ty of Troy

TROY CITY COUNCIL

COMMITTEE MEETING NOTICE
COUNCIL CHAMBERS, CITY HALL
100 S. MARKET STREET, TROY, OHIO

Monday, June 27, 2016, 6:00 PM

Personnel Committee
1.

Discussion of creation of fulltime Firefighter/Paramedic Lieutenant Position.

Other Committees/items may be added.

6-22-2016
Cc:

(Terwilliger [Chm.], Kendall, Twiss)

Mayor
Mr. Titterington
Mr. Kerber
Mr. Frigge
Department Heads
Chamber of Commerce
media

Troy, Ohio 45373

phone: (937) 335-1725/fax: (937) 339-8601
patrick .titterington@troyohio.gov

MEMORANDUM
TO:

Mrs. Baker, President of Council

FROM:

Patrick E. J. Titterington, Director of Public Service and Safety

DATE:

June 9, 2016

SUBJECT:

Creation of Fulltime Firefighter/Paramedic Lieutenant Position

'PEJT

RECOMMENDATION:
That City Council authorize the creation of an intermediate position between
Firefighter/Paramedic and Platoon Commander, called 'Paramedic Lieutenant,' at a salary
determined per Section 14.2 of the "Agreement Between City of Troy, Ohio and IAFF Local
1638, January 1, 2016-December 31, 2018" (henceforth, Contract).
JUSTIFICATION:
In 2015, the Novak Group completed a study and assessment of Fire Department staffing.
Among Novak's conclusions was that present staffing levels are sufficient to handle current fire
and EMS-related workload. However, the study also identified the need to dedicate a Safety
Officer on emergency scenes, as well as provide better staff training coordination.
A Paramedic Lieutenant position would also be responsible for researching, analyzing and
potentially coordinating the following additional assignments/duties:
Community Paramedicine
Increasing health care costs across the region, combined with changes in Medicaid/Medicare,
are forcing healthcare providers to evaluate the delivery of health services. Hospital systems are
working with EMS agencies to cultivate partnerships to help ensure the emergency room is
utilized more effectively. With recent Ohio law changes (ORC 4765.361, Performance of service
in non-emergency situations), the role of the Paramedic has changed to allow more functions in
the field for additional focused treatments at the scene. Community paramedicine adapts to the
specific needs and resources of each community. For your information, attached is a recent
article describing this concept. The Troy Fire Department has been in communication with
hospital systems to see how they can integrate this type of care. There may be opportunities to
integrate Community Paramedicine within current staffing levels, but additional research needs
to be completed to see how our department can effectively and efficiently provide this service.
Employee Health/Wei/ness Clinic
The City Administration has been researching the benefits of providing a health clinic for
employees as an alternative to emergency room, urgent care, or even primary care physician
visits in certain circumstances. Doing so could potentially lower the City's insurance rate

Request for Council Committee Assignment re Additional Fire Position

June 9, 2016 - Page 2 of2

inflation exposure by lowering our health insurance use and experience. ORC 4765.361 may
provide a better opportunity for our Paramedics to support a clinic.
Other Assignments/Duties
This position would also be responsible for:

1. evaluating alternatives to shift scheduling, assignments, and deployment;

2. analyzing current facilities, fleet, and equipment (current and future); and,
3. researching 'best practices' for increasing diversity in staff recruitment.
FINANCIAL IMPACT

Section 14.2 of the Contract requires that, in the event the City establishes a new intermediate
position below the rank of Assistant Chief but higher than Firefighter/Paramedic, the new salary
must be "within a range of 5% to 9% above the top firefighter base pay rate." That range,
annualized with estimated benefits, would be between $104,456.84 and $108,436.15. While the
2016 General Fund budget appropriation did not include those costs, the current General Fund
forecast can support this additional position. A future re-appropriation before the end of 2016
will be necessary to balance the Fire Department budget accounts.
REQUESTED ACTION:

Please assign to the appropriate City Council committee the request to authorize the creation of
the position of Paramedic Lieutenant in the Troy Fire Department, for the reasons stated above
at a salary level to be negotiated per the terms of Section 14.2 of the Contract. It is anticipated
that legislation would be presented for Council action after the final salary is negotiated.
attachment

cc:

Mayor Beamish
John Frigge, Auditor
Matt Simmons, Fire Chief
Josh Havenar, President IAFF Local 1638

http:Ucin.ci/lpzlSkA
[To be published Sunday, March 20, 2016]

Christ Hospital, local fire departments

launch house call pilot
Emilie Eaton, eeaton@enquirer.com 4:06p.m. EDT March 18,2016

(Photo: The Enquirer/Emilie Eaton)

EAST WALNUT HILLS - A new pilot partnership between Christ Hospital and six local fire
departments scheduled to launch in April will train paramedics to serve outside their customary
emergency roles as first responders.
Departments participating in the pilot include Cincinnati Fire Department, Colerain Township
Fire Department, Deerfield Township Fire Department, Miami Township Fire Department,
Monroe Fire Department and Jefferson Township Fire Department.
"We would be the gap fillers," said Larry Bennett, chair of the University of Cincinnati's Fire
Science and Emergency Management program, who is helping launch the pilot. "We would visit
patients who do not have in-home care."

The local pilot will start small, only serving Christ Hospital patients in select areas who have
congestive heart failure, but organizers hope it will eventually expand to partnerships with many
local hospitals.
If it does, there could be many benefits, advocates say. It could help connect resources to poor,
underserved communities, cut down on habitual 911 callers, and ultimately save taxpayers
money.
Community paramedicine is an emerging practice throughout the nation, with programs or
pilots in Monroe, Ohio, North Carolina, Colorado, Minnesota, Maine, and Texas. Depending on
the program, paramedics administer several different type of services while out in the
community, including:

Identifying frequent 911 callers and referring them to non-emergency, primary care
services.
Assessing each medical situation differently, instead of transporting patients to the
Emergency Room.
Providing follow-up care to people who just left the hospital.
Supporting patients with conditions like diabetes, asthma and congestive heart failure.
Referring poor, underserved populations to community health partners that provide health
services for free or at a minimal fee.

"It creates better health awareness," said Mark Johnston, EMS coordinator at Christ Hospital
who is helping launch the pilot.

On Monday, Bennett and Johnston will begin teaching a one-week course on community
paramedicine at the University of Cincinnati.
The course, which costs $1377 for non-matriculating students, will cover the foundations of
community paramedicine and mobile integrated health care. It will also discuss the opportunity
for partnerships and income opportunities.
Guest lecturers include Ohio Sen. Bill Seitz, R-Green Township; the assistant fire chief of Dallas
Fire Rescue Department; and leaders from United Way of Greater Cincinnati and the Talbert
House, a non-profit that helps people struggling with mental illness, addiction and homelessness.
Community paramedicine: An age-old idea

Community paramedicine is an emerging healthcare delivery model, but the idea has actually
been in existence since the early 1990s, according to a report by the University of Washington
School of Medicine.
One of the earliest known community paramedicine programs existed in Red River, New
Mexico. The closest hospital to the rural town was roughly a 40-mile, one-hour trip, according to
an article by Firehouse, a firefighting trade website.

In 1995, the New Mexico Senate passed an act that required the Department of Health to study
the idea of community paramedicine. Soon after, the Red River community paramedicine pilot
launched.
A later review of the program found many patients didn't use the program for primary care, but it
did reduce the number of times the ambulance went to the hospital by roughly 67 percent.
Bennett and Johnston said the idea of community paramedicine can be traced back even further,
to when doctors provided home visits. Later, when departments began training
firefighters as paramedics, paramedics played an important role in the community.
"Paramedics were designed to be the eyes and ears of the doctors in the community," Johnston
said.
In Ohio, the practice of community paramedicine is much newer.
Last year, Seitz introduced a bill that would allow paramedics and EMTs to perform services in
non-emergency situations. The bill passed and went into effect Oct. 1.
Soon after, the Monroe Fire Department launched a six-month trial program. The program was
one of the first in the state.
Getting the pilot project started
Before paramedics begin practicing community paramedicine in the Greater Cincinnati, a lot
needs to be done.
Each participating fire department has identified one firefighter it intends to be the county's
"community paramedic."
Beforehand, each paramedic will take a three-credit semester class that will teach the skills of
community paramedicine.
You may think that would be natural for someone with medical training, but Johnston said it is
not.
"Paramedics are used to asking yes or no questions," Johnston said. "Instead, we need to teach
them to communicate and ask questions like a doctor."
After paramedics complete the class, they will shadow an individual who is already practicing in
the community.
Each department's program will differ. They may roll them out at separate times, and they may
each serve a different number of patients, but Johnston and Bennett said they intend to encourage
the partners to collaborate.

And once paramedics do begin practicing in the community, Bennett wants to make one thing
clear: They will not be replicating other medical services. The program is designed to fill gaps not provide the same service as a private in-home care provider.
"We visit patients who do not have in-home care," Bennett said. "We want to work together."
Long-term benefits immense
Johnston and Bennett are starting small, but they can see the pilot expanding throughout the
regiOn.
They hope other local hospitals and medical centers will be interested in partnering, as Christ
Hospital has. A program like this doesn't really work without patient data on populations to
target.
Long term, the benefits could be immense.
For example, community paramedicine could reduce the steep costs associated with ambulance
transportation and emergency hospital care. A 201 0 Rand Corp. report found that between 14
and 27 percent of all emergency room visits were for non-urgent needs, costing taxpayers
roughly $4.4 billion.
It could also help poor, underserved populations, Johnston and Bennett said.
In 50-plus combined years in the fire service and EMT world, the two have found that lowincome neighborhoods often call 911 the most often because they don't have access to a primary
care doctor. In many cases, poor families aren't able to pay the ambulance or emergency care
bill, leaving that cost to taxpayers.
If a community paramedicine program was established, it could help address that problem.
It could also help connect poor communities to social services and local centers.
"This is a public service," Johnston said. "It will grow if we do it with well-trained medics."
IF YOU GO
What: A one-week community paramedicine course taught by Larry Bennett, chair of the
University of Cincinnati's Fire Science and Emergency Management program. There will be
dozens of guest speakers.
Where: Boy Scouts of America, 10078 Reading Road, Evendale and various locations
throughout the week.
When: 9 a.m. to 4 p.m. Monday to Thursday, and 9 a.m. to 3 p.m. Friday.

Who: Anyone can take the class.

Cost: The community is invited to attend the first day free-of-charge. The week-long course
costs $13 77 for non-matriculating students.
Deadline: Monday morning.
Register at onestop .uc.edulclasses.html.