Thurston CountyThurston CountyThurston County Thurston County Medic OneMedic OneMedic OneMedic One

RED Committee Update 2004RED Committee Update 2004S S fS S fALS System PerformanceALS System Performance

History of ALS unit modificationsHistory of ALS unit modificationsHistory of ALS unit modificationsHistory of ALS unit modifications 19741974 System establishedSystem established

2 ALS transport and 2 BLS transport2 ALS transport and 2 BLS transport 19761976 System modifiedSystem modified

3 ALS transport3 ALS transport 19951995 ALS unit added to SE countyALS unit added to SE county

4 ALS transport4 ALS transport 19981998 SPRINT unit added SW countySPRINT unit added SW countyyy

4 ALS transport and 1 ALS response4 ALS transport and 1 ALS response 20002000 SPRINT unit added NW countySPRINT unit added NW county

4 ALS transport and 2 ALS response4 ALS transport and 2 ALS responsep pp p 20022002 NW SPRINT unit upgradedNW SPRINT unit upgraded

5 ALS transport and 1 ALS response5 ALS transport and 1 ALS response 20052005?? 20052005??

EMS Call Volume, 1989EMS Call Volume, 1989--20032003Thurston County Medic One/EMS Call Volume

16011 1628417616

19876 1989420218

20000

25000

9717 9913 1008410882 11173

1310614398

15416 15815 16011 16284

15000

5000

10000

0

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

19 19 19 19 19 19 19 19 19 19 19 20 20 20 20

Year

ALS Response Time/Volume,ALS Response Time/Volume,19891989 2003 I t f S t M difi ti2003 I t f S t M difi ti19891989--2003, Impact of System Modifications2003, Impact of System Modifications

Thurston County Medic One/EMS System ALS Response volume/ALS Response time by year, first ALS on scene

ound

Cou

nty

8000

9000

10000

9.5

10

ALSM

/2 Y

elm

S14

Gra

nd M

o

S10

W. C

ount

y

M10

W. C

5000

6000

7000

9

Responses

ALSResponsetime

S

2000

3000

4000

8

8.5time

Linear (ALSResponsetime)

0

1000

1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 20037.5

TaskingTaskingggbyby

EMS CouncilEMS Counciltttoto

Operations CommitteeOperations Committee

Evaluate the current ALS response psystem for response time issues; develop options and make a recommendation to the EMS Council.

ProcessProcessProcessProcess

Review Plans Review Plans (Sept 4/Oct 2)(Sept 4/Oct 2) Review Plans Review Plans (Sept 4/Oct 2)(Sept 4/Oct 2) Review Standards and Goals Review Standards and Goals (Oct 2/Nov 6)(Oct 2/Nov 6) Analyze data against standards/goals Analyze data against standards/goals (Nov (Nov Analyze data against standards/goals Analyze data against standards/goals (Nov (Nov

6, 20/Dec 4)6, 20/Dec 4) Develop options Develop options (Dec 4/Jan 2)(Dec 4/Jan 2)p pp p ( / )( / ) Make recommendation Make recommendation (Jan 2/Feb 6)(Jan 2/Feb 6) Gather EMS Community input/comment Gather EMS Community input/comment Gather EMS Community input/comment Gather EMS Community input/comment

(Feb 6/Mar 6)(Feb 6/Mar 6) Finalize report Finalize report (Mar 6/Apr 3)(Mar 6/Apr 3)

ALS ResponseALS ResponseALS ResponseALS Response

Thurston County Thurston County EMS CouncilEMS CouncilEMS CouncilEMS Council

adoptedadoptedWAC Standards WAC Standards WAC Standards WAC Standards

for Ambulance asfor Ambulance asSystem Response System Response System Response System Response

Time GoalTime Goal

QuestionQuestion

Is there a response time Is there a response time Is there a response time Is there a response time issue in Thurston County?issue in Thurston County?

ParametersParametersParametersParameters RecommendRecommend plans, goals or standards that are plans, goals or standards that are

i t ith th M di O i i i t ith th M di O i i in concert with the Medic One mission or in concert with the Medic One mission or direction of the EMS Council and report direction of the EMS Council and report recommendations for change if they are recommendations for change if they are identifiedidentifiedidentified.identified.

Consider using only ALS contract agenciesConsider using only ALS contract agencies.. Consider private service provider only for EMS Consider private service provider only for EMS

BLS response and transport or interfacility BLS response and transport or interfacility BLS response and transport or interfacility BLS response and transport or interfacility transport services.transport services.

Maintain location of units, current agency’s unit Maintain location of units, current agency’s unit structure and existing unit types structure and existing unit types evaluate evaluate structure and existing unit types, structure and existing unit types, evaluate evaluate system wide impacts of making system wide impacts of making recommendations to change that. recommendations to change that.

ConsiderationsConsiderationsConsiderationsConsiderations Review and utilize current system plans, goals and Review and utilize current system plans, goals and

standards for response time compliance within the standards for response time compliance within the standards for response time compliance within the standards for response time compliance within the current system.current system.

Report on the level of compliance with plans, goals and Report on the level of compliance with plans, goals and standards.standards.

Identify and report goals, plans or standards that should Identify and report goals, plans or standards that should be added to the system.be added to the system.

Develop acceptable options to address areas of non Develop acceptable options to address areas of non compliance with plans goals and standardscompliance with plans goals and standardscompliance with plans, goals and standards.compliance with plans, goals and standards.

Make a recommendation for a mission acceptable option Make a recommendation for a mission acceptable option that will effect the best solution(s) to achieve those that will effect the best solution(s) to achieve those plans, goals and standards.plans, goals and standards.C t f difi ti ti d i t tC t f difi ti ti d i t t Cost of modification options and impact on system.Cost of modification options and impact on system.

Medic workload/patient contacts per medic is to be Medic workload/patient contacts per medic is to be consideredconsidered

BLS ServicesBLS ServicesAn Integral EMS System ComponentAn Integral EMS System Component

Th O i C i h h The Operation Committee assumes that the EMS System will continue to support and enhance the BLS first response component as p pit is an integral part of improving patient outcome.

Patient viability across this and any EMS system is dependent on rapid initial BLS

d t t t l d ith id response and treatment coupled with rapid ALS care and transport for critical patients. Any recommendations for ALS system y ymodifications are predicated on that assumption.

Citizen Awareness and TrainingCitizen Awareness and TrainingCitizen Awareness and TrainingCitizen Awareness and TrainingRapid actions by citizens are necessary p y ycomponents of any effective EMS system. Vital citizen training must be continued, including: awareness of the EMS system access to the awareness of the EMS system, access to the system through 9-1-1, CPR, PAD (Public Access Defibrillator) use, first aid and disaster

dpreparedness.

The Operations Committee further assumes that pthe EMS System will continue to enhance the Citizen Awareness training component of the EMS SystemEMS System.

Standards ConsideredStandards ConsideredStandards ConsideredStandards Considered

Washington State Verified Trauma Washington State Verified Trauma Washington State Verified Trauma Washington State Verified Trauma Response standardsResponse standardsThurston County Medic One ALS Thurston County Medic One ALS Thurston County Medic One ALS Thurston County Medic One ALS response goalsresponse goals

Data ReviewedData ReviewedData ReviewedData Reviewed Current ALS response time/volume by jurisdiction and trendCurrent ALS response time/volume by jurisdiction and trend

1999 ALS i b j i di i d d1999 ALS i b j i di i d d 1999 ALS response time by jurisdiction and trend1999 ALS response time by jurisdiction and trend 1999 BLS response time by jurisdiction and trend1999 BLS response time by jurisdiction and trend Compliance with WA state verified trauma response Compliance with WA state verified trauma response

standards and trendstandards and trendstandards and trendstandards and trend Compliance with TC Medic One ALS response goals and Compliance with TC Medic One ALS response goals and

trendtrend Current ALS response time/volume by ALS zone and trendCurrent ALS response time/volume by ALS zone and trend Current ALS transport volume by unit, zone and destination Current ALS transport volume by unit, zone and destination

and trendand trend “No ALS” unit available frequency, time to availability and “No ALS” unit available frequency, time to availability and

trendtrendtrendtrend BLS response time/volume by jurisdiction and trendBLS response time/volume by jurisdiction and trend Time of day/day of weekTime of day/day of week Population by jurisdiction with density, age demographic Population by jurisdiction with density, age demographic p y j y, g g pp y j y, g g p

and trendand trend Patient level per medic, per unitPatient level per medic, per unit

Urban Response AreaUrban Response AreaUrban Response AreaUrban Response Area “An incorporated area over “An incorporated area over pp

thirty thousand; orthirty thousand; or An incorporated or An incorporated or

i t d f t i t d f t unincorporated area of at unincorporated area of at least ten thousand people least ten thousand people andand a population density a population density over two thousand people over two thousand people per square mile.”per square mile.”Ambulance Service Ambulance Service Ambulance Service Ambulance Service Standard Standard [WAC 246[WAC 246--976976--010]010] : : 10 minutes, 80% of the time10 minutes, 80% of the time

Urban Areas in Thurston CountyUrban Areas in Thurston CountyUrban Areas in Thurston CountyUrban Areas in Thurston County

AgencyAgency MilesMiles22 2003 2003 Pop.Pop.

2005 2005 Pop.Pop.

ClassificationClassificationOld/NewOld/Newpp pp

OlympiaOlympia 18.7518.75 42,86042,860 45,44045,440 U/UU/U

LL 17 0917 09 32 24032 240 36 22036 220 S/S/UULaceyLacey(City)*(City)*

17.0917.09 32,24032,240 36,22036,220 S/S/UU

Suburban Response AreaSuburban Response AreaSuburban Response AreaSuburban Response Area “An incorporated or “An incorporated or pp

unincorporated area with a unincorporated area with a population of ten thousand population of ten thousand to twentyto twenty--nine thousand nine thousand yynine hundred ninety nine nine hundred ninety nine oror any area with a any area with a population density of one population density of one p p yp p ythousand to two thousand thousand to two thousand people per square mile.”people per square mile.”

Ambulance Service Ambulance Service Ambulance Service Ambulance Service Standard Standard [WAC 246[WAC 246--976976--010]010]: : 20 minutes, 80% of the time20 minutes, 80% of the time

Suburban Areas in Thurston CountySuburban Areas in Thurston CountyyyAgencyAgency MilesMiles22 2003 2003 Pop/Pop/

DensityDensity2005 2005 Pop/Pop/

DensityDensityClassificationClassification

Old/NewOld/NewFD #3FD #3 36 9136 91 39 057/39 057/ 45 440/45 440/ S/SS/SFD #3FD #3 36.9136.91 39,057/39,057/

1058105845,440/45,440/12311231

S/SS/S

TumwaterTumwater 13.4913.49 13,65613,656// 15,36015,360// S/SS/S10121012 11381138

FD #9FD #9 7272 8,7818,781121121

10,72010,720//148148

R/R/SS

Tenino (City)Tenino (City) 0.920.92 1,495/1,495/16251625

1,500/1,500/16301630

S/SS/S

FD #6*FD #6* 3030 10,98710,987//366366

12,46012,460//415415

R/R/SS

FD #1*FD #1* 6161 10,49310,493// 11,10011,100// R/R/SSFD #1FD #1 6161 10,49310,493//172172

11,10011,100//181181

R/R/SS

Rural Response AreaRural Response AreaRural Response AreaRural Response Area “Unincorporated or “Unincorporated or pp

incorporated areas with incorporated areas with total populations less than total populations less than ten thousand people or ten thousand people or ten thousand people, or ten thousand people, or with a population density with a population density of less than one thousand of less than one thousand

l l ”l l ”people per square mile.”people per square mile.” Ambulance Service Ambulance Service

Standard Standard [WAC 246[WAC 246--976976--010]010]: : Standard Standard [WAC 246[WAC 246 976976 010]010]: : 45 minutes, 80% of the time45 minutes, 80% of the time

Rural Areas in Thurston County IRural Areas in Thurston County IRural Areas in Thurston County IRural Areas in Thurston County I

AgencyAgency MilesMiles22 2003 2003 Pop/Pop/

2005 2005 Pop/Pop/DensityDensity

ClassificationClassificationOld/NeOld/NePop/Pop/

DensityDensityDensityDensity Old/NewOld/New

YFD #2YFD #2 38.2638.26 9,1869,186//240240

9,1509,150//239239

R/RR/R240240 239239

YelmYelm(City)(City)

5.745.74 3,8303,830//667667

4,3804,380//763763

S/S/RR(City)(City) 667667 763763

FD #4FD #4(Inc. Rainier)(Inc. Rainier)

3535 4,2844,284//122122

4,5804,580//130130

R/RR/R

Rural Areas in Thurston County IIRural Areas in Thurston County IIRural Areas in Thurston County IIRural Areas in Thurston County IIAgencyAgency MilesMiles22 2003 2003 Pop/Pop/ 2005 2005 Pop/Pop/ ClassificationClassification

DensityDensity DensityDensity Old/NewOld/NewFD #5FD #5 12.512.5 6,8546,854//

5485486,5406,540//

523523R/RR/R

548548 523523FD #7FD #7 1111 3,8263,826//

3473474,2104,210//

382382R/RR/R

FD #8FD #8 // // //FD #8FD #8 2323 6,9666,966//302302

8,0108,010//348348

R/RR/R

FD #11FD #11 101101 8,3578,357// 11,04011,040// R/R/SS,, //8282

,, //109109

//

FD #12FD #12 44.0844.08 2,0082,008//4545

1,8801,880//4242

R/RR/R4545 4242

Rural Areas in Thurston County IIIRural Areas in Thurston County IIIRural Areas in Thurston County IIIRural Areas in Thurston County III

AgencyAgency MilesMiles22 2003 Pop/2003 Pop/ 2005 Pop/2005 Pop/ ClassificationClassificationDensityDensity DensityDensity Old/NewOld/New

FD #13FD #13 2424 4,6294,629//192192

4,6104,610//192192

R/RR/R192192 192192

FD #15FD #15 2.52.5 916916//366366

1,1501,150//460460

R/RR/R

BucodaBucoda 1.131.13 645/645/570570

655/655/579579

R/RR/R

FD #16FD #16 3131 502502// 865865// R/RR/RFD #16FD #16 3131 502502//1616

865865//2727

R/RR/R

FD #17FD #17 2626 2,343/2,343/ 2,350/2,350/ R/RR/R9090 9090

Wilderness Response AreaWilderness Response AreaWilderness Response AreaWilderness Response Area

“Any rural area not readily “Any rural area not readily ibl b bli ibl b bli accessible by public or accessible by public or

private maintained road.”private maintained road.”Ambulance Service Ambulance Service Ambulance Service Ambulance Service Standard Standard [WAC 246[WAC 246--976976--010]010]: : As soon as possibleAs soon as possibleAs soon as possibleAs soon as possible

2003 Response Criteria2003 Response Criteria2003 Response Criteria2003 Response CriteriaUrban

Suburban

RuralWilderness/Undefined

2005 Response Criteria (Proposed)2005 Response Criteria (Proposed)2005 Response Criteria (Proposed)2005 Response Criteria (Proposed)Urban

SuburbanSuburban

RuralWilderness/Undefined

2002 ALS2002 ALS

Response PerformanceResponse Performanceversusversus

ALS System GoalALS System GoalALS System GoalALS System Goal

Urban ResponsesUrban Responses 20022002Urban Responses Urban Responses –– 2002200210 minutes, 80% of the time

AgencyAgency ALSALS TimeTime 20022002 2005 2005 g yg yResponsesResponses (Mins)(Mins) % %

GoalGoal% %

GoalGoalOlympiaOlympia 20812081 6.36.3 9494

n=1748n=17489494

n=1748n=1748

LaceyLacey 11061106 6 16 1 100100 9494LaceyLacey(City)(City)

11061106 6.16.1 100100 9494n=1040n=1040

Suburban ResponsesSuburban Responses –– 20022002Suburban Responses Suburban Responses 2002200220 minutes, 80% of the time

AgencyAgency ALSALS TimeTime 20022002 2005 2005 AgencyAgency ALSALSResponsesResponses

TimeTime(Mins)(Mins)

20022002% Goal% Goal

2005 2005 % Goal% Goal

FD #3FD #3 12071207 8.48.4 9999n=1195n=1195

9999n=1195n=1195n=1195n=1195 n=1195n=1195

TumwaterTumwater 577577 6.46.4 9999n=571n=571

9999n=571n=571

FD #9FD #9 157157 10 910 9 9494 9494FD #9FD #9 157157 10.910.9 9494n=147n=147

9494n=147n=147

Tenino Tenino (City)(City)

6767 15.315.3 8585n=57n=57

8585n=57n=57(City)(City) n=57n=57 n=57n=57

FD #6*FD #6* 208208 11.711.7 100100 9595n=197n=197

FD #1*FD #1* 544544 10 6610 66 100100 8989FD #1*FD #1* 544544 10.6610.66 100100 8989n=484n=484

Rural Responses IRural Responses I –– 20022002Rural Responses I Rural Responses I 2002200245 minutes, 80% of the time

AgencyAgency ALSALSResponsesResponses

TimeTime(Mins)(Mins)

20022002% Goal% Goal

2005 2005 % Goal% Goal

FD #2FD #2 122122 13.813.8 100100 100100YelmYelm 510510 8.48.4 9595

n=484n=484100100

FD #4FD #4(Inc. (Inc. Rainier)Rainier)

208208 12.612.6 100100 100100

FD #5FD #5 177177 10 810 8 100100 100100FD #5FD #5 177177 10.810.8 100100 100100FD #7FD #7 5555 12.612.6 100100 100100FD #8FD #8 142142 11.411.4 100100 100100

Rural Responses IIRural Responses II –– 20022002Rural Responses II Rural Responses II 2002200245 minutes, 80% of the time

AgencyAgency ALSALSResponsesResponses

TimeTime(Mins)(Mins)

20022002% Goal% Goal

2005 2005 % Goal% GoalResponsesResponses (Mins)(Mins) % Goal% Goal % Goal% Goal

FD #11*FD #11* 243243 13.613.6 100100 9090n=219n=219

FD #12FD #12 126126 14 214 2 100100 100100FD #12FD #12 126126 14.214.2 100100 100100FD #13FD #13 7272 16.916.9 100100 100100

BucodaBucoda 3939 16.316.3 100100 100100BucodaBucoda 3939 16.316.3 100100 100100FD #16FD #16 2121 18.818.8 100100 100100FD #17FD #17 5757 20.620.6 100100 100100

Medic One ALS Response time/Trauma response requirement percent, 2002

All Jurisdictions Meet Response Goal, if Goals Modified to 2005 Density

p p q p ,first ALS on scene, modified for 2005 population density

9925.0 100

3

16.9

18.8

20.6

6.3

949495

9495

90 90

20.0

90

95

0.1

13.6 14

.2 15.3

12.6 13

.8

12.9

12.3

10.8 11

.7 12.6

11.4

10.9

1

85 8515.0

me,

min

utes

80

85

rcen

t in

goal

10

8.4 9.

4

6.1 6.3

6.4

5 0

10.0tim

75

80

per

0.0

5.0

S) ) R) S) R) ) R) R) R) ) S) ) R) R) R) ) R) R) ) ) ) )

65

70

Roche

ster/1

(S)

Little

rock/1

1 (S)

FD #1

2, Te

nino (

R)

Tenin

o/12-1

(S)

Griffin/

13 (R

)

Grnd M

nd/14

(S)

Gib Vall

ey/16

(R)

Bald H

ills/17

(R)

FD#2

, Yelm

(R)

Yelm/2-

1 (R)

FD#3, L

acey

(S)

Lace

y/3-1

(U)

FD#4

, Rain

ier (R

)Rain

ier/4

(R)

Black L

ake/5

(R)

E. Olym

pia/6

(S)

N. Olym

pia/7

(R)

South

Bay/8

(R)

McLan

e/9 (S

)Buc

oda (

R)Olym

pia (U

)Tu

mwater (

S)

Response timepercentU=urban 10 min; S=suburban 20 min; R=rural 45 min

All Jurisdictions Meet Response Goal, if Goals Modified to 2005 Density

Medic One ALS Response time/Trauma response requirement percent, 2003fi t ALS difi d f 2005 l ti d itfirst ALS on scene, modified for 2005 population density

22.2

96

9897

25.0 100

3

18.1

2

4 4

91

9596

90

94 9420.0

90

95

12.7 13

.9

15.3

14.7

14.6 15

.4

13.5

0.1

12.5

11.8

11.5

0.3

15.4

8515.085

9.8

9.1 9.

7

6.5

10 10

6.2 6.4

10.0

75

80

0.0

5.0

65

70

0 0

Roche

ster/1

(S)

Little

rock/1

1 (S)

FD #1

2, Te

nino (

R)Te

nino/1

2-1 (S

)Griff

in/13

(R)

Grnd M

nd/14

(S)

Gib Vall

ey/16

(R)

Bald H

ills/17

(R)

FD#2

, Yelm

(R)

Yelm/2-

1 (R)

FD#3

, Lac

ey (S

)La

cey/3

-1 (U

)

FD#4

, Rain

ier (R

)Rain

ier/4

(R)

Black L

ake/5

(R)

E. Olym

pia/6

(S)

N. Olym

pia/7

(R)

South

Bay/8

(R)

McLan

e/9 (S

)Buc

oda (

R)Olym

pia (U

)Tu

mwater (

S)

65

ALS response timepercent in goalU=urban 10 min; S=suburban 20 min; R=rural 45 min

ALS Jurisdictional Response ALS Jurisdictional Response Cl ifi i R d iCl ifi i R d iClassification RecommendationsClassification Recommendations

Change FD #1 (Rochester) Classification Change FD #1 (Rochester) Classification Change FD #1 (Rochester) Classification Change FD #1 (Rochester) Classification •• Rural to Suburban (2003)Rural to Suburban (2003)

Change FD #6 (East Olympia) ClassificationChange FD #6 (East Olympia) Classification•• Rural to Suburban (2003)Rural to Suburban (2003)

Change City of Lacey ClassificationChange City of Lacey Classification•• Suburban to Urban (2003)Suburban to Urban (2003)( )( )

Don’t change City of Yelm ClassificationDon’t change City of Yelm Classification•• Suburban to Rural (2003) will (?) change back 2005Suburban to Rural (2003) will (?) change back 2005

Change FD #9 (McLane) FD #11 (Littlerock)Change FD #9 (McLane) FD #11 (Littlerock) Change FD #9 (McLane), FD #11 (Littlerock)Change FD #9 (McLane), FD #11 (Littlerock)•• Rural to Suburban (2005)Rural to Suburban (2005)

Maintain consistency in current classification Maintain consistency in current classification t (d ’t h FD#5 Bl k L k )t (d ’t h FD#5 Bl k L k )system (don’t change FD#5, Black Lake)system (don’t change FD#5, Black Lake)

ALS Transport UnitALS Transport UnitppAvailabilityAvailability

M di O /ALS T tMedic One/ALS Transports

6000

4000

5000

rts

2000

3000

tran

spor

0

1000

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

yeary

1993 RED Committee Report1993 RED Committee Report1993 RED Committee Report1993 RED Committee ReportStudy Study Annual Annual Percent Percent notnotyyPeriodPeriodJan 5Jan 5--Mar 5, Mar 5, 19931993

projection/weekprojection/week available available (available)(available)

19931993Incident Incident frequencyfrequency

1515 90901 7/ k1 7/ k

1.7%1.7%(98 3%)(98 3%)frequencyfrequency

n=868 callsn=868 calls1.7/wk1.7/wkn=5,280 callsn=5,280 calls

(98.3%)(98.3%)

TiTi 184 184 1 119 1 119 t 0 21%t 0 21%TimeTime 184 184 minutesminutes

1,119 1,119 minutesminutes21 5 21 5

nt=0.21%nt=0.21%(99.79%)(99.79%)

21.5 21.5 minutes/wkminutes/wk

ALS Transport Units ALS Transport Units not not Available Available 2002 S id2002 S id2002, Systemwide2002, Systemwide

Study Study Annual Annual projectionprojection Percent Percent notnotperiodperiodJanJan--DecDec10%10%

/week/week availableavailable(available)(available)

Incident Incident frequencyfrequency

33 30300.58/wk0.58/wk

0.35%0.35%(99.65%)(99.65%)

n=945 n=945 callscalls

//n=8,555 callsn=8,555 calls

TimeTime 21 min21 min 210 minutes210 minutes nt=0 04%nt=0 04%TimeTime 21 min21 min 210 minutes210 minutes4.04 min/wk4.04 min/wkt 525 600 it 525 600 i

nt=0.04%nt=0.04%(99.96%)(99.96%)

nt=525,600 minnt=525,600 minnp=306,600 peak minnp=306,600 peak min

np=0.07%np=0.07%(99.93%)(99.93%)

ALS Transport Units ALS Transport Units notnot Available Available 2002 U b U i O l2002 U b U i O l2002, Urban Units Only2002, Urban Units Only

Study Study Annual projectionAnnual projection Percent Percent notnotperiodperiodJanJan--DecDec10%10%

/week/week availableavailable(available)(available)

0%0%

Incident Incident frequencyfrequency

1010 1001001 92/wk1 92/wk

1.17%1.17%(98.83%)(98.83%)

n=945n=9451.92/wk1.92/wkn=8,555 callsn=8,555 calls

(98.83%)(98.83%)

TimeTime 146 146 1 460 minutes1 460 minutes nt=0 28%nt=0 28%TimeTime 146 146 minutesminutes

1,460 minutes1,460 minutes28.1 min/wk28.1 min/wknt=525 600 minnt=525 600 min

nt=0.28%nt=0.28%(99.72%)(99.72%)

nt=525,600 minnt=525,600 minnp=306,600 peak minnp=306,600 peak min

np=0.48%np=0.48%(99.52%)(99.52%)

AvailabilityAvailabilityAvailabilityAvailability ALS Transport unit availability is >99%ALS Transport unit availability is >99%S a spo t u t a a ab ty s 99%S a spo t u t a a ab ty s 99% There is a significant increase in Urban There is a significant increase in Urban

area Transport unit availability since the area Transport unit availability since the 1993 RED 1993 RED 1993 RED report 1993 RED report

Approximately 30 times / year ALS Approximately 30 times / year ALS transport unit are simultaneously transport unit are simultaneously transport unit are simultaneously transport unit are simultaneously committed to callscommitted to calls•• 210 minutes/year; all units210 minutes/year; all unitsy ;y ;

100 times / year urban ALS transport 100 times / year urban ALS transport units are simultaneously committed to units are simultaneously committed to callscallscallscalls•• 1,460 minutes/year; if M1,460 minutes/year; if M--2 not considered2 not considered

Ti f D D f W kTi f D D f W kTime of Day, Day of WeekTime of Day, Day of WeekALS Response PatternsALS Response PatternsALS Response PatternsALS Response Patterns

All units, locations and times 1/1/03 - 6/30/03

300

350

250

300

s SPRINT 14

150

200

resp

onse

s

Medic 10Medic 5Medic 4Medic 3

50

100

r Medic 2

0

01 to

0100

01 to

0300

01 to

0500

01 to

0700

01 to

0900

01 to

1100

01 to

1300

01 to

1500

01 to

1700

01 to

1900

01 to

2100

01 to

2300

0001

0201

0401

0601

0801

1001

1201

1401

1601

1801

2001

2201

Time of day volume, ALS, All units; 1-6/03

3001

224

200

300 23

4521

2223

24

0

100 6

719

20

8

917

18

1011

1213

1415

16

13

All units, all locations, Response volumes by time f d ll d 1/1/03 6/30/03of day, all days, 1/1/03-6/30/03

250

300

150

200

100

0

50

0001 0101 0201 0301 0401 0501 0601 0701 0801 0901 1001 1101 1201 1301 1401 1501 1601 1701 1801 1901 2001 2101 2201 2301t o

0100t o

0200t o

0300t o

0400t o

0500t o

0600t o

0700t o

0800t o

0900t o

1000t o

1100t o

1200t o

1300t o

1400t o

1500t o

1600t o

1700t o

1800t o

1900t o

2000t o

2100t o

2200t o

2300t o

2400

Response volume, day of week, all units, allResponse volume, day of week, all units, all locations, 1/1/03-6/30/03

732 733713720

740760

648

697

660680700720

average=682648

611637

600620640660

540560580600

540Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Total responses, Medic 3, all days of week, 1/1/03 to 6/30/03

8090

506070

304050

01020

0

0001

to 01

0001

01 to

0200

0201

to 03

0003

01 to

0400

0401

to 05

0005

01 to

0600

0601

to 07

0007

01 to

0800

0801

to 09

0009

01 to

1000

1001

to 11

0011

01 to

1120

012

01 to

1300

1301

to 14

0014

01 to

1500

1501

to 16

0016

01 to

1700

1701

to 18

0018

01 to

1900

1901

to 20

0020

01 to

2100

2101

to 22

0022

01 to

2300

2301

to 24

00

time of day, one hour inte rva ls

Total responses, Medic 4, all days of week, 1/1/03 to 6/30/03

80

90

50

60

70

30

40

50

10

20

0

01 to

0100

01 to

0200

01 to

0300

01 to

0400

01 to

0500

01 to

0600

01 to

0700

01 to

0800

01 to

0900

01 to

1000

01 to

1100

1 to 11

200

01 to

1300

01 to

1400

01 to

1500

01 to

1600

01 to

1700

01 to

1800

01 to

1900

01 to

2000

01 to

2100

01 to

2200

01 to

2300

01 to

2400

0001

0101

0201

0301

0401

0501

0601

0701

0801

0901

1001

1101

t12

0113

0114

0115

0116

0117

0118

0119

0120

0121

0122

0123

01

time of day, one hour inte rva ls

All responses, by time of day, FD31, all units, 1/1/03-6/30/03p , y y, , ,

60

40

50

ses

20

30

resp

ons

0

10

0

0001

to 01

0001

01 to

0200

0201

to 03

0003

01 to

0400

0401

to 05

0005

01 to

0600

0601

to 07

0007

01 to

0800

0801

to 09

0009

01 to

1000

1001

to 11

0011

01 to

1120

012

01 to

1300

1301

to 14

0014

01 to

1500

1501

to 16

0016

01 to

1700

1701

to 18

0018

01 to

1900

1901

to 20

0020

01 to

2100

2101

to 22

0022

01 to

2300

2301

to 24

00

time

M/3 sta 31, 32, 33, 36, 65; 1/1/03-6/30/03

60

40

50

s

30

espo

nses

10

20r

0

00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00

0001

to 01

0001

01 to

0200

0201

to 03

0003

01 to

0400

0401

to 05

0005

01 to

0600

0601

to 07

0007

01 to

0800

0801

to 09

0009

01 to

1000

1001

to 11

0011

01 to

1200

1201

to 13

0013

01 to

1400

1401

to 15

0015

01 to

1600

1601

to 17

0017

01 to

1800

1801

to 19

0019

01 to

2000

2001

to 21

0021

01 to

2200

2201

to 23

0023

01 to

2400

M/3, sta 34, 35, 37, 82, 83; 1/1/03-6/30/03

25

20

15

spon

ses

5

10res

0

5

0

0001

to 01

0001

01 to

0200

0201

to 03

0003

01 to

0400

0401

to 05

0005

01 to

0600

0601

to 07

0007

01 to

0800

0801

to 09

0009

01 to

1000

1001

to 11

0011

01 to

1200

1201

to 13

0013

01 to

1400

1401

to 15

0015

01 to

1600

1601

to 17

0017

01 to

1800

1801

to 19

0019

01 to

2000

2001

to 21

0021

01 to

2200

2201

to 23

0023

01 to

2400

Jan 1 – Sept 30 ALS Incidents (all), 2003 n=7483

Medic station

Jan 1 – Sept 30 ALS Incidents (8-5 Mon-Fri), 2003

n=2635/7483

Jan 1 Jan 1 –– Sept 30, 2003 ALS Incidents (Night/Weekend) Sept 30, 2003 ALS Incidents (Night/Weekend) nn=4848/7483=4848/7483

Time of Day/Day of WeekTime of Day/Day of WeekPeak Load TimePeak Load Time

The system carries a fairly consistent The system carries a fairly consistent The system carries a fairly consistent The system carries a fairly consistent loading across unitsloading across units

Peak time of day is roughly 12 hour Peak time of day is roughly 12 hour Peak time of day is roughly 12 hour Peak time of day is roughly 12 hour period from 9 AM to 9 PMperiod from 9 AM to 9 PM

Peak begins to rise steeply at 8 AMPeak begins to rise steeply at 8 AM Peak begins to rise steeply at 8 AMPeak begins to rise steeply at 8 AM Peak begins to fall gradually at 6 PMPeak begins to fall gradually at 6 PM Monday Thursday Friday are above Monday Thursday Friday are above Monday, Thursday, Friday are above Monday, Thursday, Friday are above

average volumeaverage volume Shifting location of units by time of Shifting location of units by time of Shifting location of units by time of Shifting location of units by time of

day may not be optionday may not be option

ALS tALS tALS systemALS systemFractile Response TimeFractile Response TimeFractile Response TimeFractile Response Time

ALS Response Time, Fractile, 1988-2002

90

100

60

70

80

nt

30

40

50

perc

en

10

20

30

01988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

year

% in 6 min % in 8 min % in 10 min % in 12 min % in 15 min % in 20 min % in 30 min

ALS Response Time, Fractile, 1988-2003

8090

100

607080

ent

304050

perc

e

01020

1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

year

% in 6 min % in 8 min % in 10 min % in 12 min % in 15 min % in 20 min % in 30 min

ALS First Response Fractile Response TimesCurrent Deployment Strategy

2002

1000

120050% 3,938at 7 minutes 90% 6,940

at 15 minutes

800

1000

600

er o

f cal

ls, n

=7,4

40

400

Num

be

200

01 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

Response time in minutes

ALS First Response Fractile Response TimesCurrent Deployment Strategy

2003

1200

90% 7,605at 15 minutes50% 4,309

t 7 i t

800

1000

07

at 7 minutes

600

f ALS

cal

ls n

=81

400num

ber o

f

200

0

Response time in minutesResponses n=8,107 171 136 373 641 946 1067 975 784 576 482 420 339 290 218 188 142 122 101 74 62

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

Fractile Response TimeFractile Response TimeFractile Response TimeFractile Response Time

Addition of units has mitigated the Addition of units has mitigated the Addition of units has mitigated the Addition of units has mitigated the decline in ALS response decline in ALS response Addition of units impacts all response Addition of units impacts all response Addition of units impacts all response Addition of units impacts all response time areastime areas

P l ti P j tiP l ti P j tiPopulation ProjectionsPopulation Projectionsby Fire Jurisdictionby Fire Jurisdictionby Fire Jurisdictionby Fire Jurisdiction

Population Projections, 2005-2025, Urban 2005

60,000

40,000

50,000

30,000

,

LaceyOlympia

20,000

0

10,000

0 2005 2010 2015 2020 2025

Population Projections, 2005-2025, Suburban 2005

60 000

70,000

50,000

60,000

TumwaterRochester

30 000

40,000

RochesterLFD #3East OlympiaMcLane

20,000

30,000 McLaneLittlerockTenino

0

10,000

0 2005 2010 2015 2020 2025

Population Projections, 2005-2025, Rural 2005

12 000

14,000 YelmYelm FD#2

10,000

12,000 Yelm FD#2RainierFD#4 RainierBlack Lake

6 000

8,000

Black LakeNorth OlympiaSouth BayFD#12 Tenino

4,000

6,000 FD#12 TeninoGriffinMunn LakeB d

0

2,000 BucodaBald HillsFD16 Gibson V

0 2005 2010 2015 2020 2025

Population increase, 2005-2025, by fire jurisdiction

28,67030,000

35,000

25,000

30,000

11,54015,000

20,000

5,220 4,680

7,440

1 6603,630

7,970

3,7005,870

8,690

1 9505,000

10,000

1,660810

1,950750 1,060 1,200

2001,030

0

Population change, 2005-2025, by fire jurisdiction12%2%1%1%1%0%1%

5%

9% OlympiaTumwaterRochester

5%6%

YelmLaceyRainierBl k L k

8%1%

4%

Black LakeEast OlympiaNorth OlympiaSouth Bay8%

8%

1% South BayMcLaneLittlerockTenino

4%

GriffinMunn LakeGibson Valley

30%

2%4% Bucoda

Bald Hills

Population ProjectionsPopulation ProjectionsPopulation ProjectionsPopulation Projections

All areas of the County are expected to All areas of the County are expected to All areas of the County are expected to All areas of the County are expected to show population increasesshow population increases

Urban areas have steepest population Urban areas have steepest population U ba a eas a e steepest popu at oU ba a eas a e steepest popu at oincrease ratesincrease rates

Several adjacent areas also show Several adjacent areas also show jjsignificant rates of increase: Yelm, South significant rates of increase: Yelm, South Bay, East Olympia, LittlerockBay, East Olympia, Littlerock

Proportion of population shifts to East Proportion of population shifts to East Olympia, South Bay, McLane, LittlerockOlympia, South Bay, McLane, Littlerock

Incident ProjectionsIncident ProjectionsIncident ProjectionsIncident Projectionsby Fire Jurisdictionby Fire Jurisdiction

Urban ProjectionUrban ProjectionURBAN Incident Projection

Urban ProjectionUrban Projection

7000

8000

5000

6000

dent

s

3000

4000

# B

LS In

cid

OlympiaLacey

1000

2000

0

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

2016

2017

2018

2019

2020

2021

2022

2023

2024

2025

Year

Suburban ProjectionSuburban ProjectionSuburban ProjectionSuburban ProjectionSUBURBAN Projection

3000

3500

2000

2500

ents Tumwater

FD #1

1500

# B

LS In

cide

FD #3FD #6FD #9Tenino

500

1000

0

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

2016

2017

2018

2019

2020

2021

2022

2023

2024

2025

Year

Rural ProjectionRural ProjectionRural ProjectionRural ProjectionRURAL Projection

1000

1200

800

dent

s

BucodaFD #2YelmFD #5FD #7

400

600

# B

LS In

cid FD #8

FD #11FD #12FD #13FD #16FD #17

200

FD #4

0

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

2016

2017

2018

2019

2020

2021

2022

2023

2024

2025

Year

Lacey Urban Growth AreaLacey Urban Growth Area2003 2003

Population is 29,652Population is 29,652 Density is 1 870 per square mileDensity is 1 870 per square mile Density is 1,870 per square mileDensity is 1,870 per square mile Classification = SuburbanClassification = Suburban

A ti (1A ti (1 9/2003 9/2003 Average response time (1Average response time (1--9/2003, 9/2003, 1,860 calls) stations 33, 34, 36, 37 1,860 calls) stations 33, 34, 36, 37

10 7 i t 10 7 i t = 10.7 minutes = 10.7 minutes 99.3% compliance with suburban 99.3% compliance with suburban

classification (14 calls >20 minutes)classification (14 calls >20 minutes)

Lacey Urban Growth AreaLacey Urban Growth Area20052005

Population projection is 31,750Population projection is 31,750 Population projection is 31,750Population projection is 31,750 Density would be 2,002 per square Density would be 2,002 per square

milemilemilemile Classification would be = UrbanClassification would be = Urban Response time (1Response time (1--9/2003 1 860 9/2003 1 860 Response time (1Response time (1--9/2003, 1,860 9/2003, 1,860

calls) stations 33, 34, 36, 37 = 10.7 calls) stations 33, 34, 36, 37 = 10.7 minutesminutesminutesminutes

83.4% compliance at urban 83.4% compliance at urban classification (304 calls > 10 classification (304 calls > 10 classification (304 calls > 10 classification (304 calls > 10 minutes)minutes)

ALS Response ALS Response V l /E iV l /E iVolume/Experience Volume/Experience Levels/ALS ProviderLevels/ALS Provider

2002 ALS Call Volume by 2002 ALS Call Volume by T U iT U iTransport UnitTransport Unit

M/2M/2 YelmYelm 965965M/2M/2 YelmYelm 965965

M/3M/3 LaceyLacey 24132413

M/4M/4 OlympiaOlympia 20132013

M/5M/5 TumwaterTumwater 18311831M/5M/5 TumwaterTumwater 18311831

M/10M/10 West CountyWest County 12661266

M/14M/14 South CountySouth County 3535

8523852385238523

2002 ALS Call Volume2002 ALS Call VolumeR M di /U itR M di /U itResponses per Medic/UnitResponses per Medic/Unit

(M/2+M/3 currently at 16)(M/2+M/3 currently at 16)

Combined Combined ii

VolumeVolume # of # of didi

Volume per Volume per didiunitsunits medicsmedics medicmedic

M/2+M/3M/2+M/3 3,3783,378 1818 187.7187.7M/2+M/3M/2+M/3 3,3783,378 1818 187.7187.7

M/4+M/10M/4+M/10 3,2793,279 1616 204.9204.9

M/5+S14M/5+S14 2,5692,569 1313 197.6197.6

SPRINT 14 Response Zone is aSPRINT 14 Response Zone is aSPRINT 14 Response Zone is a SPRINT 14 Response Zone is a Subset of M/5 Response ZoneSubset of M/5 Response Zone

/ / // / /2002 volume is 184.5/calls/medic/year2002 volume is 184.5/calls/medic/year

UnitUnit AreaArea volumevolume # medics# medics Volume Volume per per medicmedicmedicmedic

SP/14SP/14 S. CountyS. County 703703

M/14M/14 S. CountyS. County 3535

Subtotal Subtotal unit 14unit 14

738738 44 184.5184.5

Yelm M/2Yelm M/2Prior to Merging withPrior to Merging with

Lacey M/3Lacey M/3Lacey M/3Lacey M/3

UnitUnit AreaArea 20022002VolumeVolume

# medics# medics Volume Volume per per medicmedic

M/2M/2 YelmYelm 965965 77 137.9137.9

2002 ALS Volume2002 ALS Volumei h S/14 d M/14i h S/14 d M/14with S/14 upgrade to M/14with S/14 upgrade to M/14and Combined with M/5and Combined with M/5and Combined with M/5and Combined with M/5

Combined Combined U iU iUnitsUnitsUpgrade 14Upgrade 14 VolumeVolume # of # of

didiVolume Volume

di dimedicsmedics per medicper medicM/2+M/3M/2+M/3 3,3783,378 1818 187.7187.7

M/4+M/10M/4+M/10 3,2793,279 1616 204.9204.9

M/5+M/14M/5+M/14 1,8661,866 1616 116.6116.6

ALS Call Volume/ExperienceALS Call Volume/Experience

Current unit/staffing has equalized volume Current unit/staffing has equalized volume t 185 t 185 205 / di / 205 / di / average to 185average to 185--205 / medic / year205 / medic / year

Creating a Medic 14 Zone would impact volumes Creating a Medic 14 Zone would impact volumes for M/5 and S14for M/5 and S14--M/14M/14// //

Adding additional units/staff would have similar Adding additional units/staff would have similar impacts with current staff configurations/unit impacts with current staff configurations/unit hourshourshourshours

Pooling unit staff helps mitigate low volume at a Pooling unit staff helps mitigate low volume at a stand alone unitstand alone unitA P k h it ld i i i t ff d d A P k h it ld i i i t ff d d A Peak hour unit could minimize staff needed, A Peak hour unit could minimize staff needed, combination of overtime and new staff could combination of overtime and new staff could maintain reasonable experience if staff is pool maintain reasonable experience if staff is pool f/f i ti t tf/f i ti t tof/from existing contractorsof/from existing contractors

Potential Options to Improve Potential Options to Improve p pp pResponse Time and Address Response Time and Address

AvailabilityAvailabilityAvailabilityAvailabilityDo nothing wait (null option)Do nothing wait (null option) Do nothing, wait (null option)Do nothing, wait (null option)

Add SPRINT unitAdd SPRINT unit Add Medic Unit, Peak load/part timeAdd Medic Unit, Peak load/part time Add full time Medic UnitAdd full time Medic Unit Consider staffing options to minimize Consider staffing options to minimize

increase in personnel to effect any increase in personnel to effect any increase in personnel to effect any increase in personnel to effect any unit additionunit addition

Annual Cost Estimate of OptionsAnnual Cost Estimate of OptionsFTEFTE CostCost

AnnualAnnualMedic OneMedic One

-- ++

Full unitFull unit 77 $565,130$565,130 LeastLeast Patient ContactsPatient ContactsVehicle $147kVehicle $147k

Equipment $51kEquipment $51k

>Transport >Transport capacitycapacity

<Response time<Response time

12 hour12 hour 33 $242,199$242,199 Less Less Patient ContactsPatient ContactsEquipment $42kEquipment $42k

Vehicle ?Vehicle ?

>Transport >Transport capacitycapacity

<Response time<Response timeVehicle ?Vehicle ?

12 hour12 hourOTOT

4380 4380 hourshours

$228,004$228,004 Equipment $42kEquipment $42kVehicle ?Vehicle ?

Neutral on Neutral on Patient ContactsPatient Contacts

>Transport >Transport >Transport >Transport capacitycapacity

<Response time<Response timeVehicle ?Vehicle ?

SPRINTSPRINT 44 $322,932$322,932 Less Less Patient ContactsPatient ContactsVehicle $48kVehicle $48k

Equipment $42kEquipment $42k

Some capacity Some capacity by cancelby cancel

<Response time<Response time

RecommendationRecommendationRecommendationRecommendation Modify jurisdictional ALS response goals Modify jurisdictional ALS response goals od y ju sd ct o a S espo se goa sod y ju sd ct o a S espo se goa s

per recommendation to recognize per recommendation to recognize population growthpopulation growthPl f h ddi i f d l ff d Pl f h ddi i f d l ff d Plan for the addition of a dual staffed, Plan for the addition of a dual staffed, peak hour, response/transport unit in peak hour, response/transport unit in Lacey Fire District, in 2005, given Lacey Fire District, in 2005, given Lacey Fire District, in 2005, given Lacey Fire District, in 2005, given response trends and peak volume issue response trends and peak volume issue continue in 2003/2004. Staff unit to continue in 2003/2004. Staff unit to

ti i ti t iti i ti t ioptimize patient experience.optimize patient experience. Continue and enhance BLS and citizen Continue and enhance BLS and citizen

program components of the EMS Systemprogram components of the EMS Systemprogram components of the EMS System.program components of the EMS System.

RecommendationRecommendationRecommendationRecommendation Update ALS jurisdictional response Update ALS jurisdictional response Update S ju sd ct o a espo seUpdate S ju sd ct o a espo se

time classifications to reflect time classifications to reflect population changes that have occurred population changes that have occurred since the classifications were last since the classifications were last since the classifications were last since the classifications were last updated.updated.

Continue to monitor and report Continue to monitor and report Continue to monitor and report Continue to monitor and report annually ALS response and transport annually ALS response and transport data.data.

Consider methodologies and Consider methodologies and performance measures to preplan performance measures to preplan future ALS system deployment and future ALS system deployment and future ALS system deployment and future ALS system deployment and resources.resources.

Calculated Number of ALS Units, Calculated Number of ALS Units, C iC iComparisonComparison

Current Current REDRED Classifications Classifications ClassificationsClassifications State State =5.5=5.5 19931993 20032003 20052005 minimumminimum

Pittsburgh Pittsburgh 55 4 24 2 9 19 1 2 92 9Pittsburgh Pittsburgh modelmodel

55 4.24.2 9.19.1 2.92.9

North North 4 14 1 4 94 9 5 35 3 n/an/aNorth North Region Region minimumminimum

4.14.1 4.94.9 5.35.3 n/an/a

N th N th 8 38 3 9 89 8 10 610 6 //North North Region Region maximummaximum

8.38.3 9.89.8 10.610.6 n/an/a

meanmean 5.85.8 6.36.3 8.38.3 2.92.9