HomeMy WebLinkAboutEmergency Medical Services Tax Levy STATE OF WASHINGTON, COUNTY OF KING }
AFFIDAVIT OF PUBLICATION
CITti'OF RENTON
PUBLIC NOTICE c�TY couNcrL
NOT[CE OF
Linda M Mills, being first duly sworn on oath that she is the Legal PusLrc�EET�rrc
Advertising Representative of the NOT�cE �s HExEBY c�vEN
that a special public meeting will
be held at the regular Renton
Ciry Council meeting on the llth
day of March, 2013, at 7:00 p.m.
Renton Reporter +n the Se�enth floor �oun���
Chambers of Renton City Hall,
1055 S.Grady Way,to considec
Approving the placement of a
a weekly newspaper, which newspaper is a legal newspaper of zo�4-zo�9 �oun�yW�ae M�a��
general circulation and is now and has been for more than six months One/Emergency nned��ai ser- �
vices(EMS) Levy on the ballot
prior to the date of publication hereinafter referred to, published in �n zo�3:ana
the English language continuously as a weekly newspaper in King Taking a position �� support
of or opposing the 2014-2019
County, Washington. The Renton Reporter has been approved as countywide Medic o„eiEMs
a Legal Newspaper by order of the Superior Court of the State of t.e`'y rate of 33.s �enrs per
Washin ton for Kin COUTlt . $1,000 of assessed property
g g }� value, as proposed by the EMS
The notice in the exact form annexed was published in regular issues Aa��sory Task Fo«e.
of the Renton Reporter (and not in supplement form) which was Pro and con speakers are invited
to the public meeting to state
regularly distributed to its subscribers during the below stated period. rne�r pos�t;ons.
The annexed notice, a: City Hall is fully accessible, and
interpretive services for the hear-
Public Notiee ing impaired will be provided
upon prior notice. Call
425-430-6510 for additional in-
formation.
was published on March 1, 2013. �°°°�i��Wa�'°°
�
Published in the Renton Reporter
The full amount of the fee charged for said foregoing publication is on Ma«n 1, ao�3. #�a6�9s.
the sum of$80.50. a,�.,r�<�t�tartr�
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�Yn a M. Mills �" �'����L , ��`�
�.:, �� ��n:f ;,
Legal Advertising Representative, Renton Reporter '�.�=,�'� � � �� _ '
Subscribed and sworn to me this 1 st day of March, 2013. ° ��,;,� `'`���"�'� _���;�'
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Kathleen C. Sherman, Notary Public for the State of Washington,
Residing in Buckley, Washington
� �
RENTON CITY COUNCIL
Regular Meeting
March 11,2013 Council Chambers
Monday, 7 p.m. M I N U T E S Renton City Hail
CALL TO ORDER Mayor Law called the meeting of the Renton City Council to order and led the
Pledge of Allegiance to the flag.
ROLL CALL OF RANDY CORMAN,Council President; MARCIE PALMER; DON PERSSON; ED
COUNCILMEMBERS PRINCE; RICH ZWICKER; GREG TAYLOR. MOVED BY ZWICKER,SECONDED BY
CORMAN,COUNCIL EXCUSE ABSENT COUNCILMEMBER TERRI BRIERE.
CARRIED.
CITY STAFF IN ATTENDANCE DENIS LAW, Mayor;JAY COVINGTON, Chief Administrative Officer; MARK
BARBER,Senior Assistant City Attorney; BONNIE WALTON, City Clerk;GREGG
ZIMMERMAN, Public Works Administrator; CHIP VINCENT, Community and
Economic Development Administrator; IWEN WANG,Administrative Services
Administrator; PETER RENNER, Facilities Director;ANGIE MATHIAS,Associate
Planner; FIRE AND EMERGENCY SERVICES AQMINSTRATOR MARK PETERSON
and DEPUTY CHIEF ERIK WALLGREN, Fire & Emergency Services Department;
COMMANDER DAVE LEIBMAN, Police Department.
PUBLIC MEETINGS � This being the date set and proper notices having been posted and published in
Fire: King County Medic One/ accordance with local and State laws, Mayor Law opened the public meeting to
Emergency Medical Services consider whether the King County Medic One/Emergency Medical Services
(EMS) Levy, 2014-2019 (EMS) Levy 2014-2019 should be placed on the 2013 ballot, and to consider
taking a position supporting or opposing the proposed levy rate.
�r" t� Fire and Emergency Services Administrator Mark Peterson reported that the
�,�� Emergency Medical Services (EMS) system in Renton and King County serves
nearly two million people, and provides life-saving services on the average of
every three minutes. He stated that the City of Renton, which includes Fire
Protection Districts#25 and#40, receives$1.2 million annually in levy funds.
Chief Peterson invited King County Emergency Medical Services Division
Director 1.im Fogarty to provide more details on the proposed levy.
Mr. Fogarty reported that King County uses a regional perspective that utilizes
local basic life support(BLS) providers to handle most of the 9-1-1 calls directly,
with some patients shifted to advanced life support(ALS) providers if
necessary,and then patients are transferred to the hospital networks. He also
explained that the tiered system provides regional services which include
medical program direction,continuing medical education and oversight, and
criteria-based dispatch.
Mr. Fogarty further explained that when a person calls 9-1-1 they receive the
finest pre-hospital medicine anywhere in the nation. He stated that this is a
measurable fact,and produced statistics that show save-rates for cardiac arrest
in King County at 52%and climbing. He remarked that rates in other large
metropolitan areas like New York and Los Angeles are below 10%.
March 11, 2013 �wr✓ Renton City Council Minutes '�.++` Page 72
Continuing, Mr. Fogarty reported that a taskforce was formed to develop the
proposed levy package. He stated that many local officials served on
subcommittees that were charged with describing what services are needed for
the region over the next six years. Mr. Fogarty reported that the taskforce
recommended that the levy remain a six-year levy with a rate of thirty-three
and a half cents per$1,000 of assessed property tax value, and that an election
be held in either August or November of 2013.
Mr. Fogarty also reported that the taskforce recommended that there be no
expansion of services; that no cost-shifting occur for ALS providers;that BLS
providers continue to be funded at current levels; and that support programs
for regional services find ways to control and maintain costs. He also reported
that the fall prevention and the car seat programs remain funded and operate
as regional programs.
Concluding, Mr. Fogarty reported that in 2008 a typical homeowner would have
paid approximately$100 a year for services,and the proposed 2014-2019 levy
rate will cost a homeowner approximately$77 per year. He remarked that
each city in King County with a population over 50,000 must pass a resolution
approving the placement of the measure on the ballot in order for it to go
forward,and requested that Council pass such a resolution.
Mayor Law remarked that the intent of the public meeting was to provide both
pro and con information regarding the proposed levy. He noted that no one
had signed up or volunteered to speak in opposition to the measure.
Public comment was invited.
Dave Beedon (Renton) remarked that he believes in the value of taxes,
especially for emergency medical services,and expressed support for the levy.
Correspondence was entered into the record from Mary Weirich (Renton)
expressing support for the levy.
There being no further public comment, it was MOVED BY ZWICKER, SECONDED
_BY CORMAN, COUNCIL CLOSE THE PUBLIC MEETING. CARRIED.
MOVED BY CORMAN, SECONDED BY ZWICKER, COUNCIL SUSPEND THE RULES
AND ADVANCE TO THE RELATED RESOLUTION. CARRIED.
RESOLUTION#4175 A resolution was read approving placement of the County-wide 2014-2019
Fire: King County Medic One/ Medic One/Emergency Medical Services(EMS) Levy on the 2013 ballot,and
Emergency Medical Services supporting the proposed ballot measure. MOVED BY PERSSON,SECONDED BY
(EMS) Levy,2014-2019 CORMAN,COUNCIL ADOPTTHE RESOLUTION AS READ. CARRIED.
Annexation: Parker,SE 120th This being the date set and proper notices having been posted and published in
St& 155th Ave SE accordance with local and State laws, Mayor Law opened the public meeting to
consider the 10% Notice of Intent to Commence Annexation Proceedings
petition for the proposed Parker Annexation;20.4 acres bounded on the north
by SE 120th St.,on the east by the Urban Growth Boundary,on the south by SE
124th St., and on the west at approximately 155th Ave. SE.
Associate Planner Angie Mathias reported that the annexation site is within the
Cit�s potential annexation area and contains single-famity lots and vacant land.
She remarked that there are no regulated slopes, and there is an identified
wetland and a Class IV stream in the area.
��
Agenda Item No.:
� �.
RENTON CITY COUNCIL MEETING
PUBLIC HEARING/MEETING
SPEAKER SIGN-UP SHEET
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CONTACTED OR TO BE A PARTY OF RECORD WHEN APPROPRTATE
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RENTON CITY COUNCIL MEETING
PUBLIC HEARING/MEETING
SPEAKER SIGN-UP SHEET
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�r - /f.�i,�-.� �'I � ..%, .�/�1oan�yy�'�
From: 'Mary Weirich' <maryvweirich@comcast.net> .3_//- aO�J?
Sent: Monday, March 11, 2013 12:52 PM
To: Council �-�i!'w 3.a.
Cc: maryvweirich@comcast.net
Subject: Resolution: King County Medic One/Emergency Medical Services (EMS) Levy, 2014-2019
Thank you for taking the time to read my message. I am a former employee of both City of Renton Fire and
Emergency Services, and King County Emergency Medical Services/South King Medic One. My health issues
prevent me from attending the public meeting tonight, so I am writing to urge you to vote yes to authorize the
adoption of the King County Medic One/Emergency Medical Services (EMS) Levy, 2014-2019 resolution. This
is a crucial step in bringing this important levy to the vote of the people of Renton.
As many of you know and may have experienced, King County Emergency Medical Services is a world-
renowned, tiered, medical emergency care system. The King County pre-hospital cardiac arrest survival rate far
surpasses most other systems by a wide margin. I was involved in the administrative inner-workings in both
organizations for a combined total of over 10 years. I know staff inembers at all levels. They endeavor to
provide excellent pre-hospital care during every dispatched call. They are dedicated to also continuously assess
and improve this important system in King County.
Many people are not aware of how this system works. Medical emergencies are dispatched to the local
city/jurisdiction's firefighters/emergency medical technicians (EMTs). Depending on the level of care needed,
local/regional paramedics may also be dispatched at the same time or upon assessment by the EMTs. South
King County Medic One provides paramedic service to City of Renton. They work with and train with Renton
firefighters/EMTs as well as Renton police to ensure seamless care. No call is a routine call —whatever they
encounter, they treat- during anything from a home or business response to a full-blown disaster.
This dedicated team (including dispatchers, firefighter/EMTs, paramedics, police, researchers, physicians,
administrative personnel, and others) ensures that each individual in medical distress is treated with the utmost
care and technical expertise available in the world. We are very fortunate to have this caliber of service
available in our city. It becomes especially crucial during life and death situations.
Thank you for your consideration on this matter.
Mary Weirich
5508 NE l Oth St.
Renton, WA 98059
(425) 255-4725
This email request originated from the following link: http://rentonwa.�ov/council/
i
. ''� `�"'' 3/11/2013
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Cardiac Arrest Survival in Seattle&
__ ^`King County,2002-2011 `__________,
eo%
so%
ao%
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Grdix Arrest SurvivN Rate Comparison
5076 20%
d5%
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35%
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2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
2�% Year
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"These coordinated care systems should be in
every single EMS System in the Country"
RAND Study 2012 AHA Circulation June
• STEMI
• Traumatic Injury
• Allergic Reaction
• Safety Net of Clinical Services/Care
• Research:AHA, NHTSA,LSDF
"The most important care decisions for
heart attack patients are made
long before they get to the hospital"
Dr.James Jollis Duke University 2012
2
. � `� 3/11/2013
� � � � . ' • � . i � • �
• Began October 2011
• EMS Levy Advisory Task Force
— Representatives of 19 stakeholder agencies
— Mayor Denis Law represented Renton
• City of Renton represented on
Subcommittees by Mayor Denis Law (BLS
Subcommittee Chair), Chief Mark Peterson,
Doug McDonald, Chuck DeSmith, Iwen
Wang and Jamie Thomas
� � ' • ' • . •
Poa�rr�a�a.u,s c.n w�.a.
• Maintain existing ALS services :„ i �
• 26 medic units +x , �
• Fully funded "' �
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`GytlkAtM�.�tkre >V�MY i.u:pzu r�uMy� E
ra��,a�r�+:.a�r:�k urus a,e�as ao�.�e � • Continue reserves(indudes place
�
�«��+<� ���:� I �a�.s io�a,,, i holder for new 12-hour unit)
• Implement cost efficiencies
2014-2019 Strategic Plan,pages 23-31
3
"�r►' `�+' 3/11/2013
; � - • ' � . •
• Maintain partial funding for BLS Services(23%of LEVY)
• Support programs that reduce impact on BLS agencies
Seattle-King County EMS Service Trends 1998-2011
�.� —
174,754 178.327
1��� 162.839
152�6_23 157.325 _._' _ _'_
160,000 -14fi,i90'-�4•��-'����- � �
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2014-2019 Strategic Plan,pages 32-35
• � � � • • � � �
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• Regional Services � �y
• Maintain programs that support critical "� `$'
functions&direct services of the entire . �
Medic One/EMS system �
• Re-scope programs to meet emerging � ,-
� �.�
needs
�,:;
�s:
• Strategic Initiatives
• Encourage efficiencies,innovation and
leadership
• Provide for the future needs of regional
EMS system
_ :....A
2014-2019 Strategic Plan,pages 36-41
4
- � `""¢ 3/11/2013
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• •
• The Medic One/EMS 2014-2019 Strategic Plan is the result of
a transparent and open process spanning nearly one year.
• The Plan adheres to the principles put before the EMS
Advisory Task Force in every aspect.
Next Steps
• Cities over 50K in population (9 of them) and the King County
Council must endorse placing a levy rate on 2013 ballot.
• Emergency Medical Services Advisory Council (referred to as
EMSAC) endorsed at 12/19/12 meeting.
• King County Board of Health passed resolution supporting
regional system at 2/21 meeting.
5
� • King Ca��nty Medic One/EMS 2014-2019 lev�� �ackage
� �
SUBJECT
A briefing on the King County Medic One/Emergency Medical Services (EMS) 2014-2019 levy
package (Strategic Plan and county-wide ballot proposition)
POLICY ISSUE
The current six-year 30-cent Medic One/EMS lew will expire December 31, 2013. To ensure
continued emergency medical services in 2014 and beyond, a new levy must be approved by voters.
RCW 84.52.069:
• Allows for a property tax levy of up to $.50/$1,000 assessed valuation (AV) for the purpose of
funding emergency medical services;
• May be a six year, 10 year or permanent levy; and
� Requires that any county-wide proposal secure the approval of those cities with 50,000+ in
population prior to it being placed on the ballot. In King County, there are nine such cities:
Renton, Auburn, Bellevue, Federal Way, Kent, Kirkland, Redmond, Shoreline and Seattle.
BACKGROUND
The King County Medic One/EMS system provides essential life-saving services to the residents of
King County, regardless of location, incident circumstance, day of the week, or time of day. It is a
tiered system that relies upon coordinated partnerships with fire departments, paramedic agencies,
dispatch centers and hospitals to ensure patients receive the most appropriate level of care.
Founded on medicine, its services are derived from the highest standards of inedical training,
practices and care, scientific evidence, and close supervision by EMS physicians. Programmatic
leadership, state of the art science-based strategies, continuous improvements and its focus on
efficiencies have allowed the system to obtain superior medical outcomes, and manage the growth
and costs of the system.
� ° Universal Access: Any person regardless of location or circumstances
�'������� can access the Medic One/EMS system by calling 9-1-1 for medical
- ��'�����''�,�- assistance. This immediate and continuous access provides all areas of
King County equitable access to this lifesaving service.
Disqatcher Triage: Calls to 9-1-1 are received and triaged by
� ����"���� ; professional dispatchers who determine the most appropriate level of
� ����������!��� ���� care needed. Dispatchers are trained to provide pre-arrival instructions
������������ for most medical emergencies and guide the caller through life-saving
`�' � steps, CPR and AED instructions.
' Basic Life Support BLS): BLS personnel are the"first responders"to an
��'�`��r�fil� incident, providing immediate basic life support medical care that
� ���;��������,�} includes advanced first aid and CPRlAED to stabilize the patient. BLS
` �'������►",�'��� ��3t�j units arrive at the scene in under 5 minutes{on average) and contribute
._ .� significantly to the success of the Medic One/EMS system.
� � Advanced Life Suqport(ALS): Paramedics provide out-of-hospital
�������- ��� �� emergency medical care for critical or life-threatening injuries and
'������`���;��� .� illnesses. As the second on scene and used only for the most serious
������������ injuries and illnesses, they provide airway control, heart pacing, the
A��°�� -w dispensing of inedicine and other life-saving procedures.
' ' � ` Once a patient is stabilized, it is determined whether transport to a
��������.���"•` hospital or clinic for further medical attention is needed. Transport is
- ������`��� most often provided by an ALS agency, BLS agency or private
ambulance.
Page 1
. �
`� � ,
In addition to these components of the system, King County EMS also oversees Strateqic Initiatives
and Reqional Services. These core programs and services further provide for regional coordination
and consistent quality across all jurisdictions in King County. These services include program
supervision, BLS EMT staff training, 9-1-1 dispatch training, medical data collection and analysis,
financial oversight, contract administration, and division management. EMS regularly integrates
initiatives that are aimed at preventing/reducing emergency calls and improving the quality of the
services.
2014-2019 MEDIC ONE/ EMS LEVY PLANNING PROCESS
The EMS Advisory Task Force was established by King County Ordinance 15862 to develop inter-
jurisdictional agreement on an updated EMS strategic plan and financing package for the 2014-2019
levy funding period. Comprised of leaders and decision makers from throughout the region, the 19-
member Task Force worked collectively with EMS Stakeholders for over nine months to assess the
needs of the system and develop recommendations to direct the system into the future. Mayor Denis
Law served as Renton's representative on the Task Force.
The Task Force used a subcommittee format to concentrate efforts in four areas: ALS, BLS, Strategic
Initiatives and Regional Services, and Financial model. Mayor Law chaired the BLS Subcommittee.
The four subcommittees developed recommendations that were then brought to the full Task Force
for consideration.
The Task Force adopted its recommendations on July 26, 2012. The King Caunty Executive
transmitted these recommendations to the King County Council in December 2012, as the Medic
One/EMS 2014-2019 Strategic Plan.
TASK FORCE RECOMMENDATION/2014-2019 STRATEGIC PLAN
■ Reauthorize a six-year EMS levy to fund the system, per RCW 84.52.069;
■ Enact a levy rate of 33.5-cents/$1,000 AV to fund projected expenditures of $695 millian for
the 2014-2019 span;
■ Renew the EMS levy in 2013;
■ Continue funding ALS (paramedic) services, and a portion of first responder (BLS) services for
local fire and emergency response departments;
■ Maintain a responsible level of reserves;
■ Continue programs and initiatives that provide essential support for the system and encourage
efficiencies, innovation and leadership;
■ Use conservative financial policies and procedures; and
■ Meet future demands with services that include collaborating on programs that reduce impacts
on BLS agencies, and "rescoping" programs to meet emerging community needs.
The proposed levy rate does not raise funding levels to add services, but provides resources to
maintain existing services, incorporate efficiencies and offer improvements where appropriate. The
proposal costs less than if 2008-2013 operations were continued into the 2014-2019 levy period.
Impact on the Renton Rate Paver
2008 2014*
Average Renton residence value $335,500 $232,467
EMS levy rate $0.300 $0.335
Levy amount for average Renton residence $100.65 $77•88
'2014 value based on overal!King County increase of 3.78%projected by the King County economist
Page 2
� �� �
The 2014-2019 Medic One/EMS Strategic Plan financials differ from previous levies by:
1. Limited new programs and expenditures: With previous levies, substantial increases were
implemented during the first year of each new levy. In contrast, there is reduced planned
spending in the first year of the 2014-2019 levy, when adjusted for inflation. Proposed new
services and programs are minimal and are offset by reduced expenditures. Overall proposed
increases across the levy span are less than projected CPI plus increased population.
2. Reduced proposed revenues: The 2014-2019 levy proposes using funds from the 2008-2013 levy
to reduce, or"buy down", the amount needed to be raised over planned expenditures. Estimated
savings are $21 million, or a reduction of 1.6 cents, and result in the proposed levy rate of 33.5
cents per$1,000 AV. The savings are due to changes in reserve levels, aggressive management
to control expenditures, and conservative revenue forecasts.
The "buy down" of the rate reflects various management strategies that include millage reduction
reserves that were mandated in the current levy, and using fund balance. The savings are also
realized through not adding two anticipated 12-hour ALS units during the 2008-2013 levy period,
reducing previous contingency assumptions (such as the ALS Disaster Relief Contingency), and
reducing 2008-2013 strategic initiatives and regional services expenditures below planned levels.
These forecast savings from 2012 and 2013 are assumed toward a"buy down" for the rate.
The average annual amount of $111 million is estimated, with total revenues of $668.1 million
forecasted over the six year period, as shown below:
Forecasted Property Tax Revenue for 2014-2019 (in mrllions)
2014 2015 2016 2017 2018 20y 9 TOTAL
City of Seattle $39.2 $39.8 $40.3 $40.8 $41.3 $41.9 $243.2
KC EMS Funds $67.0 $68.6 $70.1 $71.5 $73.1 $74.6 $424.8
Total $106.2 $108.4 $110.3 $112.3 $114.4 $116.5 $668.1
Growth in Total Levy 2.07% 1.75% 1.81% 1.87% 1.84%
Expenditures
The proposed financial plan anticipates $694.4 million to support programs and services. The table
below denotes the costs by program area:
EMS Expenditures by Program Area
Program Area Seattle King County Total
Advanced Life Su ort -ALS $121,390,108 270,338,534 391,728,642
Basic Life Support— BLS 121,833.460 103,210,353 225,043,813
Re ional Su ort Services/Audit 55,178,130 55,178,130
Strate ic Initiatives/CMT Pro ram 10,017,546 10,017,546
Subtotal 243,223,568 438,744,563 681,968,131
Use of Reserves 12,398,310 12,398,310
TOTAL EXPENDITURES 243,223,568 451,'142,874 694,366,441
The Task Force Finance Subcommittee endorsed these expenditure and revenue assumptions.
These assumptions include policies for the "buy down" use of reserves, inflator policies, and the use
of a 65% confidence level financial plan.
Page 3
,
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� � � � � � � � � � �
. e :F : �.- �' -�
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rt�;� , �,�.�; `�� �73�� ����
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CoMinue with EMS levy: • Six-year EMS levy, per RCW 84.52.069
■ Forecasted budget of$695 million over six-year span, including reserves
■ Levy rate of 33.5 cents/$1,000 Assessed Valuation
■ Would be run at either the 2013 Primary or General election,with the King
CountyCouncil determiningwhich election
� � - � � � � � � . � _ � . _
Contlnue services from 2008- ■ Continue operations with the 26 units currently in service
2013 levy: • Fully fund eligible costs of existing paramedic services to prevent cost shifting
to agencies
■ Project annual increases using a compound inflator
Provlde to meet expected ■ No new medic units over the span of a six-year levy
demands: • Reservesto cover unanticipated and one-time expenses
• Efficiencies to refine ALS costs and increase effectiveness
• Fundingfor a possible 12-hour medic unit in the later years of the levy in case
demand for services increases
Contlnue services from 2008- • Partial funding for BLS services(firefighters/EMTs)
2013 levy: • Maintain King County portion of BLS funding at same percentage of overall
expenses of previous levy period
• Maintain currentfundingformulaforallocation(based 50/50 on
Assessed Values and Call Volumes)
Provlde to meei expected • Programs and Initiatives that help manage growth,reduce impacts and
demands: increase the role of BLS agencies in regional decision-making
, � � � - ' -
Contlnue services from 2008- • Essential Regional Services programs that support the Medic One/EMS
2013 levy: system
Provlde to meet expected • Re-scoped and enhanced Regional Services programs to meet emergent
demands: needs
�
a � : + —
Contlnue services from 2008- ■ Conversion of 2008-2013 Strategic Initiatives that have improved the quality
2013 levy: of service and managed growth and costs into Regional Services programs to
become ongoing programs
Provlde to meet expected ■ Revamped and new Strategic Initiatives
demands:
Pane 4
. �
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NEXT STEPS
1. Adopt a resolution approving placing on the ballot a county-wide proposition funding EMS pursuant
to RCW 84.52.069; OR
2. Do not adopt a resolution authorizing placing the EMS levy on the ballot. Without participation by
all the jurisdictions with populations over 50,000, no levy would be on the ballot in 2013, and funding
for the EMS system would expire in 2013. At that point, each jurisdiction would have to determine
how best to provide these services within its boundaries.
Page 5
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CITY OF RENTON
CITY COUNCIL
NOTICE OF PUBLIC MEETING
NOTICE IS HEREBY GIVEN that a special public meeting will be held at the regular Renton
City Council meeting on the 11th day of March, 2013, at 7:00 p.m. in the seventh floor
Council Chambers of Renton City Hall, 1055 S, Grady Way, to consider:
Approving the placement of a 2014-2019 countywide Medic One/Emergency
Medical Services (EMS) Levy on the ballot in 2013; and
Taking a position in support of or opposing the 2014-2019 countywide Medic
One/EMS Levy rate of 33.5 cents per$1,000 of assessed property value, as
proposed by the EMS Advisory Task Force.
Pro and con speakers are invited to the public meeting to state their positions.
City Hall is fully accessible, and interpretive services for the hearing impaired will be
provided upon prior notice. Call 425-430-6510 for additional information.
���cgN�Yt.�-C-�1• !�t/G�—�
Bonnie I. Walton
City Clerk �
Published: Renton Reporter
March 1, 2013
Account No. 50640
February 25, 2013 �r+ Renton City Council Minutes � Page 52
Community Service: Fee Community Services Department requested approvat to waive picnic shelter
Waiver Request, CROPWALK fees in the amount of$280 for the annual CROPWALK event. Refer to Finance
Event Committee.
CAG: 11-031, Extend Public Executive Department recommended approval of Addendum No. 1 to CAG-11-
Defender Services, Cayce& 031,with Cayce&Grove, LLC, in the amount of$450,000 to extend public
Grove LLC defender services until 12/31/2013,with the option to extend for an additional
year. Refer to Finance Committee.
Executive: Municipal Arts Executive Department recommended amending City Code by changing the
Commission Appointments, number of inembers appointed to the Municipal Arts Commission from 12 to
Code Amendment 13,and updating related code language. Refer to Communitv Services
Committee.
Fire:Accept Passenger Van Fire and Emergency Services Department recommended approval of an
Donation, King County interlocal agreement with King County to accept the donation of a passenger
van for use by the Zone 3 Explorers' program. Council concur. (See page 54 for
resolution.)
Fire: Firefighter Medical Fire and Emergency Services Department recommended approval of an
Services,Valley Medical interlocal agreement with Valley Medical Center Occupational Health Services
Center Occupational Health in the amount of$63,150(for 2013)for firefighter medical services and
Services laboratory testing from 2013 through 2015. Council concur. (See page 54 for
resolution.)
Fire: 2014—2019 County- . Fire and Emergency Services Department recommended approving placement
Wide EMS Levy „ , ` � of the county-wide EMS levy on the 2013 ballot, and setting a public meeting
����, �r'��j�`'�� on 3/11/2013 to consider pro and con testimony for taking a position
supporting or opposing the proposed 2014-2019 EMS Levy rate ballot measure.
Council concur.
Transportation: ORCA Transportation Systems Division recommended approval of the 2013-2014 One
Business Passport, King Card for All (ORCA) Business Passport interlocal agreement in the amount of
County $79,886 with King County METRO,to continue the Commute Trip Reduction
program for City employees with potential budget adjustments to be
determined. Council concur.
MOVED BY PERSSON, SECONDED BY CORMAN, COUNCIL APPROVE THE
CONSENT AGENDA AS PRESENTED. CARRIED.
UNFINISHED BUSINESS Finance Committee Chair Briere presented a report recommending approval of
Finance Committee Claim Vouchers 318698-319046,three wire transfers and one payroll run with
Finance:Vouchers benefit withholding payments totaling$4,144,091.50,and payroll vouchers
including 723 direct deposits and 55 payroll checks totaling$1,531,774.17.
MOVED BY BRIERE, SECONDED BY PERSSON, COUNCIL CONCUR IN THE
COMMITTEE REPORT. CARRIED.
Police: Increase Patrol Finance Committee Chair Briere presented a report recommending approval of
Vehicles&Assignments the staff recommendation to approve increasing the number of vehicles
assigned to the Patrol Operations Division of the Police Department by one,to
allow assigning two officers per car,and to provide for a spare patrol vehicle
pool with five retired vehicles. The combined total impact to the budget will be
$45,000 one-time funded by carry forward budget adjustment and$33,000
annual on-going cost($11,000 for Replacement Reserve,$12,000 for
� �
� I .
CITY OF RENTON COUNCIL AGENDA BILL , �
Subject/Title: Meeting:
Resolution Supporting the Medic One/EMS Levy Regular Council - 25 Feb 2013
Exhibits: Submitting Data: Dept/Div/Board:
Resolution Drafts (3 options) Fire & Emergency Services
Staff Contact:
Mark Peterson, Fire Chief(7083)
Recommended Action:
Council Concur to set a Public Meeting on March
11, 2013
Fiscal Impact:
Expenditure Required: $ N/A Transfer Amendment: $ N/A
Amount Budgeted: $ N/A Revenue Generated: $ 916,361 (2013)
Total Project Budget: $ N/A City Share Total Project: $ N/A
SUMMARY OF ACTION:
The Medic One/EMS system in King County, known worldwide for its service excellence, leadership and
medical results, is built on partnerships that are rooted in regional, collaborative and cross-
juriscfictional coordination. While each agency operates individually, the care provided to the patient
operates within a "seamless"
system. It is this consistent standardized medical care and collaboration between 30 fire departments,
six paramedic agencies, five EMS dispatch centers, 20 hospitals, the University of Washington, and the
residents throughout King County that allows the system to excel in pre-hospital emergency care. It has
the highest reported survival rates in the treatment of out-of-hospital cardiac arrest patients across the
nation; 52%in 2011.
The Medic One/EMS system is currently funded with a 6-year EMS levy which expires December 31,
2013. An EMS Advisory Task Force was created to develop an interjurisdictional agreement on an
updated EMS strategic plan and financing package for the next levy funding period of 2014-2019. The
Advisory Task Force proposes a six-year$.335 per$1,000 of assessed value countywide levy for the
years 2014-2019.
The City of Renton received $885,781 in budget revenue from Basic Life Support (BLS) allocations in
2012. It is anticipated that revenue will increase to $916,361 in 2013.
Our citizens benefit from this stratetic regional partnership daily and Renton Fire & Emergency Services
recommends moving forward with adoption of the resolution.
STAFF RECOMMENDATION:
1) Approve the placement of the 2014-2019 countywide Medic One/EMS Levy on the ballot in 2013, and
2) Hold a Public Meeting on March 11, 2013 to consider pro and con testimony for supporting the 2014-
2019 countywide Medic One/EMS Levy and urging voters to vote in favor of the Levy, and3)Adopt the
Resolution.
� �
' Option 1
C[TY OF RENTON,WASHINGTON
I
RESOLUTION NO. �
i:
A RESOLUTION OF 7HE CITY OF RENTON, WASNINGTON, APPROVING i
PLACEMEN7 OF THE COUNTYWIDE 2014-2019 MEDIC ONElEMERGENCY
MEDICAL SERVICES (EMS) LEVY OR[ THE 2043 BALLOT, AND SUPPORTII�EG TFtE
PR�POSED BALLOT MEASURE.
WHEREAS, the defivery of emergency meciical services is an essential function of the fire
and life safety responsibility of local and regionai govemment;and
wHEREAs, the internationally recognized counfywide tiered Medic OnelEMS system in �
;
King County provides county residents and visitors essential life-saving services throughout the i
regian regardless of lacation, incident circumstances, day of the week, or time of day;and
WHEREAS, it has been to the benefit of the citizens of the Cify of Renton to support and
participate in the countywide cooperative ef�ort of deli�ering advanced life support and basic
life support services;and
WFEEREAS, King County should continue to exercise {eadership and assume ;
responsibility for assuring the consistent, standardized, effective and cost efficient
development and provision of emergency services throughout the county; and
WHEREAS, RCW 84.52.069 provides for emergency medical care and service levies;and
WHEREAS, the highly praised patient and program services of the King County Medic
One/EMS sysfem are funded by a Medic One/EMS levy that expires December 31,2013;and
WHEREAS, the EMS Advisory Task Force, created via King County Ordinance 15862,
worked collaboratively wifh EMS Stakeholders to develop the Medic One/EMS 2014-2019
Strategic Plan ta continue providing this service and has recommended a countywide levy rate
of$.335 per $1,OOQ of assessed value to fund EMS service throughouf King Counfy; a�d
1
`'�"'' �.,,✓` -----... . .
i
RESOLUTION NO.
WNEREAS, the City of Renton significantiy participated in these discussions fhroughout
the process and was represented on the Task Force;
�
WHEREAS, RCW 84.52.069 requires that cities with a popuEation greater than fifty '
i
thousand approve a counfywide levy prior to placementon a baClot,and �
WHEREAS, the City af Renton i�as a population of 93,910 thousand people;
NOW, THEREFC3RE,THE CfTY COUNCfL OF THE ClTY OF REN70N,WASHlNGT�N, DOES
RESOLVE AS FOLLOWS: '
SECTION I. The above recitals are found to be true and correct in all respects.
SECTlON fl. The City Council of the City of Renfon approves placing the 2014-2019
countywide Medic One/EMS Levy on the balfaf in 2Q13. '
�ECTION IIL The City of Renfon supports the proposed six-year $.335 per $1,000 of
assessed value countywide Medic One/EMS Levy for the years 2014-2019 and urges tf�e voters
to vote in favor of the Levy.
PASSED BY THE CITY COUNCIL this day of , 2013.
Bonnie I. Walton,City Clerk
APPROVER BY TNE MAYOR this day of � 2013.
� Denis Law, Mayor
2 '
� �
RESOLUTION NO.
i
Approved as to #orm:
�
Lawrence J.Warren,City A�torney
RES.1583:2/4/13:scr �
�
�
�
'
3
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i
�ption 2
CITY�F RENTON,WASHINGT�N
RESOLUTiON NO.
A RESQLUTION OF THE CtTY OF REIYTON, WASHINGTON, APPROViNG
PLACEMENT O� TFIE COUNTYWIDE 2014-2019 M E D t C O N E/EMERGENCY
MEDICAL 5 E R V I C E S {EMS)LEVY ON THE 2413 BALLOT.
i
j
wHEREAS, the defivery of emergency medica! senrices is an essential function af the fire
and life safety responsibility of locai and regional government;and
WHEREAS, the internationally rec�gnized countywicle tiered Medic One/EMS system in
Kng Gounty pravides counfy residents and visitors essential life-saving services throughout the
region regardless of location, incidenf circumstances, day of the week, or time of day;and
WHEREAS, it has been to the benefit of the citizens �f the City of Renton to support and
participate in the countywide cooperative effort of delivering advanced life support and basic
life support services;and
WHEREAS, King County should continue to exercise leadership and assume
responsibifify for assuring fihe consisfent, standardized, effective and cost efficient
development and provision of emergertcy services throughout the county; and
WHEREAS, RCW 84.52.Q69 pro�ides for emergency.medical care and service levies;and
WHEREAS, the highly praised patienf and program services of the King County Medic
One/EMS system are funded by a Medic One/EMS levy that expires December 31,2093;and
wNEREAS, the EMS Advisory Task Farce, created via King County Ordinance 15862,
worked collaborafively with EMS Stakehalders to develop the Medic OnetEMS 2014-2019
Strategic Plan io continue providing fhis senrice and has recommended a countywide levy rate
of$.335 per$1,000 of assessed value to fund EMS service throughout King Counfy; and
1
_ -------..........
.......---------- --.._........
..._._.
_... . . . ---_-......... . ...._..
_- .:..:
� - "'�` �
RESOLU710N NO.
WHEREAS, the City of Renton significantly par�icipated in these discussions
f h ro u g h o u t the process and was represented on the Task Force;
WHEREAS, RCW 84.52.069 requires that cities with a population greater than fifty
thousand approve a countywide levy prior to placementon a ballot,and
YVHEREAS, the City of Renton has a population of 93,910 thousand people;
NOW,THEREFORE,THE CITY COUNCIL OF THE CITY OF RENTON,WASHINGTON, DOES
RESOLVE AS FOLLOWS:
SECTEON I. The above recitals are found to be true and correct in alE respects.
�ECTION II. 7he Ci#y Council of the City of Renfon approves placirrg fhe 2014-2019
countywide Medic One/EMS Levy on the ballot in 2013.
PASSED BY THE C1TY COUNCIL this day of , 2013.
Bonnie I. Walton,City Clerk '
APPROVED BY 7HE MAYOR this day of � 2013.
Denis Law, Mayor
Approved as to form:
Lawrence J.Warren,City Attorney
RES.1583:2/13113:scr
2
......,.:-:.:.:.-.: ..
� � j
Option 3
CITY OF RENTON,WASHINGTON
RESOLUTfON NO.
A RESOI.UT101V OF TNE CITY OF RENTON, WASHI(VGTON, APPROVING
PLAGEMENT Ol= THE COUNTYWIDE 2014-2U19 MEDlC ONEIEMERGEIVCY
M E D I C A L SERVICES (EMS} LEVY ON THE 2013 BALLOT, BUT OPPOSING THE
PROPOSED BALLOTNEASURE
WtiEREAS, the delivery of emergency medical services is an essentia{ function of tf�e fire
and life safety responsibility of local and regional govemment;and
WHEREAS, King County should continue to exercise leadership and assume
� responsibility for assuring tf�e consistent, standardized, effective and cost efficient
development and provision of emergency services throughout the county; and
WHEREAS, ROW 84.52.069 provides for emergency medica! care and service ievies;and
wHEREAS, the pafient and program services of the King County Medic One/EMS system
are funded by a Medic One/EMS levy that expires December 31,2013;and
WHEREAS, #he EMS Advisory Task Force, created via King County Ordinance 15862,
worked collaboratively with EMS Stakehoiders to develop the Medic One/EMS 2094-2019
Strafegic Plan to continue praviding this setvice and has recammended a countywide levy rate
of$.335 per $1,000 of assessed value to fiunci EMS service throughout King County;and
wHEREAS, the Cify of Renton participated in these discussions throughout the process
and was reRresented on ttte Task Force;
WHEREAS, ROW 84.52.069. requires that cities with a populatian greater than fifty
thousand approve a counfywide fevy prior to placement on a ballot, and
WHEREAS,the City of Renton has a population af 93,910 thousand people; and
1
. ;
� � ;
RESOLl1TION NO_
WHEREAS, the citizens af the City of Renton are burdened by a lack(uster economy and
�
fhe timing of the Levy is unfiortunate; �
NOW, 7HEREFORE,THE CITYCOUNCIL OF THE CITYOF REN7�N,WASHINGTON, DOES
RESOLVE AS FOLLOWS:
SEGTtON I. The above recitals are found to be true and correct in ali respects.
SECTiQN N_ The City Council of the City of Renton approves piacing the 2014-2019
countywide Medic One/EMS Levy on the balfot in 2013.
SECTIl,�N 111 The City of Rentan Council opposes the proposed six-year $.335 per
$1,OOQ of assessed value countywide Medic One/EMS Levy for the years 20'14-2019 and urges
the voters to vote against the Levy.
PASSED BY THE CITY COUNCIL this day of , 2013_
Bonnie I, Walton,City Clerk f
APPROVED BY THE MAYOR this day of � 2013.
Denis Law, Mayor
Approved as to form:
Lawrence J.Warren,City Attomey
RES.1 587 2/1 4/1 3:scr
2
. �- c��� �p
r
.
CITY OF RENTON COUNCIL AGENDA BILL , r ,
J
Subject/Title: Meeting:
Resolution Supporting the Medic One/EMS Levy Regular Council - 25 Feb 2013
Exhibits: Submitting Data: Dept/Div/Board:
Resolution Drafts (3 options) Fire & Emergency Services
Staff Contact:
Mark Peterson, Fire Chief(7083)
Recommended Action:
Council Concur to set a Public Meeting on March
11, 2013
Fiscal Impact:
Expenditure Required: $ N/A Transfer Amendment: $ N/A
Amount Budgeted: $ N/A Revenue Generated: $ 916,361 (2013)
Total Project Budget: $ N/A City Share Total Project: $ N/A
SUMMARY OF ACTION:
The Medic One/EMS system in King County, known worldwide for its service excellence, leadership and
medical results, is built on partnerships that are rooted in regional, collaborative and eross-
jurisdictional coordination. While each agency operates individUally, the care provided to the patient
operates within a "seamless"
system. It is this consistent standardized medical care and collaboration between 30 fire departments,
six paramedic agencies, five EMS dispatch centers, 20 hospitals, the University of Washington, and the
residents throughout King County that allows the system to excel in pre-hospital emergency care. It has
the highest reported survival rates in the treatment of out-of-hospital cardiac arrest patients across the
nation; 52% in 2011.
The Medic One/EMS system is currently funded with a 6-year EMS levy which expires December 31,
2013. An EMS Advisory Task Force was created to develop an interjurisdictional agreement on an
updated EMS strategic plan and financing package for the next levy funding period of 2014-2019. The
Advisory Task Force proposes a six-year$.335 per$1,000 of assessed value countywide levy for the
years 2014-2019.
The City of Renton received $885,781 in budget revenue from Basic Life Support (BLS) allocations in
2012. It is anticipated that revenue will increase to $916,361 in 2013.
Our citizens benefit from this stratetic regional partnership daily and Renton Fire & Emergency Services
recommends moving forward with adoption of the resolution.
STAFF RECOMMENDATION:
1) Approve the placement of the 2014-2019 countywide Medic One/EMS Levy on the ballot in 2013, and
2) Hold a Public Meeting on March 11, 2013 to consider pro and con testimony for supporting the 2014-
2019 countywide Medic One/EMS Levy and urging voters to vote in favor of the Levy, and3) Adopt the
Resolution.
� �
Option 1
CfTY OF RENTON,WASHINGTON
j
RESOLUTION NO. �
;
i'
A RESOLEITION OF 7HE CITY OF RENTON, WASHINGTOI�[, APPROVING i
PLAGEMENT OF THE COUNTYW[DE 2014-2019 MEDtC Of�tElEMERGENCY
MEDICAL SERVICES (EMS) LEVY Ot�f THE 2013 BALLOT, AND SUPPORTII�lG THE
PROPOSED BALLOT MEASURE_
WHEREAS, the defivery of emergency medicaE setvices is an essential function of the fire
and life safety responsibilify of locai and regionai government;and
WHEREAS, the internationally recognized countywide tiered Medic OnelEMS system in
King County provides county residents and visitors essential life-saving services throughout the
regian regardless of location, incident circumstances, day af the week, or time of day;and
WHEREAS, if has been #o the benefit of the citizens of the Cify of Renton to support and
parficipate in the countywide cooperative efFort of delivering advanced life support and basic
fife support services;and
WHEREAS, King County shauld continue to exercise leadership and assume
responsibility for assuring the consistent, standardized, ef�ective and cosf efficient
development and provision of emergency services throughout the county; and
WHEREAS, RCW 84.52.Q69 provides for emergency medical care and service levies;and
WHEREAS, the highly praised patieni and program services of the King County Medic
�ne/EMS system are funded by a Medic One/EMS fevy that expires December 31,2013;and
WHEREAS, the EMS Advisory Task Force, created via King County Ordinance 15862,
worked collabaratively wifh EMS Stakeholders to develop the Medic One/EMS 2014-2Q19
Strategic Plan ta continue providing this service and has recommended a countywide levy rate
of$,335 per $1,000 of assessed value to fund EMS service throughout King Caunty; and
1
. � �
�
RESOLUTION N0.
WHEREAS, the City of Renton significan�y participated in these discussions fhroughout
the process and was represented on the 1"ask Force;
�
WHEREAS, RCW 84.52_069 requires that cities with a popuiation greater than fifty . �
thousand approve a countywide levy prior to placementon a ballot,and �
WHEREAS, #he City of Renton has a population of 93,910 thousand people;
NOW, THEREFORE, THE CI7Y COUNCIL OF THE CfTYOF RENTO�I,WASHfNGTON, DOES
RESOLVE AS FOLLOWS:
SECTION I. The above recitals are found to be true and correct in al! respects.
SECTlON If. The Gity Council of the Ci#y of Renfon approves placing the 2014-2019
countywide Medic OnelEMS Levy on the ballof in 2013.
SECTION IIl. The Cify of Renfon supports the proposed six-year $.335 per $1,000 of
assessed value cauntywide Medic One/EMS Levy for fhe years 2014-2019 and urges the voters
to vate in favor of the Levy.
PASSED BY THE C[TY COIJNCIL this day of , 20�3.
Bonnie I. Walton,Giiy Clerk
APPROVEp BY TNE MAYOR this day of � 2013.
� Denis Law, Mayor
2
. � �r `�.rrr+`
RESULUTI�N NO.
Approved as to #orm:
Lawrence J.Warren,City Attorney ;
RES.1583:2/4/13:scr
�
i
3
• � � i
i
Option 2
CITY OF RENTON,WASHINGTON
RESOLUTiON NO.
A RES�LUTIUN OF THE CtTY OF RENTON, WASHlNGT�N, APPROV[NG
PLACEMENT OF THE COUI�tTYWiDE 2014-2019 M E D 1 C O H ElEMERGENCY
MEDICAL 5 E R V I C E S (EMS) LEVY QN THE 2013 BALLOT.
WHEREAS, the delivery of erriergency medica! services is an essential function af the fire �
and life safety responsibility of focai and regional government;and
WHEREAS, the internationally recognized countywide tiered Medic One/EMS system in
Kng County pravides county residents and visitors essential life-saving serviees throughout the
region regardless of location, incident circumstences, day of the week, or time of day;and
WHEREAS, it has been to the benefit of the citizens of the City of Renton to support and
participafe in ti�e countywide cooperative effort of delivering advanced life support and basic
life support services;and
WHEREAS, King Caunty should continue fo exercise leadership and assume
responsibifity for assuring the consisfer�t, standardized, efifective and cost efficient
development and provision of emergency services throughout the county; and
WHEREAS, RCW 84.52.069 provides for emergency.medical care and service levies;and
WHEREAS, the highly praised patienf and program services of the King County Medic
One/EMS system are funded by a Medic One/EMS levy that expires December 31,2013;and
WHEREAS, the EMS Advisory Task Force, created via King County Ordinance 15862,
worked collaboratively with EMS Stakeholders to develop the Medic One/EMS 2014-2019
Strategic Plan to continue providing this senrice and has recommended a cauntywide levy rate
of$.335 per $1,000 of assessed value to fund EMS service throughout King Counfy; and
1
. _.---._. _ . i
, � � � �
RESOLUTiON NO.
WHEREAS, the City of Renton significantly participated in these discussions
t h ro u g h o ut the process and was represented on the Task Force;
WNEREAS,RCW 84.52.069 requires fhaf cities with a population greater than fifty
thousand approve a countywide levy prior fo placementon a ballot,and
Wi�iEREAS, the City af Renton has a population of 93,910 thousand peopie;
NOW, THEREFORE,THE CITY COUNCIL OF THE CITY OF RENTON,WASHINGTON, DOES
RESQLVE AS FOLLOWS:
SECT(ON L The above recitals are found to be true and correct in all respects.
SECTtON II. The City Council of the City of Renfon approves placing fhe 2014-2019
countywide Medic One/EMS Levy on the balfot in 2013.
PASSED BY THE C1TY COUNCIL this day of , 2013.
Bonnie I. Walton,City Clerk
APPROVED BY THE MAYOR this day of �2013.
Qenis Law, Mayor
Approved as to form:
Lawrence J.Warren,Cify Attorney
RES.1583:2/13/13:scr
2
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oat�on 3
CIIY OF RENTON,WASHIhlGTON
RESOLUTlON NO.
A RESOLUTIOlV OF THE CITY OF RENTON, WASHENGTON, APPROVING
PLACEMENT OF THE COUNTYWlDE 2014-2013 MEDIC ONE/EMERGENCY
M E D I C A L SERVICES (EMS} LEVY OM1F THE 2013 BALLOT, BUT OPPOSING THE
PROPOSED BALLOT[VEASURE ;
WHEREAS, the delivery of emergency medical services is an essentiaE function of ti�e fire
and life safety responsibiliiy af local and regional govemment;and
WHEREAS, King County should continue to exercise leadership and assume
� responsibifity for assuring the consistent, standardized, effecfive snd cost efficient
devefopment and provision of emergency services throughout the county; and
WHEREAS, ROW 84.52.D69 provides for emergency medical care and service levies;and
WHEREAS, the patient and program services of the King Caunty Medic One/EMS system
are funded by a Medic One/EMS levy that expires December 31,2013;and
WHEREAS, the EMS Advisory Task Force, created via King County Ordinance 15862,
workecf collaboratively with EMS Stakeholders fo develop the Medic One/EMS 2014-2019
Strafegic Plan to continue providing tt►is service and has recommended a c�unfywide levy rate
of$.335 per $1,000 of assessed value to fund EMS service throughout King County; and
WHEREAS, the City of Renton participated in these discussions throughout the process
and was represented on the Task Force;
WHEREAS, ROW 84.52.069 requires that cities with a population greater than fifty
thousand approve a countywide levy prior to placement on a ballot, and
WHEREAS, the City of Renton has a population of 93,910 thousand people; and
1
. � tirr� .
RESOLUTEON NO_
WHEREAS, �he citizens of #he Cify of Renton are burdened by a lackfuster economy and
the timing of the Levy is unfar�unate; �
NOW, THERE�ORE,THE CITY COUtJCIL OF THE CITY OF RENTON,WASNiNGTON, QOES
RESOLVE AS FOLLOWS:
SECTION I. The above recitals are found to be true and correct in a!1 respects.
SECTIQN N. The City Cauncil of the City of Rentan approves placing the 2014-2019
countywide Medic One/EMS Levy on the bal(ot in 2013.
SECT'IQN Ifl The City of Renton Council opposes the proposed six-year $.335 per
$1,000 of assessed value counfywide Medic One/EMS Levy for the years 2094-2019 and urges
the voters fa vofe against the Lery. �
PASSED 8Y THE C[TY COUNCIL this day of , 2013_
�
Bannie I. Walton,City Clerk
APPROVED BY THE MAYOR this day of
� 2013.
Denis Law, Mayor
Appraved as to form:
Lawrence J. Warren,City Attomey
RES.1587:2/14/13:scr
2
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� Medic One�mergency Medical Services
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Public Health - Seattle & King County Public_Health�
, Q�V�S�O� o� Seattle & Kin�County
� �_ Emergency Medical Services
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If you have questions about the Medic One/EMS 2014-2019 levy reauthorization process or Strategic Plan,
please contact:
Helen Chatalas
King County Emergency Medical Services
4015th Ave,Suite 1200
Seattle, WA 98104
helen.chatalas@kingcounty.gov
206-263-8560 � 206-296-4866 fax www.kingcounty.gov/health/ems
2
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Acknowledgeme�
The EMS system in King County has a long history of coliaboration, and this Medic One/EMS 2014-2019 levy
planning process was no exception. The EMS Division would like to thank the numerous participants who
so willingly gave their time and expertise to assist in the development of the Medic One/EMS 2014-2019
Strategic Plan.
EMS Advisory Task Force
Representing those who oversee, authorize and are served by the system, the EMS Advisory Task Force
was invaluable in crafting the right proposal, and determining the financial implications it may have for its
individual jurisdictions. We appreciate your commitment to this undertaking.
� - ' � � �
Fred Jarrett Deputy County Executive
Steering Committee,Task Force Chair King County Executive
Tom Agnew Councilmember,City of Bothell Cities under 50,000 in population
Dave Asher Councilmember,City of Kirkland Cities over 50,000 in population
Don Davidson Councilmember, City of Bellevue Cities over 50,000 in population
Gregory Dean Fire Chief,Seattle Fire Department Pro-tem participant for Seattle
Steering Committee, ALS Subcommittee Chair (Cities over 50,000 in population)
Bob Ferguson Councilmember, King County King County Council
Craig Goodwin Councilmember,City of Black Diamond Cities under 50,000 in population
Jim Ha erton Mayor, City of Tukwila
� Steering Committee, Regional Services Subcommittee Chair Cities under 50,000 in population
Ken Hearing Mayor,City of North Bend Cities under 50,000 in population
Jon Kennison Fire Commissioner Shoreline Fire Department
Linda Kochmar Councilmember, City of Federal Way Cities over 50,000 in population
Kathy Lambert Councilmember, King County King County Council
Mayor,City of Renton
Denis Law Cities over 50,000 in population
Steering Committee, BLS Subcommittee Chair
Pete�ewis Mayor,City of Auburn Cities over 50,000 in population
John Marchione Mayor,City of Redmond Cities over 50,000 in
Steering Committee, Finance Subcommittee Chair population
Michael McGinn Mayor,City of Seattle Cities over 50,000 in population
Keith McGlashan Mayor,City of Shoreline Cities over 50,000 in population
John Rickert Fire Commissioner South King Fire& Rescue
Jim Schneider Fire Chief, Kent Fire& Life Safety Cities over 50,000 in population
Rex Stratton Fire Commissioner Vashon �sland Fire& Rescue
3
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Levy Planning Process Partners
The Medic One/EMS system in King County relies on numerous departments to provide rapid response to
9-1-1 requests for medical assistance. We would like to thank the Task Force and Subcommittee meeting
participants and attendees for their commitment to this past levy planning process:
Michael Ayala (Port of Seattle Fire Department) Karen Goroski (Suburban Cities Assaciation)
Susan Baugh (King County Auditor) Dr. Andreas Grabinsky(Harborview Medical Center)
Bob Berschauer(AMR) Chuck Heitz(Bellevue Fire Department)
Mark Brownell (Vashon Medic One) Dave Hennes(City of Seattle}
Cameron Buck MD PhD Bill Hepburn (Seattle Fire Department)
Mark Bunje (Shoreline Fire Department) John Herbert(King County Medic One)
David Burke (KCFD 45) Mike Hilley(Redmond Fire Department)
Diane Carlson (King County Executive Office) Mark Horaski (Valley Regional Fire Authority)
Nitin Chadha (Woodinville Fire & Rescue) Dave Jones(Shoreline Fire Department)
Jane Christenson (City of Redmond) Phil Jose(Seattle Fire Department)
Mark Chubb(Woodinville Fire & Rescue) Mark Jung(Kirkland Fire Department)
Allen Church (South King Fire & Rescue) Steve Kowalczik(Valley Communications)
Dr. Michael Copass(Seattle Medic One Program) Marty LaFave (Bellevue Fire Department)
Katherine Cortes(King County Office of Performance, David Lawson (South King Fire & Rescue)
Strategy and Budget) Hank Lipe (Vashon Fire & Rescue)
Wayne Corey(South King Fire & Rescue) Scott MacColl (City of Shorefine)
Matt Cowan (Maple Valley Fire Department) Diane MaKaeli (KCFD#20)
David Crossen (KCFD 20) Michael Mar(King County Office of Performance,
Deanna Dawson (Suburban Cities Association) Strategy and Budget)
Brad Doerflinger(Maple Valley Fire& Life Safety) Mamie Marcuss(King County Council)
Chuck DeSmith (Renton Fire & Emergency Svcs) Anna Markee(King County Executive Office)
Kevin Donnelly(Redmond Fire Department) Greg Markley(Kent Fire & Life Safety)
Angelo Duggins(Seattle Fire Department) Stacie Martyn (Bellevue Fire Department)
Tracey Dunlap(City of Kirkland) Vonnie Mayer(Valley Communications)
Jim Duren (Redmond Fire Department) Doug McDonald (Renton Fire & Emergency Svcs)
Mike Eisner(Bellevue Fire Department) Joe McGrath (City of Redmond)
Malisa Files(City of Redmond) Lorrie McKay(City of Kirkland)
Jeff Fuller(Redmond Fire Department) Warren Merritt(Bellevue Fire Department)
Rob Gala (City of Seattle} Mark Moulton (Bellevue Fire Department}
Kaylee Garrett(AMR) Kevin Nalder(Kirkland Fire Department)
Mike Gerber(Valley Regional Fire Authority) Bill Newbold (Redmond Medic One)
Charles Gill (Seattle Fire Department) Joyce Nichols (City of Bellevue)
Tom Goodwin (King County Office of Nick Olivas (Tukwila Fire Department)
Economic and Financial Analysis) Gordie Olson (South King Fire & Rescue)
4
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Hoke Overland (King County Medic One) King County EMS Division:
Alan Painter(King County Executive Office) Alan Abe
Steve Perry(2595 Union President) Mary Alice Allenbach
Mark Peterson (Renton Fire & Emergency Svcs) Jen Blackwood
Ed Plumlee (South King Fire & Rescue) Cynthia Bradshaw
Laina Poon (King County Auditor's Office) Helen Chatalas
Rick Ratcliff(Redmond Medic One) Linda Culley
Grace Reamer(King County Council) Ann Doll
Alan Reed (Group Health Hospital) Dr. Mickey Eisenberg
Joe Regis(City of Seattle) Jim Fogarty
Dave Reich {King County Office of Performance, Bill Oung
Strategy and Budget) Michele Plorde
Mike Remington (Bellevue Fire Department) Cleo Subido
Leonard Roberts(Seattle Fire Department) Jim Stallings
Eric Robertson (Valley Regional Fire Authority) Kevin Youngs
Tyler Running Deer(King County Office of
Performance, Strategy and Budget)
Chrissy Russillo (Public Health - Seattle & King
County)
Neil Samuelsen (Renton Fire & Emergency Svcs)
Chris Santos (Seattle Fire Department)
Polly St.John (King County Council)
Jeff Smith (Redmond Fire Department)
Mitch Snyder(Kent Fire & Life Safety)
Lee Soptich (Eastside Fire & Rescue)
Eben Sutton (Pubiic Health - Seattle & King County)
Jamie Thomas (City of Renton)
Nicole Trent(Vashon Island Fire & Rescue)
Greg Tryon (Eastside Fire & Rescue)
Chris Tubbs(Mercer island Fire Department)
Bob Van Horne (Bothell Fire Department)
Iwen Wang(City of Renton)
Cindy West(Pubiic Health - Seattle& King County)
Jim Whitney(Redmond Medic One)
5
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{ CONTENTS ``�'"' `�
Executive Summary 8
Medic One/EMS System Overview 10
EMS Levy 17
Levy Planning Process 19
Medic One/EMS 20142019 Strategic Plan 21
ALS Program Area 23
BLS Program Area 32
Regional Services&Strategic Initiatives Program Areas 36
Medic One/EMS 20142019 Financial Plan 42
Financiai Plan Overview 42
Finance Recommendations 52
Assumptions 59
Revenues 60
Expenditures by Program Area 64
Financial Plan 72
Appendices 73
Appendix A: Regional Services to be Funded 73
Appendix B: Efficiencies 76
Appendix C: ALS Units 80
Appendix D: Strategic Initiative Funding 81
Appendix E: Reserves 82
Appendix F: Inflationary Information 83
Appendix G: Comparison Between Levies 85
Appendix H: EMS Citations 88
Appendix 1: EMS Advisory Task Force &Subcommittee Meeting Schedule 91
Appendix J: EMS Advisory Task Force Work Plan 92
7
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EXECUTIVE SUMMARY
The Medic One/EMS system provides essential life-saving services to the residents of,and visitors to, King County. With
an international reputation for innovation and excellence, it offers uniform medical care regardless of location, incident
circumstances, day of the week or time of day. It is recognized as one of the best emergency medical services program
in the country,and is acclaimed for its patient outcomes, including the highest reported survival rates in the treatment of
out-of-hospital cardiac arrest patients across the nation.
The Medic One/EMS system is funded with a six-year EMS levy that is scheduled to expire December 31,2013. To
ensure continued emergency medical services in 2014 and beyond,a new Strategic Plan that defined the roles,
responsibilities and programs provided by the system, and a levy rate to fund these services, needed to be developed.
King County Ordinances 15862 and 17145 created and reformulated an EMS Advisory Task Force to develop
"interjurisdictional agreement on an updated EMS strategic plan and financing package for the next levy funding period."
Comprised of leaders and decision makers from throughout the region,the Task Force worked collaboratively with EMS
Stakeholders for nine months to assess the needs of the system and develop recommendations to direct the system into
the future.
On July 26, 2012,the EMS Advisory Task Force endorsed the Programmatic Needs Recommendations that form
the foundation of the 2014-2019 Strategic Plan. The Strategic Plan outlines how the operational and financial
recommendations that were developed collectively by the region will be executed to ensure that the integrity of the world-
class Medic One/EMS system is maintained.
Specifically,the Strategic Plan endorses:
• Maintaining the current number of inedic units and not adding any new units or agencies over the span of the
next levy period;
• Fully funding eligible Advanced Life Support(referred to as ALS,or paramedic)costs;
• Continuing the contribution to support Basic Life Support(referred to as BLS, or"first responders");
• Programs that specifically address BLS demand and support BLS's role in regional decision-making;
� Programs that provide essential support to the system and encourage efficiencies, innovation and leadership;
• Conservative financial policies and procedures that lend to financial stability,such as reserve and inflator
policies,and the use of a 65%confidence level for projecting tax revenues;
• Responsible level of reserves for unanticipated costs;
• Funding the system with renewal of a six-year EMS levy;
• Budget of$695 million over six years to maintain current level of service and meet future demands;
� Levy rate of 33.5 cents/$1,000 Assessed Valuation (AV);and
� Placement of the levy on the ballot in 2013 at either the primary or general election.
The resuit of this productive regional discussion is a Medic One/EMS levy proposal that increases services at
a funding level that is lower than the cost of continuing the current six year funding level with inflafion.
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The proposed levy rate of 33.5 cents/$1,000 AV means that the average homeowner will pay approximately$107 a
year in 2014 for highly trained medical personnel to arrive within minutes of an emergency,any time of day or night, no
matter where in King County-this is$3 less than the average homeowner paid in 2008 for these same services. Credit
for keeping costs down while preserving this most acclaimed services can be attributed to the EMS system's continued
focus on operational and financial efficiencies.
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The Medic One/EMS 2014-2019 Strategic Plan meets King County's mission and guiding principles of providing fiscally
responsible, quality driven local and regional services,and requiring accountability, innovation, professionalism and
results. The proposals incorporated within the Plan supports the Medic One/EMS system's own strong tradition of
service excellence,effective leadership and regional collaboration. The well-balanced approach will allow the system to
meet the needs and expectations of residents, now and in the future.
For over 30 years,the region has worked together to create a system with patient outcomes that people from all corners
of the world seek to replicate. This speaks to the strength of its partnerships,and the ability for King Countyjurisdictions
to collectively recognize these regional benefits and consider needs beyond their local boundaries and interests. The
expertise shared and efforts expended by our partners during this levy planning process were constant reminders of
exactly why the King County regional system continues to succeed and serve as an international model.
9
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MEDIC ONE EMS S TEM OVERVIEW �
/
KEY COMPONENTS OF THE SYSTEM
The Medic One/EMS system in King County is known worldwide for its service excellence, leadership,and most
importantly, its medical results-it has measurably among the finest of inedical outcomes in the worid for out-of-hospital
cardiac arrest. In 2011,Seattle& King County achieved a 52%survival rate for cardiac arrest,the highest rate to date
anywhere. Since most survival rates in the nation hover around 10%,this is a crowning achievement.
The optimal standardized outcome measure for assessing EMS systems is survival from cardiac arrest.This is due to the
discrete nature of a cardiac arrest: a patient has stopped breathing and their heart is not pumping.Whether a patient is
discharged alive following a cardiac arrest is identifiable and measurable,and thus easily comparable. A chart published
in 2009 illustrates the differences between systems. Please note that the King County rate has increased to 52%since
this chart was developed.
_ _ _ _ _
_ _ _
__ _ . .
Cardiac Arrest Survival Rate Comparison '
50% _ _ _
45% -
_ ._ .
40% ' _
35%
' 30% _ . _
25% . _ _ _ _ _ _ _ _ '
20% _ _
' 15%
10% _
5% . . ,_ . . ._ '
0%
C'�, O��r ,�.r�s 'S�oG �d �os 'Li� 'Li,� 'Li,/ 'f�;' '1'�� ,poc .poc Sdi� `t'd�� T4cs '
�O'�o o,�, �o Sr�o' �`i�� '9�� '�.a,�� �: �a4 �ed �or '��s�, �'es�, �d� rd °�
'�. �o/P S 'F�o 'Op�. 'F �or lo!, �°�`• �Cis, .
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Comparative survival rates, by percentage,for ventricular fibrillation across communities.
Eisenberg,Mickey. Resuscitate! How Your Community Can Improve Survival from Sudden Cardiac Arrest.
Seattle: University of Washing[on Press,2009.
The system's success can be traced to its design,which is based on the following:
Reglonal System Buflt on Partnershlns
The Medic One/EMS system is built on partnerships that are rooted in regional, collaborative and cross-jurisdictional
coordination -while each agency operates individually,the care provided to the patient operates within a "seamless"
system. It is this continuum of consistent,standardized medical care and collaboration between 30 fire departments,six
paramedic agencies,five EMS dispatch centers, 20 hospitals,the University of Washington,and the residents throughout
King County that allows the system to excel in pre-hospital emergency care. Medical training is provided on a regional
basis to ensure no matter the location within King County(whether at work, play,at home or traveling between locations)
the medical triage and delivery is the same.
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Tlered Medlcal Model
Medicine is the foundation of the Medic One/EMS system. Services provided by EMS personnel are derived from the
highest standards of inedical training, practices and care,scientific evidence,and close supervision by EMS physicians.
The tiered system is predicated on BLS agencies responding to every incident to stabilize the patient and secure the
scene. This reserves the more limited regional resource of an ALS unit(known locally as a medic unit)for the serious
or life-threatening injuries and illnesses. Managing the calls requiring advanced levels of care improves paramedic
patient skills,conserves paramedic services for events requiring advanced skills,and reduces the number of calls to
which paramedics respond. Compared to systems that send paramedics on all calls,the Medic One/EMS system in
King County can provide excelient response and patient care with fewer paramedics. At a cost of over$2 million per
paramedic unit,this approach results in significant cost savings. The Tiered Medical Model pairs highly successful
outcomes with reasonable control of costs,features that are unique to the King County system.
Programs and Innovative Strategles
Programmatic leadership and state of the art science-based strategies have allowed the Medic One/EMS system in King
County to obtain superior medical outcomes,and meet its own needs and expectations,as well as those of its residents.
Rather than focusing solely on ensuring fast response by EMTs or paramedics,the system is comprised of multiple
elements - including a strong evidence-based medical approach. This inclusive approach makes the system medically
effective as demonstrated by the impact of providing police with automated external defibrillators on improved cardiac
arrest survival rates.Continual medical quality improvement activities,such as the review of every cardiac arrest event for
the past 35 years and patient protocol compliance audits,foster obtaining the best possible outcomes of care.The result
of this on-going quality improvement is enhanced patient outcomes and a steadily rising cardiac arrest survival rate,
currently the highest in the nation.
Focus on Cost Effectiveness and Efficiencies
The Medic One/EMS system in King County has maintained financial viability and stability, even throughout the
economic recession, due to a sustained focus on operational and financial efficiencies. The unique tiered response
model contributes to the overall efficiency of service delivery by ensuring the most appropriate level of service is sent.
BLS services respond locally and integrate seamlessly with the more regional ALS tier, adding to the EMS system's
effectiveness. Targeting specific users of EMS and providing alternative, cost-effective yet still high quality and
appropriate care are strategies pursued and practiced by the region to improve the quality of Medic One/EMS services,
and manage the growth and costs of the system.
Maintaining an EMS Levy as Funding ource
Medic One/EMS is supported by levy funds that make the services it � • �
provides less vulnerable,though not immune,to fluctuations in the � • � - � � �
economy. The EMS levy falls outside the King County statutory limits with � - � • �
senior and junior taxing districts,and therefore does not"compete"for � � � - -
capacity. Had a different type of levy been adopted for the 2008-2013 �
lery span,the EMS levy would have directly resulted in taxing district pro- • � � �
rationing/rate suppression.The EMS levy is a reliable and tenable source � � � � � � . � � . �
for funding this world-renowned system.
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MEDIC ONE/EMS SYSTEM OVERVIEW - cont.
Any time you call 9-1-1 for a medical emergency,you are using the Medic One/EMS system.The Medic One/EMS
System in King County is distinctive from other systems in that it is a regional, medically based and tiered out-of-
hospital response system. Its successful outcomes depend equally upon citizen involvement as well as extensively
trained firefighter/Emergency Medical Technicians(EMTs)and highly specialized Paramedics. The system relies upon
coordinated partnerships with fire departments, paramedic agencies, EMS dispatch centers, and hospitals and is
managed by the Emergency Medical Services (EMS) Division of Public Health-Seattle&King Counry.
The response system is tiered to ensure 9-1-1 calls receive medical care by the most appropriate care provider. There are
five major components in the tiered regional Medic One/EMS system:
Universal Access: A patient or bystander accesses the Medic One/ EMS Tiered Response System
EMS system by calling 9-1-1 for medical assistance. Bystanders'
reactions and rapid responses to the scene can greatly impact the Acc�ss to EMS System:
chances of patient survival.
Bystander Calls 9-1-1
Dis�atcher Trla�e:Calls to 9-1-1 are received and triaged by
professional dispatchers who determine the most appropriate trlage by Dlspatcher:
levei of care needed. Dispatchers are trained to provide pre-arrival
instructions for most medical emergencies and guide the caller Use of Medical Response
through life-saving steps, including Cardiopulmonary Resuscitation
Assessment Criteria
(CPR)and Automated External Defibrillator(AED)instructions, until the
Medic One/EMS provider arrives.
Flrat Tier of Response:
All EMS service requests receive a first tier
Basic Llfe Support(BLS)Services: BLS personnel are the"first response from Basic Life Support
responders"to an incident, providing immediate basic life support
medical care that includes advanced first aid and CPR/AED to stabilize by Firefighter/EMTs
the patient. Staffed by firefighters trained as Emergency Medical CMT, Nurse Line
Technicians(EMTs), BLS units arrive at the scene in under five minutes
(on average). BLS contributes significantly to the success of the
Medic One/EMS system. Second Tier of Response:
Advanced Lffe Su�aort(�1LS�Services: Paramedics provide Advanced Life Support is provided
out-of-hospital emergency medical care for critical or life-threatening by Paramedics
injuries and illnesses.As the second on scene,they provide airway
control, heart pacing,the dispensing of inedicine and other life saving pddltional Medical Care•
procedures. There are 26 ALS units located throughout King County
which are strategically placed for optimal response times. Transport to Hospital
Transaort to HosQitals: Once a patient is stabilized, it is determined whether transport to a hospital or clinic for further
medical attention is needed. Transport is most often provided by an ALS agency, BLS agency or private ambulance.
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The Medic One/EMS system in King County is recognized as one of the best emergency medical services programs
in the country. It serves nearly two million people throughout King County and provides life-saving services on average
every three minutes. In 2011,firefighter/EMTs responded to more than 164,000 calls in King County;45,000 of the
calls also required paramedic responses. Approximately 1 out of 10 people will use the Medic One/EMS system in King
County,and each year,the system saves thousands of lives.
For over 30 years,the system has held steadfast to its core beliefs of providing pre-hospital medical care that is
regionally designed, medically based,and uses a tiered response model. It operates in coordinated partnerships based
on the acknowledgement by the BLS and ALS agencies that the benefits of regionalization, collaboration, and cross-
jurisdictional coordination far exceed the individual benefits associated with other Medic One/EMS service delivery and
funding mechanisms. The success of the system is testimony to the commitment of all its participants to providing high
quality services to the residents of King County.
For most, if not all, EMS systems throughout the nation, life-threatening calls(which the King County system classifies as
ALS calls) represent only approximately 25%of all EMS-related 9-1-1 requests - meaning that approximately 75%of the
requests for service involve critically important but less life threatening conditions that require a competent and effective
basic life support(BLS)service tier to handle.
The BLS response tier handles 100%of the service requests and is the foundation of the response for both BLS and
ALS parts of the system. It is imperative that BLS care arrive quickly,since minutes count in emergencies,and BLS
units arrive at the scene in under five minutes(on average). EMTs in Seattle and the remainder of King County are
among the most trained and-more importantly-most practiced providers of BLS care of systems anywhere. BLS is
provided by firefighter/EMTs aboard fire trucks and aid cars(ambulances providing BLS level care) in various deployment
configurations that are decided locally by fire agencies. The EMS levy contributes some BLS funding to local fire
agencies to help offset the costs of providing EMS services, however, most BLS funding is raised and managed locally.
The BLS tier seamlessly integrates with the more regional ALS response tier. The EMS levy provides 100%of the
funding support for ALS. ALS is provided by highly trained paramedics who have completed an extensive program
at Harborview Medical Center in conjunction with University of Washington School of Medicine. These highly trained
paramedics remain well practiced and use their skills on a daily basis to provide effective care when it is needed most.
Paramedics operate in teams of two, riding aboard ambulance type vehicles known as"medic units". There are 26
medic units strategically placed throughout King County that are deployed regionally to life-threatening emergencies. Unit
placement is reviewed on an annual basis to ensure the best mix of short response time,appropriately high levels of ALS
calls per unit,and upper limits on extremely difficult to serve areas of the county(typically rural or isolated areas). These
26 units are operated by no more than six ALS agencies. The unit analysis performed by the EMS Division during the
past three years to determine unit needs for the coming years of the next levy demonstrates that the EMS system has
ample existing capacity within these 26 units for years to come.
13
!
MEDIC ONE/EMS S STEM OVERVIEW - con� �
ALS and BLS services are managed by the EMS Division,Public Health-Seaitle&King County through
performance based contacts with service providers(and by the direct provision of services, in the case of King County
Medic One). The EMS Division also manages core support functions that tie together the regional model, providing
consistency, standardization and oversight of the direct services provided by the system's 30+ partners. It is far more
medically effective and cost efficient for the EMS Division to produce, administer and share initial training,continuing
education and instructor education for 4,000 EMTs;to manage the certification process for EMTs county-wide;to provide
medical oversight,quality improvement and performance standards for the system as a whole;than to have each local
response agency develop, implement and administer its own such programs. Regional support services managed by the
EMS Division can be found in Appendix A: Regional Services to be Funded on page 73,and programmatic efficiencies
implemented by the EMS Division and its partners can be found in Appendix B: Efficiencies on page 76.
The EMS Advisory Commlitee monitors the uniformity and consistency of the Medic One/EMS system.This Committee
has provided key counsel since 1997 to the EMS Division regarding regional Medic One/EMS policies and practices in
King County. Members convene on a quarterly basis to review implementation
of the Strategic Plan as well as other proposals put forth, including Strategic
Initiatives and medic unit recommendations. � � �
� � �
King County's Medic One/EMS system is funded with a 6-year EMS levy,and , , ,
does not impose ALS transport fees. The current rate is $.30 per$1,000 of , �
Assessed Valuation, meaning that a family of a $400,000 home pays$120 a
� � • . � �
year for Medic One services. Other systems charge much higher taxes(many
as high as$.50 per$1,000)and charge transport user fees,yet still face
increasing call volumes,cost overruns and declining revenues from user fees.
In contrast,the King County EMS system has held ALS call growth steady, making full use of existing assets and saving
its residents$49 million over 10 years in avoided and costly expansion of ALS services while at the same time providing
the best clinical outcomes of any system anywhere.
STRATEGIC PLAN
The current EMS levy and Strategic Plan will expire on December 31, 2013. Therefore,a reauthorization of the EMS
levy,along with the generation of an updated EMS Strategic Plan,are necessary to provide a continuous transition
into the new levy period. Per King County Ordinance 15862,the EMS Advisory Task Force was convened to develop
recommendations for the Medic One/EMS 2014-2019 Strategic Plan,which is due to the King County Council by
January 1,2013.
The Strategic Plan is the primary policy and financial document that will direct the Medic One/EMS system into
the future. The plan provides elected officials,the EMS community,and the public with a general description of
the programmatic services to be supported throughout the levy period,and a financing plan to implement the
recommendations. It details the necessary steps to ensure the system can meet tomorrow's commitments,yet still
allows for flexibility in addressing emerging community health needs. The result of a nine-month ail-inclusive planning
process undertaken by regional Stakeholders,the Strategic Plan reflects collaborative efforts from public and private
regional partners, cities,the King County Executive and the EMS Division.
14
,
� � �
Medic One/EMS System ObJectives
The Strategic Plan advances the following global objectives for the Medic One/EMS system to ensure it remains a
regional, cohesive, medically-based,tiered response system:
1. Maintain the IVledic One/EMS system as an integrated regional network of basic and advanced life support services
provided by King County, local cities, and fire districts.
• Emergency Medical Dispatchers receive 9-1-1 calls from citizens and rapidly triage the call to send the most
appropriate level of inedical aid to the patient while providing pre-arrival instructions to the caller.
■ Firefighters,trained as Emergency Medical Technicians, provide rapid,first-on-scene response to emergency
medical service calls and deliver immediate basic life support services.
• Paramedics,trained through the Paramedic Training Program at the University of Washington/Harborview Medical
Center, provide out-of-hospital emergency medical care for serious or life-threatening injuries and illnesses.As has
been adopted in prior Medic One/EMS strategic and master plans,Advanced Life Support services will be most
cost effective by delivering services on a sub-regional basis with a limited number of agencies.
• Regional programs emphasize uniformity of inedical care across jurisdictions,consistency and excellence in
training,and medical quality assurance.
2. Make regional delivery and funding decisions cooperatively,and balance the needs of Advanced Life Support(ALS),
Basic Life Support(BLS), and regional programs from a system-wide perspective.
3. Develop and implement strategic initiatives to provide greater efficiencies and effectiveness within the system to:
• Maintain or improve current standards of patient care;
� Improve the operational efficiencies of the system to help contain costs;and
• Manage the rate of growth in the demand for Medic One/EMS services.
�
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EMS SYSTEM POLICIES
The Medic One/EMS 2014-2019 Strategic Plan and its identified key components are consistent with the newly adopted
set of EMS Policies that establish a general framework for medical oversight and financial management of emergency
medical services in King County. The EMS System Policies(PHL 9-1)reinforce the regional commitment to the medical
model and tiered system,while the EMS Financial Policies(PHL 9-2) provide guidance and oversight for all components
related to financial management of the EMS levy fund. In addition, policies regarding ALS services outside King County
(PHL 9-3), including the formation of a service threshold for the purpose of cost recovery,are established.
15
J
� �
MEDIC ONE/EMS SYSTEM OVERVIEW - cont.
The following table summarizes the EMS System policies:
, �
The EMS Division will work in partnership with regional EMS partners to regularly review and assess EMS system
needs and develop financial and programmatic policies and procedures necessary to meet those needs.
The EMS Division will ensure the EMS system in King County remains an Integrated regional system that provides
cohesive, medically-based patient care within a tiered response system to ensure the highest level of patient care.
The EMS Division will ensure the EMS system in King County provides paramedlc training through the UW/HMC-
based educational program that meets or exceeds the standards.
The EMS Division will malntaln a rigorous and evidence-based system with medical oversight of the EMS system to
ensure the provision of quality patient care.
The Medical Program Director will adhere to the principles of regional medical oversight of EMS personnel.
The EMS Division advocates for the provision of automatic aid between agencies; should established service
thresholds be reached,affected EMS agencies will review options and establish terms for reasonable cost recovery.
ALIGNMENT WITH KING COUNTY GOALS AND OBJECTIVES
The Medic One/EMS 2014-2019 Strategic Plan promotes King County's mission to provide fiscally responsible,
quality driven local and regional services, and adheres to the County's guiding principles of accountability, innovation,
professionalism and results.
���� "�'�"�'�"°�` ��' ���s� ��� �"����°" ����',°� �"�� ;'�, � ��� Emergency medical services directly support the strategy
� 3
� � 4�• ��,,, � ��=E to"facilitate access to programs that reduce or prevent
� ��� ��
� �'������ _ � ��< �. - involvement in the ...emergency medical systems,and to
� ; � .�.,� � �yr ';� "
� ' �' promote stability for individuals currently involved in those
�..:�,�� . .
systems." Its focus on sound financial management includes
working with cities to provide services more efficiently, pursuing
, � a . + + a r - technologies that improve service while reducing delivery cost,
�� - I�• , • and managing assets in a way that maximizes their productivity
and value. EMS responses are distributed throughout
the region based on service criteria. Therefore,areas with
economic challenges are provided the same level of service as
HHP4b � - � ' � ' areas with economic prosperity. This ensures accessto health
and human services,and furthers King County's Equity and
Social Justice Program (ESJ). In addition, many EMS projects
and grants include ESJ-related elements in their criteria,such
as the proximity to low income house,or addressing Limited
� � � � � English proficiency. EMS's emphasis on increasing the number
H H P1a , � of healthy years lived, and provision of EMS services advances
the objectives of the Public Health Operational Master Plan.
16
` EMS LEVY `�''' `�
EMS LEVY
The Revised Code of Washington (RCW)84.52.069 allows jurisdictions to levy a property tax"for the purpose of providing
emergency medical services." The levy is subject to the growth limitations contained in RCW 84.52.050 of 1%per year
plus the assessment on new construction, even if assessed values increase at a higher rate.
Specifically, RCW 84.52.069:
• Allows a jurisdiction to impose an additional regular property tax up to$0.50 per$1,000 Assessed Value(AV);
• Allows for a six-year,ten-year or permanent levy period;
• Mandates that,for a countywide levy,the legislative bodies of the county and those cities with populations in
excess of 50,000 approve the levy proposal prior to placement on the ballot. For the 2014-2019 levy,the cities
in King County required to approve the ballot will be Auburn, Bellevue, Federal Way, Kent, Kirkland, Redmond,
Renton,Seattle and Shoreline;and
• Requires a simple majority for the renewal of a six-year or ten-year levy(effective June 7, 2012).
Medic One/EMS levies in King County have never been authorized for more than six years.
Historical EMS Levy Rates in Cents
(Year on Ballotj
40A
35A
I �
� 30.0 i
a
0 25A 29A 30.0
,� � 25.0 25A 29A 25A
� 20A
Q 2IA
� 15A
eo
oC
10A
5.0 f
0.0
1979 1985 1991 1997 2001 2007 2013
1998
17
,
�` ;V�` ,
Per an agreement with King County in place since the creation of the countywide EMS levy,Seattle receives all
Medic One/EMS levy funds raised within the city limits. County funds are placed in the KC EMS Fund and managed
regionally by the EMS Division based on Public Health system and financial policies,Strategic Plan guidelines and
recommendations from the EMS Advisory Committee.
King County EMS Funds are spent on these five main areas:
Advanced Life Support(ALS)Servlces: Reglonal 8upport Services:
Funding ALS services is the priority of the Medic One/ The EMS Division manages core regional Medic One/
EMS levy,which fully funds ALS services predominately EMS programs that are critical to providing the highest
through the ALS unit allocation model. ALS services quality out-of-hospital emergency care available and are
are provided by six agencies: Bellevue, Redmond, more effective and/or economical when delivered on
Seattle,Shoreline,Vashon,and King County Medic One. a regional basis. These services emphasize uniformity
Exceptions to the unit allocation model are sometimes of inedical care across jurisdictions, consistency in
required,as in the case of Snohomish County Fire excellent training,and medical quality assurance.
District#26,and are made on the basis of the specifics Proposed to receive 12%of KC EMS funds(2014-2019
of the service issue. Proposed to receive 60%of KC levy).
EMS funds(2014-2019 levy).
Strategfc Initlattves:
Basic Llfe 8upport(BLS)Services• Strategic Initiatives are pilot programs designed
BLS agencies receive an annual distribution of levy to improve the quality of Medic One/EMS services
revenue from the EMS Division to help offset the costs and manage the growth and costs of the system.
of providing EMS services. Funding levels are based Successful initiatives may be incorporated into Regional
on a combination of the volume of responses to calls Services as ongoing programs. Proposed to receive 2%
for EMS services and assessed property values within of KC EMS funds(2014-2019 levy).
the fire agencies'jurisdictions. Local jurisdictions,
not the EMS levy, cover the majority of BLS costs, and Reserves:
King County has been able to fund the system at a Reserves with strict access and use policies are
lower levy rate due in part because the majority of BLS available to fund unanticipated/one-time costs. EMS
related response costs are paid by local jurisdictions. reserves follow adopted use and access policies.
BLS services are provided by 30 fire departments and Policies describing use and access align with similar
districts, including Seattle. Proposed to receive 23%of reserve policies that exist for all of King County
KC EMS funds(2014-20191evy). government. Proposed to receive 3%of KC EMS funds
(2014-2019 levy).
18
,
� �
LEVY PLANNING P�OCESS
BACKGROUND
King County Ordinance 15862 created the EMS Advisory Task Force to "ensure continued emergency medical services for
King County by reviewing issues and options and by developing recommendations for the next Strategic Plan." Beginning
in October 2011,the Task Force began collaboratively reviewing the needs of the system with EMS Stakeholders, and
subsequently endorsed programmatic policies and a levy rate to put before the voters of King County. While not every
member of the Task Force is an EMS expert, all have a stake in ensuring the continuity in the provision of EMS services
in King County. Its membership collectively represents a balanced geographic distribution of those jurisdictions that are
required to endorse the levy proposal prior to its placement on ballot, per RCW 84.52.069.
The EMS Advisory Task Force was charged with reviewing and approving Medic One/EMS program recommendations
for the span of the next levy. The recommendations will build upon the system's proven medical model and regional
approach, establish new policy directions,and present a financial plan to support the Medic One/EMS system for 2014
and beyond.
Responsibilities included evaluating and endorsing recommendations regarding:
• Current and projected EMS system needs;
• A Financial Plan based on those needs;and
� Levy type, levy length,and when to run the levy.
Current and Projected EMS System Needs:
The Strategic Plan must ensure the EMS system remains an integrated regional system that provides cohesive, medically-
based patient care within a tiered response system to ensure the highest level of patient care, and fosters coordination
and collaboration between Medic One/EMS partners.
Financial Plan to Meet those Needs:
The Strategic Plan must support quality emergency medical services,and supply adequate funding to provide these
services. However,the plan must recognize individual jurisdictions' needs for local autonomy to meet their communities'
expectations and Medic One/EMS services.
The priority of the levy reauthorization is to ensure Medic One
� , � remains an adequately funded, regional tiered system, reflects the
existing successful medical model, and continues to provide state
of the art science-based strategies, programs and leadership.
19
r
� � `
Levy 7r►�e Length,and When to Run the Lew:
Until recently,an EMS levy required for passage an approval rate of 60%or greater at an election at which the voter
turnout must exceed 40%. Because of these voter requirements,options for running the levy were limited to general
elections. Duringthis levy planning process,the Washington State Legislature amended RCW 84.52.069 changingthe
validation rate(effective June 7,2012)to a simple majority,and eliminating the 40%voter turnout requirement.* This
provides the region with additional opportunities for running the EMS levy in 2013.
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LEVY PLANNING PROCESS
The levy planning process closely followed the EMS Advisory Task Force Work Plan submitted to the King County Council
on September 15,2010. The Task Force met four times(October 2011,January 2012, May 2012 and July 2012)and
used its four subcommittees representing Advanced Life Support(ALS), Basic Life Support(BLS), Regional Services
(RS)and Finance to complete the bulk of the program and cost analysis. Each subcommittee was chaired by one EMS
Advisory Task Force member, and met on a regular basis to conduct detailed review and analysis that was then reported
back to the Task Force. Subcommittee membership included Stakeholders and subject matter experts from all aspects
of the Medic One/EMS system (medical directors, labor representatives,finance specialists, hospitals, dispatch agencies
and private ambulance companies)and other interested parties.
Committed to ensuring sufficient time for study, discussion and agreement,the subcommittees met a total of 23
times over seven months, and generated recommendations that subsequently came to the Task Force for approval.
Emphasis was placed on allowing all participants the opportunity to bring forth concepts and provide input in an open
and transparent manner. The subcommittees evaluated each idea by balancing its merits of furthering the goals of the
system against the challenges of constrained revenues.
Potential subcommittee participants were identified by the King Counry Executive, Public Health -Seattle&King County
and the EMS Division in conjunction with the King County Council prior to the convening of the EMS Advisory Task Force,
and endorsed at the first meeting. The Chairs of the Task Force and its four subcommittees constituted a Steering
Committee that met monthly to confirm alignment with the overall goals of the planning process.The EMS Division of the
Public Health Department provided staff support in organizing, preparing for,and facilitating the meetings of the EMS
Advisory Task Force and its subcommittees.
*SB 5381 amended RCW 84.52.069 requiring a three-fifths majority to authorize a new EMS levy,and requiring a simple majority for
the renewal of a six-year or ten-year levy.
20
i 1 � � � •
Operational and Financial Proposals for the
Medic One/EMS 2014-2019 Levy
'�ht�EIVIS Advis�try T��sk�'orce�ndorsed the f�llowtng at!#s luly 28,2012 me�ting:
: Reauthorize a six-year EMS levy ����dt�a������,
fva�r th�y�ars 2#l14-�019 per RCW 84.52.069.
Enact Ievy rate of 33.5 cents,�s,�a A$����d„��a�t,Q��o
' #und�+�'t►lected��sndi�ur�s of S89�i nnilti�n ov�r the 2014-2019 span. The av�rage hameowner wt11
i��Y�A#raxitr�te�y$1liT:a year in 2Q1a far highl�traln�ed medieal personnel to arrhre with�n minutes
o#at►e�nergenc�r,a�y tlme of day or ni�ht,no ma#te►r where�n King County-this ts S31ess#han#he
av�ra��1�omi�rwner patd in 20ii8 far tl�s�se s�n�e servi�ces. The regian's da�dit#g�nc�fn fc�cusing o�t
n�ee�at�on����t#�n�ncial efficiencles can be cred(t�d with keaping costs dowa t�rhil�pr�servin�thls
t�za�t at�l��mest service. Th1s budget wiN suppar!inar+�,ased ssrvia�s at a funding level#ha#ts tower
than�he cos#af e�n#inuing the current six-year fundlr�g lev+�t with infla#ion.
R e n ew t h e E M S l e�ry i n 2 013 at etther the Primary or General
slection,w�##h tlt�e King Gounty CauncH making the final dstermin�atlon.
Continue using:financial policies �,�a��t����&��,��
i�vy,r�ftne if nec�ssary, Th�financia!poiicfes guldtng t6e 2008-20131evy perlad have provit�ed a
v�ry s#rong:#oandation for fh�;upcaming leery. The potici�s can bs fine-tunedto be##er me�et 20142015
ne�ds.
: Continue services from 2008-2013 levy th���gh
the 2Q142019 EM5 levy.;The n��ct levy should ful�Jr`fand and cantinue aperatians with tite'current
�8 ALS wnits in service,partially fund tirst r�s#►oeder servi�es far local fir�and emergency eespanse
departmer�#s,and maintain programs and In�t�ia�Eves that provide�s�en#ial�upport to the sys#em and
ee�coura�e eff#ci�ncies,innavatlon anct laader�hip,
M e et f u t u re d e m a n d.�! aver the span of th�2014-2419 levy. Ssrviees
inNuds catlabora#in�on programs tha#redu+ee in�pacts on BLS a�encies,and rescoping programs to
mest er�nerging co�mmwnity needs, No n�w or added medi�unt#s are an##ctpa#ed.
Y
/ � � � � �
- � 1 1 1
� • • � � � � � �
..�
Contlnue with EMS levy: ■ Six-year EMS levy, per RCW 84.52.069
■ Forecasted budget of$695 million over six-year span, including reserves
■ Levy rate of 33.5 cents/$1,000 Assessed Valuation
■ Would be run at either the 2013 Primary or General election,with the King
County Council determining which election
, - � � � � � � . �
Continue services from 2008- ■ Continue operations with the 26 units currently in service
2013 levy: • Fully fund eligible costs of existing paramedic services to prevent cost shifting
to agencies
• Project annual increases using a compound inflator
Provlde to meet expected • No new medic units over the span of a six-year levy
demands: • Reserves to cover unanticipated and one-time expenses
• Efficiencies to refine ALS costs and increase effectiveness
• Funding for a possible 12-hour medic unit in the later years of the levy in case
demand for services increases
�- � - , �E.� �: :� :. �.. ,: --�: �.� �GE� .. ,, . >,
Continue services from 2008- • Partial fundingfor BLS services(firefighters/EMTs)
2013 levy: • Maintain King County portion of BLS funding at same percentage of overall
expenses of previous levy period
■ Maintain current funding formula for allocation(based 50/50 on
Assessed Values and Call Volumes)
Provide to meet expected • Programs and Initiatives that help manage growth, reduce impacts and
demands: increase the role of BLS agencies in regional decision-making
, � � . .
Contlnue services from 2008- ■ Essential Regional Services programs that support the Medic One/EMS
2013 levy: system
Provlde to meet expected • Re-scoped and enhanced Regional Services programs to meet emergent
demands: needs
� �
Continue services from 2008- ■ Conversion of 2008-2013 Strategic Initiatives that have improved the quality
2013 levy: of service and managed growth and costs into Regional Services programs to
become ongoing programs
Provide to meet expected ■ Revamped and new Strategic Initiatives
demands:
22
` PROGRAM AREAS� "'�'"`"
ADVANCE LIFE SUPPORT (ALS)
Paramedics provide out-of-hospital emergency care for serious or life-threatening injuries and illnesses. As the second on
scene for critically ill patients, paramedics deliver Advanced Life Support(ALS)to patients including airway control, heart
pacing,the dispensing of inedicine, and other life-saving out-of-hospital procedures under the medical supervision of the
Medical Program Director. Paramedic interns receive nearly 2,500 hours of highly specific emergency medical training
through the Paramedic Training Program at the University of Washington/Harborview Medical Center, nearly double the
required number of hours for Washington State paramedic certification.
In King County,a paramedic unit is typically staffed by two paramedics, requiring the equivalent of approximately
nine paramedic full-time staff to provide service 24-hours per day,365 days per year. The two-paramedic model was
developed in the early 1970's in the City of Seattle and has proven to be the most effective model for enhanced patient
care outcomes when incorporated into a regionally coordinated tiered response system that includes dispatch and Basic
Life Support(BLS).
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'', ;� ��q i�d���u'��������w' "1 ���'��,� Advanced Life SupFot7(ALS)
..�,w„d � �,�Y i ;� �i��i i����n����i ww i,�,
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y� •,_ �. KY`.,�1llt��i I�' . � , e�'�.
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� ' r l � ALS Providers
,� �, �Bailevue Medic One �
�,;.�� ..b. �-� r� �: � �� � �j King County M�dfc One
_ ��� �x � ��# s i �
Redmond Medic One
. � .-:s.anr��.�o an. y '
;� }'r - . 'ShoreNne Pdedic One
� � '_' ' �Vashon Medic Csne � _
��j- •--• � �� �� ,.�„�� �� ALS Servkea by 5nohomiah Co FD�Y 28
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Advanced Life Support Agencies in King County
As of 2012,there are 26 ALS units throughout Seattle and King County. These units are managed by six ALS agencies:
Bellevue Medic One, King County Medic One, Redmond Medic One,Seattle Medic One,Shoreline Medic One,and Vashon
Medic One. Additional paramedic service in the Skykomish area is delivered via contract with Snohomish Fire District
23
� �
PROGRAM AREA - ALS - cont.
#26. Paramedic service above established thresholds into cities where the municipal boundaries or the fire agency's'
response district crosses into neighboring counties(such as Pierce and Snohomish) is provided with appropriate
reimbursement by the receivingjurisdictions, per EMS policies.
The Medic One/EMS system in King County has historically added new units to maintain paramedic service levels in
the face of ALS service challenges. Prior to any unit addition,a thorough analysis considering workload(call volumes),
average unit response times,fractile response times and critical skills is conducted. Analysis also includes an
assessment of whether medic units could be moved to other locations to improve workload distributions and response
times. Appendix C:Advanced Life Support(ALS)Units on page 80 provides a complete history of inedic units in King
County, highlighting when and where units were added.
During the 2008-2013 levy period, paramedic unit projections included the addition of three(3) 24-hour units in the
financial plan;one in the City of Seattle and two in the remainder of the county. Following a thorough regional paramedic
unit analysis,only two 0.5 units were found necessary, both of which involved converting existing 12-hour units to full
time 24-hour units. While conducting this same analysis for the 2010 unit addition, regional ALS agencies agreed to
. , � - � � ' �
(200&20131evy perlod) (201420191evy period)
Beginning End
Bellevue Medic One 4.0 units 4.0 units 4.0 units
King County Medic One 7.5 units 8.0 units 8.0 units
Redmond Medic One 3.0 units 3.0 units 3.0 units
Seattle Medic One 7.0 units 7.0 units 7.0 units
Shoreline Medic One 2.5 units 3.0 units 3.0 units
Vashon Medic One 1.0 units 1.0 units 1.0 units
, � : �
� � - � � - � - �
� � � • . � - � � . � .
� � � � � : � � • � � �
� i • � �
� � �
24
� p'�✓, �
delay further additions until it could be demonstrated they were needed. Subsequent unit analysis demonstrated
there was adequate regional unit capacity through the end of the levy period,and the remaining two 0.5 units were
released for a savings of over$2.5 million. This same unit analysis methodology predicts that there will be system
capacity for the duration of the 2014-2019 levy period,and no additional units or agencies will be needed for the
next six year levy span.
In 2011, paramedics responded to over 45,000 calis for emergency medical care in King County. This represented
27%of the total number of Medic One/EMS calis in the region. Figure 1 below reflects a trend of decreasing ALS
calls over the past four years, mostly due to the successful implementation of changes to the ALS dispatch criteria.
i- -- ---__-_—- ---------— . --- ---- -- --,
The average response time of inedic units in the county � Population&ALS Call Volume
i
is 7.5 minutes,and units respond to 95%of the calls in j Z.00
�----- -
_ _ _--_ ---- __---- --- -r so I
less than 14.0 minutes. These numbers have remained i �.ss � I �
"' • � so � �
stable over the past levy period despite increased , q �.so t . I o
population. � o �.85 � � ao r, ,
•E 1.80 � � I
io 1.75 � i 30 o I
Paramedics are more likely to attend to older patients i > >��o � � �
a
(4 0.2%of ALS calls are for 65+yrs) respond to cardiac i a �.ss � � 20 Q i
� 1.60 !- 10 I
conditions(27.0%of ALS calis)and transport 47%of the i �.ss � � �
time when called to the scene. ; �.Sa __ _�_ _�._ _�_ _+_ _ o i
� soo� sooa soos so�o zo��
I �Population —•—ALS Call Volume '
�-_ ----------___------ I
Figure 1: King County ALS population and call volume
ALS SUBCOMMIITEE:
The ALS Subcommittee recognized its tasks as determining the number of units needed in the next levy period and
establishing the cost of each unit. The committee then debated how to refine costs through efficiencies and most
appropriately fund unanticipated items that could arise. The topics of best practices and using measures other than
cardiac arrest outcomes were also raised,as were ALS transport fees and options for becoming an ALS provider.
The ALS Subcommittee adopted the following principles to gulde Its decision-making:
1. Maintain ALS as the Funding Prloritv
A�S will remain the primary recipient of the Medic One/EMS levy and the first commitment for funding within the
Medic One/EMS system.
2. Provide Full Fundin�for Eligible Costs
ALS agencies should not assume the burden of cost-shifting during the levy period.ALS agencies recognize their
obligation for cost containment and commit to best practices and other cost and efficiency methods.
25
� '
PROGRAM AREA -�LS - cont.
3. Use Unit Allocatlon Model
The standard unit allocation, designed to include all ALS-related operating expenses in order to prevent cost-shifting to
agencies,will remain the basis for funding each full time medic unit(with the exception of Seattle Medic One)until the
time that a more appropriate methodology is found. This methodology requires that ALS costs incurred in providing the
regional benefit of ALS services be distinguished from other agency category of costs,such as fire suppression.
4.���P Annual Cost Inflator
A model to accurately forecast system expenses to prevent cost-shifting to ALS agencies will be used when developing
the Financial Plan.
5.Provide Adeauate Reserves
Funding will be included to cover unplanned expenditures - whether these relate to an emergency situation,significant
changes in economic assumptions, or new operational and programmatic needs.
The ALS Subcommittee recommendatlons are as follows:
Reco m m e n d at i o n 1� Contlnue using the Unit Allocatlon Methodology
■ to determine costs.
The ALS un/t allocation methodology provldes a fatr and equitabie dlstributlon of funds to ALS agencles.
Unit Allocation Methodolo�r
Refined during the development of the Medic One/EMS 1998-2003 Strategic Plan in 1996,the standard unit cost
allocation model calculates across all ALS agencies the average annual operating costs to run a two-paramedic, 24-hour
medic unit. This methodology ensures a fair and equitable distribution of funds, helps document and justify the ALS
allocation, and establishes 100%funding of ALS services.
The standard unit allocation is the basis for funding each full time medic unit(with the exception of Seattle Medic One).
The standard unit allocation methodology is designed to include only ALS-related operating expenses in order to prevent
cost-shifting to agencies. In principle,averaging ALS costs from each of the agencies could cause cost-shifting to those
agencies above the average standard unit cost. However,the historic range between agencies has not varied greatly,
enabling agencies to modestly adjust their expenditures to prevent cost-shifting.
26
{ �
�
Reco m m e n d at i o n 2■ unit. ALS units starting at$2.12 milllon per
The ALS funding allocatlon Is based on a standard unit cost allocat/on modei appiled to each ALS agency equally
based on the number of ALS units.
Standard Unit Allocation
An equipment allocation fund was created during the 2008-2013 levy period for the purchase of vehicles,
defibrillators, IT equipment and facility improvements directly related to supporting the provision of ALS services.
As a result,the total standard unit allocation now includes two subcategories: the operating allocation and the
equipment allocation. Calculation of the average standard unit allocation for the 2014-2019 levy period required
that each ALS agency report expenditures for year 2011 for a 24-hour medic unit. Each agency's yearly total
expenditures,adjusted for known factors,were then used to project costs during the ne�levy period and averaged to
establish the standard unit allocation for each specific year.
Each individual paramedic agency's annual ALS allocation is determined by multiplying the number of operating
medic units both by the operating allocation and the equipment allocation,and combining these two amounts.
The primary o ea rating expenditure categories included:
ALS specific Personnel Wages and Benefits Vehicle Maintenance&Fuel
Medical Supplies and Equipment Training
ALS specific Facility Costs Other Operational Costs
Dispatch&Communications Indirect Costs
The primary��uipment expenditure categories included:
Medic Units (Patient Transport Vehicles)
Defibrillators
Mobile Data Computers
Radios
Standard Unit Cost Allocation
� � ,
2014 Operational Cost $2,043,121 $2,522,582
2014 Equipment Cost $84,008 $131,642
2014 Total Unit Cost $2,127,129 $2,654,224
During the Medic One/EMS 2014-2019 levy planning process,the ALS Subcommittee discussed options for
improving operational efficiencies and effectiveness. The subcommittee recommended ALS agencies thoroughly
analyze how they might e�end the vehicle life to produce savings in the equipment allocation. The EMS Division will
undertake a comprehensive medic unit life-cycle analysis and adjust the allocation based on results and periodic
review of costs.
27
� � `
PROGRAM AREA - ALS - cont.
Reco m m e n d ati o n 3■ Malntaln 26 medic units(no new additlons).
The►eglonal system has sufflcient ALS capaclty to address growth and does not need to add any new units over the
span of the six-year Medlc One/EMS levy.
• This recommendation is based on continued projected pattern of modest growth in call volumes during the six-
year levy period.
• ALS agencies conclude that there is sufficient capacity within the region to address the anticipated level of growth
without adding units or agencies.
ALS Cauaci#y Analysis
In addition to establishing the standard unit allocation, identifying the anticipated number of new medic units needed
during the 2014-2019 levy period was an important task. As indicated below in Figure 2,the pattern of growth in
paramedic calls,outside the City of Seattle, has changed dramatically since the early 1990's. This is due in large part to
the successful implementation of the ALS dispatch criteria revisions,a major Strategic Initiative from the Medic One/EMS
1998-2003 Strategic Plan. The annual rate of growth during the early 1990's was�6%per year, ranging from 4%to 8%.
Paramedic Service Trends 1990-2011
32,500 _--- ----- ----- -----_ _____ ___
30,337
29,83f
3�,U�� 2g,33B 29,473_
_ .___-______._
____.__ _._-
39,f�&__ ___.__ ----- ___- - -
28,410 28,364
27,605 27.452 27,647
27,500 zs.��4 . _ _ ___ ____ ______ _____. -----
___ __--- _-
_ __—-- --- -------
2s,at�
2�,o�s
26,530 26,213
25,000 __ -- _---- ---_ __ --
_ .______..
___ _—� ----- -----
__-- -- __ ---
—__._
25,281
22,941
22,U2
22�500 __ ___ _ __—
Z0,173
2����� -—- --. ----- ___-- --—_
20,230
17,500
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
The green neon diamond ' reflects a year in which CBD revisions were implemented.
28
+ � �
However,from 1997 through 2006,the average annual rate of growth averaged less than 1%per year, with annual
increases ranging from 10.6%to-7.9%. The pattern of decreased paramedic calls following changes to the dispatch
criteria punctuated with sudden increases is likely due in part to the demand for calls linked to growth in population
no longer being masked by the impact from revisions to the dispatch
criteria. This pattern of containment of demand allowed the Medic
One/EMS system to delay and eliminate the addition of costly �
paramedic units.
� �- � �
�� ,_.
_
Projecting future paramedic demand is an important step in estimating ��� '
the need for additional medic units so that costs could be factored {
„�,
into the 2014-2019 Medic One/EMS Financial Plan. During the past �
five years,a pattern of minimal call volume increases paired with more
recent declines has resulted in an average of over 2%decline per year.
The ALS Subcommittee reviewed unit performance trends and an array
of linear projections to assess whether the anticipated demand could be met with current resources. The group
concluded that there was adequate capacity within the region to manage anticipated demand for the duration of the
coming levy period.
Medic Unit Analysls
Since no new medic units are expected to be needed in the 2014-2019 levy period, it is critical to provide adequate
oversight of the current medic units to ensure continued high performance. The major unit indicators include the
following:
• Unit workload;
• Unit response time;
• Availability in primary service area and dependence on backup;
• Frequency and service impact of multiple alarms; and
• Paramedic exposure to critical skill sets.
Performance indicators do not, by themselves,serve as automatic triggers for adding new paramedic services,
but they do help direct attention to a geographical area of the Medic One/EMS system which may need further
examination. This broad approach to medic unit analysis is needed since there are a variety of inedic unit
environments. Some units operate in small, highly dense areas with high call volumes and short response times,
while others operate in large, more rural areas with lower call volumes and longer response times. Five year trends
are typically reviewed to identify the magnitude of any service gaps to ascertain the degree of need for additional
service.
Prior to implementing any new paramedic service,the region outside the City of Seattle conducts a thorough analysis
of inedic unit performance to determine if inedic units can be moved to alternative locations to better serve the
region. Relocating medic units to new locations is a function of having regional providers of ALS services and is an
important feature of the EMS system in King County. A regional provider can serve many cities without regard to
29
� }
PROGRAM AREA -�LS - cont.
jurisdictional boundaries, unlike other less regionally designed systems. In fact,ALS agencies may relocate units to other
locations without regard to municipal boundaries in order to mitigate the increased stress on the system. �f the regional
review concludes that additional medic unit service is required,a process of approval by the EMS Advisory Committee
and the King County Council ensues.
Recommendation4■ Contlnueto use reserves.
Reserves wlth strict access and usage pollcles are appropriate mechanlsms to cover unanticipated/one-tlme
expenses.
Reserves were included in the Medic One/EMS 2008-2013 Strategic Plan to cover unplanned expenditures,and refined
during the levy period into twelve ALS reserves and contingencies. The ALS Subcommittee recommended simplifying
these twelve ALS reserves and contingencies into four general categories for the 2014-2019 levy period. Recommended
rules and guidelines for accessing the sub-reserves remain similar to the existing reserves with small modifications. Use
of reserves requires review by the EMS Advisory Committee Financial Subcommittee,the EMS Advisory Committee,and
the King County Council (usually through the normal budget process).
R eco m m e n d at i o n 5� �tablish a placeholder(reserve)to fund a 12-
■ hour medic unit.
The ALS Subcommlttee recommends estab/tshing a reserves placeholder to fund the equlvalent of a 12-hour unit tn
2018 should projections slgnlflcantty change.
As a result of the recommendation to add no new paramedic service during the 2014-2019 levy period,the ALS
Subcommittee supported establishing a 12-hour placeholder in a reserve fund to support additional service should
projections change and the identified ALS response capacity be compromised significantly. Thls is a resource to be
used only If demand for services increase sign/flcantly above what!s pro)ected,and Is not Included as a p/an for
adding medlc units. Prior to any request for access to this reserve fund,a comprehensive medic unit analysis and
regional discussion to look for alternative options would take place. Use of reserves requires review by the EMS Advisory
Committee Financial Subcommittee,the EMS Advisory Committee,and the King County Council (usually through the
normal budget process).
R eco m m e n d at i o n 6� Contlnue to refine ALS costs through
■ effectiveness and efficisncies.
Use efflclencies to reflne ALS costs and Increase effectiveness.
As part of the ALS unit cost review process and the assessment to add no new units,the ALS Subcommittee
recommended continued refinement of the ALS unit and agency costs throughout the 2014-2019 levy period. Two
primary approaches were identified,although additional assessments are anticipated: conducting an ALS vehicle life-
cycle assessment, and examining ALS calls to determine options for reducing ALS responses.
30
, �, ,,�,
ALS Vehicle Life Cycle Assessment
ALS vehicles are currently scheduled to be replaced at six-year intervals-three years as primary,three years as back
up. In practice,the schedule varies among ALS agencies,with some using the six-year interval,while others average
ten. Although ail ALS agencies showed great interest in maximizing the replacement cycle,concerns were voiced about
the magnitude of moving from a six-year cycle to a 10-year cycle for some agencies. The ALS Subcommittee agreed
it was reasonable to recalculate the Equipment Allocation using an eight-year medic unit life cycle,and conduct a
comprehensive medic unit life-cycle analysis with adjustments to the allocation based on results of the analysis.
ALS Response Analy�
During the medic unit analysis process to determine projected needs for the 2014-2019 levy period, subsets of ALS calls
were identified that could be better served by a non-ALS response. The ALS Subcommittee recommended a thorough
examination of these ALS calls(with Seattle)to determine options for reducing these ALS responses.
Recom mendation 7■ �nflate annual costs with a Compound Inflator.
Contlnue to use the compound lnflator for ca/cu/atlon of the ALS unit allocatlon increases durtng the 201420191evy.
A critical component of the ALS unit allocation,and subsequently the EMS Financial Plan, is the use of an appropriate
inflationary index that will adequately cover costs throughout the levy period. After thoroughly examining historical costs
and inflationary trends,the ALS Subcommittee recommended continued use of the compound inflator used in the 2008-
2013 levy period with a slight amendment that uses CPI-W instead of CPI-U for wage-related costs and Producer Price
Index(PPI)Commodities(Ambulances)for vehicle costs.
� ' � � � � � �
Salary/Wages CPI-W+ 1%
Overtime CPI-W+ 1%
Benefits Weighted Average
Medical Supplies and Equipment Pharmacies&Drug Stores(PPI)
Office Supplies and Equipment CPI-U
Uniforms, Fire&Safety Supplies CPI-U
Dispatch CPI-W+ 1%
Communication Costs CPI-U
Vehicle Maintenance Costs CPI-W+ 1%
Facility Costs CPI-U
Training Costs CPI-U
Misc.Costs CPI-U
Equipment PPI-Transportation Equipment(EMS)
Overhead CPI-W+ 1%
Total projected ALS service costs during the 2014-2019 levy period can be found on page 68 within the Finance Section of this report.
31
'� ,,�, '
PROGRAM AREA
BASIC LIFE SUPPORT (BLS)
Basic Life Support(BLS) personnel are the"first responders"to an incident, providing immediate basic life support
medical care that includes advanced first aid,CPR and AED use to stabilize the patient. BLS is provided by almost 4,000
firefighters trained as Emergency Medical Technicians(EMTs)who are employed by 30 different fire-based agencies
throughout King County. EMTs receive more than 140 hours of basic training and hospital experience with additional
training in cardiac defibrillation (electrical shocks given to restore a heart rhythm). EMTs are certified by the state
of Washington and are required to complete ongoing continuing education to maintain certification. Like their ALS
counterparts, EMTs are highly practiced and use their BLS skills daily.
aocneu �.,:
� FD
\. NS"rthsh'ois
Shoreilne� fD Wootlinville�� �
#Fp" f t Fire:B Ufe Duvall FD
; �s � �,. ."Safsty � � �KCFD#50.
� , _ _�_ , �--
_._ „--_,.
� �� �'Ki�clan �,� E`: :. �� �
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, � � � ._�_ .__..._ _ �.,_ ____�___ �
5 ` , _
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1� vj ! � f�`t - ' Rre d�
e�
�"Sea FD ' �,A,� Ressue
,' f� Beil vu FD"` ; �"" _---
�'�`�- sz� C D' ,�
, r ~�land F` �a�_� , '' ��'' _+
Port�,ot j �" ����� � _
Seattls FD 5 No �� � 5�ualmie FD
r;:� HighitnetF K�FD� � ��re a �� � a'e�,�'
:_; � �2p;. _ ..
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,: , � �D�Fi � margeney ` i 8 �
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� ry �`SeaT�c• � � - _t-' Pass�FD`
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,_ a-�v� .� �..?� �. '��ffe�Safety� ___,, � ��
� ���r� � ���� ; �
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uth€ , __.. KCFD#47;
Jre 8i ``��
� ys�� .. KCFD#44 y t Fire Depa►tment
R gional Flra�, - i ServiCe Areas
A!�u+ . ' ` Y--t K%»g COunty 2012
� �� �)
Y Enumclaw�FD � N
�;, W�E
, $
0 2.5 5 �M���
. . ..�i.ei�e�^� .
Public Health,,�
�� � � � . Seatde&King County�� �o.an,�«o.
� . . . � .. . . . - An,am."m°w
Basic Life Support Agencies in King County
As the first-on-scene provider, BLS contributes significantly to the success of the Medic One/EMS system. BLS agencies
must arrive quickly and provide effective and precise medical care. Although BLS is only partially funded through the
EMS levy, it is an integral piece of the interdependency on which the King County response system is built.
32
• ;,�,, �,,
In 2011, EMTs responded to over 164,000 calls for � - I
emergency medical care in King County. Figure 3 I Population 8 BLS Call Volume '
i z �-- -- --_------- ___ - -- --- ----� zoo I
reflects the trend of steady rate of BLS calls over I I
the past five years despite the continued increase in i �.ss t � t ,S� � �
� 7.9 fi � 760 �
population in the region. The average response time ; o �.ss � �ao L
of BLS units in the county is 4.9 minutes with units i = ��8 � �zo ;, ;
i � �.�s � � � + �oo o �
responding to over 77%of the calls in less than 6.0 ; o � ,
, w �.� � I
minutes. EMTs are more likely to tend to younger I o �.65 '- � so �
patients(49.1%of BLS calls are 25-64yrs)for trauma �� a ��s ; - I ao m �
,.55 � � Z�
conditions(25.6%of BLS calis),although they do not ; � o !
�.s ,- _�_ y_ -�- ° �
transport 24.2%of the time. i Zoo� 2ooa zoos zo�o zo��
i � __ --- --- --- �
_�Population -O-BLS Call Voiume I
; - ---- - -._.__ —-- !
� �
Figure 3: King County BLS population and call volume
BLS SUBCOMMIITEE
The BLS Subcommittee focused its efforts on determining whether the BLS funding formula could be improved, and
identifying service enhancements and efficiencies. As a result,the group played a prominent role in developing and
supporting regional programs that address managing BLS demand,and increasingthe role of BLS agencies in regional
decision-making.
Ths BLS Subcommittee adopted the following principles to guide its decision-making:
1. Malntain ALS as the Funding Priorlty
Advanced Life Support(ALS)will remain the primary recipient of the Medic One/EMS levy and the first commitment for
funding within the Medic One/EMS system.
2. Provide Funding for BLS Costs as Appropriate with Levy Funds
Basic Life Support(BLS)will continue to receive limited EMS levy funds to support BLS agency costs as appropriate.
The BLS Subcommittee recommendatlons are as follows:
_ � �� � ,
� �� � 7. .m.. � �,� w� � �� ��.�� � a��� �-� a�d
, .
. °> �
,�� . .; .a � ��s ". r. , �.�> ..� �_F �.
��� , .� �� . � �� � . �, �'.�. � � _ �;�. � .r:.� �
��
$=.=' �_ ,+�rv'.,x`";a S.t�„ � .,.3'��. ar< i3�"rf.,., . � �%t * !s�; . �. ,.,� ;.�� ..'s r,. ..1''� t, >:' <�. �t f�.r . ,.; E -e�s, _
. . _. . . .. _. . . .. ...� �.�'�x
�, r
�.. .,_x.. f.�. �., 'ha 1 r . ��t .t ., _ ;�d §,4� ...h"A,., g° ...,+ akM �'�',.,.
BLS Funding Formula
The BLS Subcommittee examined seven different funding alternatives to the 2008-2013 BLS funding allocation formula
in an effort to thoroughly examine other distribution options. Criteria for review included stability, reliability,equity,and
simplicity. Following this extensive review process,the existing formula was selected as the preferred option at this time.
33
� `� '
PROGRAM AREA - BLS - cont.
� �`�"M�'�i�`$€.�3�'�s°'��� �s�, x.� ��T.:���$�,i�.���€"_�'��w�w' . � :;�"'+2�.' ��'t'��'�
� �
. . . .. .. . . , . .. _ .. . � �':S.a� .,���,�i���;��a��`.�':���`�,�3'he���`§:s��� �k�<�'�"a.� �#.,n�..:>?'��
+ry- .-s ;�3 �,�ax z '���� z ',�"� �> "r-, � _
. � � " " � t&�� .,�, ����. s #�.�_� _3 ., .
r; _r.�>�#it�' e� ..,��x .
a'!��k.$��: �`:'s.._�'�r,�... ��a:, a.aa..�"cx , ,. £,�,c� s,. e7p°��a.S�.a$t�'>. ��, 5.�,.- , , '
�„s+-�� � .�'Y��,-��$":'�.ai.�i
Total BLS Allocatlon
For the 2008-2013 EMS levy,an increase in the total BLS allocation was adopted to cover a higher proportion of the local
BLS costs. To determine the funding level, BLS agencies completed a standardized costing template to invoice specific
EMS-related costs across the region. Stakeholders recognized that full funding of BLS costs was not feasible,and
instead agreed to a funding level that existed within the 2008-2013 levy.
Due to current economic challenges related to the significant decline in assessed values in King County,the BLS
Subcommittee advocated for continued support of a total BLS allocation amount that preserved at least the same
proportion to the total EMS levy amount as planned in the 2008-2013 levy period(estimated at�23%). BLS agencies
recognized that although the Medic One/EMS levy supports primarily paramedic(ALS)service,a significant reduction in
the BLS allocation would have a severely detrimental effect on this essential tier of the EMS system.
� � �k� 3�d a�` a � �"'�•` i�r>"-� �#�'=„�t?,.�'�,�r��c'x .,��_§*.:"`S';�.
. � S9��.��..�:�#F . �'s�<'� .�..,.�a��,�.
ti, r.r�- ¢¢'� s-;�t4£� '' s>.C�,�. ... , � f.._=7¢. < � �_:�„,t ��,�,. x ,. ��". �3_ t.�. . . '� ,Y..�z. �� ,. _` �,€�3, e .w.:'r, as°€�r �,
_, y .-�. _. . _ _ . _ <
Property tax revenues that support emergency medical services in King County have fallen markedly, resulting in reduced
funding for BLS agencies. Despite these difficult conditions,the BLS Subcommittee realized an increased total BLS
allocation was not reasonable. Instead,the group supported delivering programs on a regional basis to help reduce BLS
costs and improve effectiveness.
Programs that�rovide better support and engage BLS agencies�
a. The Regional Records Management System will reduce costs incurred by agencies in managing records by having
the EMS Division assume such responsibility, both administratively and financially.
b. The expanded BLS Efflciencies Program will focus on providing the most cost effective and appropriate response
and transport. This should help lead to a decrease in BLS responses(producing cost savings)and make units available
for responding to other emergency calls. This will also result in reduced stress on the entire Medic One/EMS system and
greater EMS system effectiveness. The Taxi Voucher Program and the Community Medical Technician (CMT) Pilot are
both part of this program.
34
� � �
c. The BLS Lead Agency will coordinate BLS-related issues on a multi-agency local level, resulting in increased
knowledge, proficiency and collaboration among agencies.The concept involves regional analysis of BLS unit placement,
similar to the ALS analysis, cooperative procurement and data abstraction on a multi-agency cooperative level. The
concept is intended to be piloted as a Strategic Initiative to demonstrate the value added concept to the system.
. . ��� ��__-.� ' � �� �
����...������,:.���; „ � ,� �:��€�se�;Lc�,. .:�s"� ax;:'k��.�,,.7.a�-a;..�. �, e•`r _`k` .: r. ..
,. . . . .. . ._ ; ,.. s�-,
.,�
z. <.., ... ,. .,,.. i, ..e . _ , , 4,":`3_� �l t :" f .,
,-.. _ Y�_ _ .
s�. �,a- _
- _ .e . . ,. � ,< .,- ._ # .�.y S .-„ c.+ �t Ey f t..�y4�E ,. .. .
BLS agencies use the Medic One/EMS levy allocation to pay for a variety of EMS-specific items including personnel,
equipment and supplies. Since these items have differing inflationary trends, no one specific inflator would accurately
reflect their increasing costs. However,since most BLS costs are related to wages,the BLS Subcommittee determined
that using a standard CPI inflator tied to wages(CP�-W)as forecast by the King County economist was preferable.
Total projected BLS service costs during the 2014-2019 levy period can be found on page 69 within the Finance Section of this report.
35
.
PROGRAM AREA - Regional Services & St a egic Initiatives
Regional Services and Strategic Initiatives
Regional Services and Strategic Initiatives support the direct service activities and key elements of the Medic One/EMS
system. Regional Services are critical to providing the highest quality out-of-hospital emergency care available. These
programs help tie together the regional medical model components by providing uniform regional medical direction,
standardized EMT and emergency dispatch training, paramedic continuing education,centralized data collection,
paramedic service planning and analysis, and administrative support and financial management of the regional EMS levy
fund.
Strategic Initiatives are innovative pilot programs and operations that aim to improve the quality of Medic One/
EMS services,and manage the growth and cost of the system. Once completed and proven successful,they may be
incorporated into Regional Services as ongoing programs.
Strategic Initiatives have allowed the Medic One/EMS program
in King County to maintain its role as a national leader in its
field,and have been key in the system's ability to manage its -
costs.
�
:r�:
One of the many reasons the EMS system in King County is so � � "
medically effective is the extension of regional programs across
the different segments of the entire Medic One/EMS system.
For example, injury prevention programs help ensure the safe
use of car seats for infants and prevent falls among the elderly;
and CPR and Automated External Defibrillator(AED)programs help ensure that witnesses to cardiac arrests will have the
necessary training to notify 9-1-1 quickly and provide initial care at the scene until EMTs and paramedics arrive.
The EMS Division oversees these Regional Services and Strategic Initiatives and plays a significant role in developing,
administering and evaluating critical EMS system activities:
Regional Medical Control Regional Medlcal Quality Improvement
Best medical practices drive every aspect of the Medic EMS Medical Quality Improvement(QI) is the practice of
One/EMS system and are a main component in the programmatic,scientific,and case-based EMS system
system's success. Vital to this is a strong Medical evaluation to assure excellence in patient care. The
Program Director to oversee all aspects of inedical Regional Medical QI Section partners with investigators
care and hold people within the system accountable. in the EMS Division and at the University of Washington,
Responsibilities include writing and approving the patient allowing for collaboration across the academic and
care protocols for both paramedics and EMTs,approving operational Medic One/EMS community. QI projects
initial and continuing EMT medical education,approving impact all components of the Medic One/EMS system
Criteria Based CBD Guidelines, undertaking new and and have shed light on a more streamlined approach to
ongoing medical quality improvement activities, initiating administering CPR(usingjust chest compressions and
disciplinary actions,and working closely with the Central no rescue breaths), explored ways to improve challenges
Region Trauma Council, experienced by those with limited English proficiency
36
,
� �
when calling 9-1-1 for help, and reinforced work with fire CPR/AED Training� The EMS Division offers programs to
departments to improve ALS and BLS practices in the field. King County residents teaching them to administer life-
saving techniques until EMS agencies arrive at the scene.
Training This includes CPR classes with an emphasis on training
EMT Trainin�: The EMS Division provides initial training, teachers and students. Thousands of secondary school
continuing education and instructor/evaluator education students receive instruction on CPR and AED training each
for EMTs in King County. Through considerable research, year. In addition,a regional Public Access Defibrillation
coordination and communication among Medic One/ program encourages the registration and placement of
EMS stakeholders and the Medical Program Directors, AED instruments in the community within public facilities,
the Division develops the curricula that ensure the businesses and private homes for high-risk patients.
training and educational programs meet individual
agency,Washington State and National requirements. Growth Management
The Division is the liaison between the Washington State Managing growth reduces the stress on the Medic One/
Department of Health and the 29 EMS/fire agencies in EMS system, contributing to the overall efficiency and
King County,and relays continuing education,certification, effectiveness of the program. The region applies many
and regulatory and policy changes to Medic One/EMS different approaches to manage the rate of call growth in
agencies. the EMS system and address the demand for services.
Programs like the Communities of Care and SPHERE
Dispatch Training: Sending the appropriate resource identify and target specific users of the EMS system to
in the appropriate manner is a critical link in the EMS reduce "repeaY' callers or the inappropriate calling for 9-1-
system. The EMS Division provides comprehensive initial 1 services.
and continuing education training to dispatchers in King
County,outside the City of Seattle. Developed by the To reduce the demand of paramedic response,the
EMS Division, King County dispatchers follow medically region reviews the dispatch guidelines to safely limit the
approved emergency triage guidelines called Criteria frequency with which ALS is dispatched. Significant focus
Based Guidelines(CBD). Criteria Based dispatch uses is placed on providing alternative, more cost-effective
specific medical criteria, based on signs and symptoms,to responses that offer appropriate, high quality care to 9-1-1
send the appropriate level of care. patients with low acuity medical needs. The EMS Division
works with partner agencies to provide injury prevention
programs to appropriately install child seats, educate
,.-„�_>.
people about the dangers of distracted driving and
�. .
mitigate potential falls among older adults.
Regional Leadershlp and Management
Financial and administrative leadership and support to
internal and external customers are roles the EMS Division
plays to ensure the integrity and transparency of the entire
system. The EMS Division actively engages with regional
partners to implement the Medic One/EMS Strategic Plan,
manage EMS levy funds, monitor contract and medical
37
/
� �
PROGRAM AREA - RS & SI - cont.
compliance and performance, identify and participate in Center for the Evaluation of Emergency Medical
countywide business improvement processes,facilitate Services(CEEMS)
the recertification process for the 4,000 EMT's in King The CEEMS section conducts research aimed at improving
County, and maintain the continuity of business in the delivery of pre-hospital emergency care and advancing
collaboration with Medic One/EMS stakeholders. the science of cardiac arrest resuscitation. It is funded
by grants from private foundations,state agencies,and
Included in this is regional planning for the Medic One/ federal institutions.CEEMS is a collaborative effort
EMS system which monitors medic unit performance,the between the EMS Division and academic faculty from the
periodic assessment of inedic unit placement and other University of Washington who are recognized nationally for
system parameters. Regional planning analyzes medic their contributions in the care and treatment of cardiac
unit demand projections and measures the impacts of emergencies.Achievements made by this collective effort
regional programs,supported by ongoing data quality continue to improve outcomes from sudden cardiac arrest
improvement activities. and advance evidenced-based care and treatment.
REGIONAL SERVICES SUBCOMMITTEE:
The Regional Services Subcommittee dedicated a great deal of time systematically assessing the current Medic One/
EMS regional programs and responsibilities, including reviewing each program, its benefits and its costs. Participants
reviewed performance measures and outcomes to determine whether the programs and Strategic Initiatives were
reaching their audiences and accomplishing their intended goals. This analysis also included review of the 2008-
2013 Strategic Initiatives and whether they warranted integration into Regional Services as on-going programs within
the EMS Division. Ideas for new Strategic Initiatives emerged as the various subcommittees debated efficiencies and
effectiveness measures. The EMS Division worked with various Stakeholders to develop particular proposals, bringing
ideas back to the Regional Services Subcommittee for review and consideration. All subcommittees were kept apprised
as proposals evolved.
The Regional Services Subcommiitee adopted the following prfnciples to guide its decision-making:
1. Emergent Community Needs Programs will focus on meeting the emergent community needs to maintain or
improve standards of patient care.
2. Medical QI and Patient Care Medical Quality Improvement will be conducted to improve patient care and
must be overseen by a physician.
3. Sy�tem Efficlencfes Resources will continue to be managed to achieve effectiveness and efficiencies that
focus on:
a) Improving the quality of EMS services;
b) Managing the rate of growth; and
c)Containing costs with no degradation of services.
4. Maintaln Strate�ic Inftiatives Strategic Initiatives to meet the directives of system effectiveness and efficiencies
will be maintained,and new initiatives will be created as appropriate.
38
. � �
The Regional Services Subcommittee recommendatlons are as follows:
Reco m m e n d at i o n 1� Contlnue delivering programs that provlde
■ essentlal support to the system.
Such programs and services focus on superior medical training, oversight and improvement, innovation, data
management, regional leadership and efficiencies.
The Regional Services Subcommittee advocated for the continuation of programs that support the direct service activities
and key elements of the Medic One/EMS system. Appendix A: Regional Services to be Funded on page 73 lists and
describes these programs.
Reco m m e n d at i o n 2■ eme ging needs.hance programs to meet
Enhancements wil�broaden the reach and advance the goals of programs.
Integral to maintaining any high quality Medic One/EMS system is making improvements and innovations in the
management,scope and standards of core programs. Enhancements are recommended to broaden the reach of
programs and advance the goals of the programs.
R eco m m e n d at i o n 3� Eliminate some services that are no longer
■ needed or can be better provided on a local basis.
Elimination of services that duplicate efforts or can be assumed by another agency offers better e�ciencies.
Program Ratlonale for Discontinuing
Targeted CPR Training Regional Numerous hospitals provide such outreach to patients and
Service their families
Preschool Injury Prevention Continues through other Fire Departments
Program Regional Service
Critical Incident Stress Reduced requests for the program can be handled more
Management(CISM) Regional efficiently and effectively at the agency level
Service
All Hazards Management Efforts to coordinate Emergency Management are currently
Preparation Strategic Initiative undertaken by ALS agencies and Public Health-Seattle& King
County Preparedness
Injury Prevention Grant Writer Eliminated due to lack of revenues generated through the
Strategic Initiative position
39
� � �
PROGRAM AREA - RS & SI - cont.
Recom mendation 4■ Contlnue audits by King County Audvtor's office.
Consistent assessments help ensure the regional system is operating e�ciently and effectively. The system directly
benefits from such audits.
The King County Auditor's Office currently conducts an annual audit of EMS,as established by Ordinance as part of
the 2007 Medic One/EMS levy approval package. This review was designed to ensure financial and programmatic
operations were managed in accordance with the Council-adopted levy policies and financial plan. Each audit resulted
in positive findings along with recommendations that were practical, reasonable and once implemented,encouraged
enhanced EMS fund management and additional system efficiencies.
The Regional Services Subcommittee unanimously supported consistent assessments of the EMS system. Based upon
the positive reviews from the 2008-2011 audits,the Subcommittee recommended that the King County Auditor continue
audits on a periodic basis. Additionally,the Subcommittee requested examining and enhancing the current quality
improvement and system assessment programs. This will require convening regional partners to discuss the system's
structure from an operational and clinical perspective to identify areas for continuous improvement and the standards
for measuring system performance.
Recommendation 5� Convert 10 successful/proven Strateglc
■ Initiatives into RegOonal Services.
These programs enhance dispatching, injury prevention, and the timeliness and quality of EMS data, increasing EMS
system effectiveness.
Strategic Initiatives that achieved their intended outcomes and/or demonstrated efficacy were recommended for
incorporation into Regional Services as ongoing programs. Appendix A: Regional Services to be Funded on page 73 lists
and describes such programs.
Reco m m e n d at i o n G■ �nitiate three new Strategic Initiatives.
Areas identified inciude targeting repeat callers, reducing the inappropriate use of EMS services, and better supporting
and engaging BLS agencies with economic and quality improvement opportunities on a local level.
1. Vulnerable Populatlons
Provides EMS personnel with better tools to work with patients from vulnerable populations. This is a multi-year
evaluation to assure that EMS care is the best possible, regardless of race, ethnicity,age,socio-economic status,
culture,gender or language spoken.
2. Regfonal Records Management Svstem
Transfers the management of and financial responsibility for records management systems from indivival agencies to
the EMS Division.
40
. ;�, ,�rr�`
3. BLS Lead Agency
Tests the concept of designating a lead BLS agency to coordinate BLS-related issues for economic and quality
improvement. This could better engage several smaller BLS agencies on a local level, increasing quality improvement,
providing greater depth of knowledge and proficiency among BLS crews,and offering comprehensive interaction with
other lead BLS agencies and the EMS Division,The concept anticipates a lead agency would handle combined efforts
of data abstraction and analysis from a multiple agency perspective; provide BLS unit analysis similar to the successful
regional ALS unit analysis; assist with coordinated case review; help organize procurement and medical equipment
standardization;and coordinate other economic and quality improvement focus areas that could provide regional benefit
if conducted on a regional and multi-agency level, rather than independent and local levels.
Reco m m e n d at i o n 7■ Retool three current Strategic Initiatives.
Enhancements will support a greater range of continuous improvement projects to supplement current system
performance,and better manage demand and expected growth in request for BLS assistance.
1. BLS Efftciencies
Further develops strategies to manage current demand and expected future growth in requests for BLS assistance. Will
focus on providing more cost-effective and appropriate response and transport,and minimizing unnecessary transport.
2. EMS Efflctency&Effectiveness Studies
Funds can be used to support a range of continuous improvement projects to supplement current system performance.
For the 2014-2019 levy,this Initiative is revamped with additional focus on performance measures/outcomes/metrics.
It also makes funding explicitly available to EMS agencies via grants to develop and implement projects related to
improving operational efficiencies and effectiveness.
3. Community Medical Techniclan(CMT1
CMTs are sent on lower acuity calls in non-transport capable units to provide basic patient evaluation,assistance,
specific BLS treatment on scene,and arrange for transport if inedically necessary. CMT's may also refer patients to
community services such as the One Step Ahead fall prevention program, and other senior information and assistance
programs. The levy proposal includes slowly phasing in three regional units to help the region further examine how to
build capacity for future growth, along with reserves for an additional two unit,should the project be successful.
R eco m m e n d at i o n 8� �nflate annual Reglonal Services and Strategic
■ Initiatives cost using CPI-W+ 1%.
This inflator wf11 be based on the forecast of the econom►st at the King County Budget Offlce.
Inclusion of an appropriate inflationary index that will adequately cover Regional Service and Strategic Initiative costs
throughout the levy period is essential. Since most costs are related to wages,the Regional Services Subcommittee
determined that using a standard CPI inflator tied to wages(CPI-W)as forecast by the King County economist was
prefera ble.
Total projected Regional Services and Strategic Initiative costs during the 2014-2019 levy period can be found on page 69 within the
Finance Section of this report.
41
Medic One EMS 20 4-2019 EMS FINANCIA� PLAN
/
20142019 FINANCIAL PLAN OVERVIEW
The EMS Advisory Task Force recommended a financial plan based on programmatic needs developed by the
subcommittees. This financial plan builds on key services from the previous levy, reviewed and decreased expenditure
levels as appropriate,and was able to incorporate more services into a lower expense amount than if the current plan
had been continued into the 2014-2019 levy period.
The foliowing table summarizes the estimated expenditures, required revenues and related levy rate for the 2014-2019
levy period.
� � - � � - �
• •
Expe n d itu res $682.0
Reserves* $12.4
�
Buy-down funds from 2008-2013 levy $21.3
Revenues needed for 2014-2019 levy $673.1
E _ 1 F
1 1 1
*Including conversion of required fund balance to cash flow reserve
The Medic One/EMS 2014-2019 Financial Plan is based on minimal increases in expenditure levels from 2013.
Expenditure levels were reviewed and, if appropriate, reduced from 2013 levels. The overall increase from 2013 to 2014
is 1%. Key components include:
• Decreased ALS Operating Allocation (based on 2011 actual ALS costs);decrease of 2%(approximately
$35,000 per unit in 2014)from the cost of continuing the 2008-2013 funding level in the new levy period;
� Reduced ALS equipment allocation by e�endingthe lifespan on key equipment; decrease of 15%;
• Reduced BLS allocation to allow annual increase of CPI + 1%and remain at an overall levy amount similar to the
BLS portion of the 2008-2013 levy;
■ Incorporation of Regional Services conversion and elimination of appropriate programs;
• Lowered level of funding for Strategic Initiatives planned for 2014-2019;and
• Yearly increases in expenditures based on inflation indices(see Recommendation #3).
42
.
�rrr+° �
Reserves are continued for the 2014-2019 levy period. The EMS Division will continue to refine reserve policies as
required and needed.
• Reserves and Contingencies were included in the 2008-2013 financial plan. The King County Auditor's Office
found that the original usage policies limited agencies'ability to access reserves,and recommended that the
region revise reserve amounts and access policies.
• The 2014-2019 levy planning process led to modest changes and simplified reserve categories.
• To comply with new King County Reserve policies adopted after the subcommittees completed their review,the
End Fund Balance has been converted to a Cash Flow reserve.
Prajetted Expenses and Re�enues �
(!n Mi!lions)
,
$140 �-----------
__--- ------------------__...--------___---------
i i
$120 ;_---.�------- ___---------_-------------------------- �
—
i � � �
$100 �— ----- ---____
i
$80 '
i
$60 '
�--. -- --— -_ -- --- (
; --- --.
�.o r-- _— ----- -- ----- — — �
:
,
s2o �-- -- -- ----- ---- -
;
s- !- ----- ----
2014 2015 2Q16 2017 2018 2019
� Projected Revenues ■ Projected Expenses �
Revenues are planned to cover expenditures across the 2014-2019 levy period.
• Revenues collected in the early years of the levy cover expenditures planned for the later years of the levy.
• Revenue needs were reduced by including carryover of approximately$21 million from the 2008-2013 plan,
which is roughly equivalent to 1.6 cents of levy rate. This reflects aggressive management of funds over the
span of the 2008-2013 levy, based particularly on the knowledge that reduced AV levels would require a higher
levy rate to maintain current services.
• Revenues are forecast at 65%confidence interval to reduce the risk of revenue under-realization to the EMS
system.
43
.
Medic One/EMS 20 4-2019 EMS FINANCI� PLAN - cont.
BACKGROUND
Regional EMS partners and Stakeholders expect accountability and transparency in the management of EMS levy funds.
The EMS Division administers these funds in a responsible manner to meet system goals and objectives. To do so, it
relies on EMS partners across all aspects of the system to manage costs, increase operational efficiencies,and manage
growth in demand for services. During the 2008-2013 levy period,this shared fiscal responsibility enabled the region to
continue to provide essential emergency medical services and successfully adapt to the financial conditions imposed by
the economic downturn. Confirmation of the region's broad-based commmitment to financial stewardship and integrity
is evident in the King County Auditor's Office past four annual reviews.
The following guiding principles and practices were used in the development of the 2014-2019 Financial Plan:
• The Medic One/EMS levy will support the continuation of quality medical services and supply adequate
funding to provide these services;
• The EMS Division will continue to provide oversight and transparency of system finances;
• Advanced Life Support(ALS)services will remain the priority of the Medic One/EMS levy;
• Basic Life Support(BLS)services will be funded through a combination of local taxes and Medic One/EMS
levy funds;
• The EMS Division is responsible for the coordination and facilitation of collaborative activities necessary to
assure the success of the regional strategic and financial plans;and
� The EMS Division and regional partners will continue to evaluate the efficacy and funding of programs from a
system-wide perspective.
� e : s - - g � 9 � r :
p i . f : t " ' 9 3 9 � 4 ! -
� � $ iR ' e e • a �' y �a ��,
�
� �
�
� e c a f i i
t � a .� � � � � a �� a 4 : or c.: 4 � a
EMS 2008-2013 CHALLENGES
Revenue Reductions: One key challenge the region faced during the 2008-2013 EMS levy period was the large drop
in Assessed Valuations(AV) not envisioned when the levy was planned in 2006. For the first time in the history of the
levy,actual funds raised by property taxes decreased over the six 6-year levy period. Projected property AV for 2013 is
anticipated at 10% less than actual 2008 AV,and 33°/o less than the level planned for the 2008-2013 levy.
44
, � '`�r�
The following chart shows the difference between planned (2008 levy plan)and actual assessed valuation changes over
the 2008-2013 levy period.
__ —-— ----- _----_ _------ --.—_._ _--- --_-------— -_-----
- �
Changes in Property Assessed Values �
2008 through 2013 ;
■Planned ❑Actuaf �
2008 2009 2010 1011 2012 2013 =
14% 13ib �
� 7�O 696 6% �
6% 5% 4% �
_ _ _ _ _ _ ■.___._ _..■ --
_ u U u
-3% _q% 3%
-12%
—_ �.�_���v �!
The overall property tax assessment(the amount that is billed to taxpayers)can increase at a level of 1%a year plus
new construction. New construction values allow the assessments to grow at a higher rate and are an important part of
the calculation of the amount collected. The original 2008-2013 levy plan assumed total property tax increases at 3%
per year;this includes 1%from existing properties and 2%from new construction. During the economic downturn, new
construction AV dropped drastically from a high of$8.1 billion in 2009 to a low of$2.4 billion in 2012.
The following chart shows the difference between planned (2008 levy plan)and actual new construction changes over
the 2008-2013 levy period.
� Changes in New Construction �
2008 through 2013
■Planned �Actual �
2008 2009 2010 2011 2012 2013 �
25°,6
9% 4% I
2% 2% � 2% 2% 240 2%
_ __�._—�a____--� - -.■� __�j�'�_.
_ _�
-6�
-34% �
-52% �
:
�� _� I
45
� ,
Medic One/EMS 2014-2019 EMS FINANCIA�PLAN - cont.
The reductions in AV were so significant that they capped the EMS levy at 30 cents. This means that property taxes,
rather than increasing,actually decreased. The Medic One/EMS system met this financial challenge,first and foremost,
by prioritizing its use of funds without negatively impacting key services and outcomes.The following chart shows
planned and actual property tax assessments for the 2008-2013 levy period.
_ � _____,� --�
�
Property Tax Assessments- Planned and Actual �
I
Siio.o — �
i
$ioo.o
�
,
�
Sso.o j
i
�
$60.0 — I,
!
$ao.o
�
$Zo.o i
�
;
�
�
$_ _ ' . �
2008 2009 2010 2011 2012 2013 �
�
�
�Actual and Forecast �Original Plan —Linear(Actual and Forecast) ,
�
nanticipated Costs: Due to factors not known during levy planning in 2006,ALS agencies experienced unique costs that
were not part of the unit methodology used for allocating levy funds. Although the Financial Plan included contingencies
and reserves,the strict usage policies prevented them from being applied toward such unique/one-time costs. This was
mirrored in the King County Auditor's Office 2009 recommendations and provided an excellent opportunity to reexamine
and adjust financial policies to enhance the management of the EMS levy funds. The EMS Division worked with ALS
agencies to better define eligible ALS costs and reserve categories,and develop an approach to fund unanticipated costs
experienced by ALS agencies.
Reduced Allocations: The economic downturn not only reduced AV(which reduced revenue), but also resulted in reduced
inflation. Since the allocations are tied to published inflators,this reduced allocations for all program areas, posing a
challenge to some agencies. For example,the KC EMS Fund BLS allocation was projected to total $93 million over the
2008-2013 levy. Actuals are$91 million, or$2 million less than planned. All impacted parties, including ALS and BLS
agencies and the EMS Division, managed within these reduced allocations. The net impact, however,was expenditure
reductions that will ultimately meet, if not exceed, declines in revenue.
46
� � �
The region addressed the challenges through aggressively managing expenditures. This included focusing on programs
and initiatives that manage the growth of services(particularly ALS services which are fully funded by the EMS levy).
EMS FINANCIAL POLICIES
Financial policies for the 2008-2013 levy period were located throughout the Strategic Plan and referenced in many
different documents. As reserves were refined,and financial policies were further collected and clarified,the EMS
Division developed a written EMS Financial Policy(PHL 9-2). This policy document includes definitions, policies,and
procedures with actions required by EMS Division and EMS agencies. Worksheets and reporting forms are included as
appendices. Refining and placing financial policies in one location assisted with the transparency of the regional system
services and finances. Key areas covered by the Financial Policies include:
. ,
Oversight and management of EMS levy funds;
Methodology for fairly relmbursing ALS agencies for eligible costs, including responsibilities by both the EMS Division
and ALS agencies related to Operating and Equipment Allocations;
Requlred reporting by ALS agencies with review and analysis by EMS Division;
Methodologies for BLS,Reglonal Services and Strategic Initiatives funding;
Regional Services and Strategic Initlatives management; and
Revlew and management of reserves and designations including program balances.
EMS 20142019 ANTICIPATED CHALLENGES
_ __ _ - __ _
PYOjeCt@d ASS2SS2d V81UatIOnS: Comparison of Assessed Valuation and Property Tax �
� Assessments (30 cents/$1,000 AV) i
Assessed valuations in 2014,the first year of the proposed �
new levy, are projected to be 6% less than assessed s�al i
� Sazo '
valuations in 2008,a difference of approximately$20 billion. i ;
The 30 cent levy rate from the 2014-2019 levy will not bring � �
: ;
in sufficient funds to continue EMS services from the 2008- ;
i ',
2013 levy. While the 30 cent levy rate in 2008 resulted in ;
� $103 S% j
an assessment of$103 million,the same levy rate in 2014
is projected to raise$96 million. This 2014 amount at 30 ; ;
cents�s$7 million/ess,or 6.S%less,than the amount ! ----- _________ ___ _ �
� zooa xoia l
raised at 30 cents in 200$.
� �Assessed Values in Biliions�Property Taxes(Assessment)in Miliions
i i
47
`�' .
Medic One/EMS 2014-2019 EMS FINANCIA�PLAN - cont.
��nsitivity to Cost Increases:
The EMS system is sensitive to the costs of services provided by government agencies. In addition, King County has
a goal of keeping the growth of services to the cost of living(CPI} plus increased population. This not only requires
managing the costs related to existing services, but also managing growth of services.
Many of the past levy periods have incorporated significant new programs. The last levy period also included a
significant increase in support for BLS agencies. The following chart shows increases in the last two levy periods. There
was an overall increase of almost 17% between the levy ending in 2001 and the beginning of the 2002-2007 levy. There
was a 36%increase between the end of the 2002-2007 levy and the beginning of the 2008 levy. There was a 43%
cumulative increase over the two year implementation of new programs,services,and BLS funding(through 2009).
; EMS Levy Historical Expenditures ;
, �
I i ,
;
� _ - - ,
I $140 r---- --------- —_---- �
i
%
$120 '-------------------------------_--------__--___—__-___------- ------- �
i i i
; -- —____ '_ 1�
--- --------------_
$100 r---- � ;
�
i � �.,�: i
I . �
� Sso j----- ---- ------ — --- -- �
i %
i Seo � --------- ------------ �
�- 1
I
� � i
� �4� 6..
i '
;
! �
$20 ;
�I
�I $ 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 �i
i
� ■City of Seattle =?King County EMS Fund �
Division of Revenues: Property tax revenues are distributed proportionately between the City of Seattle and the King
County EMS Fund based on Assessed Valuation (AV). Change in distribution can affect either fund. The division of AV
remained stable at approximately 35.4%from 2002-2009. However,the economic downturn,with its reduced AVs,
changed the traditional proportion. This was due to the AVs in the balance of King County, particularly the outlying
areas,dropping more than the City of Seattle.
Comparison of Dlvislon of AV across Levy Periods
Average %ofAssessed Value
City of Seattle 35.69% 36.19% 36.42%
KC EMS Fund 64.31°/a 63.81% 63.58%
48
� � �
Maintaining Services: Another key challenge was maintaining key services and innovative strategies in light of continued
reduced revenues, potential growth in demand, expenditure growth expectations,and uncertainty(particularly since
the levy would be projecting many years out -through 2019). The EMS system is known for the delivery of effective
programs that can be implemented across the region, and the challenge will be how to maintain this culture of
excellence,as evidenced by improved patient outcomes.
l�ncertainty: With the economic downturn, health care reform laws, and other pending changes in services,the 2014-
2019 levy period presented additional challenges not present in previous levy planning processes. Again,these unknown
elements create challenges in anticipating the impacts on the EMS system so many years in advance.
FINANCE SUBCOMMITTEE
New to the levy planning process was the addition of the Finance Subcommittee to assess the programmatic
recommendations developed by the other subcommittees,and provide financial perspective and advice to the Task
Force. As the ALS, BLS and Regional Services Subcommittees each developed its own set of recommendations specific
to their program areas,the Finance Subcommittee reviewed the proposals as a whole package, rather than as individual
and independent pieces,to ensure it was well balanced and financially prudent.
The Finance Subcommittee identified transparency and accountability,which encompassed the judicious use of funds
entrusted to EMS by the taxpayers and inclusion of clear financial policies,as a requirement of the 2014-2019 Strategic
Plan. It reviewed economic forecasts, proposed expenditures,determined which indices to use to inflate annual costs,
and examined policies and procedures.
In an effort to appropriately evaluate components of the Task Force's Proposal,the Finance Subcommittee used the
following criteria to guide policy decisions:
1. Maintain Integrity of the System
2. Provide Financial Stability
3. Ensure Financial Stewardship
4. Secure Broad-based Support
5. Sustain Public Consistency
As programmatic components were evaluated and policy decisions were made,the Finance Subcommittee used these
criteria as the standard of comparison. Did a program have broad-based support? Did a policy contribute to building
financial stability? Embedded in the Task Force Recommendations,these policies are the basis for maintaining the
Medic One/EMS system and building a secure financial foundation to pay for these critical services.
49
i One EMS 20 4-2019 EMS FINANCIA�PLAN - cont.
Med c /
ADDRESSING EMS 20142019 ANTICIPATED CHALLENGES
The region developed several strategies to address the variety of anticipated financial challenges. Some were
implemented in the 2008-2013 levy period;other strategies focused on the 2014-2019 levy period. They included:
• Aggressively managing resources and saving funds from the 2008-2013 levy to "buy-down"the levy rate for the
2014-2019 levy;
• Managing of growth of services;
• Creating efficiencies to continue key existing priorities and programs while allowing room for a limited number of
new programs and services;and
• Addressing uncertainty.
A�¢rPGsivel�Managing Resources: The EMS system in King County has a long history of looking for efficiencies within
the system and saving funds when possible. With the economic downturn,the system became more aggressive in
this strategy. Programs were prioritized,scopes of projects were adjusted,efficiencies were sought. Combined with
management in growth of services during the 2008-2013 levy period, $21 million was identified to carry forward into the
2014-2019 levy period and to reduce the levy rate to support planned 2014-2019 services. This is forecast to reduce
the rate to support planned expendltures by 1.6 cents-from 35.1 cents to 33.5 cents.
Man�gement of Growth of Services: The region is also known for innovative strategies related to managing growth of
services. During the 2008-2013 levy period there was continued refinement of existing strategies(such as dispatch
criteria guideline revisions), renewed focus on other strategies(such as the Telephone Referral Project),and the addition
of new strategies(such as the Taxi Voucher project). The 2014-2019 levy continues to support proven strategies and
initiatives that manage growth of services.
Priorities and Efficiencies: In addition, levy planning focused on prioritizing services and determining services that could
be sunsetted (either because they were not producing or had served their purpose and been outgrown by the system).
There was also a focus on providing existing services in more cost effective ways. This allowed the system to increase
some key programs -such as Cardiac Case Review -while keeping increased expenditures for 2014(the first year of
the new levy)to less than projected inflation (CPI).
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50
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4lncertainty: To address uncertainty and the fact that the levy is planning many years into the future,several different
strategies were used. This included adoption of a 65%confidence interval for financial forecasts -this means that there
is a greater chance that the EMS system will have sufficient funds to cover planned expenditures. In addition,the levy
includes reserves for unplanned and unanticipated events. Key reserves address operational costs, equipment costs
(services or equipment not anticipated; inflation at rates higher than anticipated), risk,and capacity
With previous levies,substantial increases were implemented during the first years of each new levy. However, based on
current economic circumstances,the region recognized that 2014-2019 levy was not an appropriate time to expand the
system, or expand support for BLS agencies. Rather, it was a time to closely review the priorities of the services being
provided. Proposed new services and programs are minimal and offset by reductions, resulting in a plan that is less than
if the current plan were continued with inflation.
The following chart shows historical and projected levy expenses with the transition years between levies highlighted.
In contrast to the last two levy periods,the 2014-2019 plan flattens expenses while maintaining critical services to the
region.
� ----- _----_
______-------__---_---- -_.__----------_____,__�-----------
, ----__.------
� Expenditure trend EMS Levy
i Siao --- ---- --- . _---- ;
i i
j $120 -----. ____------------ ------- ___— _---- _-----------------� ��i���� ���
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2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 i
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� ■City of Seattie i King Counry EMS Fund
The overall result of these strategies is:
• Savings from 2008-2013 levy period that allows"buy-down"of levy rate by 1.6 cents(from 35.1 to 33.5 cents);
• Increase between 2008-2013 levy period and 2014-2019 levy period held to less than the rate of inflation;and
• Overall increases in the 2014-2019 levy period projected at less than the King County growth goal - less than CPI
+ new population. The proposed plan, including the reduction from 2013, is less than this estimate.
51
' EMS 20 4-2019 EMS FINANCIA�PLAN - cont.
Med�c One/
FINANCE RECOMMENDATIONS
The Finance Subcomiitee grappled with the various flnanclal challenges facing the region and developed
the following recommendations:
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The Finance Subcommittee considered continuing with the 50°/o confidence interval used for the 2008-2013 levy for
forecasting or using a 65%confidence interval. Given the volatility in the economy,the group recommended using
the 65%confidence interval. This is also consistent with King County policy(KCFC2010-09.1) requiring the Office of
Economic and Financial Analysis(OEFA)to present official County forecasts at the 65%confidence level.Confidence
level is defined as the chance that actual revenues will meet or exceed forecasted levels. Planning at this level reduces
the risk associated with actual EMS property tax revenues coming in lower than forecast.
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, � ... .r t - _. � S� .. ��� .,_
Management and Oversight of System
The EMS Division is responsible for managing the levy fund in accordance with the EMS Strategic Plan,the EMS
Financial Plan and ordinances as adopted by the King County Council. Financial policies will continue to be updated
to document and meet system needs. The Financial Plan and policies will adapt to new King County Financial Policies
within limitations of adopted funding levels. The Public Health Chief Financial Officer provides general oversight.
EMS Division responsibilities include the review and evaluation of allocations as well as the management of Regional
Services and Strategic Initiatives as reflected in EMS Strategic Plan, EMS Financial Plan and associated King County
ordinances. Strategic Initiatives are considered projects with lifetime budgets. Strategic Initiative annual budgets are
considered cash flows and can be adjusted to meet project needs over their lifetime.
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52
, � �.
Management of ALS Resources
Using standard unit allocations, with separate allocations for operating and equipment costs, provides a fair and
reasonable funding of ALS. Funds are managed locally by ALS agencies and maintained separately from other accounts.
ALS agencies are expected to provide ALS services within the unit allocation. ALS agencies develop and report
equipment replacement plans to the EMS Division. These plans account for all expenditures of levy funds, equipment
purchased with other funds(such as grants)and show that adequate amounts are reserved for future equipment
replacement. Reimbursement of eligible costs by the EMS Division and reporting of costs and revenues by ALS agencies.
On a limited basis,ALS agencies can borrow againstfuture year's allocations. The EMS Division conducts annual reviews
of allocations and cost reporting.
Reserves and Designatlons
Reserves and designations are managed in accordance the EMS strategic and financial plans and associated
ordinances as adopted by King County Council. Agencies are encouraged to use program balances to cover variances in
expenditures patterns that may occur from year to year including one-time expenses. Program balances, implemented
in the 2002-2007 levy period, are the portion of operating allocations that an agency chooses to carry forward to cover
expenses in future years. Examples of use include labor settlements that may include back-wages,variances in number
of paramedic students sent to Harborview, or smaller one-time costs.
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Reserves were first included explicitly in the 2008-2013 Medic One/EMS Financial Plan. Regional partners wanted to
ensure that funds were available to address emerging needs, particularly larger one-time expenses and unexpected/
unplanned expenses. Reserves were initially developed as a percentage of program budget, but were then changed to
specific categories in the finalized 2008-2013 Financial Plan. Based on recommendations from the King County Auditor's
Office in 2009, reserve amounts were refined and additional reserve categories were developed to include key areas not
included in the initial reserves. The result was the development of 12 separate reserves.
The 2014-2019 Financial Subcommittee made recommendations, as highlighted below,that include streamlining the
current 12 reserves into four main categories of reserves -ALS capacity,equipment, operational and risk abatement
reserves,adding a reserve for potential new CMT units(pending outcome of assessments of pilot CMT projects), and
continuation of required fund balance. (With new King County reserve policies,this is proposed to be changed to a cash
flow reserve.)
20142019 Proposed Reserves
Key elements for the 2014-2019 levy reserves include:
• Adequate and reasonable reserves should be used to fund unanticipated or one-time costs;
• Maintain strict access policies, including review by the EMS Advisory Committee;
• Reconfigure reserves to incorporate anticipated needs and combine as appropriate;
53
.
�
Medic One/EMS 2014-20i9 EMS FINANCIA�PLAN - cont.
• Consider all reserves operational; may be replenished from other sources including fund balance;
• If use of reserves in any one line item exceeds the budgeted amount,funds from other reserves could be used
based on review and approval of the EMS Advisory Committee;
• To address emerging needs during the levy period, reserves can be reconfigured, amounts adjusted,and new
reserves established with review by the EMS Advisory Committee;and
• Within limitations of levy funding, reserves can be adjusted to meet King County policies as they are adopted.
Proposed Reconfiguratlon of Reserves
By combining the existing 12 ALS reserves into categories,each element was able to be funded at a slightly lawer
amount without increasing the overall risk to the regional system because amounts from other elements within the same
reserve category could be used as needed.
The relationship of the 2008-2013 levy reserves to the proposed 2014-2019 levy reserves is shown below.
t i=: . f . 6 . 4
Facilities ALS Capaclty Reserves
Call Volume/Utilization Costs associated with managing capacity
Disaster Relief Contingency (including both temporary or long term capacity
increases)
Vehicle/Chassis Obsolescence ALS Equlpment Reserves
Communications Costs associated with changes in equipment
Medical Equipment costs and obsolescence
Salary/Wage Contingency ALS Operatlonal Reserves
Diesel Cost Stabilization Operational costs above amounts included in
Pharmaceuticals allocation
Dispatch/Communications -
Excess Backfill for Paid Time Off(PTO)
Paramedic Student Training
Outstanding Retirement Liability
Risk Abatement ALS Risk Abatement
Significant unplanned circumstances and
uninsured/underinsured motorists
More detail on reserves can be found in Appendix E: Reserves on page 82.
54
, � �,
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ME � �b... � �w.
. � �tt�+�����sn�f�►���t���ta��sd
, �.
Allocations in the 2008-2013 levy were increased by inflators with specific indices. These adequately projected
costs,although there were some areas where the indices could be better matched. The King County Auditor's Office
recommended changing the index used to inflate allocations associated with vehicle purchases. However, due to how the
previous levy documents were developed, EMS was not able to change the index used, but was able to provide additional
funds if there were a significant difference in the indices. Another change incorporated during the levy period was basing
inflators on June actuals, which correspond with the time period most ALS agencies use for Cost Of Living Adjustment
(COLA)changes.
Key elements for the 2014-2019 inflators include:
• Use CPI-W(wages) rather than CPI-U for categories primarily covering salary expenses;
� Use vehicle PPI as recommended by King County Auditor's Office;
• Based on recommendation of auditors, King County economist or finance staff,or other appropriate group, EMS
can consider adding or adjusting inflators during the 2014-2019 levy;
• Continue using a compound inflator for yearly increases to ALS allocation;
• While maintaining the KC EMS Fund BLS amount at similar level to 2008-2013 levy, change yearly increases
from CPI-U to CPI-W+ 1%;
• Change yearly increases in Regional Services from CPI-U + 1%to CPI-W+ 1%;
• Continue to set lifetime budgets for Strategic Initiatives based on inflating project budgets by CPI+1%; once
set, only adjust if changes are significant enough to affect ability to complete project. Change from CPI-U + 1°/o to
CPI-W+ 1%;and
• The 1%added to CPI for labor related expenses allows for non-COLA amounts such as step increases, changes in
personnel for ALS and also includes benefits and expense increases for other programs.
Advanced Life Support Compound inflator including CPI-W for
labor related expenses, CPI-U for other
general expenses, Pharmaceutical
and Transportation PPIs,and weighted
average of agencies for benefits
Basic Life Support CPI-W+ 1%
Regional Services CPI-W+ 1%
Strategic Initiatives CPI-W+ 1%
A table listing inflators by allocations and sources is included in Appendix F: Inflationary Information on page 83.
55
� �
Medic One/EMS 2014-20i9 EMS FINANCIA�PLAN - cont.
� � �����ra����c��#���.��������f�c�e����rs�����t�s�
� ������t�r�n
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The King County Auditor's Office conducts an annual audit of EMS. Each audit has resulted in positive findings along
with recommendations to enhance EMS fund management and implement system efficiencies. In addition,the audits
provided the region with an outside assessment of the management of the levy finances and continued a focus toward
transparency and accountability of EMS finances.
The Finance Subcommittee supported consistent assessments of the EMS system and recommended that the King
County Auditor continue both financial and programmatic EMS audits.The positive findings,coupled with input from
the King County Auditor's Office, resulted in the subcommittee recommending that the audits be strategically placed in
the levy and not occur yearly. Currently,audits are programmed for year two(2015}and year four(2017). Year 2 can
provide a review of the first year of the levy and implementation of 2014-2019 Strategic Plan;Year 4 can provide review
and recommendations that could be implemented mid-levy and also be used to inform the planning process for a levy
potentially beginning in 2020. The timing and amount dedicated to each audit could be changed to meet evolving needs.
� ����st��.���������ir�n��ac�r��������:��y��
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The Finance Subcommittee discussed an option of including ALS transport fees as a way to supplement funding
for services. It was determined that adding these fees was not consistent with the review criteria developed by the
subcommittee. Transport fees did not have broad-based support(criteria#4)and were not publicly consistent(criteria
#5). Many committee members expressed concern that transport fees could result in people not calling 9-1-1 for a
medical emergency. Delaying response to critical incidents -such as a heart attack or stroke - could result in significant
reductions in patient outcomes including death. In addition,the EMS levy has consistently been presented as the way
the residents of the region pay for ALS services. It was felt that adding transport fees would be confusing and challenge
voter support.
■ �����a�3`s��ar�����a�����rv�� �q������� �����s
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:, � � , , , ., , ., � F s ... i . .... , < ,.,
The 2008-2013 plan was developed in 2006,a considerably different economic time from current conditions. The
region has not only experienced a significant drop in assessed valuations and the amount of property taxes raised
to support the EMS levy, but also all sectors and taxpayers have experienced considerable strain during the past few
years. Based on these circumstances,the Finance Subcommittee agreed with the recommendations of the other
56
. � �,;,
subcommittees that the 2014-2019 levy was not an appropriate time for expansion. Rather, it is time to closely review
the priorities of the services being provided.
Key programs from the 2008-2013 levy, particularly those related to funding existing ALS and BLS services and
maintaining key Regional Services,were preserved. Some programs were discontinued. Any additions were scrutinized.
The resulting plan is less than If the current plan were continued wfth inflation into the future(status quo).
This resulted in a financial plan with minimal increases. Total expenditure and reserves for 2014 are projected at only
$60,000 more than 2013. This is an increase of.05%. Overall,the increase in projected expenditures and reserves
from the 2008-2013 levy to the 2014-2019 levy is projected to be approximately$60 million,a 9% increase or an
average increase of 1.6% per year. This is significantly less than inflation.
King County has a goal of containing increases to CPI + population growth. A projected increase of CPI + population
growth at 1%would result in an average increase over the six year period of approximately 3.5%. The proposed plan
represents an average increase per year of less than 3%,which is less than the King County goal.
The following chart compares estimated revenues and expenditures for the 2014-2019 levy. Since revenues increase at
a lower rate than expenditures(even with expenditures held to increases less than CPI + new population),typically more
revenues are collected in the early years of the levy to cover expenditures at the end of the levy. Due to the "buy-down"
from the 2008-2013 levy,this trend is minimized in the 2014-2019 levy. Revenues are projected at$2 million more than
expenses in 2014;expenditures are$5 million more than revenues in 2019.
�
� Estimated Revenues and Expenditures
$140 �-----..----------------------------------
i
$120 �---
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. _ __ ,_ _-
I 2014 2015 ' 2016 i 2017 7 2018 ' 2019 l
-
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-- -
■Revenues $107 $109 � $111 I� $113 � $115 $118 !
E � ._ _ ; r _ ._ .
o Expenditures $105 $109 $112 ; $115 � $119 $122
_ _ �_ . _ .._ r
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57
� �
Medic One/EMS 20i4-2019 EMS FINANCIA�PLAN - cont.
� � ������r��:����v.�;:����a���a�:����#�����u�g��a�r��:���
� ���a������y ����:�t����3�.����8�,�����n
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Regional EMS leadership quickly recognized that economic changes occurring during the 2008-2013 levy period would
not permit a 30 cent levy to support continued operations of the system. They led the region through an aggressive
program of reducing expenditures and putting aside funds to potentially reduce the levy rate for the 2014-2019 levy.
These actions included decisions to reject expantion of two 12-hour ALS units planned for King County, leverage a period
of minimal inflationary pressures to reduce expenditures below planned levels, roll the disaster relief contingency back
into reserves,and achieve significant savings in Regional Support Services and Strategic Initiative programs through
eliminating underperforming programs. Estimated savings equals$21 million,or 1.6 cents.
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58
� � �
MEDIC ONE/EMS 20142019 FINANCIAL PLAN ASSUMPTIONS
The 2014-2019 Financial Plan, like other financial plans, is based on numerous assumptions and acknowledges that
actual conditions may differ from the original projections. The objective is to make the plan fiexible enough to handle
changes as they occur while remaining within expected variance. Key financial assumptions provided by the King County
economist include new construction growth,assessed value, inflation and cost indices. Actuals,when presented,are
through 2011; 2012 is based on 3rd quarter year-end estimate;and 2013 is based on projected budget(without double
counting).
This section documents key assumptions and shows projected rates related to inflation increases and distribution
of property taxes. It also details revenues, expenditures and reserves that constitute the 2014-2019 Financial Plan.
Note that when numbers are rounded to millions for presentation purposes,some rounding errors will occur. Detailed
numbers are shown in the Financial Plan at the end of this section.
Total expenditures for the Medic One/EMS system in King County are projected to be$695 million over the 2014-2019
levy span. Funds are projected for the four Medic One/EMS program areas of Advanced Life Support, Basic Life Support,
Regional Services and Strategic Initiatives, reserves,designations and audits. Under the current economic conditions,a
levy rate of 35.1 cents per$1,000/AV would be required to support$695 million of expenditures. However,the region
began aggressively managing and saving funds during the 2008-2013 levy period to decrease the amount needed to be
raised in the next levy. Total savings from this undertaking are approximately$21 million that will reduce the 2014-2019
levy rate by 1.6 cents/$1,000 AV to a proposed starting rate of 33.5 cents/$1,000 AV.
�
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;
�
a � � � � > a � • ; �� � � � �' a r
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7
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The 20142019 Financial Plan differs from previous levles in two key ways:
1) Limited new�rograms and expenditures:
With previous levies,substantial increases were implemented during the first year of each new levy. In contrast,there
is reduced planned spending in the first year of the 201420191evy,when adjusted for Inflation. Proposed
new services and programs are minimal, and are offset by reduced expenditures. Overall proposed increases across the
levy span are less than projected CPI plus new population.
2) Reduced�rot�osed revenues:
The 2014-2019 levy proposes using funds from the 2008-2013 levy to reduce the amount needed to be raised over
planned expenditures. Estimated savings are $21 million,or 1.6 cents.
59
� .
Medic One/EMS 2014-2019 EMS FINANCIA�PLAN - cont.
KEY ASSUMPTIONS
Revenues
The Medic One/EMS 2014-2019 Financial Plan is built on an EMS property tax levy(based on assessed valuations,or
AVs)as the primary source of funding. The revenue forecast is based on assumptions of the assessed value at the start
of the levy period,assessed value growth,and new construction growth,as forecast by the King County Economist. In
addition,the King County Economist recommended assuming a 99%collection rate for properry taxes(1%delinquency
rate). Other considerations are the division of revenues between the City of Seattle and the King County EMS fund,
interest income on fund balance, and other revenues.
Assessed Valuations
The plan assumes that 2014 is the first year of growth in assessed valuations after four years of decreased assessed
valuations beginning in 2010. Total decreased AVs from 2008 to 2013 equal $21 billion, a decrease of over 6%. From
2009 through 2013,AV is expected to decrease by$78 billion or 20%.
After years of decreases,the 2014-2019 Plan assumes a 3.8%increase in AV for 2014,followed by similar increases
for the remainder of the levy. It also shows a decrease in 2014 new construction after a forecast increase from 2013.
Total projected AV growth on existing properties averages approximately 3.9%per year. Significant increases in the new
construction forecast for 2017-2019 bring the average new construction growth to 3.7%per year.
Average
Rate of Growth 2014 2015 2016 2017 2018 2019 Total
New Construction (2.29%) (1.25°/a) 3.51% 6.61% 8.49% 6.89% 3.66%
Reevaluation Existing Properties 3.78% 3.11% 3.58% 4.48% 3.89% 4.51% 3.89%
Assessment�Pro��Taxes):
Increases in assessments(property taxes)are limited to 1°/o plus assessments on new construction. Growth during the
2014-2019 levy period is projected to increased at a rate less than the projected Consumer Price Index(CPI). Previous
levies have typically included expansions in funding and services. Reflecting lower AVs and economic conditions,the
proposed 2014-2019 levy limits growth to underlying inflation and increased population growth. Additional and increased
services are limited.
60
. ;�, �,;
The following chart and table show the interrelationship between assessed valuations, levy assessment or property
taxes,and levy rate as currently forecasted. While the growth in AV(AV growth)from 2015 to 2019 averages almost 4%
per year, projected property taxes(property taxes/assessment)are projected to average less than 2% per year. This
includes a 1%increase on existing properties and the addition of new construction. Based on these increases,the levy
rate is projected to decline to 30 cents per$1,000 AV by the end of the levy in 2019.
--. ___ ---- --- -.____. __ _---- __ _ ____-
-- - ____--
___ __--- --------�
i
j 2014-2019 EMS Levy '
Projected Assessed Values, Revenues and Rates I
, I
$o.so a7oo,o00,000 ;
i $0.45 I
$0.40 $600,000,000 i
I $0.335 '
� $0.35 $0.332 $0.326
$0.317 $0.311 $0.303 $500,000,000
I � '
iQ $0.30
o $400,000,000 '
� o I
i o $0.25
� I
i � $p 20 $300,000,000 �
a
� $0.15 $200,000,000 I
I 0.1 '
� $ 0
�
$0.05 $100,000,000
�
$0.00 $_
� 2014 2015 2016 2017 2018 2019 i
� --- ---- _- _-- -_— -- --- ;
- --- -- ___ _— --
�Assessed Values Property Taxes(Assessment)" -�-Levy Rate , ;
I
z� �, �
�,��'�.";..� �`�". ,�.�"`K� ,�?�.'� �� -� "� �x�"" � .r��� ��"�. ` � >.: ^s�;,
�a�z'�.�*`�; �is�-r�" .3� �,� :.�`y ?�;., •�w ,,,��' ��,.' �«
Pro'eded Assessed Value $320,214,062,652 $330,181,944,732 $341,995,027,189 $357,326,613,542 $371,227,884,313 $387,978,236,511
Pro e Taxes Assessment' $106,198,994 $108,394,992 $110,320,026 $112,303,817 $114,366,102 $116,488,664
ForecastLev Ra� $0.335 $0.332 $0.326 $0.317 $0.311 $0.303
Growri in AV 3.11% 3.58% 4.48% 3.76% 4.65%
Growh in Assessment 2.07% 1.78% 1.$0% 1.84% 1.86%
`assuming 1%delinquency rate
61
Medic One/EMS 20 4-2019 EMS FINANCIA�PLAN - cont.
Division of Revenues: Revenues associated with the City of Seattle are sent directly to the city by King County; revenues
for the remainder of King County are deposited in the King County EMS Fund. With the economic downturn in 2010,the
traditional 35.5% proportion to the City of Seattle increased to 36.2%and is projected to increase to 37.1%in 2013,and
then gradually reduce to 36.0%by 2019.
The following table shows AV distribution trends:
Division and Estin�ated Value of Assessments for the
2014-2019 Levy Period
City of Seattle 36.42% $243.22 5243•22
KC EMS FUI1d 63.58% $424.85 $5.05 $429.90
Total 100.00% $668.07 $5.05 5673.12
*$in Million,total assuming 1%delinquency rate
Based on the forecast division of property taxes by the King County economist,the following tables show forecast
property tax assessments for the City of Seattle and King County EMS Fund. This represents the full estimated
assessment priorto under-collection (delinquency)assumptions.
Forecast Property Tax Assessment 2014-2019( in millions)
City of Seattle $39.6 $40.2 $40.7 $41.2 $41.7 $42.4 $245.7
KC EMS Funds $67.7 $69.3 $70.8 $72.3 $73.8 $75.3 $429.1
TOTAL $107.3 $109.5 $111.4 $113.4 $115.5 $117.7 $674.8
Growth in Total Levy 2.05% 1.74% 1.80% 1.85% 1.90%
Total does not include 1%delinpuency rate.
62
. � �
The following table shows estimated revenues based on assumed division of assessed value for both the City of Seattle
and the King County EMS Fund. The amount actually expected to be collected, based on a 1%delinquency rate, is
slightly less,as the following table shows.
Total Forecast Property Tax Revenue 2014-2019( in millions)
City of Seattle $39.2 $39.8 $40.3 $40.8 $41.3 $41.9 5243.2
KC EMS Funds $ 67.0 $68.6 $70.1 $71.5 $73.1 $74.6 $424.8
TOTAL $106.2 $108.4 $110.3 $112.3 $114.4 $116.5 $668.1
Growth in Total Levy 2.07% 1.75% 1.81% 1.87% 1.84%
Total Pncludes 1%delinquency rate.
Other Revenues: In addition to property taxes from the Medic One/EMS levy,the KC EMS Fund receives interest
income on its fund balance, other miscellaneous King County revenues distributed proportionately to property tax funds
(such as lease and timber taxes),and a small amount from reimbursement for services to outside companies and
organizations.
Other Revenue Assumptions
MEDIC ONE/EMS 2014-2019 Financial Plan
Charges for Services $1,180,140 23.3%
Interest Income $2,639,000 52.2%
Misc.and Other Taxes $911,100 18.0%
Other Finance Sources $324,000 6.5%
TOTAL OTHER REVENUE $5,054,240 100.0%
63
Medic One EMS 20 4-2019 EMS FINANCIA'`�PLAN - cont.
/
F.��enditures
Medic One/EMS revenues support Medic One/EMS operations related to direct service delivery or support programs:
■ Advanced Life Support(ALS)Services
• Basic Life Support(BLS)Services
• Regional Support Programs
• Strategic�nitiatives
• Community Medical Technician(CMT)services
• Audits
• Reserves
Expenditures are shown for each fund - City of Seattle and KC EMS Fund. The City of Seattle divides expenditures into
two program areas: ALS and BLS. The KC EMS Fund finances four main program areas: Advanced Life Support, Basic
Life Support, Regional Services and Strategic Initiatives. In addition,there is funding for Community Medical Technician
Units(CMTs),audits and reserves.
All programs are increased yearly with inflators appropriate to the program. These inflators include a CPI assumption.
The CPI assumptions used in this Financial Plan were provided by the King County Economist. Expenditures are inflated
by the previous year's actuals(through June). This closely approximates agencies'actual costs that are primarily driven
by labor costs and increases based on yearly indices for June.
CPI Assumptions-CPI-W
Forecast CPI-W 2.10% 2.38% 2.34% 2.39% 2.45% 2.49% 2.57%
To encourage cost efficiencies and allow for variances in expenditure patterns,designated reserves(program balances)
were added during the 2002-2007 levy and have remained in practice. Program balances allow agencies to save
funds from one year to use for variances in expenditures in future years. This is primarily used by ALS agencies to
accommodate cashflow peaks related to completing labor negotiations - both increases and instances where contracts
are negotiated after they have expired and include back wages. Within Regional Services, use of designated reserves
may be related to the timing of special projects(particularly projects supporting ALS or BLS agencies).
64
. � �
The following pie chart shows the distribution of funds by area. More than half of the funds are related to ALS,
approximately a third to BLS, and 12%covers all other projected expenses. The division of funds between program
areas is similar to the 2008-2013 levy(not including contingencies in the 2008 levy period).
Medic One/EMS 2014-2019 Levy
�
Proposed Distribution by Program Area
(Seattle & King County EMS Fund
�
I
� $55.2,8% $10.0,2% $12.4,2%
�
�
�
��
■Advanced Life Support �Basic Life Support
■Reg'I Svcs &Audits ■Strategic Initiatives & Reg'I CMT
Rese rves
�
The 2014 expenditure level for each program area was determined by projecting the costs of providing services.
This included re-costing existing services to be more cost efficient,sunsetting some existing programs and limiting
the addition of new programs and services. Expenditure levels for 2014 through 2019 are based on an increase by
an appropriate inflator for the program,the timing of new services,and cash flow projections of individual Strategic
Initiatives.
65
Medic One EMS 20 4-2019 EMS FINANCIA"�PLAN - cont.
/
EXPENDITURES BY PROGRAM AREAS
20142019 Medic One/Emergency Medical Services Levy
EMS Program Areas
October 2012
t A;
Advanced Life Support(ALS) $121,390,108 $270,338,534 $391,728,642
Basic Llfe Support(BLS) $121,833,460 $103,210,353 $225,043,813
Reglonal Support Servlces&Audit $55,178,130 $55,178,130
Strategic Initlatfves&Reglonal CMT $10,017,546 $10,017,546
Sub-Total 8243,223,568 $438,744,563 S681,968,131
Reserves $12,398,310 $12,39$,310
i E'� S 1 '
Advanced Life Support(ALS)Services
Since the first Medic One/EMS levy in 1979, regional paramedic services have been largely supported by,and are the
funding priority of,the Medic One/EMS levy. Costs have been forecast as accurately as feasible, but should the forecasts
and method for inflating the allocation be insufficient,ALS remains the first priority for any available funds.
The Medic One/EMS levy supports ALS services using a standard unit cost methodology.Contracts with the major
paramedic agencies from the KC EMS Fund are allocated on a per unit cost basis. The contract with Snohomish County
Fire Protection District#26 for services in the Skykomish/Stevens Pass area is on a per year basis. The following charts
show assumed average expenses by category for 2014.
66
. � �,:
The Standard Unit Allocation consists of the Operating Allocation and the Equipment Allocation.
��� "�t � .'ffi.. d' .'R:' ` 9 -'b�� �s0u..
-��a � � �<;
Category Average Costs %
Salaries and Benefits $1,702,769 83.3%
Medical Supplies and Equipment $45,637 2.2%
Office&Misc Costs $12,016 0.6%
Uniforms, Fire&Safety Supplies $2,918 0.1%
Dispatch $58,121 2.8%
Communications $8,824 0.4%
Fuel $11,969 0.6%
Vehicle Maintenance Costs $28,427 1.4%
Facility Costs $17,621 0.9%
Training Costs $2,038 0.1%
Indirect/Overhead Costs $152,781 7.5%
OPERATIONAL EXPENSE GRAND TOTAL $2,043,121 100%
The Equipment Allocation was developed by looking at the average cost of equipment purchases,the expected lifespan
of the equipment, and the number needed per unit. Key changes included increasing the lifespan of inedic vehicles from
six years to eight years. Each medic unit is budgeted to have two vehicles - primary and back-up for when the primary
is out of service,there is an overlap between shifts, and times when an extra response unit may be needed (such as
snowstorms or floods). This change in the vehicle lifespans was key to reducing the equipment allocation. The 2014
Equipment Allocation is a 13%reduction (over$12,000)from what it would cost to continue with the allocation from the
2008-2013 levy period.The region will continue to refine the lifespan for equipment during the 2014-2019 levy period. If
increased lifespans are achieved,the Equipment Allocation can be reduced during the levy period.
�_� ���� , �� �� � �.�; �� �- �.� ��n:
<�: f
Equipment Estimated 2014 Assumed Total
Cost Avg Lifespan # per unit per year
Medic Vehicles $209,051 8.0 2.0 $52,263
Defibrillators $33,961 8.8 3.3 $12,848
Mobile Data Computers(MDCs) $7,313 5.0 2.7 $3,900
Field Supervisor(MSO)Vehicle $67,581 10.0 0.3 $2,253
Support Vehicles $56,318 10.0 1.0 $5,632
Stretchers $16,895 7.0 2.0 $4,827
Radios, Mobile $2,816 11.4 2.7 $659
Radios, Portable $5,069 9.4 3.0 $1,626
EQUIPMENT EXPENSE GRAND TOTAL $399,005 $84,008
67
,
Medic One/EMS 20i4-20i9 EMS FINANCIA`�PLAN - cont.
F�cpenses and balances in each agency's internal equipment funds are reported yearly to the EMS Division. The 2014-
2019 levy planning process included reviewing Equipment Allocation levels. The following table shows proposed
Operating and Equipment Allocation totals for 2014.
� � � • � � � � � � �
Fund Operating Allocation Equipment Allocation TOTAL
City of Seattle $2,522,582 $131,642 $2,654,224
KC EMS Fund $2,043,121 $84,008 52,127,129
This 2014-2019 Financial Plan recommends an annual review of ALS costs to minimize cost-shifting to agencies. As has
been the practice,a group that includes representatives from the different ALS agencies will meet at least annually to
review costs and provide recommendations.
Using a compound inflator for ALS was developed as part of the 2008 levy planning process. The following table shows
the key inflators for ALS. Other programs are generally inflated by CPI + 1%.
Assumptions Used to Inflate the ALS Allocation
Title Calculations Basis Source 2014 2015 2016 2017 2018 2019
Wage Inlation CPI+1% KC Economist 3.1096 3.38% 3.34% 3.39% 3.45% 3.49%
Medicol benefit Inflation Annual%change Average of agencies 8.00% 8.00% 8•�% 8•�^ 8•�°� S.ar�°
LFOFF 2 %of Salaries State Actuary 5.24% 5.24% 5.24% SZ4% 5.24% 5.24%
Seattle Metro CPI Annua!%change KC Economist 2.10% 2.38% 2.34% 2•39% 2.45% 2.49%
FICA% %of labor charge FICA KCMI Avg 2002-2005 %.5% 96.5% 96.5% 96.5% 96.5� 96.5�
Ph armaceuticals/Med ical
Supplies KCEconomist 5.45°� 6.64% 7.51% 6.93% 6.61% 6.40%
VehicleCosts KCEconomist 0.29% 1.25% 1.54% 2.71% 2.00% 2.08%
`Previous yearbureau of laborstotls[ics numbers used ro inflate budgets(2013 Bl5 used for2014 6udge[sJ
Total Projected ALS Service Expenses Du�ing the 20142019 Levy Period
�:� ,���,; ," � ��-i.- �+r �:� �,��� r n s<w�� � -�, -��`� �� �,;�� �c`�'"
CityofSeattle � $18,579,568 $19,198,767 $19,844,720 $20,532,981 $21,244,839 $21,989,233 $121,390,108
KCEMSFund $40,913,876 $42,462,326 $44,076,832 $45,794,986 $47,596,387 $49,494,128 $270,338,535
Combined Total $59,493,444 $61,661,093 $63,921,552 $66,327,967 $68,841,226 $71,483,361 $391,728,643
68
• ,� �,,
Basic Life Su�port(BLS)�Prvices
The levy provides partial funding to BLS agencies to help ensure uniform and standardized patient care and enhance BLS
services. Basic Life Support services are provided by 30 local fire departments and fire districts. The BLS allocation is
infiated at CPI-W+ 1%per year.
Total Projeded BLS 5ervice Expenses During the 20142019 Levy Period
"`-Y`` '�� ,� "+ �,.-n �a"�`r�aw .�� 5���, y�.� �„��: ��m,,,; ��` �a�,x �°:�
» ,���. �.�� ' f� a•��.,ane.- .,., .'�,s':
CityofSeattle $2Q607,861 $20,582,195 �$20,422,089 $20,233,305 $20,041,324� $19,946,686 $121,833,460
KCEMSFund $15,801,074 $16,335,150 $16,880,744 $17,453,001 $18,055,130 $18,685,254 $103,210,353
Combined Total $36,408,935 $36,917,345 $37,302,833 $37,686,306 $38,096,454 $38,631,940 $225,043,813
Regional Su�aortServices
The EMS Division is responsible for conducting the regional Medic One/EMS programs and services that support critical
functions that are essential to providing the highest quality out-of-hospital emergency care available. This includes
uniform training of EMTs and dispatchers, regional medical control, regional data collection and analysis, quality
improvement activities,and financial and administrative management(including management of ALS and BLS contracts).
Regional coordination of these various activities is important in supporting a standard delivery of pre-hospital patient
care, developing regional policies and practices that reflect the diversity of needs,and maintaining the balance of local
area service delivery with centralized interests. Includes funds to support overall infrastructure and expenses related to
managing the regional system are budgeted in Regional Services. Regional Services are inflated at CPI-W+ 1% per year.
Total Projeded Regional Support Services Expenses for 20142019 Levy Period
.�„ � k�
s;�� :��`' .,k.��' ��'�. ,�`'�<,-� .,-���: �,�, - �',�.. � �� d�; � � �� ��.[�_-.. ��, �,�
KC EMS Fund $8,398,551 $8,682,422 $8,972,414 $9,276,579 � $9,596,621 � $9,931,543 $54,858,130��
Strategic Initiatives
Strategic Initiatives are pilots geared to meet the success of the strategic directions. Strategic Initiatives are funded with
lifetime budgets that include inflationary assumptions similar to those used by Regional Services. However,the overall
lifetime budgets are not adjusted to reflect small changes in CPI. The EMS Division has the discretion to move funds
between approved Strategic Initiatives to ensure the success of the projects. Increased funding for the programs or new
projects are reviewed and recommended by the EMS Advisory Committee for approval by the King County Council through
the normal budget process.
Total Projected Strategic Initiatives and Regional CMT Units Expenses for 20142019 Levy Period
K . ... .. . ,.
� �.��' ar. �. � �:� �' R ''�-�- �c-..�- �' r� _
,�Y,r .a.�z, ,��"�,k:
Strategitlnit $529,690 � $841,781 $1,007,823� $1,1%,833 ��° $1,233,496 � $1,264,590 ��� $6,074,213
Reg'I CMT $363,546 $704,299 $679,502 $1,104,770 $1,091,217 $3,943,334
Total $529,690 $1,205,327 $1,712,122 $1,876,335 $2,338,266 $2,355,807 $10,017,547
69
.
Medic One/EMS 20 4-2019 EMS FINANCIA�PLAN - cont.
Audlts
The King County Council adopted legislation to complement and augment the oversight and accountability of the
King County EMS Fund through increased financial review and audits by the King County Auditor's office for the 2008-
2013 levy period. Based on the positive findings of the audits,the 2014-2019 levy includes audits covering both
finances and program areas strategically through the levy period. Currently these are scheduled for 2015(the second
year of the new levy)and 2017 with the idea that the 2017 audit could also influence recommendations for the next levy.
Total Projected Annual Audit Expenses for the 20142019 Levy Period
, ,�� •a . �.� �i �w � � �°� �$� ��=�;
� „�.� k , �.. ; �,
.. .��'-"�'., �'� � `t'^ *, .��v _ ,.:
`.:� . .t".<tiw.o'^€' .. ..��. ,sg' ls:... ,.'�,rr�.,.?:�. hra. _ i,,. . � �a.'�'.�' ... ,....,, .. ,.. �ir,.s..> .�.., ..�_ , . ,..., :
KC EMS Fund $0 $160,000 $0 $160,000 $0 $0 $320,000
Reserves and Designations
Reserves were added duringthe 2008-2013 levy planning process and refined further - based on recommendations of
the King County Auditor's O�ce - during the levy period. During the 2014-2019 levy planning process, reserves were
reviewed extensively and consolidated into four main ALS categories, a reserve for CMT, and a reserve for cash flow
requirements.
Reserves fund unanticipated inflation and costs that are not included in the ALS allocation. Designations include funding
set aside by ALS agencies and regional support services for planned expenses in future years. The 2014-2019 Financial
Plan includes reserves totaling$12.4 million for the King County EMS Fund. Use of the funds is tightly controlled. If
needed to address emerging conditions,changed economic circumstances and/or King County policies,changes to
reserves can be implemented during the 2014-2019 levy period. Such changes would require review and approval by the
EMS Advisory Committee and the King County Council.
Reserves included in the 2014-2019 levy are shown in the following table. More information on reserves is available in
Appendix E: Reserves on page 82.
Total Reserves Budget for the 201420191evy Period
���� .;,..,���.,'.".,.:��,^;�a�,:.��:-�::. �� �t�.� � =°`�x v�� _�.c:,,;: �x ,�.. �-s»�. �e. �'....:.. .-;�����;"4. ." ..�2�� :;�`,��`�; .-�_.� .>. �.
ALS Capacity Reserve $1,067,700 $1,067,700 � .$1,067,700 $1,�7,700 $1,985,700 $3,358.700
ALS Equipment Reserve $4�.� $��� ��� ��� �'� �'�
ALS Operationai Reserve 5981,900 $981,900 $981,900 $981,900 $981,900 $981,90U
ALS RiskAbatement Reserve $1,510,000 $1,510,000 $1,510,000 $1,510,000 $1,510,000 $1,510,000
CMTUnitReserve $388,424 $739,897 $1,519,484 $1,519,484
CashflowReserve $4,051,338 $4,149,104 $4,250,815 $4,352,114 $4,451,498 $4,539,327
COMBINEDTOTAL $8,099,838 $8,197.604 $8,��,�39 $9,140,511 $10,937,482 $12,398,311
Note: Reserves roll over year-to-year;total budget dedicated to reserves is$12 million
70
� � �
Designations: To encourage cost efficiencies and allow for variances in expenditure patterns, program
balances were added during the 2002-2007 levy to allow agencies to save funds from one year to use
for variances in expenditures in future years. King County Medic One,the south King County ALS service
provided directly by King County, has internal designations related to its equipment replacement fund. Since
designations represent funds previously appropriated,they are generally managed by the EMS Division within
appropriation levels adopted by the King County Council.
The following chart shows planned expenditures for the 2014-2019 levy period.
Total Projected Expenditures for 2014-2019 Levy
�3� s;3 ,� � '� � � ,� ,� e F;. � �
:.:� .a:`��. -��i _�. �; �� � a •
. .... n .. .. ' .., ` ,
. . ;��: -"- � � r�...� ..
� �.,�r� . . -,.,., ,,.�_„u,_ , ..:, 2�.�.�
City of Seattle $39.2 � $39.8 $40 3 $40.8 $41.3 $41.9 $243.2
KC EMS Fund $65.6 $68.8 $71.6 $74.6 $77.6 $80.5 $438.7
COMBINED TOTAL $104.8 $108.6 $111.9 $115.3 $118.9 $122.4 $682.0
Medic One/EMS Program Areas
Projected Expenses and Reserves
"����,���¢. �"-a�.. °^° � � �c� � � �,.� �„ .. ��� � �����,�,����,
�
' x��d�r��'�'���''" � ' LL�,� `� „����a����.
�
.��'���-�a�*^ .� � �s� .�, ,� ,.
�� �..1�'Z �5�_ y. ��""a'''.'�.^�- r�, '�^ ,� ,,.rv ��,�� t C.`
a� �a,� .� � .;y�;..��r, "�� .,s'�`�'�*`�.
City of Seattle $121.4 $121.8 $243.2
�$243.2
KC EMS Fund $270.3 $103.2 $55.2 $10.0 $438.7 $12.4 $451.1
Combined Total $391.7 $225.0 $55.2 $10.0 $682.0 $12.4 $694.4
71
�
N �
EMERGENCY MEDICAL SERVICES LEVY OVERVIEW-65%CI Programmatic(with Buy-Down) �
�"1
2014 Proposed 2015 Proposed 2016 Proposed 2017 Proposed 2018 Proposed 2019 Proposed 2014-2019 Total �
REVENUES �
N
Countywide Assessed Value 320,214,062,652 330,161,944,732 341,995,027,189 357,326,613,542 371,227,884,313 387,978,236,511 O
Countywide EMS Levy 107,271,711 109,489,891 111,434,369 113,438,199 115,521,315 117,665,317 �
Countywide EMS Levy with Undercollection 106,198,994 108,394,992 110,320,026 112,303,817 114,366,102 116,488,664 �
Levy Rate 0.3350 0.3316 0.3258 0.3175 0.3t12 0.3033 �
Projected Seattle Assessed Valuation 118,158,989,119 12t,176,773,717 124,828,184,924 129,709,560,716 134,013,266,237 139,672,165,144 !��
Proportion 36.90% 36.70% 36.50% 36.30% 36.10% 36.00°/a w
Projected Seattle EMS Levy 39,583,261 40,182,790 40,673,545 41,178,066 41,703,195 42,359,514 iY
Projected Seattle Undercollection (395,833) (401,828) (406,735) (411,781) (417,032) (423,595) �
Projected Net Seattle Property Taxes 39,187,429 39,780,962 40,2&6,809 40,766,286 41,286,163 41,935,919 243,223,568 �'
Seattle Revenue 39,187,429 39,780,962 40,266,809 40,766,286 41,286,163 41,935,919 243,223,568 �
Projected Net King County Property Taxes 67,011,565 68,614,030 70,053,216 71,537,532 73,079,939 74,552,745 424,849,027 �
Projected King County Other Revenue 510,730 537,702 793,702 997,702 1,111,702 1,102,702 5,054,240 �
�
King County Revenue 67,522,295 69,151,732 70,846,918 72,535,234 74,191,641 75,655,447 429,903,267 =
TOTAL REVENUE 106,709,724 108,932,694 111,113,728 113,301,519 115,477,804 117,591,366 673,126,834
EXPENDITURES
Advanced Life Support Services--Seattle (18,579,568) (19,198,767) (19,844,720) (20,532,981) (21,244,839) (21,989,233) (121,390,108)
Advanced Life Support Services--King County (40,913,876) (42,462,326) (44,076,832) (45,794,986) (47,596,387) (49,494,128) (270,338,535)
Total Advanced Life Support Services (59,493,444) (61,661,093) (63,921,552) (66,327,967) (68,841,226) (71,483,361) (391,728,643)
Basic Life Support Services--Seattle (20,607,861) (20,582,195) (20,422,089) (20,233,305) (20,041,324) (19,946,686) (121,833,460)
Basic Life Support Services--King County (15,801,074) (16,335,150) (16,880,744) (17,453,001) (18,055,130) (18,685,254) (103,210,353)
Total Basic Life Support Services (36,408,935) (36,917,345) {37,302,833) (37,686,306) (38,096,454) (38,631,940) (225,043,813)
Regional Services �8,398,551) (8,682,422) (8,972,414) (9,276,579) (9,596,621) (9,931,543) (54,858,130j
Strategic Initiatives (529,690) �841,781) (1,007,823) (1,196,833) (1,233,496) (1,264,590) (6,074,213)
Regional CMT Units (363,546) (704,299) (679,502) (1,104,770) (1,091,217) (3,943,334) �
KC Audit(Compliance,Programmatic/Periormance (160,000) (160,000) (320,000)
TOTAL EXPENDITURES �104,830,620) (108,626,187) (111,908,921) (115,327,187) (118,872,567) (122,402,651) (681,968,133)
DIFFERENGE 1,875,104 306,507 (795,193) (2,025,668} (3,394,763) (4,814,285J (8,841,299)
RESERVES*
KC ALS Reserves (4,048,500) (4,048,500) (4,048,500) (4,048,500) (4,966,500) (6,339,500) (6,339,500)
KC CMT Reserves (388,424) (739,897) (1,519,484) (1,519,484) (1,519,484)
KC Required Fund Balance/Reserves*' (4,051,338) (4,149,104) (4,250,815) (4,352,114) (4,451,498) (4,539,327) (4,539,327)
TOTAI RESERVES (�,099,839) ; (8,1�7>604} (S,B87,739) (9,14Q,511) (1q937,482} (12,398,311) (12,39$>3'11)
"Seattle Medic One programs are backed by the crfy Generai Fund,which provides ieserve coverage. (694,366,444)
F+
*'Fund Baiance Requirement change to reserve in new King County Financial Policies �
N
O
F+
� •
,
.
Appendix A:�tegional Services for 0 4-2019 Levy
_ � � � • , � � � � � � • �
� , , �
A. TRAINING 1. EMTTraining
a. Basic Training a. Entry-level training to achieve WA State
certification
b. EMS Online Continuing Education b.Web-based training to maintain/learn new
(CE)Training skills and meet state requirements(Enhancement
SI converted to RS for 2014-2019 levy)
c.CBT Instructor Workshops c.Training for Senior EMT instructors
d. EMT Certification Recordkeeping d. Monitor and maintain EMS certification records
e. HIPAA for EMS Agencies e. Use of Public Health DepYs HIPAA training tool
2. EMD Training
a. Basic Training a.40 hours entry level dispatch training
b. Continuing Education b. Four hour in-class training to maintain skills/
learn new skills
c. EMS Online Continuing Education(CE) c.Web-based training to maintain/learn new
Training- Dispatch skills(Enhancement SI converted to RS for 2014-
2019 levy)
d.Advanced EMS Training d.Advanced training to enhance key concepts(SI
converted to RS for 2014-2019 levy)
e. EMS Instructor Training e. Instructor training for Criteria Based Dispatch
3.CPR/AED Training
a.Secondary School Students a. Conduct CPR instructor training, purchase
training supplies and equipment,train students
B. GROWTH 1. Injury Prevention
MANAGEMENT a. Fall Protection for Older Adults a. Home fall hazard mitigation and patient
assessment (SI converted to RS for 2014-2019
levy,and scope enhanced)
b. Child Passenger Seat Safety b. Proper car seat fitting and installation for
populations not served by other programs
c.Community Awareness Campaign c. Exercise opportunities to seniors to prevent falls
(SI converted to RS for 2014-2019 levy)
d. Injury Prevention Small Grants for BLS d. Provide funding to agencies to develop and
Agencies implement fall issues in their communities(SI
converted to RS for 2014-2019 levy)
e.Targeted Age Driving e.Safety interventions, include preventing driving
and texting
� 2. Criteria Based Dispatch Guidelines Analysis to safely limit frequency that ALS is
Revisions dispatched
3.TRP/Nurseline Divert low-acuity BLS calls to Nurseline for
assistance in lieu of sending unit response
73
A endix A: Regional Services cont.
pp
, � , , , � � � _ � -
� � � '
4. BLS Efficiencies
a. Enhanced Rapid Dispatch a. Process to ensure most appropriate response
is sent
b.Community Medical Technician b. 1-EMT response to lower-acuity calls
(Enhanced for 2014-2019 levy)
c.Taxi Transport Voucher c.Transport patients at lower costs using taxis vs
ambulances (Enhanced for 2014-2019 levy)
d. BLS Efficiencies d. Provide alternative,cost effective responses to
low-acuity calls(Enhanced for 2014-2019 levy)
e.Communities of Care e. Educate care facilities about when appropriate
to call 911 (Enhanced for 2014-2019 levy)
5. Performance Standards for Dispatch Standards to ensure more efficient dispatch
Centers services(SI converted to RS for 2014-2019 levy)
C. REGIONAL 1. Regional Medical Direction Oversight of all medical care;approval of
MEDICAL protocols,continued education, quality
improvement projects
QUALITY
IMPROVEMENT 2. Patient Specific Medical QI Review medical conditions to improve patient
�Q�� care
3. Cardiac Case Review Assessment and feedback re:cardiac arrest
events (Expand product developed by grant to
reach all of King County for 2014-2019)
4. Emergency Medical Dispatch QI Evaluation and feedback re:dispatch decisions
5. Dispatcher Assisted CPR QI Review of the handling of cardiac arrest calis;
evaluate and provide feedback
6. Public Access Defibrillation (PAD)
a. PAD Registry a. Maintain registry/ provide PAD location to
dispatchers
b. Project RAMPART b. Funding to buy/place AEDs in public areas;
provide CPR training to public sector employees
c. PAD Community Awareness c. Increase public placement and registration of
AEDs (SI converted to RS for 2014-2019 levy)
7.ALS/BLS Patient Care Protocols Development of EMT and Medic protocols/
standards for providing pre-hospital care
8. BLS QI Review BLS care/effectiveness to improve patient
ca re
9. Regulatory Compliance Ensure system-wide contractual/quality
assurance compliance
74
.
� �
_ � � � • � - � � � � � • �
� , , �
D. EMS DATA 1. EMS Data Collection Oversee collection/integration/use of EMS
MANAGEMENT system data, including Medical Incident Reports
2. EMS Data Analysis Analyze system performance and needs
3.Systemwide Enhanced Network Design Improve network of data collection throughout
(SEND) the region (SI converted to RS for 2014-2019
levy)
4. ECBD/CAD Interface Integration of software and CAD system to
improve call processing/data collection (SI
converted to RS for 2014-2019 levy)
E. REGIONAL 1. Regional Leadership, Management and Provide financial and administrative leadership
LEADERSHIP AND Support and support to internal and external customers;
MANAGEMENT implement EMS Strategic Plans, best practices,
business improvement process
2. Manage EMS Levy Fund Finances Oversee all financial aspects of EMS levy funding
3. Conduct Levy Planning and Develop EMS Strategic Plan; implement
Implementation programs(SI converted to RS for 2014-2019
levy)
4. KC Audit Reviews Examination of EMS management practices to
ensure adherence to council-adopted policies
(Re-scoped for 2014-2019 levy)
5. Manage Contracts and Procurement Oversee contract compliance and continuity of
business with EMS Stakeholders
F. OTHER 1.All-Hazards Management Leadership and coordination in planning and
preparing for emergency or disaster response to
ensure sustained critical business functions(Re-
scoped for 2014-2019 levy)
2. EMS Agency Support&Small Grants Funding for agencies to offset costs for
participating in EMS Division projects
G. INDIRECT& 1. infrastructure Support Infrastructure costs needed to support EMS
INFRASTRUCTURE Division including leases,vehicles,copier,etc.
2. Indirect and Overhead Costs associated with EMS Division including
payroll, human resources,contract support,
other services and overhead.
75
� I
Appendix B: Efficiencies
The EMS system and its partners have long committed to minimizing new costs and looking for programmatic efficiencies.
It was this focus on efficiencies and effectiveness that allowed the system to continue providing its world renowned
emergency medical care while successfully adapting to the financial constraints imposed by the lingering economic
downturn. These efficiencies extend through all EMS program areas,and benefit the entire regional EMS system and its
users.
The following are examples of some of the strategies undertaken by the system to manage growth in EMS services,
develop further system effectiveness and cost savings,and improve EMS care.
Manags Service Growth
Managing the rate of call growth in the EMS system is a regional priority and has been an ongoing focus throughout
the past three levy periods. Managed growth leads to cost savings and/or cost avoidance, reduced stress on the
entire Medic One/EMS system and greater EMS system effectiveness.
1. Safely limit the frequency with ✓ The ultimate objective of these revisions is to provide the most appropriate
which ALS is dispatched by revising response for the patient.
the Criteria Based Dispatch. ✓ In 2010,the King County Auditor documented$49 million worth of
savings in the 10 years since the implementation of this program.
✓ Estimated incremental savings in 2010 was around $3 million with a
cumulative total of$74 million of estimated savings over 12 years.
✓ EMS is continuing to fund this effort and work with dispatch agencies to
facilitate improved dispatching, including providing enhanced training
opportunities. New guidelines will be implemented for 2013.
2. Provide less acute 9-1-1 callers ✓ The EMS Telephone Referral Program (Nurseline)allows 9-1-1 call
with alternative, cost-effective receivers to transfer certain low-acuity, non-emergent patients to a
options that offer appropriate, high nurse line for consultation, advice,and referral to appropriate medical
qualiry care. care. EMS estimates avoided and reduced costs associated with this
program
✓ Use of taxi vouchers saves patient co-pays for ambulances, reduces
the use of high-cost ambulances for unnecessary transports, reduces
transports by BLS units,saves money for insurers, and allows BLS
units to return to service more quickly. Estimated cost avoidance to
healthcare system is$1.5 million.
✓ The Community Medical Technician is sent on lower acuity calls in non-
transport capable units. It provides basic patient evaluation,assistance,
specific BLS treatment on scene,and arranges for transport if inedically
necessary. This helps reserve other BLS transport-capable vehicles for
more serious medical and fire emergencies.
3. Identify and target specific ✓ Supporting Public Health with Emergency Responders(SPHERE)has
users of the EMS system to reduce EMS agencies identify patients with specific medical conditions and
"repeat"callers or the inappropriate connect them to appropriate resources.
calling for 9-1-1 services. ✓ The Communities of Care Program educates staff of nursing homes and
adult family homes about when to call 9-1-1 for an emergency to reduce
unnecessary EMS responses.
✓ Injury Prevention Programs address specific high-risk populations to
help reduce injuries and prevent future calis to 9-1-1 for service.
76
� � ��
Process Improvements
Developing process improvements lead to accomplishing more with existing resources,thereby increasing
effectiveness
1. Medic Unit relocation ✓ Annually review unit workload, response time and exposure to critical
skills to confirm medic units are in the most appropriate locations.
✓ Ensure the most effective use of inedic units and maximize response
times.
2. Rightsizing budgets ✓Scouring budgets for efficiencies and reprogramming funds into higher
priority regional projects reduced planned expenditures for 2014-2019,
allowing additional services to be provided without substantially increasing
the budget.
3.Share resources ✓ Share resources between KCM1 and Sheriff's Department(co-located
&share admin)-resolved the need for a new KCM1 facility, promotes
efficiencies.
✓ Take opportunity of shared goals between two major grants to realign job
duties across the studies utilizing current staff resources.
✓ Partner with University of Washington to design test approaches to
improving emergency communication for the care of cardiac arrest
involving Limited English Proficiency callers. In addition,we are
collaborating with the UW Department of Bioengineering to advance
strategies to achieve early and effective defibrillation.
4. Collaborate with local union ✓ Collaborate with local union to reposition medic unit which allows for
adequate coverage during paramedic training exercise(avoids overtime
expenses).
✓ Work with local union to reduce 3rd person shift on ALS response.
5. Implement work process changes ✓ Merge sections within the Division-Planning& Evaluation with Medical QI
and expand Cardiac Case Review project.
✓ Re-align staff in Professional Standards Section to promote efficiencies
and increase services with a focus on providing improved value to EMS
partners.
✓ Maximize clerical support to other sections within the Division.
✓ Programs transitioned to local agencies. KC EMS began infrastructure
and service many years ago; now fire agencies have incorporated this into
their systems(put ourselves out of"business").
✓ Regional purchasing program (leveraging volume purchases).
✓ Use courier service to pick up and deliver post cardiac arrest data from
outlying areas of King County rather than sending staff(time savings to be
re-i nvested).
✓ Incorporate grant developed on-line quality improvement program into levy
funded operations within existing Regional Services allocation.
77
f'
� •
Appendix B: Efficiencies - cont.
Technology
Infrastructure technologies can be e�ended to improve patient care, be more cost efficient,and deliver greater
effectiveness all around.
1. Improve the quality,accuracy and ✓ Improve efficiencies by processing more re-certifications for all EMTs and
timeliness of EMS data. paramedics in the county with same staffing; increase certifications by
20%over 2011 and reduce staff cost per certification from$42.94 per
certification (based on 2265 certifications completed in 2011)to$35.64
per certification (based on 2729 certifications for 2013)through RETRO.
✓ Enhance data collection and management for quality improvement
activities through SEND.
✓ Provide greater speed and efficiency in dispatch call processing with CBD
Software development and CAD Integration projects.
✓ Reduce travel time due to integration of electronic medical records with
two hospitals.
✓ Data validity checks to catch errors in real time (CASS project).This
creates an ability to use professional staff for other tasks.
2. Offer cost-efficient quality ✓ Reduce cost per EMT student by moving didactic portion of training to the
assurance strategies via web-based current online platform.
training techniques and tools(EMS ✓ Reduce paramedic overtime by offering paramedic online training.
Online and Cardiac Case Review).
Financial measures
✓ Reduce cost per EMT student by a variety of ineasures(reduce costs
of producing classes; increase number of students to reduce cost per
student and train more EMTS; use technology for a portion of class;
alternative storage of supplies to reduce rental fees.
✓ Ability to cover one time facility move by savings related to extending life
span of vehicles at KCM1.
✓ Ability to redirect resources due to low vehicle maintenance costs after
acquiring new vehicles.
✓ Ability to redirect resources due to using discount code for purchasing
office supplies
✓ Incorporate timeline of certain regional support services and strategic
initiatives projects into the next levy period
✓ Streamline procurement procedures at KCM1(Warehouse distribution
function. Initial implementation of new system resulted in increased
workload (and overtime) in 2012. Working with procurement to
streamline processing and procure to pay process related to distribution
functions. Reducing overtime by 320 hours a year.
78
' �, ,;�:
Such efficiency and effectiveness activities will continue over the 2014-2019 levy period, along with the following new
efficiencies:
Manage Servlce Growth: ✓ Adding no ALS new units over the span of the next levy($2 million per
medic unit).
✓ Im�roving EMS Response to Vulnerable Populations(SI)to target repeat
callers and reduce inappropriate use of EMS services.
Financ7al measures: ✓ Extending equipment life span (significant savings to the unit allocation).
Process Improvements: ✓ Implementing the Regional Records Management System and BLS Lead
A en to better support and engage BLS agencies concerning economic
and quality improvement opportunities on a local level.
✓ Ex�andin�Efficiency and Effectiveness Studies(SI)to greater focus
on performance and cost savings measurements/outcomes/metrics
related to efficiencies. Includes grants to EMS agencies to develop and
implement activities related to improving operational efficiencies and
effectiveness.
✓ Review overall operational efficiencies and patient outcomes.
79
�
� This table ref�ects medic unit additions over the past two decades. Highlights indicate where service has increased. Of note is the broad distribution of
additions across ALS agencies and over time.
Advanced Life Support(ALS)Units"
First �
Year Location revious 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2006 2009 2010 2011 2012 2013 �
Seattle �
Seattle M1&M10 1969 HMC 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 �
Seattle M14 1976 So.Sea Industrial 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
SeatNe M17 1976 Univ District 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 =
Seattle M32 1980 West Seattle 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 � 1 A
Seattle M28 1980 Rainier Valley 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 ��
Seattle M16 1979 Greenlake 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 \/
Seattle M31 1991 North ate 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 ��
Seatde M18 2001 Ballard 1 1 1 1 1 1 1 1 1 1 1 1 1 �
ToWI 6 6 6 6 6 6 6 6 6 6 7 7 7 7 7 7 7 7 7 7 7 7 7 ■■
Bellevue Medic �
Bellevue Medic 1 1972 Bellevue 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 �
Bellevue Medic 2 1982 Bellevue 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
Bellevue Medic 3(EMT/P) 1992 NoRh Bend 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 1 1 1 1 1 1 1 1 e
Bellevue Medic 14 1997 Issaquah 0.5 0.5 0.5 0.5 0.5 0.5 1 1 1 1 1 1 1 1 1 1 1 A�
Total 2 2.5 2.5 2.5 2.5 2.5 3 3 3 3 3 3 3.5 3.5 3.5 4 4 4 4 4 4 4 4 iY
Evergreen(thru 2003)I Redmond(2003 thru present) `/
Evergreen Medic 19 1989 Redmond 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 �
Evergreen Medic 23 1975 Kirkland 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 �
Evergreen Medic 35(EMT/P) 1993 Woodinville-Duvall 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 1 1 1 1 1 1 1 1
Evergreen Medic 47 1997 Bothell 0.5 0.5 0.5 0.5 0.5 1 - - - - - - - - - - - _
Totai 2 2 2.5 2.5 2.5 2.5 3 3 3 3 3 3.5 2.5 2.5 2.5 3 3 3 3 3 3 3 3 =.
King County �
KC Medic4 1977 Highline 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
KC Medic 5 1977 Vaifey 1 1 1 1 1 1 1 t 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 y
KC Medic 6 1979 Aubum/Fed Way 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 �
KC Medic 8 1981 Fed Way 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 �
KC Medic 11 1992 Covington 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
KC Medic 7 1996 Kent-Des Moines 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 �
KC Medic 12 1998 Black Diamond 0.5 0 5 0.5 0.5 0.5 0.5 1 1 1 1 1 1 1 1 1 1 O
KC Medic 13 2006 Des Moines 0.5 0.5 0.5 0.5 0.5 1 1 1 �
Total 4 5 5 5 5 6 6 6.5 6.5 6.5 6.5 6.5 6.5 7 7 7.5 7.5 7.5 7.5 7.5 8 8 8 r,�
��
Shoreline �
Shoreline Medic 63 1977 Shoreiine 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
Shoreline Medic 65 2002 Kenmore 0.5 0.5 0.5 0.5 0.5 0.5 1 1 1 1 1 1 �
ShorelineMedic47 2003 Bothell 1 1 1 1 1 1 1 1 1 1 1
Total 1 1 1 1 1 1 1 1 1 1 1 1.5 2.5 2.5 1.5 2.5 2.5 3 3 3 3 3 3 ��
Vashon-Maury ALS C
Vashon Medic 9 Vashon 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 �
Total 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
�
City of Seattle 6 6 6 6 6 6 6 6 6 6 7 7 7 7 7 7 7 7 7 7 7 7 7 y
Remainder King Counry 9 10.5 11 1� 11 12 13 13.5 14.5 14.5 14.5 15.5 16 16.5 16.5 18 18 18.5 18.5 18.5 19 19 19
Total 15 16.5 1T 17 17 18 19 19.5 20.5 20.5 21.5 22.5 23 23.5 23.5 25 25 25.5 25.5 25.5 26 26 26
Increase 1.5 0.5 0 0 1 1 0.5 1 0 1 1 0.5 0.5 0 1.5 0 0.5 0 0 0.5 0 0
.
SUMMARY OF NEW AND RETOOLED STRATEGIC INITIATIVES i�ss�2o�
With Inflation(Lifetime Budgets)
a
�
2014 2015 2016 2017 2018 2019 Total �
�
New Strate�ic Initiatives: _
Regi Records ManagementSystem(RMS) $126,443 $132,210 $138,771 $145,000 $152,299 $159,989 $854,711 �(�-
BLSLeadAgency $170,833 $176,539 $365,046 $377,640 $390,820 $1,480,878 0
VulnerablePopulationsProgram $179,062 $219,281 $291,183 $271,850 $281,229 $291,044 $1,533,648 y
rF
�
SubTotal New Strategic Initiatives $305,505 5522,323 $606,492 $781,896 $811,168 $841,853 $3,869,238 �
�
�
�
Retooled Strategic Initiatives: � ,
BLS Efficiencies $54,532 $68,903 $77,677 $80,310 $76,157 $64,485 $422,064 = i
EMSEfficiency&EffectivenessStudies $169,654 $250,555 $323,654 $334,626 $346,170 $358,252 $1,782,911 rt
�
SubTotal Retooled Strategic Initiatives $224,186 5319,457 $401,331 5414,936 $422,328 5422,737 $2,204,975 �
��
Total New 8t Retooled Strate�c Initiatives $528,680 884i,781 $1,007,823 $1,196,833 $1,233,496 51,264,590 $6,0T4,212 =
�
�
�
, �
CommunityMedicalTechnicianUnits $363,546 $704,299 $679,502 $1,104,770 $1,091,217 $3,943,334
������r��a�tu� s�s0,�6 S�,a�s,�as $i,,�,�aaa �s���s 5�ss7,�8 ��,a�,S56 �o��s
�
�
e•
� �
Appendix E: Reserves
RESERVES for 2014-2019 Levy
November 2012
ALS Capacitv Reserve
Placeholder for Additional Capacityl $ 2,291,000
Facility Renovations $ 400,000
Call Volume& Utilization/Disaster $ 667,700
Subtotal $ 3,358,700
ALS Equipment Reserve
Average lifespan 1 year shorter than planned $ 202,800
Costs 3%higher than planned $ 286,100
Subtotal $ 488,900
A�S Operational ReserveZ
1%in Operating allocation for 19 units $ 394,700
Excess PTO (2 FTEs) $ 243,200
Extra Paramedic Students $ 244,000
Outstanding Retirement Liability $ 100,000
Subtotal $ 981,900
ALS Risk Abatement Reserve
Amount over risk pooi3 $ 124,400
Costs not covered by risk pools $ 1,200,000
Cost of replacement vehicle $ 185,600
Subtotal $ 1,510,000
Total ALS Reserves $ 6,339,500
Reserves for adding Reg'I CMT Units 4 $ 1,519,484
KC Required Fund Balance/Cash Flow Reservess $ 4,539,327
Total Reserves $ 12,398,311
Chan�es since March,2012
1 Added both years of potential cost of ALS placeholder unit(added$918k)
z Reserve available for Regional Services indirect/infrastructure&benefit expenses if costs exceed 10%of plan and
program balances are not available to cover expense.
3Assumes event$1.3 million over amount covered by risk pool covered by 10 year amortization
4 Regional Services Subcommittee recommended placing funding for slow implementation of 3 units in expenses and
having reserves available for implementing additional 2 units near end of levy.
5 Required Fund Balance from 2008-2013 levy span changed to Cash Flow Reserve to be consistent with new King
County Reserve Policies.
82
v
•
EMS LEVY- INFLATOR DESCRIPTION AND USAGE 5����012
2008-2013 LEVY AND PRELIMINARY PLAN FOR 20142019 LEVY PERIOD
Cost Cate�or�es 2008-2013 Levy Period 20L4�019 Levy Period
Salary/Wages CPI-U +1% CPI-W+ 1% �
Overtime CPI-U +1% CPI-W+ 1% 'a
Benefits Weighted Average Weighted Average A
Medical Supplies and Equipment Pharmacies& Drug Stores(PPI) Pharmacies& Drug Stores(PPI) a�
Office Supplies and Equipment CPI-U CPI-U k
Uniforms, Fire&Safety Supplies CPI-U CPI-U �
Dispatch CPI-U CPI-W+ 1% ��
Communication Costs CPI-U CPI-U =
Vehicle Maintenance Costs CPI-Vehicle Cost CPI-W+ 1% �
Facility Costs CPI-U CPI-U �
Training Costs CPI-U CPI-U 0
Misc. Costs CPI-U CPI-U �
Equipment CPI-Vehicle Cost PPI-Transportation Equipment(EMS) �
gyerhe d CPI-U +1% CPI-W+ 1% �
iesel �uel Price Reserve �
Annual change in average national diesel fuel price Annual change in average national diesel fuel �
� �
BLS CPI-U CPI-W+ 1% �
�
Regional Services CPI-U + 1% CPI-W+ 1% O
Strategic initiatives CPI-U + 1%(then converted to lifetime budget) CPI-W+ 1%
iese ue rice eserve
Annual change in average national diesel fuel price Annual change in average nationai diesel fuel
e ic nits quipment au itor
� Note: the 1%add for labor intensive items is to account for the non-COLA amounts that employees receive such as step increases
w
�
�
Preceding annual change in CPI-U for Seattle- �
CPI- U Tacoma-Everett. BLS ID:CUURA423SA0 �
Average increase in empioyee benefit costs for ALS Adopted budgets for ALS jurisdictions(King =
Inflator for Employee Benefit Costs agencies County, Bellevue, Redmond,Shoreline,Vashon) �
PERS2 Blended Calendar Year Employer Contribution Rate Washington State Actuary �
Inflator for LEOFF2 Blended Calendar Year Employer Contribution Rate Washington State Actuary �
FICA Base Proportion of salaries subject to FICA Historical average and tax law changes =
Pharmacy/Drug Prices(PPI) Preceding annual change in Producer Price Index for gLS ID: PCU446110446110 �
Pharmacy/Drug Prices �
�.
CPI-Vehicle Costs Preceding annual change in overall transportation gLS ID: CUUROOOOSAT =
costs adjusted by average fuel cost �
�
Diesel Fuel Price Reserve Annual change in average national diesel fuel price U.S. Dept of Energy: On-Highway Diesel Fuel Price �
per gallon,adjusted for fuel taxes Series =
PPI-Commodities—Transportaton Recommended by KCCAO for equipment inflation; �
equipment on purchased chassis Use difference in annual change between this indice BLS ID:WPU1413029 �
including ambulances and CPI-Vehicle Costs to access Vehicle Reserves �
�
� �
. _
�
Annual change in CPI-W for Seattle-Tacoma-Everett- BLS ID: CWURA423SA0 O
Preceding annual change in overall index for �
PPI-Commodities—Transportaton ■
equipment on purchased chassis transportation equipment on purchased chassis
including ambulances
` w
M
�•
f
Append z G: Comparisons Betw en Levies
, . ,
Advanced Life Started levy span with 25 medic units: Starting levy span with 26 medic units:
Support(ALS)
18 medic units-King County 19 medic units-King County
7 medic units-Seattle 7 medic units-Seattle
3 planned additional units: 0 planned additional units
2 KC(only 1 unit added) *$2,291,000 placeholder/ reserve to fund a
1 Seattle(not added) 12 hour medic unit during last two years of
the levy span, if needed.
Determine costs using the unit allocation Determine costs using the unit allocation
methodology methodology
Starting Unit Allocation(KC): $1,783,685 Starting Unit Allocation (KC): $2,126,816
Average Unit Allocation over span of levy(KC): Average Unit Allocation over span of levy(KC):
$1,897,030 $2,344,244
12 Reserves to cover unanticipated/one-time 4 Reserve categories to cover unanticipated/
expenses one-time expenses
- Disaster Response - Capacity
- Facilities - Operations
- Call Volume Utilization - Equipment
- Pharmaceuticals/Medical Equipment - Risk
- Chassis Obsolescence
- Dispatch/Communications
- ALS Salary and Wage
- Risk Abatement
- Diesel Cost
- Paramedic Student Training
- Excess Backfill for PTO
- Outstanding ALS Retirement
Compound inflator(using CPI-U)to inflate Compound inflator(using CPI-W)to inflate
annual costs annual costs
Equipment allocation: 6-year medic unit life Equipment allocation: 8-year medic unit life
cycle(3 years primary, 3 years back-up) cycle(4 years primary,4 years back-up)
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Appendix G: Comparisons Between �evies - cont.
, � ,
Basic Life Allocates funds to BLS agencies based on Allocates funds to BLS agencies based on
Support(BLS) funding formula based 50/50 on Assessed funding formula based 50/50 on Assessed
Value and Call Volumes. Value and Call Volumes.
BLS allocation amount for KC EMS Fund BLS allocation amount for the KC EMS Fund
equal to 22.8%of levy(over entire span). equal to 23.5%of expenditures(over entire
span).
Costs inflated at CPI-U Costs inflated at CPI-W+ 1%
Reglonal Fund regional services that focus on superior Fund regional services that focus on superior
Services(RS) medical training,oversight and improvement; medical training, oversight and improvement;
innovative programs and strategies, regional innovative programs and strategies, regional
leadership,effectiveness and efficiencies. leadership,effectiveness and efficiencies.
Programs enhanced/rescoped to meet
emergent needs.
Costs inflated at CPI-U + 1% Costs inflated at CPI-W+ 1%
Strategic Total of 14 Strategic Initiatives 10 proven Strategic Initiatives converted into
Initlatives(SI) Regional Services; 2 eliminated; 2 revamped;
3 NEW Strategic Initiatives
1. eCBD/CAD Integration (Emergency Converted into RS
Medical Dispatch)
2. Dispatch Center Performance Standards Converted into RS
(Emergency Medical Dispatch)
3. Advanced Emergency Medical Dispatch Converted into RS
Training(Emergency Medical Dispatch)
4. Better Management of Non-Emergency Revamped to further develop strategies to
Calls to 9-1-1(Emergency Medical Dispatch) manage current demand and expected future
growth in requests for BLS assistance
5. Community Awareness Campaign (Injury Converted into RS
Prevention)
6. Small Grants Program for BLS Agencies Converted into RS
(Injury Prevention)
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Strategic 7. Countywide Falls Program (Injury Converted into RS
Initiatives(SI) Prevention)
8. Public Access Defibrillation Awareness Converted into RS
Ca m pa ign
9. Interactive Enhancements to EMS Online Converted into RS
10. System wide Enhanced Network Design Converted into RS
(SEND)
11. Grant writing/other funding Eliminated
Opportunities(Injury Prevention)
12.All Hazards Management Preparation Eliminated
13. EMS Efficiencies& Evaluation Studies Revamped to provide additional focus on
performance measures, outcomes, metrics,
and looking at continuous improvement
projects outside of what is currently being
done
14. Strategic Planning for Next EMS levy Converted into RS
period
3 NEW Strategic Initiatives
- Vulnerable Populations
- Regional Record Management System
- BLS Lead Agency Proposal
Other Community Medical Technician Community Medical Technician
- 2 pilots as part of EMS Efficiencies/ - Funding for 3 units, plus reserve for
Evaluation Study additional units if project is successful.
Audit Audit
- Annual audit by King County Auditor's Office - Two audits over span of six years by King
County Auditor's Office
Costs inflated at CPI-U + 1% Costs inflated at CPI-W+ 1°/o
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Appendix H: EMS Citations
Citation Chapters
Cha�ter 18 71 RCW Defining EMS personnel requirements: Physicians
18.71.021 License required.
18.71.030 F�cem ptio ns.
18.71.200 Emergency medical service personnel-Definitions.
18.71.205 Emergency medical service personnel-Certification.
18.71.210 Emergency medical service personnel-Liability.
18.71.212 Medical program directors--Certification.
18.71.213 Medical program directors--Termination-Temporary delegation of
authority.
18.71.215 Medical program directors-- Liability for acts or omissions of others.
18.71.220 Rendering emergency care-- Immunity of physician or hospital from civil
liability.
Chapter 18.73 RCW Defining EMS practice: Emergency medical care and transportatlon
services
Chapter 36 01.095 RCW Authorizing countles to establish an EMS System: Emergency
medical services—Authorfzed—Fees
Mandating public health services by requiring the local health officer to
�h pter 70.05.070 RCW take such action as is necessary to maintain the health of the public
Local health officer—powers and duties
ChaQter 70.46.085 RCW County to bear expense of providing publlc health services
Chapter 70 54 RCW Mlscellaneous health and safety provisions
Semiautomatic external defibrillator-duty of acquirer—immunity from civil
70 54 310 RCW liability
Chapter 70 168 RCW Revising the EMS&trauma care system: Statewide trauma care
system
Chapter 84 52 069 RCW Allowing a taxing district to impose an EMS levy: Emergency
medical care and service levies
Tltle 246-976 WAC Establishing the trauma care system: Emergency medical services
and trauma care systems
TRAINING
246-976-022 EMS training program requirements,approval, reapproval,discipline.
246-976-023 Initial EMS training course requirements and course approval.
246-976-024 EMS specialized training.
246-976-031 Senior EMS instructor(SEI)approval.
246-976-032 Senior EMS instructor(SEI) reapproval of recognition.
246-976-033 Denial,suspension, modification or revocation of SEI recognition.
246-976-041 To apply for training.
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CERTIFICATION
246-976-141 To obtain initial EMS agency certification following the successful completion
of Washington state approved EMS course.
246-976-142 To obtain reciprocal(out-of-state) EMS certification, based on a current out-
of-state or national EMS certification approved by the department.
246-976-143 To obtain EMS certification by challenging the educational requirements,
based on possession of a current health care providers credential.
246-976-144 EMS certification.
246-976-161 General education requirements for EMS agency recertification.
246-976-162 The CME method of recertification.
246-976-163 The OTEP method of recertification.
246-976-171 Recertification, reversion, reissuance, and reinstatement of certification.
246-976-182 Authorized care—Scope of practice.
246-976-191 Disciplinary actions.
LICENSURE AND VERIFICATION
246-976-260 Licenses required.
246-976-270 Denial,suspension, revocation.
246-976-290 Ground ambulance vehicle standards.
246-976-300 Ground ambulance and aid service--Equipment.
246-976-310 Ground ambulance and aid service--Communications equipment.
246-976-320 Air ambulance services.
246-976-330 Ambulance and aid services--Record requirements.
246-976-340 Ambulance and aid services--Inspections and investigations.
246-976-390 Trauma verification of pre-hospital EMS services.
246-976-395 To apply for initial verification or to change verification status as a pre-
hospital EMS service.
246-976-400 Verification--Noncompliance with standards.
TRAUMA REGISTRY
246-976-420 Trauma registry-- Department responsibilities.
246-976-430 Trauma registry—Agency responsibilities.
DESIGNATION OF TRAUMA CARE FACILITIES
246-976-580 Trauma designation process.
246-976-700 Trauma service standards.
246-976-800 Trauma rehabilitation service standards.
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Appendix H: EMS Citations - cont.
SYSTEM ADMINISTRATION
246-976-890 Inter-hospital transfer guidelines and agreements.
246-976-910 Regional quality assurance and improvement program.
246-976-920 Medical program director.
246-976-930 General responsibilities of the department.
246-976-935 Emergency medical services and trauma care system trust account.
246-976-940 Steering committee.
246-976-960 Regional emergency medical services and trauma care councils.
246-976-970 Local emergency medical services and trauma care councils.
246-976-990 Fees and fines.
KIn�County Code Sectlon Establishing a Division of EMS within the Public Health and describes the
2.06.080.c duties of the department:
Section 2.06.080.0
G.To fulfill the purpose of reducing death and disability from accidents,
acute illness, injuries and other medical emergencies,the duties of the
emergency medical services division shall include the following:
1.Track and analyze service and program needs of the emergency medical
services system in the county,and plan and implement emergency medical
programs,services and delivery systems based on uniform data and
standard emergency medical incident reporting;
2.Set standards for emergency medical services training and implement
emergency medical service personnel training programs, including, but not
limited to, public education, communication and response capabilities and
transportation of the sick and injured;
3.Coordinate all aspects of emergency medical services in the county with
local,state and federal governments and other counties, municipalities
and special districts for the purpose of improving the quality and quantity of
emergency medical services and disaster response in King County;and
4.Analyze and coordinate the disaster response capabilities of the
department
PHL 9-1(DPH DP) Emergency Medical Services(EMS)System Policy
PHL 9-2(DPH DP) Emergency Medical Services(EMS) Financial Policy
Updated EMS Financfal Plan Approved annually through King County budget process
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Appendix 1: Meeting Sched le
EMS Advisory Task Force
Medic One/EMS Strategic Plan & Reauthorization
Meeting Schedule
EMS Advisory Task Force:
Tuesday,October 25,2011 1:00-3:OOPM Seattle Joint Training Facilty-9401 Myers Way South,Seattle
Tuesday,January 31,2012 1:00-3:OOPM Bellevue City Hall-450 110th Avenue NE, Bellevue
Wednesday,May 30,2012 1:00-3:OOPM Community Center at Mercer View-8236 SE 24th St, Mercer Island
Thursday,July 26,2012 1:00-3:OOPM Tukwila Community Center-12424 42nd Avenue South,Tukwila
Subcommitlees:
Advanced Life Support(ALS) Basic Llfe Support(BLS)
1:00-3:OOPM 1:00-3:OOPM
Chief Gregory Dean, Chair Mayor Denis Law,Chair
November 3, 2011-Renton Fire Station#14 November 17, 2011-Renton City Hall, 7th floor
November 30, 2011-Renton Fire Station#14 ��,;,u�;�, ^L^�T«„�e�-Fi�����k
December 20, 2011-Renton Fire Station#14 January 5, 2012-Renton City Hall, 7th floor
February 7,2012-Bellevue City Hall February 16, 2012-Renton City Hall, 7th floor
March 6, 2012-Bellevue City Hall March 15, 2012-Renton City Hall, 7th floor
April 3, 2012- Bellevue City Hall April 12, 2012-Renton City Hall, 7th floor
� , , r
Regional Services Subcommiitee Finance Subcommlitee
1:00-3:OOPM 1:00-3:OOPM
Mayor Jim Haggerton,Chair Mayor John Marchione, Chair
November 10, 2011-Tukwila City Hall November 16, 2011-Eastside Fire&Rescue
December 14,2011-Mercer Island Station 91 January 24, 2012-Eastside Fire& Rescue
January 12, 2012-Mercer Island Station 91 March 28, 2012-Eastside Fire& Rescue
February 23,2012-Mercer Island Station 91
March 22, 2012-Mercer Island Station 91 May 10, 2012-Eastside Fire&Rescue
April 10, 2012- Mercer Island Station 91 ,
April 19, 2012- Mercer Island Station 91
April 26, 2012-Mercer Island Station 91
, -
Renton Fire Station#14- 1900 Lind Avenue SW, Renton-(425)430-7100
Tukwila City Hall-6200 Southcenter Blvd,Tukwila-(206)433-1800
Mercer Isiand Station 91-3030 78th Avenue SE, Mercer Island-(206)275-7607
Renton City Hall-1055 South Grady Way, Renton-(206)430-6400
Eastside Fire& Rescue HQ- 175 Newport Way NW, Issaquah-(425)392-3433
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A endix J: EMS Advisory Task Forc Work Plan
pp
EMS Advisory Task Force Work Plan
Submitted to the King County Council on September 15,2010, in accordance with SECTION 75:EMERGENCY MEDICAL
SERVICES Proviso P-1 of the King County 2010 Budget Act, Ordinance 16717.
The EMS Advisory Task Force Work Plan proposed a means for managing and coordinating the Task Force to allow for the
timely review of issues and options in developing recommendations for the Medic One/EMS 2014-2019 Strategic Plan.
The Work Plan created four subcommittees, representing the Advanced Life Support(ALS), Basic Life Support(BLS),
Regional Services(RS)and Finance program areas,to complete the bulk of the system program and cost analysis.
Recommendations regarding current and projected program needs were generated through the ALS, BLS,and RS
Subcommittees and subsequently presented to the EMS Advisory Task Force. A financial plan to adequate support
these needs was developed and reviewed by the Finance Subcommittee.
The Work Plan recommended that the EMS Advisory Task Force meet four times,starting in October 2011 and
concluding in July 2012. This allowed adequate time for the various subcommittees and the EMS Division staff to
perform necessary analyses and prepare materials for task force review and deliberation,and subsequently report their
recommendations in a timely manner to the King County Council.
Meeting#i: Meeting#2: Meeting#3: Meeting#4:
October 2011 January 2012 May 2012 July 2012
EMS Orlentatlon Prellminary Review Full Draft Revlew Final Revlew
Revlew: Overvlew: Follow-up: Take Action:
1. Task Force(TF)duties 1. EMS Levy Review 1. Subcommittees to 1.Approve programmatic
and expectations;TF ■ Length report back full draft recommendations and
timeline ■ Rate program and financial Financial Plan
• Ballot timing recommendations
2. Finalize EMS levy
Overview: Follow Un: 2. Discuss EMS Levy components
2. EMS System Review 2. Subcommittees to components ■ Length
report back preliminary ■ Length ■ Rate
programmatic and ■ Rate • Ballot timing
financial findings ■ Ballot timing
Develoa: Other: Other:
3. Subcommittee Chairs 3. Other follow up items 3. Other follow up items
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