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HomeMy WebLinkAboutResolution - 2007-R0379 - Proposal For Financial Assistance- DSHS- EMT Intermediate Training Certification - 08_23_2007Resolution No. 2007--RO379 August 23, 2007 Item No. 5.13 RESOLUTION 3E IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK: THAT the Mayor of the City of Lubbock or his designee BE hereby authorized and directed to execute and submit a Proposal for Financial Assistance with the Texas Department of State Health Services to provide funding for an EMT Intermediate Training Certification Program in connection with the City of Lubbock Fire Department, and all related documents. Said Proposal is attached hereto, and incorporated in this resolution as if fully set forth herein and shall be included in the minutes of the City Council. Passed by the City Council this 23rd day of August , 2007. ATTEST: Re cca Garza, City Secretary APPROVED AS TO CONTENT: Cooper, APPROVED AS T� FORM: D. Mi DAVID A. ALLER, MAYOR ity Attorney gs/Grant Application -Fire Dept -Homeland Security.res08101107 Resolution No. 2007—R0379 5* TEXAS Department of State Health Services rs r.: :•:r FORM A: FACE PAGE - Proposal for Financial Assistance ' %!.'" "'h EMS/LPG. 0225.1 This form requests basic information about the respondent and project, including the signature of the authorized representative. The face page is the cover eage of the EMEosal and shalt be completed in its entirety, A: Public Health Re -ion 001 RESPONDENT INFORMATION B : Trauma Service Area : TSA-B 1) LEGAL NAME: City of Lubbock Fire Department 2) MAILING Address Information (include mailing address, street, city, county, state and zip code): Check if address change ❑ 1515 E.Ursuline St. Lubbock, Lubbock County, Texas 79403 3) PAYEE Mailing Address (if different from above): Check if address change ❑ 4) Federal Tax ID No. (9 digit), State of Texas Comptroller Vendor ID No. (14 digit) or Social 75-6000590 Security Number (9 digit) : 'The vendoracknowtedges, underatandsand agrees that the vendor's choice to use a socialsecuritynumberas the vendoridentificadon number for tf* contract may result in the social security number being made public via state open records re2uests, 5) TYPE OF ENTITY (check all that apply): City ❑ Hospital ❑ State Controlled Institution of Higher Learning ❑ County 0 Registered First Responder ❑ Minority Organization ❑ Other Political Subdivision ❑ Injury Prevention Organization ❑ HUB Certified ❑ State Agency ❑ Regional Advisory Council ❑ Faith 'Based (Nonprofit Org) ❑ Indian Tribe ❑ Nonprofit Organization' ❑ Private ❑ Licensed EMS Provider ❑ For Profit Organization' ❑ Individual ❑ EMS Educational Facility ❑ Community -Based Organization ❑ Other (specify): charter number of State: 6) PROPOSED BUDGET PERIOD: Start Date: November 1, 2007 End Date: August 31, 2008 7) COUNTIES SERVED BY PROJECT: Lubbock County 8) AMOUNT OF FUNDING REQUESTED: $47410 9) PROPOSED PROJECT: (Check all that apply) EMS Equipment ❑ Ambulance ❑ Injury Prevention Training,Education ❑ MondorlDefibrillator 9A.) Number of entities represented in proposal: 001 10) PROJECT CONTACT PERSON Name: Capt- Doyce Ewing Phone: (806) 775-3070 Fax: (806) 775-2656 fax E-mail: dewing@mylubbock.us 11) FINANCIAL OFFICER Name: Raul Salazar Phone: (806) 775-3176 Fax: (806) 775-3510 fax E-mail: rsalazar(&.mylubbock.us The facts affirmed by re in this proposal are truthful and i warrant that The respondent is in compliance with the assurances and certifications contained in APPENDIX A: DSHS Assurances and Certifications. I understand that the truthfulness of the facts affirmed herein and the continong compliance wAh these i requirements are conditions precedent to the award of a contract This document has been duly authorized by the governing body of the respondent and 1 (fhe ( person signing below) am authorized to represent the respondent. j 12) AUTHORIZED REPRESENTATIVE Check if change ❑ 13) SIGNA URE OF AUH6ii�IZED REPRESENTATIVE Name: Doyce Ewing s Title. Captain- Fire Training Division Phone: (806) 775-3070 I i € Fax, (806) 775-2656 1 DATE 07110l2007 ' E-mail,dewing@mylubbock.us 1 EMS/LPG- 0225.1 FORM Be. PROPOSAL TABLE OF CONTENTS AND CHECKLIST Legal Name of respondent City of Lubbock Fire Department This form is provided as your Table of Contents and to ensure that the proposal is complete, proper signatures are included, and the required assurances, certifications, and attachments have been submitted. Be sure to indicate page number. FORK! DESCRIPTION Included page # Not Applicable A Face Page - completed, and proper signatures and date included ® 1 B Proposal Table of Contents and Checklist - completed and included ® 2 C Contact Person Information - completed and included ® 3 D Medical Director Signature Page - completed if licensed EMS provider or first responder ® 4 ❑ E Administrative Information - completed and included (with supplemental documentation attached if required) See Attached Appendix for Financial Solvency Documentation ® 5 and Appe ndix F Organization Statement of Financial Resources . completed and included ® 8 G Work Plan Guidelines -- instructions for writing Work Plan (Form H) 9 H Work Plan - completed including additional sheets if necessary 10 I Funding Request Budget Page - completed and included ® Is J Minimum Computer Specifications Form - completed and included (if applicable) ❑ K Nonprofit Board of Directors and Executive Director Assurances - form signed and included (if applicable ❑ I. Ambulance Request Form - completed and included (if applicable) ❑ M Education Program Request Form - completed and included (if applicable) ® 17 ❑ FORM C: CONTACT PERSON INFORMATION Legal Name of Respondent: City of Lubbock Eire Department This form provides infcrmation about the appropriate contacts in the respondent's organization in addition to those on FORM A: FACE PAGE. If any of the following information changes during the term of the contract, please send written notification to the Client Services Contracting Unit. EMS Administrator: Contact: Doyce Ewing Mailing Address (incl. street, city, county, state, & zip): Title: Captain 1515 E.Ursuline St. Phone: 8067753070 Ext, Lubbock, Lubbock Co., TX. 79403 Fax: 8067752656 E-mail: dewing@mylubback.us Contact: Raul Salazar Mailing Address (incl. street, city, county, state, & zip): Title: Management Assistant 1515 E.Ursuline St, Phone: 8067753176 Ext. Lubbock, Lubbock Co., TX. 79403 Fax: 8067753510 E-mail: rsalazar@mylubbock.us Contact: Shane Parker Mailing Address (incl. street, city, county, state, & zip): Title: Medical Compliance Officer 1515 E.Ursuline St. Phone: 8067753012 Ext, Lubbock, Lubbock Co., TX. 79403 Fax: 8067752656 E-mail: sparker@mylubbock.us Contact: Mailing Address (Incl. street, city, county, state, & zip): Title: Phone: Ext. T� Fax: E-mail: Contact: Mailing Address (incl. street, city, county, state, & zip): Title: Phone: Ext, Fax: E-mail: EMSILPG- 0225.1 a FORM D: MEDICAL DIRECTOR SIGNATURE PAGE Medical Director's signature is required for all proposals that request funds for an entity that is a DSHS licensed EMS provider or registered first responder organization. Single Entity Proposal The signature(s) below verifies that the entity is in compliance with regional EMS / trauma system protocols and the medical director supports this project. Multiple Entity Proposal: Each entity in a multiple entity proposal must include the signatures of their authorized representative and their medical director on this page. The signature(s) below verifies that the entity is in compliance with regional EMS / trauma system protocols and the medical director supports this project(s). (Duplicate this page as necessary for additional entities) Lubbock Fire Department 1515 E. Ursuline St. Lubbock, Lubbock Co., TX. 79403 (806) 775-3070 TDSHS FRO#300453 (Medical Directors si" ure) (date) _07/10/2007 !/date, if not included on face I (Organization name) III (Medical Director signature) (date) (Organization name) ]ate, if not inciuded on face (Medical Director signature) (date) if not included on race (Organization name.) I� (Medical Director signature) i - 1 (date) (authorized signaturerdate, if not included on face page) EMS/LPG- 0225.1 FORM D: MEDICAL DIRECTOR SIGNATURE PAGE Medical Director's signature is required for all proposals that request funds for an entity that is a DSHS licensed EMS provider or registered first responder organization. Single Entity Proposal: The signature(s) below verifies that the entity is in compliance with regional EMS / trauma system protocols and the medical director supports this project Multiple Entity Proposal: Each entity in a multiple entity proposal must include the signatures of their authorized representative and their medical director on this page. The signature(s) below verifies that the entity is in compliance with regional EMS / trauma system protocols and the medical director supports this project(s). (Duplicate this page as necessary for additional entities) � - Lubbock Fire Department 1515 E. UrSul'Ine St. Lubbock, Lubbock Co., TX. 79403 (806) 775-3070 TDSHS FRO#300453 (Medical Director signature) pry£ (date) 07/10/2007 (authorized signatureldate, if not included on face page) (Organization name) (Medical Director signature) (date) (authorized signatureldate, if not included on face page) (Organization name) (Medical Director signature) (date) (authorized signature/date, if not included on face page) (Organization name) I (Medical Director signature) 1 (date) i (authorized signatureldate. if not included on face page) ' f (Organization name) (Medical Director signature) (dates FORM E: ADMINISTRATIVE INFORMATION This form provides information regarding identification and contract history of the respondent, executive management, project management, governing board members, and/or principal officers. Respond to each request for information or provide the required supplemental document behind this form. If responses require multiple pages, identify the supporting pages/documentation with the applicable request. NOTE: Administrative Information may be used in screening and/or evaluating proposals. Legal Name City of Lubbock Fire Department Identifying Information 1. The respondent must attach the following information: If a Governmental Entity Names (last, first, middle) and addresses for the officials who are authorized to enter into a contract on behalf of the respondent. Miller, David A. Mayor, City of Lubbock 1625-13`�' St. Lubbock, Lubbock Co., Texas 79401 If a Nonprofit or For profit Corporation • Fulf names (last, first, middle), addresses, telephone numbers, titles and occupation of members of the Board of Directors or any other principal officers. Indicate the office held by each member (e.g. chairperson, president, vice-president, treasurer, etc.). • Full names (last, first, middle), and addresses for each partner, officer, and director as well as the full names and addresses for each person who owns five percent (5%) or more of the stock if respondent is a for -profit corporation. 2. Is respondent a private, nonprofit organization? ❑ YES Z] NO If YES, respondent must include evidence of its nonprofit status with the proposal. Any one of the following is acceptable evidence. Check the appropriate box for the attached evidence or complete the "Previously Filed" section, whichever is applicable. ❑ (a) A reference to the organization's listing in the Internal Revenue Service's (IRS's) most recent list of tax-exempt organizations described in section 501(c)(3) of the IRS Code. ❑ (b) A copy of a currently valid IRS exemption certificate. ❑ (c) A statement from a State taxing body, State Attorney General, or other appropriate State official certifying that the respondent organization has a nonprofit status and that none of the net earnings accrue to any private shareholders or individuals. ❑ (d) A certified copy of the organizaVon's certificate of incorporation or similar document if it clearly establishes the nonprofit status of the organization. ❑ (e) Any of the above proof for a State or national parent organization, and a statement signed by the parent organization that the respondent organization is a local nonprofit affiliate. EMS/LPG- 0225.1 FORM E: ADMINISTRATIVE INFORMATION continued Conflict of Interest and Contract Histoix The respondent must disclose any existing or potential conflict of interest relative to the performance of the requirements of this RFP. Examples of potential conflicts include an existing or potential business or personal relationship between the respondent, its principal, or any affiliate or subcontractor, with DSHS, the Health and Human Services Commission, or any other entity or person involved in any way in any project that is the subject of this RFP. Similarly, any existing or potential personal or business relationship between the respondent, the principals, or any affiliate or subcontractor, with any employee of DSHS, or the Health and Human Services Commission must be disclosed. Any such relationship that might be perceived, or represented as a conflict, must be disclosed. Failure to disclose any such relationship may be cause for contract termination or disqualification of the proposal. If, following a review of this information, it is determined by DSHS that a conflict of interest exists, the respondent may be disqualified from further consideration for the award of a contract. Pursuant to Texas Government Code Section 2155.004, a respondent is ineligible to receive an award under this RFP if the bid includes financial participation with the respondent by a person who received compensation from DSHS to participate in preparing the specifications or the RFP on which the bid is based. 1. Does anyone in the respondent organization have an existing or potential conflict of interest relative to the performance of the requirements of this RFP? ❑ YES 2 NO If YES, detail any such relationship(s) that might be perceived or represented as a conflict. (Attach no more than one additional page.) Will any person who received compensation from DSHS for participating In the preparation of the specifications or documentation for this RFP participate financially with respondent as a result of an award under this RFP? ❑ YES Z NO If YES, indicate his/her name, social security number, job title, agency employed by, separation date, and reason for separation. 3. Has any member of respondent's executive management, project management, governing board or principal officers been employed by the State of Texas 24 months prior to the proposal due date? ❑ YES El NO If YES, indicate his/her name, social security number, job title, agency employed by, separation date, and reason for separation. 4. Has respondent had a contract with DSHS within the past 24 months? ❑ YES 0 NO If YES, indicate the contract number(s): NIA M DSHS Contract Numbe EMS/LPG- 0225.1 If NO respondent must be able to demonstrate fiscal solvency. Submit a copy of the organization's most recently audited balance sheet, statement of income and expenses and accompanying financial footnotes. If an agency does not have audited financial statements, submit a copy of the organization's most recent IRS Form 990 and an explanation why an audited financial statement is not available. DSHS will review the documents that are submitted and may, at its sole discretion, reiect the proposal on the grounds of the respondent's financial capabilr'ty. See Appendix for Financial Solvency Documentation. Is respondent or any member of respondent's executive management, project management, board members or principal officers: • Delinquent on any state, federal or other debt; • Affiliated with an organization which is delinquent on any state, federal or other debt; or In default on an agreed repayment schedule with any funding organization? YES ® NO If YES, please explain. (Attach no more than one additional page.) 6. Has the respondent had a contract suspended or terminated prior to expiration of contract or not been renewed under an optional renewal by any local, state, or federal department or agency or non-profit entity? YES ® NO If YES, indicate the reason for such action that includes the name and contact information of the local, state, or federal department or agency, the date of the contract and a contract reference number, and provide copies of any and all decisions or orders related to the suspension, termination, or non -renewal by the contracting entity_ FORM F: ORGANIZATION STATEMENT OF FINANCIAL RESOURCES Instructions: All respondents must complete the following sections. If not applicable, state "N/A". (Attach additional sheets, if needed). All signatures must be obtained and all questions must be answered to uualify for consideration of funding. Note: DSHS prohibits the use of grant fwids to supplant (reducing of applicant budget upon receipt of grant) currently budgeted funds. (Funds being removed from your budget not including matching funds) Note: Failure to complete this form will result in respondent being ineligible for LPG funding. Grant Historv: List all arants (includino LPG) aoolied for and/or received in last five vears. Year Source(s) Amount Requested Amount Received Amount -I Utilized 2003 FireAct Grant -US Department of Homeland Security $75925 $75925 $75925 2004 FireAct Grant -US Department of Homeland Security $103950 $103950 $86614 2006 FireAct Grant -US Department of Homeland Security $395000 $ 0 $0 2007 FireAct Grant -US Department of Homeland Security $555729 Pending utner sources of income: kcurrent contracts, suosiaies, enaowments, aonation Source(s) I Amount NIA s, fund raisers etc.) 1. Has your organization been established for one year or more? ® YES ❑ NO 2. If your organization receives this grant, will your service have money removed from your operating or capital budget that will offset this award (other than matching funds)? "Note: Checking "yes" to this question will result in applicant being ineligible for LPG funding. Before answering this question, see definition of "supplanting" in Section 1) Introduction, C Use of Funds, 2"d paragraph." [] YES 0 NO J 9 3. Do you bill for services? ❑ YES ® NO If yes, what is the charge for emergency 911 calls? NIA If yes, what is the charge for non -emergency transports? N/A 4. What is your current billing collection rate (%); NIA In dollars per year? N/A 5. What are your current liquid assets in dollars? (Estimated savings, investments, operating budget) ' N/A i 16. What is your outstanding debt in dollars? N/A 7. What are your current accounts receivables in dollars? _ NIA 8. What is your service's source of matching funds for equipment or supply requests in this proposal? i NIA I (Must indicate source(s) if matching funds are required). Doyce Ewing- Captain, Fire Training Division Nam' and T$ a of Person Completing this Form 07-10-2007 FORM G: WORK PLAN GUIDELINES On Form H: Work Plan, describe the plan for activities and/or delivery of products, including time lines for accomplishments. Your narrative must at a minimum address the criteria below. Format your work plan to include at least the following six headings: 1. Problem. • Describe the problem and identify the best solution(s). • Describe how you identified the "need" for this project • Describe your need for funding, which may include any hardships or financial barriers to obtaining goals without this funding. 2. Objectives. • Identify the goals and objectives of this project. Your goals are your solutions to the problem and your objectives are your steps to achieving your goals. • Describe your methodology for completing this project. A description of how you plan to complete your objectives. This should include the knowledge, resources and staff available to perform the project. • Detailed implementation plan with timelines for all deliverables and the ability to accomplish the project in the time specified in this proposal. 3. Evaluation. • Describe how you will evaluate the accomplishment of objectives. • Describe how the overall success of the project(s) will be determined. • Describe your plan for addressing the resolution process for major problems that may arise during the project. 4. Budget. • Describe your budget. Explain how this proposal is the most cost-effective use of funds. 5. Plan for continuation. • Describe your plan for the continuation of the benefits of this project (short-term or long-term, as applicable to project- e.g. maintenance on equipment, continuing education for post - certification programs). 6. History of project completion or grant administration. Describe administration of past projects or grants. Include successfully implemented projects as well as failed or incomplete projects. You may add explanations for any funds that were received and not entirely utilized. I f$] cI IV, r: Wills] R'iZ�sI;1 Respondents must describe its plan For service delivery to the population in the proposed service area(s) and include timelines for accomplishments. Address the required elements (see Form G: WORK PLAN Guidelines) associated with the services proposed in this proposal. A maximum of four [41 additional pages may be attached if needed. Background: The Lubbock Fire Department serves as a licensed First -Responder Organization providing emergency medical service to the City of Lubbock, Texas (population 210,000 est. 2007). The agency providing emergency medical transport in the City Of Lubbock is Lubbock EMS, a division of University Medical Center. Current studies indicate that a major determinate in pre -hospital survival rates for emergency medical conditions is largely dependant upon the rapid initiation of the 9-1-1 system and the rapid arrival of appropriately trained and equipped response personnel. Lubbock EMS is undergoing a serious EMT-P turnover rate and is downgrading normal staffing of its all MICU fleet to one EMT-P and one EMT-B or EMT-[ from two EMT-P level personnel. This can be expected to do two things 1) increase the level of turnover due to paramedic workload and 2) decrease the number of advanced care level providers on the emergency scene. This grant proposal addresses the implementation of a plan by the Lubbock Fire Department to increase the number of advanced -level caregivers currently employed by the Lubbock Fire Department, thereby increasing the number and skill level available to the public on emergency medical responses. The Lubbock Fire Department currently employs two hundred and eighty five medically certified individuals and follows South Plains EMS protocols. Of this number, fewer than twenty individuals hold a certification higher than EMT -Basic. The Lubbock Fire Department is developing plans for implementation of ALS capable fire engines and exploring the possibility of entering the field as a transport provider in the near future. The main limiting factor to these plans is the shortage of appropriately certified individuals available to man response units. Annual medical response for LFD is approximately eighteen thousand responses as a first responder organization. The LFD plans to work in conjunction with South Plains College, a local college with a TDSHS accredited EMS program, to train twenty individuals to the EMT-1 level within the project timetable. South Plain College EMS Program Director has agreed to "Certificate of Proficiency" program whereby LFD will provide classroom space, qualified instructors, testing/ demonstration supplies and administrative oversight. South Plains College will provide the necessary clinical/field supervision, class curriculum as well as Advanced Medical Coordinator support. Future advanced certification classes are anticipated and are being actively explored for sources of funding. This program will not be possible without grant funding due to instructions from City administrators to maintain a flat budget commensurate with previous year's spending levels. Problem Statement: The decision by Lubbock EMS to downgrade staffing on its transport units diminishes the level of emergency medical care resources available to our community. The Lubbock Fire Department can positively negate the detrimental effects of that transport provider's decision by increasing the number of advanced level EMT's in our workforce. IN Plan Goal: The Lubbock Fire Department will effectively increase the level of service available to the community by increasing the number of advanced-levei first responders through a certification course administered by Lubbock Fire Department, in conjunction with the South Plains College EMS program. Plan Objectives: 1.The Lubbock Fire Department will initiate an advanced level EMT -intermediate certification class November 2007 with a class of twenty individuals. This initial number of students, while increasing the total cost, is necessary to ensure the greatest, most immediate positive impact upon the stated problem statement. A lesser number of students, while less costly, would not have as great an impact upon our service delivery to our community. Those individuals selected for training have indicated a strong desire to further their knowledge/skill base to enable them to better serve those members of the community they might be called upon to assist in a medical emergency. Personnel will be selected with station assignment evaluated with regards to ensuring appropriate dispersion of qualified certificants. 2.Resources provided by LFD will include: class space, one lead instructor, three assistant/skills instructors, and all associated textbooks, teaching aids and skill testing supplies. All LFD instructors shall have as a minimum, EMT-1 credentials and TDSHS Medical Instructor certification. 3.Class shall consist of one hundred didactic classroom hours instruction with appropriate periodic examinations, eighty hours clinical instruction with appropriate evaluation documentation, and one hundred twenty hours field training with appropriate preceptor evaluation for completion fora total of three hundred hours instruction (DOT regulations require a minimum of one hundred sixty hours). Evaluation 1.The students selected for training will successfully complete mandatory clinical and field evaluations as administered by qualified Lubbock Fire Department instructors and appropriate preceptors. 2. Certification program success will be evaluated by the total number of personnel successfully completing the National Registry of Emergency Medical Technicians EMT - Intermediate (85) computer -based knowledge and skills test. Once successfully passed, those individuals attaining a passing score will apply for upgraded certification with TDSHS. Those individuals needing to retest will be required to do so at their expense. 3. Documentation process is already in place to document all instances of procedures, including advanced -level care, being performed by LFD personnel. Process is under continual review by LFD EMS compliance team. 4. Students will be placed on a tracking chart, available for individual inspection, to track individual progress in didactic, clinical, and field training evolutions. 5. LFD administrators and class instructors will continually monitor individual progress on tracking chart and make individual adjustments as needed. 6. Tutoring by advanced -level personnel will be made available for individuals requiring assistance. is EMS/LPG- 0225.1 lmplementation Timetable: September 01- October 15,2007- Student selection interviews and selection. September 01- October 15,2007- Resource Procurement (texts, testing and demo supplies). October 16 — November 2,2007- Student Resources allocated. November 6,2007- First Class 6:00 PM @ LFD Training Complex (Classes will run Tuesday and Thursday at same location and time). November 10,2007- Saturday class 8:OOAM to 5:00 PM (first of two Saturday classes total). November 6, 2007- February 7,2008- Classes Tuesday and Thursday. January 12,2008- Second and final Saturday Class 8:OOAM to 5:00 PM. April 30, 2008- All clinical and field evaluations completed. * May 15, 2008- all students issued Certificates of Proficiency by South Plains College. May 16- June 30,2008- National Registry completion for all students. May 16-July15,2008-Certification Applications completed with TDSHS Program Verification completion sent to TDSHS. Budget- See attached sheet for budget details This grant application is for $ 47,410 to provide funding for an Intermediate level certification class for twenty individuals employed by the Lubbock Fire Department. Funding requested includes amounts for certification of proficiency fee through South Plains College EMS Program ($12,000), and equipment/supplies and textbook media for necessary didactic, clinical and field instruction and evaluations ($4590). Costs associated with a state approved Pre -Hospital Trauma Life Support class are included as well for submission for reimbursement ($1100). Additionally, funding is also requested for instructor compensation and overtime compensation to cover seven student's positions (total of seven hundred hours) while the student attends class during on -duty time ($18,900). This provision is necessary due to minimum staffing provisions in place at the Lubbock Fire Department. Funding for National Registry of Emergency Medical Technicians (NREMT) computer -based testing is included in the proposal as well, as this is a requirement mandated by TDSHS policy ($5000). Also included is funding forthe TDSHS initial EMT -Intermediate certification fee as mandated by TDSHS. This proposal describes the most cost-effective usage of funding in that: a) much of the monies allocated are for materials which will be reused in future certification classes which will drive the Lubbock Fire Department toward the eventual realization of becoming an advanced life saving provider organization, and b) significant portions of the grant monies allocated are designated for certification of proficiency program as offered through South Plains College. This cost ($600 per student) is significantly lower than the usual fee of $1400 per student as offered to the general public. Additionally, individuals have been identified within the Lubbock Fire Department that are capable, and in the process of, acquiring basic and advanced coordinator certifications through TSDHS. Once this occurs, LFD will apply for education program certification with TSDHS. This will enable LFD to develop and administer advanced -level certification courses completely in-house, further enabling LFD to augment the numbers of personnel holding advanced -level certifications. Funding necessary for future certification classes will decrease as the Certification of Proficiency program (25.31 % of requested funding) is phased out. Reducing the total number of students in future classes, thereby reducing the costs associated with overtime manning requirements, will also decrease future certification program costs. * Clinical and field evaluations will be started concurrently with the didactic portion of instruction. This timeframe indicates dates of expected completion. 12 Continuation Plan Continuation of an annual advanced -level certification program is expected but will probably be limited to ten to twelve individuals per year. Once the two individuals identified as probable TDSHS EMS Coordinator candidates have met the educational and instructional hours mandated by TDSHS regulations, the Lubbock Fire Department will submit application to TDSHS for status as a qualified educational agency utilizing either of those two identified individuals as Program Directors. Once that status is attained (expected by fiscal year 2010), accelerated effort will be implemented to provide greater access to department personnel for advanced -level certification courses. The ultimate goal is to be able to staff every fire pumper in service with LFD with at least one advanced -level emergency medical technician to facilitate optimal access for our community to advanced - level capable, first responding emergency medical technicians. The Continuing Education program currently employed by LFD already supplies the minimal total numbers of hours necessary in the required general categories, to meet the necessary hours for personnel to recertify at the basic and intermediate EMT levels. Additional continuing education hours can easily be added with minimal fiscal impact to satisfy recertification hours requirement for paramedic level certification. Future budgeting will be adjusted as necessary to account for greater cost of recertifying advanced -level personnel. Minimal budget adjustmentwill be necessary to procure the necessary medical equipment carried on LFD pumpers to facilitate advanced level procedures. Major budgetary adjustments anticipated, if LFD assumes transport role, would be augmented by billing for services policy. Grant History The Lubbock Fire Department's history with grant funding is limited to those grants funded as part of the FireAct Grant Program as administered by the Federal Emergency Management Agency, subsequently the United States Department of Homeland Security and typically covers expenditures for fire -service related equipment and/or services. In 2002, a FireAct grant request of $50,950 was not approved. In 2003, LFD accepted monies from FireAct totaling $75,925. Of this amount, $64,290 funded the acquisition and installation of diesel exhaust removal systems for two fire stations (#9 and #11). The remaining $11,336 funded the Emergency Medical Technician- Basic certification class for twelve Fire Lieutenants. All twelve students successfully completed the course and currently hold EMT -Basic certifications. The 2004 FireAct program provided $103,950 to LFD for use in procuring twenty-seven mobile data terminal laptop computers, of which $17,336 remained unused due to project terms coming in under budget with no additional projects submitted. FireAct awarded no grant monies to LFD in 2005, LFD's request for FireAct funding in 2006 for a total of $395,000 was not approved. In 2007, a Fire Act grant request of $555,729 was submitted and is pending approval for the acquisition of one heavy rescue vehicle and equipment used by the LFD Heavy Rescue team. 13 Work Plan (Form H)-Addendum Budget Detail 14 1. Certification of Proficiency Fee for 20 students ($600.00 X 20) = $12,000.00 2. Minimum staffing overtime charges to cover 7 students per class session. Average overtime wage for D-step firefighter is $26/hr. 100 hours total didactic classroom hours. ($26Ihr X 100 hours X 7 students) = $18,900,00 3. National Registry of EMT Intermediate (85) Testing Fees ($250.00 X 20) = $ 5,000.00 4. Textbooks/ Uniforms: Mosby's EMT Intermediate 3'd Ed. ($65.00 ea. X 20) $ 1,300.00 Mosby's EMT Intermediate Workbook ($32.00 ea. X 20) $ 640.00 PHTLS ($55.00 ea. X 20) $ 1,100.00 Program Uniform Shirt ($30.00 ea. X 20) $ 600.00 5. Lead Instructor Fee ($25.00/hr X 120 hours) (includes all instruction and preparation hours) $ 3,000.00 6. Skill Instructor Fee ($15.00/ hr X 20 hrs X 3 instructors) (20 hours skill evaluations during didactic learning phase) $ 900.00 7. Training Supplies (as per Form 1) $ 2,050.00 8. TDSHS EMT -Intermediate Initial Certification Fee $ 1,920.00 ($96.00 ea. X 20) Total Grant Funding Request $47,410.00 EMS/LPG- 0225.1 FORM L• FUNDING REQUEST BUDGET PAGE All respondents complete this budget page to detail the funds requested. Refer to Section 11, F. for funding preferences and limits. Use additional pages as needed If submitting a multiple entity proposal, submit a separate page for each entity for which funds are requested. Name of Entity: Lubbock Fire Department rEquipment and Supply Items: ividual item with a useful life of more than one year and more than $1,000 (including shipping) requires 50% n funds. Please be ver descri tive when listin our g Y P 9Y (e.g. make/brand, model number, year, etc. Owe 0 a h U i= a zQu1Ld w 2 u. M 0 u) K O E � U X co0LLuJ a n. O o- z < D CJ cn aof D -1 0Er 0 Z ua0�s X u- u- See Attached Sheet for Equipment/Supplies $2,050.0( 1 $2 050.00 Other Expenses Education/Training, injury prevention, etc.): None required Mosby EMT -Intermediate Textbook 3rd Ed. ISBN#0323039847 $65.00 None required $65.00 20 $1,300.00 Mosby EMT -Intermediate V Ed. Workbook ISBN#0323045154 $32.00 None required $32.00 20 $640.00 Pre -Hospital Trauma Life Support Course (PHTLS) $55.00 None required $55.00 20 $1,100.00 Program Uniform Shirt $30.00 None required $30.00 20 $600.00 Certificate of Proficiency Program Fee $600.00 None required $600.00 20 $12,000.00 Manpower Coverage Overtime Fees for 7 individual students/ class session $108/class/student $2700.00 None required $2700.00 7 $18,900.00 Lead Instructor Fee (120 hours @ $25.00/hr) $3000.00 None require $3000.00 1 1 $3,000.00 Assistant/Skill Instructor Fees (20 hrs/instructor @ $15.00/hr) $300.00 None required $300.00 3 $900.00 National Registry EMT -I (85) Testing Fee $125.00 None required $125.00 20 $5,000.00 TDSHS EMT-1 Initial Certification Fee ($96.00 ea.) $96.00 None required $96.00 20 $1920.00 Total $47,410,00 15 EMSILPG- 0225.1 Form I: Funding Request Budget Package Addendum Southeastern Emergency Equipment southeastern Emergency Equipment QUOTE I xx F�1'lY.'y:fi'IC.Y sfi:.Y:i:i ?:r'l YjV�7 ff:° ORDER PO Box 1196 Wake Forest. NC 27588-1196 ACCOLNT #: Lubbock FD DATE: 7/1012007 PO #: Shane Parker CITY: SHIP TO: ADDRESS: ADDRESS: CITY: C r1'Y : STATE: STATE: `LIP: Z111: PHOYE: FAX: QTY ITEM # DESCRIPTION Llat Price YOUR PRICE TOTAL 2 SROX1632 Terumo Surge IV Catheters SO/box 16 GA $43.D0 $38.50 $77.00 3 SROXIS32 Terumo Surflo IV Catheters(SO/box) 18 GA $43.00 $38.50 $115.50 3 SROX2032 Terumo Surflo IV Catheters 50/box 20 GA $43.00 $38.50 1115.50 2 J6126 Starling lcc TB Syringe with needle 1001box $10.00 $8.25 $16.50 2 08255 Starling 3cc Syringe UL 100/box 7 $5.75 $11.50 2 J8254bx Starline 5cc Sryin a LA- 100/box 13 $10.50 $21.00 2 J8253bx Starline 10 cc Syringe L/L 100/box 13 $10.50 $21.00 1 J8167 Startine 18 x 1 112 Needle 100/box 4 $3.40 $3.40 1 J8156 Sta dine 18 x 1 Needle 100/box 4 $3.40 $3.40 5 CDDIN1515 Jamishidi 15 GA IO 10 $8.25 $41.25 1 BD38226B Becton Dickinson 14GA X 3 114 Special Procedure 130 $110X0 $110.00 2 RU1003820 Rusch ET Tubes Uncuffed 2 $1.15 $2.30 2 RU100382025 Rusch ET Tubes 2.5 Uncuffed 2 $1.15 1 2.30 2 RU100382030 Rusch ET Tubes 3.0 Uncuffed 2 $1.15 $2.30 2 RU100382035 Rusch ET Tubes 35 Uncuffed 2 $1.15 $2.30 2 RU1003B2040 Rusch ETTubes 4.0 Uncuffed 2 $1.15 $2.30 2 RU100382045 Rusch ET Tubes 4.5 Uncuffed 2 $1.15 $2.30 2 RU112082050 Rusch ET Tubes 5.0 cuffed 2 $1.25 $2.50 2 RU112082055 Rusch ET Tubes 5.5 cuffed 2 $1.25 $2.50 2 RU112082060 Rusch ET Tubes 6.0 cuffed 2 $1.25 $2.50 2 RU112052065 Rusch ET Tubes 6.5 cuffed 2, $1.25 $2.50 2 RU112082070 Rusch ET Tubes 7.0 cuffed 2 $1.25 $2.50 2 RU 112082075 Rusch ET Tubes 7.5 cuffed 2 $1.25 $2.50 2 RU112082080 Rusch ET Tubes 8.0 cuffed 2 $1.25 $2.50 2 RU112082086 Rusch ET Tubes 8.5 cuffed 2 $1.25 $2.50 2 RU 112082090 1 Rusch ET Tubes 9.0 Cuffed 2 $1 25 $2.50 10 RU500 Rusch SI€ck S let pedi 4 $Z.95 $29.50 10 RU750 Rusch Slick St let child 4 $2.95 $29.50 10 RU1000 Ruscls Slick S IetAdult 4 S2.95 29.50 10 LA500 Laerdal Tube Tamer AduA 5 $3.25 $32.50 10 LA400P Laerdal Tube Tamer Pedl 5 $3.25 $32-50 7 BBL8000 Sbraun 1000ML NaCl IV Fluid 12,cass 17 $13.95 $97.65 96 AM108306 Arrasinol0 OTT 2 $1,55 148.80 96 AM608306 lKawasurn Amsinc 60 GTT 2 $1.65 $158.40 2 KAINT01 Intermittent Injection Sites 50,box $23.90 $47.80 3 CC144501 Cooks Cric Set 130 $115.00 S345.00 1 LF01184U _ LlfeForm IM and SubQ Simulator 65 $51.50 $51.50 1 LA270-000.01 Laerdat Multi -Venous IV Training Arm Kit Male 495. $475 A0 S475.00 TOTAL ! $2,050.001 IT+ Resolution No.2007-R0379 FORM M: EDUCATION PROGRAM REQUEST FORM This form is required on ALL education and training projects If your proposal includes a request for education and/or training, complete this form. If your proposal does not include a request for education and training, do not include this form in your proposal packet. All signatures must be obtained and all questions must be answered in order to qualify for consideration of funding. For multiple entity proposals complete an Education Program form for each entity for which education and/or training funds are requested. If your request includes reimbursement of certification or card course tuition, complete this nortion- 1. Projected number of students EMD- in each certification course: EMT EMT -I 20 EMT-P EMD Instructor BTLS/ CPR ACLS PALS PEPP PHTLS 20 NALS CISM Other course(s), not listed above. List name of course and projected number of students: 2. Participating organizations: Lubbock Fire Department 3. Are the prospective students currently involved with patient care: ® Yes ❑ No 4. What measures will be taken to ensure students will be involved in Pre -Hospital Emergency Care following successful course completion? Duties included as condition of employment with City of Lubbock. 5. What measures will be taken to ensure students maintain achieved certification? Maintenance of medical certifications is condition of employment. 6. If your request includes continuing education, describe the CE program; Currently Lubbock Fire Department provides TDSHS approved CE with a minimum of 32 hours provided per year. In- house developed protocol -based material, video presentations and PowerPoint are used with TDSHS instructors providing classroom instruction. Hours are monitored and applied to continuing education recertification option. If your request includes reimbursement for teaching an EMS course or EMS -related course(s), complete this portion. List name of course(s), number of students and frequency of offering during this grant period: Pre -Hospital Trauma Life Support and EMT -Intermediate Certification Classes 20 students single 2. Do you expect to continue offering this course after the grant period? ® Yes ❑ No If yes, explain the long-range plans for course off ering(s). Yes, depending upon fund availability. We plan to administer this course in conjunction with every advanced level course we provide. 3. If your request includes purchase of training equipment, what entity will retain possessionlresponsibility of equipment during grant period? Lubbock Fire Department 4. If your request includes purchase of training equipment, what are your plans for this equipment after this grant period (long-range plans)? Continued instruction of future certification courses. 5. Are the prospective students currently involved with patient care: Z Yes ❑ No 6 What measures will be taken to ensure students will be involved in Pre-Hospitai Emergency Care following successful course completion? Medical duties are a condition of employment and part of mission statement. 17 - _.