This morning I'm joined by colleague uh uh Council Hogan, Council Nave, President Hudson, and myself.

This morning we are going to talk about the ambulance services with uh fire departments as well as the agreement with AMR and the details within uh so first I'm joined by Chief Mann uh.

And this is uh Craig Whitmer from API from the city.

Craig, welcome.

Um and Craig's been with us um from the time we um put out the RFP and we had an RFP committee um to ensure that the items we were asking for in the RFP eventually made it into a contract to benefit the citizens.

So he's been uh with us working through our performance metrics, going through data between the city and with AMR.

Um so he's been with us the whole time.

Um also with us today, counselor um is uh Bill McGarrity from um, he's a regional director from AMR, and I have our fire department team that has been working on this.

So I know I asked I answered a few questions during a study session and I got your questions.

Um we put it in a PowerPoint.

Okay, um, it's in the black binder, and we also have it up on the screen.

Um and I was gonna let Craig Whitmer kind of run through that because he kind of organized all of our data and information, and then we'll after that, if it's okay with you, we can ask whatever answer whatever questions you have.

Let's do that.

Uh also we are joined by Councillor Johannes Rouser uh with us, so take it away.

Okay, and so in the in your black binder is the same PowerPoint presentation that's up on the screen.

So as Craig is uh going through, he'll be able to um you'll be able to look exactly what he's talking about.

Thank you.

Go ahead, Craig.

So good morning, everyone, and thank you for the opportunity to um kind of provide some background and context for how we arrived at the document we arrived at.

Um so just to run through uh we're gonna provide some uh framing of the national and local context, provide a summary of how uh API came in and was able to sell help support this project.

We're gonna run through some contract highlights, uh happy to focus there discussing performance management and SLAs.

Um then I think happy to answer any questions that I'm able to, and then obviously the experts who uh our subject matter experts will be able to provide uh better information.

So if we could move on to the um national and local context slide.

So Dan, that's next one.

So to frame the issue, uh we saw a significant increase, and this is data from uh 2023 through 2024.

Uh we saw about nearly a 30% increase in 911 calls in Onondaka County.

Um there's a lack of access to transportation that is well known by this body of about 30 percent of folks who don't own a car.

Um it's a challenging labor market for EMTs.

Um you have a decrease in positions, um, and then generally there's a significant lack of access to uh primary care doctors in Onondaga County.

Um these factors lead to uh increased ER wait times and generally um indicates stressors on the overall health care system.

So if you recall around uh 2023, there were significant concerns around the um uh utilization of the mutual aid network.

So in this instance, it was um organizations outside of the county sending their ambulances into the city to provide um emergency medical services, and that sort of conversation and local reporting um motivated us to start a conversation and try to understand what could be done to address it.

So moving on to the next slide, please.

So it's good to recognize that um AMR is a provider of these services across upstate, and we're not the only city that is dealing uh with this question.

Um as we can discuss a little bit later, uh we were able to connect with colleagues in Seattle to provide a little bit more context on the performance management side.

But this is trying to show that this is not an issue that's local to just Syracuse, it's an issue across cities and across the country, but specifically different communities are handling it different ways.

Next slide, please.

So for some background on AMR's history in Syracuse, uh Eastern Ambulance has been operating in the area for about 70 years.

They were the first agency to be providing paramedic level service.

Um really kind of led the way when it came to certain kinds of certifications, uh, service status management.

Um in 96, Eastern Ambulance was acquired by Rural Metro, and in 2015, Rural Metro was acquired by AMR.

So while AMR is a subsidiary of GMR, a national organization, the local branch has been working in the community for over 70 years.

So we're talking about working with the largest EMS provider in the country.

Um that kind of informs and answers the question of you know, why was there only one respondent to the RFP?

And it's because AMR is one of the largest providers and is the largest provider in the country, and certainly the largest provider in the area, truly the only organization that could effectively respond to the RFP and the city's needs.

Next slide, please.

So this is a little bit more information about um SFD's ambulance organization.

So and Chief, correct me if I'm wrong here, but um SFD began operating a 24-7 ambulance service in 2021 in response to the COVID pandemic, so that required a significant amount of administrative work to gain, so you have to demonstrate the need through the certificate of need, and then um while SFD has always provided EMS services as part of its function, ramping up into the full 24-7 uh service was a significant operational uh impact.

So it's important to note here and and happy to talk about it, um, perhaps in another setting that um the administrative components, so cost of recovery for service never really matched what was being spent to provide this service.

So just a little bit more background.

Uh engine company three is staff with four members.

If needed, the ambulance will be deployed with two members to provide transport service, and operationally it severely impacts the fire suppression capabilities and is only done in hot times of high demand.

So for background on the RFP, spring of 2023, we launched the RFP.

Um by March, AMR is the only respondent with a proposal.

Um then there's obviously time in between that we'll speak to in a bit in a bit, but then in July of this year, the RFP committee met and you man unanimously voted to move forward with AMR's proposal.

So the next slide is a summary of API's engagement with this project.

So around March of 2024, we were asked to um really try to do um two things.

Um achieve service level agreements with um sort of another party that we didn't really have much leverage or by way of a um authority over, which is difficult.

Um then try to be able to uh allow SFD to focus more on their core functions.

So over the course of this engagement, we did a significant amount of data collection, analysis, validation, internal presentations, uh working with folks within the mayor's office, working within SFD, um conversations with our um colleagues in Seattle who uh ran a similar procurement transformation program that had some really important lessons for us.

Um worked to develop some scenarios that we understood to be in the best interest of the city, and then kicked off our conversations with AMR in around September.

So since September, we've worked with AMR to try to understand and reconcile um what are the needs of residents to try to ensure that residents are getting the uh care they need in a timely fashion, and what is the uh sort of reasonable basis for a set of reporting mechanisms that can ensure that if there are issues that they are discussed and properly managed, and that there can be a basis of sort of mutual partnership between uh sort of two core entities providing safety and security for residents.

Next slide, please.

So after one of the first meetings, uh AMR and the fire department came out with these sort of shared objectives.

So these are kind of goals that make sense for both organizations.

So it makes sense to have quarterly command staff meetings.

It makes sense to have reporting mechanisms for when staffing levels at AMR may necessitate more strain on SFD systems, being able to reconcile the dispatch procedures that AMR is doing with what SFD understands, SFD's ability to monitor uh ambulances when they're in and out of service, establishing rehab protocols, having a CQI committee, which is related to patient outcomes, establishing assistance with transport protocols, establishing joint training initiatives because there is a significant amount of overlap, collaborating on I think changes that may be happening at the county level, which I'm I'm sure SFD is happy to have a conversation with outside of this conversation.

Ensuring that there is someone from AMR who is able to speak to these issues when they come up, uh defining and holding AMR accountable for its role in the mutual aid network and ensuring that that threshold is set at an appropriate level, um evaluating the contracts currently in place, so that meant looking at uh contracts that AMR had with other municipalities across the country and identifying financial impacts that this may have.

Uh next slide, please.

So, as you can see, um around 12 out of 13 of these are addressed and um for lack of a better term solved for within the contract, we uh spent several sessions negotiating each of these points to ensure that they're addressed, and there are uh continuing conversations that are outside of my purview related to uh county level uh health.

Next slide, please.

So when it comes to performance management and SLAs, sort of what what can you expect as a standard?

Uh, we really focused on the most critical calls when it comes to ensuring patient care is delivered appropriately.

We wanted to focus on echo calls, and so for us, that meant ensuring that from the uh moment a call is placed to the uh moment that care is delivered that cannot exceed uh eight minutes and 59 seconds, um, more than 10% during the month.

And so that covers from any one corner of the city to the other corner of the city, recognizing that uh as was discussed previously, the increase in strain on the healthcare system uh kind of since the COVID-19 pandemic has led to uh an overreliance in a way of saying it on emergency services for services that may um not necessarily not necessitate uh an ambulance to be called, right?

So if folks are um and I I don't like to use the phrase, but a stub toe is not something that you would call an ambulance for, and ensuring that we're holding AMR to their response times on heart attacks, ensuring that we're holding AMR to their response times on the most important and critical cases, and the mutual aid reliance, which is not to exceed 3% of total call volume per month.

So when this conversation really began, we were looking at a mutual aid network reliance of around 10% over the course of the last I think um six months, it has not gone above, I want to say 2%.

There was one very short period in February that was addressed in the memo that was sent along.

Um but generally speaking, it has been within the threshold of what we are trying to achieve here.

There's also these other mechanisms that might not be exactly performance management per se, but they're important to ensure that operationally AMR and SFD are on the same page about what's going on what's going on in the system to ensure that residents are able to trust that when they pick up the phone, they're going to get the care that they need.

So that includes the monthly reporting and record keeping, uh, which we talk about a little bit more about what's included in those monthly reports and records, uh memorializing the standard operating procedures so that AMR is able to get the right care uh when it's needed, and the discretion to downgrade a call.

So if a call comes in and it's coded as X by the uh Onondaga County healthcare system, but upon further conversation, it turns out it may not be as serious, it can be downgraded, but that downgrade must be recorded for posterity.

So if folks want to escalate it and say that no care needs to get there faster, that's totally fine.

But if you want to say that this person maybe has stubbed their toe rather than broken a bone, then you have to record that and ensure that it's discussed and and followed up on.

Let me just ask about that one one part.

Sure.

Um because in kind of determining um what is of most important.

How do you plan to do that when we have so many dialects here?

Like, well, what happens is when I call 911, there's a call.

Why don't we hold those questions?

So that we know all right, just like we said earlier.

Sure.

I'm gonna make record of that question.

Okay.

And then go through the presentation and then we'll dive in.

We have a lot of questions.

Thank you, counselor, for the question.

So um, as we're talking about the accountability mechanism, one thing to note is that um in our review of uh Seattle specifically, but other cities around the country, we look at fines and fees for uh non for not meeting these kinds of standards.

And in Seattle's case, uh their research showed that um even with a million dollars in fines and fees, there was no change in the actual performance.

So uh rather than coming at this with uh carrot or a stick approach, we really wanted to drill down on what was the most important um means of addressing these issues.

And so to us that looked like effective communication and accountability.

So there are kind of three layers here of how issues um for non-performance would escalate, and that would be uh conversations at the regular weekly meetings, and then if if those conversations don't um resolve the issues of performance over a period of I believe uh two to three months, then the um next step is to broaden that net to include folks from the mayor's office, perhaps bringing in Onondaga County or other kinds of stakeholders to see if there's a different root cause, and then a public meeting requirement to be able to come and speak to this body and um sort of answer the people's questions.

So running through the rest of the contract in terms of highlights.

Um this is a three-year contract that is eligible for two-year renewal after that.

The city is welcome to and and has the authority to terminate the contract on mutual consent with a certain um time frame of notice.

Um in going back and forth as as I mentioned earlier, uh, we really wanted to focus on a good foundation of mutual partnership for two organizations that play a critical role in safety uh within the city.

So, in that, um, AMR will provide two scholarships for city residents for each of their training classes.

AMR is committed to visiting high schools and presenting on career opportunities, the establishment and follow-through as is discussed later of a concern, functionally a complaint hotline.

Um AMR is required to uh ensure that their uh ambulances are, I think not more than three or five years old.

Um SFD is able to put their ambulances out into service at their discretion.

SFD is able to bring in any specialized vehicles that AMR is not able to provide, and AMR and SFD will work on joint training exercises.

So this is a little bit more um perhaps in the weeds than maybe helpful but happy to discuss.

Um this is the kind of staffing notification system that will be uh discussed between the two operational departments within SFD and AMR.

That's ensuring that there is coverage throughout different periods of time, busy seasons, um that if there isn't coverage, it's known and can be um filled in for appropriately.

Um and this is the the sort of call valve call volume to understand um exactly what it is that AMR is doing in the community.

So you're looking at a pretty consistent 130 to 140 calls a day that AMR is responding to just within the city of Syracuse.

So it is it is a significant service that AMR is providing to the city.

And just want to underscore again that there is no cost to the city for uh this contract associated with uh payment of any kind.

Um I think one other important thing to note here is that um to my understanding, the last time there was um this kind of a discussion was around 15 years ago.

Um but AMR has never operated within uh a contract for providing its services to the city.

So this would be the first time that there is a contract that is more than sort of uh general understanding, but a binding document.

And I think next slide, please.

So this is more about what the sort of monthly reports will include discussion on.

So your total number of responses, total emergency transports, um digging into the data on the distribution of response time.

So, you know, can we drill down and say that there seems to be an issue at a certain shift?

Maybe there aren't enough folks picking up uh evening shifts, overnights, et cetera, et cetera.

Um highlighted here there's a summary of customer service and operational complaints, so that there's a mechanism to be able to address concerns that are coming in.

Um clinical quality metrics, patient outcomes, response times, uh those turn calls and that summary of mutual aid network requests uh speaks to one of those original motivating factors here of how do we ensure that uh AMR is appropriately responding to the city's needs so that uh county partners are not um spending time they otherwise could be attending to county needs coming into the city.

Next slide, please.

And that concludes the presentation.

Thank you so much for the presentation.

Uh we will start with Council Joan Raoul question, and then we'll go from there.

So I got your question, uh counselor, and um I'll start off um to give an over sight of how the call works, and then I'll probably ask um Mr.

McGee to get up and uh explain how it's gonna work in uh real life with this contract.

But when uh a constituent calls um 911, it goes to the Anadaga County 911 center, and depending on um the level of seriousness and what um symptoms that the patient is describing to the call taker, they code the type of response that should happen.

Um right off the bat, the fire department, our fire department will go in our pickup trucks or one of our engines and we'll start um providing care.

You know, our response times are uh within three or four minutes, and then uh the ambulance is gonna come after that.

So the call gets transferred over to the AMR dispatch and they dispatch their ambulance based on the information that they got from the call taker and the 911 uh center also.

But if you want to, you know, get up and kind of explain, I'll let Mr.

McGardy kind of explain how it's gonna work in real time um with this contract and the accountability part about that.

Okay, yeah, thanks for having me.

Good morning.

Um yeah, so as Chief said when the calls go to the 91 Center, they're they're coded by their call takers, and they come down through the interface to us.

So we never actually have verbal contact with those callers, uh, but we do have their contact information.

So the lower acuity of the stub toes, the the fevers, those type of calls, um, we'll send not only uh we'll send a uh a lower level basic EMT ambulance that we'll save our paramedic ambulances for the strokes, the heart attacks, the cardiac arrest, the high traumas, those kind of things.

So we do that now.

That's been a practice that we've been doing for for several years, and it's something that we track every day.

So there's no one here from Anadaga County 911.

Um no, because that system is a total different system outside of the contract that we have that on the Daga County 911 Center, they um interact with every 52 fire departments in the county, all the police agencies, so everything goes through them.

But we did have a conversation um regarding one of the questions Councilor Majuk had about a study that's going on.

Um, but other than that, um we can speak about how the system works because we're dealing with it every day.

But I just wanted to know if there was like a translation component to any of it because with having so many new Americans in the community, um, are we um not understanding some individuals and not taking their cause that serious?

So, but we can't answer that question because we're not we can't answer that, but I was actually in a meeting uh over at the public safety building Friday, and the um commissioner from the 91 Center was there, and they've got an AI component now in their call taking system that can understand dozens and dozens of different languages and translate for them.

So and then we also have a language line as well in our center.

So if we do have a caller on the line that doesn't speak English, we can transfer it and get translation for us.

Okay.

So to follow up with that part of the 911 in the county.

So a call coming, it goes to 911.

911 pick it up, reroute it to AMR.

Well, before that happens, depending on the seriousness of it, well, the fire department will get dispatched to to begin um to treating the patient.

Right.

So so and with that, have we looked at the the time interval between when the call goes into the county and and into the mutual right?

That's the language, the mutual aid.

Well, well, the way it works is when the call goes into the county, the first step the county's gonna do is call AMR.

And then AMR is gonna take that information, depending on their call volume and what's going on, the seriousness of it, they're gonna dispatch an ambulance.

If for whatever reason they don't have an ambulance available, and that's where that 3% comes in that we're trying to keep this metric below 3%.

If AMR is unable to provide an ambulance, then that's when the mutual aid from the county will come in and provide the ambulance in the city.

And AMR, not only do we accept mutual aid, but AMR also provides mutual aid to the county.

So it's a give and take um process also.

So have we looked at at you know that the time interval where when the county received versus way dispatch it to AMR, the the the uh SFD, what's that like?

So when the call comes in, one of the first questions they ask is the address of the caller.

Uh a lot of that's automatic with cell phones and whatnot.

So it's geocoded, gives a location.

So if it's in the city, it's a medical call, it's gonna come to AMR.

So as soon as they geocode it and put that determinant on it, it comes down through an interface instantaneously.

We studied how much it takes?

Seconds.

Soon as it's geocoded and has that determinant, it comes down to us.

So basically when the call goes in, it gets dispatched to the dispatchers who are gonna dispatch ambulance.

The only delay is gonna be how serious the call is and what ambulance is gonna be sent to that particular situation and and what's needed to be called.

The goal is for the type of emergency that's being for the type of emergency that a patient is having is it's in the highest level of care that that that patient needs, and that's what the goal of this system is.

Um made to do, and this is what in our performance metrics that we're gonna track, we'll be able to track those every month and uh figure out what calls came in, what the response times were to these questions, we'll be able to track all of those.

Before this contract, we never there was never a situation where we had the authority to get that information.

The county could give us information, but it won't be specifically about AMR's response in the city because they are the provider in the city.

So the nine minutes is from the time of the call getting incepted to the point of the execution.

That's that's what the nine minutes are.

To the front door of the patient's house, yes.

That's what the nine minutes is.

Yep.

Along those lines, I I think there was an incident, an incident two years ago where somebody in Eastwood had a heart attack.

I don't I don't know if you remember that.

Yeah, um, there's definitely uh several times we've gotten um situations that were brought to our attention.

Um I can say um I don't remember specifically um this particular call, but every time it was brought to our attention, um, we always were able to sit down with AMR and figure out what exactly happened.

Um sometimes the call taker thinks it's taking longer than it actually is once we get the reports for the times.

Sometimes there's issues with construction and and how the uh ambulance had to get to the location.

Sometimes there's other issues that come about, but most of the time, even before this contract, um we would get an answer.

And I think um if I can recall, I believe that was um counselor maybe Joe Driscoll when he was on the council back then that came up, and um I can't remember the outcome, but we were able to get the answer to figure out what exactly happened.

It was tragic.

It ended up being person didn't make it.

And part of the reason was there was so much delay in ambulance responding that by the time they get there, it was too late.

Yeah, I can't I can't confirm that that's why the person didn't make it, but certainly there's there was situations that arose during that call.

Um, but we got called to somebody that was already in a bad predicament before we got dispatched most of the time anyway.

So what what I'm saying in all of this is to say that it's it's it's very challenging to have a comprehensive conversation around this this topic without a 911, right?

Without the county here.

Because I think I think that's a portion of it that is so significant to make a because AMR can only respond to what is given, right?

Yes, SFD can only respond to what is given and how expeditious that that that that communication was.

Yeah, right?

Yeah, but I I will say the fact is when somebody does call as soon as it gets to the dispatcher, that call is pushed down to AMR and the fire department.

Um to your point, they they do play a huge role because they are the you know the county's 911 center.

But when the call gets to the dispatcher, it immediately, like Mr.

McGuarrity said, it immediately sends out an ambulance or immediately sends out to the agencies that should respond.

So having the county here, they can go over some of the you know challenges they may face.

But when the call comes in, somebody's immediately getting dispatched once the call taker receives that information.

Chief.

Stan Downs, first deputy chief.

I think it's important to note that the reason that we got to this contract in the language that's in there, there were there have been problems in the past.

We know that.

We've we've tried to get the answers and all that.

What this contract is, the system right now is working.

It is being effective.

We're getting the answers, we're getting the proper response times.

What this contract is is memorializing, and they have agreed to let's solidify what's working.

Because the drop calls where where the issues were significantly, significantly declined.

And we said, how do we capture this moment in time and put it in writing?

And they said we can do that.

So I think the the 911 center questions all that.

While it was all working, we said we're gonna capture this and put it in the contract.

So that's really what this is.

So this is this is the signatures for when the system's working correctly and everybody's gonna be held to that standard.

And and we we we we understand that.

It's just you know, as we contractually hold ourselves accountable to this, there are components that need to be addressed, which is call time, response, and all of this stuff that that especially with with with what we talked about, the study that the county's doing with AMR and the and the and the 911 system and all of that.

And to be able to be in cohesion with with the county, where are we with this, right?

And it it it's it's it is tough to hold AMR accountable without county conversation together happening.

Because like I said, as the county dispatch the call, AMR can only do what AMR can do in conjunction with how quickly that was given to them and the coordination between.

So that's that's where I am, and that's where that question of incorporating that study that the county's doing into this allowing us to really make an informed decision with AMR with this contract.

Yes, and and I would say the contract is giving us the authority um to have oversight that we for 70 years we never had.

Regardless of we we talked to the county about the study and us having an agreement of how our constituents in the city are gonna receive ambulance services and outline with all these metrics, these meetings to make sure that we're holding them accountable, it's only gonna strengthen whatever the county's gonna do.

Um, because they also provide services in the county also, but this contract is directly regarding what AMR is gonna legitimately in a contract do for our constituents.

And when they don't meet those standards, like Chief Downs says, now we have a mechanism to sit down and discuss those and get to the bottom of that.

I understand the county discussion, but at some point not having a contract with our city doesn't give us a voice to make Mr.

McGarrity come to the table, even with them being the only loan respondent.

There's 17 other ambulance services in the county trying to coordinate everything to make sure it works and to make sure it's working in all these villages and towns when it's it's kind of disorganized.

It's not gonna be disorganized in the city now.

We've been sitting down for months meeting dozens of times to make sure that when a 911 caller in our city calls 911, we have the expectation that's in the contract of what that patient should be receiving.

So I I totally understand um the global look at the county contract, but having an agreement with the city and AMR is only gonna strengthen whatever goes on in the county.

Um, like you saw the statistics, we have 52,000 ambulance calls per year.

Right now, we have there's no way we can hold any accountability, any transparency to any, you know, discussions like you said about Eastwood if this happens tomorrow without a contract.

Luckily, we can sit down and discuss those things because we have a good working relationship, but they're gonna be bound to that in the contract, and and that's only gonna solidify anything that goes on in the county, and we confirmed that with um the EMS uh director of of the county who's overseeing that um particular, we discussed that with him because that was one of your questions.

But having an agreement of 52,000 calls and how those calls are gonna get answered will only solidify the county, whatever the county's gonna do.

So with um with um So you said there's 17 different ambulance services within the city or county.

Okay.

And so when a call comes in, is it by proximity of who gets the call?

Um, how do how do we determine if AMR is the entity that gets that call?

Chief, I can check that out.

Okay.

Uh so each one of those agencies has a uh Craig wanted a certificate of need for their area, so they're the primary responder in that area.

So I'll use Navac as an example in the village in your Syracuse.

That's their primary agency.

So if a call comes in, it's gonna go to them first.

If they don't have an uh a resource available, then it's gonna go to the next closest available in the system.

And that's managed up by the County 911 Center.

So it is by proximity.

So it is by proximity.

Okay.

So I guess I'll pivot just slightly to the um to the staffing component.

Um what is the current staffing um component and uh how do we know that AMR will meet our need solely?

Um, but again, I don't know if it is solely because now you say 17 other that will be called, so I'm not sure.

Yeah, so the other 17 are are mutual aid.

So if we don't have a have a resource ready readily available, then it goes back to the 9-1 center.

And in the contract, there is a uh a statement in there that says that our dispatch center and the 9-1 center will coordinate.

What's the best response?

What's your current number of trucks?

Right now, 32.

And we typically deploy about 25 per day in the city.

25 into specifically into the city or 35 within AMR and circus.

But our typical deployment is about 25 in the city.

In the system, I would say because we covered more than just the city.

Yeah.

Are you properly staffed now?

Yes.

We've not been, I think we were yellow if you looked at that metric one day uh about three weeks ago.

We coordinated with the fire department and they put their ambulance in service on a Saturday night, but we're we're green every day.

Okay, so you're always available, you're always hiring.

Always hire, yes.

Always hiring.

Is there a goal of how many staff that you will need?

So we currently our current staff in Syracuse is 300 employees.

Okay.

So they are able to handle all emergencies.

Um is there a bit of problem where a person calls 911 and our hole for one to two minutes?

That can delay it.

Um if there's a call and you're not available, Chief, would you be able to take a call?

I'm gonna give you an example.

If a person is who is diabetic is in dire need, uh immediate assistance.

Are you able to go to that house and assist that person if AMR is not available at that moment?

Okay, I'll let Chief Pagano answer that question.

Hello, good morning, Deputy Chief Nick Pagano.

I oversee the EMS division, and I'm also the 911 liaison for the fire department.

So to some of those questions, I'd like to go back, uh, Councilman Joke.

Your concern about response times and phone call.

I don't know if it's been discussed before this body before, but I want you to know that when somebody calls 911, whatever the emergency is, as Mr.

McGardy says, as soon as they get an address and a type of call, it's being sent to the appropriate dispatcher.

We will still have people on the phone with 911 as a fire truck as a mini, which is our medical truck shows up, or as the AMR shows up.

So they they're they're still talking, they're still trying to figure out more components of what the call is, but they don't finish the phone call, then say, okay, we need to find an ambulance, we need to find a fire truck.

That is all happening at the same time.

So those 30 seconds, it's to a dispatcher to hand out.

To your point, counselor, um, when there is a serious call, there are components that say if it's this stub toe, fire department doesn't go.

But if it's a serious call, excuse me, an individual diabetic having a medical emergency that they're not right, they're alterned mental.

That would be coded as a fire response in the closest fire truck with two EMTs or higher, would get there and begin life saving care while they figure out what they're doing for an ambulance.

Do we have EMTs signed a firehouses?

Yes.

All right, so they are there.

Yes, I think we got in 380 staffing.

I believe we're over 300 of our members are EMTs.

Yeah.

So is there a difference between when there's an emergency a rescue truck comes to an EMT?

So I'll let Chief Pogano explain.

Okay, yep.

Hi, Counselor.

Okay.

So the fire stations are all equipped with you know, fire engines and the little trucks, minis we call them, and everyone, other than about 10 people in the entire environment are EMTs or higher.

So they will respond is in a first responder phase, as we call it, and begin initial life saving care, apply it to the fibrillator, start breathing for them, administer Narcan, administer epinephrine, a life saving means while we wait for the ambulance.

So we we go to 18,000 calls.

Not every ambulance call gets a fire truck, just the serious ones, and there's a whole mechanism to determine which ones we go on.

Oh, it isn't so chief.

It isn't if somebody's available, in other words, it's like if it's a there's a criteria of serious calls you go in.

Yeah, it's specifically.

That's it.

Yep.

So with so just for clarification on the AMR annual call.

So these calls are specifically uh the data you provided here.

Are these calls specifically in the city?

Yes, sir.

Right?

Okay, so so with this contract going into place, what would this do to the type of call?

Because AMR is all over the county, right?

So it's all all over the county.

Would this be able to dedicate some of this truck specifically to the city?

Or would it so I guess what I'm asking is what in the level of prioritizing?

So how do we that's that 3% right out of a hundred calls, they could only not go to three of those calls.

And and that's that's the uh metric that we have that they're gonna hold, we're gonna have in the contract that they're gonna hold to that standard.

They're only gonna turn back three percent of those calls.

And like uh Craig Whitmer said, over the last six or seven months with their new staffing model, we they've only been turning back one to two percent of those calls.

So uh, you know, just a small um metrics out of a hundred calls, only three per month would be allowed to be turned back into the county system, and that's gonna be in the contract.

And if they exceed that, that's when we have those monthly meetings that we can figure out what the issues were, whether sometimes there's issues at the hospital where there's wait times that the ambulance has to be freed.

Um, there's different situations that might come up of why this might rise above 3%, but we're gonna have meetings to discuss those issues every every month.

And what was the previous percentage of turnbacks?

I think um the highest was a 10, I think believe it was 10%.

Um I forgot what year that was.

Yeah, 2022.

They were given back 10% of the calls.

So with with a stay for with 3% for a second.

3% um calls that that get that AMR is allowed contractually not to respond to based on the circumstances, right?

Right?

Oh, the mobility.

Right, availability, right?

Can I distinguish something real quick?

Okay.

Um I wouldn't describe it as not respond to.

Um it's more that AMR may not be in a position to respond appropriately.

Based on circumstances, right, exactly.

Exactly.

So with that, that's there's this from 911 to the where the need is, nine minutes.

I know that SFD call time on average is two to three minutes.

Right.

Why would it take this long to respond to somebody?

I mean, we're when when you when you guys can effectively do it in two to three minutes.

But our fire stations are strategically placed throughout the city.

Um, and the stations were built in every neighborhood to be able to get to this calls in a certain amount of time.

Um as far as the the response times, right?

The goal is when there's a the most serious calls, is to make sure that they have the ambulances available to respond to those within that nine minutes.

And it's just not the city, these are like national standards.

Um every city, Buffalo, Rochester, Yonkers, any system, even New York City who has their own EMS division, they are relying on mutual aid network.

This isn't just something that's going on in Onadaga County.

This goes on, I would say worldwide.

There's there's really no agency depending on the call volume, depending on what's going on in the hospital, depending on different um things that are going on that can answer these calls all the time.

That's why there's that's where that 90% of the time metrics comes in because the standards have been shown that this is what works and what is reasonably accepted throughout the country at least.

Um I don't know if you want to speak to that.

I don't think that answer my question, Chief.

I'm asking with if if SFD SFD can respond in three minutes.

Why would it take AMR a leeway of nine minutes to respond into something that could be done and and and go ahead?

To your point, counselor, as Chief Pagano said, we have the mini that is strategically located with two members.

Let's pick a pick an area of the city, let's say the north side where station two is.

You're gonna send two people to that call.

The ambulance that's closest is also gonna go to that call.

If it's a serious call.

What we also have is the two, the balance of that engine company, the two other members on the engine that are there, when the next call comes in, they're also close.

We can keep those response times down because the the two members of the four are split.

So we can almost handle two medical calls at once in a neighborhood.

We don't have two ambulances in every neighborhood.

So that response time, the the first call that comes in on the north side that could handle by the ambulance.

The next ambulance probably is coming from downtown or eastwood or whatever.

So there's the staffing models are different.

The reason the system works is we can get there, stabilize that patient, start CPR, put an AED on, do all the life-saving measures that get them back, and then by the time the ambulance with AMR shows up, they will take the transport of a stable patient and get them to the emergency room.

So that's one of the reasons why the two metrics, I understand your question.

Why is it nine for them and three for us?

Because of the staffing models, we break our engine companies down into basically two sets of first responders if needed.

How many trucks in you do we have, Chief?

How many trucks do we have?

Station, what is it, 11?

Um, 10.

We have 10 engine companies, and like Chief Downs, there's four people on two different trucks.

So they're able to essentially have 20 um responses throughout the city.

And the other part about that is when the ambulance is on scene, they're actually going to the hospital, offloading the patient and dealing with that when we're just going back in service and we're ready for the next call.

So that also reduces our response times.

How do we how do okay?

So we have we have 10 to 11 stations.

We have 35 trucks.

AMR dedicated to the city of Syracuse.

25 per day.

25 per day, right?

Yes.

So it it's have we looked at strategically in terms of scheduling to kind of mirror what the the way the city is is designed, because we if you we have 25.

There is enough capacity to strategically build in each side of town, just just like the SSFD is doing.

That's what I'm asking.

So one other data point I think I'd throw out there is an ambulance call, it's probably about 60 minutes minimum for us to turn around a call.

I defer to Chief Pagano, but how many minutes?

At least 60 minutes.

60 minutes.

We get to the patient, treat the patient, take them to the hospital, unload the patient to hospital.

Now we're ready for our next call.

It's about 60 minutes.

I'll tell you this past weekend it was three to four hours to offload patients in the ERs.

That's how bad the healthcare system is right now.

It continues to be, which is why we have 25 ambulances on duty at a time.

The fire department could do an EMS call typically probably 10 to 15 minutes, they're back in service, ready to do the next calls.

So our time on task is much longer because it's the transport and then the turnover of the patient in the emergency room.

And does um AMR have a location?

Like, do you guys have a we have our headquarters is over on Richmond Ev.

And then uh when we staff our ambulances in the city, the first one that's in service is always downtown, and then we start to strategically locate them around the city.

So nobody gets sleep just to piggyback on.

Can you say that again?

I said nobody gets any sleep on Richmond Avenue.

Um so based on the numbers, um, if we have we have four neighborhoods, four quadrants, um, eight different neighborhoods or so.

Um you could put three three ambulances in each of those eight.

H no, that's four quadrants.

But it's eight neighborhoods per those quadrants.

So you could put three in those.

I'm assuming that we have just about uh a uh fire station in at least six of the eight.

Um so why wouldn't we have three ambulances stationed at the not stationed inside, but at least close to those fire stations um on constant rotation.

So what I'll say is uh again back to it takes us about an hour to do an ambulance call.

Um we typically they're answering between 15 and 20 calls an hour uh in the city alone.

Um so those ambulances are often on a call.

They're not just yes on slower days, we're able to sit around the city and give our crews a break, but that's not very often.

They're usually moving constantly.

Okay.

So and we we study that all the time.

We we adjust our staff and and deployment plans within the city just to meet response time needs.

What are the most common calls you get?

Like Taylor, what I mean, let's say North Child, what what type of calls you're gonna get today?

It's a mix, but it it's a mid-level determinant, so a lot of illness calls, a lot of um injuries.

So you also get there's a if there's a shooting, you get the all right.

So that has to take priority.

Yep.

Maybe that would be a high determination.

So someone's on OD, which I see every day.

I see the needles, I get the cause.

So someone calls you, it's a life saving.

So gun shooting, that's the top priority.

You gotta get them to the am, you gotta get them to the hospital.

Same thing, someone is shooting on dope.

All right, or some violent act that's going on and you're involved, and you know, but what about the person if you're short staff who's calling about a diabetic issue or just had a fall off a ladder?

You know, where do we look at that?

Where your resources are being taken away because you have to handle let's say criminal activity, which it is.

And this but I look at between criminal activity and non-criminal activity that tends to take all your resources though.

So we we don't look at that piece again, it's the the determinant for so the overdoses, the the strokes, the heart attacks, the cardiac arrest, those are high priority calls.

So these are all mixed out everything, everything's mixed in.

And I think the intent really for me is in this contract is to send the right resource to the right patient.

Right.

In the in the right time frame.

Right.

And that's what we're trying to do.

In the city, correct?

Yes.

Now you you handle all the back office stuff, the billing and all that.

Yes.

Okay.

Chief, where are we with that?

We used to talk about that all the time.

So does this formalize this?

Um no, um, when we stood up our ambulance to run it 24 hours a day, seven days a week, we had a third-party um company do our billing.

Okay.

Um, as far as their billing, they're doing uh they're they're taking care of their billing.

Um, our call because they have been answering calls, our ambulance has not been um responding to as many calls.

And so um we still have the third-party company, and they just get a percentage of whatever uh the bill was for that.

Well, it would be interesting maybe before this contract was put together if we could have like sort of minimalized all this and maybe and had AMR do our billing.

I mean, I mean that would have been I mean so in effect we're just making the whole service effective.

Yes, uh formalized.

Yeah, and I I understand that, and I guess we could definitely probably look at that.

Um probably should look at that.

I mean, that would be something that probably the goal is for us to to rely on them to provide this service, so we're not doing it as much, and it the need wouldn't be as great as uh you know when we were running it 24 hours a day, seven days a week.

Because this contract doesn't have any money in it, right?

There's no money involved in it.

No, probably the first time in 16 years of the council.

I won't see that.

I mean, usually contract has money in it, but I mean I can see the uh the mutual benefit.

Benefit of this, yeah, you know.

Um other cities, Buffalo, Rochester, other cities put out RFPs, they had multiple people respond to the RFP.

We had one respondent.

Um I'm just happy that they responded because you know they don't have to go into the contract with us because there's no competition right now that could do this um amount of work.

And so, you know, we discussed the money.

Um, like I said, Buffalo, they for years had a franchise fee.

Um, they're not going towards that, and Mr.

McGardy can speak to that.

Um, companies are getting away from that because those fees and those costs that go into that take away from the service that we want to provide to the constituents.

This goal of this contract is to provide the best service to our constituents when they need it the most.

And um as we work through that, especially with them being the only one respondent, um, we wanted to make sure that there was the metrics in place to to make that come to life where the patient that calls gets the appropriate ambulance.

And to the conversation if they're busy because there's so many calls going on, um, the mutual aid system, which like I said, um occurs in every municipality in every area, um, we would have to rely on them, and that's just how the system works, not just in Syracuse, but it's just a reality of ambulance transport service systems.

Um that's kind of where we're at when you have a private company.

Um for us, you know, we have our one ambulance.

Um, it's a lot to run our one ambulance to do what they're doing.

We would have to take all of their employees, have all the liability.

It's it would be a massive undertaking to do what they're doing.

So for them to be able to come and you know provide the service that they have been providing, but now have um the oversight and um you know transparency until what happens on each call every month.

Um and also what the staffing, I I do want to say because there is a part of the staffing um part of this contract that every day they're calling us, telling us what the staffing is for that day and the next day and the weekend.

So it kind of gives us a vision of you know what possibilities problems might happen also.

So um I have a question, it's a little different.

It's gonna be off the beaten path.

Let me ask you this with all the new streets coming on line, and how are you guys working at on your GPS?

And I'm just gonna speak from my point of view.

I'm on Solar Street, and I know people have a hard time finding Solar Street.

So how do you guys plan to address that?

So our our CAD maps and the maps that are available to our crews are updated real time.

We're engaged in the community with all the road construction and the road closures every day.

That stuff is communicated to the crew.

I hope so because I'm just not I'm not trying to be, I was gonna not say anything, but it was an incident with me where your driver couldn't find my street.

So it took forever for them to get there to come and get my mother.

So I'm just curious to know how do we address that.

Right now it's all GPS driven.

There's there's a device in the every ambulance that's got the maps and routes them to the call as long as they're human beings, as long as they follow what they're told to do by the GPS, they should get there when they get there.

But it certainly is a challenge, and we're constantly adjusting our deployments based on based on the road construction in the city of Circus and really in the county.

Not even the road construction because there's gonna be some new streets coming online.

So how do you implement that?

Yeah, as those streets are added, they're added into the county 901 CAD computer system, and same same with ours.

And we're having meetings monthly, weekly with the 81, the New York State Department of Transportation.

Uh, we're collectively meeting about operational uh needs with the changing of the streets when road closures happen.

Um so we're getting that information.

We talked about it, Chief, because you know, and I've talked to the administration to try to put a street sign up for Solar Street because it's such a weird street.

So I think in your situation, because off of you know, in the parking lot, there's a bunch of buildings off of Solar Street into the into the parking lot that the parking lot is actually solar street.

Yes, and um having those labeled properly, which you know should fall on the building owner to make sure those are visible.

But I I understand what uh the situation is, and I'll I'll definitely follow up with our DPW and see if there's something that could happen for that section of the area over there, just so people can understand um what's going on in that, and especially in that lot with their multiple buildings and multiple addresses over there.

And have there been any issues with um, and this probably does have to do with the the county part that when the county comes in um with the new uh exit numbers.

The county's in these meetings also with um state DOT, so everybody's um as familiar as can be with the changes that are occurring.

So with with the um mitigation measures, um there's that's a point where that is going to be an important element, right?

And for staffing, you you said every every morning that's going to be a projection from AMR.

This is how much staffing we have, which give the mutual aid a at least a chance to kinda at least from uh SFD to kind of figure out their their part.

How is it now?

Because I think going in, that's going to be that, but what is it like now?

Um we're getting those reports right now, and um, and we're just gonna you know, um standardize those in the contract.

So we we're getting calls or an emails about what the staffing levels are, and we've been meeting, I don't know, we've been meeting for a year to get this contract squared away.

And um, there's only been one time where we actually had a help supplement um when they knew they were gonna have a staffing issue.

But other than that, um we believe that they've been based on that turn back of calls with the mutual aid system, that two and one percent that shows that they have been answering the calls that they've been dispatched to.

I have a question about the um 60 minute offload um time frame.

Um so technically when you when someone gets to the hospital um and they're taken off the the ambulance, and then there's paperwork that has to be done.

Um now, does that require both ambulance participants to be there to do the paperwork, or is there one that can handle paperwork?

I'm just in my mind and I'm and I'm a little crazy, but um I'm just thinking that maybe there's a possibility of always having like a tech on waiting.

Um maybe if the there's a tech there waiting at all times, um, then maybe an ambulance can leave out sooner and leave one tech behind who's doing paperwork, and then now they're the tech on waiting.

I don't know, I'm just taking it out outside the box.

So I'll talk a little bit about transition of care in the ER.

We get there, we unload the patient on our stretcher into the ambulance.

The patients usually physically on our stretcher for six for a significant period of time.

We're we're never in a scenario where we're just waiting there to do paperwork.

So they're on your street.

We would not we would not give a call away or or not respond to a call to wait to do paperwork.

Okay.

It's it's electronic.

Usually the provider, health caregiver in the back of the ambulance is the one that's gonna do that chart for that patient.

Okay.

And then it becomes part of the record in the case.

So it's technically the stretcher that is okay.

We can't get the patient off the stretcher because there's no place to put them.

We need to talk to the to the hospitals.

Yep, and counselor, that's a national, a nationwide problem with hospital wait times.

It's uh it's probably one of the biggest um drawbacks to the services that ambulances can provide because the more faster they can offload the patient and put them in the proper care in the hospital, they can go back into service just like the fire department does and answer the next call.

Okay.

So that's a significant part of this.

And we talked about the 911 center, there's hospitals.

There's a lot of things that go into an ambulance transport company, but this contract is really trying to double down on when our patients call, somebody's coming.

Yeah.

All these other factors we're working through them.

And um, to Craig's point, we we've discussed them, we've talked to the county, um, we've we understand what goes on in the hospitals, but this contract is to make sure that when um our constituents call, we have a contract of who's coming, and they're obligated to come per the contract, and when it when they can't come, the mutual aid system comes into place, and when that happens too much, we can sit down and have a conversation as to what happened on July 4th um when we went to Solar Street, what took so long, and they're gonna pull the data, they're gonna go over everything, they're gonna explain what the patient called, what the problem was when they arrived, what actually they found, because a lot of times somebody will call and say, I have a heart attack, but it might just be a cramp, or you know, so when they get there, we'll be able to explain get explained to us by AMR what actually happened when um AMR got there, and then this um process of going to the hospital, and we're gonna have all that in our monthly meetings when there are issues, and if for whatever reason this information um isn't um public, you know, because we're gonna meet there is that complaint line that we have, so anybody that has an issue with the service can call the complaint line, and um that's the meetings that the chief and the director are gonna have and explain whatever complaints that come through uh the system, which that's another component that we never had, and um I'm not sure of many ambulance services that have that in a contract, but I I think it's a pretty unique um process for our constituents to be able to call and figure out what happened and complain if there is any issues.

Okay, I have one more question.

This is probably completely off the record, but not off the record, but um uh not off record, but off topic.

Um how many calls do you get where maybe a family member called concerned about someone else and then the person refuses.

I was gonna ask that question.

Once once you guys get I mean, you look at them, you assess it, but they refuse to go to the hospital.

So how I would say probably about 40% of our responses result in us maybe not taking a patient to an ER.

It might be us treating them and releasing them.

To your point, they may refuse treatment because somebody else called for them and they they don't want anything to do with with going to a hospital.

Um we also have the ability to take patients to alternative destinations instead of the ER.

Um the psychiatric calls are a good thing.

We can AMR can take patients directly to CPEP, we're the only ambulance that does that.

So to and not put that patient in the medical emergency department to try to reduce the the strain there.

So how much time does that take on the refusals?

Uh dep again, depends on the severity of the call, uh, anywhere from a a few minutes to we could be there 30, 40, five minutes, depending on what we're doing for them before they go.

And sometimes they're able to like um provide care that um brings the patient enough health that they don't need to go to the ambulance, you know, to the hospital.

But it's still time consuming.

It's still time consuming.

Yes, somebody might have an asthma attack, but if they can go and provide albuterol and um calm them down and get their breathing normal, um, so oftentimes they're treating the patient where they might not have to go also instead of going to the hospital having that bill.

So 40% of calls are either released on site care or we don't know.

We don't find anybody when we get there, you know, okay.

Probably 40% of our calls don't result in a transport to an emergency room.

And then, Chief, on the reporting side, since this is a a public uh a public facing service.

Well with the contract, is there is there going to be a reporting that that the public can read in terms of how this going, or how is this how is the public going to be following this in terms of its effectiveness and the mutual agreement and its uh you know execution.

Yes, I think um our meetings um we're gonna capture the data, and I guess that's one thing um we hadn't really discussed is how could that be presented publicly.

Um so that would be I know the city does a lot of different dashboards and such.

I would uh have to figure out legally, you know, what's proprietary that could be, but whatever's in the contract, I think um API um that's right down their alley to help us figure out how to make that um become a reality.

I think for public consumption it would be it would be nice to have that, you know, so long as there's no nothing sensitive, obviously, you will, you know, but to make sure that the data, the respond time, the effectiveness, all of that, you know, somehow get published for the public to see.

I think that that that for in terms of both parties holding themselves accountable thing they will make sense.

Okay.

To your point, counselor, I think the the reason we're excited about the contract, we never had access to the data prior to this.

Even the fire department didn't have the reporting from AMR to say how many refusals did you do last month, how many transports?

We never got that.

That's what's exciting to us about this contract is for us to be able to get the data as far as proprietary and to the public.

I I see your point.

We need to get it first so that this impacts our operation.

So that's the positive really positive.

And it's gonna help us train better because we're gonna know exactly you know where those gaps in our training to what they're actually seen on the street.

And it's like I said, this is about giving the patient uh that actually needs an ambulance to get the fire department and AMR to come and make sure we're trained, and this information is gonna help us be more prepared also.

Can we make sure that somehow Joe that that the reporting component into the data system where you know if somebody's looking for research study, you know, so the public can know how's the operation going?

Is there a way we can incorporate this into this contract or at least into the legislation to make sure that is it would be best in the contract, but we need mutual agreement.

I don't think it's something that we contemplated.

I think it's a great suggestion.

Uh happy to have a conversation about it.

Okay.

Any other questions?

Um I had a question.

So um the study session is Wednesday.

Um I know this was held.

Um are we um have we answered all your questions for the study session coming up?

Well, so far.

Say that again.

So far as it's it's it's looking good.

We don't know what tomorrow we'll bring the next day.

As you can see, there's this ten of us total with the president.

And then what?

There's only five of us.

Half of the group is nine.

Yeah, we've done our best to try to answer all the questions.

And um, yeah, just if there's any more, just please let me know and I'll get the answers.

We appreciate it.

Thank you.

We appreciate it.

Yeah, let's let's look at the uh Craig, let's look at that uh reporting component.

And I think if nothing else, I want to thank AMR.

I want to thank uh fire department and all the parties involved.

Counselors, thank you.

That will conclude our meeting.

Thank you.

Thank you, Chief.

Thank you, Chief.

Thanks, Chief.

Thanks, Council.

Hey, I got you something.