1. Presented by: The Abaris Group Walnut Creek, CA www.abarisgroup.com
Merced County EMS Ambulance Request for Proposal (RFP) Advisory Committee Meeting March 2019
Presented by:
The Abaris Group
Walnut Creek, CA

2. Agenda Discuss Committee Confidentiality Review RFP Timeline
History of Merced EMS
Next Gen Task Force
Results
Consultant Recommendations
RFP Scope of Work

3. Confidentiality RFP development is a confidential process
Ensures equality for all potential bidders
No discussions outside of these meetings
Refer stakeholders with questions to Jim
Perceived conflict? Share with Jim!

4. Ambulance RFP Timeline, completed
Meet with County EMS Agency
Collect & review available reports, data, contracts, etc.
Conduct interviews with all stakeholders
Research current ambulance and first responder input
Evaluate the industry best practices and trends
Develop EMS system financial analysis
Complete strategic planning process

5. Ambulance RFP Timeline, pending
Conduct town hall meeting
Develop RFP document
Obtain County/State RFP approval
Release RFP
Facilitate bidders’ conference
Support bidder selection
Assist contract negotiations

6. History of Merced County EMS

7. History High-Performance EMS contract Two ALS ambulance providers
BLS first responders
Includes interfacility transports
Includes CCT

8. Next Gen
Task Force

9. Next Gen Task Force, results
High system user diversion
Outcome-based measures
Resource triage at dispatch
Health information exchange
Nurse triage at dispatch

10. Next Gen Task Force, results
Remaining
MediCal payer partnership
Hospital readmissions
Hospice revocation
Community paramedicine
Consolidated dispatch

11. Next Gen Task Force, rec’s
Clinical Outcomes
Resource Triage
High System User Diversion
Community Paramedicine
Health Information Exchange
Remaining best practices should be encouraged through innovation section of RFP

12. Scope of Work

13. Scope of Work, approach Working document only... nothing set in stone
Input needed and encouraged

14. Scope of Work, components
Fiscally viable
Incumbent work force
First response coordination
Mutual aid/standbys
Vehicle requirements
Service levels
Surge capacity
Response times
Dispatch
Performance standards
Outcome-driven service

15. Scope, fiscally viable
Ensure contract compliance without fiscally compromising the service
Determine reasonable number of response zones
Simplify financial statement requirements

16. Scope, EOA Current Future Includes Westside through subcontract
Continue existing EOA?
Exclude Westside?

17. Scope, incumbent work force
Maintain existing field staff
Offer interviews to existing supervisors and managers

18. Scope, first response coordination
Provide joint training regularly
Participate in County training (e.g., MCI)
Resupply first responders “one-for-one”
Support future standardized of EMS equipment with first responders

19. Scope, mutual aid/standbys
Best effort to respond to mutual-aid requests of neighboring counties
Provide ALS standby (ambulance or first responder) services as requested for
Working fires, hazardous material events, law enforcement incidents, etc.

20. Scope, vehicle requirements
Type (e.g., van, sprinter, modular)
Safety standard (e.g., KKK, NFPA, CAAS)
Stock/maintain ambulance and first response units to County standards
Approved vehicle markings
e.g., logo, text, color
No maximum mileage

21. Scope, service levels Current Future ALS & BLS 9-1-1 ALS interfacility
BLS interfacility
CCT interfacility
Future
ALS & BLS 9-1-1… yes
ALS interfacility… maybe
BLS interfacility… maybe
CCT interfacility… no

22. Scope, surge capacity Current Future Westside Ambulance
Neighboring counties
Future
Require call back policy

23. Scope, response times Current Future Emergency Non-emergency IFT
Emergency… yes (outlier penalty only)
Non-emergency calls… none
IFT… none
Consider more reasonable response zones

24. Scope, performance standards
Current
Penalties for response time non-compliance per call and monthly
Possible
Outliers only
Minimal exemptions
Credit for meeting outcome-driven metrics
Continued failure to comply, results in default and loss of contract

25. Scope, dispatch Current Future Resource Management
Independent center for ambulance
No CAD-2-CAD link
Future
Consolidate?
Resource Management
Right resources to right patient in right time…
E.G., first response to healthcare facility?

26. Scope, outcome-driven

27. Scope, outcome-driven Benchmark categories Cardiac arrest STEMI Stroke
Pain management
Respiratory distress
Hypoglycemia
Trauma
Sepsis
Seizures
Efficiency
Patient Safety

28. Scope, outcome-driven Independent patient satisfaction scoring
Communication by 9‐1‐1 call taker
Communication by firefighters
Communication by medics (patient and family)
Timeliness of ambulance response
Pain control
Cleanliness of ambulance
Ride of the ambulance
Communication by business office staff
Hospital visit within 24 hours? (for AMA calls)

29. Scope, outcome-driven Cardiac Arrest
Response interval < 5 minutes for CPR/AED
Bystander CPR rate
Bystander AED rate
Appropriate airway management
End-tidal CO2 monitored
Pit crew/focused CPR
Post resuscitation care
Therapeutic hypothermia
Aggressive BP goals
STEMI recognition
Transport to “Resuscitation Center”
ROSC percentage
Survival to discharge (e.g., overall, Utstein)

30. Scope, outcome-driven STEMI Recognition ASA administration
NTG administration
Appropriate analgesia given
Two pain scores recorded
SpO2 recorded
EKG acquired
EKG acquired within X minutes (e.g., 5-10)
12L acquired
12L transmitted
Limited scene time (e.g., < 10 minutes)
Transport to STEMI center rate
EMS access to PCI time (“911-to-balloon time”)

31. Scope, outcome-driven Stroke Time last seen normal
Use of a prehospital stroke scale
e.g., NHS, FAST, MEND, CPSS, LAPSS, MASS
Blood glucose documented
Blood pressure documented
Appropriate O2/airway management
Limited scene time (e.g., < 10 minutes)
Transport to a stroke – capable facility

32. Scope, outcome-driven Respiratory Distress (e.g., asthma)
Mental status
Resp. rate, SpO2, PEFR recorded B4 treatment
Oxygen administered (if appropriate)
Bronchodilators for pediatrics with wheezing
Beta2 agonist administration for adults
Endotracheal intubation success rate
End-tidal CO2 performed on any successful ET intubation
Improvement after treatment

33. Scope, outcome-driven Trauma Pain Management Sepsis Over-triage rate
Dispatched – enroute to hospital interval
Pain Management
Offered pain meds prior to movement
Pain score decreased
Sepsis
Protocol completed

34. Scope, outcome-driven Seizure Hypoglycemia
Glucose recorded B4 treatment
Glucose recorded after treatment
Correct disposition (e.g., transport, referral, home)
Seizure
Glucose recorded
Sp02 recorded
Anticonvulsant administration (febrile)
Temperature management (febrile)
Received intervention as appropriate

35. Scope, outcome-driven Efficiency Domain Cost per patient contact
Cost per transport
Cost per unit hour
Employee turnover rate

36. Scope, outcome-driven Patient Safety
Drops per 1,000 patient contacts
AMA to hospital within X hours (e.g., 24-72)
Mission failures per X responses/miles
Ambulance crashes per X responses/miles
Chart Review (random, manager, MD)
Protocol compliance rate

37. Input/Questions?

38. Thank You Bill Bullard, MBA Senior Vice President 707.823.0350
The Abaris Group
Walnut Creek, CA
888.EMS.0911
Thank You