EMS Redesign Steering Committee

1. EMS RedesignSteering Committee April 24, 2007

2. Pertinent Legislation • Health & Safety Code (EMS Act) • EMS Authority – Sacramento • Promulgates Regulations and Guidelines • Licensing of Paramedics (and EMTs??) • Disaster Coordination (EMS only) • Approves “plans” (EMS, trauma)

3. Pertinent Legislation • Section 1797.201 • “201” cities and fire districts providing paramedic service as if 1980 • South San Francisco is only “201” entity in San Mateo County

4. Pertinent Legislation • 1797.224 • Counties may create one or more “exclusive operating areas” • Emergency ambulance, ALS, or LALS • Awarded through competitive process at periodic intervals • EOA included in EMS Plan and approved by EMSA

5. Local EMS Agency (LEMSA) • Designated by County • San Mateo County designates the Health Department • Health Department – EMS Program

6. San Mateo LEMSA • Regulates emergency, non-emergency ambulance providers, paramedics, EMTs, EMS dispatchers • Approves EMS personnel training programs • Provides pre-hospital medical treatment protocols • Designates base and receiving hospitals, trauma centers, pediatric critical care, stroke centers (soon) • Coordinates efforts of multiple entities to provide “seamless” EMS response

7. San Mateo LEMSA • Oversees Exclusive Operating Area Contract

8. San Mateo EMS SystemHistory • Prior to 1976 there were multiple small ambulance companies – no coordination • 1975 SSF began providing paramedic service within its jurisdiction • 1976 First County to award exclusive ambulance contract (all but SSF) – Medevac (County subsidy)

9. San Mateo EMS SystemHistory • RFPs at fairly frequent intervals (2-5 years) and County subsidy eliminated • Medevac/Mobile Life Support through Hospital Consortium • Mobile Life Support - 1990

10. San Mateo EMS SystemHistory • Characteristics of 1989 system (contract with MLS) • Manual dispatch by PSC • 9 ambulances 24/7 (one on coastside) • Response time standard 9 minutes or less 90% but no way to easily measure or incentive short of breach of contract

11. San Mateo EMS SystemHistory • BLS backup of ALS system with payment by County of BLS ambulance used • Vehicles and equipment poorly maintained • Generally dissatisfied workforce • Fire first response BLS (most EMT)

12. San Mateo EMS SystemHistory • 1988-89 EMS Redesign • Subcommittee of EMCC • RFP for longer contract-performance based, standards for equipment, personnel, other • Performance-based with response time standard with financial incentives (punitive) – single response time zone • CAD for PSC

13. San Mateo EMS SystemHistory • 3 Proposers • Baystar (Medtrans) awarded 8-year contract • Comprehensive contract – included emergency ambulance only • Over the term of the contract Laidlaw purchased Medtrans then Laidlaw purchased AMR – changed all operations to AMR

14. San Mateo EMS SystemHistory • Fire service indicated it wanted increased involvement in EMS system • Health Dept invited their involvement • Cities/Fire Districts formed JPA and worked with several consultants over several year period • Health Dept conducted EMS Redesign Process 1996-97 using EMCC and expanded to include some others

15. San Mateo EMS SystemHistory • 1997 RFP • “Model A” – emergency ambulance only • “Model B” – emergency ambulance and paramedic first response • Proposers could propose A or B, or both

16. San Mateo EMS SystemHistory • Two proposals received - Rural Metro (Model B), AMR (Model A & B) • AMR Model B selected • Contract length 6 years with 2 2-year extensions • Grand Jury Report 2003 • Current contract expires June 30, 2009

17. Key Features Current Contract • Primary contract is with AMR • Includes paramedic emergency ambulance and paramedic first response • Many detailed standards for both ambulance and fire paramedic personnel • As primary contract with AMR it is responsible for services it provides and those provided by fire service

18. 5 Response Time Zones

19. Key Features (cont.) • Single dispatch center (PSC) for fire and EMS • Shorter response time from incident to paramedic arrival (first responder) • Longer ambulance response times • Five response time compliance zones (rather than one single)

20. Response Times

21. Other Contracts • County and each fire department as an “ALS Provider” required by regulation – simple designation agreement • AMR/JPA (County not a party) • AMR/County (for CDF services) • AMR/SFIA (for Airport fire paramedic first response

22. AMR Income/Expense

24. AMR Payments to System

25. Contract Extension (2006) • Substantial increase in response time fines • Included fines for failure to staff at system status plan level (unit hours) • Extension 2 ½ years

26. Current EMS Redesign Process • Needs to be completed by October 2007 • RFP to be issued in January 2008 • Guidelines • Inclusive Process (all are welcome) • Transparent Process • Website http://www.smhealth.org/ems/redesign

27. Nine Component Committees • Technology • Personnel and Clinical QI • Disaster • Performance Measurement and Management • Finance • Hospitals • Vehicles/Equipment • Deployment/Response • Community Education/Injury Prevention

28. Consultants • Claremont Graduate University – Information Systems and Technology • Integral Performance Solutions (Six Sigma) • Polaris – David Shrader (Comparative Analysis Six EMS Systems)

29. Steering Committee - Role • Group Discussion

30. Brief Updates from Committees (as time allows)

31. Next Steps