HomeMy WebLinkAboutRES 13-027RESOLUTION NO. 13 -027
BE IT RESOLVED BY THE CITY COUNCIL OF THE
CITY OF BEAUMONT:
THAT the City Manager be and he is hereby authorized to execute all documents
necessary to enter into a Resource Memorandum of Agreement between the City of
Beaumont EMS Division and Southeast Texas Regional Advisory Council (SETRAC) for
the utilization and coordination of emergency medical resources and assets in the event
of an emergency or disaster.
PASSED BY THE CITY COUNCIL of the City of Beaumont this the 5th day of
February, 2013.
• i
•
TX EMTF MOA 09/25/2012
TEXAS EMERGENCY MEDICAL TASK FORCE
RESOURCE MEMORANDUM OF AGREEMENT
This Texas Emergency Medical Task Force Memorandum of Agreement ( "TX EMTF
MOA ") is entered into by and between a Department of State Health Services- designated
Lead Regional Advisory Council ( "Lead RAC ") SouthEast Texas Regional Advisory
Council (SETRAC , Mr1 authorized to do business in the state of Texas, an
a Resource hereafter referred to as
Resource that wishes to participate as a member of Emergency Medical Task Force
( "EMTF ") in Region 6 (collectively, "the Parties ").
TERM: Ongoing until cancelled by either party with notice to the other.
507) Purpose:
The purpose of this TX EMTF MOA is to establish a mechanism for the utilization and
coordination of emergency medical resources and assets in the event of an emergency or
disaster, for training purposes, or any other purpose as determined by the Lead RAC,
EMTF Region, or DSHS. Assets may be those in the possession of the Hospital
Preparedness Program (HPP) "Contractor" or "Subcontractors," as well as others
identified through local and regional planning efforts and subcontractor agreements.
Additional purpose statements are included in subsequent sections, appendices, and
addenda of this document that relate to specific equipment, supplies, and personnel.
548) Activation & Documentation.
A) Activation
1) This agreement may be activated for a State tasked deployment, only by
written notification (the "State Mission Assignment ") by the designated DSHS
SMOC Director or his/her designees.
2) This agreement will be activated by written notification (the "State Mission
Assignment ") by the designated Lead RAC official.
3) Activation, pursuant to this TX EMTF MOA, may occur at any time, day or
night including weekends and/or holidays, only after an official written State
Mission Assignment has been sent to the designated Agencies contact(s).
4) The Resource acknowledges that assets and/or resources may be requested for
activation for any purpose in Section 1.
S) Lead RAC will reimburse the Resource the amount funded to the Lead RAC by
EXHIBIT "A"
TX EMTF MOA 09/25/2012
DSHS, after submission of completed required documentation per this agreement,
for actual costs allowable by DSHS incurred in order to make the assets and/or
resources ready for deployment and all allowable costs incurred under the State
Mission Assignment, from the time of activation through demobilization as per
the Reimbursement section of this agreement (Section 5).
6) The Resource must acknowledge receipt of the State Mission Assignment
within one (1) hour and must accept or decline the Mission within two (2) hours
of receipt. Upon acceptance of the State Mission Assignment, the Assets must be
enroute to the designated mission within the parameters of the State Mission
Assignment.
7) For cost reimbursement purposes, the Mission will start when the Asset is
activated to be "made- ready" for deployment and will conclude at the time the
deployed Asset is ready for re- deployment from its home base after the Lead
RAC issues a Demobilization Order or the terms of the State Mission Assignment
have been met.
8) The State Mission Assignment will include, at a minimum, the following:
(a) Authorization to activate;
(b) List of resources or assets requested;
(c) Number and qualifications of personnel for the activation;
(d) Reimbursement processes for personnel & resources activated, including
backfill as defined in Appendices A -D.
(e) Description of activities (including purpose, location to report, etc.); and
(i) Expected duration of the deployment.
B) Documentation Within four (4) hours of acceptance of the activation, the
Resource will receive the official packet containing the State Mission Assignment
and reimbursement forms.
509) Terms & Community Support:
A) Terms
1) The Lead RAC shall:
(a) Activate sufficient In -place assets, to include personnel, to effectively
implement the State Mission Assignment.
(b) Efficiently notify and deploy Agencies as defined in the State Mission
Assignment.
(c) Ensure all Agencies have a current, executed TX EMTF MOA in place at
the time of Activation.
(d) Assure detailed records of expenditures and time spent by Deployed and
In -place Assets are complete, accurate, and have adequate supporting
documentation as determined by DSHS.
(e) Establish. and maintain a roster of all deployed personnel and resources to
facilitate accountability.
(f) Maintain a list of Resource contacts and back -ups for Activation and
Mutual Aid purposes, including name, e-mail address, and primary /secondary
phone numbers.
(g) Maintain a list of 24/7 contact information for all activated Agencies.
0)
TX EMTF MOA 09/25/2012
2) The Resource shall:
(a) Certify that all assets (personnel, resources, and equipment) meet all
licensing, training and certification requirements related to his/her /its
particular profession and/or mission.
(b) Make necessary travel arrangements for its deployed assets. Travel
reimbursement will be at State of Texas rates unless otherwise agreed in
writing prior to deployment.
(c) Ensure deployed personnel are rostered as employees of the Resource.
3) Term of this agreement
(a) Term of this agreement shall begin on the date TX EMTF MOA is signed
by the second of the two Parties. This TX EMTF MOA may be terminated by
either Party with thirty (30) days written notice to the other Party.
B) Community Support
1) This agreement is not intended to replace any mutual aid agreements or
compacts that a Resource legally has in place in support of its community.
510) Legal Liability & General Financial Liability:
A) Legal Liability
1) Resource shall have no right, and does by this agreement waive its right, to file
a claim(s) against DSHS, the State of Texas, and the Lead RAC for any personal
or property injuries, damages or requests for State subrogation for any tort that
they may incur during activation or arising therefrom, or any other claims filed
against them as a result of their activities during activation. DSHS, the State of
Texas, and the Lead RAC do not waive any immunity from suit or liability that
they may have under state /federal laws and the Texas constitution
notwithstanding the above. To the extent that Resource is a local governmental
entity, unit of State government, or a Texas political subdivision, the waivers
provided herein are further subject to state law and the Texas constitution which
may make them unenforceable in whole or in part.
2) Resource shall assume responsibility for liability claims, malpractice claims,
disability claims, workers' compensation claims, attorneys' fees, and other
incurred costs.
3) Resource shall assume responsibility for their own acts of negligence.
B) Financial Liability
1) The Resource shall continue to assume legal and financial responsibility of the
personnel and equipment during the time of activation or deployment.
3
TX EMTF MOA 09/25/2012
511) Reimbursement:
A) Summary
DSHS, in conjunction with the EMTF program, is committed to timely
reimbursement of EMS agencies and other entities that provide resources and
personnel in times of disaster activation.
The steps below outline the process for DSHS to reimburse the provider within 45
days after a complete and accepted reimbursement packet is received at DSHS.
EMS agencies are encouraged to file their reimbursement packets through their
Lead RAC as quickly as possible to ensure timely reimbursement from DSHS and
no later than 6 (six) months after the demobilization.
The 45 day reimbursement timeline will begin only after a completed and
accepted reimbursement packet is accepted at DSHS.
B) Process
1) The Resource submits reimbursement packet to the Lead RAC
2) Lead RAC review the Packet for completeness
(a) If complete, the Lead RAC will invoice DSHS and include the packet for
reimbursement
(b) If not complete, the Lead RAC will work with the Resource to complete
the packet then submit and invoice with the packet for reimbursement.
3) DSHS will review the packet received
(a) If complete, DSHS will provide reimbursement to the Lead RAC.
(b) If incomplete,
(i) DSHS will work with the Lead RAC, or directly with the Resource if
appropriate, to identify the corrective action needed.
(ii) Once complete, DSHS will provide reimbursement to the Lead RAC.
(c) After receipt of the reimbursement from DSHS, the Lead RAC will
provide reimbursement to the Resource.
512) Credentialing:
A) The Resource shall certify that all personnel meet all licensing, training and
certification requirements related to his/her particular profession and/or mission.
B) When responding to a licensed hospital/healthcare facility, the authorized
administrator (or designee), of the requesting/impacted facility, shall be responsible
for providing a mechanism for granting emergency credentialing privileges for
physicians, nurses, and other licensed or certified healthcare providers to provide
services.
4
TX EMTF MOA 09/25/2012
513) Ambulance Strike Teams:
A) Purpose:
1) The purpose of this section is to establish a mechanism to mobilize properly
staffed and equipped Ambulances to be deployed in an Ambulance Strike Team
(AST) configuration (five (5) ambulances and an AST Leader) or other
configurations as deemed appropriate for the mission (i.e. individual ambulance
resources) as provided for in this TX EMTF MOA.
2) The Lead RAC has been tasked to enter into MOU/MOAs with EMS Agencies
to provide a minimum of five (5) ASTs from its EMTF regional area.
B) Terms for Agencies;
1) The Resource and its assets must meet the following criteria:
(a) Must be DSHS Licensed EMS Provider
(b) Must have at least twelve (12) months of experience providing local
and/or long distance emergency medical services to live human beings in the
State of Texas.
(c) Must maintain a business office within the boundaries of the State
of Texas.
(d) Must adhere and abide by all federal, state and local laws and must
adhere and abide by the Texas Health & Safety Code, Chapter 773,
Emergency Medical Services and the Texas Administrative Code,
Title 25: Health Services, Chapter 157: Emergency Medical Care
during the time of its deployment to provide mutual aid in a pending or
actual disaster and must adhere and abide by all laws and rules at all
times.
(e) Must keep detailed records (utilizing the DSHS and /or Lead RAC
packet of documents /forms) of the services requested and fulfilled, and
provide those records, as requested, to the Lead RAC to include, but
not be limited to:
(i) Patient Care Records;
(ii) Patient demographics, including patient(s) insurance
information;
(iii) A Time Log Record form of activities
(f) Must keep all receipts of expenditures during deployment, and
submit all requested information for reimbursement on the provided
documentation for prompt reimbursement under this TX EMTF MOA.
(g) Must be required to be self - sufficient for 72 hours and should be
aware that personnel could be living in austere field conditions.
(h) Resource must meet DSHS requirements for minimum, lawful
staffing per that DSHS licensed ambulance level.
(i) This TX EMTF MOA calls for each ambulance to have the
minimum number of individual crew members as required by license,
per vehicle deployed. Additional crew or support staff members, and
any vehicles they may require, must be included in the State Mission
Assignment to be eligible for reimbursement.
0) The DSHS Licensed ambulance provider must bill primary sources of
TX EMTF MOA 09/25/2012
reimbursement, such as Medicaid, Medicare, private insurances or third party
providers before sending an invoice to the Lead RAC. The DSHS Licensed
ambulance provider must submit to the Lead RAC within ninety (90) days
proof of denial, proof of payment, or request for reimbursement for each
patient that is transported. ** This requirement may only be excused by
DSHS issuing a statement or memorandum of such to the Lead RAC for this
activation. The provider must reimburse DSHS if they receive primary source
or third party reimbursement after receiving payment from DSHS.
(k) EMS Provider will be reimbursed at the rates in Appendix A.
514) Professional Staff:
A) Purpose:
The purpose of this section is to establish a mechanism whereby certified or
licensed professional medical or support staff may be deployed to provide various
clinical or support services as requested by the Lead RAC.
B) Description
1) As the Lead RAC enters into MOU /MOAs with DSHS EMS Providers for
EMS Staffing. The following list is representative of the principle tasks EMS
Personnel might be activated to accomplish:
(a) Medical support provided on buses (coach type bus or school bus)
designated to evacuate individuals with medical needs (estimated to be from 2
to 5 EMS Personnel and/or nursing staff per bus). Bus evacuees will
primarily be from hospitals, nursing homes, or are the general public who
have medical needs and require medical oversight during evacuation, but do
not meet ambulance transport criteria.
(b) Field supervision or ASTLs who will manage Ambulance Strike teams
comprised of 5 -7 ambulances and or AMBUS(es) and will report to the
appropriate Incident Command structure.
(c) Uniquely tasked EMS personnel who will serve at any level in the
Governor's Division of Emergency Management Incident Command structure
as assigned. This could include an air /ground coordination team in a DDC,
Medical Incident Support Team (M -IST) members, the State Operations
Center or Medical Operations Center, a Regional Medical Operations Center,
or in the disaster zone, and will be responsible for managing strike team
leaders, task forces, and some individual ambulance assets.
(d) Ambulance staging management and support.
2) As the Lead RAC enters into subcontracts with other entities or individuals to
provide professional medical staffing (physicians, nurses, other medical
professionals), technical and support services that would be used in the
deployment of any asset requested by DSHS, the EMTF Region, or the Lead
RAC, the following list is representative of the types of assets that might be
activated to accomplish the mission:
(a) Mobile Medical Units (MMUs) as outlined in this agreement.
(b) Other mobile shelters, vehicles, or trailers that may be used for command,
communications, storage, and any other identified reason in support of the
mission identified by DSHS.
Col
TX EMTF MOA 09/25/2012
C) Terms for Resource;
1) The Resource and its assets must meet the following criteria:
(a) If the Professional Staff is deployed to provide patient care, his or her
organization must have at least 12 months of continuing experience providing
medical services to live human beings in the State of Texas or being an
employee of an existing hospital providing direct patient care.
(b) Must maintain a business office within the boundaries of the State of
Texas.
(c) Must abide by all federal, state, and local laws.
(d) Will only deploy staff upon receipt and under the terms of the State
Mission Assignment as described in Section 2: Activations & Documentation.
(e) Will only deploy Resource employed staff as follows:
(i) EMS personnel must be currently certified or licensed in Texas at the
EMT -Basic level or above and who have no disciplinary actions pending
or under investigation that the Resource is aware of
(ii) Registered Nurses must be currently and routinely practicing in an
acute care environment providing direct patient care and who have no
disciplinary actions pending or under investigation that the Resource is
aware of.
(iii) Physicians must be affiliated with a healthcare Resource (either
directly or through a physician's group) and have no disciplinary actions
pending or under investigation that the Resource is aware of
(iv) Any other clinical staff must be employed by a healthcare Resource in
a position with the same scope of practice as their role in the activation
and have no disciplinary actions pending or under investigation that the
Resource is aware of.
(v) Any non - clinical staff must be also employed by the Resource.
(f) Will deploy the personnel ordered by DSHS in configurations designated
by the State Mission Assignment.
(g) Medical procedures undertaken by deployed EMS staff will be according
to protocols approved by the Resource's Medical Director. The MMU will be
under the direction of a physician on site.
(h) Must assure detailed records of expenditures and time spent by deployed
staff are complete, accurate, and have adequate supporting documentation.
(i) Will ensure deployed personnel are self - sufficient for 72 hours or as
detailed in the State Mission Assignment and should be aware that they could
be living in field conditions.
0) Must ensure that all deployed staff carries proof of his or hers individual
certifications and /or licenses as a Texas healthcare professional and a form of
picture identification with them at all times.
(k) Must assume responsibility for liability claims, malpractice claims,
disability claims, workers compensation claims, attorneys' fees, and other
incurred costs.
7
TX EMTF MOA 09/25/2012
515) Mobile Medical Units, Equipment, and Supplies:
A) Purpose:
1) The purpose of this section is to establish a mechanism for Mobile Medical
Units ( "MMUs "), which may include clinical personnel, support personnel,
equipment or any combination of the above per the State Mission Assignment, to
be deployed for any purpose defined in the TX EMTF MOA
B) Description:
1) The Lead RAC may enter into Subcontracts with other RACs, hospitals,
governments, or other entities to provide one or more MMUs to meet the Purpose
of this TX EMTF MOA including:
(a) Non - critical care capability
(b) Emergent care capability
(c) Temporary healthcare infrastructure
(d) Isolation capability, or as a
(e) Physical structural asset
C) Minimum requirements for a fully staffed MMU:
1) (Clinical and Support staffing) are:
(a) Sixteen bed capacity
(b) Staffing of teams sufficient to support MMU operations based on
capability as defined in the State Mission Assignment
(c) Minimum staffing per shift for each team includes clinical and logistics
staffing as defined for the primary mission in the State Mission Assignment
and consistent with DSHS typing.
(d) Clinical Staff may include MD /DOs, RNs, Paramedics/EMTs, MLPs
(PAs /APRNs), Pharmacy Technicians, clerks, etc.
(e) Logistics/Support Staff to support maintenance, electrical, HVAC,
communications, transportation, set -up, and demobilization as agreed to by
DSHS at the time of mobilization
(f) Supplies sufficient to fulfill primary mission per the State Mission
Assignment for 72 hours
(g) The Resource will schedule its MMU assets and estimated deployment
costs in Appendix D.
516) AMBUS(es)
A) Purpose:
1) The purpose of this section is to establish a mechanism whereby properly
staffed and equipped AMBUS(es) may be deployed for mass transportation and/or
care of sick and/or injured persons or to provide aid in a pending or actual disaster
as provided in this TX EMTF MOA.
B) Description:
1) The Lead RAC may enter into MOU/MOAs with EMS Providers, hospitals,
RACs or governmental entities which:
(a) Possess an AMBUS(es).
(b) The AMBUS will be licensed as a Specialty EMS Vehicle by DSHS.
8
TX EMTF MOA 09/25/2012
(c) The AMBUS will be staffed with trained and credentialed staff sufficient
to maintain operations
(d) The minimum staffing per shift are:
(i) Properly licensed vehicle driver
(ii) Crew Chief
(iii) 2 — Paramedics
(iv) 2 — EMTs or above
(e) The Resource will provide its AMBUS asset(s) list and estimated
deployment cost with Appendix B.
517) Miscellaneous
A) State Law. If state law applicable to the relationship between Resource and Lead
RAC contains additional or more stringent requirements than federal law regarding
any aspect of PHI privacy, then the Parties agree to comply with the higher standard
contained in applicable state law.
B) Consideration. Each Party recognizes that the promises it has made in this
Agreement shall, henceforth, be relied upon by the other Party in choosing to
continue or commence a business relationship with the other Party.
C) Modification. This Agreement may only be modified through a writing signed by
the Parties and, thus, no oral modification hereof shall be permitted. The Parties agree
to take such action as is necessary to amend this Agreement from time to time as may
be required by federal or state law.
D) Acceptance of Mission. Each Party understands and agrees that a Resource has
the ability to accept or reject a Mission.
E) Notice to Lead RAC. Any notice required under this Agreement to be given to
the Lead Resource shall be made in writing to:
Lead RAC: SouthEast Texas Regional Advisory Council
Attn. to: Lori Upton, Director of Preparedness
Address: 1111 North Loop West, Suite 160
City, State: Houston, Texas
Zip: 77008
Z
TX EMTF MOA 09/25/2012
F) Notice to Resource. Any notice required under this Agreement to be given
Resource shall be made in writing to:
CITY OF BEAUMONT PUBLIC HEALTH EMS
Name and Title
2870 LAUREL ST
BEAUMONT, TX 77702
With copy to:
G) Governing Law. This Agreement will be governed by and construed in
accordance with the laws of the State of Texas without regard to choice of law.
H) Transfer or Assignment
1) This agreement may be assigned or transferred, if a new Lead RAC is assigned,
without requiring the Agency to resign the agreement. The newly designated
Lead RAC will send a notice to the Resource with a current, printed copy of the
MOA and a NOTICE advising the Resource of the new Lead RAC.
2) The NOTICE will include the new Lead RAC information (SECTION 11 -E)
3) The NOTICE will also include a new Signature section as executed by the new
Lead RAC
4) Otherwise, neither party may assign, transfer, delegate, or sublicense any of its
rights or obligations under this Agreement without the prior written consent of the
other party
I) Entire Agreement. This Agreement constitutes the complete agreement between
the Parties relating to the matters specified in this Agreement, and supersedes all prior
representations or agreements, whether oral or written, with respect to such matters.
No oral modification or waiver of any of the provisions of this Agreement shall be
binding on either Party.
10
TX EMTF MOA 09/25/2012
IN WITNESS WHEREOF and acknowledging acceptance and agreement of the
foregoing, the Parties affix their signatures hereto
SETRAC
Lead RAC Abbreviation
SouthEast Texas Regional Advisory Council CITY OF BEAUMONT PUBLIC
HEALTH EMS
Lead RAC Legal Name Resource Legal Name
Signature Signature
Darrell Pile
Printed Name
Chief Executive Officer
Title
Date
Printed Name
Title
Date
11
TX EMTF MOA 09/25/2012
APPENDIX A
The TX EMTF reimbursement rates effective during the term of this Agreement for the
various Assets described are listed below. Any Asset not described or any deviation from
these amounts should be specifically included in the State Mission Assignment at the
time of the deployment.
47) Allowable costs for EMS Assets:
A) Lead RAC will coordinate reimbursement of a base rate for:
BLS, ALS, and MICU ambulances as per the current fee schedule.
B) with Volunteer Personnel:
1) Lead RAC will reimburse:
(a) Labor Rate of:
(i) $20.00 for paramedic,
(ii) $17.50 for EMT Intermediate,
(iii) $13.50 for EMT basic
for each hour the staff are deployed, plus overtime at time and a half the
established rate for any hours worked over 8 within each 24 hour period.
(b) Personal Cost: Maximum of $50.00 per crew member per deployment
(Total of $100.00 per two member crew) for items needed for the crew to be
self- sufficient during the deployment. These items may include food, water,
and personal care items. The DSHS EMS Licensed Provider must keep
receipts for these items and must submit them to the Lead RAC when the
DSHS EMS Licensed Provider submits an invoice to the Lead RAC.
C) Resource with Paid Personnel:
1) Lead RAC will reimburse:
(a) Actual labor costs
(b) Fringe benefits for two (2) crew members per ground ambulance.
(c) The overtime cost (1 /2 time) of staff required to fill the regular scheduled
shift of staff deployed.
(d) Personal Cost: Maximum of $50.00 per crew member per deployment
(Total of $100.00 per two member crew) for items needed for the crew to be
self - sufficient during the deployment. These items may include food, water,
and personal care items. The DSHS EMS Licensed Provider must keep
receipts for these items and must submit them to the Lead RAC when the
DSHS EMS Licensed Provider submits an invoice to the Lead RAC
(e) Repair of damaged equipment; if applicable.
Ambulance Reimbursement Table
12
Metric
BLS
ALS
MICU
Vehicle — one Ambulance
Per hour
$35.00
$40.00
$40.00
_ _
Per Diem -- based on $35.00 per day /per person of a two person
Amb. crew or six person AMBUS crew
Per hour
$2.92
$2.92
$2.92
Medical Supplies Cost — Based on daily rates (BLS $240.00 per
day eachxALS $288.00 per day eachXMICU or AMBUS
$360.00 per day each)_
Per hour
$10.00
$12.00
$15.00
Reimbursement Rates
Per hour
t $47.92
$54.92
$57.92
12
TX EMTF MOA 09/25/2012
APPENDIX B
The TX EMTF reimbursement rates effective during the term of this Agreement for the
various Assets described are listed below. Any Asset not described or any deviation from
these amounts should be specifically included in the State Mission Assignment at the
time of the deployment.
47) Allowable costs for AMBUS Assets:
A) Lead RAC will Reimburse:
1) Uncompensated salary costs of staff to "make ready" the Assets for
deployment once the State Mission Assignment has been issued; documentation
must be submitted for proof of payment;
2) Actual hourly labor costs of deployed staff plus fringe benefits
3) The overtime cost (1 /2 time) of staff required to backfill the regular scheduled
shift of staff deployed
4) Fuel;
5) Shipping/transportation fees;
6) Daily usage fee;
7) Actual cost for food and lodging will be reimbursed at the rates established by
the State Comptroller;
8) Personal mileage from home to deployment site and return at a rate per mile as
published by the State Comptroller for the time period specified or other specific
travel costs;
9) Use of rented vehicles will only be reimbursed at the rental rate as established
by the State Comptroller or as approved in the State Mission Assignment;
10) Use of personal vehicles will only be reimbursed for mileage using the
mileage rates currently in effect at the time of deployment as published by the
State Comptroller's office. No other expenses related to the use of personal
vehicles will be reimbursed;
11) Repair of damaged equipment; if applicable.
AMBUS Reimbursement Table
Item
Per Hour
_ Per Day
_
AMBUS
$40.00^
$960.00
_ _
Per Diem — based on $35.00 per day /per person
of a six person AMBUS crew
$8.75
$210.00
_
Supplies
$15.00
$360.00
Reimbursement Rates
13
TX EMTF MOA 09/25/2012
APPENDIX C
The TX EMTF reimbursement rates effective during the term of this Agreement for the
various Assets described are listed below. Any Asset not described or any deviation from
these amounts should be specifically included in the State Mission Assignment at the
time of the deployment.
47) Allowable costs for Professional Staff Assets:
A) Lead RAC will reimburse:
1) Paid staff:
(a) Actual hourly labor cost of deployed staff plus fringe benefits.
(b) Personal mileage from home to deployment site and return at a rate per
mile as published by the State Comptroller for the time period specified or
other specific travel costs (airline travel, rental vehicle, parking, etc.).
(c) The overtime cost (1/2 time) of staff required to fill the regular scheduled
shift of staff deployed.
2) Vehicles
(a) Resource -owned vehicles that will be used during deployment for field
supervision or team leaders will be reimbursed at daily FEMA established rate
per hour for vehicle type.
(b) Use of rented vehicles will only be reimbursed at the rental rate as
established by the State Comptroller or as approved in the State Mission
Assignment;
(c) Use of personal vehicles will only be reimbursed for mileage using the
mileage rates currently in effect at the time of deployment as published by the
State Comptroller's office. No other expenses related to the use of personal
vehicles will be reimbursed.
3) Support trailers or Vehicles
(a) Resource owned vehicles or trailers that are not supervisor vehicles may
be used by deployed personnel if approved on the State Mission Assignment.
Reimbursement for these Assets shall be reimbursed at the current FEMA
published rate.
4) Repair of damaged equipment; if applicable.
14
TX EMTF MOA 09/25/2012
APPENDIX D
The TX EMTF reimbursement rates effective during the term of this Agreement for the
various Assets described are listed below. Any Asset not described or any deviation from
these amounts should be specifically included in the State Mission Assignment at the
time of the deployment.
47) Allowable costs for MMU Assets:
A) Lead RAC will Reimburse:
1) Uncompensated salary costs of staff to "make ready" the Assets for
deployment once the State Mission Assignment has been issued; documentation
must be submitted for proof of payment;
2) Uncompensated salary costs of staff deployed with assets for set up and
management; documentation must be submitted for proof of payment;
3) Actual hourly labor costs of deployed staff plus fringe benefits;
4) The overtime cost (1/2 time) of staff if required to backfiil the regular
scheduled shift of staff deployed.
5) Fuel;
6) Shippinghmsportation fees;
7) Daily usage fee;
8) Actual cost for food and lodging will be reimbursed at the rates established by
the State Comptroller;
9) Personal mileage from home to deployment site and return at a rate per mile as
published by the State Comptroller for the time period specified or other specific
travel costs;
10) Use of rented vehicles will only be reimbursed at the rental rate as established
by the State Comptroller or as approved in the State Mission Assignment;
11) Use of personal vehicles will only be reimbursed for mileage using the
mileage rates currently in effect at the time of deployment as published by the
State Comptroller's office. No other expenses related to the use of personal
vehicles will be reimbursed
12) Supplies used; and
13) Repair of damaged equipment; if applicable.
IS
TX EMTF MOA 09/25/2012
Appendix E
DEFINITIONS
Ambulance — an EMS vehicle that is licensed as an "ambulance" in the State of Texas to
the level designated or an EMS vehicle from another state that has been given legal
authority by the State of Texas to operate as licensed ambulance in Texas during the
current event.
Ambulance Strike Team (AST) — a configuration of five like -typed Ambulances with an
Ambulance Strike Team Leader. ASTs are typed by capability.
Ambulance Strike Team Leader (ASTL) — an ASTL credentialed EMS individual,
approved by DSHS, assigned to function in a supervisory capacity over EMS resources
(usually ASTs), with appropriate, separate transportation.
AMBUS — an Ambulance Bus which is licensed as a "specialty vehicle" ambulance in the
State of Texas.
Assets — collectively all personnel, equipment, supplies, and services that may be
deployed, utilized, or coordinated by the Parties under this TX EMTF MOA, including
RAC staff.
Contractor — an organization that is a Contractor with DSHS for the purposes of
managing the Hospital Preparedness Program in a Trauma Service Area.
Deployed Assets — any Asset activated to respond to a State Mission Assignment.
District Disaster Committee — as defined by the Texas Government Code, it is the
coordination point for the disaster districts within the State and the point of local
coordination between an RMOC and the Governor's Division of Emergency
Management Incident Command Structure.
DSHS — Texas Department of State Health Services
Emergency or Disaster — any incident declared as an "emergency" or a "disaster" by the
State of Texas. May be used independently or collectively.
EMS Personnel — an EMS professional licensed or certified by DSHS, to include EMT,
EMT -I, EMT -P and Licensed Paramedics.
EMS Provider — an agency licensed in the State of Texas to provide ambulance service.
In -place Assets — any Asset activated in support of the RAC's ability to implement this
TX EMTF MOA.
�
TX EMTF MOA 09/25/2012
Lead RAC Activation — the initiation of the terms of this TX EMTF MOA by a State
Mission Assignment from the Lead RAC as authorized in Section 2 A of this document.
Lead RAC State Mission Assignment — the mobilization paperwork authorizing the
response of the Resource as specified in the State Mission Assignment.
Mission — the Asset specified objectives, goals, etc. as outlined in the State Mission
Assignment, including but not limited to destinations, tasks, command support roles, etc.
Mobile Medical Unit (MMU) — a rapidly deployable structure capable of providing
medical care in a 16 bed configuration, to include the infrastructure support and staff for
its set up and operational use. An MMU alone does not automatically include a clinical
staff. A "Staffed MMU"' includes the clinical staff configuration.
Parties — the Parties to this TX EMTF MOA, specifically the designated, signing Lead
RAC and the Resource.
RAC — an authorized Regional Advisory Council designated by DSHS
Regional Medical Operations Center (BMOC) — a regional medical coordination center,
managed at the RAC or multi-RAC (EMTF region) level, in coordination with the
Governor's Division of Emergency Management Incident Command Structure to include
local DDCs, the SOC, and the DSHS State Medical Operations Center (SMOC).
RN Strike Team (RNST) — a configuration of five like -typed Registered Nurses of which
one will be the RN Strike Team Leader. RNSTs are typed by capability.
Staffed MMU — a clinically staffed, 16 bed capable, rapidly deployable Mobile Medical
Unit, utilizing the staffing requirements as approved by DSHS
State Mission Assignment -- paperwork authorizing mobilization response of Resources
Subcontract(s) — the agreement(s) made by the RACs to implement this TX EMTF MOA
or manage HPP resources.
Subcontractor — a Resource that is a subcontractor with a RAC for the purposes of
implementing this TX EMTF MOA or managing HPP resources.
Training Events -- an event approved under this TX EMTF MOA to activate Assets for
the purposes of readiness and education of team members.
TX EMTF MOA — this specific Memorandum of Agreement
Warning Order — the initial written notice of a pending State Mission Assignment from
DSHS notifying the Lead RAC of the possibility of Activation and possible request to
determine the initial availability of Assets.
17
TX EMTF MOA 09/25/2012
Appendix F
Asset Informa #ion
The following information is needed for planning purposes only. These numbers are not
binding. Each Agency will have the option to accept or reject each deployment. Each
Agency will also determine the quantity of assets available to deploy.
Please do NOT provide minimal numbers but provide the most accurate estimate of what
could be deployed when called upon, if in a scenario that will have minimal impact
locally.
The planning numbers should allow Coastal agencies to give real numbers of what could
send to a wildfire understanding the same assets could not be provided in a Hurricane
situation.
Agencies will have the ability to deploy more or less than the planning numbers listed
below.
Agency Name:
Provider / License #:
Agency Mailing Address:
Agency City:
Agency State:
Agency Zip:
Agreement Signatory:
What Position (and above)
can approve Deployments
Deployment Contact #:
Deployment Email to:
Expiration / Renewal Date:
Does each deployable
EMS Unit have a
VHF Mobile radio
(Not HT) with TX
InterOp channels?
CITY OF BEAUMONT PUBLIC HEALTH EMS
123001
2870 LAUREL ST
BEAUMONT
TX
77702
03/31/2014
VHF-Yes) (__VHF -No)
18
# TX MICUs
# Type I ALS w/ HazMat
# Type II ALS non- HazMat
# Type III BLS w/ HazMat
# Type IV BLS non- HazMat
# Strike Team Leader
# Command Center
# AMBUS
# Mobile Medical Unit
# Support Trailer
# M -IST (Medical Incident Support):
# ASM (Ambulance Staging Manger):
TX EMTF MOA 09/25/2012
# Task Force Leaders
# EMS Group Supervisors:
# Doctors:
# Mid -Level Practitioners:
# Nurses:
# Paramedics (non on AMB /AMBUS):
# EMT - Intermediate (not on
AMB /AMBUS):
# EMT -Basic (not on AMB /AMBUS):
# Tech:
# Clerk
#Logistical Crewman:
# Command Staff:
19
N
.--+
O
N
to
N
O�
O
O
w
H
(3a
0
N