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NCFPD approves staffing for additional paramedics ambulance

Seeks SAFER grant, extends ambulance agreement with Vista

Three actions during the Dec. 12 North County Fire Protection District board meeting involve increased ambulance staffing for the district.

One approved action will add a fourth advanced life support ambulance in the district. Another action directed NCFPD staff to apply for a Staffing for Adequate Fire and Emergency Response (SAFER) grant from the Federal Emergency Management Agency's U.S. Fire Administration and directed district staff to develop a financial plan to support the two additional firefighter/paramedic positions.

The board also extended the agreement to station and staff a basic life support ambulance in Vista through the end of February 2024. All three motions were approved on 5-0 votes.

"One of the elements in our organization's strategic plan was for us to evaluate our ambulance delivery system," said NCFPD fire chief Keith McReynolds.

In September 2023, a District Delivery Model Working Group was formed to evaluate the effectiveness of the NCFPD delivery model including staffing, service hours, care level, and the unit hour utilization (UHU) of the three operating paramedic ambulances. Advanced life support ambulances are based at NCFPD Station 1 (Ivy Street), Station 4 (Pala Mesa), and Station 5 (Bonsall).

The UHU of ambulance M111, which is based at Station 1, has exceeded 30% for multiple years. For the first 11 months and two weeks of 2023, the UHU for ambulance M111 was 32.34%. The rising call volume, extended transport, patient offload, and return time results in increased demand for ambulance automatic aid, employee fatigue, and fatigue related incidents.

During those first 11 months of 2023, a total of 674 automatic aid requests for ambulance response to the NCFPD service area were made to the Pala, Oceanside, and Vista fire departments, and the majority of those requests were for ambulances to cover incidents when NCFPD ambulances were not available.

"We were having a lot of issues with availability of our ambulances," McReynolds said. A patient might be taken to the hospital as well as treated for an immediate life-threatening condition. "There are offload delays," McReynolds said.

"We have long transport times and return times for our ambulances," McReynolds said. "We might not get that ambulance back for two or two and a half hours."

The North County Fire Protection District responded to about 7,000 calls during 2023. "Our call volume is increasing," McReynolds said.

Automatic aid which had been provided by the Camp Pendleton Fire Department's Station 9 is no longer available as the military base has closed that station to meet a greater need on the west side of the base. "We lost that resource," McReynolds said.

Camp Pendleton had assisted on approximately 330 trips per year into the NCFPD service area.

The Delivery Model Working Group recommended that a fourth ambulance be added. "We've had three ambulances for over 30 years," McReynolds said. "We felt the time was right to add that resource off of Station 1 to meet that additional call volume."

The fourth ambulance will be based at Station 1 initially, so that station will have two ambulances. "We'll be renovating a small area of Station 1," McReynolds said. That renovation will allow for extra dormitories.

The estimated annual operating costs for the fourth ambulance total $631,500 and consist of $516,000 for salaries and benefits of three firefighter/paramedics and three emergency medical technicians, $50,000 for one-time equipment, $40,500 for emergency medical services equipment replacement, and $25,000 for fuel.

Ambulance fees are billed to the patient's insurance carrier; the current monthly revenue is approximately $300,000 or $100,000 per ambulance and NCFPD financial analysts believe that the fourth ambulance would provide $75,000 in monthly revenue or $900,000 annually. "It should pay for itself," McReynolds said.

"We're excited. We think that the timing is right," McReynolds said. "To have another ambulance available, it's a critical need and we are happy to step up and meet that need."

What is known as the "North Zone" has an automatic aid program where the closest available resource is deployed regardless of the city or fire district where the call for service is needed. Vista is among the fire agencies participating in the boundary drop agreement, but the location of Vista causes Vista Fire Department resources to be deployed to other cities or unincorporated communities. The automatic aid calls have left Vista itself without ambulance service, and the City of Vista had considered withdrawing from the ambulance boundary drop agreement.

The current NCFPD fleet includes three reserve ambulances as well as the three ambulances based at fire stations. In March 2022, the NCFPD board voted to station and staff a basic life support ambulance in Vista for a 30-day trial period. The NCFPD ambulance based at the Vista Fire Department's Station 6 off of East Vista Way was staffed from 9 a.m. to 9 p.m., seven days a week.

Because that ambulance is for basic life support, it is staffed by two NCFPD emergency medical technicians rather than by paramedics. The use of single-role emergency medical technicians means that no NCFPD firefighters are based outside of the NCFPD boundaries.

The ambulance at Station 6 in Vista handles lower-priority calls, which keeps the Vista ambulances available for the higher-priority calls. In addition to providing service to the Vista and NCFPD coverage areas, the ambulance has also responded to calls in Oceanside and Carlsbad.

The ambulance was first placed into service in April 2022. During the first two months, the NCFPD ambulance responded to 354 calls including 166 incidents in which the ambulance transported a patient.

The 30-day trial period was intended to confirm or refute the belief that ambulance billing would recover the NCFPD operational expenses. Over the first two months, the personnel costs were approximately $29,000 while other operating expenses such as fuel and supplies totaled approximately $10,000.

Based on information from the NCFPD third-party billing administrator, the ambulance transport revenue for that period was approximately $48,000. In July 2022, the NCFPD board voted to extend the agreement for an additional three months.

During the first five months of the agreement, the NCFPD ambulance responded to 816 calls in the Vista, Carlsbad, Oceanside, and NCFPD service areas including 398 which involved transport. That equated to an average of 2.6 transports per 12-hour shift.

Personnel expenses during that five-month period were approximately $93,000 and operating costs totaled approximately $25,000. The transport revenue was approximately $140,000. In October 2022, the NCFPD board approved an extension of the agreement for another 12 months, and that new agreement increased the NCFPD ambulance's availability from 12 hours to 24 hours each day.

The Vista fire department is finalizing its own basic life support ambulance program, so the Dec. 12 NCFPD board vote extended the agreement through Feb. 28, 2024. The monthly ambulance revenue continues to range between $50,000 and $92,000 while personnel, fuel, and other expenses are approximately $31,000 per month.

The SAFER grant would allow one year of NCFPD salaries and benefits for six personnel so that the additional advanced life support ambulance could have one firefighter/paramedic and one emergency medical technician for each shift. The SAFER grant would cover 100% of the additional personnel costs for the first year, 75% for the second year, and 50% for the third year.

"As new revenue comes in the fire district will be able to fully absorb the costs of these people," McReynolds said.

The announcement of SAFER grant awards normally occurs in the August or September after the application is submitted. "We're hoping that we will be able to have both these positions by next summer," McReynolds said.

Author Bio

Joe Naiman, Writer

Joe Naiman has been writing for the Village News since 2001


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