenses, fines, and resource requirements necessary to comply with the performance standards Identi?ed In this RFP. Documentation shall include: 1. Firmncial Statements Provide year-end financial statements for the last three years that support the organization?s financial ability to perform the services included in this RFP and the Proposal. (Submitted in separate envelope labeled ?Financial Statements. Paramedics Plus, LLC, as an operating entity of East Toms Medical Center Regional Healthcare System (ETMC), is reported as part of the consolidated ?nancial statements of ETMC. In addition to the audited financial statemean discussed below, unaudited consolidated ?nancial statemean are provided for the ten months ended August 31, 2014. Chief Financial Officer Byron Hale, certifies these unaudited financial statements. Financial statements are included wider separate cover labeled "Financial Statements." Unaudited financial statements for Paramedics Plus, LLC for the ?scal years ended October 2013, 20l2, and 2011 are also included for reference Paramedics l?lus has a long financial history demonstrating a strong pattern of managed growth combined with a low debt- to?equity ratio and ample liquidity. A unique characteristic of ETMC Paramedics Plus is the fact that ETMC, as a whole, is a fully diversified healthcare system. Due to Uiis diversity we can more capably withstand challenges in particular markets or industry segments, unlike companies solely providing ambulance services or not as diversi ficd. The financial strength of Paramedics Plus is shown in our most recent ?nancial statements. ETMC has sufficient capital to provide for implementation and start-up of Uiis contract. At August 31, 2014, and October 3l, 20I3, respectively, MC had and $290,509,000 in working capital (current assets minus current liabilities). The current ratio (Ctm'ent assets divided by current liabilities) for these periods was 4.05 to 1 and 3.62 to 1, respectively. Additionally, the quick ratio (cash 8: equivalents divided by current liabilities) further indicates strengthening liquidity at 3.49 to 1 and 3.02 to 1, respectively. lfl'MC/ Paramedics l?lus has signi?cant financial reserves that will enable it to sustain the Sioux Falls operation. At August 31, 2014, and October 31, 2013, respectively, had $429,341,100 and 5435,11 9,000 in total net assets (equity). Of these total net assets, $422,050,000 and $428,7l7,000 were unrestricted as to use. lI'il?H'll?i?i?. Il'tu?f' It: tluul?unf- '\vJ nu Curl}: ?u-Ju'u Paramedics Plus 15 169 :\AD\002\02\2X02\2X02177.docx QUALIFICATION FINANCIAL STRENGTH AND STABILITY 2. Audited tutemen ts Provide Independently audited financial statements for the most recent fiscal year. (Submitted in separate envelope labeled ?Financial Statements Consolidated audited financial statements are attached for the ?scal years ended October 31, 2013, 2012, and 2011. 3. financial Commitments Provide a list of commitmen ts. and potential commitments, which may impact assets, lines of credit, guarantor letters or otherwise affect the responders ability to perform the Contract. Paramedics Plus has no existing or potential tinandal commitmean that will in any way impact our ability to perform this fon tract. Any new operation will likely incur unforeseen expenditures. 'l'hrough our budgeting process, we believe we have minimized these occurrences. With that said, ETMC will guarantee the ?nancial and operational performance of Paramedics I?lus under the terms of the contract with which is evidenced by a letter of assurance from the Ix'l'h'lC?fs Chief Financial Of?cer found in Appendix? 5. Paramedics Plus has a very low leverage ratio. At August 31, 2014 the rah'o was .95 to 1 compared to .89 to at October 31, 2013. Long?term debt is incurred largely through issuing bonds for the purpose of capital improvements such as addiu'ons to and replacements of hospital facilities. Iospital systems such as ETth should be expected to have higher leverage in comparison to other segments of the healthcare industry. Debt instruments are integral in financing capital-intensive projects such as hospitals and clinics. has. managed this extremely well, maintaining leverage near to and maintaining excellent interest coverage. The financial stability of Paramedic; Plus is shown through the history of our ?nancial statements. A few key points to make are: 0 Revenue has been stable, and operating expenses have been controlled. 0 Cash flow from operations has been positive every period. Operating cash ?ows provide the funds to invest and finance the growth of the company. 0 The company has maintained and increased liquidity through the years. The current ratio at October 31, 2012, was 3.47 to I. At October 3] 201], it stood at 3.58 to l. If'tu?r- donning on cot: Paramedics Plus to 170 QUALIFICATION FINANCIAL STRENGTH AND STABILITY 4. Working Capital The Proposer shall describe Its working capital sources and quantity the amount it expects to need for startup and improvements to the EMS system. The information shall Include the estimated amount of start-up capital required to tinam administration and ambulance operations for the first six (6) months of the Agreement. include the source of this capital and if any part of it will be borrowed, include verification from a financial institution that your organization is approved or pre- qualified to bonow sufficient funds. With $323,153,000 in working capital as shown in our August 3] 2014 ?nancial statements, Paramedics Plus has ample ?nancial resources to support the addition of San Falls into the family of Paramedics Plus operations. We estimate operations will require $570,000 in working capital to fund the initial startup until cash ?ow from billing activities begins. This working capital will be funded from existing cash ?ow of Paramedics Plus operations. 5. Performance Security The Proposer shall document its method and ability to provide the required performance security. ICI Paramedics Plus will furnish a performance bond in the amount of one million dollars ($1,000,000) as required in the request for proposals. 6. Financial Interests The Proposer shall disclose and describe any ?nancial Interests in related businesses. If is a diversi?ed healthcare system, which in addition to Paramedics Plus, holds 14 hospitals, physician clinic network, home health agency, health insurance brokerage, administration services, and health network exchange. u?sn-n? In t1.n.lttm' us. cult- 'nv Paramedics Plus 17 :\AD\002\02\2X02\2X02177.docx 171 QUALIFICATION REQUIREMENTS EXPERIENCE AS SOLE PROVIDER C. 1. Comparable Experience The Proposer must document the areas in which it has provided comparable services to those outlined in this RFP in the past five years, the locations of these services, population, description of services and a jurisdictional contact This dowment shall include a letter from a government official confirming the provision of exclusive 91 1-paramedics ambulance service and the length of time such services have been provided. ANNUAL ALS SERVICE AREA POPULATION TRANSPORTS UNITS SERVICES PROVIDED Sunstar Pinellas 929,048 146,324 71 911 Emergency and County, FL Non?Emergency including Communications Alameda County, CA 1,578,891 87,389 65 911 Emergency and Non-Emergency Fort Wayne, IN 256,496 24,605 14 911 Emergency and Non-Emergency including Communications Waco, TX 129,030 19,498 14 911 Emergency and Non-Emergency including Communications [urisdictional Contact Information Craig A. I Iare Direct of Emergency Services I?inellas (bunty Emergency Medical Services 12490 Ulmerlon Road, Suite I34 Largo, FL 33774 Phone: 727 583-5752 Email: cliare@pinellascountyorg Alex Briscoe Director Alameda County Health Care Services Agency 1000 San Leandro Boulevard, Suite 300 San Leandro, A 94577 Phone: 510 618-3452 I Email: :\AD\002\02\2X02\2X02177.docx .4 .l . I . .. 1.. Paramedics Plus 18 172 QUALIFICATION REQUIREMENTS EXPERIENCE AS SOLE PROVIDER Gary Booher Executive Director 525 Hayden Street Fort Wayne, IN 47802 Phone: 260 420-6500 Email: Yost Zakhary Chair McLennan County EMS Seven Member City Contract 922 Estates Drive Woodway, TX 76712 Phone: 254 772-4480 Email: Yzakhary@woodwaymail.org Letters verifying services provided and length of service are provided in Appendix 6. Additional letters of reference are also available in Appendix 6. Paramedics Plus is proud of its performance in each of its operations including large high- performance systems in Florida and California. The Three Rivers Ambulance Authority system in Fort Wayne, IN has an equally impressive track record in a smaller system. In addition, we have provided information about Waco, TX, another small system, which is served by our sister organization, ETMC EMS. Paramedics Plus values each contract whether large or small and, in every instance, works transparently with the communities, governmental authority and other partners to provide quality out-of?hospital care, satisfied customers and cost efficiencies. Paramedics Plus has served since 2004 as the exclusive provider of paramedic level 911 ambulances for Pinellas County, Florida, which has a population of more than 929,048 and four million visitors annually. The Florida operation was awarded the 2009 Florida Governor?s Sterling Award, the state?s highest quality honor in a program utilizing the Malcolm Baldrige criteria, and the only ambulance service ever honored with this award. The Florida system is one of only two Paramedics Plus 19 :\AD\002\02\2X02\2X02177.docx QUALIFICATION REQUIREMENTS EXPERIENCE AS SOLE PROVIDER systems in the nation to hold accreditation from all of the top accrediting agencies in EMS: the Commission on the Accreditation of Ambulance Services (CAAS), the Commission on Accreditation of Medical Transport Systems (CAMTS) and the Accredited Center of Excellence (ACE) by the National International Academies of Emergency Dispatch. In late 2010, Paramedics Plus assumed the contract for emergency ambulance transport service in Alameda County, California. With a population of more than 1.5 million, the service area has pockets of high population density as well as pockets of wilderness. Paramedics Plus has met the challenges and contract requirements in this high- performance system Where Paramedics Plus is responsible for the daily operation including patient care, personnel management, ?eet and equipment maintenance, clinical monitoring and training. In this system, Paramedics Plus forged a strong relationship with the Alameda County Fire Department, which assumed a new role of emergency medical dispatch. In Fort Wayne, IN, with a population of 256,496, the Paramedics Plus contract has been renewed for an additional five years because of performance that meets or exceeds all contract requirements under stringent response time standards. All Paramedics Plus operations are accredited by the Commission on the Accreditation of Ambulance Services (CAAS) and the National Association of Emergency Dispatchers (NAED). ETMC EMS, which serves Waco, TX, is also accredited by CAAS and AED. Paramedics Plus 20 :\AD\002\02\2X02\2X02177.docx QUALIFICATION REQUIREMENTS EXPERIENCE AS SOLE PROVIDER 2. Government contracts The Proposer shall provide a list of exclusive service area emergency ambulance service contracts complete or ongoing during the last five years, including the term or date of termination of the agree- ment the services provided, the dollar amount of the agreement and the contracting entity. GOVERNMENT CONTRACTS I CONTRACTING ENTITY SERVICES DATE OF DATE OF I DOLLAR PROVIDED TERMINATION AMOUNT OF AGREEMENT ANNUALLY Emergency Medical Exclusive Paramedic November 1, 1998 October, 31, 2013 $56 Mil Services Authority level Emergency and 1417 North Lansing Non-Emergency, Tulsa. OK 74106 Advanced Life Support I - Pinellas County FL Exclusive Paramedic November 1 2004 November 1, 2015 $42 Craig A. Hare. MBA. Level Emergency and Paramedic Non-Emergency, EMS Division Manager Advanced Life Support Pinellas County Public Safety Services Emergency Medical Services Division 12490 Ulmerton Rd Largo, Florida 33774 Three Rivers Ambulance Exclusive Paramedic July 1, 2009 July 1, 2017 with 8 Mil Authority, Fort Wayne, IN Level Emergency and eligibility for a 3-year Non-Emergency. extension pushing Advanced Life Support the expiration date to 2020 PLUS It) Sundrfi.) 51"."an CONT.) Paramedics Plus 21 :\AD\002\02\2X02\2X02177.docx 175 QUALIFICATION REQUIREMENTS EXPERIENCE AS SOLE PROVIDER GOVERNMENT CONTRACTS CONTRACTING ENTITY SERVICES DATE OF DATE OF DOLLAR PROVIDED TERMINATION AMOUNT OFAGREEMENT ANNUALLY Paramedics Plus Exclusive Paramedic November 1, 2011 October 31, 2016 $50 Mi Alameda County, CA Level Emergency with eligibility for a Alex Briscoe Advanced Life Support five-year extension Director of ALCO Health pushing the expira- Care Services Agency tion date to 2021 1000 San Leandro Blvd, Suite 200 San Leandro. CA 94577 3. Contract Compliance The Proposer shall detail any occurrence of its failure or refusal to complete a contract with a govemmenml entity for which the Proposer was providing emergency ambulance sen/ices. At no time since its founding in 1998 has Paramedics Plus failed or refused to complete a contract, nor has it ever been in material breach of a contract. l'nluumilJlCi PLUS Paramedics Plus 22 :\AD\002\02\2X02\2X02177.docx 176 QUALIFICATION REQUIREMENTS DEMONSTRATED RESPONSE TIME PERFORMANCE The Proposer must demonstrate its ability to comply with response times by documenting experience in operation and managing an ambulance service that is required to comply with specified emergency response times based upon fractile compliance or otherwise meet response time requirements similar to those required in this RFP. Documentation may include reports provided to government oversight entities and letters confirming compliance with mandated response times. Paramedics Plus has a track record of relentless dedication to all contractual requirements with particular focus on response time performance. Call-by?call, hour- by-hour, Paramedics Plus pursues compliance through a persistent focus on operational details as well as creative solutions including development of proprietary software and an award?winning process which ultimately results in reliable achievement of stringent response time performance standards. Paramedics Plus has consistently achieved response time compliance under the most stringent requirements. For example, the Paramedics Plus Alameda County contract requires an ALS ambulance on the scene of each life threatening emergency, as presumptively determined in accordance with MPDS, within 8:59 minutes on not less than 90% of all life threatening emergency transports. This contract has sixty-one response areas in which to achieve and maintain compliance. While compliance numbers are reported here for the past year, Paramedics Plus is proud to share its record since contract inception in 2011. The Paramedics Plus contract with Pinellas County, FL, currently requires an ALS ambulance on the scene of each life threatening emergency, as presumptively determined in accordance with MPDS, within 10 minutes on not less than 90% of all life threatening emergency transports. Again, Paramedics Plus is pleased to share compliance numbers and reports since contract inception in 2005. Compliance performance for the past year is reported on the following page. Paramedics Plus 23 :\AD\002\02\2X02\2X02177.docx QUALIFICATION REQUIREMENTS DEMONSTRATED RESPONSE TIME PERFORMANCE The current contract for Three Rivers an ALS ambulance on the scene of each life Ambulance Authority in Ft Wayne, IN, threatening emergency, as presumptively requires an A LS ambulance on the scene determined in accordance with MPDS, within of each life threatening emergency, as 8:59 minutes on not less than 90% of all life presumptiver determined in accordance With threatening emergency transports. Ml?l)S within 8:30 minutes on not less than I a . . . Response lime (ompliance Reports submitted 90% of all Priority 1 emergency responsesgovemmentovers'ight entities and showmg Complete compliance data 18 available Since 2009 all priorities and contractual times for the most recent twelve month period August I, 2013 to The Waco, TX, contract is held by Paramedics Iuly 31, 2014 are provided in Appendix 7 for Plus? sister organization, EMS, and Paramedics Plus service areas and EIMC EMS has been since 2003. The contract requires Waco service area. rPriority 1 Response Time Compliance 0 Pinellas Ft. Wayne, Alameda Waco. County, FL IN County, CA Aug. 2013 94.44% 92.69% 97.87% 93.00% Sept. 2013 93.36% 90.68% 97.41 90.00% Oct. 2013 93.18% 90.48% 96.97% 92.00% Nov. 2013 94.50% 92.25% 97.33% 91 00% Dec. 2013 93.70% 91.56% 96.93% 91.00% Jan. 2014 93.42% 93.25% 96.96% 92.00% Feb. 2014 92.47% 90.44% 97.04% 90.00% Mar. 2014 93.27% 92.37% 97.23% 91 .00% Apr. 2014 92.71% 93.31% 97.76% 93.00% May 2014 93.86% 93.78% 97.21% 91.00% Jun. 2014 93.52% 90.71% 97.64% 92.00% Jul. 2014 93.67% 91 96% 97.89% 90.00% ?Waco, TX, is a contract of 15 EMS, sister organization to Paramedics Plus. f' In (Lulduio 11w u'f?o ?mam-.1 1303?.? . Paramedics Plus 24 :\AD\002\02\2X02\2X02177.docx 178 :\AD\002\02\2X02\2X02177.docx QUALIFICATION REQUIREMENTS HIGH LEVEL CLINICAL CARE 8: SOPHISTICATED SYSTEMS The Proposer must provide documentation of its demonstrated ability to provide high-level clinical care. The Proposer shall provide information and documentation of existing clinical strength in order to demonstrate the organization?s ability to manage the clinical aspects of the service. The Proposer shall document existing sophisticated internal management systems and programs that facilitate its management of its service. Documentation may include descriptions of clinical sophistication and high levels of performance in systems in which it operates. The organization should describe how it ensures consistent, high- quality clinical care and how it is able to verify and document its clinical performance. Paramedics Plus operates nationally recognized, patient-centric EMS systems, meets stringent response time standards, excels in clinical quality and improvement models, benefits from solid financial backing and produces superior customer service in a culture of fairness and family for its employees. Our clinical efforts gained national attention when two Paramedics Plus communities were named among the top five in the country in a LISA. Today study, which compared cardiac arrest survival rates among large urban EMS systems. Our efforts also led to a host of awards including the Florida Sterling award, a quality award based on Baldrige criteria, and as far as we can determine, the highest award for quality won by an EMS organization anywhere in the United States. All of our systems are accredited by the Commission on the Accreditation of Ambulance Services. In each of the systems where our employees provide the dispatch function, we are accredited by the National Academy of Emergency Dispatch. In systems where a community partner such as PSAP or the Fire Services dispatches our medics, we have cultivated highly successful relationships that are collegial and efficient. V'Hu'i?. -x on In! L's'in. in; half? it my. Paramedics Plus 25 179 :\AD\002\02\2X02\2X02177.docx QUALIFICATION REQUIREMENTS HIGH LEVEL CLINICAL CARE 8: SOPHISTICATED SYSTEMS Excellent clinical care has many components in EMS, from a well-qualified and trained cadre of medics who possess great customer service skills, to a deployment plan that ensures that well?maintained ambulances and equipment arrive at the scene We start by hiring the right people. As you will read in this proposal, we first screen qualified applicants, using the expertise of a national third party administrator, to identify those individuals with the right attitudes and attributes to work in EMS. Once selected, we carefully train and test these credentialed individuals. More about training and qualifications is provided in X. Core Requirements 3. Minimum Clinical Levels and Sta??ing Requirements. We create and sustain a culture where near misses and honest human error are seen as opportunities for learning. Self?reporting is common and provides a chance for improvement. We then arm these valuable Paramedics and EMTs with state-of?the-art medical equipment, plus power cots and other specialized equipment to keep both medics and patients safe. We partner with medical oversight to ensure that the latest clinical protocols are followed. Our systems show, that medics are compliant with medical protocols as much as 99% of the time. We monitor compliance with protocols and skill competency, and use a proven CQI program to analyze the facts, study the problem, and plan and test improvements. We carefully monitor and continually improve the care for clinical conditions that make the most difference in patient outcomes. Those include: 0 Airway Management 0 Resuscitation 0 STEMI Stroke 0 Respiratory Distress 0 Severe Trauma 0 Management of Pain and Discomfort 0 Patient Safety ?l Paramedics Plus 26 180 :\AD\002\02\2X02\2X02177.docx QUALIFICATION REQUIREMENTS HIGH LEVEL CLINICAL CARE SOPHISTICATED SYSTEMS Details on how we have made a difference in these areas can be found in X1. Competitive Criteria A. Clinical 2. Clinical and Operational Benchmarking. We connect key performance indicators to improvements and education. More on our proposed benchmarking and KPIs is found in X1. Competitive Criteria A. Clinical 2. Clinical and Operational Benchmarking. Our management team is experienced, academically prepared and supported with the latest technology so that deployment plans are designed with pinpoint ef?ciencies, each clinical element in the can be retrieved, and analyzed and all decisions can be fact-based. Cutting edge tools include a proprietary application of Tableau, the PULSE suite of products, among others. Other evidence of our clinical sophistication is seen in the number of clinical innovations in which our systems have participated. From an early adopter of CPAP to adaptation of an enhanced "pit crew? model of resuscitation team dynamics, Paramedics Plus has, along with its local medical oversight, been on the cutting edge of new approaches. More information on our clinical innovations is provided in XI. A. Clinical 2. Clinical and Operational Benchmarking. Our leadership is also evidenced in other ways. A strategic planning process involving Paramedics Plus, local medical direction, and the Fire Service, led to a plan, which was used as a foundation by the U. S. Secretary of Transportation?s National Emergency Medical Services Advisory Council to develop national guidelines for EMS. Based on past and current performance, Paramedics Plus is more than qualified to provide sophisticated, higher level clinical care to the City of Sioux Falls. Our ability to implement a quality improvement program, to continually learn and evolve the care we provide will ensure that Sioux Falls citizens benefit from excellent pre-hosptial care. Paramedics Plus 27 181 CORE REQUIREMENTS FUNCTIONAL RESPONSIBILITIES . ..317 1. Basic Services 2. Services description Attestation: 0 BED . Egan Paramedics Plus understands and agrees to I'll comply without qualification to provisions, requirements, and commitments contained in Section IV. A. (1.- 2.) Paramedics Plus 28 :\AD\002\02\2X02\2X02177.docx 182 CORE REQUIREMENTS CLINICAL 1. Clinical Overview files for tracking certi?cation compliance 2. Medical Oversight and identifying impending expirations of certi?cations licenses. Attestation: . All training, certi?cations, licenses, etc., 29,33 Paramedics Plus understands and agrees to 5532 comply without qualification to provisions, requlred Of all employees for eaCh Classl?cauon requirements, and commitments contained in are built into the Ninth Brain certification/ seem" 3' licensure module. This process will also be used to track and ensure that all ambulance 3' Mlmmum Clinical Levels and Staf?ng personnel receive the required training de?ned Requirements in State and REMSA policies as well as the a) Ambulance Staffing Requirements following training and or certi?cations. All Ambulances rendering Emergency Ambulance Services under the Agreement shall be staffed and equipped to render Paramedic level care and transport with a minimum of one (1) state certified and locally certified Paramedic and one (1) state and locally certified EMT to respond to requests from the City designated PSAP. The Paramedic shall be the ultimate responsible caregiver for all patients and is required to accompany all patients in the back of the ambulance during transport. Paramedics Plus will staff each ALS ambulance with a minimum of one Paramedic and one EMT and ensure that all ambulance personnel responding to emergency medical requests have current licenses, accreditation requirements and credentials, as appropriate, to practice in the City. Paramedics Plus will use Ninth Brain software to electronically retain PDF copies of current and valid licenses and or certi?cations of all emergency medical personnel performing services under this Agreement. Ninth Brain allows real-time access to employee 4 a . -, .--. . gm", . Paramedics Plus 29 :\AD\002\02\2X02\2X02177.docx 183 CORE REQUIREMENTS CLINICAL b) Personnel Licensure and Certification and Training . . . . Requirements Posntlon Requnred Credentials Proposer shall describe how it intends to comply EMT State and County certification. with the training and certification requirements. The CPR, 100, 200 Proposer will delineate how these programs will be provided, by whom, and where and other information NIMS 700? State to help the REMSA understand the Proposer?s issued driver?s license' commitment to meet these Core Requirements. Paramedics Plus will meet all licensure and Paramedic State and county certification, certi?cation and training requirements of the CPR, ACLS, Request for Proposal. In each Paramedics PALS, ICS 100, 200 Plus site, licensure and certi?cations are NIMS 700, EVOC, state meticulously tracked and monitored, and a issued driver?s license major investment is made in providing timely Employees HIPAAtraining customer and effective training. The credentialing service and ?Just Culture" requirements and proposed training for Sioux Falls clinical personnel are described in the following charts. Paramedics Plus 30 :\AD\002\02\2X02\2X02177.docx 184 CORE REQUIREMENTS Always (care providers' role in billing and reinburserrent) Ql Process Overview Crew Resource Management (Scene choreography related to cardiac arrests, trauma alerts, and MCI) Mass Casualty and Incident Command Assaultive Behavior Management (and Crew Safety) EVOC driving training - initial and annual updates HIPAA training - initial and annual updates Homeland Security, Weapons of Mass Destruction, Terrorism, and Active Shooter Training training Initial orientation Continuing medical education Face-to-face Continuing medical education Annual face-to-face training Orientation and annual face-to?face or computer-based Continuing medil education Dir. of Clinical and Operations Services Collaboration medical director and other providers Supervrsor in collaboration with other Public Safety Personnel Local expertise Corp sta?? for initial certification Supervisor Local programs Ll 1 CA L. rTraining/Certi?cation Method Who Where Trauma Training- Continuing medil Local certification Local facility or education programs or local hospital, or EMS training site? New-hire orientation (Orientation On-llne and FTOs and/or Local PPlus facility agenda in Appendix 8) face-to-face supervisor components Customer Service I Providing the Continuing medical COO Local facility best patient experience education and annual face-to -face training Patient Care First- . Documentation Annual facevto-face COO Local PPlus facillty Local PPlus facrlity Local PPlus facility. or REMSA or other local facility Local PPlus facility or public safety partner Local PPlus facility Local PPlus facility Local PPlus facility or on line Local public safety partner or City letter of intent from Avera School of EMS is included in Appendix 9. All training provided to employees will be provided to RFMSA for approval. i?lrtt?l?lti?lb?i grim-rm in (smirimp 11w .rr. Winnirzo Paramedics Plus 31 :\AD\002\02\2X02\2X02177.docx 185 CORE REQUIREMENTS CLINICAL Trauma Training All Paramedics Plus personnel licensed as Paramedics will maintain or certification at all times. Each employee will receive ITLS training upon employment and bi-annually thereafter to ensure compliance and competency. Paramedics Plus will maintain a copy of current ITLS certification for each licensed and credentialed Paramedic. Company and EMS System Orientation and On-Going Preparedness All field personnel will successfully complete a Paramedics Plus orientation prior to assignment to emergency medical responses. Paramedics Plus develops and designs courses around specific local needs, requirements for re-licensure and accreditation as well as in response to CQI findings. A sample orientation schedule from one Paramedics Plus operation is included in Appendix 8. A similar orientation process will be designed and implemented based on the Sioux Falls/ REMSA needs to ensure a thorough and complete orientation. Preparation for Multicasualty Response Paramedics Plus will train all ambulance personnel and supervisory staff in their respective roles and responsibilities under the County Multi-Casualty Incident Plan to prepare them to function in the medical portion of the Incident Command System. All ?eld employees will, at minimum, complete ICS 200, 300 and NIMS 700 within six months from the start of the contract. All newly hired employees receive this training during the orientation process. Supervisory personnel also complete ICS 300 within one year of promotion. All supervisory personnel, and any others involved in disaster planning, complete the NIMS 800 course. All personnel also participate in an initial three-hour class to review the ICS principles and their relationship to Medical Branch Operations, Group and Division Supervisors, START Triage and the functions of Triage, Treatment, Transport, and Staging. Other Paramedics Plus 32 :\AD\002\02\2X02\2X02177.docx :\AD\002\02\2X02\2X02177.docx CORE REQUIREMENTS CLINICAL didactic education needed to ensure performance in the roles and responsibilities described by the MCIP will be included in this training as well. This review is repeated on a two-year cycle and augmented by functional drills and exercise participation. Additional related training will include the following: 0 All supervisory personnel will complete the Basic MCI Field Operations Training Course (8 hours) and the MFT Leader Course (16 hours) within one year of promotion. 0 All ALS personnel will participate in the Basic MCI Field Operations Training Course (8 hours). Assaultive Behavior Management Training Paramedics Plus understands that ?eld crews may, on occasion, ?nd themselves in volatile, uncontrolled situations. It is important that Paramedics and EMTs have the necessary skills to de-escalate potential con?icts. Paramedics Plus will conduct ongoing classes for all field and supervisory employees in Assaultive Behavior Management. Paramedics Plus has developed a proprietary class based on the proven "Verbal Judo? techniques to be taught initially during orientation with refresher topics during CE sessions. Driver Training Paramedics Plus will maintain an ongoing driver training program for ambulance personnel. The most dangerous phase of any emergency response is emergency driving. All Paramedics Plus employees who operate emergency vehicles are required to complete our comprehensive driving program, which incorporates the classroom portion of the Coaching the Emergency Vehicle Operator (Ambulance) course (CEVO) and the driving portion of the Emergency Vehicle Operators Course (EVOC). Further driving evaluation and training is conducted throughout the Field Training phase of probation. Throughout employment, employee driving is monitored, in real-time, by the SafeForce program ?1 {321If'l-f'. . :v Paramedics Plus 33 187 CORE REQUIREMENTS CLINICAL installed on all Paramedics Plus ambulances in Some of these plans and programs include Sioux Falls City. Employees who fail to meet an Infection Control Plan, Designated Officer driving standards are subject to retraining. Program, Blood-Borne Exposure Plan, Airborne Refreshed driver training is an annual course. Exposure Control Policy, Health Maintenance Program, In-I-Iouse Vaccination Program, Reports including data gathered through . . and Safety Committees. Crew monitoring is SafeForce are rev1ewed to ensure . also performed to ass15t employees in proper employees meet company driv1ng standards. . I infection control procedures. The Clinical and SafeForce scores are part of each employee 5 . . Operations Director oversees these programs, annual rev1ew. . . ensures compliance, and collects inCident data for tracking and trending. Paramedics Plus infection control plans fully comply with Federal OSHA standards 29 CFR 19 10.1030 and other applicable standards in the areas of occupational exposure to blood- borne, airborne, and other communicable pathogens. Key elements of these plans include: 0 All employees receive the necessary training and personal protective equipment needed for protection from communicable Infection Control disease (such as exam gloves in appropriate Paramedics Plus places a high value on a sizes, protection in carry-in bags and in safe and supportive environment, both for the unit, standard surgical masks, approved its own employees and its partners. In each respirators, combination visor-masks, location, Paramedics Plus provides multiple impervious gowns and shoe covers, Level programs that address infection control for protective suits, and full face respiratory employees, our system partners, and patients. masks) Employee pOliCies regarding the donning Of 0 24/ 7 availability for the appropriate personal protective equipment and workplace management of suspected or con?rmed guidelines, create awareness and education for employee exposures or diagnosis of infection control, which prov1des protection for communicable disease our patients. Paramedics Plus 34 :\AD\002\02\2X02\2X02177.docx 188 CORE REQUIREMENTS CLINICAL 0 All employees are provided necessary immunizations to prevent communicable diseases Seek to eliminate ?sharps? exposures to employees and partners; offer post-exposure prophylaxis treatment to employees Create a hazard communications (HazCom) program to inform and train employees and partners about the potential hazards of materials they may be exposed to while performing their duties. As an organization, provide information about chemical hazards and their control through our labeling, chemical inventory, Material Safety Data Sheets (MSDS) and training programs as detailed in the formal HazCom program. Education on the following-- 0 Infectious Process 0 Latex Allergy Guidelines 0 Bio-Terrorism Guidelines 0 Respiratory Protection 0 Hand Washing 0 Cleaning and Disinfecting 0 Bio-Hazardous Waste Disposal 0 Scene Management 0 Medical Surveillance 0 Post-Exposure Infectious Control. Each employee is trained in the Infection Control Plan during his or her initial orientation and prior to reassignment to an area at risk for exposure. Critical Incident Stress Management Paramedics Plus addresses crisis intervention for critical incidents through a comprehensive, integrated multi-component system that consists of a set of core interventions useful for public safety, schools, industry, communities, etc. A sample policy and the table of contents from our comprehensive plan are included in Appendix 10. Paramedics Plus offers an Employee Assistance Program (EAP) to assist employees with issues related to repetitive stress and "burnout." The EAP, which allows three visits at no cost to employees, is strictly confidential, except in cases where attendance is required by Paramedics Plus management. In those cases, Paramedics Plus is notified only that the employee did or did not attend. Paramedics Plus 35 :\AD\002\02\2X02\2X02177.docx 189 CORE REQUIREMENTS CLINICAL The EAP helps the employee to reduce stress and assists with issues that may impair professional conduct or patient care, as well as complications from the workplace that can affect home life. Paramedics Plus is dedicated to providing employees the opportunity to receive professional counseling without the worry of cost or fear of being ostracized in the workplace. A detailed description of the EAP process will be provided to the REMSA Contract Administrator for approval prior to the start of the contract. Homeland Security Paramedics Plus employees will receive training in Homeland Security issues by participating in existing programs within the City and those available through the Department of Homeland Security. Paramedics Plus will also actively participate in training sponsored by the City. HIPAA Compliance All employees are required to complete a I-IIPAA training course. Employment is contingent on successfully passing the post-course examination. Additionally, employees are required to sign a Workforce Member Health Information Confidentiality Agreement, which ensures that employees understand the importance of their roles in maintaining patient confidentiality. Please see Appendix 11 for the Workforce Member Health Information Confidentiality Agreement. Compliance Paramedics Plus is proud of its clean record of compliance with federal and state programs. Paramedics Plus will implement a compliance program specifically for the REMSA Sioux Falls City contract that will address required components. In addition, Paramedics Plus will contract with the legal consulting firm of Page, Wolfberg and Wirth, PLLS, nationally recognized as experts in Medicare compliance, to conduct an annual compliance audit. Paramedics Plus currently contracts with Page, Wolfberg and Wirth, PLLS for compliance training in other operations. Attestation: 0 8283 Paramedics Plus understands and agrees to noon . . . nu comply without qualification to prowsions, requirements, and commitments contained in Section IV. B. 3. . Us 1:.11 . i? . I. nah-:11 Paramedics Plus 36 :\AD\002\02\2X02\2X02177.docx :\AD\002\02\2X02\2X02177.docx CORE REQUIREMENTS OPERATIONS C. 1. Operations Overview Attestation: 0&0 . Saga Paramedics Plus understands and agrees to I'll comply without qualification to provisions, requirements, and commitments contained in Section 1. 2. Transport Requirement and Limitations Attestation: 0 S333 Paramedics Plus understands and agrees to nnua . . . . . . comply Without qualification to requirements, and commitments contained in Section IV.C.2. 3. Response Time Performance Requirements Attestation: 0:999 . saga Paramedics Plus understands and agrees to comply without qualification to provisions, requirements, and commitments contained in Section IV.C.3. 4. Noti?cation of Delays for Non-Emergency Response 5. Response Time Measurement Methodology Attestation: 0 89,38 Paramedics Plus understands and agrees to sag- comply without qualification to provisions, requirements, and commitments contained in Sec- tion IV.C.4 and IV.C.5. 6. Response Time Exceptions and Exception Requests Attestation: 0 8833 Paramedics Plus understands and agrees to man . . . comply without qualification to provrsions, requirements, and commitments contained in Section 7. Response Time Performance Reporting Procedures and Penalty Provisions Attestation: SE33 Paramedics Plus understands and agrees comply wrthout qualification to requirements, and commitments contained in Section IV.C.7. 8. Fleet Requirement 9. Coverage and Dedicated Ambulances, Use of Stations/Posts Attestation: 0 2833 Paramedics Plus understands and agrees to SIDED . . . . . nu comply Without qualification to prowsrons, requirements, and commitments contained in Section (8.-9.) Paramedics Plus 37 191 CORE REQUIREMENTS PERSONNEL TREATMENT OF INCUMBENT WORKERS 1. Treatment of Incumbent Workforce Proposer shall describe how it intends to maintain continuity of service in the system by employing current personnel and efforts to retain personnel throughout the term of the Agreement. Paramedics Plus proposes to: 0 Retain credentialed, licensed, drug-free employees who pass criminal background Checks 0 Provide a smooth transition from the current Contractor to Paramedics Plus while recognizing seniority 0 Offer an improved bene?t program 0 Employ veri?cation processes that assure REMSA that the workforce is properly credentialed, licensed and Federal Medicare program is acceptable 0 Recruit nationwide with an emphasis on local recruitment. Commitment to Current REMSA Employees Experienced employees are the key asset and a fundamental part of Paramedics Plus? commitment to those it serves. As recognition of past loyalty, experience and proven capabilities, Paramedics Plus will recognize that commitment to the current REMSA employees in the system by seeking to retain the existing workforce, those with the proper clinical credentials, who are drug-free, insurable, hold a valid South Dakota driver?s license, and pass criminal background checks. Paramedics Plus will hire all eligible staff level incumbent personnel, transferring them into Paramedics Plus employment while retaining original hire dates in the REMSA EMS system. Current employment seniority status used for the purposes of bidding shifts and partners, vacation/ paid time off accruals, and requests for vacation paid time off will be transferred to Paramedics Plus in accordance with the seniority list provided by the current Contractor. In the event that an accurate and complete seniority list is unavailable, Paramedics Plus will construct, prior to contract implementation, a seniority list based on the employee?s original date of hire. Paramedics Plus 38 :\AD\002\02\2X02\2X02177.docx 192 CORE REQUIREMENTS PERSONNEL - TREATMENT OF INCUMBENT WORKERS Wages and Bene?ts Paramedics Plus also commits to the REMSA system that the wage and bene?t program for all employees will be comparable or better than the employees? current program. While we have not been given the current wage employee the wages he or she was the date of the RFP release (July Paramedics Plus assumes the contr structure, Paramedics Plus will offer each Sioux Falls workforce. paid on 20I4) in addition to any regularly scheduled increases that take effect between July 18 and the lime act. The benefit package offered by Paramedics Plus and outlined below is an enhancement for the EMTs and PARAMEDICS Hours to be worked Starting hourly rates/scales Compensation increases Paid Time Off Bereavement Leave 42 hour work week; seven 12-hour shifts per two-week period. Every other weekend off Hourly rates as of July 18, 2014. plus any regularly scheduled salary increase which occurred between then and contract start Based on annual performance review Based on years of service. See PTO chart (next page) Three days plus an additional day if more than 150 mile travel is required Paid Holidays Nine per year EXEMPT EMPLOYEES (MANAGEMENT TEAM). 1 ADMINISTRATIVE AND SUPPORT Hours to be worked 40 hour work week; ?ve 8-hour shifts per week Salaries Commensurate with education and experience Compensation Based on annual performance review increases Paid Time Off Based on years of service. See PTO chart (next page) Bereavement Leave Three days plus an additional day If more than 150 mile travel is required Paid Holidays Nine per year V4.1 :\AD\002\02\2X02\2X02177.docx ln ortru-r- iiwun ?mnmu 5 ywi Paramedics Plus 39 193 c:tl'\ CORE REQUIREMENTS PERSONNEL TREATMENT OF INCUMBENT WORKERS for 42-HOUR WORK WEEK Earned Yearly Maximum Years of Service Per Pay Period Accrual Accrual 0-1 year 3.23 83.98 251.94 >1 year?4 years 6.46 167.96 503.88 )4 years_10 years >10 9.69 251.94 755.82 years 1 PTO for 40-HOUR WORK WEEK Earned Yearly Maximum Years of Service Per Pay Period Accrual Accrual 0-1 year 3.08 80.08 240.24 >1 year.4 years 5.23 135.98 407.94 >4 years_1o years 6.77 176.02 528.06 VidUW'li'r'lCt?: Parka timid-up an :va . :\AD\002\02\2X02\2X02177.docx Paramedics Plus 40 194 CORE REQUIREMENTS, PERSONNEL TREATMENT OF INCUMBENT WORKERS . Employee Rates per Pay Period for 2014 Subject to Change as Coverage Renews in 2015 FOR ALL . . (Paramedics Plus pays 75% of premium for health, EM PLOYE dental, vision; 100% for life and disability) Employee Employee plus one Employee family HEALTH INSURANCE Health Insurance Cigna $60.32 $121.01 $192.62 3 DENTAL PLAN OPTIONS OFFERED Dental NAP - Cigna $3.66 7.78 12.17 Dental PPO ?Cigna $3.66 7.78 12.17 Dental Buy-Up PPO - Cigna $7.02 14.93 23.35 2 VISION PLANS OFFERED Wsion Bene?ts Plan A VSP .86 1.26 2.25 Wsion Bene?ts Plan - VSP .93 1.35 2.41 EMPLOYER PAID DISABILITY COVERAGE Short Term Disability - Cigna 0 0 0 Long Term Disability Cigna 0 0 EMPLOYER PAID LIFE INSURANCE 8. ADD Basic Life Insurance Cigna 0 0 0 Accidental Death and Dismemberment Cigna 0 0 0 ltd: . -.: Huntiuv. uri?. 1511-? er?i. I-?aramcdics Plus 41 :\AD\002\02\2X02\2X02177.docx 195 CORE REQUIREMENTS PERSONNEL TREATMENT OF INCUMBENT WORKERS . . . 1 Additional Benefits Dependent Care Flexible Spending Account?tax-saving way to pay Spending Account for dependent care expenses Health Savings Account Fund to pay for deductible. coinsurance and other eligible medical expenses with tax-exempt dollars. Paramedics Plus contributes $1000 annually for employees with single coverage and $2000 annually for employees with dependent coverage 401K Paramedics Plus matches all employee contributions to the 401 plan up to a maximum of six percent compared to a three percent match offered by the largest EMS provider in the country. Employees are 100% vested at the end of three years of employment Employee Assistance Program Cigna's Life Assistance Programs provides access to in-person behavioral health assistance. telephone counseling and online tools. Up to three face-to-face visits with a counseling specialist are available to employees and families at no cost Health Rewards This Cigna program o??ers discounts of as much as Discount Program 60% for a full range of health and wellness programs and services Eligibility All regular full-lime newly hired employees working are eligible for benefits on the first of the month {nllm-ving 60 days of employment. 0 Spouse or domestic partner 0 Dependent children under age 26 0 Unmarried disabled children over the age of 26 Members of the incumbent workforce are eligible for bene?ts upon the hire date. with Paramedics Plus. Part?time employees working at least 30 hours each week are eligible for medical benefi Ls. Employees may elect medical and prescription drug coverage for dependents including: More details on benefits are provided in Appendix 12. Eligibility will be modi?ed in 2015 in compliance requiremenls of changing federal health care laws. :\AD\002\02\2X02\2X02177.docx l. u'lu?l" in "w Ilil 'fliuulmu cult. ?uuru'i Paramedics Plus 42 196 CORE REQUIREMENTS PERSONNEL TREATMENT OF INCUMBENT WORKERS Smooth Transition Any change in EMS service providers inherently causes stress and concern for incumbent employees, the winning Contractor and the EMS system. Assurance of employment stability is the key factor in a smooth transition. To minimize potential anxiety, Paramedics Plus will conduct open and periodic meetings with current EMS workers after award of the contract. These meetings will be set at times which will not interfere with the current work schedule and will include the introduction of the Leadership Team, a discussion of the Paramedics Plus philosophy of an employee- friendly environment, and assurance to employees of continued employment at current wages with seniority intact. REMSA will facilitate, support, and assist with these meetings to ensure a smooth transition. The transition process will be thoroughly described and employee questions answered. Paramedics Plus is proud of its history of seamless takeovers and will conduct an ef?cient process to provide all employees a smooth orientation to the organization. Several months prior to the commencement of the contract, the incumbent workforce will be established in the Paramedics Plus computer system in an orderly fashion to minimize any system disruption or employee hardship. Orientation sessions, for the purposes of gathering demographic data for the human resource and payroll systems, will be scheduled at times which will not interfere with the current work schedule. Other orientation sessions, for the purposes of insurance and 401(k) enrollment, will again be scheduled at times which will not interfere with the current work schedule. It should be noted that the workforce will receive hours worked at regular rates of pay for attending orientation sessions. FLUS- ~Pz-utnm's Budding EMS Systems Paramedics Plus 43 :\AD\002\02\2X02\2X02177.docx 197 CORE REQUIREMENTS PERSONNEL TREATMENT OF INCUMBENT WORKERS Current workforce members who wish to be considered for employment will undergo a criminal background check, a pre?employment drug screening, a motor vehicle operator?s license check and a required federal Medicare program check. These controls are required by the organization?s insurance carrier for general and professional liability coverage. Any new applicant for a position will undergo a more thorough vetting which will require an employee screening process through Avesta, a third party administrator, a physical exam and agility testing, plus the steps noted above for the incumbents. See Appendix 13 for Paramedics Plus requirements for employment and the employee selection process through Avesta. Neither the insurance carrier nor the company will approve hiring a prospective employee who has received a debarment from the Federal Medicare program, has felony or misdemeanor convictions related to driving under the influence, drug-related offenses, assault and battery, theft or sexual offenses including, but not limited to, rape, child abuse and spousal abuse. It should also be noted that Paramedics Plus will check the validity of all holders of licenses prior to employment at any Paramedics Plus worksite. Paramedics Plus maintains a database of current licensure, which is checked frequently for any expiration of licenses of employees. Driver?s licenses are run annually to confirm that the employees have valid licenses and to check for moving Violations or suspensions that would disqualify them as insured drivers with Paramedics Plus. Paramedics Plus has a robust nationwide recruiting program which enlists for all operations?a benefit to REMSA. This program seeks out local community colleges and also recruits Paramedics and EMTs on a national basis. This program works with the local community colleges to recruit students who live and work in the area. Paramedics Plus will also provide "ride alongs" to help enhance the experience of potential employee recruits. In addition, our employees are afforded the opportunity to transfer among all of the Paramedics Plus operations when open positions are available. Attestation: 009 8938 Paramedics Plus understands and agrees to gig? comply without qualification to provisions, requirements, and commitments contained in Section IV. D. 1. 2. Character; Competence and Professionalism of Personnel 3. Internal Health and Safety Programs 4. Evolving OSHA fr Other Regulatory Requirements 5 Discrimination Not Allowed Attestation: Paramedics Plus understands and agrees to comply without qualification to provisions, requirements, and commitments contained in Section IV.D. (2-5.) Paramedics Plus 44 :\AD\002\02\2X02\2X02177.docx CORE REQUIREMENTS MANAGEMENT E. Management 1. Data and Reporting Requirements Attestation: 82083 Paramedics Plus understands and agrees to $53? comply without qualification to provisions, requirements, and commitments contained in ection IV. E.1. Paramedics Plus 45 :\AD\002\02\2X02\2X02177.docx 199 CORE REQUIREMENTS EMS SYSTEM AND COMMUNITY F. EMS System and Community 1. Participation in EMS System Development 2. Accreditation Attestation: (lb 33% Paramedics Plus understands and agrees to comply without qualification to provisions, requirements, and commitments contained in Section IV. F. (1.-2.) 3. Multi-casualty/Disaster Response 4. Mutual Aid and Stand-by Services Attestation: 33 Paramedics Plus understands and agrees to "22 comply without qualification to provisions, requirements, and commitments contained in Section IV.F. (3.-4.) EDD 5. Permitted Subcontracting 6. Communities May Contract Level ofEffort Attestation: 0 SE 33 Paramedics Plus understands and agrees to ?nalcomply Without qualification to requirements, and commitments contained in Section IV. 7. Supply Exchange and Restock 8. Handling Service Inquiries and Complaints Attestation: 88ng Paramedics Plus understands and agrees to DEED . . . . . . comply Without qualification to prOVlSlonS, requirements, and commitments contained in Section IV.F. (7.-8.) Paramedics Plus 46 :\AD\002\02\2X02\2X02177.docx CORE REQUIREMENTS ADMINISTRATIVE PROVISIONS 6.1. No Subsidy System Attestation: Proposer understands and agrees to 252?: comply without qualification to provisions, requirements, and commitments contained in Section MG. (1). 2. Contractor Revenue Recovery Attestation: 0 Paramedics Plus understands and agrees to comply without qualification to provisions, requirements, and commitments contained in Section 3. Federal Healthcare Program Compliance Provisions Paramedics Plus is proud of its clean record of compliance with federal and state programs. Paramedics Plus will amend its existing compliance program specifically for the Sioux Falls contract as necessary to address necessary components. Paramedics Plus has a consulting relationship with the legal consulting firm of Page, Wolfberg and Wirth, PLLC, nationally recognized as experts in Medicare compliance, to conduct an annual compliance audit and best practices review. We will specifically engage them to expand the compliance review to include the required scope for this contract and provide the resulting report to REMSA within 120 days of the end of the contract year. 4. State Compliance Provisions Paramedics Plus understands the importance of compliance with state and local regulations, and fully commits to compliance. We have a long history not only of federal compliance, but also compliance with state and local laws, rules and regulations in the four states in which we operate. We will continue this practice in Sioux Falls by contracting with individuals with local experience for consultation and services. 5. Billing/Collection Services The 2011 Data Systems billing system used by Paramedics Plus is configured to provide access to data at any point in the billing process, resulting in greater transparency and accountability. Billing and collection services are segmented into distinct processes from initial PCR Creation to Reporting. Every patient transport is "touched" during each phase of our process and always with the underlying goal of achieving maximum compliant reimbursement. 2.. Paramedics Plus 47 :\AD\002\02\2X02\2X02177.docx CORE REQUIREMENTS ADMINISTRATIVE PROVISIONS Specifics of the five-step process include: 0 Billing Cycle Day 1-7: During this process transports are captured, coded, and audited for regulatory compliance PRIOR to initial billing to ensure ?clean claims" are billed. Patient insurance and demographic sweeps are applied to identify coverage wherever it Ti exists. 0 Billing Cycle Day 2-14: Claims are I submitted electronically or on paper within 48 hours of receipt of complete information. Currently, 75% of all claims are billed electronically, whether Medicare, Medicaid or commercial insurer. Charges will comply with the rates set and approved by the City of Sioux 0 Billing Cycle Week 2-8: Payments are posted, and all patient and insurance 0 Reporting: Available 24/7/365 of the Billing correspondence is reviewed. Accounts . Cycle: Our reporting tools provide real-time are updated within 24 hours of receipt to . . . . access to all information entered into the ensure that revenue Is reallzed as effluently as possible. SYStem- Every Patient account, call statistic, demographic resource, . Cycle week 3'16: Accounts are ?nancial information, etc., is continuously reselved thrOUgh secondary and tertiary available which allows monitoring of every payer billing within one week of primary part of the billing process payment, timely processing of refunds, and review of all payments to Collection at time of service With the ensure they are accurately applied. Finally, exception of long distance non-emergency all aged accounts are proactively reviewed transports, at no time does Paramedics and worked through the appeals process Plus ever attempt to collect from patients as appropriate. As necessary, accounts are at the time of service. We pride ourselves referred to outside collections for follow-up. in our patient-centric approach, Billing and collection, although necessary to support operations, take a backseat to patient care. Paramedics Plus 48 :\AD\002\02\2X02\2X02177.docx 202 :\AD\002\02\2X02\2X02177.docx CORE REQUIREMENTS ADMINISTRATIVE PROVISIONS It is the goal of Paramedics Plus that every patient and third party call be professionally and courteously handled with minimum wait times. Sioux Falls patients will access customer service through a designated toll-free number which maintains active customer service hours from 8 am. to 5 pm. Central daily, excluding holidays, and utilizes an after hours messaging system 24/ 7 which is answered the next business day. Some key Paramedics Plus policies and practices regarding billing and collections are: 0 Charity Assistance Compassionate patient care is the primary focus of all ETMC companies. This compassionate focus extends to our collection policies. All ETMC entities operate under a single charity policy. Charity care will be provided to patients without regard to age, sex, race, creed, color, or national origin and who are classi?ed as financially or medically indigent after submitting an application for charity assistance. The Charity Policy is attached in Appendix 14. The policy will be revised as necessary to include the Sioux Falls operation. 0 Uninsured Patient Discount In certain cases patients may not qualify for charity assistance. Nevertheless, large healthcare bills can be a strain on individuals without health insurance. For this reason, a discount from retail charges will be made available to all uninsured patients who do not qualify for charity assistance. 0 Automated Electronic Eligibility Searches - All patient accounts will be sent through automated electronic eligibility transactions to retrieve all appropriate insurance information. The result is that patients are assured of receiving all eligible bene?ts, many times without ever receiving a bill. 0 Uncollectible Accounts Once patient accounts are fully billed and remaining balances are determined to be uncollectible, the accounts are forwarded to private agencies for follow-up. Paramedics Plus utilizes agencies specializing in healthcare accounts that incorporate soft to medium collection practices. 6. Market Rights Paramedics Plus accepts that City/ REMSA will not enter into agreements with other providers for emergency ground ambulance response. Inoln?v I .1 . Paramedics Plus 49 203 :\AD\002\02\2X02\2X02177.docx CORE REQUIREMENTS ADMINISTRATIVE PROVISIONS 7. Service Expansion Paramedics Plus understands the requirements as stipulated in this section. 8. Accounting Procedures Invoicing and payment for services Paramedics Plus will pay City REMSA on or before the 30th day after receipt of invoice for ?nes or penalties and agrees that disputes should be resolved in this thirty-day period. Audits and Inspections Paramedics Plus agrees to maintain separate ?nancial records in accordance with Generally Accepted Accounting Principles (GAAP). Paramedics Plus will give City/ REMSA access to review any and all business records and will make them available at our local of?ce or a mutually agreeable location. Paramedics Plus agrees to all facets of this requirement. On an annual basis, Paramedics Plus will provide the City/ REMSA with consolidated audited financial statements and agrees to abide by this requirement. Paramedics Plus agrees to provide periodic reports in the format approved by the Contract Administrator to demonstrate billing compliance. 9. Insurance Provisions Attestation: 0 Paramedics Plus understands and agrees to 9822 comply without qualification to provisions, requirements, and commitments contained in Section IV.G. (3.-9.) Paramedics Plus will meet or exceed the insurance requirements and coverages as required by the City of Sioux Falls. Current Certificates of Insurance are submitted in Section Submission of Required Forms. Workers Compensation and Employer Liability Paramedics Plus workers? compensation coverage complies with the statutory limits. Our coverage also includes employer's liability at $1,000,000 per accident. Additionally, umbrella liability coverage sits atop the employer?s liability providing total coverage of $6,000,000 per accident. Liability Coverages 1. Commercial General Liability. The minimum limits required are $3,000,000 per occurrence and $5,000,000 aggregate. Paramedics Plus carries a primary commercial general liability policy with a limit of $1,000,000 per occurrence and $12,000,000 general aggregate; additionally, the company also carries an umbrella liability policy with a $5,000,000 limit per occurrence and aggregate, providing total coverage . ll: '1 lfl' Paramedics Plus 50 204 CORE REQUIREMENTS ADMINISTRATIVE PROVISIONS of $6,000,000 per occurrence and $17,000,000 aggregate, exceeding the requirement. 2. Professional Liability. Paramedics Plus professional liability coverage limits are currently $1,000,000 per occurrence and $3,000,000 aggregate. With the previously mentioned umbrella coverage, the combined limits are $6,000,000 per occurrence and $17,000,000 aggregate which exceeds the requirements of $2,000,000 per occurrence and $4,000,000 aggregate. 3. Automobile Liability. The minimum limits required are $3,000,000 per occurrence. Paramedics Plus carries a primary automobile liability policy with a limit of $2,000,000 per occurrence and an umbrella liability policy with a $5,000,000 limit per occurrence. Combined, Paramedics Plus has a limit of $7,000,000 per occurrence exceeding the requirement. Paramedics Plus agrees to name the City of Sioux Falls, its of?cers, employees, and the medical director as additional insureds on all policies except workers? compensation. 10. Hold Taxes/Contributions Paramedics Plus accepts the terms of this requirement. 11. Performance Security Bond Paramedics Plus will provide a performance bond as fulfillment of requirement. 12. Term ongreement Paramedics Plus accepts the terms of this requirement. 13. Earned Extension to Agreement Paramedics Plus accepts the terms of this requirement. 14. Continuous Service Delivery Paramedics Plus agrees to work with the City/ REMSA to ensure continuous and uninterrupted delivery of services in the event of a material breach. 15. Annual Performance Evaluation Attestation: 0 8833 Paramedics Plus understands and agrees to newcomply Without qualification to requirements, and commitments contained in Section IV.G. (10.45.) 16. Default and Provisions for Termination of the Agreement Paramedics Plus accepts the terms of this requirement. I.. Hi. .1 ll lnParamedics Plus 51 :\AD\002\02\2X02\2X02177.docx CORE REQUIREMENTS ADMINISTRATIVE PROVISIONS 17. Termination 22. "Lame Duck? Provisions Paramedics Plus accepts the terms of this Anesmion: . 0 requirement. 3333 Paramedics Plus understands and agrees to 2222 comply without qualification to provisions, 18. Emergency Takeover requirements, and commitments contained in Section IV.G. (16.-22.) Paramedics Plus accepts the terms of this requirement, 23. General Proviszons . . . Attestation: 19. Transmon Planning 0 383% Paramedics Plus understands and agrees to Paramedics Plus accepts the terms of this 923. comply without qualification to provisions, requirements, and commitments contained in requirement. Section IV. 6.23 20. Remedies Paramedics Plus accepts the terms of this requirement. 21. Provisions for Curing Material Breach and Emergency Take Over Paramedics Plus accepts the terms of this requirement. 7? . - Paramedics Plus 52 :\AD\002\02\2X02\2X02177.docx 206 COMPETITIVE CRITERIA CLINICAL - QUALITY IMPROVEMENT 1. Quality Improvement Paramedics Plus will meet all minimum requirements under Clinical?Quality Improvement and proposes to: 0 Fully support quality management program and Medical Director 0 Collaborate with REMSA and First Responders to determine clinical indicators 0 Employ a comprehensive quality management program based on our award winning application of Baldrige quality criteria 0 Utilize a clear, concise set of processes and practices that produce tangible improvements. Paramedics Plus will achieve higher levels of commitment under Clinical?Quality Management and proposes to: 0 Build a platform for quality management based on the Malcolm Baldrige Health Care Criteria for performance excellence 0 Lend the guidance of leaders experienced in the Baldrige quality management criteria to the REMSA system 0 Apply measurement, analysis and knowledge management to make fact-based decisions and focus on improvement 0 Use the Institute for Healthcare Breakthrough Series Model, the concepts of Six Sigma, and Baldrige criteria to improve processes and outcomes 0 Pursue and measure patient and employee satisfaction 0 Embrace the KPIs recommended by REMSA plus other clinical and operational KPIs shown to be significant in improving care or system efficiencies 0 Reap the benefits of a "Just Culture? as a framework to support quality improvement 0 Align education and training to quality improvement feedback Paramedics Plus 53 :\AD\002\02\2X02\2X02177.docx 207 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA CLINICAL - QUALITY IMPROVEMENT a) Minimum Requirements?Demonstrable Progressive Clinical Quality Improvement Proposers must commit to a clear, concise, and implementable set of processes and practices designed to produce tangible improvements for the patients and other customers served by the EMS system, the Proposer?s employees who serve the City, and the other agencies involved in the City/ REMSA system. Quality Improvement the Paramedics Plus Way Paramedics Plus has always focused on those things that make a difference and are proven to provide tangible results for our patients and community partners. And, we have a track record for implementing quality improvement programs to do just that. We concur with position that overly complex systems or processes are not required to execute an effective Clinical Quality Improvement program. Collecting more and more data simply for the purpose of having more data is, unfortunately, what most EMS providers do. That?s not the approach Paramedics Plus takes. Paramedics Plus accepts the requirements of quality management program and commits to fully engage in the process and support the REMSA Medical Director. We will respect, support and integrate with First Responders, Metro Communications and other community partners in the Clinical Quality Improvement program. How is Paramedics Plus Different? The foundation of any quality improvement program begins with a relentless focus on doing the right thing, for the right reason, in the right way. This focus, combined with measuring processes and outcome, drives changes to ensure high quality and cost ef?cient care. How does Paramedics Plus differ from others in its approach to clinical care and quality improvement? For one, Paramedics Plus is a true partner with medical oversight. While other organizations tout national committees on everything from medical director leadership to equipment evaluation, Paramedics Plus chooses to support the local Medical Director, the Medical Board, physicians, and other partners in the communitythin"; q. Elm-Erika; . mat-jars Paramedics Plus 54 208 COMPETITIVE CRITERIA CLINICAL - QUALITY IMPROVEMENT Paramedics Plus also differs from other organizations in that we aren?t one of the largest EMS providers in the country and we don?t want to be. We specialize in serving communities that want a clinically sophisticated EMS system at a cost they can afford. Paramedics Plus is committed to partnering only in those systems where the abilities of our organization match the needs of the communities. We want to build partnerships, not just acquire another contract. That said, we have demonstrated our ability to effectively and efficiently do the job, but we are also small enough so that each contract matters. We not only have the ability to focus on and measure the right things, but also the clinical agility to respond quickly to changes in pre-hospital medicine. Paramedics Plus prides itself on creating and nurturing partnerships. The importance of our partnership with medical oversight cannot be overstated. As important as medical oversight is to any great EMS system, the will, energy and resources of the ?eld crews and management team must match the commitment of the physicians involved to achieve success and our approach to quality management bears that out. Attestation: Ulla Paramedics Plus understands and agrees to comply without qualification to provisions, requirements, and commitments contained in Section b) Higher Levels of Commitment? Ouality Management Quality Management System Paramedics Plus has built its platform for quality management on the Malcolm Baldrige Health Care Criteria for performance excellence. The Paramedics Plus Florida operation adopted this management system in 2007 and was awarded the Florida Governor?s Sterling Award for Performance Excellence in 2009. The Sterling award is based entirely on the Malcolm Baldrige criteria. The Florida operation continues to use this system as a basis for quality management. Two members of the leadership team serve as Florida Sterling examiners; one of which is a lead examiner and is an active member on the Sterling Board of Examiners. A senior leader of the Florida operation assists other Paramedics Plus operations in employing the principles of this management system. Paramedics Plus is committed to implementing the Malcolm Baldrige quality management criteria in the City of Sioux Falls. The Baldrige-based quality management system utilized by Paramedics Plus consists of seven areas that help provide an organization with a systems perspective for managing, providing alignment and integration of all departments and efforts in order to achieve performance excellence. Paramedics Plus 55 :\AD\002\02\2X02\2X02177.docx :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRIIERIA CLINICAL - QUALITY IMPROVEMENT Leadership Paramedics I?lus Executive Leadership l'eam sets the direction for the company as a whole through the development of corporate-wide mission and vision statements and values. Mission, vision, and values are communicated to the local leadership teams who focus on ensuring these directions and values are deployed to all levels of the operation. This direction, along with the needs of the local community and stakeholders, are considered when developing strategic objectives and action plans. Paramedics Plus carefully selects leaders and provides training to develop their talent to meet the specific needs of the local community. Please see Key Personnel for more information on leadership training. Senior leaders serve as role models through their ethical behavior and personal involvement in creating commitment to quality care and services. 0 Our l?inellas team is a resource for Sioux Falls in that most of the team have been trained in Baldrige quality criteria and many have been trained to Six Sigma yellow belt level. Debbie Vass is among the resources available and is listed in our Key Personnel. She is currently a l'lorida Governor's Sterling Award, which is based entirely on Baldrige criteria and the highest quality award in the State of Florida. 0 liach Paramedics l?lus system has earned the stamp of approval from the Commission on Accreditation of Ambulance Services, the gold standard of EMS. Mission Statement: To provide compassionate quality (are and service built around the needs of the patients and communities we serve through effective partnerships. Vision Statement: To be the preferred EMS provider in the eyes of our patients. partners. and communities. Strategic Planning Strategic planning is a critical component of a successful FMS System. Without it, managers may spend their time putting out tires and reacting to individual complaints and issues, or ??avor of month" ideas for improvement. Without a plan, managers may also ?nd themselves working hard to change or improve something that does not impact their mission or vision, in other words, investing energy in things that don't need . . im rovement. (Jovernor Sterling Lead Examiner and helped steer her organization, Sunstar Paramedics, to achievement of the Florida m? Il'i?lL?: ar'ru-r- utilising "w ?iunhiu CM: ya; cm Paramedics Plus 56 210 COMPETITIVE CRITERIA CLINICAL - QUALITY IMPROVEMENT All Paramedics Plus locations perform strategic planning using a template to assist in balancing the needs of all stakeholders and ensuring that improvement initiatives are aligned to not only the Paramedics Plus mission and vision, but also the local vision of the communities. Our strategic plan also helps put the big picture in perspective for the leadership team, answering the questions: 0 here do we want to go? (goals) 0 How will we get there? (strategies) 0 What does success look like? (d esired outcomes, KI?ls, and targets benchmarks) 0 How are we doing? (performance measures results) 0 How can we improve? Below is a figure demonstrating U18 strategic planning process utiIiZed to connect visions and plans with measures of success. I. STRATEGIC PLANNING PROCESS Focus on Patimtts and Other Performance excellence and quality are judged by an organization's customers; therefore, engaging with and listening to our patients and customers is an important element of our quality management system. These inputs provide us with valuable feedback to improve the level of service offered. Patients are our key customer group and outcomes and assessment of their satisfaction are key performance measures. Patient satisfaction scores are consistently high in Paramedics Plus systerm. Satisfaction surveys rate a range of elements such as overall satisfaction, timeliness, knowledge skill, courtesy caring, and instructions explanations. l'ypically, more than 95% of respondents are satisfied. Cardiac arrest survival rates are excellent. Cardiac arrest survival rates for Paramedics l?lus systems are some of the best in the country. In every case, they are far better than the national average and, in most cases, they are in the top tier of EMS systems in the US. Across all locations, the average survival rate is 4193. thile these patients represent a very small percentage of overall responses, their condition is among the most time-sensitive, and response to these patients is indicative of how the system responds to all patients. Please see Section X1. r'l. 5. Competitive riteriu: [belts on Patients and Other Customers for more details on how Paramedics l?lus listens to and responds to customers. f? ur'tu-r~ Chit {uncrn Paramedics Plus 57 :\AD\002\02\2X02\2X02177.docx 211 COMPETITIVE CRITERIA CLINICAL - QUALITY IMPROVEMENT - - Measurement, Analysis Paramedics Plus uses scorecards and and Knowledge Management dashboards as primary methods to report key KPI 1 W. Edwards Deming has been quoted as per ormance measures S) ana yze an It . saying "In God we trust, all others bring are resu 5 data.? Having data is important, but only Key Performance Measures 'f th 'htth' .Ch 1 You measure 6 ?g 008mg In the section that follows on XI. A. 2. Clinical the r' ht thin to meas re and anal 1g and Operational Benchmarking, details are the performance results of those measures . . . prov1ded about the KPIS ParamedIcs Plus are VItal to and Improvmg initially proposes to track, as well as sources of per ormance. benchmarks. Those details include de?nitions, Individual facts and performance measures, frequency of reporting and data source. while signi?cant, are not effective for setting Paramedics Plus believes that clinical organlzational strategles. component indicators measured by all system participants of the quallty management system focuses are best grounded on evidence-based on the close ahgnment between analySIS and medicine and local considerations. performance reVIews, and the overall planning and decision making of the organization. v3Paramedics Plus 58 212 COMPETITIVE CRITERIA CLINICAL - QUALITY IMPROVEMENT KEY PERFORMANCE INDICATORS (KPIS) rResponse Times Iv success rate (system) P1 Arrive 859 lV success rate (provider type) P2 Arrive <11?9 IV success rate (individual) P3 Arrive P4 Arrive min (scheduled) Complaint management Arrive min (unscheduled) Paramedic skill retention Use of mutual aid Presumptive impressions at dispatch safety compared to field interventions AHA Mission Lifeline quality indicators CARES indicators Trauma scene time total pre-hospital scene time ACS scene time total pre-hospital scene time Safety KPIS I Stroke scene time 8. total pre-hospital scene time Employee injuries Vehicle collisions %Cardiac arrest survival Critical failures Time to first defibrillation (fractile) Consumer satisfaction Employee turnover Compliance with protocols, procedures and Employee satisfaction timelines (STEMI) Compliance with destinations (STEMI) Compliance with protocols, procedures and Additional Clinical Measures timelines (ACS) or STEMI who received ASA Compliance with destinations (ACS) of nap-traumatic chest pain patients Compliance with protocols, procedures and who received ASA timelines (Pulmonary edema) Avg time Of first medical oontactto 12-Lead EKG Compliance with protocols, procedures and Avg time from 12 lead to transport time it timelines (CHF) STEMI declared Compliance with protocols procedures (asthma) Non-traumatic chest pain, acute MI. Compliance with protocols, procedures and etc. patients 35 years old timelines (seizures) received 12 lead Compliance with protocols, procedures and Compliance with protocols, procedures and timelines (cardiac arrest) timelines (cardiac problems) Compliance with protocols, procedures and Average time to call Stroke when criteria met timelines (trauma) Average time to call Trauma Load 8- Go Compliance with protocols, procedures and Average time to Gail STEMI timelines (presumed stroke) Compliance with protocols. procedures and timelines (pm when Additional Operational Measures Total lost unit hours (UH) Lost unit hours by reason Cost per mile Late preventive maintenance Successful airway management (system) Successful airway management (provider type) Successful airway management (individual) 9L0: wirwr- in Building :sw..m Winnan ci?db? Paramedics Plus 59 :\AD\002\02\2X02\2X02177.docx 213 COMPETITIVE CRITERIA CLINICAL - QUALITY IMPROVEMENT Paramedics Plus recognizes that data 0 All Paramedics Plus locations perform collection and reporting is just one piece of annual employee surveys to assess a quality management system. In an effort the employees? levels of engagement/ to achieve performance excellence in key satisfaction. Survey results indicate areas, there must be goals (based on contract employee satisfaction rates of as high as requirements, industry benchmarks, strategic 89%. More information about employee planning initiatives to achieve the mission and surveys is found in XI.C. Competitive Criteria vision, etc.) and accountability. Paramedics - Personnel Workforce Engagement. Plus will work in conjunction with REMSA and the REMSA Medical Director to develop performance goals for key performance Paramedics Plus carefully selects qualified individuals, prepares them through classroom and field orientation, and measures. Performance compared to goals will continuously develops them to ensure they be a key factor for determining areas of focus have the knowledge and Skills to perform for Process Improvement? their duties, such as to competently and Workforce Focus confidently start IVs, intubate patients and provide other advanced skills, through Ensuring that employees are engaged and personal coaching /ment0r-mg and have the abilities to accomplish their roles multiple education and training Classes in achievmg the organization 5 m1551on is Offered annually. ore information on another key criteria for a successful quality training and Skill assessment are provided management system. Paramedics Plus values in sections throughout this proposal its Workforce and is Committed to their including X.B.3. Clinical Sta??ing Levels and engagement' satiSfaCtion' devempment' and Sta?ing Requirements, XI.C.1. Competitive well?being. Criteria Person nel--Field Supervision and XI.C.Z. Competitive Criteria Personnel Risk Management. Paramedics Plus ensures employee well- being by providing competitive wages and benefits. A complete benefits package is available ranging from medical, dental, life and disability coverage to Employee Assistance Programs and Health Savings Accounts. The company not only pays a significant portion up to all of some Paramedics Plus 60 214 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA CLINICAL - QUALITY IMPROVEMENT coverage, but also contributes toward the Health Savings Account to assist with deductibles and on t-of-pocket expenses. More information is provided in AID. 1. Personnel Incumbent Workforce. Process and Paramedics Plus designs key processes and support processes with the requirements of customers, partners, and suppliers in mind. Cycle time and cost efficiency are also important factors when designing processes. I?rmess performance is monitored through measures to ensure that we are on track to achieve our desired outcome measures. For example, ROSC greater than 30% may be a patient outcome measure goal; therefore, we analyze the measures that research indicates contribute to improved ROSC such as early chest compressions, chest compression fraction time, and successful airway maintenance. Paramedics Plus prides itself on being a learning organization. Learning includes both continuous improvement of current practices and processes and signi?cant change or innovation. Paramedics Plus has a robust Quality Improvement Program that will be utilized in the City of Sioux Falls. The Paramedics Plus Quality Improvement Program is based on sound and proven approaches, techniques and tools and is executed on the local level with a strong will to improve through partnerships with medical oversight, First Responders, the Authority, 911 PSAP and other EMS stakeholders. The Paramedics Plus Quality Improvement Program uses statistical process control from local operations as a foundation. The effectiveness of the unique Paramedics Plus approach is proven by excellent cardiac arrest survival rates, reliable response time performance, unprecedented commitment to fulfill promises and below average costs to consumers. Paramedics Plus is recognized nationally for its innovative and much admired EMS Quality Improvement programs. Some of the philosophies of this plan were discussed earlier in this section. Below is additional detail related to the components of our plan. QUALITY IMPROVEMENT I'he Paramedics Plus quality improvement plan identifies deviations from medical protocols, both administrative and clinical, deviations from complete and accurate patient information and opportunities for improvement both in patient care and in efficient opera tions. f' trim-r- in annexing. ?w mi ?inninu club "1 i ?:tn Paramedics Plus 6] 215 COMPETITIVE CRITEBIAA CLINICAL - QUALITY IMPROVEMENT According to The Institute for Healthcare Paramedics Plus uses the PDSA (Plan-Do- merovement, to be succeme at Study-Act) performance improvement improvement an organization needs the model advocated by IHI. The figure below will to improve, ideas for improvement and depicts the Performance Review and l?rocesxs? the skills to execu to the change. Paramedics Improvement processes. PIUS has demonstrated its commitment to all three elements and the results are re?ected in quality patient care and ef?cient operations. PERFORMANCE REVIEW Patient Patient Employee mm? (Customer) Chart Dasm?oam Feedback Review Measu'es Assessments Observation Identify Identify Opportunities Stellar Performances for Improvement 1 accomplish? Recognize and Reinforce How we know chemo Is an lmprovement? What charge cen we make will result In Improvement? - PAT Actlon Taken) - Newsletter - Postings - change Process - Charge Protocol/Polka - charge Product - Remet?ne - Incorpor?e lMo CME PLUS Partnc rs. Modding Hw m1 Winning EMS Syamms Paramedics Plus 02 216 COMPETITIVE CRITERIA CLINICAL - QUALITY IMPROVEMENT Institute for Heal thcare Improvement Model Experience While Paramedics Plus has long contributed to an effective CQI process, several of its employees have participated in Institute for Healthcare Improvement (IHI) training. IHI Triple Aim is to improve the health of the population, enhance the patient experience of care, and reduce the cost of care. Breakthrough Series Model has produced signi?cant improvements in the hospital and medical clinic settings. Led by David M. Williams, IHI Improvement Advisor, Paramedics Plus representatives were joined by other high performance EMS services from the Coalition of Advanced Emergency Medical Systems (CAEMS) in learning about application of the model for improvement. The CAEMS project marked the first time EMS has worked in collaboration using this model. The concept uses Rapid Cycle Testing, a philosophy of implementing small tests of change, using Plan?Do-Study-Act cycles. While Plan-Do-Study-Act has been used by quality gurus for years, the Breakthrough Model modifies the process somewhat. The CAEMS group, including representatives from three Paramedics Plus operations, met for several days to learn the basics and to identify an initial project on which to practice the IHI methodologies and, hopefully, achieve sustainable change within a speci?c topic area. The learning experience was valuable in not only becoming familiar with using the Breakthrough Series Model, but also in applying process maps, control charts, Pareto charts, test planning and analysis. The tools and concepts were applied to a non-clinical project over an 18-month period, and laid the groundwork for further application of this powerful tool. Shared Learning An important piece of Paramedics Plus Quality Improvement initiatives is to identify, share, and where locally relevant, adopt the best practices from Paramedics Plus operations. Each department of Paramedics Plus operations conducts conference calls to discuss their local initiatives, challenges, performance improvement projects, and performance results. The concept here is to leverage what other operations have learned and not "reinvent the wheel.? PLUS 69:1: hur- {summit-:5 5.17: 541.1. . - . 2.32.1.5 Paramedics Plus 63 :\AD\002\02\2X02\2X02177.docx :\AD\002\02\2X02\2X02177.docx COMPETITIVE CLINICAL - QUA LITY IMPROVEMENT ust Culture? as a Framework to Support Quality Improvement At the core of our approach to Quality Improvement is the establishment of a "Just Culture," an organization that continues to learn, and a culture of safety, support, quality management and improvement. Since the publication of the Institute of Medicine?s landmark paper, To Err is Human, combined with recent findings and bends, the need to improve patient safety has never been more apparenL A ust Culture," implemented in each Paramedics Plus system, holds organizations accountable for the systems they design and for fair and just response to staff behaviors. In turn, the staff is accountable for the quality of its choices and for reporting both errors and system vuhierabiljties. It is far from a blameless culture, but rather one in which mistakes or deviations from protocols can be openly discussed, and from which all involved can learn. After all, in medicine this is how experience and practical wisdom are acquired. The Paramedics Plus employees working in REMSA will be trained in "Just Culture" and leam to apply the principles. The Chief Medical Of?cer has previously shared the principlm of "Just Culture" in face-to-face conversations with each Medical Director in each Paramedics Plus operation. The "just Culture" algorithm provided in the Appendix 15 supports local medical direction in that each Medical Director can use the process to provide consistent and fair evaluation and respond to deviations. Education and Training Aligned to Quality Improvement Feedback The linkage of CQI ?ndings to training and educau'on is fundamental to the Paramedics Plus approach to quality management and improvement. In each system we serve, we work closely with medical oversight to use training, improved processes and standardized procedures to support the full implementation of identi?ed and needed improvement changes. A detailed description of our proposed Continuing liducation requirements is provided in X1. xi. 6. Clinical Education Program Requiremei-zts. However, educational content is targeted to local system needs as identified through the CQI process. Linking the Quality Improvement Program and training efforts, coaching time with ambulance crews is focused on either system-wide topics or areas of individual performance. This is an area where Paramedics Plus excels. f? .rHu-r- in utilising on Nomi-i) CM: Paramedics Plus 64 218 COMPETITIVE CRITERIA CLINICAL - QUALITY IMPROVEMENT Results :3 5.- In? The last area of importance for a successful quality management system is the actual measure of performance. One of Paramedics Plus? competencies is management by fact. Paramedics Plus reviews performance data in several areas as described throughout this document (customers, patient care, employees, operational, financial, and process performance) to support decision making and improvement initiatives. Further details about Paramedics Plus key performance indicators are provided in the section that follows on XI. A. 2. Clinical and Operational Benchmarking. The Paramedics Plus team is well prepared, experienced and eager to support the further development of the REMSA system in Sioux Falls. Paramedics Plus 65 219 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA AND OPERATIONAL BENCHMARKING 2. Clinical and Operational Benchmarking Paramedics Plus will meet all minimum requirements under Clinical?Clinical and Operational Benchmarking and proposes to: 0 Measure, monitor and report a number of key performance indicators, both clinical and non-clinical, to be used in benchmarking and to improve care, operations or ?nancial performance 0 Track all required by REMSA 0 Provide a periodic report describing overall compliance with protocols and analysis of protocols with compliance challenges. Paramedics Plus will achieve higher levels of commitment under Clinical?Clinical and Operational Benchmarking and proposes to: 0 Expand the REMSA required KPIs to include additional clinical and operational measures 0 Demonstrate our ability to use KPIs to drive change and improvements 0 Continue to innovate and lead the industry in adopting new processes, treatment and technology 0 Benchmark not only against Paramedics Plus systems, but also EMS related organizations, published data, other EMS providers as well as comparative data from outside our industry, including Baldrige quality award winning organizations 0 Invest in those improvements that truly make a difference 0 Infuse the EMS system with a will for change 0 Invite medical oversight to participate in the Paramedics Plus Clinical Forum for benchmarking, sharing protocols and best practices, research and networking 0 Combine efforts among all Paramedics Plus operations for clinical research and continue to share results through presentations and publications. Paramedics Plus 66 220 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA AND OPERATIONAL BENCHMARKING a) Minimum Requirements? CIinical and Operational Benchmarking Proposers should describe their current and pro- posed benchmarking, monitoring, and its method for regularly assessing compliance with EMS Medical Protocols. Key Performance Indicators Paramedics Plus accepts that Key Performance Indicators measured by all system participants will be developed through collaborative efforts of First Responder agencies, the contractor, and REMSA, based on current EMS research, benchmarking and local considerations. We accept that REMSA must approve the quality monitoring and improvement plan to be used. Paramedics Plus will meet or exceed this expectation by engaging in clinical benchmarkng to understand and compare performance to other EMS systems and using clinical data published by medical organizations such as NAEMSP and State EMS Directors. Each Paramedics Plus Medical Director is also invited to participate in its Clinical Forum where KPIs from each operation may be benchmarked, protocols are shared, and physicians have the opportunity share best practices. The Key Performance Indicators proposed by Paramedics Plus meet and exceed requirements. The proposed KPIs, both clinical and operational, will allow Paramedics Plus to perform ongoing analysis to identify areas where performance can be improved. Paramedics Plus understands the proposed KPIs will evolve based on the needs of the community and as directed by the REMSA Board and the Medical Board. The following KPls, their definitions, the frequency of reporting and the data source comply with minimum standards. Additional KPIs and corresponding details are provided under Higher Levels of CommitmentParamedics Plus 67 221 COMPETITIVE CRITERIA AND OPERATIONAL BENCHMARKING Measures P1 Arrive <_8:59 P2 Arrive <11 :59 P3 Arrive 515:59 P4 Arrive min (scheduled) P4 Arrive min (unscheduled) Presumptive impressions dispatch compared to field interventions Trauma scene time total pre-hospital scene time for patients meeting Load a Go criteria ACS and STEMI scene time total pre-hospital Definition Echo/Delta response time compliance (time call dispatched to time unit arrived on scene) Charlie/Bravo response time compliance (time call dispatched to time unit arrived on scene) Alpha response time compliance (time call dispatched to time unit arrived on scene) Scheduled interfacility response time compliance of time unit arrived within 30 min of scheduled PU time) Unscheduled interfacility Response time compliance of time unit arrived within 60 min of scheduled PU time) Comparison of dispatch code with field observation Time elapse from ambulance arrival on-scene and ambulance departure. Goal: system defined, for example <10 min. Time from dispatch until arrival at receiving hospital Time elapse from ambulance arrival on-scene and ambulance scene time departure. Goal; <15 minutes for ACS. Goal for STEMI as directed by local Medical Control. Time from dispatch until arrival at receiving hospital Frequency Montth Montth Montth Data Source CAD CAD CAD CAD CAD CAD PLUS :\AD\002\02\2X02\2X02177.docx in uwmn Winning EMS Sy-ucmzt Paramedics Plus 68 222 COMPETITIVE CRITERIA AND OPERATIONAL BENCHMARKING GA easur es (fractile) (STEMI) (STEMI) (ACS) (CHF) Stroke scene time total pre-hospital scene time Cardiac arrest survival Time to first defibrillation Compliance with protocols, procedures, timelines Compliance with destinations Compliance with protocols, procedures, timelines (ACS) Compliance with destinations Compliance with protocols, procedures and timelines (Pulmonary edema) Compliance with protocols, procedures and timelines De?nition Time elapse from ambulance amval on-scene and ambulance departure. Goal' <15 minutes Time from dispatch until arrival at receiving hospital Utstein criteria Time of ambulance arrival to time of ?rst defibrillation of patients who met STEMI criteria 8. received appropriate interventions per protocol of patients declared STEMI transported to appropriate facility of patients who received appropriate care in compliance with protocols, procedures and timelines of ACS patients transported to appropriate facility Patients with primary impression of Shortness of Breath, Difficulty Breathing, Respiratory Distress. Respiratory Failure, Chest Pain compliance with protocols, procedures and timelines Patients with primary impression of Shortness of Breath, Difficulty Breathing, Respiratory Distress, Respiratory Failure, Chest Pain compliance with protocols. procedures and timelines Frequency Montth Quarterly, Annually Montth Data Source PLUS :\AD\002\02\2X02\2X02177.docx in dulluing ?Warn EMS System? Paramedics Plus 69 223 COMPETITIVE CRITERIA AND OPERATIONAL BENCHMARKING rMeasures Definition Frequency Data Source Compliance with protocols Patients with primary impression, Monme procedures Shortness of Breath, Dif?culty Breathing, Respiratory Distress, Respiratory Failure, Wheezing compliance with protocols, procedures and timelines Compliance with protocols, Patients with primary impression procedures and timelines of Seizure, Altered Mental Status, (seizures) Febrile Seizure, Eclampsia compliance with protocols. procedures and timelines Compliance with protocols, Patients with primary impression procedures and timelines of cardiac arrest (cardiac anest) compliance with protocols, i procedures and timelines Compliance with protocols, Patients who met Trauma Load . procedures and timelines Go criteria or Trauma Transport (trauma) criteria received appropriate interventions per protocol compliance with protocols, procedures and timelines Also above see Trauma scene time and Trauma Load Go criteria by Destination to Trauma center) Compliance with protocols, of patients who met Stroke procedures and timelines criteria received appropriate (presumed stroke) interventions per protocol Also above see Stroke on scene time and Stroke criteria by Destination to appropriate receiving center) Compliance with protocols, of patients with non-cardiac procedures and timelines pain who received appropriate (pain relief) interventions per protocol. Measure of difference in presenting pain level and pain level at hospital arrival 4v :\AD\002\02\2X02\2X02177.docx Paramedics Plus 70 224 PLUS - Partners in ?uilumg ?Ward Winning EMS Systems COMPETITIVE CRITERIA AND OPERATIONAL BENCHMARKINC rM easures De?nition Frequency Data Source 1. Successful airway of patients with assisted airway management (system) device of patients successfully intubated of patients successfully with advanced airway techniques of intubated patients with Et02 placed of patients with Et02 placed within 60 seconds of intubatlon Successful airway of patients with assisted management (provnder type) airway device of patients successfully intubated of patients successfully with advanced airway techniques of intubated patients with Et02 placed of patients with Et02 placed within 60 seconds of intubation Successful airway of patients with assisted management (individual) airway device of patients successfully intubated of patients successfully with advanced airway techniques of intubated patients with Et02 placed of patients with Et02 placed within 60 seconds of intubation PLUS in EMS Sy'ncmu Paramedics Plus 71 :\AD\002\02\2X02\2X02177.docx 225 COMPETITIVE CRITERIA AND OPERATIONAL BENCHMARKING Measures lV success rate (system) IV success rate (provider type) IV success rate (individual) Complaint management Paramedic skill retention Use of mutual aid Safety AHA Mission Lifeline quality indicators CARES indicators De?nition Total system number of patients with ?successful lV? intervention divided by number of patients with intervention Total number of patients with ?successful intervention, segmented by provider type, divided by number of patients with intervention Total number of patients with ?successful intervention for each individual provider divided by number of patients with intervention of complaints and segmentation by complaint type Annual skills competency (input from Medical Director) in annual in-house training- via skills check off sheets of successful) of requests for mutual aid per month; of mutual aid responses per month Patient injuries: Employee injuries Needle sticks Exposures Lost UH rate for OSHA reportable injuries Vehicle collisions Mission Lifeline criteria CARES criteria Frequency Quarterly On-going Annually Data Source Ninth Brain Excel (Review of CQI and annual skills demonstration) Dispatch CAD Access database- risk management data Attestation: 8233 Paramedics Plus understands and agrees to DUDE comply without qualification to provisions, requirements, and commitments contained in Section :\AD\002\02\2X02\2X02177.docx . .. :a Paramedics Plus 72 226 COMPETITIVE CRITERIA AND OPERATIONAL BENCHMARKING b) ngher Levels of Commitment? and Operational Benchmarking Additional Clinical and Operational Quality Measures Paramedics Plus is wholeheartedly committed to fact-based decisions. This is true not only in clinical performance, but also in capturing and analyzing the right operational measures. [n [he section below, you will see how we have used facts, our Kl?ls, to drive change and improvements. We will measure and monitor the benchmarks agreed upon in Sioux Falls to improve clinical care and operational ef?ciencies. What? more, Paramedics Plus commits to transparency in this process. In addition to clinical KPIs beyond those required by the Request for Proposal, Paramedics l?lus measures, tracks, reports and uses additional items related to operations and safety. Those Kl?ls, the definitions, frequencies and data sources are below. (Higher Levels Definition Frequency Data Source of Commitment Employee injuries of Workers comp inordents Montth Access database- risk management Employee OSHA Incident rate (all Work comps) data (WC injured employees per 100 employees) Vehicle collisions of reportable injuries 200,000 divided by Montth Access database- of employee hours worked) risk management data and Extra Fleet Vehicle contacts per 100,000 miles driven Vehicle contacts per 100,000 emergency miles driven Critical failures Critical failures per 100,000 miles driven Extra Fleet and CAD Critical failures by type Consumer satisfaction of patients score 9 or 10 on survey questions Aggregated Patient Satisfaction Net Promoter Score (loyalty question) Quarterly Surveys Employee turnover of employees Who separate from the company Excel-Human resource data Employee satisfaction overall employee engagement score Annualiy Survey monkey Stro 9L0: in 'lw.ii it CMS yutum :\AD\002\02\2X02\2X02177.docx Paramedics Plus 73 227 COMPETITIVE CRITERIA AND OPERATIONAL BENCHMARKING (Additional Clinical De?nition Frequency Data SourceW Measures of STEMI who of patients meeting STEMI criteria who received ASA received ASA (without exclusion reason) of non-traumatic of patients with CP who received ASA ePCR/cardiac chest pain patients who (without exclusion reason) monitor received ASA Avg time of first medical Time to first 12-Lead ePCR/cardiac contact to 12?Lead EKG monitor Avg time from 12 lead to Elapsed time from 12-lead to transport time transport time if STEMI for STEMI patient declared I Non-traumatic chest 12-Lead compliance for cardiac patients pain! acute MI, STEMI, meeting criteria for 12?Lead etc, patients 35 years old received 12-Iead Compliance with Patients with primary impression of tachycardia protocols, procedures and bradycardia and timelines (cardiac problems) Average time to II Total elapsed time from ambulance arrival Stroke when criteria met on-scene to Stroke notification Average time to call Time elapsed from ambulance arrival Trauma Load Go on-scene to Traurra Load Go noti?cation Average time to all Time elapsed from ambulance arrival STEMI on-scene to STEMI notification 1 1 ii Prutrih?rEDICS PLUS Partner-t in uullamp Winning EMS Paramedics Plus 74 :\AD\002\02\2X02\2X02177.docx 228 COMPETITIVE CRITERIA AND OPERATIONAL BENCHMARKING rAdditional Safety Definition Frequency Data Source Measures Patient Injuries of patient reported injuries/total of ambulance Access data base - responses Risk Data Employee injuries Employee injury by action to determine cause Access data base Employee injury by body part Risk Data of Workers comp incidents Employee OSHA Incident rate (all Work comps) (WC injured employees per 100 employees) of reportable injuries 200,000 divided by of employee hours worked) Needle sticks Number of employee exposures due to needle Access data base - sticks Risk Data Exposures Exposure occurrences by type Access data base Risk Mgt. Data Lost UH rate for OSHA of lost time OSHA injuries 200,000 divrded Access data base reportable injuries by of employee hours worked Risk Mgt. Data Vehicle contacts per of ambulance vehicle contacts per 100k miles Access data base 100,000 miles driven Vehicle contacts by cause Other risk related incidents . .4 (Additional Operational Measures Definition Frequency Data Source Total lost unit UH lost due to mechanical, administrative or System Defined CAD hours (UH) reasons other than scheduling Lost unit hours Lost UHs segmented by 11 different reasons SVstem Defined CAD by reason Cost per mile Average cost per mile for fleet System Defined Extra Fleet Late preventive Preventive maintenance performed 25 miles System Defined Extra Fleet maintenance of due :i?iCS PLUS :\AD\002\02\2X02\2X02177.docx Paramedics Plus 75 229 Partner-s in Unildmg .LXW?il?d Winnino EMS Sy-ztum . :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA AND OPERATIONAL BENCHMARKING Benchmarking Things that Make a Difference It is often said that it doesn?t matter which road you take if you don't know where you want to go. Paramedics Plus does understand what makes a difference in patient care in EMS, and has a clear View of which road to take and what things to measure to achieve optimal outcomes. Paramedics Plus bene?ts from local medical oversight that is fully engaged while being aware of developments and recommendations from such organi/ations as the U5. Metropolitan Municipalities EMS Medical Directors Consortium (Eagles), the National Asmdation of Physicians, State EMS Directors and the American College of Emergency Physicians. Other key sources of comparative and compeu'tive data from within our industry include other local and na?onal EMS providers, the journal off) mergmicy Medical Services annual multi-city survey, the National Academy of Emergency Dispatch, and the Coalition of Advanced Emergency Medical Services. Key sources of comparative data outside our industry included Baldrige quality award winning organizations, the National Bureau of Labor and Statistics, and the American Consumer Satisfaction Ind CV Clinical benchmarks have been identified for comparison between the various Paramedics Plus operations and FTMC EMS. Medical Directors representing each Paramedics Plus system are invited to participate in Paramedics Plus" Clinical Forum. The Forum utilizes secure, internet-based mftware for posting protocols, and questions posed to other Medical Directors. Most are reported with a few smaller subsets reported quarterly. Regular phone conferences allow for two-way communication between each of the Medical Directors and the Chief Medical Officer. 'lhrough the Clinical l?orum, best practices are shared and Kl?ls are benchmarked. With nearly 350,0?) transports each year, the benchmarking and best practices show real promise in improving patient care in critical areas where Paramedics Plus already provides state-of-the-art care. The focus is on linking our continuous quality improvement program to primesscs, protocol changes and continuing education of our entire workforce. Using Results to Effect Change Measuring Kl?ls is just the begimiing. Using to effect change separates Paramedics Plus [rom other EMS providers. Collecting data is nonsensical if it isn?t used to drive improvement and innova lion. For years, the communities served by Paramedics Plus have enjoyed reputations in the industry for clinical excellence and cost ef?ciency. Paramedics Plus has enhanced this reputation by using quality improvement t? orHu-r- (in?ame 'tw uu ?utnmu Paramedics Plus 76 230 COMPETITIVE CRITERIA AND OPERATIONAL BENCHMARKINC results in the pursuit of clinical innovations. Here are just a few examples of how Paramedics Plus has led the industry in clinical advancements: A Paramedics Plus system was among the ?rst systems in the country to adopt the latest science in lifesaving practices for cardiac arrest patients. Changes included increasing chest compression rates, promoting continuity of chest compressions and developing an enhanced "pit crew" model of resuscitation team dynamics. A Paramedics Plus system was the first large EMS system in the country to measure the time between insertion of the endotracheal tube until attachment of This innovative approach ensures proper placement of the endotracheal tube while providing other clinical indicators and in?uencing outcomes. This project was a poster presentation at the National Association of Emergency Medical Services Physicians 2010 Conference in Phoenix, and is one example of Paramedics Plus industry leadership in patient safety and clinical excellence. A Paramedics Plus system was U1e second service in the country to incorporate the use of Continuous Positive Airway Pr issure in patients with pulmonary edema and various other respiratory problems. Today CPAP is the standard of care for EMS providers in the .5. 0 A Paramedics Plus system was also an early adopter of the technology which facilitated the electronic transmission of EKGs from the field to multiple receivers designated by local hospitals. 'l'his innovation greatly reduces the time required for STEMI patients to receive definitive trea tmenL When one Paramedics Plus location observed an increasing number of lost Lmit hoqu due to hospital bed delays, the management team collaborated with the Medical Director and local hospitals to find and implement creative solutions that reduced the hours of bed delays by nearly 60% over a two-year period. An article in EMS A/llzgazine highlighted the innovative approach where one crew assumed the care of up to two other EMS patients. A Paramedics Plus system used cardiac arrest data to help city leaders identify high frequency areas of cardiac arrest. ?l'he identified areas were then targeted with CPR training and placement of Public Access Defibrillators. All Paramedics Plus systems have reduced scene time and time to de?nitive care for time sensitive patients such as trauma, STEMI and stroke. In one system, "door to needle time for patients is now measured as call to needle time," with times as short as 30 minutes or less. t' "luv!" (Sultan?th Mil Wm..th Chit Paramedics Plus 77 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA AND OPERATIONAL BENCHMARKING The charts below show some of the most signi?cant developments and contributions . . What makes Quality CPR. timely made by Paramedics Plus 1? areas that make a difference in defibrillation, safe airway a difference in patient care by using the ReSUSCltatlon? and breathan results from Kl?ls. The key to our success How has . Early adopter of new pit has been partnerships with local medical Plus crew concept . .. . . . pa ?er and Communications and a systems to make a . Emphasis on CPR density quality management program that measures di?eremw and airway management compliance and outcomes and quickly takes - Pre-arrival Instructions corrective action when needed. for CPR How do we know - Use of Utstein criteria AIRWAY MANAGEMENT we have made a for benchmarking i difference? What makes a Timely, safe and skillful KPls: Cardiac Arrest di??erence in Airway assessment and intervention Survival (among the best Management? in the country) How has - CPAP (2nd system in the - of R080 sustained Paramedics Plus country to adopt) to ED arrival partnered in systems to make a within 60 - Greater than 95% difference? seconds (lst system in the performance on pre-arrlval country to adopt) instructions . - King Airway?safer and less invasive - Pre-arrival instructions regarding choking i How do we know - KPls? CPAP Effect we have made a I difference - Et002 compliance after intubation within 60 seconds - Intubaticn success rates. both corporate and indivrdual - Greater than 95% performance on pre-arrival instructions A in Uuildihp Hw.? it Winnino CMS $ynlurn Paramedics Plus 78 :\AD\002\02\2X02\2X02177.docx 232 COMPETITIVE CRITERIA AND OPERATIONAL BENCHMARKING (RESPIRATORY DISTRESS What makes a Early field recognition. early What makes Appropriate assessment and difference in activation of Centers of a difference management Stroke? Excellence, minimized scene in Respiratory times and rapid transport Distress? How has - Partnered with hospitals How has - CPAP (2nd in the country Paramedics Plus for 1 2-lead transmission Paramedics Plus to adopt) partnered in and pre-arrival alerts partnered in - Call-takers identify extreme systems to make a - Pre-arrival Instructions systems to make a conditions and code for difference? for aspirin in chest pain difference? First Responders and hot patients response - Los Angeles Stroke Scale How do we know KPI: CPAP Effect for early stroke identification we have made a difference? How do we know - Shortened 911 call to 7 we have made a needle time difference? - KPls: STEMI patients to correct facility SEVERE TRAUMA Wt 12495? transm'ss'on What makes a Minimized scene time, compliance difference in Severe appropriate delivery Trauma? destination - STEMI-average time to 13? 12 km How has Contributed data for i Paramedics Plus formulation and evolution of STEeraV?f??rage tota' partnered in trauma community-wide on "me systems to make a call system difference? Stmke'aVefrage tOta' Pre-arrival instructions for on'scene "me control of bleeding and post- I I . dispatch instruction for scene - /o Aspirin administration safety I compliance How do we know KPIs: of trauma scene i Greater than 95% we have made a time of less than 10 minutes performance on pre-arrival differem? '?3tru?1lons Jr Total average on-scene time a for Trauma Alerts Priority 1, 2 and 3 Trauma destination compliance, Greater than 95% performance on pre-arrival instructions Jr, Pilotitf-lltfilC?S PLUS: :\AD\002\02\2X02\2X02177.docx Irinvru Uulldmo uw.iri1 Winning Syn-item Paramedics Plus 79 233 COMPETITIVE CRITERIA AND OPERATIONAL BENCHMARKING MANAGEMENT OF PAIN AND orscomsoa'r (PATIENT SATISFACTION What makes Reduction of pain and What makes a Capable, caring, courteous, a difference in discomfort difference in Patient clean employees who are Management of Pain Satisfaction? good communicators and Discomfort? i How has Customer service training for How has Adoption of new medications Paramedics Plus field crews and emergency Paramedics Plus such as Fentanyl partnered in medical dispatchers partnered in systems to make a systems to make a difference? difference? . How do we know Survey responses show How do we know KPI. of Patients pain we have made a greater than 95% satisfaction we have made a improved difference? differenceGATIENT SAFETY The Process, Tools and Will to Change What makes a Culture of safety' Taking the infomati()n learned fTOm d'?e'enoe Pat'em assessing performance and kev measures, Safety? . Paramedics l?lus identi fies areas where How has New stretcher training - - 0v >ment15 needed and adds val to Paramedics Plus Post-dispatch instructions 1 Pr partnered in for scene safety the Quality Improvement Process through systems to make a local application and enhancement of the difference? l?lan-Do-Study-Act process. Please see the II ll How do we know KPI: Patient injuries by body . - we have made a pan, mechanism] injury BreakUuough Series Model for improvement difference? in the previous section. J. Data and analysis are essential in Quality Improvement, but change is only effective when people accept that change and willfully incorporate it into their routines. The tools used by Paramedics Plus allow the organization to track both system level and individual adoption of changes. No other provider is able to track changes at this level or with this accuracy. 9L0: f? ortru~r~ in Winnan by-zxurn . Paramedics Plus 8U :\AD\002\02\2X02\2X02177.docx 234 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA AND OPERATIONAL BENCHMARKINC The bottom line for Sioux Falls is that Paramedics Plus is ready, willing and capable of engaging wi U1 all stakeholders and system partners to create an effective collaborative approach to clinical and operational quality improvement. Clinical Research That Makes a Difference While the REMSA system alone may not have the funding or the transport numbers to conduct groundbreaking research, Paramedics Plus is willing and able to support the Medical Director, the Medical Board and Ute Board by providing national resources to find answers to what makes a difference in patient care. There simply isn't a lot of clinical research available about what really makes a difference in pre-hospital care. One significant obstacle in clinical research is the dif?culty in doing prospective studies since patiean cannot be expected to provide "informed consent" to be part of a study in challenging and often time- sensitive situations. The most meaningful clinical research studies in EMS have consequently been multi-site studies where data is aggregated to obtain a suf?cient number of cases for statistical signi?cance. liven multi-site studies can be challenging because of inconsistencies between sites. Paramedics Plus Clinical Forum 0 All system Medical Directors invited to participate 0 Protocols shared among systems 0 benchmarking 0 Question board for networking between Medical Directors 0 Opportunities for research Retrospective studies also have challenges. ommon data de?nib'ons are required for retrospective studies, and not all EMS systems de?ne even basics such as return of spontaneous circulation" in cardiac arrest patients in the same way. Despite dif?culties inherent to clinical research in the pro-hospital set?ng, Paramedics Plus excels in its contribution to the practice of EMS in ways that do make a difference. From providing data to mulli-site studies, delivering presentations at national meetings, to publishing in peer-reviewed journals, Paramedics Plus has contributed to improving care and EMS ef?ciencies not only in our own systems, but also across the industry. crhu~r~ anu CM: 5 yu?u??n? Paramedics Plus 8] 235 COMPETITIVE CRITERIA AND OPERATIONAL Some examples of our contributions follow: Presentations by Paramedics Plus at Professional meferences; Non-Peer Reviewed Publications "Resuscitation Bundle of Care for Out-of-Hospital Cardiac Anest Improves Survival with Favorable Neurologic Outcomes, "abstract accepted for 2015 National Association of Emergency Medical Services Physicians annual meeting. ?Pre-hospital Identi?cation of Sepsis Patients and Alerting of Receiving Hospitals?the Impact of Early Goal Directed Therapy. poster presentation accepted for 2015 National Association of I?Imergency Medical Services Physicians annual meeting. Safety Course: Taking Safety to the Streets,? Preconterence session EMS Expo 2010, EMS l'oday 2011, EMS lixpo, 2012, Colorado Safety Summit, 2013. "National Transportation Research Board EMS Safety Summit," presentation on Ambulance Safely, Charlene Cobb, lNashington DC, 2011, 2012. "Teaching Safe Stretcher Operations Right the First Time. American inhulunre luurnal, 2011, Cobb, (7. "Time ?om Intubation to Placement of ET C02, poster presentation at 2010 National Association of Emergency Medical Services Physicians. "Driving Your Organization to Performance Excellence, "concurrent session at 2010 Florida Governor Sterling Conference. ?In Pursuit of Sterling: Putting Your Service to the Test. concurrent session at 2009 Pinnacle Conference. Peer-Reviewed Publications by Paramedics Plus Personnel or Utilizing Paramedics Plus Data ?Compressions-only CPR Leads to Increased Survival Among Out-of-Hospital Cardiac Arrests, abstract published in Pic-Hospital Emergency Care journal, January, 2014, Gutwein, A., Kownacki, K., Kulow, B. Abstract was also a poster presentation at 2014 National Association of Emergency Medical Services Physicians annual meeting. ?Directness of Transport of Major Trauma Patients to a Level] Trauma Center. A Propensity-Adjusted Survival Analysis of the Impact on Short- Term Mortality. Iournai ofTrauma, 2011: 1127, (lat-we, 1., (Yowan, L.D., Neas, B.R., Sacra, Albrecht, KM. ?Factors at the Scene of Injury Associated with Air versus Ground Transport to De?nitive Care in a State with a Large Rural Population, Preliospitni Care, 2011; Stewart, K.E., Cowan, L.D., Thompson, D.M., Sacra, Vti"; ur'ru-r- Unstrung. "w nu clot. Paramedics Plus 82 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA AND OPERATIONAL BENCHMARKING Propensity Score Analysis of Pre-Hospital Factors and Directness of Transport of Major Trauma Patients to a Levell Trauma Center," journal (if'l'riiuma, 201 1; 70(1): l20?129, (.Iarwc, (bwan, Neas, R, Sacra, J.C., Albrecht, R.M., Rich, K.M. ?Association of Direct Helicopter versus Ground Transport and ln-hospital Mortality in Trauma Patients: A Propensity Score Analysis, "Academic Eim?rgency A/lcdicine, 201 (18): 1208?1216, Stewart, K.E., Cowan, L.D., Thompson, D.M., Sacra, J.C, Albrecht, RM. Tale of Seven EMS Systems: An Impedance Threshold Device and Improved CPR Techniques Double Survival Rates after Out-of-Hospita/ Cardiac Arrest, abstract published in AHA Circulation, 2009, Aufderheide, T., Mirnbaum, M., Lick, C., Myers, 3., Romig, L., Stothert, J., Varlanian, L. ?The Current Status of Regionalization of Acute Care Medical Services in the United States: A Survey, A mcrimn College of Publi'cutiim, Michael Zappo, Sharon Ii. Mace, MD., Andrew I. Bern, MD. Robert R. Bass, M.D., James Michael Cusick, MD, Mark L. Mackey, M.D., John C. Sacra, David M. Siegal, Mil, J.D., approved 2009. Makes a Difference: lmpro ved Clinical Outcomes and Healthcare Savings, "Position Statement of the National EMS Advisory Council l?inance Committee, National lighway 'l'raH?ic Safety Administration, 2009, lagen Krumperman, K., Sacra, Meiser, ll, ()enning, R., J'Vingrove, G. ?Airway Management Success And Hypoxemia Rates in AirAnd Ground Critical Care Transport: A Prospective Multicenter Study. Critical Care Transport Collaborative. Outcomes Research Effort (CCT CORE) Alrway Study Group. Research Forum, Boston, 4?8 October 2009, Stephen 'l'homas, 'l'orn Judge, Mark J. Lowell, Russell D. MacDonald, John Madden, Kimberly Pickett, Howard A. Werman, Melissa L. Shear, Pina Patel, Greg Starr, Michael Chesney, Robert Domeier, Pam Frantz, Deb Funk, and Robert D. Greenberg. If'tu?r- Udilidi?fn "w on CM: u:h" Paramedics Plus 83 :\AD\002\02\2X02\2X02177.docx 237 COMPETITIVE CRITERIA AND OPERATIONAL BENCHMARKING Paramedics Plus is uniquely quali?ed to support Sioux Falls with practical and useful clinical research, whether through data collection, benchmarking, sharing of protocols, or networking with other Medical Directors through the Clinical Forum. Paramedics Plus agrees that quality improvement programs do not have to be overly complex. Collecting data for the sake of collecting data does nothing to drive improvement. What makes a difference is focusing on the right things, removing obstacles and challenges, building consensus and acting on what we learn. :\AD\002\02\2X02\2X02177.docx Paramedics Plus 84 238 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA CLINICAL OVERSIGHT PERSONNEL 3. Dedicated Clinical Oversight Personnel Paramedics Plus will meet all minimum requirements under Clinical Dedicated Clinical Oversight Personnel and proposes to: 0 Employ a well-qualified clinician, with experience in the REMSA system, to lead the on-going clinical quality program 0 Assign primary responsibility for managing key performance indicators to the most senior member of the Sioux Falls operations, the COO 0 Involve the C00 and Director of Clinical and Operational Services in REMSA led efforts including EMS, public health and safety 0 Engage senior leaders in projects designed to improve the quality of EMS in the REMSA system. Paramedics Plus will achieve higher levels of commitment under Clinical Dedicated Clinical Oversight Personnel and proposes to: 0 Engage the workforce in quality improvement by sharing scorecards with both individual and corporate data through peer review activities and medical audits 0 Employ a variety of two-way communication methods to solicit ideas and input from the workforce, to communicate system goals compared to performance and recognize outstanding efforts by employees 0 Utilize state-of?the?art tools to perform data analysis 0 Review performance data in daily PULSE meetings, weekly staff meetings and quality meetings 0 Demand an unquestionably legal and highly ethical leadership team who will model such behavior for the field staff 0 Promote a safe environment through policies, action, ?Just Culture,? a corporate safety focus, and by measuring, monitoring and acting on six safety KPIs 0 Create an environment where employees are encouraged to report near misses in order to create a safer and better system. Paramedics Plus 85 239 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA a) Minimum Requirements? Clinical Leadership Personnel A senior manager shall be responsible for oversight and management of the key performance indicators and ongoing organization-wide quality management programs. This individual shall be responsible for the medical quality assurance evaluation of all services provided pursuant to this Agreement. The Fraposer shall describe its commitment of leadership to clinical quality and describe the individual to oversee its clinical quality program including a job description and reporting relationships. The Director of Clinical and Operational Services will lead the quality program, oversee analysis of data, and work closely with the REMSA Medical Director to support the REMSA Quality Improvement Plan while interfacing regularly with the Paramedics Plus Medical Director, the Chief Operating Officer and staff on sentinel events or other time? sensitive developments. CLINICAL OVERSIGHT PERSONNEL This senior manager of the Paramedics Plus Sioux Falls team will report to the Chief Operating Of?cer and be responsible for oversight and management of KPIs and the Quality Improvement Program. The Director of Clinical and Operational Services will be a key position in the REMSA system. Paramedics Plus intends to select the individual to fill the position from the existing Sioux Falls staff. Prior knowledge of the system, community and EMS staff will be advantageous for success in this important position. This individual will provide clinical and operational leadership in several areas including system planning, quality improvement, coordination of orientation and training, maintenance of accreditation, and will also work closely with medical oversight. Paramedics Plus 86 240 COMPETITIVE CRITERIA CLINICAL OVERSIGHT PERSONNEL He or she will become proficient in the use of Tableau to facilitate in?depth analysis of all aspects of clinical and operational services. The ideal candidate will be an experienced Paramedic with academic preparation, outstanding analytical skills and the ability to manage the quality improvement process and training of new employees. He or she will interface with medical oversight to design educational offerings that address CQI findings or other system needs. Engaging a local candidate for this key position, someone who is a great clinician and well-respected personally, is challenging in that Paramedics Plus does not wish to jeopardize the current employment of candidates. However, local interviews for this key position will be conducted soon after receiving "notice of intent to award.? A job description for the Director of Clinical and Operational Services is included in Appendix 16. Attestation: gag Paramedics Plus understands and agrees to comply without qualification to provisions, requirements, and commitments contained in Section Attend community meetings related - to EMS and public heath and safety I I Public Information Officer] marketing Manageley performance indicators Oversee Clinical Quality Program Director of 0 Clinicallrey perfom'iance indicators . . . liaison with Medical Directcx Clinical OverSIght - gamma?; 0 Oversee CME/training Duties and Field Assist with quality reviews 0 Patient care report audits First line for managing and recording complaints 0 Provide performance feedback to employees 7 1 Paramedics Patient Customer service excellence Training employees Remediation Provide performance feedback to employees PLUS?Partners in Building Award-Winning EMS Systems Paramedics Plus 87 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA CLINICAL OVERSIGHT PERSONNEL b) Higher Levels of Commitment- Clinical Leadership Personnel For Sioux Falls, the Paramedics Plus COO and Director of Clinical and Operational Services will engage employees in the quality process in both formal and informal ways. Field Operations Supervisors and other team members will be involved in CQI meetings but more importantly, will be part of the process on a daily basis as the team works toward quality clinical care and great customer service. Collaborative Processes Leading to Improvement When improvement opportunities are identified, ?eld providers assist in identifying causes and generate ideas for solutions. For example, a project is currently underway in one Paramedics Plus operation, to reduce on? scene time for trauma alert patients. In a recent meeting the field crews identified obstacles and challenges. In an up-coming scheduled meeting, field providers will review several trauma alert patient reports where on-scene times were excessive in order to determine why. Once the ?why? is determined, the group will develop potential solutions to be considered by leadership. Once new ideas are researched, tested and implemented, full deployment is achieved with support from all personnel. . v. . Paramedics Plus 88 :\AD\002\02\2X02\2X02177.docx 242 COMPETITIVE CRITERIA CLINICAL OVERSIGHT PERSONNEL Scorecards Medics will receive a scorecard every six months showing their individual compliance with protocols, patient delivery, and skill success. During review sessions, which focus on key indicators, the individual?s performance is compared to set goals and standards. A sample scorecard is provided in Appendix 17. Other performance results are communicated in face-to?face conversation, in newsletters and during continuing education classes. Please see the chart on following pages. An organizational scorecard aligns mission, vision, values, critical success factors, measures, goals, and action plans into an easy to read one-page document. Ability to Analyze Performance Data and Conduct Improvement Projects The C00 and DCOS will possess quality management competencies and keen analytical skills. Paramedics Plus will prepare the leadership team both through training and tools, including the dynamic use of Tableau. Training and support is provided through the Paramedics Plus proprietary management training program, its CARE PLUS leadership training, and professional conferences, as well as through mentoring by seasoned professionals with a wealth of quality knowledge. Michael Bureau, the proposed COO for this operation, is part of the Pinellas County Florida team, which is an award?winning quality operation with bench strength in Six Sigma and making the most of the Baldrige quality criteria. Mark Postrna, Paramedics Plus Vice President, and Debbie Vass, Chief Administrative Officer at Pinellas, will continue to mentor and support Mr. Bureau and his leadership team in the analysis of performance data and implementation of improvement projects. Use of Tableau and Ninth Brain Tools used to perform data analysis include trend analysis, statistical control charts, pareto charts, gap analysis and compliance. Analysis of performance data is supported through Ninth Brain and Tableau products. The use of Tableau allows for virtually any element captured in the to be retrieved for analysis. Paramedics Plus 89 :\AD\002\02\2X02\2X02177.docx 243 COMPETITIVE CRITERIA CLINICAL OVERSIGHT PERSONNEL Information in the can be viewed as soon as the crew completes the report. The Paramedics Plus proprietary application of Tableau allows managers to see dashboard KPIs related to the clinical elements selected for measurement and tracking. The Tableau product is a business interface application that provides useful information to managers, giving them the opportunity to measure key performance indicators and support the improvement of patient care. KPIs can be built and changed as collaboration with Sioux Falls, REMSA, and other partners see the need. Ninth Brain provides a platform for collecting, recording and tracking results from peer- reviewed patient care report audits. Quality assurance data specific to protocol adherence related to documentation, pain management, medication administration, patient refusal of treatment/ transport, etc. is entered into a custom form that allows the user to follow a consistent format to review a patient care report. Detailed reports can be easily generated to provide an overview of protocol compliance, individual provider performance and trends in patient care and outcomes. The information received helps steer continuing education content, prompt the review or change of protocols, remediation of an individual provider, prompt a process improvement project and provide employee feedback and recognition. Additionally, the platform allows for real-time notification to the individual responsible for the oversight of clinical quality assurance anytime there is a patient care record ?agged for review. Overall, utilization of Ninth Brain allows for a closed-loop process for Clinical Quality Assurance. Regular and Routine Use of Performance Data On a daily basis, system performance is analyzed in PULSE meetings. These meetings provide opportunities for improvements and innovation. PULSE stands for Performance Utilization Late-call System Evaluation. Due to the size of the City of Sioux Falls operation and the flat management structure, these meetings will also include a review of any significant clinical reviews or customer service investigations. At a minimum, these meetings will be attended by the COO, Director of Clinical and Operations, the on-duty Paramedics Plus 90 :\AD\002\02\2X02\2X02177.docx 244 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA CLINICAL OVERSIGHT PERSONNEL supervisor, and the Administrative Services Coordinator to evaluate the key aspects of the operation that contribute to success in meeting our contractual requirements and providing quality care and service. On a weekly basis, staff meetings will include discussimis on (Werall operational and clinical performance. This meeting will ensure that strategic initiatives and, associated action plans, are being implemented effectively while addressing obstacles or challenges. On a basis, convene quality meetings or coordinate such meetings with to discuss all key performance indicators. At a minimum, the COD, the Director of Clinical and Operational Services, a supervisor and Adminisu'ative Services Coordinator will attend this meeting. It is our intent that a representative Speci?c examples of methods used to communicate with workforce related to quality management and performance Organizational and individual performance in employee, operational, and clinical outcome measures are key determinants of the effectiveness of employee communications meUmds. Annual employee satisfaction survey results are also used to Assess the effectiveness of communication methods. (INFORMATION METHODS TO Employee scorecards/evaluations Employee meetings Newsletters Bulletin boards Quality assurance reviews from REMSA and the EMS Medical Director WORKFORCE Employee Committees attend these meetings. In Uiis meeting, attendees (safety 3? targeted performance will review performance of all key performance impmvemem team) indicators via 'lableau dashboards, statistical E?ma? control charts, and pareto charts. Signi?cant laptop POP-UPs gaps in performance related to targets or goals Educat'm Classes will be addressed with formal action plans. Walk-arounds ride-340095 J, Methods for Open Communication and Sharing of Performance Data Methods used to communicate openly with the workforce are shown in the table below. Individual performance information is shared one-on-one, while organizational data is shared in a number of ways. l: Irma; t? .rtru-r- utilising ?unmm club 5 Paramedics Plus 91 245 COMPETITIVE CRITERIA CLINICAL OVERSIGHT PERSONNEL Strategies of Leadership Team to Promote Legal and Ethical Behavior Strategies for a legal and ethical organization begin with moral and ethical leadership at the top of the organization. Paramedics Plus prides itself on being unquestionably legal, highly ethical, and a partner that keeps its promises with all EMS stakeholders. Paramedics Plus Vice President Mark Postma is a native of the Sioux Falls area and his ethics and values still re?ect those embraced by the community today. That said, we select members of the local leadership team based in large part on their fit with the organization?s values. Ethical behavior is one of the CARE PLUS values?our commitment to perform duties in a just and honest way and encourage an organizational culture which balances accountability and fairness. CARE PLUS Values rC ustonler accountable Our commitment to honor our pledgcs and do the very best?r patients, customers, and communitu's. Attentive [0 human needs Our commitment to treat our patinits, mtu?nts??nnily members, customers, and collmgiu?s as valued individuals. Respectful Our to belumror toward our patimts, tolleagues, rustomsrs, and the public that the mspect we want to receive ourselves. Ethical Our to pm:an dutiss in a just and honest may and eru?oumge? an organiwtional culture which halaru?ss ta?countatrility with fix i mess. Partnersh Our commitment to long?term nzlationships and partnerships ?rcused on the needs of our patu?n ts and rommunitir-?s we se-?rvi?. Lead example Our to personally model our values and promote an mvironment that supports our mission and vision. nders Our commitment to understand and value diversity in our worlr?mz? and our treating all equally and without judgment. Safe Our commitment to amt? and promote the of our patients amt community. - t1: Hi'l'f; f?l?l? :\AD\002\02\2X02\2X02177.docx Paramedics Plus 92 246 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA CLINICAL OVERSIGHT PERSONNEL Michael Bureau lives. the CARP. Pl .US values, and we are confident of ?nding a local candidate to [ill the Director of Clinical and Operational Services who, likewise, is a perfect match for the values of the organization and the community of Sioux Falls. The local leadership team, like the corporate leadership team, will model ethical behavior for its staff. Senior leaders personally promote an organizational environment that fosters, requires, and results in legal and ethical behavior by personally establishing policies, procedures, and frequent monitoring of organizational performance at all levels. An ethics hotline has been established at all Paramedics Plus locations to accommodate anonymous reporting of violations of legal and ethical behavior. Additionally, leaders personally role model CARE PLUS values in their daily behavior, sending personalimd thank you notes to employee-i, and personally presenting employee recognition awards centered around the CARE PLUS values system. Leaders actively deploy the CARE PLUS values throughout the organization. Ethics training for employees begins in orientation and is reinforced annually through mandatory in?house training. All employees are required to sign a document annually signifying their commitment to the Paramedics Plus codes of conduct. Members commit to reaf?rm understanding and commitment to the CARE PLUS philosophies and ethical business practices. Paramedics Plus has professional conduct and human resource polices that reflect our core values and are reviewed bi-aimually. These polices are reviewed with new em ployees during orientation. Additiimal approaches and deployment methods include employees receive amiual ethics training and annually sign a document signifying their conunitment to our codes of conduct. Members of the leadership team write newsletter articles on legal and ethical behavior, deploy CARI-I PLUS in their areas of responsibility, and hold their staff accountable through immediate termination of employees who, after investigation, are found guilty of violating legal and ethical behavior. Process for Handling Breaches of Ethical Behavior Paramedics Plus does not tolerate violations of the code of ethics. If there is a report of a breach of ethical behavior, the employee is placed on administrative suspension during an investigation. The matter is investigated quickly, thoroughly, and con?dentially. If there is suf?cient evidence that a breach of ethics occurred, the employee enters disciplinary process, which may include termination of . . employment. of the leaderslup team and supervxsors revrew the leadership code of conduct and annually 0! Hi? It?i-lt??E t? orHu-r- donning "w Nummu club 5 Paramedics Plus 93 247 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA CLINICAL OVERSIGHT PERSONNEL A Culture Focused on Patient and Employee Safety The leadership of Paramedics Plus promotes a culture based on patient and employee safety through the vision and mission statements, values, and critical success factors described previously. Safety is a core value re?ected in the CARE PLUS philosophy. 5qu Our oommi tment to create and promote the safety of our workforce, patients and community. A safe workforce is also one of our key strategic objectives. The Leadership Team creates and promotes a culture of patient safety through policies and procedures that address and emphasize the safety of patients and employees, safety training, the Safety Committee and monitoring of safety measures. The Director of Clinical and Operational Senices will ensure Uial safety is integrated into processes and the core of the operation to create a successful and safe environment for patients, employees and the community. Performance related to safety is measured on a regular and continuous basis and re?ected on organizational scorecards. Safety measures can be found in the table below in the Slt/iff?y Kl?ls section. urpomte Safety Initiative Paramedics Plus recently launched a corporate for employees and pah'ents. As a result, new processes were developed along with revised training approaches to patient movement. The result was a 16.8% reduction in patient handling injuries over two years. A ssessing (Minions The leadership also assesses our employees' views of safety in the employee satisfaction survey. The survey asks employees to rate their opinion of the statement: "My safety seems to be a high priority." "lust Culture Another component of our organizational approach to safety behavior is our adoption of "Just Culture.? Paramedics Plus uses "Just Culture" as a framework to support quality improvement and patient safety. "just Culture" is taught by Paramedic: l?lus Corporate Trainer Rodney )yche and embraces not only the active identification of safety issues, but also responds with appropriate actions. "Just Culture" is a framework, which balances accountability with a sense of fairness, resulting in an open sharing of information between management and the workforce and ultimately leading to improved systems and better care for patients. More details on "Just Culture" are provided in XI. C. Supervision and Work safely initiative involving leadership from Schedules. each system who gathered together to consider causes and solutions to injury, both i! m? It-iItC-?z f? orhwr- an autumn? ?ummo cm: 5 Paramedics Plus 94 248 COMPETITIVE CRITERIA CLINICAL OVERSIGHT PERSONNEL Patient Safety Paramedics Plus is a clinical organization and is organized to produce clinical quality. Several operational policies are used to deploy standards for patient safety, including Key methods and measures used by safety leadership for ensuring employee health, safety, and security are listed here. Movement of Patient/ Safety Restraints, Child (KPI Safely Restraints, Stretcher Safety, General Safety Program, and Infection Control Plan. In addition to clinical programs, others such as SafeForce provide our medics with the tools needed to monitor their driving performance in real time and also provide measures to guide the Leadership Team in decision- making. Sryi?ety Employee safety is addressed through safety and risk policies, an infection control plan, the hazard communications program, the emergency action plan; safety initiatives, and the Safety Committee. Other mechanisms for keeping employees safe include careful screening to ensure new hires are physically capable of performing the job, vaccinations to keep employees healthy, personal protective equipment, isolation kits and a robust training program. More details about employee safety are covered in X1. C. 3. Persmmel - Internal Risk - - Marragement/Loss antral Program. DEFINITION Employee injuries Patient injuries Needle sticks Exposures Lost UH rate for OSHA reportable injuries Vehicle collisions Other risk related incidents of Workers' comp incidents Employee OSHA incident rate (all Work comDS) (WC injured employees per 100 employees) of reportable injuries 200,000 divided by# of employee hours worked) of patient reported injuries/total of ambulance responses Number of employee exposures due to needle sticks Exposure occurrences by type of lost time OSHA Injuries 200,000 divided by of employee hours worked Vehicle contacts per 100,000 miles driven Vehicle contacts by cause 9L0: :\AD\002\02\2X02\2X02177.docx Ir'IiVi" Paramedics Plus 95 249 limitime Willi-inn c. ?zy-?Jtsm . :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA CLINICAL OVERSIGHT PERSONNEL Reporting Adverse Events and Near Misses Paramedics Plus encourages, and requires through its policies, employees to report adverse events and near misses. To strengthen our abilities to be a safe EMS provider, Paramedics Plus has partnered with the patient safety organization (PSO) Center for Patient Safety. Participation with this PSO allows Paramedics Plus to improve the quality and safety of care processes and activities while securing federal-level confidentiality protection under the federal Patient Safety and Quality Improvement Act of 2005. The PSO provides clinicians, certified quality, risk professionals and data to support Paramedics Plus? quality and safety improvement efforts. Paramedics Plus is the only EMS provider to fully implement ?Just Culture? and participate in a PSO on a nation-wide basis. Paramedics Plus?s proprietary policies and procedures are designed to facilitate the confidential reporting of medical errors, near-misses and other identified unsafe conditions. Once reported, a full event investigation is launched to discover the root cause of the reported issue. Paramedics Plus utilizes a robust reporting system via the Ninth Brain Online Software suite where all employees report a wide range of incident types. Field employees are able to access the incident reporting system through a tablet PC transported in each ambulance. Employees are encouraged to report any and all incidents as part of the ongoing effort to improve processes and decision behavior. In the context of our "Just Culture," employees rather than management report the vast majority of incidents. Paramedics Plus also addresses adverse impacts on society of our key services through frequent monitoring and by measuring of our key processes to ensure compliance to contractual obligations, industry standards and regulations; performing annual driver license and background checks of all employees; a multiple data base search Via Ninth Brain for employee violations; and a formal hiring process. Paramedics Plus 96 250 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA CLINICAL OVERSIGHT PERSONNEL Yum Ma?a? (mm Regional Neallnme Methods used to anticipate public concerns With our current services include our annual strategic planning process that includes SWOT weaknesses, opportunities and threats) and environmental scans; maintenance of several accreditations; certification of clinical staff; continuing education; quality assurance reviews; daily monitoring of our performance; and, review of customer satisfaction surveys. For example, an adverse effect of emergency driving in heavy traf?c is addressed through our risk reduction processes. These include our mandated Emergency Vehicle Operators Course which provides classroom education and driving range management, driver?s license annual reviews, and our SafeForce driving system to monitor and record unsafe vehicle operating parameters such as speeding and high vehicle g-forces caused by rapid accelerations, hard decelerations and high speed turns. Param edi cs Plus 97 251 COMPETITIVE CRITERIA CLINICAL - MEDICAL DIRECTION AND SUPPORT 4. Medical Direction and REMSA Medical Control Paramedics Plus will meet the minimum requirements of Medical Direction and Support for REMSA Medical Control and proposes to: 0 lingage a well-qualified and m?perienced Medical Director, acceptable to RIEMSA Medical Control, to oversee clinical activities 0 Utilize the Paramedics Plus Chief Medical ()l?f?icer as a resource until the IIMS Medical Director is employed. Paramedics Plus will achieve higher levels of commitment and proposes to: 0 Employ an EMS Medical Director who is Board Certi?ed in Emergency Medicine, collegial and an active member of the Sioux Falls medical community 0 Send the EMS Medical Director to the NAEMSP Medical Directors? Course if the selected candidate has not already attended 0 Support the local EMS Medical Director through the Paramedics Plus Clinical Forum. a) Requlrements? Medlml Proposers shall engage a as Its Medial Dlrector to oversee the Contractor's Upon noti?cation of intent to award the contract, Paramedics Plus Chief Medical Of?cer John Sacra, M.D., F.A.C.P., will meet personally with the Medical Director to seek guidance on the best possible local candidates or this position. Dr. Sacra has already made contact with quali?ed candidates in Sioux Falls who have interest in this position with Paramedics Plus. The current EMS Medical Director is well-qualified but, understandably, may be re?cent to show interest in a position with an organimtion competing against his current employer in this RFP process. Should Paramedics Plus be noti?ed of "intent to award," the organization will welcome the opportunity to talk with him and other quali?ed physicians. A complete job description is available in Appendix 18. While Paramedics Plus is con?dent in its ability to enlist a well-qualified physician or this position prior to contract start, our Chief Medical Of?cer Dr. John Sacra will be a resource leading up to the commencement date. He is well prepared and equipped to assist as needed. Dr. Sacra is a Fellow of the American College of Emergency Physicians, has more than a decade of experience as the Medical Director for the system, which l. u'lu t" In ?w us. . Paramedics Plus 98 :\AD\002\02\2X02\2X02177.docx :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA CLINICAL MEDICAL DIRECTION AND SUPPORT serves more than 1.2 million Oklahomans, has been the director of a busy trauma emergency center, and has served as a practicing emergency physician. More about Dr. Sacra is available in XI. D. Key Personnel. His curriculum vitae is provided in Appendix 19 Attestation: 0 Paramedics Plus understands and agrees to comply without qualification to provisions, requirements, and commitments contained in Section b) Higher Levels of Commitment Paramedics Plus commits to employ a local actively practicing physician who is board certified by the American Board of Emergency Medicine and fully engaged not only in emergency medicine, but also in the Sioux Falls medical community. If the successful candidate for EMS Medical Director has not attended the National Association of EMS Physicians Medical Director's course, Paramedics Plus will pay travel and tuition for the physician to attend. The selected Sioux Falls Medical Director will work closely and collaboratively with the REMSA Medical Director. He or she will be actively involved with Paramedics Plus and its employees through training, field observation and appropriate research. He or she will also be a liaison with other members of the medical community to support the system and resolve issues. He or she will assist Paramedics Plus in ensuring compliance with all system medical protocols and all administrative policies established by REMSA in addition to ensuring compliance with the REMSA Quality Management requirements. The Medical Director will provide input to REMSA on a periodic basis for the purpose of updating the system?s protocols and policies, and he or she will participate with the REMSA Medical Director in the continuing quality improvement process, regular case reviews and provide full access to field personnel for direct contact with the REMSA Medical Director, REMSA clinical oversight personnel and base hospital physicians on issue of patient care as needed. Paramedics Plus 99 253 COMPETITIVE CRITERIA CLINICAL MEDICAL DIRECTION AND SUPPORT Paramedics Plus will support the Sioux Falls EMS Medical Director in a variety of ways, including the Clinical Forum which is comprised of Medical Directors from each Paramedics Plus system and led by the Chief Medical Of?cer for Paramedics Plus. The Clinical Forum is supported by a secure software site, which houses protocols, both clinical and operational, for each system. It also boasts a question board where any Medical Director can pose questions to other Medical Directors for input. KPIs are shared and benchmarked through the process and regular conference calls facilitate the free flow of information. Paramedics Plus 100 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA CLINICAL FOCUS ON PATIENTS AND CUSTOMERS 5. Focus on Patients and Other Customers Paramedics Plus will meet all minimum requirements under Clinical Focus on Patients and Other Customers and proposes to: 0 Employ an efficient Complaint Management process to ensure that all complaints are captured, tracked, trended and resolved and effectively 0 Publish a Customer Hotline to provide 24/ 7 access to local management. Paramedics Plus will achieve higher levels of commitment under Clinical Focus on Patients and Other Customers: 0 Determine customer requirements and expectations through communication and feedback methods, taking action when indicated 0 Connect the Voice of the Customer to the planning process by carefully aggregating, segmenting and analyzing complaints and using that information to create action plans for correction 0 Provide the same level of care to ALL patients regardless of age, gender, ethnicity, neighborhood or medical condition 0 Ensure patient safety through a robust infection control program. a) Minimum Requirements? Focus on Patients and Other Customers At a minimum, the Contractor shall have a comprehensive mechanism for handling patient and customer complaints or issues. The Proposer shall describe the organization?s mechanism for managing complaints. Include methods for receiving, investigating, resolving, and tracking complaints. Include the method for analyzing complaint patterns along with examples of improvement activities that have resulted from this analysis. Paramedics Plus 101 :\AD\002\02\2X02\2X02177.docx 255 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CLINICAL - FOCUS ON PATIENTS AND CUSTOMERS Contractor shall establish and publish a Customer Access Hotilne giving lntemai and extemai customers and system participants the ability to contact a designated liaison of the Contractor?s leadership team to discuss recommendations or suggestions for service improvements. Complaint Management It has been said that, "Customers don?t expect you to be perfect. They do expect you to [ix things when they go Porter Our goal is always 100% satisfaction, but when things don?t meet our customers? expectations, whether the customer is a patient or patient?s family, First Response, local Emergency Department staff, the public, or our own employees, we work hard to respond and appropriately. Paramedics Plus has a formal complaint management process to ensure complaints are captured, tracked, trended and resolved effectively and Our policy provides a consistent framework for use by every member of the organiration. Every member of the Paramedics Plus team has a responsibility first, to provide great customer service, then to follow established procedures so that each issue is documented, investigated and resolved expeditiously. Paramedics Plus empowers employees to resolve issues appropriately and as quickly as possible. The Paramedics Plus employee who initially receives the customer inquiry starts by obtaining a clear understanding of the issue. If employee can resolve the issue professionally and accurately, he or she is encouraged to do so immediately. The employee will then report the complaint, and the resolution action taken to resolve the complaint, to a supervisor for discussion and documentation in Ninth Brain. More comple\ complaints or inquiries received by field personnel should be sufficiently documented and sent to the supervisor, who will contact the customer making the complaint within 60 minutes. The supervisor will confirm the nature of the complaint and attempt to resolve any mismderstandings of agency policy when possible. Customer Hotline Not all patients or customers with a complaint will have direct contact with represtm tatives of Paramedics Plus. Therefore, Paramedics Plus will provide a customer hotline to provide 24/ 7 access to local management; The hotline will be published in the local telephone directory and website and publicized to local healthcare facilities, fire stations, and public safety agencies. All complaints are assigned to a supervisor or lead peer who is for investigating, documenting, and contacting the complainant to resolve the investigation This designee will return a customer's call within 60 minutes, 90% of the time. Compliance to this standard will be tracked in our complaint software management system. ar'lu?f' In tit-Junie nu Titania.) CM: 31. Paramedics Plus 102 256 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA CLINICAL FOCUS ON PATIENTS AND CUSTOMERS If the supervisor or lead investigator believes agency rules may have been violated or medical protocols not followed, a formal internal investigation follows. Feedback from the investigation is provided to the complainant as soon as possible with a goal of 72 hours or less. When indicated, inquiries involving clinical performance are forwarded to medical oversight and the Director of Clinical and Operational Services to determine if a quality assurance review is dictated. Paramedics Plus will cooperate fully with medical oversight. Through the quality assurance review, feedback is provided to involved individuals, and the customer is contacted to provide closure. Complaint data is reviewed and summarized quarterly. When a system or employee trend is identified, or the design of a system or process is deemed to be a contributing cause, the organization will respond appropriately by modifying the process or providing education and training to address the problem. Attestation: 0 32% Paramedics Plus understands and agrees comply Without qualification to prowsrons, requirements, and commitments contained in Section COMPLAINT OR CONCERN IS RECEIVED YES RESOLVE AT POINT OF W0 FORMAL COMPLAINT FILED LOGGED INTO TRACKING SYSTEM ROUTED TO APPROPRIATE DEPT. SUPERVISOR, RISK MGT.. TRAINING EDU. 1 NO (?cumm I YES FORWARD TO REMSA QUALITY REPORT IS INITIATED INVESTIGATES. LOGS. TRACKS 8 DETERMINES RESOLUTION DEPLOYMENT OF RESOLUTION COMPLAINT RESOLVED OR CLOSED b) Higher Levels of Commitment Focus on Patients and Other Customers Determining Key Customer Requirements Paramedics Plus uses several communication and feedback methods to determine key requirements of the various customer groups. From our experience in other operations and interviews with patients, the following table is an example of key external customers, ("Paramedics Plus 103 257 COMPETITIVE CRITERIA CLINICAL- FOCUS ON PATIENTS AND CUSTOMERS their requirements and expectations, and the feedback methods employed to determine compliance. Key customer requirements are validated annually. Emergency Patients (and their femi?es) Non-Emergency Patients (and their families) Residents and Visitors of City of Sioux Falls Facilities Requesting Ambulance Services Recognizing that customer satisfaction is a team effort, Paramedics Plus partners with its employees, local fire departments, hospital personnel, Medical Director, dispatch center, local education institutes, and law enforcement agencies to fully meet the needs and service expectations of our customers. Key Customer Requirements and Expectations 0 Arrive quickly 0 Compassion and caring - Knowledgeable 8. competent - Tell me my family what you are doing and listen to my ansWers - Polite and respectful I Professionalism 0 Overall quality of care - Arrive on-time 0 Knowledgeable 0 Courteous and kind 0 Gentle and careful lifting me 0 Talk with me listen to my needs 0 Professionalism - Helpful and caring 0 Make me comfortable - Overall quality of care REMSA key contract requirements met - Positive working relationship - Fast 0 Safe 0 Efficient 0 Disaster preparation and management 0 Profess'onal - Timely Communication and Feedback Methods 0 Patient surveys 0 Website 0 Phone calls 0 Emails 0 Letters 0 Direct contact with employees 0 Community events 0 Community meetings 0 Medical Director?s Office and REMSA fomrel and feedback 0 Patient surveys 0 Website 0 Phone calls - Emails - Letters 0 Direct contact with employees 0 Community events 0 Community meetings - Medici Directors Office and REMSA formal and informal feedback 0 Review of Contract Requirements 0 Quality meetings 0 Patient Busines Services Meetings - Vthk-erounds - Equipment/Supply meetings 0 Review of remonse time pertormance 0 Review of safety related incidents - Emergency Management meeting to work disaster prqiaredness plans 0 Review of response time performance 0 Nurse Manager meetings - STEMI and other workgroup meeting 0 Meetings with hospital administrators PLUS - Partner?; in Building Sy?tern-A :\AD\002\02\2X02\2X02177.docx Paramedics Plus 104 258 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA FOCUS ON PATIENTS AND CUSTOMERS Using the Voice of the Customer Linked to Planning All complaints are segmented into two groups - clinical and non-clinical. Non-clinical complaints, such as lost items, questions about policics, or conduct of the crew are investigated internally by Paramedic-s Plus staff. All information is entered into a tracking database (the Ninth Brain) and classi?ed by the type of complaint. Complaint types are summarized and reviewed for trends by type or by employee to identify areas for improvement. l'hese reviews are inputs into Paramedics Plus strategic planning process and may result in changes to current policies for the bene?t of improving customer service. They are also used to identify employees who require remediation regarding service expectations of patients and customers. Clinical complaints are investigated by Paramedic: Plus staff and reported to Medical Director, the Medical Director and other entities as directed. All complaints and clinical quality reviews are tracked, and results are used to steer changes in protocols and determining continuing medical education topics. Determining Customer Satisfaction Paramedics Plus will incorporate the methods for communication and feedback listed in the table above to determine customer satisfaction. For the primary customer group, Paramedics Plus will survey 10% of patients to determine their level of satisfaction with the service they received. Survey recipients are randomly selected. Paramedics Plus mails the surveys, paying for the outgoing postage as well as self-addressed stamped envelopes. Completed surveys are initially received and reviewed by and may be entered into a database. Completed Surveys are then passed on to Paramedics Plus personnel to review and record. Any survey with comments or scoring re?ecting dissatisfaction is investigated by the Director of Clinical and Operational Services or designee, and in many cases, the patient is contacted for feedback and resolution. Paramedics Plus aLso uses patient satisfaction feedback to recognize exemplary employees and to track and trend results. The survey results data are summarized on a quarterly basis and reviewed by the Paramedics Plus leadership team to evaluate overall satisfaction performance and identify areas for improvement. Improvement areas are translated into strategic initiatives in our annual strategic plan and help drive the focus on topics for in-house employee training. Satisfaction results, by question, are shared with all employees annually at mandatory training sessions. The quarterly summary of patient satisfaction results will be shared with REMSA and the Medical Director. orHu-r- In (lull:th '\w.uu club Paramedics Plus 105 259 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA CLINICAL FOCUS ON PATIENTS AND CUSTOMERS Action Based on Feedback An example of a change in a process due to feedback from hospital personnel involved the method used to transmit the electronic patient care report. Facilities were receiving these reports via fax machine once the documentation had been completed. The feedback from facilities indicated that receiving reports by fax tied up their machines and created a backlog of incoming paperwork. As a result of this feedback, Paramedics Plus purchased a product that allowed the report to be securely sent to an email address. The facility could then create an email group so those needing a copy of the would have it. Additionally, since the was sent as a PDF, this saved the facility from scanning in the paper document in order to upload it into their electronic system. Patients don?t often complain if it takes a paramedic two times to start an IV. They do, however, have great concern if their belongings are lost. Based on our complaint data, the number one reason patients contact us after a transport is that they are missing a personal item. Many times the investigation reveals that the item was either never taken with them in the ambulance, was misplaced at the hospital, or was secured by a family member. Regardless of the disposition, it is our goal for service excellence to be able to reunite the patient with their personal item as quickly and ef?ciently as possible. A secondary goal is to reduce the man-hours spent investigating lost items. As a result of these goals, new processes and crew education were implemented. The "patient belonging? field was altered a bit with a ?closed call" component added, forcing crews to list any items transported and to whom they were returned. A report was created that allowed the person receiving the complaint call to quickly research that speci?c ?eld in the to provide real time information to the caller regarding whether we had the belongings in the ambulance and who received them. Another process enhancement was the creation of a "found" database. This allows any person who receives the call regarding a lost item to see if has been turned in at any of the ambulance deployment locations. Employees are educated regarding the documentation of patient belongings and are held accountable to ensure that items left in the ambulance during their shift make it back to the patient before they leaveParamedics Plus 106 260 COMPETITIVE CRITERIA CLINICAL FOCUS ON PATIENTS AND CUSTOMERS Equitable EMS Services Paramedics Plus, through the quality management and performance review processes described in Section XI. A. 1. Quality Improvement, will ensure that all patients, regardless of age, gender, ethnicity, neighborhood, or medical condition (substance abusers, mental health, etc.), receive the same level of medical care and customer service (patient experience). One of Paramedics Plus? values is "Understanding our commitment to understand and value diversity in our workforce and our community by treating all individuals equally and without judgment.? The COO for the City of Sioux Falls will personally deliver this message to every new employee and reiterate this value to provide our best to every patient, every time at annual training sessions. Patient Safety Paramedics Plus places a high emphasis on patient safety with ?Safe? being one of the CARE PLUS values. Safety of patients is ensured through a "Just Culture,? policies and procedures, employee training and safety awareness, as well as safe equipment. As described in section XI. C. 3. Personnel-- Internal Risk Management/Loss Control Program, Paramedics Plus provides multiple programs that address infection control for employees and patients. One such practice that is critical is "re-gloving.? Employees are taught to change their gloves before exiting the room/ location with the patient, preventing contamination of hard surfaces in the ambulance that may result in cross-contamination. Another reinforced practice is a standard method for re-dressing the stretcher after every patient and wiping down the stretcher and equipment, as appropriate, with Bleach or Cavicide wipes. The details of the Infection Control policies can be found in Appendix 20. :\AD\002\02\2X02\2X02177.docx PARAWIEDICS PLUS?Partners Budding Award-Winning EMS Systems Paramedics Plus 107 261 COMPETITIVE CRITERIA CLINICAL CONTINUING EDUCATION PROGRAM REQUIREMENTS 6. Continuing Education Program Paramedics Plus will achieve higher Requirements levels of commitment under Clinical? Paramedics Plus will meet all minimum Continuing Education Program requirements under Clinical?Continuing Requirements and proposes to: Education Program Requirements and 0 Provide three hours of training each proposes to: month to meet requirements and to meet 0 Provide training sufficient to meet identi?ed system needs all State and REMSA licensure/ certi?cation . Target education to the Speci?c health reCIUirementsr at no met to employees needs of the demographics of Sioux Falls 0 Partner with Avera McKennan School . Employ engaging and effective teaching of EMS for courses such as ACLS, PALS, models from case scenarios and reenactments to rapid topic discussion 0 Collaborate with the REMSA Medical and internet-based modules Director to provide specific continuing . Use a range of methods to determine education programs to meet system needs mastery of knowledge and Skills Submit educational programs to REMSA . provide the Staff with Opportunities to for approval- network locally and beyond. a) Minimum Requirements? Continuing Education Program Requirements Contractor shall provide in-house or sub-contracted in-service training programs designed to meet all state and REMSA Iicensure/certification requirements at no cost to employees. All in- service and continuing education programs must comply with state regulations. The REMSA Medical Director may mandate specific continuing education programs and content requirements, and REMSA may review and audit any continuing education programs offered by the Contractor. Paramedics Plus will provide, at no cost to the employee, either in-house or through sub-contracted services, training adequate to meet State and REMSA requirements. Training - topics offered can be found in the table under r? - ll: . Paramedics Plus 108 :\AD\002\02\2X02\2X02177.docx 262 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA CLINICAL CONTINUING EDUCATION PROGRAM REQUIREMENTS X. B. 3(b) Personnel Licensure Certification and Training Requirements. Paramedics Plus will partner with Avera McKennan School of EMS for a minimum of three hours of training each month. Courses may include ACLS, PALS, and education programs towards State recertification requirements. The letter of intent from Avera McKennan School of EMS can be found in Appendix 6. Upon contract award, Paramedics Plus will submit to REMSA: 0 A statement identifying classes to be offered and delivery format 0 A sample of our Tamper Resistant Course Completion Certificate 0 A calendar of anticipated classes to be offered in the coming year 0 Paramedics Plus will submit continuing education content to the REMSA Medical Director for review and audit. Topics will be consistent and compliant with REMSA initiatives and standards. Paramedics Plus will design courses based on REMSA system needs and within the NHTSA National Standard Training Curriculum for EMS Personnel. Courses may include ACLS, PALS, and education programs towards State recertification requirements. Upon contract award, Paramedics Plus will apply for and maintain approval as a continuing education provider in the City of Sioux Falls. All in?service and programs for CE credit will comply with Federal, State and County regulations. Paramedics Plus may also utilize training personnel from other operations to provide some educational content, such as EVOC or provide train-the?trainer education. Attestation: 8833 Paramedics Plus understands and agrees to DEED . . . . . . nu comply Without qualification to prowsions, requirements, and commitments contained in Section Paramedics Plus 109 263 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA CLINICAL CONTINUING EDUCATION PROGRAM REQUIREMENTS b) Higher Levels of Commitment Training Program Content and Delivery In addition to the continuing education provided to meet the State and REMSA requirements, Paramedics Plus will offer, through its partnership with Avera McKennan School of EMSA, up to three hours of continuing education each month, at no cost to our employees or system partners. Paramedics Plus employees working in the REMSA system will also be required and paid to attend a mandatory annual eight-hour update. Education offerings will be aligned with system initiatives and based on needs identified through the quality improvement program. Paramedics Plus will work with Fire Department First Responders and other Key Stakeholders such as physicians, nurses, and other groups of Paramedics and EMTs, including our own employees, to develop a common framework for continuing education. This framework will include specific attributes derived from "Education Agenda for the Future: A Systems Approach,? will be patient?centered, medically accurate, professionally relevant, timely and will support education based on system needs. The content of additional in-house training will target the specific needs of the REMSA system and the population of the city of Sioux Falls. For example, in a community with a disproportionate number of elderly, crews may receive training in Geriatric Emergency Medical Services. A good portion of the annual in-house training update includes hands-on skills reviews and competency check offs. New and Engaging Formats for Learning Paramedics Plus strives to make education and training interactive and engaging for the medic students. When possible, scenarios are used to provide medics with clinical training. This allows for an assessment of the provider?s critical thinking skills and competency, and reinforces learning. Paramedics Plus will purchase adult, pediatric, and airway training manikins which will be used for scenario training and skills evaluation. 6 .u . . Paramedics Plus 110 264 COMPETITIVE CRITERIA CLINICAL CONTINUING EDUCATION PROGRAM REQUIREMENTS Education provided will include both hands- on skills training and performance evaluation coupled with rapid topic discussion mastered and utilized at the Gathering of Eagles Conference. This style of instruction provides for meaningful discussion and active learning. Case scenario and re?enactmen ts are the foundations of local system performance and evaluation. Some of our Paramedics Plus locations have used social media to encourage on-going education. For example, on a team member only liacebook group page, administration may post a challenging 12-l.ead l'iCG strip (removed of any patient information) for team members to interpret. Scenarios may also be posted for comment. These postings promote critical thinking and problem solving among team members and training personnel. When providing education on topics such as HIPAA, OSHA, sexual harassment, etc., some of our Paramedics Plus operations use videos, some of which are produced in- house, to provide a more entertaining and engaging way to present these annual topics. Paramedics Plus will utilize these training videos for the staff in Sioux Falls when appropriate. Paramedics Plus will also make use of the Ninth Brain software system to provide delivery of educational content that does not necessarily bene?t from face-to-face class time. Educational Networking Paramedics Plus will ensure that its education and training staff are exposed to new ideas and changes in liMS by sending representatives to local and national EMS Facebook Settings are such that all comments conferences. must be approved by administration before being posted. ?Hu-r- NW.qu Ch?b 5 ?yawn. Paramedics Plus 11 :\AD\002\02\2X02\2X02177.docx 265 COMPETITIVE CRITERIA OPERATIONS COMMUNICATIONS 1. Dispatch 8 Communications a) Minimum Requirements? Dispatch and Communications Center Interactions The Contractor shall provide and maintain all equipment and software interfaces necessary to receive requests for ambulance services made by City PSAP. Paramedics Plus will meet all minimum requirements under Operations Dispatch and Communications and proposes to: 0 Invest and maintain more than $145,000 of state-of?the-art equipment and software interfaces to receive requests for ambulance services. Paramedics Plus will achieve higher levels of commitment under Operations ?Dispatch and Communications and proposes to: 0 Fully support Metro Communications through training, collaboration and cooperation, including providing a MPDS qualified instructor 0 Lend the policies, procedures and experience gained in a similar communications configuration for the benefit of the City and its PSAP 0 Work collaboratively with Metro Communication to develop a mutually satisfactory process for problem resolution 0 Utilize the Paramedics Plus proprietary and award winning PULSE process to monitor daily essential data elements which contribute to efficient deployment plan execution 0 Offer PULSE Live, a new software tool to improve response times, better utilization of resources, greater employee engagement, and improved analysis and management of the System Status Plan and its field execution 0 Engage its Corporate Deployment Director with key representatives from across the operation in daily monitoring as well as long?term projections and plans to ensure effective deployment planning. Paramedics Plus 112 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA OPERATIONS COMMUNICATIONS In public safety, the communications/ dispatch component is essential to the entire service delivery process. When citizens call Metro Communications for service, the initial contact with the call taker sets the stage for the response to the call. As the Contractor, Paramedics Plus will work with Metro Communications staff to develop the software interfaces and provide the equipment necessary for ambulances to receive requests for ambulance services from Metro Communications. Paramedics Plus operates dispatch ?Accredited Centers of Excellence? in Florida, Texas and Indiana and has great appreciation for the role of the dispatch function in a well-run EMS system. Paramedics Plus has a history of working cooperatively with public safety communications center personnel and will cultivate a collegial relationship with Metro Communications focused on patient and community benefits. Paramedics Plus has a three-year history of working with Alameda County Regional Emergency Communications Center (ACRECC) in Alameda County, California. ACRECC, in partnership with Paramedics Plus, was the first All-Fire dispatch center to switch to high performance EMS dispatch of a private ambulance provider. Paramedics Plus provided the tools and training necessary for ACRECC staff to successfully dispatch. Currently a dispatch ?Accredited Center of Excellence," ACRECC dispatches 67 Paramedics Plus ambulances with 99% accuracy. Paramedics Plus responds to approximately 125,000 calls for service each year in the Oakland Bay area in this high performance EMS system. The Corporate Director of Deployment and Analysis along with the local administrative staff will work collaboratively with Metro Communications management to assist with training, identify improvement areas, and facilitate a quality working relationship between Metro Communications personnel and field personnel. Daily PULSE meetings with Metro Communications staff will facilitate the analysis of late runs, modification of the resource deployment plan, personnel issues, and any other issues affecting the delivery of patient care. The PULSE process is further explained in ?Higher Levels of Commitment." :\AD\002\02\2X02\2X02177.docx Paramedics Plus 113 267 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA OPERATIONS COMMUNICATIONS Equipment and Software Interfaces Paramedics Plus will provide Motorola Brand VHF mobile radio equipment and wireless cellular phones on each supervisor and ambulance unit, and obtain all radio channels, necessary FCC licenses and other permits required to effectively receive communications from Metro Communications on the South Dakota Digital Trunked Radio System. A full description of the proposed mobile radio equipment is provided in Appendix 21. Paramedics Plus will be capable of receiving and replying to requests for emergency ambulance services by both voice and data links. Each ambulance will be equipped with an Onboard Mobile Gateway (OMG) linked via Verizon wireless air cards to the New World CAD and Zoll billing system. The Onboard Mobile Gateway is an onboard computer server which connects and controls the interface for the 12?Lead EKG Monitor, AVL, Mobile Data Computer running the New World System Mobile Client, devices, and the Road Safety device. The OMG also facilitates the transmission of 12-Lead to hospitals for rapid real-time patient evaluation of STEMI's. More information about the Onboard Mobile Gateway is provided in Appendix 22. Paramedics Plus will install and maintain AVL devices on all ambulances used within the REMSA system. The AVL system proposed will be compatible and interface capable with the Metro Communications Dispatch Center?s New World CAD as well as capable of adjusting polling times to better manage field resources. Paramedics Plus will permanently mount into each ambulance a Motorola APX 6500 (3600/ 9600) analog and digital capable VHF trunked mobile radio with an external antenna mounted on the ambulance box roof. These radios will have DTMF capabilities to alert hospital emergency department radios of incoming radio traffic. All mobile radios will be compatible with the South Dakota Digital Trunked Radio System. Paramedics Plus 114 268 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA OPERATIONS COMMUNICATIONS Each ambulance crew member will carry a Motorola APX 4000 (3600/ 9600) analog and digitally capable, VHF trunked portable radio with remote public safety speaker microphone. All portable radios will be compatible with the South Dakota Digital Trunked Radio System. In addition, each Paramedics Plus employee will be assigned a pager for call dispatching, emergency alerts, and staffing/ scheduling noti?cations. Paramedics Plus will operate subscriber radios in compliance with all rules and regulations of the Federal Communications Commission, City of Sioux Falls and REMSA. Paramedics Plus will equip each ambulance and ?eld supervisory vehicle with a wireless cell phone programmed for quick access with numbers for local hospitals, Metro Communications and other necessary personnel and agencies. These cell phones can also be used as a secondary backup communications device if the radio system should ever fail. A description of this device can be found in Appendix 23. Paramedics Plus will equip all ambulances and supervisory vehicles used in providing service to Sioux Falls with radios for communications with hospital receiving facilities and for ambulance-to-hospital communications. The proposed mobile and portable radios have DTMF capabilities to alert hospital emergency department radios of incoming radio traffic, to allow ambulance- to?hospital communications and will be compatible with the South Dakota Digital Trunked Radio System. Attestation: 0 3833 Paramedics Plus understands and agrees comply Without qualification to provismns, requirements and commitments contained in Section V. B. 1.a. b) Higher Levels of Commitment? Dispatch and Communications Paramedics Plus welcomes the opportunity to work with Metro Communications to collaboratively develop policies and procedures, implement new software solutions and processes to improve response times, provide enhanced training and, generally, work as a partner with Metro Communications to improve service to the community. Paramedics Plus successfully partnered with Alameda County Regional Emergency Communications Center in a very similar arrangement and is confident in both its will and ability to be a true ally to Metro Communications. Strategies to Reduce Response Times Paramedics Plus is offering a dynamic enhancement to the REMSA system in the form of a powerful new software tool, superior to any on today?s market, that leads to improved response times, better utilization of resources, greater employee engagement, and improved analysis and management of the System Status Plan and its field execution. . liz? 5'31; 141:. ?t?lru, Paramedics Plus 115 269 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA OPERATIONS COMMUNICATIONS PULSE, patent pending, for Performance Utilization Latecall System Evaluation, is a revolutionary visual software tool that, in its newest version, employs Google MAPS API combined with color codes and other visual cues to improve the system status dispatch and management processes. The PULSE suite of software is valued at more than $150,000 plus annual support. Now in its fourth version, the product is developed from data in the Computer Aided Ihspalch (CAD) combined with Deployment Planner, which develops the System Status Plan, and the mapping application installed in each ambulance. Created three years ago by Paramedics Plus sister organization ETMC EMS and in response to identi?ed System Status Controller and EMS management needs, this powerful software allows System Status Controllers to not only see the system as itis operating in real time, but to see it on "street view" in its actual ecosystem. While other products are map-supported or map-centric, PULSE utilizes Google MAPS API to provide distinct advantages since landmarks and terrain are easily identified and the street view dispatchers clear understandings of any challenges to the "mission." Google MA Ps A PI also has an application on mobile devices. PULSE Live There are three components to the software. The ?rst of which is Live" which allows Communications employees to observe the system, in real time, in its entirety and to quickly discern available units From busy units. PUISE Review The second major function of this exciting new softwareis Review." I'his allows the Communications team or Operations team to focus retrospectively on any segment of the system to learn how responses might have been improved. While PULSE Review is used most often to analyze late calls, it can be used at anytime to find ways to improve the system whether or not a late call occurs. SF l'x?ppm?ting 'l'he third and final function of the software is Reporting," which facilitates reporting on any number of performance related items such as response time reporting, scene times, transport times, hospital drop times and others. tf'l'n?r' Building ,I\W.uix Ch?b 5 3"uic:tn. Jaramectics Plus 116 270 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA OPERATIONS COMMUNICATIONS Daily PULSE Meetings Paramedics Plus will work with Metro Communications staff to implement daily PULSE meetings to strengthen the relationship between Metro Communications staff and Paramedics Plus. The PULSE meeting process has been a critical component in the successful team effort between ACRECC and Paramedics Plus. The PULSE process literally takes the ?pulse? of the system through a daily exchange between those who create the plan, those who make certain the plan is followed and those responsible for ensuring resources for plan execution. During the daily meetings, as many as seventeen variables are reported to system decision makers representing all aspects of the operation. The Corporate Director of Deployment and Analysis joins by phone to support the process. The variables reported at each PULSE meeting include: 0 number of ambulances available 0 number of cots 0 number of 0 number of needed for special events 0 the peak unit hours scheduled by day for the next seven days 0 number of shifts open by day for the next seven days 0 unit hour utilization for the previous day 0 number and reason for exceptions the previous day 0 number and reason for lost unit hours the previous day 0 status of employees in the orientation academy 0 status of employees in field training and expected date of release 0 clinical investigations 0 compliance percentage for the previous day 0 compliance month-to?date 0 compliance quarter-to-date 0 transport volume year-to-date 0 absences year-to-date 0 any late call for the preceding 24 hours. The open, honest and transparent sharing of information between the Communications team and the Paramedics Plus team builds trust and will enhance response time compliance overall for the REMSA system. Paramedics Plus 117 271 COMPETITIVE CRITERIA OPERATIONS COMMUNICATIONS Deployment Training of PSAP Personnel response times for patient care. Please see A d' 25 1 1' Paramedics Plus will install, at its own cost, ppen 1X or examp es 0 6 p0 mes an the PULSE suite of software along with the server and interface to the New World CAD procedures Paramedics Plus developed with ACRECC in Alameda County, CA. in Metro Communications for dispatchers Paramedics Plus proposes to work jointly with use in dispatching ambulances. Four hours of Metro Communications in an effort to explore training in the use Of PULSE will be provided ways to share more efficient ways to conduct to Metro Communications dispatch staff. EMD Q. Paramedics Plus will provide 16 hours of System Status Management (SSM) training tO Metro Communications staff to review and prepare them for the movement toward high performance EMS. See Appendix 24 for Curriculum and Table Of Contents. Training will be conducted in Sioux Falls by Rodney Dyche, our Director of Corporate Training. His extensive EMS background brings credibility to his training programs as is exhibited in his resume in Appendix 38. Paramedics Plus also understands the investment Of time and expense to maintain the Accreditation. Paramedics Plus has corporate EMD Instructors and will provide an EMD Instructor for one EMD class per year in Sioux Falls for Metro Communications staff. Paramedics Plus will work with Metro Communications staff to develop comprehensive policies and procedures for high performance dispatching. In addition, the Paramedics Plus highly trained staff will provide classroom and on-the-job training to Metro Communications staff to improve Paramedics Plus 118 :\AD\002\02\2X02\2X02177.docx 272 COMPETITIVE CRITERIA OPERATIONS COMMUNICATIONS Problem Resolution Process Paramedics Plus will assign an administrative staff person to work closely with Metro Communications so issues can be addressed quickly and outcomes tracked for trending. In our Alameda County operation, problems are resolved using the following process: 1. In instances where field crews feel an incorrect assignment has been made for either an emergency or non-emergency call, the crew completes the Quality Improvement Feedback Form housed on the Ninth Brain. 2. The form is submitted to the Clinical Field Supervisor. The crew does not contact the Communications Center but continues to the call so that patient care is not delayed. . The Paramedics Plus Communications Center liaison investigates the incident, provides documentation as to the resolution in Ninth Brain and sends feedback to the crew. . Should an Emergency Medical Dispatcher encounter an issue with the crew, the same procedure is followed with documentation, investigation and feedback. Paramedics Plus 119 :\AD\002\02\2X02\2X02177.docx 273 COMPETITIVE CRITERIA OPERATIONS COMMUNICATIONS While the same process could be adopted in Sioux Falls, Paramedics Plus would propose initial discussions with Metro Communications and representatives of Paramedics l?lus operations to design a process that would work in Sioux Falls. For Paramedics Plus, problem resolutions generally follow the same steps used for process improvement. The steps follow: 1. Meet with stakeholders to discuss the issue or problem. 2. As a group, discuss and determine the root cause of the problem. 3. Brainstorm and develop alternative solutions. What are we trying to accomplish How will we know that a change is an improvement? 5 What change can we make that will result in improvement? mm 4. Select the best solution. 5. Implement the solution. 6. Evaluate whether the solution achieved the desired effect. 7. Alter the initial solution based on the evaluation findings, implement and re-evaluate. Working Toward the Future As Mobile Integrated Healthcare evolves, Paramedics Plus is committed to working with REMSA and Metro Communications to implement innovative programs to provide more appropriate responses to responses to 911 calls. Panhn?nCS PLUS Partnvi-t in Building ilw Iftl Winning: Syn: . Paramedics Plus 120 :\AD\002\02\2X02\2X02177.docx 274 COMPETITIVE CRITERIA OPERATIONS AND EQUIPMENT 2. Competitive Criterion: Vehicles Minimum Requirements? Vehicles Paramedics Plus will meet all REMSA At a the contrath meet the requirements listed below. minimum requirements under Vehicles and 1. All ambulances shall meet applicable South Dakota ro oses to: State law and Administrative Rules, including but not PU rcha?se an appropriately marked ?eet limited to SDCL ch. 34-11 and ARSD Article 44:05 et of all new ambulances, which meets all seq, and all local ordinances and regulations. Federal, State and RICMSA standards. Our 2. Ambuhnoe vehicles used In providing contract vehicle ?eet will be at 150% of initial peak services shall bear the markings of the REMSA logo and ?Regional Emergency Medical Services I 5 a Authority" In at least four (4) inch letters on both 0 Equip each ambulance With and sues. Such vehmes sha? the demand Systems emergency telephone number on both sides. Replace ambu'ances 0? a 6811]? dedule' 3. Ambulance vehicles shall be marked to identity the company name, but shall not display any telephone Paramedics Plus will achieve a higher number other than 9-1-1 or any other advertisement. level of commitment and proposes to: 4. Overall design, color, and lettering are subject to . Equip the all new ambulanceq with the approval of the Contract Administrator. SafeForce driver monitoring behavior 5. Proposer shall describe the ambulance and modi?cation technology at a cost of supervisory vehicles to be utilized for the services covered under the Agreement more than $65,000 . Equip ambulances with advanced 6. Ambulance replacement shall occur on a regular schedule and the Proposer shall Identify its policy for caregiver leChn Ology to keep Palm" '3 the maximum number of years and mileage that an and crew sale ambulance will be retained in the EMS System. . Immediately Pu? from Serv?cc any 7. Each ambulance shall be equipped with GPS route ambulance which does not meet our navigation capabilities and devices to interact with AVL system. rigorous standards 0 Provide a process for thoughtful consideration of emerging Selection of the right ambulance ?eet is an essential component to a successful EMS developments in ambUJance Clem-8"" operation. Reliability, safety, functionality, ease of use, ease of maintenance, crew comfort, efficiency and performance were all considered when selecting a combination of si\? Type ambulances and two I'ype l ambulance vans. The addition of Type 1! units to the ?eet provides improved ef?ciencies In'tn Hun Lin' nil .. (I Paramedics Plus 121 :\AD\002\02\2X02\2X02177.docx 275 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA OPERATIONS AND EQUIPMENT particularly on long distance transfers. Each ambulance will be equipped with GPS route navigation capabilities and devices to interact with Metro Communication?s AVL system. The Type ambulance specifications include: 2015 Medix Metro Express Type Ambulance Module on a GM 3500 chassis with a 139? wheelbase and interior space of 90? Wx 68. A 6.6-liter engine will power the Type 1111 units. The Type 11 unit specifications include: 2015 Medix Silverhawk Type II ambulance vans on a GM Chassis with a 155? wheelbase. All units selected for use in the REMSA system will provide a professional, modern and technologically supported environment for patients and staff. Paramedics Plus will utilize a new 2015 Ford XLT, four-wheel drive Expedition for the supervisory/ administrative vehicle in the Sioux Falls EMS system. All ambulances purchased by Paramedics Plus for use in the REMSA system will meet applicable South Dakota state law, Administrative Rules and all local ordinances and regulations as required by the Request for Proposals. In addition, all ambulances will display the REMSA required markings. All vehicle designs, colors and lettering will be submitted for approval of the Contract Administrator. Paramedics Plus recognizes the importance of a dependable fleet of ambulances. To ensure a dependable ?eet, Paramedics Plus will maintain and repair the ?eet to keep it in top condition and utilize a six year or 250,000 mile replacement schedule on ambulance units; however, should a unit prove to be unreliable, it may be replaced at any time. More information on the maintenance plan is provided in X1. B. 4. Vehicle and Equipment Maintenance. Attestation: Paramedics Plus understands and agrees to comply without qualification to provisions, requirements, and commitments contained in Section . f: It?: Paramedics Plus 122 276 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA OPERATIONS AND EQUIPMENT b) Higher Levels of Commitment? Vehicles All New Vehicles Proposed Paramedics Plus has carefully evaluated the needs of the REMSA system and proposes to provide six new 2015 Medix Metro Express Type Ambulances and two new Type 112015 Medix Silverhawk Type II ambulance vans. The number of ambulances to be provided to the system is more than 150% of predicted peak demand. Paramedics Plus will utilize a 2015 Ford XLT, four-wheel drive Expedition for the supervisory/ administrative vehicle in the Sioux Falls EMS system. gig? Par - mg amedlcs . .. Reliability, Appearance and Policies for Replacement Quality appearance and reliability of ambulances are vital to the images of Sioux Falls EMS and Paramedics Plus. The condition and appearance of physical equipment re?ects on the quality of the overall EMS service. In all Paramedics Plus operations, it is policy to remove any unit or equipment that does not meet rigorous standards. In Sioux Falls, equipment or ambulances which do not re?ect well on the REMSA system and Paramedics Plus will be immediately pulled from service. Paramedics Plus utilizes a six year or 250,000 mile replacement schedule on ambulance units; however, should a unit prove to be unreliable, it may be replaced at any time. Paramedics Plus 123 277 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA OPERATIONS AND EQUIPMENT Driver Monitoring/Behavior Modification Technology Safety to our employees, patients and public is a top priority of Paramedics Plus, which is why Paramedics Plus will invest $65,500 to equip all ambulances with the Zoll SafeForce driving system. The SafeForce system monitors and records unsafe vehicle operating parameters, including excessive speed and high vehicle g-forces caused by rapid accelerations, hard decelerations or high speed turns. This system provides audible warning as the driver approaches an unsafe condition, allowing sufficient time for corrective action. If a driver ignores system warnings, an exception report is generated for management. The system also creates driver performance ranking reports, which encourage competition between drivers or groups of drivers to drive safely, without excessive speed or vehicle forces. This interactive SafeForce training approach is another way to reduce the potential for vehicle accidents and part of an overall approach to creating a culture where safe driving expectations are clearly understood and achieved. ln addition, Paramedics Plus will also utilize the latest LED emergency lighting technology to ensure visual enhancement during emergency driving. It will also utilize the Opticom traf?c signal system in all ambulance units. Advanced Caregiver Safety Technology Paramedics Plus proposes the following enhancements to safeguard the health of both caregivers and patients. Bariatric System Paramedics Plus proposes the Transafe Bariatric Type ambulances. These six ambulances can be utilized to transport bariatric patients as oux Falls EMS system. This system provides comfort and safety for the patients while reducing potential injuries to employees. Model 6083 Bariatric Stretcher Paramedics Plus proposes one bariatric stretcher to be utilized within the Sioux Falls EMS system. The bariatric transport stretcher features a wide patient surface and wheelbase, providing stability during transport. This stretcher can be used in conjunction with the Transafe Bariatric system v: .. 2-: . . . Paramedics Plus 124 278 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA OPERATIONS AND EQUIPMENT to ensure a safe, comfortable transport of our bariatric patients. The tow package, side? liit handles, and push pull handles reduce potential operator strain. LED Chassis Undercarriage Lighting - A safe environment around the ambulance unit on accident scenes is crucial in an emergency situation. As Paramedics Plus reviewed emergency calls and examines areas of potential work related injuries, one area of concern was nighttime ground darkness when exiting ambulances. To reconcile this issue, Paramedics Plus installed LED undercarriage lighting on all ambulances to illuminate the ground before the Paramedics step out of the unit. Stair Chairs At times, medics need to move patients in spaces that won?t accommodate a cot. Stair Chairs allow for the safe transport of patients through tight spaces and down stairs. To reduce potential injury and risk from improper movement, which can lead to potentially serious injury to the patient or the Paramedic, Paramedics Plus proposes the Stair?PRO Model 6252 on each ambulance unit. MX Pro Power Stretcher The innovation of battery-p ow ered stretchers has resulted in a significant reduction in back injuries and potentially longer EMS careers for medics. Paramedics Plus proposes the MX Pro with its 700 lb. lift capacity to be utilized in each ambulance. Meeting Changing Guidelines Paramedics Plus continuously evaluates new equipment and products within the EMS industry. As new equipment becomes available or when personnel have suggestions for new or different equipment which would change the standard of care Paramedics Plus recommends aprocess similar to one utilized elsewhere in our organization. .- :v l- hv'ii . Paramedics Plus 125 279 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA OPERATIONS AND EQUIPMENT Once a suggestion has been received, the Medical Director and Review Committee will first review the suggestion to determine if the suggestion has sufficient merit to warrant further consideration. Copies of the "standard of care suggestion" form with all pertinent information about the change are then posted for all affected agencies personnel. Over the next thirty days, comments on the proposed change are accepted, after which time a committee made up of personnel particularly interested in clinical issues and appointed by the Medical Director, review the suggestion. All related documentation must be provided to this committee at least 30 days prior to the committee meeting. 0 Should the suggestion have merit, as determined by the Medical Director and the committee, a ?nancial impact study is conducted by the EMS Agency. 0 The Agency?s comments regarding economic aspects of the proposed change are then presented to the Medical Director and committee. 0 With the approval of both parties, the change then moves forward and the change in the standard of care is of?cial. 3. Competitive Criterion: Equipment Paramedics Plus will meet all minimum requirements under Equipment and proposes to: 0 Meet and exceed minimum requirements for ambulance supplies and equipment 0 Address signi?cant changes in technology 0 Allow insw?pections at any time and respond immediately to correct deficiencies Paramedics Plus will achieve higher levels of commitment and proposes to: 0 Provide all new state-of?theart medical equipment for advanced clinical care capabilities 0 Equip ambulances with power cots and bariatric capabilities to keep medics and patients safe. a) Minimum Requirements? Equipment Contractor shall have sole responsibility for iumlsh- ing all equipment mssary to provide required service. All on-board equipment, medical sappiles and personal communication equipment will meet or exceed the minimum requirements of Ambulance Equipment and Supply List. Paramedics l?lus agrees to equip each REMSA ambulance with all necessary equipment to provide 911 ALS emergency response. Furthermore, we agree and understand the medical supplies and personal communications equipment and will meet or exceed requirements. Paramedics l?lus agrees to inspections and to remove n" Ilto ?Vt-out?t; Cal}.- Paramedics Plus 120 280 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA OPERATIONS AND EQUIPMENT any ambulance deemed to be deficient, and understands the potential ?nancial penalty for ambulances which fail to meet the minimum in-service requirements. Please see Appendix 26 for details on vehicles and equipment. Attestation: 0 SE33 Paramedics Plus understands and agrees to noon . . . . . . comply Without qualification to requirements, and commitments contained in Section b) Higher Levels of Commitment?Equipment In addition to the equipment required by REMSA, Paramedics Plus proposes the following equipment enhancements to provide higher levels of patient care, increased safety for crew and patients, and items which improve working conditions and ef?ciencies-- Medtronic Physio-Control LIFEPAK 15 Monitor Paramedics Plus proposes the LIFEPAK 15 cardiac monitor/ de?brillator on each ambulance. The LIFEPAK 15 cardiac monitor/ de?brillator, the latest technology from Physio? Control, incorporates every aspect of the LIFEPAK 12 monitor with new enhancements. The LIFEPAK 15 integrates Masimo Rainbow SET technology, which monitors Sp02, Carbon Monoxide and Methemoglobin, and includes a metronome to guide CPR compressions and ventilations. Auto-Ventilator Resuscitator - Paramedics Plus proposes the LSP AutoVent 3000 for the Sioux Falls EMS system. The LSP AutoVent 3000, designed for EMS, has independent controls for Tidal Volume and BPM. The equipment uses state-of-the-art pneumatics to assure reliable, time-cycles, constant ?ow ventilation powered by a minimum of source gas. It can be used for adult or pediatric patients. EZ-IO Interaosseous Infusion System Paramedics Plus proposes the system, which provides immediate vascular access to a patient in need of rapid ?uid replacement or medication route. The EZ-IO provides rapid, smooth entry into the bone?s medullary cavity, creating an immediate conduit to the central circulation of a patient. This system can be . .41 ",wjl Paramedics Plus 127 281 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA OPERATIONS AND EQUIPMENT applied to both the adult or pediatric patient and will be available on each ambulance. OTE - On-Board Temperature Controlled Drug Box - Inconsistent ambient temperatures can be detrimental to medications. To resolve this problem, Paramedics Plus proposes to install the temperature controlled drug box in each ambulance unit to provide continuous thermostatically controlled temperatures [or medications requiring such conditions for optimal potency and shelf life. Pro - Pauwr Stretcher - The innovation of battery-powered stretchers has resulted in a significant reduction in back injuries and potentially longer IZMS careers for medics. Paramedics Plus proposes the MX Pro with its 700 lb. lif capacity to be utilized in each ambulance. Iian'atric System - Paramedic: Plus proposes each Type ambulance will be equipped with the Transal'e Bariatric System mounts. This system will allow each Type ambulance to utilize the bariatric system in conjunction with the 6083 Bariatric stretcher to ensure a sale and comfortable transport of a bariatric patient. Sh'yker .N?lX?ProA/lmiel 608.3 Barz'atric Stretcl-wr Paramedics Plus proposes one bariatric stretcher to be utilized within the Sioux Falls EMS system. The MX-PRD bariatric transport stretcher features a wide patient surface and wheelbase, providing stability during transport. This stretcher can be used in conjunction with the Transafe Bariatric System to ensure a safe, comfortable transport of our bariatric patients. Ihe tow package, side-lift handles, and push/ pull handles are utilized to reduce potential operator strain. Stair hairs - At times, medics need to move patients in spaces thatwon't accommodate a cot. Stair Chairs allow or the sale transport of patients through tight spaces and down stairs. To reduce potential injury and risk from improper movemen l, which can lead to potentially serious injury to the patient or the Paramedic, Paramedics Plus proposes the Stair-PRO Model 6252 on each ambulance unit. tf'l'u?r' Build-no '\w.uu ?mmvm 5 yuiu?'n. Paramedics Plus 128 282 COMPETITIVE CRITERIA OPERATIONS AND EQUIPMENT 4. Competitive Criterion: Vehicle and Equipment Maintenance Paramedics Plus will meet all minimum requirements under Vehicle and Equipment Maintenance and proposes to: 0 Maintain ambulances and equipment to the highest standards 0 Remove from service any ambulance that is deficient in maintenance or appearance 0 Bear the cost of all ambulance or equipment repairs 0 Maintain records of all fleet and equipment repairs Paramedics Plus will achieve higher levels of commitment under Vehicle and Equipment Maintenance and proposes to: 0 Require preventive maintenance at frequencies and standards that exceed manufacturers? recommendation 0 Benchmark ?eet KPIs against the experiences of other Paramedics Plus ?eet operations and other EMS operations 0 Meet or exceed all equipment maintenance practices required by the Commission on Accreditation of Ambulance Services 0 Maintain service agreements with manufacturers for the maintenance of and stretchers. a) Minimum Requirements? Vehicle and Equipment Maintenance Contractor shall be responsible for all maintenance of ambulances, support vehicles, and on-board equipment used to the performance of its work. City/ REMSA expects that all Ambulances and equipment used in the performance of the Agreement will be maintained in an excellent manner. Any Ambulance, support vehicle, and/or piece of equipment with any deficiency that compromises, or may reasonably compromise its function, must immediately be removed from service. Paramedics Plus assumes all costs related to maintenance of ambulances, support vehicles and onboard equipment and recognizes that ambulances and equipment must not only be maintained in excellent working condition, but also look professional. The maintenance Paramedics Plus 129 :\AD\002\02\2X02\2X02177.docx 283 COMPETITIVE CRITERIA OPERATIONS AND EQUIPMENT program utilized in each Paramedics Plus site, as well as in its sister organization ETMC-EMS, achieves the highest standard of reliability appropriate to a modern high? performance ambulance service. While Paramedics Plus proposes to contract in the Sioux Falls area for maintenance of its vehicles, the contractor will be held to the same standards as those adopted throughout the organization. Those standards meet or exceed all CAAS standards and exceed the vehicle manufacturers? recommendations. Attestation: 0 8833 Paramedics Plus understands and agrees to BEBE . . . . . . nu comply Without qualification to requirements, and commitments contained in Section b) Higher Levels of Commitment? Vehicle and Equipment Maintenance Paramedics Plus operates an ambulance maintenance program second to none in the industry. With the experience of maintaining more than 350 ambulances in its four systems and sister system, Paramedics Plus invests heavily in preventive maintenance (PM) requiring PM more frequently and at higher standards than the manufacturers? recommendations. Each higher standard implemented is based on the experience of our fleet staff in maintaining vehicles, which operate beyond the demands anticipated by the manufacturer. While maintenance will be performed through a subcontracting f? Paramedics Plus 130 :\AD\002\02\2X02\2X02177.docx 284 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA OPERATIONS AND EQUIPMENT relationship, the REMSA system will benefit from the higher standards required by Paramedics Plus. The Paramedics Plus preventative maintenance program is designed to minimize vehicle failures by identifying and correcting problems prior to malfunction. [his proactive approach to service and repairs reduces costly repairs and delayed repair downtime. The following approach is proposed for the Sioux Falls EMS System: Local Authorized Repair Services Under the Supervision of Paramedics Plus Fleet Director Paramedics Plus will utilize local authorized repair centers and dealerships to perform routine preventative maintenance and repairs under the direction of the Paramedics Plus Fleet Director, employing the higher standards required by Paramedic; Plus. All services/ repairs will meet or evceed the manufacturer?s recommendations and be incorporated into the lixtraf'leet software systems for record maintenance. Please see Appendix 27 for Paramedics Plus Preventive Maintenance Schedule. Benchmarking Recognizing that the second greatest cost of the country. Information is shared between Paramedics Plus operations. The sharing of best practices has resulted in the implementation of ideas that have reduced downtime and lowered costs. Records Maintenance Detailed vehicle maintenance records will be tracked utilizing lixtral?leet software. EvtraFleet has been used throughout the Paramedics Plus system since 1997 and provides a ?exible, easy-to-use, vehicle maintenance management tool. Features include complete vehicle records, work orders, vendor history, parts inventory, custom report writer and purchase orders among others. By watching and analyzing critical failures, ?eet managers and staff are able to identify maintenance practice which reduce downtime. Changing vacuum pumps as part of the preventive maintenance process is an example of changes brought about from data tracking and analysis. By analyzing data captured on l-Ixtralileet, reviewing control chart key process indicators and sharing information across the Paramedics Plus system, a number of changes have been implemented to improve reliability and extend the life of the ambulance. In Sioux Falls, Paramedics Plus will monitor the Contractor?s work and maintain a record of operating an EMS system behind payroll is all maintenance. the cost of purchasing and maintaining the ?eet, Paramedics Plus benchmarks against our other operations as well as operations across 0! Hi? It'ult Vt f? orHu-r- timid-no ?Wu (hum-i a chi: 5 yucm Paramedics Plus 131 285 :\AD\002\02\2X02\2X02177.docx COMPETITIVE OPERATIONS AND EQUIPMENT Management and Quality Improvement of the Fleet Program Another component of the vehicle maintenance program involves the quality improvement process and related key performance indicators. Achievement of certain identified key processes in ?eet maintenance leads to organizational success. Key Performance Indicators (KPIs) provide quantitative performance measurements, which are benchmarked against other Paramedics Plus operations as well as against other EMS systems. Tracking and comparing Kl?ls allow Paramedics Plus to gauge ef?ciency and performance. Key Performance Indicator 1 Computer Aided Dispatch Data ExtraFleet Software Analysis/Management How Is data used? Operations management team revrews daily for patient care Issues and downtime/system inellrciencres Corporate Director of Fleet and Support Servrces revrews daily. weekly and to and monitor problems or trends Corporate Director of Fleet and Support Servrces revrews and bench- marks against other systems Critical failures per month represent the first KPI. Critical failures are plotted on control charts each month and results are addressed at a Quality Improvement Steering Committee meeting. Key Performance Indicator 2 LOST UNIT HOURS AT TRIBUTABLE TO UNSCHEDULED MAINTENANCE Computer Aided Dlspatch Data ErtraFleet Software Analysis/Management Howls data used? Operations rrlanagenrenl team revrews daily for downtime/system inell?rcrencres Communications function reports In daily PULSE meetings Corporate Director of Fleet and Support Services reviews daily, weekly and to Identity and monitor problems or trends Corporate Fleet and Support Servrces Director and bench- marks against other syaems The second KPI measures the number of productive unit hours lost attributable to fleet operations. Fach day fleet personnel document unit downtime by reason. The Communications Manager reports ?eet related downtime in the daily Pulse meeting. Through statistical process control, the ?eet supervisor analyzes ?eet downtime and addresses any special cause variation or downtime trends, making service adjustments as needed to the loss of productive unit hours. rri (Stillman urn. this". Paramedics Plus 132 286 COMPETITIVE OPERATIONS AND EQUIPMENT Key Performance Indicator 3 A: low as possible assuming all preventive maintenance is completed on schedule mm Data Eman Softer Analysis/Management Fleet md Support Sermons Dirtcior review: to ensue ind cost per mile is appropriate?inacaling Preventive Maintenance is being done as scheduled and as appropriate. How is data used? Corporate Fleet and Support Savices Director revwws monith aid against other systems Chief Operating Officer renews for colnplison with budget Key Performance Indicator 3 for vehicle maintenance is the ?eet cost per mile, which is calculated as the total cost of ?eet services (minus insurance and depreciation) divided by the number of ?eet miles traveled per month. Key Performance Indicator 4 Late Prevenh've Maintenance LATE PREVENTIVE MAINTAINENCE All preventive maintenance performed Within 25 miles at schedule Data ExtraFleet Software Analysis/Management How is data used? Corporate Director of Support Services reviews to ensure that all Preventive Maintenance is performed as scheduled and as appropriate. Corporate Fleet and Support Services Director reviews Equipment Maintenance Paramedics Plus is committed to a high standard of equipment maintenance and ensuring that the right equipment, supplies and medications are always available for patient care. Paramedics Plus follows or goes beyond the manufacturers" speci?cations for safe, useful life expectancies. Equipment requiring repair or replacement before the scheduled replacement date is serviced or replaced with identical or comparable items. All equipment repairs, service and annual preventive maintenance are documented by Paramedics Plus, and are under the service agreement contract with the manufacturers. Paramedics Plus utilizes a comprehensive bio-medical equipment repair inspection process with annual bench checks completed and documented by an approved facility or the manufacturer?s service department. The highest quality equipment will be well maintained, following all manufacturers' guidelines regarding service and replacement schedules. PLUS Mutidino liw ti?il? Paramedics I-?lus 133 :\AD\002\02\2X02\2X02177.docx 287 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA OPERATIONS AND EQUIPMENT Paramedics Plus maintains all bio-medical equipment to meet the Standards of the Joint Commission on the Accreditation of Healthcare Organizations and/ or an equivalent standard. We accept the costs of maintenance and repairs including parts, supplies, spare parts and inventories of supplies, labor, subcontracted services and costs of extended warranties. Paramedics Plus has cleaning schedules for all equipment to ensure a clean, safe workplace and professional image. A comprehensive program includes cleaning, preventive maintenance, and replacement of dirty, broken 4..- ~c I or damaged equipment, using daily visual inspection, scheduled preventive maintenance and manufacturer evaluations as needed. Cardiac monitors are checked, on-site, by the manufacturer annually. The manufacturer also provides status reports on repairs and preventive maintenance inspections. Paramedics Plus policies on equipment checking, damage inventory and durable medical equipment preventive maintenance are available in Appendix 28. Paramedics Plus 134 288 COMPETITIVE CRITERIA DEPLOYMENT PLANNING 5. De la tPlannin ymen Paramedics Plus will achieve Paramedics Plus will meet all minimum higher levels of commitment under requirements under Operations? Operations?Deployment Planning Deployment Planning and proposes to: and proposes to: 0 Implement a deployment plan that achieves 0 Use its experience in achieving some the Response Time requirements of this of the industry?s most stringent Request for Proposals response times standards to improve 0 Re?ne the deployment plan through a six- the REMSA SyStem step process 0 Employ its award-winning PULSE 0 Monitor, on a daily basis, a host of process to monitor things that make a operational variables which impact Response difference Time performance 0 Provide the PULSE suite of software, . Impose an nemergemy cutoff level" to an innovative new tool, to monitor ensure adequate ambulance coverage. the SYStem Performance in real timer improve adherence to the System Status Plan and provide options for analysis and reports 0 Utilize the most sophisticated technology in the EMS industry to ?ne-tune the system 0 Support the REMSA system with a Director of Corporate Deployment who will interface with local operations daily and advise on all issues related to deployment. Paramedics Plus 135 :\AD\002\02\2X02\2X02177.docx 289 COMPETITIVE CRITERIA DEPLOYMENT PLANNING 3) Minimum HeqUifementS- Deploymem Plannmg and engages all aspects of the organization: Contractor shall agree to deploy its ambulances analysis, 591d Operations; dispatch ?eet, in a manner to aChieVe the Response Time materials, scheduling, recruitment and clinical requirements. The Contractor shall also commit to modify and adjust its deployment strategies in the event that Response Time performance is not complying with the standards or if areas of the City are chronically experiencing deiayed responses. ensure the system has the resources it needs to meet future demands. From future projections, education. The process starts with long-range planning to The Proposer shall describe its methods and initial deployment plans to be used in the City, including the experienced] highly quali?Ed ParamEdiCS its "emergency cut-Off?eve A description Of the Plus team employs a proven six step process: methodoiogy used by the organization to monitor a a Analysis and modify its plans Will also be documented. Geographical Analy51s Paramedics Plus has demonstrated its ability Geographical Ambulance Deployment Creation of Ambulance Work Schedules Complete System Status Plan to create, refine and execute deployment plans that work as shown by its ability to achieve stringent clinical response time requirements Plan Refinement in all its contracts. Deployment planning The most sophisticated technology currently available in the EMS industry will be employed to continually ?ne-tune the system methodology to be used by Paramedics Plus in the REMSA system is both an art and science, for optimal performance. The technology is Tableau which provides the analytics to recommend re-deployment of resources based on demand for services and geographical coverage needs and is fully described in Appendix 29. The density map on the following page represents Tableau?s strength and ability to show the demand for services in geographical format. PLUS. li? EMS iyuowm Paramedics Plus 136 :\AD\002\02\2X02\2X02177.docx 290 COMPETITIVE CRITERIA DEPLOYMENT PLANNING These six steps are followed by ongoing, continuous plan re?nement using the Plan- Do-Study-Act process. Deployment Planning Leadership Paramedics Plus employs a Corporate Deployment Director, based in Florida and with unparalleled experience and insight, to support deployment planning and execution. Barry Niemann, Corporate Deployment Director, will lend his strong analytical skills and in-depth knowledge of EMS acquired over the course of his career to support operations. Mr. Niemann serves as a resource to each Paramedics Plus system on issues related to performance improvement, compliance and efficiency in operations. Building and Re?ning the Deployment Plan With the benefit of long-range planning described later in this section, Paramedics Plus is positioned for designing the deployment plan. The following steps are followed in creating and fine-tuning the system status plan: Step I. Data Analysis Paramedics Plus will utilize Tableau software to provide an historical geographic View of call demand. The software queries the Computer Aided Dispatch (CAD) system data for a given time period to produce a map of both incident locations and demand densities for each hour of every day. The process will account for seasonality of the PARANIEDICS PLUS Partners in ?uitding Awtu?ri Winning EMS Systems Paramedics Plus 137 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA OPE DEPLOYMENT PLANNING REMSA system, dynamically monitoring for much quicker responses to changing demands as the seasonal volumes vary. The analysis is continued through the use of traditional demand analysis methodology. A typical demand analysis would include the review of the previous 20 weeks of historical 91] calls to create a 168?hour chart based on calls received into the Metro Communication center. This 168-hour chart is used to develop call demand graphs illustrating the maximum number of Monday 20 Week Demand 16:00 - 17:00 calls received each hour of the day and each day of the week for the 20 weeks analyzed. A map is produced for REMSA showing both incident locations and demand densities for each hour of every day. Paramedics Plus conducted site visits to assist with the analysis of the data provided by REMSA to produce an accurate System Status l?lan. :\AD\002\02\2X02\2X02177.docx PHRIXME PLUS Partners in ?uilding Award Winning EMS Systems Paramedics Plus 138 292 COMPETITIVE CRITERIA DEPLOYMENT PLANNING Step 2. Geographical Analysis Once the 911 call demand pattern is determined, data is imported into the Tableau software server which is used to create a System Status Plan that most efficiently covers the demand in Sioux Falls. Using the density maps created from Tableau to visualize the areas of demand at a given time of day and day of week, the System Status Manager modifies post locations to achieve both response time standards and system efficiency. Step 3. Geographical Ambulance Deployment Once the call demand has been determined, a deployment plan is built in the New World CAD. Since call patterns shift by time of day and day of week, the vehicle placement, or post location, changes to meet the anticipated call demand. Once a System Status Plan is drafted, input is obtained from Operations and Communications. In a recent example, a post location in one Paramedics Plus system was identified at a location that was less than desirable for crews, since there were no facilities in the area for restroom breaks. A new convenience store was opening in the area and the System Status Manager checked the needs of the system against a slight shift in the posting location to determine if the convenience store location would work just as :\AD\002\02\2X02\2X02177.docx Paramedics Plus 139 293 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA DEPLOYMENT PLANNING well, and make the crews much happier. The post location moved the day the convenience store opened. Step 4. Creation of Ambulance Work Schedules Once the best posting locations are identified, ?eld work schedules are developed. Work schedules are enhanced with input from both management and field employees to ensure call demands are met, crew fatigue is minimized, and employee needs are accommodated. While the RescueNet Resource Planner predicts the minimum number of staffing hours required, Paramedics Plus consistently staffs at or above the mo: 0400. DAY 0100 0200 OWMNOSWOOW 2?5 280 280 280 280 280 280 280 280 280 280 280 245 projected level to ensure that patients receive the care they need through quick responses. More information about Zol] RescueNet Resource Planner is available in Appendix 30. Based upon our years of experience with High Performance systems and analysis of the current data, Paramedics Plus has anticipated the needed ambulance unit hours for this Request for Proposals. This number will increase as needed to meet the contract requirements. Paramedics Plus fully accepts that the REMSA contract is performance-based and is not simply a "level of effort" system. 1900- 2000- 2100? 2200- 301} TotStep 5. Completed REMSA SSP Once the best System Status Plan is selected, it is adjusted for changes in call volume so that the number of ambulances increases or decreases to ensure the best ambulance coverage and the most efficient operation. The maximum number of posts to be utilized in Sioux Falls is four. The number of weekly unit hours to be deployed in the initial System Status Plan is 588. Paramedics Plus 140 294 COMPETITIVE CRITERIA OPERATIONS- DEPLOYMENT PLANNING By instituting an emergency call cut off level, Paramedics Plus will ensure ambulance availability for the next emergency response. The plan is built for a cut-off level of one. Through our daily PULSE meeting, that level will be considered and modi?cations made upon analysis of the call data. Sioux Falls Post Map fig.) [15.5.W soun- 014 4 {Ql' PARAMEDICS PLUS?Partners in Building Award-Winning EMS Systems ParamedicsPlus 141 :\AD\002\02\2X02\2X02177.docx 295 COMPETITIVE CRITERIA OPERATIONS- DEPLOYMENT PLANNING Emer Cut-Off ro'Day Level Poat1 90312 90:13 90314 0:00:0010 01:00:00 2.00:00 to 03:00:00 :00:00to05:oo:oo :oo:oo:oos:oo:oo snowmoom 1200:0010 13:00:00 nmnmamm 14:00:00to15:00:00 nmnmamnmm 6:00:00to17roo:00 18:00:0010 19:00:00 Post Locations Post 1 - S. Kiwanis Ave 8: W. 12th St Post 2 - S. Sycamore Ave 8: E. 26th St Post 3 - S. Louise Ave 8: W. 57th St PARAMEDICS PLUS?Partners in Building Award-Winning EMS Systems Paramedics Plus 142 :\AD\002\02\2X02\2X02177.docx 296 COMPETITIVE CRITERIA DEPLOYMENT PLANNING Seven Day Chart? The Paramedics Plus approach to developing, refining and executing the System Status Plan has been effective when combined with daily meetings which literally take the "pulse" of the system through a face?to?face exchange between not only those who create the plan, but also those that make certain the plan is followed. the PULSE process is explained below. 5th 6. Plan Using the Institute for Healthcare Improvement? (II-II) Model for Improvement, Paramedics Plus applies Plan -Do-Study-Act to adjust and refine system. Plans can be modified daily, as needed, but are always reviewed every five months or twenty weeks. What are we trying to accomplish How Will we know that a change IS an Improvement? What change can we make that Will result In Improvement? 9 Once the planning stage of the System Status Plan is complete, it is entered into the Computer Aided Dispatch (CAD) system. During the "do" stage of the improvement process, the full implementation of the plan is monitored to make certain that the plan is followed every day, all of the time. Only a consistently followed plan can be accurately reviewed and refined. Dispatchers have a visual of the plan through the PULSE software product and monitors in the Communication Center. If an ambulance is "out of plan," it will show as red; ambulances "in plan" are in green. Dispatchers make decisions ab0ut moving a unit to a higher level post when the unit previously posted there is dispatched to a patient. This inh'icate movement of ambulances continues day and night to assure that ambulances are available where they are most likely to be needed next. The ?study? phase of the improvement plan involves monitoring and tracking deviations and errors. First, deviations from the plan are corrected. These deviations include failures to make post-to-post moves in a timely marmer, late starts, etc. Errors which directly affect responses are also corrected. These errors include such things as poor route selection by the crew, poor unit selection by the dispatcher and communications problems. l'l? F'Jr'tu?f' an (Sulfa-he 11w an ?mnlizu th 5 ism . Paramedics Plus 143 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA DEPLOYMENT PLANNING Causes of lost unit hours are carefully tracked and monitored so that solutions can be identi?ed and implemented. Examples of wasted unit hours include inef?cient re?supply practices, vehicle failures and long drop times at hospitals. Control charts are maintained and reviewed regularly on the following key performance indicators: 0 Total lost unit hours Unit hours that are lost due to mechanical, administrative or reasons other than scheduling. 0 Average mission time The average amount of time our units are out of service on a call from the time of dispatch until the unit returns to service at the hospital. 0 Critical vehicle failures Mechanical failures that interrupt the response to a patient or the transport of a patient to the hospital. 0 Lost unit hours due to special events -: Unit hours deployed to cover a special event. 0 Lost unit hours due to decontamination Unit hours spent decontaminating units after messy calls. 0 Lost imit hours due to employee injuries -- Unit hours lost because of an employee injury. 0 Lost unit hours due to late sign on /crew late Unit hours lost because of ?eld personnel arriving late to work. 0 Lost unit hours due to stocking and equipment tours lost because the unit was not fully stocked and equipped for duty 0 Lost unit hours due to el?CR or issues Hours lost due to malfunctioning computers used to either create patient care reports or to navigate the unit 0 Lost Unit hours due to mechanical lours lost due to mechanical issues such as tire pressure or a defective light bulb. 0 Lost Unit hours due to staffing tours lost because of empty shifts. 0 Lost Unit hours due to vehicle contact 'r Hours lost because of accidents and contacts with other items. tf'l'u?r' li?l Min/Jul Cfl?b Paramedics Plus 144 :\AD\002\02\2X02\2X02177.docx 298 COMPETITIVE CRITERIA DEPLOYMENT PLANNING The "act" phase of the improvement plan in one Paramedics Plus system recently involved an effort to impact an upward trend observed in lost unit hours. An analysis included the creation of a Pareto chart which showed the top three culprits were late starts for crews, late starts due to equipment or supply issues, and administrative downtime. Armed with data, the operations team went to work identifying and implementing solutions. A focused effort resulted in a 75% improvement. Attestation: SE33 Paramedics Plus understands and agrees to newcomply Without qualification to requirements and commitments contained in Section b) Higher Levels of Commitment? Deployment Planning Monitoring Effectiveness through the PULSE Process When the Paramedics Plus system in Pinellas County Florida created a new process for the daily monitoring of operational issues impacting response time compliance, it had no idea the concept would be so successful or receive so much attention. The process, which looks at a host of variables impacting EMS operations, was presented at the industry?s premier national meeting, Pinnacle. It earned the 2008 Sterling Showcase award, and dozens of EMS professionals from across the country have traveled to the Paramedics Plus location in Florida to watch and learn. All Paramedics Plus operations employ the process to achieve the most stringent response time requirements in the country. The effectiveness of the deployment plan is meticulously and relentlessly monitored through the daily PULSE (Performance Utilization Late-call System Evaluation) meetings. The PULSE process is proprietary and available only through Paramedics Plus. Multiple variables are reported each day at all Paramedics Plus operations when decision makers representing all aspects of the operation meet to discuss issues which impact execution of the deployment plan. The Corporate Deployment Director will participate, by phone, in daily PULSE meetings with the Sioux Falls team. The issues include: the number of ambulances available, number of cots, number of number of needed for special events, the peak unit hours scheduled by day for the next seven days, number of shifts open by day for the next seven days, unit hour utilization for the previous day, number and reason for exceptions the previous day, number and reason for lost unit hours the previous day, status of employees in orientation, status of employees in field training and expected date of release, clinical investigations, compliance percentage for the previous day, compliance month-to?date, compliance quarter?to?date, transport volume year-to-date and absences year-to-date. - J. . ll; -. 1:1. I lrI-i 2'4 Paramedics Plus 145 :\AD\002\02\2X02\2X02177.docx 299 COMPETITIVE CRITERIA DEPLOYMENT PLANNING The Paramedics Plus personnel review each late call occurring in the preceding 24 hours to identify the cause. Was the system "out of plan," meaning units were not properly posted? Did the crew select the best route? Did the Dispatcher select the right unit for the call? What percentage of late calls are the result of Dispatcher or field crew errors? Supervisors follow?up with staff on all ?human? errors, and follow-up is confirmed during the I?Ulb?li meeting. The chart below shows how interventions identi?ed in the PULSE process were implemented to improve compliance and meet the daily and compliance goals after the 2004 award of the Pinellas Coun ty contract. An increased call volume along with an ineffective schedule and post plan were addressed. A peak load staffing scheduled was created to meet the increased demand for services. A new l68?hour post plan went into effect with immediate results. Continuous adjustments were made to the shift schedule and post plan to ensure we are meeting the needs of our patients. 1 Emergency Compliance 95% 95% 194% ?9399 [92% I 91% .- -Continuous monitqrinsand- modi?cation of post plan 909s 89% I 88% i NewPostPlan 87 . s.999999999999.e99999999 .PLUS Building wama Winning EMS $y-chrn Paramedics Plus 146 :\AD\002\02\2X02\2X02177.docx 300 :\AD\002\02\2X02\2X02177.docx COMPETITIVE DEPLOYMENT PLANNING Paramedics Plus Offers the New PULSE Suite of Software Products to Enhance Analysis of the REMSA Deployment Plan Execution Paramedics Plus, one of the most sophisticated HMS organizations in the United States, has developed state-of-the-art proprietary software to Support the communications function. All Paramedics Plus and llelC operations deploy the PULSE Live software. This high-tech tool is supported nationally by our Director of Corporate Deployment who interfaces daily with local operations to help forecast, improve system status plans, and advise on all issues related to deployment No other company, in this country or Europe, offers this cutting edge approach. This powerful new software tool, superior to any on today's market, leads to improved response times, better utilization of resources, greater employee engagement, and improved analysis and management of the System Status Plan and its ?eld execution. lthas a value of more than $150,000 and will be provided at no cost to the REMSA system. PULSE, patent pending, for Performance Utilization Late-call System Evaluation, is a revolutionary, visual, software tool that, in its newest version, employs Google MAPS combined with color codes and other visual cues to improve the system status dispatch and management processes. Now in its fourth version, the product is developed from data in the Computer Assisted Dispatch (CAI combined with the System Status Plan, and the mobile client application installed in each ambulance. The product?s version 4.0.3 will interface with the New World CAD system used by Metro Communications. Created five years ago by Paramedics Plus sister organization EMS, and in response to identified dispatcher and liMS management needs, this powerful software allows Dispatchers to not only see the system as it is operating in real time, but to see it on "street vi ew" in its actual ecosystem. A superior product to others which are map- supported or map-centric, PULSE utili7es (ioogle MAPs API to provide distinct advantages since landmarks and terrain are easily identified and the street View gives dispatchers clear understandings of any challenges to the "missitm." Google MAl?s API also has application on mobile devices. The product?s previous version has been used more than four years in the largest rural liMS operation in the United States, and since November 2011 in the high volume Paramedics Plus operation in Alameda County, California. It was also recently installed in the Paramedics Plus operation at 'l'hree Rivers Ambulance Authority in FL Wayne, Indiana, and in the Paramedics Plus system in l?inellas County, Florida. f? orHu-r- In timid-nu kuu club Paramedics Plus 147 301 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA DEPLOYMENT PLANNING PULSE Live There are three components to the software. The first of which is Live,? which allows Communications employees to observe the system, in real time, in its entirety and to quickly discern available units from busy units. PULSE Live shows each ambulance "mission" from dispatch, en-route to scene, on scene, transport, arrival at hospital and then available for service. The ambulance viewed on Google MAP is color coded depending on the patient condition priority and matched to the colors used in the CAD so there is no confusion and learning is fast. Loaded with the necessary response time standards and matched with the patient?s color-coded priority level, the software includes visual response clocks where a color coded circle signi?es the unit and its relationship to the response time. When the unit exceeds the target response time, a late call alert is illustrated with a large red triangle icon shown within the vehicle label box. The PULSE Live tool has several advantages to offer Metro?s busy Communications Center. In addition to those already mentioned, the intuitive and easy-to-use visuals reduce training time for dispatchers since the relationship between posting locations and the system?s geography is clear, giving controllers better spatial awareness of the system. Medical dispatchers become more engaged in the process of getting the unit to the patient on time with the use of PULSE Live. Managers report that controllers are more likely to provide an extra bit of assistance when they can see that the unit may not meet the response time, and also that controllers become fully engaged and, at times, even "cheer" the unit on as progress is observed. As an additional benefit, the tool incorporates shift information so that Dispatchers can see when crews are nearing the end of shifts. Since being held late to run a call after a grueling 12-hour shift is a source of crew dissatisfaction, the software helps Dispatchers know when to consider another crew that may be able to PLUS Un?t-era Britain?) ?aws! Elulif- Systems Paramedics Plus 148 302 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA DEPLOYMENT PLANNING expeditiously handle the call. The information gained through PULSE Live observations also allows employees opportunities to provide input on improvements that make a difference on future responses. In addition, the product adds a level of security for crews since each ambulance is identi lied on the map by number. PU .Sfi Live includes options for incorporating Department of Transportation updates on closed roads and camera feeds on heavily traveled streets such as 10th Street, Sioux Falls, to provide information on local traffic flow. Managers can use the PULSE Live function to observe a multitude of variables about the system including whether or not the posting plan is being followed, and that post move- ups follow a domino pattern rather than leap frog which may leave an area vulnerable longer than necessary. PULSE Review The second major function of exciting new software is LSIZ Review" which allows the Communications team or Operations team to focus retrospectively on any segment of the system to learn how responses might have been improved. While PULSE Review is used most often to analyze late calls, it can be used at anytime to find ways to improve the system whether or not a late call occurs. Any number of questions can be answered through the use of PULSE Review. Calls can be reviewed to make certain the closest and most apprOpriate unit was diSpatched. Was the dispatch time reasonable and appropriate? Was the posting plan followed prior to the call? What was the out-of-chute time for the unit? Did the crew take the optimal route? Were there unexpected delays caused by a train crossing, traf?c or weather? The software includes a weather option which incorporates storable weather data for retrospective review. PULSE Review includes timestamps, making it easy to analyze calls. PULSE Review is also useful when there are a variety of response zones such as in the RI system here response times will be measured throughout Sioux Falls to ensure parity. PULSE Review will be used daily to analyze late calls in PULSE meetings described earlier in this section. Since the history shown in CAD is the ?nal call priority, the PM Sli product is helpful in cases where calls may be upgraded during the course of the call based on new information. Previous to the introduction of this new product, review of daily calls for service in some systems could take three hours, while the entire day of calls can now be reviewed in 30 minutes or less. .Sf'f Reporting The third and final function of the software is "l?Ul Sli Reporting" which facilitates reporting on any number Of performance f? N'Hvr? ?Won ?lmomu CM: Paramedics Plus 149 303 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA DEPLOYMENT PLANNING related items from response time reporting, scene times, transport times, hospital drop times and others. Prebuilt reports and easily customizable reports all draw on data from the Computed Aided Dispatch system, consolidating report generation in one place with one software package. System refinements are also facilitated by graphs which are integrated into the reporting segment. Graphs allow managers to look for patterns and identify ways to improve the system. More information about PULSE is available in Appendix 31. The 20,000 Feet Planning Perspective An analogy has been made that the deployment plan starts from a perspective 20,000 feet above where seasoned Paramedics Plus professionals use extensive call volume history combined with census reports and age band data to predict the needs of the REMSA system this year, next year and 10 years into the future. his prediction, which is shown to be very accurate, creates a "road map? for recruitment, training and staf?ng so that the system is prepared for the future. Organizations that simply use historical data will miss opportunities to plan for increased demands of large age bands, including Baby Boomers who are living longer and experiencing current trends, the transport demands of age bands, shifts in pepulation segments and census data. Once the transport volume projections are available, the Corporate Deployment Director translates the projections into resource needs including the number of new liM'l's and Paramedics that will be needed to efficiently run the system. Mr. Niemann's projections also help the REMSA system plan for ambulance and equipment purchases. On an ongoing basis, Mr. Niemann monitors actual volume compared to projections to ensure that organization is looking beyond the immediate situation and prepared for the future. The PULSE software enhancement will I bene?t the REMSA system by: 0 Reducing response times 0 Assisting dispatchers in adherence to the System Status Plan 0 Shortening training h'me required for new Dispatchers Increasing the level of engagement of Dispatchers 0 meroving analysis and management of the system '0 Ensuring calls are goo-coded to the different health challenges than cone? Response Zone previous generations. Transport projections are based on a formula which considers l! tli?ll?i?lb"; pL? cr'tu-r- In (5 is Thuultlu Paramedics Plus 150 304 COMPETITIVE CRITERIA PERSONNEL FIELD SUPERVISION 1. Field Supervision Paramedics Plus will meet all REMSA minimum requirements under Field Supervision and proposes to: 0 Provide a capable, well-trained and well- supported Field Operations Supervisor 24 hours a day 0 Equip supervisors with technology which provides real time information from electronic patient care records, employee files, and policies, procedures and protocols. Information is accessible from anywhere in the service area at any time 0 Ensure supervisors successfully complete all required Incident Command Structure COUTSES. Paramedics Plus will achieve a higher level of commitment under Field Supervision and proposes to: 0 Offer focused scholarships to supervisors for the American Ambulance Association?s Ambulance Service Managers Program 0 Offer more than 140 hours of proprietary training suf?cient to develop EMS knowledge and leadership skills 0 Provide field supervision with sound foundation for the fair and equitable treatment of employees through "Just Culture? training. a) Minimum Requirements?Field Supervision Contractor shall provide 24-hours a day on-duty supervisory coverage within the City. An on-duty employee or officer must be authorized and capable to act on behalf of the Contractor in all operational matters. The Proposers shall also specifically describe how its Supervisors are able to monitor; evaluate and improve the clinical care provided by the Contractor?s personnel and to ensure that on-duty employees are operating in a professional and competent manner. All field supervisory level staff will have successfully completed ICS 100, 200, 300 400, NIMS 700 800. Paramedics Plus 151 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA PERSONNEL FIELD SUPERVISION Selection of Field Supervision The selection of a supervisor is one of the most important tasks undertaken by the management of our organization. It speaks to the overall representation of Paramedics Plus to the employees, its patients and the public. Ambivalence and mediation are not roles in supervision. A supervisor is a front line extension of management, twenty-four hours a day. Many supervisors feel that their role is to be a middleman between management and the ?eld, taking neither side, only to act as the go-between. We disagree with that premise. We expect better and so do our employees. Thus, we select these special individuals on the basis of their proficiency, quality, judgment, experience, responsibility, peer respect, and conviction that patients and employees come first. Once selected, the supervisor is provided all of the didactic and practical training and equipment needed to perform their jobs. At Paramedics Plus, we understand the importance of a highly trained and well? prepared supervisory staff available to handle any clinical or operational situation 24 hours per day, seven days per week. To ensure this quality of service, Paramedics Plus proposes four full-time Field Operations Supervisors for the REMSA system. While on duty, each supervisor will have the authority to act on behalf of the company in all operational 6 co." I'm matters. Each supervisor will be assigned to an . If l. ambulance for a 12-hour shift, and there will be a supervisor on duty 24 hours a day. Monitoring, Evaluating and Improving Patient Care All supervisors in the REMSA system will be able to monitor, evaluate and improve the clinical care of employees through use of innovative software as well as face-to-face follow-up with employees on issues related to clinical care and work performance. Through use of a powerful and innovative software tool called Tableau, all on?duty supervisors will have access, in real-time, to statistics that directly relate to patient care. Paramedics Plus 152 :\AD\002\02\2X02\2X02177.docx 306 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA PERSONNEL FIELD SUPERVISION The Tableau product automatically tracks documentation from the electronic patient care record and the CAD, which allows the management team to analyze a wide range of variables including such things as comparison of presumptive impressions at dispatch compared to field observation. At any time, a supervisor can query an employee?s ?le to review his or her patient care and treatment history, which is invaluable for tracking protocol compliance, medication administration, skill competence, established and selected call types with certain specific impressions. Sample reports generated by Tableau are provided in Appendix 32. Another software tool available to on- duty supervisors is called Ninth Brain Suite. This very useful software program allows supervisors to track everything from conversations and disciplinary action to education credentials and license renewals for employees. As a web-based program, Ninth Brain can be accessed at any time and allows a supervisor to remotely View an employee?s ?le essentially creating a mobile office for the supervisor. Furthermore, Ninth Brain allows the supervisors to actively investigate con?icts, inquiries or complaints and document investigative results. This information is readily available for all administrative staff to review and provides reporting statistics for possible trending and system improvement. In today?s high-tech society, instant access to information has become the standard. Through use of the Panasonic Toughbook tablet and the On Board Mobile Gateway on each ambulance, the on-duty supervisor will have continuous access to the Tableau and Ninth Brain products as well as company email. Each on duty supervisor will be issued a company cell phone. The phone will allow employees, hospital and fire department representatives, and other customers to have a direct 24-hour line to a supervisor. In the event the supervisor is on a call and unable to answer, voicemail is available to allow the caller to leave a message or have the option to contact the administrator on call for urgent issues. The contact information for the administrator on call will be provided on the voicemail message. A supervisor or director is available each day to handle issues or situations that arise at any time of day. Paramedics Plus 153 307 COMPETITIVE CRITERIA PERSONNEL FIELD SUPERVISION Quali?cations Qualifications for the position of Field Operations Supervisor (FOS) require: 0 Experience as a Paramedic in the REMSA system 0 An exemplary service record 0 A thorough understanding of REMSA and Paramedics Plus policies, procedures and protocols 0 Current Paramedic certification 0 Current certification in CPR, ACLS, PALS, IT LS or PHTS 0 Excellent communication and interpersonal skills 0 Excellent clinical skills and documentation 0 Approval by both the Paramedics Plus and REMSA Medical Directors. The Field Operations Supervisors should also exemplify the Paramedics Plus values: 0 Customer Accountable 0 Attentive to Human Needs 0 Respectful 0 Ethical 0 Partnership 0 Lead by Example 0 Understanding 0 Safe In addition to the Field Operations Supervisor position, Paramedics Plus proposes four Assistant Supervisors/ Field Training Officers. These Assistant Supervisors/ FT Os will function as the primary Field Training Of?cers for the REMSA system and provide backup to the Field Operations Supervisor. Each Assistant Supervisor/ FTO will be assigned to an ambulance and work 12?hour shifts. Qualifications for the position of Assistant Supervisor/ FTO mirror the requirements for the FT 0. All Field Operations Supervisors and Assistant Supervisors/ FT Os will be trained in ICS 100 (Introduction to Incident Command System), 200 (Single Resources and Initial Action Incidents), 300 (FEMA), and 400 (Advanced ICS for Command and General Staff, Complex Incidents), as well as NIMS 700 (National Incident Management System) and 800 (National Response Framework) by the end of year one of the contract except those who previously earned these certifications. Attestation: C) 8833 Paramedics Plus understands and agrees to DUDE . . . comply without qualification to prowsions, requirements and commitments contained in Section . -- I'm. I Paramedics Plus 154 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA PERSONNEL FIELD SUPERVISION b) Higher Levels of Commitment? Field Supervision Paramedics Plus will require exemplary quali?cation requirements as described above and support ?eld supervision through educational opportunities, a robust career ladder and a "Just Culture.? Paramedics Plus will exceed minimal requirements for leadership and supervisory training through focused scholarships to the American Ambulance Association?s Ambulance Service Manager Certi?cate Program, as well as providing a robust proprietary on-site leadership and supervisory training program. Ambulance Service Manager Program (ASM) Paramedics Plus will create focused scholarships to send promising operations supervisors and management staff to the ASM program offered through the American Ambulance Association. The ASM program is recognized across the industry for its proven ability to help develop leadership competencies and sharpen essential management skills for both new and experienced EMS managers. The program, held in Kansas City, provides a broad foundational curriculum that matches current management theory with real-life practical army! 171 Paramedics Plus 155 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA PERSONNEL FIELD SUPERVISION applications. In year two, the ?rst deserving candidate will be sent to this intense two- week program of face-to?face instruction and experiential learning led by industry leading faculty. Paramedics Plus Leadership Training Program Paramedics Plus has a proprietary management and leadership training program unique in the Emergency Medical Services industry. Based on the values of the organization, it emphasizes commitment to clinical care and those who provide that care. The program is designed to allow individuals at all levels in the organization to identify and pursue their educational objectives and also gives them the tools to improve the care delivered to patients. This program is ?exible and driven by the needs identified by managers in local operations. Rodney Dyche, who has more than 30 years of EMS experience, leads this program. Mr. Dyche worked as a nationally registered paramedic in Kansas City, Reno, NV, and Las Vegas, NV, and held positions including system status controller, field supervisor, operations supervisor, communications manager, director of support services and general manager. He also owned his own law firm representing EMS organizations and individual providers. Mr. Dyche teaches courses as part of the leadership training program, which uses a combination of teaching strategies including on-line learning, role play, and classroom instruction to allow superior employees to pursue careers in management and clinical leadership. Below are the components of the management and leadership training program. Paramedics Plus 156 :\AD\002\02\2X02\2X02177.docx 310 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA PERSONNEL FIELD SUPERVISION Training Needs Addressed in Four Categories 0 Skills needed to carry out a "lust Culture" so that the response to staff behaviors is fair and just, yet holds employees accountable for the quality of their choices and for reporting boU1 errors and system vulnerabilities Paramedics Plus values and basic leadership skills needed at each level of management in the company to interact with subordinates and superiors, including skills in counseling, confrontation, problem solving, group process, negotiation, and leadership styles Skills needed to improve individual performance, including skills in computer programs such as MS Of?ce, time management and organization Skills for dealing with those outside the organi7a tion, including customer, governmental and media relations; public speaking and business etiquette, knowledge of EMS system design, SSM, and key processes including EMS system design, system status management, proposal and grant writing, and budgeting and billing. "just Culture? Paramedics Plus is the only nationwide EMS provider to implement the concepts of "Just Culture" in all of its operations. These concepts have successfully improved safety in such high-risk industries as aviation, and have been a major focus for Paramedics Plus and its leadership training program over the last three years. "Just Culture? refers to a culture that holds the organization accountable for system design and responding to staff behaviors fairly and justly, while employees are held accountable for die quality of their choices and for reporting both errors and system vulnerabilities. Through balanced accountability, "Just Culture? provides better tools to manage the complicated risks within EMS. ust Culture? training for organizational leaders is an eight-hour program where participants learn what to do when an employee has made a mistake or performed in a manner inconsistent with policies, procedures, or values. Training focuses on separating human error from at-risk behavior and distinguishes reckless behavior from all others. These concepts and the CARE PLUS organizational values are the foundation of all Paramedics l?lus training. In order to establish an environment that encourages employees to be totally honest and forthright in doing their job, accountability must be balanced with justice. A "Just Culture? holds organizations accountable for U1e systems they design and for fair and just response to staff behaviors. In turn, the staff is accountable for the quality of its choices and for reporting both errors f? orHu-r- in (immune mi Him:th chib 5 Paramedics Plus 157 311 COMPETITIVE CRITERIA PERSONNEL FIELD SUPERVISION and system vulnerabilities. It is far from a blameless culture, but rather one in which mistakes or deviations from protocols can be openly discussed and from which all involved can learn. After all, in medicine this is how experience and practical wisdom is acquired. A ?Just Culture? embraces not only the active identification of safety issues, but also responses with appropriate actions. On the other hand, if the corporate structure is always punitive regarding mistakes, errors are often hidden, and there is the risk of creating a mediocre system rather than a learning organization which continues to improve. In general, there are three categories of mistakes that can occur in the use of medical protocols. Honest mistakes, which are simple human errors, happen frequently. They may or may not be avoidable or predictable as "to err is human." A second type of mistake may occur when one makes a choice to deviate from a rule or protocol by making a conscious decision based on circumstances existing at the time, analogous to a physician using his or her clinical judgment. There may be justifiable reasons for a provider of health care taking such a risk, if at the time it is felt to be in the patient?s best interest, even if the ultimate outcome is less than desirable. The third type, and most egregious, occurs when there is reckless behavior without regard to a patient?s welfare. Examples include abuse or a provider being under the in?uence of drugs or alcohol while on duty. in itni?v'sinfa lam/5?2 turn} E: )vs toms Paramedics Plus 158 :\AD\002\02\2X02\2X02177.docx 312 :\AD\002\02\2X02\2X02177.docx COMPETITIVE PERSONNEL FIELD SUPERVISION Only by categorizing mistakes and considering them in context, such as the employee's past history of mistakes and trending of errors, can one truly implement an appropriate response to employee behavior and accountability. Appropriate and available responses and corrective actions span the range from counseling to discipline, and from coaching to termination. By establishing for the workforce a clear understanding of performance expectations, the means of evaluation and Ule corrective action, the workforce can anticipate for making an error, and 3 ?Just Culture" can be successfully developed. Balancing accountability with a sense of fairnem results in an open sharing of information between management and the workforce, and ultimately leads to improved systems and better care for patients. "Just Culture" is an atmosphere of trust in which people are encouraged (even rewarded) for providing essential safety-rela ted information, but in which they are also clear about where the line must be drawn between acceptable and unacceptable behavior. A "Just Culture" refers to a way of safety thinking that promotes a questioning attitude, is resistant to complacency, is committed to excellence, and fosters both personal accountability and corporate self -regulation in safety matters. 0 The "Just Culture" concept is embraced by Paramedics Plus at its highest corporate leadership level. 0 The Chief Medical Of?cer for Paramedics l?lus also embraces ?Just Culture." By including and engaging local Medical Director in efforts to create a "Just Culture," employees are assured of consistency when errors do occur. - Environment healthy behaviors - Increased situational awareness Human Error At-Risk Behavior Reckless Behavior 1 Product of the Current A Choice: Risk Believed Conscious Disregard of System Design insigni?cant or Justi?ed Unjusti?abie Risk Manage through changes Manage through? Manage through? in? - Removing incentives for 0 Remedial action - Processes at-risk behaviors - Disciplinary action Procedures . . - Incentives for - Desngn Coach \Acknowledge/Leam Discipline 3f r' orHu-r- in t5uiltlu10 '\w.nrl V?huulu?.) '3 Paramedics Plus 159 313 COMPETITIVE CRITERIA PERSONNEL FIELD SUPERVISION 0 The "Just Culture? concepts will be taught in leadership training courses to all levels of the Paramedics Plus management team in Sioux Falls, including directors, managers, Field Operations Supervisors and Field Training Officers. 0 Managers across the organization are strongly encouraged to apply "Just Culture" concepts and employ the "Just Culture? algorithm in considering employee discipline. The "Just Culture" framework supports trust and fairness and guards against arbitrary and capricious discipline. 0 Paramedics Plus educators and managers set clear performance expectations during employee orientation and in interactions beyond orientation. The Supervisor Academy is a stepping stone to higher levels of leadership training. Paramedics Plus Supervisor Academy 0 140 hours of workshop presentations 0 Pre? and post-workshop assignments: 2 hours pre; 1 hour post 0 Assignments posted on Ninth Brain Suite 0 Training organized into "blocks" which build upon one another 0 Basic supervisory skills, management tools and senior management development. Paramedics Plus Leadership Academy 0 "Just Culture? concepts for leaders 0 Event Investigation within ?Just Culture.? :\AD\002\02\2X02\2X02177.docx Paramedics Plus 160 314 COMPETITIVE CRITERIA PERSONNEL FIELD SUPERVISION BLOCK 100 BLOCK 200 0 Online Computer Skills Training 0 Workshop 204?performance evaluation 0 Reading Comprehension Writing Skills metrics and PPlus values principles 0 Workshop System components, 0 Workshop 205?when and how to PPlus values; supervisory responsibilities discipline within a ?Just Culture?; helping 0 Workshop lOZ?situational leadership employees set and meet goals and diagnosing personnel performance 0 Workshop 206?goal-setting and habits of problems effective people 0 Workshop lO3?-interviewing candidates for 0 Workshop 207?prioritization, productivity, employee resolving con?icts effective meetings, emotional intelligence 0 Workshop 208?managing relationships with government of?cials, media outlets and customers 0 Workshop 209?System Status Management BLOCK 300 0 Workshop from the patient?s perspective 0 Workshop 311?risk management, ?eet management, materials management 0 Workshop 312?developing an operational budget for high performance EMS 0 Workshop 313?Requests for Proposal analysis 0 Workshop 314?PPlus values 8: principles, wage hour rules, proposal and grant writing. Each ?eld operations supervisor will complete the management and leadership training program in its entirety by the conclusion of the third year of the REMSA contract. Each assistant supervisor/ FTO will complete all levels of the program except for blocks 200 and 300 in the same timeframe. Details regarding this program can be found in Appendix 33f'n-ibifx "t .Ii u' '41 In u! Paramedics Plus 161 315 COMPETITIVE CRITERIA PERSONNEL WORK SCHEDULES 2. Competitive Criterion: Work Schedules Paramedics Plus will meet all REMSA minimum requirements under Work Schedules and proposes to: 0 Build the schedule around 12-hour shifts 0 Allow for at least eight hours of rest between shifts whenever possible, recognizing that there may be emergency or weather conditions under which this may not be possible. Paramedics Plus will achieve higher levels of commitment and proposes to: 0 Monitor the Unit Hour Utilization to ensure employees are not overworked 0 Protect patients, employees and the community by monitoring and acting on employees who appear overly tired 0 Utilize voluntary overtime whenever possible. Contractor is expected to support employees by employing reasonable work schedules and conditions. a) Minimum Requirements? Work Schedules Patient care must not be hampered by impaired motor skills of personnel working extended shifts, part-time jobs, voluntary overtime, or mandatory overtime without adequate rest. Contractor?s employees working on an emergency ambulance or as a field supervisor should work reasonable schedules to ensure that potential fatigue and the resulting safety issues are reduced. Proposer shall describe its policies and procedures used to motor employee fatigue and impairment. Paramedics Plus 162 :\AD\002\02\2X02\2X02177.docx 316 COMPETITIVE CRITERIA PERSONNEL WORK SCHEDULES There has been much debate in recent years regarding shift work and employee fatigue in the emergency medical services industry. Studies have shown that fatigue increases the risk of employee injury and accidents. At Paramedics Plus, we are committed to the health and well-being of our employees and believe work schedules play a key role in this area. As a result, Paramedics Plus proposes that all full-time ambulance work schedules in the REMSA system consist of a rotating schedule where the employee works seven 12? hour shifts in a two week period (four 12-hour shifts one week and three 12-hour shifts the next), for a combined average work week of 42 hours. On this rotating schedule, employees work 14 shifts per month. This allows between 14 and 17 days off per month depending on the month, as well as every other weekend off. In Sioux Falls, it will be Paramedics Plus' policy that no employee will work a shift longer than 16 hours and that no employee will be permitted to start a shift with fewer than eight hours off-time between shifts. Supervisors are to protect patients, employees and the community by monitoring and acting on employees who appear overly tired. Attestation: 0 883% Paramedics Plus understands and agrees to comply without qualification to provisions, requirements and commitments contained in Section Paramedics Plus 163 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA PERSON NEL WORK SCHEDULES ?9 "Ighe?" Levels 0? commnmem-work swam,? 0 Allow for at least eight hours of rest Pmamedicq Plus is CO -ued to procedures between shifts whenever possible. and policies ?ong with monitoring recognizing that there may be emergencv I mechaniqmg lhat ensure employees. are nm or weather conditions under which this I overworked, or expected to work 1' or extended may not be POSSible? time periods. ?l'hese are the approaches 0 Protecting patients, employees and the Paramedics Plus will take so that employees community by removing 0v =rly tired are able to perform safely and appropriately: employees from their shifts. 0 Monitor the Unit Hour Utilization to make . When Shifts must be covered by overtime, Certam that employees are overworked mandatory overtime is a last resorL When Paramedics Plus has an initial goal of 0.35 to it is imposed, it is done in a manner 0-40 UHU the REMSA bUt may which considers the needs of individual adjust the target based on actual time emplovees as well as the needs of the involved on calls. organization. 0 Build the schedule around 12-hour shifts . Offer generous bene?ts including Paid with shifts restricted to a maximum of 16 vlime OH: so that emplovms have ample houfS- opportunity to rest and rejuvenate. 0 Schedule employees for seven shifts each two-week period so Uiat employees have more days off for rest. Lin-Ming EMS ?Ey-xtmw. Paramedics Plus 164 :\AD\002\02\2X02\2X02177.docx 318 COMPETITIVE CRITERIA PERSONNEL RISK MANAGEMENT - LOSS CONTROL 3. Internal Risk Management/Loss Control Program Paramedics Plus will meet all REMSA minimum requirements under Internal Risk Management/Loss Control Program proposes: 0 A careful and deliberate pre-screening process that selects employees who demonstrate characteristics for safe behavior for themselves, patients and the community 0 Policies and actions that demand and produce a drug-free workforce 0 A robust training program including lifting techniques, assaultive behavior management and safe ambulance driving 0 An ongoing driver?monitoring program through SafeForce 0 A process for tracking, trending, monitoring and acting on employee health and infection control issues 0 A process for reporting FDA reportable events 0 An immunization plan to protect employees 0 The purchase of new, safe equipment and ambulances along with a maintenance and replacement plan to ensure safety and efficiency. Paramedics Plus 165 :\AD\002\02\2X02\2X02177.docx 319 COMPETITIVE CRITERIA PERSONNEL RISK MANAGEMENT- LOSS CONTROL. Paramedics Plus will achieve higher levels of commitment and proposes: 0 A ust Culture? that encourages employees to report safety or risk issues 0 A combination of its "Just Culture" with participation in the Center for Patient Safety for effective approaches to reporting and handling near misses 0 A national safety effort which allows all Paramedics Plus systems to benchmark against one another and share best practices 0 Software tools to support employees and managers as they work to ensure a safe environment 0 A comprehensive safety plan which includes a Safety Committee to reduce incidents, heighten awareness and provide continuous quality assurance for the safety and risk incident program. Education and aggressive prevention of conditions In which accidents occur are the best mechanism to avoid Injuries to Contractor staff and Patients. a) Minimum Requirements?Risk Management REMSA requires Contractor to implement an aggressive health, safety and loss mitigation program including, at a minimum: 1. Pre-screening of potential employees; 2. Drug free workforce policies and procedures; 3. Initial and on-going driver training; 4. Ufting technique training; 5. Assauitlve Behavior Management ?Ilaining 6. Review current information related to medical device FDA reportable evens, recall, equipment failure, accidents 2 Review employee health/Infection control related Information such as needle sticks, employee injuries, immunizations, exposures and other safety/tisk management issues. Planning for safety and risk mitigation processes will include, at a minimum: 1. Gathering data on ALL Incidents that occur among the Contractors workform; 2. Devlse policies prescribing safe practices and providing Intervention in unsafe or unhealthy work- reiated behaviors; 3. Gather safety information as required bylaw; 4. Implement training and corrective action on safety related incidents, as required bylaw; and 5. Provide safe equipment and vehicles. Proposer shall describe its risk management program. the heath and well-being of Paramedics l?lus employees has a profound effect on patient care and patient satisfaction, as well as the operating ef?ciency of the organization. That is why Paramedics l?lus begins the process of ensuring a safe EMS system wiUI the purposeful selection of well-qualified, professional employees with healthy personal values, safe behavior and good physical fitness. A tire?assessment helps evaluate key descriptive competencies that provide insight in to a candidate's beliefs and values. The goal is to identify individuals whose core values match with atlribu tes necessary to succeed in EMS, which includes working safely. Paramedics Plus it?) :\AD\002\02\2X02\2X02177.docx 320 COMPETITIVE PERSONNEL RISK MANAGEMENT - LOSS CONTROL Pre-Screening Physical Screening and Drug Testing The employee selection and physical pre- screening process includes drug testing, plus functional testing based on physical requirements of the job. Our pre-screening physical agility testing keeps pace with changes in the liMS work environment and is reviewed annually by a licensed physical therapist. In addition, all new Paramedics Plus employees are required to complete a hearing examination, vision exam, OSHA respiratory exam and medical history, and an examination administered by a certified and licensed occupational provider. This exam includes a lO-panel drug screen conducted by Clinical Reference Laboratory, an experienced and credentialed national leader in corporate wellness testing. Paramedics Plus has a strong commitment to its employees to provide a safe workplace. We are also committed to the general public and our customers, including the City of Sioux Falls, to operate our business in a safe and prudent manner. Consistent with this spirit and intent, our goal is to establish and maintain a work environment that is free from the physical and impairment caused by the use of alcohol and drugs. Observance of our Alcohol and Drug- Free Workplace policy is vital to ensure that adverse effects of physical or mind-altering substances do not threaten the quality and safety of our operation. A copy of the Alcohol and Drug-Free Workplace policy is available in Appendix 34. Driver Training and Ongoing Monitoring Paramedics Plus? driver training program is mandatory for all vehicle operators within the organization. Our certi?ed Emergency Vehicle Operations Course is one of the most comprehensive and well-regarded programs in the industry. All new employees receive behind-the?wheel ?eld instruction in both simulated and real-world environments, reinforcing classer instruction and hands- on practice of EMS driving behaviors. Field instruction teaches maneuverability and vehicle control on a cone course, including backing, sudden stops, rapid turning and ?xed object avoidance. Employees move on to field driving with a preceptor, gradually driving for longer periods until they gain 32 hours of behind-Uie-wheel experience. Employees found to be driving below company standards or involved in an on- the-job preventable accide11t are placed in a remedial program with training personnel. This process can include a review of company driving policies, completion of the EVOC program, hands-on?practice and or supervised driving. critu?r- til Utlilillhu Hit (Insulin) Chit; '3 Paramedics Plus 167 :\AD\002\02\2X02\2X02177.docx :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA PERSONNEL RISK MANAGEMENT - LOSS CONTROL SafeForce Supports Ongoing Safe Driving Paramedics Plus commits to monitor and support safe driving habits through Zoll?s SafeForce product, an intensive driving training program, and its own safe driving policies. An investment of $65,000 in SafeForce by Paramedics Plus to equip each REMSA ambulance with the driver feedback system is part of an overall approach to creating a culture where safe driving expectations are clearly understood and achieved. The SafeForce system is a proven solution to reduce aggressive driving, improve safety and significantly reduce costs through behavior modi?cation. It modi?es behavior through real-time audible warnings that alert the driver as he or she approaches or operates the vehicle in an unsafe manner. This immediate feedback allows medics to correct driving behavior before it leads to a crash and provides an environment which allows medics to continuously learn and improve their driving performance. Since the system allows management the ability to monitor driver behavior, appropriate training can be provided in areas that need improvement. Besides behavior modification, the "black box? system can be used for accident reconstruction and investigation of allegations. Among the parameters monitored by the system are: 0 Speed 0 Back?up spotter use 0 Use of turn signals 0 Braking 0 Ignition 0 Emergency Lights and Sirens use 0 Seatbelt use 0 Over forces, hard accelerations/ decelerations 0 RPMS 0 Total trip times 0 System tampering Use of SafeForce benefits the EMS system in several ways: Better for patient care by providing a smooth and stable environment for the patient and the paramedic providing treatment. Paramedics Plus 168 322 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA PERSONNEL RISK MANAGEMENT - LOSS CONTROL Costs from vehicle contacts are reduced through real-time audible cues that "train" drivers when they approach an unsafe driving condition such as excessive forces or speeds. It also encourages the use of spotters so that even instances of minor damage are reduced. A safer community is realized as medics learn to anticipate potential dangers earlier and approach red light intersections carefully, even when responding to an emergency call. Reduced costs from maintenance since the wear and tear on vehicles is lessened and brakes last longer. Feedback and Monitoring that Get Results Paramedics Plus combines the SafeForce product with an intensive driving training .- t~ IN 1? program and a policy that reinforces the importance we put on safety. A copy of the Paramedics Plus driving policy is provided in Appendix 35. Safe Stretcher Handling To reduce the number and severity of injuries sustained by our EMS personnel, Paramedics Plus has developed a one?day lifting program and obstacle course that teaches safe stretcher operation. This situational training puts employees through many of the challenging scenarios they may encounter when moving a patient. Various devices are provided to the employees, including slide mats, friction reducing devices, backboards and scoop stretchers, helping to assess the best method Paramedics Plus 169 323 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA PERSONNEL RISK MANAGEMENT - LOSS CONTROL of moving a ISO lb. manikin from the ground to the stretcher. Next, employees must demonstrate the ability to lift the "patient" and stretcher using good body mechanics. If dangerous or unacceptable techniques are used, they are remediated in real time to avoid injury. In addition, employees must move the stretcher to the ambulance via a stretcher course that includes various terrains and ground services to mimic conditions found in the field. This includes dirt, sand, water, grass and asphalt. Finally, students are taught how to control the stretcher while it is moving, how to communicate with partners on scene and how to avoid a tip over if weight isn?t equally distributed. Teaching Paramedics Plus employees to use critical thinking skills and situational awareness, While in control of their stretcher and patient, is the key to our effective stretcher training. More information about the success of this program is provided under I ligher Levels of Commitment below. Assaultive Behavior Management Training As EMS personnel, Paramedics Plus paramedics and EMTS are called upon to intervene in crisis situations that may become dangerous if not handled safely and appropriately, which is why all ?eld employees are trained in aggression control, utilizing both classroom instructitm and scenario?based training. The course explores the prevention of aggressive behavior and crisis intervention techniques, which include verbal de-escalation and physical interventions. In addition, employees identify the definition of aggression, warning signs for aggressive behavior, strategies to diffuse aggressive situations, crisis intervention techniques and employee responsibility after an event. Corporate Management Trainer Rodney Dyche, who has more than 31 years of EMS experience, teaches this course. Equipment Failure Equipment or medical device failures are considered a top priority under Paramedics Plus' risk management and loss control program. Any piece of equipment that malfunctions or causes injury to an employee or patient is immediately placed out of service, undergoes quality assurance review and is reported to the FDA. If notice is made to our organization of an FDA recall based unreported accidents or failures, that device and or equipment is removed from the system and returned to the supplier for immediate replacement. All medical device reporting is tracked and documented in- house by Operations and issues are reported immediately to the FDA and supplier/ manufacturer. orHu-r- In (Stunting in; Thu-ulna) Chit; '3 y-ihnn Paramedics Plus 170 324 COMPETITIVE CRITERIA PERSONNEL RISK MANAGEMENT - Loss CONTROL Employee Health Screening, Immunizations and Personal Protective Equipment Paramedics Plus is alert to risks inherent to EMS as an occupation and the environment in which our employees work. Our safety and risk management strategy actively and equally engages three principles: 0 We are compliant with Federal, State, and Local regulations. 0 We effectively manage worker?s compensation. 0 We diligently promote and expect a safe culture and safe behavior from our workforce. Paramedics Plus makes available, at no cost to the employee, health screening and recommended immunizations including Hepatitis B, Tdap (Tetanus, Diphtheria and Pertussis), Influenza (seasonal), Varicella doffing of PPE, and PPE maintenance. If there is an occupational injury or illness, the and MMR (measles, mumps and rubella). In addition, Paramedics Plus provides a . . . 1nc1dent IS investigated thoroughly, reVIewed TubercuIOSIS Skin Test and a respiratory Fit collaboratively by a multidepartment team, Test upon employment and at least annually and analyzed root cause analy51s. thereafter. All employee exposures, including needle Employees are also provided with sticks, will be handled by a Paramedics Plus personal protective equipment, including employee assigned to the Infection Control protection, high Visibility vest, head role, who will ensure that noti?cation, testing protection, hand protection, face protection, and medical follow-up occurs in real time. respiratory protection and Level protective The Infection Control employee will act as the suits. Training includes the intended and liaison with the employee, source patient and applicable use along with any limitations health care facility to ensure that the employee and special instruction, proper donning and is counseled quickly and thoroughly. PAR PM 5 Pa: 'tn-?Ti Bruit.? Hg d-Winning Ems ms Paramedics Plus 171 :\AD\002\02\2X02\2X02177.docx 325 COMPETITIVE CRITERIA PERSONNEL - RISK MANAGEMENT - Loss CONTROL The Paramedics Plus of our "Just Culture,? employees, rather than Risk Management Program management, report the vast majority of Paramedics Plus supports a safe environment madents' through culture, training and education, Management has a separate set of tools that screening for employees with the right set of promote safe system design. These tools are attributes, well-maintained equipment and unique to Paramedics Plus and provide the ambulances, and also technology to facilitate manager access to a range of analytics and documentation, trending and resolution of intelligence relating to incidents and our incidents. performance. The Incident Management Performance Tool ensures incidents are bein Paramedics Plus utilizes a robust reporting 8 system Via the Ninth Brain Online Software suite where all employees report a wide range of incident types from vehicle contacts to medication errors. This tool allows managers to explore a effe ctively managed as incident closure rates are tracked for the system and for each individual manager. number of dimensions that lead to more ef?cient decisions and better processes for an environment of enhanced risk management and the unique ability to continuously design safer systems. There are 25 primary incident types including incidents such as employee injury, medication error, documentation, vehicle problem, customer complaint and many others. Each primary type has the option of multiple subtypes allowing for greater and . . greater sensitivity in analysis. Each incident I a I collects a standard set of information that allows management to dynamically build analysis on any number of dimensions Field Employees are able to access the 1 di 1 hift incident reporting system through a tablet PC me _ng emp Oye?' Gimp semonty' . type, time or date, 1nc1dent type, and decrsron transported in each ambulance. Employees . . behavior. are encouraged to report any and all 1nc1dents as part of the ongoing effort to improve processes and decision behavior. In the context F'l? AMEDICS PLUS mm f- in: Building Aw in It Nivmim; 3y: ?In Paramedics Plus 172 :\AD\002\02\2X02\2X02177.docx 326 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA PERSONNEL RISK MANAGEMENT - LOSS CONTROL Safe Vehicles and Equipment Paramedics Plus provides safe vehicles and equipment. All new equipment will be provided for the REMSA operation. Future new vehicles and equipment will be evaluated by the Safety Committee (described below) to ensure proposed equipment is safe and reasonably appropriate to integrate into care procedures and other work processes. Safe vehicles are mandatory at Paramedics Plus. Crews are required and encouraged to report any and all vehicle issues immediately. If an ambulance or other vehicle is not safe, it is immediately removed from service until the issue is resolved. Paramedics Plus employees are never asked or required to use unsafe vehicles or equipment. Attestation: Egg Paramedics Plus understands and agrees to comply without qualification to provisions, requirements, and commitments contained in Section b) Higher Levels of Commitment? Risk Management Paramedics Plus Safety Initiative; Benchmarking and Best Practices A Paramedics Plus Safety Initiative, launched in 2012, offers ongoing opportunities for all Paramedics Plus systems to benchmark against one another and share best practices, which have led to new policies, training and success. The REMSA system would be fully engaged in this effort. The ?rst activity of the project was a complete comprehensive organizational risk assessment, which established benchmarking numbers for key risk control elements. The Paramedics Plus sites were visited by outside risk and safety experts who rode on ambulances, observed and talked with crews and management. Combining the analysis of injuries, which shows most injured employees Paramedics Plus 173 327 COMPETITIVE CRITERIA PERSONNEL RISK MANAGEMENT - LOSS CONTROL are young (between 21 and 25) and haVe been and safe driving. Campaigns are multifaceted employed two years or less, plus the risk and include: assessment, indicated a need to bring more 0 Review of the training program and, where focus on safety issues and deploy messages necessary, retrain and re-instruct clinical more effectively to field crews. educators who teach field medics during . . . . orientation and team meetin The end goals of the new 1n1t1at1ve were to reduce injuries in the following areas by the . Enhanced preparation Of Field safety end of 2014: 1. Patient handling from ground to stretcher 2. Patient handling from stretcher to bed 3. Stretcher loading and unloading. Officers who observe and coach field crews 0 Enhanced preparation of Field Operation Supervisors who also observe and coach field crews 0 Deployment of safety concepts to field At all Paramedics Plus locations, top crews by peers and managers on the Safety management continuously supports safety Committee efforts which include campaigns emphasizing Communication Via posters, electronic education and awareness on aspects of safe messaging, memos, etc, patient handling, safe equipment handling Paramedics Plus 174 :\AD\002\02\2X02\2X02177.docx 328 :\AD\002\02\2X02\2X02177.docx COMPETITIVE PERSONNEL RISK MANAGEMENT - LOSS CONTROL In addition, more emphasis has been placed on tracking, trending and monitoring safety data with an ultimate goal of improving equipment or processes so that injuries are prevented. When they do occur, Paramedics Plus is taking a more active role in the management of injuries and formalizing its transitional duty program. The transitional duty program allows employees to assume new duties while injuries heal, always within the medical restrictions prescribed by physicians. Keeping employees in the habit of coming to work, while they heal, has documented benefits for the employee as well as the organi7ation. the initiative also includes development of a database for accident reporting and investigation, creation of an accident trending dashboard, development of critical work activities, and safety behavioral processes for patient handling and equipment handling, developing process metrics for activities, and developing progress and outcome metrics for results. As part of this process, Paramedics Plus conducted an analysis of injuries at its Pinellas County, Florida, location in 2012 and found an increase in back injuries caused by patient handling. By combining the analysis of injuries with an overall risk assessment, the Pinellas staff con ?rmed the need to bring more focus on safety and training, while deploying messages more effectively to field crews. The end goal of the safety initiative was to reduce injuries from patient handling by 20%. Over the course of a year, the Pinellas Paramedics Plus team utilized communication via posters, electronic messaging and employee newsletters. The group reviewed the training program and, where necessary, retrained and re?instructed clinical educators, liield 'lraining Of?cers and Operations Supervisors and deployed safety concepts to field crews by peers and managers on the Safety Committee. The campaign worked. At the end of 2013, employee injuries from lifting patients were reduced by 24%, exceeding the initial goal of 20%. Since the inception of the 2012 Paramedics Plus corporate-wide safety initiative, injuries as a result of patient handling have been reduced by l6.8% and the severity of those injuries is down In addition, the frequency of injuries as the result of manual material handling (is equipment handling such as stretcher lifling), has been reduced by Our safety efforts in regards to injury reduction have been proven successful; however, we continue to communicate with the workforce and improve our education processes. This national campaign to lift patients and equipment safely is ongoing. Risk leaders from each Paramedics Plus operation continue to benchmark incidents, share best practices and work collaboratively to ?nd better, safer ways to operate. .. ti ir'tivr- In (Sodding ?won ?own-i) chi: ?1 Paramedics Plus 175 329 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA PERSONNEL RISK MANAGEMENT - LOSS CONTROL. Reporting Adverse Events and Near Misses While many safety activities are reactive rather than proac?y'e, Paramedics Plus encourages and requires employees to report adverse events and near misses so that corrections can be made to prevent a recurrence. To strengthen our abilities to be a safe EMS provider, Paramedics l?lus has partnered with the patient safety organization (PSO) Center for Patient Safety. Participation with this organization allows Paramedics Plus to improve the quality and safety of care processes and activities while securing federal level confidentiality protection under the federal Patient Safety and Quality Improvement Act of 2005. 'l he PSO provides clinicians, certi?ed quality and risk professionals and data to support Paramedics Plus's quality and safety improvement efforts. Paramedics Plus is the only EMS provider to fully implement "Just Culture" and participate in a PSO on a nationowide basis. Paramedics I?Ius's proprietary policies and procedures are designed to facilitate the confidential reporting of medical errors, near-misses and other identi?ed unsafe conditions. Once reported, a full event investigation is launched to discover the root cause of the reported issue. Healthy and Safe Work Environment for Sioux Falls A healthy and safe work environment is a high priority goal for each Paramedics Plus operation. To meet this goal, comprehensive policies have been developed and deployed to address both clinical and operational safety issues, based on industry standards and healthcare guidelines. Educational offerings ensure that employees receive health and safety training during initial orientation, annually, and any time there are changes to existing safety procedures. Health and Safety polities include, but are not limited to: 0 General safety rules that apply to all employees 0 Expectations of each employee in the event of workplace emergencies 0 Importance of using safety equipment and devices 0 Procedures for reporting unsafe conditions, accidents and "near-misses? 0 Safe performance of speci?c work activities 0 Safe ambulance driving and SafeForce 0 Safe operation and maintenance of all associated tools and equipment 0 Interfacing the job-speci?c activities as they relate to tasks performed by other employees 0 Speci?c State and Federal regulations those requiring written compliance programs and job-sped fic training. r' .rtru-r- In timid-no "won (trauma) 5 Paramedics Plus 176 330 COMPETITIVE CRITERIA PERSONNEL RISK MANAGEMENT - LOSS CONTROL To further our commitment to employee safety and health, Paramedics Plus will establish a Safety Committee with involvement from all levels of the organization. This committee will: 0 Meet at least quarterly to discuss site- specific workplace safety and health issues. 0 Develop, establish, and communicate procedures for conducting internal safety inspections. 0 Assist administration in reviewing and updating workplace safety rules and policies, work processes, medical equipment devices, and personal protective equipment based on accident investigation findings, inspection findings, employee reports of unsafe conditions or work practices, and accepting and addressing suggestions and anonymous complaints from employees. 0 Assist management in updating the workplace safety and health program by evaluating employee injury and accident records, identifying trends and patterns, and formulating corrective measures to prevent recurrence of accidents and injuries. 0 Participate in safety training and assist 0 Assist administration in evaluating management in monitoring employee safety and health training to ensure that training is employee acadent and mlury prevenhon effective and documented. programs, as well as promoting safety and health awareness and co-worker participation through continuous improvements to the workplace safety and health program. Paramedics Plus 177 :\AD\002\02\2X02\2X02177.docx 331 COMPETITIVE CRITERIA PERSONNEL - RISK MANAGEMENT - LOSS CONTROL The long-term goals of the Health and Safety Employees at all levels are held accountable for Committee are to reduce incidents, heighten following the established safety and risk plan, awareness, and provide continuous quality programs, procedures and policies. Numerous assurance for the safety and risk incident mechanisms are used by Paramedics Plus to program. The Health and Safety Committee monitor Safety and Risk compliance including is nondisciplinarian and cannot recommend the following: discipline regardless of findings. SAFETY 8: RISK COMPLIANCE 1 2 34 5 INCIDENT INVESTIGATION PIE-D AND ROOT 885- TRAINING CAUSE mm mm I -- a PARAMEDICS PLUS ?Partners in Building Award-Winning EMS Systems Paramedics Plus 178 :\AD\002\02\2X02\2X02177.docx 332 COMPETITIVE CRITERIA WORKFORCE ENGAGEMENT 4. Workforce Engagement Paramedics Plus will meet all minimum requirements under Workforce Engagement and proposes to: 0 Utilize more than a dozen merds for communicating with and to employees 0 Engage front line employees in the quality and performance improvement process 0 Provide performance feed back every six months using a scorecard with goals aligned to the Critical Success Factors 0 Assist employees by maintaining credentials, reminding them individually of upcoming certificatnm needs 0 Promote a diverse and inclusive workforce through policies, actions and diversity training and awareness 0 Maintain a drug-free workplace for a safe, healthy and work-ef?cient environment 0 Implement a robust employee recognition program using a variety of approaches to reward and acknowledge employees. Paramedics Plus will achieve higher levels of commitment under Workforce Engagement and proposes to: 0 Employ a proven employee satisfaction survey to gain insight into employee happiness 0 Use the Baldrige National Quality Program to guide management of employee engagement 0 Solicil employee suggestionss and evaluate and implement those with merit 0 Assure REMSA of a credentialed workforce through licensing and credential database and the routine search of 1,400 federal and state sources to ensure each employee is eligible for treating patients who are part of Federal Health Care programs 0 Contribute to the assessing, maintaining and developing new employee skills through daily check-off sheets, scenario testing, written clinical and protocol testing 0 Offer opportunities for learning, development and career advancement 0 Assess the maintenance and development of new employee skills through daily check-off sheets, scenario testing, and written clinical and protocol testing 0 Employ multiple methods of communication with employees 0 Implement a successful employee recognition program 0 Adopt a proven approach to succession planning and career advanwment. :\AD\002\02\2X02\2X02177.docx :32 ?5 .ul?ll??t ii .i lili Paramedics Plus 179 333 COMPETITIVE CRITERIA WORKFORCE ENGAGEMENT a) Minimum Requirements? Workforce Engagement At a minimum, the Proposer shall describe and document the following: 1. Describe the organization?s method for providing system and individual performance feedback to employees. 2. Describe the organization?s mechanism for involving front line employees in quality and performance improvement projects. 3. Describe the credentialing requirements for the employees including but not limited to paramedics, dispatchers, billers, and mechanics. 4. Describe the methods to assess, maintain, and develop new skills for employees in the workforce. 5. Describe the organization?s practices to ensure diversity in the workforce. Address the organization?s level of diversity alignment with the communities that you serve. 6. Describe the organization?s practices and policies designed to promote workforce harmony and prevent discrimination based on age, national origin, gender, race, sexual orientation, religion, and physical ability. 7. Impaired providers present a significant safety risk for patients, partners, and others in the community. Proposers should describe their commitment to ensuring that providers are free from the influence of alcohol and intoxicating drugs. Providing Performance Feedback Paramedics Plus will utilize a Performance Scorecard System to provide system and individual performance feedback to employees. Employee performance is evaluated every six months using a scorecard with goals aligned with the organization's Critical Success Factors. Feedback is provided in the areas of response times, hospital drop times, out of chute times, attendance, safety, and customer satisfaction. System performance regarding response times is communicated via a TV screen in employee work areas and/ or deployment areas. System clinical performance is also communicated during the biannual scorecard evaluation meetings with employees. Specific performance measures which need improvement are shared with employees to provide focus. Additional clinical performance is communicated in newsletters and in continuing education classes. :\AD\002\02\2X02\2X02177.docx I .. . 4 v.1?l .1. 1?4' Paramedics Plus 180 334 COMPETITIVE CRITERIA WORKFORCE ENGAGEMENT Ourleadership team takes an active role in reward and recognition programs to reinforce high performance ard a customer and business focus through the development, deployment. and active participation in all employee recognition program. Examples of approaches and deployment methods include: 0 The COO perscmally writes thank you notes and gives movie tickets sent to the horns of employees who exhbit exemplary examples of CARE PLUS values or display g'eat ef-brts 0 Each year'the Leadership Team signs and writes a personal messa ge in birthday cards sent to employees. Program 20 Points 15 Points to Point: 5 FATS 0 At the annual holiday gthering in Dec errber: the Leadership Team participates in recognizing employees for years of servie with the company. Throughout the year the Leadership Team actively participates in nominating employees for local, state, and national EMS awards. 0 Every year'in May during EMS week our Leadership Team lonors our employees and their families slowing their apprec iationby providinga week- of events such as a BBQs, breakfast. and game day. 0 Supervisor's recognize employees througm PAT (Positive Action Taken) forms, which are posted on the bulletinboard and placed in employees? file. GO LD Pm H0140?.va ram-res SI LVE NEWSLETTER BRONZE PIN NEWSLETTER COP PER NMSLETTSR :00. Paramedics Plus 181 :\AD\002\02\2X02\2X02177.docx 335 :n :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA WORKFORCE ENGAGEMENT Front Line Employees? Involvement in Quality and Performance Improvement One key driver of employee engagement is the belief that the employee?s opinions count and effect change. For Sioux Falls, the Paramedics Plus Quality Improvement Team will involve participation from front line employees and others as appropriate. Paramedics Plus will also utilize employees in other committees such as the Safety Committee and Equipment Committee. Employees are paid to attend team or committee meetings. Further, Paramedics Plus will solicit employee suggestionss. Employees will be encouraged to share ideas via email or comment cards to identify areas or specific ideas for improvement and ideas. Evaluation and action plans will follow, with employees often engaged in the process beyond the suggestion. A recent example demonstrating employee involvement occurred when employees shared that the primary response bag they carried into the scene of a call was too full and disorganized to the point where some medication Vials were breaking. A team of employees was assembled to determine what would be used in place of the current bag and where the supplies would be placed. Once a decision was made to go to a hard pelican box and a few were assembled, a pilot test was conducted with only a few being deployed to obtain further feedback from field employees. During this slow roll out, new ideas for improvement were identified related to location of medications, placement of the box on the unit to a lower shelf to prevent injury, and the need for a better locking device. After these new ideas were implemented, full deployment was achieved with support from all personnel. Credentialing Requirements Paramedics Plus understands that its credibility and reputation as an organization is based on the reliability of its employees? qualifications and the individual medic's ability to apply the knowledge gained through these credentials. Paramedics Plus takes pride in providing highly skilled, qualified and credentialed personnel to support its operations 4. - . . ., lil?. Paramedics Plus 182 336 COMPETITIVE CRITERIA WORKFORCE ENGAGEMENT and continues to monitor maintenance of credentials throughout employment. Paramedics Plus ensures that all personnel maintain clinical credentials required by the REMSA system by providing all necessary education and training in our ongoing education process. Paramedics Plus not only offers all con?nuing education required to maintain required credentials, but offers courses at no cost to employees. Since good driving records are important for the crew, patient and community safety as well as insurability, Motor Vehicle Record checks are conducted regularly on each employee. All employee certifications and licensures are scanned into the Ninth Brain computer database and Hacking system with expiration dates recorded. This system allows for email notification to employees, supervisors, and administrative personnel, advising of impending certification or license expiration dates. Reports are run with employees notified 60 days prior to expiration to allow ample time for obtaining renewal certi?cations licenses. Through Ninth Brain, Paramedics Plus also monitors on an ongoing basis to ensure that employees have not been sanctioned, excluded or debarred from federal health care programs as required by the Patient Protection and Affordable Care Act. Key functions of this process include: 0 Thoroughly and continuously screen over 1,400 federal and state sources all searches are public records 0 24/ 7 monitoring 0 Verify and monitor state-issued, non-physician healthcare provider certifications/ licenses and National Registry of Emergency Medical Technicians 0 Monitor all states for sanctions/ disciplinary actions 0 Monitor federal exclusions/ debarments meeting expanded exclusions 0 Search for state Medicaid actions 0 Expand search to include: 0 OIG Exclusions General Service Administration Departments 0 SSN Death Master Index 0 DEA Registrant Search 0 Office of Foreign Asset Control Hills ir. bungling 65.42:} S?gillvg-?nt? Paramedics Plus 183 :\AD\002\02\2X02\2X02177.docx :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA WORKFORCE ENGAGEMENT Assessing, Maintaining and Developing New Employee Skills Paramedics and EMTs working for Paramedics Plus in the REMSA system will be supported by: Preceptors who ensure that providers are adequately prepared to work independently through the field orientation process; by Preceptors who provide ongoing training in the field, and observe and coach on safety issues where and when medics work; and by a Field Operations Supervisor who works directly with Paramedics and EMTs to ensure the system runs smoothly. New knowledge and skills are reinforced through daily check-off sheets, scenario testing, and written clinical and protocol testing. continuing education strengthens new knowledge through skills stations with pro?ciency testing. Additional reinforcement methods include patient care report audits, recertification, and drills. Newsletter articles reinforce employee knowledge of protocols and medications. New equipment or protocols are introduced into the system with training at least two months prior to the implementation date to ensure ample opportunity to train every EMT and paramedic in the system. Patient care reports are reviewed after the implementation of new protocols to determine compliance with new protocols and performance of skills. Skills stations or display stations will reinforce learning. Should Quality Assurance Reviews indicate a particular employee has problems with a certain skill, the Director of Clinical of u. . . -. a .53?.47 Paramedics Plus 184 338 COMPETITIVE CRITERIA WORKFORCE ENGAGEMENT Operational Services works with the employee to design a customized training regimen to bring the employee?s skill pro?ciency to an acceptable level. This customized training is not punitive and no record of this skills remediation is maintained in the employee?s permanent file. The Director of Clinical and Operational Services maintains records of training and proficiency on all employees. Diversity in the Workforce Diversity training and awareness begins with a clear understanding of Paramedics Plus policy of non-discrimination. During the performance of this contract, Paramedics Plus agrees that it will comply with all applicable provisions of federal, state, and local laws and regulations that prohibit discrimination. In a harassment-free workplace where employees are free from ridicule, jokes and inappropriate behavior due to differences, employees and management can value diversity and improve diversity awareness. Employees are confronted each and every day with differences in race, color, creed, religion and socio-economic circumstances. While workplace diversity benefits traditional businesses in many ways, it is even more valuable to employees of Paramedics Plus as they work to care for a diverse population in the midst of unplanned health emergencies, often in the intimacy of patients? homes. Through the recruitment, development, support and retention of a diverse workplace, Paramedics Plus will ensure alignment with the cultural needs of Sioux Falls. Please see XI. E. EMS System and Community for more details on the Paramedics Plus plan to create a more diverse workplace in Sioux Falls. Paramedics Plus has policies and practices that support a diverse and inclusive workforce. We define diversity in broad terms to include race, ethnicity, age, gender, sexual orientation, and disability. We believe that diversity and inclusion are essential to organizational effectiveness and that services are enhanced when our workforce is re?ective of the communities that we serve. All practices regarding recruitment, hiring, placement, transfer, promotion, rate of pay, benefits, and termination are to be administered in accordance with the provisions of the Civil Rights Act of 1964, the Age Discrimination Act of 1967, the Rehabilitation Act of 1973, FLSA and the Americans with Disabilities Act of 1990. :\AD\002\02\2X02\2X02177.docx f? . 7? V'vhnzainc- ti ?l3 12:, ms Paramedics Plus 185 339 COMPETITIVE CRITERIA WORKFORCE ENGAGEMENT Our organization will not discriminate against or harass any employee or applicant for employment because of race, color, creed, religion, national origin, sex, sexual orientation, disability, age, marital status, or status as a Vietnam era or special disabled veteran. Policies and practices that help ensure that we have a diverse and comprehensive workforce include: 0 Sexual Harassment Prevention 0 Workplace Violence and Harassment Prevention 0 Equal Opportunity Employer policy 0 Disability and Non-discrimination policy 0 Domestic Partner Bene?ts 0 Tuition Assistance Program 0 Electronic Job Posting with blind applications (age and race are not inquired of applicants) 0 Employee Assistance Program (EAP) 0 Collective Bargaining Unit 0 Ethics Hotline 0 Annual Diversity training 0 Career counseling to advise and encourage employees to seek advancement opportunities. Paramedics Plus will develop recruitment plans with the goal of increasing representation of under-utilized groups in the applicant pool. Paramedics Plus also prohibits retaliation against any employee or person seeking employment for bringing a complaint of discrimination or harassment pursuant to this policy. This policy also prohibits retaliation against a person who assists someone with a complaint of discrimination or harassment, or participates in any manner in an investigation or resolution of a complaint of discrimination or harassment. Retaliations include threats, intimidation, reprisals, and/ or adverse actions related to employment. PARIXMEDICS l-?LUS?Pwtners 12* Emitting EMS Systems Paramedics Plus 186 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA WORKFORCE ENGAGEMENT Workforce Harmony and Preventing Discrimination As outlined above, Paramedics Plus has a diversity plan that works to create a diverse workforce representative of the community it serves, as well as promote workforce harmony and prevent discrimination. Paramedics Plus supervisors and managers promote our "Value of Understanding.? This is "our commitment to understand and value diversity in our workforce and our community by treating all individuals equally and without judgment.? Employees receive diversity and code of conduct training upon hire as well as annually. All Paramedics Plus operations are accredited by the Commission on Accreditation of Ambulance Services. The accreditation process requires attorney review of all policies for compliance with state and federal non? discrimination regulations. Copies of current EOE and Code of Conduct policies are included in Appendix 36. Workplace Free from Alcohol and Intoxicating Drugs Paramedics Plus is committed to a workplace free from alcohol and controlled substances to ensure a safe, healthy and work?ef?cient environment for Paramedics Plus employees, patients and the general public. Employees must be free of the effects of controlled substances and alcohol while on duty as a condition of employment. The Paramedics Plus policy for Sioux Falls will be compliant with all state laws and county regulations regarding drug abuse reporting and testing of individuals who are in Employee Assistance Programs. Paramedics Plus has a comprehensive alcohol and chemical substance abuse policy which is strictly enforced. The no? tolerance policy allows for drug testing as part of the pre-hire process; testing for cause; post?accident testing; periodic testing; and post?rehabilitation testing. Any employee who tests positive may be placed on administrative suspension pending further investigation which may lead to termination of employment. A sample Paramedics Plus policy regarding alcohol and drugs is included in Appendix 31. Attestation: 0 S333 Paramedics Plus understands and agrees to DUDE . . . . . nu comply Without qualifications to requirements, and commitments contained in Section r. .x . lit z. . Paramedics Plus 187 341 COMPETITIVE CRITERIA WORKFORCE ENGAGEMENT 1' b) Higher levels of commitment - Workforce Engagement Assessing the Engagement and Satisfaction of Employees Paramedics Plus will utilize the Baldrige National Quality Program as the foundation for creating an extensive process for the management of employee engagement with measurement of key performance indicators of engagement and satisfaction. Paramedics Plus has successfully implemented this process elsewhere. The primary method of determining key factors affecting workforce engagement and satisfaction used by Paramedics Plus is information gained through a survey tool and research conducted by the Gallup Juli. '1 . . - :tl-Organization over the past twenty?five years. The Gallup Organization interviewed more than 80,000 managers and 105,000 employees to reveal the 12 questions (key requirements of employees) that are predictors for higher employee engagement. In the annual employee survey, employees rate the following statements on a five point Likert Scale ranging from Strongly Agree to Strongly Disagree. 1. I know what is expected of me at work. 2. I have the materials and equipment I need to do my work right. 3. Paramedics Plus is a safe place to work. 4. At work, I have the opportunity to do what I do best every day. 5. In the last seven days, I have received recognition or praise for doing good work. :\AD\002\02\2X02\2X02177.docx -.. .. . . . f. . ., - .. (up? WW. "iuw?; Paramedics Plus 188 342 COMPETITIVE CRITERIA WORKFORCE ENGAGEMENT 6. My supervisor or someone at work For a more meaningful analysis of the EMS seems to care about me as a person. operations, the workforce is segmented 7. There is someone at work who into two groups, clinical and non-clinical encourages my development. (administrative support personnel). The 8. At work, my opinions seem to count. results of the annual workforce engagement 9. 'l'he mission/ purpose of Paramedics Plus survey are used to discover opportunities for makes me feel my job is important. improvement by identifying specific questions 10. My co-workers are committed to doing where results are below 3, or overall results quality work are below established targets. The information 11. In the last year, I have had the is provided to department directors who opportunity at work to learn and grow. then use the results to improve performance. 12. I would recommend Paramedics Plus to Attrition rate, absenteeism, and information a friend as a great place to work. from exit interviews are also useful indicators of employee engagement. Employee Engagement 340 surveys) 100% 90% 80% - 70% 50% 40% 30% 20% 10% Satisfaction Rating (Strongly Agree or Agree) 3% 2008 2009 2010 2011 2012 2013 I Admin Staff I EMT/Medic/Nurse I All summarized PMRAMEDICS PLUS Partner". on EMS Systems Paramedics Plus 189 :\AD\002\02\2X02\2X02177.docx 343 COMPETITIVE CRITERIA WORKFORCE ENGAGEMENT Other informal methods are also used to ascertain factors affecting employee engagement and satisfaction, such as inputs obtained from supervisor and manager interactions with employetb?, employee meetings, employee suggestions, six-month employee evaluations, and walk?arounds. Results of the above formal indicators and information from informal methods are reviewed quarterly and annually to determine areas for improvement. If performance is below goal, an action plan is created and implemented to improve performance. For example, in our Pinellas operation we identi?ed the need to improve satisfaction and engagement around the question, "My supervisor or someone at work seems to care about me as a person." improvement involved shjfu'ng from a supervisory culture of discipline and corrective action to one of "Just Culture,? which is predominately more about supporting and coaching employees. Leadership Effectiveness Training and "Just Culture" Training were provided to all training officers, supervisors, managers, and directors. Further, surveys were conducted regarding feedback for each supervisor and manager to identify personal opportunities for improvement. This feed back was used to develop employee persrmal improvement plans. As you can see from the graph below, our efforts gained improvement 100% 90% 80% 70% 60% 50% 40% 30% 20% Satisfaction Ranng (Strongly Agree or Agree) 10% My supervisor or someone at work seems to care about me as a person. PLUE Pur'tu?l?n in Building NW.qu Winning System. Paramedics Plus 190 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA WORKFORCE ENGAGEMENT Two-way Communication Methods between Front Line and Leadership Paramedics Plus will adopt and adapt for Sioux Falls, the successful methods used at other Paramedics Plus operations for two-way communication between front line employees and the Leadership Team. Methods for communicating with the Workforce are listed below. Performance in employee, operational, and clinical outcome measures is a key determinant of the effectiveness of employee communication methods. METHOD FREQUENCY ONE-WAY TWO-WAY ?Employee MeEtings 2 {gr?year Safety Committee Meetings Quarterly Employee Orientation As needed Supervisor Encounters Daily Management Viblk?Arounds Daily Employee Evaluations 2 per year Education Classes Email On-going Clinical Performance Reviews On-going Laptop Start Up Messages On-going Employee suggestions On-going Paging On-going Newsletters TV Monitors at Stations On-going Bulletin Board Posters On-going J. PLUS dulltimp :le .rn Winnino EMS ?5 y-xzum Paramedics Plus 191 :\AD\002\02\2X02\2X02177.docx 345 :\AD\002\02\2X02\2X02177.docx COMPETITIVE WORKFORCE ENGAGEMENT Employee Improvement Suggestions Paramedics Plus will implement a system to encourage, obtain and act on feedback from employees. The employee suggestion program will utilize forms on which employees document suggestions for improvements and provide feed back on current processes. l'imployee suggestion forms will be reviewed weekly at administration meetings. The decision to implement an idea will be made by the Leadership Team after careful review. Some employee suggestions develop into small projects or action plans. In one Paramedics l?lus operation, an average of 38% of employee suggestions resulted in action by the organization. Employees are Specialty Services (SWAT. COT) Assistant Supervisor Paramedic Training Of?cer BLS Paramedic Preceptor Preceptor BLS Training Of?cer contacted and receive feedback and follow? up on their submissions. Employees who submit improvement ideas are often recruited to paru'cipate in the improvement plan development and implementation. Career Ladder and Professional Development The figure below shows a sample career progression for key positions within the organization. Management of effective career is facilitated by de?ned job responsibilities and requirements. Employees are supported in career advancement through ?exible work schedules to accommodate classes, and pay differentials for specialized training. EMS OPERATIONS Director of (Operations) Operatic ns SuperviSOr Operations Manager ln it"nvf' in (immune- Uw Titanium byuiaztr?l . Paramedics Plus 192 346 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA WORKFORCE ENGAGEMENT To deliver the quality expected by the communities we are honored to serve, Paramedics Plus places significance and dedicates resources to the creation and maintenance of a caring environment for our clinical staff. We provide these professionals with superb tools, training and support. Our coaching staff or leadership talent assembled both from people inside the community and others networked from outside the community is highly experienced and academically prepared. Development of the workforce begins with providing growth opportunities through our Preceptor and Field Training Officer programs. These programs provide individuals with experience in mentoring, coaching, and performing clinical competency evaluations. As EMTs and Paramedics become experienced and Show proficiency, they can apply to become a preceptor and then an FTO. Employees also have opportunities to obtain instructor certifications and can assist in teaching orientation or any of our many classes that we have each year. Employees who have demonstrated in coaching and leadership have the opportunity to be further developed professionally for supervisor positions. These employees start out as assistant supervisors and receive continuous mentoring from full- time supervisors after their initial training. Paramedics Plus 193 347 COMPETITIVE WORKFORCE ENGAGEMENT Training Plan One of the goals of a training program is not only to address the needs of the organimtirm but also to address the education needs of individual leaders. The Leadership Training Program was designed to meet these needs. The Paramedics l?lus Education and 'l?raining curriculum is developed from the Ambulance Service Agreement contract requirements, state credentialing requirements, strategic plan, patient satislaction survey results, new protocols, competencies, Quality Assurance Review data, learning needs identi?ed, and workforce and management input. The workforce provides input into the teaming delivery systems through department meetings, employee engagement surveys, employee suggestionss forms, and email or discussions with the qucaljon and Training personnel. Supervisors and the Leadership Team provide input on additional training offerings through regular meetings, employee engagement surveys and needs assessments. Customired to meet the individual needs of eadi operating unit, the Paramedics l?lus? training program includes modules that allow for rapid training of managers and other staff. All leaders in the company at the level of Field Training Of?cer and above are required to participate in the training program. This would include Held 'l'rainin Of?cers, Superviwrs, Managers, and Directors in the operation. Methods of training include lace-tn?face classroom, off?site daily retreats, and on-line modulw. TRAINING Preceptor Company mission. vision, and values; documentation; coaching and teaching skills; customer service/patient experience Training and/or Safety Of?cer Preceptor training described above; overview of Just Culture;" Leadership Effectiveness Training; problem solving; Assistant Supervisor and Supervisor Training described above; social media; computer software usage; incident investigation; employee engagement; financial overview; human resources; SOP overview; System Status Management; ICS required series; ambulance billing; data analysis and process improvement Manager and Director Training described above; Leadership Plus Academy; strategic planning; ambulance RFP process overview. public speaking; media relations; political etiquette Chief Operations Of?cer Training described above; Budget Development i f? in uutlmno Worm-m clilb byw?u?n Paramedics Plus 194 :\AD\002\02\2X02\2X02177.docx 348 :\AD\002\02\2X02\2X02177.docx COMPETITIVE WORKFORCE ENGAGEMENT Leadership Plus Academy is conducted at Paramedics Plus in 'lyler, 'lexas. The curriculum includes management level education in the following areas: 0 Mission, Vision, Values 0 System Status Management 0 Dashboards and Scorecards Heel 0 Materials 0 l'inance and Budget 0 Political Environments 0 Human Resources 0 Customer Service/ Community Relationships 0 Problem Solving 0 Strategic Planning l'he leadership is proficient in using numerous software applications provided by Paramedics Plus to support each system. Among others, software includes Tableau, Ninth Brain, SafeForce and MS Office Suite. All leaders have experience in dealing with patients, local of?cials, health providers, and public safety agencies. Our leaders enjoy strong relationships with staff of governmental and media agencies. We have a strong background in EMS system design, system status management, key processes, proposal and grant writing, and budgeting. As a part of our culture, all leaders are educated in statistical process control, variation, and quality management. Succession Planning As described, Paramedics Plus has a leadership and management training program that encourages employees at all levels of the organization to advance. Senior leaders personally participate in succession planning and the development of future organizational leaders through the creation of a formal "career path" for all positions. Senior leaders mentor supervisors for manager or director positions and managers for director positions. Senior leaders periodically review those who are in the next lower level to key positions to determine backups for those critical or leadership positions. Currently these individuals receive informal mentoring by the person in the next level position. Newly appointed leaders complete formal training as listed above which includes Leadership Effectiveness Training. This course is based on Dr. Thomas Gordon's book, which has been a core program in more than 1,000 corporations around the world. In addition to mentoring and the training listed in the table above, the development of personal leadership attributes are further addressed as part of the performance appraisal process. Leaders identify behavior based goals and reach agreement with their superiors on desired personal leadership attributes. Leaders may attend classes or seminars to improve or develop specific attributes. 9L0: f? orHu-r- In Chi-5 Paramedics Plus 195 349 COMPETITIVE CRITERIA MANAGEMENT KEY 1. Key Personnel Paramedics Plus will meet all REMSA minimum requirements in the category of Key Personnel and proposes to: 0 Bring benefits from local and offsite management teams with complementary core competencies 0 Combine the experience and wisdom of seasoned, well-respected leaders in the EMS industry with the enthusiasm of up- and-coming young managers who are the leaders of tomorrow 0 Focus its management team on clinical excellence, operational ef?ciencies and safe practices Paramedics Plus will achieve a higher level of commitment in the category of Key Personnel and proposes to: 0 Provide robust management and leadership training programs for key managers and EMS supervisors at no cost 0 Offer scholarships to the Ambulance Service Manager Program 0 Mentor young local leaders with experienced executives such as former Sioux Falls area native Mark Postma, Vice President of Paramedics Plus 0 Match promising women employees with senior women leaders to prepare these employees for management positions 0 Offer a stable leadership team and employ methods to measure its level of engagement plus work to retain talented leaders 0 Share best practices across Paramedics Plus locations while focusing on local needs of the REMSA system 0 Work to improve operational efficiencies and high quality pre-hospital care with its experienced and capable leadership team 0 Employ leaders with both personal and corporate integrity who can be counted on to Ful?ll promises 0 Build community partnerships through a local leadership team with respect for key partners including Fire Services. 1. Competitive Criterion: Key Personnel a) Minimum Requirements?Key Personnel Proposals shall lden my the Individuals who ?ll key leadership positions. if the positions have not been filled, provide the [ob Including minimum quali?wtlons and scope of responsibili- ties. Identify out-of-clty leadership personnel who will be actively Involved In operatlons include resumes, quall?w?ons and scope of Paramedics Plus offers \-vell?qualified, experienced key personnel with proven track records in high performance EMS. This academically prepared team has depth and breadth of experience and positive synergy? Paramedics Plus 1% :\AD\002\02\2X02\2X02177.docx :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA MANAGEMENT KEY PERSONNEL a great combination for moving the REMSA system forward. Paramedics Plus is confident of the ability of this leadership team to address new challenges and take the system to the next level. Resumes for each are provided in Appendices. Paramedics Plus proposes to use many of the key employees currently working in the REMSA system. This would include support staff and Paramedic Supervisors and Field Training Officers. Their knowledge of the system is important for continuity of clinical and operations management, which will be enhanced by the new onsite Paramedics Plus leadership as well as a seasoned and knowledgeable offsite team. The following key offsite and onsite personnel will fill key leadership positions within the REMSA system. Michael Bureau, EMT-P Chief Operating Officer Years in EMS: 10 . Core Competencies: EMS operations and management, leadership, clinical education Michael Bureau will serve as the Chief Operating Of?cer for Paramedics Plus in the REMSA system. Having begun his EMS career in Michigan in 2004, Mr. Bureau was also a classroom instructor for EMS and involved in the clinical tracking and compliance for Huron Valley Ambulance?s Center for EMS Education in Ann Arbor, MI. In 2007, Mr. Bureau joined Paramedics Plus in its Sunstar Florida operations. Mr. Bureau is currently the Administrative Supervisor at the Sunstar headquarters in Largo, FL where more than 146,000 patients are transported each year. He has an extensive background in field operations, field training, special events, leadership development and electronic management of inventory. Mr. Bureau has extensive training in deployment and response time compliance for EMS. Mr. Bureau is near completion of a Bachelor?s degree in Management and holds a current Florida Paramedic License. Mr. Bureau will report directly to Vice President Mark Postma (see below). Mr. Bureau?s resume and job description are provided in Appendix 37. EMS Medical Director Upon notification of intent to award the contract, Paramedics Plus national Medical Director, Dr. John Sacra, will meet personally with the REMSA Medical Director to seek guidance on the best possible local candidates for this position. Paramedics Plus will make every effort to employ a local, actively practicing physician who is board certified by the American Board of Emergency Physicians and fully engaged, not only in emergency medicine, but also in the Sioux Falls medical community. If the successful candidate for 3? "017'. it? i? swan; .. ?fiv .1 'cil.. rll t. Paramedics Plus 197 351 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA MANAGEMENT KEY PERSON NEL EMS Medical Director has not attended the National Association of EMS Physicians Medical Director's course, Paramedics Plus will pay travel and tuition for the physician to attend. The selected Sioux Falls Medical Director will work closely and collaboratively with the Medical Director. le or she will be actively involved with Paramedics Plus and its employees through training, field observation and appropriate research. He or she will also be a liaison with other members of the medical community to support the system and resolve issues. I le or she will assist Paramedics Plus in ensuring compliance with all system medical protocols and all administrative policies established by REMSA in addition to ensuring compliance with the REMSA Quality Management requirements. the Medical Director will provide input to REMSA on a periodic basis for the purpose of updating the system's protocols and policies. [e or she will participate with the REMSA Medical Director in the continuing quality improvement process, conduct regular case reviews and provide full access to field personnel for direct contact with the REMSA Medical Director, REMSA clinical oversight personnel and base hospital physicians on the issue of patient care as needed. A complete job description is available in Appendix '18. Director of Clinical and Operational Services The Director of Clinical and Operational Services will be a key position in the REL-ISA system. Paramedics Plus intends to select the individual to fill the position trom the existing Sioux Falls staff. Prior knowledge of the system, community and staff will be advantageous for success in this important position. This individual will provide clinical and operations leadership and management including system planning, quality improvement, coordination of orientation and training, maintenance of accreditation, and work closely with medical oversight. le or she will become pro?cient in the use of Tableau to facilitate in-depth analysis of all aspects of clinical and operational services. Engaging a local candidate for this key position, someone who is a great clinician and well- respected personally, is challenging in ?at Paramedics Plus does not wish to jeopardize the current employment of candidates. lowever, local interviews or this key position will be conducted soon after receiving "notice of intent to award." A job description for the Director of Clinical and Operational Services is included in Appendix '16. ornu-r- In (Sullitmo (Momma) Paramedics Plus 198 352 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA MANAGEMENT - KEY PERSONNEL OFF SITE LEADERSHIP POSITIONS Ronald Schwartz President, Paramedics Plus Years in EMS: 28 Core Competencies: EMS executive leadership, EMS operations management, EMS contract administration, EMS Communications, Firefighter/Paramedic Ronald Schwartz was named the President of Paramedics Plus in 2011. He also serves as Vice President, East Texas Medical Center, the parent organization of Paramedics Plus. He oversees all Paramedics Plus operations in addition to the ETMC EMS system. He is truly the driver of change and progress for Paramedics Plus. While embracing the core values of Paramedics Plus of honoring commitments and providing quality care at a reasonable price, Mr. Schwartz also added his own emphasis on partnerships?partnerships with the communities served by Paramedics Plus, partnerships with employees, First Responders, the health care community and customers. Mr. Schwartz was with ETMC EMS for more than 11 years before taking the helm of Paramedics Plus. During his tenure at ETMC EMS, he helped ETMC EMS, the largest rural provider of EMS in the United States, to expand services to several markets in Texas, including Waco and Pasadena. Mr. Schwartz began his career as an EMT, earning his license while attending the University of South Dakota in Vermillion. After obtaining his license he worked for the Vermillion/ Clay County service. Deciding to further his career he moved to Michigan and became Paramedic certified. He later served in management positions in ambulance services in Reno, Nevada, and Lincoln, Nebraska. Mr. Schwartz earned a degree in EMS management from Davenport College in Michigan. His resume is available in Appendix 38. Mark Postma, M.H.A, (retired) Vice President, Paramedics Plus Years in EMS: 36 Core Competencies: EMS executive leadership; EMS operations management, Field Paramedic and Communications, ambulance accreditation Mark Postma, born and raised in the Sioux Falls area, has served as the Vice President of Paramedics Plus since 2011. He continues to be involved as the Chief Operating Of?cer for the Paramedics Plus Sunstar operation in Pinellas County, FL, a role he has filled since the award of the Paramedics Plus contract in 2004. His engagement and commitment to the REMSA system is demonstrated through ongoing communication and frequent visits to ensure operational efficiencies and dissemination of best practices. 0157}, LUS- F?i- - . ,v .iI {.1735 System; Paramedics Plus 199 353 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA MANAGEMENT - KEY PERSONNEL Mr. Postma has been involved in EMS since becoming an EMT at age 16. He holds a Master of Science in Health Services Administration, is a former EMT-P and former NAEMD dispatcher. He is the recipient of the Iowa Governors Safety Award, named one of the Top Business Leaders in the Quad Cities, served on the Board of Directors of the Iowa EMS Association and is the immediate past Chair of the Commission on Accreditation of Ambulance Services (CAAS). He currently serves as the Vice Chair of CAAS and is the Region 2 Director for the American Ambulance Association. The Sunstar operation he directs was awarded the Florida Sterling Award, based on Baldrige criteria, for quality in 2009. Mr. Postma was awarded the Volunteer of the Year in 2012 by the YMCA of North Pinellas County. Mr. Postma grew up in Harrisburg, South Dakota and graduated from Harrisburg High School. He also worked as an EMT and Paramedic for Sioux Falls Ambulance (now Rural Metro) from 1979 to 1982 on a part-time and full-time basis. Mr. Postma is very familiar with the Sioux Falls community and his parents still live in Sioux Falls. His resume is available in Appendix 38. Tony Farmer, C.P.A. Chief Financial Of?cer Years in EMS: 14 Years in Public Accounting: 29 Core competencies: Public Accounting, EMS operating and capital budgeting processes, EMS billing and collections Tony Farmer provides leadership, planning and direction to all financial aspects of Paramedics Plus and has, since the company?s inception. He is directly involved in ensuring that Paramedics Plus operations comply with all contractual requirements. As the Chief Financial Of?cer for ETMC EMS since 2000, Mr. Farmer is responsible for the ?nancial activities of the organization. Mr. Farmer had 15 years of experience prior to joining ETMC EMS as a project accountant for the University of Texas MD. Anderson Cancer Center and in the banking industry in credit administration, commercial lending, and internal audit. He also has experience in public accounting. A graduate of Baylor University, Mr. Farmer holds a Bachelor of Business Administration degree and is a Certi?ed Public Accountant licensed by the Texas State Board of Public Accountancy. He will oversee the ?nancial aspects of the Paramedics Plus contract in Sioux Falls. His resume is available in Appendix 38. . .- Paramedics Plus 200 354 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA MANAGEMENT KEY PERSONNEL John C. Sacra, M.D., F.A.C.E.P. Chief Medical Of?cer for Paramedics Plus Years in EMS: 36 Years in Emergency Medicine: 42 Core Competencies: Emergency Medicine, leadership, EMS medical oversight, and trauma system development John C. Sacra, M.D., F.A.C.E.P., emergency physician, was named the national Chief Medical Officer for Paramedics Plus in 2012. Dr. Sacra offers local medical directors support through his unique perspective of having served as a local medical director, the director of a large trauma center, a practicing emergency physician and a leader in trauma system development. Dr. Sacra served for 11 years as the Medical Director for the Medical Control Board which provides oversight to the Emergency Medical Services Authority, serving more than 1.2 million people in the State of Oklahoma. Dr. Sacra, Chair Emeritus of the Department of Emergency Medicine, University of Oklahoma College of Medicine, was also the driving force behind efforts to fund and create the Department of Emergency Medicine at the University of Oklahoma, College of Medicine, Tulsa, which now trains young Emergency Physicians to serve across Oklahoma. He serves in a consulting role to the Oklahoma State Department of Health on trauma system development and EMS issues and is a published author on the subjects. Before becoming the Medical Director for the Medical Control Board, Dr. Sacra was the Medical Director of the Trauma Emergency Center at Saint Francis Hospital in Tulsa for 18 years after serving in similar capacities in Augusta, Georgia, and at St. John Medical Center in Tulsa. His colleagues in the American College of Emergency Physicians recognized Dr. Sacra, the recipient of countless local, State and national awards, nationally in 2006 for his lifetime contributions to EMS. He also served on the National Emergency Medical Services Advisory Council to the Secretary of Transportation in 2009. In 2013, he was asked to participate in a Trauma Stakeholder Meeting hosted by the White House and the US. Departments of Homeland Security, Transportation and Health and Human Services. Dr. Sacra?s curriculum vitae can be found in Appendix 19. 1? I . Lzze.? E?Jii?. Paramedics Plus 20] 355 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA MANAGEMENT KEY PERSONNEL Erik Switzer Corporate Fleet and Support Services Director Years in EMS: 29 Core competencies: Fleet management, EMS operations and management, Field Paramedic Erik Switzer is the Corporate Fleet and Support Services Director for Paramedics Plus. He began his career with ETMC EMS as a field provider in 1983. He has experience as a ?eld Paramedic, a Paramedic as part of a ?ight crew and as a Field Training Officer. Prior to his current position, he served as the Director of Support Services for ETMC EMS. Mr. Switzer holds a Bachelor of Science in Religious/ Bible Studies and Christian Counseling and is currently completing a master?s degree in theological studies. Erik Switzer?s reSLune is available in Appendix 38. Jeffrey A. Haislet Corporate Communications Director Years in EMS: 20 Years in Public Safety Communications: 37 Core Competencies: selection, installation and management of communications equipment; EMS call center management As Corporate Communications Director, Jeff Haislet is a resource to all Paramedics Plus operations. He directs the daily operations of ETMC EMS, one of the largest rural EMS providers in the country, with annual transports of about 100,000. He has extensive experience in all aspects of public safety communications, from managing employees to selecting state?of?the-art communications equipment. Mr. Haislet has carefully selected more than $145,000 worth of new communications equipment and software for Sioux Falls. His experience, leadership abilities and calm, steady manner make him an invaluable member of the Paramedics Plus team. In addition to his experience in EMS, Mr. Haislet has also worked in various capacities, most related to communications with police departments in two Texas communities and the Mayor?s Office in El Paso as the Communications Project Manager. Jeffrey Haislet's resume is available in Appendix 38. . . . I -..- -- . Paramedics Plus 202 356 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA MANAGEMENT KEY PERSONNEL Rodney L. Dyche, Corporate Management Trainer Years in EMS: 31 Core Competencies: EMS law, EMS contracting, EMS operations, Communications, supply logistics, Field Training O??icer, Paramedic Preceptor, ?lust Culture Rodney Dyche, ID. has been involved in Emergency Medical Services for more than 30 years. Today he serves as the Corporate Management Trainer for Paramedics Plus? robust proprietary training program that promotes continued learning for current managers and develops skills for tomorrow?s leaders. Mr. Dyche was instrumental in bringing the concepts of Just Culture to Paramedics Plus. He also heads the Paramedics Plus Leadership Academy, a management and leadership training program unique to the industry and built on the specific needs of Paramedics Plus systems and managers. Mr. Dyche began his EMS career in rural Missouri while volunteering with the local fire department. He has worked as a nationally registered Paramedic in Kansas City, Reno and Las Vegas. He also has held positions including system status controller, field supervisor, operations supervisor, communications manager, director of support services and general manager. Most recently, Mr. Dyche owned his own law firm representing EMS organizations and individual providers. Mr. Dyche is a graduate of the University of Nevada, Las Vegas and California Western School of Law. Rodney Dyche?s resume is available in Appendix 38. Melinda M. Switzer Corporate Safety Director Paramedics Plus Years in EMS: 24 Core Competencies: lzealthcare safety, ?eld Paramedic, EMS clinical education, ambulance service accreditation process Melinda Switzer serves as the Corporate Safety Director for Paramedics Plus. Over the past 24 years, Ms. Switzer has been a field Paramedic, a Field Training Officer, an injury prevention program coordinator, a project manager for CAAS accreditation and an area safety director. In her current role, Ms. Switzer leads the national safety effort for Paramedics Plus and ETMC. She holds a Bachelor?s degree in Business Administration. Melinda Switzer?s resume is available in Appendix 38. Wot-?3?. - AL .iir'n'ru. if?i': x. Paramedics Plus 203 357 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA MANAGEMENT KEY PERSONNEL 6 Phil Collins Chief Information Of?cer Paramedics Plus Years in EMS: 11 Years in Information Technology: 38 Core Competencies: information technology, EMS technology, information technology management Phil Collins is the Chief Information Of?cer for Paramedics Plus. In this capacity, he manages the technology needs of each Paramedics Plus location in addition to overseeing information technology for ETMC EMS. Mr. Collins served in several capacities with School-Link Technology before joining ETMC EMS in 2011. He has 35 years of IT support experience and Bachelor of Science in Mathematics. Phil Collins? resume is available in Appendix 38. Barry Niemann Corporate Director of Deployment Paramedics Plus Years in EMS: 32 Core Competencies: Ambulance Deployment strategies and forecasting, medical dispatching, management Barry iemann, the Corporate Director of Deployment, has been involved in EMS for 32 years and joined Paramedics Plus in 2004. Mr. Niemann holds a degree in Emergency Medical Services, and is an and Advanced EMD. He led the Sunstar Communications Center effort in earning accreditation from the National Academies of Dispatch in 2000. He served as the Communications Manager for Paramedics Plus Sunstar operations before becoming the Director of Deployment for that operation. Mr. Niemann has been a guest speaker at several national conferences and hosted ambulance operations from all over the world. Barry Niemann?s resume is available in Appendix 38. Katrina Lazare Business Office Director Paramedics Plus Years in EMS: 2 Years in accounting: 26 Core Competencies: ambulance coding, accounting, billing practices, finance, operations management Katrina Lazare is the Business Of?ce Director for Paramedics Plus where she utilizes her background in accounting, finance and operations management. Ms. Lazare holds a Bachelor?s Degree in Business Administration and is a Nationally Certi?ed Ambulance Billing Coder and member of the Healthcare Financial Management Association. She is also a certi?ed advisor to surgery centers seeking to achieve or maintain Accreditation for Association of Ambulatory Health Care status. I if? - . tantra tin-l Lax? Paramedics Plus 204 358 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA MANAGEMENT KEY PERSONNEL Prior to joining Paramedics Plus, she was Chief Administrator and then Financial Officer for Compass Mental Health. Ms. Lazare will supervise a staff responsible for billing and collecting for the REMSA system. Ms. Lazare?s resume is available in Appendix 38. Cindy Essl Paramedics Plus Years in EMS: 6 Years in Human Resources: 20 Core Competencies: hiring process, implementation of company-wide HR programs and initiatives, competitive market analysis, HR leadership, employee communications, Human Resource regulatory compliance Cindy Essl is the Director of Human Resources for Paramedics Plus and ETMC EMS, having joined ETMC EMS in 2008. In this capacity, she develops and implements human resources policies to meet organizational needs and comply with State and Federal laws. She also analyzes trends at each EMS location in turnover, hiring, promotions, separations and grievances to determine support or action needed to adjust unfavorable trends. Ms. Essl holds a Bachelor of Science in Business Administration from LeTourneau University. Prior to joining ETMC, she held several Human Resources positions, with progressively increasing responsibilities at Alcatel-Lucent, a global telecommunications company. She will advise the Sioux Falls Director of Human Resources Paramedics Plus operations on Human Resources issues. Ms. Essl?s resume is available in Appendix 38. Debbie Vass, RN, EMT-P Chief Administrative Of?cer Paramedics Plus Sunstar Operations in Pinellas County, FL Years in EMS: 28 Core competencies: EMS executive leadership, EMS operations management, EMS clinical management, EMS instructor, quality processes, Nurse, Paramedic Debbie Vass is the Chief Administrative Of?cer of the Paramedics Plus Sunstar operation in Pinellas County, FL. She previously served as the Director of Clinical Services for Sunstar from 2004 to early 2012. Emergency Medical Services has been Ms. Vass? career choice since 1986. She holds an Associate of Science in Emergency Medical Technology and an Associate of Science in Nursing and is a certi?ed Paramedic and licensed Nurse in the State of Florida. Debbie served as an adjunct, non-credit faculty/ CME Instructor for St. Petersburg College for six years and taught Pinellas County Continuing Education classes to the system EMTs, Paramedics, and Nurses. She was the recipient of the 2008 State of Florida Nurse" award. Prior to being named the Chief Administrator for the Florida operations, Debbie focusedflu-~IEI" Paramedics Plus 205 359 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA MANAGEMENT KEY PERSONNEL her role as Director of Clinical Services, on ensuring quality throughout all levels of the organization. Debbie is a Florida Governor Sterling Lead Examiner and helped steer her organization, Sunstar Paramedics, to the achievement of the Florida Governor?s Sterling Award in 2009. Ms. Vass will be an advisor to the Sioux Falls operation on Baldrige criteria, KPIs and dashboard development. She will also serve as a lead mentor for women in the REMSA system who show management potential. Debbie Vass? resume is available in Appendix 38. Elmer G. Ellis President and CEO East Texas Medical Center Regional Healthcare System Elmer G. Ellis has served as the President and Chief Executive Of?cer of the East Texas Medical Center Regional Healthcare System since 1985. Under Mr. Ellis? supervision, the system has experienced dynamic growth and is today an organization with $4.4 billion in gross annual revenues with more than a million patient visits each year. ETMC System and ETMC Tyler have been recognized as being among the top 100 systems or hospitals in the country. Mr. Ellis is a Fellow of the American College of Healthcare Executives and holds an MBA. from East Texas State University. Mr. Ellis has served in many capacities in service to the healthcare industry through the American College of Healthcare Executives, the American Hospital Association and the Texas Hospital Association among many others. His commitment to the community includes service on the boards of the American Cancer Society, the American Heart Association, as well as a host of civic and business related organizations. Byron Hale Senior Vice President and CFO East Texas Medical Center Regional Healthcare System Byron Hale is the Senior Vice President and Chief Financial Of?cer of the East Texas Medical Center Regional Healthcare System. He is a Certi?ed Public Accountant, a Fellow in the American College of Healthcare Executives, and holds an MBA. from Texas Tech University. Attestation: 88 83 Paramedics Plus understands and agrees to DEED . . . . . . nu comply Without qualification to prowsrons, requirements, and commitments contained in Section l. Paramedics Plus 206 360 COMPETITIVE CRITERIA MANAGEMENT KEY PERSONNEL b) Higher LeVels 0' COMMitment 0 Skills for dealing with those outside the organization, including customer, Ongoing Training for Key Managers governmental, and media relations, public Paramedics Plus provides extensive on- Speaking and business etiquette, knowledge going training and development for its key of EMS System design, 55M, and key managers bOth through its comprehemlve processes including EMS system design, Propriemry in'house Program and national system status management, proposal and conferences and certi?cation programs. grant writing, and budgeting and billing Besides attendin annual national conferences . 0 510118 needed to carry out a "Just Culture? 5 ch as Pinnacle, Na i ator and National . . . so that the organization IS accountable Assoc1ation of EMS Phy51c1ans, Paramedics for System design and responding to Staff Plus sends managers to the Ambulance behaviors fairly and justly while employees sen/Ice Manager Program? and bUdgEt for are held accountable for the quality of their h' . . ocused sc 0 ars so that ta en ed members Chmces and for reportmg both errors and of the Sioux Falls team have the opportunity to system vulnerabilities. earn this certification. In addition to the Ambulance Service Manager Program, Paramedics Plus has a proprietary management and leadership program unique in the Emergency Medical Services industry. The program is more fully detailed in Appendix 33 and includes training in the following areas: 0 Paramedics Plus values and basic leadership skills needed at each level of management in the company to interact with subordinates and superiors including skills in counseling, confrontation, problem solving, group process, negotiation, and leadership styles. 0 Skills needed to improve individual performance including skills in computer programs such as Microsoft Office, time management and organization. Paramedics Plus 207 361 COMPETITIVE CRITERIA MANAGEMENT - KEY PERSONNEL Leadership training begins with the Paramedics Plus Supervisory Academy. Paramedics Plus Supervisor Academy 0 140 hours of workshop presentations 0 Pre- and post-workshop assignments: 2 hours pre; 1 hour post 0 Assignments posted on Ninth Brain Suite 0 Training organized into "blocks" which build upon one another 0 Basic supervisory skills; management tools; senior management development Care Plus Leadership Academy 0 "Just Culture" Concepts for Leaders 0 Event Investigation within "Just Culture? BLOCK 100 0 (Wine Computer Skills 'l?raining 0 Reading Comprehension Writing Skills 0 Workshop System components, PPlus values; supervisory responsibilities 0 Workshop ?lOZ?Situational leadership and diagnosing personnel Perfonnance problems 0 Workshop IDS?Interviewing candidates for employmen l; resolving conflicts BLOCK 200 0 Workshop 204?Performance evaluation metrics and PPlus values 8: principles 0 Workshop 205?When and how to discipl'me within a ?Just Culture;"helping employees set and meet goals I Workshop 206?0021] setting and habits of effective people 0 Workshop 207?Prioritization; productivity; effective meetings; emotional intelligence 0 Workshop ZOB?Managing relationships with government of?cials, media outlets and customers 0 Workshop 209?System Status Management BLOCK 300 0 Workshop 31 from the patient's perspective 0 Workshop 31 l?Risk management; ?eet management; materials management 0 Workshop 312?Developing an operational budget for high performance EMS 0 Workshop 313?Requests for Proposal analysis 0 Workshop 314?PPlus values 8: principles; wage 6: hour rules; proposal 8: grant writing Care Plus Leadership Academy CARE PLUS Leadership Academy is a four-day program in which the leaders of Paramedics Plus are immersed in the philosophies, current industry and internal practices. During this program, senior leaders are paired with those less tenured to serve as mentors and counselors. This intense program focuses the attendees on teamwork and sb'esses the importance of reaching out to those within the organization when assistance is needed. At the end of this program, attendees leave with orinvr- In Vltuul'l.) Chit Paramedics Plus 208 :\AD\002\02\2X02\2X02177.docx 362 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA MANAGEMENT - KEY PERSON NEL a level of energy and enthusiasm that helps to ensure the organization's success. Current Paramedics Plus leaders attend an internal program offered each year in Tyler, l"X. 'l?he four-day curriculum helps participants develop a broad base of knowledge and understanding of the organization's operations, procedures and policies, and to Further develop as an EMS professional. A wide range of topics is discussed including: 0 Systems status management 0 Strategic planning 0 Finance and budgeting 0 Community relationships 0 Medical oversight 0 Risk and safety 0 Problem solving. More information about the Care Plus Leadership Academy is provided in Appendix 39. Mentoring and Succession Planning Top Paramedics Plus leaders as well as management persomiel at all levels are actively engaged in mentoring employees with leadership potenlial. One significant example for Sioux Falls is the mentoring of proposed (:00 Michael Bureau by Paramedics Plus Vice President and former Sioux Falls resident Mark Postma. This and other mentoring relationships in the organization are built on: 0 Mutual respect 0 Acceptance and ?exibility 0 Honesty and direct communication 0 Preparation 0 Commitment 0 Shared values 0 Trust 0 Willingiess to work through obstacles. The mentoring relationship between Mr. Postma and Mr. Bureau is of particular benefit to REMSA, as Mr. Poshna not only knows but also knows Sioux Falls and its values. Mr. Postma has been actively engaged in mentoring Mr. Bureau during Mr. Bureau's steady climb in the organization. Paramedics Plus also proposes to match Paramedics Plus women leaders with Sioux Falls women with potential for leadership in mentoring relationships. (Please see Section XI. EMS System and Community for more details.) Females are underrepresented in the EMS workforce as well as in leadership positions; Paramedics Plus will use mentoring as one avenue for increasing the number of women in leadership. As described more fully in X1. C. Engagement, mentoring plays an important role in Paramedics Plus succession planning. Senior leaders personally participate in succession planning and the development of future organizational leaders through the creation of N'Hvr? in Building CM: 5 Paramedics Plus 209 363 COMPETITIVE CRITERIA MANAGEMENT KEY NEL a formal "career path? for all positions. Senior leaders mentor supervisors for manager or director positions, and managers for director positions. Senior leaders periodically review those in the next lower level in key positions to determine backups for those critical or leadership positions. Currently these individuals receive informal mentoring by the person in the next level position. Newly appointed leaders complete formal training as listed above, which includes Leadership Effectiveness Training. l'he course is based on Dr. Thomas Gordon?s book, which has been a core program in more than 1,000 corporations around the world. In addition to the mentoring already discussed, newly promoted managers and directors often travel to our high-performance system in Florida to be mentored in their respective areas by the Florida leadership team. Leadership Team Stability It is apparent from the years of experience of the Key Personnel listed that the Paramedics Plus leadership has longevity and varied experiences? valuable resources for REMSA. The average length of time in EMS for those individuals listed as Key Personnel is more than two decades. Because Paramedics Plus is a relatively young organization, having been founded in 1998, most of our managers have experience working for our competitors. What these leaders find in Paramedics Plus is a different culture?one with honesty, integrity and transparency, one that keeps its promises, and one that provides first-class service at a reasonable cost to the communities it serves. In all, Paramedics Plus is the kind of company boU1 our leaders and employees feel good about. Paramedics Plus evaluates the satisfaction of its leadership team both through employee surveys and through honest, open communication with their superiors. Our most recent employee survey results show Uiat 86% of Paramedics Plus managers are. extremely satis?ed or satisfied. Paramedics Plus provides competitive wages and bene?ts to its managers?another reason for longevity in the managerial ranks. Stability is also ensured through the mentoring process, which prepares managers for future positions through engagement and recognition. Managers are encouraged to share opinions, empowered to make decisions and groomed for upward mobility through continuous feedback and assistance in meeting personal development goals. Employees, even at higher levels, are encouraged to continue to learn and develop new skills and to take on new challenges in the organization. N'tu?r? Utiilttm'; "won (?mum-a CM: 5 yum-m Paramedics Plus 2] :\AD\002\02\2X02\2X02177.docx :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA EMS SYSTEM AND COMMUNITY 1. Area Providers Collaboration Paramedics Plus will meet all REMSA minimum requirements under EMS System and Community?Area Providers and Collaboration and proposes to: 0 Sustain and enhance existing mutual aid relationships to ensure optimal transitions of care. Paramedics Plus will achieve higher levels of commitment under EMS System and Community?Area Providers and Collaboration and proposes to: 0 Work with area providers with a spirit of cooperation and partnership 0 Include area providers in CQI and training opportunities 0 Utilize qualified and experienced former REMSA medics as part-time employees, recognizing their value to the system and community a) Minimum Requirements-? Collaboration with area providers At a minimum, the Proposer will agree to negotiate in good faith with hospitals, air and ground providers and execute a sub-contract to back-up and mutual- aid ambulance services in the City. Mutual Aid Paramedics Plus is committed to creating positive working relationships with local hospitals as well as surrounding air and ground providers. Since all Paramedics Plus operations are CAAS accredited, and the accreditation process requires formal Mutual Aid agreements with local EMS agencies, we are very familiar with this process. Paramedics Plus will continue any and all previously agreed upon Mutual Aid contracts created between the current provider and the surrounding ambulance services, cities and districts. Each agreement will be scrutinized with the intent of providing the highest quality of care to the residents and visitors of the REMSA response area. Paramedics Plus will look to enhance these agreements in the best interest of all parties and make needed improvements. These improvements would include a proactive and comprehensive plan to address surges in the EMS system and the coordination of mutual aid in these circumstances. Paramedics Plus acknowledges that it retains ultimate responsibility for any sub-contractor. Attestation: C) 8833 Paramedics Pius understands and agrees to noon . . . . . comply without qualification to prowsrons, requirements and commitments contained in Section 365 r. -. ..Il Paramedics Plus 211 COMPETITIVE CRITERIA EMS SYSTEM AND COMMUNITY b) Higher Level of Commitment? Other Providers Group Purchasing Extended to Area Services Through collaboration with East Texas Medical Center, Paramedics Plus enjoys membership in the First Choice Cooperative. This membership provides Paramedics Plus with significant purchasing power and discounts on medical supplies. First Choice Cooperative will work with local providers who choose to participate in a supply ordering agreement. The agency will be billed at the discounted rate for the supplies. This group purchasing option will significantly improve the buying power for smaller agencies in the system. On top of this, Paramedics Plus will work with local volunteer EMS agencies to help provide quality used equipment, owned by Paramedics Plus or ETMC EMS that may have been phased out of other Paramedics Plus or ETMC EMS systems, but, would benefit the local Sioux Falls area volunteer services. Proven Partners with Local Hospitals Paramedics Plus is committed to partnerships with local hospitals. In fact, 11 hospital CEOs in Pinellas County, Florida, wrote letters of support for Paramedics Plus to continue its EMS contract with Pinellas County. This is a solid testament to the quality of service and commitment Paramedics Plus provides to our partners in the EMS system. This strong partnership is evident in all Paramedics Plus locations and will be a primary focus in Sioux Falls. :\AD\002\02\2X02\2X02177.docx PARAMEDSCS PLUS?Partner's in Buiitiing Awarii?WEnning EMS Systems Paramedics Plus 212 366 COMPETITIVE CRITERIA EMS SYSTEM AND COMMUNITY Paramedics Plus will work REMSA to include hospital-based EMS services in continuing education, quality improvement meetings as well as share the expertise of its Medical Director as requested. Recognizing Former REMSA Medics Paramedics Plus recognizes that from time to time, experienced REMSA medics will accept positions at local hospitals or the Fire Department. Medics who are in good standing with Paramedics Plus when they leave our employment will be recognized for their continued value to the EMS system and considered qualified for part-time employment should they desire. 2. Supporting Improvement in the First Response System Paramedics Plus will meet all REMSA minimum requirements under EMS System and Community?Supporting Improvement in the First Response System and proposes to: 0 Encourage positive working relationships with First Responders through a range of activities including shared training, a designated liaison, and joint quality improvement efforts, as well as both formal and informal meetings with both rank and file First Responders and leadership 0 Provide supplies for on-scene exchange with First Responders 0 Include First Responders in REMSA approved hours of continuing education 0 Offer ride-alongs and internship opportunities to students at Avera McKennan School of EMS 0 Demonstrate our willingness to partner with First Responders by establishing respectful, collegial relationships from our COO to field crews. PARAMEDICS Partners in Building Await?E-Winning EMS Systems Paramedics Plus 213 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA EMS SYSTEM AND COMMUNITY Paramedics Plus will achieve higher levels of commitment under EMS System and Community?Supporting Improvement in the First Response System and proposes to: 0 Offer discounted prices on medical equipment through our group purchasing arrangements 0 Address call surges through internal methods and with our mutual aid partners and First Response 0 Engage locally with First Responders through public health initiatives such as Live Well Sioux Falls 0 Support existing Fire Service Child Passenger Safety efforts by increasing the number of nationally certified CPS technicians available in the system 0 Collaborate in a number of areas from group leadership training to joint public information announcements 0 Engage the Fire Services in Paramedics Plus quality improvement efforts a) Minimum Requirements?First Response System Each Proposer must commit to: 1. Maintain positive working relationships with First Responders; 2. Make continuing EMS education available to First Responders at no cost; 3. Restock basic life support supplies on a one-to- one basis, at the Contractor?s cost; 4. Provide at least four hours annual REMSA approved continuing education 5. Provide internship opportunities for EMT students giving preference to local programs 6. Designate a single individual as liaison for First Response agencies. First Responders are valued partners with Paramedics Plus in every system served. First Responders perform a vital role with direct and profound impact on patient care. Paramedics Plus recognizes the separate and distinct role of First Responders and works to support them in many ways. Positive Working Relationships with First Responders Paramedics Plus requires high standards of personal conduct for all its employees, which includes respect for First Response partners. A positive attitude and collaborative team Paramedics Plus 214 :\AD\002\02\2X02\2X02177.docx 368 COMPETITIVE CRITERIA EMS SYSTEM AND COMMUNITY approach with valued Fire partners are expected of each Paramedics Plus employee. On the rare occasions when issues involving First Response arise, Field Operations Supervisors and the Chief Operating Of?cer will fairly and thoroughly investigate the situation and arrange a face-to-face meeu'ng at a neutral site with all parties. Because of varying shifts of providers in both agencies, prompt resolution is an important aspect. The Paramedics Plus Employee Code of Conduct is included in Appendix 40. 111 other Paramedics Plus systems, we have found that regular informal and face- to-face dialogue between leaders in First Response and our local leaders results in improved communication and cooperation. The Paramedics Plus COO for Sioux Falls will make every effort to join fire leaders for a breakfast or lunch to further cooperative relationships. Joint Training 8: ln-service for Fire liach month Paramedics Plus will share its continuing education schedule with educators from the Fire Department. Paramedics Plus educators will also meet with fire educators for a quality improvement meeting each month to collaborate on training which supports (TQI findings. Once the training curriculum for Transport providers has been approved, it will be shared with fire educators so that First Response and Transport is seamless for the patient. First Responders from the Fire Services are invited to attend any Paramedics Plus led educational program. Through a partnership with Avera McKennan School of EMS and Paramedics Plus, three hours of RISMSA approved education will be offered each month and First Responders will be invited to attend these events. In addi?on, representatives from the tire Services and from the REA-ISA system will be invited, when appropriate, to speak at training sessions as well as Paramedics Plus new hire orientation. Paramedics Plus proposes a Meet and Greet," prior to the May, 2015 effective date, to which all liire [First Responders and other EMS agencies in the region will be invited and able to meet Paramedics Plus management, tour facilities, and see new ambulances and equipment purchased for the betterment of the REMSA system. Paramedics Plus is commi tted to becoming a fully integrated part of the Sioux Falls community. BLS Supplies BLS supplies will be provided on a one-for? one basis with Paramedics Plus covering the cost of basic life support supplies. Paramedics Plus also proposes to install Operative inventory management software which will not only ensure that First Response supplies are there when needed, but also provides an electronic tracking system including electronic narcotic tracking. orttu-r- In '\w.uu (Jinan-i.) CM: 5 y-t?unn Paramedics Plus 215 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA EMS SYSTEM AND COMMUNITY The software, designed specifically for the demands of the EMS industry, employs electronic record keeping coupled with barcode scanning to decrease inventory time and track expiration dates to support stock rotation, so that medications rarely expire and costs related to expired supplies are minimized. Operative 1Q provides automated notification of when and how much to order. More information about Operative IQ is available in Appendix 41. Internship Opportunities for Local EMT Training Programs Paramedics Plus recognizes the importance of high quality education and internship opportunities for EMS students. As a result, Paramedics Plus will offer ride time and internship opportunities to students of the Avera McKennan School of EMS. In addition to this, Paramedics Plus will offer a scholarship for underrepresented students to attend EMT school at the Avera McKennan School of EMS. Paramedics Plus will collaborate with the local EMS program administrators to provide this scholarship. This program will benefit REMSA with additional diversity within its EMS system and will help to kick start an opportunity for a lifelong career in EMS for these individuals. Liaison with First Responders The Chief Operating Of?cer, who works for Paramedics Plus in the REMSA system, will be the designated liaison with the Fire Department. He will meet regularly with his counterparts in the Fire Service and work collaboratively to create a positive working partnership with Fire First Responders, as well as to work toward continuous system improvements with the goal of providing the highest possible care and service to the Sioux Falls community. Attestation: 0 $333 Paramedics Plus understands and agrees to SIDED . . . . . . comply Without qualification to requirements and commitments contained in Section Paramedics Plus 216 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA EMS SYSTEM AND COMMUNITY (nopesaiive b) Higher Level of Commitment? First Response System Group Purchasing As mentioned previously, Paramedics Plus enjoys membership in the First Choice Cooperative. 'l'his membership provides Paramedics Plus with signi?cant purchasing power and discounts on medical supplies. Paramedics Plus will work with the Fire Department on a supply ordering agreement that will allow the ordering of supplies directly through First Choice. The agency will be billed at the discounted rate for the supplies. This will significantly improve the buying power for the Sioux Falls Fire Department. Collaborative Leadership Training Paramedics Plus recognizes that there are opportunities to integrate training between First Response and Transport including Joint Supervisor Training. Paramedics Plus is committed to moving forward in this area of cooperation which would include joint training for coordinated scene safety, special event planning, integrated Incident Action Plans for large events as well as training and alignment on the Incident Command System, radio etiquette and radio discipline policies. Collaborative Strategies to Address Call Surges 'I'he Paramedics Plus approach to call surges will start first with the internal coordination and management of the non-emergency queue. While non-emergency inter?facility calls must be managed with a focus on customer service and patient care, emergency calls must take priority. In the rare event that a system surge results in a possible delayed response, an administrative unit consisting of a management crew, all of whom will be REMSA certified medics, will support the system in a lully equipped ALS ambulance. if increasing internal capacity does not meet the demand, mutual aid relationships will be engaged to assist. While our partners in Fire First Response do not have the ability to transport, we will continue to engage them in response and treatment of the patient until an ambulance is available. Paramedics Plus 217 :\AD\002\02\2X02\2X02177.docx :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA EMS SYSTEM AND COMMUNITY Quality and Performance Improvement Support Paramedics Plus will engage local First Responders in its quality improvement program and work collaboratively with First Response agencies in achieving and sustaining clinical performance goals that meet the requirements of the REMSA Medical Director. Coordination of Public Education Initiatives Paramedics Plus will participate in Live W?ll Sioux Falls, an organization that currently benefits from support from the Fire Department. In addition, Paramedics Plus is eager to partner with the Fire Services on public education initiatives including and beyond Child Passenger Safety. ,1 t) Coordination of Injury and Illness Prevention Programs Paramedics Plus proposes to train one employee annually as a nationally certified Child Passenger Safety Technician. Certified employees will be available to assist the Fire Department in its car seat checks. In addition, Fire personnel will be invited to participate in Paramedics Plus led injury and illness prevention programs such as fall prevention. First Responders would be valuable partners in documenting potential fall conditions or other situations, which undermine good health for vulnerable members of the community. Paramedics Plus proposes to work with the Fire Services to determine criteria for documentation and a process for getting information into the hands of those who may be able to helpParamedics Plus 218 372 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA EMS SYSTEM AND COMMUNITY Collaborative Public Information Services The Public Information function will be assigned to the Chief Operating Of?cer in the Paramedics Plus Sioux Falls operation. Paramedics Plus is more than willing to collaborate with commtmity partners, including the Fire Service, to more effch ver communicate to Sioux Falls. Paramedics l?lus proposes to workjointly with the Fire Department to create a 911 education program that can be delivered to any number of groups in the Sioux Falls area. Other Paramedics Plus locations routinely coordinate joint announcements with the press related to public health such as weather alerts and preparedness activities related to health. 3. Health Status Improvement and Community Education Paramedics Plus will meet all REMSA minimum requirements under EMS System and Community?Health Status Improvement and Community Education and proposes to: 0 Develop 91 education presentations appropriate for key community groups and a school age program for Sioux Falls children 0 Continue involvement in CARES 0 Adopt a new program aimed at increasing the incidence of bystander CPR Recognize employees during ICMS Week 0 Implement injury prevention programs in the areas of Child Passenger Safety and fall prevention. Paramedics Plus will achieve higher levels of commitment under EMS System and Community Health Status Improvement and Community Education and proposes tn: 0 Analyze the existing workforce and consciously, actively pursue a more diverse staff, one which matches the community's demographics 0 Match women leaders in Paramedics Plus with REMSA system employees to increase the number of women in top management positions through mentoring 0 Offer an annual EMT scholarship to an individual from an underrepresented group to support diversity in the workforce 0 Engage as part of the existing community public health efforts including but not limited to Live Well Sioux Falls initiatives 0 Explore, with REMSA, expanding roles for EMS including Mobile Integrated Healthcare programs or Community Paramedicine Hutu-p11,: litltl~iltl?l sz?cl 23"}l . Paramedics Plus 219 373 COMPETITIVE CRITERIA EMS SYSTEM AND COMMUNITY a) Minimum Fiequirements? Community Education Contractor shall continue to support involvement in CARES. Contractor shall annually plan and implement a definitive community education program, which shall include: identification of and presentations to key community groups which influence the public perception of the EMS system?s performance, conducting citizen CPR training events, participation in EMS week and other educational activities involving prevention, system awareness/access, and appropriate utilization of the EMS system. 911 Education For school age children - Paramedics Plus employees will participate in school and community-based demonstrations with the focus of reaching children ages ?ve through 14 with age-appropriate 911 emergency education. The events, also commonly known as "touch-a-truck? are often held at schools, day care centers, Boy Scout and Girl Scout meetings, and community-wide events such as festivals. Paramedics Plus would participate by taking a REMSA ambulance with a Paramedics Plus crew to demonstrate and allow those in attendance to tour the ambulance and operate equipment such as lights and sirens. The educational focus is to teach young children how to recognize an emergency, when it is appropriate to call 911, how to call 911, and what to expect once they have placed the call. For adults - Paramedics Plus will create a select employee group of ?Community Ambassadors? to represent REMSA with community leaders, city councilor members and the public. Paramedics Plus employees will work with REMSA, Sioux Falls Fire Department and Police Department to develop a community program that explains what happens behind the scenes of a 911 call. The program will explain, among other things, why Emergency Medical Dispatchers ask so many questions, why Fire Department medics may also respond and why it is particularly important to call 911 for certain Ambassadors will also look for ways the EMS system can engage and volunteer in the community, attend neighborhood association meetings, do public speaking engagements, and be spokespersons to the public, media and on social media. Paramedics Plus 220 :\AD\002\02\2X02\2X02177.docx 374 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA EMS SYSTEM AND COMMUNITY Injury Prevention Based on existing community health needs assessments and the goals of request for proposals, Paramedics Plus proposes the injury prevention programs described below. The following programs have been successfully implemented in Paramedics Plus sites, but the key to success in Sioux lialls will be buy-in from the local community including REMSA and public health of?cials. Should programs other than the ones listed below be a better ?t for Sioux l?alls, Paramedics Plus will. work in partnership to support other efforts. Child Passmger Safety - Paramedics Plus will send one employee each year for the first three contract years for training to become a National Child Passenger Safety Technician. Paramedics Plus CPS Technicians will be available to support REMSA or the Sioux Falls Fire Department and other groups during local car seat checks and will also be a resource to patients and the community throughout the year. Matter of Balance - a national program, which emphasizes practical strategies to reduce fear of falling and increase activity level. Participants learn to view falls and fear of falling as controllable, set realistic goals to increase activity, change their environment to reduce fall risk factors and exercise to increase strength and balance. Cardiac Arrest Registry to Enhance Survival (CARES) Paramedics Plus will support involvement in CARES. Paramedics Plus recognizes the benefits of CARES in helping local EMS administrators and community leaders determine who is affected in the community, when and where cardiac evean happen, what parts of the system are working well and which parts can work better, and generally how emergency cardiac treatment can be improved. Paramedics Plus systems are experienced in collecting and analyzing cardiac arrest data. Paramedics Plus will support REMSA's involvement in CARES and commits to working to improve the Chain of Survival in Sioux Falls. Sioux Falls cardiac arrest survival to hospital discharge in 2013 was 12.5% compared to the national CARES number of 10.6% and total national survival rate of Clearly, Sioux Falls already bene?ts from a high rate of bystander CPR and appropriate pre-hospital care. Paramedics Plus is extremely proud of iLs cardiac arrest survival rates in other systems it serves, which are among the top tier in the country, and looks forward to involvement in CARES and increasing the incidence of bystander CPR in Sioux Falls. donning, "w mi ?mum-a CM: 5 yum-m Paramedics Plus 221 375 COMPETITIVE CRITERIA EMS SYSTEM AND COMMUNITY Take 10 Hands-Only CPR Training Take 10 hands-only CPR training requires just 10 minutes to learn techniques for high quality, uninterrupted chest compressions. Modeled after a successful program in Austin, Texas, the program works to increase the number of people who know the simple steps that can save the life of a person who suddenly collapses from cardiac arrest. In just 10 minutes, instructors can teach the basics in a neighborhood association meeting, workplace, church, park or most anywhere. The program to coordinating the programs with trained lay focuses on tralmng lay people to be CPR instructors and to loan kits to those instructors instructors. Training lay people to be trainers for teaching in the community. This Program has several advantages including their ability is a communityiocused effort to improve to keep the training and messages Simple and bystander CPR rates and potentially triple serving as known ?messengers? throughout . surv1val rates. their personal community networks to spread the word about CPR During the class, the PulsePoint pre?arrival software currently in use in Sioux Falls, AS the title implies? training takes juSt 10 will be discussed, and participants will be mmUtes? bUt eaCh partmpant gets two to encouraged to download the app to their three mmUtes 0t hands?0n practlce durlng smart phones or tablets. Trained bystanders the sess10n. The Austin Take 10 program has who are noti?ed of a cardiac arrest can offered use of videos and program guidelines . . improve the chances of surv1va1. to Paramedics Plus. In the ?rst contract year, Paramedics Plus will purchase five American The Take 10 Program Will augment efforts by Heart Association CPR Anytime Kits, which the Fire Department, Red Cross and other local include in?atable mannequins, trainer guides PrOViders With different approad?es t0 and videos. An additional three kits will be disseminating CPR skills- purchased in year two of the new contract. Attestation: paramedics plus will conduct a minimum SEES Paramedics Plus understands and agrees to ?232 comply without qualification to provisions, requirements and commitments contained in Falls. The clinical educator will devote time Section v_E,3,a_ of one training session each month in Sioux Paramedics Plus 222 :\AD\002\02\2X02\2X02177.docx 376 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA EMS SYSTEM AND COMMUNITY b) Higher Level of Commitment-Health Status Improvement and Community Education Matching the Workforce to the Community The EMS industry and Paramedics Plus have concluded that the ethnic and racial composition of its workforce should closely resemble the composite of the general population of the community they serve. The community make up is vastly different in Oakland, California; Fort Wayne, Indiana; and Sioux Falls, South Dakota. In each case there is no one?size fits all program to provide for each community?s ideal ethnic and racial mix of employees. We do know, however, that a community that is served by a provider that best matches the community will provide improved service and create a level of confidence in the community toward their EMS provider. Paramedics Plus has created a search for diversity data for Sioux Falls and reports the following data that captures the composition of the community. PERCENT RACE 86.8% White 4.4% Hispanic or Latino 4.2% African American 2.7% Native American Source: QuickFacts.census.gov One other area not frequently rolled into the diversity picture and needed is the gender make-up of the community. PERCENT 50.4% GENDER Female With this information as a background, this proposer does not have an EEO-1 form for the current provider and does not know the diversity of the incumbent work force. Upon award of the bid, Paramedics Plus will learn these details during the interviews, health screenings and background checks of the incumbents for hire to the new contractor. Once this data is learned Paramedics Plus will know the gaps in representation and can create a plan to close these gaps. Paramedics Plus 223 377 :\AD\002\02\2X02\2X02177.docx COMPETITIVE CRITERIA EMS SYSTEM AND COMMUNITY It?s important to note that Paramedics Plus does not have to reinvent the wheel as certainly the City of Sioux Falls and/ or its Fire Service probably already have diversity programs in place that we can follow. This will give us the jump-start we need to begin closing gaps while at the same time creating new linkages with those communities of interest. Paramedics Plus provides focused scholarships to deserving community participants to remove barriers to entry to the EMS profession. It also provides close contact with community colleges and other private training resources to encourage those populations that are underrepresented a chance to obtain the necessary skill set to join the organization. Normally, this entry-level opportunity occurs at the EMT level. Once trained and on the payroll, the employees earn the right to another series of focused scholarships to attend additional training at the Paramedic level. Upon completing the training, the employee can choose to remain or transfer to other Paramedics Plus organizations in its several locations. In terms of outreach to those who are underrepresented in the workforce, there are multiple ways to contact people to introduce them to the employment possibilities in EMS. Many communities provide services to the long-term unemployed and often subsidize work/ learning opportunities. Once again, community colleges are other sources. Publications issued in the minority communities and the clergy are other means that we have used to create interest in EMS. To create a greater emphasis in recruiting women, we will identify women in the work force to act as role models and mentors for potential or existing employees. Around the country, women are frequently underrepresented in the EMS workplace. We have created mentoring arrangements for entry into leadership positions. We have some incredibly able women in positions of leadership at Paramedics Plus, and they generously share their time and experience to help other women succeed. Sioux Falls deserves a provider who takes a special interest in its efforts to have diversity in the work place. These efforts are more than written forms and data elements. There are people who reside in Sioux Falls who are looking for opportunities to grow '5 w. 5 . NLU - All ?L'Ililfiil'q Elil? 7? 0.11:5 Paramedics Plus 224 378 COMPETITIVE CRITERIA EMS SYSTEM AND COMMUNITY professionally and financially. We can 0 Paramedics Plus will offer a minimum of make that happen, all the while creating an one scholarship to an underrepresented improved community atmosphere and better group each year providing all tuition, books health outcomes for our community. and fees plus paying the student for hours spent in course attendance. Recruitment of Underrepresented Groups 0 Once a scholarship is awarded to a member Paramedics Plus will implement a multi? of an underrepresented group and the faceted recruitment program targeting recipient successfully completes EMT-Basic underrepresented groups Will PrOVide training, he or she will become eligible for clinical certification for entry level positions as a Paramedic scholarship after two years of we? as pay for time Spent in training satisfactory employment with Paramedics 0 Paramedics Plus meet w1th local Plus in the Sioux Falls System. minority community leaders and education . . 0 Paramedics Plus Will place advertisements leaders to gather information about . . . . . in minority oriented publications and work obstacles or deterrents to attracting and . . w1th South Dakota resources that speCIalize retaining minorities for careers in EMS. . . . in recruiting, selecting and training underrepresented groups. Paramedics Plus 225 :\AD\002\02\2X02\2X02177.docx 379 COMPETITIVE EMS SYSTEM AND COMMUNITY 0 Paramedics Plus will create a program to mentor women with potential for leadership positions. Paramedics Plus will also: 0 [insure that selection, compensation systems and promotions are nondiscriminatory. 0 Review compensation systems periodically to determine where there are apparent gender, race, or ethnicity based disparities. here disparities cannot be justi fied in terms of performance, length of service, etc., corrective action will be taken. Engaging with Sioux Falls to Improve Community Health Paramedics Plus will plan and implement a definitive community education program based on collaboration with the local community. Sioux Falls is fortunate in that public health needs of the community are well researched and efforts are already underway to address unmet needs. Paramedics Plus representatives will meet with Sanford USI) Health and Avera McKennan Hospital to see how EMS can complement the work, in progress, identified in each institution's Community Health Needs Assessment. Paramedics Plus commits to working collaboratively with Live Well Sioux lialls providing support for the "Big Squeeze" and in other ways which further the group?s goals to prevent and reduce tobacco use; increase control and awareness of high blood pressure and high cholesterol; and improve the community environment to support health. . .4. me PATIENT OTECTION Aft; AFFORDABLE CARE ACT Partnering for the Future As federal and state governments wrestle with the high cost of health care, several recent developments, including the Patient Protection and Affordable Care Act, may have a profound impact on EMS both in the way it is reimbursed and in the services provided. The good news for EMS is that healthcare providers in the new models have far greater latitude in choosing partners that meet quality measures, help improve outcomes, reduce costs and improve patient satisfaction. Over the past five years, has been engaged in a number of successful projects focusing on: 0 Reducing HF admissions or readmissions Decreasing utilization of EMS by frequent ti li 7ers 0 Reducing Hospice revocation pL'l?: f' H'Yruf' 1.: Mudihngi I a 231?.- . Paramedics Plus 220 :\AD\002\02\2X02\2X02177.docx 380 COMPETITIVE CRITERIA EMS SYSTEM AND COMMUNITY 0 Decreasing utilization by patients at risk for a number of attributes applicable to the new falling approach, which is frequently referred to as . Reducing CHE AMI, COPD and pneumonia Mobile Integrated Healthcare or Community Paramedicine. Attributes include: 0 24-hour availability 0 Physician directed protocols and care 0 0 Experience in working in a collaborative readmissions 0 Decreasing utilization of patients with substance abuse issues or mental illness. Trials and programs conducted around the country vary based both on population needs mOdel and the healthcare team involved. Paramedics Measurements mdUdmg ease Plus is enthusiastic and eager to partner with EXiSting infrasn'ueture' REMSA as it investigates successful programs Several Sioux Falls entities have conducted that work to matCh Pahents W1th the most recent community health needs assessments suitable source of care W1th approprlate and so unmet needs are well researched and cost effective transportation. Until now most documented Sanford USD Medical Center EMS systems had little choice but to deliver every patient to the hospital emergency has identified dental care and services for the elderly, mental health services and obesity as department regardless of the appropriateness community health issues. of the delivery. Some programs are seeing . savings of thousands of dollars and achieving impressive patient satisfaction scores for the call-taking process, recommendation, nurse, transportation and understanding of the medical complaint. Paramedics Plus employees working in the REMSA system will collaborate with local hospitals to learn how the EMS system could partner in a pilot Mobile Integrated Healthcare program. Such collaboration will allow EMS to bring value to the community through adaptation of core EMS competencies including call-taking, patient instructions, triage, medical transportation and Paramedic skills. Beyond core competencies11.Paramedics Plus 227 :\AD\002\02\2X02\2X02177.docx 381 COMPETITIVE CRITERIA EMS SYSTEM AND COMMUNITY Avera McKennan Hospital and University Center identi?ed the following themes in its research: obesity/ poor diet lack of exercise; health care access for uninsured/ underinsured people, including specialty care and mental health services; management of chronic conditions and smoking/ alcohol use. Any number of possibilities exists for IIMS collaboration with area insh'tutions, but could include using Paramedics in new ways to help Primary Care physicians manage chronic conditions. Paramedics Plus and its resources can work with local hospitals on programs that reduce readmission rates for target diagnoses like Cl IF, COPD, or as well as reduce hospital revocation, etc. These read missions cost hospitals significantly in Medicare fiulds. Paramedics Plus brings experience, resources, know-how and, above all, the will to partner with Sioux Falls to meet the community's needs under new models. The adaptation of EMS core competencies for new purposes will require input and support from medical oversight, REMSA and local healthcare providers. Paramedics Plus is ready and willing to support transformation to meet the needs of Sioiu Falls tomorrow. All location photographs taken by Scott BerkIey, ETAIIC irHu-r' In Building Ci?db Spututn. Paramedics Plus 228 :\AD\002\02\2X02\2X02177.docx 382 QJN LIISioux Falls RFP Appendices Corporate Overview .. Paramedics Plus Articles of Organization ..3 Ficticious Name ..7 Licenses .. 5 Letter of Assurance from Byron Hale ..21 Letters Verifying Contracts .23 Response Time Compliance Reports . 35 Sample Orientation Schedule ..93 Avera McKennan School of EMS Letter of Intent .. 105 CISM .. I07 Workforce Member Confidentiality Agreement .. 109 Employee Bene?ts .. 111 Avesta limployment and Selection Process .. 13] Charity Policy ..133 Just Culture Algorithm ..141 Director of Clinical and Operational Services Job Description .. 143 Scorecard .. 145 PMS Medical Director Job Description ..153 Chief Medical Of?cer's CV .. 155 Infection Control Policies .. 165 Mobile Radio Description .. 189 On-Board Mobile Gateway .. 197 Cell Phone Description ..201 SSM Training Curriculum .203 ARECC Sample Policies .. 205 Vehicle and Equipment Details .. 211 lileet PM Policies and liorm ..229 Policies on Equipment Checking .233 Tableau Software .235 loll Rescue Net Resource Planner .243 PULSE Suite of Software .253 'l'ableau Sample Reports ..255 Leadership/ Supervisor Training .. 26] :\AD\002\02\2X02\2X02177.docx 383 34 Sample Drug Policy .. 275 35 Driving Policy ..281 36 EOE SOP and Code of Conduct .. 291 37 Michael Bureau Resume and Job Description .. 293 38 Key Personnel Resumes Phil Collins .. 297 Rodney Dyche .. 299 Cindy E551 .. 301 C. Anthony Farmer .. 305 Jeffrey Alan Haislet .. 307 Katrina Lazare ..3'11 Barry Niemann .. 313 Mark'l'. l?oslrna . 3l5 Ronald Schwartz .. 319 Erik Switzer .. 323 Melinda SwiL/er .. 325 Debbie Vass .. 327 39 Care Plus Leadership Training .. 329 40 Standards of Conduct Sample . 339 4] Opera Live IQ .. 357 :\AD\002\02\2X02\2X02177.docx 384 l?I?IhSioux Falls Rl-l? Appendices Digital Version ETMC Corporate Overview ..3 Paramedics Plus Articles of Organization ..4 liicticious Name ..7 Licenses .. 15 Letter of Assurance from Byron Hale ..2l Letters Verifying Con tracts .. 22 Response Time Compliance Reports .. 28 Sample Orientation Schedule ..86 Avera McKennan School of EMS Letter of 1ntent ..98 CISM ..99 Workforce Member Con?dentiality Agreement .. 101 Employee Bene?ts .. 103 Avesta Employment and Selection Process .. 123 Charity l?olicy ..124 Just Culture Algorithm .. I31 Director of Clinical and Operational Services Job Description ..132 Scorecard .. 134 EMS Medical Director Job Description .. 141 Chief Medical Of?cer's (TV .. 143 Infection Control Policies .. 152 Mobile Radio Description .. 176 (in?Board Mobile Gateway ..184 Cell Phone Description .. 188 88M Training Curriculum .. 189 ARECC Sample Policies .. l9 Vehicle and Equipment Details .. 196 Fleet PM Policies and Form ..213 Policies on Equipment Checking ..216 Tableau Software ..218 2011 Rescue Net Resource Planner ..225 PULSE Suite of Software ..235 Tableau Sample Reports .. 237 Leadership/ Supervisor Training ..242 :\AD\002\02\2X02\2X02177.docx 385 34 Sample Drug Policy .. 256 35 Driving Policy .. 261 36 EOE SOP and Code of Conduct .. 209 37 Michael Bu rcau Resume and Job Description .. 270 38 Key Personnel Resumes Phil Collins .. 273 Rodney Dyche .. 274 Cindy Essl .. 276 C. Anthony Farmer .. 279 Jeffrey Alan Haislet .. 280 Katrina Lazare .. 284 Barry Niemann .. 286 Mark T. l?ostrna .. 287 Ronald Schwartz .. 290 Erik Switzer .. 293 Melinda Swit/er .. 295 Debbie Vass .. 297 39 Care Plus Leadership Training .. 299 40 Standards of Conduct Sample .. 309 4] Opera Live IQ .. 326 :\AD\002\02\2X02\2X02177.docx 386 "blah East Texas Medical Center Regional Healthcare System 1 If? Easl Texas Easl l?exas EIMC llama Easl Texas Medical Cenlei - Medical Cenler a Career Health SEMES, Medkal Cenler Well Alhem lnr. lmmdatlnn Easl Texas I [351 lexas 1 ETMC ACCess Dime! Lake Sheet Medical (fenle! Medial Cenler ?l 4 wk Risk Rele?lnn Cadhage Hospilal (limp I Texas East Texas ETMC Heamm mural Cenler H??i Medial Cenler ?l lalty -1 ix Cnxkell Fainield Jspilal Toms . rag rem FlMl' Comranmd Medical Center Medial Cenler "mm Cledemialmg Gimer Henderson Smiles servires. lnr. tasl Texas Easl Texas I I MM Malta] (Tamer mm Caner a PM lar?kmnv?e nu ll he I E351 Texas Pas! Texas Palamullts Medical Ceule 4 Medial (?enlm Pqu Qullman Pmburg I East lens 1 East Exas Medial Cenler Health lilnily Nelmlk Elmer G. FACHE Presumt/CEO. HMC Rajlonal Heallhcare System 1 bid]? :\AD\002\02\2X02\2X02177.docx 387 ARTICLES OF ORGANIZATION OF PARAMEDICS PLUS, LL .. (1h: Company?) ARTICLBONE ARTICLETWO mummde ARTICLETBREE mum halalun ARTICLEFOUR IONS Dachau, Bhbong ARTICLEHVE minim mnfollows Elmer Elks 1000 Beddnn Tyler Tan 7570! Anthony Myers 1000 Beddnm Tykt, Texas 7570! Lindsey Hudson: 1000 Tying Texas 7570! Jack Scout 160 Camden Road Wes Rivet, MDZOTIS :\AD\002\02\2X02\2X02177.docx 388 U11 FED-II ARTICLE SIX 10005 75701 SEVEN Whyme bytheundauynd SOLE mm: {d :\AD\002\02\2X02\2X02177.docx 389 FILED In the Of?ce of the Secretary of State of Texas STATEMENT OF CHANGE OF REGISTERED OFFICE ORMAY 2 1 2?10" REGISTERED AGENT OR BOTH BY A CORPORATION, LIMITED LIABILITY COMPANY on LIMITED 59000? 1. The name of the entity is Paramedics Plus. LLC. The entity?s charter/certi?cate of authority/?le number is 703850722. 2. The registered of?ce as PRESENTLY shown in the records of the Texas secretary of state is: 1000 S. Beckham, Tyler, Texas 75701. 3. The address of the registered agent will not change. 4. The name of the registered agent as PRESENTLY shown in the records of the Texas secretary of state is: Lindsey Birdsong. 5. The name of the NEW registered agent is Elmer G. Ellis. 6. Following the changes shown above. the address of the registered of?ce and the address of the of?ce of the registered agent will continue to be identical, as required by law. 7. The changes shown above were authorized by the board of directors. PARAMEDICS PLUS. LLC :\AD\002\02\2X02\2X02177.docx 390 No. 3 9/27/88 9:32 A.M. Mitchell #35 AFFIDAVIT FOR REGISTRATION OF FICTITIOUS NAME, SUNSTAR (EMERGENCY MEDICAL SERVICES) - APPROVED FOR EXECUTION Noting for the record that the Board is now sitting as the Pinellas County Emergency Medical Services Authority, County Adminis? trator Fred B. Marquis recommended that the Affidavit for Registration of Fictitious Name, SUNSTAR. be approved. In his memorandum of September 27, 1988, Mr. Marquis indi? cated, in part, that Medic One Ambulance Service, Inc. is providing ambulanCe service under the name, that this is in accordance with the contract awarded to Medic One by the Board of County Commis? sioners, acting as the Emergency Medical Services Authority; that the Authority also bills persons for ambulance service in the name of that the fictitious name SUNSTAR is used in order to ensure uninterrupted and continuous ambulance service; and that if an ambulance contractor changes, the name of the ambulance service will not. Commissioner Greer moved, seconded by Commissioner Tyndall and carried, that the recommendation Of the County Administrator be approved. :\AD\002\02\2X02\2X02177.docx 391 To: The Honorable Chairman and Members of the Board of County Commissioners FROM: Fred B. Marquis County Administrator SUBJECT: Approval of Affidavit for Registration of Fictitious Name DATE: September 27, 1988 RECOMMENDATION: I recommend that the Board of County Commissioners, acting as the Emergency Medical Services (EMS) Authority, auth- orize the Chairman of the Board to execute the attached affidavit for registration of the fictitious name, SUNSTAR. ANALYSIS: Medic One Ambulance Service, Inc. is providing ambulance service under the name, SUNSTAR. This is in accordance with the contract awarded to Medic One by the Board of County Commissioners, acting as the Emergency Medical Services Authority. The Authority also bills persons for ambulance service in the name of SUNSTAR. The fictitious name SUNSTAR is used in order to ensure uninterrupted and continuous ambulance service: If an ambulance contractor changes, the name of the ambulance service will not. Attachment . :\AD\002\02\2X02\2X02177.docx 392 OF COUNTY COMMISSIONERS COUNTY. FLORIDA 3?5 COURT CLEARWATER. FLORIDA 3?616 COMMISSIONERS JOHN CHESNUT.JR. . PHONE (813) 462-3354 BRUCE WNDALL - VICE CHAIRMAN eneen - CHARLES e. mmev BARBARA SHEEN SUSAN H- couurv ATYORNEV October 5. 1988 David W. Pettis. Jr. Pettis McDonald. P.A. Post Office Box 1528 Tampa. Florida 33601 Re: Pinellas County EMS: Sunstar Dear Mr. Pettis: Enclosed is the original Service Mark Registration Application for "Sunstar" as approved by the Board of County Commissioners. I understand you will be filing this the state. As you may know. Joe Saunders is no longer with the County Attorney's office. Therefore. please copy me on all corres? pondence related to the registration of this service mark. Thank you for your assistance; sincerely. Karen A. Edwards Assistant County Attorney KAEzdtr Enc. cc: Stephen F. Dean. Jr.. Director Fire EMS Administration 0082q :\AD\002\02\2X02\2X02177.docx 393 TO: Division ol Corporations Florida Department of State. George Firestone. Secretary at State TRADE RK Application for Registration at 3 38131106 Maer Florida Statute 495. Name and address to whom correspondence should .be sent: Jr. Pettis McDonald, P.A. P. 0. Box 1528 Tampa, Florida 33601 Post Office Box 6327 Tallahassee. Florida. FL 32314 Applicant's Phone Number(813) 222 - 8176 Applicant?s name; ems comm may MEDICAL SERVICES AUTHORITY 23% ol the State at Florida County of Pinellas individual )parlnership )general )limited at the State of Business address; 2190 So. Belcher Road Largo, FL 34641 The goods or services in connection with which the mark is used; to identify ambulance services The mode or manner in which the mark is used: This mark is displayed on the vehicles themselves, on the ?billing statements, membership forms, letterhead and all promotiOnz material . . The class(es) in which goods or services tall: 39 PART II Date lirst used by Applicant, predecessor or a related company. Date first used anywhere: June 1/ 1938 (D) Date ?rst used in Florida: 31108 1' 1983 (4-87) :\AD\002\02\2X02\2X02177.docx 394 :\AD\002\02\2X02\2X02177.docx PART The mark to be registered'is' SUNSTAR DISCLAIMER (it applicable) N0 CLAIM IS MADE TO THE EXCLUSIVE RIGHT TO USE THE TERM APART FROM THE MARK AS SHOWN. JOHN being duly sworn. deposes and says (hemmed is Chairman of PineAas County Bterqency Medical sex-Vic Authorlty applicant herein. and makes this at?bavit and verification in its behalf. That (he) (ehek has read the above and foregoing application and knows the the (acts set out herein are true and correct and that the Fontents thereof and that three specimens at the mark tiled herewith are true and correct. and to (his)(her) best knowledge and belie! no other person. ?rm. corporation or association has the right to use said mark in this State, either in identical torm or in Such near resemblance thereto as might be calculated to deceive or confuse. PINELLAS COUNTY EMERGENCY MEDICAL SERVICES AUTHORITY rne bus' John CheSnutL Jr., Chairman pplicant or authorizewil?r signature (give title) loch day of October 1988 Signature of Notary Public. me this {Ngary Seal) 0 My Commission Expires: UL r: - APPROVED AS TO FORM OFFICE or OUNTY ATTORNEY 33? I i . - . FEE: $50.00 per class L: z-J Attorzmv p-I - .L?Jladu . - L. 395 No. BCC 9-15-98 6:30 P.M. Day #69 MARK RENEWAL APPLICATION FOR RENEWAL OF SERVICE MARK - APPROVED FOR EXECUTION Noting for the record that the Board is now sitting as the Emergency Medical Services Authority, County Administrator Fred B. Marquis recommended approval of a Mark Renewal Application for renewal of the service mark "SunStarJ? Commissioner Parks moved, seconded by Commissioner Stewart and carried, that the recommendation of the County AdminiStrator be approved. :\AD\002\02\2X02\2X02177.docx 396 or manna: ii ?i/lsl?l?i i T0: The Honorable Chairman and Members of the Board of County Commissioners FROM: Fred B. Marquis, County Administrator RE: Renewal of "Sunstar" Service Mark DATE: September 15. 1998 I RECOMMEND THAT THE BOARD OF COUNTY COMMISSIONERS, ACTING AS THE PINELLAS COUNTY EMERGENCY MEDICAL SERVICES AUTHORITY, AUTHORIZE THE CHAIRMAN TO SIGN THE ATTACHED APPLICATION FOR RENEWAL OF THE SERVICE MARK 218.915.5193; In 1988, the Board of County Commissioners, acting as the EMS Authority, authorized the registration of the service mark "Sunstar" for the County?s EMS System. It was determined that, even if the ambulance contractor changes, the name of the service does not. This provides a recognizable, continuing name with which County citizens remain familiar. The service mark expires October 27. 1998. N3 :\AD\002\02\2X02\2X02177.docx 397 MARK RENEWAL APPLICATION Name and Address of Owner: Return To: Division of Corporations Pinellas County Emergency Medical PO. Box 6327 Services Authority Tallahassee. FL 32314 12490 Ulmerton Road Largo, FL 33774 Mark Registered: SUNSTAR Registration Number: T09967 a Date Filed: 10/ 27/38 Renewal Date: 27/ 98 Class(es) Filed: 39 Renewal statement pursuant to section 495.071, Florida Statues. Below you must state the mark is still in use in Florida or the reason for its nonuse. The mark is still in use within the State of Florida If applicant is a corporation, enter the state of incorporation: 1 L?gg?mg 51/5274 20 be being swam, depose and say that I am the owner or that I am authorized to sign on behalf of the owner of the trademark and/or service mark referenced herein and make this application and -ven?cation owner '5 behalf I further acknowledge that I have read the application and know the anterijts; there that the facts stated herein are true and correct. - 5- BLAKER, CLERK PINELLAS COUNTY macabre! MEDICAL sagvxcas 5 .1 i, Typed t?Printed - - 111110er . . Depqt'xftl'erk A 1 - - Owner 5 Signature or Authonz Person 5 ,42/ Signature CHAIRMAN comfort": PENELLAS On this .27 day omig? personally appeared before me, me personally known to me 0 whose identity I proved on the basis of I Mark Malctanes(Seal) .- 33"? Notary Public 5 Signature reg-?56" moan Notary Public's Printed Name Fee: $87.50 Per Class Certi?cate of Renewal $8.75 (Optional) Cinema/97) 12 :\AD\002\02\2X02\2X02177.docx 398 Issus' BATE STATE or: CALFORNM CONTROL WR NLIABER DEPARTMENTOF CALIFORNM HIGHWAY PATROL 2034 . ?7212014 8/21/2015 EMERGENCY AMBULANCE Wm Mame? hi I id NON-TRANSFERABLE LICENSE 9i 33?5? a 2 3 CHP 360A (REV. 01m) Op, 062 PROPERTY OF THE CALIFORNIA HIGHWAY PATROL (CHP) AND PHYSICAL (onl?di?ereni from below). This license is NON-TRANSFERABLE and must be surrendered to the jRA?M?mcsp?Lus CHP upon demand or as reqUIred bylaw. A mapnty change In ownership or control of the licensed activity shall require a new license. PATENTS PLUS This license may be renewed within the 30day period prior to the 575 MARINA BLVD- expiration date indicated above. CA i A Ambulance operations must cease immediater upon expiration of this NAME AND ADDRESS license. THERE IS NO GRACE PERIOD FOR A LICENSED IMRAEDE PLUS The Department will accept an application for renewal during the 30- day penod followmg the IIoense expiratton date provrded all requIred "rims PLUS documentation is complete and accompanied by the initial license fee 575 MARINA BLVD. of $200.00. For license information contact CHP. Research and SAN LEANDRO: CA ?577- Planning Section at (916) 843-3440. Attention: DALE FELOHAUSER. coo :\AD\002\02\2X02\2X02177.docx 399 AWW mnncamasmum roam am VALID FOR m: amass. YOU MAY ?team To mm A Mun zomuo 70 0mm: uscauv. makes . . . Ilea DOCUMENT ALTERATION PROTECYED AND H.115 I UNDUI UV 1 14 :\AD\002\02\2X02\2X02177.docx 400 STATE or I FLORIDA DEPARTMENT OF HEALTH BUREAU OF EMERGENCY MEDICAL OVERSIGHT ADVANCED LIFE SUPPORT LICENSE This is to certify that PINELLAS COUNTY EMS AUTHORITY DBA SUNSTAR Name of Provider 12490 ULMERTON ROAD. LARGO. Fl. 33774 Address has complied with Chapter 40L Florida Statutes, and Chapter 64J-l Florida Administrative Code, and is authorized to operate as an Advanced Life Support Service subject to any and all limitations speci?ed in the applicable Certi?catds) of Public Convenience and Necessity for the County(ies) listed below: TRANSPORT El NON-TRANSPORT PINELLAS Countyt ies) cy Medical Serv es Administrator Florida Department of Health Date: 05/27/2014 Expires: 06/30/2016 DH Form 1 I6 I. March 20 3 This certi?cate shall be posted in the above mentioned establishment :\AD\002\02\2X02\2X02177.docx 401 PINELLAS COUNTY BOARD OF COUNTY COMMISSIONERS CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY PINELLAS COUNTY EMERGENCY MEDICAL SERVICES AUTHORITY, d/b/a SUNSTAR, pursuant to Pinellas County Code Section 54, and in accordance with Section 401.25, F. S., is authorized by the Board of County Commissioners to provide non-transport Advanced Life Support First Responder Services In Pinellas County. Signature: T. Chairman, Board of County Commissioners EFFECTIVE: Januam 1I 2014 EXPIRATION: December 221I 2014 16 I :\AD\002\02\2X02\2X02177.docx 402 State of Florida Department of State I certify from the records of this of?ce that PARAMEDICS PLUS, L.L.C. is a limited liability company organized under the laws of Texas, authorized to transact business in the State of Florida, quali?ed on April 23, 2004. The document number of this limited liability company is M04000001558. I further certify that said limited liability company has paid all fees due this of?ce through December 31, 201 1, that its most recent annual report was ?led on January 10, 2011, and its status is active. I further certify that said limited liability company has not ?led a Certi?cate of Withdrawal. Given under my hand and the Great Seal of Florida, at Tallahassee, the Capital. this the Sixth day of March, 2012 wot-tit Secretaty of State Authentication ll): To authenticate this certi?cateyisit the following site. enter this ID, and then follow the instructions displayed. :\AD\002\02\2X02\2X02177.docx 403 18 :\AD\002\02\2X02\2X02177.docx 404 East nuns Medical Center Regional Healthcare System September 14, 2014 Mr. Scott Rust Purchasing Manager City of Sioux Falls 224 W. Ninth Street Sioux Falls, South Dakota 57104 Dear Mr. Rust: East Texas Medical Center Regional Healthcare System (ETMC System) wholly owns Paramedics Plus, LLC. Paramedics Plus is submitting a proposal to provide EMS services to Sioux Falls pursuant to your request for proposals. ETMC System has the existing cash reserves and cash flow to fund the equipment and working capital requirements to begin operations in Sioux Falls. If Paramedics Plus? proposal is selected, the ETMC System guarantees the financial and operational performance of Paramedics Plus under the terms of the contract with Sioux Falls. The purpose of this letter is to formally state that the ETMC System guarantees Paramedics Plus? performance with the full faith and credit of the ETMC System. Sincerely, MM Byron Hale Senior Vice President 8 CFO Administration Po. Box 6400 - Tyler, Texas 7571119PH: (903) 5970351 - FAX: (903)535-6334 :\AD\002\02\2X02\2X02177.docx 405 ALAMEDA COUNTY HEALTH CARE SERVICES AGENCY ALEX BRISCOE, Director ADMINISTRATION INDIGENT HEALTH 1000 San Leandro Boulevard, Suite 300 San Leandro. CA 94577 TEL (510) 618-3452 FAX (510) 351-1367 October 1, 2014 Julie Charbonneau REMSA 521 North Main Avenue, Suite 101 Sioux Falls, SD 57104 Dear Ms. Charbonneau: Please accept this letter as documentation of the excellent performance of Paramedics Plus, the contractor for emergency medical transports in Alameda County, California since November 2011. Paramedics Plus is not only in compliance with some of the most stringent response time requirements nationwide, but also meets or exceeds our expectations for 156 other contract requirements involving operational, administrative and quality measures. A proactive participant in the Alameda County healthcare community, Paramedics Plus has cultivated unprecedented and positive partnerships with First Responders and other system stakeholders. We have been impressed by their application of technology and effective management practices, which are contributing to quality care and efficient operations for the betterment of our community. I highly recommend Paramedics Plus to you or any other community. Sincerely, Ale Briscoer Alameda County Health Care Services Agency 20 :\AD\002\02\2X02\2X02177.docx 406 Three Rivers Ambulance Authority September 25, 2014 Ms. Julie Charbonneau Executive Director REMSA 521 North Main Avenue, Suite 101 Sioux Falls, SD 57104 Dear Ms. Carbonneau: I am writing in regard to the Three River Ambulance Authority's (TRAA) recommendation of Paramedics Plus, a contractor for emergency medical services. Paramedics Plus has been the ambulance contractor for TRAA since July 1, 2009. The original contract was renewed for additional years because of performance meeting or exceeding all extension requirements, including response time performance. Under Paramedics Plus, the TRAA Operations Division earned re-certi?cation by the National Academies for Emergency Dispatch and the Commission on the Accreditation of Ambulance Services, the gold standard for EMS. in addition to meeting or exceeding each contract element, Paramedics Plus brings an attitude of partnership to the community, First Response, the Authority, and its employees. I recommend Paramedics Plus to you without reservation. Please contact me if I can provide more information. Sincerely, AM Gary Booher Executive Director 525 HAYDEN STREET. PO. BOX 11724. FORT WAYNE. INDIANA. 46802. PHONE (260) 4206500 FAX (260) 422-3381 :\AD\002\02\2X02\2X02177.docx 407 BOARD OF COUNTY COMMISSIONERS Pinellas Janet Long lorroni "2.3m. County ?m$?cn EMERGENCY MEDICAL SERVICES September 29, 2014 Ms. Julie Charbonneau Executive Director Sioux Falls Regional EMS Authority 521 North Main Avenue. Suite 101 Sioux Falls. South Dakota 57104 Dear Ms. Charbonneau: This letter is to con?rm that Paramedics Plus has been the exclusive 9-1-1 Paramedic ambulance service provider in Pinellas County, Florida slnce contract inception on October 1. 2004. Since Craig re. MBA, Paramedic Director of Emergency Medical Services Emergency Medial Services 12490 Uhierton Reed Largo. Florida 33774 (727) 582-5750 :\AD\002\02\2X02\2X02177.docx 408 922 ESTATES DRIVE WOODWAY, TEXAS 767l2-3432 254/772-4480 FAX 254/772-0695 YOUSRY ZAKHARY CITY MANAGER September 2, 2014 Julie Charbonneau Executive Director REMSA 51 North Main Avenue, Suite 101 Sioux Falls, SD 57104 Dear Ms. Charbonneau: As the chair of the McLennan County EMS Seven Member City Contract, we have an excellent working relationship with East Texas Medical that goes back eleven (11) years. When we were looking for an innovative EMS provider to join with us in our public/private partnership, we found that non?profit status made them uniquely quali?ed. That ultimate qualification was because their driving force was the outcome of the patient and was never compromised as a result of a pro?t motive. Patient care is of utmost importance to ETMC. The EMS delivery system we enjoy with ETMC has enabled us to be better prepared for any emergency that strikes our city because of the cost-effective, high-quality EMS they provide alongside our ?rst responder professionals. have personally observed them at major incidents, the most recent being West, Texas on April 17, 2013, and they responded very well, and had the agreements in place to dispatch multiple ambulances and helicopters saving dozens of lives. We are actually on our second ?ve year term with ETMC and they continue to perform better every day. ETMC EMS is a very professional company that has delivered exceptional contracted service to the citizens of Bellmead, Beverly Hills, Hewitt, Lacy-Lakeview, Robinson, Waco and Woodway. local management team is solution oriented and effectively maintains strong relationships with City leadership and departments. When a question arises, they are very quick to respond to it from the top down and are always willing to make appropriate swift adjustments if necessary. They are very involved in the community and support all of our community events. We have valued their support and performance and would highly recommend their services. Welcome Homezgo Woodway :\AD\002\02\2X02\2X02177.docx 409 If you have any questions please do not hesitate to contact me at (254) 772-4480 or zakha woodwa mail.or . Sincerely, 'City Manager/Public Safety Director 24 410 September 8. 2014 Sioux Falls City Hall 224 W. Ninth St. Sioux Falls. SD 57] 17-7402 To Whom It May oncem: East Texas Medical Center EMS (ETMC EMS) has been the sole provider of emergency ambulance services for Pasadena. Texas since 2002. As Public Health Manager. it has been my professional pleasure to work with ETMC EMS who has been continuously committed to ensuring the highest quality of EMS health care service for Pasadena residents and citizens. ETMC EMS and its administrative staff have effectively built outstanding relationships with a wide range of community partners and the company participates extensively in community events. Throughout its tenured history with Pasadena. ETMC EMS has consistently met and exceeded contractual response time standards and adhered to reporting requirements. Additionally. medical and communications equipment have been upgraded in accordance with contracts. Local managers have been responsive and accountable in keeping the City informed of current activities. issues and policy changes while also sharing expertise and resources. In closing. ETMC EMS has demonstrated a high degree of professionalism throughout the term of their contracts and has exhibited a spirit of dedication to serving Pasadena. a. Kathy Perez. R.S. Public Health Manger City of Pasadena Health Department Cityol Pasadena. Texas PO. Box 672 77501 78 477 lill http. 25 :\AD\002\02\2X02\2X02177.docx 41 1 mulls 1 Pius Alameda County Zone Summary Hollup summoku luu warm: Paramedics @Hus Namath Coumy I but: but! 19ml ml: Um. mm?m nun-sum Npcu lino [ca-m] nu- Rho up: have can I can AW Run [anme m? Alylu lino [cum-1 ou- m? TIMWMIwc-lvuh man won I var-v "no 5mm Ism Isno My! new 5""0 15M 15": wu- I-aw 54M 1an ?an ":30 Mon two my? nun mum-mama-Imam Mum nun c:qu ou- mn ph Invo an? 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7? tan-var} 38 :\AD\002\02\2X02\2X02177.docx 424 ".mma??m Em ergency Com llance Resgonses 1m Comgliancg Run Com 91. 91112013 380 24 93.68% 93.68% 91212013 364 13 96.43% 95.03% 91312013 38 8 16 95.88% 95.32% 91412013 388 39 89.95% 93.95% 91512013 412 23 94.42% 94.05% 91612013 422 18 95.73% 94.35% 91712013 3 63 20 94.49% 94.37% 918120 1 3 3 57 6 95 32% 94.50% 91912013 393 44 88.80% 93.86% 911012013 419 55 86.87% 93.10% $500 91 1 11201 3 360 22 93.89% 93.17% 91 1212013 342 27 92 .1 1% 93.09% 911312013 392 21 94.64% 93.21% 911412013 366 30 91.80% 93.12% 911512013 337 23 93.18% 93.12% 911612013 409 43 89.49% 92.88% 911712013 376 25 93.35% 92.90% 911812013 366 32 91.26% 92.82% 911912013 386 25 93.52% 92.85% 912 01201 3 405 19 95 .31 92 .98 912112013 394 24 93.91% 93.03% 912212013 353 22 93.77% 93.06% 912312013 362 22 93.9 2% 93.10% 912412013 389 32 91.77% 93.04% 912512013 330 11 96.67% 93. 17% 912612013 394 26 93.40% 93. 18% 912712013 393 36 90.84% 93.09% 9128120 13 366 18 95.08% 93 . 15% 912912013 351 9 97.44% 93.29% 913012013 347 16 95.39% 93.36% 1 1,304 751 93.36% Pri nbed on: 0 812512014 13: 55:46 IE. .1013.? 10". 211114 51m: ?1 E115 1111 191.1; Rem-w: 39 :\AD\002\02\2X02\2X02177.docx 425 Em ergency Compliance DMD Clovis Rgsponses La 5 Com gliame Rug Com 10I1I2013 368 27 92.66% 92.66% 10I2I2013 364 38 89.56% 91.12% 10I3I2013 40 1 17 95.76% 92.76% 10I4I2013 403 20 95.04% 93.36% 10I5I2013 41 4 20 95.17% 93.74% 10I6I 2013 392 30 92.35% 93.51% 10I7I2013 378 30 92 .06% 93.31% 10I8I 2013 374 36 90.37% 92.95% 10I9I2013 381 35 90.81% 92.72% 10I10I2013 391 54 86.19% 92.06% $500 10I11I2013 388 30 92.27% 92.08% 10I12I2013 366 15 95.90% 92.38% 10I13I2013 352 7 95.17% 92.58% 10I14I2013 392 30 92.35% 92.56% 10Il 5I2013 375 21 94.40% 92.68% 10I16I2013 363 25 93.11% 92.71% 10Il 7I2013 343 25 92.71 92 .71 10I 18I2013 361 27 92.52% 92.70% 10I 19I2013 371 15 95.96% 92.87% 10I20I2013 350 21 94.00% 92 .92 10I21I2013 374 27 92.7 8% 92 .9 1% 10I22I2013 379 32 91 .5 6% 92.8 5% 10I23I2013 339 13 96.1 7% 92.9 8% 10I24I2013 340 33 90.2 9% 92.88% 10I 25I2013 389 35 91.00% 92. 80% 10I26I2013 342 11 96.78% 92.94% 10I27I2013 380 20 94.74% 93.01% 10I 28I2013 381 14 96.33% 93.13% 10I29I2013 373 33 91.15% 93.06% 10I30I2013 372 15 95.97% 93.16% 10I31I2013 351 21 94.02% 93.18% 1 1,547 787 93. 18% Printed on: 081232014 13:57:07 Inu-wlah 201-4 :u-m a 15 an 29.. ver: 40 :\AD\002\02\2X02\2X02177.docx 426 'on-quu-v .4 ?ag A '1 Em ergency Com Ilance- Qate Emma: Lam 9911112113135: 311mm. 111112013 411 19 95.38% 95.38% 111212013 365 12 96.71% 96.01% 111312013 342 15 111412013 41 1 32 92.2170 94.90%: 111512013 405 32 92.10% 94.31% 111612013 356 1 5 95.79% 94.54% 111712013 375 22 111812013 392 30 111912013 354 24 93.22% 94.11% 1 111012013 365 15 95.89% 94.28% 1111112013 410 34 91 .87?/o 1111212013 355 17 94.13%: 1 111312013 343 22 93.59% 94.09% 1 11 1412013 360 28 92.22% 93.96% 1111512013 337 34 91 .21?/o 1 11 1 612013 338 3 93 .99?/o 1111712013 355 13 1111812013 403 31 92.31% 94.02% 1111912013 378 22 94.18% 94.03% 1 112012013 377 22 94.16 94 .03 1 112112013 407 23 94.35% 94.05% 1 11 2212013 396 1112312013 417 26 93 .7 6% 93.95% 1 112412013 330 9 97.27% 1 112512013 353 13 96.37% 94.16% 1112612013 348 17 95.11% 94.19% 1112712013 324 10 96.91% 94.28% 1112312013 303 4 1 112912013 352 15 95. 74% 94.45% 1 113012013 327 13 96.02% 94.50% 1 1,052 608 94.50% Printed on: 0812512014 13:57:56 l'I" ar B15. 41 :\AD\002\02\2X02\2X02177.docx 427 Em ergencv Compliance "0:0 Rgsponses Comgliance Run Com 9] . 12!1!2013 343 15 95.63% 95.63% 12! 2! 2013 366 24 93.44% 94.50% 12!3!2013 414 49 88.16% 92.16% 12! 4! 2013 383 35 90.86% 91.83% 12!5!2013 383 22 94.26% 92.32% 12! 6! 2013 429 54 87.41% 91.42% $500 2013 384 19 95.05% 91.93% 12! 8! 2013 349 1 1 96.85% 92.49% 12!9! 2013 404 38 90.59% 92.27% 12! 10! 2013 383 23 93.99% 92 .44% 12!11!2013 391 30 92.33% 92.43% 12!12!2013 370 37 90.00% 92.24% 12!13!2013 360 14 96.11% 92.52% 12! 14! 2013 398 21 94.72% 92.68% 12!15!2013 352 13 96.31% 92.91% 12!16!2013 372 19 94.89% 93.03% 12!17!2013 374 29 92.25% 92.98% 12! 18! 2013 406 21 94.83% 93.09% 12! 19! 2013 403 29 92.80% 93.08% 12! 20! 2013 414 37 91.06% 92.97% 12! 21! 2013 393 14 96.44% 93.14% 12! 22! 2013 362 16 95.58% 93.24% 12! 23! 2013 396 28 92.9 3% 93.2 3% 12!24!2013 350 10 97.14% 93.38% 12! 25!2013 338 17 94.97% 93.43% 12! 26! 2013 381 25 93.44% 93.43% 12! 27! 2013 375 26 93.07% 93.42% 12! 2812013 396 19 95.20% 93.49% 12! 2912013 377 25 93 . 37% 93.48% 12! 30! 2013 383 15 96.08% 93.57% 12! 31! 2013 363 8 97.80% 93.70% 1 1 .792 743 93.70% Printed om 03!25!2014 13:53:51 IE Jan-mob Bull 4 ENE 5? 7? 42 :\AD\002\02\2X02\2X02177.docx 428 "mam {2:12 Em ergency Corn llance Resgonses like; Comgliance Run Com 91. 11112014 407 48 88.21% 88.21% 11212014 399 24 93.98% 91 07% 11312014 400 23 94.25% 92.12% 11412014 390 21 94.62% 92.73% 11512014 359 12 96.66% 93.45% 11612014 365 9 97.53% 94.09% 11712014 357 14 96.08% 94.36% 11812014 408 33 91.91% 94.04% 11912014 403 20 95.04% 94.15% 111012014 454 38 91.63% 93.86% 111 112014 384 17 95.57% 94.01% 111212014 348 17 95.11% 94.09% 111312014 433 33 92.38% 93.95% 111412014 410 44 89.27% 93.60% 111512014 393 28 92.88% 93.55% 111612014 386 42 89.12% 93.28% 111712014 375 26 93.07% 93.27% 111812014 374 13 96.52% 93.44% 111912014 347 20 94.24% 93.48% 112 012014 385 20 94.81 93.55% 112112014 353 18 94.90% 93.60% 112212014 339 14 95.87% 93.69% 112312014 398 39 90.20% 93.54% 112412014 367 29 92 .1 0% 93.48% 112512014 355 23 93.52% 93.48% 112612014 361 22 93.91% 93.50% 112712014 407 32 92. 14% 93.44% 112812014 390 31 92.05% 93.39% 112912014 398 22 94.47% 93.43% 113012014 365 20 94.52% 93.47% 113112014 407 32 92.14% 93.42% 1 1,917 784 93.42% Printed on: 0312512014 14:00:35 :.op.-uah 2004.9er .. EMS 6119.91.13 Reich-Jeri 43 :\AD\002\02\2X02\2X02177.docx 429 .?wimqgg Emergency Compliance 03$ Responses IE Compliance Rug Com g1. 21112014 391 28 92 .84% 92 84% 21212014 406 41 89.90% 91 34% 21312014 448 44 90.18% 90.92% 21412014 394 40 89.85% 90.67% 21512014 400 19 95.25% 9156% 21612014 353 18 94.90% 92.06% 21712014 371 25 93.26% 92.22% 21812014 380 10 97.37% 92.84% 21912014 385 28 92.73% 92.83% 211012014 433 59 86.37% 92.12% $500 211112014 424 23 94.58% 92.36% 211212014 360 15 95.83% 92.62% 211312014 363 22 93.94% 92.72% 211412014 403 34 91 56% 92.63% 211512014 394 20 94.92% 92.79% 211612014 360 19 94.72% 92.90% 211712014 435 32 92.64% 92.88% 211812014 418 48 88.52% 92.62% 211912014 414 25 93.96% 92.70% 212 012014 432 42 90.28% 92.57% 212112014 433 51 88.22% 92.3 4% 212212014 419 43 89.7 4% 92.22% 212312014 401 33 91.77% 92.20% 212412014 413 42 89.83% 92.10% 212512014 392 25 93.62% 92. 16% 212612014 367 16 95.64% 92.28% 212712014 378 18 95.24% 92.38% 212812014 407 21 94.84% 92.47% 11,174 841 92.47% Printed on: 0812512014 14:01 :28 Zoo-?10h EM: AH Mgr-12 7? 99:1"1cr1 44 :\AD\002\02\2X02\2X02177.docx 430 Em ergency Com llance Responses 1% Comgliance Rug Com g1. 31112014 368 18 95.11% 95.11% 31212014 418 42 89.95% 92.37% 31312014 447 41 90.83% 91.81% 31412014 441 29 93.42% 92.23% 31512014 407 25 93.86% 92.55% 31612014 387 19 95.09% 92.95% 31712014 412 49 88.11% 92.26% 31812014 420 32 92.38% 92.27% 31912014 376 20 94.68% 92.52% 311012014 446 67 84.98% 91.70% $500 311112014 449 47 89.53% 91.49% 311212014 433 36 91.69% 91.51% 311312014 432 42 90.28% 91.41% 311412014 387 29 92.51% 91 .48% 311512014 427 35 91.80% 91.50% 311612014 406 21 94.83% 91.71% 311712014 437 23 94.74% 91.89% 311812014 390 13 96.67% 92.14% 311912014 412 25 93.93% 92.24% 312012014 416 18 95.67% 92.41% 312112014 461 42 90.89% 92.33% 312212014 422 20 95.26% 92.46% 312312014 363 11 96.9 7% 92.6 3% 312412014 400 31 92.2 5% 92.62% 312512014 444 26 94. 14% 92. 68% 312612014 422 22 94.79% 92.77% 312712014 380 18 95.26% 92.85% 312812014 393 12 96.95% 92.99% 312912014 371 18 95.15% 93.06% 313012014 370 7 98.11% 93.21% 313112014 424 21 95.05% 93.27% 12,761 859 93.27% Pri nbed on: 0 312512014 14:02: 10 IE. :.opw MN 201: 1 .2 uw. .1 E145 an ught; 9.21.. w: 45 :\AD\002\02\2X02\2X02177.docx 431 Em ergencv Compliance ?My Res onses Comgliancg Rug Comgl. 41112014 450 28 93.78% 93.78% 41212014 413 21 94.92% 94.32% 41312014 384 21 94.53% 94.39% 41412014 470 66 85.96% 92.08% $500 41512014 462 30 93.51% 92.38% 41612014 422 42 90.05% 92.00% 41712014 4 57 3 3 92.78% 92.12% 41812014 387 1 6 95.87% 92.54% 41912014 4 14 32 92.27% 92.51% 411012014 419 34 91 89% 92 .45% 411 112014 400 35 91.25% 92.35% 411212014 412 33 91.99% 92.32% 411312014 384 20 94.79% 92.49% 411412014 445 36 91 .91% 92.45% 411512014 332 25 93.46% 92.51% 411612014 397 26 93.45% 92.56% 411712014 385 18 95.32% 92.71 411 812014 385 33 91 .43 92 .65 411912014 367 15 95.91 92.80% 412012014 375 15 96.00% 92.95% 412112014 393 15 96.18% 93.10% 412212014 389 29 92.54% 93.07% 412312014 404 23 94.31% 93.1 2% 412412014 415 25 93.98% 93.16% 412512014 432 27 93. 75% 93.19% 412612014 461 48 89.59% 93.03% 412712014 410 28 93.17% 93.04% 412812014 405 32 92.10% 93.00% 412912014 414 52 87.44% 92.81% $500 413012014 385 40 89.61% 92.71% 12,318 898 92.71% Printed on>0812512014 14:03:11 zoo-web 2121-1 EME 51mm: 48 :\AD\002\02\2X02\2X02177.docx 432 Emergency Com liance "amp-r.- ovozs 2? . Da_te Rgsponses IE Compliance Run Com pl. 51112014 392 20 94.90% 94.90% 51212014 392 28 92.86% 93.88% 51312014 369 15 95.93% 94.54% 51412014 339 31 92.03% 93.90% 51512014 396 33 91 67% 93.45% 51612014 445 3 0 93.26% 93.41% 51712014 406 25 93.84% 93 .47% 51812014 431 2 4 94.43% 93.60% 51912014 422 26 93.84% 93.63% 511012014 366 15 95.90% 93.84% 51 1 11 2014 382 24 93 32% 93.83% 511212014 423 21 95.04% 93.93% 511312014 426 39 90.85% 93.68% 511412014 395 17 95.70% 93 82% 511512014 406 31 92.36% 93.73% 511612014 406 27 93.35% 93.70% 511712014 379 32 91 .56 93.58% 511 812014 379 17 95.51% 93.68% 511 912014 418 11 97.37% 93.89% 512012014 394 26 93 .40 93 .86 512 112014 389 19 95.1 2% 93.9 2% 512212014 384 20 94.7 9% 93 .9 6% 512312014 442 32 92.76% 93 .9 0% 512412014 396 17 95.7 1% 93.98% 512512014 393 29 92.62% 93.92% 512612014 392 17 95.66% 93.99% 512712014 412 22 94.66% 94.01% 512812014 419 31 92.60% 93.96% 512912014 437 43 90. 16% 93.82% 513012014 404 30 92.57% 93. 78% 513112014 385 13 96.62% 93.86% 12,469 765 93.86% Printh on: 0812512014 14:03:48 1:3 .lopmah 2004 9mm..- EMS 4? emu/Hi 47 :\AD\002\02\2X02\2X02177.docx 433 Em ergency Compliance Rgsponses La 5 Comgliagce Rug Com QI. 61112014 359 13 96.38% 96.38% 61212014 363 1 1 96.97% 96.68% 61312014 400 31 92 25% 95.10% 61412014 417 21 94.96% 95.06% 61512014 38 1 24 93.70% 94.79% 61612014 401 14 96.51% 95.09% 61712014 394 24 93.91% 94.92% 61812014 386 1 7 95.60% 95.00% 61912014 438 1 3 97.03% 95.25% 611012014 386 22 94.30% 95.16% 611 112014 386 31 91 .97% 94.87% 611212014 434 46 89.40% 94.37% 611312014 403 42 89.58% 94.00% 611412014 374 18 95.19% 94.08% 611512014 373 19 94.91% 94.13% 611612014 406 45 88.92% 93.79% 611712014 421 46 89.07% 93.50% 611812014 365 32 91 23% 93.38% 611912014 362 10 97.24% 93 57% 612012014 393 41 89.57% 93.37% 612 112014 391 35 91 .0 5% 93.2 6% 612212014 355 19 94.65% 93.32% 612312014 404 15 96.29% 93.4 5% 612412014 333 27 92.95% 93.43% 612512014 394 31 92. 13% 93.38% 612612014 429 28 93.47% 93.38% 612712014 397 13 96.73% 93.51% 612812014 422 49 88.39% 93.31% 612912014 369 16 95.66% 93.39% 613012014 41 1 12 97.08% 93.52% 1 1,797 765 93.52% Printed on: 0812512014 14:04:26 Ion-?10h 201-4 EMS AM 48 :\AD\002\02\2X02\2X02177.docx 434 "memm Em ergency Com llance Rgsgonses 1% Comgliancg Run Com 71112014 384 31 91 .93% 91 .93% 71212014 400 30 92.50% 92.22% 71312014 399 47 88.22% 90.87% 71412014 431 38 91.18% 90.95% 71512014 430 36 91.63% 91.10% 71612014 358 21 94.13% 91.55% 71712014 380 19 95.00% 92.02% 71812014 391 24 93.86% 92.25% 71912014 402 26 93.53% 92.39% 711012014 383 25 93.47% 92.50% 711112014 379 13 96.57% 92.85% 711212014 374 16 95.72% 93.08% 711312014 397 21 94.71% 93.21% 711412014 390 21 94.62% 93.31% 711512014 421 35 91. 9% 93.19% 711612014 386 23 94.04% 93.24% 711712014 374 14 96.26% 93.41% 711812014 379 23 93.93% 93.44% 711 912014 385 20 94.81 93.51 712 012014 407 15 96.31% 93.66 712112014 409 24 94.13% 93.68% 712212014 395 37 90.6 3% 93.54% 712312014 423 26 93.85% 93.56% 712412014 363 17 95.32% 93.62% 712512014 414 35 91.55% 93.54% 712612014 376 12 96.81% 93.66% 712712014 396 20 94.95% 93.70% 712812014 394 24 93.91% 93.71% 712912014 383 29 92.43% 93.67% 713012014 389 23 94.09% 93.68% 713112014 379 25 93.40% 93.67% 12, 171 770 93.67% Pri nbed on: 0 312512014 E115 an lg?; p. axe. w: 49 :\AD\002\02\2X02\2X02177.docx 435 TRM Prima P1 Com liance Data Trackin Sheet Au ust 2013 Inc Late Inc Late Inc Late Inc Inc Inc Late 13 0 1 .008/3/2013 92.00% 0 100.00% 10 100.00% 2 1 91.67% 9 66.67% 12 100.00% 23 2 91 .30% 8/5/2013 91.13% 2 187.50% 115 1 00.00% 19 89.47% 15 80.00% 22 100.00% 37 4 89.19% 8/7/2013 92.41% . 18 100.00% 28 89.29% 18 83.33% 28 100.00% 45 91.1 1 1 1% 1 61 8/1 1/2013 92.1 1% 92.00% 100.00% 86.84% 84.00% 97.50% 71 91 .55% 8/13/2013 92.13% 93.10% 96.77% 89.13% 85.19% 98.00% 84 90.48% 8/15/2013 92 94.59% 96.88% 88.46% 86.67% 98.28% 90 91 .1 1% 8/17/2013 92.94% 95.35% 97.14% 89.39% 86.84% 97.22% 92.00% 8/19/2013 92.33% 93.62% 97.37% 87.84% 86.67% 97.65% 91 .30% 8/21 13 94.12% 95. 88.89% 87.04% 9 .00% 91 . 8/23/2013 94.55% 87.64% 87:10% 96.36% 8/25/2013 94.83% 88.17% 88.24% 96.67% 1% 3 . 88.10% 8/31/2013 88.64% here :\AD\002\02\2X02\2X02177.docx 436 P1 Com liance Data Trackin Sheet September 2013 Inc Late Inc Late Inc Late Inc Late Inc Inc Late Inc Late 9/1/2013 27 4 85.19% 2 1 50.00% 5 0 100.00% 7 1 85.71% 3 0 100.00% 3 1 66.67% 7 1 85.71100.00% 16 1 90.92.24% 12 2 83.33% 14 0 100.00% 21 95.24% 18 88.89% 95.24% 30 90.00% 1 13 2 84.629/7/201 3 153 93.46% 15 2 86.67% 20 100.00% 27 96.30% 86.96% 27 96.30% 41 92.68% 1 211 94.31% 22 1% 28 100.00% 36 9 35 9 .14% 94.92% 9/1 1/201 92.13% 28 89.29% 36 97.22% 43 86.1 1% 52 92.31% 91 .67% 9/1 3/2013 92.62% 32 90.63% 44 97.73% 56 87:80% 62 .94% 93.33% 91.76% 37 91.89% 96.1 62 84.31% 73 93.1 91.09.91 53/19/2013 91.47% 91.84% 94.44% 85.71 92.55% 91.74% 9/21/2013 91.04% 90.74% 95.00% 85.25% 93.33% 90.98% 1 . 1 86. 94 9/25/2013 90.82% 90.32% 88.10% 85.29% 94.21% 90.32% 9/27/ 201 91 .35% 91 .30% 88.76% 86.49% 94.78% 90.30% 91 .45% 88.00% 89.36% 87.65% 8 94.59% 90.75% 51 :\AD\002\02\2X02\2X02177.docx 437 TRM Prima P1 Com liance Data Trackin Sheet October 2013 Inc Late Late Inc Late Inc Late Inc Late 10/1/2013 30 2 93.33% 0 100.00% 4 0 100.00% 10 1 90.00% 2 1 50.00% 2 0 100.00% 5 0 100.00% 10/3/201 67 6 91.04% 1 90.91% 100.00% 17 94.12% 6 66.67% 6 1 83.33% 17 1 94.12% 1 . 10/5/2013 118 18 84.75% 1 94.12% 100.00% 26 76.92% 11 81.82% 16 1 93.75% 35 77.14% 10/7/2013 1 58 20 87.34% 95.24% 93.75% 34 82.35% 13 84.62% 29 96.55% 45 80.00% 10/9/201 192 23 88.02% 95.65% 94:74% 44 81.82% 16 872571: 35 97.14% 55 83.64% 10/1 1/2013 241 29 87.97% 95.83% 96.15% 58 81 .03% 22 81 82% 9 .78% 66 83.33% 10/13/201 279 88.53% 96.43% 97.14% 60 81 67% 26 84.62% 98.00% 80 82.50% 10/15/2013 322 89.13% 93.94% 97.44% 70 84.29% 31 87.10% 98.25% 82.61% 89.1 91 . 98.28% 1 . . 10/19/2013 90.63% 89.58% 98.1 1% 87.64% 87.80% 98.63% 85.71% 10/21/2013 91.19% 90.91% 98.1 5% 88.54% 88.64% 98.75% 86.40% 10/23/201 3 91 .30% 91 .80% 98.31% 87.50% 88.89% 98.88% 86.76% 1 3 90.93% 92.19% 98.39% 86.09% 87.27% 98.94% 87:33% 10/27/201 90.32% 91.18% 96.97% 85.61% 86.44% 98.1 1% 87.50% 10/29/201 90.44% 90:41% 97.01% 86.01% 87:10% 98.25% 87:71 10/31 13 90.4890.48% 97.37% 85.43% 85.71% 87.77% 3.30 52 :\AD\002\02\2X02\2X02177.docx 438 TRM Prima P1 Com liance Data Tracking Sheet November 2013 Inc Late Inc Late Inc Late Inc Late Inc Inc Late Inc Late 11/1/2013 29 1 96.55% 4 1 75.00% 3 0 100.00% 4 0 100.00% 1 0 100.00% 6 0 100.00% 11 0 100.0090.91% 8 0 100.00% 5 1 93.33100.0092.1 13 1% 16 93.75% 21 1 95.2495.24% 1 28 96. 94. 1 1/7/2013 92.67% 15 93.33% 21 95.24% 25 92.00% 17 76.47% 34 97.06% 38 94.74% 11 13 188 . 17 94.12% 24 89.19% 23 39 9 . 48 11/1 1/2013 246 93.09% 26 96.15% 31 96.77% 92.45% 28 51 98.04% 96.49% 36 11/13/2013 294 92.86% 32 93.75% 37 94.59% 93.10% 36 63 98.41% 94.12% 11/1 13 92.73% 36 94.44% 43 93.02% 94.03% 38 98. 92.50% 1 1 41 1 . 11/19/2013 91.65% 45 95.56% 90.57% 93.75% 97.87% 88.99% 11/21/2013 91.45% 96.00% 89.29% 94.32% 98.06% 87.3911/25/2013 91.19% 95.16% 84.13% 95.24% 84.62% 97.52% 87.14% 11/27/2013 91.58% 94.29% 85.07% 95.54% 85.92% 97.78% 87.42% 11 13 92.05% 94.67% 86.30% 95.90% 86.84% 97.26% 88.27% 4 53 :\AD\002\02\2X02\2X02177.docx 439 TRM Prima P1 Com liance Data Trackin Sheet December 2013 12/ 1 /201 100.00% 2 0 100.00% 2 100.00% 3 100.00% 100.00% 6 100.00% 12/3/201 95.08% 6 100.00% 100.00% 91.67% 100.00% 100.0012/7/201 93.29% 100.00% 92.00% 89.66% 87.50% 97.37% 93.1 0% 1 1 94.76% 100.00% 93. 33% 91 89% 90.00% 97.92% 95.12% 12/11/201 93.88% 100.00% 94.87% 91.67% 86.67% 98.31 91.84% 12/13/201 93.42% 96. 89.47% 86.11% 92.31% 12/15/201 90.91% 91.89% 96.00% 90.32% 85.00% 94. 94% 86. 30% 1 2/1 12/17/201 88.92% 90.48% 94.12% 87.18% 80.00% 93.33% 86.59% 12/1 48% 79.1 12/19/201 88.63% 90.70% 94.64% 86.59% 78.43% 92.86% 86.96% 1 12/21/201 89.41% 91.49% 94.92% 87.78% 80.36% 93.46% 87.61% 1 2/23/201 89.39% 92.00% 93.94% 87.25% 82.54% 93.28% 87. 50% 1 82.54% 1 2/2 5/201 89. 72% 92.16% 94. 52% 87.39% 80.88% 93. 94% 88.49% 1 Z2 7/201 90.22% 92.86% 94.94% 86.99% 82.19% 94.52% 89.1 2% 95. 87 1 12/29/201 90.24% 90.16% 95.29% 87.02% 83.54% 94.38% 89.33% 1231/201 90.30% 90.77% 95.45% 86.81% 84.71% 94.61% 88.89% Paste last line 1 3 4 6 7 90.30% 90.77% 2 95.45% 86.81% 84.71% 94.61% 88.89% otal 91 5 92.31 87 97.01 1 90. Bucket 11.1 4. 20. :\AD\002\02\2X02\2X02177.docx 440 TRM Primary P1 Com liance Data Trackin Sheet Janua 2014 Inc Inc Inc Late Inc Late Inc Inc Inc Late 1/1 1 25 2 92.00% 4 100.00% 5 1 80.00% 4 0 100.00% 3 100.00% 4 75.00% 5 0 100.00% /3/201 85.71% 6 100.0088.89% 12 83.33% 20 85.001/7/201 52 26 30 43 69.77% 15 86.67% 32 78.1382.00% 71 1 1/1 1/201 67 79.06% 86.84% 29 82.76% 81 36% 78 18 76.92% 1/13/201 74 79.95% 88.10% 36 77.78% 81.16% 20 77.01% 1 1 78 81 .0 88.89% 80.95% 81 .82% 20 79.381/19/201 82.67% 88.71% 80.00% 79.82% 82.00% 83.50% 20 83.47% 1/21/201 83.60% 89.23% 80.00% 81.51% 84.21% 84.35% 21 84.09% 1 1 84.1 1 81 1/25/ 201 85.07% 90.67% 82.29% 83.45% 86.15% 85.61% 84.62% 1 1/27/201 83.73% 90.00% 79.61% 82.12% 83.82% 86.01% 82.74% 1 84.23% 89.66% 80.00% 82.80% 82.67% 87.33% 83.52% 81 1 1/31/201 84.66% 89.36% 81 36% 82.74% 82.72% 87.97% 84.18have 84.66% 89.36% 81 36% 82.74% 82. 8 .9 84.18% otal 55 441 P1 Compliance Data Tracking Sheet February 2014 Overall Subzone 1 Subzone 2 Subzone 3 Subzone 4 Inc Late Inc Late Inc Late Inc Late Inc Late 2/1/2014 29 1 96.55% 5 0 100.00% 3 1 66.67% 13 0 100.00% 8 0 100.00% 2/2/2014 32 8 75.00% 4 2 50.00% 4 0 100.00% 12 4 66.67% 12 2 83.33% 2/3/2014 19 1 94.74% 3 0 100.00% 9 1 88.89% 4 0 100.00% 3 0 100.00% 2/4/2014 17 2 88.24% 5 0 100.00% 1 0 100.00% 2 0 100.00% 9 2 77.78% 2/5/2014 31 9 70.97% 2 1 50.00% 4 2 50.00% 6 1 83.33% 19 5 73.68% 2/6/2014 34 5 85.29% 8 3 62.50% 9 0 100.00% 7 0 100.00% 10 2 80.00% 2/7/2014 34 6 82.35% 8 0 100.00% 7 3 57.14% 8 2 75.00% 11 1 90.91% 2/8/2014 26 4 84.62% 3 0 100.00% 11 3 72.73% 8 1 87.50% 4 0 100.00% 2/9/2014 22 5 77.27% 5 2 60.00% 2 0 100.00% 9 1 88.89% 6 2 66.67% 2/10/2014 31 4 87.10% 7 0 100.00% 10 2 80.00% 5 2 60.00% 9 0 100.00% 2/11/2014 28 4 85.71% 5 0 100.00% 4 0 100.00% 9 3 66.67% 10 1 90.00% 2/12/2014 18 3 83.33% 3 0 100.00% 6 3 50.00% 5 0 100.00% 4 0 100.00% 2/13/2014 32 3 90.63% 3 0 100.00% 9 2 77.78% 7 0 100.00% 13 1 92.31% 2/14/2014 22 3 86.36% 2 0 100.00% 8 2 75.00% 7 1 85.71% 5 0 100.00% 2/15/2014 22 1 95.45% 5 0 100.00% 5 0 100.00% 6 1 83.33% 6 0 100.00% 2/16/2014 35 2 94.29% 5 1 80.00% 13 1 92.31% 8 0 100.00% 9 0 100.00% 2/17/2014 26 5 80.77% 4 1 75.00% 6 0 100.00% 8 2 75.00% 8 2 75.00% 2/18/2014 16 2 87.50% 4 0 100.00% 8 2 75.00% 3 0 100.00% 1 0 100.00% 2/19/2014 27 3 88.89% 4 0 100.00% 8 1 87.50% 7 0 100.00% 8 2 75.00% 2/20/2014 26 6 76.92% 6 1 83.33% 8 2 75.00% 6 2 66.67% 6 1 83.33% 2/21/2014 27 3 88.89% 8 0 100.00% 3 0 100.00% 6 1 83.33% 10 2 80.00% 2/22/2014 32 5 84.38% 9 2 77.78% 12 1 91.67% 3 1 66.67% 8 1 87.50% 2/23/2014 21 2 90.48% 4 1 75.00% 5 1 80.00% 4 0 100.00% 8 0 100.00% 2/24/2014 16 0 100.00% 3 0 100.00% 6 0 100.00% 2 0 100.00% 5 0 100.00% 2/25/2014 30 0 100.00% 6 0 100.00% 5 0 100.00% 9 0 100.00% 10 0 100.00% 2/26/2014 26 3 88.46% 6 0 100.00% 10 1 90.00% 4 1 75.00% 6 1 83.33% 2/27/2014 15 2 86.67% 2 0 100.00% 7 1 85.71% 2 0 100.00% 4 1 75.00% 2/28/2014 28 0 100.00% 5 0 100.00% 7 0 100.00% 5 0 100.00% 11 0 100.00% Overal Suozone1 Subzone2 Suazone 3 Subzone 4 Total 722 92 87.26% 134 14 89.55% 190 29 84.74% 175 23 86.86% 223 26 88.34% Weather excTotal 722 69 90.44% 134 13 90.30% 190 21 88.95% 175 20 88.57% 223 15 93.27% Bucket -72 3.20 -20 7.10 -29 7.50 -26 6.25 '33 18.45 On Time Calls Needed -32 -47 -50 -41 -123 56 442 mm P1 Compliance Data Tracking Sheet March 2014 Overall Subzone 1 Subzone 2 Subzone 3 Subzone 4 Inc Late Inc Late Inc Late Inc Late Inc Late 3/1/2014 26 5 80.77% 4 2 50.00% 12 1 91.67% 1 0 100.00% 9 2 77.78% 3/2/2014 20 2 90.00% 6 0 100.00% 3 1 66.67% 7 0 100.00% 4 1 75.00% 3/3/2014 11 0 100.00% 1 0 100.00% 3 0 100.00% 1 0 100.00% 6 0 100.00% 3/4/2014 24 2 91.67% 4 0 100.00% 7 2 71.43% 4 0 100.00% 9 0 100.00% 3/5/2014 20 1 95.00% 6 1 83.33% 6 0 100.00% 4 0 100.00% 4 0 100.00% 3/6/2014 20 1 95.00% 5 0 100.00% 3 0 100.00% 6 1 83.33% 6 0 100.00% 3/7/2014 22 1 95.45% 3 0 100.00% 7 0 100.00% 6 1 83.33% 6 0 100.00% 3/8/2014 22 2 90.91% 8 0 100.00% 4 0 100.00% 5 1 80.00% 5 1 80.00% 3/9/2014 16 3 81.25% 0 8 3 62.50% 4 0 100.00% 4 0 100.00% 3/10/2014 20 3 85.00% 4 0 100.00% 6 2 66.67% 6 1 83.33% 4 0 100.00% 3/11/2014 28 2 92.86% 5 0 100.00% 7 0 100.00% 5 0 100.00% 11 2 81.82% 3/12/2014 28 4 85.71% 6 0 100.00% 5 1 80.00% 6 1 83.33% 11 2 81.82% 3/13/2014 17 1 94.12% 2 0 100.00% 4 0 100.00% 3 1 66.67% 8 0 100.00% 3/14/2014 29 3 89.66% 5 1 0.00% 7 1 85.71% 9 0 100.00% 8 1 87.50% 3/15/2014 28 3 89.29% 4 0 100.00% 11 2 81.82% 6 1 83.33% 7 0 100.00% 3/16/2014 26 96.15% 7 0 100.00% 5 1 80.00% 4 0 100.00% 10 0 100.00% 3/17/2014 16 1 93.75% 3 0 100.00% 5 1 80.00% 2 0 100.00% 6 0 100.00% 3/18/2014 24 0 100.00% 6 0 100.00% 8 0 100.00% 4 0 100.00% 6 0 100.00% 3/19/2014 19 2 89.47% 2 0 100.00% 0 0 6 0 100.00% 11 2 81.82% 3/20/2014 18 2 88.89% 8 1 87.50% 4 0 100.00% 3 1 66.67% 3 0 100.00% 3/21/2014 18 2 88.89% 2 0 100.00% 7 1 85.71% 2 1 50.00% 7 0 100.00% 3/22/2014 23 0 100.00% 8 0 100.00% 7 0 100.00% 4 0 100.00% 4 0 100.00% 3/23/2014 23 5 78.26% 7 2 71.43% 8 1 87.50% 4 2 50.00% 4 0 100.00% 3/24/2014 25 3 88.00% 4 0 100.00% 7 1 85.71% 8 2 75.00% 6 0 100.00% 3/25/2014 23 0 100.00% 5 0 100.00% 4 0 100.00% 5 0 100.00% 9 0 100.00% 3/26/2014 25 2 92.00% 8 0 100.00% 6 1 83.33% 3 1 66.67% 8 0 100.00% 3/27/2014 29 2 93.10% 6 1 83.33% 6 1 83.33% 8 0 100.00% 9 0 100.00% 3/28/2014 23 2 91.30% 4 1 75.00% 4 0 100.00% 4 1 75.00% 11 0 100.00% 3/29/2014 29 1 96.55% 6 0 100.00% 4 0 100.00% 7 0 100.00% 12 1 91.67% 3/30/2014 27 2 92.59% 8 1 87.50% 6 0 100.00% 10 1 90.00% 13 0 100.00% 3/31/2014 16 0 100.00% 4 0 100.00% 3 0 100.00% 1 0 100.00% 8 0 100.00% Overall Zone 1 Zone 2 Zone 3 Zone 4 Total 695 58 91.65% 151 10 93.38% 177 20 88.70% 148 16 89.19% 229 12 94.76% rWeather exc. 5 1 1 3 Total 695 53 92.37% 151 10 93.38% 177 19 89.27% 148 15 89.86% 229 9 96.07% Bucket -70 16.50 -23 12.65 -27 7.55 -22 7.20 -34 25.35 On Time Calls Needed -165 -84 -50 -48 -169 :\AD\002\02\2X02\2X02177.docx 57 443 mm. P1 Compliance Data Tracking Sheet April 2014 Overall Subzone 1 Subzone 2 Subzone 3 Subzone 4 Inc Late Inc Late Inc Late Inc Late Inc Late 4/1/2014 28 2 92.86% 8 0 100.00% 4 0 100.00% 7 2 71.43% 9 0 100.00% 4/2/2014 23 0 100.00% 5 0 100.00% 7 0 100.00% 5 0 100.00% 6 0 100.00% 4/3/2014 21 5 76.19% 5 1 80.00% 5 0 100.00% 5 3 40.00% 6 1 83.33% 4/4/2014 17 0 100.00% 2 0 100.00% 4 0 100.00% 5 0 100.00% 6 0 100.00% 4/5/2014 20 1 95.00% 2 0 100.00% 5 1 80.00% 3 0 100.00% 10 0 100.00% 4/6/2014 24 2 91.67% 3 0 100.00% 9 1 88.89% 4 1 75.00% 8 0 100.00% 4/7/2014 30 0 100.00% 7 0 100.00% 10 0 100.00% 2 0 100.00% 11 0 100.00% 4/8/2014 25 0 100.00% 3 0 100.00% 8 0 100.00% 3 0 100.00% 11 0 100.00% 4/9/2014 22 2 90.91% 5 0 100.00% 7 1 85.71% 2 0 100.00% 8 1 87.50% 4/10/2014 28 2 92.86% 10 0 100.00% 6 1 83.33% 3 0 100.00% 9 1 88.89% 4/11/2014 20 0 100.00% 5 0 100.00% 6 0 100.00% 4 0 100.00% 5 0 100.00% 4/12/2014 30 4 86.67% 5 0 100.00% 7 1 85.71% 3 0 100.00% 15 3 80.00% 4/13/2014 18 2 88.89% 2 0 100.00% 5 0 100.00% 3 0 100.00% 8 2 75.00% 4/14/2014 19 1 94.74% 7 1 85.71% 5 0 100.00% 3 0 100.00% 4 0 100.00% 4/15/2014 20 1 95.00% 5 1 80.00% 3 0 100.00% 3 0 100.00% 9 0 100.00% 4/16/2014 21 1 95.24% 5 0 100.00% 4 1 75.00% 5 0 100.00% 7 0 100.00% 4/17/2014 15 1 93.33% 4 1 75.00% 1 0 100.00% 4 0 100.00% 6 0 100.00% 4/18/2014 21 2 90.48% 2 0 100.00% 11 1 90.91% 2 1 50.00% 6 0 100.00% 4/19/2014 16 3 81.25% 3 1 66.67% 3 0 100.00% 2 0 100.00% 8 2 75.00% 4/20/2014 18 1 94.44% 4 0 100.00% 6 1 83.33% 4 0 100.00% 4 0 100.00% 4/21/2014 22 2 90.91% 5 0 100.00% 6 2 66.67% 6 0 100.00% 5 0 100.00% 4/22/2014 24 1 95.83% 1 0 100.00% 9 0 100.00% 4 1 75.00% 10 0 100.00% 4/23/2014 19 1 94.74% 3 0 100.00% 4 0 100.00% 4 0 100.00% 8 1 87.50% 4/24/2014 20 1 95.00% 7 1 85.71% 3 0 100.00% 6 0 100.00% 4 0 100.00% 4/25/2014 31 1 96.77% 3 0 100.00% 15 0 100.00% 6 1 83.33% 7 0 100.00% 4/26/2014 25 2 92.00% 5 0 100.00% 5 0 100.00% 4 1 75.00% 11 1 90.91% 4/27/2014 26 2 92.31% 4 0 100.00% 6 1 83.33% 9 1 88.89% 7 0 100.00% 4/28/2014 17 2 88.24% 2 0 100.00% 7 1 85.71% 3 0 100.00% 5 1 80.00% 4/29/2014 27 3 88.89% 10 1 90.00% 8 0 100.00% 3 1 66.67% 6 1 83.33% 4/30/2014 26 0 100.00% 8 0 100.00% 6 0 100.00% 4 0 100.00% 8 0 100.00% 0 Overal 190%) Subzone1 Suozone 2 Suozone 3 Subzone 4 Total 673 45 93.31% 140 7 95.00% 185 12 93.51% 121 12 90.08% 227 14 93.83% Weatherexc. Total 673 45 93.31% 140 7 95.00% 185 12 93.51% 121 12 90.08% 227 14 93.83% Bucket -67 22.30 ?21 14.00 -28 15.75 -18 6.15 ~34 20.05 On Time Calls Needed -223 -93 -105 -41 -133 58 444 mm P1 Compliance Data Tracking Sheet May 2014 Overall Subzone 1 Subzone 2 Subzone 3 Subzone 4 Inc Late Inc Late Inc Late Inc Late Inc Late 5/1/2014 20 3 85.00% 4 0 100.00% 5 1 80.00% 4 0 100.00% 7 2 71.43% 5/2/2014 32 0 100.00% 7 0 100.00% 8 0 100.00% 3 0 100.00% 14 0 100.00% 5/3/2014 26 1 96.15% 3 0 100.00% 12 1 91.67% 4 0 100.00% 7 0 100.00% 5/4/2014 24 2 91.67% 4 0 100.00% 5 0 100.00% 8 2 75.00% 7 0 100.00% 5/5/2014 30 2 93.33% 6 1 83.33% 7 1 85.71% 7 0 100.00% 10 0 100.00% 5/6/2014 24 4 83.33% 5 1 80.00% 8 1 87.50% 6 2 66.67% 5 0 100.00% 5/7/2014 26 0 100.00% 4 0 100.00% 7 0 100.00% 7 0 100.00% 8 0 100.00% 5/8/2014 28 1 96.43% 10 0 100.00% 7 1 85.71% 4 0 100.00% 7 0 100.00% 5/9/2014 34 3 91.18% 8 1 87.50% 10 0 100.00% 4 1 75.00% 12 1 91.67% 5/10/2014 23 2 91.30% 0 0 9 1 88.89% 3 1 66.67% 11 0 100.00% 5/11/2014 22 1 95.45% 6 1 83.33% 8 0 100.00% 3 0 100.00% 5 0 100.00% 5/12/2014 26 2 92.31% 8 0 100.00% 6 0 100.00% 7 0 100.00% 5 2 60.00% 5/13/2014 27 4 85.19% 5 1 80.00% 9 2 77.78% 5 0 100.00% 8 1 87.50% 5/14/2014 17 1 94.12% 4 0 100.00% 2 0 100.00% 5 0 100.00% 6 1 83.33% 5/15/2014 17 0 100.00% 3 0 100.00% 4 0 100.00% 4 0 100.00% 6 0 100.00% 5/16/2014 25 1 96.00% 5 1 80.00% 5 0 100.00% 6 0 100.00% 9 0 100.00% 5/17/2014 15 1 93.33% 4 0 100.00% 4 0 100.00% 2 1 50.00% 5 0 100.00% 5/18/2014 17 0 100.00% 4 0 100.00% 8 0 100.00% 2 0 100.00% 3 0 100.00% 5/19/2014 22 0 100.00% 5 0 100.00% 6 0 100.00% 6 0 100.00% 5 0 100.00% 5/20/2014 26 3 88.46% 5 0 100.00% 5 1 80.00% 8 2 75.00% 8 0 100.00% 5/21/2014 17 2 88.24% 4 0 100.00% 2 1 50.00% 4 1 75.00% 7 0 100.00% 5/22/2014 17 2 88.24% 4 0 100.00% 3 0 100.00% 4 2 50.00% 6 0 100.00% 5/23/2014 32 1 96.88% 7 0 100.00% 9 0 100.00% 7 1 85.71% 9 0 100.00% 5/24/2014 17 1 94.12% 5 0 100.00% 4 1 75.00% 3 0 100.00% 5 0 100.00% 5/25/2014 22 2 90.91% 8 1 87.50% 5 0 100.00% 4 1 75.00% 5 0 100.00% 5/26/2014 24 1 95.83% 5 1 80.00% 6 0 100.00% 5 0 100.00% 8 0 100.00% 5/27/2014 26 0 100.00% 6 0 100.00% 4 0 100.00% 5 0 100.00% 11 0 100.00% 5/28/2014 22 0 100.00% 3 0 100.00% 7 0 100.00% 4 0 100.00% 8 0 100.00% 5/29/2014 31 1 96.77% 2 0 100.00% 5 0 100.00% 5 1 80.00% 19 0 100.00% 5/30/2014 26 3 88.46% 2 0 100.00% 7 1 85.71% 7 1 85.71% 10 1 90.00% 5/31/2014 24 2 91.67% 7 0 100.00% 2 0 100.00% 6 1 83.33% 9 1 88.89% Overal Suozone 1 Suozone2 Suozone 3 Subzone 4 Total 739 46 93.78% 153 8 94.77% 189 12 93.65% 152 17 88.82% 245 9 96.33% Weather exc. Total 739 46 93.78% 153 8 94.77% 189 12 93.65% 152 17 88.82% 245 9 96.33% Bucket -74 27.90 -23 14.95 ~28 16.35 -23 5.80 -37 27.75 'TTime Calls Needed -279 -99 -109 -38 -185 59 445 TRM P1 Compliance Data Tracking Sheet June 2014 Overall Subzone 1 Subzone 2 Subzone 3 Subzone 4 Inc Late Inc Late Inc Late Inc Late Inc Late 6/1/2014 19 3 84.21% 3 1 66.67% 5 1 80.00% 7 0 100.00% 4 1 75.00% 6/2/2014 18 1 94.44% 6 0 100.00% 3 0 100.00% 4 0 100.00% 5 1 80.00% 6/3/2014 27 0 100.00% 6 0 100.00% 7 0 100.00% 4 0 100.00% 10 0 100.00% 6/4/2014 29 5 82.76% 4 2 50.00% 10 3 70.00% 6 0 100.00% 9 0 100.00% 6/5/2014 33 2 93.94% 6 0 100.00% 11 0 100.00% 5 1 80.00% 11 1 90.91% 6/6/2014 24 0 100.00% 5 0 100.00% 4 0 100.00% 9 0 100.00% 6 0 100.00% 6/7/2014 29 1 96.55% 7 0 100.00% 5 0 100.00% 3 0 100.00% 14 1 92.86% 6/8/2014 19 0 100.00% 3 0 100.00% 4 0 100.00% 3 0 100.00% 9 0 100.00% 6/9/2014 28 1 96.43% 5 0 100.00% 6 1 83.33% 2 0 100.00% 15 0 100.00% 6/10/2014 25 0 100.00% 6 0 100.00% 2 0 100.00% 4 0 100.00% 13 0 100.00% 6/11/2014 17 0 100.00% 2 0 100.00% 4 0 100.00% 5 0 100.00% 6 0 100.00% 6/12/2014 28 0 100.00% 6 0 100.00% 8 0 100.00% 7 0 100.00% 7 0 100.00% 6/13/2014 21 2 90.48% 2 0 100.00% 4 1 75.00% 7 1 85.71% 8 0 100.00% 6/14/2014 17 1 94.12% 1 0 100.00% 10 1 90.00% 2 0 100.00% 4 0 100.00% 6/15/2014 21 1 95.24% 3 0 100.00% 5 1 80.00% 3 0 100.00% 10 0 100.00% 6/16/2014 19 2 89.47% 4 1 75.00% 3 0 100.00% 1 0 100.00% 11 1 90.91% 6/17/2014 20 3 85.00% 2 0 100.00% 5 1 80.00% 5 1 80.00% 8 1 87.50% 6/18/2014 25 4 84.00% 7 1 85.71% 8 1 87.50% 3 0 100.00% 7 2 71.43% 6/19/2014 25 4 84.00% 6 1 83.33% 4 1 75.00% 4 1 75.00% 11 1 90.91% 6/20/2014 24 3 87.50% 4 1 75.00% 5 1 80.00% 4 0 100.00% 11 1 90.91% 6/21/2014 35 5 85.71% 7 0 100.00% 11 1 90.91% 5 0 100.00% 12 4 66.67% 6/22/2014 24 7 70.83% 3 2 33.33% 7 2 71.43% 6 1 83.33% 8 2 75.00% 6/23/2014 24 3 87.50% 5 0 100.00% 6 2 66.67% 3 0 100.00% 10 1 90.00% 6/24/2014 22 2 90.91% 7 1 85.71% 6 1 83.33% 4 0 100.00% 5 0 100.00% 6/25/2014 32 2 93.75% 5 0 100.00% 9 1 88.89% 9 1 88.89% 9 0 100.00% 6/26/2014 23 3 86.96% 6 0 100.00% 8 0 100.00% 5 2 60.00% 4 1 75.00% 6/27/2014 22 1 95.45% 1 0 100.00% 5 0 100.00% 11 1 90.91% 5 0 100.00% 6/28/2014 24 4 83.33% 6 1 83.33% 4 1 75.00% 4 1 75.00% 10 1 90.00% 6/29/2014 25 6 76.00% 5 2 60.00% 7 2 71.43% 7 1 85.71% 6 1 83.33% 6/30/2014 22 1 95.45% 8 1 87.50% 6 0 100.00% 4 0 100.00% 4 0 100.00% Overal Suozone1 Suozone2 Suozone 3 Subzone 4 Total 721 67 90.71% 141 14 90.07% 182 22 87.91% 146 11 92.47% 252 20 92.06% Weather exc. Total 721 67 90.71% 141 14 90.07% 182 22 87.91% 146 11 92.47% 252 20 92.06% Bucket ?72 5.10 ?21 7.15 ?27 5.30 -22 10.90 -38 17.80 On Time Calls Needed -51 -47 -35 -72 -118 60 :\AD\002\02\2X02\2X02177.docx 446 P1 Compliance Data Tracking Sheet July 2014 TRM Overall Subzone 1 Subzone 2 Subzone 3 Subzone 4 Inc Late Inc Late Inc Late Inc Late Inc Lat 7/1/2014 30 0 100.00% 7 0 100.00% 6 0 100.00% 5 0 100.00% 12 0 100.00% 7/2/2014 25 2 92.00% 5 0 100.00% 8 0 100.00% 5 2 60.00% 7 0 100.00% 7/3/2014 23 2 91.30% 5 0 100.00% 5 2 60.00% 9 0 100.00% 4 0 100.00% 7/4/2014 16 1 93.75% 3 0 100.00% 3 0 100.00% 4 0 100.00% 6 1 83.33% 7/5/2014 17 1 94.12% 6 0 100.00% 4 0 100.00% 1 0 100.00% 6 1 83.33% 7/6/2014 16 1 93.75% 2 0 100.00% 4 0 100.00% 7 1 85.71% 3 0 100.00% 7/7/2014 20 0 100.00% 7 0 100.00% 3 0 100.00% 1 0 100.00% 9 0 100.00% 7/8/2014 21 4 80.95% 4 0 100.00% 6 2 66.67% 3 1 66.67% 8 1 87.50% 7/9/2014 28 4 85.71% 9 1 88.89% 5 2 60.00% 6 0 100.00% 8 1 87.50% 7/10/2014 32 4 87.50% 4 0 100.00% 9 1 88.89% 12 2 83.33% 7 1 85.71% 7/11/2014 22 2 90.91% 8 1 87.50% 4 1 75.00% 4 0 100.00% 6 0 100.00% 7/12/2014 25 3 88.00% 3 0 100.00% 5 1 80.00% 6 0 100.00% 11 2 81.82% 7/13/2014 29 6 79.31% 6 1 83.33% 9 3 66.67% 6 1 83.33% 8 1 87.50% 7/14/2014 21 2 90.48% 11 0 100.00% 4 1 75.00% 3 1 66.67% 3 0 100.00% 7/15/2014 16 0 100.00% 0 0 7 0 100.00% 2 0 100.00% 7 0 100.00% 7/16/2014 25 2 92.00% 2 0 100.00% 6 0 100.00% 4 0 100.00% 13 2 84.62% 7/17/2014 18 1 94.44% 3 0 100.00% 4 0 100.00% 6 0 100.00% 5 1 80.00% 7/18/2014 17 0 100.00% 3 0 100.00% 6 0 100.00% 1 0 100.00% 7 0 100.00% 7/19/2014 16 2 87.50% 5 0 100.00% 1 1 0.00% 3 1 66.67% 7 0 100.00% 7/20/2014 21 2 90.48% 4 1 75.00% 5 0 100.00% 4 0 100.00% 8 1 87.50% 7/21/2014 19 2 89.47% 4 0 100.00% 7 2 71.43% 0 0 8 0 100.00% 7/22/2014 21 2 90.48% 4 1 75.00% 7 0 100.00% 1 1 0.00% 9 0 100.00% 7/23/2014 25 0 100.00% 3 0 100.00% 9 0 100.00% 4 0 100.00% 9 0 100.00% 7/24/2014 24 1 95.83% 5 0 100.00% 4 1 75.00% 8 0 100.00% 7 0 100.00% 7/25/2014 25 0 100.00% 4 0 100.00% 7 0 100.00% 3 0 100.00% 11 0 100.00% 7/26/2014 30 3 90.00% 5 0 100.00% 6 1 83.33% 10 1 90.00% 9 1 88.89% 7/27/2014 23 3 86.96% 4 0 100.00% 5 1 80.00% 2 0 100.00% 12 2 83.33% 7/28/2014 28 3 89.29% 10 0 100.00% 9 3 66.67% 7 0 100.00% 2 0 100.00% 7/29/2014 27 0 100.00% 11 0 100.00% 1 0 100.00% 5 0 100.00% 10 0 100.00% 7/30/2014 21 0 100.00% 4 0 100.00% 7 0 100.00% 5 0 100.00% 5 0 100.00% 7/31/2014 28 4 85.71% 4 1 75.00% 13 2 84.62% 2 0 100.00% 9 1 88.89% Overal Subzone 1 Subzone 2 Subzone 3 Subzone 4 Total 709 57 91.96% 155 6 96.13% 179 24 86.59% 139 11 92.09% 236 16 93.22% Weatherexc. Total 709 57 91.96% 155 6 96.13% 179 24 86.59% 139 11 92.09% 236 16 93.22% Bucket -71 13.90 -23 17.25 -27 2.85 -21 9.85 -35 19.40 On Time Calls Needed -139 -115 -19 -65 -129 61 447 OI Response Time Compliance Date IS BETWEEN 0801/2013 AND 08/31/2013 "E'er nu Waco (Cumulative) I Life Threatening Non-Life Threatening Scheduled Unscheduled - comrath comphance? 90/? Emergencies Emergencies Routine Transfers Routine Transfers 8:59 12:59 20:00 1:00:"Con?dentiagg. Proprietary" :\AD\002\02\2X02\2X02177.docx 448 5% Response Time Compliance Date IS BETWEEN 08/01/2013 AND 0613112013 0% 1653 99% 0 0% 0 0% 382 100% 1 "Confidential Proprietary? 63 :\AD\002\02\2X02\2X02177.docx 449 Response Time Compliance Date is BETWEEN 09/012013 AND 09/30/2013 ?3 Waco (Cumulative) I Compliance 90% Life Threatening Non-Life Threatening S'cheduled Unscheduled Emergencies Emergencies Routine Transfers Routine Transfers 8 59 12 59 20 00 1.0059 3 it ?In ?la It It "lo ?Con?dentialegi Proprietarr' :\AD\002\02\2X02\2X02177.docx 450 . . 02"- Response Time Compliance ia?im Dale IS BETWEEN 09/01/2013 AND 0900/2013 ?3 5/ :c 3 10 54:59 0 0% 386 100% 1 0% 1,603 99% 0 0% 13 100% 0 0% 1g; 100% 5( 3 10 60:59 0 016 386 10016 1 016 1,604 9992 0 016 13 10016 0 016 16?5 100% 71 :c a 1. (mar 0 0% 386 100% 1 0% 1,606 100% 0% 13 100% 0 0% 165 100% :\AD\002\02\2X02\2X02177.docx "Confidential 8. Proprletary" 65 451 Response Time Compliance Date l8 BETWEEN 10/01/2013 AND 1031/2013 EEIMC nu Waco (Cumulative) I . Life Threatening Non-Life Threatening Scheduled Unscheduled leracled Compliance 90% . . . Emergencies Emergencues Routine Transfers Routine Transfers 8,59 1259 20 00 10059 "Con?dentiagg. Proprietary? :\AD\002\02\2X02\2X02177.docx 452 Response Time Compliance ll! Date IS BETWEEN 11/01/2013 AND 11/30/2013 Waco (Cum ulatlve) I Contracted Gunman? 90% Life Threatening Non-Llfe Threafemng Scheduled Unscheduled EmergenCIes Emergencues Routine Transfers Routine Transfers 8.59 12:59 20:00 1 00:"lo ?Confidential 8- Proprietary" 67 :\AD\002\02\2X02\2X02177.docx 453 It" Response Time Compliance Date IS BETWEEN 11/01/2013 AND 11/30/2013 l55:001055:59 1 1% 164 100% "Con?dential CgProprietary" :\AD\002\02\2X02\2X02177.docx 454 Response Time Compliance no Date IS BETWEEN 12/01/2013 AND 12/31/2013 Waco (Cumulative) . 0 Life Threatening Non-Life Threatening Scheduled Unscheduled con?ded Gunman? 90" Emergencies Emergencies Routine Transfers Routine Transfers 3.59 12 59 20:00 1 0059 ?Confidential Proprietary? 69 :\AD\002\02\2X02\2X02177.docx 455 It" Response Time Compliance Date IS AND 12/31/2013 nu 33;oot033;59 "Con?dential ioProprietary" :\AD\002\02\2X02\2X02177.docx 456 Response Time Compliance Date IS BETWEEN 01/01/2014 AND 01/31/2014 Waco (Cumulative) I Contracted Compliant! 90% Life Threatening Non-Life Thregtening Sgheduled Unscheduled Emergencnes Emergenmes Routine Transfers Routme Transfers 5 59 12 59 20/00 1 0059 "Con?dential Proprietary" 71 :\AD\002\02\2X02\2X02177.docx 457 . . g: a Response Time Compliance a?am Date IS BETWEEN 02/01/2014 AND Waco (Cu mulatlve) I Cmnacted Cmp'iance: 90% Life Threatening Non-Life Threetening ?cheduled Unscheduled Emergencnes Emergenmes Routine Routine Transfers 8:59 12.59 20:00 100259 "Con?dential7?. Proprietary" :\AD\002\02\2X02\2X02177.docx 458 . . a: a Response Time Compllance :?im Date IS BETWEEN 02/01/2014 AND 02/28/2014 4' :91: 101159 0 0% 404 100% 0% 1,542 99% 016 27 10011. 1 0:6 24_a_ 99% ?unmeg 014, 404 10015 1 01/. 1,543 10015 0 01s 27 1005. 0% 243 99% 0 0% 404 100% 0 0% 1,543 100% 0% 27 100% 2 1% 250 100% :\AD\002\02\2X02\2X02177.docx "Con?dential 8. Proprietary? 73 459 OI Response Time Compliance Date IS BETWEEN 03/01/2014 AND 03/31/2014 "E'er nu Waco (Cumulative) I Life Threatening Non-Life Threatening Scheduled Unscheduled - comrath comma?: 90/? Emergencies Emergencies Routine Transfers Routine Transfers 8:59 12:59 20:00 1:00:"Con?dential? Proprletary? :\AD\002\02\2X02\2X02177.docx 460 Response Time Compliance nu Date IS BETWEEN 03/01/2014 AND 03/31/2014 0 0% 454 100100% 0 0% 200 96% "Con?dential 8. Proprietary? 75 461 OI Response Time Compliance Date IS BETWEEN 04/01/2014 AND 04/302014 "E'er nu Waco (Cumulative) I Life Threatening Non-Life Threatening Scheduled Unscheduled - comrath comma?: 90" Emergencies Emergencies Routine Transfers Routine Transfers 8:59 12:59 20:00 1:00:59 an we ve ve alive "Confidentiai? Proprietary" :\AD\002\02\2X02\2X02177.docx 462 Response Time Compliance Date IS BETWEEN 04/01/2014 AND 04/30/2014 441 100% 0% 1630 99% 0 0% 19 100% :\AD\002\02\2X02\2X02177.docx "Confidential Proprietary? 77 463 . L0 Response Time Compliance 5.53m nu Dale IS BETWEEN 05/01/2014 AND 0561/2014 [Waco (Cumulative) I Life Threatening Non-Life Threatening Scheduled Unscheduled comrade" compl'ance 90% Emergencies Emergencies Routine Transfers Routine Transfers 8:59 12:59 2000 1.00.?Confidentialfg Proprietary? :\AD\002\02\2X02\2X02177.docx 464 Response Time Compliance Date IS BETWEEN 05/01/2014 AND 05/312014 0 0% 442 100100% 0 0% 21 2 96% "Con?dential 8 Proprieta ry" 79 :\AD\002\02\2X02\2X02177.docx 465 Response Time Compliance Date IS BETWEEN 06/01/2014 AND 05/30/2014 ?3 Waco (Cumulative) I Compliance 90% Life Threatening Non-Life Threatening Scheduled Unscheduled Emergencies Emergencies Routine Transfers Routine Transfers 59 12 59 20 00 1 0059 "In ?Con?dentiaiag Proprietarr' :\AD\002\02\2X02\2X02177.docx 466 5% Response Time Compliance Date IS BETWEEN 06/01/2014 AND 066012014 0% 10 100"Confidential Proprietary? 81 :\AD\002\02\2X02\2X02177.docx 467 Response Time Compliance Dale IS BETWEEN 07/01/2014 AND 07/310014 [Waco (Cumulative) I . Life Threatening Non-Life Threatening Scheduled Unscheduled cm'mded comphance 90% Emergencies Emergencles Routine Transfers Routine Transfers 6?59 12.59 20:00 1.0059 'lo "Con?dential 8- Proprietary? 82 :\AD\002\02\2X02\2X02177.docx 468 Response Time Compliance 5335?: um Date IS BEFWEEN 07/01/2014 AND 07/31/2014 0 0% 419 100% 1 0% 1 100% 0 0% 23 100% 0 0% 207 98% "Con?dential 8. Proprietary" 83 :\AD\002\02\2X02\2X02177.docx 469 I PARAMEDICS Orientation Schedule September 8, 2014 Day 1 Monday 08:00 - Welcome to Sunstar Debbie Vass 09:30 CAREPLUS 09:30 - Sunstar Paramedics/Paramedics Plus Richard Schomp 10:00 10:00 - Breakouts 12:00 A Fit Testing Ed Wilson ?Vaccinations Greg Moran Kevin Hull Pinellas County Certification Doreen Schomp Pictures Pam Stargel 12:00 - Lunch in HOUSE COO Mark Postma 13:00 CAO Debbie Vass DOO Richard Schomp 13:00 - Just Culture Greg Moran 14:00 Josh Schuster 14:00 - Bene?ts Overview; Paperwork Kathy Jonas 15:00 I-9, W-4, LOA, Injury: Work or Non Work Related 1500? Payroll Overview Kimberly Gargiulo 16:00 Sharon Lee 16:00 - Emergency Management Ron Shiner 17:00 :\AD\002\02\2X02\2X02177.docx 470 sens?tale PARAMEDICS HOMEWORK Instructions: HIPAA - ETMC Regional Healthcare System - After signing on to the website you will register with the Medelearn Org. before starting your HIPAA Training. Due to new Texas regulation for HIPAA every Paramedics Plus Employee is required to complete an online HIPAA training every two years. How to Register: First Time Student, Click Here to RegistergAll employees need to register as first time students. Registered Student Log In (Retuning student) User ID: Student?s last name Password: Last four of the student?s Social Security number Only complete the course titled S/Paramedic Plus/Patients Plus Employees New HIPAA Training.? If you have any difficulty registering forthe course or completing the course. Please contact Doreen Schomp Dschomp@sunstarems.com or Vicki Glenn Vqlenn@sunstarems.com. OPEN COURSES MENU Lesson- Course Due By Work Course Priority Level Course Name Date Completed Type 10 1 EMS/Paramedics Plus/Patients Plus Employees - New 0% Reql?ired HIPAA Training 10 1 HealthFirst Employees - New HIPAA Training 0% Required 10 1 Hospital Employees - New HIPAA Training 0% ReqUired 10 1 Employees - New HIPAA Training 0% Required 2 1500 Customer Service Refresher 0% Reql?imd In are a few courses on our system you are reguired to take. HOMEWORK: - You only need to take the following listed courses: To log on to the system, please go to There you will be asked to enter: User Name your PR number 34 Password Sunstar1234 Company ID 11392 it Next box contains ?My Course Assignments?, ?Take a Course? and ?Credentials Education". If you have been requested to Take a Course please click on take a course and view the ?Course Catalog?. Choose ?My Company? or Library?. Scroll down to the course you want to take and click on it. The first screen will show you the ?Course Overview?. You will register to take the course (which is up in the right hand corner) and begin taking your course. It is not necessary to print your certi?cate as is automatically saves in My Education Record in this section. Default Course Title Topic Credw Status Date Review 0 Mo Review 0 Month Review 0 Sunstar Orientation 2 Revised 09.2014 85 471 s?Mst PARAMEDICS Orientation Schedule Day 2 Day 3 Tuesday, September 9, 2014 OR Wednesday, September 10, 2014 EVOC St. Petersburg College All State Campus 3200 34 Street South St. Petersburg, FL. 33733 08:30 ?17:00 Allstate Center Driving Course EVOC Please, NO open toe shoes, or inappropriate length shorts and No red shirts or shirts with logos on it. Tomorrow, Thursday, we will be working with the stretcher outside. So, please wear comfortable clothing Sunstar Orientation 3 Revised 09.2014 86 :\AD\002\02\2X02\2X02177.docx 472 and shoes (preferably your black military style work boots). Orientation Schedule September 11, 2014 Day 4 Thursday 08:00 - Stretcher Mechanics Greg Moran 12:00 Proper Stretcher Making Kevin Hull Health Well Being Josh Schuster Bariatric Unit, Pediatric Mate Car Seat 12:00 - Lunch 13:00 On Your Own 13:00 - Crew Resource Management Josh Schuster 14:00 Greg Moran 14:00 - Standing Operating Procedures (SOP) Supervision 15:00 Incident Command Leslie McAllister Materials Management 15:00 - Risk Management Kathy Sterling 15:30 15:30 Electronic Patient Care Reports Ed Wilson 17:00 HELP Menu Hydrant Mapping Mobile Home Park Maps Sunstar Orientation 4 Revised 09.2014 87 :\AD\002\02\2X02\2X02177.docx 473 an. IC .1 PARAMEDICS Orientation Schedule September 12, 2014 Day 5 - Friday 08:00 - Electronic Patient Care Reports Ed Wilson 10:00 Billing Documentation 10:00 Union Local 247 Union Rep. 10:30 10:30 - Support Services Philip Young 11:15 1 1 :15 Scheduling Overview Tracy Johnson 12:15 12:15 - Lunch 13:15 On Your Own 13:15 - Patient Billing Services Michelle Hamilton 14:15 Federal Regulations Training Patient Signatures 14:15 - Payroll Kimberly Gargiulo 14:30 Set employees up in system Sharon Lee 14:30 - Communication Center Ron Shiner 17:00 Sunstar Orientation 5 Revised 09.2014 88 :\AD\002\02\2X02\2X02177.docx 474 s1; Test-a? I PARAMEDICS Orientation Schedule September 15, 2014 Day 6 Monday 08:00 - Mapping Familiarization Paul Hawkey 12:00 12:00 - Lunch - 13:00 On Your Own 13:00 - Mapping Familiarization Paul Hawkey 15:00 15:00 - Specialty Services Josh Schuster 15:30 SWAT, FTO, Preceptor, Special Events Team Larry Marshall ACH, CCT, MHT 15:30 - CME Compliance Vicki Glenn 17:00 Employee Services Paperwork Turn ln Kathy Jonas :\AD\002\02\2X02\2X02177.docx Stapled, signed pages of Orientation Book Final Orientation Test Sunstar Orientation 6 Revised 09.2014 89 475 sen-w PARAMEDICS Orientation Schedule September 16, 2014 Day 2 Tuesday 08:00 EVOC Legal Kevin Hull 12:00 Vehicle Overview and Mechanics Communications Road Safety Road Rage and Distracted Driver 12:00 Lunch - - 13:00 On Your Own 13:00 - EVOC Driving Lecture EVOC Instructors 15:00 Kevin Hull 15:00 EVOC - Emergency Driving Greg Moran 17:00 Sunstar Orientation 7 Revised 09.2014 90 :\AD\002\02\2X02\2X02177.docx 476 seesaw PARAMEDICS Orientation Schedule September 17, 2014 Day 3 Wednesday 08:00 OSHA Lecture, Hazcom, Greg Moran 12:00 Kevin Hull 12:00 - Lunch 13:00 On Your Own 13:00 - Workplace \?olence Kevin Hull 17:00 Street Survival Greg Moran Fire Extinguisher Training Patient Care Safety issues Diversity Elderly Diversity Elderly and Child Abuse Sexual Allegations Safety Training Sexual Harassment Prevention Patient Belongings .. Employee BBQ Wednesday. September 17. 2014 .5. from 1 100-1900 Sunstar Orientation 8 Revised 09.20 I 4 91 :\AD\002\02\2X02\2X02177.docx 477 s- In?ll-an PARAMEDICS Orientation Schedule September 18, 2014 Day 9 Thursday 08:00 - Pharmacology Education and Training Dept. 17:00 WE 92 :\AD\002\02\2X02\2X02177.docx 478 culling! T?i?u la PARAMEDICS The September 2014 ONLINE CME This CME is Required for ALL EMTs and Paramedics. PLEASE NOTE: September 2014 CME Online will launch first part of September. EACH CME should be completed in the FIRST month offered. September is the month, October is considered to be the month. CME Stipend Paz Changes Starting Agril 1?t On the first pay date after December 1, 2011 the Employer will offer a five hundred dollar ($500. 00) CME stipend to Pine/[as County EMS, full time paramedics, EMT or SSC employees who have not been suspended for non-compliance in the during the period December 1 2010 and December 1, 2011 On the ?rst pay date after December 1 in 2012 and 2013 employees shall receive a CME Stipend in accordance with the requirements set forth below: Full-time Pine/las County EMS EMTs, Paramedics and SSCs shall receive a $500.00 CME stipend and, part- time Pine/las County EMS EMTs, Paramedics and SSCs (not required to attend CME by another employer) shall receive a $250 CME stipend so long as they completed all of the required CME and in house training in the month in which the training was initially offered, If employees do not complete the training in the month that it was initially offered but complete it in the following/makeup month, the stipend shall be reduced by fifty percent. Employees who do not complete the training in the month that it was initially offered or the following/makeup month then those employees shall not be eligible to receive any CME stipend. The following conditions shall also apply; The employee must be on the payroll at the time of payment and have been employed by the Employer for at least one (1) year at time of payment and CME attendance must be required by the employee?s job description. Exceptions to this payment shall be at the Employer?s discretion and handled on a case by case basis (Le. employees on approved LOAs, work related injuries) SPC - CME implemented a new policy which went into effect December 17 2010. The policy is for the ?On-Line? Employees who have not completed the CME in the month offered (in this case will be June) and then in the make up month (in this case, July) will have 10 days during the special make up month (in this case, August). The approximate dates (give or take a few) will be starting on 5th of the month thru 15th of the month. AFTER failing to make up the special CME, the employee will then be suspended by the Office of the Medical Director. Finally, there will be a $66.00 charge to attend the ?special? ?special? make up. If you are on a Leave of Absence with us, durina the entire 90 days CME is offered, it is not required for you to do the CME while out on LOA. However, it will be required for you to complete any and all prior to your return to work. WEBSITEwith:User name, first initial of your first name, first initial of your last name and the last 4 of your social security number John Doe would use JD1234) 3. Password 6 digit County ID Number 4. Click on: EMP0319 PCEMS CME link Please contact the office at davis.glenn@spcollege.edu or (727) 341-3601 if there are any questions or concerns. Username/ Password/Assistance: Did you forget your user name? Did you forget your password? Do you have questions about how to log on? The SPC Help Desk can assist you with these issues. Please contact them at HelpDesk@spcollege.edu or 727-341-4357. Sun star Orientation 10 Revised 09.2014 93 :\AD\002\02\2X02\2X02177.docx 479 sea?saw PARAMEDICS E-mail Disclosure: ANGEL e-mail may be subject to public and media disclosure under the Florida Sunshine Act covering communications with state employees on matters of public concern. SPC EMERGENCY MEDICAL SERVICES CONTINUING MEDICAL Sunday August Make-Up Handtevy 7 14 21 28 St. Petersburg College Monday I Tuesday 1 2 SS - 0900 8 9 SI. #1 - 1330 SI. #20 - 1800 SI. #53 - 0900 15 16 SI. #1 1330 SI. #48 - 1700 22 23 SI. #1 - 1330 29 30 AS OF: 08/06/ 14 I Wednesday 3 SS - 1300 10 SI. #20 - 1800 SI. #53 - 0900 17 SI. #48 - 1700 24 SI. #65 0900 Thursday 4 SS - 0900 1 1 SI. #20 - 1800 SI. #53 - 0900 18 SI. #48 0900 25 SI. #65 - 0900 September 2014 Friday Saturday St. #65 0900 AUGUST MAKE-UP CLASSES :\AD\002\02\2X02\2X02177.docx Sunstar Orientation 11 94 480 Revised 09.2014 ell-seller la PARAMEDICS Station #1 Saint Petersburg Fire Rescue Station 455 8th ST Saint Petersburg, FL 33731 Station #20 South Pasadena Fire Department 911 Oleander WAY South Pasadena, FL 33707 Station #29 Seminole Fire Rescue 11195 70th Ave Seminole, FL 33772 Station #35 Pinellas Park Fire Department 11350 43rd ST Pinellas Park, FL 33780 Station #48 CleanNater Fire Rescue 1700 North Belcher Road Clearwater, FL 33765 Station #53 Safety Harbor Fire Department 3095 McMuIIen Booth Rd. Safety Harbor, FL 33761 Station #65 Palm Harbor Special Fire Control Rescue District 250 Lake RD Palm Harbor, FL 34684 Sunstar Paramedics Headquarters 12490 Ulmerton Rd Largo, FL 33774 Pinellas County Center for Pre-hospital Medicine Florida Botanical Gardens 12211 Walsingham Road, Largo, FL 33774 Sunstar Orientation 12 Revised 09.2014 95 :\AD\002\02\2X02\2X02177.docx 481 Avera?? McKennan Hospital 1325 South cam Avenue University Health Center Po. Box 5045 Sioux Falls, SD 57117-5045 (605) 322-8000 September 1 7, 2 0 1 4 This letter of intent is written in support of creating a partnership between Avera McKennan School of Emergency Medical Services (EMS) and Paramedics Plus. This partnership is for the purpose of advancing patient care through EMS educational programs for Paramedics Plus employees and the students of the School 'l?he Avera McKennan School of EMS desires to establish a relationship with Paramedics Plus that will permit the sponsorship of EMS educational programs such as Emergency Medical Technician, Paramedic, Advanced Cardiac Life Support, Pediatric Advanced Life Support, and Pre-Hospital Trauma Life Support for Paramedics Plus employees, and field internship opportunities for the School of EMS students. Education programs may include classroom, hospital, and field internship experiences. The educational programs shall meet the requirements of the Standards and Guidelines for the Accreditation of Educational Programs in the Emergency Medical Services Professions established by the Commission on Accreditation of Allied Health Educational Programs (CAAHEP) as recommended by the Committee on Accreditation of Educational Programs for the Emergency Medical Services Professions The programs meet the requirements of the American Heart Association, the National Registry of Emergency Medical Technicians, the National Associations of EMT's, and are approved by the South Dakota Department of Public Safety - EMS Division and the South Dakota Board of Medical and Osteopathic Examiners. We look forward to joining Paramedics Plus in their vision for the advancement of medical care for the residents of South Dakota. if you have any questions, please do not hesitate to contact me. Si ncerely, . i 2%qu x? Don Jones Avera McKennan School of EMS Avera McKennan Hospital and University Health Center 1325 South CliiTAvenue Sioux Falls, South Dakota 57117-5045 dormQuestwayggra,gil?g (605) 322-2086 Sponsored by the Benedictine 93 and Presentation Sisters :\AD\002\02\2X02\2X02177.docx 482 SUBJECT: POLICY: EFFECTIVE DATE: Purpose Critical Incident Stress Management (CISM) 600-35 12/01/2004 To describe the circumstances where there may be a need for CISM intervention during an event that has had or may have the potential for a serious emotional impact on personnel. It is intended to de?ne a critical incident. de?ne CISM. and to describe the procedures for CISM. Description: A Critical Incident is an event that has the potential to produce a crisis response. Crisis Intervention is first aid. CISM is a comprehensive. integrated multi- component crisis intervention system that consists of a set of core interventions useful for public safety, schools. industry, communities. etc. The goals of CISM are: - Stabilize prevent from worsening - Reduction of - Re-establish functional capacity and/or. - Seek further assessment or increased level of care Policy 1. Communications Center System Status Controller (850) will ?rst acknowledge that there is an event or situation that a crew is involved in that has the potential of a serious emotional impact. b. c. d. e. Code or death (traumatic or non-traumatic) involving an adolescent 18 years of age oryounger Death (expected or unexpected) including attempted suicide of a PCEMS employee. Large scale operations involving ?ve or more patients with deaths. Injury or illness requiring hospitalization of a PCEMS personnel. Any incident the Director of Operations or the CISM leader deems appropriate to notify them. The $80 will then alert the Communication Center Supervisor who, in turn. will notify the on-duty Supervisor to respond to the scene. The on-duty supervisor will contact the Risk Manager or his/her designee immediately. If the Risk Manager does not respond within 10 minute the Ops Manager or Director of Operations will be notified. The Risk Manager will contact the current crisis intervention partner to respond to the employees' needs. This may involve meeting with crewmembers at the scene. hospital or headquarters. :\AD\002\02\2X02\2X02177.docx The crew(s) will be placed out of service as needed. Employee well-being will be assessed offer a break. food. drink. talk Introduction 1 00-4 97 483 7. The CISM team member may chose to do a defusing if the crew(s) agrees, or at the request of the crew if appropriate. This should take anywhere between 20-45 minutes. 8. Additional CISM team members will be notified. including but not limited to, any mental Health or Pastoral team member. 9. A neutral environment. free of distraction will be provided. Never conduct a defusing at the scene. 10. After the defusing is done. the CISM team will inquire if there is a need for a formal 7- phase debrie?ng. Personnel will be provided with resources and follow-up information. 11 . At no time will any personnel return to duty if they are not mentally and physically able to do so. Introduction 1 00-4 98 :\AD\002\02\2X02\2X02177.docx 484 WORKFORCE MEMBER HEALTH AGREEMENT East Texas Medical Center Regional Healthcare System This Health Information Confidentiality Agreement ("Agreement") applies to all members of EThtC?s workforce including sta?'. employees. volunteers, trainees and others who, in the performance of work for ETMC. are under ETMC's direct coinrol and who have access to protected health infomiation maintained, received, or created by Please read all sections of this Agreement. and privacy and security poltetes and procedures, before below. ETMC has a legal and ethical responsibility to safeguard the pnvacy of all ETMC patients and to protect the con?dentiality and security of their health in formation In the course of your employment. whether or not you are directly involved in provuling patient services, you may hear information that relates to a patient?s health. or read. access or see computer systems or clchonic or paper ?les containing and/or create documents containing PHI. Because you may have contact with PHI. ETMC requests that you agree to the following as a condition of your employment: I understand that all protected health information which may in any way identify a patient or relate to a patient?s health must be maintained con?dentially. 1 will regard con?dentiality as a central obligation of patient care. I also understand that I must treat computerized data and information with the same con?dentiality. 'tc i a I agree that, except as required under my job responsibilities or as directed by ETMC, I Will not at any time during or atler my work for about or share any PHI with any person I understand that this means that I should not discuss patients with co-workers exeept as required by my job duties. I understand and agree that persoruiel who have access to health records must preserve the con?dentiality and integrity of such and no one is permitted access to the health record of any patient without a necessary, legitimate, worlorelated reason. I shall not inappropriately examine or photocopy a patient record or remove a patient record from ETMC. 1 will use ETMC's computers. systems and electronic information in a manner consistent with my job functions, and for conducting ETMC business. a . I understand that when is within my control, I must use all reasonable means to prevent it from being disclosed to others, except as otherwise pemtittcd by this Agreement. When PHI must be discussed with other healthcare practitioners in the course of my work for ETMC, shall make reasonable efforts to avoid such conversations from being overheard by others who are not involved in the patient?s care. Protecting the con?dentiality of PHI means protectmg it from unauthorized use or disclosure in any form oral, 11m, written, or electronic. If I keep patient notes on a handheld or laptop computer or other electronic device. will ensure that my supervisor knows of and has approved such use I agree not to send patient identi?able health information in an entail, or email attachment. miless I it!" directed to do so by my supervisor. In order to protect the integrity of ET computing equipment and systems, I Will not maintain personal information. for business other than that pertaining to or any form ot?non-compuny data on computing systems. In addition. I will not download any so?warc. or ?les onto system. If I notice any activity on or malfunction of computer systems. including events that may be the result of computer viruses or malicious software. I will notify my supervisor immediately. Ea Mguggnenl. I am aware that the user le, passwords. and access codes assigned to me are con?dential and are to be used only by me I will not at any time reveal to anyone my user le. passwords. or access codes to information systems. and I will take all reasonable measures to prevent the disclosure of my access codes or passwords to anyone. feel that my user ID. password, or access code has been used by anyone else, I will notify my supervisor immediately. I will not enter tmnsactitms in any computer system under another person?s user ll). password, and?or access code, nor will I attempt to gain access to information or computerized systems for which I am not speci?cally authorized. or otherwise have a ?need to know? in the course of my work for ETMC. Revised 9/23/l3 Al I ll 99 :\AD\002\02\2X02\2X02177.docx 485 When accessing or logging on to cmnputeri'led systems. will take care not to allow others to View my user IDs. passwords. or access codes. if 1 notice any discrepancies when I log onto a system. or if I have trouble using any user password. or access code that has worked in the past, I will notify my supervisor immediately I will comply with ETMC procedures in the assigrunent and format ofmy password. If i lose or forget my password. or wish to have it changed I will notify my supervisor. who will then relay 3 request to the Information Technology department for action. I also understand that if may. at any time. monitor and audit my use ot?the electronic/automated patient record and systems. 5. est cti i ol'H atio If. as part of my job responsibilities, 1 must take Pill off the premises of ETMC, i shall ensure that have permission to do so. I shall protect the PHI from disclosure to others. and I shall ensure that all of the PHI. in any form. is returned to ETMC or destroyer! in a manner that renders it unreadable and unusable by anyone else. 0. Termination. At the end ot'my employment with IZTMC, or when my assignment for is otherwise terminated. i will make sure that I take no Pill with me? and that all in any form is returned to or destroyed in a manner that renders it unreadable and unusable by anyone else. Discharge or termination. whether voluntary or not. shall not affect my ongoing obligation to safeguard the con?dentiality of PHI and to retum or destroy any such PHI in my possession ?anctior? I understand that my unauthorized access or disclosure of PHI may Violate state or federal law and cause irreparable marry to li'l?Mt? and harm to the patient who is the subject of the Pitt and may result in disciplinary and/or legal action being taken against me. including tcnnimtion of my employment. 8. ortir Nor - ted Us i agree to immediately report to any unauthorized use or disclosure of PHI. or the unauthorized use of computer systems or access codes. by any person. The person to whom I report unauthorized uses and disclosures is my supervisor. the Privacy (mice at 903-596-3388 or the Privacy llotline at l-800-688-3l 44. 9. Disclosure to Third Earties. I understand that I am not authorized to share or disclose any Pill with or to anyone who is not part ot? workforce. [inlets otherwise permitted by this Agreement. IO. its ot't re an tot? and ur a Qe cos. I agree to cooperate with any investigation by the Secretary of the S. Department of Health and Human Services or any agent or employee of HHS or other oversight agency, for the purpose of determining whether ETMC is in compliance with federal or state privacy laws. I Disclosures Reguircd by Law. I understand that nothing in this Agreement prevents me from using or disclosing PHI it? I am required by law to use or disclose Pllt. By my signature below, I agree to abide by all the terms and conditions of this Agreement and af?rm that it is my responsibility to complete ETMC's HIPAA training on privacy and security. Signature of Workforce Member: Printed Name: Date: ITacilily/Demrnnent: Social Security Number: Work Phone: Do you work at other Facilities? Yes No Il?yes. please list: PLEASE FAX THIS AGREEM T0 lRl'l'Y OFFICE (903) 531-8881 Revised 9/23/[3 2 All 100 :\AD\002\02\2X02\2X02177.docx 486 0 DC DB .- Plus East ?xes Medical Center Reame "murmur Svsum Paramedics I I 2014 CALIFORNIA OPEN ENROLLMENT NEWSLETTER an organization of the Eligibility, Qualified Life Events, Health Care Reform Medical and Drug Benefits Understanding a Health Account Dental Benefits Vision Benefits Disability and Life Benefits Flexible Spending Account Kaiser Permanente Servrces Employee Assistance. Program: Added Value Programs Benefit Contributions Open This Enrollment Newsletter covers only the highlights of Paramedics Plus' Benefits Programs. While we have tried to be as acetirate as possible in developing this information. the official plan documents govern in all cases. Paramedics Plus intends to continue these programs but reserves the right to change or end them at any time. Participation in the programs does not imply a contract of employment. :\AD\002\02\2X02\2X02177.docx Welcome to Paramedics Plus 2014 Open Enrollment November 20th?December 4th Paramedics Plus is pleased to present your 2014 Open Enrollment information. During Open Enroll- ment, you can enroll in or make changes to your benefit elections without having a qualifying change in life status event. This benefits summary explains your benefit options available to you for the new plan year. Our benefit plan year is from January 1. 2014 through December 31, 2014. Paramedics Plus offers a comprehensive selection of benefits that you and your family can use to protect your health, finances and future. In addition. there is flexibility built into the program so that you can select the benefit options that fit the needs of you and your family. We invite you to take some time and carefully consider each of the benefit options to decide which is right for you and your family. Should you have any questions, you may call the Employee Benefits Service Center at 888-215-9819, Monday?Friday, 9 a.m.-8 pm. ET. Changes for for 2014? The Paramedics Plus benefits package is designed with the understanding that each employee has different needs. We appreciate your commitment to your work as well as your desire to make a positive difference. Annually we review our benefits package and compare many plans to ensure our offerings remain competitive and cost effective. We are pleased to announce that there will no plan or carrier changes for 2014. We will, however, be changing our new hire waiting period to of the month following 60 days to align with PPACA. There will also be slight changes to payroll contributions. You will also be able to cover your eligible dependent children for medical, dental. vision and voluntary life to age 26 regardless of student status. EnrollOnlineTM Makes Benefit Enrollment Easy! Paramedics Plus has engaged with Trion's Benefit Administration Div. and as a result, you will be using ?EnrollOnline? for selecting your annual Open Enrollment benefit elections. This year's enroll- ment is active which means you must go online through EnrollOnline and review and/or make ap- propriate changes to your 2014 employee benefit package. if you will be covering your eligible de~ pendents. in addition to providing their name. date of birth and relationship, you will also need to include their Social Security Number. We are also collecting your Beneficiary Designation for your life insurance coverage; you will need to provide your beneficiary's name. date of birth and relation? ship. Easy Steps for Enrolling Onllne a Go to a Login using your Employee ID (6 digit number) to Enter your password using the last four digits of your Social Security Number (you will be prompted to change password after initial login) ?4 Confirm your personal information) information name, address, date of birth, dependents 9 Review your benefits and make your appropriate elections. Make sure that you add your life insurance beneficiary(les). 9 Call the Paramedics Plus Employee Benefit Service Center with questions. The Employee Advocates can answer your benefit questions about plan provisions and enrollment options. from 9:00 am. - 8 pm. ET, Monday-Friday. 101 487 ELIGIBILITY ll regular full-time employees working 36+ hours per week will be eligible 2014 Open Enrollment Newsletter You may elect medical/prescription coverage for your dependent(s) including: Your legally married spouse (same or opposite sex) Your domestic partner (same or opposite sex, subject to imputed income) Dependent children under the age of 26: your naturally born child(ren), step- child(ren), legally adopted child(ren). or eligible foster child(ren) regardless of Unmarried disabled children over the age of 26 who are not able to support themselves because of their physical or mental disability. The carrier must ap- prove this coverage. NOTE: Effective January 1. 2014. you may cover your dependent children up to the age of 26 regardless of student status for medical/prescription, dental, vision and voluntary dependent life insurance. for benefits on the ist of the month the ualif in de endent?s marital followingGO days ofemployment. status and student status (excludes spouse and child of dependent child) QUALIFIED LIFE EVENTS Under Section 125 of the Internal Revenue Service (IRS) code, you are allowed to pay for certain group insurance premiums with tax- free dollars. However, you must make your benefit elections carefully, including the choice to waive coverage. Your pretax elections will remain in effect until the next annual open enrollment period unless you experience an IRS approved qualifying change in status. Qualifying change in status events include, but are not limited to: Marriage, divorce, or legal separation 4. Death of spouse or other dependent o: Birth or adoption of a child co A spouse's employment begins or ends to A dependent?s eligibility status changes due to age, student status, marital status, or employment You or your spouse experience a change in work hours that affect benefit eligibility All changes due to a qualifying event must be made within 31 days of the family status change. Please see HR to make any changes. Because this is an IRS regulation, a new election to participate in a pre-tax program must be on file with your employer each and every year. HEALTH CARE REFORM IN 2014 2014 promises to be an important year for health care reform. That's because the law's ?individual mandate? goes into effect. One of the most important provisions of the Patient Protection and Affordable Care Act (PPACA), it requires most US. citizens and legal resi- dents to have medical insurance as of January 1, 2014 or pay a penalty. With this in mind, you should know that Paramedics Plus? medical plan meets the requirements for minimum essential coverage un~ der the law. So if you're enrolled in our medical plan for 2014, you will have coverage that satisfies the individual mandate. However, if you waive coverage under our plan, you will need to have sufficient coverage through another source, or pay the penalty unless you qualify for an exception. For example, there's no penalty for being withOut health insurance if you don't have to file a tax return because your income is below the tax-filing threshold. Sources for obtaining coverage that will satisfy the individual mandate may include a spouse's employer's health plan. a public plan like Medicaid, or the Health Insurance Marketplace. The Health Insur- ance Marketplace is an online one-stop sh0p for finding, comparing, and purchasing health insurance. For more information on the individual mandate, your options, and the Health Insurance Marketplace in general, go to healthcaregov or call the US. Government Health Insurance Marketplace Service Center at 800-318-2596. 102 :\AD\002\02\2X02\2X02177.docx 488 2014 Open Enrollment Newsletter MEDICAL BENEFITS aramedics Plus has partnered with Cigna Healthcare and Kaiser Permanente to provide you with an extensive medical bene?ts program. We are pleased to offer you Comprehensive Open Access Plus Copay and Open Access Plus Coinsurance Plans through Cigna and two ln-Network Only HMO plans though Kaiser. Please refer to the chart on the next page outlining the plans ma ior features. Paramedics Plus will be contributing $1,000 into your Chase HSA bank account if you elect individual coverage and $2,000 if you elect dependent coverage when electing the Cigna HDHP Plan. Paramedics Plus will contribute $500 to a Flexible Spending Healthcare Account when you elect the Cigna Copay or one of the Kaiser medical plans. oz. Preventive Care is covered under all medical plans with no benefit maximum, and is not subject to the annual deductible for in network care. This includes coverage for routine adult physical exams and immunizations, well baby and well child visits. Mammograms, PSA and pap smear covered at 100% of allowed amount. If related to a diagnosis, deductible and coinsurance apply. Prescription coverage (both retail and mail order) will continue to be included in the medical plans PRESCRIPTION DRUG BENEFIT 7 hen you enroll in one of the Paramedics Plus medical plans, you automatically receive prescription drug coverage. Regardless of which medical plan you select, your prescription drug benefit includes a retail and mail order option for obtaining your prescriptions. Each plan has a three-tier prescription drug option, generic, brand formulary, and brand non-formulary. To help you save money, whenever possible request a generic equivalent drug. On the following page is a summary of the copayment for obtaining a 30day prescription at retail. Save Money - Use Mail Order! The prescription plan also includes a Mail Order program, which allows you to purchase up to a 90day supply of medications you take on an ongoing basis (known as maintenance drugs). When you order prescriptions through the mail, in most cases, you pay a lesser amount than you would at a retail pharmacy for a 90-day supply. On the following page is a summary of the copayment for obtaining prescriptions at mai l-order:. For additional information on the Prescription Drug program, call Cigna or Kaiser customer service at the number located on the back of your medical identification card. Elections under the Cigna HDHP plan will be required to satisfy the Deductible before the plan will recognize the retail and mail?order prescription drug copayments. Use generic drugs whenever possible. even for over-the?counter medications Remember, the most expensive drug doesn't indicate it?s the best. There are usually less expensive generic equivalents to the drugs you see advertised on TV. Before your physician writes you a prescription, ask about generic equivalents, lower-cost brand name drugs to treat the same condition, and even over- the-counter options. 103 :\AD\002\02\2X02\2X02177.docx 489 2014 Open Enrollment Newsletter MEDICAL BENEFITS elow is a chart that highlights the medical bene?ts under the Cigna and Kaiser medical plans. This chart provides a snapshot of the differences in copayment and coinsurance levels when you use in- and out-of-network previders. This is not intended to be a comprehensive summary. It will only give you basic details about available medical plan options. For more details. please see the Summary of Bene?ts located in the Resources and Forms section of EnrollOnline. . . . Kaise' Perm-?1- Kalaor Perma- 3n 00-10 Wixx Pl- IS l?lrn reaiu'r: W. ne?te nonto Coins iralloo u'l Pm copay HVOQO an Plan ln~\otworlt end-Network Ill-Network ln-Netwom 0rin Cal Yr Deductible $200/ $400 $400 $800 $250/ $500 Out of Pocket Maximum $1.500 $3.000 $3.000 $6.000 ily . (reinsurance 80% 50% 80% Primary Care Of?ce 50% after $20 copay after Visit $20 mpay deductible deductible 50% after $20 copay after sonata om? we" $40 ?may deduct-pie deductible Inpatient 80% after 50% after 80% after Hoapltallzatlon deductible deductible deductible . 80% after 50% after 80% after ()"mmcm sugary deducnoie deductible deductible $100 copay. then no charge alter in 80% my Emergency Room network ded is met icopay waived -s dcdm?mblc admitted) RX Ded $100 $200 Drugs Rx Ded $250 (Retail - 30 day sup- I RX OOP Max Brand Name $500 Fam Generic 90% alter ded 70% after ded 53313302031? Formulaly (Brand) 80% alter nod 70% after am ?gay Non-formulary (Brand) 60% after ded 70% after ded Rx Ded $100 ind/$700 Prescription Drug(Mail Fam $250 Brand Name Order- 90 day supply) Rx OOP Max Rx ded $500 ram Generic $20 copay after den $10 copay Formulary (Brawl $40 copay after tied NM $30 copay after $100 copay after ded Non-farmulary (Brand) $500 fleXible Employer Health (are $500 Flexinie Spending Account (FSA) Spending Account Account Contribution contribution l0r 2014 contribution for 7014 Domestic Partner Imputed Income?Congress and the Internal Revenue Service (IRS) do not Currently recognize domestic partners as qualified dependents for tax free benefits such as medical, dental and vision group plans. As a result, if you enroll your domestic partner and/0r any of your domestic partner's children, you will have additional taxable income reflecting the value of the coverage previded (it will be added on a pay period basis). You must be taxed on the portion of the cost paid by the Company as well as y0ur share. Federal and state income taxes as well as taxes will be withheld each pay period and your taxable income will be reported on your W-2 form at year end. 4 104 :\AD\002\02\2X02\2X02177.docx 490 2014 Open Enrollment Newsletter UNDERSTANDING A HEALTH SAVINGS ACCOUNT What is a Health Savings Account? A Health Savings Account (HSA) is an account that can be funded with your taxexempt dollars by yourself or your employer to help pay for eligible medical expenses not covered by an insurance plan, including the deductible and coinsurance. There are certain advantages to putting money into these accounts, including favorable tax treatment. Who is eligible for an Anyone who is: Covered under an HSA-qualified High Deductible Health Plan (HDHP) oz. Not Covered by any other first-dollar medical coverage; :o Not enrolled in Medicare; or Not eligible to be claimed as a dependent on another person's tax return. When do I use my After visiting a physician, facility, or pharmacy, your medical claim will be submitted to Cigna for payment. Your HSA dollars can be used to pay your out of pocket expenses (deductibles and coinsurance) billed by the physician, facility, or pharmacy, or you can choose to save your HSA dollars for a future medical expense. When do I contribute to my HSA account, and how often can You, or your employer, can contribute to your HSA account through payroll deduction(s) or as a deposit You can contribute as often as you like, provided the annual contribution limits do not exceed: $3,300 for individual coverage or $6,550 for family coverage in 2013. individuals that are age 55 or older may be eligible to make an additional catch-up contribution of $1,000 in 2014. Individuals who are eligible individuals on the first day of the last month of the taxable year (December for most taxpayers) are allowed the full annual contribution (plus catch up contribution, if 55 or older by year end), regardless of the number of months the individual was an eligible individual in the year. For individuals who are no longer eligible individuals on that date, both the HSA contribution and catch up contribution apply pro rata based on the number of months of the year a taxpayer is an eligible individual. Paramedics Plus will make a annual contribution to your HSA account in the amount of $1,000 for an individual and $2,000 for an employee One or Employee Family. Paramedics Plus will deposit 1/2 of the annual contribution in January, 1/4 in July and 1/4 in October. This .9 amount is also pro-rated for anyone that is eligible for insurance after January lst. When can i start using my HSA dollars? You can use your HSA dollars immediately following your HSA account activation and once contributions have been made. In order to use your debit card or write yourself a check for eligible medical expenses, the bank account must have the appropriate funds in it at the time of purchase. 105 :\AD\002\02\2X02\2X02177.docx 491 2014 Open Enrollment Newsletter UNDERSTANDING A HEALTH SAVINGS ACCOUNT 9% What enroll in an HSA in the middle of a year? rm If you enroll in an HSA in the middle of a year. you are allowed to make a full year's contributions. provided that you remain covered by the HSA for at least the 12 month period following that year. What have HSA dollars left in my account at year end? The money is yours to keep. it will continue to earn interest and will be available for you and your healthcare costs next yearnetwork at time of servlce with my HSA dollars? Y0u should request that the network provider submit your claim to your health plan. You should make sure that your provider has your most up to date insurance information. Once the medical claim has been processed. out of pocket expenses will be billed. At this time you may choose to use your HSA debit card to pay for any out of pocket expenses. or you may choose to write a personal check. receiving reimbursement at a later date. You should always ask that your medical claim be submitted to the health plan before you seek reimbursement from your HSA. This procedure will ensure that provider discounts are applied. Also. remember to keep all medical receipts and Explanation of Benefits (EOBs). However. remember that in order to use the HSA debit card or be reimbursed by the HSA. you must have the monies in the account to cover the expense. How do I manage my The HSA account is your account; the HSA dollars are your dollars. Since you are the account holder. you manage your HSA account. You may choose when to use your HSA dollars or when not to use your HSA dollars. HSA dollars pay for any eligible expense. Most commonly, the HSA account holder will pay their out of pocket expenses (Le. deductible and coinsurance) associated with their high deductible health plan with their HSA dollars. What expenses are for relmbursement from my HSA dollars may be used for qualified medical expenses inCurred by the aceOunt holder and his or her spouse and dependents. Quali?ed medical expenses are expenses for medical care and are outlined within IRS Section 21.3w). In summary, the IRS Section 213(d) states that "the expense has to be primarily for the prevention or alleviation of a physical or mental defect or illness." Examples include out of pocket expenses for physician and hospital fees. prescription drugs. over the counter medications such as aspirin (when purchased with a written prescription). dental and hearing care expenses. deductibles, coinsurance and much more. For more information. see IRS Publication 502 at Can I use my HSA dollars for non-eligible expenses? Money withdrawn from an HSA account to reimburse non-eligible expenses is taxable at regular income tax rates to the acmunt holder and is subject to an additional 20% tax penalty. unless over age 65. disabled. or upon death of the account holder. Are there any banking or transaction fees to use my account? There is a monme service charge which is covered by Paramedics Plus. As with any other banking account. you could also incur fees for items such as a returned item. stopping payment or replacing a lost debit card which you would be responsible for. 106 :\AD\002\02\2X02\2X02177.docx 492 2014 Open Enrollment Newsletter UNDERSTANDING A HEALTH SAVINGS ACCOUNT The following are examples of eligible and ineligible medical expenses. This list is not all-inclusive. Remember. the IRS may modify its list of eligible expenses from time to time. As always. consult your tax advisor should you recurre speci?c tax advice. Eligible medical expenses may include: 5. Ineligible medical expenses may include: Acupuncture Alcoholism treatment Ambulance Arti?cial limb Arti?cial teeth Breast reconstruct ion surgery (mastectomy-related) Chiropractor Contact lenses and solutions Cosmetic surgery( if clue to trauma or d'seaSe) Dental treatment (X-rays. ?llings. braces. extractions etc) Diagnostic devices (such as blood sugar test kits for diabetics) Doctor's office (including OWSicians. surgeons, specialists or other medical practitioners) visits and procedures Advance payment for future medical care Amounts reimbursed from any other source (such as other health coverage or a Flexible Spending Account) Babysitting. child care and nursing services for a normal. healthy baby Betting (including lottery, gaming. chips or track wagers) Cosmetic surgery (unless due to trauma or disease) I :\AD\002\02\2X02\2X02177.docx 6 Drug addiction treatment Drugs. prescription Eyeglasses and exams (for medical reasons) surgery (such as laser surgery or radial keratotomy) Fertility enhancements Hearing aids (and batteries for use) Hospital services Laboratory fees Long term care (for medical expenses and premiums) Nursing home Nursing services Operations/surgery (excluding unnec- essary cosmetic surgery) Osteopath Diaper services Electrolysis or hair removal Funeral expenses Gasoline Health club dues Household help illegal operations and treatments Maternity clothes Meals Nutritional supplements 107 493 4- Over the counter (OTC) medical ex- penses for items teed solely to treat a medical condition (such as aspirin. pain relievers. decongestants. caugh suppressant. etc). Must have phys'r cian's written prescription. Physil Therapy care Special education (for learning disabili- ties) Speech Therapy Stop smoking programs including nicotine gum or patches) Vasectomy Weight loss program (to treat a spe ci?c disease diagnosed by a physician) Wheelchair Over the counter drugs and medicines other than those used exclusively for medical purposes Personal use items (such as toothbrush. toothpaste) Swimming lessons Teeth whitening Weight loss program (unless pre- scribed to treat a specific disease) 2014 Open Enrollment Newsletter DENTAL BENEFITS aramedics Plus offers a choice of three dental plans through Cigna. The three plans consist of the Core Plan, Core ln-Network Only Plan and the Buy-Up Plan. All three plans use the Cigna Core Dental Network. You may locate participating dentists by going to Your dental ID card may be obtained from your local HR Representative once you have enrolled or you may print a copy of your ID card from the website. Calendar Year Deductible NAP Plan PPO ln-Network Only Buy-Up PPO Plan ln-Network (Individual/Family) $50/$150 None $50/$150 Out-of-Network (lndividual/Family)* 150 Not Covered $50/$150 Preventive Services ln-Network 100% deductible waived 100% deductible waived 100% deductible waived Out-of-Network 100% deductible waived Not Covered 100% deductible waived Basic Services ln-Network 80% after deductible 100% 90% deductible waived Out-of-Network* 80% after deductible Not Covered 90% deductible waived Major Services ln-Network 50% after deductible 60% 60% deductible waived Out-of?Network* 50% after deductible Not Covered 60% deductible waived Orthodontic Services ln?Network?Child and Adult 50% after deductible 50% 50% after deductible Out?of-Network* 50% after deductible Not Covered 50% after deductible Lifetime Payment Limit $1,500 $1,500 $2,000 Annual Plan Maximums ln-Network $1,500 combined ln- $1,500 $2,000 combined ln- Out-of~Network* Out-Network Out?Network *Subject to and to balance billing :\AD\002\02\2X02\2X02177.docx 108 494 VISION BENEFITS 2014 Open Enrollment Newsletter aramedics Plus offers vision care benefits thrOugh Vision Service Plan (VSP). Throagh its VSP Network Doctors. VSP provides Plan Benefits to yen and your eligible dependents. Subject to the limitations. exclusions and copaymenlts) described. When you wish to obtain Plan Bene?ts from a VSP Network Doctor. contact any VSP Network Doctor. identify yourself as a VSP member. VSP will provide Benefit Authorization directly with the VSP Network Doctor prior to your appomtment. For additional information or to locate a participating Vision care speCialist. contact VSP's customer service at 800- 877?7195 or on their website at Below is a summary of the vtsron care bene?t available: and schedule an apporntment. Eyeglass Frames 9 $140 allowance for frame of your chOICe* 4? 20% oft the amount over your allowance Vision Service Plan (VSP) Plan A Ptan WciiVision Exam $10 copay $10 copay Eyeglass Lenses $25 copay includes: $25 copay includes: Slnmo Single v:v Lincd Bifomi Lined Bifocal c- Lincd Trifocai Lined Trifocal Polyrarbiinatetl' Polycarbonate? $140 allowance for hum: of your cholce? 20% off the amount over your allowance Cantata Lenses (in lieu of eyeglasses) No copay $120 allowance for contacts the canton No copay $120 allowance for contacts the contact and anti?reflective coatings like progressives and scratch-resistance 20% oft additional glasses and sunglasses. Including lens options* and evaluation) Out-ot-Network Reimbursement: Exam Up to $50 Up to $50 Single Vision Lenses Up to $50 Up to $50 Lined Bifocal Lenses up to $75- Up to 375? - Lined Tritoeal Lenses Up to $100 Up to $100 Frame Up to $70 Up to $70 Comm Up to $105 Up to $105 to the Plan Elam Discounts and Savings (Plan A and Plan B) Glasses and Sun?asses Laser Vision Correction 4 Average 30% savings on lens options 4- 15% off cost ol? contact lens exam (toting Average 15% ON the regular price or 5% oil the promotional price trom contracted facilities 0 Alter surgery. use your mime allowance (if eligible) for sunglasses from any VSP doctor *Avaiiablc from any VSP doctor Within 12 months 0? your last exam (In lieu of eyeglasses) Frequency Bramlnation Once every 12 months Once every 1 2 months Eyegi Lenses Once every 24 months Once every '12 months Eyeg Frames Once eVery 24 months Once every 24 months Contact Lenses Once every 24 months Once every 12 months :\AD\002\02\2X02\2X02177.docx 109 495 2014 Open Enrollment Newsletter DISABILITY BENEFITS California Short Term Disability To be eligible for the Disability benefit, you must have earned at least $300 during the base period that ends five months before the onset of a disability. The 12-month base period is broken down into four quarters. You are eligible to receive 55% of your average weekly earnings in the highest quarter of the base period. For 2014, the maximum weekly benefit has not been published as of this time. Benefit payments begin following seven consecutive days of disability. Disability payments are reduced by any income received during your disability sick leave, the event you become d'SabIed due to a no" wqu'related holiday pay, workers compensation bene?ts or any other injury or illness, disability income benefits are ?prowded as 3 sources of income)_ source of income through Cigna. You are eligible to receive benefits after a 180day elimination period. This plan covers 60% of your current base salary, to a Long Term Disability?CIGNA maximum of $10,000. Your benefit will be payable for 2 years Paramedics Plus provides you with Long Term Disability if you are unable to perform the material duties of your own coverage at no cost. occupation. Thereafter, your benefit will be payable to the Long Term Disability provides protection for you and yourfamily security N?rmal Retirement Age If you are ?name to against loss of income if you become disabled. perform the material duties of any occupation. LIFE DEATH DISMEMBERMENT BENEFITS Basic Life Accidental Death 8: Dismemberment lnsurance?CIGNA Paramedics Plus provides you with Basic Life and Accidental Death and Dismemberment coverage at no cost. Basic Life and coverage is administered by Cigna. This benefit will be paid to your beneficiary in the event of your death. Paramedics Plus provides you with a Basic Life and benefit in the amount of 2 times your annual compensation rounded up to the next higher $1,000 to a maximum of $350,000. During this Open Enrollment period it is important to designate a beneficiag for your Life Insurance in the event of your death. You may designate your beneficiary on EnrollOnline. You may also change your beneficiary anytime throughout the year. Voluntary Life Accidental Death 84 Dismemberment aramedics Plus offers you the opportunity to purchase Voluntary Life and Voluntary Accidental Death Dismemberment insurance. Cigna administers the Voluntary Life and benefits. The cost of Voluntary Life insurance is based on your age. Employees may purchase voluntary life insurance coverage for yourself in amounts of 1X, 2X, 3X or 4X your annual salary up to a maximum of $800,000. Any amount over the guarantee issue amount of $100,000, will require medical underwriting. Spouse/ Domestic Partner coverage is available in the amount of 100% of the employee elected amount with a maximum amount of $50,000. Dependent child life insurance is available in the amount of $10,000. No medical underwriting is required for child coverage. If you do not elect voluntary coverage when you are first eligible, Evidence of lnsurability is required when electing or increasing your elected amount of voluntary life insurance. Employees may purchase Voluntary insurance coverage for yourself in amounts of 1X, 2X, 3X or 4X your annual salary up to a maximum of $350,000. For dependent coverage, you may select the Family Plan. This plan will cover your spouse at a benefit of 50% of your elected amount, and each of your covered children at a benefit of 10% of your elected amount. This coverage also has additional benefits for comes, for wearing your seatbelt, and for exposure and disappearance. Medical Evidence forms are available on EnrollOnline in the Resources and Forms section. 10 110 :\AD\002\02\2X02\2X02177.docx 496 2014 Open Enrollment Newsletter FLEXIBLE SPENDING CARE aramedics Plus provides you with a tax-saving way to pay for certain health care and dependent care expenses through Flexible Spending Accounts. These accounts allow you to set aside pre-tax dollars to reimburse yourself for certain health care and dependent care expenses. By reducing your taxable income, you will also reduce your Federal Taxes and spend less for the same healthcare and child care expenses. Trion Group, a Marsh McLennan Agency. LLC will be our Administrator for these plans for the 2014 plan year. How Flexible Spending Accounts (FSA) Work Each calendar year, you decide how much to set aside during the upcoming calendar year for health care and/or dependent care expenses. Your contributions are deducted from your paycheck on a pre-tax basis in equal installments throughout the calendar year. The health care and dependent care are separate accounts. You may choose to participate in one, both or neither. Carefully estimate your Spending Account contributions because, according to the IRS rules, any funds left in your account at the end of the year are forfeited. Furthermore, you cannot change the amount you contribute during the year or stop contributing, unless you have a qualified life event. Participating in the Health Care Spending Account You can use your Health Care Spending Account to pay for many of the health care expenses that the IRS considers deductible on your income tax return and that are not reimbursed from any other source. Paramedics Plus will contribute $500 to your Health Care FSA and you may contribute additional monies up to $2,500. Expenses must be incurred between January 1st and December 31st to be eligible for reimbursement. Expenses are considered incurred when the service is provided, not when you are billed or when you pay for the service. You may submit claims at any time throughout the year. In addition, you will have until March 30th of the following year to submit a claim. For example, you will have until March 30, 2015 to file Spending Account claims for eligible expense incurred in 2014. Examples of Eligible Medical Expenses Through The Flexible Spending Account Your Health Care Reimbursement Flexible Spending Account lets you pay for medical care expenses not covered by your insurance plan with pre-tax dollars. Some examples include: Insurance deductibles and copays Prescriptions .o Dental and orthodontia services, including braces .o Durable medical equipment oz. services oz. Vision exams and care, including laser surgery The above listing is not all-inclusive and additional expenses may qualify. To access the IRS listing of eligible expenses, you may visit the IRS website at 11 111 :\AD\002\02\2X02\2X02177.docx 497 2014 Open Enrollment Newsletter FLEXIBLE SPENDING CARE Paramedics Plus provides you with a tax-saving way to pay for dependent care expenses through a Flexible Spending Account. This account allows you to set aside pre-tax dollars to reimburse yourself for dependent care expenses. By reducing your taxable income, you will also reduce your Federal Taxes and spend less for dependent care expenses. The Dependent Care Spending Account is designed to pay for dependent care expenses on a pre-tax basis so that you and your spouse (if you are married) can work. Consequently, you can use the Dependent Care Spending Account only if your spouse is employed, is a full-time student or is disabled. Eligible Dependents For purposes of enrolling in a Dependent Care Spending Account. a dependent is defined as dependent children under age 13 whom you claim as dependents on your Federal income tax return. Otherfamily members, such as disabled children or elderly parents, who are unable to care for themselves, require full-time care, and whom you claim as dependents on your tax return, are also eligible. You and your spouse may contribute up to $5,000 per year to a Dependent Care Spending Account. This limit is set by the IRS. If you?re married and file separate tax returns, the maximum contribution is $2,500, but in no event can you and your spouse jointly contribute more than $5,000. Expenses must be incurred between January and December 315t to be eligible for reimbursement. Expenses are considered incurred when the service is provided, not when you are billed or when you pay for the service. You may submit claims at any time throughout the year. In addition, you will have until March 3lst of the following year to submit a claim. For example, you will have until March 31, 2015 to file Spending Account claims for eligible expenses incurred in 2014. You may submit eligible and approved claims for reimbursement from your account; however, you can only receive up to the contributions applied and available in your account balance. Carefully estimate your Dependent Care Spending contributions because, according to IRS rules, any funds left in your account at the end of the year are forfeited. Dependent Care Spending Account versus U.S. Child Care Tax Credit Keep in mind that any expenses reimbursed through your Dependent Care Spending Account cannot be claimed from an IRS childcare credit when you file on your tax return. Generally, the Dependent Care Spending Account will save you more money than the tax credit if your gross or adjusted gross income is over $25,000. You should consult your tax advisor if you have any questions about which approach is betterfor you. Trion ?Benny Card? To avoid the hassles of paper during the reimbursement process you can use the Trion Benny Card. Bern-23' The Trion Benny Card is an innovative use of a MasterCardG' that allows for easier benefit access, increased satisfaction and reduced administrative hassles for tax-favored and defined contribution benefits. With the card, you have instant access to your FSA Health Care account funds for eligible health care expenses - right at the point of service at the pharmacy counter, dentist, optometrists or doctor's office, wherever MasterCard debit cards are accepted. 12 112 :\AD\002\02\2X02\2X02177.docx 498 2014 Open Enrollment Newsletter KAISER PERMANENTE SERVICES My Health Manager If you choose one of the Kaiser medical plans, you will get free ac- cess to the secure features of Kaiser's My Health Manager. These convenient tools can help you manage your care at Kaiser Perma- nente facilities such as: 6- E-mail your doctor's office with non-urgent health questions. Order prescription refills and have most mailed to your home. Make or cancel routine appointments to ?t your busy schedule. View most lab test results and summaries of past of?ce visits. Health Wellness Programs You will also have access to many Health Wellness programs by Kaiser Permanente: Healthy Lifestyles Programs, i.e. Quit Smoking, Preventive Care, Weight Management, Healthy Aging, etc. Information regarding Conditions Diseases Information regarding various Drugs Natural Medicines Member programs and classes such as how to Manage Back Pain, Manage Diabetes, Eat Healthy, Reduce Stress, etc. 24?Hour Health Advice Kaiser's registered nurses are available anytime by phone. They can help assess your and give you advice on how to care for minor conditions at home, or direct you to a facility for medical care. Health Care Costs Ask Your Doctor Questions. Amazingly, many patients do not ask their doctor basic questions. ?How much will my treatment cost?" ?Can I be treated another way that is equally effective but less costly?" ?What are the risks?" ?What are the side effects?" Patients often blindly accept their doctors' advice without truly understanding what treatment alternatives are available, and what if any differences there are in cost and effectiveness among those alternatives. Many health plans still allow for great freedom in your choice of physicians. If you have such a plan, your doctor has little incentive to find the perfect balance between treatment effectiveness and cost effectiveness. That is, unless you ask. Carefully check all medical bills. Insurance companies and hospitals are not exempt from making billing errors. Insurers often miscalculate the family deductible, so keep a careful tally of individual as well as total family payments to be sure you don't pay too much. If you have a hospital stay, try to keep a log of all the services, medications and supplies you are given, so when you get a bill you can be sure you are not charged for procedures you didn?t have or items you didn?t use. Ask for an itemized bill. Compare prices. Shop around for the pharmacy that offers the best value for your needs. You may even need to get different medications from different pharmacies depending on which offers a better price. Don't skimp on preventive care. Be sure your child gets routine checkups and vaccines as needed, both of which can prevent medical problems (and bills) down the road. Also, adults should get preventive screenings recommended for their age to detect health conditions early. 13 113 499 2014 Open Enrollment Newsletter EMPLOYEE ASSISTANCE PROGRAM aramedics Plus provides Employee Assistance Program coverage through Cigna to all employees and their eligible dependents. Employees and their family members will have 24-hour 7-days a week access to confidential support and counseling for per- sonal and work related issues. Members can seek unlimited telephonic assistance at 877-622-4327 or on Cigna?s website at Achieve work life balance. Get extra support for handling life's demands. Call for advice or a referral to a service in your community on topics such as: Legal Consultation - Receive a 30-minute and up to a 25% discount on selected fees 9 Parenting - Receive guidance on child development, sibling issues. separation anxiety. and much more 9 Senior Care - Learn about challenges and solutions associated with caring for aging loved ones 6 Child Care - Whether you need care for all day orjust after school. find a place that's right for your family 0 Pet Care - From boarding to grooming to veterinary services. we can help you find what you need for your pet .2. Temporary Back up Care . Don't let an unplanned event get the best of you We can assist in finding back-up care Face to Face Counselor Services - Your EAP provides you and your family members with up to three (3) confidential face to face visits with a counseling specialist at no cost. Crisis Intervention - Members may contact the program 24?hour 7? days a week. ADDED VALUE PROGRAMS Healthy Rewards? Discount Program Through the Cigna Healthy Rewards program members have access to an array of discount programs and wellness resources. Weight Management and Nutrition - Members and families have access to discounts on weight loss programs and products through Jenny Craig; weight management program. and to registered dieticians 9 Fitness - Members have access to fitness club discounts and programs such as Just Walk 10.000 Steps 3 Day? 4' Vision and Hearing Care - Members and families have access to discounts for vision care and hearing aid items 0 Tobacco Cessation - Members and families have access to Smoking Cessation program a Altematlve Medicine - Members and families can access reduced rates on services from ?natural therapy professionals." which include acupuncturists, chiropractors. and massage therapists. v- Mlnd/Body - Members and families have access to mind/body program. 9 Vitamins, Health and Wellness Products- Members and families can access reduced rates on vitamins and wellness products. No referrals. No claim forms. No catch. You value your health enough to make smart choice. A better, healthier lifestyle is only a click away. Simply visit the Healthy Rewards website to print out a wallet card that you and your covered family members can present to any Healthy Rewards provider to your get your discount. To access more information on the Healthy Rewards program contact their helpline at 800-258-3312 or on the website at Cigna.com/ rewards (password: savings). 14 114 :\AD\002\02\2X02\2X02177.docx 500 2014 Open Enrollment Newsletter ADDED VALUE PROGRAMS (CONTINUED) Will Preparation Program The death of a family member can be a confusing and conflicting time. There are many tasks and decisions to make?all when emo- tions and stress are high. time limited and energy may be low. Planning in advance helps relieve these uncertainties for family mem- bers left behind and ensures that your wishes are known. Cigna?s Will Center is secure. easy to use and available to you and your spouse seven days a week. 365 days a year. Visit CignaWill- Center.com to register and immediately start building your own personalized estate and funeral plan. including: Last will and testament Determine what's to be done with your property when you die. and name the executor of your estate and your guardian for your minor children Living will: Outline you wishes regarding the use of extraordinary life support or other life-sustaining medical treatment 0 Health care power of attorney: Allow someone to make ?nancial decisron on your behalf if you are unable 6 Medical authorization for minors: Em power medical personnel to treat your child if you are not present 4- Funeral planning resources: You will find available many informational guidebooks and a personal information organizer tool Cigna Secure Travel Emergencies can happen while traveling on vacation or company business. All Cigna Secure Travei? Services are available when you travel over 100 miles from home or company business or vacation. Emergency medical oesistnnoe?Cigna Secure Travel will pay to arrange such things as transportation to a hospital or medical facility. emergenCy medical evacuation. repatriation of remains. prescription refills services. etc. (a Help with the unexpected?In time of emergency. Cigna Secure Travel can provide; emergency changes to travel plans, emer- gency message center. translation and interpretation assistance. etc. 5" Pretrip planning?Cigna Seoure Travel can assist in you in understanding immuni7ation. visa and passport requirements. foreign exchange rates. em bassy/consuiar referrals. travel/tourist advisories. etc. To learn more about Cigna Secure Travel. call 888-226-4567 and give them the Paramedics Plus Policy Cigna Identity Theft Program Identity then is America's fastest growing crime. victimiling almost 11 million people a year. When you are covered by Cigna Group life coverage. you have access to Cigna's identity theft program at no cost. No matter where or when you come under the attack of identity lhelt. Cigna?s services are here for you Such as: Assistance with credit card fraud. and ?nancial or medical identity theft Assislance with replacement or lost or stolen documean Access to free credit reports 5" Provide you with an identity theft resolution kit and an identity theft af?davit for credit bureaus and creditors. Real-time, one-on-one assistance?24 hours a day, 365 days a year-in every country in the world 0 You'll have unlimited access to personal case managers until your problem is resolved Cigna's website offers helpful information to reduce your risk of identity theft before it happens. If you suspect you might be a victim of identity theft. call Please indicate that you are a member of Cigna identity theft program and group #57. 15 115 :\AD\002\02\2X02\2X02177.docx 501 2014 Open Enrollment Newsletter BENEFIT CONTRIBUTIONS Paramedics Plus reviews the benefit programs and makes revisions and updates to ensure that we continue to offer a competitive, cost-effective benefit program to you and your family. Below is a chart outlining your benefit contributions for the 2014 plan year. Per Pay Period (Bi-Weekly) Medical Rita kaiser Imozo Elan Kaiser ?Mo Dell. Plan Employee $60.32 $82.29 $92.41 $54.67 Employee One $121.0 1 $163.48 $184.83 $109.35 Employee Family $192.62 $261.90 $293.87 $173.87 Rates Per Pay Period Dental Rates Plan arenas-1m: PPd?Plan Employee $3.66 $7.02 Employee One $7.78 $14.93 Employee Family $12.17 $23.35 Vision Retes- A Plan], Employee $0.86 $0.93 Employee One $126 $1.35 Employee Family $2.25 $2.41 Managing your health re expenses For most illnesses or injuries. the best choice for medical care may be a visit to your general practitioner or primary care physician. Your regular doctor knows you best, has your medical history, and has the expertise to diagnose and treat most conditions. For most illnesses and injuries. and for regular checkups and preventive ca re, your doctor can provide the most cost-effective care. 16 116 :\AD\002\02\2X02\2X02177.docx 502 CO NTACTS 2014 Open Enrollment Newsletter Customer Service Contact Information Service and Carrier Name Website Address Telephone Number Medical: CIGNA Member Services 800-244-6224 Medical: Kaiser Member Services 800-464-4000 English 800488?0616 Spanish 800-757-7585 Chinese Dental: CIGNA Member Services 800-244-6224 Weion: VSP Member Services 800-877-7195 Life/Voluntary Life: CIGNA Claim Services 800-732-1603 AD&D/Voluntary CIGNA Claim Services 800-732?1603 LTD: CIGNA Member Services 800-732-1603 Employee Assistance Program: CIGNA Member Services 877-622-4327 Healthy Rewards Program: CIGNA Member Services Cigna.com/rewards (password: savings) 800?258?3312 Employee Benefit Service Center: TRION 888-215-9819 Flexible Spending Accounts: TRION Trion FSA Service Center 866542?3862 :\AD\002\02\2X02\2X02177.docx 117 503 17 IMPORTANT NOTICES ABOUT YOUR BENEFITS Women's Health and Cancer Rights Act If you have had or are going to have a mastectomy. you may be entitled to certain bene?ts under the Women?s Health Care and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits. coverage will be provided in a manner determined in consultation with the attending physician and the patient for. All stages of reconstruction of the breast on which the mastectomy has been performed. at Surgery and reconstruction of the other breast to produce a symmetrical appearance. Prostheses. and Treatment of physical complications of all stages of mastectomy. including This coverage will be provided in consultation with the attending physician and the patient. and will be subject to the same annual deductibles and coinsurance provisions that apply for the mastectomy. Health Insurance and Accountability Act (HIPAA) - State Children?s Insurance Program (SCHIP) Loss of other caverage: If you decline enrollment for y0urself or for an eligible dependent (including your ammo) while other health insurance or group health plan coverage is in effect. you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents' other coverage). However. you must request enrollment within 31 days after your or your dependents? other coverage ends (or after the employer stops contributing toward the other coverage). Loss of Medicaid or SCHIP coverage: If you decline enrollment for yourself or for an eligible dependent (including your spouse) while Medicaid coverage or coverage under a state children?s health insurance program is in effect. you may be able to enroll yourself and your dependents in this plan if y0u or y0ur dependents lose eligibility for that other coverage. However. you must request enrollment within 60 days alter you or your dependents? coverage ends under Medicaid or a State children's health insurance program. New dependent; If yOu have a new dependent as a result of marriage birth. adoption. or placement for adoption. you may be able to enroll yOurself and y0ur new dependents. However. yOu must request enrollment within 31 days after the marriage. birth. adoption. or placement for adoption. Eligibility for Medicaid or SCHIP premium assistance: If you or ycur dependents (including your spoase) become eligible for a state premium assistance subsidy from Medicaid or through a state :\AD\002\02\2X02\2X02177.docx 118 children?s health insurance program with respect to coverage under this plan. you may be able to enroll yourself and your dependents in this plan. However. yen must request enrollment within 60 days alter y0ur or year dependents determination of eligibility for such assistance. Medicaid and the Children's Health Insurance Program (CHIP) Offer Free Or LowCost Coverage CHIP is short for the Children?s Health Insumnce Progam?a program to provide health insurance to all unimured children and who are not eligible for or enrolled in Medical Assistance. CHIPRA is the reauthoritlon act of CHIP which was s'gned into law in February 2009. Under CHIPRA. a state CHIP program may elect to offer premium assistance to subsidize employer-crowded coverage for eligible low-income children and families Newborn Mothers' Health Protection kt Group health plans and health insurance issuers offering group health coverage generally may not restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 home following a vaginal delivery. or less than 96 hOurs following a delivery by cesarean section. However. the plan or issuer may pay for a shorter stay if the attending provider. after consultation with the mother. discharges the mother or newborn earlier. Plans and issuers may not set the level of benefits or out- of-pocket costs so that any later portion of the 48-hour (or 96- hour) stay is treated in a manner less favorable to the mother or newborn than any earlier portion of the stay. In addition. a plan or is5uer may not require that a physician or other healthcare provider obtain authorization for prescribing a length of stay of up to 48? hours (or 96-hours). However. to use certain providers or facilities. or to reduce your cutof-pockot costs. you may be required to obtain precertification. Patient Protection Patient Access to Obstetril and Gynecological Care You do not need prior authorization from Cigna or your provider in order to obtain access to obstetrical or gynecological care from a health care professional in our network. The health care professional. however. may be required to comply with certain procedures. including obtaining prior authorization for certain services. following a preapprovcd treatment plan. or procedures for making referrals. For a list of participating health care professionals who specialize in obstetrics or gynecology. contact Cigna at 1-800-CIGNA24. 18 504 Premium Assistance Under Medicaid and the Children?s Health Insurance Program (CHIP) If you or your children are eligible for Medicaid or Cl lit? and you are eligible for health coverage from your employer. your State may have a premium assistance program that can help pay for coverage. These States use ?uids from their Medicaid or CHIP programs to help people who are eligible for these programs, but also have access to health insurance through their employer. if you or your children are not eligible for Medicaid or CHIP. you will not be eligible for these premium assistance programs. Ifyou or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, you can contact your State Medicaid or t.?i of lice to ?nd out it?premium assistance is available. if you or your dependents are NOT currently enrolled in Medicaid or CHIP. and you think you or any of your dependents might be eligible for either oi'these prognms, you crur contact your State Medicaid or CHIP of?ce or dial or to ?nd out how to apply. If you qualify. you can ask the State it it has a program that might help you pay the prennums for an errqiloyer-smmsored plan. Once it is determined that you or your dependents are eligible for prernirun assistance under Medimid or CHIP, as well as eligible under your employer plan. your employer must permit you to enroll in your employer plan ifyou are not already enrolled This is called a ?speciai enrollment? opportunity. and you must request coveragewithin 60 days of being determined eligible for premium assistance. if you have questions about enrolling in your employer plan, you can contact the Department of Labor electronically at wmv.'.iskebsa.dol.gov or by calling loll-free 1-866-444-EBSA (3272). If you live in one of the following States. you may be eligible for assistance. paying your employer health plan premiums. The following list of States is current as of July 31, 2013. You should contact your State for further information on eligibility - ALABAMA - Medicaid INDIANA - Medicaid Website: hit ov Website: Phone: 1-855-692-5447 Phone: 1-800-889-9949 ALASKA Medicaid Medicaid Website: hit ?rms/mediurid/ webs? dl We Ens/hi - - ?5 Phone (Outside of Anchorage): 1-888-318-8890 Phone: 1-888-346-9562 Phone (Anchorage 907-269-6539 ARIZONA CHIP KANSAS - Medicaid Website: ov/a licants b3} 4 r, Phone (Outside oi Mancopa County): 1-877-764-5437 Phi"! 2-800 79? :88! Phone (Maricopa County): 602-417-5437 C0 LORADO - Medicaid KENT UCKY - hiedicaid pr" .g '1 . websuc 1m co'orado Website: Medicaid Phone (In state); 1-800-866-3513 1-800-635-2570 Medicaid Phone (om nrsiaie); 1-800-221-3943 hone FIDRIDA - Medicaid LOUISIANA - Medicaid Website: ii edi id ecov Website: . .louisiana. ov Phone: 1-877-357-3268 Phone. l-888-695-2-H7 GEORGIA - hiedicaid Website: gov/ Website: Click on Programs, then Medicaid, then Health Insurance Premium Payment i ll PP) Phone: 1-800-977-6740 Phone: 1-800-869-1 TTY: 1-800-977-6741 IDAHO Medicaid and CHIP MASSACHUSETTS Medicaid and CHIP Website: ss. ow. as He th Medicaid Website: .acc as - . . Phone? ?300?463'1120 Medicaid Phone: l-StX)-926-2588 NIINNESOTA - Medicaid CHIP Website: nwynamedicgdidghogoy website; ?ap; mnug/ CHIP Phone: 1-800-936-3588 Click on Health (Tare, then Medical Assistant? Phone 1-800-657-3629 119 :\AD\002\02\2X02\2X02177.docx 505 - Medicaid - Medicaid Vebsilc: i It )zlm'ww 'hone: 573-751-2005 Website: in state pa. [Ls/him) Phone' 1-800-692-7462 MONTANA Medicaid RHODE ISLAND Medicaid Ld it ?hone: 1-800-694?3084 Website: mvwohlisngov Phone. 401-162-5300 NEBRASKA Medicaid SOUTH CAROLINA ?l\rIedicaid Vebsile: SSNebmska. m:ng 'hone: 1?800-383-4278 Website: Phone: 1-888-549-0820 NEVADA Medicaid SOUTH DAKOTA Medicaid Aedicaid Website: xiedicaid Phone: 1-800-992-0900 Website: Phone: 1-888-828-0059 NEW HANIPSI-IIRE Medicaid TEXAS Medicaid 'i 1 ?ns?ii Website: hilp'NWW)! gctm'pptezgasgim Phone: 1-800?440-0493 NEW JERSEY - Medicaid and UTAH - Medicaid and CHIP Aedicaid Website: ht'tprl us'humunservices:dmahs/ lienls/inedicaid Aedicaid Phone: 609-631-2392 Website: hgp: Uvm'wnj fami lycareorg/ind Tl ll Phone: 1-800-701-0710 Website; ?992 Phone: 1-866-435-7414 VERMONT Medicaid Medicaid Website: http: Medicaid Phone: 1-800-250-8427 NEW YORK Medicaid VIRGINIA - Medicaid and CHIP Vebsite: :waww. vhealth. owhealih ?honc: 1-800-541-2831 NORTII CAROLINA - Medicaid Vebsite; ?hnne: 919-855-4100 Medicaid Website: ili?i?htni Medicaid Phone: 1-800-432-5924 CHIP Webiste: CHIP Phone: 1-866-873-2647 NORTH DAKOTA Medicaid WASHINGTON Medicaid Vebsile: 'hone: 1?800-755-2604 Website: shim Phone: 1-800-562-3022 ext. 15473 OKLAHOMA Medicaid and CHIP WEST VIRGINIA Medicaid Vcbsiic: 'hone: 1-888-365-3742 Website: gov/bms/ Phone: 1-877-598-5820. HMS Third Party Liability OREGON -- Medicaid and Cl [11? WISCONSIN - Medicaid Vebsile: hit onhealihvkids. (w hit on. ov ?honc: 1?800-699?9075 Website: in In: 1? urg/pubs?p- i 0095 .hlm Phone: 1-800-362-3002 WYOMING Medicaid Website: heathwx'o gov/healthcarc?nvcm i care. Phone: 307-777-7531 To see if any more states have added a premium assistance program since July 3 l, 2013. or for more infomiation on special enrollment rights, you can contact either: .S. Depannlenl of Labor Employee Bene?ts Secunty Admimstration wxwudolgovlebsa (3272) Control Number l210-0i3'7 (expires 09/30/20?) :\AD\002\02\2X02\2X02177.docx US. ot?l lealih and Human Services Centers for Medicare Medicaid Services hits-gov 1-877-367-2323, Menu Option 4, Exl. 61565 20 120 506 ParamedicsPlus utilizes a comprehensive online recruitment, selection and hiring program referred to as "CandidateCare". The program is fully customized to emulate the strict hiring standards and procedures required by ParamedicsPlus in each of its business units. The ParamedicsPlus CandidateCare program ensures consistent due diligence is conducted for each qualified job candidate. The program also helps ParamedicsPlus focus on workplace diversity and requires that each job candidate is evaluated fairly. The program ensures that each ParamedicsPlus hiring decisions is based entirely upon objective job-fit. The CandidateCare program provides each ParamedicsPlus hiring manager with the tools and training to make objective hiring decisions, free from personal bias. The program includes the use of validated competency-based selection tools and structured interviews. Validation of the selection tools includes a rigorous review of all applicable job information to determine measures of relevant work behaviors. Validation and applicable job analysis were professionally completed by a team of Industrial- Organizational This process ultimately defined critical work behaviors and measures for successful performance in key jobs at ParamedicsPlus. In addition to ensuring a fair and consistent process, the ParamedicsPlus selection and hiring program is aimed at reducing bias, adverse impact and employee turnover. ParamedicsPlus selection methods were designed in accordance with the Uniform Guidelines on Employee Selection Procedures, adopted by The Equal Employment Opportunity Commission. 121 :\AD\002\02\2X02\2X02177.docx 507 EAST TEXAS MEDICAL CENTER REGIONAL HEALTHCARE SYSTEM CHARITY CARE 8 UNINSURED PATIENT POLICY By virtue of their exemption from federal and state taxes and as a part of their mission to serve the health care needs of their communities, each hospital within the East Texas Medical Center Regional Healthcare System (System) will provide charity care to patients who meet the criteria of this policy and do not have the ?nancial means to pay for hospital services. Charity care will be provided to patients who present themselves for care at a System hospital without regard to age, sex, race, creed, color, or national origin and who are classified as financially indigent or medically indigent according to the terms of this policy. Each hospital within the System reserves the right to limit charity care on a and annual basis consistent with Texas state law and the hospital?s ?nancial resources. Each hospital reserves the right to refuse charity care for elective care. A discount from the hospital's retail charges will be made available to uninsured patients who do not qualify for charity care, under the terms of this policy. DEFINITIONS a. Bad_D.ebt Charges resulting from treatment for services provided to a patient and/or guarantor who, having the requisite financial resources to pay for health care services, has demonstrated by his/her actions an unwillingness to comply with the contractual arrangements to resolve a bill or satisfy their outstanding obligations. b. Cha?tyjlate inpatient and outpatient medical treatment and diagnostic services for uninsured or underinsured patients who cannot afford to pay for the care according to the guidelines of this Policy. Charity Care does not include bad debt or contractual allowances from government programs and insurance, or Uninsured Patient Discounts, but may include insurance co- payments or deductibles, or both. The patient will have no obligation, or a discounted obligation, to pay for any services received which are deemed to be Charity Care under this Policy. c. Contractualjitmaance The difference between the level of payment established under a contractual agreement and the patient's billable charges. 0. Elective Care The patient's condition permits time for medical services to be scheduled. November 1, 2009 :\AD\002\02\2X02\2X02177.docx 508 EAST TEXAS MEDICAL CENT ER REGIONAL HEALTHCARE SYSTEM CHARITY CARE 8 UNINSURED PATIENT POLICY e. EmergenQLCare The patient requires immediate medical intervention due to a severe, life-threatening, or potentially disabling condition. Generally the patient is admitted through the emergency room. f. Patient The terms ?patient? and "person" are used throughout this Policy for ease of understanding and drafting. This Policy applies to the guarantor of the patient's account, and the term guarantor is interchangeable with the terms patient and person throughout this Policy, when the guarantor is different from the Patient. g. Rata?Lbarges The standard rates charged to all patients, which do not reflect any contractual allowances or discounts. These rates are commonly referred to as ?gross? charges in the healthcare industry. h. Uninsuredl?atient A person receiving healthcare services who does not have private healthcare insurance, and is not qualified to participate in a governmental program which provides healthcare benefits to its eligible participants (such as Medicare or Medicaid), and for purposes of this Policy does not qualify for Charity Care. i. UninsuredEatient Discount The amount of discount applied to Retail Charges incurred by Uninsured Patients. j. Urgem_Care The patient requires immediate attention for the care and treatment of a physical or mental disorder. Generally the patient is admitted to the ?rst available and suitable accommodation. CHARIMAREELIQBWILIA Lanamiauy_lnmgem a. A financially indigent patient is a person who is uninsured or underlnsured and whose bill will result in no obligation or a discounted obligation to pay for the services rendered based on the eligibility criteria set forth in this policy. b. To be eligible for charity care as a financially indigent patient, a person's income shall be at or below the percentage of the federal poverty guidelines noted at Exhibit A. The hospital may consider other financial means of the person when determining c. The hospital will use the most current poverty income guidelines issued by the US. Department of Health and Human Services to determine an individual's eligibility for charity care as a ?nancially indigent patient. The poverty income guidelines are published in the Federal Register in the Spring of each year and for purposes of this policy will become effective the ?rst day of the month following the month of publication. November I, 2009 2 123 :\AD\002\02\2X02\2X02177.docx 509 EAST TEXAS MEDICAL CENTER REGIONAL HEALTHCARE SYSTEM CHARITY CARE 8 UNINSURED PATIENT POLICY d. The System may adjust the eligibility criteria from time to time based on financial resources and as necessary to meet the charity care needs of each community. The System may limit charity care to only those patients requiring emergency or urgent care. e. Patients with a current Texas Medicaid card will be considered to be financially indigent with regard to any unpaid balances. a. A medically indigent patient is a person whose unpaid hospital charges exceed their ability to pay and whose remaining bill will result in no obligation or a discounted obligation to pay for the services rendered, based on the eligibility criteria set forth in this policy. b. To be eligible for charity care as a medically indigent patient, the amount owed by the patient on the hospital bill after payment by third-party payers, if applicable, must exceed the percentage of the patient?s annual gross income noted at Exhibit B, and the patient must be unable to pay the remaining bill. The hospital may consider other financial means of the person when determining ability to pay. c. Charity care for the medically indigent may be provided in an amount that is less than the patient liability. d. The System may adjust the eligibility criteria from time to time based on financial resources and as necessary to meet the charity care needs of each community. The System may limit charity care to only those patients requiring emergency or urgent care. NAMED PATIEWIYQIIEBLA An uninsured patient who does not qualify as financially or medically indigent shall receive a discount according to Exhibit C. 1. PEOQEQHRE Adden??sation of Charity Cases a. Hospitals will inform each patient of the charity care program and how to apply for charity care. This will be done by posting notices in each patient registration area and providing a written notice to each patient. An additional notification shall be provided on the System's web-site. November 1, 2009 all.) 510 EAST TEXAS MEDICAL CENTER REGIONAL HEALTHCARE SYSTEM CHARITY CARE 8 UNINSURED PATIENT POLICY b. The Business Office will attempt to identify all cases that may qualify as charity at the time of admission, and ask the patient to apply at that time. Patients who desire to apply for charity care shall complete a Financial Assistance Application form (Exhibit D) and return it to the specific address so noted. d. The Business Office will refer those patients who may qualify for financial assistance from a governmental program to the appropriate program, such as Medicaid. e. As soon as sufficient information is available concerning the patient's financial resources and status of eligibility for governmental assistance, a determination will be made concerning the patient's eligibility for charity. B. Cha?tlnetecminatinn?rmess All charity applications will be forwarded to the Community Benefits Department where they will be evaluated according to established charity care application processing procedures. The Community Benefits Department will determine if the application qualifies for charity care. C. Recor?keeplngand?eppningof CharityLarg a. All completed charity care applications and supporting documentation will be retained and kept on file for five (5) years in the Community Benefits Department. b. information regarding the amount of charity care provided by the hospital in its' fiscal year shall be aggregated and Included in the hospital's annual report filed with the Bureau of State Health Data and Policy analysis at the Texas Department of State Health Services. This report also will include information concerning the provision of govemment-sponsored indigent health care and other community benefits. DJLninsured An uninsured patient discount will be applied to all uninsured patients who do not apply for, or do not meet the criteria of, the requirements for receiving charity care. The amount of the discount is noted at Exhibit C, and may be changed by the System from time to time. November 1, 200.9 4 125 511 East Texas Medical Center Regional Healthcare System Exhibit A Charity Care 8 Uninsured Patient Policy Financially indigent Charity 2009 Qualification Federal Poverty Guidelines Limits Size of Maximum (200% of Family Family if income Does Unit income Not Exceed 1 10,830 21,660 2 14,570 29,140 3 1 8,31 0 36,620 4 22,050 44,100 5 25,790 51,580 6 29,530 59,060 7 33,270 66,540 8 37,01 0 74,020 ea. Add?i Person 3,740 7,480 FPG (Federal Poverty Guidelines) in addition to meeting the income guidelines, a person's other financial means may be considered in the charity care determlnation process. 126 512 East Texas Medical Center Regional Healthcare System Exhibit Charity Care 8 Uninsured Patient Policy Medically indigent 2009 Federal Poverty Guidelines Size of Maximum Maximum income Levels" Minimum Unpaid Hospital Charges Family Family 250% 300% >300% 250% 300% >300% Unit income 1 5 10,830 5 27,075 32,490 32,490 2,708 5 3,249 10% of 2 14,570 36,425 43,710 43,710 3,643 4,371 actual 3 18,310 45,775 54,930 54,930 4,578 5,493 annual 4 22,050 55,125 66,1 50 66,150 5,513 6,61 5 income 5 25,790 64,475 77,370 77,370 6,448 7,737 6 29,530 73,825 88,590 88,590 7,383 8,859 7 33,270 83,175 99,810 99,810 8,318 9,981 8 37,010 92,525 111,030 111,030 9,253 11,103 ea. Add'l Person 3,740 9.350 1 1,220 11,220 935 1,122 Unpaid charges as of income 10% 10% 10% Amount of each payment 5 40 50 60 Number of months payments are due 24 mo?s. 24 mo's. 24 mo's. gpianation: A person is Medically indigent if their unpaid hospital charges exceed the amounts listed in the table above, for the corresponding family income levels and their financial means are insufficient to render a payment for services received. Persons qualifying as Medically indigent will be responsible for 24-montth payments as noted above, and receive charity care for the balance of unpaid charges. FPG (Federal Poverty Guidelines) In addition to meeting the income guidelines. a person's other financial means will be considered in the charity care determination process. 127 513 East Texas Medical Center Regional Healthcare System Exhibit Charity Care 8 Uninsured Patient Policy A person without healthcare insurance, who does not qualify for charity care, shall receive an uninsured patient discount. Uninsured patients will receive a general discount as noted below. In addition, each System hospital may offer specific pricing to uninsured patients for certain common services by utilizing a predetermined list which is available to uninsured patients for their review prior to receiving services. The specific discounts may be equal to or greater than, but not less than, the general discount amount. The amount of the general discount is: General Effective Date: Discount Amount November 1, 2005 30.0% 128 514 :\AD\002\02\2X02\2X02177.docx 515 Duty to Avoid Causing Unjustifiable Risk or Harm The Just Culture Algorithm?va.1 Actions Did the employee kmw'ngly substantlal end unpstifn?a rink? Threshold an employee putan organlutlonel . - Intellect orvelue In harm's way? Investigation Didme Should the no not Consider employee ha" punitlve 6mm?, known they were employ? action "?5un ma taking a suhsla'ltlal action and unjusti?able risk7 RE unluetmable rhl?? In; Consider aollon We: the harm Juetlt'lad Potential or actual harm to persons it Potential or actual harm to property Canada employee and conduct human error investigation RB Al ell tunes. in employee will he owned to the duty In avuld causing umusllnable or harm to hl'nsell. to lcllow employees. customers wailnrl. and to the organization Under this duty. an employee who has acted with reckless disregard towerd a potential harm will be subbed 01mm unclle aclon (R3) Duty to Follow a Procedural Rule (system largely controlled by the employer) Note: rm test We when the employee mm min I oystem end I: responded: [arm tenable comeoml within that syslem What happened? Did the employee hm a peed him but Comider hello! that the punitive vloletlon we: action or pew-ad? RE Was the duly Wee l1 lolollawa rule followaproceduralrulelnaeyetem Rulespedlleehowtopertonnmelob - What normally happens? employee loading to m: "c for demon il-nsk behawor 5" to Violate rule ARE I What does procedure require? (If applicable) Where work-nu under a duty to follow a procedural rule main 3 system, an employee wil be lubiecl Io disaplinary ad?on when they have acted with reoklees (fur-gate Inward the rink minted with noncompliance 1 Burden olproducnorl run on earphone Duty to Produce an Outcome (system largely controlled by the employee) Actlons Why It happen? Note 7M5 tasl apart" when the employee is were he or she controls the system and-'1 WWO "to wipe! ollhu sy?cm la the rate 0' Value to produce Auel My? Old the social the outcome in produc'ng bene?t exceed man the better outcomes. the rink? onpectauone at or oonudor those to whom punitive when the duly ls owed? Accapl outcome Where working under a duty to produce an outcome. an employee will be held eowunlacle as diraaed bytne code olconduct and indmoual potion These palms put the employee on nollce lo the duly. and praeal'be acceptable outcomes allached In each duly (a lune end attendance. area: code). Waa lhe My to produce an onloome known to the employee? DIdtheemployeebreecheMyb produceenoutconle? I How was the organization managing the risk? Nu manual-moo! leading l0 l'rvesllgete Immowom-mm A Burden (introduction fall: on employee JOB DESCRIPTION Job Title: Director of Clinical and Operational Services Reports To: Chief Operating Officer Exempt (YIN): Yes Effective Date: Last Revised: Summary: This position provides clinical and operations leadership and management for the organization to support our mission and vision. Major Duties and Responsibilities: :\AD\002\02\2X02\2X02177.docx Support and implement philosophies. objectives, Policy, Procedures and practices Assure quality patient care and high customer satisfaction Establish and maintain positive relationships with all stakeholder groups Responsible for system planning. both long- and short-term. associated with assigned areas Monitor the quality of all services provided, ensuring that standards are met or exceeded and directs and coordinates corrective actions when necessary Responsible for planning. coordinating. evaluating, and conducting formal clinical quality assurance and improvement efforts Work closely with the Medical Director in research and development of protocols. procedures, new equipment, and identifying system-wide improvements and continued education needs Ensure compliance with all regulatory agencies and accrediting bodies and oversee reaccreditation process Ensures clinical performance measures are being achieved Prepare, coordinate. and participate in new hire orientation Monitors the orientation and training of new employees Manage field training on a daily basis- coordinate schedule with employees. paperwork completion. etc. Responsible for maintaining training site accreditations Supervision of all internal and external educational programs Responsible for the management of the daily Operations and Scheduling Responsible for Promotion. Discipline. Team building and hiring determination for assigned staff Responsible development of new ways to achieve a financially viable performance as 130 516 well as meet contractual demands 0 Performs other such duties as may be required Minimum Quali?cations: - Valid Class A South Dakota Driver's License - State and locally certified paramedic AS Degree in EMS or equivalent experience - Excellent public, employee, and customer relation skills 0 Must hold instructor ratings in all required additional certifications - Must live in response area - Basic computer skills Desired Qualifications: 0 Bachelor's Degree from accredited college 0 Knowledge in Federal, State, and Local statutes Physical Requirements: 0 Occasionally: Walking inside. carrying no greater than 25 pounds. kneeling. stooping. bending. leaning - Frequently; Hearing/listening. clear speech. touching. typing - Constantly: Sitting. seeing 517 Dashboard Measures serve through effective partnerships. Uri-eu- has been (?muplotcd Red is highest priority l?urplo second hiuht'sl pi'iurit) To Provide Compassionate Quality Care and Service built around the needs of the patients and conmmnities we People llighl) Engaged, ('mnpasxiunate. Skilled and Safe Workforce Measures De?nition Frequency Data Source 91; Overall Employee Engagement Score (Strongly agree and agree) All Employee group roll up Annually Excel or Survey Monkey data base Customers Rate Workforce Concemed and Question from patient survey or Access (county) Caring or greater on scale) Quarterly uest'o em 1? ec 0 Feel company values emplovcc safer Saved or stifn?ly Annually Excel or ?51?ch Monkey data base agree) a of Workers Comp Incidents 01 emfloy? infidcms that Access data base quahly as workers comp 0?0 of em lovees with AML S, ITLS. ACLS, and if of em loyees with advance . PEPP cert I tolt)al number of medics Annually leh Bram . . . - a ofrc ortablc in'urics U1 055'? ?mm rate (all work cot" p5) Zl'lt?i?l'u'itfdiwded by ii of ee Access data base'.? imured ees per 100 employ ees) hours worked Lost time rate- of OSHA reportable injuries 1?4 of lost lime OSHA injuries when ee loses time off their shift (days away 200.t'lt'i0 divided by f? of ee Access data base '7 from work} includes light duty hours worked Vehicle contacts per lt'H'U?II'it'i miles driven f' 0' Access data base? contacts per 100k miles . . . .. . of ambulance vehicle chicle contacts Per 100.000 emergencyiles conlam Per Hm Em agency Access data base? miles Aggregation of employee injury types by type to Access data base? determine cause of patient reported injury Pt injury rate total a ol? ambulance Access data base? responses off work on time (?rcw actual clock out limit: In 1% ol itmt- employees clock out from w-wlt crew scheduler compared to Crew Scheduler scheduled) scheduled end of shift time Time crew involved in a call l?rotlucthit) (responding. on-scene. spit-m transporting, time at CAL) cm ployce destination) Divided by total time in the CAD ft of ambulance transports total of ALS unit hours on I the schedule system CAD in if of ambulance transports.- total of employee shift length Version l0/?3/201 :\AD\002\02\2X02\2X02177.docx 132 518 Quality Quality and Timely Care to Our Patients Measures De?nition Frequency Data Source Overall EMD Compliance Dispatcher compliance to Emergency Medical Dispatch overall quality indicators Excel Response Times 0'0 Arrive Emerg. Within 10 Min. Emergency Response time compliance (time call rec. into dispatch to time unit arrived on scene) CAD Arrive Scheduled non-Emerg. Within 20 Min Scheduled lnterfacility Response time compliance 01' time unit arrived Within min of scheduled PU time) CAD Arrive Unscheduled Non-Emerg. Within 60 Min. Scheduled Interfacilily Response time compliance oftime unit arrived on-scene Within 60 min PU time) Montth CAJ) CARDIAC ?vr. ROS (f Return 0fSp0ntane0us Circulation sustained to arrival at LED Month lvr'Quarterly ('ctl?dluc A rrest Survival L'tstein Criteria Month ly "Quarterly fin-Scene time For cardiac :irreztt i\\'hen tiarisportcd) Time elapse from ambulance arrival on-scene and ambulance departure Montth time to lirst detihrillzition (Fractile) Time of ambulance arrival to time ot'?rst detihrillation time to liist compressmn i'Fi?actile) Time ot'amhulance arrival to time of ?rst compressmn PCR Compliance with S'l'liMl protocols and procedures or) 01? patients who met criteria received appropriate interventions per protocol ol? Sl'l-Xll patients ti'nnsipoi'ted to l'ncnlig of patients declared transported to P(?l facility ()ii-sceiic for Total elapsed time from ambulance arrival to depart scene Oii?su?iie l'm patients Total elapsed time from ambulance arrival to depart ol?S'l?l?lVl ho l't?t?t?Ht?d ASA of patients meeting STEMI criteria who received ASA (without exclusion reason) el?C chon' 1 3801 4 :\AD\002\02\2X02\2X02177.docx 133 519 til'non-trnuimitic Chest pain patients of patients with CP who who recdved received ASA (without I exclusion reason) Avg and 90" ercentile ?time oft'irst . . ePCR/cardiac 'mcdical cgntact to lZ-Lead EKG Time to nicad monitor 9, time from 12 Lead transport time Elapsed time from lit-lead to it SI declared transport time for blel pt non-traumatic Chest pain. acute MI. 12 Lead compliance for S'I'Exll. etc. patients 1> .35 cardiac patients meeting years old received 12 lead criteria for 12-Lead STROKE Average time to call Stroke Alert Total elapsed time from ambulance arrival to depart scene 'Jttm time to call stroke alert Elapsed time for medic to call Stroke alert from time of arrival on scene Avg Stroke Scene Time Time elapse from ambulance arrival on-scene and ambulance departure ?M?i'h Percentile Stroke tin-scene time Time elapse from ambulance arrival on-scene and ambulance departure Stroke by Destination Breakdown of transport destination for Stroke Alert patients to determine appropriate destination Compliance with Stroke protocols and of patients who met Stroke procedures criteria received appropriate interventions per protocol TRAUMA 0.. ?l'ru-imu \leri llosp Within ofTrauma Alert patients Golden Hour to? ininutes- time call rec to at arrived at trauma center within destination timci 60 minutes of call rec. time \vcr?nge time to call 'l?rnum.i Alert Time elapse from ambulance arrival on-scene to Trauma Alert noti?cation Qi'i'? Percentile to call Trauma alert Time elapse from ambulance arrival on-scene to Trauma Alert notification Avg ?1 rauma Alert on Scene 'mcdtuul contact In triitispmt Segmentation of timestamps Etrt?lV?-tl to transport on-scene tor trauma alerts -time ot'trauma alert to transport can? Percentile Trauma Alert tin-scene time t. . . -l medicalcontuct to transport Segmentation of timestamps arrival to transport for trauma alerts -timt- illt?rl to transport til ltduma .ileit.. called .ittu stun or In oftrauma alerts called trzmaiport during transport Version: 10/3/2014 :\AD\002\02\2X02\2X02177.docx 134 520 l?lm': on scene by Elapsed time on-scene by employee to determine performance level Trduum .\lett.; h\ 'l'mumzt I?cnlL-rl Breakdown of transport destination for Trauma Alert patients to determine appropriate destination RESPIRATORY ?tllt Pulmonary ..ttu.l pmcedures Patients with Primary Impression of: Shonness of Breath, Dif?culty Brenthirig? Respiratory Distress, Respiratory Failure. Chest Pain? what time to time applied SPOZ- what We? Monitor/ [2 lead? Oxygen- it Yes, method and dose CPAP- if Yes, dose Nitroglycerin- if yes. how many times and dose Advanced aiiway (King. ET tube) v. Asthma .md es Patients with Primary ot?. Shoxtness of Breath, Dif?culty Breathing, Respiratory Distress, Respiratory Failure: wheezing? what time ufl-?MC to time applied SPOZ-what Monitor/l Z-lead- what 94: Oxygen- if yes. method and dose Albuterol it?yes, how o?en and (lose Atrovcnt- if yes. how often and dose Solumedi'ol (maybe-)- ifyes, how u?en and ?lose Epi (may be in their protocol} if yes. how often and dose Magnesium- if yes. how o?cn and (1056 Advanced Airway Management was it needed/what was used l- King, ET Tube Version: 103/ 201 4 :\AD\002\02\2X02\2X02177.docx 135 521 ll- and Patients with Primary Impression of: Shortness of Breath Dif?culty Breathing, Respiratory Distress, Respiratory Failure. Chest Pain? what lime of FMC to time applied SPOZ- what Monitor/12 lead- what Oxygen- if Yes, method and dose CPAP- if Yes, dose Nitroglyeerin- if yes, how many times and dose Advanced airwaytKing, E'l' tube) (?apnography Compliance for patients with aSSisted airway of patients with assisted airway who had capnography applied Time to apply capnography on cardiac/respiratory arrest patients Total elapse time from ambulance arrival to application of Capnography for cardiac/reap arrest patients ?successful airway management? of Patients with primarily impression related to breathing dif?culty with Pulse Ox maintained above 94%; of Patients with assisted airway device with capnography between 35-45 and Pulse Ox above 94% OTHER Compliance with seizure protocols and procedures Patients with Primary Impression of: Seizure, Altered Mental Status, Febrile Seizure. Eclampsia? SPOQ- what what Monitor- what Treatment (Valium. Verscd, Ativan - which ever in protocol) Blood Glucose- what Magnesium tit'eclampsia)- if yes, (lose? printing in ED compliance of printed at hospital at time of patient arrival Patient Signature compliance (9-6 ot?signatures received were patient or approved signer (not signed by employee)) Version: 10/3/2014 :\AD\002\02\2X02\2X02177.docx 136 522 Responsible Financially Optimize Financial Performance (Ef?cient and Equitable) Measures Definition Frequency Data Source Totztl ot? Al .1. montth ("oat PM I ?ltlt llour Total "of unit .\lonthl_\' Excel "total montth (?ost l?cr transport expenses 'l 0131 [ixch transports l'ines ussessed l'or Response Time Compliance lines .\-Ionthl\' [Excel non-compliance Er contract . . lntzil num her til~ em Im'ees . e. ?r ol mandated tor 7 . mandated on the schedule . . . . . Total hours on the schedule 0 ol shitts on the schedule tilled lw )l . totnl 0\'Cl' time on sclied . . . Actual extensescom tired to . 'a Variance to Budgeted .\lonthl\' laxch budget . revenue com to . to P-uduetcd Revenue I ltxcel budget Service Exceed The Expectations of Our Customers - . . . Dulu Measures Dellniliun l'requenrv . .Souree ?a ("Listomer Sat "0 ol?ull U-l -l and non- cmcrucncv . lcuuntt above 0 out ol lH Key Requu'cmeuts \let (?omplmucc \i?ith mnhulance H) in cuts Transport/Technology - Optimize Use of Resources (Fleet and Technology) Measures De?nition Frequency Data Source ol' trucks available [or "u lleet needs were met (mg ofduily) service if ot'trucks required .\lonthl\' lixeel per the (?i?iticnl Finlurcs per miles of times could l?x?ccl Version Ill 3 31-1 137 :\AD\002\02\2X02\2X02177.docx 523 not complete mission due to mechanical issue per mile driven Segmentation of critical purchased (T . I .rilical lailurcs by 1) pt: mums by reason \lonlhl) L\cc o. . . "on-time" Within 1.000 '0 01 units get PM on time mil? Month!) Extra Fleet Ambulance out ot?scn'icc *1 hours related to tlect mechanic hours related to mechanical Excel issues 003 unit hours by type of out 0? Excel service houis by reason Em plovee Productivitv Number (ll-hours from ?ml Extra Fleet and . llcel of total hours worked to of time. charged out to employee) bchedulcr (.?ost poi milc driven Tow] ?cm CQSB by Excel total miles driven 'l'otal miles driven diVided by Miles per Gallon 'l'otal gallons of fuel Excel Verswii: 10/392014 :\AD\002\02\2X02\2X02177.docx 138 524 PARAMEDICS PLUSI LLC Job Description Job Title: Contract Medical Director Exempt (YIN): Yes Reports To: Chief Operating Of?cer Date Revised: 09I0112014 Summary: Provides general oversight of all medical and clinical aspects of patient care Major Duties and Responsibilities: :\AD\002\02\2X02\2X02177.docx Active involvement with the contractor and its employee through training. field observation and appropriate research Provide liaison with other members of the medical community to support the system and resolve issues Work closely with the REMSA Medical Director Assist the Contractor in ensuring compliance with all system medical protocols established by REMSA Assist the Contractor in ensuring compliance with all administrative policies established by REMSA Assist the Contractor in ensuring compliance with the REMSA Quality Management requirements Assist the Contractor in establishing documentation describing the performance and compliance with the REMSA established protocols and policies by the Contractor and its employees Provide input to REMSA on a periodic basis for the purpose of updating the system's protocols and policies Ensure full access of all Contractor personnel for direct contact with the REMSA Medical Director. REMSA clinical oversight personnel. and base hospital physicians on issues of patient care as needed Participate with the REMSA Medical Director in regular case reviews Participate in REMSA's continuous quality improvement process Participate in Continuing Medical Education activities sponsored as needed or requested; and perform as the medical Director for any such activity as required by South Dakota rule or statute. Provide medical expertise to and participate in ancillary educational offerings (such as ACLS. ITLS. PALS or PEPP courses) and perform as the Medical Director for any such course as necessary according to the course requirements. May be requested to perform job-related tasks other than those speci?cally presented in this description. 139 525 Qualifications: 0 Active practice of emergency medicine in the community - Board certi?ed in Emergency Medicine 0 Must possess the ability to communicate effectively in written and verbal communications 0 Must possess the ability to demonstrate compassion and a sincere dedication to employee needs, concerns and information confidentiality Work Environment: - The work has a high stress environment and must have the ability to maintain composure and tact in stressful situations 0 While performing the duties of this job, the employee may work in outside weather conditions and may be exposed to wet and/or humid conditions, extreme cold and extreme heat. 0 Works regularly with con?dential information. 140 :\AD\002\02\2X02\2X02177.docx 526 BIRTIIDATE EDUCATION MILITARY SERVICE HONORS AND PROFESSIONAL OFFICES :\AD\002\02\2X02\2X02177.docx CURRICULUM VITAE John C. Sacra, MD, February 8. 1944 Pauls Valley. Oklahoma l?auls Valley High School United States Military Academy University of Oklahoma College of Medicine University of Oklahoma Internship St. John Medical Center Tulsa, Oklahoma lntemal Medicine Residency Tulsa Medical Education Foundation (Thief Resident Internal Medicine Medical College of Georgia United States Arm 3? Honorable Discharge Alpha Omega Alpha Honor Society Univeisity College of Medicine Secretary-Treasurer. Georgia Chapter American College of Emergency Physicians Member. Board ol?Directors Georgia Chapter American College Physicians Examinee, Validation Exam Emergency Medicine Certi?cation Exam National Counselor Representing the State of Georgia American College ol'Emergency Physicians Member. Board of Directors Oklahoma Chapter American College of Emergency Physicians 141 527 1959-1962 1962-1964 1964- 1966 I966- 970 1970-1971 1971-1972 1978-1979 964 1970 1976-1977 1976-1979 I977 1977- 1979 1979- 984 HONORS AND Member, Toxicology Committee PROFESSIONAL American College of Emergency Physicians OFFICES (continued) Member. Trauma Committee American College of Emergency Physicians Chairman. 'l'rauma Committee American College of Emergency Physicians Fellmy American College of Emergency Physicians Member Technical Medical Direction Committee Oklahoma State Department of Health h'Iember, Physicians? Advisory Board City ol?Tulsa Editorial Board Urgent Care Update Memben Board of Directors American Trauma Society Member, Board of Trustees Emergency Medical Services Authority Member. Board of Directors Oklahoma Chapter American College of Emergency Physicians Chairman, l?hysicians' Advisory Board City of'l'ulsa Chairman, Institutional Ethics Committee Saint Francis Hospital Member. Executive Committee American Trauma Society Co-Chainnan. 'l?rauma Committee American College of Emergency Physicians Chairman. Trauma Committee American College of Emergency Physicians Member Emergency Medical Services Advisory Council Oklahoma State Department of Health I-J 142 :\AD\002\02\2X02\2X02177.docx 528 979- 980 1980-1985 19814984 1982- Present 1982?1991 1982-1983 1984-1988 1985-2004 1987-1993 l988-1?1?esent 1988-1990 1988-1997 1990-2004 1990-1991 1991-1993 1991-1992 HONORS AND Chairman: Medical Subcommittee 1991-1992 PROFESSIONAL Emergency Medical Services Advisory Council OFFICES Oklahoma State Department of Health (continued) Chairman 1992-1994 Emergency Medical Services Advisory Council Oklahoma State Department of Health Member, Medical Control Board 1993-1998 Emergency Medical Services Authority Member l994-l?rescnt State Trauma Advisory Council Oklahoma State Department of Health Chairman 1996-] 998 Trauma Advisory Council Oklahoma State Department ol?lleallh Governor ?3 Trauma System Task Force 1996.2000 State of Oklahoma Secretary. Board of Directors l997-l 998 American Trauma Society Member, EMS Committee 1998-2004 American College of Emergency Physicians Vice President, Board of Directors 1998-2000 American Trauma Society President. Oklahoma Chapter 1998-2000 American College of Emergency Physicians lVlembe?r 1 999-2005 Emergency Medical Service Advisory Council Oklahoma State Department of Health President 2000-2002 American Trauma Society Member 2001-2010 Emergency Medical Care Committee Oklahoma County Medical Society Member 2001-2004 Council on Community Relations Tulsa County Medical Society 1?3 :\AD\002\02\2X02\2X02177.docx 529 HONORS AND PROFESSIONAL OFFICES (continued) I :\AD\002\02\2X02\2X02177.docx Member Task Force. Emergency Medicine Department and Residency 'l'raining Program University of Oklahoma College of Medicine Chairman Emergency Medical Alliance of Tulsa Chairman Emergency Medical Alliance of Oklahoma City Member Task Force for Bioterrorism Oklahoma State Medical Society A'Ieinber-National Advisory Council National Study on Costs and Outcomes of Trauma Care Member-National Advisory Council Trauma Information and Exchange Program Member Terrorism Response Ad Hoc Committee National Association Physicians Member Mayor ?s Homeland Security Task Force City of'I'ulsa Member Governor '5 Committee on Homeland Security Funding Member Medical Direction Subcommittee Oklahoma Emergency Response Systems Development Advisory Council Curtis 1? Artz Award Highest Honor Bestowed by the American Trauma Society for Contributions to Trauma Care American College of Emergency Physicians Outstanding Contribution in EMS Award 144 530 2001-2004 200 -2005 2001-2005 2001- 2008 2000-2009 2000--2009 200 -2005 2002-2009 2003-2008 2005-Presenl 2005 2006 HONORS AND PROFESSIONAL OFFICES (continued) SOC IETY PROFESSIONAL EXPERIENCE :\AD\002\02\2X02\2X02177.docx OU-Tulsa Prairient?s Leadership Award 2009 School of Community Medicine. Distinguished Service Award Chaimian 2006-Present Medical Audit Committee Trauma System Oklahoma State Department oI'IIealth Member 2008-2010 National Emergency Medical Services Advisory Council National Highway Traf?c Safety Administration Oklahoma State Medical Association 2011 Ed L. Calhoun. MD. Leadership in Medicine Award Lifetime Achievement Award 2012 Oklahoma Ambulance Association American (?ollege of Emergency Physicians Tulsa County Medical Society Oklahoma State Medical Society Medical Director l972?l974 Department of Emergency Medicine St. John Medical Center Tulsa. Oklahoma Associate Director of Medical Education 1972-1974 St. John Medical Center Tulsa. Oklahoma Emergency Department Physician 1974-1978 Associate Director University Hospital Emergency Services Augusta. Georgia Assistant Professor of Surgery 1974-1979 Medical College of Georgia Regional EMS Medical Director Region W. State of Georgia 1977- 1998 Assistant Professor of Medicine 1978-1979 Medical College ol'Georgia Medical Director 1979-1997 'l?rauma Emergency Center Saint Francis Hospital Tulsa. Oklahoma 145 531 Medical Director 19794997 PROFESSIONAL Tulsa Life Flight EXPERIENCE Saint Francis Hospital (continued) Tulsa. Oklahoma Medical Director 1 983- 99 Physical Performance Center Wellness Program Cardiac Rehabilitation Saint Francis Hospital Tulsa. Oklahoma Medical Director 1980- 1982 Emergency Medical Services Authority (?ity of'l?ulsa Clinical Associate Professor 1993-2003 University of Oklahoma College of Medicine, Tulsa Instructor l978-2009 Advanced Cardiac Life Support Af?liate Faculty 1978-1995 Advanced Cardiac Life Support Regional Faculty NOS-2009 Advanced Cardiac Life Support Instructor 1980-2009 Advanced Trauma Life Support Medical Director 1998-2009 Medical Control Board Emergency Medical Services Authority Clinical Associate Professor 2003-2006 Department of Internal Medicine Division Head of Emergency Medicine University of Oklahoma College of Medicine. Tulsa Chairman 2006-2009 Department of Emergency Medicine University of Oklahoma College of Medicine. Tulsa Professor of Program Development 2009-2012 Department of Emergency Medicine School of Community Medicine University of Oklahoma. 'I'ulsa Professor and (?hair Emeritus September 25. 2012 Department of Emergency Medicine University of Oklahoma College of Medicine 146 :\AD\002\02\2X02\2X02177.docx 532 MEDICAL LICEN SPECIALTY STATUS CONSULTING :\AD\002\02\2X02\2X02177.docx C11 ict? Medical Of?cer Paramedics Plus Oklahoma State-95 12 Georgia State-16667 Diplomat. American Board of Internal Medicine Diplomat, American Board of Emergency Medicine Former DiplomaL American Board of Emergency Medicine American Board of Emergency Medicine State of New ,Mexico Trauma Designation Consultant University of New Mexico Review of Emergency Department EMS Foundation Fort Wayne. Indiana Review of Prehospital EMS State of Trauma Systems Foundation Consultant State of Oregon Trauma Designation Consultant Coordinating Emergency Physician for President George Buqh?s Visit to Oklahoma State of Florida Trauma Designation Consultant State of Mississippi State Emergency Nledical Sen/ices Evaluation State of Alaska State Emergency Medical Services Evaluation 147 533 July 20 lO-l?rescnt 971 -Present 974- 980 1980-20] 20 lZ-Presenl 1992 2001 1981-1984 I981 1983 l986-2004 1988-2000 I990 1992-1998 1 992 1994 and CONSULTING National Faculty 1994-1996 (continued) Development of 'l'rauma Systems National Highway Traf?c Safety Administration Consultant ZOOR-Prcsent Oklahoma State Department of Health for Emergency Medical Services and Trauma Consultant February ll, 2013 Whitehousc. DHS, DOT and HHS Trauma Stakeholders Meeting ?Emergency (?are of the Hemophiliae Patient". AND SCHOLARLY Anna/s qumergencyMedrcme. 9:476-479. WORK September. 1980. Guthrie. TIL. Jr.. and Sacra. JP. Liaison from American College of Emergency Physicians to Committee on Trauma ofthe American College of Surgeons for the Update of: ?Hospital and Prehospital Resources for Optimal Care of the Injured Patient" 1983. ?Community Hospital Level II Trauma Center Outcome", Journal nfTruuma. 32: 3, I992, Drs. Thompson. Bickell. Wm. H.. Siemens. Roger A.. Sacra. John C.. Saint Francis Hospital. ?Model Trauma Care System Plan." U.S. Department of Health and Human Services, September 30. 1992. "Trauma Systems". Principr of EMS Systems. Second Edition, Chapter 3: 25-50, 1994. ACFP. Sacra. John M.D.. Martinez. Ricardo. MD. ?National Inventory of I Iospital Trauma enters." Journal ofllw American Afedical Association, Vol. 289, No. 12: 1515. March 26. 2003. Ellen J. Mackenzie. David B. Hoyt, John C. Sacra. Gregory .lurkovieh. Anthony R. Carlin i. Sandra D. Teitelbaum, Harry Teter. Jr. LLB. ?Trauma Systems", Principles of EMS Systems. Third Edition, Chapter 4:40-57, 2005, ACEP, Sacra. John C. MT). 143 :\AD\002\02\2X02\2X02177.docx 534 PUBLICATIONS ?Guiding Principles and ore Issue EMS System Design.? 2006. unpublished. Sacra. John C. ?Tducational Modules for Prehospital and Interfacility Trauma Triage and Transfer." Oklahoma State Department of Health. 2010. unpublished. Sacra. John C. ?The Current Status ol'Regionalization of Acute Care Medical Sen'ices in the United States: A College of Emergency Physician Publication. Michael 7.3ppo. MI). Sharon F.. Mace. M.D.. Andrew I. Bern. MD. Robert R. Bass. MD. James Michael Cusick. NLD. Mark L. Mackcy, M.D.. .lohn C. Sacra. M.D.. David M. Sicgal. M.D.. approved 2009. Makes a Difference: lmprovcd Clinical Outcomes and AND Ilealthcare Savings.? Position Statement oft/w National SCI [01 ARI .Y El IS A dwarer 701mm"! Finance Committee. National Highway Tra ?ic WORK Safety Administration. 2009. Hagen T.. Krumpennan. K. Sacra, (continued) Mciser. 0.. Downing. Wingrovc. G. ?Directness of Transport 01' Major Trauma Patients to a Level I Trauma Center: A Propensity?Adjusted Survival Analysis of the Impact on Short- 'l?crm (Jin'auma. 2011: Garwc. '12. (Iowan. L.D.. Ncas. BR. Sacra. .l Albrecht. KM. ?Factors at the Scene of Injury Associated with Air versus Ground Transport to De?nitive Care in a State with a Large Rural Population.? Prelrospltal Emergency Care, 2011; Stewart. K.E.. Cowan. L.D.. Thompson. D.M.. Sacra. J.C. Propensity Score Analysis of Pro-Hospital Factors and of 'I'ransport ofMajor Trauma Patients to a Level I Trauma 2011: 70( 1): 120-129. Garwc. (Iowan. L.D.. Ncas. R. Sacra. 1.0. Albrecht. Rich, KM. "Association of Direct Helicopter versus Ground Transport and In? hospital Mortality in 'l'rauma Patients: APropensity Score Analysis,? Academic Emengenqnl-ledicr'ne. 2011; 1208-1216. Stewart. K.E.. owan. L.D.. Thompson. D.M.. Sacra. J.C., Albrecht. RIVL Updated October I, 3014 169 :\AD\002\02\2X02\2X02177.docx 535 SUBJECT: Infection Control Plan POLICY 200-28 EFFECTIVE DATE: 1/1/2005 Purpose Sunstar Paramedics shall fully comply with 29 CFR 19101030; and other applicable standards in the areas of occupational exposure to bloodborne, airborne, and other communicable pathogens recognizes that communicable disease exposure is an occupational health hazard. The health and welfare of each employee is a joint concern of the employee. the operational chain of command, and this organization at large. While each employee is ultimately responsible for his or her own health, this organization recognizes a responsibility to provide as safe a workplace as possible. The purpose of the Infection Control Program and its elements is to provide a comprehensive infection control system that maximizes protection against communicable diseases for all employees and for the public they serve. Policy It is the policy of Sunstar Paramedics to: 0 Provide specialized medical and transportation services to the public without regard to known or suspected diagnoses of communicable disease in any patient. 0 Regard all patients, blood, and other potentially infectious materials (including most body ?uids) as potentially infectious. Body Substance Isolation shall be observed at all times. 0 Provide all employees with the necessary training, immunizations and personal protective equipment (PPE) needed for protection from communicable disease. 0 Recognize that all elements of an ambulance and clinical care, and many related support functions, have the potential for exposure to communicable disease. 0 Recognize the need for work restrictions based on certain infection control concerns - Encourage participation in critical incident stress debriefings(C SD) and employee assistance programs (EAP) 0 Prohibit discrimination against any employee for health reasons, including infection and or conversions with HIV or any hepatitis virus. 0 Regard sensitive medical information as strictly confidential. Employee health information shall not be released to unauthorized persons outside Sunstar Paramedics without the signed written consent of the employee. ROLES AND RESPONSIBILITIES: Director of Training and Safety 1. The tasks of implementing and assuring compliance with the IIPP and Infection Control Programs may be delegated to appropriate staff as noted below. However, the ultimate responsibility for the health and welfare of all employees. as well as effective and sustained implementation of Sunstar Paramedics safety and health programs, remains that of Director of Training and Safety 2. In addition to other duties, the Director of Training and Safety has overall responsibility for the development and evaluation of Occupational Health and Safety programs, including infection control for Sunstar Paramedics. The Director Training and Safety, with input from other individuals and/or committees shall: - Develop and implement an immunization program. Health and Safety 200-27 150 :\AD\002\02\2X02\2X02177.docx 536 Develop and implement a post-exposure program. Develop, implement and provide ongoing technical assistance and guidance to the Infection Control Program Provide technical assistance and guidance to Designated Infection Control Of?cers Provide technical assistance and guidance in the development of appropriate Infection Control education and training Maintain con?dentiality of all medical and exposure records Designated Infectious Control Of?cer Director of Training and Safety shall designate a Designated Infectious Control Of?cer. This person must have two years experience as a Paramedic. The Designated Infectious Control Of?cer will: Handle every suspected or con?rmed employee exposure or diagnosis of communicable disease confidentially and in accordance with this program. Serve as the operation's "Designated Of?cer" as required by the Ryan White Comprehensive AIDS Resources Act of 1990 (PL 101 -381). Make recommendations for the purchase of infection control PPE, and propose adequate stocking levels for each station and response vehicle. Evaluate possible employee exposures to communicable diseases and coordinate communications between the company, area hospitals, and the County Health Services Agency where appropriate. Collect compliance, implementation, and quality data on the Infection Control Program and present the findings appropriately. Notify the Director of Training and Safety if data indicates the presence of a safety hazard or trend Coordinate with the Director of Training and Safety or designee regarding spot inspections of various work locations to ensure compliance with infection control policy Facilitate the immunization program with the Director of Training and Safety: As requested, assist the Risk Manager to maintain a con?dential database of exposures and treatment given Provide technical input to appropriate personnel regarding the development of the infection control education and training curriculum Keep abreast of new developments in the field of infection control and make appropriate recommendations locally and to the Director Health Safety Ensure the proper maintenance of the Sharps Injury Log, per instructions provided by the Risk Manager. Clear all new employees prior to assuming patient contact duties until initial medical evaluation, initial immunizations, and infection control training have been completed 3. Clinical and Educational Services In addition to existing responsibilities, the Director of Training and Safety?are responsible for the development and delivery of comprehensive infection control education and training which complies with 29 CFR 1910.1030 and applicable state requirements. The Infection Control Of?cers and operations staff are encouraged to provide input and technical assistance. 4. Director of Director of Training and Safety Health and Safety 200-27 151 :\AD\002\02\2X02\2X02177.docx 537 In addition to other duties, Director of Training and Safety has overall responsibility for the development and evaluation of Occupational Health and Safety programs, including infection control for Sunstar Paramedics. The Director of Training and Safety, with input form other individuals and/or committees shall: - Develop and implement an immunization program - Develop and implement a post-exposure program 0 Develop implement and provide ongoing technical assistance and guidance to the Infection Control Program 0 Provide technical assistance and guidance to Designated Infection Control Of?cers 0 Provide technical assistance and guidance in the development of appropriate infection Control education and training 0 Maintain con?dentiality of all medical and exposure records 5. Designated Physician/Health Care Professional The Designated Physician/Health Care Professional facilitates the health maintenance program. Presently this program provides baseline physicals, return-to-work or reasonable cause determinations. The Designated Physician, in conjunction with the Director of Training and Safety will oversee: 0 The immunization program 0 The Designated Infectious Control Of?cer Program 0 Confidentiality of all medical and exposure records 6. Operations Supervisors and other management staff The Operations Supervisors and management staff shall: 0 Support and enforce compliance with the Infection Control Program?s provisions - Actively support safe operating practices 0 Correct any unsafe acts and refer employees for remedial infection control training if required 0 Institute appropriate disciplinary measures for gross or repeated non-compliance 0 Refer to the designated infectious control of?cer, when appropriate, any employee possibly un?t to work for infection control or other reasons 7. Employee All employees shall: 0 Assume ultimate responsibility for personal health and safety - Always use appropriate PPE as the situation and Sunstar Paramedics Policy dictate 0 Report any suspected occupational exposure to communicable disease to their designated infectious control of?cer in real time. 0 Report any diagnosis of communicable disease to their designated infectious control of?cer PROGRAM EVALUATION At least on an annual basis, the Infection Control Program shall be carefully reviewed by the Director of Training and Safety staff to ensure that its provisions remain as current and effective as possible. Updates and changes shall be based on: Health and Safety 200-27 152 :\AD\002\02\2X02\2X02177.docx 538 0 Signi?cant changes in assigned tasks or procedures, which alter the infection control equipment or controls necessary to prevent occupational exposures - New and reliable infection control information, which directly contradict one or more significant sections of this Program New or revised regulatory requirements which cause suf?cient need to revise this program 0 Evidence that clearly indicates that one or more elements of this Program are de?cient, as determined by Director of Training and Safety. 0 New technology and products (engineering controls) available in the area of safer sharps devices. ENGINEERING. ADMINISTRATIVE. AND WORK PRACTICE CONTROLS The success of Sunstar Paramedics Infection Control Program depends heavily on consistent and proper application of this policy and the corresponding standard operating procedures (SOP's). Employees are required to seek clari?cation from their supervisor or manager on any engineering, administrative. or work practice control they do not understand. 1. Timing and Frequency of Infection Control Training a. All employees with occupational exposure to blood or other infectious materials shall be required to complete: 0 Initial infection control education and training before assignment to tasks where occupational exposure may occur - Refresher training at least annually thereafter b. Employees who have received Sunstar Paramedics training in bloodborne pathogens in the year preceding the effective date of the revised Bloodborne Pathogens Standard only require training in the portions of the Standard which were not included in the previous training curriculum. c. Sunstar Paramedics shall provide additional training when signi?cant changes, such as: (1) introduction of new engineering or equipment, administrative, or work practices controls, (2) modi?cation of tasks or procedures, or (3) institution of new tasks or procedures that affect employees' occupational exposure. This additional training may be limited to addressing the new exposures created, and may be delivered using the most appropriate means. 2. Delivery of Required Training Sunstar Paramedics may provide infection control training using traditional classroom-based instruction or other delivery methods as approved by the Director of Training and Safety. A few examples of alternative delivery methods include: 0 On-the-job training (remedial or post-incident); 0 Interactive web based or video (portions of orientation or annual refreshers); Informational memos or newsletters (periodic notices and informational updates). 2a. The Sunstar Paramedics Director of Training and Safety and the Safety Committee shall collaborate and develop annual refresher training curriculum and delivery methods. Input from all interested parties is encouraged and shall be carefully considered for inclusion. Health and Safety 200-27 153 :\AD\002\02\2X02\2X02177.docx 539 3. Curriculum Content Initial training will be in compliance with OSHA Regulation 29 CFR 19101030, and other state plan equivalents. Such training shall. at minimum, include: a. An accessible copy of the Bloodborne Pathogen Standard and an explanation of its contents; A general explanation of the epidemiology and of bloodborne diseases; An explanation of the modes of transmission of bloodborne pathogens; An explanation of Sunstar Paramedics Exposure Control Plan and the means by which an employee can obtain a copy of the written plan; An explanation of the appropriate methods for recognizing tasks and other activities that may involve exposure to blood and other potentially infectious materials An explanation of the use and limitations of methods that will prevent or reduce exposure, including appropriate engineering, administrative. or work practice controls and personal protective equipment; Information on the types, proper use, location, removal, handling, decontamination and disposal of personal protective equipment; An explanation of the basis for selection of personal protective equipment; Information on the hepatitis vaccine, including information on its efficacy. safety, and the bene?ts of being vaccinated; and that the vaccine and vaccination will be offered free of charge; Information on the appropriate actions to take and persons to contact in an emergency involving blood or other potentially infectious materials An explanation of the procedure to follow if an exposure incident occurs, including the method of reporting the incident, the medical follow-up that will be made available, and the procedure for recording the incident on the Sharps Injury Log; Information on the post-exposure evaluation and follow-up that the company is required to provide for the employee following an exposure incident: An explanation of the signs and labels and/or color coding required for biohazard materials; Information on the proper storage and disposal of biohazard materials; An opportunity for interactive questions and answers with the person conducting the training session. 4. Training Documentation Written records of all required training sessions shall be maintained for three years after the date on which the training occurred and include: The dates of the training sessions; The contents or a summary of the training sessions; The names of persons conducting the training; and The names and job titles of all persons attending the training sessions. I :\AD\002\02\2X02\2X02177.docx Health and Safety 154 200-27 540 SUBJECT: Bloodborne Exposure Plan POLICY 200-29 EFFECTIVE DATE: 01/01/2005 Purpose The purpose of this policy is to identify those employees who have occupational exposure to blood or other potentially infectious materials; describe the infection control plan; and identify the procedure for evaluating circumstances surrounding exposure incidents. Policy EXPOSURE DETERMINATION 1. All employees in the following Job Classifications have occupational exposure: - EMT Paramedic MMA MHT RN Fleet Maintenance 2. The following are the tasks and procedures in which the employees identified may experience occupational exposure: 0 Conducting repairs in ambulance patient compartments with risk of encountering materials contaminated with blood or body fluids 0 Cleaning contaminated equipment - Handling sharps containers from operations I Handling or processing infectious linens - Patient care IMPLEMENTATION 1. The Infection Control Program is applicable to all employees providing medical care and transportation services. fleet maintenance. and materials operations. 2. SUNSTAR PARAMEDICS Infection Control Program consists of a detailed policy and exposure control plan. The policies identify the specific procedural guidelines for all aspects of response and environments where disease transmission can be reasonably anticipated. as well as training. administrative aspects of the program. and post-exposure evaluation/investigation. Speci?c Program components are identified as follows: Infection Control Policy Health Maintenance Policy Cleaning. Disinfection, and Disposal Policy Sharps Exposure Prevention Policy Personal Protective Equipment Policy Post-Exposure Management Policy Bloodborne Exposure Control Plan The Infection Control Policy and the policies cited above address the following specific topics: Health and Safety 200-28 155 541 3. Methods Of Compliance: a. :\AD\002\02\2X02\2X02177.docx General - Universal Precautions/ Body Substance Isolation Isolation Precautions Health/medical training and post-exposure record keeping requirements Engineering and Work Practice Controls Needleless systems Needles with engineered sharps injury protection Non-needle sharps with engineered sharps injury protection Sharps disposal containers Mechanical devices for medically necessary recapping Secondary containers for blood specimens Hand washing facilities and antiseptic hand cleaner/toweiettes Labels for contaminated equipment Bio-hazard bags and containers Work Practice Controls Hand washing after removal of gloves or PPE Immediate washing after skin or mucous membrane contact with blood or potentially infectious materials Prohibition against routine needle recapping Requirement to activate engineered sharps injury protection features Requirement to properly dispose of contaminated sharps Prohibited activities in areas with risk of occupational exposure Use of secondary containers for blood specimens Decontamination of blood-contaminated equipment Labeling of contaminated equipment Personal Protective Equipment (PPE) i. PPE provided include: Gloves protection Full-face shields or mask/eye protection combination Gowns Shoe covers Bag valve resuscitators Surgical masks Respirators HEPA Masks Use of PPE - Gloves and eyewear required Other required PPE based on situation or work task Accessibility Immediately accessible in the field, in the ambulance. Disposal and Laundering Use of contracted providers or in-house staff. Materials Health and Safety 156 200-28 542 0 General 0 Cleanup of spills 0 Regulated medical waste - Laundry 4. Hepatitis Vaccination and Post-Exposure Evaluation and Follow-Up General Hepatitis Vaccination Post Exposure Evaluation and Follow?up Information provided to the health care professional Health care professionals written opinion Medical Recordkeeping 5. Communication of Hazards to Employees Labels and Signs information and Training 6. Recordkeeping Medical Records Training Records Availability/Accessibility Transfer of Records EVALUATION OF EXPOSURE The procedure for the evaluation/investigation of circumstances surrounding incidents of exposure to blood, other body fluids, or other potentially infectious materials is detailed in policy: Post- Exposure Management. Exposure-related medical follow-up. documentation. record keeping, and con?dentiality requirements are also de?ned in policy. 1. Sharps Exposure Prevention Processes address; :\AD\002\02\2X02\2X02177.docx Engineering. administrative. and work practice controls related to sharps; Gathering information required by the Sharps Injury Log; Determining frequency of sharp/brand use; Annual Identification and evaluation of new technology available in the area of engineering controls; Documenting patient safety determinations (not applicable) Solicitation and input from non-managerial employees in evaluation of new or existing engineering controls and; Infection Control Training in accordance with policy of this Program Health and Safety 157 200-28 543 SUBJECT: Potential Bloodborne Pathogen Exposures POLICY 200-30 EFFECTIVE DATE: 01/01/2005 Purpose The purpose of this policy is to outline the process and responsibilities when an exposure occurs. De?nition A bloodborne exposure is de?ned as contact with blood or body ?uids that have the potential to be infectious through a needle stick. through broken or non-intact skin. or through the mucous membranes of the nose. mouth or eyes. Policy 1. For signi?cant bloodborne exposures. be advised that post-exposure HIV prophylaxis (drug therapy) is most effective when administered no later than "hours not days" after the exposure event. For this reason. it is vital that the post-exposure management process (described below) is completed as ef?ciently as possible. 2. Not every bloodborne exposure warrants post-exposure prophylaxis. The physician and the employee should discuss how to proceed based on the specific nature of the potential exposure and the recommendations regarding the most appropriate course of treatment. 3. To greatly simplify the process of coordinating the roles and responsibilities of each person that will be involved in the post-exposure management process, SUNSTAR PARAMEDICS has developed checklist-driven documentation and reference packets. These tools help to guide the employee. field supervisor. physician. and designated officer through the process in an ef?cient and coordinated fashion. For potential bloodborne exposures. the following packets are involved: - Employee's Confidential Report of Possible Bloodborne Pathogen Exposure Supervisor's Confidential Report of Possible Bloodborne Pathogen Exposure Physician's Confidential Report of Possible Bloodborne Pathogen Exposure Designated Of?cer Confidential Report of Possible Bloodborne Pathogen Exposure The Bloodborne Pathogen Standard Sunstar Paramedics First Report of Injury Consent for Alcohol and Drug Testing EMPL EE SPONSIBILITIES 1. Immediately wash the exposed area with soap and water or waterless hand cleaner. If mucous membranes are involved. irrigate them liberally with water or saline solution. 2. Notify the Sunstar Paramedics Designated Infectious Control Of?cer immediately and obtain authorization for an initial evaluation at a designated medical facility. While your supervisor can serve as your advocate to ensure proper follow-up at the treating facility. it's okay to request privacy during the evaluation if you wish. 3. Carefully complete the ?Employee?s Con?dential Report of Potential Bloodborne Pathogen Exposure" packet. Present this completed packet to the physician for review. Health and Safety 200-29 158 :\AD\002\02\2X02\2X02177.docx 544 During the evaluation, provide the physician with the ?Physician?s Confidential Report of Potential Bloodborne Pathogen Exposure? and a copy of the Bloodborne Pathogen Standard (both included in the bloodborne exposure envelope). Indicate that the documentation packet must be completed prior to the conclusion of the evaluation. The employee should retain a copy. Request source patient testing for HIV, HBV, and HCV under Florida Law from the treating facility. Record the pertinent information carefully, including the names and contact numbers of the persons responsible. If the employee does not want his/her blood tested for HIV, HBV, and HCV?he/she has the right to have a sample drawn and preserved for up to 90 days in case he/she changes his/her mind later. It is in the employees' best interest to have these tests performed to establish a baseline blood status. Compare the physician's treatment regimen (if any) with CDC recommendations by working through the algorithm. For any exposure complete a Sunstar Paramedics BBP Exposure Packet (see on-duty supervisor). If the employee is provided with a drug regimen or course of treatment. it should be followed carefully and consistently and plan ahead to accommodate scheduled blood tests and follow-up medical appointments. They will play a vital role in the employee's treatment. Make sure all the employees? questions are answered. If they are unable to provide the information the employee needs, contact the Training Safety Department or the designated infectious control of?cer. Your supervisor can reach Training Safety and the designated infectious control of?cer 24 hours a day. DESIGNATED INFECTION CONTROL OFFICER RESPONSIBILITIES 1. :\AD\002\02\2X02\2X02177.docx Make sure the employee immediately washes the affected area and/or irrigates mucous membranes. Notify supervision that the unit is out of service. Arrange rapid evaluation at a locally designated facility or at the nearest appropriate facility if time between the exposure and the evaluation is likely to exceed 1 hour. Call the facility in advance to authorize evaluation and treatment and to ensure the employee will be able to access de?nitive care quickly upon arrival. Notify Health Safety Management. Have the supervisor meet the employee at the selected facility and review the employee's exposure packet to ensure each relevant item is completed accurately. Then, check to make sure the physician was given a copy of the Bloodborne Pathogen Standard AND the Physician?s report packet. Aggressively pursue source patient blood testing AND employee baseline blood testing for HIV, HBV, and HCV. Obtain responsible person names. numbers, and ?rm commitments. Health and Safety 159 200-29 545 8. Compare the proposed course of treatment to the CDC treatment algorithms to verify appropriate care. If discrepancies are noted, discuss these with the physician immediately. In case of uncertainty or disagreement with the physician about how to proceed, contact Health Safety Management. 9. For any exposure have him/her complete a Sunstar Paramedics BBP Exposure Packet. 10. Make sure the employee receives post-exposure medical counseling, and offer emotional counseling through the Sunstar Paramedics Employee Assistance Program (EAP) and/or CISD service providers. 11. If the employee declines medical evaluation and/or treatment. ensure he or she reads and signs the Con?dential Post Exposure Acknowledgement and Waiver after brie?ng him/her on the risks of the exposure and the benefits of evaluation and treatment. 12. The completed BBP Exposure Packet should be turned over to the Training Safety Department. 13. Sunstar Paramedics Infection Control Of?cer will follow-up treatment of all exposures and maintain the exposure ?les. 14. Upon receipt of bloodborne exposure-related documentation, contact the appropriate hospital to determine source patient blood test results, and make sure the employee's physician is made aware of same. 15. Discuss confidentiality with employee prior to releasing the source patient's blood test results and answer any related questions to ensure understanding. 16. Emphasize the importance of the employee participating in all scheduled blood tests (egweeks) and answer any related questions to ensure understanding. 17. If employee blood testing was recommended by the physician. record the frequency or dates of scheduled appointments for evaluation and/or testing. Make calendar entries for purposes of reminding the employee prior to each appointment. 18. Offer the employee services, provide information regarding how to initiate this counseling, and inform employee that all records of participation remain strictly confidential. 19. Verify that Sunstar Paramedics Risk Management received all related paperwork. 20. Make sure that local management identi?ed the primary and root causes of the exposure and has taken (or has scheduled) appropriate intervention to reduce the chances of reoccurrence. If additional training or corrective action is needed. make recommendations to the investigating supervisor. HEALTHCARE RESPONSIBILITIES The following steps are required by regulation under the Bloodborne Pathogens standard: It's Sunstar Paramedics ?rm expectation that each step will be completed in accordance with this regulatory standard and the most current guidelines published by the Centers for Disease Control and Prevention. Health and Safety 200-29 160 :\AD\002\02\2X02\2X02177.docx 546 1. The source individual's blood shall be tested as soon as feasible and after consent is obtained in order to determine HBV, HCV, HIV status and viral load. 2. If consent is not obtained, the employer shall establish that legally required consent cannot be obtained. When the source individual's consent is not required by law. the source individual's blood, if available, shall be tested and the results documented. 3. Results of the source individual's testing shall be made available to the exposed employee, and the employee shall be informed of applicable laws and regulations concerning disclosure of the identity and infectious status of the source person. 4. The exposed employee's blood shall be collected as soon as feasible and tested after consent is obtained. Note: If the employee consents to baseline blood collection, but does not give consent at that time for HIV serologic testing. the sample shall be preserved for at least 90 days by the treating facilities lab. If, within 90 days of the exposure incident, the employee elects to have the baseline sample tested, such testing shall be done as soon as feasible. 5. Additional collection and testing shall be made available as recommended by the US. Public Health Service (CDC). 6. Post-exposure prophylaxis shall be provided. when medically indicated, in accordance with the current recommendations of the US. Public Health Service (CDC). 7. Medical counseling must be provided during the initial evaluation. Note: medical counseling must include discussion of USPHS recommendations for prevention and transmission of HIV infection, the risks of transmission based on the circumstances of this potential exposure, treatment options, risks and benefits of the treatment options, and the speci?c safe practices to use during the follow-up period. SUNSTAR PARAMEDICS will make available counseling services as needed. 8. The Physician?s Professionals Written Opinion for post-exposure evaluation and follow-up must be provided to the employee within 15 days of the initial evaluation. The Written Opinion shall be limited to the information included on the form provided. All other findings and diagnoses are considered con?dential, and may only be shared with the designated Sunstar Paramedics Infection Control Officer for purposes of exposure follow-up and coordination. POTENTIAL AIRBORNE PATHOGEN EXPOSURES Under the Ryan White Act, medical treatment facilities should notify Sunstar Paramedics of a patient transported with a diagnosis of an airborne transmissible disease. When so notified, the Infection Control Officer shall contact employees involved and schedule a medical evaluation if it is determined that a signi?cant exposure did in fact occur. Detailed information on airborne exposure prevention, including post-exposure management. can be found in the Sunstar Paramedics Tuberculosis Infection Control Program (Airborne Exposure Control Plan). WORK RESTRICTIONS Contracting viruses or infections from caregivers can create serious problems for compromised patients. Any evidence of the following common diseases mandates consultation with a physician Health and Safety 200-29 151 :\AD\002\02\2X02\2X02177.docx 547 regarding work status. The following are general work guidelines subject to modification by physician. Positive tuberculosis skin test (PPD) with no evidence of clinical disease - may work after a physician clearance and follow-up. Bacterial conjunctivitis - may work only in jobs with no patient contact until drainage is absent. Frequent hand washing essential and employees need to be counseled on cross contamination. Acute diarrhea with other (bloody or fever) - do not work until subside. Draining wounds on hands or arms - do not work until culture is negative. Keep wound dressed. Herpes simplex virus (cold sores, draining herpetic whitlow [herpetic lesions on ?ngers/handsj) - may work with drainage contained by dressing after explanation of potential hazards. No contact with newborns or immunocompromised patients. Hepatitis A - may return to work 7 days after jaundice appears with physician authorization. Hepatitis - no patient contact until authorized by a physician and approved by management. Impetigo - no patient contact until antibiotic therapy initiated and crusts begin healing. Lice or scabies infestation - do not work until 24 hours after treated with appropriate lotion or shampoo. Mononucleosis - do not work until authorized by a physician. Measles (Rubeo/a) - do not work until 7 days after rash appears. Susceptible employees exposed to measles without wearing mask and gloves shall not work on ambulance from 5th through 21st day after exposure. Mumps - do not work until 9 days after glands begin to enlarge. Rubella (German measles) - do not work until 5 days after rash appears. Susceptible employees exposed to German measles without wearing mask and gloves shall not work on ambulances from 7th through 21st day after exposure. Strep throat - do not work until 24 hours after initiation of antibiotic therapy. Upper respiratory infection or flu - may work but avoid contact with high-risk patients or wear a surgical mask and gloves. Chicken pox (varice/la, shingles) - do not work until lesions are dry and crusted. Susceptible employees exposed to chicken pox/shingles without wearing mask and gloves shall not work on ambulance from 7th through 21 st day after exposure. Any employee on restricted or no duty status is required to have a fit for duty status form filled out by their treating physician prior to returning to work. :\AD\002\02\2X02\2X02177.docx Health and Safety 162 200-29 548 SUBJECT: Designated Of?cer POLICY 200-33 EFFECTIVE DATE: 8/01 /2005 Purpose The purpose of this policy is to comply with the Ryan White Law- Public Law: 101-381; to promote standardization in post exposure medical treatment; and to facilitate the post exposure medical treatment and management of post exposure follow-ups for all Sunstar Paramedics employees. Policy 1. The Designated Of?cer will be required to have knowledge of the occupational risk for communicable diseases. their transmission. incubation periods. pre and post exposure treatments. Therefore the 0.0. will be required initially to attend a Designated Infectious Control Of?cers course and there after to remain current with the CDC, MMWR guidelines for healthcare workers disease exposures. The 0.0. will also have a background in health care. knowledge of OSHA standard (29 CFR Part 19101030) and the guidelines regarding con?dential ?le management. 2. This person will interact with the Safety committee and management. They will assist in developing curriculum and training the workforce in the core curriculum for Bloodborne and Airborne pathogens. 3. The D. 0. will be responsible for aiding the employee in determining exposure, maintaining con?dentiality. facilitating the testing of the source patient. communicating with the treating facility. supervision and management. and scheduling the follow up appointments for the exposed employee. The Primary 0.0. will manage the confidential exposure file and all information regarding the exposure. 4. There will be multiple Designated Officers that will be directed by a primary 00. Each of these secondary D.O.'s will provide coverage in the event that the primary D0. is out of the area. 5. Sunstar Paramedics will have a designated cell phone for real time. direct communication with the exposed employee. This phone will be manned by a Designated Officer 24 hours a day. The phone will have a back-up 00. phone number in its answering service in the event that the primary 0.0. is unavailable. In the event that this phone fails. the employee will contact the Communications Supervisor to have the D0. or Director of Training and Safety contacted by other means. The phone will be transferred to a secondary D. 0. if the primary 0.0. is anticipating be unavailable for call. 6. The employees will be given training on the Designated Officer program. and on when and how to access it. The employee will be given the contact number and a copy of the MMWR guidelines for management of Occupational Exposure to HBV, HCV. and HIV Recommendations for Post exposure Prophylaxis. The employee will receive training every two years or when changes are made by the CDC. 7. The employee will be offered pre-exposure vaccinations for HBV, measles. mumps, and rubella and for varicella if they do not have natural immunity or proof of previous vaccination. Health and Safety 200-32 163 :\AD\002\02\2X02\2X02177.docx 549 8. The employee will be offered PPE and education on protecting themselves from exposure. D.O.Procedures for HIV: 1. When the employee contacts the 0.0. a log will be started. Information pertinent to the source patient and BBP or OPIM exposure will be documented. The employee will work with the D0. to determine if an exposure has actually taken place and to what signi?cance. If it is determined that it is not an exposure, the employee may fill out an incident report and route it to the 0.0. for review. The employee will stay in service if there is no exposure. if it is determined that there is an exposure. the receiving hospital and contact numbers for the exposed employee will be required. 2. The Communication Center Supervisor will be notified that the employee will be out of service. The supervisor only needs to know that the employee is being taken out of service for a possible exposure. They do not need to know what the exposure is. as to maintain as much confidentiality as possible. 3. The ?eld supervisor will be contacted to meet with the exposed employee at the facility and fill out an exposure packet. 4. The facility will be contacted to advise of the incoming exposure. At that time the facility will be asked if they do rapid HIV screening. if they do, the employee will stay at that facility for treatment. If they do not do rapid HIV testing and the results will take longer than 20 hours, the facility will be requested to supply the exposed employee with a blood sample from the source to be taken to a facility that does provide the rapid testing. The CDC recommendation is that the exposed healthcare professional receives the PEP medications with-in hours but not days. It is important to get a commitment that the source results will be provided to the exposed employee in a manner that is conducive to the employee receiving the medications with-in the CDC's timetable. 5. If source testing is negative, exposed employee will not be treated with PEP medications but will continue evaluation for Hepatitis and C. Counseling by treating physician regarding risks must occur. 6. The 0.0. will act as the liaison between the facility and the exposed employee. If there is any problem with treatment or testing, the DC. will contact a facility of?cial such as a charge nurse or infection control nurse. The 0.0. will have the supervisor provide the facility a copy of the Florida state statue and the CDC protocol if there is a question concerning testing the source or treatment of the exposed employee. If there is a con?ict between the treating physician and the employee regarding the treatment, the physician will be contacted by the 0.0. to seek expert opinion with the National Clinicians Post exposure Prophylaxis Hotline 1-800-448-4911. This hotline is for the clinician only not for the exposed employee to call. 7. if the source patient refuses HIV testing the D0. will contact the County Medical Director for assistance in obtaining consent. If there is still denial of consent Director of Training and Safety will be noti?ed to assist in obtaining a court order. 8. The 0.0. will verify that the exposed employee has completed treatment with the treating physician and that a written opinion has been rendered. If the employee was prescribed medications. the 0.0. will direct them to the pharmacy. Health and Safety 200-32 164 :\AD\002\02\2X02\2X02177.docx 550 9. The employee will be requested to meet with the 0.0. as soon as possible to evaluate the exposure, provide remedial feedback and to set up future medical appointments. 10. The DC. will follow up with the exposed employee until they are released from medical treatment by the physician. 11. The exposure file will be completed with final report from 0.0. and placed into the employees thirty year OSHA ?le. 12. The Risk Manager will add the exposure to the OSHA log. 9.0. Procedure for Hepatitis B: 1. Find out immunization status of exposed employee. If employee has had a positive titer of >11 in the past, they have immunity to the disease. 2. Fill out exposure pack for blood borne exposure. 3. Advise treating physician for the blood borne exposure of the immunity. 4. If employee has not finished the vaccine program or initially declined vaccine. advice treating physician so that they can give employee vaccine and/or immunoglobins. 5. Follow above procedures for log and paperwork, filing and counseling. 0.0. Procedure for Hegtitis C: There is no prophylaxis treatment for Hepatitis C. Follow procedures for bloodborne exposure, log. paperwork. and follow up treatment, counseling and testing. 00. Procedures for Airborne Diseases: 1. General: Most airborne diseases do not require immediate prophylactic treatment. Ask employee what disease they think they have been exposed to and why. If they had appropriate PPE in place. it is not considered an exposure. only documentation. Good hand washing is also advised. 2. Meningitis: Follow up with the receiving facility. Ask if they are testing the patient for this disease. Give them a contact number and have them call the 0.0. with the preliminary results and the final report. Note: Just because a facility thinks a patient has meningitis isn't reason to send employee for treatment. We will treat if the preliminary test comes back with gram negative rods. Send employee to facility, medications must be consumed within 72 hrs. of the exposure. If it is greater than 72 hrs.. the employee will be evaluated and counseled by facility. Follow up with employee for paperwork and counseling. File paperwork in OSHA file. 3. Tuberculosis: Contact receiving facility for further information. Most often the patient had previous treatment for TB and the crew lacks understanding. lf patient is diagnosed with actiye IE. the 0.0. will have the exposed employee come in for a baseline PPD, if they have not had one in the past three months. They will follow up with a questionnaire and a PPD TB test 8 - 10 weeks post exposure Health and Safety 200-32 155 :\AD\002\02\2X02\2X02177.docx 551 If employee has a 5mm or greater wheal post exposure, they will be considered positive and will follow up with a chest x-ray to rule out active TB and referred to the Pinellas County Health Department for continued treatment. 4. Measles. Mumps and Rube/Ia: Employees have been vaccinated against these diseases prior to working in the field. 5. Varice/Ia Zoster: Employees have had disease or vaccine prior to working in ?eld. Anytime an employee has possible exposure to a disease they may contact the Designated Of?cer for direction or further information. Health and Safety 200-32 156 :\AD\002\02\2X02\2X02177.docx 552 SUBJECT: Airborne/TB Exposure Control Policy POLICY 200-34 EFFECTIVE DATE: 01/01/2005 Purpose Sunstar Paramedics recognizes that employees providing pre-hospital medical care and transportation are exposed to patients who may have TB. Because of this potential exposure, Sunstar Paramedics shall provide to employees. information and training. personal protective equipment. medical surveillance and evaluation and treatment in the event of positive TB test results. De?nitions Acquired Drug Resistance- Resistance to one or more antituberculosis drugs which develops while a patient is on therapy. usually the result of nonadherence on the part of the patient or inadequate therapy prescribed by a health care provider. Aerosol. Aerosolization. In TB. it refers to the infectious droplet nuclei that are expelled from a person which can be transmitted to other people. Alveoli.- The small air sacs in the lungs which lie at the end of the bronchial tree. The site where carbon Dioxide is replaced by oxygen in the lungs, and the site where TB infection usually begins. Showing or causing no Booster Phenomenon- Seen when an individual with infection does not react to tuberculin because his/her body's cell responses to tuberculin have gradually waned over the years. An initial tuberculin test may stimulate (boost) the immune system so that the next test will be positive. This phenomenon is important in infection control in order to distinguish between recent converters and people who have been infected for a long time. and determine if in fact transmission is taking place. Although the booster phenomenon may occur at any age. it is most frequent among persons over 55. Chest Radiograph- In patients showing signs or of TB, 3 radiograph of the chest is taken to view the respiratory system. Abnormalities. such as lesions or cavities in the lungs and enlarged nodes. may indicate the presence of TB. Contact- An individual who has shared the same air as a person with infectious TB for a sufficient amount of time so that there is a probability that transmission of TB has occurred. Directly Observed Therapy? An adherence enhancing strategy in which each does of medication is ingested by the patient under the supervision of a health care worker. Droplet Nuclei. Microscopic particles (1 to 5 microns in diameter) produced when a person coughs, sneezes. shouts . or sings. The droplets can carry tubercle bacilli and remain in the air by normal air currents in the room. Drug Susceptibility Tests- Laboratory tests which determine if the tubercle bacilli cultured from a patient is susceptible or resistant to various anti-tuberculosis drugs. Health and Safety 200-36 167 :\AD\002\02\2X02\2X02177.docx 553 Exposure- The condition of being subjected to something such as infectious agents which may have a harmful effect. A person exposed to TB does not necessarily become infected. Efficiency Particulate Air) Filter. Specialized ?lter that is capable of removing 99.7% of particles 0.3 microns in diameter. It may be of assistance in control of TB transmission. Requires expertise in installation and maintenance. Induced Sputum- Sputum obtained form a patient unable to cough up a spontaneous specimen. The patient inhales a mist of saline which stimulates a cough from deep within the lungs. Infection- The condition in which organisms capable of causing disease Tuberculosis) multiply within the body and cause a response from the host?s immune defenses. Infection may or may not lead to clinical disease. Infectious- Capable of causing infection in TB. 3 person is infectious only if he/she has clinically active TB. TB patients whose sputum is positive are often infectious. Mantoux Test- A tuberculin test given by injecting a measured amount of liquid tuberculin into the dermis with a needle and syringe. It is the most reliable and bet standardized technique for tuberculin testing. Positive PPD reaction- A reaction to the puri?ed protein derivative (PPD) test that suggests the individual tested is infected with tubercule bacilli. Determination of the reaction is largely dependent on interpretation by the person evaluating the test given the patient's or health care workers medical history and risk factors. Puri?ed Protein Derivative Test Conversion Growth in induration within a two-year period after initially negative reaction with a difference of 10 or more millimeters of induration. Such "conversion" may represent new infection which is associated with a high risk of developing disease or may occur as a result of the Booster Phenomenon. Source Case- An infectious individual who has transmitted tubercle bacilli to another person or persons. Specimen- Any body fluid, secretion, or tissue sent to the laboratory where smears and cultures for tubercule bacilli will be performed. The specimen may consist of sputum, urine, spinal ?uid. material obtained from biopsy, etc. Transmission- The spread of an infectious agent like Tuberculosis from the individual to another. The duration and intensity of exposure to TB is directly related to the likelihood that transmission will occur and a person will become infected. Tuberculosis Isolation Precautions- Infection control procedures that should be applied when persons with known or suspected infectious TB are hospitalized or residing in other impatient facilities. These precautions include the use of a private room with negative pressure in relation surrounding air and removal of air from the room directly to the outside. Not the same as ?respiratory isolation" which calls for a private room. but does not require negative pressure and exhaust of room air to the outside. Health and Safety 200-36 153 :\AD\002\02\2X02\2X02177.docx 554 Policy INTRODUCTION 1. All elements of the Sunstar Paramedics Tuberculosis Infection Control Program constitute official company policy. Occupational exposure to tuberculosis (TB) is recognized as a hazard to Sunstar Paramedics field employee. Sunstar Paramedics will provide education to employees to reduce this risk. Sunstar Paramedics will supply, at no charge to the employee. respiratory protection equipment capable of filtering out TB bacilli. Sunstar Paramedics shall provide free screening (Mantoux skin test) prior to placement in high risk settings and medical surveillance retesting annually for ambulance employees and annually for all others who provide medical transportation. Sunstar Paramedics will provide medical evaluation. management and treatment in cases of exposure and positive test results. All medical records including pretesting, medical surveillance and treatment shall be kept con?den?al EARLY IDENTIFICATION OF SUSPECT OR CONFIRMED INFECTIOUS TB PATIENTS 1. If a patient. family member. treating facility. convalescent home. hospital or other health care facility offers verbal or written information indicating active TB, the patients shall be considered a confirmed active TB case. 2. Pertinent information received by dispatch regarding con?rmed or suspect TB shall be relayed to the responding employee(s) prior to arrival. 3. Known high-risk groups as identified by the current CDC guidelines. 4. Criteria for suspected active TB patients: 0 Any member of one of the above high risk groups complaining of productive cough or over two weeks duration; or 0 Any person not of a high risk group complaining of productive cough of over two weeks duration accompanied by any of the following secondary complaints: - fever chills night sweats lethargy or weakness loss of appetite weight loss coughing up blood CONTROL MEASURES 1 Engineering Controls :\AD\002\02\2X02\2X02177.docx Health and Safety 200-36 159 555 Ambulances purchased after the effective date of this policy shall be equipped with a patient compartment exhaust fan capable of producing not less than 20 air changes per houn 2 Work Practice Controls 3. When treating suspect or confirmed active TB patients on scene, ventilation of closed rooms should be increased to the greatest extent possible by opening doors, windows, etc. b. Suspect or confirmed active TB patients should be asked to wear a surgical mask (not a respirator) to prevent droplet generation from coughing. c. Such patients should be provided with tissues and instructed to cover their mouth and nose when coughing or sneezing if they find it necessary to temporarily remove the surgical mask to clear their airway. 3 Personal Protective Equipment 3. Employees must continuously wear NIOSH-approved HEPA particulate respirators in any of the following circumstance: - While occupying rooms with suspect or confirmed active TB patients 0 When intubating, ventilating. suctioning or administering aerosolized medications to suspect or confirmed active TB patients - When transporting suspect or confirmed active TB patients e. Employees are not required to wear respirators while driving so long as the patient is masked. f. Non-coughing patients who report a history of TB but have been reliably taking prescribed medication for a month or more usually post no risk to employees. Having only the patient wear a surgical mask during treatment and transport is normally sufficient in such cases. 9. Employees shall utilize the HEPA respirator for all situations described in the Sunstar Paramedics Infection Control Program as requiring a high ?ltration mask for protection against airborne diseases. h. Employees may also wear the HEPA respirator any other time they believe a high level of protection against airborne or droplet-contact disease is indicated. DECONTAMINATION 1. Non-critical items such as gurneys, blood pressure cuffs and stethoscopes do not transmit TB infection. Cleaning with detergents or low level disinfectants is all that is required. 2. The Centers for Disease Control and Prevention (CDC) has indicated that once impacted on a filter. biological particles are not readily returned to the air. Thus respirator filters can remain safe and functional for weeks to months. Current Sunstar Paramedics practice however. calls for disposal of the respirator after use with one patient. 3. Instructions for routine periodic sanitizing of reusable cartridge-type respirators are contained in section 11.0 (Respiratory Protection Program). 4. A reusable disposable type respirator shall be discarded if it loses its structural or functional integrity or is contaminated with blood, body ?uids. sputum. vomitus or other visible organic matter. Health and Safety 200-36 170 :\AD\002\02\2X02\2X02177.docx 556 EM OYE 1. EDI AL SC EENING AND SURVEILLANC Every employee hired for pre-hospital care and transportation shall have a Puri?ed Protein Derivative test (PPD) performed prior to placement in a position which would put them at risk of infection. Initial testing: each employee shall provide proof of having a TB test in the previous 6 months or shall have two-step testing to detect any boosting phenomena that might later be misinterpreted as a skin test conversion. PPD tests should be read by designated trained personnel between 48 and 72 hours after injection. Self-reading by employees is not acceptable Every employee who provides pre?hospital care and transports shall receive a PPD yearly. Every employee who provides non-ambulance medical transportation only and is not otherwise exposed to infection based on duties performed and does not perform high risk procedures shall be tested annually. Any employee who tests positive after employment begins shall be followed according to the current standards as set by the CDC. REPORTING AND EVALUATING EXPOSURE INCIDENTS 1. :\AD\002\02\2X02\2X02177.docx UAT ON AND MA AGE An "exposure incident" is an event in which an employee sustains substantial exposure to a confirmed infectious TB case without the benefit of the particulate respirator described in Section 4.3. Determination of a "substantial" exposure is based on: The infectious nature of the exposure source 0 Proximity of the employee to the exposure source - Extent of protective measures employed - Length of the exposure event Upon discovery that an employee has been subject to an exposure incident. that employee shall be notified of that incident. Within one week from the date of discovery of the exposure incident and again 10 - 12 weeks after the exposure. the employee shall be sent to the designated medical facility for treatment if required. The treating facility shall report all testing and treatment requirements to the company's appointed Infection Control Representative as well as to the employee. The Company will monitor and insure that all appointments for the employee?s treatment and evaluation are kept. If the treating facility provides this service, a copy of that agreement shall be maintained on file. The Company shall reasonably accommodate any additional treatment and testing as deemed necessary at no cost to the employee. OF TB POSITIVE PLOYEES Health and Safety 200-36 171 557 1. Medical management of a positive test on an employee shall meet at least the current standard set by The Department of Health and Human Services and the CDC. 2. A determination shall be made by the treating physician or health care provider as to the infectious state of the employee. 3. if the employee could present risk of infection to other employees or the general public, the employee shall not return to his previous duties. If a safe work environment cannot be created for the employee during his infectious state, the employee will be considered unable to working until he is no longer considered infectious to others. Authorization to return to work without infection shall be made by the treating physician or health care facility. 4. If the employee is not infectious to others and does not present a risk to employees or the general public. the employee shall work assigned duties. Should the employee's status change, the treating physician or health care facility shall notify the employee and the Company. EMPLOYEE TRAINING AND INFORMATION 1. All ambulance and transportation employees shall receive TB training prior to initial assignment and periodically thereafter. 2. Current employees who have not received such training shall be trained at the earliest opportunity. 3. TB training of employees shall include at least the following: How TB is transmitted. The difference between latent TB infection and active TB disease. 0 Signs and of TB. - Control measures to reduce the risk of transmission in the out of hospital environment. How to properly use particulate respirators provided by Sunstar Paramedics. How to report a suspected exposure to TB. The process to follow for medical treatment. How this case of exposure will be followed and further testing requirements. All training required as part of the respiratory protection program. 4 Respirator training of employees shall consist of at least the following: 0 The use and limitations of the HEPA particulate respirator. - Cleaning and inspection procedures for reusable canister respirators (if used). - How to wear. adjust and determine proper fit of the designated respirator. - Employees? successful completion of a documented fit-test conducted by a trained fit-tester. RECORD KEEPIN UIR MENTS 1. Exposure records. skin testing results. medical evaluations and treatment shall be maintained as part of the employee's confidential Exposure and Medical Record. 2. All medical records may be viewed by the appropriate government agency such as OSHA. the employee or the treating medical facility or physician upon approval by the employee. Health and Safety 200-36 172 :\AD\002\02\2X02\2X02177.docx 558 All medical records shall be kept for the duration of employment plus 30 years or as amended by Federal OSHA Standard. Records of TB training and respirator training shall be maintained for at least 3 years Records of cleaning and inspection of reusable respirators (if in use) should be maintained for 3 years. TB infection (skin test conversion) and TB disease are both recordable on the OSHA 300 Log. RESPIRATORY PROTECTION PROGRAM 1. 11 :\AD\002\02\2X02\2X02177.docx Respirators provided for employee use are solely for protection against airborne transmission of TB and other airborne diseases. The only acceptable respirator is a NIOSH-approved HEPA particulate respirator. Selection of this respirator is based on existent regulations. recommendations and policies of FED-OSHA and the CDC. This respirator is intended solely for protection against TB and other airborne biological pathogens. It is not protective in hazardous chemical atmospheres. Employees shall be trained in the proper use and limitations of this type(s) of respirator prior to such use. Documentation of such training shall be retained for not less than 3 years by the local operations CES department. If reusable cartridge type respirators are used they shall be cleaned at regular intervals by the employee to whom issued using appropriate cleaning materials supplied by the Company. Respirators shall be inspected for worn or deteriorated parts at such time. Cleaning and inspection shall be documented using the method provided. Sunstar Paramedics shall have respirators available at all times. Employees shall report conditions or circumstances where exposure could not be controlled or use of the respirator adversely affected the employee. Such reports should be evaluated for opportunities to improve this program. Each respirator user shall be trained in how to wear. adjust and determine proper fit of the respirator. Each respirator wearer shall pass a documented fit-test prior to being approved for respirator use. Qualitative fit-testing shall employ bitters and/or sodium saccharine. Respirators shall not be worn if facial hair comes between the sealing surface of the face piece and the face. Employees with such facial hair will not be tit-tested. . Employees who cannot pass a respirator fit-test may not function on an ambulance. .Any employee who is ineligible for fit-testing due to facial hair is expected to shave as necessary. to pass the test. Health and Safety 200-36 173 559 SPECIFICATION SHEET 6500 PROJECT 25 MOBILE RADIO We've put exceptional flexibility into an advanced mission critical mobile radio that's easy to operate and intuitive to use. The APX 8500 P25 mobile allows users to choose from 4 control heads, mid and high power models and multiple installation configurations in an easy to install design. Innovative safety features such as GPS location tracking, intelligent lighting and one- touch controls help to keep first responders safer than ever before. Focus on the task not the technology, with the hardworking mission critical mobile that turns mission critical into mission complete. MOTOROL A FLEXIBLE PLATFORM I Interchangeable control heads that best support your operational needs - 02, O3, 05, 07 I Two transceiver options - high-power and mid-power I Dual control head support offered on the 02, 05 and 07 control heads EASY TO INSTALL AN EFFORTLESS TO USE I Mid-power model fits into any existing XTL footprint, so you can reuse mounting holes and cables I High-power model trunnion design lets you remove the radio without removing the cables I 12 character RF ID label helps you track information without uninstalling your radio CUTTING-EDGE TECHNOLOGY AND ADVANCED FEATURES I Project 25 Phase 2 technology provides twice the voice capacity I Integrated GPS letsyou locate and track an or vehicle I Advanced features like intelligentlighting, radio profiles and text messaging Improve communication and coordination Comose a Coe 124 in Action I Please reply Optn Del Back 174 :\AD\002\02\2X02\2X02177.docx 560 APXTM 6500 SPECIFICATIONS Ships standard IP54 FEATURES AND BENEFITS: Available in 700/800 MHZ, VHF, UHF R1 and UHF R2 bands Channels: 870* Trunking Standards supported: I Clear or digital Trunked Operation I Capable of SmartZoneP, SmartZone Omnilink, SmartNet? Analog MDC-1200 and Digital APCO P25 Conventional System Configurations Narrow and wide bandwidth digital receiver Embedded digital signaling and ASTRO 25] Integrated GPS capable Integrated Hardware Intelligent lighting Radio profiles Unified Call List Utlizes Windows XP, Vista and Windows 7 Customer Programming Software I Supports USB Communications I Built in support Re-use of most accessories, plus new IMPRES accessories OPTIONAL FEATURES: Enhanced Software Options Programming over Project 25 Text Messaging Over the Air Rekeying 12 character RF ID asset tracking Tactical OTAR ?Enhancement package available IRANSMII TIR TYPICAI PERIURMANUE 700 000 Frequency 764-776MH1 806024MHZ 704-008 MHZ 051?070 MHZ Channel Spacing 25/20/125 25/20/125 Maximum Frequency Separation Full Full Rated RFOutput PowerAdj? 10-30 Watts 10-35Watts Frequency Stability? 20.00015 95 20.00015 [?30?l3 Ref.) Modulation Limiting? :5 kHz/:4 /22.5 Modulation Fidelity 228 22.8 t25kHz Digital Channel Emissions? Conducted+ Radiated+ Con ducted Ra diated ?20/?4003m 4505c . ?20tIBm Audio Response? -3 dB FM Hum &Noise 25 ?50dB ?50 dB 12.5kHz ?48 03 ?4808 Audio Distortion? 2 2 VHF 130-174 25/20/125 Full 10-50 Watts or 25-110Watts 20.0002 :5 M25 :23 Conducted Radiated ?85 ?20 ?52 dB 2% UHF Range 1 330470 25/20/125 Full 10-40 Watts or 25-110Watts J20.0002 :5 l225 :28 Conducted Radiated ?35 ?20 2% UHF Range 2 450-520 25/20/125 Full 10-45Watts [450?485 MH2110-40 Wattst405512 MHZ) 10-25Wattst512- 520 20.0002 25 12.5 :20 Radiated ?20 Conducted ?85 2% DIMENSIONS Mid Power Radio Transceiver 05Control Head 02 Control Head 07 Control Head Mid Power Radio Transceiverand 05 Control Head?De sh Mount Mid Power Radio Transceiverand 02 Control Head - Dash Mount Mid Power Radio Transceiverand 07 Control Head - Dash Mount Mid Power Radio Transceiverand Remote Mount High Power Radio Tra nsceiver High Power Radio Tra nsceiverwith Handle Indies 2X7X8.E 2x7x25 2.7x 8x21 2X7X1.5 2x7x00 2,7x8x10.5 2x7x103 2.0x7x90 29x115x08 3.4x11.5x 0.8 6.8lbs Mid Power Radio Transceiverand 05 Control HeadWeight Mid Power Radio Transceiverand 02 Control Head Weight Mid Power Radio Transceiverand 07 Control Head Weight High Power Radio TransceiverWeight With Trunnion Without Trunnion :\AD\002\02\2X02\2X02177.docx 7.12 8.74 14.2 12 175 561 Millimeters 50.0x1770x 213.4 50.8x180.3 83.5 63,4 x206 52. as 50.0x170x 40 50.0x100.3x243.8 634 X200 x288 50.0x170x 262 50.0x100.3x243,0 74x 203x 223 37 x293 223 3.0 kg 3.23 kg 3.06 kg 0.4 kg 5.4 kg SPECIHITATIONS APX 6500 CONTROL HEAD PORTFOLIO 02 RUGGED O3 HAND HELD OS STANDARD 01 ENHANCED CONTROLHEAD CONTROL HEAD CONTROL HEAD CONTROL HEAD I Large color display with intelligent I Large color display with intelligent I Fri-color displaywith I Large color displaywith intelligent lighting lighting intelligent lighting lighting I 31inesoftext14 characters max/ 1 line ofioons/l line ofmenus I Available with Lighting 8! Siren Controls or DTM Keypad I Multiple control head con?guration (up to 21 I Multifunction volume/channel knob I Night/day mode button I 2 inesoftext14 characters max/ 1 Iineofioons/l line ofmenus I Available with Keypad Microphone I Multiple control head con?guration (up to 21 I Display contrast selector I 2 lines oftext 14 characters max! 1Iine oficons/t line ofmenus I Integrated full size DTMF keypad I Hand-held control head with intuitive user interface I Two quick-access side buttons I Display contrast selector I 3 lines oftext 14 characters max/ 1 line oficons? line ofmenus I Builtin 7.5 watt speaker I Multiple control head configuration (up to 2) I Multifunction volume/channel knob I Night/day mode button A SPECIFICATIONS 000 VHF UHFRange1 UHFRange 2 Frequency 764-776MHZ 851-870 136-174MH2 380470MH2 450-520 Chan nel Spacing 25/20/125 25/20/125 25/20/125 25/20/12. 5 25/20/12. 5 Maximum Frequency Separation Full Ba Full Ba Full Ba Full Full Ban dsplit AudioOutput Power 7.5Wor15W++ 7.5Wor15W++ 7.5War15W++ 7.5W or15W++ 7.5Wor15W++ at 3% distortion? Frequency Stability? (?nammsooci +2590 PPM PPM PPM Pre-A mp Standard Pre-Am Standard Pre-Amp Standard AnalogSensitivity? 12 dB SINAD ~121dBm -121 -123dBm -119dBm .123dBm -119dBm ?123dBm -119dBm DigitalSensitivity 5% BER -121.5dBm -121,5dBm -123dBm . -119dBm -123dBm -119dBm -123dBm ~119dBm Intermodulation 82dB 86dB 02dB 36dB 8203 82 dB 05 dB 86 dB 33dB 05dB 8308 85118 Spurious Rejection Audio Distortion at rated? 1.20% 120% 1.20% 1.20% 1.20% FM Hum &Noise 25kHz 59dB 59dB 59dB 55dB 57 dB 125 50dB 50118 50113 5003 50113 Selectivitf SIGNAI INO IASIRI) MODE) UPS SPECIFICATIONS Signaling Rate 9.8 Channels 12 Digital ID Capacity 10,000,000 Conventional [43,000 Trunking Tracking Sen sit ivin -153dBm Digital NetworkAccess Codes 4096 network sitead dresses Accuracy? <10 meters195%] Digital UserGroupAddresses 4,096 network site ad dresses Cold Start <80 sezonds Project 25?03111 Digital UserGroupAddresses 65,000 Conventional/4,094 Trunking Hot Start <10 secondst95%] Error Correction Techniques Golay,BCH,Beed-Solomon codes Mode of Operation Autonomous Data Access Control Model Type Minimum RF Power Output Slotted CS Utilizes intrastruct ore-sourced data status bits embedded in both voiceand data transmissions. POWFII AND BATTERY DRAIN 136-174 MHZ 10-35 Watt (704-870 IO-SO Watts 01 25-110Watts (130-174 or25-110Watts1380470 10-40Watt (435-512 1025Watts1512-520 MHZ) Operation 13.881 DC 120% Negative Ground Standby at 1331/ 08501784870 MHZ), OBEA [300470 0.85Att150-520 Receive Current at Hated Audio at 13.8V 0 3% (138-174 3.2A [450- 520 Transmit Current (Aiat Hated Power 136-174 MHzt10-50 Watt) 8A 704-870 MHzt1035 Watt) 12A [5010] 330-470 MHZ [1040Watt] 11A (40W) BA 138-174 20A 380-470 MHZ [1040101311] 11A MSW) BA 380-470 MH2125-110Watt] 24A 178 :\AD\002\02\2X02\2X02177.docx 562 APX '6500 SPECIFICATIONS STANDARDS 810 C, 1) MIL-STD mc MIL-STD MIL-8T0 310E Muhod Pu!ch Mdhod 1?er Mothod Prom/Cat. low SUKJ Huh Tunpet?dluw 5?11 1 1? 11 501 2 W11 111M 501 '3 UN 16mmeer 5071 507 VCR. 11/171 5117 3 1/13111/131 5021 1 WM 503 '30] 301w Redralnn 5051 11 50?: I 5053 Ram 511/1 ll 11 50} '3 ll '53? 109 5091 Wrot 5097 1 509 3 1 Part Blowrng Dust 5101 511) 1? I 11 511.1 3 11 Vthtatlon 514 1w Curve-W 1/10, 11/3 51? 4 1/10 11/3 snort I. Bus 3 t, v,v: 516? to vr Stpportad Enayntton Alum (japamty Keys per 113ch Encryouonlrarm Flo-sync Keyng Vector Generator In? my Srerago Key Erasure Standard; ADP AES. DES DES-XL DVP-XL 11 Module capable ol stormg 10241cey: tor GA Emmott Koy Raloronro or 16 Phys-:31 loonlma (P10) kwloedar XL - Counter Addressna, UFB- Uulnul Feedback Nattonat or Stanoards and leomotogytNIS 1t .mpmwu random nurtber generator Tamer protected votartta or non votatrto momorv keyboard cortmand and tamper detectm 19514001910313 193197 Motorola Lohtms. I301 Algooqun Read Schaurrturg 60195 A mloreluoluleumm A, an, I ITIDNS and me 0ng are or ragmmd ?emu 01 Motorola Trademark 111. and are Ill-8T1) 8106 Mothotl Procle Maillot! Plot/Cal 500 I 11 5011 5 11 5m 4 mm tt/ttot stub IN 50? 4 1/121, 11/1'1 507 5 113,11 5014 so)! I Proc 5015 II Aggravalod 509 I Ptu5115 1/24 514 5 lat 21 5155 5166 r_v vr IUMIUNS HGDT Upotatmg fitnperatura Storage Temputattle E31) Water and Dust are MH7 136 136-174 380410 380-470 MHZ 150.570 Peer 31D xv TYPE ACCEPTANCE 10 0mm POWER 10-35 Watts 25 11" Watts 10-50 Watts tn-analts 25-th Watts tn-ASWatrs T?ll?m tumour 117497115855 AZABZF 13821 A24921138ZI AZIQIF ALISZF 14837 AIIQZF 141196 Mawad tn the analog mode per1lA/E1A urn modems Autumn specs are lot long term uacltr-g (Shut parranlla altar. >5 vtubln at: manual 4311 (Em mural 311801111 ?specsmduk; pulam-u-u 1a IN uutnut pow In to 8 and 3 2 ohm orth streams respova Emulators 211111;! to cram); mane All tram-mum: sluwn are Hedromats rewlem regal-mam used under lemma All other trathnm: 3181M property or mart owners 0 ?0t 3 Motorola Summons, Inn. All msorvnd 0 "mm :\AD\002\02\2X02\2X02177.docx 177 563 1111 -1 311571: PRO DUOT SPEO SHEET 4000 MISSION READY WHEN IT MATTERS MOST 4000 PROJECT 25 PORTABLE RADIO Chemical spill. Catastrophic storm. Power outage. When every minute matters, you must communicate instantly with other agencies and responders. But how do you prepare for a disaster and keep comrol of operating costs? That's where the ?1000 P25 portable radio answers the call, expertly and affordably. The APX 4000 delivers all the benefits of TDMAtechnology in the smallest P25 capable portable inthe industry. Easy to use,tough as nails, a hardvalue to beat, it searrlessly connects public safety agencies and public works for fast, interoperable communications. EVERY INCH AN APX The APX 4000 leverages the leading attributes of the APX fanily of P25 TDMA portables. Fromthe 2-microphone design that reduces background noise so you can speak and hear clearly over heavy equipment, diesel engines and sirens to the high-spec RF performance for excellent coverage in challenging environments. With its easy-to-use interface, color display, intelligent lighting and radio profiles, you get all the power of APX in a compact radio. Plus,you can extend the performance of your radio with a complete portfolio of industry-leading IMPRES smart energy and audio accessories. :\AD\002\02\2X02\2X02177.docx COMPACT AND UNCOMPROMISING The smallest P25 Phase 2 capable portable,the APX 4000 gets thejob done without getting in the way. Simplified controls and a choice of either dedicated volume and channel knobs, or an enlarged multifunction knob,the APX 4000 provides readiness for any type of work setting. And its standard IP67 and MIL-STD certified to withstand dust, heat, shock, drops and water immersion, so you can count on it whereveryou need it - at the factory line, power line orfire line. P2 5 PERFORMANCE, INSIDE AND OUT Loaded with key P25 features to increase safety,the APXAUDU features Mission Critical Wireless, a unique Bluetootho solutionthat provides an linkto a high performance earpiece, GPSfor quickly locating personnel outdoors,AES irrproved security, and over-the-air programming to program radios in the field without interruptingvoice operation. IMPROVE RESPONSE AND EXPENSES The APX 4000 is P25 Phase 2 capablefortwice thevoice capacity soyou can add more users without adding more frequencies or infrastructure. And it's backWards and forwards compatible with all Motorola rrission critical radio systems, so you can interoperate with confidence while you improve operating expenses. 178 564 POWER UP WITH APX 4000 ACCESSORIES - Designed, tested and certified for optimum performance with your rad'n - Complete portfolio of remote speaker microphones. headsets and Mission CriticalWireless Bluetooth? accessories - High-powered batteries that have a slim design tofitthe compact rad?n size FEATURES AND BENEFITS Pnailable in Mil/8120 UHFRI. UHF RZand 913 bands Trunking sia ndards supported: 0 Clearordi ital ration I Capable Srraleone?,SnartZone Umnrlink. Analog Digital APCU P25 Conventional System Config rations Narmand wide bandwidth digital rec?ier Superior Audio Features: I USW high audiospealer I 2-mic noise canceling tech nobgu XEVista and Window 7 Customer Programing So?waretCPS) I Supports - Built in Full m?folbofacoessarbs including IMPHES batteries. chargers and audiodeuices3 3Dklk/25an? op?oNAL fEATunEs Standard with Zdedicaned control knots forvolurreand Mision CriticalWireless? . channelchanges . . ABS Encwp?on .- Errbedded digital Signaling (ASTBU R0 25) Over ijmzs ammo? Man Down Text Messaging Aiailable in 2 models BPS Local ion Tracking lnheg ted BPS capable Man Dom Lightbarwith lntell'gent Lighting Site Selectable Alert Tones Radio homes P25 [her the Ame-laying Uni?ed can as Link byerAut henticat ion Lberproglan?mableVoice Announcement Enhanced Data Multifunction Knob MeetsAprlitatle D. E. Fand IP67 standard rreuer. 30 rrin uhesjz Rugged Submersible housing [2 meters forZ hours]' :\AD\002\02\2X02\2X02177.docx Pa theft]: prodms VHL UHRI suhm Red for chanfrcamnafua January 1. 0H aermraed from beng gamed cau?cauon at for Lhred Stats Some; local Makesonly. 2 Radios meet 'rdi?y sundads for in masicn. 301agysard batter isfor ihe APX 4200radiosdo not intimate! with other APXradios. ?Ozcnpatble wih BT2 and and PA BTPro?ls. ?When used with a llanrdow ?Only avaiHJle i1 multifurmbn knob mode ?Gilyocmpatblewidnknub model. TRANSMITTER - TY PIMLPEBHRMANBE VIIF Mllz? Frequency Fange/ 700 MHZ an 835324351370 136-174 333470 493520 $331358?) Channel Suacing 25112.5 W125 25/125 kl-h W125 125 kit Maxirmm FrequencySeparation Full Ba Full Full Full Full Ba Rated BF Output PomerAdj? ISWatts Max 16 Watts Max ISWatts Max 15 Watts Max 1-2.5 Watts Max Frequency Stabilitv? wmc; +2330 M.) $013310 $6 $0.me 20.03310 50130310 ModulationLimrting? t5kHz/24kHz/225le Emissions (fonduched and Rad'anad)1 45 dB -?5dB 45 dB ??5dB 45 dB AudioResponsa? +l.?3d8 +1.?3dB +1.~3dB +l.?3dB +l.?3dB - 4? dB ?47dB ?47 dB ?47 dB FM mmg?mme 125m: 45dB 47dB ?visas ?45d8 45:13 . . . 25 Audio Distomon '25 k? 1.03% ?20% LEM 103% BATTERIES FOB APX 4m Eaten hpncity I Type lineal": (llexD) Weight hm Pan?lmher EM capacity Li-lon IMPRES 191'] mah IP67 1145x5504x1735 1509mm 1910 Li~lon IMPHES 2300 with IP67 Non 1145x5504?315 IBJgIarrs 2300 Li-lon IMPRESZBCO man IP67 Hazloc? ll45x5504x23.15 1&3glarrs 2300 "All PAGE 2 1 .79 565 IIGT SPEC SHEET APXWIEIJD II Ml In 0 ELS MOB EL: EL: Full bitmap color LCD display Full bitmap color LCD display 3 inesoftextx 14 characters 3linesoftextx14chalacte1$ Display 1 Iineof icons 1 Iineof icons 1 menu inex3menus 1 nenulinexamenus Whine hacldigm White backlight hyped Backliglit keypad aso? Ines-s . gm" ms. Keypad 4diraztion Naugatbn key 4 ma?a" $333350" by Home and Data buttons I ?wand Um humus Channel Capacity 512 512 64MB BQMB 711M330 (763 870 MHI) F151 0508K H51 OSBOGX H51 0360M UHF Range 1 470 101sz OSBOGL 03mm UHF Range 2:45-5:13 lulsz $15013?me 03mm 930 MHztEmem HS1WBF3PW8AN 03m? OSSDJE Large PTT button IAngIed Unl?fi Volume Contiol I 16 position top-mounted rotary Mitch I Bum? 8? SNIIC has lange emergency button '3 pioglammable side buttons TRANSMITTER CERTIFICATION Inn/630 (764-869 A2469 F17949 H3 UHF Bange 1 (333-470 AZ489FT4905 UHF Flange 20133-5213 AZ489FT491D 930 MHZ 601. 935-940 FCC EMISSIONS DESIGNATOHS 'v I FCC Emissions Designatms 11KOF3E 1? 7 5'5 1 Emissions Designamus'forgno 11KBF3E.8K10F1D. ?KinnE. SKIDFIW . ., J. . POWER SUPPLY PONerSupva Onenetbaigeable Li-lon 1930 mf-Ih batten! sta ndald.or23C0 mill-Wi?m highcapLi-lon. i, i I. I 70ml! VIIF Inge! ?Flame: Frequech $3 an: $313 33 136-174 383470 453-521: 9354940 Channel Spacing W125 W125 Ht 25/125 Hf 25/125 125 Maximum quency Separation Full Full Full Full Full Audb Output Ponierat Bated' annw 8:me ammw 5:an Fiequenw Sta bility?(?30?C to NC: +25?c Ref.) gamma mimic 20111310 n. 3000010 nu :oxm 10 u. Anabg Sensitivity? 12 dB SINAD 0266111! DZIBW 0.234111! 034W OZSBW Digital Sensitivity? 1% BER 1&1) 0.403111! 02?? pl! 0.3137111! 0307111! 0.3?3nV 5% BER 023W [Haw UEJTW 02117 11?! 023W Selectivitu1 25 Ier channel -76d8 46 dB -76dB -78 dB 12.5Id-lzchannel ~67 dB -70dB 6MB 67 dB 67 dB Inten'nodulation 45:Spurious ijection -765dB 65:18 made md? Fin Human Noise 25 we -51dB was me 12.51tHz -47 d8 45dB 45dB 45dB 47 d8 Audio Distottion? 1 1.03% 111113 1.113% 100% mass 180 :\AD\002\02\2X02\2X02177.docx 566 WOT SPEC SREET 4000 PORTABLE STANDARDS 8100 FR. 0 POL-STD 8100 Mound Prom/Cat I 0? Pressure 500 I th Ianparatue 501 I I, II law Inmpamnre 502 I I Ierwerature Shock 503 I I 3er Radralm 505 Humtd?v 510] I II Salt fog 509 I I BIowng [hm 510 I Blotan Sand I Ptoc I Plot Vbratvon 514.2 Curve-W 910d: SIS I. 9106:1000) 516 2 DIMENSIONS UI RAUIUS WI BM ILHY Wrath Push-To-Talk button Depth Push-Io-TaII: button Width Top Depth Trip Werght of the radm wdhout balm-1y Method Prom/Cat. Mnlhod I?rocJCaL 500] II 3113 II 5012 WM 501 3 502 .7 50.7 3 I 503-2 50343 $1352 I 5053 I 5062 509? I 509 3 I 510?. 510 3 5102 Il SIG 3 II 5143 51? 5163 I, V. VI 5154 I. V. VI 5162 516 4 IV (I max? 5 5'6/5 237/2 42 I 12" 4 256/162 713/184 81701/I0l15m (1 ho 133/137 7 50 2/51 4 43 6/35 75 85/65 55 43/45 7 '60 9/285 9 lit-SID MoIhod ProcJCat. sun A II SDI 4 I/Hot, II/Basm Hot 502 ProIlla 515 5 I. V, VI 516 UPS SPEUIICAIIUNS Lhannels Irackmg Acwracy' Cold Star! Ilul Slarl Mode oIOperatron m-sm 8106 Method hoe/Cat. 5 II 501 IIAI5(1) 5 I, 507 5 IllAggavated 5m 5 I I'459 <10 <80 mend: (95% <10 seconds Autonomous GPS SPECIFICATIONS AIIP. AIS. DES. DES-XI. Suppurwd I?nCIypImn Algorithms Enayptron Algal Capecrty incry Rad? Fnayptron Frame FIe-swnc Interval [nuyptum Keying Vector Generator Iype Key Storage Key Erasme Standards MuIntoIa Sui/Irons Inr. I301 East Hnad Smaumburg. Illmuns 50I96, II A 800-367-7336 Morhle capable oI stu- mg I026 keys Programmable for 64 Common Key Reference I6 P25 CAI 300 mSec Key Loader XI. - Counter Addressmg OFB -Dutput Feedhadt Natmnal InstrIuIe 01 Standards and Iechnology (N ISTI approved random numbor goneratnr Iampel pth:ch vnIaItIe nm-volattla mommy Keyboard command and lance: detectm FIPS 140-2 Level 3.FPS I97 Opemm Ienmeratura? Slalng Iemperutms6 Ilumuitly [50 Water and Dust htruston Immersmn MUIDIIOLA. MUIU IDRDLA SUIU IIDNS and mo Logo are tram-mans or trauma/is 01 Motorola Ir adamarb Hc-Idngs. LIC and am used mm: All Omar t1 adorned: am the prowty of mpomvo owmrs (I 2014 Motorola Solution; Inc All "gm: rosavod mm :\AD\002\02\2X02\2X02177.docx 181 567 Pu MIL-SID 301-2 KV IP67 nan-20500 :\AD\002\02\2X02\2X02177.docx onBoardTM MOBILE GATEWAY RUGGED, RELIABLE COMMUNICATIONS 2000 The onBoard Mobile Gateway is a multi-network. rugged communications platform designed to deliver secure, wireless wide area networking for vehicles. The extends the enterprise network and management to the ?eet. ensuring reliable. secure corporate network access for mobile users in the ?eld. The functions as a multi-radio mobile router and broadband access point. VEHICLE AREA NETWORKING: CONSOLIDATE CONNECTIONS The includes a built-in 802.11 b/g/n w-Fi access point that creates a mobile hotspot in and around the vehicle allowing multiple devices to connect. reducing the proliferation of radio modems. antennas and wireless accounts otherwise needed. The allows devices to connect via Ethernet. Serial. USB. Wi-Fi and Bluetooth. SECURITY: SECURE SWITCHING BETWEEN AND CELLULAR NETWORKS The can be con?gured with multiple wireless modems that provide access to a combination of cellular data. 802.11 a/b/g/n w-Fi. 4.9 broadband. carrier 46 LTE. public safety broadband LTE (FirstNet) and other broadband network services. Multiple radio form factors are supported including USB/ExpressCard. PCI Express Mini (PEM) and MiniPCl for maximum radio ?eXibility. The oMG's network policy engine enables intelligent switching between networks. based on a variety of operational factors. A patent-pending cognitive wireless system automatically senses. assesses and selects the best available network. lM-Fi links are protected using the latest security standards and an embedded mobile VPN capability (onBoard Connection Manager - can secure communications for all connected devices and applications across wide area connections. The is available with an optional FIPS 140-2 compliant lPsec client. MANAGEABILITY: MANAGE, MONITOR AND ADMINISTER YOUR FLEET REMOTELY The includes a built-in GPS receiver and microcomputer. enabling value- added applications arch as vehicle tracking. RFID asset tracking. vehicle telemetry. and remote device access. Remote management of the is provided by the DATAS ET KEY FEATURES Creates mobile hotspot in and around vehicle Connects devices using Ethernet. Serial. USB. Wi-Fi and Bluetooth . . . . . . . . . . . . . . - . . . . . . . . . . . . . . . . . . . . . . . . . . . .. Automatically senses and selects best network and switches based on user- defined policies Supports multiple wireless broadband networks including 4G LTE. FirstNet. Public Safety Optimized remote monitoring. management and configuration - . - . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - - .- Integrated security for all connections and devices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. Advanced integrated GPS with multi-cast and WAAS onBoard Mobility Manager a power software suite that provides status monitoring. device management. and application interfaces. A dashboard provides an up-to?date view of the entire fleet. and a comprehensive reporting suite presents data on-demand. or via prescheduled reports. TECHNOLOGY S. A WIRELESS 182 568 DATAS ET BENEFITS SINGLE PLATFORM FOR ALL COMMUNICATIONS - Reduces operating and capital costs for infrastructure - Simpli?es management and maintenance of ?eld IT equipment - Reduces communications costs by consolidating traf?c over single/preferred network connections - Enables organizations to leverage Vl?-Fi infrastructure - Provides a core platform for upcoming applications and devices CREATES A MOBILE HOTSPOT - Connects all wired and wireless devices in and around the vehicle - Enables quick and easy deployment of new applications - Reduces distraction of mobile crews enabling them to focus on day to day responsibilities ENDURING - Supports all IP devices in the vehicle - Supports current and future wireless wide area networks, including Public Safety Band Class 14 LTE (FirstNet) - Field upgradeable REDUNDANCY - Selects ?best available? network using up to 6 modem card slots and seamlessly switches traf?c - Maintains user sessions preventing false connection status SECURE, RELIABLE - VPN client to provide secure communications for all connected devices and applications and supports VPN pass-through - Eliminates the need for VPN software clients for individual devices and applications - Sends logs and other data to management system REMOTE MANAGEMENT - Remote mass con?guration - Over-the-air updates - Remote troubleshooting - Log data stored locally and transmitted to the onBoard Mobility Manager server HOST APPLICATIONS In Motion Technology applications include: - GPS vehicle tracking - Asset tracking of RFID Wr?Fi tags - Vehicle diagnostic telemetry via - Remote device trouble-shooting - Turn by turn navigation via Garmin Fleet Management Interface RUGGEDIZED - Built for in-vehicle use 183 :\AD\002\02\2X02\2X02177.docx 569 DATAS ET FEATURE SPECIFICATION VEHICLE AREA NETWORK (VAN) Support for all on?board devices - wired and wireless 802.11 b/g/n with 2x2 MIMO (built-in vehicle AP) Ethernet: RJ45 4 ports Ethernet USB Serial: R8232. D89 DHCP Server (RFC 2131) USB: USB 2.0 2 (Serial or Ethernet) Bluetooth: DUN (optional external adapter required) Antenna Connectors: SMA (1), RP-SMA (up to 10) to support MIMO/diversity capable radios Rear panel supports custom connector con?gurations Compatibility - Operates with Wi-Fi certi?ed client devices - Supports all major client operating systems WIDE AREA NETWORK (WAN) VWre/ess Networking Radio form factor diversity to support multiple. evolving - Up to 6 modem card slots; accepts USB. ExpressCard, PCIExpress Mini (PEM) network data services and MiniPCl formats Integrated compatibility with wireless WAN standards: EVDO. GPRS, EDGE, UMTS, HSPA. LTE 802.11 a/blg/n with 2x2 MIMO 802.11-based 4.QGH2 Public Safety Satellite (via Ethernet) Future compatibility with new wireless WAN standards using standard ExpressCard. USB or MiniPCl or MiniPCle form factors - Future support for Public Safety Band Class 14 LTE Transmit voice. video and data through the OMB 003 0 Applications priority queuing SECURITY WLAN Security andAuthentication Secures all data transmitted to and from vehicle without the - WE P. WPA. WPA2 need for VPN client software on every device - Key management WPA-PSK and WPA-EAP Firewall - Port forwarding - Port blocking - lPsec including (FIPS 140-2 compliant modules available as an option) Authentication and Accounting - authentication Network Selection - Multiple WAN connections - WAN connection policy managed by network priority. availability, signal strength, GPS location. time-of-day Protocols Supported - Transparent support for HTTP. SMTP, POP, IMAP, - (RFC 2516) GPS Embedded 12 channel GPS receiver Track vehicle locations on maps. provides location - WAAS and Double Precision LLA awareness and mapping to reporting suite - NMEA and TAIP messaging - Local and remote fonlvarding via TCP or UDP - Available to all IP devices on LAN PHYSICAL Weight: 6.5 b/2.9 kg Width: 8.8 in/22.3 cm Compact, purpose built for mobile applications Length: 10.8 in/27.4 cm - Height: 2.4 in/6.0 cm 184 :\AD\002\02\2X02\2X02177.docx 570 DATASH EET FEATURE SPECIFICATION POWER Runs on stendend vehicle power or shore power Power Supply Compatible with 12/24 VDC systems: support for under and over-voltage conditions - lntemal converter with reverse polarity - Locking power connector - AC adapter (option) Power Management System - Auto power-up on ignition sense including programmable start timer and shut- down delay - Input voltage monitoring with auto-shutdom at low voltage Out-ot-range lem peralure detection and shutdown protection MA NAG EME m? Menage mobile network. vehicle and network heath Operational support services for fault. con?guration, accounting. pedormance and securtly Network coverage reporting Location-based reporting Historical logging Remote software updates Secure VNC Email alerts tor con?gurable thresholds ee-ee ENVIRONMENTAL Purpose-bull for moblle environment - Operating Temperature: to - Optional: to +60% - Storage Temperature: to - Operating Humidity: 535% relative humidity; non-condensing - Storege Humidity: 595% relative humidity: non-condensing Platform - AMD Geode LX processor - Linux operating system - 1 GB onboard solid state storage Ingres: Protectlon - IP54 Vibration/Shock - In accordance with SAE M455 - FCC Part 15 Standards/Approvals - FCC/industry Canada - - and Verizon Wireless certified Order/n9 Information Please contact In Motion Technology for updated list of supported radio con?gurations muguut'ny 13"? 3m f2? {Net in20? Mum am?! umrt Mr or mu 265310 I home- ,1 lunar-37? Irr It otter new? wereth Moe at? - a war-react: tr?er toxemia MR: TECHNOLOGY A I RA cuvrum :\AD\002\02\2X02\2X02177.docx 185 571 Convenience In A Snap vo?zm LG 3 (VN170) r- I I 300 PM COMPACT, STYLISH FLIP DESIGN INNER AND OUTER DISPLAYS Thu, Aug 7 MESSAGING FEATURES FULL DEPTH MENU READOUTS PRELOADED HEARING ASSIST MODE FOR BETTER VOICE CLARITY Be the hrs! to reVIew WHERE TO BUY ADD TO COMPARE FEATURES TECHNICAL SPECIFICATIONS REVIEWS KEY FEATURES ?rp.? n: Mobile Web Text and Voice Messaging 1.3 Megapixei Camera Bluetooth? Connectivity Speakerphone MOBILE ACCESSORIES Get all the lixings for your LG mobile phone (accessories sold separately). BATTE RI ES BLUETOOTHE HEADSETS CABLES ICHARGERS FIND ACCESSORIES 186 :\AD\002\02\2X02\2X02177.docx 572 ACRECC SSM Syllabus Description: During this four hour course, participants are introduced to the basic concepts of managing a high performance emergency medical service. They learn the importance of following a deployment plan, why priority dispatching is superior to call screening and the significance of fractile response time performance. Pre-requisites: Reading the pre~course study material and completion of the Basic Concepts of System Status Management Self-Test. Learning Objectives: At the end of this training the participants will: 1.) Understand what SSM is and how a deployment plan is developed? 2.) Be able to describe why SSM is important to Alameda County residents 3.) Know the difference between call screening and priority dispatching 4.) Understand and be able to measuring fractile response time performance 5.) Review Basic Concepts of System Status Management Self-Test 187 :\AD\002\02\2X02\2X02177.docx 573 188 :\AD\002\02\2X02\2X02177.docx 574 ALAMEDA COUNTY REGIONAL EMERGENCY COMMUNICATIONS CENTER Subject: Posting Procedure for Ambulance Resources UCY Approved by: Sheldon D. Gilbert, Fire Chief Page 1 of 3 Reviewing Authority: Effective Date: Revised Date: ACRECC Dispatch Manager 11/01/10 Center Operations PURPOSE: This policy sets forth a standard method of posting ambulance resources to ensure consistency and efficiency amongst dispatchers managing the ambulance response system. RESPONSIBILITY: All ACRECC personnel shall be familiar with and adhere to the following procedures. POLICY: ACRECC C-MED dispatchers shall maintain adequate ambulance system coverage by strictly adhering to the System Status Post Plan (SSP) developed and provided by Paramedics Plus. PROCEDURES: C-MED is designated as the Alameda County primary dispatch channel for posting ambulance resource and shall be performed from either Positions 1 or 11, unless otherwise specified from by the Dispatch Supervisor, Dispatch Manager. or their designee. The purpose of the C-Med position is to coordinate the deployment of ambulance resources to all requests for service, through the use of a dynamic post plan based on previous call volume aggregated through a demand analysis. in addition to this task, it is the C-Med controller's responsibility to: Monitor the Start of Shift (SOS) and End of Shift (EOS) process Track unit assignments Ensure time stamps are recorded accurately Divert and reassign resources when appropriate Monitor and maintain the System Status Post Plan (SSP) Coordinate and document the unit meal breaks (C7s) Dispatchers working the C-MED channel shall monitor the Pulse Live software to ensure that available posts are assigned to the closest available ambulance unit. Ambulance units clearing from call assignments on other channels will return to C-MED to receive post assignments. l. Unit Types Medic Unit: 0 An ALS (Advanced Life Support) ambulance staffed with at least one Level 3 Paramedic and one EMT-Basic, two Level 2 Paramedics, or one Level 2 or Level 1 Paramedic 189 :\AD\002\02\2X02\2X02177.docx 575 A Medic Unit can respond to any medical emergency in the county Ambulance Unit - A BLS (Basic Life Support) ambulance staffed with two EMT-Basics - An Ambulance unit may only respond to Alpha and Omega level emergencies and 5150 transports. Mental Health Transport Unit 0 A specialized unit staffed with one EMT-Basic with additional mental health training 0 A Mental Health Transport Unit may only respond to 5150 transports. Each unit type will have a unique post plan associated with it. Each plan should only have the appropriate unit type assigned to its post locations. ll. Domino Posting Method The Domino Posting method consists of sending the closest available unit to the open post location. and then backfilling each additional open post in the same way. Units, then, will shift from post to post like a series of dominos toppling. This allows for the shortest driving distance for units which covers the necessary geography in the shortest amount of time and maintains a line of coverage between open posts. Post assignments shall be made within 60 seconds of a change in system status. Correct Posting Script Format C-MED dispatchers shall use the following radio script when posting units. - Medic Number 0 Post Number Example: ?Medic Forty-One Twenty-Four, ALCO, Post 200" Ill. Unit Response Once the unit acknowledges the post assignment, the C-MED dispatcher shall update the unit's status in the CAD to ?En route Post? (EP). Once the unit arrives at the assigned post, they should change their status to (On Post). if the unit fails to acknowledge the post move, it is the responsibility of the C-MED dispatcher, to confirm the unit has acknowledged the new post assignment and is en route. if the unit cannot be reached or fails to comply with the assigned post assignment. the Paramedics Plus Shift Commander shall be noti?ed. Policy No. 39.422 - Page 2 190 :\AD\002\02\2X02\2X02177.docx 576 lV. City of Alameda Posting Should Alameda become depleted of medic resources, and Paramedics Plus has sufficient units (greater than Level 8), a Paramedics Plus unit shall be posted at Alameda Fire Station 3 (PALAOS). Should Paramedics Plus not have enough units (less than Level 8) to post Alameda, a Paramedics Plus unit will still be assigned to an active incident in Alameda until Alameda resources are restored. Cross References: OAG 39.211, Dispatch Performance Standards Policy No. 39.422 - Page 3 :\AD\002\02\2X02\2X02177.docx 577 ALAMEDA COUNTY REGIONAL EMERGENCY COMMUNICATIONS CENTER Subject: Start and End of Shift Policy for Medic Units 53"? NO- Approved by: Sheldon D. Gilbert, Fire Chief Page 1 of 2 Reviewing Authority: Effective Date: Revised Date: ACRECC Dispatch Manager 11/01/10 Center Operations PURPOSE: This policy sets forth a standard method of managing the start and end of shift process for medic units. RESPONSIBILITY: All ACRECC personnel shall be familiar with and adhere to the following procedures. POLICY: ACRECC C-MED dispatchers shall maintain and monitor the start and end of shift status for medic units to ensure adequate system status and to ensure units end their shifts at the appropriate times. PROCEDURES: I. Start of Shift All field units start and stop their shifts at the Paramedics Plus headquarters in San Leandro. Units are placed on-duty in the Intergraph CAD by Paramedics Plus logistics personnel with a status of (Start of Shift) as they are being issued their unit and equipment. The unit shall come up on the C-MED channel for a post assignment within ten (10) minutes of being entered into the CAD. If a unit has been placed in 808 for more than 15 minutes without making themselves available for assignment, a follow up phone call will be made to logistics counter (510 746 5732). Once a unit notifies C-MED that they are available, the dispatcher shall: 0 Complete the Crew/Meal Break Roster with the unit number and the unit?s start and end of shift times - Advise the unit of any hospital diversions in effect 0 Assign the unit a post or an event ll. End of Shift Upon entering the final 30 minutes of its shift. the CMED dispatcher will update the unit's status to (End of Shift) and assign the unit to Post 311 (Paramedics Plus Headquarters). Once the unit arrives at the Paramedics Plus Headquarters, the unit will advise ACRECC of their arrival and the CMED dispatcher will remove the unit from the CAD system. 192 :\AD\002\02\2X02\2X02177.docx 578 Level 8 or Less Should system levels fall below Level 8. units in the End of Shift status who have not reached headquarters will be placed back into the system and posted appropriately. Once the system has reached Level 8 or higher, units being held over past the end of their shift shall be released to headquarters. When considering releasing units for end of shift in conjunction with maintaining a minimum of Level 8; units who have been held over the longest shall be given priority. When choosing between two units who have been held over the same amount of time, the unit's actual start time shall be considered as the deciding factor. Cross References: OAG 39.211. Dispatch Performance Standards Policy No. 39.422 - Page 2 193 :\AD\002\02\2X02\2X02177.docx 579 METRO EXPRESS RP90ES TYPE I. Built to f_ [717? Mcdix Specialty Vehicles, Inc. 3008 Mobile Drive Elkhart, IN 46514 Ph 574266091 1 - Fx 574-266?6669 Email - salcsumedixambulance.com mm.medixambuuancmm the Medix difference :\AD\002\02\2X02\2X02177.docx 580 :\AD\002\02\2X02\2X02177.docx "i7. Rip-90$? 6 90?"Wx 4 If Wan-imam Marcelino" who one. Hg? 80!. Front- Whalon 4500 Halogen Body Red Halogen on side and roar corners; (1) 9x7 Amber Halogen cam-r mar. (2) 917 Red Halogen roar mid-body as Brake and Warning Grill.? (2) 512 Red EDS bezels Imam (2) 713 Red Halogen w/chrome bunk 800M Halogen 8'-32' Load nghu- (2) 9:7 Halogen 8?32? MOM. Hand-Held- 400.000 CP in cab Sinn- 200 watt mlcrophone ln lront con? W, Siren- (2) 100 watt thru bumper ?in! no Squad Bench Aisle- w-inchos Cab to Patient Compartment Walk-Thru- sliding door Wood Cablnotry- Full 38 Wall cabinetry or Seat Anton Am and Overhead cabinet Walk-Thu: Ind Bulkhead Storage Cabinets ALS Clbinot- Lower locking cabinet; Middle and Uppev open storage wladiustable shell Lem sliding doors wlextrudod pull handles Squad Bench- (2) bolted posltions Sir-rpm" drop-ln wired plox lid Seat- Captain's chalr wITypc ll haul-boulder belt on steel base wistorage interior (3) Halogen dome lights mud in calling WIS-minute check?out ulnar: 18" LED bar light in Action Area Grab landles- $5 on each entry door panel Grab Rall- 72" overhead In ceiling Cushions, Forrnodlsoarnloss upholstery loam Flooring-125" Vinyl w/3" roll-up 581 Suction Aspirator- RICO RS-AX Oxygen Outlets- (2) In Action Area, (1) over Squad Bench Oxygen Cylinder Retentron- steel bracket w't3l straps 5 collar Oxygen Cylinder Wrench IV Holders- CPI 2008 fold-down raccssed hangers Col Mount- FW 8175-3. sungch posmon removv able Star-ot-Lule Decais~ Optional Paint Strupe- Optional Package- Optional NO SMOKING t2; FASTEN SEATBELTS Electncal- 72 months 72.000 Lumtted- 12 months '12 000 miles Pamt- 48 months Body Structure~ 15 years . \m a. 7" ?l Auto Vent? 2000/ 3 000 Automatic Transport Ventilator Quality by Design 0 Small, compact, and transport ready. 0 Designed to perform in harsh and toxic environments. 0 Assembles quickly with simpli?ed operating instructions printed on the case. 0 Impact-resistant case with shock-absorbing bumpers and recessed control settings. a Rate and volume settings independently operated. Easy-to-monitor patient valve assembly and toxic atmosphere valve are able to deliver additional breaths Autovcm 2000 on demand by inspiratory effort of the patient. 0 Operates exclusively on standard 50 psi source gas, eliminating air entrainment and maintaining the integrity of the speci?ed oxygen concentration. 0 Operates at extreme temperatures ranging from 0? to 125? F. Pneumatically powered batteries not required. 0 Allows for PEEP attachment. 0 Meets ASTM, ISO and standards. AutoVent 3000 The ?rst ventilator designed expressly for the EMS professional, the AutoVent 2000 provides independent controls for tidal volume and BPM. The AutoVent 3000 with additional inspiratory time settings offers an even wider range of patient applications to meet most critical emergency care situations. Both models are designed to meet ventilator needs in a variety of applications, from intra? and inter-hospital transports to sophisticated air rescue. Automatic transport ventilators have been recommended by the American Hospital Association as the preferred equipment to provide ventilator support in the pre-hospital setting. The AutoVent 2000/ 3000 uses state-of-the-art pneumatics to assure reliable, time-cycled constant ?ow ventilation powered by a minimum of source gas. Both models may be used with all models of the LSP single patient use ventilation circuits as an added protection against patient cross-contamination. Each AutoVent is accompanied by the proven LSP patient valve with its bright green visual breath indicator. built-in audible pressure limit alarm, and intermittent mandatory ventilation providing gas ?ow for spontaneous breathing patients. The patient valve is available with an anti-inhalation valve for use in toxic environments. Life Sup ort Pr byAllied 196 :\AD\002\02\2X02\2X02177.docx 582 Auto Vent? 2000/ 3 000 SPECIFICATIONS 9mm Patit ve Ass Supply Pressure Range: 40-60 psig Operating Temperature: 0? to 125? Storage Temperature: -40? to 160? Frequency - AV2000: 8 to 20 BPM Frequency - AV3000: 8 to 28 BPM Tidal Volume - AV2000: 400 to 1200 m1 (Insp.) Crack Pressure: Exhalau'on Resistance: Inspiratory Time - AV3000: approx. .75, 1.5, or 2.0 seconds Expiratory Time: 1.5 to 6.0 seconds [-13 Ratio: 1:1 to 1:4 Weight: 24 oz. (680 grams) Dimensions: 6" 1-3/4" 3?1/2" Case Material: polyester Input connection: plated brass Output Connection: plated brass Minute Volume: 0 to 241pm Gas Consumption Driving Gas: 0.5 [pm maximum Driving Gas: 0.5 [pm maximum outlet ?tting - Flow: as required in demand mode: 0-48 1pm at 50 psig Peak Inspiratory Flow: less than 2.5 cm HZO Delivery Pressure: 60i5 cm H20 48 1pm at an airway pressure drop in. H20) Tidal Volume - AV3000: 200 to 1200 ml LPM (max) Flow Rate: 16 to 481pm 0-10 1.5 Inspiratory Time - AV2000: approx. 1.5 or 2.0 seconds 11:70 3.8 Gas Consumption Driving Gas: 0.5 1pm maximum Dead Space: 8 ml (excluding mask) Supply Pressure: 40 to 60 psig Operating Temperature: 0 to 125 Storage Temperature: 40 to 160 Inlet Fitting: standard male oxygen DISS Filter: 25 micron stainless steel mesh Outlet: 22 mm outside diameter 15 mm inside diameter; ?ts standard medical masks, endon'acheal tubes, and tracheostomy tubes) Weight: 16 oz. (450 grams) Materials: body - anodized aluminum; cover - polycarbonate; polycarbonate; inlet ?tting - plated brass ORDERING INFORMATION AutoVent 2000 L460: Control Module, patient valve, supply tubing, 6? 02 hose, and non-rebreathing valve with hose. Inspiratory Time: 2.0.secands. AutoVent 3000 L461: Control Module, patient valve, supply tubing, 6' Oz hose, and non- rebreathing valve with hose. Inspiratory time: 2.05econds. L460-150: Same as L460. Inspiratory time: I . 5 seconds L461-150: Same as L461. Inspiratory time: .75 and 1.5 seconds L523: AV 3000 portable system for or Jumbo cylinder (cylinder not included): L461 AutoVent 3000, L270-220 02 regulator, L099-005 adult L099-002 child cu?'ed masks, handwheel, and L040124 soft-pack carry case AutoVent 2000 3000 L599-010 Accessories L270-220: Oxygen Regulator, CGA 870, 0-25 1pm, with gauge, 2 check valves, hose barb outlet L280-220: Oxygen Regulator, CGA 540, 0-25 1pm, with gauge, 2 check valves, hose barb outlet L599-010: Ventilation Circuit, single patient use, with patient valve, corrugated tubing, 10/ case L599-030: Ventilation Circuit, single patient use, with patient valve, corrugated tubing, swivel connector, 10/ case L599-090: Ventilation Circuit, single patient use, with patient valve, corrugated tubing, swivel connector, exhalation ?lter, 10/ case L535026: Oxygen Hose, DISS ?ttings L535114: Oxygen Hose Assembly Allied Healthcare Products, Inc. - 1720 Sublette Avenue - St. Louis. MO 63110 USA 314/771-2400 - 800/444-3954 - FAX: 314/771-0650 - U.S. Toll Free: 800/444-3940 FAX: 800/477-7701 6.06? Ui .KV ISO 13485: 2003 ?A Iied Healthcare Products. Inc.0 197 :\AD\002\02\2X02\2X02177.docx 583 Canada Mexico Toll Free: 800/446-0552 FAX: 800/246-6201 All specifications are nominal and subject to change without notice. International Telephone: 314/268-1683 FAX: 314/771-5183 Form 90-00-0007 June 2010 9/29/2014 Arrow lntraosseous Vascular Access System Arrow? Intraosseous Vascular Access System When vascular access presents a challenge, go directly to the bone with Arrowo lntraosseous Vascular Access System. The Arrow? Intraosseous Vascular Access System is a complete solution for fast vascular access whether you?re facing difficult vascular access challenges or need fast intraosseous access for critical situations and life-threatening emergencies. With the Arron/3? System, getting fast vascular access for difficult vascular access (D VA) patients is: 198 1/4 :\AD\002\02\2X02\2X02177.docx 584 9/29/2014 Arrow Intraosseous Vascular Access System c? Safe <1 serious complication rate[1 Fast Vascular access with anesthesia and good flow in 90 second WezIo-ciMIiona-atudies) Efficient 97% first-attempt access success ratel 3 ""?Wt?t?m??udw Versatile 199 2/4 :\AD\002\02\2X02\2X02177.docx 585 9/29/2014 Stair-PRO? About EMS Contact I EMS News Events Search I I .- Products Ambulance Cots Model Number: 6252 Get Accessories 3m, Chairs cot Fasteners Stair-PRO (Model 6252) is scientifically proven to reduce the risk of operator injury. Evacuation Equipment More Information Stair Chairs Stair-PRO? Model6252 Literature to Sta" PRO Stair-PRO Brochure Model 6251 Staippnog Stair-PRO Spec Sheet Model 6250 EMS Product Catalog a Jet, w? e- . .- ?1 Overview Accessories Interactive Demos Videos Independent ergonomic experts found Stair-PRO users had less physical stress and risk of back injury than operators of any of the six major competitive chairs'. The operator position. adjustability ol handles. angle at the track and the built-in descent control made Stair-PRO the safest chair in its product category. Stair-PRO has an innovated system that allows medics to transport a patient down stairs without lifting. Locate a Terrltory Manager Products Free Newsletter EMS Zip Code Ambulance Cots Sign up now 3800 East Centre Avenue Cot Accessones Portage, MI 49002 USA Cot Fasteners 1.800.327.0770 Select a Country/Region Stair Chairs Y?ll mum Evacuation Equipment and black color scheme is a prapn'uary Australia snem ap trademark Corporation. Privacy Statement 200 1/2 :\AD\002\02\2X02\2X02177.docx 586 9/29/2014 TranSafeRamps.com TranSafe Ambulance Cot Stretcher Loading and bariatric care ramps. EWelcome To TranSafeRamps.com The System Recommended By America's Leading Cot Manufacturers. Ambulance EMS Stretcher Bariatric Transport Ramp Page Links: 255;,? Introducing the TranSafeTM Bariatric Cot Loading System. Better by "It's no surprise that patient transport equipment manufacturers nationwide are reporting a design steady increase in the demand for bariatric equipment, products specifically designed for obese patients. The equipment runs from wheelchairs to special lifts" Health Care Purchasingjews-June 2002. TranSa [e Ramps Brochure TranSate Inspection Sheet TranSate System Technical Specifications TranSate Installation Guide 1/4 201 :\AD\002\02\2X02\2X02177.docx 587 9/29/2014 TranSafeRamps.com TranSafe Ambulance Cot Stretcher Loading and bariatric care ramps. "With Today's worker comp issues and the high cost of comp claims, it makes good common sense to consider the TranSafe Bariatric Ramp System!" *The TranSafe System Is Available In Ready To Install Kits Or Can Be Custom Fit To Your Application A WELL KNOWN FACT I NUMBER OF OBESE TRANSPORTS WILL CONTINUE TO Health Care Purchasing News-June 2002. ARE YOU PREPARED Ambulance cot loading system 1 lam]: Ill: 31-. ., -I A Handles up to 1300 pounds without lifting, pushing or pulling! COMPATIBLE WITH YOUR EXISTING AMBULANCES AND COT FASTENERS FOR MAXIMUM ECONOMY AND VERSATILITY click here to view a ramp system in use 202 3/4 :\AD\002\02\2X02\2X02177.docx 588 9/29/2014 TranSafeRamps.com TranSafe Ambulance Cot Stretcher Loading and bariatric care ramps. TranSafe Operation Guide Pricing Information Ordering the TranSafe ?we_m_ The TranSafe Bariatric System Conforms To Your Existing Ambulance Fasteners For Maximum Economy and Versatility "Nearly 40 million American adults -- a full 22.3 percent of the population -- can be classified as obese, according the National Institute of Health. This translates to increased costs and challenges for hospitals that treat severely overweight patients. Many facilities find standard equipment ill-suited to address the transportation needs of bariatric patients, and increasingly, caregivers are being injured on the job when moving obese patients." The TranSafe bariatric Ramp System Can Load 1300 without lifting, pulling or pushing Collapses for easy storage and will fit in your side compartment The TranSafe Ramp can be used as a bridge for patient loading in difficult situations. This ramp will conform to uneven terrain 203 2/4 :\AD\002\02\2X02\2X02177.docx 589 bariatric transport ?at? Standard loutures . Transport at load height capability - Positive action height adjustment Easy?to-use release handle design Color?coded controls - Lap belt extensions 0 High visibility powder-coated frame - Lightweight. aluminum construction - Scienti?cally optimized li? bar design . Lower lifting bar 0 Seven height positions - Integrated bumper system - Lift?capahle safety bar - Perforated litter surface - One-hand release breakaway head section with safety bar - Floor-mounted safety hook - One-hand release. fold-down side rails One-hand release. in?nite positioning. pneumatically assisted backrest - Oversized wheels with sealed caster and wheel bearings Re?ective labeling - Sealed ?at mattress 0 Shock positioning a Two lap belts and one four?point shoulder restraint Optlonll Features - Heavy duty two or three-stage IV poles (patient right or left) - Base storage tray - Nonpocketed head end storage . Height limit kit? - Permanent or removable oxygen bottle holders (foot end) - Rigid head and foot and push/pull handles a Single or dual wheel lock - X-frame guards - Side lift handles - Tow package CE :\AD\002\02\2X02\2X02177.docx EMS iq?uiwnent 3000 E. Centre Ave. Portage. MI 49002 U.S.A. t: 269 329 2100 f: 269 329 2315 toll free: 800 784 4336 Spocl?cattone Model Number 6083 Height? Position 1 13.5 in (34 em) Position 2 24.5 in (62.2 cm) Position 3 27.5 in (69.9 cm) Position 4 30 in (76.2 cm) Position 5 32.5 in (82.6 cm) Position 6 34.5 in t87.6 cm) Position 7 37 in (94 em) Length Standard 80 in (203 cm) Minimum 62 in (157 cm) Width 29 in (74 cm) Weight? 111 lb _(50 kg) Wheels Diameter 6 in (15.2 cm) Width 2 in (5.1 Cm) Articulation Backrest 2? 73" Shock Position +14? Maximum Weight Capacity? 850/1600 lb (385/725 kg) Minimum Operator Required Occupied Cot Unoccupied Cot Recommended Fastener System Floor Mount Wall Mount Recommended Loading Height Warranty 2 1 Model 6370. 6377 6378 Model 6371 One?? parts. labor and travel or two years parts - Lifetime on all welds' Extended warranties available. 25-year service life. Height limit kiI "(unintended/or load height: leis Iimu 28 inches (7) cm). High height kil rewmmendedfor load heights more that 32 inches (in cm). Height mensuredfrom bottom of mattress at not section to ground level. Cat is weighed without matirur and restraints. 1600 lb capacity at the lowest position. reserves the right to change speel?rmious without notice. The MX-PRO Bariairic Transport is designed to be compatible with competitive mifastener systems. Speci?cations are rounded to the nearest whole number. Conversions are ealrulaied before rounding. The yellow and black color rcheme is a proprietary trademark aftlie Corporation. 204 590 Copyright 0 2011 10/13 Mk1 Lit-474 25 Oct 2010 Rev 3.0 XPS expandable patient surface Standard Features - Increased patient surface area 0 Adjustahility for patients and environments - 7 locking positions 0 Integrated into Cot - Always there - Easily retro?tted to existan compatible cots - Enhanced safety built into release handle - Durable aluminum over-mold design 0 Mattress design reduces transter gap 0 Enhanced patient comfort 0 Compliant tip stability and dynamic crash certi?cations' 3800 EA Centre Ave. Portage. Mi 49002 USA. t: 269 329 2100 f; 866 795 2233 toll free: 800 784 4336 2012 Mk1 Lit-8M 19 DEC 2012 Rev Al :\AD\002\02\2X02\2X02177.docx Speci?cations Includes 2 XPS Sideralls XPS Mattress Weight' 7 Locking Surface Area Expenelon Locking Angle 10Height 0 Length XPS Mattress XPS Compatlhle Cots Power-PRO XT Power-PRO TL Pertormance-PRO Xi EMS Equlpment 8 lb (4 kg) Between 10?~52? Width - Total Surface Area cm) 321n((58 cm) Model 6500I6506 Model 6550 Model 6085/6086 Certi?ed to 6060 lo; Power-PRO XT and Power-PRO TL. BS-EN 1789 for Power-PRO XT Power~PRO TL. and Parlor/nanCC-PRO Additional weight compared to standard Side/arts no! Including mattress "Width rs measured at widest point rStandard bolster mattress 19 in 48 cm) Patents pending. reserves the right to change spacillcatinns wrlhout notrce. All numbers rounded I0 nearest whole value. 205 591 19506A Large Mobile Medical Cabinet Automatic Heating and Cooling INTERNATIONAL 6695 CR 4628 Athens, TX 75752 Inside Dimensions Outside Dimensions Height 17.50" 22.65" Width 17.25" 22.95" Depth 16.25" 22.10" VDC 11-15 VDC 22-26 VDC Amps .5 to 7.5(12) .5 to 3.7(24) Airflow Requirements: 65CFM Product Overview 0 Unit is installable in a variety of configurations 0 Functional in mobile, temporary or stationary environments Reliable, Robust and Low Maintenance Solid-State technology 0 Snap locks for fast and consistent access to contents - Padlock, key Keypad or other methods of locking for security of narcotics High tech insulation and thermoelectric proportional controlled methodology 0 Manufactured in U.S.A. Electrical Unit operates at 12 or 24 VDC, AC power conversion optional. Peak power Consumption is dependent upon model and operating environment but typical power consumption at normal ambient temperatures to 30F) is 50-80% of peak. Unit can be equipped with optional low voltage shutdown. (when voltage is restored the unit automatically restarts) Temperature Control Heating and cooling is accomplished using high ef?ciency thermoelectric technology. The temperature control boards use a proportional control program to maintain minimal temperature variation inside the unit. Internal temperature is preset but custom temperature settings are available. Insulation is state of the art vacuum and PU panels that provide a barrier of maximum ef?ciency from external temperatures. Design Products contain no nor harmful contaminants requiring only standard tools for installation. Unit is ?eld serviceable with the ?eld service guide. Unit can be con?gured to operate on 120/220 VAC with optional DC power conversion. OTE engines are designed and manufactured to work day in and day out in the toughest conditions. Specification for reference only and are subject to change without notice. 206 :\AD\002\02\2X02\2X02177.docx 592 Road Satety? Where Safety and Savings Meet the Road Protect your assets. Equip your tleet with Road Safety trom ZOLL, the leading proactive driver teedback and performance monitoring system. With Road Safety you can improve satety, reduce costs associated with daily vehicle operations, and create a culture ot satety throughout your emergency response organization. I :\AD\002\02\2X02\2X02177.docx . A Why Road Safety? L) L) K. UVV 3 Accidents cost employers $60 billion annually in medical care, legal expenses, property damage To change the results, you need to change the and 05i productivity. behavior. Road Safety is a proven solution to reduce aggressive driving, improve safety, and significantly An average crash costs an employer $17,500. reduce costs through behavior modification. When on on-the.iob crash results in on iniury, Road Safety modifies behavior through real-time that cost increases to $74,000*. audible warnings that alert the driver as they approach or operate the vehicle in an unsafe manner. This immediate feedback allows drivers to correct driving behavior before it leads to a crash and What are your aggressive provides an environment which allows vehicle . . operators to continuously learn and improve their drivers costing you? driving performance. Less aggressive driving reduces vehicle maintenance and other costs associated with your fleet. Savings Emergenc)? response is dangerous ond 0&9? on brakes, tires, transmissions, fuel mileage and l?ClUd?5 aggreSSlYe driVlng 'Wl?iCl? lead insurance premiums are iust a few of the financial lo occ'denls and 'nfloie Veh'c_le mo'ntenance benefits of Road Safety. By reducing these costs and and Olher costs ossoc'med W'th your fleet increasing the lifespan of your fleet, the Road Safety Emergency response vehicles are 13 times more likely SYSiem Pays for "sell in one to M0 Years to be involved in an accident. Many can result in 0 Use- iniuries and death. And when an ambulance crash is fatal, the costs associated can reach $1,500,000*. Not only do crashes impact your budget, but they also 87% decrease in Preventable aceidenls? impact the community in delayed response times and . 3 mimon mi es without an iniury accidenr patient outcomes, which can damage your reputation. Safety results after irl'ii,,len'ientiriri Road Safety 0 60% reduction in collisions? Crashes are largely preventable and these costs can . A be avoided an emergency response organization Miler lmpl??tiif?rtiili?ig :?iLll??i'y? committed to a culture of vehicle safety. 0 41% decrease In annual maintenance costs? 0 $120 in annual fleet maintenance savings? 0 75% reduction in claims' (cm you will -: :95! Zulu/1112;: ?713 well ?in [return or) I?'vC?Hitenli Cilcrrictiori tc- help determine ?l'Ir'E financial impact Fraud Sal-371V ?trim hr'w on yrzu' Road Safety is used in both EMS and Fire apparatus. 208 :\AD\002\02\2X02\2X02177.docx 594 How it Works ADMINISTRATION Through easy webbased administration, you can set-up road safety. Management decides what the driving safe zone is for various actions and sets parameters. The Road Safety box is installed in the vehicle and configured to capture data on various actions associated with the individual driver and vehicle including speed, turns, braking, acceleration, lights and sirens, turn signals, back-up spotter, seatbelts, engine idle and vehicle diagnostics. You can access reports and monitor driver performance anytime, any- where and the platform allows for no?touch upgrades. Audible tones alert drivers they are approaching vehicle safety limits. The driver will receive an initial audible warning letting them know to take corrective action. The audio warning will continue and increase in intensity until the driver corrects the issue. These audible tones are the core to behavior modification. IMMEDIATE IMPROVEMENTS Through behavior modification and training, drivers can correct and improve driving behavior before it leads to a crash. This creates a safe driving environment and provides added benefits of reduced vehicle maintenance costs, improved fuel economy, extended vehicle life, and better patient care and outcomes. DATA ANALYTICS AND REPORTING PROACTIVE FEEDBACK Analyze overall driver performance through our safety dashboard that you can access online at any time. This allows you to evaluate driver behavior and provide any necessary training to improve safety. Additionally, managers can receive instant violation alerts (email/text) and easy access to critical reports. 209 :\AD\002\02\2X02\2X02177.docx COMMUNICATIONS HUB 0 Road Safety is a robust, onboard computer. Acting as a wireless access point*, it allows Wi-Fi devices to communicate seamlessly. GPS data can be used in multiple vehicle tracking systems giving fleet managers valuable insight at any time. With Road Safety monitoring driver performance, it's like having an onboard safety officer in the vehicle with your drivers on every response: Back-up spotter G-forces (ie: hard-braking and fast-comering) lights and sirens RPMs Seat belts Signals Speed 595 CULTURE OF SAFETY PROGRAM The ZOLL Culture of Safety program goes beyond the typical driver training for emergency vehicle operation. With this program, we take a topdown approach to vehicle safety within an organization. Starting with senior leadership, best practices are developed to ensure all key documentation and tactics are in place for a comprehensive safety program. This approach ensures that everyone in your organization understands the Road Safety system, its far-reaching benefits and its direct impact to their departments. a Road Safety coupled with the Culture of Safety Where safety and savings Mee, the Road Program ensures your organization is committed and equipped to attain the goal of improving the safety of crews, patients and the community. Road Safety has been installed in thousands of locations around the globe, protecting millions of communities. ZOLL. US Sales 800 474 4489 Direct Dial +l 303 80l 3 ill lat flirt-I, :w-V I75 Jam: Ill". :21. Ll -7 Ha lz-r,? wn1l xi 210 :\AD\002\02\2X02\2X02177.docx 596 SUBJECT: Vehicle Maintenance EFFECTIVE DATE: 11/01/2004 REVISED 4/16/l2012 Purpose: To provide Company guidelines for maintaining vehicles. Policy: 1. All vehicle maintenance schedules are currently kept in a database. 2. The vehicle maintenance schedule is updated and reported weekly every Friday. Updates are made by the Fleet personnel. 3 Each update includes vehicle mileage and engine hours for all vehicles, which is gathered and entered into the ?eet maintenance database. Each vehicle is tracked by: a) Unit Number b) Miles and engine hours To PM (Preventive Maintenance) c) Current Odometer Reading 3. Currently, PARAMEDICS PLUS utilizes the following limits for scheduling vehicles for preventive maintenance: a) All diesel ambulances are maintained every 4000 miles or 200 engine hours. All gas vehicles are maintained every 3000 miles 4. During each Preventive Maintenance, ?eet mechanics will change the oil, change the oil ?lter, and inspect the brakes and tires. In addition, the fleet mechanic will inspect and evaluate each item listed on the Preventative Maintenance Inspection Sheet (see attached). When needed, Fleet mechanics will repair/replace items that do not pass inspection. The Preventative Maintenance Inspection Sheet includes the following information: a) Unit Number b) Date of Preventive Maintenance c) Mileage ofUnit d) Mechanic performing Preventive Maintenance c) Inspection areas: 0 Chassis 0 Engine Rear Chassis 0 Inside Cab 5. A copy of the completed Preventive Maintenance inspection Sheet is ?led in the Fleet Manager?s of?ce and available for review. :\AD\002\02\2X02\2X02177.docx 597 Ql IreI-ag PARAMEDICS P.P Inspection Form Indicate Condition of each item in "Check" Space Vehicle Vehicle Miles Provided Item Date Inspected is okay Item was Mechanic repaired UNDERCARRIA GE, CHASSIS, WHEEL INSPECTION UNDERCARRIAGE CONTINUED NO. ITEMS . 1 DRAIN OIL REMOVE FILTER ALL 2 SIREN MOUNTING BRACKETS CH CAPS AIR 3 SWAY BAR BUSHINGS CHECK ALL WHEEL STIMULATORS 4 I BEAM RADIUS ARM BUSHINGS PRESSUR 5 FRONT SPRINGS TOWERS TREAD DEPTH LF RF /32 6 FRONT SHOCKS BUSHINGS 32 7 TIE ROD ENDS TREAD DEPTH REAR 0 I32 I 32 8 UPPER LOWER BALL JOINTS CHECK REAR AXLE BOLTS 9 STEERING STOPS 1O STEERING BOX COUPLING 52 ADD OIL QUARTS 11 OVERALL FRONT END ALIGNMENT 53 COOLANT DEG. PH. 12 LOWER POWER STEERING HOSES 54 RECOVERY TANK CAP 13 LOWER COOLANT HOSES CLAMPS 55 COOLANT SYSTEM PRESSURE TEST 14 NC COMPRESSOR, CLUTCH HOSES 56 WATER PUMP 15 VALVE COVER GASKETS 57 UPPER COOLANT HOSES CLAMPS 16 TRANSMISSION COOLER HOSES 58 UPPER RADIATOR MOUNTING TANK 17 FRONT BRAKE CALI PER HOSES 59 COOLANT LEVEL 18 CAB MOUNTS 60 FAN BLADE SHROUD 19 ENGINE EXHAUST MANIFOLDS 61 DRIVE BELTS PULLEYS 20 STARTER 62 VACUUM PUMP 21 TRANSMISSION LINKAGE 63 ALTERNATORS, 22 TRANSMISSION HEAT SHIELDS 64 FUSE BOX MOUNTING 23 TRANSMISSION LINES FITTINGS 65 FUEL LINES LEAKS 24 TRANSMISSION CROSS MEMBER MOUNT 66 OIL LINES LEAKS 25 PARKING BRAKE ASSEMBLY 67 POWER STEERING FLUID LEVEL 26 PARKING BRAKE CABLE SPRING 68 BRAKE FLUID LEVEL 27 DRIVE SHAFT YOKES, SPLINE JOINTS 69 VVINDSHIELD WASHER FLUID LEVEL 28 CARRIER BEARING 70 TRANSMISSION FLUID LEVEL 29 PINION SEAL BATTERIES CHARGING SYSTEM 30 SKID PLATE REAR COVER 71 Main Batteries Load Test 31 REAR DIFFERENTIAL FLUID LEVEL Inside Volts SOC. 32 REAR BRAKE HOSE TUBING Outside Volts SOC. 33 REAR WHEEL SEALS 72 Emergency Start Batteries Load Test 34 REAR SHOCKS BUSHINGS Inside Volts SOC 35 REAR LEAF SPRINGS AND BOLTS Outside Volts SOC. 36 FUEL TANK MOUNTING, HOSE, CAP 73 BATTERY ACID LEVEL 37 REAR BUMPER MOUNTING SUPPORT 74 EMERGENCY START CIRCUIT 38 MUFFLER, EXHAUST PIPES CLAMPS 75 CABLES CONNECTIONS 39 LUBE ALL CHASSIS COMPONENTS 76 BATTERY DRAWER HOLD DOWNS 40 FRONT BRAKE PADS /32 32 77 BATTERY DRAWER OPERATION 41 REAR BRAKE PADS I32 /32 78 UPPER ALTERNATOR 42 REPLACE OIL FILTER AND DRAIN PLUG 79 LOWER ALTERNATOR 43 CHECK ALL TIRES FOR DAMAGE 8 WEAR 80 CHARGE IDLE 212 :\AD\002\02\2X02\2X02177.docx 598 669 SIZ 'W'd ?8 830:! 8 BENT AHBAEI 'W'd HIV ?8 130d Hi?ld ?8 WIO BSD-I AHBAE 8 'lN'd MOBHO HEIDH ?8 WIO 3801 BNISNE 002 JO SBWIW 000?? SVL ?8 TIV ?le HVEIH J.NOH2I ?dWBi 77L SHBCIIAIG GHVOEIMOVS ZLL EMVHS SVI HONEHM 3Hll ILL SNIHEIELS ZVL SIHSBG OICIVH OIL LVL 60L SEISFIVS MOHHO OVL BSOVO ?8 ZO 80L EAIHCI .LSELL 68L ?8 MNVJ. ZO AOL NHOH HIV ?8 NSHIS 89L 90L (308100) 98L HEHOLEIHLS ?W'd 90L HOLWIS SDOEI HEIHDLEIHLS 3801 VOL 138W 'W'd VSL CHOH HOOCJ HVEIH 80L 813238 ?8 SNBHOS HOOCI ZOL EHOSNOO HELNEIO 89L ?8 HOOCI LOL 0 ZSL SVHED HOOCI ?8 00L EWOG LEI 66 CIVEIH 08L ?8 1138 ?86 SHOSIA 62L NESAXO ?6 HO.LOW MOCINIAA 83L HELLHEIANI 96 HOOCI AZI HELVEH ?8 DIV 96 813238 ?8 HOOG QZI V6 831M008 ?8 SNES .LVEIS SZI CIHVOSNO 86 SLSEH SLVEIS VZI ?8 HOIH SEWOCI .LHEDIH Z6 SZI M01 ?8 HOIH L6 .LHSH VEIHV 06 HEIWLL ?8 SLHOH 68 ?8 SINHV ?8 1.831 OILSONSVICI NEHIS 88 SHEICINEH WHV1V ?8 ESHEAEIH ?8 dOiS ?8 SESNIH SIQUSIS ?8 EMVHEI 98 SCIHVOS ONINNDH HEMHVW ?8 CIVEIH 98 7 BNEIOS V9 HVEIH 88 anOW ZS ?8 11V L8 SWELLI 33H: AONESHEWH '8 9NI1H9I1 uuog uonaadsm d'd sunstar PAMMEDWS Operations Policy Manual SUBJECT: Equipment Failures POLICY: 600-17 EFFECTIVE DATE: 12/01/2004 Purpose Paramedics Plus has preventative maintenance and repair programs in place to assure the equipment that is assigned to you is reliable and in good working order. There will be times however when you may experience an equipment failure. It is important that these incidents are reported, tracked, and handled timely and appropriately. The following policy reflects the process for handling equipment failures. Definitions Reportable Event: Event in which medical devices have or may have caused or contributed to serious injury and /or death of a patient. This includes any malfunction and/or operator error of the medical device which causes or contributes to a serious injury or death of a patient. Serious Injugj: 0 Life threatening injuries 0 Injuries resulting in permanent damage or impairment 0 Injuries which require medical intervention to preclude permanent damage or impairment Policy 1. We are required to report adverse events related to equipment failure in accordance with the Medical Device Reporting Regulation issued by the Food and Drug Administration (FDA) pursuant to the Safe Medical Devices Act (SMDA). 2. To avoid or reduce critical failures, it is important that your primary equipment is checked out prior to your shift. The Materiel?s Department routinely performs vehicle checkouts. EMTs and Paramedics are responsible for checking out their equipment at the beginning of their shift. HANDLING CRITICAL FAILURES 1. Critical Failures are incidents when you experience an equipment failure while caring for a patient (see de?nition of Reportable Event). It is vital that any such occurrence be reported to the Supervisor immediately and documented in a timely manner. 2. When you experience a failure. accommodate for the failure and continue to care for the patient. 3. Report any equipment failure to an Operations Supervisor. Complete the Equipment failure form and fill out an additional incident report if there was any patient compromise as a result of the failure. Describe in the incident report what accommodations were made for the failure. Operations 600-17 214 231 :\AD\002\02\2X02\2X02177.docx 600 sunstar PARAMEDWS Operations Policy Manual 4. Paramedics PIus/Sunstar is required by law to report any suspected medical device related patient deaths or serious injuries to the FDA and the manufacturer. If this occurs, an additional form (MedWatch 3500A) will need to be completed. This form can be obtained from the Material?s or Operation?s Supervisor. (The 3500A form will be submitted to manufacturer and FDA when indicated within 10 days of incident through the Medical Director?s Of?ce process. a The Of?ce of the Medical Director will be noti?ed in all reportable events. 0 The Director of Health and Safety will be noti?ed in all reportable events. 5. The equipment will be secured and placed out of service to investigate the cause of the failure. The approved vendor will perform the investigation and service of the equipment. 6. The Material?s Supervisor will maintain durable medical equipment service and failure records. Events will be tracked and trended on a regular basis to determine if a piece of equipment needs to be removed from service and replaced. Reportable Event ?les will be maintained for at least 2 years. 7. Employees who write up equipment for service or failures will be able to follow up on the outcome of their report. The logbook of Equipment Reports will be available to the employee upon request to the Material's Department. EQUIPMENT SERVICE REPAIR REQUESTS 1. if you experience a problem with any of your equipment during your start of shift checkout or at any time during your shift, report it to the Supervisor and Material?s Department. 2. Fill out the Equipment Failure Report Form. attach to the equipment and turn in to Materials or the Field Operations Supervisor by the end of your shift. 3. The Material?s Supervisor maintains durable medical equipment service and failure records. Events will be tracked and trended on a regular basis to determine if equipment needs to be removed from service and replaced. 4. Employees who write up equipment for service or failures will be able to follow up on the outcome of their report. The logbook of Equipment Reports will be available to the employee upon request to the Material's Department. VEHICLE CRITICAL FAILURES 1. Refer to the Fleet Service Issues Policy contained in this manual. 2. The Fleet Supervisor will maintain service records on all vehicles for the life of the vehicle. Records will be transferred with the vehicle in the event it is sold or donated. The Fleet Supervisor will track all service requests and repairs. Data will be reviewed for trends on a quarterly basis to determine if a vehicle needs outsourced services to retain reliability or if it needs to be replaced prior to its replacement schedule of 5 years. 3. Employees can receive feedback from their Vehicle Failure Reports via the service logbook upon request to the Material's Department. Operations 600-1 7 215 232 :\AD\002\02\2X02\2X02177.docx 601 'm (W 1W Wm? Wand-IO" I. mm?. PIS :\AD\002\02\2X02\2X02177.docx 602 Agenda Tableau Interactive Overview/ Demo Introductions Who is Tableau? Demonstration Day in the Life of an Analyst Demonstration Demonstration Salesforce Integration High-Level Tableau Overview 217 :\AD\002\02\2X02\2X02177.docx 603 Help People see and understand their data . ?Q'(My: I it) ?1 I :\AD\002\02\2X02\2X02177.docx 604 Where We Starteelw Fast and easy analytics for everyone - - STANFORD we UNIVERSITY huh?hum,? "Ill-n In). I. 0" - Minivan-com? sun?- . 219 :\AD\002\02\2X02\2X02177.docx 605 What?s Wrong with Traditional Bl? Heavy Slow Moving Complicated Expensive Inflexible :\AD\002\02\2X02\2X02177.docx 606 What Customers Say Easiest to use business intelligence product on the market Figure 1. Magi: Dust-lam for Intelligence and Anal-mt: Merit-rims Logi Analytics . Bin. Actum . I Trait. awphn . Anew: lnfov . ABILITY TO EXECUTE COMPLETENESS 0F VISION 'El'm-H .i?s-r mar 14 :\AD\002\02\2X02\2X02177.docx . Tableau Ola: Miaoso? aim . SAP 86-min .Tibeo sum Oracle InIonnatbn Builds: Jmerso? . Meryl ngmu . my? . Panama Softwar- Boanl Inumatioml iem Management Company As ol February 2014 221 607 ?Tableau is the ?sweetheart? of the Magic Quadrant? Gartner ?Tableau had the highest score in the area of in-house implementation by a very wide margin, skewing the entire chart. No other product came close? BARC "Tableau Software continues to set the stan dards. . Forrester ?Few, if any. other vendors have such enthusiastic customer bases? Gartner Customers 24.000 customers from every Industry and . I Bunka *1 06% Lam-?Ll (IOUSIC miur-r EMC, ?9 dW mus? mu Aol. PayPaI Manson .ulmll. Dumbo B-nk . SAFEWAYO ~42 (intel) ?cam elillsewssern CREDIT BARCLAYS amazoncom majg 99m Dell. chap: I Healthcare Medical Media Entertainment Consumer Goods Transportation Logistics 0 "warm, a: ?mm a? mama cam-.2 . I . Buvcr new *Helneken Mx?mlm. Ens Angelcs Eimrs - 099? 31mg? recix v, .n MSKESSON A - redbox GALLUP 2 VJ ?annada I: mu" Bloomberg 103m" urn-mum oxvouu Qt?Hhm ?4 . mm. . mm' ps may: . - '9 ALA-uch Allstate . EgonMobu HALLIIURTDN Duke mlIRS um. ?munitle 0? my?: a :\AD\002\02\2X02\2X02177.docx RescueNet' RescueNef Suite 5/ The most complete electronic patient care reporting system that fits any budget. With the RescueNet solution from ZOLL, you're able to simplify data collection, improve access to information, and enhance operational efficiency. Over 450 organizations across North America use the RescueNet Suite to document over 20 million PCRs every year, including both large and small agencies who are able to realize the benefits of the industry?s leading system. RescueNet is now available as a hosted solution to meet your specific budget and maintenance needs. No large, upfront investment. No high?priced IT resources. With hosted solution, you get all the benefits of a world-class system regardless of your agency's size or resources. And as youragency grows you won?t have to worry about switching to a more robust and flexible solution you?ll already have that with ZOLL. So, whether you do 100 runs per year or 1,000,000, ZOLL has the perfect solution for you. 223 :\AD\002\02\2X02\2X02177.docx 609 QA Comments Daefl?lme Emued By Comm (list 30 chats) 04 08 201016252 Whannel. John Looks goodto me 04 08 201016154 Gral. Chris Patient sigiature is technical 04 08 2010 16:56 Whamel. John You're right. must have missed 04 08 2010 17:05 Tuner. Jelt Rick has ?xed this - please I 04 08 2010 17:06 Grai. Chris CA review passed WI. %u-a Users can only edit or delete their own comments. QA Markers amazon 1; 52 Looks 90 0A Mutton (5 0' 5) I mm- 0 Protocol Fotlowod l5 El MM II Protocol Not Followed you." "9 Signatures Massun amazon I) Is Rock has It OWUWUIG mm." Stat! Cmmsehng Completed - Stat! Coxnsehng ?eqned Unsoioct All {Elml l'mlWl 224 610 Chronological list of QA comments for each PCR. Users have access to view QA comments if authorized. Authorized users can add, edit, and delete comments. Select multiple categories (markers) for each QA Comment Customize the categories (markers) to meet your needs. Search for PCRs Search for PCRs that meet your criteria (such as specific QA Markers). mm Ant-J inn-m Imp :1 0?00 (Jan?m gym-ma Qum- nun-m m" Se Editor mud. "mmnm a a WW I - gm", 3% gnu. Save criteria for future searches. IL Thaw-e: - i Combine criteria to fine tune searches. a mmre, 2 Resurrect PCRs From Archive Results of searches provide a list of matching PCRs. gal; M. ., earc esu 8 . . Resurrect specnfic PCRs Blane: amusurcnos BNwSemn grammar". an??!st a?esumuSolamu archive into a custom workflow Elm! 1516716 .Jltk'son erhwen Erin's liav?lacoA ?15192: Lave-c ?1 aim "35] WW 1234 mmt?immo mm m" wit! I mm mm? mm W. Use the resurrection feature 'pl 551 mm In sum Jonan an Mum to support research studies 12_l5 . or identify trends. Mum?dl 225 61 1 :\AD\002\02\2X02\2X02177.docx Move or copy PCR m. Move 16 .lnhn CINE Lin-vi [ugh muster Pcn[ Company I JW's Ambulance Service -ardm, Uavld mm: 0 Nyian. Rick "etc-'5, Cm: Emir-.1? ting. tip-mm, Rh Turn-Z i, J-l'h? Move Copy I Transfer a PCR to another crew in the same company or a different one. Use Move when only the transporting crew needs to com piete a PCR. Use Copy when both the first responders and transporting crews need to complete a PCR. ZOLL. US Sales 800 474 4489 I US Fax 303 301 0001 I US Direct Dial +1 303 801 0000 Asia/Paci?c +61 ?2 9420 8733 I Europe +44 (0) 1925 846400 2C0010LL Dan swans. All am; ose vra. ZOLL Data .3va ma Bummer. in mystery: uadomm of 2-H. Medical Causation. :\AD\002\02\2X02\2X02177.docx 226 612 Better Operational Efficiencies with RescuoNet' Electronic Patient Care Reporting 9/ AH organiza tions that provide emergency medicai services can use efectron ic pa tien care rep ortin to eiimin ate in efficien paper processes, increase manpower efficiency, meet HIPAA requirements, speed up the reporting process, and increase biifing cofiection rates, The inefficient paper patient care report Paper patient care reports cost organizations much more than just the cost of the form. The documentation process, from first mark to filing, is riddled with inefficiencies. There are many areas where the traditional process of documentation costs organizations much more than first expected. Let?s face it Reading other people?s handwriting is never an infallible process. Try reading the handwriting of someone thatjust saved a person?s life in the middle of the night and is now trying to scribble outwhat he or she did at3 am. under extreme circumstances. The legibility of this documentation quickly becomes a concern. Deciphering patient demographic, billing information, vitals, procedures, and medications would require someone skilled in the artof decoding Pre-hospital care documentation provides important information for organizations. This data can help improve patient care, allow for service reimbursements, and reduce exposure to litigation. When the data collected is inaccurate or incomplete, there can be serious ramifications. Many agencies have personnel that are solely responsible for ?ling and cataloging completed documentation. Quite often, off site storage is leased and reports are stored for upwards of seven years. The time it takes to maintain the filing system and the real-estate to store the files can cost agencies quite a bit of money. Additionally the paper-filing system leads to a number of HIPAA concerns if proper procedures are not in place to control access to the files. One of the huge benefits any organization can realize from accurate documentation is being able to process the data thathas been collected. This data can provide agendes with performance metrics, information about quality of care, data that can help justify grants or funding, and in many cases it can provide a competitive edge to help them expand their organization. However, if this data is not readily available the process of transcribing the data from the paper reports can be time consuming and often ?53' results in unreliable and inaccurate dataAdditionally, the billing department needs access to this data typically in a differentformat. This results in redundant efforts in data conversion, . These inefficiencies can be eliminated with the implementation of an electronic patient care reporting system. And many benefits can be realized once an system is in place at your organization. 22? 613 RescueNet White Paper What's so great about electronic patient care reporting? Eliminating paper processes can result in a number ofbenefits. These benefits can help your organization reduce operational costs, predict future trends, and most importantly have the data that provides you with key performance indicators that help you run a more efficient operation. Regardless ofwhether or not you have a billing department or use a billing service, the efficiencies gained by using can greatly help in this process as well. Many agencies have reported that they lost revenue due to incomplete, inaccurate, or misplaced patient care reports. A successful implementation of an solution can lead to better accuracy in documentation, timelier submittal of PCRs and quicker turnaround in the billing process. It is not uncommon for an organization to be able to provide same-day billing fortheir services. Speeding up the billing cycle can help with cash flow and collections. The number of rejected claims can be reduced by ensuring that the appropriate information has been collected on the PCR. Actual size sample Additionally, many billing services offer reduced rates when they are able to get from PCR "arm've the data submitted to them electronically. Paper patient care reports result in inefficient The electronic data gathered can provide organizations with crucial metrics to operations and inaccurafe help run a more efficient business and provide necessary controls to improve data entry Clan cause {valor I problems With comphancy. the quality of care offered. The quality assurance process can be streamlined once data is put in place. The ability to pull reports that show how well your crews are able to perform certain procedures will provide the metrics that help determine what training is required. Additionally, this gives your organization proof that they are running optimally and can provide competitive advantages. This data also simplifies the reporting processes that may be required by your county or state regulatory agencies. The process of submitting data to these organizations can be invisible to your operations. When the data is collected through the course of day-to-day operations and automatically submitted, you can reduce the amount of time taken to make sure the state/county has the information they require. The reduction of paper saves more than just trees. Being able to reduce the time and resources dedicated to filing and storing historical data will provide your operation with a more efficient process over time. With an solution all the documentation can be stored electronically and pulled out of the database in its original format with a click of the mouse. Additionally, the HIPAA procedures are automated in that all access to this data can be controlled and logged to ensure that necessary patient privacy procedures are followed. Also, many solutions allow the ability to attach other documents such as images and ECGs, and signatures to be attached to the permanent record providing more complete documentation of the sen/ices rendered. These efficiencies and more should be expected from any solution that you choose to employ. The cost savings, the time savings, and the data collected will help your organization run more efficiently. 228 614 RescueNet ite Paper What should you look for in an electronic patient care reporting solution? When choosing an solution, there are a number ofcriteria you should use to ensure the system will be able to run optimally within your organization. 0 Ease of customization Nothing can be more frustrating than buying a software package and realizing thatany changes to the system require custom development Or a timely process that can either cost money or delay the implementation of the system. Because of this, it is important to choose a solution that provides you with the ability to con?gure and customize the system to meetthe requirements of your organization, work within your established protocols, and provide a solution that is "out-of-the-box?. Custom solutions, while sometimes necessary, should be avoided to help ?future-proof" your system in order to receive and implement timely updates from the software vendor. 0 Ease of use The best solutions will fail if adoption by the people using it takes months of training and realignment of key personnel. A good solution should be easy to use by your oews. Many ofyour personnel will be somewhat reluctantto abandon pen and paper and move to a computerized solution. Because of this, it is absolutely necessary that the system is intuitive and can be used with minimal training. This will reduce the amount of time to train existing and new employees, and should resultin a quick implementation of the system. 0 True integration Many organizations interface a series of "best of breed? information systems to run their organizations. This approach of grouping disparate software together can deliver somewhat reasonable results. True integration is the most ef?cient method for software functions to work together. This approach usually costs the software developer more to create but saves the end user on ongoing costof maintaining interfaces. With true integration, software components are designed from the ground up to run in concertwith each other. 0 Integration to medical devices A chain is only as strong as its weakest link. If one of the goals of an solution is to run more efficiently, it should be expected that the data from your medical devices be able to integrate with your solution. This includes being able to electronically attach ECGs from your defibrillators, bring in the key data from your monitors into the patientcare report (such as vitals and even ts) and store those permanently within the 229 615 RescueNet ite Paper 0 Flexible Routing When you go paperless, it becomes important to be able to route the electronic PCR to various groups within the organization for review, QNQI, and possibly completionAgood solution will allow you to do this electronically instead of printing copies of the PCR to be distributed to various disciplines in your organization. 0 Flexible reporting Many facilities will require a paper copy of the run report Over time, this may be eliminated when hospitals and other healthcare facilities begin to adopt better electronic means of getting the data, but today you mustbe able to provide your facilities with the data they needA good solution will not only allow printing of the PCR in the field, but should allow the ability to automatically fax or email this data to any healthcare facility. 0 National and state reporting requirements In an effort to standardize the collection of EMS data, the National EMS Information System (NEMSIS) developed a database for storing national EMS data. Many states have additional reporting requirements. You will want an that meets NEMSIS reporting requirements as well as any specialized reporting requirements your state may have in place. State-of-the-art electronic field data collection RescueNet offers an solution that can meet the needs of your organization today and in the future. RescueNet is the latest reincarnation ofan solution that has been in the industry for over lOyears. The original incarnation started in the days of DOS-based mobile terminals and was sold by a company called Westech. Over the years this system evolved into a product called EMS Pro Due to the vision provided by ZOLL Medical Corporation, the acquisition of this technology and the visionaries that created ithelped push this solution to the next level. RescueNet and its predecessors have been sold to over 2100 fire and EMS organizations representing one ofthe largest installed-bases of an solution. RescueNet is the first field RescueNet offers a number of bene?ts to organizations that adopt 0933 solution that combing this epCR solution: proven, reliable technology the most easy-to-use interface in the industry. the Latest 0 Windows-based ideas and technology in usabiirty to the electronic field data RescueNetePCR supports laptops, tablets, and desktop computing ?Dene? _9 systems providing flexible input and display options. Our typical installations are on ruggedized tablets provided by a number of manufacturers. These solutions offer durable options for our customers and work well with Rescu eNet 230 616 RescueNet White Paper 0 Integration with Defibrillators RescueNet offers complete integration with the ZOLL Series, Series, AED Pro, as well as the LifePak 12 and LPSOO from Physio. This integration provides the ability to automatically input Vitals and events into the PCR directly from the monitor. Additionally, this offers customers the ability to electronically store ECGs with the 0 NEMSIS Gold Certified RescueNet 5.1 is NEMSIS Gold Certified which means that it meets the highest level of national reporting requirements. RescueNet also provides several exports to meet individual state reporting requirements. 0 Customizable RescueNet is one of the only solutions that offers extreme ?exrbility via customization to our customers. Customers have the ability to change labels on buttons, customize lists, add fields, and configure screens. This customization allows our customers to implement a solution that is easily adopted by their crews. Additionally, it is available "out-of-thebox" reducing hidden fees and charges related to customizing the application. 0 Reliability As with any software, the longevity of a solution typically leads to stability and reliability. With over 15 years of experience with solutions, RescueNet offers a solution that meets the needs and requirements of ?re and EMS organizations And with a solid, financially-stable parent company like ZOLL Medical Corporation, you can be sure that new releases with innovative features and functions will be introduced each year for upgrades, and that a dependable technical support team of experts will be at your service 24/7. User interface designed for experts. by experts A poorly designed user interface can result in long learning curves for the users, inaccurate data being collected, and many frustrations Because of this, ZOLL Data Systems focused on providing a world-class user interface in RescueNet This interface was designed with a few criteria in mind: 0 The ability to use it with little or no training 0 The ability to customize it easily in order to meet requirements of our customers To accomplish this, we brought in experts to assist in the design of the system. The following mechanisms were used in designing RescueNet user interface: 0 Usability labs These provided ZOLL Data Systems with the ability to observe users on the system in order to understand what areas needed to be simplified, and which operations were tedious for users. Users with no training were brought in and asked to document various scenarios The results from these lab tests led to many changes in our initial design to optimize the experience for our customers 231 617 RescueNet White Paper - Designed for touch-screen (stylus or finger) and keyboard input We realize that everyone's choice of hardware will vary. There will be customers that like stylus (pen) based systems, others that prefer touch-screens, and those that will only use the system on a desktop or a laptop. Because of this, we designed an interface that can be used optimally on any of these platforms. 0 Any screen accessible within two taps/clicks it can be frustrating to be buried in an application and not remember how you got there or from whence you came. We designed the user interface with the goal of being able to access any screen within two clicks. This provides a system that is both logical and intuitive. - Pick-Lists, buttons labels, and other elements can be easily customized to meet the needs of your organization Customization is key. We realize this and designed the system accordingly. In addition to this, we realize that reducing the amount of typing or writing will increase the accuracy of documentation. Most fields in the system can be completed by selecting an item from a list. This greatly speeds the time the documentation takes, and reduces errors in data entry. 0 intuitive design requires little training for medics and EMTs With everything above, the end result is a system that is easily adopted by your personnel. The results are quickly tangible, and once the system is con?gured, the process of going live is a breeze. Integration with other business processes brings even more benefits RescueNet is a member of the RescueNet family. What does this mean? in short, ZOLL Data Systems understands the needs of fire and EMS organizations. We have offerings that cover every aspect of the operation. From the second the call comes in, we have solutions that drive the success of your organization. For EMS RescueNet Dispatch RescueNet Crew Scheduler RescueNet RescueNet Billing RescueNet Resource Planner RescueNet Nomad For Fire Rescue RescueNet RescueNet RescueNet RescueNet Mobile RescueNet Billing RescueNet Navigator About ZOLL Data Systems ZOLL Data Systems of Broom?eld, Colorado, develops, markets, and sells the RescueNet suite-computer- aided dispatch, billing, fire records management, field data collection, and mobile data software for the fire and emergency medical services (EMS) market. RescueNet is the only fully integrated information management system that allows fire and EMS organizations to manage critical information for maximum performance. For more information, visit or call 800.474.4489. 232 618 PERFORMANCE UTILIZATION .: SYSTEM EVALUATION MONITORING RESP . YOU CAN SAVE LIVES AND PROPER In an emergency, every second counts. PULSE is an advanced vehicular tracking system that makes a real difference in fulfilling compliance agreements, which ultimately saves lives and property. PULSE alerts its users upon detecting service that does not meet set standards. PULSE then provides administrators and review boards with comprehensive data for constant improvement analysis. KEY FEATURES PULSE Replay analyzes unit response indicators to ensure the quickest routes are being used. PULSE Reporting provides real-time feedback on the health of the system based on compliance standards. Google MapsTM layers reveal possible obstructive conditions, such as weather or traffic. PULSE reduces training time for dispatch personnel. PULSE helps units shorten arrival time and minimize vehicular wear and tear as well as driver "windshield lets us display our system in real time time?. as well as replay and report on demand.? Real-time visualization allows dispatchers to divert or Chad Richey reassign units and prioritize with color coding. communica?ions Manage" ETMC EMS More details on reverse side +1 903-787-7400 +1 877-548-0465 0 PULSE@genesisworld.com LSE 233 619 PULSE PULSE Replay allows for supervisors and administrators to evaluate calls from single?unit to system?wide to verify the closest, most appropriate unit was assigned or diverted to a ILmImii I an response. A I "spam; - . PULSE Replay displays breadcrumbs of each units route taken marinas ENNIS rx . . . . '51?566?1 from the first AVL position update after the call assignment all eraser/2? ?rum: 5654326: the way to the scene. A route review can then confirm the .mf" 453-55 ovum?.? won: 5 W, a, fastest, most appropriate route was taken to the scene. mm $31.55" [lit :migorcy an?, Jim PULSE Reporting provides Key Performance Indicators (KPI) and on-demand reports which deliver real-time feedback on the . health of the system or individual contract areas. This allows for supervisors to make appropriate changes right away in service areas where compliance may be borderline. PULSE displays unit and incident data on Google MapsW to aid in dispatching units to incidents efficiently, thus minimizing potential response penalties. 1 PULSE serves as an effective training tool, whether for small or complex systems, helping dispatch personnel become proficient ltF'. mutant .liaghgsiw without delay. ?mm. f? PULSE helps make postings (unit move-ups) more efficient by mum- replacing leapfrog posting (crossing units) with domino posting. Jul PULSE helps eliminate unnecessary post moves on ambulance ?mm 0 units and crews, minimizing crew fatigue (windshield time), wear - i ax?- and tear on vehicles, and fuel consumption. Due to color coding, immediate visualization allows for diverting a unit already en route from a lower priority call to respond instead to a higher priority call. Supervisors can swiftly classify and code late calls for real-time compliance statistics due to immediate visualization and - .. notification of late calls within contractual response areas. +1 903-787-7400 +1 877?548?0465 - an?s PU LSE 234 :\AD\002\02\2X02\2X02177.docx 620 SE Paramedics 2.. Plus Tableau 8.0 Paramedics Plus has implemented an exciting new tool that gives us an accurate picture of our operation, using the data we?re already collecting. Tableau 8.0 allows us to create limitless customized applications, all viewable on any iPad or personal computer. Already Paramedics Plus has developed a number of standardized dashboards for the application, while customized and highly visual reports can be produced within minutes. The Tableau software, used with your system's data, helps the management team see and understand information, so they can quickly analyze, visualize and share. Tableau is unique from other products in that it is easily individualized to the needs of each system allowing local medical oversight and the governing authority to design, capture and analyze any clinical and operational data determined to be of value. Virtually any data collected in the can be retrieved in any format desired for the purpose of tracking KPls, evaluation of compliance to established clinical and operational protocols and make system improvements when needed. ml? Camus-1x I female .0. . I mule 700Percentage of 12 leads for patients with (?rst u. ever 35 years of age by 510:. $00 4% 'I'his meets Mission lifeline Mazeurwueul. 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