The AP Triton EMS Feasibility Report is available:
As expected it presents four options for possible EMS services going forth:
Option 1:
Negotiate a Contract with Rescue Inc.
Option 1 retains the current system of a third-party EMS transport system with no internal costs, employees, or other overhead costs to the Town. Under this system, the third-party provider would retain all EMS revenue, and the Town would compensate Rescue Inc. at its proposed rate of $288,240 for the following year. The basis behind the stated subsidy is $24.02 multiplied by a 12,000-resident population.
Due to the lack of congruency for private ambulance systems and limited revenue from the EMS system, prospective bids will be limited. The Town put out an RFP for private ambulance transport. The process resulted in three provider submissions. One of the three companies has now gone out of business. The second provider has minimal experience in providing 911 ambulance transport. Finally, based on interviews with neighboring agencies, the third provider has poor satisfaction based on current performance.
The decision to continue using private ambulance companies in the Town of Brattleboro will likely result in the requirement to routinely repeat the current selection process.
Option 2:
One 24/7 BFD unit staffed with one FF/Paramedic and one FF/EMT for each of the three shifts and one BFD ten-hour per day/365 days per year staffed with a Paramedic and an EMT.
Option 2 deploys one medic unit, staffed by one Firefighter/Paramedic and one Firefighter/EMT, on a 24-hour, seven day a week, fire department shift rotation and one medic unit, staffed with a Paramedic and EMT, operating 10 hours a day, seven days a week. The operational rotation is proposed to be four 10-hour days, followed by four days off. Two shifts of Paramedics and EMTs could handle this rotation as each shift would work an average of approximately 35 hours per week or 1,825 hours per year. In addition, an EMS Division supervisor’s position with a rank assignment of at least a Captain would be required to manage the division. Benefits for payroll taxes, retirement, certification incentives, health, and other insurance costs total approximately 18% of gross wages.
Operating costs of the division would include equipment costs for the defibrillators and gurneys to be placed on the medic units, medical supplies and consumables, maintenance of the medic unit, technology-related expenses for the software data terminals and ePCR notebooks for the units, fuel, training, and uniform costs. In addition, reserve funds are expected to replace the units at the six-year mark and then replace the cardiac monitors and gurneys at the 10-year mark. Reserve funds can be accumulated annually by converting depreciation expenditures recognized into a reserve capital equipment fund. This fund could be for the exclusive use of apparatus replacement.
The Town would retain all EMS billing revenue to offset some of the costs associated with delivering the services.
Option 3:
One 24/7 unit staffed with one FF/Paramedic and one FF/EMT for each of the three shifts and one private ambulance staffed with one single-role Paramedic and one single-role EMT.
Option 3 deploys one medic unit, staffed by one Firefighter/Paramedic and one Firefighter/EMT, on a 24-hour, seven days a week, fire department shift rotation and retains one private ambulance on a 24-hour per day/seven days per week basis. This option also includes an EMS supervisory position, as discussed in Option 2. Operating and capital costs have been adjusted to reflect the deployment of one unit through the Brattleboro Fire Department. A contract payment of $125,000 to the third-party ambulance service is included, and EMS revenue will be retained 100% by Golden Cross Ambulance as part of the contract language agreement. Furthermore, the Town of Brattleboro must recognize the total cost of augmenting this option by using six on-duty Firefighters. The sunk cost embedded into this option is an additional $556,887 making the total General Fund commitment $676,877.
Option 4:
Two 24/7 units staffed with one FF/Paramedic and one FF/EMT for each of the three shifts.
Option 4 deploys two medic units, staffed by one Firefighter/Paramedic and one Firefighter/EMT, on a 24-hour, seven-day-a-week fire department shift rotation. This option also includes an EMS supervisory position, as discussed in Option 2. Operating and capital costs have been adjusted to reflect the deployment of one unit through the Brattleboro Fire Department. Under this option, a third EMS unit would be acquired as a reserve unit. The Town would retain all EMS billing revenue to offset some of the costs associated with delivering the services.
