HomeMy WebLinkAbout1999-068Ll
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3. Legal Status of EMS Organization (Check only one response).
(1) ❑ Private Not For -Profit (attach copy of IRS's 501 (c)(3) letter or other legal documentation of this status)
(2) ❑ Private For -Profit (3) ❑ City/Municipality
(4) ® County (5) ❑ State
4. Federal Tax ID Number: VF 5 9 6 0 0 0 6 7 4
5. Medical Director
I hereby affirm my authority and responsibility for
the use of all medical equipment and continuing
education in this activity.
(7 -
Medical Darecto
1 zt Date'
Rnvcr 1. Nicosia. Jr. DO NOS O(l(}_s)6 ---
Printed Name and FL Medical License No
FLORIDA DEPARTMENT OF HEALTH
EMS MATCHING GRANT APPLICATION
M (BENS to. Code)
Total Grant Amount
1. BCG or EMS Organization
:Indian River County Board of CouBU Commissioners
Authorized Official
:Kenneth R Macht -
Title
:Chairman
Mailing Address
:1840 251h Street
City
:Vero Beach
State
:Florida
Zip
:32960 - County: Indian River
Telephone
:(5611 567-8000 ext 490 (SC):
Email Address
2. Contact Person
:Jim Judge
Title
:EMS Chief
Mailing Address
:1840 25i1 Street
City
:Vero Beach
State
:Florida
Zip
:32960
Telephone
:(561) 567-2154 (SC):
Email Address
:ircesiiCa sune[ net
3. Legal Status of EMS Organization (Check only one response).
(1) ❑ Private Not For -Profit (attach copy of IRS's 501 (c)(3) letter or other legal documentation of this status)
(2) ❑ Private For -Profit (3) ❑ City/Municipality
(4) ® County (5) ❑ State
4. Federal Tax ID Number: VF 5 9 6 0 0 0 6 7 4
5. Medical Director
I hereby affirm my authority and responsibility for
the use of all medical equipment and continuing
education in this activity.
(7 -
Medical Darecto
1 zt Date'
Rnvcr 1. Nicosia. Jr. DO NOS O(l(}_s)6 ---
Printed Name and FL Medical License No
40
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PROJECT DESCRIPTION AND JUSTIFICATION
A 12 POINT FONT MUST BE USED OR LEGIBLE HAND PRINTING
6. State Plan: Brief synopsis and relationship to state plan goal, if applicable.
Not Applicable per Matching Grant Instruction Booklet.
Project Description/Justification: This is the NEED STATEMENT. Describe and justify the project.
Include (1) all available numerical data, time frame for the data, data source: (2) number of people
directly impacted by the grant(s); (3) whether the project will serve single municipality, county, multi
county, or regional area (4) whether the project will coordinate with other EMS organizations.
NEED STATEMENT: (use only the space provided)
The purpose of the Matching Grant is to increase existing levels of EMS on a countywide basis by
purchasing ten (10) Twelve Lead Monitor/Defibrillators. This equipment would allow for specific
prehospital treatment of an acute MI as determined by the area of infarct (Inferior vs Anterior) as
indicated by the diagnostic quality of the LifePac 12 units. This new equipment, along with our
cardiac alert program, will decrease the current door to drug time for thrombolytic administration with
the receiving physician presented with the diagnostic level 12 lead EKG strips upon arrival of the
patient. In addition it will improve overall patient care and heart monitoring on a countywide basis
with modern up-to-date diagnostic quality EKG equipment.
The following stats are for a SIX month period froth August 1, 1998 through January 31, 1999
4,674 Total Calls
2,778 Total ALS Calls
2,377 Total calls monitored for possible cardiac uysrltvttmua
1,169 Patients that were monitored with cardiac arrhythmias
The Indian River County Department of Emergency Services. Division of EMS, serves over 107,000
residents with four municipalities including numerous visitors, marry of whom are elderly and suffer
from cardiac and respiratory ailments. Having modern mechanisms for the care and treatment of
these patients, as well as providing up-to-date care through modern technology and efficient and
effective protocols; is of the utmost importance in providing excellent quality care for our citizens.
dib
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8. Outcome measurable: Degree to which need will be met or changed. ;Use only the space provided)
The outcome of this project will improve and expand EMS on a countywide basis by upgrading the
existing level of EKG equipment carried by all of the licensed ALS ambulances in the EMS Division.
These new LifePac 12's will reduce the need for high maintenance of older and out dated EKG units
currently in use and will increase the reliability and accuracy of the patient's EKG. LifePac 12s also
serve as a platform for other medical diagnostic equipment, i.e. SA02 monitors, ETCOZ monitors,
NIBP monitors and other technologies. It will provide patients and physicians with the most accurate
and up-to-date mechanisms for ALS cardiac care and patient monitoring. This new equipment will
allow for the ability to view more than one waveform at a time. The 4 wire lead selection allows the
ability to obtain readings in Leads I, II, III, AVR, AVL and AVF which when used by our
department's cardiac alert program spotlights Acute Myocardial Infarctions with early recognition and
proves to be a positive bonus for early detection. This option will be used with the Indian River
County Emergency Medical Services AMI protocol. It will also allow for a significant decrease from
door to drug time in thrombolytic administration from over 40 minutes to less than 10 minutes and
significantly improve prehospital medical care to cardiac as well as all monitored patients.
Additional improvements can be measured by an upgrade in service at one station and by adding EMS
service at a new location. The first station will go from a BLS first response to an ALS licensed
transport unit to be located at Emergency Services Station S and at the projected Emergency Services
Station 11 to be located on the north barrier island. Both locations will be staffed by Paramedics and
licenced ALS ambulances. Two of the ten LifePac 12s will be placed at these locations.
The tenth unit will provide all EMS staff with a training tool for use by the EMS training officer as
well as provide for a higher level of back up service for use at stand-bys and special events.
Work activities and time frames: Indicate procedure for delivery of project. (use only the space
provided)
Ten LifePacl2 units would be purchased within 90 days of grant approval. One month for staff
training on the new equipment with full implementation 120 days post approval. The entire EMS staff
has already completed the necessary 12 lead training :u facilitate the start of ilie program.
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10. BUDGET
CATEGORIES
APPLICANT
STATE
i TOTAL
MATCH
FUNDS
Expenditures
$
$
$
TOTAL EXPENDITURES
$
$
$
Equipment
(7) Twelve Lead Monitor/Defib-
ri11ator with pacer, carry case, pouch
$ 32,415.25
$ 97 ,245.75
$ 129,661.00
and battery support system (unit
cost of $18,523.00)
— Less Trade in Value of (7)
–8,575.00
–25.725.00
–34,300.00
current defibrillator
Total Cost to purchase equipment
$ 23,840.25
$71,520 75
$ 95,36'11.00
(3) Additional Twelve Lead
$ 13,892.25
$ 41,676.75
$ 55,569.00
Monitor/Defibrillator with pacer,
carry case, pouch and battery
I
I
SU pport system for Stations 8 and
11 and training/backup. (Unit cost of
$18.523.00)
—
TOTAL EQUIt'MEN 1 CO5 T S
$ 37,732.50
I $ 1 13.197 50
$ 150.930.00
GRAND TOTAL I $ 37,732.50 I $ 113,197.50 I r *50,93 0.00
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Item 11
FLORIDA DEPARTMENT OF HEALTH
EMS MATCHING GRANT PROGRAM
REQUEST for ADVANCE PAYMENT
(Governmental Agency and Not -for -Profit Entity Only) I
In accordance with the provisions of Section 401.113(2)(b), Florida Statutes, the undersigned hereby request
an EMS matching grant distribution (advance payment) for the improvement, expansion and continuation o
prehospital EMS.
Remit Payment To:
Name of EMS Organization :Indian River County Board of Countv Commissioners
Address :1840 25" Street
City :gnat.,.6
ach State: Florida Zip: 32960
Authorized Official 3
Date
Kenneth R. Macht. Chairman
Type Name and Title
Sign and return this page with your application to:
Florida Department of Health
GEMS Rural Matching Grants Program
2002 - D Old St. Augustine Road
Tallahassee, Florida 32301-4881
Do not write below tnis line For use by BEMS personnel only
I --
Matching Grant Amount for State to Pay: $ Grant ID. Code: M
Approved By:
i,
Signature & Title of BEiv1S Grant Officer Date
State Fiscal Year:
Organization Code
64-25-60-00-000
Federal Tax ID: VF
E.O. -bled Code
BU 7
OH Form 1767P. Effective Jan. 99. Revised Feb 99
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ASSURANCES
Item 12
PAYMENT FOR GRANT PROJECT: The grantee certifies, understands and accepts that due to state cash flow
and activity priorities, the grantee may not receive payment from the state for this activity until several
months after announcement of awards. The work activity time frames will be adjusted based on the date
payment is received, except the ending date of the grant will remain as specified in the Notice of Grant
Award letter.
STATEMENT OF CASH COMMITMENT: The grantee certifies that the cash match will be expended between
the beginning and ending dates of the grant and will be used in strict accordance with the content of the
application and approved budget for this activity. No costs count towards satisfying a matching
requirement of a department grant if also used to satisfy a matching requirement of another state or
federal grant. Cash, salaries, fringe benefits, expenses, equipment, and other expenses as listed in this
application shall be committed and used for the department's final approved activity during the grant
period.
ACCEPTANCE OF TERMS AND CONDITIONs: The grantee accepts the grant terms and conditions in the I
"Florida EMS Matching Grant Program Application Manual", and acknowledges this when funds are drawn I
or otherwise obtained from the grant payment system.
DISCLAIMER: The grantee certifies that the facts and information contained in this application and any
attached documents are true and correct. A violation of this requirement may result in revocation of the
grant, return of all funds and interest to the Department and any other remedy provided by law.
NOTIFICATION OF AWARDS: The grantee understands and accepts that the notice of award will be
advertised in the FAW, and that 21 days after this advertisement the grantee waives any right to
challenge or protest pursuant to Chapter 120, F.S.
MAINTENANCE OF IMPROVEMENT AND EXPANSION: The grantee agrees that any improvement, expansion or
other effect brought about in whole or part by grant funds, will be maintained for five years after the
activity ends, unless specified otherwise in the approved application or unless the department agrees in
writing to allow a change. Any unauthorized change within five years will necessitate the return of grant
i
, pinterest.
ATURE OF AUT ORIZED OFFICIAL (Individual Identified in Item 1) DATG
Chairman Board of County Commissioners
TITLE
DH Form 1767A. Effective Jan. 99, Revised Feb_ 99
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ESC RESOLUTION NO. 99- 06
A RESOLUTION OF THE EMERGENCY SERVICES
DISTRICT BOARD OF COMMISSIONERS, INDIAN RIVER
COUNTY, FLORIDA, AUTHORIZING THE APPLICATION
® FOR FUNDING COUNTY EMERGENCY MEDICAL
SERVICES (EMS) MATCHING GRANT AWARDS TO BE
SUBMITTED TO THE STATE OF FLORIDA DEPARTMENT
A OF HEALTH, BUREAU OF EMERGENCY MEDICAL
MSERVICES.
WHEREAS, The Florida Department of Health, Bureau of Emergency Medical
Services announced that applications for funding County Emergency Medical Services
(EMS) Matching Grant awards are now being accepted and a matching grant application
has been prepared for Indian River County; and
WHEREAS, an application for matching grant funds for fiscal year 1999/2000 has
been prepared by the County; and
NOW, THEREFORE, BE IT RESOLVED BY THE EMERGENCY SERVICES
DISTRICT BOARD OF COMMISSIONERS OF INDIAN RIVER COUNTY, FLORIDA, that
the Chairman is authorized to sign and execute the application for EMS matching grant
funds certifying that monies from the EMS Matching 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 Stanbridge who
moved its adoption. The motion was seconded by Commissioner G i nn and,
upon being put to a vote, the vote was as follows:
Chairperson Kenneth R. Macht Ayp
Vice -Chairperson Fran B. Adams Absent
Commissioner Caroline D. Ginn Aye
Commissioner Ruth Stanbridge Ave
Commissioner John W. Tippin Ave
The Chairperson thereupon declared the resolution duly passed and adopted this
16 - day of __ March 1999
ATTEST: EMERGENCY SERVICES DISTRICT
BOARD OF COMMISSIONERS
INDIAN RIVER COUNTY, FLORIDA
BY:
Jeffrey K. arton, Clerk enneth . M cht, hairperson