King County Medic One ALS Study

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King County ALS Study
King County Emergency
Medical Services Division
December 2016

Team
2
Nikiah Nudell, MS, NRP
Chief Data Officer / Project Manager
+1.760.405.6869
nnudell@paramedicfoundation.org
Fred Morrison, BSBA, EMT-P
CEO / Co-Project Manager
+1.970.390.3733
fmorrison@paramedicfoundation.org
Gary Wingrove, EMT-P (ret.)
President
+1.202.695.39-1-1
wingrove@paramedicfoundation.org
Paul Anderson, MS, NRP
Healthcare Consultant
Andrea Corage Baden, PhD, MPH
Social Scientist
Robert McNally, MS
GIS Analyst
David Shrader
EMS Systems Consultant
Davis Patterson, PhD
Social Scientist

Study Purpose
3
1. Determine the optimal number of ALS agencies in King County
2. How many medic units are appropriate for each to operate
3. Develop a regional process for:
• responding to any changes to the current ALS agency configuration
• configuration meeting county needs for the next ten years

Data Sources & Methodology
4
• 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)

5
KCEMS Census Tracts

KCEMS Demographics
6
Paramedic
Agency
Paramedic
Units
Paramedics
Service
area(s)
ServiceArea
Population
(2014)
ServiceArea
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 Center
750,157 670
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

Economy of Scale
7
Agency&
#Medic
Units
2015ALS
Costs
ALS
Responses
ALS
Transports
Costper
response
Costper
transport
Annual
UnitHours
Costper
UH
Costper
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 $42
RFD 3 $6,349,125 3,723 1,019 $1,705 $6,231 26,280 $242 $32
BFD 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

Salaries & Benefits Contribution to Cost
8
Agency
#
Medic
Units
Salaries &
Benefits per
UH*
Vashon 1 $209.56
Redmond 3 $215.14
Shoreline 3 $228.84
Bellevue 4 $203.72
KCM1 8 $190.99
$180
$190
$200
$210
$220
$230
$240
0 2 4 6 8 10
$Salary/BeneitsperUnitHour
# Medic Units
SALARIES & BENEFITS PER UNIT
HOUR (2015)
SEATTLE DATA NOT AVAILABLE

Economic Impact to EMS Levy
9
For every medic unit operated by an agency the: p-value
Cost per capita decreases -$18.05 0.22
Cost per response decreases -$353.42 0.05
Cost per transport decreases -$1,055.73 0.14
Cost per unit hour increases +$3.15 0.2

Cost per Capita
10
Seattle Bellevue Redmond Shoreline KCM1 Vashon
# Medic Units 7 4 3 3 8 1
Cost per Capita $24.36 $27.40 $31.88 $42.21 $23.29 $188.49
0
20
40
60
80
100
120
140
160
180
200
CostperCapita
2015 KCEMS Cost per Capita and # Medic Units

Costs Viewed by # Medic Units
11
$0
$1,000
$2,000
$3,000
$4,000
$5,000
0 2 4 6 8 10
CostperResponse
# Medic Units
COST PER RESPONSE
(2015)
$0
$5,000
$10,000
$15,000
0 2 4 6 8 10
CostperTransport
# Medic Units
COST PER TRANSPORT
(2015)
$150
$200
$250
$300
0 2 4 6 8 10
CostperUnitHour
# Medic Units
COST PER UNIT HOUR
(2015)
-$50
$0
$50
$100
$150
$200
0 2 4 6 8 10
CostperCapita
# Medic Units
COST PER CAPITA (2015)

System costs are greatly reduced by having fewer
agencies operating more units per agency
12
• 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

From an efficiency and financial perspective, the
optimal number of ALS agencies countywide is one
13
• 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

Formal changes to the current configuration of
ALS agencies should follow a process
14
• 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

Questions, comments, discussion
15
• Thank you for taking the time to participate and sharing your
thoughts with our team

King County Medic One ALS Study

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