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June 29, 1984
NOTICE OF WORKSHOP MEETING
CITY COUNCIL
CITY OF TAMARAC, FLORIDA
There will be a Workshop Meeting of the City Council
on Thursday, July 5, 1984 at 1:00 R.M. in the Council
Chambers of City Hall, 5811 NW 88 Avenue, Tamarac.
The purpose of this meeting is in reference to the
Ambulance Service.
The public is encouraged to attend.
Marilyn Bertholf
City Clerk )7& 1
KLICY OF NON-DBCPJMMTMN ON BASIS OF HANDICAPPED STATUS
"An Equal Opportunity Employer"
CITY OF TAMARAC
CITY COUNCIL WORKSHOP MEETING
July 5, 1984
Tape CALL TO ORDER: Mayor Kravitz called the Workshop Meeting to order
1 at 1:00 P.M. on Thursday, July 5, 1984 in the Council Chambers at
City Hall.
ROLL CALL: PRESENT: Mayor Philip B. Kravitz
Vice Mayor Sydney M. Stein
Councilman Jack Stelzer
Councilman John J. Dunne
ABSENT AND EXCUSED: Councilman Raymond J. Munitz
ALSO PRESENT:
Laura Z. Stuurmans, City Manager
Jon M. Henning, City Attorney
Patricia Marcurio, Secretary
Mayor Kravitz read the Notice of the Workshop Meeting into the
record stating that the purpose of the meeting is in reference to
the Ambulance Service. C/M Stelzer said this is
in reference to additional ambulance service in lieu of what the
City intends to provide. He said the proposition is to provide
ambulance service which would be in direct competition with the 2
ambulances purchased by the City. He said they will be providing
all the services necessary and not require sending the fire and
emergency trucks out. He read from the Minutes of the Safety
Advisory meeting signed by Jim Stuurmans, Safety Officer,which cited
a case of charging 2 people that were transported by the ambulance
at the same time the same charge. He.said the_y__have discussed many
times that it would be more advantageous for the City to have their
own private ambulances with a 4-1/2 minute response time.
He said the operation and cost would not be borne by all of the
residents of the City but only by those people using the service.
V/M Stein asked the purpose of this Workshop meeting and Mayor
Kravitz said the Council only accepted the concept and the City
Manager said in order to get approval from the County, the City
would have to have the ambulances as a prerequisite, therefore, on
that basis, they were ordered. Mr. Henning said this meeting was
requested by Mr. Cory, representative of Medics Ambulance Service,
at a previous Council meeting. He said the County licenses the
distribution of emergency services in Broward County and divides
the County into various zones which includes several cities in each.
He said Community Ambulance was assigned to the zone where Tamarac
is located until recently and then in April of this year the County
changed the licensing procedure and Tamarac is now covered by MEDICS
Ambulance. He said it is the same County system but is just a different
company performing the service. He said as far as the implementation
of the ambulance service run by the City, the City needed the avail-
ability of these ambulances to be considered by the County and Council
approved their purchase. He said an Ordinance is needed to implement
the ambulance system if Council proceeds in having a City -operated
service with the Fire Department running the ambulances owned by the
City. He said the City has an agreement with MEDICS that whenever
the City goes on line with the system, they would not object to the
City operating their own ambulances and they would not be responsible
for the Tamarac area except as backup, which has not been worked
out as yet.
Mr. Henning said when Mr. Cory appeared at the last Council meeting,
Mr. Henning requested that Mr. Cory submit a written proposal as to
what he was suggesting as a business proposition. He said Mr. Cory
responded that he did not have a specific proposal but wanted to
discuss ambulance service in general. C/M Stelzer asked Mr. Henning
if the previous Council approved the concept and budgeted approximately
$170,000 on ambulances with the thought of approving only the concept?
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C/M Stelzer said he is certain the previous Council had intentions
of implementing an Ordinance and having a City -owned ambulance service.
Mayor Kravitz said he recalled the previous Council said they were
voting only on a concept since it was only a prerequisite for County
approval and if the City did not need the ambulances, they could
dispose of them.
Jack Cory, representative of Medics Ambulance Service, said his firm
has been in business for several years in Broward County. He explained
the difference between ALS, Advanced Life Support,and BLS, Basic
Life Support, which is what private enterprise provides. He said
presently the only City that provides BLS is Pembroke Pines but there
are several cities that provide their own paramedic service as well
as transportation. He said it is very expensive and is a direction
that Broward County decided to avoid. He said both Lauderdale Lakes
and Lauderhill have a professional Fire Department and yet they have
decided to go into an advanced contract to provide a high level of
service. He said in March, 1984, the Board of County Commissioners
studied the ambulance and paramedic services in detail and then
implemented a new program that would provide for the residents being
able to call 911, having a paramedic van respond and then having
ambulance zones throughout the County. He said they selected Medics
to serve Tamarac, they have met with staff and tried to cooperate
fully.
Mr. Henning said there have been many Council workshops on this subject
and the expenditure to purchase the ambulances was approved at a
regular meeting. Bernie Simon, Fire Chief, said he was under the
impression that Mr. Cory was going to present his plan at this workshop.
He said he will just be adding more details to what he proposed in
September and, in comment to Mr. Cory's remarks, the ALS is not
always first on the scene of an accident since the Fire Department is
BLS and they are first on the scene. He said if BLS is on the scene
first, a 10 minute response is allowed to ALS. He said he has a paper
from the Florida Fire Chiefs Association which discussed all types of
life support and stated, "An estimated 80% of emergency medical
service, including both basic and advanced in this State, is supplied
by the Fire Service". He said response time was one of their issues
and their response time for 5,500 runs was less than 3--1/2 minutes.
He said no private ambulance company could match that time. He said
the City studied both Community Ambulance Service and Medics Ambulance
Service and Community had a much better record. He said Mr. Cory
called him for information and he had other priorities at the time
but never refused him at any time. He said he did allow for personnel
in the nature of an incentive in the amount of $10,080 and that still
applies regardless of Mr. Cory's memo dated 4/20/84 which stated
that there is no provision in the Fire Department's proposal for
employees.
Mr. Henning said for clarification, they are discussing 3 agencies,
the County EMS, Emergency Medical Service, the private ambulance
carrier and the Fire Department. He said when a 911 call comes
through there is a race for all 3 agencies to get to the scene and
the first one there would administer aid. City Manager Stuurmans
asked the Fire Chief how many EMS units there are in Broward County
and he said 17 to 25 and they are fortunate that they have 1 in
Tamarac. The City Manager asked in those instances when there is an
emergency response call, what percentage of time is the Tamarac Fire
Department there first of any of the other responders and Chief Simon
said over 60% of the time. The City Manager said under the contract
the City has with EMS, the City is obligated to supply that type of
support -to Broward County EMS. She said the City is currently pro-
viding this service with fire apparatus equipment and she asked the
Fire Chief how many runs the City has on an average. Chief Simon said
1,600. The City Manager said the reality of what is being done
currently is important to Council as there is further discussion on
both Mr. Cory's point of view and what the Fire Department has pre-
viously proposed.
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/pm
Mr. Cory said he tried to make it clear that they do not have a plan
but many ideas since any time a City is spending so much money it
should require a workshop meeting for discussion. He said the Fire
Chief has distributed copies of additional information to Council and
he requested copies of this. He said he has submitted copies to
staff with reference to the proposal that is presently in operation
and is being used by Lauderhill and Lauderdale Lakes. He said it
is saving the City money because it is a contract without increasing
budgets each year and this system also increases the level of
service which is something that municipalities cannot provide through
basic and higher level types of transportation. He said there are
2 areas before Council today, this type of proposal and maintaining
the status quo and since the majority of this Council has not had
a chance to fully review the Fire Chief's proposal, he recommended
that Council give serious consideration to that before expending these
funds. He said there is a service in effect, the members of the
County Commission have approved that and this should be reviewed
further.
Chief Simon said Mr. Cory's comment that there is no increase in
tax dollars is incorrect since there was an increase of approximately
$144,000. He gave Mr. Cory a projected operational budget of less
than $17,000 operating through the Fire Department plus the capital-
ization start-up money. Mr. Henning said the City is heading towards
the direction of implementing a City -operated ambulance system. He
said the ambulances were held up on delivery because there was an
unanticipated del.ay_and-he asked if an Ordinance should be written
for this. Mr. Henning said the Chief had a report in which he endorsed
a City -operated system and he asked if Council would want a line -by-
line account of this proposal or should staff write the Ordinance and
report to Council staff's recommendations.
City Manager Stuurmans said the big question that remained to be
resolved when they previously discussed City service was whether or
not that service would be provided within the tax base or would be
offset through the implementation of a user fee and that direction
was never set forth by Council. She said the considerations were
whether or not there would be a rate schedule or it would be absorbed
as a part of the operating cost of the Fire Department, there were
2 possible directions in which the City could move. Mr. Henning asked
if the service would be the same and the City Manager said it would
be emergency response service within the corporate limits of the City
of Tamarac to all. Mr. Henning said that would be budgeted by the
Fire Department budget or a user fee.
V/M Stein said at that time this was subject to the approval of the
County and the City Manager said whether they were used as ambulances
or first responder rescue vehicles, there was merit in proceeding with
the purchase. She said the City was moving towards a user fee basis
but there had been raised a question of whether or not it should
be supported by tax funds and it was not decided. Chief Simon said
........... ........
that under certain conditions, the ambulances could be used for trans-
portation without a Certificate of Convenience and Necessity such as
in extreme emergency. He said on the second page of his new present-
ation, he gave Council a cost factor using fire apparatus or ambulances
and he gave projected revenue of about half the price to run an
ambulance as a first -line piece of fire apparatus, which is in excess
of $120,000. City Manager Stuurmans said she just submitted a budget
projection for 84/85 and she asked if Chief Simon could extract from
those specific operating costs what would constitute the general funds
cost to have the ambulances once they have arrived. She said those
ambulances are on order and the subsidiary equipment was under separate
purchase requisition so they are costs of the current fiscal year.
She said beyond that into 84/85, she asked Chief Simon what the cost
would be for the personnel -incentive and the operation of that service
that is projected. --
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/pm
Chief Simon said it would be the prenegotiated contract which calls
for an 8% increase on 10/l/84 and could be an 8 to 12% increase in
the incentives/salary for personnel. City Manager Stuurmans asked
the Fire Chief if the City did not have the ambulance service would
it still be sustained at 8% for the IAFF increase and Chief Simon
said yes. City Manager Stuurmans said the County will not give
approval until they make a physical inspection of the vehicles and
_
..._there is no reason to assume they will not get approval. C/M Dunne
asked Chief Simon how long the Fire Department has been handling
this service and Chief Simon said since June, 1975.
_Gary-Gr_alla, resident, said .._ this -_has been_ discus sed . for ..quite. some
time and he feels Council should proceed with writing an Ordinance.
V/M Stein said what Mr. Gralla said has validity, however, Council
wants to determine if the objections to the Cit o eratin _
Y p g its awn
Tape ambulance service are valid. C/M Stelzer asked if anyone has computed
2 what it would cost to amortize the costs of the two ambulances?
Mayor Kravitz said to the best of his knowledge they have not. City
Manager Stuurmans said they were talking last year about $45,000 with
a capital cost of approximately $85,000 for both. She said there is
an annual savings of existing operating expense of $45,000 by just
buying the vehicle.
Hy Fox, resident, asked why the County must wait to inspect the
ambulances since they are made to specification. City Manager
Stuurmans said those are their regulations. She said the City is
buying the same ambulances the County buys under their bid package.
Mr. Cory said since they are being bought by the City under the
County bid package, if the Council decided they wanted to cancel
the purchase of the ambulances, they would be assigned to another
City that is on the waiting list. He said the only no -tax cost
proposal would be to cancel the order of these ambulances, study all
the ramifications and have the facts. He introduced to Council Mr.
Robert Cunningham, former Director of Emergency Services Division of
Broward County. He said Mr. Cunningham designed the emergency medical
services of Broward County. Mr. Cunningham said he has been retained
by Medics Ambulance Service as a consultant. He said he reviewed the
9/16/83 Workshop Meeting material and he felt Tamarac has a very fine
system presently and he suggested that rather than buy these ambulances,
Council might consider something as simple as pick-up trucks. He
said the idea of the first responder is to get someone on the scene
within 4 minutes since effective CPR is critical in some situations.
Mr. Cunningham said in his opinion the present EMS system in this
City, which utilizes the private sector ambulances for Basic Life
Support transportation is operating effectively within medical
standards and guidelines and is in a cost-effective manner. He
said the proposal before Council will significantly change the
present EMS system and potentially increase the cost of present
services to the taxpayer. He said each current system component
has backup resources both in manpower and equipment in sufficient
quantities to insure present level of service. He said the review
of the level of service provided to the City by Medics Ambulance
Service since the inception of their contract reveals the total
ambulance calls were 158 and their average response time was 6.23
minutes. He said there were 7 cases of delayed response time which
equalled 4.4% of the calls the first month they were operating. He
said they had one response that was over 18 minutes which would happen
no matter who the provider is. He said the Journal of the American
Medical Association, titled"Standards and Guidelines for Cardio-
Pulmonary Resuscitation and Emergency Cardiac Care" dated 8/l/80,states,
in reference to EMS response time, "Emergency cardiac care system
as first responder, should be able to provide Basic Life
Support, CPR, during the first 4 minutes of cardiopulmonary arrest.
There should be a sufficient number and appropriate placement of ALS
units to ensure the delivery of ALS to that patient in approximately
8 to 10 minutes ".
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/pm
Mr. Cunningham said Advanced Life Support is probably no more than
10% of the EMS calls in this City; therefore, the BLS is needed the
remaining 90% of the time. He said the average on -the -scene time
for a paramedic component in Broward County is 21 minutes, that is
the ALS component. He said the paramedics in the field and the
first responders as a team will do as much to stabilize a patient
as any emergency room in the County. He said in his opinion the
report provided for the ambulance workshop does not contain sufficient
backup data in 2 specific areas to support the proposal and allow
Council to make an appropriate business decision in the matter.
The 2 areas were financial data and EMS operational data. He said
his concerns on the financial data are what are the projected
revenues in accordance with the proposals, who will provide the
billing and collection functions, at what cost, what are the pro-
jected uncollectables, are there any future manpower costs, what
is the specific financial advantage of the proposal over the current
system? He said operationally it is fine to cite -other communities
who operate BLS ambulances in their EMS system. However, most of
the reference services are ALS transport. He said the data does
not provide a basis for comparison either in cost effectiveness or
system design.
Mr. Cunningham said the present EMS system in the City is operating
well within medical standards and guidelines and contains no weak
points. He said it could be improved in the vehicle area, and
the proposal before Council would result in 4 firemen out of 11
assigned to a shift responding to a call, therefore, being unavail-
able for fire fighting duties. He said if they become the transport
service they are committed and cannot leave the scene and tic up
a fire vehicle. He said the average time spent on each EMS call
as a basic life support first responder will be at least 45 minutes
to 1 hour per call. He questioned with the remaining 8 firemen on
duty and 2 fire stations, would there be sufficient manpower pro-
vided to maintain the current fire suppression capabilities and
levels of service. He said he estimates 8 people are required for
each 2 ambulance positions as has been his experience.
Mr. Cunningham questioned whether reduced manpower__and fire
suppression operations have any impact on Tamarac's
insurance office rating? He said the residents' homeowners fire
insurance is based upon this. He said the City could find them-
selves paying a higher fire insurance premium. He suggested that
it is not feasible to have only 2 ambulances since a third one is
needed (at an estimated price of $48,000) for maintenance needs.
He asked who would provide the back-up units for multiple EMS
calls? He said the implementation of the proposal may present new
legal liabilities to the City since the private sector has 5 million
dollars in liability coverage. Mr. Henning said the Statute provides
for approximately a minimum of 1 million dollar coverage. Mr.
Cunningham asked if the current Tamarac EMS medical evaluation
treatment data was evaluated and considered during the development
of the proposal.
He asked if the geographical layout of the City was
considered when the proposal was developed since the City is so
large and far reaching. He said he would recommend that Tamarac
defer the acquisition of the 2 ambulances and capital outlay of
approximately $98,000 since there is no basis for changing the
present system.
City Manager Stuurmans said the present system is a "3-tier system",
the Fire Department, the EMS and the private sector for transport.
She asked Mr. Cory if his proposal is that the City continue with
that relationship and Mr. Cory said that was correct. Chief Simon
said concerning Mr. Cunningham's reference to pick-up trucks vs.
....... ... .
„ambulances,..this..is aqainst his proposal which was for consideration
with the 2 ambulances., Ht-___.said Mr. Cunn.ingha-m'_s._fiqures for manpower.
were incorrect since his own proposal includes sixteen people at
3.5 per position, allowing for everyone taking vacation and sick
leave.
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/pm
Chief Simon said the percentage of structural fires in Tamarac is
less than 5%. He said according to national standards, there are
1.83 fire fighters for 1,000 population throughout the country and
Tamarac, considering an ambulance service, would make the Fire
Department no larger than presently, which is 1.27. He said 90%
of his department is qualified to proceed with this program now,,
and _. their fire suppression response proposal is 3 men on an
engine company and 2 men on an ambulance creating a 5 man unit.
He said a fire is very seldom critical after 10 minutes and there
is nothing in the City that cannot be covered by that manpower.
He said most insurance companies today only rate people as pro-
tected or unprotected.
Chief Simon said they have arrangements for a third ambulance.
He said they have had no problems with the system as it exists
and they have a very good rapport with the doctor in charge of
the Emergency Room of Community Hospital and he has geared sug-
gestions to the City as to what is required under 4.01 of the
State Statutes. He said as soon as the ambulances arrive he will
try to solicit donations from the residents for all the ambulances
needed.
City Manager Stuurmans said there was a proposal that was given to
some members of Council in April which had within it this per
capita and now the discussion concerns a continuation of the
existing service. She said Mr. Cunningham said that 10% of the
calls are life threatening and she questioned whether Mr. Cunningham
understood that when the City was proposing to provide its service
they were addressing only emergency services. She said for the
type of ambulance service that is needed to move an individual
from the initial hospital they were directed to be delivered to
would be done by a private provider. Mr. Cory said that was not
in the documentation that the Fire Chief gave to them and he was
not sure that system would work.
Mr. Cunningham said if the City wants to take care of the 90% of
calls that are not life threatening, the City would be spending
a lot of money for little demand. Captain Budzinski. of the.Fire
Department, said they transport whenever directed to do so by a
Tape paramedic on the scene. V/M Stein said it is important to know
3 how many the City would be using for a private company in spite of
the fact that the City has their own ambulance. Captain Budzinski
said that in approximately 80% of the calls they respond to are
transported to the hospital, although they might not be life
threatening, they must still go to a hospital. C/M Dunne asked
why there are sometimes 3 police cars that respond to emergency
calls and Captain Budzinski said the police are not trained as
first responders. C/M Stelzer said at one time there was a dis-
cussion as to whether the City would be involved in convenience
transport and it was decided not to do it. He said he cannot see
any difference in the services unless it would be a monetary saving.
V/M Stein said there are differences. Chief Simon said they will
abide by the 10 minute response and there is no place in the City
that takes more than 10 minutes from either station. V/M Stein
asked what would happen should there be a break -down or accident
with the ambulances and Chief Simon said they have arrangements.
Mr. Cory said the only proposal before Council that will not cost
any taxes is instructing the City Attorney to draft an Ordinance
and cancel the order for ambulances. City Manager Stuurmans said
staff has stated that they would be more than happy to work with
a private provider, however, staff has been of the opinion in the
last year of reviewing this that the City can provide ambulance
service more expediently at a lesser cost.
6
7/5/84
/pm
Mr. Cory suggested Council review all the facts further before
proceeding with the City ambulance service. Mayor Kravitz thanked
everyone present for their input on this workshop meeting and
adjourned the meeting at 2:45 p.m.
ASSISTANT CITY CLERK
This public document was promulgated at a cost of $ 111.20 or
$ 3.08 per copy to inform the general public and public officers
and employees about recent opinions and considerations by the
City Council of the City of Tamarac,
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