Vision WestJuly 18, 2013

Division of EMS & TraumaND Department of Health

Tom Nehring

Reality

What I Am What I Am Not

Division Director – Ambulance Services and Trauma

Given Advantages Because of Rural EMS Improvement Project and Very Active NDEMSA and OIEMS

Focused on Oil Impact Because of the Ever Changing Impact on Trauma and Ambulance Services

Healthcare Oil Impact Guru Recognized Authority for

Representing the Entire Continuum of Healthcare

Ahead of the Impact Able to Give a Complete

Picture in One Hour

BAKKEN ACTIVITY

2010 - 2011Estimates 2013 March Actual

178 drilling rigs 5,439 active wells 359,589 barrels per day 2,000 new wells to come

on line in 2011 1,500- 1,900 new wells per

year up to 21,250 wells (NDSU, 2010)

Possibly 50,000 new wells (Bismarck Tribune, 2010)

189 drilling rigs 8634 active wells 24,267,186 in

March Almost 800,000 barrels per

day Possible peak of 2 – 3

billion per day 1,500- 1,900 new wells per

year up to 41,200 wells

Issues Boom has not peaked Uncertain about size of future demand Not confident about information Current needs are greater than resources

Oil/Energy Impact in HealthcareJust keeping up!!!

Oil/Energy Impact

a crisis within a crisis with all the characteristics of a slow disaster, presenting dangers to patients, providers and the public.

Oil/Energy ImpactMagnitude

Populations growth Housing Traffic / roads Public safety The money

Oil/Energy Impact 7 Challenges 1. Increasing demand for service2. Difficultly getting keeping staff3. Where to live4. Real and perceived safety issues5. Funding issues6. Lack of collaboration7. Just keeping up

Oil/Energy Impact Getting and Keeping Staff Some workers have left jobs for oil jobs Long distance transport time difficult for

volunteers Difficult to compete with oil wages Hiring nearly impossible Housing shortage and cost of housing

Entire continuum◦ Dispatchers◦ First Responders/QRU, Law Enforcement, Fire, etc.◦ Emergency Medical Services◦ Clinics◦ Physicians◦ CAH Hospitals◦ Tertiary Hospitals◦ Long Term Care Facilities◦ Public Health◦ Disaster Preparedness◦ Health Department◦ Other healthcare delivery entities◦ Patients

Who Is Impacted

Level 1 – Big four – Epicenter - Mountrail County, McKenzie County – Williams County – Dunn County

Level 2 – Divide County – Burke County – Billings County – Bottineau County – Bowman County –Stark County

All Others – Peripheral Impact Based on Active Rigs and Oil Production Production Tax

Size of Impact Area

17 original oil impacted counties Recently added two more 44 ambulance services within impacted

area 3 ambulance services that are full time 41 ambulance services that are volunteer

Ambulance Services

Since 2006◦ Non-oil agencies increased 5.37%◦ Oil related agencies increased 58.99%

Epicenter agencies increased as much as:◦ Watford City 628%◦ New Town 164%◦ Billings County 238%◦ Killdeer 257%◦ Dickinson 94%

EMS Volume Issues

Fatalities increasing dramatically 2 times last year

More domestic issues/violence Large increase in motor vehicle accident Greater acuity of those injured Much more traffic Unable to respond as 1st responders on EMS calls Unavailable because of workload Have had to provide housing or allowances Workforce

Law Enforcement

Oil/Energy Impact

“This is crazy.” “We’re overwhelmed.” “You can’t assess this with the numbers. You have to see it.” “It’s getting worse everyday.” “We’re starting to understand big city EMS.” “Some days its nonstop.” “We’ve never been so busy.” “We used to know our patients, now we don’t know anyone.” “No need to turn on lights and sirens, no one pulls over.” “You’ve got both hands gripping the wheel where ever you go – it’s exhausting.” “They’re making new roads and wrecking roads faster than we can keep up.” “We were having trouble keeping people before all this.” “Who wants to volunteer to take care of people who are making thousands and don’t care you have to get

up at night?” “If we had money to hire people where would we put them?”

(EMS leader/provider interviews)

NW Trauma region increase 108% from 2007 to 2011◦ 2007 – 750 cases vs. 2011 – 1556 cases

Trinity In Minot increased in trauma 107% from 2007 to 2012◦ 2007 – 490 cases vs. 1015 cases in 2012

This is the busiest quadrant of the state for trauma

Trinity is the busiest hospital for trauma in North Dakota

Oil/Energy ImpactIncreasing Demand

Myth Because of increased volume in healthcare

everyone should be making more money Cost/needs vs. revenue Bad Debt vs. transient population (workers

making increased money does not translate into less bad debt)

Hospitals – Survey by ND Hospital Association Bad debt – more significant in oil impacted

areas Increase in ER visits Turnover percentage Open positions at year-end Annual contract labor costs Increased wages and benefits Housing crisis

NDHA Top 3 Concerns Growing bad debt Workforce Housing

Physicians & Other Providers Large increase in volume Much more time spent in ER Recruitment and retention – communities

not the same Cannot offer appointments as in the past Transfers – paperwork, notification,

arranging details

Long Term Care Suffers from the same issues as others Contract staffing Workforce issues Housing Older permanent population moving out of

area

Oil/Energy Impact Funding Issues

Increased costs of response/readiness Equipment Vehicles Workforce Workforce housing Training No pays Updating or building new facilities

Oil Impact Grants2012 Calendar Year 3rd Cycle – Emergency Services – Starts in

January 44 Million dollar ask for 2 million dollar

availability Was increased to 12 million Only included EMS, Law Enforcement, Fire Did not include funding for staffing Additional cycle started in August – 4 million

available

Oil Impact Grant2013 Calendar Year EMS – 7 million dollars Starts in September ? Staffing Hospitals – low interest loan program – 40

million dollars – task force working on applications

Fire and Law Enforcement

Stop!! Dividing into separate and distinct groups

all asking from the same sources (funding) Keeping challenges to your group Ignoring the issues Living in the present

Recommendations Tell a uniform story over and over and over

again to anyone who will listen Promote collaboration and regional planning Practice workforce planning Define meaningful performance measures

and collect appropriate data Become familiar with real data and

incorporate into the story Temporary staffing relief

Recommendations (cont.)

◦ Supplemental staffing grants◦ Equipment, vehicle, facility grants ◦ Training for oil rig response and safety ◦ Housing ◦ Supplemental long-distance transfer resources◦ Reimbursement for no-pays◦ Informing politicians about what is going on

DEMST Website nd.gov/health/ems

Questions?