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ty

of Troy

Monday June

27

2016 6:00 P

Personnel Committee

TROY

CITY

COUNCIL

COMMITTEE MEETING NOTICE

COUNCIL CHAMBERS, CITY HALL

100 S. MARKET STREET, TROY, OHIO

Terwilliger

[Chm.]

Kendall, Twiss

1.

Discussion

of

creation

of

fulltime Firefighter/Paramedic Lieutenant Position.

Other

Committees/items

may

be added.

6-22-2016

Cc: Mayor

Mr. Titterington

Mr. Kerber

Mr. Frigge

Department Heads

Chamber

of Commerce

media

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MEMORANDUM

TO: Mrs. Baker, President of Council

Troy, Ohio 45373

phone: (937) 335-1725/fax: (937) 339-8601

patrick .titterington@troyohio.gov

FROM: Patrick

E. J.

Titterington, Director

o

Public Service and Safety

PEJT

DATE: June 9 2016

SUBJECT: Creation of Fulltime Firefighter Paramedic Lieutenant Position

RECOMMENDATION:

That City Council authorize the creation o

an

intermediate position between

Firefighter/Paramedic and Platoon Commander, called 'Paramedic Lieutenant,' at a salary

determined per Section 14.2 of the Agreement Between City

o

Troy, Ohio and IAFF Local

1638, January

1

2016-December 31, 2018 (henceforth, Contract).

JUSTIFICATION:

In 2015, the Novak Group completed a study and assessment o Fire Department staffing.

Among Novak's conclusions was that present staffing levels are sufficient to handle current fire

and EMS-related workload. However, the study also identified the need to dedicate a Safety

Officer on emergency scenes, as well as provide better staff training coordination.

A Paramedic Lieutenant position would also be responsible for researching, analyzing and

potentially coordinating the following additional assignments/duties:

Community Paramedicine

Increasing health care costs across the region, combined with changes in Medicaid/Medicare,

are forcing healthcare providers to evaluate the delivery of health services. Hospital systems are

working with EMS agencies to cultivate partnerships to help ensure the emergency room

is

utilized more effectively. With recent Ohio law changes ORC 4765.361, Performance of service

in non-emergency situations), the role o the Paramedic has changed to allow more functions

in

the field for additional focused treatments at the scene. Community paramedicine adapts to the

specific needs and resources

o

each community. For your information, attached is a recent

article describing this concept. The Troy Fire Department has been

in

communication with

hospital systems to see how they can integrate this type of care. There may be opportunities to

integrate Community Paramedicine within current staffing levels, but additional research needs

to be completed to see how our department can effectively and efficiently provide this service.

Employee Health/Wei/ness Clinic

The City Administration has been researching the benefits

o

providing a health clinic for

employees as an alternative to emergency room, urgent care,

or

even primary care physician

visits

in

certain circumstances. Doing so could potentially lower the City's insurance rate

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Request for Council Committee Assignment re Additional Fire Position

June 9 2 16 Page 2

of

inflation exposure by lowering our health insurance use and experience. ORC 4765.361 may

provide a better opportunity for our Paramedics to support a clinic.

Other Assignments Duties

This position would also be responsible for:

1.

evaluating alternatives to shift scheduling, assignments, and deployment;

2.

analyzing current facilities, fleet, and equipment (current and future); and,

3.

researching 'best practices' for increasing diversity in staff recruitment.

FINANCIAL IMPACT

Section 14.2 o the Contract requires that, in the event the City establishes a new intermediate

position below the rank o Assistant Chief but higher than Firefighter/Paramedic, the new salary

must be within a range of 5 to 9% above the top firefighter base pay rate. That range,

annualized with estimated benefits, would be between $104,456.84 and $108,436.15. While the

2016 General Fund budget appropriation did not include those costs, the current General Fund

forecast can support this additional position. A future re-appropriation before the end o 2016

will be necessary to balance the Fire Department budget accounts.

REQUESTED ACTION

Please assign to the appropriate City Council committee the request to authorize the creation of

the position o Paramedic Lieutenant in the Troy Fire Department, for the reasons stated above

at a salary level to be negotiated per the terms o Section 14.2 of the Contract. It is anticipated

that legislation would be presented for Council action after the final salary is negotiated.

tt chment

cc: Mayor Beamish

John Frigge, Auditor

Matt Simmons, Fire Chief

Josh Havenar, President IAFF Local 1638

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http:Ucin.ci/lpzlSkA

[ o be published Sunday, March 20, 2016]

Christ Hospital local fire departments

launch house call pilot

Emilie Eaton, eeaton@enquirer.com 4:06p.m.

EDT

March

18,2016

(Photo: The Enquirer/Emilie Eaton)

EAST WALNUT HILLS - A new pilot partnership between Christ Hospital and six local fire

departments scheduled to launch in April will train paramedics to serve outside their customary

emergency roles as first responders.

Departments participating in the pilot include Cincinnati Fire Department, Colerain Township

Fire Department, Deerfield Township Fire Department, Miami Township Fire Department,

Monroe Fire Department and Jefferson Township Fire Department.

We would be the gap fillers, said Larry Bennett, chair of the University ofCincinnati's Fire

Science and Emergency Management program, who is helping launch the pilot. We would visit

patients who do not have in-home care.

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The local pilot will start small, only serving Christ Hospital patients in select areas who have

congestive heart failure, but organizers hope it will eventually expand to partnerships with many

local hospitals.

f it does, there could be many benefits, advocates say. It could help connect resources to poor,

underserved communities, cut down on habitual

9

callers, and ultimately save taxpayers

money.

Community paramedicine is an emerging practice throughout the nation, with programs or

pilots in Monroe, Ohio, North Carolina, Colorado, Minnesota, Maine, and Texas. Depending on

the program, paramedics administer several different type of services while out in the

community, including:

Identifying frequent 9 callers and referring them to non-emergency, primary care

services.

Assessing each medical situation differently, instead of transporting patients to the

Emergency Room.

Providing follow-up care to people who

just

left the hospital.

Supporting patients with conditions like diabetes, asthma and congestive heart failure.

Referring poor, underserved populations to community health partners that provide health

services for free or at a minimal fee.

It creates better health awareness, said Mark Johnston, EMS coordinator at Christ Hospital

who is helping launch the pilot.

On Monday, Bennett and Johnston will begin teaching a one-week course on community

paramedicine at the University of Cincinnati.

The course, which costs $1377 for non-matriculating students, will cover the foundations

of

community paramedicine and mobile integrated health care. It will also discuss the opportunity

for partnerships and income opportunities.

Guest lecturers include Ohio Sen. Bill Seitz, R-Green Township; the assistant fire chief

of

Dallas

Fire Rescue Department; and leaders from United Way ofGreater Cincinnati and the Talbert

House, a non-profit that helps people struggling with mental illness, addiction and homelessness.

Community paramedicine: An age old idea

Community paramedicine is an emerging healthcare delivery model, but the idea has actually

been in existence since the early 1990s, according to a report by the University of Washington

School of Medicine.

One of the earliest known community paramedicine programs existed in Red River, New

Mexico. The closest hospital to the rural town was roughly a 40-mile, one-hour trip, according to

an article by Firehouse, a firefighting trade website.

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In 1995, the New Mexico Senate passed an act that required the Department of Health to study

the idea of community paramedicine. Soon after, the Red River community paramedicine pilot

launched.

A later review of the program found many patients didn't use the program for primary care, but it

did reduce the number

of

times the ambulance went to the hospital by roughly 67 percent.

Bennett and Johnston said the idea of community paramedicine can

be

traced back even further,

to when doctors provided home visits. Later, when departments began training

firefighters

as

paramedics, paramedics played an important role in the community.

Paramedics were designed to be the eyes and ears of the doctors in the community, Johnston

said.

In Ohio, the practice of community paramedicine is much newer.

Last year, Seitz introduced a bill that would allow paramedics and EMTs to perform services in

non-emergency situations. The bill passed and went into effect Oct. 1

Soon after, the Monroe Fire Department launched a six-month trial program. The program was

one of the first in the state.

etting the pilot project started

Before paramedics begin practicing community paramedicine in the Greater Cincinnati, a lot

needs to be done.

Each participating fire department has identified one firefighter it intends to be the county's

community paramedic.

Beforehand, each paramedic will take a three-credit semester class that will teach the skills of

community paramedicine.

You m y think that would be natural for someone with medical training, but Johnston said it is

not.

Paramedics are used to asking yes

or

no questions, Johnston said. Instead,

we

need to teach

them to communicate and ask questions like a doctor.

After paramedics complete the class, they will shadow an individual who is already practicing in

the community.

Each department's program will differ. They

m y

roll them out at separate times, and they may

each serve a different number of patients, but Johnston and Bennett said they intend to encourage

the partners to collaborate.

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And once paramedics do begin practicing in the community, Bennett wants to make one thing

clear: They will not be replicating other medical services. The program is designed to fill gaps -

not provide the same service as a private in-home care provider.

We visit patients who do not have in-home care, Bennett said. We want to work together.

Long term benefits immense

Johnston and Bennett are starting small, but they can see the pilot expanding throughout the

regiOn.

They hope other local hospitals and medical centers will be interested in partnering, as Christ

Hospital has. A program like this doesn't really work without patient data on populations to

target.

Long term, the benefits could be immense.

For example, community paramedicine could reduce the steep costs associated with ambulance

transportation and emergency hospital care. A 201 0 Rand Corp. report found that between 14

and 27 percent of all emergency room visits were for non-urgent needs, costing taxpayers

roughly $4.4 billion.

It could also help poor, underserved populations, Johnston and Bennett said.

In 50-plus combined years in the fire service and EMT world, the two have found that low

income neighborhoods often call 911 the most often because they don't have access to a primary

care doctor.

n

many cases, poor families aren't able to pay the ambulance or emergency care

bill, leaving that cost to taxpayers.

f a community paramedicine program was established, it could help address that problem.

It could also help connect poor communities to social services and local centers.

This is a public service, Johnston said. It will grow if we do it with well-trained medics.

IF YOU GO

What: A one-week community paramedicine course taught by Larry Bennett, chair of the

University ofCincinnati's Fire Science and Emergency Management program. There will be

dozens

of

guest speakers.

Where: Boy Scouts ofAmerica, 10078 Reading Road, Evendale and various locations

throughout the week.

When: 9 a.m to 4 p.m. Monday to Thursday, and 9 a.m. to 3 p.m. Friday.

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Who: Anyone can take the class.

Cost: The community is invited to attend the first day free-of-charge. he week-long course

costs 13 77 for non-matriculating students.

Deadline: Monday morning.

Register at onestop.uc.edulclasses.html.