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Emergency Ambulance Service
Business Plan for
The City of Germantown
February 22, 2011
Germantown Fire Department Louis Correale, Battalion Chief
Jeff Beaman, Lieutenant-Paramedic
Mark Carter, Lieutenant-Paramedic
7766 Farmington Blvd
Germantown, TN 38138-2902
(901) 757-7268
(901) 757-7290 - fax
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[email protected]@germantown-tn.gov
I. Table of Contents
I. Table of Contents 2
II. General Company Description 5
III. Products and Services11
IV. Marketing Plan 13
The Marketing Plan: 13
Revenue Forecast 18
V. Operational Plan 19
Provision of service 19
Location 19
Legal Environment 19
Personnel 20
Credit Policies 22
VI. Management and Organization 23
Professional and Advisory Support 23
VII. Financial History and Analysis 25
VIII. Financial Plan 26
Seven-Year Revenue and Expense Projection 26
IX. Appendices 27
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Executive Summary
The Germantown Fire Department mission is to provide timely and effective
response to fire and medical emergencies for the protection of life and
property in Germantown. The Fire Department is in the business of saving
lives, protecting property, educating the public on issues of fire and home
safety, responding to a wide range of emergencies, solving problems, and
preparing the community to be able to respond to disasters. As the primary
provider of Advanced Life Support services to the community since 1979,
the Fire Department proposes to establish an emergency ambulance
transport service that will serve as the gateway for the sick and injured into
the local health care system.
The number of calls for emergency medical services, historically, has
increased each year. In 1987, the department responded to 546 EMS calls.
In 2008, the department responded to 1,632 EMS calls. The reason for this
increase is closely related to the development of the medical corridor on
Wolf River Boulevard and the increasing age of the residents. For over 50
years, the Germantown Fire Department has been an innovative leader in
the fire and emergency services. The men and women are well trained and
have demonstrated time after time their ability to plan and adapt to the
changing needs of the community. The number of calls for medical
emergencies will continue to increase and the department is continuing
meet this changing demand.
The City of Germantown currently participates with Shelby County and the
cities of Arlington, Collierville, Lakeland, and Millington in a contract with
Rural Metro Ambulance service to emergency ambulance service in these
cities and the unincorporated areas of Shelby County. Many of the past
problems with the ambulance transport service have been alleviated, but
unfortunately, some of those problems persist today. The average
ambulance response time has improved, but not to the time frame
recommended by the American Heart Association which is five minutes.
The Fire Department’s response time is five minutes. On medical
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emergency calls, fire department paramedics initiate advanced patient care,
and then turn the patient over to the third party ambulance service for
transport. The care of the patient will be interrupted during this process
and some information is lost regarding the patient or patient care during
the transfer. The knowledge, skills, abilities, and standard of care of
Germantown Fire Department personnel is a known quantity. Even though
the private ambulance personnel are licensed, their knowledge, skills, and
abilities are not known. The fire department will have full control of patient
care from the time a person calls 911 for help until they are transferred at
the emergency room for definitive treatment.
The public only has to dial 911, and not matter what the emergency is, the
fire department responds. The Fire Department is equipped and trained to
handle that emergency. Whether it is a fire, a call for a medical emergency,
a hazardous materials incident, extrication, rescue, or anything else, the
Fire Department will take care of the emergency. The Fire Department is
naturally deployed for rapid response and if the response is not fast, it isn’t
an emergency response. There are no other systems, except for the Fire
Department, that respond with a complete toolbox to handle any incident
that is out of a hospital, which requires emergency medical care.
The population of Germantown is approximately 41,000 people with a total
area of 19 square miles. The median age is 41.3 years, higher than the
national average of 35.3 years. The largest age group in Germantown is
between the ages of 45-54 and in the near future the largest group will be
55 and older. It is foreseen that Germantown will need to provide medical
and other services to seniors sooner than other communities. The most
common calls for medical services associated with an older population are
breathing problems, chest pain, cardiac arrest, stroke, diabetic
emergencies, and falls.
The socioeconomic environment in Germantown and the surrounding areas
indicate a high potential for collecting revenues for transport services.
Service fees have been established based upon transport categories
determined by Medicare. A billing vendor will be selected by competitive
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bid to handle all aspects of billing. This is more cost effective than an
internal billing clerk hired by the City. Fire Department personnel will
work closely with the billing vendor to monitor revenues and expenses.
The major capital cost is the purchase of four Type I ambulances that will
be strategically placed at two of the four fire stations. Thirteen personnel
will be hired, with at least 6 paramedic/firefighters and the rest fire
fighter/EMTs. An EMS Supervisor position will be established to manage
the day-to-day ambulance operations, supplies, in-house CEU training, and
be the point of contact between the department and the billing vendor.
Policies will be established to provide mutual aid requests for an
ambulance, transport geographic boundaries, and to request mutual aid for
an ambulance in the event there are no ambulances available.
Transporting the sick and injured is the only part of emergency services not
provided by the Germantown Fire Department. By providing ambulance
transportation, the Fire Department will have total control and involvement
from the time a person dials 911 until they enter the healthcare system.
The City is financially able to provide this service and utilizing the
S.A.F.E.R. grant, many of the initial costs can be off-set or reduced. The
department enjoys an excellent reputation in the community and scored
very well in past community surveys. This business plans meets the goals
outlined in Vision 2020. When a citizen dials 911, it may be the worst day
of the patient’s life, and it is essential that the EMS response be at its best.
The best product is a fire-based emergency ambulance service provided by
the Germantown Fire Department.
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II. General Company Description
Mission statement: The mission of the Germantown Fire Department is to
provide timely and effective response to fire and medical emergencies for
the protection of life and property in Germantown.
We carry out our mission through primary and other businesses, which are
as follows. Core businesses are designated with an asterisk.
PRIMARY BUSINESSES
Suppress Fires*
Treat Patients with Medical Emergencies*
Educate Community on Fire, Health and Safety*
Rescue People and Provide Specialized Rescue Services*
Develop and Enforce Fire-Related Laws and Codes*
Handle HAZMAT Emergencies
OTHER BUSINESSES
Serve as Lead Agency for Emergency Management
Advocate for Fire Service and Life Safety
Respond To and Solve Community Problems – “Ghostbusters”
Pursue Business Opportunities under Managed Competition
The City of Germantown is driven by its core beliefs, which were
established through a community-wide consensus process that created
Vision 2020. The philosophy of the City of Germantown is that we, the
Germantown managers and employees, strive for Service excellence,
Produce “‘A+” results, take the Initiative, are Responsible, are Innovative,
and practice Teamwork. This reflects the S.P.I.R.I.T. of Germantown.
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The Germantown Fire Department’s core beliefs were developed through a
department-wide consensus process that produced the Germantown Fire
Department's strategic plan. The Fire Department's core beliefs are
reflected in the following statement: We, the employees of the Fire
Department, demonstrate Responsibility, Effectiveness, Service,
Productivity, Effort, Caring and Teamwork. In summary, the business
philosophy of the Germantown Fire Department is that we demonstrate
RESPECT for each other and for our customers. The Vision 2020
philosophy and the Fire Department’s core beliefs interconnect on
responsibility, service, productivity, and teamwork, with the added values of
effort and caring.
The Fire Department is in the business of saving lives, protecting property,
educating the public on issues of fire, emergency medicine, and general
safety. The Fire Department responds to a wide range of emergencies,
solves problems, and prepares the community to be able to respond to a
disaster. Our mission reflects on five major public safety goals in Vision
2020, specifically, making Germantown the safest city in the southeast,
taking a proactive approach to community safety, providing an effective
emergency response, providing safe buildings and homes, and maintaining
a top-quality fire workforce.
For the purpose of this business plan, our target market for an emergency
transport ambulance service is the residents and visitors to the City of
Germantown and our principle objective is the maintenance of life and relief
of suffering.
Providing fire, medical and other emergency response services to a
community has historically been the duty of local government. Very few
private companies offer municipal fire services, but there are many private
companies that offer emergency ambulance service. The Germantown Fire
Department is the primary provider of advanced life support (ALS) services
to the community with paramedics, and began providing ALS service in
1979. In 1975, three Germantown fire fighters became licensed as
Emergency Medical Technicians and the department placed a basic life
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support (BLS) response truck in service. Before 1975, fire fighters trained
in first aid responded to calls for medical assistance. The number of
emergency medical services (EMS) calls in Germantown has increased
every year. In 1987, for example, the department responded to 564 EMS
calls. Twenty years later, in 2007, the department responded to 1,617 calls,
and in 2009 the department responded to 1,657 calls. The majority of this
growth is attributable to the increase in medical facilities in Germantown.
A medical corridor has developed along Wolf River Boulevard and south on
Germantown Road from Wolf River Boulevard. Germantown is home to
several world-class medical facilities providing specialized services, such as
cardiac and orthopaedic care, to residents of Germantown and the region.
Four major hospitals are located within 7 miles of Germantown’s city hall,
which makes Germantown attractive for doctor’s offices, medical clinics,
and specialized medical service facilities such as diagnostic imaging and
out-patient surgery. We foresee a continued increase in the number of
medical responses in Germantown.
Form of ownership: The Germantown Fire Department is a key business
unit of the City of Germantown, a political subdivision and municipal
corporation in the State of Tennessee.
Company history: The Germantown Fire Department has provided fire
protection and increasing levels of emergency medical care for the city over
50 years, first as a volunteer department and progressing to a mostly-paid
combination department. On October 15, 1977, the department began 24-
hour staffing with career fire fighters and EMTs, and added paramedics in
1979.
Even though the department is young in terms of a career fire department,
the men and women of the department are well trained and provide a wide-
range of emergency and non-emergency services. These services range
from fire suppression, EMS and fire inspections to responding to hazardous
materials (Hazmat) incidents and responding with Tennessee Task Force 1
(TN-TF1) to national emergencies including the Pentagon on 9/11 and
Hurricane Katrina. The department’s Hazmat Team was the first team in
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Tennessee to be certified by the Tennessee Emergency Management
Agency. These examples illustrate the leadership ability of the department,
the department’s ability to provide a wide variety of services in an effective
and efficient manner, and the ability to plan for and adapt to the changing
needs of the community.
Members of the command staff possess academic degrees and professional
certifications that reflect on the department’s commitment to stay current
on all aspects of leading and managing a full-service fire department.
The department enjoys an excellent reputation in the community, having
scored as the top city department on the last two citizen satisfaction
surveys. The department has been innovative in securing grant funding for
many projects, including the Learning About Fire Safety (LAFS) program, a
live fire training simulator, CERT training, and a state-of-the-art
communications van.
Throughout the years, the department has met and solved problems
through innovation and adapting to changes in the emergency services
environment. This experience has taught the department that Germantown
residents take pride in their community and expect exceptional service. As
indicated above, the Fire Department has met this challenge with programs
tailored to the risks present in the community. Emergency medical calls
account for over 60% of the total emergency incidents and this is the
largest emergency service we provide. Yet, emergency medical service is
the only service we provide where we lack total control over the service. A
critical success factor in the emergency response strategy in Vision 2020 is
for the City to have total control for patient care.
Most important strengths and core competencies: The Germantown
Fire Department has always been innovative and adaptive. For example, in
the early 1980s the department followed a detailed plan of improvement
and improved the department’s ISO rating from Class 5 to Class 3, which
significantly reduced the cost of insurance for Germantown residents and
business owners. Long-range planning identified a major risk to the
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community from a transportation accident involving hazardous materials, so
Germantown created a Level A (able to respond to the highest hazards)
Hazmat team and was the first team in Tennessee to achieve certification
from the Tennessee Emergency Management Agency (TEMA). The
Germantown Fire Department’s major competitive strengths are its
strategic plan, its continued focus on providing its core businesses and,
most importantly, the highly skilled professional workforce that constantly
demonstrates a commitment to service excellence. The Fire Department
consistently demonstrates the ability to provide an exceptionally high level
of emergency and non-emergency services to the community, which is our
strongest core competency.
The department’s ability to serve is reflected in the response to the City’s
third community survey in 2005. The purpose of the survey was to measure
how satisfied residents were with current services, to obtain their input on
specific issues, and to find out what residents like best and least about
living in Germantown. The city mailed a 100-question survey to 13,814
households and received 4,798 completed surveys. This is a 35% response
rate (5-10% is typical), which is exceptional for a survey of this type and
complexity and provides a 95% confidence level for the results. Such a high
response rate indicated that Germantown residents do care about city
services and do have strong opinions about issues facing the city.
Fifty-eight questions pertained to resident satisfaction with city services.
Six of those questions (10.3%) related to Fire Department services. All six
of the fire department measurements fell within the top-scoring 15
questions (top 25.8%). The fire department was the only department to
have a very satisfied score above 70 on any item in the survey. The results
confirmed that the response of the city’s fire fighters and paramedics is
professional, effective, and timely. Residents feel confident in the fire
department’s ability to protect them from loss of life or property due to fire
and to respond to their needs in a medical emergency. The fire department
is doing a good job because of the continuous, professional effort shown
every time fire personnel roll out the door on a call or interact with the
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public. We build this high level of community trust and satisfaction one fire
call at a time, one EMS call at a time, one fire station tour at a time, one
public education talk at a time, one phone call at a time, one little extra
effort at a time. The men and women of the Fire Department built this level
of trust and satisfaction by consistently doing their job well, one day at a
time, and this level of care, concern, and compassion will carry over to a
transport ambulance service.
Significant EMS challenges the community faces now and in the near
future: In the evolution of a community, the City of Germantown is
approaching build-out, which means the rapid growth and increasing
revenues enjoyed in the previous two decades has slowed. The next stage
after build-out is a maturing community where the revenues will stabilize
but the cost of services will continue to increase. The City has developed a
Smart Growth Plan to renew the community with a focus around the current
center business area to bring together commercial, residential, and open
green areas that will renew growth within the City. The City must make
decisions to avoid having the cost of city services exceed revenues while
still maintaining the high level of service the residents of Germantown
desire. Germantown is using managed competition to reduce the cost of
service delivery without sacrificing quality and accountability. The City’s
Directors have been tasked with maintaining service levels without the
traditional use of a tax increase.
Germantown currently participates with Shelby County and the cities of
Arlington, Collierville, Lakeland and Millington in a contract with
Rural/Metro Ambulance Service for emergency ambulance service in these
cities and the unincorporated areas of Shelby County. Each entity pays a
portion of the cost of the contract based upon use. Germantown’s portion
for 2009 was $404,477. Under the current Shelby County Ambulance
Contract, most of the problems of the past that plagued the ambulance
transport service have been alleviated. However, there are still some issues
with the current vendor. This includes lack of equipment on the
ambulances, the vendor charging patients for supplies and medical
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procedures provided by fire department personnel, and the overall lack of
accountability and control by the Germantown Fire Department. The
average response time of the ambulances has improved to a contract
required 9 minutes, 90% of the time. Many injuries and medical conditions
are time sensitive, and there are very few minutes available for patient
treatment to prevent continued suffering. The American Heart Association
recommends a response time of five (5) minutes for people suffering from a
heart attack. The Fire Department’s response time is 5 minutes.
The Germantown Fire Department is well suited to provide emergency
ambulance service to the residents of Germantown. The department has
been providing advanced life support for 30 years and serves as the entry
point for patients into the local healthcare system when they call 911. Fire
Department personnel have been professionally trained to operate within
the time critical windows common to medical emergencies. For example, in
cardiac arrest, brain death typically occurs within 6-8 minutes. The time
between cessation of the heartbeat and initiation of CPR, defibrillation, and
advanced cardiac life support determines the patients chances for survival.
Currently, at emergency medical incidents, Fire Department paramedics
and EMTs provide patient treatment and then turn patient care over to the
third-party ambulance service. When patient care is turned over to the
private ambulance service, Germantown relinquishes a large amount of
accountability and control. At this time, the care provided by Fire
Department personnel is interrupted and some information regarding the
patient’s chief complaint, condition, and treatment is lost during the
transfer. In addition, the knowledge, skills, and abilities of Germantown
Fire Department personnel, along with the Germantown standard of care, is
a known quantity when care is provided by the Fire Department. Even
though the personnel on the private ambulance are licensed, Germantown
does not know or control the level of knowledge, skills and ability of the
private company’s employees. To address this, Fire Department personnel
accompany the patient to the emergency room for major medical and
trauma transports or when the fire department paramedic has administered
a narcotic drug for patient treatment. The International Association of Fire
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Chiefs has stated that the documented survival rates are markedly higher
for patients served by cross-trained, multi-role fire fighters than for those
victims served by providers of non-fire service based systems. The Fire
Department proposes to gain full control and accountability for all
emergency medical services in the City by operating an emergency
ambulance service with Germantown Fire Department personnel. It simply
makes sense for the EMT or paramedic who initiates patient care to provide
seamless care until the patient reaches the hospital.
Long term: The Fire Department proposes to operate an emergency
ambulance service for the City of Germantown. This service meets the
immediate need of providing exceptional patient care and having full
control of the EMS system. Under this business plan, the Fire Department
will operate a primary emergency ambulance service that provides ALS
response to 911 calls.
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III. Products and Services
The Germantown Fire Department provides an ALS first responder service
within the corporate limits of Germantown and serves as the entry point for
patients into the local healthcare system for EMS calls. The department
operates four fire engines, one truck company and one rescue squad, all
staffed with licensed medical personnel. All of these apparatus are
equipped to provide both ALS and BLS emergency medical care. The
department staffs, as a minimum standard, each engine company with a
paramedic for the provision of ALS. The truck company, at most times, is
also staffed with paramedic.
Factors that give the Germantown Fire Department a competitive
advantage include the department’s strategic plan, its understanding of
Vision 2020, its experience in providing EMS services in the community,
response capabilities, and the commitment of the men and women of the
department.
The fire chief is a licensed paramedic with 34 years of EMS experience, 32
of those years as a paramedic, and has completed the Management of
Emergency Medical Services course at the National Fire Academy. He has
been involved in drafting past county ambulance contracts and representing
Germantown’s interests on ambulance contract committees dating back to
the early 1980s. He has served on the Mid-South EMS council, and
currently represents Germantown on the Shelby County Emergency Medical
Response Oversight Committee (EMROC), charged with administration of
the Shelby County Ambulance Service Contract. He has served on Mayor
Wharton’s Shelby County Blue Ribbon Committee for Emergency
Communication and Shelby County’s Emergency Response Subcommittee,
and holds professional accreditation as a Chief Medical Officer (CMO) from
the Commission on Professional Credentialing.
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The EMS Coordinator is a licensed paramedic with over 27 years in EMS,
including service as a supervisor with a private ambulance company. He
represents Germantown’s EMS interests on the Mid South EMS Council and
oversees the quality assurance (QA) program for the Fire Department. He
regularly communicates with our physician medical director to keep Dr.
Holley informed, to receive feedback on the QA program, and to maintain
inventory and accountability of controlled substances used in providing
emergency medical care. He is responsible for inventory control and
oversees the program to provide the training and education necessary so
EMS personnel can recertify every two years.
Other key staff personnel are licensed paramedics or EMTs and have been
involved in the delivery of emergency medical care for decades. The most
important key factor Germantown brings to the table is desire: the men and
women of the Germantown Fire Department want to provide this service to
the community. They have witnessed the quality of service from the current
and past providers of ambulance service, and this is not what they want for
Germantown. Following the department’s strategic plan, they reflect the
S.P.I.R.I.T. of Germantown in the performance of their duties and serve the
community with R.E.S.P.E.C.T. Fire Department personnel providing a
transport ambulance service within the Fire Department is logical since fire
personnel initiate patient care through the first responder program. The
most important product the Germantown Fire Department has to offer in
creating a fire-based ambulance service is a quality and effective emergency
response by highly skilled, professional employees dedicated to serving the
community.
For the public, it means they only have to dial “911” and no matter what
their emergency is, the fire department responds. The Fire Department is
equipped and trained to handle that emergency. Whether it is a fire, a call
for a medical emergency, a hazardous materials incident, extrication,
rescue, or anything else, the Fire Department will take care of the
emergency. The Fire Department is naturally deployed for rapid response
and if the response is not fast, it isn’t an emergency response. There are no
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other systems, except for fire serviced based medical services, that come
with a complete toolbox to handle any incident out of a hospital that
requires emergency medical care.
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II. Marketing Plan
The Marketing Plan:
Economics and Research In Tennessee, only one county and five cities use a fire department
based ambulance service as the primary provider of emergency ambulance service for their local community, which represents just 1.5% of all ambulance services in Tennessee. Two of those six ambulance services are in Shelby County (Memphis and Bartlett).
The total size of the market in Germantown is 41,011 people and 19 square miles. The Germantown Fire Department is the primary provider of first responder advanced life support and has access to 100% of the EMS market in Germantown.
The current demand for service in the target market area of Germantown 1,650 EMS calls annually with approximately 1,350 actual transports.
Requests for emergency ambulance service response in Germantown increase annually. The growth of Germantown’s medical community will result in an increase in emergency ambulance responses to these facilities. Current customers include one rehabilitation hospital, three assisted care living facilities, and numbers physician’s offices and specialty care clinics.
An aging population indicates a growth in the need for emergency medical services.
o During the next 10 years, the majority of the baby boomer generation will reach 67 years of age
o It is projected that between now and 2020, the growth rate for persons over 65 will be twice the growth rate for the general population
o Germantown’s median age is 41.3 years, which is higher than the median age of the US population, which is 35.3 years.
o Germantown is growing at a faster rate than the national average. The largest age group in Germantown is between the ages of 45 to 54 (21.7%). In four years, the largest group will be 55 and older
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o Germantown will need to provide medical (and other) services to seniors sooner and at a much higher rate than in many other communities.
o The number of medical responses the Fire Department makes to elderly residents is increasing.
o The most common medical calls in Germantown associated with the elderly include respiratory problems, chest pain, cardiac arrest, stroke, diabetic emergencies, general illness, and falls.
o In Tennessee, residents seek hospital services at a higher rate than the national average because of a lack of primary care providers leading these patients to use the EMS system as a substitute for a primary health care provider.
The socioeconomic environment in Germantown and the market area indicates a high potential for collecting revenue for services provided. The market area contains many third-party payers.
o The vast majority of Germantown residents are well educated: over 40% are college graduates and over 22% have postgraduate degrees. This educational level indicates the probability that most residents have jobs or careers that provide medical benefits and/or they understand the need for comprehensive health insurance.
o Over 89% of the households in Germantown report annual salary and wage earnings.
o Over 81% of households in Germantown report annual earnings of $50,000 or more. Over 46% of households report annual earnings of $100,000 or more.
o The median household income in the US is $49,538 and in Shelby County, it is $47,613. In Germantown, the median household income is $113,769
o The per capita income in Germantown is $44,021 and ranks 6th in Tennessee. By contrast, the per capita income in Memphis is $17,838 and ranks 129th in Tennessee out of 382 ranked cities. The national per capita income is $21,587.
Cost factors for the Germantown Fire Department Ambulance Service
o Capital Costs – Four Type I ambulances will be purchased. Two new ambulances will be used for front-line service and two used will serve as back-up ambulances.
o Personnel costs – Germantown will continue to hire personnel that are cross-trained fire fighters. Thirteen (13) personnel will be hired. A minimum of six (6) of these personnel will be
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paramedic/fire fighters and the remaining personnel will be fire fighter/EMTs.
o Marketing costs – The Germantown Fire Department is well known in the community. Any marketing costs to establish a presence in the community would be minimal.
o Consumer acceptance/brand recognition – The Germantown Fire Department enjoys an exceptional reputation in the community for fast, professional response, quality personnel, excellent equipment, and premier service.
o Training/skills – In cooperation with a local community college, an in-house training program has been developed to deliver state approved training to provide the quality training the paramedics and EMTs need to stay current on treatment protocols and recertify every two years.
o Start-up costs – The Fire Department administration will oversee and manage the ambulance service operation. Since management and oversight is already in place for the first responder program, there will be minimal increased costs for overseeing the ambulance operation. Housing the crews and ambulances in fire stations eliminates the need to rent space for quarters. The cost for purchasing ambulances is included in the capital costs. The selected billing contractor will charge a flat percentage rate of the transport revenue.
o Germantown is one of only a few cities in the nation to have a triple-A bond rating from both Moody’s and Standard & Poor’s. Germantown should get excellent rates, should the decision be made, to lease or lease-purchase ambulances and equipment.
ProductsThe Germantown Fire Department’s product is a consistently high quality,
professional emergency medical response with the best equipment in good
working order. This is what the customer expects when they dial 911 for a
medical emergency. On what may be the worst day of the patient’s life, and
in the life of the patient’s family, it is essential that the EMS response be at
its best. This is the product the Germantown Fire Department will provide
through a fire based emergency ambulance service.
Primary research has shown that the number one issue with users of the
EMS system and an ambulance service is quality service and a quick
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response by medical personnel. Excessive response times for a transport
ambulance negate the benefits of a quality paramedic first response
program. Customers can be distressed over ambulances that respond
without the proper equipment or basic amenities such as sheets and
blankets. Fire department personnel have witnessed firsthand ambulances
arriving lacking critical equipment such as the way to measure a diabetic
patient’s blood glucose level or working equipment such as an EKG monitor
for a heart patient, and getting lost responding to calls.
Features and BenefitsThe Germantown Fire Department will provide a professional, well-
managed emergency transport ambulance service with the best paramedics,
EMTs and equipment, responding in a timely and efficient manner,
committed to saving lives and to ease pain and suffering. The City of
Germantown retains total control over patient care from the initial contact
until the patient is admitted to the emergency department.
Two items mentioned in the Germantown Vision 2020 document are
“safety” and “access to premier healthcare.” Premier healthcare includes
emergency ambulance service as this serves as the point of entry into the
healthcare system. For a private contractor, a major motivator to serve
Germantown is profit. Unlike a private contractor, the major motivator for
the Germantown Fire Department to provide emergency ambulance service
is desire: The men and women of the Germantown Fire Department want to
provide this service to the community because it meets the S.P.I.R.I.T. of
Germantown and we serve with R.E.S.P.E.C.T. for the community.
Compliance with Vision 2020.
Safest City in the Southeast
o People are safe and feel secure
Proactive Approach to Community Safety
o Awareness of national trends and “Best Practices” and how they apply to our community
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Effective Emergency Response
o Meeting response time standards: EMS 5 minutes
o Response by highly trained, professional public safety personnel prepared to handle the emergency
o Right equipment and resources available to handle the emergency
o Emergency medical transport ambulance service with state-of-the-art patient care operated by the City
o Effective communications and dispatch facilitating the emergency response
o Retaining total control for patient care from the emergency scene to the hospital
Top-quality workforce
o Hiring and retaining the “best public safety employees”
o Highly skilled, professional workforce dedicated to serve the community
o Training and educational opportunities available to develop knowledge, skills and abilities
CustomersOur customers include the residential population of the City of Germantown
(approximately 41,000 people) plus daily visitors to the area. We estimate
that 80% of Germantown’s EMS customers are residents of Germantown.
Germantown itself is roughly rectangular with a network of several major
streets to facilitate ease of movement in the community. Ninety percent of
patients transported from within Germantown go to four hospitals that are
located within 7 miles of the intersection of Germantown Road and
Farmington Boulevard, which means the ambulance is able to return to
service in Germantown in a minimal amount of time once the patient has
been accepted by the hospital.
Page 23 of 43
More and more of our customers are located in medical facilities at the time
of the request for service. These facilities include residential care facilities,
physician’s offices, specialty clinics, and outpatient surgery facilities.
The population in Germantown is affluent and well educated. This infers an
understanding of the benefits of good health care and a personal emphasis
on the importance of having access to prompt emergency medical care and
transportation.
In Germantown, over 52% of the residents work in management,
professional and related occupations and over 30% are employed in sales
and office occupations. This economic statistic indicates a high likelihood
that the majority of the residents have well paying jobs with medical
benefits.
Competitive AnalysisThe Germantown Fire Department is intimately familiar with the EMS
market in Germantown, is adept at providing exceptionally good service,
has an excellent reputation in the community, has fire stations strategically
located to provide rapid response to all portions of the city, has a strategic
plan that envisions the department providing transport ambulance service,
and has the desire to provide the service. The City of Germantown is
financially sound and able to fund the cost of providing a transport
ambulance service. The service provided will be exceptional, with control
and accountability that cannot be matched by contracting with a for-profit
company.
PricingTransport fees have been established based upon the level of service
provided to the patient. The different levels of service are ALS1, ALS2,
BLS, and non-transport. These categories were developed utilizing the
Medicare reimbursement rates for ambulance transport as a guide. All
billing vendors interviewed, expressed that private medical insurance
companies utilize Medicare’s classification of patient transport services.
The billing vendors also suggested when billing for transport service, to bill
Page 24 of 43
a flat rate fee versus itemized billing. The Medicare reimbursement base
rates and mileage are established by the Federal Government annually.
Utilizing the private billing vendor to handle all billing aspects the following
rates will apply:
ALS2 - $750 Medicare ALS2 - $542.38
ALS 1 - $650 Medicare ALS1 - $374.73
BLS - $550 Medicare BLS - $315.56
Treatment and No Transport - $450 Medicare Treatment and Non
Transport – 0
Mileage - $12.50 per loaded mile Medicare Mileage - $6.87 per
loaded mile
A non-transport fee will be assessed when a call for emergency services is
made from a specific address by the patient or by the patient’s immediate
family, who is located at the same address as the patient, and the patient
then decides not to be transported against medical advice from the fire
department paramedics. This covers the cost of the emergency response to
the patient, the ALS patient assessment, and any interventions performed
until the patient refuses transportation to an emergency room.
A non-transport fee will not be assessed when a third-party caller makes the
911 call for an emergency response and the patient refuses treatment and
transportation.
Revenue Forecast
Transport Rate – 88% Collection Rate – 85% Transport Rate –
78%, Collection Rate – 85%
Page 25 of 43
Year 1 - $659,613 Year 1 -
$585,368
Year 2 - $673,787 Year 2 -
$596,950
Year 3 - $695,650 Year 3 -
$608,756
Year 4 - $717,512 Year 4 -
$620,791
Year 5 - $739,375 Year 5 -
$633,059
Year 6 - $761,238 Year 6 -
$645,564
Year 7 - $783,100 Year 7 -
$658,312
Page 26 of 43
Operational Plan
Provision of service
The Germantown Fire Department will respond to calls for emergency
ambulance service made within the service area. The dispatch office
Germantown will process the request and dispatch the appropriate first
responder fire company and ambulance(s). The department will use its
existing quality improvement program to monitor the service provided and
ensure that all patient care meets state standards and follows approved
protocols. A written policy will be established to handle mutual aid
requests for an ambulance. The EMS Supervisor will provide daily
supervision of the ambulance service. Existing, proven inventory control
procedures for equipment and medications will be used to maintain a
sufficient stock of medical supplies and accountability for controlled
substances. Revisions to operating procedures will be made as needed after
review and evaluation of the first quarter of operation of the service and
thereafter as needed. A quality review council (QRC) will be established
with Fire Department representatives to oversee operation of the service.
Location
The Germantown Fire Department has four fire stations strategically
located to provide rapid response to all portions of the city. Ambulances
will be strategically placed at Fire Stations 3 and 4 to provide the best
coverage and response times for the service area. These stations offer
living quarters for the ambulance crews and bay space to house
ambulances, along with the infrastructure for dispatching the ambulances
and space for storage, recording keeping and related activities, which keeps
ambulances from having to travel to a “home office” for paperwork and re-
supply. The fire stations are well maintained and present a positive public
image, which will match the image projected by the ambulances and crews.
Page 27 of 43
Legal Environment
The Germantown Fire Department will apply to the Tennessee Department
of Health, Emergency Medical Services Division for a Class A ambulance
service license. A Class A license indicates that the service provides
advanced life support or critical care service. A license is required to
operate an ambulance service in Tennessee. The license is renewed
annually and expires on June 30 of each year. The initial license fee is
$5,000. The annual renewal fee is $500.
The City will be required to have each ambulance inspected and permitted
by the state before placing the ambulance in service. Ambulance permits
expire annually. Regional EMS consultants inspect ambulances annually.
The annual permit fee for each ground ambulance is $250.
Regional EMS consultants conduct annual service audits. The service audit
demonstrates that the ambulance service complies with pertinent federal
and state laws and regulations.
All personnel providing emergency medical care must be licensed to
practice in Tennessee. The department will investigate all potential
employees to ensure they possess a valid license. Paramedics must obtain
30 hours of approved continuing educational units (CEU) and EMTs must
obtained 20 hours of CEU in order to apply for renewal of their license. The
Fire Department’s EMS training program provides sufficient hours so
personnel can comply with this requirement.
The City of Germantown carries appropriate insurance for its ALS first
responder program and insurance to cover the care provided by paramedics
and EMTs. The City will provide the required liability insurance for
operating an ambulance service and insurance on the ambulances.
Tennessee is a TOSHA state. The department has and enforces infection
control and contaminated waste polices in compliance with federal and
state laws. The department offers Hepatitis A and B vaccinations to all
employees.
Page 28 of 43
Personnel
The Germantown Fire Department has 68 full-time employees, 4 part-time employees, and 25 reserve employees (Of the 25 fire reserves; 19 are seeking full-time employment with the Germantown Fire Department. Of these personnel; two are paramedics, three are currently in paramedic school, and eleven are EMT’s)
The department provides highly specialized and technical services requiring skilled, professional employees. Many of the fire department’s paramedics and EMTs have vast experience providing ambulance transportation services which will streamline the transition from providing only ALS first responder service to an ALS ambulance transportation service. The employees will alsobe required to acquire and maintain special certifications or state licenses.
The department will recruit new employees first from the current Germantown Fire Department Fire Reserve Program, second from the local Fire/EMS market, and third from the region by advertisement. The service will require seven (6) EMTs and six (7) paramedics.
The quality of existing staff is exceptional. The department will use proven hiring techniques to ensure that personnel hired for the ambulance service meet the same high standards as existing personnel.
The personnel required to staff the ambulance service will be compensated based upon the Fire Department’s Career Development Program. Since ambulance personnel will be public safety employees, they will receive the same benefit package as police officers and fire fighters.
All new personnel will complete an orientation program before going to work. Personnel will adhere to the existing policies and procedures of the Fire Department. Personnel will participate in the EMS training program, which is well established and provides continuing education units (CEUs) needed for license renewal.
Fire Fighter/Paramedics and Fire Fighter/EMTs will staff fire apparatus and ambulances utilizing an approved rotating schedule.
Page 29 of 43
Credit Policies
The Fire Department will provide transport ambulance service on an as-
needed credit basis. Although payment will be due when service is
rendered, the ambulance crew will transport the patient without regard to
collecting the service fee before providing emergency medical care or
transport. Fire Department personnel will not collect money for patient
transports. The ambulance crew will collect pertinent information utilizing
an electronic patient care report and the selected billing vendor will
execute the billing services for patient transport and treatment services.
The emphasis will be on patient care regardless of the patient’s ability to
pay.
Other than providing emergency medical services in arrears, the
department does not extend credit. The Fire Department administration
will carefully manage the budget by monitoring department expenditures
and will stay in constant communication with the billing contractor to
monitor revenue.
The Fire Department will use a contact service for billing. This is more
effective than hiring a billing clerk and then having them to continually
train on changes in Medicare and Medicaid rules and regulations. The
billing contractor will be diligent in collecting outstanding bills and in
keeping delinquent accounts receivables to a minimum. Accounts
receivable aging will be done on a monthly basis. Once a billing contractor
is selected, policies will be established to manage collections from
delinquent customers.
Page 30 of 43
III. Management and Organization
The fire chief will lead and manage the ambulance service operation. Fire
Department staff possesses the knowledge, skills, ability and experience to
operate an ambulance service. If this plan is adopted, the 8-hour EMS
Supervisor position will be created and staffed. The department’s EMS
Battalion Chief will provide daily supervision of the ambulance service.
The Fire Chief will promote a qualified Lieutenant-Paramedic to the position
of EMS Supervisor.
Professional and Advisory Support
Fire Department staff
o Dennis Wolf, Fire Chief
o John Selberg, Assistant Fire Chief
o Edgar Babian, Deputy Fire Chief
o Mark Carter, EMS Coordinator
City Attorney
o C. Thomas, Cates, Burch, Porter and Johnson
Finance
o Kristen Geiger, Assistant City Administrator
Risk Manager/Treasurer
o Michael Stoll
Medical Director
o Joseph Holley, MD
Page 31 of 43
Proposed Organizational Chart
Daily Operational Plan
Page 32 of 43
The Germantown Fire Department will place two full-time ambulances into service
daily. These will both be staffed by a paramedic/fire fighter and a fire fighter/EMT.
In the event an additional ambulance is needed for response to an emergency
incident, personnel can be reallocated from Engine 93 or Truck 41 to staff the
reserve ambulances. In the event, the need for ambulances exceed the number of
available ambulances, a mutual-aid request for additional ambulances can be made
from the Memphis and Shelby County Fire Departments or even from a private
ambulance service. The Memphis and Bartlett Fire Departments have established
agreements with private ambulance services, at no cost, to provide additional
ambulances in the event their present call volume exceeds their current transport
capability.
IV. Financial History and Analysis
The Germantown Fire Department’s operating budget comes from the
general fund of the City of Germantown. The operating budget for FY2010
is $7,087,281. Small grants are sometimes used to fund special projects,
but grant funding is inconsistent and unreliable for operational funding.
The City has a triple-A bond rating from Moody’s and from Standard &
Poor’s. The city has adequate reserves and a sound financial history.
The Fire Department’s FY2011 operating budget does not contain funds for
the establishment of an ambulance service. This possibility was not
foreseen when the budget was created starting in January of 2010, because
of the desire to have total control over emergency medical services and the
uncertain future of the Memphis\Shelby County consolidation referendum
currently being proposed.
If this plan is adopted by the BMA, this plan will call for the service to be in
place by October 1, 2010. There are many things that must be done
between the adoption of the plan and the start date, including hiring and
training personnel, purchasing ambulances and equipment, selecting a
billing contractor, and getting the required licenses.
Page 33 of 43
V. Financial Plan
5-Year Revenue and Expense Projection
Revenue FY 12 FY 13 FY 14 FY 15 FY 16
Transport Fees 0$564,
505
$575,
670
$587,
050
$598,
651
Non-Transport
Fees0
$20,8
63
$21,2
80
$21,7
06
$22,1
40
Total Revenue 0$585,
268
$596,
950
$608,
756
$620,
791
Expenses1st
Year
2nd
Year
3rd
Year
4th
Year
5th
Year
Personnel$153,
702
$585,
231
$638,
062
$661,
379
$710,
708
Related Personnel
Costs
$90,7
76
$240,
138
$261,
270
$270,
597
$290,
328
Vehicle Expense 0$29,0
00
$31,0
00
$33,0
00
$35,0
00
Equipment*$98,0
00
$41,5
00
$41,5
00
$41,5
00
$41,5
00
Insurance 0$10,0
00
$10,1
60
$10,3
23
$10,4
88
Billing Service
Fee0
$58,5
37
$59,6
95
$60,8
76
$62,0
79
Capital Outlay$500,
0000 0 0 0
Page 34 of 43
Page 35 of 43
Appendices
Appendix A Germantown - Sex by Age (census data)
Appendix B Germantown - Sex by Educational Attainment for Population 25
Years and Over (census data)
Appendix C Germantown - Household Income in 1999 (census data)
Appendix DGermantown - Earnings in 1999 for Households (census data)
Appendix E Germantown - Year Structure Built (census data)
Appendix F Seven-Year History of Ambulance Responses in the Market Area
Appendix G Collierville – Household Income for 1999 (census data)
Page 36 of 43
Appendix A
Sex by Age – Universe: Total population. Data Set: Census 2000 Summary File (SF1) 100% Data
Germantown,
Tennessee PercentCumulative
Percent
Male:
Under 5 years 994 5.46% 100.00%
5 to 9 years 1,449 7.96% 94.54%
10 to 14 years 1,692 9.30% 86.57%
15 to 17 years 1,167 6.41% 77.27%
18 to 20 years 659 3.62% 70.86%
21 to 24 years 479 2.63% 67.24%
25 to 29 years 477 2.62% 64.61%
30 to 34 years 650 3.57% 61.98%
35 to 39 years 1,230 6.76% 58.41%
40 to 44 years 1,644 9.04% 51.65%
45 to 49 years 1,939 10.66% 42.62%
50 to 54 years 1,996 10.97% 31.96%
55 to 59 years 1,405 7.72% 20.99%
60 to 64 years 864 4.75% 13.27%
65 to 69 years 626 3.44% 8.52%
70 to 74 years 399 2.19% 5.08%
75 to 79 years 305 1.68% 2.89%
80 to 84 years 154 0.85% 1.21%
85 years and over 66 0.36% 0.36%
Total Male: 18,195 48.72% 48.72%
Female:
Under 5 years 957 5.00% 100.00%
5 to 9 years 1,384 7.23% 95.00%
10 to 14 years 1,672 8.73% 87.78%
15 to 17 years 1,151 6.01% 79.05%
18 to 20 years 534 2.79% 73.04%
21 to 24 years 478 2.50% 70.25%
25 to 29 years 518 2.70% 67.75%
30 to 34 years 824 4.30% 65.05%
35 to 39 years 1,477 7.71% 60.75%
40 to 44 years 1,966 10.26% 53.04%
45 to 49 years 2,195 11.46% 42.77%
50 to 54 years 1,989 10.38% 31.31%
55 to 59 years 1,270 6.63% 20.93%
60 to 64 years 839 4.38% 14.30%
65 to 69 years 621 3.24% 9.91%
70 to 74 years 480 2.51% 6.67%
75 to 79 years 426 2.22% 4.17%
80 to 84 years 217 1.13% 1.94%
85 years and over 155 0.81% 0.81%
Total Female: 19,153 51.28% 51.28%
Page 37 of 43
Grand Total: 37,348 100.00% 100.00%
Appendix B
Sex By Educational Attainment for Population 25 Years and Over
Germantown,
Tennessee PercentMale:
No schooling completed 2 0.02%Nursery to 4th grade 0 0.00%5th and 6th grade 29 0.25%7th and 8th grade 5 0.04%9th grade 18 0.15%10th grade 36 0.31%11th grade 37 0.31%12th grade, no diploma 86 0.73%High school graduate (includes equivalency) 891 7.55%Some college, less than 1 year 437 3.70%Some college, 1 or more years, no degree 1,766 14.97%Associate degree 438 3.71%Bachelor's degree 4,812 40.78%Master's degree 1,950 16.53%Professional school degree 931 7.89%Doctorate degree 362 3.07%Total Male: 11,800 47.65%
Female: No schooling completed 17 0.13%Nursery to 4th grade 9 0.07%5th and 6th grade 6 0.05%7th and 8th grade 55 0.42%9th grade 23 0.18%10th grade 38 0.29%11th grade 32 0.25%12th grade, no diploma 90 0.69%High school graduate (includes equivalency) 1,840 14.19%Some college, less than 1 year 907 7.00%Some college, 1 or more years, no degree 2,426 18.71%Associate degree 714 5.51%Bachelor's degree 4,506 34.76%Master's degree 1,826 14.08%Professional school degree 377 2.91%Doctorate degree 99 0.76%Total Female: 12,965 52.35% Grand Total: 24,765 100.00%
Page 38 of 43
U.S. Census Bureau Census 2000
Page 39 of 43
Appendix C
Household Income in 1999 – Universe: Households
Data Set: Census 2000 Summary File 3 (SF3) – Sample Data
IncomeGermantown,
Tennessee Percent
Cumulative Percent -
Increasing
Cumulative Percent -
DecreasingLess than $10,000 246 1.86% 1.86% 100.00%$10,000 to $14,999 159 1.20% 3.06% 98.14%$15,000 to $19,999 132 1.00% 4.06% 96.94%$20,000 to $24,999 268 2.03% 6.08% 95.94%$25,000 to $29,999 240 1.81% 7.90% 93.92%$30,000 to $34,999 324 2.45% 10.35% 92.10%$35,000 to $39,999 367 2.77% 13.12% 89.65%$40,000 to $44,999 323 2.44% 15.56% 86.88%$45,000 to $49,999 434 3.28% 18.84% 84.44%$50,000 to $59,999 906 6.85% 25.69% 81.16%$60,000 to $74,999 1,486 11.23% 36.92% 74.31%$75,000 to $99,999 2,157 16.30% 53.22% 63.08%$100,000 to $124,999 1,767 13.35% 66.58% 46.78%$125,000 to $149,999 1,255 9.49% 76.06% 33.42%$150,000 to $199,999 1,277 9.65% 85.72% 23.94%$200,000 or more 1,890 14.28% 100.00% 14.28%TOTAL 13,231 100.00%
U.S. Census Bureau Census 2000
Appendix D
Earnings in 1999 For Households - Universe: Households
Data Set: Census 2000 Summary File 3 (SF 3) - Sample Data
Germantown,
Tennessee PercentTotal: 13,231 With salary and wage earnings 11,860 89.63%Other earnings/No earnings 1,371 10.37%
U.S. Census Bureau Census 2000
Page 40 of 43
Page 41 of 43
Appendix E
Year Structure Built
Data Set: Census 2000 Summary File 3 (SF3) – Sample Data
Germantown, Tennessee
Total: 13,703
Built 1999 to March 2000 460
Built 1995 to 1998 1,329
Built 1990 to 1994 1,270
Built 1980 to 1989 4,375
Built 1970 to 1979 5,030
Built 1960 to 1969 879
Built 1950 to 1959 204
Built 1940 to 1949 62
Built 1939 or earlier 94U.S. Census Bureau Census 2000
Appendix F
Page 42 of 43
Page 43 of 43
Appendix G
Household Income in 1999 – Universe: Households
Data Set: Census 2000 Summary File 3 (SF3) – Sample Data
IncomeCollierville, Tennessee Percent
Cumulative Percent -
Increasing
Cumulative Percent -
DecreasingLess than $10,000 194 1.88% 1.88% 100.00%$10,000 to $14,999 248 2.40% 4.28% 98.12%$15,000 to $24,999 539 5.22% 9.50% 95.72%$25,000 to $34,999 704 6.82% 16.32% 90.50%$35,000 to $49,999 956 9.26% 25.58% 83.68%$50,000 to $74,999 2,098 20.32% 45.90% 74.42%$75,000 to $99,999 1,920 18.60% 64.50% 54.10%$100,000 to $149,999 2,209 21.40% 85.90% 35.50%$150,000 to $199,999 773 7.49% 93.38% 14.10%$200,000 or more 683 6.62% 100.00% 6.62%Total 10,324 100.00% U.S. Census Bureau Census 2000