Memo Resolution Allocation of funds for joint community care project with NE Meth HospitalCITY COUNCIL MEMORANDUM /RESOLUTION
City Council Meeting: July 27, 2010
Department:
EMS
Agenda No. 7
Subject: Allocation of funds for joint community care project
with Northeast Methodist Hospital
:: OX041111 Ll I
Modern day EMS has its roots in the 1970's when it was developed with two primary missions: help
prevent deaths from trauma and to rapidly assess, treat and transport cardiac arrest patients. The trauma
mission has been successful for a number of years with a robust care system in place all over the country.
However, the care of cardiac arrest victims (the sickest of the sick) has not progressed as well. For
example, the national cardiac arrest save percentage was approximately 4 -5% in 1975 and in 2005, the
save percentage was still 4 -5% nationally.
As Council has witnessed with our presentation of six cardiac arrest survivors during EMS Week, these
numbers are changing through new research, additional education and a closer working relationship
between EMS agencies and receiving hospitals to insure that what is done in the field compliments what
is necessary to be done once the patient arrives at the Emergency Department.
No where is this joint working relationship moving forward better than it is between Schertz EMS and
Northeast Methodist Hospital. We work monthly between both of our organizations to make sure we are
both doing everything possible to provide the highest level of care for our patients.
Moving parallel with these efforts at working closer together, is an amazing amount of research that is
clearly showing what parts of cardio- pulmonary resuscitation (CPR) actually work and what ones have
potentially been detrimental. To boil it all down, the current recommendations show that CPR should be
done continuously, with limited or no interruption, at a very specific depth of 2 ". It should not be
interrupted to breath for the patient and if bystanders are doing CPR, they should not do mouth to mouth
at all. Then, the recommendations take an unusual step to say that no matter who is doing the chest
compressions no rescuer should do them for any longer than 2 minutes due to rescuer fatigue. Research
now clearly shows that CPR done by humans, is only provided appropriately for up to 2 minutes before
the efficacy of it drops off dramatically.
This has led us in the EMS Department to seriously evaluate how we provide CPR. When we respond to
these calls, we have two people on the ambulance and 3 -4 personnel on the fire apparatus. With the
recommendations of only doing CPR for 2 minutes this takes three personnel to just do CPR which only
leaves 2 -3 personnel to provide the remainder of the advanced patient care that is required for these
critical patients.
For the last 18 months, we have been evaluating a number of options to not only provide CPR in better
accord with the current recommendations but to also have more assistance on scene. During this time, we
have field tested an Automatic CPR Device. This device provided CPR precisely as recommended by
Memo- Resolution.doc
City Council Memorandum
Page 2
research and it doesn't fatigue or need to be stopped once it is going. In addition, it freed up three
personnel on scene and allowed for shorter scene times and faster patient arrival at the hospital ED.
During this trial, Northeast Methodist Hospital was our receiving facility for the 8 patients we used it on.
The ED staff was very impressed with the LUCAS device and we also began developing a plan for how
this tool could be carried throughout the hospital if needed yet the vehicle it came off of would not be
without this valuable tool.
After our field trial, we began moving forward to acquire these devices for our EMS system. These
devices are approximately $15,000 each with a 10 year or greater anticipated life span. The first attempt
was to utilize a federal grant program to obtain them for all front -line fire apparatus. This plan would
have required 12 -14 devices so that each of our first responder fire agencies would have them. This grant
was unsuccessful.
The EMS Department then began working on obtaining enough for ambulance deployment. To do this
minimally, we would need five devices and to properly outfit our entire agency, we would need eight.
This expenditure of $75 - $120,000 was just not possible this current fiscal year or next year. Although
this tool appears to be very valuable, it was just going to have to wait.
Approximately six months ago, during a Cardiac Care Quality Improvement Committee meeting with
Northeast Methodist staff, this device came up. I explained that we were working on obtaining funding
for these devices and we hoped to do so in the next 24 months. I then explained that ideally, when we did
this, we would like Northeast Methodist Hospital to purchase one as well so that we could keep the
patient on our device when we arrived at the ED, but if the ambulance needed to leave, we could grab
their unit so that we still had one with us. Northeast Methodist staff was very interested in this and felt it
would be highly appropriate for them to do this when we were ready to move forward.
Then, three weeks ago, Northeast Methodist Hospital CEO Mark Bernard asked for a meeting with Dr.
Butter, Jason Mabbitt and 1. He explained at this meeting that Northeast Methodist desired to do more
than just purchase one for the ED. He said they wanted to enter into a partnership with Schertz EMS to
improve the overall care of Cardiac Arrest victims in our entire service area.
To do this, they are going to purchase us two LUCAS devices. Then, they want to partner with us to
outfit our system as well as we can so for every LUCAS device Schertz EMS purchases, Northeast
Methodist will purchase us an additional one. This means for Schertz EMS to acquire eight devices, the
hospital will buy 2, we will buy three and the hospital will match our purchase with another three devices.
This is an incredible offer of partnering together for the citizens that both of our organizations are charged
with protecting, and we are coming to City Council with a plan to make this happen as soon as possible.
The EMS Department has explored the option of leasing the three devices we desire to purchase.
Although this is possible, the lease loan rate of almost 7% makes this seem unwise. So, instead, as an
enterprise fund under the City of Schertz, we would like to borrow the $45,000 needed from the Water
Department enterprise fund with a payback schedule not to exceed five years. The small annual payment
will be more than capable of being made and it is our hopes that our system will allow us to pay this back
much earlier than the five year mark.
FISCAL IMPACT
The fiscal impact will be a reduction of $45,000 in the reserve funds of the Water Department enterprise
fund that will be repaid with interest by the EMS enterprise fund in no more than five years.
Memo - Resolution.doc
City Council Memorandum
Page 3
RECOMMENDATION
Staff recommends Council approval of the loan arrangement between the EMS and Water Department
enterprise funds.
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF SCHERTZ:
««««««« «««««««««<O » » » > » » » »»»»»»»» » » » »»
PASSED AND APPROVED at a regular meeting of the City Council of the City of Schertz, Texas this
27`h day of July, 2010, at which meeting a quorum was present, held in accordance with the provisions of
the Texas Government Code, §551.001 et seq., as amended.
j ;API'R0 l
al Baldwin, Mayor
ST:
LA NAX 1
renda Dennis, City Secretary
Memo- Resolution.doc