2015 ANNUAL REPORT · 6 | ANNUAL REPORT 2015 AMPLE Total Franchise Fees Paid $998 K Other Taxes $52 K Payroll Taxes $2.5 M FISCAL IMPACT FRANCHISE FEES 2010 2011 2012 2013 2014 2014

2015 ANNUAL REPORTTampa, Florida

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2 | ANNUAL REPORT 2015

LETTER FROM LOCAL LEADER ..............................................................................3

LIST OF SERVICES ........................................................................................................4

STATISTICAL AND CLINICAL GRAPHS .................................................................5

FISCAL IMPACT ..............................................................................................................6

ECONOMIC IMPACT .......................................................................................................7

HISTORICAL TREND ......................................................................................................8

PAYMENT TREND ...........................................................................................................9

FREQUENT MEDICAL RESPONSES ...................................................................... 10

COMMUNITY OUTREACH ............................................................................................11

FOCUS ON SERVICE ....................................................................................................12

HUMAN INTEREST STORY .........................................................................................13

LOCAL COMMUNITY EVENT.................................................................................... 14

MAJOR EVENT SUPPORT ..........................................................................................15

CLINICAL MESSAGE .................................................................................................... 16

APPRECIATION MESSAGE .........................................................................................17

LOCAL EMPLOYEE PROFILE ................................................................................... 18

MESSAGE FROM RCEO .............................................................................................. 19

NATIONAL CPR CHALLANGE ................................................................................ 20

AMR MEDICINE OVERVIEW ......................................................................................21

LEARNING CENTERS ..................................................................................................22

DIVERSITY AND INCLUSION....................................................................................23

NATIONAL SCOPE ...................................................................................................... 24

AIR AMBULANCE .........................................................................................................25

MIH OVERVIEW ............................................................................................................ 26

TABLE OF CONTENTS

AMR – (CITY) | 3

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ullamcorper suscipit lobortis nisl ut aliquip ex ea commodo consequat.

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LETTER FROM (LOCAL AMR LEADER)


911 EMERGENCY

911 emergency ambulance services from the nation’s leading EMS provider

MEDICAL & SECURITY SVCS

Round-the-clock security officers who are state-certified EMS providers

LOCAL EMS

Delivering EMS to your local community

INTERFACILITY TRANSPORTATION

Fleet of specialty ambulances for patient and partners’ needs

EVENT MEDICAL

Emergency crews available during your events

MOBILE INTEGRATED HEALTHCARE

Innovation in the home, mobile and alternative settings

FEDERAL DISASTER RESPONSE

Bringing clinical expertise, equipment and speed to local disasters

AIR AMBULANCE

Seamless bed-to-bed ground and air ambulance services

MANAGED TRANSPORTATION

Non-emergency medical transportation management

ONSITE HEALTH & SAFETY

Customizable services for your work locations

SOLUTIONS WE PROVIDE optional photo, text or graphic

AMR – (CITY) | 5

DATA

REQUIRED FRACTAL RESPONSE

85%

86%

87%

88%

89%

90%

91%

92%

93%

94%

2012 2013 2014

92% 92% 92%

85%

86%

87%

88%

89%

90%

91%

92%

93%

94%

2012 2013 2014

94% 93% 92%

ON-TIME RESPONSES

AMR MedicWest

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Total Franchise Fees Paid

$998 K

Other Taxes

$52 K

Payroll Taxes

$2.5 M

FISCAL IMPACT

FRANCHISE FEES

2010 2011 2012 2013 2014 2014 VOT $0 K 0

30 K $200 K

$400 K 60 K

$600 K 90 K

$800 K 120 K

$1,000 K 150 K

Volum

e of t

rans

port

(VOT

)

CLARK COUNTY CITY OF (BLANK) OPTIONAL 2ND CITY

Property Taxes

$44 K

In addition to the economic benefits generated by AMR and MedicWest, each company also pays substantial taxes and fees that support local government programs and services. AMR and MedicWest pay all property, payroll and sales and use taxes as required in Clark County. Additionally, they pay substantial franchise fees to do business in each jurisdiction in which they operate.

A franchise is an arrangement or an agreement granted by the local government authorizing a particular business the use of public property or services in order to provide services for the good of the public for a fee. The franchise also requires certain performance standards be met to keep the agreement active.

The franchise fee percentage distribution is set by the ambulance service ordinance. Changes in the franchise fees are determined by the change in the annual average Consumer Price Index (CPI) for medical care services as defined by the US Department of Labor Statistics.

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AMR – (CITY) | 7

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In addition to providing patients and customers with life-saving emergency services, AMR and MedicWest also provide a substantial economic benefit to the Las Vegas Valley as a result of their operations. These economic benefits go beyond the direct impact of the companies’ own employees and payrolls. Indirect, or secondary impacts, are often referred to as the “ripple” effect, respecting the reality that an industry’s impact reaches beyond just those workers showing up to a company’s worksite. Indirect impacts include the jobs, wages and economic output supported by the local suppliers and vendors used by the EMS industry. Induced impacts are generated when AMR/MedicWest employees go out into the local economy and spend their paychecks at the market, a local doctor’s office or the movie theater. The total economic impacts of AMR and MedicWest include the direct, indirect and induced impacts generated by their operations, their suppliers and vendors and their employees.

DIRECT INDIRECT INDUCED

640

116

259

Employment 2014

Labor Income 2014

$34.6 M

$4.3 M $8.7 M

TotalJobssupported1,015

TotalLaborIncome$47.6 M

TotalEconomicGain$105 M

Economic Output 2014

$69.0 M

$10.3 M

$25.6 M

SAM

PLE

ECONOMIC IMPACT



HISTORICAL TREND IN ECONOMIC IMPACT

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DIRECT INDIRECT INDUCED

1,039 1,011 1,027 1,015

‘11 ‘12 ‘13 ‘14

EmploymentAMR/MEDICWEST

$46.8 M $46.5 M $47.3 M $47.6 M

‘11 ‘12 ‘13 ‘14

Personal IncomeAMR/MEDICWEST

$93.7 M $93.4 M $96.7 M$104.8 M

‘11 ‘12 ‘13 ‘14

Economic OutputAMR/MEDICWEST

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AMR – (CITY) | 9

PAYMENT TRENDBY PAYER

PAYER TYPESBY SHARE OF TOTAL TRANSPORTS

% PAYMENT % WRITE OFF % BAD DEBT

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Private Insurance

Diagnostic Related Grouping Contracts

Veterans Administration

Medicare

Medicaid

Private Pay

PRIVATE INSURANCE 16%

VETERANS ADMINISTRATION 2%

MEDICARE 31%

MEDICAID 25%

DRGs CONTRACTS 1%

PRIVATE PAY 25%

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FREQUENT MEDICAL RESPONSES

TOTAL MEDICAL RESPONSES

TOTAL MEDICAL RESPONSES151,898 119,144

BREATHING PROBLEM

12,306BREATHING PROBLEM

9,483SICK PERSON

9,509SICK PERSON

14,258

BACK INJURY

9,121BACK INJURY

7,049CHEST PAIN

8,743CHEST PAIN

7,454OTHER MEDICAL

103,064OTHER MEDICAL

73,042

MAN DOWN

7,858MAN DOWN

7,858

CITY 1 12.5%OPTIONAL CITY 2 14.4%

SURVIVAL TO HOSPITAL DISCHARGE

Cardiac ArrestNATIONAL AVERAGE: 10.6%Source: C.A.R.E.S.

(CITY) (OPTIONAL 2ND)

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AMR – (CITY) | 11

COMMUNITY OUTREACH ALS BLS ILS

NAME OF EVENT Level HrsMEALS BY MEDICS 20MEDICAL AT METRO MEMORIAL 4.5METRO WELLNESS DAY 5MOCK DISASTER DRILL 10NEVADA SKILLS USA 9NLVPD 2014 SAFE HALLOWEEN EVENT 8OPERATION FIRE HEAT 4OVER THE EDGE 10OVIP NIGHT 5PEDAL TO THE MEDAL 10PEDIATRIC HEART WALK 4PJ 5 K 7PRIDE FESTIVAL 25PRO WRESTLING 5PROJECT HOMELESS CONNECT 9RACE FOR THE CURE 18RECRUITMENT OPEN HOUSE-VTCTA 5ROCKIN RABBIT 1/2 MARATHON 6RUN 4RUNNIN FOR THE HOUSE 4SAFE KEY 41SAFETY FAIR 18.5SANTA RUN 5SCALE THE STRAT PREVIEW 10SCHOOL CARNIVAL 4SENIOR HEALTH FAIR 2.5SPECIAL OLYMPICS NEVADA 91.5TAKE KIDS TO WORK DAY 8.5TEDDY BEAR CLINIC 6TOUCH A TRUCK 16TOUR DE CURE 24TRAUMA TALKS 4TRUCK OR TREAT 13UNIVERSITY HEALTH FESTIVALS 23VETERANS DAY PARADE 4WALK FOR HOPE 4WALK FOR WISHES SOUTHERN NV 6WILD WEST 5K CHALLENGE 6WORLD CPR DAY 36YOU DRINK YOU DRIVE YOU LOSE 6

503.5 HOURS

ESTIMATED IN-KIND COMMUNITY EDUCATION

809.5 HOURS

ESTIMATED IN-KIND DONATED MEDICAL TOTAL DONATED

1,313 HOURS

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NAME OF SPECIALTY SERVICE

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OPTIONAL 2ND SERVICE

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FOCUS ON SERVICE


AMR – (CITY) | 13


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accumsan et iusto odio dignissim qui blandit praesent luptatum zzril delenit augue duis dolore te feugait nulla facilisi. Lorem ipsum dolor sit amet, consectetuer adipiscing elit, sed diam nonummy nibh euismod tincidunt ut laoreet dolore magna aliquam erat volutpat.


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LOCAL HUMAN INTEREST STORY



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THE CHALLENGE

Sudden Cardiac Arrest (SCA) unexpectedly takes the lives of thousands of Americans each year. Annually, AMR crews care for more than 25,000 SCA patients. Studies show that survival from SCA can be doubled or tripled if CPR is administered until emergency medical services arrive. That fact inspired AMR to find innovative means for ensuring that local citizens know what to do when they encounter a victim of SCA.

WHAT DID WE ACCOMPLISH?

Using our network of EMTs and paramedics in (location), we put in place a compression-only CPR training day, designed to provide this life saving training to as many individuals as possible in one day. The first AMR CPR World Challenge was held May 22, 2013 and we trained nearly 55,000 people in 24-hours in communities across the country. The 2014 CPR Challenge taught more than 61,000. The message is simple and three-fold:

n Call 911

n Push hard and fast in the center of the chest until help arrives

n Send someone to find an AED if possible

CPR CHALLENGE (LOCAL)


AMR – (CITY) | 15


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accumsan et iusto odio dignissim qui blandit praesent luptatum zzril delenit augue duis dolore te feugait nulla facilisi. Lorem ipsum dolor sit amet, consectetuer adipiscing elit, sed diam nonummy nibh euismod tincidunt ut laoreet dolore magna aliquam erat volutpat.


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MAJOR EVENT SUPPORT





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mazim placerat facer possim assum. Lorem ipsum dolor sit amet, consectetuer adipiscing elit, sed diam nonummy nibh euismod tincidunt ut laoreet dolore magna aliquam erat volutpat. Ut wisi enim ad minim veniam, quis nostrud exerci tation ullamcorper suscipit lobortis nisl ut aliquip ex ea commodo consequat.

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A MESSAGE FROM (INSERT NAME)


AMR – (CITY) | 17




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APPRECIATION MESSAGE



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Lorem ipsum dolor sit amet.


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SPOTLIGHT ON (INSERT NAME)


AMR – (CITY) | 19




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MESSAGE FROM RCEOS



THE CHALLENGE

Sudden Cardiac Arrest (SCA) unexpectedly takes the lives of thousands of Americans each year. Annually, AMR crews care for more than 25,000 SCA patients. Studies show that survival from SCA can be doubled or tripled if CPR is administered until emergency medical services arrive. That fact inspired AMR to find innovative means for ensuring that local citizens know what to do when they encounter a victim of SCA.

WHAT DID WE ACCOMPLISH?

Using our network of EMTs and paramedics across 40 states, and several countries, we put in place a compression-only CPR training day, designed to provide this life saving training to as many individuals as possible in one day. The first AMR CPR World Challenge was held May 22, 2013 and we trained nearly 55,000 people in 24-hours in communities across the country. The 2014 CPR Challenge taught more than 61,000. The message is simple and three-fold:

n Call 911

n Push hard and fast in the center of the chest until help arrives

n Send someone to find an AED if possible

WHY TRAIN COMPRESSION-ONLY CPR?

Recent studies by the American Heart Association (AHA) concluded that compression-only CPR is an effective and life-saving procedure. When by-standers perform compression-only CPR, the American Heart Association found that it is as effective as traditional CPR that utilizes breathing techniques. The study also found that people are much more willing to perform compression-only CPR on a stranger.

&

COMMUNITY HEALTH

WE ARE THE SECOND LARGESTAMERICAN HEART ASSOCIATIONTRAINING CENTERIN THE U.S.

LARGEST PROVIDER OFPREHOSPITAL EDUCATION

IN THE U.S.

67,047OF THOSE WERE TRAINED ON THE 3RD ANNUALCOMPRESSION-ONLY CPR CHALLENGEON MAY 20, 2015

183,774

NU

MB

ER

OF PEO

PLE WE TRAINED DURING OUR CPR CHALL

ENG

E EV

EN

TS

QUALIFIED TEAMS

WE PROVIDE CARE IN COMMUNITIES NATIONWIDE

26,188

WE OPERATE:67

1

CLINICIANS & SUPPORT PERSONNEL

2 NATIONAL INTERPROFESSIONAL COMMAND CENTERS

25 INTERNATIONAL ACADEMY OF EMERGENCY DISPATCHACCREDITED CENTERS OF EXCELLENCE

COMMUNICATION CENTERS

NATIONAL DISASTER COMMAND CENTER (NATCOM)

33

NUMBER OF COMMISSION ON ACCREDITATION OF AMBULANCE SERVICES (CAAS) ACCREDITED

AMBULANCE SERVICES.

THAT’S MORE THAN ANY OTHER EMS SYSTEM!

VEHICLES & AIRCRAFT

6,275TOTAL VEHICLES

WE DRIVE THE EQUIVALENT OF 84 COAST-TO-COAST ROUND TRIPS

EACH DAY

123

56 7

9

101112

8

4

12 NUMBER OF FIXED WING AIRCRAFTSAMR AIR HAS NATIONWIDE

TRANSPORTS

4.4 MILLI N NUMBER OF PATIENTS TRANSPORTED LAST YEAR

87NUMBER OF PEDIATRIC

PATIENTS TRANSPORTED EVERY HOUR

PATIENT INTERACTIONS

WE RESPONDED TO A MOTOR VEHICLE CRASH

MINUTESEVERY 4

EVERY 10 MINUTESWE PERFORMED A CRITICAL INTERVENTION

8,755,250 VITAL SIGNSWERE DOCUMENTED LAST YEAR

*ON AVERAGE

3 BABIES A DAY*

WE DELIVERED

CPR CHALLANGE (NATIONAL)


AMR – (CITY) | 21

Almost 8,600 times each day, AMR caregivers respond to patients in need of emergency medical care and transportation. These professionals must be prepared to provide high-quality care in a variety of situations — from critical life threatening injury and illness to non-emergency transportation from the hospital to home.

We set high standards of clinical excellence for our caregivers, managers and educators. For AMR, clinical excellence involves having the tools, knowledge, judgment, skills and passion to perform at the highest level. It requires providing caregivers with education and training that meets or exceeds current industry standards.

n Improving patient satisfaction

n Improving community health

n Reducing costs

Clinical excellence at AMR also involves providing refresher courses and ongoing education to keep our caregivers trained on current trends in emergency medicine practices. We have several initiatives to bolster ongoing education:

n eGrand Rounds

n eCase Reviews

n Clinical Quality Initiatives

Our Chief Medical Officer, Dr. Ed Racht, keeps the teams updated regularly with his blog, Friday Nights Under the Lights.

AMR MEDICINE



As the leading provider of emergency and non-emergency ambulance services in the United States, with local operations in 40 states, we know how important it is to keep up with the latest in our profession. AMR offers nationally accredited EMS education through its National College of Technical Instruction, IHM Academy of EMS and the Las Vegas Academy for Prehospital Emergency Care.

NATIONAL COLLEGE OF TECHNICAL INSTRUCTION

NCTI is the largest nationally accredited private EMS institute in the country. NCTI provides paramedic and EMT-Basic training along with an associate of Applied Science degree, and an associate of Science degree at 20 campuses and satellite training sites across the nation. NCTI also offers continuing education for EMS professionals, including doctors, nurses and EMTs.

IHM ACADEMY OF EMS

IHM offers a nationally accredited paramedic training program along with a critical care program, a registered nurse to paramedic bridge program and an associate degree in Occupational Science. IHM serves the St. Louis and Kansas City metropolitan areas and southwestern Illinois. It is the only institution in the Kansas City metro area that is dedicated solely to paramedic training and career advancement.

LAS VEGAS ACADEMY FOR PREHOSPITAL EMERGENCY CARE

The LVAPEC name was formed by combining the Clark County Unified Paramedic Program, NCTI-Las Vegas and Medicwest Ambulance Courses in 2011-2012. Course curriculum, schedules and

operations are maintained by an executive board consisting of one member from the private ambulance services, one member from the fire department services, and one member from the University School of Medicine. We receive advisory support from an 18-member Advisory Panel.

STAYING AHEAD OF THE CURVE


AMR – (CITY) | 23

We focus on developing a workforce that mirrors the communities that we serve. Our success in rendering patient care and serving those communities is a credit to the efforts of our diverse global workforce. We are committed to investing in our team members and celebrating the myriad of cultures, lifestyles, experiences, and ideas they have to offer our organization, our clients and our patients.

We are proud to be an employer that champions diversity and inclusion, as reflected in our Code of Business Conduct and various other policies. We believe our team members are our greatest strength and that each individual contributor is an integral part of our success. It is to that end that we embrace diversity. We hope you will consider becoming part of our hard-working, diverse global workforce today.

AMR serves more communities and customers than any other private ambulance service provider in the nation. Our team members participate in the communities where we live and work. As a result of our dedication to serving various communities, we focus on having a workforce that mirrors the communities that we serve. Our success in rendering patient care and serving communities is due to the efforts of our global, diverse workforce. We are committed to investing in our team members and celebrating the myriad of cultures, lifestyles, experiences, and ideas they have to offer our organization.

EQUAL EMPLOYMENT OPPORTUNITY

We respect, value, and welcome diversity in our workforce, as well as in our customers, suppliers, and the global marketplace. Our policy is to provide equal employment opportunities for all applicants and team members.

We do not discriminate on the basis of race, color, religion, sex, national origin, ancestry, age, disability, veteran status, marital status, gender identity or sexual orientation. This policy applies to all aspects and stages of employment from recruitment through retirement.

AFFIRMATIVE ACTION

AMR is proud of its commitment to affirmative action. As an affirmative action employer, we recognize that our success depends on the development and use of the full range of affirmative action programs. Through administration of these programs, we intend to ensure that all people of all backgrounds are included in our workforce.

OPEN DOORS, OPEN MINDS

Our long-standing Open Door guidelines encourage team members at every level, regardless of their title or role, to raise issues and to expect a timely response and resolution.

CHAMPIONS OF DIVERSITY AND INCLUSION



PATIENT INTERACTIONS

WE RESPONDED TO A MOTOR VEHICLE CRASH

MINUTESEVERY 4

*ON AVERAGE

3 BABIES A DAY*

WE DELIVERED

VEHICLES & AIRCRAFT

6,275TOTAL VEHICLES

WE DRIVE THE EQUIVALENT OF 84 COAST-TO-COAST ROUND TRIPS

EACH DAY

34 125

78 9 10 11 12

6

12 NUMBER OF FIXED WING AIRCRAFTSAMR AIR HAS NATIONWIDE

QUALIFIED TEAMS

WE PROVIDE CARE IN COMMUNITIES NATIONWIDE

26,188

WE OPERATE:67

1

CLINICIANS & SUPPORT PERSONNEL

2 NATIONAL INTERPROFESSIONAL COMMAND CENTERS

25 INTERNATIONAL ACADEMY OF EMERGENCY DISPATCHACCREDITED CENTERS OF EXCELLENCE

COMMUNICATION CENTERS

NATIONAL DISASTER COMMAND CENTER (NATCOM)

COMMUNITY HEALTH

WE ARE THE SECOND LARGESTAMERICAN HEART ASSOCIATIONTRAINING CENTERIN THE U.S.

LARGEST PROVIDER OFPREHOSPITAL EDUCATION

IN THE U.S.

NATIONAL SCOPE

AMR – (CITY) | 25

OUR HEALTHCARE KNOWS NO BOUNDARIES

AMR Air Ambulance coordinates a full range of air ambulance services, including neonatal, pediatric and adult intensive care transports and commercial medical escorts for domestic and international medical air transport flights.

AMR Air is an indirect air medical transport carrier that arranges and coordinates air ambulance services for critical care, advanced life support and basic life support patients. All flights are operated on dedicated medical aircraft by direct air carriers holding certificates issued under 14 C.F.R. Part 135. AMR Air is fully accredited by The Commission on Accreditation of Medical Transport Systems (CAMTS), and carries the highest allowable insurance limits in the industry. AMR Air has an excellent safety record for its long-standing service in the emergency medical transport industry. In addition, AMR Air Ambulance is an in-network provider with most major insurance carriers as well as many regional health plans.

1,953total patientstransported1,172,913 miles flown with patient

80xaround the Earth

countriesvisited spanning

6 continents

51

10 Learjet 35/36

4 King Air C90

2 King Air B200

CAMTSAccredited

since 2004

AMR AIR AMBULANCE


Our mobile integrated healthcare services include:

SENTINEL™

Transition-to-home services and 24/7 program-specific niche intervention services for home hospice patients, their families and caregivers when changes in patient condition occur or when unexpected needs arise. Sentinel specialist providers conduct rapid event assessments and immediate communication with the patient’s normal hospice team member in order to enhance on-scene support and allow an informed decision by the hospice team as to whether an off hours or unplanned visit is needed.

AMBASSADOR™

Experience-focused transition-to-home services. These services can include transport to residence, prescription fulfillment and delivery, medication reconciliation, reconnecting the patient with family and social supports, communicating with the patient’s primary physician to re-establish routine surveillance and care, follow-up visits or call center telephone contacts to ensure successful reintegration in the home, identification of patient experience gaps, and more.

CONTINUUM

Longitudinal interprofessional medical care for patients in their homes. Continuum is a family of medical care programs that feature multiple providers working within an interprofessional team who design patient-specific care plans and then care for previously deteriorating patients immediately post-discharge from a hospital in order to prevent relapse and avoidable E.D. visits.

NAVIGATOR™

Specialized care navigation services for patients with unusually frequent 911 ambulance requests or abnormally recurrent presentation to emergency departments.

POPULATION HEALTH MANAGEMENT AND CARE


Documents

2015 ANNUAL REPORT · 6 | ANNUAL REPORT 2015 AMPLE Total Franchise Fees Paid $998 K Other Taxes $52 K Payroll Taxes $2.5 M FISCAL IMPACT FRANCHISE FEES 2010 2011 2012 2013 2014 2014