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HomeMy WebLinkAboutMINUTES - 12121995 - C46 t�l To: BOARD OF§UPERVISORS N. FROM: Mark Finucane, Health Services Director - �"�� � '�. Contra Costa DATE: December 19, 1995 ��e « County sTq. .. SUBJECT:' Emergency Medical Services System Plan SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION RECOMMENDATION: A. Approve the Contra Costa County Emergency Medical Services System Plan, dated November 1995 as the official plan for the development of Contra Costa County's Emergency Medical System. B. Authorize the Contra Costa County Health Services Department to submit the approved plan to the California State Emergency Medical Services Authority for approval. BACKGROUND: California Health and Safety Code Division 2.5 requires that each local EMS Agency submit an EMS Plan, developed in accordance with State guidelines, to the State EMS Authority (SMSA). The Board approved Contra Costa County's first EMS System Plan on August 14, 1985, which was forwarded to and approved by SMSA. In June 1993, the EMS Authority introduced updated standards and guidelines which reflected the growth of EMS throughout California. These standards and guidelines include components for manpower and training; communications; transportation; assessment of hospitals and critical care centers; system organization and management; data collection and evaluation; public information and education; and disaster response. Updated local EMS System Plans based on these new standards are now required. The 1995 EMS Plan has been developed over a sixteen month period with representatives of over sixty agencies in the EMS system serving on one or more of eight ad hoc specialty committees. The Plan was developed in accordance with the California EMS Authority's guidelines and is written in the required format. The Emergency Medical Care Committee approved this plan on September 13, 1995. FISCAL IMPACT: There is no General Fund impact. CONTINUED ON ATTACHMENT: E'S SIGNATURE RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE APPROVE _OTHER SIGNATURE(S): ACTION OF BOARD ON IZ _ I -I�IJ APPROVED AS RECOMMENDED V000' OTHER VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE UNANIMOUS (ABSENT ) AND CORRECT COPY OF AN ACTION TAKEN AYES: NOES: AND ENTERED ON THE MINUTES OF THE BOARD ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN. Contact: Emergency Medical Services 646-4690 CC: Health Services Administration ATTESTED _ I a 19 Emergency Medical Services PHIL BATCHELOR,CLERKO THI BOARD OF SUPERVISORS AND COUNTY ADMINISTRATOR BY DEPUTY CO 1 •( 1, � � \ � ( 11 - � � � J � _ � � r s •.count of Contra r�Cost�a ) Emergency Medical , Services, . , t, ., '' � l , 11 � .' '` .. I � i n � � � 1 � •, , i 1 �- ''�' � \I .\. / Nowernber 1 , 19951` Lr` r 6� ( ... <> 4 / U .J i. r� :::• A i c , \ 1 f .. Jr e .... i < I :I 1 - - e r I:. r 1� \ a a. \ - n ` i 1 \ / 1 \• �� .r r 'fit ,' SECTION TABLE OF CONTENTS PAGE INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 GEOGRAPHIC INFORMATION . . . . . . . . . . . . . . . . 2 A. General Description of the Area . . . • . • . • . . • • . . . . . • 2 B. Transportation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 C. Climate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 DEMOGRAPHIC INFORMATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 A. Population . . . . . . . . . . . . . . . 5 . . . . . . . . . . . . . . . . . . . . . . . B. Recreation and Points of Interest 5 C. Major Industry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 D. Epidemiological Characteristics . . . . . . . . . . . . . . . . . . . . . . . . 6 E. EMS System Overview 18 1. Delivery of EMS Services . . . . . . . . . . . . . . . . . . . . . . . 18 2. County Service Area EM-1 (Measure H) Funding . . . . . . . . 19 SECTION I EXECUTIVE SUMMARY/OVERVIEW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 A. Purpose 23 B. Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 C. Local EMS Agency Functions . . . . . . . . . . . . . . . . . . . . . . . . . 25 D. Overall Program Priorities/Direction . . . . . . . . . . . . . . . . . . . . . 26 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 New Direction/Philosophy . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 EMS System Management and Organization . . . . . . . . . . . . . . . 27 EMS Medical Director . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Staffing and Training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Communications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Response and Transportation . . . . . . . . . . . . . . . . . . . . . . . . . 29 Facilities and Critical Care . . . * * * , , , " , , * * , , * , " , * . . . * * * 30 Data Collection and System Eval . . . . . . . . . . . . . . . . . . . 30 Public Information and Education . . . . . . . . . . . . . . . . . . . . . . . 31 Disaster Medical Response 32 SECTION II . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . SYSTEM ASSESSMENT 35 System Organization and Management . . . . . . . . . . . . . . . . . . . . . . . 37 Staffing/Training • . , . . • . . . • • . . . • . , • . . . . . • . . . • . . , . . • ' . 65 Communications 77 Response and Transportation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 Facilities and Critical Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 Contra Costa EMS Plan Page i 1 SECTION TABLE OF CONTENTS PAGE Data Collection and System Evaluation . . . . . . . . . . . . . . . . . . . . . . 123 Public Information and Education . . . . . . . . . . . . . . . . . . . . . . . . . . 134 Disaster Medical Response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138 SECTION III SYSTEM RESOURCES AND OPERATIONS . . . . . . . . . . . . . . . . . . . . . . . . 157 EMSA TABLE 1 : Summary of System Status . . . . . . . . . . . . . . . . . 159 A. SYSTEM ORGANIZATION AND MANAGEMENT . . . . . . . 159 B. STAFFING/TRAINING . . . . . . . . . . . . . . . . . . . . . . . . . 162 C. COMMUNICATIONS . . . . . . . . . . . . . . . . . . . . . . . . . . 163 ' D. RESPONSE/TRANSPORTATION . . . . . . . . . . . . . . . . . . 164 E. FACILITIES/CRITICAL CARE . . . . . . . . . . . . . . . . . . . . . 166 F. DATA COLLECTION/SYSTEM EVALUATION . . . . . . . . . . 167 G. PUBLIC INFORMATION AND EDUCATION . . . . . . . . . . . 168 H. DISASTER MEDICAL RESPONSE . . . . . . . . . . . . . . . . . 169 SYSTEM RESOURCES AND OPERATION . . . . . . . . . . . . . . . . . . . . . 171 EMSA TABLE 2: System Organization and Management . . . . . 171 EMSA TABLE 3 - Personnel/Training . . . . . . . . . . . . . . . . . . . 178 EMSA TABLE 4 - Communications . . . . . . . . . . . . . . . . . . . . . 179 EMSA TABLE 5 - Response/Transportation . . . . . . . . . . . . . . . 180 EMSA TABLE 6 - Facilities/Critical Care . . . . . . . . . . . . . . . . . 182 EMSA TABLE 7 - Disaster Medical 183 RESOURCES DIRECTORY TABLES . . . . . . . . . . . . . . . . . . . . . . . . . 185 EMSA TABLE 8 - Providers . . . . . . . . . . . . . . . . . . . . . . . . . . 185 EMSA TABLE 9 - Approved Training Programs . . . . . . . . . . . . 192 ' EMSA TABLE 10 - Facilities . . . . . . . . . . . . . . . . . . . . . . . . . 195 EMSA TABLE 11 - Dispatch Agency 200 SECTION VI APPENDICES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203 APPENDIX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205 Definitions and Abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205 ANNEX AB 3153 Compliance ( Section 1797.224 H&SC) . . . . . . . . . . . . . . . . . . . 209 ANNEX II I Trauma Care System Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217 Page ii Contra Costa EMS Plan ''-' i r INTRODUCTION This Contra Costa County Emergency Medical Services (EMS) Plan has been developed through an extensive process with input from a wide variety of EMS system participants. The Contra Costa County Health Services Department engaged the assistance of the EMS consultants, The Abaris Group, to facilitate the process. The Plan development process included interviewing a multitude of syst m participants and stakeholders. Representatives from first responder organizations, receiving hospitals, base hospitals, fire departments, ambulance services, physician groups, the EMS Agency, elected officials, and other government staff were interviewed in order to develop appropriate standards, goals, and objectives for this EMS Plan. Eight task forces were formed to develop the conceptual framework for the EMS Plan. Their input was invaluable in establishing a comprehensive plan to meet the diverse needs and challenging environment characteristic of Contra Costa County. The ultimate goal of the EMS Plan is to define an effective and efficient EMS system which will continue to assure consistent, high-quality emergency medical services to the residents and visitors of Contra Costa County using available resources. Other important considerations include providing a fiscally stable and responsible system, means for community involvement in defining the level of emergency medical services, and development of a system that can withstand future challenges and thrive. ~ `E Contra Costa EMS Plan Page 1 GEOGRAPHIC INFORMATION ' A. General Description of the Area Contra Costa County is located in the Bay Area of California and encompasses an area of 720 square miles. The boundary of the County extends from the San Pablo Bay, Carquinez Strait, and the Sacramento River Delta on the North (Marin, Sonoma and Solano Counties), Alameda County on the South and Southwest, San Joaquin County on the East, and San Francisco Bay on the West. The landscape is characterized by rolling, oak-covered hills and urbanized valleys. Although the County is California's ninth smallest in geographical size, it is the ninth largest in population. Contra Costa County is commonly divided into three regions which reflect , variations in terrain and industry. West County, which includes the cities of EI Cerrito, Hercules, Pinole, Richmond, and San Pablo, contains the County's heaviest industry and is the location of major oil and chemical plants. Central County, which includes the cities of Clayton, Concord, Danville, Lafayette, Martinez, Moraga, Orinda, Pleasant Hill, San Ramon and Walnut Creek, has the highest population density and is the County's major employment center. The central portion of the County.is sometimes further divided into the Central and San Ramon Valley Regions. East County, which includes the cities of Antioch and Pittsburg, has strong service, retail and manufacturing industries, as well as some agricultural lands in its eastern regions. East County is sometimes further divided into the Antioch-Pittsburg Region and the Far-East Region. B. Transportation The automobile is the predominate form of transportation in Contra Costa County. U.S. Interstate 680 bisects the County in a north/south direction and connects Concord to San Jose and Sacramento. U.S. Interstate 80 runs along the western edge of the County and connects Richmond to Sacramento and San Francisco. State Highway 24 runs east-west linking Interstate 680 at the City of Walnut Creek to Interstate 80 at Oakland. State Highway 4 runs east-west, linking Interstate 680 (at the city of Martinez) to Interstate 80 (at Hercules). U.S. Interstate 580 links Richmond to San Rafael. There is a Page 2 Contra Costa EMS Plan = %� network of county and city roads which provide access among incorporated cities, agricultural lands and rural communities of the County. Bay Area Rapid Transit (BART) maintains 34 stations (8 of which are within the County) that provide public transportation to many Bay Area communities between 6:00 A.M. and midnight. BART is the means of transportation to work for 5.5 percent of County residents. The end line stops are located in Daly City, Fremont, Concord, and Richmond. There are current plans to extend service to Pittsburg and Antioch. In addition, most of the cities in ' Contra Costa County offer public bus services which provide transportation to work for around 1 .6 percent of County residents. Amtrak maintains stations in Martinez, Richmond and Antioch. Interstate bus service is available at a station in San Pablo. San Francisco and San Pablo Bays and the Sacramento River Delta offer significant water transportation options to major industry located in the County. San Francisco and Oakland International Airports are located anywhere from r30 minutes to two hours from locations within Contra Costa County. Both these airports offer daily flights with many major airlines. Oakland Airport has public transportation services linked to BART. Buchanan Field and the new Byron Airport, both metropolitan airports that offer air taxi, charter and training services, are also located within the County. C. Climate The Contra Costa County area has a Mediterranean climate with mild winters and warm summers. Precipitation falls almost entirely between November and March and averages about 18.4 inches per year. Concord averages 72"F in July with an average high of 90'F and 46"F in January with an average low of 38`F. Occasional late-night frosts occur during the winter months, but continuous freezing temperatures are not experienced outside of the mountain regions of the area. Short-lived snow at the top of 3,849 ft. of Mt. Diablo is common. Coastal and Valley fog is common in during some seasons, though it often burns off by midday. This fog can become dense at the higher elevations. Please see Figure 1 for a map of Contra Costa County. <.. '" ' Contra Costa EMS Plan Page 3 DEMOGRAPHIC INFORMATION A. Population According to the 1990 Census, Contra Costa County's population in 1990 was 803,732. Population projections place the County's population at around 891,200 in 1995,969,700 in 2000, 1,040,400 in 2005 and 1,104,700 in 2010 as shown in Table 1 . Using the 1995 projection, the population density for Contra Costa County is around 1,238 persons per square mile, which places the entire County in the urban classification using the United States Census Bureau's definition. Out of the 161 census tracks in the County, 158 are categorized as urban. In 1990, there were only 14,272 County residents living in rural areas. Between the years 1990 and 2010 the , population is expected to increase by around 300,000 (37 percent) with much of the growth occurring in East County. Tables 2 through 4 provides an overview of population, age and other demographic indicators for Contra Costa County. Of significance is the population over 65 years (10.9 percent), which is comparable to California as a whole (10.5 percent), and the population living below the poverty line (7.3 percent) both of which impact emergency medical services. B. Recreation and Points of Interest Contra Costa County is an integral part of the greater Bay Area which is famous for numerous and diverse recreational opportunities. Within Contra Costa County alone, there are 16 art galleries, 6 museums, 7 historical sites and 9 regional and state parks. Mt. Diablo (3,849 ft) offers extensive views ' and with 19,000 acres, the park offers many attractions to its visitors including camping, hiking, rock climbing and horseback riding. The Concord Pavilion, located at the base of Mt. Diablo, is the site of many top performances in the Bay Area including an annual Jazz Festival. San Pablo and Briones Reservoirs provide areas for boating, fishing, hiking and picnicking. The Sacramento Delta, which borders the County to the north, is available for waterskiing, fishing and boating. Cultural activities are also a common feature offered by Contra Costa County. Page 4 Contra Costa EMS Plan The County boasts a total of 12 theater companies, 4 ballet companies, 4 orchestras and 4 opera houses. Nearby Alameda and San Francisco Counties also have much to offer and U.C. Berkeley, which is only 20 minutes away, often presents top artists and performers from around the world. Chinatown, North Beach and Golden Gate Park are popular sites in San Francisco. California's famous Wine Country is 40 minutes away, Monterey Bay and Carmel are 2 hours away, and the Sierra-Nevada Mountain Range is around 3 hours away. ' C. Major Industry Much of the future job growth in Contra Costa County will be in computer related services, especially in Central County where most of the County's office space is located. In West County, biotechnology is a growing ' occupational field. Chevron Corporation, Bank America Corporation, Pacific Bell and the County of Contra Costa are the largest employers in the County with over 35,000 employees collectively in 1993. Service is the strongest industry in the County in terms of the number of persons employed. Retail trade followed by manufacturing, and finance/insurance/real estate are the rnext three strongest industries. A fair number of migrant workers enter the East County to work in the agricultural fields. Due to the transient nature of their work, these migrant workers generally have not had adequate access to primary health-care services and may enter the health-care through emergency medical services. D. Epidemiological Characteristics Statistics from the California Department of Health Services reveal that the major causes of death in Contra Costa County are heart disease and cancer which is the consistent with the trend throughout California and the United States. Table 5 presents selected data regarding cause of death in Contra Costa County and in the State as a whole. It is noted that, with the exception of homicides and cancer, Contra Costa County has a lower death rate in the categories reviewed compared to the State as a whole. This may reflect the quality of current emergency medical services. Contra Costa EMS Plan Page 5 Injuries and their sources have been a major priority for the public health ' system and the EMS Agency in Contra Costa County. Voters in Contra Costa County were first in the nation to approve an action plan for violence prevention. Table 6 demonstrates that poisonings is the leading cause for t hospitalization in Contra Costa County for intentional injuries. Firearms are the number one cause of death for the same category. Table 7 shows that 1 unintentional deaths accounts for 54.7 percent of the deaths by injury for the County. Table 8 demonstrates the leading causes of injury death for children. The leading cause is motor vehicles at 41 .6 percent followed by firearms at 25.7 percent. Table 9 demonstrates that motor vehicles are the leading cause of child hospitalizations in Contra Costa County followed by falls (19.8 ' percent) and other vehicles (9.9 percent). Table 10 is a breakdown of injury by County area. i 1 . 1 1 1 1 1 Page 6 Contra Costa EMS Plan .f- Table 1 CONTRA COSTA COUNTY ' Population Projections 1200 1 1000 800 Z O F= � 600 O a 400 •West County 6Central County 200 ©East County @Total CountyV I 0 1980 1990 •1995 2000 2005 2010 YEAR S Contra Costa EMS Plan Page 7 Table 2 Contra Costa County Population Projections By Region City Region 1996 2000T 2005 2010 Antioch East 76,700 93,500 106,300 113,200 Brentwood East 14,100 24,000 33,200 43,700 Clayton Central 10,300 12,100 13,500 14,000 Concord Central 117,000 121,000 124,800 129,100 Danville Central 36,600 40,600 43,200 46,400 EI Cerrito West 29,800 30,000 29,900 30,100 Hercules West 19,900 21,700 22,700 23,600 ' Lafayette Central 25,900 26,000 26,400 27,200 Martinez Central 42,300 43,900 44,800 45,500 Moraga Central 16,100 16,200 16,600 16,600 Orinda Central 17,100 17,300 17,400 17,900 Pinole West 28,200 29,000 29,400 30,300 Pittsburg East 72,500 79,300 86,900 90,900 Pleasant Hill Central 41,400 42,400 43,000 43,800 Richmond West 109,500 114,000 118,500 119,200 San Pablo West 29,700 32,000 32,600 33,400 San Ramon Central 40,600 41,900 43,800 46,500 Walnut Creek Central 75,700 77,900 79,700 81,100 Alamo-Blackhawk Central 24,900 25,800 25,900 26,000 Rodeo-Crockett West 12,100 12,100 12,100 12,100 Rural East County East 37,900 48,700 63,000 79,500 Remainder Central 12,900 19,100 26,800 34,600 TOTAL ALL 891,200 968,600 1,040,50 1,104,70 0 0 Source: 1990 U.S. Census, ABAG Regional Data Center, Contra Costa County. Page 8 Contra Costa EMS Plan Table 3 Age Distributions Contra Costa County 1990 Census ' A-ge Group West County Central County East County Total County aercent of total population 0-4 8.0% 5.8% 9.8% 7.2% 05-24 27.0% 25.2% 30.1% 26.7% 24-44 34.3% 35.2% 36.4% 35.2% 45-64 18.8% 22.1% 15.9% 20.0% >65 11.9% 11.7% 7.8% 11.0% Total Population 213,268 425,461 165,003 803,732 Median Acle 33.8 36.1 30.3 N.A. Source: 1990 U.S. Census, ABAG Regional Data Center, Contra Costa County. '' Contra Costa EMS Plan Page 9 Table 4 Contra Costa County 1990 Census Summary Population: Total 803,732 ' White 69.7% Black 9.1% Asian/Pac Island 9.2% Nat Am/Aelut/Eskimo 9.2% Hispanic 11.4% Other 0.2% , Population over 65 Years 11.0% Persons Below Poverty 7.2% Births 13,589 Deaths 5,626 Net Migration 6,850 Housing Units: Number 316,170 Mean Value $254,100 Number of New Units 1990-1993 19,368 Persons per Household 2.64 Mean Monthly Costs: With Mortgage $ 1,395 Without Mortgage $ 242 Median Rent $ 642 Vacancy Rate 6.4% Mean Family Income $ 61,988 ' Mean Travel Time to Work 29.3 min Source: 1990 U.S. Census, ABAG Regional Data Center, Contra Costa County 1 Page 10 Contra Costa EMS Plan t ' Table 5 Contra Costa County 1993 Death Rates for Selected Causes per 100,000 Residents SLocation: California Contra Costa Co Disease/Condition Population: 31,522,000 852,750 Acute Ischemic Heart 55.9 49.5 Accidnets & Adverse Efects 30.3 28.1 -Motor Vehicle Traffic Accidents 13.6 10 Cancer 161 169.7 Heart Disease (all causes) 220.8 203 ISuicide 12.1 10.1 Homicide 13.3 14.8 Source: California Department of Health Services, Health Demographics Section '� Contra Costa EMS Plan Page 11 Table 6 Contra Costa County Leading Causes of Death/Hospitalization Due to Intentional Injury(1991) Rate per 100,000 ®Injury Deaths Hospitafizations GD 40 30 20 10 0 :L Firearms Poisoning Cuiffe w t hmmed F%ft Straudation Sourcm Ca6fomia Department of Health Services Office of Statewide Health Planning and Development a.ti Page 12 Contra Costa EMS Plan =" _r Table 7 Contra Costa County Injury Deaths by Intent of Injury(1988-1992) (20.4%)Homicide - (54.796)Urrntentianal (24.4°6)Suctide (0.5%)Undetenidned • total=2'� rSouroe:California Department of Health Services Table 8 Contra Costa County Leading Causes of Chid Injury Death(1988-1990) (10.996)other injuries (4.0%)l (55.0° txowrun9 (3.0%)Fue&Burris (9.9%)Suffocation (25.7%)Firearms (41.6%)Motor VeNdes Trial=181 Source:Cardornia Health Servioes Department r'_' Contra Costa EMS Plan Page 13 Table 9 Contra Costa County Causes of Child Injury Hospitalization(1986-1988} (41.6%)Motor Vdides (2.0%)Firearm (8.9%)other (5.096)Fais«dr�g (9.9%)OUw Vehicles (19.8%)Falls (3.0%)SoEfxJS'IraVA-don (5.0%)Blurt O*cts (&0%)tuttkg aid PiemhV 7ck�=1.315 Source:Childhood Injury Project:OSHPD/UCSF Patient data from John Muir Medical Center and Oakland Children's Hospital. Page 14 Contra Costa EMS Plan Table 10 rCountra Costa County Injury Hospitaf¢ations by County Region(1986-1988) 0 0-5 yrs ®1417 yrs HmI*armations per 100,000 peryear 9 6-13 yrs ®all ages<18 yrs 1200 1000 800 600 400 200 0 West Courdy C tral Courcy Sarth Carriy East Carly Region of County Source:Childhood Injury Project,OSHPD/UCSF. ' Contra Costa EMS Plan Page 15 cD U2 d tx 1�O O� 1�� t 0 U c c� c M F M i } b A t flm�- its � Yl ,4 E. EMS System Overview 1. Delivery of EMS Services EMS services in Contra Costa County are typically provided in response to a medical emergency reported through the 9-1-1 emergency telephone system. A 9-1-1 call placed from a telephone is automatically routed to the appropriate designated Public Safety Answering Point (PSAP). A dispatcher or complaint operator at the PSAP determines the nature of the emergency and, if the PSAP is part of a fire/medical dispatch center, obtains information necessary to dispatch the appropriate response units. If the PSAP is not part of the fire/medical dispatch center, the call is transferred to a "secondary PSAP" where a dispatcher then obtains the necessary information to dispatch fire and medical units. The initial response to a potential life threatening incident includes both a fire 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.... Firefighters are trained and equipped to provide extrication and rescue, first aid, and cardiac defibrillation tecfiniques. Emergency ambulance service in most of the County is provided by a private company, American Medical Response West (formerly Regional Ambulance) under contract with the County. In San Ramon Valley and Moraga Fire District areas, emergency ambulance service is provided by the fire service also under contract with the County. 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). Ambulances may be staffed with personnel trained at either the EMT-Paramedic or EMT-I level. Advanced life support (ALS) ambulance units are staffed with two paramedics and are dispatched to potentially life threatening incidents. Paramedics work under direction of base hospital physicians and nurses and are able to administer life saving drugs and perform other invasive life saving procedures. Basic life support (BLS) ambulances are staffed by two •��-""' Contra Costa EMS Plan Page 17 EMT-I's and may be used for non-emergency response or to provide additional support at an emergency incident. In some areas, first responders may respond to medical emergencies in an ambulance vehicle rather than an engine. This provides backup transport capability to the paramedic ambulance in the event there are multiple victims or delays in the paramedic ambulance response. Patient treatment and transport are carried out under State and local EMS policies and procedures. These policies may include, in the case of paramedics, making contact with a Mobile Intensive Care Nurse (MICN) or a physician at a designated base hospital to obtain direction in management and/or hospital destinations of the patient. Patients are then transported to the appropriate hospitals. Hospital destination determination is based upon County EMS protocols and/or patient preference. Critical patients must be directed to the nearest emergency department or to a trauma center. Non-critical patients may be transported to a hospital of choice within reasonable travel time. Medical helicopter service is available to transport critical patients when ground ambulance transport time would be excessive. CALSTAR, one of eight medical helicopter services authorized to respond to EMS calls in Contra Costa, maintains a 24-hour helicopter unit staffed by specially trained flight nurses based at Buchanan Field in Concord. Other helicopter services are available to respond from neighboring counties if CALSTAR is unavailable and/or special additional resources are required. 2. County Service Area EM-1 (Measure H) Funding In 1988, the voters of Contra Costa County passed county-wide Measure H providing for enhancements to the EMS system including increased paramedic ambulance service, additional medical training and equipment for firefighter first responders and an improved EMS communications system. Following a 71 .6 percent affirmative vote, the Board of Supervisors, with the support of the 18 city councils, formed County Service Area EM-1 to levy charges on real property as specified Page 18 Contra Costa EMS Plan `- in Measure H. Annual assessments are limited to two single benefit 0 units for a single family residence. Commercial and industrial properties are assessed multiple benefit units depending upon the use code classification of the parcel. For FY 1994-1995, the assessment rate per unit was $9.22 for all areas of the County except the San Ramon Valley. The rate in San Ramon Valley was $3.95, the lower rate reflecting that there is no ambulance subsidy in that area. Measure H assessments have been used to add six staffed paramedic ambulance units to respond to 9-1-1 calls; to establish a firefighter first responder defibrillator program; to purchase semiautomatic defibrillators for all fire response units; to purchase medical supply caches for use in multi- casualty and disaster response; to upgrade the Medical Emergency Disaster Area Response System (MEDARS) radio system used for ambulance-to-hospital communications; and to upgrade the dispatch system and dispatcher preparedness. A summary of emergency ambulance response data is provided in Table 11 . Table 11 Emergency Ambulance Responses j1991 1992 1993 1994 All EMS Ambulance Responses 39,496 100.0% 40,780 100.0% 43,774 100.0% 44,473 100.0°x6 Code 3 (emergency, lights & 33,110 83.8% 33,997 83.4% 36.484 83.3% 36,172 81.3% sirens) 18.7% Code 2 (emergency, no lights & 6,386 16.2% 6,783 16.9% 7,290 16.7°x6 8,301 siren) American Medical Response 36,691 92.9% 37,737 92.5% 40,650 92.9% 41,329 92.9% San Ramon Fire 2,330 5.9% 2,491 6.1% 2,561 5.9°x6 2,613 5.9% Moraga Fire 475 1.2% 552 1.4% 563 1.3% 531 1.2% Transport 29,057 73.6% 29,774 73.0% 30,886 70.6% 31,332 70.5% No Transport (Dry Run) 10,439 26.4% 11,006 27.0% 12,888 29.4% 13,141 29.5% Average Code 3 Response Time 6.91 minutes 6.11 minutes 6.85 minutes 6.87 minutes Source: Contra Costa County EMS Agency Response times are from receipt of call to arrival of ambulance. ' Contra Costa EMS Plan Page 19 SECTION EXECUTIVE SUMMARY/OVERVIEW SECTION 1 - EXECUTIVE SUMMARY AND OVERVIEW A. Purpose The Emergency Medical Services (EMS) Plan for Contra Costa County is a description of the current capabilities and future goals of the EMS system in the County. The purpose of this plan is to comply with the California Health and Safety Code and provide direction to the EMS system as defined by the Contra Costa County Board of Supervisors. It is intended to provide an organized and logical guide toward assuring the highest quality of emergency care to all in Contra Costa County. This plan recognizes that a vast partnership of organizations, institutions and individuals form the nucleus of a quality EMS system. It is only through this partnership and adherence to the highest standards of care that the goals of this plan will be achieved. B. Background During 1966, the so-called EMS "White Paper" titled "Accidental Death and Disability: The Neglected Disease of Modern Society," identified deficiencies in providing emergency medical care in the country.' This paper was the catalyst to spurring federal leadership toward an organized approach to EMS. Through enactment of the 1966 Highway Safety Act, the States' authority to set standards and regulate EMS was further reinforced and encouraged. This Act also provided highway-safety funds to buy equipment and train personnel. During 1973, the Emergency Medical Services Act (PL-93-154) was-enacted to promote development of regional EMS systems. Fifteen program components were recognized as essential elements of an EMS system. During 1981, this program was folded into the Preventive Health and Health Services (PHHS) Block Grant Program. The original "White Paper," the accompanying Highway Safety Act, the Emergency Medical Services Act and subsequent block-grant programs have contributed significantly to the improvement of EMS across the country. National Committee of Trauma and Commitlx on Shock."Accidental Death and Disability:The Neglected Disease of Modem Society," Washington D.C.,National Academy of Sciences/National Research Council,1966 J [` Contra Costa EMS Plan Page 23 Early in California, this improvement took the form of increased standards for vehicle licensing and personnel certification. Emergency Medical Technician (EMT) training was required for ambulance personnel, as were ambulance inspections by the California Highway Patrol. Unbridled growth of ambulance services and the difficulty of monitoring ambulance providers and their personnel led some communities to limit the number of transport ambulance services serving their communities. These communities relied on licensing ambulance services into designated service areas and limited new licensees. For the most part, franchising was limited to monitoring equipment and controlling patient charges and did not begin to address the broad-ranged needs of an EMS system. Significant State EMS direction and a leadership component for development of EMS systems began occurring in 1981 with the establishment of State law and the California EMS Authority. After considerable debate, the California State Legislature enacted the "Emergency Medical Services System and . Prehospital Emergency Medical Care Personnel Act" (Health and Safety Code 1797, et seq.). This law specifically authorized local EMS agencies to "...plan, implement, and evaluate an emergency medical services system...consisting of an organized pattern of readiness and response services.... " (Health and Safety Code 1797.204). The Act further authorized local EMS agencies to plan, implement and monitor limited advanced life support and advanced life support programs. During 1985 and pursuant to Section 1797.103 of the California Health and Safety Code, the California EMS Authority promulgated Emergency Medical ` Services System Standards and Guidelines. These recently revised guidelines describe basic components and general function of an EMS system as follows: 1 . Staffing/Training 2. Communication 3. Res ponse/Transportation 4. Facilities/Critical care 5. System organization and management 6. Data collection/System evaluation 7. Public information and education 8. Disaster medical response Page 24 Contra Costa EMS Plan f i During 1990, it was apparent that EMS in California had surpassed these original published standards, and, in the intervening years, new regulations had been adopted (i.e., trauma, EMS dispatching standards, etc.) necessitating updating the document. New standards and guidelines were issued and adopted in 1994. C. Local EMS Agency Functions The principal functions of a local EMS Agency are specified in the State Health & Safety Code. These include: ► Planning, implementing, and evaluating emergency medical services. ► Monitoring and approving EMT-1, paramedic, and Mobile Intensive Care Nurse (MICN) training programs. ► Conducting certification/accreditation/authorization and licensing programs for EMT-I's, EMT-P's and MICN's. ► Authorizing advanced life support (ALS) programs. ► Establishing policies and procedures for medical control of the EMS system, including dispatch, patient destination, patient care, and quality improvement. ► Establishing ordinances and/or exclusive operating areas for the regulation of ambulance services. P. Developing and implementing a trauma system plan. The Contra Costa County Board of Supervisors has further charged the Health Services Department as local EMS Agency with the following responsibilities: r ► Monitoring interfacility patient transfers. NO. Implementing EMS program enhancements funded under County Service Area EM-1 (Measure H). , Additionally, the EMS Agency is the lead agency responsible for: ► Planning and coordinating disaster medical response. ► Administering the County Ambulance Ordinance and monitoring the ambulance contracts. Contra Costa EMS Plan Page 25 To accomplish these functions, the EMS Agency employs a full time staff of nine persons, including the EMS Director, Program Coordinator, two Prehospital Care Coordinators, Trauma Coordinator, Training Coordinator, Administrative Aide, and two clerks. D. Overall Program Priorities/Direction M Overview The Contra Costa EMS Agency is responsible for planning, administering, monitoring and evaluating the EMS system in Contra Costa County. This plan identifies key expectations, needs, program priorities, objectives and actions for each of the eight EMS system components. This plan also introduces a new document, EMS Master Plan for First Responder Services, which will be developed to assure the logical and orderly development of first responder services in the County. It is the intent of this plan to provide a clear, and orderly framework for implementing a comprehensive EMS system for Contra Costa County. New Direction/Philosophy The overall philosophy in this plan is to pro-actively map a strategy for the EMS system of the future. This will involve challenging the basic assumptions of EMS system delivery, validating appropriate systems, recommending revised approaches when the historical method cannot be documented to be the appropriate method for achieving quality and efficiency. One significant area to be explored is the existing prehospital delivery model. The health care industry and payers have been stressing the need for more accountability and documentation as to the outcome of current methods for responding to requests for emergency assistance. Fire and private EMS agencies within the County have begun to investigate their future roles in EMS. Other counties in the State are developing models for alternative EMS patient response and treatment approaches that may be more appropriate for their specific needs and keep emergency medical resources available for high- risk patients. f Page 26 Contra Costa EMS Plan =%% The method to achieve this effort will be through participatory planning with extensive use of advisory committees steered by a revamped and revitalized Emergency Medical Care Committee. All planning and potential alternatives evaluated and implemented will be tied to a comprehensive management ' information system (MIS) and continuous quality improvement (CQI) process. Collaborative planning with, all system participants, including health care providers and payers, will be encouraged. The premise will be quality, efficiency, outcomes and validation based on parameters defined by the advisory groups. Key ingredients to this effort are outlined below based on the objectives written in this plan. EMS System Management and Organization To achieve the goals of this plan and obtain participatory input, it will be necessary to review and revamp the advisory committee structure for the EMS system. This revision should include reconstituting the Emergency Medical Care Committee (EMCC) membership, mission and expectations. The EMCC should continue in its oversight function but expand its charge to include the broad-based planning steps called for in this plan. To accomplish this task, seven advisory committees would be formed as subcommittees of the EMCC with active charges to accomplish the specific goals of this plan. Medical audit committees would be the responsibility of the Assistant Medical Director. The Measure H Oversight Committee should be linked into the EMCC hierarchy. Some of the subcommittees may initially start with a small, working task force to accomplish the early investigation and planning necessary to achieve their specific goal. Existing advisory committees and task forces would fold into these subcommittees. The EMCC and its subcommittees should be advisory to the County Health Services Director through the EMS Agency. Supportive to this plan is the refocusing of EMS system activities on proactive planning. One key ingredient is the need to review EMS Agency staff functions and assignments. A reassessment of staff service lines with a view towards realignment towards the priorities and goals of this plan is needed. Assignments of existing functions may be consolidated or integrated with new '�' Contra Costa EMS Plan Page 27 responsibilities. Existing. staff and expertise exist within the EMS Agency to accomplish these roles with the exception of the management information system area. A management information specialist will be needed to provide the expertise and direction to support the information needs of this plan and to assist with supplying the critical foundation of the quality improvement commitment in this plan.. Outside expert help may be needed to temporarily support technical planning (e.g., Communication planning, MIS design) or to provide temporary assistance in the planning process (e.g., CQI Plan, Public Information and Education Plan). Figure 2 provides an organization chart of the proposed EMS system configuration. EMS Medical Director Currently, EMS medical direction comes from the County Health Officer with support from a part-time EMS medical director position and the advisory committees. This plan calls for redefining the roles and job description of the EMS medical dire. ctor for a formal half-time EMS system medical director or assistant medical director. This medical director will be experienced in emergency medicine and emergency medical systems. The assistant medical director will report to the EMS Agency and the Health Officer and provide medical oversight and direction on all medical policies. This position will also be significantly involved in the development of components of the CQI model and assist with the potential future direction of the EMS delivery model. Additional emergency medical support in the form of participation on advisory committees will also be encouraged. System and Organization Component Priorities • Establish revised EMS Medical Director position • Reorganize/revitalize the EMS advisory committees • Link to CQI program Page 28 Contra Costa EMS Plan =� Staffing and Training An expanded role within the EMS Agency is planned for designing and establishing curriculum and continuing education standards. The support in this area will extend to BLS services as well. A county-wide emergency ' medical dispatch (EMD) program is being implemented. Personnel involved in curriculum design and education activities should be adequately prepared to provide these services. Staffing and Training Component Priorities • Further EMD county wide • Link to the CQI program Communications The continued development and fine tuning of EMS communication capabilities is contemplated. Needs will be determined through the ongoing assessment of the communications system. 1 Communication Component Priorities • Assess basic communication system Response and Transportation A significant scope of this component is the review and potential conceptual redesign of the current model used for response to emergency requests. An evaluation will be conducted to determine whether or not different models or approaches will be taken on issues of call triage, method and type of response '�' Contra Costa EMS Plan Page 29 and alternatives for a patient destination and their potential effect on improving care, quality, outcome and efficiency. Only those programs able to meet the scrutiny of these parameters and others established by the advisory committees will be recommended for implementation. Improved air medical coordination and analysis of appropriate utilization patterns will be conducted. r Response and Transportation Component Priorities • Improve coordination and utilization patterns with air medical services • Establish a county-wide call triage, pre- arrival EMD program • Conduct a proactive review of Prehospital systems for the future _ r Facilities and Critical Care This area will receive focused attention on receiving center verification, pediatric resource planning and alternatives to poison center requests. 1 Facilities and Critical Care Component Priorities • Inventory and assess receiving centers r • Continue study of alternatives to Poison Control Centers Data Collection and System Evaluation This is a significant focus of the EMS plan and an important link to potentially directing the future of the EMS system. Excellent data that describes and Page 30 Contra Costa EMS Plan r tracks system impact, performance, outcome and quality indicators is essential to achieve the goals of the plan. This component defines two important tasks of planning and implementing a comprehensive management information system (MIS) and the preparation and implementation of a Continuous Quality Improvement (CQI) Plan. Existing databases and software, linkages with the designated trauma center will also need further refinement. Data and Evaluation Component Priorities • Develop a Y complete MIS system . p • Link all components of EMS system to MIS system. • Develop a CQI plan and integrate into EMS system. • Refine trauma system data system. r Public Information and Education Informed and educated consumers are also important to this plan's success. However, there is a danger that EMS public education activities will be too global and lack clear outcome expectations. This component specifically speaks to a targeted effort for public information and education, with identified outcome expectations and the utilization and cataloging of existing resources where possible. r Public Information/Education Component Priorities • Assess ongoing public information and educations needs. • Target public education efforts. �'J' Contra Costa EMS Plan Page 31 Disaster Medical Response �. While disaster planning has received a high priority in the County, continued improvements in the level of preparedness are planned. Key priorities are re- evaluating the command structure for consistency with the new State SEMS regulations, establishing a network for hospital communications, adopting the Hospital Emergency Incident Command System (HEICS) in all hospitals, and r providing increased training opportunities for EMS personnel at all levels. Disaster and Mutual Aid Component Priorities • Adopt SEMS. • Establish hospital communications network. • Adopt HEICS in all hospitals. • Provide increased training. r ;f Page 32 Contra Costa EMS Plan %% CV) CO 0- � } -{ 0- \ /t ou 0) 0 0 Lf) LLJ 0 t fj o 0 U 0 LL " Ln En & 0 0 4-J c 0 U E.6 a 7\ %ƒR &# In i SECTION II SYSTEM ASSESSMENT The following charts describe the California EMS Authority standard (listed as "standard") for each of the eight components of the EMS Plan along with a focused local goal established for Contra Costa County (listed as Goal ). Time frames are listed as Short (one year or less) or Long Range. Priorities are listed as 1 (highest) to 4 (lowest). "Complete" and "partially complete" indicates that the component is in substantial compliance with the State requirements, lacking only locally initiated enhancements. i System Organization and Management Agency Administration Standard: Goal: 1 .01 Each local EMS Agency shall An effective organizational 'structure have a formal organizational which enables the EMS Agency to plan, structure which includes both implement, monitor and evaluate the Agency staff and non-agency local EMS system. EMS Agency coordi- resources and which includes nation of the multiple participants of the appropriate technical and clinical EMS system. EMS Agency functioning expertise. as system advocate to the community and other governmental entities. Current Status: The Contra Costa County Board of Supervisors designated the Department of Health Services as the local EMS Agency. Currently, the EMS Agency has nine staff positions including: an EMS Director, an EMS Program Coordinator, two Prehospital Coordinators, a Trauma Nurse Coordinator, a Data Management Coordinator, a Training Coordinator, and two clerical staff. The EMS Agency is a part of the Contra Costa County Health Services Department. Need (s): Identify staffing needs, review and modify job descriptions and employee classifications in keeping with the mission and goals of the EMS Agency and this plan. Objective: Enhance functional and personnel components of the EMS Agency to P 9 Y address goals. Time Frame for Objective: fShort Term Implementation Long Range Plan Complete/Partially ow Resource Requirement © Priority U-6 mont Time Requirement il'�' Contra Costa EMS Plan Page 37 System Organization and Management Agency Administration Standard: Goal: 1 .02 Each local EMS Agency shall A comprehensive system-wide plan, implement, and evaluate the Continuous Quality Improvement (CQI) EMS system. The Agency shall and evaluation program. i use its quality/evaluation process to identify needed system changes. Current Status: Although most EMS system monitoring currently occurs using a quality assurance method, the continuous quality improvement (CQI) approach to monitoring activities is being developed and integrated within a number of programs. The CQI approach is currently used in the trauma and transfer review programs. Individual facilities and providers conduct some CQI components. Some evaluation processes are generally complaint-driven. Need (s): A comprehensive CQI program plan is needed which encompasses the receiving hospitals, base hospitals, trauma center, first responders, dispatch, training programs, ambulance service providers and other system components. Specific outcomes and quality indicators of the quality improvement process need to be defined. Policies, procedures and regulations need to be developed to require quality improvement activities by the system participants. The EMS Agency should make CQI responsibilities a staffing priority and should use various participant resources, establish participant work groups, and develop comprehensive procedures and , standards for system participants. Objective: Establish a system-wide CQI plan. Implement the plan with the provision of appropriate feedback to individual providers and system participants. Use the information developed in this process to identify and implement needed system changes. i Time Frame for Objective.. Short Term Implementation F3(-1 Long Range Plan Complete/Partially ig Resource Requirement Q Priority - years Time Requirement Page 38 Contra Costa EMS Plan - System Organization and Management Agency Administration ' Standard: Goal: 1 .03 Each local EMS Agency shall Broad-based input from EMS system actively seek and shall have a participants and consumers in the mechanism (including the emer- ongoing management and evaluation of gency medical care committee the EMS system. and other sources) to receive ' appropriate consumer and health care provider input regarding the development of plans, policies, and procedures, as described throughout this document. Current Status: A system of advisory committees including the Emergency Medical ' Care Committee (EMCC), has developed over the years to provide EMS system related input and recommendations to the Board of Supervisors, the Health Services Department and the EMS Agency. Need (s): Review and re-define missions, responsibilities, expectations and membership for EMS committee structure including the EMCC to meet the EMS system objectives defined in this plan. Enhance linkages between the EMCC, the various advisory committees, and the EMS Agency. Objective: Establish and maintain strong permanent committees for oversight of the ' operational and administrative functions of the EMS system and for monitoring and defining the clinical care aspects of the system. Develop advisory committees to respond to the ongoing needs of the EMS system. Link the Measure H Oversight Committee to the EMCC. Develop limited term task forces to address specific objectives such as the development of system-wide CQI, preparation of an EMS communication plan and the development of performance standards for various EMS system components. Time Frame for Objective: ' Short Term Implementation Long Range Plan Complete/Partially ow Resource Requirement © Priority mo, Time Requirement '�' Contra Costa EMS Plan Page 39 System Organization and Management 1 Agency Administration Standard: 1.04 Each local EMS Agency shall Local EMS Agency medical leadership appoint a medical director who is with administrative experience in a licensed physician who has emergency medical services systems. ' substantial experience in the Clinical specialty resources available to practice of emergency medicine. provide clinical input as needed through specialty advisory groups composed of ' physicians with appropriate specialties and non-physician providers (including ' nurses and prehospital providers), and/or through medical consultants with expertise in trauma care, pediatrics, and other clinical specialties. Current Status: The County Health Officer currently operates in the role as EMS , medical director. A contract has been established for physician medical oversight for the First Responder Defibrillation Program, the Emergency Medical Dispatch Program, and certain aspects of the prehospital care program on a limited basis. Specialty physicians are asked to provide input on specialty programs and policies on an ad hoc basis. Need (s): Develop additional EMS physician leadership and time commitment to the EMS Agency. Provide the Medical Advisory Committee with an opportunity to provide ' input on qualifications and responsibilities for an EMS Agency assistant medical director. This individual should report directly to the County Health Officer on medical matters and to the EMS Director on operational issues. Specialty resources, including advisory groups or specialty medical consultants, need to be developed formally to provide input into specialized system issues. Objective: An organization structure which provides strong, specialized EMS system clinical oversight of EMS system activities. Time Frame for Objective: ® Short Term Implementation ='Long Range Plan Complete/Partially ' ow Resource Requirement © Priority 12 mont s Time Requirement Page 40 Contra Costa EMS Plan -": Planning Activities System Organization and Management Standard: figat 1.05 Each local EMS Agency shall A comprehensive and dynamic EMS develop an EMS system plan plan for the County of Contra Costa to based on community need and meet existing and future challenges to utilization of proper resources, the EMS system. and shall submit it to the EMS Authority. The plan shall: a) assess how the current system meets guidelines, b) identify system needs for patients within each of the clinical target groups, and c) provide a methodology and time line for meeting these needs. Current Status: The previous EMS Plan was approved in 1986. This revised EMS Plan is the foundation for a process of ongoing planning and implementation for Contra Costa County EMS. Many of the activities directed by this plan will focus on target issues and evaluation of the system's performance outcomes. . Need(s): Develop ongoing process for monitoring the implementation of plan activities and modifying the plan to meet changing needs. Develop a specific action plan for each system component with a time-frame and accountability for plan implementation. Respond to the complex and changing health care field with defined parameters of accountability, performance and cost efficiency. Obiective: Implement plan activities on a timely basis. Provide mechanisms to modify plans as needed. Evaluate all plan components for response to the health care industry changes through the development of a framework of accountability, performance and cost efficiency. Time Frame for Objective: ' Q Short Term Implementation Q Long Range Plan Complete/Partially Resource Requirement Priority Ongoing I Time Requirement Contra Costa EMS Plan Page 41 System Organization and Management Planning Activities Standard: 1.06 Each local EMS Agency shall Regular status reports regarding Contra develop an annual update to its Costa County EMS to the Board of EMS system Plan and shall Supervisors and the California EMS ' submit it to the EMS Authority. Authority. The update shall identify progress made in plan implementation and ' changes to the planned system design. Current Status: This plan represents the initial revised plan to meet the new EMS system guidelines. Therefore, there have been no current annual updates. Need (s): Develop a comprehensive process to solicit input and provide updates and ' modification to the existing EMS plan. Report EMS system progress to the County Board of Supervisors and submit an updated plan to the State EMS Authority every 12 months after the acceptance of the initial plan. ' Objective: Provide annual reports to the County Board of Supervisors and update the EMS plan each year. ' Time Frame'for Objective: Short Term Implementation Long Range Plan Complete/Partially ' ow Resource Requirement © Priority Annual Time Requirement Page 42 Contra Costa EMS Plan 1 ' System Organization and Management Planning Activities ' Standard: Goal: 1.07 The local EMS Agency shall plan Local EMS Agency designation and ' for trauma care and shall trauma center contract in place. determine the optimal system Agreements with trauma facilities in design for trauma care in its other jurisdictions. jurisdiction. Current Status: There is a trauma system and a designated Level II trauma center in Contra Costa County. All essential components of the approved trauma system plan are in place, including criteria for hospital designation, medical control, and data collection. Trauma triage policies have been approved. Integration of all the existing EMS system components into a functional trauma system has been fully completed. There is also and extensive bi-county (Alameda and Contra Costa County) medical ' review process of trauma patient care. Need (s): The trauma system evaluation process, including specialized review and focused audits, should be incorporated into the EMS system CQI process as identified in Standard 1.02. Objective: To continue a coordinated and comprehensive trauma system plan for Contra Costa.County with ongoing program evaluation and linkages to the EMS system Quality Improvement Plan as it is developed. r Time Frame for Objective: ' ® Short Term Implementation Long Range Plan Complete/Partially Resource Requirement © Priority 0ngoiFg---J Time Requirement r.. c Contra Costa EMS Plan Page 43 System Organization and Management ' Planning Activities Standard: Goal: , 1.08 Each local EMS Agency shall plan Advanced life support response and for eventual provision of transportation throughout Contra Costa advanced life support services County for all patients triaged as , throughout its jurisdiction. needing that level of service. Current Status: Advanced life support services are provided county-wide. All emergency ambulance services routinely respond ALS resources to emergency medical requests. An innovative rural ALS first response unit has been implemented to respond to the identified needs in one rural area (Byron). Two fire districts, Moraga Fire Protection District and San Ramon Valley Fire Protection District, have established ALS first response units. , Need (s): There are no identified needs in this area. , Objective: Ongoing review and monitoring. Time Frame for Objective: , Short Term Implementation Long Range Plan Complete/Partially t ow Resource Requirement Q Priority ungoing Time Requirement Page 44 Contra Costa EMS Plan % ' ' Planning Activities System Organization and Management Standard: figaL 1 .09 Each local EMS Agency shall Comprehensive awareness of resources develop a detailed inventory of used in the provision of emergency EMS resources (e.g., personnel, medical services and prior identification vehicles, and facilities) within its of resources which may be needed to area and, at least annually, sh 11 meet unusual system requirements. update this inventory. Current Status: Inventories exist for personnel, vehicles (air and ground), facilities, and agencies within the jurisdiction of Contra Costa County. Need(s): Review and update inventory of EMS resources Objective: Identify resources which may be needed for emergency medical service response and update the inventory annually. Time Frame for Obiective: ' Q Short Term Implementation Long Range Plan Q Complete/Partially ow Resource Requirement 173 1 Priority 2-5 years Time Requirement Contra Costa EMS Plan Page 45 System Organization and Management ' Planning Activities Standard: 1.10 Each local EMS Agency shall Services developed for special identify population groups served population groups requiring specialized by the EMS system which require EMS services as appropriate. (e.g., , specialized service (e.g., elderly, elderly, handicapped, children, non- handicapped, children, non- English speakers). English speakers). , Current Status: Some targeted specialty population planning has occurred to date particularly in trauma, and in pediatrics. Need (s): Assess the needs of specific population groups which may require ' specialized services. Work with other programs which provide specialized services to the public such as the County Injury Prevention Program. Develop plans to enhance service delivery to specialized groups where needed. Objective: Assure appropriate access to the EMS system by all individuals and groups ' within the County. r Time Frame for Ob'ective: ' Short Term Implementation Long Range Plan Complete/Partially ' ow Resource Requirement F4-� Priority Z-b yjjFF--J Time Requirement Page 46 Contra Costa EMS Plan - : ' System Organization and Management Planning Activities Standard: Ghat 1.11 Each local EMS Agency shall The local EMS Agency ensures that identify the optimal roles and system participants conform with their responsibilities of system assigned EMS system roles and participants. responsibilities, through mechanisms such as written agreements, facility designations, and exclusive operating areas. Current Status: Procedures, policies and performance standards have been developed for ALS and BLS system personnel. Some activities lack standardization throughout the system. Need(s): Evaluate and/or develop EMS related roles, responsibilities and performance standards for EMS system providers! Review existing contracts with EMS providers to assure responsibilities and standards developed through this process are addressed. Develop and execute agreements or letters of understanding between the County (through the EMS Agency) and EMS providers including receiving hospitals, medical dispatch centers, first responder agencies,ncies, emergency helicopter provider agencies and other system providers to reflect id entifie roles, responsibilities and performance standards. Objective: Establish comprehensive roles, responsibilities, and performance standards for the EMS system providers. Develop written agreements which identify these roles, responsibilities and performance standards as well as provide the mechanisms to ensure compliance. Develop mechanisms to link the monitoring efforts of EMS providers to the EMS C01 plan. Time Frame for Objective: Short Term Implementation Q Long Range Plan Complete/Partially f-Fligff"l Resource Requirement Q Priority 1-2 years I Time Requirement Contra Costa EMS Plan Page 47 System Organization and Management ' Regulatory Activities Standard: 1 .12 Each local EMS Agency shall The Emergency Medical Care provide for review and monitoring Committee responsible for EMS system of EMS system operations. operational oversight. EMS system , operations monitored and evaluated through a data collection system. Written agreements in place which ' identify minimum EMS performance standards with system participants. Contra Costa County EMS system's operational performance is evaluated, documented, and reported on a regular ' basis. Current Status: Lack of contemporary data collection and analysis resources, coupled , with limited definitions of expectations and quality indicators has restricted the EMS Agency's ability to review and monitor EMS system operations. Ambulance response data is currently collected as the primary measure of compliance. Need (s): Redefine the EMCC and its advisory committee functions. Develop specific , parameters and responsibilities for reviewing and monitoring EMS system performance. Facilitate that review and monitoring through development of a contemporary management information system, written agreements with the various system participants and a CQI plan. Develop EMS Medical Director position and realign EMS Agency staff. Integrate review and monitoring of the various quality improvement and data collection activities. ' Objective: A comprehensive, ongoing review and monitoring process used to evaluate EMS system performance. The system review process is to be based on data and to ' address methods for providing feedback to participants as well as for managing non- compliance. Time Frame for Ob'ec ive: , ® Short Term Implementation Long Range Plan Complete/Partially Resource Requirement Priority I- years Time Requirement Page 48 Contra Costa EMS Plan , System Orga ization and Management Regulatory Activities Standard: . Goal: 1.13 Each local EMS Agency shall System-wide coordination through the coordinate EMS system efforts of the Emergency Medical Care ' operations. Committee, sub- committees, limited- term task forces. Information is provided through multiple avenues with ' system participants. ' Current Status: Substantial coordination exists between the EMS Agency and the system providers. System coordination is currently provided through a network of the Emergency Medical Care Committee j nine advisory committees in the County and one multi-county advisory committee. These committees operate with varying missions and meeting schedules based on needs. The EMS Agency publishes a bi-monthly EMS newsletter which provides information about EMS system operations. ' Need (s): The EMCC and advisory committee network k should be revised. The EMS Agency should emphasize communications with EMS system participants and should irespond promptly to all requests for information or assistance. Objective: The Emergency Medical Care Committee with its revised, system-wide representation, will lead coordination efforts through establishment of permanent and limited-term subcommittees and task forces to address specific issues and components of the EMS system plan. The EMS Agency will also regularly r communicate through multiple avenues with system participants. Time Frame for Objective: ® Short Term Implementation Long Range Plan Complete/Partially ow Resource Requirement © Priority iF5T--1 Time Requirement �_ ' Contra Costa EMS Plan Page 49 System Organization and Management ' Regulatory Activities Standard: G-� ' 1.14 Each local EMS Agency shall A comprehensive policies and develop a policy and procedures procedures manual is maintained for the manual which includes all EMS Contra Costa County EMS system. ' Agency policies and procedures. The Agency shall ensure that the manual is available to all EMS ' system providers (including public safety agencies, transport services, and hospitals) within ' the system. Current a u : EMS Agency policies n , � y N s a � a prehospital core manual are available t� all the EMS system providers within the system. These are reviewed on a regular basis. ' Need (s): Additional policies and procedures may need to be developed subsequent to the approval of this EMS plan. Objective: Maintain comprehensive policy and-procedure manuals for EMS system participants. Review and modify as identified by CQI program. Time Frame for Objective: Short Term Implementation Long Range Plan Complete/Partially ' ow Resource Requirement © Priority ngoing Time Requirement Page 50 Contra Costa EMS Plan % ' ' S n System Org nization and Management ' Regulatory Activities Standard: Goal: 1 .15 Each local EMS Agency shall A strong legal foundation which enables have a mechanism to review, the County to comply with State monitor, and enforce compliance mandates and to ensure the EMS ' with system policies. system's functioning. Current Status: The Contra Costa County has contracts in place and guidelines to monitor and regulate ground ambulance services. The contracts along with EMS policies, procedures and guidelines are used to monitor and enforce compliance with system regulations. There is an ordinance in place which provides limited support to the monitoring and enforcement issues. Need (s): The current County Ambulance Ordinance has been in place for a number of years and should be amended or replacedwith a comprehensive ordinance as system needs change. Compliance monitoring should be integrated into the CQI plan. ' Objective: Reaffirm the legal foundation for the organizational structure, authority and scope of activities of the EMS Agency and its relationship with system providers including performance criteria and penalties with the authority to enforce compliance. Time Frame for Objective: Short Term Implementation Long Range Plan Complete/Partially ' ow Resource Requirement Priority - years Time Requirement Contra Costa EMS Plan Page 51 System Organization and Management ' System Finances Standard: 1.16 Each local EMS Agency shall A strong independent financial basis for have a funding mechanism which the EMS system and system is sufficient to ensure its participants. ' continued operation and shall maximize use of the Emergency Medical Services Fund. ' Current Status: EMS Agency and support program funding is derived from several sources: the County Special Benefit Assessment (Measure H), the County general fund, grant funds, certification fees, funds derived from Senate Bill 612, and other fees from EMS system participants. Need (s): The existing funding sources appear adequate. Ongoing monitoring is needed. ' Objective: Continue ongoing monitoring of EMS funding needs. Time Frame for Objective: , Q Short Term Implementation Long Range Plan Complete/Partially ' ow Resource Requirement ® Priority Ungoing Time Requirement Page 52 Contra Costa EMS Plan % ` ' System Organization and Management Medical Direction Standard: Goal: 1.17 Each local EMS Agency shall plan All agencies within the EMS system for medical direction within the with direct patient care responsibilities ' EMS system. The plan shall have medical directors to oversee the identify the optimal number and clinical aspects of the Agency's ' role of base hospitals and operations. Designated base hospitals alternative base hospitals and the have comprehensive EMS related roles, responsibilities, and policies and procedures. Base ' relationships of Prehospital and personnel have adequate training and hospital providers. guidance to fulfill their responsibilities. Current Status: The County has designated two base hospitals (one of the two is also designated as the trauma system base). Roles and responsibilities of the base hospitals and base hospital personnel are identified in the County's policies, procedures and protocols manual, as well as in the base hospital contract. ALS providers as well as first responder agencies participating in the first responder defibrillation program are under the medical control of the County EMS Medical Director. Need (s): The role and responsibilitieis of base hospitals are in need of review. The changing requirements of the ALS program and first responder defibrillation programs coupled with the diminishing needs for day to day oversight may necessitate a revision 1 in the mission, scope and configuration of base hospitals. Objective: Implementation of a plan for medical control for all patient care providers. Evaluation and refinement of current system of providing ALS medical oversight, monitoring and education through base hospitals. Time Frame for Objective: Short Term Implementation Long Range Plan Complete/Partially ow Resource Requirement Priority 1-2 years Time Requirement .. �'' Contra Costa EMS Plan Page 53 System Organization and Management Medical Direction Standard: 1.18 Each local EMS Agency shall EMS participants in-house procedures establish a quality assurance identify methods of improving the (QA)/quality improvement (QI) quality of care provided. ' program to ensure adherence to medical direction policies and procedures, including mechanism ' for compliance review. Provider- based programs approved by the EMS Agency and coordinated with other system participants may be included. Current Status: There is no formal system-wide QI plan in place. Retrospective QA methods are primarily used to evaluate system components. Many evaluation , activities are complaint-driven (except for trauma, transfer and some base hospital and provider functions) and do not reflect comprehensive QA/QI planning. An EMD pilot program with a QI component has been implemented in the San Ramon Fire District. , Need (s): A system-wide QI Plan should be developed with input from EMS providers. A comprehensive QI Plan should include identification of appropriate outcome , measures, indicators, identification of a common data set, individual provider agency responsibilities, and feedback mechanisms. Medical policies and procedures for care ' providers should be established or modified by the EMS Agency based on trends identified by the CQI program. EMS providers should have their own CQI programs which interface with the system plan, including responsibility for agency QI activities. ' QI activities should be monitored by a quality council, with regular reports to the EMCC and other appropriate advisory committees. Objective: Establish a system-wide CQI plan which is monitored by a quality council ' and integrates individual provider QI plans. Time Frame for Objective: Short Term Implementation Long Range Plan Complete/Partially ,g Resource Requirement © Priority 1-3 years Time Requirement Page 54 Contra Costa EMS Plan - ' System Organization and Management Medical Direction Standard: Goal: 1.19 Each local EMS Agency shall Comprehensive set of policies, develop written policies, procedures, and protocols is available Sprocedure, and/or protocols for all agencies and individuals including, but not limited to: functioning within the EMS system. a) triage, County-wide standard for emergency b) treatment, medical dispatching, with review c) medical dispatch protocols, developed and based on the CQI model. d) transport, e) on-scene treatment times, f) transfer of emergency patients, g) standing orders, h) base hospital contact, 1) on scene physicians and other medical personnel, j) local scope of practice for prehospital personnel. Current Status: Detailed policies, procedures and protocol exist for most clinical and operational prehospital situations. A County-wide system of emergency medical dispatching is being developed. Need (s): New policies as well as modifications to original EMS policies and procedures should be based on findings of the EMS CQI program. County-wide policies for EMS dispatching and call-taking should be completed. Objective: Continue to provide comprehensive guidelines, policies, procedures and protocols for all EMS personnel functioning within the EMS system. Incorporate specific policies and procedures to address commonly occurring circumstances. Develop a county-wide standard and review process for emergency medical dispatching. Conduct all processes fusing CQI methods. Revise other policies based on system needs identified through implementation of this system plan. Time Frame for Objective: Short Term Implementation Long Range Plan Complete/Partially ow Resource Requirement F2-1 Priority -2 yejFF-j Time Requirement 'f' Contra Costa EMS Plan Page 55 System Organization and Management , Medical Direction Standard: Goal: 1.20 Each local EMS Agency shall Adequate guidelines, policies and have a policy regarding "Do Not procedures to support personnel in the Resuscitate" (DNR) situations, in field for determining when it is ' accordance with the EMS appropriate not to resuscitate patients. Authority's DNR guidelines. Current Status: An EMS "Do-Not-Resuscitate" policy is in place. Need (s): No current needs have been identified. Objective: Continue to monitor these procedures. ' Time Frame for Objective: ' Short Term Implementation Long Range Plan Complete/Partially ' Resource Requirement Q Priority ongoi= Time Requirement i Page 56 Contra Costa EMS Plan ': Medical Direction System Organization and Management ' Standard: Goal: 1 .21 Each local EMS Agency, in Ongoing monitoring of policies. conjunction with the County coroner(s) shall develop a policy regarding determination of death, including deaths at the scene of apparent crimes. Current Status: A policy regarding determination of death is in the Agency's policy and procedures manual. Occasional issues surface with law enforcement agencies regarding "pronouncement". rNeed (s): Ongoing monitoring and role clarification as appropriate. Objective: Continue to monitor/revise as needed. Time Frame for Objective: Short Term Implementation Long Range Plan Complete/Partially ow Resource Requirement rl-4-1 Priority Ongoing Time Requirement �' Contra Costa EMS Plan Page 57 System Organization and Management ' Medical Direction Standard: Goal: 1.22 Each local EMS Agency, shall Updating of policies on an ongoing ensure that providers have a basis. mechanism for reporting child abuse, elder abuse, and suspected SIDS deaths. Current Status: The mechanism for reporting child and elder abuse has been addressed in the EMS Agency's policies and procedures manual. Need (s): No identified needs. Objective: Ongoing review and monitoring. Time Frame for Objective: Q Short Term Implementation Long Range Plan Complete/Partially ow Resource Requirement © Priority ungojng Time Requirement Page 58 Contra Costa EMS Plan ' System Organization and Management Medical Direction Standard: Goal: 1.23 The local EMS medical director Ongoing monitoring and review. shall establish policies and protocols for scope of practice of all prehospital medical personnel ' during interfacility transfers. Current Status: Policies and procedures have been developed and are in place for identifying the scope of practice for prehospital medical personnel during interfacility transfers. Need (s): No identified needs. Objective: Ongoing monitoring and review. Time Frame for Objective: Short Term Implementation Long Range Plan Complete/Partially ow Resource Requirement © Priority ungoing Time Requirement '�' Contra Costa EMS Plan Page 59 r System Organization and Management , Advanced Life Support Standard: Goal: 1.24 Advanced life support services Provision of ambulance services based shall be provided only as an upon exclusive operating areas for ALS approved part of a local EMS providers throughout Contra Costa system and all ALS providers County. shall have written agreements with the local EMS Agency. ' Current Status: Agreements exist between the ALS providers and the EMS Agency. ' Need (s): No identified needs. Objective: Ongoing monitoring and review. 1 r 1 'r . r r r Time Frame for Objective: Short Term Implementation Long Range Plan Complete/Partially ow Resource Requirement © Priority Ungoi Time Requirement r Page 60 Contra Costa EMS Plan -` . r 1 Advanced Life Support System Organization and Management Standard: figaL 1.25 Each EMS system shall have on- An EMS system medical control plan line medical direction, provided which determines: by a base hospital (or alternative a) System base hospital configuration; base station) physician or b) Base hospital selection and authorized registered nurse. designation processes which allow all eligible facilities to apply; c) The process for determining when prehospital providers should appoint an in-house medical director; or, d) An appropriate medical control configuration for the future. Current Status: Two base hospitals have been designated for the County with each providing on-line medical control by physicians or authorized registered nurses. One of the two base hospitals also provides medical control for all trauma cases. There is a base station application and selection process for designation. The County currently �. provides funding for Base Hospital services. Need (s): The medical control system as it relates to the EMS delivery model should be validated. An.assistant EMS medical director position should be developed and filled. Objective: Study the base hospital system to validate its mission, scope and configuration as in 1.17. Time Frame for Objective: Short Term Implementation Long Range Plan Complete/Partially ®e Resource Requirement © Priority 1-2 years Time Requirement ' Contra Costa EMS Plan Page 61 System Organization and Management Trauma Care System Standard: Goal: 1 .26 The local EMS Agency shall A trauma care system plan within the develop a trauma care system County in order that all trauma patients plan which determines: receive the most appropriate level of a) The optimal system design for trauma care in a timely manner. trauma care in the EMS area, and b) The process for assigning roles to system participants, including a process which ' allows all eligible facilities to apply. Current Status: The trauma care system plan has been developed and successfully implemented. It was determined that only one trauma center was needed within the County, and John Muir Medical Center has been designated as the local level 2 trauma center. Need (s): No identified needs. Objective: Continue the comprehensive trauma system plan for Contra Costa County. , Time Frame for Objective: ' = Short Term Implementation Long Range Plan Complete/Partially Resource Requirement © Priority ngoing Time Requirement Page 62 Contra Costa EMS Plan System Organization and Management Pediatric Emergency Medical and Critical Care System Standard: Goal: 1.27 The local EMS Agency shall Children in Contra Costa County have develop a pediatric emergency timely access to the most appropriate medical and critical care system level of pre-hospital and in-hospital plan which determines: medical care. a) The optimal system design for pediatric emergency medical and critical care in the EMS area, and b) The process for assigning roles to system participants, including a process which allows all eligible facilities to apply. Current Status: Currently, most seriously injured children are transported or interfacility transferred to Children's Hospital Oakland. Pediatric treatment, advanced airway and other prehospital procedures for children have been implemented in the County. While the seriously injured child component has been comprehensively addressed, the EMS Agency has begun to evaluate the total pediatric emergency medical and critical care system needs. Need (s): A comprehensive pediatric emergency medical and critical care system plan needs to be developed. The components of the plan would include the development of triage protocols, criteria for designation of pediatric facilities, and the drafting and execution of agreements between the EMS Agency and the designated receiving and specialty care facilities. Objective: Implementation of a comprehensive pediatric emergency medical and critical care system plan for Contra Costa County. Time Frame for Objective: Short Term Implementation Long Range Plan Complete/Partially ow Resource Requirement © Priority z_5 years Time Requirement a: �'' Contra Costa EMS Plan Page 63 System Organization and Management Exclusive Operating Area Standard: Goal: 1.28 The local EMS Agency shall Residents and visitors to Contra Costa develop, and submit for State County to have access to timely approval, a plan based on advanced life support ambulance community needs and utilization transportation service. of available resources for granting of exclusive operating areas which determines: a) The optimal system design for ambulance service and , advanced life support services in the EMS area, and b) The process for assigning roles to system participants, including a competitive process for implementation of exclusive operating areas. Current Status: All residents and visitors of Contra Costa County have access to ALS services. The Moraga Fire District is "grandfathered" as an exclusive operating area ' (EOA) under 1797.201 of the H&S code. The other EOA's have not been reviewed in several years and their configuration may no longer be appropriate. Need (s): A review of the EOA configuration and definitions needs to be conducted. Objective: Conduct a review and redesign the EOA system, if necessary. Time Frame for Objective: Short Term Implementation Long Range Plan Complete/Partially ow Resource Requirement © Priority 1-2 years Time Requirement Page 64 Contra Costa EMS Plan ' Local EMS Agency Staffing/Training. Standard: Goal: 2.01 The local EMS Agency shall Adequate numbers of well-trained routinely assess personnel and personnel for the Contra Costa County 1 training needs. EMS system. Current Status: The EMS Agency has taken a leadership role in the development of a fire service EMT program. However, the EMS Agency has no formal program to routinely assess personnel and training needs. Multiple training programs are available ' throughout the County. Need (s): A formal process to receive input from the various EMS providers with regard to personnel shortages and training needs for prehospital (ground and air) and hospital participants should be developed. (Creative methods to assist and support various system participants in providing local training programs and continuing education should be used.) The development of standards for curriculum, competencies and continuing education programs at all EMS provider levels should occur. Objective: To have adequate training and continuing education opportunities throughout the County to assure orientation to the critical pathways defined in the CQI iplan. Develop a standardized curriculum, competency list and continuing education program format for all EMS provider levels to assist the providers and meet the intent of the new State defined roles. Time Frame for Objective: = Short Term Implementation 0 Long Range Plan Q Complete/Partially ow Resource Requirement F4-� Priority - years Time Requirement "' Contra Costa EMS Plan Page 65 Staffing/Training Local EMS Agency Standard: Goal: 2.02 The EMS Authority and/or local High quality Contra Costa County EMS agencies shall have a training programs support personnel mechanism to approve an involved in the Contra Costa County emergency medical services EMS system. education program which requires approval (according to regulations) and shall monitor them to ensure that they comply with State regulations. ' Current Status: Procedures and mechanisms are in place to approve EMS education programs. Need (s): Activities devoted to approval and monitoring of training programs should be ' implemented. Periodic on-site monitoring of teaching activities and training program outcomes should take place. Objective: Assure the training programs approved by the County comply with regulations and that the outcome of the programs results in appropriately trained personnel. Time Frame for Objective: Short Term Implementation Long Range Plan Complete/Partially ' ow Resource Requirement © Priority 1-Z years Time Requirement Page 66 Contra Costa EMS Plan Staffing/Training Local EMS Agency Standard: oal: 2.03 The local EMS Agency shall have Prehospital medical personnel are mechanisms to accredit, appropriately qualified to function jauthorize, and certify prehospital within the EMS system. medical personnel and conduct certification reviews, in accordance with State regulations. This shall include a process for prehospital providers to identify and notify the local EMS Agency of unusual occurrences which could impact EMS personnel certification. Current Status: State licensing and local accreditation is required for EMT-P's; County certification for first responder defibrillators and EMT-I's; and authorization for MICN's. Procedures, policies and requirements are in place to credential first responder defibrillator personnel, EMT-1's, EMT-P's, and MICN's. Provisions are included for the Agency to be notified in the event of unusual occurrences which could impact EMS certification. Need (s): Current credentialing procedures should be reviewed with the aim of simplifying and expediting the process. Objective: Continue to develop policies and procedures which assure that qualified personnel are operating within the system, and link credentialling procedures to the CQI plan. Time Frame for Objective: Q Short Term Implementation Long Range Plan Complete/Partially Resource Requirement © Priority Ungoing Time Requirement ' �'�' Contra Costa EMS Plan Page 67 Staffing/Training Dispatchers Standard: Goal: 2.04 Public safety answering point Public safety answering point (PSAP) (PSAP) operators with medical operators with medical dispatch responsibility shall have responsibilities and all medical dispatch emergency medical orientation personnel (both public and private) are and all medical dispatch trained and certified in accordance with personnel (public and private) the EMS Authority's Emergency Medical ' shall receive emergency medical Dispatch Guidelines. dispatch training in accordance with the EMS Authority's Emergency Medical Dispatch Guidelines. Current Status: First responders are dispatched by designated medical dispatch agencies located in fire or police dispatch centers. EMS dispatchers also notify private ambulance services when their resources are needed. Contra Costa County Fire District dispatchers have been using a County-approved emergency medical dispatch program including pre-arrival instructions since 1988. The EMS Agency has established a pilot computerized emergency medical dispatch program with the San Ramon Valley Fire Protection District on EMD. Need (s): A long-term process needs to be undertaken to evaluate the current public safety answering point and dispatch system for Contra Costa County emergency medical services. County-wide policies,.procedures and an evaluation process for emergency medical dispatch needs to be developed. Incorporation of EMD county- wide should continue to be promoted. An EMS system orientation program for call ; takers and dispatchers within-the County should.be developed. Objective: Continue the plan for county-wide EMD based on approved policies and ' procedures and evaluation processes. Facilitate the implementation of the EMD concept to answering and dispatch system for all emergency medical services providers. Time Frame for Objective: ® Short Term Implementation Long Range Plan Complete/Partially ' IpfeT Resource Requirement Priority mos. Time Requirement Page 68 Contra Costa EMS Plan -`: Staffing/Training First Responders (non-transporting) Standard: Goal: 2.05 At least one person on each non- A first responder master plan is in place transporting EMS first response for the county. First responce units are unit shall have been trained to staffed with EMT4 and defibrillation administer first aid and CPR trained personnel. Defibrillation within the previous three years. programs for first responders receive continued support. Current Status: Emergency medical first responder services are generally provided by various fire services within the County and all fire first responders are trained to the first responder level. All fire first responders were accredited to defibrillate by March, 1992 and EMT-1 trained personnel are prevalent. There have been discussions within some fire services regarding the provision of ALS first response services. Although ' there is no current plan for implementation of a county-wide ALS first response system, standards for an ALS first responder program are currently being developed. Need(s): . A master plan for first responder services including policies, procedures and treatment guidelines needs to be initiated and coordinated by the EMS Agency. Enhancement of first responder resources in those areas not served by EMT-1 trained first responders should be promoted. A subcommittee of the Emergency Medical Care Committee should begin the development of a first responder needs' assessment (basic and advanced life support) and a master plan to address first responder needs and planning issues, make recommendations and promote a County-wide first response system. Allowances for various first responder levels (first responder through ALS) should be accommodated within the EMS system structure. ' Objective:. Promotion of a coordinated and planned expansion of first response capability based on identified needs. Time Frame for Objective: ® Short Term Implementation Long Range Plan Complete/Partially ig Resource Requirement © Priority 15-12mos. Time Requirement l /` ' Contra Costa EMS Plan Page 69 1 Staffing/Training ' First Responders (non-transporting) Standard: Goal: 1 2.06 Public safety agencies and All patients who may benefit from first industrial first aid teams shall be response receive those resources. encouraged to respond to medical emergencies and shall be utilized in accordance with local EMS Agency policies. Current Status: There are a number of organizations providing medical first response , within the County. All fire services provide first responder services. There are also law enforcement and industrial teams. Need (s): On-going liaison between EMS Agency and transport as well as non- 1 transport first responder agencies including law enforcement should be maintained. Objective: Continue to inventor and coordinate with county-wide first responder 1 Y Y � programs. i 1 • 1 1 1 Time Frame for Objective: 1 Short Term Implementation ® Long Range Plan Complete/Partially 1 ow Resource Requirement © Priority Ungoi Time Requirement Page 70 Contra Costa EMS Plan 1 1 ' Staffing/Training ' First Responders (non-transporting) Standard: Goal• 2.07 Non-transporting EMS first A county-wide first response capability 1 responders shall operate under with appropriate clinical levels and medical direction policies, as monitoring mechanisms. specified by the local EMS Agency medical director. Current Status: The County EMS Agency policies and procedures manual provide medical protocols for EMS first responders. Limited monitoring and evaluation of first responder efforts have been incorporated within the County system. Needs �l Include first responders in the proposed CQI plan. Develop a standard data set and form for first responder use in order to collect needed information. Develop policies and procedures and/or regulations requiring all first responder programs to have physician input. Objective: Development of a coordinated first responder program within the County with appropriate medical oversight. 1 Time Frame for Objective: Short Term Implementation0 Long Range Plan Complete/Partially® 0 e®, Resource Requirement © Priority 1-2 years Time Requirement "' Contra Costa EMS Plan Page 71 Staffing/Training ' Transport Personnel Standard: 29AL 2.08 All emergency medical transport .All patients requiring emergency vehicle personnel shall be medical transportation are transported certified at least at the EMT-I by vehicles staffed to the advanced life level. support (paramedic) level. Current Status: All emergency medical transport vehicles are required to be staffed at ' the EMT-P level. Need(s): Current considerations for first responder ALS services may permit consideration of an EMT-1/EMT-P configuration for ambulances served by ALS first responders. Objective: Consider the optimal staffing levels for EMS transport services once the first responder master plan is put into place. Time Frame for Objective: D ® Short Term Implementation Long Range Plan Complete/Partially ow Resource Requirement © Priority 6-12 mo Time Requirement Page 72 Contra Costa EMS Plan - % Staffing/Training Hospital Standard: Goal: 2.09 All allied health personnel who Personnel responsible for direct provide direct emergency patient emergency patient care provide CPR to care shall be trained in CPR. patients who need it. Current Status: All first responders, ambulance personnel and hospital personnel who provide direct emergency patient care are trained in CPR. ' Need (s): No identified needs. Objective: Continue to encourage all allied health personnel who provide direct emergency patient care to be trained in CPR. Time Frame for Objective: Short Term Implementation ® Long Range Plan Complete/Partially ow Resource Requirement FT-1 Priority ungoi Time Requirement Contra Costa EMS Plan Page 73 Hospital Staffing/Training Standard: Goal: ' 2.10 All emergency department Hospitals providing medical control or physicians and registered nurses receiving patients provide ACLS-trained who provide direct emergency personnel for direct emergency patient patient care shall be trained in care at all times. All emergency advanced life support. department physicians are certified by the American Board of Emergency Medicine (ABEM). Current Status: All base hospital emergency physicians and MICN's are required to maintain current ACLS certification. Some receiving hospitals do require that all licensed critical care nursing staff possess current ACLS certification. All base hospital physicians are required to be Board eligible or Board certified with the American Board of Emergency Medicine. Need (s): Conduct a survey to determine ACLS requirements for licensed emergency q 9 Y department staff. Revise receiving hospital criteria to encourage ACLS certified personnel to be available at all times (for non-ABEM staff). Encourage ABEM for all t emergency physicians. Objective: Ensure that adequate numbers of emergency department physicians and registered nurses who provide direct emergency patient care will be trained in advanced cardiac life support (if not ABEM) and encourage emergency physicians to be ABEM. ' Time Frame for Objective: Short Term Implementation ® Long Range Plan Complete/Partially ow Resource Requirement F7r-1 Priority 12-5 years Time Requirement Page 74 Contra Costa EMS Plan ' Staffing/Training Advanced Life Support Standard: figah 2.11 The local EMS Agency shall Qualified and well prepared advanced establish a procedure for life support personnel for the Contra accreditation of advanced life Costa County EMS system. ALS support personnel which includes personnel/providers are integrated into orientation to system policies and the County CQI processes. procedures, orientation to the roles and responsibilities of providers within the local EMS system, testing in any optional scope of practice, and enrollment into the local EMS Agency's quality improvement process. fCurrent Status: Procedures have been implemented for accrediting advanced life support personnel which include orientation to system policies and procedures, orientation to roles and responsibilities of providers within the local EMS system, and testing for optional scopes of practice. ' Need (s): A mechanism to link advanced life support activities to the county-wide quality improvement process. Revision of current orientation process. ' Objective: Link advanced life support providers and their personnel to the proposed CQI program. Time Frame for Objective: ' ® Short Term Implementation Long Range Plan Complete/Partially Ipfe Resource Requirement © Priority 15-12 mo Time Requirement Contra Costa EMS Plan Page 75 Staffing/Training ' Advanced Life Support Standard: Goal: ' 2.12 The local EMS Agency shall Incorporation of early defibrillation into establish policies for local the County's EMS and first responder accreditation of public safety and system. , other basic life support personnel in early defibrillation. Current Status: Certification policies and procedures for the development of first responder defibrillation programs are in place within the EMS guidelines. All the fire first responder agencies have adopted early defibrillation programs. Need (s): No identified needs. Objective: Ongoing monitoring and review. Time Frame for Objective: ' = Short Term Implementation ® Long Range Plan Complete/Partially e® Resource Requirement © Priority Ungomg Time Requirement Page 76 Contra Costa EMS Plan 1 Communications Communications Equipment ' Standard: Goal: 3.01 The local EMS Agency shall plan On-going evaluation of the overall EMS for EMS communications. The communication needs of the County. A ' plan shall specify the medical county-wide communication network communications-capabilities of for EMS which takes into consideration emergency medical transport the availability of new technologies, ' vehicles, non-transporting e.g., satellite and cellular technology. advanced life support responders, and acute care facilities and shall ' coordinate the use of frequencies with other users. Current Status: The EMS Agency has implemented a communications system for ' emergency medical services. Certain communication capabilities are in need of refinement (particularly the fire and ambulance linkages) or updating to meet the continuing needs of the EMS system. ' Needs • Refine the current county-wide EMS communications system with improved coverage for ambulance services and updated voice and digital capability for dispatchers. Objective: Develop a plan to enhance EMS communications and identify funding sources to begin implementation of necessary improvements. Time Frame for Obiective: Short Term Implementation ® Long Range Plan Complete/Partially ow Resource Requirement © Priority Z-b years Time Requirement %� .. Contra Costa EMS Plan Page 77 i Communications Communications Equipment Standard: Goal: 3.02 Emergency medical transport Emergency medical transport vehicles vehicles and non-transporting have two-way radio communications advanced life support responders, equipment which complies with the ' shall have two-way radio local EMS communications plan and communications equipment which provides for vehicle-to-vehicle which complies with the local (including both ambulances and non- ' EMS communications plan and transporting first responder units) which provides for dispatch and communications. ambulance-to-hospital ' communication. Current Status: Medical transport vehicles are required to have radio capability to 17 � N Y communicate with dispatch, with fire agencies, and for ambulance to hospital communication. There are some limited needs to improve EMS communications in the ' County. Needs • Develop enhanced EMS communications capability based on needs. , Objective: Identify needs and develop enhanced EMS communications capability based on needs. ' Time Frame for Objective: Short Term Implementation ® Long Range Plan Complete/Partially , ig Resource Requirement © Priority Z-b years Time Requirement Page 78 Contra Costa EMS Plan Communications Communications Equipment Standard: Goal' 3.03 Emergency medical transport Effective communication capability ' vehicles used for interfacility among ambulances and all hospitals. transfers shall have the ability to access both the sending and ' receiving facilities. This could be accomplished by cellular telephone. Current Status: All permitted ambulances providing emergency interfacility transfer ' services have communications capability with sending and receiving facilities through the MEDARS system (T-Band) frequencies. All ALS vehicles have cellular phone capability. ' Need(s): Identi areas in the County where radio communication is ineffective and Identify tY incorporate remedies into an EMS communication plan of action. Objective: Identify areas in the County where radio communication is ineffective and incorporate remedies into an EMS communication plan of action. Time Frame for Ob*ective: Short Term Implementation ® Long Range Plan Complete/Partially Resource Requirement © Priority -2 years I Time Requirement Contra Costa EMS Plan Page 79 Communications Communications Equipment Standard: Goal: 3.04 All emergency medical transport County-wide EMS radio vehicles where physically communications capability. possible (based on geography , and technology), shall have the capability of communicating with a single dispatch center or disaster communications command post. Current Status: Multiple communication avenues are available to ambulance services throughout most of the County but in some areas, radio communication capability is , erratic due to large distances or geographical barriers such as mountain ranges. Communication capability with out-of-county providers or for Contra Costa County providers responding into other counties does not exist. Need (s): Assess communication needs of EMS provider services for "dead spots" in the County and establish possible linkages with out-of-county providers. Objective: Ongoing assessment of EMS communication needs. Time Frame for Objective: ' Short Term Implementation ® Long Range Plan Complete/Partially ' ow Resource Requirement © Priority 1-2 years Time Requirement Page 80 Contra Costa EMS Plan t Communications Communications Equipment Standard: Goal: 3.05 All hospitals within the EMS All hospitals have direct system shall (where physically communications access to relevant ' possible) be able to communicate services in other hospitals within the with each other by two-way system (e.g., poison information, radio. pediatric and trauma consultation). Current Status: Although the MEDARS system is designed to permit radio ' communications between hospitals, ambulances and the County, design requires that hospitals communicate via the County Communications Center. ' Need (s): Assess the communications needs of hospitals in the EMS system and include in the County EMS Communication Plan. Objective: On-going assessment and support of EMS communications needs. ' Time Frame for Objective: Short Term Implementation ® Long Range Plan Complete/Partially ow Resource Requirement © Priority Ungoing Time Requirement 1 �'' Contra Costa EMS Plan Page 81 Communication Equipment Communications Standard: Goal: , 3.06 The local EMS Agency shall Effective disaster communications review communication linkages capability is available county-wide. among providers (prehospital and , hospital) in its jurisdiction for their capability to provide service in the event of multi-casualty , incidents and disasters. Current Status: An emergency communications area has been created to provide system coordination during a multi-casualty or disaster event. The disaster plan including the communication component has been integrated with other agencies ' within the County. Need (s): Evaluate hospital communications needs in a disaster situation. Disaster ' needs should be considered in communications planning. Objective: Include disaster needs in communications planning. Enhance EMS disaster ' communication capability especially with hospitals. Time Frame for Objective: ' Short Term Implementation ® Long Range Plan Complete/Partially ' ow Resource Requirement © Priority 1-7. yea—F Ts -1 Time Requirement Page 82 Contra Costa EMS Plan �r- Public Access Communications Standard: 29C ' 3.07 The local EMS Agency shall Effective call answering, accurate participate in on-going planning transfer of dispatch information, and and coordination of the 9-1-1 prompt dispatch of first responders and ' telephone service ambulances. iCurrent Status: Enhanced 9-1-1 has been implemented in Contra Costa County. It is functional throughout the County. The EMS Agency has little involvement in ' coordination and on-going participation with the 9-1-1 telephone service system. Need (s): Develop activities directed towards being an active participant in the ' monitoring and performance of the 9-1-1 telephone system calls related to EMS. Continue to develop computer linkages between 9-1-1 dispatch and response entities actually responsible for dispatching first responders and ambulances. Objective: Direct linkage of 9-1-1 to first responder and ambulance dispatch centers should be encouraged in the EMS communication's plan. Time Frame for Objective: Short Term Implementation ® Long Range Plan Complete/Partially ' e Resource Requirement Priority 1-2 years Time Requirement '`` Contra Costa EMS Plan Page 83 Communications Public Access Standard: 3.08 The local EMS Agency shall be Public awareness and familiarity with involved in public education appropriate 9-1-1 use. regarding the 9-1-1 telephone , service, as it impacts system access. Current Status: The EMS Agency, along with the EMCC has developed a 9-1-1 access brochure to assist with the educational process. ' Need (s): 9-1-1 educational information should continue to be included in public relations services and updated literature for the public. 9-1-1 cellular protocol ' development statewide or regionally should be encouraged. Identification and promotion of appropriate policies of prehospital emergency care access should be undertaken with managed care organizations. Objective: Continue to assist with the provision of public information regarding appropriate use of 9-1-1 . Link with statewide and/or regional 9-1-1 cellular access , planning. Time Frame for Objective: Short Term Implementation ® Long Range Plan Complete/Partially ' e®. Resource Requirement ® Priority ngoing Time Requirement Page 84 Contra Costa EMS Plan -'� Communications Resource Management ' Standard: Goal: 3.09 The local EMS Agency shall An emergency medical dispatch priority establish guidelines for proper reference system, including systemized dispatch triage, identifying caller interrogation, dispatch triage appropriate medical response. policies, and pre-arrival instructions is in place. Current Status: The County has actively participated with the establishment of ' guidelines for proper dispatch triage and identification of appropriate medical response. Need (s): Dispatch triage as well as appropriate medical response policies and procedures should be included in the communication plan, as well as in efforts to coordinate and standardize EMS call answering and dispatch procedures. iObjective: Medically oriented call-answering, prioritization of calls, and dispatch policies, procedures and evaluation mechanisms which are linked EMD objectives identified in this plan. ' Time Frame for Objective: Short Term Implementation ® Long Range Plan Complete/Partially e® Resource Requirement © Priority Ongoing Time Requirement : � . Contra Costa EMS Plan Page 85 Communications Resource Management Standard: Goal: 3.10 The local EMS system shall have Communication mechanisms to ensure functionally integrated dispatch appropriate system-wide ambulance with system-wide emergency coverage during periods of peak , services coordination, using demand are in place. standardized communications frequencies. , Current Status: Currently the County Sheriff operates in a radio communication and , resource coordination role for emergency ambulances. This function is largely being replaced through direct computer links between the 9-1-1/PSAP's and the provider agencies. Ambulance providers do not necessarily respond the closest unit irrespective of the jurisdiction of the responding ambulance agency. , Need (s): The ongoing needs for radio and resource coordination should be evaluated in EMS communication planning. The routine use of the Sheriff Department may need to be refocused for major incidents and/or disaster roles. Closest unit ambulance dispatch procedures should be established. , Objective: Evaluate and continue to integrate dispatch and emergency response through the development and implementation of EMS communication planning and r appropriate procedures. Time Frame for Objective: Short Term Implementation FX'� Long Range Plan Complete/Partially ow Resource Requirement © Priority ungoiFg----1 Time Requirement Page 86 Contra Costa EMS Plan -': Response and Transportation Standard: Goal: 4.01 The local EMS Agency shall A county ordinance or similar ' determine the boundaries of mechanism for establishing emergency emergency medical transportation medical exclusive operating areas. service areas. Current Status: Boundaries for EMS transport agencies have been defined by the Board of Supervisors as emergency response areas for ground ambulances. The purpose of the ERA's is to aid in the dispatch of the appropriate ambulance service to the scene of an incident. These zones remain intact but have been informally restructured for purposes of data reporting. Need (s): A review of exclusive operating area (EOA) boundaries needs to be conducted for both air and ground. Agreements are needed with air transport agencies. Objective: Re-evaluate current configuration of exclusive operating areas and adjust if indicated. Time Frame for Objective: Short Term Implementation ® Long Range Plan Q Complete/Partially Resource Requirement © Priority 1-2 years Time Requirement "' Contra Costa EMS Plan Page 87 i Response and Transportation Standard: Goal: 4.02 The local EMS Agency shall A county ordinance or similar , monitor emergency medical mechanism for licensure of emergency transportation services to ensure medical transport services. This compliance with appropriate ordinance promotes compliance with , statutes, regulations, policies, overall system management and, and procedures. wherever possible, replaces any other local ambulance regulatory programs within the EMS area. Current Status: A County ambulance ordinance and County contracts with emergency ground ambulance providers provide a mechanism for the local EMS Agency to permit and monitor medical transportation services. Need (s): Ambulance ordinance revision which complies with this plan should be developed. i Objective: Revise ambulance ordinance as necessary to comply with this plan. r i i Time Frame for Objective: ShortTerm Implementation ® Long Range Plan Q Complete/Partially �e Resource Requirement © Priority 1-2 years Time Requirement Page 88 Contra Costa EMS Plan - Response and Transportation Standard: Goal• 4.03 The local EMS Agency shall Patients in Contra Costa County receive determine criteria for classifying appropriate response resources (e.g., medical requests (e.g., emergent, first responder, ALS ambulance, urgent, and non-emergent) and helicopter, etc.) specific to their needs shall determine the appropriate and are transported as necessary to level of medical response to destinations appropriate for their each. medical conditions. Current Status: The urgency of current medical requests is largely dependent upon the means of access to the system. In general, 9-1-1 calls are treated as emergency events. The EMD program is well on the way to being implemented county-wide. However, the current EMS system, particularly the prehospital system, has not been studied for the needs and direction for the future. Need(s): The prehospital care system should be studied to assess the current and future needs of the EMS system patient and link these needs with appropriate resources allocation and utilization. The need to link with EMS system providers, managed care organization, consumers and policy makers is paramount in the planning of this issue. New models for delivery may be the outcome of this objective. Validation of existing approaches may also be considered. This study should also include a review of contemporary planning efforts in similar counties. Objective: A comprehensive study of the prehospital care system and its positioning for the health care delivery system of the future should be conducted. Time Frame for Objective: ® Short Term Implementation Long Range Plan Complete/Partially ig Resource Requirement © Priority Ongoing Time Requirement ' '"' Contra Costa EMS Plan Page 89 Response and Transportation Standard—. ROL 4.04 Service by emergency medical A totally integrated medical transport vehicles which can be transportation system which maximizes pre-scheduled without negative performance and resource efficiency, medical impact shall be provided while holding down cost. only at levels which permit compliance with EMS Agency policy. Current Status: Existing ALS provider system status plans do not allow for utilization of emergency resources for non-emergency use. Emergency ambulance vehicles in the County are staffed and equipped to the paramedic (ALS) level. . of Need(s): Evaluate and adopt procedures that allow the efficient and effective use all ambulance resources to achieve a contemporary medical transportation system for the County consistent with the other objectives of this plan and the future needs of the County. Objective: Evaluate the overall medical transportation needs of the County and incorporate these needs and other objectives in this plan into the ambulance contracting process. Time Frame for Objective: FX-J Short Term Implementation Long Range Plan Complete/Partially Resource Requirement Priority 83-1 z mos. 1 Time Requirement Page 90 Contra Costa EMS Plan 1 Response and Transportation Standard: Goal: 4.05 Each local EMS Agency shall Defined response time standards develop response time standards throughout County EMS system in the for medical responses. These following areas: standards shall take into account the total time from receipt of the a) BLS/CPR provider call at the primary public safety b) First responder defibrillation ' answering point (PSAP) to arrival c) BLS/ALS first response of the responding unit at the d) BLS/ALS transport scene, including all dispatch intervals and driving time. Current Status: The provider contracts required by the EMS Agency specify response time standards. Need (s): Existing response time standards should be reviewed by EMCC and appropriate response time standards set for each of the categories specified in the goal. Response time standards should consider constraints of geography and resource availability. Objective: Establish performance standards for prehospital EMS operating zones with the definition of sub-zones for response time standards through input from County and local community representatives. Time Frame for Objective: Short Term Implementation ® Long Range Plan Complete/Partially ow Resource Requirement © Priority 12. rn s Time Requirement Contra Costa EMS Plan Page 91 r Response and Transportation , Standard: oal: 4.06 All emergency medical transport All emergency medical transport vehicles shall be staffed and vehicles providing ALS service are equipped according to current staffed and equipped with at least one State and local EMS Agency EMT-P per unit. ' regulations. Current Status: Adequate regulations, policies and procedures exist to assure that , ambulances are staffed and equipped according to current State and local standards. Need (s): Adequate policies and monitoring mechanisms are in place to assure that this level is met and maintained. Objective: Ongoing review and analysis. Time Frame for Objective: Q Short Term Implementation ® Long Range Plan Complete/Partially ow Resource Requirement © Priority Ungoing Time Requirement Page 92 Contra Costa EMS Plan - Response and Transportation Standard: Goal: 4.07 The local EMS Agency shall A county-wide first responder system integrate qualified EMS first for emergency medical incidents. responder agencies (including public safety agencies and industrial first aid teams) into the system. Current Status: The EMS Agency has been integrally involved with first responder agencies in both first responder coordination, EMT training and elevation of programs to the first responder defibrillation level of care. New interest in ALS first response ' services has been raised by some fire agencies. Need (s): A first responder master plan which would: • Develop standards for first responder agency participation in the EMS system. • Establish a process to be used for patient care documentation on a county-wide basis by first responders. • Develop first responder performance standards with contract terms. • Develop processes by which first responders participate in the EMS Agency CQI program, including the establishment of outcome expectations and measurement tools. • Evaluate first responder ALS needs. • Plan for overall first responder future needs. Assure that first responder involvement in the EMS system is facilitated through agreements or letters of understanding between the County and first responder services. Objective: Integrate first responder agencies and functions into the framework of the County EMS system through agreements and letters of understanding. Time Frame for Objective: 1 Short Term Implementation ® Long Range Plan Complete/Partially Resource Requirement © Priority -2 years Time Requirement Contra Costa EMS Plan Page 93 Response and Transportation Standard: Goal: 4.08 The local EMS Agency shall have Using State standards, when they exist, a process for categorizing the local EMS Agency should plan for medical/rescue aircraft and shall medical and rescue aircraft response to develop policies/procedures for: and transport of emergency patients a) authorization of aircraft to be within its service area. This plan should utilized in prehospital care. consider existing EMS resources, b) requesting of EMS aircraft. population density, environmental , c) dispatching of EMS aircraft. factors, dispatch procedures and d) determination of EMS aircraft catchment area. patient destination. e) orientation of pilots/flight EMS aircraft providers participate in QI crews to local EMS system. process. f) addressing and resolving formal ' complaints regarding EMS aircraft. Current Status: Helicopter S s: a icopter guidelines provide a mechanism for emergency helicopter access. The EMS Agency has a procedure to authorize air medical programs to respond within the County. Eleven air medical providers are on a call list for the County. Helicopters are requested through fire/medical dispatch centers. Need (s): An evaluation of current emergency helicopter services should be undertaken to determine effective utilization and quality of care provided. Agreements with air ambulance providers should be developed which include staffing, equipment, and response standards, as well as monitoring and QI mechanisms. Consideration of air- medical services as first response when the patient's location is likely to involve an extended response, where ground transport may exacerbate injuries and when the patient's condition is likely to be life threatening. The air medical response program should be linked to the County EMS COI program. Objective: Coordinated air medical response to emergency events in which time is , essential. Include case review and evaluation of outcome expectations for air medical response in the EMS CQI plan. Time Frame for Objective: , Short Term Implementation Long Range Plan Complete/Partially ow Resource Requirement © Priority 1-2 YeNFF-J Time Requirement Page 94 Contra Costa EMS Plan r ' Response and Transportation Standard: Goal: 4.09 The local EMS Agency shall Prompt and efficient air medical designate a dispatch center to response to designated emergencies. coordinate the use of air ambulances or rescue aircraft. Current Status: Air medical and air rescue requests are conducted by the appropriate fire/medical dispatch agency. Need (s): No Current needs. Objective: Ongoing review. 1 tTime Frame for Objective: Q Short Term Implementation ® Long Range Plan Complete/Partially e®, Resource Requirement © Priority ungoi Time Requirement Contra Costa EMS Plan Page 95 r Response and Transportation , Standard: Goal: 4.10 The local EMS Agency shall Prompt and efficient air response to 1 identify the availability of medical designated medical emergencies. and rescue aircraft for emergency patient transportation and shall maintain written agreements with aeromedical services operating within the EMS system. Current Status: The EMS Agency has designated various agencies that provide t medical and rescue aircraft. Need (s): On-going communication and coordination, as well as written agreements ' with agencies providing air medical services are needed. Objective: Assure ongoing adequate resources for air medical responses for EMS in Contra Costa County. Time Frame for Objective: , Short Term Implementation ® Long Range Plan Complete/Partially ow Resource Requirement © Priority 1-2 years Time Requirement Page 96 Contra Costa EMS Plan - : ' Response and Transportation Standard: Goal: 4.11 Where applicable, the local EMS A plan for response by and use of all Agency shall identify the terrain vehicles, snowmobiles, and availability and staffing of all water rescue vehicles, which considers terrain vehicles, snow mobiles, existing EMS resources, population and water rescue and other density, environmental factors, dispatch transportation vehicles. procedures and catchment area. Current Status: The issue has not been addressed by the local EMS Agency. Individual agencies within the County have various rescue capabilities. Need (s): The EMS Agency needs to conduct an inventory of special rescue resources within the County and provide a mechanism for activation of special rescue resources when needed. Objective: Establish specialized medical rescue program. Time Frame for Objective: Short Term Implementation ® Long Range Plan Complete/Partially ow Resource Requirement FT-1 Priority Z-b years Time Requirement .. Contra Costa EMS Plan Page 97 Response and Transportation Standard: Goal: 4.12 The local EMS Agency, in A plan for mobilizing adequate response cooperation with the local office and transport vehicles in the event of a of emergency services (OES) disaster. shall plan for mobilizing response and transport vehicles for disaster. Current Status: There is an existing comprehensive medical disaster plan for the County that is currently being updated to meet new EMS guidelines. Need (s): County medical disaster plan should be updated to meet new EMS guidelines. Objective: Complete revision of County medical disaster plan. �I Time Frame for Objective: ' Short Term Implementation ® Long Range Plan Complete/Partially Resource Requirement Priority _ years Time Requirement Page 98 Contra Costa EMS Plan -'� Response and Transportation Standard: Goal: I 4.13 The local EMS Agency shall Mutual aid agreements and automatic develop agreements permitting aid agreements which identify the inter-county response of optimal configuration and responsibility emergency medical transport for EMS responses are encouraged and vehicles and EMS personnel. coordinated. Current Status: Count fire departments have mutual aid in lace. Medical mutual aid Y P P and automatic aid are not fully developed although there exist many formal and informal agreements. Need (s): As a part of the ambulance ordinance and agreements between EMS providers and the County, there should be a clear definition of mutual and automatic aid response requirements. Objective: Assurance that patients receive the most prompt response possible. r �r Time Frame for Ob'ective: Short Term Implementation Long Range Plan Complete/Partially ow Resource Requirement © Priority 6-12mos. Time Requirement Contra Costa EMS Plan Page 99 Response and Transportation Standard: 4.14 The local EMS Agency shall Effective comprehensive multi-casualty develop multi-casualty response response for EMS incidents within the plans and procedures which County. include provisions for on-scene medical management, using the Incident Command System. Current Status: The incident command system is utilized for multi-casualty incidents. Hospitals have not universally adopted an incident command system (e.g. Hospital Emergency Incident Command System). Need(s): The multi-casualty, response plan, adopted by the EMS Agency and all d prehospital EMS providers, needs to be better communicated to hospital personnel an other providers within the County. All EMS providers should be encouraged to adopt an incident command system. Objective: Encourage continued adoption of the ICS system by all EMS providers including the HEICS system for hospitals. Facilitate better communication of the plan with medical community. Time Frame for Objective: Short Term Implementation Q Long Range Plan Q Complete/Partially ow Resource Requirement © Priority 12 months I Time Requirement Page 100 Contra Costa EMS Plan ' Response and Transportation Standard: Goal: 4.15 Multi-casualty response plans and Continued monitoring and updating of procedures shall utilize State MCI plans as necessary. standards and guidelines when they exist. �. Current Status: Existing State guidelines are utilized as a basis for the County's multi- casualty plans. Need (s): There are no identified needs. Objective: Ongoing review and analysis. r f i' Time Frame for Objective: Short Term Implementation ® Long Range Plan Complete/Partially ow Resource Requirement © Priority Ongoing Time Requirement .. Contra Costa EMS Plan Page 101 Response and Transportation Advanced Life Support Standard: Goal: 4.16 All ALS ambulances shall be Ambulance staffing at the ALS level to staffed with at least one person assure safe, high quality advanced life certified at the advanced life support services. ' support level and one person staffed at the EMT-I level. Current Status: Currently all ALS ambulances are staffed with two paramedics. Need (s): An evaluation of this standard is needed in light of the evaluation of ALS ' first response programs. Objective: Continue to study and update this staffing policy where appropriate. Time Frame for Objective: Short Term Implementation ® Long Range Plan Complete/Partially ow Resource Requirement © Priority ngomg Time Requirement Page 102 Contra Costa EMS Plan �-'i Response and Transportation Advanced Life Support Standard: Goal: 4.17 All emergency ALS ambulances All ambulances fully equipped for shall be appropriately equipped paramedic ALS level of care. for the scope of practice of level of staffing. Current Status: Adequate regulations, policies and procedures exist to assure that ALS ambulances are appropriately equipped for the scope of practice of its level of staffing. Need (s): There are no identified needs. Objective: Ongoing review and monitoring. r r r. r- r i Time Frame for Objective: Short Term Implementation ® Long Range Plan Q Complete/Partially Fca—w--i Resource Requirement © Priority ngoing Time Requirement r Contra Costa EMS Plan Page 103 1 Response and Transportation Ambulance Regulation Standard: Goal: 4.18 The local EMS Agency shall have EMS transportation agencies comply a mechanism (e.g., an ordinance with EMS policies and procedures. and/or written provider agreements) to ensure that EMS transportation agencies comply with applicable policies and procedures regarding system operations and clinical care. Current Status: Most EMS providers have contracts which define and require - compliance with EMS policies and procedures. The exception is air medical services. Need (s): Revision of the current ordinance to comply with this plan may be needed. Establish agreements where needed. Objective: Revision of the ambulance ordinance and establishment of agreements to comply with this plan. , Time Frame for Objective: Short Term Implementation ® long Range Plan Q Complete/Partially ow Resource Requirement © Priority -z year Time Requirement Page 104 Contra Costa EMS Plan - ' Response and Transportation Exclusive Operating Permits Standard: oal: 4.19 Any local EMS Agency which Selected ambulance services are desires to implement exclusive assigned responsibility for medical operating areas, pursuant to transportation within exclusive Section 1797.224, H&SC, shall operating areas. A legal framework develop an EMS transportation which defines and requires compliance plan which addresses: with performance standards is in place. a) Minimum standards for transportation services, b) Optimal transportation system efficiency and effectiveness, and c) Use of a competitive process to ensure system optimization. Current Status: The Contra Costa County Board of Supervisors has approved an EMS ground transportation plan. Need (s): Revision of the transportation plan to comply with this plan may be needed. Objective: Assure the transportation plan complies with this plan. Time Frame for Objective: Short Term Implementation ® Long Range Plan Complete/Partially ow Resource Requirement © Priority 1-2 years Time Requirement ' ;;' Contra Costa EMS Plan Page 105 Response and Transportation Exclusive Operating Permits Standard: Goal: 4.20 Any local EMS Agency which Medical transportation entities desires to grant an exclusive designated for exclusive operating areas operating permit without use of a are appropriately selected and awarded competitive process shall specified areas. document in its EMS transportation plan that its existing provider meets all of the requirements for "grand fathering" under Section 1797.224, H&SC. Current Status: Exclusive operating areas that have been granted comply with the H&S Code. Need (s): Ongoing review and an update of the EOA configuration may be needed. Objective: Review and update the EOA configuration. Time Frame for Objective: Short Term Implementation ® Long Range Plan Complete/Partially Resource Requirement © Priority 1-2 years Time Requirement Page 106 Contra Costa EMS Plan - ' R Exclusive Operating Permits Response and Transportation Standard: Goal: 4.21 The local EMS Agency shall have Selected ambulance services are a mechanism to ensure that EMS assigned responsibility for medical transportation and/or advanced transportation within exclusive life support agencies to whom operating areas. A legal framework to exclusive operating permits have define and require compliance with been granted, pursuant to performance standards is in place. Section 1797.224, H&SC, comply with applicable policies and procedures regarding system operations and patient care. Current Status: Count ordinance contracts and EMS Agency policies and procedures require compliance of ambulance providers. Need (s): No identified needs. Objective: Ongoing review. 1 . t Time Frame for Objective: Short Term Implementation ® Long Range Plan Complete/Partially ow Resource Requirement © Priority 1-2 years Time Requirement Contra Costa EMS Plan Page 107 Response and Transportation Exclusive Operating Permits Standard: Goal: 4.22 The local EMS Agency shall The EMS system is able to respond to periodically evaluate the design changes by implementing an ongoing of exclusive operating areas. program for monitoring and modifying activities to meet the needs of the County residents and enhance system effectiveness. Current Status: Exclusive operating areas are in place. ' Need (s): EOA's should be periodically evaluated. Ob'ective: Review and update exclusive operating area configuration as needed. 1 P P 9 9 Continue to monitor the performance of the EMS system and exclusive operating areas. r Time Frame for Objective: Short Term Implementation ® Long Range Plan Complete/Partially ow Resource Requirement © Priority Ungoing Time Requirement Page 108 Contra Costa EMS Plan =- 1 Facilities and Critical Care Standard: Goal: 5.01 The local EMS Agency shall The local EMS Agency, using State i assess and periodically reassess standards (when they exist) should the EMS-related capabilities of assess, periodically reassess, and acute care facilities in its service disseminate to EMS providers, area. information about the EMS-related capabilities of acute care facilities in its service area. Current Status: Criteria has been developed by the EMS Agency for some specialty receiving hospitals but not for general emergency receiving center capability. An assessment of receiving hospital capabilities has not been conducted by the County. Need(s): Develop criteria for emergency receiving hospitals with input from hospitals and prehospital providers. Prepare a self-assessment tool to assure capability of receiving hospitals. Develop letters of understanding between the EMS Agency and receiving hospitals. Include the receiving hospitals in the EMS Agency's quality improvement program and data collection activities. Obiectiv : Work with receiving hospitals to assure the capability exists to provide the 1 e 9 P p Y optimal and appropriate care to patients transported to those facilities through a self assessment and monitoring system. Time Frame for Objective: Short Term Implementation ® Long Range Plan Complete/Partially ow Resource Requirement © Priority - years Time Requirement =' Contra Costa EMS Plan Page 109 Facilities and Critical Care Standard: Goal: 5.02 The local EMS Agency shall EMS patients are delivered to the most ' establish prehospital triage appropriate facility to treat their needs. protocols and shall assist hospitals with the establishment of transfer protocols and agreements. Current Status: The local EMS Agency has developed comprehensive prehospital triage and transfer protocols. Need (s): Review prehospital and hospital triage and transfer protocols and, if necessary, revise to be consistent with this plan. Objective: Policies and procedures which assist field and base hospital personnel in determining the most appropriate disposition of patients. Work with hospitals to develop any transfer policies, protocols and agreements revised in response to this plan. Time Frame for Objective: Short Term Implementation ®,Long Range Plan Complete/Partially ow Resource Requirement © Priority 1-2 years Time Requirement Page 110 Contra Costa EMS Plan - Facilities and Critical Care t Standard: Goal: 5.03 The local EMS Agency, with the EMS patients are delivered to the most participation of acute care appropriate facility to treat their needs. hospital administrators, physicians and nurses, shall establish guidelines to identify patients who should be considered for transfer to facilities of right capability and shall work with acute care hospitals to establish transfer agreements with such facilities. Current Status: The EMS Agency has developed criteria to help identify patients who should be considered for transport or transfer to facilities with specialized or limited capabilities. The EMS Agency has assisted in development of transfer agreements between these facilities. Need (s): Continue to monitor and refine criteria to identify patients who should be considered for transfer to facilities of higher capability and provide consultation to hospitals developing new transfer agreements. Follow up data is needed from destination hospitals to evaluate EMS system effectiveness. Objective: Continue to monitor and refine criteria to identify patients who should be considered for transfer to facilities of higher capability and develop guidelines and work with facilities to develop any new transfer agreements. Develop a mechanism to obtain patient disposition data from receiving hospitals. ! Time Frame for Objective: Short Term Implementation ® Long Range Plan Complete/Partially ow Resource Requirement © Priority 1-2 years Time Requirement Contra Costa EMS Plan Page 111 ! Facilities and Critical Care Standard: Goal: 5.04 The local EMS Agency shall The local EMS Agency, using State designate and monitor receiving standards (when they exist), should hospitals and, when appropriate, designate and monitor receiving and, specialty care facilities for when appropriate, specialty care specified groups of emergency facilities for specified groups of patients. emergency and definitive care patients. Current Status: Criteria have been developed for specialty receiving hospitals but have not been formally developed for general receiving centers. There has been work ' on pediatrics in the area of prehospital treatment guidelines and direct transport of some seriously injured children to Children's Hospital Oakland. Need (s): Review criteria for receiving P 9 hospital designation and conduct needs' ' analysis on pediatric specialty designation requirements. Incorporate all related activities into the County EMS CQI program. Objective: Establish a system in which a patient with an identified or unique need can be transported directly to the specific facility medically appropriate to provide treatment. Time Frame for Objective: ' Short Term Implementation ® Long Range Plan Complete/Partially ow Resource Requirement © Priority 1-2 yg5Fs---1 Time Requirement Page 112 Contra Costa EMS Plan Facilities and Critical Care Standard: Goal: 5.05 The local EMS Agency shall The local EMS Agency provides encourage hospitals to prepare consultation to hospitals on preparation for mass casualty management. for mass casualty management when requested, including procedures for the coordination of hospital communication and patient flow. The incident command system for hospitals (HEICS) has been adopted by hospitals. Current Status: There is a comprehensive plan for mass-casualty incidents. Individual hospitals have their own disaster and mass-casualty incident plans. Most have not adopted a compatible incident command system. Need (s): Hospitals should continue to receive EMS system support in preparing for mass casualty management including the development of procedures for coordination of hospital communications and patient transportation. Hospital adoption of the HEICS system of emergency management should be encouraged. Individual facility plans should be reviewed to assure that they are coordinated and integrate with the County disaster plan and with each other. Oboective: Hospitals which are prepared in mass casualty management and are well integrated into the County disaster plan. �I Time Frame for Objective: Short Term Implementation ® Long Range Plan Complete/Partially ow Resource Requirement © Priority Z-b years Time Requirement ' Contra Costa EMS Plan Page 113 Facilities and Critical Care Standard: Goal: 5.06 The local EMS Agency shall have A plan in place in the event that a a plan for hospital evacuation, hospital must be evacuated. including its impact on other EMS system providers. Current Status: Hospital evacuation guidelines have been developed by the Bay Area Medical Mutual Aid (BAMMA) Committee and each hospital has an evacuation plan as required by law. Additionally, the County Multicasualty Incident Plan can be implemented to handle transport and distribution of patients from a hospital being evacuated. Needs EMS Agency should continue to work with hospitals to assure coordination between hospital disaster and County EMS planning for hospital evacuation. Objective: Coordination of hospital disaster and County EMS planning for hospital evacuation. Time Frame for Objective: Short Term Implementation ® Long Range Plan Complete/Partially ow Resource Requirement © Priority Z-b years Time Requirement -.. Page 114 Contra Costa EMS Plan ' Facilities and Critical Care Standard: Goal: ' 5.07 The local EMS Agency shall, A system to provide medical direction using a process which allows all for prehospital providers. eligible facilities to apply, ' designate base hospitals or alternative base stations as it determines necessary to provide ' medical direction of prehospital personnel. ' Current Status: Two hospitals have been designated as base hospitals in Contra Costa County (Mt. Diablo and John Muir Medical Centers). One, John Muir Medical Center, has also been designated to receive all of the trauma system base contacts. The hospitals were selected by application and hospital agreements define base hospital standards. Base hospitals have signed agreements with the County to provide base hospital services. Need (s): There is a need to review the overall requirements, expectations and ' configuration of base hospitals and base hospital standards, as well as the designation process. Based on this review and potential configuration changes, updated agreements with base hospital(s) and the County will be necessary. ' Objective: Review the overall requirements, expectations and configuration of base hospitals, related standards and designation process. Update agreements between the ' base hospital(s) and the County, as necessary. Time Frame for Objective: Short Term Implementation ® Long Range Plan Complete/Partially ow Resource Requirement © Priority - mos Time Requirement Contra Costa EMS Plan Page 115 Facilities and Critical Care ' Trauma Care System Standard: 5.08 Local EMS agencies that develop A plan and procedures which ensure trauma care systems shall that trauma patients are delivered determine the optimal system, promptly to trauma centers. ' including: a) The number and level of trauma centers, ' b) The design of catchment areas (including areas in other counties, as appropriate), with ' consideration of workload and patient mix, c) Identification of patients who t should be triaged or transferred to a designated center, including consideration of patients who , should be triaged to other critical care centers. d) The role of non-trauma center ' hospitals, including those that are outside of the primary triage area of the trauma center, , e) A plan for monitoring and evaluation of the system. Current Status: Criteria for trauma care facilities have been developed by the County , EMS Agency. The County has one designated Level II trauma center. Need (s): There are no specific needs for the trauma system. ' Objective: Ongoing monitoring and review. Time Frame for Objective: ShortTerm Implementation ® Long Range Plan Complete/Partially Resource Requirement © Priority ngoing Time Requirement Page 116 Contra Costa EMS Plan �� ' Facilities and Critical Care Trauma Care System ' Standard: Goal: 5.09 In planning its trauma care A plan and procedures which ensure system, the local EMS Agency that trauma patients are delivered shall ensure input from both promptly to trauma centers. providers and consumers. Current Status: This standard has been met. ' Need (s): There are no needs in this area. ' Objective: Ongoing monitoring and review. Time Frame for Objective: ' Short Term Implementation ® Long Range Plan Complete/Partially ow Resource Requirement © Priority ongoing Time Requirement Contra Costa EMS Plan Page 117 1 Facilities and Critical Care Pediatric Emergency and Critical Care Systems Standard: Goal: 5.10 Local EMS agencies that develop A plan and procedures to ensure that ' pediatric emergency medical and critical pediatric patients receive the most care systems shall determine the appropriate prehospital and in-hospital ' optimal system, including: specialty medical care. a) Number/role of system participants, particularly ED's, ' b) Catchment area design with regard to workload/patient mix, c) Identification of patients to be , primarily triaged or secondarily transferred to designated centers; d) Role of providers qualified to , transport such patients to designated facilities, e) Identification of tertiary care centers , 'for pediatric critical care and pediatric trauma, f) Role of non-pediatric critical care , hospitals including those outside the primary triage area, g) Plan for monitoring and evaluation of ' the system. Current Status: Prehospital treatment guidelines have been implemented for seriously Y ill/injured pediatric patients. Trauma system policies direct triage/transfer of seriously injured children to a pediatric trauma center. There is not a comprehensive plan , addressing triage/transfer of other than seriously injured pediatric patients. Need (s): An Emergency Medical Services for Children Plan should be developed. ' Objective: Establish a pediatric emergency medical and critical care system plan. Time Frame for Objective: ' Short Term Implementation ® Long Range Plan Complete/Partially ' 1pled Resource Requirement © Priority Z-b years Time Requirement Page 118 Contra Costa EMS Plan - ' Facilities and Critical Care Pediatric Emergency and Critical Care Systems Standard• 999L 5.11 Local EMS agencies shall identify A procedure for identifying emergency minimum standards for pediatric departments which meet standards for capability of an emergency pediatric care, for pediatric critical care department, including: centers and pediatric trauma centers. a) staffing, b) training, c) equipment, ' d) identification of patients for whom consultation with a pediatric critical care center is appropriate, e) quality assurance, and f) data reporting to the local EMS ' Agency. Current Status: The EMS Agency has not developed criteria and standards for pediatric capability in emergency departments beyond high-acuity pediatric trauma care. ' Need (s): In conjunction with the development of the pediatric emergency medical and critical care systems plan, it will be necessary to identify the capability of existing ' emergency departments. Objective: Establish a coordinated response to pediatric emergency medical and ' critical care patients in conjunction with Objective 5.10. Time Frame for Objective: Short Term Implementation ® Long Range Plan Complete/Partially e®, Resource Requirement © Priority 2-5 years Time Requirement j� Contra Costa EMS Plan Page 119 Facilities and Critical Care Other Critical Care Systems Standard: 5.12 In planning its pediatric Plans for appropriate prehospital emergency medical and critical response, treatment and transport of care system, the local EMS pediatric patients are developed with agency shall ensure input from input from the clinical specialists. the prehospital, hospital providers and consumers. ' Current Status: EMS Agency efforts towards EMS for children have been mainly t directed toward trauma and prehospital treatment of seriously ill children. Need (s): In conjunction with a recommendation on pediatric emergency planning, , ensure input from all specified groups. Objective: Identify and provide coordinated input from related groups on pediatric emergency planning. Time Frame for Ob'ective: Short Term Implementation ® Long Range Plan Complete/Partially ' Resource Requirement © Priority 2-5 years Time Requirement Page 120 Contra Costa EMS Plan ' Facilities and Critical Care rOther Critical Care Systems Standard: Goal: 5.13 Local EMS agencies developing Patients with specific clinical conditions specialty care plans for EMS- are provide for appropriate response targeted clinical conditions shall and treatment. ' determine the optimal system, for the specific condition involved including: a) The number and role of system participants, b) The design of catchment areas ' (including inter-county transport, as appropriate), with consideration of workload and ' patient mix, c) Identification of patients who should be triaged or transferred to a designated center, d) The role of non-designated hospitals, including those which ' are outside of the primary triage area, e) A plan for monitoring and evaluation of the system. Current Status: The major clinical condition targeted by the EMS Agency for the development of a systematic plan has been trauma. ' Need (s): In conjunction with the recommendation to focus on the specialty care area of pediatrics, other targeted patient groups may be identified which should be specifically addressed through protocols and procedures to provide a coordinated response, delivery or transfer by secondary means to the most appropriate facilities. Objective: Identify and provide coordinated EMS response to targeted patient groups. Time Frame for Objective: Short Term Implementation Long Range Plan Complete/Partially ' e®, Resource Requirement © Priority 2-5 years Time Requirement r . ��' Contra Costa EMS Plan Page 121 Facilities and Critical Care Standard: Goal: 5.14 In planning other specialty care Plans and procedures for the delivery of , systems, the local EMS Agency patients to speciaty centers receive shall ensure input from both input from both providers and providers and consumers. consumers. ' Current Status: Comprehensive specialty patient planning thus far has been targeted f towards trauma care. Need (s): The development of all system-wide specialty planning system will require ' input from receiving hospitals, specialty hospitals, the EMS Agency, and various EMS providers. Objective: Obtain wide input into development of all specialty patient plans, as identified in standard 5.13. , Time Frame for Ob'ective: ' Short Term Implementation ® Long Range Plan Complete/Partially , 11 e7I�. Resource Requirement F47-1 Priority Z-b years Time Requirement r Page 122 Contra Costa EMS Plan :�� Data Collection and System Evaluation Standard: Goal: 6.01 The local EMS Agency shall Resources are available to evaluate establish an EMS quality patient response and the care provided improvement/assurance (01/QA) specific patients. ' program to evaluate the response to emergency medical incidents and care provided specific ' patients. Programs shall address the total EMS system, including all prehospital provider agencies, rbase hospitals, and receiving hospitals. It shall address compliance with policies, procedures, and protocols and identification or preventable morbidity and mortality and shall utilize State standards and guidelines. The program shall use provider-based QI/QA programs and shall coordinate them with other providers. Current Status: The EMS system has some components of a comprehensive quality improvement program in place. rNeed (s): Philosophy and commitment to the total quality continuum concept should be developed by all EMS system participants. A comprehensive system-wide CQI (Continuous Quality Improvement) Program which involves all system providers should be developed and implemented. For the County CQI Plan to be successful, various system participants will need to provide in-house QI activities. An extensive manage- ment information system should be developed to support the County CQI program. Objective: A comprehensive Continuous Quality Improvement Plan for Contra Costa ' County EMS activities county-wide. Time Frame for Ob'ective: ' ® Short Term Implementation Long Range Plan Q Complete/Partially ig Resource Requirement © Priority -z years Time Requirement ' ,.,, Contra Costa EMS Plan Page 123 Data Collection and System Evaluation , Standard: Goal: 6.02 Prehospital records for all patient Comprehensive documentation of , responses shall be completed and patient contacts and interventions by all forwarded to appropriate EMS providers. agencies as defined by the local ' EMS Agency. Current Status: The EMS Agency has established a prehospital care report (PCR) form which is completed by all contract emergency ambulance providers. Copies of these forms are submitted to the EMS Agency upon request. There is no standard first , responder intervention form. Need (s): A standardized first responder patient intervention form needs to be r developed and implemented among the first responder agencies. A MIS system needs to be established to support the information and evaluation needs of the EMS system. Contemporary data collection (e.g., "paperless" data entry) and evaluation systems need to be investigated and where appropriate integrated into the EMS evaluation system. The patient PCR system needs to be integrated into a comprehensive quality improvement program. A standard reporting format should be in place with regular dissemination of information to EMS providers. Objective: An EMS MIS plan needs to be developed and integrated into the CGI program. The State Data Set, along with other data necessary to evaluate the system, are to be collected and used in the CQI program. Time Frame for Objective: Short•Term Implementation ® Long Range Plan Complete/Partially , ig Resource Requirement © Priority 1-2 years 'Time Requirement Page 124 Contra Costa EMS Plan Data Collection and System Evaluation Standard: Goal: 6.03 Audits of prehospital care, A mechanism is in place to link ' including both clinical and service prehospital records with dispatch, delivery aspects, shall be emergency department,.inpatient and ' conducted. discharge records. ' Current Status: Current audits of prehospital care are done largely at the base hospital and the provider levels. EMS Agency audits are often precipitated by complaints. Currently the only time prehospital records are linked with dispatch and emergency ' department inpatient and discharge records, is on a case-by-case request for information. The exception is the special review that the First Responder Defibrillation program receives which covers from field care through hospital discharge. Need (s): Establish a comprehensive audit/review program for all aspects of the EMS system as part of the MIS and CQI plans. As a part of the CQI program, clinical indicators and outcome measurements should be identified and studied. Objective: Establish an effectively linked MIS and CQI program in conjunction with objective 6.02. ' Time Frame for Objective: ® Short Term Implementation Long Range Plan Complete/Partially ig Resource Requirement Priority 1-2 years Time Requirement r'`' Contra Costa EMS Plan Page 125 Data Collection and System Evaluation Standard: Goal• 6.04 The local EMS Agency shall have Appropriate monitoring of medical a mechanism to review medical dispatch process. dispatching to ensure that the appropriate level of medical ' response is sent to each emergency and to monitor the appropriateness of pre- , arrival/post dispatch directions. Current Status: Currently there is a pilot computerized emergency medical dispatch , (EMD) program being conducted with San Ramon Valley Fire Protection District which has had extensive EMS Agency oversight. There is no county-wide system for the r EMS Agency to review medical dispatching. Need (s): EMD programs county-wide need to be involved in an overall evaluation plan, tied to the CQI effort to enhance medical dispatch within the County. Objective: Medical dispatch monitoring is included in the EMS CQI program. ' r Time Frame for Objective: Short Term Implementation ® Long Range Plan Complete/Partially ig Resource Requirement © Priority 1-3 years Time Requirement Page 126 Contra Costa EMS Plan fData Collection and System Evaluation Standard: Goal: 6.05 The local EMS Agency shall An integrated data management system establish a data management which includes system response and ' system which supports its clinical (both prehospital and hospital) system-wide planning and data. Patient registries, tracer studies, evaluation (including and other monitoring systems are used ' identification of high risk patient to evaluate patient care at all stages of groups) and the QA audit of the response. care provided to specific patients. ' It shall be based on State standards (when they are available). Current Status: Contra Costa County EMS Agency has established limited-use computer programs for prehospital report information. This information is currently being entered and the program is consistent with a limited data management system. A county-wide prehospital data set is in draft form. ' Need (s): A comprehensive MIS which supports.the EMS Agency CQI efforts. The system should be compatible with the EMS providers so that information can be ' electronically transferred to the system. A common patient identifier and data set for transportation providers, receiving hospitals, base hospitals, dispatch centers and trauma centers will need to be developed. Objective: Establish a comprehensive MIS which can integrate data from the various EMS system participants. Monitor EMS system performance using MIS data. Time Frame for Objective: ® Short Term Implementation Long Range Plan Q Complete/Partially ig Resource Requirement © Priority 1-2 years Time Requirement ' Contra Costa EMS Plan Page 127 Data Collection and System Evaluation ' Standard: Goal: 6.06 The local EMS Agency shall A data based evaluation process for ' establish an*evaluation program Contra Costa County EMS performance to evaluate EMS system design which focuses on identified desired and operations. This shall outcomes. , include structure, process, and outcome evaluations, utilizing State standards and guidelines ' when they exist. Current Status: The EMS Agency , g cy evaluates its Program components but there is not a regular comprehensive system review based on outcome. Manual collection of information is often required. Achievement of comprehensive system analysis would be time and resource consuming using the present methods of evaluation. Need (s): Development and implementation of this EMS System Plan, establishment of comprehensive MIS and CQI programs, needed input by EMS providers and creation of various policies and procedures should allow for overall EMS system program evaluation. A review of other program models should be conducted including the potential for a co-review program with neighboring counties. , Objective: The EMS Agency will regularly evaluate and report on the status of EMS system operations through the tools of the MIS system and CQI program. Time Frame for Objective: ' Short Term Implementation ® Long Range Plan Complete/Partially , e® Resource Requirement © Priority 2-3 years Time Requirement Page 128 Contra Costa EMS Plan , Data Collection and System Evaluation ' Standard: Goal: 6.07 The local EMS Agency shall have All providers in the EMS system ithe resources and authority to participate in the system-wide require provider participation in evaluation process. ' the system-wide evaluation program. Current Status: Evaluation processes for some EMS system components include providers, but there is not a mechanism for a system-wide review process. Resources ' are not available to fully implement comprehensive system-wide evaluation activities. Need (s): Additional resources, including personnel, would need to be dedicated to ' system evaluation activities in order to accomplish system-wide evaluation. A more comprehensive county ordinance and provider agreements should include opportunities for provider participation and support in the evaluation program. Specific funding sources should be identified and tapped to support evaluation processes. Expertise within the EMS Agency should be developed for the MIS plan. Objective: A system-wide EMS evaluation program which includes participation by all EMS providers. i Time Frame for Objective: Short Term Implementation ® Long Range Plan Complete/Partially �g Resource Requirement © Priority - years Time Requirement '�' Contra Costa EMS Plan Page 129_ Data Collection and System Evaluation Standard: Goal: 6.08 The local EMS Agency shall Increased awareness of the EMS ' periodically report on EMS system's accomplishments and system operations to the Board(s) activities. of Supervisors, provider , agencies, and Emergency Medical Care Committee(s). Current Status: The EMS Agency reports to the Board of Supervisors, the EMCC and the advisory committees on a regular basis. These reports define milestones and ' measurable EMS Agency and provider performance. .Need(s): Provide on-going information regarding performance of the Contra Costa , County EMS system's performance coordinated with the proposed CQI plan. Objective: Provide regular reports on the performance and accomplishments of the i Contra Costa County EMS system. . i 1 1 1 1 1 Time Frame for Objective: , Short Term Implementation ® Long Range Plan Complete/Partially ow Resource Requirement 0 Priority Ungoing Time Requirement Page 130 Contra Costa EMS Plan :- ' Data Collection and System Evaluation ' Standard: Goal: 6.09 The process used to audit The local EMS Agency's integrated data treatment provided by advanced management system includes life support providers shall prehospital, base hospital, and receiving evaluate both base hospital (and hospital data. alternative base station) and prehospital activities. Current Status: Most of the treatment evaluation for providers is done by base hospitals. There is little global or system evaluation of cases. Base hospitals perform an annual self-assessment of base hospital standards. Evaluation of base hospital clinical performance occurs on an isolated basis and is not linked to a CQI plan. Need (s): The integrated MIS plan should include prehospital, base hospital, and receiving hospital data. An on-going process for evaluation of clinical performance of base station hospitals and prehospital activities is a key function of the quality improvement program proposed previously. Objective: Institution of a comprehensive MIS and CQI program. i Time Frame for Objective: ® Short Term Implementation Long Range Plan Complete/Partially �g Resource Requirement © Priority 1-2 years Time Requirement r �'' Contra Costa EMS Plan Page 131 Data Collection and System Evaluation ' Trauma Care System Standard: Goal: 6.10 The local EMS Agency shall Trauma system activities are integrated develop a trauma system into the EMS system's quality including: improvement/assurance program. ' a) A trauma registry, b) A mechanism to identify patients whose care fell outside ' of established criteria, and c) A process of identifying potential improvements to the , system design and operation. Curren Status: The r u i t a ma registry has been successfully implemented and in use for the trauma system for the past nine years, however recent difference between the hardware and software of the trauma center and the EMS Agency has created data compatibility problems. Need (s): Attention needs to be given to the software and data reporting compatibility i problems. There is also a need to plan and rectify difficulties in getting patient information from non-trauma centers and to address confidentiality protection strategies. f Objective: As part of the MIS plan, meet with trauma center and non-trauma center providers and rectify data needs and procedures. Time Frame for Objective: Short Term Implementation ® Long Range Plan Complete/Partially ow Resource Requirement FT-1 Priority 1-2 years Time Requirement Page 132 Contra Costa EMS Plan -' Data Collection and System Evaluation Trauma Care System Standard: Goal: 6.11 The local EMS Agency shall A functioning and comprehensive ensure that designated trauma quality improvement/assurance program centers provide required data to which includes collection of essential the EMS Agency, including trauma care information. patient specific information which is required for quality assurance and system evaluation. Current Status: The EMS Agency is not able to collect all pertinent trauma system information from the designated trauma center and other hospitals which may be receiving trauma patients due to incompatibilities in software and policies. Need (s): Work with providers to rectify the problem areas. Objective: Work with providers to rectify the problem areas - 1 P Y Time Frame for Objective: Q Short Term Implementation ® Long Range Plan Complete/Partially ow Resource Requirement © Priority 1-2 years Time Requirement ="' Contra Costa EMS Plan Page 133 Public Information and Education ' Standard: Goal• 7.01 The local EMS Agency shall Community education programs on the promote the development and use of emergency medical services in dissemination of materials for the its service area are targeted. public which addresses: a) Understanding of EMS system .design and operation, b) Proper access to the system, c) Self help, e.g., CPR, first aid, etc. d) Patient and consumer rights as they relate to the EMS system, e) Health/safety habits as they relate to prevention/reduction of health risks in target areas. f) appropriate utilization of ED's. Current Status: The EMS Agency has developed information and materials for dissemination to the public including a 9-1-1 brochure. EMS participants have been involved in the Health Services Division Child Injury Prevention Coalition. The EMS Agency has acquired a "1-800-GIVE CPR" telephone number. The EMS PIE Committee has also-worked with the County fire agencies to assist in the provision of EMS related information. Staffing limitations and other program priorities have restricted efforts in this area. Need (s): Develop target needs, public information materials, and coordinate/assist the various provider groups in developing information for the public regarding EMS , activities. This program should be specifically tied to the COI plan, with clear and measurable outcomes. Objective: Complete a revised public information and education plan to accomplish the goal of this plan. Time Frame for Objective: Short Term Implementation ® Long Range Plan Complete/Partially ..._- i Resource Requirement ® Priority 2-5 years Time Requirement Page 134 Contra Costa EMS Plan �= Public Information and Education Standard: Goal: 7.02 The local EMS Agency, in The local EMS Agency promotes the conjunction with other local. development of special EMS educational health education programs, shall programs for targeted groups at high work to promote injury control risk of injury or illness. and preventive medicine. Current Status: The EMS Agency supports and provides resources to injury control efforts including the Child Injury Prevention Coalition of the Health Services Department. Need (s): To support programs developed by other facilities and agencies within the County to promote preventive medicine and to continue injury control efforts. Objective: Advocate and support existing programs within the County. Develop programs devoted to injury control and preventive, medicine as identified in the public information and education plan. i Time Frame for Objective: Short Term Implementation ® Long Range Plan Complete/Partially ow Resource Requirement ® Priority 2-b years Time Requirement 1 Contra Costa EMS Plan Page 135 Public Information and Education Standard: Goal: 7.03 The local EMS Agency, in The local EMS Agency, in conjunction ' conjunction with the local office with the local office of emergency of emergency services, shall services (OES), produces and promote citizen disaster disseminates information on disaster ' preparedness activities. medical preparedness. Current Status: The local EMS Agency is involved with the County's emergency 9 Y 9 Y services division in promoting citizen disaster preparedness activities. Need (s): On-going participation in promoting citizen awareness of emergency ' preparedness activities. Objective: Continue to provide citizen awareness programs on emergency Y preparedness as needed. f Time Frame for Objective: Short Term Implementation Long Range Plan Complete/Partially , ow Resource Requirement © Priorityongoing— Time Requirement Page 136 Contra Costa EMS Plan ='i Public Information and Education Standard: Goal: 7.04 The local EMS Agency shall The local EMS Agency has adopted a promote the availability of first goal for training an appropriate aid and CPR training for the percentage of the general public in first general public. aide and CPR. A higher percentage is achieved in high risk groups. Current Status: The EMS Agency has taken a lead in promoting CPR training for the ' general public largely through acquisition of an "800" phone which when called provides information regarding locations of citizen CPR classes. Multiple providers within the County have provided CPR training and are actively promoting such programs. Need (s): The EMS Agency should continue to pursue supporting first aid and CPR program information availability in the EMS public education plan. Objective: Increase access to first aid and CPR training programs through advocacy and resource identification. Time Frame for Objective: r' Q Short Term Implementation ® Long Range Plan Complete/Partially ow Resource Requirement © Priority Z-b years j Time Requirement c Contra Costa EMS Plan Page 137 Disaster Medical Response , Standard: Goal: 8.01 In coordination with the local Prompt and adequate medical response office of emergency services in the event of catastrophic disasters. (OES), the local EMS Agency shall participate in the i development of medical response plans for catastrophic disasters, including those involving toxic t substances. Current Status: A county-wide disaster response plan is in place which includes two health related indexes (medical and public health). The Health Services Department ' -has organized an Emergency Response Team which meets regularly to develop specific plans for disaster medical response. The EMS Agency is the lead agency for the Health Service Department on major emergency medical responses. Need (s): Revise medical disaster plan to comply with new SEMS requirements. All response agencies need to be trained in the new plan. , Objective: Revise medical disaster plan and provide training to participants. Time Frame for Objective: Short Term Implementation ® Long Range Plan Complete/Partially ow Resource Requirement © Priority OngoiFg---J Time Requirement Page 138 Contra Costa EMS Plan J!;i Disaster Medical Response Standard: Goal: 8.02 Medical response plans and The California Office of Emergency procedures for catastrophic Services emergency plan, prepared disasters shall be applicable to under Standardized Emergency incidents caused by a variety of Management System (SEMS), serves as hazards, including toxic the model for the development of substances. medical response plans for catastrophic disasters. Current Status: Medical response-plans are in place for a variety of potential disastrous or hazardous incidents. Need (s): The Hospital Emergency Incident Command System (HEICS) and SEMS programs should be incorporated into current planning and procedure development of hospitals. Increased involvement of system participants in medical response planning. Objective: Continue to develop and update medical response plans to meet the variety ' of potential hazards which exist in County and to conform to State requirements Time Frame for Objective: Short Term Implementation ® Long Range Plan Complete/Partially ow Resource Requirement © Priority Z-b years Time Requirement Contra Costa EMS Plan Page 139 Disaster Medical Response ' Standard: al: 8.03 All EMS providers shall be Trained and informed personnel respond , properly trained and equipped for to and manage medical incidents response to hazardous materials involving hazardous materials. incidents, as determined by their system role and responsibilities. Current Status: The County's fire departments and the County Health Services Department's Environmental Health Division have addressed hazardous materials response. All emergency ambulance providers are required to attend eight hours of HAZMAT training. Need (s): Continuation of exiting liaison among EMS, prehospital and hospital industry ' agencies. Objective: The EMS Agency should continue to ensure availability of hazardous materials incident training for EMS system participants. - f i 1 1 Time Frame for Ob•ective: Short Term Implementation ® Long Range Plan Complete/Partially pfe Resource Requirement © Priority , 1 2-5 years Time Requirement Page 140 Contra Costa EMS Plan =.� Disaster Medical Response Standard: fiagh 8.04 Medical response plans and ICS training is provided for all medical procedures for catastrophic providers. disasters shall use the Incident Command System as the basis for field management. Current Status: Medical response plans and procedures for catastrophic disasters are utilized in the incident command system (ICS) as the basis for field management and coordination. Training for incident command system activities is required in the emergency ambulance contracts. Need (s): On-going evaluation and enhancement of catastrophic disaster plans. The requirements of designation, permitting, or agreements with the various EMS providers, including SEMS coordination and training exercises, should include mechanisms to further incident command system training. Objective: Expanded ICS and SEMS training exercises for medical providers. Time Frame for Objective: Short Term Implementation ® Long Range Plan Complete/Partially ow Resource Requirement © Priority Z-b yeFj--j Time Requirement '�' Contra Costa EMS Plan Page 141 Disaster Medical Response Standard: Goal: 8.05 The local EMS Agency, using The local EMS Agency, using State State guidelines when they are guidelines when they are available, and available, shall establish written in consultation with the Regional Poison procedures for distributing Center, should identify hospitals with disaster casualties to the most special facilities and capabilities for appropriate facilities in its*service receipt and treatment of patient with area. radiation and chemical contamination and injuries. Current Status: Patient distribution procedures are provided for by the County disaster plan. Specialized HAZMAT training has been provided to hospital emergency personnel. All basic emergency departments are considered capable of receiving and treating patients with hazardous materials contamination. Needs : Review and revise procedures if needed. Identify specialized receiving facilities for specific hazardous materials incidents. Objective: Continue to provide on-going review, and revise procedures as needed. Establish options for the distribution of casualties and identify appropriate facilities based on unique incident factors as needed. Time Frame for Objective: Short Term Implementation ® Long Range Plan Complete/Partially ' ow Resource Requirement © Priority ngoing Time Requirement Page 142 Contra Costa EMS Plan i Disaster Medical Response Standard: Goal: 8.06 The local EMS Agency, using The local EMS Agency's procedures for State guidelines when they are determining necessary outside available, shall establish written assistance in a disaster are exercised Procedures for early assessment yearly. of needs and resources and an emergency means for communicating requests to the State and other jurisdictions. Current Status: Specific components of the disaster plan address out-of-county medical mutual aid requests. A comprehensive Regional Disaster Health and Medical Coordination (RDHMC) system has been established in Region II with the CCC EMS Agency as the lead. Need (s): On-going review and revision of disaster-management policies, procedures, and plans. Regular testing of components. Objective: Ability to determine early in a disaster situation that outside assistance is needed with defined procedures to acquire help. Time Frame for Objective: Short Term Implementation ® Long Range Plan Complete/Partially ow Resource Requirement ® Priority ngoing"' Time Requirement '�' Contra Costa EMS Plan Page 143 Disaster Medical Response Standard: figLalh 8.07 A specific frequency (e.g., Capability to communicate with and CALCORD) or frequencies shall coordinate activities of participants in a be identified for interagency disaster situation. communication and coordination during a disaster. Current Status: CALCORD is the frequency in the Count for interagency coordination q Y Y 9 Y at the command level. Additionally, all fire and emergency ambulance units are capable of unit to unit communication. All paramedic ambulances are equipped with cellular telephones. Need(s): To have communications capability with out-of-county ambulances responding on mutual aid requests. Objective: To establish communications capabilities for out-of-county ambulances i responding to a mutual aid request. Time Frame for Objective: Short Term Implementation ® Long Range Plan Complete/Partially Resource Requirement ® Priority Ungoing-1 Time Requirement Page 144 Contra Costa EMS Plan -'i Disaster Medical Response Standard: Goal: 8.08 The local EMS Agency, in The local EMS Agency, using State cooperation with the local OES, guidelines when they are available, shall develop an inventory of should ensure that emergency medical appropriate disaster medical providers and health care facilities have resources to respond to multi- written agreements with disaster casualty incidents and disasters medical resource providers for the likely to occur in the service area. provision of appropriate resources to respond to multi-casualty incidents and disasters likely to occur in its service area. Current Status: Resource directories have been developed by Y Count OES and by the Bay Area Medical Mutual Aid Committee (BAMMA). Need (s): Periodic review and updating of resource directories. P 9 1 Objective: Maintain existing directories. Time Frame for Objective: Short Term Implementation ® Long Range Plan Complete/Partially ow Resource Requirement ® Priority Ungoing Time Requirement ; , .. Contra Costa EMS Plan Page 145 Disaster Medical Response Standard: figaat 8.09 The local EMS Agency shall ongoing review and analysis. establish and maintain relationships with disaster medical assistance teams (DMAT) teams in its area. Current Status: No DMAT teams have been established in the Contra Costa Area. Need(s): None. Objective: None. Time Frame for Objective: Short Term implementation Q Long Range Plan Complete/Partially ow Resource Requirement F4--j Priority Time Requirement Page 146 Contra Costa EMS Plan Disaster Medical Response Standard: Goal• 8.10 The local EMS Agency shall Provide adequate response resources to ensure the existence of medical significant medical incidents and during mutual aid agreements with other periods of extraordinary demand. counties in its OES Region and �. elsewhere, as needed, which ensure that sufficient emergency medical response and transport vehicles, and other relevant resources will be made available during significant medical incidents and during periods of extraordinary system demand. Current Status: Inter-county medical mutual aid planning has been extensive particularly in the EMS Agency's role with the Bay Area Medical Mutual Aid (BAMMA) Committee and as the Regional Disaster Medical Health Coordinator (RDMHC). Need(s): Master (s1 t Medical Mutual Aid Plan within the Region or the State. Objective: Continue to engage in medical mutual aid planning with other counties in the Region as well as the State. �I Time Frame for Objective: Short Term Implementation ® Long Range Plan Complete/Partially ow Resource Requirement © Priority ungoing Time Requirement ;r Contra Costa EMS Plan Page 147 Disaster Medical Response tan ar figat 8.11 The local EMS Agency, in County-wide designation of casualty coordination with the local OES collection points for use in disasters. and County health officer(s), and using State guidelines when they are available, shall designate casualty collection points (CCP's). Current Status: CCP sites have been designated for all areas of the County. Need(s): Continue to evaluate and designate sites as needed, review site selection, equipment, staffing needs and mechanisms for supply acquisition. Objective: Review of existing sites and the designation of additional CCP sites throughout the County, as necessary. Time Frame for Objective: Short Term Implementation Long Range Plan Complete/Partially aw Resource Requirement PriorityOngoing I Time Requirement Page 148 Contra Costa EMS Plan Disaster Medical Response Standard: fiac 8.12 The local EMS Agency shall Establishment of CCP's with develop plans for establishing communication capabilities during CCP's and a means for disasters. communicating with them. Current Status: CCP's have been designated and communication requirements are available through the County EOC. Need (s): On-going review and revision of CCP designation and operational procedures, as needed. Objective: Define plans for establishing communication with CCP's, as needed. z Time Frame for Objective: Short Term Implementation ® Long Range Plan Complete/Partially FEB—w--1 Resource Requirement © Priority ungoin—g---1 Time Requirement Contra Costa EMS Plan Page 149 i Disaster Medical Response Standard: Goal• 8.13 The local EMS Agency shall EMS responders are appropriately review the disaster medical trained in disaster response, including training of EMS responders in its the proper management of casualties service area, including the proper exposed to and/or contaminated by management of casualties toxic or radioactive substances. exposed to and/or contaminated by toxic or radioactive substance. Current Status: Policies, procedures, and treatment guidelines for substance specific ' hazardous material incidents have been developed. EMS Agency requires eight hours of HAZMAT training for all ambulance personnel. EMS providers participate in training exercises. SEMS training is planned. Need (s): Continue to develop policies, procedures, and treatment guidelines for substance specific hazardous material incidents. Develop curriculum and coordinate t training programs regarding medical disasters as needed. Coordinate prehospital exercises with hospital responses. Continue to review the disaster medical training of first responders. Objective: Continue to establish plans, policies, and procedures for disaster response. Conduct a continued review of management of toxic or radioactive substances. Time Frame for Objective: Short Term Implementation ® Long Range Plan Complete/Partially ow Resource Requirement © Priority Ungoing Time Requirement Page 150 Contra Costa EMS Plan :�'� Disaster Medical Response Standard: 8.14 The local EMS Agency shall Coordinated response and management encourage all hospitals to ensure of disaster situations. that their plans for internal and external disaster are fully integrated with the County's medical response plan(s). Current Status: Hospitals have internal and external disaster plans in place. There is integration with the County's disaster plans. EMS Agency facilitates the Hospital Disaster Forum for hospitals to share ideas and assist each other in disaster planning. Need(s): Continue to encourage and require receiving hospitals to participate with the EMS Agency in disaster planning integration of the hospital and system plans. Encourage the implementation of the HEICS program in hospitals. Continue involving hospitals in exercises. Continue facilitating participation in the Hospital Disaster Forum. Objective: Integrated disaster plans for hospitals, providers, and EMS system. Time Frame for ObLective:, Short Term Implementation Long Range Plan Complete/Partially ow Resource Requirement Priority Ongoing ] Time Requirement Contra Costa EMS Plan Page 151 Disaster Medical Response Standard: Goal: 8.15 The local EMS Agency shall Hospitals within County linked through ensure that there is an radio communication capability. emergency system for inter- hospital communications, including operational procedures. ' Current Status: Although the MEDARS system is designed to permit radio communications between hospitals, ambulances and the County, design requires that hospitals communicate via the County Communications Center. Needs • A digital network is needed to link the hospitals, county communications and EMS, with the capacity to display hospital status and to transmit emergency information. Objective: Establish a digital hospital network. Time Frame for Objective: ® Short Term Implementation Long Range Plan Complete/Partially ig Resource Requirement FT-1 Priority - years Time Requirement r Page 152 Contra Costa EMS Plan =- tDisaster Medical Response Standard: 920h 8.16 The local EMS Agency shall Medical response agencies and acute ensure that all prehospital care hospitals have written policies and medical response agencies and procedures for the management of acute care hospitals in its service specific medical incidents and area, in cooperation with other participate in at least one disaster local disaster medical response exercise per year. agencies, have developed guidelines for the management of significant medical incidents and have trained their staffs in their use. Current Status: All hospitals and medical response agencies have written policies and procedures for the management of significant medical incidents. Not all hospitals participate in multi-agency exercises on an annual basis. Need (s): Multi-agency disaster exercises. Objective: All agencies and hospitals to participate in multi-agency annual exercises. Time Frame for Objective: Short Term Implementation ® Long Range Plan Complete/Partially ow Resource Requirement © Priority ungoing Time Requirement Contra Costa EMS Plan Page 153 Disaster Medical Response Advanced Life Support Standard: oal: 8.17 The local EMS Agency shall Ability to acquire ALS resources from ensure that policies and outside of County during significant procedures allow advanced life medical incidents. support personnel and mutual aid PP responders from other EMS systems to respond and function . during significant medical incidents. Current Status: Current policies waive restrictions on responders during disasters. There are reciprocal agreements with other county EMS agencies. Need (s): None. Objective: None. Time frame for Objective: j�ective: Short Term Implementation ® Long Range Plan Complete/Partially ow Resource Requirement © Priority ungoiFg----1 Time Requirement Page 154 Contra Costa EMS Plan Disaster Medical Response Critical Care System Standard: Goal: 8.18 Local EMS agencies developing Identification of most appropriate trauma or other critical care patient destinations during significant systems shall determine the role medical incidents, including specialty of identified specialty centers " systems when appropriate. during significant medical Maintenance of normal EMS operations incidents and the impact of such during significant medical incidents. incidents on day-to-day triage procedures. Current Status: Capabilities during major incidents and MCI's are addressed in their respective plans. Need(s): None. q it Objective: Ongoing review. Time Frame for Objective: Short Term Implementation FX-1 Long Range Plan 0Complete/Partially Resource Requirement FT-1 Priority ongoing Time Requirement Contra Costa EMS Plan Page 155 1 Disaster Medical Response Exclusive Operating Areas/Ambulance Regulation Standard: oa- 8.19 Local EMS agencies which grant Access to external ambulance services exclusive operating permits shall during significant medical incidents or ensure that a process exists to periods of extraordinary demand. waive the exclusivity in the event of a significant medical incident. Current Status: Current policies and County contracts with providers allow exclusivity waiver in the event of disaster and mutual aid requests. Need (s): There are no current needs. Objective: Ongoing review and analysis. Time Frame for Objective: Short Term Implementation ® Long Range Plan Complete/Partially ow Resource Requirement © Priority Ongoing Time Requirement Page 156 Contra Costa EMS Plan SECTION III SYSTEM RESOURCES AND OPERATIONS The following tables are provided in the format required by the California EMS Authority and are labeled EMSA Table 1-8 respectively. �I EMSA TABLE 1: Summary of System Status A. SYSTEM ORGANIZATION AND MANAGEMENT Does not Meets Meets Short-range Long-range currently most minimum recommended Pian Plan Agency Administration standard standard guidelines 1.01 LEMSA Structure X X X 1.02 LEMSA Mission X X X 1.03 Public Input X X X 1.04 Medical Director X X Planning Activities 1.05 System Plan X X X 1.06 Annual Plan X X X Update 1.07 Trauma Planning* X X X 1.08 ALS Planning* X X X 1.09 Inventory of X X X Resources 1.10 Special X X X Populations 1.11 System X ' X X Participants �I i' Contra Costa EMS Plan Page 159 Does not Meets Meets Short-range Long-range currently meet minimum recommended Plan Plan Regulatory Activities standard standard guidelines 1.12 Review& X X X Monitoring 1.13 Coordination X X X 1.14 Policy & X X X Procedures Manual 1.15 Compliance X X X w/Policies System Finances 1.16 Funding X X X Mechanism Medical Direction 1.17 Medical X X X Direction* 1.18 QA/QI X X X ' 1.19 Policies, X X Procedures, Protocols 1.20 DNR X X X 1.21 Determination of X X X Death 1.22 Reporting of X X X , Abuse 1.23 Interfacility X X X Transfer Enhanced Level: Advanced Life Support 1.24 ALS System X X X 1.25 On-Line Medical X X X Direction Page 160 Contra Costa EMS Plan Does not Meets Meets Short-range Long-range Enhanced Level: currently meet minimum recommended Plan Plan Trauma Care System standard standard guidelines 1.26 Trauma System X X X Plan t. Enhanced Level: Pediatric Emergency Medical and Critical Care System 1.27 Pediatric System X X Plan Enhanced Level: Exclusive Operating Areas 1.28 EOA Plan X X X r 4_. '% Contra Costa EMS Pian Page 161 B. STAFFING/TRAINING Does not Masts Meats Short-range Long-range currently meet minimum recommended Plan Plan Local EMS Agency standard standard guidelines 2.01 Assessment of X X X Needs ' 2.02 Approval of X X X Training 2.03 Personnel X X X ' Dispatchers , 2.04 Dispatch Training X X First Responder (non-transporting) 2.05 First Responder X X X Training 2.06 Response X X X 2.07 Medical Control X X X Transporting Personnel 2.08 EMT-1 Training X X X Hospital 2.09 CPR Training X X X 2.10 Advanced Life X X ' Support Enhanced Level: Advanced Life Support 2.11 Accreditation X X X Process 2.12 Early X X X Defibrillation 2.13 Base Hospital X X X Personnel Page 162 Contra Costa EMS Plan .�- C. COMMUNICATIONS Does not Meets Meets Short-range Long-range Communications currently meet minimum recommended Plan Plan Equipment standard standard guidelines 3.01 Communications X X X Plan• 3.02 Radios X X X 3.03 Interfacility X X X Transfer* 3.04 Dispatch Center X X X 3.05 Hospitals X X X 3.06 MCl/Disasters X X Public Access 3.07 9-1-1 Planning/ X X X Coordination 3.08 9-1-1 Public X X X Education Resource Management 3.09 Dispatch Triage X X 3.10 Integrated X X X Dispatch ,;, Contra Costa EMS Plan Page 163 D. RESPONSE/TRANSPORTATION Does not Meets Meets Short-range Long-range currently meet minimum recommended Plan Plan Universal Level standard standard guidelines 4.01 Service Area X X X Boundaries* 4.02 Monitoring X X X 4.03 Classifying X X X Medical Requests 4.04 Pre-scheduled X X . Responses 4.05 Response Time X X Standards' 4.06 Staffing X X X 4.07 First Responder X X X Agencies 4.08 Medical & X X X Rescue Aircraft' 4.09 Air Dispatch X X Center 4.10 Aircraft X X X Availability• 4.11 Specialty X X X _I Vehicles 4.12 Disaster X X X Response 4.13 Intercounty X X Response* 4.14 Incident X X X Command System 4.15 MCI Plans X X X ■ Page 164 Contra Costa EMS Plan =- Does not Meets Meets Short-range Long-range Enhanced Level: currently meet minimum recommended Plan Plan Advanced Life Support standard standard guidelines 4.16 ALS Staffing X X X ' 4.17 ALS Equipment X X X ' Enhanced Level:Ambulance Regulation 4.18 Compliance X X X Enhanced Level: ' Exclusive Operating Permits 4.19 Transportation X X X Pian 4.20 'Grand X X X fathering' 4.21 Compliance X X X 4.22 Evaluation X X X Contra Costa EMS Plan Page 165 1 E. FACILITIES/CRITICAL CARE Does not Meets Meets Short-range Long-range currently meet minimum recommended Plan Plan ' Universal Level standard standard guidelines 5.01 Assessment of X X Capabilities , 5.02 Triage &Transfer X X X Protocols• 5.03 Transfer X X X t Guidelines* 5.04 Specialty Care X X ' Facilities* 5.05 Mass Casualty X X X ' Management 5.06 Hospital X X X Evacuation• Enhanced Level: Advanced Life Support 5.07 Base Hospital X X X Designation* Enhanced Level: Trauma Care System 5.08 Trauma System X X X Design 5.09 Public Input X X X Enhanced Level: Pediatric Emergency Medical and Critical Care System ' 5.10 Pediatric System X X Design 5.11 Emergency X X Departments 5.12 Public InputsX X Enhanced Level: Other Specialty Care Systems 5.13 Specialty System X X X ' Design 5.14 Public Input X X X ' Page 166 Contra Costa EMS Plan ' ' F. DATA COLLECTION/SYSTEM EVALUATION ' Does not Meets Meets Short-range Long-range currently meet minimum recommended Plan Plan Universal Level standard standard guidelines ' 6.01 QA/Ql Program X X X 6.02 Prehospital X X X ' Records 6.03 Prehospital Care X X Audits ' 6.04 Medical Dispatch X X 6.05 Data X X X ' Management System• 6.06 System Design X X ' Evaluation 6.07 Provider X X X Participation ' 6.08 Reporting X X X Enhanced Level: Advanced Life Support 6.09 ALS Audit X X Enhanced Level: Trauma Care System ' 6.10 Trauma System X X X Evaluation ' 6.11 Trauma Center X X X Data ' Contra Costa EMS Plan Page 167 G. PUBLIC INFORMATION AND EDUCATION , Does not Meets Meets Short-range Long-range , currently meet minimum recommended Plan Plan Universal Level standard standard guidelines , 7.01 Public X X X Information Materials , 7.02 Injury Control X X X 7.03 Disaster X X X Preparedness , 7.04 First Aid &CPR X X X Training ' Page 168 Contra Costa EMS Plan H. DISASTER MEDICAL RESPONSE ' Does not Meets Meets Short-range Long-range currently meet minimum recommended Plan Plan Universal Level standard standard guidelines 8.01 Disaster Medical X X X Planning• ' 8.02 Response Plans X X X 8.03 HAZMAT X X X Training 8.04 Incident X X X Command System ' 8.05 Distribution of X X X Casualties• ' 8.06 Needs X X X Assessment 8.07 Disaster X X X Communication* 8.08 Inventory of X X X Resources ' 8.09 DMAT Teams X X 8.10 Mutual Aid X X X ' Agreements• 8.11 CCP X X X Designation' ' 8.12 Establishment of X X X CCP's ' 8.13 Disaster Medical X X X Training 8.14 Hospital Plans X X X 8.15 Inter-hospital X X Communications 8.16 Prehospital X X X Agency Plans ��' Contra Costa EMS Plan Page 169 Does not Meets Meets Short-range Long-range ' Enhanced Level: currently meet minimum recommended Plan Plan Advanced Life Support standard standard guidelines 8.17 ALS Policies X X X ' Enhanced Level: Specialty Care Systems , 8.18 Specialty Center X X X Roles 8.19 EOA/Disasters X X X t Page 170 Contra Costa EMS Plan =� ' ' SYSTEM RESOURCES AND OPERATION EMSA TABLE 2: System Organization and Management ' EMS System: Contra Costa County Reporting Year 1994 1. Percentage of population served by each level of care by county: (Identify for the maximum level of service offered; the total of a, b, and c should equal ' 100°6.) County. Contra Costa County a. Basic Life Support (BLS) b. Limited Advanced Life Support (LALS) ' c. Advanced Life Support (ALS) 100 2. Type of agency b a - Public Health Department b - County Health Services Agency c - Other (non-health) County Department d - Joint Powers Agency e - Private Non-profit Entity f - Other: 3. Person responsible for day-to-day EMS Agency activities reports to d a - Public Health Officer b - Health Services Agency Director/Administrator c - Board of Directors d - Other: County Health Officer 4. Indicate the non-required functions which are performed by the Agency Implementation of exclusive operating areas (ambulance franchising) X ' Designation of trauma centers/trauma care system planning X Designation/approval of pediatric facilities Designation of other critical care centers Development of transfer agreements X Enforcement of local ambulance ordinance X Enforcement of ambulance service contracts X ' Operation of ambulance service Continuing education r ' "' Contra Costa EMS Plan Page 171 s EMSA TABLE 2 - System Organization & Management (cont.) , Personnel training X Operation or oversight of EMS dispatch center Non-medical disaster planning Administration of critical incidents stress debriefing (CISD) team Administration of disaster medical assistance team (DMAT) Administration of EMS Fund [Senate Bill (SB) 12/6121 ' Other: Other• Other: 5. EMS Agency budget for FY 1993-1994 A. EXPENSES Salaries and benefits (all but contract personnel) S 586.000 Contract Services (e.g. medical director) 289.000 Operations (e.g. copying, postage, facilities 135,000 Travel NA ' Fixed assets NA Indirect expenses (overhead) 372,000 Ambulance subsidy 2.561,000 EMS Fund payments to physicians/hospital 678,000 ' Dispatch center operations (non-staff) NA Training program operations NA ' Other: 1st Responder Enhancements 486,000 Other: Communications Enhancements 330.000 ' Other: Transfer to Reserve 33,000 TOTAL EXPENSES S 5.470,000 ' r Page 172 Contra Costa EMS Plan ' EMSA TABLE 2 - System Organization & Management (cont.) B. SOURCES OF REVENUE Special project grant(s) (from EMSAI Preventive Health and Health Services (PHHS) Block Grant $ 160,000 Office of Traffic Safety (OTS) NA State general fund NA County general fund 242,000 Other local tax funds (e.g., EMS district) 3,706,000 County contracts (e.g. multi-county agencies) NA Certification fees 10,000 Training program approval fees NA ' Training program tuition/Average daily attendance funds (ADA) Job Training Partnership ACT (JTPA) funds/other payments NA Base hospital application fees NA ' Base hospital designation fees NA Trauma center application fees 0 Trauma center designation fees 75,000 Pediatric facility approval fees NA Pediatric facility designation fees NA ' Other critical care center application fees NA Type: ' Other critical care center designation fees NA Type: ' Ambulance service/vehicle fees NA Contrib4tions NA EMS Fund (SB 12/612) 850,000 ' Other grants: - NA Other fees: NA Other (specify): Carry over 427,000 TOTAL REVENUE $ 5,470,000 TOTAL REVENUE SHOULD EQUAL TOTAL EXPENSES. IF THEY DON'T, PLEASE EXPLAIN BELOW. ' �'% Contra Costa EMS Plan Page 173 EMSA TABLE 2 - System Organization & Management (cont.) ' 6. Fee structure for FY 1993-1994 ' We do not charge any fees X Our fee structure is: ' First responder certification $ 0 EMS dispatcher certification ' EMT-I certification 15 EMT-I recertification 15 EMT-defibrillation certification 0 EMT-defibrillation recertification 0 , EMT-II certification NA- EMT-11 recertification NA EMT-P accreditation and certification 35 Mobile Intensive Care Nurse/ Authorized Registered Nurse (MICN/ARN) certification 25 ' MICN/ARN recertification 20 EMT-1 training program approval 0 I EMT-11 training program approval NA EMT-P training program approval 0 ' MICN/ARN training program approval 0 Base hospital application 0 ' Base hospital designation 0 Trauma center application 10,000 , Trauma center designation 75,000 Pediatric facility approval NA Pediatric facility designation NA ' Other critical care center application ' Type: Other critical care center designation Type: Page 174 Contra Costa EMS Plan P ' EMSA TABLE 2 - System Organization & Management (cont.) ' Ambulance service license 5 0 Ambulance vehicle permits 300 ' Other: Non-emergency vehicle permit 300 Other: Other: Other: ' 7. Complete the table on the following pages Agency two a es for the EMSA enc staff for the fiscal year of 1994 . ��' Contra Costa EMS Plan Page 175 cc m ao m N a- z Z 'LU O V Im o , cn cR y o0 0�° o� o SRO LL TO M M M M M M W W m Z W m C C is CL m F- a m ' a � Qo rn o cnm o w V) N N N N N N ~ N ' a = d v O W ed H i C O U c Z -i O W O Z , z H O t y aci 02 E a m , m c eo .W.t � C c o v o U :° U O , o c F- U o V a o a c ° o ° cUo N ° Q ° w m -- •c O ° L me m � mm t0 V mO O d o ii l=C O o Q O 0- cn cn vi � v, a `o ao cn E w w .- a NU MU w a. o v1 V N oC v 0 W O (7 C - UFOU0 .VO�— .0m WEQ 2 o p p N v E E crn-0 c � as 0 omo Iwii W W U mom `\.. ' n m a m cn CL Z � v U U W to C c C C p U D U U L co LL Co c 00 w N O O Z16-- LLI M M M m c C cc i m0. } W0 L n Ln y Q � -i O M n 00 W uci Q c0 M T- •- •- - U = O t� 0 O W U ' C 0 U N v } C J ' V° w O Z LO In r r r LL N N O O O o d 02 CL LU E 0 CD � � v LU U ' co J C F 0) C C m L F- i0 cd C �W m m 0 7 G C N Q m m N C Im w (A be be cn � Cn mom, � .� m _m Q W y W 0 h m N E o o N �0 v CD CL �; •- U N U o n. cn r- N N vI . N _ \ L L L U) N p� 4-; m c m m w m W 7 O m 7 C 7 C i V U J h N co c Q p e LU 1-' Q V L °r a�oo 0 � � m U w 6 m C a v n +° d o cn co 0 C = N y o �' co j Q j o X o 2 O2F- 0 3a "a O w d dU w O D LU co r- 4)co 1 CL O to W CL 2 0 1 LU .r Z co wt z cn (3) ills: ...........I. O 0 LU LU LU xi m C 01 LD .G !t cn cm t: o 0 (D %- I a LU C3 CL %w < CO 0 Z m 4a (D LU c M U) > 4J 4-j M.-i LU 0 g& Im �Ig, 0 0 cm C c0M.71 E E e��:�ri � m m L , AL cn .2 Z z ca 4t xl: cc q) cc c c 0 Ma Y IL41 IS C 'm co LU ui -j -0 O. 0 0 (6 > C4 4- 0 " :) (Dowo 0 0 CL c ee < cnCD 0 cf) w E E .. ....... 0 z z LU LU ......... SYSTEM RESOURCES AND OPERATIONS SMSA TABLE 4 - Communications ' EMS System: Contra Costa County County: Contra Costa County Reporting Year: 1994 1. Number of primary Public Service Answering Points (PSAP) 10 2. Number of secondary PSAP's 2 3. Number of dispatch centers directly dispatching ambulances 3 ' 4. Number of designated dispatch centers for EMS aircraft 5 5. Do you have an operational area disaster communication system? yes X no ' a. Radio primary frequency MEDARS (T-Band) 4 channel b. Other methods Alternative telephone system: local government radio frequencies ' c. Can all medical response units communicate on the same disaster communications system? yes X no d. Do you participate in OASIS? yes X no e. Do you have a plan to utilize RACES as a back-up communication system? yes X no 1) Within the operational area? yes X no 2) Between the operational area and region and/or state? yes X no ' 6. Who is your primary dispatch agency for day-to-day emergencies? Four designated fire/medical disoatch centers. 7. Who is your primary dispatch agency for a disaster? Sheriff's Dispatch '' Contra Costa EMS Plan Page 179 EMSA TABLE 5 - Response/Transportation EMS System: Contra Costa County Reporting Year: 1994 ' Note: Table 5 is to be reported by Agency. TRANSPORTING AGENCIES 1. Number of exclusive operating areas 5 2. Percentage or population covered by Exclusive Operating 100% Areas (EOA) 3. Total number responses 44.473 a) Number of emergency responses (Code 2: expedient, Code 3: lights and siren) 44.473 b) Number non-emergency responses (Code 1: normal) unknown 4. Total number of transports 31,332 ' a) Number or emergency transports (Code 2: expedient, Code 3: lights and siren) 31.332 b) Number of non-emergency transports (Code 1: normal) unknown ' Early Defibrillation Programs 5. Number of public safety defibrillation programs 15 , a) Automated 15 b) Manual NA 6. Number of EMT-Defibrillation programs 0 a) Automated 0 , b) Manual 0 Air Ambulance Services , 7. Total number or responses unknown a) Number of emergency responses unknown b) Number of non-emergency responses unknown 8. Total number of transports 408 a).Number of emergency (scene) responses 408 b) Number of non-emergency responses unknown * Includes interfacility transfers. , Page 180 Contra Costa EMS Plan co m CD a ca a aC r WZ E r N w 0- too m ' 0 D co CD "° a N C N d Q `01 ca m Z Z E c •� m s v N o rAL1 N m CD CA C y r d c o E E W c O W � Q d m -a -o G y o m H s� r o c, `m 0 o •'a .y ... O O• G p O 1 43 co GZ 4 m m N m L m trots W `� NC7 D +� O• �, d + N d m G UCl* io d Z to c m o 0 U U O � > �m ..• � � co W G � N r r EMSA TABLE 6 - Facilities/Critical Care EMS System: Contra Costa County Reporting Year: 1994 Trauma care system - based on admittance data 1. Trauma patients: a) Number of patients meeting trauma triage criteria 1 .152 b) Number of major trauma victims transported directly to a trauma 967 center by ambulance c) Number of major trauma patients transferred to a trauma center 96 d) Number of patients meetings triage criteria who weren't treated 89 , at a trauma center Emergency departments: 2. Total number of emergency departments 10 a) Number of referral emergency services 0 , b) Number of standby emergency services 1 c) Number of basic emergency services 9 d) Number of comprehensive emergency services 0 r 3. Number of receiving hospitals with agreements 0 i 1 1 1 Page 182 Contra Costa EMS Plan % EMSA TABLE 7 - Disaster Medical EMS System: Contra Costa County County: Contra Costa County Reporting Year: 1994 SYSTEM RESOURCES 1. Casualty Collections Points (CCP) a. Where are your CCP's located? see attached b. How are they staffed? no staffing clan c. Do you have a supply system for supporting them for 72 hours? yes X no 2. CISD Do you have a CISD provider with 24 hour capability? yes X no 3. Medical Response Team a. Do you have any team medical response capability? yes no X ' b. For each team, are they incorporated into your local response plan? yes no c. Are they available for statewide response? yes no d. Are they part of a formal out-of state response system? yes no 4. Hazardous materials a. Do you have any HAZMAT trained medical response teams? yes X no b. At what HAZMAT level are they trained? First Resr)onder tc. Do you have the ability to do decontamination in an emergency room? yes X no ' d. Do you have the ability to do decontamination in the field? yes X no OPERATIONS 1. Are you using a standardized Emergency Management System (SEMS) that incorporates a form of Incident Command System (ICS) structure? yes X no 2. What is the maximum number of local jurisdiction EOC's you will need to interact with in a disaster? 20 3. Have you tested your MCI Plan this year in a: a. real event? yes X no b. exercise? yes X no �' Contra Costa EMS Plan Page 183 EMSA TABLE 7 - Disaster Medical (cont.) 4. List all counties with which you have written medical aid agreement. none 5. Do you have formal agreements with hospitals in your operational area to participate in disaster planning and response? yes no X 6. Do you have a formal agreement with community clinics in your operational areas to participate in disaster planning and response? yes no X 7. Are you part of multi-county EMS system for disaster response? yes no X 8. Are you a separate department or agency? yes no X 9. If not, to whom do you report? Health Services Department ' 10. 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Advanced Life Support - ALS - Special services designed to provide definitive prehospital emergency medical care as defined in Health and Safety Code Section 1797.5 2,including, but not limited to, cardiopulmonary resuscitation, cardiac monitoring, cardiac defibrillation, advanced airway management, intravenous therapy, administration of specified drugs and other medicinal preparations,and other specified techniques and procedures administered by authorized personnel under the supervision of a base hospital. Ambulance Service - A qualified provider of medical transportation for patients requiring treatment and/or monitoring due to illness or injury. Ambulance Service Area(zone)-A designated geographic area contiguous to other such areas and delineated by the local EMS agency for the purpose of ensuring availability of emergency medical transport services at all times by one or more specified providers. Ambulance Unit - An ambulance staffed with qualified personnel and equipped with appropriate medical equipment and supplies. Base Hospital- One of a limited number of hospitals which, upon designation and upon the completion of a written contractual agreement with the local EMS agency, is responsible for directing the advanced life support (ALS) system and prehospital care system assigned to it by the local EMS agency. Basic Life Support (BLS)- Emergency first aid and cardiopulmonary resuscitation procedures which,as a minimum,include recognizing respiratory and cardiac arrest and starting the proper application of cardiopulmonary resuscitation(CPR)to maintain life without invasive techniques until the victim by be transported or until advanced life support is available. Casualty Collection Point (CCP) - A site for the congregation, triage (sorting), preliminary treatment, and evacuation of casualties following a disaster. Code Three-Ambulance response with red lights and sirens to an emergency incident. When responding Code 3, the emergency unit may proceed through red lights and may exceed the posted speed limit within certain restraints, although the driver is responsible for assuring safety for his/her unit and other drivers while doing so. Code Two - Used by EMS systems to refer to an immediate ambulance response to a potentially urgent but non-life threatening incident without the use of red lights and sirens and adhering to all requirements of the vehicle code (speed limits and rights-of-ways). Contra Costa EMS Plan Page 205 Communications System- Resources and arrangements for notifying the EMS system of an emergency, for mobilizing and dispatching resources, for exchanging information, for remote monitoring of vital indicators and for the radio transmission of treatment procedures and directions. Computer Aided Dispatch or CAD-Computer-Aided Dispatch system consisting of associated hardware and software to facilitate call taking, system status management, unit selection, ambulance coordination resource dispatch and deployment,event time stamping,creation and real time maintenance of incident database, and providing management information. Dispatch Center - A coordinating center for the efficient management of all participating emergency resources within a designated area of responsibility. The center dispatches rescue personnel and `equipment and coordinates these various resources to ensure maximum effectiveness. Definitive Care-A level of therapeutic intervention capable of providing comprehensive health care services for a specific condition. Emergency (medical) - a situation in which there is a real or perceived need for immediate action, attention or decision making to prevent mortality or to reduce serious morbidity. Emergency Medical Dispatch (EMD) - Personnel trained to State and national standards on emergency medical dispatch techniques including call screening, resource priority and pre- arrival instruction. Emergency Medical Services Authority (SMSA)-The State EMS organization which develops standards for local EMS systems and provides coordination and leadership. Emergency Medical Services Medical Director- Every local EMS agency shall have a licensed physician as medical director designated by the county to provide medical control and assure medical accountabilitythrough ough planning., implementation and evaluation of the EMS system. Emergency Medical Services System- A specially organized arrangement which provides for the personnel, facilities, and equipment for the effective and coordinated delivery of medical care services under emergency conditions. _ Emergency Medical Technician-1(EMT-1)- Individuals trained in basic life support according to standards prescribed by the California Code of Regulations and certified by a local EMS agency. Emergency Medical Technician-Defibrillator(EMT-D)-Individuals trained to initiate automatic or semiautomatic defibrillator procedures. Emergency Medical Technician-Paramedic(EMT-P)-Individuals trained in basic and advanced life support according to the California Code of Regulations and who have been licensed by the State. Page 206 Contra Costa EMS Plan `�': First Responder- The first person (unit) dispatched to the scene of a medical emergency to provide patient care. Health Services Department - A department of county government responsible for health related issues. The Contra Costa County Health Services Department, which includes the Emergency Medical Services Agency, has been designated by the local Board of Supervisors as the "Local EMS Agency", and the County Health Officer as the "EMS Medical Director". Local EMS Agency -The local agency, usually a county health department, or office having primary responsibility for administration of emergency medical services in a county or multi- county area. Medical Control-Physician responsibility for the development,implementation,and evaluation of the clinical aspects of an EMS system. Medical Disaster-A natural or human-caused event which overwhelms the medical resources within a system. it is characterized by a wide geographic scope and by damage to medical facilities and the transportation system. Because of its wide scope, it must be managed by a centralized, off-scene command system. Mobile Intensive Care Nurse !M/CN or Authorized Registered Nurse ARNJ-A Registered Nurse who is authorized to give medical direction to advanced life support personnel from a base hospital under direction of a base hospital physician. Metro - All census places with a population density of greater than 500 persons per square mile; or census tracts and enumeration districts without census tracts which have a population density of greater than 500 persons per square mile. Multi-Casualty Incident A natural or human-caused event which may overwhelm the medical resources within a system. It is characterized by a limited geographic scope and can be managed by an on-scene command system. Mutual Aid- The furnishing of resources by one agency to another agency. Quality Improvement/QualityAssurance-A method of evaluation of services provided, which includes defined standards, evaluation methodology, and utilization of evaluation results for continued system improvement. Receivina Facility- A general acute care facility which has been assigned a role in the EMS system by the local EMS agency. Response Time - The total interval from receipt of a request for medical assistance to the primary public safety answering point (PSAP) to arrival of the responding unit at the scene. This includes all dispatch intervals and driving time. Rural Area - All census-places with a population density of 7 to 50 persons per square mile; or census tracts or enumeration districts without census tracts which have a population density of 7 to 50 persons per square mile. Contra Costa EMS Plan Page 207 Suburban Area-All census places with a population density of 51 to 100 persons per square mile; or census tracts or enumeration districts without census tracts which have a population density of 51 to 100 persons per square mile. System Status Management or Systems Status Plan (SSP)- A management tool to define the "unit hours" of production time, their positioning and allocation, by hour and day of week to best meet demand patterns. Transfer Agreement - A written agreement between health facilitiesproviding reasonable assurance that transfer of patients will be effected between health facilities whenever such transfer is medically appropriate, as determined by the attending physician. Trauma Care System- A subsystem within the EMS system designed to manage the triage, transportation and treatment of the trauma patient. Urban Area - All census places with a population density of 101 to 500 persons per square mile;or census tracts and enumeration districts without census tracts which have a population density of 101 to 500 persons or more per square mile. Wilderness - Census tracts or enumeration districts without census tracts which have a population of less than seven persons per square mile. Page 208 Contra Costa EMS Plan ==� r T ANNEX 1 �' AB 3153 Compliance ( Section 1797.224 H&SC) CONTRA COSTA County EXCLUSIVE OPERATING AREAS FACT SHEET 1. Area or subarea (zone) name or title: ERA 1 2. Name(s) of current provider(s): American Medical Response West 3. Area or subarea (zone) geographical description: Emergency response area one includes the unincorporated areas of West County. The cities of El Cerrito, Richmond, Pinole, Hercules, San Pablo, Kensington, Martinez, Pleasant Hill, Lafayette, Orinda and Walnut Creek west of Highway 680 and adjacent unincorporated areas. 4. Statement of exclusivity: Exclusive 5. Method to achieve exclusivity: Request for Proposal 6. Tyne of exclusivity: Emergency Ambulance. 7. Addendum: None Contra Costa EMS Plan Page 211 CONTRA COSTA County EXCLUSIVE OPERATING AREAS FACT SHEET 1. Area or subarea (zone) name or title: ERA 2 2. Name(s) of current provider(s): American Medical Response West 3. Area or subarea (zone) geographical description- Emergency response area two includes Clayton, Concord, Walnut Creek east of Highway 680 and adjacent unincorporated areas. 4. Statement of exclusivity: Exclusive 5. Method toachieveexclusivity: Request for Proposal 6. Type of exclusivity Emergency Ambulance. 7. Addendum: None Page 212 Contra Costa EMS Plan CONTRA COSTA County EXCLUSIVE OPERATING AREAS FACT SHEET 1. Area or subarea (zone) name or title: ERA 3 2. Name(s) of current provider(s): Moraga Fire Protection District 3. Area or subarea (zone) geographical description: Emergency response area three includes Moraga and adjacent unincorporated areas along Moraga Fire Protection District boundaries. 4. Statement of exclusivity: Exclusive 5. Method to achieve exclusivity: Grandfathered pursuant to H.S. 1797.201 6. Twe of exclusivity: Emergency Ambulance. 7. Addendum: None Contra Costa EMS Plan Page 213 CONTRA COSTA County EXCLUSIVE OPERATING AREAS FACT SHEET 1. Arear r o subarea (zone) name or title: ERA 4 2. Name(s) of current provider(s): San Ramon Valley Fire-Protection District 3. Area or subarea (zone) geographical description: Emergency Response area four includes the entire San Ramon Valley (Alamo, Danville, San Ramon and Tassajara). 4. Statement of exclusivity: Exclusive 5. Method to achieve exclusivity: Request for Proposal 6. Tvoe of exclusivity: Emergency Ambulance. 7. Addendum: None i�. Page 214 Contra Costa EMS Plan =. CONTRA COSTA County iEXCLUSIVE OPERATING AREAS FACT SHEET ' 1. Area or subarea (zone) name or title: ERA 5 2. Name(s) of current provider(s): American Medical Response West 3. Area or subarea(zone)geographical description: Emergency response area five includes all of East County (Pittsburg, Bay Point, Antioch, Brentwood and unincorporated areas) along the 9-1-1 boundary line separating East from Central County. 4. Statement of exclusivity: Exclusive 5. Method to achieve exclusivity: Request for Proposal 6. Tyne of exclusivity: Emergency Ambulance. 7. Addendum: None M! 1 c Contra Costa EMS Plan Page 215 i ANNEX II Trauma Care System Plan CONTRA COSTA County Trauma Care System Plan The Trauma Care System Plan for Contra Costa County was adopted by the Board of Supervisors on November 19, 1985. This plan was approved by the State Emergency Medical Services Authority on December 20, 1985, as meeting proposed State Trauma Regulations, and was re-approved on November 28, 1988,as meeting the new State Trauma Regulations. 4 The Trauma Care System Plan is available from the EMS Agency upon request. i 1 _ 1 Contra Costa EMS Plan Page 219 This Page Left Intentionally Blank