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INFORMATIONINFORMATION BELOWBELOW FORFOR USEUSE ONLYONLY BYBY THE.THE. CITYCITY
AppointedAppointed to:to: MM
DateDate ofof originaloriginal appointment:appointment:
- - LengthLength ofof Term:Term: I'I'
Date(Date( s)s) re-re- appointed:appointed:
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CITY COUNCIL MEETING
June 9, 2009
1
Discussion - Direction - Action
Accept receipt of Fl Dept of Health 2009 Award of
Emergency Medical Services Grant
Synopsis: To purchase training equipment for
recertification purposes and training City employees
Agenda Item Number: 8. 1
CITY OF FORT WALTON BEACH
MEMORANDUM
DATE: June 2, 2009
TO: Robert T. Mearns, City Manager
FROM: Mike Dutton, Fire Chief
SUBJECT: Florida Department of Health' s 2009 Award
of Emergency Medical Services Matching Grant to the City of Fort
Walton Beach
BACKGROUND: The City of Fort Walton Beach Fire Department has been
licensed as an Advance Life Support provider by the State of Florida for several
years now. While providing the optimal of Emergency Medical Services to our
citizens there are many certifications needed that require annual renewals for both
our Basic Life. Support and Advance Life Support personnel. Extremely tight
budgets have necessitated the Fire Department to teach most of these renewal
classes " in house" but we have had to borrow equipment each time and schedule
our classes only when the training aids were available.
DISCUSSION: In February of 2009 the Fire Department applied for this grant
asking for an Advanced Life Support Adult Simulaid, an Advanced Life Support
Pediatric Simulaid, and a Basic Life Support CPR Package which includes 4 Adult
manikins and a Pediatric manikin. The Fire Department was notified May 27, 2009
of the award. This award will not only allow us to teach our personnel for renewals
of required certifications; but will enable us to teach the rest of the City
Departments Basic Life Support with CPR as well.
RECOMMENDATION: This grant from the Florida Department of Health,
Bureau of Emergency Medical Services provides for 75% of all costs associated with
this equipment or $7,039.99. This leaves the City of Fort Walton Beach' s match at
25% or $ Staff recommends Council authorize the City to receive the
2,346.66.
Emergency Medical Services grant. If approved a budget amendment would be
necessary to pay for the training equipment.
n
Submitted by:
Mike Dutton, F' ' ef
Reviewed for Agenda:
bent T. Mearns, City Manager
45 f p,
tp ylU 1
RIDA DEPARTMENT OF
H7EALT-:''*
Ch arlie Crist Ana M. Viarnonte Ros, M.D., M.P. H.
Governor State Surgeon General
May 27, 2009
Mr. Michael Dutton
Fire Chief
Fort Walton Beach Fire Department
5 NE Hollywood Boulevard
Fort Walton Beach, FL 32548
Dear Chief Dutton:
It gives me great pleasure to inform you that your organization has been awarded an
emergency medical services ( EMS) matching grant, number M9030, in the amount of
7, 039. 99, which is 75 percent of the total project costs. According to section 401. 113, Florida
Statutes, the grant is 75 percent state funds and 25 percent matching funds, which must be
provided by the applicant. Your required local cash match for this grant is $ 2, 346.66. The
purpose of this grant is to assist your organization in the purchase of ALS adult and pediatric
Simulaids for airway management and BLS adult and pediatric manikins for CPR training and
recertification.
You acknowledge acceptance of the grant terms and conditions when you draw or otherwise
obtain funds from the grant payment system. Your signed grant application acknowledges you
have read, understood, and will comply with all terms and conditions of the approved grant and
departmental rules. You may place these funds in any type of bank account you choose;
however, any interest earned on these funds must be returned to the department.
The Bureau of Emergency Medical Services will provide by separate letter a copy of the
approved grant budget, a list of any special grant conditions, and the due dates of the required
This matching grant begins on the date of this letter and will end June 30, 2010.
grant reports.
Thank you for your continued support and involvement in improving and expanding the
prehospital EMS system. If you need assistance, please feel free to contact Mr. Alan Van
Lewen, Health Services and Facilities Consultant in the Bureau of EMS, at ( 850) 245 -4440,
extension * 2734.
Sincerely,
Ana M. Viamonte Ros, M. D., M. P. H.
State Surgeon General
AVR /avl
cc: Captain Kristopher R. Kempf
Office of the State Surgeon General
4052 Bald Cypress Way, Bin A00 - Tallahassee, FL 32399 -1701
46-
EALT
FLORIDA DEPARTMENT OF HEALTH
AUREA° OF EIMERCENCY
a.! EDiCAL SERYi CEj
1V ml
Revised: June 2002
47—
EMS MATCHING GRANT APPLICATION
FLORIDA DEPAR imENi OF HEALTH
Bureau of Emergency Medical Services
Complete all items unless instructed differently within the application
Type of Grant Requested: Rural F71 Matchln
0. Code (The State Bureau of ENIS i,1' ill assign the ID Code - leave this blank)
1. Organization Name: Fort Walton Beach Fire Department
2. Grant Signer: (
The applicant sig natory.who has authority to sign contracts, grants, and other legal
documents. This individual must also sign this application)
Name: Michael Dutton
Position Title: Fire Chief - City of Fort Walton Beach
Address: 5 NE Hollywood Boulevard
City: Fort Walton Beach County: Okaloosa
State: Florida zip Code: 32548
Telephone: ( 850) 833 -9565 Fax Number: 850 833 -9685
E -Mail Address: mdutton fwb. org
3. Contact Person: (
The individual with direct knowledge of the. project on a day -to -day basis and
responsibility for the implementation of the grant activities. This person may sign project reports arid
may request project changes. The signer and the contact person may be the same.)
Name: Kristopher R. Kempf
Position Title: Captain Paramedic / ALS Division Captain
Address:Address: 55 NENE HollywoodHollywood BoulevardBoulevard
City:City: FortFort WaltonWalton BeachBeach County:County: OkaloosaOkaloosa
State:State: FloridaFlorida Zip Code: 32548
Telephone: ( 850) 833 -9571 Fax Number: 850 833 -9685
E -mail Address: kkempfp_
fwb.org
uri rorm 1767, Rev. June 100-9
48-
4. Legal Status of Applicant Organization ( Check only one response}:
1) Private Not for Profit [Attach documentation -501 ( 3) ©]
2) Private For Profit *
Note: The Ft. Walton Beach Fire Dept. is a
3) City /Municipality/ TownNillage non -transport ALS agency underthe transport
4) County license ( #2480) of Okaloosa County EMS.
5) State
6) Other (specify):
5. Federal Tax ID Number (Nine Digit Number). VF 59 -6000 -323 _
6. EMS License Number; 2480 Type: Transport ONon- transport. 0—
Both
BLS ALS Transport 3 ALS non -transport.
7. Humber of permitted vehicles by type:
8. Type of Service ( check one): [] Rescue & Fire Third Service ( County or City Government,
nonfire) [] Air ambulance: Fix_ed wing f1Rotowiing Both_ [ 711ther ( specify)
9. Medical Director of licensed EMS provider: If this project is approved, I agree by signing below that I
will affirm my authority and responsibility for the use of all medical equipment and /or the provision of all
continuing EMS education in this project. [ No signature is needed if medical equipment and'
professional EMS ducaH n are n his ec :,
Signature:
r
nI! ate: c2
3 1
Print/ Type: Name of Director Vq wIt"g- ( Aoret ,, PAD
FL Med. Lic. No. M k 2 1q
Note: All organizations that are not licensed EMS providers must obtain the signature of the medical
director of the licensed EMS provider responsible for EMS seniices in their area of operation for projects
that involve medical equipment and /or
