FLORIDA DEPARTMENT OF HEALTH Bureau of Emergency Medical Services

Complete all items unless instructed differently within the application

Type of Grant Requested: Rural Matching ID. Code (The State Bureau of EMS will assign the ID Code - leave this blank) 1

3. Contact Person: (The individual with direct knowledge of the project on a day-today basis and responsibility for the implementation of the grant activities. This person may sign project reports and may request project changes. The signer and the contact person may be the same.)

Name: Anthony F. Lopinto

Position Title: Emergency Services Director

Address: 4111 Land 0' Lakes Blvd. Suite 208

City: Land 0' Lakes I County: ~ a s c o State: Florida I Zin Code: ?hh?Q-LLn?

1. Organization Name: Pasco County Emergency Services

2. Grant Sianer: (The applicant signatory who has authority to sign contracts, grants, and other legal documents. This individual must also sign this application)

Name: Jack Mariano

Position Title: Chairman, Board of County Commissioners

Address: 8721 Citizens Drive

City: New Port Richey State: Florida Telephone: ( 7 2 7 ) 847-241 1 ext. 8100

County: Pasco ZipCode: 34654 Fax Number:

E-Mail Address:

4. Leaal Status of Applicant Oraanuation (Check onlv one response): (1) q Private Not for Profit [Attach documentationdO1 (3) 01 (2) q Private For Profit (3) City/Municipality/TownNillage (4) Ed County (5) State (6) Other (specify):

5. Federal Tax ID Number (Nine Digit Numberl. VF 59'620_L)_722 - 6. EMS License Number: 2867 Type: OTransport ONon-transport OBoth

7. Number of permitted vehicles by type: L B L S X A L S Transport L A L S non-transport.

8. Type of Service (check one): a ~ e s c u e a ~ i r e UThird Service (County or City Government, nonfire) OAir ambulance: OFixed wing ORotowing OBoth mother (specify)

9. Medical Director of licensed EMS provider: If this project is approved, I agree by signing below that I will affirm my authority and responsibility for the use of all medical equipment and/or the provision of all continuing EMS education in this project. [No signature is needed if medical equipment and professional EMS education are not in this project.]

Signature:

PrinVType: Name of

FL Med. Lic. No. 054598

Note: All organizations that are not licensed EMS providers must obtain the signature of the medical director of the licensed EMS provider responsible for EMS services in their area of operation for projects that involve medical equipment andlor continuing EMS education.

If your activity is a research or evaluation project, omit Items 10,11,12,13, and skip to ltem - Number 14. Otherwise, proceed to ltem 10 and the following items.

10. Justification Summarv: Provide on no more than three one sided, double spaced pages a summary addressing this project, covering each topic listed below.

A) Problem description (Provide a narrative of the problem or need); B) Present situation (Describe how the situation is being handled now); C) The proposed solution (Present your proposed solution); D) Consequences if not funded (Explain what will happen if this project is not funded); E) The geographic area to be addressed (Provide a narrative description of the geographic area); -. -. . . . . - . . . . - . . - . . . . ~ ~

10. Justification Summary

A. Problem Description and B. Present Situation

As a result of rapid urbanization and development, Pasco County has experienced

exponential increases in population since 1980. In 2000, the population of Pasco County

grew to 344,765, representing a seventy-eight percent increase fiom 1980. Between 2000

and 2006, Pasco County experienced an additional thirty percent increase, leading to a

total population of 450,17 1 (US Census Data). Approximately twenty-one percent of the

current population is over the age of 65 years.

In 2007, the leading cause of death in Pasco County was heart disease (FL DOH).

In addition, over 230 instances of AMI were reported per 100,000 persons. This is

significantly higher than the state-wide rate of approximately 196 instances of AM1 per

100,000 persons. Approximately twelve percent of adults within the County report ever

having a heart attack, angina, or coronary artery disease. In addition to known instances

of disease, the large percentage of the citizens of Pasco County have risk factors for AM1

such as smoking (30%), diabetes (8%), hypertension (29%), high blood cholesterol

(42%), or are overweight (36%). In 2008, PCESD transported 1448 patients with

cardiac-related complaints.

Pasco County Emergency Services (PCESD) strives to provide quality Advanced

Cardiac Life Support Care (ACLS) in accordance with guidelines fiom the American

Heart Association. A critical component of this care is the early identification of patients

strongly recommend completion of 12-lead EKGs on all patients complaining of non-

traumatic chest pain.

Currently, all ambulances within PCESD are equipped with 12-lead EKG

monitor/defibrillators. However, advanced life support (ALS) engines are equipped with

3-lead EKG monitor/defibrillators. Pasco County has identified several engine

companies that routinely respond to medical calls and reach the patient prior to arrival of

the ambulance. Because the ambulance is responding from a further distance, it is

important that the paramedic on the engine company be able to fully assess cardiac

patients, determine whether they meet the criteria for a "cardiac alert" and notify the

receiving facility of the patient's status as soon as possible. This early notification will

allow for preparation of the cardiac catheterization team at the receiving facility.

C. Proposed Solution

PCESD is requesting funding for three (3) 12-lead EKG monitor/defibrillators to be

placed into service with ALS engine companies that frequently reach the patient before

the ambulance crew. This grant project is part of a multi-year plan to equip all ALS

engine companies with this important equipment.

D. Consequences If Not Funded

If this project is not funded, acquisition of this equipment will not occur in this budget

year. Due to current budget constraints, replacement of the out-dated EKG

monitor/defibrillators would be unlikely.

a rural community. Engine 27 serves the citizens of the town of St. Leo located in the

north-central portion of the county. Each of these engine companies is located in a station

that does not have an ambulance assigned to it. As a result, ambulance response into

these areas is from a station seven to eight miles away.

F. Proposed Time Frames

Within two months of the grant approval, requisitions will be submitted for the

equipment. Within four months of the grant approval, purchase orders will be issues and

within nine months of the grant approval, the monitors will be placed into service.

G. Data Sources

Population data and estimates were obtained from the US Census Bureau. Information

about chronic disease rates, death rates, risk factors, and health information was obtained

from the Florida Department of Health - CHARTS website. Information regarding

American Heart Association Guidelines was obtained from: ACC/AHA Guidelines for the

Management of Patients with ST-Elevation Myocardial Infarction - Executive Summary:

A Report of the American College of Cardiology/American Heart Association Task Force

on Practice Guidelines published in Circulation in 2004 and Development of Systems of

Care for ST-Elevation Myocardial Infarction Patients: The Emergency Medical Services

and Emergency Department Perspective published in Circulation in 2007. Data

regarding response times and call types was extracted from the electronic patient care

report system.

11. Outcome

A. Quantify the Situation for the Past 12 Months

Between January 1,2008 and December 3 1,2008, PCESD transported 1448

patients to the Emergency Department for cardiac-related complaints. Using data from

January 01,2008 to December 3 1,2008, response times were reviewed. In 27 zone,

Engine 27 arrived on scene prior to five minutes for 18 percent of calls and prior to ten

minutes for 80 percent of calls. However, ambulances arrived on scene in 27 zone after

ten minutes in 66 percent of the time. In 34 zone, Engine 34 had less then a five minute

response time for 30 percent of the calls and less than a ten minute response time in 94

percent of the calls. In contrast, ambulances had a greater than ten minute response time

in 45 percent of the time. In 39 zone, Engine 39 was on scene prior to five minutes in 20

percent of calls and prior to ten minutes in 88 percent of calls. In no instances did an

ambulance arrive on scene prior to five minutes in 39 Zone and in only 44 percent of

cases did an ambulance arrive prior to ten minutes.

In all three zones identified, it's clear that the engine companies routinely arrive

on scene earlier than the ambulance. In all of these instances, a 12-lead EKG was not

available until the ambulance arrived on scene.

B. In the 12 months after this project's resources are on-line, estimate what the

numbers you provided under ''(A)" should become.

The proposed grant project will not change the response times of the ambulance

PCR). The purpose of the proposed grant project is not to change the response times, but

to improve the level of care provided to patients while awaiting an ambulance.

D. What other outcome of this project do you expect? Be quantitative and explain

the derivation of your figures.

It's anticipated that providing Engines 27,34 and 39 with cardiac monitors will provide

hospital staff with early notification of a cardiac alert while awaiting ambulance arrival.

As a result, "door to balloon" times should decrease in these cases. Local cardiac centers

provide PCESD with feedback regarding cardiac alert outcome; however, it is unlikely

that we will be able to identify which cases involved the engine company utilizing a 12-

lead EKG. Because we are presented with summary data, the overall "door to balloon"

times should decrease.

E. How does this integrate into your agency's five year plan?

Pasco County Emergency Services does have a ten year Master Plan; however, this plan

relates primarily to the addition of new stations and vehicles and the replacement of

outdated stations and vehicles. This project does confirm to Pasco County Emergency

Services overall goal to provide high quality patient care in the pre-hospital setting. In

addition, this project coincides with the cooperative effort between PCESD and several

local hospitals to obtain cardiac certification for these facilities.

15. Statutorv Considerations and Criteria

A. The 12-lead EKG monitor/defibrillators will be placed on Advanced Life Support

(ALS) engines which will operate within Pasco County Emergency Services' response

zone. This population is at risk for acute myocardial infarction and will benefit from

early identification of STEMI and transportation to a cardiac center.

B. Florida EMS Rule 645-1 requires ALS permitted vehicles to stock defibrillation and

cardiac monitor equipment. This grant project would comply with that requirement,

while improving the ability of the paramedic to identify STEMI patients.

C. This project proposal would comply with the equipment required for ALS-permitted

vehicles in EMS Rule 645- 1.

D. NIA

E. Completion of this grant project would allow for paramedics assigned to ALS engine

companies in Pasco County to acquire 12-lead EKG readings on patients complaining of

cardiac symptoms prior to arrival of the ambulance. As a result, the likelihood of early

identification of STEMI patients and hospital notification will increase. This grant

project coincides with Pasco County Emergency Services' multi-year plan to provide 12-

lead EKG monitorldefibrillators on all ALS engines.

17. Countv Governments: If this application is being submitted by a county agency, describe in the space below why this request cannot be paid for out of funds awarded under the state EMS county grant program. Include in the explanation why any unspent county grant funds, which are now in your county accounts, cannot be allocated in whole or part for the costs herein.

16. Work activities and time frames: Indicate the major activities for completing the project (use only the space provided). Be reasonable, most projects cannot be completed in less than six months and if it is a communications project, it will take about a year. Also, if you are purchasing certain makes of ambulances, it will take at least nine months for them to be delivered after the bid is let.

Pasco County Fire Rescue (PCFR) is approaching the end of the period of performance for the 2007-2008 County Awards Grant (C7051). These funds were used to purchase equipment to implement CPAP on all ambulances, automatic external defibrillators for BLS companies, and power-assist stretchers. Due to competitive pricing, unspent funds were available to be carried forward. These unspent funds and the 2008-2009 County Awards Grant (C8051) will be used to purchase four (4) 12-lead EKG monitors/defibrillators. Both the C8051 purchase and this EMS Match Grant proposal are part of a multi-year plan to provide 12-lead EKG monitors/defibrillators to all ALS engine companies.

Work Activity

Approval of Grant Requistions submitted for all equipment Purchase orders issues for all equipment Equipment placed into service

Number of Months After Grant Starts Begin End

Within two months of grant approval Within four months of grant approval Within nine months of grant approval

Expenses: These are travel costs and the usual, ordinary and incidental expenditures by an agency, such as, commodities and supplies of a consumable nature, excludinq expenditures classified as operating capital outlay (see next category)

18. Budnet

Three (3) 12-lead EKG monitorldefibrillators with capnography capability

Salaries and Benefits: For each position title, provide the amount of salary per hour, FICA per hour, fringe benefits, and the total number of hours.

TOTAL:

TOTAL DH Form 1767, Rev. 2002

Costs: List the price and the source of the price identified.

Costs

$0.00

$84,600.00 total

$28.200.00 each

Justification: Provide a brief justification why each of the positions and the numbers of hours are necessary for this project.

Justification: Justify why each of the expense items and quantities are necessary to this project.

One monitor each for Engine 27, Engine 34 and Engine 39.

Vehicles, equipment, and other operating capital outlay means equipment, fixtures, and other tangible personal property of a non consumable and non expendable nature, the normal expected life of which is 1 year or more.

TOTAL:

State Amount (Check applicable program)

Matching: 75 Percent

Rural: 90 Percent

Local Match Amount (Check applicable program)

Matching: 25 Percent

Rural: 10 Percent

Costs: List the price of the item and the source(s) used to identify the price.

Justification: State why each of the items and quantities listed is a necessary component of this project.

19. Certification: My signature below certifies the following. I am aware that any omissions, falsifications, misstatements, or misrepresentations in this application may disqualify me for this grant and, if funded, may be grounds for termination at a later date. I understand that any information I give may be investigated as allowed by law. I certify that to the best of my knowledge and belief all of the statements contained herein and on any attachments are true, correct, complete, and made in good faith.

I agree that any and all information submitted in this application will become a public document pursuant to Section 119.07, F.S. when received by the Florida Bureau of EMS. This includes material which the applicant might consider to be confidential or a trade secret. Any claim of confidentiality is waived by the applicant upon submission of this application pursuant to Section 119.07,F.S., effective after opening by the Florida Bureau of EMS.

I accept that in the best interests of the State, the Florida Bureau of EMS reserves the Ghw -

reject or revise any and all grant proposals or waive any minor irregularity or technicality in proposals received, and can exercise that right.

I, the undersigned, understand and accept that the Notice of Matching Grant Awards will be advertised in the Florida Administrative Weekly, and that 21 days after this advertisement is published I waive any right to challenge or protest the awards pursuant to Chapter 120, F.S.

I certify that the cash match will be expended between the beginning and ending dates of the grant and will be used in strict accordance with the content of the application and approved budget for the activities identified. In addition, the budget shall not exceed, the department, approved funds for those activities identified in the notification letter. No funds count towards satisfying this grant if the funds were also used to satisfy a matching requirement of another statc grant. All cash, salaries, fringe benefits, expenses, equipment, and other expenses as listed in this application shall be committed and used for the activities approved as a part of this grant.

Acceptance of Terms and Conditions: If awarded a grant, I certify that I will comply with all of the above and also accept the attached grant terms and conditions and acknowledge this by signing below.

I Signature of Authorized Grant Signer M M I D D I W -

I - (Individual Identified in Item 2)

DH Form 1767. Rev. June 2002

FLORIDA DEPARTMENT OF HEALTH EMS GRANT PROGRAM

REQUEST FOR GRANT FUND DISTRIBUTION

n accordance with the provisions of Section 401 .I 13(2)(b), F. S., the undersigned hereby quests an EMS grant fund distribution for the improvement and expansion or continuation of )re-hospital EMS.

30H Remit Pavment To: Name of Agency: Pasco County Emergency S e r v i c e s

Mailing Address: 4111 Land 0' Lakes Blvd. S u i t e 208

Land 0' Lakes, FL 34639-4402

Federal Identification Number 59-6000793

Authorized Agency Official: Signature Date

J a c k Mariano Board Ch'airman Type Name and Title

Sign and return this page with your application to:

Florida Department of Health BEMS Grant Program

4052 Bald Cypress Way, Bin C18 Tallahassee. Florida 32399- 1 738

Do not write below this line. For use by Bureau of Emergency Medical Services personnel only

3rant Amount For State To Pay: $ Grant ID Code:

4pproved By: Signature of EMS Grant Officer Date

state Fiscal Year: 2007 - 2008

3manization Code - E.O. 54-42-1 0-00-000 03

OCA - Obiect Code SF003 750000

=ederal Tax ID: VF

17. Countv Governments: If this application is being submitted by a county agency, describe in the space below why this request cannot be paid for out of funds awarded under the state EMS county grant program. Include in the explanation why any unspent county grant funds, which are now in your county accounts, cannot be allocated in whole or part for the costs herein.

16. Work activities and time frames: Indicate the major activities for completing the project (use only the space provided). Be reasonable, most projects cannot be completed in less than six months and if it is a communications project, it will take about a year. Also, if you are purchasing certain makes of ambulances, it will take at least nine months for them to be delivered after the bid is let.

Pasco County Fire Rescue (PCFR) is approaching the end of the period of performance for the 2007-2008 County Awards Grant (C7051). These funds were used to purchase equipment to implement CPAP on all ambulances, automatic external defibrillators for BLS companies, and power-assist stretchers. Due to competitive pricing, unspent funds were available to be carried forward. These unspent funds and the 2008-2009 County Awards Grant (C8051) will be used to purchase four (4) 12-lead EKG monitorsldefibrillators. Both the C8051 purchase and this EMS Match Grant proposal are part of a multi-year plan to provide 12-lead EKG monitors/defibrillators to all ALS engine companies.

Work Activity

Approval of Grant Requistions submitted for all equipment Purchase orders issues for all equipment Equipment placed into service

Number of Months After Grant Starts Begin End

Within two months of grant approval Within four months of grant approval Within nine months of grant approval

I Expenses: These are travel I Costs: List the I Justification: Justify why each of the 1

18. Budqet

costs and the usual, ordinary and incidental expenditures by an agency, such as, commodities and supplies of a consumable nature, excluding expenditures classified as operating capital outlay (see next category)

price and the source of the price identified.

Justification: Provide a brief justification why each of the positions and the numbers of hours are necessary for this project.

Salaries and Benefits: For each position title, provide the amount of salary per hour, FICA per hour, fringe benefits, and the total number of hours.

TOTAL:

expense items and quantities are necessary to this project.

Costs

$0.00

Two (2) 12-lead EKG monitorldefibrillators with capnography capability

$56,400.00 total

$28,200.00 each

One monitor each for Engine 27, Engine 34 and Engine 39.

I I 1 TOTAL 1 $84,600.00 DH Form 1767, Rev. 2002