notice of cancellation · 2018-03-22 · san jose, ca 95126 408.885.4250 voice 408.885.3538 fax ....

County of Santa Clara Emergency Medical Services System Emergency Medical Services Agency 976 Lenzen Avenue, Suite 1200 San Jose, CA 95126 408.885.4250 voice 408.885.3538 fax www.sccemsagency.org

NOTICE OF CANCELLATION

NOTICE IS HERBY GIVEN that the meeting of the Emergency Medical Services Committee Meeting scheduled at 1:00 p.m. on Thursday, December 4, 2014 at the Sheriff’s Department Auditorium, 55 West Younger Avenue, San Jose, has been cancelled. The next regular meeting of the Emergency Medical Services Committee is scheduled for 1:00 p.m. on Thursday, March 5, 2015 at the Sheriff’s Department Auditorium, 55 West Younger Avenue, San Jose.

A division of the Santa Clara County Public Health Department


EMERGENCY MEDICAL SERVICES COMMITTEE

Chair: Health Advisory Commissioner Harry Hall

Thursday, December 4, 2014

1:00 pm – 3:00 pm

(Voting Members Requested to RSVP by November 26, 2014)

Santa Clara County Sheriff’s Department Auditorium 55 West Younger Avenue

San Jose, CA 95110

All reports and supporting material are available for review on the Santa Clara County EMS Agency website at www.sccemsagency.org and in the EMS Agency’s offices at least one week prior to the meeting. This information is also available the day of the meeting. ( Indicates supporting documentation attached. Indicates committee action required). 1. Call to Order / Roll Call (Commissioner Hall) 2. Introductions and Announcements (Commissioner Hall) 3. Public Comment (Staff) This portion of the meeting is reserved for persons desiring to address the EMS Committee on a Committee-related matter not on the agenda. Speakers are limited to two (2) minutes. The law does not permit Committee action or extended discussion on any items not on the agenda except under special circumstances. Statements that require a response may be placed on the agenda for the next regular meeting of the Committee. Regular Items (Commissioner Hall) 4. Approval of October 2, 2014 Meeting Minutes

A division of the Santa Clara County Public Health Department EMSCO December 4, 2014 Page 1 of 52

http://www.sccemsagency.org/

5. Summary of Items Presented to Board of Supervisors or Health & Hospital Committee (Natividad)

6. EMS System Update (Petrie)

A. County Staff Recommendation Regarding Exclusive Operating Area

Request for Proposal

7. Medical Director Report – Clinical Care (Dr. Rudnick) () 8. EMS Trust Fund (Petrie) ()

A. Accept Written Report on the Financial Status of the EMS Trust Fund (Natividad and Petrie)

9. Exclusive Operating Area Contract Status (Blain)

A. County EOA Update i. Accept Rural/Metro Response Time Performance Report () ii. Accept Status of Deliverables ()

B. Accept Fire Department Response Time Performance Report ()

C. Palo Alto EOA Update – Accept Verbal Report 10. Hospital Destination, Diversion, and Advisory Status Report (Diaz) () 11. FY 15 EMSCO Meeting Dates 12. Member Roundtable and Reports 13. Next Meeting and Adjourn (Commissioner Hall)

March 5, 2015 from 1-3 pm at the Sheriff’s Department Auditorium, 55 West Younger Avenue, San Jose, CA 95110

Venue and Parking Instructions • Visitor parking is available at the County building parking lot designated “Visitor” areas. • No food or uncapped beverages are permitted in the training room. • This meeting will be recorded.

EMSCO December 4, 2014 Page 2 of 52

Emergency Medical Services Committee Sheriff’s Department Auditorium, 55 W Younger Avenue

October 2, 2014 1300 to 1500 Hours

Meeting Minutes

Item Discussion Action 1. Call to Order/Roll Call Chairman Harry Hall called the meeting to

order at 1:04 p.m. A quorum was present. • Meeting called to order.

2. Introductions and Announcements

• None

3. Public Comment No members of the public provided comment.

• None

Calendar Items 4. Approval of June 5, 2014 Meeting Minutes Without discussion, the committee approved

the consent calendar. M/S/C • June 5, 2014 Meeting Minutes

approved. M/S/C J. Coffaro/R. Hooks

5. Distribution of Revised EMS Committee Standing Rules

Michael Petrie reported that at the EMS Committee’s June 5, 2014 meeting members voted to revise the Standing Rules of the EMS Committee to require only two members of the Health Commission on the EMS Committee and to allow the committee to maintain a quorum with only on Health Commissioner present. Reducing the number of Health Commissioners assigned to the EMS Committee reduced the total committee membership to 15 and changed the quorum requirement from 9 to 8. A copy of the new Standing Rules of the EMS Committee provided for members.

• Informational Only

1


6. Summary of Approved or Pending Board of Supervisors, and Health and Hospital Committee Items

Without discussion, the committee accepted the approved Board of Supervisor and Health and Hospital Committee items. Health and Hospital Approved Committee Approved Items: • Emergency Medical Services (EMS)

Agency Report – August 13, 2014 • Report-back on Status of Agreement

with Racing Hearts – September 10, 2014

Summary of Board of Supervisors Approved Items: • Report on Improving First Responder

Time Performance – June 10, 2014 • Agreement with FirstWatch – September

9, 2014 • Request for Delegation of Authority to

Execute Agreement with Rural/Metro’s Accountant – September 9, 2014

• Informational Only Summary of Approved BOS and HHC items accepted as presented.

7. EMS System Update A. Rural/Metro Contract Revision

Michael Petrie reported: • On September 23, 2014, County staff

presented a report to the Board of Supervisors recommending that we begin the development of an RFP for 911 Paramedic Ambulance Services in the Santa Clara County Exclusive Operating Area to potentially award a new contract, starting July 1, 2016. The Board of Supervisors unanimously voted to support County staff’s recommendation.

• Mr. Petrie emphasized that this action only allows the EMS Agency to develop the RFP; thus providing the County with the option of later releasing a RFP. The Board of Supervisor’s action does not compel the County to release the RFP or, if it


2


B. San Jose Fire Department Response Time Performance

releases the RFP, to execute an agreement with the bidder. Further, County staff has committed to bring the RFP back to the Board of Supervisors before it is released. This action does not negate the County’s right to extend the term of the Agreement with Rural/Metro for one or two additional 3-year periods, by providing Rural/Metro no less than (60) days prior written notice. A copy of the report provided for members.

• The EMS Agency anticipates approximately that 18 months is necessary to create and release an RFP for 911 EOA paramedic ambulance services, to select the desired vendor, and to provide time for the vendor to prepare for operation.

• Michael Petrie reported on the San Jose

Fire Department’s Code 3 response time performance between January 2012 and April 2014, based on information provided by the San Jose Fire Department.

• The report details the San Jose Fire Department’s Code 3 (Red light and Siren) and Code 2 (No Red Light and Siren) response time performance between January 2014 and July 2014. The response time standard for each category is 90 percent.

• The County of Santa Clara Auditor (Harvey Rose Corporation) is continuing their management audit of the San Jose Fire Department’s response time. While the EMS Agency has support that audit, we are not privy to the content or timing of the results of that audit.


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8. Medical Director Report – Clinical Care • Dr. Rudnick provided reported on the Ebola Response at the EMS Agency. A meeting was held with the Public Health Officer to develop guidelines for Infectious Disease Control Measures for EMS providers which is to be sent out on Monday, October 6, 2014.

• Information only.

9. Exclusive Operating Area Contract Status A. County EOA Update –

i. Accept Rural/Metro Response Time Performance Report

ii. Accept Status of Deliverables

B. Accept Fire Department Response Time Performance Report.

C. Palo Alto EOA Update – Accept Verbal Report

• John Blain provided an update on the

status of Rural/Metro as the EMS System’s 911 paramedic ambulance provider. The report on (September 2013 to August 2014) response time performance shows Rural Metro has been compliant in all zones and overall performance.

• John Blain reported on the Fire

Department Response Time Performance (July 2013 to June 2014). The audit by Harvey Rose Agency is near completion and they will provide a report to the County

• No report.

• Rural/Metro Response Time

Performance Reported accepted as presented. M/S/C K. Horowitz/J. Coffaro

• Fire Department Response Times

Performance Report accepted as presented. M/S/C J. Coffaro/R. Hooks

10. Hospital Destination, Diversion, and Advisory Status Report

• Linda Diaz reported on the status of hospital destination, diversion and hospital advisory status levels for February 2014 through July 2014.

• The overall volume and daily averages of patients transported within the last six months saw a small decrease. Despite the decrease, the overall hours of diversion hours have increased. There was a significant increase in stroke diversion although this was attributed to one facility with a prolonged CT issue. Trauma Center an STEMI center diversion times remained low.

• Information only.

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11. Member Roundtable and Reports

• Richard Kline reported that the California State Trauma Advisory Committee has sent out the State Trauma Plan for a second and final comment period. To view the plan, visit the State EMSA website: www.emsa.ca.gov/trauma.

• Jo Coffaro commended the EMS Agency for their work Wall Times. The California Hospital Association will hold a meeting in late October to discuss wall times and how to work with ambulances and hospitals so everything is working well together. The Santa Clara County EMS Agency will assist with presentation to providers as they are highlighted for their best practices. Ms. Coffaro also reported on the State EMS Awards for 2014. The Hospital Council and the California Hospital Association have been accepted be sponsors for EMS Providers.

• Michael Petrie announced the State EMS Awards Luncheon will be held in San Francisco on Wednesday, December 5, at the Marine’s Memorial Hotel.

• Information only

12. Next Meeting The next meeting will be held on December 4, 2014 from 1:00 to 3:00pm at the Sheriff’s Department Auditorium.

• As noted.

13. Adjournment There being no further business, the meeting was adjourned at 1:45pm

• Meeting adjourned.

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http://www.emsa.ca.gov/trauma

MEMBERS PRESENT Harry Hall, Chair, Health Advisory Commission Kenneth Horowitz, , Health Advisory Commission Jo Coffaro, Hospital Council of Northern CA Rick Kline, Santa Clara County Trauma Surgeons Jose Chavez, Public Safety Sector Paramedic/EMT Randy Hooks, Permitted Non-911 Ambulance Provider Kralyevich, Private Service EMT/Paramedic Elaine Nelson, South Bay Emergency Medical Directors James Silva, Santa Clara County Medical Association Michelle Woodfall, Santa Clara Trauma Managers

MEMBERS ABSENT Steven Drewniany, Santa Clara County Police Chief’s Tom Haglund, County City/County Managers Jeff Taylor, 911 Contracted Ambulance Provider Ginger Miramontes, Emergency Department Managers Eric Nickel, Santa Clara County Fire Chief’s Assoc STAFF PRESENT Michael Petrie, Director John Blain, EMS Specialist Lilia Felix-Villalobos, Executive Assistant Daniel Franklin, EMS Specialist Michael Cabano, EMS Specialist John Montes, EMS Specialist

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County of Santa Clara Emergency Medical Services System

Emergency Medical Services Agency 976 Lenzen Avenue, Suite 1200 San Jose, CA 95126 408.885.4250 voice 408.885.3538 fax www.sccemsagency.org

Date: December 4, 2014 To: Santa Clara County EMS Committee Members From: Patricia Natividad

Senior Management Analyst

Subject: Summary of Approved or Pending Board of Supervisors and Health and Hospital Committee Items

Health and Hospital Approved Committee Approved/Pending Board Items:

Semi-annual report relating to the status of the EMS Agency and EMS System for period January 1, 2014 through August 31, 2014 – November 12, 2014.

Accept semi-annual report from Emergency Medical Services (EMS) Agency relating to the status of the EMS Agency and EMS System for period January 1, 2014 through August 30, 2014.

At their December 14, 2010 meeting, the Board of Supervisors requested that the EMS Agency provide regular updates to the Health and Hospital Committee regarding the performance of the County Exclusive Operating Area 911 Ambulance Provider, Rural/Metro of California.

On November 22, 2011, the Health and Hospital Committee requested that the EMS Agency provide an update in February 2012, and then provide future updates in May and November of 2012 and in subsequent years. A semi-annual report covering January 1, 2014 through August 30, 2014, is attached and provides the requested information. A copy of the report can be viewed on the Health and Hospital Committee Meeting Agenda web and is attached. Summary of Board of Supervisors Approved Items: Direct Administration to begin the process of developing a Request for Proposals for Countywide Exclusive Operating Area (EOA) Advanced Life Support Emergency Ambulance Services that may result in the implementation of a new EOA Emergency Ambulance contract on July 1, 2016 – September 23, 2014. In order to maintain the highest degree of flexibility for the County and to keep all options open for the Board regarding the EMS Ambulance contract, the Administration recommends the initiation of a process that may result in a new Request for Proposal for services starting 7/1/2016. The development of a new RFP and the implementation of a new 911 Exclusive Operating Area ambulance contract typically take approximately 2 years to complete.



Although the contract implemented in 2011 with Rural Metro is considered a model contract by many throughout the state, changes in health care and EMS reimbursement have materially impacted the financial viability of our EMS system in Santa Clara County and other EMS systems throughout California and the nation. The County’s relationship with Rural Metro has been challenging in a number of ways since the contract was initiated on July 1, 2011. However, both parties have been working diligently toward stabilizing the local EMS system as that is our singular priority. Rural Metro is current performing as expected and meeting or exceeding response time requirements. In addition, the costs of services for Rural Metro are significantly lower than those of surrounding jurisdictions. Thus, the citizens of Santa Clara are currently receiving quality ambulance service at a very good price. The recommendation to develop a new RFP does not commit the County to actually issue the RFP, to change our current contract, to change providers, or not to extend the current contract when it ends in 2016. However, starting the process does provide the Board with those options in the future. Due to the California Emergency Medical Services Authority (CAL EMSA) imposed limitations on the modification of the 911 Exclusive Operation Area (EOA) contract to address financial and other operating issues, administration cannot currently recommend such actions. After three years of experience working with this contract, we now understand both its strengths and weaknesses. Since we have little or no flexibility to modify the existing agreement without significant risk to the EMS system, our only practical option is to begin the RFP process.


County of Santa Clara

Santa Clara Valley Health & Hospital System

Public Health Department

Board of Supervisors: Mike Wasserman, Cindy Chavez, Dave Cortese, Ken Yeager, S. Joseph Simitian Page 1 of 2 County Executive: Jeffrey V. Smith

74090

DATE: November 12, 2014

TO: Health and Hospital Committee

FROM: Daniel Peddycord, Public Health Director

SUBJECT: Semi-annual Report on EMS System and EMS Agency

RECOMMENDED ACTION

Accept semi-annual report from Emergency Medical Services (EMS) Agency relating to

status of the EMS Agency and EMS System for period January 1, 2014 through August 31,

2014.

FISCAL IMPLICATIONS

This report is for informational purposes only; there is no impact on the General Fund.

The County does not provide any direct funding in support of the services provided by the

911 emergency medical services system because the cost of the Santa Clara County

Emergency Medical Services (EMS) System is paid by system providers, such as hospitals

and ambulance companies, individuals who use these services, and their medical insurers.

REASONS FOR RECOMMENDATION

During their meeting on December 14, 2010, the Board of Supervisors requested that the

EMS Agency provide regular updates to the Health and Hospital Committee regarding the

performance of the County Exclusive Operating Area 911 Ambulance Provider, Rural/Metro

of California.

On November 22, 2011, the Health and Hospital Committee requested that the EMS Agency

provide an update in February 2012, and then provide future updates in May and November

of 2012 and subsequent years. This report provides the requested information including the

status of the EMS System and highlights of some activities of the EMS Agency during the

period from January 1, 2014, through August 31, 2014.

CHILD IMPACT

The recommended action will have no/neutral impact on children and youth.

SENIOR IMPACT


Board of Supervisors: Mike Wasserman, Cindy Chavez, Dave Cortese, Ken Yeager, S. Joseph Simitian Page 2 of 2 County Executive: Jeffrey V. Smith

Agenda Date: November 12, 2014

The recommended action will have no/neutral impact on seniors.

SUSTAINABILITY IMPLICATIONS

The recommended action will have no/neutral sustainability implications.

BACKGROUND

This semi-annual report emphasizes the period from January 1, 2014, through August 31,

2014.

Because the EMS Agency has been reporting frequently to the Health and Hospital

Committee and Board of Supervisors regarding EMS system issues, this report emphasizes a

few of the EMS Agency’s activities such as Ebola preparedness and response and focuses on

areas most central to EMS system performance such as pre-hospital clinical care and quality

improvement.

CONSEQUENCES OF NEGATIVE ACTION

The Health and Hospital Committee would not receive the information requested from the

EMS Agency.

ATTACHMENTS:

2014 November Semi Annual HHC REPORT 2014-11-12 (PDF)


Santa Clara County Emergency Medical Services Agency

Semi-Annual Report To the Board of Supervisors’ Health and Hospital Committee

November 2 0 1 4 January 1 to August 31, 2014


1 Santa Clara County EMS Agency November 2014

TableofContents

Table of Contents ......................................................................................................... 1

EMS Agency Activities ................................................................................................... 2

Ebola Preparedness and Response ................................................................................. 2

Hospital Diversion and Delay of Ambulances at Hospital Emergency Departments ............... 3

Training and Education ................................................................................................... 4

Rural/Metro serving as County Ambulance .................................................................... 7

EMS Trust Fund ............................................................................................................. 7

EMS Trust Fund Revenue ................................................................................................ 8

EMS Trust Fund Expense ................................................................................................. 9

EMS Agency Fee Schedule ........................................................................................... 10

EMS System Descriptive Statistics ............................................................................... 12

Prehospital Clinical Care and Quality Improvement .................................................... 14

Rural/Metro Response Times ....................................................................................... 14

Air Ambulance Transports ............................................................................................ 19

Hospital and Specialty Care Facilities .......................................................................... 20

Hospital Volume and Destinations ................................................................................ 20

Hospital Diversion of Ambulances ................................................................................ 21

Trauma System ............................................................................................................. 22

Stroke System ............................................................................................................... 23

STEMI Care System ....................................................................................................... 24



EMSAgencyActivitiesThis semi‐annual report emphasizes the eight‐month period from January 1, 2014

through August 31, 2014, and includes information and data from calendar year 2013 to

provide context and precedent to the reader.

EbolaPreparednessandResponseThe Santa Clara County Emergency Medical Services (EMS) Agency, in collaboration with

the Department of Public Health and County Health Officer, has acted rapidly and

comprehensively in response to the threat of Ebola. The EMS system’s efforts started in

late July by reeducating EMS providers about proper infection control techniques and

the use of Personal Protective Equipment (PPE). As the outbreak expanded, the EMS

System began to distribute information form the Centers for Disease Control and

Prevention (CDC) and the World Health Organization (WHO) to stakeholders to inform

emergency responders of the scope of the Ebola outbreak and to identify the signs and

symptoms of the disease.

The Ebola epidemic is the largest Ebola outbreak in history. Ebola is at epidemic levels in

Guinea, Liberia, and Sierra Leone. Following identification of the case in Dallas, Texas,

The EMS Agency instituted specific Ebola screening methods within the EMS System to

quickly identify potential Ebola cases within Santa Clara County. This immediate action

was necessary to protect pre‐hospital providers should they encounter a patient that

potentially has the disease, and to provide mechanisms to immediately notify the

County Health Officer and the Centers for Disease Control and Prevention. The EMS

Agency released an Administrative Order on October 8, 2014, that revised Santa Clara

County Prehospital Care Policies relating to infection control and implemented a new

policy regarding Ebola Virus Prevention and Control. These policies define different

types of infection control precautions, define minimum equipment inventories,

treatment guidelines, and created a screening mechanism for the Ebola virus. These

policies also prescribe the practice by which emergency responders identify suspect

cases and rapidly notify the Health Officers and EMS command staff.

As the epidemic evolves, care standards and CDC guidance continue to change. The

EMS Agency and Public Health Department are working to ensure our policies remain

consistent with current guidelines. The EMS Agency has convened a committee of EMS



System stakeholders, including representatives from fire agencies, ambulance providers,

communications centers, and hospitals. This committee is working together to ensure

that prudent policies and procedures are in place to properly identify, treat and

transport a potentially Ebola infected patient. The EMS Agency will continue to review

the tools, conduct exercises and make any corrections to the guidance as needed. All

responding agencies have initiated training activities.

While there is a very low likelihood that an Ebola infected person may present to the

Santa Clara County EMS System, there is a very high likelihood that system responders

will be able to safely identify, treat and transport this patient appropriately.

HospitalDiversionandDelayofAmbulancesatHospitalEmergencyDepartmentsIn summer of 2014, the Santa Clara County EMS Agency, collaborating with hospitals in

Santa Clara County, the County Communications Department, and Rural/Metro, hosted a

Lean Six Sigma Black Belt Course to provide advanced statistical process control training

to EMS System stakeholders and to statistically evaluate the root causes of extended wall

times in Santa Clara County. Generally defined, wall times are the time interval starting

when the ambulance arrives at the emergency department (ED) and ending when

emergency department staff accepts responsibility for the patient and moves that

patient off the ambulance gurney.

The results of this project were surprising. The conventional wisdom that most of the

wall time delays were attributable to hospitals failing to rapidly accept care of the patient

was statistically proven inaccurate in most instances in Santa Clara County. In fact, this

study identified that the mean time interval starting from the ambulance patient arriving

in the emergency department and ending when the ambulance was available for another

response was 31.32 minutes. Of that time, a mean of 1.57 minutes was used to enter the

facility, a mean of 10.42 minutes was used to place the patient in a bed and to transfer

care to the hospital, and a mean of 18.52 minutes was used by the ambulance crew to

restock and to complete paperwork. Thus we learned that most of the “wall time” delay

was attributable to the EMS crews restocking and completing their paperwork.

While this study had a small sample size, its findings are significant. In many instances,

the current practice of automatically placing ambulances back in service during slow



periods at 30 minutes may increase out of service times. Therefore, EMS practices are

being revised to create a culture that strives for 20 minute hospital drop times for all

patients transported to hospital emergency departments, and hospitals are investigating

new methods of emergency department intake of ambulance patients. While this

problem will be solved in the long term, this study shows the importance of

understanding, defining and measuring the problem, before solving the problem. If the

EMS Agency would have tried to unilaterally reduce extended wall times through

regulatory fiat, before truly understanding the problem, the results would have angered

stakeholders, but not reduced wall times. This study is a great example of the EMS

System emerging as a learning and quality‐focused meta‐organization.

TrainingandEducation

Training

From January 1, 2014, to August 31, 2014,

the Santa Clara County EMS Agency

provided 1,293 hours of continuing

education to 244 EMS personnel. From

October 2013 to February 2014 over 2,400

providers complete the annual EMS

Update Training. This mandatory annual

training emphasizes policies and protocols that have been revised; however, this

training cycle also included education and assessment training on the Santa Clara

Assessment for Missed Posterior Stroke (S.C.A.M.P.S) Trial.

EMS System Training and Education Videos

The Santa Clara County EMS Agency created and released the following videos as

educational resources for those who live, work and play in Santa Clara County. Each

video provides insight into the 911 Emergency Medical Services System and feature

some of the equipment used by the EMS professionals in the Santa Clara County EMS

System.

EMS Training and Education Totals

Training Opportunities 9

Number of Prehospital personnel in attendance

244

Number of Continuing Education Hours provided

1,293



The Santa Clara County EMS System Overview

video provides a summary of the services provided

in the Santa Clara County EMS System.

AN INSIDE LOOK: Santa Clara County 911 Ambulances

This video provides an orientation to the

capabilities and equipment contained within Santa

Clara County 911 Ambulances known as "Medic"

units.

Santa Clara County EMS RADIO SYSTEM and COMMUNICATIONS PROCEDURES

This video provides guidance for the use of the Santa

Clara County’s EMS Communication System.

Santa Clara County Multiple Patient Management

Plan ‐ MPMP

This video provides an overview of how to implement the Santa Clara County Multiple

Patient Management Plan while responding to a multi‐causality incident (MCI).

Public Education

From January 1, 2014, to June 30, 2014, the EMS Agency promoted six public education

campaigns related to emergency medical services. These monthly campaigns included

Medical Alerts, the Santa Clara County Emergency Alert System (AlertSCC), Pool Safety,



Stroke Awareness, Preventing Snake Bites and “Pull to the Right for Sirens and Lights.”

Each month the EMS Agency provides educational campaign materials to every fire

department and ambulance company within the Santa Clara County EMS System. These

materials include educational flyers, postcards, posters, and pamphlets to pass out to

the community, and talking points for use during presentations. By coordinating the

public education campaigns for all providers within the EMS System, the public message

is consistent, regardless of which organization provides the message. This minimizes the

possibility of misinformation and assures a coordinated message countywide.

Social Media

The EMS Agency actively uses social

media to promote and distribute

information about EMS events. As a

result, the number of people following

the EMS Agency’s Facebook page has



doubled since last year. On the EMS Agency’s Facebook page or Twitter feed, you will

find information about monthly educational campaigns and training announcements,

recognition of EMS providers and information about EMS meetings and forums. An

example of recognition shared on the Agency’s Facebook and Twitter feed was the

Proclamation issued in recognition of EMS Week held in June of 2014. This provided a

way for the EMS Agency to share the event with the many EMS Providers that were

unable to attend the Board of Supervisors meeting. The EMS Agency’s Twitter feed is

@XSCEMS.

Rural/MetroservingasCountyAmbulanceRural/Metro of California, operating as County Ambulance, has provided emergency

paramedic ambulance service for the Santa Clara Emergency Medical Services (EMS)

System since July 1, 2011. The

Santa Clara County EMS System

continues to be stable, and

assures that every person who

calls 911 for a medical

emergency will receive an

emergency paramedic

ambulance and trained first

responders.

From January 1, 2014, through August 30, 2014, Rural/Metro met contractual response

time performance standards, every month, in all five zones, for emergency and non‐

emergency calls. Detailed information about EMS System performance, including

Rural/Metro’s response time performance statistics, is provided later in this report.

EMSTrustFundThe EMS Trust Fund’s purpose is to provide funding for projects with a countywide

benefit to EMS System providers, enhance the services provided within the EMS System

and to improve the delivery of 911 emergency medical care in the County. The EMS

Trust Fund is a backward‐looking fund; that is, funds collected in one year are expended

the following year. This process provides policy and spending oversight by the Board of

Supervisors, and provides adequate time to consider spending allocations in the context



of strategic EMS System change. EMS Agency plans to bring its FY16 EMS Trust Fund

Recommendations to the Health and Hospital Committee for review and approval in

March 2015.

EMSTrustFundRevenueThe EMS Trust Fund is funded with revenues from liquidated damages (fines) from the

contracted 911 paramedic ambulance provider (Rural/Metro) for failing to meet per‐call

response time standards; monthly zone response time standards; or for failing to meet

other contract stipulations, such as maintaining minimum ambulance availability or

avoiding ambulance breakdowns.

Month / Year Amount

July 2013 $183,000

July 2013 – Rural/Metro Bankruptcy Relief ($183,000)

August 2013 $209,250

September 2013 $217,750

October 2013 $272,500

November 2013 $271,750

December 2013 $278,280

January 2014 $238,750

February 2014 $281,000

March 2014 $278,280

April 2014 $249,000

May 2014 $182,500

June 2014 $330,500

TOTAL $2,809,560

Average Monthly Liquidated Damages $234,130

The amount of these liquidated damages is significantly greater than the amount of

liquidated damages in previous 911 paramedic ambulance service contracts. However,

the greater amount of liquidated damages is primarily due to a substantially more

expensive fine structure. In some cases, fine levels in the Rural/Metro contract are ten

times greater than in prior contracts.



EMSTrustFundExpenseEMS Trust Fund expenses are approved by the Health and Hospital Committee and the

Board of Supervisors before the start of the fiscal year. The EMS Agency routinely

provides detailed financial reports to the Health and Hospital Committee about the EMS

Trust Fund. This EMS Trust Fund summary discusses how expenditures from the EMS

Trust Fund improve emergency medical services within Santa Clara County.

Category A: Reserve

At the Board of Supervisors’ direction, starting in Fiscal Year 2011‐2012, a reserve

category was established in the EMS Trust Fund. This amount, which is at least 20% of

the EMS Trust Fund, is placed into reserve and used only for significant strategic projects

that benefit the EMS System with a long range focus. Following approval by the Board

of Supervisors, these funds could also be used if the EMS System experiences an

unanticipated financial burden, such as the failure of an ambulance provider or an

extraordinary increase of cost of service or supplies, or a material decrease in system‐

wide third‐party payor reimbursement. During the 2013‐2014 Fiscal Year, $575,000 of

the EMS Trust Fund monies was placed into reserve.

Category B: Training, Education and Recognition Funding authorized in this category was used for annual training, education, exercises,

and recognitions. Funds were used in the following subcategories:

∙ EMS System Information to the Public

∙ Training (which is not funded by grants or other sources)

∙ Exercises (which are not funded by grants or other sources)

∙ EMS Provider and committee member recognition, and EMS Week

During the 2013‐2014 Fiscal Year, $235,000 was allocated to training, education, and

recognition.

Category C: Benefit to EMS System Stakeholders

Funds were allocated from this category to assist EMS System Stakeholders with one‐

time or short‐term needs. During Fiscal Year 2013‐2014, funds were allocated to the fire



departments within Santa Clara County to provide hardware to support the County EMS

System Data Project. This funding will provide fire departments with the ability to enter

and transmit patient care data from the scene of an emergency; rather than waiting to

enter data until the unit has returned to a fire station. This allocation was essential to

creating a comprehensive EMS System data collection and analysis capability. During the

2013‐2014 Fiscal Year, $200,000 was allocated to short term and one time projects that

benefit EMS System Stakeholders, such as manikins to help emergency responders

improve their ability to secure patients’ airways and to better analyze EMS System

clinical data.

Category D: Strategic Initiatives

Projects in this category emphasize initiatives that strategically advance the Santa Clara

County EMS System, often in the longer term. During FY 2013‐2014, funds were

allocated to the implementation of the 10 Goals in the EMS System Strategic Plan.

Implementation of the EMS System Strategic Plan is necessary to allow the County EMS

System to adapt to the anticipated care and reimbursement changes associated with

the federal Affordable Care Act and national health care reform. Implementation of the

10 Goals in the strategic plan would allow the County EMS System to continue to

provide excellent clinical care, to better target patient needs to resources, to assure

operational efficiency, to remain financially stable, and have high levels of patient and

stakeholder satisfaction. Monies were also allocated to fund further development of

the Comprehensive EMS Data System. Category D funds were also spent to support the

development of the Integration of hospitals into the Comprehensive EMS Data System,

to support development of the Sobering System, Six Sigma Training, and the Public

Health Department Operations Subsidy. During Fiscal Year 2013‐2014, $1,640,000 was

allocated to strategic projects and $750,000 was provided as a general subsidy to the

Public Health Department.

EMSAgencyFeeScheduleThe EMS Agency relies on fee‐for‐service fees for funding operations, including system‐

wide planning, policy and clinical protocol development, analysis, and operational and

clinical quality improvement. The EMS Agency has not increased its fees since July 1,

2011.



The EMS Agency did not request a fee modification from the Board of Supervisors for

Fiscal Year 2014, because unprecedented changes in the EMS System operations and

EMS Agency planning and quality improvement linked to the EMS System Strategic Plan

will occur in starting in the second half of Fiscal Year 2014. The current fee structure is

listed on the following page:

Fiscal Year 2015 EMS Agency Fee Schedule

ITEM/SERVICE FEE

INDIVIDUAL FEES

EMT Certification $50

EMT Re‐Certification (biennial) $50

Paramedic Local Accreditation $150

Identification Card $20

Replacement ID Card (certification, accreditation, system ID)

$20

Photocopying $4.75 (1st page)

$.10/ea. Addl.

COMPANY FEES

Ambulance Service Permits (annual fee)

Basic Life Support $5,500

Advanced Life Support $6,000

Critical Care Transfer $6,000

Air Ambulance Service $8,000

Ambulance Vehicle Permits (annual fee)

Basic Life Support $950

Advanced Life Support $950

Critical Care Transfer $950

Air Unit $950

Non‐Transport BLS/ALS Unit $800

Education Program Certification (every 4 years)

EMT Program $1,000

Paramedic Program $5,000

Prehospital Continuing Education $1,000

Specialty Care Designation (annual fee)

Trauma Center Designation $100,000



Stroke Center Designation $10,000

STEMI Receiving Center Designation $10,000

911 Receiving Center Designation $10,000

EMSSystemDescriptiveStatisticsListed in the following tables are statistics that describe the characteristics of the Santa

Clara County EMS from January 1, 2014, through August 30, 2014.

The County of Santa Clara

Daytime Population 2.2 million

Resident Population 1.8 million

Geographic Size 1,132 square miles

Proportion of Rural/Urban Land 2/3 rural

Municipalities 15

911 System Call Volume

January through

August 31, 2014 Annualized

Total Responses 73,513 126,022

Total Events with Ground Ambulance Transports 48,521 83,778

Total Patients Transported by Ground Ambulance 48,987 83,977

EMS Aircraft Response 86 147

EMS Aircraft Transports 57 97

Ground Ambulance Interfacility Transports

January through


Ground Ambulance (Jan‐August 2014) 28,843 49,445

Ground Ambulance 2013 54,982



Specialty Center Patients

January through


Stroke Patients 1,249 2141



Trauma Patients 3,923 6725

STEMI Patients 216 370

Pre‐Hospital Care Provider Agencies

Fire Departments 11

Ground Ambulance Services 11

Air Ambulance Services 2

Pre‐Hospital Care Personnel

Emergency Medical Technicians 2,489

Paramedics 754

Mobile Intensive Care Nurses 22

Accredited EMS Field Supervisors 17

Permitted EMS Assets

Fire Apparatus 159

Private Ground Ambulances 216

Private Air Ambulances 3

Private EMS Non‐Transport Units 16

Communications Centers

Public Safety Answering Points (PSAPs) 13

Secondary PSAPs 10

Private Ambulance Dispatch Centers 10

Air Ambulance Dispatch Centers 2

Acute Care Facilities

Acute Care Hospitals 12

Emergency Departments 11

Level 1 Trauma Centers 2

Level 2 Trauma Centers 1

Base Hospitals 1

Burn Centers 1

Stroke Centers 10

STEMI Centers 8

County Managed Medical and Health Disaster Resources

Field Treatment Site Trailers 8



Specialty Services Trailers 3

Chem‐Packs 8

Medical‐Health Operations Center 1

EMS Radio Caches 7

Disaster Medical Support Units 2

Prehospital Training Programs

Emergency Medical Technician 7

Paramedic 2

EMS Fellowship 0

PrehospitalClinicalCareandQualityImprovement

Rural/MetroResponseTimes

AmbulanceResponseTimestoEmergencyCallsThe chart below identifies Rural/Metro’s response times to Code 3 (emergency red light

and siren) calls by month from January 1, 2014, through August 30, 2014, in each of the

five ambulance subzones within Santa Clara County. The response time standard is 90%

or greater, and is represented by the yellow horizontal line on this graphic. During the

January 1, 2014 to August 31, 2014 reporting period, Rural/Metro met contractual

response time standards in each of the five subzones, every month.



County Ambulance Code 3 Response Times

Code 3 Response Jan 14 Feb 14 Mar 14 Apr 14 May 14 Jun 14 Jul 14 Aug 14

Overall 93.30% 92.64% 92.83% 91.67% 94.03% 93.97% 92.66% 92.58%

Zone 1 92.40% 92.07% 93.03% 91.38% 94.19% 93.46% 92.12% 92.65%

Zone 2 91.93% 91.58% 92.46% 90.19% 94.09% 93.45% 91.50% 91.60%

Zone 3 94.29% 93.41% 92.69% 92.86% 94.06% 94.01% 94.63% 93.70%

Zone 4 93.38% 93.34% 92.85% 91.64% 93.40% 93.83% 91.82% 92.02%

Zone 5 95.49% 90.62% 93.68% 91.45% 95.81% 97.12% 92.33% 92.62%

AmbulanceResponseTimestoNon‐EmergencyCallsThe chart below identifies Rural/Metro’s response times to Code 2 (non‐emergency)

calls by month from January 1, 2014, through August 31, 2014, in each of the five

ambulance subzones within Santa Clara County. The response time standard is 90% or

greater, and is represented by the yellow horizontal line on this graphic. During the

January 1, 2014 to August 31, 2014 reporting period, Rural/Metro met contractual

response time standards in each of the five subzones, every month.

86.00%

88.00%

90.00%

92.00%

94.00%

96.00%

98.00%

100.00%

Jan 14 Feb 14 Mar 14 Apr 14 May 14 Jun 14 Jul 14 Aug 14

County Ambulance Code 3 Response Time Compliance by Month

Overall Zone 1 Zone 2 Zone 3 Zone 4 Zone 5



County Ambulance Code 2 Response Times


Overall 94.60% 92.70% 94.60% 93.32% 94.79% 95.62% 93.18% 94.23%

Zone 1 97.16% 95.34% 94.95% 95.64% 95.95% 96.87% 97.06% 95.83%

Zone 2 94.76% 92.64% 93.72% 93.44% 96.27% 95.89% 91.67% 93.20%

Zone 3 93.41% 90.79% 95.02% 93.36% 94.73% 96.30% 92.72% 92.67%

Zone 4 93.80% 91.63% 93.74% 91.09% 92.13% 93.55% 91.48% 94.78%

Zone 5 92.68% 95.24% 100.00% 94.12% 98.04% 97.35% 94.74% 95.83%

FireDepartmentFirstResponderResponseTimes

FireDepartmentFirstResponderResponseTimestoEmergencyCallsThe chart identifies fire department response times to Code 3 (emergency red light and

siren) calls by month from January 1, 2014, through August 31, 2014, for each of the first

responder fire departments within Santa Clara County. Fire departments should achieve

a response time of 90% or greater, and those who achieve a response time of 95% or

greater are exempted from any response time liquidated damages incurred during that

month.

86.00%

88.00%

90.00%

92.00%

94.00%

96.00%

98.00%

100.00%


County Ambulance Code 2 Response Time Compliance by Month

Overall Zone 1 Zone 2 Zone 3 Zone 4 Zone 5



The San Jose Fire Department has complied with the 90th percentile response time

performance standard three times during the Janaury 2014 through August 31, 2014

period. While this performance does not allow the City of San Jose to cure its

continuing Breach of Annex B, which is the voluntary reimbursement agreement, it

appears that since the Board of Supervisors’ action in February 2014, the San Jose Fire

Department’s response time performance is trending toward gradual improvement.

In February 2014, the Board of Supervisors directed its Management Audit Division to

conduct a limited scope of management audit of the San Jose Fire Department’s 911

EMS response policies and procedures to identify the issues impeding the department’s

ability to respond to emergency medical 911 calls in accordance with the goals specified

in the agreement between the County and City, and to make recommendations that

would enable the City to achieve the performance goals. The findings and

recommendations of the final audit report have not been released and are not included

in the report. A summary of the final audit report will be included in the next EMS

Agency’s Semi Annual Report to the Board of Supervisors’ Health and Hospital

Committee in May 2015.

80%

82%

84%

86%

88%

90%

92%

94%

96%

98%

100%


Fire Department Code 3 Response Time Compliance by Month

Gilroy Milpitas Morgan Hill Mt. View San Jose

Santa Clara Santa Clara Co. So. Santa Clara Co. Sunnyvale



Fire Department Code 3 First Responder Response Time Compliance by Month


Gilroy 98.54% 98.18% 96.79% 98.18% 98.78% 99.59% 98.05% 98.45%

Milpitas 98.27% 95.28% 96.60% 97.36% 96.04% 96.72% 95.17% 96.46%

Morgan Hill 95.16% 95.65% 98.34% 98.33% 99.54% 96.32% 95.81% 95.48%

Mt. View 96.76% 97.40% 97.20% 95.78% 95.33% 96.51% 97.61% 97.28%

San Jose 88.06% 87.66% 88.75% 90.39% 88.94% 90.31% 92.53% 88.95%

Santa Clara 96.54% 95.67% 96.91% 95.47% 95.40% 95.13% 96.07% 93.91%

Santa Clara Co. 96.12% 95.25% 96.10% 97.17% 96.30% 95.31% 95.39% 95.96%

So. Santa Clara Co. 93.15% 90.24% 97.03% 95.45% 94.12% 96.33% 90.91% 90.99%

Sunnyvale 97.78% 98.36% 98.81% 98.35% 98.25% 98.79% 99.20% 98.28%

FireDepartmentResponseTimestoNon‐EmergencyCallsThe chart below identifies fire department response times to Code 2 (non‐emergency)

calls by month from January 1, 2014 through August 31, 2014 for each of the first

responder fire departments within Santa Clara County. Fire departments should achieve

a response time of 90% or greater, and those who achieve a response time of 95% or

greater are exempted from any response time liquidated damages incurred during that

month. Several fire departments choose to respond Code 3 to all incidents.

80%

82%

84%

86%

88%

90%

92%

94%

96%

98%

100%



Mt. View San Jose Santa Clara Santa Clara Co.





Mt. View 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 97.44% 97.87%

San Jose 94.46% 93.67% 96.18% 96.55% 96.55% 96.50% 97.86% 97.30%

Santa Clara 98.52% 98.58% 95.47% 98.47% 96.64% 98.62% 99.21% 97.35%

Santa Clara Co. 100.00% 98.73% 100.00% 99.37% 100.00% 98.67% 99.45% 99.35%

AirAmbulanceTransports

Air ambulance utilization continued at relatively low levels during the first half of 2014.

The number of air ambulance dispatches and transports shown in this chart is based on

the first eight months of 2014. This volume of responses and transports has remained

relatively static since approximately 2009. The EMS Agency considers this volume of air

ambulance responses and transports appropriate.

Year Dispatches Transports Utilization Percent

2002 540 254 47%

2003 524 236 45%

2004 545 251 46%

2005 463 205 44%

2006 443 221 50%

2007 442 207 47%

2008 248 137 55%

540 524545

463443 442

248

184 176 179 183

12986

254236 251

205 221 207

137111 103 107 109

74 57

0

100

200

300

400

500

600

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Air Ambulance Utilization by Year

Responses Transports



2009 184 111 60%

2010 176 103 59%

2011 179 107 60%

2012 183 109 60%

2013 129 74 57%

2014 (8 months) 86 57 66%

HospitalandSpecialtyCareFacilities

HospitalVolumeandDestinationsFrom March 1, 2014, through August 31, 2014, there were 37,782 ambulance

transports from the 911 System to hospitals within Santa Clara County. Santa Clara

Valley Medical Center continues to demonstrate the highest volumes.

Ambulance Destination by Hospital

Hospital Mar 14 Apr 14 May 14 Jun 14 Jul 14 Aug 14 Total

El Camino ‐ Los Gatos 100 107 95 86 90 82 560

El Camino ‐ Mt. View 694 637 667 661 594 670 3,923

Good Samaritan 594 568 567 595 588 589 3,501

Kaiser ‐ San Jose 596 559 599 543 513 519 3,329

Kaiser ‐ Santa Clara 675 685 677 629 597 624 3,887

O'Connor 595 583 564 551 496 575 3,364

Regional San Jose 1,080 1,120 1,116 1,072 1,033 1,145 6,566

0

200

400

600

800

1000

1200

1400

Mar‐14 Apr‐14 May‐14 Jun‐14 Jul‐14 Aug‐14

Ambulance Destination by HospitalMarch - August 2014

El Camino ‐ Los Gatos

El Camino ‐ Mt. View

Good Samaritan

Kaiser ‐ San Jose

Kaiser ‐ Santa Clara

O'Connor

Regional ‐ San Jose

Saint Louise

Stanford

VA ‐ Palo Alto

VMC



Saint Louise 269 233 273 246 212 260 1,493

Stanford 441 440 511 511 492 521 2,916

VA ‐ Palo Alto 89 95 87 78 151 79 579

VMC 1,308 1,259 1,318 1,273 1,242 1,264 7,664

Total 6,441 6,286 6,474 6,245 6,008 6,328 37,782

HospitalDiversionofAmbulancesHospital diversion levels have dropped significantly over this six month period. EMS

Agency policy limits hospitals to no more than 36 hours of diversion per month and all

facilities have met this benchmark. This standard is represented by the yellow horizontal

line on this graphic. There was a significant increase in the hours noted for stroke

service advisory. This was attributed to a mechanical failure and resulted in a 124 hour

CT/stroke diversion. This issue has been resolved and the agency does not anticipate

any further problems.

0.005.00

10.0015.0020.0025.0030.0035.0040.0045.0050.00

Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14

Ambulance Diversion by HospitalMarch-August, 2014

El Camino - LosGatosEl Camino - Mt.ViewGood Samaritan

Kaiser - San Jose

Kaiser - SantaClaraO'Connor

Regional - SanJoseSaint Louise



Total Monthly Hours of "AMBULANCE DIVERSION" Status

Hospital Mar 14 Apr 14 May 14 Jun 14 Jul 14 Aug 14 Total

El Camino ‐ Los Gatos 0.00 0.00 0.81 0.00 0.00 0.00 0.81

El Camino ‐ Mt. View 21.09 12.51 12.04 10.11 12.78 14.83 83.36

Good Samaritan 1.51 1.50 0 0.00 3.01 0.00 6.02

Kaiser ‐ San Jose 2.91 9.78 4.51 11.63 6.00 10.99 45.82

Kaiser ‐ Santa Clara 0.00 6.02 1.5 0.00 0.00 1.51 9.03

O'Connor 3.00 1.50 1.51 3.00 6.63 3.00 18.64

Regional San Jose 0.09 0.00 3.11 3.58 3.01 1.26 11.05

Saint Louise 16.58 7.51 19.05 4.52 16.59 8.93 73.18

Stanford 4.53 0.00 3.03 1.50 9.05 4.52 22.63

VA ‐ Palo Alto 6.98 2.44 10.68 12.04 16.15 21.04 69.33

VMC 30.44 15.58 14.75 19.19 10.35 22.24 112.55

Total 87.13 56.84 70.99 65.57 83.57 88.32 452.42

TraumaSystemBetween January 1, 2014, and June 30, 2014, 3,923 trauma patients were seen in the

Santa Clara County trauma system. This includes 3,257 adults and 323 pediatric patients

(pediatric age range is 0 to less than age 15). Eighty percent of trauma patients were

transported to a trauma center by ambulance, while eleven percent of trauma patients

were transported to a trauma center by an air ambulance. Effort continues to

standardize the trauma system within the Bay Area through the Regional Trauma Care

Committee. This committee is evaluating inter‐facility trauma transfers and working to

increase outreach to non‐trauma centers in order to facilitate an ease of transfers for

seriously injured patients.

CountyofOriginSanta Clara County is the primary county of origin for trauma patients that enter the

Santa Clara County trauma system, producing 44% of the volume of trauma patients.

Other counties refer some of their trauma patients to Santa Clara County, producing

significant proportions of the total trauma volume in Santa Clara County. Those counties

include: Alameda County at 2%; San Mateo County at 13%; Monterey County at 5%; San

Benito County, and Santa Cruz County at 3%.



MechanismofInjuryNinety‐three percent of the injuries in the Santa Clara County trauma system are caused

by a blunt mechanism of injury, such as motor vehicle/motorcycle injuries, pedestrians

struck by car, and bicycle accidents. The remaining seven percent are caused by

penetrating mechanisms of injury, such as gunshot wounds and stabbings. These

percentages have remained constant for the past four years.

DispositionfromtheEmergencyDepartmentFifty‐one percent (51%) of trauma patients are admitted to the hospital. Forty‐eight

percent (48%) of trauma patients are discharged from the emergency department. Less

than one percent (0.80 %) of trauma patients expired in the emergency department.

StrokeSystemThe Santa Clara County Board of Supervisors approved a stroke care system developed

by the Santa Clara County Emergency Medical Services Agency in March of 2006. This

evidence‐based system provides patients the opportunity to be transported to the

closest, specially designated hospital, which can provide immediate stroke care to

patients who show symptoms of an acute stroke.

0%5%

10%15%20%25%30%35%40%45%50%

Santa Clara Alameda Monterey San Benito Santa Cruz San Mateo

Injury by County of Origin January ‐ June 2014



The need for rapid intervention is based on clinical evidence that treatment with an

anti‐clotting drug (IV tPa) within three and a half hours of the onset of their symptoms

may prevent and possibly reverse the effects of the blocked circulation to the brain. The

Santa Clara Stroke System was designed with two specific goals. The first goal is to

increase the number of patients who arrived in the emergency department at the stroke

center within the time necessary to allow administration of anti‐clotting agents. The

second goal is to educate the public about stroke symptoms, and the need to call 9‐1‐1

if symptoms are present.

January 1, 2014 through June 30, 2014 Performance Data

Criteria County

Performance Data Percentages

Total Stroke Volume 1,249 100%

Total Number of Ischemic Strokes 1,003 80%

Total Strokes Transported by EMS 648 39%

Total Strokes Self‐Transported 485 41%

Total patients by interfacility Transfer 96 8%

% of Ischemic Stroke treated by IV tPA 17% National Average (1‐8%)

STEMICareSystemSanta Clara County’s STEMI (S‐T Elevation Myocardial Infarction) Care System continues

to be regarded as a model system of care. A STEMI is a serious type of heart attack

associated with higher rates of morbidity and mortality. Patients identified by

paramedics as STEMI Alert patients, based on a 12‐lead electrocardiogram, are treated

rapidly with Percutaneous Coronary Intervention (PCI), which includes balloon

angioplasty and stents, to open the blockage in the artery.

The median length of stay in the hospital after the procedure is two days. From January

2014 through June 2014, 94% of the patients treated with Percutaneous Coronary

Intervention had median door to balloon (D2B) of less than 90 minutes, versus a

national benchmark of 75% of cases treated in 90 minutes or less.



Median door to balloon times for patients that arrive by EMS is 55 minutes, well below

the national benchmark of 58 minutes. The median time for those who arrive by other

methods is considerably higher with a rate of 77 minutes.

Criteria Jan to Jun 2014 Jan to Jun 2013

Total cases with documented STEMI 216 217

Median Door to Balloon time in Minutes

64 66

Goal Met (D2B <90 min 75% of cases National standard)

94% of PCI cases were performed in less than 90

minutes

95% of PCI Cases were performed in less than 90

minutes

Total STEMI cases brought by EMS 123 124

Total STEMI Cases who self‐transported

43 83

Total STEMI Cases brought by Interfacility transport

8 12




Emergency Medical Services Agency 976 Lenzen Avenue, Suite 1200

San Jose, CA 95126

408.885.4250 voice 408.885.3538 fax

www.sccemsagency.org

Date: December 4, 2014 To: Santa Clara County EMS Committee Members From: Michael Petrie EMS Director Subject: Rural/Metro Contract Revision On September 23, 2014, the Board of Supervisors directed County Staff to begin to develop a request for proposal (RFP) for 911 Paramedic Ambulance Services in the Santa Clara County Exclusive Operating Area to potentially award a new contract, starting July 1, 2016. It is important to emphasize that this action only allows the EMS Agency to develop the RFP; thus providing the County with the option of later releasing a RFP. The Board of Supervisor’s action does not compel the County to release the RFP or, if it releases the RFP, to execute an agreement with a bidder. Further, County staff has committed to brining the RFP back to the Board of Supervisors before it is released. This action does not negate the County’s right to extend the term of the Agreement with Rural/Metro for one or two additional 3-year periods, by providing Rural/Metro no less than (60) days prior written notice. Since the last EMSCO meeting on October 2, 2014, the EMS Agency has released a solicitation to hire a RFP consultant, met with the California EMS Authority to discuss their parameters, considerations, and constraints on RFP processes to create an exclusive operating area, and begun to draft a new RFP. The EMS Agency anticipates approximately that at least 18 months is necessary to create and release an RFP for 911 EOA paramedic ambulance services, to select the desired vendor, and to provide time for the vendor to prepare for operation. I will provide an oral report on this item and answer questions at the EMS Committee Meeting. Options 1) Accept the EMS Director’s oral report as presented. 2) Do not accept the EMS Director’s oral report as presented. Recommendation 1) Accept the EMS Director’s oral report as presented.




Date: December, 2014 To: Santa Clara County EMS Committee Members From: Eric M. Rudnick, MD, FACEP, FAAEM Santa Clara County EMS Agency Medical Director

Subject: Clinical Care/Medical Directors Report

The Santa Clara County EMS Agency has been incredibly busy in regards to planning for the most recent emerging infectious disease (EID), Ebola Viral Disease (EVD). This epidemic has been devastating to various Western African countries. The outbreak has been the largest since the viral hemorrhagic fevers were first identified in1976. Although currently the risk is small to the citizens of Santa Clara County, we at the EMS Agency have used this to strength our working relationship with Public Health. I have worked closely with our Health Officer Sara Cody, MD, and our Deputy Health Officer George Han, MD. There have been many long hours planning for the possibility of a patient presenting with EVD.The various stakeholder groups have risen to the challenge of trying to protect the public and their providers with a disease that has such a high mortality rate. We have taken advantage of this opportunity to strengthen the approach to provider safety and how EMS deals with infectious diseases. We have released an “Infectious Disease Control Measures” protocol to reinforce what is good practice for the EMS provider community. We have also released an EVD specific protocol following both CDC and Cal-OSHA guidance. To place this current threat in perspective, the 1918-1919 Pandemic Influenza outbreak killed approximately 50 million people worldwide. It is estimated that between 20 to 40% of the world’s population became ill. So it was felt that a strong approach to infectious diseases was long overdue. Thank you for your attention and respectfully submitted.



Month / Year Amount

January-14 $238,750.00

February-14 $281,000.00

March-14 $278,280.00

April-14 $249,000.00

May-14 $182,500.00

June-14 $330,500.00

July-14 $206,750.00

August-14 $323,500.00

September-14 $349,000.00

October-14 $325,500.00

November-14 $

December-14 $

Total for CY14 $2,764,780.00

Average Monthly Total In Period $276,478.00



Date: December 4, 2014

To: Santa Clara County EMS Committee Members

From: Patricia Natividad

Senior Management Analyst Subject: EMS Trust Fund – Liquidated Damages for Calendar Year 2014

Monthly Liquidated Damages for Response Time

January 1, 2014 – December 31, 2014 .





Date: December 4, 2014 To: Santa Clara County EMS Committee Members From: John Blain Contract Manager Subject: County EOA Service Area Response Time Performance Report for County Ambulance History and Issue The County has entered into agreements with private and public entities to provide emergency medical response and advanced life support ambulance transportation services. Periodic response time compliance reports have been provided to the EMS Committee for the purpose of providing public review of those entities’ performance and compliance with contractual response time requirements. The County has performance based contracts with the following entities:

1. Rural/Metro of California (County Ambulance provider) Context Compliance is measured by several key performance indicators that include; response time requirements based on population density; designated response areas; type of response priority (red lights & siren or non-red lights & siren); total number of responses; total number of late responses; and total number of responses exempted (removed) from compliance calculations. Compliance is achieved when ninety (90%) percent or more of the responses meet the specified response time requirement in each response priority within each designated response area. This report contains response time compliance data for November 2013-October 2014. Cost There is no direct cost to the EMS Committee to accept and/or not accept the report. Legal Issues There are no legal issues related to accepting and/or not accepting the report. Options 1) Recommend that the EMS Committee accepts the “County EOA Service Area Response Time Performance Report for November 2013-October 2014”. 2) Recommend that the EMS Committee does not accepts the “County EOA Service Area Response Time Performance Report for November 2013-October 2014”. Recommendation 1) Recommend that the EMS Committee accepts the “County EOA Service Area Response Time Performance Report for November 2013-October 2014”.


Rural/Metro of California [County Ambulance Provider]

Code 3 Response Nov 13 Dec 13 Jan 14 Feb 14 Mar 14 Apr 14 May 14 Jun 14 Jul 14 Aug 14 Sep 14 Oct 14

Overall 93.26% 92.90% 93.30% 92.64% 92.83% 91.67% 94.03% 93.97% 92.66% 92.58% 92.17% 92.44%

Zone 1 91.78% 92.73% 92.40% 92.07% 93.03% 91.38% 94.19% 93.46% 92.12% 92.65% 91.52% 91.31%

Zone 2 93.71% 92.63% 91.93% 91.58% 92.46% 90.19% 94.09% 93.45% 91.50% 91.60% 91.44% 92.20%

Zone 3 94.25% 93.62% 94.29% 93.41% 92.69% 92.86% 94.06% 94.01% 94.63% 93.70% 92.35% 93.03%

Zone 4 92.83% 92.47% 93.38% 93.34% 92.85% 91.64% 93.40% 93.83% 91.82% 92.02% 92.59% 91.99%

Zone 5 92.81% 92.84% 95.49% 90.62% 93.68% 91.45% 95.81% 97.12% 92.33% 92.62% 93.19% 95.35%


Rural/Metro of California [County Ambulance Provider]

Code 2 Response Nov 13 Dec 13 Jan 14 Feb 14 Mar 14 Apr 14 May 14 Jun 14 Jul 14 Aug 14 Sep 14 Oct 14

Overall 94.43% 94.44% 94.60% 92.70% 94.60% 93.32% 94.79% 95.62% 93.18% 94.23% 93.11% 93.61%

Zone 1 96.50% 96.91% 97.16% 95.34% 94.95% 95.64% 95.95% 96.87% 97.06% 95.83% 93.71% 95.73%

Zone 2 93.61% 93.74% 94.76% 92.64% 93.72% 93.44% 96.27% 95.89% 91.67% 93.20% 91.91% 94.02%

Zone 3 94.57% 94.27% 93.41% 90.79% 95.02% 93.36% 94.73% 96.30% 92.72% 92.67% 93.70% 93.77%

Zone 4 92.60% 92.98% 93.80% 91.63% 93.74% 91.09% 92.13% 93.55% 91.48% 94.78% 92.49% 90.90%

Zone 5 97.67% 95.56% 92.68% 95.24% 100.00% 94.12% 98.04% 97.35% 94.74% 95.83% 96.19% 96.75%




Date: December 4, 2014 To: Santa Clara County EMS Committee Members From: John Blain Contract Manager Subject: County EOA Service Area Response Time Performance Report for Fire Departments History and Issue The County has entered into agreements with private and public entities to provide emergency medical response and advanced life support ambulance transportation services. Periodic response time compliance reports have been provided to the EMS Committee for the purpose of providing public review of those entities’ performance and compliance with contractual response time requirements. The County has performance based contracts with the following entities:

1. Gilroy, City of 2. Milpitas, City of 3. Morgan Hill, City of 4. Mountain View, City of 5. San Jose, City of 6. Santa Clara, City of 7. Santa Clara County Central Fire Protection District 8. South Santa Clara County Fire District 9. Sunnyvale, City of

Context Compliance is measured by several key performance indicators that include; response time requirements based on population density; designated response areas; type of response priority (red lights & siren or non-red lights & siren); total number of responses; total number of late responses; and total number of responses exempted (removed) from compliance calculations. Compliance is achieved when ninety (90%) percent or more of the responses meet the specified response time requirement in each response priority within each designated response area. This report contains response time compliance data for October 2013-September 2014. Cost There is no direct cost to the EMS Committee to accept and/or not accept the report. Legal Issues There are no legal issues related to accepting and/or not accepting the report.


Options 1) Recommend that the EMS Committee accepts the “County EOA Service Area Response Time Performance Report for October 2013-September 2014”. 2) Recommend that the EMS Committee does not accepts the “County EOA Service Area Response Time Performance Report for October 2013-September 2014”. Recommendation 1) Recommend that the EMS Committee accepts the “County EOA Service Area Response Time Performance Report for October 2013-September 2014”.


Fire Departments

Code 3 Response Oct 13 Nov 13 Dec 13 Jan 14 Feb 14 Mar 14 Apr 14 May 14 Jun 14 Jul 14 Aug 14 Sep 14

Gilroy 97.46% 96.45% 97.99% 98.54% 98.18% 96.79% 98.18% 98.78% 99.59% 98.05% 98.45% 98.76%

Milpitas 94.93% 96.96% 97.59% 98.27% 95.28% 96.60% 97.36% 96.04% 96.72% 95.17% 96.46% 91.61%

Morgan Hill 96.49% 100.00% 100.00% 95.16% 95.65% 98.34% 98.33% 99.54% 96.32% 95.81% 95.48% 96.41%

Mt. View 98.58% 98.64% 99.71% 96.76% 97.40% 97.20% 95.78% 95.33% 96.51% 97.61% 97.28% 96.12%

San Jose 96.89% 83.87% 83.87% 88.06% 87.66% 88.75% 90.39% 88.94% 90.31% 92.53% 88.95% 89.36%

Santa Clara 96.81% 95.20% 97.07% 96.54% 95.67% 96.91% 95.47% 95.40% 95.13% 96.07% 93.91% 95.08%

Santa Clara Co. 95.14% 96.13% 95.54% 96.12% 95.25% 96.10% 97.17% 96.30% 95.31% 95.39% 95.96% 95.78%

So. Santa Clara Co. 91.94% 92.31% 97.92% 93.15% 90.24% 97.03% 95.45% 94.12% 96.33% 90.91% 90.99% 90.48%

Sunnyvale 98.13% 98.08% 97.65% 97.78% 98.36% 98.81% 98.35% 98.25% 98.79% 99.20% 98.28% 99.16%


Fire Departments

Code 2 Response Oct 13 Nov 13 Dec 13 Jan 14 Feb 14 Mar 14 Apr 14 May 14 Jun 14 Jul 14 Aug 14 Sep 14

Mt. View 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 97.44% 97.87% 95.45%

San Jose 96.67% 97.73% 98.55% 94.46% 93.67% 96.18% 96.55% 96.55% 96.50% 97.86% 97.30% 96.29%

Santa Clara 100.00% 99.26% 97.35% 98.52% 98.58% 95.47% 98.47% 96.64% 98.62% 99.21% 97.35% 97.00%

Santa Clara Co. 100.00% 99.26% 97.35% 100.00% 98.73% 100.00% 99.37% 100.00% 98.67% 99.45% 99.35% 98.74%




Emergency Medical Services Agency 976 Lenzen Avenue, Suite 1200

San Jose, CA 95126

408.885.4250 voice 408.885.3538 fax

www.sccemsagency.org

Date: December 4, 2014 To: Santa Clara County EMS Committee Members From: Linda Diaz BSN, RN, PHN Clinical Section Manager Subject: Hospital Destination, Diversion and Advisory Status Report History Diversion is a management process that diverts ambulances to the next closest facility. This may be used temporarily by local hospitals when the patient load exceeds emergency department or specialty center resources. Facility diversion should be a last resort and utilized only when emergency department/specialty center resources continue to be overwhelmed after internal procedures to manage the situation have been implemented. Report

The overall volume and daily averages of patients transported within the last six months saw a small increase. Despite the increase, the overall hours of diversion hours are trending down. There was a significant increase in stroke diversion although this was attributed to one facility with a prolonged mechanical problem that was resolved. Trauma Center and STEMI center diversion times remained low. Options

1) Recommend to accept report 2) Recommend to NOT accept report 3) Other options, as determined by the EMS Committee Recommendation

EMS Committee should accept the “County Hospital Destination, Diversion and Advisory Status Report for May 2014 through October 2014”.


County of Santa ClaraEmergency Medical Services SystemMonthly Hospital Destination, Diversion and Advisory Status Report

Report for Time Period: Oct 2014Table 1: Number of Patients Transported to Hospital ED from 9-1-1 System*Hospital May-14 Jun-14 Jul-14 Aug-14 Sept-14 Oct-14 TotalEl Camino - Los Gatos 95 86 90 82 71 99 523El Camino - Mt. View 667 661 594 670 641 709 3942Good Samaritan 567 595 588 589 561 607 3507Kaiser - San Jose 599 543 513 519 535 579 3288Kaiser - Santa Clara 677 629 597 624 587 680 3794O'Connor 564 551 496 575 575 593 3354Regional - San Jose 1116 1072 1033 1145 1094 1158 6618Saint Louise 273 246 212 260 256 253 1500Stanford 511 511 492 521 533 511 3079VA - Palo Alto 87 78 151 79 83 75 553VMC 1318 1273 1242 1264 1248 1272 7617Total 6474 6245 6008 6328 6184 6536 37775

Hospital May-14 Jun-14 Jul-14 Aug-14 Sept-14 Oct-14 6 Mth AvgEl Camino - Los Gatos 3 3 3 3 2 3 3El Camino - Mt. View 22 22 19 22 21 23 22Good Samaritan 18 20 19 19 19 20 19Kaiser - San Jose 19 18 17 17 18 19 18Kaiser - Santa Clara 23 21 19 20 20 22 21O'Connor 18 18 16 19 19 19 18Regional - San Jose 36 36 33 37 36 37 36Saint Louise 9 8 7 8 9 8 8Stanford 17 17 16 17 18 16 17VA - Palo Alto 3 3 5 3 3 2 3VMC 43 42 40 41 42 41 42Total Daily Average 211 208 194 206 207 210Source: Santa Clara County Communications & Palo Alto Fire Department*Notes for Tables 1 and 2: These numbers only reflect patients that originated in Santa Clara County and were transported bythe County's EOA Ambulance Provider and Palo Alto Fire Department. Data for Stanford does not include patients from San MateoCounty. The data includes but, does not differentiate specialty center status (TRAUMA, STROKE, STEMI, BURN) Page 1 of 2

Source: Santa Clara County Communications & Palo Alto Fire DepartmentTable 2: Daily Average of 9-1-1 Patients Transported By Hospital*

County of Santa ClaraEmergency Medical Services SystemMonthly Hospital Destination, Diversion and Advisory Status Report

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County of Santa ClaraEmergency Medical Services System

Monthly Hospital Destination, Diversion and Advisory Status Report


Table 3: Total Monthly Hours of "AMBULANCE DIVERSION" StatusHospital May-14 Jun-14 Jul-14 Aug-14 Sept-14 Oct-14 TotalEl Camino - Los Gatos 0.81 0.00 0.00 0.00 0.00 0.00 0.81El Camino - Mt. View 12.04 10.11 12.78 14.83 7.51 4.51 61.78Good Samaritan 0.00 0.00 3.01 0.00 2.97 3.01 8.99Kaiser - San Jose 4.51 11.63 6.00 10.99 13.59 9.02 55.74Kaiser - Santa Clara 1.50 0.00 0.00 1.51 0.00 0.00 3.01O'Connor 1.51 3.00 6.63 3.00 1.93 1.51 17.58Regional - San Jose 3.11 3.58 3.01 1.26 0.00 0.00 10.96Saint Louise 19.05 4.52 16.59 8.93 9.03 9.02 67.14Stanford 3.03 1.50 9.05 4.52 7.51 10.53 36.14VA - Palo Alto 10.68 12.04 16.15 21.04 42.29 12.01 114.21VMC 14.75 19.19 10.35 22.24 14.89 18.05 99.47Total 70.99 65.57 83.57 88.32 99.72 67.66 475.83

Above 37hrs Above 30hrs Below 30hrs

Color Legend for Ambulance

Diversion ONLY

Table 4: Total Monthly Hours of "STROKE / CT DOWN" Status*Hospital May-14 Jun-14 Jul-14 Aug-14 Sept-14 Oct-14 TotalEl Camino - Los Gatos 0.00 0.00 0.00 0.00 0.00 0.00 0.00El Camino - Mt. View 0.00 0.00 0.00 0.00 0.00 0.00 0.00Good Samaritan 0.00 0.00 0.00 0.00 0.00 0.00 0.00Kaiser - San Jose 0.00 0.00 0.53 4.27 0.00 0.00 4.80Kaiser - Santa Clara 0.00 0.00 0.00 0.00 0.00 0.00 0.00O'Connor 9.66 0.70 0.93 4.22 0.00 58.65 74.16Regional - San Jose 10.07 0.00 0.00 0.00 0.00 0.00 10.07Saint Louise 7.96 26.20 124.69 20.08 111.49 117.14 407.56Stanford 0.00 0.00 0.00 0.00 0.00 0.00 0.00VA - Palo Alto 0.00 6.07 0.00 0.00 105.16 0.00 111.23VMC 2.95 2.24 0.02 0.41 1.53 0.00 7.15Total 30.64 35.21 126.17 28.98 218.18 175.79 614.97Table 5: Total Monthly Hours of "STEMI" Service Advisory Status*Hospital May-14 Jun-14 Jul-14 Aug-14 Sept-14 Oct-14 TotalEl Camino - Mt. View 0.00 0.00 0.00 0.00 0.00 0.00 0.00Good Samaritan 0.00 0.00 0.00 0.00 0.00 0.00 0.00Kaiser - San Jose 0.00 0.00 0.00 23.68 18.81 0.00 42.49Kaiser - Santa Clara 0.00 0.00 0.00 0.00 0.00 0.00 0.00O'Connor 0.00 12.57 0.00 0.00 0.00 0.00 12.57Regional - San Jose 0.00 0.00 0.00 0.00 0.00 0.00 0.00Stanford 0.00 0.00 0.00 0.00 0.00 0.00 0.00VMC 0.00 0.00 0.62 0.00 0.69 0.00 1.31Total 0.00 12.57 0.62 23.68 19.50 0.00 56.37Table 6: Total Monthly Hours of Trauma Center "BYPASS" StatusHospital May-14 Jun-14 Jul-14 Aug-14 Sept-14 Oct-14 TotalRegional - San Jose 5.00 3.84 4.02 11.52 7.45 0.96 32.79Stanford 0.00 0.00 0.00 0.00 0.00 0.00 0.00VMC 0.00 0.00 7.21 0.00 1.51 0.00 8.72Total 5.00 3.84 11.23 11.52 8.96 0.96 41.51Page 2 of 2


County of Santa Clara Emergency Medical Services System Emergency Medical Services Agency 976 Lenzen Avenue, Suite 1200 San Jose, CA 95126 408.885.4250 voice 408.885.3538 fax www.sccemsagency.org Date: December 4, 2014 To: Members of the EMS Committee From: Michael Petrie EMS Director Subject: 2015 EMS Committee Meeting Dates Michael Petrie will report on the 2015 EMS Committee Meeting Dates. The meetings will continue to be held at the Santa Clara County Sheriff’s Department Auditorium on the following dates:

• March 5, 2015 • June 4, 2015 • October 1, 2015 • December 3, 2015


notice of cancellation · 2018-03-22 · san jose, ca 95126 408.885.4250 voice 408.885.3538 fax ....

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