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ENFIELD TOWN COUNCIL
MINUTES OF A SPECIAL MEETING
DECEMBER 2, 2002
A Special Meeting of the Enfield Town Council was called to order by Chairman Vayda in the Enfield Room of the Enfield Town Hall, 820 Enfield Street, Enfield, Connecticut on Monday, December 2, 2002 at 6:07 p.m.
ROLL-CALL - Present were Councilmen Egan, Fiore, Jones, Mangini, Tait, Tallarita, and Vayda. Councilman Hall entered at 6:10 p.m., and Councilman Kaupin entered at 6:31 p.m. Councilmen Edgar and Strom were absent. Also present were Town Manager, Scott A. Shanley; Assistant Town Manager, Daniel Vindigni; Town Clerk, Suzanne F. Olechnicki; Director of Public Works, John Kazmarski; EMS Manager, Gary Wiemokly.
EMERGENCY MEDICAL SERVICE
Mr. Wiemokly reviewed a packet which had been distributed to the Town Council. He referred to the first page entitled, "EMS Models for the Town of Enfield". He stated whatever model the Town chooses as a plan, he feels the Town should do the following items:
" Citizen CPR/911 Access
" EMD - Emergency Medical Dispatch
" Police Department as First Responders; providing assessment/patient size-up, minor treatment, life saving maneuvers, i.e., CPR and Semi-Automatic External Defibrillation
" Fire Service would be involved as far as managing vehicle extrications and/or rescue elevations including scene safety and incident management. Provide supplemental first responder activities in conjunction with the Police Department as deemed necessary.
" Elimination of boundaries within the Town of Enfield for EMS response. Town-wide vehicles should be able to move to any section of town, not just within specific jurisdictions
" Decrease dependence on receiving mutual aid to "cover our own calls."
" Improve mutual aid response to neighboring communities
Mr. Wiemokly referred to the second page of the report entitled, "Emergency Medical Service for the Town of Enfield - Recommended System". He pointed out this is the system that he recommends. He highlighted this system as follows:
Name - Enfield Community Ambulance (system) would be known as Enfield Emergency Medical Services (EMS). This will more accurately reflect the mission of the providers. He noted the Enfield Community Ambulance, Inc. would remain as a philanthropic organization by the Maciolek Post to supplement funds to help defray the costs of equipment and ambulances.
Access - Access to Emergency Medical Services will be done through the enhanced 911 system already in place.
Mr. Wiemokly stated CRCOG has recommended using Medical Priority Dispatch which has been in use for over 20 years. He noted since Enfield is within that region, he sees no reason to select something different, and it is a good product.
BLS Vehicles - The system would have four ambulances. Two ambulances should be available 24 hours a day, seven days a week. The third ambulance should be staffed at peak times, which is from 7:00 a.m. to 11:00 p.m. The fourth ambulance would be a mechanical backup and would be put into service when the front-line ambulances are having routine maintenance or there's a mechanical malfunction. This backup could be utilized at times of extraordinary volume or a major incident. Each ambulance should have a couple locked cabinets.
Staffing - The ambulances would be staffed with two Connecticut Certified Emergency Medical Technicians (EMT-B). These EMT-Bs would have additional training and education through Johnson Memorial Hospital Sponsorship Program so that they'd be able to use epi-pens for anaphylaxis and semi-automatic defibrillation and CombiTube placement for cardiopulmonary arrest patients.
ALS Staffing and Vehicles - The system will also be staffed with two Connecticut Licensed Paramedics 24 hours per day, seven days per week. The paramedics would operate out of two intercept vehicles. The intercept vehicles would not be patient transport capable, however, they will be fully stocked with Advanced Life Support (ALS equipment). This would be a tiered response and would be done in concert with the emergency medical dispatching.
A third paramedic intercept/supervisor vehicle (the EMS Manager) would be available for times of extraordinary call volume or multi-casualty events.
Vehicle maintenance would be handled by Public Works.
Medical Supplies - Medical supplies for the system will be stored with a locker system. There would be environmental controls. Some medications need to be maintained within a suitable range to keep their potency.
Vehicle and Staff Housing - Relationships and arrangements should be in place to house ambulances and staff at fire and police locations.
Record Keeping - Patient Care Reports (PCRs) will be completed by who ever is handling the patient. An electronic means of doing this is recommended since they would be able to integrate with a billing system and they could expedite the revenue recovery.
Overview of System Function - A 911 call comes into the dispatch center. The police, as first responders, would respond with an average response time of 3.9 minutes. The Police Chief and police officers are in agreement that the police would remain as first responders. This would be followed up by BLS ambulance and if necessary, the paramedic unit. If it's determined the paramedic isn't necessary, the patient can be turned over to the BLS crew and the patient will be transported by the basic life support ambulance.
System Advantages - The system remains "fluid" in that they are able to move the ambulances about if necessary, as well as the paramedics. With this type of system, there's not a blurring of who is responsible for what. The EMS provider is directly responsible for patient care and that is their primary focus. He noted they would ultimately answer to the EMS Manager.
Mr. Wiemokly then reviewed System Two as follows:
Name and Access - Same as first model
Vehicles - As in the first model, four ambulances would still be in place, as well as the time frame they'd be utilized.
Staffing - Staffing would consist of one EMT and one Paramedic. The staffing of the ambulances would be at the Advanced Life Support Level at all times due to the presence of the paramedic.
The EMS Manager would have an intercept/supervisor's vehicle equipped to handle events.
Medical Supplies - Same as first model
Record Keeping - Same as first model
Overview of System Function - Every vehicle is an ALS vehicle; therefore, paramedics would always be going.
System Advantages/Disadvantages
As concerns revenue recovery and billing, they would have to be very specific as to how they bill.
He noted the down side is that even if you don't need the paramedic, they would be going anyway.
With this system, they do lose a set of hands. On the most critical calls with the recommended system, they have the hands of the first responder, the two BLS providers in the ambulance, plus the paramedic. He noted with this type of system they do lose that set of hands, and they'd have to call upon that from somewhere else.
Staff focus remains on patient care. Quality assurance and performance can be done in a scheduled as well as in an impromptu manner.
Mr. Wiemokly then described System Three (Public Utility System) as follows:
Name
The name and the access and the BLS vehicles remain the same as the recommended model.
Staffing
Staffing would still be with two Connecticut certified EMT-B's and they would still have the additional training from Johnson Memorial regarding an Epi-pen, defibrillation and CombiTube placement. The EMT-B staff would come from a contracted pool of human resources that would be comprised of firefighter/EMT-N's from the Town's fire districts. From this pool, the staffing of the ambulances would occur. Contractual agreements and relationships would need to be developed. Protocol system expectations on how this would function would need to be developed and put into place.
ALS Staffing and Vehicles
Mr. Wiemokly recommended the same as the first system whereby they would have two paramedics 24 hours per day, seven days per week using Town of Enfield employees and this would be a tiered type of system.
Medical supplies, vehicle housing and record keeping would be the same as the first system.
Essentially the function would be the same as the first system and the advantages of that are the same regarding the ability to have the paramedics increase their availability when necessary.
The disadvantage of this system is that the supervision for the BLS crew would not fall under control of the EMS Manager and essentially the firefighters would remain under control of their fire officer. Mr. Wiemokly stated his belief that could potentially lead to some problems later down the road. He stated his concern about the possibility of having four or five supervisors within the agency, meaning the fire chiefs and him providing the oversight, and he believes this would be the downfall of the system. He explained there has to be a true line of control and supervision to maintain the quality assurance and the performance improvement. He noted if there's an issue as to how he is managing a situation, or if he's in conflict with one of the fire chiefs, there's a potential for downfall or degradation to the EMS system. He stated he's not really sure how to resolve this or the issue of liability within that. He noted he does not recommend this system because of these issues.
Mr. Wiemokly then reviewed System Four as follows:
This would involve the Town contracting with a commercial provider. He noted there is no commercial ambulance service that would be willing to tell him what the best deal is, therefore, the costs he provided were from the best information he was able to procure from other services that have contracted with different commercial providers.
Mr. Wiemokly stated a BLS ambulance would cost the Town anywhere from $300,000 to $400,000 per year per unit. He noted the down side has to do with most of the contracts being based upon a national standard response time which he doesn't find acceptable. He stated BLS times of eight minutes and 59 seconds seem long to him. He went on to note the advantage of this system is that the Town would contract with a service, write a check, and it would relieve the Town of significant administrative and management responsibilities, including workers' compensation, human resource issues, and most liability issues.
Mr. Wiemokly stated he does not recommend this system. He stated his belief the cost for this system is just about the same as if the Town had its own system. He noted the advantage of the Town having its own system is that they can develop revenue recovery. He stated he doesn't expect the EMS system to be a major revenue generator, however, he expects they could generate significant revenue to offset some of the costs.
Mr. Wiemokly stated the Office of the Inspector General has said municipally operated services that have their funding coming from a Town tax source don't have to send a co-pay bill for Medicare patients, however, if someone comes from another town, they would be required to bill them.
EMS Transitional Phase-In
Mr. Wiemokly stated if the Council were to adopt the system that he recommends, he would recommend a transitional phase-in so that the dollars are not so intimidating. He reviewed the phase in as follows:
Year one: Two (ALS) ambulances twenty-four hours a day, seven days a week
Staffing: One EMT-B and one EMT-P (Paramedic)
First back-up ambulance: BLS Level ambulance Police Department staffed
Utilization of the EMS Manager when available as a paramedic
Year tw Add a third ALS ambulance for peak hours
Year three: Three BLS ambulances and two paramedic intercept vehicles
Year four: Complete system reevaluation to look at:
Response times
Appropriate coverage to meet customer needs
Appropriate level of service available (ALS vs. BLS)
Consideration for expansion of service
Consideration for service licensure vs. ambulance certification
(Currently the Town is certified - Mr. Wiemokly stated he does not recommend considering licensing ambulances at this point because they'd be met with a tremendous amount of resistance from any of the commercial services, however, this is something they can look at again in the future.)
Consideration for ambulance billing by Town staff. (Mr. Wiemokly stated initially he would not recommend the Town do this since there are a number of very qualified services, but perhaps at Year Four it might be worthwhile considering this)
Mr. Wiemokly stated his belief the two ambulances twenty four hours per day, seven days per week and the one at peak hours will probably suffice the Town's needs five years out unless there's a huge growth in population.
Mr. Wiemokly referred to other cost factors:
Communications Center: Additional dispatcher/call taker (can be delayed until
Year Three)
Ambulances: Mr. Wiemokly stated they received a report from the
Town Garage regarding the current condition of the
ambulances and how to go about putting them into service
and keeping them maintained.
Fleet Maintenance: An additional mechanic would need to be put in place. He
recommended this person have some emergency vehicle
expertise.
Mr. Wiemokly stated the Council has before them budgetary documents which were compiled by the Director of Finance and this provides a breakout of the four years.
Councilman Hall stated her belief the Council should hold off on a lot of discussion and debate until the EMS Committee has the opportunity to review this report. She added she would like to see the finances for all the different systems.
Councilman Tait agreed with Councilman Hall and stated his belief it's important that the EMS Committee has an opportunity to fully investigate this report. He stated his belief this report is an excellent beginning and will generate a lot of discussion.
Councilman Fiore agreed with Councilman Hall and stated he also would like to see the finances for all the different systems.
Chairman Vayda expressed his appreciation for all the work that went into this report. He stated he looks forward to hearing from the Committee. He noted they need to demonstrate to the community that they're getting the best value for their dollars.
Mr. Shanley stated part of the cost increase is not about reductions elsewhere but actually quality that should be there.
Chairman Vayda questioned when the EMS Committee will come back to the Council, and the Chairman of the EMS Committee, Earl Provencher, stated initially the charge of the Committee is to have a recommendation of implementation and structure to the Council in December of 2002, however, that deadline looks difficult to meet, therefore, they may be looking for an extension to that deadline.
It was the consensus of the Council that there's no problem extending the deadline for the EMS Committee to report back to the Town Council.
FAMILY RESOURCE CENTER
Mr. Shanley stated they went out to bid for the Family Resource Center and they received bids. He noted the Director and Assistant Director of Public Works reviewed the bids and had some questions and additional information was asked of the bidders. He stated they will probably have a meeting with each of the three lowest bidders next week to be sure everything is clarified and they will then select a bidder or determine it needs to be re-bid.
Councilman Egan questioned whether these bids came in for the single and two-story building, and Mr. Shanley responded yes.
Mr. Shanley stated staff would come back to the Council later this month with more information.
MOTION #6264 by Councilman Jones, seconded by Councilman Tait to go into Executive Session.
Upon a SHOW-OF-HANDS vote being taken, the Chair declared MOTION #6264 adopted 9-0-0, and the meeting stood recessed at 7:10 p.m.
EXECUTIVE SESSION
The Executive Session of the Enfield Town Council was called to order by Chairman Vayda at 7:12 p.m.
ROLL-CALL - Present were Councilmen Egan, Fiore, Hall, Jones, Kaupin, Mangini, Tait, Tallarita, and Vayda. Also present were Town Manager, Scott A. Shanley; Assistant Town Manager, Daniel Vindigni; Town Clerk, Suzanne F. Olechnicki.
Personnel Matters, Pending Litigation, and Real Estate Negotiations were discussed with no action or votes being taken.
Chairman Vayda adjourned the Executive Session at 7:16 p.m. He reconvened the Special Meeting at 7:17 p.m. and stated that during Executive Session they discussed Personnel Matters, Pending Litigation, and Real Estate Negotiations with no action or votes being taken.
ADJOURNMENT
MOTION #6265 by Councilman Kaupin, seconded by Councilman Hall to adjourn.
Upon a SHOW-OF-HANDS vote being taken, the Chair declared MOTION #6265 adopted 9-0-0, and the meeting stood adjourned at 7:18 p.m.
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