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					European Emergency Data Project

Richmond Ambulance
     Authority
        Jerry Overton
      Executive Director
 Richmond Ambulance Authority
      Associate Professor
Department of Emergency Medicine
  Medical College of Virginia
                         History

Lack of Accountability
 • Response Times
 • Clinical
 • Costs
 • Rates
   Survival of Out-of-Hospital
        Cardiac Arrest - 1990




Basic EMT   EMT-D   Paramedic   EMT/Para EMT-D/Para Richmond
         Richmond Ambulance
                   Authority

• Organizational Structure
    The Public Utility Model


High Performance Emergency
      Medical Services
       System Design
      The Public Utility Model

• High Performance
• All Advanced Life Support
• Alignment of Incentives
• Competitively Selected
  Contractor
      The Public Utility Model

Competitively Selected Contractor
 • Credentials
 • Quality
 • Price
      The Public Utility Model

• Care Objectively Monitored
• Encourages Innovation
• Neutralizes Cost Cutting
  Incentives
         Richmond Ambulance
                   Authority
• Provides System Infrastructure
• Funds Development of
  Management Information System
• Manages Finances and Business
  Affairs of the System
• Coordinates Public Information
          Richmond Ambulance
                    Authority
• Establishes Performance Criteria
• Employs Contractual Safeguards
• Conducts Periodic Analysis for
  Bidding
• Revises Rate Structure
• Manages Accounts Receivable
     External Medical Control

• Recommends Standard of Care
• Establishes and Updates
  Protocols
• Monitors Clinical Provisions
• Oversees and Controls
  Paramedic Performance
Ambulance Service Contractor

• Personnel Hiring
• Equipment Maintenance
• In-service Training
• Dispatching
Ambulance Service Contractor

• System Status Management
  • Coverage Levels
  • Shift Schedules
  • Post Locations
• Inventory Control
• Maintain All Permits and
  Certifications
    System Status Management


The art and science of matching the
production capacity of an EMS
system to the changing patterns of
demand placed on that system.
           System Status Plan

• Temporal Deployment
• Geographic Deployment
         Richmond Ambulance
                   Authority

• Organizational Structure
• Legal Framework
          Richmond Ambulance
                    Authority

• State Enabling Legislation
• City Authorizing Legislation
  • City Code
  • City Regulations
• Performance Contract
Ambulance Service Contractor


“Provides and manages the delivery
 of ambulance services by meeting
 or exceeding the requirements of
 this agreement.”
Ambulance Service Contractor


“Everything that might affect
 the Contractor’s ability to perform is
 under the Contractor’s control . . .”
         Richmond Ambulance
                   Authority

• Organizational Structure
• Legal Framework
• National Standards
         National Standards

• None
         Richmond Ambulance
                   Authority

• Organizational Structure
• Legal Framework
• National Standards
• Finance
                     Financial

• Limited Sources
 • Medicare
 • Medicaid
 • Insurance/HMO/Contracts
 • Subsidization
         Richmond Ambulance
                   Authority

• Geographic Size-Emergency
 • 62.5 Square Mile
• Population-Emergency
 • 200,000
            Richmond Ambulance
                      Authority
• Number of Emergency
  Responses (Annual)
 • 40,000
• Number of Emergency
  Transports (Annual)
 • 28,900
                                                                                                                            Graph 4.1
                                                                                                              Service Area (square miles*)

3,500



3,000



2,500



2,000



1,500



1,000



 500



    0

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                                                                                                                                                        *Nova Scotia not show n in graph due to outlier status (33,300 sqare miles)
                                                                                                        Graph 4.2
                                                                                   Population of Primary Service Area


1,000,000


 900,000


 800,000


 700,000


 600,000


 500,000


 400,000


 300,000


 200,000


 100,000


        0
                                                                                                                               t          ck
                  n   e              th
                                             Ci
                                               ty
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                                              O        Pi                                                                                                        o
                                                                                                                                                                M
                                                  Graph 4.4
                            Emergency Transports (per square mile)


500


450

400


350


300


250

200


150

100


50

 0

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                     *Nova Scotia figure not used in Mean and Median due to outlier status (0.62 emergency transports per sqare mile)
         Richmond Ambulance
                   Authority
• Basic Staffing-First Response
  • Law Enforcement
  • Fire
         Richmond Ambulance
                   Authority
• Basic Staffing-First Response
• Basic Staffing-Transport
  • All ALS
         Richmond Ambulance
                   Authority
• Basic Staffing-First Response
• Basic Staffing-Transport
• Medical Oversight
     External Medical Control

• Recommends Standard of Care
• Establishes and Updates
  Protocols
• Monitors Clinical Provisions
• Oversees and Controls
  Paramedic Performance

				
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