FOR TILLAMOOK COUNTY,

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1 FOR TILLAMOOK COUNTY, OREGON. Order Reassigning the Garibaldi ) Ambulance Service Area t Tilla-) mk Cunty General Hspital ) ORDER NO " This matter cming n t be heard this 11th day f July, 1990 at which time it appears that n April 20th, 1990 Garibaldi Ambulance Service submitted a written request fr reassignment and ntice f vacatin fr their Ambulance Service Area (ASA); and WHEREAS, ntice f the vacatin and an invitatin t make applicatin fr assignment f the ASA was published in the Headlight Herald n May 2 and May 9, 1990, and in the Sunday Oregnian n April 29 and May 6, 1990; an~ WHEREAS, by 5:00 pm n May 31, 1990, the deadline fr applicatins, nly ne applicatin had been received, that being frm Tillamk Cunty General Hspital; and WHEREAS, the Tillamk Ambulance applicatin has been evaluated pursuant t sectin 9, EMS Ordinance 41, and the General and Specific Criteria f the ASA Plan (pp 29-31), and the Quality Assurance (QA) Crdinatr has develped Findings f Fact, Cnclusins and a Recmmendatin; and WHEREAS, at it's regular meeting n June 21, 1990, the Tillamk Cunty Quality Assurance Cmmittee reviewed the Findings f Fact, Cnclusins and Recmmendatin f the QA Crdinatr, and the Cmmittee recmmended that the Garibaldi ASA be reassigned t Tillamk Hspital, but that Tillamk Hspital either verify at the hearing that it can achieve the standard expressed in Findings 14 and 15, r mdify fr the recrd that the full time Advanced Life Supprt (ALS) staffing wuld als include the use f Emergency Medical Technician-3s (EMT-3s); and WHEREAS, subsequent t the Findings f Fact, Cnclusins and Recmmendatin f the QA crdinatr, Tillamk Hspital has relcated ambulance quarters elsewhere in Garibaldi; and

2 , ~~. 11 J WHEREAS, n July 11, 1990 a public hearing was held by the Bard f Cmmissiners t cnsider Tillamk Hspital's applicatin fr reassignment, at which time written and ral testimny was received; and BEING FULLY ADVISED, the Bard f Cmmissiners makes the fllwing Findings f Fact, Cnclusins and Order: 1. The QA Crdinatr's Findings f Fact are attached heret and by this reference are made a part heref, except as hereinafter mre specifically amended, mdified r supplemented. 2. The full time ALS staffing t be prvided by Tillamk Hspital fr the Garibaldi ASAwill include the use f bth EMT 3s and EMT-4s. 3. The ambulance quarters fr the Garibaldi ASA will be lcated at 804 Garibaldi Avenue, in Garibaldi. 4. Tillamk Hspital's applicatin describes a prpsal fr flexible system status management that will imprve respnse times n first respnse dispatches. 5. The prpsed level and pattern f staffing, as well as staff rtatin t Tillamk Ambulance ~SA, will expand the level f service t the Garibaldi ASA withut adversely affecting the existing first respnse system. 6. Based n Tillamk Hspital's successful experience in perating under the lwer call vlume f the Nehalem ASA, the higher call vlume f the Garibaldi ASA (276 calls annually), is sufficient t financially justify the service t be prvided. 7. Tillamk Hspital, as part f the Adventist Health Systems, has been a lng standing and financially sund nt-frprfit institutin,and when cmbined with revenues generated by TEAM memberships, prvides an alternate funding surce sufficient t supprt the required level f care t be prvided. 8. Tillamk Hspital's prpsal des nt jepardize the financial ability f ther ambulance service prviders t prvide efficient service t the remainder f the cunty. NOW THEREFORE, IT IS HEREBY ORDERED that the Garibaldi ASA be and is hereby reassigned t Tillamk Cunty General Hspital t be effective at 12:01 am n July 12, 1990; and

3 IT IS FURTHER ORDERED that the QA Crdinatr prmptly deliver a cpy f this rder t the Tillamk Cuhty Emergency Cmmunicatins District, and cause a cpy t be sent t the state Health Divisin. Dated this I{~ day f July, BOARD OF COMMISSIONERS FOR TILLAMOOK COUNTY, OREGON Ida A. Lane, ChaPirsn Frm: ~ r ~j~~ Kenneth M. Burd~c, V~ce-Chairpersn (2~1~ be~ es, Cmm~ss~ner ()

4 GARIBALDI AMBULANCE SERVICE AREA REQUEST FOR REASSIGHHENT FACTS OF FINDING, CONCLUSIONS AND RECOJUIENDATION BACKGROUND The Garibaldi Ambulance Service-Area (ASA) is presently being perated under State Health Divisin Licenses issued fr tw Garibaldi Fire Department ambulances t the city f Garibaldi. Garibaldi Ambulance began serving this area in 1965 and became the grandfathered ASA prvider when the cunty adpted its ASA Plan and EMS Ordinance # 41 n December 28, The tw ambulances are statined at the Garibaldi Fire statin and are licensed as Advanced Life Supprt (ALS) units. The Garibaldi ASA encmpasses the cmmunities f Nednna, Manhattan Beach, Rckaway Beach, Twin Rcks, Barview, Garibaldi and nrth Bay city. Alng Highway 101 it is bunded n the nrth by milepst Z47 at Jetty Fishery, and n the suth it is bunded by Tillamk Street in Bay city. On the west the ASA is bunded by the Pacific Ocean and it extends easterly t include prtins f the Miami-Fley Cunty Rad, the Miami River Drainage Basin, and the rural cmmunities lying therein. Althugh Garibaldi Ambulance is predminantly a vlunteer rganizatin, it is staffed and manned during business hurs by ne paid full time persn. After business hurs, cverage is maintained by a vlunteer under a duty rster. Vlunteer EMTs als pr~vide supplemental 24 hur respnse. On April 20, 1990 Stan Sheldn, Directr f Garibaldi Ambulance submitted a written request fr reassignment and ntice f vacatin. Pursuant t sectin 11(E) f EMS Ordinance 41, the bligatins f Garibaldi Ambulance t prvide service wuld terminate JUly 23, 1990 unless the ASA were sner reassigned by the Bard f Cmmissiners.. Ntice f the vacatin and an invitatin t make applicatin fr assignment f the ASA was published in the Headlight Herald n May 2 and May 9, 1990, and in the Sunday Oregnian n April 29 and May 6, The deadline fr applicatins was set at 5:00 pm, May 31, Requests fr infrmatin packets were received frm, and packets were mailed t, Tillamk Hspital, Buck Ambulance C. f Prtland, and AA Ambulance f Prtland. By 5:00 pm n May 31, 1990, hwever, nly ne applicatin frm Tillamk Hspital (attached heret) had been received. The Tillamk Ambulance applicatin has been evaluated pursuant t sectin 9, EMS Ordinance 41; the General and Specific criteria f the ASA Plan (pp 29-31), and the fllwing Facts f Finding, Cnclusins and Recmmendatin are repectfully submitted.

5 ". RECOMMENDATION Based n the criteria fund in sectin 9, EMS Ordinance #41, and the applicatin f the General and Specific criteria f the ASA Plan (pp 29-31), it is recmmended that the Garibaldi Ambulance ASA be reassigned t Tillamk Hspital. Level and Quality f Service FACTS OF FINDING Tillamk Ambulance will prvide full time ALS service at Garibaldi Fire Statin. (Applicatin p. 2) Thirty five licensed EMT's (Exhibit A-6) will rtate frm Tillamk Ambulance t staff the Garibaldi ASA. (Appli. p. 2) Tillamk Hspital presently wns, and hlds State Health Divisin licenses n, fur type III ALS Ambulances. (Ex. A-5) Tillamk Hspital is prpsing t purchase at least tw if nt three mre Type III ALS ambulances. (Ex. A-5) (Appli. p. 5) Patient care equipment is prvided by Tillamk Ambulance exceeding State Health Divisin.requirements. (Appli. p. 5) (Ex. A-15) 6. Tillamk Hspital paramedics and EMT's wh will staff Garibaldi will als rtate int Tillamk fr shifts t benefit frm the experience f higher call vlumes and inhuse pprtunities. (Appli. p. 2) 7. Tillamk Hspital will nt be subcntracting fr any services with the exceptin f certain peridic equipment maintenance as described in the cntract attached t their applicatin. (Appli. p. 2; Ex. A-13) 8. Tillamk Hspital plans t augment revenues fr the Garibaldi ASA by the sale f memberships in TEAM. (Appli. pp. 3-4; Ex. A-8) Respnse Time Standards 9. The lcatin f the first call ambulance fr the Garibaldi ASA remains unchanged, i.e. Garibaldi Fire statin. (Appli. p. 5) () 10. Upn dispatch f the first ambulance frm Garibaldi, Tillamk Ambulance will autmatically call in a secnd ambulance t Garibaldi fr cntinuus cverage. (Appli. p. 5)

6 11. The existing Garibaldi ASA first respnse system cnsists f Garibaldi Ambulance, Rckaway Beach Fire Rescue, Garibaldi Fire Rescue and Bay City Quick Respnse Team (QRT). 12. The Bay City QRT cvers the municipal City limits f Bay City, encmpassing nly small prtins f bth the Garibaldi ASA and Tillamk ASA within Bay City, but n ccasin des respnd t Garibaldi Fire statin fr cverage. 13. Tillamk Hspital intends t emply as per diem emplyees, all existing Garibaldi Ambulance persnnel. (Appli.,p. 2) 14. A full time paramedic r EMT-4 will staff the Garibaldi statin. (Appli. pp. 2,3) 15. The full time paramed'ic r EMT-4 wuld be augmented by a predesignated n-call per diem emplyee identified n the duty rster. (Appli. pp 2,3) 16. Tillamk Hspital has fur ambulances and will sn have at least six ambulances available with backup crews maintained arund the clck. (Appli. p. 5) () Business Practice standards 17. Tillamk Hspital's applicatin prvides a descriptin f it's management structure (Appli. pp. 5,6; Ex. A-9), and jb descriptins fr ambulance persnnel (Appli. p. 6; Ex. A-10). 18. Tillamk Hspital's applicatin prvides it's vehicle maintenance schedule (Appli. pp. 5-6; Ex. A-14), vehicle maintenance checklist (Appli. p. 6; Ex. A-12), and present vehicle mileage indicating that all first line vehicles have less than 100,000 miles. (Ex. A-14). 19.' Tillamk Hspital's 'applicatin prvides inspectin and maintenance schedules fr equipment carried n ambulances. (Appli. p. 7; Ex A-15; Ex. A-13) 20. Insurance cverage fr Tillamk Hspital meets r exceeds the requirements fr Persnal Liability and Prperty Damage, Vehicle Replacement, Equipment Replacement, Errrs and Omissins, and Malpractice. (Ex. A-7). 21.' Tillamk Hspital's applicatin describes billing practices, cllectin plicies and write-ff plicies. (Appli. p. 1; Ex. A-16) 22. Wrkers Cmpensatin is carried fr each emplyee based n a wage f $800/mnth r actual salary, whichever is greater. (Ex. A-1?)

7 23. Malpractice/Errrs and Omissins cverage is prvided fr each emplyee. (Ex. A-17). cmmunicatins standards 24. Tillamk Hspital presently hlds FCC licenses fr PS special Emergency Radi Service under call signs KDU387, KA62400, WGI362, WGI363, and WGI364. (Ex. A-19). cntinuing Educatin 25. Tillamk Hspital prvides an Inservice and cntinuing Educatin prgram fr EMT recertificatin. (EX. A-19j Ex. A-20) 26. Tillamk Hspital presently has prcedures fr i~entifying and crrecting quality f care prblems with th~ ambulance service. (Ex. A-20i Ex. A-21). Quality Assurance 27. The Tillamk Cunty EMS QA Crdinatr and QA Cmmittee presently have prcedures fr EMS prviders t supply infrmatin fr case reviews, screens and investigatins, and Tillamk Hspital cperates fully with these prcedures and with the QA Cmmittee. Mutual Aid 28. Tillamk Cunty is a signatry t the Tillamk Cunty Mutual Aid Agreement. 29. Tillamk Hspital presently participates in disaster planning, training and respnse crdinated by the Tillamk Cunty Office f Emergency Management. 30. Tillamk Hspital's applicatin includes a written prcedure fr cntinuity f service in the event f decreased persnnel levels, financial failure, r revcatin f cntract due t nncmpliance. (Appli. Ex. A-22). CONCLUSIONS () 1. Tillamk Hspital's applicatin describes a prpsal fr flexible system status management that will imprve respnse times n first re$pnse dispatches. 2. The prpsed level and pattern f staffing, as well as staff rtatin t Tillamk Ambulance ASA, will imprve the quality and level f service t the Garibaldi ASA withut adversely affecting the existing first respnse system.

8 3. Based n Tillamk Hspital's successful experience in perating under the lwer call vlume f the Nehalem ASA, the higher call vlume f the Garibaldi ASA (276 calls annually), is sufficient t financially justify the service t be prvided. 4. Tillamk Hspital, as part f the Adventist Health Systems, has been a lng standing and financially sund nt-fr-prfit institutin, and when cmbined with revenues generated by TEAM memberships, prvides an alternate funding surce sufficient t supprt the required level f care t be prvided. 5. Tillamk Hspital's prpsal des nt jepardize the financial ability f ther ambulance service prviders t prvide efficient service t the remainder f the Cunty. RECOHHENDAT:ION (J Based n the criteria fund in sectin 9, EMS Ordinance # 41, and the applicatin f the General and specific criteria f the ASA Plan (pp 29-31), it is recmmended that the Garibaldi Ambulance ASA be reassigned t Tillamk Hspital. Respectfully SUbmitted, cpies distributed n 6/8/90 t: Bard f Cmmissiners Tillamk Hspital QA Cmmittee members

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