HomeMy WebLinkAbout981811.tiff RESOLUTION
RE: APPROVE EMERGENCY MEDICAL SERVICE REPORT AND PLAN AND AUTHORIZE
CHAIR TO SIGN
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Board has been presented with an Emergency Medical Service Report
and Plan from the County of Weld, State of Colorado, by and through the Board of County
Commissioners of Weld County, on behalf of the Weld County Emergency Medical Services, to
the State Advisory Council on Emergency Medical Services, with terms and conditions being as
stated in said plan, and
WHEREAS, after review, the Board deems it advisable to approve said plan, a copy of
which is attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld
County, Colorado, that the Emergency Medical Service Report and Plan from the County of
Weld, State of Colorado, by and through the Board of County Commissioners of Weld County,
on behalf of the Weld County Emergency Medical Services, to the State Advisory Council on
Emergency Medical Services be, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized
to sign said plan.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 30th day of September, A.D., 1998.
BOARD OF COUNTY COMMISSIONERS
WEl p COUNTY, COLORADO/.
, f ///�/ S,T..x
ATTEST: LU �i��l� ,, l -tea � ����
Constance L. Har ert, Chair
Weld County Clerk to-the : - (b;- $ //011/1244
W. . ebster, Pro-Tem /.
BY: :.5'
Deputy Clerk to th-= &?
•7-_ "r' orge . Baxter
APB ED FORM:
Dale K. all
ounty A n y
Barbara J. Kirkmeyer
981811
1qm EM0007
urns
Community College
September 28, 1998
Mr. Don Warden
Weld County Government
915 — 10th Street
Greeley, CO 80631
Dear Don:
Here is the EMS plan for Weld County. It is similar to years past, with updates that will
effect our request for any grant monies from the Department of Health. Please call if you have
any questions.
The deadline for submitting the plan is October 1, 1998. I apologize for the short time
line on this. I needed to get information form several sources to complete the plan. If this poses
a problem, please let me know.
Thank you for your time. Please have your office call me when it is signed, so I can run
by and pick up the originals. Hope this finds you well.
Sincerely,
ra oster, EMT-P
EMS Coordinator Weld County
EMS Department Chair
Barbara E. Foster, BA, EMT-P
'm 5 Department Chair
Weld County EMS Coordinator
Community College
(970)330-8008 Ext.6449
5401 West 20th Street ' FAX(970)339-6622
P.O.Box 69 E-mail: bfoster@aims.edu
Greeley, CO
80632
981811
TIMELINE FOR SUBMITTING YOUR REPORT AND PLAN
Ongoing Technical assistance available
October 1 each year Deadline - 5 Copies of your report and plan must be
postmarked by this date and sent to the EMS Division
office at the address listed below. Reports and plans
not postmarked by this date will not be accepted and
funding will not be vrovided.
October-November Evaluation of your report and plan by the State
Advisory Council on EMS
November You will be informed as to the acceptance of your
report and plan - or requested to provide
additional information or make revisions.
December 1 each year Revised copies of your report and plan must be
mailed to the address below and postmarked no
later than December 1 .
December Evaluation of resubmitted plans
Jan. each year Payments will be made to Counties that have complied
with the requirements of the law.
Mail your plan to:
The State Advisory Council on EMS
c/o The Department of Public Health & Environment
Emergency Medical Services & Prevention Division
4300 Cherry Creek Drive South, EMSD-ADM-A3
Denver, CO 80222-1530
Phone 303-692-2987 or 2980
Revised 6/97
1
991E 1
EMERGENCY MEDICAL SERVICE REPORT AND PLAN SUBMITTED BY:
NAME OF COUNTY
WELD
DATE PLAN SUBMITTED: September 1998
CONTACT PERSON - the person responsible for submitting
this application (this person should be able to answer all
questions pertinent to the content and development of your
county report and plan).
Name Barbara Foster
Address Aims Community College
PO Box 69
Greeley, CO 80632
Phone number (970) 330-8008 extension 6449
Other Phone numbers: (970) 535-4106
County Commissioners Office (970) 356-4000
County Administrator Office (970) . 356-4000
County Financial Officer (970) 356-4000
Revised 6/97
2
981811
SECTION I -
LICENSING AND INSPECTION
1 .1 COUNTY RESOLUTION, LAWS OR ORDINANCES
Please answer the following questions regarding your current regulations governing
ambulance services.
Most county resolutions need to be reviewed on a regular basis.
When was your last review? 1998
1 .2 AGENCY RESPONSIBLE FOR LICENSING, INSPECTING AND REGULATING
AMBULANCE SERVICES
AGENCY OR GOVERNMENT ENTITY Weld County Health Department
CONTACT PERSON Charlotte Davis TITLE Environmental Health Specialist
ADDRESS 1517 — 16`" Avenue Court, Greeley, CO 80631
PHONE (970) 353-0635 extension 2239
NAME OF PERSON DOING PHYSICAL INSPECTION OF AMBULANCE:
Lyle Moore Jr. TITLE Environmental Health Specialist
ADDRESS 1517 — 16th Avenue Court, Greeley, CO 80631
PHONE (970) 353-0635 extension 2223
1 .3 INSPECTION AND LICENSING - PROCESS
1 . How often do you license ambulance services? Annually X Semi-Annually
2. How often do you physically inspect ambulances? Annually X Semi-Annually
3. Are the policies and procedures for licensure of ambulances included in your county
resolution? Yes X No_
4. In your inspection of ambulances, do you verify that the vehicle equipment
conforms with the minimum essential equipment list contained within the Colorado
Board of Health Rules? Yes X No
If not explain:
Revised 6/97
3
981811
EMERGENCY MEDICAL SERVICES
SERVICE: AMBULANCE: DATE: TIME:
AMBULANCE EQUIPMENT CHECKLIST
(Basic Life Support)
EMERGENCY SYSTEMS: MEDICAL EQUIPMENT&SUPPLIES:
(Cont.)
—Flashing red lights —Irrigation(sterile solution&50 mI syringe)
-Radio communications _I.V.solution,D-5W,250 ml(4) *
—Siren _I.V.solution,volume expander, 1,000 ml (4)*
—Oxygen and Suction _I.V.administration sets 15 gtt(4)&60 gtt(4)*
_I.V.venipuncture sets*
MEDICAL EQUIPMENT & SUPPLIES: -a sterile,obstetrical
Litter,portable
—Adjustable gurney (4 wheeled) —Light diagnostic
—Airways,nasopharyngeal and oropharyngeal, —Mask surgical(2)
Adult to Infant —Newborn heat retention cap
_Aluminum Foil,silver swaddler —0x gen,portable (2"E"tanks)
or porta-warmer —Oxygen canulas,nasal(4)
—Bag Valve Mask 1000 cc with —Oxygen masks,non-rebreather,four adult&
four child
masks&oxygen reservoir
—Bag Valve Mask 500 cc with —Poison treatment kit-30 ml Ipecac and activated
masks and oxygen reservoir charcoal
_Bandages,self-adhesive,roller —Pads,prep,alcohol&betadine
Bandages,triangular _Pads,sterile,eye
_Bite Stick —Shears,heavy duty
—Blankets(4) —Spine board,long,with straps adult&pediatric
—Blood pressure manometer,large —Spine board,short,with straps or extrication
— device
Blood pressure manometer,med.
—Blood pressure manometer,sail. —Splints&arm boards(assorted)
—Bulb suction —Splint,traction,lower extremity
—Burn Sheets(2) —Stethoscope
_Cervical collars,rigid,adult —Stretcher,stair chair,with
to child&"no neck"sizes wheels(optional)
— Stretcher,scoop
Compartmentalized pneumatic —
Suction unit,portable with
Trousers,three compartment* —
Constricting band rigid tips and soft catheters
—Cutter,ring(optional) 5 Fr.through 14 Fr.
_Dressings,sterile 4"x 4" —Tape,adhesive,2" (two rolls)
_Dressing s,sterile 10"x 36"
—Eye protection,crew
_Gloves sterile,2 pr. ADDITIONAL EQUIPMENT &
-Gloves,non sterile, one box SUPPLIES
—Head immobilization devices,
adult and pediatric Advanced and Intermediate
life support
*IF REQUIRED BY THE PHYSICIAN
ADVISOR FOR THE SERVICE SEE SEPARATE LIST
981811
AMBULANCE EQUIPMENT CHECKLIST
(Cont)
SAFETY EQUIPMENT:
"No Smoking"sigt (patient compartment)
_Fire extinguishers(2.5 lb)(One accessible inside,one accessible from outside)
_Safety belts-including squad bench
_"Sharps"collector
_Flash light or lantern
_Spare tire and tools
_Triangular warning reflectors
_Radio equipment
_Vehicle condition(state motor vehicle regulations)
_Restraining devices for all items in patient compartment
COMMENTS:
SIGNATURE: SIGNATURE:
(Ambulance Representative)
991811
Requirements for Advanced Life Support-Intermediate
1. All equipment listed under"Basic Life Support Ambulance"
2. Adult and pediatric endotracheal intubation equipment per physician protocol.
Pediatric sizes for endotracheal tubes uncuffed range of 2.5-5.5 and cuffed range of
5.0-8.0: and laryngoscope blades straight and/or curved of 0-3.
3. Monitor/defibrillator with tape write out and adult EKG electrodes and paddles. For a
manual model monitor/defibrillator you must have pediatric EKG electrodes and
paddles or paddle adapters by July 1995 and the capability to dial down to appropriate
watt/seconds for pediatrics by July 30, 2005.
4. Pharmacologic agents per physician advisor protocol.
5. Pediatric equipment and drug dosage tape or age/weight chart.
Requirements for Advanced Life Support-Paramedic
All equipment listed under"Basic Life Support Ambulance and other equipment and
pharmacologic agents per physician advisor protocols.
THIS IS A SAMPLE FORM AND SHOULD BE MODIFIED BY THE
PHYSICIANADVISOR(S) IN THE COUNTY.
DEPARTMENT OF HEALTH AND ENVIRONMENT
EMERGENCY MEDICAL SERVICES
SERVICE: AMBULANCE: DATE: TIME:
AMBULANCE EQUIPMENT CHECKLIST
(Advanced Life Support)
EQUIPMENT: EQUIPMENT: (Cont.)
Blood Pumps(6) _Microdrip administration set,60 gtt/ml, (6)
_Chest decompression kit or angiocath, 10 gauge or _Monitor/Defibrillator(with adult and pediatric
12 gauge,with syringe paddles
_Cricothyrotomy tray or equipment _Nasogastric tube(sizes 16 or 18)
Delee suction units(size 8)(2) _Nebulizer
_Disaster pack(triage tags) _Obstetric kit or equipment
Endotracheal tubes,2 ea(cuffed 2.5,3,4, 5,& 5.5) _Radio,portable,hand held(Medical UHF
(cuffed 5,6,6 A,7,7 'A,8,&9) frequencies)
_Laryngoscope and blades(adult&pediatric curved _Suction catheters,(5 fr. To 14 fr.)
or straight) _Suction tips,rigid(6)
_MAST suit _Pediatric Drug Dosage Tape or Age/Weight Chart
_McGill forceps(adult&pediatric)
991811
MEDICAL EQUIPMENT & SUPPLIES
INTRAVENOUS FLUIDS: MEDICATION:
_D5W.250 ML BAGS(6) _Dopamine,200 mg/5 ml(2)
LR or NaCL, 1,000 ml bags(6) _Droperidol,2.5 mg/ml,2 ml amps(2)
_D5W or NaCL 50 ml bags(4) _Diphenhydtamine,50 mg/ml(2)
_Epinephrine, 1:1000, 1 mg/ml(2)
MEDICATIONS: _Epinephrine, 1:10,000.01 mg/ml(4)
_Furosemide,20 mg/ml(2)
_Glucagon, 1 mg(1)
_Adenosine,6 mg. (4)
Albuterol Sulfate Sol.2 mg,3 ml unit Dose Vials(2) —Ipecac,30 ml(2)
_Lidocaine,20%, I gm 5 ml (2)
_Atropine, 1 mg/5 ml(4)
_Bretylium,500 mg/10 ml(2) _Lidoca ne,2%, 100 mg/5 ml(4)
_Calcium chloride 10%, 1 gm/ 10 ml(2) _Magnesium sulfate,50%, 1 gm 2 ml(4)
_Morphine sulfate, 10 mg/ml(2)
_Charcoal, 50 g,2 bottles
Naloxone,4 mg(4)
_Dextrose,25%,250 mg/ml(1) _
_Dextrose,50%,500 mg/ml(1) _Nitroglycerine,sublingual,tablet or spray, one of
ea.
__Diazepam, 10 mg/2 ml(2) _Oxytocin 10 units/ml(2)
_Racemic Epinephrine(1)
_Sodium Bicarbonate,4.2%,5 meg/ 10 ml(4)
_Sodium Bicarbonate, 8.4%, 5 meg/5 ml
_Verapamil,5 mg/2 ml(2)
MONITOR/DEFIBRILLATOR OPERATIONAL CHECK
(OPTIONAL USE FORM)
Model:_Monitor Serial 4: Defibrillator Serial 4:_
PATIENT CABLES OUTPUT
_Lead 1 (white/black) _360 ws(338-382)
_Lead 2(white/red) _300 ws(282-318)
_Lead 3 (black/red) 200 ws(188-212)
_100 ws(94-106)
_Paddles 50 ws(47-53)
_Presentation _20 ws(18-22)
_Other
_Presentation
Recorder
COMMENTS:
981811
EMERGENCY MEDICAL SERVICES
APPLICATION
AMBULANCE SERVICE LICENSE
Date of Application:
Name of Ambulance Services:
(owner or parent company)
Doing Business As:
Address:
Name And Address Of Each Stockholder Or Partner owning 10% Or More
Of The Outstanding Stock Of The Company Or Having More Than A 10%
Ownership Interest(if applicable):
•
Name,Address And Phone Number of Manager Or Individual Responsible for
The Operation Of The Services:
What Area Of Your County Will Be Served By This Company? Please Attach A Map Indicating
Tne Service Area.
List All Location(Central Station And Sub Stations) where ambulances
are to be located. Attach Zoning Authorization If Appropriate.
How Many Ambulances Do You Operate?
If This Is An Initial Application(not a renewal application)Attach
981811
A SEPARATE Permit Request For Each Ambulance.
Provide Name And Address Of Your Insurance Carrier.
Name Of Agent:
ATTACH A CERTIFICATE OF INSURANCE TO THIS APPLICATION.
I HEREBY CERTIFY THAT THE INFORMATION PROVIDED IN THIS
APPLICATION IS TRUE TO THE BEST OF MY KNOWLEDGE AND BELIEF AND CONTAINS NO
WILLFUL MISREPRESENTATION OR FALSIFICATION.
DETERMINATION THAT AN AMBULANCE SERVICES LICENSE HAS BEEN ISSUED BASED ON FALSE
INFORMATION CONSTITUTES GROUNDS FOR LICENSE REVOCATION AND POSSIBLE CRIMINAL
PROSECUTION.
/ /
Signature of Applicant Date
SUBSCRIBED AND AFFIRMED BEFORE ME THIS DAY , 19_, IN THE COUNTY
OF ,STATE OF COLORADO.
Signature of Notary
My Commission expires:_/_/ _/
(For Office Use Only)
Date Received:_/ / / Documents Checked:
Fee Paid or Excused: Receipt#:
Remarks:
Approval Recommended(Y/N): Date Referred to B.O.C.C._/_/_/
Licensing Agent
991911
COUNTY
APPLICATION FOR AMBULANCE VEHICLE PERMIT
DATE: / /
NAME OF VEHICLE OWNER:
NAME OF AMBULANCE SERVICE:
ADDRESS:
CITY: STATE: ZIP:
TELEPHONE NUMBER
DESCRIPTION OF AMBULANCE:
YEAR: MAKE: MODEL(type): 4 WHEEL DRIVE(Y/N):_
MANUFACTURERS IDENTIFICATION NUMBER(1/I.N.):
COLORADO STATE LICENSE NUMBER(REGISTRATION NO.):
REGISTERED WITH THE STATE OF COLORADO AS AN EMERGENCY VEHICLE? (y/n):
DESCRIBE COLOR SCHEME,INSIGNIA,NAME,MONOGRAM AND OTHER DISTINGUISHING
CHARACTERISTIC:
DATE AMBULANCE PLACED IN SERVICE: / /
NORMAL LOCATION OF AMBULANCE:
INSURANCE COVERAGE ON THIS VEHICLE:
A.COMPANY:
B.AGENT:
C.BODILY INJURY:S /$
D.PROPERTY DAMAGE:$ /$
I HEREBY CERTIFY THAT THE INFORMATION PROVIDED IN THIS APPLICATION IS TRUE TO THE BEST OF MY KNOWLEDGE AND
BELIEF AND CONTAINS NO WILLFUL MISREPRESENTATIONS OR FALSIFICATION. SUBSEQUENT DETERMINATION THAT A
PERMIT HAS BEEN ISSUED BASED ON FALSE INFORMATION CONSTITUTES GROUNDS FOR PERMIT REVOCATION.
SIGNATURE OF APPLICANT DATE: /_/_/
SUBSCRIBED AN AFFIRMED BEFORE ME THIS_DAY OF I9_. IN THE COUNTY OF
STATE OF COLORADO.
SIGNATURE OF NOTARY: My Commission Expires: / /_
991911
(FOR OFFICE USE ONLY)
Date Received: / /
Documentation Verified:
Inspection Satisfactory(y/n):_Date: /_/_
Hold For:
Recommend Approval of Permit(y/n):
Comments:
SIGNATURE
9s1811
CERTIFICATE OF MOTOR VEHICLE CONDITION
DATE: / /
The undersigned,professing to be motor vehicle mechanic,has of this date, evaluated the mechanical
condition o the identified ambulance and determined that this vehicle is in safe operating condition.
Said evaluation does NOT warrantee future status of the ambulance due to conditions beyond my
control.
VEHICLE IDENTIFICATION NUMBER(V.I.N.):
VEHICLE OWNER:
EVALUATION CHECK LIST
ITEMS ACCEPTABLE NOT COMMENTS
ACCEPTABLE
Wheels&Tires
Steering
Alignment
Suspension
Brakes
Hand Brake
Lights
Electrical System
Glass
Exhaust System
Fuel System
Body&Sheet Metal
MECHANIC:
(SIGNATURE)
AGENCY ,ADDRESS
991811
5. COPY/COPIES OF THE FORM/S YOU USE TO LICENSE AND INSPECT
AMBULANCES MUST BE ATTACHED.
6. Do all of the licensed ambulance services within your county comply with the
statewide data collection program through the State EMS Division? Yes X No_
(IF THEY DO NOT COMPLY YOUR COUNTY WILL NOT BE ELIGIBLE FOR FUNDING)
1 .4 AMBULANCE AGENCIES LICENSED AND INSPECTED
SEE ATTACHED TRANSPORT AGENCY FORM, ATTACHMENT
A - THIS FORM MUST BE FILLED BY OR FOR EACH
TRANSPORT AGENCY WITHIN YOUR COUNTY AND SENT IN
WITH YOUR PLAN.
Revised 6/97
4
481811
Mute„u,Or ype Attachment A
Page 1 of 2 Pages
_ Emergency Medical Services(EMS)Plan
Transport Agency Profile
AgencyName Weld County Ambulance Service
Address 1121 M Street Greeley, Colorado 80631
Director Name Gary McCabe Phone No. 970-353-5700 x 13204
Fax No. 970-353-5700 x 13215 E-mail No. (If Applicable) dbressler@co.weld.co.us.
Private for Profit_ Non-profit X Special District_
Are YOIA Hespru Rand_ Fin Dad� NIA_
Agency Staffing Jr Treatment Profile:
TiticAevet Number of Full Time Number of Non compensated
Paid Part Time Paid • Volunteers
Basics 5 5 none
Intermediates 4 2 none
Paramedics 18 13 none
Nurses
n/a n/a nnno
First Responders y/a n/a none
How Many of Your Basics Are AEA Authorized: 10
Physician Advisor Name Jim Campain Phone:970-353-5700 x 13211
Address 1121 M Street Greeley Colorado 80631
Physician Advisor's Licensure Number5_2697 "
•
Number of Emergent EMS Runs per Year
Number of Non-Emergency Transports per Year_
Approximate Number of Inter-Hospital Transfers per Year
Name& Phone Number of Dispatching Agency/ies
weld County Reeional Comm. Phone 970-356-1212 EMD- ® No
Phone EMD- Yes No
'Includes volunteers paid per run
981811
Page 2 of 2 Pages
Transport Profile:
Ambulance Type Good Condition Fair Condition Poor Condition
and Age
Attach an Additional Sheet to List Ambulances as Necessary
** See attached list. All ambulance in good condition.
Training Profile:
Training Institution Most Often Used Aims Community College
Do You Provide Your Own Continuing Education X Yes _No
Name of CE Training Group Same as above.
Fee Structure Profile:
BLS ALS
Base Rau $420.00 $420.00
Rate per Mile Ain nn , S10 no
Medicare Rate Same Same
Non-Transport treatment/response fee S 78.00
Approximate Rate of Collection Q.L., Name of Agency doing your billing Weld County Ambulance
If You Have a Subscription Program,Please Describe the Fcc Structure: /Service
Do you have a CLIA permit for Blood Glucose Monitoring? Yes_ Nog
Do you have a computer available to personnel for computer based tra,.,ini ?? Yes_x No_
If"yes" - Computer operating system(circle one DOS WIN 3.1 (w+i`i 95) WIN 98 MAC
Processor Speed (circle oat) 486 P166 > 166
CD ROM? Yes x No
Please Return this Form To:
By this Date , _
Your County has ken required to hays this form filed art by each arontport agency at a part a!the manly EMS Plan.
gyms.agency form is not submittal with the Plan,the plan will be considered incomplete
411811
WELD COUNTY AMBULANCE SERVICE VIN NUMBERS
UNIT# MANUFACTURE DATB<
01 1993 FORD DIESEL
02 1993 FORD DIESEL
03 1995 FORD DIESEL
04 1994 FORD DIESEL
05 1994 FORD DIESEL
06 1995 FORD DIESEL/TURBO
07 1995 FORD DIESEL/TURBO
08 1996 FORD DIESEL/TURBO
09 1996 FORD DIESEL/TURBO
9S1811
Please pant or type
Attachment A
Page 1 of 2 Pages
_ Emergency Medical Services(EMS)Plan
Transport Agency Profile
Agency Name nn C‘dc,.n YY1s2&cc,,\ t-cocrA,nsei
Address 3fSC0 CCU'i\
Director Name Phone No. 303- 1011
Fax No. 303- S-torn E-mail No.(If Applicable) V .S`ce
Private for Profit X Non-profit_ Special District
An You: awns Sand_ Fue Par NA_
Agency Staffing&Treatment Profile:
Titlellevel Number of Full Tune Number of Non compensated
Paid Part Time Paid* Volunteers
Basics 1L0 ZO
Intermediates
Paramedics `S
Nurses
First Responders
How Many of Your Basics Are AED Authorized:3U'
Physician Advisor Name tir ttiv Phone: SOS-`90-2O37
Address NW esti\ Ace icSos., co ilok,z.
Physician Advisor's Licensure Number —
Number of Emergent EMS Runs per Year 724c)
Number of Non-Emergency Transports per Year 'tBCL
Approximate Number of Inter-Hospital Transfers per Year a?-�
Name&Phone Number of Dispatching Agency/ies
(1)QGL Phone 4LA- V/ EMD-(� No
I_GC- Phone �b-tanl-Scot EMD- Y Avno_ aoa-lpa-awoo •kO
*includes volunteers paid per run
.d991811
Transport Profile: Page 2 oft Pages
Ambulance Type Good Condition Fair Condition
Poor Condition
and Age
Attach an Additional Sheet to List Ambulances as Necessary
Training Profile: '\\
Training Institution Most Often Used & nor Cor w. silro,k
Do You Provide Your Own Continuing Education X Yes No
Name of CE Training Group(LioAor Gcu �1
Fee Structure Profile: * Fitt-Au),
BLS ALS
Base Rate
Rate per Mile
Medicare Rate
Non-Transport treatmendresponse fee$
Approximate Rate of Collection_% Name of Agency doing your billing
If You Have a Subscription Program, Please Describe the Fee Structure:
Do you have a CLIA permit for Blood Glucose Monitoring? Yes—No_
Do you have a computer available to personnel for computer based Yes x No__
If"yes"-Computer operating system(circle one DOS WIN 3.1 WIN 9,5r WIN 98 MAC
Processor Speed(circle one) 486 P166 >P16.
CD ROM? Yes X No,
Please Return this Form To: , „
By this Dar-_ _T
Your County has been required to have this form filed oar by each transport agency trepan of the county EMS Platt
if your agency form it not:abridged with the Plan,the pion will be considered incomplete
E 9S1811
Ambulance List American Medical Response
Boulder County 9/14/98
YEAR VIN
1989 1 FDHS34M1 KHC17150
1992 1 FDKE30M2NHB06405
1996 1 FDJS34F8THA70586
1994 1 FDJS34M4RHB31746
1995 1 FDJS34F8SHB61033
1996 1 FDJS34F1THB41899
1994 1 FDJE30M9RHB41962
1994 1 FDJE30M2RHB41964
_ 1997 1 FDJS34F2VHA60011
481 811
Pleats prim or type Attachment A
Page 1 of 2 Pages
_ Emergency Medical Services(EMS)Plan
Transport Agency Profile
Agency Name re, • A?9 F H lg 1,1 !R H ( tine e r 6/ T pre -n
Address 2.0 130x ripe / r2 PN O/It- Sr. fr r Pre tc D 80530
Director Name Phone No. (303) $33 -14 5241
Fax No.(3 t73') 83 3- 3 7 7&.. E-mail No.(If Applicable)
Private for Profit_ Non-profit Special District x
An You. HoeplW Baud_ FNe
Agency Staffing&Treatment Profile:
Title/level Number of Full Time Number of Non compensated
Paid Part Tbno Paid• Volunteers
Basics
Intermediates ! Cn
Paramedics _ `f
Nurses
_FirstResponders -9-
How Many of Your Basics Are AED Authorized: 21/9
04,204.
Physician Advisor Name He(k D f 3 k t^r Phone: (303 NSO N'!3 c
Address 4.5u go k,nom inIi'Cf1A. erg . q19 ) Gte.ntvrSr rN0Rntron, c3ozz`/
Physician Advisoes Licensure Number
Number of Emergent EMS Runs per Year (COO
Number of Non-Emergency Transports per Year.S
Approximate Number of Inter-Hospital Transfers per Year-2
Name&Phone Number of Dispatching APhone e c 851•/ies
3;H EMD- Yes X No
Wl:t.6 Cpu Ai-7
Phone EMD- Yes No
*Includes volunteers paid per run
r. 'd
9S1811
Page 2 of 2 Pagos
Transport Profile:
Ambulance Type Good Condition Fair Condition Poor Condition
and Age
/R4lo rent il X
I Co.1
Attach an Additional Sheet to List Ambulances as Necessary
Training Profile:
Training Institution Most Often Used J. S u 0" a /Lisa, if?f 4 r r /-lc CZ ed, e e i-
Do You Provide Your Own Continuing Education _Yes X No
NemcofCE Training Group nl SHMei40 tJ net f ale.ac C Trn-
Fee Stnictnre Profile:
BLS ALS
Base Rate s0.00 �O. oO
Rate per Mile t o 00 10.00
Medicare Rate a.60.00 5-00.00
Non-Transport treatment/response fee S
Approximate Rate of Collection % Name of Agency doing your billing
If You Have a Subscription Program,Please Describe the Foe Structure:
Do you have a CLIA permit for Blood Glucose Monitoring? Yes_ No_ iv/t1
Do you have a computer available to personnel for computer based training? Yes__ No X
If"yes"- Computer operating system(circle one)DOS WIN 3.1 WIN 95 WIN 98 MAC
Processor Speed(circle one) 486 P166 *166
CI)ROM? Yee No
Please Return this Form To:, „
By this Datk Your agency as a If your
County has f ken required to have this firm farm is not submitted with the Plan,lled out the plan will be each transport
d incomplete.part of the county EMS Plan.
IIPe agency
991811
1.5 LIST HERE ALL OTHER AGENCIES WITHIN YOUR COUNTY WHO PROVIDE
EMERGENCY MEDICAL SERVICES (i.e., search and rescue, fire, police, quick response
teams)
AGENCY NAME DIRECTOR ADDRESS PHONE
include zip code 970 Area code
unless stated
AIR LIFE OF LYNN MAIER 1801 - 16TH ST 350-6257
GREELEY GREELEY
80631
AULT PIERCE FIRE SANDY PO BOX 1146 834-2848
PROTECTION WINGFIELD AULT
DISTRICT 80610
BRIGGSDALE FIRE DUANE PO BOX 1 656-3503
PROTECTION HALVERSON BRIGGSDALE
DISTRICT 80611
EATON FIRE GARY GEISICK 224-1ST ST 454-2115
PROTECTION EATON
DISTRICT 80615
EVANS FIRE RANDY HOUCHEN 1100 - 37TH ST 339-5344
PROTECTION EVANS x117
DISTRICT 80620
FREDERICK FIRE DOMINIC CHIODA PO BOX 129 (303)
PROTECTION FREDERICK 833-2742
DISTRICT 80530
FORT LUPTON PHIL TIFFANY 1211 DENVER (303)
FIRE AVE 857-4603
DEPARTMENT FORT LUPTON
80621
GALETON FIRE BOB BOWERS PO BOX 697 454-3439
PROECTION EATON
DISTRICT 80615
HUDSON FIRE BOB DECHANT PO BOX 322 (303)
PROTECTION HUDSON 536-4202
DISTRICT 80642
JOHNSTOWN GREG SPAUR PO BOX 979 587-4477
FIRE PROTECTION JOHNSTOWN
DISTRICT 80534
Revised 6/97
5 951811
KERSEY FIRE CRAIG HERBST PO BOX 448 353-3890
DEPARTMENT KERSEY
80644
KODAK PLANT JEAN CLARK 9952 EASTMAN 686-4200
PROTECTION PKWY
WINDSOR
80551
LASALLE FIRE BRET SCHISSLER PO BOX 245 284-6336
PROTECTION LASALLE
DISTRICT 80645
MILLIKEN FIRE DAVE MEYER 101 S0. IRENE 587-4464
PROTECTION MILLIKEN
DISTRICT 80543
MOUNTAIN VIEW JOHN DEVLIN 9119 COUNTY (303)
FIRE PROTECTION LINE ROAD 772-0710
DISTRICT LONGMONT
80501
NEW RAYMER JOE KUGLER PO BOX 92 437-5713
FIRE PROECTION NEW RAYMER
DISTRICT 80742
NUNN FIRE ALVAN SHIPPS PO BOX 128 437-5713
PROTECTION NUNN
DISTRICT 80742
PAWNEE FIRE RODNEY PO BOX 66 895-2461
PROECTION ESHELMAN GROVER
DISTRICT 80729
PLATTEVILLE GLENN MILLER PO BOX 407 785-2322
GILCREST FIRE PLATTEVILLE
PROTECTION 80651
DISTRICT
SOUTHEAST MARK GRAY PO BOX 1 (303)
WELD FIRE KEENESBURG 732-4424
DISTRICT 80643
INCLUDES:
KEENESBURG,
ROGGEN AND
PROSPECT
VALLEY FIRE
DEPARTMENTS
Revised 6/97
6 991811
UNION COLONY BILL MARTIN 919 - 7TH ST 350-9500
FIRE RESCUE GREELEY
AUTHORITY 80631
WINDSOR/ STEVE LUTZ, SR 728 MAIN ST 686-2626
SEVERANCE FIRE WINDSOR
PROTECTION 80550
DISTRICT
Revised 6/97
7
991811
INTRODUCTION
COUNTY PLAN SECTION OF THE REPORT
The law enabling the County Subsidy program requires that all plans submitted
include a description of the existing system, deficiencies or improvements, and
goals and objectives. You will see that the format we are providing for submission
of your plan emphasizes this.
Do not reference page and paragraph numbers from a previous plan. Please fill in
all categories.
The format we are requiring is available on Word Perfect word processing program
6.1 and will be provided for your use upon request. To receive a copy of this
format on disk you must send a formatted disk to the EMSP Division (the address is
listed on the first page of this booklet). If you do not have a Word Perfect program
feel free to computerize the following format in your word processing program, use
this form, or retype it if necessary. This format will also be available on the EMS
web site, http://www.state.cous/gov_dir/cdphe_dir/em/emhom.html. EMS Regional
Coordinators will also have a copy on disk.
The following EMS representatives were active in the development of this report
and plan - please mark all that apply
County Health Department X
Physician Advisors X
County Wide EMS Council X
EMS Provider Agencies:
Ambulance Agencies X
Fire Departments X
Search & Rescue Providers X_
Clinics or Hospitals X
Dispatcher Communications X
Training Center Reps. X
Revised 6/97
8
991811
SECTION II - PLAN
ACCOMPLISHMENTS: (list any completed goals or accomplishments in the area of EMS in
your county)
Goal # & Obj # Type treatmentcomm.etc. description & accomplishment
Goal & Type of Goal Accomplishment/s
Objective (Treatment, etc.)
Number
Implemented preceptor program for ALS candidates
and their field instructors (WCAS)
UCFRA has begun construction of new fire station
in Greeley
2.2.C #1 Transportation WCAS increased on call ambulances by adding an
additional paramedic unit
2.1 .C #4 Communications Communications system has hired an additional five
dispatchers
2.1 .C #3 Communications Communications center has progressed to the final
stages for a county backup communications center
2.1 .C #3 Communications Communications center has upgraded their radio and
2.1 .C #6 phone systems for more efficient use
2.1 .C #5 Communications Communications center has upgraded software for
the EMD program
2.2.C #2 Transportation Air Life of Greeley took delivery of a new helicopter
and is now operational, training with EMS agencies
is ongoing
Johnstown Fire Department completed construction
for a new station to accommodate growth in the
area
Revised 6/97
9
991811
Hudson Fire District is planning a new station for
their district
2.3.C #2 Treatment Protocols have been distributed and all EMS
response agencies have completed training
2.3.C #2 Treatment Revisions to protocols have been ongoing
Treatment A regional ATAC has been established with
representation from all counties it serves
Treatment North Colorado Medical Center has been awarded a
Level II trauma center status
2.3.C #2 Treatment First Responder programs in the area volunteer
departments have expanded, are in accordance with
the Division of Fire Safety testing and curriculum
2.1 .C #5 Communications EMD has been implemented, all training completed
2.3.C #3 Treatment Weld County's Disaster Plan (Health and Medical
Annex) has been completed
2.3.C #2 Treatment Aims Community College has plans for an EMT-
Intermediate program to begin in the Spring 1999
Safety vests have been purchased for WCAS
employees
2.1 .C #3 Communications Communications in the eastern part of Weld County
has improved dramatically with the purchase of land
and construction of radio tower in the New Raymer
area
2.5.C #1 Optional- WCAS participated in the county health innoculation
Public Education program
LaSalle Fire District has completed construction of
their new fire station
2.4.C #1 Documentation WCAS has completed the initial set up for a
computerized trip reporting system
A server will be located at Station 1 with plans to
network the county for a computerized trip format
2.3.C #3 Treatment AED funding for UCFRA was approved for additional
units
2.1 .C #1 Communications Digital pagers have been leased for seven agencies
and WCAS to improve dispatch times and response
Revised 6/97
10
091911
2.2.C #4 Transportation All mutual aid agreements have been updated
including ambulance services (WCAS, Platte Valley,
AMR Cheyenne and Sterling)
2.2.C #2 Transportation Agreements are in place to house ALS ambulances
in LaSalle, Windsor, Johnstown, Fort Lupton, and
Platteville fire stations
2.3.C #2 Treatment ALS response has been improved by the addition of
EMT intermediates to UCFRA and WCAS personnel
2.3.C #1 Treatment Disaster drills were a great success at Loveland and
Kodak sites
2.3.C #1 Treatment Planning for a disaster drill at Fort St Vrain in
conjunction with the Dept of Energy progresses
2.3.C #2 Treatment Aims and WCAS plan advanced EMS training for
Critical Care Transport
2.1 .C #3 Communications New radios were purchased for Platteville and
Gilcrest Fire Departments
UCFRA has appointed a new fire chief
2.2.C #1 Transportation WCAS has appointed a new shift supervisor and
allocated staff to decrease the total number of hours
worked each week by field personnel
Revised 6/97
11
951811
2.1 .A EXISTING SYSTEM DESCRIPTION - COMMUNICATIONS
Describe your system. Include the following: 1 ) Functional description of paging,
dispatch, on scene and medical control, ambulance to ambulance, ambulance to
hospital, alternate communications, communications to air transport and other
agencies, etc. 2) System functional diagrams identifying dispatch, base stations,
control stations, repeaters, telephone lines, frequencies, etc. Include as much
detail as possible.
Weld County Regional Communications Center accepts and directs all calls for
emergency service through an Enhanced 911 system, using Emergency Medical
Dispatch (Medical Priority)procedures. Notification and information for emergency calls
are then paged to the appropriate agency. If the agency has digital pagers, an alpha
page is sent concurrently. The channels/frequencies are listed below:
Weld County EMS: VHF 155.400 (receive and transmit)
Fire A VHF 153.785 (receive and transmit)
Fire 8 VHF 154.145 (receive and transmit)
Fort Lupton Fire Dept VHF 154.235 (receive and transmit)
Union Colony Fire Resuce UHF 451.150 (receive)
458.150 (transmit)
Air Life of Greeley VHF 155.400 (receive and transmit)
North Colorado Medical Center
Medical control is established and maintained either through the use of cellular phones
or medical channels on the radio. Cellular phones are generally available for all fire
departments and WCAS personnel.
Digital paging has increased in the past year, with more agencies interested.
Emergency Medical Dispatch training has completed, and with the additional staffing of
five dispatchers, the communications center has seen some significant changes in the
past two years. All hardware and software is in place, after major remodeling and
restructuring.
A systems diagram is included for your review.
Revised 6/97
12 991 911
2.1 .B IDENTIFY AREAS NEEDING IMPROVEMENT - COMMUNICATIONS
Identify the changes or improvements you plan to make within your current
communications system. If none, please state "NONE", and move on to the next
component.
Complete installation of direct link from communications center to agencies
Complete Weld County Communications Center back-up site
Emergency Medical Dispatch
Train response agencies ref: dispatch codes and response modes
Conduct public education segments to inform citizens of the new program
Incorporate dispatch recommendations into county protocols
Address growth issues in county
Evaluate changing designations for agencies
Expanding channel capabilities
Redistricting for response agencies
Investigate the potential of GPS system for WCAS
Increase in numbers of radios and pagers for fire agencies
Revised 6/97
13 981 811
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2.1 .C State your goals and objectives and place them here.
Communications Goal# 1
Complete installation of direct link from communications center to agencies in
county
Communications Goal#2
Complete installation of equipment for communications back up site
Communications Goal#3
Emergency Medical Dispatch
To inform the general public about the EMD system and its components
Communications Goal#4
Emergency Medical Dispatch
To inform response agencies about the EMD system, response codes and
recommendations inherent in the system
Communications Goal#5
Emergency Medical Dispatch
Incorporate EMD parameters in to the county protocols to assure high
consistency and awareness of the EMD system
Communications Goal#6
Address growth issues in Weld County by evaluating the system ret channel
capabilities, agency designations and possible redistricting, to make more
efficient use of resources.
Communications Goal#7
Increase the effectiveness of communications transmissions by purchasing
additional portable radios and pagers by individual agencies.
Revised 6/97
14
Qs1s11
List the objectives (process by which you intend to accomplish this goal) and state
any progress toward attaining this communications goal.
Objective -- Goal# 1
Allocate resources to accomplish direct link capability, this process is under way
at this time.
Objective - Goal#2
Resources for the back up site have been identified, equipment is being
relocated from the active communications center, as new hardware was installed.
Objective - Goal#3
Conduct/offer EMD training sessions at the communications center for citizen
tours and information. Explore options for news advertisements and radio
announcements.
Objective - Goals #4
Incorporate information into the CME program to address agency concerns with
the new information that is being aired with the new EMD system, including response
codes and recommendations.
Objective - Goal #5
Review EMD protocols with the communications center staff and administration.
With advisement from the physician advisor, include EMD information in the existing
protocols when possible. Include this new information in the CME courses that are
currently being offered.
Objective - Goal#6
Communications staff and adminstrators, through the county 911 board will
discuss and investigate issues that are directly related to the enormous growth in the
county, specifically addressing
1. possible redistricting for fire/law responses
2. channel capabilities present and future needs
3. agency designations
Objective -Goal#7
At this time, growth in the county is increasing the numbers of members with
some agencies in the county. Assistance will be made available to them for grant
applications and alternative resources to procure needed radios and pagers.
Revised 6/97
15 9s1811
2.2.A EXISTING SYSTEM DESCRIPTION - TRANSPORTATION
Describe your current system. Include: 1 ) the number of ambulance agencies, quick
response units, search and rescue, and fire agencies within your county; 2) the
number of transport vehicles and their condition should be provided in Attachment
A, Transport Agency Profile; 3) Coverage; 4) Mutual Aid Agreements in place; and
5) coordination of resources.
At this time there are five entities that are licensed in Weld County for patient treatment
and transport. This only includes those with initial response areas in the County and
does not include mutual aid agreements with other agencies that reside outside Weld
County.
1. Air Life of Greeley (ALS air transport)
2. Weld County Ambulance Service (BLS and ALS transport)
3. Tri Area Ambulance Service (BLS and ALS transport)
4. American Medical Response (BLS and ALS transport)
5. Frederick Area Fire Protection Disctrict(BLS transport only)
Fire agencies are capable of transport by county resolution, only under certain
conditions.
Coverage is provided to the entire 4004 square miles of Weld County. Mutual aid
agreements are in effect with all agencies that have the potential for response within
the boundaries of Weld County.
Coordination of resources is accomplished with the following:
1. Active County EMS Advisory Council
2. Active representation on the established ATAC
3. Weld County Regional Communications Center dispatches the majority of the
emergency calls directly to the appropriate agencies. Weld County
Communications Center will notify other dispatch centers when necessary for
emergency responses.
Revised 6/97
16 991911
2.2.6 IDENTIFY ANY AREAS NEEDING IMPROVEMENT - TRANSPORTATION
Identify the changes or improvements you plan to make in your current EMS
transportation system. If none, please state "NONE", and move on to the next
component.
Investigate regional plans for listing all transport vehicles
Incorporate new safety features for ambulances
Expand MCI equipment and continue investigation of trailer for storage and transport
Review resolution 77D provisions for the transport of patients in Weld County
2.2.C State your goals and objectives and place them here.
Transportation Goal# 1
The EMS Advisory Council, Weld County Fire Chiefs Association and the
Emergency management office working together, should compile a fist for all
transport vehicles in the county.
Transportation Goal#2
WCAS will incorporate new features for safety of the crews in their ambulances.
Transportation Goal#3
Inventory and list all MCI equipment in the county. WCAS personnel are working
on the possibility of a vehicle to store and move equipment to areas of need.
Transportation Goal#4
Resolution 77D will need to be reviewed and critiqued for the efficacy of its
provisions for treatment and transport of patients in Weld County.
Revised 6/97 17 991811
Please list the objectives (process by which you intend to accomplish this goal) and
state any progress toward attaining this transportation goal.
Objective for Goal#1
At the respective meeting dates for the EMS. WCFCA and Emergency
Management, set a date for initial meeting, discussing the time lines, data to be
obtained and methods for compiling data. The deadline for completion of the
activity should be set with regard to all committee timelines and agency
commitments.
Objective for Goal#2
WCAS will research the latest safety features and aspects of ambulance
operations and make recommendations to the administration for implementation
in the 1998-99 year.
Objective for Goal#3
The inventory for equipment for MCI's can be accomplished in the same manner
as the inventory for transport vehicles listed in the first objective. WCAS
personnel are actively involved in the research for a trailer that can be used to
store and move equipment in the event of a large disaster, or MCI.
Objective for Goal#4
The EMS Advisory Council in the county should be actively involved in the review
of resolution 77O. Regular meeting dates could be utilized to explore the resolution,
assure that all provisions are still appropriate for the county growth that is occurring.
Recommendations are then to made to the County Commissioners for revisons.
Revised 6/97
18
9S1811
2.3.A EXISTING SYSTEM DESCRIPTION - TREATMENT
Describe your current system and include the following: 1 ) treatment protocols; 2)
destination policies; 3) medical control; 4) quality assurance; 5) manpower; 6)
training; 7) mass casualty; 8) Trauma specific policies, protocols and procedures
Please tell us how your EMS providers are working with their ATACS to develop
their trauma plan.
1. Treatment protocols-
Protocols were released to the county in the Fall of 1997. These protocols are to
apply to all care givers from First Responder to Paramedic. Training was
completed in February of 1998. Protocol review is scheduled for November
1998. New members to agencies are either trained in-house by approved
instructors, or at county sector meetings with the physician advisor held on a
quarterly basis.
2. Destination policies
Destination policies are dearly stated in the protocols.
3. Medical control
Currently on-line medical control is established for all EMS providers by radio or
phone communications, mostly through NCMC. Our physician advisor, Jim
Campain, currently oversees most ground EMS agencies. Air transport is
supervised by Tim Huchison.
North Suburban Medical Center provides physician advisor capabilities for
Mountain View Fire, Tri Area Ambulance and Frederick Fire.
Kersey Fire Department has made several changes in their membership and are
at this time petitioning for physician advisor with the same physician's group
sponsoring the majority of the agencies in the county.
4. Quality assurance is at this time the responsibility of the physician advisor, or his
designee. With the computerized system that will be implemented by WCAS, there
may be significant changes in the QI process. There continues to be random review
of most calls with attention to all ALS and AED calls at the fire agencies.
5. Manpower and staffing issues are addressed by each agency.
6. Training is provided by Aims Community College to those agencies that are
interested. Each agency assumes responsibility for training through their medical
Revised 6/97
19
9‘1811
training officer on the department. Training includes initial certification courses,
refresher courses and degree programs in EMS. Other training centers in the area
include Front Range Community College and Thompson Valley Ambulance.
7. Mass casualty and emergency preparedness issues have been addressed with the
update of the Weld County Disaster Plan. Work is continuing for the inventory and
allocation of equipment.
8. Trauma specific protocols, procedures and destination policies are dearly stated in
the protocol manual. CME course work reinforces and updates trauma information
on a regular basis.
9. There has been and continues to be, a dear and distinguished representation of
Weld County on the regional ATAC. Information from the ATAC meetings is brought
to the EMS Advisory Council and passed to each department by the sector
representatives serving on the Council, and/or, the newsletter that is distributed
throughout the county.
2.3.6 IDENTIFY ANY AREAS NEEDING IMPROVEMENT - TREATMENT
Identify the changes or improvements you plan to make within your current
treatment system. If none, please state "NONE", and move on to the next
component.
Review the existing infection control policy from NCMC. Once the review is completed,
assure that all agencies are familiar with the procedure for reporting and evaluation of a
potential exposure by rescue personnel.
Keep current on managed health care information, medicare, treat and release
procedures. refusals and other changes that effect the care given in the prehospital
setting.
F911411
txpiore possroniues ror researcn wim pauenr outcomes, using me new compurenzeo
trig reporting system.
Continue to identify training issues through needs assessments, surveys, and call
review.
Investigate possibilities and resources for CISD training to care for the care givers.
Revised 6/T
20
2.3.C Please list your goals and objectives and place them here.
Treatment Goal#1
Educate all EMS agencies ref.• new infection control procedures at NCMC.
Include information for each agency about the roles and responsibilities of all members
outlined in the policy.
Treatment Goal#2
Increase awareness of the implications for managed health care, treat and relase
procedures, medicare, refusals and other changes that effect EMS workers.
Treatment Goal#3
Track patient outcomes, based on criteria established by the WCAS.
Treatment Goal#4
Conduct appropriate, effective training throughout the county, through Aims
Community College CME offerings and special seminars in conjunction with Fire Science
programs.
Treatment Goal#5
With an increase in the population, and the additional strains on resources, we
need to pay special attention to the critical incidents that are becoming more frequent.
The goal would be to conduct and maintain training and information sessions for care
givers, spouses and the victims themselves.
Revised 6/97
9F'1AiZ
21
List the objectives (process by which you intend to accomplish this goal) and state
any progress toward attaining this treatment goal.
Objective for Goal#1
CME coordinator to work with staff at NCMC to assure that all procedures and
policies are explained, and information is available. CME coordinator to
implement training programs for all fire agencies, either through the CME
schedule or upon request
Objective for Goal#2
In order to use resources more effectively, train individuals to conduct refusals,
treat and release procedures and other on scene care. In addition, keep current
with managed health care guidelines, trends with medicare and medicaid
procedures, by attending meetings, seminars, and conferences. Conduct
training, informational sessions when necessary.
Objective for Goal#3
Using the new software programs that are to be available, track patient
outcomes based on treatment, location, time of response, or, other criteria
established that can be used to manage a more efficient system.
Objective for Goal#4
Conduct needs assessments, surveys, compile call review data to maintain
training topics that are consistent with protocols, and address areas of concern,
interest and need for individuals and agencies.
Objective for Goal#5
Conduct stress management dasses that target
1. the emergency worker
2. spouses, significant others of emergency workers
-and-
3. the victim or witness of critical events
Revised 6/97
22
9‘1811
2.4.A EXISTING SYSTEM DESCRIPTION - DOCUMENTATION
Describe your existing system and include the following: 1 ) Address any prehospital
care reporting system that your county may have other than the statewide data
collection system provided by the state; and 2) identify any medical quality control
measures your county may have in place to evaluate and improve medical care
Weld County does not have a county wide data-base at this time. There is a
system that is being initiated at WCAS to accommodate computerized trip reports. We
hope that this system will be the foundation for the future of computerized trip reports
in the county.
2.4.B IDENTIFY ANY AREAS NEEDING IMPROVEMENT - DOCUMENTATION
Identify the changes or improvements you plan to make within your current
documentation system. If none, please state "NONE", and move on to the next
component.
County wide data systems are indicated for the improvement of patient care,
consistency of quality control and physician monitoring.
2.4.C State your goals and objectives and place them here.
DOCUMENTATION GOAL # 1
Establish system for computerized trip reporting, beginning with Weld County
ambulance and gradually implement the system county wide. This will depend soley on
the capacity for the individual department and financial resources.
List the objectives (process by which you intend to accomplish this goal) and state
any progress toward attaining this documentation goal.
Objective A for Goal #1 -
Implement system at WCAS to serve as a "plot"for the county system.
Objective B for Goal#1
Conduct assessment to recommend changes or modifications for the system
before going "county wide'.
Revised 6/97
23
991811
2.5.A EXISTING SYSTEM DESCRIPTION -
OPTIONAL COMPONENT
State any component of your EMS system that has not already been identified and
describe what is in place in your county at this time.
Improve participation for EMS Week by fire and EMS agencies.
2.5.B IDENTIFY ANY AREAS NEEDING IMPROVEMENT -
Identify the changes or improvements you plan to make within your current system
in the above stated area.
Increase involvement in EMS Week activities.
2.5.C State your goals and objectives and place them here.
Goal#1
Increase involvement of fire and EMS agencies in EMS Week activities.
List the objectives (process by which you intend to accomplish this goal) and state
any progress toward attaining this goal.
Objective for Goal#1
Begin planning late in 1998 for all activities in the Spring, organizing committees and
volunteers through the EMS Advisory Council.
Revised 6/97
24
9.91911
SECTION III . - FINANCIAL
(THIS SECTION MUST BE ATTESTED TO BE YOUR COUNTY FINANCE OFFICER IN
ORDER TO DOCUMENT EXPENDITURES)
3.1 REPORT ON COUNTY SUBSIDY FUNDING
Are you currently holding over any county subsidy funds from the previous year/s?
Yes No X If so, how much $
List below the intent for use of any funds held over from previous years.
Date Payee Purpose Dollar Amount
t-'\7-if-3 of 9:
25
9. 19311
Please list below the expenditures of State provided EMS funds for the current
calendar year. You must fill in this section even if you delegated the responsibility
for expenditure of the funds, the State sees the County as the responsible party.
(All funds may not be expended at the time this report is filed, so please indicate
where the unexpended funds will be spent and mark those unexpended funds with
an "*"1
Date Payee Purpose Dollar Amount
1998 Weld County Funding EMS Coordinator All
I ATTEST TO THE FACT THAT INFORMATION CONTAINED IN THIS FINANCIAL
SECTION IS ACCURATE AND THAT THE COUNTY HAS DOCUMENTATION FOR
ALL EXPE DITURE : ' " I
I' ri ,
SIGNED: Qu I&f( ty TITLE: �t 2 ] �this form must a sig)aii
ed by the county official responsible for ounty financial
transactions.
Revised 6/97
26
9411 Ail
FINANCIAL NARRATIVE - (use this space to explain how the expenditure of funds
upgrade EMS in your county).
To supplement funding to the Weld County EMS Coordinator position through
Aims Community College.
Revised 6/97
27
99'1811
ANTICIPATED EXPENDITURES FOR NEXT YEAR'S SUBSIDY FUNDING: (Please use
this space to list anticipated expenditures - we realize that circumstances alter cases and you may not
necessarily expend your funds for these anticipated expenditures.) As of January 1, 1998 you must
make expenditures in accordance with Attachment A to your county contract with the EMSP Division.
Goal Number & Descrip. Type of Expenditure Approx. Dollar Amount
Most goals and objectives are
the responsilbility of the EMS Subsidize Salary All
Coordinator
Revised 6/91
28
COUNTY SUBSIDY PAYMENT DISTRIBUTION FORM
COLORADO EMERGENCY MEDICAL SERVICES
SUBSIDY PROGRAM FOR COUNTIES
In accordance with the provision of CRS 25-3.5-605, the undersigned hereby requests an EMS
county subsidy distribution payment for the improvement and expansion of prehospital EMS.
It is understood that payment is contingent upon approval of the statutatory reporting
requirements by the State Advisory Council on EMS and your county's contract with the State.
Payment To: Weld County Commissioners
Name of Board of County Commissioners (payee)
915 10th Street
Address
Greeley CO 80631
(City) (State) (Zip)
Authorizing County Official
SIGNATURE: ,/,/g? o). el,` tivtar DATE: 09/30/98
Printed Name: Constance L. Harbert, Chair Title:
SIGN AND RETURN THIS FORM ALONG WITH ALL REPORTING
DOCUMENTATION
This area for use only by Department of Public Health & Environment, Emergency
Medical Services & Prevention Division
Amount: $
Approved By: Date:
EMS - Pre-hospital Care Services Program
Fund Agency Appr Code Func Obi GBL
409 FLA 8300 FLWT 5120 008S
Revised 6/97
29
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