Cache County EMS Authority

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Taken from the license application filed with and approved by the State of Utah Bureau of EMS:

The role of the Cache County EMS Authority is to oversee the formation and management of a county-wide comprehensive Emergency Medical Services program providing Emergency Medical Services to all citizens of Cache County, as a joint program of the Office of the Cache County EMS Coordinator and the Ambulance Program of the Logan City Fire Department. The Authority will accomplish this mission by providing the EMS Coordinator’s Office and the Logan Fire Department Ambulance Program four key services: 1) strategic policy direction; 2) pre- city and county council budgetary approval; 3) ambulance billing and collection; and 4) revenue for ambulance operations and grants for volunteer medical first responder companies.

The Cache County EMS Authority is proposing to own and manage a co-licensure of three different ambulance and paramedic licenses. These proposed licenses are:

  • Paramedic transfer ambulance
  • Paramedic rescue
  • Intermediate ambulance.

The Authority’s duties would be focused on policy and oversight, and would specifically not have authority over day to day operations or tactical procedures. Those responsibilities would be reserved for the Logan Fire Chief and the County EMS Coordinator (currently contracted to the Smithfield City Fire Chief) in regard to their respective organizations.

Each first responder group in the county would maintain their own autonomy and function under inter-local contracts with the Cache County EMS Authority. The contracts would allow for funding for the extra work load that may occur. These agreements will greatly improve the level of service for the towns and cities throughout the county (i.e., more total medical units, reduced response times, etc.).

Funding for Cache County EMS Authority will be provided by funding from ambulance revenue and a county property tax. The Cache County EMS Authority will then fund the County EMS Coordinator’s budget and most of the Logan City Fire Department Ambulance budget.

The County EMS Coordinator’s budget would consist of the county portion of the Coordinator’s salary, office and training expenses associated with the Coordinator’s duties, the salaries and other HR costs of the county ambulance personnel, and annual financial grants for the volunteer EMS first responder companies.

The Cache County EMS Authority will fund 88.36 percent of the Logan City Fire Department Ambulance budget. This is equivalent to the assistance from the county agreed to in principle by the city and the county in June of 2003.

Additionally, the inter-local agreement also stipulates that the ambulance billing (for both Logan City and Cache County) is the be the responsibility of the Cache County EMS Authority. The Authority will issue a Request for Proposals (RFP) for ambulance billing/collections and would enter into and manage a contract for the services.

The county-wide EMS force structure would consist of a force structure of first responders and ambulances organized under the Logan City Fire Department for Logan City and the Cache County EMS Coordinator for Cache County. Both sets of responders would be tied together in an integrated and “seamless” EMS system by means of specific automatic and mutual aid language contained within the Agreement between the city and the county, or by mechanism of aid agreements between the county and the individual cities and towns.

Logan City’s responders would consist of:

  • Two paramedic first responder engine companies
  • A paramedic ambulance (to cover Logan City)
  • A paramedic rescue squad (to provide paramedic service to Cache County)
  • Automatic aid back up from Cache County’s ambulances.

Cache County’s responders would consist of:

  • 9 Volunteer Basic Life Support first responder units
  • 3 Volunteer Intermediate Life Support first responder units
  • 2 Intermediate ambulances (one in Smithfield and another in Hyrum) (paid staffing 0700-2200 hrs.; on call 2200-0700 hrs.)
  • Paramedic rescue service from Logan (for paramedic level calls)
  • Automatic aid back up from Logan City’s ambulances

The initial force structure would have the flexibility for future growth as the county or city population expands, if authorized by the Authority. Basic life support units may be upgraded in the future to Intermediate, and Intermediate units could be raised to paramedic level as population and call volume increases. Furthermore, additional city or county ambulances can be added when circumstances justify expansion that is approved by the Authority.

The Cache-Logan EMS concept of operations:

Logan City/Zone 7 Operations: The nearest paramedic first responder engine company and Rescue 70 (paramedic ambulance) would first handle medical emergencies. The closest available paramedic first responder engine company would then handle second emergencies and a second ambulance staffed by the paramedics off Squad 70. One paramedic each off of Engine 70 and Truck 70 would provide a third needed ambulance. Cache County (Ambulances 160 and 161) would provide fourth and fifth needed ambulances. Remaining suppression staffing and/or on-call or emergency recall personnel would provide sixth and seventh ambulances.

Cache County Ambulance concept of operations:

In areas of Cache County outside of Logan City/Zone 7, medical emergencies would first be handled by the nearest volunteer EMS first responder company and either Ambulance 160 out of Smithfield (for the north county) or Ambulance 161 from Hyrum (for the south county). Paramedic Rescue Squad 70 would also respond for calls triaged by Dispatch as a paramedic level call. Second ambulance calls would also be handled by the nearest first responders and Rescue 70 (paramedic ambulance) from Logan City. Logan City, using paramedics from either Squad 70 if available, or one paramedic each from Engine 70 and Truck 70, would provide the third needed ambulance. Logan City will provide the fourth through sixth ambulances using remaining suppression staffing and/or on-call or emergency recall personnel. The seventh ambulance would be provided by whichever of the county ambulances is still available in the opposite end of the county.

If, at any point in the above operational sequence, there is not sufficient staffing available to provide at least one suppression company and one ambulance in Logan City, after recalling Logan’s four on-call personnel, the administrative staff, and initiating an emergency recall of other off duty personnel, or if Logan City is out of ambulance vehicles, then Dispatch will move-up to Station 70 in Logan whichever of the two county ambulances remains available in service.

The recommended concept of logistics is to have all logistical needs for the county ambulances provided by Logan City. There are several reasons for this recommendation. First, the logistics apparatus is already in place and those logistics costs are already being born by the Fire Department’s Ambulance Program.

Secondly, given the recommended financial mechanism for the county-wide EMS system, the Fire Department’s Ambulance Budget will be reviewed and approved by the Cache County EMS Authority, inclusive of the logistical costs for all county-wide ambulance operations. Sufficient funding will then be provided by the Authority to cover those costs at the rate they are currently covered. (Note: additional funding would need to be approved by the Authority for Logan City to cover increased logistical costs that would result from Authority-approved expansion of the existing ambulance fleet to meet elevated call volume and/or population).

Third, and perhaps as critically, utilizing Station 70 in Logan as the logistical base for the outlying ambulances will facilitate the regular interaction between the county units and Logan City fire fighters. Such interaction will help to heal wounds and bridge what communication gap still remains.

Specifically, the following logistical support is envisioned as being provided to Cache County by Logan City as part of the Agreement:

  • Provision of the initial two ambulances for use in the county sub-stations (title would be transferred for liability purposes). Provided the budget adopted by the Authority allows for it, those ambulances can be repainted and have new logos (decals) placed specific to the new county ambulance program.
  • Provision of all needed equipment and supplies to set up the ambulances (including cardiac monitors, backboards, oxygen/airway bag etc.).
  • On-going provision (refilling) of all operational supplies including, but not limited to, oxygen, medicines, bandages, splints, backboards, fuel, etc.
  • Provision of all maintenance and/or repair for the ambulances.
  • Provision of reserve ambulances as needed to backfill for county ambulances out of service for maintenance or repair. Liability issues will need to be resolved to allow for exchange of ambulances and/or drivers between the city and county units in order for the integrated and seamless system to function properly. To achieve that requirement, it may be necessary for the CCEMS Authority to hold the titles to the ambulances and then, by mechanism of the Agreement, “assign” units for use by both the city and county ambulance programs.
  • Training assistance as necessary to Cache County units and personnel.

The Cache County EMS Coordinator, on the other hand, would be responsible for the following logistical tasks:

  • With assistance from Cache County, hire, train, staff, pay, and supervise Cache County ambulance personnel.
  • Provide training assistance as needed to Logan City fire fighters.

In conclusion we this program substantially enhances the level of Emergency Medical Services available in both Logan City and Cache County as a whole. It creates an integrated, seamless, system that synergistically has more redundancy and countywide participation (and, therefore, buy in). It is reasonably economical for our constituents and has flexibility to grow with increases in the county’s population and the resulting call volume escalation. Finally, the proposal will put an end, once and for all, to a very contentious issue that has long plagued Cache Valley, and having done so, open up many other opportunities for further cooperation within Cache County’s fire and EMS community.