Fairfax EMS by 89YpOi

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									  An Analysis of Emergency Medical Services
for the Fairfax EMS, Osage County, Oklahoma




    Oklahoma Cooperative Extension Service,
          Oklahoma State University

      Oklahoma State Department of Health,
      Office of Rural Health & EMS Division


                  January 2001
                                                                           AE-01005




            An Analysis of Emergency Medical Services
          for the Fairfax EMS, Osage County, Oklahoma




       Cheryl F. St. Clair - Extension Associate, OSU, Stillwater
                              (405) 744-6081

      Gerald A. Doeksen - Extension Economist, OSU, Stillwater
                           (405) 744-6081

 Jack Frye, District R. D. Specialist, SE District Extension Office, Ada
                             (580) 332-4100

     Dee E. Cooper - Osage County Extension Director, Pawhuska
                          (918) 287-4170

Ronald P. McCummins - Director, EMS Division, OSHD, Oklahoma City
                         (405) 271-4027

           Rick Bronson - Field Coordinator, OSHD, Grove
                           (918) 786-7534




                   RURAL DEVELOPMENT
              COOPERATIVE EXTENSION SERVICE
               OKLAHOMA STATE UNIVERSITY




                             January 2001
                          An Analysis of Emergency Medical Services
                        for the Fairfax EMS, Osage County, Oklahoma



       The Fairfax community and surrounding area are serviced by the Fairfax EMS provider,

currently through a private contractor. In order to provide more timely and cost effective service

to the Fairfax EMS service area, an analysis of the Fairfax EMS is being included in this report.

The objectives of the study will include:

        1) an analysis of the 1999 EMS calls,

        2) two different funding alternatives including total capital expenditures and annual

            capital and operating expenses, and

        3) an analysis of different revenue options.

Through this analysis, the Cooperative Extension Service is not advocating any of the

alternatives presented. This report is not in the form of a recommendation. This report is

provided for informational purposes only.



                        An Analysis of the Fairfax EMS Calls for 1999

       Data was provided by the private contractor that is currently providing EMS services to

Fairfax and the surrounding area. EMS call data is for the 1999 year and is summarized in the

next five tables (Tables 1-5).

       The Fairfax EMS provider serviced 472 calls in 1999. Calls are classified as either

emergency or non-emergency in both the “initial” response mode and the “at scene” response

mode. In the “initial” response mode (Table 1), one hundred forty-seven (147) EMS calls or

31% of the total calls were considered emergency calls and another 325 EMS calls (69%) were

                                            Table 1
                                      Fairfax EMS Service
              "Initial" Response Mode -- Call Type Analysis, 1999 Data

                                             Number              Percent of
               Call Type                     of Calls            Total Calls

Emergency                                               147                    31%
Non-Emergency                                           325                    69%

Total Calls                                             472                    100%




                                         2
considered non-emergency. However, in the “at scene” response mode (Table 2), only 31 EMS

calls or 7% of the total calls were considered emergency calls. Another 409 calls or 87% were

classified as non-emergency calls and 29 calls or 6% were “No Transport” calls. Two calls were

transported by helicopter and one call was a standby call.

       Table 3 shows the call pick-up locations or patient origination locations as indicated on

the reports received from the Fairfax EMS service. The majority of the EMS calls originated in

hospitals, with 206 calls or 43.6% of the total calls. Of these 206 calls, the majority, 180 calls,

originated at the Fairfax Memorial Hospital. Another 21 calls originated at Tulsa Hospitals,

including four from Hillcrest, two from St. John’s, one from Tulsa Regional, and fourteen from

St. Joseph’s. The remaining five calls were “other” hospitals located in Cleveland (1), Pawnee

(2), Stillwater (1), and Pawhuska (1).

       The next largest category of call pick-up locations was nursing homes with 116 calls or

24.6% of the total calls. Of the 116 nursing home call originations, a total of 114 were from the

Fairfax Manor Nursing Home. Private residences represented the next largest call pick-up

category with 103 calls or 21.8% of the total calls. The scene of an accident was the next largest

pick-up category with 41 calls or 8.7% of the total calls. Doctors’ offices were the pick-up

location for four calls and “other” locations were the pick-up location for two calls.

       Table 4 shows the call origination location or call pick-up location by the city of the call

location. Fairfax was the city where the majority of the EMS calls originated, with 417 calls or

88.3% of the total calls. Ponca City was the next largest category of city pick-up locations

with19 calls or 4% of the total. Next, Stillwater was the pick-up location of 11 calls or 2.3% of

the total calls and Tulsa was the pick-up location of 10 calls or 2.1% of the total calls.




                                                  3
                                     Table 2
                               Fairfax EMS Service
              "At Scene" Response Mode -- Call Type Analysis, 1999 Data

                                                       Number              Percent of
Call Type                                              of Calls           Total Calls

Emergency                                                   31                   7%
Non-Emergency                                              409                  87%
No Transport                                                29                   6%
Transported by Helicopter                                    2                   0%
Standby Calls                                                1                   0%

Total Calls                                                472                 100%




                                         4
                                       Table 3
                                 Fairfax EMS Service
                          Call Pick-Up Locations, 1999 Data

Call Pick-Up                         All Categories    % of    Sub-Categories    % of
Location                               No. of Calls    Calls     No. of Calls    Calls

Hospitals                                      206    43.6%              206    43.6%
 Fairfax Memorial Hospital                     180    38.1%
 Tulsa Hospitals                                21     4.4%
  Hillcrest Medical Center                       4     0.8%
  St. John's Hospital                            2     0.4%
  Tulsa Regional Medical Center                  1     0.2%
  St. Joseph's Reg. Med. Ctr.                   14     3.0%
 Other Hospitals                                 5     1.1%
  Cleveland Area Hospital                        1     0.2%
  Pawnee Municipal Hospital                      2     0.4%
  Stillwater Medical Center                      1     0.2%
  Pawhuska Hospital                              1     0.2%
Nursing Homes                                  116    24.6%              116    24.6%
 Fairfax Manor Nursing Home                    114    24.2%
 Shawn Manor Nursing Home                        1     0.2%
 Other (Not named)                               1     0.2%
Doctors' Offices                                 4     0.8%                4    0.8%
 Doctors' Offices                                3     0.6%
 Tulsa VA Out Patient Clinic                     1     0.2%
Private Residences                             103    21.8%              103    21.8%
Scene of Accident                               41     8.7%               41     8.7%
Other                                            2     0.4%                2     0.4%
 Cancer Treatment Ctr. of Tulsa                  1     0.2%
 Kaiser Rehab Center                             1     0.2%

 TOTALS                                        472    100%               472    100%




                                         5
                                      Table 4
                                Fairfax EMS Service
                 Call Pick-Up Locations By City Locations, 1999 Data

                                                     Number             Percent of
City Location                                        of Calls          Total Calls

  Tulsa                                                   10                2.1%
  Hominy                                                   3                0.6%
  Fairfax                                                417               88.3%
  Cleveland                                                1                0.2%
  Ponca City                                              19                4.0%
  Pawnee                                                   2                0.4%
  Ralston                                                 11                2.3%
  Stillwater                                               1                0.2%
  Blanchard                                                1                0.2%
  Blackburn                                                1                0.2%
  Pawhuska                                                 2                0.4%
  Burbank                                                  3                0.6%
  Other (in Oklahoma)                                      1                0.2%

  TOTALS                                                 472                100%




                                         6
       Table 5 shows the drop-off location or patient destination location of the Fairfax 1999

EMS calls. Hospitals were the largest category of drop-off or patient destination locations, with

348 calls or 73.7% of the total calls. Fairfax Hospital received the majority of the hospital

patients, 223 calls or 47.2% of the total calls, and Tulsa Hospitals were the next largest hospital

patient destination category, with 101 patients or 21.4% of the total.

       Nursing homes received 77 of the calls or 16.3% of the total calls; of the total 77 nursing

home patient destinations, the Fairfax Manor Nursing Home received 72 patients. Private

residences were the patient destination of 10 calls or 2.1%. Another 19 calls or 4% of the total

calls refused transportation from the EMS service. Ten calls (2.1%) were DOA; another 3 calls

were transported to doctors’ offices; two calls were transferred to other EMS services and two

were transported by Life Flight; one call was a standby call.

       The total mileage for the 472 EMS calls in 1999 for the Fairfax EMS has been estimated

to be 18,000 miles. Of this total, approximately 8,100 miles are estimated to be “billable” miles.

These mileage numbers will be utilized in the budget and revenue alternatives presented.

                  Estimated Costs of Funding Alternative Delivery Systems

       Two alternative Fairfax EMS systems will be illustrated. The first alternative

(Alternative 1) is based on basic EMS service provided 24 hours per day, 365 days per year.

Alternative 1 will include a Type I ambulance vehicle and ambulance equipment designed for

providing basic life support service. The second alternative (Alternative 2) is based on an

advanced life support EMS service provided 24 hours per day, 365 days per year. A Type III

ambulance vehicle equipped with advanced life support equipment is assumed for Alternative 2.

For both alternatives, the living quarters including utilities and telephone are being provided for

the EMS service. Therefore, no building costs, rental costs, office furnishings, utilities, building

insurance,

                                                 7
                                          Table 5
                                    Fairfax EMS Service
                             Call Drop-Off Locations, 1999 Data
                                                          All                    Sub-
Call Drop-Off                                      Categories     % of     Categories     % of
Location                                          No. of Calls    Calls   No. of Calls    Calls

Hospitals                                                 348    73.7%            348    73.7%
   Fairfax Hospital                                       223    47.2%
   Tulsa Hospitals                                        101    21.4%
      Hillcrest Medical Center                             43      9.1%
      St. John's Hospital                                   2      0.4%
      St. Francis Hospital                                  5      1.1%
      Tulsa Regional Medical Center                        10      2.1%
      St. Joseph's Reg. Med. Ctr.                          41      8.7%
   Other Hospitals                                         24      5.1%
      Jane Phillips Hosp. (Bartlesville)                    4      0.8%
      Pawnee Municipal Hospital                             3      0.6%
      Southcrest Med. Ctr.                                  1      0.2%
      Stillwater Medical Center                            12      2.5%
      Select Specialty Hospital                             1      0.2%
      Pawhuska Hospital                                     1      0.2%
      Other Hospitals (Not Named)                           2      0.4%
Nursing Homes                                              77    16.3%             77    16.3%
   Fairfax Manor Nursing Home                              72    15.3%
   Shawn Manor Nursing Home                                 1      0.2%
   Hominy Nursing Home                                      3      0.6%
   Other (Not named)                                        1      0.2%
Doctors' Offices                                            3      0.6%             3    0.6%
   Doctors' Offices                                         2      0.4%
   Tulsa VA Out Patient Clinic                              1      0.2%
Private Residences                                         10      2.1%            10     2.1%
DOA                                                        10      2.1%            10     2.1%
Refused Transport                                          19      4.0%            19     4.0%
Transfer to Other EMS                                       2      0.4%             2     0.4%
Transported by Life Flight                                  2      0.4%             2     0.4%
Standby Only                                                1      0.2%             1     0.2%
   TOTALS                                                 472     100%            472    100%



                                              8
building maintenance or building upkeep costs will be included for either Alternative 1 or

Alternative 2. Also, for both alternatives, dispatch service is being provided through the local

law enforcement and no costs are included for a base communications system. A third column

(Alternative 3) is left blank for the convenience of the decision-makers to add another budget

alternative, if desired. These alternatives are not recommendations but rather an informational

analysis of different methods for funding the Fairfax EMS system.

       Capital and operating budgets are developed based on information derived from Sloggett

et al. (1988) [1] and information derived from Kleinholz et al. (1990) [2]. Capital and operating

costs are based on the average known replacement or operating costs. Annual capital costs are

defined as the annual depreciation of the capital equipment (ambulance, radios, equipment,

buildings, etc.). These annual capital costs are important since they act as a sinking fund to

replace worn capital items and are needed to purchase additional capital items in the future.

Annual operating costs are the day-to-day expenses of operating the EMS system (salaries,

benefits, fuel, oil, maintenance, supplies, insurance, etc.).

Alternative 1 - Fairfax Basic Life Support EMS System (Type I Vehicle)

       Alternative 1 is based on estimated costs for an EMS system that would provide basic

level service, 24 hours a day, 365 days per year. Costs are based on research [1,2]. Table 6

shows the estimated capital costs.

       The capital equipment items needed for a basic life support service are included in the

second column of Table 6. Again, no costs will be included for building or rental costs or for

base communications cost; the local community law enforcement is providing dispatch services

to the Fairfax EMS service at this time. The ambulance vehicle will include one Type I vehicle

at


                                                   9
                                         Table 6
                                   Fairfax EMS Service
                              Estimated Capital Expenditures

                              Alternative 1                   Alternative 2              Alternative 3
                                                 Total                         Total                      Total
                           Unit                 Capital    Unit               Capital   Unit             Capital
        Capital Items      Cost     No.          Costs     Cost    No.         Costs    Cost   No.        Costs
Vehicle - Type I         80,000      1         $80,000
Vehicle - Type III                                        75,000      1       $75,000
Vehicle Basic Equip.     15,000       1        $15,000
Vehicle ALS Equipment                                  47,000        1        $47,000
Vehicle Radios            1,000       1         $1,000 1,000         1         $1,000
Oxygen Sets               1,000       2         $2,000 1,000         2         $2,000
Portable Radios/Phones      600      12         $7,200    600       12         $7,200


Total Capital Costs                           $105,200                    $132,200




                                                10
$80,000. The vehicle will be equipped with basic life support equipment, at a cost of $15,000.

The basic life support equipment necessary to equip an ambulance is listed in Appendix A. The

EMS service may desire to contract with a neighboring EMS service for backup support since

only one vehicle is available. A vehicle radio will be needed for an estimated cost of $1,000.

Oxygen sets will be stocked and at a cost of $1,000 each, a total of $2,000 would be spent to

stock two sets for the vehicle. Communications between the dispatcher and the EMS staff are of

utmost importance; portable radios/phones will be needed to facilitate these communications and

it is estimated that 12 portable radios/phones will be needed. At a cost of $600 each, the total

cost would be $7,200. The total capital costs for Alternative 1 are approximately $105,200.

       A sinking fund or capital equipment replacement fund is necessary to provide for the

long-term needs of an EMS system. For Alternative 1, the annual capital costs (or annual

replacement costs or depreciation) are shown in Table 7. According to Sloggett [1], ambulance

vehicles are depreciated based on 75,000 miles or seven years, whichever comes first. The

annual depreciation cost for the ambulance vehicle is based on annual total miles of 18,000.

Over a seven year period, the total miles driven will be approximately 126,000. Therefore, the

vehicle will be depreciated over 4.2 years, based on the maximum of 75,000 miles

(75,000/18,000 = 4.2). This results in an estimated annual replacement cost of $19,048 for the

Type I ambulance vehicle. The basic life support equipment is depreciated over a seven-year

period, resulting in an annual replacement cost of $2,143. The vehicle radio, oxygen sets, and

portable radios/phones are all depreciated over five years, resulting in annual replacement costs

of $200, $400, and $1,440, respectively. The estimated total annual capital costs for Alternative

1 are $23,230.




                                                11
                                      Table 7
                                Fairfax EMS Service
                         Estimated Annual Capital Expenses

                         Alternative 1              Alternative 2             Alternative 3
                                          Annual                    Annual                 Annual
                                          Capital                   Capital                Capital
        Capital Items        Yrs.          Costs        Yrs.         Costs        Yrs.      Costs
Vehicle - Type I              4.2        $19,048
Vehicle - Type III                                       4.2    $17,857
Vehicle Basic Equip.            7         $2,143
Vehicle ALS Equip.                                       7.0        $6,714
Vehicle Radios                  5           $200           5          $200
Oxygen Sets                     5           $400           5          $400
Portable Radios/Phones          5         $1,440           5        $1,440
Total Annual
 Capital Costs                           $23,230                $26,611




                                           12
       Annual operating costs are the day-to-day expenses of operating the EMS system

(salaries, benefits, fuel, oil, maintenance, supplies, insurance, etc.). The annual operating costs

for Alternative 1 are shown in Table 8. Vehicle expenses include gas at $1.50/gallon. The total

mileage is estimated at 18,000 miles. Based on 8 mpg, the total gallons is estimated to be 2,250

(18,000/8 = 2,250), for an annual cost of $3,375 for gas. Gasoline may be obtained at a lower

cost from local government officials if local arrangements can be made. The vehicle

maintenance, repairs, and inspections are estimated to cost $1,582. Maintenance and repair

expenses include tires, oil, filters, and lubrications, vehicle licensing, and all other maintenance

and repairs on the vehicle. The vehicle insurance is estimated at $2,100 per year. Insurance may

be acquired at a lower cost by checking with appropriate insurance carriers or by contacting the

Director of the EMS Division, Oklahoma State Department of Health, at (405) 271-4027.

       The billing expenses for Alternative 1 are estimated to be $2,360 per year. This is based

on a billing fee of $5 per call for the total of 472 calls at Fairfax. Equipment maintenance and

repairs are important for effective communications and the vehicle radio is estimated to cost $60

per year to maintain. The portable radios/phones are estimated to cost $40 each per year to

maintain, for an annual total of $480. Licensing expenses are estimated to be $480 per year. The

medical supply expenses are based on a cost of $3.50 per call for all 472 calls ($1,652) and a cost

of $20.00 per call for emergency calls of 31 ($620), for a combined total of $2,272 yearly.

       The labor costs for Alternative 1 are detailed in Table 9. An EMS Director (EMT-

Intermediate) is employed full-time at an annual salary of $20,000 to work 40 hours per week as

an EMT and to supervise the entire Fairfax EMS operation. Each crew will consist of one EMT

Intermediate or Basic and one EMT Basic or First Responder. The day and evening crews will

work five 8-hour shifts or 40 hours per week. The EMS Director will be a part of this crew and


                                                 13
                                              Table 8
                                       Fairfax EMS Service
                             Estimated Annual Operating Expenses
                                Alternative 1              Alternative 2            Alternative 3
                                              Annual                     Annual                  Annual
                           Unit             Operating  Unit           Operating   Unit        Operating
Operating Expense Items    Cost      No.       Costs   Cost    Yrs.       Costs   Cost Yrs.       Costs
Vehicle Expenses
  Gas                      $1.50   2,250     $3,375 $1.50     2,250     $3,375
  Maint/Repairs/Insps.                       $1,582                     $1,582
  Insurance               $2,100      1      $2,100 $2,100       1      $2,100
Billing Expense               $5    472      $2,360     $5     472      $2,360
Vehicle Radios               $60      1         $60    $60       1         $60
Portable Radios/Phones       $40     12        $480    $40      12        $480
Licensing Expense                              $480                       $700
Medical Supply Exp.                          $2,272                     $6,203
Labor Costs                                $122,959                   $135,106
Office Supplies             $50      12        $600    $50       12       $600
Training Expense           $300      12      $3,600 $300         12     $3,600
Wrkrs Cmp/ Ins/Bens                25%      $29,276            25%     $32,168
Miscellaneous             $1,500      1      $1,500 $1,500        1     $1,500
Total Annual
  Operating Costs                          $170,644                   $189,834
Total Annual Capital &
  Operating Costs                          $193,874                   $216,446
Cost Per Call                               $410.75                    $458.57




                                             14
                                             Table 9
                                       Fairfax EMS Service
                              ALTERNATIVE 1 - LABOR COSTS
                  Based on Providing BASIC Service, 24 hours/day, 365 days/year,
                       with a 2-Person Crew (One EMT Basic or Intermediate
                      and One EMT Basic or Intermediate or First Responder)

FTE's Description                                                                  Labor Costs

To cover M - F, from 8 a.m. - 4 p.m.
  1 Full-Time EMS Director (EMT Intermediate) ($20,000/yr.)                            $20,000
         (Working EMT)
  1 EMT Intermediate or Basic or First Responder                                       $15,600
         ($7.50/hr., 40 hrs./wk, 52 wks./yr.)

To cover M-F from 4 p.m. - midnight 12:00 p.m. (40 hrs. per week)
  1 EMT Intermediate or Basic                                                          $17,680
        ($8.50/hr., 40 hrs./wk, 52 wks./yr.)
  1 EMT Intermediate or Basic or First Responder                                       $15,600
        ($7.50/hr., 40 hrs./wk, 52 wks./yr.)

To cover weekends, from 8 a.m. - midnight Sat and Sun)
 0.8 EMT Intermediate or Basic                                                         $14,144
        ($8.50/hr., 32 hrs./weekend, 52 weekends/yr.)
 0.8 EMT Intermediate or Basic or First Responder                                      $12,480
        ($7.50/hr., 32 hrs./weekend, 52 weekends/yr.)

To cover 8 Hours On Call Daily from midnight - 7:59 am
        (1 EMT Intermediate or Basic and 1 EMT or First Responder)                     $18,200
Call-In Pay
        (68 calls, $25/call, 2 persons, 1 EMT and & 1 EMT or First Responder)           $3,400

TOTAL BASE SALARIES                                                                   $117,104

 Overtime Pay                                                                           $5,855

TOTAL BASE SALARIES AND OVERTIME                                                      $122,959

 BENEFITS                                                                              $29,276

TOTAL LABOR COSTS FOR ALTERNATIVE 1                                                   $152,235




                                              15
will work as an EMT from 8 am – 4 pm Monday thru Friday. Assuming the average wage

currently paid for an EMT Basic or First Responder is $7.50, the cost for the second daytime

crew member will be $15,600 annually. A second two-person crew will be employed to work

from 4 pm – midnight Monday through Friday. The cost will be $17,680 for the first crew

member, an EMT Intermediate or Basic, based on an average hourly rate of $8.50. The second

crew member, an EMT Basic or First Responder, will cost $15,600 in base salary, based on $7.50

per hour.

       To cover weekends from 8 am until midnight on Saturday and Sunday, another crew will

be needed; the first crew member is estimated to cost $14,144 (an EMT Intermediate or Basic at

$8.50/hour) and the second crew member $12,480 (an EMT Basic or First Responder at

$7.50/hour). The remaining hours, from midnight until 8 am daily seven days per week, will be

covered by an on-call crew; the on-call crew will consist of one EMT Basic or Intermediate and

one EMT Basic or First Responder.. Each crew member will be paid $25 per day on-call pay, for

an annual total of $18,200 (2 persons x $25/day x 7/days/week x 52 weeks/year = $18,200).

When the crew is called in, each crew member will be paid $25 per call, for an annual cost of

$3,400. This is based on an estimated 68 calls per year occurring during the hours of midnight

until 8 am daily (68 calls x $25/call x 2 persons = $3,400). This number was estimated based on

research from Sloggett [1]. Research shows that approximately 14.4% of the total calls occur

between the hours of midnight and 8 am. Based on this, there will be approximately 68 calls

annually that will occur during the on-call period (472 calls x 14.4% = 68 calls).   The total of

base salaries, on-call pay, and call pay for Alternative 1 is $117,104. An additional 5% of base

salaries is added to allow for overtime pay, for an annual overtime pay total of $5,855. Benefits

in the amount of 25% are added onto the base salaries for a total of $29,276. The total labor


                                                16
costs for Alternative 1 are estimated to be $152,235.



       Returning to Table 8, the total of base salaries and overtime of $122,959 ($117,104 +

$5,855 = $122,959) are included under labor costs and the 25% benefits ($29,276) are included

under workers’ compensation/insurance/benefits. Office supplies are estimated at $50 per

month, for an annual total of $600 for Alternative 1. Training expenses are estimated at $300

per person for 12 persons, for an annual total of $3,600. A miscellaneous category has been

included to cover any other costs; the annual estimated miscellaneous cost is $1,500. The total

annual operating costs for Alternative 1 are estimated to be $170,644. The total annual capital

and operating costs for Alternative 1 are estimated to be $193,874, representing a cost of

$410.75 per EMS call for the Fairfax EMS service.



Alternative 2 - Fairfax Advanced Life Support EMS Service – (Type III Vehicle)

       The second funding alternative (Alternative 2) would provide advanced life support

service, 24 hours a day, seven days a week. Only the differences between Alternative 1 and

Alternative 2 will be discussed in the text.

       In Table 6 the estimated capital equipment items for Alternative 2 are shown. For

Alternative 2, it is assumed that a Type III ambulance vehicle will be utilized for an annual cost

of $75,000. To equip the ambulance with advanced life support equipment will cost an estimated

$47,000. The remainder of the capital expenditures for Alternative 2 are the same as

Alternative 1 and will not be listed in detail again. The total annual capital costs for Alternative

2 are estimated to be $132,200 for the Fairfax EMS service.

       The estimated annual capital costs for Alternative 2 are shown in Table 7. The


                                                17
depreciation on the vehicle is based on the same method as Alternative 1. The vehicle will need

to be replaced every 4.2 years; the annual replacement cost for the Type III vehicle will be

$17,857 annually. The advanced life support equipment is depreciated over 7 years based on a

straight line depreciation methodology, for an annual cost of $6,714. The annual capital costs for

Alternative 2 are estimated to be $26,611 for the Fairfax EMS service.

       The annual operating costs for Alternative 2 are illustrated in Table 8. Again, only the

differences between Alternative 1 and Alternative 2 will be discussed in the text. The licensing

expense for an ALS system is estimated to be $700 per year. The medical supply expense for an

ALS system will be much higher. The total medical supply expense is estimated to be $6,203 per

year. The base cost of medical supplies is $11.50 per call for all 472 calls ($5,428) and an

additional cost of $25 is estimated for emergency calls of 31 calls ($775), for a combined total of

$6,203.

       Labor costs and benefits for Alternative 2 are shown in detail in Table 10. The base

salary for the EMS Director is estimated to be $22,000 and will need to be a working Paramedic.

The EMS Director will work the Monday through Friday 8 am – 4 pm shift, with an EMT

Intermediate or Basic as a second crew member. The second crew member is estimated at a base

salary of $17,680 per year, based on an hourly rate of $8.50. Each two-person crew will consist

of one Paramedic and one EMT Intermediate or Basic. The next shift, 4 pm – midnight, will be

covered by a two-person crew. The Paramedic is estimated at a base salary of $19,670, based on

an hourly rate of $9.50, and the EMT Intermediate or Basic at a base salary of $17,680, based on

an hourly rate of $8.50.

       To cover weekends, a two-person crew will be employed to work from 8 am until

midnight on Saturday and Sunday; the cost of the Paramedic is estimated at $15,808 (based on


                                                18
                                            Table 10
                              Fairfax EMS Service
                       ALTERNATIVE 2 - LABOR COSTS
       Based on Providing ADVANCED LIFE SUPPORT Service, 24 hours/day, 365 days/year
      with a 2-Person Crew (One Paramedic and One EMT Basic or Intermediate)

FTE's Description                                                             Labor Costs

To cover M - F, from 8 a.m. - 4 p.m.
  1 Full-Time EMS Director (Paramedic) ($22,000/yr.)                               $22,000
         (Working Paramedic)
  1 EMT Intermediate or Basic                                                      $17,680
         ($8.50/hr., 40 hrs./wk, 52 wks./yr.)

To cover M-F from 4 p.m. - midnight (40 hrs. per week)
  1 Paramedic                                                                      $19,760
        ($9.50/hr., 40 hrs./wk, 52 wks./yr.)
  1 EMT Intermediate or Basic                                                      $17,680
        ($8.50/hr., 40 hrs./wk, 52 wks./yr.)

To cover weekends, from 8 a.m. - midnight Sat and Sun)
 0.8 Paramedic                                                                     $15,808
        ($9.50/hr., 32 hrs./weekend, 52 weekends/yr.)
 0.8 EMT Intermediate or Basic                                                     $14,144
        ($8.50/hr., 32 hrs./weekend, 52 weekends/yr.)

To cover 8 Hours On call Daily from midnight - 7:59 am
        (1 Paramedic & EMT Intermediate or Basic)                                  $18,200
Call-In Pay
        (68 calls, $25/call, 2 persons, 1 Paramedic and 1 EMT Int.or Basic)            $3,400

TOTAL BASE SALARIES                                                               $128,672

 Overtime Pay                                                                          $6,434

TOTAL BASE SALARIES AND OVERTIME                                                  $135,106

 BENEFITS                                                                          $32,168

TOTAL LABOR COSTS FOR ALTERNATIVE 2                                               $167,274




                                               19
$9.50 hourly rate) and the EMT Intermediate or Basic at $14,144 (based on $8.50 hourly rate).

The remaining hours, from midnight until 8 am daily seven days per week, will be covered by an

on-call crew; the on-call crew will consist of one Paramedic and one EMT Basic or Intermediate.

Each crew member will be paid $25 per day on-call pay, for an annual total of $18,200 (2

persons x $25/day x 7/days/week x 52 weeks/year = $18,200). When the crew is called in, each

crew member will be paid $25 per call, for an annual cost of $3,400. This is based on an

estimated 68 calls annually occurring during the hours of midnight until 8 am daily (68 calls x

$25/call x 2 persons = $3,400). This number was estimated based on research from Sloggett [1].

Research shows that approximately 14.4% of the total calls occur between the hours of midnight

and 8 am. Based on this, there will be approximately 68 calls annually that will occur during the

on-call period (472 calls x 14.4% = 68 calls).

       The total of base salaries, on-call pay, and call pay for Alternative 2 is $128,672. An

additional 5% of base salaries is added to allow for overtime pay, for an annual overtime pay

total of $6,434. Benefits in the amount of 25% are added onto the base salaries for a total of

$32,168. The total labor costs for Alternative 2 are estimated to be $167,274.

       Referring back to Table 8, the base salaries and overtime ($135,106) are included as

labor costs and benefits ($32,168) are included as Workers Compensation/Insurance/Benefits

under Alternative 2. The total annual operating expenses for Alternative 2 are estimated to be

$189,834. The total annual capital and operating expenses for Alternative 2 are estimated to be

$216,446, representing a cost of $458.57 per call for Alternative 2.



Alternative 3 - Blank

       A blank column is available in Tables 6, 7, and 8 for the local decision-makers to build


                                                 20
their own funding alternative. Also, blank forms are included in Appendix B to be utilized for

the same purpose.

                           An Analysis of Alternative Revenue Sources

        Decision makers for the Fairfax EMS service have several ways to raise revenues. Some

of these ways, like community fund-raisers, are commendable but not reliable. More reliable

sources are user fees, sales taxes, subscription/membership fees, third party reimbursement, fee

collected on local utility bill, and special taxation districts.

        User fees are generally charged for EMS services; however, these fees generally do not

cover costs and have not kept up with EMS costs and inflation. Thus, they are often

supplemented with other forms of revenues. For this study, user fees, millage levies from

formation of a special taxation district, mileage fees, sales tax, and fee per utility bill are

presented in Tables 11a - 11e.

        Table 11a shows the revenues possible for user fees with alternative collection rates.

Base rates for ambulance user fees, starting at $425, and continuing with $450, $475, $500, $525,

$550, $575, $600, and ending with $625, are shown. These are shown based on emergency calls

and non-emergency calls, so that an EMS service could charge different rates for these two types

of calls. Alternative collection rates are shown: 90%, 80%, 70%, 60%, and 50%. For the

Fairfax EMS service, approximately 42 calls were non-billable; of the remaining calls, 31 were

considered emergency calls and 399 were non-emergency calls.

        Table 11b illustrates the estimated revenues that would be generated from millage levies

through the creation of a special taxation district. The total net property valuation for all Fairfax

school districts for FY 1999 was $6,865,997. Three mills would generate $20,598, two mills

$13,732, and one mill $6,866.


                                                    21
                                                        Table 11a
                                                  Fairfax EMS District
                                      Emergency and Non-Emergency User Fees Per Call
                                                                    Total Calls      472 Emergency                           31
                                                                   Total Miles   18,000 Non-Emerg                           399
                                                                Ave. Miles/Call       38            Non-Billable             42
                                                                                         Total Calls                        472
EMERGENCY CALLS
                                                                Estimated User Fee Per Call
                             $425       $450       $475          $500         $525         $550      $575       $600       $625

Emergency Calls      31    $13,175    $13,950    $14,725    $15,500        $16,275     $17,050     $17,825    $18,600    $19,375
90% Collections    90%     $11,858    $12,555    $13,253    $13,950        $14,648     $15,345     $16,043    $16,740    $17,438
80% Collections    80%      10,540     11,160     11,780     12,400         13,020      13,640      14,260     14,880     15,500
70% Collections    70%       9,223      9,765     10,308     10,850         11,393      11,935      12,478     13,020     13,563
60% Collections    60%       7,905      8,370      8,835      9,300          9,765      10,230      10,695     11,160     11,625
50% Collections    50%       6,588      6,975      7,363      7,750          8,138       8,525       8,913      9,300      9,688

NON-EMERGENCY CALLS
                                                                Estimated User Fee Per Call
                             $425       $450       $475          $500         $525         $550      $575       $600       $625

Non-Emerg. Calls    399   $169,575   $179,550   $189,525   $199,500       $209,475    $219,450    $229,425   $239,400   $249,375
90% Collections    90%    $152,618   $161,595   $170,573   $179,550       $188,528    $197,505    $206,483   $215,460   $224,438
80% Collections    80%    $135,660   $143,640   $151,620   $159,600       $167,580    $175,560    $183,540   $191,520   $199,500
70% Collections    70%    $118,703   $125,685   $132,668   $139,650       $146,633    $153,615    $160,598   $167,580   $174,563
60% Collections    60%    $101,745   $107,730   $113,715   $119,700       $125,685    $131,670    $137,655   $143,640   $149,625
50% Collections    50%     $84,788    $89,775    $94,763    $99,750       $104,738    $109,725    $114,713   $119,700   $124,688




                                                           22
                                          Table 11b
                                     Fairfax EMS District
                              Estimated Revenues - Millage Levies


                                         TOTAL NET              THREE           TWO         ONE
                                        VALUATION*              MILLS          MILLS        MILL

FY 1999
Fairfax School District                      $6,865,997         $20,598       $13,732      $6,866




* Based on Total Net Valuation of $7,227,365 which includes personal, real, and public property,
  LESS 5% adjustment for collections. Information received from Osage County Assessor's Office at
  918-287-3448.




                                               23
        Mileage charges (Table 11c) are shown for $3 per mile, $4 per mile, $5 per mile, $6 per

mile, and $7 per mile for one-way (loaded) miles. For Fairfax, one-way miles are approximately

45% of the total miles, for a total of 8,100 miles (18,000 x 45% = 8,100 miles one-way).

Calculations are shown on how much revenue could be generated if 50, 60, 70, 80, or 90 percent

of the total fees are collected.

        Another revenue option is to pass an additional sales tax (Table 11d). If a $0.0025 sales

tax or $0.0050 were passed in Fairfax, the amounts of $14,036 and $28,073 are estimated to be

generated, respectively. The table illustrates further that $42,109 would be generated from a 3/4¢

sales tax, $56,145 from a 1¢ sales tax, $84,218 from a 1 ½¢ sales tax, and $112,291 from a 2¢

sales tax.

        Table 11e illustrates the revenue from a fee per utility billing. The table shows the

revenues resulting from a $2.50 per month fee up to a $15 per month fee. If a $2.50 per month

utility fee were initiated, each household would pay a total of $30 per year. With an estimated

total of 615 households in Fairfax, the annual resulting revenues are estimated to be $18,450,

assuming 100% of the households are currently paying utilities. The table illustrates the annual

total revenues based on 95%, 90%, and 85% utility usage.

        To illustrate how to utilize the revenue tables, Alternative 1 (Table 8) would need an

estimated $193,874 for total annual capital and operating expenses. One method to fund

Alternative 1 is to charge a mileage fee of $5 (70% collections) to generate $28,350, to charge a

non-emergency call fee of $550 (70% collections) to generate $153,615, and to charge an

emergency call fee of $575 (70% collections) to generate $12,478 (Table 12). The total of these

three fees is $194,443, which leaves a surplus of $568 (Table 12, Alternative 1, Funding

Option #1).


                                                24
                                  Table11c
                            Fairfax EMS District
                      Estimated Revenues - Mileage Fees


                                                      Mileage Fees
                              $3            $4           $5          $6        $7

For One-Way Miles   8,100    $24,300        $32,400     $40,500      $48,600   $56,700
90% Collections        0.9    21,870         29,160      36,450       43,740   $51,030
80% Collections        0.8    19,440         25,920      32,400       38,880   $45,360
70% Collections        0.7    17,010         22,680      28,350       34,020   $39,690
60% Collections        0.6    14,580         19,440      24,300       29,160   $34,020
50% Collections        0.5    12,150         16,200      20,250       24,300   $28,350




                                       25
                                                      Table 11d
                                                 Fairfax EMS District
                                            Estimated Revenues - Sales Tax


                         Sales Subject to        1/4¢           1/2¢        3/4¢         1¢        1 1/2¢        2¢
                           Sales Tax*          Sales Tax      Sales Tax   Sales Tax   Sales Tax   Sales Tax   Sales Tax




Fairfax (FY 1999)          $5,614,533          $14,036        $28,073     $42,109     $56,145     $84,218     $112,291




* Based on 1999 Fairfax Sales Tax of 3% and Sales Tax Collections of $168,436, from Oklahoma Tax Commission, 1999.




                                                         26
                                                            Table 11e
                                                      Fairfax EMS District
                                            Estimated Revenues - Fee per Utility Billing


Fee/Month                      $2.50      $3.00       $4.00          $5.00     $6.00         $7.50    $10.00    $12.50     $15.00
Fee/Year                         $30        $36         $48            $60       $72           $90      $120      $150       $180
   Households*
       615

Total Utility Fees          $18,450     $22,140     $29,520        $36,900   $44,280       $55,350   $73,800   $92,250   $110,700

       Utilization of 95%   $17,528     $21,033     $28,044        $35,055   $42,066       $52,583   $70,110   $87,638   $105,165
       Utilization of 90%   $16,605     $19,926     $26,568        $33,210   $39,852       $49,815   $66,420   $83,025    $99,630
       Utilization of 85%   $15,683     $18,819     $25,092        $31,365   $37,638       $47,048   $62,730   $78,413    $94,095




* Based on 1999 U.S. Census population estimate of 1,611 for Fairfax and based on 2000 Woods and Poole Economics,
  Inc., number of persons per household of 2.62 for Osage County for 1999.




                                                              27
                                                         Table 12
                                                  Fairfax EMS District
                                                Possible Funding Options
          ALTERNATIVE 1                            ALTERNATIVE 2                           ALTERNATIVE 3
          Funding Option #1                        Funding Option #1                       Funding Option #1
Costs:                                  Costs:                                   Costs:
 Total Annual Capital                    Total Annual Capital                    Total Annual Capital
   & Operating Expenses        $193,874     & Operating Expenses        $216,446 & Operating Expenses
Revenues:                               Revenues:                                Revenues:
 Mileage Fee, $5, 70%           $28,350 Mileage Fee, $6, 70%             $34,020
 Non-ER Fee, $550, 70%         $153,615 Non-ER Fee, $550, 70%           $153,615
 ER Fee, $575, 70%              $12,478 ER Fee, $550, 70%                $11,935
                                         EMS District, 3 mills           $20,598
 Total Revenues                $194,443 Total Revenues                  $220,168 Total Revenues
Difference                         $568 Difference                        $3,722 Difference
           ALTERNATIVE 1                            ALTERNATIVE 2                           ALTERNATIVE 3
           Funding Option #2                        Funding Option #2                       Funding Option #2
Costs:                                  Costs:                                   Costs:
 Total Annual Capital                    Total Annual Capital                     Total Annual Capital
    & Operating Expenses       $193,874     & Operating Expenses        $216,446     & Operating Expenses
Revenues:                               Revenues:                                Revenues:
 Mileage Fee, $5, 70%            28,350 Mileage Fee, $7, 70%             $39,690
 Non-ER Fee, $475, 70%         $132,668 Non-ER Fee, $500, 70%           $139,650
 ER Fee, $575, 70%               12,478 ER Fee, $575, 70%                $12,478
 EMS District, 3 mills          $20,598 Sales Tax, 1/2¢                  $28,073
 Total Revenues                $194,093 Total Revenues                  $219,891 Total Revenues
Difference                         $219 Difference                        $3,445 Difference




                                                            28
       Another method to fund Alternative 1 would be to create a special taxation district.

Table 12, Alternative 1, Funding Option #2 shows that $20,598 would be generated from

creating a special taxation district with 3 mills, $28,350 from a $5 mileage fee (70% collections),

$132,668 from a $475 non-emergency call fee (70% collections), and $12,478 from a $575

emergency call fee (70% collections). These four fees total $194,093, which more than covers

the total annual capital and operating costs of $193,874 for Alternative 1, leaving a very small

surplus of $219 (Table 12, Alternative 1, Funding Option #2).

       To fund Alternative 2, Table 12, Alternative 2, Funding Option #1 illustrates one

methodology to cover the total annual capital and operating expenses of $216,446. Assuming

70% collections, a mileage fee of $6 would generate $34,020, a non-emergency fee of $550

would generate $153,615, an emergency fee of $550 would generate $11,935, and the creation of

a special taxation district at 3 mills would bring in $20,598. Total revenues equal $220,168,

leaving a surplus of $3,722 (Table 12, Alternative 2, Funding Option #1).

       Another method to fund Alternative 2 would be to vote a 1/2¢ sales tax, in addition to

charging user fees and a mileage fee, to cover the total annual capital and operating expenses of

$216,446. A 1/2¢ sales tax would bring in $28,073. With an assumed 70% collection rate, a

mileage rate of $7 would bring in $39,690, a non-emergency user fee of $500 would bring in

$139,650, and an emergency fee of $575 would bring in $12,478. This would generate a grand

total of $219,891 in revenues. This would cover the entire cost of $216,446, leaving a surplus of

$3,445. (Table 12, Alternative 2, Funding Option #2).




                                                29
                                  The Creation of an EMS District

       The State of Oklahoma allows for the formation of a special EMS District for the purpose

of raising funds to support EMS. Table 13 outlines the procedures involved in creating an EMS

District and the powers and responsibilities of its Board of Trustees. In brief, the County

Commissioners must call for a special election to create the district. The district may encompass

one or more counties, incorporated cities, a township, school districts, or parts of a school district

that lie within the borders of a county. The district may assess up to three mills of ad valorem

taxes to support the operation of the EMS system. The total net assessed valuation for the

Fairfax School Districts for FY 1999 was $6,865,997. For a more up-to-date valuation, decision-

makers should contact the Osage County Assessor's Office at (918) 287-3448. If an EMS

District were created, a three mill tax levy (Table 11b) for the Fairfax school districts would

raise $20,598 annually ($6,865,997 x .003), a two mill tax levy, $13,732, and a one mill tax levy,

$6,866.



                                            Conclusion

       The analysis of the Fairfax EMS service presented in this paper is designed to aid local

decision makers as they determine the kind of EMS system best suited to the Fairfax area.

Through this analysis, the Cooperative Extension Service is not advocating any of the

alternatives presented. This report is not in the form of a recommendation. If further analysis is

desired, contact your County Extension Director. Personnel in the EMS Division of the

Oklahoma State Health Department and Office of Highway Safety are also willing to help in any

way they can.




                                                 30
                                          TABLE 13

            A SUMMARY OF THE PROCEDURES TO CREATE AN EMS
             DISTRICT AND THE POWERS AND RESPONSIBILITIES
                       OF ITS BOARD OF TRUSTEES 1


 I.   Creation of a District

       A. Special election called by the County Commissioners or through them as called for
          by a petition of greater than 10 percent of the registered voters of the affected area.

II. Affected Area

       A. One or more counties or portions of counties (must follow school district lines).
       B. Incorporated cities.


III. The Election and Ad Valorem Tax Levy

       A. Both capital and operational millage levy must be approved by a majority of the
          voters.
       B. The operational millage levy cannot exceed three mills and the capital millage levy
          cannot exceed three mills.
       C. The operational millage levy continues until voters change it; the capital millage
          levy is in effect until bonds are completely repaid.

IV.    The Board of Trustees

       A. Appointed by the County Commissioners.
       B. Powers and Responsibilities:
          1. Make necessary rules, procedures, and contracts.
          2. Hire appropriate personnel.
          3. Issue bonds upon approval by a majority of the voters at a special election.
             Bonds are paid for out of the capital millage levy.
          4. Responsible for the economical expenditure of funds.
          5. Can charge additional fees for services.
          6. Can sue and be sued.




                                              31
                                       References

[1]   Sloggett, Gordon R., Doeksen, Gerald A., Hays, Marvin, and Larsen, Sam. "A
      Community Development Guide for Emergency Medical Services: A Systematic
      Approach to Funding and Administration." EMS Division, State Health Department;
      Oklahoma Highway Safety Office; Oklahoma Cooperative Extension Service, Oklahoma
      State University, MP-126, July 1988.

[2]   Kleinholz, Sharon, Doeksen, Gerald, Henderson, Ed, Bullard, Vernon, et.al. "A
      Guidebook for Rural Fire Protection Services." Oklahoma Cooperative Extension
      Service, Oklahoma State University, MP-131, November 1990.




                                           32

								
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