HomeMy WebLinkAbout972116.tiffRESOLUTION
RE: APPROVE COUNTY PLAN AND REPORT ON EMERGENCY MEDICAL SERVICES
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 a County Plan and Report on
Emergency Medical Services from the County of Weld, State of Colorado, by and through the
Board of County Commissioners of Weld County, on behalf of the Ambulance Services
Department, and the State Advisory Council on EMS, do, The Department of Public Health and
Environment, Emergency Medical Services and Prevention Division, 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 County Plan and Report on Emergency Medical Services from
the County of Weld, State of Colorado, by and through the Board of County Commissioners of
Weld County, on behalf of the Ambulance Services Department, and the State Advisory Council
on EMS, do, The Department of Public Health and Environment, Emergency Medical Services
and Prevention Division, 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 29th day of September, A.D., 1997.
BOARD OF COUNTY COMMISSIONERS
972116
tie: Ano
WELD4OUNTY, COLORADO
AM0010
Con Plan and Report
on
Emergency Medical Services
Distributed by:
Colorado Department of Public Health & Environment
Emergency Medical Services & Prevention Division
Prehospital Care Programs
4300 Cherry Creek Drive South
Denver, CO 80222-1530
(303)692-2987 or (303)692-2980
Distributed June 1997
972116
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 provided.
October -November Evaluation of your report and plan by the State
Advisory Council on EMS
November
December 1 each year
December
Jan. each year
Mail your plan to:
Revised 6/97
You will be informed as to the acceptance of your
report and plan - or requested to provide
additional information or make revisions.
Revised copies of your report and plan must be
mailed to the address below and postmarked no
later than December 1.
Evaluation of resubmitted plans
Payments will be made to Counties that have
complied with the requirements of the law.
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
1
972116
EMERGENCY MEDICAL SERVICE REPORT AND PLAN SUBMITTED BY:
NAME OF COUNTY
Weld
DATE PLAN SUBMITTED: 9-29-97
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
Emergency Medical Services Department
PO Box 69, Greeley, Colorado 80632-0069
Phone number (970) 330-8008 x 6449
Other Phone numbers: (303) 535-4106
County Commissioners Office (97O) 356-4000
County Administrator Office (970) 356-4000
County Financial Officer (970) 356-4000
Revised 6/97
2
Qwn� w e
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? 1997
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
ADDRESS 1517-16`h Avenue Court, Greeley, CO
PHONE (970) 353-0635 x 2239
NAME OF PERSON DOING PHYSICAL INSPECTION OF AMBULANCE:
Lyle Moore Jr. TITLE Environmental Specialist
ADDRESS 1517 - 16`h Avenue Court, Greeley, CO 80631
PHONE (970) 353- 0635 x 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
972116
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 6/91
4
SHELL: EAMB0I.EPS
FORM: A:\EAMBO1.FRM
* AMBULANCE APPLICATION
COVER LETTER *
DATE:
Certified Letter No.: P ***
TODAY
THIS WEEK
OTHER:
CERTIFIED
LEGAL ACTION
APPROVAL NEEDED?
STAMP: YES NO
ATTACHMENTS: YES NO
ADDITIONAL INSTRUCTIONS:
Dear
Enclosed are your application forms for 199 Licensure of your ambulance
service and ambulance vehicle permits. Weld County Ordinance Number 77—C,
Sections 3.10 and 3.16 states:
3.10 Obtaining or attempting to obtain any license or permit hereunder by
fraudulent means or misrepresentation shall be grounds for denial,
suspension, or revocation of such license or permit.
3.16 All licenses and permits shall be renewed annually, shall expire on
December 31 of the year issued, and shall not be renewed until the
application has been approved by the Department.
All applications for renewal of licenses and permits shall be made not
later than sixty (60 days) prior to the date of expiration. The
Department shall notify, by certified mail, return receipt requested,
each licensee of the renewal requirements of this section, within
ninety (90) days prior to the date of expiration.
Be advised that all vehicles, etc. are required to be inspected before a new
license can be issued. Therefore, please return your applications to
Environmental Protection Services by November 1, 199
972115
Ott .1,
COLORADO
Application year:
WELD COUNTY AMBULANCE
LICENSE APPLICATION
Application for Exempt Status: Yes No
1. Owner: Name:
DEPARTMENT OF HEALTH
1517 - 16 AVENUE COURT
GREELEY, COLORADO 80631
ADMINISTRATION (303) 353.0586
HEALTH PROTECTION (303) 353-0635
COMMUNITY HEALTH (303) 353-0639
Address:
Phone Number:
2. Operations Manager:
Name:
Address:
Phone Number:
3. List all Emergency Vehicles on the attached vehicle list.
4. Location and description of the place(s) from which this ambulance service
will operate. *
Street Number:
City: State Phone
Street Number:
City: State Phone
*If more than two locations, attach separate sheet with the above
information.
972116 1
Weld County Ambulance
License Application
Page 2
5. Physician advisor:
Name:
Address:
Phone Number:
6. What area(s) will you be serving?
7. List all emergency personnel who will be responding to an emergency with
your ambulance on the attached personnel list.
8. Proof of insurance, as required in Section 4.4 of Ordinance 77-C.
9. Vehicle Maintenance and Safety Inspection Protocol. Describe your vehicle
maintenance and safety inspection program including frequency and the
facility which performs inspections.
10. Provide a copy of the Colorado Department of Health E.M.S. approval of
your quality control program required in Section 3.2, Part B of the
Colorado Revised Statutes and Regulations on Emergency Medical Services.
11. Provide as required in Section 3.8-9 of Ordinance 77-C, a current copy of
E.M.T. or Paramedic Protocols adopted by the ambulance service in
accordance with standards approved by the Ambulance Services' Physician
Advisor.
972116
Weld County Ambulance
License Application
Page 3
12. Provide as required in Section 3.8-10 of Ordinance 77-C, a current copy of
the Ambulance Service's Training Standards in accordance with the
requirements approved by the ambulance service's Physician Advisor.
13. Provide a notarized statement by the person operating the vehicles or the
person in charge of operating the vehicles declaring the purpose of the
transportation conducted by that person or entity and the reasons by which
the person or entity is entitled to an exemption from the ambulance
licensing requirements of Ordinance 77-C.
EAMB05A
W1�'Dc.
COLORADO
GELD COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL PROTECTION SERVICES
DEPARTMENT OF HEALTH
1517 - 16 AVENUE COURT
GREELEY, COLORADO 80631
ADMINISTRATION (303) 353-0586
HEALTH PROTECTION (303) 353-0635
COMMUNITY HEALTH (303) 353-0639
Ambulance Service and Vehicle Equipment Survey Report
Dace of Inspection:
Inspected By:
Ambulance Service:
NAME:
ADDRESS:
TELEPHONE: CONTACT:
Qualification: Advanced Life Support:
Basic Life Support:
Motor Vehicle Chassis No.
Make & Model Year
Weld County License Tag No. Data of Expiration
Odometer Vehicle Identification No.
97211.5
AMBULANCE SURVEY REPORT
I. Each ambulance shall contain the following equipment which shall be
maintained in good working order:
A. Siren operational.
B. Lights operational:
YES NO
Emergency Lights YES NO
Headlights YES NO
Parking Lights YES NO
Tail Lights YES NO _
Brake Lights YES NO _
Hazard Lights YES NO _
Turn Signals YES NO _
C. Safe tires with snow tires/chains'available. YES NO _
•
D. Vehicle safety inspection log. YES NO
Basic Sanitation. YES NO
E. Vehicle preventive maintenance log. YES NO
F. Are there always two qualified drivers present
on a run who hold valid drivers licenses? YES NO
G. Ambulance drivers are:
1. Paramedic
2. Intermediary --EMT
3. Emergency Medical Technician
4. First Responder
5. American Red Cross Advanced First Aid and
Cardiopulmonary Resuscitation Card or equivalent.
H. When transporting a patient, is there a
licensed Emergency Medical Technician
present in the patient compartment? YES NO
I. Do you have insurance that complies with
the latest Colorado requirements?
(Ordinance 77-C Section 4.4)
J. The lighting and space are adequate for the
performance of cardiopulmonary resuscitation,
airway maintenance, suctioning, hemorrhage
control, shock care, dressing of wounds and
burns, immobilization of fractures, oxygen
therapy, and ceiling light sufficient for
adequate administration of IV fluids.
K. Safer, belts in forward compartment; safety
belts or ocher safety restraining devices
available for patients being transported.
YES NO
YES NO
YES
NO 9721.„.6
L. Two-way Radio Equipment - which provides
adequate communications between the ambulance
in the field and the hospital, clinic or
ambulance service physician advisor or
medical control point.
YES NO
II. Minimum required equipment for Colorado Ambulances.
"Each ambulance based and licensed in Colorado shall, ac a minimum, be
equipped in accordance with the following list of equipment, pursuant co
CRS 25-3.5-301 (2) (a)." Colorado Statutes n Regulations on Emergency
Medical Services, January, 1985, pg. C13-14.
A. Ventilation and Airway Equipment
1. Portable suction apparatus with wide -
bore tubing and pharyngeal suction tip. YES NO
2. Hand -operated bag -mask ventilation unit
with adult, child and infant sized masks
(clear masks are preferable). Valves
must operate in cold weather, and the
unit must be capable of use with an
oxygen reservoir. YES NO _
3. Oropharyngeal and nasopharyngeal airways
in adult, child and infant sizes. YES NO _
4. Portable oxygen equipment with a variable
flow regulator; adequate length tubing;
transparent, non-rebreathing valveless
masks in adult and child sizes and
transparent valveless infant -sized
mask; and nasal canuia. YES NO
B. Bandages and Dressings
1. Large and small sterile dressings. YES NO _
2. Roller bandages, both soft and elastic,
4 inch or larger. YES NO
3. Adhesive tape, 2 inch or larger. YES NO
4. Two clean burn sheets (do not have to
be sterile). YES NO
5. Triangular bandages with safety pins. YES NO
3
87211s
C. Immobilization Devices
1. Lower extremity traction splint.
YES NO
2. Extremity immobilizing devices, eg.
inflatable splints or splinting
materials for immobilizing the joint
above and the joint below the fracture. YES NO
3. Long spine board and appropriate
accessories to immobilize the
cervical spine. YES NO
4. Short spine board or equivalent
stabilization/immobilization device
(eg. "KED" type device) and appropriate
accessories to stabilize cervical spine. YES NO
D. Sterile Obstetrical Kit, Containing:
1. Sterile Gloves YES NO
2. Scissors YES NO
3. Aspiration Device YES NO
4. Umbilical Clamps or Tapes YES NO
5. Sterile Dressings YES NO
6. Towels YES NO
7. Plastic Bags YES NO
E. Miscellaneous.
1. Blood Pressure Cuff/Sphygmomanometer YES NO
2. Stethoscope YES NO
3. Sterile Irrigation Solution
(eg. normal saline) YES NO
4. Roll of aluminum foil, large enough
to cover a newborn infant. YES NO
5. Shears or heavy scissors capable of
cutting clothing, bandages, boots, etc. YES NO _
6. Flashlight with spare batteries and
spare lightbulb. YES NO
7. "ABC" fire extinguisher, minimum 5
pound capacity, with current annual
inspection. YES NO
4
Recommended Optional Equipment
It is strongly recommended and encouraged that every ambulance be
equipped with, and the ambulance crew be proficient in using, a set
of Pneumatic Ancishock (Mast) Garments. Such pneumatic antishock
garment should be compartmentalized (separate leg and abdomen
compartments) and be equipped with control valves (valves to have
closed and open position) and an inflation pump. The pneumatic
ancishock garments should cover the body from the lower legs to the
rib cage only. ancishock garments which cover the chest area are not
permitted.
YES NO
NOTE:
Surveyor:
It is important co note that EMT -Basics may use pneumatic ancishock
garments only i£ specifically trained in their use through a
Departmental approved course of instruction, and only if they are
used under the specific direction and authority of a physician
advisor, in accordance with the EMS Rules of the Colorado Board of
Medical Examiners (tit so-called "Acts Allowed").
Ambulance Service Representative:
General Comments and/or Suggestions:
Licensed to operate as the following:
Advanced Life Support Ambulance
Personnel:
YES NO
EMT -Paramedic
EMT -Intermediate
RN with Advanced Cardiac Life Support Certificate
Physician with Advanced Cardiac Life Support Certificate
Drive with valid Colorado Drivers License and current
EMT -Basic
Basic Life Support Ambulance
Personnel:
YES NO
ENT-3asic
Driver with valid Colorado Drivers License and American Red
Cross Advanced First Aid Card and CPR Card or equivalent of
both.
5
9'72,:.1.5
WIWDe.
COLORADO
Name of Ambulance Service :
WELD COUNTY AMBULANCE
PERSONNEL LIST
(Also includes driver's
which are not EMT's)
DEPARTMENT OF HEALTH
1517 - 16 AVENUE COURT
GREELEY, COLORADO 80631
ADMINISTRATION (303) 353-0586
HEALTH PROTECTION (303) 353-0635
COMMUNITY HEALTH (303) 353-0639
Application Year:
Name:
Address:
Date of Birth:
Highest level of certification, licensure or training attained:
Attach a photo copy of current Colorado
EMT -I, or Paramedic Certificate; or an
American Red Cross; or a First Responder
a Cardiopulmonary Resuscitation Card
Association or the American Red Cross.
Department of Health EMT -B,
Advanced First Aid Card from the
Course Completion Certificate; or
issued by the American Heart
Attach proof of a valid Colorado Driver's License.
Attach a statement of criminal complaint or convictions, including Class
I and II traffic violations within the previous twelve (12) months.
Section 5.3 of Weld County Ordinance Number 77-C States:
Before the state certification of an EMT, EMT -B, EMT -I or Paramedic
expires, the ambulance service shall provide the Department with a written
statement showing the name of EMT, EMT -B, EMT -I or Paramedic, the date the
certificate was issued, the date of expiration, and the certificate number
of the new State Certificate. Failure to comply with this section
disqualifies an EMT, EMT -B, EMT -I or Paramedic from practice in any Weld
County Ambulance Service.
EAMB05C
COLORADO
Name of Ambulance Service:
Application Year:
Vehicle #1
Vehicle 02
Vehicle #3
Vehicle #4
WELD COUNTY AMBULANCE
EMERGENCY VEHICLE LIST
DEPARTMENT OF HEALTH
1517 - 16 AVENUE COURT
GREELEY, COLORADO 80631
ADMINISTRATION (303) 353-0586
HEALTH PROTECTION (303) 353.0635
COMMUNITY HEALTH (303) 353-0639
Make
Year of Colorado State Motor Vehicle
Manufacture License Number Chassis Number
Length of time this vehicle has been in service
Location of the Chassis Number
Make
Year of Colorado State Motor Vehicle
Manufacture License Number Chassis Number
Length of time this vehicle has been in service
Location of the Chassis Number
Make
Year of Colorado State Motor Vehicle
Manufacture License Number Chassis Number
Length of time this vehicle has been in service
Location of the Chassis Number
Make
Year of Colorado State Motor Vehicle
Manufacture License Number Chassis Number
Length of time this vehicle has been in service
Location of the Chassis Number
Ila"vOlar
Weld County Ambulance
Emergency Vehicle List
Page 2
Vehicle 45
Vehicle #6
Vehicle #7
Vehicle #8
Make
Year of
Manufacture
Colorado State Motor Vehicle
License Number Chassis Number
Length of time this vehicle has been in service
Location of the Chassis Number
Make
Year of
Manufacture
Colorado State Motor Vehicle
License Number Chassis Number
Length of time this vehicle has been in service
Location of the Chassis Number
Make
Year of
Manufacture
Colorado State Motor Vehicle
License Number Chassis Number
Length of time this vehicle has been in service
Location of the Chassis Number
Make
Year of
Manufacture
Colorado State Motor Vehicle
License Number Chassis Number
Length of time this vehicle has been in service
Location of the Chassis Number
Section 3.11 of Ordinance Number 77-C States:
If a vehicle is replaced or an additional vehicle or vehicles are added to
a service's fleet, an application for a vehicle permit shall be filed with
the Department WITHIN 30 DAYS of receipt of the new vehicle or vehicles.
The completed application shall include a description of the vehicle(s)
that were replaced. Upon receipt of a new vehicle permit application, the
Department shall inspect the new vehicle and issue the new vehicle permit,
if appropriate.
EAMBO5B
9721?
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
include zip code
PHONE
Air Life of Greeley
Maggie Valcourt
1801 - 16`h Street
Greeley, CO
80631
(970) 350-6257
Ault -Pierce Fire
Protection District
Sandy Wingfield
PO Box 1 146
Ault, CO
80610
(970) 834-2848
Briggsdale Fire
Protection District
Duane Halverson
PO Box 1
Briggsdale, CO
99
80611
(970) 656-3503
Eaton Fire
Protection District
Gary Geisick
224 - 1' Street
Eaton, CO
80615
(970) 454-2115
Evans Fire
Protection District
Doug Melvey
3918 Denver St.
Evans, CO
80620
(970) 339-3920
Frederick Area
Fire Prot. District
Dominic Chioda
PO Box 129
Frederick, CO
80530
(303) 833-2742
Fort Lupton Fire
Protection District
Phil Tiffany
1211 Denver Ave
Fort Lupton, CO
80621
(303) 857-4603
Galeton Fire
Protection District
Doug Batt
PO BOX 697
Eaton, CO
80615
(970) 454-3439
Gilcrest Fire
Protection District
Glenn Miller
PO Box 43
Gilcrest, CO
80623
(970) 737-2966
Hudson Fire
Protection District
Robert Dechant
PO Box 322
Hudson, CO
80642
(970) 536-4202
F.evised 6/97
S
9 211
AGENCY NAME
DIRECTOR
ADDRESS
include zip code
PHONE
Johnstown Fire
Protection District
Greg Spaur
PO Box F
Johnstown, CO
80534
(970) 587-4477
Keenesburg Fire
Protection District
Mark Gray
PO Box 1
Keenesburg, CO
80643
(970) 732-4424
Kersey Fire
Protection District
Dave Wright
PO Box
Kersey, CO
Kodak Plant
Protection
Jean Clark
9952 Eastman
Pkwy
Windsor, CO
80551
(970) 686-4200
LaSalle Fire
Protection District
Tim Cole
PO Box 245
LaSalle, CO
80645
(970) 284-6336
Milliken Fire
Proection District
Dave Meyer
101 So. Irene St
Milliken, CO
80543
(970) 587-4464
Mountain View
Fire Protection
District
John Devlin
9119 County Line
Rd.
Longmont, CO
80501
(970) 772-0710
New Raymer Fire
Protection District
Guy McEndaffer
PO Box 92
New Raymer, CO
80742
(970) 437-5713
Nunn Fire
Protection District
Alvan Shipps
PO Box 128
Nunn, CO
80742
(970) 897-2239
Pawnee Fire
Protection District
Rodney Eshelman
PO Box 66
Grover, CO
80729
(970) 895-2461
Platteville Fire
Protection District
Glenn Miller
PO Box 407
Platteville, CO
80651
(970) 785-2322
Revised 6/97
6
AGENCY NAME
DIRECTOR
ADDRESS
include zip code
PHONE
Prospect Valley
Fire Prot. District
Bob Tegtman
4910 Colorado
Highway 79
Keenesburg, CO
80643
(970)
Roggen Fire
Department
Jan Winters
407 - 2nd Street
Roggen, CO
80652
Union Colony
Fire Rescue
Authority
Gary Novinger
919 - 7th Street
Greeley, CO
80631
(970) 350-9500
Windsor/
Severance
Fire Protection
District
Steve Lutz
728 Main Street
Windsor, CO
80550
(970) 686-2626
Revised 6/97
7
9721.1.S
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
Fire Departments
Search & Rescue Providers x_
Clinics or Hospitals x
Dispatcher Communications x
Training Center Reps. x
Revised 6/97
8
SECTION II - PLAN
ACCOMPLISHMENTS: (list any completed goals or accomplishments in the area of
EMS in your county)
Goal &
Objective
Number
Type of Goal
(Treatment,
communications, etc.)
Accomplishment/s
2.3.C
Treatment
Revised Medical Protocols Completed
#1, # 4
9/97
2.3.C
Treatment
AED in use for one year
#9
2.3.B
#3
Treatment
DOT curriculum for EMT Basics in
place for over one year
2.3.C
Treatment
CME program in place
#3
Communications
Participation increases for Weld
County EMS Advisory Council
2.3.B
Communications
Participation increasing in all public
#5,6
Treatment
education aspects
2.1 .C
Communications
Public Education Programs include
#1
2.3.B
Treatment
Video productions with Aims
Community College and Air Life and
#5
Aims Community College and
UCFRA
2.1.C
Communications
Emergency Medical Dispatch training
#1
to begin Jan 1998, plan for training
and budgeting has been approved for
additional dispatchers and software
expenses
2.1.C
Communications
Funds have been allocated for
completely functional backup
. ,
communications center
Revised 6/97
9
97211.5
Goal &
Objective
Number
Type of Goal
(Treatment,
communications, etc.)
Accomplishment/s
2.1.C
#2
Communications
Digital pager grant approved for
WCAS and Air Life of Greeley
2.1.C
#3
Communications
Air Life of Greeley awarded funds for
hand held units for GPS system
2.1.C
Communications
Weld County Regional
Communications Center has updated
microwave links in the county
Communications and
Treatment
Direct participation by Weld County
officials and EMS members in the
regional ATAC
Communications and
Treatments
EMS newsletter sent out to all EMS
agencies in the county
2.2.B
# 4, 5
Transportation
Mutual aid agreements are current
and will be revised as needed
2.2.B
#4
Transportation
Mutual aid committee meetings with
Larimar County and Southern
Wyoming have been initiated
2.3.B
#6
Treatment
Three multi -agency drills occurred
this past year
2.2.C
#2
Treatment
System Status Management has been
implemented with an 18 percent
decrease in response time for WCAS
2.3.C # 2
2.3.C #1,2,
and 4
Treatment
and Documentation
New prehospital medical report forms
have been introduced and are
currently being used
2.3.C # 2
2.3.C #1,2,
and 4
Treatment and
Documentation
Request for Information (RFI) for
computer generated trip reports was
completed
Revised 6/97
10
9+/2i .15
Goal &
Objective
Number
Type of Goal
(Treatment,
communications, etc.)
Accomplishmentfs
2.3.C # 2
2.3.C #1,2,
and 4
Treatment and
Documentation
Pilot program in place with WCAS for
computer generated trip reports using
Galles system
2.3.C # 2
2.3.C #1,2,
and 4
Treatment and
Documentation
All WCAS ambulances have installed
MDT units
Western Hills and Greeley Fire
Departments have merged to form
Union Colony Fire Rescue
Galeton Fire Protection District has
completed their new fire station
2.3.C
Treatment
WCAS upgraded spinal immobilization
equipment and is distributing
materials county wide
2 2 C
21
Transportation
WCAS has added a Community
Service vehicle with BLS and ALS
capablities, in addition to
accommodations for wheel chair
transport
2.
2 2 C
Transportation
WCAS has two new CCU
ambulances
Transportation
Air Life of Greeley has taken delivery
of their new helicopter
2.3.C
# 8
Treatment
Committee work is under way for the
revision of the County Disaster Plan
Air Life of Greeley received CAAMS
accreditation in 1996
F.ev:sec 619?
11
9721.1.5
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 assistance through an enhanced 911 system. Notification of emergency calls
for EMS are paged on the following channels/frequencies, depending on the
circumstances and location:
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 Department VHF: 154.235 (receive and transmit)
Union Colony Fire Rescue Authority
UHF 451. 150 (receive)
UHF 458. 150 (transmit)
Air Life of Greeley 155.400 (receive and transmit)
North Colorado Medical Center
Medical control is established and maintained either through the use of
cellualr phones or medical channels on the radio. Cellular phones are generally
available for all fire departments and ambulance personnel.
Digital paging systems are being set up at this time with the additional
resources obtained from the EMS grant funds in July 1997. Software and
hardware was already in place, courtesy of Greeley Police Department. The
system has been used on a limited basis to date with some agencies, with great
success.
Emergency Medical Dispatch is to date, "ready to go". Funds have been
allocated and donated, including the funding for three additional dispatchers. The
computer components are being purchased. It is anticipated that EMD courses will
begin in January 1998.
A systems diagram is included for your review.
Revised 6/97
12
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972116
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972116
STAFFED BY 25 FULL TIME EMPLOYEES
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3 SHIFTS PER DAY
NUMBER OF TELEPHONE CALLS HANDLED BY THE CENTER PER YEAR?
800,000 PLUS
OVER 180,000 OF THE CALLS REQUIRE INCIDENT NUMBERS TO BE
CREATED.
972116
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.
1. Digital pagers, and paging capabilities, while acquired for some of the
agencies in the county, still need to be pursued for other Fire
Departments. Paging has been shown to decrease radio traffic and get a
more efficient emergency response from agencies.
2. 800 megahertz capabilities should be explored as well.
3. Even though the communications system was upgraded this past year,
research needs to be on going to increase the efficiency of radio
transmission capabilities.
4. Staffing should be increased at the Regional Communications Center.
5. Emergency Medical Dispatch, while gaining much ground has yet to be
"up and running". Continued effort, planning and follow up are
necessary to maintain what has been started.
6. Computer software needs to be installed in the communications center to
allow dispatchers to monitor the location of the Air Life helicopter and
crew.
2.1 .C State your goals and objectives and place them here.
Communications Goal #1
Goal —To provide agencies with digital pagers, allowing individuals to more
accurately respond to emergency calls.
Communications Goal #2
Goal —To explore the capabilities of 800 and 900 megahertz, to improve the
reception of radio transmissions, and the capabilities for additional
frequencies and digital transmissions.
Communications Goal #3
Goal —To improve the transmitting and receiving capability of the present
system, allowing outlying areas to receive and transmit information with
greater accuracy and less interference.
Revised 6/97
13
972116
Communications Goal #4
Goal —To increase staffing at the regional communications center, as need
arises, to ensure that the system is not over burdened, particularly with the
introduction of Emergency Medical Dispatch.
Communications Goal #5
Goal —Implement the Emergency Medical Dispatch program, beginning with
training in January of 1998 and continuing until all dispatchers have
completed the program.
Communications Goal #6
Goal —To purchase software to be installed in the communications center to
complement the GPS units in the Air Life helicopter.
List the objectives (process by which you intend to accomplish this goal)
and state any progress toward attaining this communications goal.
Objective A for Goal #1
Explore the funding possibilities for agencies that wish to acquire digital
paging systems for their agencies. Discuss and make recommendations to
the individual departments based on their budgets and available funds.
Objective A for Goal #2
Research in 1998 the cost and equipment requirements for 800/900
megahertz capabilities and report to the EMS Advisory council.
Objective A for Goal #3
Assess the capability of the existing system, including the improvements
that were recently made to the system, with individual agencies. The
assessment should then be taken to the E-911 Board and brought to the
EMS Advisory Council to implement a plan of action for further improving
the system.
Objective A for Goal #4
Assess the staffing requirements of the regional communications system
after the EMD program has been initiated and in place for a reasonable
amount of time. Even though there is funding for three additional
dispatchers, there may be a need for additional staff, particularly with the
increase in call volume experienced by the county.
Revised 6/97
14
972116
Objective A for Goal #5
Training for EMD has been slated to begin in January 1998. Target date for
being "on line" with EMD is April 1998. This will include the completion of
training and the installation of new hardware and software in the
communications center.
Objective A for Goal #6
To purchase the software for the communications center, to enable GPS
units to be fully functional. Grant money will be requested in 1998.
Revised 6/97
15
972116
Reproduce this page if additional space is necessary.
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.
1. Air Life of Greeley (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 Fire Protection District (BLS Transport -back up unit)
Twenty - eight fire agencies respond wholly or in part in Weld County.
Some agencies do have rescue units that are capable of transport, but only
Frederick Area Fire Protection District is licensed by the County
Commissioners to do so.
Coverage is provided to the entire 4004 square miles of Weld County.
Mutual aid agreements are in place with all agencies that have the potential
to respond either in or to Weld County.
Coordination of Resources includes:
1. An active EMS Advisory Council
2. Representation on the Northeast Colorado Trauma Consortium
3. Regional communications center that will dispatch the majority of
the emergency calls to the appropriate agencies. If other
communications centers are responsible for paging agencies,
information is forwarded to them in a timely manner.
Revised 6/97
16
972116
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.
1. System status management will be reviewed and upgraded as necessary
for WCAS.
2. With the arrival of Air Life's new helicopter, safety training tapes are in
need of being reviewed and revised.
3. The addition of a 4x4 vehicle would assist with search and rescue and
the transportation issues that arise in the county.
4. There is a need for education and review of Resolution 77D.
2.2.C State your goals and objectives and place them here.
TRANSPORTATION GOAL #1
Goal —To further decrease response time and increase the efficiency of the
WCAS system, system status management will be reviewed.
TRANSPORTATION GOAL #2
Goal —To train all agencies that routinely request Air Life of Greeley
reference the new helicopter and its safety features.
TRANSPORTATION GOAL #3
Goal —To research the need for a 4x4 vehicle to assist with locating and
transporting patients in Weld County.
TRANSPORTATION GOAL #4
Goal —To educate all appropriate agencies reference the implications and the
requirements of Resolution 77D.
Revised 6/97
17
972116
Please list the objectives (process by which you intend to accomplish this
goal) and state any progress toward attaining this transportation goal.
Objective A for Goal #1
Conduct a review of the data recorded from dispatch tapes and times to
allocate resources of WCAS more effectively. This review is to be done by
December 1998. Review of the data will initiate changes as deemed
necessary and possible given the resources available.
Objective A for Goal # 2
Request funding from the EMS grant program in 1998 for the production
and duplication of safety issues related to the Air Life response.
Objective A for Goal #3
Conduct a needs assessment by WCAS to ascertain if a 4x4 vehicle is
necessary for emergency response in the county by December 1998. At
that time it will be determined if the allocation of funds is necessary.
Objective A for Goal #4
Compile data and information related to Resolution 77D. Distribute to all
agencies that are effected. Organize and conduct training sessions if there
is a need demonstrated in the county.
Reproduce this page if additional space is necessary.
Revised 6/97
18
972116
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 are completed and will be made available to all
agencies in the county that are supervised by North Colorado Emergency
Physicians group. These protocols reflect the latest curricular
terminology and perspectives. The protocols apply from the First
Responder level of care to the Paramedic level of care.
Other agencies are required to adhere to policies, procedures and
protocols set forth by their physician advisor.
2. Destination policies are outlined in the "new" protocols are reflect the
trauma legislative standards.
3. Medical Control is provided for Air Life of Greeley, WCAS and the
majority of the fire districts by the North Colorado Emergency Physicians
group. North Suburban Medical Center provides physician advisor roles
for Mountain View Fire Protection District, Tri-Area Ambulance Service
and Frederick Area Fire Protection District.
4. Quality assurance programs are the responsibility of the physician
advisor or his designee. Each entity is reviewing the process and
researching methods to gather information, compile data and get
information back to providers allowing for improved patient care.
5. Manpower and staffing issues are addressed by each agency.
6. Training is provided to the majority of the agencies by Aims Community
College. Other agencies elect to use Front Range Community College,
North Suburban Medical Center or Avista Hospital. Each agency
assumes the responsibility for arranging for continuing education and
initial training for their members. There are several training centers that
have made their services available to all agencies.
7. Mass casualty and emergency preparedness are being addressed at this
time by committee members volunteering to review and revise the Weld
County Disaster Plan. Work was started in August 1997. There are
general guidelines and information for mass casualty events in the
revised protocols.
Revised 6/97
19
972116
8. Trauma specific protocols, procedures and destination policies are clearly
stated in the revised protocol manual. Continuing medical education
sessions review those protocols on a regular basis.
9. There has always been a clear and distinguished representation of Weld
County on the regional ATAC. Currently there are two designated
members that are in attendance at each meeting. Reports are then made
to the EMS Council. Information is then distributed through the county
EMS newsletter.
2.3.B 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.
A. Many issues revolve around training, notifications and communication of
events and guidelines.
1. Training issues ref: revised protocols will need to be widespread and in
some cases unconventional, specifically when training Emergency
Department personnel.
2. Scheduling mass casualty exercises WELL in advance of the event will
help with increasing participation and involvement across the county.
3. Training issues that arose during EMS Advisory Council Meetings did
include, but may not be limited to the following:
a. Protocols
b. BTLS and PHTLS standards
c. Mutual Aid Agreements
d. Infection Control Information/Designated Officer Training
e. Leadership and Supervisory Training
f. Preceptor Training
g. EMD Training, Information About EMD to all Agencies
h. Crime Scene Training
i. Interface Training with Law Enforcement
j. Budgeting and Grant Writing Seminars
k. Interagency Incident Command Training
1. Stress Management and Personal Growth Topics
m. EMS Officer Training
n. Tactical Rescue Training
o. Trauma Legislation (ATAC)
Revised 6/97
20
972116
p. Mass Casualty Drills
q. Post Incident Reviews
1. Establish guidelines
2. Train agencies to implement strategy
r. Revised County Disaster Plan
s. Joint training with mutual aid response agencies
B. Equipment needs include, but are not limited to:
1. AED capability for more agencies
2. Additional spinal immobilization equipment
3. Blankets and pillows for outlying agencies
4. Pulse oximetry equipment
5. Stair chairs for transport agencies
6. Additional heavy rescue equipment
2.3.C Please list your goals and objectives and place them here.
TREATMENT GOAL #1
Goal —To schedule in January of each year the events that would entail
mass casualty exercises, to be held throughout the year.
TREATMENT GOAL #2
Goal —To prioritize training needs and implement programs to address those
needs, at this time, specifically addressing revised protocols.
TREATMENT GOAL #3
Goal —To define methods for gaining additional equipment as needed by
various departments in the county.
List the objectives (process by which you intend to accomplish this goal)
and state any progress toward attaining this treatment goal.
Objective A for Goal #1
Set as an agenda item for the EMS Advisory Council Meetings that all mass
casualty drills should be advertised months in advance of the set date.
Objective B for Goal #1
Advertise in the EMS County Newsletter that the information will be
discussed and all interested parties must indicate dates and intent for drills
no later than the January meeting. Dates will be published through out the
year as a reminder in the newsletter.
Revised 6/97
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972116
Objective A for Goal #2
Send needs assessments out to EMS agencies, at least once per year, listing
at minimum the information that is presented above. Rankings will be
compiled and classes organized for the coming months. Scheduling courses
should reflect the times of the year when it is most convenient for the EMS
agencies to meet for the classes.
Objective B for Goal #2
State EMS requirements for training will be reflected in the final course
offerings, as well as through the regularly offered CME classes.
Objective A for Goal #3
Establish "supply list" through the EMS Council that may be used to request
funding from EMS grant sources or other grant sources and allocate
equipment to those with the greatest need.
Objective B for Goal #3
Work with the committee members revising the County Disaster Plan to
identify areas of concern and need for equipment.
Reproduce this page if additional space is necessary.
Revised 6/97
22
972116
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 shared data base system at this time.
Although the process has begun to generate a system in conjunction with
the communications center, city and county agencies. At this time, medical
field reports are hand written for the most part and reviewed as time
permits.
Air Life, WCAS, Tri Area Ambulance Service, Frederick Fire Protection
District and Mountain View Fire Protection District work through North
Suburban Medical Center for their COI program.
Call review is done on an individual basis with call review by the EMS
Coordinator with direction of the physician advisor. Incident reports/
concerns/ issues are addressed through the EMS Coordinator with the
direction of the physician advisor.
Revised 6/97
23
972116
2.4.6 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.
1. The report form for the volunteer agencies has changed since the last
EMS plan was written. Although the implementation was not 100% due
to specific agency concerns.
2. WCAS has implemented a pilot program for the review of computer
generated field reports. This review, when completed should supply
information concerning the direction of medical reporting.
3. Interagency and intergovernmental links for exchange of data should be
explored and researched.
4. Quality assurance programs need to be completely reviewed to allow for
more immediate feedback.
5. Computer hardware and software costs should be analyzed with the new
programs.
6. Computer capability issues were addressed some time ago, but there is
not a clear indication of what program would be best suited to the
agencies.
7. There needs to be assurance with any system that is initiated in the
county that all information is confidential, yet allows CQI to be shared
with all agencies that respond to a particular patient.
Revised 6/97
24
972116
2.4.C State your goals and objectives and place them here.
DOCUMENTATION GOAL # 1
Goal —Initiate a cost efficient, computer generated trip report for all agencies
in Weld County
DOCUMENTATION GOAL #2
Goal —To establish COI program that allows for efficient and worthwhile
feedback to emergency responses in the county.
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
Continue pilot program by WCAS for computer generated trip reports.
Objective B for Goal #1
Examine other alternatives, (funding and program alternatives) in the
meantime, to address needs of specific agencies, if it is discovered, that the
program will be cost prohibitive to the majority of agencies.
Objective C for Goal #1
Establish consensus for the program chosen and begin implementation at
the earliest possible date.
Objective A for Goal #2
Establish parameters and generate fields that would obtain information
needed by the EMS Division and the county.
Objective B for Goal #2
Establish patterns of treatment to serve as a template for training issues and
generate specific data that reflects quality of care.
Revised 6/97
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972116
Objective C for Goal #2
Provide feedback to the individual care giver that improves the level of
patient care, allowing for the critique of individual patients and mass
casualty incidents.
Revised 6/97
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972116
2.5.A EXISTING SYSTEM DESCRIPTION -
OPTIONAL COMPONENT: PUBLIC EDUCATION ACTIVITIES
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.
Public Education programs in place are effective but somewhat limited
in scope. These include the child safety seat program, and video
presentations that have been developed for Air Life, Communications and
the public -at -large.
2.5.6 IDENTIFY ANY AREAS NEEDING IMPROVEMENT
Identify the changes or improvements you plan to make within your current
system in the above stated area.
The segments of the population in Weld County are very diverse, as
in most sections of our state. There should be a variety of programs
established to educate the citizens we serve about EMS, healthy life styles
and various prevention programs. We plan to research different programs,
brainstorm ideas and gather information to effect programs that will inform
and educate.
2.5.C State your goals and objectives and place them here.
Public Education Goal #1
To investigate the possibility for educational programs in Weld
County, to be disseminated to the general public.
List the objectives (process by which you intend to accomplish this goal)
and state any progress toward attaining this goal.
Objective A for Goal # 1
Establish work groups interested in producing programs that would
reflect the goals to increase public education opportunities in the county.
Objective B for Goal # 1
Determine costs and benefits and implement programs in a timely
fashion.
Reproduce this page if additional space is necessary.
Revised 6/97
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972116
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
•Revised 6/97
28
972116
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 "*")
Date
Payee
Purpose
Dollar Amount
1997
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 EXPENDITURES:
Geor a E. Bax r (09 29/ 7)
SIGNED: ( ' TITLE: Chair. County Board of Commissioners
this forth/. mu be signed by the county official responsible for county
financial transactions.
Revised 6/97
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972116
FINANCIAL NARRATIVE - (use this space to explain how the expenditure of
funds upgrade EMS in your county).
To supplement funding for the Weld County EMS Coordinator position
through Aims Community College.
Revised 6/97
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972116
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 & Description
Type of Expenditure
Approx. Dollar Amount
Most goals and objectives are job
functions of the EMS Coordinator
Subsidize salary
All
Revised 6/97
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972116
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 statutory reporting
requirements by the State Advisory Council on EMS and your county's contract with the State.
Payment To: Weld County Commissionsers
Name of Board of County Commissioners (payee)
915 10th Street
Address
Greeley
(City)
Authorizing County 0 f
SIGNATURE:
Printed Name: George E. Baxter
CO 80631
(State) (Zip)
DATE: og12e/47
Title: Chair, County Board of Commissioners
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 Oar Appr Code Func Obi GBL
409 FLA 8300 FLWT 5120 008S
Please print or type
Revised 6/97
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972116
Attachment A
Page 1 of 3 Pages
Emergency Medical Services (EMS) Plan
Transport Agency Profile
Agency Name Weld County Ambulance Service
Address 1121 "M" Street Greeley, CO 80631
Director Name Gary McCabe
Phone No. 353-5700 x 3204
Fax No. 353-5700 x 3215 E-mail No. (If Applicable)
Private for Profit Non-profit Special District
Agenc
Are You: Hospital Based_ Fire Based N/A X
Title/level
Number of Full
Time Paid
Number of
Part Time Paid
Number of
Volunteer
Basics
9
5
0
Intermediates
0
1
0
Paramedics
13
11
0
First Responders
0
0
0
How Many of Your Basics Are AED Authorized: 14
Physician Advisor Name James Campain Phone: 350-6366
Address North Colorado Medical Center 1801 - 16th Street Greeley, CO 80631
Physician Advisor's Licensure Number 32697
Approximate Number of Emergent EMS Runs per Year 4446
Approximate Number of Non -Emergency Transports per Year 915
Approximate Number of Inter -Hospital Transfers per Year 100
Name & Phone Number of Dispatching Agency/ies
Weld County Regional Communications Center Phone 356-1212 EMD- Yes No X
Phone EMD- Yes No
Revised 6/97
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972116
Page 2 of 3 Pages
Transport Profile:
Ambulance Type
and Age
Good Condition
Fair Condition
Poor Condition
See Attached Form
Attach an Additional Sheet to List Ambulances as Necessary
Training Profile:
Training Institution Most Often Used Aims Community College
Do You Provide Your Own Continuing Education _Yes X No
Fee St
BLS
ALS
Base Rate
420
420
Rate per Mile
9.50
9.50
Medicare Rate
140.61
202.43
Approximate Rate of Collection 69 %
If You Have a Subscription Program, Please Describe the Fee Structure: N/A
Please Return this Form To:
By this Date:
Your County has been required to have this form filled out by each transport agency as a pan
of the county EMS Plan. If your agency form is not submitted with the Plan, the plan will be
considered incomplete.
Revised 6/97
34
972116
Transport Profile:
Page 3 of 3 Pages
Ambulance Type
and Age
Good Condition
Fair Condition
Poor Condition
1993 TYPE III
X
1993 TYPE III
X
1995 TYPE III
X
1994 TYPE III
X
1994 TYPE III
X
1995 TYPE III
X
1995 TYPE III
X
1996 TYPE III
X
1996 TYPE III
X
Revised 6/97
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972116
Attachment A
Page 1 of 3 Pages
Emergency Medical Services (EMS) Plan
Transport Agency Profile
Agency Name Tri - Area Ambulance Service
Address 204 Oak Street PO Box 708 Frederick, CO 80530-0708
Director Name Ron Dever Phone No. (303) 833-4824
E-mail No. (If Applicable)
Fax No. (303) 833-3772
Private for Profit Non-profit Special District X
Are You: Hospital Based_ Fire Based N/A_X_
Agency Staffing & Treatment Profile:
Title/level
Number of Full
Time Paid
Number of
Part Time Paid
Number of
Volunteer
Basics
1
10
0
Intermediates
0
0
0
Paramedics
4
9
0
First Responders
0
0
0
How Many of Your Basics Are AED Authorized: 0
Physician Advisor Name Donald Massey
Address North Suburban Medical Center
Physician Advisor's Licensure Number
Approximate Number of Emergent EMS Runs per Year 1000
Approximate Number of Non -Emergency Transports per Year 600
Approximate Number of Inter -Hospital Transfers per Year 0
Phone:
Name & Phone Number of Dispatching Agency/ies
Weld County Regional Communications Center Phone 356-1212 EMD- Yes No X
Phone EMD- Yes No
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Page 2 of 3 Pages
Transport Profile:
Ambulance Type
and Age
Good Condition
Fair Condition
Poor Condition
See Attached Form
Attach an Additional Sheet to List Ambulances as Necessary
Training Profile:
Training Institution Most Often Used
Do You Provide Your Own Continuing Education _Yes No
Fee Structure Profile:
BLS
ALS
Base Rate
In District
125
Out of District
250
In District
250
Out of District
500
Rate per Mile
5
10
5
10
Medicare Rate
Approximate Rate of Collection 98 %
If You Have a Subscription Program, Please Describe the Fee Structure: N/A
Please Return this Form To:
By this Date:
Your County has been required to have this form filled out by each transport agency as a part
of the county EMS Plan. If your agency form is not submitted with the Plan, the plan will be
considered incomplete.
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Transport Profile:
Page 3 of 3
Ambulance Type
and Age
Good Condition
Fair Condition
Poor Condition
1994 Type III
X
1996 Type III
X
1997 Type III
X
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Attachment A
Page 1 of 3 Pages
Emergency Medical Services (EMS) Plan
Transport Agency Profile
Agency Name American Medical Response of Colorado
Address 3800 Pearl Street Boulder, CO 80301
Director Name Brad Baker Phone No. (303) 442-7375
Fax No. (303) 443-6397
E-mail No. (If Applicable)
Private for Profit X Non-profit Special District
Agenc
Are You: Hospital Based_ Fire Based_ N/A X
Title/level
Number of Full
Time Paid
Number of
Part Time Paid
Number of
Volunteer
Basics
16
25
0
Intermediates
0
0
0
Paramedics
22
13
0
First Responders
0
0
0
How Many of Your Basics Are AED Authorized: None
Physician Advisor Name(s) David Jones (441-2037) and Ron Genova (651-5000)
Address Boulder Community Hospital, Boulder CO 80301
Longmont United Hospital, Longmont, CO 80501
Physician Advisor's Licensure Number Not available
Approximate Number of Emergent EMS Runs per Year 9000
Approximate Number of Non -Emergency Transports per Year 5000
Approximate Number of Inter -Hospital Transfers per Year 1500
Name & Phone Number of Dispatching Agency/ies
Boulder County Communications _Phone 441-4444 EMD- Yes X No
Longmont Communications Phone 651-8501 EMD- Yes X No
American Medical Response Phone 614-8900 EMD Yes X No
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Page 2 of 3Pages
Transport Profile:
Ambulance Type
and Age
Good Condition
Fair Condition
Poor Condition
See Attached Form
Attach an Additional Sheet to List Ambulances as Necessary
Training Profile:
Training Institution Most Often Used Boulder Community Hospital
Do You Provide Your Own Continuing Education X Yes No
Fee Structure Profile: Corporate Policy dictates this is privileged information and not available
BLS
ALS
Base Rate
Rate per Mile
Medicare Rate
Approximate Rate of Collection %
If You Have a Subscription Program, Please Describe the Fee Structure:
Please Return this Form To:
By this Date:
Your County has been required to have this form filled out by each transport agency as a part of
the county EMS Plan. If your agency form is not submitted with the Plan, the plan will be
considered incomplete.
Revised 6/97
40
972116
Transport Profile:
Page 3 of 3
Ambulance Type
and Age
(310) 1990 Type II
(312) 1991 Type III
Good Condition
Fair Condition
X
X
Poor Condition
(314) 1993 Type III
X
(315) 1991 Type II
X
(317) 1991 Type II
X
(318) 1996 Type III
(319) 1997 Type II
X
X
(326) 1997 Type II
X
(327) 1996 Type III
(329) 1998 Type II
X
X
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Attachment B County Name WELD
COUNTY MEDICAL MULTI/MASS CASUALTY PLAN SURVEY
DEFINITION: For purposes of this survey, multi/mass casualty is defined as the comination of
numbers and types of injuries that goes beyond the capability of an entity's normal response
(normal response includes agency capability and standing mutual aid agreements with surrounding
jurisdictions).
RISK/HAZARD ASSESSMENT:
After reviewing the attached hazard analysis, what multi/mass casualty events listed for your
county and/or municipality might create a mass casualty in your jurisdiction.
List by Hazard 1. All listed hazards
2. Stadium collapse
3. Plane Crash(es)
4. Train Crashes/Derailments
5. University/Nursing Home Fires
6. Chemical/Industry Accidents
7. Acts of Terrorism
Are there other hazards or risks in your county that are not listed that have mass/multi casualty
consequences (ie: Planned gatherings, etc.)? If so, please list them:
1. Greeley Stampede
2. Parades
3. Concerts
4. Interstate, highways and county roads
Of the hazards / risks listed above has there been actual occurrences in your jurisdiction with
multi/mass casualty consequences? YES _X_ When 1992 1995
Where LaSalle I-25 and Hwy 7
#'s of Victims 100 plus
NO
Do you presently maintain a listing of all EMS resources (personnel, equipment, transport units)
within your county? YES X_ If so, who is responsible for maintaining the
information?
Ed Herring
Revised 6/97
NO
Are you planning to develop such a resource
listing in conjunction with you Area Trauma Council
ATAC?
Yes X No
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What is the estimated maximum numbers of victims in a single event that your existing resource
system, (ie: triage, treatment and transport) is capable of handling (including use of existing
mutual aid agreements) ?
Estimated number of victims -
Eleven patients would fill all the current ALS transport units in the county, and fill
the Emergency Department at NCMC. However, with the additional resources available
through mutual aid, the county may be able to handle many times that number, estimated
up to 1000 patients, given the usual ratio for critical patients, versus, noncritical patients.
This is providing that all units are available and transport to other agencies is possible.
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MANAGMENT SYSTEM:
Has a formal Mass Caualty Management Training Sytem been made available in your county?
YES X NO
If so, which of the following elements of a management system were discussed?
ICS X TRIAGE X TREATMENT X
TRANSPORT X STD. TRIAGE TAGS X DESTINATION POLICY X
STANDARDIZED TRAIGE AND RAPID TRANSPORT X
Has your county developed a Standardized Incident Management System designed for a mass
casualty event that addresses roles, responsibilities, interface with hospitals, fire rescue and other
critical response systems? YES _X_
NO Do you intend to develop such a plan?
Yes , if so, When
No
COMMUNICATIONS:
Does your county have as agreed upon, formally adopted communications plan (ie: designated
frequencies)?
YES X NO
If no, is the county making plans for a communications plan as part of the Area Trauma Council
(ATAC) development?
YES NO
AGREEMENTS:
Do you presently have written Mutual Aid Agreements in support of EMS operations that would
be adequate in managing a mass casualty event in your county?
YES _X_ NO
MEDICAL FACILTIES:
Is a system designated for addressing mass casualty response in place that specifically addresses
notifying hospitals of an event and providing immediate and accurate assessments of hospital bed
count and overall capability?
YES X NO
THANK YOU FOR TAKING THE TIME TO ASSIST US IN DEVELOPING THIS
CRITIC INFORMATION.
Your a .�. �c .' [ 'J Phone %(3) m0 "&fig
Revised 6/97
44
k £4AS
972116
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