HomeMy WebLinkAboutMINUTES - 07082014 - D.9RECOMMENDATION(S):
DIRECT Contra Costa EMS (Emergency Medical Services) Agency on the Request for Proposal (RFP) Process and
Timeline for Emergency Operating Area (EOA) I, II and V :
Prepare the emergency ambulance RFP for exclusive operating areas currently served by American Medical
Response.
1.
Solicit a panel of neutral, qualified out of county RFP reviewers to objectively score each RFP submission.
Review panel members to consist of EMS, fire and clinical experts.
2.
Issue the RFP and conduct the procurement process in accordance with the following timeline:3.
a. Draft RFP to EMS Agency - October 28, 2014
b. RFP to EMS Authority - November 25, 2014
c. RFP Released to Bidders - February 18, 2015
d. Proposer’s Conference - March 4, 2015
e. Proposals Due - April 15, 2015
f. Notice of Intent to Award - May 5, 2015
g. Contract Executed - July 1, 2015
h. New Contract Start - January 1, 2016
APPROVE OTHER
RECOMMENDATION OF CNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE
Action of Board On: 07/08/2014 APPROVED AS RECOMMENDED OTHER
Clerks Notes:
VOTE OF SUPERVISORS
Contact: Dorothy Sansoe,
925-335-1009
I hereby certify that this is a true and correct copy of an action taken and entered on the minutes of the
Board of Supervisors on the date shown.
ATTESTED: July 8, 2014
David Twa, County Administrator and Clerk of the Board of Supervisors
By: , Deputy
cc:
D. 9
To:Board of Supervisors
From:William Walker, M.D., Health Services Director
Date:July 8, 2014
Contra
Costa
County
Subject:Request for Proposals on Provision of Emergency Ambulance Services
RECOMMENDATION(S): (CONT'D)
APPROVE the sole provider minimum credentials and qualifications for emergency ambulance RFP candidates.
The following minimum credentials and qualifications are based on requirements associated with the prior RFP
and recent emergency ambulance RFPs conducted in the Bay Area.
Experience as a sole provider in providing Advanced Life Support (paramedic) ambulance service.1.
Demonstrated ability to meet performance based response time standards.2.
Experience in providing consolidated emergency medical dispatch services.3.
Demonstrated ability to provide a high level of clinical competency and performance at advanced life
support level.
4.
Demonstrated financial strength and stability.5.
Demonstrated expertise in EMS ambulance flexible deployment, management, and clinical quality
improvement processes
6.
AUTHORIZE the EMS Agency to issue a request for proposal incorporating the following features and changes
based on recommendations from the Fitch EMS Modernization report:
1. A five year performance based competitive contract for emergency ambulance services at no cost to the county
with an option for 5 year extension to include the ability to support future consolidated emergency medical
dispatch and other mobile health services.
2. Proposers will be required to employ whatever level of effort is necessary to achieve the clinical, response time,
quality improvement, customer satisfaction and other performance results required by the EMS System
specifications.
3. Support the integration of operational and patient care data systems consistent with state and federal privacy
and protection laws.
4. Assist to develop and provide expanded mobile health care services in partnership with health system providers.
5. Urban Response Areas will be expanded consistent with EMS study demand analysis resulting in shorter
response times for those newly designated urban areas.
6. Paramedic Quick Response Vehicles (QRVs) will be eliminated
a. In 2004 QRVs were created to provide a paramedic response within 10 minutes.
b. EMTs scope of practice has increased in the last ten years.
c. Rapid first medical response is competently managed by all fire agencies responsible at both the EMT
and Paramedic service levels.
7. RFP may lengthen response times ONLY in the designated urban areas commensurate with a similar decrease
in dispatch times not to exceed 60 seconds pending further modeling of demand analysis by the Fitch consultants.
a. Achieving response time performance is the major cost driver to the EMS System.
b. The EMS system needs to support reasonable response times that have evidence of providing a
maximum patient benefit.
c. Richmond response time requirement would be modified to match the remainder of the County’s urban
areas.
8. Minimum emergency ambulance staffing will be standardized in all response areas to one EMT (Emergency
Medical Technician) and one paramedic consistent with EMS science, medical efficacy and cost/benefit
utilization.9. Require provider to dedicate resources for Community Outreach including HeartSafe communities,
injury prevention, education and training supporting CPR (Cardiopulmonary resuscitation) in schools, AED
(automated external defibrillation), Stroke, Heart Attack and Cardiac Arrest.
a. Prevention and early recognition are essential to improving survival.
b. Bystanders and HeartSafe communities are part of the chain of survival for cardiac arrest, heart attack
and stroke.
c. Bystander CPR and early defibrillation are known to be the important factors supporting long term
meaningful survival.
10. Require bariatric capable ambulances to support community demands.
11. Require a performance based review program for consumer billing complaints with options for extended
payment and compassionate care in coordination with the Contra Costa County HICAP (Health Insurance
Counseling and Advocacy Program).
FISCAL IMPACT:
No fiscal impact.
BACKGROUND:
The Contra Costa EMS system is a high performance, collaborative network of public safety, fire, transport, and
emergency hospital personnel committed to improving patient outcomes. The EMS system serves all regardless of
ability to pay, every hour of the day, 365 days a year. In 2013, the Contra Costa EMS system responded to over
80,000 9-1-1 calls for medical assistance with 7-13% associated with critical or “life and death” events. At the
same time EMS is known to be the most costly way for individuals to access emergency department care.
In 2004 the Contra Costa Board of Supervisors approved the first EMS System Design supporting the
development of paramedic first response, advanced life support enhancements, emergency communication and
dispatch. Prior to 2004 the County had paid over $ 2.5 million of Measure H (CSA-EM1) funds annually for
emergency ambulance services. After 2004, emergency ambulance services have been exclusively supported by
revenue from patient co-pays and medical insurance reimbursement. Measure H funds used previously to provide
an ambulance provider subsidy were re-allocated to support fire first medical response.
Changes associated with health care reform, downturns in local economies and increased costs associated with the
practice of pre-hospital medicine have created new fiscal challenges. Expenses have risen while revenues have
not. Several ballot measures to support EMS system stakeholders have failed.
It is the EMS Agency’s recommendation that the county use a cost savings approach to continue emergency
ambulance services without a subsidy. Any savings should be exclusively used to support a fiscally sound,
accountable, safe and high quality emergency ambulance service. The EMS Modernization Report identified
significant cost savings, consistent with EMS industry standards, EMS science and based on following priorities:
Safe, quality patient care1.
A consistent level of sustainable service delivery2.
Value driven performance3.
A commitment to create a consolidated dispatch4.
Value driven EMS Systems use the best available evidence to provide optimal deployment of resources to meet
patient care needs, within the fiscal capabilities of the communities served. While long term solutions will be
determined by policy makers, in the short term RFP efforts should be redirected to reduce cost for the county
while redirecting savings based on value while optimizing flexibility in EMS service delivery.
CONSEQUENCE OF NEGATIVE ACTION:
Opportunities to achieve financial savings, improve patient outcome and ambulance deployment, as well as
explore alternative service delivery models to enhance and support the EMS System will be missed.
CHILDREN'S IMPACT STATEMENT:
Approximately 8-10% of EMS system services are provided to children.
CLERK'S ADDENDUM
RELISTED to July 29, 2014; and DIRECTED the Director of Emergency Medical Services Department to
work with the Emergency Medical Care Commission, County Fire Protection Districts and other appropriate
stakeholder groups before the matter returns to the Board.
ATTACHMENTS
Optimization of Prehospital Care in Contra Costa County
Measure H Guidelines
Measure H Chart 2013-14 Allocations
Contra Costa Emergency Medical Services
Optimization of Prehospital Care in Contra Costa County
July 8, 2014
Background: As a core function, Contra Costa Emergency Medical Services (EMS) is tasked with assuring timely 911 ambulance availability throughout the county, coordinating the efforts of fire first-responder services in conjunction with ambulance responses, receiving hospitals and specialty care centers to establish the most optimal configuration of the system. The goal of that configuration is to provide safe, effective, and efficient medical care that meets the needs of patients with emergency conditions within the capabilities of the community. In Contra Costa’s EMS system, the level of care provided by EMS responders has evolved over the past three decades. Initially in the early 1980’s, the first-responder component consisted of fire agencies with EMT (emergency medical technician) or first aid levels of training. The ambulance system was configured primarily with EMT-level personnel, with a limited number of paramedic units. Over time, increasing paramedic ambulance units were added, and the ambulance system became all-paramedic 10 years ago. Fire departments began implementing first-responder paramedic programs in the late 1990’s and currently six of nine fire departments are providing first-responder paramedics (covering approximately 75% of responses) while three other agencies -remained at the EMT responder level. As the system evolved, EMS also developed modifications in response to come closer to providing the same relative access to paramedic care in those areas with EMT-level first responders through reduced response times (Richmond) and addition of Quick Response Vehicles (QRVs) in Crockett and east county areas.
The Science and Local Experience of EMS First Medical Response Over the past decade we have had an ample opportunity to observe the performance of our system to assess the utility of first-responder paramedics in both the QRV and first-responder fire setting. As well, we have seen the science of EMS develop world-wide with research that demonstrates which paramedic interventions improve patient outcomes. Well-done research out of Ottawa, Canada (known as the OPALS study) demonstrated that addition of paramedic (advanced life support) care improved outcome in patients with respiratory distress. Similar research from that area has shown that ALS care did not improve outcomes in cardiac arrest or traumatic injuries. In cardiac arrest, providing CPR early defibrillation (basic life support skills) are key interventions. In trauma, early transport along with hemorrhage control and basic airway management (again basic life support skills) appear to be the critical interventions. There are no other large-scale studies showing the benefit of advanced life support in other conditions, although there is growing evidence that early treatment and cessation of seizures improves patient outcomes. As well, it is known that delayed
Contra Costa Emergency Medical Services recognition and treatment of anaphylaxis (severe allergic reaction) worsens outcomes, so it is widely accepted that early treatment is appropriate. Management of hypoglycemia (low blood sugar) is also an accepted urgent treatment – delay in treatment within a few minutes of onset may not make a huge difference in outcome, but depending on the length of time the condition is present prior to EMS activation it is always prudent to treat in a rapid fashion. Clearly there are interventions that provide increased comfort to patients, but the number of time-sensitive treatments that paramedics provide that have been shown to improve outcome are small and the addition of those skills in a system-wide manner in the first-responder setting (both with QRVs and first-responder paramedic fire units) comes at a significant cost for the minimal additional impact to the system. The provision of many paramedic-level interventions in a slightly earlier time frame may lead to earlier relief of symptoms or earlier recognition of conditions, but this care does not lead to significant outcome improvements. The most efficient EMS system configuration is complementary – the pieces fit together in a way to provide the best system without large gaps in care and without significant duplication of services. Ambulances transport patients from the scenes of incidents to hospitals, and then are re-posted to areas of the county that have the best access to the next call. The deployment is -flexible and can take advantage of predictable hourly or daily utilization. First-responder fire units are statically deployed (when engine-based, posted at their stations) and advantageously have presence in some areas with lower volume of calls, geographically placed in locales where ambulances may not tend to be posted (frequently far from hospital facilities). An overlap or redundancy in paramedic care in the system exists in urban and suburban areas where there is a high likelihood of ambulance resources being promptly available. In those areas, first-responder fire units arrive at nearly the same time as ambulance resources, and the duplication of paramedic resources in those situations add minimal or no value to the system.
Fire First Medical Response Funding Recognizing the fiscal commitment fire agencies had to take on to support paramedic first medical response in 2004, the Contra Costa Board of Supervisors (BOS) created funding to support the expansion of paramedic first medical response. The Board was able to do this by redirecting Measure H funds used to subsidize emergency ambulance service.to fire first responders providing a paramedic level of service. In 2013 that funding model was broadened to support all fire first responder agencies service level enhancements the EMS System. The new funding model recognized the science, that all fire service providers enhance EMS Systems, by participating in a coordinated, data driven EMS system of care. The EMS Agency respects that the primary responsibility for fire first medical response rests with the fire district governing bodies. We understand that the board of directors of each fire agency providing first-responder EMS service have the option to choose a level of service that they feel best meets the needs of their communities.
Contra Costa Emergency Medical Services
Quick Response Vehicles (QRVs) Based on 2013 data, we have an ability to look at the impact of QRVs in Contra Costa. Outside the city of Brentwood, time-sensitive interventions provided by QRVs in East County and in Crockett are rarely administered – if one looks at the treatments for cardiac arrest, altered level of consciousness requiring glucose, anaphylaxis requiring epinephrine, and active seizures, those interventions amount to an average of less than 2 episodes per month. Treatment of shortness of breath with albuterol similarly is administered less than twice a month in those outlying areas. Approximately 90% of all QRV calls are responses in Brentwood, and while there are a larger number of calls, the frequency of time-sensitive interventions is even less frequent than in outlying areas, which speaks to the duplication of services that QRVs provide in that setting. Given the minimal clinical impact of QRVs (associated with an extremely low volume of calls in outlying areas and the duplication of efforts in Brentwood), EMS no longer supports the QRV concept in those areas. We believe patients will be better served by the ambulance provider in the future by enhancing ambulance availability rather than to provide QRV services. Among first-responder fire agencies providing paramedic care (excluding the transporting departments of Moraga-Orinda Fire and San Ramon Valley Fire Protection District who generally do not document first-responder interventions separately), critical interventions are also seen in low numbers (again by 2013 data). Time-sensitive interventions are provided in those four agencies (Contra Costa County Fire, Pinole Fire, Rodeo-Hercules Fire and El Cerrito Fire) the order of approximately five times per day in these first-responder fire agencies. While data is not easily available for Moraga-Orinda or San Ramon Valley Fire, it would not be surprising to see a similar pattern in those agencies. Approximately one-half of time-sensitive interventions are related to cardiac arrest. Treatment of shortness of breath with albuterol averages around 1.2 times per day in the four agencies. Treatment of hypoglycemia (low blood sugar) and anaphylaxis (severe allergic reaction) occurs approximately once every other day. Treatment of active seizures occurs approximately twice per month. Overall, important time-sensitive treatments are provided by first-responder fire providers in 2-4% of all calls in which they arrive on scene.
The Value of Fire First Responder Paramedic Care It should not be inferred that there is no value in paramedic care or in first-responder paramedic care – certainly this care provides important medical assessments, –comfort for patients and begins the continuum of care with rare events where earlier critical treatments can be given. While provision of first-responder paramedic care in low-volume (rural) areas and fractional increase in ambulance response times in urban areas does not appear cost-effective, there are
Contra Costa Emergency Medical Services limited suburban areas in which first-responder paramedics more can predictably provide paramedic interventions in an earlier time frame (at times several minutes prior to ambulance arrival). These are generally areas where ambulance responses may be slightly longer on average (typically in areas distant from hospitals). Examples of these areas include but are not limited to the El Cerrito, Rodeo, and the Rossmoor, Clayton, and Bay Point areas of CCCFPD districts-. However, many first-responder units based at fire stations have response areas typically well-covered in a timely fashion by ambulance responses, and first-responder paramedics represent duplication in resources in areas already reasonably well covered by ambulances. While the “squad” concept may more effectively provide first-responder paramedic services in our county is yet unknown – the program recently developed by CCCFPD is small and the patient care impact data sample is also small. It is again recognized that the level of response provided by first-responder personnel is a decision each first responder agency’s governing body must make. But in consideration of optimally structuring the EMS system however, the expenditure of Contra Costa EMS financial resources on first-responder paramedic care does not appear to be cost-effective. The continuation of prior efforts to modify the system to marginally increase paramedic arrival time (with shorter response times in Richmond and QRV placement in other areas) also does not appear to be warranted. We have established previously that fire first-responder services at the BLS (basic life support) level are indispensable in an EMS system to provide critical aid such as early defibrillation. We believe support for those services are vital. Beyond the direct provision of care, there are also necessary costs for infrastructure to support high-quality paramedic-level care for first-responder fire agencies. These costs include training, quality improvement and system oversight. Paramedic-level interventions are not without risk and when skills used are done infrequently, there needs to be additional emphasis on training. In Contra Costa, the EMS training and quality improvement infrastructure in many of the fire agencies is minimal at best, and in our opinion is not currently robust enough to support sustained high-quality training and oversight in those agencies. Fire agencies desiring to provide ALS level care need to be willing and able to support those costs necessary to assure appropriate patient care and safety. Some of the same concerns are certainly applicable to the level of care provided by our 911 ambulance providers. Less than half of the EMS transports require advanced life support skills and less than 10 percent require critical interventions. In many situations, rapid transport is the most important “treatment” provided.
Optimal System Design: Tiered EMS Service Delivery Going forward, Contra Costa EMS wants to consider a tiered 911 ambulance service with provision of both basic life support (EMT) and advanced life support (paramedic) units. Given the abundance of calls for transport of patients with
Contra Costa Emergency Medical Services mental health issues, other transport modalities (neither a BLS nor ALS ambulance) may be appropriate. This is an EMS system re-design that leverages partnerships to provide a comprehensive EMS System of care as part of a broader health care delivery system. In such a EMS System the EMS Agency within its medical control can partner with EMS System stakeholders to create an environment that supports enhancements in patient safety, flexibility and cost savings for service providers using strategic deployment of coordinated EMS System resources.This approach is intended to benefit communities by providing informed choices within their fiscal capabilities. Lastly, to accomplish optimal system function, an essential feature is a high-quality emergency medical dispatch system that can help determine the appropriate level of resources to send to an incident (as well as the appropriate urgency of response). This is fundamental in order to effectively utilize a tiered system and assure that the appropriate level of response is matched to the needs of the patient.
CCEMS 7/5/13
Contra Costa Emergency Medical Services
Guidelines for Fire First Medical Response Population Based Allocation
County Service Area EM1 (Measure H) Funds
July 5, 2013
Measure H Advisory
“Shall a Countywide Emergency Medical Services benefit assessment be established to finance
improvements in emergency medical and trauma care system including expanded countywide
paramedic coverage; improved medical communications and medical dispatcher training; and medical
equipment and supplies and training for firefighter first responders, including training and equipment for
fire services electing to undertake a specialized program of advanced cardiac care(defibrillation)”
Passed November 8, 1988 with 71.6% voter support.
Background: CSA EM-1 (Measure H) is a countywide benefit assessment district under which the
Board of Supervisors (BOS) has established charges on real property to support EMS. The CSA was
established in 1990 following a countywide advisory election demonstrating voter support for a benefit
assessment with annual parcel charges to support enhancements to the county’s EMS System, including
expanded paramedic program services, Trauma, EMS communications, medical training and equipment.
The EMS Agency serves as the BOS designated trusted agent for the administration of Measure H.
CSA EM-1 funds have been used to provide limited but important funding to enhance the EMS system for
different purposes over the years. Some of the most important enhancements in the Contra Costa EMS
System have been funded with seed money from Measure H, typically as "one time" funding to support a
program, technology or other EMS system enhancement due to the Measure H fund limit.
Fire District CSA EM-1 funding allocations were established in 2004 as a Fire First Responder Paramedic
Fund to improve paramedic first responder capability as part of the May 18, 2004 Board order for
ambulance services. Funding distributions were based on a "per engine" formula for man y years ,
however beginning in 2009 fire station closures began to prevent full distribution of funds creating
unintended budget shortfalls for impacted fire agencies.
New Population Based Allocation Formula (CSA-EM1 Zone B Fire Agencies): On May 14th, 2013, a
population based allocation formula to distribute $2,331,133 was adopted to support preserving fire first
medical response to mitigate the unprecedented reductions to fire agency funding. Under this new
formula all fire first responder agencies regardless of first responder service will benefit from Measure H
funds. The new formula also builds in a 25% differential for paramedic service level agencies.
Funding levels for fire agencies with current written agreements will be honored and a population based
"transition" model has been established over the next 2 years, sun-setting at the end of FY 2014-2015.
The EMS Agency views the transition model as an "interim approach" and has recommended to the
Board that Measure H funding be "revisited" after the completion of the EMS System study and as part of
the upcoming ambulance RFP process.
What Will happen to Measure H Fire-EMS Special Project Funding? Since 2004, unallocated
Measure H funds have been made available for special project funding providing an excellent source of
project driven enhancement. Under the new population based formula, fire funding will be fully allocated
each year significantly reducing the availability of Fire-EMS special project funds. Fire agencies should
consider collaboratively contributing a portion of their Fire-EMS funding for joint or regional Fire-EMS
projects under this new funding formula. It is estimated that available special project funding will be
reduced from approximately $500,000 per year to $100,00 year.
CCEMS 7/5/13
Population based Transition Funding Allocations 1
Agency Effective 2013-14 thru FY 2014-15
Population Based Transition Funding
Richmond (BLS) $ 177,670
El Cerrito/Kensington (ALS) $ 119,315
Pinole (ALS) $ 79,543
Rodeo-Hercules (ALS) $ 79,543
Crocket-Carquinez (BLS/volunteer) $ 7,063
Moraga Orinda (ALS/Transport) $ 198,858
East Contra Costa (BLS) $ 180,773
Contra Costa Fire (ALS) $ 1,488,368
Fiscal Year 2015-2016 Funding 2
Agency3 Effective FY 2015-16
Full Implementation of Population Based Funding
Richmond (BLS) $ 223,022
El Cerrito/Kensington (ALS) $ 111,012
Pinole (ALS) $ 49,437
Rodeo-Hercules (ALS) $ 88,004
Crocket-Carquinez (BLS/volunteer) $ 7,063
Moraga Orinda (ALS/Transport) $ 92,748
East Contra Costa (BLS) $ 226,125
Contra Costa Fire (ALS) $ 1,533,722
Written Agreements and New Measure H Utilization Reporting: Measure H first responder allocations
require a written agreement with the EMS Agency. Fire districts without written agreements will need to
establish one prior to distribution of funds. Written agreements will be posted on the EMS Agency
website. Established Fire agencies written agreements will need minor modification to reflect the new
population based funding. All written agreements will include standardized accountability reporting of
fund utilization that must be submitted annually to the County Emergency Medical Care Committee for
review and will be posted on the EMS agency website for transparency.
What Qualifies for Use of Measure H Funding: Measure H funds are dedicated under the ballot
measure to support enhancement of Emergency Medical Services (EMS) and includes advanced life
support (aka paramedic, advanced EMT and EMT expanded scope) pre-hospital care, technology,
equipment, communications, training, medical control, quality improvement and oversight of the practice
of medicine in the field. Funds may not be used to supplant normal "all hazards" fire operations including
differentials for EMS line personnel, vehicles, gasoline and maintenance of non-EMS equipment or
systems. The following is a list of qualifying items consistent with the utilization of Measure H public
funds.
1 The transition funding was approved to support a 2 year period for those fire agencies that would see reduced
funding due to their population base.
2 Measure H funding is subject to change by the BOS in accordance with ballot measure requirements. The EMS
Agency and CAO office has recommended that any new use of Measure H funding be considered after the findings
of the EMS System Modernization project and the CCFPD fire service studies are thoroughly evaluated.
3 In FY 2015-16 Moraga Orinda Fire, El Cerrito/Kensington, and Pinole will have reductions in funding. These
reductions are solely due to the reduced population in those service areas. Population numbers are based on 2010
US Census for the cities in those fire districts.
CCEMS 7/5/13
Qualifying Priorities for Fire-Measure H Fund Use 4
Priority Items Supporting Enhancement in Prehospital Care (Fund First)
Fire agencies should fully fund all staff time and materials dedicated to EMS quality activities and patient care
competency sustainability.
Fire personnel patient care and oversight time associated supporting national EMS performance standards of care
(e.g. Response times, Quality Improvement, STEMI, Stroke, Trauma, EMS for Children, Cardiac Arrest, and Dispatch
Communications) including performance reporting, committees, meetings and workgroups e.g. Medical Advisory
Committee, STEMI Advisory Group, Stroke Advisory Group, Trauma Advisory Group, MCI task force, Quality
Leadership)
Funding of pilot projects for improvement or enhancement of the EMS System (e.g. community and at risk population
programs)
Funding for Advanced EMT or paramedic program development (e.g. training, equipment, patient care oversight)
County approved EMS equipment, medication and supplies including EMS disaster and MCI caches
Fire personnel and support staff time and materials allocated to support national standards for dispatch call processing
time and dispatch quality improvement, oversight of patient care or dispatch (e.g. EMD, ProQA, Dispatch Center of
Excellence)
All fees, upgrades, Fire personnel training and oversight time supporting costs associated with dispatch
software/hardware to maintain a highly reliable process of quality patient care documentation and compliance with pre-
hospital electronic medical records completion.
Instructor and Provider Neonatal and Pediatric EMS equipment and training for EMT/EMT-P to support competency in
the trauma and medical care of infants and children.
Fees, time (Fire-EMS staff, IT staff, Communications/Dispatch staff) and materials associated with enhancing
utilization, sustainability and upgrade of Dispatch software/Hardware to support EMS communications and
Emergency Medical Dispatch e.g. First Watch, ATRUS, AQUA, ProQA
Costs with enhancing, integrating or sustaining communication devices or software platforms to support EMS system
oversight, situational awareness and response (e.g. Pulse Point, Reddinet, EBRECs,ATRUS, First Watch, Zoll)
Fire personnel time and materials supporting competency, training, orientation, classroom or online training supporting
pre-hospital/EMS patient care (e.g. IHI Open School online certification in Quality Improvement and Patient Safety)
Priority Items supporting Sustainability of Enhancement in Prehospital Care
Fire personnel training time and materials to complete BLS and ALS competency checklists (e.g. infrequent skills,
CPR, PEPP, PALS, ACLS, ITLS, EMS System Updates, Fire-EMS quarterly consortium training)
Fire-EMS staff time and materials associated with supporting compliance with EMS system performance reporting as
described in Fire Agency and EMS Agency written agreements (e.g EMS System core patient care performance and
annual reporting)
Fire-EMS personnel time reviewing and compiling EMS system clinical, utilization and performance reports
Fire personnel time and materials to support injury prevention, Heartsafe communities, AED, and CPR programs
Fees supporting accreditation and certification of EMS personnel e.g. certification fees
Fire personnel costs associated with medication inventory, oxygen devices, narcotics control systems
Patient Care Equipment and Patient Care Monitoring Devices, service plans and supplies (e.g.Physio Monitors and
supplies)
Fire personnel time for County Multi Casualty plan exercises and training development, implementation and
participation
Acquisition and replacement costs to support and sustain specialty EMS equipment (e.g. Lucas Devices, AEDs)
Fire HazMat training and exercises that includes triage and decontamination of patients or personnel
Fire Infection Control Officer staff time and infection control/personnel protective equipment training of EMS personnel
4 This is not intended to be an all-inclusive list. Please contact the EMS Agency Director if your Fire-EMS activity is
not listed to assure it meets Measure H criteria for enhancement of the EMS system.
Fire Subtotal, $2,811,721, 60%Sheriff Subtotal, $250,000, 5%EMS System Programs and Studies Subtotal$775,907, 17%County Subtotal, $817,500, 18%Measure H Fire and Non‐Fire Distributions2013‐14 Projected Annual AllocationsTotal Allocation $4,655,128