HomeMy WebLinkAbout2016 05-09 City Council Workshop PacketPPLLEEAASSEE NNOOTTEE SSTTAARRTT TTIIMMEE
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AGENDA
MAPLEWOOD CITY COUNCIL
MANAGER WORKSHOP
5:00 P.M. Monday, May 9, 2016
City Hall, Council Chambers
A. CALL TO ORDER
B. ROLL CALL
C. APPROVAL OF AGENDA
D. UNFINISHED BUSINESS
None
E. NEW BUSINESS
1. Presentation and Discussion of Fire EMS Workgroup Final Report
2. Presentation of Planned Operational Strategy for the Purpose of Implementing the
Workgroup’s Identified Priorities
F. ADJOURNMENT
THIS PAGE IS INTENTIONALLY LEFT BLANK
MEMORANDUM
TO:Melinda Coleman, City Manager
FROM:Paul P. Schnell, Chief of Police
DATE:May 4, 2016
SUBJECT:Presentation and Discussion of Fire EMS Workgroup Final Report
Introduction
The Fire/EMS workgroup authorized by Council action in early February has completed its study
of the City’s current Fire/EMS delivery model. The Workgroup will review its work and present
its findings and recommenations to the City Council.
Background
The Fire/EMS workgroup, approved by the City Council in February, held ten 4-hour long
meetings and one 2-hour long meeting, and has finalized its initial mission. The workgroup will
review its study and present its findings and recommendation.
As a collective, the workgroup invested more than 450 hours in the study, which results in its
report and recoomendation. The following people served on the workgroup:
•Sue Allhiser, Resident/Business Owner
•Richard Baldwin, Resident
•John Donofrio, Resident
•William Kuntson, Resident
•Jeri Mahre, Resident
•Rich Dawnson, Firefighter/Paramedic (FT)
•Mike Funk, Assistant City Manager
•Mike Lochen, Battallion Chief (PT)
•Steve Lukin, Fire Chief/Emergency Management Director
•Mike Mondor, Assist Fire Chief (EMS)
•Dr. Pete Tanghe, former Medical Director
•Paul Schnell, Police Chief/Public Safety Director
Recommendation
It is requested that the City Council review the report and provide feedback and general support
for the strategic framework suggested by the Workgroup.
Attachments
1. Final report (pages 1-7)
2. Workgroup meeting notes (pages 8 - 53)
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Maplewood Fire – Emergency Medical Services (EMS) Workgroup
Final Report & Executive Summary:
A Maplewood City Council approved workgroup was established to study the delivery of fire
and emergency medical response services in the City. The workgroup was established to
identify opportunities for innovation and ensure long-term sustainability. It is important to note
that the group’s objective was not an effort to fix a deficit, but to ensure continued excellence in
Fire/EMS service delivery.
The workgroup, consisted of five Maplewood residents, Maplewood Fire Department command
and fire fighter/paramedic staff, a representative of the City Manager’s office, and the City’s
Director of Public Safety. The workgroup convened ten four-hour long facilitated meetings. As
a collective, the workgroup invested more than 450 hours to studying the current state of the
City’s Fire/EMS service delivery and exploring the potential for future options.
The workgroups collective study and work was grounded in certain core principles. These
principles demanded that the review and consideration of current and future Fire/EMS service
delivery be studied through the prism of:
1. The desire to ensure EXCELLENCE IN SERVICE DELIVERY, and
2. The need to provide RESPONSIBLE STEWARDSHIP OF PUBLIC RESOUCES,
and,
3. That the standard of FAIRNESS be applied to those delivering Fire/EMS service and
those receiving the Fire/EMS services.
In addition, participants were asked to think beyond the boundaries of the existing Fire/EMS
service delivery paradigm. The workgroup’s goal instead was to conceive a Fire/EMS service
model for which no model currently exists. The only priority was identifying a system offering
excellent service, economic viability and sustainability, which is fundamentally fair to those who
provide and receive the services.
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The Workgroup proved to be an incredible collective of people with varied interests and focus,
yet as a group we were able to identify a strategic framework for the future of Fire/EMS service
delivery in the city of Maplewood, which includes:
1. Community Risk Reduction/CommunityWellness: Making Maplewood a community of
choice.
2. Enhance Fire Response Capacity WhileAssuring Firefighter Safety
3. Ensure Response for HighAcuity EMS Events
4. Proactive Fire Prevention/InspectionActivities
5. Address LowAcuity EMS Events and Response
It is notable that the current Fire/EMS delivery model is nearly inverse to the framework being
presented.
Discussion:
As an industry, the fire service in Maplewood and across the nation, has been extremely
successful with its prevention efforts. Over the past 100 years, the fires resulting in substantial
property destruction and loss of life have dropped significantly. In addition, the fire service has
done much to reduce risk, minimize the incidence and severity of fire losses, and prevent fires
from spreading. These dramatic outcomes were the dividend of effective building codes and
proactive efforts of educating school children on fire risks.
The Maplewood Fire Department, as it is today, is the result of considerable effort by highly
committed people. The decision in 2002 to start a full-time professional fire department was
challenging, but also reflected the reality of the time and the reality that the City could no longer
rely upon the services of volunteer or paid per call fire department. In late 2010, Maplewood
Fire presented a 2011-2016 strategic plan to the City Council. The plan was approved and
resulted in the difficult, albeit challenging, decision to close two fire stations, the former
Parkside Fire Department or McMenemy Station, and the former East County Line Fire
Department or Londin Lane Station. Despite the closure decisions being made on the basis of a
sound review of data and best practices, the actions demanded significant courage and
leadership.
Today, Maplewood Fire/EMS effectively responds to a wide range of community needs. The
Workgroup’s collective assessment of the department is as follows:
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•Maplewood Fire/EMS benefits from highly skilled personnel
•Maplewood Fire/EMS is an all hazards capable agency highly committed to community
service
•Maplewood Fire/EMS personnel are highly trained and have benefitted from excellent
medical direction
•Maplewood Fire/EMS has a history of employing state of the art technology to benefit
fire suppression and emergency medical services
•Maplewood Fire/EMS has response times at
•Maplewood Fire/EMS has a history of
•Maplewood Fire/EMS has a history of being on the leading edge of best practices in
emergency medical treatment
•Maplewood Fire/EMS has a documented history of being able
evidenced by the creation of the East Metro Fire Training Center and the recent
unit dispatching” agreement.
The Workgroup also reviewed the department provided data that clearly exposed the challenges
currently being faced by the department.
Increased demand for emergency medical services
responded to slightly more than 4,300 Rescue/EMS call
than 1,000 calls since 2008. Increase modeling suggests that EMS demand will
additional 1,500 calls over the next five years.
3
Maplewood Fire/EMS benefits from highly skilled personnel
Maplewood Fire/EMS is an all hazards capable agency highly committed to community
Maplewood Fire/EMS personnel are highly trained and have benefitted from excellent
Maplewood Fire/EMS has a history of employing state of the art technology to benefit
fire suppression and emergency medical services
Maplewood Fire/EMS has response times at, or below,national performance standards
Maplewood Fire/EMS has a history of being able to adapt to changing community needs
Maplewood Fire/EMS has a history of being on the leading edge of best practices in
emergency medical treatment
Maplewood Fire/EMS has a documented history of being able to collaborate, as
ation of the East Metro Fire Training Center and the recent
unit dispatching” agreement.
The Workgroup also reviewed the department provided data that clearly exposed the challenges
currently being faced by the department.The challenges are as follows:
Increased demand for emergency medical services – In 2015,Maplewood Fire/EMS
responded to slightly more than 4,300 Rescue/EMS calls, which represents an increase of more
than 1,000 calls since 2008. Increase modeling suggests that EMS demand will
additional 1,500 calls over the next five years.
Maplewood Fire/EMS is an all hazards capable agency highly committed to community
Maplewood Fire/EMS personnel are highly trained and have benefitted from excellent
Maplewood Fire/EMS has a history of employing state of the art technology to benefit
national performance standards
being able to adapt to changing community needs
Maplewood Fire/EMS has a history of being on the leading edge of best practices in
collaborate, as
ation of the East Metro Fire Training Center and the recent “closest
The Workgroup also reviewed the department provided data that clearly exposed the challenges
Maplewood Fire/EMS
, which represents an increase of more
increase by an
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EMS demand largely results from low acuity calls
increases in high acuity or emergency
low acuity (non-emergency) calls have sparked the most significant increase in demand.
Maplewood has a challenging (insurance) payer mix
service are provided to persons covered by Medicare or Medicaid, which has capped
reimbursement rates –often below City cost to provide the services. Since we provide with
EMS services outside a vertically integrated
the ability to monetize other additional services to spread risk.
Increased EMS demand results in decreased readiness for fire
provide responsive service and capture all avail
personnel allocated to EMS call response. In these cases, the department must call
personnel to staff stations.When this occurs the City’s readiness and actual ability to safely and
4
EMS demand largely results from low acuity calls –While the department has seen slight
or emergency calls for services, likely commensurate with population,
emergency) calls have sparked the most significant increase in demand.
has a challenging (insurance) payer mix –The vast majority of EMS calls for
service are provided to persons covered by Medicare or Medicaid, which has capped
often below City cost to provide the services. Since we provide with
EMS services outside a vertically integrated health system, Maplewood Fire/EMS does not have
the ability to monetize other additional services to spread risk.
Increased EMS demand results in decreased readiness for fire incidents –In an effort to
provide responsive service and capture all available EMS revenue, the department has all
personnel allocated to EMS call response. In these cases, the department must call
When this occurs the City’s readiness and actual ability to safely and
While the department has seen slight
calls for services, likely commensurate with population,
emergency) calls have sparked the most significant increase in demand.
The vast majority of EMS calls for
service are provided to persons covered by Medicare or Medicaid, which has capped
often below City cost to provide the services. Since we provide with
health system, Maplewood Fire/EMS does not have
In an effort to
able EMS revenue, the department has all
personnel allocated to EMS call response. In these cases, the department must call-back off duty
When this occurs the City’s readiness and actual ability to safely and
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effectively respond to fire incidents is limited, which results in over
aid resources.
Maplewood’s ambulance rates among the highest in the Twin Cities
natural cost shifting process, Maplewood’s ambulance rates have inc
the highest in the area. During a time when people are being asked to be thoughtful consumers
of medical services and it is increasingly common for people to be enrolled in high deductible
insurance plans, these costs can be b
marketplace.
Conclusion:
Based on the Workgroup’s review of the strengths and challenges, the established strategic
direction was a natural conclusion.
public and private EMS providers further illuminated both the wealth of available community
resources and an array of partnership possibilities.
Fire Department, Regions/HealthPartners, Health East, and Allina,
explore the current services provided by these entities and the intersection for
partnership. The Workgroup concluded that all the organizations offered meanin
to share resources and create partnerships.
5
nd to fire incidents is limited, which results in over-reliance on auto and mutual
Maplewood’s ambulance rates among the highest in the Twin Cities –Over time, as part of a
natural cost shifting process, Maplewood’s ambulance rates have increased to the point of being
the highest in the area. During a time when people are being asked to be thoughtful consumers
of medical services and it is increasingly common for people to be enrolled in high deductible
insurance plans, these costs can be burdensome and not wholly reflective of the broader
ased on the Workgroup’s review of the strengths and challenges, the established strategic
direction was a natural conclusion.In addition to strengths and challenges, presentations from
and private EMS providers further illuminated both the wealth of available community
resources and an array of partnership possibilities.Comprehensive presentations by the St. Paul
epartment, Regions/HealthPartners, Health East, and Allina,allowed the Workgrou
explore the current services provided by these entities and the intersection for a possible
concluded that all the organizations offered meanin
to share resources and create partnerships.
reliance on auto and mutual
Over time, as part of a
reased to the point of being
the highest in the area. During a time when people are being asked to be thoughtful consumers
of medical services and it is increasingly common for people to be enrolled in high deductible
urdensome and not wholly reflective of the broader
ased on the Workgroup’s review of the strengths and challenges, the established strategic
In addition to strengths and challenges, presentations from
and private EMS providers further illuminated both the wealth of available community
presentations by the St. Paul
the Workgroup to
possible
concluded that all the organizations offered meaningful opportunity
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In order to determine the viability of the various partnership options, Maplewood Fire/EMS will
need to dedicate resources to develop a work plan to operationalize the strategic direction. To
address the department’s ability to meet the fire response demand, the department will explore
utilizing potential partners to respond to low acuity EMS calls for service, which should free up
resources. These resources will improve fire resource readiness and allow for development and
experimental implementation of City operated Community Paramedicine program. It is through
Maplewood’s Community Paramedics that the community health risk reduction and community
wellness strategy will be accomplished.
Finally, we believe that devoting our highly skilled and committed Fire/EMS personnel to the
priorities of risk reduction and safe and effective response to fire emergencies and high acuity
emergency medical services reflects one of our premise values of providing excellent service.
The potential for partnerships are wide ranging. While there is possibiltiy in all the proposed
partnership opportunities, each will require closer analysis for viability and applicability to
Maplewood’s needs. The partnership proposals included:
•LowAcuity Medical Response Partnership
•Basic Life Support Peak Load Staffing
•Shared Fire/EMS Resources
•Shared Real-Time Deployment
o Border Drop
•Emergency Medical Dispatch Services
•Supply Chain Management
•Billing
•Population Health Improvement
o Community Paramedicine
o Mobile Integrated Healthcare
o Injury Prevention/Community Outreach
•Medical Direction
•EMS Education
•Technology Integration/Data Management
•Research and access to grant funding
•Employee Wellness Partnership
Developing some partnership for low acuity EMS calls, is seen as a sustainable means of
meeting current and future EMS needs, and also reflects the second stated value of
responsibly stewarding public resources. Finally, the thoughtful and measured
implementation of this strategic framework recognizes the core value of fairness to our Fire
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Fighter/EMS personnel who provide these
of those who live, work, and visit the City of Maplewood.
Appendix A: Workgroup meeting
Appendix B: Statement of firmly held beliefs by resident Workgroup members
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Fighter/EMS personnel who provide these critical community safety services and the needs
of those who live, work, and visit the City of Maplewood.
: Workgroup meeting session notes
: Statement of firmly held beliefs by resident Workgroup members
critical community safety services and the needs
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Appendix A
Meeting Notes
EMS/Fire Strategy Working Group
Meeting 1: February 22, 2016
Police Chief Paul Schnell convened the meeting by thanking all participants and establishing the
overall goal for this working session process: to identify opportunities to innovate in the delivery
of EMS and Fire Suppression/Rescue services. He stressed that the current department was
providing excellent service, and also noted that this was a time to look for ways to improve
service delivery, contain costs to the public and/or to those receiving services, or both. He also
noted that we would be engaging other EMS providers in future sessions to explore how they
might partner with the City to achieve these goals.
Facilitator Chad Weinstein led the group in a discussion about becoming an effective team for
the purpose of making recommendations to the City. He also proposed three values against
which our recommendations are to be considered, framed, and assessed:
•Excellent Public Service
•Sound Stewardship of Resources
•Fairness
The group then had open, preliminary discussion about the mechanics of emergency response,
focused largely on EMS. Members expressed their support for innovating broadly without undue
focus on the status quo, and the power of focusing on goals in our innovative thinking. Members
also shared their strong concern that emergency medical response times be maintained or
improved – not out of criticism for the current state, but to assure that changes are not made that
degrade EMS response times or capabilities.
Fire Chief Steve Lukin and Assistant Chief Mike Mondor presented the first part of an overview
of the Maplewood Fire Department, including some framing comments:
•Service demands, current and future
•Cost of service demands
•Risk factor: shrinking finances
•Goal: maximize service while controlling cost
The chiefs provided an overview of current Fire/EMS capabilities:
•Stations
•Staffing
•History of Paramedics/EMS
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•Initial EMS
We discussed the core concept of a Primary Service Area (PSA), which mandates the entity that
has primary responsibility for EMS response by geographic area. Maplewood has the PSA for
the City of Maplewood. A map of regional PSAs was distributed. Maplewood EMS has
benefitted from an internal Quality Improvement Committee (QIC) as well.
The chiefs also cited a new, enabling technology, improved Computer aided Dispatch, and muti-
jurisdicitonal agreements that support GPS/AVL Capability (closest unit dispatching). In other
words, the nearest unit will be dispatched to a fire, rescue, or EMS call regardless of that unit’s
agency. This will especially benefit Maplewood residents living near city borders.
Other notes:
Standards: Maplewood has only Advance Life Support Ambulances (ALS)
City can establish PSA standards
BLS (Basic Life Support) ambulances are still responding to emergencies in some cities.
Fire standards………..OSHA has requirements that must be followed (e.g., “two in-two out”
requiring at least two firefighters plus a pump operator outside of the emergency zone to support
two firefighters going in (except to save a saveable life).
Upcoming meetings:
March 4th we will tour fire stations and discuss response times and how they are measured. We
will also discuss departmental budgets.
The next two meetings more data with discussions and come up with a vision.
The following four meetings we will have visits from outside parties with discussions afterwards.
Finally, we also established a “Parking Lot” for topics that merit future consideration. One item
was added:
•Fire staff working out while on duty.
Meeting Notes
EMS/Strategy Working Group
Meeting 2: March 4, 2016
Meeting 3: March 7, 2016
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Facililtator Chad Weinstein briefly discussed our previous meeting and reminded group the
purpose was to gain knowledge of what is needed for our mission. He also asked the group if
there were any concerns.
One question asked was if the members of the Fire Department felt comfortable speaking freely
having management in the room during this process. All members of the Fire Department
assured the group they were comfortable and many of these subject matters had been discussed
in the past with management. They felt this group would hold healthly conversations. Chief
Schnell added that this subject was well thought out before the group was formed. Chad
Weinstein told the group that because this is forward looking and not a study of current programs
we are good.
Chief Schnell went over the next few meetings agendas:
•Today (3/4) and Monday (3/7) would include data review and tours of the fire stations
•March 14 will be discussions of everything we have learned and models and options
going forward
•The next four meetings will have vendors in to go over their programs with group
discussion to follow
Assistant Chief Mondor then went over his presentation on standards and how the fire
department gets there. Overview is as follows:
•Current state of the department and services provided
•Response times
•Staffing vs Standard
•Fire Response Realities/Risk
•Station Placement/future needs
•Shift length considerations Cost/benefits
Insurance rates for residents were discussed with the closing and moving of some fire
stations. Maplewood’s rating has not been affected.
Auto aid and Mutual aid was explained:
•Auto aid is dispatched at time of call by dispatch
•Mutual aid is decided by the situation and need for additional help
Asst. Chief Mondor explained why the City went from on call paid PT fire fighters to PT shifts
where the fire fighter signs up and is used where and when needed. Full time pay vs part time
pay for fire fighters was also discussed. The question was raised if full time fire fighters had
concerns working with part time fire fighters and if the pay affected part timers feelings towards
full timers. All fire fighters assured the group this is not a problem.
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Maplewood is billed $47,000 a month for dispatch service through the Ramsey County Dispatch
Center.
Asst. Chief Mondor went over past and future trends for fire calls and EMS. He explained
transported patients and those not transported and how this was affecting the budget. He showed
graphs of times Maplewood needed mutual aid and how many time Maplewood gave mutual aid.
Current staffing levels were shown for all fire stations.
Asst. Chief Mondor explained how often all resourse were on calls leaving no one to staff the
fire stations. With 900 calls year to date, there were 42 times no one was in a station. This does
not mean there was a call during these times. Chief Schnell asked how many times call back
manpower were called in to fill these times and what the OT cost was and if there where times
auto or mutual aid had to handle a call.
Group next toured all 3 fire stations.
When the group returned to the meeting room Chad Weinstein asked that at our next meeting we
hold all questions until after the presentation was over.
Chad Weinstein was also going to get information on Quiet Sirens/Empty Boots
Meeting 3: March 7, 2016
Rich Dawson absent
Maplewood Mayor Nora Slawik sat in the first hour of the meeting. Mayor Slawik thanked the
panel for their time.
Asst. Chief Mike Mondor continued his presentation. Items that were covered:
•Non Transport by severity (over 1000 out of 4500 were non transport 40%)
•Minimum staffing in each station (63 % of the time only 9 FF on staff)
•50% failure rate on new hires for various reasons. Many Part time FF are finding full
time jobs in other cities. Maplewood has a very good training program. Chief Lukin
has spoken with Century College in hopes of getting more qualified candidates.
Response times : The 911 call is not included in this time. Tones to Arrival is the time counted.
Response Inclusion:
•Fire
•EMS
•Emergency Response
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90% of Maplewood’s response time is 10 minutes or less the past 4 years.
NFPA call out time is defined as wheels moving.
Asst. Chief Mondor showed a video on how a fire spreads in your home years ago and currently.
With the synthetic materials, items burn faster with gases. Also, structures are not made like in
the past and can collapse much quicker.
There are many duties that Fire Fighters do each shift that you cannot put a time frame on like
you can when they are on a call.
More details will be coming on Community Paramedicine. Maplewood has two people in class.
UHU (Unit Hour Utilization) was discussed with unit hours per week rising.
Open discussion was held on Mutual Aid and if it is a risk to our readiness. Considerations
should be given to mutual aid in the future. Auto aid was also discussed. Chief Lukin explained
when it is used and how it is dispatched. He also told the group that there is an agreement in
place on how many people respond to a mutual or auto aid.
Report writing was discussed to see if there was an easier way to handle this part of the job.
Asst. Chief Mondor explained the different options for shift lengths and a discussion was held.
Currently Maplewood has 24 hours shifts and is hiring two more FF that will work 10 hours
shifts during high peak hours Monday through Friday. Maplewood spends between $30,000 to
$50,000 on FLSA hours (Fair Labor Standards Act) on 24 hours shifts. There would be a
savings in payroll if the 24 hour shifts went away.
Chief Schnell went over Police staffing and how things have changed to fit the City needs.
Mike Funk discussed how the Fire Department has been forward thinking through this whole
process and looking 5 years in the future.
One thing the group needs to figure out through this process is a base level of readiness.
Chief Schnell asked the group to think of any ideas that could work in coming up with an EMS
program. The sky is the limit. Also we need to ask any partner if they have community
programs that would possibly lower calls.
Next, Chief Lukin went over budget information. He explained the fire budget that the taxpayer
is paying vs the EMS, which is revenue based. Chief Lukin went over the number and type of
calls and what it costs vs what insurance covers. He covered the three different levels of care
and the costs. He showed a graph of what other cities charge and what Maplewood charges and
explained why. Maplewood is the only city that does not get money from the general fund to run
their EMS program. Chief Lukin showed us the cost savings of closing the fire stations and the
cost expected on remodels of current fire stations.
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The final discussion was on the growing number of elderly housing and if the City was
marketing to them. Chief Lukin explained that because of lot size many multi-housing units
have been built and the elderly like the City and what it has to offer.
A question was asked if the City can partner with someone to fill peak hours.
Chief LukIn will continue with budget information and services at our next meeting.
PARKING LOT
Work out times during shifts for Fire Fighters and/or equipment in the stations for them.
Legislation: what would be needed to change who can be sent to call that is a non- emergency.
City of Maplewood’s wellness program.
Do we know response time…how much time is occupied. Also a readiness score.
Can the City hire a grant writer?
Meeting Notes
EMS/Strategy Working Group
Meeting 4: March 14, 2016
Chief Schnell opened the meeting with an explanation of a meeting that was held last Friday with
Chief Lukin, Asst. Chief Mondor and all vendor parties except SPFD. Discussed in this meeting
were items the City would like to see covered in their presentations. This meeting was held as a
group so all vendors got the same information. Some of the areas that were discussed were that
this would be a partnership (Maplewood is not giving up its PSA), and that the scope should
include community health and Paramedicine. Vendors were asked to be creative. (St. Paul Fire
will have a different conversation since it would be a government partnership, and because they
really do mirror our service delivery approach and capabilities).
The vendors thought that Maplewood forming this group was unique and significant; none were
aware of other such groups being formed in the past. Participating partner candidates are:
•Allina
•Health East
•Health Partners/Regions
•St. Paul Fire Department
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Chief Lukin went over his presentation covering the General Fund Overview.
•Revenue sources
•General Fund expenditures (9 to 10% go to the fire department)
All budgetary funds expenditure summary
•50 cents of each dollar goes to public safety
•Debt service refers to loan (e.g. bond) payments
Chief Lukin then went over each step in the budget process and explained how the process starts
and finishes. A 1% levy is approximately $90,000. City Council will set a levy at the end of this
process. If money from the general fund is not used within a calendar year, the money is
returned to the general fund. Money from the EMS enterprise fund remains in that fund year to
year if not used. Grant money is not included in the budget request and typically has time limits.
Bonds are used to fund larger projects or purchases for which the City does not have adequate
cash.
Taxes in perspective
Maplewood residents pay the highest tax rates in Ramsey County outside of St. Paul but the
actual City of Maplewood does not have the highest municipal taxes. Percent property tax
allocation:
•39.4 County
•31 City
•24 School
•5.6 Other
Callback data for 2016
Callbacks occur when career or POC personnel are called to the station. (There is no data for
how many calls came in when call back personnel were called in). Money spent on call backs:
about $4500 a quarter. FT and PT fire fighters get a minimum of 2 hours of pay for coming in.
•44 calls
•Avg turnout 4.5 personnel
•Avg response 8.74 minutes
Demands for service on a map were shown next. Chief Lukin went over areas of the City that
had the most calls and explained what type of residences or business were there.
The remodeling of station 3 on Hazelwood Street was discussed. It was noted that while
sleeping quarters are limited, by far the greatest demand for service occurs during daytime hours.
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Community Paramedicine would add direct cost to deliver service but has the potential to lower
overall costs to the City and to improve health outcomes in the community.
•Integrated health system or model
•Focused on prevention and the reduction of emergency (911) medical calls by preventing
medical complication
•Preventative efforts should be financially incented
•Broader vision: Paramedicine would be used to reduce re-admissions or lower total cost
and better utilize emergency personnel
•Design individual programs for certain people
•Alternate dispatch, triage, or response models (examples):
o Dispatchers refer to urgent care or emergency room.
o Responders arrive without an ambulance to assess and/or treat on site.
o Responders set longer-timeframe, lower-cost response expectations where
appropriate.
These are all broad, categorical options to consider.
Opportunity Brainstorm
Chief Schnell introduced the idea of Paradigm, drawn from the work of philosopher Thomas
Kuhn. A paradigm represents the overall framework and concepts that we use to understand a
situation – a filter through which we see and understand something. We make many
assumptions based on the paradigm we are using. Sometimes that paradigm shifts. In the hard
sciences, this changes the way scientists ask questions and design experiments – it literally
changes what they observe and even what they are able to see or measure.
For us, our discussion of Fire and EMS has been through the paradigm of emergency response:
someone calls for help, we go there with the best available resources as quickly as possible. For
our work to be successful, we must go beyond this paradigm to look at services in totally
different ways.
In all instances, we are seeking to maximize the 3-legged stool: excellent public service, sound
stewardship of resources, and fairness. We looked at opportunities through two paradigms:
•Emergency Response
•Community Risk Reduction
Our notes, below, are organized to capture opportunities and ideas according to these paradigms,
along with a third category of opportunities, aptly and creatively called, “Other.”
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Emergency Response
When looking at emergency response, we tend to evaluate success in terms of:
•Fast
•Capable
•Compassionate
•Safe
•Cost-Effective
•Consistent
Opportunities discussed:
•Align staffing with demand: deploy responders in the right places at the right times of
day.
o This includes shift structures.
o Local bases or truly mobile response
•Improved dispatch and communications
•Facilities and equipment (firehouse updates, apparatus)
•Employee wellness (on-duty exercise, sound ergonomics, stress management, etc.)
•Scope/expectations of service
•Reducing what are now the highest fees for ALS response
•Budget allocations: City commitment to public safety versus other priorities. Look at
both enterprise fund and City overhead.
•Continue to be leaders in High Risk/Low Frequency events
•Engage excellent medical direction and responder training/continuing education
•Regionalize for scale – look at fire/EMS districts with governance and taxing authority.
•Look at regulation to “tax” high-frequency institutional users, shifting costs to private
enterprise housing-with-services provider.
•Define service levels based on market expectations. Influence market expectations for
service levels.
Conceptual questions within this paradigm:
•What limits our resources? Public opinion?
•Should we be in the transport business?
•Should Maplewood employees do this work?
•Should public safety services be delivered for profit?
Community Risk Reduction
As Asst. Chief Mondor put it, just as the fire service has used prevention to try to put fire
suppression out of business, community risk reduction should aim to put emergency medical
response out of business.
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Benefits could include making Maplewood a city of choice and an employer of choice
Strategic operational goals: support health and prevent illness and injury. Example: chronic
condition monitoring and proactive care.
Analog: community policing strategies are problem-solving, data-driven management, and
relationship building. These could also be community risk reduction strategies.
Opportunities discussed:
Hire an “interventionist” to study data, identifying opportunities for proactive response based on
response/call patterns. This person could also field calls.
Medical Director/community paramedics
Partnerships within and beyond health care systems.
Can we focus on the right impacts? Do we understand the implications of our decisions?
Drive integration and improve access to health care
Lower frequency of non-transport calls or treat on-site with reimbursement
What are the best Proxy Metrics to assess outcomes, both individual and community-wide?
Other
Additional topics and opportunities arose from our discussion, which either crossed paradigms or
did not fit neatly into either:
Public education for efficient utilization (possible incentives, either for receiving education, for
reducing utilization, or both). Can we teach people to utilize community-based services
effectively?
Community vitality/economic development
City mission and strategic priorities
Demographics. Will Maplewood become a City of eldercare and starter homes?
Marketing opportunities, example Maplewood as the City of the future
Advance state of art, including this process
Employee health benefits
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Social determinates of health service to marginalized populations
Future meetings:
•March 18th continue discussions
•March 24th SPFD
•March 30th Allina
•April 1st Health Partners/Regions Hospital
•April 11th Health East
•April 13th Put everything together for workshop with the City Council sometime in
early May
The possibility of one other meeting if we do not get everything put together on the 13th.
PARKING LOT
Work out times during shifts for Fire Fighters and/or equipment in the stations for them.
Legislation: what would be needed to change who can be sent to call that is a non- emergency?
City of Maplewood’s wellness program.
Do we know response time…how much time is occupied. Also a readiness score. .
Can the City hire a grant writer?
Tax rates: definition of metrics (to be handled offline)
Relationship with assisted living or housing with services…can City regulate?
Meeting Notes
EMS Strategy Working Group
Meeting 5: March 18, 2016
Absent: Bill Knutson
City Manager Melinda Coleman was present and thanked the group for participating in this
important process. Chief Schnell advised the group that on March 28th he and Chief Lukin will
give a short update to the city council. A workshop will be held the first or second week of April
(possibly April 14) and the group is asked to be in attendance. The workshop will run from 5 pm
to 7 pm. There might be a need for another workshop in early May.
Our objectives for this meeting:
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•Frame topics and develop a set of questions for upcoming presentations by potential
partners. The group observed that Saint Paul Fire differed from the others as a public
agency and a fire department, so the question set would also likely differ.
•Continue to expand our discussion across paradigms, with particular attention to
community risk reduction.
Chief Schnell encouraged the group to think broadly by posing a foundational question: should
Maplewood be delivering EMS services? This led the group to briefly consider options like
treatment without transportation (with or without some future mechanism for reimbursement - it
was noted that currently the vast majority of EMS revenue comes from transportation). One
additional possibility: some kind of revenue share among responding agencies. Various ways of
splitting how and how much we would get paid in a partnership. Would Maplewood be in
charge of the operations?
Maplewood is looking for a true partnership, we are not interested in ceding or transferring our
PSA. Group members also stated that Maplewood must maintain oversight and the ability to
hold any partner(s) accountable for quality of service delivery, including response times.
Initial Discussion: Topics to Explore with Partners
We divided this broad discussion into topics related to “ends” and “means.” This led into the
next discussions, generating specific topics and questions for Saint Paul Fire, and for the other
partner candidates.
ENDS
•Faster response, more often
•Lower cost to taxpayers and users
•Improve community health and wellness
•Health system benefits: reduced cost and risks. Maplewood and partner(s) to find ways
to share rewards
•Use information to predict - and EMS resources to prevent - adverse health events.
•Additional value added reimbursable services
MEANS
•Revenue generation
•A partnership could mean more rigs – access to staff and apparatus on demand.
•Take scheduled transport calls.
•Move rigs around to optimize response times
•Shares calls with partners – how to share work and revenue?
•Maintain control --accountability for quality and service. (This revealed a broader
concern by some group members regarding for-profit delivery of EMS services)
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•Metrics to manage/improve under both paradigms. What are best-practice metrics to
measure and improve performance?
•Subscription services e.g. for assisted living or other health care organizations.
•Become a mobile urgency room as a means to both provide services and capture revenue.
•Bill hospitals for the transportation and/or care.
•Bill for automobile accidents to collect from insurance companies through Personal
Injury Protection coverage
•Hire a data analyst to understand opportunities and guide continuous improvements.
•Hire community health workers to promote wellness and work with other providers.
•Become part of an Accountable Care Organization (ACO).
This discussion also led to a brief but significant discussion about quality. What is quality EMS?
How do we measure and improve it?
Discussion about Specific Questions:
The following notes reflect topics and questions identified in discussion. These are also re-
organized into one page handouts for participants at the bottom of this document. The following
notes reflect the discussion process itself.
St. Paul Fire Department:
•What are their goals for a partnership?
•What are their expectations for the implications of a partnership on costs, revenue,
and service delivery?
•Do they do community paramedicine? What specific services and models? How are
they delivered? What are the goals?
•What other services do they offer e.g. inter-facility transport/BLS scheduled
transport?
•What could a partnership or consolidation look like and what are the implications of
rig location and call times?
•Southern leg managed other ways? Could Saint Paul help to improve response to that
part of Maplewood while freeing up Maplewood resources for the rest of the city?
•Is there an area of St. Paul where greater involvement by Maplewood – fire and/or
EMS – would be helpful?
•Balance policies and procedures. How similar or different are St. Paul and
Maplewood policies and/or Standard Operating Guidelines (SOGs)?
•One option: a straight “border drop” where St. Paul and Maplewood respond without
regard for a city boundary. What would that look like?
•What labor challenges might we anticipate?
•What operational efficiencies could be gained through partnership? These might
include training, education, billing and admin, etc.
•What would SPFD do different if they could?
•Elder care dynamics volume and cost
•Partnership parameters: just EMS, just fire or both
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•Sustainability and future business - how does their business model differ from ours?
•Will they share risk and cost along with benefits?
Private Partnerships
•What are their goals -what’s in it for them?
•What are the plans for sustainability, with or without partnership?
•What is their current business model for EMS? What are revenue streams and how are
costs offset or justified?
•Will they share risks and rewards?
•Explain how integated they are as a system.
•Could/should partnership go beyond EMS e.g. to include senior services?
•Can we integrate for seamless service?
•Urgency rooms-clinics? Is there an opportunity there?
•Do they have lobbying power or other government relations resources that would be
helpful?
•Could a nurse call line - with instructions and training – reduce unnecessary EMS calls?
•Could we work together to triage low-acuity calls and stack them for prompt but not
emergency response? This could allow Maplewood EMS to gain some balance and
increase utilization without losing emergency response capacity.
•Is there an opportunity to partner on both high and low acuity calls?
•How does the partner view its civic duty to serve the most vulnerable users?
•Could the partner provide excellent medical direction?
•What other partnerships are they pursuing or participating in?
•What are the partner’s current and planned telemedicine capabilities?
When we meet with all vendors, they will be limited to 3 hours for presentation and for questions
and answers. We will then spend our last hour on discussion.
PARKING LOT
Allowing firefighters to work out on duty, both at the Community Center and on enhanced
equipment at the station. This is seen by some participants as a wellness, stress reduction, and
fairness issue.
Legislation: what would be needed to change who can be sent to on non-emergency calls?
City of Maplewood’s wellness program.
Can the City hire a grant writer?
Tax rates: definition of metrics (to be handled offline)?
Relationship with assisted living or housing with services…can City regulate?
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EMS service areas-partnership with Oakdale/Newport etc.
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Question/Discussion Preparation Sheet: City of Saint Paul
The following notes are provided for the convenience of panel members participating in
discussions with potential partners. They represent notes from previous working sessions that
have been reorganized and rephrased for clarity. This document is not intended to limit
discussion in any way.
General/Framing Questions:
•What goals might Saint Paul have for a partnership with Maplewood? What might your
department – or your city and community – stand to gain?
•What are your preliminary thoughts on the implications of a partnership on our respective
departments’ costs, revenue, and service delivery?
•Sustainability and future business - how does your business model differ from ours? How
about pricing?
•Are you open to sharing risks and costs as well as benefits?
•What partnership parameters would you consider? EMS, fire, or both?
More Specific Background Questions:
•Do you do community paramedicine? What specific services and models? How are the
services delivered? What are the goals? How is it funded?
•Beyond emergency response/EMS, what other services do you offer? e.g. inter-facility
transport/BLS scheduled transport?
•Alignment of policies and procedures. How similar or different are St. Paul and Maplewood
policies and/or Standard Operating Guidelines (SOGs)?
•What labor challenges might we anticipate?
•Imagine that you could design your department and its service delivery from scratch. What
would you have SPFD do differently if you could?
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Specific Opportunities:
•What could a partnership or consolidation look like and what are the implications of
crew/ambulance location and call times?
•Could we manage service to our southern end of the City differently? Could Saint Paul help
to improve response to that part of Maplewood while freeing up Maplewood resources for
the rest of the city?
•Is there an area of St. Paul where greater involvement by Maplewood – fire and/or EMS –
would be helpful?
•Please consider one option for a service change: a straight “border drop” where St. Paul and
Maplewood respond without regard to a city boundary. What would that look like?
•Beyond emergency response, what operational efficiencies could be gained through
partnership? These might include training, education, billing and administration, etc.
Question/Discussion Preparation Sheet: Private Sector Partner Candidates
The following notes are provided for the convenience of panel members participating in
discussions with potential partners. They represent notes from previous working sessions that
have been reorganized and rephrased for clarity. This document is not intended to limit
discussion in any way.
General/Framing Questions:
•We expect that all potential partners will provide an overview of their capabilities. If there
are gaps or questions, those are a good place to start our questions.
•What are your goals - why might you want to partner?
•What are your organization’s plans for economic sustainability? What major economic
risks are you managing right now? How are you managing them?
•We are seeking partner(s) who will share both risks and rewards. Are you open to that kind
of relationship?
•What other partnerships do you have in place or in development?
•Please discuss how your organization sees your – and our - civic duty to most vulnerable
users. How do you operationalize your commitment to serve those who are most
vulnerable?
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•How do you measure quality? How do you strive for continuous improvement?
•Have you operationalized the “triple aim” of health outcomes, customer service, and cost
containment in your EMS operations? How have you done so?
•What other key metrics do you use for your EMS business?
•How does your business model differ from ours?
Capabilities:
•How integrated are you as a system? Acute and sub-acute care, clinics and outpatient
services, urgency rooms or urgent care?
•Could we integrate with you for seamless serviced delivery? What would key enablers or
challenges be?
•Current and planned telemedicine services and capabilities?
Specific Services:
•Should partnership go beyond EMS e.g., to include sub-acute health care or services for the
elderly?
•Are there opportunities to use or align with capabilities such as:
o Medical direction
o Continuing education and training
o Urgency rooms-clinics
o Nurse call line
•Could we work together to triage low-acuity calls and respond promptly but not on an
emergency basis? Could this help to improve resource utilization and maintain local
capacity for high acuity calls?
•Do you have government relations or lobbying resources that would help us affect policy
changes required to implement our partnership, if necessary?
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Meeting Notes
EMS/Strategy Workding Group
Meeting 6: March 24, 2016
Presenter:
Fire Chief Tim Butler
St. Paul Fire Department
tim.butler@ci.stpaul.mn.us
651 775 6752
Chief Butler was introduced along with EMS Assistant Chief Matt Simpson. Chief Butler framed
his remarks both as the SPFD Fire Chief, and as a resident of Maplewood.
Chief Butler began by highlighting some similarities between Maplewood and Saint Paul Fire
Departments. 80% of calls for SPFD are EMS calls. Chief Butler gave a quick history of the
SPFD. They are the oldest ALS service provider and the largest EMS based. SPFD partners
with St. Paul Regions Hospital. SPFD has 450 firefighters/EMS responders, 150 of which are
Paramedics. 114 personnel on staff per day. SPFD use ABC shifts.
EMS System Options:
•Police based
•Fire (crossed trained or separate
•Private EMS Service
•Public-Private Partnerships (e.g. Elk River)
•Third Agency
SPFD has one Community Paramedic, one in training and will be getting one more. They work
Monday through Friday for an eight hour shift, and do not do emergency response. This is a
pilot program.
BLS ambulances can handle scheduled transfers , meet with patients and visit clinics. They
operate Monday through Saturday 8 am to midnight. SPFD’s BLS transport units, Ambulances
51 and 52, are staffed by graduates of the SPFD’s EMS Academy, which serves inner-city youth
and adults who meet need-based and performance-based criteria. BLS transports charge
insurance companies and have some negotiations with hospitals. Money collected from BLS
services pays for the service and the EMS Academy. EMS Academy members can go to any
agency. Some remain on staff in St. Paul and can become trained to become firefighters and/or
paramedics (at their own expense) while working as St. Paul EMTs.
SPFD had over 42,000 runs last year. In terms of transports, they collect 37% of what they bill,
which is also comparable to Maplewood.
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SPFD firefighter wellness includes fitness equipment in each fire station and some medical
screening. Chief Butler expressed that this was an area for improvement in SPFD, constrained
by financial resources.
Chief Butler acknowledged his bias for fire-based EMS, and stated the following advantages and
drawbacks:
PROS:
•Efficient and effective service
•Brings all hazards response
•Integrated command and communications
•Citizen relationship and support
•Accountable to citizen leaders
•Some financial return
CONS:
•Difference to balance response with rising EMS workload
•75-80% of business is EMS business
Chief Butler explained their Dual staff model. The Super Medic runs with 6 people. Four on a
fire rig and 2 in an ambulance. Once they arrive on scene they figure out if all are needed. It is
possible the fire rig will go back to the station or proceed to another call. Generally, two-person
crews are sent to alpha medicals while four-person crews respond to most medical calls.
SPFD has no real partnerships but is looking to work with Minneapolis on the west side of their
city and has mutual and auto aid just like Maplewood does.
EMS Response times
•National standards BLS 5 mins (1T/4 travel) to turn out
•ALS arrival within 8 minutes
•90% of the time
•Brain starts dying in 6 minutes without oxygen
•10% reduction in cardiac survival for every minute of response time
Medical Direction/Regions
•Value of on scene Physician response
•East Metro Collaboration and protocols
•Training center and training staff
•Advance procedures and mentoring
•Research/field trials
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Doctors from Regions respond to many SPFD EMS calls; they are issued squad units for this
purpose. The fire department can request them or they may just come. They respond to 2/3 of
their major calls.
Chief Butler shared his views regarding potential pitfalls in contracts with private EMS Services,
primarily (1) that organizations covering larger areas can shift resources away from a given
geographic area, increasing response times to that area, (2) that rates may increase, and (3) that
data may be harder to obtain. In all, he cited the following pitfalls:
•PSA ownership (important to maintain)
•No money in EMS services
•Private data ~ difficult to measure
•Rate increases
•Slow response times
•Lack of accountability and citizen connection
Chief Butler also noted that, with a private ambulance you would still have to send a fire rig.
He also proposed the following considerations for this decision:
•Clearly define performance standard
•Know all the costs up front
•Measure outcome vs effect
•Push for transportation data
•Robust Public debate and education
Fire Services System Considerations
Response time and NFPA
•First five minutes 1T/ 4 travel
•Full assignment in 9 minutes
•90% of time
•Full assignment 2000 foot home with 16 Fire fighters
Fire crew size
•NIST studies crew size vs job completion
•2 vs 4 person crew
•Safety , workers comp, liabilities
•1x4
Steps for small crew responses
•Comprehensive fire prevention efforts
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•Public education
•Mitigation (sprinklers/stove top extinguishers)
•Rapid discovery 911
•Throwable fire extinguishers
•On duty crews
•Front load resources using mutual and auto aid. Get resources moving immediately,
cancel as necessary.
Partnerships in Ramsey County
•Joint grant applications
•Unified protocals
•Unified training
•Standard equipment (CAD, SCBAs, radio)
•Joint projects like Lifesaver
•Shared facilities
•Closest unit dispatch
Possibilities with SPFD
•Shared training facilities and staff
•Shared auto aid station and personnel
•Fire/EMS district formation
•Contract for fire and EMS
•Fire explorers on CERT for response
Possibilities: Special Tax District
•Special taxing district MN 144.E
•Established by resolution of 2 or more cities
•$555,000 limit.
•For EMS equipment, crews,training
•Communication and 1st responders unit
•On duty crew
Possibilities with BLS Unit
•Use BLS to transport Alpha and Bravo calls
•ALS referrals to BLS
•BLS response to non emergency care facilities
•ALS or BLS crew augmentation
•Joint EMS academy and fire medic cadets
Community Paramedic Cooperative
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•Schedule ALS level homecare
•Reduction in unnecessary EMS transport
•Shared pool of community paramedics and fire fighters
•Fire prevention/accident reduction programs
•Rapid fire/EMS response availabilty
•Subject to past regional grant requests
•Open to partnerships and collaboration
According to Chief Butler, Allina has a strength in its dispatching and Health East has their own
garage and radio repair.
SPFD annual budget is $52 million. About one fourth of that budget is offset by fees for EMS
services. All service fees go to the City’s general fund, but credit is assigned to the fire
department for that revenue.
Chief Butler explained that the primary reason for closures of fire stations in St. Paul have been
because of motorized vechicles. Their response times are so much better they did not need so
many fire stations. They have added only 4 fire fighters to the overall numbers since 1965.
When asked how this is possible with the increase of calls Chief Butler explained many upper
management/non fire fighers positions have been eliminated and filled with fire fighters.
Four priorities for SPFD
•Safety of fire fighters
•Lives
•Property
•Environmental impact
IFF can provide GIS data and research to recommend station locations based on demographics
and call data.
Chief Butler shared his view that the best partnership between SPFD and Maplewood would be
both for fire service and EMS. He talked about the favorable relationship that the two cities
already share. He thinks the EMS academy graduates could be used by Maplewood and they
could gain some very good experiences.
Chief Butler was asked if he would object to private companies for EMS and he said yes. He
was in favor of a partnership with Maplewood. There have been many discussions throughout
the years of partnering with other cities but it never has happened. There are many aspects of a
partnership inclulding unions. He is in favor of starting small to see how things go and building
from there. East Metro agencies have the same training, same radio systems and medical control
Chief Butler said dispatch could tell us if Maplewood is used more in St. Paul vs how many
times they help us. This was in response to the risk of people thinking we end up paying for
more than we use. Chief Butler said education of the citizens would be key in any kind of
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partnership. This may include hands-only CPR and AED use, fire prevention, and the broader
use of stovetop and throwable extinguishers.
Discussion:
Chief Lukin was asked if he has a preference Fire/EMS vs EMS. He said he does support the
Fire/EMS. He said they have talked to SPFD before about joint stations and a need for a four
crew engine. He said we have to keep in mind what kind of service we are looking for. What
level of service do most citizens expect? Participants also noted that not all calls require – or
benefit from – 4-person crews.
We also discussed a key distinction between “compromise” and “combination:” are we giving
things up, or are we working together to create something greater than the status quo? This
question is key as we consider both public and private partnerships.
We also recapped one of our key questions: how might SPFD and the City of Saint Paul benefit
from a partnership? This question is a key indicator of the viability and sustainability of a
partnership. Chief Butler’s comments included the following potential benefits:
•St. Paul gains help at an eastside station.
•Work for the BLS ambulance (both experience and potential revenue)
•EMS academy
•Training facility
•Inter operability
•shared apparatus
We also discussed the views of citizen panelists regarding the need for Maplewood to
signifciantly increase funding for Fire/EMS. Some panelists strongly believe that any outcome
will include increased net investment. Others do not share that view.
Finally, we clarified different means of formal consolidation:
•EMS district (authorized by Section 550), which Chief Butler noted, would levy taxes
dedicated for EMS services, but would not necessarily hold the PSA or deliver EMS
services.
•A Fire District would be a new taxing authority that would also provide fire (and/or
EMS) services by means of a District Fire Department.
•A JPA (joint powers agreement) is a means for cities to share authority to offer a joint
agency, typically governed by a board but contingent on member cities’ support.
PARKING LOT
Allowing firefighters to work out on duty, both at the Community Center and on enhanced
equipment at the station. This is seen by some participants as a wellness, stress reduction, and
fairness issue.
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Legislation: what would be needed to change who can be sent to on non-emergency calls?
City of Maplewood’s wellness program.
Can the city hire a grant writer?
Tax rates: definition of metrics (to be handled offline)?
Relationship with assistant living or housing with services…can city regulate?
EMS service areas-partnership with Oakdale/Newport etc.
Get a map of fire stations bordering Maplewood
Case study of raising rates once service is contracted
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Meeting Notes
EMS/Strategy Working Group
Meeting 7: March 30, 2016
Meeting 8: April 1, 2016
Allina Health Emergency Medical Services
Present from Allina:
William Snoke MPA Director William.snoke@allina.com
Brian LaCroix President EMS
Kevin Miller Deputy Chief EMS
Chuck Kaufman Director of Communications
Bill Snoke introduced everyone to the group. Brian LaCroix talked about Allina and that patient
care is the most important goal. Allina has approximately 330 calls per day for their ambulances.
Allina is a nonprofit health care system by law. Allina re-invests in their organization and
community. Allina has 13 hospitals in MN and one in WI. There are 2600 employees company
wide. Allina is the largest resource for rehabilitation (through Courage Kenney and other
divisions) in the upper Midwest.
LaCroix next talked about the various Allina service areas. They have ambulances in New Ulm,
Glencoe, and Hutchinson. LaCroix explained how ambulances are staged and how their
partnerships in those areas work. Crews work 12-hour shifts. Ambulances are always moving to
cover activity. Crews post in locations depending on the day, time of day and activity. A
consortium including Allina and ten other companies owns Life Link, an air transport. Allina
handles both BLS and ALS scheduled transports.
LaCroix next explained the ALF service area, which Allina took over as the primary provider.
(ALF Stands for “Apple Valley, Lakeville, and Farmington.”) All of those ambulances are co-
branded with the cities logo and Allina Health. Allina meets quarterly with the cities sharing
financial and other data. Their mission is service to the community. These cities never were a
Fire/EMS model, just EMS. Fire services do respond to calls when needed. These are all
agreements made up at the time the partnerships are formed. Allina has GPS in all ambulances
and can see on the computer screen where all trucks are located at any time. Three ambulances
have been added to ALF because of volume and to meet response times. Terms of response
times are included in agreements.
ALF has two paramedics on each ambulance, though clinical evidence does not show a
difference in outcomes between two paramedics and paramedic/EMT crews.
LaCroix discussed an agreement with Elk River that represents a more innovative partnership.
In Elk River, the Fire Department runs the EMS, but they “rent” the Allina employees. Allina
does the billing. Allina has many business models.
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This year Allina will buy 13 new chassis. Allina keeps the “box” and refurbishes and reuses it.
The chassis last about four years and the box of the ambulance about 12 years. Allina has its
own maintenance facility and program.
Allina will not enter into an agreement when it knows it cannot service the area.
Allina has a 90% retention of employees and measures staff engagement on an ongoing basis.
Allina has several bargaining units within their company. IAEP Local 167 covers the
EMT/Paramedics and dispatch since 1998. In the case of ALF, employees who came to Allina
went to this union. Allina can keep up with wages and health benefits prevalent in the public
sector, but does not match PERA (pension).
Allina has full and part-time employees who work 12 hours shifts and casual employees who are
called in when the staffing department recognizes help is going to be needed. All full and part-
time bid twice a year for their shifts. The casual employee does not bid but does fill in as
described above. They get paid for 4 hours minimum if called in. They will also work special
events and bad weather events. Full and Part time paramedics can also be held for four
additional hours. The final hours of their shift they call dispatch and put themselves in “Bravo”
mode and will not be given a call unless they are the only ones available. This way they are
more likely to go home on time.
Community Paramedicine
Allina has been in this business for three years with a mobile integrated health care model. They
have 11 community certified paramedics. They will go to high-risk re-admissions, behavioral
health patients or for the emergency department. They have not billed these types of visits as of
yet but feel in the long run they are saving money on the hospital side. They will do Allina
patients visits only. Either a social worker or a physician will refer a patient for a visit. These
paramedics travel in an unmarked vehicle for the sake of patient privacy and usually do not
transport a patient but could if needed, usually for a behavioral health issue.
Allina makes strong use of the “Health Care Triple Aim” triangle:
•Quality of care/health outcomes
•Patient experience
•Cost
Dispatch Services
Cities pay Allina for dispatching services. Part of this is shared real-time deployment plus you
can see where all ambulances are.
Allina’s dispatch center is ACE Accredited. 22 dispatch centers are involved. When a citizen
calls 911 and the “Primary PSAP” telecommunicator triages this as an EMS need, the call is
transferred to the correct EMS service, along with the data that the caller has given to the tele-
communicator. This process is seamless, and the caller will not know. The employees in
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dispatch are EMD’s (emergency medical dispatchers). They are most likely an EMT or
paramedic and have worked in the field. One thing Allina does is immediately send the
ambulance as quickly as possible, but as they are talking to the caller, they advise the responding
crew en route. They can also slow down the ambulance if they are not needed Code 3 (lights and
siren). Risk goes down when the ambulance can slow down. Dispatch also knows where the
nearest ambulance is.
When a partnership is formed, Allina brings in many shared resources which include dispatch,
closest ambulance, and software with IT help. Allina puts their laptop in the ambulance with
software. It would be possible to put a laptop into a fire rig since Maplewood goes on EMS runs.
Allina also deploys a spare laptop to partners, so if there are problems, you just swap it out and
do not have to figure out the problem.
Allina is open to partnering with Maplewood Fire/EMS with revenue sharing and billing for
what they do. Allina and Maplewood would have a common platform for care and would
participate in research studies. Allina has a mobile communication vehicle that Maplewood
could benefit from using at events or at long-term emergency scenes. Allina would change its
dynamic deployment, maybe taking from Vadnais Heights and Little Canada. It would depend
on volume and expectation in the agreement
Allina does not have any coverage near South Maplewood but has been in discussion with
Woodbury if anything should come up with Maplewood, Woodbury would be interested.
Allina and Health East are in collaboration on Community Benefits and Health East will discuss
when they give us their presentation.
The Allina Dispatch Center is located on the United Hospital campus in downtown St. Paul.
Tours are available and we are invited to see the facility.
LaCroix acknowledged that Allina is a large organization and that can make fast movement
challenging. He also noted that any multi-partner collaboration will be subject to some
roadblocks and challenges, but he expressed a commitment to work through the issues. Allina is
eager to explore a flexible partnership and other partners.
Discussion from group after presentation
Take aways:
•Allina is good at what they do (as are other partners)
•There is value in Allina’s dispatch capabilities. One challenge: because we will still need
Ramsey County dispatch (ECC) for fire, this will add an expense.
•Real-time AVL deployment would change the way we do business.
•Dynamic deployment is a theme among partners.
•Phase or pilot program is likely.
•Financial revenue/cost sharing/ACO benefits are likely.
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•No matter the partnership, our future is uncertain: need excellent service -must be a
sustainable solution – therefore we need flexibility.
•Eventually, details and execution are critical for partnership success. It comes down to
the details.
•Allina geography contributes to their ability to help us with low acuity and low-payer-
mix patients
•With dynamic deployment, downside is sometimes long wait time. (Sometimes we are
delayed on any deployment model)
•Need to define service levels and projected cost of status quo. This must be part of our
presentation to the City Council.
What is in it for Allina:
•More business for their dispatch center
•ACO benefits for system by serving Allina patients.
•Potential to be a part of an innovative effort in the community.
Strategic Priorities:
What is the business? The people are the core of our offering. In other words, our professional
and committed personnel are the essence of the value we bring to the community.Therefore,
our aim must be to put our people where their impact is greatest and use partners for rest.
All of this is in order to assure quality of care.
Mike Mondor observed that, for the best overall community outcomes, our priorities should be:
•Community Risk Reduction
•High acuity response
•Low acuity response
The way we do business today, we spend our energy and resources on (in descending
order):
•Low acuity response
•High acuity EMS response and fire/rescue response
•Community Risk Reduction (to a much lesser degree)
Making this transition in priorities will be a critical step toward a transformation that optimizes
excellent public service, sound stewardship of resources, and fairness.
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Meeting 8: April 1, 2016
Regions brought a large, multidisciplinary team to present various facets of their organizational
capabilities. The Discussion was led by Administrator Pat McCauley, Assistant Medical
Director Dr. Bjorn Peterson Medical director, Education manager Tia Radant, and EMS Director
David Walz. Dr. R.J. Frascone and others also contributed considerably to the discussion.
Regions Hospital’s presentation:
Health Partners has two hospitals in the east metro, Regions in St. Paul and Lakeview in
Stillwater. Regions also provides a wide range of EMS services, mostly through partnerships
with – and in support of - other EMS providers. Lakeview EMS provides EMS response and
ALS transportation to North Saint Paul, Stillwater, other East Metro areas, and multiple
communities in Wisconsin. Health Partners Medical Transportation provides scheduled
transportation for customers requiring either stretchers or wheelchairs.
Regions Hospital includes a leading comprehensive Stroke Center, award-winning
Cardiovascular Care Center, a Level I Adult and Pediatric Trauma Center and a world-renowned
Burn Center. Regions (and its predecessor, Ramsey County Medical Center) has been training
paramedics for 40 years and continues to develop their EMS training program. Regions has 22
EMS partners.
EMS Medical Direction
Regions has four MD medical directors that provide quality control, medical direction, and
hands-on support to EMS providers. Their work is characterized by:
•Physician Engagement
•Advocacy and Regional Coordination
•EMS Fellowship
Regions places EMS Physicians out in the community in marked squads for quality insurance
and direct observations. ER doctors train EMS, do ride alongs and work in dispatch to assure
that they are intimately familiar with, and in a position to guide and oversee, all aspects of EMS
operations.
Regions has recently signed up for First Watch, a data-driven technology platform. First Watch
collects data from EMS calls and generates data very quickly that can help doctors with a plan of
treatment. First Watch can analyze data from all 22 partners and can get data in as little as 5 to
10 minutes. Doctors can set up such things as a Community Paramedic to visit a patient at their
home within 24 hours of the ambulance run. The First Watch company is currently in
discussions with Ramsey County Dispatch to explore a possible partnership that would help in
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determining the level of medical response needed at the time of the call. Their deployment with
Regions is underway.
Regions also offers full EMS services at large events like the MN State Fair, the Xcel Energy
Center, and CHS Field.
EMS education:
Regions has long offered comprehensive continuing education for EMS providers at all levels
from first responder to advanced EMT-P (paramedics). Their programs are innovative, data-
driven, and largely experiential rather than traditional lecture- or textbook-centric. Regions also
works closely with providers to adapt their training to the specific needs, scopes or practice, and
circumstances of their partner organizations.
Community Paramedicine: This is an emerging program. Regions and the St. Paul Fire
Department have one community paramedic, one in the process of certification, and another
planned. The overall results at this early stage have been a reduction in 911 calls, hospital visits,
and overnight stays in the hospital. St. Paul’s community paramedic serves patients regardless of
health care system affiliation.
This program is grant-funded, and no patients or health systems are currently being billed for
services.
Injury Prevention:
Regions has one full-time staff member and other assistants who develop and deliver training
programs to prevent injuries in the community. This program is broad in scope, and aims to
“train trainers” so that others can deliver programs with even broader reach and greater impact.
For example:
•Meals on Wheels volunteers have been trained to identify basic fall risks and to
recommend improvements to the residents they serve.
•School programs encourage bicycle helmet use.
•Regions trains firefighters and EMS responders (including Maplewood personnel) to
install and teach parents to install child car seats.
Regions seeks grants to cover many of these programs. Their model is to empower other
community agencies and organizations to promote efforts that improve community safety and
wellness through injury prevention education and interventions.
Applied Clinical and Community-Based Research:
Regions has 62 studies currently underway; about 25% are EMS based. Regions actively
partners with EMS providers to design, seek funding, and conduct research projects that are
based on ideas from the field. One example: a paramedic noted that it was difficult to efficiently
and effectively communicate patient information during the transition into the ER. This concept
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led to the study and ultimate implementation of the “TTA Time out” at Regions where doctors
and staff are waiting for the ambulance to arrive, and all pause at once to listen to the medical
information from the arriving EMS team. TTA practice has been picked up by hospitals
nationwide.
Regions noted partnerships (or vendor relationships) with the following agencies:
•Saint Paul Fire Department with Community Paramedics (as well as medical direction
and continuing professional education.
•Cottage Grove Public Safety, with supplies provided by Regions.
•Ellsworth WI with management and medical direction and staffing such as paramedics.
This partnership allowed Ellsworth community members to maintain governance and to
provide EMT staff as available.
Lakeview Ambulance:
Lakeview is a non-profit hospital-based ambulance service based out of Stillwater. They
respond to 911 calls and do ALS/BLS transports. Lakeville handles around 6000 calls a year
over a 300 square mile area. Lakeview has had a 27-year partnership with Regions for training.
Lakeville staffs all ambulances with two paramedics. They do dynamic staging and constantly
move their ambulances where they are needed. They have an 8 minute fractile response time, but
in No. St. Paul it is about 4 minutes from dispatch to arrival on the scene. Their billing of
patients’ rates is within the market range. They received 36% of billing and broke even last year.
They do have the backing of Lakeview Hospital for funding.
Lakeview is partners with the following agencies:
•Washington County SWAT
•The City of No. St. Paul
•Regions EMS
•Ellsworth WI
•Amery WI
Lakeview feels they are in the right position to help Maplewood in their needs when they already
have the NSP area. Lakeview already has mutual aid with Maplewood and has helped on fires
and ambulance runs in the past. Lakeview has two ambulances in NSP and one in Stillwater each
day but does have two more ambulances if needed or for special events. Allina is Lakeview’s
dispatch center. Lakeview does not currently run a BLS ambulance in the City of North St. Paul.
Health Partners Medical Transportation recently began when they bought an ambulance
company to meet their BLS needs. Regions uses SPFD unit 51 for scheduled transportation, but
needed more capacity. This BLS service has 6000 BLS calls a year with 16 employees and five
ambulances. They also have a wheelchair transport vehicle. They operate M-F 6 to 9:30 pm and
8 to 3 on weekends. If Regions were to take on more business, they would run more hours, up to
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24 hours a day. All BLS ambulances and wheelchair vehicles are staffed with EMT’s (which
exceeds regulatory requirements).
Regions Supply Chain Management:
Regions is a single point for supplies to EMS agencies. Orders are placed by phone or
electronically by 1000 hours, and are typically delivered the next day. They have cost and
buying power that can result in 30 to 40% percent savings over what an agency would pay with
other third parties. There is no delivery charge. RX typically provide 20 to 30% savings, and
can be ordered by 1400 hours for next day delivery. Regions is DEA compliant and can handle
medical waste as well.
We diverged from our previous discussion process* and shared our broad perspective with
Regions personnel in order to increase team learning. We stated that Maplewood wants to focus
on:
•Risk Reduction and Wellness
•High acuity calls
•Fire response
•Low acuity calls
Maplewood wants to be a city of choice - vitality.
One important leverage point: the Accountable Care Organization (ACO) Maplewood sees
opportunities to participate in achieving beneficial ACO outcomes and thereby participating in
ACO rewards and risks.
*A participant raised fairness concerns about this change in process, which were noted. We will
be certain to involve all potential partners in future discussions to assure that they have a
common understanding of Maplewood’s perspective. Further, our aim is not to let the partners
design our future for us.
Post-Presentation Discussion
Take aways:
•Regions may be able to provide financing and expertise for Public Health and
Community Paramedics
•Research capabilities can provide a data-driven back end for all efforts, and can lead to
greater efficiencies. Regions’ need for data also provided an incentive to partner with
Maplewood in order to expand data base.
•First Watch is a high-cost, high-value tool for data collection and analysis.
•Supply management can offer immediate savings, including by ordering smaller
quantities of perishable items.
•Dynamic deployment at Allina and Lakeview may indicate a best practice.
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•AVL could support closest-unit dispatch.
•Regions could add BLS transports and may add emergency response capacity.
•Integrated possibilities in the future:
o East Metro BLS
o Integrated medical direction
o Sharing fees for services
•Lakeview ambulance growth may also represent an opportunity. Increased demand from
Maplewood under the auspices of a partnership could justify expansion of their capacity.
•On-site continuing education has real value.
One key priority for us to remember: we want to maintain an available 4-person fire engine crew
to cover the city at all times.
Chief Lukin pointed out that one key challenge will be financing new services over time,
especially during a ramp-up period. We will also need to manage capacity to maintain service
excellence of existing services while investing in launching new offerings. Further, we must
have a high level of confidence in the benefits of an “end game” to justify the risk.
PARKING LOT
Allowing firefighters to work out on duty, both at the Community Center and on enhanced
equipment at the station. This is seen by some participants as wellness, stress reduction, and
fairness issue.
Legislation: what would be needed to change who can be sent to on non-emergency calls?
The City of Maplewood’s wellness program.
Can the city hire a grant writer?
Tax rates: definition of metrics (to be handled offline)?
Relationship with assistant living or housing with services…can city regulate?
EMS service areas-partnership with Oakdale/Newport etc.
Projection what status quo would cost and what it will look like in 10 years
Police response
IT services
East Metro Training Facility (potential use by Regions)
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One suggestion from a participant: invite the partners to work together without Maplewood’s
involvement to propose a joint offering to the City. This was contrasted with the concern, noted
above, that the City should lead in designing a future solution.
Meeting Notes
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EMS/Strategy Working Group
Meeting 9: April 11, 2016
HealthEast Medical Transport
HeatlhEast was represented by multiple leaders, including EMS Director Laura Olson, Medical
Director Dr. Keith Wesley, and Operations Manager Mr. Shannon Gollnick. They began by
sharing their organizational values, and their history, which includes opening St. John’s Hospital
in Maplewood in 1985. St. John’s has 184 beds, 3000 deliveries a year and does 6000 surgeries.
It is the Hmong hospital of choice with 38% of deliveries to Hmong families. HealthEast is106
years old and has 3 other hospitals besides St. John’s: St. Joe’s, Woodwinds and Bethesda along
with 16 clinics. HealthEast Medical Transport recently opened a new building on St. Paul’s
Eastside where their maintenance and dispatch is located. Squad car conversions are also done at
this facility. 25 conversions for the City of Maplewood have been completed. HealthEast
Medical Transport has 160 employees.
HealthEast had 37,000 patients with a net patient revenue of $36 million in FY 2015.
HealthEast is committed to LEAN process improvement, which encourages all employees to
submit time or cost cutting ideas. To date over 100,000 ideas have been submitted.
Ambulance Division Capabilities:
•ALS
•BLS
•Critical care
•Bariatric
911 Service area:
•South/West St. Paul
•Inver Grove Heights
•Mendota Heights
•Eagan
•Rosemount
HealthEast dispatch uses the ZOLL computer aided dispatch (CAD). This system has extensive
reporting capabilities.
Vehicle Services:
•Fleet of 44 vehicles
•Onsite service center
•ASE mechanics
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•GEO tab vehicle monitoring which can catch issues before they are critical and get the
vehicle in for service. It also shows where all vehicles are and will record data on how
crews are driving the ambulance in regard to speed/seat belt usage and driving patterns.
HealthEast EMTs and Paramedics are all nationally registered which exceeds what is currently
required in MN. Critical Care Paramedics are NPR certified. HealthEast is very proud of their
pain management program. They also follow Evidence Based patient care protocols.
HealthEast’s Medical Director Keith Wesley MD and his staff review all critical code 3 calls.
They will also respond to any complaint or concern within 48 hours. Physician’s help and
guidance is available by phone 24 hours a day for paramedics.
HealthEast has many partners including Fairview, Hennepin County Medical Center and the U of
M Health. PSA are listed above under service area.
HealthEast is always looking for ways of delivering patient care. They have peak load staffing
to handle the next emergency. They may staff higher on bad weather days or for certain
activities. Low acuity calls can be handled by BLS ambulances leaving fire department available
for high acuity calls.
Peak Load Staffing Partnership Opportunity:
•Right Resource
•Right Time
•Right Place
•Community focused, seamless integration
•Shared recruiting of staff*
*Shannon Gollnick noted that they have experienced staff attrition, including some who came to
Maplewood. He noted that the organizations could work together to hire the right people.
Healthcare Innovation – focus on Disruptive (game-changing) Innovation:
Break down barriers with all partners. Facillitate an “On Demand Economy,” The patient will
determine what hospital, what care and what doctor they want.
Mobile Integrated Healthcare (MIH) is an end – community paramedics are one kind of provider
in achieving that end. MIH:
•Rooted in population health initiatives
•Funded by ACO’s multi partners
•IHI triple aim:
o Patient (or population) outcomes
o Patient experience
o Cost containment
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Business models are changing, along with health care as a whole. Paramedics are an extension
of a physician. The focus now is to fix business model to take care of patient longer at home.
HealthEast is partnering with Orthopedics and hospice on specific initiatives.
Fall Prevention for our aging population.Evaluating why they fell and to prevent future falls.
•Managed Care Transition
•Affordable
•Adaptable
•Customized
•Accessible
HealthEast is looking for ways you could pay off your bill by volunteering. By doing so patients
would be integrated into the community. HealthEast would like to have different medical
screening etc. at the Maplewood Mall along with a wellness walking program. There could also
be grant sharing, research opportunities, technology and billing sharing.
Sustainability-Growing relationships
•Vested interest
•Data driven
•Long term health of the community’
•Accessible, adaptable and customized
HealthEast’s Recommendations for Fire/EMS
•Tiered cooperative response plan…BLS
•Coordinated data retrieval reporting
•Shared medical direction
•Coordinated educational opportunities
•Coordinated recruiting
•Shared purchasing opportunities
•Standardized equipment utilization
•Community outreach/education programs
•Shared recourses & technology innovation
Questions:
HealthEast’s ambulances go out of St. Paul and Eagan. Their active PSA is primarily in Dakota
County. Response times vary by community driven largely by geography/population density.
They report performance monthly to communities.
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Staff leaders (Grollnick and Wesley) write grants. The HealthEast Foundation provides some
grant funding.
As far as the future of health care…..HealthEast sees a new trend in consolidation, purchasing
health insurance companies and less brick and mortar buildings to home based care.
HealthEast focus is on community with a more personal experience. They are smaller so they
feel they can develop better relationships.
HealthEast could provide a wellness program to EMS personnel by taking on any level of care at
St. Johns. They could also provide rehab for injured personnel. They are working with Code
Green which deals with the mental health of first responders.
As stated earlier, St. Johns has many Hmong patients and would be able to integrate that into
their ambulance service if needed. Currently their EMS personnel have not been as engaged in
diversity initiatives because of the populations they serve.
GROUP DISCUSSION
Sue shared her experience riding along and observing operations over two shifts. She was struck
by the amount of effort involved in responding to calls, maintaining readiness in all respects, and
participating on committees. She was also struck by the physical demands of the job, and
especially by the level of professionalism exhibited by the team members. She reiterated the
need for fitness facilities for stress management.
After the presentation, the group shared the following perspectives, focused on Maplewood’s
past and current experience with HealthEast, and on learning arising from the presentation.
Current Experience:
•Medical direction – past seven years.
•Some patient/provider interaction at hospital points of contact.
•Some training – recently moving to more interactive and relevant training from other
providers.
•Missed opportunities for partnering
•Vehicle builds and refits
Take aways:
•St. John’s is a huge part of our community. HealthEast also has a major clinic presence
and a large base of patients who are residents in the community.
•Focus on IMH (Integrated Mobile) as a vision is interesting, but not necessarily distinct
from other providers’ visions or capabilities.
•Potential: participating in fall prevention/higher level of integration
•Paradigm of ambulance provider was evident in presentation
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•Major opportunity is in clinical/hospital presence
•Potential funding/revenue through ACO/patient service
Other insights:
•Smaller partners could factor into solution
PARKING LOT
Allowing firefighters to work out on duty, both at the Community Center and on enhanced
equipment at the station. This is seen by some participants as wellness, stress reduction, and
fairness issue.
Legislation: what would be needed to change who can be sent to on non-emergency calls?
The City of Maplewood’s wellness program.
Can the city hire a grant writer?
Tax rates: definition of metrics (to be handled offline)?
Relationship with assistant living or housing with services…can city regulate?
EMS service areas-partnership with Oakdale/Newport etc.
Projection what status quo would cost and what it will look like in 10 years
Police response to high acuity EMS calls
IT services
East Metro Training Facility (potential use by Regions)
One suggestion from a participant: invite the partners to work together without Maplewood’s
involvement to propose a joint offering to the City. This was contrasted with the concern, noted
above, that the City should lead in designing a future solution.
Meeting Notes
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EMS/Strategy Working Group
Meeting 9: April 13, 2016
Asst. Chief Mondor along with Chief Lukin had a brief presentation to summarize the partner
presentations and offer high-level recommendations. Their summary focused on:
•Diversity of thought
•Sustainability
•IHI triple aim
Right now the Fire Department sends the same level of response to all calls. Only 10% of their
time is for Community Risk Reduction.
This is how the current paradigm looks for calls, over the last five years.
•Alpha 22%
•Bravo 21%
•Charlie20%
•Delta 20%
•Fire 16%
•Echo 1%
In the future, this needs to be reversed. Community Risk, High Acuity, Fire Response and Low
Acuity.
Chiefs Mondor and Lukin also included the following summaries of each presentation:
St. Paul Fire Department
•Ambulance 51 (scheduled BLS calls). These are physician ordered at a negotiable rate.
•Shared Fire resources
•Border drops (eastside and south end)
When Dr. Pete Tuenge was asked if BLS transports is a business we should be in he said no, but
we need to keep it on the table and keep it in mind with the future of MIH. He feels the
monitoring and improving the back-to-home health care (post-discharge) is a big part of the
future.
Chief Lukin and Asst. Chief Mondor believe that Community Paramedics would have an impact
on low acuity calls with visits to nursing and group homes and to follow up from transition care.
It is currently the gap in health care. It is possible that a volunteer program could also help with
visits to homes.
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Allina
•Dispatch services (CAD terminal and IT services)
•Shared real time deployment (better deployment with Allina’s dispatch)
•Population Health improvement
South end would still be left out with Allina. Lakeview is a Health Partners ambulance that is
dispatched by Allina. Lakeview is ready to add an ambulance if they had more of an area to
cover. i.e., greater incremental demand.
With respect to population health improvement, we will end up with multiple partnerships,
because every health system has some percentage of patients going from Maplewood EMS to
their hospitals. St. John’s receives 60% of Maplewood’s EMS patients.
Cost of dispatching through Allina could be an added expense; fire calls would still be
dispatched out of Ramsey County Dispatch.
Health Partners/Regions
•Medical Direction
•EMS education
•Data management (FIRST WATCH)
•Research
•Supply chain management (This would help with our supply which may expire before
use and cost and delivery would be an added bonus. It is estimated it takes one person 8
hours a week to manage supply)
•Injury prevention/community outreach (Maplewood already does clinics with Health
Partners such as bike rodeos and fall care)
•Shared deployment (Lakeview/Allina)
•BLS transport capabilities (scheduled)
Health Partners is very interested in using the East Metro training facilities for training. This
would be a plus for Maplewood since the Paramedics are not leaving the city for training and
could respond to a call. It also creates more demand and usage of that facility.
HealthEast
•BLS Peak Load Staffing
•Fall prevention
•Medical Direction
•EMS training (it may be less expense to partner with at St. John’s
•St. John’s partnership (which would be in our best interest to keep for the community
outreach)
•Vaccination/screening of city personnel at St. John’s Hospital
•Technology integration
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•Billing (as with any partner)
•Mobile Integrated Health-Passport (this is seen as a vision of the future)
Per Chief Lukin, Regions is more blended than HealthEast for education since Health Partners
and Maplewood EMS do things the same way.
Recommendation Summary from Chief Lukin and Asst. Chief Mondor
•Invest in Community Risk Reduction. Dig deeper into smaller partners and Ramsey
County. Study the scope of potential partners we haven’t looked at yet.
•Address impact of low acuity EMS
•Build surge capacity through partnerships and data sharing
•Ensure initial fire response aligns with OSHA requirements (2 in 2 out)
•Explore medical directions opportunity
•Address long term staffing considerations.
We then built out a set of intended outcomes, and voted on the relative importance of those
outcomes. Residents voted in red; staff members in green (note that the team has 5 residents and
7 staff members).
DESIRED OUTCOMES
•Excellent EMS/Fire response XXXX XXXXX
•Improved community wellness /Cost and risk reduction XXX XXXXX
•H.C. makes Maplewood a city & employment of choice X
•Financial sustainability-High value for city people-Cost containment & value XXXX
XXXXX
•Maplewood fire/EMS is a leader in system innovation X XXXXXX
•Strong community partners: Agen- Volunteers-LE-Public buy in XXX XX
•Measurable and reportable outcome X
•Value of our workforce: supported and trained-Fairness XXXX XX
•Strategic vision and direction, Long range goals X X
We then discussed a range of different means/topics related to achieving those outcomes.
Means/topics are underlined. Notes are shared below.
Fire response capabilities
•4 Person crews NFPA & OSHA
•Key outcome: improve response-initial response
•Note: this is a primary objective of this working group: to improve fire response
capabilities and secure appropriate resources for non-EMS emergency response.
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ALS response capabilities
•Continuum of response
•Liability perspective must be managed
•Right response – Right time – Right place
BLS response capabilities
•Add capacity to provide a less robust response where appropriate
•Find an effective means of capturing revenue.
Dispatch capabilities
•Need tiered response
Information and analysis to guide action
•Data gathering/continuous improvement: health outcomes, patient experience
•Decisions support cost
Medical Direction
•In field is important
•High priority for relationships
Proactive Mobile Health Care e.g. Community Paramedic/EMT
Non-emergency transportation
•Possible offering – scheduled transport services.
Payment links to ACSO
•Part of system relationship development/management
Dynamic deployment EMS
•Can improve response
•Balance with readiness needs
•Integrate with partners
IT support
•Linked to dispatch
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Health care linkage with all systems
•These relationships require strategic development and management.
Grants/Fundraising
•City grant writers
•Be cautious about total cost/benefit of actually taking grants.
Relationship development/management system design
•Legislature/policy initiatives
•Must invest in this capability now
Use volunteers
Supply chain management:
•Medium impact, quick implementation possible. This is a priority.
EMS Education:
•Should be linked with Medical Direction
Waste reduction:
•Engineer the organization to achieve the mission and to support deployment service
model. This might take place over time.
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Appendix B:
We began our discussion by sharing some firmly-held beliefs shared by resident participants
over the course of our work together.We labelled these considerations “Loud and Clear,” to
reflect that they were heard as such:
1. Excellent service is paramount
2. Need to define and measure quality and excellence
3. Firefighter wellness is a priority
•Fitness equipment
•Workouts for mental health and physical fitness
•Improved workplace where appropriate
4. Novel solutions must be measured against expanded status quo
5. Consider capital management e.g. leasing
6. We value our people and the excellent service they provide
7. Need for fiscal responsibility: sources and uses of funding must be considered in all
instances.
E1, Attachment 2
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MEMORANDUM
TO:Melinda Coleman, City Manager
FROM:Paul Schnell, Chief of Police
Steve Lukin, Fire Chief
DATE:May 4, 2016
SUBJECT:Presentation of Planned Operational Strategy for the Purpose of Implementing
the Workgroup’s Identified Priorities
Introduction
Based on the Fire/EMS Workgroup’s identification of the strategic framework, we are
recommending a staffing plan to develop Phase 2, which includes a deeper analysis of
partnership possibilities for EMS service service delivery.
Background
The resulting recommendation of the workgroup will necessitate an allocation of resources to
explore and develop potential partnerships. To that end, we are manking a recommendation to
the City Manager to promote Assistant Chief Mike Mondor to the position of Chief of Emergency
Services. It is our belief that dedicating appropriately ranked staff to studying the range of
possibilities is necessary to maintain operational efficiency.
Recommendation
Information only.
Attachments
1. Memorandum from Chiefs Lukin and Schnell to City Manager Coleman
E2
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City of Maplewood
Department’s of Public Safety
EMS-FIRE-POLICE
TO:Melinda Coleman, City Manager
FROM:Paul Schnell, Director of Public Safety
Steve Lukin, Fire Chief
DATE:April 27, 2016
SUBJECT:Recommendation Based on Fire/EMS Workgroup Findings
Attached you will find a brief Fire/EMS workgroup summary report. It was a tremendous
pleasure to walk through the review and potential partner presentations with the workgroup
members. We all learned a great deal about the services provided by the City’s Fire/EMS
Department. Each member, whether resident volunteer or City staff member, contributed to the
outcome of the strategic framework. Each member may have a slightly different view of the best
way forward or next steps, but in order to be effective, such an endeavor cannot be the work of a
group. It is, and should be, the ongoing role of this group to test staff’s operating assumptions
and work plans as the broad strategic framework is developed into a working model. Know that
turning the group’s strategic framework into a functioning plan will not be without challenge.
To date, no complete or known model exists for accomplishing the overarching goal of
community risk reduction and community wellness. Should the workgroup’s recommendation
be adopted, Maplewood will once again blaze a trail that, we believe, will make the City a
national leader in strategic partnerships that improves, the health, well-being, and vitality of this
community.
In order to accomplish this lofty but attainable goal, the City will need to appropriately staff the
endeavor. As such we are recommending the following organizational changes:
Promotion of Assistant Chief Michael Mondor to Chief of Emergency Medical Services. Based
on Chief Lukin’s high regard for the work of Assistant Chief Mondor, his knowledge of the
emergency and paramedicine environment, and in line with the City’s overall goal of building
and developing future leadership, this promotion is important to accomplishing the Workgroup’s
vision.
As Chief of EMS, Assistant Chief Mondor would remain a full operational ranking member of
the Maplewood Fire Department. He would continue to oversee EMS service delivery and will
begin to develop a work plan.
The Chief of EMS would become a direct report of the Director of Public Safety thereby
ensuring to potential partners that he has the senior management level role to credibly and
effectively represent the City’s interests in matters pertaining to current and future EMS serves.
E2, Attachment
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Chief Lukin will continue to serve as Fire Chief, Emergency Management Director, and the
authority having jurisdiction over fire inspection and fire code matters. As is currently the case,
Chief Lukin will also be a direct report to the Director of Public Safety.
As divisional Chiefs within the Fire/EMS department, Chief Lukin and Chief Mondor will have
a shared leadership role. However, in matters pertaining to fire suppression and emergency
management, Chief Lukin shall maintain primary administrative and operational oversight. In
matters pertaining to EMS, Chief Mondor shall assume primary administrative and operational
oversight. Obviously, since Maplewood’s Fire and EMS services are inextricably linked, the two
Chiefs will need to collaborate on the management of their primary and overlapping areas of
administrative focus. In the absence of one, the other shall assume full control over the matter at
hand.
Recommendation 1: We recommend that the promotion of Assistant Chief Mondor to Chief of
EMS be effective on or about May 16, 2016. In the two weeks that follow his promotion, it
would be my expectation that Chiefs Lukin and Mondor develop a written strategy identifying
their administrative and operational “work lanes,” including who supervises respective
department staff. Upon completion of the working strategy, the Public Safety Director would
review it with the two of them and approve the final version.
Recommendation 2: Upon finalization of the working agreement among and between the
Chiefs, I will expect that Chief Mondor develop a written work plan to initiate Phase One of the
strategic framework through the identification of needed partner agreements. Obviously, this
work will need to be done in close coordination with Chief Lukin, the City’s Finance Director,
along with you and the Public Safety Director. We expect the creation of the work plan will take
approximately four weeks to complete.
Recommendation 3:The EMS Workgroup members remain as an established group to provide
a review of, and feedback on, the planned efforts of the Chiefs and review call for service and
response time data to ensure progress and accountability. The Fire/EMS would then develop a
workgroup convening schedule upon the recommendation of Chiefs Lukin and Mondor for
periodic meetings, but no less than 3 times annually through 2017.
Recommendation 4: The EMS work plan must contain some plan to utilize a partner to respond
a portion of Maplewood’s low acuity EMS calls to free up resources for community
paramedicine and high acuity fire and EMS calls for service. Obviously, any partner agreements
will be reviewed by the City Attorney following consultation with you prior to being brought
before the City Council for consideration of approval.
Thank you for allowing me to participate in this process with such an incredible group of people
convening around an incredibly important issue. We are excited to see and support the
development of the way forward. We believe that through this effort, Maplewood is creating the
future of effective Fire/EMS service delivery.
We look forward to discussing the implementation of these recommendations with you. Please
let either of us know if you have questions or concerns.
E2, Attachment
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