1. EMS Redesign Steering 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
“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
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 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)

9. 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

10. 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

11. 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)

12. San Mateo EMS System History
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 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

14. 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 using EMCC and expanded to include some others

15. 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

16. 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

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

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

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