HomeMy WebLinkAbout990332 Tri-Area Ambulance District
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204 Oak Street • P.O. Box 708 • Frederick, Colorado 80530
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FEBRUARY 16 1999
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY
P.O. Box 758
GREELEY, CO 80632
DEAR BOARD OF COUNTY COMMISSIONERS;
ENCLOSED IS A COPY OF A GRANT WE SUBMITTED TO THE COLORADO DEPARTMENT OF HEALTH
AND ENVIRONMENT, PREHOSPITAL CARE PROGRAM. PER GUIDELINES OF THE GRANT COMMITTEE,
A COPY OF EACH GRANT SHALL BE SUBMITTED TO THE COUNTY COMMISSIONERS OF THE COUNTY
IMPACTED.
IF YOU HAVE ANY QUESTIONS OR IF I CAN PROVIDE FURTHER INFORMATION, PLEASE DO NOT
HESITATE TO CONTACT ME.
RESPECTFULLY,
TRI-AREA AMBULANCE DISTRICT
JUDY Y
DISTRICT ADMINISTRATOR
PI
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Phone: (303) 833-4824 990332
Co"er fur Waiver_ Grant X
GRANT ABSTRACT •
Tri—Area Ambulance
Agency Name District Location: City Frederick County Weld
PROJECT AREA (Mark a'l that apply):
X Communications X MedicaURescue Equipment _Manual Automated Defibrillator
Extrication Training Continuing Education
Training Equipment Public Education Injury Prevention/Pier Projects
• Other
EMIiRGENCY VEHICLE:
X Ambulance Quick Response Rescue
Total dollar amount requested from the State $ 2,620.00 •
Total cash match provided by applicant $ 2,620.00
Total In-Kind match provided by the applicant $
Summarize in one paragraph:
1. The need for this project (for instance- Our county wide ambulance service has been BLS since its
inception. We have become a favorite retirement-spot for many Colorado residents in the past 5 years. The
complexity of our calls has increased along with the number. We want to upgrade to ALS within the next
year. We need to replace our worn out transport ambulance)
Tri-Area Ambulance District (TAAD) has experienced a significant increase in the number
of calls in the last several years due to increased industrial and housing growth and
increased vehicle traffic on major roadways serving the southwest part of weld 'county.
With the increase in calls the percentage of multiple patient incidents has also
increased. TAAD's goal is to acquire appropriate and adequate equipment to assess , treat
and safely transport multiple patients. In addition, TAAD would like to decrease the
amount of time it takes to mobilize an additional ambulance when needed.
2. A description of the project (for instance-Priority#/ We would like to upgrade the level of service
countywide to 24 hr ALS; a) training for 6 new EMT 1; b) 2 manual defibs; c)radios for EMT-Is, Priority#2
ambulance to replace 1980 Type 11 with 150,000 miles on it, etc.)
TAAD would like to supplement our current equipment with: Priority #1 - two pulse
oximeteis, Priority #2 - two child safety seats, Priority #3 - two intubation kits and
Priority #4: digital pagers for all staff members.
AN erage number of EMS runs yearly 772
Attachment A
LEGAL NAME OF AGENCY FEDERAL TAX ID
tread instructions carefully on this item)
Tri-Area Ambulance District 84-0988365 -
CONTACT PERSON PHONE (DAY) PHONE (NIGHT)
Judy Lay (303)833-4824 (303)833-5567
AGENCY MAILING ADDRESS
P.O. Box 708, Frederick, CO 80530-0708
STREET - CITY
LIP
204 (Yak Street Frederick, Colorado 80530
LEGAL STATUS OF AGENCY/ORGANIZATION (Mark all that apply):
_ PRIVATE NOT FOR PROFIT PRIVATE FOR PROFIT _COUNTY/CITY GOVERNMENT
_STATE AGENCY X SPECIAL DISTRICT OTHER
PROJECT AREA (Mark all that apply):
X Communications _ Training
MedicaVRescue Equipment _ Continuing Education
Manual_ Automated Defibrillator _ Training Equipment
Public Education _ Extrication
Other _ PIER/Injury Prevention Programs
Emergency Vehicle
Ambulance_ Quick Response
Rescue -
County Wide Grant _ Regional Grant _ State-wide Grant Individual Agency Grant
50% CASH MATCH REQUIREMENT MET _ WAIVER HAS BEEN REQUESTED
I,the undersigned,do hereby attest that the information contained within this application is true to the best of my kilo ledge. I
also attest that the County Commissioners from the areas impacted by this project will be provided a copy of this appl ation by
no later than 02/16/99 , I understand that my application will be disqualified should either of these statements in. untrue.
, WI\1:_J ± President
rINTAYAME TITLE
February 15. 1999
SIGNATURE' DATE
JUSTIFY WHY IS THIS PROJECT NEEDED(see instructions on opposite page)
Tri-Area Ambulance District (TAAD) is located in a rural setting that is rapidly
becoming a suburb of the Front Range, encompassing 81 square miles of district and
response area. This area includes 20 miles of major highway, 27 miles of paved county
road and over 70 miles of dirt roadway. Our closest hospital is 15 miles away and the
closest trauma center is 35 miles away. In addition to roads and highways, TAAD serves
the residents of the City of Dacono, Town of Firestone and Town of Frederick with a
combined estimated population of 7,500.
TAAD was established in 1985 to provide paid ALS service as a special tax district.
Ambulance service is available 24 hours a day, 7 days a week and is staffed by one
Paramedic and one EMT. Currently TAAD employs 5 full-time and 8 part-time Paramedics and
EMT's with plans to increase staff in 1999. Revenues are allotted for the maintenance of
two ALS ambulances, which are rotated weekly to reduce wear and tear. However, due to
limited equipment, some equipment is moved back and forth from one ambulance to the other
during the weekly ambulance rotation.
Alarm response in TAAD's service area has increased 46% since 1992 . (Based on 540
calls in 1992 and 786 in 1998.) Current annexations (over the last six months) by
Dacono, Firestone and Frederick include 13 sub-divisions and 5 business parks. (The weld
County Assessor's Office reports that the tax base increase from 1996 to 1997 was 12% for
the City of Dacono, 32% for the Town of Firestone and 31% for the Town of Frederick.)
The increase in alarm response is due not only to an increase in residential and
industrial growth but to an increase in traffic volume and accidents on the major
highways and interstates that service the southwest part of weld County. TAAD responds
to an eleven-mile section of 1-25 that accounts for 25% of TAAD alarms and includes a
high number of multiple patient occurrences. In 1997 TAAD responded to 143 calls on
Interstate 25 and in 1998 there were 200 calls on the Interstate for an increase of 40%
for Interstate 25, trauma incidents. The majority of 1-25 calls have multiple patients.
Nearly y: of all TAAD alarms are trauma related.
Limited, aging equipment for the District ambulances include one Pulse Oximeter
monitoring device (7 years old) which is shared by both ambulances and one intubation kit
per ambulance (both 10+ years old) . Maintaining only one Pulse Oximeter does not provide
for a backup in the event of equipment damage or failure causing major restrictions in
patient monitoring. One intubation kit per ambulance does not provide for multiple
patient or mass casualty incidents. One intubation kit allows management of the airway
for one patient at a time, to the detriment of additional patients. Cleaning and
sterilization prior to reusing intubation equipment requires taking the ambulance out of
service at the receiving hospital or keeping the ambulance out of service until they can
return to the District to get backup equipment. Recent changes in the "Minimum Equipment
List" of the Transportation Committee of the State Advisory Council on EMS, Section 12 of
the Rules pertaining to Emergency Medical Services provides for (12.1.6 Miscellaneous
Equipment) each ambulance to have a child safety seat. These requirements must be met
prior to licensing in 2000. The District does not have any infant safety seats and
currently utilizes the patient's infant seat, if available, or secures the infant to an
adult spine board. Communications within the District are far below the capabilities of
other Agencies within the County. TAAD employees provide their own pagers (if they have
them) and not all pagers have the same capabilities. Digital pagers and paging
capabilities need to be upgraded to meet the same standards as other Agencies within weld
County.
County Plan Reference(see instructions on opposite page):
weld County EMS Plan (2.3.6. IDENTIFY ANY AREAS NEEDING IMPROVEMENT - TREATMENT)
states equipment improvement as an area needing attention. The list specifically states
PULSE OXIMETRY EQUIPMENT and includes, by reference, additional individual agency needs
such as TAAD's request for intubation kits. The Weld County EMS Plan also identifies
(2.1.B. AREAS NEEDING IMPROVEMENT - COMMUNICATIONS) digital pagers and paging
capabilities (which have been acquired for some agencies in the county) as a needed
improvement to decreasing radio traffic and increasing efficient emergency response. In
addition, the County Plan identifies: incorporating new safety features in ambulances
(the 1998 updated 2.2.6.) . This reference, in addition to the new "minimum equipment"
required for licensing, shows integration of our request for child safety seats with the
countywide plan.
2
DESCRIPTION OF THE PROJECT AND HOW YOUR PROJECT UPGRADES EMS
(See instructions on opposite page)
It is TAAD's continued goal to fulfill it's Mission Statement of "delivering
emergency medical care that meets or exceeds our citizens expectations as provided by
skilled, dedicated professionals committed to quality, patient satisfaction and well
being". TAAD believes that to meet this goal their ambulances need to be stocked with
medical equipment and backup units adequate to assess and treat the patient(s) they care
for regardless of the age of the patient, the nature of the call or the number of
patients being treated. Having appropriate equipment to treat and safely transport
multiple patients is imperative to providing skilled, quality, professional emergency
medical service to area residents and to those passing through TAAD's service area. TAAD
also believes that immediate contact with staff members is essential in putting into
service an additional ambulance to meet the increased volume of calls that the service
area continues to experience. Increasing EMS personnel in 1999 is also a part of TAAD's
solution to handling the number of multiple and/or overlapping calls that are occurring
at an increased rate within TAAD's service area and additional salaries have been
budgeted for in 1999.
The purpose of this project is to increase equipment needed for both ambulances and
to have' additional backup equipment available, fulfilling TAAD's goal of continuing to
provide emergency medical service to citizens and travelers within the District.
Implementation of this project increases the quantity and quality of the patient services
provided to previously under-served populated areas. The "population boom" that the TAAD
service area is experiencing makes it increasingly difficult to maintain the high quality
standards that the District has set for itself. Keeping pace with the increasing
population growth of this area is essential to the health and welfare of the citizens we
serve. The ability to manage more than on patient at a time by having additional
intubation kits helps accommodate the increasing number of multiple patient incidents.
Adding two pulse oximeters allows the District to have a unit on each ambulance plus a
backup unit in case of equipment failure. New child safety seats , which are required
prior to 2000 licensing, are needed to safely transport infants. Providing all staff
with pagers that can be accessed with the newly acquired computer and paging program,
shortens the amount of time required to contact additional personnel when needed. Plans
for the immediate addition of EMS personnel and the providing of well stocked emergency
vehicles helps meet the long range goal TAAD has had since it's inception. TAAD plans to
fully implement these priorities by year end 1999 and has already begun taking steps to
increase needed staff.
Line item budget for Priorities 1-4
Priority # 1 Qty. 2 Portable Pulse Oximeter $1,460.00 each $2 ,920.00 total
Priority # 2 Qty. 2 Inflatable Pedi-Seat $350.00 each $700.00 total
Priority # 3 Qty. 2 St Fiber Optic Laryngoscope $650.00 each $1, 300.00 total
Priority # 4 Qty.20 Pagers $16.00 each $320.00 total
TOTAL EQUIPMENT AMOUNT: $5 ,240.00
3
How will the project provide for a long-term solution to the current problem?
This project provides for two pulse oximeters, two intubation kits, two child safety
seats and 20 pagers. Adding two pulse oximeters will give TAAD a backup in the event of
equipment failure and will also permit both ambulances to have the same equipment when
the need to have both ambulances in service arises. The purchase of two intubation kits
will give TAAD an additional kit on each ambulance in the event of multiple patients/mass
casualties and will provide backup units when only one ambulance is in service.
Acquiring child safety seats for each ambulance will make the patient more comfortable
and safer during transport and is also a pre-requisite to being licensed by Weld County
in 2000.
we anticipate that increasing equipment to the levels requested will meet the
District's need for those particular items for the next 5-7 years based on the current
rate of growth. TAAD's current expansion plans include hiring additional personnel in
1999-2003 to cover an additional ambulance placed in service on weekends and during
extreme weather conditions. with the additional requested equipment, we will be able to
staff and equip both ambulances. we do not anticipate having two ambulances in service
full-time until 2004-2006 at which time we will have need for an additional backup
ambulance and equipment. By the time two full-time ambulances are needed, tax revenues
(as property taxes are paid in arrears) and increased billings for increased transports
will have caught up with TAAD's budget needs. TAAD's 5-year plan includes budgeting for
the addition of another ambulance and adequate equipment. In addition, TAAD's EMS
professionals are dedicated team members who take care of the equipment they have as
shown by the age of the existing pulse oximeter (7 years old) and intubation kits (10+
years old) .
Solving the current problem of limited equipment will also accommodate the longer-
range goal of keeping pace with the increased service demands.
If this project is funded, how will the project be sustained in subsequent years?
Maintaining the levels of equipment we are requesting would be provided for in
future budgets.
List other any options you have researched to meet the need and provide dollar amounts of other options you have
explored.
The other options we have explored include purchasing disposable intubation kits.
At the current cost of a disposable kit ($67.00 and $82.65 plus blades) and taking into
consideration the length of service from a non-disposable kit - TAAD's figures show that
the purchase of a non-disposable kit is the most cost effective in the long run.
Other options for the remaining requested items have not been explored. We have
however, selected an equipment vendor (for the pulse oximeters, intubation kits and
infant seats) we have purchased equipment from before that offers good pricing, and
excellent warranty benefits.
Explain why this is the most cost-effective way of meeting the need.
Although the initial monetary outlay for the equipment purchases is high, over
time, given TAAD's history in caring for it's equipment, the cost per year of service
outweighs the purchase of disposable equipment.
4
EQUIPMENT LIST(Listing brands will not preclude applicant Iron,having to obtain bids for the generic equipment types)
(see instruction on opposite page)
Priority Quantity Description Cost
1 2 NONIN 5600 Pulse Oximeter, portable
with large LED displays, lightweight,
long life internal battery, adjustable
pulse tone. includes one finger clip
and one ear clip sensor, 9' patient
cable, battery charger and 1 year
warranty. $1,460 each $2,920.00
2 2 Responder Inflatable Pedi-Seat for
children from 20-40 pounds with 5 point
self-adjusting retractable restraint
system, clear plastic fill hose and CO2
cartridge. $350.00 each $ 700.00
3 2 ST Fiber Optic Laryngoscope with 5 blades
which can be sterilized with ethylene
oxide, rnld-rhpmi_cal disipfpr.tant and
can withstand repeated autoclaving.
Lightweight and operational in low temps.
without freezing. $650.00 each $1,300.00
Other 2 Pagenet pagers with voicemail
capabilities. $16.00 each $ 320.00
TOTAL $5,240.00
5
TRAINING LIST — NOT APPLICABLE
Fill in this form if this application is requesting training.
TITLE OF TRAINING COURSE:
TYPE OF TRAINING:
Has your agency been approved by the EMSP Division to conduct this program?
Yes No
If No,name the agency/training officer/coordinator who will conduct the training:
COST OF PROJECT:
How much of the total CASH cost of training project will be paid by:
The EMS GRANT The Agency Cash Match The Student Cash Match
S $ S
for each training list the foll"wing information:
Training #of Person Course Cost Travel Cost Total Cost
Type To be Per Person Per Person Per type of
Trained course
EMT Basic
EMT-I
EMT-P
First Resp.
Cont. Ed.
First Resp.
List any training equipment on Equipment List on page 5.
A DETAILED BUDGET BREAKDOWN IF THIS IS A MAJOR TRAINING PROJECT
6
COMMUNICATIONS
IF YOUR APPLICATION IS REQUESTING RADIO EQUIPMENT,THIS SECTION MUST BE COMI ,ETED. LIST
FREQUENCY AND RADIO SERVICE OF THE SYSTEM BEING DEVELOPED, MODIFIED OR UPGaADED.
If frequencies are UHF MED channels,put"Med Channels". If repeater operation, list both frequencies.
FREQUENCY RADIO SERVICE
If the communications system is shared with other public safety services,please indicate which service(mark all that apply)
Police Fire Highway Maintenance_ Other
• Major communications projects must provide a separate sheet of paper, with a functional diagram of th ,troposed
system.
▪ Major communications projects-IF A COMMUNICATIONS PLAN HAS BEEN DEVELOPED, PROVI+IE A COPY
OF THIS PLAN WITH THE APPLICATION(TI IE NEW SYSTEM MUST HAVE.AT A MINIMUM,A CONCEITUAL PLAN
PROVIDED WITH THIS APPLICATION)
New of upgraded communications system must provide technical engineering information.
I.Name and telephone number of individual providing technical specifications or responsible for answer questions regarding s ecifications..
Name Phone E-Mail
2. If technical engineering has not been completed,please pro)ide the name. telephone and cost quoted for the individual or agency you will be
using. •
Name Phone E-Mail _
3. Will you need to bid for development of technical specification for the system?
Yes No Estimated Cost
7
FILL IN THIS SECTION ONLY IF REQUESTING EXTRICATION EQUIPMENT
Location and type(RS-10, Hurst,etc.)Of nearest extrication equipment (place, distance in miles, travel time):
Do you have a written_or verbal_agreement to share extrication equipment?
If so, name of agency with whom you share:
Do any other agencies(i.e., fire, police, rescue) plan to share in the use of equipment bought with funding from this
grant?_Yes _No
If Yes, please list names:
How many of your agency's EMS runs required extrication equipment in the past year?_
Average time of extrication
a
DEFIBRILLATION INFORMATION SECTION
The following information should be available from your physician advisor.
Number of EMS runs in the past 2 years that were cardiac arrests _
Number of EMS runs in the past 2 years that were witnessed arrests _
Number of CPR starts that took place on your EMS runs in the past 2 years
BLS avg Response Time ALS Avg Response Time
Telephone CPR Yes_ No_
Citizen CPR Program_
Agencies required to have medical oversight for the use of Defibrillation must have the approval signature of the] Physician
Advisor here Date
OR attach a letter from their Physician Advisor approving their request as page 8a of this application.
as. -
8
PROJECT FUNDING
A) EMS Fund Request s $2,620.00
B) Local Government Share- Cash S $2,620.00
(List source) 1999 budgeted amount
C)Other Cash S
D)Total Cash Proj. Cost.(A+B+C) S $5,240.00
E)Dollar Estimate of In-kind match S
F)Total Program Cost(D+E) S $5,240.00
Describe the in-kind match you can provide:
9
Applicants Budget EMS PORTION -Cash flow Projection for next full Fiscal Year(this section is solely
for the EMS portion of the budget).
Anticipated - Anticipated '
Revenue Expenditures
Cash Balance at start of Operating Costs
your Fiscal Year $176,928.00 $305,697.00
Donations Salaries
$276,000.00
Special Dist Funding Capital Improvement
Mil Levy 6. 543 mils $301,560.00 $16,180.00
City/County Funding ' Loans(Explain)
Investment Income Other(Explain)
$4,000.00
Run Revenue $215,000.00
Other:(Explain)
Total $697,488.00 Total $597,877.00
Anticipated Cash Balance at the end of the FY $99,611.00
Explain the purpose of the cash balance(i.e. reserve, building fund,etc.) Reserve, Building fund
Explain any anticipated capital improvement expenditures: computer & software, office
furniture, ambulance equipment, pagers
Number of EMS runs per year 786 (1998)
Number of Transports per year 364 (1998)
Fee Structure Information: •
Does your agency bill for services Yes X No_(if not, please explain):
Rates:
Basic Life Support $250.00
Advanced Life Support $500.00
Charge per patient Mile $10.00
Charge for Unloaded Mile N/A
If your charges are much lower than other EMS providers in your area-please explain if there are barrie. 's to increasing
your rates: Recent inquiries by TAAD reveal our charges are comparable
to other service providers in the area.
to
Agency Portion of Budget - See instructions on opposite page
Anticipated Anticipated
Revenue - Expenditures
Cash Balance at start of Operating Costs
your fiscal year
Donations Salaries
Special Dist Funding Capital Improvement
Mil Levy
City/County Funding Loans(Explain)
Investment Income Other(Explain)
Other:(Explain)
Total Total
Anticipated Cash Balance at the end of the FY
Explain the purpose of the cash balance(i.e. reserve, building fund,etc.)
Explain any anticipated capital improvement expenditures:
•
II.
EMS PROVIDER INFORMATION
All of the information in this section is mandatory for your application to be considered complete. Please list only the
personnel that are trained or certified. Persons currently in training should not be listed in this section. If the number of
persons currently in training is pertinent to your application, list them in the project description narrative.
Years in Operation 14
TYPE OF SERVICE:
_ALS(EMT-P& EMT-1) BLS X Combination
Fire/Rescue service
X Transport 211_Non-transport 364 transports, 185 refusals
_Other(i.e.,Air,etc.)
Name of physician advisor(if agency has one) Dr. Donald Massey
PERSONNEL BY TRAINING LEVEL(number of each):
level of Training Number of Full Time Paid Number of Part Time Paid Number of Volunteers
EMT-B 1 5
EMT-I
EMT-P 4 3
First Responder Cert.
CPR,Other,etc. —J
PRIMARY Hospital transported to: Longmont United Hospital
Distance to PRIMARY Hospital: 15 miles
Average number of EMS Runs Annually: 772
Average number of Runs Annually:
12
EMS Provider Information(cont'd)
EMS Service Area and Geographic Description: (See Instructions)
Tri-Area Ambulance District was established in 1985, as a special tax district, to
provide ADVANCED LIFE SUPPORT (ALS) to the residents of the City of Dacono, Town of
Firestone, Town of Frederick and the surrounding rural area. TAAD was originally
established as a volunteer agency supported by thousands of volunteer hours from trained,
dedicated area residents. Today TAAD employs five full-time and eight part-time
Paramedics and EMT's with a combined medical knowledge and experience of over 50 years.
Plans to increase staff in 1999 are underway. Service is available 24 hours a day, seven
days a week by calling 911. Currently, revenue is generated from billing for transport
services and from property tax mil levies. Revenues are allotted for the maintenance of
two ALS ambulances, one in service and a second as backup and as an additional ambulance
when needed.
TAAD is located in a rural setting that is rapidly becoming a suburb of the Front
Range encompassing 81 square miles of district and response area. This area includes 20
miles of major highway, 27 miles of paved county road and over 70 miles of dirt roadway.
our closest hospital is 15 miles away and the closest trauma center is 35 miles away.
TAAD responds to an eleven-mile section of 1-25 that accounts for 25% of TAAD alarms and
includes a high number of multiple vehicle/patient occurrences. In 1997 TAAD responded
to 143 calls on 1-25 and responded to 200 calls on the Interstate in 1998 for a 40%
increase. With a majority of the highway being located along open terrain,
transportation of trauma patients to a trauma center is usually not accomplished by air
ambulance during inclement weather because they are usually grounded. Transport during
inclement weather is normally accomplished by ambulance, adding an additional 10 minutes
to transport time and increasing response times by 5-10 minutes.
TAAD serves the growing population of Dacono, Firestone and Frederick with an
estimated population of 7, 500. Annexations in the last six months for the three Tri-Town
cities include 13 sub-divisions and 5 business parks. The Weld County Asssessor's office
quotes the tax base increase for Dacono at 32%, Firestone at 31% and Frederick at 31% for
the years 1996 to 1997. TAAD responded to 786 calls in 1998 - a 46% increase over calls
in 1992 and epitomizes the population growth and increased traffic in the Tri-Town area.
The increase in alarm response is due not only to an increase in residential and
industrial growth but to an increase in traffic volume and accidents on the major
highways and interstates that service the southwest part of weld County. Nearly IS of all
TAAD alarms are trauma related.
Although the population of the Tri-Town area served by TAAD continues to increase,
for now at least - it still has that small town flavor. TAAD is proud to be involved in
Tri-Area activities and provides stand-by service to Frederick High School during
football season, Frederick Area Fire Protection District during fire safety week and the
Tri-Town area during Fiesta Days. Crewmembers, driving an "ambulance rig", participated
in Frederick High School 's Homecoming Parade and more recently in Dacono's Christmas
Parade and entered a "float" constructed by TAAD crewmembers. TAAD also provides free
blood pressure checks at the Tri-Town Senior Center every Thursday at 11 :30 P.M. and
attends the 9-Health Fair. An important part of the service offered by Tri-Area
Ambulance is to residents in the area that were here when this was a mining town. These
residents are elderly now and Tri-Area offers public assistance to them and welfare
checks at the request of family members and/or friends.
It is TAAD's continued goal to provide quality medical care to ALL the residents of
this area by providing skilled, professional EMS personnel equipped with appropriate and
adequate equipment.
13
EMS PROVIDER INFORMATION CONTINUED
EMS VEHICLES OWNED BY YOUR AGENCY -
Write in the number of vehicles owned of each type in the age group.If your agency does nut own vehicles please check h<re N/A
Type of Vehicle Ito 3 yrs old 4 to 7 yrs old 3 to I I vrs old II years or> Number&
Number& Mileage Number& Number& Mileage
Mileage Mileage
Type I I / I /
Type II
31,846
Type III 2 / 45,000 + (at /maintenance shop — nD exact miles)
Rescue Vehicle
First Response
Extrication Equipment
Age #of RS 10 Kits # Spreaders #Cutters # Rams #Air Bags
I to5yrs
6 yrs-older •
EMERGENCY MEDICAL EQUIPMENT OWNED BY YOUR AGENCY
Defibrillators:
Manual
3 1-3 years old _ 4 years or older
Semi-automatic or automatic
1-2 years old 3 years or older
Suction(electric/battery):
1-2 years old _ 3 years or older
Back Boards(number owned): 0
Stretchers:
4 Scoop _ Wire
14
COMMUNICATIONS EQUIPMENT
Mobile Radios(VHF):
Please check all agencies who use this equipment:
Fire X EMS Police
List the number of mobile radius(VHF)equipment you have in the correct age group:
2 0-5 years old _ 6-10 years old
11 years or older
Mobile Radios(UHF):
Please check all agencies who use this equipment:
• Fire X EMS Police
List the number of mobile radios(UHF)equipment you have in the correct age group:
2 0-5 years old _ 6-10 years old
I 1 years or older
Portables:
Please check all agencies which use this equipment:
_Fire XEMS Police
List the number of Portables you have in the correct age group:
3 0-5 years old _6-10 years old
_ II years or older
Pagers:
Please check all agencies this equipment is used by:
_Fire IEMS_Police
List the number of pagers you have in the correct age group:
0 0-5 years old _6-10 years old
_11 years or older
TRAINING EQUIPMENT OWNED BY YOUR AGENCY
Please list the equipment on the following lines:
Training Mannequins: 1 — Infant, 1 - Child, 1 - Adult
CURRENT FEE STRUCTURE:
$500.00 ALS $140.00 E-Tube
$250.00 BLS $140.00 Cardiac pacing
10.00 per mile $60.00 EKG
$100.00 disposable supplies $60.00 Oxygen
$25.00 Drugs
15 $80.00 IV Drug Therapy
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