WHY  EXPAND  THE  CCAD  BORDERS???  By  Kasha  Driskill  EMT-­‐P,  BS  Executive  Administrative  Director  

 The  Christian  County  Ambulance  District  has  an  annexation  election  on  the  April  5,  2016  ballot,  which  if  approved,  will  expand  the  CCAD  borders  to  include  the  Clever  Fire  District  response  area  in  Christian  County  as  well  as  Stone  County.    Additionally,  there  is  a  ballot  question  to  also  annex  the  Stone  County  portion  of  the  Highlandville  Fire  District.    (See  map)    This  election  will  require  a  majority  vote  from  the  current  ambulance  district  members  as  well  as  a  majority  vote  from  areas  wishing  to  be  annexed  into  CCAD.      Currently  the  ambulance  district  covers  all  of  Christian  County  except  the  Clever  and  Billings  areas  of  the  panhandle  and  has  been  that  way  since  the  district  was  formed  in  1984  due  to  those  areas  previously  belonging  to  Triangle  EMS  that  covered  Clever,  Billings  &  Republic  cities  and  rural  areas  which  has  since  gone  out  of  business.    Since  that  time  Cox  EMS  has  historically  covered  those  areas  out  of  their  Republic  station  which  houses  one  ambulance  at  night  and  two  during  the  day.    Republics  ambulance  covers  Republic,  Clever,  Billings,  Western  Greene  County  and  all  of  the  surrounding  rural  areas  for  these  communities.  The  City  of  Billings  had  specifically  requested  to  not  be  included  in  this  initiative.      

 

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Exhibit A

Existing Ambulance District

Clever Fire Protection District

Highlandville Fire Protection District

Not included in Ambulance District or Annexation

µ0 2.5 51.25 Miles

 Incorporating  these  areas  into  the  ambulance  district  will  help  support  current  operations  as  well  as  allows  CCAD  to  keep  up  with  the  rate  of  regional  growth.    CCAD  currently  helps  on  occasion  cover  these  areas  due  to  their  current  provider  not  being  available  or  CCAD  having  a  closer  ambulance  to  the  call.    We  can  also  offer  guaranteed  response  time  protocol  compliance,  increased  oversight  and  direct  control  of  quality  of  care  &  patient  satisfaction  which  are  all  changes  brought  about  to  existing  district  members  during  2015.      Added  benefits  to  these  areas  in  the  annexation  is  increased  training,  supplies  and  support  for  first  responders  and  fire  departments  as  well  as  public  education  programs  for  district  members  including  first  aid,  CPR,  and  safety  and  awareness  programs  for  the  schools  and  community.    CCAD  controls  how  much  can  be  charged  for  ambulance  transport  through  a  maximum  average  billing  structure  with  its  current  contractor  CoxHealth.      CCAD  members  receive  a  substantially  discounted  rate  in  the  event  they  are  transported  by  ambulance  and  will  transport  to  the  local  hospitals  of  the  patients  choice.    

CCAD  currently  has  EMS  stations  in  South  Ozark,  Sparta,  Spokane,  and  Nixa  and  will  be  opening  their  newest  station  in  North  Ozark  this  spring.    If  successful  in  the  annexation  there  will  be  a  sixth  station  added  in  the  Clever  area  to  serve  all  of  the  Clever  Fire  Protection  District  response  areas.    CCAD  utilizes  a  fleet  of  ten  ambulances  that  includes  a  mix  of  Freightliner  and  Ford  Chassis,  two  first  response  sport  utility  vehicles,  a  heavy  utility  vehicle,  an  administrative  vehicle,  and  a  4X4  all  terrain  vehicle.    During  the  day  time  hours  we  have  6  ambulances  on  duty  and  4  during  the  night  hours.    If  successful  with  the  Clever  annexation,  one  more  will  be  added  in  Clever  for  24  hour  a  day  coverage.  CCAD  is  governed  by  six-­‐elected  board  members  for  the  Board  of  Directors  and  day-­‐to-­‐day  operations  are  overseen  by  the  one  District  Executive  Administrator.  CCAD  is  property  tax  funded  $1.3  Million  annually  with  an  annual  levy  of  .1324    or  .13  cents  per  $100  of  ASSESSED  value  which  is  a  levy  amount  of  about  1/3  of  the  amount  levied  in  the  fire  districts  within  the  proposed  annexed  areas.    A  quick  rule  of  thumb  on  a  residence  with  a  market  value  of  $100,000  you  can  expect  to  pay  $25.15  annually  to  CCAD  to  support  EMS  services.    For  a  $200,000  home  you  can  double  that  amount,  etc.      We  have  discovered  that  a  good  portion  of  people  we  currently  serve  now  do  not  even  realize  we  are  a  county  based  ambulance  district  or  that  they  pay  taxes  to  CCAD  for  services.    The  ambulance  district  has  done  a  pretty  good  job  of  staying  out  of  the  spotlight  in  recent  years  however,  we  are  trying  to  change  that  and  share  with  the  communities  we  serve  the  great  things  we  are  doing  how  we  are  moving  our  services  to  be  a  more  progressive,  customer  oriented  and  patient  care  focused  EMS  provider.  

CCAD  boasts  bringing  the  first  “high  performance  EMS  contract  based  system”  model  to  Southwest  Missouri.      High  performance  based  EMS  focuses  heavily  on  simultaneously  providing  clinical  excellence,  guaranteed  response  time  reliability,  economic  efficiency  and  customer  satisfaction  and  improving  patient  care  through  continuous  measurements  and  inputs  using  key  performance  indicators.      As  a  part  of  a  high  performance  based  EMS  contract,  CCAD’s  strategic  partner,  CoxHealth  has  been  held  to  higher  standards  than  what  they  have  been  in  the  past  with  punitive  fines  or  penalties  assessed  for  poor  performance  with  the  ability  to  terminate  the  contract  for  repeated  poor  performance  or  penalties  assessed.    CCAD  is  committed  to  setting  the  bar  very  high  in  Christian  County  for  the  EMS  system  and  had  to  enact  a  system  of  accountability  in  which  to  enforce  our  mission  and  values.    We  are  committed  to  our  community  and  providing  the  citizens  with  the  high  quality  emergency  medical  services  that  they  deserve.    What  this  means  for  Christian  county  is  that  in  2015  there  were  7653  calls  for  EMS  with  an  average  response  time  of  8  minutes  and  37  seconds  for  all  areas  within  the  entire  district  including  the  cities  and  rural  areas.    We  have  effectively  cut  response  times  by  2  minutes  18  seconds  since  transferring  to  this  new  system  in  2015  as  well  as  have  decreased  the  rate  of  mortality  for  time  critical  

emergencies  &  increased  cardiac  arrest  survival  rates.    Expanding  the  size  of  the  CCAD  district  will  also  add  jobs  to  Christian  County.  

In  essence,  what  we  are  getting  in  Christian  County  is  a  better  value  for  our  EMS  system  or  simply  stated,  better  performance  for  the  costs.    In  the  last  3  years,  CCAD  has  increased  performance  standards  tenfold  while  simultaneously  cutting  costs  to  improve  system  efficiency  for  a  savings  of  over  $400,000  in  which  is  being  used  to  invest  back  into  the  ambulance  districts  infrastructure  &  services  to  ensure  we  are  providing  Christian  County  with  the  best  quality  EMS  system  for  every  tax  dollar  invested  in  our  system.      Additionally,  over  $465,000  was  spent  in  the  last  3  years  on  fleet  maintenance  and  auto  body  repairs  and  by  moving  these  services  from  Greene  county  into  Christian  county  we  can  expect  to  be  infusing  those  dollars  back  into  the  Christian  County  economy,  something  that  is  very  important  to  us.    While  we  are  a  public  safety  agency,  we  are  also  a  business  and  how  we  protect  our  funding  and  invest  it  affects  not  only  our  agency,  but  also  our  community  as  a  whole.        The  number  one  statement  made  to  me  while  talking  to  people  about  the  annexation  is  that  “we  get  our  ambulance  out  of  Republic  or  Stone  County  and  they  do  a  pretty  good  job  and  we  don’t  have  to  pay  taxes  for  that.”    What  I  want  the  community  to  understand  is  that  yes,  when  Republic  is  available  you  will  receive  EXCELLENT  care  with  response  times  average  15  and  ½  minutes  according  to  the  data  supplied  to  us  from  CoxHealth.    What  most  don’t  understand  are  2  ambulances  during  the  day  and  only  one  at  night  servings  thousands  of  people  leaves  this  area  without  with  the  closest  ambulance  being  from  Stone  County,  Nixa  or  Springfield.    I  monitor  our  system  daily  and  through  software  on  a  computer  or  even  my  smartphone  can  see  every  ambulance  in  the  Cox  &  Mercy  systems  as  well  as  our  own  and  can  tell  you  with  100%  accuracy  that  you  DON’T  have  available  ambulances  to  serve  Clever  almost  as  much  as  you  do  simply  put  because  Republic  is  a  busy  system  and  those  guys  work  very  hard  over  there  serving  their  own  community.    That  for  me  is  too  big  of  a  gamble  for  my  family  and  me.    I  will  also  share  that  the  Nixa  ambulance  is  part  of  the  CCAD  and  we  prioritize  our  calls  for  our  district  members  so  yes,  this  ambulance  will  respond  to  Clever  as  a  matter  of  mutual  aid  when  nobody  else  is  available  but  only  if  our  system  is  not  currently  being  depleted.      We  try  to  reserve  the  CCAD  ambulances  for  district  members  first  and  foremost  after  all  that  is  what  they  are  paying  for.      Anything  else  is  our  secondary  priority.      Friends  and  neighbors  that  know  what  I  do  for  my  job  and  will  reach  out  to  me  and  share  a  story  of  someone  they  know  that  had  to  wait  20  minutes  or  30  minutes  for  an  ambulance  in  the  Clever  area  and  simply  put,  I  can’t  help  them  since  this  isn’t  our  district.    When  your  current  system  works,  it  works  well.    But  when  it  doesn’t  because  it’s  already  so  heavily  utilized,  then  it  can  be  life  changing.      What  we  offer  our  community  is  so  much  more  than  faster  response  time.    Although  I  can  safely  say  that  with  us  here  we  can  easily  cut  your  response  times  in  half  the  better  part  of  the  time.    You  receive  discounted  EMS  transport  for  being  a  district  member,  free  training,  education  and  support  for  your  first  responders  and  fire  department  as  well  as  supplies  and  oxygen.      We  offer  safety  programs  for  the  schools  and  health  initiative  programs  for  organizations.    We  will  have  a  presence  in  your  community;  we  will  buy  our  fuel  here,  eat  in  your  restaurants  and  buy  food  from  your  grocery  store.    In  some  of  our  smaller  communities  citizens  often  stop  by  to  have  our  staff  check  their  blood  pressure  or  “check  them  out”  for  something  in  the  event  they  can’t  afford  to  go  to  a  healthcare  facility  or  cannot  get  into  a  doctors  office  timely.    There  are  times  this  has  happened  and  we  have  discovered  potentially  life-­‐threatening  situations  and  have  been  able  to  help  people  get  the  immediate  care  they  needed.      We  can  be  a  healthcare  resource  in  communities  that  otherwise  have  none  such  as  Clever.    We  are  always  happy  to  do  free  blood  pressure  clinics  at  senior  events  or  come  to  the  schools  to  do  CPR  training.    We  are  here  to  serve.    Being  a  part  of  an  ambulance  district  offers  you  security  of  services  that  you  don’t  otherwise  have.    Recently  I  posted  a  story  link  where  Mercy  ambulance  was  shutting  down  services  in  the  Berryville  Arkansas  area  due  to  financial  losses.    Private  providers  such  as  Cox  or  Mercy  have  

that  ability  to  walk  away  from  services  that  are  not  self-­‐sustaining.    CoxHealth  tells  me  that  the  services  in  Stone  County  are  not  self-­‐sustaining  due  to  the  low  call  volumes.    I  have  concerns  about  the  future  of  this  station  one  day  but  admire  CoxHealth  for  hanging  in  there  knowing  that  without  it  all  of  northern  Stone  county  will  have  no  provider  whatsoever  and  one  less  for  Clever  and  Billings.    You  are  not  guaranteed  an  EMS  provider  in  your  community  unless  you  are  a  part  of  an  ambulance  district.    Private  EMS  systems  can  simply  walk  away  at  any  point  or  reduce  services  to  help  balance  losses.    Another  good  example  of  this  is  that  I  used  to  be  a  full  time  Flight  Paramedic  for  Cox  Air  Care  out  of  the  Branson  area  when  Cox  had  two  helicopters.    I  walked  in  for  a  shift  one  day  and  was  met  by  about  20  Administrators  as  well  as  our  entire  staff  had  been  called  in  and  they  announced  effectively  immediately  Cox  Air  Care  2  was  being  shut  down  permanently  because  of  financial  losses  of  operating  that  system.    We  were  all  allowed  to  choose  jobs  somewhere  else  in  the  Cox  system.      I  chose  Christian  County,  this  is  my  home.      CCAD  has  been  in  Christian  County  for  well  over  30  years  and  our  number  1  priority  is  to  provide  excellent  EMS  services  to  those  that  we  serve.      CCAD  is  a  district  and  walking  away  is  simply  not  an  option  for  us.      CCAD  has  had  a  rapid  rate  of  growth  &  change  and  transitioned  to  the  High  Performance  EMS  System  Model  and  has  completed  its  inaugural  year  with  staggering  results  and  improved  efficiency.      We  have  drastically  increased  performance  while  cutting  costs  through  system  efficiency  and  want  to  put  those  dollars  back  into  our  system.    We  are  investing  back  into  our  district  with  the  hopes  that  by  expanding  our  borders  we  can  provide  better  EMS  care  to  these  underserved  areas  that  are  already  a  part  of  our  community.      What  I  want  the  people  of  the  Clever  area  to  understand  the  most  about  this  annexation  is  that  this  isn’t  about  money  as  it  will  likely  take  at  least  10  -­‐  15  years  to  break  even  after  spending  the  close  to    $1  million  dollars  it  will  take  to  “set  up  shop”  in  Clever  as  we  expect  that  CCAD  will  collect  an  estimated  $70,000  annually  in  additional  tax  dollars  if  we  successfully  annex  the  Clever  areas.      But  this  is  about  providing  a  needed  resource  and  a  service  to  our  community.      I  live  in  the  Clever  area  as  well  as  have  family  here  and  because  of  my  role  at  CCAD  I  am  intimately  familiar  with  how  the  current  EMS  system  works  here  and  I  know  without  a  doubt  that  we  can  improve  the  services  tenfold  if  the  people  of  Clever  will  allow  us  to.    I  can  say  with  utmost  certainty,  if  you  will  allow  us,  you  will  be  happy  we  are  here.      Ultimately,  the  decision  is  yours  Clever.      

   

For  more  information  about  CCAD  please  contact  us  at  (417)  581-­‐3700,    Email  me  at  kdriskill@ccadems.com  or  visit  us  at    

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