HomeMy WebLinkAbout1991-174RESOLUTION NO. 91- 174
A RESOLUTION OF THE BOARD OF COUNTY
COMMISSIONERS OF INDIAN RIVER COUNTY, FLORIDA,
AUTHORIZING THE APPLICATION FOR FUNDING COUNTY
EMERGENCY MEDICAL SERVICES (EMS) MATCHING
GRANTAWARDS TO BE SUBMITTED TO THE STATE OF
FLORIDA DEPARTMENT OF HEALTH AND
REHABILITATIVE SERVICES.
WHEREAS, The Florida Department of Health and Rehabilitative
Services has announced that applications for funding County
Emergency Medical Services (EMS) Matching Grant awards are now
beingacceptedand a grant application has been prepared for Indian
River County; and
WHEREAS, an application for matching grant funds fiscal year
1992-93 has been prepared by the County; and
NOW, THEREFORE, BE IT RESOLVED BY THE BOARD OF COUNTY COM-
MISSIONERS OF INDIAN RIVER COUNTY, FLORIDA, that the Chairman is
authorized to sign and execute the application for matching grant
funds certifying that monies from the EMS Grant Program For
Counties will improve and expand the County's pre -hospital EMS
system and that the funds will not be used to supplant existing
County EMS budget allocations.
The foregoing Resolution was offered by Commissioner
Eaae t who moved its adoption. The motion was seconded
by Co, ssioner Scurlock and, upon being put to a vote, the
vote was as follows:
Chairman Richard N. Bird
Vice -Chairman Gary C. Wheeler
Commissioner Don C. Scurlock, Jr.
Commissioner Margaret C. Bowman
Commissioner Carolyn R. Eggert
Ape.
Aye--
..Aye
Aye
Aye
The Chairnnn thereupon declared the resolution duly passed and
adopted this day of ovember , 1991.
ATTEST:
Jeff
K. Har on, Clerk
e.
BOARD OF COUNTY COMMISSIONERS
INDIAN RI R COUNTY, FLORIDA
BY:
ichard N. Bird, Chairman
ID Code to be Assigned by State EMS Office: MI
Florida Department of Health and Rehabilitative Services
Office of Emergency Medical Services (EMS)
MATCHING GRANT APPLICATION
1.
Legal Name of
Agency/Organhation: Indian River County Emergency Medical Services
Name and Title of
GrantSigner: Richard N. Bird, Chairman Board of County Commissioners
Mailing 1840 25th Street
Address: Vero Beach, FL 32960 County: Indian River
Telephone Number: (407) 567-2154 SunCom Number. 224-1444
2.
Name and Title of
Contact Person: James A. Judge, Chief of Emergency Medical Services
Mailing 1840 25th Street
Address: Vero Beach, FL 32960
Telephone Number: (407) 567-2154 SunCom Number: 224-1444
3.
Legal Status of
Agency/Organization: Mink only ons)
Feiner Not for Profit (yrs mret Fervid' ow of eerdfiter)
Your (beau yam
10/1/92 9/30/93
1110111! NNW
_
Now for Profit XX yob
—
4.
Agency/Organization's Federal
Tax Identification Number digits VF 5 9 6 0
0 0 6 7 4
nine
S.
Application Status: (Mole air ewe)
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pegrare.
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XX This M as der eoinirwodoe of a molest shoofly ended by the WO DN! Reeding
6. Type of Project: (mak wily ens):
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Cwawrwi mieaa
lwegerrtr Tempest Whim — Pablo 1/wades
srrtr.1wMredeefQaeMrr Aetweao _ aeeeawb
Me/kaYlattww yaimmot (et mMem a "wiled hi aero IA sal Ne)
eemtuuMs Pesbmiewnl ldneartee (moMral dbumw tent dee arm 1!a)
Does few pejeet imbeds dao member" of my teamweloalMne 'grimmer/
6A. State Plan Goal, Objective, and Improvement and Expansion:
State EMS Plan Goal: Identifyis th. ice below th. epecifc Soli and ib pcss .umber is the l Y 1991-93 .tate
EMS plea, which your project ae help accomplish. Describe how you project addisree thio Seai.
Critical and Specialized Care 1.3 of the State Plan,
Medical Direction 2.3 of the State Plan (Priority 6):
Purchase computer hardware/software to facilitate Quality Assurance, data collection
and storage. Provide electronic data transfer from outlying EMS sub -stations
to the Emergency Mediae]. Services administrative office. Initiate the ability
to transfer the uniform prehospital EMS Run Report and Trauma Log information
to the State EMS/HRS office. Improve inventory control for all expendable supplies
and capital equipment. Safeguard critical personnel records. Provide the ability
to collect up -to -the minute statistical data.
(See Pages 3-9 of the State Plan Critical & Specialized Care)
(See Pages 22-24 of the State Plan Medical Direction)
State EMS Plan Objective: Ideetify boil. below th. sped Re objective sod Wimp umber WOO Mata phis,
which your project will help accomplish. Dewxibe bow your project will address thio objective.
Critical and Specialized Care 1.3 of the State Plan,
Medical Direction 2.3 of the State Plan (Priority 6):
Purchase hardware/software to comply with the up coming Statewide Data Collection
System. Enhance our Quality Assurance•program. Provide State EMS office with
mandated uniform prehospital run report elements and trauma registry data requirement
through electronic transfer.
(See Pages 3-9 of the State Plan Critical & Specialized Care)
(See Pages 22-24 of the State Plan Medical Direction)
Improvement and Expansion of Prehospital EMS. Describe in measurable terms, bow your project will bot
improve and expend prehospital EMS.
New computer hardware/software would allow current staff to improve and expand
the existing computer system, creating a network between the EMS sub -stations
and the central EMS office.
The expansion will allow management staff the ability to identify system deficits
and needed EMS staff training through an enhanced duality assurance program utilizinc
the computer network and the up-to-date information this network will provide.
Response statistics and data entry would be accomplished in a more cost/time effectii
manner with up -to -the minute EMS statistics. Equally important would be the ability
for improved inventory control of medical supplies and capital equipment.
1
6A. State Pian Goal, Objective, and Improvement and Expansion:
State EMS Pian Goal: Identify in the space below the specific goal and its page number ie the PY 1991-93 .sea
BMS plan, which your project will help accomplish. Describe bow your project addresses this pal.
Critical and Specialized Care 1.3 of the State Plan,
Medical Direction 2.3 of the State Plan (Priority 6):
Purchase computer hardware/software to facilitate Quality Assurance, data collection
and storage. Provide electronic data transfer from outlying EMS sub -stations
to the Emergency Medical Services administrative office. Initiate the ability
to transfer the uniform prehospital EMS Run Report and Trauma Log information
to the State EMS/HRS office. Improve inventory control for all expendable supplies
and capital equipment. Safeguard critical personnel records. Provide the ability
to collect up -to -the minute statistical data.
(See Pages 3-9 of the State Plan Critical & Specialized Care)
(See Pages 22-24 of the State Plan Medical Direction)
State EMS Pian Objective: Identify Wale belaw tbe.pecilia objective and its pap number hole stets plan,
which your project will help accomplish. Describe bow your project will address this objective.
Critical and Specialized Care 1.3 of the State Plan,
Medical Direction 2.3 of the State Plan (Priority 6):
Purchase hardware/software to comply with the up coming Statewide Data Collection
System. Enhance our Quality Assurance•program. Provide State EMS office with
mandated uniform prehospital run report elements and trauma registry data requirements'
through electronic transfer.
(See Pages 3-9 of the State Plan Critical & Specialized Care)
(See Pages 22-24 of the State Plan Medical Direction)
Improvement and Expansion of Prehospital EMS. Describe in measornbto terms, bow pour project will both
improve and opand prebospitat EMS.
New computer hardware/software would allow current staff to improve and expand
the existing computer system, creating a network between the EMS sub -stations
and the central EMS office.
The expansion will allow management staff the ability to identify system deficits
and needed EMS staff training through an enhanced quality assurance program utilizing
the computer network and the up-to-date information this network will provide.
Response statistics and data entry would be accomplished in a more cost/time effective
manner with up -to -the minute EMS statistics. Equally important would be the ability
for improved inventory control of medical supplies and capital equipment.
For both the need and outcome statements: include numeric data, the time frame for the data,
the data source, and the target population and geographic
7. Need Statamemt fuse omly the sQacm below)•• IRC EMS needs a time/cost effective
14,0000
method for current staff to compile run report data. EMS will respond to staistics
medical emergencies this year; all run report data and trauma registry/log
are entered into the computer by the EMS secretary. This information is required
to comply with the State HRS/EMS office. With the increase of mandated information
by the state office and the upcoming state wide run report and Q/A requirements,
a more cost/time effective method
thodefe orninputing information is needed to utilize
current staff in a more
S. Outcome Statement (use only the space below): With the purchase of eight (8)
computer work stations, a software package, additional computer memory and modems,
the EMS staff would be able to input all response information and trauma data
into the computer network system at each EMS sub -station and download to a central
location for interpretation and electronic transfer to the State HRS/EMS office.
Up -to -the minute statistical information would become readily available.
9. Research Projects Only:
B poo sea set serer a,,,,en% d,oj,st. slap Ms Om sari pts boo 10.
it per oto eoaaredag s mamas point. atm* M dotsod ri�e` ice. � a1/ �tapplication oesteloo stemma of tho h� Mom* w/M�. rieit
to wont Immo lobjred. sap ih itNba, books
i
10. Work Activities, Objectives and Time Frames (Use only 8M spew below):
Bid, purchase, install and network computer equipment within one to three months
after grant begins. Facilitate training for EMS staff utilizing the computer
equipment and software purchased.
•
CATEGORIES
APPLICANT
Pagtate
TOTS
1Nasti frigid
11. Salaries and Benefits:
a. New positions.
N/A
Do Na Writs
Is Thio Ana
Do Not welts
is This Am
Do Not Writs
Is This Mea
TOTAL EXPENSES
b. Existing/In-Kind Positions
Do Na Weil.
Is Ms Ana
Do Not Writs
Io Mb Ma
TOTAL SALARIES and BENEFITS
12. Expenses
a. New Expenses
N/A
Do Not Weir
la „yea
b. ing✓In-fid
Do Na Writs
Is Thio Ana
Do Not Writs
Is This Mea
TOTAL EXPENSES
/Aw
CATEGORIES
APPLICANT
kte
g
TOTAL
hh
1Ncc autch %rad
13. Equipment:
a. New equipment.
Do Noe write
Eight (8) Computer Work Stations
$8,000.00
Wilds Ares
$8,000.00
$16,000.00
Eight (8) Computer Modems
$2,400.00
s
$2,400.00
$ 4,800.00
Software Package
$ 200.00
The above figure
$ 200.00
$ 400.00
Increase Drive in File Server by
600 Megabytes
$1,500.00
must be equal
$1,500.00
$ 3,000.00
Technician setup costs x 8 work
stations
$ 520.00
Grand
$ 520.00
$ 1,040.00
b. Existing/In-Kind Equipment
Nun of the
pNc.d&ty twee
Taal
the cub mach
two Fiscally
Do Not Write
to Ibis Ana
Do Not Willa
la Thle Ares
coking
TOTAL EQUIPMENT COSTS
soles=
$12,620.00
$12,620.00
$25,240.00
14. Financial Summary - Total of saluies
and benefits, expenses, and equipment,
all combined.
$ 12,620.00
s
$12,620.00
$ 25240 00
Gab
The above figure
lite above evee
The above Bine
Match
must be equal
cwt equal the
must equal the
Grand
to or len than
the sun oldie
the
Nun of the
pNc.d&ty twee
Taal
the cub mach
two Fiscally
Orad Total
coking
soles=
Pate
15. Medical director's signatures: Skip this item if your project b not a Medical Rescue •
Equipment or Professional Education Project.
a. Professional Education
All continuing education described in this application is developed and conducted
with my input and approval.
Medical Director's Signature
Medical Director's Printed Name
Date
b. Medical Equipment Projects:
I hereby accept authority and responsibility for the use of Medica! Anti -Shock
Trousers (MAST), Esophageal Obturator Airways (EOAs) semi-automatic and automatic
defibrillators, AIS equipment identUled in Chapter 10D-66, F.A.C., and equipment not
identified in Chapter 10D.66, F.A.C.
Medical Director's Signature
Medical Director's Printed Name
Date
c. I hereby acknowledge that the applicant responds routinely to rescue or medical
incidents under written agreement with my licensed EMS system.
Nov. 13, 1991
Medical Director's or Authorized Person's Signature Date
Roger J. Nicosia, Jr. D.O.
Printed Name
APPLICATION ITEM 16 (signature required)
UEST FOR MATCHING GRANT DISTRIBUTION (ADVANCE PAYMENT)
EMERGENCY MEDICAL SERVICES (EMS)
Governmental Agency and Non-profit Entity ONLY
In accordance with the provisions of paragraph 401.113(2)(b). F.S.. the undersigned hereby requests an EMS matching
grant distribution (advance payment) for the improvement and expansion of prehospital EMS.
Payment To:
Indian River County Emergency Medical Services
Legal Name of Agency/Organisation
1840 25th Street
Vero Beach
(City)
Address
FL 3.7960
(State) (gip)
thorized Official
SIGNATURE: "DATE: //- / i •
Printed Name: Richard N. Bird
Title: Chairman
SIGN AND RETURN WITH YOUR MATCHING GRANT APPLICATION TO:
Department of Health and Rehabilitative Services
Office of Emergency Medical Services (HSTM)
EMS Matching Grants
1317 Winewood Boulevard
Tallahassee. Florida 32399-0700
Foe Vas Only by Deponent of Health and Rehabilitative $. vires,
Me of B+eerproy Medical Services
Matching Grant Amount:$ Grant ID Code:
Approved By: Date:
Signature. Title. State EMS Grant Officer
Stag Fiscal Year: Amounts $
Organization Codt
60-20-60-30-100
Las
HS
Obiect Cod*
Federal Tax ID V Ft
Grant Beginning Data: Ending Data:
17. ASSURANCES AND APPLICATION SIGNATURE (Applications without an appropriate signature
for this item will not be considered for funding):
Certification of Standards Statement
I, the undersigned, certify that if granted funds under Chapter 401, Part II, F.S.; as amended, all applicable regulations and
standards will be adhered to including: Chapter 401, F.S.; Chapter 10D-66, F.A.C.; Minimum Wage Act; Title VI of the
Civil Rights Act of 1964.(42 ISC 2000D et. seg.); DHEW Regulation (45 CFR Part 80); Rehabilitation Act (Sec 504);
Developmentally Disabled Assistance and Bill of Rights of 1975 (P.L. 95-602) u amended by Title V of the
Comprehensive Rehabilitative Services Amendments of 1978: Confidentiality; Human Rights; Habilitation Plana;
Employment of the Handicapped; Services for Persons Unable to Pay.
Statement of Cash & In-jCind Commitment
I, the undersigned, certify that cash and in-kind match will be available during the grant period and used in direct support
of this grant project. State and federal funds will not be used for matching requirements, unless specified by law. No costs
or third -party in-kind contributions count towards satisfying a matching requirement of a department grant if they are used
to satisfy a matching requirement of another state or federal grant. Cash, salaries, fringe benefits, expenses, equipment,
and other expenses u listed on this application shall be committed and used for the department's final approved project
during the grant period.
Acceptance of Terms and Conditions
Acceptance of the grant terms and conditions in Appendix C of the booklet, 'Florida Emergency Medial Services Matching
Grant Program 1992-93', by the Department of Health and Rehabilitative Services is acknowledged by the grantee when
funds are drawn or otherwise obtained from the grant payment system.
.11
I, the underigaed, hereby certify that the facts and information contained in this application and any follow-up documents
are true and correct to the best of my knowledge, information, and belief. I further understand that if it is subsequently
determined that this is not correct, the grant funded under Chapter 401, Part II, F.S.; Chapter 10D-66, F.A.C.; as amended
by Chapter 85-167, Laws of Florida, may be revoked, and any monies erroneously paid and interest earned will be
refunded to the department with any penalties which may be imposed by law or applicable regulations.
Notification of Awardj
I understand the availability of the notice of award will be advertised in the Florida Administrative Weekly, and that 30
calendar days after this Florida Administrative Weekly advertisement I waive any right to challenge or protest in anyway
the decisions to aw grants.
Signature of Authorized Grant Signer
(Individual Identified in Item 1)
/ /- i 9- 9/
Date
NOTE:
Please check to insure that all required signatures have been made for Items 15, 16, and 17.
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