EMERGENCY MEDICAL SERVICES COMMITTEE

Transcription

1 County of Santa Clara Emergency Medical Services System Emergency Medical Services Agency 976 Lenzen Avenue, Suite 1200 San Jose, CA voice fax EMERGENCY MEDICAL SERVICES COMMITTEE Chair: Health Advisory Commissioner Harry Hall Thursday, October 3, :00 pm 3:00 pm (Voting Members Requested to RSVP by September 26, 2013) Santa Clara County Sheriff s Department Auditorium 55 West Younger Avenue San Jose, CA All reports and supporting material are available for review on the Santa Clara County EMS Agency website at and in the EMS Agency s offices at least one week prior to the meeting. This information is also available the day of the meeting. ( Indicates supporting documentation attached. Indicates committee action required). 1. Call to Order / Roll Call (Commissioner Hall) 2. Introductions and Announcements (Commissioner Hall) 3. Public Comment Period (Staff) This portion of the meeting is reserved for persons desiring to address the EMS Committee on a Committee-related matter not on the agenda. Speakers are limited to two (2) minutes. Calendar Items (Commissioner Hall) Calendar items matters may be of an informational nature, not requiring an action/vote; or may require the Committee to take an action based on nature of the material presented. A division of the Santa Clara County Public Health Department Page 1 of 100

2 4. Approval of June 6, 2013 Meeting Minutes 5. Election of Chairperson (Hall) 6. Summary of Items Presented to Board of Supervisors or Health & Hospital Committee (Natividad) 7. EMS System Update (Staff) A. EMS System Strategic Assessment and Planning Process (Petrie) i. EMS System Strategic Plan ii. EMS System Strategic Plan Implementation Plan B. EMS System FY 14 Emphasis Areas C. Sobering System Planning (Petrie) 8 Medical Director Report Clinical Care (Dr. Rudnick) ( ) 9. EMS Trust Fund (Petrie and Davies) ( ) A. Accept Written Report on the Financial Status of the EMS Trust Fund (Natividad) 10. Exclusive Operating Area Contract Status (Blain) A. Rural/Metro Update (Petrie) B. County EOA Update First Quarter 2013 i. Accept Rural/Metro Response Time Performance Report ( ) ii. Accept Status of Deliverables ( ) C. Accept Fire Department Response Time Performance Report ( ) D. Palo Alto EOA Update Accept Verbal Report 11. Hospital Destination, Diversion, and Advisory Status Report (Petrie) ( ) A. Six Sigma Analysis of Wall Time and Diversion Page 2 of 100

3 12. FY 14 EMSCO Meeting Dates 13. Member Roundtable and Reports 14. Next Meeting and Adjourn (Chairperson) December 5, 2013 from 1-3 pm at the Sheriff s Department Auditorium, 55 West Younger Avenue, San Jose, CA Venue and Parking Instructions Visitor parking is available at the County building parking lot designated Visitor areas. No food or uncapped beverages are permitted in the training room. This meeting will be recorded. Page 3 of 100

4 Emergency Medical Services Committee Sheriff s Department Auditorium, 55 W Younger Avenue June 6, to 1500 Hours Meeting Minutes Item Discussion Action 1. Call to Order/Roll Call Chairman Harry Hall called the meeting to Meeting called to order. order at 1:36 p.m. A quorum was present. 2. Introductions and Announcements As noted. 3. Public Comment No members of the public provided comment. Calendar Items 4. Approval of March 7, 2013 Meeting Minutes Without discussion, the committee approved the consent calendar. M/S/C None March 7, 2013 meeting minutes approved as presented. M/S/C S. Drewniany/J. Kralyevich 5. Summary of Approved or Pending Board of Supervisors, and Health and Hospital Committee Items 6. EMS System Update A. EMS System Strategic Assessment and Planning Process 1. Presentation of Draft 2 of EMS System Strategic Plan Without discussion, the committee accepted the approved Board of Supervisor and Health and Hospital Committee items. Michael Petrie reported on the Strategic System Assessment and Planning process. The Abaris Group and EMS Agency personnel met with EMS key leadership groups, including Fire Chiefs, Hospital CEOs, Police Chiefs, County Health and Hospital leadership, County Communications, specialty center medical directors and program managers, and emergency and nonemergency ambulance personnel. Comments from these groups were evaluated, and many were incorporated into draft 4 of the EMS System Strategic Plan, which was distributed to EMS System stakeholders for review on May 14, Draft 4 of the EMS System 1 Summary of Approved BOS and HHC items accepted as presented. EMS System Strategic Assessment Plan Draft 2 approved as presented. M/S/C J. Coffaro/K. Horowitz Page 4 of 100

5 B. Sobering System Planning Strategic Plan was reviewed with all EMS System stakeholders at a final workshop held on May 20, Based on comments received at the final workshop, a final draft of the strategic plan was developed. Following review of the EMS System Strategic Plan by the Health and Hospital Committee and approval by the Board of Supervisors, the plan will be proofed and printed, and a strategic plan rollout meeting will be held to release the approved Santa Clara EMS System Strategic Plan to EMS System stakeholders and the public The Abaris Group will develop an implementation plan, which sequences recommended activities necessary to implement the strategic plan. Michael Petrie updated the committee on the planning process for a Sobering System for Santa Clara County. County representatives from the Public Health Department, Mental Health Department, Drug and Alcohol Program, and the EMS Agency presented a sobering system business case to the Hospital Council and Hospital Chief Executive Officers on May 4, These executives supported the sobering system, but expressed concern about the high price of the sobering system, and encouraged county representatives to also seek funding from others who may benefit from a sobering center, such as law enforcement agencies. Information only. 2 Page 5 of 100

6 C. EMS Semi-Annual Report for May 2013 Mr. Petrie reported on the Santa Clara County EMS Agency semiannual report reviewing the operations of the EMS Agency and discussing the status of the Santa Clara County EMS System. This report emphasizes the period from July 1, 2012 through December 31, 2012, but includes information from January 1, 2012 through December 31, Information only. 7. Medical Director Report Clinical Care Dr. Eric Rudnick reported on the medication shortages that continue to plague Santa Clara County as well as the nation. The most recent issue is the critical shortage of dextrose (Glucose) solutions. The Santa Clara County EMS Agency has begun to work closely with County Ambulance in developing an inventory control policy procedure. These processes should allow earlier notification of Santa Clara EMS Agency when these shortages reoccur with other critical medications for EMS. Information only. 8. EMS Trust Fund A. Fiscal Year 14 EMS Trust Fund Recommended Allocations Dr. Rudnick also updated the committee on the EMS Authority task for the development of Core Measures for California. Michael Petrie presented a report on the Financial Status of the EMS Trust Fund. The Fiscal Year 2014 EMS Trust Fund monies are generated from liquidated damages and other charges that occurred in the Santa Clara EMS System during fiscal year The EMS Agency estimates that during 2013, the EMS Trust Fund grew by $3,400,000 dollars. Therefore, allocations from the EMS Trust Fund for 2014 equal that amount. The Fiscal Year 14 EMS Trust Fund Recommended Allocations approved as presented. M/S/C M: S.Drewniany/S: J Coffaro 3 Page 6 of 100

7 $750,000 was allocated to subsidize the general operations of the Public Health Department to offset targeted general fund budget reduction of $1,500,000. The Public Health Department has services and programs that complement many of the interests of EMS. This general operational subsidy will assist the Department from having to make deeper budget reductions in and across these areas of services. This will not impact approved projects. It will impact money that is moved into reserves. Funds that were not used were put into an unassigned category within the EMS Trust Fund. The amount of money in the unassigned account has grown steadily over the years. Based on the anticipated drawdown of $1,520,000, which are the amount of EMS Trust funds already approved for expenditure, and rolling over $578,571 for expenditure in 2014, the projected balance of the EMS Trust Fund at June 30, 2013 will be $5,971,050. B. Accept Written Report on the Financial Status of the EMS Trust Fund Michael Petrie reported on the Financial Status of the EMS Trust Fund liquated damages. Balance of Trust Fund. Accept Written Report on the Financial Status of the EMS Trust Fund S. Drewniany/J. Nelson C. EMS Trust Fund Category C Solicitation Increasing Proposals (Commissioner Hall) Chairperson Hall reported that at the March 7 EMS Committee meeting the committee members approved that a subcommittee be formed to review the EMS Trust Fund Funding Packet Applications. Additional projects are needed to spend the allocated funds available. Informational Only 4 Page 7 of 100

8 9. Exclusive Operating Area Contract Status A. County EOA Update First Quarter 2013 i. Accept Rural/Metro Response Time Performance Report B. Accept Fire Department Response Time Performance Report. C. Palo Alto EOA Update Accept Verbal Report 10. Hospital Destination, Diversion, and Advisory Status Report John Blain reported on the first quarter (January to March 2013) response time performance. Rural Metro has been compliant in all zones and overall performance. John Blain reported that the fire departments response time performance met standards for emergency and non-emergency calls each month from January to March The only one variance was for the City of San Jose. The EMS Agency is working with them to identify solutions for meeting 90% performance response rate. Performance reports are posted on a monthly basis to the EMS Agency website. John Blain reported on the City of Palo increase ambulance coverage. Brought in a third ambulance. Impact has been seen diminished EOA response in the area. The improved response time will be reflected in the June report. Michael Petrie reported on the status of hospital destination, diversion and hospital advisory status levels for January to March of The EMS Agency is working with the Health and Hospital Committee to use EMS Trust Funds to hire a Six Sigma consultant to focus on reducing wall times and diversion, and increasing ED availability. The RFP solicitation process to begin in October Information only. The Fire Department Response Times Performance Report accepted as presented. M/S/C J. Kravelovich/J. Coffaro Information only. Information only. 11. Member Roundtable and Reports Dr. Rudnick reported on the site-visit to MedStar Mobile HealthCare in Forth Worth, Texas to evaluate EMS Systems for final recommendations of EMS Strategic Plan. Information only 5 Page 8 of 100

9 12. Next Meeting The next meeting will be held on October 3, 2013 from 1:00 to 3:00pm at the Sheriff s Department Auditorium. 13. Adjournment There being no further business, the meeting was adjourned at 2:48pm As noted. Meeting adjourned. MEMBERS PRESENT Harry Hall, Chair, Health Advisory Commission Kenneth Horowitz,, Health Advisory Commission Jo Coffaro, Hospital Council of Northern CA Steven Drewniany, Santa Clara County Police Chief s Tom Haglund, County City/County Managers Randy Hooks, Permitted Non-911 Ambulance Provider Ken Kehmna, Santa Clara County Fire Chief s Assoc John Kralyevich, Private Service EMT/Paramedic Elaine Nelson, South Bay Emergency Medical Directors Mark Norman, 911 Contracted Ambulance Provider James Silva, Santa Clara County Medical Association MEMBERS ABSENT Jose Chavez, Public Safety Sector Paramedic/EMT Rick Kline, Santa Clara County Trauma Surgeons Ginger Miramontes, Emergency Department Managers Nathaniel Montgomery, Health Advisory Commission Michelle Woodfall, Santa Clara Trauma Managers STAFF PRESENT Michael Petrie, Director Eric Rudnick, Medical Director Lilia Felix-Villalobos, Executive Assistant John Blain, EMS Specialist Michael Cabano, EMS Specialist Kevin O Loughlin, EMS Specialist Anne Marcotte, Specialty Nurses Program Jason Vega, EMS Specialist 6 Page 9 of 100

10 County of Santa Clara Emergency Medical Services System Emergency Medical Services Agency 976 Lenzen Avenue, Suite 1200 San Jose, CA voice fax Date: October 3, 2013 To: From: Subject: Santa Clara County EMS Committee Members Patricia Natividad Senior Management Analyst Summary of Approved or Pending Board of Supervisors and Health and Hospital Committee Items Health and Hospital Approved Committee Items: Semi-annual report relating to the status of the EMS Agency and EMS System for period January 1, 2012 through December 31, 2012 May 15, Accept semi-annual report from Emergency Medical Services (EMS) Agency relating to the status of the EMS Agency and EMS System for period January 1, 2012 through December 31, At their December 14, 2010 meeting, the Board of Supervisors requested that the EMS Agency provide regular updates to the Health and Hospital Committee regarding the performance of the County Exclusive Operating Area 911 Ambulance Provider, Rural/Metro of California. On November 22, 2011, the Health and Hospital Committee requested that the EMS Agency provide an update in February 2012, and then provide future updates in May and November of 2012 and in subsequent years. A semi-annual report covering January 1, 2012 through December 31, 2012, but emphasizing the period from July 1, 2012 through December 31, 2012, is attached and provides the requested information. Emergency Medical Services FY14 Trust Fund Recommendations May 15, 2013 Accept annual report from Emergency Medical Services (EMS) Agency relating to Fiscal Year 2014 EMS Trust Fund. The Emergency Medical Services Trust Fund is funded by liquidated damages, which are fines and penalties, paid by Rural/Metro (the contracted ambulance provider) and other miscellaneous revenue sources, such as first responder non-performance penalties and interest on the Emergency Medical Services Trust Fund balance. During FY13, the EMS Agency anticipates receiving approximately $3,449,000 in financial penalties from liquidated damages; funds abandoned by fire departments that elected not to A division of the Santa Clara County Public Health Department Page 10 of 100

11 provide advanced life support first responders; quarterly first responder non-performance penalties; and interest on the fund balance. Acceptance of the FY14 EMS Trust Fund expenditure recommendations would allow the Public Health Department to include this expenditure plan in its FY14 recommended budget that will be presented to the Board of Supervisors for consideration. Rural Metro Response Time Report June 12, 2013 Accept report from the Public Health Department relating to Rural/Metro response time performance. On December 14, 2010, the Board of Supervisors approved a five-year service agreement with Rural/Metro of California. On July 1, 2011, Rural Metro began providing 911 ambulance and paramedic service in Santa Clara County, serving as the County Exclusive Operating Area provider. During the May 15, 2013 Health and Hospital Committee meeting, Supervisor Yeager requested that the EMS Agency routinely provide information regarding Rural/Metro s 911 paramedic ambulance response times to the Health and Hospital Committee. Supervisor Yeager requested that the EMS Agency provide an initial written report and oral presentation at the June 12, 2013 Emergency Medical Services (EMS) System Strategic Plan June 12, 2013 Accept report from the Public Health Department relating to the Santa Clara County Emergency Medical Services System's Strategic Plan. The EMS System Strategic Assessment and Planning Process provides a forum for the EMS Agency and EMS System stakeholders to collaboratively identify and prioritize threats and opportunities in the external environment, and proactively shape the EMS System to mitigate these threats and capitalize on the opportunities. This process should help develop a shared vision of the EMS System and position the system to provide excellent clinical care, maximum operational efficiency, and to assume a larger role as an integrated medical and health care component within Santa Clara County. On May 14, 2013, the EMS Agency presented a fourth draft of the EMS System Strategic Plan to all EMS System stakeholders. The fourth draft was reviewed with all EMS System stakeholders at a final workshop held on May 20, Based on comments received at the final workshop, minor revisions were made to the strategic plan. Following review of the EMS System Strategic Plan by the Health and Hospital Committee and approval by the Board of Supervisors, the plan will be printed, and a strategic plan rollout meeting will be held to release the approved Santa Clara EMS System Strategic Plan to EMS System stakeholders and the public. Phase 3 is the development of the implementation plan to support the goals and objectives in the EMS System Strategic Plan. Following review of the EMS System Strategic Plan by the Health and Hospital Committee and approval by the Board of Supervisors, The Abaris Group A division of the Santa Clara County Public Health Department Page 11 of 100

12 and the EMS Agency will create best practice recommendations to assist EMS System stakeholders to implement the goals and objectives in the EMS System Strategic Plan. Summary of Board of Supervisors Approved Items: Approve Agreement for Medical Oversight of EMS Agency and System June 25, 2013 (Approved HHC PBI June 12, 2013) Approve Agreement with Eric Rudnick, M.D., relating to providing medical oversight of the Emergency Medical Services (EMS) Agency and system in an amount not to exceed $125,000 for period July 1, 2013 through June 30, California Health and Safety Code Division states that every local EMS agency shall have a full or part-time licensed physician and surgeon as medical director, who has substantial expertise in the practice of emergency medicine, as designated by the county or by the joint powers agreements, to provide medical control and to assure medical accountability throughout the planning, implementation, and evaluation of the Emergency Medical Services system. Following a competitive bid process in July 2009, the Santa Clara County EMS Agency selected Dr. Rudnick as the EMS Medical Director because of his combined expertise in the area of emergency medicine and his experience providing clinical oversight and direction to other EMS systems in the California. Public Health Department is currently working with Employee Services Agency for the purpose of requesting the creation of a new job classification/code that once created, would allow the Department to hire a permanent/classified employee to fill this role rather than contracting with an individual for this purpose. If approved, Dr. Rudnick s job duties as EMS Medical Director would include the provision of medical direction for the EMS Agency and system, assuring medical accountability throughout the planning, implementation, and evaluation of the EMS System. A division of the Santa Clara County Public Health Department Page 12 of 100

13 County of Santa Clara Emergency Medical Services System Emergency Medical Services Agency 976 Lenzen Avenue, Suite 1200 San Jose, CA voice fax Date: October 3, 2013 To: From: Subject: Santa Clara County EMS Committee Members Michael Petrie EMS Director EMS System Strategic Assessment and Planning Process Status Since the last report to the EMS Committee on June 6,2013, the EMS System Strategic Assessment and Planning Process has continued to progress. The final draft of the EMS System Strategic Plan was released to EMS System stakeholders in early June, A final workshop to receive comments from stakeholders was held in mid-june. At the end of that workshop, those present indicated support for the plan. The Santa Clara County EMS System Strategic Plan was endorsed by the Santa Clara County Board of Supervisor s Health and Hospital Committee on June 12, 2013 and accepted by the Santa Clara County Board of Supervisors on June 25, Based upon the final Santa Clara County EMS System Strategic Plan, the EMS Agency developed the Strategic Plan Implementation Plan. The Implementation Plan supports the EMS System Strategic Plan by prioritizing and sequencing the goals and objectives in the Strategic Plan, and by showing the linkages between and among goals and objectives in the Strategic Plan. The implementation plan also recommends stakeholders whose engagement is crucial for successful implementation of each goal and suggests schedules for each goal. After this document was developed, it was distributed for comment from August 19 through August 30, Following final review and editing, both documents were sent for printing, were distributed to all stakeholder organizations, and were placed on the EMS Agency website. A formal Santa Clara County EMS System Strategic Plan Rollout will be held on Friday, October 25, 2013, from 1:30 p.m. to 3:00 p.m. at the Santa Clara County Training Center, located at 2310 North First Street, Suite 102, San Jose. All are encouraged to attend. A division of the Santa Clara County Public Health Department Page 13 of 100

14 Santa Clara County EMS System Strategic Plan JUNE 2013 A Collaborative Effort of the Santa Clara County EMS System Page 14 of 100

15 Contents The Santa Clara County EMS System Strategic Plan... 1 Executive Summary... 1 The Santa Clara County EMS Strategic Assessment and Planning Process... 2 The Goals of the EMS System Strategic Plan... 3 Santa Clara County s Current EMS Delivery System... 4 The Future State of a Successful EMS Delivery System... 5 EMS System Strategic Plan Mission, Vision, and Value Statements... 7 Strategic Mission Statement... 7 Strategic Plan Vision... 7 Strategic Value Statements... 7 EMS System Motto... 7 EMS System Strategic Plan Goals... 8 Santa Clara County EMS Strategic Planning Goals and Objectives Next Steps Step 1 Preparation Step 2 Implementation Vision Step 3 Implementation Team Conclusion Page 15 of 100

16 The Santa Clara EMS System The Santa Clara County EMS System Strategic Plan was developed with counsel, support, and review by: Contracted 911 Ambulance Provider County Ambulance (provided by Rural/Metro) Ambulance Providers American Medical Response Bayshore Ambulance Service CALSTAR Golden State Medical Services NORCAL Ambulance Services ProTransport-1 Ambulance Services Royal Ambulance Services Rural/Metro Ambulance Services Silicon Valley Ambulance Stanford Life Flight United Ambulance Service Westmed Ambulance Service Fire Service Agencies CALFIRE Gilroy Fire Department Milpitas Fire Department Morgan Hill Fire Department Mountain View Fire Department NASA/Ames Fire Department Palo Alto Fire Department San Jose Fire Department Santa Clara County Fire Department Santa Clara Fire Department South Santa Clara County Fire District Spring Valley Volunteer Fire Department Sunnyvale Department of Public Safety Hospitals El Camino Hospital of Los Gatos El Camino Hospital of Mountain View Good Samaritan Hospital Kaiser Permanente Santa Clara Medical Center Kaiser Permanente San Jose Medical Center Lucile Packard Children's Hospital at Stanford O'Connor Hospital Regional Medical Center of San Jose Saint Louise Regional Hospital Santa Clara Valley Medical Center Stanford Hospital and Clinics Stakeholder Organizations and County Departments Hospital Council of Northern and Central California Santa Clara County Fire Chief s Association Santa Clara County EMS Committee Santa Clara County Health and Hospital System Santa Clara County Police Chiefs Association Santa Clara County Public Health Department South Bay Emergency Medical Directors Association Santa Clara County EMS Agency Page 16 of 100

17 The Santa Clara County EMS System Strategic Plan Executive Summary The Santa Clara County Emergency Medical Services (EMS) System is meeting the needs of Santa Clara County s nearly 2.2 million residents and visitors. The diverse population of Santa Clara County is served by an equally diverse community of EMS system stakeholder organizations including fire service and public safety EMS first responders, a contracted ALS 1 emergency ambulance contractor, ALS and BLS 2 non-emergency ambulance providers, air ambulance providers, hospitals, mental health providers, the public health department, health prehospital insurance plans, county service providers, training organizations, and nonprofit agencies. The current County Ambulance contractor began providing service in Santa Clara County on July 1, There are many emergency care and tertiary services available in the county: twelve hospitals, eleven receiving hospitals, three Level 1 and 2 trauma centers, ten stroke centers, eight cardiac specialty centers, one burn center, and one spinal center. These hospitals provide higher levels of care and treatment in their respective specialties, which benefits the community through decreased rates of morbidity and mortality. 1 Advanced Life Support care provided by paramedics. 2 Basic Life Support care provided by Emergency Medical Technician-Basics. 3 County Ambulance is a term used to denote the provider of the County Service Area Exclusive Operating Area (EOA), which is currently served by contract with Rural/Metro of California. The Santa Clara County EMS System is well regarded by EMS professionals throughout California, due largely to the EMS system participants, the structure and processes of the EMS delivery system, and the EMS Agency. While some gaps and future capacity challenges loom, this strategic plan emphasizes opportunities to leverage the strengths and opportunities in the EMS system to close existing gaps, and to move toward a more advanced health care delivery system, based upon the concepts of the Institute for Healthcare Improvement (IHI) Triple Aim Initiative: improving clinical care, maintaining or reducing costs, and improving patient and stakeholder satisfaction. 4 Through the Santa Clara County EMS delivery system, patients receive proficient EMS and hospital care, but some patients, such as serial inebriates, some mental health patients, and frequent EMS and emergency department users, do not receive the treatment for their underlying medical, social or behavioral health issues. Many hospitals in Santa Clara County are full, and more than half of the Emergency Departments have limited growth potential. Projections with EMS, emergency department and hospital capacity demonstrate future capacity gaps with a lack of clarity of how these gaps will be filled. There are also opportunities to enhance the level of service provided by the EMS system. The Patient Protection and Affordable Care Act (PPACA or ACA and otherwise known as Health Reform in this report) and other 4 The Institute for Healthcare Improvement (IHI) Triple Aim Initiative is described at /default.aspx Page 17 of 100 Health Reform and other anticipated healthcare changes offer an unprecedented opportunity to rethink, revitalize and reform Santa Clara County s EMS delivery system. 1

18 anticipated healthcare changes offer an unprecedented opportunity to rethink, revitalize and reform Santa Clara County s EMS delivery system. 5 The healthcare delivery system of the future will emphasize accountability and value over the current paradigm, which is primarily based on payments for services delivered. Santa Clara County is already considering some of these innovations, such as a Sobering System, and the EMS Agency is monitoring the evaluation of other innovative EMS initiatives throughout the nation. To absorb the potential influx of 139,000 newly-insured Santa Clara residents under the Patient Protection and Affordable Care Act between 2014 and 2019, the community must address the reality that EMS delivery services are vulnerable to economic and other forces, as well as being expensive and inadequate to meet the growing healthcare needs of Santa Clara County. 6 The Santa Clara County EMS Strategic Assessment and Planning Process The Santa Clara County EMS Agency initiated the Santa Clara County EMS System Strategic Assessment and Planning Process in response to projected changes in the healthcare, medical, public health, and public safety environments anticipated over the next three to seven years. During the 2013 to 2020 planning horizon period of this plan, Santa Clara County s EMS delivery system will be forced to either react to these mandated changes or will 5 Public Law , 124 Stat. 119, to be codified as amended at scattered sections of the Internal Revenue Code and in 42 U.S.C. 6 Santa Clara County s EMS Assessment Report, The Abaris Group, November 2012 create its own roadmap and direction to prepare for and guide such changes under the leadership of the County, its EMS Agency, and EMS system stakeholders. 7 As the EMS Agency, the County, and EMS stakeholders define their own EMS road map for the future, the result will be an era of innovation, embracing the opportunities available within health care reform initiatives. This strategic plan will guide the Santa Clara County EMS System into the future. The Santa Clara County EMS System Strategic Assessment Process started in July 2012, following the U.S. Supreme Court s decisions on cases relating to healthcare reform and implementation of the federal Patient Protection and Affordable Care Act. The Abaris Group, the consulting firm selected to assist the Santa Clara EMS Agency with the Santa Clara EMS System Strategic Assessment Process, interviewed approximately 150 stakeholders, representing all disciplines of the EMS system. The Abaris Group also observed ambulance staff, field supervisors, EMS Specialists, first responders, and EMS dispatchers. The Abaris Group reviewed policies, procedures, and reports of the Santa Clara County EMS System. This system information was integrated with operational, economic, and demographic information about the County of Santa Clara, its communities, its medical and health stakeholder organizations, and its people. The findings of this comprehensive assessment were released in the Santa Clara County EMS System Strategic Assessment Report in November Stakeholders are defined as health providers, governance structures and consumers with an interest to quality and affordable EMS delivery systems for persons of need in the county. Page 18 of 100 the community must address the reality that EMS delivery services are vulnerable to economic and other forces 2

19 The Santa Clara County EMS System Strategic Planning Process began in November 2012 and was completed in June During that period, a series of seven workshops was conducted with EMS Stakeholders. These workshops had the following objectives: To present and receive stakeholder feedback on the EMS System Strategic Assessment Report To identify the stakeholders perceptions of the Strengths, Weaknesses, Opportunities, and Threats facing the Santa Clara County EMS System To introduce EMS system stakeholders to innovative and best-practice EMS programs throughout the United States, including: The MedStar Community Health Program 8 from Fort Worth, Texas Medical Priority Dispatch s Omega and Low Code Programs San Mateo County s San Mateo Mental Assessment and Response Team (SMART) 9 To develop consensus around a shared vision among EMS system stakeholders To collaboratively develop a comprehensive EMS System Strategic Plan, including memorializing for the first time, the EMS system s Mission, Vision, Values, and Goals Following these workshops, The Abaris Group and the Santa Clara County EMS Agency conducted focused meetings with groups of EMS system leaders to test the validity of the goals, objectives and presumptions within the draft strategic plan, and to seek consensus and support. Focused meetings were held with fire chiefs, the Sheriff and municipal police chiefs, emergency department medical directors, hospital chief executives, specialty clinical services leaders, emergency and nonemergency ambulance managers, and County Health and Human Services leadership, including public health, mental health, drug and alcohol programs, and social services. Based on these meetings, the EMS System Strategic Plan was revised and recirculated to the larger EMS Community for input. A final EMS Stakeholder workshop was held to solicit final comment in May 2013, and in June 2013, the 2013 Santa Clara County EMS System Strategic Plan was presented to the Board of Supervisors Health and Hospital Committee and accepted by the Board of Supervisors. The Goals of the EMS System Strategic Plan The Santa Clara County EMS Strategic Planning Project s goals are to utilize a community-driven input process to develop the plan to enhance access, coordinate care, reduce unnecessary utilization, and improve the quality of the County s EMS delivery. This Strategic Plan s ultimate vision is to serve as a collaborativelydeveloped roadmap, which identifies the optimal route forward for the Santa Clara EMS System during the next three to seven years. Page 19 of 100 This Strategic Plan s ultimate vision is to serve as a collaboratively - developed roadmap, which identifies the optimal route forward for the Santa Clara EMS System during the next three to seven years. 3

20 Santa Clara County s Current EMS Delivery System The Santa Clara County EMS System Strategic Assessment Report identified a number of critical issues impacting the stability and capability of the current EMS delivery system: 1. Lack of a Comprehensive EMS Quality Improvement Program. The current quality assurance program lacks many of the components of a comprehensive continuous quality improvement program, including innovations that are becoming common in the health care field, such as Just Culture, statistical measures of performance, and implementation of Lean Six Sigma doctrine 10. These innovations have been demonstrated to be associated with improved patient clinical outcomes and reduced costs. 2. Insufficient Hospital and Emergency Department Capacity. Many hospitals and most emergency departments are usually full and cannot respond quickly at all times to the current EMS volume, as evidenced by significant ambulance wall times or diversion at some hospitals. Demand and patient volume is expected to increase, further exacerbating hospital and emergency department capacity problems. Without strategic steps to rethink the management of EMS patients, this problem could escalate. The problems of insufficient emergency department and hospital capacity are exacerbated by unclear and poorly defined future reimbursement strategies for first 10 responders and ambulance providers by government and third-party payers. 3. Communication Systems are Fragmented. There are eleven Public Safety Answering Points (PSAPs) and six emergency medical dispatch (EMD) centers in the Santa Clara County EMS System. This number of centers cause undesirable variation in the EMS call reception and management processes. The current system does not allow tracking of call reception, transfer time points or time intervals from the reception of the call at the primary PSAP through call disposition. Moreover, the number of PSAPs and transfers between PSAPs and County Communications limits effective quality oversight and continuous quality improvement. 4. Data Transparency and Evidence- Based Research are Not Part of the EMS Culture. Access to patient care data by specialty centers for outcome studies and access by EMS providers do not exist within the current system. There is also a lack of published research on the current EMS system and its successes. These characteristics are contrary to fostering a culture that is passionate about innovation and decision-making based on evidence and data. 5. Prevention Programs are Fragmented. There are many public education and prevention programs within Santa Clara County, but these programs are not coordinated or linked to data streams and formal quality initiatives that would enable tracking of impact. Page 20 of 100 4

21 6. Lack of Collaboration Limits the EMS System s Successes. While there are collaborative efforts within the Santa Clara County EMS system, many of the emerging and innovate practices in EMS require higher levels of collaboration. Collaboration is essential to achieving effective and efficient solutions to system-wide problems and issues. 7. The EMS System Leadership and Advisory Group Structure is Complicated. The current EMS advisory committee structure is duplicative. There is no hierarchy, which creates confusing information exchange and minimal accountability. The EMS committee structure makes it difficult for stakeholders to invest in these committees and to see benefit from their investments in these committees. Oversight by the EMS Agency needs to be improved to allow the Agency meet its system planning and oversight responsibilities. Currently there is insufficient staffing to support the advisory groups and to ensure value for these advisory groups and the work they conduct. The Future State of a Successful EMS Delivery System There have been a number of attempts by national committees and EMS experts to define the ideal EMS system for the future. 11, 12 Research indicates that the 11 EMS Agenda For the Future, NHTSA, 2010, 10.pdf 12 Institute of Medicine (2006) Emergency Medical Services: At the Crossroads, 9 Santa Clara EMS System Strategic Plan should incorporate the principles of a world-class EMS delivery system, which include: Collaboration The best EMS systems are based on collaborations among the diverse organizations that comprise the EMS system. When these organizations strengths are emphasized by system-wide integration and a culture of trust, the EMS system can more effectively capitalize on new opportunities and mitigate threats to the system. The Santa Clara County EMS System Strategic Plan calls for the maximum use of collaboration to achieve the desired world-class EMS delivery system. Outcome Driven The best EMS systems hold themselves accountable to meet performance standards and superior outcomes resulting from the EMS system s optimal performance. The Santa Clara County EMS System Strategic Plan targets the development of clear, measurable, and literature-driven patient and customer outcomes consistent with a world-class EMS delivery system. Cost Effective, Financially Sustainable, and Value Driven EMS systems must be based upon a sound financial foundation. Successful EMS systems of the future will be based on the ability to provide emergency and other services that add value, centered on a documented, evidence and outcome-based evaluation. EMS systems that produce services that do not improve outcomes or Page 21 of 100 The Santa Clara EMS System Strategic Plan should incorporate the principles of a world-class EMS delivery system. 5

22 cannot document the addition of value will not be demanded by the market and are not sustainable. Innovation and Excellence Successful EMS systems of the future must innovate and reinvent themselves as clinical, operational, and economic environments transform. Innovation and excellence must be integrated into all efforts by the EMS delivery system. Prevention and Education Healthcare reform emphasizes prevention in all aspects of medical care and community life. Prevention reduces the incidence of illnesses and critical injuries and contributes to a community s overall health. Through the prevention component of its mission, EMS systems should work to put the EMS system out of business. While this goal will never be achieved, EMS systems should endeavor to reduce emergency medical services utilization through education and information. Customer Service The future EMS system must meet customers and payors expectation for service by providing value-driven and clinically superior patient care. Successful EMS systems will also accentuate customer service by emphasizing professionalism, dignity, and respect. These characteristics of professional public service must be embedded in the culture of the EMS delivery system and must be actively measured and monitored. Information Technology and Transparency The ideal EMS delivery system should leverage information systems technology to the highest degree possible, in order to ensure accurate and comprehensive measures and analysis of key performance indicators. The ideal EMS system should access and provide global medical and health systems data to measure efficiency, clinical care, and outcomes. The ideal EMS system should also be data transparent informing stakeholders, payors, and consumers about the EMS system, to the extent permitted by law. These increasingly essential, highperformance EMS delivery system characteristics should be integrated into the Santa Clara County EMS System Strategic Plan and the Santa Clara County EMS delivery system. The ideal EMS delivery system should leverage information systems technology to the highest degree possible, in order to ensure accurate and comprehensive measures and analysis of key performance indicators. Page 22 of 100 6

23 EMS System Strategic Plan Mission, Vision, and Value Statements The following statements were collaboratively developed by the stakeholders of the Santa Clara County EMS System: Strategic Mission Statement The mission of the Santa Clara EMS System is to evolve a cost-effective, collaborative, and outcome-based EMS delivery system that produces clinically superior and culturally competent care, while achieving high levels of patient satisfaction from the people of Santa Clara County. Strategic Plan Vision We envision a comprehensive, accessible, and sustainable EMS delivery system, realized through collaboration, which provides clinically superior, efficient, and innovative care. Leadership: Leadership is provided through collaboration and facilitation to ensure accountability and high quality clinical care while ensuring fiscal and operational stability. Participation: We welcome the contributions of the public, other agencies and organizations, and individuals in the development, implementation, evaluation, and improvment of the EMS system. EMS System Motto The EMS system motto describes our goal of adaptation in an ever-changing world: Innovative EMS in the World's Capital of Innovation We envision a comprehensive, accessible, and sustainable EMS delivery system, realized through collaboration, which provides clinically superior, efficient, and innovative care. Strategic Value Statements Dignity and Respect: We treat all people with dignity, honesty, and respect. Progressive: We are dedicated to the continuous improvement of our processes and systems based on evidence-based data, as well as best and promising practices. Professional and Objective: We treat all individuals and organizations professionally, objectively, and without prejudice or bias. Page 23 of 100 7

24 EMS System Strategic Plan Goals Goal One Research and Design an Enhanced Contemporary EMS Medical Direction Model The Santa Clara County EMS System s medical direction structures and processes should be redesigned to drive clinical excellence in all aspects of medical service delivery, including the new delivery models proposed in this strategic plan. Goal Two Evaluate and Redesign the EMS System Stakeholder Committee Structure for Effectiveness and Focus The Santa Clara County EMS System should assess and redesign the EMS advisory committee structure to improve collaboration, stakeholder input, EMS Agency oversight, and to emphasize continuous quality improvement while reducing oversight gaps, redundancies, and meet EMS agency and EMS stakeholders staffing requirements. Goal Four Standardize EMS Communication and Align the EMS Communication System The Santa Clara County EMS System should establish a single modern integrated EMS communication and resource deployment system that improves functionalities, efficiencies, interfaces, and reduces duplication. Goal Five Create Enhanced Collaborative Models with Other Public Safety and Health Organization Stakeholder Partners The collaboration called for in this plan should include an increased presence of the Santa Clara County EMS Agency reaching out to system stakeholders including public safety, health and medical leadership, and policy makers to increase collaboration and develop partnership models that advance EMS system initiatives. should establish a single modern integrated EMS communication and resource deployment system assure the stability and sustainability of current and future EMS system delivery programs. Goal Three Develop an Effective Continuous Quality Improvement (CQI) Program The Santa Clara County EMS System should build on the current quality improvement program and create a coordinated and functional CQI program that provides quality outcomes, guidance for current and future EMS delivery policies and practices, and direction and resources for a robust EMS research program. Page 24 of 100 8

25 Goal Six Assure the Long-Term Financial Solvency and Stability of the Santa Clara County EMS System The Santa Clara County EMS System should evaluate the current funding model, and consider and implement other funding models as necessary to assure the stability and sustainability of current and future EMS system delivery programs. Goal Seven Research, Design, and Implement Contemporary EMS Delivery Methods and Service Delivery Options The Santa Clara County EMS System should evaluate and adopt appropriate contemporary EMS delivery methods to create cost-effective value for the EMS system, patients, and payors, and to ensure that the services provided are anchored in evidence-based best practices. Goal Eight Partner with Public Health and Public Safety Organizations to Align and Enhance Public Education and Prevention Efforts The Santa Clara County EMS System should enhance its public education and prevention program while integrating with existing and emerging public education and prevention programs to establish common topics, messages, and channels, ensuring that EMS-relevant public education and prevention messages are emphasized. Santa Clara County EMS System stakeholders should adopt a collaborative model to study, design, and implement long-term solutions that address Emergency Department/Hospital capacity problems and resulting EMS system delays. Goal Ten Develop a Common Legislative Action Plan to Support the Implementation of this EMS Strategic Plan The Santa Clara County EMS System stakeholders should develop a common legislative action plan to support the implementation of future system capabilities and outcomes. should adopt appropriate contemporary EMS delivery methods to create costeffective value for the EMS system, patients, and payors implement long-term solutions that address Emergency Department/ Hospital capacity problems and resulting EMS system delays. Goal Nine Develop a Collaborative Model to Prevent and Respond to Emergency Department/Hospital Capacity Problems and Resulting EMS System Delays Page 25 of 100 9

26 Santa Clara County EMS Strategic Planning Goals and Objectives Goal One Research and Design an Enhanced Contemporary EMS Medical Direction Model The Santa Clara County EMS System s medical direction structures and processes should be redesigned to drive clinical excellence in all aspects of medical service delivery, including the new delivery models proposed with implementation of this strategic plan. Objective 1.1. Create a task force of EMS Agency, EMS provider, emergency department medical directors, specialty service medical directors, and other clinical and operational leaders to study and recommend a redesign of the Santa Clara County EMS System s medical direction model. The redesign should incorporate: Increased EMS medical direction and quality improvement capability commensurate with EMS system scope and complexity Provisions for online medical direction of emergency and alternate delivery services Processes to assure that the EMS Medical Director s oversight is communicated among EMS providers medical advisors and quality improvement personnel Medical direction that encompasses all components of the EMS system, including EMS field operations and EMS communications, as required for comprehensive system oversight Consistency with the revised EMS Quality Improvement Plan Promotion of County and stakeholder-based research efforts Education and training to ensure the EMS Medical Director remains current on emerging practices, including specialty programs, quality improvement, and EMS operations Appropriate medical direction for new EMS delivery options Objective 1.2. Submit draft revised medical direction plan to EMS stakeholders and the EMS Agency for input and direction Objective 1.3. Revise EMS System Policies and Procedures to support the new medical direction model of the Santa Clara EMS System Objective 1.4. Implement the new EMS System Medical Direction model Objective 1.5. Develop EMS Medical Director bench strength by ensuring that future EMS Medical Directors are developed and mentored drive clinical excellence in all aspects of medical service delivery models proposed with implementation of this strategic plan. Page 26 of

27 Goal Two Evaluate and Redesign the EMS System Stakeholder Committee Structure for Effectiveness and Focus The Santa Clara County EMS System should assess and redesign the EMS advisory committee structure to improve collaboration, stakeholder input, EMS Agency oversight, and emphasize continuous quality improvement while reducing oversight gaps, redundancies, and meetings EMS agency and EMS stakeholders staffing requirements. Objective 2.1. The EMS Agency and EMS system stakeholders should conduct a baseline assessment of advisory and oversight committees using zerobased or clean slate assumptions. The optimal committee structure should: Provide for comprehensive coordination of EMS system planning, regulation, and quality improvement Facilitate policy development and quality improvement functions for all components of the EMS system Minimize redundancies in committee responsibilities and authorities Efficiently utilize EMS Agency and EMS system stakeholders staff, resources, and time Provide maximum stakeholder and public transparency in areas other than those protected through quality improvement processes Provide neutral EMS Agencysponsored meeting forums for EMS system-related issues to assure transparency and access in decision making Objective 2.2. Submit draft EMS advisory group models for EMS stakeholders input Objective 2.3. Revise EMS System Policies and Procedures to support the new EMS System Stakeholder Committee Structure Objective 2.4. Implement the new EMS System Committee Structure Page 27 of 100 redesign the EMS advisory committee structure to improve collaboration, stakeholder input, EMS Agency oversight, and emphasize continuous quality improvement 11

28 Goal Three Develop an Effective Continuous Quality Improvement (CQI) Program The Santa Clara County EMS System should build on the current quality improvement program and create a coordinated and functional CQI program that provides quality outcomes, guidance for current and future EMS delivery policies and practices, and direction and resources for a robust EMS research program. Objective 3.1. Create a team of EMS Agency, hospital, prehospital, and clinical leaders to revise the EMS Agency s EMS Quality Improvement Plan (EQIP). The plan should: Incorporate the new EMS System medical direction model and new EMS System committee structure Integrate best practices from other EMS systems and specialty service credentialing organizations Emphasize a coordinated, functioning, and outcome-based continuous quality improvement (CQI) program Assure complete loop closure on all studied elements, including findings of after action reports and plans of correction Integrate all EMS system participants, all clinical initiatives, and essential operational measures within the EMS system Provide access to reliable EMS system data to stakeholders and public, as allowed by law Foster research and publication of quality improvement results to advance the science of EMS Integrate the philosophy and components of a Just Culture program Incorporate the concepts and practices of Lean Six Sigma Objective 3.2. The EMS Agency and the EMS Quality Improvement Plan Committee submits the draft CQI plan for EMS stakeholder input Objective 3.3. Conduct educational and workshop sessions to roll out the plan and the Just Culture model Objective 3.4. Continue to conduct Lean Six Sigma training to orient EMS system stakeholders to Lean Six Sigma methods and processes Objective 3.5. Revise EMS System Policies and Procedures to support the new EMS System Quality Improvement Plan Objective 3.6. Implement the new EMS Quality Improvement Plan Objective 3.7. Continue to develop the Comprehensive EMS Data System, which incorporates data from EMS communication centers, first responders, emergency and non-emergency ambulance providers, specialty centers, and hospitals., to comply with mandates of state law, and facilitate operational and clinical quality improvement efforts Page 28 of 100 build on the current QI program and create a coordinated and functional CQI program 12

29 Objective 3.8. Design and develop research programs that are publishable incredible medical and social sciences journals, based on the experiences and successes of the Santa Clara County EMS System Page 29 of

30 Goal Four Standardize EMS Communication and Align the EMS Communication System The Santa Clara County EMS System should establish a single modern integrated EMS communication and resource deployment system that improves functionalities, efficiencies, interfaces, and reduces duplication. Objective 4.1. Create a multidisciplinary EMS Communications Task Force comprised of EMS, public safety, and communication center leaders to develop a comprehensive EMS communication and resource deployment system plan. The task force should have as its objectives: Developing a coordinated, consolidated, and integrated EMS communication and resource deployment system Developing baseline capabilities, accreditation, and performance criteria of the EMS communication and resource deployment system Identifying and establishing essential (i.e., Computer Aided Dispatch (CAD)-to-CAD interfaces, MARVLIS13, latitude/longitude determinants, etc.) and desirable technological interfaces for the EMS communication and resource deployment system Defining monitoring roles and tools for performance Defining characteristics of interfaces necessary for alternate EMS deployment and disposition models including community paramedics and caller referral Developing viable and sustainable funding models for the communication and resource deployment system Objective 4.2. The EMS Communications Task Force should submit a draft Alignment Plan for EMS stakeholder, public-safety, county and municipal executive input Objective 4.3. The EMS Communications Task Force should develop a draft Alignment Plan for county and municipal executive and elected official approval Objective 4.4. The EMS Agency should develop an EMS Communication Center Quality Improvement Plan, which may be an annex to the EMS System Quality Improvement Plan Objective 4.5. The EMS Agency should develop EMS System Communication Center Policies and Procedures establish a single modern integrated EMS communication and resource deployment system 13 Mobile Area Routing and Vehicle Location Information System MARVLIS Page 30 of

31 Goal Five Create Enhanced Collaborative Models with Other Public Safety and Health Organization Stakeholder Partners The collaboration called for in this plan should include an increased presence of the Santa Clara County EMS Agency reaching out to system stakeholders including public-safety, health and medical leadership, and policy makers to increase collaboration and develop partnership models that advance EMS system initiatives. Objective 5.1. Create a task force of EMS Agency, EMS providers, fire service, other public safety, and public health leaders to identify methods to increase interdisciplinary collaboration and to improve the stature of EMS as an equal discipline. The model could consider: Identifying shared missions, goals, and objectives, which may be enhanced by collaboration Creating interfaces for interaction and shared vision among the EMS Agency and public safety and public health partners Providing options for data and information sharing within Santa Clara County s hospitals, fire services, EMS, ambulance providers, public health department, mental health department, law enforcement agencies, social service providers and other EMS stakeholder organizations Objective 5.2. Design a collaborative model that allows multidisciplinary input to the Exclusive Operating Area (EOA) ambulance provider s monitoring and performance process, contract changes, and renewals or rebids Objective 5.3. The EMS Agency and the County s public safety agencies should design an enhanced public safety collaborative model. The model may include: An Exclusive Operating Area (EOA) performance monitoring committee An Exclusive Operating Area (EOA) performance reporting and input process Developing additional policy and operational public-safety interfaces Periodic orientation and educational sessions for public policy makers Objective 5.4. Submit draft revised EMS collaborative models for EMS stakeholders input Objective 5.5 Submit revised EMS collaborative models for approval by appropriate EMS stakeholder organizations leadership Objective 5.6. Develop a culture within the Santa Clara County EMS System that drives services and individuals to present themselves professionally in their demeanor, actions and appearance at all times Objective 5.7. Provide ongoing and structured opportunities for EMS workforce education, development, and Page 31 of 100 increase collaboration and develop partnership models that advance EMS system initiatives. 15

32 mentorship to develop EMS system bench strength Objective 5.8. Define, train, and inform EMS Stakeholders on the relationship of the EMS Agency and County Ambulance, including the roles and responsibilities of the EMS Duty Chiefs and County Ambulance Supervisors Page 32 of

33 Goal Six Assure the Long-Term Financial Solvency and Stability of the Santa Clara County EMS System The Santa Clara County EMS System should evaluate the current funding model, and consider and implement other funding models as necessary to assure the stability and sustainability of current and future EMS system delivery programs. Objective 6.1. Create a multidisciplinary task force consisting of EMS, public safety, hospitals, ambulance providers, and payors to develop comprehensive EMS funding strategies Objective 6.2. Identify and map current funding sources for first response, transport, education and other EMS services Objective 6.6. Identify and quantify the difference between current and future funding based upon a traditional EMS delivery model and alternate EMS delivery models to determine the need and the value of incorporating alternate EMS delivery models Objective 6.7. Develop funding models that implement and sustain the goals articulated in this strategic plan Objective 6.8. Submit draft funding plan for EMS, public safety, hospital, payor, municipal, County and public policy leadership input assure the stability and sustainability of current and future EMS system delivery programs. Objective 6.3. Define and quantify the anticipated and probable funding changes driven by health reform for traditional EMS delivery models Objective 6.4. Identify and quantify the potential costs and funding sources for the alternate delivery models contemplated in this strategic plan Objective 6.5. Establish first responder and public safety funding resource inventories (i.e., first responder, new statutory improved reimbursement for government ambulance providers, etc.) and other system delivery providers as needed Page 33 of

34 Goal Seven Research, Design, and Implement Contemporary EMS Delivery Methods and Service Delivery Options The Santa Clara County EMS System should evaluate and adopt appropriate contemporary EMS delivery methods to create cost-effective value for the EMS system, patients, and payors, and to assure the services provided are anchored in evidence-based best practices. Objective 7.1. Continue to implement contemporary EMS delivery methods already under development. These delivery methods include: The pre-hospital component of Sobering System The Resource Allocation Program (high user identification and management system) Objective 7.2. Create one or more alternative delivery steering groups consisting of EMS, public safety, hospital, clinical, payor leaders, and other interested stakeholders to begin to identify and credential contemporary EMS delivery and service options. These options may include: EMS-based mental health services Community paramedic assess, treat and release Community paramedic alternate destinations Community paramedic frequent user case management, including non-compliant user case management Community paramedic chronic disease patient care, if system and scope is feasible Community paramedic post hospital discharge patient care, if system and scope is feasible Community paramedic community health services (e.g., immunizations), if system and scope is feasible Tiered prehospital response based on enhanced medical triage (e.g., Omega model) Integration of mid-level practitioners (nurse practitioners and physician s assistants) into the EMS system Integration of law enforcement as a provider of reimbursed services Registered Nurse call referral at Communications Center models (e.g., Low Code model) Use of EMS for wrap services (i.e., social services, case management, housing, etc.) for identified key patients Integration into comprehensive medical and health data sharing infrastructure, which allows access to a patient s electronic medical record to any EMS, emergency department or other organization evaluating or treating an EMS patient (similar to the San Diego Beacon model) Page 34 of 100 create costeffective value for the EMS system, patients, and payors, and to assure the services provided are anchored on evidencebased best practices. 18

35 Other options deemed valuable by EMS system stakeholders Objective 7.3. The alternate delivery steering groups should develop a formal business plan for each alternative delivery model it wishes to consider for limited term pilot studies Objective 7.4. The EMS system should field test potentially viable models through limited term pilot studies Objective 7.5. Develop viable and sustainable long-term funding models for the accepted alternate delivery models Objective 7.6. Submit draft plans and models for EMS stakeholder input Objective 7.7. Formally integrate desired alternative delivery models into the Santa Clara County EMS System Page 35 of

36 Goal Eight Partner with Public Health and Public Safety Organizations to Align and Enhance Public Education and Prevention Efforts The Santa Clara County EMS System should enhance its public education and prevention program while integrating with existing and emerging public education and prevention programs to establish common topics, messages and channels, ensuring that EMSrelevant public education and prevention messages are emphasized. Objective 8.1. In partnership with the Public Health Department s Injury Prevention Program and Data Management Unit, conduct an assessment of leading causes of EMS system transports Objective 8.2. Convene a multidisciplinary task force consisting of EMS, the Public Health Department s Injury Prevention Program, public safety, hospitals, ambulance providers, and other interested stakeholders to continue to develop the EMS System s injury prevention and public education program: Conduct best practice reviews of effective EMS-based public education and prevention programs and effective outreach and education prevention strategies, including an inventory of other county programs, national and state campaigns, and existing programs in Santa Clara County Prioritize the outreach and education prevention strategies to be implemented through the EMS system, including identification of resources and development of an implementation plan Objective 8.3. Establish cooperative agreements across the EMS system and implement the priority outreach and education prevention strategies Objective 8.4. Identify resources and funding components to implement these prevention/education programs Objective 8.5. Implement the outreach and education prevention strategies outlined in the implementation plan and in coordination with public health, county-wide injury prevention campaigns Page 36 of 100 establish common topics, messages and channels, ensuring that EMS-relevant public education and prevention messages are emphasized. 20

37 Goal Nine Develop a Collaborative Model to Prevent and Respond to Emergency Department/Hospital Capacity Problems and Resulting EMS System Delays Santa Clara County EMS System stakeholders should adopt a collaborative model to study, design, and implement long-term solutions to address Emergency Department/Hospital capacity problems and to reduce resulting EMS system delays. Objective 9.1. The EMS Agency should work with the Hospital Council of Northern and Central California and all hospitals within Santa Clara County to collaboratively study and respond to capacity problems as identified in the EMS Assessment Report. These capacity issues are typified by frequent ambulance diversion, delayed patient off-loads, and other delays at some hospital emergency departments. This collaborative should consider the following tenets: The collaborative should be endorsed and monitored by the senior leadership of all participating entities The desired end result and measurements of success should be defined upon initiation The topics of the collaborative should include prehospital, hospital, and population strategies The collaborative should consider best and promising practices identified in other EMS systems The collaborative should be briefed on other related initiatives driven by this strategic plan, including alternate EMS delivery models The collaborative should develop actionable and measurable short and medium-term objectives, which can be used to demonstrate progress toward meeting the end goal Objective 9.2. The EMS Agency should develop EMS System Policies and Procedures to implement the successful results of the collaborative Objective 9.3. Hospitals leadership should develop hospital policies to implement the successful results of the collaborative Objective 9.4. The collaborative should publish its successful results to assist other EMS systems to prevent and respond to emergency department/hospital capacity issues and resulting EMS system delays...implement long-term solutions to address Emergency Department/Ho spital capacity problems and to reduce resulting EMS system delays. Page 37 of

38 Goal Ten Develop a Common Legislative Action Plan to Support the Implementation of this EMS Strategic Plan The Santa Clara County EMS System stakeholders should develop a common legislative action plan to support the implementation of future system capabilities and outcomes. Objective Create a legislative task force to identify legal empowerment gaps between goals and the current legal system (i.e., statutes, regulations, ordinances, contracts, policies, etc.) develop a common legislative action plan to support the implementation of future system capabilities and outcomes. Objective Develop an inventory of legislative advocates to assist with resolving these gaps Objective Develop a plan to implement the desired legislative model and to close the gaps Objective Submit a draft plan for input from EMS, public safety, public health, County, and governmental leaders Page 38 of

39 Next Steps Implementation is an essential part of this EMS system strategic planning process. All those who are committed to improving the Santa Clara County EMS system, as well as policymakers at every level of government, need to prioritize the EMS delivery system transformation. Santa Clara County can seize the opportunity of health reform to fundamentally strengthen health care quality in general and EMS quality specifically. It will take a sustained and concerted effort to fully realize the goals articulated in this strategic plan. There are three immediate steps that should be undertaken to start implementing the Santa Clara County EMS System Strategic Plan. Step 1 Preparation This is an ambitious work plan for the Santa Clara County EMS System. Before the EMS System can proceed, the EMS Agency and EMS System stakeholders will need to identify: Key champions, who will assist in leading this effort in our EMS system and bring other leaders to the table Resources (staff, funding, etc.) to support these leaders The right organizations who will sign on as partners Whether federal, state, and local political leaders and policies support the efforts described in this plan in both the short and long term Whether the region s leaders agree on what they want to accomplish There is a real appreciation of what is necessary to implement this strategic plan Whether the funding and other resources to carry out the planning and program development is available The Santa Clara County EMS Agency must affirmatively answer these questions and establish one or more planning coalitions to make an informed decision to proceed with the projects outlined in this plan. Step 2 Implementation Vision The Santa Clara EMS System must have a strategic vision of how to change to achieve the vision of what to change. A shared vision lets everyone know the desired end result and why that result is important. This step involves clarifying exactly how the elements of the strategic plan implementation will work. Each of the advisory groups, task forces and committees listed in this plan should generate a charter or business plan for their strategic plan deliverable that includes all financial, operational and implementation details for the plan s program components. Step 3 Implementation Teams Implementation teams composed of stakeholders who understand the Strategic Plan s purpose and implementation process will shepherd this plan from concept to Page 39 of seize the opportunity of Health Reform to fundamentally strengthen health care quality in general and EMS quality specifically. 23

40 reality. Small groups supported by, and reporting to, a steering committee that can encourage progress, answer questions, and provide guidance would serve this purpose. Generally, an implementation team will be created to implement each goal. However, for goal 7, which considers new EMS delivery options, an implementation team may be established to evaluate each service option. The Santa Clara County EMS Agency should develop small teams that have senior leadership, strong financial skills and experience, and professional support to implement the strategic plan recommendations. Page 40 of

41 Conclusion The Santa Clara County EMS Agency launched the Santa Clara County EMS System Strategic Planning Process in 2012 with the goal of charting a course to improve the Santa Clara County EMS System s clinical care, operational efficiency and financial stability, as well as patient and stakeholder satisfaction. This strategic plan provides a road map to achieve that overarching goal of creating a stronger EMS delivery system to serve the people of Santa Clara County. Certainly, the challenges facing the region are tremendous, but the transformative opportunities sparked by the Patient Protection and Affordable Care Act are equally great. This strategic plan charts the course that must be taken to achieve the Santa Clara County EMS System s vision of health care reform. The Santa Clara EMS Agency and EMS System stakeholders will need to work together and seize this unprecedented opportunity to create a collaborative, accessible, high quality, and culturally competent EMS delivery system. Success is within reach, if those in the Santa Clara County EMS System reach for it together. The potential rewards are immeasurable: a healthier and brighter future for all emergency care patients in Santa Clara County. improve the Santa Clara County EMS System s clinical care, operational efficiency and financial stability, as well as patient and stakeholder satisfaction. create a collaborative, accessible, high quality, and culturally competent EMS delivery system. Page 41 of

42 Santa Clara County EMS System Strategic Plan Implementation Plan June 2013 A Collaborative Effort of the Santa Clara County EMS System Page 42 of 100

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44 Santa Clara County EMS System Strategic Plan Implementation Plan Table of Contents The Santa Clara County EMS System Strategic Plan... 3 EMS System Strategic Plan Mission, Vision, and Value Statements... 4 Strategic Mission Statement... 4 Strategic Plan Vision... 4 Strategic Value Statements... 4 EMS System Motto... 4 Prioritization and Sequencing of Goals in the Santa Clara EMS System Strategic Plan... 5 Categorization of Goals by Function... 6 Goal 1: Research and design an enhanced contemporary EMS medical direction model... 8 Goal 2: Evaluate and redesign the EMS System Stakeholder committee structure for effectiveness and focus Goal 3: Develop an Effective Continuous Quality Improvement (CQI) Program Goal 4. Standardize EMS Communications and Align the EMS Communication System Goal 5: Create enhanced collaborative models with other public safety, health and medical stakeholder organizations in which EMS is an equal partner Goal 6: Assure the Long Term Financial Solvency and Stability of the Santa Clara County EMS System Goal 7: Research, Design, and Implement Contemporary EMS Delivery Methods and Service Delivery Options Goal 8: Partner with Public Health and Public Safety Organizations to Align and Enhance Public Education and Prevention Efforts Goal 9: Develop a Collaborative Model to Prevent and Respond to ED/ Hospital Capacity Issues and Resulting EMS System Delays Goal 10: Develop a common legislative action plan to support the Implementation of this EMS Strategic Plan Page 44 of 100 2

45 Santa Clara County EMS System Strategic Plan Implementation Plan The Santa Clara County EMS System Strategic Plan The Santa Clara County EMS System Strategic Plan was created between July 2012 and June 2013 to guide the future direction of the Santa Clara County EMS System. The assessment process evaluated the opportunities and threats facing the EMS System from national, regional and local influences and set goals to optimize the structure, processes, and outcomes of the EMS System. The assessment considered threats and opportunities in the context of the strengths and weakness of the EMS System, and emphasized a 3 to 7 year planning horizon, focusing on: 1) maintaining or improving clinical care; 2) improving patient satisfaction; and 3) improving operational efficiency, and assuring the cost effectiveness and financial solvency of the EMS System. The planning process was supported by, and involved, all EMS System stakeholders, including County and Health and Hospital System leadership, fire service leadership and labor, law enforcement leadership, communication center leadership, ambulance provider leadership and labor, hospital leadership, emergency room physicians and nurses, EMS Agency personnel, the EMS Medical Director, Trauma Centers, STEMI Centers, Stroke Centers, and others. The strategic planning process was collaborative and included consensus building processes, town hall meetings, a public comment period, and other significant opportunities for input. The results of this process were the EMS System's Mission, Vision, Values, Goals and Objectives. The EMS System Strategic Plan was endorsed by the Santa Clara County Board of Supervisor s Health and Hospital Committee on June 12, 2013 and accepted by the Santa Clara County Board of Supervisors on June 25, The ten goals within the Santa Clara County EMS System Strategic Plan are most relevant to the EMS System s ability to adapt to the changing healthcare environment. The first six goals in this draft strategic plan are necessary to assure clinical and operational quality, cost effectiveness, and patient and stakeholder satisfaction, even if the EMS System does not restructure to better meet the anticipated changes in the healthcare environment -- these changes are necessary to simply keep pace with improving standards of EMS care. The remaining four goals in the draft strategic plan position the Santa Clara EMS System to proactively prepare to meet anticipated changes in the healthcare environment, driven by the Patient Protection and Affordable Care Act, and other statutory, regulatory, and economic changes. Page 45 of 100 3

46 Santa Clara County EMS System Strategic Plan Implementation Plan EMS System Strategic Plan Mission, Vision, and Value Statements The following statements were collaboratively developed by the stakeholders of the Santa Clara County EMS System: Strategic Mission Statement The mission of the Santa Clara EMS System is to evolve a cost-effective, collaborative, and outcome-based EMS delivery system that produces clinically superior and culturally competent care, while achieving high levels of patient satisfaction from the people of Santa Clara County. Strategic Plan Vision We envision a comprehensive, accessible, and sustainable EMS delivery system, realized through collaboration, which provides clinically superior, efficient, and innovative care. Strategic Value Statements Dignity and Respect: We treat all people with dignity, honesty, and respect. Progressive: We are dedicated to the continuous improvement of our processes and systems based on evidence-based data, as well as best and promising practices. Professional and Objective: We treat all individuals and organizations professionally, objectively, and without prejudice or bias. Leadership: Leadership is provided through collaboration and facilitation to ensure accountability and high quality clinical care while ensuring fiscal and operational stability. Participation: We welcome the contributions of the public, other agencies and organizations, and individuals in the development, implementation, evaluation, and improvement of the EMS system. EMS System Motto The EMS system motto describes our goal of adaptation in an ever-changing world: Innovative EMS in the World's Capital of Innovation Page 46 of 100 4

47 Santa Clara County EMS System Strategic Plan Implementation Plan Prioritization and Sequencing of Goals in the Santa Clara EMS System Strategic Plan The Santa Clara EMS System Strategic Plan Implementation Plan provides guidance to implement the 10 goals in the Santa Clara County EMS System Strategic Plan. This Strategic Plan Implementation Plan prioritizes and sequences the 10 goals, based on the concept of reinforcing and improving medical control, improving quality improvement and clinical oversight, and establishing a firm foundation for EMS System activities, before more aggressive initiatives are considered. For each of the 10 goals, this document details the tasks, recommended stakeholders, and the suggested timeline. The table below identifies, for each goal, the other goals that are precedent those goals that must be completed first or dependent those goals that can only be completed after the listed goal is accomplished. Some goals are independent, meaning they can be completed at any time, without specific regard to the status of another goal. Those goals do not have precedents or dependents. Goal Precedents Dependents Goal 1: Enhance Medical Direction Model Goal 2, Goal 3, Goal 4, Goal 7 Goal 2: Redesign EMS System Committee Structure Goal 1, Goal 3 Goal 7 Goal 3: Continuous Quality Improvement Program Goal 1 Goal 2 Goal 4: Standardize EMS Communication Goal 1, Goal 3 Goal 2 Goal 5: Enhance EMS as an Equal Partner Goal 6: Assure Fiscal Solvency of EMS System Goal 7 Goal 7: Contemporary EMS Delivery Models Goal 2, Goal 2, Goal 3, Goal 4, Goal 7 Goal 6 Goal 8: Public Education and Injury Prevention Goal 9: Reduce ED Diversion and Wall Times Goal 10: Develop a Legislative Platform Page 47 of 100 5

48 Santa Clara County EMS System Strategic Plan Implementation Plan Categorization of Goals by Function The ten goals listed in the Strategic Plan can also be categorized, based on their purpose, such as structural goals, action goals, and support goals. The relationships of these categories of goals are graphically displayed: Structural Action Support Structural Goals Three of the goals in the Santa Clara County EMS System Strategic Plan provide the structural framework for the EMS System. These goals should be accomplished early in the implementation process, because the objectives in each of these goals are necessary for the safe and effective operation of the EMS System regardless of whether new initiatives are considered and because other goals depend upon the completion of these goals. Goal 1: Research and design an enhanced contemporary EMS medical direction model Goal 2: Evaluate and redesign the EMS System Stakeholder committee structure for effectiveness and focus Goal 3: Develop an Effective Continuous Quality Improvement (CQI) Program Page 48 of 100 6

49 Santa Clara County EMS System Strategic Plan Implementation Plan Action Goals There are five goals in the Santa Clara County EMS System Strategic Plan that require evaluation, and decision making before action can be taken. Many of these goals are dependent upon completion of the Structural Goals, defined above. The Action Goals are goals which significantly develop and enhance the capabilities of the EMS System in the medium and long term. Goal 4: Standardize EMS Communications and Align the EMS Communication System Goal 5: Create enhanced collaborative models with other public safety, health and medical stakeholder organizations in which EMS is an equal partner Goal 7: Research, Design, and Implement Contemporary EMS Delivery Methods and Service Delivery Options Goal 8: Partner with Public Health and Public Safety Organizations to Align and Enhance Public Education and Prevention Efforts Goal 9: Develop a Collaborative Model to Prevent and Respond to ED/ Hospital Capacity Issues and Resulting EMS System Delays Support Goals There are two support goals in the Santa Clara County EMS System Strategic Plan. These goals do not directly improve the capabilities of the EMS System, but provide the external environment that allows the successful implantation of the Action Goals. Goal 6: Assure the Long Term Financial Solvency and Stability of the Santa Clara County EMS System Goal 10: Develop a common legislative action plan to support the Implementation of this EMS Strategic Plan Page 49 of 100 7

50 Santa Clara County EMS System Strategic Plan Implementation Plan Goal 1: Research and design an enhanced contemporary EMS medical direction model Santa Clara County Strategic Planning Goals and Objectives Goal Task Objective Steps Notes/ Timeframe The Santa Clara Objective 1.1. Create a task force of Note 1: Change in County EMS EMS Agency, EMS provider, ED medical medical direction model system s medical directors, specialty service medical will drive changes in the direction structures directors, and other clinical and EMS System Stakeholder and processes operational leaders to study and committee structure should be recommend a redesign of the Santa and EMS CQI Program, redesigned to drive Clara County EMS system s medical which are considered in clinical excellence direction model. The redesign should Goals 2 and 3, in all aspects of incorporate: respectively. Thus, the medical service o Increased EMS medical director outputs of this delivery, including and quality improvement capability committee drive work in the new delivery commensurate with EMS system Goal 2 and Goal 3. models proposed scope and complexity with o Provisions for online medical Note 2: This committee implementation of direction of emergency and may benefit from an this strategic plan. alternate delivery services independent facilitator. 1. Research and design an enhanced contemporary EMS medical direction model o o o o o Assurances that the EMS medical director s oversight is communicated among EMS medical advisors Assurances that medical direction encompasses all components of EMS system, including EMS field operations and EMS communications Consistency with the revised EMS Quality Improvement Plan Promotion of county and stakeholder-based research efforts Education and training to ensure (1) Create a task force that includes: a. EMS Agency b. EMS Medical Director c. Fire Agency d. County Ambulance e. Non-emergency ambulance f. County communications g. ED medical director h. Trauma medical director i. Stroke medical director j. STEMI medical director k. Helicopter medical advisor (2) Create a task force charter with mission, measures and timeframes (3) Define EMS agency staff resources to be assigned (4) Initiate task force for monthly meetings (6 recommended) (5) Support this work group Timeframe: completed by March Page 50 of 100 8

51 Santa Clara County EMS System Strategic Plan Implementation Plan Santa Clara County Strategic Planning Goals and Objectives Goal Task Objective Steps Notes/ Timeframe the EMS medical director remains as required based on current on emerging practices, the objectives identified including specialty programs and quality improvement o Medical direction for new EMS delivery options Objective 1.2. Submit draft revised medical direction plan to EMS stakeholders and the EMS Agency for input and direction Objective 1.3. Revise EMS system policies and procedures to support the new medical direction model of the Santa Clara EMS System Objective 1.4. Implement the new EMS System Medical Direction model Objective 1.5. Develop EMS medical director bench strength by ensuring that future EMS medical directors are developed and mentored Page 51 of 100 9

52 Santa Clara County EMS System Strategic Plan Implementation Plan Goal 2: Evaluate and redesign the EMS System Stakeholder committee structure for effectiveness and focus Goal Task Objective Steps Notes/ Timeframe The Santa Clara Objective 2.1. The EMS Agency and (1) Form a workgroup Note 1: The medical County EMS system EMS system stakeholders should representative of each direction structure should assess and conduct a baseline assessment of discipline within the created by the Goal 1 redesign the EMS advisory and oversight committees EMS System, including: committee will affect advisory committee using zero-based assumptions. The a. EMS Agency the EMS System structure to optimal committee structure should: b. EMS Medical Stakeholder Committee improve o Provide for comprehensive Director Structure. The medical collaboration, coordination of EMS system c. County direction structure stakeholder input, planning, regulation, and quality Communications should be identified EMS Agency improvement d. Other EMS before the Goal 2 oversight, and o Facilitate policy development and Communication committee s work is emphasize quality improvement functions for Center finalized. continuous quality all components of the EMS system e. Fire improvement while o Minimize redundancies in f. County reducing oversight committee responsibilities and Ambulance gaps, redundancies, authorities g. Other ambulance and meetings EMS o Efficiently utilize EMS Agency and h. Helicopter Agency and EMS EMS system stakeholders staff, i. Hospital ED stakeholders resources, and time j. Trauma staffing o k. Stroke requirements. l. STEMI 2. Evaluate and redesign the EMS System Stakeholder Committee structure for effectiveness and focus o Provide maximum stakeholder and public transparency in areas other than those protected through quality improvement processes Provide neutral EMS Agencysponsored meeting forums for EMS system-related issues Objective 2.2. Submit draft EMS advisory group models for EMS (2) Assess advisory and oversight committees purposes, scope of responsibility, and outputs by reviewing meeting minutes. (3) Determine what committee structure Note 2: The EMS System Continuous Quality Improvement (CQI) program identified in Goal 3 will also affect the EMS System Stakeholder Committee Structure. The medical direction CQI program should be identified before the Goal 2 committee s work is finalized. Timeframe: completed by March Page 52 of

53 Santa Clara County EMS System Strategic Plan Implementation Plan Goal Task Objective Steps Notes/ Timeframe stakeholders input Objective 2.3. Revise EMS system policies and procedures to support the new EMS System Stakeholder Committee structure Objective 2.4. Implement the new EMS System Committee structure provides seamless oversight of all components of EMS System, provides clear reporting, and reduces time spent in meetings. (4) Submit draft of EMS advisory group models to stakeholders and key policy entities (5) Revise EMS system policies and procedures (6) The single committee policy should identify the purpose, scope, leadership, confidentiality of each committee. (7) Implement new EMS System Committee structure Page 53 of

54 Santa Clara County EMS System Strategic Plan Implementation Plan Goal 3: Develop an Effective Continuous Quality Improvement (CQI) Program Goal Task Objective Steps Notes/ Timeframe The Santa Clara Objective 3.1. Create a team of EMS Note 1: The work of County EMS Agency, hospital, pre-hospital, and Goal 1: Medical System should clinical leaders to revise the EMS Direction Structure build on the Agency s EMS Quality Improvement Committee will affect current quality Plan (EQIP). The plan should: the work of Goal 3: EMS improvement o Incorporate the new EMS System System Continuous program and medical direction model and new Quality Improvement create a EMS System committee structure Program Committee. coordinated and o Integrate best practices from The medical direction functional CQI other EMS systems and specialty structure should be program that service credentialing identified before the provides quality organizations Goal 3 committee s outcomes, o Emphasize a coordinated, work is finalized. guidance for functioning, and outcome-based current and future continuous quality improvement EMS delivery (CQI) program policies and o Assure complete loop closure practices, and on all studied elements, including direction and findings of after action reports resources for a and plans of correction robust EMS o research program. 3. Develop an Effective Continuous Quality Improvement (CQI) Program o o o Integrate all EMS system participants, all clinical initiatives, and essential operational measures within the EMS system Provide access to reliable EMS system data to stakeholders and public, as allowed by law Foster research and publication of quality improvement results to advance the science of EMS Integrate the philosophy and (1) Hire a consultant to revise the EMS Agency s EMS Quality Improvement (EQUIP) Plan and to create an EQUIP Plan Template for fire and ambulance providers. (2) Create a group of clinical leaders to support the EQUIP consultant: a. EMS Medical Director b. EMS Agency QI Coordinator c. ED medical director (2) d. ED nurse managers (2) e. Trauma Center nurse /physician f. Stroke Center nurse/physician g. STEMI Center nurse/physician h. County Ambulance medical advisor/paramedic i. Fire first response medical Note 2: The work of Goal 3: EMS System Continuous Quality Improvement (CQI) Program Committee will also affect Goal 2: EMS System Stakeholder Committee Structure. The CQI Program should be identified before Goals 2 committee work is finalized. Timeframe: completed by March Page 54 of

55 Santa Clara County EMS System Strategic Plan Implementation Plan Goal Task Objective Steps Notes/ Timeframe components of a Just Culture program advisor/paramedic (3) EMS Quality o Incorporate the concepts and practices of Lean Six Sigma Improvement Plan Committee submits draft of CQI plan for Objective 3.2. The EMS Agency and stakeholder input the EMS Quality Improvement Plan (4) Revise EMS System Committee submits the draft CQI plan policies and procedures for EMS stakeholder input for consistency with Objective 3.3. Conduct educational new CQI Program and workshop sessions to roll out the (5) Conduct educational CQI plan and the Just Culture model workshops to rollout Objective 3.4. Continue to conduct plan Lean Six Sigma training to orient EMS (6) Revise and implement system stakeholders to Lean Six Sigma EMS System Quality methods and processes Improvement Plan Objective 3.5. Revise EMS system (7) Develop training policies and procedures to support the program for Just new EMS System Quality Improvement Culture, Lean Six Sigma, Plan and other appropriate Objective 3.6. Implement the new EMS CQI training. Quality Improvement Plan (8) Provide training as Objective 3.7. Continue to develop the identified in objectives. Comprehensive EMS Data System, which incorporates data from EMS communication centers, first responders, emergency and nonemergency ambulance providers, specialty centers, and hospitals Objective 3.8. Design and develop research programs that are publishable in credible medical and social sciences journals, based on the Page 55 of

56 Santa Clara County EMS System Strategic Plan Implementation Plan Goal Task Objective Steps Notes/ Timeframe experiences and successes of the Santa Clara County EMS System Page 56 of

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58 Santa Clara County EMS System Strategic Plan Implementation Plan Goal 4. Standardize EMS Communications and Align the EMS Communication System Goal Task Objective Steps Notes/ Timeframe The Santa Clara Objective 4.1. Create a Note 1: The initial County EMS multidisciplinary EMS output of this System should Communications Task Force committee is to establish a single comprised of EMS, public safety, and recommend a process to modern integrated communication center leaders to implement uniform EMS EMS develop a comprehensive EMS call reception, caller communication Communication and Resource interrogation, pre-arrival and resource Deployment System Plan. The task instructions, dispatch deployment system force should have as its objectives: standards, reporting and that improves o Developing a coordinated, QI standards throughout functionalities, consolidated, and integrated EMS all EMS Communication efficiencies, communication and resource Centers throughout the interfaces, and deployment system EMS System. reduces o duplication. 4.Standardize EMS Communicatio ns and Align the EMS Communicatio n System o o o Developing baseline capabilities, accreditation, and performance criteria of the EMS communication and resource deployment system Identifying and establishing essential (i.e., CAD-to-CAD interfaces, MARVLIS, latitude/longitude determinants, etc.) and desirable technological interfaces for the EMS communication and resource deployment system Defining monitoring roles and tools for performance Defining characteristics of interfaces necessary for alternate EMS deployment and disposition (1) Create an EMS Communications Task Force composed of: a. EMS Agency b. EMS Medical Director c. Fire Departments (2) d. Police Departments(2) e. County Communications f. Other Communications Center g. County Ambulance h. EMS Dispatch Supervisor/AMPDS QI Supervisor (2) Develop EMS Communication and Resource Deployment System, Alignment, and EMS Communication Center Quality Improvement Plans (3) Publish recommendations and timeframe Note 2: A desirable output of this committee is to recommend consolidation of dispatch centers, if that consolidation can demonstratively improve operational and clinical performance. This output is distinct from the output discussed in Note 1. Note 3: Standardization of EMS call reception, caller interrogation, pre- Page 58 of

59 Santa Clara County EMS System Strategic Plan Implementation Plan Goal Task Objective Steps Notes/ Timeframe models including community paramedics and caller referral o Developing viable and sustainable funding models for the communication and resource deployment system Objective 4.2. The EMS Communications Task Force should submit a draft Alignment Plan for EMS stakeholder, public-safety, county and municipal executive input Objective 4.3. The EMS Communications Task Force should develop a draft Alignment Plan for county and municipal executive and elected official approval Objective 4.4. The EMS Agency should develop an EMS Communication Center Quality Improvement Plan, which may be an annex to the EMS System Quality Improvement Plan Objective 4.5. The EMS Agency should develop EMS System Communication Center Policies and Procedures arrival instructions, dispatch standards, reporting and QI standards throughout all EMS Communication Centers throughout the EMS System is a prerequisite to the dispatch-based alternate delivery models identified in Goal 7: Contemporary EMS Delivery Methods and Service Delivery Options. Timeframe: standardization of EMS Communication completed by December 2014 Timeframe: communication Center consolidation progresses based on funding, political interest, and demonstrated benefit. Page 59 of

60 Santa Clara County EMS System Strategic Plan Implementation Plan Goal 5: Create enhanced collaborative models with other public safety, health and medical stakeholder organizations in which EMS is an equal partner Goal Task Objective Steps Notes/ Timeframe The collaboration Objective 5.1. Create a task force of Timeframe: completed called for in this EMS Agency, EMS providers, fire by December plan should include service, other public safety, and public an increased health leaders to identify methods to presence of the increase interdisciplinary collaboration Santa Clara County and to improve the stature of EMS as EMS Agency an equal discipline. The model could reaching out to consider: system o Identifying shared missions, goals, stakeholders and objectives, which may be including publicsafety, enhanced by collaboration health, o Creating interfaces for interaction medical leadership and shared vision among the EMS and policy makers Agency and public safety and to increase public health partners collaboration and o develop partnership models that advance EMS system initiatives. 5. Create enhanced collaborative models with other public safety, health and medical stakeholder organizations in which EMS is an equal partner Providing options for data and information sharing within Santa Clara County s hospitals, fire services, EMS, ambulance providers, public health department, mental health department, law enforcement agencies, social service providers and other EMS stakeholder organizations Objective 5.2. Design a collaborative model that allows multidisciplinary input to the Exclusive Operating Area (EOA) ambulance provider s (1) Create a task force of: a. EMS Agency b. County Ambulance c. County Communications d. EMS Labor e. Other ambulance provider f. Fire service g. Police Department h. Public health leaders (2) Design an enhanced public safety collaborative model (3) Identify potential for mutually beneficial initiatives (4) Revise and submit EMS collaborative models to stakeholders (5) Identify potential career paths for EMS professionals, based on formal education, training, and experience. (6) Develop career path programs for field EMS care (community Page 60 of

61 Santa Clara County EMS System Strategic Plan Implementation Plan Goal Task Objective Steps Notes/ Timeframe monitoring and performance process, contract changes, and renewals or rebids Objective 5.3. The EMS Agency and the County s public safety agencies should design an enhanced public safety collaborative model. The model may include: o o o o An Exclusive Operating Area (EOA) performance monitoring committee An Exclusive Operating Area (EOA) performance reporting and input process Developing additional policy and operational public-safety interfaces Periodic orientation and educational sessions for public policy makers Objective 5.4. Submit draft revised EMS collaborative models for EMS stakeholders input Objective 5.5 Submit revised EMS collaborative models for approval by appropriate EMS stakeholder organizations leadership Objective 5.6. Develop a culture within the Santa Clara County EMS System that drives services and individuals to present themselves professionally in their demeanor, paramedic and advanced care paramedic), quality improvement, management, and system oversight. (7) Recruit EMS professionals into career path programs. (8) Formalize role of Duty Chief into EMS System concept of operations, policies, procedures, and contracts. Page 61 of

62 Santa Clara County EMS System Strategic Plan Implementation Plan Goal Task Objective Steps Notes/ Timeframe actions and appearance at all times Objective 5.7. Provide ongoing and structured opportunities for EMS workforce education, development, and mentorship to develop EMS system bench strength Objective 5.8. Define, train, and inform EMS Stakeholders on the relationship of the EMS Agency and County Ambulance, including the roles and responsibilities of the EMS Duty Chiefs and County Ambulance Supervisors Page 62 of

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64 Santa Clara County EMS System Strategic Plan Implementation Plan Goal 6: Assure the Long Term Financial Solvency and Stability of the Santa Clara County EMS System Goal Task Objective Steps Notes/ Timeframe The Santa Clara Note 1: This goal links County EMS with Goal 7: System should Contemporary EMS evaluate the Delivery Methods and current funding Service Delivery Options model, and because delivery consider and methods identified in implement other Goal 7 should contribute funding models as directly or indirectly to necessary to assure the long term financial the stability and solvency and stability of sustainability of the Santa Clara County current and future EMS System. EMS system delivery programs. 6. Assure the Long Term Financial Solvency and Stability of the Santa Clara County EMS System Objective 6.1. Create a multidisciplinary task force consisting of EMS, public safety, hospitals, ambulance providers, and payers to develop comprehensive EMS funding strategies Objective 6.2. Identify and map current funding sources Objective 6.3. Define and quantify the anticipated and probable funding changes driven by health reform for traditional EMS delivery models Objective 6.4. Identify and quantify the potential costs and funding sources for the alternate delivery models contemplated in this strategic plan Objective 6.5. Establish first responder and public safety funding resource inventories (i.e., first responder, new statutory improved reimbursement for government ambulance providers, etc.) and other system delivery providers as needed Objective 6.6. Identify and quantify the difference between current and future funding based upon a traditional EMS delivery model and alternate EMS delivery models to determine the need and the value of incorporating alternate EMS delivery (1) Create a task force to develop comprehensive EMS funding strategies. Task force should consist of: a. EMS Agency b. Fire Department c. Hospitals (2) d. County Ambulance e. EMS Labor f. Payers (2) (2) Identify and map current funding sources and strategies and potential costs (3) Develop funding models (4) Submit draft funding plan for input to stakeholders and system leaders. Note 2: The primary consideration of the committee formed under this Goal is to look at longer term trends and strategies to capitalize on changing reimbursement models and new revenue sources. Timeframe: completed by June 2015 Page 64 of

65 Santa Clara County EMS System Strategic Plan Implementation Plan Goal Task Objective Steps Notes/ Timeframe models Objective 6.7. Develop funding models that implement and sustain the goals articulated in this strategic plan Objective 6.8. Submit draft funding plan for EMS, public safety, hospital, payer, municipal, County and public policy leadership input Page 65 of

66 Santa Clara County EMS System Strategic Plan Implementation Plan Goal 7: Research, Design, and Implement Contemporary EMS Delivery Methods and Service Delivery Options Goal Task Objective Steps Notes/ Timeframe The Santa Clara Objective 7.1. Continue to implement Note 1: Each initiative County EMS contemporary EMS delivery methods identified in Objective system should already under development. These 7.2 may require a evaluate and adopt delivery methods include: distinct task force, based appropriate o The pre-hospital component of upon the agencies that contemporary EMS Sobering System will be affected by the delivery methods o The Resource Allocation Program decisions of the to create costeffective (high user identification and committee. value for management system) the EMS system, Objective 7.2. Create one or more Note 2: Most of the patients, and alternative delivery steering groups initiatives identified in payers, and to consisting of EMS, public safety, Objective 7.2 cannot be assure the services hospital, clinical, payer leaders, and considered until other provided are other interested stakeholders to begin objectives in Goals have anchored in to identify and credential been completed or are evidence-based contemporary EMS delivery and in progress. best practices. service options. These options may 7. Research, Design, and Implement Contemporary EMS Delivery Methods and Service Delivery Options include: o EMS-based mental health services o Community paramedic assess, treat and release o Community paramedic alternate destinations o Community paramedic frequent user case management, including non-compliant user case management o Community paramedic chronic disease patient care, if system and (1) Create one or more alternative delivery steering groups consisting of: a. EMS Agency b. Fire Department c. Police Department d. County Ambulance e. EMS Labor f. Hospitals g. Clinical h. Payor leaders i. Mental Health j. Drug and Alcohol Services k. Homeless Services l. Interested stakeholders (2) Select service delivery options for evaluation, based on the significance of the problem in the EMS and potential for solution to solve problem. (3) Alternative steering groups should develop a formal business plan for each alternative delivery model Initiatives in Objective 7.2 that contemplate an expanded medical scope of practice are contingent upon Goal 1: Enhanced Contemporary Medical Direction Model, and Goal 3: Effective CQI Program. Initiatives in Objective 7.2 that contemplate call screening and Page 66 of

67 Santa Clara County EMS System Strategic Plan Implementation Plan Goal Task Objective Steps Notes/ Timeframe scope is feasible o Community paramedic post hospital discharge patient care, if system and scope is feasible o Community paramedic community health services (e.g. immunizations), if system and scope is feasible o o o o o o Tiered pre-hospital response based on enhanced medical triage (e.g. Omega model) Integration of mid-level practitioners (nurse practitioners and physician s assistants) into the EMS system Integration of law enforcement as a provider of reimbursed services Registered Nurse call referral at communications center models (e.g. Low Code model) Use of EMS for Wrap services (i.e., social services, case management, housing, etc.) for identified key patients Integration into comprehensive medical and health data sharing infrastructure, which allows access to a patient s electronic medical record to any EMS, ED or other organization evaluating or treating an EMS patient (similar to the San Diego Beacon model) (4) Field test potentially viable models through limited term pilot studies (5) Submit draft plans and models for EMS stakeholder input (6) Implement plans and models into Santa Clara County EMS Policies and Procedures referral from a communication center, dispatch of nontraditional resources or change in the response code of traditional resources are contingent upon Goal 1: Enhanced Contemporary Medical Direction Model, Goal 3: Effective CQI Program, and Goal 4: EMS Communication. Timeframe will be agreed to in each steering groups charter. Page 67 of

68 Santa Clara County EMS System Strategic Plan Implementation Plan Goal Task Objective Steps Notes/ Timeframe o Other options deemed valuable by EMS system stakeholders Objective 7.3. The alternate delivery steering groups should develop a formal business plan for each alternative delivery model it wishes to consider for limited term pilot studies Objective 7.4. The EMS system should field test potentially viable models through limited term pilot studies Objective 7.5. Develop viable and sustainable long-term funding models for the accepted alternate delivery models Objective 7.6. Submit draft plans and models for EMS stakeholder input Objective 7.7. Formally integrate desired alternative delivery models into the Santa Clara County EMS system Page 68 of

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70 Santa Clara County EMS System Strategic Plan Implementation Plan Goal 8: Partner with Public Health and Public Safety Organizations to Align and Enhance Public Education and Prevention Efforts Goal Task Objective Steps Notes/ Timeframe The Santa Clara Objective 8.1. In partnership with the (1) Create EMS Public Note 1: Results of illness County EMS Public Health Department s Injury Education and and injury assessment system should Prevention Program and Data Prevention Committee should drive public enhance its own Management Unit, conduct an or join existing education and public education assessment of leading causes of EMS committee with same prevention campaign. and prevention system transports function in Public program while Objective 8.2. Convene a Health Department Timeframe: completed integrating with multidisciplinary task force consisting (2) EMS representation by December existing and of EMS, the Public Health should include: emerging public Department s Injury Prevention a. EMS Agency education and Program, public safety, hospitals, b. Fire Department prevention ambulance providers, and other c. County Ambulance programs to interested stakeholders to continue to d. Hospital establish common develop the EMS system s injury e. Public Health topics, messages prevention and public education (3) Assess leading causes of and channels, program EMS system transports ensuring that EMSrelevant o Conduct best practice reviews of (4) Develop EMS system s public effective EMS-based public injury prevention and education and education and prevention public education prevention programs and effective outreach program messages are and education prevention (5) Establish and emphasized. strategies, including an inventory implement the outreach of other county programs, and education national and state campaigns, and prevention strategies existing programs in Santa Clara designed to blanket County community with o common message. 8. Partner with Public Health and Public Safety Organizations to Align and Enhance Public Education and Prevention Efforts Prioritize the outreach and education prevention strategies to be implemented through the Page 70 of

71 Santa Clara County EMS System Strategic Plan Implementation Plan Goal Task Objective Steps Notes/ Timeframe EMS system, including identification of resources and development of an implementation plan Objective 8.3. Establish cooperative agreements across the EMS system and implement the priority outreach and education prevention strategies Objective 8.4. Identify resources and funding components to implement these prevention/education programs Objective 8.5. Implement the outreach and education prevention strategies outlined in the implementation plan and in coordination with public health, county-wide injury prevention campaigns Page 71 of

72 Santa Clara County EMS System Strategic Plan Implementation Plan Goal 9: Develop a Collaborative Model to Prevent and Respond to ED/ Hospital Capacity Issues and Resulting EMS System Delays Goal Task Objective Steps Notes/ Timeframe Santa Clara County Objective 9.1. The EMS Agency should Timeframe: completed EMS system work with the Hospital Council of by June stakeholders Northern and Central California and should adopt a all hospitals within Santa Clara County collaborative to collaboratively study and respond model to study, to capacity problems as identified in design, and the EMS Assessment Report. These implement longterm capacity issues are typified by solutions to frequent ambulance diversion, address delayed patient off-loads, and other ED/Hospital delays at some hospital EDs. This capacity problems collaborative should consider the and to reduce following tenets: resulting EMS o system delays. 9. Develop a Collaborative Model to Prevent and Respond to ED/ Hospital Capacity Issues and Resulting EMS System Delays o o o o The collaborative should be endorsed and monitored by the senior leadership of all participating entities The desired end result and measurements of success should be defined before initiation The topics of the collaborative should include pre-hospital, hospital, and population strategies The collaborative should consider best and promising practices identified in other EMS systems The collaborative should be briefed on other related initiatives (1) Engage consultant to conduct evaluation of ED/Hospital capacity issues, wall times, and diversion rates. (2) Seat work group to represent stakeholders throughout process. Stakeholders should include: a. EMS Agency b. Each hospital ED c. County Ambulance d. Non-emergency ambulance provider e. Fire Department f. County Communications (3) Establish policies and procedures to implement the successful results of the collaborative (4) Publish results of process. Page 72 of

73 Santa Clara County EMS System Strategic Plan Implementation Plan Goal Task Objective Steps Notes/ Timeframe driven by this strategic plan, including alternate EMS delivery models o The collaborative should develop actionable and measurable short and medium-term objectives, which can be used to demonstrate progress toward meeting the end goal Objective 9.2. The EMS Agency should develop EMS system policies and procedures to implement the successful results of the collaborative Objective 9.3. Hospitals leadership should develop hospital policies to implement the successful results of the collaborative Objective 9.4. The collaborative should publish its successful results to assist other EMS systems to prevent and respond to ED/hospital capacity issues and resulting EMS system delays Page 73 of

74 Santa Clara County EMS System Strategic Plan Implementation Plan Goal 10: Develop a common legislative action plan to support the Implementation of this EMS Strategic Plan Goal Task Objective Steps Notes/ Timeframe 10. Develop a common The Santa Clara County EMS Objective Create a legislative task force to identify legal (1) Create work group to identify legal Timeframe: completed by June 2015 legislative system empowerment gaps between goals empowerment gaps action plan to stakeholders and the current legal system (i.e., between goals and should develop a support the statutes, regulations, ordinances, current legal system common legislative contracts, policies, etc.) (2) Establish inventory of Implementatio action plan to Objective Develop an inventory legislative advocates to n of this EMS support the of assist with resolving these gaps help resolve gaps Strategic Plan implementation of Objective Develop a plan to (3) Develop a plan to future system capabilities and implement the desired legislative model and to close the gaps implement legislative model outcomes. Objective Submit a draft plan for (4) Submit draft plan for input from EMS, public safety, public input to County, health, county, and governmental municipal, and health leaders care leadership. Page 74 of

75 976 Lenzen Avenue, Suite 1200 San Jose, CA voice fax sccemsagency.com Santa Clara County EMS Strategic Planning Strategic Plan Rollout Meeting The County of Santa Clara EMS Agency invites you to join us for the formal rollout of the 2013 Santa Clara County EMS System Strategic Plan on Friday, October 25, This strategic plan, which was collaboratively developed during the past year, will serve as the roadmap of the Santa Clara EMS System for the next five to seven years. This will be the final meeting in the Santa Clara County EMS System Strategic Assessment and Planning Process. At the Strategic Plan Rollout Meeting, the EMS Agency will formally release the 2013 Santa Clara County EMS Strategic Plan, the 2013 EMS Strategic Plan Implementation Plan, and discuss how the goals and objectives described in these documents will be introduced in the Santa Clara County EMS System. We will discuss the linkages among goals, priorities and sequencing of goals, and answer your questions. Please contact Michael Petrie with any questions at or Friday, October 25, 2013 Roll Out of Final Strategic Plan 1:00 p.m. to 3:00 p.m. Santa Clara County Training Center 2310 North First Street, Suite 102, San Jose Who should attend? All persons and organizations interested in the future and direction of the Santa Clara EMS System, including: Paramedics and EMTs Communication Center Leaders Hospital Executives Fire Chiefs and Executive Officers Specialty Center/Service Leaders Physicians and Nurses Ambulance Company Managers Law Enforcement Executives Labor Representatives A division of the County of Santa Clara Public Health Department Page 75 of 100

76 County of Santa Clara Emergency Medical Services System Emergency Medical Services Agency 976 Lenzen Avenue, Suite 1200 San Jose, CA voice fax Date: October 3, 2013 To: From: Subject: Santa Clara County EMS Committee Members Michael Petrie EMS Director EMS System FY 14 Emphasis Areas The Santa Clara County EMS System Strategic Plan is a roadmap for the Santa Clara County EMS System for the next 5 to 7 years. Because each of the 10 goals identified requires substantial resources, it is necessary to prioritize and sequence our work toward the goals and to consider work currently performed in the EMS System. During Fiscal Year 2014 (July 1, 2013 through June 31, 2014) the EMS Agency will emphasize the following goals, from the Santa Clara County EMS System Strategic Plan: Goal One: Research and Design an Enhanced Contemporary EMS Medical Direction Model Goal Two: Evaluate and Redesign the EMS System Stakeholder Committee Structure for Effectiveness and Focus Goal Three: Develop an Effective Continuous Quality Improvement (CQI) Program Goal Four: Standardize EMS Communication and Align the EMS Communication System Goal Six: Assure the Long-Term Financial Solvency and Stability of the Santa Clara County EMS System Goal Nine: Develop a Collaborative Model to Prevent and Respond to Emergency Department/Hospital Capacity Problems and Resulting EMS System Delays This does not mean that the EMS Agency will ignore the other goals, only that it will focus on the previously-mentioned goals. These goals serve as a foundation on which future system modifications, such as community paramedic or treat and release programs, are based. An oral report will be provided at the EMS Committee meeting. A division of the Santa Clara County Public Health Department Page 76 of 100

77 County of Santa Clara Emergency Medical Services System Emergency Medical Services Agency 976 Lenzen Avenue, Suite 1200 San Jose, CA voice fax Date: October 3, 2013 To: From: Subject: Santa Clara County EMS Committee Members Michael Petrie EMS Director Sobering System Planning Status Since the last report to the EMS Committee on June 6, 2013, there has been little progress on Sobering System planning and development. On May 4, 2013, County representatives presented a sobering system business case to the Hospital Council and hospitals chief executive officers. While these executives conceptually supported the sobering system, they expressed concern about the high price of the sobering system, and encouraged County representatives to seek funding from others who may benefit from a sobering center, such as law enforcement agencies. Due to high priority items within the EMS System and the county, these discussion have not progressed. Concept of Operations, Scope, and Financial Information The goal of the sobering system is to divert individuals from hospital emergency departments and quickly move to discharge individuals from emergency departments who are medically stable but intoxicated to a stand-alone sobering center, where these patients can rest through their intoxicated period, and be referred to longer term clinical and social programs. The preferred model includes the sobering system being operated by private sector vendors; rather than a county department. The sobering system will consist of three components: 1) pre-hospital identification, assessment, and transport of clinically-stable inebriates to a sobering center by a sobering van or ambulance; 2) a stand-alone 20-bed sobering center, staffed by a registered nurse, and other allied health personnel; and, 3) integration of inebriates into long term clinical and social programs, from sobering center referrals. The Public Health Department, Mental Health Department, Drug and Alcohol Program, and the EMS Agency estimate the cost of the sobering system will be $2.15 million to $2.5 million annually. Options 1) Accept the EMS Director s report on the progress of the Santa Clara Sobering System. 2) Request additional information regarding the Santa Clara Sobering System. 3) Other actions, as determined by the EMS Committee. A division of the Santa Clara County Public Health Department Page 77 of 100

78 Recommendation 1) Accept the EMS Director s report on the progress of the Santa Clara Sobering System. Page 78 of 100

79 County of Santa Clara Emergency Medical Services System Emergency Medical Services Agency 976 Lenzen Avenue, Suite 1200 San Jose, CA voice fax Date: October 3, 2013 To: From: Subject: Santa Clara County Emergency Committee Members Eric M. Rudnick, MD, FACEP, FAAEM, and Medical Director EMS System Clinical Care/Medical Directors Report All high performing EMS systems perform continuous quality improvement (CQI) to improve the clinical care delivered to the citizens. We in Santa Clara County have multiple projects on-going for this. First, the EMS Agency is conducting the annual EMS System Update on 10/10/13. The clinical educators and clinical managers will receive the coming year s ambitious improvement plan projects. We are starting a several year project focusing on the care of the trauma patient; this year we developed a clinical module focusing on the pediatric trauma patient. Through a collaborative process involving trauma stakeholders, the teaching didactic module was vetted by all the Trauma Medical Directors from each of our Trauma Centers. A pre- and postexamination will be given to the system providers. Aggregate measurements will be reviewed to assess the impact the module has on the knowledge level of the individual providers. In the future, modules focusing on adult trauma patients and high risk procedures will be developed and implemented. Second, the beginning of a yearlong CQI process will be kicked off at the annual update. This one focuses on the intubation procedure. The first part is a didactic module focusing on educating the provider on intubation techniques. This skill is currently within the scope of the paramedic provider; however, it is a high risk, low volume procedure meaning it is a skill that needs to be performed properly each time to achieve the desired results- breathing for patients that are not able to so for themselves. The issue is that the opportunity to perform the procedure does not occur very frequently. The didactic module is concise in scope and a second module is available for the educators for reference material. The main focus will be on the second phase of this process. This will be psychomotor training-actually giving the individual providers the opportunity to develop improved muscle memory. This curriculum is currently being developed. This education of the educators will be a master class approach. The EMS medical director will conduct several small class practicums in January, then, once the educators are trained, we will roll out the classes for the EMS system as a whole. The provider agencies will need to expend funds to purchase airway training manikins and other tools. This is an ambitious project that will dramatically benefit the patients that these paramedics and EMT s serve. Thank you for your attention and respectfully submitted. Action: For informational purpose only, no action required. A division of the Santa Clara County Public Health Department Page 79 of 100

80 County of Santa Clara Emergency Medical Services System Emergency Medical Services Agency 976 Lenzen Avenue, Suite 1200 San Jose, CA voice fax Date: October 3, 2013 To: From: Santa Clara County EMS Committee Members Patricia Natividad Senior Management Analyst Subject: EMS Trust Fund Liquidated Damages for Fiscal Year 2013 Liquidated Damages for Response Time Non-Performance & Monthly Zone Non-Compliance July 1, 2012 June 30, 2013 Month / Year Amount July-12 $198, August-12 $235, September-12 $222, October-12 $297, November-12 $284, December-12 $281, January-13 $305, February-13 $279, March-13 $214, April-13 $260, May-13 $269, June-13 $176, Total for FY13 $3,024, Average Monthly Total In Period $252, A division of the Santa Clara County Public Health Department Page 80 of 100

81 County of Santa Clara Emergency Medical Services System Emergency Medical Services Agency 976 Lenzen Avenue, Suite 1200 San Jose, CA voice fax Date: October 3, 2013 To: From: Subject: Members of the EMS Committee Michael Petrie EMS Director Rural/Metro Update EMS Director Michael Petrie will provide an update on the status of Rural/Metro as the EMS System s 911 paramedic ambulance provider. A division of the Santa Clara County Public Health Department Page 81 of 100

82 County of Santa Clara Emergency Medical Services System Emergency Medical Services Agency 976 Lenzen Avenue, Suite 1200 San Jose, CA voice fax Date: October 3, 2013 To: From: Subject: Santa Clara County EMS Committee Members John Blain Contract Manager County EOA Service Area Response Time Performance Report History and Issue The County has entered into agreements with private and public entities to provide emergency medical response and advanced life support ambulance transportation services. Periodic response time compliance reports have been provided to the EMS Committee for the purpose of providing public review of those entities performance and compliance with contractual response time requirements. The County has performance based contracts with the following entities: 1. Rural/Metro of California (County Ambulance provider) 2. Gilroy, City of 3. Milpitas, City of 4. Morgan Hill, City of 5. Mountain View, City of 6. San Jose, City of 7. Santa Clara, City of 8. Santa Clara County Central Fire Protection District 9. South Santa Clara County Fire District 10. Sunnyvale, City of Context Compliance is measured by several key performance indicators that include; response time requirements based on population density; designated response areas; type of response priority (red lights & siren or non-red lights & siren); total number of responses; total number of late responses; and total number of responses exempted (removed) from compliance calculations. Compliance is achieved when ninety (90%) percent or more of the responses meet the specified response time requirement in each response priority within each designated response area. This report contains response time compliance data for April-June San Jose Fire Department failed to achieve 90% zone compliance during this period of review. In the month of April 2013, Code 3 compliance was 89.52%. In May 2013, Code 3 compliance was 87.32%. In the month of June 2013, Code 3 compliance was 86.84%. In the month of June 2013, Code 2 compliance was 89.52%. As documented in the previous report to the committee, other performance deficiencies have occurred in prior months. Remediation is being conducted in accordance with the terms of the agreement. A division of the Santa Clara County Public Health Department Page 82 of 100

83 Cost There is no direct cost to the EMS Committee to accept and/or not accept the report. Legal Issues There are no legal issues related to accepting and/or not accepting the report. Options 1) Recommend that the EMS Committee accepts the County EOA Service Area - Response Time Performance Report for April-June ) Recommend that the EMS Committee does not accepts the County EOA Service Area - Response Time Performance Report for April-June Recommendation 1) Recommend that the EMS Committee accepts the County EOA Service Area - Response Time Performance Report for April-June Page 83 of 100

84 Rural/Metro 2013 EMS Response Time Performance Report Apr May Jun Totals CODE 3 - Responses 6,436 6,941 6,444 19,821 Cancel On Time ,401 Unadjusted Late Calls ,643 Unadjusted Compliance 89.44% 90.86% 91.40% Adjusted Late Calls ,128 Adjusted Compliance 92.80% 93.57% 94.21% Extended Minutes 1,047 1, ,845 Apr May Jun Totals CODE 2 - Responses 2,509 2,508 2,480 7,497 Cancel On Time ,235 Unadjusted Late Calls Unadjusted Compliance 93.04% 92.84% 94.63% Adjusted Late Calls Adjusted Compliance 94.76% 94.04% 96.45% Extended Minutes ,056 Responses with Transports 5,909 6,026 5,703 17,638 Total Patients Transported 5,981 6,070 5,750 17,801 Page 84 of 100

85 Rural/Metro 2013 Zone Performance Report Apr May Jun Totals Zone 1 CODE 3 - Responses 1,001 1,170 1,078 3,249 Late Responses Adjusted Compliance 93.44% 93.71% 93.27% CODE 2 - Responses ,616 Late Responses Adjusted Compliance 96.29% 94.23% 97.11% Zone 2 CODE 3 - Responses 1,311 1,349 1,236 3,896 Late Responses Adjusted Compliance 91.06% 92.93% 93.83% CODE 2 - Responses ,688 Late Responses Adjusted Compliance 94.70% 93.98% 97.64% Zone 3 CODE 3 - Responses 1,850 1,962 1,875 5,687 Late Responses Adjusted Compliance 93.57% 93.92% 94.85% CODE 2 - Responses ,792 Late Responses Adjusted Compliance 95.68% 93.63% 94.98% Zone 4 CODE 3 - Responses 1,878 2,010 1,848 5,736 Late Responses Adjusted Compliance 93.06% 93.65% 94.50% CODE 2 - Responses ,090 Late Responses Adjusted Compliance 92.87% 93.79% 96.02% Zone 5 CODE 3 - Responses Late Responses Adjusted Compliance 92.05% 93.23% 93.63% CODE 2 - Responses Late Responses Adjusted Compliance 94.37% 96.97% 97.80% Page 85 of 100

86 Page 86 of 100

87 Gilroy Fire Department 2013 EMS Response Time Performance Report Apr May Jun Totals CODE 3 - Responses Adjusted Late Calls Adjusted Compliance 97.86% 98.11% 98.21% Page 87 of 100

88 Milpitas Fire Department 2013 EMS Response Time Performance Report Apr May Jun Totals CODE 3 - Responses Adjusted Late Calls Adjusted Compliance 97.65% 96.62% 97.89% Page 88 of 100

89 Morgan Hill Fire Department 2013 EMS Response Time Performance Report Apr May Jun Totals CODE 3 - Responses Adjusted Late Calls Adjusted Compliance 97.12% 94.44% 98.69% Apr May Jun Totals CODE 2 - Responses Adjusted Late Calls Adjusted Compliance % % % Page 89 of 100

90 Mountain View Fire Department 2013 EMS Response Time Performance Report Apr May Jun Totals CODE 3 - Responses Adjusted Late Calls Adjusted Compliance 98.31% 98.73% 97.76% Apr May Jun Totals CODE 2 - Responses Adjusted Late Calls Adjusted Compliance 90.00% % % Page 90 of 100

91 San Jose Fire Department 2013 EMS Response Time Performance Report Apr May Jun Totals CODE 3 - Responses 4,455 4,225 3,926 12,606 Adjusted Late Calls ,395 Adjusted Compliance 89.52% 87.32% 86.84% Apr May Jun Totals CODE 2 - Responses ,282 Adjusted Late Calls Adjusted Compliance 92.37% 92.14% 89.52% Page 91 of 100

92 Santa Clara City Fire Department 2013 EMS Response Time Performance Report Apr May Jun Totals CODE 3 - Responses ,115 Adjusted Late Calls Adjusted Compliance 95.85% 95.60% 95.59% Apr May Jun Totals CODE 2 - Responses Adjusted Late Calls Adjusted Compliance 99.29% 98.33% 98.62% Page 92 of 100

93 Santa Clara County Central Fire District 2013 EMS Response Time Performance Report Apr May Jun Totals CODE 3 - Responses ,214 Adjusted Late Calls Adjusted Compliance 96.84% 94.51% 95.03% Apr May Jun Totals CODE 2 - Responses Adjusted Late Calls Adjusted Compliance 99.32% 99.60% 97.35% Page 93 of 100

94 South Santa Clara County Fire Protection District 2013 EMS Response Time Performance Report Apr May Jun Totals CODE 3 - Responses Adjusted Late Calls Adjusted Compliance 95.24% 93.18% 91.21% Apr May Jun Totals CODE 2 - Responses Adjusted Late Calls Adjusted Compliance % % % Page 94 of 100

95 Sunnyvale Department of Public Safety 2013 EMS Response Time Performance Report Apr May Jun Totals CODE 3 - Responses ,502 Adjusted Late Calls Adjusted Compliance 96.67% 97.79% 97.98% Page 95 of 100

96 County of Santa Clara Emergency Medical Services System Emergency Medical Services Agency 976 Lenzen Avenue, Suite 1200 San Jose, CA voice fax Date: October 3, 2013 To: From: Subject: Santa Clara County EMS Committee Members Diana Sandoval Health Care Program Analyst Hospital Destination, Diversion and Advisory Status Report History Diversion is a management process that may be used temporarily by local hospitals when the patient load exceeds emergency department or specialty center resources. Facility diversion is a last resort when emergency department/specialty center resources continue to be overwhelmed after internal procedures to manage the situation have been implemented. Issues El Camino Mountain View Hospital ED diversion hours are higher in August 2013 than any other time. Santa Clara Valley Medical Center has the highest number of trauma diversion hours. Options 1) Recommend to accept report 2) Recommend to NOT accept report 3) Other options, as determine by the EMS Committee Recommendation EMS Committee should accept the County Hospital Destination, Diversion and Advisory Status Report for Aril through August A division of the Santa Clara County Public Health Department Page 96 of 100

97 County of Santa Clara Emergency Medical Services System Monthly Hospital Destination, Diversion and Advisory Status Report Report for Time Period: August 2013 Table 1: Number of Patients Transported to Hospital ED from System* Hospital Mar - 13 Apr - 13 May - 13 Jun - 13 Jul-13 Aug-13 Total El Camino - Los Gatos El Camino - Mt. View ,842 Good Samaritan ,547 Kaiser - San Jose ,367 Kaiser - Santa Clara ,768 O'Connor ,318 Regional - San Jose 1,102 1,088 1,110 1, ,082 6,431 Saint Louise ,387 Stanford ,764 VA - Palo Alto VMC 1,216 1,295 1,191 1,205 1,255 1,362 7,524 Total 6,229 6,168 6,254 5,919 6,095 6,213 36,878 Source: Santa Clara County Communications & Palo Alto Fire Department Table 2: Daily Average of Patients Transported By Hospital* Hospital Mar - 13 Apr- 13 May - 13 Jun - 13 Jul-13 Aug-13 Total El Camino - Los Gatos El Camino - Mt. View Good Samaritan Kaiser - San Jose Kaiser - Santa Clara O'Connor Regional - San Jose Saint Louise Stanford VA - Palo Alto VMC Total Source: Santa Clara County Communications & Palo Alto Fire Department *Notes for Tables 1 and 2: These numbers only reflect patients that originated in Santa Clara County and were transported by the County's EOA Ambulance Provider and Palo Alto Fire Department. Data for Stanford does not include patients from San Mateo County. The data includes but, does not differentiate specialty center status (TRAUMA, STROKE, STEMI, BURN) Santa Clara County EMS l 976 Lenzen Avenue, Suite 1200 l San Jose, CA l Page 1 of 2 Page 97 of 100

98 Table 3: Total Monthly Hours of "AMBULANCE DIVERSION" Status Hospital Mar - 13 Apr - 13 May - 13 Jun - 13 Jul-13 Aug-13 Total El Camino - Los Gatos El Camino - Mt. View Good Samaritan Kaiser - San Jose Kaiser - Santa Clara O'Connor Regional - San Jose Saint Louise Stanford VA - Palo Alto VMC Total Color Legend for Ambulance Diversion ONLY Above 37hrs Above 30hrs Below 30hrs Table 4: Total Monthly Hours of "STROKE / CT DOWN" Status* Hospital Mar - 13 Apr - 13 May - 13 Jun - 13 Jul-13 Aug-13 Total El Camino - Los Gatos El Camino - Mt. View Good Samaritan Kaiser - San Jose Kaiser - Santa Clara O'Connor Regional - San Jose Saint Louise Stanford VA - Palo Alto VMC Total Table 5: Total Monthly Hours of "STEMI" Service Advisory Status* Hospital Mar - 13 Apr - 13 May - 13 Jun - 13 Jul-13 Aug-13 Total El Camino - Mt. View Good Samaritan Kaiser - San Jose Kaiser - Santa Clara O'Connor Regional - San Jose Stanford VMC Total Table 6: Total Monthly Hours of Trauma Center "BYPASS" Status Hospital Mar - 13 Apr - 13 May - 13 Jun - 13 Jul-13 Aug-13 Total Regional - San Jose Stanford VMC Total Santa Clara County EMS l 976 Lenzen Avenue, Suite 1200 l San Jose, CA l Page 2 of 2 Page 98 of 100

99 County of Santa Clara Public Health Department Emergency Medical Services Agency 976 Lenzen Avenue, Suite 1200 San José, CA voice fax Date: October 3, 2013 To: From: Subject: Members of the EMS Committee Michael Petrie EMS Director Six Sigma Analysis of Wall Time and Diversion Goal number nine, of the Santa Clara EMS System Strategic Plan is to Develop a Collaborative Model to Prevent and Respond to Emergency Department/Hospital Capacity Problems and Resulting EMS System Delays. The EMS Agency recently hired Six Sigma and EMS consultant Todd Hatley to begin a Six Sigma project to achieve this goal. Mr. Hatley will work with the Hospital Council, leaders from County Communications, each hospital, County Ambulance, and the EMS Agency to analyze, measure, and reduce ambulance wall times and emergency department diversion within Santa Clara County. This project will start this calendar year and conclude before June 30, The success of this project is based upon the participation, engagement, and support of the stakeholder organizations identified above. Mr. Hatley is known to the Santa Clara County EMS System, as he taught two yellow and green belt Six Sigma courses last year. This year, as part of his contract, in addition to leading the Six Sigma Wall Time and Diversion Project, Mr. Hatley will teach another yellow and green belt Six Sigma course, and a black belt Six Sigma course. Mr. Hatley will also revise the EMS Agency s EMS Quality Improvement Plan and develop an EMS Quality Improvement template, for use by all EMS first responder and ambulance organizations. The EMS Agency encourages all organizations in the EMS System to send personnel with quality improvement responsibilities to Six Sigma training. Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, Liz Kniss County Executive: Jeffrey V. Smith Page 99 of 100