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Ambulance Equipment and Supply Costs

SOURCE: TAMPA BAY TIMES

What’s in a Sunstar ambulance and how much does it cost?

Pinellas County owns the Sunstar ambulance system, which is funded by the approximately $41 million in user fees collected each year. The county pays Texas-based Paramedics Plus about $21 million a year from those user fees to buy ambulances, fuel and service them, hire and pay paramedics and emergency medical technicians to staff the vehicles, and transport emergency medical calls.

The 74 ambulances in the fleet are owned by Paramedics Plus, but the county has the right to take them should the company default or leave the county.

Pinellas pays Paramedics Plus another $2.8 million a year to buy supplies, such as bandages and drugs, for the ambulances and fire department vehicles that are used for emergency medical services. Most of that — about $1.8 million a year — is used for the Sunstar ambulances.

But how much does it cost to put an ambulance on the road? About $182,731 for supplies, equipment and ambulance personnel. Add another $122,939 for the ambulance itself, the gas and other related costs. That’s about $305,670. And the county has up to 64 on the road at any one time.

DOUGLAS R. CLIFFORD | Times
Sunstar paramedic Bryan Findley , left, and emergency medical technician Trevor Jackson sit in the back of Sunstar ambulance unit No. 71, which is stocked with essential equipment and supplies.

Equipment and Supplies

 

Total: $161,016

Not shown: Temperature-controlled drug storage with contents, $1,694; EKG cabinet, $233; burn cabinet, $28; restraint cabinet, $265; pediatric cabinet, $432; IV cabinet, $269; action area, $287; airway bag, contents include portable oxygen, oxygen masks, other equipment, $747; Stryker stair chair, $2,305; scoop stretcher, $436; pediatric immobilizer, $182; Sager splint, $239; KED immobilizer ($112 each, two per ambulance), $224; head blocks ($4 per set, four sets per unit), $16; adult cervical collars ($4 each, four per vehicle), $16; portable suction unit, $480; EZIO intraosseous infusion system, $688; personal protective equipment kit, includes surgical masks, $24; blood pressure cuff, $11, and car seat, $147.
Total: $8,723

Electronics equipment not shown: Mobile data terminal and OMG gateway (wireless network), $4,782; road safety system, $3,195; Motorola mobile $4,071; and Motorola UF pagers ($472 each, two per unit), $944.
Total: $12,992.

Total contents: $182,731

 

Ambulance

A. AEV Chevrolet/GMC Trauma Hawk Ambulance. Cost $120,000
B. Striping/lettering. $2,000
C. Fuel, 50-gallon tank, $219 to fill up at current prices
D. Tires, $720

Total: $122,939.

Source: Paramedics Plus

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Austell, GA 30106

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EMS World Innovation Award Winner Operative IQ

Just-in-Time Stock Control

SOURCE: EMS WORLD MAGAZINE

Just-in-Time Stock Control

For every ambulance on the street there is a supply room, or store, somewhere containing equipment and possibly medications to fill up that vehicle when it returns from its run. The management of this store, whether it looks after one ambulance or 100, can be the cause of financial hemorrhage and litigation risk without tight logistics and operations management.

While preparation and planning is always encouraged, when it comes to expensive medical equipment and supplies, stock on the shelf represents hard cash. If such equipment and supplies spend their entire shelf lives on the shelf, then you might as well throw money away.

The key to good stock control is the creation of a system and processes that ensure efficiency and accountability are maintained at all times. After payroll, medical stock and equipment is the largest expenses an organization has to deal with, so constant attention is a must.

Where to Begin

To best manage your stock, you need to understand usage and flow from the store, or point of ordering, onto the ambulance or into the med pack, and how it is dispensed during the patient episode.

This understanding identifies the par, or stock level required to keep the organization moving. Moving is a key term, as analysis of stores consumed identifies items that move through the logistics system faster than others and consequently must be replenished more frequently.

Once the par is identified, the time it takes a supplier to go from order received to stock on the shelf must be factored in. Par levels may need to be adjusted or stores ordered once they hit a certain level in order to maintain system flow.

Having identified all of the above, a scientific approach to stock control can be adopted with the goal of having enough in stock to deal with normal operations, but not so much that you risk it going out of date before use. This process is known as “just-in-time supply.”

The Richmond Ambulance Authority (RAA) employs this system and can offer some best practices to aid both logistics management and stock flow.

Tracking Systems

When tracking supplies, using an electronic inventory management system enhances the ability to see what supplies are used most and how much money is spent in each individual category (e.g., oxygen, medical equipment, medical supplies and medications).

Such systems can be either bar code reader-based or radio frequency identification (RFID) systems. RAA employs a bar code system that reads directly into a central database that identifies stock usage against the par and stocks to be electronically ordered. If it is not practical to implement an electronic inventory management system, Excel spreadsheets are useful, particularly when trying to track expiration dates.

Moving Stock

The RAA system has identified that a week’s worth of fast-moving supplies (e.g., IV supplies, nonrebreathers, nasal cannulas, ECG pads and nebulizers) is required. Conversely, slower-moving stock (e.g., defibrillation pads, endotracheal tubes and decompression needles) can last 7–10 days before reorder. Do not overstock on these supplies; pay attention to expiration dates.

When ordering supplies, it is best to set aside a specific day of the week to place orders. This allows for a good working relationship between the EMS agency and its supplier. The supplier and its warehouse will know when to expect orders and what supplies are needed. This will help to avoid back orders. RAA’s logisticians set aside early Monday morning for placing supply orders, allowing the orders to be delivered by midweek (based on knowledge of delivery lag times). After the supplies are received, a midweek order is also placed.

High-Performance Logistics

Using a sealed-bin speed-loading system eliminates ambulances being over- or understocked and allows for consistency on each ambulance. Sealed bins are loaded by logistics staff by commodity or treatment (identified by logistics and vehicle-stocking standard operating procedures). Stores are heat-sealed into packs and placed on every ambulance in the same position, providing a uniformity that makes spot-checking easy. From an accountability perspective, as stock is taken from the storage area and sealed into bins, it is classified as used and the par level adjusted, which in turn cues reorder.

For the binning system to be successful, there has to be a level of trust between logistics and field personnel. Field personnel need to be confident that when they open their bins, everything that is supposed to be there is in fact there. The binning system is most successful when staff are dedicated to stocking the bins.

The sealed-bin system allows for the logistics department to successfully manage just-in-time stock control measures. Personnel dedicated to binning have the greatest knowledge about how fast supplies are used. Their knowledge of how quickly supplies move allows for accurate orders to be placed when in a nonautomated stock control system.

Leveraging External Relationships

It is important for EMS agencies to have strong working relationships with their local hospitals. Ask if it’s possible to rotate equipment through and/or have a one-for-one stock exchange. For example, if a nonrebreather, ECG pads and IV lock set are used on a patient, could those supplies be replaced on patient handover? Sign an agreement so both parties understand what is expected. There may also be a requirement to have a one-for-one stock exchange with first response agencies. If they use a nonrebreather, the transporting agency will give them a nonrebreather because it can then be replaced at the hospital. This allows the first response agency to maintain its bag and readiness.

Logistics staff serve a crucial role in ensuring smooth operations. RAA logistics staff not only clean and stock ambulances so they are ready for field crews, they also visit area hospitals and pick up equipment left by field crews after patent handovers. This equipment is brought back to logistics and cleaned prior to being placed back in service. This helps improve hospital turnaround times—crews aren’t tied up cleaning equipment. Each ambulance is deep-cleaned monthly. All bins are removed from the ambulance and replaced with fresh ones. Cabinets are emptied and wiped down. Floors are scrubbed with a heavy-duty cleaner. Logistics staff can also be used for lifting assistance, which avoids the need to take another ambulance or first response fire apparatus out of service.

Stores equal cash on the shelf. A just-in-time supply system keeps stock moving at the appropriate rate of both affordability and consumption.

Best Practices for Stock Control

Don’t overorder: Track what’s used most often and keep enough stock on the shelf for one week. This should provide enough time to place an order with your supplier and have items delivered.

Only order relevant stock: Don’t favor supplies or toys that are outside your EMS agency’s scope of practice. Your OMD can recommend what supplies and equipment work best.

Appoint a lead: Having one person in charge of ordering supplies avoids the potential for double orders or orders being missed.

Implement checks and balances: Check supplies regularly. Complete a thorough walk-through of all supplies needed at least once a week, although we recommend doing it twice.

Manage shelf stocking: When new supplies arrive, place them behind the old stock. This will rotate the stock that needs to be used before expiration.

Stay oxygenated: Sending unused O2 back in cylinders returned for refill is wasteful. Keep an eye on how often oxygen is being exchanged and set a standard for when it should be changed out. RAA uses 500 lbs. for the main oxygen and 700 lbs. for its portable oxygen. RAA is an inner-city system with relatively short transport times; rural system may want to allow for greater minimums.

EMS Technology Solutions, LLC
3771 Tramore Pointe Parkway, SW
Austell, GA 30106

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USA: 877-217-3707
Canada: 647-694-0150

EMS World Innovation Award Winner Operative IQ

Fire Captain Mandolini on Operative IQ Professional Services

Fire Captain Mandolini on Operative IQ Professional Services

When Operative IQ rolled out its Professional Services: Onsite Training, we were excited to see how much benefit customers would truly gain from the face-to-face training. As it turns out, there is a clear advantage to onsite training over traditional/virtual training. In a brief interview with Fire Captain Josh Mandolini of the Big Bear Fire Department in Big Bear Lake, California, the benefits of onsite training became apparent: Learning how the software can fit the agency’s needs, and the ability to go beyond “good enough”.

Are you guys fully live at this point?

“Yeah, we’re fully live.”

Awesome! Do you guys like it?

“So far, so good. We love it.”

Can you give me a brief description of some of the reasons why you guys chose Operative IQ and Professional Services Training?

“Well, it started out as we just wanted a way to track our assets, and at some point we decided we were going to start purchasing our own EMS supplies. We were previously being stocked by the hospital so once we took that over we had no idea what we annually spent on this or monthly spent on that. We were doing a bulk order here, a bulk order there and having no idea what was coming in or going out. We looked at some scanning software, and we just happened to hear about you [Operative IQ] at a trade show. Once we saw your software we said, “Uh, why would we even think about scanning software? It doesn’t even make sense.” So that’s kind of how it all evolved. Inventory became our priority, and it’s doing well for what we needed in that category.”

I’m glad it’s working out for you! What made you chose the onsite training service over the traditional training?

“I wanted to make sure that if we’re going to start, we’re going to start right and not mess it up. I didn’t want to come back 3 years from now and say, ‘we should have been doing it this way.”

Right. Using it how it’s meant to be used and getting the full benefit from it.

“Exactly”.

When you’ve purchased software in the past, was there training involved or were you pretty much on your own?

“It’s kind of hard to describe but it was just one guy running the show and he’s thinking, ‘Oh, this is how I would do it.’ And instead of talking to the people who actually designed the software and going, ‘how do people use it’ or, ‘how do you use it, how was it designed to be used?’ I think that’s more important. To actually understand how it was designed to be used and are we using it that way.”

Operative IQ is such a huge software, do you think that Onsite Training gave you the ability to customize it to match how you do your current processes?

“Honestly, I think if I were to compare Operative IQ to some of the other software we use around here, it’s is probably one of the more user friendly. It almost seemed like we really didn’t need the training once we got here. That was our initial thought.

Once we got Malia at the table and we were doing it, our guys had so many questions that it was obvious that we weren’t ready. They thought they were ready because the software is so easy to use. Sitting down with Malia, you be like, ‘Well, yeah, that is the simple way and that will work, but why would you not do it this way? Why would you not track expirations?’

The one guy being in charge of something and saying, ‘Well this works for me,’ but in reality he wasn’t using the whole software. I think that’s the benefit. We didn’t feel like we needed it because it was such an easy software to get running on by ourselves but I think we would have missed all the little fine details to truly understanding.”

Do you feel that the two days was enough? I understand that you guys purchased Fleet as well as Inventory Management.

“I definitely think we got our money’s worth. But I could see taking 3 more days with her. She kept on complimenting us, making it sound like we had done so much work prior to her getting here. We were feeling like we didn’t need her because we thought we had squared it all away.”

Having a trainer at your disposal is always a good thing to have.

“She came out and she did an awesome job. I definitely felt like she had our back. She was there for us. It went well.”

Did you feel that everything was addressed that you had questions or concerns about?

“Absolutely. When she came, we didn’t really think that we had anything to address. She brought more light to the software. Like, ‘Oh, this is what it is capable of.’ Being able to talk about it over the phone or looking at a PowerPoint we can see that it’s an awesome software but to actually see all the tiny little ins and outs and the way to line stuff up better and to have someone sit down right next to you and say, ‘ok this is how we’re doing it, this is how you set this up.’ That was beneficial.

If I had one more day, that one day would have been on reporting. That’s all it would have been. What kind of reports do we need? How do we set those up? And a step by step of how these little buttons work.”

If you guys add more of our features in the future, would you be interested in professional services again?

“I would recommend it to anybody. Unless you told me that something was coming, did you have anything in mind?”

There are always things coming! You said that you would definitely recommend us, and that’s great! Do you have any other comments or anything else you’d like to add?

“I definitely think it’s a great software. I think it leans toward fire service and lines up well with it. We do like it, and we do appreciate the support that came out to us.”

EMS Technology Solutions, LLC
3771 Tramore Pointe Parkway, SW
Austell, GA 30106

Contact Us

USA: 877-217-3707
Canada: 647-694-0150

EMS World Innovation Award Winner Operative IQ

Operative IQ’s Controlled Substance Tracking Receives Top Innovation Awards

 

Operative IQ’s Controlled Substance Tracking Receives Top Innovation Awards

EMS Technology Solution’s Controlled Substance Tracking module was recognized by EMS World magazine as a top innovation of 2014. The two awards, beautiful as they are gratifying, were presented to Operative IQ at an awards banquet during the EMS Today Conference in Baltimore.

EMS World recognizes new and innovative solutions specific to the Emergency Medical Services industry each year. The Top 25 Innovation candidates were selected by a board of EMS professionals.

This 2014 award marks the second year in a row EMS Technology Solutions has been recognized by EMS World for a top innovation. In 2013, EMS Technology Solutions was recognized for its Inventory and Asset Management application.

As a pioneer in the industry, EMS Technology Solutions continues to listen to industry feedback in order to establish new ways technology can assist first responders as they serve their communities.

Industry wide pleas for a better way to track controlled substances were loud and clear. EMS Technology Solutions responded with tracking software designed specifically for First Response professionals. Controlled Substance Tracking was developed to provide administrators the necessary visibility into their operation’s narcotic use, but it turned into so much more.

Released last July, this forward-thinking software enhanced narcotic tracking and management throughout the industry. Critical information is no longer forced to reside in multiple paper log books filled with illegible signatures. Time-consuming and often frustrating traditional reporting is replaced by advanced security features that allow for increased accountability and peace of mind.

Vial-specific information and transactions to include lot numbers and expiration dates, physical location, chain of custody, and finally administration details or destruction records make it easy to provide documentation to anyone at any time. Enhanced security features like the FBI endorsed biometric finger print readers and the ability to capture witness finger prints are united with true cradle-to-grave tracking making Operative IQ’s Controlled Substance Tracking the definitive narcotic tracking software.

EMS Technology Solutions, LLC
3771 Tramore Pointe Parkway, SW
Austell, GA 30106

Contact Us

USA: 877-217-3707
Canada: 647-694-0150

EMS World Innovation Award Winner Operative IQ

What Will Make You Great?

What Will Make You Great?

Football season is in full swing. As you cheer on your favorite team, imagining you’re the all-star quarter-back throwing the game winning pass with seconds left in the fourth quarter. Are you thinking about the guys protecting you on the front line?

Odds are you aren’t. You’re entirely focused on finding an open man in the in-zone and building the gusto to heave the pigskin 40 yards. Your eyes scan from man to man, and you begin to pull your tired, bruised arm back in anticipation. Your seasoned instinct alerts you to your waning protective front line, and the pressure becomes panic. Ah hah! You see your target in the end zone. As the line growls and bends, you fire a pass that will land you in the history books. Touchdown!

Now, we’ve all imagined ourselves in varied moments of greatness, but have you stopped to think, “what made it possible for us to become great?” Greatness, much like sports moments that change history, is neither innate nor learned. Greatness occurs in a perfect storm of opportunity and preparation.

As the quarter-back in leading your operation, when will you have your moment of greatness? With Operative IQ, it can happen sooner than you think.

Whether your team is a small community operation or a multi-station company, Operative IQ is your protection on the front line. From Inventory and Asset Management to Controlled Substance Tracking, Operative IQ’s intuitive operations management software offers all the protection EMS and Fire professionals need to form the perfect storm of opportunity and preparation.

How prepared are you for your opportunity of greatness?

Inventory supply requests sent directly from electronic check sheets, fleet issues reported from the road, and an unmatched narcotic tracking feature that will have you questioning how you ever stayed fully DEA compliant without it. In essence, Operative IQ prepares you and your operation for the big game. We’ve got you covered. Our training will coach you, and our support staff will guide you. Operative IQ is your winning team!

Contact Operative IQ to find out how great your operation can truly be.

EMS Technology Solutions, LLC
3771 Tramore Pointe Parkway, SW
Austell, GA 30106

Contact Us

USA: 877-217-3707
Canada: 647-694-0150

EMS World Innovation Award Winner Operative IQ

Lynchburg and Seattle: The latest cautionary-tales

Lynchburg and Seattle: The latest cautionary-tales

Suspected theft and internal diversion affected two operations last month adding to mounting evidence of inadequate controlled substance processes. It is becoming increasingly apparent that controlled substance diversion is an issue that demands to be addressed.

Levi Pulkkinen of SeattlePI, an investigative online newspaper, reported that “nine tampered vials (morphine) were found at Medic One stations” in Seattle and the surrounding area. In a second incident occurring in Lynchburg, VA, Eleanor Roy of the News and Advance, cited the theft of 273 vials of fentanyl. These recent events emphatically stress the need for increased controlled substance security on such a large scale that it is now painfully obvious that something beyond “safes of substantial construction” must be implemented.

It’s no secret that controlled substances play a complicated role in pre-hospital care. Acknowledged or not, a loophole in current security measures provide a potential opportunity for diversion. This potential diversion opportunity is facilitated by the inadequate tracking tools that quietly tangle the web of measures we once thought provided sufficient accountability and security.

Divergent risk does not discriminate between large, multi-branched organizations or small, “mom and pop” community operations. As illustrated by the events in Lynchburg, simply replacing a targeted narcotic with a different narcotic does little to change the divergent activity.

Once diversion is suspected, the first course of action is to review the chain of custody for that individual vial. Unfortunately, completing this process with multiple paper logs and absolutely no signature validity can prove daunting and frustrating. As in the case of Lynchburg, authorities were unable to target a suspect because they lacked a clear and accurate timeline of narcotic movement.

Divergent events regularly making headlines should provide the necessary incentive to avoid becoming the next “cautionary-tale”. Understanding and appreciating this great risk is critical to the success of all ALS capable crews and ultimately your operation. As a decision-maker in your operation and a leader in your community, you’ll do everything in your power to ensure a solid and credible name. Don’t add your company’s name to the already long list of investigated organizations.

What do you need to do to minimize risk and a secure a positive community presence?

1) Be Proactive.

Pushing it off until next year or reciting a mantra of, “it will never happen here”, will not suffice.

2) Contact Operative IQ.

Operative IQ’s Controlled Substance Tracking offers the industry’s only true cradle-to-grave record for every medication, giving you the upper hand in establishing accountability.

3) Rest Easy.

Know exactly who participated in each transaction with the certainty of biometric finger print validation, gain visibility across multiple safes, and limit access to these high risk areas.

In this age of advanced technology, your operation’s future does not have to hinge on undependable paper logs. Switch to a system that actually works to increase accountability and establish accurate record-keeping. Operative IQ’s controlled substance tracking arms you with a true cradle-to-grave view of every medication that will help put your medical director’s mind at ease.

EMS Technology Solutions, LLC
3771 Tramore Pointe Parkway, SW
Austell, GA 30106

Contact Us

USA: 877-217-3707
Canada: 647-694-0150

EMS World Innovation Award Winner Operative IQ