The Seven Regional EMS Agencies

A Growing Fiscal Crisis

EMS Act - 1981

Legislative Intent – “To provide the state with a statewide system for emergency medical services.”

(H&S Code 1797.1)

EMS Act - 1981

Requires each county to have a local EMS agency (LEMSA) to develop, implement and monitor the EMS system

EMS Act - 1981

To ensure EMS was provided throughout the state, not just in the urban pockets, the EMS Act, “Provides for special funding to multi-county EMS agencies (LEMSAs) which serve rural areas with extensive tourism to reduce the burden of providing the increased services due to that tourism.” (H&S Code 1797.108)

Responsibilities of The LEMSA:

Plan & Implement the EMS System Coordinate & Regulate EMS Personnel and

Resources Provide Local, Independent Medical Oversight

for the EMS System Set Local Medical Protocol and Policy Approve EMT & Paramedic Training Programs

& Continuing Education Issue State EMT Certifications

LEMSA Responsibilities (cont.):

Approve ALS Ground and Air Operations Designate Base Hospitals, Trauma Centers,

Specialty Centers Oversee Quality of Patient Care & Evaluate the EMS

System Develop EOAs, Ambulance Service Contracts, and

Trauma, Quality Improvement, Multi-Casualty / Disaster Plans

Resolve Local EMS System Issues

California Has 31 LEMSAs

24 Single County LEMSAs

7 Regional LEMSAs

The Seven EMS Regions include 58% of the Counties in California:

34 of 58 Counties are in EMS Regions 91% of the Counties with Less Than 100,000

Residents are in EMS Regions 93% of the Counties with Less Than 200,000

are in EMS Regions EMS Regions are Predominantly Rural /

Remote/ Wilderness Areas

Regional EMS Geography 101: The Seven EMS Regions Collectively Cover 66% of

the entire State of California

EMS Regions

Local County Agency

Combined Regional Static Population is Second Largest in the State

#1. Los Angeles County = 9.94 Million

#2. Seven Regions = 6.68 Million

#3. Orange = 2.97 Million

#4. San Diego = 2.93 Million

California Totals 35.89 Million Residents

Benefits of Multi-County Agencies (EMSA #104):

Reduced administrative and program costs Standardized system coordination of emergency

response and patient flow Focus on regional EMS development / concerns Sharing of limited EMS resources among multiple

counties More effective impact of smaller counties at the state

level Matching administrative boundaries with natural

response and patient flow systems

State Funding Eligibility for Regional EMS Agencies:

Rural multi-county agencies with heavy Non-Resident EMS system use

Three counties or more Matching funds of at least $1 for each state dollar

received (6 Regions); or, regions with less than 300,000 provide a cash match of $.41 per capita or more (1)

Delegation of specific H & S Code responsibilities by the contract counties

EMS Plan on file with the EMSA Must follow all state and federal statutes, regulations and

guidelines

State GF Funding for EMS Regions:

Formula is Based on # of Counties & Population 2007-08 Total Allocation = $ 2.42 Million Current # of Counties & GF Distribution:

– Nor Cal 11 22%– Central Cal 4 16%– SSV 5 15%– Mt. Valley 5 14%– Coastal 3 12%– ICEMA 3 12%– North Coast 3.3 9%

Is State Funding continuing to support the legislative Intent of

providing and maintaining a statewide EMS system?

State Support for Regions (1998 to 2007)

FY 1998-99 was the Last State General Fund Augmentation

Since 1998-1999 : - Basic Inflationary Costs have Increased 78%

WHILE:

- The State has Cut Regions 4% Annually since 2001

- Special Project Funds have been Completely Eliminated

State Funding for Regional & Local EMS Agencies

$0

$500,000

$1,000,000

$1,500,000

$2,000,000

$2,500,000

$3,000,000

$3,500,000

Rate of Inflation

State Funding

Block Grants

Combined Regional Workload Increase 1998-2007 = 114.6% (Estimated combined program Increase)

Ambulance Volume = +86% Certified Personnel = +25.5% Contracts = +114.5% EOAs = +462.5% Trauma Centers = +233.3% Training Programs = +65.8% New State/Regional Programs = +140%

In Addition:

Actual Operating Expenses Increased 80%

Local Funding for Regions has Increased 51% to try to offset the growing deficit

Regional staffing (FTEs) have only Increased 3.8%

The Regional Funding Crisis

-20%

0%

20%

40%

60%

80%

100%

120%

140%

1999

2000

2001

2002

2003

2004

2005

2006

2007

Year

Per

cen

t In

crea

se

Regional Workload

Regional OperatingCosts

Local Funds

Staff FTEs

State General FundsFor Regions

Why can’t local funding simply be increased to offset the growing deficit?

Regional funding requirements pursuant to H&S 1797.108 requires a dollar per dollar local match (50% / 50%). (Smaller counties were originally able to participate in a statewide EMS system because of this 1 to 1 match.)

Since 1998, local funding has continually increased in all regions while state funding has been reduced.

Current match:– Local - 73% – State’s 27%

Can county contributions and fees be further increased to off-set the growing deficit?

Fees: Fees (e.g. certification) have been increased to a maximum. Increasing fees beyond current levels will significantly reduce the number of responders (many of which are part-time volunteers) in the system and undermine the response system.

County Contributions: The majority of counties in EMS regions are small counties with limited tax bases relative to a small static resident population.

How does the state expenditure for Regions compare to other governmental agency per-capita expenditures?

Government Expenditure % Increase on a Per-Capita Basis Compared to Regional Per-Capita EMS Agency

Funding 1987 / 1997/ 2007

-40%

-20%

0%

20%

40%

60%

80%

100%

120%

140%

1987 1997 2007

Federal Per-CapitaExpenditure

US State/Local Gov.Per-Capita Expenditure

Calif. State Per-CapitaExpenditure

Inflation Rate

Regional Per-CapitaFunding

EMS Regions at the Cross Roads

State GF Dollars have Decreased Special Project EMS Funds have Dried Up Little or No Post 9-11 Disaster Funding

Available Fiscal Burden Shift to Local Sources has been

Maximized Operating Costs and Workload have Sky-

Rocked EMS Staff Size is Stagnant or Decreased

Well, it can’t get any worse can it?

Well, it can’t get any worse can it?

The state has proposed an additional

10% cut

in regional contributions for FY

2008/09!

A Failing State/Local Partnership?

The 1981 State Fiscal Commitment to Regional EMS has helped establish Advanced EMS Systems in most of the Rural Counties in California

The lack of continued commitment over the past ten years is placing Regional EMS Systems in jeopardy.

A State GF Regional Augmentation of $1.4 Million is Essential To:

Prevent Existing Regions from Weakening or Collapsing

Maintain Over 30 Years of Multi-County EMS System Continuity

Continue Administrative Cost Savings Ensure that 25 Rural Counties Maintain

Effective EMS Systems for Residents & Visitors

If EMS Regions Disappear Due to State Fiscal Cuts:

Established EMS Systems in Over 2/3s of the State and in 34 Counties will be Jeopardized

The Cost for Abandoned Counties to Continue EMS will Increase 3 to 4 Fold just for Minimal Services

Smaller Rural Counties will NOT be able to Support the Existing EMS Systems

Cost to the State will increase due to more LEMSAs Small County EMS Influence at the State Level will be

eroded Up to 6 million Residents and 10s of Millions of

Tourists will be Less Likely to Survive a Medical Emergency

Increased State Funding for Regional EMS Agencies:

Ensures Continuation of Effective EMS Systems throughout 2/3s of California

Maintains Multi-County Management of 9-1-1 Medical Emergencies, MCIs and Disasters in 34 of 58 Counties

Increases Chances of Surviving a Medical Emergency in the Majority of Rural Areas of the State

A additional10% Decrease in State Funding for Regional EMS Agencies next FY will result in:

An Immediate Reductions or Elimination of:– Public Information & Education Programs– System Monitoring (Training Programs, Ambulance Services, etc)

– Data Collection / Reporting / Analysis – Quality Improvement Programs– Training and C.E. Programs– Disaster / WMD Preparedness Planning / Drills

How Can You &/or Your Organization Help?

Join the Seven EMS Regions by writing

letters of support for long overdue

State General Fund Augmentation

Support for the EMS Regions is vital to the future of the

California EMS System!