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4 , <br /> paramedics to citizens (paramedics to be available for every call) ; <br /> reduced medical liability due to the provision of an advanced paramedic <br /> assessment for every patient; an implementation of Total Quality <br /> Management concepts in EMS delivery by delegation of responsibilities <br /> and sub-management in day-to-day activities; timely response of persons <br /> qualified to effectively manage multi-casualty, high stress, and <br /> unusually demanding scenes; and a potentially positive impact on <br /> patient outcome through advanced training in medical and trauma care <br /> delivery. We also note that implementation of this delivery model has <br /> the potential to strengthen the working relationships and enhance the <br /> cooperation between County EMS staff and squad volunteers . <br /> The Orange County Medical Director also is highly supportive of the <br /> initial response paramedic service delivery proposal (see attached <br /> letter) . <br /> Descriptions of Alternative Financing Mechanisms <br /> The Resource Subcommittee examined many potential revenue sources <br /> during its discussions . The Subcommittee did not achieve consensus <br /> about any one financing mechanism, but there was significant support <br /> for two specific options . Accordingly, the Subcommittee agreed to <br /> present two distinct options for comment by the EMS Council and for <br /> deliberation by the Board of Commissioners . These models are described <br /> below. <br /> Financing Option 1 The first mechanism would be based on a <br /> combination of elective memberships and fee for service. Under this <br /> mechanism, billing and collection would be administered by the Orange <br /> County Tax Collector. Citizens could elect to purchase, for $50 per <br /> year, a membership in the EMS system for them and all other dependent <br /> members of their household. The membership fee would entitle members <br /> to unlimited necessary emergency medical service (but not convalescent <br /> service) for a year, with no additional out of pocket costs . However, <br /> the Tax Collector would pursue collection of bills with third party <br /> payers (e.g. insurance companies, Medicaid) . <br /> ,Financing Option 2 The second mechanism would be based on the <br /> creation of a Countywide special district tax for EMS and rescue <br /> 'service that would cover all expenses for the Emergency Management <br /> Department except those services already funded by a specific dedicated <br /> revenue source (e.g. fire inspection covered by fees, or E911 service <br /> covered by 50 cent subscriber charges on monthly telephone bills) . One <br /> possible variation would be to include third party billing only of EMS <br /> users. The thrust of the second mechanism is to ensure no additional <br /> direct out-of-pocket expenses to Orange County residents for EMS. <br /> EMS Council Discussions After reviewing the financing alternatives, <br /> the Council made it clear that it does not support the idea of a <br /> membership program to help finance the system. A common observation is <br /> that an EMS membership program is extremely cumbersome and time <br /> consuming to manage and that there is some question whether the cost of <br /> administering it is an efficient use of resources . The Council voted <br />