Item N10
BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
Meeting Date: Wednesday, October 20,2004
Division: BOCC
Bulk Item: Yes
No XX
Department: Commissioner Rice, District 4
AGENDA ITEM WORDING: Approyal to reject proposal submitted in response to RFP for
trauma services, and approyal to adyertise a Request for Proposals for trauma services proyider
for a public-priyate partnership to proyide trauma care transport to Ryder Trauma Center as
recommended by the Trauma System Study Group.
ITEM BACKGROUND: The Trauma System Study Group was created by the BOCC in August
of 2003 to study trauma care deliyery issues in the Middle and Lower Keys and recommend
enhancement of the trauma system into the long-term future. The Middle and Lower Keys are
not well served by out-of-county based air transport due to the distance and trayel time inyolyed.
The group recommendation in their Final Report to the BOCC is a public-priyate partnership.
The RFP for a trauma services proyider was adyertised with Board approyal earlier this year. It
is anticipated that this service would also proyide backup trauma transport to the Upper Keys as
required.
PREVIOUS RELEVANT BOCC ACTION: As per aboye.
CONTRACT/AGREEMENT CHANGES:
STAFF RECOMMENDATIONS:
TOTAL COST: Cost of Advertising
BUDGETED: Yes
No XX
COST TO COUNTY: Cost of Advertising SOURCE OF FUNDS: Ad-Valorum
REVENUE PRODUCING: Yes
No
AMOUNTPERMONTH_ Year
APPROVED BY: County Atty _ OMB/Purchasing _ Risk Management_
DIVISION DIRECTOR APPROVAL:
(}-fLfu~~l-~_
(David P. Rice, Commissioner, District 4)
DOCUMENTATION:
Included XX
ToFollow_ NotRequired_
AGENDA ITEM #~J
DISPOSITION:
Revised 1103
.. Mvwuc C()unty Trauma Study Group Interim Report
October 2004
STUDY GROUP CONCLUSIONS AND RECOMMENDATIONS
From review of the information provided by the working committees, the Study Group
concluded that three options should be considered when deliberation is made by the Momoe
County Board of County Commissioners (BOCC) on maintaining the current level of air trauma
transport services. The options were:
I) Purchase a helicopter;
2) Develop a public-private partnership for rendering air trauma transport services; or
3) Seek the private operation of an air trauma transport service.
The Study Group acknowledged the advantages and disadvantages associated with each of the
options under consideration (See Table I). For Option I, the primary disadvantage of bearing the
full burden of purchasing an aircraft (estimated $4.5M) overshadowed the identified advantage
of having full authority and control of air transport operations.
Under Option 2, the advantage of having joint operational control through a public-private
partnership was considered promising by the Study Group. The financial burden would be
mitigated through the sharing of operational costs and the combined expertise of two
organizations would help streamline planning and assist in delineating organizational
responsibilities. The private vendor would provide the aircraft and collect net revenues from
charges to appropriate insurance companies and patients for services rendered. The County
would furnish pilots, storage infrastructure, maintenance personnel, and medical staff.
A fully privately owned and operated air ambulance service in Monroe County was entertained
as Option 3. The chief advantage is the community's need for air trauma transport services
would be met at no cost to the public. The concerns shared by Study Group members were the
history of few comp~s, expressing interest in establishing local-based service and the lack of
control over the tenure of local service rendered by a private company.
Table I: Options for Maintaining Air Trauma Transport
Options
Purchase
Helico ter
Advantage County retains full
control/authority
Establish Public-Private
Partnershi
County maintains some
level of control through a
contractual arrangement
Seek Private
o eration
No burden of cost
borne by County;
service need is
addressed
No control over
Ion evit of service
Disadvantage
Some level of cost borne by
Coun
8
Monroe County Trauma Study Group Interim Report
October 2"0U4-
To determine the viability of Options 2 and 3, a request for proposal (RFP) was developed and
advertised in June 2004 (per approval by the BOCC in May 2004). Vendor requirements
included two essential criteria. First, the applicant must be an FAA approved Part 135 air
ambulance operator and secondly, have a minimum of five continuous years as a certified
Florida air ambulance helicopter service provider.
In July 2004, one vendor responded and submitted a proposal that was similar to Option 2. In
September 2004, the Study Group convened to discuss the vendor's response and the
recommendation of the appropriate option to the BOCC. At the September meeting, the Study
Group identified several positive elements of the vendor's proposal, which included a revenue
sharing arrangement (conditional on the level of excess profits), a five-year service tenn,
coverage of maintenance service costs, and the provision of an aircraft. The proposal also
included Part 135 training for pilots and the assumption of all risks for billing, collections, and
non-payment of services.
Recommendations
The Study Group agreed that Option 2 (public-private partnership) was the most viable strategy
for the County Commission to consider for further development. The Study Group identified
two key _ features as considered highly important for consideration during the contract
negotiations process with any vendor under this option. These features were: a) the financial
stability of the vendor and b) acquiring an aircraft for long-term service that can accommodate
two patients in addition to a two member patient care crew.
Staffing and logistical recommendations endorsed by the Study Group were to:
. . Hire and train a flight staff comprised of a) a flight nurse and a paramedic for inter-
facility transfer~~liQ.d b) two paramedics for trauma transport from the incident scene;
. Develop appropriate standards and procedures for conducting inter-facility transfers of
critical patients within trauma transport air services;
. Designate the Middle and Lower Keys as the primary service area and provide secondary
support to the Upper Keys due to its closer vicinity to a trauma center;
. Place the current Trauma Star helicopter on back-up status as a resource to the newly
acquired aircraft;
. Station the aircraft in Marathon;
. Explore (through long range planning) the designation of a trawna agency to improve
data collection and quality assurance mechanism for the provision of trauma care; and
. Review possible funding sources for trauma care services for the Middle and Lower
Keys.
The Study Group acknowledged that further meetings would be needed to determine possible
methods for funding trauma care for the uninsured and indigent trauma patients transported to a
trauma center from the Middle and Lower Keys. It was concluded that having a contractual
relationship with an experienced air ambulance operator would provide the best opportunity to
ensure the local EMS system will continue to provide timely, quality air transport services for
residents and guests of Monroe County who are critically injured.
9