Ambulance Advisory Committee

AMR-Nashua, NH 380 West Hollis Street, Nashua, NH 03060 Business Phone: (603) 882-5330; Business Fax: (603) 598-9403 City of Nashua, NH Monthly 9-1-1 Ambulance Activity Report For the Period between: October 1, 2011 through October 31, 2011 November 17, 2011 This report contains the data and information required by the City of Nashua, New Hampshire in the agreement between Nashua and American Medical Response (hereafter AMR) that was made on September 30th, 2011. The contents of this report reference the requests for Emergency Medical Services (here after EMS) provided to the community by the three primary response ambulances required by the agreement. This report utilized data from the city’s CAD program as well as AMR’s data base of EMS reports generated by the contractually dedicated ambulances operating under the dispatch control of Nashua Fire Rescue. Section II.M.2.a: Number of EMS response made: 793 Section II.M.2.b: Number of Patients transported: 628 Section II.M.2.c: Number of Patients receiving Advance Life Support (ALS): 493 Section II.M.2.d: Nature of Patient’s problems (transported): BREATHING DIFFICULTIES ALS 82 SICK/UNKNOWN ALS CRITERIA MET 65 CARDIAC DISORDER ALS CRITERIA 52 FALL/ACCIDENT ALS CRITERIA MET 50 MOTOR VEHICLE ACCIDENT ALS 42 UNCONCIOUS/SYNCOPE/UNRESP ALS 36 SEIZURES ALS CRITERIA MET 34 CVA (STROKE) ALS CRITERIA 18 FALL/ACCIDENT BLS CRITERIA MET 17 OVERDOSE ALS CRITERIA MET 17 SICK/UNKNOWN BLS CRITERIA MET 17 TRAUMA W/INJURY ALS CRITERIA 17 EMOTIONALLY DISTRESSED ALS 16 ABDOMINAL PAIN ALS CRITERIA 14 BLEEDING (NON-TRAUMATIC) ALS 11 TRAUMA W/INJURY BLS CRITERIA 11 EMOTIONALLY DISTRESSED BLS EME 8 DIABETIC ALS CRITERIA MET 6 ALLERGIC REACTION ALS CRITERIA 5 CARDIAC / RESPIRATORY ARREST 5 BACK PAIN ALS CRITERIA MET 4 ENVIRONMENTAL EMERGENCIES ALS 4 BACK PAIN BLS CRITERIA MET 3 MEDFLIGHT GROUND TRANSPORT 2 MEDFLIGHT HELIPAD TRANSPORT 2 PREGNANCY/CHILDBIRTH ALS 2 SPECIAL CARE TRANSPORT 2 ALS EMERGENCY 1 BLEEDING (NON-TRAUMATIC) BLS 1  HAZMAT ALS CRITERIA HEADACHE ALS CRITERIA MET 1 MOTOR VEHICLE ACCIDENT BLS 1 POISONING ALS CRITERIA MET 1 Section II.M.2.e: Number of patient refusals or false alarms: Number of Patient Refusals or false alarms: 171 Section II.M.2.f: Average non-ALPHA response time, time on scene and transport time: Average Response Time: 05:27 Average Time On Scene: 16:04 Average Transport Time: 08:25 Section II.M.2.g: An explanation of all non-ALPHA emergency responses that exceed the NFPA 1710 standard: UNUSUAL WEATHER 11-24322 UNUSUAL WEATHER 11-24409 UNUSUAL WEATHER 11-24588 UNUSUAL WEATHER 11-24669 UNUSUAL WEATHER 11-24519 UNUSUAL WEATHER 11-24532 UNUSUAL WEATHER 11-24777 UNUSUAL WEATHER 11-24805 UNUSUAL WEATHER 11-24402 UNUSUAL WEATHER 11-24333 UNUSUAL WEATHER 11-24459 UNUSUAL WEATHER 11-24463 UNUSUAL WEATHER 11-24472 UNUSUAL WEATHER 11-24656 UNUSUAL WEATHER 11-24660 UNUSUAL WEATHER 11-24668 UNUSUAL WEATHER 11-24675 UNUSUAL WEATHER 11-24712 UNUSUAL WEATHER 11-24481 UNUSUAL WEATHER 11-24594 UNUSUAL WEATHER 11-24498 UNUSUAL WEATHER 11-24603 UNUSUAL WEATHER 11-24647 UNUSUAL WEATHER 11-24680 UNUSUAL WEATHER 11-23799 CREW ISSUE 11-22826 CREW ISSUE 11-22957 CREW ISSUE 11-22038 CREW ISSUE 11-24234 DISTANCE/TRAFFIC 11-23821 DISTANCE/TRAFFIC 11-22594 DISTANCE/TRAFFIC 11-21959 DISTANCE/TRAFFIC 11-23003 DISTANCE/TRAFFIC 11-23823 DISTANCE/TRAFFIC 11-24249 DISTANCE/TRAFFIC 11-22313 DISTANCE/TRAFFIC 11-22864 DISTANCE/TRAFFIC 11-23304 DISTANCE/TRAFFIC 11-23459 DISTANCE/TRAFFIC 11-23495 DISTANCE/TRAFFIC 11-22640 DISTANCE/TRAFFIC 11-23101 DISTANCE/TRAFFIC 11-22513 DISTANCE/TRAFFIC 11-22865 DISTANCE/TRAFFIC 11-22966 DISTANCE/TRAFFIC 11-24167 DISTANCE/TRAFFIC 11-24218 DISTANCE/TRAFFIC 11-23346 DISTANCE/TRAFFIC 11-23458 DISTANCE/TRAFFIC 11-23722 DISTANCE/TRAFFIC 11-23968 DISTANCE/TRAFFIC 11-24219 DISTANCE/TRAFFIC 11-24233 DISTANCE/TRAFFIC 11-22183 DISTANCE/TRAFFIC 11-22355 DISTANCE/TRAFFIC 11-22732 DISTANCE/TRAFFIC 11-23426 DISTANCE/TRAFFIC 11-23786 DISTANCE/TRAFFIC 11-23870 DISTANCE/TRAFFIC 11-23989 DISTANCE/TRAFFIC 11-22307 DISTANCE/TRAFFIC 11-24209 DISTANCE/TRAFFIC 11-23125  DISTANCE/TRAFFIC 11-24241 DISTANCE/TRAFFIC 11-23383 DISTANCE/TRAFFIC 11-22560 MINIMUM REQUIRED NFPA1710 RESPONSE STANDARD: 90% ACTUAL NFPA17O RESPONSE STANDARD ACHIEVED: 95% Section II.M.2.h: Date, time, duration and reason of stand-bys: STAND BY FIRE 11-22170 10/4/2011 STAND BY FIRE 11-23653 10/22/2011 STAND-BY FIRE 11-23849 10/25/2011 STAND-BY FIRE 11-23914 10/26/2011 EOC COVERAGE EOC 10/30/2011 STAND-BY FIRE 11-24451 10/30/2011 EOC COVERAGE EOC 10/31/2011 SHELTER COVERAGE NHS SOUTH 10/31/2011 Section II.M.2.i: Date, time, duration and receiving community of mutual aid requests for service out of Nashua: MUTUAL OUT TO HUDSON 11-22368 10/7/2011 MUTUAL OUT TO HUDSON 11-22365 10/7/2011 MUTUAL OUT TO HUDSON 11-24595 10/30/2011 MUTUAL OUT TO HUDSON 11-24598 10/30/2011 MUTUAL OUT TO HUDSON 11-24693 10/31/2011  MUTUAL OUT TO LITCHFIELD 11-24641 10/30/2011 MUTUAL OUT TO HUDSON 11-24574 10/30/2011 MUTUAL OUT TO HUDSON 11-24111 10/28/2011 Section II.M.2.j: Date, time, duration and sending community of mutual aid requests for service into Nashua: MUTUAL IN MERRIMACK 10/2/2011 11-22020 MUTUAL IN HUDSON 10/9/2011 11-22643 MUTUAL IN MERRIMACK 10/14/2011 11-23098 MUTUAL IN HOLLIS 10/30/2011 11-24556 MUTUAL IN HUDSON 10/30/2011 11-24520 MUTUAL IN HUDSON 10/31/2011 11-24707 MUTUAL IN HUDSON 10/31/2011 11-24738 MUTUAL IN HUDSON 10/31/2011 11-24785 MUTUAL IN HOLLIS 10/31/2011 11-24787 MUTUAL IN MERRIMACK 10/31/2011 11-24708 MUTUAL IN HUDSON 10/31/2011 11-24714 MUTUAL IN MERRIMACK 10/31/2011 11-24740 MUTUAL IN MERRIMACK 10/31/2011 11-24741 Section II.M.2k: Payer class spread: NATIONAL HERITAGE INS CO 227 UNDETERMINED AT TIME OF TRANSPORT 145 NEW HAMPSHIRE MEDICAID 61 ANTHEM BC/BS 49 HARVARD PILGRIM HEALTH CARE 19 CIGNA HEALTHCARE 16 UNITED HEALTHCARE 12 AETNA NON-HMO - NON CONTRACTED 9 SECURE HOIZONS RETIREMENT GROU 6 BX FEDERAL INSURANCES 3 HEALTH PLANS INC 3 TUFTS HEALTH PLAN 3 AARP HEALTHCARE OPTIONS 2 CAMBRIDGE NETWORK HEALTH 2 PALMETTO GBA RAILROAD MEDICARE 2 NEIGHBORHOOD HEALTH PLANS 1 SECURE HOIZONS RETIREMENT GROU 1 ANTHEM SMART VALUE PVT FEE FOR 1 AVIZENT 1 BCBS OF MA -BLUE CARDS 1 BMC HEALTHNET PLAN 1 BRAVO HEALTH - MEDICARE HMO 1 CARELINK TUFTS 1 COMMERCE - AUTO INS 1 DEPT OF VETERANS AFFAIRS 1 HEALTH NET FEDERAL SVCS, LLC 1 HMO BLUE 1 HUMANA GOLD CHOICE - MEDICARE 1 MASS HEALTH ER ONLY 1 NEIGHBORHOOD HEALTH PLANS 1  PROGRESSIVE INS CO - AUTO INS 1 STATE FARM AUTO INSURANCE 1 TUFTS TOTAL HEALTH PLAN 1 USFHP AT MARTINS POINT 1 VERMONT MUTUAL - AUTO INS 1 Section II.M.2.l: Number of Mechanical Failures: There were 2 instances of unplanned maintenance issues resulting in other AMR units being assigned to calls. No calls were lost, unanswered or significantly delayed. Section II.M.2.m: Personnel changes, levels of certification upgrades: Please see the attached spreadsheet. Section II.M.2.n: Vehicle maintenance log activity: RA11 Bulb Replacement FICM replacement/re-flash PM – routine RA16 R&R driver seat R&R 8 fuel injectors PM - routine RA19 R&R driver seat R&R pass seat R&R 8 fuel injectors PM- routine Section II.M.2.o: Discuss complaints or other relevant issues: AMR began full operations at 18:00 hours on September 30, 2011 – 3 days after final contract approval by the Nashua Board of Aldermen. A significant number of former Rockingham Ambulance employees were hired, trained and deployed into AMR’s Nashua system comprising over 80% of the full time AMR employees assigned to Nashua’s 9-1-1 program. October proved to be one of the busiest months on record for EMS requests within the City of Nashua. The end of the month snow storm and widespread power loss significantly increased call volume and resulted in unprecedented system demand. AMR provided shelter coverage, EOC coverage and provided additional ambulances to the city beyond what is required 35 times during the month of October. Ongoing and/or relevant action items also included:  City provided with all required insurance documents, bonds, licenses, medical resource hospital agreement, narcotic possession agreement and other information necessary and/or required to meet the specifications of the agreement.  System for disposable medical equipment replacement developed and implemented with Nashua Fire Rescue.  Delivery of new ambulances complete. Vehicles are in-service.  Delivery of new EKG Lifepak 15 units complete. Crew training complete. Deployment complete.  Delivery of LUCUS auto-mated CPR machine complete. Crew training complete. Deployment complete.  EMT-Refreshers for Nashua Fire Rescue scheduled and in progress.  Developing a plan to address a need by NPD relative to post OC spray procedures.  Unplanned cessation of equipment and medication re-stocking by both City hospitals resulted in the re-tooling of AMR’s medication and equipment replacement process to maintain uninterrupted operational efficiency.  AMR’s Nashua Physician Medical Director (SNHMC Dr. Peter Row) and AMR’s National Medical Director met and discussed system performance and quality expectations. Dr. Row then rode with AMR-Nashua crews on calls and will continue that practice.  Delivery of MCI trailer complete. Currently being set-up and stocked. Scheduled deployment to Nashua is prior to December 31, 2011.  Delivery of second operations manager SUV complete. Deployment scheduled for mid-November. This vehicle will have towing capability for the MCI trailer.  Nashua Fire Rescue provided with 40 new “D” size oxygen cylinders and a replenishment process was developed and implemented.  Developing a plan to install a computer terminal at Nashua Fire dispatch to allow them to track the AMR Nashua 9-1-1 vehicles in real time for enhanced dispatching capabilities.  On-going discussion with Nashua Fire Rescue dispatch about enhancing pre-alert procedures to increase crew notification time of an incoming call.  Patient satisfaction survey program began on October 1, 2011. Results will be able to be compiled and reported after a two month cycle has passed.  Application process for AMR Nashua CAAS accreditation began on October 10, 2011. Projected timeline for completion of data gathering and application submission is April 1, 2012. Projected timeline for required on-site verification inspection is before June 30, 2012.  AMR provided community ALS ambulance coverage at more than a dozen community events in Nashua during October including football games, children’s tours and the Salvation Army annual apple fest. Planning is underway for coverage of the annual Holiday Stroll event and for participation in NHS-South’s Operation Safe Prom program video shoot.  Numerous visits were made to local community locations to introduce AMR and interact with the community.  Planning process underway for community open house.