2012 - Bensalem EMS

Bensalem Rescue Squad
Annual Report 2012
Thomas Topley, Executive Director
March 2013
www.bensalemrescue.org
Bensalem EMS
Annual Report 2012
1
Executive Summary
Dear Friends and Neighbors:
This year has been a successful year for the rescue
squad because of all of the support our
community, Mayor Joseph DiGirolamo, and the
Bensalem Township Council. Bensalem EMS has
received the increased funding that was approved
by our community in November 2010. This
funding has allowed us to replace ambulances and
Bensalem Rescue personnel work with local chemical
company to mitigate a rail car problem and avoid a potential
emergency.
equipment that was at the end of its service life. The
new ambulances and equipment will allow us to
continue providing state-of-the-art care to our
community.
Received
Mututal
Aid
6%
Provided
Mutual
Aid
6%
The increased funding will also allow Bensalem EMS to
continue staffing levels that allow us to be the only
EMS service in Bucks County to carry special
medications. Bensalem EMS will also be able to
continue using additional crews to meet the needs of
our community during large scale emergencies and
busy seasons of the year.
As you read this report you will see that Bensalem EMS
continues to be a leader in our region. We also have
proven that training pays off. As we lead the regions in
very important treatments and techniques, such as the
ability to secure an advanced life support airway, or
regain pulses on victims of sudden cardiac arrest.
The officers and members of Bensalem EMS are
confident that 2013 will be a positive financial year
and that our next five years will continue to show
improvements in our equipment and service.
Once again, Thank You, to all who have supported us
in the Bensalem community. We are proud to serve
our home.
Calls in
Bensalem
88%
Call Volume
7250
7013
7000
6750
6679
6500
6679
6483
6250
6147
6000
5873
5750
5500
5250
5254 5241
5000
4750
4500
2005 2006 2007 2008 2009 2010 2011 2012
Annual Report 2012
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Annual Report 2012
Contents
Executive Summary.....................................1
2012 Year in Review....................................3
Bensalem: Best in Region ............................5
Parx Casino Grant .......................................6
New Ambulances Arrive..............................6
Danny Mac Bill Becomes Law ......................7
SWAT training for Paramedics ....................8
Drug Shortages a Costly New Norm ............9
Looking to Our Future ...............................10
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Annual Report 2012
2012 Year in Review
Although Bensalem EMS ended 2012 showing a
financial loss, the year proved to be quite successful
for the squad. This is the first year the squad
received tax money from the 2010 election. The
funding allowed the squad to reduce old debt and
purchase new vehicles for our fleet that is aging and
overdue for replacement. In 2012, our call volume
was slightly reduced from our 2010 high of 7,000
plus calls. The increase in funding also let us hire
additional personnel and to retain valuable
crewmembers who’d been leaving for other careers.
The squad concentrated highly on training in 2012
to improve patient care throughout our community.
Throughout 2012, the rescue squad experienced many ups and downs. The year began on a
financial high, with the squad receiving both the increase in tax funding and our annual donation
from Parx casino in Bensalem. The increased funding helped to offset much debt that was
accrued over the last two years and also allowed us to purchase two new ambulances. The Parx
donation helped to provide training and medical equipment needed to continue providing the
residents and visitors of Bensalem with the best medical care possible.
Even as the rescue squad received this additional funding and began to implement our ten year
plan, financial troubles began to threaten the squad once again. In April 2012, the
administrators of Pennsylvania’s Medicare program suddenly changed the rules that effect
ambulance billing. Prior to April, a squad could bill for a large number of diagnosis codes that
corresponded to our patient complaints. Pennsylvania’s Medicare program changed the
company that administers the funding in order to save money. The new administrators changed
the amount of codes ambulances can bill for to just over 120. Many of these new codes do not
apply to nearly all of our patients. Although Pennsylvania worked hard to correct these
problems, Medicare billing is still greatly affecting our area. The rescue squad estimates a loss
of nearly $50,000 a year due to the Medicare changes. In addition, we are still dealing with an
estimated loss of $50,000-$60,000 per year due to people keeping their insurance checks that
are meant to pay for ambulance bills.
The rescue squad has worked with other agencies in the area for over 10 years to have our
legislators change the law to prevent this from happening. However, the insurance lobbyist in
Pennsylvania continue to prevent 911 ambulances from being paid directly from the insurance
carrier. Our combined sluggish economy, a lack of direct pay laws for insurance carriers, and
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Annual Report 2012
these new Medicare changes will greatly affect the squad’s ability to remain a state-of-the-art
service well into the future. Bensalem Rescue Squad will continue to adapt our plans and
ensure our community the best care possible. At the end of 2012, the rescue squad was able to
invest $300,000 into a fund to ensure long-term operations.
In May 2012, the rescue squad took delivery of its first two F-series type I ambulances since
1993. The squad has been using Ford Econoline series Type III Ambulances since 1996. In early
summer 2012, through the help of Congressman Michael Fitzpatrick, the Danny Mac bill became
law. This bill closed a loophole that precluded the families of fallen paramedics to be paid
federal benefits. With the passing, this bill would have made sure that Danny’s family received
much needed aid and paid his death benefits quickly. In the fall of 2012, the rescue squad
experienced the busiest period of operations in our history. During Hurricane Sandy operations,
the rescue squad responded to 72 calls in 58 hours. Although our immediate area was spared
from much of Sandy’s destruction, Bensalem EMS personnel worked with Bensalem fire, police
and public works departments to ensure safety of our community. Bensalem EMS also sent to
commanders to work with area strike teams in New Jersey immediately after Sandy’s
destruction.
Overall, 2012 was a very good year for Bensalem Rescue Squad. We were able to make capital
purchases to replace two ambulances at a cost of nearly $320,000. We were able to improve
our state-of-the-art equipment and replaced equipment that was passed its service life. We
were able to staff ambulances to adequately meet the demands of our community and staff
extra units in times of anticipated demand increases. Finally at the end of 2012, the rescue
squad was able to invest in its own future by funding an account specifically for our long-term
operations. Our officers and members will continue to adapt our operations and provide our
community with the best ambulance care in our region.
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Annual Report 2012
Bensalem continues to be the best in our region
In 2012, Bensalem EMS continued to be the only ambulance service in our region to use the
drug Etomidate. This medication is used to sedate patients and allow EMS crews to secure their
airway and provide rescue ventilations in the event of an emergency. Our protocols require two
paramedics be on scene to use this drug and the rescue squad had to do much training to be
allowed to carry the medication. The technique, called intubation, allows paramedics to insert a
tube directly into a patient’s trachea or windpipe and provide oxygen directly to a patient’s
lungs while protecting the airway from aspiration. In 2012, Bensalem EMS once again had the
highest success rate for intubations in Bucks County. Bensalem EMS also has a mobile airway
lab that was provided from a 2007 federal grant. In 2012, the Bucks County medical advisory
committee requested our lab to be used at their annual in-service training for paramedics
throughout Bucks County. It is a great honor for Bensalem EMS to be able to share our
equipment with our brothers and sisters in Bucks County.
In 2012, Bensalem Rescue Squad also had the highest rate in the region of ROSC (return of
spontaneous circulation). This means for every patient that Bensalem Rescue Squad treated in
cardiac arrest, we had the highest percentage of restarting the patient’s heart. We attribute this
to the large amount of training that our community has allowed us to do over the years. We
also attribute this to the great cooperation between our community and our first responders.
Bensalem has a large number of AED’s, or defibrillators, placed throughout our community; in
schools, restaurants, malls, police cars, and fire trucks. Bensalem’s first responders are very
aggressive and respond to calls for people that may not be breathing or their heart may have
stopped. The early application of CPR and AED highly increases the chances of survival for the
person. At this time, we would like to recognize our fellow responders at Bensalem Police,
Bensalem Fire Rescue, and the six volunteer fire companies that responded to so many calls to
ensure our citizens’ safety. These responders really do make a difference.
100%
90%
80%
BEMS
70%
Bucks County
60%
50%
1st Attempt
(2011)
Overall (2011)
1st Attempt
(2012)
Overall (2012)
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Annual Report 2012
Parx Casino Continues to Support EMS in Our Community
In January 2012, Parx casino made a generous donation of $89,000 to Bensalem Rescue Squad.
This is the sixth year in a row Parx has made this valuable donation. Parx has made this
donation annually to help offset the cost of our service to the community. Our community’s
aggressive development since 2006 has caused increased call volume for our staff. Although our
call volume was slightly down from our highest
level in 2010 of 7,013 calls, this year 6,364 calls
still represents nearly a 20% increase in calls
since 2006. Although our call volume remains at
this increased level, our residents are actually
only experiencing a wait time of around eight
minutes for an ambulance to arrive. This is 12
minutes below the state minimum standards for
BLS and two minutes below the state minimum
standard for ALS. Without Parx assistance each
Parx Check Presentation at BEMS Headquarters
year, we would not be able to staff additional
resources to keep these times so low. Our
community would have to wait longer for aid in time of an emergency, when minutes actually
save lives. The officers and members of Bensalem Rescue Squad wish to thank Parx for
continuing their generous donations.
New Ambulances Arrive to Help Aging Fleet
In May 2012, Bensalem EMS received two new ambulances which were ordered at the end of
2011. These newer ambulances replaced two 2003 ambulances, which were three years
overdue for replacement. Due to problems with its Econoline Series chassis and diesel engines,
Ford no longer makes the chassis we’ve used on our ambulances since 1996. Because of many
factors, such as different wheel bases and, cab-to-axle ratios, the patient compartment of our
ambulances can no longer be used on the new chassis. This forced Bensalem Rescue Squad to
redesign our trucks from the ground up. Bensalem EMS formed its first ambulance committee
since 1996 to work on this project. The new ambulances are on an F-series Ford chassis. The
patient compartment, or box, was completely designed by our committee. A Request-forProposal was issued from which bid specifications were designed and sent out to numerous
ambulance manufacturers. Horton won the bid for the new ambulances. After receiving the
new vehicles we still had some work to do installing radios, mounting equipment and oxygen
delivery systems. The new trucks were put in service in July 2012 and have proven to be a
successful design. Our committee concentrated on equipment storage and practical workflows
for patient treatment in the back of the ambulance. All of our crews are reporting to be very
happy with the design. We hope these trucks will be as proven as our other trucks over the
years. These trucks have assisted us in upgrading our fleet and reducing serious downtime for
our ambulances. This has greatly increased our operational readiness to serve our community.
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Annual Report 2012
Bensalem EMS placed two 2012 Ford F450 Type III ambulances in service in July
Danny Mac and Dale Long Bills Become Law
In March 2010 we lost our brother Daniel McIntosh, who suffered a heart attack and died while
struggling with the patient in the line of duty. Although many of us realize our job is dangerous,
we often never think about it. However, we all
feel that our family will be taken care of, should
something horrible happen, through the Public
Safety Officers Benefits program at both the
state and federal levels. Danny left behind a
widow and two small children. Although it took
some time, the rescue squad assisted Dan’s
family in receiving both state PSOB benefits and
workers comp insurance benefits. However, we
encountered a loophole in the federal law that
precluded paramedics, such as Daniel McIntosh,
from receiving federal death benefits. By the
letter of the law only municipal employees and a
few select groups of paramedics, were covered. This was obviously an oversight as private
ambulances that provide 911 service to municipalities were not covered. Although Bensalem
understands how this oversight could be made because this model is not the norm in most of
our country, it unfortunately meant that the law had to be changed in order for Daniel’s family
to receive these benefits.
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Annual Report 2012
Bensalem EMS also found a similar situation occurred in New England where paramedic Dale
Long perished in the line of duty and his family was rejected federal benefits. Thanks to the
efforts and hard work of Congressman Michael Fitzpatrick and his staff, the Danny Mac law was
introduced into Congress. At the same time, Senator Patrick Leahy introduced the Dale Long Bill
into the Senate. Both of these laws were passed and signed in the law by the President of the
United States this year. Both laws were made retroactive, so that Danny’s family and Dale
Long’s family will be covered. We hope the both families will receive the benefits shortly and
this chapter of their lives will be closed so they can move on raising their children and
recovering from these terrible losses.
SWAT Training for Paramedics, TEMS, TECC, and TCCC
In 2012, Bensalem Rescue Squad continued training paramedics to work with our SWAT officers.
Bensalem EMS began this program in 1996. Since that time, Bensalem has specially trained
paramedics who work with the SWAT team to provide medical care in the event of an
emergency or injury to an officer. Over the years our members have helped several officers who
were injured during training. The availability of a paramedic close by means that SWAT officers
can be quickly treated and reduce recovery time, which could keep an officer away from his or
her job. When Bensalem EMS started this program many years ago, our primary responsibility
was preventative medicine for the officers. Specially trained paramedics were taught principles
of team health and preventative medicine. Should an officer or civilian be injured, traditional
methods of EMS were used to
treat injuries. In April 2011,
Bensalem EMS personnel
participated in the first of
many programs that bring
combat medicine to the
civilian world. Paramedics
were taught how to
quickly and effectively
treat wounds suffered
from combat trauma such
as gunshot wounds and
blast injuries. Our
paramedics were also
trained in these
techniques under stress to
give us the confidence to
work in austere
environments. In 2012
Bensalem Rescue Squad
continued this training. We’ve sent
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Annual Report 2012
staff members to be trained in T.C.C.C. or tactical combat casualty care; T.E.C.C., which is tactical
emergency casualty care; and concepts of T.E.M.S., tactical emergency medical services. These
skills are proving crucial not only to help our SWAT officers but to prepare our community for
unthinkable events such as an active shooter situation or the use of an IED in a crowded place.
Bensalem EMS has also entered into an agreement with Temple University Hospital to provide
three physicians to work with our tactical paramedics and the SWAT team. The addition of
these doctors provide oversight for the paramedics who work with the team and provide them
with constant education in the latest techniques available. The physicians also perform skills
paramedics cannot, which has added another dimension to the ability of care we can give to our
officers. An added benefit of our agreement with Temple University Hospital is that the doctors
can also provide training to all of our staff members. Temple University Hospital is a teaching
hospital and operates a busy urban emergency room. The education and experience of these
doctors will be an invaluable asset to our organization well into the future.
Our medics have also trained our police officers, many first responders, and security personnel
throughout our town in the use of simple medical techniques to save lives in the event of mass
trauma. Bensalem EMS and Bensalem Township, through our Department of Public Safety, are
on the cutting edge of these techniques and safety concepts. We hope to expand these types of
training to other responders and safety personnel throughout our community. As part of its
mission to work aggressively with other first responders to improve the safety for our
community, Bensalem EMS is very proud of our work in this area. Other communities are
looking to Bensalem Township for advice on how to keep their schools safe and prepare their
community. We all should be proud.
Drug Shortages - A Costly New Norm
Since the rescue squad was founded 1980, the medications provided to patients by our
paramedics have been provided by local hospitals through a donation program set up
throughout Bucks County. In the past years of our slow economy, more and more hospitals are
looking for ways to cut costs and save money. Our medication replacement program has been
looked at by many local hospitals as one of the programs for them to cut. Luckily local EMS
agencies have been able to negotiate that the program still remain in place. The medication
replacement program saves local rescue squads thousands of dollars each year. It is important
to also note that ambulances cannot bill most insurance companies for the medications.
However, to improve patient care throughout the state, Pennsylvania has made some optional
medications available to ambulance services. Our local hospitals have opted not to provide
optional medications to squads in Bucks County. This has left Bensalem Rescue Squad the need
to purchase medications such as Etomidate and Fentanyl from our own operating funds.
Although these medications themselves are not very expensive, we do need to stock them in
each and every one of our ALS licensed ambulances. The medications also expire, causing us to
incur a cost for medication that was never used.
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Annual Report 2012
Another obstacle that revealed itself in 2012 was the shortage of many medications. In an effort
to reduce operating costs and increase profits, many drug companies have elected to make
medications in batches once a year. If the medication runs out is not available until the next
cycle where the drug companies will produce the medicine. We have found these are relatively
inexpensive medications with small profit margins. However, this has caused Bensalem EMS to
buy more medications than normal. The hospitals are not as willing to provide us with
medications that they believe will be shortage. So far this year, we found shortages in fentanyl
and morphine, which are painkillers commonly used in the ambulance service. We have only
seen this sporadically in the past when the medication would be replaced by a new, more
expensive medication and the old medication was no longer produced. However, we feel this
new medication shortage will be a norm in the healthcare industry for some time to come.
Bensalem EMS will do its best to try to keep medications on hand or order extra medications as
soon as we are notified of the possible shortage. This level of preparation will continue to cost
money that would normally be spent on our medical supplies. Bensalem is also working with
area hospital system to replace medications before they expire and keep our stock well
supplied. As always, we strive to provide our community with the best care possible and this
includes having a well-supplied arsenal of common medications that we are allowed to
administer in the event of emergencies.
Looking to Our Future
For Bensalem EMS, 2012 ended in a negative financial position. This is the first time in our
history that we’ve had two negative financial years in a row. However, the squad feels our
negative financial position was the result of replacing major capital equipment that was not
affordable prior to this year. The effect of insurance regulations decreasing payments to
ambulance services throughout the Philadelphia region also contributed to this negative
number. However, Bensalem Rescue Squad is confident that 2013 will be the turnaround year
where we post a positive financial outlook.
Bensalem EMS has adopted a five-year budget to ensure cost-effective operations for the near
future. The squad has also placed money away into a long-term operations fund that will gain
interest and ensure continued service into the next 10 years. In 2013, Bensalem EMS hopes to
continue to pay off debt and balance our books. We will tailor our service and our staffing to
meet the needs of our community while respecting the new billing environment in which we
work in.
As things occur and change, we are also predicting that our call volume may continue to drop in
small increments as our economy continues to struggle in its recovery. Many people are being
sent home from the hospital in poor health and are given directions for home care. Many other
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Annual Report 2012
people are not calling 911 because they simply have no insurance to cover the cost of the ride or
the hospital stay. Finally, more people have lost their jobs and their health insurance and are
winding up on Medicaid, Pennsylvania’s state subsidized insurance carrier. Medicaid is the
lowest paying insurance provider and only covers 10 to 20% of the cost of an ambulance bill.
The federal government has identified the Philadelphia area is one of the most abused areas for
ambulance service and Medicare fraud. Therefore, we are predicting even tougher billing
regulations in the future. All these factors combined are causing lower revenues for ambulance
billing, making even more crucial for Bensalem EMS to go into the future aware of these issues
and to conservatively plan future budgets.
Bensalem also needs to continue to support our local legislators in their efforts to establish
direct pay billing laws in the Commonwealth of Pennsylvania. Insured persons who use the
ambulance service continue to cash checks and keep funding that was meant to pay their
ambulance bills. Numerous bills have been introduced to stop this process and to make
ambulance companies be paid directly by the insurance companies. Independence Blue Cross
and the Insurance Federation of Pennsylvania have lobbied strongly against this as they want
ambulances to be in network providers for service. However, the in network rates these
insurance companies pay are only around 25% of an ambulance bill. This problem affects not
only Bensalem Rescue Squad, but all of the 9-1-1 ambulance providers in Pennsylvania. We will
continue our efforts to remedy this situation and continue to support our local politicians in
introducing bills that will protect our EMS system.
We also need to continue to educate and inform our federal legislators on the effects Medicare
laws are having on the Pennsylvania EMS system. Many ambulance squads in Bucks County and
throughout Pennsylvania are not as fortunate as Bensalem EMS to have not only a good call
volume, but a supportive community to offset its costs. Many local EMS services are struggling
for daily operations and could possibly have to close doors in the next 3 to 5 years. The entire
system teeters daily on failure. We hope that a catastrophic event does not occur before
legislators realize something must be done. Money from the insurance Federation pales in
comparison to the negative impact of decreased ambulance service in Pennsylvania.
Another factor that will greatly impact our future is the passing of Pennsylvania Act 37 in 2010.
This act replaces the former Pennsylvania Act 45 of 1985 as the basic framework for our EMS
system. It provides all the rules and regulations that govern how rescue squads operate and
what level of training is acceptable for the providers who care for the public. Since its passage in
2010 Act 37 has yet to be enacted. The state is currently in the process of developing detailed
rules and regulations to explain the intent of the approved law. Bensalem EMS knows that basic
issues, such as what a paramedic has to do to maintain his or her certification, is on the
forefront of things to change. However, we do not know what those changes are and what rules
we will have to comply to. We also know that the governing body that provides ambulance
safety specifications is changing to the national fire protection agency. We don’t know what the
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Annual Report 2012
new rules are going to be requiring ambulance safety. This will certainly impact the cost of
future ambulances, as well as the design and work functionality of what Bensalem knows to be a
proven vehicle.
Even with all of these financial and operational challenges that face us, Bensalem EMS is
confident that our future is bright. We now have the funding needed to meet operational
deficits and we have a committed staff in place with many years of experience in the ambulance
industry. We will continue to be on the forefront of these changes and plan accordingly,
keeping in mind the needs of our community. Bensalem EMS is typically an agency that others
look to for guidance and example. We will continue to be this agency in the future through staff
education, hands-on training, and working with other skilled agencies to improve our knowledge
and our skill sets.
As Executive Director of Bensalem Rescue Squad, I would like to thank all the stakeholders who
helped make this the great organization that we are and will continue to be well into the future.
We all look forward to working together in 2013 as an organization.
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