EMS Redesign Steering Committee April 24, 2007

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)

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

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

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

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

San Mateo LEMSA Oversees Exclusive Operating Area Contract

San Mateo EMS System History 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)

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

San Mateo EMS System History 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

San Mateo EMS System History 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)

San Mateo EMS System History 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

San Mateo EMS System History 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

San Mateo EMS System History 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

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

San Mateo EMS System History 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

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

5 Response Time Zones

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)

Response Times First Responder Ambulance Prior to 1999 No Standard 8:59 minutes Since 1999 6:59 minutes 12:59 minutes

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

AMR Income/Expense

AMR Payments to System

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

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

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

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

Steering Committee - Role Group Discussion

Brief Updates from Committees (as time allows)

Next Steps