HomeMy WebLinkAboutFD04-253 - Original - Seattle KC Dept of Public Health - Basic Life Support Services (EMS Levy) - 01/01/2003 4
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KENT Document
WASHINGTON
CONTRACT COVER SHEET
This is to be completed by the Contract Manager prior to submission to City Clerks Office. All
portions are to be completed, N you have questions, please contact Mary Simmons, City
Clerks Office.
Vendor Name: Seattle-King County Public Health Vendor Number
JD Edwards Number
Contract Number:
This is assigned by Mary Simmons
Description: Basic Life Support Services
Detail: Seattle-King County Department of Health/Emergency Medical Services BLS Levy
Project Name:
Contract Effective Date: 01/01/02 Termination Date: 12/31/07
Contract Renewal Notice (Days):
Number of days required notice for termination or renewal or amendment
Contract Manager: Linda Y. Mock Department: Fire
Abstract:
AUNif91 Revenue amended annually
S Public\RecordsManagement\Porrns\ContractCover\ADCL7B32 07102
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King County Contract No. D33049D
Federal Taxpayer ID No. j f_ 6 DOS�
Department/Division Seattle-King County Department of Public Health/Emergency Medical
Services Division
Agency Kent Fire Department
Project Title Basic Life Support Services
Fund Code Real Property Taxes
Contract Period From: January 1,2003 TO December 31,2007
KING COUNTY AGENCY SERVICES CONTRACT—EMERGENCY MEDICAL SERVICES
THIS CONTRACT is entered into by KING COUNTY(the"County'),and Kent Fire Department,whose
address is 24611 1 le Avenue SE,Kent,Washington 98031 (the"Agency").
WHEREAS,the County has been advised that the following is the current funding source and the effective
dates of such funding source:
FUNDING SOURCE EFFECTIVE DATES
Real Property Taxes 1/1/02—12/31107
and
WHEREAS,the County desires to have certain services performed by the Agency as described in this Contract,
and as authorized by Ordinance No. 14576.
NOW THEREFORE,in consideration of payments,covenants,and agreements hereinafter mentioned,to be
made and performed by the parties hereto,the parties covenant and do mutually agree as follows:
I. SCOPE OF SERVICES
The Agency shall provide services and comply with the requirements set forth in this Contract;in
accordance with the Proposed Budget Form(Exhibit 1)as approved annually by the Health Department,
and in accordance with Basic Life Support Standards(Exhibit 11).
The following attached exhibits are incorporated herein by reference:
® Scove of Services(Program Plan and Budget) Attached hereto as Exhibit I
® Basic Life Support Standards Attached hereto as Exhibit II
® Invoice Attached hereto as Exhibit III
® Mission.Method.and Expectations Attached hereto as Exhibit IV
® Certificate of Insurance Attached hereto as Exhibit V
D33049D:Kent FD
Basic Life Support Services Contract 1
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V. INTERNAL CONTROL AND ACCOUNTING SYSTEM
The Agency shall establish and maintain a system of accounting and internal controls which complies
with applicable,generally accepted accounting principles,and governmental accounting and financial
reporting standards.
VI. MAINTENANCE OF RECORDS
A. The Agency shall maintain accounts and records,including personnel,property,financial,and
programmatic records and other such records as may be deemed necessary by the County to ensure
proper accounting for all Contract funds and compliance with this Contract.
B. These records shall be maintained for a period of six(6)years after termination hereof unless
permission to destroy them is granted by the Office of the Archivist in accordance with Revised
Code of Washington(RCW)Chapter 40.14.
C. The Agency shall inform the County in writing of the location,if different from the Agency
address listed on page one of this Contract,of the aforesaid books,records,documents,and other
evidence and shall notify the County in writing of any changes in location within ten(10)working
days of any such relocation.
VII. EVALUATIONS AND INSPECTIONS
A. The Agency shall provide right of access to its facilities,including those of any subcontractor to
the County,the state,and/or federal agencies or officials at all reasonable times in order to monitor
and evaluate the services provided under this Contract. The County will give advance notice to the
Agency in the case of fiscal audits to be conducted by the County.
B. The records and documents with respect to all matters covered by this Contract shall be subject at
all times to inspection,review,or audit by the County and/or federal/state officials so authorized
by law during the performance of this Contract and six(6)years after termination hereof,unless a
longer retention period is required by law.
C. The Agency agrees to cooperate with the County or its agent in the evaluation of the Agency's
performance under this Contract and to make available all information reasonably required by any
such evaluation process. The results and records of said evaluations shall be maintained and
disclosed in accordance with RCW Chapter 42.17.
VIM CORRECTIVE ACTION
If the County determines that a breach of Contract has occurred,that is,the Agency has failed to
comply with any terms or conditions of this Contract or the Agency has failed to provide in any manner
the work or services agreed to herein,and if the County deems said breach to warrant corrective action,
the following sequential procedure will apply:
A. The County will notify the Agency in writing of the nature of the breach;
B. The Agency shall respond in writing within three(3)working days of its receipt of such
notification,which response shall indicate the steps being taken to correct the specified
deficiencies. The corrective action plan shall specify the proposed completion date for bringing
the Contract into compliance,which date shall not be more than ten(10)days from the date of the
D33049D:Kent FD
Basic Life Support Services Contract 3
C. If expected or actual funding is withdrawn,reduced,or limited in any way prior to the termination
date set forth above in Section II,the County may,upon written notification to the Agency,
terminate this Contract in whole or in part.
If the Contract is terminated as provided in this Subsection: (1)the County will be liable only for
payment in accordance with the terms of this Contract for services rendered prior to the effective
date of termination; and(2)the Agency shall be released from any obligation to provide such
further services pursuant to the Contract as are affected by the termination.
Funding or obligation under this Contract beyond the current appropriation year are conditional
upon appropriation by the County Council of sufficient funds to support the activities described in
the Contract. Should such appropriation not be approved,this Contract will terminate at the close
of the current appropriation year.
I
D. This Contract may be terminated by the Agency without cause,in whole or in part,prior to the
date specified in Section II,by providing the County one-year advance written notice of the
termination.
E. The Agency may terminate this Contract upon seven(7)-days written notice,should the County
commit any material breach of this Contract. If the Contract is terminated by the Agency pursuant
to this subsection,the County shall be liable for damages caused to the Agency as a result of the
breach.
F. Nothing herein shall limit, waive,or extinguish any right or remedy provided by this Contract or
law that either party may have in the event that the obligations,terms,and conditions set forth in
this Contract are breached by the other party.
M. FUTURE SUPPORT
The County makes no commitment to support the services contracted for herein and assumes no
obligation for future support of the activity contracted herein except as expressly set forth in this
Contract.
XH. HOLD HARMLESS AND INDEMNIFICATION
A. In providing services under this Contract,the Agency is an independent Contractor,and neither it
nor its officers,agents,or employees are employees of the County for any purpose. The Agency
shall be responsible for all federal and/or state tax,industrial insurance, and Social Security
liability that may result from the performance of and compensation for these services and shall
make no claim of career service or civil service rights which may accrue to-a County employee
under state or local law.
The County assumes no responsibility for the payment of any compensation,wages,benefits,or
taxes by,or on behalf of the Agency,its employees,and/or others by reason of this Contract. The
Agency shall protect,indemnify,and save harmless the County,their officers,agents, and
employees from and against any and all claims, costs,and/or losses whatsoever occurring or
resulting from(1)the Agency's failure to pay any such compensation,wages,benefits,or taxes,
and/or(2)the supplying to the Agency of work,services,materials,or supplies by Agency
employees or other suppliers in connection with or support of the performance of this Contract.
D33049D:Kent FD
Basic Life Support Services Contract 5
For All Coverages: Each insurance policy shall be written on an"occurrence"form;except that
insurance on a"claims made"form may be acceptable with prior County approval.
If coverage is approved and purchased on a"claims made"basis,the Agency warrants
continuation of coverage,either through policy renewals or the purchase of an extended discovery
period,if such extended coverage is available,for not less than three years from the date of
Contract termination,and/or conversion from a"claims made"form to an"occurrence"coverage
form.
By requiring such minimum insurance,the County shall not be deemed or construed to have
assessed the risks that may be applicable to the Agency under this Contract. The Agency shall
assess its own risks and,if it deems appropriate and/or prudent,maintain greater limits and/or
broader coverage.
Nothing contained within these insurance requirements shall be deemed to limit the scope,
application and/or limits of the coverage afforded, which coverage will apply to each insured to
the full extent provided by the terms and conditions of the policy(s). Nothing contained within this
provision shall affect and/or alter the application of any other provision contained within this
Agreement.
B. Minimum Scone of Insurance
Coverage shall be at least as broad as:
1. General Liability:
Insurance Services Office form number(CG 00 01 Ed. 11-88)coveringCOMMERCrAL
GENERAL LIABILITY).
2. Professional Liability:
j Professional Liability,Errors,and Omissions coverage. In the event that services delivered
pursuant to this Contract either directly or indirectly involve or require professional services,
Professional Liability,Errors,and Omissions coverage shall be provided. "Professional
Services",for the purpose of this Contract section,shall mean any services provided by a
licensed professional.
3. Automobile Liability:
In the event that services delivered pursuant to this Contract involve the transportation of
clients by Agency personnel in Agency-owned vehicles or non-owned vehicles,the Agency
shall provide evidence of the appropriate automobile coverage.
Insurance Services Office form number(CA 00 01 Ed. 12-90)coveringBUSINESS AUTO
COVERAGE, symbol 1 "any auto";or the appropriate coverage provided by symbols 2,7, 8,
or 9.
D33049D:Kent FD
Basic Life Support Services Contract 7
2. All Policies
Coverage shall not be suspended,voided,canceled, reduced in coverage or in limits,except by
the reduction of the applicable aggregate limit by claims paid,until after forty-five(45)days
prior written notice has been given to the County.
F. AccMigbilfty of Insurers
Unless otherwise approved by the County,
Insurance is to be placed with insurers with a Bests'rating of no less than A:VHI,or,if not rated
with Bests,with minimum surpluses the equivalent of Bests' surplus size VIII.
Professional Liability,Errors,and Omissions insurance may be placed with insurers with a Bests'
rating of B+VII. Any exception must be approved by King County.
If,at any time,the foregoing policies shall be or become unsatisfactory to the County,as to form
or substance,or if a company issuing any such policy shall be or become unsatisfactory to the
County,the Agency shall,upon notice to that effect from the County,promptly obtain a new
policy,and shall submit the same to the County,with appropriate certificates and endorsements,
for approval.
G. Verification of Coverage
The Agency shall furnish the County with certificates of insurance and endorsements required by
this Contract. The certificates and endorsements for each insurance policy are to be signed by a
person authorized by that insurer to bind coverage on its behalf. The certificates and endorsements
for each insurance policy are to be on forms approved by the County prior to the commencement
of activities associated with the Contract. The County reserves the right to require complete,
certified copies of all required insurance policies at any time.
H. Subcontractors
The Agency shall include all subcontractors as insureds under its policies or shall famish separate
certificates of insurance and policy endorsements from each subcontractor. Insurance coverages
provided by subcontractors as evidence of compliance with the insurance requirements of this
Contract shall be subject to all of the requirements stated herein.
I. Municipal or State Agency Provisions
If the Agency is a Municipal Corporation or an Agency of the State of Washington and is self-
insured for any of the above insurance requirements,a certification of self-insurance shall be
attached hereto and be incorporated by reference and shall constitute compliance with this section.
XIV. NONDISCRIMINATION
The Agency shall comply with all applicable federal,state and local laws regarding discrimination.
D33049D:Kent FD
Basic Life Support Services Contract 9
• Utilizing the services of available minority community organizations,minority
contractor groups,local minority assistance offices,the County,and other
organizations that provide assistance in the recruitment and placement of M/VVBEs.
E. Any violation of the mandatory requirements of the provisions of this Section shall be a material
breach of contract for which the Agency may be subject to damages and sanctions provided for by
contract and by applicable law.
XVI. CONFLICT OF INTEREST
A. The Agency covenants that no officer,employee,or agent of the County who exercises any
functions or responsibilities in connection with the planning and implementation of the program
funded herein,or any other person who presently exercises any functions or responsibilities in
connection with the planning and unplementation of the program funded herein shall have any
personal financial interest,direct or indirect,in this Contract. The Agency shall take appropriate
steps to assure compliance with this provision.
B. If the Agency violates the provisions of Subsection XVI.A.,the County will not be liable for
payment of services rendered pursuant to this Contract. Violation of this Section shall constitute a
substantial breach of this Contract and grounds for termination pursuant to Section X. above,as
well as any other right or remedy provided in this Contract or law.
XVH. POLITICAL ACTIVITY PROHIBITED
None of the funds,materials,property,or services provided directly or indirectly under this Contract
shall be used,directly or indirectly,for the purpose of assisting a campaign for election of any person to
any office or for the promotion of or opposition to any ballot proposition.
XVM. EQUIPMENT PURCHASE,MAINTENANCE,AND OWNERSHIP
A. The Agency agrees that any equipment purchases,in whole or in part,with Contract funds at a cost
of$1,000 per item or more,when the purchase of such equipment is reimbursable as a Contract
budget item,is upon its purchase or receipt the property of the County and/or federal/state
government.
B. The Agency shall be responsible for all such property,including the proper care and maintenance
of the equipment;provided,however,that the County agrees that the Agency shall not be liable for
the normal wear and tear of such equipment.
C. The Agency will ensure that all such equipment will be returned to the County or federal/state
government upon termination of this Contract unless otherwise agreed upon by the parties.
D. The Agency will admit County staff to the Agency's premises for the purpose of marking such
property with County property tags.
E. The Agency shall establish and maintain inventory records and transaction documents(purchase
requisitions,packing slips,invoices,receipts)of equipment purchased with Contract funds.
D33049D:Kent FD
Basic Life Support Services Contract 11
N IIV. SERVICES PROVIDED IN ACCORDANCE WITH LAW AND RULE AND REGULATION
The Agency and any subcontractor agree,when applicable,to abide by the terms of Washington State
law and rules and regulations promulgated thereunder,the Basic Interagency Contract between the
Department of Social and Health Services and King County, as amended,and regulations of the state
and federal governments,as applicable,which control disposition of funds granted under this Contract,
all of which are incorporated herein by reference.
In the event that there is a conflict between any of the language contained in any exhibit or attachment
to this Contract, the language in the Contract shall have control over the language contained in the
exhibit or the attachment,unless the parties affirmatively agree in writing to the contrary.
KING COUNTY KENT FIRE DEPARTMENT
'i ,
FOR
King County utive Si Lure
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Date—� Name(Please type or print)
Date
Approved as to Form:
OFFICE OF THE KING COUNTY
PROSECUTING ATTORNEY
February 25,2003
D33049D:Kent FD
Basic Life Support Services Contract 13
EMERGENCY MEDICAL SERVICES FUNDS
2003 PROPOSED BUDGET FORM - BASIC LIFE SUPPORT SERVICES
Applicant Agency City of Kent/King County Fire Prot. Dist. #37
Agency Service Area(s) East Kent city limits. North border is SE 192nd, east border is
188th Ave SE and the City of Covington City Limits. South border is SE 288th, Kent WA
Contact Person _ Al Bond Title Battalion Chief/EMS Officer
Address
24611 116th Ave SE
Kent WA 98030 Phone 253.856.4300
Amount Reauested
Budget Category in 200 *
A. Personnel
1. Salaries & Benefits ** $ 695,520
2. Per Shift Payments
(list rate per shift) -
3. Per Call Payments
(list rate per call)
B. Supplies (itemized on separate sheet) 219317
C. Eauioment (itemized on separate sheet) 11,720 D. Support Service (itemized on separate sheet)
E. Total EMS Funds Allocated by King County EMS
in 2003 (Please refer to the attached funding 728,557
allocation) --
*Please list only total amount of requested funds by category on this
page. Attach itemized list of proposed expenditures if you are
requesting funds for supplies, equipment, or support services.
**Attach explanation of how requested funds for salary and benefits
were calculated and how they will be used in accordance with the
expenditure guidelines.
An agency may request BLSS funding for that portion of salaries and
benefits that can be attributed to EMS (% aid calls out of total fire
and aid calls) up to the BLSS allocation for that agency. Show Ws
and total salary/benefit budget used to derive BLSS request.
EXHIBIT 1
2003 PROGRAM PLAN AND PROPOSED BUDGET
I. Identification Information
A.- Name and number of Fire Protection District or Fire Department:
City of Kent/Xing County Fire Prot. Dist. #37
B. Name of Chief: Jim Schneider
Mailing Address: 24611 116th Ave SE
Kent WA 98030
C. Name of EMS Coordinator (and Training Coordinator if different):
Al Bond Telephone No. 253.856.4300
Dale Robertson Telephone No. 253.856.4331
D. Location: manned or unmanned status of all fire stations in your
department of district; location of aid vehicles. Include the
address of each station (use other side if necessary)_
Defib No. EMS Response No. & Tyne Fire
Address - Unit Status Vehicles at Location Vehicles at Location
1. Station # 71a X Full Time X 1 In Service 1 Engine/Aid
504 W Crow St Part Time/yoi - -rA�Yulaacls-
Kent WA 98032
2. Station # 72 X Full Time X 1 In Service 1 Engine/Aid
25620 140th Ave SE Part Time/
Vol 1 Tender
Kent WA 98042
3. Station # 73 X Full Time-A- _L Ina,Seryice 1 Engine/Aid
Part Time/ l Engine/Aid (reserve)
26512 Military Rd. So. Vol 1 Engine/Aid (reserve)
1 Mobile Command (reserve)
Kent WA 98052 1 Ambulan P (reserve)
4. Station # 74 X Full Time x 1 In Service 1 Engine/Aid
Part Time/ 1 In ServiceI Ambuiance
24611 116th Ave SE Vol 1 In Service 1 Ladder
n Service I Commanda is e
Kent WA 98030 1 In Service 1 Air Vehicle
*Include aid units as well as fire apparatus, command cars, rescue units, etc.
STATIONS PLANNNED for construction in 2003 Address
Status
Vehicles
ADDRESS DEFIB UNIT STATUS AID VEHICLES FIRE VEHICLES
Station#75 XX Full Time 1 In Service 1 Engine/Aid Vehicle
15635 SE 272°d 1 Reserve 1 Engine/Aid Vehicle(reserve)
Kent WA 98042 1 Aid(reserve)
1 MCI Vehicle
1 Air Vehicle
Station#76 XX Full Time 1 In Service 1 Ladder(reserve)
20676 71"Ave So. 1 Engine/Aid Vehicle
Kent WA 98032 1 Haz Mat Unit
2 EnghWAid(reserve)
Station#77 XX Full Time 1 In Service 1 Engine/Aid Vehicle
20717132ed Avo Se 1 Engine(reserve)
Kent WA 98031
NOTE: All of our engine/aid vehicles,as well as one of our ladder units,are licensed as aid units by D.S.H.S. We
have nine(9)licensed aid units and four(4)licensed ambulances.
Exhibit 1
2003 Program Plan and Proposed Budget
Page 2
E. Agency Response Information
Number of fire suppression responses in 2002 705
Number of EMS aid responses in 2002 9200
Total number of responses in 2002 12,895
Percent aid responses of total responses 71%
II. Relationships With other EMS Agencies
A. Specify location of transfer points with paramedic provider groups
if applicable:
Exhibit 1
2003 Program Plan and Proposed Budget
Page 3
III. Personnel
A. Number of full-time paid fire fighters 149 of which
128 are EMT's and 0 are First Responders.*
B. Number of volunteer fire fighters -0- of which
-0- are EMT's and -O are First Responders.*
C. Number of personnel currently trained in defibrillation _ 129
Automated External Defibrillator Certified 20
Manual Defibrillator Certified 109
* Certified as First Responders by State of Washington
IV. EMT Defibrillation Program
MEDTRONIC PHYSIO CD .
A. Number and type of defibrillator units 12 - LIFE PACK 121S Manual
B. Location of defibrillation equipment (address) ALL STATIONS, TRAINING CENTER AND
and a AED located on the Shift -Commanders vehicle.
C. Unit numbers of aid vehicle(s) usually carrying defibrillation equipment
-- (use_number-(s-)_recorded when -completing EMS Medical_ Incident Reporting
Form). 57 - All first line apparatus carry a life pack
V. Budget
The EMS Division is seeking to collect information that documents total fire
department expenditures for emergency medical services. We are also requesting
each fire department to report its total operating budget for the year. In
order that the information be consistent, please exclude from these totals
major capital expenditures including vehicles and buildings, and monies
earmarked for bond payments, etc.
A. Estimated total EMS budget for 2003 S 1 ,4780319
of which S 728,557 is provided by EMS funds.
B. Total fire department or fire district S 16,929,521
budget for 2003.
Exhibit 1
2003 Program Plan and proposed Budget
Page 4
VI. fees for Services
A. Does your department charge for providing emergency services?
Yes No y
B. If yes, please provide a list of charges below.
VII. Service Improvements/Changes
Please describe how EMS funds will be used by your department
in 2003 to improve services to the citizens of King County.
To supplement total EMS budget to maintain quality and timely
delivery of EMS in the face of increasing deman4,for services and budget reductions,
With local funds we will cover the remaining costs of the total EMS budget.
0
BLS Provider Date
Alonzo Plough, Director and Health Officer Date
Department of Public Health
ITEMIZED LIST OF PROPOSED EXENDITURES FOR SUPPLIES AND EQUIPMENT
2063 BASIC LIFE SUPPORT SERVICES -EMERGENCY MEDICAL SERVICES FUNDS
APPROX
CATEGORY ITEM COST
EQUIPMENT BACKBOARDS $2,500.00
EQUIPMENT BP CUFFS $500.00
EQUIPMENT CYLINDER REQULATOR GUAGES $1,000.00
EQUIPMENT DISP.BAG VALVE MASKS $800.00
EQUIPMENT KED'S $720.00
EQUIPMENT OXYGEN CYLINDERS $1,000.00
EQUIPMENT RING CUTTER $200.00
EQUIPMENT SCOOP STRETCHER $1,500.00
EQUIPMENT STETHESCOPES $500.00
EQUIPMENT SUCTION UNITS $1,000.00
EQUIPMENT TRACTION SPLINTS $2,000.00
TOTAL EQUIPMENT $11,720.00
SUPPLY BANDAIDS $100.00
SUPPLY BB STRAPS $1,000.00
SUPPLY BLANKETS $1,000.00
SUPPLY BLS TRAUMA PACKS $500.00
SUPPLY BURN SHEETS $300.00
SUPPLY CANNULAS/TUBBING $1,500.00
SUPPLY COLD/WARM PACKS $800.00
SUPPLY CPR MICRO SHIELDS $500.00
SUPPLY ECG PRINTER PAPER $1,000.00
SUPPLY ELECTRODES $1,500.00
SUPPLY EXTRACATIONGO 1� ARS__ $2,200.00
SUPPLY GAUZE $700.00
SUPPLY GAUZE PADS $500.00
SUPPLY GLOVES $4,217.00
SUPPLY IPECAC $50.00
SUPPLY LIFE PAK BATTERIES $1,000.00
SUPPLY OB KITS $100.00
SUPPLY OXYGEN CYLINDERS $1,000.00
SUPPLY PENLIGHTS $300.00
SUPPLY PILLOWS $200.00
SUPPLY SCISSORS $200.00
SUPPLY THERMOMTERS $150.00
SUPPLY TRAUMA DRESSINGS $500.00
SUPPLY TRIANGULAR BANDAGES $500.00
SUPPLY TYVEK JUMPSUITS $500.00
SUPPLY VENT KITS $500.00
SUPPLY WATERPROOF TAPE $500.00
TOTAL SUPPLIES $21,317.00
I
EXHIBIT II Contract# D33049D
KING COUNTY EMERGENCY MEDICAL SERVICES
Basic Life Support Standards
Agencies shall comply with the following standards in order to be eligible for basic life support
services funding from King County. Failure to comply with the standards adopted by King County
pursuant to Chapter 2.26 of the King County Code or by the County Medical Program Director
pursuant to Chapter 18.73 RCW,shall be sufficient grounds for notification,remediation, and
possible termination of funding.
Review and modifications of BLS standards may be conducted on an annual basis. Proposed
changes will be submitted to the Emergency Medical Services Advisory Committee and local
provider agencies for advisory comment prior to implementation.
I. Personnel: All emergency medical services personnel supported directly by King County
funds must be certified as Emergency Medical Technicians ad defined by RCW 18.73.
Basic EMT training standards have been established by King County Emergency Medical
Services.
II. Continuine Medical Education: EMTs will remain certified as required by WAC 246-
976. Continuing Education and proficiency standards will be set by King County
Emergency Medical Services and the Medical Program Director. Agencies must report
completion of education and skill proficiency updates to King County Emergency Medical
Services in an agree upon summary format.
III. Medical Standards: Each agency providing emergency medical services shall adhere to
standards of medical care for the triage,treatment and transport of patient as authorized by
the Medical Program Director pursuant to RCW 18.73 and 18.71, and Chapter 2.26 of the
King County Code. Standards of medical care are delineated in the King County EMS
training curriculum approved by the Washington State Department of Health,"Patient Care
Guidelines for Basic Life Support", and in the 1996, 1997, 1998, 1999, and 2000
Competency Based Training(CBT)modules. Additional CBT modules will continue to be
issued annually. CBT modules may also be offered by the EMS Division electronically via
Internet access.
a. Scope of Practice: Evaluation and treatment activities by EMTs from provider agencies
not described in the standards of medical care are deemed outside the scope of practice.
Changes or additions to this scope of practice will be issued periodically by the Medical
Program Director.
b. Record Keeping and Record Submission: The Medical Incident Report Form (MIRF)
must be completed as soon as possible following an incident. These reports should them
be submitted to King County Emergency Medical Services, either electronically or by
mail, within 30 days from the date the incident occurred. Agencies will be responsible
for retention of copies of the reports.
c. Transportation Policy: Each provider will be responsible for developing a policy for
the transport of patients from the incident scene tot he treatment scene. Such policy
should provide for transportation based upon determinants of transport need, including
medical necessity,mitigating circumstances, and provider budget.
The decision to transport a patient seen by BLS personnel will be determined by the
patient's medical condition as described in the Basic EMT core curriculum and any
mitigating circumstances. The mode of transport will be consistent with the patient's
medical condition and provide humane, efficient and expedient care. Transport
destinations should be consistent with the State Trauma System Activation Guidelines.
d. King County Medical Oualitv Assurance/Ouality Improvement Programs: Each
BLS provider will agree to participate in a King County Medical Quality
Assurance/Quality Improvement program. This program will be developed by King
County EMS Division, with the assistance of the EMS Advisory Committee and BLS
providers. Elements of this program include: 1) run review by clerical and provider
personnel to ensure completeness, 2) run review by a reviewer (local paramedic or
personnel from within the organization for medical appropriateness and compliance with
King County Emergency Medical Services standards, 3) case follow up and discussion
conducted by the run review personnel,and 4)paramedic involvement in CBT Training.
e. Patient Confidentiality: Information concerning the evaluation and treatment of a
patient by BLS personnel in the performance of their duties is to be handled as
confidential material, including patient name, medical history, incident location, or any
other confidential information. Confidential medical information may not be released
unless the patient or his/her court-appointed representative completes and signs an
Authorization for Release of Information form.
IV. Euuipment
a. All vehicles used to deliver emergency medical services must meet vehicle standards as
established by the Washington State Department of Health pursuant to RCW 18.73,
unless waived by the State Department of Health Office of EMS Trauma Prevention
Licensing.
b. Medical equipment used by personnel supported funds must meet appropriate federal or
state standards or county protocols.
V. Mutual Aid Agreements: Each public agency providing basic life support services shall
have written mutual aid agreement or similar arrangements is effect.
VI. Proposed Research and Evaluation Activities: Any proposed clinical research or
evaluation activities involving personnel, equipment or data supported directly or indirectly
by King County funds must receive prior review and written approval by the Medical
Program Director and the King County Emergency Medical Services Division Manager and
must be in compliance with State, County and local regulations and laws.
Basic Life Support Services Contract
M the
VII. Performance Indicators and OversiEht: In accordance with findings of EMS
Financial Planning Task Force, the EMS Division — with the assistance of the EMS
Advisory Committee and the Financial Staff Team—shall develop mechanisms for improved
performance oversight by the EMS system and elected officials. Performance indicators will
be established and reviewed by King County EMS and reported by the EMS Division to
each BLS agency and in public presentations. Mitigation activities will be initiated with
local providers if needed.
Reports will be distributed to provider agencies on a regular basis. Standards for each
provider will be monitored in the following major areas: total call volume, average response
time for code red calls, percent of response times greater than or equal to 4, 6, 8, and 10
minutes, out-of-service times, number of transports and mode of transport. Additional
performance indicators may be added, with the assistance of the EMS Advisory Committee
and the Financial Staff Team.
VIII. Financial Indicators and Oversieht: In accordance with findings of the EMS Financial
Planning Task Force, indicators shall be developed which improve financial oversight by the
EMS system and elected officials. The EMS Division, in conjunction with the EMS
Advisory Committee and the Financial Staff Team, shall develop reporting financial
reporting measures that will include,but may not be limited to:
a. Selection,development, and tracking of system costs.
b. A standard costing system for reporting dollar expenditures for BLS activities.
c. Funding allocation mechanism.
Basic Life Support Services Contract
Exhibit III
Basic Life Support Services Invoice
Fire District/Dept.or City Contract# D33049D Invoice Date
Address City Zip Code
Budget Item Expenditures Expenditures Budget for Balance
Category* To Date Period Unexpended
Grand Total
I,the undersigned,do hereby certify that the materials have been furnished,the services rendered or the labor performed as
described herein,and that the claim is a just,dim and unpaid obligation against the County of King,and that I am authorized to
authenticate and certify to said claim.
Signature Title Date
*Indicate supplies,equipment,salaries and support services.
Basic Life Support Services Contract
EXHIBIT IV Contract#D33049D
Mission,Method, and Expectations
Public Health Program Activities Provided by Community Partners
A.Mission
■ The overall mission of Public Health—Seattle&King County is to provide public health
services that promote health and prevent disease to King County residents,in order to achieve
and sustain healthy people and healthy communities.
B. Method
One of the key methods that Public Health Seattle&King County uses to support this mission
and extend the reach of public health program activities is to engage in contractual partnerships
with community based organizations.This partnering activity increases access to needed and
mandated health services, and enables community partner agencies and the people they serve to
benefit from service models that are informed by sound public health principles and practices.
Community partner organizations,with the support of funds provided through this contractual
relationship,extend Public Health's activities to promote population health, according to goals
and outcomes determined under state and national performance standards.
C. Expectations
■ Public Health expects that its community based contracting partners will perform contracted
health services in accordance with the goals,performance measures, and accountability methods
that are outlined in the program-specific exhibits that accompany this contract.
■ Public Health will provide professional and technical assistance to community partner
organization program staff in order to support the development and maintenance of strong and
effective program services.
■ Public Health and community partner organizations will collaborate in developing and
performing program evaluation activities that will measure the effectiveness of program efforts,
including efforts to measure the impact of program activities on the health status of residents of
King County.
Basic Life Support Services Coohad
WA CITIES•INSLWNCE Fax:4252777242 Jun 18 2003 9:48 F.0
ewi f s t'f V
MWA + qr .�§
Insurance Authority R.0 Ba.
Renton 'V
18-Jun-03 Cart#o 3204
Phone,
Public Health--Seattle&King County
Attn: Grant &Contract Services Fax:42 '
999 Third Ave., Suite 1520
Seattie,WA 98104
RE: City of Kent
Grant for Basic Life Support Services Contract for 2003.
Evidence of Coverage
The above captioned entity is a member of the Washington Cities Insurance Authority
(WCLA.),which is a self insured pool of over 106 municipal corporations in the State of
Washington.
WCIA has at least$1 million per occurrence combined single limit of liability coverage
in its self insured layer that may be applicable in the event an incident occurs that is
deemed to be attributed to the negligence of the member.
WCIA is an Interlocal Agreement among municipalities and liability is completely self
funded by the membership. As there is no insurance policy involved and WCIA is not
an insurance company,your organization cannot be named as an"additional insured'.
Sincerely,
� 4Z3
Eric B, Larson
Assistant Director
cc: Christopher Hills _
CIOUK