 Meeting of the Committee of the Whole to to order. Mr. President. Thank you. Gisha. Here. Sir. Here. Ryan. Here. Bowel. Here. Fast. Excuse. Kittleston. Kittleston's here. Warren. Here. Hyderin. Here. Ringflesh. Clioness. Here. Decker. Wagoner. Here. Decker's excused. Thank you. Meyer. Here. Matamoror. Here. Van Der Weer. Here. Very good, 13. 13 present. Thank you, we'll do the Pledge of Allegiance. Please rise. I pledge allegiance to the flag of the United States of America and to the republic for which it stands, one nation, under God, indivisible, with liberty and justice for all. Very good, Jen, that'd be number four. I would entertain a motion to approve the minutes from our meeting of June 23rd. So moved. Approving the minutes of June 23rd, say aye. Aye. Opposed? Motion carries. I wanted to take just a brief moment at our last meeting, there were some questions about why is the chairman not voting. It is going, and I just want to be very clear about that, I should have done it my first night as chair. It will be my intention, straight out of Robert's rules so that the chair can do their best to remain neutral, not to vote on a particular motion. Certainly when it comes before us as a council, I will make my vote, but it will be my habit moving forward through the year on anything that I will not be voting unless it becomes necessary to break a tie. That's my question. So I just want, let's see, I should have been more clear about that and it's consistent with Robert's rules, that's where I found it, and I think it makes good sense. I just wanted to clarify that. So we're going to start with, Kerry Couser is going to talk to us for a minute on council agenda item 82, that communication from charter about how excited they are to offer us a new channel lineup. Kerry, if you would, and a programming note, at your table if you're going to speak tonight, we need you to share the microphone between you so the channel eight can pick it up for the folks at home. We're not broadcasting live tonight but we will be played over and over again via delay tape. So please, Kerry. My name is Kerry Couser. I'm with TV eight. I represent the city for the cable access channel. Thanks for having me here tonight. Talk to you about the channel changes that charter has proposed. Now, if you have charter communication, you should have received a notice like this in the mail. Now, this is regarding to charters programming changes. That they stayed will take place in August. Some of these changes are due to, they want to expand their programs as far as high definition channels and also to gear up for the February 09 digital transition. What's going to be taking effect on some of those channel changes are the channels, all the peg channels which are TV eight, the school channel, channel 20, UWS and LTC. Now these channels will be put onto what is called a charter neighborhood public affairs channel. And you can pass these out. Now these channels, in this handout, there's the proposed listing of channels. And Sheboygan is in the upper top left corner. The other listings you can disregard those groups. Now in this proposed lineup, TV eight will be channel 990. And some of the other changes, the school channel will be 993, LTC, 991. It's listed local WSHS, but that should be WSCS. This was provided by charter, by the way. Kerry, on this document that we have before us where it shows the lineup, the peg channels are listed as a bonus. It's a new tier, but it's listed as channels 984 to 994, which you explained. Anything above 99, it sounds like you're going to need a converter box, though, right? And do you know which charter to be charging for that for those that want access to those channels? Yes, they will be. You have four options. Basically, you have to have either a TV that has the digital cable card or a QAM tuner or a DVD player that has a QAM tuner or purchase a QAM tuner from wherever you can find one. And charter will rent you a converter box for I believe it's around $5 a month. Additional charge to your cable. So if they have a fairly modern DVD player or if they have a fairly recent TV, digital TV, then they'll be able to get these 900 series channels without a converter? Not necessarily. Okay. There are different tuners. And, okay. Please. Carrie, if a person has a digital box right now from Charter, you will be able to get the 900 channels? If it's one of their QAM tuners. Right, and that's one of the newer digital boxes. Is that correct? I can't answer that. I think you'd have to find out from Charter. Thank you. And I just, for the record, I called Mr. Vowell whose name appears on the letter we all got today. And he only had a day to get back. Don't know what his day was like, but I did call him and ask him to give me a call and find out what he could contribute to this conversation. Oh, number Gisha, please. Thank you. Carrie, a couple of quick questions and then maybe some clarification. One is AT&T, which is now in the city of Sheboygan. I understand in their sales discussions with people who are saying that their intention was to take on TVA. Has there been any contact from a technical side regarding that? Nothing? Nothing. And a follow up, this is, there was a lawsuit filed last week by a state assembly person regarding just this issue, these changes Charter's making in their bundling and where they're putting things on channel. But it's important for everybody to understand we have no say in any of this. And I would encourage, as a beginning in 2008, the state has taken control of all local cable functions including whether we have peg channels or whether we don't have peg channels. If people are concerned about this, they should contact their state legislators. They can contact us all day. We have zero control, none, any longer. It's been removed from us by our state government. We don't even have a cable TV committee anymore, I don't think. There's nothing to oversight. We have no say in any of these channel movings whatsoever. Thank you. Please, I'll go first. Thank you, Mr. Chairman. I'd like to know, Kerry, then those 990 channels, will those, if you have basic cable, is that in addition then to your basic cable or will that all be connected to basic cable and do you have to pay extra then for those 990 channels? No, as far as what was stated in here in the letter, it should be part of the basic tier. It should be part of the basic tier, so that's all included in your basic cable. But if you need to rent that box, it's gonna cost you more money. But if you already have cable TV, that should be included. Charter, right. I mean charter, charter, thank you. Okay, thanks. Okay, thank you. Just wanted to know what, this was originally going to take place to change on August 12th, but at four o'clock today, Charter called me and said, because of some issues with the WAPC, which is a state organization which we are a member, I don't know if that's the reason they pushed this whole change back to late September now. That's good news, because as I understand at the WAPC, WAPC is considering filing a lawsuit to which we as a council later may have the opportunity to vote to contribute to that legal fund so that the WAPA can act on our behalf. Right, but back to Alderman Gish's point that the state really is the controlling issue. So Flood, our good servants, Akerman, or Van Akron, and Joe Leipholm's office. Flood him with your discontent, please, sir. So far, you're only talking about the digital signal. Is that not right? You aren't talking about my definition at this point, are you? No. I don't believe Channel 8's gonna be converting to high def anytime soon, but if it is, I'm gonna need some makeup. I thought you were talking about the general, the general program that we have access to here in Oregon. No, no, this is specifically just about Peg, the Channel 8. Community access, okay. Yes, sir. Anything else, please? Alderman Meier. Thank you, Chairman. I believe what you were just speaking about with the lawsuit and contributing, I believe that was filed at the last council meeting. That had already come into finance, and it's been filed. Okay, then we may have the opportunity to resurrect that, depending on what the WAPA is able to, sounds like they've gotten a charter to delay it, and perhaps if you will call Terry Van Akron's office and Joe Leipholm's office, perhaps we can stir things up in Madison a little bit. Okay, anything else, Terry? All right, thank you very much for coming into it. Sure, thank you. Now we will move on to item number seven. We're gonna discuss in the recommendation vote on RC number 970809, which is council item 659, up to 80 minutes on an RC referred by public protection and safety that has to do with the Sheboygan Fire Department's Ambulance Quality Assurance Plan. The plan is supported by documents in the Fire Department Suggested Operating Guidelines Manual and the City of Sheboygan Fire Department Ambulance Plan that has been approved by the State of Wisconsin. Public protection and safety refers to the favorable recommendation, so we will be having a presentation that I'm gonna turn over to Chief Listosky to kick off and we're gonna hear about the plan, hear about the billing, and then if there's time, we'll have some financial input from our billing partner as well. So without further ado, Chief. Thank you, Mr. Chairman and members of committee and my whole citizens, and I would like to thank everyone for giving us this opportunity to speak tonight. As an overview, I'm gonna try to keep this as brief as possible because Commander Butler and Dr. Nelson will be addressing the quality assurance process in quite a bit more detail. When we go through the financial numbers, we also will enlist the assistance of Marian Sulek who is President of National EMS Billing. I would like to thank both Dr. Nelson and Marian for being here tonight, taking time out of their busy schedule to assist with this meeting. Also, I'd like to thank TV8. I know it was difficult for you to do the setup here and appreciate the extra time that you put in to do that and the firefighters and staff who prepared the open house and some of the presentations prior to the meeting. Tonight we're gonna touch on three specific items, one is just a brief overview of the ambulance service to date and the second is the quality assurance process and the third is the activity report that's gonna be given tonight in to the committee of the whole and lieu of the finance committee I believe and then it's a follow up to the quarterly report that we did about three months ago. About 14 months ago and about 1500 medical calls ago the city of Sheboygan Common Council entrusted the Sheboygan fire department with the authority and a responsibility to provide paramedic ambulance service to our community effective January 1, 2008. As with all our entrusted responsibilities we obviously took this process and the responsibility that goes along with that very seriously. We immediately put our plan in place to ensure that there would be a smooth transition and the public could be assured that come January 1, 2008 they could expect a high quality ambulance service that would inspire confidence and trust in our department and its service to the community. There were many components of the service that required cooperative efforts from many different groups, individuals, committees and agencies to ensure that that transition would be seamless, effective and efficient. Commander Butler and the staff were diligently with state, county and hospital officials to complete a detailed and comprehensive ambulance plan that was quickly adopted and accepted by all those involved. The plan included medical protocols, medical direction and control, quality assurance and many other items required to ensure that the plan was detailed and complete. The department worked cooperatively with the mayor, the council, salary and grievance committee, the HR department and a police and fire commission to implement and complete a new hire testing process that ensured that the city of Sheboygan would be hiring the highest quality professional firefighter medics to help implement our new service. Through the process, we were able to hire exceptionally enthusiastic, educated and experienced individuals who enhanced our existing employee base to provide the depth of experience necessary to meet the needs of a new service. Our department worked diligently and cooperatively both internally with support agencies within the city, such as Sheboygan police department, dispatch, the engineering department, IS department, the finance department and many others to integrate the changes in both operational and support services. New response guidelines suggested operating procedures, dispatch protocols, vehicle, station assignments, personnel issues, individual responsibilities were determined and the staff, city and firefighters union were able to address these issues in a manner that was fair to both the city and the union with service to the community always at the heart of the discussion. New unused equipment was purchased, prepared and put into service in a timely and effective manner to ensure both preparedness prior to the implementation of the service and to accommodate effective stewardship of the startup cost responsibilities of the service in general. The Sheboygan fire department ambulance services implemented January one and it became evident early on that our preparation and planning was an essential component of a successful system. We identified and continued to see response numbers that are higher than we had projected. We're averaging approximately 7.7 ambulance calls a day and our projections were in the area of six. We've handled as many calls as 19 ambulance calls in one 24-hour period. We've also continued to maintain our excellent fire rescue and support services to the community. I would like to commend the staff and firefighters of the Sheboygan fire department. As we all know, change can be extremely difficult. The changes implemented to accommodate this new system required long tenure firefighters, existing EMS personnel, staff officers and newly hired personnel to accept duties responsibility and department interaction that in many instances is contrary to what has been accepted practices in the past. The positive interaction has energized many within our department who may have not had the opportunity because of systematic or perceived limitations to excel in many different areas. There's a spirit of cooperation and teamwork that we're seeing both within our department on a daily basis and on emergency scenes where we see excellent teamwork and coordination between the different response vehicles and individuals who are responding to the emergencies of the community. I've heard actually from a couple of our new hires that their worst day here is better than their best day at their previous position. And I'm struck by that, not because it's so easy here, but because they believe we have a vision and a commitment to providing a high quality service through training, development of our people and development of our service that they have not seen in other places. And they have been, many of our new people have worked at a number of different ambulance services and some of our existing paramedics have also done the same. We as a department fully understand the emotion and controversy that the entire ambulance system change has evolved. We have been and will continue to be committed to bridging those gaps and proving to the community that the change to a fire-based EMSS system is not only a positive change, but one that ensures the highest quality service with increased efficiency for many years to come. There's a number of different data sets that we'll go through tonight. We'll be able to answer some questions as we go through that. But as an overview, I think it's important to realize that the change that we incorporated into our department January 1st of this year is the biggest change that has ever occurred in the Shwoigen Fire Department. And I believe, and the feedback we've gotten from multiple calls per week from very satisfied individuals who have used our service, the interaction with the hospitals, the amount and capability of our personnel to respond to these many emergencies and coordinate that service has been extraordinary for a service that has only been here for approximately six and a half months. I'm not saying it's perfect. No service like this ever is. And we strive every day to, and we've done that historically for fire and rescue services to improve upon every call that we go on. And we will continue to do that as far as the EMS portion of it. So with that, I'll sit back and if there's specific questions or if we'd like to get moving with the Quality Assurance presentation, we can do that. Are there any other questions for the Chief? But, okay, great, we'll move it along. I'll turn it over to Commander Butler and Dr. Todd Nelson. We're gonna be handing out essentially a copy of our current Quality Assurance plan that's actually been taken from our suggested operated guidelines. This is also on file with the State of Wisconsin in our operational plan for paramedic ambulance service. It's to some detail outlines basically our process for assuring quality to the public and those we serve. And so as I talk, what I'm gonna be saying up here is essentially what's in there only maybe a little different form. And then I'll try to explain from the ground up essentially what we do as a service to assure quality to the public that we serve. So for those that don't know me, my name is Commander Chuck Butler. I'm the Commander for the Chevroletian Fire Department and I'm actually gonna ask, here, I'll take care of it. Be right back. Just before you get started. Sure. Can you tell us the document we have to vote on later tonight has this general Quality Assurance plan in it revised 529? Is there any substantial difference between what you're gonna talk about tonight and that revision of 529? No, there is not. I think what happens is because of the way it's set up in my computer, when I open it, it changes that revision date and I have to fix that. Okay, so I just wanna be clear. So that is the same document. That is the same document later. It'll be the same plan we hear tonight. Correct. Has everyone seen that document already? Okay. Well, it's before everybody. Okay. In 529. Okay, great. And I'm gonna have to ask you guys to leave unless you wanna plant it on your forehead. Again, my name is Commander Butler. I am the training officer for the Sheboygan fire department and as of January 1st of 2008, I am also the EMS service director for the city Sheboygan fire department ambulance provision. And I have 23 years experience in fire and EMS. Approximately 14 and a half of those years are with the Sheboygan fire department. And prior to my moving to the Sheboygan fire department, I actually worked for three years for Orange Cross Ambulance. And that was actually the reason that I moved to the city of Sheboygan was to begin working here when the city went paramedic in the first place. I'm a licensed paramedic. I've got experience in both volunteer and a career fire department, also with private services. So I have a pretty broad understanding of the process and how the provision of ambulance service works. Believe me, I'm learning things every day. And as we go along through this, I'm learning as well as everybody else is and it's actually been sort of exciting, maybe a little too exciting. To my left here is Dr. Todd Nelson. Todd is, as you can see up here, he is the board certified emergency physician. He is the medical director of Holy Family Memorial Medical Center in Manitowoc, Wisconsin. He is also a flight physician for MedFlight at UW Hospital. He's on the board of directors for the American College of Emergency Physicians, chair of the executive committee of the Northeast Wisconsin Trauma Advisory Council, National Association of EMS Physicians, trained medical director through the state of Wisconsin. He's on the Holy Family's Quality Review Committee. In that packet, there's actually a complete CV for Dr. Nelson and that kind of outlines. And the reason I give that to you is Dr. Nelson is largely responsible for the medical review and oversight of what we do as a service. And essentially the whole idea of paramedics is that the paramedics in the field work essentially under his license. So what we do, he is responsible for. And so he has a very vested interest in tracking the paramedics, what they do, the type of care being delivered in the field and following up on improving those types of things that are happening out in the field. He is a service medical director for the city Sheboygan Fire Department. He's also the medical director for City of Manitowoc Fire and EMS, Valder's Fire and EMS, all of which are paramedic level services. And he's also a medical director for 10 other smaller EMS provision agencies. According to Wisconsin Statutes, medical director means the physician who is designated in an EMT operational plan to be responsible for all of the following offline medical direction activities. And this is sort of a paraphrase of a general duty responsibility. Controlling, directing, and supervising all phases of the EMS program, establishing the standard operating protocols, coordinating and supervising the evaluation activities, which is a little bit of what we're gonna talk about tonight, and designating online medical physicians. And the difference between an offline medical physician and an online medical physician is the offline medical physician is like, say for instance, Dr. Nelson. He actually fills both roles in some places. They're responsible for doing the protocols and doing the training and doing the follow-up with the paramedics and all that type of stuff. The online medical physician are the guys who are working 24 hours a day in the local receiving hospitals. When our paramedics go out in the field, they actually will call into the hospital. They have an immediate interaction with a physician who's been designated by Dr. Nelson and placed in our operational plan to provide medical direction to those paramedics using the established protocols of our service. So they maintain the care being delivered into the field within the scope of what our medics are trained to do and what we carry on our ambulances, and that is the difference between online and offline medical direction. Tonight, and pardon me if I start to get a little bit basic, but I wanna start from the very beginning a little bit about quality and what it means to have quality and how we assure quality and how we continue to improve quality in anything we do, whether it's just a landscaper or a manufacturer or anybody. These are things that, quality is kind of a thing that we associate with high-grade services generally. You don't necessarily think of something that only lasts a week and what's made really poorly is being quality. Superiority comes to mind, excellence. These are all things, consistencies, either all things that we typically associate with quality unless of course you put an adjective in front of it like poor quality. But as far as quality in itself goes, those are the types of things we look for. The fire service in general over the years has actually had a very high standing in the eyes of the public with regard to trustworthiness. This is something that didn't come very easily. This is something that through years of tradition and years of work and years of selflessness, I don't know if I got that word out right, but it's there. This is something that we value personally and as an organization a great deal. Without that trustworthiness of the public and we hear a lot about that in the management of the fire services, public trust. Without public trust, we don't exist. Right now when people need something right now and it's bad and it's their worst day they've ever had, they call 911. They call the fire department. They call the police department. And why? Because they trust that that day, that time in their worst day, that's where their best help is gonna come from. And so that is who they call. And with the EMS system, it's no different. And I like to use the analogy of currency. It's the same thing. Without that trust that you're gonna get the same value for that dollar, that dollar means nothing. So you have to have public trust and when the public trust starts to wane, your organization, especially in the emergency services starts to wane and then we have problems and the system breaks down and then who knows where your help is coming from. So right now, according to our numbers and everything that we're seeing when people really need help on their worst day, they're still calling 911 for that help and we do our best to provide it. So how do we maintain our public trust and we consistently deliver a quality product? We like to think that we've consistently delivered a quality product since 1888 when our fire department was first put here. We've outlasted a lot of things in this community and we've stayed, we're like the river that runs through it. As a fire department, we're here. We protect the public sometimes when they don't even know they're being protected. But if we're not here when somebody needs help and calls, you don't know what you're gonna get necessarily. So over the years, I think we've been fairly consistent. And I like to think that the Schwoigen Fire Department is actually in an excellent status as far as fire departments go. Of course, fire departments across the board are wonderful but I do believe that the Schwoigen Fire Department has paid a special attention to detail over the years by the people at Hires and the way we do our business. The activity, now quality assurance is actually, when you think of that as, okay, we do a quality product and I can say we have a quality product and I can talk to you all day but if you look at me and say, well, prove it. That's essentially what quality assurance is. Quality assurance is the activity of collecting and providing evidence needed to establish quality and work and that activity is requiring good quality or actually being performed effectively. In other words, like I said, I can tell you guys all day we're doing a quality service but the quality assurance part of it is I can get data and I can prove to you that we're doing a good thing and that we're doing it right based on all kinds of things, standards and what everybody else is doing. So in general, the fire department uses a lot of practices to establish quality, not just in the medical delivery but also in the fire department in general. There's legislative compliance. There's a lot of laws that are written and believe me, there are many laws through the Wisconsin Department of Commerce with Wisconsin Department of Health and Family Services, all of these state agencies. If we did everything really poorly, they'd be down on us like a ton of bricks. And there are agencies out there that walk a very fine line to legislation. We never really have to worry too much about legislation other than being compliant to it and knowing what we're supposed to be doing, what papers to file, how we're supposed to operate all of those things. So there is a certain amount of quality that starts just in the legislature to make sure that agencies that call themselves paramedic services are actually delivering the quality that they're supposed to be delivering. We also have very strict hiring practices. We have written tests, we have backgrounds, we have medical physicals, we have pre-employment, the psychological evaluation. We have an assessment center here at the fire department where we have the medical director involved and staff. And we have a number of different hoops, I guess you call them, that these people have to jump through to get a job here. We require a great deal of training which has changed over the years. It's becoming at a higher and higher level of training that people have to have to get onto a fire department. You hear it out there, it's a good job if you can get it. It's very, when I took the test, there were 300 people that applied. I was fortunate to come out on number three on the list. So we're very particular about who we hire. We hire a high standard, not only in moral and educational background, but just the commitment to service to what they're doing. The fire department also is sort of a paramilitary organization. Our structure is set up that there's checks and balances in everything that we do. Everybody has one boss, the unity of command goes all the way to the top. It's not multiple people telling different people what to do. We have our procedures, we stick to them, and it's no different than the military. You can't have three different bosses telling you how it's gonna be done that day. It doesn't work out well. You end up having chaos. Continual training, the fire department has a specific department just for training, which is my area. And that is mostly because it's extremely important. We get one chance to do it right sometimes. And if you don't train on it and train on it and train on it, and I'm not talking about learning new things. I'm talking about like dog training. Like you do it over and over and over again until it's second nature to you. So when the building is falling down and there's people on the second floor screaming or you've got a family member over your shoulder yelling at you, don't let my family member die, that that stuff comes back to you and you just know how to do what you're doing. That's the kind of training that we like to employ. We certainly learn new things, but those are the types of things that I say training. We do it over and over again because it doesn't come up every day. We do networking. We actually, we have kind of a high commitment to getting our members in associations and getting out to conferences and speaking with other fire chiefs and other training officers. And we belong to a number of associations that allow us to kind of get out there and say, hey, what's working for you guys? What's the best practice out there? What is it gonna take for us to be just like you because it looks like what you're doing is really good. And we try to do the best that we can to get out there and network with other professionals both in the private industry and in the career fire service. And based on that networking, then we try to employ a different batch of best practices that allows us to do what's actually working best in the industry. And it's taken a long time and people go, why do you do it that way? And hopefully we don't too often say because we've always done it that way. That is typical to the fire service, but we like to change things as they need changing. And using those best practices in the industry, that's good. So how do we assure quality? We collect and track data that can be compiled and analyzed for the purpose of quality measurement. In other words, we collect numbers. We always did it for years and years. It used to be with the fire service and I think we still do it. How much property loss was there for the year in the fire department? How many buildings were damaged? They even measured how many feet of hose were laid for the fire department in those annual reports. So reporting and coming up with that data is nothing new. Certainly there's more data involved in the medical provision, but we measure response times. And I'll get to that a little bit how we actually track that, but we measure response times. We measure patient outcomes based on what we're doing. How many people are living from that? And that's not just us, that's industry-wide. There's so many different organizations out there that are actually measuring what's going on with patient outcome and trying to change and improve the pre-hospital medical system that it's just mind-boggling. And at some point, you actually just have to kind of slow down. Do you have a question? Are these metrics uniform across the state of Wisconsin? Are there a set of 10 metrics or five metrics or three metrics that you measure yourself against neighboring communities? To be honest with you, no. They're not very standard. I think the one that always pops out to most people is response time. I know when the original thing went on with the fire department, the police department, and Curtis and all that years ago, the thing that just kept popping up all the time was response time. And response time is absolutely important, but it's more important that you get your initial response there fast. And there's a lot of studies that are showing that it's rare that as long as you get the initial response of some kind of a trained provider to basically stop whatever is happening and correct and have some sort of intervention that the distance and the need for that ambulance to come within that duration of time is not as important because that's largely the transport. And there are, obviously, you have to have a mix of that. But there is not really a set thing. Response time, patient outcome, skill success rates, these are largely internal. If you try to put an endotracheal tube in somebody and you've done 10, how many are actually getting put in? And if they're not getting put in properly, why is that? Those are the types of things that we start to track that way. We do employee evaluations and we do testing from time to time. Customer feedback, financial records, standard of care. Are we doing what is the standard out there and are we meeting that standard of care as best we can? Those are all things that we try to measure to come up with some sort of a measure of quality and what are we reproducing as a product to the public and is it working? Otherwise, it's sort of nebulous out there is what we're doing a good thing or is it a bad thing? Yeah, absolutely. Todd Nelson. One of the things that has been put in place by the state is the word system, which is a computerized program that's been put out so that way we can collect data much more effectively than we've been able to in the past. And so from my home in Manitowoc, every night I log in and I can see everything that's happened in Sheboygan today and I can review every call. Well, we'll get into it later, but some of the things that I actually do, but this program has been designed so that way you can get the information that you want. I think this was kind of the inaugural type of database that's been set up so that then the state can now take that a step further and say, okay, these are all the things that we want to collect and then provide reports for in the future so that we compare different municipalities with each other. To that point, it hasn't been designed to do that, but it's been kind of service dependent on what you want to look at. I think that's probably what the ultimate goal will be though in the future is so that we have a benchmark for our community and a benchmark then to compare ourselves with others. That worked out really good. I had a break and I could give my throat a break. I've had a cold for like two weeks and I'm hoping my voice holds. This is wards. What wards is, as you read it on there, Wisconsin Ambulance Run Data System. It is a software program put in place by the state of Wisconsin, the Department of Health and Family Services, designed to track and to get some sort of historical database on all the ambulance services in Wisconsin and what's going on out there and how are we doing it. And it also, it works for us. It's kind of a data collection tool. It also is what we use for doing patient care records in the field. We have high speed internet at all of our stations. We do run report entry in all those stations after calls and they are directly done online, paperless to this system in Madison. And from all of the input screens, and I'll get to that in a minute, from all the input screens, a patient care record is generated. We also have the ability to scan and attach any other medical things. Any of the medication lists from facilities or from people's homes. We have signature pages for releases, electrocardiograms that we take out in the field. All of these things are things that we can attach to this record and they're permanently attached and they're always there. Now the only people that can access this, I'd say only because it's good that only a few people can access but there's some other things that are good that others can access. The people who are on the call are the only ones that can access that call within the fire department other than myself and Dr. Nelson. These are not public records. These are medical records that are protected under HIPAA. We do not allow anybody to look at these and if we do any kind of quality assurance case review or something like that, all of the information is to the best of our ability to actually do that is protected. So anyway, I've got a, now let's see if this is gonna work for me. I apologize, I have to go back and forth here. I do have a grant to move all of this to the front coming so hopefully we'll. That's all I want. I did a sample so don't worry about actually looking at anybody's patient information. Can I use one of these mics with that pickup? If I borrow that mic from back here. Excuse me, it's a logistical thing. Okay, I can actually make this work from back here now. The screen you're looking at right now is our input screen for our patient information and I've done a sample report here and basically what this allows is for us to take information directly from the dispatch times, we input all of the information that the patient has put in here. Incident information across the top there, call information, demographics, all of this stuff is put into the patient care record. And then from this information input screen is generated a pre-hospital, well that's a large font one, pre-hospital care record. And it'll take a second to come up here but it really is there, here it comes. Okay, so this is actually what is generated from all of that input on that call. This is the pre-hospital care record. It provides a very neat and organized and consistent report based on what happened on that call and it goes into the patient's permanent medical record. So all of this information is there. Now that being said, the hospital that that patient is transported to, as well as our medical director and myself and anybody else that was on that call can access simply those pre-hospital reports. And from that, actually our billing agency has access to that as well and they are also HIPAA compliant. So they actually will go in there to the same system we input this into. They look at the report and they bill accordingly and they code accordingly to what was actually performed on the call. Dr. Nelson has the ability to go in there and based on certain parameters on certain types of calls that we're reviewing, which you'll see a list in that packet that was given to you, we will actually go in then and or Dr. Nelson will go in and review the calls and measure them against the standard of care. He'll read the narrative of what the people did and actually what happened and essentially deem whether it was appropriate or not appropriate. Now, having done that, there's another step that is actually very nice as part of this system that we use. And by the way, this system is free. Free is good. And this was like a lifesaver. I thank the state of Wisconsin for doing something very helpful. They put this in place. And if I had to, well, you know what? And you're free about it. You are correct. We could actually talk a lot about cost in free hospital medicine. The system in general is extremely expensive. Not just the fire department, not just hospital ERs, the people that have to do the work. I mean, there's a lot involved in providing the pre-hospital response to anything. And it is not inherently a great moneymaker because it is there to serve whoever calls. And sometimes whether they pay or not is you do the best you can, but the system across the board is very expensive. And I'm not getting into all those studies, but once this report has actually been written, if a medic has a question about the call and needs to speak with the medical director about it, or would like an opinion, or the medical director can actually do this, there is an internal messaging system within this program that is undiscoverable in the quality assurance process that the conversation can occur between the medical director and the care provider based on things that are happening on the call. And not everybody can see this except whoever you want that message to go to. So for instance, here, this medic, and I just typed this in as a sample, could I have done anything better with this call? And the medical director could look at this and get the message and send right back to that person. And the next time they log in, they have an inbox that only they can actually read. So the system has got some very nice things that are working and it saved us a tremendous amount of work because actually January 1st, by coincidence, was the date for compliance in the state of Wisconsin that every ambulance service in the state of Wisconsin report data to the ward system. Now some places actually had data systems already in place and they had a big struggle of trying to get the data to transfer to the ward from their system. We didn't have that because we directly put our information into that database in Madison directly. Okay, I'll give you a mic back now, sorry. Oh, I'll be done soon. My voice will be done in two minutes so we'll try to speed her up here a little bit. Now we've established how we do the assurance. This is how we get all our numbers and our measurement and what we do is a fire department to put this in place. You've heard probably CQI, Continuous Quality Improvement. There's all kinds of things out there to measure quality and if there was a perfect way, there wouldn't be so many different ways to find out what your quality measure is. But we get all kinds of feedback. We get immediate feedback from online medical control physicians. If I'm a paramedic out in the field in somebody's house, I can get on my cell phone or the radio and I can call directly to the medical control physician at the hospital and go, look, you know, I got this, this, this and this, could be this, could be this, what would you like me to do? I'm not sure, give me a little input. And so there's that dialogue that occurs in the field with the control physician in the hospital that you're gonna be transporting to and sometimes with the hospital that you're not transporting to but whoever's available to answer your questions. We also get immediate feedback from the hospital staff. When that patient actually arrives at the hospital, there's a conversation and a transfer of information that has to occur between the paramedics and the hospital staff that's gonna be taking over care for that patient and we give them information of what we saw and what we dealt with and if they say, hey, you know, why didn't you do this? Well, maybe next time consider doing it this way. So there's this ongoing kind of a dialogue with the other caregivers in the hospital about this patient as well to make sure they get the proper continued care. We also have excuse me, ongoing training and education and this kind of goes back to the legislation thing. Believe me, if paramedics didn't have to go back to school, they'd be like nurses, they probably wouldn't. Paramedics, because of what they do and the period of time that may occur between those critical events in the field, they're required to have continuing ed training all the time. Every two years, paramedics have to have a minimum of 48 hours continuing education in all of the areas or not 48 in every section but a total of 48 hours and then they designate that you have to have some of it in advanced cardiac care, some of it in geriatrics, some of that in pediatrics. There's all types of things that they make us go to to continue this process and education. We're also required to recertify and advance cardiac life support through the American Heart Association every couple of years. We have to do CPR every couple of years and believe me, I've done a lot of CPR classes over the years and it's changed and there's a lot of things going on and on. Within our department, we also do other training. We have specialist command. We had Flight for Life here last week discussing how we were gonna do hot loads or how we were gonna set up their landing zones and what our communication was gonna be. So it's just inherent to the fire department. We train, train, train on a lot of different subjects and that is part of our process for continuing our quality. And I talked a little bit in the awards program about the QI and the QI messaging. Messaging, I said, genie, that's the right word. With the medical director regarding specific calls or just general things. And then we do periodic case reviews and I'm gonna let Dr. Nelson talk a little bit about what his process is, what he looks for when he goes in and reviews these run reports and I'll just turn it over to Todd here and I'm gonna give him some water. Well just quickly, before I came to Manitowoc I was in Puri, Illinois and we were a base resource hospital for 72 EMS agencies. And so what that meant was any ambulance that was going to, within three counties to another hospital, they called us for medical control. And so we got really good at providing regard, able to provide medical control to EMS ambulances and that's what sparked my interest in doing EMS. I always loved emergency medicine but not everybody that does emergency medicine really is in tune with EMS. You wouldn't think that's necessarily the case but believe me, it's the way it is. There's not a lot of people that really enjoy pre-hospital care and I really enjoy pre-hospital care and I really enjoy working with the folks here at your point again because they're all very enthusiastic, bright-eyed and very eager to learn and it's very apparent every time that I'm here. Along with the periodic case reviews and the things that you've seen, I do do ride-longs with the paramedics as well so I come down here and I'll spend four or five hours and any call that comes through, Commander Butler will take me out to the scene. I'll be right at the patient's side with the personnel and we'll walk through the entire process. I get to see what they do, I get to interject, provide some medical opinion at the time, bring them to the hospital and then we have dialogue that's ongoing throughout the patient interaction so we have an opportunity to interact on a very personal level along with doing then the case reviews. For probably the first three months, every call I looked at and you have to understand that takes a little bit of time when you're averaging about 200 calls a month and especially when I'm the medical director for Manitowoc Fire, Valder's Fire and several other agencies along with being a medical director of the emergency department where I have those to review as well but I did it because I thought it was very important and that's why we set it up that way at the very beginning and with that initial case review, it allowed me very direct access to the individuals and was able to provide lots of comments to them which they have all received very, very well and some of them very pro saying oh you did a great job and others that were saying things like you should have added this to your report not that there was necessarily care that was inappropriately given but in a world of medicine it's not only about what you do it's about what you document, okay and so we have worked extensively with them to be able to make sure their reports actually reflect what took place on scene not only for quality assurance, medical legal aspects but also from a billing perspective which is very important to the survival of any EMS agency. So that initial onslaught if you will of reviewing all of those cases provided a good background for them to kind of know what we were expecting of them along with being here with them to do the initial runs and go through things I think helped them out very much. We also, in terms of what's happened since that time, I think you've all received some information on some of the things that we do from an ongoing review and those being all cardiac arrest cases. So there's certain things that don't happen every day that I review and this be here or with any EMS agency I'm associated with and that would be all cardiac arrest cases, pediatric cases, even in emergency medicines not like we're in the city of Milwaukee and working at a pediatric emergency center and working at Children's Hospital, we're in a small community and so our providers in the clinics do a great job of keeping our kids healthy but when they're sick they need people to be able to take care of them and unless you continuously think about pediatric cases things are easily overlooked and so every pediatric case I review as well any OB case, obstetric gynecology case where there's an expectant mother, major traumas, helicopter requests, these are something that's something very familiar to me is I'm the flight physician with University of Wisconsin that flight and unfortunately we just lost one aircraft and three of my friends died and as you are well aware that helicopter EMS services are being looked at throughout the country and what we're doing appropriate, not appropriate, we have the same discussion at the fire-based EMS service level or any EMS level is is it appropriate to call for a helicopter and so every time that one's called we review those cases to make sure yes it was an appropriate use of the call and the ones that have been through here are certainly appropriate. The ones really that tend to be questionable are the inter-hospital facility transfers and we don't get involved with what happens between the local hospitals and whether or not they're going to another facility. It's solely if a Sheboygan fire department calls for an aircraft to pick a patient up. Usually it's intercept at the hospital if we know that there's a significant trauma patient that's no way gonna be able to be managed here. We call them and say, me and us at St. Nick's or at Aurora and they'll pick the patient up from that facility. And then any advanced airway placement be it endotracheal tube or COMBA tube or even the use of CPAP and people know about CPAP at night for sleep apnea. Well, you can use CPAP for other respiratory problems, congestive heart failure being one of the biggest ones and we've seen a great amount of people that have turned the corner in the past. These people had to be put on ventilators and with the use of CPAP it's really turned things around dramatically and so every time that those devices are used that triggers an internal response for me to take a look at those. How we set this up with the computer system is that we can do runs and we can have reports that are generated and I can know every time that endotracheal tube is placed just by putting in that as one of the indicators that I'm searching for. So for I take a week and I can put in endotracheal tube I can see every time that procedure was done or IV start or oxygen therapy or so forth or I can look at it from a complaint if someone has chest pain. I can pull every chart where somebody had a complaint of chest pain and I can see if oxygen, nitroglycerin, aspirin, morphine and EKG all those things were done and if they aren't I can send a message to the paramedic and say why wasn't this done? And then I would get a response back oh it was done I didn't document it or whatever happened but it's a continuous process that we have in place that we can actually do that which in the past was impossible to do until this system came in place and so a lot of what Commander Butler was talking about we owe to the state of Wisconsin for coming up with this because it would be impossible for me to do the job that I do for the service unless I lived in the fire department it would not be able to be done but because of that I am. I think that the paramedics are doing in EMT eyes, basics, first responders all throughout the system are doing a great job. I stand behind them 100% in addition to them being able to contact me through the email system they also all have my cell phone number and I've given that to them on numerous occasions and I've had some call me when they get done with a call on scene and they'll call me with a question and we can talk directly. I have an open door policy I think Commander Butler has an open door policy and nobody, I don't believe anybody feels threatened by anything that we've done I think it's a mutual respect and they all seem very appreciative of the time commitment that we've set aside for them. Wilson for coming tonight. I have a question, I'm Chair of Public Protection and Safety, you work with numerous communities in terms of, are you able to provide information to a committee like Public Protection and Safety well within the confines of HIPAA and give us kind of summary information periodically? I don't want you to reinvent the wheel but are there reports that you provide other city council or subcommittees? Your city is set up somewhat different than other places in which I work. In Manitowoc we have an EMS association which we have a meeting every other month. It's comprised of members of those various EMS agencies along with Joint Dispatch and I'm also the medical director for the 911 Dispatch Center of Manitowoc County and we have a little bit of a different system in that regards priority medical dispatch which we can talk about at another time because that's a very important aspect of pre-hospital care. But we meet every other month and we do not report directly to any board any EMS council or anything like that from the city of Sheboygan. I wouldn't have a problem in providing you with whatever information you would find informative regarding the number of cardiac calls that we go on, the number of cardiac arrest calls or any of that type of stuff. Those reports are easily, we're able to pull those together without too much of a problem. And so yeah, anything that I think you would want as long as we don't have to attach people's names to it, it falls within the hip hop. So, sir. Thank you. I just got one little thing to wrap up with here. I was just continuing on the quality improvement part. We get feedback from the customer. Some of it is solicited, some of it's not solicited. We accept both kinds. We have a process in place that if a person has a concern or a question regarding their bill, they are able to contact National EMS Billing, which handles the billing for the city of Sheboygan Paramedic Service. They can contact my office if they've got a question about care. Certainly I will take those calls and we have a process in place that if for some reason along the way they're unable to get the answer they want or they're dissatisfied with something that can be pushed all the way to your older person and taken to public protection and safety to have that issue resolved as best that we can. So we do want to interact with the public if they have concerns or questions and we try to be as transparent as possible in that regard. And then the medical director and service director, which is myself, we review things quite a bit. And then we do a periodic and annual reports like we've always done to the mayor. And a couple of things just in summary, our fire department or your fire department has actually been asked to perform a new and expanded service that addresses several identified needs for our community. We believe we've undertaken this task with the utmost of professionalism and skill. And it's our mission to continue to perform at a high level and all that we do to say, to serve the community whenever their need arises. So unless somebody has a question for me, I think I'm pushing the time here. So I'll get out of the spot here. Thanks, Commander. I just have one comment related to what Commander Butler had said as far as the process. As part of what we had submitted the public protection and safety, there is a concern form in a format that will be available electronically or at any of our fire stations or can be mailed out to someone in the event that an individual actually is a process that if we get a concern, we've gotten some already to follow up on that Commander Butler or whoever is appropriate can follow up on that. It's tracked, it's forwarded to the appropriate resource, whether that is the billing agency, public protection and safety, could be another agent entity or it could be the police and fire commission if it's some sort of personnel issue that there's an issue with. That will be, it's not available online right now, will be available online in our stations for many one and those will be tracked as well. So I just want to make you aware of that. Thanks Chief. Thank you. Next we'll be, and Marianne, I don't know if you have a presentation, should we keep our seats? Or I had intended to go through some of the general numbers and then if you had any questions for her. Great, I think what I'd like to do is have you go through yours briefly, introduce Marianne, and then I think in the interest of time because same information's gonna be presented at finance, but I think Chairman Gisha would like to summarize some things so we can get as many people, finance won't be on television, so we'd like to get his summary I think out to the people. Can we try to do all that? Should I just quickly go through our information as far as the expenses and otherwise, I guess I'm just not sure how. Chairman Gisha, do you want to do the summary here and then go through detail and finance? Sure. Okay, so how about if we do that, would you introduce Marianne and just talk briefly about national EMS and then Chairman Gisha will talk about your estimation in the summary. Certainly, thanks. One of the important aspects that I did not mention earlier as far as the success initially of our EMS service, our Ambulance Service, is the fact that I believe it was in October we hired national EMS billing of Cedarburg, Wisconsin to be our billing agent for the city of Shevaugin. National EMS has been billing for, and I'm just gonna do this quickly, 19 years for physicians and municipalities. More recently, they switched, moved away from billing for physicians and bill solely EMS motor vehicle accidents and other type of billings for municipalities. We've got the president of national EMS billing, Marianne Sulek. She is a 40 year experienced person in the field of billing. One of the most wonderful things about this agency that we've run into is their ability to communicate with them immediately. I have Marianne's number and Chuck does. They're available to us all the time, even though they service a vast number of municipalities process 45 to 55,000 run calls from their main office. They also have an auxiliary office in Florida where they process 20 to 25,000 calls. The level of experience of their staff, they have approximately 25 staff people and their interaction with us has been exceptional. They also assisted us in all the documentation and paperwork that was necessary to put together the processes for Medicare, Medicaid and their experts in that area and we're very thankful for that. So with that being said, I guess if Alderman Gisho wanted to do a synopsis and then if anybody has questions for Marianne, we can certainly try to answer those. Okay, and I'd like to thank Marianne for being here and Alderman Ryan and I happen to be on the group that interviewed several of the billing companies when they were in that role and they were just very professional, had a great experience with them. They are not just a bunch of people that take calls and make sure the bills get paid. They recommended several strategies to the fire department on how they can increase the billables that will get paid and stuff. So they're a strategic partner of ours when it comes to getting money coming into the city. So with that, I think I'll, oh, hold on a minute. Just have a quick question because you're gonna, I'm assuming Alderman Gisho, you're gonna go over the summary piece here. I just need to reconcile these two reports real quick. And that's what I was gonna ask was my first question. Okay, because my question is in the formal handout, we have a year-to-date amount bill of 935,741. And on the summary report, we have 983,928. I asked the chief about that prior and that Mary Ann could add. On the summary sheet that was handed out, I've got scribbles all over it, it says city of Sheboygan initial report, the receipts and the billed numbers are off from the handout that had to do with city of Sheboygan internal numbers of cut-off dates, like around the 25th of June and things like that. And Mary Ann, if you can correct me, under receipts and billed, the billed amount of 983 is exactly what you have billed out for the city of Sheboygan. I believe these numbers came from you. And what you have sent to us in the form of cash is the 983,270. Correct? The receipts. No, pardon me, two, that wishful thinking. 298,327, okay. So those were the two, you had the same questions as I did. I think the same question. So, and this data is good through June 30th. So with that in mind, I think it might be important from a historical perspective to go back over what we expected and where we're at. And I appreciate the opportunity with the, and we'll go over this in more great detail in the finance committee meeting. First of all, we expected detailed expense summaries. And the handouts everybody has here, I just, I know I went through it and found that every cotton ball, every swab, every everything is included in the expense summary. And I wanted to come in the fire department for being incredibly open about that training, everything. There's been a lot of people banding around of hiding this or hiding that, I'll assure you nothing, absolutely nothing if you look at this report is hidden. It's all in there. So that being said, our expense number year to date. Well, let me run it back. We have built out, city of Sheboygan has built out through our partners at National EMS $983,000 this year, two people who have called for ambulance service. We've received back to date $293,000. Our expenses are $179, let's call it $180,000. So what does all that mean? Just some quick math. We anticipated from a historical perspective of having gross receipts for the whole year of 2008 of $675,000. You compare that to our gross bills right now, six months through the year at $983,000. We are at, in my estimation, 145% already year to date on gross. They're talking about everything we send out in bills. 145% of the entire year's goal right at this moment. Now you have expenses to take off of that. Year to date expenses, I know it was 179,883, we said 180. Using the updated numbers from our billing partners, that shows year to date net income. In other words, our income over our expenses of 113,387. Profit in my world, net income in this world. Terry, are you nodding? Okay. Our goal for the year, per the proposal that we all voted on, was total net income for the year of $195,000. So here midway through the year, we're at roughly 60% of our entire goal. One second, I'll look for some more. Thank you, Mr. Chairman. Alderman Gisha on the document that we received that the finance committee received. Right. On the bottom here where it says gross charges, actual versus projected six month period. Wouldn't the projected 668,134 feet for six months? And I think you said that was for a year. I haven't shown here for a year. It's in the proposal that we voted on for a year. The original proposal? That's the one I was just in. Oh, okay. Please, Chief. If I could clarify and I don't have that in front of me, but I believe that the gross charges projected in that for the year was 1.2 something million for the year. I apologize, you're absolutely right. And Alderman Boren, you're right for the six months. Thank you. Thanks for clarifying. But year to date, net income of $113,000 compared to the total revenue expected, I believe of 195. That number is accurate on the sheet of 195. You know, it's kind of a wow moment. I can't begin to explain it. In my world, I lend money to people based on business plans and their success. This is a year, at least year to date, the operation has just been absolutely stellar financially. If people are wondering where the tax decrease comes next year, hug a fireman, because a great deal of those monies are coming right from the net income of this operation. And I see Alderperson Hannah nodding his head and that was part of the discussions. There is an ambulance benefit, or not just an ambulance benefit, the benefit of looking at additional revenue sources that fall down to a net income number. Because it's important to remind the folks that any of that net profit or net income goes to the general fund. Correct, it doesn't go back to the fire department. So I just wanted to, I guess, summarize where according to the latest numbers that we have here are at, that we are a net profit of $113,387. We're about 60% of the goal. This is a startup business. You have to build accounts receivable. We're kind of hit that critical mass. We have receipts of about $144,000 last year. It should be a very good year. Okay, and Alderperson Warren. Wow, I was just gonna, I was just thinking, Mr. Chairman, I was just gonna follow up the, if the projected was 668 and we're at 935, that's a difference of a plus 267607, which is fantastic. And I'll tell you the, we all know this was a very emotional thing the council went through last year. There were those who were pro and those who were con. I'll tell you the people who were con and made these numbers is one of the people who were against this or had their own feelings on this made this proposal better, I think. I think the chief alluded to that one other time. It helped. So the good mix of camaraderie and people hashing stuff out is one of the reasons that we're to this point. And Alderperson. Thank you. I just would like Alderperson Guesha to comment on the mix of our business. Are we tracking where you were projected Medicare at almost 45% and Medicaid at 15? Commercial insurance at 24 and self-pay at 16? Are those numbers, and maybe the chief can come into that? I can comment briefly on it. Only I found the fact that self-pay is our largest receivable column to be quite interesting. I would have thought it would have been something else. But I think we're gonna go into more detail. These numbers are that you have regarding the percentages based on category are in response to a suggestion from Alderperson Bourne. This is the first time Alderperson Bourne and I have seen those particular breakouts. So I think we'll end up talking more in detail that in the finance committee. So I don't have anything for you in that. Are there any questions about the financial documents or any questions for Chairman Guesha about the broad financial numbers? Or any other member of the finance committee? Right, so we'll take more questions in the finance committee following this, but I want him to just get a top line overview for the folks at home. Then I'd like to invite Chairman Hanna, Chairman of the PPS, to just comment because this document we'll be voting on in a couple of minutes, 970809. Not only does it have to do with the content that Commander Butler presented, but another element of it is that the Public Protection Safety Committee would be the QA committee, if you will, for annual service. So I'll invite Chairman Hanna to speak on that. Well, thank you. And I really appreciate the presentation we had earlier from our physician director. I think that it certainly gave me a lot of confidence in what's going on. I was very impressed with what we already had in place on that. So the charge here for the committee, the whole, is to direct either the Public Protection and Safety, as it exists today, that we take on that ongoing role of the Quality Assurance Committee, or do you want to direct us to form a subcommittee of Public Protection and Safety? So that's really the direction we need from this group. And if we vote, the document as it exists now, 970809, Chairman Hanna, does that keep it as the Public Protection and Safety or does that force the convening of a subcommittee? I don't have that in front of you, but I think it keeps it as Public Protection and Safety. Okay. Are there any more? So I guess I would need, I would understand a motion to approve 970809. So moved. Second. Okay, and then under discussion for that, does anybody have any comments? One more question. All of my clients, they're all first of clients. Yeah, thank you. I'd like to ask the Public Protection and Safety, can you feel confident reviewing things that may come up as concerns, complaints, referrals? How do you feel in terms of that? Much more so after listening to the medical director. I thought that was a real IOB presentation that in terms of our responsibility and our rigors, it's really gonna be looking at response times, complaints in an office fashion. It's not really, our charge is not into the medical quality. That he, it's obvious to me that they've got a mechanism in place to cover that. Second question. How will you use the medical director? Well, that's why I was asking him tonight. I'm gonna develop a list of metrics, if you will, of items that I want him to report periodically to the Public Protection and Safety. And I was hoping to sit down and have a private conversation with him, pick his brain to see what's gonna be most useful from an oversight committee. I don't wanna be micromanaging the process, but I wanna have good data. And it certainly sounds to me like he's very receptive to working with us. All in one, please. Thank you, Mr. Chairman. I guess my only concern would be if the complaint that came to Public Protection and Safety was of a medical nature, whether it was not expertise on the committee and the committee felt it was necessary to get somebody from the outside to look at the specific complaint because of the medical nature of the complaint, would the committee be prepared to bring in somebody if need be? If we have to, sure. And for the doctor, perhaps Commander Butler, if it were a question, a QA question on the medical nature, wouldn't the state get involved, wouldn't the auspices of the state that all of this charter is under, wouldn't they get involved as well? Well, I think the first thing that would happen is, in some ways it's unfortunate that those medical type things can't be brought to light by name. When something comes to light by name, that individual will probably be getting, you'll be getting a call from their attorney or the city will be getting a call from their attorney based on some sort of a malpractice issue or something else. And then likely our city attorney or some special council that has been retained for the purposes of handling that medical case will be brought to light. However, I can also let you know that pre-hospital litigation and malpractice and things like that are extremely rare. A lot of that has to do with all of the checks and balances put in place for these types of systems to occur. And the other thing is just the uncontrolled nature sometimes of what does happen pre-hospital. So I'm not apologizing for what we do. I'm not saying that we are above the law and what we do in the field, but they are rare. And if it does come up, you're gonna be getting a call from probably somebody's attorney or the city, I should say, will be named and will be named and everybody else and it'll become a major issue. So you won't be discussing medical type patient information in that committee. You'll largely be getting numbers, data, and things like that. And the medical community is gonna be handling the issue specific to patient care. So I don't know if that helps. A follow-up question. Yeah. We have a comment about it. The former quality assurance committee that with the oversight of Orange Cross, was there an independent medical professional on that oversight committee? No. Thank you. In the interest of time, I'll leave it to the person who wants to make it. Thank you, I'll leave it to the person who wants to make it. With this quality assurance plan filed with the state and meeting the state guidelines and public protection and safety and police and fire commission, I think that's wonderful oversight. And we, individuals, should not be micromanaging when there's that much oversight already. Okay, thank you. I want to run. Thank you, Mr. Chairman. I agree, you know, the real question here is whether we form another subcommittee of PPNS of public protection and safety, which really does not make any sense, because as you know, we are not medical professionals. We do have medical professionals to take care of this. The public is invited to all public and protection, all public protection and safety meetings. It's an open meeting for the public to be there if they have any questions about the oversight. So I think to form a subcommittee would be our redundancy at best. And all in line, it's my intention to make this an agenda item every three months, just so that we can address it so it's a regular occurrence. If we need to make it a monthly agenda item, so be it, but let's try it in a three month cycle. Okay, and Dulcey, is it a financial question or is it a process? No, it's related to problems. Okay, then please. Mrs. Johnson. I feel very strongly that... Can you hand her a microphone? I got it, I got it. I can just use this. Okay. Now that you've broken it. Yeah. Thank you. I feel very strongly that we need to have another oversight committee, which would include citizen members and medical personnel. I don't think that any of the members of public protection and safety have medical experience. And I think it would be more appropriate to name such a committee now rather than do that after the fact when the need arises. So I strongly encourage you to form a separate oversight committee in place. And if we feel we have to have subcommittees to govern the committees we already have, then we need to make other committees to for all the departments. And we'll have to have a committee, another committee for the police department, for the inspections department to oversee what they're doing. I think we have enough steps in place. And I think to move forward with the motion would be the way to go. Okay, thank you. Oliver Heidemann. Thank you. Thank you, Chairman. What assurances do our citizens have that the next public protection and safety committee are gonna go by the same rules that are set by the chairman now? You can have another chairman and you say, well, I'm not gonna have a three-month review. I'm gonna do that every six months. I might do that once a year. What can we as a council or as a committee do to make sure that those things that we're addressing today stay and our citizens are assured that that's what's gonna happen? You can put in that in the motion tonight that you require no less than quarterly inclusion and quality assurance at the public protection and safety, and then it's in there. I'll make an amendment to the motion. Second. Okay, so then what we'll be voting on then is are there any discussion on the motion? Excuse me, the amendment. The amendment would add a provision to the document that would say the chairman of public protection and safety shall have a quarterly review of the QA process. So without further ado, all in favor of that amendment? Aye. All opposed? Amendment carries. So now is there any more discussion on the QA itself, the document 970809? Okay, so just to vote yes on this, we'll approve the general principles of the QA presentation we saw and it will establish a public protection and safety committee as the QA committee for the St. William Fire Department Ambulance Program with the additional requirement that a report of the PP&S committee will go over this. So if you'll call the roll. Gisha. Aye. Zurich. Aye. Ryan. Aye. Baal. Sting. Kittleson. Aye. Warren. Aye. Heidemann. Aye. Clowness. Aye. Longerman. Aye. Hannah. Aye. Meyer. Aye. Montemure. Aye. Vanuwil. Aye. 12 ayes, one abstention. Very good. That takes care of agenda item number seven. Before we go on to number eight, I just need quick, I would entertain a motion to file document E2 that we talked about earlier. I should have. Second. And any discussion on that? Okay. I won't call the roll on that, we're just moving to file. So in all in favor of filing document eight two, say aye. Aye. Opposed? Motion carries, thank you. Agenda item number eight, I've got a request from the, from Paul and Inder's team that they'd like to bring in our Taylor Drive master plan consultants on August 25th and have a, committed a whole meeting that evening. Normally we would be meeting on the 11th, that's just the normal rotation we've set up, so my question to the committee is, in addition to the August 25th meeting that I'll call for that consultant presentation, is there a desire to have a meeting on August 11th? No. Okay, I'm hearing no on that. And then with regard to the August 25th meeting, Paul, that'll, you guys can fill that time, right? 60 minutes? Okay, are there any other subjects the committee would like to see put on that for the remaining 30 minutes? Dog parks and anything like that? Yeah. A little more. Thank you, Mr. Chairman. Any documents that would be in your folder? We'll do some housekeeping, actually I have those here. Thanks for reminding me. I have a document from the Taxpayers Alliance that is in our, Oh, yeah, 30 minutes to talk about the Taxpayer Alliance, their proposals for how we can save some money. The city ordinance about the cell phones that no longer, I don't think we need to talk about it because there's a separate group being formed on that. There's a referral from Aldermen Verhastl, I think about big box stores, from Aldermen born on that, with that? That would be something also maybe Paulette or Steve Sokolowski could comment on whether they've done any research on it. That's document 530 in case you guys wanna weigh in that next. So we'll put that on there. And there was one other one from me in here. That's property tax. Oh, okay, which, and we can do that, especially given the budget. Okay, so we will do 636 and 530 and that remains 30 minutes. Location will be August 25th. I'll come up with a location, probably the chamber because we'll wanna get that filmed. We'll wanna be on TV for the Taylor Heights plan. So August 25th, that is a second, so the finance committee meeting's at seven, just like tonight. So it'll be 530 p.m., August 25th, for those topics. I wanna thank the Chewbacca Fire Department for hosting tonight, the presentation and the surroundings. I wanna thank Channel 8 for being here. I know it's difficult for them to get set up. So without further ado, I'd entertain a motion to adjourn. Discussion? All in favor? Aye. Opposed? We stand adjourned. Thank you.