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11/19/2003DANNY L. KOLHAGE CLERK OF THE CIRCUIT COURT DATE: December 9, 2003 TO: Fire Chief Clark Martin Fire Rescue Department ATTN.- Darice L. Hayes, Administrative Assistant Fire Rescue Department FROM: Pamela G. Hanc Deputy Clerk At the November 19, 2003, Board of County Commissioner's Meeting the Board granted approval to submit Grant Applications to the Florida Department of Health, Bureau of Emergency Medical Services, to fund EMS related equipment and to have the applications signed by the proper County authorities. Enclosed is a duplicate original of the above -mentioned for your handling. Should you have any questions please do not hesitate to contact this office. cc: County Administrator w/o document County Attorney Finance File ✓ EMS MATCHING GRANT APPLICATION FLORIDA DEPARTMENT OF HEALTH Bureau of Emergency Medical Services Complete all items unless instructed differently within the application Type of Grant Requested: ❑ Rural ❑X Matching ID. Code (The State Bureau of EMS will assign the ID Code - leave this blank) 1. Organization Name: Board of County Commissioners Monroe County, Florida 2. Grant Signer: (The applicant signatory who has authority to sign contracts, grants, and other legal documents. This individual must also sign this application) Name: Dixie M. Spehar Position Title: Mayor Address: City: Key West County: Monroe State: Florida Zip Code:33040 Telephone: (305) 292-3440 Fax Number: 305 292-3466 E-Mail Address: boccdis1@monroecounty-f1.gov 3. Contact Person: (The individual with direct knowledge of the project on a day-to-day basis and responsibility for the implementation of the grant activities. This person may sign project reports and may request project changes. The signer and the contact person may be the same.) Name: Clark 0. Martin, Jr. Position Title: Fire Chief Address: City: Marathon County: Monroe State: Florida Zip Code: 33050 Telephone: 305 289-6004 Fax Number: E-mail Address: ma un Form i 767, Rev. June 2002 4. Legal Status of Applicant Organization (Check only one response): (1) ❑ Private Not for Profit (Attach documentation-501 (3) ©1 (2) ❑ Private For Profit (3) ❑ City/Mun icipality/TownNil I age (4) El County (5) ❑ State (6) ❑ Other (specify): 5. Federal Tax ID Number (Nine Digit Number). VF5 .9 6 00 07 4 9 6. EMS License Number: 002176 Type: RgTransport ❑Non -transport ❑Both 7. Number of permitted vehicles by type: 0 BLS 9 ALS Transport 2 ALS non -transport. 8. Type of Service (check one): BRescue ❑Fire ❑Third Service (County or City Government, nonfire) ❑Air ambulance: []Fixed wing ❑Rotowing ❑Both ❑Other (specify) 9. Medical Director of licensed EMS provider: If this project is approved, I agree by signing below that I will affirm my authority and responsibility for the use of all medical equipment and/or the provision of all continuing EMS educati i his project. [No signature is needed if medical equipment and professional EMS edu t' n a not in this project.] Signature: Date: 10/30/2003 f MONROE COJiv IY A-fORNEY Print/Type: Name of Director Dr. Sandra Schwemmer AP OVED AST M _o -�� FL Med. Lic. No. OS 4022 UZANNIS 9.'FRl7 TON ASSISTAN co"T%V.AORNEY Note: All organizations that are not licensed EMS providers must obtain the signaturAlt'rum4dica1. 7 director of the licensed EMS provider responsible for EMS services in their area of operation for projects that involve medical equipment and/or continuing EMS education. If your activity is a research or evaluation project, omit Items 10, 11, 12, 13, and skip to Item Number 14. Otherwise, proceed to Item 10 and the following items. 10. Justification Summary: Provide on no more than three one sided, double spaced pages a summary addressing this project, covering each topic listed below. A) Problem description (Provide a narrative of the problem or need); B) Present situation (Describe how the situation is being handled now); C) The proposed solution (Present your proposed solution); D) Consequences if not funded (Explain what will happen if this project is not funded); E) The geographic area to be addressed (Provide a narrative description of the geographic area); F) The proposed time frames (Provide a list of the time frame(s) for completing this project); G) Data Sources (Provide a complete description of data source(s) you cite); H) Statement attesting that the proposal is not a duplication of a previous effort (State that this project doesn't duplicate what you've done on other grant projects under this grant program). DH Form 1767. Rev ENIS Grant Application 10..Justification Summary, Attachment Page 1 of 2 A. ITEM I (LifePak 12) Monroe County Fire Rescue has been using a military surplus UH- l helicopter, outfitted and licensed for ALS transport/Transfers since March, 2002. Some medical equipment for the aircraft was purchased with grant funds (ProPaq Encore Monitor and Eagle Ventilator); however other equipment necessary to outfit the aircraft was taken form reserves and backup inventory throughout our system. The LifePak IOC currently in use for patient Defibrillation and Pacing uses older monophasic technology; is subject to greater interference while in flight; and the display is extremely small and difficult to see. ITEM 2 (Crew Safety Gear) Military surplus safety equipment is currently used by the flight crews on the aircraft. All of the equipment is functional, but in varving states of repair and quality. Crews attending the patients are not afforded the same safety equipment as are the pilots at this time. B. ITEM 1 (LifePak 12) Currently patients are monitored by one of the two ProPak EKG monitors installed in the aircraft. Patients at risk for cardiac dysrhythmias or in need of electrical therapy must also be monitored (and therapy delivered) by the LifePak 1 OC. The Propak monitors do not have defibrillation / cardioversion or pacing ability. ITEM 2 (Crew Safety Gear) Currently our flight crews wear army surplus nomex flight suits, some of which do not fit well as they are in generic sizes. There is no other safety gear available for them to wear during flight, such as safety vests and head/eye protection. C. ITEM 1 (LifePak 12) Monroe County Fire Rescue proposes the purchase of one Medtronic LifePak 12, with a high visibility screen; electrical therapy capacity (defibrillation, cardioversion and pacing). Since the LifePak 12 delivers Bi-Phasic energy, current delivered to the patient can be reduced, resulting in less tissue/muscle damage. The high visibility screen will provide easier to read tracings in flight, and assist the flight medic in delivering the appropriate care. The LifePak 12 was chosen since it is used throughout our county and will interface with our electronic field data collection system. ITEM 2 (Crew Safety Gear) In order to ensure the continued safety of our personnel, MCFR will purchase new Nomex flight suits individually fitted for each crew member. This will provide protection from blood borne and other pathogens, as well as a measure of protection from a possible fire in the cabin. Also included in our proposal is a safety/survival vest, identical to those worn by the pilots. These incorporate a life vest and a "spare air" survival cylinder, essential since a vast majority of our transports take the aircraft over open water to the mainland. Helmets will provide eye and hearing protection, and greatly enhance communications between the flight crews in the patient area, communications with ground crews and also the receiving facilities. EMS Grant Application 10. .Justification Summarv, Attachment Page 2 of 2 D. ITEM 1 (LifePak 12) Nlonroe County is pursuing an expansion of the availability of trauma services throughout the Keys, and enhancing the level of care and service the helicopter can provide might aid in our pursuit of this end. Any enhancements to staff and equipment are a selling point in obtaining further funding from the residents in the area (such as the addition of the LifePak 12). Owing to the unique geography of the Florida Keys; the volume of visitors and seasonal residents; and distances to a trauma facility. the helicopter remains a vital link in the chain of survival for many of our trauma victims. The fight medics cannot perform their duties if they are not protected from injury themselves. If these projects are not funded, operations will continue as they are now, but might impact further local funding for our trauma helicopter. E. ITEM 1 (LifePak 12) ITEM 2 (Crew Safety Gear) ivlonroe County Fire Rescue provides EMS services to residents and visitors to the Florida Keys, from mile marker 4.5 (Cow Key channel bridge) to Mile Marker 113 (Miami -Dade county line), exclusive of the municipalities of Marathon (mile marker 40-56) and Islamorada ( mile marker 73-90); although we do provide mutual aid to these cities as well as the City of Key West. The helicopter serves all trauma and critical care patients throughout the county. F. ITEM 1 (LifePak 12) ITEM 2 (Crew Safety Gear) Time frame: BOCC approval to expend matching funds (after receipt of award): 3 months. BOCC approval to purchase equipment (Bid Process): 2 months. Order of equipment, receipt of equipment and outfitting aircraft/crews: 3 months. Total time frame: 8 months. G. Not Applicable. No quantitative data H. ITEM 1 (LifePak 12) ITEM 2 (Crew Safety Gear) This project and request does not duplicate any other grant project or request previously or currently in submission through the State of Florida Department of Health or any other entity. Next, only complete one of the following: Items 11, 12, or 13. Read all three and then select and complete the one that pertains the most to the preceding Justification Summary. 11. Outcome For Proiects That Provide or Effect Direct Services To Emergency Victims: This may include vehicles, medical and rescue equipment, communications, navigation, dispatch, and all other things that impact upon on -site treatment, rescue, and benefit of emergency victims at the emergency scene. Use no more than two additional one sided, double-spaced pages for your response. Include the following. A) Quantify what the situation has been in the most recent 12 months for which you have data (include the dates). The strongest data will include numbers of deaths and injuries during this time. B) In the 12 months after this project's resources are on-line, estimate what the numbers you provided under the preceding "(A)" should become. C) Justify and explain how you derived the numbers in (A) and (6), above. D) What other outcome of this project do ycu expect? Be quantitative and explain the derivation of your figures. E) How does this integrate into your agency's five year plan? 12. Outcome For Training Projects: This includes training of all types for the public, first responders, law enforcement personnel, EMS and other healthcare staff. Use no more than two additional one sided, double-spaced pages for your response. Include the following: A) How many people received the training this project proposes in the most recent 12 month time period for which you have data (include the dates). B) How many people do you estimate will successfully complete this training in the 12 months after training begins? C) If this training is designed to have an impact on injuries, deaths, or other emergency victim data, provide the impact data for the 12 months before the training and project what the data should be in the 12 months after the training. D) Explain the derivation of all figures. E) How does this integrate into your agency's five year plan? 13. Outcome For Other Projects: This includes quality assurance, management, administrative, and other. Provide numeric data in your responses, if possible, that bear directly upon the project and emergency victim deaths, injuries, and/or other data. Use no more than two additional one sided, double- spaced pages for your response. Include the following. A) What has the situation been in the most recent 12 months for which you have data (include the dates)? B) What will the situation be in the 12 months after the project services are on-line? C) Explain the derivation of all numbers. D) How does this integrate into your agency's five year plan? DH Form 1767, Rev. 2002 EMS Grant Application 11. Outcome For Proiects That Provide or Effect Direct Services to Emeraencv Victims Attachment Page 1 of 1 A./B. ITEM 1 (LifePak 12) ITEM 2 (Crew Safety Gear) During the first year of the helicopter's operation (3/1/02 — 3/I/03), we transported 62 patients. These patients included High Index trauma alert patients (no patients are flown on Paramedic judgment criteria alone), and critical care medical patients. We are currently in our second year of operation, so far (3/l/03— 10/23/03), we have transported 49 patients, again all high index trauma alert patients to trauma centers or Critical care medical patients to specialized care facilities ( Miami Heart Institute, etc) Monroe County does not have a Trauma Center, and the three local hospitals have limited surgical capabilities (This situation has grown worse in recent months in light of the malpractice insurance issues). There is no foreseeable downward trend in the number of patients we will be transporting in the future. ' C. ITEM 1 (LifePak 12) ITEM 2 (Crew Safety Gear) Patient transport numbers in (A/B) above derived from statistical data, recorded at Fire Rescue Headquarters. D. ITEM 1 (LifePak 12) ITEM 2 (Crew Safety Gear) Enhanced level of care provided to our patients, and increased level of safety for our flight crews. E. ITEM I (LifePak 12) ITEM 2 (Crew Safety Gear) Within the next five years we anticipate the acquisition of a next generation aircraft; however all of the equipment and gear will be wholly transferable and applicable to the new aircraft. Skip Item 14 and go to Item 15, unless your project is research and evaluation and you have not completed the preceding Justification Summary and one outcome item. 14. Research and Evaluation Justification Summary. and Outcome: You may use no more than three additional one sided, double spaced pages for this item. A) Justify the need for this project as it relates to EMS. B) Identify (1) location and (2) population to which this research pertains. C) Among population identified in 14(B) above, specify a past time frame, and provide the number of deaths, injuries, or other adverse conditions during this time that you estimate the practical application of this research will reduce (or positive effect that it will increase). D) (1) Provide the expected numeric change when the anticipated findings of this project are placed into practical use. (2) Explain the basis for your estimates. E) State your hypothesis. F) Provide the method and design for this project. G) Attach any questionnaires or involved documents that will be used. H) If human or other living subjects are involved in this research, provide documentation that you wilt comply with all applicable federal and state laws regarding research subjects. 1) Describe how you will collect and analyze the data. 15. Statutory Considerations and Criteria: The following are based on s. 401.113(2)(b) and 401.117, F.S. Use no more than one additional double spaced page to complete this item. Write N/A for those things in this section that do not pertain to this project. Respond to all others. Justify that this project will: A) Serve the requirements of the population upon which it will impact. B) Enable emergency vehicles and their staff to conform to state standards established by law or rule of the department. C) Enable the vehicles of your organization to contain at least the minimum equipment and supplies as required by law, rule or regulation of the department. D) Enable the vehicles of your organization to have, at a minimum, a direct communications linkup with the operating base and hospital designated as the primary receiving facility. E) Enable your organization to improve or expand the provision of: 1) EMS services on a county, multi county, or area wide basis. 2) Single EMS provider or coordinated methods of delivering services. 3) Coordination of all EMS communication links, with police, fire, emergency vehicles, and other related services. UH Form 1767, Rev. 2002 EMS Grant Application 15. Statutory Considerations and Criteria, Attachment Pace 1 of I A. ITEM 1 (LifePak 12) ITEM 2 (Crew Safety Gear) Due to the distances involved in trauma transport from Monroe County to a SARTC, and the limited surgical capabilities of the local facilities in the Keys, any enhancement to our air transport service will have a positive impact on the residents and visitors to Monroe County. B. ITEM 1 (LifePak 12) ITEM 2 (Crew Safety Gear) While already in compliance with rule, we will be enhancing the equipment used to deliver care. C. ITEM 1 (LifePak 12) ITEM 2 (Crew Safety Gear) See (B) above. D. ITEM 1 (LifePak 12) ITEM 2 (Crew Safety Gear) In the request for the crew safety gear (Item 2), the helmets have integrated communication devices, enhancing the crew's ability to communicate with the operating base and the receiving facility. This currently requires two separate radio systems. E. ITEM 1 (LifePak 12) ITEM 2 (Crew Safety Gear) Award of this grant request will enhance all of items E.1), E.2), and E.3). 16. Work activities and time frames: Indicate the major activities for completing the project (use only the space provided). Be reasonable, most projects cannot be completed in less than six months and if it is a communications project, it will take about a year. Also, if you are purchasing certain makes of ambulances, it takes at least nine months for them to be delivered after the bid is let. Work Activity Number of Months After Grant Starts Seek Board of County Commissioner's approval to expend matching funds (after Begin End receipt of award) 1 Month 3 Months Board of County Commissioner's approval te Purehase (bid �3 Months 5 Months equipment process) Order of equipment, receipt of equip- 5 Months 8 ment, and outfitting aircraft/crews I 17. County Governments: If this application is being submitted by a county agency, describe in the space below why this request cannot be paid for out of funds awarded under the state EMS county grant program. Include in the explanation why any unspent county grant funds, which are now in your county accounts, cannot be allocated in whole or part for the costs herein. The reason this request cannot be paid for out of funds awarded under the State DIS County Grant Program is because we have just completed the implementation phase of an electronic field data collection system. The first phase was to get the system up and running in the unincorporated areas of the county, then eYland to all other areas. A portion of the County Award Grant from 2002 and n11 of 03 and 20O4's funds have been pledged tn, and completely expended on this �* DH Form 1767, Rev. 2002 18. Bud et: Salaries and Benefits: For each position title, provide the amount of salary per hour, FICA per hour, fringe benefits, and the total number of hours. Costs Justification: Provide a brief justification why each of the positions and the numbers of hours are necessary for this project. N/A TOTAL: Expenses: These are travel costs i and the usual, ordinary, and incidental expenditures by an agency, such as, commodities and supplies of a consumable nature, excluding expenditures classified as operating capital outlay (see next category). Costs: List the price and source(s) of the price identified. Justification: Justify why each of tree . expense items and quantities are necessary to this project. N/A TOTAL: $ un rorm i iot, Rev. zuuz Vehicles, equipment, and other Costs: List the price Justification: State why each of the items operating capital outlay means of the item and the and quantities listed is a necessary equipment, fixtures, and other source(s) used to component of this project. tangible personal property of a identify the price. non consumable and non expendable nature, and the normal expected life of which is 1 ear or more. Meacronic i e a W high definition screen, Pacer Defi rillator Cardi - version, adapter cable fo field reporting tablets, (25) Flight Suits - Nomex for EIS flight personnel) $ 8,050* Provides rotection/utilitv (25) Survival vest including flotation & spare air, Cu--tom made to conform to specs cf pilots. $ 22,500* Safety for over water transport (25) Helmets - helicopter compatible w/visor, noise attenuation, & communica- Enha a comet ca ion• r vide * eye, searing sea prbt�cgion TOTAL: $ 62,300 State Amount (Check applicable program) ® Matching: 75 Percent $ 46,725 0 Rural: 90 Percent $ Local Match Amount (Check applicable program) ® Matching: 25 Percent $ 19,979 0 Rural: 10 Percent $ Grand Total $ DH Form 1767. Rev. 2002 0 19. Certification: My signature below certifies the following. I am aware that any omissions, falsifications, misstatements, or misrepresentations in this application may disqualify me for this grant and, if funded, may be grounds for termination at a later date. I understand that any information I give may be investigated as allowed by law. I certify that to the best of my knowledge and belief all of the statements contained herein and on any attachments are true, correct, complete, and made in good faith. I agree that any and all information submitted in this application will become a public document pursuant to Section 119.07, F.S. when received by the Florida Bureau of EMS. This includes material which the applicant might consider to be confidential or a trade secret. Any claim of confidentiality is waived by the applicant upon submission of this application pursuant to Section 119.07,F.S., effective after opening by the Florida Bureau of EMS. I accept that in the best interests of the State, the Florida Bureau of EMS reserves the right -to reject or revise any and all grant proposals or waive any minor irregularity cr technicality in;' proposals received, and can exercise that right. I, the undersigned, understand and accept that the Notice of Matching Grant Awards will be advertised in the Florida Administrative Weekly, and that 21 days after this advertisement is published I waive any right to challenge or protest the awards pursuant to Chapter 120, F.S. I certify that the cash match will be expended between the beginning and ending dates of the rant and will be used in strict accordance with the content of the application and approved budget for the activities identified. In addition, the budget shall not exceed, the department, approved funds for those activities identified in the notification letter. No funds count towards satisfying this grant if the funds were also used to satisfy a matching requirement of another state grant. All cash, salaries, fringe benefits, expenses, equipment, and other expenses as listed in this application shall be committed and used for the activities approved as a part of this rant. Acceptance of Terms and Conditions: If awarded a grant, I certify that I will comply with all of the bove and also accept the attached grant terms and conditions and acknowledge this by signing below. i nature of AuthotTzed Grant Signer MM / DD / YY (Individual Identified in Item 2) DH Form 1767. Rev. June 2002 MONROE COUNTY ATTORNEY AOM97 10 FLORIDA DEPARTMENT OF HEALTH EMS GRANT PROGRAM REQUEST FOR GRANT FUND DISTRIBUTION In accordance with the provisions of Section 401.113(2)(b), F. S., the undersigned hereby requests an EMS grant fund distribution for the improvement and expansion or continuation of pre -hospital EMS. DOH Remit Payment To: Name of Agency: Board of County Commissioners, Monroe County, Florida Mailing Address: 490 63rd Street, Marathon, Florida 33050 Federal Identification Number 5 9 6 0 0 0 7 4 9 Authorized Agency Official: �� / 9 0 3 Si re Date Dixie M. Spehar, Mayor i Type Name and Title Sign and return this page with your application to: 4= • Florida Department of Health BEMS Grant Program MONROE COUNTY ATTORNEN 4052 Bald Cypress Way, Bin C18 APPROVED AS T M• Tallahassee, Florida 32399-173 ZANN A. HUTTON Do not write below this line. For use by Bureau of Emergency Meckr,@tRKAVf VIor�nTRPNly Grant Amount For State To Pay: $ Approved By: Signature of EMS Grant Officer State Fiscal Year: - Grant ID Code: Organization Code E.Q.. OCA Obiect Code 64-25-60-00-000 N N2000 7 Federal Tax ID: VF Grant Beginning Date: DH Form 1767P, Rev. June 2002 Grant Ending Date: Date 'v3 11 EMS MATCHING GRANT APPLICATION FLORIDA DEPARTMENT OF HEALTH Bureau of Emergency Medical Services Complete all items unless instructed differently within the application of Grant Reauested: IX I Rural I I Matchi . ID. Code (The State Bureau of EMS will assign the ID Code - leave this blank) 1. Or anization Name: Board of County Commissioners, Monroe County, Florida 2. Grant Signer: (The applicant signatory who has authority to sign contracts, grants, and other legal documents. This individual must also sign this application) Name: Dixie M. S ehar Position Title: Mayor Address: 500 Whitehead Street City: Key West County: Mnnrnp State: Florida Zip Code: 33040 Telephone: Fax Number: E-Mail Address: 3. Contact Person: (The individual with direct knowledge of the project on a day-to-day basis and responsibility for the implementation of the grant activities. This person may sign project reports and may request project changes. The signer and the contact person may be the same.) Name: Clark 0. Martin, Jr. Position Title: Fire Chief Address: 490 63rd Street Ocean, Suite 160 City: Marathon County: Monroe State: Florida Zip Code: 33050 Telephone: (305) 289-6004 Fax Number: (305) 289-6336 E-mail Address: martin-clark@monroecounty-fl.gov DH Form 1767, Rev. June 2002 3 4 (1) ❑ Private Not for Profit (Attach documentation-501 (3) ©] (2) ❑ Private For Profit (3) ❑ City/Municipality/Town/Village (4) County (5) ❑ State (6) ❑ Other (specify): 5. Federal Tax ID Number (Nine Digit Number). VF5 9_6 0_0 0_7 4 9 6. EMS License Number: 002176 Type: RRTransport ❑Non -transport ❑Both 7. Number of permitted vehicles by type: 0 BLS 9 ALS Transport 2 ALS non -transport. 8. Type of Service (check one): BRescue ❑Fire ❑Third Service (County or City Government, nonfire) ❑Air ambulance: ❑Fixed wing ❑Rotowing ❑Both ❑Other (specify) 9. Medical Director of licensed EMS provider: If this project is approved, I agree by signing below that I will affirm my authority and responsibility for the use of all medical equipment and/or the provision of all continuing EMS education in this project. [No signature is needed if medical equipment and professional EMS educ io are not in this project.] Signature: Date: 10/30/2003 MONROE COUNTY ATTORNEY Print/Type: Name of Director Dr. Sandra Schwemmer / 9FPRO�VRM: FL Med. Lic. No. OS 4022 SUZANNEW H� TTON SIS tvT �OUDfLY TIORNEY Note: All organizations that are not licensed EMS providers must obtain the signature of the medical director of the licensed EMS provider responsible for EMS services in their area of operation for projects that involve medical equipment and/or continuing EMS education. If your activity is a research or evaluation project, omit Items 10, 11, 12, 13, and skip to Item Number 14. Otherwise, proceed to Item 10 and the following items. 10. Justification Summary: Provide on no more than three one sided, double spaced pages a summary addressing this project, covering each topic listed below. A) Problem description (Provide a narrative of the problem or need); B) Present situation (Describe how the situation is being handled now); C) The proposed solution (Present your proposed solution); D) Consequences if not funded (Explain what will happen if this project is not funded); E) The geographic area to be addressed (Provide a narrative description of the geographic area); F) The proposed time frames (Provide a list of the time frame(s) for completing this project); G) Data Sources (Provide a complete description of data source(s) you cite); H) Statement attesting that the proposal is not a duplication of a previous effort (State that this project doesn't duplicate what you've done on other grant projects under this grant program). DH Farm 1767_ Rev 4 EMS Grant Application 10. Justification Summarv, Attachment Pabe 1 of 2 A. ITEM 1 (LifePak 12) Monroe County Fire Rescue has been using a military surplus UH-I helicopter, outfitted and licensed for ALS transport/Transfers since March, 2002. Some medical equipment for the aircraft was purchased with grant funds (ProPaq Encore Monitor and Eagle Ventilator); however other equipment necessary to outfit the aircraft was taken form reserves and backup inventory throughout our system. The LifePak IOC currently in use for patient Defibrillation and Pacing uses older monophasic technology; is subject to greater interference while in flight; and the display is extremely small and difficult to see. ITEM 2 (Crew Safety Gear) Military surplus safety equipment is currently used by the flight crews on the aircraft. All of the equipment is functional, but in varying states of repair and quality. Crews attending the patients are not afforded the same safety equipment as are the pilots at this time. B. ITEM I (LifePak 12) Currently patients are monitored by one of the two ProPak EKG monitors installed in the aircraft. Patients at risk for cardiac dysrhythmias or in need of electrical therapy must also be monitored (and therapy delivered) by the LifePak 1 OC. The Propak monitors do not have defibrillation / cardioversion or pacing ability. ITEM 2 (Crew Safety Gear) Currently our flight crews wear army surplus nomex flight suits, some of which do not fit well as they are in generic sizes. There is no other safety gear available for them to wear during flight, such as safety vests and head/eye protection. C. ITEM 1 (LifePak 12) Monroe County Fire Rescue proposes the purchase of one Medtronic LifePak 12, with a high visibility screen; electrical therapy capacity (defibrillation, cardioversion and pacing). Since the LifePak 12 delivers Bi-Phasic energy, current delivered to the patient can be reduced, resulting in less tissue/muscle damage. The high visibility screen will provide easier to read tracings in flight, and assist the flight medic in delivering the appropriate care. The LifePak 12 was chosen since it is used throughout our county and will interface with our electronic field data collection system. ITEM 2 (Crew Safety Gear) In order to ensure the continued safety of our personnel, MCFR will purchase new Nomex flight suits individually fitted for each crew member. This will provide protection from blood borne and other pathogens, as well as a measure of protection from a possible fire in the cabin. Also included in our proposal is a safety/survival vest, identical to those worn by the pilots. These incorporate a life vest and a "spare air" survival cylinder, essential since a vast majority of our transports take the aircraft over open water to the mainland. Helmets will provide eye and hearing protection, and greatly enhance communications between the flight crews in the patient area, communications with ;round crews and also the receiving facilities. EMS Grant Application 10. Justification Summary, Attachment Page 2 of 2 D. ITEM 1 (LifePak 12) Monroe County is pursuing an expansion of the availability of trauma services throughout the Keys, and enhancing the level of care and service the helicopter can provide might aid in our pursuit of this end. Any enhancements to staff and equipment are a selling point in obtaining further funding from the residents in the area (such as the addition of the LifePak 12). Owing to the unique geography of the Florida Keys; the volume of visitors and seasonal residents; and distances to a trauma facility, the helicopter remains a vital link in the chain of survival for many of our trauma victims. The fight medics cannot perform their duties if they are not protected from injury themselves. If these projects are not funded, operations will continue as they are now, but might impact further local funding for our trauma helicopter. E. ITEM 1 (LifePak 12) ITEM 2 (Crew Safety Gear) Monroe County Fire Rescue provides EMS services to residents and visitors to the Florida Keys, from mile marker 4.5 (Cow Kev channel bridge) to Mile Marker 113 (Miami -Dade county line), exclusive of the municipalities of Marathon (mile marker 40-56) and Islamorada ( mile marker 73-90); although we do provide mutual aid to these cities as well as the City of Key West. The helicopter serves all trauma and critical care patients throughout the county. F. ITEM 1 (LifePak 12) ITEM 2 (Crew Safety Gear) Time frame: BOCC approval to expend matching funds (after receipt of award): 3 months. BOCC approval to purchase equipment (Bid Process): 2 months. Order of equipment, receipt of equipment and outfitting aircraft/crews: 3 months. Total time frame: 8 months. G. Not Applicable. No quantitative data H. ITEM 1 (LifePak 12) ITEM 2 (Crew Safety Gear) This project and request does not duplicate any other grant project or request previously or currently in submission through the State of Florida Department of Health or any other entity. Next, only complete one of the following: Items 11, 12, or 13. Read all three and then select and complete the one that pertains the most to the preceding Justification Summary. 11. Outcome For Proiects That Provide or Effect Direct Services To Emergency Victims: This may include vehicles, medical and rescue equipment, communications, navigation, dispatch, and all other things that impact upon on -site treatment, rescue, and benefit of emergency victims at the emergency scene. Use no more than two additional one sided, double-spaced pages for your response. Include the following. A) Quantify what the situation has been in the most recent 12 months for which you have data (include the dates). The strongest data will include numbers of deaths and injuries during this time. B) In the 12 months after this project's resources are on-line, estimate what the numbers you provided under the preceding "(A)" should become. C) Justify and explain how you derived the numbers in (A) and (B), above. D) What other outcome of this project do you expect? Be quantitative and explain the derivation of your figures. E) How does this integrate into your agency's five year plan? 12. Outcome For Training Projects: This includes training of all types for the public, first responders, law enforcement personnel, EMS and other healthcare staff. Use no more than two additional one sided, double-spaced pages for your response. Include the following: A) How many people received the training this project proposes in the most recent 12 month time period for which you have data (include the dates). B) How many people do you estimate will successfully complete this training in the 12 months after training begins? C) If this training is designed to have an impact on injuries, deaths, or other emergency victim data, provide the impact data for the 12 months before the training and project what the data should be in the 12 months after the training. D) Explain the derivation of all figures. E) How does this integrate into your agency's five year plan? 13. Outcome For Other Projects: This includes quality assurance, management, administrative, and other. Provide numeric data in your responses, if possible, that bear directly upon the project and emergency victim deaths, injuries, and/or other data. Use no more than two additional one sided, double- spaced pages for your response. Include the following. A) What has the situation been in the most recent 12 months for which you have data (include the dates)? B) What will the situation be in the 12 months after the project services are on-line? C) Explain the derivation of all numbers. D) How does this integrate into your agency's five year plan? DH Form 1767, Rev. 2002 EMS Grant Application 11. Outcome For Projects That Provide or Effect Direct Services to Emergencv Victims Attachment Page I of I A./B. ITEM 1 (LifePak 12) ITEM 2 (Crew Safety Gear) During the first year of the helicopter's operation (3/1/02 — 3/l/03), we transported 62 patients. These patients included High Index trauma alert patients (no patients are flown on Paramedic judgment criteria alone), and critical care medical patients. We are currently in our second year of operation, so far (3/l/03— 10/28/03), we have transported 49 patients, again all high index trauma alert patients to trauma centers or Critical care medical patients to specialized care facilities ( Miami Heart Institute, etc) Monroe County does not have a Trauma Center, and the three local hospitals have limited surgical capabilities (This situation has grown worse in recent months in light of the malpractice insurance issues). There is no foreseeable downward trend in the number of patients we will be transporting in the future. C. ITEM 1 (LifePak 12) ITEM 2 (Crew Safety Gear) Patient transport numbers in (A/B) above derived from statistical data, recorded at Fire Rescue Headquarters. D. ITEM 1 (LifePak 12) ITEM 2 (Crew Safety Gear) Enhanced level of care provided to our patients, and increased level of safety for our flight crews. E. ITEM 1 (LifePak 12) ITEM 2 (Crew Safety Gear) Within the next five years we anticipate the acquisition of a next generation aircraft; however all of the equipment and gear will be wholly transferable and applicable to the new aircraft. Skip Item 14 and go to Item 15, unless your project is research and evaluation and you have not completed the preceding Justification Summary and one outcome item. 14. Research and Evaluation Justification Summary, and Outcome: You may use no more than three additional one sided, double spaced pages for this item. A) Justify the need for this project as it relates to EMS. B) Identify (1) location and (2) population to which this research pertains. C) Among population identified in 14(B) above, specify a past time frame, and provide the number of deaths, injuries, or other adverse conditions during this time that you estimate the practical application of this research will reduce (or positive effect that it will increase). D) (1) Provide the expected numeric change when the anticipated findings of this project are placed into practical use. (2) Explain the basis for your estimates. E) State your hypothesis. F) Provide the method and design for this project. G) Attach any questionnaires or involved documents that will be used. H) If human or other living subjects are involved in this research, provide documentation that you will' comply with all applicable federal and state laws regarding research subjects. 1) Describe how you will collect and analyze the data. 15. Statutory Considerations and Criteria: The following are based on s. 401.113(2)(b) and 401.117, F.S. Use no more than one additional double spaced page to complete this item. Write N/A for those things in this section that do not pertain to this project. Respond to all others. Justify that this project will: A) Serve the requirements of the population upon which it will impact. B) Enable emergency vehicles and their staff to conform to state standards established by law or rule of the department. C) Enable the vehicles of your organization to contain at least the minimum equipment and supplies as required by law, rule or regulation of the department. D) Enable the vehicles of your organization to have, at a minimum, a direct communications linkup with the operating base and hospital designated as the primary receiving facility. E) Enable your organization to improve or expand the provision of: 1) EMS services on a county, multi county, or area wide basis. 2) Single EMS provider or coordinated methods of delivering services. 3) Coordination of all EMS communication links, with police, fire, emergency vehicles, and other related services. UH f-orm 1767, Rev. 2002 EMS Grant Application 15. Statutory Considerations and Criteria, Attachment Page 1 of 1 A. ITEM 1 (LifePak 12) ITEM 2 (Crew Safety Gear) Due to the distances involved in trauma transport from Monroe County to a SARTC, and the limited surgical capabilities of the local facilities in the Keys, any enhancement to our air transport service will have a positive impact on the residents and visitors to Monroe County. B. ITEM 1 (LifePak 12) ITEM 2 (Crew Safety Gear) While already in compliance with rule, we will be enhancing the equipment used to deliver care. C. ITEM 1 (LifePak 12) ITEM 2 (Crew Safety Gear) See (B) above. D. ITEM 1 (LifePak 12) ITEM 2 (Crew Safety Gear) In the request for the crew safety gear (Item 2), the helmets have integrated communication devices, enhancing the crew's ability to communicate with the operating base and the receiving facility. This currently requires two separate radio systems. E. ITEM 1 (LifePak 12) ITEM 2 (Crew Safety Gear) Award of this grant request will enhance all of items E.1), E.2), and E.3). 16. Work activities and time frames: Indicate the major activities for completing the project (use only the space provided). Be reasonable, most projects cannot be completed in less than six months and if it is a communications project, it will take about a year. Also, if you are purchasing certain makes of ambulances, it takes at least nine months for them to be delivered after the bid is let. Work Activity Seek Board of County Commissioner's approval to expend matching funds (afte Number of Months After Grant Starts Begin End receipt of award) 1 Month 3 Months Board of County Commissioner's approval te 3 Months 5 Months purchase equipmene (bid process) -Order of equipment, receipt of equip— 5 Months 8 Months ment, and outfitting aircraft/crews I i ' I 17. County Governments: If this application is being submitted by a county agency, describe in the space below why this request cannot be paid for out of funds awarded under the state EMS county grant program. Include in the explanation why any unspent county grant funds, which are now in your county accounts, cannot be allocated in whole or part for the costs herein. The reason this request cannot be paid for out of funds awarded under th EMS County Grant Program is because we have just completed the implementation phase of an electronic field data collection system. The first phase was to get the system up and running in the unincorporated areas of the county. then expand to all other areas. A portion of the County Award Grant from 2002 and all of 20O3 and 20O4's funds have been pledged to, and comnlarPl3P.nhis naXd�,jt: H Form 1767, Rev. 2002 18. Budget: Salaries and Benefits: For each position title, provide the amount of salary per hour, FICA per hour, fringe benefits, and the total number of hours. Costs Justification: Provide a brief justification why each of the positions and the numbers of hours are necessary for this project. N/A TOTAL: Expenses: These are travel costs and the usual, ordinary, and incidental expenditures by an agency, such as, commodities and supplies of a consumable nature, excluding expenditures classified as operating capital outlay (see next category). Costs: List the price and source(s) of the price identified. Justification: Justify why each of the . expense items and quantities are necessary to this project. N/A TOTAL: $ DH Form 1767, Rev. 2002 Vehicles, equipment, and other Costs: List the price Justification: State why each of the items operating capital outlay means of the item and the and quantities listed is a necessary equipment, fixtures, and other source(s) used to component of this project. tangible personal property of a identify the price. non consumable and non expendable nature, and the normal expected life of which is 1 ear or more. riedEronic i e a W high definition screen, Pacer De i rillator Cardi - version, adapter cable fo field reporting tablets, (25) Flight Suits - Nomex for EMS flight personnel) $ 8,050* Provides protection/utility „ (25) Survival vest including flotation & spare air. Cu tom made to conform to specs cf pilots. $ 22,500* Safety for over water transports (25) Helmets - helicopter compatible w/visor, noise attenuation, & communica- Enha a comet ca ion• r vide * eye,�iearingniieatd prbt�c�ion TOTAL: $ 62,300 State Amount (Check applicable program) ❑ Matching: 75 Percent $ 0 Rural: 90 Percent $ 56,070 Local Match Amount (Check applicable program) ❑ Matching: 25 Percent $ Rural: 10 Percent $ 6,230 Grand Total $ DH Form 1767. Rev. 2002 19. Certification: My signature below certifies the following. I am aware that any omissions, falsifications, misstatements, or misrepresentations in this application may disqualify me for this grant and, if funded, may be grounds for termination at a later date. I understand that any information I give may be investigated as allowed by law. I certify that to the best of my knowledge and belief all of the statements contained herein and on any attachments are true, correct, complete, and made in good faith. agree that any and all information submitted in this application will become a public document pursuant to Section 119.07, F.S. when received by the Florida Bureau of EMS. This includes material which the applicant might consider to be confidential or a trade secret. Any claim of confidentiality is waived by the applicant upon submission of this application pursuant to Section 119.07,F.S., effective after opening by the Florida Bureau of EMS. I accept that in the best interests of the State, the Florida Bureau of EMS reserves the right to reject or revise any and all grant proposals or waive any minor irregularity or technicality in - proposals received, and can exercise that right. I, the undersigned, understand and accept that the Notice of Matching Grant Awards will be advertised in the Florida Administrative Weekly, and that 21 days after this advertisement is published I waive any right to challenge or protest the awards pursuant to Chapter 120, F.S. I certify that the cash match will be expended between the beginning and ending dates of the rant and will be used in strict accordance with the content of the application and approved budget for the activities identified. In addition, the budget shall not exceed, the department, approved funds for those activities identified in the notification letter. No funds count towards atisfying this grant if the funds were also used to satisfy a matching requirement of another state grant. All cash, salaries, fringe benefits, expenses, equipment, and other expenses as listed in this application shall be committed and used for the activities approved as a part of this rant. Acceptance of Terms and Conditions: If awarded a grant, I certify that I will comply with all of the above and also accept the attached grant terms and conditions and acknowledge this by signing below. ii l�9 /03 k_4ignaturp of Autlfbri7ed Grant Signer MM / DID / YY (Individual Identified in Item 2) Dn rutia,:a_, 67, Rev. June 2002 L. KO A CL MONROE COUNI'Y' Al`TORNE` A VED AS T F IQZANNE A. HLTTTON ASSISTANT COJr1N ATTORNEY date._.+... P2 ILI FLORIDA DEPARTMENT OF HEALTH EMS GRANT PROGRAM REQUEST FOR GRANT FUND DISTRIBUTION In accordance with the provisions of Section 401.113(2)(b), F. S., the undersigned hereby requests an EMS grant fund distribution for the improvement and expansion or continuation of pre -hospital EMS. Remit Payment To: Name of Agency: Board of County Commissioners, Monroe County, Florida Mailing Address: 490 63rd Street, Marathon, Florida 33050 Federal Identification Number 5 9 6 0 0 0 7 4 9 Authorized Agency Official: Si n ture Date p Dixie M. Spehar, Mayor Type Name and Title Sign and return this page with your application to: ,� MONROE COUN'fY ATTORN �..NY terK Florida Department of Health ROVED AS R BEMS Grant Program 052 Bald Cypress Way, Bin C18 UZA A. KTTON Tallahassee, Florida 32399-1738 ISTANTCOU,41Y&'WRNE' Do not write below this line. For use by Bureau of Emergency Medical Services personnel onl Grant Amount For State To Pay: $ Approved By: Signature of EMS Grant Officer State Fiscal Year: - Grant ID Code: Organization Code E.Q.. OCA Obiect Code 64-25-60-00-000 N N2000 7 Federal Tax ID: VF Grant Beginning Date: Grant Ending Date: DH Form 1767F, Rev. June 2002 Date 11