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Questions related to the fiscal impact to your EMS agency

The emergency declaration has far reaching implications and EMS is already struggling financially.  We will be collecting data each week and forwarding onto the Governor's office, legislators and other state agencies on the need to look at and protect emergency medical services and their ability to continue to provide services.

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* 1. Lost income from actual decrease in 911 volume, if any (Please include only a dollar value)

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* 2. Lost revenue from actual decrease in non-emergency transportation volumes (Please include only a dollar value)

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* 3. Lost revenue due to more patients keeping reimbursements sent directly to them (Please only include a dollar value)

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* 4. Lost revenue due to more patients unable to pay copayments (Please include only a dollar value)

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* 5. Loss of other revenue (subscriptions, donations, municipal funding) does not include events

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* 6. Loss of revenue from events and fundraising

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* 7. Increase in payroll due to replacing infected or quarantined staff (Please include only a dollar value)

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* 8. Increase in payroll due to overtime (Please include only a dollar value)

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* 9. Increase in any expendable supply costs (Please include only a dollar value)

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* 10. Increase in "time on task" for disinfecting the ambulance, etc.

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* 11. I am considered:

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* 12. My region:

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* 13. Have you applied for funding under the CARES Act or the PPP (Payroll Protection Program)?

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* 14. Have you received funding under the CARES Act or the PPP (Payroll Protection Program)?

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