Item C19
BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
Meeting Date: March 15,2006
Division:
Emplovee Services
Bulk Item: Y es ~
No
Department:
Staff Contact Person: Teresa Aguiar
and Clark Martin
AGENDA ITEM WORDING: Approval to create three (3) new positions to allow one flight qualified
paramedic to be assigned to Trauma Star at the hanger for each 24-hour shift.
ITEM BACKGROUND: Since 2002 the Trauma Star program has proven its worth by rapidly
evacuating critically ill and injured patients to mainland medical facilities for specialized care. For the
first three years medical staffing was provided by "robbing" ground ambulances oftheir crews to
accomplish this mission. This was problematic because of delays incurred, if the ground ambulance was
even available. Even so, this caused diminished service levels in the area from which the medical crew
was plucked. The Trauma System Study Group (TSSG), chaired by Commissioner Rice, identified early-
on the need for dedicated EMS crew for the helicopter to alleviate these delays and impact on service
delivery.
PREVIOUS RELEVANT BOCC ACTION: On February 15, 2006 the BOCC approved the purchase
of a replacement helicopter for Trauma Star. Creation of these positions is necessary to achieve 24-hour
staffing of the helicopter when it becomes operational later this spring.
CONTRACT/AGREEMENT CHANGES: N/A
ST AFF RECOMMENDATIONS: ApprovaL
TOTAL COST: $36,803.24 per year plus benefits (each position) BUDGETED: Yes _ No~
Cost to be absorbed in current budget
COST TO COUNTY: $163,406.29 per year
SOURCE OF FUNDS: Ad Valorem Taxation
and Billing Revenue
REVENUE PRODUCING: YesR- No AMOUNTPERMONTH_ Year
* Once Part 135 Certificate is obtained and billing for aeromedical service commences
APPROVED BY: County Atty NI A OMB/Purchasing Yes Risk Management NI A
DIVISION DIRECTOR APPROVAL:
j1" ;;::// in} } " .~~
-.)-L...~~( €A r E~
Teresa Agdiar
Not Required_
DOCUMENTATION:
Included X
DISPOSITION:
AGENDA ITEM #
Revised 2/05
FIRE RESCUE DEPARTMENT'
Chtrk O. Martin, Jr., Fire Chief
490 63rd Street, Suite 141
~arathon.F1.33050
r"'''''':'--'~
BOARD OFCOUNTYCOM~NERS
Mayor Charles "Sonny" McCoy, District 3
Mayor Pro Tem Murray E. Nelson, District 5
DiXie Spehar, District 1
George Neugent;. District 2
David P. RIce, DIstrict 4
O!!~t~~~~E
MJ;;MO;RANDUM
TO:
FROM:
Teresa Aguiar, Division Director
Employee Services {Jilt
Chief Clark O. Martin, .
Fire Rescue
SUBJECT:
DATE: March 01, 2006
I am requesting three new Firefighter/Paramedic positions to provide for 24-hour staffing of
Trauma Star once the new aircraft is acquired and becomes operational later this spring.
New Positions for Trauma Star
Backgtoung
In early 2002, reati2ing the need for Keys~based aeromedical service to evaCllil.te critically
injured or ill patients to appropriate medical facilities in mainland South Florida, Monroe
County Sheriff Richard Roth was successful in acquiring a used Viet Nam era UH-l Huey
helicopter, which was already configured for EMS transport use, from Marion County,
Florida. Through a partnership with Monroe County Fire Rescue, Trauma Star began
operations where the Sheriff's Office pilots operated the helicopter and Monroe County Fire
Rescue paramedics provided care in the patient/EMS compartment. Over time, Trauma
Stat's use in transporting the sick and injured to more definitive care fat exceeded initial
projections. The proficiency of the pilots. medical crew and ground~support units also
increased
There were, however, three major drawbacks to the program as it operated until the fall of
2005:
. Because the helicopter was a "public use" aircraft, the County could not bill
patients and their health insurance companies for the transportation and medical
care.
. The staffing configuration required Trauma Star to take off from Marathon
Airport without paramedics and rendezvous with a designated Monroe County
Fire Rescue ambulance at a designated helispot (landing zone). This caused
varying delays in Trauma Star's arrival at the patient pick-up point and also
resulted in a ground ambulance and/or fire engine being removed from service for
the duration of that mission. some three to four hours.
. The wear and tear of the higher-than-projected call volume shortened the service
life of the UH-l to the point that it was removed from service in the fall of 2005.
In light of the above, among other concerns, a Trauma System Study Group (rsSG) was
fonned by Comtnissioner Rice in the fall of 2003 to address sustaining a Monroe County-
based aeromedical service. The TSSG fonned three subcommittees:
. Aviation - to research and determine the most suitable replacement aircraft
. Finance - to project costs and potential revenue
. Sttucture and Operations - to consider various staffing configurations with relation
to patients' demands, for both inter-facility movements and patients picked-up
from a trauma scene
The final report included a recommendation from the Sttucture and Operations
Subcommittee for medical crew configuration that the optimum staffing would consist of a
nurse/paratnedic and a paramedic for inter-facility transfers and two paramedics for on-
scene trauma removals. They further recommended that the medical crew be stationed with
the helicopter for immediacy of response and to lessen impact on ground assets.
In the interitn, a new used helicopter has been located which is suitable for our use and is far
superior to the UH-l it is replacing. Negotiations for its purchase are near completion.
Discussions between the County Administrator and the Sheriffs office have determined that
it would not be economically feasible to staff Trauma Star with two on-duty paramedics in
the near term until some history is developed with cost offset by revenue generation. With
regard to flight nurse/paramedics, there is sottle doubt that Monroe Count)' would be
capable of providing the compensation that these highly-qualified individuals would
demand, if there even is a pool of them available locally.
Due to a particular patient's condition, if additional medical personnel are needed, they will
be "borrowed" from ground units at the scene of the sending hospital This will introduce
significant but surmountable training challenges into the operation to assure flight crew and
patient safety as well as compliance with Florida Department of Health and Federal Aviation
Administration requirements.
Recomnwnda lion IRequest
I am rt'tiuesong; die crcati(Hl of three firefighter/pararnedrc t:'ositions, one each ~or A, B, and
C ShiEls. Creation of these positions as tttettghter/panmedics offers the followtng
;tdvanta,J,cs:
. Existing, incumbent flight medics who already have the experience operating in the
aeromedical environment in Monroe County will be able to more rapidly place the
program back into operation once they are acclimated to the new aircraft.
. Granting "first shot" to those incumbent flight medics who have built the program
to where it is today will be a morale booster.
. Assuring the option to under fill these three firefighter/paramedic positions with
non-tire-certified paramedics gives us the flexibility to use these personnel if they are
the best, or only, applicants for the positions.
. Assuming the positions are filled with firefighter paramedics, this yields gteater
flexibility to rotate personnel through these assignments and back to ground
ambulances and fire apparatus to assure skills retention for all personnel involved.
The fact is that in most cases, a flight paramedic ends up maintaining the patient in
the packaging and treatment regimen initiated by the first-attiving ground unit
paramedic. A flight paramedic who spends all of her time in this assignment will
eventually suffer diminished "street skills". Likewise, back-up flight medics must
spend periodic or rotational titne on the helicopter to remain proficient with aircraft-
based operations.
. In my experience, once pennanent flight medics are introduced into an EMS system,
there is a risk of a "prima donna" relationship developing in opposition to the
ground units' paramedics. This can be avoided through a regular rotation through
these assignments to foster the team concept.
Should you have any questions, please do not hesitate to call me.
COM/dlh