Category Archives: Fire Department

ATM votes last Monday on ALS & AHT

town meeting

ALS Study Committee & Affordable Housing Trust at ATM

The town posted a summary of the votes on each warrant article at last Monday’s annual town meeting (ATM) (20170424-Warrant_votes_2017) .

On the only two substantially disputed warrant articles, my own estimate of the votes was that the warrant article:

  • #15 about ALS had the ATM voting about 80% against giving $500,000 to the selectmen to implement ALS as it saw fit in the next year if the selectmen felt it was needed – a clear mandate that the residents wants to make that decision themselves, rather than delegate it.  ALS will now go to the study committee that both the Warrant Committee and selectmen recommended; and
  • #17 about funding the Affordable Housing Trust with a $1m. bond had the ATM voting about 80% in favor.  Those monies will provide the town a financial tool to use to create affordable housing, in its efforts to get to 10% affordable housing and to therefore eliminate unfriendly 40B’s.  The town needs about 139 more affordable housing units to reach that 10% threshold, or about 160 if one considers the likely increase in housing units in town to be needed after the 2020 census.

Residents interested in serving on either the newly created ALS Study Committee or the just created Affordable Housing Trust should contact Evelyn Clarke (eclarke@medfield.net) to make his or her interest known.

Warrant Committee handout about ALS

ALS OPTIONS OVERVIEW

 

The Warrant Committee has prepared this Options Overview for Article 15.

 

Option 1.  As Is – For a Limited Time Period

 

Rely on neighboring communities to provide ALS intercept service (as we have in recent past) while evaluating an optimal long term solution

 

Expected Investment:             Potential $25K to study committee (no over-ride required)

Service:                                   Effective – ALS intercept will continue to work well for us if neighbors continue to support us while we evaluate other solutions

Uncertainty:                           Not a long term solution

 

Option 2.  Contract out ALS Services

 

Contract with a private service to dedicate an ambulance and 2 Paramedics to Medfield 24/7

 

Expected Investment:             $570K per year (based on one quote only)

Service:                                   Response time fast (have 2 ambulances available – ALS & BLS)

Ambulance utilization low

Staffed from a pool of paramedics with high utilization/experience

Uncertainty:                           Control of resources, Potential to share costs & services

 

Option 3. Hire FF/Paramedics

 

Hire paramedics and equip current ambulance to accommodate ALS service

 

Expected Investment:             6 hires < $700K ($544K-$606K per year +  $90K startup costs)

(Lower if we hire entry level Paramedics but will grow to this level within 7 years as a result of step increases)

4 hires would decrease investment 30%

8 hires would increase investment 30%

Service:                                   Response time fast (assuming no concurrent calls),

Equipment and Paramedic utilization low

Uncertainty:                           Number of hires/level of coverage
New Fire Chief not yet available – who will hire/train?
Cost (contract negotiations ongoing, retirement benefits not included,
budget to support required wage growth without future over-rides)

 

Option 4. Regionalize ALS Services

 

Share resources (either hired or contracted ALS) with other towns locally

 

Expected Investment:             Unknown – but lower than other long term options.

Potentially half (or less) than other options; could it be a profit center?

Service:                                   Response time fast (assuming no concurrent calls) especially if ambulance housed in Medfield, Utilization higher

Uncertainty:                           Partners, cost sharing, location of ambulance

Fire Chief selection process

The Board of Selectmen were given the following outline of a Fire Chief selection process on Tuesday evening this week by Kristine Trierweiler.  She said it was a process that she had worked out with the Personnel Board, mainly derived from the town’s last Police Chief search.  The difference this time is that the town’s consultant will be hired at the outset, instead of when we are substantially into the process, as was done with the Police Chief.

Kris opined that the process of selecting a new chief will take 4-5 months, which means that we should have a new chief on board to have input into resolving the ALS issue, if the town opts to pursue the recommendation of the Warrant Committee and selectmen to appoint an ALS Study Committee at the town meeting.

Mike Sullivan opined that the Chief needs to live in town, and/or commit to moving to town within 18 months per Kris, and that will be an issue that the selection committee will decide.  I have heard the suggestion that it is not a necessity and not required by other towns.

Residents interested in serving on the committee should contact Evelyn Clarke at the Town House – 508-906-3012.

mfd

April 2017

FIRE CHIEF SELECTION PROCESS

  1. Personnel Board to develop Fire Chief Selection process and file with the Town
  2. Formation of a search committee to include:

Scott McDermott, Town Moderator

Robert Cordon, Personnel Board Representative

Dr. Jeffrey Marsden, Superintendent of Public Schools

Chief Robert Meaney

Kristine Trierweiler, Asst Town Administrator

John Naff, Building Commissioner

Current/Retired Fire Chief

Resident at Large

Resident at Large

Committee’s first tasks will be to choose a Public Safety Management Consultant to assist in the transition and Assessment Center Process as well as develop selection criteria for position posting.

  1. Development of selection criteria
  2. Selection Criteria Finalized and Position Posted

Selection Committee will present selection criteria to the Board of Selectmen for their review. All changes should be agreed upon by both the Search Committee and the Board of Selectmen at a joint meeting.

Selection criteria determined after interviews with town officials, fire department employees and residents.

  1. Design of Comprehensive Assessment Center

Consultant will work with the Selection Committee to design and conduct a Fire Chief Assessment Center to evaluate candidates using various exercises and measure performance.

 

April 2017

  1. Recruitment and Selection

Selection Committee will work with Consultant to utilize various recruitment sources to construct a list of potential candidates. Initial screening of all resumes will be completed by the Selection Committee.

Candidates will be chosen by the Selection Committee to attend preliminary interviews and/or the One day Assessment Center to evaluate knowledge, skills, and ability.

Once the Committee has final list of candidates, the Consultant will complete character, background, and reference, checks on each of the finalist candidates. Standard reference checks will be used for all candidates by the Consultant in consultation with the Personnel Board.

  1. Board of Selectmen Appointment

After the reference checks are completed, finalist candidates will be presented to a full meeting of the Board of Selectmen. The Board of Selectmen will then interview each of the candidates and based on the scores of the Assessment Center, interviews and the reference checks a Fire Chief may be appointed by the Board of SelectmenMFD

ALS intercept clarification

John Kraus corrected my understanding of how the ALS intercept actually happens.  Thank you John.

ambulance

Good afternoon.  Just a comment / clarification on the intercept process: if our ambulance is transporting a patient to the hospital and meets up with an ALS truck (whether from a mutual aid department or a private service) the patient remains in the Medfield ambulance with our EMT and the paramedics will get on board with us (bringing along their equipment) and provide ALS care while we continue to the hospital. The patient is not moved from one ambulance to another during transport. If the patient is still at the scene and has not been loaded in the Medfield ambulance yet the mutual aid department maybe elect to transport in their truck, but I didn’t want the public to have the impression that the patient is being transferred from one truck to another on the side of the road during the intercept.  Thanks.

ALS status

ambulance

The Warrant Committee and the Board of Selectmen held a joint 2.5 hour meeting last night with about 25-30 residents to discuss how to best proceed with the advanced life support (ALS) issue at the annual town meeting (ATM).  The collective wisdom of the all town officials (all the Warrant Committee and selectmen) was to create an ALS Study Committee to gather all the data, to figure out the best solution, and to report back on how the town should best provide ALS services.

Currently, since the private providers ceased providing our ALS intercept services several months ago on short notice, the town provides paramedic service by means of ALS intercepts with ambulances staffed by paramedics from Westwood, Walpole, and Norfolk via the mutual aid that fire departments render to one another.  ALS intercept services are the ALS ambulance from one of the other towns meeting the Medfield ambulance en route and transferring the patient to the ALS ambulance to complete the transfer to the hospital.  Medfield then splits the monies from those ALS intercept calls with the other towns.  It is expected that mutual aid will continue until the Town of Medfield solves how it will provide ALS on its own.

The Warrant Committee presented the issues as it has determined them, and unanimously recommended the creation of an ALS Study Committee to better define the best solution.  The following was the Warrant Committee’s written report:

 

ALS Options Overview

BoS/WC Joint Working Session, April 10th, 2017

 

As Is For A Very Limited Period – ATM, 2018  

Rely on mutual aid to provide ALS intercept
(while evaluating an optimal long term solution)

 

Financial:        Potential $25K to study committee

Service:           Same as we have been receiving for several months

Uncertainty:   Not a long term solution

 

 

 

Contract ALS

Hire a service to dedicate ambulance and medics to Medfield

 

Financial:        $600K budget

Service:           Equivalent to hiring medics

Uncertainty:   Control of resources, Potential sharing of costs & services

 

 

 

Hire ALS

Hire medics and equip current ambulance to accommodate ALS service

 

Financial:        $750K budget (Cost of hiring plus $90K to equip ambulance)

Service:           Response time fast (assuming no concurrent calls), utilization low

Uncertainty:   # of hires/level of coverage, who hires/trains,

cost may be higher due to estimates for benefits/OPEB

 

 

 

Regionalize ALS

Share resources (either hired or contracted ALS) with other towns locally

 

Financial:        Unknown – but lower than other long term options.

Potentially 1/3  to ½ of cost of other solutions – or profit center)

Service:           Response time fast (assuming no concurrent calls), utilization higher

Uncertainty:   Partners, cost sharing, location of ambulance

 

Selectmen Marcucci proposed asking the annual town meeting (ATM) to vote to approve about $650,000 of monies to implement the ALS services, and to just leave the form of the ALS services to be implemented in the discretion of the Board of Selectmen.   In that scenario, the Board of Selectmen would first get the ALS study results, and then implement on what is proposed.  Selectman Murby seemed to agree with that proposal.  I prefer to give the town residents the right and opportunity to vote the ALS monies once the Board of Selectmen determines and presents to the residents what the Board of Selectmen thinks is the best ALS solution.  However, if the residents opt to trust the selectmen with the monies now to make the best ALS decision later, I am happy to execute on that trust.

 

 

 

 

ALS discussion 4/10

ambulance

The Warrant Committee and the Board of Selectmen just confirmed arrangements for a joint meeting at 7:30 PM on Monday April 10 to discuss the pending Advance Life Support (ALS) town meeting warrant article and the town’s ALS situation and its solution.

The town’s private ALS service providers ceased supplying ALS services on short notice to the town last year, and the town now relies on mutual aid from Westwood, Walpole, and Norfolk to supply ALS intercept services as needed.

On average, the Medfield Fire Department has two ambulance runs per day and where about 25% of the runs require ALS services, therefore the town averages one ALS run every other day.

Before announcing his retirement, Chief Kingsbury had recommended the hiring of six full time firefighter-paramedics to provide the ALS service, at a present cost of close to $500,000 a year, which was exclusive of the retirement pension and retiree health care costs the town would eventually pay later.

Other possible alternatives include:

  • hiring a private service to provide the needed ALS service (estimated at $600,000/year); and
  • seeking a regional solution with the surrounding towns that also do not now provide ALS services – Dover, Sherborn, Millis, and Medway.

It really comes down to a policy decision of both how much the town is willing to pay to have the paramedic answer the calls when the ALS services are needed, and how best to have the paramedic there when needed from among the various options that are available.

ALS costs

Chief Kingsbury provided new figures for various permutations (use the link to get a copy with correct formatting):

ambulance

20170131-wk-advanced-life-support-for-the-town-of-medfield

 

Advanced Life Support for the Town Of Medfield

 

 

Total calls for service by the Medfield Fire Dept. was 1274 for 2016 of that 517 were for Emergency Medical Services.

 

 

Emergency Medical Services

 

517 Requests               257 BLS Transports                189 ALS Transports               71 Refusals

 

 

The 189 transports were accompanied by paramedics from Events EMS, Westwood FD, Walpole FD, Norfolk FD and Brewster EMS.

 

Events EMS ceased operations and Brewster as of now is not available.

 

The Problem? Who is going to provide Advanced Life Support (ALS) for the almost 200 calls requiring Paramedic (Medic) intervention? What are our options?

 

  • If we do nothing.

 

We might be able to get away with it. It delays providing in-house ALS for a year if not more. It takes advantage of other communities ALS at their expense. We risk being shut off from their services as it is not mutual aid. A fellow chief who is struggling to staff his volunteer Fire Dept. and is using mutual aid excessively said it best,

 

“Mutual Aid is a network of sharing, with resources flowing back and forth across jurisdictional borders, and should not routinely benefit one partner in the form of subsidized services by the taxpayers of another community.”

 

  • Hire a Private Provider

 

Initial conversations with Millis & Medway resulted in a proposal from a private company for a dedicated ALS response truck to service the three communities it would be @ $600,000 per year and another $225.00 per intercept. Millis & Medway were not interested in pursuing further. On 01/19/17 as requested, I met with Chris DiBona of Brewster Ambulance to see if there was anything his company could do with either the three towns of Medfield, Dover and Sherborn or from their base in Norwood. Chris got back to me on 01/25/17 and said they were still working on it. I reached out to the Fire Chiefs in Sherborn and Dover, Sherborn expressed a little interest as they are struggling too and Dover does not appear to be interested.  I have not heard anymore as of yet. I will provide any info as soon as it’s available.

 

 

 

 

 

 

 

  • Add Staffing (options)

 

  1. I met with the Fire Chiefs from Millis and Medway on 01/23/17 to further discuss what options we might have. Both of those towns are pursuing advancing to the ALS level through hiring and training, more so hiring. As a result of these discussions if we were to get to the level of at least four (4) Medics each we could seek permission from our Medical Directors to run at a Paramedic/Basic (P/B) level and when needed we would pull a second medic from a neighboring town to facilitate a two medic event.

 

Pro’s: It’s a start                                                       Con’s: 2nd Medic availability =

We would have 2 Medics 50% of the time     delayed response

Increased Revenue                                           Expense

 

Cost Estimate:  4 Staff @ $80,556 = $322,224

Startup                       $90,400

Est. Total                                           $412,224         

 

 B)If we were to hire six (6) additional Medics we would have adequate resources to staff the Ambulance at the ALS level 24/7/365. The additional staff would have two shifts with four (4) personnel and two shifts with three (3) personnel.

 

Pro’s: 24/7 coverage at the ALS level                  Con’s: Expense

Increased Revenue

Staffing to aid in medical calls

Staffing to respond to fire calls

 

 

Cost Estimate:  6 Staff @ $80,556 = $483,336

Startup                        $90,400

Est. Total                                            $573,336

 

  1. If we were to hire eight (8) additional Medics we would have adequate resources to staff the Ambulance at the ALS level 24/7/365. The additional staff would have all shifts with four (4) personnel. With the additional staff and by having a second ambulance, in the event of back to back medicals, we could staff it to respond at the Basic Life Support (BLS) level. Added Medic staff would be able to cover open shifts to maintain ALS staffing.

 

Pro’s: 24/7 coverage at the ALS level                  Con’s: Expense

Increased Revenue

Run a 2nd BLS ambulance

Staffing to aid in medical calls

Staffing to respond to fire calls

 

 

Cost Estimate:  8 Staff @ $80,556 = $644,451

Startup                        $90,400

Est. Total                                            $734,851

 

 

According to Joy Ricciuto our Town Accountant, the Ambulance service generated $439,644 for FY16. Although I do not want to predict how much in this volatile time in Healthcare, it is safe to say there will be an increase to our revenue stream by advancing to the ALS level of service. By keeping it in-house we will keep the $62,000 we paid for outside services. The likelihood of increased revenue by way of increased demand for ALS calls and being able to reciprocate with mutual aid does exist.

 

Hiring additional Staff to provide ALS

 

Pro’s:

 

By providing in-house ALS you get the needed resources to the patients side the fastest possible way. No delay with patient care by waiting for a regional or alternative ALS intercept service.

Patients deteriorate every minute you wait for intervention.

 

You have more control on direct patient care by managing ourselves. We can choose the equipment to use to provide services. You have the ability to participate with any project waivers when they are available.

 

We can control the training of in-house medics. Training is key to this type of operation.

 

We have the ability to schedule medics in teams to capitalize on their experiences and skill level to provide the best service for the town.

 

We will maintain our own local medical control MD that is knowledgeable of the region and will oversee our entire service.

 

Increased billing for services rendered at the ALS level will result in increased revenue.

 

Increased staffing could result in running a 2nd ambulance resulting in increased revenue.

 

Increased staffing will aid in responding to Fire related calls for service as well as the day to day operational activities that are done.

 

Con’s:

 

Delay in providing ALS intervention to patients in need. Our avg. response time is under five minutes; it is a fifteen minute response from Norwood if we were to use Brewster as an intercept.

 

The startup expense is a downside but will be offset by increased revenues that will be better determined after it is up and running.

 

Conclusion:

 

This is an issue that will not be going away. We as a community need to address it so that all our residents have the best medical resources available to them in their time of need. I believe this decision as to what level of care is acceptable to our taxpayers should be left up to them. I would recommend the hiring of six (6) Medics to properly cover at the ALS level 24/7/365.