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TO PROVIDE FIRST RESPONDER EMERGENCY MEDICAL SERVICES -, I I I I I I I I >>1 I I I I I I I I I '0 ~e I, In V1'~1 leu!, ) ;;2//:.~ /! ! I I EMERGENCY MEDICAL SERVICES FIRST-RESPONDER AGREEMENT City of Clearwater January 1988 /\ -"7" :,) f-.);../ ,I i ,l )'j '..I ; - (;. .). ,., t I '1 I I I II I I I I I I I I I I I I I I I EMERGENCY MEDICAL SERVICES FIRST-RESPONDER AGREEMENT This Agreement. made and entered into between the Pinellas County Emergency Medical Services Authority. a special district of the State of Florida. hereinafter called "Authority" and the City of Clearwater. a municipal corporation. hereinafter called "Contractor." WIT N E SSE T H: WHEREAS. the Authority is a county-wide special district in Pinellas County. FL. created pursuant to Chapter 80-585. Laws of Florida Special Acts of 1980. and; WHEREAS. the Authority is authorized to enter into agree- ments for emergency medical services and the Contractor is will- ing and able to provide first-responder emergency medical services. and; WHEREAS. the Authority wishes to bring long-term direc- tion and financial stability to the entire emergency medical services system. including the first-responder program. and; WHEREAS. the Authority wishes to preserve the progress already made in the development of first-responder services throughout Pinellas County while controlling and managing the future growth of first-responder services by way of the funding pOlicies contained in this contract; and r'l I I I I I I I I I I I I I I I I I I I I WHEREAS. the Authority will pay the reasonable and cus- tomary marginal costs defined by the Authority as required by state statute for funding various levels of services as justified by demand volumes. and; WHEREAS. the parties wish to establish a long-term relationship so that both parties can predict and control the growth of expenditures. and; WHEREAS. the Authority is providing for a gradual cor- rection of "excess compensation" as defined herein; that is. funds being paid to Contractor in excess of the reasonable and customary marginal costs of providing first-responder services. and; WHEREAS. the Authority wishes to encourage the use of the 911 telephone number for emergencies and to discourage the improper use of the 911 system and first-responder resources for nonemergency calls. and; WHEREAS. should a contract be refused or terminated by the Contractor. the Authority shall provide an alternative means of service as the Authority deems appropriate. 2 I I I I I I I I I I I I I I I I I I I I I NOW. THEREFORE. and in consideration of the mutual cov- enants. terms and conditions herein set forth to be kept and performed by and between the parties hereto. it is agreed as follows: SECTION I. Definitions. A. ALS Unit Hour. An "ALS Unit Hour" is one hour of an advanced life support first-responder unit which is either available for a call or on a call. B. Ambulance Service Contractor. "Ambulance Service Contractor" is a company selected by the Pinellas County Emergency Medical Services Authority to provide emergency ambulance service. C. Audi tor. "Audi tor" is the person or persons selected by the Executive Director to conduct the annual finan- cial analysis of allowable marginal costs of first- responder services in accordance with the standards and provisions set forth in Subsection III. - G. of the contract. D. Authoritv. "Authority" means the Pinellas County Emergency Medical Services Authority. 3 I I I I I I I I I I I I I I I I I I I I I E. Earned Compensation. "Earned compensation" is the amount calculated in accordance with the financial policies and accounting methods set forth in Section III of this con- tract. The Authority shall annually conduct a countywide analysis of the marginal costs of providing each of the five levels of first-responder services defined herein during the most recent 12-month period for which financial information is then available. The product of this analysis shall be a uniform rate of payment for each level of service for the fOllowing year applicable to all first-response contracts. which rates shall be annually adjusted to incorporate a pro- jected allowance for inflation as provided for in Section III-G. hereof. To determine the quantity and level of services for which Contractor shall be eligible for payment. the Authority shall annually analyze the frequency of demand for Contractor's services during the most recent 12-month period for which statistical information is then avail- able. The amount of "earned compensation" for which Con- tractor shall be eligible during the fOllowing year shall be the product of mUltiplying the quantities and levels of serv- ice for which payment is found to be justified by their respective rates of payment as authorized by the Authority. F. Excess Compensation Payments. "Excess Compensation Payments" are the payments provided by the Authority as necessary to insure that Contractor's total annual compen- 4 I I I I I . . I I I I I I I I I I I I I I F. Excess Compensation Payments. - (Continued) sation for first-responder services is not less than Con- tractor's compensation in fiscal year 1987/1988. as listed in Attachment 2. "Schedule of First Year Monthly Payments." The excess compensation payments are those amounts in addi- tion to "earned compensation" paid Contractor. G. Executive Director. "Executive Director" means the Executive Director of the Emergency Medical Services Authority of Pinellas County. H. First-Responder Services. "First Responder Services" are emergency medical services provided by a city or fire department which responds rapidly to a 911 medical emer- gency and provides treatment and care at the scene of the emergency. First-Responder services do not include the transport of a patient from a scene of an emergency to a medical facility. I. First-Responder Station. "First-Responder Station" is a fire station designated by Contractor and in which are housed a crew and vehicle for the provision of first-responder services. 5 I I I I I I I I I I I I I I I I I I I I I J. Levels of First-Responder Service. "Levels of First-Responder Service" are the types of units and personnel standards for provision of first-responder services as defined below: 1. "BLS Engine" means a vehicle which is designed primarily for firefighting purposes. is staffed with at least two emergency medical technicians (EMTs). is capable of providing basic life support services which may include EMT-defibrillation. and is operated in accord- ance with standards and procedures approved by the Medical Control Board. 2. "One-Paramedic ALS Engine" means a vehicle designed primarily for firefighting purposes. which carries advanced life support equipment. is staffed by at least one paramedic and at least one other person trained to the basic life support level. is capable of providing advanced life support services. is licensed by the state as an advanced life support unit. and is operated in accordance with standards and procedures approved by the Medical Control Board. 6 I I I I I I I I . I I I I I I I I I I I I 3. "Two-Paramedic ALS Fire Engine" means a vehicle designed primarily for firefighting purposes which carries advanced life support equipment. is staff by at least two paramedics. and at least two additional BLS trained per- sons. is licensed by the State of Florida as an advanced life support unit. is capable of pro- viding advanced life support services. and is operated in accordance with standards and pro- cedures approved by the Medical Control Board. 4. "One-Paramedic Rescue Unit" means a vehicle designed primarily for response to medical emer- gencies. which is licensed by the State of Florida as an advanced life support unit. is staffed by at least one paramedic and one other person trained to the BLS level. is capable of providing advanced life support services and is operated in accordance with the policies. and procedures established by the Medical Con- trol Board. 5. "Two-Paramedic Rescue Unit" means a unit designed primarily for response to medical emergencies. which is licensed as an advanced life support unit by the State of Florida. is 7 I I I I I . I I . I I I I I I . I I I I I s. "Two-Paramedic Rescue Unit" - (Continued) staffed by two paramedics. is capable of pro- viding advanced life support services. and is operated in accordance with standards and pro- cedures approved by the Medical Control Board. K. Medical Control Board. "Medical Control Board" is the board of directors of the Emergency Medical Services Foundation of the Bay Area Hospital Council which is contracted by the Authority to provide medical direction and physician oversight to to the Emergency Medical Services System of Pinellas County. L. Medical Direction. "Medical Direction" is the process of physician supervision of the activities of emergency medical technicians and paLamedics who provide prehospital basic and advanced life support services. M. Medical Director. "Medical Director" is a physician who is selected by and serves at the pleasure of the Medical Control Board. N. Nearest Unit DispatCh POlicy. "Nearest Unit Dis- patch Policy" is the pOlicy authorized by the Auth- ority which requires a first responder to respond to 8 I I I I I '. I I I I I I I I I -I I I I I I N. Nearest Unit Dispatch POlicy. - (Continued) a 911 medical emergency if it is determined by a County-authorized 911 dispatch center that the Con- tractor's unit or station is nearest the location of the emergency. If the nearest first-responder unit is a basic life support unit. then an advanced life support unit shall also be sent. From time to time. the Authority in consultation with the Contractor. will review historical data and the allocation of locations within the county to first-responder stations to ensure that the first-responder unit nearest each location in the county is sent. o. Nearest Unit Response Matrix. "Nearest Unit Response Matrix" is the table allocating grid or grid sections within Pinellas County to the nearest first-responder stations. P. 911 EMS Call. A "911 EMS Call" is a request for emergency medical assistance received via the 911 telephone number in a County-authorized dispatch center. Requests entering the system by a telephone number other than 911 shall not be considered 911 EMS calls. 9 I I I I . I I . I I I I I I I I I I I I I Q. 911 Transport. A "911 Transport" is the transport of a patient by ambulance or rescue unit to a hospital emergency department as a result of a request for assistance via the 911 emergency telephone number or via the Contractor's own emergency number. provided the 911 control center is notified of such request as required under Paragraph 14 of Subsection II. B." R. Priority Dispatch Protocol. A "Priority Dispatch Protocol" is a written-description of the procedures to be followed when processing a telephone request for emergency medical assistance. as approved by the Medical Control Board. S. Reasonable and Customary Costs. "Reasonable and Customary Costs" means the reasonable and customary marginal costs of producing each of the defined levels of first-responder services as determined in accord- ance with the accounting procedures stipulated in Section III of this Contract. These are the costs S. Reasonable and Customary Costs. - (Continued) incurred in the course of providing first-responder services which would not be incurred if first- responder services were terminated or had never been initiated. 10 I I I I . I I I . . I I I I I I . I . 1 I T. Unified Record Keepinq System. A "Unified Record Keeping System" is a system of recording and main- taining records of primary data from EMS calls including dispatch data. data recorded by first-responders and ambulance providers at the scene of a medical emergency and other primary data related to each emergency response. Such recordkeeping system shall be capable of meeting the information needs of the Medical Control Board. the requirements for response-time performance monitoring. the requirements of medical billing and accounts receivable management. the requirements of determining levels of demand for first-responder service in accordance with Section III of this con- tract. and other information needs. Design and opera- tion of the unified recordkeeping system shall be the responsibility of the Executive Director. Data in the unified record-keeping system shall be made available to the Contractor as may be reasonably requested by the Contractor. 11 I I I . . . I I . . . I I I . . . I . 1 I SECTION II. SCOPE OF WORK A. General 1. Upon notification by a County-authorized 911 dispatch center and in accordance with priority dispatch protocols approved by the Medical Control Board.Contractor will provide first response serv- ices in accordance with the Authority's then-cur- rent closest unit dispatch pOlicy. Contractor shall be notified of. and may respond to. all medical emergencies to which Contractor's units have been determined to be the nearest in accord- ance with the nearest unit dispatch pOlicy. B. Additional Provisions 1. Contractor shall furnish. maintain. and replace as necessary. equipment and personnel as required. and shall maintain licensure as an advanced life support provider. if applicable. and comply with the rules and regulations adopted by the Medical Control Board. 12 I I I . I . I I . . . I I I I . . I I I I B. Additional Provisions - (Continued) 2. Contractor shall comply with the current Medical Operations Manual (MOM) protocols as approved by the Medical Control Board and shall strictly adhere to the transport pOlicies set forth in MOM. 3. If Contractor is a fire department. Contractor is responsible for the evacuation of persons in a hurricane or other natural emergency or disaster. If Contractor is not a fire department. Contractor shall assist with the evacuation of persons in a hurricane or other natural emergency or disaster." 4. Contractor shall adhere to data and record- keeping requirements of the Authority and the Medi- cal Control Board as defined by the unified medical record-keeping system. s. Contractor shall comply with the inventory control procedures of the Authority. 13 I I I . . I I I . . I I I I . . I I I I I B. Additional Provisions - (Continued) 6. Contractor shall comply at all times with the Authority's protocol for on-scene control of patient care whereby the first paramedic who arrives at the scene of a medical emergency shall be in charge of patient care. Contractor's paramedic may ride with the ambulance to the hospital at the discretion of Contractor's paramedic. If requested to ride to the hospital by the ambulance contractor's paramedic. Contractor's paramedic shall comply. Policies concerning control at the scene of patient care are subject to revision by the Medical Control Board. 7. Contractor shall comply and cooperate fUlly with medical audits and investigations of complaints by the Executive Director. the Medical Director or their designees. 8. Contractor shall provide levels of first-responder services equal to or better than the levels of serv- ice funded hereunder. Contractor may. at its option. substitute alternate methods of production if those methods are equal to or better than the levels of service being replaced. approved by the Executive Director. and consistent with provisions set forth in paragraph 2 of Subsection III. D. hereof. 14 I I I . . . I I . I I I I I . . . I I I I B. Additional provisions - (Continued) 9. Contractor shall maintain financial and operating records required by the Authority as necessary for the annual determination of the reasonable and customary costs of producing the contracted for levels of service as defined herein. 10. Contractor shall provide or otherwise make avail- able inservice training for first-responder personnel as required by state regulation and the Medical Con- trol Board. Satisfactory participation by Contrac- tor's personnel in the inservice training provided and made available by the Authority shall constitute fulfillment of this obligation. 11. Contractor shall not unreasonably restrict its employees from seeking or performing part-time employment with the Authority'S ambulance service contractor. 12. Contractor shall allow the Authority. the Execu- tive Director or his designee to inspect equipment. vehicles. premises and records as may be reasonably required to determine compliance with this Contract. IS I I I . I I I I . I I I I I I I . I I I I B. Additional Provisions - (Continued) Contractor shall also allow representatives of the Medical Director and the Executive Director to ride in Contractor's vehicles during responses to medical emergencies. However. such representatives shall conduct themselves in a professional and courteous manner. shall not interfere with the Contractor's employees in the performance of their duties and shall at all times be respectful of Contractor's employee/employer relationship. Contractor shall have the right to refuse to allow any representative of the Authority to ride as third person on a Con- tractor's vehicles if that representative does not sign the personal waiver form attached hereto as Attachment 1. 13. Contractor's personnel shall conduct themselves in a professional and courteous manner at all times. It is recognized that first-responder services are often rendered in the context of stressful situa- tions and in some cases. even flawless performance by the Contractor may draw complaints. The Con- tractor shall address and correct any occasional departures from this standard of conduct. 16 I I I I I I I I I I I I I I I I I I I I I B. Additional Provisions - (Continued) 14. Should Contractor receive a request for emergency medical assistance on a telephone number other than 911. Contractor shall take the address and telephone number of the caller and obtain the location and nature of the emergency. Contractor shall immedi- ately respond to a request for emergency medical assistance. if appropriate. and shall immediately advise the appropriate 911 center of the information received. and the response initiated by Contractor. if any. SECTION III. COMPENSATION. In consideration of Contractor's provision of the first-respond- er services which are the subject of this contract. the Auth- 'ority shall provide payment and other consideration in accord- ance with the following provisions: A. General POlicy. During the first year of this contract. Contractor shall be paid as provided for in Attachment 2. /lSchedule of First Year Monthly Payments." Annually thereafter throughout the term of this contract, Contractor's monthly service payments shall be the sum of: /learned 17 I I I I I I I I I I I I I I I I I I I I I A. General POlicy. - (Continued) compensation." i.e.. the reasonable and customary mar- ginal costs of producing the quantities and levels of first responder services deemed justified by the Auth- ority based upon frequency of demand for service. and determined in accordance with the financial pOlicies and accounting methods set forth in this Section III; plus "excess compensation." i.e.. payments in excess of "earned compensation" sufficient to bring total com- pensation up to level of Contractor's compensation for EMS services during FY 1987/88. as shown on Attachment 2. hereof. entitled "Schedule of First Year Monthly Payments." B. Establishment of Earned Compensation Amount. In accordance with the financial pOlicies and accounting methods set forth in this Section III. the Authority shall annually conduct a countywide analysis of the marginal costs of providing each of the five levels of first responder services defined herein during the most recent 12-month periOd fer which financial information is then available. The product of this analysis shall be a uniform rate of payment for each level of service for the following year. applicable to all first-response 18 I I I I I I I I I I I I I I I I I I I I I B. Establishment of Earned Compensation Amount. _ (Continued) contracts. annually adjusted to incorporate a projected allowance for inflation as provided for in Subsection III-G. hereof. To determine the quantity and level of services for which Contractor shall be eligible for pay- ment. the Authority shall annually analyze the frequency of demand for Contractor's services during the most recent 12-month period for which statistical information is then available. Contractor's "earned compensation" for the fOllowing year shall be the product of mUltiplying the quantities and levels of service for which payment is found to be justified by their respective rates of pay- ment as authorized by the Authority. C. Rationale for "Excess Compensation." The Authority has determined that its previous contracts for first-responder services were seriously deficient in financial controls. incentives for cost containment. and- long-range financial pOlicy. These contracting defic- iencies allowed and encouraged both cost-shifting and use of inefficient production methods to such an extent that compensation paid by the Authority for first-responder services has grown to exceed the reasonable and customary costs of such services. To make possible a gradual restoration to EMS uses of shifted funds and an orderly 19 I I I I I I I I I I I I I I I I I I I I I c. Rationale for "Excess Compensation." - (Continued) conversion to more efficient production methods. where appropriate. "excess compensation payments" shall be pro- vided as necessary to ensure that Contractor's total annual compensation for first-responder services is not less than Contractor's compensation in FY 1986/87. as listed in Attachment 2. "Schedule of First Year Monthly Payments." Provided. however. that any Contractor found in substan- tial default of its contract for first-responder services shall not be eligible for such "excess compensation." D. Cost Containment Incentives. To encourage and reward increased productivity and creative cost containment. the following provisions shall apply: 1. Demand-Based Production POlicy. In the past. each first-response Contractor was funded at an individually negotiated rate of payment to provide any requested type of first-responder service. without consideration of frequency of demand for service. efficiency of pro- duction method. or overall pOlicy guidelines. Under this Contract. eligibility for funding for each type of first responder service shall be based upon fre- quency of demand for service (see Subsection III-F. hereof). with consideration for reliability of serv- ice. economic efficiency. and reasonable productivity. 20 I I I I I I I I I I I I I I I I I I I I I 2. SUbstitutions Allowed. Savings Retained. Con- tractor may at its option. and at its own cost. sub~ ject to approval by the Executive Director. substi- tute the alternative production methods set forth below. in lieu of those for which funding is made available hereunder. To the extent such substituted production methods may prove more economical than the production method for which funding is provided here- under. Contractor may retain savings resulting from such substitutions. subject to approval by the Execu- tive Director. allowed substitutions shall be as follows~ a) In lieu of a funded 2-paramedic rescue unit. Contractor may substitute either: one 2-paramedic ALS engine; or. two I-paramedic ALS engines; or a combination of an ALS engine and an ALS rescue unit scheduled for peak period coverage only. b) In lieu of a funded I-paramedic rescue unit. Contractor may substitute either: a 2-paramedic ALS engine. or. a I-paramedic ALS engine. c) In lieu of a funded 2-paramedic ALS engine. Contractor may substitute either: two I-paramedic ALS engines; or a I-paramedic ALS engine with addi- tional paramedic staffing during peak periods only. Contractor may also substitute a one-paramedic rescue unit. 21 I I I I I I I I I I I I I I I I I I I I I d) In lieu of a funded I-paramedic ALS engine, no sUbstitutions shall be allowed. In addition. BLS capability may not be substituted for any level of funded ALS service. e) In the event Contractor elects to employ. at a given station. a substitution that is not approved as provided for in this Contract (e.g.. operation of a BLS engine instead of a funded one paramedic ALS engine). so as to substitute a less reliable level of care than that for which funding would otherwise be made available. the Authority will calculate the amount of compensation the Contractor would receive for all funded levels of service. From this amount. the Authority shall subtract the value of services which the Con- tractor is actually providing. and the difference will be deducted from the Contractor's earned or total compensation. whichever is greater. For example. should a contractor elect to operate a BLS engine at a station where a one-paramedic engine is funded. the Authority would subtract the cost of the operation of a BLS engine from the cost of operation of a one-paramedic ALS engine and deduct the difference of these two sums from that contractor's compensation. The 22 I I I I I I I I I I I I I I I I I I I I I e)- (Continued) Authority shall not pay for services that are not provided except for authorized substitutions. 3. Weighted Averages Used to Establish "Customary" Costs. In annually determining the customary mar- ginal costs in Pinellas County of the various factors of production allowed as compensation for each defined level of first responder service. the "weighted aver- age" shall be employed. as defined in Subsection III-G. hereof. Contractors who succeed in holding their actual costs of these production factors below the "weighted averages" may retain savings realized thereby. Contractors who are unable to hold their actual costs within the weighted average shall not be eligible for additional compensation. 4. More Accountable Inventory Control. In the past~ the Authority has furnished certain on-board supplies without regard to inventory controls tied to docu- mented usage of supplies in rendering patient care. Under this contract. supplies shall be replaced on a one-for-one basis as used in patient care and docu- mented on Authority-approved patient information forms. Contractors are made responsible for costs of 23 I. I I I I I I I I I I I I I I I I I I I I 4. More Accountable Inventory Control. - (Continued) replacing out-dated supplies lost through inadequate stock rotation. as well as supplies lost. stolen. dam- aged. or otherwise unaccounted for. (See Subsection III-I. hereof.) s. Responsibility for Equipment. In the past. fund- ing for EMS equipment has been approved on the basis of individual negotiations--not on the basis of clear pOlicy guidelines. Under this Contract. provision is made for establishment of fully funded equipment replacement programs based upon stated assumptions regarding safe useful life expectancy and. in part. upon frequency of utilization. In addition. con- tractors are made responsible for costs of premature replacement due to loss. theft. accident. abuse. or neglect. (See Subsection III-G & H.) E. Deductions for Technical Default. Contractor shall maintain such records of staffing and operation of ALS first reponder units as may be required by the Authority in order to document that the contracted- for levels of service are reliably maintained. In the event the contracted levels of service are not continu- ously maintained (e.g.. due to problems in personnel scheduling or for other reasons). or Contractor is found 24 . I I I I I I I I I I I I I I I I I I I I I E. Deductions for Technical Default. - (Continued) to be in violation of EMS licensing requirements by the EMS Office. Department of HRS. State of Florida. the Auth- ority shall deduct from Contractor's payment an amount equal to the Authority's average price paid Contractor per ALS unit hour purchased under this Contract for each deficient unit hour produced. For example. if the total annual contract amount is $1 million (including "excess compensation") for the production of a total of 25.000 ALS unit hours during the year. the Authority would deduct from Contractor's payments $40 per manpower-deficient unit hour produced (i.e.. $1 million divided by 25.000 ALS unit hours). Chronically deficient unit hour production may constitute grounds for a finding of major default and termination of this Contract by the Authority. F. Frequency of Demand Justifying Each Production Method. The various available methods of producing first responder services differ dramatically in their respective marginal production costs. and therefore in their cost to the Auth- ority. Under this Contract. the primary factor in deter- mining which production method is most appropriate for use in a given location shall be frequency of demand for 911 EMS service at each first responder station. That is. 25 I I I I I I I I I I I I I I I I I I I I I F. Frequency of Demand Justifying Each Production Method. (Continued) where frequency of demand for service is low. less expensive production methods are justified. The follow-ing pOlicies are hereby established to govern determination of the production methods to be funded under this Contract. 1. Demand Allocated to Nearest First Responder Station. In allocating historical levels of demand. eligible 911 EMS incidents shall be allocated to the nearest first-responder station in accordance with the c.ounty's then current "nearest unit response matrix" as defined in Section 1. "Definitions." 2. Method of Allocating 911 EMS Requests. To promote the proper use of the 911 access system and its related resources. while providing fair compensation for services rendered. the fOllowing method shall be used to annually establish the frequency of demand for first-responder services allocated to each first-responder station: a) Calculating "911 Transports." To avoid financially rewarding improper use of the 911 system. and to encourage proper use of 26 I I I I I I I I I I I I I I I I I I I I t a) Calculating 11911 Transports. II - (Continued) the 911 system when appropriate. only EMS requests via 911 which result in the trans- port of a patient to a hospital facility shall be counted in calculating frequencies of demand for first responder services. Each patient transported as a result of a 911 EMS request shall be counted as a separate "911 transport. II (Basing demand allocation upon per--patient transports also anticipates and compensates for mUltiple unit assignments to multiple-patient incidents.) b) Allocating "911 Transports" to Stations. Based upon the then-current "nearest unit response matrix." each "911 transport" occurring during the most recent 12-month period for which statistics are then available shall be allocated to the nearest first-responder station. c) Double Count for Out-of-District Calls. To encourage and reward continued participation in the county's IInearest unit dispatch pOlicy. II every "911 transport" responded to at the County's request by another jurisdiction's first responder 27 I I I I I I I I I I I I I I I I I I I I I c) Double Count for Out-of-District Calls. (Continued) unit shall be allocated twice--i.e.. once to the nearest first-responder station as provided for immediately above. and also to the nearest first- responder station within the same jurisdiction where the incident occurred. d) Use of the "No-Transport MUltiplier." To com- pensate Contractor for responding to EMS requests in addition to those defined under paragraph a). above (e.g. prank calls. minor emergencies. requests via access methods other than 911. etc.). the "911 transports" allocated to each first-respontler station shall be multiplied by Contractor's "no transport mUltiplier" to deter- mine the "frequency of EMS demand per station. II e) Establishing the "No-Transport Multiplier. II Prior to the second year of this Contract. a separate "no transport multiplier" shall be estab- lished by the Executive Director for each first- response contractor. The mUltiplier shall be established as the ratio of the total number of EMS responses by Contractor's units during calen- dar years 1986 and 1987 to the number of patients 28 I I I I I I I I I I I I I I I I I I I I I e) Establishing the "No-Transport MUltiplier." (Continued) actually transported to hospitals by ambulance or rescue unit as a result of those same EMS incidents. f) Frequency of Demand Per Station. Each first- responder station1s "frequency of demand" (i.e.. allocated "911 transports" multiplied by Contrac- tor's "no tranport mUltiplier") shall serve as the basis for determining the level~f first-responder service for which funding shall be made available to the Contractor. (Important note: Because the intent of these provisions is to allocate funding eligi- bility in accordance with "nearest unit" dispatching policies. no shifting or re-allocation of allocated demand among stations shall be allowed.) 3. Demand Level Funding Table. Beginning with the second year of this Contract. Contractor shall be eliq- ible for funding of first-responder services under this contract in accordance with the fOllowing table. . Demand Level Fundin Table "Ad. usted DemandCVStation Authorized For Fundin 0--<1 Avera e Dail Demand BLS En one 1--<3 Avera e Dail Demand I-Paramedic ALS En one 3--<7 Avera e Dail Demand 2-Paramedic ALS En one 7--<12 Avera e Dail Demand I-Paramedic Rescue Unit 12--<16 Avera e Dail Demand 2-Paramedic Rescue Unit 29 . I I I I I ! I I I I I I I I I I I I I I I I 4. Application Examples. The fOllowing examples illustrate proper application of the "Demand Level Funding Table" in calculating funding eligibility for two typical first-responder stations: Example a) Assuming the frequency of "911 trans- ports" allocated to a given first-responder station is established at an average of 5 patient transports per day (including double-counted out-of-district requests). and assuming the Contractor's then cur- rent "no-transport multiplier" is 2.0. the "adjusted daily demand" upon this station would be established at ten 911 EMS calls per day. Thus. the Contractor responsible for this station would be eligible to receive funding for one I-paramedic rescue unit. since the level of demand at this station falls within the range of 7 to less than 12 - 911 EMS calls per day. (While substitutions may be made as provided for in Subsection D-l of this Section III. compensation would be authorized to cover the allowable cost of one I-paramedic rescue unit only. regardless of substitutions allowed.) Example b) Assuming the frequency of "911 transports II allocated to a given first-responder station is established at 30 I I I I I I I I I I I I I I I I . I I I I Example b) - (Continued) an average of 10 patient transports per day (includ- ing double-counted out-of-district requests). and assuming the Contractor's then-current "no transport mUltiplier" is 1.8. the "adjusted daily demand upon this station would be established at 18 EMS calls per day. Thus. the Contractor responsible for this station would be eligible to receive funding for one 2-paramedic rescue unit. plus one I-paramedic ALS engine. (While several substitution combina- tions could be allowed. as provided for in Sub- section D-l of this Section III. compensation would be authorized to cover the allowable costs of one 2-paramedic rescue unit. plus one I-para- medic ALS engine. regardless of sUbstitutions allowed.) G. Payment Amounts. Florida Special Act. Chapter 80-585 requires that. in pur~ chasing EMS services. the Authority shall pay the "reason- able and customary cost of said services. such cost to be defined by the Authority" (emphasis added]. The reasonable and customary cost of first-responder services is hereby defined. for purposes of this Contract. as the weighted average allowable marginal costs collectively incurred by first-response contractors operating in Pinellas County. 31 I I I I I I I I I I I I I I I I I I I I I G. Payment Amounts. - (Continued) Beginning with the second year of the term of this Con- tract. the Authority shall annually conduct a financial audit of the allowable marginal costs of first-responder services in accordance with the standards and provisions set forth in this Subsection III. G. The auditor shall submit his annual findings to the Executive Director who shall establish a single rate of payment for each of the five types of first-responder service purchased by the Authority. The sum of such payments to each first-response Contractor shall be referred to as "earned compensation." In cases where "earned compensation" is less than the amount listed in Attachment 2. "Schedule of First Year Monthly Payments." the Authority shall pay. in addition to "earned compensation." "excess compensation" as provided for in Subsection III. C hereof. 1. Allowable Marginal Costs. "Allowable marginal costs" are hereby defined as the portion of the pro- duction factor costs listed in Paragraph 3. below. which are incurred in the production of first- responder services and which would not be incurred if first-responder services were terminated or had never been initiated. Only line-item costs specifically listed in that Paragraph 3 shall be considered. 32 I I I I I I I I I I I I I I I I I I I I I 2. Determining the Weighted Average Costs. To deter- mine the weighted average cost of the below-listed factors of production. an auditor appointed by the Executive Director shall: a) identify the total actual costs incurred for these production factors by all first- response Contractors during the most recent 12-month period for which figures are available; and. b) divide the resulting totals by the number of "units" whose costs make up the totals to determine the "weighted average unit cost." (For example. assuming the total annual salaries of all Contractor's firefighter/para- medics was $10.8 million. and that the salaries of 450 persons constituted that total. then the "weighted average salary" of firefighter/paramedics would be established at $24.000--i.e.. $10.8 million divided by 450 firefighter/paramedics.) Thus. the "weighted average" method allows the generally higher costs of larger departments to dominate compensation calculations. 3. Allowable Costs Per Method of Production. The matrix listing below identifies the specific marginal production costs which shall be included in annual calculations to establish the rate of compensation allowed for each type of first-responder service pur- chased by the Authority. (Note: "FTE" means full- time equivalent.) 33 I I I I I I I I I I I I I I I I I I I 3 . AlloJable Costs Per Method of pJoduction. _ (Continued) The annual cost of sick and vacation leave granted to an employee. whether such leave is taken by the employee or not. shall be calculated in determining the average fringe benefit cost. This includes leave accrued. but not taken during the fiscal year. In calculating Contractor's constant manning mUltiplier. the AUditor shall include the cost of covering posi- tions temporarily vacated due to sick leave and vaca- tion time. Allowable Cost Matrix Item Oescri tion Production Method BLS l-Para 2-Para l-Para 2-Para Eng. ALS ALS AIS ALS En. En. Rescue Rescue Personnel Firefighter Salary 1 FF /Para. Premium Pay 2 Fringe Benefits 3 Cont. Staffin Multi lier 4 Medical Equipment Deprec.! Amort. @ 5 yrs. 5 Maintenance Contracts 6 Consumable Med. Su lies 7 Additional Insurance Costs 8 Licensin Fees 9 Additional Medical Services 10 Misc. Overhead & Su ervision 11 Marginal Vehicle Cost/Run* Cost of Fuel/Run 12 Yes Yes Yes Accelerated Veh. Maint. 13 Yes Yes Yes Accelerated De reciation 14 N/ AYes Yes In-Service Trainin Costs 15 (See note 15, below.) Annual Inflation Allowance 16 Yes Yes Yes Yes Yes * Note: Payment of "Per Run Marginal Costs" shall only apply to 911 EMS responses actually made by I' Contractor, as requcsted bJ_~he ~unty's 911 Center. .... _u_ '___ N/A N/A N/A N/A N/A 1 1 Yes 1 FIE 2 1 Yes 2 FIE 1 2 Yes 2 FIE 2 2 Yes N/A 1 set N/A 1 set (Su lies re (see note re N/ AYes Yes Yes N/ A $9000 1 set 1 set 1 set 1 set Yes Yes Yes Yes Yes Yes 34 I I I I I I I I I II I I I I I I I I I I I Notes to Allowable Cost Matrix 1. Firefighter Salary. In calculating this item. the auditor shall include only the salaries of per- sonnel normally assigned to and responding on first- responder units. Salaries of supervisory personnel and management staff shall be excluded including those who only occasionally ride such units. If salaries reported include additional compensation for special responsibilities (e.g.. HAZMAT. biomedical communica- tions. in-service training. engineering duties. etc.). such costs shall not be included in calculations to establish the basic weighted average salary of fire- fighters working in Pinellas County. 2. Firefighter/paramedic Premium Pay. In calcu- lating the weighted average premium pay for fire- fighter/paramedics. only premium pay directly related to EMS duties. and only that paid to cross-trained firefighter/paramedics currently certified and assigned to paramedic first-response units shall be considered. 3. Fringe Benefits. In calculating the weighted average cost of firefighter/paramedic fringe benefits, benefits associated with in-service training. sub- 35 I I I I I I I I I I I I I I I I . I I I I 3. Fringe Benefits. - (Continued) scriptions. travel reimbursement. and membership fees shall not be included. Also note that. to correct inadequate past funding of its retirement program. the fringe benefit costs of the St. Petersburg Fire Department are temporarily inflated and do not reflect current costs of fringe benefits. Therefore. until such time as this correction is complete. St. Petersburg Fire Department's fringe benefit costs shall be excluded from these calculations. Fringe benefits costs related to special responsibilities (e.g.. HAZMAT. biomedical communications. in-service training. engineering duties. etc.) shall not be included in establishing weighted average fringe benefit costs. The annual cost of sick and vacation leave granted to an employee. whether such leave is taken by the employee or not. shall be calculated in determining the average fringe benefit cost. This includes leave accrued. but not taken during the fiscal year. In calculating Contractor's constant manning mUltiplier. the AUditor shall include the cost of covering posi- tions temporarily vacated due to sick leave and vacation time. II 36 I I I I I I I I I I I I I I I I I I I I I 4. Continuous Staffing MUltiplier. The continuous staffing mUltiplier shall be applied to the sum of the weighted average costs of Items 1. 2. and 3 to calculate the "multiplier costs." In establishing this multiplier. the auditor shall take into con- sideration the fact that differing work week lengths may require differing mUltipliers to produce con- tinuous coverage of positions. The auditor shall also make adjustments as necessary to avoid double- counting of sick leave and vacation coverage costs. For example. if costs of covering sick leave and vacation time are counted among fringe benefit costs. such costs should not be counted again in estab- lishing the continuous staffing mUltiplier. s. Medical Equipment Depreciation/Amortization. Attachment 3. "Schedule of Initial Depreciation Adjustment Payments." includes provision for suf- ficient funding to compensate Contractor for the depreciation costs of medical equipment already in use at the start of this Contract. Thus. all medi- cal equipment depreciation costs included in mar- ginal cost calculations shall be based upon a safe useful life expectancy of five years beginning upon commencement of this Contract. Depreciation of equipment furnished by the Authority under the 37 I I I I I I I I I I I I I I . I I I I I I s. Medical Equipment Depreciation/Amortization. (Continued) "On-Scene Equipment Exchange Program'l described in Subsection III. H. hereof. shall not be included in these calculations. Costs of premature replace- ment of equipment items lost or damaged through loss. abuse. neglect. accident. or theft shall not be considered. Only the depreciated costs of medical equipment required by the State of Florida. the Authority. or the Medical Control Board shall be included in these calculations. 6. Medical Equipment Maintenance Contracts. Reason- able costs of contracts for maintenance of required equipment shall be included. except cost of repairs resulting from accident. abuse. or neglect. 7. Consumable Medical Supplies. No costs shall be included for consumable medical supplies. as these shall be replaced on a one-for-one basis by the Authority as described under Subsection III, I. "Supply Replacement Program. II Costs of supplies lost or damaged through abuse. neglect. loss. or theft. including costs of replacing out-of-date supplies shall be the responsibility of the Con- 38 I I I I I I I I I I I I I I I I I I I I I 7. Consumable Medical Supplies. - (Continued) tractor. (Note: the supply replacement program shall be effective beginning the second year of this contract.) 8. Additional Insurance Costs. To the extent marqinal insurance costs are documented by the auditor (i.e.. additional insurance costs directly attributable to the production of first-responder services and which would not be incurred in the absence of provision of such services). such costs shall be included. sUbject to the approval of the Executive Director. (Note: So long as Contractor is indemnified by the County for errors and omissi- ons in the delivery of first-responder services. the weighted average cost of malpractice insurance shall be deducted from Contractor's earned compensation.) 9. Licensing Fees. Actual costs of vehicle permits. EMS licensure. and radio licensure exclusively related to provision of first-responder services shall be included. For reasons described under Item 15. below. fees associated with EMT and paramedic certification shall not be allowed. 39 I I I I I I I I I I I I I I I I I I I I I 10. Additional Medical Services. Costs of physicals. vaccinations and inoculations (e.g.. Hepatitis-B). and medical testing (e.g.. AIDs testing. testing for drug abuse. etc.) shall be included so long as such medical services are required by the Authority. the State of Florida. EMS Division. or the Medical Con- trol Board. 11. Miscellaneous Overhead and Supervision. Because it may be difficult or impossible to determine the marqinal cost of overhead and supervision directly attributable to the production of first responder services. allowances for these costs are stipulated by the Authority within the "Allowable Cost Matrix. II which allowances shall be employed by the auditor in calculating rates of payment to be allowed under this Contract. In years three (3)through ten (10) of this Contract. the inflation allowance shall be applied to the "miscellaneous overhead and super- vision" amounts listed in the Allowable Cost Matrix. including cumulative inflation adjustments, applied during previous contract years. 40 I I I I I I I I I I I I I I I I I I I I I 12. Cost of Fuel/Run. To determine the average con- sumption of fuel per EMS response. Contractor shall cooperate in an annual study of fuel consumption per response by selected first-responder units by record- ing fuel consumption by the selected units during the period of the test. The total fuel consumed by the selected units shall then be divided by the total num- ber of responses (fire and EMS) made by the selected units during the period of the test to determine the averaqe consumPtion per response. MUltiplying this average consumption per response by the average price paid for fuel during the test period shall establish the average cost of fuel per run. 13. Accelerated Vehicle Maintenance. Because a large portion of the cost of fleet maintenance of fire- fighting apparatus is entirely unrelated to the first- responder role (e.g.. pump and hose maintenance. pre- ventive maintenance performed on a weekly or monthly basis regardless of mileage. etc.). it may be diffi- cult or impossible to determine the actual marqinal cost of vehicle maintenance directly attributable to first-responder usage. Even where separate "EMS rescue units" are employed. the marqinal maintenance costs may be difficult to isolate where maintenance personnel. equipment. and facilities are used to 41 I I I I I I I I I I I I I I I I I I I I I 13. Accelerated Vehicle Maintenance. - (continued) maintain both fire apparatus and rescue units. Therefore. the accelerated vehicle maintenance cost per 911 EMS response shall be annually established by the Executive Director through collective negotiations with first-response service contractors. in accordance with the fOllowing guidelines: a) Contractors shall submit to the Executive Director an estimate of their total costs of maintaining and repairing the complete fleet of firefighting vehicles including EMS rescue units. if any. during the most recent 12 months for which figures are available. with such sup- porting accounting information and documentation as may be requested by the executive director. (Costs of fuel shall not be included in this estimate.) b) Contractors' estimates shall include a break- down of these maintenance and repair costs into the fOllowing categories: Group l--costs attri- butable to administrative vehicles and support units; Group 2--costs attributable to equipment used exclusively for fire suppression purposes (e.g.. vehicles used for fire suppression but not 42 I I I I I I I I I I I I I I I I I I I I I b) - (Continued) normally used for EMS work. fire suppression equipment on board ALS engines. and other equip- ment exclusively related to fire suppression and/or HAZMAT activities. etc.); and. Group 3-- costs attributable to equipment normally used for EMS response (e.g.. drive-train components of ALS engines. rescue units. etc.). The accounting rationale to support this breakdown of costs shall also be supplied. c) Contractor shall furnish a statement showing the total amount of fuel consumed by all fire suppression and rescue units during the same accounting period. d) The Executive Director shall then sum the total of all Group 3 costs for which the sub- mitted documentation and supporting rationale are. in the opinion of the Executive Director. reasonable and adequate. and shall then divide the resulting amount by the total fuel consumed during the same accounting period. to establish the "overall maintenance cost per gallon." 43 I I I I I I I I I I I I I I I I I I I 1 I e) The Executive Director shall then multiply the "overall maintenance cost per gallon" by the average fuel consumption per response (established as described under Item 12. above) to determine the allowable cost per run of vehicle maintenance to be employed by the auditor. 14. Accelerated Vehicle Depreciation. The auditor shall establish a separate vehicle depreciation cost per run for ALS rescue units versus fire apparatus used as EMS first-responder units. In establishing these amounts. the auditor shall recognize the fOllowing guidelines: a) The auditor shall assume that ALS rescue units. including one dispatch radio but exclusive of on-board equipment and medical communications gear. shall be scheduled for replacement every five years. Thus. the allowable cost per run of vehicle depreciation of ALS rescue units shall be determined by dividing the average annual cost of depreciation per ALS rescue unit (i.e.. original cost less estimated residual value) by the average annual number of EMS runs per ALS rescue unit. 44 I I I I I I I I I I I I I I I I I I I 1 I b) The auditor shall assume that an average of less than one EMS run per day shall have no effect upon the rate of vehicle depreciation. and that obsolescence--not utilization--is the primary rea- son for replacing such equipment. c) The auditor shall assume that an ALS engine which runs 2190 EMS responses per year (i.e.. approx. 6.0 EMS calls per day X 365 days per year). in addition to its fire suppression duties. should be due for replacement after 10 years of service. Engines responding to less than 2190 EMS calls per year. not counting fire suppression calls would be replaced less fre- quently. while engines responding to more than 2190 EMS calls per year (plus fire suppression calls) would be replaced more frequently. d) The auditor shall determine the percent- age of total countywide ALS engine deprecia- tion costs to be allocated to EMS use by annually calculating the ratio of EMS calls to the total number of calls responded to collectively by all ALS engines. exclUding calls responded to by ALS rescue units (for which depreciation costs are separately established). 45 I I I I I I I I I I I I I I I I I I I 1 I e) The auditor shall determine the average origi- nal cost of ALS engines then currently under con- tract to the Authority by dividing the total of their original costs by the number of engines involved. and shall then establish their average annual cost of depreciation by dividing the aver- age original cost. less average estimated residual value. by the 10-year average life expectancy. Vehicles which have been in service more than five (5) years at the time these calculations are made. shall be excluded from these calculations. f) The percentage of average annual ALS engine depre- ciation costs attributable to the EMS usage shall then be established by mUltiplying the average annual depreciation cost per ALS engine by the allocation- percentage determined as per paragraph d) above. g) The auditor shall then establish the allowable depreciation cost per EMS run of ALS engines by dividing the average annual ALS engine depreciation cost attributable to EMS usage by 2190 EMS calls per year. 46 I I I I I I I I I I I I I I I I I I I I I h) Since these funds for equipment replacement will normally be received well in advance of the actual replacement. and can thus be invested by Contractor to offset inflation of equipment costs. no separate allowance shall be made by the auditor for replacement cost inflation. i) Since rates of compensation paid by the Auth- ority under this Contract include funding for future equipment replacement. Contractor shall establish and maintain. throughout the term of this Contract. a fully-funded equipment replace- ment program designed to ensure that sufficient funds are available to fund replacement of the subject equipment as scheduled. IS. Costs of In-Service Training. The Authority has made provision within its competitively-awarded ambu- lance service contract for establishment of a county- wide in-service training program capable of meeting all state. local. and National Registry requirements for recertification of ALS and BLS personnel. including requirements of the Medical Control Board. These in- service training opportunities shall be made available to Contractor and Contractor's EMS personnel effective at the start of the second year of this Contract. 47 I I I I I I I I I I I I I I I I I I I I I IS. Costs of In-Service Training. - (Continued) The Authority shall annually calculate the weighted average hourly overtime pay of firefighter/paramedics and shall reimburse the Contractor for off-duty EMS related in-service training attended by Contractor's paramedic personnel at that rate of reimbursement. subject to the fOllowing provisions: 1. Such reimbursement shall be made only for off-duty time. and only for in-service sessions required by the State of Florida. the Authority. or the Medical Control Board as a condition of maintaining paramedic certification. not to exceed ISO hours of off-duty inservice training per paramedic per year; 2. If such training is attended during the employee1s on-duty time. no reimbursement shall be provided; 3. Such reimbursement shall be made only for one-time participation in required in-service programs. and shall not be made for extra sessions attended voluntarily by the employee. 48 I I I I I I I I I I I I I I I I I I I I I 3. - (Continued) or for repeat or remedial sessions required due unsatisfactory performance by that employee either in rendering patient care or in completing a previous in-service session; and 4. To calculate the maximum monthly reimburse- ment owed the Contractor under this provision. the Executive Director or his designee shall maintain records of attendance by Contractor's personnel at required in-service training ses- sions and shall mUltiply eligible hours by the weighted average overtime rate. In addition. Contractor shall maintain its own records of actual overtime compensation paid off-duty para- medic personnel for attendance at the subject in-service sessions. and shall submit to the Executive Director a monthly invoice for such amount. The Authority shall pay the Contractor the invoiced amount. not to exceed the maximum amount as determined by the Authority. 16. Annual Inflation Allowance. As allowable marginal costs shall be determined by retrospective analyses of contractorsl actual experience. an allowance shall 49 I I I I I I -I I I I I I I I I I . . I I , 16. Annual Inflation Allowance. - (Continued) be annually made to adjust for projected inflation during the fOllowing year. The method of adjustment shall be to increase the total of calculated allow- able costs for each of the five types of first- responder service by a percentage equal to 100 per- cent of the percentage increase in the Municipal Cost Index during the most recent 12-month period for which figures are then available. as published by American City & County magazine; provided. however. that such increase shall be applied only to calculated "earned compensation" amounts and not to Ilexcess compensa- tion." 17. Medical Communications Equipment. The Authority shall furnish one medical communication radio and one medical communication portable unit (i.e.. UHF med- channel radio) for each ALS first response unit under contract to the Authority. The Authority shall also provide preventive and routine mainte- nance for such radio equipment at the Authority's expense. except for maintenance and repairs result- ing from accident. abuse. or neglect of said equip- so I I I I I I I I I I I I I I I I I I I I I 17. Medical Communications Equipment. - (continued) mente Radio equipment lost. stolen. or damaged by accident beyond repair shall be replaced by Con- tractor at Contractor's own expense. H. On-Scene Equipment Exchange Program. Certain on-board patient care equipment shall be subject to the Authority's "on-scene equipment exchange program." That is. when an equipment item listed in Attachment 4. liOn-Scene Equipment EXhange Items." is employed by first- response crews in the course of preparing a patient for transport. ambulance crews shall exchange with that first- response crew that same item of equipment from its own on-board inventory. (This program shall go into effect beginning the second year of this contract.) The Authority shall furnish Contractor an initial inven- tory of the equipment listed in Attachment 4 prior to startup of the equipment exchange program. Except for replacement of items lost. stolen. or otherwise unac- counted for in Contractor's inventory. the Authority shall furnish replacement items of said listed equipment where replacement is necessary due to normal wear and tear. It shall be Contractor's responsibility to comply with an Authority-approved inventory control record- 51 I I I I I I I . I . I I I I . I I I I I I H. On-Scene Equipment Exchange Program. - (Continued) keeping system capable of accurately tracking the locations of equipment items included in the on-scene equipment exchange program. Replacement of items lost from the inventories of units other than those of the Contractor shall not be Contractor's responsibility. I. Supply Replacement Program Except for items listed in Attachment 5. "Exempt On-Board Supplies." hereof. the Authority shall replace as neces- sary on a one-for-one basis and without cost to the Con- tractor. the medical supplies used by the Contractor in rendering patient care under this Contract. as use is documented by Contractor's first-response personnel on Authority-approved patient report forms. Contractor's authorized representative may sign for and pick up such supplies at a central location designated by the Auth- ority. The one-for-one method of inventory control shall become effective beginning the second year of this con- tract. At such time as one-for-one inventory control is in place. Contractor shall be responsible for costs of replacing inventory items lost. stolen. or damaged. and for costs of replacing items remaining in stock past their respective dates of expiration. 52 I I I I I I I . I I I . I I I I I I I I t I. Supply Replacement Program - (continued) Prior to startup of the one-for-one inventory control program. the Authority shall request from Contractor a current inventory of supplies in stock and on-board Con- tractor1s units. and shall furnish additional items or recover over-stocked items as necessary to provide Con- tractor with an initial inventory of medical supplies sufficient to provide for approximately two months of operations. based upon an analysis by the Executive Director of Contractor's historical usage. If requested by Contractor. the Authority shall cooperate to relocate to units serving in areas of higher demand stocks of supplies nearing their dates of expiration. provided such supplies are returned to the Authority not later than 90 days prior to date of expiration. In cases of supplies which are packaged and used in such a manner as to render precise "one-for-one" replacement impos- sible or impractical (e.g.. oxygen. etc.). an alternative method of inventory control and modified replacement/ reimbursement procedure shall. prior to the second year of this contract. be developed by the Executive Director and employed for these purposes. 53 I I I . . I II I . I . . I I . . I I . I I J. Uniform Charges for Medical Transportation It is the pOlicy of the Authority that a uniform rate plus mileage fees shall be charged by the Authority for every 911 patient transported by the Authority's first-response con- tractors. or by its competitively-selected ambulance service contractor. For patients who wish to fix-price and prepay uninsured portions of medically necessary emergency (and non- emergency) medical transportation services. the Authority shall continue to make available its ambulance service sUbscription program. No additional compensation shall be paid to Contractor for the transport of patients by first-responder units. K. Annually Revised Compensation Schedule The Executive Director shall prepare a schedule of compensation. hereinafter referred to as Attachment 8. "Annually Revised Compensation Schedule. 'I which will be revised annually and will establish the compensation level for each year of this Contract after the first year. L. Retrofit Conversions for ALS Engines. This is a one-time cost allowable for each of Contractor's ALS rescue units which are in operation as of September. 1987 and are converted to ALS engines. The cost will be paid only once during the life of this contract. for each such conversion. The Authority shall pay Contractor an amount 54 I I I I I . I I . . I I I I . . I I I I I , L. Retrofit Conversions for ALS Engines. - (Continued) which will not exceed $2.500.00 for each conversion. payable upon completion of the conversion. This amount will not be determined by the auditor. SECTION IV. Insurance. This section applies only to those contractors listed in Attach- ment 6. "Contractors Indemnified by the Authority. II A. The Authority shall provide for the purchase of insur- ance for the payment of any negligence or tort claims liability. automotive liability. and medical malpractice liability arising out of the activities of any qualified. authorized and directed personnel performing EMS activi- ties. Contractor covenants and agrees to maintain such workers' compensation coverage for its employees and others performing services for the Authority under this Agreement as may be required under state law. B. Contractor covenants. warrants and agrees. in con- sideration of the insurance coverage provided by the Authority. to comply with the EMS Loss Control Regula- tions attached hereto as Attachment 7 and made a part 55 I . I I . I I . . . . . I I . I I I I I I SECTION IV. Insurance. - (Continued) hereof. and to cooperate with the Risk Management Depart- ment of Pinellas County in monitoring and enforcing said loss control program as required by the insurance carrier for the EMS program. C. In the event the Authority is unable. after reason- able and good faith efforts. to secure or maintain insur- ance coverage as provided in this section. the Contrac- tor's sole remedy shall be the right to terminate the contract with thirty (30) days' notice to the Authority. SECTION V. Mutual Obligations of Parties. This section applies only to those Contractors who are not indemnified by the Authority and are not listed in Attachment 6. The Authority and the Contractor agree that each will save the other harmless on account of the negligent acts of its employees. officers. or agents. including volunteers. or on account of any negligent operation of equipment. The Authority and the Contractor shall only be obligated to indemnify and hold harmless the other under this Agreement to the extent that each may be held liable under Chapter 768.28 of the Florida Statutues. as it may be amended from time to time. or under any other applicable sovereign immunity law. 56 I I . I . I I . . I . . I I I 'I I I I I , SECTION VI. Obligations Not for Third Party Benefit or to be Assigned. This Agreement is not intended. nor shall it be construed. to enure to the benefit of any third person or entity not a party hereto. and no right. duty or obligation of the Contractor under this Agreement. shall be assigned to any person. private associa- tion or corporation. not-for-profit, corporation. or pUblic body without the prior written consent of the Authority. SECTION VII. Term of Agreement. These terms and covenants shall be in effect commencing upon the date of execution and continuing through September 30. 1997 unless terminated or renewed in accordance with this Agreement. This Agreement super cedes all previous written and/or oral agreements. ~""- CO,,"\-I"0~('-_\-'-"- '~,c_( -t-".y,:,I',-''\'t- 'T'f-.(-':, 1{\c~r-"-0')\i""):'\- -' \ 'I] _ I 1 . I J C (, )- '. y-,-l;JLO )'l-~j, ~ \_' \. - _' It' )-\~+',,,- "'- -1-(' {JT~\-t-- he', V\('~-I'., c}/ f'- ' Du" --"['Y-"''' \"'I----,C L-Ci\-I T -e_~ L- G /~'I" 'SE~~I~~}~I ~j;~\:on:;a:t:~ 'L' ':'~~~~~ndent Contractor. R&-. ~cP r~00 The parties agree that throughout the term of the contract. and during the performance of any obliqations hereunder. Contractor is an independent Contractor in all respects and shall not be the agent. servant. officer. or employee of the EMS Authority of Pinellas County. 57 I . I I . I I . . . . . I I . I I I I I , SECTION IX. Nondiscrimination. A. The Contractor. during the performance of this Agree- ment. agrees to comply with all applicable provisions of federal, state. and local laws and regulations pertaining to prohibited discrimination. B. The Contractor will not discriminate against any appli- cant for employment because of race. religion. color. na- tional origin. sex or age. The Contractor will take affirma- tive action to ensure that applicants are employed without regard to their race. religion. color. national origin. sex or age. Such action shall include. but not be limited to the fOllowing: employment. upgrading. demotion or transfer; recruit- ment or recruitment advertising; layoff or termination; rates of payor other forms of compensation; and selection for training. including apprenticeship. The Contractor agrees to post in conspicuous places. available to employees and applicants for employment. notices to be provided setting forth the provisions of this non-discrimination clause. C. The Contractor. will. in all solicitations or adver- tisements for employees placed by or on behalf of the Con- tractor. state that all qualified applicants will receive consideration for employment without regard to race. religion. color. national origin. sex or age. 58 I . . I . . I . . . . . I I . I . . I I , D. The Contractor will send to each labor union or repre- sentative of workers with which it has a collective bar- gaining agreement or other contract or understanding. a notice to be provided advising the labor union or workers' representative of Contractor's commitments under this sec- tion. and shall post copies of the notice in conspicuous places available to employees and applicants for employment. The Contractor will take action with respect to any sub- contract or purchase order as the administering agency may direct as a means of enforcing such provision. including sanctions for non-compliance. SECTION X. Fiscal Non-Funding. The funds to be used for services performed pursuant to this Contract are sUbject to periodic appropriation of funds by the Authority. After contract award. further obligations under this Contract beyond funds appropriated in the 1987/1988 budget for this Contract are contingent upon the availability of funds. If funds are not appropriated by thp Pinellas County EMS Auth- ority for any or all of this Contract. the Authority shall not be obligated to pay for any services performed under this Con- tract beyond the portion for which funds are appropriated. Such failure of appropriation shall not constitute a breach of this 59 I . . . . ,I I . . . . . . I . I I . . I , SECTION X. Fiscal Non-Funding. Agreement. The Authority agrees to promptly notify the Con- tractor in writing of such failure of appropriation. This Agreement shall terminate upon the last date of service for which funds were previously appropriated. SECTION XI. EMS Central Dispatch Services. The Pinellas County EMS Authority will continue to pro- vide or contract for countywide EMS centralized EMS dispatch services. SECTION XII. Resolution of Disputes. In the event the Executive Director finds the Contractor in substantial or technical default of this Contract and after written notification to the Contractor and reasonable opportu- nity to correct such a default. and if the Executive Director continues to find the Contractor in substantial default. and the Contractor disputes the Director's findings. the Contractor may appeal the finding of default to the County Administrator. 60 I . . I . . I . . . . . I I . I . . I I , SECTION XIII. Billing Authorization. Contractor authorizes Blue Cross and Blue Shield of Florida (BCBSF) to process claims submitted by the Authority for services rendered by Contractor. The Authority is auth- orized to submit claims on Contractor's behalf and warrant that the services have been rendered by Contractor. The Authority or Contractor shall not knowingly submit claims which conflict with the Social Security Act as amended. Federal rgulations. or Medicare guidelines. Contractor places responsibility and liability on the Authority for any Medicare/ Blue Shield claims submitted or for any adjustment of payment on Contractor's behalf and agrees to refrain from billing the Medicare beneficiary/BCBSF subscriber any portion of services rendered on behalf of the Authority. This provision is to be used solely for the purpose of allowing Medicare Band BCBSF to process claims submitted on Contractor's behalf under the name of the Authority. 61 I I I I I ,I I I I I I I I I I I I I I I I IN WITNESS WHEREOF the parties hereto, by and through their undersigned authorized officers. have caused this Agreement to be executed on this. the ~ day of ~~~ . 1988. ATTEST: KARLEEN F. DeBLAKER. CLERK PINELLAS COUNTY EMS AUTHORITY By: ~, By:- hairman (SEAL) APPROVED AS TO FORM: PINELLAS COUNTY ATTORNEY 0/' ~~ 4/f c6 t Attorney CITY OF CLEARWATER 'ii:: Approved as to form and correctness: Attest: c~o~ By: -:_~ - - "" .~ '-.- ::... -' - '.~ , ~ ..----,- - '- ---- - 0278j-l/63 01/88 62 I LIST OF ATTAC~NTS' PERSONAL WAIVER FORM SCHEDULE OF FIRST YEAR MONTHLY PAYMENTS SCHEDULE OF INITIAL DEPRECIATION ADJUSTMENT PAYMENTS ON-SCENE EQUIPMENT EXCHANGE ITEMS EXEMPT ON-BOARD SUPPLIES LIST OF CONTRACTORS INDEMNIFIED BY THE AUTHORITY EMS LOSS CONTROL REGULATIONS ANNUALLY REVISED COMPENSATION SCHEDULE I I I- I . I I I . I . I I I I I I I I I I ATTACHMENT 1 PERSONAL WAIVER FORM WHEREAS. allowed to observe the operations Personnel employed by entail riding in its vehicles; and WHEREAS. age or older; and has requested that he/she be of the Emergency Medical . which shall is eighteen (18) years of WHEREAS. hospitalization insurance with NOW. THEREFORE. in consideration of has furnished proof of company. 's grant of permission to observe the Emergency Medical Personnel of and to ride in its vehicles. hereby agr~s as follows: 1. Not to participate in or become a party t6 any kind of claims. causes of action. demands or suits for negli- gence that may arise by participating in the program and riding in vehicles. against the . its officers. employees. agents and servants. 2. That he/she is fully aware of the risks involved and the possibility of personal injury or death and property damages by participating in this program. 3. That he/she fully agrees to place himself/herself under the direction and orders Emergency Medical Personnel. 4. That he/she understands that he/she will be permitted to observe only and will not be permitted to assist in any way. IN WITNESS THEREOF. has caused this Release and Indemnity Agreement to be executed this day of 198 Signed: WITNESSES: 02s0j-63 I . . . I I I I II I I I . I I I I I I I I ATTACHMENT 2: SCHEDULE OF FIRST YEAR MONTHLY PAYMENTS DISTRICTS TOTAL CLEARl-JATEj=;: $ 1,64'7',230 ':$38~:, 100 D!.Jt~~lED I r'.-i EAS1- L{-)r:::E $317, ,:-'00 GULFF'OHT $269,000 INDIAN ROCKS BEACH U4EGO $679,830 $ 1 , 58.4, 5(H) LEPIU.1AN $6::.2,440 r1AI)ER I A 8EAI:t-l $272, 2(H) OLDSMAR $15,000 PALM HARBOR $575,220 PINELLAS PARK 5871,970 SAFETY HARBOR $564,570 ST. PETERSBURG $3,522,580 ST. PETERSBURG BEACH $613,360 SEMINOLE $1,122,720 SOUTH PASADENA $326,300 TARPON SPRINGS 5563,560 TREASURE ISLAND $289,400 TOTAL 514,256,580 r.tONTHL Y $137,436 $32,258 $21:.., ..q.6-7 .;I:....,I~ ."'''- .>>.:...:.., -'+ 1 / .wi;:CL, LC"-=:" --.iJIIuU, '_h.J._. $132,042 $52,7()3 $22,683 $ 1 , 25() $47,935 $72,664 $47,048 $293,548 $51,113 $93, 56(i $27,192 $46,963 $24,117 $1,188,048 I I . I I I I I . I . . . I I I I I I I I ~TTACHMENT~: SCHEDULE OF INITIAL DEPRECIATION ADJUSTMLNT PAYMENTS At--INUflL DISTRICTS CLEARWATER DUNEDIN Cf':IPITAL $5 1, 1 1 (i $(: EAST LAKE ~$t3:t 8(;~) GULF;='ORT INDIAN ROCKS BEACH T(j:t :3~:'(: $1(;~ 5':;'(; LAF:GO $24, () l(i ;...EALl"1AN "$.14, 65(i r-iADER IA 8EACH OLDSt-1Ar;; $8, 25C~ PAU1 HAR80R $ 11 , 600 ;:' I NELL AS ;='ARi::: ~.2C', ~jf:..(; SAFETY HPIRBOR 5T. PETERSBUF:G ST. PETERSBURG BEACH BE!'1INCLE SOUTH PASADENA T P,RPON SF'F=: I NGS TREASUF:E ISLAND TOTAL $ 17 , 6(j(i $57,28(: $18,53(; $28, 27(, $6, 55(:: $2(),66(: $'~, 13(: $317 , 32(; t-lONTHLY C'~P I T ~~L $4,259 $(; ':i '7-=:-~ -+" ; "_'0_' ~5 7i'E3 $883 $2,001 $ 1 , 221 ,t; L. c':= ..,....., '-J'-1 $(: $96,' $1,747' $1,467 $4,773 $ 1, 54.c.. $2, 35.~ $-= -" L. -J Lf '-I $1,722 $761 $26,4i1:3 THESE PAYMENTS SHALL BEGIN IN OCTOBER 1987 AND SHALL END IN SEPTEMBER 1991 FOR A TOTAL OF FORTY. EIGHT (48) MONTHLY PAYMENTS. I I I I I I I I . I I I I I I I I I I I ATTACHMENT 4 1 ON-SCENE EQUIPMENT EXCHANGE ITEMS Specific brand names will be specified by the Medical Control Board. The cost of all these items will be borne by the Authority. 1. Cervical Collars 2. "Short" Spinal Immobilization Devices 3. "Long" Spinal Immobilization Devices 4. Traction Splints s. Air Splints or other Limb Immobilization Devices 6. Anti-Shock Trousers (Adult and Pediatric) 7. Stretchers (For exchange with transport capable first-responder units) I I I I I I I I :1 I I I I I I I I I I I ATTACHMENT 5 EXEMPT ON-BOARD SUPPLIES NONE I I I I I I I I I I I I I I I I I I I I I ATTACHMENT 6 I CONTRACTORS INDEMNIFIED BY THE AUTHORITY CITY OF CLEARWATER CITY OF GULF PORT CITY OF LARGO CITY OF MADERIA BEACH CITY OF SAFETY HARBOR CITY OF ST. PETERSBURG CITY OF ST. PETERSBURG BEACH CITY OF TARPON SPRINGS CITY OF TREASURE ISLAND I I I I I I I I I I I 'I I I I I I I I I I ATTACHMENT 7 LOSS CONTROL FOR EMS 1. Each person who drives emergency vehicles which respond to medical emergencies shall successfully complete an Emer- gency Vehicle Operator's Course (EVOC). 2. Each person who drives emergency vehicles which respond to medical emergencies shall successfully complete a refresher or advanced Emergency Vehicle Operator's Course at least once each year. 3 . Prior to hiring an employee who will drive an emergency vehicle to medical emergencies the Contractor shall check the employee's driving record. A. Persons with questionable records shall receive remedial training. B. Those whose records meet the criteria in items 4B or 4C shall not be hired. 4. Each Contractor shall examine the state driving records of each driver annually. A. A driver shall take remedial training. if more than one moving violation with points is found in the driving record. I I I I I I I I I I I I I I I I I I I I I LOSS CONTROL FOR EMS (Continued) B. A driver shall be placed on probation and receive remedial training if the driver has more than two moving violations with points. or is within one violation (3 points) of suspension. C. A driver who is convicted of Driving While Intoxicated (DWI) or who has had their driver's license suspended. or revoked shall not be allowed to drive at all. In order to drive again. the driver must obtain a Florida driver's license and drive one year without receiving any citations for moving violations. In addition. the driver shall receive remedial training. D. Any driver whose Florida driver's license is revoked or suspended must report same to their employer. If such suspension or revocation is found on a regular license check. and has not been reported. the driver shall be prohibited from driving emergency vehicles which respond to medical emergencies. 5. District coordinators shall ride with each driver on a random basis and evaluate the driver's skill during the term of this contract. I I I I I I I I I I I I I I I I I I I I , LOSS CONTROL FOR EMS (Continued) 6. The Contractor shall investigate each accident and identify those accidents which were preventable. This investigation may be done by management or by peers. Recommendations shall be made for additional training where applicable. 7. No oral or written statements shall be given to anyone other than the investigating officers and other medical personnel regarding any patient or incident. Pinellas County Risk Management shall be immediately informed of any subpoenas received or requests for statements or documents. 2/86 0250j-90/92 ~ff. 9/87 I I I I I I I I I I I I I I I I I I I I , ATTACHMENT 8 ANNUALLY REVISED COMPENSATION SCHEDULE (TO BE PROVIDED ANNUALLY AFTER THE FIRST YEAR OF CONTRACT)