king county medic one als study

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King County ALS Study

King County EmergencyMedical Services Division

December 2016

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TeamNikiah Nudell, MS, NRPChief Data Officer / Project [email protected] Fred Morrison, BSBA, EMT-PCEO / Co-Project [email protected] Gary Wingrove, EMT-P (ret.) [email protected]

Paul Anderson, MS, NRPHealthcare Consultant Andrea Corage Baden, PhD, MPHSocial Scientist Robert McNally, MSGIS Analyst David ShraderEMS Systems Consultant Davis Patterson, PhDSocial Scientist



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Study Purpose1. Determine the optimal number of ALS agencies in King County 2. How many medic units are appropriate for each to operate3. Develop a regional process for: • responding to any changes to the current ALS agency configuration • configuration meeting county needs for the next ten years



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Data Sources & Methodology• Qualitative data from stakeholder interviews (provide context for

quantitative analysis)• Paramedic reports & dispatch records from last ten years• Financial analysis from EMS Division & Seattle Fire Department

provided cost data from last five years• Demographic data from King County demographer & US Census• Census tracts assigned to closest ALS stations (2014 Census)



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KCEMS Census Tracts

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KCEMS Demographics



Paramedic Agency

Paramedic Units

Paramedics Service area(s)

Service Area Population

(2014)

Service Area

Density (2014)

Seattle Medic One 7 73 Seattle 690,151 8,225

King County Medic One 8 71

Auburn, Black Diamond, Burien, Covington, Des Moines, Enumclaw, Federal Way, Kent, Maple Valley, Pacific, Renton, Seatac, Sea-Tac Airport,

Skyway, Tukwila, White Center750,157 670

Shoreline Medic One 3 29 Bothell, Kenmore, Lake Forest Park, Shoreline 161,143 3,354

Bellevue Medic One 4 37 Bellevue, Issaquah, Mercer Island, North Bend,

Sammamish, Snoqualmie 314,075 332

Redmond Medic One 3 31 Duvall, Kirkland, Redmond, Woodinville 199,180 526

Vashon Medic One 1 7 Vashon and Maury Island 10,946 16

Total 26 248 2,125,652

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Economy of Scale

Agency & # Medic Units

2015 ALS Costs

ALS Responses

ALS Transports

Cost per response

Cost per transport

Annual

Unit Hours

Cost per UH

Cost per

Capita

VIFR 1 $2,063,247 506 150 $4,078 $13,755 8,760 $236 $189

SFD 3 $6,801,262 4,394 2,241 $1,548 $3,035 26,280 $259 $42RFD 3 $6,349,125 3,723 1,019 $1,705 $6,231 26,280 $242 $32BFD 4 $8,604,502 5,382 2,171 $1,599 $3,963 35,040 $246 $27

SFD 7 $16,812,533 19,897 6,484 $845 $2,593 61,320 $274 $24

KCM1 8 $17,472,315 17,214 4,185 $1,015 $4,175 70,080 $249 $23



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Salaries & Benefits Contribution to Cost

Agency#

Medic Units

Salaries & Benefits per

UH*Vashon 1 $209.56

Redmond 3 $215.14Shoreline 3 $228.84Bellevue 4 $203.72

KCM1 8 $190.99



0 1 2 3 4 5 6 7 8 9 $170 $180 $190 $200 $210 $220 $230 $240

Salaries & benefits per unit hour (2015)

Seattle data not available

# Medic Units

$ Sa

lary

/Ben

eits

per

Uni

t Hou

r

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Economic Impact to EMS Levy

For every medic unit operated by an agency the: p-valueCost per capita decreases -$18.05 0.22Cost per response decreases -$353.42 0.05Cost per transport decreases -$1,055.73 0.14Cost per unit hour increases +$3.15 0.2



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Cost per Capita



Seattle Bellevue Redmond Shoreline KCM1 Vashon0

20

40

60

80

100

120

140

160

180

200

2015 KCEMS Cost per Capita and # Medic Units

Cost

per

Cap

ita

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Costs Viewed by # Medic Units



0 1 2 3 4 5 6 7 8 9$0

$1,000

$2,000

$3,000

$4,000

$5,000

Cost per response (2015)

# Medic Units

Cost

per

Res

pons

e

0 1 2 3 4 5 6 7 8 9$0

$5,000

$10,000

$15,000

Cost per transport (2015)

# Medic Units

Cost

per

Tra

nspo

rt

0 1 2 3 4 5 6 7 8 9$150

$200

$250

$300

Cost per unit hour (2015)

# Medic Units

Cost

per

Uni

t Hou

r

0 1 2 3 4 5 6 7 8 9$0

$50

$100

$150

$200

Cost per Capita (2015)

# Medic Units

Cost

per

Cap

ita

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System costs are greatly reduced by having fewer agencies operating more units per agency

• Reduces redundant administration and operational support increasing the economic efficiency of the system

• It is untenable, both economically and operationally, to operate a single medic unit

• It may be unrealistic for any agency to operate fewer than three medic units yet still maintain the capacity to absorb and respond to logistical, operational and system demand issues



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From an efficiency and financial perspective, the optimal number of ALS agencies countywide is one • Consolidating into one ALS agency countywide is not likely to be

politically feasible in the near future• Consider a more acceptable short term approach such as a move towards

consolidating agencies operating in Zone 1 (Northeast King County)

• Consider opportunities to improve the operations, finances and performance of the system • Increase standardization, reduce duplication, and facilitate the portability of

paramedics from one agency or area to another



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Formal changes to the current configuration of ALS agencies should follow a process

• Start with interagency communication, cooperation, coordination, & collaboration

• Process should demonstrate a clear determination of community need, impartial facilitation, and consensus

• Proposals must include a business case outlining costs, impacts, public value, and how the change would either improve the system or fix an existing problem



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Questions, comments, discussion• Thank you for taking the time to participate and sharing your

thoughts with our team



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