HomeMy WebLinkAbout7061RESOLUTION NO. 7,061
A RESOLUTION AUTHORIZING THE CITY MANAGER
TO ENTER INTO A CONTRACT WITH THE ARKANSAS
EMERGENCY PHYSICIANS' FOUNDATION, INC. FOR
THE PROMOTION OF IMPROVEMENTS IN THE CLINICAL
QUALITY OF EMERGENCY MEDICAL SERVICES.
WHEREAS, the Arkansas Emergency Physicians' Foundation,
Inc. has been created by concerned physicians in the central
Arkansas area for purposes of promoting improvements in the
clinical quality of emergency medical services in central
Arkansas, as well as the advancement of emergency medical
services in general through research, education, and other
service activities; and
WHEREAS, the City desire to support and promote the work
of the Arkansas Emergency Physicians' Foundation, Inc. and to
utilize the expertise in emergency medicine of the Foundation,
its members, and its medical director to assist the City in
expert advisory and specialized fact - finding capacities related
to the City's regulatory responsibilities as regards ambulance
services.
NOW, THEREFORE, BE IT RESOLVED BY THE BOARD OF DIRECTORS
OF THE CITY OF LITTLE ROCK, ARKANSAS:
Section 1. The City Manager is hereby authorized to enter
into the contract with the Arkansas Emergency Physicians'
Foundation, Inc. attached hereto, identified as Exhibit A, and
expressly incorporated herein by reference.
ADOPTED: September 20, 1983
ATTEST: APPROVED: y
C y Clerk e Czech ayor J. W. nafi d
M . wee =tam CAWac metWntM M M� �XH� A�
CONTRACTOR SERVICES RELATED TO ORGENCY 65
MEDICAL SERVICES QUALITY CONTROL
This agreement is entered into between the City of Little Rock,
hereinafter referred to as "City," and the Arkansas Emergency Physicians
Foundation, Inc., an Arkansas not for profit domestic corporation,
hereinafter referred to as the "Foundation."
WHEREAS, the Arkansas Emergency Physicians Foundation has been
created by concerned physicians in the central Arkansas area for pur-
poses of promoting improvements in the clinical quality of emergency
medical services in central Arkansas, as well as the advancement of
emergency medical services in general through research, education,
and other service activities; and
WHEREAS, the City desires to support and promote the work of
the Arkansas Emergency Physicians Foundation, and to utilize the ex-
pertise in emergency medicine of the Foundation, its members, and
its medical director to assist the City in expert advisory and
specialized fact - finding capacities related to the City's regulatory
responsibilities as regards ambulance services;
NOW THEREFORE, the parties agree to the following terms and con-
ditions relative to the conduct of certain developmental and fact-
finding services:
I. Scope of Work
In accordance with both the current and future applicable
No. 14,511
provisions of the ambulance ordinance ( ), attached hereto as
attachment I of this contract, and as provided for by the terms
of this agreement the foundation shall perform certain develop-
mental, advisory and fact - finding services for the City as follows:
(See attached
Contract Amendment Pertaining to 3. Personnel
Testing for Certification, pp., 5 -6
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A. The Foundation begin the monthly collection of "run"
data from existing ambulance providers, including such data
on all emergency, and nonemergency, and no haul activities,
14,511
as required by the ambulance service ordinance j� and
the Foundation shall make such data available to City's
representatives for analysis and verification of run volumes
needed in determining franchise fees. The Foundation further
agrees to use its best efforts in monitoring S clinical
quality of services provided by current ambulance services
with respect to response time performance and adherence to
established medical standards.
B. In anticipation of Public Utility Model system operations
14,511
beginning one year from the date ordinance #_ is approved
the Foundation agrees to begin developmental activities that
will allow the Foundation the capability to perform expert
advisory and specialized fact - finding capacities related to
the City's ambulance service regulatory responsibilities
beginning with the new system operations. Such developmental
activities shall include at a minimum:
1. Protocol Development. The Foundation shall develop
written clinical protocols which shall identify all
procedures to be normally employed in response to
to
various clinical conditions /which the protocols relate,
and where a given procedure may be initiated by either
a BLS crew or "first responder," or ALS crew -only upon
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receipt of verbal authorization from the medical control
physician, as designated by the Foundation. To the
maximum extent practical, each protocol shall identify
the respected task of various BLS and ALS personnel
functioning together as an emergency team executing a
uniform protocol set. By way of example, a protocol
involving use of IV fluids might include a statement to
the effect that the BLS or first responder person may
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be as by the senior paramedic in charge to secure
and set up the gear required for IV therapy, but that
actual insertion of needle shall be done by an ALS crew
member only. In addition, to the extent that equipment
and supplies are to be employed in the rendering of the
various procedures which are included in the various
protocols, such equipment shall be specifically identified,
with specification provided, and where conformity with
specific types or brand names as medically appropriate(to
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insure safety / better familiarity of equipment when
crew members of multiple providers function together in
serving the same patient )allowable types of brand names of
equipment and supplies shall be specifically defined.
The Foundation understands that time is of the essence in
development of the first set of protocols and its attached
materials, therefore the initial set of protocols may
necessarily deal principably with the more common and
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life- threatening types of clinical conditions and
medical incidents, and may necessarily omit detailed
reference to less frequent or lower risk medical events.
However, over the period of this agreement, the Foundation
shall continuously expand the clinical specificity in
range of clinical conditions and patient types dealt with
by the protocols, and shall conduct a formal review of
all then current protocols not less than annually, and
more often than annually if findings from the medical
audits or developments in the technology and prehospital
care warrant more frequent review as specific protocols
affected by the findings or developments.
Where a change in protocol,. procedure, or team
member task definition may reasonably require additional
training of prehospital care personnel prior to implemen-
tation of that change, the Foundation shall specifically
require such training be made available prior to the
implementation of the change, and the nature of such
training shall be described with a reasonable length of
time defined to allow effective provider organizations
to conduct such training prior to implementation of the
change.
2. Medical Audits. The Foundation shall develop specific
physician- supervised medical audit procedures of cases
served by ambulance service providers. All such audits
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shall be conducted directly by the medical director
of the Foundation and shall meet all of the standards
for conduct of such audits specified in'the ambulance
14,511
ordinance A— The medical director may, however,
designate a licensed physician other than the medical
director to conduct such audits when, in the opinion
of the medical director, the division of such responsi-
bility among other members of the medical community may
be desirable as a means of broadening physician involve-
ment in the system, or because of the nature of the
specific case makes it desirable to involve a physician
more specialized in the handling of cases of that type.
Providing, however, that all such audit process and re-
views of such audits shall conform with standards and
procedures of due process approved by the Foundation
and distributed in writing to all provider organizations,
and provided that no physician who is not currently
approved by the Foundation to provide medical control in
the Little Rock Ambulance Service System may be assigned
to conduct a medical audit as system performance.
3. Personnel Testing for Certification. The Foundation
shall develop and annually revise and administer both
written and practical test for the certification of
personnel serving as paramedics, BLS crew members, and
system status managers in the Little Pock EMS system.
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� In developing such written tests, the medical director
shall assess the testing requirements and methods em-
ployed by the State Department of Health which licenses
EMS personnel, and shall require additional testing only
in those areas and knowledge of competence which must
necessarily go beyond state testing requirements, such
as specific knowledge of local medical protocol, use of
specific equipment required by Foundation - approved regu-
lation, division of team member responsibilities developed
for multiple provider participation in a single emergency
event, etc.
All written testing shall be supervised by the
medical director or his or her designee. All practical
testing shall be supervised by the medical director or
by licensed physicians designated by the medical director
who has been approved by the Foundation or has a medical
control position. Application forms, written test forms,
score sheets, written test objectives, and applicant's
guide to adequate test preparation shall be developed for
all levels of personnel, including system status managers.
4. Due Process. Prior to initiation of personnel testing
for certification and recertification, the Foundation
board of directors shall develop, approve and distribute
written as standards and procedures of due process des -
re
cribing the rights of applicants as regards /taking of
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tests or failed portions of tests, refresher training
requirements, temporary certification at a lower level
pending retesting, and such other information as is
reasonable and appropriate to protect the rights and
interests of EMS personnel and provider organizations
without jeopardizing the rights and interests of EMS
patients.
The Foundation is advised but not required to employ
test methods and grading systems of a type which will
promote the assurance and competence at the desired
level of knowledge and capability, as opposed to general
scheme of grading competence in percentages. However,
the City understands that such pass /fail determinations
may be difficult or impossible to utilize relative to
certain items of skill or knowledge, and the Foundation
may use its best judgment in selecting testing and
scoring methodologies.
5. Approving and Monitoring Medical Control Coverage.
The Foundation shall develop and administer such educational
programs, materials, and /or test as deemed necessary and
appropriate by the Foundation board of directors to insure
that physicians desirous of directing patient care in
the field by radio communications are appropriately know-
ledgable of the Little Rock Ambulance Service system, its
medical protocols, attendant procedures, personnel
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capabilities, on -board equipment, and medical supplies
so that patient care is normally rendered in a uniform
manner consistent with the approved medical protocol
for that patient's condition, unless extenuating circum-
stances reasonably call for an informed departure from
such medical protocol. When any physician has success-
fully complied with such standards and requirements
approved by the Foundation board of directors, the board
shall officially indicate its approval of the physician
to provide medical control of field activities in the
Little Rock Ambulance Service system, and the medical
director shall so inform that physician in writing on
Foundation letterhead, and such letter of approval shall
serve as official authorization to that physician for
the provision of medical control field activities con-
ducted by ambulance service providers.
6. Vehicle Inspections. The medical director of the
Foundation or his designee shall periodically perform
inspection of ambulances and on -board equipment as re-
quired by applicable provisions of the ambulance ser-
14,511
vice ordinance # Such inspections shall include,
where appropriate, functional testing of on -board
equipment as necessary to insure that such equipment
is in good working order. The inspector shall document
the results of such inspections utilizing a detailed
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check list, with comments if appropriate, providing
the crew, the Authority, and the City with copies of
such inspection check list when completed. Prior to
the initiation of such an inspection program, the.
Foundation board of directors shall approve the check
list and inspection methodology as prepared by the
medical director, including a specific identification
of items of inspection which, in the opinion of the
board of directors, may constitute grounds for requiring
removal of the vehicle from service until the defined
deficiency has been corrected. In addition, the Foun-
dation shall develop, approve,and distribute standards
of due process relative to vehicle and on -board equip-
ment inspections, covering such considerations as
reasonable time frames for correction of deficiencies,
with or without removing the vehicle from service pending
correction, and defining deficiencies sufficiently
serious enough to warrant a finding that the provider
organization has violated its provisions of ambulance
service ordinance. The Foundation, as part of its
vehicle inspection program, will conduct most vehicle
inspections on an unscheduled and unannounced basis,
by visiting the vehicles based during off -peak hours,
or by requesting that the vehicle be allowed to remain
at a receiving facility after delivering a patient, so
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that inspections may be conducted
Each vehicle
serving the Little Rock Ambulance Service system shall
be inspected at least annually to obtain the required
vehicle permit or permit renewal, and shall receive at
least one unscheduled inspection annually in addition.
C. Inasmuch as the Little Rock Ambulance Authority's ability
to successfully conduct a nationally competitive procurement
for a "ambulance operations contractor" is contingent upon
the ability to demonstrate to all potential bidders a type of
ambulance service system and standards under which it operates
so that such bidders can prepare their pricing on such ser-
vices, the Foundation agrees to assist the Little Rock Ambu-
lance Authority during the course of its bid process, and
especially at the "Pre -bid Conference," in presenting the
medical standards and operating protocols that will be
utilized at the time of system "start -up." Because of the
timing on such events it may be necessary for the Foundation's
representatives, during the course of their presentation,
to advise potential bidders of those protocols, standards,
and procedures which have, at that point in time, been
officially enacted by the Foundation board of directors,
and further present the time table and specific areas of
consideration relative to the balance of protocol standards,
and procedures which will be considered by the Foundation
for the new system. The Foundation agrees to use its best
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efforts to identify those items of standards, and their
probable disposition, which will directly affect the
pricing calculations on the part of potential bidders.'
By way of example, a requirement to have two paramedics
aboard all runs vs. a paramedic and an EMT - driver would
make a significant impact upon assumed labor cost to
bidders.
D. The Foundation agrees to further assist the Little Rock
Ambulance Authority in its procurement efforts for all
capital equipment and expendible supplies and drugs that
would be required prior to system start -up. As such, the
Foundation shall identify those items of on -board equipment
and vehicle specifications that will be necessary as a
result of the medical standards and protocols developed by
the Foundation.
II. Compensation and Method of Payment
This agreement between the City and the Foundation will
be cost - reimbursable in nature, not to exceed payments
totaling $25,000 during the term of the agreement. The
Foundation shall prepare an invoice of its cost at the end
of each calendar month and submit such invoice to the City
within 15 days after the end of that calendar month. The
City agrees to reimburse the Foundation within 15 days after
submission of said invoice.
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III. Term of Agreement
This contract shall be for a period of one year from
execution of the agreement. Extensions, modifications,
or other changes shall be subject to the mutual written
agreement of the Foundation board of directors and the
City's contract officer.
IV. Contract Officer
The City hereby designates Nathaniel Hill
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as the
Contract Officer for this agreement, and such Contract Officer
shall make all judgments concerning compliance with this
agreement, approval of payments, and all other such matters
in the concept of these contractual obligations.
V. Responsibilitv for Claims and Liabili
The Foundation shall indemnify and hold harmless the City
and its employees, its director, and agents from and against
all claims or suits brought for injuries to persons or
property caused by the Foundation, or its agents, in the
performance of work under this contract. The City agrees
to indemnify and hold harmless the Foundation and its em-
ployees, its director, agents and subcontractors from all
liability,cost or expenses, including but not limited to
attorney's fees or judgments, which may arise by reason of
litigation instituted by any third person(s) or entity(ies),
excluding agents or employees of the Foundation, which alleges
Foundation's
liability by reason of the Atitkerity's- business or contractual
relationship with the City.
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TN WITNESS WHEREOF, the parties hereby execute this agreement this
/D day of November, 1983.
For the City of Little Rock b-y:
NA'LHANIEL HILL, CONTRACT OFFICER
r � - rr,
SUSAN B. FLEMiNG,J CITY MAN ER
Arkansas Emergency Physicians
Vu a "on, Inc.
AND MUNDIE, AEPF PRESIDENT
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of Little Rock
Office of the city Hall
City Manager Markham at Broadway
Little Rock, Arkansas 72201
371 -4510
Amendment to Contract for Services
Related to Emergency
Medical Services Quality Control
Pursuant to City Board
Resolution
Language reflected in said contract, pp. five (5) and six (6),
under and including "3. Personnel Testing for Certification."
shall be deleted from said contract.
77 -A
Said contract shall be amended to substitute the following lan-
guage:
3. Personnel Testing and Certification. With regard to per-
sonnel testing for initial employment and yearly recertifica-
tion, the Foundation shall develop guidelines for certifica-
tion of personnel serving as paramedics, BLS crew members and
system status managers in Little Rock EMS systems.
IN WITNESS WHEREOF, t'he parties hereby agree to this contract
amendment this 10th day of`November, 1983.
City of Little Rock by:
Nathaniel Hill, Contract Officer
Susan B. Fleming, City Manager
Arkansa Emergency Physicians
F ^u n i/o /n I me . b y
and Mundie, AEPF President