CITY COUNCIL AGENDA ITEM
ACTION REQUESTED:
title
Authorize the City Manager to increase the 2023 personnel headcount and hire an additional six full-time Firefighters/Paramedics (Item 1 of 2)
body
DEPARTMENT: Fire Department
SUBMITTED BY: Mark Puknaitis, Fire Chief
BOARD/COMMISSION REVIEW:
N/A
BACKGROUND:
The Challenge
The Naperville Fire Department (NFD) is experiencing an increase in calls for service in the areas of mental health and quality of life issues for senior citizens and residents with chronic illnesses/injuries.
Between 2020 and 2022, the number of EMS calls increased by 2,227.
|
Year |
# of Calls |
# of EMS Calls |
|
2020 |
14,170 |
9,868 |
|
2021 |
15,942 |
11,370 |
|
2022 |
16,859 |
12,095 |
Over that same time frame, EMS calls categorized as mental health and/or quality of life concerns increased by 299.
|
Year |
# of EMS Calls |
Calls Categorized as Mental Health/Quality of Life |
|
2020 |
9,868 |
3,006 |
|
2021 |
11,370 |
3,134 |
|
2022 |
12,095 |
3,305 |
Most of these types of calls do not require transport to a comprehensive hospital facility but do require a greater investment of time than a typical EMS call.
The chart below shows a rising trend of the length of time medic units are actively on a call for service (referred to as unit utilization).
|
Year |
Unit Utilization |
|
2020 |
13.1% |
|
2021 |
16% |
|
2022 |
17.7% |
Increasing unit utilization rates impact the availability of ambulances and have resulted in increased response times to calls as shown in the chart below.
|
Year |
% Target 6 min Response Time Achieved |
|
2019 |
87% |
|
2020 |
86.5% |
|
2021 |
86% |
|
2022 |
85% |
The Law
On August 25, 2021, Illinois Governor J.B. Pritzker signed the Community Emergency Services and Supports Act (CESSA) into law. This legislation recognizes that these types of calls need a response different from a traditional EMS emergency. CESSA requires emergency Public Safety Access Points (PSAPs) to dispatch the most appropriate responders - behavioral health mobile crisis teams, emergency medical technicians, and/or law enforcement - given the specific circumstances associated with the call.
Essentially, CESSA requires providers to deviate from the traditional model that leaves gaps in the continuity of care, to a community advocate response for low-level and low-risk behavioral health crises. The Act also requires 911 dispatchers and first responders to complete specific training, including but not limited to, use of de-escalation techniques and availability of community mental health services. Even with the training, Fire Department first responders will still function as firefighters and paramedics as authorized the Illinois Department of Public Health and the Office of the Illinois State Fire Marshal.
Funding
The Ground Emergency Medical Transportation (GEMT) Program is a voluntary program that allows publicly owned or operated emergency ground ambulance transportation providers to receive supplemental payments that cover the difference between a provider’s actual costs per GEMT transport and the Medicaid base payment, mileage, and other sources of reimbursement.
The Emergency Triage, Treat, and Transport (ET3) Model is a voluntary, five-year payment model. It is part of the GEMT Program and provides greater flexibility for ambulance teams to address emergency needs of Medicare beneficiaries.
The City of Naperville participates in the GEMT Program and, in June 2023, was notified that treat-no-transport/alternative destination costs would be reimbursed through ET3.
DISCUSSION:
NFD Response
In preparation for CESSA implementation, and to address the increased call volume in mental health and quality of life issues for senior citizens and residents, the NFD launched a Community Advocate Response Team (CART) pilot program in January 2022.
The pilot was made possible by reassigning three shift personnel to a 40-hour (Tuesday - Friday, 7 a.m. - 5 p.m.) work week and using existing technology, equipment, and a reserve ambulance.
The Findings
From the pilot, the NFD identified 119 residents who were calling 911 for their frequent health care needs. By applying a team approach and using social services, community, and non-profit resources the NFD was able to find appropriate health care solutions for all but 18 individuals.
Data collected during the pilot shows an average on-scene call duration of more than 60 minutes compared to an average of less than 20 minutes for all other call types, a gap in service from 5 p.m. - 7 a.m., and no service on Saturday, Sunday, and Monday. Having high unit utilization rates will impact the availability of ambulances as well as response time to calls.
The Recommendation
In order to address call and service findings from the pilot, the NFD is recommending the implementation of a 24/7 CART Program.
Because the current department operational numbers and staffing model do not allow for an efficient 24/7 CART Program response without an estimated $1,100,000 annual overtime expense, the NFD is also requesting the addition of six firefighter/paramedics.
Existing technology, equipment, and a reserve ambulance will support the program. Uniforms, bunker gear, and miscellaneous small equipment will be needed.
Given that the NFD participates in the GEMT Program and can seek reimbursement for treat-no-transport/alternative destination costs through ET3, the City of Naperville could realize estimated revenue in excess of 2024 costs.
FISCAL IMPACT:
The addition of six firefighter/paramedics would result in an estimated cost of $175,000 for 2023. This amount assumes that the six positions would not be filled until October, incurring only three months of salary and benefits in 2023. The estimated annual cost for an entire year in 2024 rises to $750,000 and increases annually as salary, benefit, and pension costs increase.
Through the first half of 2023, Fire Department expenses are trending in line with the budget and staff does not expect there to be capacity within the budget for this expense in the fourth quarter. Therefore, staff recommends that the 2023 annual budget be amended to accommodate this request.
A budget amendment is included as Item 2 of 2 of this request.