Fiscal Year 2014

Annual Report

Dear Community Member,

Mobile Medical Response (MMR) has one committed and central focus – to provide our communities with unrivaled access to medical care. This year we are celebrating 20 years of service to our communities and have surpassed 1,000,000 patients served. Our organization has grown to over 105 ambulances, approximately 600 employees and is now licensed to operate in 13 counties in the state of Michigan. We believe our success and continued growth is based on creating a vision of perfection, listening to our customers and delivering on our promise.

Creating a Vision of Perfection – Our mission statement urges us to provide service to our communities that exceeds expectation. At MMR we focus on creating “raving fans.” We believe that just satisfying our patients, families and communities is not enough. We want those we served to be so pleased that they can’t wait to tell someone about our service.

Listen to our Customers – Our patients want us to get to them in a timely manner, take care of the problem and treat them with respect. We do this by committing ourselves to create a competent, compassionate, empowered and accountable workforce. We have experienced success in this regard. In MMR’s 2014 patient satisfaction survey we had a 98.2% positive response when patients were asked if they were likely to recommend MMR to others.

Deliver on our Promise – MMR strives to consistently improve service by collaborating with our communities and focusing on outcomes. We continue to work with our communities in developing solutions to improving community response to sudden cardiac arrest. Over the last 5 years, MMR has trained over 10,000 citizens in CPR, deployed over 50 AEDs through a matching grant program and in collaboration with the Pulse3 Foundation enrolled over 4,000 people in PulsePoint smart phone cardiac arrest alert system.

MMR does what we say by providing a consistent, high level of service while continually improving service. During our 2014 fiscal year MMR was re-accredited by the Commission on Accreditation of Ambulance Services (CAAS). MMR has been accredited by CAAS since 1997. Our state of the art Medical Communications Center was re-accredited as an Accredited

Center of Excellence by the International Academy of Emergency Dispatch. MMR was the first EMS organization in Michigan to receive that distinction back in 2011. Also, over the last year, MMR’s dispatch center was recognized by the National Center for Missing and Exploited Children as the first EMS dispatch center in the United States to meet their policy and training requirements.

In addition to this validation of consistent high performance, MMR is playing an important role in the health care delivery system as it moves from volume to value. Our data indicates we are improving pain management and documentation as well as response to stroke management in our community.

As we celebrate 20 years of service to our communities and treating over one million patients, I would like to thank our community partners, patients and families for their support. In addition I would like to thank our devoted employees for providing professional and compassionate care to our patients at their most vulnerable time. We are abundantly grateful for your contributions to our mission.

Sincerely,

Mark Thompson MMR President

1994

2014

24 Ambulances100 Employees

2000 Square miles4 Hospitals3 Counties served

3.4 million Payroll$1.05/gallon Diesel fuel

13,068 Annual billable calls300,000 Population

Paper Patient care reports

105 Ambulances600 Employees

7500 Square miles19 Hospitals13 Counties served

18.1 million Payroll6.5 million Charity care

$4.25/gallon Diesel fuel89,226 Annual billable calls

1.5 million PopulationElectronic Patient care reports

MMR Services

EMS Training Centers

Membership Program

Wheelchair Van Service

Fleet Maintenance

Billing and Consulting Services

Basic and Advanced Life Support and Critical Care Transportation Services

Continuing Education for EMS Professionals

Community CPR and First Aid Instruction

Medical Dispatching Services

Medical Stand-By Service for Community Events

Disaster Assistance Response Team

Two Decades of Clinical AdvancementHealth care is always in a constant state of change and refinement. Over the last 20 years the EMS industry has made significant advancements in the practice of pre-hospital care and transport of the sick and injured. Years ago, a quick response time was one of very few measurements of success. We now know it is much more important to take a more “system approach” to calls for service. Sending the proper level of care based on caller information over simply “racing” lights and sirens to every call has made a difference in how EMS now functions within the public safety environment.

Some of the most notable changes have been in the area of trauma. Twenty years ago we treated patients on scene with IV’s and compression devices. We now know that rapid transport to a regional trauma center where a surgeon is standing by is paramount. We continue to stabilize the patient while enroute but no longer delay transport to achieve that. State of the art equipment and devices allow us to quickly stabilize patients for transport.

By contrast, we found that we can better manage cardiac arrest patients on the scene. The entire CPR

procedure has changed dramatically. CPR compressions are no longer interrupted to perform other procedures. EMS crews simply work around each other to keep compressions steady and strong, and blood and oxygen flowing to the heart and brain. MMR introduced “Rescue Pods” in 2013, a device that increases the amount of circulating blood to reach the vital organs in cardiac arrest patients. We also have several mechanical CPR machines in our most rural communities where CPR rescuer fatigue can be an issue. These machines called “thumpers” perform the “hands on” CPR for us. We know that the more common use of AEDs and bystander CPR in the community is helping to save lives. A smart phone application called PulsePoint is yet another example of exciting technology used as we work towards achieving heart safe communities.

We continue to find better ways of controlling obstructed airways in patients by investing in LED technology to visualize the airway with intubation. We strive to better control our patients’ pain and discomfort not only with medication, but the human touch as well. MMR has recently embarked on a company-wide customer service training initiative as our industry moves into value and quality based measurements and outcomes.

“I have been consistently impressed with MMR’s ability to succeed both strategically and operationally.  MMR functions as a successful business because its leaders always demonstrate strong professional values.”   

- Spence Maidlow, CEO, Covenant Healthcare

20

Matt Foley

Phil Petzold

Carl Bryans

Sheri Bird

Randy Barnes

Jim Zobel

Nick Bernelis

Jeff McCumber

Dave Fitzgerald

Year Veterans

Dave Crampton

Bill Hall

Steve Spellerberg

Rick Gilman

Jay Cooper

MMR Salutes Our 20 Year Employees!On day one, MMR employed a staff of approximately 124. Today, there is an elite group of 14 that continues to serve our patients and communities. MMR salutes these employees for their longstanding dedication to our organization, to careers in EMS and to providing outstanding patient care, leadership, innovation and creativity.

Tuscola County Operations Randy Barnes, EMT Matt Foley , EMT Jeff McCumber, Paramedic Jim Zobel , Paramedic Rick Gilman, Paramedic Supervisor

Saginaw & Bay County Operations Dave Crampton, Paramedic Sheri Bird, Paramedic

MMR West Carl Bryans, Paramedic Supervisor

Arenac County David Fitzgerald, Paramedic Supervisor

Administration Steve Spellerberg, Fleet Maintenance Manger Bill Hall, Instructor/Coordinator Phil Petzold, Operations Manager Tuscola Co. Nick Bernelis, Operations Manager Iosco Co. Jay Cooper, Director of Ancillary Services

MMR Timeline of Growth1994 Inception of MMR in September

1995 Gratiot County EMS becomes MMR of Gratiot County

1996 MMR begins operation in Isabella County, Arenac County EMS becomes MMR of Arenac County, MMR purchases Frankenmuth Ambulance Services, MMR purchases Clare County EMS.

1998 MMR becomes exclusive provider of EMS services in Isabella County

2000 MMR begins operations in Crawford County

2001 MMR begins operations in Bay County

2003 MMR and Vassar Area Ambulance Service combine forces to form Vassar Area MMR

2004 MMR purchases Chesaning Valley Ambulance

2007 MMR begins operations in Owosso Township and City of Durand

2009 MMR begins operations in Genesee County

2010 MMR becomes sole provider of EMS services in Clare County

2013 MMR begins operations in Lansing with preferred provider agreement with Sparrow Hospital

“We here at MMR are proud of the progress that we have made over the last 20 years as we transitioned from multiple ambulance companies to the very efficient company we are today. What was a vision of quality and service has become a reality and we continue to strive to improve even further. None of this progress would be possible without the dedication of our employees and the support of the communities we serve. We promise to continue to deliver excellence in each interaction with our company and compassionate, quality patient care to our communities.”

- Jim VanTiflin Chair, MMR Board of Directors

Last year MMR rolled out new software technology called MARVLIS in our dispatch center that uses historical call data to forecast call locations. The software seamlessly integrates with our CAD or computer aided dispatch technology to predict the time and location of the next called based on six years of call data. The technology has proven to be a valuable asset to our Medcom center and to our staff in the ambulances. We have been able to modify the placement plan for our ambulances from a static system to a dynamic, flexible system. We are now positioning resources based on demand for services rather than merely covering square miles. This has resulted in the significant reduction of unnecessary post moves, reduction of mileage on our vehicles and fuel costs. However, most importantly, this system puts our resources in the right place at the right time allowing for improvement in response times to our callers.

(decrease of 1,000 miles per week @ savings of $52,000 annually fuel and maintenance costs)

Predicted demand, displayed visually, allows dispatchers to strategically place resources.

Predictability Software It Works!

ACE

ACCR

EDIT

ED

CENTRE OF EXCELLENCE

THE INTERNATIONAL ACADEMY OF EMERGE

NCY

DISP

ATCH

ACE – Accredited Center of Excellence, International Academy of Emergency Dispatch – Accredited Centers share a common goal of improving public care and maximizing the efficiency of 911 systems. The National Academies of Emergency Dispatch, through its College of Fellows, has established a high standard of excellence for emergency dispatch, providing the tools to achieve this high standard at both the dispatcher level through Certification, and at the communication center level through the Accreditation Program. MMR provides superior, up-to-date public care and efficient resource utilization to achieve maximum results in emergency situations.

CAAS – Commission on the Accreditation of Ambulance Services – the gold standard in the ambulance industry for organizational and operational success. MMR has been CAAS accredited since 1997 and was recently recognized by CAAS for a perfect score re-accreditation review.

MMR Aligned to Secure FIVE National EMS Accreditations & Certifications

Letter of Review – MMR has submitted the application to have our paramedic training program accredited. Accreditation helps to assure potential students that a school is a sound institution and has met certain minimum standards in terms of administration, resources, faculty and facilities. MMR has taken the necessary steps to design our programs to meet the accreditation standards and is currently awaiting our approval status.

CAC – Certified Ambulance Coder, National Academy of Ambulance Coding – the nation’s leading source for education and certification programs in ambulance billing and compliance, arms EMS billing professionals with the critical knowledge and commitment to excellence necessary to assure accuracy, professionalism and compliance. Many of our professional billers are Certified Ambulance Coders.

ASE – ASE is short for the National Institute for Automotive Service Excellence. Since 1972 ASE has worked to promote excellence in automotive industry by testing and certifying repair and service professionals. Each one of MMR’s Fleet Maintenance staff are ASE certified.

Providing a Safe Working Environment MMR Fleet Maintenance DepartmentFirst impressions do make a difference. From our uniformed staff to our building grounds, we take great pride in our appearance. Our ambulances and response vehicles are no exception. MMR’s fleet maintenance department is staffed by seven ASE Master level mechanics that care for our vehicles with the same passion as our EMS professionals care for their patients. Servicing, monitoring and tracking maintenance schedules for over 100 vehicles is a monumental task that, over the years, has been perfected by the MMR team. What was once a two person department has grown into a sophisticated, tech saavy process that keeps our vehicles always “response ready.”

Vehicle upkeep is maintained using a robust preventative maintenance schedule. Each vehicle is serviced at least every 4,000 miles. From a Schedule A that takes two hours to a Schedule H taking three days, our maintenance team provides bumper to bumper service in two locations – our Saginaw Headquarters and our Pickard Road station in Mt. Pleasant. Providing a safe, clean and functioning environment for our patients as well as first-rate workspace for EMTs and Paramedics is key to a quality experience for all.

MMR’s re-chassis shop is also located in Mt. Pleasant. This operation gives new life to older ambulances – ones with 350,000+ miles. The “box” or patient care area is removed from the chassis and then remounted to the new chassis. The box is then freshened up with new upholstery, diamond plated flooring and electric service. Our team does such a great job that one cannot tell the difference between a new ambulance and a re-chassis. The re-chassis team will produce about 15 vehicles each year. This process will save over 40% of the cost of a new ambulance.

Safe vehicle operation is a priority at MMR. Monitoring driver and vehicle performance helps keep our employees, our patients and our communities safe. By driving responsibly, we also save thousands of dollars in fuel expenses as well

as decrease maintenance costs. MMR uses a driver feedback system called AceTech that provides immediate as well as web-based feedback on driver and vehicle performance. An audible “beep” is emitted when the ambulance exceeds posted speed limits or is exceeding G-force parameters in accelerations, deceleration and turning. Patient satisfaction scores tell us the skill of the driver is key – it’s important to keep our patients as comfortable as possible during transportation.

The AceTech system also provides Google maps/GPS replay to show where a vehicle was, the speed it was travelling, if emergency lights were activated and when brakes where applied and the identity of the person driving. Additionally, when the ambulance is at idle, the AceTech system monitors the electrical and heating/cooling needs of the vehicle. When parameters are met, the system will shut off the engine until the needs meet another threshold and the system will re-start the vehicle.

Fun facts:

3.29 million miles annually

$1.8 million in fuel annually

Heartsafe Communities

• Heart Safe Communities is a program designation to promote survival from out-of-hospital sudden cardiac arrest. It is a general concept focused upon strengthening the “chain of survival” as described by the American Heart Association; it recognizes and stimulates efforts by individual communities to improve their system for preventing sudden cardiac arrest (SCA) from becoming irreversible death.

• Goals support bystander CPR, public access defibrillators, aggressive resuscitation protocols for responders and hospitals.

CARES Database

Cardiac Arrest Registry to Enhance Survival or CARES is a secure, web-based data management system in which participating communities enter local data and generate their own reports. Communities compare the EMS system performance to de-identified aggregate statistics and the local, state or national level and discover practices that could improve emergency and cardiac care.

Upcoming EndeavorsPulse3 Collaboration and SCA Training Consortium

MMR continues to work together with the Pulse3 Foundation and others to raise awareness and educate our communities about sudden cardiac arrest, bystander CPR training, use of AEDs and the importance of having an plan for emergencies – of any kind. The SCA Training Consortium is a group of local healthcare institutions, providers, instructors and funders. Our mission is to provide opportunities and the necessary tools for training and education.

8th Annual Shocks and Saves Charity Hockey Game

Scheduled for February 7th, this annual event pits local EMS professionals against local physicians in a charity hockey game to raise awareness regarding sudden cardiac arrest, and the critical need for bystander care, education and AEDs in our communities. To date, this collaboration between the Pulse3 Foundation, MMR and the Saginaw Spirit has raised over $350,000 and placed 150 AEDs. AEDs donated through this endeavor have been responsible for saving the lives of five people!

What is an AED? Automated External Defibrillator. Used for public access. Cost about $1300.

MMR Board of Directors

Jim VanTiflin – Chair, Retired Citizens Bank

John Graham – President, St. Mary’s of Michigan

Spence Maidlow – President, Covenant Healthcare

Ed Bruff – Chief Operating Officer, Covenant Healthcare

Mike McCloskey – Community Member

Randy Bierlein – President, Schaefer Bierlein Chrysler Dodge Ram Jeep

Ed Holtcamp – Community Member

MMR Director’s Council

Lynn Schutter – Director of Community Relations & Strategic Planning

Jill Westall – Director of Human Resources

Jay Cooper – Director of Ancillary Services

Dr. Ken Hanson – Medical Director Board Certified Emergency Medicine

Mark Thompson – President

Mike Barrow – Vice President Operations

Michelle McGill – Vice President Finance

Matt Holtcamp – Director of Operations

Jason MacDonald – Director of Operations

Steve Myers – Director of Patient Access

John Brophy – Director of Quality

834 S. Washington Avenue • Saginaw, MI 48601 • (989) 758-2900 • www.mobilemedical.org

MMR Mission

To provide our communities with unrivaled

access to medical care

MMR VisionWe are a strong, agile, values-driven and collaborative EMS

organization, recognized nationally for excellence while committing

ourselves to the following pillars of success:

Growth & Creativity, Organizational Excellence, Human Resources

& Community Service

MMR Values

Professionalism

Respect

Integrity

Dedication

Excellence