610 Washington St

P.O. Box 2907 Weaverville CA 96093

(530) 623-2500

911 for Emergencies

Trinity County Life Support Report of Operations

Thank you for reading our 2018 report of operations.  Trinity County Life Support crews are providing emergency care that makes a difference in patient outcomes and in their in quality of life. 

Important updates in patient care protocols provide expanded tools and capabilities to make that difference. The TCLS team of caregivers shares a commitment to provide the best care, to do the right thing to help each patient.  

The Staff and Board of Directors are focused on preserving and enhancing service to the community.  We’ve been seeking solutions to financially stabilize ambulance service.  TCLS is facing a long term and worsening challenge to provide consistent high-quality care in an environment of increasing operating deficits. 

The TCLS Board of Directors and Management strongly believe in preserving advanced life support staffing.  Our caregivers approach our responsibility to the community very seriously.  We are part of the community and care for you as we do our own.

Our organization has been operating on a shoe-string budget for many years which has resulted in a decrease in service level to the communities that we serve.  If not for some dedicated employees with a “make it work attitude” our services would have been diminished.

For TCLS to continue providing our services to the community the formation of a Special District is now a critical need for our service area.  Many outside influences, including a series of minimum wage increases, lack of true cost reimbursements from Federal and State health systems, and inability to compete with adjacent ambulance service wages in Shasta County, have led us to propose a solution to voters, Measures D and E.    

The following report of operations details the challenges TCLS has been facing to protect service levels.

We are proud of the service provided by our staff, and it is difficult to ask for help from the community.  We have reached a point where service level will suffer without action. 

We welcome your comments and hope for your support at the Primary Election in March of 2020. 

shawn poore
Shawn Poore’, General Manager
Kathy Ratliff
Kathy Ratliff, Administrator

Goals

We have an excellent service that is underfunded.  To continue to serve the community properly we must make changes and to support those changes we must ask for community support.  We are asking citizens to help us:   

  • Move from a non-viable non-profit status without access to government reimbursements
  • Form a special district for access to these reimbursements
  • Pass an emergency services parcel assessment with 66% voter approval
  • Discard a shift structure that causes fatigue, stress, and is a barrier to recruitment
  • Implement the 48/96 shift structure, providing 24-hour pay for 24-hour shift
  • Add 4 full-time ambulance positions to fill the schedule and build backup response capability
  • Restore adequate management staffing for improved operations
  • Enrich emergency medical training for all personnel

With voter approval of Measures D and E, TCLS will continue to operate 2 advanced life support ambulances 24/7, one stationed at our quarters in Hayfork and one stationed at Weaverville.  Each ambulance would be staffed with a Paramedic and an Emergency Medical Technician.  Ambulance personnel would move to a 48/96 shift schedule and additional medical personnel would be hired to fill the schedule.

More available medical staff provides a stable base for improved response capabilities and planned backup staffing.  It also allows TCLS to look at additional programs to serve the community. 

We would make both of our management positions full time.  They are currently part time due to limited budget.  These two positions are vitally important to maintaining a well-trained, patient care-oriented service.  The General Manager will be responsible for the daily operations and organizational training.  The Administrator will be able to focus on the financial health of the organization including fund raising and grant writing. These vital functions to the organization are currently being done by part time employees with frequent emergency response responsibility, which results in a crisis management.

Our goal is stable ambulance service.  We affirm to the community that Measures D and E will provide this for the long term.  We will continue to require conservative spending, grant writing for special projects, and no wasteful spending of your/our local parcel assessment for a local essential service. 

helicopter

Service Methods of Operation and Details

TCLS has operated as a non-profit since 1993, providing 911 advanced life support (ALS) ambulance service to the majority of Trinity County.  Bordering ambulances providing service in Trinity County are Southern Trinity Area Rescue (STAR) ambulance serving the communities of Mad River and Zenia-Kettenpom, and Hoopa Ambulance in the West, serving Hawkins Bar and Salyer.

Our service was formed with a focus on quality patient care and the provision of emergency medical training to our volunteer fire departments and community.  Our mission statement, written 26 years ago, remains the basis of our operations. 

“Trinity County Life Support’s Mission is to provide the highest level of advanced life support pre-hospital emergency medical services to our community, and to assist in the education and training of our local fire departments, schools, and the general public on health and safety issues.”

TCLS has a staff of 20, 17 of whom are ambulance attendants.  10 are full-time, working either 3 consecutive 24-hour shifts per week.  The remaining 7 are part-time or casual, scheduled for open shifts.  Ambulance staff are ALS Paramedic or basic life support (BLS) EMTs.

The ambulance staff is assigned a 24-hour shift, receiving 16 hours of pay, the additional 8-hours are paid only if the sleep period is interrupted.  Full-time employees work 3 consecutive 24-hour shifts.  

Management staff (2) is paramedics, each working part-time hours.   There is just 1 staff member who is not an emergency responder, this is a full-time position performing daily business, training center, and membership functions.

TCLS maintains four ambulances in readiness, two staffed 24/7.  One each is stationed in Weaverville and Hayfork.  Two reserve ambulances are in Weaverville, off-duty staffing is called in when needed and available.  Preferred ambulance staffing is one ALS and one BLS crew member.  TCLS has struggled to recruit and retain Paramedic staffing due to shift structure and non-competitive wage.  This is resulting in basic life support staffing (two EMTs) at times on our Hayfork ambulance. 

The Weaverville Station is a 35-year lease with County of Trinity, entered in 2009. The terms of the lease require $1 annually, TCLS is responsible for upkeep and maintenance of the buildings and grounds.  This facility, constructed in 1948, has been renovated extensively with reserves and grants and consists of office space, classroom, crew quarters and a detached 3 bay-garage for ambulances and supplies. 

 

Hayfork Station is a two-bedroom one bath house for on-duty Hayfork crew.  This building is owned by TCLS and was paid off in 2014.

 

This photo is the Hayfork station getting an exterior paint update with materials donated by Bayley Lumber.  The TCLS crew was painting, three awesome Hayfork Fire personnel spontaneously dropped in and joined the effort. 

ladder

Ambulances are registered to County of Trinity as a courtesy to TCLS for the benefit of DMV fee exempt status.  Current ambulances:

Ambulance Model Milage Location
2016 Mercedes Sprinter 4x4
66,350 miles
Weaverville First-Out
2013 Chevy 2500
135,000 miles
Hayfork First-Out
2007 Ford E350
178,680 miles
Weaverville Second-Out
2002 Ford E350
277,898 miles
Weaverville Third-Out (new engine/trans 93,664 miles)

Ambulances are purchased with TCLS reserves and grants.  Ambulance replacement occurs based on mileage and reliability.  Ambulances rotate out of first-out status at 150,000 miles.  First out ambulances travel an average of 30,000 miles annually.  Second and third-out ambulance mileage is approximately 2,000-3,000 miles per year.

The USDA Rural Development Community Facilities program has granted 75% of the purchase price for 2019 Sprinter 4×4 for Hayfork, projected for December.  McConnell Foundation is contributing towards our 25% match.

AmbHeliPicSec4End22552

Ambulance Response Data

Call volume is remarkably stable with an average annual 1500 calls for service.  Call volume has not changed significantly for years.  Revenues result from billing of this call volume.  The cost of being “911 ready” with staff, supplies, equipment and ambulances steadily increases.  New scopes of practice and medications add life-saving capabilities but also additional expense.

Our service area is over 2000 square miles, containing the ten communities and volunteer fire departments on the following table.  (Exception – Mad River, a mutual aid response.)

Following are call statistics for the most recently completed year, 2018.  Each number represents a person needing emergency care.  The communities of Hayfork, Hyampom, Post Mountain (numbers included with Hayfork), and Wildwood are served by Hayfork Ambulance 303.  The balance served by Weaverville Ambulance 301.

Location

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Totals

Coffee Creek

1

1

1

1

0

1

0

1

4

0

3

0

13

Douglas City

13

7

9

10

8

10

8

9

5

5

8

4

96

Down River

4

1

0

3

3

8

0

0

4

1

5

6

35

Happy Camp

0

0

0

0

0

0

0

0

0

0

0

0

0

Hayfork

26

35

60

32

31

34

56

48

40

32

29

48

471

Hyampom

0

1

0

0

1

1

0

1

3

2

1

2

12

Junction City

6

3

0

2

10

6

4

5

4

2

3

5

50

Lewiston

10

12

18

11

17

11

7

14

13

9

14

8

144

Mad River

 

0

0

0

0

0

0

0

0

0

0

1

1

Trinity Center

5

0

3

6

6

7

1

0

3

3

1

2

37

Weaverville

49

31

59

44

48

60

69

54

61

41

50

40

606

Wildwood

1

3

0

0

3

0

0

2

0

0

0

0

9

Total

115

94

150

109

127

138

145

134

137

95

114

116

1474

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Call Type

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Totals

IFT

10

5

12

12

7

15

9

12

11

11

8

13

125

Scene

105

89

138

97

120

123

136

122

126

84

106

103

1349

Total

115

94

150

109

127

138

145

134

137

95

114

116

1474

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Non-Transport

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Totals

Cancel

17

18

22

21

28

26

18

14

20

15

12

18

229

Coroner

4

0

1

2

2

2

1

1

6

1

1

1

22

Public Assist

1

1

0

0

2

1

2

4

1

3

0

1

16

Release/AMA

13

4

17

6

11

12

13

11

10

9

17

7

130

Standby

1

1

5

0

0

0

1

0

1

2

3

0

14

Total

36

24

45

29

43

41

35

30

38

30

33

27

411

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Transport

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Totals

Treat/Transport

73

60

92

74

70

85

94

93

92

61

75

82

951

Transfer Care

4

7

8

1

5

6

10

5

0

2

0

6

55

LZ Transport

2

3

4

5

9

6

6

6

7

2

6

1

57

Total

79

70

104

80

84

97

110

104

99

65

81

89

1063

IFTs (interfacility transfers) are medically necessary transports by ambulance from Trinity Hospital for patients requiring a higher level of care for specialties such as cardiology, neurology, orthopedic consultations, ICU (intensive care unit) and other medical specialties not available locally.

Non-transport calls may result in pre-hospital care being provided with use of supplies, fuel and personnel time.  Roughly 28% of total responses will generate little to no reimbursement. 

transport chart

Ambulance

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Totals

Weaverville 301

83

60

89

70

85

94

92

77

91

62

73

64

940

Hayfork 303

26

29

50

35

32

37

45

49

38

30

36

48

455

Weaverville 302

5

5

10

4

8

7

8

1

8

3

5

4

68

Third Out 308

1

0

1

0

2

0

0

7

0

0

0

0

11

Total

115

94

150

109

127

138

145

134

137

95

114

116

1474

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Destination

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Totals

Enloe Hospital

0

0

0

0

0

0

0

0

1

0

1

1

3

Trinity Hospital

41

39

57

42

44

54

76

56

59

40

51

47

606

Mercy Hospital

23

19

28

27

25

31

15

33

33

17

27

24

302

Shasta Regional

11

5

9

9

8

6

9

10

6

7

3

9

92

St. Elizabeth

0

0

0

1

0

0

0

0

0

0

0

0

1

St. Joseph

0

0

0

0

0

0

1

0

0

0

0

1

2

UC Davis

0

0

1

0

1

0

0

0

0

0

0

0

2

TCLS Ambulance

4

7

9

1

5

6

9

5

0

2

0

7

55

Total

79

70

104

80

83

97

110

104

99

66

82

89

1063

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Air Ambulance

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Totals

CHP

0

0

1

1

0

0

0

0

0

0

0

0

2

Enloe

0

0

1

0

0

1

0

0

0

0

0

0

2

Reach

1

3

1

3

4

3

2

5

1

1

4

1

29

PHI

1

0

1

1

5

2

4

1

6

1

2

0

24

Total

2

3

4

5

9

6

6

6

7

2

6

1

57

Historically, the Weaverville ambulance runs two-thirds of TCLS call volume, with this trend continuing for 2018. 

patient destinations

Patient destination decisions are based on medical condition and level of care needed to treat the emergency.  TCLS ambulance is listed as 5% of patient destinations.  This is one TCLS ambulance handing off to another TCLS unit for continued care and transport.  This occurred once in 2018 due to a mechanical issue, and it can occur at a scene with multiple patients.  In the last few years, beginning in 2017, Hayfork 303 is sometimes staffed at BLS level by two EMTs.

When Hayfork 303 is staffed BLS, Weaverville 301 is dispatched to the call with 303.  BLS 303 arrives, assesses medical condition, provides care, and

  • Transports to Trinity Hospital, releasing 301 if BLS care is appropriate, or
  • Transports toward 301 for ALS rendezvous, or
  • Transports toward air ambulance as appropriate

BLS staffing in Hayfork is due to the long-term challenge in retaining paramedics due to pay and shift structure.  This situation affects all the areas we serve.  Hayfork was staffed BLS for 25% of 2017, 18% of 2018, and 9% year-to-date in November of 2019.  The EMTs working the BLS ambulance, a number of them Hayfork residents, are proud to serve the community in this way.

percentage air medical

Air ambulances are utilized based on patient condition and distance from the hospital.  This very important resource is based on the need to reach a distant destination faster, especially from remote areas, in cases like a stroke, a myocardial infarction “heart attack”, trauma, and other conditions where expidited arrival will benefit patient outcome.

In 2018 95% of patients were transported by ground, 5% were transfesrred to air medical service.

TCLS transport revenue comes from Medicare (50%), Medi-Cal (29%) Insurance (14%) and Private Pay (7%).  These percentages remain stable for Trinity County, with the most notable change in the last 10+ years being a decrease in private pay/indigent and increase in Medi-Cal, attributed to the Affordable Care Act reducing Medi-Cal eligibility thresholds. 

 

payer mix

In impoverished rural service areas such as Trinity, ambulances are recognized as the primary access to medical care for families in poverty. 

Medicare and Medi-Cal pay a fixed rate, both less than the cost of providing service, resulting in unreimbursed costs.  Medi-Cal reimbursement is significantly less than cost, resulting in a shortfall of over $500/transport.

Listed below is detail on Patient billing for a one-year period, July 1, 2017 to June 30, 2018:

Payments

Responsible Party

# Patients Billed

Cost to Serve

Unreimb Cost

$20,251

010 -Self Pay

88

$82,600

($62,349)

$53,511

020 -Medicare

75

$70,397

($16,886)

$116,903

021 –Medicare-Medi-Cal

220

$206,499

($89,596)

$166,191

022 -Medicare/Insurance

206

$193,358

($27,167)

$12,708

030 -Medi-Cal Fee for Service

34

$31,913

($19,205)

$48,711

030 -Medi-Cal Managed Care

247

$231,842

($183,131)

$220

033 -Medi-Caid Other State

2

$1,877

($1,657)

$3,040

034 -Insurance/Medi-Cal

1

$939

$2,101

$43,980

040 -Commercial Insurance

54

$50,686

($6,706)

$118,906

050 -Blue Cross

47

$44,116

$74,790

$58,780

051 -Blue Shield

27

$25,343

$33,437

$9,585

060 -Third Party Liability

6

$5,632

$3,953

$12,450

070 -Workers Comp

10

$9,386

$3,064

$665,236

 

1017

$954,588

($289,352)

 

Public Safety Training Facility

TCLS is a public safety training facility, serving volunteer fire departments, Trinity Hospital, and the community at large.  Support of the volunteer system is an essential function for TCLS and we are training an average of 300 persons in public safety courses annually. 

TCLS teaches American Heart Association and American Red Cross Professional and Layperson First Aid and CPR, Public Safety First Aid (entry level minimum for volunteer fire personnel), Emergency Medical Responder (EMR), Emergency Medical Technician (EMT). 

The EMT program, implemented in 2016, ensures that classes can occur regularly.  Previously taught by Shasta College with a 25-student minimum, classes routinely had to be cancelled due to low enrollment.  This was negatively impacting the system with lack of available EMTs to hire and for local volunteer fire departments.  We are very pleased to be teaching the class and are reaching out to the high schools as a source of vocational training.  Below are education outreach numbers for the last ten years. 

EDUCATION OUTREACH

2009

2010

2011

2012

2013

2014

2015

2016

2017

2018

Healthcare CPR

129

194

95

203

110

262

130

222

144

152

First Aid/CPR

101

121

71

106

84

141

152

124

131

118

Public Safety First Aid

33

23

31

13

30

0

0

36

20

32

Emergency Med Responder

      

6

 

12

 

Emergency Med Technician

       

5

7

11

 

263

338

197

322

224

403

288

387

314

313

Emergency medical training is the foundation of everything that we do for the community.  It is critical for quality care.  It is the foundation for good patient outcomes.  Budget shortfalls threaten progress.   

car turned
class

Financial Data

Below are unaudited actuals for 2018.

REVENUE

 

Patient Income

$677,336

Membership

$57,272

Community Outreach

$26,523

Fire Camp – Carr Fire

$80,675

County Subsidy

$55,000

County IGT

$60,223

 

$957,030

  

EXPENSE

 

Employee Benefits

$75,869

Operations

$173,362

Payroll

$717,125

 

$966,356

  

NET REVENUE

-$9,326

  

Interest Earned

$1,108

  

NET REVENUE

-$8,218

Patient income is from billing for services.  Medicare, Medi-Cal, Private Pay, Insurance are the primary payers.

Membership is offered for TCLS ground ambulance service and the Alliance membership for ground and local air ambulances, Reach and PHI.   Membership ensures no out of pocket expense for medically necessary emergency transport.

Community outreach is a combination of donations and income generated by TCLS training facility.

Fire camp revenue is available sporadically.  Just over $80,000 in revenue was generated in 2018 by contract ambulance standby for the Carr Fire. 

The 2018 budget deficit would have been over $88,000 without the fire contract. 

Contract subsidy from County of Trinity includes a $55,000 Health Realignment contribution, and IGT (Intra-Governmental Transfer) reimbursement related to Healthcare Reform and Partnership Health Plan.

2018 income sources
2018 expense

Employee benefits, training, uniforms, licenses, certification and physicals is 8% of total expense. Combined with 74% expended for wages, payroll taxes, simple IRA 3% match and workers’ compensation, staffing is 82% of total expense. 

Operating expense including administrative functions such as dues and subscriptions, accounting, office and household supplies, facilities, plus ambulance fuel, repair, medical supplies, patient care reporting software, is 18% of total expense. 

multi year income

Revenues are stable.  Patient billing is timely and efficient with 70-80% of allowable charges collected within 90 days. 

multi year expense

Administrative staff was cut long ago to protect patient care staff.  TCLS expenses are directly tied to patient care services.  Trinity County Life Support is now utilizing reserves to protect ambulance staffing levels.  There is very little overhead staff, an arrangement that is no longer functional due to increasing workload and mandated reporting. 

ending cash bal

Ordinary operating expense exceeds income and will continue to do so.  Reserves, built carefully, are being used to protect service levels rather than address deferred maintenance and needed equipment updates. 

With our current stable income base (call-volume based), the only way to meet the escalating expense of staffing, equipment and supplies is to reduce staffing and service levels or secure an additional and stable revenue source.  A reduction in staff/service is detrimental to the people we serve. 

This is not a new problem to Trinity County Life Support and it is a common problem for rural ambulance services across our Country.   It is worsening.  We are all struggling to preserve service and find the solution to protect patients.  Healthcare reform continues, Medicare reform is underway, but the issue of less than true cost reimbursement from Medicare and Medi-Cal is long embedded.   At this point we have little confidence that it will be addressed and no option to wait this out.  We need your assistance now to protect lives of patients and the jobs of ambulance caregivers.    

State and Federal programs that support rural services have been contacted and continue to be monitored.  There are grant programs available for equipment and training and we rely on these regularly, but there are no programs configured to pay for staffing. 

There are two programs that provide some relief of Medi-Cal shortfalls.  These programs, GEMT (Ground Emergency Medical Transport) and IGT (Intra-Governmental Transfer) do not extend to non-profits. 

GEMT is a stable program with no sunset date. It pertains to Medi-Cal Fee for Service, a small percentage of our Medi-Cal mix.  The IGT program, reimbursement for shortfalls of Medi-Cal Managed Care, is continuing this fiscal year.  Beyond that the status of this program is unknown. 

Partnerships with Trinity PUD, Trinity Hospital (Mountain Communities Healthcare District), and the Weaverville Fire Protection District were explored as a possible route to these reimbursements.  We found that a contract/partnership relationship fully exposes those agencies to TCLS financial liability.

A County-run ambulance was discussed and found to be unsustainable. 

The solution recommended by representatives of the above districts, County representation, Local Area Formation Commission (LAFCO), and EMS consultants (who donated their time) is the formation of a special district for access to potential reimbursements of Medi-Cal shortfalls, and a request to voters to assist in the stabilization of ambulance service with a parcel assessment.  The Trinity County Life Support Board of Directors believes this is the best option to stabilize our service for long term operations.     

Measures D and E on the March 2020 ballot.  A campaign committee has been formed, “The Committee to Pass Measures D and E”, and they are working to get the word out to voters.  You can learn more, join the effort, and donate on their website www.tlscsd.org