Loading...
HomeMy WebLinkAboutMINUTES - 08102004 - D3 TO: BOARD OF SUPERVISORS .......• •.o Contra FROM: William B.Walker, MD, Director, '» Health Services DepartmentCosta DATE: August 10, 2004 `. ; ��� County SUBJECT: Request for Proposal for Emergency Ambulance ServicesR. ` SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION RECOMMENDATION: Approve the attached.Request for Proposal (RFP) for emergency ambulance services covering all areas of the county currently served by American Medical Response (AMR) and authorize the Health Services Department to conduct a competitive selection process in accordance with the RFP. FISCAL IMPACT: No General Fund impact. It is intended that ambulance services obtained under this procurement be provided through user fees without County subsidy; however, should a subsidy be necessary to obtain the level of service desired, the subsidy will be provided through CSA EM-1 (Measure H) funds. BACKGROUND: On May 18, 2004, your Board approved staff recommendations to modify and extend the ambulance service agreement with American Medical Response(AMR)through June 30, 2005, to establish a First Responder Paramedic Fund with savings realized from elimination of the County subsidy to AMR, to enter into agreements with fire services for paramedic first responder services, and to develop an RFP for emergency ambulance services for approval by the Board. Your Board also directed that staff include in the RFP, or address in a report to the Board, concerns raised in a letter dated May 14, 2004 from IAFF Local 1230 and SEW Local 250 (attached). County staff, together with the County's consultant Mr. Rick feller of Fitch and Associates, met with representatives of the two labor groups in order to clarify the 16 points raised in the May 14th letter. The proposed RFP was developed by Fitch and Associates. The RFP includes those EMS system changes approved by the Board on May 18th and includes those concerns raised in the May 181h letter with which staff concur. The RFP includes the letter from Locals 1230 and 250 as an appendix to assure that all prospective bidders are aware of the labor concerns and invites responders to submit supplemental cost estimates for specified features. CONTINUED ON ATTACHMENT: X YES SIGNATURE: ----------------------------- -- -- ------------_ _--------------------_- --------------------------- ----- RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE APPROVE OTHER SIGNATURE(S): ----------------------------------------------- ------- ---------------------–-------------------------------–-----------–-----------–--------------------------- ACTION OF BOARD ON k y� � t �F � a6�APPROVE AS RECOMMENDED OTHER L`tY`.c./,s'G,.' CG>v",P.. %'f-"a- e'�✓ �Ft`-'-!J•!, jC-C',--i3't,'%`[„�,. VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE AND CORRECT COPY OF AN ACTION TAKEN UNANIMOUS(ABSENT—,&L ) AND ENTERED ON THE MINUTES OF THE BOARD OF SUPERVISORS ON THE DATE AYES: NOES: SHOWN. ABSENT: ABSTAIN: ATTESTED J HN SW EN,CLERK 8P11- BOARD OF Originating Department: Emergency Medical Services 646-4690 SUPERVltIbRS AND COUNTY ADMINISTRATOR cc: County Administrator County Counsel Health Services Administration Emergency Medical Services Contra Costa County Fire Chiefs Association Each Fire Chief BY 0 _a- DEPUTY Summary of Key RFP Provisions Key RFP provisions include the following: (1) Paramedic response to be provided through a combination of(a)non-transporting first response units including fire service operated paramedic engines and private ambulance service operated Quick Response Vehicles (QRVs) and(b)paramedic ambulance units. (2) Ambulance response time requirement to be changed from existing 10-minute standard to 12- minute (11:59) standard in areas with first responder paramedic service. (3) Minimum ambulance staffing requirement to be changed from 2 paramedics to 1 paramedic/1 EMT-I in areas with first responder paramedic service. (4) County ambulance subsidy to be eliminated. (5) Ambulance contractor to provide 4 QRVs (or cost equivalent services at County direction) without charge. Existing AMR Contract The existing AMR contract expires June 30, 2005. The AMR contract was initially approved by the Board on October 28, 1997 following a competitive selection process initiated in November 1996. The contract was awarded for a 5-year term November 3, 1997 through November 2, 2002, and has been extended to June 30, 2005. The most recent contract extension, approved by the Board on May 18, 2004, extends the contract from July 1, 2004 through June 30, 2005 and modifies the contract to incorporate the above stated key RFP provisions, including elimination of the County ambulance subsidy, effective September 1, 2004. Competitive Selection Timeline May 15, 2004 Board direction to develop RFP Aug 10 Board approval of RFP Sept 1 Bidders conference Oct 15 Proposals due Dec 1 Proposal review and recommendation to Board completed Dec 14 Presentation to Board; negotiation of contract authorized Jan 7 Contract negotiations completed March 15, 2005 Board approval of contract July 1 Startup of new contract Issues Raised in May 14th Letter from Labor Groups (1) Both IAFF Local 1230 and SEIU Local 250 should each have a voting member on the Committee that recommends an ambulance provider to the County Board of Supervisors. The approach employed by Health Services in carrying out the ambulance selection process will include the following steps: Step 1 - RFP is distributed to prospective bidders. Step 2 - Bidders conference is held to answer prospective bidders' questions, provide additional data that may have been requested. Step 3 - Proposals are received by staff and reviewed to determine conformation with RFP requirements. Step 4 - Proposals are analyzed and rated according to specified criteria by panel of experts appointed by Health Services Director; recommendations of panel are provided to Health Services Director. Step 5 - Health Services Director makes recommendation to Board of Supervisors. Step 6 - Board of Supervisors approves selection of provider. Step 7 - Board of Supervisors approves ambulance contract. Page 2 Health Services has considered three options for selection of the proposal review panel: Option 1 —Outside expert panel. Such a panel might include an EMS administrator, an emergency physician, a fire chief, an emergency nurse, a field paramedic, and a hospital administrator---all from outside Contra Costa County. An outside expert panel is the approach recommended by the County's consultant Fitch &Associates to assure prospective bidders of a fair, professional selection process and thereby increase the pool of likely bidders. Option 2—Stakeholder panel. Such a panel might include representatives of the County Fire Chiefs' Association, Police Chiefs' Association, Public Managers' Association, Alameda-Contra Costa Medical Association, Hospital Council, emergency physicians, emergency nurses, field paramedics, and a consumer representative. A stakeholder panel would bring more local knowledge to the selection process and would assure that those involved in the selection have an interest in assuring a favorable outcome for the residents of the county. Disadvantages of a stakeholder panel include actual or perceived bias among the stakeholder groups and the lack of recognized outside expertise. Option 3 —Mixed outside/local panel. A third option, and the option recommended by Health Services, is the use of a mixed panel of outside and local experts appointed by the Health Services Director to include the following: (1) EMS administrator from outside Contra Costa County (2) Fire chief from outside existing AMR service area (3) California Highway Patrol representative (4) Field paramedic from outside Contra Costa County (5) City manager from Contra Costa County (6) Emergency physician from Contra Costa County (7) Law enforcement representative from Contra Costa County (8) Hospital administrator from Contra Costa County (9) Emergency nurse from Contra Costa County (10)Consumer from Contra Costa County The mixed expert/stakeholder panel outlined under Option 3 provides a balance of outside experts and local representatives knowledgeable about the Contra Costa EMS system. Names of panel members will be held confidential until the panel recommendations are forwarded to the Health Services Director, and bidders will be precluded from contact with panel members until the panel recommendations are completed. It is important to note that organizations prospective bidders may need to contact in the preparation of proposals are not included in the mixed outside/local panel. (2) The RFP should have worker retention language for all EMSpersonnel currently employed by American Medical Response that also recognizes the union and maintains the current collective bargaining agreement in case another provider other than American Medical Response is chosen. The RFP contains clear language regarding the importance of retaining the current experienced work force through preference in hiring, maintenance of seniority, and the compensation and benefit package. Commitment to employees is identified in the RFP as one of the major areas for proposal scoring. (3) All 911 responding ambulances shall maintain the Dual Medic configuration, which could be phased out, by attrition, to a I-EMT/1 paramedic configuration during the life of the contract. The Dual Medic configuration shall remain in place for West County and other areas in the County where Fire Departments are not capable of providing Engine-based paramedic services. The plan for EMS system changes to support fire paramedic programs entails shifting responsibility for initial paramedic response from the ambulance service to the fire service in those areas where first responder paramedic service is provided. Changes in ambulance staffing and response time requirements will result in savings to be used to support the first responder paramedic programs. These changes will begin September 1, 2004 under the AMR contract extension approved by the Board. Quick Response Vehicles (QRVs) will be used to augment engine-based paramedic services so that the only area not covered by first responder paramedics will be the City of Richmond. Existing ambulance staffing and response time standards will be maintained for Richmond. AMR has stated the company's intent to implement these changes without paramedic layoffs. Page 3 (4) Safety equipment should be provided for each EMS crewmember on 911 responding ambulances to provide protection on motor vehicle accidents'or other calls requiring a high level of protection. The RFP contains language requiring the contractor to provide programs to enhance the safety and health of its work force and requiring the contractor provide personal protective gear and equipment to its employees working in hazardous environments. (5) 911 responding ambulances should be capable of providing safety for crewmembers and workspaces that will allow for unhindered, quality patient care. 911 Ambulance mileage shall not exceed 200,000 miles. The RFP requires that the contractor maintain ambulances in good working order consistent with manufacturer's specifications, maintain detailed maintenance records, and meet the Commission on Accreditation of Ambulance Services (CAAS) standards. Each proposal is required to identify the maximum number of years and mileage for its units to remain in service. Most ambulances used in metropolitan areas are a Type II(van type) ambulance. A Type III (modular)ambulance offers more room in the patient compartment but with compromise in patient comfort due to the heavier duty suspension and in maneuverability due to the larger size. The RFP requires proposals to identify what additional costs, if any, would be associated with a requirement for Type III ambulances. (6) The County should establish Joint training for EMS and Fire personnel on ICS, Biological, Nuclear and Chemical disasters. This is not an RFP issue. Such training is currently offered through various agencies including EMS, fire, CARE, and other governmental and non-governmental organizations. Recently, training has been made available for law, fire, and medical personnel through the Sheriff's Department through a Homeland Security grant. (7) The County should establish a Joint Committee of Firefighters and EMS Ambulance personnel to address Emergency Services issues, including, but not limited to, recruitment and retention of a diverse workforce in EMS and Fire Service. This is not an RFP issue. Both firefighters and ambulance personnel have representation on the Emergency Medical Care Committee. The EMS Agency is currently engaged in a project looking at cultural diversity issues in the ambulance service. (8) All BLS ambulances should have AED capability. This is an excellent idea and should be implemented in connection with the ambulance permit system to include all ambulance services operating in Contra Costa County. The EMS Agency will include this as a part of an update to the County Ambulance Ordinance. (9) ALS units will not be used to respond on 5150 calls unless the patient requires ALS treatment such as an overdose or major trauma. California lacks a comprehensive system for transport of persons experiencing psychiatric emergencies. As a result, most counties rely on the EMS system to provide field evaluation and transport of patients under Section 5150 hold to a designated psychiatric facility or, if emergency medical care is needed, to a hospital emergency department. Existing policies provide for the County ambulance contractor to respond to all ambulance requests originating through a public safety dispatch center, including psychiatric and other non-life-threatening emergencies. While BLS units are used for these responses when available, ALS units may be used when no BLS unit is available. (10) The County shall maintain the current language on response time. Fire services and representatives of both unions should review the list of response time exceptions. As stated in the response to item#3,the plan for EMS system changes to support fire paramedic programs entails shifting responsibility for initial paramedic response from the ambulance service to the fire service in those areas where first responder paramedic service is provided. Under the proposed plan, initial paramedic response (except within Richmond)will be provided by either paramedic engines or QRVs. EMS will monitor these response times to assure compliance with existing standards. If needed, funds may be diverted from the Paramedic First Respond Fund Page 4 established using savings from elimination of the ambulance subsidy to provide additional paramedic ambulance or QRV hours. (l 1) .The contract provider,fire services and EMS office should work together to provide adequate Continuing Education classes to insure that all paramedics and EMTs can meet their biannual requirements. This is not an RFP issue. The EMS Agency believes that sufficient continuing education classes are currently available and has not received complaints in this area. (12) All Measure H money should be returned to the County and put to use in expanding-and maintaining an engine based paramedic program. The RFP identifies the intent of the County to obtain emergency ambulance services at no County subsidy. (13) The County should set a minimum number of 911 ambulances that must be in the field daily. The RFP identifies a performance standard that the contractor must meet, not a level of effort. The contractor should determine the number of ambulance units that must be in the field at any given time to meet the required performance standard. (14) Contra Costa Fire should dispatch the 911"ambulances. Dispatch of ambulances by Contra Costa Fire is a concept worthy of consideration. However, such a change raises a number of issues that would require fiirther study and collaboration with other agencies. These issues include operational feasibility, costs, establishment of ongoing review mechanisms to assure contractor accountability for meeting response standards, and reassessment of the role of the Sheriff's Department Communications Division with respect to ambulance radio and dispatch coordination. (15) Firefighters should have a higher priority,for f lling training positions on ambulances. The RFP includes language that requires the contractor to implement policies to facilitate Contra Costa firefighters in scheduling time on ambulances to meet training requirements and requires all contractor-provided continuing education to be made available to firefighters on the same terms and conditions as it is made available for contractor's employees. (16) There should be an ambulance parked at every Fire station that currently stores the multicasualty caches in the county. That ambulance is only to be used during disaster situations. While staff do not support a requirement that the ambulance contractor park ambulance units at designated fire stations for disaster use, the RFP does include language requiring that proposals identify a cost per unit of providing and maintaining between five and fifteen such units. ADDENDUM D.3 August 10, 2004 On this day,the Board of Supervisors considered approval of a Request for Proposal (RFP) for emergency ambulance services covering all areas of the County currently served by America Medical Response(AMR.) and authorization for the Health Services Department to conduct a competitive selection process in accordance with the RFP. The Chair invited public comment. The following persons presented testimony: Lou Paulson, Firefighters Local 1230, 112 Blueridge Drive,Martinez; Bill Bower, SEIU Local 250, 7715 Westland Drive, Stockton; Dan Martin, SEIU Local 250; Leslie Mueller, American Medical Response, Director of Operations-Contra Costa County Division, 2350 Whitman Road, Concord; Brad. White, American Medical Response, 2350 Whitman Road, Concord; Rob Billings, SEIU Local 250, 613 Blarney Circle,Vacaville. The Hoard discussed the matter. The Board examined issues including: lengthening response times forseeable in the far East County area, the current and future use of Quick Response Vehicles(QRV)to enhance response times,and the Board's desire to have to data on the response times a part of the RFP process; the September 3, 2004 certification election for bargaining unit SEIU Local 250 in relation to the bid conference date set for September 1,2004;the composition of the proposal review panel; and the necessity for language modifications required to align the RFP with actions taken today. Following their discussion,the Board took the following actions. 1. APPROVED the Request for Proposal (RFP) for emergency ambulance services covering all areas of the County currently served by American Medical Response, as modified today to include an optional County bidding item related to response time standards for the quick response vehicles for East County; 2. AUTHORIZED the Health Services Department to conduct a competitive selection process for provision of such services; 3. ORDERED the date of the bidding conference to be changed to September 6, 2004; 4. SPECIFIED that the selection panel comprise ten members, one representing each of the following. Contra Costa Fire Chiefs' Association; Contra Costa Police Chiefs' Association; Contra Costa Public Managers' Association; Hospital Council; Emergency Room physician (trauma center preferred); field firefighter/paramedic from the existing AMR.service area in Contra Costa County (Local 1230); field paramedic from AMR's legally-certified bargaining unit; emergency medical services administrator from outside Contra Costa County; Emergency Room nurse from outside Contra Costa County; consumer from the Emergency Medical Care Committee; 5. SPECIFIED that the Board would solicit the appropriate organizations to nominate representatives for: emergency medical services administrator from outside Contra Costa County, Emergency Room nurse from outside Contra Costa County, consumer from the Emergency Medical Care Committee, said nominees to be approved by Dr. Walker; and 6. DIRECTED that the RFP be modified by staff to eliminate any inconsistencies that result from the preceding actions. Zj 7 1A:1 CONTRA COSTA HEALTH SERVICES Emergency Medical Services Agency Request for Proposal for Emergency Ambulance Services and EMS System Performance Specifications for Lantra Costa County California August 10, 2004 DRAFT Proposal submittal deadline: Thursday, October 15, 2004, 4:00 p.m. Centra Costa Health Services Emergency Medical Services Agency 1340 Arnold [give, Suite 125 Martinez, CA 94553 (925) 646-4690 fax (925) 646-4379 www.cccems.org Table of Contents I. SYSTEM DESIGN SUMMARY.............................................................................................................................1 A. OVERVIEW................................................................................................................................................1 B. EMERGENCY RESPONSE AREAS(ERA'S).................................................................................................2 C. BACKGROUND..........................................................................................................................................3 D. OVERVIEW OF EMS SYSTEM DESIGN.......................................................................................................3 E. NEW EMS SYSTEM INNOVATIONS............................................................................................................4 F. RELEVANT INFORMATION REGARDING SERVICE AREAS............................................................................6 If. PROCUREMENT INFORMATION...............................................................................................................„.....7 A. PERFORMANCE-BASED CONTRACT..........................................................................................................7 B. NOTICE TO PRt7PC'ISERS............................................................................................................................7 C. USE OF OWN EXPERTISE ANDJUDGMENT.................................................................................................8 D. PROCUREMENT TIME LINE........................................................................................................................8 E. PROCUREMENT PROCESS.........................................................................................................................9 F. PROPOSAL INSTRUCTIONS.....................................................................................................................10 G. PROPOSAL EVALUATION PROCESS.......................................................................................................11 H. EVALUATION CRITERIA..........................................................................................................................14 I. SCORING MATRIX..................................................................................................................................18 III. SERVICE PLAN................................................................................................................................................20 A. COUNTY'S RESPONSIBILITIES.................................................................................................................20 B. CONTRACTOR'S FUNCTIONAL RESPONSIBILITIES...................................................................................20 IV. CLINICAL AND EMPLOYEE PROVISIONS.................................................................................................22 A. CLINICAL OVERVIEW..............................................................................................................................22 B. MEDICAL OVERSIGHT.....„......................................................................................................................22 C. DEMONSTRABLE PROGRESSIVE CLINICAL QUALITY IMPROVEMENT& CONTINUING EDUCATION REQUIRED..............................................................................................................................................23 D. CLINICAL AND OPERATIONAL BENCHMARKING AND RESEARCH REQUIRED...........................................26 E. TRANSPORT REQUIREMENT AND LIMITATIONS.......................................................................................27 F. COUNTY APPROVED BASE STATION HOSPITALS...................................................................................28 G. MINIMUM CLINICAL LEVELS AND STAFFING REQUIREMENTS..................................................................28 H. FIELD SUPERVISION...............................................................................................................................31 I. TREATMENT OF INCUMBENT WORK FORCE............................................................................................31 J. CHARACTER COMPETENCE AND PROFESSIONALISM OF PERSONNEL...........„........................................32 K. KEY PERSONNEL...................................................................................................................................32 L. INTERNAL HEALTH AND SAFETY PROGRAMS.........................................................................................33 M. EVOLVING OSHA&OTHER REGULATORY REQUIREMENTS..................................................................33 N. DISCRIMINATION NOT ALLOWED............................................................................................................33 O. WORK SCHEDULES AND HUMAN RESOURCE ISSUES-AN EMPLOYEE MATTER....................................34 V. OPERATIONS MANAGEMENT PROVISIONS.............................................................................................35 A. SERVICES DESCRIPTION........................................................................................................................36 B. RESPONSE TIME PERFORMANCE,RELIABILITY&MEASUREMENT METHODS........................................35 C. RESPONSE TIME PERFORMANCE REPORTING PROCEDURES AND PENALTY PROVISIONS.....................43 D. VEHICLES AND EQUIPMENT....................................................................................................................45 E. COMMUNICATIONS SYSTEM MANAGEMENT............................................................................................48 F. DATA ANIS REPORTING REQUIREMENTS.................................................................................................50 G. COVERAGE AND DEDICATED AMBULANCES,USE OF STATIONS/POSTS.................................................54 H. PROVISION OF NON-TRANSPORTING PARAMEDIC FIRST RESPONSE UNITS............................................54 I. DEVELOPMENT AND INTEGRATION OF FIRST RESPONDERS....................................................................55 J. INTERNAL RISK MANAGEMENT/LOSS CONTROL PROGRAM REQUIRED..................................................55 K. HEALTH STATUS IMPROVEMENT AND COMMUNITY EDUCATION..............................................................56 L. ACCREDITATION.....................................................................................................................................57 M. PARTICIPATION IN SYSTEM DEVELOPMENT............................................................................................57 N. DISASTER ASSISTANCE AND RESPONSE................................................................................................58 O. MUTUAL Alb AND STAND-BY SERVICES.................................................................................................59 P. DEPLOYMENT PLANNING.......................................................................................................................60 Q. HANDLING SERVICE INQUIRIES AND COMPLAINTS..................................................................................60 VI. REGULATORY COMPLIANCE AND FINANCIAL PROVISIONS..............................................................61 A. FEDERAL HEALTHCARE PROGRAM COMPLIANCE PROVISIONS..............................................................61 B. STATE COMPLIANCE PROVISIONS..........................................................................................................61 C. CONTRACTOR REVENUE RECOVERY......................................................................................................62 D. BILLINGICOLLECTION SERVICES............................................................................................................62 E. BILLING SYSTEM PROFESSIONALISM AND REGULATORY COMPLIANCE..................................................63 F. CONTRACTOR COMPENSATION FROM COUNTY......................................................................................63 G. ACCOUNTING PROCEDURES..................................................................................................................64 H. INSURANCE PROVISIONS........................................................................................................................65 1. INDEMNIFICATION...................................................................................................................................66 J. PERFORMANCE SECURITY BOND...........................................................................................................67 VII, ADMINISTRATIVE PROVISIONS.................................................................................................................68 A. TERM AND RENEWAL PROVISIONS.........................................................................................................68 B. SERVICE PLAN.......................................................................................................................................68 C. CONTINUOUS SERVICE DELIVERY..........................................................................................................68 D. ANNUAL PERFORMANCE EVALUATION...................................................................................................68 E. DEFAULT AND PROVISIONS FOR TERMINATION OF THE AGREEMENT......................................................69 F. TERMINATION.........................................................................................................................................70 G. EMERGENCY TAKEOVER........................................................................................................................71 H. END TERM PROVISIONS.........................................................................................................................72 1. TRANSITION PLANNING..........................................................................................................................73 J. COUNTY'S REMEDIES.............................................................................................................................73 K. PROVISIONS FOR CURING CARDINAL DEFAULT AND EMERGENCY TAKE OVER......................................73 L. "LAME DUCK"PROVISIONS....................................................................................................................74 M. GENERAL PROVISIONS...........................................................................................................................75 Figure 1. Illustrates Proposed Retrospective QI Process..........................................................24 Figure 2. Response Time Compliance Requirements..............................................................376 Figure 3. Graphic illustration of the Anatomy of an EMS Incident...... ........ ......... ...387 APPENDICES 1, Emergency Response Area Map 2. Emergency Response Zone Map 3. Current Approved Ambulance Service Rates 4. Current System Response Time Performance Data 5. Mandatory Forms to be Submitted with Proposals 6. Required Pricing Forms to be Submitted with Proposals 7. Letter from Labor Unions with their Concerns for the RFP Process 8. Designated Rural Areas 9. County Required On-Board Equipment and Supplies Lists 10. County Message Transmission Network Standard REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY A. Overview Contra Costa County(County)is a political subdivision of the State of California with authority for designating emergency ambulance service providers through a competitive procurement managed by the Contra Costa County EMS Agency. The County desires to enter into a performance based Agreement with the selected emergency ambulance service provider to deliver the services specified in this Request for Proposal. A successful emergency medical system has three consumer objectives: help prevent lost lives, minimize patients'physical pain,and reduce the expenses associated with catastrophic injury or illness. The County seeks to meet these objectives now and in the future,while ensuring good value for the community's investment. The purpose of Contra Costa County's EMS Agency is to sustain its high performance EMS system. Essential elements of this high performance system include: • Prevention and early recognition Bystander action/system access • Medical Dispatch Telephone protocols&pre-arrival instructions First responder and ambulance dispatch • First responder services(ALS and BLS) • Transport ambulance services • Direct(on-line)medical control • Receiving facility interface • Indirect(off-line)medical control • Independent monitoring The County desires to ensure the provision of high quality EMS service within its Service Areas in order to provide for the public health and safety. Response times are one measure of a high performance system. This comprehensive systems approach requires creating geographic and density based response time zones and achieving ambulance response times for life-threatening emergencies within defined time frames in each of these zones. The approach involves the County maintaining certain items of infrastructure for the system in the public domain while using the Contractor's entrepreneurial talent to manage the day-today 1 REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY operations. This model has been designed to ensure high quality clinical care, provide efficient and reliable EMS services at a reasonable cost to consumers,and provide the community with an operationally and financially stable system. The County intends for the Contractor to be the sole provider of Emergency Ambulance services in the designated areas of the County covered by this Request for Proposals(RFP), This is a Request for Proposal(RFP)for an emergency medical ground transportation system at an Advanced Life Support(ALS)level of service for Contra Costa County. The successful Proposer will be awarded an exclusive five-year contract to respond to 9-1-1 and other public safety or County generated ambulance requests for the period 01 July 2005 through 30 June 2410,with an option to extend by mutual agreement for up to two 2-year periods. Contra Costa County will contract with a single entity to provide these services. Contractor shall be required to respond to all emergency and urgent medical calls within the designated geographic area of responsibility when requested by County or County-designated medical dispatch center(s). Each Proposer is required to submit a Proposal describing Proposees qualifications to provide emergency ambulance service and plans to meet or exceed the performance standards identified in this RFP. 8. Emergency Response Areas (ERXs) Proposals are being sought for three of the County's five designated Emergency Response Areas or ERA. Maps of the ERA are included in Appendix 1. ERA 1- Including(1)all of west County including the cities of Richmond, El Cerrito, San Pablo, Pinole,and adjacent unincorporated areas and(2)the central County cities of Martinez, Pleasant Hili, Lafayette,Walnut Creek west of Interstate 680, and surrounding unincorporated area except for those portions of ERA 1 contained within the Moraga-arinda Fire Protection District ERA 2—Including the central County cities of Concord,Clayton,Walnut Creek east of Interstate 680,and adjacent unincorporated areas. ERA 5—Including the cities of Pittsburg, Antioch, Brentwood,and the unincorporated areas of east County. The areas of the Moraga-Orinda Fire Protection District that comprises ERA 3 and a portion of ERA 1,and the areas of the San Ramon Valley Fire Protection District that comprises ERA 4 are excluded from this procurement process. Except for the exclusion of the areas of these two fire districts,this RFP covers the entire area of Contra Costa County. Proposers must submit a Proposal for the provision of emergency ambulance services for all three ERA covered in this RFP. 2 REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY Background The three ERA's covered by this RFP have had advanced life support(paramedic)ambulance services to respond to medical emergencies since the late 1970s and the existing Contractor has provided these services since 1991 under a performance-based Agreement that has resulted in achieving specified response times and services levels. The ELVIS system performance expectations and design have evolved over the last two decades with the expansion of ALS first response by the fire departments,improvements in clinical care,the implementation of non-transporting ALS quick response vehicles, and other improvements. In 2002 the County undertook a process to evaluate the current system and to determine if changes could be made to integrate the first responder and ambulance services and to maximize the use of the system resources. This RI=P incorporates changes in the system design accepted during this process. D. Overview of Design Requests for assistance to medical emergencies typically are made through the 9-1-1 phone system. These calls are answered at the County-designated medical dispatch centers. Personnel at the centers identify the caller's needs and if medical aid is needed follow priority dispatching protocols to identify the nature of the call and location. This information is transferred to the ambulance service Contractor(via phone or electronic data interface)and to the fire department first response agency, if appropriate. The two County-designated fire/medical dispatch centers answering requests for medical assistance in the relevant ERA are operated by Contra Costa County Fire and Richmond Police. The initial response to a potentially life threatening incident includes both a first response unit and a paramedic-staffed ambulance. The location of fire stations throughout the County enables firefighters to make a rapid initial response to a medical emergency. The expansion of ALS first response by the fire departments has allowed changes to the system response times to emphasize the initial response of paramedics rather than the transporting ambulance. Emergency ambulance service is provided by the County's emergency ambulance Contractors,American Medical Response in ERA's 1,2 and 5 covering about 90 percent of the County,San Ramon Valley Fire District in ERA 4,and Moraga-Orinda Fire district in ERA 3 and a portion of ERA 1. Depending upon the nature of the incident,an ambulance may be dispatched Code 3(red lights and siren)or Code 2(immediate response, but following normal traffic regulations). Only ALS units are dispatched to potentially life threatening incidents. Currently, most ALS ambulance units are staffed with two paramedics. Paramedics work under the direction of base hospital medical personnel and are able to administer advanced life support. Basic life 3 REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY support(BLS)ambulance units are staffed by two EMT-is and may be used for non- emergency responses or for additional support at an emergency incident. Patient treatment and transport are carried out under State laws and regulations,as well as County EMS Agency policies and procedures. These policies may include,in the case of paramedics,making contact with a mobile intensive care nurse(MICN)or physician at a designated base hospital to obtain direction in management of the patient. Patients are transported to appropriate receiving facilities. Hospital destination is based upon patient preference and County EMS protocols. Critical patients are normally transported to a nearby emergency department or to a trauma center,as appropriate. Non-critical patients may be transported to hospitals of choice within reasonable travel time. Medical helicopter service is available to transport critical patients when ground ambulance transport time would be excessive and patient meets helicopter transport criteria. Further information regarding Contra Costa's EMS system can be found in the Contra Costa County Emergency Medical Services Agency's"2003 Annual Program Report"and in the "Emergency Medical Services System Plan"approved by the Emergency Medical Care Committee and adopted by the County Board of Supervisors. Both of these documents are available at the Emergency Medical Services Agency. E. New EMS System Innovations The expansion of the ALS first responder program among County fire agencies has precipitated changes in the emergency ambulance service Contractor's performance requirements and in a reallocation of system funding to partially support the fire agencies' efforts and expenses. The EMS system has focused its efforts on getting paramedical care to patients in the shortest possible time frame whether it is from fire agency first response, emergency ambulance service,or non-transporting ALS quick response vehicles(ARVs). When ALS response time performance is provided by first responding agencies and quick response vehicles,the transporting ambulance response time requirements are not as stringent. Secondly,with the expansion of paramedic first response services,the need for two paramedics staffing every emergency ambulance is decreased. The combined effect of lengthening response times in certain zones and not requiring two paramedics reduces the emergency ambulance services staffing and deployment requirements--therefore reducing expenses. In order to capitalize on these changes,the County has modified its system design and performance requirements in this RFP. The important changes are described in the following paragraphs. 4 - REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY 1. Emergency Response Zones Established The three ERAS were divided into five(5)Emergency Response Zones(ERZ). This was achieved to allow for integrated paramedic first responder and paramedic ambulance services on a zone by zone basis conditioned on fire services in a specific zone being ready to provide paramedic first responder coverage for the zone. The zones are: • Zone A---City of Richmond(Richmond Fire) • Zone B--West County,except Richmond(El Cerrito Fire, Contra Costa County Fire, Rodeo-Hercules Fire, Pinole Fire,Crockett-Carquinez Fire) • Zone C--Central County(Contra Costa County Fire) • Zone D--Pittsburg, Bay Point,Antioch area(Contra Costa County Fire) • Zone E—l=ast County(East Contra Costa County Fire) See Appendix 2 for maps of the Emergency Response Zones. 2. hick Response Vehicle urogram Expanded The Contractor will be required to provide four(4)non-transporting paramedic quick response vehicles 24 hours per day,7 days per week. Three of these units will be deployed in East County and one will be positioned in the northwestern portion of the County. These units will be provided by the Contractor at the Contractors expense.There shall be no charge to the County or charges to patients serviced by these units.The expansion of the QRV paramedic first response units will provide quicker paramedic response in those areas that do not have ALS first response from the fire agencies. 3. Minimum Crew Confteratlon MoWied With the existing and forthcoming ALS engine-company first response,the need for two paramedics on every ambulance is decreased. Therefore,the minimum staffing for emergency ambulances in ERZ B,C, D,and E will be one EMT-Paramedic and one EMT-l. Ambulances that generally service the City of Richmond will retain the two-paramedic staffing configuration. 4. 'Transp ord"Ambulance Response Times lengthened The emergency ambulance response time requirements have been lengthened in ERZ B, C, D,and E. Life-threatening emergencies will require an ambulance response within eleven minutes fifty-nine seconds(11:59)for ninety percent(90%)of all Priority One responses. _.. _. _ . REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY The response time requirements for the City of Richmond will remain the same including the Priority One response time requirement of ninety-five percent(95%) within ten minutes and p seconds(10:00). 5. Emm"nc y Ambulance Service Subsidy Ellmirtated With the changes implemented in the EMS system design, it is anticipated that the emergency ambulance service Contractor will be able to provide the required services without a direct subsidy from the County. Contractor is to Invoice County for patients transported for whom the County Health Services is financially responsible. These transports will be billed to the County at MediCal payment rates for indigent patients and at the Medicare rate for non-indigent patients. F. Relevant Information Regarding Service Areas The County specifically makes no promises or guarantees concerning the number of emergency and non-emergency calls or transports, quantities of patients,or distance of transports that are associated with this procurement. Every effort has been made to provide accurate information,but the Proposers are to use their professional judgment and expertise to develop their economic and operational plans and proposals. 1. Historical Service Volume The call and transport volumes for the ERA covered by the RFP are included in the EMS Agency's Annual Report. This can be found downloaded at hfp:/ANww.cchealth.org, 2. Current Approved Ambulance Service Rates The current approved ambulance service rates are included in Appendix 3. 3. Current System Pertormance The response time performance of the current system is delineated in Appendix 4. 1.111.. REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY A. • - - r Contract The result of the procurement will be an award of a performance-based contract. The resulting Agreement will require the highest levels of performance and reliability,and the demonstration of effort,even diligent and well-intended effort will not replace demonstrated performance results. Failure to perform will result in financial penalties and may cause the replacement of the Contractor. The essential areas where performance must be achieved include.- Ambulance nclude;Ambulance and QRV response times • Ambulance and QRV equipment and supply requirements • Ambulance and QRV staffing levels including personnel with current and appropriate levels of certification/licensure • Clinical performance consistent with approved medical standards and protocols Comprehensive quality improvement and compliance activities and results • Accurate and timely reporting • Customer and community satisfaction with the services provided The resulting Agreement is not a level-of-effort contract. In accepting the Proposer's offer,the County accepts the Proposer's promise to employ whatever level of effort is necessary to achieve the clinical, response time,customer satisfaction,quality improvement, and other performance results required by the EMS System Specifications. B. Notice Proposers This Request for Proposal does not commit the Contra Costa County Health Services Department{County}to award a contract,to pay costs incurred in the preparation of a Proposal responding to this request,or to procure a contract for service. County reserves the right to accept or reject any or all Proposals received as a result of this request,to negotiate with qualified Proposers the restructuring of system design elements,or to cancel in part or in its entirety the Request for Proposal if it is in the best interests of the County to do so. The County may also require the Proposer selected to participate in negotiations concerning contract price or the nature and extent of services to be provided. Although cost to the County and cost to the consumer will be considered as part of the Proposal, this procurement is not a REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY low bid process. The contract, if awarded,will be negotiated with the Proposer who can hest meet the County's needs as identified in this Request for Proposal. C. Use of Own Expertise and Judgment Each Proposer is specifically advised to use its own best expertise and judgment in deciding on the methods to be employed to achieve and maintain the performance required under the resulting Contract. By"methods"the County means compensation programs,shift schedules, personnel policies,asset acquisition,supervisory structure, deployment plans, and other business matters that comprise the organization's strategies and activities. The County specifically makes no promises or guarantees concerning the number of emergency and non-emergency calls or transports,quantities of patients or distance of transports that will be associated with this procurement. ProcurementD. The following schedule is proposed for the procurement. Any changes to the schedule will be published on the Contra Costa County EMS Agency's website and organization's requesting the RFP will be notified by the EMSA. 10 August 2004 Board approval of RFP 13 August 2004 Release of the RFP 25 August 2004 Deadline for submission of suggested RFP changes and written 4:00 p.m. questions to be answered at Pre-Bid Conference 1 September 2004 Proposers conference at 1350 Arnold Drive, I"floor conference 1:00 pm room, Martinez 24 August 2004 Addendum to RFP to be distributed 15 October 2004 Proposals due and Public Proposal Opening 4:00 p.m. 1 December 2004 Proposal review and recommendation to Board completed 14 December 2004 Presentation to Board; negotiation of contract authorized 7 January 2005 Contract negotiations completed 15 March 2005 Board approval of contract 01 July 2005 Startup of new contract REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY ProcessE. Procurement 1. Pr,4M Procew Questions regarding,or suggested changes to,the Request for Proposal should be submitted in writing to: Art Lathrop EMS Director, 1340 Arnold Drive, Suite 126 Martinez, CA 94553 By facsimile to(925)646-4379 Or, by email to ALathrot)CW-hsd.co.contra-costa.ca.us This material will be accepted prier to the Proposers'Conference, but no later than 4:00 p.m.on the date specified in the Procurement Time Line. 2 Proposer.'Conelf"noe A Proposers'Conference will be held to answer questions regarding the RFP specifications and process. The conference will be held at the time and place specified in the Procurement Time Line. All written material received from potential Proposers, as well as any related County responses,will be distributed to all attendees of the Proposers'conference. Any changes or clarifications to the Request for Proposal made following the Proposers Conference will be distributed to all potential Proposers who attend the Proposers'conference,or who have indicated in writing their intent to submit a Proposal. & Propomll Sulbrn*skm One(1)original and twelve(12)copies of Proposals shall be submitted by 4:00 p.m., Pacific Standard Time.A CD-ROM of the Proposal and attachments in Microsoft Word or PDF format shall accompany each Proposal.Any Proposals received after the deadline will not be considered. No Proposal may be withdrawn for a period of ninety(90)days after the scheduled deadline for receipt of the Proposals. Proposals shall be submitted in a sealed container.The outside of the container and each Proposal shall be labeled to indicate the Request for Proposal number and name. Proposals shall be delivered to: Contra Costa County Health Services Department Emergency Medical Services Agency 1340 Arnold Drive, Suite 126 Martinez, CA 94553 REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMs AGENCY 4. Public Proposal Op enling All proposals received prior to the time set for opening shall be kept unopened and secured in a lacked area.All proposals received prior to the deadline will be publicly opened at the EMS Agencies Offices at 4:00 p.m. PST,October 15,2004.General information about each proposal will be recorded and read aloud to the persons present. g. Additional Proposer Responsibillffies Proposers may be requested to provide additional information,documentation or a formal oral presentation to the proposal review panel. Such requests will be fulfilled by the Proposer or their Proposal may be rejected. F. Proposal 1. Proposall=onnat It is the intent of the County to ensure that all Proposals be concise and directly respond to the required information in this RFI'. In order to facilitate the evaluation process, Proposals shall be limited in size. The following requirements shall be adhered to: The entire Proposal and exhibits shall be contained within two(2) 1"three ring binders. One binder shall contain the narrative and the second the exhibits, The narrative portion of the Proposal shall be limited to fifty(50)pages. The narrative portion will adhere to the following specifications: Easily readable font, no smaller than 12 point Line spacing no smaller than 1 !2 lines Single sided page printing Standard 8%z"by 14"'paper Pages must be numbered sequentially The exhibits shall be inserted in the second binder. Each exhibit shall be labeled and referenced in the narrative. Z Mandatmy Table of Contents The Proposals shall be written to directly respond to evaluation criteria presented in Section II-H.Table of Contents that must be adhered to is also provided in that section Proposals shall incorporate all information requested in this RFP, in the order that it is requested. County performance standards for emergency ambulance service are 10 REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY identified in the Service Proposal and System Specifications Sections of the RFP and shall be addressed in the manner identified for each standard. Proposers may elect to use reference"exhibits"or"attachments"in the Proposal to provide additional detail. Any exhibits or attachments should be incorporated into a supplemental"reference document"which is to be in a separate binder from the narrative of the Proposal. Each Proposal must contain all forms located in Appendix 5 of this RFP. The first page of the RFP is to consist of Form A W Face Sheet. ProposalG. 1. Pro;iosall Review Panel The procurement process will be conducted by the County Health Services Department's EMS Agency. A multi-disciplinary,independent proposal review panel will be designated by the Health Services Director to evaluate and rank all Proposals received in response to this RFP. Meetings of the proposal review panel will be closed to the public. Rankings and recommendations will be submitted to the Health Services Director, The Health Services Director may consider any other pertinent information before making his recommendation to the Board of Supervisors. The review panel is expected to consist of ten outside and local experts including an outside EMS administrator,fire chief, field paramedic,and California Highway Patrol representative and,from within the county,a city manager, emergency physician, hospital administrator, law enforcement representative,emergency nurse,and consumer. To assure a fair process for all Proposers, review panel members will be asked to avoid discussing any Proposals or the RFP process with any Proposer. Proposers shall avoid any communications regarding Proposals or the RFP process with any panel member outside of the formal procurement process. If it is determined that Proposer participation in such communications has occurred, Proposer's Proposal may be disqualified. 2, Pr salt Review Pis Proposals that, in the judgment of the proposal review panel,do not meet the minimum requirements of this Request for Proposal will be considered unresponsive and disqualified. The Review Process includes the following steps. • Each reviewer will be provided a copy of each responding organization's Proposal. The reviewer will be expected to read each Proposal prior to convening of the review panel. II <;i REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY • A discussion of all Proposals will take place. • Each Section of the Proposals will be evaluated separately. (e.g. Clinical Offerings,Operational Proposals,etc.) The minimum requirements contained in the REP will be presented and each organization's response to those requirements will be discussed. • After a full discussion is completed on each Section,reviewers will then complete the individual ranking sheet for each Proposal using the scoring guidelines discussed in a later section of this RI=P. • The points awarded by each reviewer will be totaled by section and then the overall average calculated. • The recommendations of the review panel and the rankings of the proposals will be forwarded to the Health Services Director. • The Health Services Director will make a recommendation to the Board of Supervisors. EMS Agency with the assistance of its consultant shall serve as staff to the review panel but shall not participate in the scoring of proposals. 3. Post Submission Presentation Any Proposer may be asked to meet with the proposal review panel to provide additional information, provide a formal presentation,and answer questions. 4 #nvesti a tion Upon completion of proposal review panel evaluations,County staff may undertake additional investigation to verify claims made by the recommended Proposer during the Proposal evaluation process. Such additional investigation may involve site visits, reference checks,financial inquiry or any other reasonable means of determining the accuracy and completeness of information supplied by the Proposer. Prospective Proposers are advised that County reserves the right to continue its investigation of claims after contract award and throughout the term of the contract, and that the furnishing of false or misleading information during the bid process may constitute a major breach of contract even if discovered after contract award. 5. Nlotiification Proposers will be notified of the status of their proposal(recommended for selection, not recommended for selection,or disqualified)following completion of the proposal review process. Notification will be by facsimile transmission to the telephone number given in the proposal for receipt of facsimiles. 12 _ __ _ _ _ REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY 6. Protest Any protest of the recommendation of the proposal review panel must be made in writing within five business days following above notification,to the Health Services Director. The Health Services director shall consider the merits of the protest and such additional information that,in his judgment,is pertinent to the issue of the protest before making a recommendation to the Board of Supervisors. 7. Avv=d The final decision on contract award will be made by the Board of Supervisors following recommendation from the Health Services Director. If for any reason the selected proposer is unable to enter into a contract with the County in a timely manner in accordance with the time interval identified in the RFP for contract negotiation,the Health Service Director may recommend selection on an alternate proposal to the Board of Supervisors. & Required Bond The successful Proposer will be required to sign a contract with County according to time schedule as identified in the RFP Timetable or post a$50,000 bid bond by that date if negotiations have not been completed. The bid bond requirement will not apply to public safety agencies. 9, Required E e€9 errcy Ambulance Pem:it Contra Costa County has an Ambulance Services Ordinance that governs ambulance services within the County. Pursuant to the Ambulance Services Ordinance,an ambulance company providing emergency and/or nonemergency ambulance services must obtain the appropriate Ambulance Service Permit.The successful Proposer will be required to obtain a Contra Costa Emergency Ambulance Service Permit to provide emergency ambulance services in Contra Costa County.County fee for a three(3)year Emergency Ambulance Service Permit is$1,500 for each Emergency Response Area(three ERA's are included in this procurement process). The Contra Costa County Ambulance Services Ordinance and application forms are available on the EMS Agency website at www.cccems.org,or at the EMS Agency. 10. . r"Crfteft It is the County's specific intent that the clinical and operational quality of service be the primary factor in this procurement although financial issues are an important consideration. Therefore,the County's scaring methodology includes the opportunity for points to be awarded to those Proposers whose service quality is independently judged on an objective basis to be clearly superior and to be most cost effective. 13 REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY Each section of all Proposals will be scored after discussions of the Performance Requirements and the Proposers'Responses prior to the scoring of the next section. The best Proposers response for a particular section will receive the total points available for that section. The reviewers will then rate the other Proposals,based on their evaluation of the offerings an equal or lesser score for the section. For example, Proposer#1 offers to exceed the minimum performance standards for a particular section and Proposer#2 offers to meet the standards. Proposer#1 would receive the total points available for the section and Proposer#2 would receive a lesser number of points based on the Reviewers judgment of how the Proposals compare. Examples of areas for which the Proposer might offer enhancements and proposals to exceed minimum requirements may include,but are not limited to the following: 1. Response time/performance standards 2. Level of clinical sophistication 3. Dispatch and communications systems 4. Technology commitment 5. Type of vehicles & Compensation package and working conditions 7. Commitment to advancing EMS System H. Evaluation Criteria The following outlines the criteria that will be scored in the Proposal Review Process. The Proposers must fallow the mandatory table of contents,which is replicated below with the criteria and the total points to be awarded for each section. All Proposers are required to achieve minimum specifications and performance requirements contained in this RI=P. In evaluating each Proposers response to the criteria,a Proposers offer to exceed minimum requirements will be considered when Proposals are scored. 1. Mandatory Taiaie of Contend and Evaluation Criteria This section includes the criteria that will be considered in scoring the Proposals. It also includes the required Table of Contents with Sections 1 through 8. Section 1= Credentials and Qualifications This section will be evaluated to determine whether or not the Proposer has the experience,resources and financial structure to provide the services identified in the request for proposal,and will be rated as"qualified"or"not qualified." The following qualifying criteria will be used: REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY 1.1 Experience as a sale provider in providing Advanced life Support (paramedic)service. 1.2 Demonstrated ability to meet response time standards. 1.3 Demonstrated ability to provide high level of clinical performance. 1.4 Financial strength and stability. 1.5 Demonstrated expertise in EMS system management. Section 2: Commitment to Clinical Quality The County intends to maintain or improve the level of clinical sophistication and care delivery in the EMS System. This section will be evaluated to determine the Proposer's plan to achieve this goal. The following criteria will be used: 2.1 Clinical quality improvement processes and resources committed to implementing and maintaining a comprehensive Q.I. program. 2.1.1 Financial commitment 2.2.2 Staff commitment 2.2 Continuing education program 2.3 Clinical benchmarking and research activities 2.4 Personnel certification and training requirements 2.5 Medical equipment and supplies 2.6 Collection and use of patient care data 2.7 Community injury and illness prevention activities 2.8 Additional commitment to improve EMS System's clinical care Section 3: Commitment to Employees The Proposal will be evaluated and scored based on the following criteria: 3.1 Employee compensation and benefits 3.2 Commitment to maintain incumbent workforce 3.3 Employee recruitment, selection,and orientation policies and programs REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY 3.4 Provision of field supervision 3.5 Leadership and supervisory training 3.6 Diversity awareness training and involvement plan 3.7 Internal health and safety programs Section 4: Operations Management The Proposal will be evaluated and scored based on the following criteria: 4.1 Commitment to response time standards 4.2 Initial deployment plan and mechanisms for fine-tuning plan 4.3 Ambulance and support vehicle fleet 4.4 Equipment and feet maintenance 4.5 Dispatch center operations 4.6 Communications system commitment and management 4.7 Commitment to advanced technology 4.8 Non-transporting paramedic staffed quick response vehicles Section 5: Commitment to EMS System and Community 5.1 Participation in EMS System development 5.2 Public education programs 5.3 Customer service monitoring and improvement processes 5.4 Development and integration of First Responder program 5.5 Commitment to EMS System stakeholders including public safety, medical providers,County and others 5.6 Disaster planning assistance and response 5.7 Mutual aid and stand-by services Section 6: Management and Administration 61 Key personnel commitment REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY 62 Compliance plans and policies 6.2.1 Federal healthcare program compliance 6.2.2 HIPAA compliance 6.2.3 Compliance with local,state,federal laws,regulations,and rules 6.2.4 OSHA and other state and federal program compliance 6,3 Commitment to accreditation 6.4 Billing and collection policies 6.5 Proposed implementation plan Section 7: Organizational Requirements The following criteria must be addressed and supported in the Proposal. The support includes the provision of audited financial statements for the most recent fiscal year and other documents. 7.1 Organizational ownership and legal structure 7.2 Organizational background under present business name,as well as related prior business names 7.3 Similar contracts completed during last five(5)years(year,services,dollar amount,location and contracting agency) 7.4 Details of failure or refusal to complete a contract 7.5 Financial interests in related businesses 7.6 Names of persons with whom the prospective contractor has been associated in business as partners or business associates in the last five(5) years 7.7 A description of experience in the service to be provided or similar experience of principal individuals of the prospective contractor's present organization 7.8 A list of major equipment to be used for the direct provision of services 7.9 Financial statements to support organization's financial ability to perform services 17 REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY 7.10 A list of commitments,and potential commitments which may impact assets, lines of credit,guarantor letters,or otherwise affect the responder's ability to perform the contract 7.11 Business or professional licenses or certificates required by the nature of the contract work to be performed and held by the responder 7.12 Working capital sources and amount required for startup 7.13 Summary of any and all federal,state,or local government regulatory investigations,findings,actions or complaints and their respective resolutions for the Proposer's organization and affiliated organizations within the last three(3)years. 7.14 Method and ability to provide required performance security Section 8: Proposed Pricing Each Proposer is required to complete each line on the three Price Sheets included in Appendix 6. The Optional services prices will not be considered in the scoring of the Proposals but will allow the County to determine the cost of the identified services for possible implementation. 8.1 Proposed patient charges 8.2 Proposed service charges 8.3 Optional services price list 1. Scoring Matrix The matrix that will be used in the Proposal review process is defined below, The total points that can be awarded for each area are identified. Section Section Title Total:Points 1 Credentials and Qualification 0 i 2 Commitment to Clinical Quality 250 3 Commitment to Employees 250 3 4 Operations Management 200 5 Commitment to EMS System and Community 200 �8 REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY 6 i Management and Administration 150 7 Organizational Requirements 1010 8 Proposed Pricing 250 TOTAL POSSIBLE POINTS 1,400 ! ... . REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY Section Sewim Pim This and the subsequent two sections define the Service Plan that is to be proposed in response to this Request for Proposal. l County's In this performance-based approach it is the County's responsibility to: • In accordance with this RFP to select and enter into an Agreement with an Emergency Ambulance Service Provider; • Provide contract administration and management services for the Agreement Monitor the EMS system's performance and compliance with these performance based specifications • Commit along with the County's fire agencies to the continued development of a high quality ALS First Response service on life-threatening incidents; • Provide certain County owned assets for the Contractor's use; Provide Medical Direction for the system • Contract with first response agencies for the provision of ALS first response services; Develop and modify EMS system protocols and procedures; • Contract with base hospitals to provide on-line medical control • Secure or provide, in the event of Contractor's default,an EMS delivery system that represents the interests of its taxpayers and the general public as consumers of EMS services within the County. B. Contractoes Functional Responsibilities Contractor shall provide emergency ambulance services as requested by the County's designated public safety dispatch center(s)and interfacility transfer services as requested by Contra Costa Health Services, in County-specified Emergency Response Areas 1,2 and 5, except for those portions of ERA 1 contained within the Moraga-Orinda Fire Protection District. Emergency ambulance ERA's are delineated in the map entitled"Emergency Response Areas of Contra Costa County" as amended,on file in the office of the Sheriff Coroner and Clerk of the Board of Supervisors. Such services shall be provided in accordance with the requirements of Health and Safety Code Sections 1797 et seq., Division 48 of the Contra Costa County Ordinance Code,and all regulations promulgated thereunder,and in REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY accordance with any amendments or revisions thereof. In performing services hereunder, Contractor shall work cooperatively with County's Health Services director or his designee,the Emergency Medical Services Agency director(also referred to herein as"Contract Administrator"). 1. Basic Services In consideration of the County's referral to Contractor of Emergency Ambulance Service requests originating in Emergency Response Areas 1,2 and 5,except in those portions of ERA 1 contained within the Moraga-Odnda Fire Protection District, Contractor shall perform the following services to the complete satisfaction of the County: i. Contractor shall provide emergency ambulance services including interfacility patient transfers when requested by Contra Costa Health Services,without interruption,24 hours per day,7 days per week, 52 weeks per year,for the full term of this Contract. ii. Contractor shall provide emergency ambulance services without regard to the patients race,color,national origin,religious affiliation,age,sex,or ability to pay. iii. The Proposal submitted by Contractor in response to this County Request for Proposal for Emergency Response Areas 1,2 and 5,except in those portions of ERA 1 contained within the Moraga-©dnda Fire Protection District,will be retained and will be incorporated herein by this reference and made a part of the final Agreement,except that in the case of any conflicting provisions,the provisions contained in the Ambulance Service Agreement shall prevail. iv. Contractor shall participate in pilot emergency response programs that Contract Administrator may authorize from time to time. Contract Administrator may waive one or more standards contained herein, in the event that conflicting standard(s)are established for a pilot program. Any such pilot program must be approved by the EMS Medical Director,and shall be done with the advice of the Emergency Medical Care Committee. Contractor agrees that Contractors participation in the pilot projects shall entail no additional cost to County. Contractor further agrees that Contractors services provided under pilot projects shall be in addition to the other services described herein. REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY Section %Clinical and BIM" oyee Provisions IV A. Clinical Overview The County's goal is to provide a clinically sophisticated system that achieves contemporary benchmarks of clinical excellence and can continue to do so in a sustainable fashion. These system specifications are drawn from many reference sources but are generally consistent with the direction provided in the document:`The EMS Agenda for the Future." t Clinical outcomes in EMS systems are difficult to define and measure. The clinical goals of progressive EMS systems are guided by the broad outcome measures established by the US Public Health Service. These include: discomfort is minimized;disability is reduced;death is minimized;destitution eliminated;disfigurement is reduced;and, disease is identified and reduced. The current level of the scientific research and the numbers of variables impacting patient outcomes beyond the EMS system's control limit the applicability of outcome measurement. EMS systems typically use process measures and process improvement as a point of reference in moving toward enhanced clinical outcomes. It is anticipated that these measures will be utilized and further developed throughout the term of the Agreement. B. Medical + The County shall fumish medical control services at its expense, including the services of a System EMS Medical Director for all system participants'functions in the EMS System(e.g. medical communications,first responder agencies,transport entity,online control mobile intensive care nurses and physicians). County shall appoint a Medical Advisory Committee to advise the Medical Director and perform other duties outlined herein. County recognizes the unique role of the EMS Medical Director in providing his/her delegated authority to perform certain medical acts to Contractor personnel in accordance with the standards outlined by California law. It is the County's intent that a single EMS Medical Director be utilized for all aspects of its coordination of the EMS system. Other service agreements with the EMS Medical Director may be desirable or necessary;however,any other relationship between any individual or organization with the EMS Medical Director shall not conflict with the roles and responsibilities as outlined herein. US Department of Transportation,National Highway Traffic Safety Administration-EMS,1996. REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY 1. Medical Protocols Contractor shall comply with Medical Protocols and other requirements of the System Standard of Care as established by the EMS Medical Director in consultation with the Medical Advisory Committee. Contractor shall statistically document compliance to system medical protocols. This documentation shall describe the performance of Contractor as a whole,its component parts(e.g.communications,first responders and transport),and individual system participants(personnel). Medical protocols shall be reviewed and updated by the EMS Medical Director on an annual basis with input from system participants. The review process is to be defined in writing by the EMS Medical Director and at a minimum shall address the effectiveness of the protocol and document the system's compliance to the protocol. Current Medical Protocols are available at the EMS Agency and on the Agency's website. 2. Direct biteraction vvkh nrodi cal chi Contractor personnel functioning under these specifications have the right and responsibility to interact directly with the system's medical leadership on all issues related to patient rare. This personal professional responsibility is essential. 3. Medical revier Waw The goal of the medical audit process is to improve patient care by providing feedback on the system and individual performance. If the audit process is to be positive, it routinely must produce improvement in procedures,on-board equipment,and medical practices. It is Contractor's responsibility to operationalize this corrective feedback. The EMS Medical Director may require that any Contractor employee attend a medical audit when necessary. Employees,at their option and expense,may attend any audit involving any incident in which they were involved that is being formally reviewed but must maintain the confidentiality of the medical audit process. Attendance of every certificate holder involved in a case being reviewed is not required, unless mandated by the Medical Director. 1 C. Demonstrable Progressive Clinical Quality Improvement & Continuing Education Required The County requires that the Contractor develop and implement a comprehensive continuous quality improvement(CQI)process which will be integrated with the entire EMS system, including first responder agencies, medical communication center operations,and the County REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY EMSA. The clinical indicators measured by all system participants will be developed through collaborative efforts of the first responder agencies,the Contractor,and the County. The County ultimately will approve and implement the quality monitoring and improvement plan to be used in the County by all providers. 1. Quality I sibnPnx*Ss" Contractor's clinical quality improvement program shall be designed to: • Regularly and accurately evaluate the patient care oriented activities of the system's personnel, including supporting determination of patient outcomes for designated patient categories, • Regularly and accurately evaluate the operational,administrative and procedural activities of the system as it relates to the delivery of patient care, • Accurately determine the training and educational needs of individuals and the system as a whole, and evaluate the effectiveness of training and education provided, • Provide regular training and continuing education on both a scheduled and as needed basis to individuals in all areas of patent care and operations, • Support discovery, investigation,and resolution of internal or external complaints, • Facilitate the evaluation of protocols,procedures,and patient care standards on a regular basis, including re-evaluation based on system events and leamings, • Encourage positive involvement and interaction of individuals at all levels within the system, in ways which improve care, • Objectively report performance of both individual and system participants and components for further evaluation by the Medical director. REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY Figure 1. Illustrates Proposed Retrospective Qi Process SMS QI ;p3'AT�k';RSL rib AQt1.7'#=: R3evr,,tfigRY-. :{,rr[{,ttAfaON ♦ M�IJAi:7ii ..-�MfiiNWliiZ %%�iffRW �itl65�N�'8+'< C•otv6+cuwcc RpviEw +��s dzvtcarlsmYt 9tvw5PrneN ,. gPNPW., i MxMip WWt !ay PaYAae 8ebrsroneP I Pre}.*r TniMq Aa Yk ixp Dnu a'mrr D,nn Re.kw uxwx. Nwx p.rr.w xy.bann c.u.eoan awwa c,�pcna coup a,an+ewi z*M.ia MW Mg�nry NWrm Cnaner h�'a'. Pala fawwixry @v.Mtxw .e.beYnm 1tadNyx Vepr APPr^FNx> Apawa Prean war„ryx. a.ann Px. � ManMlW Pnarror,✓ s. gy<'9rP Nraneexeiftim, F%ta me.a6.f MAewN 09P tr.x.aoa P,aeMw.. 1 nw,> xaeafreuanhe cm,pnmmPrw..n � rna 4'�7 C+wflmaa CbCaapNam. $ G..ytp,nwwt Rti9'enr�• $ y4n5 at eb M R.rbw Pony I :kAWuw Aue1y'dauf ban hmyAU 6 j Am i Stn Yrx � � 1 Bm,aMMrkn e�r Shuw,run TMn� Wwv „ taa,aYvaa Crc.Wret CnecWrrS P"aie'e^'M'"" Lnmtv4w hwWa,x Ma Yu Trtatna Rnrhw Re-£uUux. Min W4 $n,,,ew.,a.ea. I Pwe�wewaYun Pxu + IwnnwnU ilwae,mablbn I It is expected that this component of Contractor's service delivery system will have high levels of interaction with and collaborative involvement of the EMS Medical Director. Contractor's CQI program shall provide an organized,coordinated,multidisciplinary approach to the assessment of pre-hospital emergency medical response and patient care. An example of a retrospective QI process is outlined in Figure 1. Contractor's involvement will require: • Contractor participation in system related COI activities and CQI project teams. • Contractor notification of County of any unusual occurrences that could impact certification, accreditation or licensure of any pre-hospital personnel. 2. Dedik�ated Personnel Requilmd Contractor shall provide a physician or a Registered Nurse to implement and oversee Contractor's on-going CQI program. This individual shall be responsible for the medical quality assurance evaluation of all services provided pursuant to this Agreement. At a minimum,the Contractor shall provide and maintain two full-time Clinical and Educational Services positions,one of which may be the individual identified to oversee the Contractor's on-going CQI program. In addition,the Contractor shall provide at least one full-time Analyst to evaluate Patient Care Reports and eighty(80)compensated hours per month for designated field personnel to participate in clinical quality improvement activities. 25 REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY Qua1lf y Imprr Verne t Hotkw Contractor shall establish a QI Hotline giving customers and system participants the ability to leave commendations or suggestions for service improvements on a voice mailbox. The hotline number will be publicized at local healthcare facilities,First Responder stations,and public safety agencies. Members of the Contractor's Of/Leadership Team are to be automatically notified via pager of any incoming calls. Incidents that require feedback are to be attended to by the end of the next business day. QI processes are deemed confidential,including proceedings,findings,and documents and are protected from disclosure. All system participants will be required to enter into privacy agreements as required by law and that compel individuals involved to adhere to the confidentiality requirements of the process. QI documents will not be released except as required by law or as required by individual regulatory monitoring agencies or fiscal intermediaries according to pre-established County policy and agreement. 4. C00113nuing Education Pim Requmftn Contractor shall provide in-house or sub-contracted in-service training programs designed to meet state certification requirements at no cost to employees. All In- service and continuing education programs must comply with state regulations and also must be approved by the Medical director. 0. Clinical and Operational Benchmarking and Research Required Benchmarking of Key Clinical Indicators(KCI)and Key Performance Indicators(KPI)of the system is required. Some of the interim measurement may be process oriented in lieu of outcome measurements. It is anticipated that the KCI will evolve with the development of the local EMS system as approved from time to time by the EMS Medical Director. Contractor shall provide information necessary to benchmark KCIs. Key benchmarks to be measured will include,at a minimum: • measuring cardiac arrest survival in accordance with Utstein protocols, • presumptive impressions at dispatch compared to field intervention, • fractal measurement of time to first defibrillation, • successful intubation rate by entire system, provider type and individual, • successful IV application rate by entire system,provider type and individual, • field procedures authorized, • pain reduction, and • fractal measurement of response time: REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY • ALS(QRV)first responders, + ALS transport ambulance arrival, Other KCI benchmarking may include comparing clinical data published by the National Association of EMS Physicians or other national organizations comparing the system with other similarly designed clinically sophisticated systems. Examples of non-clinical Key Performance Indicators(KPI)to be benchmarked may include: • employee injuries, • vehicle collisions(>$250 damage)per 100,000 fleet miles, • critical vehicle/equipment breakdowns(interfering with a response or transport) per 100,000 fleet miles, + consumer satisfaction, • employee turnover, employee satisfaction, Participation in, or publishing the results of, peer reviewed research is another strong process measure of a system's ongoing commitment to clinical sophistication. To that end Contractor shall use best efforts over the term of the Agreement to participate in out of hospital research. For illustration,such projects might include but are not limited to research involving: + Impacts of Public Access Defibrillation(PAD), • Reduction of"at scene"time, • Reduction of"at patient"status to first shock or ALS intervention, + Communications system research projects or • Other research projects as approved by the Medical Director. E. Transport As outlined in greater detail in other sections, Contractor has an obligation to respond to all emergency medical requests and provide ambulance transport in Contra Costa County. However,there are limitations and flexibilities as described herein. 1. Destbiadons Contractor shall be required to transport Patients from all areas of the County, in accordance with Medical Control Destination Protocols. 27 REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY 2. Prohlbilltlon agla€rmt lntluenchM destinadon decisions Contractor personnel are prohibited from attempting to influence a patients destination selection other than as outlined in the destination policy. 3. Provision to restrict service based upon den!Watr ect abuse Should Contractor determine that specific individuals have chronically abused the required transport provision of the EMS service,they shall report the names of those individuals to the EMS Agency.EMS will work with Contractor to develop procedures to discourage inappropriate use. F. County Approved Base Station Hospitals County,through its Ambulance Permit Officer,shall notify Contractor in writing, upon execution of this Contract,of all County approved Base Station Hospitals. Further,County shall notify Contractor in writing of changes or additions to such approved hospitals,as such changes or additions occur. G. Minimum Clinical Levels and Staffing Requirements l. Am lance Staling Requivernents All Ambulances rendering Emergency Ambulance Services under this Agreement shall be staffed and equipped to render paramedic level care, The paramedic shall be the primary caregiver for all Patients(e.g.emergent and non-emergent)and shall accompany all Patients in the back of the Ambulance during any patient transport Contractor is required to staff a minimum of one(1)EMT-P and one(1)EMT for all emergency transport units responding to requests from the County designated PSAP originating in ERZ B, C, D,and E. The emergency ambulances primarily providing coverage to Zone A will be staffed with two(2) EMT-P. Contractor may send Basic Life Support(BLS)units staffed with two(2) EMT-€'s to requests for multi-unit response and any calls in which the County designated medical dispatch center determines BLS response is appropriate according to protocols and procedures approved by the County EMS Agency and the EMS Medical Director. At Contractor's sole option,the requirement for EMT staffing levels on any or all units may be enhanced to higher levels of training without additional obligation of the County. 28 REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY ii!,. Per"rinei Cel ffwado t mW Training Requirements All of Contractor's ambulance personnel responding to emergency medical requests shall be currently and appropriately credentialed to practice in Contra Costa County. Contractor shall retain on file at all times,copies of the current and valid licenses, certifications, and/or accreditations of all emergency medical personnel performing services under this Agreement. a. Advanced Cardiac Life Support ACILSJ Certification. All paramedics responding to potentially life threatening emergency medical requests shall be currently certified in ACLS by the American Heart Association or the Contractor shall document that each paramedic has satisfactorily completed comparable training adequate to ensure competency in the skills included in the ACLS curriculum. Contractor shall retain on file at all times,copies of the current training documentation and valid certifications of all paramedics performing services under this Agreement b. R uired Trauma Training. Contractor shall staff each ALS ambulance with a minimum of one paramedic certified in Prehospital Trauma Life Support(PHTLS),Basic Trauma Life Support(BTLS),or the Contractor shall document that each paramedic has satisfactorily completed comparable training adequate to ensure competency in the skills included in the PHTLS or BTLS curriculum. Contractor shall retain on file at all times,copies of the current training documentation and valid certifications of all PHTLS or BTLS qualified paramedics performing services under this Agreement. All paramedics shall be required by Contractor to obtain certification in PHTLS, BTLS,or have completed a comparable program within six(6) months of hire by Contractor. c. Required Pediatric Education for Prehospital Personnel (PEPP). Contractor shall staff each ALS ambulance with a minimum of one paramedic certified in Pediatric Education for Prehospital Personnel(PEPP),or the Contractor shall document that each paramedic has satisfactorily completed comparable training adequate to ensure competency in the skills included in the PEPP curriculum. Contractor shall retain on file at all times,copies of the current training documentation and valid certifications of all PEPP qualified paramedics performing services under this Agreement. All paramedics shall be required by Contractor to obtain certification in PEPP, or have completed a comparable program within six(6)months of hire by Contractor. 29 REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY d. Companv Orientation and On-Goma Preparedness. Contractor shall properly orient all field personnel before assigning them to respond to emergency medical requests. Such orientation shall include at a minimums,provider agency policies and procedures; EMS system overview; EMS policies and procedures;radio communications with and between the provider agency,base hospital,receiving hospitals,and county communications centers;map reading skills including key landmarks, routes to hospitals and other major receiving facilities within the County and in surrounding areas;and ambulance and equipment utilization and maintenance. e. Preparation for Multicasualty 1=feapAnSe Contractor shall train all ambulance personnel and supervisory staff:in their respective roles and responsibilities under the County Multi-casualty Incident Plan(MCIP)which is on file at the County EMS Agency, and prepare them to function as the medical portion of the Incident Command System. f. Driver Tralnin . Contractor shall maintain an on-going driver training program for ambulance personnel. The program,the number of instruction hours,and the system for integration into the Contractor's operations(e.g.,accident review boards, impact of accidents on employee performance reviews and compensation, etc.)will be reviewed and is subject to approval by County initially and on an annual basis thereafter. Map reading shall be an integral part:of driver training. g. Assaultive Behavior Management TrainI . Contractor shall provide ambulance personnel with the training,knowledge, understanding,and skills to effectively manage patients with psychiatric, drug/alcohol or other behavioral or stress related problems,as well as difficult or potentially difficult scenes on an ongoing basis. Emphasis shall be on techniques for establishing a climate conducive to effective field management,and for preventing the escalation of potentially volatile situations. h. Infection Control. Contractor shall develop and strictly enforce policies for infection control and contaminated materials disposal to decrease the chance of communicable disease exposure. 30 REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY L Critical Incident Stress [debriefing. Contractor shall establish a critical incident stress debriefing program and an ongoing stress reduction program for its employees. Plans for these programs shall be submitted to the Contract Administrator for approval. j. Homeland Security Contractor and Contractor's employees shall participate in and receive training in Homeland Security issues,including participating in existing programs available within the County for dealing with terrorist events, weapons of mass destruction,and other Homeland Security issues. FieldH. Supervision Contractor shall provide at all times and within Contra Costa County an on-duty employee or officer,authorized to act on behalf of the Contractor in all operational matters. Incumbent1. Treatment of A number of dedicated highly trained personnel are currently working in the Contra Costa EMS system. To ensure a smooth transition and to encourage personnel to remain with the system, all current qualified Contractor Ambulance employees will be considered for preferential hiring by the Contractor. The Contractor should offer employees employment in substantially similar positions. Employment stability within the EMS system is an important concern of incumbent employees. The employees have been active participants in the system redesign process and have identified some of their issues that they would like addressed in the procurement and system design transition. A letter listing some of the issues that two of the System's labor groups is included in Appendix 8. Contractor agrees that all incumbent personnel hired will retain"seniority status"earned while working full-time in the Contra Costa EMS system and will be used as criteria for"bidding„ shifts, partners or other assignments. Contractor will provide a benefit program comparable to the employees'current program,for all full time employees. The County expects that to attract and retain outstanding personnel, Contractor must utilize reasonable compensation methods. Contractor's economic efficiencies are not to be derived from the use of sub-standard compensation. The system in no way intends to restrict the ingenuity of Contractor and its employees from working out new and creative compensation (salary and benefits)programs. The system's goal is simply to ensure that Contractor initially 31 REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY and throughout the term of the Agreement provides a financial benefit to encourage employee retention and recruitment for the system. The entry level annual base salaries(including scheduled overtime)which may be utilized for Contractor positions at a minimum,shall be equal to or exceed the current entry level base salary(including scheduled overtime)currently in place for the positions. Incumbent employees'beginning annual Contractor base salary shall be comparable to the annual base salary provided that individual as a Contractor employee. Consideration may be appropriate in assessing Contractor's compliance with this section to account for different work schedules, work weeks,flexible compensation plans and levels of productivity. Personnel--------------- J. Character Competence and Professionalism of The parties understand that Ambulance services are often rendered in the context of stressful situations. The County expects and requires professional and courteous conduct and appearance at all times from Contractor's Ambulance personnel,medical communications personnel, middle managers and top executives. Contractor shall address and correct any occasional departure from this standard of conduct. All persons employed by Contractor in the performance of its work,shall be competent and holders of appropriate licenses and permits in their respective professions and shall undergo a criminal record check. It is the County's intent in requiring a criminal record check that Contractor is aware of any felony or misdemeanor convictions that could be a factor related to an individual's performance in an EMS system. These should include,at a minimum,debarment from the federal Medicare program,felony or misdemeanor convictions related to driving under the influence, drug related offenses,and sexual offenses including rape,child abuse,and spousal abuse. Contractor must independently judge the employability and potential liability associated with employing any individual with a past history of such offenses. K. Key Personnel Key managers shall participate in on-going training and development programs for EMS managers and supervisors offered to those personnel at no cost. While there is no specific requirement regarding the exact content of the development program, managers should receive training equivalent to the American Ambulance Association's Ambulance Service Manager Certificate Program. 32 REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY L. Internal Health * Safety Programs The Contractor shall propose and demonstrate that it will have multiple programs to enhance the safety and health of the work force. These shall include driver training,safety and risk management training. The Contractor shall provide adequate personal protective gear and equipment to employees working in hazardous environments such as rescue operations, motor vehicle accidents,etc. At a minimum,personal protective gear shall include appropriate head and flesh protection for employees. M. Evolving OSHA & Other Regulatory Requirements It is anticipated,during the term of the Agreement awarded to Contractor,that certain regulatory requirements for occupational safety and health,including but not limited to infection control,blood borne pathogens and TB, may be increased. It is the County's expectation that Contractor will adopt procedures that meet or perform better than all requirements for dealing with these matters. Contractor shall make available at no cost to its employees all currently recommended immunizations and health screening to its high-risk personnel N. Discrimination Not Allowed During the performance of the Agreement,Contractor agrees that it will comply with all applicable provisions of federal,state and local laws and regulations prohibiting discrimination. Specifically,Contractor warrants that it will fully comply with Title VI and VII of the Civil Rights Act of 1964,as amended,the Americans with Disabilities Act(ADA), and all other regulations promulgated thereunder, Contractor will not discriminate against any employee or applicant for employment because of race,religion,color,disability, national origin,sex, sexual preference or age. Contractor will take affirmative action to ensure that employment is offered and that employees are treated during employment without regard to their race, religion,color, disability,national origin,sex, sexual preference or age. Such action shall include but is not limited to the following: employment,upgrade, demotion of transfer; recruitment or recruitment advertising; lay-off or termination;rates of pay or other forms of compensation;and selection, including apprenticeship. 33 REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY 0. Work Schedules and Human Resource Issues-An Employee Matter Although this is a performance-based Agreement and Contractor is encouraged to be creative in delivering services,Contractor is expected to employ reasonable work schedules and conditions. Specifically,Patient care must not be hampered by impaired motor skills of personnel working extended shifts, part-time jobs,voluntary overtime,or mandatory overtime without adequate rest. The County emphasizes that Contractor is responsible for conducting the employment matters with its employees,including managing personnel and resources fairly and effectively in a manner that ensures compliance with the Agreement ultimately executed by Contractor. The County will not otherwise involve itself in Contractor's management/employee relationships. 34 REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY ----------------- Section A. Services Description Contractor shall furnish all Emergency Ambulance service for the entire population of the ERA. All Contractor Emergency Ambulance services shall be provided at the EMT-Paramedic level. Additionally,the Contractor shall furnish four(4)non-transporting, paramedic first response vehicles or quick response vehicles(QRV). These units will be staffed twenty-four(24)hours per day, seven(7)days per week. Three of ARVs will be located in ER Zone E and one will be positioned in the northwest portion of the County. The QRV's shall be provided without charge to the County and without additional charge to the patient beyond those charges approved for patient transport. Contractor shall be the sole Ambulance organization authorized by the County in the ERA covered under this RFP to provide emergency services. All requests for EMS originating in the defined service area processed through the 9-1-1 facilities will be referred to Contractor. B. Response • Reliability Methods Response times are a combination of dispatch,operations,and field operations. Because this Agreement is performance based,the County will not limit Contractor's flexibility in the methods of providing ambulance service. This is based upon Contractor's commitment to conform to the Response Time Standards. Therefore,an error on Contractor's part in one phase of its operation(e.g.dispatch,system deployment plan,ambulance maintenance,etc., shall not be the basis for an exception to Contractor's performance in another phase of its operation(e.g. clinical performance or response time performance). Appropriate response time performance is the result of a coordinated effort of Contractor's total operation and therefore, is solely Contractors responsibility. Response time shall be measured in minutes and integer seconds, and shall be"time stamped"by the County approved computer aided dispatch system. 1. Descrfp*m of caN ckwA01ficaldon These Specifications outline three priorities with which Contractor must comply by meeting specified Response Times. The call classification as Emergency or Non- Emergency assignment as Priority 1 through 3 is accomplished by presumptive prioritization by the County's designated medical communications centers in 35 REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY accordance with the then current Emergency Medical Dispatching protocols as approved by Medical Director. 2. Response Time Pince Require nems For response time monitoring, reporting and compliance purposes the Emergency Response Areas 1,2 and 5,except in those portions of ERA 1 contained within the Moraga-C7rinda Fire Protection District have been divided into five(5)zones,A, B, C, D,and E. C..ontractor's response time on requests for emergency medical service originating from within the service area shall meet the following performance standards: a. Potentially Life Threatening Emergency Response{Priority 11. Contractor shall place an Emergency Ambulance on the scene of each life- threatening emergency assignment as presumptively designated by the designated fire/medical dispatch center originating within zones B, C, D,and E within eleven minutes and fifty-nine seconds(11:59)in sub-areas designated urban/suburban on not less than ninety percent(90%)of all life- threatening emergency response requests as measured within any consecutive 30-day period,and with a maximum response time of twenty (217:00)minutes in sub-areas designated as rural as set forth in Appendix 9, attached hereto and incorporated herein by this reference. Contractor shall place an Emergency Ambulance on the scene of not less than ninety-five percent(95%)of all potentially life threatening emergency ambulance requests as measured within any consecutive 30-day period originating within zone A within ten(10:00)minutes. For every presumptively defined life-threatening emergency call exceeding the Response Time Standard defined herein, Contractor shall document in writing the cause of the extended Response Time and Contractor's efforts to eliminate recurrence. b. Nan-Life Threatening Emer encu Response(Priority 2). Contractor shall place an Emergency Ambulance on the scene of at least ninety percent(90%)of all non-life threatening Priority 2 emergency ambulance requests received from a fire/medical dispatch center within fifteen(15:00)minutes in designated urban/suburban areas and within thirty (30:00)minutes in designated rural areas,and shall immediately notify the County dispatch agency if the response time will exceed the maximums set forth herein. For every presumptively defined non-life threatening emergency call exceeding the Response Time Standard defined herein, Contractor shall document in writing the cause of the extended Response Time and Contractor's efforts to eliminate recurrence. 36 REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY e. Non Emergency Response (Prioritl 3}. Contractor shall place an emergency ambulance on the scene of at least ninety percent(90%)of all non-life threatening Priority 3 non-emergency ambulance requests received from a fire/medical dispatch center within thirty (30:00)minutes in designated urban/suburban areas and within forty-five (45:00)minutes in designated rural areas,and shall immediately notify the County dispatch agency if the response time will exceed the maximums set forth herein. For every presumptively defined non-emergency call exceeding the Response Time Standard defined herein, Contractor shall document in writing the cause of the extended Response Time and Contractor's efforts to eliminate recurrence. d. Summary of Response Time Requirements Figure 2 summarizes the Response Time Compliance requirements for ambulances in the specified Emergency Response Zones for each priority and density designation. Figure 2.Response Time Compliance Requirements * ERZone Compliance Urban/Suburban Rural Priority 1 B,C, D,E 90% 11 mini.59 sec. 20min.;0 sec. Priority 1 A 95% 10 min.0 sec. N/A Priority 2 A, B,C,D, E 90% 15 min.0 sec 30 min.0 sec. Priority 3 A,B,C, D, E 90% 30 rain.0 sec. 45 rain.0 sec. Whenever Emergency production requirements necessitate temporary delays in Unscheduled Non-Emergency responses,Contractor shall notify the individual organization requesting such service,explain the reasons for the temporary delay, and shall furnish a realistic estimate of when service will be available. Contractor shall make every reasonable effort to reduce and eliminate delays for those utilizing Non-Emergency services. 3. EApft in Response Trt throughout the County The County recognizes that equity in response times is largely based upon call and population densities within the Service Area. In developing high Response Time Standards,the County has established five(5)Emergency Response Zones and two 37 REQUEST FOR P'ROP'OSAL CONTRA COSTA COUNTY EMS AGENCY (2)call density sub-areas(zones)for urban/suburban and rural response time compliance measurement. At intervals of not less than once every three years the call density changes occurring within each zone shall be evaluated by the County. Should the call density of any significant contiguous area within the rural zones become equal to or greater than the call density to the adjacent urban/suburban zone,then that area will be considered urban/suburban for response time compliance upon the next anniversary date of the Agreement. Response time compliance changes pursuant to this section will be modified by readjusting the then current map defining the rural zones. 4a ttesporme Tim Mea tirrr next IVI i -- Tire following graph summarizes the time intervals of an EMS incident. The Contractor's response time interval requirements will be defined by the terminology represented in this graph. Figure 3.Graphic illustration of the Anatomy of an EMS incident l i e �'I Tta>4a �r13=ffkti�yiRax#x#it iitaetnxya�#i�incuv+i! Aai;�srof+rri�eVd 7Fif�atiasc tloaN4�tF�lFN�!wY�rttttat'; Ai����A� ,tt�usi+r��irrai�icno . :a Peaw4xxM g;t iNNt kiiR Si N!RITM lyOx Inadsnt dW E Wn Gefsuit PatentA(E Gall Reye, il nro:iw NtAMwI Flint s)T."'g7 U!di Departs PytyM-d WPX Dfscywry TrMafer EaablwMd At 9oane CPR(EM51 TemdnaMd &»ns Ynnawrsd Peat Fa EMs Unit P.4.'I FW D frwwwy Shack lEus) AY Rftbfa tr DeMrm!nani Ro$01W.9cn Aaalpunent ..wt txe+ion Rsstixd IntftV-Atiempwd7Mhbwd dspaM EMS V.d%. d (.WtAWpnsd ftmeymss Rag V_ftdon UmtAmwa Pham U rads/ N A.ecass Atwmwwd+Achbwd Dw.tkn !re'tat Acaew Ptak up dew ,wdy ktlaktad 70 6ti M dj b—Adm Contractor's response times shall be calculated on a monthly basis to determine compliance with the fractal standard set forth in Section V.8.1.-3.,above, Response times are calculated from the time Contractor receives the request(disconnect time) 38 . . ... ............................................. REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY until an ALS ambulance unit arrives at the nearest public road access to the scene,or is cancelled by a public safety agency. The Response Time measurement methodology employed can significantly influence operational requirements for the EMS system. The following are applicable: a. Time intervals For the purposes of the Agreement,Response Times shall be measured from the time the call is received at Contractor's Medical Communications Center until arrival at incident location by the first arriving Paramedic transporting Ambulance("73 to T7")or until the call is cancelled by a public safety agency. For all Emergency and Non-emergency requests for service,the"time call received"shall be the moment the Communications Officer at Contractor's Medical Communications Center has received(either by telephone or computer data link)both sufficient location information to know a response is required and sufficient information to determine the presumptive nun priority designation(T-3),or thirty(30)seconds after the call is transferred from County designated PSAP(T-2),whichever is earlier. Arrival at incident location means the moment an Ambulance crew notifies Contractor's Communications Center that it is fully stopped at the location where the Ambulance shall be parked while the crew exits to approach the Patient(T-7). In situations where the Ambulance has responded to a location other than the scene(e.g.staging areas for hazardous materials/violent crime incidents,non-secured scenes,or wilderness locations),arrival at scene shall be the time the Ambulance arrives at the designated staging location or nearest public road access point to the patients location. The Medical Director may require Contractor to log time"Patient Contacted"for medical research purposes. However,during the initial term of the Agreement,arrival time for patient contact intervals shall not be considered part of the contractually stipulated Response Time. In instances when Ambulances fail to report"at scene,"the time of the next communication with that Ambulance shall be used as the"at scene"time (e.g.time at Patient). However,Contractor may be able to document the actual arrival time through another means(e.g. First Responder,AVL, communications tapes/logs,etc.)so long as an auditable report of any edits is produced. 39 _...... .._._._. ......... ...__._.... _... ........ REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY From time to time special circumstances may cause changes in call priority classification. Response Time calculations for determination of compliance with Agreement standards and penalties for bion-compliance will be as follows: a. Upgrades. If an assignment is upgraded, prior to the arrival on scene of the Emergency Ambulance, (e.g.from priority 2 to priority 1),Contractor's compliance and penalties will be calculated based on the shorter of: i. Time elapsed from call receipt to time of upgrade plus the higher priority Response Time Standard,or ii. The lower priority Response Time Standard. b. Downgrades If a call is downgraded, prior to arrival on scene of the Emergency Ambulance,(e.g.from Priority 1 to Priority 2),Contractor's compliance and penalties will be determined by: L If the time of the downgrade occurs after the Emergency Ambulance has exceeded the higher priority Response Time Standard,the more stringent higher priority standard will apply;or, ii. If the time of the downgrade occurs before the Emergency Ambulance has exceeded the higher priority Response Time Standard,the less stringent lower priority will apply. In all such cases documentation must be presented for validation of the reason why the priority status was downgraded. If the downgrade was, justified in the sole discretion of the County Contract Administrator, the longer standard will apply. c. Reassignment En route. If an Ambulance is reassigned en route or turned around prior to arrival on the scene by the Emergency Ambulance,(e.g.to respond to a higher priority request),compliance and penalties will be calculated based on the Response Time Standard applicable to the assigned priority of the initial response. The Response Time clock will not stop until the arrival of an Emergency Ambulance on the scene from which the Ambulance was diverted. 40 REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY d. Canceled Calm. If an assignment is canceled prior to arrival on the scene by the Emergency Ambulance,Contractor's compliance and penalties will be calculated based on the elapsed time from receipt of call to the time the call was canceled. S. Response tunes outside primary service area are excluded Contractor shall not be held accountable for Emergency or Non-Emergency Response Time compliance for any assignment originating outside the primary service area. Responses to requests for service outside the Service Area will not be counted in the total number of canis used to determine compliance. 7. Each!rK* wd a.separate response Each incident will be counted as a single response regardless of the number of units that are utilized. The Response Time of the first arriving transporting Emergency Ambulance will be used to compute the Response Time for that incident. g, Response Time exceptions and exception requests Contractor shall maintain mechanisms for backup capacity,or reserve production capacity to increase production should a temporary system overload persist However, it is understood that from time to time unusual factors beyond Contractor's reasonable control effect the achievement of specified Response Times Standards. In the monthly calculation of Contractor's performance to determine compliance with the response time standards,every request from the County's designated medical communications centers originating from within Contractor's assigned Emergency Response Zones shall be included except as follows: a. Standby When one or more of Contractor's Emergency Ambulances have been placed on stand-by status, not including the first one hour of stand-by, provided, however,that Contractor gave prior notice to County that said stand-by might limit Contractor's ability to meet response time standards. b. Multicasualty Disaster. The response time requirements shall be suspended during a declared multicasualty incident, medical advisory,or disaster in Contra Costa County, or during a declared disaster in a neighboring jurisdiction to which ambulance assistance is being provided by as requested by Contra Costa County. c. Good Cause. The Contract Administrator may allow exceptions to the response time requirements for good cause as determined in his sole discretion. At a 41 ...............: . ....................... ............................ REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY minimum,the asserted ground(s)for exception must have been a substantial factor in producing a particular excess response time and Contractor must have demonstrated a good faith effort to respond to the call(s). Good cause for an exception may include,but is not limited to, unusual system overload, incorrect or inaccurate dispatch information received from County designated firelmedical dispatch center, disrupted voice or data radio transmission; mobile data terminal failure; material change in dispatch location;Computer Aided Dispatch(CAD)failure;unavoidable telephone communications failure; inability to locate address due to non-existent address; inability to locate patient due to patient departing the scene;delays caused by traffic secondary to the incident unavoidable delays caused by road construction or inclement weather,e.g.,fog; unavoidable delays caused by trains;when units are providing County authorized mutual aid;when hospital(s)are on emergency department diversion or trauma center bypass when said diversion or bypass can be shown to affect response times;and off-road locations. d. Exception Re uest Procedure It is the Contractors responsibility to apply to the Contract Administrator for an exception to a required response time. If Contractor feels that any response or group of responses should be excluded from the calculation of Response Time Standards due to unusual factors beyond Contractor's ability to reasonably control,the Contractor may provide detailed documentation for each actual response in question to the Contract Administrator(or designee)and request that the County exclude these runs from calculations and late penalties. Any such request must be in writing and received by the Contract Administrator within ten business days of the end of each month with the Contractor's monthly performance reports. The Contract Administrator shall grant or deny exceptions to performance standards and shall so advise the Contractor. Equipment failure,traffic congestion not caused by the incident,ambulance failure,Contractor dispatcher error,or other causes deemed to be within the Contractor's control or awareness shall not be grounds to grant an exception to compliance with the Response Time Standard, 42 REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY PerformanceReporting - i Penalty 4 Provisions 1. Response Trots Pince Reporting Retry a. Documentation of Incident Time intervals Contractor shall document all times necessary to determine total ambulance response time, including but not limited to time call received by Contactor (T2),time location verified(T3),time ambulance crew assigned(T5),time en route to scene(T5-T7),arrival at scene time(7),total on-scene time(T7- T8);time en route to hospital(T8),total time to transport to hospital(T8-T9); and arrival at hospital time(T9). All times shall be recorded on the County Patient Care Report Form(PCR)and as in the Contractor's computer aided dispatch system. b. Response Time Performance Report Within ten(10)business days following the end of each month,Contractor shall document and report to Contract Administrator in writing, in a manner required by the Contract Administrator,information as specified in Section V.F. i. Contractor shall use response time data in an on-going manner to evaluate Contractor's performance and compliance with response time standards in an effort to continually improve its response time performance levels. ii. Contractorshall identify the causes of failures of performance,and shall document efforts to eliminate these problems on an on-going basis. 2. Pertaity Provis1wn s Isolated instances of individual deviations of response times are considered instances of minor non-compliance with the Agreement. However, deviations of Response Time compliance,which are severe or chronic, may constitute a Default of the Agreement as defined by these Specifications. a. Penalty for Failure to Provide Data to Determine Compliance. Contractor shall pay County a$200 penalty each and every time an emergency ambulance is dispatched and the ambulance crew fails to report and document on-scene time. The Contractor, in order to rectify the failure to report an on-scene time and to avoid the penalty may demonstrate to the satisfaction of the Contract Administrator an accurate on-scene time. 43 REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY Where an on-scene time for a particular emergency call is not documented or demonstrated to be accurate,the response time for that call shall be deemed to have exceeded the required response time for purposes of determining response time compliance. b. Penalty for€allure to Comply with Rest�anse Time Requirements Contractor shall pay County a penalty each and every month that the Contractor fails to comply with the response time requirements for each priority level(1,2,and 3)in each Response Zone(A, B, C, D,and E)based on the percentage of compliance for each priority and zone according to the following schedule: c. Prlorl!y One(Code 3)Responses ER Zone Compliance% Penalty A 94.5% <95% $10,000 94%< 94.5% $25,000 < 94% $50,000 B,C,D, E 89.5% <90% $10,000 89% < 89,5% $25,000 <89% $50,000 d. Priority Two Responses ER Zone Compliance% Penalty A 94.5% < 95% $5,000 94% < 94.5% $10,000 < 94% $15,000 B,C,D,E 89.5% < 90% $5,000 89% < 89.5% $10,000 < 89% $15,000 44 REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY e. Priority Three Responses ER Zone Compliance% Penalty A,B,C,D, E 89.5% < 90% $2,500 89% <89.5% $5,000 < 89% $7,500 €. Phase In of Penalty Provisions. Imposition of the penalties for Priority 1 (Ocie 3)ambulance responses will be in effect for the first month of service provided by the Contractor(July 2005). The imposition of the penalties for Priority 2 and 3 ambulance responses will be in effect when ALL of the public safety agencies dispatching the Contractor's ambulances for calls originating in the Response Zones have implemented policies and procedures approved by the County Emergency Services Agency for identifying Priority 1, Priority 2 and Priority 3 ambulance responses and have successfully demonstrated this capability for three consecutive months. If all of the County designated firelmedical dispatch centers have implemented and complied with the County's policies and procedures for presumptively identifying Priority 1,2,and 3 requests for at least three months prior to the implementation date, then the penalty provisions for Priority 2 and Priority 3 responses will be in effect for the first month of service. g. Penalty Disputes. Contractor may appeal to the Contract Administrator in writing within(10) working days of receipt of notification,from the imposition of any penalty or regarding County's penalty calculations. D. Vehicles and Equipment Contractor shall acquire and maintain all ambulances,support vehicles,on-board medical supplies/equipment and office facilities and equipment to be used by Contractor to perform its services under the Agreement. All costs of maintenance including parts,supplies,spare parts and costs of extended maintenance agreements shall be the responsibility of the Contractor. 45 REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY 1. Ambulances All ambulances shall meet the standards of Title XIII, California Code of Regulations. 2. Vehicle Markings. Ambulance vehicles used in providing contract services shall bear the markings "Contra Costa County Emergency Medical Services"in at least four(4)inch letters on both sides. Such vehicles shall display the"919"emergency telephone number and state the level of service, "Paramedic Unit", on both sides. Ambulance vehicles shall be marked to identify the company name,but shall not display any telephone number other than 911 or any other advertisement. Overall design,color, and lettering are subject to the approval of the Contract Administrator. 3. Vehicle MahAsnance Contractor shall maintain its vehicles in a good working order consistent with the manufacturer's specifications. In addition,detailed records shall be maintained as to work performed,costs related to repairs,and operating and repair costs analyses where appropriate. Repairs shall be accomplished and systems shall be maintained so as to achieve at least the industry norms in vehicle performance and reliability. Ambulance replacement shall occur on a regular schedule and the Proposer shall identify its policy for the maximum number of years and mileage that an ambulance will be retained in the EMS System 4, EquiprneM Contractor shall have sole responsibility for furnishing all equipment necessary to provide required service. All onboard equipment,medical supplies and personal communications equipment utilized by Contractor will meet or exceed the minimum requirements of the County Ambulance Equipment and Supply List. A listing of the on-board equipment and medical equipment and supplies required by the County is included as Appendix 10. Contractor agrees that equipment and supply requirements may be changed with the approval of the Contract Administrator due to changes in technology. & Failure to Meet Mf murn In4ervi ce lFuipment3upply ReWilrements. County may inspect Contractor's ambulances at any time,without prior notice. If any ambulance fails to meet the minimum in-service requirements contained in the County Ambulance Equipment and Supply list as determined by County,the County may: 46 REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY i. Immediately remove the ambulance from service until the deficiency is corrected if the missing item is deemed a critical omission. ii. Subject the Contractor to a$500.00 penalty. The Contract Administrator shall bill the Contractor for the$500.00 penalty. HE The foregoing shall not preclude dispatch of the nearest available ambulance even though not fully equipped, in response to a life threatening emergency so long as another appropriately equipped ambulance of at least equal level of service is also dispatched to the scene. County may adopt protocols governing provisional dispatch of ambulances not in compliance with minimum in-service requirements and Contractor shall comply with these protocols. 6. Vehlele and Equqwnent Mamteenance Contractor shall be responsible for all maintenance of ambulances,support vehicles and on-board equipment used in the performance of its work. The County expects that all Ambulances and equipment used in the performance of the Agreement will be maintained in an excellent manner. Any Ambulance,support vehicle and/or piece of equipment with any deficiency that compromises,or may reasonably compromise its function, must immediately be removed from service. The appearance of ambulances and equipment impact customers'perceptions of the services provided. Therefore,the County requires the Ambulances and equipment that have defects,even significant visible but only cosmetic damage, be removed from service for repair without undue delay. Contractor must ensure an Ambulance maintenance program that is designed and conducted to achieve the highest standard of reliability appropriate to a modern paramedic level Ambulance service by utilizing appropriately trained personnel, knowledgeable in the maintenance and repair of Ambulances,developing and implementing standardized maintenance practices,and incorporating an automated or manual maintenance program record keeping system. Contractor shall comply with or exceed the maintenance standard as outlined in Section 203 of the Standards—Accreditation of Ambulance services published by the Commission on Accreditation of Ambulance services. Contractor shall maintain all bio-medical equipment to the then current and applicable Joint Commission on the Accreditation of Healthcare Organizations(JCAHO)or equivalent standard. All costs of maintenance and repairs,including parts, supplies, spare parts and inventories of supplies, labor,subcontracted services and costs of extended warranties,shall be at the Contractor's expense. 47 ...__. .._ .. .. . ......._. ........ ......... ............ ........ ......... ......... _...... .. ....._....... ...... REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY E. Communications 1. Dllspatch Center Contractor shall provide a dispatch center and maintain all equipment and software (fixed, mobile,linkages)necessary to receive requests for emergency ambulance services made by County fire/medical dispatch centers. Contractor shall establish a dispatch radio communications system including obtaining radio channels and all necessary FCC licenses and other permits as may be required for the operation of said system,which will enable Contractor to effectively dispatch ambulance units throughout all areas of Contra Costa County. Contractor shall be capable of receiving and replying to such requests for emergency ambulance services by voice and by the data linkage as specified in the current version of the County Message Transmission Network Standard which is incorporated herein by reference,a copy of which is on file at the EMS Agency and included in Appendix 11. Contractor's dispatch center shall be capable of dispatching all ambulance units used to provide services pursuant to this Agreement. 2. Dispatch Center Sbafflng Staffing levels shall be such that electronic or telephonic notifications from the County designated public safety dispatch centers are answered or responded to within fifteen (15)seconds. Contractor shall adequately train and prepare emergency ambulance dispatchers to process emergency medical requests for service. Said dispatchers shall be given a company orientation as well as a thorough orientation to the County EMS system before being assigned to operate as part of Contractor's ambulance dispatch system. a. Dispatch Evaluation. Contractor shall implement an on-going program for the evaluation of dispatch operations,education and training of dispatchers,and problem identification and resolution. 3. Subconbng Dish Center Services Nothing in this Request for Proposal will preclude the Contractor from subcontracting Dispatch Center Services to another agency within or outside of the County. Regardless,the Contractor will retain accountability and responsibility for the performance of the Dispatch Center. 48 ........ ......._. ....._.. _.... . .... ........... ......... _......_. ......... ......... ......... ............ REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY 4„ CommunkatIlDns E*dpmeM mW DWpaft1 Contractor shall pay for all interfaces to its computer equipment,the total mileage costs, if any, and for hardware at its dispatch facility. The County shall be responsible for hardware and software at its site(s). New dispatch system costs shall not be imposed upon Contractor without due regard to costs. Contractor reserves the right to petition the County for recovery of significant cost increases. 5. Ambulance CommunkaWn EguipimeM a. Contractor shall equip all ambulances and supervisory vehicles used in performance of services to County with radio equipment for communications with Contractor's dispatch center on Contractor's radio channels. b. Contractor shall equip all supervisory vehicles with radio equipment suitable for operation on the CALCORD California On-Scene Emergency Coordination Radio System and shall maintain a cache of 10 portable CALCORD radios with vehicle chargers ready at all times for immediate deployment on ambulance units that may be used for mutual aid. C. Contractor shall equip all ambulances and supervisory vehicles used in providing service to the County with 4-channel radios for communication on County's MEDARS radio system which operates on the T-band,and with cellular telephones for ambulance to base hospital communications. County will lease to Contractor,or Contractor may supply in accordance with County Communications specifications,additional two-way vehicular or portable radio equipment for communications with fire or other emergency response agencies.The following terms shall apply to all radio equipment used for communications on County frequencies: i. Radio frequencies and communications equipment provided by the County may only be used for emergency medical response under the terms of this Agreement within Contra Costa County,or as directed by a County communications center,or in compliance with policies and protocols established by County. ii. Radio frequencies shall be designated by County for the purpose of communications with a County designated Communications Center and for ambulance-to-hospital communications. iii. Radio equipment used for ambulance-to-hospital communications shall be configured so that personnel actually providing patient care 49 ........ ....... ...__....... _. .. ... ...............__.... ....... ................- .. _...... _ _ .................. REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY are able to directly communicate with base or receiving hospital staff about the patient. iv. Approved radio equipment shall be installed in conformance with existing County policies prior to assignment of a vehicle to an emergency response area. Installations and removals will be at Contractor's expense. V. Contractor shall obtain a certificate of inspection of approved radio equipment by County following installation and on an annual basis thereafter and shall make vehicles available for inspection of County owned radios upon reasonable request of County. Alternate procedures may be adopted by Contract Administrator and County Communications Division. vi. Specific radio equipment purchased by County at County expense for the Contractor shall remain the property of and under control of the County at all times. vii. County owned radios damaged due to accidents,malicious mischief, and acts of God, shall be repaired or replaced at County's option by County,for which Contractor shall pay County's actual cost of repair or replacement,or by Contractor with County's prior approval. Equipment shall remain the property of the County. viii. Contractor shall operate the two-way radios in conformance with all applicable rules and regulations of the Federal Communication Commission,and in conformance with all applicable County rules and operating procedures. All operators of the two-way radios shall at all times be subject to the exclusive control of County. ix. All radio equipment other than Contractor's internal company system must be approved by the County Communications Director. F. Data and Reporting The long-term success of any EMS system is predicated upon its ability to both measure and manage its affairs. Therefore,the County will require Contractor to provide detailed operations,clinical and administrative data in a manner which facilitates its retrospective analysis. 50 REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY 1. Dlispatch contpu ter The dispatch computer utilized by Contractor shall include security features preventing unauthorized access or retrospective adjustment and full audit trail documentation. Z. Esseritiall Patient Care Record(PCR)and Assignment Data Contractor shall utilize County's EMS Agency approved computerized patient care report(PCR),for patient documentation on all EMS system responses including patient contacts,cancelled calls, and non-transports. The PCR shall be accurately completed to include all information listed in Section 100170 of the California Code of Regulations,and information shall be distributed according to established EMS Policies and Procedures. Within twenty-four(24)hours,Contractor shall provide records in computer readable format and suitable for statistical analysis for all Priority 1, 2,and 3 ambulance responses. Records shall contain all information documented on the PCR for all EMS system responses including patient contacts,cancelled calls,non-transports. Contractor shall identify files or PCRs for trauma transports(patients meeting trauma triage criteria). Contractor shall be required to provide other data points which may be reasonably requested,including any needed modifications to support EMS system data collection. 3. Records Contractor shall complete, maintain and provide to the County if requested adequate records and documentation to demonstrate its performance compliance and aid the County in improving, modifying,and monitoring the EMS system. 4. Monft Reports Required Contractor shall provide,within ten(10)days after the first of each calendar month, reports dealing with its performance during the preceding month as it relates to the clinical,operational and financial performance stipulated herein. Contractor shall document and report to Contract Administrator in writing in a form required by the Contract Administrator. Response time compliance and customer complaints/resolutions shall be reported monthly. Reports shall include,at a minimum a. Clinical • Continuing education compliance reports, • Summary of clinical/service inquiries and resolutions, 51 REQUEST FOR PROPOSAL, CONTRA COSTA COUNTY EMS AGENCY • Summary of interrupted calls due to vehicle/equipment failures, • A list of trauma transports,by city and by hospital, including all times necessary to calculate each and every response time, on-scene time, and transport to hospital time. b. Pp rational • Calls and transports, by priority, ER Zone • A list by ER Zane of each call where a BLS ambulance was dispatched when an ALS ambulance should have responded according to County dispatch standards • A list of each and every call,sorted by Emergency Response Zone where there was a failure to properly record all times necessary to determine the response time;and,for patients meeting trauma criteria, on-scene time and/or transport to hospital time. • A list of mutual aid responses to and from system c. Response time compliance • A list of each and every emergency call dispatched for which Contractor did not meet the response time standard, divided by Emergency Response Zone. • Canceled transports, • Exception reports and resolution, • penalties and exemptions, d. Response Time Statistical Data. Within 10 working days following the last day of each month,Contractor shall provide ambulance response time records to County in computer readable format approved by the Contract Manager and suitable for statistical analysis for all ambulance responses originating from requests to the County communications centers. Said records shall include the following data elements: a. unit identifier b. service level(paramedic or EMT-I) c. location of call—street address 52 �w�AC��C�w�E�w�� n�u�T��p�p�� ^ d. kocationofcdl—cit/Crun community ^ e. lomadonofceU-ThomaaBnother'anlapcoonjinstes t location ofcall—EMS zone g. nature ofcall(EMD Code) h. code bzscene i time call received i time call dispatched h. time unit enroute i time unit on-scene nn. time unit enroute tohospital n. time unit adhospital o. time unit clear and available for next call p. outcome(dry nun'transport) q. receiving hospital r. code bohospital G. majortrauma(Mll/. non4NT\A t. number ofpatients transported m. Personnel Reports. Contractor shall provide County with a list of paramedics currently employed byContractor and shall update that list whenever there ismchange. The personnel list shall include,at a minimum,the name, address,telephone number,California paramedic license and expiration date,ACLS expiration date,and California Drivers License number ofeach person onthe|bt. f. Communilly/Governmentall Affairs Re * Number ofconducted community education events, ^ PRactivities,first responder recognition, 53 REQUEST FOR PROPOSAL CONTRA COSTA COUNTY SMS AGENCY • Government relations contact report. g. Other Rpt its Contractor shall provide County with such other reports and records as may be reasonably required by Contract Administrator G. Coverage and Dedicated Ambulances, Use of Stations/Posts These specifications are for a performance based approach rather than a level of effort undertaking involving defined locations. The County neither accepts nor rejects Contractor's level of effort estimates, rather the County accepts the Contractor's commitment to employ whatever level of effort is necessary to achieve the clinical Response Time and other performance results required by the terms of the Agreement as outlined in these specifications. Contractor shall therefore endeavor to deploy ambulance resources in a manner consistent with this goal. If, as a result of local zoning or use restrictions,Contractor is unable to obtain adequate ambulance station locations,Contractor may request the Contract Administrator to exclude designated areas from the response time standard. The Contract Administrator shall take into account Contractor's diligence in seeking station locations and any necessary permits in granting or denying an exclusion. H. Provision of . . . Paramedic The Contractor shall provide 24 hours per day/7 days per week,at no cost to the County,four (4)First Responder Paramedic Units to be located in Zones and at locations approved by the Contract Administrator. The County shall pay Contractor the rates specified in Appendix 6 as" First Responder Paramedic Unit"for any additional County-authorized first responder, non- transport paramedic units. Except for disposable supplies expended at the scene, Contractor shall not bill any patient for services provided by a non-transport paramedic unit. The County will use its best efforts to identify locations for basing the First Responder Paramedic Units in the designated service areas. If there is a delay in the Contractor's provision of the four First Responder Paramedic Units beyond the start date for the Agreement,the County may request and the Contractor shall provide additional ambulance unit hours equivalent to the cost of providing the First Responder Paramedic Units. The cost per hour shall be based on the Contractor's marginal cost of providing additional unit hours identified in its Proposal, if the Contractor and County are unable to identify a suitable location for basing a First Responder Paramedic Unit,the County may request and the Contractor shall provide additional ambulance unit hours equivalent to the cost of providing the First Responder Paramedic Unit. 54 REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY i i. ► Integration t Responders First Responders are an integral part of the EMS system. The Contractor will support the development and integration of the First Response component. During the term of this Agreement,it is expected that the fire services will continue to expand ALS first response capability. The Contractor will cooperate and support the expansion of ALS first response and insure that its personnel work professionally and collaboratively with fire first responders in the transition of patient care at the scene. The Contractor will implement policies to facilitate Contra Costa County First Responders in scheduling time on ambulances to fulfill training and internship requirements. The County will rely upon the entrepreneurial and innovative methods proposed by Contractor under this procurement to enhance the first response capabilities within the County. Contractor will support the development of an integrated First Response program. At a minimum it shall include: 1. Availability of Conflnuft Education All Advanced Life Support(ALS)and Basic Life-Support(BLS)continuing education offered by Contractor to its employees shall be available to First Responders on the same terms and conditions upon which it is made available to employees. 2. First Responder Liaison Contractor shall designate from among its employees a single individual as its contact person/liaison for the First Response agencies within the Service Area. 3. First Responder Equipment and Supply Exp Contractor shall establish a mechanism to exchange on a one-for-one basis non- expendable medical supplies and equipment supplied by a fire first responder agencies in connection with patient transports, in those situations where said supplies and equipment are interchangeable. Management/LossJ. Internal Risk x - - t County believes that education and aggressive prevention of conditions in which accidents occur, is the best mechanism to avoid injuries to Contractor staff and Patients. Therefore,the County requires Contractor to develop and implement within twelve(12)months an aggressive health,safety and loss mitigation program including,at a minimum: • Pre-screening of potential employees(including drug testing), 55 REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY • Initial and on-going driver training, • Lifting technique training, • Hazard reduction training, • Review current information related to medical device FDA reportable events, recall, equipment failure,accidents; • Review employee health/infection control related information such as needle sticks,employee injuries,immunizations,exposures and other safety/risk management issues; • Involvement of employees in planning and executing its safety program. Planning for safety and risk mitigation processes will include,at a minimum: • Gathering data on ALL incidents that occur within Contractor workforce. • Analyze the data to find causative factors and determine preventive measures • Devise policies prescribing safe practices and providing intervention in unsafe or unhealthy work-related behaviors • Gather safety information as required by law • Implement training and corrective action on safety related incidents,as required by law + Provide initial and on-going training on those practices and interventions • Provide safe equipment and vehicles Monitor the results of employee compliance or non-compliance with the safety plan, and • Refine the plan as new information becomes available. K. Health Status Improvement and Community Education The County desires that its Contractor take significant steps to improve prevention and system access through community education programs provided to the school system and community groups. It is County's expectation that Contractor will plan such programs working collaboratively with other public safety and EMS related groups such as the American Heart Association, American Stroke Association,the American Red Cross,and area healthcare organizations. Contractor shall annually plan and implement a definitive community education program, which shall include:identification of and presentations to key community groups which influence the public perception of the EMS system's performance,conducting citizen CPR training events, participation in EMS week and other educational activities involving prevention, system awareness/access,and appropriate utilization of the EMS system. 56 REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY Contractor shall annually undertake at least one project that shall demonstrably improve the health status in the community. Health status improvement programs targeted to"at risk populations"may include but are not limited to:seat belt use,child safety seat use, bike safety program,participation in NTHSA Safe Communities Program, CPR training,911 awareness,gun safety,hunting safety, drowning prevention,equestrian accident prevention,senior safety program,home hazard inspection program. The impact of the annual health status improvement project is to be statistically demonstrable. For example,this includes selecting indicators that can be used to measure the process and outcomes of an intervention strategy for health improvement,collecting and analyzing data on those indicators,and making the results available to the community to inform assessments of the effectiveness of an intervention and the contributions of participating entities. Steps in this health improvement project will include: • Analyzing the community's health issues • Inventorying resources • Developing a health improvement strategy • Establish accountability for activities • Monitor process and outcomes Contractor is to use its best efforts to obtain external grant funding for health status improvement projects. AccreditationL. With in eighteen months of the beginning of the Term of the Agreement,the Contractor will attain Accreditation as an ALS Ambulance Service through the Commission on Accreditation of Ambulance Services{CARS}or comparable organization. The Contractor shall maintain its accreditation throughout the term of the Agreement. Development The County anticipates further development of its EMS system and regional efforts to enhance disaster and mutual-aid response. The County requires that its Contactor actively participate in EMS Agency activities,including EMCC meetings,committee meetings,and work groups. Contractor agrees to participate and assist in the development of system changes subject to negotiated costs, if any. 57 REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY For example,the EMS Medical Director and his Medical Advisory Committee(MAC)are working to develop a paramedic 12-lead ECG program for patients suspected of having heart attacks that would allow the paramedic to relay ECG findings to receiving hospitals,which could result in faster care for cardiac patients on arrival at the hospital. N. Disaster Assistance i Response 1NIuItkasnalty/DWwtor Response Contractor shall cooperate with County in rendering emergency assistance during a declared or an undeclared disaster,or in multi-victim response as identified in the County Multi-casualty Plan or the Expanded Medical Emergency Response Plan. In the event the County declares a disaster within the County,or in the event the County directs Contractor to respond to a disaster in a neighboring jurisdiction,normal operations shall be suspended and Contractor shall respond in accordance with the disaster plan. Contractor shall use best efforts to maintain primary Emergency services and may suspend Non-Emergency services as required. At a multi-victim scene,Contractor's personnel shall perform in accordance with appropriate County multi-victim response plan and within Incident Command System (ICS). During disaster or declared multi-casualty situations,Contractor will be exempted from all responsibilities for response-time performance until notified by the County. When Contractor is notified that multi-casualty or disaster assistance is no longer required, Contractor shall return all of its resources to primary area(s)of responsibility and shall resume all operations in a timely manner Any additional direct marginal costs resulting from the performance of disaster services that are non-recoverable from third parties may be invoiced for payment by the County consistent with the then current Federal guidelines. This shall not include any cost for maintaining normal levels of service during the disaster, but shall be limited to the reasonable and verifiable direct marginal cost for these additional services. 2. Interna!DWaster Response NotHkatlon Contractor shall develop a plan for immediate recall of personnel during multi-casualty or widespread disaster. This plan shall include the capability of Contractor to alert off- duty personnel. 58 REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY 3. Disaster Response VehWeequiptnent Contractor shalt provide one vehicle as a disaster response vehicle. This vehicle shall not be an ambulance used in routine, day-to-day operations,but shall be kept in good working order and available for emergency response to the scene. This vehicle may be used to carry personnel and equipment to a disaster site. The following equipment shall be stored in this disaster vehicle. backboards and straps;cervical collars;head immobilization sets and foam wedges;splints for legs and amens;oxygen equipment; extra dressing and bandages;advanced life support equipment,especially IV therapy equipment,County approved disaster tags,and checklists for medical Incident Command personnel. 4. Incident NottWx=tion Contractor shall have a mechanism in place to communicate current field information to appropriate County Health Services and EMS staff during multi-casualties,disaster response, hazardous materials incidents and other unusual occurrences. 5. Interagency Training for EcercisestUrills County expects Contractor to participate in EMS sanctioned exercises and disaster drills and other interagency training in preparation for this type of response. ' 0. Mutual Aid and Stand-by 1. Mutual AM Requirernerrts Contractor shall respond in a mutual aid capacity to other service areas within and outside of the County if so directed by Contract Administrator. Contractor shall be prepared to respond one Ambulance Strike Team staffed and equipped to the California Emergency Medical Services Agency Ambulance Strike Team Guidelines when directed by County in accordance with a disaster mutual aid request. 2. stan"y service Contractor shall provide,at no charge to County or requesting agency,stand-by services at the scene of an emergency incident within its emergency response area when directed by a County designated fire/medical dispatch center upon request of a public safety agency. A unit placed on stand-by shall be dedicated to the incident for which it has been placed on stand-by. Stand-by periods exceeding eight(8)hours shall be approved by Contract Administrator. County shall pay Contractor the rates specified in it Proposal as"Marginal Hourly Reimbursement Dates"when stand-by(non-transport)services for periods exceeding twenty-four(24)hours are requested in writing by County. 59 REQUEST FOR PROPOSAL. CONTRA COSTA COUNTY EMS AGENCY Arnbullance Service Assistance Contractor,to be best of its ability,shall assist in servicing any other emergency response areas where the County contract for that response area has been suspended or terminated if requested to do so by Contract Administrator. P. Deployment Planning The County understands that Contractor will be developing enhanced coverage and deployment plans during its term of operations. Coverage plan modifications,throughout the term of the Agreement, including any changes in post locations, priorities or hour of day coverage levels, may be made at Contractor's sole discretion. 0. Handling Service Inquiriesand Complaints Contractor shall log all inquiries and service complaints. Contractor shall provide prompt response and follow-up to such inquiries and complaints, Such responses shall be subject to the limitations imposed by patient confidentiality restrictions. Contractor shall on a monthly basis submit to the County a list of all complaints received and their appropriate disposition/resolution. Copies of any inquiries and resolutions of a clinical nature shall also be referred to the Medical Director within twenty-four(24)hours, 60 REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY Section VReguhtovy Complianm and He Proviskons A. Federal Healthcare Program Compliance Provisions Contractor shell comply with all applicable Federal laws,rules and regulations for operation of its enterprise,ambulance services and those associated with employees. 1. Medicare Compliance Program Requirements Contractor shall implement a comprehensive Compliance Program for all activities, particularly those related to documentation,claims processing, billing and collection processes. Contractor's Compliance Program shall substantially comply with the current regulatory approach program outlined in the Office of inspector General(OIG) Compliance Program Guidance for Ambulance Suppliers as published in the Federal Register on March 24,2003(03 FR 14255). 2. HIPAA Compliance Program Requirements Contractor is required to implement a comprehensive plan and develop the appropriate policies and procedures to comply with the provisions of the Health Insurance Portability and Accountability Act of 1996 and the current rules and regulations enacted by the Department of Health and Human Services. The three major components of HIPAA include: • Standards for Privacy and Individually Identifiable Health Information. • Health Insurance Reform: Security Standards. • Health Insurance Reform:Standards for Electronic Transaction Sets and Code Standards. Contractor is responsible for all aspects of complying with these rules and particularly those enacted to protect the confidentiality of patient information. Any violations of the HIPAA rules and regulations will be reported immediately to the County along with Contractor s actions to mitigate the effect of such violations. B. State Compliance Provisions 1. :state and UwAd Regulations Contractor shall comply with all applicable state and local laws,rules and regulations for businesses, ambulance services,and those associated with employees. 61 REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY Contractor shall also comply with County EMS policies, procedures and protocols. Contractor is responsible for complying with all rules and regulations associated with providing services for recipients of and being reimbursed by state Medicaid and other state and federally funded programs. Contractora The primary means of Contractor compensation is through fee-for-service reimbursement of patient charges. The County provides reimbursement for specified patients for whom it is responsible. 1. Pal dLat Charges Contractor shall receive income from patient charges. Contractor shall comply with fee schedules and rates proposed in response to this RFP and negotiated with the County. The current approved rates and scheduled increases are included in Appendix 3. Z Fee Adjusbnents Contract Administrator will approve annual increases to patient charges based on changes in the Consumer Price Index for All Urban Consumers, San Francisco- Oakland. Annual rate increases will be the greater of two and one-half percent(2.5%) or the increase of the CPI that will be capped at five percent(5%)for any given year. In the event that changes occur within the County that substantially impacts the Contractor's costs of providing services,the Contractor may request and Contract Administrator may approve increases or decreases in charges to patients to mitigate the financial impact of such system financial changes. Contract Administrator may approve charges for expendable supplies when said supplies are newly required by EMS pre-hospital protocols adopted during the term of this Agreement or when the Contract Administrator approves new items to be stocked on ambulances. The increase in-patient charges for new items shall not exceed 150%mark-up over purchase cost. D. Billing/Collection Contractor shall maintain a business office within Contra Costa County. Contractor shall operate a billing and accounts receivable system that is well documented, easy to audit,and which minimizes the effort required of patients to recover from third party sources for which they may be eligible. The billing system shall: 62 REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY • automatically generate Medicare and Medicaid statements; itemize all procedures and supplies employed on patient bills; be capable of responding to patient and third party payer inquiries regarding submission of insurance claims,dates and types of payments made, itemized charges,and other inquiries. Contractor shall make no attempts to collect its fees at the time of service. ProfessionalismE. Billing System - Compliance Contractor shall conduct all billing and collection data collection functions for the EMS system in a professional and courteous manner. F. Contractor Compensation from County It is the County and Contractor's shared goal to perform the EMS services outlined herein while requiring no subsidy during the term of the Agreement. 1. Reimbursement for Transports for vWfleh County is Responsible Contractor shall invoice the County for any transport of patient for whom the Health Services Agency is financially responsible. For indigent patients the Contractor shall bill the County at the then current MediCal payment rates for the services provided. For non-indigent patients the Contractor shall bill the County at the Medicare allowable rate for the services provided. Contractor agrees that the payment provisions contained herein include payment in full for all ambulance services for which Contra Costa Regional Medical Center or Contra Costa Health Plan is financially responsible, including transport of prisoners. Critical care transport services(ambulance services which provide specialized staffing and equipment beyond that found on pre-hospital emergency ambulances,)are not covered by this Agreement. Contractor shall submit monthly invoices, performance reports,and statistical data to County. No payments shall be made to Contractor until County receives and accepts the monthly invoice and performance reports and statistical data. Penalties assessed during the previous calendar month shall be deducted by County prior to payment to Contractor. 2. Market rights Except for provision of backup services, or suspension of this Contract,County shall not enter into agreements with any other provider for ground response to emergency 63 REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY ambulance requests from County designated EMS communications center or other designated public safety dispatch center within Contractor`s response area during the term of this Agreement. County reserves the right to enter into separate transport agreements with air ambulance providers. Notwithstanding any other provision of this Contract,County may provide for air transport of patients when such transportation is deemed to be medically in the best interest of the patient(s). However, no such agreement shall provide for air transport of non-critical patients or of critical patients when a ground ambulance is on-scene and transport time by ground ambulance to the most accessible emergency medical facility equipped,staffed,and prepared to administer care appropriate to the needs of the patient is the same or less than the estimated air transport time 3. Addkilonal Sevvices During the term of the Agreement,the County may opt to purchase additional services or service upgrades from the Contractor. if this occurs the County will negotiate with the Contractor to reach agreement on compensation terms. The Optional Services Price List includes specific items that the County may want to consider. The Proposer is to complete the{optional Services Price List and submit with its Proposal. 4, dans By furnishing services clinically superior to the requirements of this specification,the County may grant certain rights to extensions. G. Accounting Procedures 1. i wollcing and int fay'se mdrA s Contractor shall render its invoice on or before the I e business day of each month for the previous month. County shall review and subject to the reconciliation of any penalty provisions as outlined herein shall pay Contractor invoice on or before the 3e day after receipt of the invoice. County shall render its invoice for any fines or penalties to the Contractor within 10 business days of the County's receipt of the Contractors monthly performance reports. The Contractor shall pay County on or before the 3e day after receipt of the invoice from the County. Any disputes of the invoiced amounts should be resolved in this thirty-day period. if they have not been resolved to the County or Contractor's satisfaction,the invoice shall be paid in full and subsequent invoices will be adjusted to reflect the resolution of disputed amounts. 64 REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY 2. Audft and hispectors Contractor shall maintain separate financial records for services provided pursuant to this Agreement in accordance with generally accepted accounting principles. With reasonable notification and during normal business hours,County shall have the right to review any and all business records including financial records of Contractor pertaining to this Agreement. All records shall be made available to County at their Contra Costa County office or other mutually agreeable location. The County may audit,copy, make transcripts,or otherwise reproduce such records, including but not limited to contracts, payroll, inventory,personnel and other records,daily logs,and employment agreements. On an annual basis, he Contractor shall provide County with audited financial statements by certified public accountants for Contractor's ambulance operations and/or separate business records of financial accounting of any other businesses that share overhead with the Contractor's ambulance service operation. Contractor may be required by County to provide County with periodic report(s)in the format approved by the Contract Administrator to demonstrate billing compliance with approved/specified rates. H. Insurance Provisions Contractor shall keep in effect during the entire term of Contract and any extension or modification of Contract, insurance policies meeting the following insurance requirements unless otherwise expressed in Contract: 1. Contractor shall provide malpractice insurance and comprehensive liability insurance, including coverage for owned and non-owned vehicles,each with a minimum combined single limit coverage of$1,000,000 for all damages,including consequential damages, due to bodily injury,sickness or disease,or death to any person or damage to or destruction of property,including the loss of use thereof, arising from each act,omission, or occurrence. Such insurance shall be endorsed to include the County of Contra Costa and their respective officers and employees as additional named insured as to all services performed by the Contractor under this contract. 2. Contractor shall provide workers'compensation insurance coverage for its employees. I Contractor shall provide County with a certificate(s)of insurance evidencing liability, medical malpractice and workers'compensation insurance as required herein no later than the effective date of Contract. if Contractor should renew the insurance policy(ies)or acquire either a new insurance policy(ies)or amend the coverage afforded through an endorsement to the policy(ies)at any time during the term of Contract,then Contractor shall provide(a)current certificate(s)of insurance. 65 REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY 4. The insurance policies provided by Contractor shall include a provision for thirty(30)days written notice to County before cancellation or material change of the above specified coverage. Said policies shall constitute primary insurance as to County, State and Federal Governments,and their officers,agents,and employees,so that other insurance policies held by them or their self-insurance program(s)shall not be required to contribute to any loss covered under Contractor's insurance policy or policies. 1. Indemnification 1. Contractor(as indemnitor)will be required to indemnify,save and hold County,its officers and employees,agents,successors and assigns(as indemnitee)harmless from and against and in respect of any act,judgment,claim,domain,suit, proceeding,expenses, orders,action,loss,damage, cost, charge, interest,fine, penalty, liability,reasonable attorney and expert fees, and related obligations(collectively,the"claims")arising from or related to acts and omissions of Contractor in its performance under the Agreement, whether direct or indirect including but not limited to, liabilities,obligations, responsibilities, remedial actions, losses, damages,punitive damages,consequential damages to third parties,treble damages,costs and expenses,fines, penalties,sanctions, interest levied and other charges levied by other federal,state and local government agencies on County by reasons of Contractors direct or indirect actions. This indemnity will survive and remain in force after the expiration or termination of the Agreement and is unlimited; provided, however that the indemnity is not intended to cover claims against the County arising solely of County's own negligence or intentional misconduct. For purposes of this section,the term County shall include the County,officers, its employees and consultants. 2. County(as indemnitor)will be required to indemnify,save and hold Contractor,its officers and employees,agents,successors and assigns(as indemnitee)harmless from and against and in respect of any act,judgment,claim,domain,suit, proceeding,expenses, orders, action,loss,damage,cost,charge, interest,fine, penalty, liability,reasonable attorney and expert fees,and related obligations(collectively,the"claims")arising from or related to acts and omissions of Contractor in its performance under the Agreement, whether direct or indirect including but not limited to,liabilities,obligations, responsibilities, remedial actions, losses,damages,punitive damages,consequential damages to third parties,treble damages,costs and expenses,fines,penalties,sanctions, interest levied and other charges levied by other federal, state and local government agencies on Contractor by reasons of County's direct or indirect actions. This indemnity will survive and remain in force after the expiration or termination of the Agreement and is unlimited; provided, however that the indemnity is not intended to cover claims against Contractor arising solely of Contractor's own negligence or intentional misconduct. For purposes of this section,the term Contractor shall include Contractor, officers, its employees and consultants. 66 REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY The following provisions shall control the indemnity provided hereunder: 1. Indemnity defense. Indemnitor,at its cost and expense,shall fully and diligently defend indemnitee against any claims brought,investigations undertaken or actions filed which concern claims for which Indemnitee is indemnified. Indemnitor may employ qualified attorneys of its own selection to appear and defend the claim or action on behalf of indemnitee upon Indemnitee approval. Indemnitor, acting in good faith and in the best interest of Indemnitee,shall have the sole authority for the direction of the defense,and shall be the sole judge of the acceptability of any compromise or settlement of any claims or actions against Indemnitee so long as such compromise or settlement does not impose a liability on Indemnitee not fully covered and satisfied by the indemnity provided by this section or, in Indemnitee's judgment,subject to any material adverse order,judgment,or decree which impairs its image or ability to operate its business as previously conducted. Otherwise, Indemnitee reserves the exclusive right to reject any such compromise or settlement and prosecute the claim,compromise or settlement. Indemnitor shall inform Indemnitee,on a quarterly or more frequent basis, on the progress and proposed resolution of any claim and shall cooperate in responding to inquiries of Indemnitee and its legal counsel. 2. Reimbursement for expenses. Indemnitor shall reimburse Indemnitee for any and all necessary expenses, attorney's fees, interest,penalties,expert fees, or costs incurred in the enforcement of any part of the Agreement thirty(30)days after receiving notice that Indemnitee has incurred them. 3. Cooperation of parties and notice of claim. Contractor and County shall provide the other prompt written notice of any such audit or review of any actual or threatened claim,or any statement of fact coming to that party's attention which is likely to lead to a claim covered by the indemnity. Each party agrees to cooperate in good faith with the other and respond to any such audit or review and defending any such claim. J. Performance Securisty Bond Contractor shall furnish performance security in the amount of$500,000 in one of the following forms: 1. A faithful performance bond issued by a bonding company,appropriately licensed and acceptable to County; or Z. An irrevocable letter of credit issued pursuant to this provision in a form acceptable to County and from a bank or other financial institution acceptable to County. 67 _ _ ....................... REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY is Admin Provisions VI i A. Term ► Renewal Provisions The initial term of the Agreement ultimately executed by Contractor shall be for a period of five (5)years commencing at 12.01 a.m. on July 1, 2005 and terminating at midnight,June 30, 2010. The Contract may be extended by mutual consent of County and Contractor for two extension periods of two years each, provided Contractor has met the requirements of County and has earned the right to negotiate for renewal based on the performance criteria.The County shall make the offer of extension to Contractor at least twelve(12)months prior to the scheduled end of the term of the Agreement or any previously granted extension. B. Service Plan The Service flan section of the contract will consist of all performance standards and any additional proposed or negotiated services and terms. Delivery Contractor expressly contracts that, in the event of a Default by Contractor under the Agreement, Contractor will work with the County to ensure continuous and uninterrupted delivery of services, regardless of the nature or causes underlying such breach. Contractor agrees that there is a public health and safety obligation to assist County in every effort to ensure uninterrupted and continuous service delivery in the event of a Default,even if Contractor disagrees with the determination of Default. �' D. Annual Performance Evaluation 7 The Emergency Medical Care Committee will evaluate the performance of the ambulance provider at least annually. An evaluation report will be submitted to the Health Services Director. 68 REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY The following criteria will be included in the performance evaluation: 1. Response time performance standards have been met at or above the minimum requirements in the Contract; 2. Clinical performance standards have been met at or above the minimum requirements in the Contract; 3. Innovative programs to improve system performance have been initiated. 4. A stable work force has been maintained and there have been documented efforts to minimize employee turnover. Default ► Agreement County shall have the right to terminate or cancel Contract or to pursue any appropriate legal remedy in the event Contractor materially breaches Contract and shall fail to correct such default within seven(7)days following the service on it of a written notice by County specifying the default or defaults complained of and the date of intended termination of rights hereunder absent cure. 1. Definitions of Brest Conditions and circumstances that shall constitute a material breach by Contractor shall include but not be limited to the following: a. Willful failure of Contractor to operate the ambulance service system in a manner which enables County or Contractor to remain in substantial compliance with the requirements of the applicable Federal, State,and County laws, rules, and regulations. Minor infractions of such requirements shall not constitute a material breach but such willful and repeated breaches shall constitute a material breach; b. Willful falsification of data supplied to County by Contractor during the course of operations, including by way of example but not by way of exclusion, dispatch data, patient report data,response time data,financial data,or falsification of any other data required under Contract; c. Willful failure by Contractor to maintain equipment in accordance with good maintenance practices; d. [deliberate,excessive,and unauthorized scaling down of operations to the detriment of performance by Contractor during a"lame duck"period; 69 REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY e. Wilful attempts by Contractor to intimidate or otherwise punish employees who desire to sign contingent employment contracts with competing Proposers during a subsequent bid cycle; f. Willful attempts by Contractor to intimidate or punish employees who participate in protected concerted activities,or who form or join any professional associations; g. Chronic and persistent failure of Contractors employees to conduct themselves in a professional and courteous manner, or to present a professional appearance; h. Willful failure of Contractor to comply with approved rate setting, billing,and collection procedures; i. Repeated failure of Contractor to meet response time requirements after receiving notice of non-compliance from Contract Administrator; j. Repeated failure of Contractor to respond to emergency medical requests with a paramedic unit when ALS level of response is indicated by County dispatch protocol; k. Failure of Contractor to provide and maintain the required insurance and performance security bond; 1. Failure of Contractor to comply with the vehicle lease provisions; m. Failure of Contractor to comply with or exceed the minimum employee wage/salary benefit package as submitted;or, n. Wilful and repeated material breaches of Contractor's backup provisions. TerminationF. 9. .l■.{,ten Notre This Contract may be canceled immediately by written mutual consent. 2. Fallliure to Pew County, upon written notice to Contractor,may immediately terminate this Contract should Contractor fail to perform property any of its obligations. In the event of such termination, County may proceed with the work in any reasonable manner it chooses. The cost to County of completing Contractor's performance shall be deducted from any sum due Contractor under this Contract,without prejudice to County's rights otherwise to recover its damages. 70 REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY $. Cessaftm of Fundi tag The sole revenue source for Contract is the County Service Area EM-1 service charges collected or to be collected on County tax rolls. If any IoM-1 service charges become unavailable to County for any reason, including but not limited to a court decision,or if any service charges are legally challenged in a timely manner,Contract may be immediately terminated by notice to Contractor,and County shall have no financial obligation to Contractor hereunder except for services provided to termination date. Should any of the foregoing events occur, nothing in this subparagraph is intended to prevent County, at its sole discretion,from utilizing any other funds available to it to allow for the continuation of services hereunder. Emergencyr In the event County determines that a material breach, actual or threatened, has or will occur, or that a labor dispute has prevented performance,and if the nature Of the breach is, in Contract Administrator's opinion,such that public health and safety are endangered,and after Contractor has been given notice and reasonable opportunity to correct deficiency,the matter shall be presented to the Board of Supervisors. If the Board concurs that a breach has occurred and that health and safety would be endangered by allowing Contractor to continue its operations,Contractor shall cooperate fully with County to effect an immediate takeover by County of Contractor's ambulances and crew stations. Such takeover shall be effected within not more than 72 hours after Board of Supervisors'action. In the event of an emergency takeover, Contractor shall deliver to County ambulances and associated equipment used in performance of Contract, including supervisors'vehicles. Each ambulance shall be equipped,at a minimum,with the equipment and supplies necessary for the operation of ALS ambulances in accordance with County ALS Policies and Procedures. Contractor shall deliver ambulances and crew stations to County in mitigation of any damages to County resulting from Contractor's breach. However,during County's takeover of the ambulances and equipment,County and Contractor shall be considered Lessee and Lessor, respectively. Monthly rent payable to Contractor shall be equal to the aggregate monthly amount of Contractor's debt service on vehicles and equipment as documented by Contractor at Contract Administrator's request, and verified by County Auditor, County Auditor shall disburse these payments directly to Contractor's obligee. In the event an ambulance is unencumbered,or a crew station is not being rented,County shall pay the Contractor the rentals specified in Contract. Nothing herein shall preclude County from seeking to recover from Contractor such rental and debt service payments as elements of damage from a breach. However,Contractor shall not be precluded from disputing the Board's findings or the nature and amount of County's damages,if any,through litigation. However,failure on the part of Contractor to cooperate fully with County to effect a safe/smooth takeover of operations shall itself constitute a breach of 71 REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY Contract,even if it is later determined that the original declaration of breach by the Board of Supervisors was made in error. County shall indemnify,hold harmless, and defend Contractor against any and all claims arising out of County's use,care,custody, and control of stations,equipment and vehicles, including but not limited to, equipment defects,defects in material/workmanship,and negligent use of vehicles and equipment. County shall have the right to authorize the use of vehicles and equipment by another company. Should County require a substitute contractor to obtain insurance on equipment,or should County choose to obtain insurance on vehicles/equipment, Contractor shall be"Named Additional Insured"on the policy,along with the appropriate endorsements and cancellation notice. County agrees to return Contractor's vehicles and equipment to Contractor in good working order, normal wear and tear excepted,at the end of takeover period. For any of Contractors equipment not so returned, County shall pay Contractor fair market value of vehicle and equipment at time of takeover, less normal wear and tear, or shall pay Contractor reasonable costs of repair,or shall repair and return vehicles and equipment. County may unilaterally terminate takeover period at any time,and return facilities and equipment to Contractor. The takeover period shall last, in County's judgment,no longer than is necessary to stabilize the FMS system and to protect the public health and safety by whatever means County chooses. All of Contractor's vehicles and related equipment necessary for provision of ALS services pursuant to this Contract are hereby leased to County during an emergency takeover period. Contractor shall maintain and provide to County a listing of all vehicles used in the performance of this Contract, including reserve vehicles,their license numbers,and name and address of lienholder, if any. Changes in lienholder,as well as the transfer,sale,or purchase of vehicles used to provide ALS services hereunder shall be reported to County within 30 days of said change,sale,transfer or purchase. Contractor shall inform and provide a copy of takeover provisions contained herein to lienholder(s)within 5 days of emergency takeover. Emergency takeover procedures shall not apply to public safety agencies. H. End Term Provisions Contractor agrees to return to County all County issued equipment in good working order, normal wear and tear excepted, at termination of this Contract. For any County equipment not so returned,County shall repair or replace said equipment at Contractor's expense and deduct cost thereof from any payments owed to Contractor. In the event Contractor is not owed any payments under this Contract,Contractor shall reimburse County for actual cost of repairs and/or replacement. 72 REQUEST FOR PROPOSAL. CONTRA COSTA COUNTY EMS AGENCY 1. Transition Planning 9. Comp ire IBW Reguk ed Contractor acknowledges that County intends to conduct a competitive procurement process for the provision of emergency ambulance service within Contractor's Emergency Response Area(s)following termination of this Contract. Contractor acknowledges and agrees that County may select a different ambulance service provider to provide exclusive emergency ambulance services within all or Emergency Response Area{s}specified herein following said competitive procurement process. 2. Future 11W Cycles Contractor acknowledges and agrees that supervisory personnel, EMTs, paramedics, and dispatch personnel working in the EMS system have a reasonable expectation of long-term employment in the system,even though Contractors may change. Accordingly,Contractor shall not penalize or bring personal hardship to bear upon any of its employees who apply for work on a contingent basis with competing Proposers, and shall allow without penalty its employees to sign contingent employment agreements with competing Proposers at employees`discretion. Contractor may prohibit its employees from assisting competing Proposers in preparing bid Proposals by revealing Contractor's trade secrets or other information about Contractor's business practices or field operations. Remedies1 J. County's If conditions or circumstances,constituting a Default as set forth in Section VILE exist,County shall have all rights and remedies available at law in equity under the Agreement,specifically including the right to terminate the Agreement. The right to pursue Contractor for damages and the right of Emergency take-over as set forth in Section VII.F.G.and K. All County's remedies shall be non-cumulative and shall be in addition to any other remedy available to the County. K. Provisions for Curing Cardinal Default ; Emergency In the event the County Board of Supervisors determines that there has been a material breach by Contractor of the standards and performances as defined in this specification,which breach represents an immediate threat to public health and safety,such Cardinal Default shall constitute a Default of the Agreement. In the event of a Cardinal Default, County shall give Contractor written notice, return receipt requested,setting forth with reasonable specificity the nature of the Cardinal Default. Contractor shall have the right to cure such Cardinal Default within seven(7)calendar days of receipt of such notice and the reason such Cardinal Default . REQUEST FOR PROPOSAL CONTRA COSTA COUNT`!EMS AGENCY endangers the public's health and safety. Within twenty-four(24)fours of receipt of such notice,Contractor shall deliver to County, in writing,a plan of action to cure such Cardinal Default. If Contractor fails to cure such Cardinal Default within the period allowed for cure(with such failure to be determined in the sole and absolute discretion of County)or Contractor fails to timely deliver the cure plan to the County,County may take-over Contractor's operations. Contractor shall cooperate completely and immediately with County to affect a prompt and orderly transfer of all responsibilities to County. Contractor shall not be prohibited from disputing any such finding of Default through litigation, provided, however that such litigation shall not have the effect of delaying, in any way,the immediate take over of operations by the County. These provisions shall be specifically stipulated and agreed to by both parties as being reasonable and necessary for the protection of public health and safety,and any legal dispute concerning the finding that a Default has occurred shall be initiated and shall take place only after the Emergency take-over has been completed. Contractor's cooperation with and full support of such Emergency take-over shall not be construed as acceptance by Contractor of the findings and Default,and shall not in any way jeopardize Contractors right of recovery should a court later find that the declaration of Default was made in error. However,failure on the part of Contractor to cooperate fully with the County to affect a smooth and safe take-over of operations,shall itself constitute a breach of the Agreement,even if it was later determined that the original declaration of Default by the County was made in error. For any Default by Contractor which does not endanger public health and safety, or for any Default by County,which cannot otherwise be resolved,early termination provisions which may be agreed to by the parties will supersede these specifications ducW' Provisions Should the Agreement not be renewed,extended,or if notice of early termination is given by Contractor,Contractor agrees to continue to provide all services required in and under the Agreement until the County or a new entity assumes service responsibilities. tinder these circumstances Contractor will,for a period of several months, serve as a lame duck Contractor. To ensure continued performance fully consistent with the requirements herein through any such period,the following provisions shall apply. 1. Contractor shall continue all operations and support services at the same level of effort and performance as were in effect prior to the award of the subsequent Agreement to a competing organization, including but not limited to compliance with provisions hereof related to qualifications of key personnel; REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY 2. Contractor shall make no changes in methods of operation that could reasonably be considered to be aimed at cutting Contractor service and operating costs to maximize or effect a gain during the final stages of the Agreement, 3. County recognizes that if another organization should be selected to provide service, Contractor may reasonably begin to prepare for transition of service to the new entity. County shall not unreasonably withhold its approval of Contractor's request to begin an orderly transition process, including reasonable plans to relocate staff,scale down certain inventory items,etc.,as long as such transition activity does not impair Contractor's performance during this period. 4. Should the County select another organization as a service provider in the future, Contractor personnel shall have reasonable opportunities to discuss issues related to employment with such organizations without adverse consequence. M. General Provisions 1. Asslgnnum t Contractor shall not assign any portion of the Agreement for services to be rendered without written consent first obtained from the County and any assignment made contrary to the provisions of this section may be deemed a default of the Agreement and, at the option of the County shall not convey any rights to the assignee. Z Permits and 11censes Contractor shall be responsible for and shall hold any and all required federal,state or local permits or licenses required to perform its obligations under the Agreement. In addition,Contractor shall make all necessary payments for licenses and Permits for the services and for issuance's of state Permits for all Ambulance vehicles used. It shall be entirely the responsibility of Contractor to schedule and coordinate all such applications and application renewals as necessary to ensure that Contractor is in complete compliance with federal,state and local requirements for Permits and licenses as necessary to provide the services. Contractor shall be responsible for ensuring that its employee's state and local certifications as necessary to provide the services, if applicable,are valid and current at all times. 3. Compliance vvith hiws and regulations All services furnished by Contractor under the Agreement shall be rendered in full compliance with all applicable federal,state and local laws,ordinances, rules and regulations. It shall be Contractor's sole responsibility to determine which, and be fully familiar with all laws,rules, and regulations that apply to the services under the Agreement,and to maintain compliance with those applicable standards at all times. 75 REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY 4. Prkrate VVork Contractor shall not be prevented from conducting private work that does not interfere with the requirements of Contract. 5. Retention of Records Contractor shall retain all documents pertaining to Contract for five(5)years from the end of the fiscal year following the date of service,for any further period that is required by law;and until all Federal/State audits are complete and exceptions resolved for this Contract's funding period. Upon request,and except as otherwise restricted by law,Contractor shall make these records available to authorized representatives of the County,the State of California,and the United States Government_ G. Product wsenwWadvertIlsft Contractor shall not use the name of Contra Costa County or its EMS Agency for the endorsement of any commercial products or services without the expressed written permission of the Contract Administrator. 7. Observation and iinspecltiions County representatives may, at any time,and without notification, directly observe Contractor's operations of the Medical Dispatch Center,maintenance facility,or any Ambulance post location. A County representative may ride as"third person"on any of Contractor's Ambulance units at any time,provided,that in exercising this right to inspection and observation,County representatives shall conduct themselves in a professional and courteous manner,shall not interfere with Contractor employee's duties,and shall at all times be respectful of Contractor's employer/employee relationships. At any time during normal business hours and as often as may be reasonably deemed necessary by the County,County representatives may observe Contractor's office operations,and Contractor shall make available to County for its examination any and all business records, including incident reports, patient records,financial records of Contractor pertaining to the Agreement. County may audit,copy, make transcripts,or otherwise reproduce such records including but not limited to contracts, payroll, inventory,personnel and other records,daily logs, employment agreements, and other documentation for County to fulfill its oversight role. & Onv*xm pmvils lion Contractor understands and agrees that for four years following the conclusion of the Agreement it may be required to make available upon written request to the Secretary of the US Department of Health and Human Services,or any other fully authorized representatives,the specifications and subsequent Agreements,and any such books, REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY documents,and records that are necessary to certify the nature and extent of the reasonable costs of services. 9. Small busbum utillbatim Contractor shall consider and involve small businesses,women,and minority owned firms in its purchasing and Sub-Contracting arrangements. 10. Relationship of the parties Nothing in the Agreement resulting shall be construed to create a relationship of employer and employee or principal and agent, partnership,joint venture, or any other relationship other than that of independent parties contracting with each other solely for the purpose of carrying out the provisions of the Agreement. Nothing in the Agreement shall create any right or remedies in any third party,it being solely for the benefit of the County and Contractor. 11. Rights mW r+r3rmredilles not waived Contractor will be required to covenant that the provision of services to be performed by Contractor under the Agreement shall be completed without further compensation than that provided for herein. The acceptance of work under the Agreement and the payment therefore shall not be held to prevent maintenance of an action for failure to perform work in accordance with the Agreement. In no event shall payment of consideration by County constitute or be construed to be a waiver by County of any default or covenant or any Default by Contractor. County's payment shall in no way impair or prejudice any right or remedy available to County with respect to such default. 12. Consent to jurisdictiorii Contractor shall consent to the exclusive jurisdiction of the courts of the State of California or a federal court in California in any and all actions and proceedings between the parties hereto arising under or growing out of the Agreement. Venue shall lie in Contra Costa County,California. I& E:nd term pirovisilons Contractor shall have ninety(90)days after termination of the Agreement in which to supply the required audited financial statements and other such documentation necessary to facilitate the close out of the Agreement at the end of the term. 14. Notice of litligati+crni Contractor shall agree to notify County within twenty-four(24)hours of any litigation or significant potential for litigation of which Contractor is aware. REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY I& Cost of r��orii'i�nt If County or Contractor institutes litigation against the other party to enforce its rights pursuant to performing the work contemplated herein the actual and reasonable cost of litigation incurred by the prevailing panty, including but not limited to attorney's fees, consultant and expert fees,or other such costs shall be paid or reimbursed within ninety(90)days after receiving notice by the party which prevails. I& Ger al Corvbmt Provilons In addition to the specific contract provisions listed this document,the written Contract will include general conditions required by County in contracts such as this. 78 _t REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY Emergency Response Area Map-Appendix 1 � a�tsk,f• t a w .�1 4 t 4 �e y a Un� a m CL kv f F •v C . s x 88 yy 4 ! ^ itYW,��YI x r'w a s YW,W!➢ � f F� REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY .. Emergency Ambulance a` -pe Zone r '.rp Appendix � s MT P ( rf s a � k s z 3� n+�.� h�_ ?•5� �'i ,^3� +SbS a yk�,,� �: Nb�q r F �,�,``�� `�"�-`; s � � ! y Y S eaYNY m y? � � r 4K , m y� m REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY Current.: Approved Ambulance Service Rates Appendix ALS Base Emergency 877.69 Intubation supplies 32.35 ALS Base Multiple Patient 553.19 Intraosseous needle 16.94 BLS Base Emergency 570.00 Intraosseous kit 66.96 BLS Base Multiple Patient 402.62 IV Saline-lock supplies 30.01 Mileage(ALS&SLS) 19.75 I.V.Start Pak 15.17 Oxygen 60.76 Lasix 15.17 Adenosine 80.59 Lidocaine Preload 24.32 Airway nasal 15.17 Mask pocket 16.44 Airway/oral 7.62 Morphine 1517 Albuterol/Nebulizer 5,21 Narcan 15.17 Bag valve mask 59.24 Nebulizer 5,59 Bandages Triangular 7.62 Non-rebreather mask 7.62 Atropine 36.44 Normal Saline 1000cc 59.20 Sed pan 7.62 OB pack 22.80 Benadryl 15.17 Pacing Electrodes 29.55 Blanket-disposable 15.17 Pleural decompression kit 49.39 Blood-draw tube/needle 15.17 PTV kit 40.35 Bretylium 85.07 Pulse Ox Sensor, Disposable 47.11 Burn sheet 15.17 Resuscitator valve(lisp) 15.17 Calcium Chloride 22.80 Sodium Bicarbonate 30.39 Cervical collar 53.17 Splint-arm(lisp) 10.63 Activated charcoal 15.24 Splint--leg{lisp} 10.63 CO2 detection devise 26.32 Sterile water inj. 15.17 Cold/Hot pack 6.05 Suction tube/tip sup 23.86 Dextrose 50% 30.39 Universal precautions 16.70 Defib/Electrodes Pediatric 59.55 Urinal 7.62 Valium 15.17 Defib paddles(pedi) 9.58 Versed 10rng 45.85 Defib Pads 29.55 Wait time(per%hr) 151.90 Dopamine 15.17 Dressing-major 7.62 EKG monitor 91.15 EKG electrodes 15.17 EOA Combi-tube,ptl 133.45 Epinephrine 1:1001 mg/cc 15.17 Epinephrine 1:10,000 19.74 Epinephrine 1:1,000 1 mg/30cc 30.39 Extra attendant-ALS 227.82 Extra attendant-BLS 113.94 Special handling 80.76 Glucagon 90.30 Glucose paste 22.80 Headbed immobilizer 10.50 REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY Current Response Time Performance Data-Appendix 4' Ambulance Dispatch Report-Year 2003 Responses by Community,Response Code and Average Code 3 Response Time Community All Responses Code Two Code Three Avg.Response # % # % # % Time* Totals 67,480 100.0 15,709 23.3 51,771 76.7 7.43 Richmond 10,922 16.2 1,337 12.2 9,585 87.8 6.96 San Pablo 2,598 3.9 i 762 29.3 1,836 70.7 6.16 El Cerrito 1,818 2.7 204 11.2 1,614 88.8 7.69 El Sobrante ( 457 0.7 82 17.9 375 82.1 8.51 Kensington 208 0.3 22 10.6 186 89.4 11.60 Pinole 1,515 2.2 374 24.7 1,141 75.3 6.75 Hercules 995 1.5 247 24.8 748 75.2 8.84 Rodeo 408 0.6 125 30.6 283 69.4 8.62 Crockett 256 0.4 67 26.2 189 718 12.58 Concord 10,089 15.0 2,947 29.2 7,142 t- 70.8 6.96 Martinez 3,188 4.7 844 26.5 2,344 73.5 7.95 Pleasant Hill 2,418 3.6 703 29.1 1,715 70.9 6.89 Pacheco 178 0.3 49 27.5 129 72.5 7.10 Clayton* 475 0.7 131 27.6 344 72.4 f 10.23 Clyde 13 0.0 8 61.5 5 38.5 9.40 Walnut Creek 6,011 8.9 1,446 24.1 4,565 75.9 7.40 Lafayette 1,149 1.7 332 28.9 817 71.1 9.24 Orinda 838 1.2 230 27.4 608 72.6 8.06 Moraga 764 1.1 192 25.1 572 74.9 7,55 Alamo 609 0.9 47 7.7 562 92.3 6.72 Danville 1,798 2.7 52 2.9 1.746 97.1 6.91 San Ranson 1,755 2.6 71 4.0 1,684 96.0 7.10 Diablo 45 0.1 0 0.0 45 100.0 8.00 Blackhawk 189 0.3 2 1.1 187 98.9 7.58 Antioch 6,766 10.0 1,906 28.2 4,860 71.8 7,06 Pittsburg 5,714 8.5 1,785 31.2 3,929 68.8 7.33 Bay Point 1,141 1.7 306 26.8 835 73.2 7.88 Oakley 1,421 2.1 392 27.6 1,029 72.4 8.35 Bethel Island 513 0.8 1 127 24.8 386 75.2 9.84 Brentwood- 2,179 3.2 603 27.7 1,576 72.3 9.10 Discovery Bay* 552 0.8 200 36.2 352 63.8 12.73 Byron* 370 0.5 I 92 24.9 278 75.1 10.67 Other/Unknown 128 0.2 24 18.8 104 81.3 18.19 *Average response times do not include calls cancelled enroute or calls by Unit 75{first responder} _....: REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY Mandatory Forms To Be Submitted with Proposals -Appendix 51 Face Sheet-FORM A PROPOSAL TO PROVIDE EMERGENCY AMBULANCE SERVICES TO CONTRA COSTA COUNTY 2004 'THIS FORM MUST APPEAR AS THE FIRST PAGE OF THE PROPOSAL*** This is a proposal to contract with Contra Costa County to provide primary emergency ambulance service to persons requesting said services through the County or a County- designated emergency dispatch center, NAME OF BIDDER: dba LEGAL ADDRESS: PHONE: FAX(required for notification) CONTACT PERSON: PHONE: email ADDRESS FOR MAILINGS(if different): OFFICIAL USE ONLY: DO NOT FILL IN THIS SECTION PROPOSAL# DATE RECEIVED: TIME RECEIVED: BY: REQUEST FOR PROPOSAL CONTRA COSTA COUNTY FMS AGENCY Paramedic and EMT-I Compensation Packages - FORM B Provider Personnel Category: Paramedic EMT-I_ ***FORMS FOR PARAMEDICS AND FOR EMT-I'S MUST BE INCLUDED IN THE PROPOSAL*** New Employee After 2 Yrs Employment After 5 Yrs Employment Hourly Wage: Lowest $ /hr Lowest $ /hr Lowest $ /hr (Straight time) Highest $ /hr Highest $ Jhr Highest Jhr Median $ /hr Median $ /hr Median $ /hr Average number of hours per week for full time employees: Average gross earning per year for full time employees: Paid Vacation days/year days/year dayslyear Paid Holidays days/year days/year days/year Sick Leave days/year days/year days/year Paid Continuing Ed. hourstyear hours/year hourslyear Uniform Allowance $ /year $ /year $ /year Tuition Reimbursed $ /year $ /year $ /year Health Care a.Medical %covered %covered %covered $ deductible $ deductible $ deductible b.dental %covered %covered %covered C.Optical %covered %covered %covered Stock Options: Profit Sharing: Day Care Services: Career Development: Pension Plan: _._. .:a REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY Budget Format-FORM C Page 1 of 4 ***THIS FORM MUST BE INCLUDED IN THE PROPOSAL' PROPOSED OPERATING BUDGET Provider: Year: EXPENSES 1. Personnel Paramedics a. Wages $ b. Benefits $ EMT-I's C. Wages $ d. Benefits $ Other Personnel e. Wages $ f. Benefits $ Subtotal $ 2. Vehicles a. Gasoline, oil, tires $ b. Repair and maintenance $ C. Depreciation $ Subtotal $ REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY Budget Format-C=ORM C (Mage 2 of 4) 3. Medical Equip�upp( a. Supplies $ b. Equipment lease/depreciation $ C. Maintenance& Repair $ Subtotal $ 4. Other a. Rents and leases $ b. Insurance $ C. Utilities and telephone $ d, Office supplies&postage $ e. Professional Services $ f. Taxes $ g. h. $ i. $ 1- $ Subtotal $ 5. Total Expenses $ ... .. REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY Budget Format-FORM C (page 3 of 4) REVENUES 6. Patient Char a. Private payments $ b. Medi-Cal $ C. Medicare $ d. Other third party payments Subtotal $ 7. Cather, Specify: a. $ b. C. $ d. $ 8. Total Revenue $ 9. NET INCOME (item 11 minus Item 7) REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY Budget Forma-FORM C (page 4 of 4) Basis for Patient Revenue Projections: Annual Average Number of Payment/ Annual Source of Payment Transports % Transport Revenue* Private $ $ Medi-Cal Only Medicare/Medi-Cal Medicare Only C)ther No Payment 0.00 0.00 TOTAL 100% $ $ *Must correspond to Item 8. REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY A. Patient Charges Complete the proposed charge for each of the items listed below. No other patient charges will be considered. BLS Base Rate $ BLS-Emergency Base Rate $ ALS 1 Base Rate $ ALS 1-Emergency Base Rate $ ALS 2 Base Rate $ Loaded Ambulance Mile Rate $ Treat and no transport charge $ REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY B. Service Price Sheet Annual cost of 2417 of paramedic staffed non-transporting quick response vehicle(QRV): $ per year Hourly cost of QRV: $__ per hour Marginal Paramedic Ambulance Hourly Reimbursement Rate: $ per hour REQUEST FOR PROPOSAL. CONTRA COSTA COUNTY EMS AGENCY C. Optional Services Price List It is the intent of this procurement to result in a zero subsidy for the Ambulance Contractor. The Ambulance Contractor shall rely on collections from patient charges and reimbursement from the County for transporting patient for whom the County is financially responsible. The County may Capt to purchase additional services or service levels from the Contractor. The purpose of this Optional Services Price List is to allow the County to identify the actual costs of these services. The Contractor will provide the following services if requested by the County for the amount entered on this Price List for the term of the Agreement plus any annual C.P.I.adjustments as provided for in the Agreement. Upgrading Ambulance Fleet If the Proposer submitted its Proposal with the intention of providing Type It(van-style) ambulances for emergency responses within the County,what would be the total additional annual cost to upgrade the Emergency Ambulance Fleet to Type III(van/modular)ambulances? Total annual cost of upgrading to Type III ambulances: $ per year. Deployment of Reserve Ambulance Fleet If the County decides to deploy between five(5)and fifteen(15)fully stocked and equipped reserve ambulances throughout the County for Disaster and Mass Casualty situations,what would be the total annual cost for acquisition, insuring, maintaining,and equipping each ambulance. Please differentiate between the cost of providing Type II and Type III ambulances. Cost per reserve ambulance: Type It $ per year Type III $ per year REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY If All 4ii 1: LMAL WV MW t4„ ArtLathmp 0400tor.Cwtm CosW EnwVMW MWICW Sore 1 UO AnwOa 120 Marfinez,CA 94$51631 FOX )64379 r W,i Healthcare arx Unim,SEW Local 250 sM IAFF Local 1230 krx*Met a inW serAom ham to corors Coof* an cm*mmwft our marfters,WhD we respons6le for prn ' ' in Cmft 00sta ty�have mony tin r"abw how these 8&-vkm are hPieff0to in out Communfly, W *0woLwpWWP&4m in the RW proms*as VU to insudr t that kmWedge ltd OnWliwoe of tty p iWAMS tit the on at 40y beels an ulftwd to agu a medical wre in amarpmvq situmicm, nwuo carwOnuft docusslormon wr Ima wWkgons, we have drookwed a Not of ua am 1 W insusing a successful RFP process, I "AFF Local 1230 and SOU Local M ohm"each ham a v0finq rnember on ft Comndoe that r+ s on ambWerm pw0der to of supsmsom . The FtFP ahaMhm wo*w*wtkm Wguage torah EMS pammW cur r ' to"cal that also f0cogntm We unlon colleake is h cM another provider oftr n American Modkw Respomo i - Alt 011 roVanding ambvkmcan Malt muftain the Dual Medic oomfi4proWn,WNch oftlocontroa The ChAl madic=69uragan mmtn k,piamlorw"county REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY and other aress In tPos Coirdy whwe Fire Deparbi*ft am not cwable of Enolno,twed perarneft wAces. dh Safety oquiprnant should bo woviload for*a*EMS nre ber on 911 responding amhulances.10 d* dJon r W*a W Of Mails, tit is!'riga l of protaccton. 6� 911 se s Moss Should Sam be of �ngi c a� _ _ a+s that vA allowr unhindered.qmft lostient cars. 981 AftWonve lsep Shelf not owood 200MO nos~ C The (y r§t ing for NG end Fire pe on ECS, csi,NuoWar anO Chemical dilss . ? The C;ounty shotild estelollsh a JoIM C4mmffteFimfthWs said EMS Ambulance fle to addreas Emwvomy Swvloes Issues,induclift,but not lkyAted to, nwuArnomt and ratealion of a diverse wodftroe in EMS and Firs SoNics,. f3. AJi BLS anft4arom should hove A! D capability. 9. ALS u It l not til►used to respond on 5150 ca requires At. Weatrnant such as an"rdose or major frau". W US County,s: 4anquago and toprestota0ves of both ur0ans should ` .the W of reVora*time 1 I-Ther*,W poovidar,11re**rAces and EW office should v4rk togto poovide wkqu&M Confioainq Education<iosses that alb paramedics and EMTs can meet t nts. 12-Al12-Al Measure H money shouW be raft trnea8 to tm put to uae W OV*ndirq and mxkftWng ars er►9ine based parerneft program, 13.Ttw County showd seta rninlemm nst, r of 911 am"n=ftt rust bo ki.tt fele t* lgra ftWd dbNfth ft,91 t am t: I& F haus a hVWr pf fillirg Vak*19 s on ambulances. 10-Them shote be lam pwWad at, ty Fif'e sumon vias euxonvy stores the VIUM 0WORY its ft=04Ya That arrWance is dolly to be du d rsl s REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY WO MOke ftge WWwmdatlons in the hope that by wwlong t098MW Wft the hodsm of,ur Clounly,we ton gasum teat cvr Commungy is a svft pigm to t�m wd workfcsr ow famikes,Mends,and rs, Rats LOU N proWkiew i . SEW Local 260 J FF Loost I a REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY Maps of Urban/Suburban and Rural Areas-Appendix 8; Rural Map Pages-Thomas Bras. Digital Edition 2006 550 C6-7 E1-7 C1-3 656 All 136-7 F1-7 D1-3 657 All E6-7 G1-7 E1-4 658 A1-4 F6-7 H1-7 F1 B1-4 G5-7 J1-7 613 A5-7 C1-4 H5-7 591 A1-7 B4-7 D1-3 J6-7 B1-7 C2-7 E1 557 All C1-7 D2-7 F1 558 A1-4 D1-7 E2-7 676 Al-2 B1-3 E1-7 F1-7 B1-2 570 CI-4 F5-7 G2-7 C1-2 D1-7 G5-6 1-13-7 D1 E1-7 594 A1-4 J3-7 E1 F1-7 B1-7 614 A3-7 F1 G1-7 C1-7 B1-7 G1 H1-7 D1-7 C1-7 J1-7 EI-7 131-7 571 A1-7 F1-7 E1-7 B2-7 G1-7 F1-7 574 A6-7 1-12-7 G1-7 576 E2 J3-7 HI-7 F2 595 A3-7 J1-7 G1-2 B3-7 615 All 1-11-3 C6-7 616 A6-7 ,11-4 D6-7 B6-7 577 A1-4 E6-7 C5-7 B1-4 F6-7 D6-7 C1-7 G6-7 E6-7 DI-7 H6-7 F4-7 E1-7 J6-7 G4-7 F1-7 597 All H4-7 G1-7 598 Al-7 J4-7 H1-7 B2-7 617 All J1-7 C5-7 618 A1-7 578 A2-7 609 G1-2 B1-7 B1-7 H1-3 C1-7 C1-6 11-4 D1-3 D3-4 610 A1-7 634 All 589 D4-5 B1-7 635 All E4-6 C1-7 636 All F5-7 D1-7 637 All G5-7 E1-4 638 A1-7 1-16-7 F1-4 B1-7 14-7 G1 C5-7 590 A4-7 HI D5-7 B1-7 11-2 E5-7 C1-7 611 Al-2 F5-7 D1-7 B1-3 655 All REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY CONTRA COSTA HEALTH SERVICES December 1,2002 EMERGENCY MEDICAL SERVICES AMBULANCE 9QUIPMENTAND SUPPLY RPOUIREMENTS 1. Vehicles a) Ambulance vehicles shell meet standards specified in Title 13, California Cade of Regulations, and each shall possess a valid emergency vehicle permit issued by the California Highway Patrol. b) Vehicles shall be maintained,clean and in sound mechanical and body condition at all times. C) All ambulances shall have adequate space in the patient care compartment to accommodate at least one stretcher patient and two providers. There shall be sufficient space to allow for patient care activities during transport. 2. General Emergency Care Equipment and Supplies Ambulances shall meet the :Mate requirements for emergency care equipment and supplies. All equipment and supplies carried for use in providing emergency medical care shall be maintained in clean condition and good working order and shall include,but not be limited to: Minimum ITEMS In-service Requirement Oropharyngeal airways:000, 00,0, 1,2, 3,4,5,6 1 each Nasopharyngeal airways: 28,30, 32, 34 1 each Padded bite sticks(commercial or homemade) 2 Oxygen mask—adult/pediatric{non-rebreather} 2 each Oxygen mask—infantipediatric 2 each Nasal cannula--pediatric/adult 2/adult—21ped 02 tank--fixed in vehicle with regulator(M-tank or equivalent) 1 Portable 02 tank with regulator(sufficient to provide patient with not less than 10 1pm for 20 1 minutes} Resuscitation Bag-Valve,capable of use with 02: Infant, Pediatric,Adult 1 each Clear mask for use with Bag-Valve and demand-valve(adult only): Adult 2 Clear mask for use with Crag-Valve: Infant, Pediatric 1 each Portable Suction—mechanical/hand powered 1 Pharyngeal tonsil tip(rigid}for suctioning 2 Suction catheters: 8FR, 1017R, 18FR 1 each Band-Aids 12 4"Sterile bandage compresses or equivalent 12 3x3Y or 4x4" sterile gauze pads 4 REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY 2"or 3"rolled bandages 6 40"triangular bandages 4 10x30"or larger universal dressing 2 V, 2"or 3"adhesive tape 2 rolls Bandage shears 1 Vaseline gauze 2 Arm splints—with soft or cushioned surface or equivalent padded board,wrap around,wire ladder, inflatable or cardboard Leg splints—with soft or cushioned surface or equivalent padded board,wrap around,wire 2 ladder, inflatable or cardboard `fraction splints—with lower extremity limb support slings, padded ankle hitch traction strap 1 each and heel rest or equivalent(reel,sager or equivalent): Adult/Pediatric Spineboard`long with 4 straps(or equivalent) 2 Spineboard—short with 2 straps or equivalent(Kendrick Extrication Device) 1 Head immobilizer—disposable or impervious to bodily fluids—sand bags are not acceptable 2 Cervical collars—Hard: sizes to fit all patients over one(1)year of age 2 each Optional: adjustable cervical collar(hard only):sizes to fit all patients over one(1) 2 year of age Scoop stretcher with straps(or equivalent) 1 Blood pressure cuffs with manometers(portable): Adult, Large arm(obese), Pediatric, 1 Infant each Stethoscope: Adult/Pediatric(or combination) 1 Burn sheets(sterile)—may be disposable or linen(with date of sterilization and expiration 1 set indicated) Irrigation tubing 1 Saline for irrigation,sterile: 2000cc Cold packs 2 Obstetrical Kit(sterile,to include minimum of umbilical cord tape or clamps(2), 1 scissors or scalpel, 1 aspirating bulb syringe, 1 pair gloves,2 drapes, dressings&towels,clean plastic 1 bag Newborn Stocking Cap 1 Emergency thermal blanket(reflective fail) 2 Ambulance gurney—capability for elevating the head and be adjustable,straps for securing patient to gurney,wheels,non-permeable covering material, means of securing gurney in 1 vehicle. Triage tags 20 Current map of entire county (within 2 years)or ambulance zone maps 1 Current Contra Costa EMS Field Treatment Guidelines and policies 1 ........... _. ................................. _ _.. REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY Restraints—leather ankle and wrist or other soft restraints(4 per set) 1 set Battery operated flashlight 1 Emesis basin or disposable emesis bards and covered waste container 1 Linen—towels,sheets,pillow cases, blankets, pillows 2 each Glucose Paste 1 tube ALS Ambulance Emergency Care Equipment and Supplies:In addition to the BLS ambulance supply& equipment requirements,advanced life support units shall include,but not be limited to,the following: Minimum in- ITEMS service Requirement Cellular telephone 1 Monitor/defibrillator(portable)—must have strip chart recorder and synchronized cardioversion capabilities Extra charged batteries for monitor/defibrillator 1 Defibrillator paddles/patches: Adult, Pediatric 1 set each i Laryngoscope handle 1 Laryngoscope blades:#0, 1, 2, 3,4 Miller 1 each Laryngoscope blades:#2, 3,4 Macintosh leach Endotracheal tubes:6.0, 7.0, 8.0,9.0 cuffed 2 each Endotracheal tubes: 2.5, 3.0, 3.5,4.0 uncuffed 4 each Endotracheal tubes:4.5, 5.0, 5.5,6.0 uncuffed 2 each i Water soluble lubricant—individual packets 3 Magill forceps: Adult,Pediatric 1 each Batteries(extra)for laryngoscope 1 set Bulbs(extra)for laryngoscope 1 ETT securing device: Adult, Pediatric 2 each i Stylet: Adult,Pediatric 1 each Pen light 1 End-Tidal CO2(ETCO2)detector 2 � ETT placement assessment device(bulb) 1 ETT Nebulizer Adapter 2 i ... .... ...... ..... ..... ..... ,:::}............................................. ..... REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY Meconium aspirator I 2 Esophageal Tracheal Double Lumen Airway(ETDLA) 1 Hand-held nebulizer for inhalation 2 Nebulizer mask 2 Pleural Decompression/Needle Thoracostomy kit: (or equivalent) ✓ Angiocatheter-12-14ga ✓ Syringe--30cc ✓ One-way valve ✓ Rubber connecting tube 2 sets j ✓ Betadine swabs(4) ✓ Alcohol swabs(4) ✓ Vaseline gauze(2) ✓ Sterile gauze pads(2) ✓ Tape Needle cricothyrotomy kit(or equivalent): ✓ Angiocatheter-10-13 ga ✓ Syringe—30cc ✓ Scalpel with#11 blade ✓ Betadine swabs(4) ✓ Alcohol swabs(4) 1 set ✓ Vaseline gauze(2) ✓ Sterile gauze pads(2) ✓ Tape E ✓ Oxygen tubing ✓ Y'connector ✓ IV extension tubing Intraosseous IV kit(or equivalent): ✓ Sterile gloves(2 pair) ✓ Intraosseous needle(2) 2 sets ✓ Betadine swabs(3) ✓ Syringe—3cc Syringes: 1 cc, 30cc 2 jSyringes: 3cc, 5cc, 10/12cc I 2each Needles: 18ga 1",20ga 1",22ga 12",25ga e'(or equivalent) 2each Medication-added labels 2 €V catheters: 14ga, 16ga, 18ga,20ga,22ga,24ga 4 each 2x2 sterile gauze pads 10 j Alcohol swabs 5 Tourniquet 2 Razor 1 Armboard: Infant,child,adult 1 each i Normal Saline solution—1000cc bag 4 REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY Normal Saline solution—250ml or 500ml for pediatric patients 2 Saline'lock with extension tubing 2 r €V tubing: mini drip(60gtt), macro drip(10115gtt),extension tubing(or equivalent) 4 each Glucometer(with lancets and test strips) i 1 Secured drug box 1 Broselow tape(or length-based equivalent) 1 Activated Charcoal(25gm) 2 Adenosine(6mg) 5 Albuterol(2.5mg/3m€unit dose ampule) 4 Atropine(I mg preload) 4 Aspirin(81 mg tablets) 1 bottle Diphenhydramine(Benadryl)(50mg/1cc) 2 Calcium Chloride(1 gm) 2 Dextrose 25% j 2 Dextrase 50%(25gm/50cc) 2 r Dopamine(400mg/250cc premixed bag)(or equivalent) 1 Epinephrine 1:10,000(1mg/10cc) 4 Epinephrine 1:1,000(1mg/1cc) 2 Glucagon(1 mg/1 cc) i 1 Furosemide(Lasix) 100 mg Lidocaine 2% 300 mg Midazolam(Versed) (5mg/ml ampule/vial) 20 mg Morphine Sulfate(10mg/l cc ampule/vial) 2 Naloxone(Narcan) 6 mg Nitroglycerin(0.4 mg/tab or multidose spray) 1 bottle Sodium Bicarbonate(50mEq/50cc) I 1 REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY County Message Transmission Network Standard-Appendix 10: The EMS Message Transmission Network(MTN)automates the processing of requests between various EMS service provider computerized dispatch centers(CAD's). The detailed Contra Costa County Emergency Medical Services"Automated EMS Message Transmission Network Specification"which describes the design guidelines and specifications for the EMS Message Transmission Network(MTN), is available on line at www.cccems.org or in hard copy at the EMS Agency Offices. .... It a/c Yt LL � We have reviewed the Board order and attached RFP for the new ambulance contract. We do have concerns of staff's recommendations about the 16 points that we raised to you in May. We will be present to spear tomorrow at the Board meeting spear on those issues. One area we would like to address in this email is the review panel. We will also speak on this again tomorrow. We do not support staff s recommendation for Option 3.We believe Caption. 1 and Option 3 lack the diversity of panel,members from both inside and outside of the actual EMS system. We also believe that Caption 2 "Stake holders panel"may not be appropriate for the balance that staff is looking for. We would support Option 2 as is with the understanding that field paramedics are both firefighter paramedics and ambulance paramedics (Local 1230 and Local 254 members) We would like to also offer another option,which we believe addresses staff's overall concerns of balance, it is as follows: Panel will include: (1) Member of the Fire Chiefs' Association (2) Member of the Police Chiefs' Association (3) Member of the County Public Managers' Association (4) Member of Hospital Council (5) Emergency room physician from Contra Costa County(Preferably from the Trauma Center) (6) Field Firefighter Paramedic from existing AMR.service area(All field firefighter paramedics are Local 1230 members) (7) Field Paramedic from AMR.(Local 250 member) (8) EMS administrator from outside Contra Costa County(Selected by Dr. Walker) (9) Member of the Mayors' Conference (10) Emergency room nurse from outside Contra Costa County(Selected by Dr. Walker) We believe that this panel provides a mix of internal, external,policy makers and users of the system that provides a balance look at potential bidders to the system. We have purposefully left off the California Highway Patrol, as while they are involved in the EMS system they do not have direct involvement in care and outcome of the system. We have also not included a Consumer representative. We do recognise that the ultimate user of the system is the consumer. However we believe that many of the nuances of the RFP would be difficult for a Consumer representative to be familiar with in this short of a time period. - -ILA-* ------------------------ Leslie K. Weiler Phone (925) 602-1300 Director of Operations Fax(925) 685-8804 Contra Costa County Division E-mail leslie_mueller@amr-ems.com August 9, 2004 The Honorable Federal Glover Supervisor, District V 315 E. Leland Avenue Pittsburg, CA 94585 Dear Supervisor Glover: On August 31, and September 2, 2004, American Medical Response (AMR) EMS employees will be voting to determine who will be their future collective bargaining representation. AMR anticipates the release of the election results by the National Labor Relations Board (NLRB) on September 3, 2004. AMR respectfully requests a continuance of Board approval of the EMS Request for Proposal (RFP) until the next Board hearing following the release of election results. The RFP document under your consideration today establishes a key section for scoring "Commitment to Employees". As the current EMS Employer within Contra Costa County, and in accordance with Sections 7 and 8(a)(1) of the Management Labor Relations Act,AMR is prohibited from engaging in any actions that may interfere with the employees' ability to exercise a free and reasoned choice in a pending election. By negotiating with SEIU or NEMSA, prior to September 3`d, and with the election pending, AMR could give the impression that we favor one union over the other, or cause the employees to favor one union over the other, thus interfering with the employees' ability to make a free and reasoned choice. This NRLB prohibition places AMR in a distinct disadvantage in the RFP process as other bidders may freely negotiate with SEW or NEMSA in building their"Commitment to Employees" section of the RFP. AMR and its predecessor companies have been the providers of Paramedic ambulance services in Contra Costa County for over 25 years. AMR and its 245 caregivers have performed to the highest standards, as collaborative partners with the agencies and communities that we have been granted the privilege to serve. AMR supports a fair and equitable RFP process which results in peace of mind for our patients, communities, caregivers, and does so in a fiscally sustainable manner for all citizens of Contra Costa County. American Medical Response.Contra Costa County division 2350 Whitman Road,Ste.F,Concord CA 94518 Email:Leslie MUe4lerQamr-Goan 2350 Whitman Road, Suite F, Concord, CA 94518 ................................................ ... ....... Based on the above, AMR respectfully requests a continuance of Board approval of the EMS Request for Proposal(RFP) until the next Board hearing following the release of election results. Sincerely, ie K. Mueller rector 0 r of Operations Contra Costa County Division CC: John Sweeten, County Administrator Supervisor John M. Gioia, District I Supervisor Gayle B. Uilkema, District 11 Supervisor Millie Greenberg, District III Supervisor Mark DeSaulnier, District IV Art Lathrop, Director, Contra Costa County EMS Agency American Medical Response a Contra Costa County Division 2350 Whftman Road,Ste,F,Concord CA 94518 EnvW:Lesffe—Mueftrtkarnr-com .......... ........................... Rug 09 04 02: 57p p. 2 N a t i o n a I a F A s s o c i a t i o n 1007 7 "1 Street, Suite 200, Sacramento, CA 95814 Toll Free: 866.544.7398 - Direct: 916-551-3378 www.NEMSAUSA.org Dear Supervisors It has come to our attention that the Contra Costa County RFP for ambulance transport is due to be released this week. The purpose of this letter is to respectively request a delay in the release be afforded until such time as the National Labor Relations Board can complete the representation election currently underway for the 273 EMT's and paramedics currently employed by American Medical Response in Contra Costa County. The P.FP process would be negatively affected during this change and would create undue hardship on an already volatile situation. Prior to and during the RFP process American Medical Response will rightfully consult with and involve the EMS workers in the field, through their respective labor representation. American Medical Response is preclude by law to enter into discussions with the new organization prior to the new organization being certified. The switch will occur no later than September 3, 2004. As you have already indicated the input from the EMS workers in the field is important in this process. That input would be significantly compromised while the representation is influx_ Yourprompted attention to this matter is greatly appreciated. Please contact me or the National Labor Relations Board Agent Region 32 Virginia Jordan if you have any questions or need further information. Sincerely Torren Colcord- President NEMSA